Downloaded by [New York University] at 04:58 12 August 2016

Counseling Techniques

The third edition of Counseling Techniques: Improving Relationships with Others, Ourselves,
Downloaded by [New York University] at 04:58 12 August 2016

Our Families and Our Environment enhances the author’s previous efforts to provide a
comprehensive overview of counseling techniques in a manner that makes these theories
accessible to students pursuing mental health professions, counselor educators, and seasoned
practitioners alike. New to this edition is a chapter on play therapy and a host of other updates
that illustrate ways to use different techniques in different situations with different populations.
Counseling Techniques stresses the need to recognize and treat the client within the context of culture,
ethnicity, interpersonal resources, and systemic support, and it shows the reader how to meet
these needs using more than 500 treatment techniques, each of which is accompanied by step-
by-step procedures and evaluation methods.

Rosemary A. Thompson, EdD, LPC, NCC, NCSC has over 25 years of experience in public
schools as a school counselor and administrator working with children, adolescents, and families.
She taught concurrently in the department of counseling and human services at Old Dominion
University in Norfolk, Virginia, and was an associate professor in the school of psychology and
counseling at Regent University in Virginia Beach, Virginia. She is currently in private practice
with Phoenix Mental Health Services, LLC, in Virginia Beach.
Downloaded by [New York University] at 04:58 12 August 2016

Page Intentionally Left Blank

 Counseling Techniques
Improving Relationships with Others,
Ourselves, Our Families, and Our Environment

Third Edition

Rosemary A. Thompson
Downloaded by [New York University] at 04:58 12 August 2016
 Third edition published 2016
by Routledge
711 Third Avenue, New York, NY 10017
and by Routledge
2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2016 Rosemary A. Thompson
The right of Rosemary A. Thompson to be identified as author of this
work has been asserted by her in accordance with sections 77 and 78 of the
Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced or
utilised in any form or by any electronic, mechanical, or other means, now
known or hereafter invented, including photocopying and recording, or in any
information storage or retrieval system, without permission in writing from
Downloaded by [New York University] at 04:58 12 August 2016

the publishers.
Trademark notice: Product or corporate names may be trademarks or
registered trademarks, and are used only for identification and explanation
without intent to infringe.
Note from the author: Congress enacted the No Electronic Theft (NET) Act
in 1997 to facilitate prosecution of copyright violation on the Internet. The
NET Act makes it a federal crime to reproduce, distribute, or share copies
of electronic copyrighted works such as songs, movies, games, or software
programs, even if the person copying or distributing the material acts without
commercial purpose and/or receives no private financial gain. Electronic
copyright infringement carries a maximum penalty of three years in prison
and a $250,000 fine. The NET Act is applicable in situations such as running
a file sharing application with outgoing transfers enabled, hosting files on a
web account, transferring files through IRC, and other methods of making
copyrighted material available over networks.
First edition published by Accelerated Development, A Member of the Taylor
and Francis Group 1101 Vermont Avenue, N.W., Suite 200 Washington, D.C.
20005–3521
Second edition published by Routledge 2003
Library of Congress Cataloging-in-Publication Data
Thompson, Rosemary
  Counseling techniques : improving relationships with others, ourselves, our
families, and our environment / Rosemary Thompson. — 3rd ed.
  pages cm
  Revised edition of the author’s Counseling techniques, 2003.
  Includes bibliographical references and index.
 1. Psychotherapy.  2. Counseling.  I. Title.
  RC480.T449 2015
 616.89'14—dc23
 2015008345

ISBN: 978-0-415-70492-2 (hbk)

ISBN: 978-0-415-70493-9 (pbk)
ISBN: 978-1-315-88611-4 (ebk)

Typeset in Galliard
by Apex CoVantage, LLC
 This book is dedicated to my husband, Charlie, who at 17 began
Downloaded by [New York University] at 04:58 12 August 2016

to nurture, strengthen, and support all our most rewarding

relationships as a couple.
Downloaded by [New York University] at 04:58 12 August 2016

Page Intentionally Left Blank

 Contents

Preface ix
Downloaded by [New York University] at 04:58 12 August 2016

Acknowledgments xiii

  1 Professionalism in Counseling and Psychotherapy 1

  2 Client–Therapist Relationships: Counseling Intentions, Interventions,

and Therapeutic Factors 9

  3 Eclectic Techniques for Group Therapy 17

  4 Classic Gestalt Techniques 46

  5 Therapeutic Expressive Techniques: Art Therapy, Dance/Movement

Therapy, Phototherapy, Drama Therapy, and Music Therapy 63

  6 Cognitive-Behavioral Therapy, Dialectical Behavior Therapy, and

Solution-Focused Counseling 76

  7 Rational Emotive Behavior Therapy and Reality Therapy 109

  8 Classic Behavioral Techniques 130

  9 Person-Centered Techniques and Psychoeducational

Counseling Approaches 154

10 Improving Relationships with Our Environments: Conflict

Resolution and Stress Management Techniques 184

11 Trauma, Loss, Grief, and Post-Traumatic Stress

Debriefing Strategies 229
 viii  Contents

12 Psychodynamic Techniques 250

13 Eclectic Techniques for Use with Family Systems

and Family Development 263

14 Play Therapy Techniques for Children and Adolescents 290

References 325
Bibliography 339
Index 345
Downloaded by [New York University] at 04:58 12 August 2016
 Preface

As counseling and psychotherapy evolved, a kaleidoscope of helping initiatives emerged to meet

Downloaded by [New York University] at 04:58 12 August 2016

the needs of the human condition. Each given time period had its clashes of prominent theorists
and ideologies. In the 1940s, Freud and psychoanalytic theory was perhaps the initial major
influence on all other formal systems of counseling and psychotherapy. Many other perspectives
evolved as an extension of or rebellion against psychoanalytical principles, such as the ego psy-
chologists or neo-Freudians of the 1950s and the convincing ideas of Carl Jung, Alfred Adler,
Karen Horney, Erich Fromm, Harry Stack Sullivan, Erick Erickson, and Wilhelm Reich, who felt
that interpersonal aspects have a more significant influence on the development of the individual.
Existential therapy evolved as the third force in psychotherapy as an alternative to psychoanalysis
and behavioral approaches, with the person-centered approach developed by Carl Rogers and the
Gestalt therapy of Fritz Perls.
Essentially, the 1960s was touted as the decade of person-centered therapy, with the empha-
sis on feelings, and the importance of relationships, and focus on the congruency between the
ideal and the real self. The 1970s was the decade of behaviorism and behavior therapy, focusing
on measurable and observational data to monitor client growth and change. The 1980s emerged
as the decade of cognition and cognitive therapy, focusing on the client’s ability to change per-
ceptions, attitudes, and thinking regarding the human condition. The 1990s rapidly emerged as
what some have termed the age of dysfunction and the decade of eclecticism. As we enter the
21st century, counseling and psychotherapy will have to sustain their worth in response to the
constraints of managed care. Solution-focused and brief therapy models will prevail as a means
to meet the needs of the growing diversity of clients. There is also a movement toward theoretical
integration of all theories. Today, because of managed health care, the theories and counseling
perspectives that are most frequently used are cognitive-behavioral therapy, dialectical behavior
therapy, and solution-focused therapy. The popularity of these more contemporary approaches
has evolved because of the need to be able to deliver and disseminate evidence-based treatment
protocols. Finally, online counseling, a fairly new method for providing therapy, has introduced a
variety of modalities, including cyber therapy, cyber counseling, e-therapy, and distance therapy.
This will probably generate considerable debate and controversy within the next decade in terms
of creditability, confidentiality, and legal and ethical issues.
In this third edition, the reader will find a more enriched and inclusive book that expands and
strengthens the therapeutic process. According the American Psychological Association (APA), 75%
of the people who engage in psychotherapy were more content then nontreated people who had
congruent disorders. In addition, the type of therapy did not seem to be as significant as the rela-
tionship between the therapist and the client being treated (APA, 1994). Collectively, each chapter
has been updated and strengthened with additional counseling techniques and strategies. For
example, Chapter 10 introduces the psychoeducational life skill instructional model to enhance
social, emotional, and cognitive skills to maximize human potential. An emphasis on “ownwork”
(i.e., homework assignments) as a follow-through to group work is also outlined. Chapter 12 is a
 x  Preface
new chapter that recognizes outcomes studies of psychodynamic techniques. Chapter 13, “Eclectic
Techniques for Use with Family Systems and Family Development,” addresses experiential tech-
niques when working with families. Chapter 14 is a new chapter on play therapy, a medium through
which children can express themselves when they are not ready for talk therapy.
Ultimately, no single theory can account for or reflect the full range of human experiences. Perry
(2008) maintains that techniques of counseling and therapy are compatible with the metasystem
model of doing therapy because there is no such thing as one size fits all clients in therapy. Further,
adhering to exclusive models in counseling and psychotherapy could be perceived as limiting ther-
apeutic options. Interventions must be considered within the context of culture, ethnicity, interper-
sonal resources, and systemic support. Thus, any single theory and associated set of techniques are
unlikely to be equally or universally effective with the wide range of client characteristics, coping
repertoires, and interpersonal as well as intrapersonal skills.
In addition, through research, advocacy, and articulation, helping professionals are beginning to
Downloaded by [New York University] at 04:58 12 August 2016

recognize and acknowledge the following trends in counseling and psychotherapy:

• A collaborative continuum of care between helping professionals has emerged that reflects
the following services: outpatient clinics, intensive case management, home-based treatment
services, family support services, day treatment programs, partial hospitalization, emer-
gency/crisis services, respite care services, therapeutic group home or community residence,
crisis residence, and residential treatment facilities.
• Homework assignments, treatment planning, and follow-through designed to put increased
responsibility on the client have become an expectation. Treatment planning that reflects
many alternatives and combines methods in a logical and systematic way to maximize a more
positive therapeutic impact is imperative.
• Counseling and psychotherapy have emerged as an educational-developmental model that
is holistic, reflecting the interdependence of physical and psychological well-being and the
realization that both coping skills and coping opportunities occur in systems (i.e., individu-
als live, grow, develop, or become defeated in family systems, organizational work groups,
communities, culture, and the environment).

The utilization of professional counselors in all aspects of the health care delivery system,
addressing the mental health and developmental needs of all people, is supported in both public
and private sectors. In addition, the most rapidly growing field in counseling and psychotherapy is
human services counseling.
Bringing multicultural awareness into all aspects of the helping profession with sensitivity to
values; beliefs; race; ethnicity; gender; religion; and historical experience within cultures, socioeco-
nomic status, political views, and lifestyle has been integrated into therapeutic practice.
Promoting standards for professional development, accreditation, licensure, and ongoing pro-
fessional growth and development is systematically promoted, structured, and monitored.
Counselors, mental health professionals, and therapists are launching into cyberspace for instant
access to other counselors and therapists around the world, as well as to a host of other coun-
seling and mental health resources. This represents a new terrain with a tremendous opportunity
for interaction, shared professional growth, and visibility in a more global community.
It is clear that the mental health and counseling profession has grown and changed extensively
during the preceding decades. The resourceful, responsive, and responsible therapist will have the
benefit of a therapeutic repertoire gleaned from the visions and perspectives of his or her prede-
cessors, reflecting a full spectrum of counseling techniques to meet the demands of an increasingly
diverse and demanding clientele.
This book is unique to the profession in that it collectively assembles more than 500 techniques
to provide helping professionals with critical skills to meet the demanding needs of today’s clients.
 Preface  xi
The primary focus, central to all therapies, is improving relationships—those with others, our
families, our environment, and ourselves. Fundamentally, a counseling technique is presented as
a strategy. A strategy is an intervention. An intervention is a counselor’s or therapist’s intention
to eliminate or illuminate a self-defeating behavior. Counseling techniques that are included in
this book are intended to be broadly applicable to a wide range of client problems, from enhanc-
ing relationships to dealing with grief, loss, stress, anxiety, depression, post-traumatic stress dis-
order, low self-esteem, emotional crisis, personality disorders, addictions, and family dysfunction,
to name a few. In the schools, counseling services remediate racism, relational aggression, gang
involvement, bullying behavior, drug prevention, sexual harassment, identity issues, physical and
verbal aggression, truancy, probation supervision conflicts with authority, and academic achieve-
ment. Each technique provided in this book is followed by a counseling intention, as outlined in
Chapter 2, followed by a brief description.
A final value of this book lies in the greater understanding that may be gained from perspectives
Downloaded by [New York University] at 04:58 12 August 2016

for the therapist, the small reflections that flow through the pages of the book that can bring exis-
tential meaning to the work of the helping professional. This brings content and consciousness
together and provides hope and meaning for the reader.

A Caveat on Using Counseling Techniques

Specific techniques implemented by the counselor to elicit client change are an important com-
ponent of the counseling process. Techniques in counseling and psychotherapy, however, are
offered with the precaution that the acquisition of techniques alone merely produces a technician
skilled in gimmicks, not a therapist whose intention is to effect change. The counseling experi-
ence is much more than the counselor’s use of technique; the human dimension of the thera-
peutic alliance, as well as the readiness and responsiveness of the client, are also very important.
Fundamentally, a technique may be conceptualized as a preferred strategy of the counselor
and may be drawn from many available sources. The skillfulness with which the intervention is
implemented is critical. A counseling technique must be organized around a fundamental principle
of treatment and directed toward the ultimate goal of wellness through specific treatment plans
that best meet the needs of the client. Therapeutic goals should contribute to the total process by
becoming an assimilated force in the counseling relationship. Lambert (1989) suggested that the
technically skilled counselor could have a major impact on the counseling process and therapeutic
outcome.
Although a technique may or may not be associated with a specific theory of counseling, each
theory or model has its own repertoire of techniques integrated into the total therapeutic pro-
cess. Most counseling interactions are universal, regardless of theoretical orientation. A successful
technique must be flexible, appropriate, and pragmatic. Flexibility is a prerequisite to attending to
diverse populations with varying expectations and needs. Furthermore, a technique that is too pre-
scriptive and rigid will hamper the interaction between client and therapist, and may significantly
impede progress.
Simkin and Yontef (1984) provided two guidelines for integrating techniques in the counseling
session: (1) it has the aim of increasing awareness, and (2) it is within the bounds of ethical practice.
Byrum (1989) further outlined ten components critical to a client’s understanding and acceptance
of techniques:

  1. State the purpose of the technique.

  2. Introduce the technique in familiar language that the client can understand.
  3. Support the use of the technique or the rationale.
  4. Relate the technique to the client’s experience.
  5. Indicate how the technique has worked for other clients.
 xii  Preface
  6. Indicate that the technique is voluntary and that the client has the right to decline to partici-
pate in the experience.
  7. Give an overview of what will happen.
  8. Take the participant through the process.
  9. Process the experience with the clients.
10. Provide for action planning and follow-up (pp. 79–89).

Finally, I would be remiss if I did not acknowledge that many of these techniques have been
gleaned from many resources, and I have tried to credit counselors, psychotherapists, and research-
ers as much as possible. I have been both a student and a counselor in the fields of psychology and
psychotherapy for the last three decades and have been influenced by many counseling initiatives.
I consider myself a counseling historian in that I have tried to archive and bring the ideas of
leading therapists collectively to the forefront to further the profession. I hope the book will
Downloaded by [New York University] at 04:58 12 August 2016

be helpful for aspiring students, counselors, therapists, psychologists, social workers, counselor
educators, school counselors, human service counselors, health care professionals, mental health
counselors, case managers, juvenile justice authorities, drug and alcohol counselors, the religious
community, and any helping professional who works with people in an effort to help them func-
tion more effectively, both interpersonally and intrapersonally.
From this perspective, it becomes clear that techniques used in counseling or psychotherapy
are guided by ethical responsibility and are not intended to be used haphazardly or capriciously.
This book does not assume full coverage of all the practical procedures with which counse-
lors need to be familiar in selecting and assessing clients, implementing appropriate counseling
techniques, and evaluating the therapeutic process. Counseling techniques are intended to be
broadly applicable to a wide range of client problems—depression, phobias, sexual inhibitions,
crisis intervention, and family dysfunction. Moreover, this is not a comprehensive handbook cov-
ering all the strategies and tactics that a helping professional might want to assimilate in his or her
therapeutic repertoire. However, with more than 250 systems of counseling and psychotherapy
and an emerging collection of counseling techniques, this book is perhaps a beginning.
 Acknowledgments

Many professional counselors and therapists, directly or indirectly, have contributed to or influ-
Downloaded by [New York University] at 04:58 12 August 2016

enced the development of this book. Through my career as teacher, counselor educator, and
therapist, it has become increasingly difficult to know from where much of my knowledge and
many of my ideas came. I began my first edition of this book in 1996, my second edition in 2003
that was also translated into Korean, and my third edition in 2015 that is infused with newer
therapies and techniques, along with a new chapter on play therapy. I feel this book represents
a metacognition between my academic experiences, professional development activities, and the
sharing of ideas between practitioners and colleagues. However, the driving motivation was to
put approximately 500 techniques in one book that can meet the growing needs of an increas-
ingly diverse clientele in our society. I call these techniques my own from the perspective that
I have made them my own, but I am well aware that most techniques were given to me by some-
one else. As a literature scavenger, I merely have organized and reframed information in a more
systematic way and given credit to innovators in the field.
I am most grateful to the late pioneer Dr. Joseph Hollis, a former publisher of Accelerated
Development, who launched my writing career. His patience, guidance, support, and suggestions
throughout the years have been invaluable. He nurtured my career in writing in 1986. I also wish
to thank Dr. Nina W. Brown, professor and eminent scholar in the Department of Counseling
and Human Services at Old Dominion University, Norfolk, Virginia, who is a prolific writer and
has been both a mentor and close friend. Through the years, she has shared her resourceful ideas
and valued perspectives on the growing dynamics of counseling and psychotherapy. I would
be remiss if I did not mention the support of the exceptional staff at Routledge/Taylor
and Francis Group.
Finally, I am most indebted to my husband, Charles, and our two adult children, Jessica and
Ryan, all of whom are in the fields of architecture or engineering. As an author, therapist, and
counselor educator, I represent the only alien in our home. Cognitively, none of us understands
each other’s books or technical attributes, nor can we hold a meaningful conversation about them.
It has provided a unique contribution to our family system because we never talk about work, and
that is a good thing! However, opening a conversation with “How do you feel about that?” does
provide a venue for processing important emotional information.
Downloaded by [New York University] at 04:58 12 August 2016

Page Intentionally Left Blank

 1 Professionalism in Counseling and
Psychotherapy

Perspective for Therapist: On psychotherapy

Downloaded by [New York University] at 04:58 12 August 2016

But, ineffably, psychotherapy heals. It makes some sense of the confusion, reins in the terrifying thoughts
and feelings, returns some control and hope and possibility of learning from it all.
Kay Redfield Jamison, An Unquiet Mind, 1995, p. 89 (Reprinted with permission)

A pivotal debate exists among counselors and therapists on the efficacy of particular practices and
theoretical approaches in counseling and psychotherapy. The continuum of discussion focuses on
adhering to a single therapeutic model, pursuing a theoretical integration of models, or adopting
a more eclectic approach or a metasystem model to therapy in an effort to meet the changing
needs of diverse client populations because one theory does not fit all clients. The pervasive
question is, “Do practicing counselors and therapists clearly understand how they use counseling
theories and other cognitive schemata to guide their therapeutic perspective and their therapeu-
tic interventions?”
Technical eclecticism has been touted as the fundamental thrust of counseling and psycho-
therapy in the 21st century primarily because of the time constraints of managed care (Lazarus,
Beutler, & Norcross, 1992). Technical eclecticism advocates the selective combination of the
most efficient techniques, regardless of their theoretical origin, to achieve optimal therapeutic
results for a specific client (Lampropoulos, 2000, p. 287). Beutler and his associates have been
using personality-matched eclecticism for more than 30 years (Beutler & Clarkin, 1990; Beutler,
Goodrich, Fisher, & Williams, 1999). Collectively, the researchers have developed an eclectic
model called Systematic Treatment Selection. It has become an advanced eclectic approach using
systematic, empirically based treatment selection. It has been developed to allow eclectic recom-
mendations for specific disorders such as depression (Beutler, Clarkin, & Bongar, 2000) and
alcoholism. For implementing eclectic approaches, Lampropoulos (2000) makes the following
training recommendations for therapists: (a) educate them to identify and be aware of their
relationship styles; (b) train them to explore and attempt varying therapeutic styles, when neces-
sary; (c) train them to recognize important criteria for adopting different relationship styles; (d)
educate them to identify and maintain an optimal level of fit or difference in the relationship; and
(e) train them to make appropriate referrals when there is a clear incompatibility and mismatch
in the relationship that cannot be fixed (p. 291).
The pragmatic emphasis of managed care is loosening therapists’ attachments to schools of ther-
apy and forcing conceptual refinement of practice. Other developments are also de-emphasizing
schools of therapy, with a movement to integrate the psychotherapies (Norcross & Goldfried,
1992). Only theories and techniques that correlate with cost effectiveness and quality are likely
to survive in the managed-care environment (Cummings & Sayama, 1995). Other developments
are also forcing the de-emphasis of schools of therapy. The movement to integrate the psycho-
therapies has been gathering momentum and support (Norcross & Goldfried, 1992).
 2  Professionalism in Counseling

Counseling Theory: Philosophy or Conceptual Model?

Many researchers and practitioners have taken on the arduous task of attempting to define the
theoretical aura that surrounds counseling practice. The image of a “theoretical aura” reflects
the continuum of debate about whether counseling and psychotherapy are guided by a theory, a
philosophy, or a conceptual model. Caple (1985) stated that a theory is a formally organized col-
lection of facts, definitions, constructs, and testable propositions that are meaningfully related.
Ginter (1988) emphatically asserted that “therapy cannot exist without theory” (p. 3). A theory
serves as a conceptual map and the fundamental foundation of a counseling practice, mean-
ingfully relating therapeutic constructs, counseling intentions, and client outcomes. Within the
theory are specific functions. Boy and Pine (1983, p. 251) outlined six functions of theory that
make counseling pragmatic:

1. It helps counselors find unity and relatedness within the diversity of existence.
Downloaded by [New York University] at 04:58 12 August 2016

2. It compels counselors to examine relationships they would otherwise overlook.

3. It gives counselors operational guidelines by which to work and helps them in evaluating
their development as professionals.
4. It helps counselors focus on relevant data and tells them what to look for.
5. It helps counselors assist clients in the effective modification of their behavior.
6. It helps counselors evaluate both old and new approaches to the process of counseling.

Thus, theory is the basis from which new counseling approaches are constructed. To separate
theory from the context of the theorist can distort our perception not only of the theory, but
also of its application to the client and his or her world. Thus, there are four requirements of an
effective theoretical position:

1. It is clear, easily understood, and communicable. It is coherent and not contradictory.

2. It is comprehensive, encompassing explanations for a wide variety of phenomena.
3. It is explicit and generates research because of its design.
4. It is specific in that it relates methods to outcomes.

Brammer and Shostrom (1977) further stressed the value of a theoretical framework for the
counselor:

Theory helps to explain what happens in a counseling relationship and assists the counselor in
predicting, evaluating, and improving results. Theory provides a framework for making scien-
tific observations about counseling. Theorizing encourages the coherence of ideas about coun-
seling and the production of new ideas (p. 28).

Here, counseling theory can be very practical by helping to make sense out of the counse-
lor’s observations. But is it practical? Does it serve as a formative perspective that is routinely
consulted to meet the needs of every new client who is counseled? As Kelly (1988) stated, “The
ultimate criteria for all counseling theories is how well they provide explanations of what occurs
in counseling” (pp. 212–213). Theory is, at best, a hypothesis or a speculation about people’s
behavior, their developmental unfolding, and their capacity for adjustment.

The Theoretical Void: Validating Research and Practice

To many, counseling research based on theory has not demonstrated outcome accountability.
Falvey (1989) illuminated the practitioner’s problem by noting that practitioners tend to ignore
 Professionalism in Counseling  3
research findings because those findings do not provide consistent, relevant guidelines for under-
standing therapeutic changes in applied settings. Strupp (1981) and Falvey (1989) emphasized
the importance of linking research and practice. Strupp and Bergin (1969) stressed that psycho-
therapy research should be reformulated as a standard scientific question: What specific thera-
peutic interventions produce what specific changes in specific patients under specific conditions?
Patterson (1986) responded to this dilemma in the profession and outlined the specifics for such
a proposal. As a frame of reference, counselors or therapists would need:

• A taxonomy of client problems or a taxonomy of psychological disorders (a reliable, relevant

diagnostic system).
• A taxonomy of client personalities.
• A taxonomy of therapeutic techniques or interventions.
• A taxonomy of therapists (therapeutic style).
Downloaded by [New York University] at 04:58 12 August 2016

• A taxonomy of circumstances, conditions, situations, or environments in which therapy is

provided.
• A (set of) guiding principles or empirical rules for matching all these variables (p. 146).

Linden and Wen (1990) suggested that the limited influence of research on practice stems
from its failure to provide conclusive evidence regarding the relative effectiveness of psychothera-
peutic interventions with different clients and problems:

When addressing the reasons for a lack of conclusive evidence, it has been argued that the out-
come literature is essentially noncumulative and not informative enough for clinicians, that
studies lack the power to detect effects, and that the current review and publication process is
more of a hindrance than a help for accumulating a solid data base on therapy outcome, The
lack of accumulated knowledge has been attributed to a tendency among researchers to conduct
mostly analogue studies and typically small-scale, independently initiated, and uncoordinated
studies (p. 482).

This can create skepticism and doubt in the counseling profession because unlicensed clini-
cians or overzealous believers in nonempirically demonstrated interventions can enlist the ser-
vices of desperate clients and do serious harm to those they think they are trying to help. Two
examples are attachment therapy and sweat lodge therapy, which were performed inappropriately
and resulted in the deaths of clients. Attachment therapy, formulated by John Bowlby, identifies
the importance of early attachment relationships for the child and the mother and the impli-
cations to disruption through separation, deprivation, and bereavement The client (usually a
traumatized child) is often wrapped up tightly in a blanket and pressed upon by other people to
simulate the darkness and compression of the birth canal, which was considered a fringe form of
Bowlby’s psychotherapy to treat reactive attachment disorder closely resembling a New Age cult
in order to give the client a “second birth” to eliminate previous trauma. This was conducted by
two overzealous, unlicensed social workers and resulted in the death of Candace Newmaker, age
10, in Evergreen, Colorado. The social workers were charged with reckless child abuse because
Candace died of asphyxiation.
Sweat lodge therapy has evolved to treat mental health problems and addiction issues through
an experiential approach where clients engage in chanting, drumming, and prayer. It is a simu-
lated Native American sweat lodge purification ceremony that costs $9,000 for participants.
Within a tent in the absence of light and in sweat-inducing heat, clients are encouraged to look
inward and leave their past mental health transgressions behind and gain spiritual enlightenment.
This experiential programming at Angel Valley, another New Age spiritual retreat in Sedona,
Arizona, was led by the controversial spiritual leader James Arthur Ray, who was arrested and
 4  Professionalism in Counseling
charged with three counts of manslaughter and sentenced to two years in prison because of
three deaths of participants on October 9, 2010 —Kirby Brown, James Shore, and Liz Newman
(Ferran, 2010). Both of these selected incidents violate the ethical guideline of doing no harm
to clients. Therefore, it is imperative to keep up with the ethical standards set by the American
Counseling Association and other professional groups and to maintain the annual continuing
education requirements in ethics.
Essentially, clinicians need to have positive proof that interventions with clients make a differ-
ence, and this can only be assured through evidence-based practices that empirically demonstrate
that counseling interventions work and have positive results for the client. Practicing initiatives
that work in counseling and psychotherapy raises the integrity of the profession and serves to
protect the public from dangerous interventions and treatments as described in the previous
paragraph.
Thus, the debate over whether the practice of counseling and psychotherapy is empirically
Downloaded by [New York University] at 04:58 12 August 2016

anchored in theory or is merely a representation of one’s philosophy or conceptual models con-

tinues to divide practitioners. Counseling is both a science and an art. It is also the counselor’s or
therapist’s responsibility to understand that one model of counseling may be too limited when
working with an increasingly diverse population (Allen, 1988).
In the long run, conceptual frameworks are helpful, but individuals are too diverse, too com-
plex, and too nebulous for therapists to expect that the ultimate, most comprehensive theoretical
model will be discovered. This assumption is supported by the theory of chaos, which maintains
that human behavior is so complex that no single traditional scientific discipline will enable us to
understand behavior and its causes. The concept of chaos requires a multidisciplinary approach
because “complex behavior implies complex causes” (Gleick, 1988, p. 303).
Thus, adhering to exclusive models in counseling and psychotherapy could be perceived as
limiting therapeutic options when working with clients, especially when options are considered
in the context of culture, ethnicity, interpersonal resources, coping skills, and systemic sup-
port. Okum (1990) related how this has been detrimental to the practice of counseling and
psychotherapy:

Each of the major models of psychotherapy has devotees who believe that their view is the only
correct view. This type of doctrinarism has probably done more harm to the development and
credibility of the psychotherapy field than any other single variable, because it has reinforced
turf competition and dichotomous thinking such as right or wrong, science or art, good or bad.
Therapists afflicted with this doctrinarism are unlikely to select treatments that can be flexibly
and effectively tailored to the needs of clients who are experiencing distress related to today’s
sociocultural context (p. 3).

Any single theory, including its associated set of techniques, is unlikely to be equally or uni-
versally effective with the wide range of client characteristics or dysfunctions. Nance and Myers
(1991) argued that counselors or therapists who work from only one theoretical model may be
unable to work with a heterogeneous group of clients because they find themselves unable to
adapt to a wide range of presenting problems. This is clearly illuminated from a multicultural
perspective. Multicultural counseling practice takes into consideration the client’s specific values,
beliefs, and actions and how they relate to race, ethnicity, gender, religion, and historical experi-
ences with the dominant culture, socioeconomic status, political views, lifestyle, and geographic
region (Wright, Coley, & Corey, 1989). Socioeconomic diversity among the poor, for example,
can include single mothers, elderly persons, unskilled laborers, unemployed workers, migrant
farm workers, immigrants, and homeless people. Within this framework, adhering to a single
theoretical model clearly would be anachronistic.
 Professionalism in Counseling  5

Pluralism, Systematic Eclecticism or Evidence-Based Practices

Okum (1990) proposed the concept of pluralism as an alternative to single-theory or theoretical
integration to provide an opportunity for an open-system, multifaceted perspective of current
and emerging theoretical models of psychotherapy. Pluralism acknowledges and attends to the
different levels and diversity of the human experience and the accompanying systems that operate
with the client’s worldview. Okum (1990) maintained that:

pluralism allows for consideration of both the mind and body, conscious and unconscious, biol-
ogy and culture, quantitative and qualitative, subjective and objective, masculine and femi-
nine, insight and behavior, historical and ahistorical, directive and nondirective, autonomy
and connectedness, content and process, linear and cybernetic causality, along with the other
major polarities associated with the dichotomous thinking of the major models of psychotherapy.
Pluralism opens up the possibilities of varying and different levels of human experience as well
Downloaded by [New York University] at 04:58 12 August 2016

as possibilities of varying and different levels of therapeutic change. It acknowledges the equal
value of the different models, takes personal preference into account, and encourages a careful
assessment of what model is best utilized for what person with what problem in particular cir-
cumstances (p. 407).

A pluralistic approach embraces the notion that many appropriate ways exist to treat a client;
several different theoretical perspectives might explain the client’s problem(s), and at least several
different therapists could be effective for each client. Fundamentally, a therapeutic pluralistic
approach accounts for diversity on the part of the client, the therapist, the treatment, and the
theoretical rationale.
Many researchers have identified a major shift toward eclecticism in the practice of counseling and
psychotherapy (Andrews, 1989; Corsini, 1989; Garfield & Bergin, 1986; Ivey & Simek-Downing,
1980; Kelly, 1988; Nance & Myers, 1991; Norcross & Prochaska, 1983; Simon, 1989; Smith,
1982). Yet, eclecticism was defined as a construct as early as 1958 by English and English:

Eclecticism in theoretical system building, is the selection and orderly combination of com-
patible features from diverse sources, sometimes from incompatible theories and systems; the
effort to find valid elements in all doctrines or theories and to combine them into harmonious
whole. The resulting system is open to constant revision even in its major outlines (p. 18).

Eclectic practice coincides with the current knowledge based on a growing body of empirical
research that no one theoretical approach produces reliable counseling outcomes with a hetero-
geneous group of clients. Many researchers also have articulated the advantages of developing an
eclectic approach (Brabeck & Welfel, 1985; Brammer & Shostrom, 1982; Rychlak, 1985) from
the perspective that no single theory is comprehensive enough to be applicable to all individuals
under all circumstances. Eclecticism reflects our growing knowledge of people and the dynamics
of change in counseling. Nicholson and Berman (1983) have contended that “eclecticism is finally
being appreciated for what it is—an essential perspective for dealing with the complexity of human
problems” (p. 25). The research literature is filled with nomenclatures such as creative synthesis,
emerging eclecticism, technical eclecticism, theoretical eclecticism, systematic eclecticism (Herr,
1989), pragmatic technical eclecticism (Keat, 1985), eclectic psychotherapy (Norcross, 1986),
and “adaptive counseling and therapy: an integrative eclectic model” (Howard, Nance, & Myers,
1986). For example, Simon (1989) distinguished between technical and theoretical eclecticism
and suggested that general systems theory (GST) could provide the framework for pulling eve-
rything together. Simon (1991) defined technical eclecticism as a kind of eclecticism “based on
the assumption that the primary task of an eclectic theory is to indicate in a systematic manner
 6  Professionalism in Counseling
which particular intervention or style of intervening should be used in which particular coun-
seling situation” (pp. 112–113). McBride and Martin (1990) proposed a “theoretical eclecticism”
as opposed to “syncretism, or unsystematic, atheoretical eclecticism.” Hershenson, Power, and
Seligman proposed an “integrated-eclectic” model, a mental health counselor–specific eclecticism
(1989a), and the need for a “skilled-based, empirically validated” model (1989b).
Evidence is mounting that the therapist of the future will require more than a single set of
methodological and theoretical answers to meet the needs of an increasingly diverse clientele.
Fundamentally, no single theory can fully account for the myriad phenomena characterizing the
range of human experiences. Within the context of contemporary society, a systematic, eclec-
tic approach may be a constructive response to a wide range of client differences. Counseling
approaches and client outcomes can be viewed as a matrix of possible interactions with the mutual
goal of personal well-being and interpersonal adjustment. Systematic eclecticism embraces the
perspective that no single theory-bound approach has all the answers to all the needs that clients
Downloaded by [New York University] at 04:58 12 August 2016

bring to the therapeutic setting. Eclectic practice should resemble a “systematic integration” of
underlying principles and methods common to a wide range of therapeutic approaches, integrat-
ing the best features from multiple sources.

Evidence-Based Practices
However, evidence-based practices are now becoming the norm in government organizations, edu-
cational practices, and the counseling profession. Health care providers and mental health agencies
are increasingly demanding to see counseling practices that demonstrate effectiveness. As a profes-
sional obligation, counselors and therapists need to continually scrutinize what works effectively,
efficiently, and with a continually growing diverse population. Health care providers are beginning
to pursue the notion that they may stop reimbursement of mental health practitioners who don’t
use evidence-based practices. Theory, sound techniques, a strong therapeutic alliance, and factors
outside such as a sound support system are part of the equation for client change. Evidence-based
program initiatives are programs that have been shown by scientifically rigorous evaluation that
is empirically based to reduce debilitating or dysfunctional behavior of children, adolescents, and
families. Evidenced-based practice is defined by the American Psychological Association (2001)
as “the integration of the best available research with clinical expertise in the context of patient
characteristics, culture, and preferences” (p. 54) and by the Institute of Medicine (2001) as “the
integration of best-research evidence and clinical expertise with patient values” (p. 5).
Further, the manual that many mental health professionals use to identify client disorders is
the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and is concurrently used
in evidence-based research; however, it should not be the ultimate resource because it does not
account for environmental, economic, or sociocultural aspects of the individual, which is critical
in today’s society. Essentially, it is impossible to write a comprehensive, scientifically valid text of
all mental illnesses because a diagnostic manual cannot capture the full spectrum of psychiatric
disorders. In addition, labels are disabling and many clients have co-occurring disorders.

Goals of Psychotherapy
Psychotherapy can be defined by its goals, its process (stages), its tools, and the principles for
using those tools. Future-oriented psychotherapy’s intent is to help patients do something posi-
tive for themselves after they leave the office. The goals of most psychotherapy relationships fall
into six categories (Beitman, 1997):

1. Crisis stabilization. A person is distraught because his wife has suddenly left him for another
man, for example.
 Professionalism in Counseling  7
2. Symptom reduction. A person has been depressed for several months, which is interfering
with his work and social functioning.
3. Long-term pattern change. A woman repeatedly develops intimate relationships with
abusive men.
4. Maintenance of change, stabilization, and prevention of relapse. A woman with a chronic
medical disease, a disabled husband, and recurrent depressive episodes requires continuing
support to help maintain current functioning.
5. Self-exploration. A person with reasonably good social and work functioning wants to
understand himself more fully.
6. Development of coping strategies to handle future problems. A person learns to handle emo-
tions that increase the likelihood of wanting to drink alcohol excessively but wants to gener-
alize this coping strategy to other situations (p. 203).
Downloaded by [New York University] at 04:58 12 August 2016

Client Variables
In the real world, the success of psychotherapy is anchored in the lives of the client’s current
functioning, as well as the strength of the client’s social support networks. Several critical vari-
ables play a more important role than theory and technique in influencing the outcomes:

1. The client’s readiness to change (Prochaska, DiClemente, & Norcross, 1992).

2. The nature and strength of the client’s social network (Bankoff & Howard, 1992; Marziali,
1992; Moos, 1990).
3. Indexes of severity, chronicity, and complexity of symptoms; motivation; acceptance of
personal responsibility for change; and defensive operations (Anderson & Lambert, 1995;
Safran, Segal, Vallis, Shaw, & Samstag, 1993).
4. Strength of the working alliance between the client and the therapist (Horvath & Green-
berg, 1994).
5. Number of sessions (Howard, Orlinsky, & Lueger, 1994; Lambert, 1996).
6. Perseverance, depth of affective experiencing, specific problem versus pervasive problem and
acute difficulties versus chronic problems, and well-established correlates of potential client
improvement (Robertson, 1995).

Theory and technique are also shaped by the cultural context in which the therapy is being prac-
ticed. Psychotherapy is strongly influenced by its sociopolitical context and may sometimes influ-
ence the culture in which it grows.
Therapists adjust to influences patients bring to the psychotherapy relationship. Generally, thera-
pists strive to match client characteristics and problems with the most potentially effective inter-
ventions rather than attempting to force patients into therapist-imposed restrictive formats.
Effective therapists learn to move easily among the commonly accepted change strategies. Three
metastrategies guide the application of change strategies:

1. Key-change strategy: Sometimes the available evidence suggests that one strategy offers the
quickest, most efficient avenue to change.
2. Shifting-change strategy: Therapy begins with the most easily used change strategy. If the
initial strategy is ineffective, the therapist switches to another strategy.
3. Maximum-impact strategy: With some complex cases, therapists must work simultaneously
on several patterns.

Instead of hoping for a sequential effect, therapists may need to work for a synergistic effect,
as multiple changes mass together to bring about a desired state. The use of these strategies relies
 8  Professionalism in Counseling
on the principle of using the least amount of energy to produce the greatest output (Prochaska &
Prochaska, 1994).
Effective therapists reflect on and analyze their own thinking. Effective therapists seem to
reflect upon their own responses to patients to differentiate their own neurotic responses from
patient-induced ones. They attempt to use this understanding to help patients and to help them-
selves grow as individuals and as therapists. Overall, the guiding strategy of psychotherapists is an
ethical one: everything therapists do is intended to help their patients (Prochaska & Prochaska,
1994).
In summary, the resourceful, responsive, and responsible therapist of the next millennium
would have within his or her therapeutic repertoire a full spectrum of counseling techniques and
educational therapies to meet the demands of an increasingly diverse clientele. This perspective
supports the observations of Garfield and Bergin (1986):
Downloaded by [New York University] at 04:58 12 August 2016

A decisive shift in opinion has quietly occurred; and it has created an irreversible change in
professional attitudes about psychotherapy and behavior change. The new view is that the
long-term dominance of the major theories is over and that an eclectic position has taken
precedence. I would go even further and state that all good therapists are eclectic (p. 7).

Conclusion
There is a professional obligation to ensure that every client receives optimal benefits from thera-
peutic services. Planned, systematic clinical approaches with accountable, evidence-based out-
comes must be the therapeutic norm rather than the therapeutic exception. Interdisciplinary
collaboration and the acceptance of individual diversity will create a climate of openness and
growth for all who embrace the helping relationship and the responsibilities that come with it.
Further, a mature counseling profession has evolved. Several factors—professionalism,
accountability, credentialism, health care consumerism, and public demands for quality mental
health care—indicate a need for more definitive statements or standards of practice in coun-
seling. In response to this need, Anderson (1992) identified five discernable forces influencing
the counseling profession:

(1) a growing demand for quality mental health counseling, (2) increasing public awareness
of specific issues in mental health care and general health care consumerism, (3) increasing
demands for quality assurance, accountability, and containment of mental health care costs,
(4) progressing state-by-state initiatives in credentialism and licensure, and (5) increasing
national emphasis on counselor professionalism and professional identity. Existing laws,
standards of practice, and codes of ethics have shaped the expectations and views that coun-
selors have professional conduct (p. 22).

Gibson and Mitchell (1990) maintained, “A profession’s commitment to appropriate ethical and
legal standards are critical to the profession’s earning, maintaining, and deserving the public’s
trust. Without this trust, a profession ceases to be a profession” (p. 451). At a minimum, com-
prehensive standards should include (1) professional disclosure statements, (2) treatment plans,
(3) clinical notes, (4) formative evaluations, (5) documentation of consultation or supervision,
(6) professional performance evaluation and peer review, (7) psychotherapy for impaired prac-
titioners, and (8) awareness of and responses to ethical and legal foundations of the profession.
 2 Client–Therapist Relationships
Counseling Intentions, Interventions, and
Therapeutic Factors

We all have a load; and we have to work with the load we’ve got, with the way we are. We could all use
Downloaded by [New York University] at 04:58 12 August 2016

some time to think about ourselves. The routine time is fifty minutes, but that’s ten minutes of getting
started, twenty minutes of therapeutic alliance, ten minutes of work, and ten minutes of preparation
to get back to reality.
Elvin Semrad, The Heart of a Therapist, 1983, p. 101

Within the therapeutic relationship, counselors and therapists often provide assistance in a short
amount of time, with the presenting problem remediated contingent upon the client’s resources
and the degree of the counselor’s expertise. For the most part, counselors and therapists find
themselves gathering information, exploring feelings, generating alternatives, or merely provid-
ing unconditional support in a safe and secure environment. An outline of the universal compo-
nents of the therapeutic process includes:

• Creating a therapeutic alliance.

• Establishing counselor credibility (i.e., explaining credentials, experience, theoretical per-
spective and the use of techniques).
• Identifying the presenting problem and uncovering the real problem.
• Identifying real, attainable goals.
• Meeting client expectations.
• Understanding the developmental needs of the client.
• Understanding the implication of diversity on therapy.
• Developing techniques for remediation and self-efficacy.
• Planning and preparing for termination.

Sexton and Whiston (1991) provided a conceptual three-component model of counseling.

Their model consists of (1) existing factors, that is, those characteristics clients and counselors
bring to counseling such as race, sex, and psychological characteristics; (2) counseling process;
and (3) intended outcome. Their model evolved after reviewing over 120 studies and significant
meta-analysis (Lambert, Shapiro, & Bergin 1986; Luborsky, Crits-Christoph, Mintz, & Auer-
bach, 1988) in an effort to assess trends related to counseling that may be important to practi-
tioners, students, and counselor educators.
Of all the characteristics in the model, the counseling process is perhaps the most critical. “It
begins with the relationship between counselor and client upon which organizational and expe-
riential elements of the counseling session, as well as specific techniques and interventions, are
based” (Sexton & Whiston, 1991, p. 331). The existing factors and the counseling process result
in the intended outcome of counseling client action and behavioral change. Sexton and Whiston
(1991) stressed that counseling effectiveness should be defined by the ability of an element in the
counseling process to effect the client’s change according to research that is data based.
 10  Client–Therapist Relationships

Therapist Intentions: Eighteen Therapeutic Characteristics

Within the therapeutic relationship, counselors and therapists want to provide assistance effec-
tively and efficiently. For the most part, counselors find themselves gathering information, explor-
ing feelings, generating alternatives, or merely providing support in a secure environment. One
means that counselors and therapists might use to clarify their intended purpose and to provide a
focus for interventions could revolve around Hill and O’Grady’s (1985) 18 therapeutic intentions:

 1. Set limits. To structure, make arrangements, establish goals and objectives of treatment, and
outline methods.
 2. Get information. To find out specific facts about history, client functioning, future plans, and
present issues.
 3. Give information. To educate, give facts, correct misperceptions or misinformation, and give
reasons for procedures or client behavior.
Downloaded by [New York University] at 04:58 12 August 2016

 4. Support. To provide a warm, supportive, empathic environment; to increase trust and rap-
port so as to build a positive relationship and to help the client feel accepted and understood.
 5. Focus. To help the counselee get back on track, change the subject, and channel or structure
the discussion if he or she is unable to begin or has been confused.
 6. Clarify. To provide or solicit more elaboration; emphasize or specify when the client or
counselor has been vague, incomplete, confusing, contradictory, or inaudible.
 7. Hope. To convey the expectations that change is possible and likely to occur; convey that the
therapist will be able to help the client; restore morale, and build the client’s confidence to
make changes.
 8. Catharsis. To promote a relief from tension or unhappy feelings; allow the client a chance to
talk through feelings and problems.
 9. Cognitions. To identify maladaptive, illogical, or irrational thoughts or attitudes (e.g.,
“I must perform perfectly”).
10. Behaviors. To identify and give feedback about the client’s inappropriate or maladaptive
behaviors and/or their consequences; to do a behavioral analysis, point out discrepancies.
11. Self-control. To encourage the client to own or gain a sense of mastery or control over his or
her own thoughts, feelings, behaviors, or actions; help the client become more appropriately
[internally] in taking responsibility.
12. Feelings. To identify, intensify, and/or enable acceptance of feelings; encourage or provoke
the client to become aware of deeper underlying feelings.
13. Insight. To encourage understanding of the underlying reasons, dynamics, assumptions, or
unconscious motivations for cognitions, behaviors, attitudes, or feelings.
14. Change. To build and develop new and more adaptive skills, behaviors, or cognitions in deal-
ing with self and others.
15. Reinforce change. To give positive reinforcement about behavioral, cognitive, or affective
attempts to enhance the probability of change; to provide an opinion or assessment of client
functions.
16. Resistance. To overcome obstacles to change or progress.
17. Challenge. To jolt the client out of a present state; shake up current beliefs, patterns, or feel-
ings; test validity, adequacy, reality, or appropriateness.
18. Relationship. To resolve problems; build or maintain a smooth working alliance; heal rup-
tures; deal with dependency issues; uncover and resolve distortions (p. 10–12).

Other important intentions include:

 1. Objectivity. To have sufficient control over feelings and values so as not to impose them on
the client.
 Client–Therapist Relationships  11
 2. Implementation. To help the client put insight into action.
 3. Structure. To structure the ongoing counseling sessions so that continuity exists from ses-
sion to session.
 4. Inconsistencies. To identify and explore with the client contradictions within and/or between
client behaviors, cognitions, and/or affect.
 5. Goals. To establish short- and long-range goals congruent with the client’s potential.
 6. Flexibility. To change long- and short-term goals within a specific session or during the
overall counseling process as additional information becomes available.
 7. Behavioral change. To develop specific plans that can be observed for changing the client’s
behavior(s).
 8. Homework. To assign work to the client to reinforce change.
 9. Problem solving. To teach the client a method for problem solving.
Downloaded by [New York University] at 04:58 12 August 2016

Therapeutic Interventions: Strategies That Are the

Same for Individual and Group Processes
Therapeutic interventions consist of therapist and client actions intended to facilitate the change
process and therapeutic factors in counseling and psychotherapy.
Outcome is enhanced when clients develop a problem-solving attitude (O’Malley, Suh, &
Strupp, 1983) and become actively engaged in experiences that help them master problematic
situations (Lubarsky et al., 1988). Lambert et al. (1986) found that counselors who let the client
ramble, did not focus the counseling session, and failed to integrate these issues and themes into
counseling contributed to negative client outcomes. Sexton and Whiston (1991) also reported
that 50% of the benefit of counseling seems to occur within the first 6 months of weekly sessions
in which the client was involved, developed a problem-solving attitude, and learned to master
problematic situations in his or her life and experienced a wide range of emotions while maintain-
ing a positive expectation for change.

Reciprocity. Reciprocity is manifested through warmth, role implementation, comfortable-

ness, trust, openness, expression of feelings, liking, respect, positive regard, and interper-
sonal attributes (Fuhriman & Burlingame, 1990).
Engagement. Extent of engagement, involvement, and commitment by client and therapist is
a contributing factor to the bonding component of the relationship. Substantial evidence
supports the therapist’s and client’s engagement as a central construct of the therapeutic
relationship (Fuhriman & Burlingame, 1990).
Transference. With transference, the client responds to the therapist as though he or she were
a significant figure in the client’s past, frequently a parent. Both individual and group pro-
cesses use the construct of transference as a significant variable of the therapeutic relation-
ship. Transference can be positive or negative. Transference and countertransference of the
therapist are important constructs.
Detachment. Fundamentally, the therapist has to remain detached from the client. One of the
concepts of the metasystem (from structural theory) maintains the principle that the client
innocuously will try to triangulate the therapist into the presenting problem (Nichols &
Schwartz, 2005). It is important to maintain appropriate boundaries while also remaining
present and demonstrating emotional contact.
Confrontation. Confrontations focus attention on discrepancies between verbal and nonver-
bal behavior. Empirical evidence from both individual and group research reveals that
confrontations are consistently associated with client improvement.
Interpretation. Interpretative intervention is normative and prescriptive in individual and
group treatment, and is defined as explanatory interventions to provide clients with
insight. The overall effectiveness also may be a function of how interpretations interact
 12  Client–Therapist Relationships
with other variables such as content focus, patient characteristics, and timing (Fuhriman &
Burlingame, 1990).
Content focus. The therapist is perceived as responsible for the topical boundaries of
therapist-client interactions, with support in the literature for focusing on client affect,
cognition, and the therapeutic relationship. Content focus on the here-and-now receives
more conceptual attention in group treatment.
Concrete rationale. The therapist focuses on the importance of conveying a concrete ration-
ale, including a vocabulary for defining and describing client problems and pregroup
preparation.
Guidance. Guidance and giving advice in both individual and group contexts have received
mixed reviews in the literature, from highly valued to less valued.
Therapist self-disclosure. Disclosure of a personal fact or experience by the therapist is often
a technique to maintain therapist transparency; however, it is viewed as less appropriate
Downloaded by [New York University] at 04:58 12 August 2016

when clients are more psychologically impaired.

Exploration. “Exploration in the form of probes is an intervention to collect information and
to focus on important aspects of the client’s experience” Fuhriman and Burlingame (1990,
p. 34). They found in group studies that exploratory interventions are most often incorporated
into investigations of group structure where high-structure conditions include not only expe-
riential activities, but also more directive interventions, such as focused questions and probes.
Reflection. Reflection as an intervention involves repeating or rephrasing the client’s statement
or nonverbal manifestations to clarify communication and to check for understanding.
Encouragement. Encouragement is used to establish and to maintain the supportive alliance of
the therapeutic relationship. It can range from minimal encouragers to more direct maneu-
vers of support, approval, and encouragement.
Experiential activities. Interventions can be advanced as a “novel” means of fostering client
improvement.
Pretherapy activities. Pretherapy activities, a growing professional trend advocated in both
individual and group therapy, provide preparation exercises that train the client to partici-
pate in treatment more effectively. “Role preparation appears to affect early therapeutic
processes positively and also seems to be linked to later client improvement” (Fuhriman &
Burlingame, 1990, p. 36).
Within-therapy activities. The analysis of the impact of specific within-therapy activities for
both individual and group therapy is not easily clarified. Fuhriman and Burlingame (1990),
however, cited a number of studies that reveal that therapeutic structure is preferred (1) for
clients who are severely disturbed, (2) for more dependent and externally oriented clients
(Stockton & Morran, 1982), and (3) at early stages of treatment to negotiate particular
developmental factors (Stockton & Morran, 1982, pp. 47–68).
Ownwork. This is the author’s term for prescriptions or homework because homework often
has a bad connotation for some clients. This is given after each session and is reviewed
during the next session. It can be given in writing or verbally. Clients need to apply what
they learned within the counseling session to home, work and interpersonal relationships.
If they do not practice what they have learned during their counseling setting, they will not
integrate it into their personal repertoire for personal change. Essentially, it is a cognitive
behavioral technique.

Therapeutic Factors
Common Factors in Individual and Group Processes
Therapeutic factors are the mainstay of the therapeutic process. According to Garfield and Ber-
gin (1986), research indicates that counseling effectiveness can be explained best by “common
 Client–Therapist Relationships  13
factors,” variables shared by many approaches and exhibited by a variety of skilled counselors and
therapists, regardless of their therapeutic school:

Insight. Insight is an integral process in both individual and group processes where the cli-
ent makes connections between new information generated in therapy and present
circumstances.
Catharsis. Catharsis is a significant therapeutic process in both individual and group treat-
ment. The nomenclature is synonymous with emotional ventilation, affective arousal, and
release of tension, and it is sometimes used synonymously with abreaction.
Reality testing. Reality testing as feedback and confrontation is significantly and posi-
tively associated with the client’s outcome. The impact of feedback and confrontation,
however, may differ in individual and group therapy. Bloch and Crouch (1985) main-
tained that “group therapy is unique in providing a forum for the mutual exchange of
Downloaded by [New York University] at 04:58 12 August 2016

honest, explicit feedback. By contrast, feedback in individual therapy can only come
from an authority figure—a radically different experience than from one’s peers”
(p. 51).
Hope. The instillation of hope and the expectation for improvement are the catalysts of the
therapeutic process. Hope is also a variable that interacts with client improvement and
premature termination. The instillation of hope is magnified by the vicarious learning that
occurs in the group experience.
Disclosure. Self-disclosure is a prerequisite for growth and change. In regard to the group
experience, Fuhriman and Burlingame (1990) cite Stockton and Morran’s (1982) research,
which documented that client self-disclosure is related to (1) reciprocal disclosures from
other members, (2) greater liking and attraction, (3) higher levels of cohesion, and
(4) a more positive self-concept.
Identification. Identification involves relating oneself to others, resulting in a perception of
increased similarity. The process of clients identifying with their therapist emerges as a
primary ingredient in all theoretical orientations; the client can relinquish old values or
behaviors and replace them with new values based on their inherent identification with the
therapist. At the group level, client identification with both the therapist and other group
members fosters greater client improvement.

Factors Unique to the Group Process

Fuhriman and Burlingame proposed four recognized sources of learning unique to group treat-
ment: “(1) participating in a developing social microcosm, (2) giving and receiving feedback in
the group, (3) consensually validating, and (4) reciprocal functioning of members in the group”
(1990, p. 47).

Vicarious learning. Learning by observing others (or the process), often termed “spectator
therapy,” has a unique and potent therapeutic aspect for the group process. Vicarious
learning that occurs when members observe the therapist perform a difficult social interac-
tion is often helpful in groups of shorter duration.
Role flexibility. The group process provides members greater role flexibility because they can
reciprocally function as helper and help seeker. Fuhriman and Burlingame conceptualized
three consequences of role flexibility in group treatment:

(1) enhancement of a member’s self-esteem from responsible contributions to the thera-

peutic process, (2) dilution of the therapist power base so the client does not stay in a
“one down” position with the therapist, and (3) attribution of change to self, resulting in a
healthier organization of treatment effects. (1990, p. 49)
 14  Client–Therapist Relationships
Universality. Universality is based on the notion that others are struggling with similar issues,
that “we all are in the same boat,” and that one’s experiences are not unique. Universality
is the most highly valued therapeutic factor in self-help groups.
Altruism. Altruism consists of unselfishly offering support, reassurance, suggestions, and
insights to group members. Caring for others also empowers clients to relinquish their
own self-absorption in exchange for the curative factors of helping others. Altruism also
has more therapeutic attributions in self-help groups.
Family reenactment. The group experience provides a microcosm of interpersonal interac-
tion that resembles one’s family. The group fosters an environment where a member
can correctively relive and rework early familial conflicts. Yalom (1985) outlined several
aspects of the group experience that resemble one’s family of origin: male–female cothera-
pists (parental authority figures), member–member rivalry for therapist attention (sibling
rivalry), and individual client–therapist interactions (early parental interaction patterns).
Downloaded by [New York University] at 04:58 12 August 2016

Kerr and Bowen (1988) maintained that the family is always being dealt with even when
just one person is present.
Interpersonal learning. Interpersonal learning involves clients’ increasing their ability to
socialize with others, and to behaviorally and attitudinally adapt to interaction within the
group. “Individuals who stay in a group longer may have more time to experience oppor-
tunities for social skill acquisition, which group therapy is uniquely capable of providing”
(Fuhriman & Burlingame, 1990, p. 51).

Yalom (1985) and Hansen, Warner, and Smith (1980), as well as others, also have stressed
the “curative” and “therapeutic” factors responsible for producing change in productive groups:

Development of social skills. The development and rehearsal of basic social skills are therapeutic
factors that are universal to all counseling groups.
Imitative behavior. Group members learn new behaviors by observing the behavior of the
leader and other members.
Group cohesiveness. Group membership offers participants an arena to receive unconditional
positive regard, acceptance, and belonging that enables members to fully accept themselves
and be congruent in their relationships with others.
Catharsis. Learning how to express emotion reduces the use of debilitating defense
mechanisms.
Existential factors. As group members face the fundamental issues of their life, they learn that
they are ultimately responsible for the way they live, no matter how much support they
receive from others.

When trying to compare individual and group techniques, it is important to remember that
other variables influence both modalities. These variables include the differences among ther-
apists, clients, techniques, and interventions. From the perspective of accountability, it may
become necessary to control for theoretical approach, counseling intervention, coping skills on
the part of the client, and therapist style before the individual and group process can be validated.
Nonetheless, a compendium of strategies, techniques, and divergent approaches are a beginning.

The Effectiveness of Psychotherapy

Seligman (1995) maintained that clients benefited substantially from psychotherapy, that
long-term treatment did considerably better than short-term treatment, and that psychotherapy
was even more effective with appropriate medication. Furthermore, no specific modality of psy-
chotherapy did better than any other for any disorder. In addition, Seligman revealed that an
 Client–Therapist Relationships  15
“effectiveness” study of how patients fare under the actual conditions of treatment in the field
can yield useful and credible “empirical validation” of psychotherapy and medication. There
were a number of clear-cut results, among them:

• Treatment by a mental health professional usually worked. Most respondents got better.
• Averaged over all mental health professionals, of the 426 people who were feeling very
poor when they began therapy, 87% were feeling very good, good, or at least so-so by the
time of the survey. Of the 786 people who were feeling fairly poor at the outset, 92%
were feeling very good, good, or at least so-so by the time of the survey. These findings
converge with a meta-analysis of efficacy (Lipsey & Wilson, 1993; Shapiro & Shapiro,
1982).
• Long-term therapy produced more improvement than short-term therapy. This was true
for patients both in psychotherapy alone and in psychotherapy plus medication. There was
Downloaded by [New York University] at 04:58 12 August 2016

no difference between psychotherapy alone and psychotherapy plus medication for any
disorder.
• Although all mental health professionals appeared to help their patients, psychologists, psy-
chiatrists, and social workers did equally well and better than marriage counselors.
• Family doctors did just as well as mental health professionals in the short term, but worse in
the long term. Some patients saw both family doctors and mental health professionals, and
those who saw both had more severe problems.
• Long-term treatment by a mental health professional was advantageous not only for the spe-
cific problems that led to treatment, but also for the ability to relate to others, coping with
everyday stress, enjoying life more, personal growth and understanding, and self-esteem and
confidence.
• Alcoholics Anonymous (AA) did especially well, and significantly better than mental health
professionals. People who went to non-AA groups had less severe problems and did not do
as well as those who went to AA.
• Active clients did better in treatment than passive recipients.
• No specific modality of psychotherapy did any better than any other for any problem. These
results confirm that all forms of psychotherapies do about equally well.

These findings are significant because the research provided empirical validation of the effec-
tiveness of psychotherapy. It revealed the efficacy of self-help groups such as AA, the determina-
tion of clients actively seeking therapy, and the importance of long-term therapy.

Conclusion
The techniques presented in this book focus on improving relationships—relationships with our-
selves, with our peers, with our families, and with our environment. Inevitably, clients engage in a
relationship with a therapist because of current conflict or unfinished business with relationships
in the past or the present. For example, we know that numerous dysfunctions or self-defeating
ways of relating typically are learned in childhood:

• How to remain superficial.

• How to build façades.
• How to play interpersonal games.
• How to hide from ourselves and others.
• How to downplay risk in human relating.
• How to manipulate others (or endure being manipulated).
• How to hurt and punish others, if necessary (Egan, 1990).
 16  Client–Therapist Relationships
An important point to realize is that every behavior is a communication, and often behav-
ior that is self-defeating or dysfunctional carries with it an underpinning of poor interpersonal
relationships. This is acutely apparent when we examine the void in relationships among our
young people and the adults who are responsible for them. The growing concern over adoles-
cent suicide rates, alcohol and other drug abuse (such as prescription drugs), alienation, depres-
sion, self-injury, family dysfunction (i.e., separation, divorce, custody issues), unintended teen
pregnancy, gangs, violence, increasing diversity, and dropout rates and the tremendous impact of
social media among our youth demonstrates the critical need for responsible adults to establish
close, caring relationships with our young people. Youth drop out of school because of poor rela-
tionships with teachers and authority. Youth begin drinking when they start driving and dating
because of the uncertainty and anxiety about interpersonal relationships with the opposite sex.
Youth have unintended pregnancies because of their need to have a relationship with someone
who will depend on them. Youth join gangs because of their need to belong and to have power
Downloaded by [New York University] at 04:58 12 August 2016

and authority. Youth attempt suicide because of difficulties in relating to others, feeling alone,
and feeling depressed about either their relationships or lack of them. True, we are a technologi-
cally advanced society, but we are all walking around with broken hearts. This malady of poor
relationships is pervasive and cuts through all ethnic, racial, and social strata. It is relentless, and
it is devastating.
This book seeks to provide helping professionals with critical skills to assist their clients’ inter-
personal functioning. Each technique is followed by the counseling intention and a description.
The techniques in this book are not all inclusive, but they do represent a beginning.
 3 Eclectic Techniques for Group
Therapy

Many theorists such as Andrews (1989), Corsini (1989), Garfield and Bergin (1986), Kelly
Downloaded by [New York University] at 04:58 12 August 2016

(1988), and Norcross (1986) collectively asserted that the rise of eclectic counseling and the
development of metatheoretical eclectic models are viewed as a pragmatic response to the wide
range of client differences. Any single theory and associated counseling techniques are unlikely to
be universally effective with increasingly diverse client populations that reflect an equally diverse
array of support systems.
Group counseling is an interpersonal process where members explore themselves in relation-
ship to others in an attempt to modify their attitudes and behavior. Reality testing within the
group gives the individual a unique behavior-modifying experience. Carroll and Wiggins (1990)
identified general goals for helping members in the group:

• Become a better listener.

• Develop sensitivity and acceptance of others.
• Increase self-awareness and develop a sense of identity.
• Feel a sense of belonging and overcome feelings of isolation.
• Learn to trust others as well as self.
• Recognize and state areas of belief and values without fear of repression.
• Transfer what is learned in the group to the outside by accepting responsibility for solving
one’s own problems (p. 25).

In broad terms, four types of groups can be identified: (1) support groups, including self-help
groups of all kinds, which offer relief as opposed to change; (2) psychoeducational or skill-building
groups aimed to induce change in social, emotional, and cognitive skills; (3) interpersonal groups
that attempt to change long-standing interpersonal or intrapersonal patterns and concerns; and
(4) psychotherapy groups that focus on deeper disturbances in intrapsychic and/or interpersonal
functioning.
According to Pollack and Sian (1995), a number of questions should be asked of group
participants:

1. What kind of help do they need and want? Are they favorably disposed toward a group
intervention?
2. Can they talk in the presence of others? Can they reveal themselves? Do they wish to?
3. Are they willing to help others by offering feedback as well as by receiving it?
4. Will they attend reliably?
5. Do they understand and accept limitations on social contact with other group members?
6. Are they willing to take risks?
7. Can they share the spotlight?
 18  Eclectic Techniques for Group Therapy
8. Can they tolerate the anxiety and tension that group work often elicits?
9. Do they accept the curative factors and goals of group therapy? (p. 508–509)

Scheidlinger (1997) revealed that within the group, the therapeutic process, experiential fac-
tors (i.e., corrective emotional experience), and meaningful attributions (i.e., insight) work hand
in hand:

(1) structuring the group’s composition, time, meeting place, and remuneration proce-
dures; (2) structuring the conduct of the sessions with reference to confidentiality, agenda,
physical contact, therapeutic techniques (i.e., Gestalt exercises, role-play, rational-emotive
techniques); empathically accepting and caring for each client, embedded with a belief in
the client’s potential for change and growth; (4) encouraging the open expression of feel-
ings and concerns; (5) fostering a climate of tolerance and acceptance of variance in feelings
Downloaded by [New York University] at 04:58 12 August 2016

and behaviors and on peer helping, coupled with a stress on self and interpersonal scrutiny
and awareness in which all members are encouraged to participate; (6) controlling within
acceptable limits the drive, expression, tension, and anxiety levels in individual patients;
(7) controlling group-level manifestations (i.e., scapegoating, inappropriate contagion) in
the interest of both individual clients and group morale; and (8) using verbal interventions
ranging from simple observations through confrontation to interpretations, aimed at reality
testing and at eliciting meaning and connections. (Scheidlinger, 1997, pp. 151–152)

Dies (1994) stresses “contracting” with group members to stem “fears of attack, embarrass-
ment, emotion contagion and harmful effects” (p. 64). Some specifics of the contract include
issues of confidentiality, extragroup interaction, and boundary issues. Early discussion of these
expectations serves as an antidote to apprehension and increases client optimism for clinical
improvement (Dies & Dies, 1993). Group members can establish control over their negative
concerns about group treatment and increase the feeling of group cohesion and commonality
(Dies, 1994). However, the group leader should be cautioned that because of the dynamics of
human nature, he or she will encounter personalities in the group that may impede progress or
divert the group from reaching their goals. This includes:

• The mandated client (i.e., court ordered) who may be negative to the group experience and
who also may be resistant.
• The chronic talker, who feels a need to try to dominate the group.
• The distracter, that is, the member who wants to take the group off target because issues
may be too sensitive.
• The rescuer, that is, the member who wants to align with another member or find a quick
solution for another member’s issues.
• The client who wants to confront the leader and challenges interventions and exercises, and
may be critical of the group outside of sessions.
• Dealing with silence and having the patience to wait it out as a therapist.
• Dealing with strong emotions and a client crying in the group (one caveat: handing a client
a tissue sends a message that you want the client to stop crying, so allow clients to reach for
the tissue themselves).
• Handling mutually hostile members, especially with marriage and family groups.
• Dealing with diversity, prejudice, and insensitive group members.

It is critical to have ground rules at the very beginning of the group and to enlist other ground
rules from group members to validate their concerns and to ensure ownership in the group
process.
 Eclectic Techniques for Group Therapy  19
This chapter is a compilation of group counseling techniques that facilitate group process,
encourage self-awareness, and foster greater communication among group members. Fuhriman
and Burlingame (1990) found that directive interventions appeared to have more empirical evi-
dence of efficacious effect on the process and outcome of treatment. Learning by observing
others has a unique and potent therapeutic aspect for the group process and often is termed
spectator therapy.

Perspective for the Therapist: Creating Trust

Trust must be developed during the early stage of the group. One of the best ways of building trust is to
create a group climate characterized by respect for the opinions and feelings of the members. It is essential
that members openly express their feelings concerning the degree of trust they experience in their group.
Marianne Schneider Corey and Gerald Corey,
Groups Process and Practice, third edition, 1987, p. 123
Downloaded by [New York University] at 04:58 12 August 2016

Technique: Risk Taking and Trust Building

Counseling Intention Trust building.
Description For any group to be successful, there must exist a sufficient sense of
comfort among the individuals for them to speak freely without fear
of attack, to express opinions and values that they cherish without fear
of being ridiculed. One of the ways to overcome the fear of speaking
out is to provide activities whose primary purpose is to build cohe-
siveness within the group. Following the risk-taking/trust-building
activity, it is essential to process the experience and to draw from the
participants their feelings and thoughts about the activity.

Trust Fall: Partners stand, one with his back turned, his arms extended sideways; he falls back-
ward and is caught by his partner. Reverse roles and repeat.
Trust Walk: One partner closes her eyes and is led blind through, around, and over things.
Reverse roles and repeat (Canfield & Wells, 1976).
Trust Run: Outside, one partner closes his eyes and is led by the other in a vigorous run.
Reverse roles and repeat.
Tug-of-War: Partners imagine a line between them on the floor and have a tug-of-war with an
imaginary rope. One partner is to be pulled across the line.
Mirroring: Partners stand facing each other. One becomes the mirror image of the other’s
bodily movements. With hands in front, palms toward partner, they move expressively.
Then reverse roles and repeat.
Circle Pass: Group participants stand in a tight circle. A volunteer or participant who wants to
develop additional trust in the group is rolled around inside the circle.
Machine: One at a time, each participant stands up and imitates a part of a machine, using his
body for active parts and his voice for machine-like sounds. After one person is up, the next
goes up, and so on. The facilitator can ask the machine to quicken or slow down.
Eye-Contact Chain: Participants form two lines, facing each other about a yard apart. They
hold hands, and the persons at the two ends hold hands. This forms a chain similar to a
bicycle chain. Without talking, everyone looks in the opposite person’s eyes. The group
takes one step to the right, then each looks the next person in the eyes. The group takes
steps to the right until everyone has returned to the original position.
Personal Interview: Dyad members interview each other. A rule of thumb should be that any
question one person asks, he or she should be willing to answer. Each person has the right
to decline to answer any question with which he or she feels uncomfortable.
 20  Eclectic Techniques for Group Therapy

Technique: Opening Activities for Beginning Groups

Counseling Intention To break the ice; to help participants get to know one another.
Description  The following activities provide a low-risk, structured activity to
engage members in the process of getting to know one another.

Paired Introductions: Members pair in groups of two. Partners get to know each other and in
turn introduce their partners to the group. Variations:
1. Partners get to know each other and instead of introducing each other to the group, they
join another pair of two and introduce their partners (this is sometimes less threatening).
2. The leader can limit the topics that individuals use to introduce themselves, such as,
“Tell your partner about yourself without mentioning anything about family, job, or
school.” This cuts straight to what the client values because it is easy to hide through
topics surrounding family, work, or school issues.
Downloaded by [New York University] at 04:58 12 August 2016

One-Minute Autobiography: Members group in quartets. Using a timekeeper, each person is

given one minute to tell about himself. Again, dialogues can be restricted (e.g., nothing
about job, school, family, place of birth, or hobbies). Limits such as these move members
into sharing their values, goals, attitudes, and beliefs rather than staying in the comfort of
talking about jobs, family, and school.
Deeper Reaches: In groups of four, members are given 5 minutes each to share deeper reaches
of themselves: In the first 3 minutes, tell others in your group what has brought you to
this point in your life; 1 minute is used to describe your happiest moment; the last minute
is used to answer questions from others. The leader may model disclosure for the group to
increase their comfort level.
Long and Winding Road: Each person draws on a sheet of paper a picture of his or her
life using stick figures and symbols (newsprint and colored markers can also be used).
The road can be divided into developmental stages (childhood, adolescence, adulthood)
depicting critical stepping stones in his or her life that brought him or her to where he or
she is today.
Name Circle: Members sit in a large circle. The leader begins by stating the name of the per-
son seated on his right, followed by her own name. The person to the leader’s right repeats
the leader’s name, his own name, and adds the name of the person seated to his right. The
process is repeated around the entire circle.
Known/Not Known: Sheets of paper or poster board are placed on the walls with headings
of “Things I Know” and “Things I Want to Know” (about the content or purpose of the
group). Nonverbally, members circulate around the room and write their concerns on the
paper. Concerns are processed.

Technique: Group Consensus on Where to Begin

Counseling Intention To provide a structure for the group as to where to begin (Dyer &
Verend, 1977).
Description  As leader, define self-defeating behavior. Group members anony-
mously write on an index card a self-defeating behavior they would
like to change. The leader collects completed cards and redistributes
them, instructing members to take any card but their own. Members
read their new card aloud and the group assigns a rating to the prob-
lem from 1 to 10 (1 = low/10 = high). The leader tallies and ranks
the problems for the group. The highest collectively rated problem
is identified. The individual who wrote it is identified, and the group
counseling begins with the focus on that person’s concerns.
 Eclectic Techniques for Group Therapy  21

Technique: Affirmations of Trust

Counseling Intention To build physical, intellectual, and emotional trust.
Description Each member is instructed to distribute as many statements from the
“Trust Is” poem that best describe his or her trust in another member
in the group and to write the other person’s name, the number of
applicable statements, and his or her own signature on a slip of paper
and give it to the member. Each member is instructed to do this for
every other member of the group. Members can discuss their reactions
to this experience and focus on its goals.

Perspective for the Therapist: On Trust . . .

Trust Is
Downloaded by [New York University] at 04:58 12 August 2016

Trust is keeping your word.

Trust is the willingness to communicate.
Trust is being there.
Trust is consistency.
Trust is saying, “I understand.”
“I believe you.”
Trust is not needing to explain.
Trust is a responsibility,
Trust is a compliment.
Trust is being open.
Trust is willingness to be vulnerable.
Trust is a reciprocal thing,
Trust is knowing one another,
Trust is not taking advantage.
Trust is different things to different people.
Trust is, above all, risky.
—Anonymous

Technique: Controlling and Influencing Communication

Counseling Intention To facilitate communication and confront issues of control, domi-
nance, or resistance.
Description Using a ball or other inanimate object, instruct group members that
only the person in possession of the ball is permitted to speak. A mem-
ber who wishes to say something must gesture nonverbally to the indi-
vidual in possession of the ball to receive it. This exercise may be used
either as an icebreaker or with focus topics such as reaction to the group
experience, dealing with ambiguity, or dealing with life stressors. Focus
topics are limited. Members who control, influence, dominate, or with-
draw from communication in the group also could be processed.

Technique: One-on-One Risk Taking on a Scale of 1 to 10

Counseling Intention To encourage group self-disclosure.
Description Self-disclosure is a form of risk behavior that proceeds to different
levels. Groups or individuals can explore their own risk boundaries
 22  Eclectic Techniques for Group Therapy
by listing or exchanging disclosure statements on a scale of 1 to 10.
Either an individual lists or partners exchange a statement that repre-
sents an attempt to disclose feelings, emotions, attitudes, and experi-
ences that represent a level of risk. Rank the levels of each statement
on a scale from 1 to 10 (10 = high risk, 1 = no risk).

Technique: Breathing and Vocalizing; Yawning and Sighing

Counseling Intention To get in touch with deep breathing.
Description The group can sit or stand for this exercise. Ask them to do a huge,
silent yawn, then to yawn and allow a modest sound to come out, and
finally to yawn very noisily. Next, show the group how to breathe in
through the nose and give a sigh, then breathe in and sigh longer, and
finally to exaggerate this by making a loud noise.
Downloaded by [New York University] at 04:58 12 August 2016

Technique: Deep Breaths

Counseling Intention To get in touch with deep breathing.
Description Ask the group to stand for this activity. Demonstrate how to breathe
in through the nose to a count of three, hold the breath for three, and
breathe out to a count of three. Explain that when breathing naturally,
we pause between inhalation and exhalation.

Technique: Enclosed Feelings

Counseling Intention To express latent feelings.
Description 

1. Have each group member take a turn at being encircled by a group of five or six people.
2. Instruct the circle to link arms. The person in the middle is to be “a feeling in need
of expression,” and the circle is representative of those inhibitions that prohibit its full
expression.
3. Have each group member define how the roles can best be played to represent his or her
own unique struggle.
4. Process the experience.

Technique: Energy Warm-up

Counseling Intention To increase group cohesiveness.
Description Instruct the group that they have 1 minute in which to touch four
corners of the room, the floor, and six pairs of knees. Indicate when
50 seconds have elapsed and when the time is up. Invite the group
to retrace their steps exactly. Can they remember whose knees they
touched and in what order?

Technique: Fantasy Trips
Counseling Intention To confront unfinished business.
Description Have members imagine they approach a door, open the door, descend
down a flight of stairs, and encounter another door. When they open
it, they see a scene or mirror with a face (other than their own) or see a
 Eclectic Techniques for Group Therapy  23
person standing there. They must say something to the person or situ-
ation that they have wanted to say for a long time. The person answers.
They have a dialogue and the members retrace their steps. Share and
process the experience.

Technique: Feedback with Role Reversal

Counseling Intention To enhance perceptions of others.
Description Ask group members to form groups of two. Ask them to become
aware of those parts within themselves that might interfere with expe-
riencing their partner. Ask them:

1. To share those issues that might hinder them from making a connection
Downloaded by [New York University] at 04:58 12 August 2016

2. To give their partners feedback in the here-and-now with regard to the way they are perceiv-
ing and feeling that person
3. To reverse roles with each other and continue giving feedback (reverse back)
4. To reverse roles and support or correct any perceptions
5. To share and process the experience

Technique: Feelings
Counseling Intention To gain a greater understanding of self.
Description Ask group members to consider privately:

1. What brings you most joy?

2. What brings greatest pain?
3. What do you find yourself feeling most of the time?
4. Have them share the answers with the group.

Technique: Group Body
Counseling Intention To reveal perceived roles of group members.
Description

1. Ask the group members to identify a part of the body that best represents what function they
individually provide for the group.
2. Ask the members to take the role of the body part, identify themselves to others, and physi-
cally position themselves in relationship to others (e.g., the head is at the head; the heart,
lungs center appropriately; etc.). Let the roles interact with one another.
3. Share and process the experience.

Technique: Group Dance
Counseling Intention To enhance communication nonverbally.
Description

1. Instruct group members to move to music, then periodically stop the music and ask mem-
bers to freeze in their positions.
2. Ask them to make a statement congruent with their body message.
3. Share and process in the group.
 24  Eclectic Techniques for Group Therapy

Technique: Group Feedback

Counseling Intention To gain knowledge of impediments to realizing one’s full potential.
Description Have the group divide into small groups of five to eight. Have each
member receive feedback from all small-group members on:

1. What is seen as his or her strongest attribute?

2. What gets in his or her way of maximizing that attribute to its fullest potential?

After hearing from each member, allow each individual to respond before moving to the next
group member. Share and process the experience.

Technique: Group Sculpture

Downloaded by [New York University] at 04:58 12 August 2016

Counseling Intention To examine close and distant relationships in a group.

Description

1. Ask group members to sculpt the group and individual members in terms of their feelings of
closeness and who feels distant from whom.
2. Instruct the sculptor to give each statue one line to say to the group/or other individual
group members.
3. Share and process the experience.

Technique: Growing Old
Counseling Intention To empathically connect with aging issues.
Description

1. Ask two people to pretend they are very old.

2. Insert cotton wool balls in their ears, dim the lights, and ask them to converse with each
other.
3. Give them a topic, such as “What is going on in your life?”
4. Process issues of life, change, deterioration, relationships, and mortality.

Technique: Hand Examination

Counseling Intention To increase interpersonal exploration.
Description Instruct two people to nonverbally examine each other’s hands. Ask them
to decide which one will examine first and to allow them at least 3 min-
utes to touch and look at the partner’s hands before instructing the other
partner to be the examiner. Ask each to verbally share the experience and
relate specifically what they were able to discover about their partner.

Technique: Here-and-Now Feedback

Counseling Intention  To identify feelings of the moment.
Description

1. Instruct individuals in pairs to experience each other in the here and now.

2. Have them give each other feedback and relate the feelings that are evoked within while in
the other’s presence. If they find themselves talking of the past or future or about someone
else, ask them to simply stop talking until they can refocus on the here and now.
3. Share and process the experience.
 Eclectic Techniques for Group Therapy  25

Technique: Heroes and Heroines

Counseling Intention  To explore expectations and admirations.
Description

1. Ask individuals to consider who they admire, respect, or love from literature or history.
2. Ask each person to do a self-presentation of the famous figure to the rest of the group.
3. After the self-presentation, instruct the client to choose a group member to role-play the figure.
4. Have a conversation with the historic or literary figure.
5. Share and process the experiences.

Technique: Holidays
Counseling Intention To gain an understanding of expectations for the holidays, both realis-
Downloaded by [New York University] at 04:58 12 August 2016

tic and idealistic.

Description Direct members to move around the room and recall a family holiday.
Have them pack a suitcase with all the things that were important to
them at that time. Have each group member reveal what he or she
has in the suitcase. What was the object of strength in their case, or
what would they have liked to be in that case that they did not have at
the time?

Technique: Last People on Earth

Counseling Intention To assess members’ resourcefulness and problem-solving skills.
Description Instruct the group that a holocaust has struck the Earth and they find
themselves to be the sole survivors.

1. Help them establish the time, place, and circumstances.

2. Ask them to enact how they would behave and what they would do.
3. When the drama has reached a natural conclusion, have the members share.

Technique: Living Newspaper

Counseling Intention To enhance verbal and nonverbal communication skills.
Description

1. Divide the group into small groups of four or five people.

2. Give each group a newspaper, asking them to select one article they will enact for the rest of
the group.
a. Set the scene of the event.
b. Introduce the characters via a self-presentation.
c. Provide a warm-up to the circumstances.
d. Establish the time.
e. Tell the story through action.
3. Share and process the experience.

Technique: Nature Walk
Counseling Intention To express feelings via symbols.
Description Ask group members to take a nature walk and bring something back
that best represents how they are feeling about themselves. Share and
process the experience.
 26  Eclectic Techniques for Group Therapy

Technique: Obituary
Counseling Intention 
To reflect on self, values, accomplishments, and regrets (Simon,
Howe, & Kirschenbaum, 1972).
Description Ask members of the group to separate themselves from one another and
find a comfortable place to write. Instruct them to write their own obit-
uaries, indicating the cause, date, time, and place of death. List any sur-
viving family members, life accomplishments of the deceased, and other
relevant data. Allow time for contemplation, writing, and rewriting.

Choose one of the following methods of sharing:

1. Post the obituary on a wall or bulletin board for other members to read.
2. Have each member read his or her obituary to the group.
Downloaded by [New York University] at 04:58 12 August 2016

3. Share the experience of the role of a survivor.

4. Enact the funeral and ask the auxiliary ego, in the role of minister, priest, rabbi, or friend, to
read the obituary.
5. Share and process the experience thoroughly.

Technique: Object Presentation

Counseling Intention To understand self in relation to physical objects.
Description Ask group members to become an object that best represents how they
feel about themselves. Let the objects interact as a group or in dyads.

1. Choose:
• An object they admire.
• An object they detest.
• An object they find useful.
• An object they find useless.
2. Process the experience.

Technique: Picture Frame
Counseling Intention To project feelings and emotions.
Description Bring into the group an empty picture frame (or an imaginary one will
do) and ask each group member to imagine a scene or picture for the
frame. Instruct the group to create a scene that best fits the situation,
such as a family picture, members of the family, a counseling session, or
a scene from their lives. After a few moments of silence, allow the mem-
bers to verbally share their picture in the group. Share and process.

Variation: Have the group enact their pictures by setting the scene and using group members
to represent the various parts, or choose only one to enact.

Technique: Self-Poems
Counseling Intention To reveal more about self.
Description Ask people to experience themselves and write a poem that best describes
how they “are.” Ask members to read their poems either to one other
person or to the entire group as an introduction. Share and process.
 Eclectic Techniques for Group Therapy  27

Technique: Role Party
Counseling Intention To assess the roles members select for themselves.
Description Instruct the group to assume roles and interact with one another as
if they were attending a party together. Establish the time, place, and
circumstance. Do one, some, or all of the following:

• Be your hero or heroine.

• Be part of your body.
• Be a Hollywood celebrity.
• Be a character from literature.
• Be a figure from history.
• Be yourself and bring something you have created (e.g., picture, object, or song).
• Share and process the experience.
Downloaded by [New York University] at 04:58 12 August 2016

Technique: Significant Other Presentation

Counseling Intention To project roles or scripts of family members.
Description Ask each person in a dyad to do a self-presentation of someone who
knows him or her fairly well. Allow time for them to warm up physi-
cally, emotionally, spiritually, and intellectually to their respective roles.

Ask them to talk about themselves through the eyes of this role. For example: Mark chooses
to assume the role of his boss, and as his boss, talks about their employer–employee relationship.
Share and process the experience.

Variation:
1. Ask them to assume the role of someone who dislikes them.
2. Ask them to assume the role of their favorite teacher, student, supervisor, parent, child, a
friend, or a sibling.

Technique: Talk to Yourself

Counseling Intention To reveal portions of one’s self to the group.
Description Instruct the group members to imagine they are sitting in a chair, and
one at a time, address the chair as if they were having a heart-to-heart
talk with themselves. Ask them to talk to themselves at different ages
(e.g., 2 years, 10 years, 18 years, 40 years, and 80 years old). Share and
process the experience.

Technique: The Funeral

Counseling Intention To confront one’s own mortality and life span.
Description Ask the group members to separate themselves from others in the
group and to contemplate their own deaths. Have them visualize the
date, time, place, and cause of death. Ask them to picture their funerals.

1. Who is there?
2. What they are saying and feeling?
3. Does the deceased leave behind any unfinished business?
4. Share and process the experience thoroughly.
 28  Eclectic Techniques for Group Therapy

Technique: Three Questions

Counseling Intention To conduct a personal evaluation of oneself.
Description Instruct the group to find a comfortable place for themselves, either
lying on the floor or couch or sitting in a chair. Ask them to answer for
themselves the following three questions:

1. Who am I? (That is, what makes them uniquely different from others and what they have in
common with others?)
2. Where do I fit? (That is, what are the collectives of people with which they have an affiliation,
and who are the people who feel special and vital?)
3. How well am I functioning? (Consider the various roles enacted through the day, week, and
month and have them conduct a personal evaluation on them.)
4. Share and process the experience.
Downloaded by [New York University] at 04:58 12 August 2016

Technique: Unfinished Business

Counseling Intention To have an opportunity to say things that were not said.
Description Have group members consider someone with whom they have unfin-
ished business—someone they wish would have said or done some-
thing with. This can be:

1. Someone close to you

2. Someone with whom you work
3. Someone with whom a communication problem exists for them or you
4. Someone who died
5. Have them pretend the person is in an empty chair and talk to the person about the unfin-
ished business.
6. Process the experience.

Technique: Sculpting Repressed Feelings

Counseling Intention To help a member express difficult feelings.
Description If someone in a group is experiencing difficulty expressing personal
feelings to another member to the point that it is interfering with
his or her personal growth, nonverbal sculpting of repressed feelings
may be helpful. The individual who is having difficulty expressing
feelings moves with the other participant to the center of the group
circle. The recipient is to assume the role of a lump of clay. The
individual who is having difficulty expressing feelings becomes the
sculptor. The sculptor molds the statue of clay to reflect the way
in which the sculptor is experiencing the individual and his or her
behavior. Feedback should include facial expression, gestures, and
posture.

After the sculpting, the statue holds the position. Next, the group leader instructs the sculptor
to sculpt himself in relation to his feelings toward the other member and hold the position. Pro-
cess both members’ positions, feelings, and relation to one another. Encourage group members
to share their insights.
 Eclectic Techniques for Group Therapy  29

Technique: Positive Perceptions

Counseling Intention  To focus the group on sending positive messages.
Description Each group member is to write a positive personal message to each
other member of the group. The messages are intended to make the
person feel positive about herself. Positive messages could reflect a
positive attitude, appearance, success, or special message. Members
can sign their positive perception or have the option of leaving it
blank. Variations could include sending messages only to individuals
for whom they have significant positive feelings. Another alternative
could be providing two messages to the individual, one positive per-
ception and one self-defeating perception.

Technique: Best Friend

Downloaded by [New York University] at 04:58 12 August 2016

Counseling Intention To project and introduce oneself in a less threatening manner.

Description Individual or group members are asked to identify someone who knows
them better than anyone else. He or she can be a mother, father, sister,
brother, wife, or husband. He or she will be called the “best friend.”
Have them write out what their best friend would say about them:
“He is a person who likes _____.” “One thing that he or she dislikes is
_____.” “If he or she could do one thing in life, it would be _____.”

Place a chair in the middle of the room or group. Each member stands behind the empty chair
and introduces himself or herself as he or she would expect his or her “best friend” would do it.
Process what was learned by everyone from this projected experience.

Technique: Choose an Object

Counseling Intention To project a perception of self (Canfield & Wells, 1976).
Description A collection of objects of varying size, weight, composition, color, and
sensation is placed in a container so that others cannot see the objects.
Members are to move to the container and select one item that they
can identify with. Each member must identify with a single object.
Members explore their respective object and their identification with
it. Others give feedback to each other as to whether the projected
identifications matched or did not match their perceptions of each
other.

Technique: Introspection for Individual Assessment and Feedback from Others

Counseling Intention To compare perceptions of self and those held by others.
Description Each individual completes the Introspection Continuum (Table 3.1)
according to the instructions. He or she writes his or her name on a
second sheet and gives it to his or her partner to complete in terms
of how that person sees him or her. Each member then compares his
or her personal introspective continuum with the one completed by
another member and discusses his or her reactions to the similarities
and differences. Processing the experience could focus on why descrip-
tions are different or similar from other people’s descriptions in terms
of congruency.
 30  Eclectic Techniques for Group Therapy
Table 3.1  Introspection Continuum Scale
The following words were selected to enable you to record your per-
ceptions of yourself. Place an “X” on one of the spaces between each
pair of words. The distance from the “X” to a word indicates the
degree to which it represents your view of yourself.
I AM
Impulsive Cautious
Relaxed Tense
Interesting Boring
Self-confident Self-conscious
Secure Insecure
Happy Sad
Productive Lazy
Flexible Rigid
Downloaded by [New York University] at 04:58 12 August 2016

Competent Incompetent
Compassionate Cold
Attentive Preoccupied
Friendly Aloof
Agreeable Disagreeable
Mature Immature
Modest Flamboyant
Pleasant Abrasive

Technique: Life-o-gram
Counseling Intention 
To bring the then-and-there into the here-and-now; to identify
transgenerational issues and behavior patterns.
Description  Write a one-page autobiography that focuses on the things most
important to your life up to the present. Reread it and then write a
description of how the places, people, events, or crises shaped who you
are today—your values, your beliefs, and your goals.

Technique: Lifeline
Counseling Intention To bring the then-and-there into the here-and-now; to identify behav-
ior patterns and significant role models (Howe & Howe, 1975).
Description Draw a horizontal line on paper. On the far left, place an “X” and
indicate date of birth; on the far right, place an “X” for today’s date.
Divide the line into three parts: childhood, adolescence, and adult-
hood. Write in significant people and meaningful events along the life-
line. What significant events brought fond memories? Process what
significant events brought painful memories. What messages were
heard? What values were imparted and assimilated by the significant
people and meaningful events?

Technique: Twenty Questions for the Chair Inside the Circle

Counseling Intention To encourage self-disclosure; to provide an opportunity to focus on
deeper levels of understanding (Vriend, 1985).
 Eclectic Techniques for Group Therapy  31
Description A chair is placed in the middle of the group circle. Any group member
may be invited to occupy the chair and assume the risk of answering
any question that group members ask. Questions can reflect various
levels of self-disclosure, such as family or interpersonal relationships,
fears, expectations, unfulfilled dreams, or feelings toward other mem-
bers or the group leader. Both questions that are answered or declined
reveal the risk-taking capacity of the group member.

Vriend (1985) found that taking a risk in the controlled context of the group fosters more
consequential risk taking in the client’s real world; appropriate risk-taking goals can be targeted
in the interval between group sessions. The chair in the middle also can be used in the introduc-
tory stage of the group.
Members can be asked to introduce themselves without reference to the roles they enact in
Downloaded by [New York University] at 04:58 12 August 2016

their lives by answering the question “What kind of person am I?” while seated in the chair in
the middle. Two chairs in the middle can be used for members who are in conflict or to process
a psychodrama. All group members can turn outward to the circle (backs toward the center) in
order to be less distracted when the leader wants to introduce a guided imagery for the group.

Technique: Superlatives
Counseling Intention To bring closure to the group in a positive way.
Description To provide a structured opportunity for group closure, group mem-
bers are asked to list the names of all participants, including them-
selves, and indicate what positive behavior each member is likely to
accomplish as the result of the group experience by responding to the
superlative “Most likely to ____.” For example, “John is most likely
to stop procrastinating.” “Susan is most likely to charge less on her
credit cards.” “Tammy is most likely to finish graduate school.” Posi-
tive affirmations and collective feedback provide a tremendous oppor-
tunity for group closure.

Technique: Strength Test
Counseling Intention To focus on individual strengths.
Description An index card for each group member is passed around the group. The
leader asks each member to write a positive strength for every group
member on his or her card. Incomplete sentences can also be used
as stimulus statements about likes, dislikes, family, friends, goals, or
wishes. Focus topics can help the counselor understand clients, identify
problem areas, and establish rapport. Some examples are as follows:

My greatest fear is _______________________.

The thing that creates the most difficulty for me is _______________________.
The thing I like to do most is _______________________.
The person in my family who helps me most is _______________________.
The nicest thing I ever did for anyone was _______________________.
The nicest thing anyone ever did for me was _______________________.
I used to be _______________________, but now I’m _______________________.
The thing I would like people to admire me for is _______________________.
Something I’ve never told anyone about before is _______________________.
The one thing I most want to accomplish is _______________________.
 32  Eclectic Techniques for Group Therapy

Technique: Actualizing Human Strengths

Counseling Intention To help actualize positive strengths of people in the group.
Description Each person writes his or her name on a piece of paper. One member’s
name is chosen at random. A volunteer is chosen to record the mem-
ber’s strengths. The member who was selected at random expresses to
the group all the strengths she sees in herself. She then asks the group
to express the barriers they see that she must overcome. Engage all
participants to process the experience.

Technique: Confronting Member Resistance with a Chair Outside the Circle

Counseling Intention To encourage a greater self-disclosure; to confront resistance (Vriend,
Downloaded by [New York University] at 04:58 12 August 2016

1985).
Description It is not unusual for a group member to engage the group in circu-
lar counseling by either rejecting facts or information or becoming
defensive, excluding any possibility for helpful intervention. Members
become frustrated with their attempts to mend a “broken record”
(Vriend, 1985). An intervention may resemble the following:

“Bill, I’d like to pause and ask you to look at yourself as a member of the group for a moment.
Would you mind some feedback from myself and other members? You seem to be going on and
on about your situation and have told us everything you would like us to know. You’ve also been
repeating yourself and objecting to whatever suggestions you receive from anyone.
“Perhaps it would be helpful now if we gave you a reprieve, another chance to hear us
and respond to our suggestions. I’m going to ask you to move your chair back out of the circle
and turn it around so that you face away from all of us. We’ll close you out of the circle for
a moment. Then what we’re going to do is go over what you have told us and figure out ways
to be of help to you. Don’t look around and don’t respond to anything anyone says. When
we’re finished, we’ll invite you back in. That’s when you can tell us if you heard anything you
think would work for you in this situation. You’ll then get a chance to react, OK?” (Vriend,
1985, p. 217)

When the client is situated outside of the circle, the counselor leads a review and evaluation of
what has transpired during the group process. All members are involved in talking about rather
than to the outside member and providing information about their perceptions, the member’s
needs, expectations, and self-defeating behaviors. The member is invited back into the circle and
responds to what he or she has heard.
This should resemble a gentle carefrontation (i.e., gently share cares and concerns with the
member without hostility) between group members. Process completely with all members.

Technique: Role Reversal

Counseling Intention To facilitate a change in attitude; to experience opposing beliefs; to
reevaluate the intentions of another; to become more understanding
of another’s position or belief.
Description The client is requested to play a role opposite to her own natural
behavior or to examine her attitudes and beliefs about a situation (e.g.,
“for gun control” vs. “against gun control”). The client may also play
the role of another person she knows or switch roles with another
 Eclectic Techniques for Group Therapy  33
person in a dyadic role-playing situation within a group setting. This
allows the client to experience rather than talk about a situation.

Members briefly state their position to each other about their beliefs. Members switch roles
with each other and present their positions as if they were the other person. When revers-
ing roles, members should be authentic and as accurate as possible in restating the other’s
position.

Technique: Journal Writing

Counseling Intention To record experiences, feelings, and thoughts.
Description  Journals may be used by the client to record innermost feelings,
thoughts, or other events. (Note: Children often respond well to a
homework assignment of keeping a diary, and it often provides a feel-
Downloaded by [New York University] at 04:58 12 August 2016

ing of closeness to the counselor between sessions.) The journal or log

provides the counselor and client with a record of feelings, thoughts,
and events to be explored. It is also helpful to have group members
write logs at the end of every session. Also, a 3" × 5" card entitled
“Group Reflections” provides a useful format to use after each group
session. The cards can be signed so that the leader can keep in touch
with each member. These logs should never be read aloud to the
group or referred to in the group by the leader.

Technique: The Three Most Important People in Your Life

Counseling Intention To focus on role models and transgenerational issues.
Description Have individual group members identify three important people in
their lives at ages 5, 10, and 20. Then have them project into the
future: “Who will be the most important people in your life?” This
technique helps the counselor gain valuable insights into the indi-
vidual’s world at various life stages, particularly in the dimension of
psychological dependency.

Technique: Double Dialogue Technique

Counseling Intention To provide feedback to other members over issues discussed.
Description After group counseling, a double dialogue technique can be used
among group members to provide feedback to other members over
issues discussed, or the counselor may have each member close the
group experience by writing to the counselor on index cards about
his or her group experience at that particular session. This allows the
counselor to keep in touch with each individual group member about
significant issues that may be affecting him or her (Powers & Hahn,
1977).

Technique: Writing a Letter Aloud

Counseling Intention To focus on unresolved issues or on unfinished business in relation-
ships (Vriend, 1985).
Description The leader asks a group member to write an oral letter within the group
setting. The recipient of the letter is an individual who is significant in
 34  Eclectic Techniques for Group Therapy
the group member’s life, someone to whom the group member is hav-
ing some difficulty relating, someone with whom the group member
has never resolved a conflict, or someone who is deceased. The letter
should contain whatever the group member would like to say that
has not been previously said, the reason for any existing bitterness,
and how the relationship should change. When the letter has been
completed, everyone in the group is requested to react and say what
thoughts and feelings the letter elicited.

This technique is most appropriate when an individual expresses a concern about a signifi-
cant other who is troublesome, agonizing, bitter, frustrating, and full of upsetting interactional
demands and unreasonable behavior. The technique is most appropriately invoked after a mem-
ber has emitted considerable data about the relationship’s difficulties and has expressed obvious
Downloaded by [New York University] at 04:58 12 August 2016

frustration about attitudes or abusive actions (Vriend, 1985).

Rewriting the letter in the group is very important to demonstrate what the group member
can say in a more positive and effective manner. The contrast in letters will actively demonstrate
differences in effective and self-defeating thinking patterns.

Technique: I Have a Secret

Counseling Intention To explore self-disclosure; to confront irrational assumptions.
Description This exercise can be a method to explore fears, guilt feelings, and cat-
astrophic expectations. Clients are asked to think of some personal
secret. They do not actually share the secret with others, but imagine
themselves revealing the secret. Clients are to explore what fears they
have about other people knowing their secret and how they imagine
others might respond.

Technique: Here-and-Now Face
Counseling Intention To disclose feelings and emotions (Kranzow, 1973).
Description The here-and-now face is an activity designed to help group members
disclose and discuss their feelings and emotions. Instruct members to
draw a face that represents the feelings they are experiencing at the
present time. Below the face have them write a verbal description
of those feelings and the reasons for them. The discussion should
include both “what” the feelings are and “why” they exist in the per-
son at the present time. For example, “I am feeling ______ because
______.” This exercise is a means of generating a discussion of the
importance of feelings in their lives and brings the group into per-
sonal contact.

Technique: Life-Picture Map
Counseling Intention To bring the then-and-there into the here-and-now.
Description Ask group members to draw an illustrated road map that represents
their past, present, and future. The map should pictorially depict expe-
riences the members have had, obstacles they have overcome, what
their present lives are like, what their goals are for the future, and what
 Eclectic Techniques for Group Therapy  35
barriers stand in the way of accomplishing those goals. Upon comple-
tion of the drawings, have members share their maps with the group,
explaining various illustrations. Process the experience.

Technique: Competitive Thumb Wrestling

Counseling Intention To confront aggressive and hostile behaviors among group members.
Description This exercise is useful when the leader perceives that two members may
be experiencing hidden aggression or hostility toward one another.
Those involved should select their preferred hand, interlace their fin-
gers, and hook their thumbs. One person then attempts to force the
thumb of the other person down for a count of three. The leader then
assists in processing the feelings of hostility between members.
Downloaded by [New York University] at 04:58 12 August 2016

Technique: Strength Bombardment

Counseling Intention To explore perceptions held by self versus those held by others (Can-
field & Wells, 1976).
Description One group member volunteers to tell his or her personal strengths;
the group responds by telling the strengths they see in him or her. The
member continues and asks, “What do you see that is preventing me
from using my strengths?” The group responds again. Finally, group
members construct a group fantasy in which they imagine what the
focus member can be doing in 5 or more years if he or she uses those
strengths to their full potential. The focus member reflects on this
experience in the group.

Technique: I Am Becoming a Person Who ____

Counseling Intention To assess personal growth in the group.
Description Group members are given paper and pencils and are instructed to
write their first names in large block letters on the top of the sheets.
Then they are asked to complete the following sentence in as many
ways as they can: “I am becoming a person who _____.” They silently
mill around the room reading each other’s sheets; then they leave the
group session.

Technique: Map of Life

Counseling Intention To review significant life events.
Description On sheets of newsprint, members draw maps of their lives, illustrating
significant events. In an insert, they draw a map of the current week up
to the here-and-now. Each member explains his or her map to the group.

Technique: Think-Feel
Counseling Intention To focus on cognitive-emotional issues.
Description Members are instructed to write on one side of a 3" × 5" index card
a sentence beginning with the phrase, “Now I am thinking ____” and
on the other side a sentence beginning with “Now I am feeling ____.”
Members are asked to process their thoughts and feelings from both
sides of their cards.
 36  Eclectic Techniques for Group Therapy

Technique: Here-and-Now Wheel
Counseling Intention To identify and focus on feelings.
Description This can be used as a closure activity to enable people to get in touch
with the emotions they are feeling, to put a label on them, and to try
to determine why they are feeling them.

1. Have group members draw a circle on a piece of paper and divide the circle into four parts
(four quadrants).
2. In each part, they are to write a word that describes a feeling they have at the moment.
3. The leader can ask for five volunteers to share their wheels with the entire group.
4. Process the experience.

Technique: Value Box
Downloaded by [New York University] at 04:58 12 August 2016

Counseling Intention To explore what clients value.

Description Each group member is to bring in a box containing three to six items.
These items are those that hold special meaning or represent some-
thing that holds significant meaning for the individual. Group mem-
bers take turns explaining the content of their boxes, with each person
revealing and explaining the objects he or she has selected.

Technique: Who Are You?

Counseling Intention To explore dimensions of the self (Simon et al., 1972).
Description Have the group members take nine pieces of paper and respond to
the question “Who am I?” nine times. Record each answer on one of
the sheets. Members may reply with anything that comes to mind as
self-identification: age, sex, profession, a symbol, image, or a value.
After members have finished, direct them to rank the papers in impor-
tance (9 being the highest and 1 the lowest). Direct members to place
each piece of paper face down in front of them and turn up number
nine and think about what it represents. Have them consider what life
would be like without number nine, and proceed through each num-
ber to number one.

Process the filtering out of parts that are not essential to oneself. Do members think beyond
their activities, titles, or career? Are there aspects of codependency with others regarding their
identity and meaning to others?

Technique: Cued Sharing

Counseling Intention To promote more open dialogues among group members; to assess
locus of control.
Description Cue the group to share with one another:

1. An episode from childhood or adolescence that was very formative

2. A personal secret
3. Feelings about a part of one’s body (e.g., proud or ashamed)
4. Feelings about occupation—satisfactions or frustrations
5. Information on their financial situation
6. Feelings about their love life, past and present, or marriage
7. Feelings about other members in the group
 Eclectic Techniques for Group Therapy  37

Technique: Out in the Cold

Counseling Intention To confront the worst kind of rejection—being completely cast away
from the group, ignored, or not taken seriously by others (Lewis &
Streitfeld, 1970).
Description The group forms a circle. Each member in turn steps out of the cir-
cle and wanders around the room exploring how he or she feels in
different locations, focusing on how it feels to step away from the
group. For example, he or she may feel intensely rejected, isolated,
weak, or meaningless to the group. On the other hand, he or she may
be relieved and may feel liberated.

The member then returns to the group and focuses on how he or she feels now. For example,
do you feel whole or fragmented? Do you feel awkward or comfortable? Are you happy or sad?
Downloaded by [New York University] at 04:58 12 August 2016

Other members should focus on how they felt when someone leaves. Are you sorry? Or do you
feel rejected when someone moves away? Some members may feel that the group has annihilated
the one who has left and that they can abuse him or her. Others may feel that the person who has
left is freer and stronger than the group.

Technique: Impressions of Self

Counseling Intention To gain a fuller impression of how one sees oneself.
Description Build a representation of yourself in three dimensions. To do this,
empty a junk drawer or closet. Dump out a collection of heterogene-
ous materials such as papers, pictures, matchbooks, strings, scraps of
wood, magazines, and any other miscellaneous finds. Gather some of
these things from the pile and build a portrait of yourself out of them.
Process the experience.

Technique: Group Reentry Questions

Counseling Intention To check in with group members regarding their group experiences
(Canfield & Wells, 1976).
Description Reentry questions help to reestablish the level of group rapport that
has been developed, as well as positively enhance self-concepts of
group members. Questions such as these are useful:

1. What was the most exciting thing that has happened to you in the last week?
2. What was one of the most exciting things that you did?
3. Suppose you had a magic box. In it can be anything you want that will make you happy.
What is in your box that makes you extremely happy?
4. If you could teach everyone in the world just one thing—an idea, a skill, a hobby—what
would it be?

Technique: Group Drawings

Counseling Intention To enhance group cohesiveness (Brown, 1996).
Description Doodling and drawing can say a lot about a person. Sitting in groups
of four to six people around a large piece of poster board, group
members draw with crayons and marker pens. Do not specify if the
drawings are to be an individual or a group effort—that’s up to the
group.
 38  Eclectic Techniques for Group Therapy
Process by discussing the drawings, how they compare to other groups’ drawings and were
influenced by each member, and the group dynamics that transpired while creating the drawings.
Compare the drawings from the different groups to see if this reveals any similarities and differ-
ences in group dynamics.

Technique: Mood Role-Plays

Counseling Intention To see how moods and emotions affect group dynamics.
Description Take the group’s pulse by going around the room and having each
member state one word that describes how he or she is feeling at that
moment. Divide the group into subgroups so that everyone in each
subgroup has a similar mood state, such as anxious/stressed, relaxed/
satisfied, happy/feeling good, or angry/annoyed.
Downloaded by [New York University] at 04:58 12 August 2016

Have each group discuss their mood state among themselves and then create a role-play that
illustrates that mood. Each group then takes turns improvising their role-play before the group.
Process how a particular mood affects group dynamics. For example, how are communication
patterns, body language, group cohesion, task performance, and self-disclosure affected by the
emotion in the group?

Technique: The Group Tell-a-Story

Counseling Intention To explore the various facets of a group’s personality.
Description Group members create a story, one word at a time. The group sits in
a circle and one person is chosen to start the story by offering one
word. The person sitting next to that person then offers the second
word, and so on around the circle, with each person adding one more
word to the story. Periods to end one sentence and start another usu-
ally happen spontaneously, but a person may insert one explicitly if
she so chooses. Process the following questions to encourage mem-
bers to think about how the story might reflect underlying group
dynamics:

• How does the story start off? Might this say something about how the group started off?
• Are there themes or issues that repeat in the story? Are these important themes in the group
itself?
• Is there a pattern to the verbs and adjectives in the story? What does this say about the
group?
• Are there symbols in the story?
• What are the feelings and moods in the story? Do they change?
• What are the relationships among the people in the story?
• Where does the story “fall apart” (become chaotic) and where does it flow well? What might
that mean?
• Do conflicts or problems arise in the story? Are they resolved?
• What other changes or transitions occur in the story?

Technique: Group Checkers

Counseling Intention To enhance cohesion and collaboration among team members.
Description Members of the group try to beat the leader in the game of checkers.
Members must make the move as a team. That is, the team (group)
 Eclectic Techniques for Group Therapy  39
must decide on what will be the move of choice and who will be mov-
ing the checker, prior to the actual move.

Process the experience by discussing issues of teamwork; communication; frustration/anger

management; being heard; winning (or losing); problem solving; compromise; and how this
activity is like school, work, or home.

Technique: Management of Resistance Using the Time-out Technique

Counseling Intention 
To confront group resistance that has occurred over an extended
period, for one or several sessions.
Description The therapist says something like the following: “I sense there was so
much more going on here than what was expressed. We have about 10
Downloaded by [New York University] at 04:58 12 August 2016

minutes remaining; perhaps we can take time out to reflect upon what
could have happened that didn’t. Could each of you say something
about what you did not express during the session? Even a headline or
opening statement would help” (Barbanell, 1997, p. 510).

Cultural Competency
Cultural competency can be defined as a set of congruent behaviors, attitudes, and policies
that come together in a system, community, institution, and among individuals that enables
them to work effectively in cross-cultural situations. Cultural competency is the acceptance and
respect for differences, a continuous self-assessment regarding culture, attention and respect for
the dynamics of difference, and a continuous self-assessment pertaining to relational dynamics
(Cross, Bazron, Dennis, & Issacs, 1989, p. 33).
Competency refers to understanding more explicitly the mores, traditions, customs, formal
and informal helping networks, and mastery of the English language (Thompson, 2012, p. 302).
Consideration of cultural differences when sending or receiving nonverbal messages is critical.
A message that has a particular meaning in one culture can have a completely different meaning
in another culture. For example, in the United States we encourage eye contact as an indicator of
honesty, interest, and openness. However, people in some other cultures believe that they should
look down when talking to another person to indicate deference and respect for the individual
they are speaking with during their conversation. For them, direct eye contact might be consid-
ered offensive and disrespectful. Other general examples follow:

• Shaking your head up and down means “yes” in the United States and left to right means
“no.” Yet in some parts of the world the meanings are just the opposite.
• The hand signal for OK in the United States is an obscene gesture equivalent to
giving someone in the United States “the finger” in many countries such as Brazil and
Germany.
• The thumbs-up gesture is a positive sign in most of the world, but in some cultures it is
considered a rude gesture.
• The V-shaped hand gesture with the index finger and middle finger may mean victory or
peace in the United States, but in some countries it could be interpreted as an obscene
gesture.
• Use of a finger or hand to indicate “come here please.” This is the gesture used to beckon
dogs in some cultures and is very offensive. Pointing with one finger is also considered to be
rude in some cultures, and Asians typically use their entire hand to point to something.
 40  Eclectic Techniques for Group Therapy
• Chinese, Japanese, and Koreans bow, and Thais bow their heads while holding their hands
in a prayerlike position. The bumiputra, or Muslim Malaysians, have a greeting of their own:
they shake hands as Westerners do, but they follow up by touching their heart with their
right hand to indicate that they are greeting you “from the heart.”
• Whereas patting a child’s head is considered to be a friendly or affectionate gesture in West-
ern culture, it is considered inappropriate by many Asians to touch someone on the head,
which is believed to be a sacred part of the body.
• In the Middle East, the left hand is reserved for bodily hygiene and should not be used to
touch another or transfer objects. In Muslim cultures, touch between opposite gendered
individuals is generally inappropriate.
• Eye contact is interpreted in Western culture as attentiveness and honesty; essentially, we
have been conditioned to “look people in the eye” when talking. In many cultures, however,
including Hispanic, Asian, Middle Eastern, and Native American, eye contact is thought to
Downloaded by [New York University] at 04:58 12 August 2016

be disrespectful or rude, but lack of eye contact does not mean that a person is not paying
attention. Women in some cultures may especially avoid eye contact with men because it can
be taken as a sign of sexual interest.
• It is common in Western culture for adults to admire babies and young children and com-
ment upon how cute they are. This should be avoided in Hmong and Vietnamese cultures
for fear that these comments may be overheard by a spirit that will try to steal the baby or
otherwise cause some harm to come to him or her in the future.
• Although smiling is an expression of happiness in most cultures, it can also signify other
emotions. Some Chinese, for example, may smile when they are discussing something sad or
uncomfortable.
• In Hong Kong, it is important not to blink one’s eyes conspicuously, as this may be seen as
a sign of disrespect and boredom.
• Some Venezuelans may use their lips to point at something, because pointing with a finger
is impolite.
• In Russia, even numbers of flowers are only ever given at funerals, and such a gift to some-
one is seen as inviting death.

Head Movements
• In Lebanon, the signal for “Yes” may be a nod of the head. To signal “No,” a Lebanese may
point his or her head sharply upward and raise the eyebrows.
• Saudis may signal “Yes” by swiveling their head from side to side. They may signal “No” by
tipping their head backward and clicking their tongue.

Hand and Arm Gestures

• The “OK” sign is interpreted in Japan as the symbol for money, because the circular shape
of the index finger and thumb together suggests the shape of a coin. In Argentina, Belgium,
France, Portugal, Italy, Greece, and Zimbabwe, the sign means “zero” or “nothing.” In
some Eastern European countries, as in other countries throughout the world, the gesture
indicates a bodily orifice and is highly offensive, especially in Brazil, Germany, and Russia.
• In some parts of the United States, to hold up crossed fingers is to wish good luck, but to
hold crossed fingers behind your back negates whatever pledge or statement you’re think-
ing. In Russia, this is a way of rudely rejecting or denying something. In Argentina and
Spain, this sign is made to ward away bad luck. In China, it signifies the number ten.
• The “thumbs-up” gesture has a vulgar connotation in Iran.
 Eclectic Techniques for Group Therapy  41
• In Colombia, tapping the underside of the elbow with the fingers of the other hand suggests
that someone is stingy.
• Many Chinese people point with their entire hand; using the forefinger to point is
viewed as rude. Similarly, in India one may use a full hand to point, but never just a
single finger.
• In Latin America, a shrug with the palms facing skyward may be interpreted as a vulgar
gesture.

Personal Space
• Compared to most people in the United States, Latin Americans are accustomed to stand-
ing and sitting close to people who are not well known to them. Even within the majority
population in the United States, there are important variations in the size of the personal
Downloaded by [New York University] at 04:58 12 August 2016

comfort zone.
• People from the Middle East may stand quite close when talking with each other.
• In some Muslim cultures, a woman may be alarmed if a man, even a male physician, stands
or sits too close to her.

Touching
• In some cultures, light touching of the arm or a light kiss on the cheek is common, even
among people who have just met. People from Latin America and Eastern Europe may be
very comfortable with this kind of touching, whereas people from many Asian cultures may
prefer less physical contact with acquaintances.
• Touching another person’s head is considered offensive by some people from Asia and the
Middle East. It is therefore inappropriate to pat a child on the head.
• Some Chinese may be uncomfortable with physical contact early in a relationship. Although
many Chinese will use a handshake to greet a Westerner, any other contact may be consid-
ered inappropriate. This is especially important to remember when dealing with older people
or those in positions of authority.
• Men in Egypt tend to be more touch oriented; a handshake may be accompanied by a gentle
touching of the recipient’s elbow with the fingers of the left hand.
• A strong, warm handshake is the traditional greeting between men in Latin America. How-
ever, because most Latin Americans show affection easily, male friends, like female friends,
may embrace. Women may lightly brush their cheeks together.
• Throughout most of the Middle East, it is the custom to reserve the left hand for bodily
hygiene. For this reason, one should never offer the left hand to shake hands or accept a gift.
This is also true of some African cultures.
• A Western woman should not initiate a handshake with a man in India. Many Indian women
will shake hands with a foreign woman, but not a foreign man.
• To many Indians, it is considered rather offensive to (even accidentally) step on someone’s
foot. Apologies should be made immediately.

Eye Contact
• Making direct eye contact is a sign of disrespect in some cultures. In other cultures, refusing
to make direct eye contact is a sign of disrespect. Many Asians may be reluctant to make eye
contact with an authority figure. For example, when greeting a Chinese, it is best to avoid
prolonged eye contact as a sign of respect and deference.
 42  Eclectic Techniques for Group Therapy
• Many Middle Easterners have what North Americans and Europeans consider “languid
eyes.” It may appear that the person’s eyes are half closed, but this does not express disinter-
est or disrespect.
• In Ghana, young children are taught not to look adults in the eye because to do so would
be considered an act of defiance.
• In Latin America, good eye contact is important in both social and business situations.

Physical Postures
• In many cultures throughout the world, it is impolite to show the bottom of the shoe, which
is often dirty. Therefore, one should not sit with the foot resting on the opposite knee.
• In Argentina, standing with the hands on the hips suggests anger or a challenge.
• In many cultures, slouching or poor posture is considered disrespectful. For example, good
Downloaded by [New York University] at 04:58 12 August 2016

posture is important in Taiwan, with Taiwanese men usually sitting with both feet firmly
fixed to the floor.

Tips for Clinicians and Therapists

1. Follow the client’s lead. If the client moves closer or touches you in a casual manner, you
may do the same.
2. Use hand and arm gestures with great caution. Gestures can mean very different things in
different cultures.
3. Be careful in interpreting facial expressions. They may lead you to misinterpret the patient’s
feelings or to over- or underestimate the patient’s level of pain. This is also true of the pres-
ence or absence of crying and other expressions of pain, which are closely tied to a person’s
culture.
4. Don’t force a client to make eye contact with you. He or she may be treating you with
greater respect by not making eye contact.

These issues are critical as we become a more diverse society. Not understanding these nuances
can significantly affect the therapeutic alliance and the therapeutic outcome. Attention to non-
verbal behavior and cultural differences is critical today as we are becoming more diverse, repre-
senting less of a “melting pot and more of a salad bowl” when it comes to understanding ethnic,
cultural, and racial differences (Morris, 1994).

Technique: Cultural Competency Activity: Social Class Privilege Exercise

Counseling Intention To provide a visual representation of a client’s social class status and
the reality of social class hierarchies in our society. This exercise is also
one to illustrate White privilege.
Description Participants line up shoulder to shoulder in a straight line and then
take either a step forward or backward regarding their personal social
class experiences. Use a rope to show the reference by beginning to
end. Sometimes a large building with steps works well. Have partici-
pants line up, and read the following scenarios aloud:

• If your parents went to college, take one step forward.

• If there were more than 50 books in your house when you grew up, take one step forward.
• If you ever had to skip a meal or were hungry because there was not enough money to buy
food when you were growing up, take one step back.
 Eclectic Techniques for Group Therapy  43
• If you were brought to art galleries, plays, or museums by your parents or guardians, take
one step forward.
• If one of your parents was unemployed or laid off, not by choice, take one step back.
• If prior to age 18, you took a vacation out of the country, take one step forward.
• If one of your parents did not complete high school, take one step back.
• If you or your family owns their own house, take one step forward.
• If you were ever offered a good job because of your association with a friend or family mem-
ber, take one step forward.
• If you ever inherited money or property, take one step forward.
• If public transportation was a requirement and not a choice, take one step back.
• If you ever paid back a loan to a bank or lender, take one step forward.
• If you received a scholarship in college, take one step forward.
• If your family has a summer home or second house, take one step forward.
Downloaded by [New York University] at 04:58 12 August 2016

• If you have worked at a fast food restaurant, take one step backward.
• If you have a trust fund or own stocks and bonds, take one step forward.
• If you shared a bedroom as a child, take one step backward.
• If you have shopped with food stamps, take a step backward.
• If you or someone in your family was enrolled at a private elementary or secondary school,
take a step forward.
• If your social class membership was ever the target of a joke, take one step back.

After the activity is over, have participants sit in a circle and ask them to debrief. Some good
discussion questions could include:

1. Look at where you are located in regard to where you started. Are you above or below the
starting line? How does your position make you feel? Are you surprised about where you are
located?
2. Do you think this activity is an accurate representation of social class privilege?
3. Those of you toward the front, do you consider yourself privileged? Why or why not? Those
of you toward the back, do you believe you belong in the underprivileged group? Those in
the middle, how does it feel to be the middle class?
4. Did you learn anything surprising about any of your peers? Why were you surprised?
5. Would your placement have been different if the exercise included questions about disability
or religion?
6. How could affirmative action affect these issues?

Have members meet in pairs to process and then have them report back to the group as a
whole (McCaffry, 2002, p. 4–6).

Technique: A Cultural Autobiography

Counseling Intention To create an abbreviated autobiography that focuses on four areas of
exposure to individuals of different backgrounds, education, travel,
and personal experience.
Description This autobiography should contain descriptions of people or experi-
ences that challenged the client’s biases or perceptions in the past.
Clients might also include a description of a situation in which they
did not experience cultural competence within themselves or other
people. Then discuss what they could have done differently to make
the experience more successful in the future. The goal of this exercise
 44  Eclectic Techniques for Group Therapy
is to have the client examine his or her own cultural competence and
to examine any biases he or she may hold and challenge those biases or
preconceived notions (Smith, Moallem, & Sherrill, 1997).

Technique: The Face Game

Counseling Intention To understand personal perceptions.
Description  Gather diverse pictures of people from magazines representing
all cultures and ethnicities. Each client gets a picture and gives a
description of the person based on his or her perceptions. Include
the following:

• Name
• Occupation
Downloaded by [New York University] at 04:58 12 August 2016

• Age
• Race
• Emotional mood
• Family dynamics
• Friends
• Educational background
• Socioeconomic status
• Religious beliefs
• Leisure activities

Have each client talk about his or her person with the rest of the group and explain how he or she
derived these descriptions and whether they were based on physical appearance or personal experience.

Technique: Circles of My Multicultural Self

Counseling Intention To highlight the multiple dimensions of our identities and the relation-
ships between our desires to self-define our identities and the social
constructions that label us, regardless of how we define ourselves.

Figure 3.1
 Eclectic Techniques for Group Therapy  45
Description The client places his or her name in the center circle of the following
structure. The client writes an important aspect of his or her identity
in each of the satellite circles—an identifier or descriptor that the cli-
ent feels is important in defining himself or herself. This can include
anything: Asian American, female, mother, athlete, educator, scientist,
or any descriptor with which the client identifies (Gorski, 2014).

1. Share a story about a time you were especially proud to identify with one of the descriptors
you used.
2. Share a story about a time it was especially painful to be identified with one of your identi-
fiers or descriptors.
3. Name a stereotype associated with one of the groups with which you identify that is not
consistent with who you are. Fill in the following sentence:
Downloaded by [New York University] at 04:58 12 August 2016

I am (a/an) __________ but I am NOT (a/an) __________.

So if one of a client’s identifiers is an “athlete,” and it was thought a stereotype was that
all athletes will get a scholarship to a university, the client’s sentence might be: I am an
athlete, but I am not good enough to get a scholarship to the university. (Gorski 2014).

Conclusion
Group psychotherapy has been effective as a treatment for loss and grieving, depression,
obsessive-compulsive disorder, eating disorders, bipolar disorder, personality disorders, and sub-
stance abuse or other addictive behaviors. Coping and social skills training have demonstrated
significant efficacy. Group psychotherapy is suitable for a large variety of problems and difficul-
ties, beginning with people who would like to develop their interpersonal skills and proceeding
to people with emotional problems such as anxiety, depression, or panic disorder.
 4 Classic Gestalt Techniques

Perspective for the Therapist: On Expectations

Downloaded by [New York University] at 04:58 12 August 2016

I do my thing and you do your thing. I am not in this world to live up to your expectations. And
you are not in this world to live up to mine.
You are you and I am I. And if by chance we find each other, it’s beautiful. If not, it can’t
be helped.
Fritz Perls, “Gestalt Therapy Verbatim,” 1969. p. 1

Today, within the realm of more humanistic–existential psychotherapies, Gestalt therapy is

perhaps the most prominent. It is parallel to other “third force” approaches (Seltzer, 1986)
with its strong conceptual emphasis on self-fulfillment and the development of authenticity and
self-responsibility. Gestalt therapy stresses here-and-now awareness and the unity of mind, body,
and feelings. “Lose your mind and come to your senses” (Perls, 1969) is a major tenet in this
counseling approach. Gestalt therapy, unlike psychoanalysis, has little to add to a dynamic inter-
pretation of psychopathological phenomena. It is a “therapy” more than a theory, an art more
than a psychological system.
Inherently, it is an experiential therapy designed to help people experience the present moment
more fully and gain awareness of what they are thinking, feeling, and doing. Unfinished business
from the past (such as unexpressed feelings of resentment, anger, guilt, or grief) is viewed as
needless emotional debris that clutters present-centered awareness. Gestalt therapy uses confron-
tational techniques as an invitation for the client to become aware of discrepancies between ver-
bal and nonverbal expressions, between feelings and actions, or between thoughts and feelings.
Perls maintained that people often fragment their lives and sabotage their potential by los-
ing touch with their inner selves and by not coming to terms with unfinished business (i.e.,
unfulfilled needs, unexpressed feelings, or lack of closure to significant life events such as loss).
Individuals often find themselves experiencing a split in their being between what they think
they should do and what they want to do. People also tend to flounder at times between existing
polarities in their lives such as love/hate, internal/external, or real/unreal. Gestalt techniques
are experiential exercises to bring clients in touch with the full range of their experiences. It is
concerned with wholeness and the completion of form. A Gestalt includes both the formation
and the destruction of the whole (Van De Riet, Korb, & Gorrell, 1980). As a need grows within
a person, it comes to the foreground of attention-seeking resolution. The primary focus of atten-
tion is referred to as the figure, and all else in awareness is known as the ground. The process
involves many of the following components:

Enhancing awareness. Clients are helped to attend to that which they are presently experiencing.
Changing questions to statements. Clients are encouraged to use statements rather than ques-
tions, which leads them to express themselves unambiguously and to be responsible for
their communication.
 Classic Gestalt Techniques  47
Assuming responsibility. The client is asked to substitute the use of the word won’t for can’t.
Experimentation in this substitution often leads individuals to feel that they are in control
of their fears.
Asking “how” and “what.” Asking “why” leads to defensiveness and intellectualization rather
than experiencing and understanding. “How” and “what” enable individuals to get into the
experience of their behavior.
Bringing the past into the now. Much of that which is dealt with in counseling is concerned
with past events. Rather than rehashing the past, previous experiences or feelings can be
brought into the here-and-now.
Verbal and nonverbal congruency. The counselor observes the client’s body language and
focuses attention on discrepancies and brings them to the client’s awareness.

Gestalt therapy alerts us to the interrelationship between awareness and energy. When aware-
Downloaded by [New York University] at 04:58 12 August 2016

ness is scattered and bound up in unknown feelings and thoughts, energy flow is diminished
throughout one’s personality. A Gestalt counselor, by suggesting the practice of structured expe-
riences, focuses and amplifies effort to free themselves from mental, emotional, and physical
blocks to greater self-awareness. The Gestalt approach is designed to approach observable behav-
ior rather than merely to lead the person to talk about what he or she is thinking. The aim of
Gestalt therapy is to enable the client to act on the basis of all possible information and to appre-
hend not only the significant factors in the external field, but also significant information from
within. The Gestalt therapist pays close attention to the whole person-to-body movement, to
emotional congruity, and to the language that deflects from the client’s awareness (Crose, 1990).
The client is directed to pay attention at any given moment to what he or she is feeling, what he
or she wants, and what he or she is doing. The goal is noninterrupted awareness. The process of
increasing awareness enables individuals to discover how they interrupt their own functioning.

Basic Tenets of Gestalt Therapy

1. Live now. Be concerned with the present rather than with the past or future.
2. Live here. Deal with what is present than with what is absent.
3. Stop imagining. Experience the real.
4. Stop unnecessary thinking. Rather, taste and see.
5. Express rather than manipulate, explain, justify, or judge.
6. Give in to unpleasantness and pain just as to pleasure. Do not restrict your awareness.
7. Accept no should or ought other than your own.
8. Take full responsibility for your actions, feelings, and thoughts.
9. Surrender to being as you are (Fagan & Shepherd, 1970, pp. 49–50).

Stages in Gestalt Therapy

From the Gestalt perspective, every psychological problem can be explored and resolved as a
polarized conflict between two aspects in personality. Fiebert (1983) identified four stages in
the unfolding of a therapeutic session and the corresponding counselor behaviors that serve to
guide a conflict into awareness, expose its ramifications and internal experience, and aid in its
resolution.

Stage 1: Emergence of the Problem

The first stage involves a client bringing into awareness with increasing intensity a major conflict
in the here-and-now to a counseling session. Initial interventions guide the client’s attention to
his or her immediate experience—the “what and how” of behavior—and away from speculations
 48  Classic Gestalt Techniques
as to causes—the “whys”—for such action. During this process, clients are encouraged to assume
increasing responsibility (ability to respond) for individual thoughts, feelings, and sensations and
to experience the intimate, basic connection between verbal and nonverbal behaviors. The focus
of the first stage consists of exploring what a client is currently experiencing in awareness. Clients
can be guided to experience greater degrees of personal responsibility by the simple means of
restating and repeating particular phrases in communication, such as substituting “want” for
“should,” “won’t” for “can’t,” “I” for “it,” and presenting all material in the present tense. The
end phase of stage 1 is marked by a client’s ability to readily focus awareness when directed and
express feelings and sensations in the immediate present.

Stage 2: Working with External Polarities

The client is now asked to take the growing tension that is experienced and explore it within
Downloaded by [New York University] at 04:58 12 August 2016

the framework of an external dialogue. With an interpersonal problem, there is little difficulty
in employing two chairs and having the client change places as a conversation unfolds. The
major thrust of the work at this point is to bring hidden feelings into awareness by dramatizing
the outer manifestation of an inner conflict. In the closing phase of stage 2, clients can become
quite immersed in the process of self-discovery and need little overt guidance to shuttle between
chairs, appropriately express feelings, and monitor and modify behavior patterns. It is useful to
have the client sequentially express (1) what direct issues and feelings are present in the relation-
ship with the significant other, (2) what covert feelings and hidden agendas are perceived in the
relationship, and (3) what the desired solutions are to the stated issues and conflicts.

Stage 3: Working with Internal Polarities

The central focus of activity in stage 3 is a growing confrontation between two significant and
opposing aspects within the client’s personality. The more fully each aspect or pole of tension
is dramatized and experienced, the more likely it can be resolved. During a session, one can
observe an inner conflict, initially latent, emerge with increasing power as the thoughts, feelings,
sensations, and bodily responses associated with a historical trauma come into awareness. As each
polarity expands its “territory” into awareness, the tension may painfully stretch until it becomes
unbearable for the client. This phenomenon is indicative of the “implosive layer” of personality
and is a necessary precondition for the formation of a new Gestalt.

Stage 4: Integration
The integration stage celebrates the triumph of unity over separate factors within the client’s
personality, signals the emergence of a new Gestalt, and reflects that within the struggle between
the yin and the yang is the tao. The core element at this stage is a resolution of the internal con-
flict resulting from a major reorganization and renewed perception of the problem. Integration
is a continual, evolutionary, life-sustaining experience—there is no “final” Gestalt. In the process
of integration, factors that were opposing each other in consciousness are identified. Encourage
clients to express verbally what each opposing aspect can truly appreciate and respect in the other
one. Some clients will respond more effectively to the opportunity to express these attitudes in a
nonverbal manner, through gesture or movement. A guided fantasy of mutual acceptance can be
presented by the therapist, who incorporates the positive qualities of each aspect of each polar-
ity by moving them toward each other and embracing them. Some clients may choose to work
with a meditation technique that allows them to harmonize and integrate the polar tension. To
facilitate a client’s cognitive reorganization, the therapist may present his or her perceptions of
the changes observed from the beginning to the end of a session.
 Classic Gestalt Techniques  49
Finally, there are a number of different styles of processing and different general subjects to
process. Some of the most used tools are:

Dialoguing: Talking back and forth about the issue, seeing it from different angles, trying to
zero in on what is going on.
Hunting for illogic: Following or challenging illogical statements, trying to get to the underly-
ing meanings.
Reframing: Inviting the client to see something from a different perspective. Unfixing: Free-
ing up fixed ideas, stuck thoughts, and stuck emotions.
Re-experiencing: Clearing up kinesthetic reactions by experiencing events differently.
Recursion: Repeating the same action or question to exhaust the responses to it.
Polarity integration: Bringing opposite personality traits together.
Soul retrieval: Bringing back parts of the person that are lost.
Downloaded by [New York University] at 04:58 12 August 2016

Perceptual processing: Isolating and changing the perceptions associated with an issue.
Entity processing: Addressing perceptual phenomena as a live, independent unit.
Awareness: Attending to and observing one’s own sensing, thinking, feelings, and actions;
paying attention to the flowing nature of one’s present-centered experience.
Confluence: Creating a disturbance in which the sense of the boundary between self and envi-
ronment is lost.
Confrontation: Inviting the client to become aware of discrepancies between verbal and non-
verbal expression, between feelings and actions, or between thoughts and feelings.
Deflection: Avoiding contact and awareness by being vague and indirect.
Dichotomy: Splitting a person’s experiences into opposing forces of a polarity: weak/strong,
dependent/independent.
Unfinished business: Having unexpressed feelings (e.g., resentment, guilt, anger, grief) going
back to childhood that now interfere with effective psychological functioning; needless
emotional baggage that clutters present-centered awareness and functioning.

These techniques are unique to Gestalt therapy, providing another lucrative means for explor-
ing the client’s world.

Technique: The Empty Chair Technique

Counseling Intention To address conflict or relationship issues for the client; to stimulate
thinking and to highlight emotions and attitude (Tillett, 1984).
Description A role-playing technique involving the client and an imaginary person
in the empty chair is presented. The client sits opposite the empty
chair when speaking to the imaginary person; the client plays his or her
role and the role of an imaginary person or partner.

Technique: Accept Responsibility for Choices Made

Counseling Intention To examine how one denies responsibility for many choices, wants,
fears, and weaknesses.
Description Begin this experience by completing these sentences with several responses:

1. I had to ___________________
2. I can’t ___________________
3. I need ___________________
4. I’m afraid to ___________________
5. I’m unable to ___________________
 50  Classic Gestalt Techniques
Now, go back and try substituting these words for the five previous beginnings:

1. “I chose to” instead of “I had to.”

2. “I won’t” instead of “I can’t.”
3. “I want” instead of “I need.”
4. “I’d like to” instead of “I’m afraid to.”
5. “I’m unwilling to work hard enough to” instead of “I’m unable to.”

Technique: Working through Unfinished Business

Counseling Intention To understand emotional “leftovers” from previous experiences (Perls,
1969).
Description When experiencing a strong unwanted emotion (e.g., anger, sadness,
loneliness, or insecurity), first let go and feel the emotion full strength,
Downloaded by [New York University] at 04:58 12 August 2016

no matter how unreasonable, dangerous, and crazy it may be. Second, go

looking for concealed emotions, asking, “Do I also feel something else?”

Classic Examples of Intense Emotions

• Crying hides anger.
• Dependency suppresses anger.
• Excessive smiles conceal depression.
• Physical complaints contradict anxiety.
• Anger overshadows fears.

Third, investigate bodily sensations and emotions for more subtle additional feelings. Fourth,
ask yourself, “What do these current feelings and the situation remind me of in the past?” and
“Have I been there before?” Relive the earlier experiences over and over until the strong emo-
tions are drained. The next time there is a feeling of over-responding emotionally, reflect on
unfinished business that is brought to the situation. Say to yourself, “It’s not the orders from the
boss that are irritating me; it is my resentment of my mother’s criticism.”

Technique: Centering
Counseling Intention To become comfortable in the present; to reach a state of rest men-
tally, emotionally, and physically when doing something.
Description Sit down comfortably with closed eyes and do nothing but be aware of
what is going on. Don’t try to do anything in particular, and don’t try
to not do anything in particular. Just notice what is happening, what
sounds are in the room, how your body feels, and the thoughts going
through your head. Don’t try to change or stop any of it. Just perceive
it all as naturally occurring noise. Simply allow everything to happen,
and thoughts and feelings will become quiet.

Technique: Four Magic Questions to Handle Upsets

Counseling Intention To uncover something hidden that causes the upset.
Description These questions are general enough to cover most recent upsets:

1. “What did ________do that wasn’t right?”

2. “What did_______ fail to do?”
 Classic Gestalt Techniques  51
3. “As far as____________ is concerned, what did you do that wasn’t right?”
4. “As far as ________ is concerned, what did you fail to do?”

These questions are general enough to cover most upsets, but the client is most likely to
provide the exact keys producing the upset. Another series of questions along similar lines
would be:

1. “What should I have known?”

2. “What should _______ have known?”
3. “What should you have known?”
4. “What should have been known?”

Fundamentally, the upset is there because somebody did not know what the other person
Downloaded by [New York University] at 04:58 12 August 2016

expected and therefore acted differently.

Technique: Dialoging
Counseling Intention To find something that is in need of resolution; to narrow down an
area so that a more specific technique can be used (Perls, 1969).
Description Dialoguing is a free-form method of assessing or resolving an area and
the client’s answers. This goes on until either enough information has
been compiled or until the area has been resolved. The purpose of the
dialoguing process is for the facilitator and the client to both under-
stand the nature of the subject to a point where it is either resolved
for the client or the client knows what to do with it. The object is to
get a mutual understanding about what it is and for the client to take
responsibility for it.

The therapist helps the client resolve the subject by asking the right questions. The therapist
will get the client to keep looking and talking about what is there until he or she has progressed.
To help the client, the therapist can ask various things concerning the subject:

• Possible causes.
• Ideas.
• Thoughts.
• Considerations.
• Data.
• Solutions.
• Attempted solutions.
• Failed solutions.
• Feelings.
• Remedies.
• Improvement.
• Attempts to get rid of.
• Help toward.
• Time, place, form, and event.
• Who, what, where, when, and how.
• What one could do about it.
• Possibly taking responsibility for it.
• How things would be without it.
 52  Classic Gestalt Techniques
Any question will help the therapist clarify what the client said and summarize it without
judging it.

Technique: Unblocking
Counseling Intention To provide a list of meaningful questions that will unblock an area.
Description Unblocking is a list of keys that are useful to use in dialoguing to free
up some kind of positive direction. The keys on the list are mostly fac-
tors that might inhibit a positive outcome:

• Holding back.
• Obstacles.
• Resources.
• Attempts.
Downloaded by [New York University] at 04:58 12 August 2016

• Failures.
• Consequences.
• Judgments.
• Inhibitions.
• Obsessions.
• Mistakes.
• Anxiety.
• Suppressed.
• Forgotten.

Out of each key concept, the therapist constructs a question, such as:

“In regard to _____, is there anything that you are holding back?”
“Has anything been held back about ____?”
“Are you holding yourself back concerning _____?”
“Is someone else holding something back about your ______?” “What resources are available
to use for _________?”
“Do you have any anxiety about _________?”

Technique: Hot Seat
Counseling Intention To confront a group member regarding interpersonal issues or resist-
ance (Perls, 1969).
Description A technique to focus intensely on one member of the group at a time.
The member sits opposite the group leader and dialogues on a life
problem with intermittent input from other members upon request by
the group leader.

Technique: Mirror
Counseling Intention To provide feedback to the client regarding how he or she is perceived
by the group or one member.
Description A technique employing role-playing: The role-playing group member
with the problem is asked to remove himself or herself from the group
setting while a volunteer group member comes forth to imitate the
role-player and also to provide alternative role-played behavior. The
original role-player observes as an objective, nonparticipatory learner.
 Classic Gestalt Techniques  53

Technique: Monotherapy
Counseling Intention To facilitate awareness and a therapeutic dialogue (Perls, 1969)
Description In Gestalt therapy, a technique in which the counselor requests that
the client write or create a dramatic scene and role-play all characters
involved; the client is encouraged to role-play personal fantasies or
repressed wishes.

Technique: Playing the Projection

Counseling Intention To gain a deeper awareness of one’s own projections from the perspec-
tive of others (Perls, 1969).
Description  The purpose of this exercise is to demonstrate how often we see
clearly in others the qualities or traits that we do not want to see or
Downloaded by [New York University] at 04:58 12 August 2016

accept within ourselves. Group members are to make a direct state-

ment to each person in their group and then apply that statement to
themselves. For example, one member might say to another member,
“I think you are very manipulative” and then say “I am manipula-
tive.” Or one member might say to another member, “I don’t think
you really care about me” and then say, “Then I don’t care about
me.” This technique serves to create a deeper awareness of one’s own
projections.

Technique: Territoriality and Group Interaction

Counseling Intention To reveal a group sociogram of member interaction.
Description After the group has been in session for a time, ask them to change
seats. Process the issues of territoriality—that is, did the group mem-
bers tend to arrange themselves in the same seating order? How did
they feel when they saw someone else sitting in their seat? Ask group
members to diagram with arrows the interactions of a given period of
group discussion. Discuss cross-currents in the group. Who are iso-
lates? Who are stars? Is there ease of communication, direct eye con-
tact, and equal air time?

Technique: Think-Feel
Counseling Intention To focus on discrepancies between thoughts and feelings.
Description Members are instructed to write on one side of a 3" × 5" index card a
sentence beginning with the phrase “Now I am thinking” and on the
other side a sentence beginning with “Now I am feeling.” Members
are asked to process their thoughts and feelings from both sides of
their cards.

Technique: Making the Rounds

Counseling Intention 
To provide a structured opportunity to relay difficult feelings or
thoughts.
Description In this exercise, a person goes around the group and says something
that is difficult to say. For example, one member might have mentioned
that she does not trust the other group members enough to risk any
self-disclosure. She may be given the opportunity to go around the
 54  Classic Gestalt Techniques
group and say to each member, “I don’t trust you because _____” or
“If I were to trust you, then ______.”

The person making the rounds completes the sentence with a different ending for each group
member. The purpose of the exercise is to give participants the experience of confronting a given
fear and concretely stating that fear in the group.

Technique: “I and Thou”
Counseling Intention To enhance communication; to get in touch with barriers to commu-
nication as it is perceived by others (Perls, 1969).
Description Clients often respond as if they are talking either to a blank wall or
about a person or persons rather than to another person, as if they did
not exist. The client is asked, “To whom are you saying this?” He or
Downloaded by [New York University] at 04:58 12 August 2016

she is led to discover the distinction between “talking to” and “talking
about” another. The client is led to discover whether or not his or her
voice and words are reaching the receiver. Awareness of how voice and
verbal behavior may inhibit relating to others also can be explored.

Technique: The Principle of the Now

Counseling Intention To relate experience in the here-and-now; to gain greater self-awareness
(Perls, 1969).
Description To encourage communication in the present tense, the therapist asks,
“What is your present awareness?” “What is happening now?” “How
do you feel at this moment?” The client is taught to experience him-
self or herself in the now to gain awareness. Self-awareness is not
thinking about the problem, but is itself a creative integration of the
problem.

Technique: Turning “It” Language into “I” Language

Counseling Intention To empower the client to take responsibility.
Description It is not at all uncommon for individuals to refer to their bodies and
their behavior in “it” language (for example, “What are you experienc-
ing in your stomach?” The client answers, “It is upset.”). The client
is directed to change “it” into “I”—instead of “it is upset,” “I am
upset,” and going a step further, “I am upsetting myself.” The client
begins to see himself or herself as an active agent who does some-
thing rather than as a passive recipient to whom things somehow hap-
pen. The client can see immediately the degree of responsibility and
involvement that is experienced.

Technique: Awareness Continuum

Counseling Intention To guide the client(s) into the present; to diminish the façade of
rationalizations, verbalizations, explanations, and interpretations.
Description The client is diverted away from the emphasis on the why of behav-
ior, as in psychoanalytic interpretation, toward the what and the how
of behavior. Questions can include “What are you aware of at this
moment?” “How do you experience this now?” “Can you be your
thoughts and your eyes and tell me the dialogue for them?”
 Classic Gestalt Techniques  55

Technique: Parallel Dialogue

Counseling Intention To integrate personality and create a greater awareness of conflicting
forces (Perls, 1969).
Description When a dichotomy is manifested in the perceptions or behavior of
a client, the client is asked to have an actual dialogue between these
two components—for example, aggressive versus passive, secure ver-
sus insecure, outgoing versus shy. The dialogue also can be developed
between the individual and some significant person. The client simply
addresses the person as if he or she was there, imagines the response,
or replies to the response. An understanding of more satisfying behav-
iors can be outlined.

Technique: No Gossiping
Downloaded by [New York University] at 04:58 12 August 2016

Counseling Intention To facilitate direct confrontation of feelings (Fagen & Shepherd,

1970).
Description The “no gossiping norm” facilitates direct confrontation of feelings.
Clients often gossip about others when they have not been able to
handle directly the feelings they arouse. Gossiping is defined (Fagen &
Shepherd, 1970) as “talking about” individuals who are present rather
than “talking to” them. For example, a group member might speak
about another group member. Sue comments, “It frustrates me that
we cannot begin on time because John is always late.” The counse-
lor intervenes and asks Sue to “talk to” John rather than about him:
“John, I get frustrated when you come late because the group cannot
begin on time.”

Technique: May I Feed You a Sentence?

Counseling Intention To confront thematic issues; to clarify perceptions (Fagen & Shep-
herd, 1970).
Description By listening to and observing the client, the counselor may infer that
a particular theme, attitude, or message is implied—a key sentence.
He or she may suggest or say, “May I feed you a sentence?” The key
sentence is proposed for the client to practice with others in the group
or with others in the client’s daily interactions.

The counselor proposes the sentence, and the client tests out personal reactions to the sen-
tence. Although this technique may seem highly interpretive, the client is encouraged to make it
his or her own experience through active participation. With the counselor’s selective framing of
the key issue, the client then can provide spontaneous development.

Technique: Can You Stay with This Feeling?

Counseling Intention To confront issues habitually avoided; to encourage self-confidence
and autonomy (Fagen & Shepherd, 1970).
Description This Gestalt technique is most effective when the client refers to a
feeling, mood, or state of mind that is unpleasant, coupled with the
defense mechanism of denial or avoidance. At a therapeutic junction,
the client may feel empty, confused, frustrated, or discouraged. The
counselor says, “Can you stay with this feeling?”
 56  Classic Gestalt Techniques
The counselor asks the client to remain deliberately with his or her present experience. The
counselor asks the client to elaborate on the what and the how of his or her feelings—for exam-
ple, “What are your sensations? Your perceptions? Your fantasies? Your expectations?”

Technique: Shuttle Between Here and There (Between Reality and Fantasy)
Counseling Intention To discover what is missing in the now.
Description Close your eyes and go away in your imagination to a place where you
feel secure and happy. Come back to the here-and-now. Compare the
two situations. You may be more aware of this world and have your
goals more clearly in mind. Very often, the “there” situation was pref-
erable to the “here” situation. How was it preferable? What is it you
want? Close your eyes and go away again, wherever you’d like to go.
Downloaded by [New York University] at 04:58 12 August 2016

Did you notice any change since your last fantasy?

Come back to the here-and-now, and again compare the two situations. Has any change
taken place? Continue to shuttle between the “here” and “there” until you feel comfortable
in your present situation. Do this in any boring, tense, or uncomfortable situation. Very often,
Perls (1969) maintained, the “there” situation gives you a cue for what is missing in the now.
The difference between your “there” and “here” can show you the directions in which you
want to move. As a long-range goal, the client may try making the real life more like his or her
fantasy life.

Technique: Bringing a Dream Back to Life

Counseling Intention To use dreams as a way to reveal unfinished business; to understand
images in dreams that represent aspects of the client’s personality
(Fagen & Shepherd, 1970).
Description Relive your dream as if it were happening now. Act it out in the pre-
sent. Say the dream aloud, using the present tense. Be aware of what
you are feeling when you say it. List all the elements of your dream:
the people, animals, objects, colors, and moods. Be particularly aware
of any situations, such as dying or falling, which you avoided in the
dream by running away or waking up. Act out each of the elements.
What does each part have to say? What do you have to say to it? What
do the parts say to each other?

If in your dream there were situations you avoided, try to finish the dream by acting through
frightening situations in fantasy. In acting out parts of your dream, you turn into a dreamer again
and become one with your dreaming self. You may give words to characters whose emotions were
unspoken in the dream so that now they engage in a dialogue.
Keeping a “dream diary” may help a client remember dreams. The following guidelines may
be helpful:

1. Before going to sleep, repeat aloud, “Tomorrow morning I will remember my dreams.” Say
it 10 times slowly, like a chant.
2. Keep a paper and pen next to your bed. Upon awakening, record your dream in the greatest
detail possible. If you do not remember a dream, lie quietly and see what comes to you. Very
often, any images or pictures that come to you are pieces of a dream.
 Classic Gestalt Techniques  57
3. After accumulating several weeks of notes on dreams, review them. What kinds of situations
and which people occur most often? Notice images, sounds, colors, tastes, or smells that
occur.

Sort your dreams in any way that seems meaningful to you. A dream is a personal letter to
yourself. Dreams are windows to the subconscious.

Technique: Mothers and Fathers/Husbands and Wives

Counseling Intention To evoke resentment and resolve conflict.
Description Perls called resentment “the bite that hangs on.” Resentment is
eclipsed in guilt. The two always go together. Any time you feel guilty,
you resent the person you feel guilty toward. When you feel resentful,
Downloaded by [New York University] at 04:58 12 August 2016

you also want the other person to feel guilty. This exercise seeks to
destroy symbolically the object of resentment.

Close your eyes and picture your mother (father, husband, or wife) in your mind’s eye. Bang
on a pillow and scream until you have discharged completely the resentment held toward this
individual. Seek to destroy symbolically this oppressive individual. Become so physical with the
pillow that you could answer yes to the question “Is the individual dead?”
Next, name all things that you hate a person for: “I hate him or her for beating me when I was
a kid.” “I hate him for embarrassing me in front of my friends.” “I hate him for being so abusive
toward my mom and for dying before I grew up.” Then look at these resentments and forgive
the person for it. If you get your feelings out, you will free the self from a demoralizing conflict.
In addition, you can no longer go back and blame that individual again because, symbolically at
least, he or she is dead inside you.

Technique: Reviewing Past Experience in the Here-and-Now

Counseling Intention To assist clients who are suffering from post-traumatic stress disorder,
unresolved conflicts, or unfinished business; to encourage the client
to reenact stories from the past by bringing them in present-tense lan-
guage (Levitsky & Perls, 1973).
Description The therapist should encourage re-experiencing the emotion so that
the confusion, the fright, and the panic of a past event are experienced
again in the present. For example, if a client says, “I was walking
down the street and I felt disoriented,” the therapist may have the
client restate this as though it were happening in the present and in
greater detail so that the statement might be, “I am walking down
Elm Street. It is 10 am. The air is humid and I feel hot and sticky. I am
aware that I am lightheaded and confused. I realize that I am lost and
I am feeling scared. Now I am feeling a sense of panic” (Crose, 1990,
p. 283).

This maneuver allows the client to relive the experience rather than merely report what had
occurred. By bringing the incident into the here-and-now, the therapist can facilitate the client’s
closure on the disturbing past event. Bringing past feelings into present awareness can assist a
client in the final development state of ego integration.
 58  Classic Gestalt Techniques

Technique: Dialoguing
Counseling Intention To process or articulate feelings of resentment.
Description Identify someone for whom you have strong feelings of resentment.
Sitting in a chair, get in touch with all the emotions, feelings, and
behaviors that you resent about the individual. Verbally express your
resentful feelings.

Next, switch chairs; think about what behaviors you demand they change. Identify your feel-
ings toward the individual when they change the behaviors you resent. Verbally express your
demands to that person. Finally, switch chairs again and think about the things that you appreci-
ate about the individual.
Identify your feelings of appreciation for this individual. Verbally express all your feel-
ings of appreciation to this individual. Shift back and forth, switching chairs between
Downloaded by [New York University] at 04:58 12 August 2016

resentment, demands, and appreciation. The therapist assists the client in processing the
experience.

Technique: I Take Responsibility for _____

Counseling Intention To help a client accept personal responsibility for his or her own feel-
ings (Levitsky & Perls, 1973).
Description Have the client make a statement aloud describing personal feel-
ings and then add, “I take responsibility for it.” For example, if
the client often feels helpless, he or she might say, “I feel helpless,
and I take responsibility for it.” Other feelings that can be the
objects of this exercise are boredom, isolation, rejection, or feeling
unloved.

Technique: Developing a Personal Vocabulary of Sight, Sound, and Movement

Counseling Intention To identify one’s personal vocabulary by expressing perceived sights,
sounds, and motions all at once as preverbal language.
Description With chalk, crayons, pens, brushes, and paints, instruct the clients
to draw. Make happy lines, tender lines, angry lines. Fill in shapes
that express something about the self. Try different colors and vari-
ous combinations of shapes. Recognize those that have significance.
“You learn for yourself your own visual language; in creating your
individual way of expression, you discover the messages you give your-
self” ’ (Rhyne, 1970, p. 277). Next, begin making sounds to express
the form that is emerging from the paper. Let the sounds flow with
the lines being drawn; synchronize visual rhythms with vocal ones.
Next, stop drawing and direct the clients to express what has been
drawn by moving their body: stand up and dance, lie down and roll,
sit and rock, crawl, stomp, wiggle, leap, or curl up to convey what is
being felt.

Process that movements are part of private sensory language and sounds are a way of saying
something without wordiness. Communicating nonverbally, with sights and sounds and move-
ments, sending and receiving messages, is one’s personal preverbal vocabulary.
 Classic Gestalt Techniques  59

Technique: Creating Yourself with Clay

Counseling Intention To accept one’s being (Rhyne, 1970).
Description Ten to twelve people sit on the floor in a large circle facing each other.
Each is given lump of clay. Direct them to feel and explore the clay;
mold the clay; change its surface, texture, and form. Press, twist,
squeeze, stretch, break, gouge, fold, smooth, scratch, and caress the
clay, becoming aware of their feelings as this is done. With eyes closed,
stay with the feelings.

Play-fantasize as if you were dreaming—play a game with yourself in pretending this lump of clay
is you. You can create yourself by what you do to yourself. Do what you feel like doing, and feel what
you like doing. Do not try to conceive of any representation of yourself or try to form any image of
yourself. Open your eyes and see the form you have created. Be aware of your identity with it and
Downloaded by [New York University] at 04:58 12 August 2016

of how much you can accept the clay as being an expression of you. As you look at your clay figure,
relax your eyes, letting them become receivers of your image and your perception of yourself. Begin-
ning with your eyes, relax your whole body. Lie down on the floor in a comfortable position and
let yourself go on a fantasy trip. For a few minutes, imagine that there is no one in the world but
you. What are you? You are not a simple, monumental being. You are a complex structure, with
many parts making up the whole. Physically, emotionally and spiritually you are continuously in
motion within yourself. Every part of you is affected by every other part—you cannot separate your
mind from your body from your soul. Your breathing affects your feeling, your thinking affects
your breathing; when you feel fear, you become tense, when you become tense you can’t feel—when
you don’t trust your senses, you think so much you can’t know anything that makes sense. All of
these complex, interwoven patterns are you. You are a whole, too, functioning as a figure with the
world around you as your background. You are a constellation in a galaxy. You are enough to
make you dizzy. Allow yourself to be dizzy. Stop analyzing, stop thinking and allow yourself to sense
and accept your being as you are. Let yourself flow with yourself wherever your fantasies take you.
(Rhyne, 1970, pp. 278–279)

Instruct members to come back to the world of the here-and-now. They may speak to oth-
ers about their experience, but also understand that words cannot describe the totality of their
experience.

Technique: Yourself and an Other in Space

Counseling Intention To communicate graphically (Rhyne, 1970).
Description Place a large piece of blank paper and chalks of many colors between
partners. Direct the partners to look at each other until they feel they
have made contact and on some level know each other. Direct them to
look at the paper between them. The paper represents an environment in
which partners are being together. Have them draw on the one sheet at
the same time. Discover what each feels in sharing his or her relationship
with the other within that space. Using lines, shapes, and colors, they
must communicate nonverbally. While drawing, partners can demand
that space be left alone; push his or her partner into a corner; share some
areas or the whole page; go toward or retreat from each other; support,
cross out, cover up, or cooperate with each other. Each can oppose, lead,
or follow his or her partner. Process how each person graphically com-
municated and how well each gave and received messages.
 60  Classic Gestalt Techniques

Technique: An Other Who Is Also You

Counseling Intention To explore and discover awareness with clay (Rhyne, 1970).
Description Provide clients with a large amount of clay. Direct them to move the
mass with their hands and express what they are feeling. Have the
clients close their eyes and gradually focus their awareness on some
person with whom they have deep emotional ties. With the clay form,
have clients form an image of this person as the client perceives that
person. Process the following: “How much of your emotional energy
is invested in the other?” “Do you know experientially who the other
is in a part of you?” “Can you separate his ‘is-ness’ from your own?”
“Is this other also you?” “Are you making an image of a disowned part
of yourself?” (Rhyne, 1970, p. 276).
Downloaded by [New York University] at 04:58 12 August 2016

Technique: Giving Attention to Another Person

Counseling Intention Partners from a group are given handfuls of clay and a clay board on
which to work to create three images.
Description First, the partners are to sit down back to back on the floor, plac-
ing the clay in front of them. Partners touch as much of each other’s
back, shoulders, head, and arms as can be agreed upon nonverbally.
They are to give full attention to sensing each other, as they perceive
each other to be. Next, they work the clay into an image representing
what impressions they received from each other on making the initial
back-to-back contact. Upon completion of the clay image, partners
turn and face each other and discuss briefly with each other how the
nonverbal responses are reflected in the clay images.

Second, with paper and drawing tools, partners are to sit facing each other and, by making
eye contact, discover as much as they can about each other. Then they draw a portrait of the
other, using only eyes as senders and receivers of messages. The portrait can be representational,
abstract, or symbolic. Upon completion of the portraits, briefly discuss the portrait without
going into detailed interpretations or explanations.
Third, partners should try knowing each other through hands. They should touch and explore
each other’s hands; move each other’s hands together; and be aware of feelings, desires, and
resistances and what each is trying to convey. Each partner is to draw a representation of how he
or she felt he or she was experienced through the exploration of his or her hands.
Using the three images as a reference, partners speak to each other using words, touching,
drawing, movement, and perhaps silence to reflect on the experience.

Technique: Creating a World That Is “You”

Counseling Intention To graphically represent on a primitive level one’s perception of ter-
ritoriality and how it affects and is affected by one’s relationship with
another person (Rhyne, 1970).
Description Provide a collage and collection of art materials such as paper, wood,
wire, leaves, stones, magazines, newspapers, cardboard, or parts of
boxes. The client is to create his or her world from the materials pro-
vided. The client is to choose any material he or she feels like and
use them in any way he or she has a feeling for doing. The important
goal is for the client to see his or her own world and recognize it for
 Classic Gestalt Techniques  61
what it is. From a Gestalt point of view, the client should embrace
that “I structured this world with materials I chose; within the limits
of what is possible for me, I take responsibility for creating my own
personal world” (Rhyne, 1970, p. 283).

Technique: Accepting and Rejecting What Is Offered

Counseling Intention To become aware of feelings and to express them.
Description Sit in a closed circle of 10 to 12 members with one sheet of paper
and felt-tip pens in many colors. The client begins drawing on his or
her sheet of paper, starting but not finishing a graphic description of
something important to him or her. The members are instructed to
pass their drawings to the person on the left, at the same time receiving
Downloaded by [New York University] at 04:58 12 August 2016

a drawing from the person on the right. Members are to work on the
drawing they received as if it were their own, adding and changing it
at will. This rotating process continues until the members receive their
own original drawings.

Upon receiving their modified drawing, members should be directed to become aware of how
they feel on seeing the expressions of others imposed on their drawing. Process the following
questions: Is there anything of you left in that composite drawing? Is there anything that is not
you but that you would like to keep? Are there areas you would like to obliterate? What do you
want to do with this pattern that is in your hands now? Using art materials, what can you do?

Technique: Making a World Together

Counseling Intention To explore, experience, and express what is not imaginary (Rhyne, 1970).
Description Members sit around a large paper circle with a pile of assorted stuff
such as odd shapes of colored paper, pieces of string, straw, beads, bits
of wood, and foam rubber. Members are to pretend that the circle is a
space where they as a group can create a world and use the materials to
create a Gestalt, a figure on and related to the background of his or her
world—the world made here-and-now among them. Each member is
to choose what he or she wants to represent himself or herself in the
world. They will use scissors, crayons, and glue to create a collage on
the circle, representing their interrelationships and how they perceive
themselves as being in one limited environment.

Members are encouraged to talk with one another as they work. Instruct them to be aware of
each one’s personal role in this process and to reflect on feelings of how much they are doing
now, as well as in their real-world living situation. Process that this is an imagery game that makes
concrete and explicit the members’ acceptance of self as an active creator of the world of process
with many others and that what members are being and doing in an environment that is nothing
in itself: With our capacities for awareness and our abilities for action, we make our own world out
of materials available to us.

Technique: Parent Interview

Counseling Intention  To help clients discover changes they want to make in themselves.
Description The therapist invites the client to be the parent who seems most
ambiguous or aloof to him or her. The therapist then invites that
 62  Classic Gestalt Techniques
parent by given name to talk to the therapist about his or her own life
feelings and experiences. The client enters the internal parent ego state
and discloses information to which the client may not be aware he or
she has access. In the parent interview, the client’s voice, demeanor,
attitude, and vocabulary change and approximate the parent ego state
from early life. The values and beliefs of the parent also become clear.
The client is often surprised at the information available through the
parent interview. Other members in the group corroborate for the cli-
ent the changes gone through during the process (Gladfelter, 1990,
1992).

Conclusion
Downloaded by [New York University] at 04:58 12 August 2016

Gestalt therapists try to help clients become aware of their feelings through the use of a variety of
techniques. One of the unique approaches in Gestalt therapy is telling clients to “own their own
feelings” by talking in an active rather than a passive way. For example, “I feel anxious when he’s
around” instead of “He makes me anxious when he’s around.” Redecision therapy is a hybrid
therapy that employs a lot of techniques from theories such as Gestalt therapy.

Gestalt therapy has been successfully employed in the treatment of a wide range of psy-
chosomatic disorders. Gestalt therapists have successfully worked with couples, with indi-
viduals having difficulties coping with conflict or authority figures and with a wide range of
individuals with emotional conflicts. Gestalt therapy probably has a greater range of styles
and modalities than any other classic theoretical perspective. The wide range of experiential
activities outlined in this chapter demonstrates this propensity. Gestalt therapy is practiced in
individual therapy, groups, workshops, couples therapy, families, and with children and ado-
lescents. It is practiced in clinics, family service agencies, hospitals, private practices, growth
centers, agencies and the workplace.
(Yontef, 1993, p. 166)

The styles in each modality vary dramatically on many dimensions: type of structure; quality of
techniques used; frequency of sessions (intensive workshop sessions, such as a weekend work-
shop often are more productive) supportive relationships; focus on body, cognition, feelings,
interpersonal contact; knowledge of and work with psychodynamic themes; and degree of per-
sonal encountering.
Gestalt therapy is not concerned with the whys of the client’s behavior, which may have
emerged from the client’s past history, experience, or unconscious. Gestalt therapy focuses on
present characteristics in the “here-and-now” of the client’s behavior of which he or she is una-
ware. The unaware is broader than the unconscious, including not only material that has been
repressed, but also material that has faded or become blind spots.
 5 Therapeutic Expressive Techniques
Art Therapy, Dance/Movement
Therapy, Phototherapy, Drama
Therapy, and Music Therapy

The expressive or creative arts therapies included in this chapter are art therapy, dance therapy,
Downloaded by [New York University] at 04:58 12 August 2016

phototherapy, drama therapy, and music therapy. The use of creative expressive techniques pro-
vides the therapist with a more multifaceted approach to helping clients. For example, many
retirement communities pipe in music from the era that the residents grew up with, and many
elementary schools pipe in classical music in the hallways to create a calming effect. Creative
expressive approaches and specifically the use of creative techniques allow the therapist to
approach an issue from a multisensory vantage point, tapping into a client’s visual, auditory, and
experiential learning style and identify “blind spots or “pinch points” (triggers that irritate the
client) in their relationships with themselves and others. These therapies use art modalities and
creative processes during intentional interventions in therapeutic, rehabilitative, community, or
educational settings to foster health, communication, and expression; to promote the integra-
tion of physical, emotional, cognitive, and social functioning; to enhance self-awareness; and
to facilitate change. Although unique and distinct from one another, the creative arts therapies
share related processes and goals, providing meaningful therapeutic opportunities for awareness
and self-expression that may not be possible through more traditional therapies. Brown (1996)
maintained that “both the therapists and members can expect to realize benefits from using the
expressive process.” Beaulieu (2003) reinforces the concept that therapists need to “get beyond
words and enlist more of the client’s senses. The counselor will find the counseling process to
be enhanced and expanded, and group members can expect progress toward their individual
therapeutic goals” (p. 19).

Art Therapy
Art therapy is a human service profession that uses art media, images, the creative process, and
patient/client responses to their created products as tangible products that symbolize the client’s
inner world reflections of an individual’s development, abilities, personality, interests, concerns,
and conflicts. Art therapy is reaching and touching emotions through artwork to promote the
recognition and identification of feelings about oneself and others. This nonverbal process allows
clients to work through concerns, conflicts, and unresolved issues in a therapeutic setting. The
goals of art therapy are to move toward healing and growth. The therapeutic outcome can be
enlightening, empowering the client with a stronger sense of awareness, identity, accomplish-
ment, and self-knowledge.
Using art materials in a psychotherapeutic environment for the purpose of self-disclosure
allows the client to connect with the symbolic language of the unconscious. Art therapy practice
is based on human developmental and psychological theories, and can be used for diagnostic pur-
poses as well as therapeutic understanding. It is implemented in the full spectrum of models of
assessment and treatment, including educational, psychodynamic, cognitive, transpersonal, and
other therapeutic means of reconciling emotional conflicts, fostering self-awareness, developing
 64  Therapeutic Expressive Techniques
social skills, managing behavior, solving problems, reducing anxiety, and increasing self-esteem.
It is especially conducive for populations who tend to be nonverbal (such as children) or for cli-
ents who overintellectualize and have difficulty reading other parts of their psyche. Art therapy is
an effective treatment for the developmentally, medically, educationally, socially, or psychologi-
cally impaired, and it has been practiced in mental health, rehabilitation, medical, educational,
and forensic institutions. Art therapists work with individuals, couples, families, and groups and
serve populations of all ages, races, and ethnic backgrounds. Research in art therapy has included
studying the influence of depression on the content of drawings, using art to assess cognitive
skills, the correlating psychiatric diagnosis and formal variables in art, and the effect of art therapy
interventions as measured by single-case designs.

Technique: Melting Mirror

Counseling Intention To identify early memories that made deep impressions.
Downloaded by [New York University] at 04:58 12 August 2016

Description Reach back to childhood imaginatively. As you look at yourself in a

mirror, it seems to melt and the image wavers. When it settles it reveals
you as a child in a room in your house. Imagine the room and a con-
versation between you and your child-self. What does the child say to
you? What do you reply? Paint the situation and see if there are any
messages in it for you now (Liebman, 1986. p. 145).

Technique: Life Priorities Collage

Counseling Intention To reassess priorities.
Description On a large piece of paper, paint three horizontal bands of color to rep-
resent far, middle, and near distances. Then cut out or draw pictures
to represent different aspects of your work, family, and social life. Glue
or tape these pictures on the appropriate band of color. When you
have finished, reflect on the results and move pictures around until the
whole feels comfortable (Liebman, 1986, p. 144).

Technique: The Shield

Counseling Intention To deflect negative comments from friends, family, or co-workers.
Description When a client’s anger is a response to feeling attacked by another per-
son, it can be useful to teach them that they have a mental shield. The
therapist provides an 8.5 × 11 piece of Plexiglas to represent a shield
and holds it up to the client. Give it to the client and say, “When I come
at you with a negative comment that hurts your feelings, I want you to
protect yourself with this shield.” The therapist role-plays the client’s
boss criticizing her in a public meeting, but the shield blocks the criti-
cism in advance. Also, have the client practice having a more forceful
voice. Ask, “How does it feel to have some protection?” Explain how
the shield is helpful in dealing with the other person’s negative criti-
cism. The client can deflect the comments instead of internalizing them
and feeling both hurt and anger (Schimmel & Jacobs, 2011, p. 4).

Technique: Advertisements
Counseling Intention To bring up negative feelings that inhibit self-esteem.
Description Have the client draw or paint an advertisement of themselves. This can
involve “selling oneself” and may bring up negative feelings from lack
 Therapeutic Expressive Techniques  65
of self-esteem, and can also involve thinking about the sort of peo-
ple who would be attracted by the advertisement. A variation could
involve a group where members add to each advertisement aspects
that were missed by the client (Lieberman, 1986, p. 148–149).

Technique: Life Priorities Collage

Counseling Intention To reassess priorities.
Description On a large piece of paper, have the client paint three horizontal lines
equally distanced on the page. Then cut out or draw pictures to rep-
resent different aspects of the client’s life work, family, and social life.
Place the pictures on the appropriate band with a glue stick. When
the client has finished, reflect on the results and move pictures around
until the whole feels comfortable. Discuss and process priorities
Downloaded by [New York University] at 04:58 12 August 2016

(Lieberman, 1986, p. 148–149).

Technique: Childhood Memories

Counseling Intention To bring up hurts from childhood that people have repressed or have
been unaware of consciously.
Description Draw your first or early memory, any memory which made a deep
impression. These themes often bring up damaging events from child-
hood that may not have been processed, and can be difficult to deal
with. It is important to allow enough time for discussion of these.
Process:

• A happy childhood memory and an unhappy one.

• A good memory and a bad one.
• An embarrassing moment.
• Memories associated with strong feelings (Lieberman, 1986, p. 148–149).

Dance/Movement Therapy
Dance therapy, also referred to as movement therapy, is the psychotherapeutic use of movement
as a process to integrate the emotional, cognitive, social, and physical processes of the client.
Dance is the most fundamental of the expressive arts, involving direct expression through physi-
cal movement of the body. Based on the assumption that body and mind are interrelated, dance/
movement therapy (DMT) is defined by The American Dance Therapy Association (ADTA) as
“the psychotherapeutic use of movement to further the emotional, cognitive, physical, and social
integration of the individual” (ADTA, 2009, p. 1). Dance therapy effects changes in feelings,
cognition, physical functioning, behavior, and attitude, helping clients to:

• Reduce stress.
• Tap emotions and sensations that people ordinarily avoid.
• Build self-confidence.
• Define boundaries personally and somatically without having to do so in relation to
others.
• Be assertive or intimate without losing sense of self.
• Experience and honor the present no matter what stage of healing.
• Express themselves authentically through dance, movement, music, writing, and art
making.
 66  Therapeutic Expressive Techniques
DMT involves a variety of approaches that focus on a variety of domains: emphasizing aware-
ness and attention to inner sensations; using movement as a form of psychotherapy, expressing
and working through deep emotional issues; emphasizing alignment with gravity and specific
movement sequences; encouraging spontaneous movement; increasing the ease and efficiency
of bodily movement; and addressing the reality of the body “as movement” instead of the body
as only something that runs or walks independently apart from the body. It’s what the author
considers in many situations where the mind says go, but the body says no! Another impor-
tant benefit of dance/movement therapy is social support, and it has the potential to reduce
stress and suffering from depression, mental illness, autism, and cancer; it improves body image,
self-esteem, and chronic pain. It provides cardiovascular fitness and increases communication
skills. Other work in mental health settings includes brain-injured and learning-disabled children,
the elderly, and disabled adults and those who are committed to personal growth.
Downloaded by [New York University] at 04:58 12 August 2016

Technique: Laban Movement Analysis (LMA) (Irmgard Bartenieff)

Counseling Intention To analyze a system of body training; once the client experiences a
physical foundation, emotional and intellectual expression become
richer.
Description LMA is a comprehensive system for discriminating, describing, analyz-
ing, and categorizing movements by observing recurring patterns, not-
ing movement preferences, assessing physical blocks and dysfunctional
movement patterns, and suggesting new movement patterns. It uses
specific techniques that are practiced on the floor, sitting, or standing
to engage the deeper muscles of the body and enable a greater range
of movement and expression (Bartenieff, 1980). It analyzes the “inner
impulse, i.e., a movement sensation, a thought, a feeling or emotion
from which movement originates” (Maletic, 2010, p. 9). More factors
that influence this therapeutic process can be found in Moore and
Yamamoto’s (2012) book Laban Movement Analysis and Harmonic
Theory.

Technique: Authentic Movement (AM)

Counseling Intention To understand dance, movement, and depth psychology.
Description Authentic Movement was developed by Mary Starks Whitehouse and
is heavily anchored in Jungian theory and the notion that the body
functions in relation to the psyche, the self, and the cultural environ-
ment. The technique includes a mover and a witness. The mover lis-
tens for an impulse to move and then follows, or “moves with,” the
spontaneous movements that arise of the witness. The movements
may be in response to an emotion, a dream, a thought, pain, joy, or
whatever is being experienced in the moment. The witness serves as a
compassionate, nonjudgmental mirror and brings a special quality of
attention to or presence in the here-and-now. The role of the witness
is to consciously observe the mover and reflect back what he or she
observed, such as bodily sensations, perceived emotion, mood, and
energy, as well as role and story that the mover may project. At the
end of the session, the mover and witness speak about their experi-
ences together. Movements may or may not be visible to the witness.
Authentic Movement is a powerful approach for self-development,
awareness, and unconditional feedback and provides access to prever-
bal memories, creative ideas, and unconscious movement patterns that
 Therapeutic Expressive Techniques  67
limit growth. It helps with clients experiencing burnout, compassion
fatigue, vicarious trauma, self-discovery, and healing (Pallaro, 1999).

Technique: Rolfing Movement Integration (RMI)

Counseling Intention To restore your structure to balance by changing the movement habits
that perpetuate imbalance.
Description Rolfing movement integration was founded by Ida P. Rolf. Rolfing
rhythms are movement designations that reinforce and help to inte-
grate the structural body changes brought about by the hands-on work
of Rolfing (structural integration, i.e., to improve health by bringing
segments of the body (e.g., pelvis, legs) into proper alignment). RMI
uses a combination of touch and verbal directions to help develop
greater awareness of one’s vertical alignment and habitual movement
Downloaded by [New York University] at 04:58 12 August 2016

patterns to encourage the principles of ease, length, balance, and har-

mony with gravity. Proponents claim RMI improves performance,
increases self-awareness, decreases pain, and improves body image.
“Research has demonstrated that it stimulates the parasympathetic
nervous system, [helps] the recovery of damaged tissue, degenerative
joint tissue and lower back pain” (Bernau-Eigen, 1998, p. 236). Rolf-
ing practitioners must be trained and certified by the Rolf Institute of
Structural Integration in Boulder, Colorado.

Technique: Neurokinetics (Aston-Patterning Bodywork)

Counseling Intention To increase muscle tone, stability stretching, and cardiovascular fitness.
Description Aston-Patterning Bodywork was developed by Judith Aston and
instructs the client into ways of moving with greater ease throughout
everyday activities with the purpose of releasing tension in the body. It
integrates movement, coaching, bodywork, ergonomics, fitness train-
ing, and massage along with toning, stretching, and cardiovascular
fitness (Aston, 1998).

Technique: Rosen Method Movement

Counseling Intention To increase balance and rhythm and create more space for effortless
breathing.
Description The Rosen Method of Movement is body-centered therapy developed
by Marion Rosen to address emotional and physical ailments and how
clients reveal their emotions in their body postures, which often reveal
barriers to full expression and intimacy. Physical therapy is often done
to music in a group setting. Through gentle swinging, bouncing, and
stretching, every joint and muscle in the body experience a full range
of movement. The Rosen Method has been used to reduce stress and
cardiac problems and strengthen weak immune systems (Rosen &
Brenner (1993). Specialized training and supervision is required to
practice as a therapist using the Rosen method.

Technique: The Feldenkrais Method to Movement Therapy

Counseling Intention To reeducate the brain without tiring the muscles.
Description The Feldenkrais method was developed by Moshe Feldenkrais and
consists of specific structured movement experiences to reeducate the
 68  Therapeutic Expressive Techniques
brain without tiring the muscles. Most lessons are done lying down on
the floor or sitting and are designed to improve ability, provide hope
in change, and turn the once difficult into easy by bringing awareness
through movement and functional integration (Feldenkrais, 2002).
Additional training and certification in this method are required.

Conclusion
In addition to those with severe emotional disorders, people of all ages and medical conditions
can receive dance/movement therapy. Examples of these are individuals with eating disorders,
adult survivors of violence, sexually and physically abused children, dysfunctional families, the
homeless, autistic children, the frail elderly, and substance abusers. An emerging area of speciali-
zation is using dance/movement therapy in disease prevention and health promotion programs
Downloaded by [New York University] at 04:58 12 August 2016

and with those who have chronic medical conditions. Many innovative programs provide dance/
movement therapy for people with cardiovascular disease, hypertension, chronic pain, or breast
cancer.
The American Dance Therapy Association requires the credential of board-certified dance/
movement therapist (DMT) as the required credential for teaching, supervising, or using dance
therapy in private practice. Essentially, there are two alternatives to training: 1) an approved
ADTA graduate program, or 2) a master’s degree and additional specific dance/movement ther-
apy coursework, fieldwork, and an internship.

Phototherapy
Phototherapy can be a therapeutic tool, especially in the age of social media (Suler, 2008). In par-
ticular, it can be used in interventions with clients who have body image disorders (Fisher-Turk,
2005).Online communities such as Facebook, Twitter, LinkedIn, and others have changed the
way we interact and communicate with others, and significant life experiences such as birthdays,
anniversaries, weddings, and other celebrated events now have a wider audience. Social network-
ing sites spread information more rapidly than any other form of media. Social media has the
potential to facilitate social and political change and disseminate useful information rapidly from
social events and breaking news such as “Amber Alerts.” Law enforcement has begun to use
social networking to identify the patterns and connections of potential criminals, and potential
employers and university admissions directors are beginning to view Facebook sites, for example,
to gain insight into potential candidates’ character. Unfortunately, on the down side, terrorists
often use and review social networking sites to gather information, and it has also promoted
cyber bullying and online harassment among school children.

Technique: Therapeutic Online Photosharing in Social Media

Counseling Intention To share photo of one’s self in order to reveal more about himself or
herself such as personality, relationships, and lifestyle.
Description The client selects an image that may represent something about them-
selves in the past, an anniversary, the present, or a future endeavor.
This provides an opportunity to comment on a client’s image within
an online setting, which is another way in which written interactions
occur in photo-sharing communities. These therapeutically written
interactions, unlike verbal interactions, offer the client the opportu-
nity to reread comments at any time much like a journal or diary.
The image can be psychologically pleasing and elicit strong emotion,
 Therapeutic Expressive Techniques  69
validation, or opinions by others from cyberspace in social media.
“These comments may be simple compliments, critiques and technical
remarks, personal reactions, interpretations of the photographer, topi-
cal comments, or questions” (Suler, 2008, p. 559). “The therapeutic
effect of photosharing groups could be compared to a self-help group
which has a focus on overcoming or coping with life stresses” (John-
son & Johnson, 2009, p. 502). However, it could have detrimental
effects if feedback is given negatively, yet it can also lend itself to per-
sonal insight. Negative comments should be initiated by the client and
not the therapist. Irrational perceptions should be disputed.

Technique: Phototherapy to Change Women’s Negative Self-Images

Downloaded by [New York University] at 04:58 12 August 2016

Counseling Intention (Fisher-Turk, 2005) combines black-and-white photography and jour-

nal writing as a medium for changing women’s negative self-images
as the result of body dysmorphic disorder (anorexia, bulimia); over-
weight; and those who have negative feelings about their bodies as the
result of rape, incest, sexual abuse, surgery, or diseases such as cancer.
Description “Phototherapy uses a woman’s multiple images to shift her negative
self-image. By being seen and not judged, by being photographed
nude and seeing what they’re most afraid of seeing, women have the
opportunity to reconstruct how they see themselves” (Fisher-Turk,
2005, p. 1). Clients are given sheets of 36 pictures on a page and are
asked to keep a journal of the experience of being photographed to
re-experience their individual beauty, their uniqueness, their potential,
and their personal strengths. The clients choose the positions and set-
tings, and the therapist uses her camera to make a bridge to get past
their pain and critical self-judgments to allow them to be their real
selves in a secure setting.

The therapist and clients gently confront their visual depictions of themselves without other
people’s opinions filtering the process, concluding how many of their perceptions and expecta-
tions often arise from internalizing other people’s projections about them, rather than reflecting
on their own true “inner self.” Thus, a client begins to understand that only she, and not other
people’s perceptions, is actually responsible for initiating desired changes and improvements.
The onus of responsibility to change behavior and proceed with more positive actions gives
clients a voice through their photographic depictions of various aspects of their personal lives.

Conclusion
In most counseling circles, phototherapy is accepted as a way to use photography, including
personal snapshots, in psychotherapy. Clinicians use these techniques to help clients address road
blocks or attributes of themselves not noticed prior to intervention. A caveat: some practitioners
who are not therapists practice therapeutic phototherapy, which can be damaging without the
appropriate orientation and training. Without clinical training in counseling and psychotherapy,
a practitioner may not fully understand the importance of the therapeutic alliance between cli-
ent and therapist and may interject his or her own personal bias. Phototherapy requires the
involvement of a professionally trained therapist to formally guide and support the process of
using emotional information unconsciously embedded in the client’s personal photographs for
self-awareness and understanding.
 70  Therapeutic Expressive Techniques

Drama Therapy
Drama therapy is the systematic and intentional use of drama/theater processes, products, and
associations to achieve the therapeutic goals of symptom relief, emotional and physical inte-
gration, and personal growth. Drama therapy is an active approach that helps the client tell
his or her story to solve a problem, achieve a catharsis, extend the depth and breadth of inner
experience, understand the meaning of images, and strengthen the ability to observe interper-
sonal roles and intrapersonal feelings. The balanced verbal and nonverbal components of drama
therapy, with its language of metaphor, allow clients to work productively within a therapeutic
alliance.
Drama therapy benefits many client populations and is used in a variety of settings. Drama
addresses the needs of people from young children to the elderly. It can be used in the assessment
and treatment of individuals, couples, families, and groups, and in settings such as psychiatric
hospitals, mental health facilities, day treatment centers, nursing homes, centers for the physi-
Downloaded by [New York University] at 04:58 12 August 2016

cally/developmentally/learning disabled, substance abuse programs, schools, businesses, and

correctional facilities.
Benefits associated with drama therapy are reducing feelings of isolation, developing new
coping skills and patterns, broadening the range of expression of feelings, experiencing posi-
tive interactions, and developing relationships. Drama therapy is firmly rooted in a belief
in the healing power of drama. It is dynamic, active, and experiential. This approach can
provide the context for participants to tell their stories, set goals, solve problems, express
feelings, or achieve catharsis. Through drama, the depth and breadth of inner experience
can be actively explored and interpersonal relationship skills can be enhanced. Participants
can expand their repertoire of dramatic roles to find that their own life roles have been
strengthened. Behavior change, skill building, emotional and physical integration, and per-
sonal growth can be achieved through drama therapy in prevention, intervention, and treat-
ment settings.

Technique: Life-Size Dolls
Counseling Intention To open a new avenue of creativity to deal with life issues.
Description Life-size dolls may be cast as family members, significant others,
a teacher, a child, and other important characters in stories yet to
come. A life-size doll can also represent an externalized problem (i.e.,
anger) or that inner voice that comes forth in a discovery of personal
agency or a secondary character in the retelling of a personal history
Dunne, 2014, p. 1). Clients project their issues through their life-size
dolls.

Technique: Masks
Counseling Intention To reveal feelings, emotions, and perceptions previously not
expressed.
Description Through the use of masks, the client learns more about himself or
herself and reveals feelings, emotions, and perceptions previously not
expressed. “The client experiences the world with a new freedom and
creativity. The mask transforms the client into a different persona.
The mask as another persona helps the individual explore aspects
of the self and functions as double aspects of the person” (Dunne,
2014, p. 1).
 Therapeutic Expressive Techniques  71

Technique: Life Scripts

Counseling Intention To break out of old patterns and explore new ones.
Description “Creating an autobiographical script allows clients an opportunity for
integration and synthesis of important life experiences” (Dunne, 2014,
p. 1). It provides a significant advantage for review and documentation
of a therapeutic and self-evolving process and allows the opportunity
to break out of old patterns of interacting with self and others and a
chance to explore new life scripts. “The life script presentation may
be centered in ritual, dance or multimedia formats, and represent any
of the following dramatic methods such as Greek theatre, stand up
improvisation, living newspaper, ritual, mime vignette or any other
creative theatrical style” (Dunne, 2014, p. 2).
Downloaded by [New York University] at 04:58 12 August 2016

Technique: Narradrama
Counseling Intention To gain greater self-knowledge and awareness.
Description “Any form of drama (i.e. story, life script, sculpture, scene) is explored
from a narrative perspective which allows a client to change a rela-
tionship or a problem by exploring alternative directions and unique
outcomes” Dunne, 2014, p. 2) (e.g., times when clients manage not
to be controlled by their problems—much like solution-focused ther-
apy). Drama therapy and narrative processes open space for alternative
meanings and possibilities. The gains in awareness and self-knowledge
come through experiencing oneself in an empowering way against the
problem.

Technique: Photo and Drama Therapy

Counseling Intention To reduce or relieve painful psychological symptoms and to facilitate
psychological growth and therapeutic change.
Description By integrating phototherapy and drama therapy, the trained drama
therapist aims to accomplish the following goals: “(1) evoke various
emotional feelings and states; (2) elicit verbal response or confronta-
tion (i.e., carefrontration); (3) model and/or master a new positive
enhancing skill; (4) facilitate greater socialization and (5) encourage
creativity and expression” (Dunne, 2014, p. 2).

Conclusion
As clients process the layers of meaning contained within their photograph, they also reveal
underlying information about themselves, such as their inner value system, beliefs, attitudes,
preconceived notions about their worldview, and expectations that accompany their perception
of their photos that they have collected or their perceptions of their own bodies over time.
Phototherapy is not about the therapist interpreting the client’s photos for him or her; the
input should always come from the perspective of the client. Together, the client and therapist
explore the image, the emotional impact, the perceptions, and the associated feelings that each
photo evokes in the client. Therapists trained in phototherapy techniques are taught to look for
patterns of responses, repeated themes, symbolic content, and emotional reactions indicating
inner feelings that the client may or may not be cognizant of in the here-and-now, allowing cli-
ents to express aspects of themselves that words alone could not fully express.
 72  Therapeutic Expressive Techniques

Music Therapy
Music therapy unites the fields of music and therapy to provide a creative treatment and medium.
It combines music modalities with humanistic, psychodynamic, behavioral, and biomedical
approaches to help clients attain therapeutic goals that are usually mental, physical, emotional,
social, and/or spiritual in nature. Problems or needs are addressed through the therapeutic rela-
tionship between the client and music therapist, as well as directly through the music itself. Music
is one of the most social art forms, in that it creates communication between people in many
different ways. Many studies have been done on the beneficial physiological changes promoted
by music on mood, blood pressure, breathing, pulse rate, respiration, cardiac output, heart rate,
muscle tension, pain, and relaxation. Music therapeutically addresses physical, psychological,
cognitive, behavioral, and/or social functioning.
Music therapists work in a wide variety of settings with the emotionally disturbed, the learning
disabled, the mentally handicapped, and the physically challenged. They also work with clients
Downloaded by [New York University] at 04:58 12 August 2016

with psychiatric disorders, alcohol and drug problems, and neurological disorders, and those who
are terminally ill. Music therapists offer services in skilled and intermediate care facilities, adult
foster care homes, rehabilitation hospitals, residential care facilities, hospitals, adult day care cent-
ers, retirement facilities, senior centers, hospices, senior evaluation programs, psychiatric treat-
ment centers, and other facilities. Music therapists also work for agencies that provide in-home
care. Music therapy is also used with healthy individuals to assist in stress reduction, childbirth,
and biofeedback. Advanced opportunities in education and private practice are possible.

Music Therapy for Families and Children:

• Provides a forum to share common experiences and enjoyment as a couple or family.
• Gives meaningful time spent together in a positive, creative way.
• Achieves unity and intimacy for families through verbal and nonverbal interaction therapy.
• Stimulates all of the senses and involves the child at many levels. This “multimodal approach”
promotes developmental skills.
• Allows play to occur naturally and frequently.
• Resolves conflicts, leading to stronger family and peer relationships, as well as positive
changes in mood and emotional states.
• Can help a child manage stressful situations.
• Encourages socialization, self-expression, communication, and motor development, as well
as helps explore personal feelings and therapeutic issues such as self-esteem or personal
insight.
• Improves reality testing, problem solving, concentration, and attention span, as well as
develops independence and decision-making skills.
• Because the brain processes music in both hemispheres, it can stimulate cognitive function-
ing and may be used for remediation of some speech/language skills (Bartlet, Kaufman, &
Smeltekop, 1993; Boldt, 1996).

Music therapy may serve as a positive outlet for interaction, providing fun activities that can
include parents, siblings, and extended family. Often, music therapy allows a family to see a child
in a new light as the child’s strengths are manifested in the music therapy environment. Music
therapy can be an eclectic one that encompasses concepts found in Rogerian psychotherapy
(humanistic), cognitive behaviorism (e.g., positive self-talk), and Jungian psychotherapy (analyti-
cal) to help clients attain their therapeutic goals. Bruscia (1998) maintains that “music therapy
is a systematic process of intervention wherein the therapist helps the client to promote health,
using music experiences and the relationships that develop through them as dynamic forces of
 Therapeutic Expressive Techniques  73
change” (p. 18). The American Music Therapy Association (AMTA, 2004) defines music therapy
as “the clinical and evidence-based use of music interventions to accomplish individualized goals
within a therapeutic relationship by a credentialed professional who has completed an approved
music therapy program” (p. 2).
Music therapists have been successful in a wide variety of settings with the emotionally dis-
turbed, the learning disabled, the mentally handicapped, and the physically challenged. They also
work with clients with psychiatric disorders, such as schizophrenia, depression, substance use
disorders, trauma, neurological disorders, Parkinson’s disease, Alzheimer’s, brain injuries, and
those who are terminally ill who are dealing with cancer pain. Music therapy is also used with
healthy individuals to assist in stress reduction, childbirth, and biofeedback (Bartlett, Kaufman, &
Smeltekop, 1993; Boldt, 1996).

Technique: Rewriting “What a Wonderful World” by Louis Armstrong

Downloaded by [New York University] at 04:58 12 August 2016

Counseling Intention To focus on the emotional and cognitive domain through emotional
expression and lyric analysis.
Description Supplemental materials needed for this technique are “What a Won-
derful World” lyrics, “Happy List” worksheet, “What a Wonderful
World” with blanks worksheet, guitar, “What a Wonderful World” gui-
tar chords, and writing utensils. Observe participation, appropriate or
inappropriate responses, reality orientation and emotional expression.

1. Hand out lyrics to “What a Wonderful World.”

2. Sing and discuss “What a Wonderful World” and give clients copies of the song’s lyrics.
3. Give client(s) a pencil and worksheet(s).
4. Have client(s) list five things that make them happy on the “Happy List” worksheet.
5. Using things from client(s)’ “Happy Lists,” fill in blanks to “What a Wonderful World”
worksheet.
6. Sing new version of the song with client(s)’ answers (Clayton, 2010, p. 2).

Happy List
1._________________________________________________________
2._________________________________________________________
3._________________________________________________________
4._________________________________________________________
5._________________________________________________________

Technique: Identifying “True Colors” by Cyndi Lauper

Counseling Intention To get closer to the emotions of adolescents and adults through lyric
analysis and integrated arts.
Description The materials needed for this technique are a recording of “True
Colors” and CD player or guitar and song chords, lyrics sheets, “9
Tips for Building Self-Esteem” worksheet, large roll of paper (big
enough to cover a table), and drawing utensils (Clayton, 2010, p. 3).

1. Introduce and play the song “True Colors.”

2. Go over the song, analyzing the lyrics that lead into self-esteem.
3. Hand out self-esteem worksheets and go over them.
4. Have clients think of three things about themselves that they like.
 74  Therapeutic Expressive Techniques
5. Tell clients to draw the things on the paper.
6. Use the finished project as an art poster to hang on the wall (optional) (Clayton, 2010,
p. 4).

Technique: Wastin’ Time to the Song “(Sitting on) the Dock of the Bay” by Otis Redding
Counseling Intention To increase social and emotional permission to take time for one’s self,
reality orientation, appropriate responses, and analyze leisure skills.
Description The materials needed for this technique include guitar or piano, chords
to “Dock of the Bay” by Otis Redding, copies of “Leisure Activities!”
handout, copies of lyrics to “(Sitting on) the Dock of the Bay” by Otis
Redding for each client, white board and marker, or chalkboard with
chalk (Clayton, 2010, p. 5).
Downloaded by [New York University] at 04:58 12 August 2016

1. Hand out lyrics to “(Sitting on) the Dock of the Bay” to all clients and introduce the song.
2. Play the song and encourage clients to sing along.
3. Discuss the lyrics of the song and what “leisure time” is.
4. Have clients come up with 50 (or 75 or 100) positive leisure activities and write them on the
board.
5. Have clients figure out how many hours of leisure time they have per week (subtract amount
of time for work, sleep, eating, and bathing from 168 hours).
6. At the end of group, hand out copies of leisure activities list for clients to keep (Clayton,
2010, p. 5).

Technique: “Lean on Me” by Bill Withers: Tips for Building Trust

Counseling Intention To increase social, emotional, and cognitive trust through lyric analy-
sis, singing along, and reading the content of the message.
Description The materials required for this technique include a guitar or piano,
chords to “Lean on Me” by Bill Withers, copies of “10 Tips for Build-
ing Trust” handout, and copies of the lyrics to “Lean on Me” by Bill
Withers for each client.

1. Hand out lyrics to “Lean on Me” to all clients and introduce the song.
2. Play the song and encourage clients to sing along.
3. Discuss the lyrics of the song and what they have to do with trust.
4. Hand out “10 Tips” worksheet and review them with clients (Clayton, 2010, p. 6).

Ten Tips for Building Trust

  1. Build a reputation for doing things that are kind, helpful, and useful for someone else.
 2. Become more competent every day by embracing lifelong learning because competence
builds trust.
  3. Don’t lose time by procrastination; firm decisions and commitment are less stressful.
  4. Be congruent by matching what you say. Consistency builds trust.
  5. Be transparent. Don’t behave differently in one situation or another.
  6. Project and consistently have unquestionable integrity.
  7. Create confidence by overcommunicating.
  8. Be emotionally intelligent. I.Q. gets you hired, but emotional intelligence (i.e., having posi-
tive relationships with others) gets you promoted.
 Therapeutic Expressive Techniques  75
  9. Preface communication with “Can I be honest with you?” This encourages trustworthiness.
10. When your consciousness is filled with thoughts of faith, confidence, hope, charity, and posi-
tive expectations, it helps you maintain trust (Clayton, 2010, p. 6).

Conclusion
Expressive techniques and the creative arts therapies use arts modalities and creative processes
during intentional intervention in therapeutic, rehabilitative, community, or educational set-
tings to foster health, communication, and expression; to promote the integration of physical,
emotional, cognitive, and social functioning; to enhance self-awareness; and to facilitate change.
Although unique and distinct from one another, the creative arts therapies share related processes
and goals, providing meaningful therapeutic opportunities for awareness and self-expression that
may not be possible through more traditional psychotherapies.
Downloaded by [New York University] at 04:58 12 August 2016
 6 Cognitive-Behavioral Therapy,
Dialectical Behavior Therapy, and
Solution-Focused Counseling

Cognitive-Behavioral Therapy
Downloaded by [New York University] at 04:58 12 August 2016

Cognitive therapy is a focused, problem-solving approach to psychological treatment that was

developed by Aaron T. Beck in the 1970s. Earlier in his career as a psychiatrist, Beck practiced
from a psychoanalytic tradition and found himself frustrated by the painfully slow progress of
his patients. He strove to develop a more direct and potent approach to therapy; his ideas have
become widely known as cognitive therapy (also known as cognitive-behavioral therapy or CBT).
Cognitive therapy is essentially a method that identifies thoughts that produce negative or
painful feelings, as well as result in maladaptive behavior or reactions. Beck discovered that the
primary point of intervention was at the level of a person’s thoughts; if changes are made in
thinking (automatic thoughts, assumptions, and core beliefs), changes in emotions and behav-
ior will follow. Behavioral techniques and strategies are employed as needed to enhance the
treatment outcome (i.e., anger management, relaxation training, graduated exposure to feared
situations, assertiveness training). The course of treatment is typically brief, and people usually
experience relatively rapid relief and enduring progress.

A Meta-analysis on the Effectiveness of Cognitive Therapy

How effective is cognitive therapy, for which disorders, and compared to what? Butler and Beck
(2000) reviewed 14 meta-analyses that investigated the efficacy of cognitive therapy with a total
of 9,138 subjects in 325 studies involving 465 specific comparisons. Meta-analysis is a statistical
approach that allows researchers to aggregate the results of multiple studies and describe these
results in a standard unit known as an effect size.

Features of Cognitive Therapy

• Empirically based. Cognitive-behavioral methods have been shown in controlled studies to
provide effective treatment for numerous clinical problems. Cognitive-behavioral therapy
has been shown to be as effective as drug treatment for depression and anxiety disorders.
• Goal-oriented. The cognitive-behavioral therapist works with his or her patient to set goals
for therapy and to monitor progress periodically to assess whether the goals are being met.
• Practical and concrete. Therapeutic goals focus on solving concrete problems. Typical goals
include reducing depressive symptoms, eliminating panic attacks, reducing or eliminating
compulsive rituals, reducing hair pulling, decreasing procrastination at work, improving
relationships with others, or decreasing social isolation.
• Active. Both patient and therapist play an active role in therapy. The therapist serves as
teacher and coach, teaching the client about what is known about his or her problems and
solutions to those problems. The client works outside of the therapy session to practice the
strategies learned in therapy.
 Cognitive Behavioral, Dialectical Behavioral, and Solution-Focused Therapies  77
• Collaborative. Client and therapist work together to understand and develop strategies to
address the patient’s difficulties.
• Short term. Cognitive-behavioral therapy is short term whenever possible.

To date, this approach to therapy has produced the empirical data to demonstrate therapeu-
tic outcomes. When compared with other treatment approaches, cognitive therapy has dem-
onstrated the following aspects of effectiveness and efficiency. There has been a trend since the
1970s to apply cognitive therapy to an increasingly wider spectrum of disorders. Substance abuse,
post-traumatic stress disorder, bipolar disorder, personality disorders, anorexia nervosa, and schiz-
ophrenia are among the disorders receiving recent empirical attention (Butler & Beck, 2000).

Cognitive-Behavioral Techniques
Downloaded by [New York University] at 04:58 12 August 2016

Millions of individuals suffer from a wide range of emotional distresses because they hold harmful,
mistaken beliefs about themselves and the world around them. This directly or indirectly affects
their relationships with others. Cognitive-behavioral therapy (CBT) is one of the most contem-
porary approaches used in counseling and psychotherapy today. Cognitive-behavioral therapy
(Beck, 1976; Burns, 1989; Ellis & Harper, 1975; McMullin, 1986; McMullin & Giles, 1981;
Meichenbaum, 1977) is a model for client reeducation. It is built on the premise that all behavior
is learned and that new behaviors can be learned to replace faulty patterns of functioning.
Inherently, individuals’ thoughts mediate between feelings and behaviors. Thoughts always come
before our emotional reactions to situations. Individuals experience emotional distress because of
distorted thinking and faulty learning experiences. This approach emphasizes individuals’ capacity
for creating their emotions, their ability to change and overcome the past by focusing on the pre-
sent, and their power to choose and implement satisfying alternatives to current patterns.

Technique: Cognitive Restructuring

Counseling Intention To recognize and stop self-defeating thoughts; to substitute self-
defeating thoughts with positive, self-enhancing, or coping thoughts.
Description Clients are instructed to note what they tell themselves before, during,
and after a problem situation or setting. Further, clients are instructed
to note and record their negative thoughts before, during, and after
stressful or depressing situations for 1 or 2 weeks. A client’s log should
be analyzed for self-defeating and illogical thoughts and the location
of negative thoughts (i.e., before, during, or after the experience).

The therapist helps the client work toward identifying more positive coping thoughts that can
replace the negative ones. Coping thoughts should be incompatible with self-defeating thoughts.
Coping thoughts can be practiced and applied using imagery and role-playing exercises.

Technique: The Cognitive Therapy Process

Counseling Intention To introduce the client to specific steps in resolving problems using
cognitive therapy.
Description Guide the client through the following steps:

1. Help clients become aware of precisely what they think when they feel anxious.
2. Write or record in some way those thoughts so that the client can read them and study the
exact words used.
 78  Cognitive Behavioral, Dialectical Behavioral, and Solution-Focused Therapies
3. Analyze thoughts for errors in thinking. For example, is the client using all-or-nothing
thinking, comparative thinking (“I’m not as good as”), perfectionism, or overgeneralizing?
4. Brainstorm goals to change the client’s unwanted behavior.
SMART Goals
• S - Specific. Clarify and identify steps.
• M - Motivating. Self-motivating begins with stating the goal as “I will.”
• A - Achievable. It has a time frame and it is realistic.
• R - Realistic. The client can succeed.
• T - Trackable. Change can be measured, and progress can be monitored.
5. Break the problem down into workable parts.
6. Analyze possible courses of action by making separate lists of the advantages and disadvan-
tages of pursuing or not pursuing each one.
Downloaded by [New York University] at 04:58 12 August 2016

7. Prepare a backup plan (“Plan B”) by going through the same steps as required for the first
plan. Have the client take action. (Freeman & DeWolf, 1989, pp. 18–19).

Technique: Turning Negative Thoughts about Studying into Positive Thoughts

Counseling Intention To reduce anxiety by turning negative thoughts around or replacing
them with positive thoughts.
Description Three steps:

1. Identify your goals.

2. Try to figure out the negative messages you are giving yourself.
3. Rephrase the message in positive terms (e.g., my goal is to get a “B” in geometry).

• Ask for clients to share a goal, and go through the process with them.
• Have each client practice writing affirmations.
• Lead a “go around” so that all members can practice saying their affirmations aloud.
• Have clients pick the affirmation they like best.
• Tell them to write it 10 times and think it to themselves as they write it.
• Have them practice it every night and at the beginning of every session.

Negative Thoughts:
The work is too hard.
I’m dumber than anyone else. I don’t know how to begin.
I’m tired.

Affirmations:
I am bright and capable. Teachers and friends like me.
I know how to ask questions and get started.
I’m ready for action.

Technique: Reducing Test Anxiety

Counseling Intention To provide strategies to reduce test anxiety.
Description Everyone at some time experiences test anxiety. There are strategies to
reduce this vague feeling of uneasiness that frequently looms before
 Cognitive Behavioral, Dialectical Behavioral, and Solution-Focused Therapies  79
tests and examinations. The following strategies and techniques can
help clients cope:

• Engage in deep breathing exercises for 2- to 5-minute intervals. Instruct the client to close
his or her eyes and concentrate on the air going in and out of the lungs. Take long deep
breaths, fill the lungs and abdomen, hold the breath, and then exhale.
• Tense and relax muscle groups such as your neck and shoulders. This will help you to be
aware of the relaxation of muscles and help you relax more. You will feel more in control of
your anxiety.
• Engage in positive self-talk by thinking about (1) rational responses to counter negative
thoughts, (2) thoughts that help one cope with stress, and (3) thoughts that keep one
on task. Example: “I have the ability to do this.” “A little bit of anxiety is helpful.” “I can
answer this question if I break it down into parts.”
Downloaded by [New York University] at 04:58 12 August 2016

• Visualize doing well.
• Do not fall into the trap of comparing self to others.
• Reward yourself for doing well.

Technique: Gaining Confidence and Motivation to Study

Counseling Intention To think more confidently.
Description Self-discipline, confidence in abilities, and motivation to continue
studies can be accomplished with the following self-statements:

1. Self-statement: “I am responsible.” Compare study time with grades achieved. Prove to your-
self that you are in control of your grades—not luck, fate, or someone else.
2. Self-statement: “I can be in control.” Schedule study time and reward your efforts. Take
pride in your self-control.
3. Self-statement: “I have ability.” Develop ability in study skills, reading and test taking, time
management, and efficiency. Make an effort to gain control of your aptitude and achievement.
4. Self-statement: “I value learning.” (The greater the island of knowledge, the longer the shore-
line of wonder.) Remind yourself that each successful step in school means four things: good
grades, a better career, greater income, and a feeling of self-fulfillment.

Technique: Creative Problem-Solving

Counseling Intention To look at problem-solving more creatively.
Description Sensing Problems

Recognize situations that need improvement and choose one area of concern to explore:

• What needs to be improved?

• What really bothers me?
• What is not working?

Think, brainstorm, seek information, and list alternatives.

Fact-Finding
Identify attributes, aspects, and facts related to the area of concern:

• Why am I concerned?
• Who is involved? What is involved? Where? How? When?
• How does the situation affect others? Observe, ask questions, and list alternatives.
 80  Cognitive Behavioral, Dialectical Behavioral, and Solution-Focused Therapies
Problem-Finding
Examine the facts and analyze the situation. Look at the various aspects of the situation from
different points of view. Restate the problem as questions until one that best describes the situ-
ation is found.

• Who is involved? What is involved? Where? When?

• How many ways can I state the problem (i.e., flexibility)?
• How can I review, analyze, brainstorm, and list alternatives?

Idea-Finding
Explore and generate alternative ways of improving or solving the problem (i.e., fluency). What
are all the possible solutions to this problem? What could be done to improve the situation?
Downloaded by [New York University] at 04:58 12 August 2016

Brainstorm; graphically organize information; and develop lists, charts, or other cognitive maps.

Solution-Finding
Examine all ideas and select five that seem most appropriate. Develop criteria for analyzing and
evaluating ideas to improve the situation or to solve the problem. Select the best idea to imple-
ment and try it.

Acceptance-Finding
Develop a plan of action by describing what needs to be done and how to accomplish it.

• Ask questions.
• Construct an idea web.
• Put a plan into action and evaluate the results.

Technique: Strategies and Attitudes in Problem-Solving

Counseling Intention To reach the best possible solution.
Description

1. Do not settle for the first plan presented.

2. Search vigorously for alternatives.
3. Examine how the problem is perceived. Are there unnecessary assumptions? How else could
the problem be conceived?
4. List possible solutions uncritically, then sift them.
5. Carefully make a comparative evaluation of alternatives (consider consequences and costs).
6. Maintain attitudes of perseverance and playful exploration.
7. Apply subskills of creative thinking.

Technique: Cognitive Focusing

Counseling Intention To help clients crystallize their emotional reactions to certain stimuli;
to help clients clearly identify the causes of their personal unhappiness;
to shift core beliefs that are irrational and replace them with a more
rational belief (McMullin, 1986).
 Cognitive Behavioral, Dialectical Behavioral, and Solution-Focused Therapies  81
Description

  1. Ask the client to relax briefly, clearing the mind and focusing inwardly for the next few min-
utes. Changing the focus from an external to internal focus narrows attention, increasing the
likelihood that images will form.
  2. Present the client with an analogy to help uncover the major sources of discomfort. McMul-
lin (1986, pp. 144–145) provided the “storeroom analogy” as follows: Imagine sitting in
a storeroom cluttered with boxes. In each box is the client’s problems. Each problem has a
different box, and the largest boxes contain the largest problems.
  3. Now picture that the boxes move, one at a time, into the corners of the room so that there
is space to sit down. From a relatively comfortable perch in the middle of the room, survey
the boxes carefully. Pull out the box that the client most wants to open, and open it.
  4. Lift the problem out of the box and look at it. Turn it from side to side so that every aspect
Downloaded by [New York University] at 04:58 12 August 2016

of it can be seen. Try to step outside yourself and watch your reactions to it.
  5. Once the client has selected a problem from his or her “storeroom,” ask the person to focus
upon how he or she feels about the problem.
  6. Instruct the client to focus on the overall emotion that best captures how he or she feels
about the problem.
  7. Once the overall emotion has been defined, involve the client in a careful analysis of various
aspects and components of that feeling.
  8. Have the client recall in detail other similar situations in which he or she has felt that same
emotion.
  9. Have the client resonate those situations with the feelings so that you can confirm that an
association has been made between the anxiety and the situations (past or present).
10. Probe to determine what thoughts sparked the same emotion in each of these similar situa-
tions. In each setting, determine what the client has been saying to himself or herself. What
meaning does the client assign to these situations?
11. Try to help the client switch the emotion. First, ask the client to focus on similar situations
that did not incite the negative emotion. Remind him or her to not simply recall what was
experienced, but to try to re-create the same feelings.
12. Instruct the client to focus on his or her thoughts, beliefs, or what self-talk occurred dur-
ing similar situations when the overall emotion was different. Guide the client through an
analysis of these feelings.
13. Have the client practice replacing those initial feelings (Steps 4 and 5) with those feelings in
the other situations (Step 8). McMullin (1986) maintained the key to switching the emo-
tions is switching the thoughts. Have the client imagine those thoughts when he or she
was not anxious (Step 9, rather than Step 7). Teach the client how to practice this shifting
technique at home, using a variety of concrete examples from the client’s own experiential
repertoire. Continuous rehearsal of shifting from negative to positive emotions is necessary
to assimilate the new behavior.

Technique: Alternative Interpretation

Counseling Intention To encourage the client to suspend judgment until he or she has
obtained more information and to perceive the situation more
objectively.
Description A client’s first impression of an event is usually not the best; later judg-
ments are often more rational. The intent of this exercise is to get
the client to suspend judgment until he or she obtains more infor-
mation and perceives situations more objectively. Between counseling
 82  Cognitive Behavioral, Dialectical Behavioral, and Solution-Focused Therapies
sessions, have the client keep a written log of the worst emotions expe-
rienced during a 1-week period identifying (1) the activating event
and the initial interpretation of this event and (2) thinking about the
event.

After the next session, for the next week have the client continue the log, finding at least four
interpretations for each event. At the next counseling session, help the client rationally decide
which of the four interpretations has the most objective evidence to support the belief. The client
should then be instructed to continue to find alternative interpretations and to actively suspend
judgment until some time and distance provide a more objective assessment. This process should
be continued for a month until the client can assimilate the procedure automatically (McMullin,
1986, p. 11).
Downloaded by [New York University] at 04:58 12 August 2016

Technique: Anti-catastrophic Reappraisals

Counseling Intention To overcome the negative emotion caused by catastrophizing (think-
ing the worst) about situations and events.
Description Clients often distort reality; their exaggerations become habitual,
causing chronic anxiety and chronic dread of unpleasant situ-
ations. The therapist frames a new interpretation to correct the
negative emotion caused by catastrophizing. List the situations
the client catastrophizes. Record the damage the client antici-
pates for each situation on a continuum from 1 to 10. Discuss
counter-catastrophizing with the client, and record the best pos-
sible thing that could happen in each of the situations. Mark the
extent of the damage for this outcome. Have the client decide,
based on past experience, whether the catastrophic or best possible
outcome is most likely to occur. Have the client use the continuum
to predict danger in upcoming situations that are feared. After the
event actually occurs, have the client check the scale to see whether
the anticipated level of damage occurred. The client should practice
counter-catastrophizing regularly until he or she can more realisti-
cally assess anticipated damage.

Technique: Changing Thinking Patterns and “Internal Conversations”

Counseling Intention To change distorted thinking and negative self-talk.
Description Emery (1981) outlines the following procedures for changing dys-
functional thinking patterns:

• Maintain a continuing quest for greater self-awareness—assess your goals, dreams, feelings,
attitudes, beliefs, and limitations. Recognize, keep track, and challenge your “automatic
thoughts,” that is, the involuntary inner dialogue that occurs especially in stressful situa-
tions. Use critical thinking skills to clarify emotional reactions to an event (e.g., “Is my reac-
tion logical, based on evidence?”).
• When looking at a situation, consider alternative explanations and another perspective. Try
to substitute positive images for negative ones, and view challenges or criticism as oppor-
tunities for change rather than condemnation. Do something specific to change negative
thoughts, keep a journal, make a plan, and monitor your progress.
 Cognitive Behavioral, Dialectical Behavioral, and Solution-Focused Therapies  83

Technique: The Anxiety Formula: “Knowness” versus Importance

Counseling Intention To reduce the level of anxiety.
Description With the anxiety formula, anxiety is the degree of known multi-
plied by the importance of loss. Have the client think about an
anxiety-provoking situation: (1) Rate its degree of “knowness” and
importance from 0 to 10 to find the anxiety score. (2) Generate ideas
that would help lower the unknown aspect of the situation. (3) Gener-
ate ideas that would make the event less important, then go back and
redo Step 2 (Emery & Campbell, 1986). An example is as follows:

Situation: Airplane Flight

Downloaded by [New York University] at 04:58 12 August 2016

Rate degree of knowness and importance: Unknown × Importance = Level of Anxiety: 9 ×

10 = 90% Anxiety
What would make the event less important? Course on fear of flying
Rate knowness and importance again: 4 × 10 = 40% Anxiety

Technique: The ACT Formula: Accept, Choose, Take Action

Counseling Intention To help the client focus on personal choice (Emery & Campbell,
1986).
Description If a client is experiencing painful, overwhelming anxiety, introduce the
ACT formula:

A - Accept your current reality.

C - Choose to create your own vision, that is, your picture of what you want in life.
T - Take action to create it.

Technique: Create What You Want

Counseling Intention To assist the client in planning for his or her vision for the future.
Description The client should be instructed to keep a journal and to write in it
10 experiences he or she wants to create. Make each item specific
and measurable (for example, “I will walk 2 miles a day for the next
month.”) Put an “I choose to have” in front of each vision and say the
sentence aloud (for example, “I choose to walk 2 miles a day for the
next month.”) Have the client update the list as he or she reaches each
desired vision (Emery & Campbell, 1986).

Technique: Alternative Solutions

Counseling Intention To assist the client in understanding that alternatives are usually
unending.
Description A client is asked to list all of the possible alternatives to a situation
without any initial judgments of these alternatives. Then the counselor
can assist the person in placing various value judgments on the most
reasonable possible solutions. From this more limited list, the indi-
vidual then can begin to weigh and select an ultimate choice.
 84  Cognitive Behavioral, Dialectical Behavioral, and Solution-Focused Therapies

Technique: Changing Inner Beliefs

Counseling Intention To enhance positive inner beliefs.
Description Decide what behavior you would like to change about yourself. Think
positively. Develop your own positive inner belief.

• Write down your negative inner belief and change it to positive. State it in the present tense
(“I believe this about myself”).
• Repeat your positive inner belief at least 10 times a day. Write your positive inner belief on a
card that you can see frequently.
• Visualize your positive inner belief as if it was already happening. See and feel what it would
be like to let go of your negative inner beliefs. Picture yourself being successful.
• Act as if the positive inner belief is already true.
Downloaded by [New York University] at 04:58 12 August 2016

Technique: Nine Ways to Handle Stress Effectively

Counseling Intention To enhance inner well-being.
Description To reduce stress, acknowledge your feelings, identify them, and allow
yourself to experience them.

1. Work it off. Hard physical activity—running, tennis, working in the garden, for example—is
a good outlet.
2. Talk it out. Share your feelings with someone you trust so you do not become overwhelmed.
Share your sense of stress. Sometimes another person can help you get a new perspective on
your problem.
3. Learn to accept what you cannot change. Spinning your wheels gets you nowhere. Don’t
overcommit. Save time for yourself. Acknowledge that you are not perfect and are not sup-
posed to be.
4. Avoid self-medication such as alcohol. The ability to cope with stress comes from within, not
from a bottle.
5. Get enough rest. Give yourself an occasional break. Schedule recreational activities that
require you to give your mind a vacation, even a brief one.
6. Do something for others. Another way of getting your mind off your own problems is to help
solve someone else’s problems.
7. Take one thing at a time. Don’t deliberately put yourself in a loser’s position by biting off
more than you can chew.
8. Give in once in a while. Don’t insist on being right all the time. It’s relaxing to admit you’re
wrong from time to time.
9. Make yourself available to others. Don’t feel sorry for yourself.

Technique: Coping with the Feeling of Being Overwhelmed

Counseling Intention To maintain manageable frustration levels.
Description In today’s information age, there are many times when clients may feel
overwhelmed. The stress and anxiety associated with this feeling can
have long-range implications for one’s own mental well-being.

• With the first signs of anxiety, just pause.

• Keep the focus on the present; what is it you have to do?
• Label your fear from 0 to 10 and watch it change.
 Cognitive Behavioral, Dialectical Behavioral, and Solution-Focused Therapies  85
• You should expect your fear to rise.
• Don’t try to eliminate fear totally; just keep it manageable.
• You can convince yourself to do it. You can reason your fear away.
• It will be over shortly.
• It’s not the worst thing that can happen.
• Just think about something else.
• Do something that will prevent you from thinking about fear.

Technique: Self-Talk to Maintain Composure

Counseling Intention To gain self-control.
Description Self-talk statements should be generated that would be useful before,
during, and after the situation.
Downloaded by [New York University] at 04:58 12 August 2016

Before: Take a minute to become more centered. “What is it that I want to do?”
During: Take a moment to exhale. Take things one step at a time. People get irritated. It’s
nothing more than that. Then clearly say what you want. Don’t raise your voice.
After: Rate yourself. On a scale of 1 to 10, you handled that with a 9. “I’m getting better at
this every time I try.”

Technique: Using Self-Control Techniques

Counseling Intention To maintain calm and composure.
Description Maintaining self-control is a skill that may take some time and practice
to learn. It is not easy maintaining grace under fire. The following are
some self-control techniques:

• Avoid frustrating situations by noting where you have become angry in the past.
• Reduce your anger by consciously taking time to focus on other emotions that are more
passive, avoiding the weapons of aggression.
• Respond calmly to an aggressor with empathy or unprovocative comments, or make no
response at all.
• If angry, concentrate on the undesirable consequences of becoming aggressive.
• Tell yourself that you are not going to give them the satisfaction of seeing you get upset.
• Review your present circumstances and try to understand the motives or point of view of the
other person.
• Learn to become empathetic and forgiving of others and to tolerate individual differences.

Technique: Aggression Control Methods

Counseling Intention To gain control over anger.
Description Methods for preventing and controlling anger can be learned.

• Reduce your frustrations. Try to avoid topics of conversation, personal opinions, or situa-
tions that grate on you.
• Reduce the environmental settings that encourage an aggressive response. Avoid aggressive
subcultures, gangs, hostile friends, television violence, or violence in other forms of media
such as the movies or music.
• Cultivate new friends who are not quick tempered, hostile, prejudiced, or agitators.
 86  Cognitive Behavioral, Dialectical Behavioral, and Solution-Focused Therapies
• Disclose some of your own anxiety prior to being abrasive or rude. Comments such as “I’m
having a bad day,” “I’m stressed out,” or “I’m upset” change the context and soften your
remarks.
• Control anger through stress management, problem-solving methods, using I-messages, or
positive self-talk.
• Stop hostile fantasy building. Preoccupation with frustrating situations increases anger.
Move out of the situation or use thought-stopping techniques.

Technique: Writing a Learning History of Angry Reactions

Counseling Intention To assess the extent of angry reactions.
Description Take 2 weeks and carefully and systematically record anger-causing
thoughts to become aware of the common but subtle triggers for your
Downloaded by [New York University] at 04:58 12 August 2016

emotional reactions and how to avoid future conflict. A learning his-

tory of the behavior or angry reactions should include the following:

• Record the specific situations that triggered the reaction.

• Record the nature and intensity of your anger.
• Note your thoughts and feelings of the situation immediately before and during the anger.
• List what self-control methods you used and how well they worked.
• Record the consequences and how others responded following your emotional reaction.
• Evaluate the payoffs you get from your anger, clarify to yourself the purpose of your aggres-
sion, and give up some of your unhealthy payoffs.

Technique: Psychological Forces that Block Intelligent Decision-Making

Counseling Intention To understand the forces that block decision-making.
Description There are numerous conscious and unconscious barriers that block
decision-making.

• You may block clear thinking because you may be out of touch with painful or stressful
feelings.
• You may be experiencing anxiety, depression, self-doubt, or lack of hope, which may lead to
self-defeating behaviors or lack of action.
• You may feel overly dependent on someone or something, which may get in the way of logi-
cal thinking.
• You may have an unrealistic image about yourself and what you are capable of achieving,
which may lead to a poor decision.
• You may be experiencing wishful thinking such as perfectionism and all-or­nothing thinking
that gets in the way of making a realistic decision.
• You may procrastinate and drag things along to avoid making decisions because of failures
in the past.
• You may become emotionally overwhelmed and rush decisions, which may ultimately lead
to a bad choice.

Technique: Confronting Irrational Thoughts

Counseling Intention To overcome depression, stress, and panic attacks.
Description It’s important to confront irrational thoughts and related anxiety to
counteract depression, stress, and panic attacks. Irrational beliefs can
be classified into one of five categories:
 Cognitive Behavioral, Dialectical Behavioral, and Solution-Focused Therapies  87
• Self-defeating beliefs that interfere with basic goals and drives.
• Dogmatic, highly rigid beliefs that lead to unrealistic preferences and wishes.
• Antisocial beliefs that cause people to destroy their social groups.
• Unrealistic beliefs that falsely describe reality.
• Contradictory beliefs that originate from false premises.

Technique: Changing Thinking Patterns and Internal Conversations

Counseling Intention To change distorted thinking and negative self-talk.
Description Follow these procedures for changing dysfunctional thinking patterns:

1. Maintain a continuing quest for greater self-awareness. Assess your goals, dreams, feelings,
attitudes, beliefs, and limitations.
Downloaded by [New York University] at 04:58 12 August 2016

2. Recognize, keep track of, and challenge your “automatic thoughts”—the involuntary inner
dialogue that occurs especially in stressful situations.
3. Use critical thinking skills to clarify emotional reactions to an event. “Is my reaction logical,
based on evidence?”
4. When looking at a situation, consider alternative explanations and another perspective.
5. Try to substitute positive images for negative ones; view challenges or criticism as opportu-
nities for change rather than condemnation.
6. Do something specific to change negative thoughts; keep a journal, make a plan, and moni-
tor your progress.

Technique: The ABCDE’s of Stopping Unhappy Thoughts

Counseling Intention To identify how many times negative thoughts and feelings occur.
Description Keep a journal on negative thoughts and feelings. Record in your jour-
nal when you notice being upset following a situation or an event:

A: Facts and events: Record the facts about the unhappy event.
B: Self-talk: Record the things you tell yourself about the event.
C: How you felt: Record how you felt.
D: Debate: Debate or dispute any statement that is not logical or objective.
E: Examine the future: State how you want to feel in the future in this kind of situation.

Technique: Giving Constructive Criticism

Counseling Intention To resolve conflict in a more positive way.
Description A formula for giving someone constructive criticism involves six steps:

Step 1. Give the person two compliments. Be honest, sincere, and specific.
Step 2. Address the person using his or her name.
Step 3. In a pleasant tone of voice and with a pleasant look on your face, state your criticism
in one or two short, clear sentences.
Step 4. Tell the person what you would like him or her to do. Keep it simple. Set a time limit
if it is appropriate to do so.
Step 5. Offer your help, encouragement, and support.
Step 6. Thank the person for his or her time and for listening.

In reality, when confronting another individual, the client should be cautioned that he or she
may be interrupted. He or she should be encouraged to listen and acknowledge the other person
 88  Cognitive Behavioral, Dialectical Behavioral, and Solution-Focused Therapies
and adhere to the formula. A helpful procedure is to role-play or practice the formula ahead
of time.

Technique: Mood-Monitoring Chart
Counseling Intention To record sensations of anxiety or panic.
Description The following information is charted: date/time; situation (where
the client was and who was there); what happened (preceding anxiety
or panic); thoughts (before and during the attack); feelings experi-
enced (include label used and possible alternative labels); degree of
discomfort (from 0 to 10, low to extreme discomfort) (Belfer, Munoz,
Schacter, & Levendusky, 1995). Identify a problem that needs chang-
ing and write a goal and complete the action in Table 6.1 to develop
strategies for coping with problems when they occur, and keep track
Downloaded by [New York University] at 04:58 12 August 2016

of progress made.

Technique: Reframing
Counseling Intention To allow the client to adopt a more positive, constructive perspective
(Gutterman, 1992).
Description Reframing requires three simple steps:

1. The therapist must use a nonjudgmental listening cycle to gain a complete understanding of
the client’s problem.
2. Build a bridge from the client’s point of view to a new way of looking at the problem; con-
currently include some aspects of the client’s perspective while also suggesting a new one.
3. Reinforce the bridge until a shift in perspective develops, and give the client “ownwork” that
reinforces the client to see the problem in a new way

Technique: Staying with Anxiety

Counseling Intention To stay in the situation; to not flee or panic when anxiety is present or
impending (Belfer et al., 1995).
Description For anxiety-provoking situations, the client should write the follow-
ing self-instruction statements on an index card and refer to them as
needed:

1. Face the situation. Don’t avoid.

2. Accept the feelings. Don’t fight them.
3. Float through the experience. What will happen will happen. There is no need to offer
resistance.
4. Let time pass. The experience will have an end. The feelings of anxiety will pass (Belfer et al.,
1995).

Table 6.1  Action Plan

Goal_______________

Action Plan Time to Begin Possible Problems Strategies to Overcome Problems Progress

Source: Greenberger and Padesky (1995) Mind Over Mood. New York: Guilford, p. 126. Reprinted with permission.
 Cognitive Behavioral, Dialectical Behavioral, and Solution-Focused Therapies  89
Table 6.2  Understanding Anxiety with a Thought Record
Situation Moods Automatic Thoughts (Images)
Who? What did the client feel? What was going through the client’s mind just
What? Rate each mood before he or she began to feel this way?
When? (0%–100%) Circle the hot thought
Where?
Waiting in room Anxiety 80% What if I lose my thoughts and the projector or
before giving a Panic 90% my computer does not work?
keynote address to What if the audience is critical about my topic?
professional peers. I’ll be embarrassed if my professional colleagues
see that I am shaking, having trouble breathing,
and cannot speak because I have a dry mouth.
My heart is starting to race already.
I feel a panic attack is coming on.
Downloaded by [New York University] at 04:58 12 August 2016

What if I have a heart attack or pass out?

Image—I see myself grabbing my chest, drinking
lots of water, and colleagues a starting to leave
my presentation.
Source: Greenberger and Padesky (1995) Mind Over Mood. New York: Guilford, p. 183 Reprinted with permission.

Table 6.3  Anxiety Profile

Physical Reactions Thoughts
Sweaty palms Overestimation of danger
Muscle tension Underestimation of your ability
Racing heart to cope
Flushed cheeks Underestimation of resources that
Lightheadedness are available
Gastrointestinal distress Worries and catastrophic thoughts
Behaviors Moods
Avoiding situations where anxiety might occur Nervous
Leaving or avoiding situations when anxiety begins to occur Irritable
Trying to do things perfectly or trying to control events to Anxious
prevent danger Panicky
Self-doubt
Self-consciousness
Source: Adapted from Greenberger and Padesky (1995) Mind Over Mood. New York: Guilford, p. 175. Reprinted
with permission.

Overcoming anxiety can occur with cognitive restructuring, relaxation training, progressive
muscle relaxation, controlled breathing, imagery, or distraction techniques.
Important events in our lives can contribute to anxiety, such as trauma, sexual abuse, PTSD
from accidents or war, loss, illness, or death. Table 6.3 illustrates a profile of anxiety that can
interfere with a client’s fully functioning in his or her daily life.

Technique: Counterargument to Avert a Panic Attack

Counseling Intention To replace anxious thoughts with self-statements in the form of coun-
terarguments (Belfer et al., 1995).
Description Counterarguments prevent feelings of anxiety from spiraling and
averting a panic attack.
 90  Cognitive Behavioral, Dialectical Behavioral, and Solution-Focused Therapies
Catastrophic thought counterarguments: Anxiety reduction
Instruct the client to follow a three-step procedure:

1. Recognize anxiety: “I feel anxious.”

2. Specify fears: “I’m afraid that _____”
3. Counterargue: “My counterarguments are _____”

Technique: Stress Inoculation

Counseling Intention To reduce the effects of stress and anxiety.
Description Stress inoculation is basically learning to “talk yourself down” or fac-
ing a stress and finding ways to handle it. For others, “stress inocu-
lation training” is a complex therapeutic process. It is a major part
Downloaded by [New York University] at 04:58 12 August 2016

of cognitive-behavioral therapy and involves (1) helping the patient

become a better observer and a more accurate interpreter of incom-
ing information; (2) teaching stress management skills, such as social
interaction, problem-solving, and how to use self-instructions for
relaxation, self-control, and praise; and (3) help in applying the vari-
ous self-help skills in life.

Use “nervous energy.” Channel the anxiety created by stress into constructive, beneficial activi-
ties, such as taking a course, preparing for a promotion, or helping others. Good stress keeps us
motivated and enthusiastic about life.
Develop psychological toughness. Physical demands must be made on the body to develop
strength, and we must be exposed to bacteria and diseases to develop immunity to them. Simi-
larly, humans may need to be exposed to stresses and emotions before we develop coping mecha-
nisms and toughness. Clients can develop toughness by being repeatedly exposed to demanding
situations while having the skills, power, courage, and confidence to deal with the challenges. We
increase toughness by being committed to work, having a sense of control over what happens
in life, embracing challenges, feeling we will learn from experiences, problem-solving to reduce
stress, and focusing on self-improvement.
Acquire skills training. Reduce stress by acquiring helpful skills such as problem-solving
ability, decision-making skills, social skills, assertiveness skills, empathic response skills, and
time-management skills. To reduce fears, change self-talk and -thinking by substituting
constructive, positive self-statements for self-defeating statements.
Correct faulty perceptions. Change automatic assumptions from “I will fail” to “I can handle
it.” Validating or having our perceptions confirmed by others is sometimes a critical step. Learn
to recognize tendencies to distort, such as exaggerating our importance, denying our responsi-
bility, expecting the worst, being overly optimistic, blaming ourselves, or distrusting others. Be
aware of perceptual biases, and constantly check impressions or views in that area with others.
Replace the catastrophic thinking with rational, reassuring thoughts: “I can prevent this panic
attack” or “My heart is beating fast but that is okay.”

Technique: Overcoming Depression

Counseling Intention To eliminate loneliness, anxiety, and despair. Change in thinking, feel-
ing, and acting is a key feature in depression. A depressed client can
be helped by changing his or her errors in thinking, rather than by
concentrating on his or her depressed mood.
Description Self-talk that manifests as depression:
 Cognitive Behavioral, Dialectical Behavioral, and Solution-Focused Therapies  91
• “My wife left me because I wasn’t good enough for her. I will never be able to get along
without her.”
• “My hair is thinning. I’m losing my looks. No one will care about me anymore.”
• “I just can’t get myself to do any work around the house. My marriage is falling apart.”

It is important to (1) recognize negative thoughts and (2) correct them by substituting more
realistic thoughts.

Technique: Checklist of Negative Thoughts

Counseling Intention To counter depressive feelings.
Description Whenever depressing feelings occur, think back and try to recall what
thought either triggered or increased the feeling of sadness. This
Downloaded by [New York University] at 04:58 12 August 2016

thought may be a reaction to something that happened quite recently,

perhaps within the last hour or the last few minutes, or it may be a
recollection of a past event. The thought may contain one or more of
the following themes:

• Negative opinion of yourself. This notion is often brought about by comparing oneself with
other people who seem to be more attractive or more successful or more capable or intel-
ligent: “I am a much worse student than Mike,” “I have failed as a parent,” “I am totally
lacking in judgment or wit.”
• Self-criticism and self-blame. The depressed person feels sad because he focuses his attention
on his presumed shortcomings, he blames himself for not doing a job as well as he thinks he
should, for saying the wrong thing or causing misfortune to others. When things go badly,
the depressed person is likely to decide it’s her own fault. Even happy events may make you
feel worse if you think, “I don’t deserve this—I am unworthy.”
• Negative interpretations of events. Depressed people often respond in negative ways to situ-
ations that are not a concern to them when they are not depressed.
• Negative expectations of the future. People can fall into the habit of thinking that feel-
ings of distress or problems will last forever. The depressed person tends to accept future
failure and unhappiness as inevitable and may tell herself it is futile to try to make her life
go well.
• “My responsibilities are overwhelming.” People may feel unable to do tasks or feel that it will
take weeks or months before they are completed. Some depressed clients deny themselves
rest or time to devote to personal interests because of what they see as pressing obligations
coming at them from all sides. They may even experience physical feelings that can accom-
pany such thoughts—sensations of breathlessness, nausea, or headaches.

Technique: Changing Negative, Depressive Thoughts

Counseling Intention To gain control over negative thoughts and to focus on the positive.
Description

• Daily schedule. Try to schedule activities to fill up every hour of the day. Do not ruminate
about negative thoughts.
• “Mastery and pleasure” method. Write down all of the events of the day and then label those
that involve some mastery of the situation with the letter “M” and those that bring some
pleasure with the letter “P.”
 92  Cognitive Behavioral, Dialectical Behavioral, and Solution-Focused Therapies
• The ABC of changing feelings. Feelings are derived from thinking. Sort out three parts of a
problem:
1. The event
2. Your thoughts
3. Your feelings
• The double-column technique. Write down unreasonable automatic thoughts in one column
and answers to the automatic thoughts opposite these. (Example: John has not called. He
doesn’t love me. Answer: He is very busy and thinks I am doing better than last week, so he
doesn’t need to worry about me.)
• Solving difficult problems. Write down each of the steps that you have to take to accomplish
the job and then do just one step at a time. Problems that seem unsolvable can be mastered
by breaking them up into smaller manageable units.
Downloaded by [New York University] at 04:58 12 August 2016

Technique: Strategies for Overcoming Depression

Counseling Intention To eliminate anxiety, guilt, sadness, hopelessness, loss, low self-regard,
loneliness, guilt, and shame, which are complex conditions or
processes.
Description The focus is on behavior, emotion, cognition, and unconscious factors.

Behavior. Increase pleasant activities, avoid upsetting situations, get more rest and exercise,
use thought-stopping techniques, reduce your worries, atone for wrong-doings, seek sup-
port, and use other behavioral changes.
Emotions. Desensitize sadness to specific situations and memories, vent anger and sadness, and
try elation or relaxation training.
Skills. Learn social skills, decision-making, and self-control techniques to reduce helplessness.
Cognition. Acquire more optimistic perceptions and attributions, challenge depressing irra-
tional ideas, seek a positive self-concept, become more accepting and tolerant, and select
good values and live them.
Unconscious factors. Read about depression, learn to recognize repressed feelings and
urges that may cause guilt, explore sources of shame (perhaps even going back to
childhood).

Positive events or activities lead to positive moods; negative events to depression. The depressed
person must become aware that this is true in everyone’s life. Have clients rate their mood on a
1 to 10 scale and keep a daily log or a diary of positive events and activities. It is likely that mood
reflects what is happening in the client’s life. After about a week, have the clients plot their daily
mood rating and the number of pleasant events for that same day on a graph. Ascertain if the
client’s mood doesn’t go up and down according to how many pleasant events occurred that day.
If so, this is a powerful argument to increase the number of pleasant events in the client’s life and
to help the client appreciate the nice things that happen.

Technique: Focus on Positive Events

Counseling Intention To help the client realize contributions to success and reduce the
responsibility for failure.
Description Think of an important recent event and describe it:

• In what ways were other people, chance, luck (good or bad), or fate responsible for this
event?
 Cognitive Behavioral, Dialectical Behavioral, and Solution-Focused Therapies  93
• In what ways were you (your efforts, skills, abilities, experience, appearance—or lack thereof)
responsible for this event?
• What percentage of the responsibility for this event was attributable to you?

Do this for several events, including both positive and negative events. Work toward positive
events and against negative events. So if clients do not think they are truly responsible for more
than 50% of the pleasant events, have them reconsider their explanation of those events and
see if they aren’t causing more positive things than they thought. Factually based confidence
in self-control is a powerful antidote to pessimism and helplessness. (Remember that depressed
people underestimate their problem-solving ability.)

Technique: Reversing the Downward Depression Spiral

Downloaded by [New York University] at 04:58 12 August 2016

Counseling Intention To provide a number of strategies to assist the client.

Description

Use self-reinforcement. Make a list of assets—true positive traits. Read it frequently and add
accomplishments to it. Make another list of possible rewards, and use them in self-help
projects. Depressed people need more good things in their lives.
Get active. Undertake profitable, beneficial activities that solve problems, improve the current
situation or the future, and replace sad thoughts. Start with easier tasks, and work up to
harder ones. Reward progress.
Avoid unpleasant, depressing situations. Interpersonal situations powerfully influence hap-
piness. Introversion, loneliness, dependency, isolation, marital or interpersonal relation-
ship problems often precede the onset of depression. Avoid losses and these conditions if
possible.
Change the environment. Try to change depressing environments—working conditions, fam-
ily interactions, stressful relationships, and so on. Mood reflects one’s surroundings.
Reduce negative thoughts. Reduce the negative thoughts that characterize depressed peo-
ple: self-criticism (“I’m really messing up”), pessimistic expectations (“It won’t get
any better”), low self-esteem (“I’m a failure”), and hopelessness (“There’s nothing
I can do”). How does the client stop or limit these depressing thoughts, memories,
or fantasies? Try using thought-stopping, paradoxical intention (massed practice), or
punishment.
Have more positive thoughts. Make an effort to have a lot more positive thoughts: satisfaction
with life (“Living is a wonderful experience”), self-praise (“I am thoughtful—my friends
like that”), optimism (“Things will get better”), self-confidence (“I can handle this situa-
tion”), and respect from others (“They think I should be the boss”).
Avoid self-put-downs. Become aware of any payoffs for depression or self-put-downs.
A therapist should reduce these reinforcements: Don’t complain or display sadness,
and ask others to ignore the client’s sadness as well (but interact with him or her more
during good times). Remember excessive talking about depression may sometimes
increase depressed feelings. (But clients should not use this as an excuse for not seek-
ing help.)

Pursue happiness.

1. Focus on achieving emotional closeness with loved ones.

2. Find things about work that are enjoyable and work hard on them.
3. Help others.
 94  Cognitive Behavioral, Dialectical Behavioral, and Solution-Focused Therapies
4. Exercise and do something enjoyable.
5. Plan to do new fun things too.
6. Have lots of nice “moments,” not just big highs.

Practice desensitization and stress inoculation. If the depressing event is anticipated, use desen-
sitization and stress inoculation in advance to reduce the impact.
Challenge faulty perceptions. Question any irrational ideas, automatic ideas, faulty conclusions,
or excessive guilt. If automatic negative thoughts slip by too quickly to notice (but they still cause
sadness), try starting the search for the negative thoughts at the moment the emotions occur.
Write down thoughts, and then objectively ask:

1. What is the evidence for this idea that may be causing me to feel bad? Is it true?
2. Is there another way of looking at the situation?
Downloaded by [New York University] at 04:58 12 August 2016

3. Even if my first thought were correct, is it really as awful as I feel it is? Or is the situation just
“awful” reality?

Use tolerance training (challenge irrational demands). Help the client learn that he or she can’t
always avoid unwanted outcomes.
Challenge false conclusions. The depressed person has been preprogrammed to think negatively
and irrationally. This is not a conscious, intentional effort to come to negative conclusions; it is
an automatic process. Challenge the client’s negative thinking.
Attribution retraining. An old adage says everyone has three characteristics:

1. That which he or she has.

2. That which he or she thinks he or she has.
3. That which others think he or she has.

The depressed person is prone to believe “This bad situation will never get better,” “It will
ruin my whole life,” and “It’s all my fault.” If those views of the situation were accurate, the per-
son would have a right to be depressed. Shift attributions to show clients they are less responsible
for an unfortunate happening (divorce, failure, accident, thoughtless inconsiderate act) to make
them feel less guilty or depressed. Changing attributions can provide more hope of improving
the situation in the future.

Technique: Increased Activity Levels

Counseling Intention To control depression by increasing the client’s activity level.
Description Cantwell and Carlson (1983) found that depression could begin to be
controlled by increasing the client’s activity level. Client involvement
in selecting and planning the activities will improve the likelihood of
a more successful intervention. When the activities are fun, the prob-
ability of a positive response will be enhanced.

The major obligation for adolescents, for example, is one of attending school and should be a
priority. Parents should insist gently that the child do chores and participate in family activities, as
well as think small and accept small gains (Downing, 1988). With the child’s involvement in the
intervention process, he or she may assimilate the system of skills without adult assistance in the
future. The more commitments or obligations the youth meets, the more he or she maintains a
self-perception of normalcy and confidence.
 Cognitive Behavioral, Dialectical Behavioral, and Solution-Focused Therapies  95

Technique: Limit Inappropriate Attention

Counseling Intention To reinforce behaviors that gain attention in positive ways.
Description Sometimes family relationships become co-dependent, where indi-
viduals take responsibility for another’s behavior and consequences.
Members of the intervention team should not feel that they need
to ask continually how the child is feeling. Response efforts
should be focused on behaviors that gain attention in positive
ways.

Technique: Teaching Coping and Changing Skills

Counseling Intention To learn ways to avoid feelings or ideas that may provoke
Downloaded by [New York University] at 04:58 12 August 2016

depression.
Description Clients can be taught to be aware of depressive feelings and thoughts
when they occur. The client should be helped to develop a repertoire
of activities to implement when feeling depressed, such as (1) increas-
ing his or her activity level, (2) redirecting thoughts to pleasant experi-
ences, (3) using deliberate internal affirmations, (4) using productive
fantasies or daydreams, or (5) using biofeedback either to increase or
to decrease the pulse rate to control the body. All strategies have one
common denominator—they empower the client with strategies that
put him or her in control to actualize change (Cantwell & Carlson,
1983; Downing, 1988).

Conclusion
Therapists who practice cognitive-behavioral therapy (CBT) focus on the present moment and
current events rather than self-awareness or insight derived from past experiences. CBT is a
time-limited approach, and because of this some clients may view this approach as superficial
or failing to meet their needs. From another perspective, cognitive approaches emphasize the
importance of rapport and foster the therapeutic alliance and do not require the client to reveal
intimate details of his or her life experiences, past events, or intense emotion. This approach
appeals to a wide array of cultural backgrounds, especially those cultures that may discourage the
sharing of family-related issues, such as Latino cultures, or the exploration of intense emotion,
such as Asian cultures. Cognitive-behavioral therapy may improve mental health conditions such
as depression, bipolar disorders, anxiety disorders, obsessive-compulsive disorders (OCDs), per-
sonality disorders, schizophrenia, PTSD, sleep disorders, sexual disorders, eating disorders, and
substance use disorders (SUDs).

Dialectical Behavior Therapy

Dialectical behavior therapy (DBT) is a comprehensive cognitive-behavioral treatment for
complex, difficult-to-treat mental disorders. The dialectic in dialectic behavior therapy means
to balance and compare two things that appear very different or even contradictory (McKay,
Wood, & Brantley, (2007). The balance is between change and acceptance. Clients need to
learn how to change the behaviors in their lives that lead to suffering and simultaneously accept
themselves the way they are. Dialectical behavior therapy depends on acceptance and change,
not acceptance or change. Marsha M. Linehan (1993) pioneered this treatment originally to
 96  Cognitive Behavioral, Dialectical Behavioral, and Solution-Focused Therapies
treat chronically suicidal individuals. DBT has since evolved into a treatment for individu-
als with borderline personality disorder (BPD); it has been adapted for seemingly intractable
behavioral disorders among the BPD population involving emotion dysregulation, including
substance dependence and binge eating. It has been employed in other clinical populations
(e.g., depressed, suicidal adolescents) and in a variety of settings (e.g., inpatient, partial hospi-
talization, forensic).
As a comprehensive treatment, DBT serves five functions:

1. Enhances behavioral capabilities.

2. Improves motivation to change by modifying inhibitions and reinforcement contingencies.
3. Ensures that new capabilities generalize to the natural environment.
4. Structures the treatment environment in the ways essential to support patient and therapist
capabilities.
Downloaded by [New York University] at 04:58 12 August 2016

5. Enhances therapist capabilities and motivation to treat patients effectively.

In standard DBT, these functions are divided among modes of service delivery, including
individual psychotherapy, group skills training, phone consultation, and therapist consultation
team. The fundamental dialectic in DBT is between validation and acceptance of clients as they
are within the context of simultaneously helping them change. Change strategies in DBT include
behavioral analysis of maladaptive behaviors and problem-solving techniques, including skills
training, contingency management (i.e., reinforcers, punishment), cognitive modification, and
exposure-based strategies.
DBT is designed to treat individuals with BPD at all levels of severity and complexity and
is conceptualized as occurring in stages. In Stage 1, the primary focus is on stabilizing the
client and achieving behavioral control. Behavioral targets in this initial stage of treatment
include decreasing life-threatening, suicidal behaviors. DBT targets behaviors in a descending
hierarchy:

1. Decreasing high-risk suicidal behaviors—parasuicidal acts, including suicide attempts,

high-risk suicidal ideation, plans, and threats.
2. Decreasing responses or behaviors (by either therapist or patient) that interfere with
therapy—missing or coming late to session, phoning at unreasonable hours, not returning
phone calls.
3. Decreasing behaviors that interfere with/reduce quality of life—depression, substance
dependence, homelessness, chronic unemployment.
4. Decreasing and dealing with post-traumatic stress responses.
5. Enhancing respect for self.
6. Acquisition of the behavioral skills taught in groups—skills in emotion regulation, interper-
sonal effectiveness, distress tolerance, mindfulness, and self-management.
7. Additional goals set by client.

In the subsequent stages, the treatment goals are to replace “quiet desperation” with non-
traumatic emotional experiencing to achieve “ordinary” happiness and unhappiness and
reduce ongoing disorders and problems in living, and to resolve a sense of incompleteness and
achieve joy.

Technique: Radical Acceptance

Counseling Intention To accept circumstances or situations without judging them.
 Table 6.4  An Outline of Dialectical Behavioral Therapy Foundational Skills
MINDFULNESS IS LIKE Focus and direct your attention to be mindful of the
A FLAME (MEDITATION) present moment
Let go of distracting thoughts and judgments
Use radical Acceptance to remain nonjudgmental
Use wise Mind to make healthy decisions
Do what’s Effective to accomplish your goals
“It is important to remember that mindfulness is both
an outcome (mindful awareness) and a process (mindful
practice): (1) Mindfulness awareness: an abiding presence or
awareness, a deep knowing that manifests as freedom of mind
(e.g., freedom from reflexive conditioning and delusion); and
(2) Mindful practice: the systematic practice of intentionally
attending in an open, caring, and discerning way, which
Downloaded by [New York University] at 04:58 12 August 2016

involves both knowing and shaping the mind” (Shapiro,

2009, p. 556).
MINDFULNESS (Wise Mind) Using the What skills: observe, describe, participate
A struggle between the reasonable Using How skills: nonjudgmentally, one-mindfully,
mind and the emotional mind effectively
An operational working definition of mindfulness is “the
awareness that emerges through paying attention on
purpose, in the present moment, and nonjudgmentally to
unfolding of experience moment by moment” (Kabat-Zinn
2003, p. 144).

DISTRESS TOLERANCE Using crisis survival: distraction with wise mind through
acronym ACCEPTS:
Activities
Contributing
Comparisons
Emotions
Pushing Away
Thoughts
Sensations
Using self-soothing skills using the five senses: taste, smell,
see, hear, touch
Improve the moment through the acronym IMPROVE:
Imagery
Meaning
Prayer
Relaxation
One thing at a time
Vacation
Encouragement
EMOTION REGULATION Reduce vulnerability to distressing emotions with the
acronym PLEASE:
P & L Treat physical illness
Eating

(Continued)
 98  Cognitive Behavioral, Dialectical Behavioral, and Solution-Focused Therapies
Table 6.4  (Continued)

Altering drugs (don’t do any drugs unless prescribed by

the doctor
Sleep
Exercise
INTERPERSONAL Using objectiveness effectiveness with the acronym DEAR
EFFECTIVENESS MAN:
Describe
Express
Assert
Reinforce
Mindful
Downloaded by [New York University] at 04:58 12 August 2016

Appear Confident
Negotiate
USING RELATIONSHIP Improving relationships through the acronym GIVE:
EFFECTIVENESS Gentle
Interested
Validate
Easy Manner
SELF-RESPECT Improving self-respect more effectively with the acronym
EFFECTIVENESS FAST:
Fair
Apologies (or no apologies)
Stick to value
Truthful
THE ART OF NEGOTIATION To negotiate productively, use the acronym RAVEN:
Relax
Avoid the adversive
Validate the other person’s need or concern
Examine your values
Neutral voice should be used
RADICAL ACCEPTANCE Accepting something completely without judging it.
Radically accepting the present moment opens up the
opportunity for the client to recognize the role that the
client has played in creating his or her current situation.
Adapted from numerous resources and McKay et al. (2007) The Dialectical Behavior Therapy Skills Workbook.
Oakland CA: New Harbinger Publications, Inc. Reprinted with permission.

Description Practicing radical acceptance:

1. Read a controversial article in the newspaper or watch the news without judging it.
2. Review a nonupsetting event that happened in your past, and use radical acceptance to
remember the event without judging it.
3. Whether too young or too old, accept your age without judging it (adapted from (McKay,
et al., 2007, p. 12).
 Cognitive Behavioral, Dialectical Behavioral, and Solution-Focused Therapies  99

Technique: Distract Yourself from Self-Destructive Behaviors

Counseling Intention To avoid excessive rumination and obsessing over circumstances or
situations.
Description Distract in the following ways:

1. Draw faces of people you hate on balloons and then pop them.

2. Write letters to people who have hurt you. Tell them what they did to you and tell them why
you hate them. Then throw the letter away or save them to read later.
3. Write about your feelings in your journal. Write a poem about your feelings.
4. Take a walk or exercise. The physical release of energy is helpful.
5. Take a bath or shower. Let the water soothe you and help release your stress. Talking out
loud or crying in the shower helps get the pain out that is locked inside you. Let the stress
rinse off and send it ‘down the drain.’
Downloaded by [New York University] at 04:58 12 August 2016

Go to the safe place you have created inside. Visualize nice things, comforting things, favorite
things. Allow yourself to be surrounded by good things in life, even if it exists only in your inter-
nal world at that moment (adapted from McKay et al., 2007, p. 13).

Table 6.5  Distress Tolerance Action Plan

Client triggers (internal or external): Relationships, that is, family, friends, and working
relationships; anger management; thinking negatively about self from past experiences and
uncertainty about the future.
Client warning signs (i.e., feelings, thoughts, physical sensations, urges, or actions): Anxiety,
sadness, hurt, despair, depression, hopelessness, unbearable or unchangeable thinking; feeling efforts
are futile, low energy, isolation; or the urge to self-medicate to dull the pain.
Client’s commitment to eliminating escape methods and doing an opposite action to increase
distress tolerance: Encourage the client to stay with the feeling rather than isolating the self and
self-medicating.
Client accepts the distress (practice mindfulness or a distress script.): Okay, the client is feeling
sad, which is a normal emotion to experience. The client doesn’t have to be afraid of it or try to get
rid of it.
Watch emotion: Have the client experience the feeling, make space for it, and give him or her
permission to not be consumed with it. Have the client identify where he or she is feeling the
emotion (i.e., stomach and shoulders, feeling lethargic) and recognize it is a feeling. The client is not
the emotion, but rather an observer of the emotion, observing the feeling like a cloud floating past
in the sky until it drifts out of sight.
Be present: Have the client turn his or her attention back to the task at hand and breathe, noting
each in and out breath
Dealing with emotional rebounds: The client may feel the sadness returning, Encourage the client
to go back to watching again as another cloud in the sky.
Improving the client’s distress (active and soothing distress improvement activities): Take a
walk, go to the beach or the park, clean a room, make a creative meal, sing or turn on your favorite
music, play with a pet—focus on any positive aspects of your life. Encourage the client to say “I can
get through this,” “This, too, shall pass.”
Source: Adapted from Clen, S. L., Mennin, D. S. and Fresco, D. M. (2011). Major depressive disorder. In M. J.
Zvolensky, A. Bernstein and A. A. Vujanovic (eds.), Distress Tolerance: Theory, Research, and Clinical Applications
(pp. 149–170). New York: Guilford. Reprinted by permission.
 100  Cognitive Behavioral, Dialectical Behavioral, and Solution-Focused Therapies

Technique: Take a Time-Out

Counseling Intention To put more balance in one’s life.
Description Take a time-out by:

1. Doing one nice thing for yourself that you have been putting off.
2. Taking a half-day off from work. Go somewhere beautiful like the ocean, a lake, the moun-
tains, a museum, or a shopping center
3. Doing something for your well-being like doing errands, doctor’s appointments, a massage,
or a new haircut. (Adapted from McKay et al., 2007).

Technique: Using Self-Encouraging Coping Thoughts

Downloaded by [New York University] at 04:58 12 August 2016

Counseling Intention To have encouraging words to keep motivated; to help endure the
current pain a client is experiencing.
Description Coping thoughts many people find helpful in distressing situations
include:

1. “This situation won’t last forever.”

2. “This, too, shall pass.”
3. “I can be anxious and still deal with the situation.”
4. “I’m strong enough and I can ride this out.”
5. “These are just my feelings, and eventually they’ll go away.” (Adapted from McKay, et al,
2007.)

Technique: Self-Affirming Statements

Counseling Intention To develop a healthier self-image; to identify good qualities to
provide strength and resilience when confronted with distressing
situations.
Description Examples of self-affirming statements include:

1. “I know I have some faults, but I’m still a good person.”

2. “I’m altruistic and care about both myself and other people.”
3. “I accept who I am.”
4. “I understand and accept both my good and bad qualities.”
5. “I’m a sensitive person with rich emotional experiences.” (Adapted from McKay, et al. 2007.)

Technique: Practicing Mindfulness by Focusing on a Single Object

Counseling Intention Mindfulnesss is related to meditation. Focusing on a single object is a
mindfulness skill.
Description Train your “mental muscle” to maintain focus on whatever you’re
observing. Pick a small object that is emotionally neutral. The object
can be a pen, a plant, a figurine, a picture, or something similar. Find
a place where you will not be disturbed. Set the timer for 5 minutes.
Practice this technique once or twice a day for 2 weeks, choosing a
different object to focus on each time. (Adapted from McKay et al.
2007.)
 Cognitive Behavioral, Dialectical Behavioral, and Solution-Focused Therapies  101

Technique: Thought Defusion

Counseling Intention Thought defusion is a technique borrowed from acceptance and com-
mitment therapy (Hayes, Strosahl, & Wilson, 1999), which has been
proven to be effective treatment for emotional distress.
Description Thought defusion requires the use of imagination. Visualize thoughts,
either as pictures or words, floating away without obsessing or over-
analyzing them. For example:

1. Imagine sitting in a field watching your thoughts float away with the clouds.
2. Picture sitting near a stream watching your thoughts float past on leaves.
3. Write distressing thoughts in the sand and then watch the waves wash them away.
4. Imagine driving your car and see your thoughts diminish as you pass each billboard on the
highway.
Downloaded by [New York University] at 04:58 12 August 2016

Technique Eliminating Negative Judgments

Counseling Intention To recognize when negative judgments impede resolving problems.
Description To change a problem is to recognize when that problem occurs and
recognize if the client is being judgmental and critical. Keep track of
all negative judgments and criticisms made, including things read in
the newspaper, on social media sites, and television, that the client feels
about self and other people. Record judgments as soon as they are rec-
ognized. A Post-it note at work or home with the word judgments could
be used as a cue. Record what the negative judgment was and where it
occurred. Practice the technique for 1 week until negative judgments
can be automatically recognized. (Adapted from McKay et al., 2007.)

Technique: Keeping an Emotional Record

Counseling Intention To help the client recognize emotions, it is helpful to say how the cli-
ent is feeling aloud to highlight emotions and experiences, and to pay
extra attention to the emotions that may be disturbing.
Description Say aloud, “Right now I feel _____.” The client should record emo-
tions in order to recognize, label, and describe them, such as:

• I feel angry.
• I feel sad.
• I feel anxious.
• I feel jealous.
• I feel lonely.
• I feel happy.
• I feel disappointed.
• I feel apprehensive. (Adapted from McKay et al., 2007.)

Technique: Blocks to Using Interpersonal Skills

(i.e., Old Habits of the Aggressive Kind)
Counseling Intention To identify aversive strategies learned in our family of origin that mod-
eled handling conflict utilizing fear, shame, or hurtful psychological
pressure.
 102  Cognitive Behavioral, Dialectical Behavioral, and Solution-Focused Therapies
Description Old habits include:

• Discounting—the feelings of the other person are invalid, lack legitimacy or importance.
• Withdrawing/abandoning—the message that if the client does not get what he or she wants,
he or she will leave.
• Threatening—the message is “do what I want or I’ll hurt you.”
• Blaming—the problem becomes the other person’s fault.
• Belittling/denigrating—making the other person feel foolish and wrong to have a particular
need, opinion, or feeling.
• Guilt-tripping—the message is that the other person is a moral failure, and his or her needs
are wrong and must be given up.
• Derailing—this maneuver switches attention from the other person’s feelings and needs.
• Taking away—to withdraw some form of support, pleasure, or reinforcement from another
Downloaded by [New York University] at 04:58 12 August 2016

person as punishment for something he or she said, did, or wanted. (Adapted from McKay
et al., 2007.)

In summary, the orientation of the treatment is to first get constructive action under control,
then to help the client to feel better, to resolve problems in living and residual disorders, and
to find joy and, for some, a sense of transcendence. The approach incorporates what is valuable
from other forms of therapy and focuses on a clear acknowledgement of the value of a strong
relationship between the therapist and client. The techniques used in DBT are extensive and
varied, addressing essentially every aspect of therapy. Techniques for achieving change are bal-
anced with techniques of acceptance and problem-solving. The client is helped to understand
self-defeating behaviors and taught to deal with situations more effectively. Advice and support
between sessions between the client and therapist encourage clients to take responsibility for
dealing with their current life challenges. This is unique in the DBT approach. Research has
shown DBT to effectively reduce suicidal behavior, dropout from treatment, psychiatric hospi-
talization, substance abuse, anger, and interpersonal difficulties. DBT skills training has also been
successfully used to treat bulimia and binge eating.

Solution-Focused Brief Therapy

Professional therapists use the solution-focused brief counseling (SFBC) model with various
clients in diverse settings, including community mental health centers, state and private hos-
pitals, private psychiatric practices, and schools (de Shazer, 1985; de Shazer & Berg, 1997;
David-Ferdon & Kaslow, 2008). Factors that impede therapist effectiveness include heavy case-
loads, inadequate resources, and lack of professional development.
SFBC has proved beneficial in schools and agencies (Murphy, 1997; Metcalf, 2008; Cooley,
2009). It was originally conceptualized by de Shazer and colleagues (de Shazer, 1991, 1994;
Walter & Peller, 1992) as a set of clinical assumptions and strategies in response to the ques-
tion, “What works in counseling?” SFBC emphasizes wellness: individuals are seen as having
the resources to solve their own problems (Berg & Miller, 1992) in a practical, immediate way,
and problems are not seen as evidence of an underlying pathology (Berg & Miller, 1992; Fisch,
Weakland, & Segal, 1982). SFBC is future-oriented and focuses on finding solutions to resolve
current complaints rather than on the cause of the problem. The professional school counselor’s
job, therefore, is to help get the solution started and then “get out of the way” (Berg & Miller,
1992; De Shazer, 1985). SFBC is cooperative (Berg & Miller, 1992). Table 6.6 historically cap-
tures the characteristics of solution-focused brief counseling.
Professionals in the field of counseling and therapy who use the model have benefited in terms
of their perceptions of professional efficacy, the time constraints on service delivery, and a clear
 Cognitive Behavioral, Dialectical Behavioral, and Solution-Focused Therapies  103
Table 6.6  Characteristics of Solution-Focused Brief Counseling
Koss and Shaing (1991):
  1.  The focus of counseling is clearly stated and maintained throughout the process.
  2.  There is a high level of counselor activity and involvement.
  3.  The counselor remains receptive and flexible.
  4.  Interventions are introduced in a timely manner.
  5.  The expectations of termination are addressed throughout the counseling process.
Bloom (1992, 1997):
  1.  Interventions are introduced immediately.
  2.  There is a high level of counselor involvement.
  3.  Specific, realistic, but limited goals are established.
  4.  A clear focus for counseling change is identified and maintained.
  5.  A solution-focused limit for the counseling process is set.
Downloaded by [New York University] at 04:58 12 August 2016

Bruce (1995):
  1.  The school counselor and student establish a strong working alliance.
  2.  The school counselor recognizes and uses the student’s strengths and resources.
  3.  A high level of counselor and student affective and behavioral involvement is achieved.
  4.  Counselor and student establish clear and concrete goals.
Metcalf (2008):
  1.  Using a nonpathological approach makes problems solvable.
  2.  There is no need to attempt to understand or promote insight to solve problems.
  3.  It is not necessary to know a great deal about the complaint.
  4.  Students, teachers, administrators, and parents have complaints, not symptoms.
  5.  The student defines the goal.
  6.  Motivation is a key ingredient for change.
  7.  There is no such thing as resistance when all cooperate.
  8.  If it works, don’t fix it; if it doesn’t, do something different.
  9.  Focus on the possible, the changeable.
10.  Rapid change is possible.
11.  Every complaint pattern contains some sort of exception.
12.  Look at problems differently and redescribe them (pp. 16–23).
Sources: Adapted from Davis, T. E. & Osborn, C. J. (2000). The Solution Focused School Counselor: Shaping Profes-
sional Practice. Philadelphia: Accelerated Development. Metcalf, L (2008) Counseling Toward Solutions: A Prac-
tical Solution-Focused Program for Working with Students, Teachers, and Parents (2nd ed) San Francisco: John
Wiley & Sons, Inc. Reprinted with permission.

sense of increased professional direction in the therapeutic process. SFBC can offer the therapist
a usable, succinct, yet effective and highly practical approach to meeting the various needs of
clients by enhancing their coping skills and focusing on solutions to problems rather than mag-
nifying problems and looking at problems and life circumstances through a deficit lens.
The SFBC model can be used with youth and adults. Helping professionals trained in the use
of SFBC would be an effective first line of defense in any crisis situation affecting both the physi-
cal and psychological well-being of children and adolescents. SFBC has the following attributes:

• Goals are chosen in part by the client.

• Attention is directed on one focused issue.
• Counseling is directed at clarifying feelings, thoughts, and behavior manifestations in the
here-and-now. Diagnosis, history taking, or exploration of the problem is minimized.
• Emphasis is placed on the client identifying the change that is needed or the coping goals
related to the problem.
• The client is encouraged to (a) actively search for exceptions to the problem and (b) identify
strengths in his or her coping repertoire.
 104  Cognitive Behavioral, Dialectical Behavioral, and Solution-Focused Therapies
The stages of SFBC proceed as follows:

Stage 1: Define the problem (for example, the client is experiencing panic
attacks).
• Communicate an expectancy of change.
• Reframe the problem situation as normal and modifiable. This can be accomplished by using
systematic questions. For example, the presenting problem may be that the client is experi-
encing panic attacks in his or her G.E.D. class.

Systematic questions include:

“What is different about the times when you are not having a panic attack?”
Downloaded by [New York University] at 04:58 12 August 2016

“Who else noticed your panic attack?”

“How do you respond when you have a panic attack during a presentation?”

Stage 2: Establish treatment goals.

The process of setting goals initiates the intervention. Critical questions include:

“What will be the first signs that things are moving in the right direction?”
“Who will be the first to notice?”
“What do you need to do to make it happen more?”

Stage 3: Designing the intervention involves three integral steps.

• Reframing the problem in a more positive light to provide the mechanism that encourages
change.
• Utilization of whatever the student presented, including a rigid belief system, behaviors,
demands, or characteristics, to motivate the student to act differently.
• Strategic task assignment to be carried out between sessions. The primary goal is to get the
student to do something different to fulfill the goals that were outlined in the first stage.
This is also called the Formula First Session Task (FFST), or the “ownwork” assignment,
the therapist gives the counselee to complete before the next meeting. “Between now and
the next meeting, I would like you to observe what happens in your family, life, friends that
you want to continue to happen” (De Shazer, 1985, p. 137). The goal of using the FFST is
to promote optimism by framing for the student that positive things will happen and change
will occur.

Stage 4: Delivering a strategic task.

• The task is clearly outlined. The client writes certain instructions down that may be critical
to the task performance and completion.

Stage 5: Emphasizing positive new behavior.

• This stage is enhanced by questions that encourage positive change and solutions:
“What is happening that you would like to continue to happen?”
“Who else will notice your progress?”
“How did it make things go differently?”
 Cognitive Behavioral, Dialectical Behavioral, and Solution-Focused Therapies  105
• The most engaging intervention is termed the miracle question (de Shazer, 1991): “Imagine
tonight while you sleep, a miracle happens and your problem is solved. What will be happen-
ing the next day, and how will you know your problem has been solved?” Often, the answers
are specific and concrete because the focus is on what will be present when the problem is
absent.

One way to change self-defeating, self-deprecating behavior is to reframe the presenting prob-
lem into solution talk. The following common complaints experienced as problem talk can be
reframed as solution talk.

Problem Talk Solution Talk

Hyperactive Very energetic at times
Downloaded by [New York University] at 04:58 12 August 2016

Attention deficit disorder Short attention span sometimes

Anger issues Gets upset sometimes
Depressed Sad or unhappy sometimes
Oppositional defiant Argues a point often
Rebellious Prefers to develop his or her own way
Family problems Worries about home life
Disruptive Often forgets the rules
Shy Takes time to know people
Negative peer pressure Allows other people influence him or her
Feelings of rejection People forget to notice him or her
Isolating Prefers to be alone
Source: Metcalf, L (2008). Counseling Toward Solutions: A Practical Solution-Focused Program for Working with
Students, Teachers and Parents. San Francisco: Jossey-Bass. Reprinted with permission.

Stage 6: Termination. Typically, the client recognizes problem resolution and

then initiates termination.
This simple approach has some enduring interventions because it empowers the client to
maximize his or her own resources to effect change. This model integrates theory and tech-
nique by providing a comprehensive, empirical approach from proponents of strategic and
solution-focused counseling. Therapists have a growing interest in becoming more efficient and
effective with clients especially with growing caseloads and increasing diversity among our cur-
rent population.

Technique: Mapping the Influences of the Problem (Gutterman, 2006)

Counseling Intention To help the client understand how the problem has influenced his or
her life and to increase opportunities for identifying unique outcomes
(a parallel that is similar to exceptions) and to provide a way to speak
to some part of the client’s life, including relationship, work, and daily
functioning.
Description First, when mapping the influences of the problem, the therapist
asks how the problem has affected various aspects of the client’s life,
including relationships, work setting, and everyday daily functioning.
Mapping the influences of the problem is a way to address some cli-
ents’ need to talk about the problem and address the influences. Map-
ping the influences of the problem can address personal concerns. For
 106  Cognitive Behavioral, Dialectical Behavioral, and Solution-Focused Therapies
example, if the problem is depression, then the counselor might ask
the client to identify ways in which depression has affected aspects of
his or her life. Salient questions could be, “How has the depression
affected your work and concentration?” or “How has the depression
affected your relationships with your spouse, partner, or family mem-
bers?” or “How has the depression affected your health, i.e., emotion-
ally, physically, or cognitively?”

Second, after the client has clearly identified the influences as a basis from which to further
identify exceptions, the counselor can go back to these influences and identify exceptions (Gut-
terman, 2010).

Technique: Scaling
Downloaded by [New York University] at 04:58 12 August 2016

Counseling Intention To help clients who find it difficult to discriminate and notice differ-
ences by using the Scaling Technique.
Description Molnar and de Shazer (1987) developed a reverse scale that can be
more effective. This was developed to help redirect the up-down meta-
phor and to have the shift from “depressed” (i.e., 7 or 8 rating) to nor-
mal (2 or 1 rating) be represented by a “downhill slide” rather than an
“uphill battle.” (p. 352). Keep a record of one’s rating. For example,
for clients with anxiety, ask them to rate the severity of their anxiety on
a daily basis. Ask the client to record other information, such as what
happened, what he or she did to cope, and who he or she spends time
with. Finally, review the ratings with the client and focus on the client’s
best days and highlight the other information that was recorded, as
these are exceptions that can be amplified (Guterman, 2010).

Technique: More of the Same

Counseling Intention To look at exceptions and amplify them to help the client change from
problems to solutions.
Description The following checklist will assist in improving the process:

• Did you diligently and patiently help the client identify exceptions?
• Did you identify small exceptions?
• Did you identify potential exceptions?
• Did you try to ask questions differently?
• Did you persist in your efforts?
• Did you negotiate small, simple, and relevant goals that the client knows how to accomplish?
• Did you amplify the exceptions? (Gutterman, 2006.)

Solution-focused brief therapy focuses on developing solutions to problems rather than dwell-
ing on problems of the past. Evidence-based outcome research has proven its effectiveness
through randomized controlled trials, meta-analyses, and case studies (De Jong & Berg 2008, de
Shazer, Dolan, Korman, Trepper, McCollum, & Berg 2006). This theoretical approach differs
from traditional treatment by concentrating on solutions rather than on problematic feelings,
cognitions, and behaviors and outlining interactions, which provides the client with interpre-
tations, confrontations, and education. The client develops a desired vision of the future to
solve his or her problem and explore and amplify related exceptions, strengths, and resources
to co-construct a client-specific (e.g., not therapist-specific) passageway to make the client’s
 Cognitive Behavioral, Dialectical Behavioral, and Solution-Focused Therapies  107
solution-focused vision a reality. With this approach, each client identifies his or her unique solu-
tions based on his or her evolving goals, strategies, strengths, and resources. It is applicable as
a traditional psychotherapy and has been effective in family therapy; couples therapy; domestic
violence; addictive disorders; and school, agency, and institutional settings, as well as business
environments.

Technique: Flagging the Mindfield

Counseling Intention To help the client generalize what he or she learned in counseling to
future situations that he or she may encounter.
Description Use the technique at the end of the counseling process to identify trig-
gers or pinch points that may trigger early dysfunctional behavior that
can recur as potential pitfalls and optimal functioning. In flagging the
Downloaded by [New York University] at 04:58 12 August 2016

mindfield, the importance of recognizing warning signs or triggers of

potential pitfalls is critical to changing behavior. Table 6.7 outlines 20
questions or techniques that enhance the solution-focused approach
to therapy (Sklare, 2005).

Table 6.7  Twenty Solution-Focused Questions or Prompts that Focus the Therapeutic Relationship
on Solutions Rather Than Problems
Question or Prompt Example
  1. The scaling On a scale of 0 to 10 (i.e., 0 = least progress; 10 = most progress),
question how would you rate your situation or problem? The therapist could
employ “a success scale,” “a motivation scale,” “a confidence scale,” “a
competence scale,” or “an independence scale.”
  2. The past success Guide the client to remember when he or she was able to cope with
question a problem. For example, “When have things already been a little bit
better?” “Have you ever been able to solve such a problem before?”
and “Have you ever experienced a situation which is a little bit like the
situation you want to achieve?”
  3. The preferred This invites the client to describe how he or she would like the situation
future question to become. For example, “What does your preferred future look like?”
“How do you want your situation to be?” “What would you like instead
of [the problem]?” and “How will you notice things will become
better?”
  4. The platform The platform question helps the client to see what already has been
question accomplished or achieved. For example, “What have you already
achieved?” or “What has helped to bring you to your current position?”
  5. The exception- The exception directs the client to focus on times when things were
seeking better; for example, “Are there times when the problem does not
question happen?” “When was this?” “What was different?” “How did you make
this happen?”
  6. Reframing Reframing is an alternative, usually positive, interpretation of
troublesome behavior that gives a more positive meaning to the client’s
interaction with those in his or her environment. It suggests a new
and different way of behaving, freeing the client to alter behavior and
making it possible to bring about changes while saving face.
  7. Indirect An example of this solution-focused technique may be, “Wow, how did
compliments you manage to finish that task so quickly?” or “What do your colleagues
appreciate in how you work?”
  8. The miracle “What if, in the middle of the night, a miracle happened and all the
question problems that brought you here today are solved just like that?” This
gives the client hope, energy, and ideas for moving forward.

(Continued)
 108  Cognitive Behavioral, Dialectical Behavioral, and Solution-Focused Therapies
Table 6.7  (Continued)

  9. Summarizing The summary reassures the client that he or she was listening carefully,
the client words was heard accurately, shows respect for the client’s frame of reference,
and helps formulate the next question based on what the client revealed.
10. The what-is- This question is used further on in the therapy sessions. “What is better
better question since we last talked?” This helps the client focus on progress made since
the last session and also focus on what has worked well.
11. Normalizing The therapist works to depathologize people’s concerns and present
them as normal daily living difficulties, reinforcing that they are
not abnormal for having this problem “Of course, you are angry,
I understand. It’s normal to be angry right now.”
12. The usefulness “So far, has this conversation been useful to you?” If the answer is no:
question “What are your ideas about how we can make the conversation more
useful?”
Downloaded by [New York University] at 04:58 12 August 2016

13. Observation “Could you, between now and our next conversation, pay attention to
suggestions situations in which things are a bit better?”
14. The perspective Have the client visualize how their situation will be different once their
change question situation has become better. For example, “How will other people
notice things are better?”
15. The coping For example: “What keeps you going under such difficult
question circumstances?” “How do you manage to deal with such difficult
situations each day?” How have you been able to do so well while the
circumstances are so hard?”
16. The “What happens in your situation that you want to continue to happen?”
continuation
question
17. The yes-set “Is it alright if I ask you a question?” “Would you like your situation to
become a bit better?”
18. The prediction This question encourages a self-fulfilling prophecy. The therapist asks
suggestion the client, “Each night, before going to bed, predict whether or not you
will succeed in __________ the next day.”
19. The overcoming “Pay attention to what you do when you overcome the temptation or
the urge urge to fall back.”
question
20. The optimism “What makes you optimistic?” “What indications do you have that you
question will be able to achieve_______?” or “What small signs will you see that
indicate you will succeed in _____?”
Source: Visser, C. (2011). 21 Solution-Focused Techniques. The Progress-Focused Approach. Retrieved from http://
www.progressfocused.com/2011/07/21-solution-focused-techniques.html Reprinted with permission.

Conclusion
Cognitive therapy’s concise, simple model has proven to be the most powerful and effective type
of psychological treatment in outcome studies conducted over the past several decades. Due to
the availability of literature and training of professionals, CBT, DBT, and SFBC currently enjoy
widespread popularity, and are practiced by many qualified professionals throughout the United
States and internationally. Cognitive therapists believe in the importance of cognitions, with
“cognition” referring to conceptions, ideas, meanings, beliefs, thoughts, inferences, expecta-
tions, predictions, and attributions (Davis & Fallowfield, 1991). These cognitions mediate client
problems and are available for scrutiny and subsequent change by the client. They are the pri-
mary target for change in attempting to address the client’s cognitive, affective, and behavioral
difficulties. Spinelli (1994) suggested that those with a cognitive perspective share the common
philosophical viewpoint that humans are disturbed by the views they hold about events rather
than the events themselves.
 7 Rational Emotive Behavior Therapy
and Reality Therapy

Rational Emotive Behavior Therapy

Downloaded by [New York University] at 04:58 12 August 2016

Rational emotive behavior therapy (REBT) is a humanistic, action-oriented approach to emo-

tional growth that emphasizes (1) the individuals’ capacity for creating their emotions, (2) the
ability to change and overcome the past by focusing on the present, and (3) the power to choose
and implement satisfying alternatives to current patterns. REBT is a comprehensive approach to
psychological treatment that deals not only with the emotional and behavioral aspects of human
disturbance, but also emphasizes its cognitive component: “There is nothing either good or bad,
but thinking makes it so” (William Shakespeare).
Rational emotive behavior therapy assumes that people do not get disturbed by their early or
present life experiences, but rather they have a strong innate predisposition to disturb them-
selves consciously and unconsciously. Clients assimilate their preferential goals, standards, and
values from their families and culture, and change them into explicit and tacit “shoulds,”
“oughts,” and “musts” that become imposed on their expectations on themselves and other
people. Ellis (1992) maintained that when people needlessly disturb themselves, they produce
dysfunctional thoughts (e.g., obsessions), feelings (e.g., panic disorders, depression, anxiety,
self-criticism, self-hatred), and dysfunctional behaviors (e.g., phobias, obsessions, compulsions,
mood disorders, and depression). The role of the therapist is to focus on the elimination of
emotional responses to irrational thinking by rationally challenging beliefs and providing cli-
ents with more accurate and realistic appraisals of themselves and their life experiences. The
therapist challenges the client to work to change his or her powerful “mustabatory” thinking,
emoting, and acting.
REBT is promulgated on a few basic principles, which have profound theoretical
implications:

l. A client is responsible for his or her own emotions and actions.

2. A client’s harmful emotions and dysfunctional behaviors are the product of the client’s irra-
tional thinking.
3. A client can learn more realistic views and, with practice, make them a part of his or her
emotional repertoire.
4. The client will experience a deeper acceptance of self and greater satisfactions in life by devel-
oping a reality-based perspective.

REBT distinguishes clearly between two distinct types of problematic difficulties: practical
problems and emotional problems. Flawed behavior, unfair treatment by others, and undesir-
able situations represent practical problems. Universally, clients have the tendency to become
 110  Rational Emotive Behavior Therapy and Reality Therapy
upset, serving as a catalyst for creating a second order of problems—emotional suffering. REBT
addresses emotional suffering with the following four tenets.
First, clients need to take responsibility for their own distress. Only the client can upset himself
or herself about current events. Yet the events themselves, no matter how difficult, do not have
absolute power to upset the client. Inherently, the client must recognize that neither an indi-
vidual nor an adverse circumstance can ever disturb the client. Essentially, arbitrary emotional
disturbance is self-inflicted. The client invariably creates his or her own emotional suffering or
self-defeating behavioral patterns as the result of what others say or do.
Second, the client needs to identify his or her inner dialogue of “musts.”
Essentially, there are three core distortions that focus on the client’s self-defeating “must”
dialogue:

• “Must” 1, an unrealistic expectation of one’s self: “I must do well and get approval, or else
Downloaded by [New York University] at 04:58 12 August 2016

I’m worthless.” This irrational self-imposed demand causes anxiety, depression, and emo-
tional distress.
• “Must” 2, an unrealistic expectation about others: “You must treat me reasonably, consid-
erately, and lovingly, or else you’re no good.” This “must” leads to resentment, hostility,
alienation, conflict, self-destructive behavior, and even violence.
• “Must” 3, an unrealistic expectation of situations or circumstances: “Life must be fair, easy,
and hassle free, or else it’s awful.” This distorted thinking fosters hopelessness, helplessness,
procrastination, depression, anxiety, and addictions to self-medicate.

Third, it becomes paramount that therapists teach the client to dispute his or her irrational,
self-imposed “musts.” What is the evidence for his or her “musts”? How are they true? If there’s
no evidence, the client’s “musts” are entirely false.
Fourth, the therapist needs to teach the client to reinforce his or her preferences:

Preference 1: “I strongly prefer to do well and get approval; but even if I fail, I will accept
myself unconditionally and fully.”
Preference 2: “I strongly prefer that others treat me reasonably, kindly, and lovingly, but
since I don’t run the universe and it’s a part of human nature to err, I cannot control
others.”
Preference 3: “I strongly prefer that life be fair, easy, and hassle free, and it’s very frus-
trating that it isn’t; but I can bear frustration and still enjoy life without self-imposed
expectations.”

REBT is based on the assumption that clients label “emotional” reactions, which are largely
caused by conscious and unconscious irrational and self-defeating evaluations, interpretations,
expectations, and philosophies. Thus, clients feel anxious or depressed because their belief system
strongly convinces them that it is terrible when they fail at something or that they can’t stand
the pain of being rejected, unloved, or excluded. Ellis (1992, pp. 63–80) identified 12 irrational
ideas that cause and sustain neurosis among clients. Rational therapy holds that certain core irra-
tional ideas, which have been clinically observed, are at the root of most neurotic disturbance.
They are:

  1. The idea that it is a dire necessity for adults to be loved by significant others for almost eve-
rything they do.
  2. The idea that certain acts are awful or wicked, and that people who perform such acts should
be severely condemned.
 Rational Emotive Behavior Therapy and Reality Therapy  111
  3. The idea that it is horrible when things are not the way people like them to be.
  4. The idea that human misery is invariably externally caused and is forced on us by outside
people and events.
  5. The idea that if something is or may be dangerous or fearsome, people should be terribly
upset and endlessly obsess about it.
  6. The idea that it is easier to avoid than to face life’s difficulties and self-responsibilities.
  7. The idea that people absolutely need something other or stronger or greater than themselves
on which to rely.
  8. The idea that people should be thoroughly competent, intelligent, and achieving in all pos-
sible respects.
  9. The idea that, because something once strongly affected our life, it should indefinitely affect
it, as well as the idea that people must have certain and perfect control over things.
10. The idea that human happiness can be achieved by inertia and inaction.
Downloaded by [New York University] at 04:58 12 August 2016

11. The idea that people have virtually no control over their emotions and cannot help feeling
disturbed about things.

Further, Walen, DiGuiseppe, and Wessler (1980, pp. 72–73) have defined the somewhat elu-
sive concepts of rational and irrational beliefs as follows:

1. A rational belief is true. The belief is consistent with reality in kind and degree; it can be
supported by evidence; and it is empirically verified. Also, it is logical, internally consistent,
and consistent with realities.
2. A rational belief is not absolute but is conditional or relative. A rational belief is usu-
ally stated as a desire, hope, want, wish, or preference. It reflects a desire rather than a
demand.
3. A rational belief results in moderate emotion. Rational beliefs lead to feelings that range from
mild to strong but that are not upsetting to the client.
4. A rational belief helps you attain your goals. Rational beliefs are congruent with satisfaction
in living, minimizing intrapersonal conflict, minimizing conflict with the environment, and
enabling affiliation and involvement with others and personal growth.

Irrational beliefs are defined in terms of a set of opposite constructs (Walen, DiGuiseppe, &
Nessler, 1980, pp. 73–74):

1. An irrational belief is not true. It does not reflect reality; it often begins with an inaccurate
premise and leads to inaccurate deductions. It is not supported by evidence, and it often
represents an overgeneralization.
2. An irrational belief is an intrapersonal command. It represents an absolute rather than a
problem-solving philosophy, and it is expressed as “demands” or “shoulds” rather than as
“wishes” and “preferences.”
3. An irrational belief promotes disturbed emotions. Apathy or anxiety is debilitating and
nonproductive.
4. An irrational belief does not help to attain personal goals. When one is consumed with
absolute edicts and paralyzed by upsetting emotions, it becomes increasingly difficult
to maximize pleasure and minimize discomfort in order to feel competent in everyday
life.

Adolescence is a period that is often characterized by “storm and stress,” as well as the
developmental task of identity formation. Because this is a very self-­conscious period for many
 112  Rational Emotive Behavior Therapy and Reality Therapy
teenagers, they may manifest the following irrational beliefs identified by Walters (1981,
pp. 136–144):

• It would be awful if peers didn’t like me. It would be awful to be a social loser.
• I shouldn’t make mistakes, especially social mistakes.
• It’s my parents’ fault I’m so miserable.
• I can’t help it; that’s just the way I am and I guess I’ll always be that way.
• The world should be fair and just.
• It’s awful when things do not go my way.
• It’s better to avoid challenges than to risk failure.
• I must conform to my peers.
• I can’t stand to be criticized.
• Others should always be responsible.
Downloaded by [New York University] at 04:58 12 August 2016

Difference Between REBT and Other Schools of Psychotherapy

REBT differentiates itself from other schools of therapy in three areas: (1) it deemphasizes early
childhood experience, (2) it applies scientific thinking to irrational thinking and attempts to shift
the clients’ point of view, and (3) it uses homework to reinforce what was learned in the thera-
peutic setting. The therapist inherently believes that no matter what the client’s basic irrational
philosophy of life, he or she is presently disturbed because he or she still believe this self-defeating
perception of himself or herself and the world. If the client will identify exactly what he or she is
irrationally thinking in the present and begin to challenge and question these self-statements, the
client has the opportunity to improve significantly.
REBT strives to reconfigure the client’s outlook on life. It teaches the client that adults do not
need to be accepted or loved, even though it is highly desirable. Clients are shown how to ques-
tion (1) the scientifically ambiguous hypotheses that they construct, as well as (2) preconceived
notions about themselves and their relationships. Clients are shown how to ask themselves,
“Granted that my acts may be mistaken, why am I a totally bad person for performing them?
Where is the evidence that I must always be right in order to consider myself worthy? Assuming
that it is preferable for me to act well rather than badly, why do I have to do what is preferable?”
REBT maintains that in reality, to be human is to be fallible. This reality can be accepted if one
works hard to become a little less fallible and do so without creating undue discomfort and
distress.
In REBT, actual homework (or ownwork) assignments are frequently given to practice new
learnings outside the therapeutic setting. Assignments may include becoming more assertive by
asking someone out on a date, or looking for a new job or career, or resolving a relationship
that was previously conflicted. The therapist actively encourages the client to undertake such
assignments as an integral part of the therapeutic process and rate his or her level of satisfaction
at accomplishing assignments on a scale from 1 to 10 (1 = low, 10 = high).
The REBT practitioner provides clients unconditional rather than conditional posi-
tive regard because the REBT philosophy maintains that no one should be condemned for
anything, no matter how deplorable their behavior may be. The therapist’s intentions are
unconditional acceptance while actively teaching clients how to fully accept themselves, to
express their feelings, and to stop berating themselves. Rational emotive behavior therapy
uses expressive-experimental methods and behavioral techniques. It is not, however, primarily
interested in helping people ventilate emotion and feel better, but in showing them how they
can truly get better and lead to less dysfunctional, less self-defeating, and more self-actualized
lives.
 Rational Emotive Behavior Therapy and Reality Therapy  113
Two of the foremost cognitive-behavioral interventionists are Maultsby and Ellis. Maultsby
is recognized for rational behavior therapy (RBT) and Ellis for rational emotive therapy (RET).
In 1993, Ellis changed the name from rational­-emotive therapy to rational-emotive behavior
therapy. Maultsby (1975) and Ellis (1973) articulated the role of the interventionist by demon-
strating to troubled clients that through (1) their own thinking and (2) the use of a structured
strategy, they can reorder their perceptions and behavior to remove the source of their difficul-
ties. Essentially, Ellis (1979, 1985, 1990) has developed an ABC theory of personality that
holds that (A) activating events do not directly cause (C) emotional and behavioral consequences.
Rather, the emotional and behavioral consequences (C) are largely caused by (B) one’s beliefs
about the activating event. The disputation method involves identifying, debating, and challeng-
ing irrational beliefs and replacing them with rational beliefs (Ellis, 1975; Ellis, 1989). Thoughts,
feelings, and behavior are all interrelated.
Self-statements can become habitual responses to stress or conflict. By cognitively restructur-
Downloaded by [New York University] at 04:58 12 August 2016

ing, the client can learn specific coping skills to restructure thoughts, reduce stress, and increase
relatively positive or negative feelings.

Rational Emotive Behavioral Techniques

Technique: Ellis’s A-B-C-D-E Paradigm

Counseling Intention To correct distorted thinking or self-defeating belief systems.
Description Albert Ellis maintained that people upset themselves via their own
belief systems. Clients are taught how they falsely attribute their own
upsets to outside or activating events. When feeling upset, clients are
directed to examine their B (beliefs) instead of blaming the A (activat-
ing events).

They are shown that activating events (A) do not result automatically in emotional and behav-
ioral consequences (C), but that it is mainly the beliefs (B) about A that are responsible for the
impact at point C. By disputing (D) the irrational beliefs at point B, the effect (E) is the elimina-
tion of negative consequences (C).
The client may be provided with a homework exercise to begin identifying self-defeating feel-
ings such as anger:

A = Activating event. Describe a situation about which you became angry.

B = Beliefs. What do you tell yourself about the situation?
C = Consequences, behavioral or emotional. Describe the upset feeling. Describe what you did
because you were angry.
D = Dispute. Question the client’s angry thoughts, expectations, and disappointments. Is
there a different way of looking at the situation?
E = Effect. What would the client like to see happen? What can the client change and what
should he or she accept?

Technique: Charting Irrational Beliefs

Counseling Intention To correct distorted thinking or self-defeating belief systems (Ellis,
1988).
Description Table 7.1 is helpful in charting irrational beliefs.
 Table 7.1  Charting Irrational Beliefs
(A) Activating Events—thoughts or feelings that happened just before I felt emotionally dis-
turbed or acted as if I were defeated.
(B) Beliefs—self-defeating talk about the experience or situation.
(C) Consequence of Conditions—disturbed feelings or self-defeating behavior that I produce
and would like to change.
(B) Beliefs-Irrational Beliefs (IB) leading to my (D) DISPUTES (E) EFFECTIVE
CONSEQUENCES (emotional disturbance or for each circled RATIONAL BELIEFS
self-defeating behavior). Circle all that apply to IRRATIONAL (RBs) to replace my
these ACTIVATING EVENTS (A). BELIEF. IRRATIONAL
BELIEFS (IBs).

 1. I must do well or very well! Example: “Why ‘must’ Example: “I’d ‘prefer’
I do very well?” to do very well but
Downloaded by [New York University] at 04:58 12 August 2016

I don’t ‘have to.’ ”

 2. 
I am a bad or worthless person when I act Example: “Where is Example: “I am a
weakly or stupidly. it written that I am a person who acted badly,
BAD PERSON?” not a bad person.”
 3. I must be approved or accepted by people Example: “Where is Example: “There is no
I find important. the evidence that I evidence that I ‘have’
‘must’ be approved and to be approved, though
accepted?” I would like to be.”
 4. I am a bad, unlovable person if I get
rejected.
 5. People must treat me fairly and give me
what I need.
 6. People who act immorally are undeserving,
rotten people.
 7. People must live up to my expectations or it
is terrible.
 8. My life must have few major hassles or
troubles.
 9. I can’t stand really bad things or very
difficult people.
10. It’s awful or horrible when major things
don’t go my way.
11. I can’t stand it when life is really unfair.
12. I need to be loved by someone who matters
to me a lot!
13. I need a good deal of immediate
gratification and have to feel miserable
when I don’t get it.
14. I should be promoted; I have worked hard.
15. Everyone I meet should like me
100 percent.
16. Life should be fair because I am in control.
17. Other people should live up to my
expectations.
Source. Albert Ellis (1988) How to Stubbornly Refuse to Make Yourself Miserable About Anything, Yes Anything. New
York: Kensington Publishing, p. 45. Reprinted with permission.
 Rational Emotive Behavior Therapy and Reality Therapy  115

Technique: Identifying Unpleasant Emotions

Counseling Intention To identify antecedents to subsequent feelings.
Description Identify the last time you were feeling a strong, unpleasant emotion.
Write the emotion under “C.” Under “A,” write in the event before
the emotion occurred. Under “B,” identify what you were thinking
between the event and the emotion.

A = (activating event): “My clients do not implement the action plans developed in therapy.”
B = (my thinking): “Maybe I come on too strongly.” “Maybe I’m really a poor therapist.”
“She really doesn’t know what is best for her.”
C = (my feelings and behavior): Self-doubt about skills; anger about client’s lack of initiative.
B causes C, but people believe that A causes C.
Downloaded by [New York University] at 04:58 12 August 2016

Next, analyze the accuracy of the facts and events written in “A.” This can be accomplished
through rational self-analysis (i.e., “Where is the evidence that what I believe is true?”). In addi-
tion, one can differentiate between rational and irrational beliefs by answering the following
questions:

1. Do the client’s beliefs reflect an objective reality? Would a second party perceive the situation
in the same way? Are the beliefs exaggerated and personalized?
2. Are the beliefs helpful to the client? (Self-destructive thoughts are usually irrational.)
3. Are the beliefs helpful in reducing conflicts with others, or do they foster an “us versus
them” mentality?
4. Do the beliefs help or get in the way of short-term or long-term goals?
5. Do the beliefs reduce or enhance emotional conflict?

Write the objective version of the facts and events at “D.” Only an event that can be recorded
by a camera, video camera, or tape recorder is a fact. If the event cannot be recorded, it is
probably an opinion, a feeling, or an evaluation. This strategy should help the client see how
misperceptions of situations can alter one’s self-talk or inner dialogue, and in turn affect one’s
emotional response. Irrational thoughts lead to negative emotional feelings. Negative emotional
feelings ultimately lead to depression (Wilde, 1992, 1996).
Finally, the therapist should have the client decide how he or she would like to feel in the situ-
ation described in “D” and enter the feeling under “F.” Is it realistic to have a positive emotional
response to a stressful situation, or is it more appropriate to accept a neutral feeling? Now have
the client attend to the “E” section and develop a more rational alternative to the irrational
thoughts at “B.” The rational alternatives should be acceptable to the client and meet at least
three of the five criteria for rational thinking.
This exercise merely outlines some strategies for developing a rational plan of action and
changing unwanted feelings and behaviors. This could be reframed in the following manner:

D (objective event): “My client did not carry out his action plan.”
E (my rational thinking): “He is responsible for his own behavior.”
F (desired feeling or behavior): “Relaxed with continued therapeutic interactions.”

Technique: Three R’s

Counseling Intention To encourage the client to think about better ways of handling a
situation.
 116  Rational Emotive Behavior Therapy and Reality Therapy
Description
Poor Way to Handle Situation Better Way to Handle Situation
React Retreat
Retreat Rethink
Rethink Respond

Twelve Distressing Myths Revisited

Inherently, people worry and become upset because of the way they interpret their stressors. Yet,
people can choose to react rationally (reasonably) or irrationally (unreasonably) to a stressor.
Roberts and Guttormson (1990) listed 12 irrational beliefs (myths) to which people commonly
cling.
Downloaded by [New York University] at 04:58 12 August 2016

Myth 1: “I must be loved by everyone, and everyone must love everything I do.”
Myth 2: “I must be intelligent, competent, and capable in everything I do.”
Myth 3: “Some things in the world are bad, wrong, or evil, and I must be punished severely
if I see, do, think, or feel them.”
Myth 4: “The world is over when things don’t turn out the way I want them to.”
Myth 5: “I have no control over my own happiness. My happiness depends on what happens
to me.”
Myth 6: “Worrying about something bad keeps it from happening.”
Myth 7: “It’s always easier to run away from problems than it is to deal with them.”
Myth 8: “You need someone else to depend on. You can’t function independently.”
Myth 9: “If something bad happened in your past, it must affect you forever.”
Myth 10: “If someone else doesn’t live his or her life in the way you think he or she should,
you must do everything you can to change that person.”
Myth 11: “There is only one correct answer to any problem. If that answer isn’t found, the
consequences will be terrible.”
Myth 12: “You can’t help feeling the way you do.”

These distressing beliefs are complicated when unreasonable demands emerge as unrealistic
expectations. Schriner (1990) aptly stated that “[d]isappointment is the caboose on the train
of expectation.” Many clients spend a tremendous amount of time and energy wrestling with
distorted perceptions of themselves made up of self-criticisms, comparisons with others, appre-
hension, unrealistic expectations of the future, relentless demands for improvement, defensive
excuses for failures, and an array of accompanying self-defeating thoughts and feelings.

Technique: Eliminating the “Big 10” Cognitive Distortions

Counseling Intention To confront irrational thought and related anxiety; to counteract
depression, stress, and panic attacks.
Description Crawford and Ellis (1989) have classified irrational beliefs into five
categories:

1. Self-defeating beliefs that interfere with basic goals and drives.

2. Highly rigid, dogmatic beliefs that lead to unrealistic preferences and wishes.
3. Antisocial beliefs that cause people to destroy their social groups.
4. Unrealistic beliefs that falsely describe reality.
5. Contradictory beliefs that originate from false premises.
 Rational Emotive Behavior Therapy and Reality Therapy  117

Technique: A Collective Identification of Irrational Thinking and Suggested Solutions for Panic
Disorder and Depression
Counseling Intention To challenge irrational, self-defeating talk.
Description Most people who suffer from panic disorders also are depressed. Han-
dly and Neff (1985) outlined and provided solutions to the “big 10”
cognitive distortions that affect most anxious people:

Problem 1: Perfectionism. Often, a high-achieving client may set unreasonably high standards
for himself or herself but credit accomplishments to mere luck.
Solution: Don’t strive to achieve unrealistically high levels in everything attempted.

Problem 2: Rejectionitis. The client may have the tendency to exaggerate a single rejection by
Downloaded by [New York University] at 04:58 12 August 2016

someone to the point that it affects every dimension of his or her life.

Solution: Prove that this assumption is not true by listing your good qualities, and make
another list of people you know who have these same good qualities.

Problem 3: Negative focus. This is the tendency or habit of letting a negative experience oblit-
erate all the positive dimensions.
Solution: Go to an alpha state of consciousness where the brain wave activity is at a lower fre-
quency than the normal waking state, and picture all the good things about oneself; then
select some positive affirmations and repeat them throughout the day.

Problem 4: Refusing the positives. Refusing the positives expands the “negative focus.” A client
may tell himself or herself that even “good” things in life are negatives—that is, choosing
to be uncomfortable with thinking one is successful, refusing the positive, and inviting
depression.
Solution: When you get a compliment or recognition for something well done, say “thanks”
and not another word.

Problem 5: The white-is-black phenomenon. A client may use neutral or even positive facts to
make negative conclusions about his or her relationships to others. For example, the client
interprets another’s action as being particularly hostile to him, when in actuality the person
was experiencing some discomfort (e.g., the client assumes that someone didn’t return a
call because she doesn’t like him, when in reality she was out of town and didn’t receive
the message).
Solution: Think rationally and check reality. Have clients remind themselves that they are not
responsible for another person’s behavior.

Problem 6: Stretch-or-shrink thinking. The client may either stretch the truth into an
“anxiety-producing fiction” (i.e., overreacting when one has done something undesir-
able) or shrink from attention and accolades until invisible when having done something
extraordinarily well.
Solution: Apologize for human mistakes. Acknowledge yourself aloud; sending good messages
to your unconscious can result in pleasant dreams and positive imagery.

Problem 7: Creating fictional fantasies. Letting emotions substitute for the truth about what
is happening is creating a fantasy.
Solution: Counter fictional fantasies with the acknowledgment that distorted thoughts create
negative feelings.
 118  Rational Emotive Behavior Therapy and Reality Therapy
Problem 8: Use emotional transfusion to change feelings at the unconscious level. “Shoulds” and
“oughts” cause clients to act in ways they would prefer not to, as they misconstrue respon-
sibilities, expectations, or obligations.
Solution: Recognize that you alone are responsible for your actions.

Problem 9: Mistaken identity. Clients tell themselves that they are bad because of a mistake.
Solution: Try saying “I made a mistake,” and let it go.

Problem 10: Saying “It’s my fault.” The client assumes all blame and responsibility for a nega-
tive event, even when no one is responsible. In reality, no one can control another person.
Solution: Express your concern, but do not accept responsibility.

Problem 11: Controlling. The desire to be in control of our lives is entirely human; it is hardly
Downloaded by [New York University] at 04:58 12 August 2016

irrational, but it can lead to irrational behavior when we are unconsciously manipulated by
our self-destructive and self-sabotaging beliefs. To be “in control” means to understand
the facts of reality that bear on our life so that we are able to predict, with reasonable accu-
racy, the consequences of our actions.
Solution: Accept that some things are not within your control.

Technique: Direct Questioning

Counseling Intention To understand different cognitions that may be influencing the emo-
tions of the client (Walters, 1981).
Description General prompts to use with the client include:

“What were you thinking when it happened?”

“What sorts of things were you saying to yourself?”
“What name did you call your brother when he _____________________?”
“Tell me the first thing that comes into your mind when you think ________.”
“Picture yourself back in class; what did you think when ______?”

Technique: Cognitively Modeled Self States to Reduce Hair Pulling

Counseling Intention To reduce or eliminate self-destructive behavior (Bernard, Kratoch-
will, & Keefauver, 1983).
Description Outline the following self-statements for the client:

Problem Definition: “What am I supposed to do?”

Problem Approach: “I’m going to build a protective bubble around me so that nothing wor-
ries me until I get my homework done.”
Focusing of Attention: “I’d better pay attention to my assignment. What is the next thing
I have to do?”
Coping Statements: “Oh, I’m starting to worry about school and I just pulled a hair. I know
if I just relax and focus on my work that I won’t worry.”
Self-Reinforcement: “Hey, that’s great. I finished that bit of work. I didn’t worry. And I didn’t
pull my hair out. I knew I could do it!”

Technique: Internalizing New Skills

Counseling Intention To help a client practice and apply skills used in a counseling session
(Walters, 1981).
 Rational Emotive Behavior Therapy and Reality Therapy  119
Description Encourage the client to practice the following homework assignment:

1. Monitor feelings.
2. Make a list of personal demands.
3. Use rational emotive imagery.
4. Practice changing feelings and thoughts in a real situation.
5. Take a responsible risk.
6. Reinforce self through positive self-talk.

Technique: Perceptions versus Reality

Counseling Intention To assist the client in assuming personal responsibility for choices and
actions; to shift the center of responsibility.
Description Have the client think of an incident that really made him or her angry
Downloaded by [New York University] at 04:58 12 August 2016

or resentful, one that he or she still has some feelings about.

1. Have the client, in writing, describe the incident as if others were completely responsible for
bringing about the event. Blame them. Make it clearly their fault.
2. Have the client rewrite the incident as if he or she were solely responsible for starting, devel-
oping, and getting on with the problem. Take full account of what he or she could have
done so that the whole problem would not have arisen.
3. Although the client may feel a sense of unreality about both points of view, have him or her
reexamine them and see which one he or she feels most comfortable with. Does it alter the
opinion originally held if he or she accepts the blame or feels like a victim?

Technique: Conceptual Shift
Counseling Intention To dismantle a client’s damaging pattern of thinking about himself or
herself (McMullin, 1986, pp. 85–86).
Description Have the client list all the thoughts connected to a targeted negative
emotion:

1. Collapse the thoughts into one major negative core belief or theme.
2. List the situations (past and present) that are connected to the core theme.
3. Develop a list of alternative, more positive beliefs for each negative thought.
4. Summarize the positive beliefs into one core theme.
5. Help the client reinterpret the past and present situations in terms of the new perspective.
Go through each individual thought and situation and demonstrate how the client misinter-
prets situations.
6. Have the client practice reviewing more situations and reinterpreting them in terms of the
new themes.

Technique: Making Mistakes

Counseling Intention To get the client to give up the demand for perfection in others.
Description The following statements should be processed and discussed:

1. Everyone will always make mistakes.

2. No one is perfect.
3. Mistakes do not change a person’s good qualities.
4. A person is not the same as his or her performance.
 120  Rational Emotive Behavior Therapy and Reality Therapy
5. People who make mistakes do not deserve to be blamed and punished.
6. People are not bad because they make mistakes.
7. The reasons why people make mistakes are (a) lack of skill, (b) carelessness or poor judg-
ment, (c) insufficient information, (d) being tired or ill, and (f) irrationality.

Technique: Interpersonal Cognitive Problem Solving

Counseling Intention To have parents teach interpersonal cognitive problem solving in the
context of everyday happenings (Spivack, Platt, & Shure, 1976, p. 210).
Description Both mother and child engage in a problem-solving style of thinking
and communication.

Type of Problem: Child engaged in interpersonal conflict.

Downloaded by [New York University] at 04:58 12 August 2016

Specific Problem: Child initiates hurting or grabbing behavior.

1. Why [did you hit him]?

2. [Hitting] is one thing you can do. How did it make [Tommy] feel?
3. What happened when you [hit Peter]? What did [Peter] do or say?
4. Can you think of another way to [repeat reason child gave why he hit] so that won’t happen?
5. [After child answers] That’s a different idea. What might happen if you try that?

Technique: Identifying Personal Rights and Changing Irrational Thinking

Counseling Intention To challenge irrational thinking.
Description List four rational thoughts that directly counter your irrational
thoughts and underlying ideas.

1. _____________________
2. _____________________
3. _____________________
4. _______________________

Technique: Systematic Rationalization Process

Counseling Intention To help the client cope with stressful life events.
Description Stressors are defined for the client as events that produce aversive
symptoms such as feelings of tension, anxiousness, urgency, anger, or
concern. Systematic rationalization classifies stressful life events into
four quadrants: controllable, uncontrollable, important, and unim-
portant. It focuses on three steps:

Step 1: Identification of stressors. The client is asked to write down any event, no matter how
trivial, that is causing the stress in his or her life.
Step 2: Identification of stressors. The client classifies each event on the list as controllable or
uncontrollable based on his or her perception of personal ability to manage or act on the
stressor and as important or unimportant based on the client’s personal priorities for each
outcome. The therapist learns how the client conceptualizes the stress in his or her life.
Step 3: Review the classification. A systematic review of the stressors is conducted. The review
begins with stressors perceived as unimportant. Events listed as unimportant, whether
controllable or uncontrollable, can be referred to as hassles (i.e., small life events such as
 Rational Emotive Behavior Therapy and Reality Therapy  121
traffic jams, long lines, long waits, bad weather, out-of-order ATM machine, missed flight,
or missed train).

Events perceived as important contain issues of personal priority (e.g., job, family, financial
security, safety, or orderliness). These stressors are reviewed as two separate classifications: con-
trollable and uncontrollable. Reactions for these stressors are accomplished by personal planning
and goal setting. Specific action aimed toward managing one or more of these stressors may be
assigned to the client as homework. Stress management techniques for important and control-
lable stressors include stress inoculation, behavioral rehearsal, imagery, and progressive relaxation
or other techniques that encourage the client to take responsibility for his or her behavior.
Stressors listed as important and uncontrollable are the most difficult concerns for clients to
handle effectively. To reduce the stress associated with important and uncontrollable concerns,
the therapist may encourage the client to change his or her perception of these stressors by
Downloaded by [New York University] at 04:58 12 August 2016

reclassifying the event. This therapeutic process may include the use of rational emotive therapy,
coping skills training, and positive self-talk.

Technique: Daily Activities to Help the Client Give Up Irrational Thinking

Counseling Intention To keep the client focused on strategies taught in counseling sessions
(Grieger, 1986).
Description The following activities can be assigned to clients between counseling
sessions:

1. Pleasurable pursuits—committing time each day to pleasurable pursuits.

2. Rational-emotive imagery—vividly picturing difficult events and practicing thinking ration-
ally about them.
3. Shame-attacking exercises—performing “silly” or “embarrassing” acts in public to demon-
strate that there is no need to feel ashamed.
4. Courting discomfort—deliberately doing uncomfortable things or staying in uncomfortable
situations a little longer.
5. Risk taking—doing things feared.
6. Behavioral rehearsal—practicing unskilled or scary things.
7. Rewarding and penalizing—rewarding or punishing for doing or not doing something.

Technique: Depersonalizing Self
Counseling Intention To help clients look at themselves as others look at them (McMullin,
1986, pp. 117–118).
Description Have the client make a list of 20 negative events that he or she has
recently experienced; then:

1. Record the hypothesized internal self-deficiencies that the client thinks cause the events
(beliefs that caused hyperpersonalization).
2. Teach the client to look for the causes of these events outside himself or herself. Instruct the cli-
ent in the use of the scientific method: look for stimuli, reinforcements, or environmental con-
tingencies that serve as triggers of negative events. Rewrite all proprioceptive causes as external.
3. Have the client keep a daily log of events and supposed internal and external causes. Teach
clients to see themselves and others as objects, subject to environmental influences.
4. Once clients have learned not to take responsibility for these influences, teach them the
kinds of problem-solving methods that can be used to modify the environment.
 122  Rational Emotive Behavior Therapy and Reality Therapy

Technique: Overcoming Resistance to Change

Counseling Intention To get the client to confront irrational beliefs and self­-defeating behav-
ior (Grieger, 1986).
Description Resistance often impedes the client from risk taking or taking respon-
sibility for change. Examples of resistance are as follows:

• Fear of discomfort—believing that the effort to change is too difficult, that it is easier to drift
along with problems than to make the effort to change them.
• Fears of disclosure and shame—believing present feelings, actions, or thoughts are inappro-
priate and that it would be terrible if anyone else knew it.
• Feelings of powerlessness and hopelessness—believing that one is unable to change, that prob-
lems are too big to overcome.
• Fear of change—believing that the safety and security of present self-defeating behaviors are
Downloaded by [New York University] at 04:58 12 August 2016

less risky than change.

• Fear of failure and disapproval—believing that one must always succeed, fearing that current
behaviors may lead to failure and disapproval.
• Self-punishment—believing one is a bad person and deserves to suffer.
• Discouragement—believing that disturbances cannot be overcome.

Technique: Rational-Emotive Imagery (REI)

Counseling Intention To help the client think more rationally and to become less upset.
Description

Negative Imagery
Picture yourself or fantasize, as vividly and intensely as you can, the details of some unpleas-
ant activating experience (A) that has happened to you or will likely occur in the future. As
you strongly imagine this event, let yourself feel distinctly uncomfortable—for example, anx-
ious, depressed, ashamed, or hostile—at (C) (your emotional consequence). Get in touch
with this disturbed feeling and let yourself fully experience it for a brief period of time. Don’t
avoid it; confront it, face it, and feel it.
When you have actually felt this disturbed emotion for a while, push yourself to change
this feeling in your gut, so that instead you only feel keenly disappointed, regretful, annoyed,
or irritated but not anxious, depressed, guilty, or hostile. Do not think that you cannot do
this. You can get in touch with your gut-level feelings and push yourself to change them so
that you experience different feelings.
Push yourself only to feel disappointed or irritated; look at what you have done in your
head to make yourself have these new, appropriate feelings. Upon close examination, you
will recognize that you have in some manner changed your Belief System (or B.S.) at “B,”
and have thereby changed your emotional Consequences, at (C) so that you now feel regret-
ful or annoyed rather than anxious, depressed, guilty, or hostile.
Let yourself clearly see what you have done, what important changes in your Belief Sys-
tem you have made. Become fully aware of the new beliefs (B) that create your new emo-
tional consequences (C) regarding the unpleasant Activating Experience (A) that you keep
imagining or fantasizing. See exactly what beliefs you have changed in your head to make
yourself feel badly but not emotionally upset.
Keep repeating the process. Make yourself feel disturbed; then make yourself feel dis-
pleased but not disturbed. Keep repeating the process. See exactly what you did in your
head to change your feelings. Keep practicing until you can easily, after you fantasized highly
 Rational Emotive Behavior Therapy and Reality Therapy  123
unfortunate experiences at “A,” feel upset at (C); change your feelings at (C) to one of dis-
appointment but not disturbance.
Practice REI for at least 10 minutes every day for the next few weeks. You will get to the
point where whenever you think of this kind of unpleasant event, or when it actually occurs
in practice, you will tend to feel easily and automatically displeased rather than emotionally
upset.
(Ellis, 1975, pp. 211–212)

Positive Imagery
To employ imagery and thinking, picture to yourself as vividly and intensely as you can the
details of some unpleasant activating experience (A) that has happened to you or will likely
occur in the future. Picture the situation at (A) at its very worst. Let yourself feel distinctly
uncomfortable—anxious, ashamed, depressed—at (C), your emotional consequence. Fully
Downloaded by [New York University] at 04:58 12 August 2016

experience this disturbed feeling.

As you feel upset at (C), notice what you keep telling yourself at (B) (your belief system
or B.S.) to make yourself feel disturbed. When you clearly see these Beliefs, dispute them
at (D) as you would in the usual kind of Disputing that RET or rational behavior training
(RET) teaches you to do.
Now, as you see these irrational beliefs and vigorously dispute them, strongly fantasize
how you would feel and behave after you started giving them up and after you started
believing, instead, rational beliefs about what keeps happening to you at (A). Intensely
picture yourself disbelieving your irrational beliefs and believing your rational ideas about
obnoxious events that may occur at (A) and then feeling appropriately displeased and disap-
pointed rather than inappropriately depressed and hostile at (C); and then, finally, acting in
a concerned instead of an upset manner at (E).
Keep practicing this procedure so that you first imagine something unfortunate or disad-
vantageous; then make yourself feel depressed, hostile, or otherwise disturbed about your
image. Then see what irrational beliefs you hold to create your disturbance; then work on
changing these beliefs. Then strongly picture yourself disbelieving these ideas and feelings
and acting in accordance with your new rational philosophies of being only concerned and
displeased rather than depressed and hostile.
(Ellis & Harper, 1975, pp. 36–38)

Technique: Disputing Irrational Beliefs (DIBS)

Counseling Intention To teach clients to seek out, discover, and dispute their irrational
beliefs.
Description To increase rationality and to reduce irrational beliefs, spend at least 10
minutes every day asking the following questions and carefully think-
ing through the appropriate answers. Write each question on paper, or
record the question and answers on a tape recorder.

• What irrational belief do I want to dispute and surrender? For example, I must always be liked
by others.
• Can I rationally support this belief? No.
• What evidence exists of the falseness of this belief? Many indications exist that this belief is
false: No law of the universe says that everyone must like me.
• Does any evidence exist of the truth of this belief? No evidence exists for any absolute must
that others should like me.
• “What is the worst thing that could actually happen to me if I don’t get what I think I must?”
 124  Rational Emotive Behavior Therapy and Reality Therapy
Technique: Disputing Irrational Beliefs by Using “A-FROG”
Counseling Intention To provide a five-step thought process for thinking and behaving more
rationally (Beck & Emery, 1985).
Description Use the acronym A-FROG to decide if one is thinking rationally:

A - Does it keep me alive?

F - Do I feel better as a result?
R - Is it based on reality?
O - Does it help me get along with others?
G - Does it help me get to my goals?

Technique: Rational Self-Analysis (RSA)

Downloaded by [New York University] at 04:58 12 August 2016

Counseling Intention To provide a systematic way to change unpleasant emotions and to

follow up on inappropriate behavior (Sabatino & Smith, 1990).
Description Record (write or tape record) just what happened—not what you
think about it—just a description of the event. Address the following:

Self-talk or opinion. Record what you said to yourself about the event.
Emotions and actions. Record the emotions and actions that you experienced.
Rational challenges. Take each statement you made and substitute a rational statement based
upon what you know to be fact. Ask why you tell yourself each of these things.
New ways of thinking and feeling. Record new feelings and the thinking that might lead to
solving the problem.

Technique: Overcoming Panic Attacks

Counseling Intention To incorporate skills to lessen the effects of a panic attack.
Description Symptoms of a panic attack include a pounding heart, legs feeling
weak and trembling, a tight throat, lightheadedness, or fears of a heart
attack. The anxiety-prone person, rather than ignoring those discom-
forts, dwells on them, magnifying and prolonging them by thinking: I
must know precisely why I’m feeling like this. I must be certain it’s not
serious. I must never lose control or act crazily. I must not do some-
thing stupid or look foolish. I must have a guarantee I’m not going to
die. I must not make myself panic.
Step 1: Encourage the client to recognize the “musts”—although it
would be highly preferable to avoid discomfort, it’s never a must. The
client does not always have to feel entirely comfortable, and most peo-
ple usually don’t. Step 2: Encourage the client to confront and dispute
persuasively, vigorously, and persistently those unrealistic musts until
he or she gives them up.
Also, pushing the client to do the things he or she is afraid of doing
will reaffirm with these actions that great discomfort is never horrible, but
rather tends to diminish when it is consistently faced, rather than avoided.

Technique: Working Toward a Happier Mental Outlook

Counseling Intention To challenge the client’s irrational or self-defeating beliefs.
Description As the client follows the acronym “I SAW IT A CURSE,” the client
should be encouraged to express the thoughts behind them and in
 Rational Emotive Behavior Therapy and Reality Therapy  125
his or her own words interpret what they mean. I SAW IT A CURSE
consists of two parts: (1) I SAW tells the client what to do, and (2)
IT A CURSE tells the client what irrational or self-defeating beliefs
should be challenged.

Do:
I - inspire yourself to work on your attitude by remembering that many people have become
more involved in life, happier, and more productive by using REBT principles, and that
many people have used other commonsense, nonperfectionistic, noncondemning philoso-
phies to enjoy life more.
S - set rational and reasonable goals: Be happy with progress.
A - accept behavior in the moment. Work calmly to become more relaxed, change behavior,
Downloaded by [New York University] at 04:58 12 August 2016

and gain more of what is wanted.

W - write or record some thoughts and progress of growth and self-help.

Challenge:
I - insufficient allocation of priorities, time, energy, and money to learn to live more happily.
T - too hard; too intense trying, which is self-defeating.
A - absolute; perfectionistic standards only lead to grief.
C - childish catastrophizing. Even though you often say, “I can’t stand this,” no one has died
of it.
U - useless urgency. It will take as long as it takes to get to where you want to go! Set priorities,
allocate time for relaxation, and “smell the roses.”
R - ridiculous rating of self. We are all alive, we have a tendency to falter, and all of us do!
We have so many characteristics and deeds and misdeeds that we cannot be globally rated.
S - silly performance shame.
E - expecting failure. Just because you have not succeeded in the past does not mean you will
not succeed in the future.

Technique: DEFUSE spelled DPHEWES

Counseling Intention To achieve a more optimum sense of well-being.
Description The following acronym is helpful in overcoming the client’s irrational
“shoulds,” “musts,” and “oughts.”

D - don’t place demands on self, others, or the world. Demands in self-talk are expressed by
terms as “must” or “he should.”
P - prioritize, plan, subdivide into achievable goals, and then do them (one at a time).
H - humor yourself and others; take life less seriously.
E - exude relaxed calmness using REBT techniques, and calmly accept one unpleasant reality
every day of your life.
W - work on bad moods and challenge irrationalities, and do the tasks at hand.
E - establish a routine to tackle problems.
S - shun the words “should,” “must,” and “have to” when used in the sense of being a demand.

REBT is a semantic therapy. That is, even though it is quite correct to say that all the signs
indicate it should rain tomorrow, it is quite illogical to say you should be able to get the highest
score on this test. A better way is to be more accurate: “If I study harder than anybody else and
 126  Rational Emotive Behavior Therapy and Reality Therapy
know more than they do, I will probably receive a high score on the exam. If nobody is extraor-
dinary, neither lucky nor a genius, I may even get the highest score.”

Reality Therapy and Choice Therapy

Another rational approach is reality therapy. Glasser (1982) conceptualized reality therapy in
seven steps, which are cooperative endeavors between the counselor and the client:

1 Make friends; create a relationship to gain support.

2. Deemphasize the client’s history and find out what is going on now.
3. Help the client learn to make an evaluation of behavior. Help the client find out whether
what he or she is saying is really helping.
4. Once the client behavior has been evaluated, explore alternative behaviors that may prove
Downloaded by [New York University] at 04:58 12 August 2016

more helpful.
5. Get commitment for a plan of action.
6. Maintain an attitude of “no excuses if you don’t do it.” The client must learn to be respon-
sible in carrying out the plan.
7. Be tough without punishment. To create a more positive motivation, teach clients to do
things without punishing them if they don’t.

Reality therapy, with its emphasis on appropriate social behavior and on individual responsibility,
is a powerful counseling approach in educational, institutional, corporate, and correctional settings.
Glasser (1999) added another dimension to reality therapy called choice theory. Choice theory
states that all we do is behave, that almost all behavior is chosen, and that we are driven by our
genes to satisfy five basic needs: survival, love and belonging, power, freedom, and fun. In practice,
the most important need is love and belonging, as closeness and connectedness with the people
we care about is a requisite for satisfying all of the needs. Disconnectedness is the source of
almost all client problems such as mental illness, drug addiction, violence, crime, school failure,
and spousal and child abuse (Glasser, 1999).

The 10 Axioms of Choice Theory

       1. The behavior we can control is our own.
       2. All we can give another person is information.
       3. All long-lasting psychological problems are relationship problems.
       4. The problem relationship is always part of our present life.
       5. What happened in the past has everything to do with what we are today, but we can only
satisfy our basic needs right now and plan to continue satisfying them in the future.
       6. We can only satisfy our needs by satisfying the pictures in our quality world.
       7. All we do is behave.
       8. All behavior is total behavior and is made up of four components: acting, thinking, feeling,
and physiology.
       9. All total behavior is chosen, but we only have direct control over the acting and thinking
components. We can only control our feeling and physiology indirectly through how we
choose to act and think.
10. All total behavior is designated by verbs and named by the part that is the most recognizable.

The client has the following options:

• Autonomy, which is a state of accepting responsibility and taking control of one’s self and
one’s life.
 Rational Emotive Behavior Therapy and Reality Therapy  127
• Commitment by not altering his or her confirmed plan for change.
• Responsibility for satisfying personal needs while not interfering with people who fulfill their
own needs, that is, not manipulating others to get one’s own needs met.
• Utilizing paining behaviors, where clients choose misery by developing symptoms (such as
headaches, depression, anxiety, or avoidance) because at the time they seem to be the best
behaviors to assimilate to survive in their current circumstance.
• Self-evaluation involves the client’s self-assessment of current behaviors in order to
determine if his or her behaviors are working and if behaviors are meeting his or her
needs.

Choice theory is part of reality therapy. Because unsatisfactory or nonexistent connections

exist between people, the goal of reality therapy is to help people reconnect. This reconnection
almost always starts first with the therapist connecting with the individual. The therapist uses this
Downloaded by [New York University] at 04:58 12 August 2016

connection as a model for how the disconnected person can begin to connect with the people he
or she needs. To create the relationship vital to reality therapy, the therapist will:

• Focus on the present and avoid discussing the past, because all human problems are caused
by unsatisfying present relationships.
• Avoid discussing symptoms and complaints as much as possible, because these are the ways
that counselees choose to deal with unsatisfying relationships.
• Understand the concept of total behavior, which means focus on what counselees can do
directly—act and think. Feelings and physiology can be changed, but only if there is a change
in the acting and thinking.
• Avoid criticizing, blaming, or complaining and help the client do the same. Clients learn to
avoid these extremely harmful external control behaviors that destroy relationships.
• Remain nonjudgmental and noncoercive, but encourage clients to judge everything they do
by this choice theory axiom: “Is what I am doing getting me closer to the people I need?”
If the choice of behaviors is not getting clients closer, then the therapist works to help them
find new behaviors that lead to more rewarding connections.
• Focus on specifics. Assess whom clients are disconnected from and work to help them choose
reconnecting behaviors. If they are completely disconnected, focus on helping them find a
new connection.
• Help clients make specific, workable plans to reconnect with others and follow through on
what was planned by helping them evaluate their progress. Based on their experience, clients
may suggest plans, but should not receive the message that there is only one plan. A plan is
always open to revision or rejection by the client.
• Be patient and supportive but keep focusing on the source of the problem—disconnectedness.
Clients who have been disconnected for a long time will find it difficult to reconnect.

Choice theory is a rational approach that focuses on the relationship between therapist and
client, with the intent that this relationship will transfer to the client’s own behavioral reper-
toire so that he or she can make more positive and self-fulfilling connections with others. The
WDEP system includes procedures that are applied to the practice of reality therapy groups;
strategies help clients identify their wants, determine the direction behaviors take them, conduct
self-evaluations, and design plans for change.

Technique: WDEP: What, Doing, Evaluate, Plan (Wubbolding, 2000)

Counseling Intention To develop realistic and specific plans and then express how the client
might carry them out in everyday life.
 128  Rational Emotive Behavior Therapy and Reality Therapy
Description

W: Stands for identifying wants, needs, and perceptions. The therapist does not tell the client
what he or she should change, but encourages the client to examine what he or she wants.
D: Stands for exploring the client’s direction of his or her current behavior and helping the
client determine what he or she is doing to attain this.
E: Stands for evaluation, which consists of the client making his or her own evaluation about
what he or she is actually doing. It is up to the client to decide how well his or her current
behavior is working.
P: Stands for planning.

After the therapist and client work through the steps of the WDEP model and identify thera-
peutic goals, it is necessary to collectively decide on the various alternatives by which these goals
Downloaded by [New York University] at 04:58 12 August 2016

can be accomplished.

Technique: SAMIC (Wubbolding, 1991)

Counseling Intention To ensure planning and commitment.
Description A good plan needs to be:

S = Simple
A= Attainable
M= Measurable
I = Immediate and involved
C= Controlled by the client

Conclusion
Choice theory outlines the seven caring habits to replace the seven deadly habits, which are
destructive to healthy relationships, listed in Table 7.2.

Table 7.2 Seven Caring Habits vs. Seven Deadly Habits

Caring Habits Deadly Habits
Supporting Criticizing
Encouraging Blaming
Listening Complaining
Accepting Nagging
Trusting Threatening
Respecting Punishing
Negotiating differences Bribing, rewarding to control
Source: Adapted from Glasser, W. (1999). Choice Theory: A New Psychology of Personal Freedom. New York: Harper
Collins.

Deadly habits have the potential to destroy clients’ abilities to find satisfaction in their rela-
tionships and result in distance and disconnection from each other. Being disconnected is the
dilemma of almost all human problems, such as mental disturbance, substance abuse disorders,
violence, crime, school failure, child sexual abuse and spousal abuse, depression, and other
self-defeating behaviors.
 Rational Emotive Behavior Therapy and Reality Therapy  129

Conclusion
With the advent of rational emotive behavior therapy (REBT), formerly known as rational emo-
tive therapy (RET), the missing links were scientifically established. REBT provides the major
tools to facilitate the therapy process. It theorizes that emotional and behavioral problems are
not caused directly by events, but rather by how one perceives those events. RET theorizes that
emotional and behavioral problems are caused primarily by irrational beliefs that arise when
clients intensify strong desires into absolute demands, that is, “musts” and “shoulds.” Irrational
beliefs impede some clients from working toward their goals, beliefs, and values; rational beliefs
help individuals work toward their goals (Ellis, 1979, 1989).
REBT employs a variety of cognitive, emotive, and behavioral techniques aimed at diminishing
emotional and behavioral problems (Ellis, 1985; Ellis & Dryden, 1990). REBT’s main interven-
tion is the disputation method, which has been outlined as “any process where a client’s irrational
beliefs and cognitive distortions are challenged and restructured for a more positive outcome”
Downloaded by [New York University] at 04:58 12 August 2016

(Ellis, Sichel, Yeager, DiMattia, & DiGiuseppe, 1989, p. 49). The philosophy of choice theory
emphasizes that respect and empathic acceptance are essential to psychotherapy. Its practice is
based on a contract between client and therapist, in which each takes equal responsibility toward
common goals. The methods and concepts used are made open to the client in the understand-
ing that power is shared.
Reality therapy, on the other hand, is more of a philosophy or attitude about one’s being by
stressing that the client’s inner world is most influential in determining which behaviors the
person chooses. The client must have clear insight and the willingness to change perception, atti-
tudes, and actions. There are not many techniques tied to reality therapy to reinforce change in
behavior; therefore, the client must have good insight and continued motivation for therapeutic
behavioral change.
 8 Classic Behavioral Techniques

The basic principles of learning and behavioral change are classics in the school of behavior
Downloaded by [New York University] at 04:58 12 August 2016

therapy. Fundamentally, all behavior is learned, whether adaptive or maladaptive. Abnormal

behavior is the result of faulty learning experiences, a product of social learning and condition-
ing. Behavior modification is the goal of therapy. This includes eliminating maladaptive behaviors
and learning new effective behaviors. Behavioral techniques have been used with much success
to eliminate undesirable behavior such as smoking, overeating, and nail biting, and to improve
weight loss, study skills, and coping with stress. Krumboltz and Thoresen (1976) outlined prin-
ciples for strengthening and developing appropriate behavior, as well as eliminating inappropri-
ate behavior. All complex behavior is learned, shaped, and subject to observable laws:

• One can change behavior through rewards and punishments.

• Behavior is determined by the environment, the consequences or anticipated consequences
of that behavior.
• Some of what we learn is not the direct result of reinforcers, but is rather the result of
observing others and the consequences of their actions and modeling our behavior.
• Virtually all work behavior is operant—it generates consequences in its environment, and
these consequences in part shape and control behavior.

Behavior modification is defined as the use of rewards or punishments to reduce or eliminate

problematic behavior, or to teach an individual new responses to environmental stimuli. Three
tools used in behavior modification are positive and negative reinforcement and cueing. The goal
of a program of behavior modification is to change and adjust behavior that is inappropriate or
undesirable in some way. When embarking on a program of behavior modification, it is impor-
tant that the undesirable behaviors be isolated and observed. With this awareness comes a greater
goal of understanding the cause and effect of the behaviors, and thus change can be made. In
many cases, some form of behavior modification, along with cognitive therapy and medication
therapy, are the preferred methods of treatment for disorders such as attention deficit disorder
(ADD), attention deficit hyperactivity disorder (ADHD), conduct disorders, and oppositional
defiance disorder. Behavior modification and cognitive therapy are the principal forms of treat-
ment for eating disorders and alcohol or other drug abuse.
Essentially, behavior modification therapy is based on the idea of antecedents (events that
occur before a behavior is apparent) and consequences (the events that occur after the behavior
occurs). The appropriate behavior is learned by observing and changing both the antecedents
and the consequences of the behavior so that the appropriate behavior increases and the inap-
propriate behavior decreases. The use of rewards to help affect change is called positive rein-
forcement, and the use of punishment—for example, withdrawal of privileges—is called negative
reinforcement. A behavioral modification program to change behavior consists of a series of
 Classic Behavioral Techniques  131
stages. First, an inappropriate behavior is identified and stopped, and then a new behavior must
be developed, strengthened, and maintained.
To stop an inappropriate behavior, first the behavior must be observed. To understand the pat-
tern of the behavior, it is helpful to chart the behavior: What events precede the behavior? What
time of day it is observed? It’s important at first to focus on just one or two offending behavior
patterns. Once a behavior pattern is recognized and its pattern charted and understood, a system
of rewards can then be constructed.
Table 8.1 shows one way to categorize behaviors. Any particular behavior may have aspects
fitting in several categories. Fundamentally, there are six stages of change.

1. Precontemplation Stage: Frequently, other people see the problem, but the individual does
not; therefore, he or she sees no need for change. Inherently, people will try to change only
after pressure has been applied by others.
Downloaded by [New York University] at 04:58 12 August 2016

2. Contemplation Stage: The problem has been acknowledged, and the person is beginning to
think more seriously about overcoming his or her maladaptive or self-­defeating behavior. He
or she may begin weighing the pros and cons of the self-defeating behavior. This stage may
last for years.
3. Preparation Stage: General goals have been defined and objectives for change have been
written down. Goals have been shared with significant people in the client’s life.
4. Action Stage: This stage requires the greatest commitment on the part of the client. Specific
guidelines are followed, and an optimistic mind-set for positive change evolves. Relapse is
common at this stage. There is a need to be in this stage for 6 months in order to integrate
into the client’s lifestyle and behavioral repertoire.
5. Maintenance Stage: The client is able to maintain behavior for up to 5 years and strives to
prevent relapse.

Table 8.1  Types of Behavior

Behavior Description Examples
Appropriate Achieves necessary and desired Maintains healthy habits; obtains satisfaction
goals without infringing on the for a problem without demeaning others; has
rights and needs of others. Includes appropriate social, emotional, and cognitive
appropriate social and emotional skills; is self-sufficient and resilient.
responses.
Deficiency Lacks skill or knowledge needed Passive responding in social situations; lack
for performing the behavior; has of social, emotional, and cognitive skills;
many social, emotional, or cognitive deficient in such skills as assertiveness,
deficits. problem solving, decision making, and
impulse control.
Excessiveness Too much of a maladaptive or Drinking until passed out; overeating;
self-defeating behavior. smoking; addicted to sex, the Internet, or
gambling; abuses illicit or prescription drugs.
Other The behavior occurs at a time or Bed wetting; fire setting; exhibitionism;
Inappropriate place that is inappropriate. If it stalking people; shoplifting.
occurred under other circumstances,
the behavior would be acceptable.
Maladaptive Capable of performing, but has a Social phobia, shyness, anxiety, panic attacks,
Emotional stronger-than-typical autonomic obsessive-compulsive disorder, agoraphobia,
system reaction, most often as fears depression, bipolar disorder.
and anxieties.
 132  Classic Behavioral Techniques
6. Termination Stage: Once a client has maintained a change in behavior for 5 years or more,
he or she enters the termination phase and can exit the cycle of change without fear of
relapse or failure.

Essentially, to change takes courage and determination; to maintain change takes commitment
and routine; and to master change takes the integration of healthy behaviors within one’s lifestyle
and behavioral repertoire.

Behavior Modification Program Steps

Assess the Target Behavior
Describe the Behavior
Downloaded by [New York University] at 04:58 12 August 2016

Look for patterns in the behavior by finding the answers to these questions:

• Under what circumstances does the behavior occur and when does it not occur?
• What is the pattern that the behavior displays?
• Where does the behavior occur? Only at home? At school? In the presence of particular
persons or objects?
• When does it occur? What time of day? What day of week? On weekends or weekdays?
• When the behavior occurs, how long does it endure?
• How intense is the behavior (e.g., is the child talking or screaming)?
• How frequently does it happen? Per hour, per day, per week, per year? (Select the single
most meaningful period of time.)
• What was present or occurring 5 to 10 minutes before the behavior?
• What was present or occurring within 2 to 3 minutes after the behavior?
• Who was present during an instance of the behavior? Describe how these people are related
to the subject.
• Describe in specific behavioral terms what an instance of the behavior looks like. Describe it
so an actor could display the exact behavior. Relate what was said, as well as what was done
and with what. Even seemingly insignificant actions could provide a clue for moderating the
behavior.
1. Not: “He disrupted the class.”
2. Not: “He yelled a lot.”
3. Better: “He spoke in a volume that drowned out my voice and said, ‘I want my pencil
back.’ Then he jumped on his chair and wiggled his hips while pointing at Tim in the
right-hand seat. He was laughing and smiling throughout this period.”
• Sometimes comments by significant others can be helpful. Favor behavioral examples over
summative evaluations.
1. Not: “He annoys others.”
2. Better: “He interrupts everyone who speaks within a few minutes.”

Measure the Behavior to Get Precise Data

Methods
• Frequency: Number of times a response is performed per a unit of time (e.g., day). Example:
Subject smokes 24 cigarettes every day.
• Amount of time: The length of time a response lasts. This may be measured in terms of:
 Classic Behavioral Techniques  133
1. The duration of the behavior from start to finish. Example: Subject takes 2 minutes or
20 minutes to smoke a single cigarette.
2. The number of intervals in which the behavior is observed occurring. Example: Subject
only smokes during the 9 am break, never at any other time (one interval vs. a cigarette
every hour = 18 hours). If the behavior occurs frequently and has a clear beginning and
end, then use short intervals (10 to 15 seconds). A behavior lasting less than 5 seconds
is too short, as it is difficult to tell which interval the behavior occurred in. Don’t use
interval recording if the behavior is “continuous,” that is, it persists for long periods of
time with no clear beginning or end point (e.g., thumb sucking).
• Intensity: The magnitude or size of the response. Example: Does the subject smoke the
cigarette down to the filter or take a few puffs and put it out?
• Latency: The time that elapses until a response is performed. Example: How long can the
subject go before pulling out a cigarette?
Downloaded by [New York University] at 04:58 12 August 2016

Identify Baseline for the Behavior

Behavior modification is about real change. You cannot determine if real change has occurred
unless you know what behavior is typical. Typical behavior is the baseline against which the suc-
cess of your intervention is measured. If you fail to collect baseline data, then you have no way to
tell if your intervention worked. Behaviorists do not rely on memory, which is fallible. Without
baseline data, you do not have a behavior modification program.
Identifying a baseline means you collect data over a period of time without trying to change
the behavior. How long do you collect data? It depends on the characteristics of the behavior.
In general, you collect enough that the behavior of interest shows a steady pattern. With some
animal behaviors, that might be 1 hour. With some human behaviors, it may take several weeks.

Commit to the Program

All significant parties should be involved and demonstrate commitment. Encourage participation
in decisions by the subject and persons who might have an impact on the success or failure of the
program, including parents, teachers, administrators, spouses, children, bosses, and co-workers.
Be specific and precise about the behavioral goals

Example of a Precise Goal
• Not: “To eat healthily.”
• Better: “To reduce the number of snacks (defined as ice cream, candy, or Twinkies) from
one with each meal and one in the evening to one every third day, and to increase the num-
ber of vegetable portions (as defined by government standards) from one with my evening
meal to six portions per day.”

Begin the Program

Identify Potential Interventions and Select One or Several that Match the Target Behavior
Categorize your target behavior as one of the following and then develop appropriate interventions.

• Teach a never-before-performed behavior (reinforcement: positive and negative).

• Increase or strengthen an existing behavior (reinforcement: contingency contract, token econ-
omy, modeling).
 134  Classic Behavioral Techniques
• Extend an existing behavior:
1. To a new environment (stimulus generalization, stimulus control, modeling)
2. To new behaviors (response generalization, shaping, chaining, fading, prompting,
modeling)
3. To over time (maintenance, intermittent reinforcement, modeling)
• Narrow an existing behavior to limited environments (e.g., only snacking in the kitchen)
(also discrimination training, modeling).
• Reduce or eliminate the display of an existing behavior (extinction, time-out, response cost,
desensitization, reinforcement of incompatible responses, modeling, punishment).

Most projects will use some type of reinforcement.

Downloaded by [New York University] at 04:58 12 August 2016

1. Identify appropriate reinforcers for the individual.

2. Specify the conditions under which reinforcement can be earned.
3. You already trained any needed data collectors during the baseline. Continue to collect data
throughout using the same methods.
4. Apply intervention. Persist with intervention until:
A. Change occurs.
B. It is clear that change is not going to occur and the method needs evaluation and
refinement.
5. Proceed to evaluation.

Graph the Results

Most data collection can be graphed (occasionally a table is more appropriate). Graphs quickly
reveal progress or lack thereof. They allow for evaluation of hypotheses as to what happened (or
didn’t). Small variations in behavior are normal. Judge progress based on viewing multiple data
collection periods. (That might mean, for example, looking at a week’s worth of data, graphed
by days.)

Evaluate the Results and Reach Conclusions

Conclusions will be similar to one of the following:

• The intervention was successful in producing change, as shown by X.

• The intervention was not successful in producing change, as shown by X.
• The data offer a mixed picture. These elements were successful, as shown by X.
• These elements were not successful, as shown by Y.

A behavior modification program is based on the following issues:

• What behaviors are desired?

• Are these behaviors observable and measurable?
• What reinforces these behaviors?
• When are the reinforcements applied?
• What are the consequences of these reinforcements?
• How can the reinforcement pattern be improved?
 Classic Behavioral Techniques  135
Based on the answers to these questions, a behavioral modification program includes the fol-
lowing steps:

• Targeting specific behaviors.

• Analyzing the causes and antecedents of existing behavior or barriers to new behavior.
• Setting explicit, concrete, measurable goals.
• Training.
• Clear reinforcement: praise, recognition, money, etc.
• Concrete, continuous feedback.

The key to a successful program of behavior modification is consistency. Expanded behavior

intervention programs will increasingly incorporate a variety of efficacious strategies and tech-
niques, some operant, some cognitive-mediational, some observational. Cognitive-behavioral
Downloaded by [New York University] at 04:58 12 August 2016

approaches can be integrated to provide the optimal combination of strategies to enhance the
adjustment of the client.

Principles of Behavior Modification

To Develop a New Behavior:
1. Successive Approximation: To teach a client to act in a manner in which he or she has seldom
or never before behaved; reward successive steps to the final behavior.
2. Continuous Reinforcement: To develop a new behavior that the client has not previously
exhibited, arrange for an immediate reward after each correct performance.
3. Negative Reinforcement: To increase a client’s performance in a particular way, you may
arrange for her or him to avoid or escape a mild aversive situation by improving her
or his behavior or by allowing her or him to avoid the aversive situation by behaving
appropriately.
4. Modeling: To teach a client new ways of behaving, allow him or her to observe a positive role
model performing the desired behavior.
5. Cueing: To teach a client to remember to act at a specific time, arrange for her or him to
receive a cue for the correct performance just before the action is expected rather than after
she or he has performed it incorrectly.
6. Discrimination: To teach a client to act in a particular way under one set of circumstances
but not in another, help him or her to identify the cues that differentiate the circumstances
and reward him or her only when the action is appropriate to the cue.

To Strengthen a New Behavior:

7. Decreasing Reinforcement: To encourage a client to continue performing an established
behavior with few or no rewards, gradually require a longer time period or more correct
responses before a correct behavior is rewarded.
8. Variable Reinforcement: To improve or increase a client’s performance of a certain activity,
provide the client with an intermittent reward.

To Maintain an Established Behavior:

Substitution: To change reinforcers when a previously effective reward is no longer controlling
behavior, present it just before (or as soon as possible to) the time you present the new,
hopefully more effective, reward.
 136  Classic Behavioral Techniques
To Stop Inappropriate Behavior:
10. Satiation: To stop a client from acting in a particular way, you may allow her or him to con-
tinue (or insist that she or he continue) performing the undesired act until she or he tires
of it.
11. Extinction: To stop a client from acting in a particular way, you may arrange conditions so
that he or she receives no rewards following the undesired act.
12. Incompatible Alternative: To stop a client from acting in a particular way, you may reward
an alternative action that is inconsistent with or cannot be performed at the same time as the
undesired act.
13. Punishment: To stop a client from acting in a certain way, deliver an aversive stimuli imme-
diately after the action occurs. Because punishment results in increased hostility and aggres-
sion, it should only be used infrequently and in conjunction with reinforcement.
Downloaded by [New York University] at 04:58 12 August 2016

To Modify Emotional Behavior:

14. Avoidance: To teach a client to avoid a certain type of situation, simultaneously present to
the client the situation to be avoided (or some representation of it) and some aversive condi-
tion (or its representation).
15. Fear Reduction: To help a client overcome her or his fear of a particular situation, gradually
increase her or his exposure to the feared situation while she or he is otherwise comfortable,
relaxed, and secure or rewarded.

Providing for Consequences

Consequences are the events that follow immediately after the target behavior and are contin-
gent on the behavior (they occur only if the behavior occurs). There are two major kinds of
consequences:

1. Reinforcers, which increase behavior they follow.

2. Punishers, which decrease behavior they follow.

The label “reinforce” or “punisher” is given after examining the behavior for changes.

• It is not given on the basis of how most react to the event.

• It is given on the basis of how the behavior of the particular subject reacts to the event
(Krumboltz & Krumboltz, 1972, p. 110–111).

Contingency Contract
A contingency contract is an agreement between a client and counselor that states behavioral or
academic goals for the student and reinforcers or rewards that the student will receive contingent
upon achievement of these goals. Although the target behavior is the bulk of the contract, several
other components are vital.
Contract conditions: The client and therapist must decide under what conditions the contract
will be in effect.
Contract completion criteria: The criteria describe the level of performance for completion.
Does the behavior need only to be achieved once, or will it need to be maintained for a period
of time (i.e., “client will reduce smoking by 60% for 8 days in a period of 10 consecutive
days”)?
 Classic Behavioral Techniques  137
Reinforcers: The contract should include a reinforcer or reward that the client will earn upon
contract completion. This should be something the client chooses, within reason. Positive con-
sequences (i.e., rewards) should be delivered immediately upon contract completion.
Review and renegotiation: The contract includes dates on which progress will be reviewed with
the client. The therapist may choose to review the contract weekly with the client to help keep
him or her on track and to evaluate progress. If there is no progress after a couple of reviews, it
may be necessary to renegotiate the contract. Goals may be unreasonable and reinforcers may be
inappropriate. It is also appropriate to state a goal date for contract completion.
Language and signatures: The contract should be written in simple, clear language that the
client can understand. For example, “reward” should be used instead of “reinforcer.” This will
make the contract more relevant to the client.
Zirpoli and Melloy (1993, p. 160) make the following recommendations to prevent satiation
(i.e., the reinforcer losing appeal for the client):
Downloaded by [New York University] at 04:58 12 August 2016

• Varying the reinforcer or using a different reinforcer for each target behavior.
• Monitoring the amount of reinforcement delivered and using only enough to maintain the
target behavior.
• Avoiding edible reinforcers (if you must use edibles, vary and apply them minimally).
• Moving from a constant to an intermittent schedule of reinforcement as soon as possible.
• Moving from primary to secondary reinforcers as soon as possible.

Technique: Affirming New Positive Behavior

Counseling Intention To strengthen or teach a new behavior.
Description Positive Reinforcement Principle. To increase or enhance a certain
activity, provide a reward immediately after each correct performance.
The reward is something the person values; it may have material value
(e.g., clothes or money), social praise by a support group (e.g., com-
pliments or encouragement), or an opportunity to participate in a
pleasant activity (e.g., dining out). The positive reinforcement cycle is
“response-then-reward,” with the distinct prerequisite that the reward
does not occur unless the behavior occurs first.
Description Token or Point Reward Paradigms. To maintain the behavior until it
is well established in the client’s repertoire of positive responses, a
point or token system can be established. The token or point system
is set up as a contract where the recipient receives points for posi-
tive behaviors, accumulates them, and cashes them in for a desirable
behavior. This is applicable for increasing such behaviors as assertive-
ness, weight loss, and nonviolent behavior. For example, after losing
so many pounds (such as 2 pounds a week) and accumulating so many
points, one might “cash in” the points for new clothes. The point
system gives the client small rewards for the small successes toward
the larger goal.

Technique: Developing New Positive Behavior

Counseling Intention To develop new behavior.
Description Successive approximations principle, or shaping, means each small suc-
cessive step toward the final behavior is rewarded. This is most appli-
cable when teaching a behavior that someone had never attempted
before, such as learning the motor skills of riding a bike or learning
 138  Classic Behavioral Techniques
to ski (e.g., the new skier starts on the beginner’s slopes and, upon
mastery, proceeds to the intermediate and then to the advanced
slopes).

Principle of Modeling: Modeling is essentially learning by example or learning by observation.

It is teaching a new behavior by showing how an effective person performs the desired behavior.
This strategy has been successful in assertiveness training, teaching teachers to teach, fear-related
behaviors, delinquents, addicts, and helping professionals.
Principle of Cueing: To establish new behavior for a specific time, a cue can be established to
signal for the appropriate behavior just before the action is expected.
Discrimination Principle: To encourage a particular behavior under a particular set of cir-
cumstances but not another, the client should be assisted in identifying the cues that dif-
ferentiate the circumstances and establish the reward only when the action is appropriate to
Downloaded by [New York University] at 04:58 12 August 2016

the cue.

Technique: Maintaining New Positive Behavior

Counseling Intention To maintain new behavior.
Description Intermittent Reinforcement: To encourage an individual to continue
performing an established behavior with few or no rewards by gradu-
ally and intermittently decreasing the frequency with which the cor-
rect behavior is rewarded.
Contingency Contracting: To facilitate a client’s goal for behavior
change, contingency contracting may be helpful. It can be broken
down into six steps:

1. The therapist and client identify the problem to be solved.

2. Data are collected to verify the baseline frequency rate for the occurrence of the undesired
behavior.
3. The therapist and the client set mutually acceptable goals.
4. Specific counseling techniques and methods are selected for attaining the goals.
5. The counseling techniques are evaluated for observable and measurable change.
6. Step 4 is repeated if the selected counseling techniques are not effective. If the techniques
are effective, a maintenance plan is developed to maintain the new behavior.

Technique: Stopping Inappropriate Behavior

Counseling Intention To stop inappropriate behavior.
Description Principle of Extinction: Extinction is removing a pleasant consequence,
resulting in decreased responding. To stop someone from acting in an
undesirable way, try to arrange conditions so that the person receives
no rewards following the undesired act.
Principle of Alternative Behavior: This principle for eliminating
undesirable behavior involves rewarding an alternative action that
is inconsistent with or cannot be performed at the same time as the
undesired act. An example could be substituting positive self-talk in
the place of negative self-talk.
Principle of Satiation: To decrease a behavior, allow the individual
to continue (or insist he or she continue) to perform the undesired act
until he or she tires of it.
 Classic Behavioral Techniques  139

Technique: Anger Expression

Counseling Intention To get in touch with one’s anger; to take responsibility for anger
expression.
Description A prerequisite to expressing anger is the acknowledgment that it does
exist. Once the anger is owned, it can be either eliminated through
rational disputation or channeled into appropriate, more assertive
expression. Teaching the client to state “I am angry” over and over,
louder and louder, can be used to bring the client in touch with his or
her anger.

This process is particularly successful in a group setting. Pounding rubber dolls, cushions, pil-
lows, or other indoor-safe toys can be used to express anger in a less threatening way. Behavioral
rehearsal then can be taught to the client for future encounters. By rehearsing the desired behav-
Downloaded by [New York University] at 04:58 12 August 2016

ior through role-play with the therapist, the client often feels more competent and successful in
future relationships.
It may be helpful to the client to develop a relaxation response when beginning to feel angry
or annoyed. Learning stress inoculation techniques or learning how to express anger assertively
may be beneficial. Developing a rational belief system and overcoming irrational beliefs (such as
the world should be fair) would be another intervention.

Technique: Anxiety Management Training

Counseling Intention To develop self-control, self-confidence, and self-management of
anxiety.
Description Relaxation training and goal rehearsal are prerequisite skills in which
the client should become proficient prior to anxiety management train-
ing. The client is directed to generate anxiety and the concomitant sen-
sations, cognitions, and emotions. Following this anxiety-provoking
experience, the client is directed to perform the opposite behavior,
that is, to elicit relaxation and to dwell on calm sensations, to pic-
ture peaceful images, to dispute irrational ideas, and to concentrate on
tranquil and relaxing thoughts.

Technique: Behavior Rehearsal

Counseling Intention To assist the client to assimilate new behavior.
Description Clients often need to practice new behaviors in the confines of a secure
therapeutic setting. Through role-play, the therapist assumes the role
of the individual. The client then can confront (e.g., therapist is the
employer; client is the employee) and practice the new behavior as
an actual encounter. The dialogue should be videotaped so that the
therapist and client can critique the playback. Roles are reversed and
the same procedure is followed. Behavior rehearsal and video play-
backs are continued until the therapist and client are satisfied with
the client’s performance. To help the client meet his or her goal, the
therapist should plan an intervention as follows:

• Specify the target behavior—what the client wants to change.

• Identify the setting or situation for which the skill is needed.
 140  Classic Behavioral Techniques
• Construct a hierarchy (from least threatening to most threatening) of settings or situations
to practice the targeted skill.

Beginning with the least threatening setting or situation, have the client engage in a rehearsal
(role-play) of the targeted skill. Give the client feedback about the strengths or weaknesses of the
assimilation of the targeted skill. Feedback can be enhanced with video playback. Assign home-
work consisting of in vivo rehearsal of the targeted skill.
Determine when the client has satisfactorily demonstrated the assimilation to the targeted
skills and proceed up the hierarchy to client mastery. Behavior rehearsal has been successfully
used with clients dealing with anger, frustration, anxiety, panic attacks, and depression, and it
eliminates self-defeating behaviors such as smoking, substance abuse, overeating, and self-injury.

Technique: Thought Stopping or Thought Blocking

Downloaded by [New York University] at 04:58 12 August 2016

Counseling Intention To eliminate self-defeating or illogical thinking (based on unrealistic

fears and assumptions); to control or eliminate negative ideas.
Description Thought stopping has proven effective in helping clients who obses-
sively ruminate on the same thoughts all day long. Clients can learn
to cope more effectively in an anxiety-producing situation by prac-
ticing what they will say the next time it occurs. They should be
encouraged to rehearse appropriate replies, mentally practicing the
response. A simple method of combating certain obsessive and intru-
sive thoughts is simply to scream “STOP” (subvocally) over and over
again. The client is instructed to imagine himself or herself in a situ-
ation or setting that produces an irrational thought sequence (e.g.,
“I am in my boss’s office with a new idea to present, but he won’t
give me the time; he really thinks I’m stupid”). The procedure is as
follows:

1. Ask the client to verbalize the thoughts that are occurring as he or she imagines the scene.
2. When the client starts to verbalize nonproductive thinking, the therapist interrupts the client
with a loud “stop” and handclap or the flicking of the wrists with a rubber band.
3. The client processes what happened in this self-defeating chain when it was abruptly inter-
rupted by the therapist.
4. The procedure is repeated with the client interrupting the nonproductive thinking overtly
(aloud) and covertly (imagined).
5. The client is instructed to continue covert and overt interruption of self-defeating thoughts
as they occur in his or her daily experiences.

Rathus and Nevid (1977, pp. 33–34) modified the thought-stopping technique listed earlier
by using a tape recorder. The procedure is as follows:

1. Have the client outline clearly the content of the negative ruminative thoughts.
2. Construct two or three statements that oppose the helplessness and self-defeating nature of
the ruminations.
3. Have the client record in his or her own voice the strongly stated command “STOP!” Then,
while in a comfortable position, have the client purposefully ruminate on the distressing
thoughts. Press Play on the recorder. The recording disrupts the ruminations and provides
assertive, counter-ruminative statements.
4. Repeat the procedure 10 times in a row, three or four times a day, for 2 weeks. After that
time frame, use the procedure 10 times in a row once daily for another couple of weeks.
 Classic Behavioral Techniques  141

Technique: Self-Management
Counseling Intention To empower clients to master and manage their own behavior.
Description The major difference between self-management and other procedures
is that the clients assume major responsibilities for carrying out the pro-
gram, including arranging their own contingencies or reinforcements. To
benefit from self-management strategies, clients must use them regularly
and consistently. The client should be instructed to do the following:

1. Select and define a behavior to increase or decrease.

2. Self-record the frequency of the behavior for a week to establish a baseline measure (i.e., the
present level before the implementation of self-management procedures).
3. Record (a) the setting in which it occurs, (b) the antecedent events leading to the behavior,
and (c) the consequences resulting from the behavior.
Downloaded by [New York University] at 04:58 12 August 2016

4. Using self-monitoring, the client should proceed either to increase or decrease the baseline
of behavior, depending on the client’s goal. The self-monitoring should occur for 2 weeks.
A contract with the client will reinforce this process.
5. Change the setting and the antecedent events leading up to the target behavior.
6. Change the consequences that reinforce the target behavior.
7. Evaluate the use of self-management on the targeted behavior at the end of the contractual
period. Arrange a plan to maintain the new, more desirable, behavior.

Technique: Goal Rehearsal or Coping Imagery

Counseling Intention To rehearse a new skill or situation.
Description Goal rehearsal implies the deliberate and thorough visualization of
each step in the process of assimilating a new behavior. The deliberate
picturing or coping imagery of a new situation enhances transfer to the
actual event. Clients should be encouraged to be realistic in reaching
their goal (i.e., to not expect perfection). For example, an individual
may experience a severe panic attack when called on to speak in public.
He or she may picture the audience scene vividly, replete with all the
anxious feelings toward the situation that may emerge, with a feeling
of accomplishment if three out of five symptoms are reduced.

Technique: The Step-Up Technique

Counseling Intention To decrease anxiety and panic attacks over upcoming events.
Description Some clients can be paralyzed by anxiety or panic about upcoming
events such as a public speech, job interview, or blind date. The step-up
technique consists of picturing the worst thing that can possibly happen
and then imagining oneself coping with the situation—surviving even
the most negative outcome. Once the client successfully pictures him-
self or herself coping with the most unlikely catastrophes deliberately
called into the imagination, anticipatory anxiety tends to recede. When
the real situation occurs, the individual may feel less anxious. Difficult
cases may require self-instruction training (Lazarus, 1977, p. 240).

Technique: Self-Instruction Training

Counseling Intention To directly influence clients to change what they say to themselves.
Description Self-instruction can break a chain of negative feelings and sensations
such as fear, anger, pain, and guilt. Meichenbaum (1977) and Ellis
 142  Classic Behavioral Techniques
(1962) have shown empirically that negative self-talk contributes to
many peoples’ failures and anxiety. On the other end of the contin-
uum, the deliberate use of positive, self-creative statements can facili-
tate successful coping.

Lazarus (1977) cited the following sequence of self-instruction to use with a client who is
experiencing anticipatory anxiety over an upcoming event: “I will develop a plan for what I have
to do instead of worrying. I will handle the situation one step at a time. If I become anxious,
I will pause and take in a few deep breaths. I do not have to eliminate all fear; I can keep it man-
ageable. I will focus on what I need to do. When I control my ideas, I control my fear. It will get
easier each time I do it” (p. 238).

Technique: Systematic Desensitization

Downloaded by [New York University] at 04:58 12 August 2016

Counseling Intention To teach anxiety reduction strategies and self-control skills to clients.
Description According to Wolpe (1982, p. 133), systematic desensitization is

. . . one of a variety of methods for breaking down neurotic anxiety response habits in piece-
meal fashion. A physiological state inhibitory of anxiety is induced in the patient by means
of muscle relaxation, and he or she is often then exposed to a weak anxiety-evoking stimulus
for a few seconds. If the exposure is repeated several times, the stimulus progressively loses its
ability to evoke anxiety. Successively stronger stimuli are then introduced and similarly treated.

Clients experiencing public speaking anxiety, test anxiety, nightmares, fear of flying, fear of
death, fear of criticism or rejection, acrophobia (fear of heights), agoraphobia (fear of open
places), or other anxiety-provoking situations can often benefit from this approach. In this proce-
dure, events that cause anxiety are recalled in the imagination, and then a relaxation technique is
used to dissipate the anxiety. With sufficient repetition through practice, the imagined event loses
its anxiety-provoking power. At the end of training, when actually faced with the real event, the
client will find that it, too, just like the imagined event, has lost its power to create anxiety. Sys-
tematic desensitization consists of the gradual replacement of a learned fear or anxiety response
with a more appropriate response, such as the feeling of relaxation or a feeling of being in control.
Three steps are involved in the self-administered systematic desensitization procedure:

1. Training in deep-muscle relaxation or coping responses.

2. Constructing a hierarchy of anxiety-provoking scenes.
3. Pairing deep relaxation with the visualization of scenes from the anxiety hierarchy.

Desensitization should not be used when the client’s anxiety is vague or free­-floating (Foa,
Stekette, & Ascher, 1980). Clients with many fears or with general, pervasive anxiety may benefit
more from cognitive change strategies.
Components of systematic desensitization consist of the following:

1. IDENTIFICATION OF ANXIETY-PROVOKING SITUATIONS.

The counselor and client must ascertain the specific anxiety-provoking situations associated with
the fear; specific emotion-provoking situations must be identified. The client can be instructed
to observe and keep a log of the anxiety-­provoking situations as they occur during the week,
noting what was going on, where and with whom, and rating the level of anxiety on a scale of 1
(low) to 10 (high).
 Classic Behavioral Techniques  143
2. CONSTRUCTION OF HIERARCHY OF STIMULUS SITUATIONS.

A hierarchy typically contains 10 to 20 items of aversive situations. The client and the counselor
can begin generating items during the session. The client can be instructed to generate items
during the following week on 3 × 5 index cards. The cards then can be ordered from the least
stressful situation at the bottom and successfully more stressful items in an ascending order (i.e.,
from least to most anxiety provoking). See Table 8.2 for an example.

3. SELECTION AND TEACHING OF COUNTERCONDITIONING OR COPING RESPONSES.

For desensitization to be successful, the client must learn to respond in a way that either inhibits
anxiety or copes with anxiety. The counselor selects the most appropriate counterconditioning
or coping response and trains the client in the procedure. The anxiety-inhibiting or countercon-
ditioning response most used in desensitization is deep-muscle relaxation. Other examples of
Downloaded by [New York University] at 04:58 12 August 2016

counterconditioning or coping responses include emotive imagery (focusing on pleasant scenes

during desensitization), meditation (focus on breathing and counting), assertion responses, music,
and coping thoughts (whisper or subvocalize coping statements, e.g., “I can do this”). Teach-
ing muscle-relaxation response will take several sessions to complete. Identification of hierarchy
items should not occur simultaneously with relaxation; however, teaching a counterconditioning
or coping response can occur simultaneously with hierarchy construction. Teaching should be
continued until the client can discriminate different levels of anxiety and can achieve a state of
relaxation. It is helpful to have the client rate the level of stress or anxiety felt on a scale of 1 to
10 before and after each teaching session. Daily homework practice also should be a requirement.

4. EVALUATION OF CLIENT’S CAPACITY TO GENERATE IMAGES.

The client’s capacity to generate images is critical to the success of this procedure. Marquis,
Morgan, and Piaget (1973) proposed four criteria for creating effective imagery: the client must
be able to imagine the scene completely with detail to touch, sound, smell, and sight sensations;

Table 8.2  Sample Hierarchy: Test Anxiety

  1.  Taking a course examination 3 months from now.
  2.  Two months before taking course examination.
  3.  One month before taking course examination.
  4.  Three weeks before taking course examination.
  5.  Two weeks before taking course examination.
  6.  One week before taking course examination.
  7.  Four days before taking course examination.
  8.  Three days before taking course examination.
  9.  Two days before taking course examination.
10.  One day before taking course examination.
11.  Morning of taking course examination.
12.  Three hours before taking course examination.
13.  Two hours before taking course examination.
14.  One hour before taking course examination.
15.  Thirty minutes before taking course examination.
16.  Entering building where course examination is to be given.
17.  Entering room where course examination is to be given.
18.  Examiner walks in the room with course examination.
Note: Least anxiety-provoking situation = 1; most anxiety provoking = 18
 144  Classic Behavioral Techniques
the scene should be imagined in such a way that the client is a participant, not an observer; the
client should be able to switch a scene on and off upon instruction; and the client should be able
to hold a particular scene as instructed without drifting off or changing the scene (p. 10).
Each scene in the hierarchy is paired with the counterconditioning or coping response so
that the client’s anxiety is inhibited or diminished. Each scene-presentation session should be
preceded by a training session involving the designated counterconditioning or coping response.
Successive scene presentation always begins with the last item successfully completed at the pre-
ceding session. Typically, when the client visualizes an item and reports anxiety associated with
the visualization, the client is instructed to remove or stop the image, then to relax away the ten-
sion. A helpful procedure is to have a signaling system between the counselor and the client. One
method advocated by Wolpe (1982, p. 57) is to instruct the client to raise the left index finger
1 inch as soon as a clear image of the item is formed. Wolpe presented the item for a specified
time (usually between 7 and 10 seconds) and then asked the client to stop the image and to rate
Downloaded by [New York University] at 04:58 12 August 2016

the level of anxiety felt during the visualization on a scale of 1 to 10. An alternative approach is
to have the client imagine the scene and indicate when anxiety is felt by raising an index finger.

5. STEPS IN GRADUALLY PROLONGING EXPOSURE TO AN ANXIETY-PROVOKING SITUATION.

Rathus and Nevid (1977) suggested reducing some fears by gradually prolonging exposure to
the anxiety-provoking situation. Fears amenable to these conditions include fear of being in a
small room, fear of hospital rooms, and fears of handling sharp tools.
First, ascertain that the target situation or thing meets two requirements: (a) the client can
tolerate brief exposure to the target, and (b) the client has complete control over the duration of
exposure to the target. Create a situation in which the client can readily expose himself or herself
to the target and then readily remove himself or herself. The client then places himself or herself
in the target situation until he or she begins to feel discomfort. The client should maintain him-
self or herself in the situation for only a few moments longer. The client leaves the situation and
relaxes, breathing deeply and focusing on a peaceful setting.
After re-achieving relaxation, the client should return to the fear-inducing situation until dis-
comfort is experienced. Remain a few minutes longer and then leave. Through gradually pro-
longing exposure to a fear-inducing situation and then allowing the physical sensations of fear
either to dissipate or be replaced by the physical sensation of relaxation, the ability to remain in
the anxiety-provoking situation will become stronger.

6. HOMEWORK AND FOLLOW-UP.

Homework should include daily practice of the selected relaxation procedure and visualization
of the hierarchy items completed to date. The client also should be encouraged to participate in
real-life situations that correspond to situations covered in hierarchy-item visualization during
counseling sessions.

Technique: Confronting Shyness (Zimbardo, 1977)

Counseling Intention To assist the client in becoming more assertive.
Description Three simple guidelines can be considered when assertive behavior has
implications:

1. The best way to get what you want is to ask for it.

2. The best way to get someone to stop doing something you do not want the person to do is
to tell him or her how those actions make you feel.
 Classic Behavioral Techniques  145
3. Assertiveness implies a special type of self-disclosure. Do not avoid expressing negative
feelings. Negative feelings are just as important as positive ones. Focus on first-person
“I” language to signify that the statement you are making is an indication of your own
feelings.

Technique: Cost and Benefits of Shyness (Zimbardo, 1977)

Counseling Intention To assess missed opportunities for growth.
Description Does shyness cost anything? Has the client missed any opportunities
or passed by any unique experiences because he or she is shy? Have the
client draw up itemized costs (Table 8.3).

Table 8.3  Shyness Costs

Downloaded by [New York University] at 04:58 12 August 2016

Time of Your Life Valued Event or Opportunity That Was Personal Consequence to You
Delayed or Diminished

Technique: Shyness Journal (Zimbardo, 1977)

Counseling Intention To evaluate dimensions of shyness.
Description Keep a journal of the times you feel shy. Write down the time, what
happened, your reaction, and the consequences for you (Table 8.4).

Table 8.4  Shyness Journal

Time Situation or Physical Symptoms Mental Notation (+) (-)
Setting Reactions
3rd Bell U.S. Government Heart pounding “I can’t remember “I’ve lost another
class current events nervous, avoiding anything that I read opportunity for my
eye contact this morning.” grade.” Anxiety; panic

Technique: Undoing Negative Self-Talk

Counseling Intention To identify circumstances around negative inner dialogue.
Description Have the client make a list of his or her weaknesses; put them on the
left side of the page. Then put the opposite positive statements on the
right side. See Table 8.5 for an example.

Table 8.5  Undoing Negative Self-Talk

Weaknesses Truth
“No one who knows me likes me.” “Everyone who really knows me, like
Jake, Jan, and Jessica, likes me.”
“There are few things about me that are attractive.” “I have a lot of attractive features—my
eyes, my hair, and my teeth.”

Technique: Writing Yourself a Letter

Counseling Intention To identify and validate personal attributes that are positive.
Description Write yourself a letter focusing on your positive attributes, or record a
message about your successes, hopes, and possibilities and play it back
to listen to it.
 146  Classic Behavioral Techniques

Technique: First-Time Talking

Counseling Intention To focus on critical social skills.
Description If you find that you have a difficult time talking to “anyone,” try some
of the following less threatening experiences:

• Call the local discount department store and check on the price of something advertised in
the paper.
• Call a radio talk show, compliment their format, and then ask a question.
• Call a local movie theater and ask for the discounted show times.
• Call the library and ask the reference librarian some question about the population in your
town or the United States.
• Call a restaurant and make reservations for four, then call back within the hour and cancel
them. Thank the reservation desk and note their reaction.
Downloaded by [New York University] at 04:58 12 August 2016

Technique: Saying Hello (Zimbardo, 1977)

Counseling Intention To begin an experiential hierarchy of anxiety-provoking situations
(Zimbardo, 1977).
Description On campus, in hallways at school, or at work, smile and say hello to
people you do not know.

Technique: Beginning a Dialogue with a Stranger

Counseling Intention To continue structured interpersonal experiences.
Description An ideal way to practice initial conversational skills is to initiate a safe
conversation with strangers in public places, such as grocery store
lines, theater lines, the post office, a doctor’s waiting room, lottery
lines, the bank, the library, or the lunchroom. Start a conversation
about a “common experience”: “It looks like mystery meat for lunch
again.” “I hope this will be my lucky lotto ticket.” “Have you seen
Sleepless in Seattle [or a recently released movie]?

Technique: Giving and Accepting Compliments

Counseling Intention To provide an opportunity to integrate social skills into interpersonal
relationships.
Description Giving and accepting compliments is an easy way to start a con-
versation and make the other person feel good about himself or
herself. Yet it is probably the most overlooked ice breaker between
people. Suggestions on items about which to comment include the
following:

What a person is wearing—“That’s a cool jacket.”

How a person looks—“I like your haircut.”
A skill—“You sure know how to catch those waves.”
Personality trait—“I love your laugh.”
Possessions—“Your car is awesome!”

To get further into the conversation, simply ask a question: “What an awesome car. How long
have you had it?”
 Classic Behavioral Techniques  147

Technique: Starting a Conversation

Counseling Intention To identify comfort levels in interacting with others.
Description A conversation can be started in a number of ways. Choose the one
that is most appropriate and comfortable for you.

• Introduce yourself. “Hello, my name is_________________. ” (Practice this in a mirror at

home or with a tape recorder.) This is best practiced when you are at gatherings where eve-
ryone is a stranger to you. Give a compliment and then follow it up with a question. “That’s
a terrific suit. Where did you get it?”
• Request help. Make it obvious you need it, and be sure the other person can provide it.
“Last time I went to this library, I used the card catalogue. How can I find the works of Carl
Rogers with this search engine?”
• Try honesty and self-disclosure. When you make an obviously personal statement, it will cre-
Downloaded by [New York University] at 04:58 12 August 2016

ate a positive, sympathetic response. Be honest and say, “I’m not sure what I’m doing here.
I’m really quite shy.”
• Cultivate your normal social graces. “Looks like you need a refill; let me get it for you; I’m
headed that way.” “Here, let me help you with those groceries.”

Technique: Keeping the Conversation Going (Zimbardo, 1977)

Counseling Intention To provide the client with strategies to sustain a conversation (Zim-
bardo, 1977, p. 180).
Description Once you have initiated a conversation, you can use several techniques
to keep it going:

1. Ask a question that is either factual (“Can you believe how poor the Knicks look this year?”)
or personal (“How do you feel about gun control?”). Offer one of your own personal stories
or opinions.
2. Read a lot about some political or cultural issues and become knowledgeable about them,
for example, the national deficit or violence in society. Come up with a few interesting things
that have happened to you recently and turn them into brief interesting stories, for example,
registering for classes; incidents on the job; a new video game; learning to surf or roller-
blade; or encounters with teachers, parents, brothers, and sisters. When you meet people, be
ready with several stories to tell or interesting comments to make. Practice ahead of time in
the mirror or on a tape recorder. Get the other person to talk about himself or herself—his
or her interests, hobbies, work, or education.
3. Express interest in the other person’s expertise. “How were you able to land a job like that?”
“How did you make it through Gaskin’s class?”
4. Above all, share your reactions to what is taking place at that moment while you are interact-
ing. Relate your thoughts or feelings about what the other person has said or done.

Technique: Becoming More Outgoing

Counseling Intention To increase the client’s interpersonal repertoire of experiences.
Description Start with the easiest reaching-out exercise and progress to those more
difficult. Record your reactions to each of these opportunities.

• Introduce yourself to a new person in one of your classes.

• Invite someone who is going your way to walk with you.
 148  Classic Behavioral Techniques
• Ask someone you do not know if you can borrow something and then give it back to him
or her.
• Find someone of the opposite sex in your class whose phone number you have. Call him or
her on the phone and ask about the latest class assignment.
• Stand in line at a grocery store. Start a conversation about the line with the person near you.
• Ask three people for directions.
• Go to the beach, swimming pool, or sports stadium and converse with two or three strangers
you meet.
• Notice someone who needs help in school or class. Offer to help.
• Invite someone to eat with you.
• Say “Hi” to five new people during the week. Try to provoke a smile and return “Hi”
from them.
Downloaded by [New York University] at 04:58 12 August 2016

Technique: Making a Date with the Opposite Sex

Counseling Intention To decrease irrational thoughts of rejection.
Description Dating is a social contact that is anxiety provoking for many. Shy daters
feel more vulnerable to irrational thoughts of rejection.

• Make your date by telephone initially. Be prepared ahead of time and have two specific
activities in mind.
• When you contact the person by phone, identify yourself by name and explain when you met
(if applicable). “This is Jim Thompson. I met you at the yearbook signing party.”
• Be sure you are recognized.
• Pay the person a compliment related to your last meeting, one that recognizes his or her
talent, values, or position on an issue. “You really did a great job designing the cover of the
yearbook.”
• Be assertive in requesting a date: “I was wondering if you’d like to come to a movie with
me this Saturday?” Be specific in your request, state the activity in mind, and state the time
it will take place.
• If the answer is “yes,” decide together on the movie and the time to meet. End the conver-
sation smoothly, politely, and quickly. If the answer is “no,” suggest an alternative such as
a more informal get together: “How about meeting for drinks after work on Monday—my
treat?”
• If the answer is still “no,” politely end the conversation. Refusal is not necessarily rejection.
There may not be enough interest or there may be previous commitments—school, work,
or family.

Technique: Anxiety Hierarchy for Fear of Flying

Counseling Intention To reduce anxiety and gain some control over an anxiety-provoking
situation.
Description Create about 16 or 17 anxiety-provoking situations to create the hier-
archy, ending up with about 10 to 15 items in your final version. To
aid in sorting the items, write each one on a separate index card. Grade
the anxiety of each item by assigning it a number on a scale from 0 to
100, where 100 is the highest level of anxiety imaginable and 0 is no
anxiety (complete relaxation). Write this number on the back of the
index card for the item being graded. When each item has an anxiety
grade, sort the cards into five piles. Each pile will represent a different
category of anxiety (Table 8.6).
 Classic Behavioral Techniques  149
Table 8.6  Anxiety Hierarchy
Pile Anxiety Grade
Low Anxiety 1–19
Medium Low Anxiety 20–39
Medium Anxiety 40–59
Medium High Anxiety 60–79
High Anxiety 80–100

The goal is to end up with at least two items in each pile. Combine all the cards into one pile
that is ordered from lowest to highest anxiety to create a personal fear of flying anxiety hierarchy.
Set the cards aside for one day. On the next day, shuffle the index cards to reorder them without
looking at the grades on the backs of the cards. Then check the grades to see if the second order-
Downloaded by [New York University] at 04:58 12 August 2016

ing is the same as the first. If not, make some adjustments.

Sample Fear of Flying Anxiety Hierarchy

The following is a sample “fear of flying” hierarchy to help clients develop their own hierarchy:

• Making reservations.
• Driving to the airport.
• Realizing you have to make a flight.
• Checking in.
• Boarding the plane.
• Taking off.
• Waiting for boarding.
• Taxiing.
• In-flight service.
• Moving around the cabin.
• Climbing out.
• Descending.
• Waiting for departure.
• Landing.
• Turbulence.

Overview of the Pairing Procedure

1. The overall goal of systematic desensitization is to reduce the ability of certain situations to
cause anxiety. Confront each item of the anxiety hierarchy while the client is in a deep state
of relaxation.
2. The systematic desensitization sessions should not exceed 30 minutes. Do not desensitize for
more than three of your anxiety hierarchy items per session.
3. Each session (except the first one) should begin with the last item from the previous session.
That is, if the last item was successfully desensitized, review it in the next session, and if it
was not successfully desensitized, begin with it in the next session.
4. Progress will depend on how many times a week the client practices. A schedule of two ses-
sions per day, every day, would be more ambitious than most people would attempt. Once
a day five times a week would be admirable; two times a week would be average. Consider
Table 8.7 as a plan for an anxiety hierarchy consisting of 15 items.
 150  Classic Behavioral Techniques
Table 8.7  Pairing Sessions
Session Item Numbers
1–3
2 3–5
3 5–7
4 7–9
5 9–11
6 11–13
7 13–15

Using a schedule of five sessions per week, the desensitization plan will be completed in about
Downloaded by [New York University] at 04:58 12 August 2016

1 to 2 weeks.

Technique: The Self-Administered Systematic Desensitization Procedure

Counseling Intention To empower the client outside of therapy.
Description The self-administered systematic desensitization procedure consists of
seven steps that are repeated for each item of your fear of flying anxiety
hierarchy. The task will be to work through each item of the anxiety
hierarchy following these seven steps:

Step 1. Induce relaxation using a preferred relaxation technique.

Step 2. Read the appropriate item from your hierarchy. (In the first session, this will be the
first item in the hierarchy. In all other sessions, this will be the last item from the previous
session.)
Step 3. Imagine the situation for a tolerable time.
Step 4. Stop imagining the situation and determine the level of anxiety that is experienced (on
a 0–100 scale). Reestablish relaxation again and relax for about 30 seconds.
Step 5. Re-read the description of the situation. Imagine the scene for a tolerable time.
Step 6. Stop and again determine the level of anxiety. If experiencing any anxiety, return to
Step 2. If feeling no anxiety, go on to Step 7.
Step 7. Move on to the next item of the hierarchy. Repeat the previous procedure for this next
item, beginning with Step 1. End each session with several minutes of relaxation.

Research has shown that long-term success in overcoming a fear of flying depends on taking an
actual flight (in vivo) after treatment is complete. Some people call it a graduation flight. Before
each flight, work through the anxiety hierarchy to reinforce the ability to remain relaxed. Above
all, remember to practice relaxation techniques on a daily basis to both cope with daily stress and
also improvise short desensitization sessions as needed.

Technique: The Family Chip System

Counseling Intention To provide immediate reward for appropriate behavior and immediate
consequences for inappropriate behavior (Myers, 2000).
Description

1. Purchase a box of poker chips.

2. Hold a family meeting to discuss the need for the program. Tell the children that it will help
them to learn to be in charge of themselves. Tell older children that this system is similar
to what adults experience: (1) Adults earn money for working; (2) adults have to pay fines
 Classic Behavioral Techniques  151
for breaking rules like speeding or making a late payment; (3) adults spend their money on
things they need, as well as a few things they want.
3. Develop a list of behaviors they will earn chips for. Start with the morning and then go
throughout the day, looking for behaviors to reward. Some possibilities are:
• Getting up on time.
• Brushing teeth.
• Getting ready for school on time.
• Playing nicely with brother or sister.
• Completing chores such as feeding a pet or taking out the trash.
• Saying please and thank you.
• Doing things the first time they are asked.
• Doing homework without a fuss.
• Getting ready for bed on time.
Downloaded by [New York University] at 04:58 12 August 2016

• Going to bed on time.

• Cleaning bedroom.
4. Agree on a list of behaviors that result in a loss of chips. These can include behaviors that are
oppositional, defiant, or disruptive. Some examples are:
• Tantrums.
• Yelling.
• Screaming.
• Fighting.
• Arguing.
• Throwing things.
• Jumping on the furniture.
• Getting up after bed time.
• Swearing.
• Putting others down.
5. Agree on a list of privileges they will earn and pay for with chips. Some privileges will be
bought for the day; others will be bought for a period of time (usually a half hour). These
can include:
• Watching TV.
• Playing outside.
• Computer time.
• Staying up late.
• Playing a game with a parent.
• Having a friend over to spend the night.
• Trip to a favorite fast-food restaurant.
6. Assign point values to each item on the list (Table 8.8).
7. Post the list of behaviors and chips earned in a convenient place.
8. Let your child decorate a paper cup in which to keep his or her chips. Place the “bank’s”
chips in a jar or bowl and put it in a place that is out of reach of children.
9. Practice giving and receiving chips before starting the program. The practice should be
based on the rules for parent and children provided next.

Rules for Parents When Giving Chips

1. Be near your child and able to touch him or her (not 20 feet or two rooms away).
2. Look at your child and smile.
 152  Classic Behavioral Techniques
Table 8.8  Sample Chip Program
Earn Chips
Making bed 2
Picking up bedroom 2
Brushing teeth 2
Setting the table 4
Being ready for bed on time 2
Going to bed on time 2
Doing things first time asked 1
Saying please and thank you 1
Lose Chips
Throwing things 4 + Time-out
Tantrums 4 + Time-out
Downloaded by [New York University] at 04:58 12 August 2016

Arguing 2
Interrupting 2
Running in the house 2
Privileges to Spend Chips On
Watching TV 5 chips per half hour
Playing outside 5 chips
Having a friend over 5 chips for the day
Going to friend’s house 10 chips
Playing game with parent 5 chips

3. Use a pleasant voice.

4. Make sure your child is facing you and looking at you.
5. Praise your child: “Hey, that’s great. You’re really doing a nice job. That’s really helping
me.” Reward your child with chips: “Here are two chips for doing a great job.”
6. Describe the appropriate behavior for your child so he or she knows exactly what behavior
he or she is being praised and rewarded for.
7. Hug your child occasionally or use some other form of positive touch.
8. Have your child acknowledge you, such as “Thanks, Mom” or “OK.”

Rules for Parents When Taking Away Chips

  1. Be near your child and able to touch him or her.
  2. Look at your child and smile.
  3. Use a pleasant voice.
  4. Make sure your child is facing you and looking at you.
  5. Explain what was inappropriate, such as, “Remember, you are not allowed to run in the
house because it is not safe” or “You need to learn not to yell and scream so we can enjoy
being together at home.”
  6. Be sympathetic. “I know it’s hard to lose chips, but that’s the rule.”
  7. Give your child the chip fine.
  8. Make sure your child gives you the appropriate chips.
  9. Prompting the appropriate responses will sometimes be necessary. For example, “Come on,
give me a smile!”
10. If a chip loss is taken very well by your child, it is a good idea to give him or her back a chip
or two.
11. If your child is too mad or upset to give you the chips, don’t force the issue. Place your child
in time-out to cool off and then get the chips.
 Classic Behavioral Techniques  153
Rules for Children When Getting Chips
1. You should be facing your parents, looking at them and smiling.
2. You should acknowledge the chips by saying “OK,” “Thanks,” or something else pleasant.
3. The chips should be put in a specified container. (Any chips left lying around are lost.)

Rules for Children When Losing Chips

1. You should face your parents, look at them, and smile (not frown).
2. You should acknowledge the chip loss with “OK” or “All right,” and “I’ll get the chips,”
etc. (You must keep looking at them and be pleasant.)
3. You should give the chips to your parents pleasantly.

Technique: Mystery Motivator (a variation of the token economy)

Downloaded by [New York University] at 04:58 12 August 2016

Counseling Intention To motivate the client in order to discover the mystery.

Description Instead of telling the client what the reinforcement is, the reward
is placed in an envelope and remains a mystery. The client becomes
motivated to earn tokens in order to discover what is in the mystery
envelope. This technique can be used to improve classroom manage-
ment, school phobia, disruptive behavior, ADHD, serious emotional
problems, psychological disorders such as autism, eating disorders,
schizophrenia, and addictions.

Conclusion
Fundamentally, behavior modification therapy is based on the idea of antecedents (events that
occur before a behavior is apparent) and consequences (the events that occur after the behavior
occurs). The appropriate behavior is learned by observing and changing both the antecedents
and the consequences of the behavior so that the appropriate behavior increases and the inap-
propriate behavior decreases. The use of rewards to help effect change is called positive rein-
forcement, and the use of punishment (for example, withdrawal of privileges) is called negative
reinforcement. A behavioral modification program to change behavior consists of a series of
stages. First, an inappropriate behavior is identified and stopped, and then a new behavior must
be developed, strengthened, and maintained.
 9 Person-Centered Techniques and
Psychoeducational Counseling
Approaches

Three conditions constitute a growth-promoting climate, whether speaking of the relationship

Downloaded by [New York University] at 04:58 12 August 2016

between therapist and client, parent and child, leader and group, teacher and student, administra-
tor and staff, or employer and employee. The first condition is genuineness or congruence. The
more the therapist is authentic in the therapeutic relationship (i.e., putting up no professional
front or personal façade), the greater the likelihood that the client will change and grow in a
constructive manner. The second condition is a climate for change with unconditional positive
regard. It means that when the therapist is experiencing a positive, nonjudgmental, accepting
attitude toward whatever the client is at that moment, therapeutic movement or change is more
likely. Finally, the third condition is empathic understanding. This means that the therapist senses
accurately the feelings and personal meanings that are being experienced by the client and com-
municates this acceptant understanding to the client (Rogers, 1986). A set of central values that
are implicit or explicit in Rogers’s theoretical writings are central to the person-centered approach:

  1. Human nature is basically constructive.

  2. Human nature is basically social.
  3. Self-regard is a basic human need, and self-regard, autonomy, and individual sensitivity are
to be protected in helping relationships.
  4. People are basically motivated to perceive realistically and to pursue the truth of situations.
  5. Perceptions are a major determinant of personal experience and behavior, and thus to under-
stand people, one must attempt to understand them empathically.
  6. The individual person is the basic unit, and the individual should be addressed (not groups,
families, organizations, etc.) in situations intended to foster growth.
  7. The concept of the whole person is valid.
  8. People are realizing and protecting themselves as best they can at any given time and under
the internal and external circumstances that exist at that time.
  9. The pursuit of control or authority over other people must be abdicated, and instead a com-
mitment must be made to strive to share power and control.
10. In helping relationships, the helper is committed to honesty in relation to himself or herself.
This honesty is a major means for helpers to maintain and enhance their mental and emo-
tional health and the health of their relationships.

Carl Rogers’s basic notion was that we are all struggling to become our “real,” true, unique
selves. What stands in our way? It was the tendency to deny our own needs and feelings, to
pretend to be someone we aren’t, to avoid facing our true self. Person-centered counseling
assumes that each individual is endowed with the urge to expand, to develop, to mature, and
to reach self-actualization (Hansen, Stevie, & Warner, 1986). This is the only major therapeutic
approach that relies on the counselee’s innate movement toward growth. Individuals are viewed as
self-healing, only needing a warm, supportive environment to reach higher levels of self­-fulfillment.
 Person-Centered Techniques  155
The counselor–client relationship continues to be considered a vital ingredient in psychother-
apy (Gelso & Carter, 1985; Henry, Schacht, & Strupp, 1986). Counseling relationships differ
from other relationships. In daily relationships between family and friends, for example, commu-
nication is reciprocal, focusing on give-and-take statements that may offer advice, judgments, or
personal perspectives. The major barrier to interpersonal communication lies in our inherent ten-
dency to judge others—that is, to approve or disapprove of the statements of the other person.
In the counseling relationship, however, communication is focused on the person experiencing
difficulty and is nonreciprocal. Rogers (1986) described the three facilitative conditions as (1)
“genuineness, realness, or congruence,” (2) “acceptance, or caring, or prizing—unconditional
positive regard,” and (3) “empathic understanding.” Rogers maintained that there is a body of
steadily mounting research evidence that, by and large, supports the view that when these facili-
tative conditions are present, changes in personality and behavior do indeed occur. Such research
has been carried on in the United States and other countries from 1949 to the present.
Downloaded by [New York University] at 04:58 12 August 2016

Studies have been made of changes in attitude and behavior in psychotherapy, in degree of
learning in school, and in the behavior of schizophrenics. In general, they confirm Rogers’s ideas
(Rogers, 1986, p. 198). A number of studies have reported improved psychological adjustment,
greater tolerance for frustration, decreased defensiveness, accelerated learning, and less tangible
improvements such as increased self-esteem and congruence between one’s ideal and real selves.
The works of Carkhuff and Berenson (1967) and Truax and Carkhuff (1967) have validated the
important contributions that the variables of empathy, respect, and genuineness make to the
counseling process.

Person-Centered Counseling
Researchers have acknowledged that conditions proposed by Rogers for counseling are sufficient
to bring change to the client. Through person-centered counseling, clients have enhanced their
self-esteem and also “tend to shift the basis for their standards from other people to themselves”
(Corsini & Wedding, 1989, p. 157). One major difference between person-centered counseling
and other approaches is the increased responsibility placed upon the client compared with that
assumed by the counselor (Brammer & Shostrom, 1982). Core Rogerian concepts have become
fundamental conditions in the counseling and therapeutic relationship today.

Unconditional Positive Regard

Possessing unconditional positive regard is accepting the client without judging the behavior,
event, or feeling as good or bad. Verbal sharing responses to communicate positive regard might
include, “I really look forward to our talks together.”

Empathy
Empathy is the ability to sense and identify the feelings of others and to communicate them to
the client from his or her point of view—that is, entering the client’s frame of reference. The
conceptual importance of empathy is not unique to Rogerian-related approaches. It has been
adapted by others under a different nomenclature. Special references to empathy are apparent in
approaches such as Adlerian psychotherapy (Dinkmeyer, Pew, & Dinkmeyer, 1979) and devel-
opmental counseling and therapy (Blocher, 1974; Ivey, 1989).
In addition, even though behavioral therapy (Krumboltz & Thoresen, 1976) and cognitive
therapy (Bedrosian & Beck, 1980) put less emphasis on counselor–client relationships, they do
focus on the use of empathy to understand the client’s problem accurately. Even Ellis’s rational
emotive behavioral therapy regards empathy as an important counseling component.
 156  Person-Centered Techniques
Patterson (1986) has emphasized empathic understanding as one of the core elements in
relationships common to most therapeutic systems. Brammer and Shostrom (1968) delineated
that responding with empathy is “an attempt to think with rather than for or about the client”
(p. 180). For example, if a client says, “I’ve tried to get along with my boss, but it never works
out. She’s too hard on me,” an empathic response could be, “You feel discouraged about your
unsuccessful attempts to get along with your boss.” In contrast, if the counselor responded with,
“You should try harder,” the counselor is responding from his or her own frame of reference.
The communication formula for basic empathy (Egan, 1990), for responding verbally to the cli-
ent’s feelings about concern, uses a statement that identifies the client’s feelings and the content
of the situation:

“I feel [fill in the right category of emotion and the right intensity] because [fill in the expe-
riences, behaviors, or both that elicit the feeling or emotions].” Sample response: “You feel
Downloaded by [New York University] at 04:58 12 August 2016

frustrated because your boss doesn’t trust you to run the operations when he is out of town.”

Genuineness
Genuineness is the ability to be authentic, or “real,” with others. The counselor does not distort
communication, hide motives, operate from hidden agendas, or become pretentious or defen-
sive. Genuineness means being oneself, not playing a role. The counselor’s actions and words
match his or her feelings, both verbally and nonverbally.

Active and Reflective Listening

Listening is an art. Full attention is given both to what the client is saying and to other nonver-
bal cues such as posture and facial expression. Attending is a precondition to helping. An active
listener feeds back what has been said in his or her own words for three reasons: (1) to make sure
that he or she understands correctly, (2) to reassure the client that he or she was heard, and (3)
to facilitate more disclosure on the part of the client. Identifying feelings communicates to clients
that the counselor is listening and encourages them to express themselves more freely. This facili-
tates the focus on key issues for working out a satisfactory solution. McKay, Davis, and Fanning
(1983) maintained that active listening requires the counselor’s participation as a collaborator in
the communication process through paraphrasing, clarifying, and feedback.

Paraphrasing Responses
The therapist states in his or her own words what the client has actually said, using such lead-ins as:

• “What I hear you saying is . . . ”

• “In other words . . . ”
• “So basically now your feeling is . . . ”
• “Let me understand what is going on with you, which is . . . ”
• “Do you mean . . . ?”

The counselor should paraphrase when the client says something of any importance. The ben-
efits of paraphrasing in the counseling relationship are that clients deeply appreciate feeling heard:

• Paraphrasing stops escalating anger and cools down crises.

• Paraphrasing stops miscommunication (false assumptions, errors, and misinterpretations are
corrected in the counseling session).
• Paraphrasing helps the counselor remember what was said.
 Person-Centered Techniques  157
• Paraphrasing inhibits blocks to listening on the part of the counselor, such as judging, com-
paring, advising, or the preoccupation of other thoughts (McKay et al., 1983, p. 24).

Clarifying Responses
Clarifying complements paraphrasing responses by asking questions to clearly understand the
client beyond vague generalities. The counselor uses these clarifying responses to understand
events in the context of how the client thinks and how the client feels about the problem.

Feedback
During the counseling interview, feedback provides the counselor with an opportunity to share
what was thought, felt, or sensed and to check perceptions. To check perceptions, the counselor
frames what was heard and perceived into a tentative description. For example,
Downloaded by [New York University] at 04:58 12 August 2016

• “I want to understand how you feel. Is this [give a description] the way you feel?”
• “As I listened to what you said, it seems like _________ is what is really happening in this
situation.”

Feedback is nonjudgmental and should be honest, supportive, and in the here-and-now.

Congruence
Congruence requires the counselor to be transparent to the client; that is, if the counselor is
feeling angered by the client’s communication, it would be incongruent to deny these feelings
or to try to hide them from the client. Sometimes, trying to be congruent may conflict with try-
ing to be nonjudgmental, illustrating how difficult it is to provide relationship conditions that
are facilitative. To be an effective communicator, the counselor must attend to both verbal and
nonverbal communication. Collectively, we learn:

10% of what we read

20% of what we hear
30% of what we see
50% of what we both see and hear
70% of what is discussed with others
80% of what we experience personally
95% of what we teach to someone
(Glasser, 1985)

Listening for Feeling

Effective communication involves the thorough understanding of the other person’s world
(listening) and conveying that understanding to that person (responding). Through accurate
listening and responding, barriers that hinder mutual understanding can be broken down (Dink-
meyer & Losoncy, 1980). Identifying and verbalizing the feelings in messages are framed with
responses such as “sounds like,” “you are kind of feeling,” “your feeling now is that,” or “if I’m
hearing you correctly.”

Listening with Empathy

Empathy means that the counselor recognizes that “this is hard to hear, but this is another human
being trying to live.” The counselor should ask himself or herself: “How did this belief or this
 158  Person-Centered Techniques
decision, though it eventually may fail, lower this person’s anxiety or get some needs met?” McKay
et al (1983) suggested that if listening with empathy is difficult, the counselor should ask these
questions:

• What need is the self-defeating behavior coming from?

• What danger or anxiety is the person experiencing?
• What is he or she asking for?

Listening with Openness

The counselor needs to hear the whole communication before judging; more information may
be disclosed later, and all the information may not be present.

Listening with Awareness

Downloaded by [New York University] at 04:58 12 August 2016

Awareness is accomplished by comparing the client’s verbal and nonverbal communication with
tone of voice, emphasis, facial expression, and posture for any mismatch between expression
and content. Brigman and Earley (1990) maintained that in order to have a satisfying relation-
ship with others, a client must learn to communicate effectively. Much of our ineffective com-
munication practices involve nagging, reminding, criticizing, threatening, lecturing, advising,
and ridiculing.

Respect
Respect is an interpersonal skill that demonstrates an appreciation of the uniqueness of others,
tolerance of differences, and willingness to interact with others equally.

Concreteness
Concreteness is demonstrated with specific, clear, and unambiguous communication—one uses
“I messages” rather than “you messages” (Table 9.1). One uses “I messages” to take responsibil-
ity for feelings, emotions, and actions. Effective communication messages involve three compo-
nents: (1) owning feelings, (2) sending feelings, and (3) describing behavior. Sending a feeling
message adheres to the following communication formula: Ownership + Feeling Word + Descrip-
tion of Behavior = Feeling Message. For example: “I [ownership] am anxious [feeling word]
about sending in my tax return on time [description of behavior].”

Immediacy
Immediacy is the ability to discuss openly what is happening in the here-and-now, as well as the
ability to use constructive confrontation.

Self-Disclosure
Self-disclosure is the willingness to share personal experiences with others without being critical
or judgmental. Self-disclosure facilitates intimacy and self-exploration. Self-exploration also can
occur on three levels:

Level 1: Clients talk of others and things related to themselves, such as general events and
ideas, global conceptual ideas, universal and public issues, and historical perspectives in the
“there-and-then.”
 Person-Centered Techniques  159
Level 2: The client will talk of self and ideas as related to others, such as personal events and
opinions, personal goals, and perspectives for the future with significant others or peers in
the “there-and-then.”
Level 3: The client begins to talk about self and related feelings as they affect
self-experience, with attention on personal meanings, feelings, and perceptions in the
“here-and-now.”

Confrontation
Confrontation is the ability to tell others about their behavior and its effect on oneself without being
aggressive, critical, judgmental, or defensive. Confrontation is an open, sincere identification of one’s
self-defeating patterns, behavior, thoughts, feelings, or actions that may interfere with interpersonal
relationships. Confronting an individual’s discrepancies, at a minimum, leads to greater awareness
of the reality that the particular behavior is helping or hindering interpersonal relationships.
Downloaded by [New York University] at 04:58 12 August 2016

Warmth
Warmth is the ability to be open, friendly, and accepting of others with nonverbal communica-
tion that conveys congruent signals of openness and readiness to listen. The person-centered
approach of Carl Rogers has the potential to be applied to a variety of educational, psychologi-
cal, political, industrial, managerial, recreational, medical, and other settings (Purkey & Schmidt,
1990, p. 129). This counseling model is especially important for self-acceptance by those who
have a physical disability. In particular, the self-acceptance of children who have disabilities is
needed to assist this population in their efforts to move toward greater use of the potential they
possess (Williams & Lair, 1991, p. 202).

Technique: The Use of “I Messages”

Counseling Intention To respond assertively and to resolve interpersonal conflicts.
Description Alberti and Emmons (1986) identified a three-step empathic assertive
response model:

1. Let the person know you understand his or her position: “I know it’s not your fault.”
2. Let the person know your position (what the conflict is): “But I ordered my steak well done,
not medium rare.”
3. Tell the person what you want or what you plan to do: “I would like you to take it back and
have it cooked some more.”

The communication formula for an assertive response is: “I know [the other person’s position]
but [my position] and [what I want].”

Technique: The Companion

Counseling Intention To feel the personal presence of a loving, caring companion; to fulfill
a profound emotional need (Schriner, 1990, p. 77).
Description Imagine that a deeply caring and insightful person is standing beside
you, touching you in a reassuring manner and offering words of
encouragement. You listen, perhaps writing down the suggestions.
Then you go on with your activities, knowing you can come back for
advice and support any time you choose.
 160  Person-Centered Techniques

Technique: Repeating the Obvious

Counseling Intention To clarify thinking or redirect feelings about a problem situation
(Schriner, 1990).
Description Two kinds of obvious statements are especially valuable to repeat:

1. “I understand” statements. We can explain why we have a problem or an unhappy feeling:

“Of course I’m feeling anxious—I always feel nervous speaking in front of people. This
always happens to me.” Or, “My client’s boss is prone to mood swings; this just must be one
of my boss’s days.”
2. “I can” statements. Repeating what we do to alleviate our problems is empowering and
reassuring: “I can remind myself to breathe deeply and to recall how I have been successful
in past situations.” Or, “If my boss is still irritable after three days, I can request a personal
Downloaded by [New York University] at 04:58 12 August 2016

conference.”

Several writers have developed lists of more than 100 “assertive rights.” The most basic ones
include:

• The right to act in ways that promote your dignity and self-respect as long as others’ rights
are not violated in the process.
• The right to be treated with respect.
• The right to say “no” and not feel guilty.
• The right to experience and express your feelings.
• The right to take time and to slow down and think.
• The right to change your mind.
• The right to ask for what you want.
• The right to ask for information.
• The right to make mistakes.
• The right to feel good about yourself.

Technique: Assertiveness Skills

Counseling Intention To be in control; to ignore irrational fears or anxieties; to express feel-
ings; to ask for support or assistance.
Description The following are different ways to be in control:

1. Don’t be afraid to say “no.” Saying “no” is acceptable.

2. Make eye contact and maintain an open posture.
3. Repeat your request to reinforce your position. State your demand over and over again to
transcend the barrier of resistance or the barrier of avoidance.
4. State your goal clearly. Be sensitive to the needs of others, but be firm in expressing what you
need and what you want.
5. Recognize the needs of others, and reassure them that you are aware of their position on
their point of view.
6. Regulate your pitch and tone of voice to communicate a firm, controlled position.
7. Stand straight and thank the person for listening to your request.

Creating more assertive dialogue is represented in Table 9.1.

 Person-Centered Techniques  161
Table 9.1  A Continuum of Assertiveness
From Less Assertive To More Assertive
“I’m going to. . . ” or “I will. . . ” “I’ve decided to . . . ”
“One day I’m going to . . . ” “My goal is to by. . .”
“I don’t think . . . ” “I think that . . . “ or “My thoughts are . . .”
“I can’t do it . . . ” “I want to do it . . . ”

Technique: Different Ways to Refuse a Request

Counseling Intention To provide alternatives to saying “no” to a request.
Downloaded by [New York University] at 04:58 12 August 2016

Description The following are different ways to refuse a request:

1. Simply say “no.”

2. Use an “I want” statement; for example, “No, I don’t want to loan you my car, I may
need it.”
3. Use an “I feel” statement; for example, “No, I just wouldn’t feel comfortable parting with
it right now.”
4. Use an “empathetic assertion” statement; for example, “I can see you’re in a bind, but
I can’t loan you my car tonight.”
5. Use a “mixed feelings” statement; for example, “Part of me says let you have my car this
evening, and the other part is saying ‘No, I may need it and you will be stranded.’ ”

Technique: Inner Processing of Personal Feelings

Counseling Intention To assess emotional well-being.
Description Go inside yourself and identify how you feel. (Are you feeling depressed,
disappointed, nervous)?

1. Go inside yourself and identify what you feel. (Are you experiencing anger, frustration, or
lack of control)?
2. Identify what happened to make you feel this way. (Was it a particular event, a phobia,
behavior of another, or an uncontrollable situation)?
3. Make a mental list of ways you could express your feelings, or identify ways you
could act.
4. Choose the best way for the current circumstances. Carry out your choice.

Technique: Inner Processing of How Another Person Is Feeling

Counseling Intention To empathetically assess how another person may feel.
Description Observe the other person’s behavior and actions.

1. Pause and listen to gain an understanding of what the other person is saying.
2. Identify with your inner dialogue, the feelings you think the other person is having. (Inner
dialogue to self: He must feel embarrassed.)
3. Mentally list specific feelings you think the other person is experiencing.
 162  Person-Centered Techniques
4. Decide if you need to do a perception check to verify the other person’s experience.
5. Use reflection skills to verify the feelings the other person has to show that you
understand.

Technique: Handling the Perennial Dilemma of Peer Pressure

Counseling Intention To learn peer pressure refusal skills.
Description Use the following steps:

1. Listen to what someone wants you to do and give it a name (e.g., underage drinking, steal-
ing, cutting class, getting a false ID, calling in sick to work, cheating on taxes).
2. Think about what would happen if you were caught. What would be the consequences (e.g.,
suspension from school, committing a felony, getting a DUI)?
Downloaded by [New York University] at 04:58 12 August 2016

3. Think about what you want or need to do (e.g., walk away, suggest an alternative, blow
it off).
4. Examine possible consequences and rank them from 1 to 10 (1 = least; 10 = most).
5. Decide what to do to maintain your best interest.
6. Explain to others your needs and wants (e.g., I need to stay straight; I want to avoid trouble).

Technique: Peer Pressure Refusal Skills

Counseling Intention To become assertive in resisting peer pressure.
Description A list of “one-liners” to peer pressure could include the following:

• Invent a routine excuse, such as “I have to be at work at that time.”

• Use delay tactics: “I’m not ready.”
• Walk away and avoid the situation.
• Shift the blame and try to make the pressure group feel guilty.
• Act ignorant about how to do something.
• Identify the other things that are more important to do at the moment.
• Get away from the situation as soon as possible.
• Take control of the situation: “I don’t want to do it.”
• Ask them to justify why you should do what they want you to do: “What is in it for me?”

Technique: Dealing with Fear and Anxiety

Counseling Intention To assess the source of fear and anxiety.
Description Think about what is causing the fear or anxiety.

1. Is the situation in your control? Is there an alternative solution?

2. Is this situation life threatening? Do a perception check with someone else. Is he or she
experiencing the same discomfort?
3. Talk with someone, leave the situation, or approach the situation gradually.
4. Take steps to reduce your fear or anxiety. Ask yourself the following questions:
• Is it really a big deal?
• Is this worse than what I handled before?
• Will this seem important two weeks from now?
• What is the worst thing likely to happen, and will I be able to cope with that?
 Person-Centered Techniques  163

Technique: Communicating to Enhance Relationships

Counseling Intention To identify communication skills that would enhance interpersonal
relationships.
Description To enhance relationships, try the following strategies:

• Speak directly. Tell your partner what you want (e.g., “I want to go to the game with you on
Saturday.”).
• Distinguish between needs and wants. Needs are the minimum requirement for the relation-
ship to exist. Wants are things that enhance the relationship.
• Listen actively and attentively. Maintain a relationship where feelings are shared, along with
hopes and dreams, without the fear of condemnation.
• Fight fairly. State your feelings using “I messages” and learn how to respond assertively,
such as “I think” or “I feel.”
Downloaded by [New York University] at 04:58 12 August 2016

• Focus on behavior, not personality. Concretely describe the problem behavior.

• Avoid gunny sacking. Don’t save up all your hurt feelings and hostilities and let them accu-
mulate into one explosive episode. Deal with significant issues when they occur. Stay in
the here-and-now. Bringing up the past is disrespectful and merely brings on more hos-
tility. Work so that both parties win. Lasting relationships require daily maintenance and
fine-tuning.

Technique: Positive Affirmations

Counseling Intention To increase intrapersonal well-being and self-esteem.
Description Many people are limited by their negative thinking: “I can’t” or
“I don’t deserve.” Negative beliefs are blocks to positive action.
Sometimes you must consciously work to maintain good feelings
about yourself. Remind yourself that day-to-day life has its ups and
downs.

Guidelines for Positive Affirmation

  1. Begin with the words “I am.”
  2. Include your name in the affirmation.
  3. Include positive feeling words such as enthusiastic, awesome, tremendous.
  4. Phrase it in the present tense.
  5. Keep the statements short.
  6. Incorporate your strengths within your affirmations.
  7. Choose action words.
  8. Choose positive words.
  9. Include a feeling word to motivate action (I am happy when I receive compliments).
10. Once you have constructed an affirmation, close your eyes, repeat the affirmation several
times (at least three), and notice what inner picture it creates. If the picture it creates matches
your desired outcome, your affirmation is a good one.

Technique: Poor and Good Listening Characteristics

Counseling Intention To identify positive and negative listening characteristics.
 164  Person-Centered Techniques
Description
Characteristics of Poor Listening
• Interrupting.
• Looking at the clock.
• Taking the focus off the topic by talking about yourself.
• Acting bored.
• Poor posture.
• Joking or trying to top the person with another story.

Characteristics of Good Listening

• Maintaining eye contact.
• Paraphrasing what the other person said.
Downloaded by [New York University] at 04:58 12 August 2016

• Asking relevant questions.

• Nodding.
• Using body language that shows interest.

Technique: Using I Messages, You Messages, and We Messages

Counseling Intention To differentiate messages that hinder or help with communication.
Description “I messages” express thoughts, feelings, wants, needs, and expecta-
tions; for example:

• I think Jennifer is the best candidate for the job.

• I feel disappointed that you are behind.
• I am put at a disadvantage when I don’t receive the information on time.
• I want you to give me an explanation for your absence from practice.
• I need your help.
• I expect you to inform me when you change shifts with someone.
• I would prefer that you talk with me rather than write a note.

Your messages can express empathy or understanding of the other person’s dilemma and sym-
pathetically describe the other person’s behavior; for example:

• You are feeling a great deal of pressure.

• Your position has some positive points.
• You handled the conflict very well.

“We messages” express alternatives, compromises, and mutual problem solving; for example:

• We have three options: work through lunch, work late, or come in early.
• How can we solve the conflict with the team to our mutual satisfaction?
• We’ve decided to have the luncheon instead of the breakfast.

Technique: Confirming Interpersonal Hunches about Others

Counseling Intention To understand relationships and feelings about others.
Description What you think someone thinks about you, and what you think about
that person, are powerful determinants about how you will relate to
 Person-Centered Techniques  165
and interact with each other. Some of the following relationship skills
may help:

1. If both of you disagree about how you perceive each other, reserve judgment and make
more observations of each other’s behavior.
2. If you feel misunderstood, try to change the other person’s experience with you. Let him or
her see another side of you.
3. Try to change your behavior.
4. Try to change the other person’s behavior, or help him or her make the desired changes.
5. Try to change your views of the other person.
6. Become more aware of your needs and wants.
7. Start a crusade to be better understood by others.
Downloaded by [New York University] at 04:58 12 August 2016

Technique: Clarification and Reflection

Counseling Intention To understand someone else’s feelings through clarification and
reflection.
Description To clarify and reflect back to another person, remember the following
acronyms:

FAT: Feelings, Actions, Thoughts

CPR: Clarify, Paraphrase, Reflect

Technique: Active Listening

Counseling Intention To listen to the feeling under the words.
Description Listen for the feelings under the words:

1. Identify discrepancies in behavior.

2. Summarize target issues.
3. Use silence to encourage responses from others.
4. Paraphrase the essence of what was said.
5. Obtain feedback about perceptions versus realities.
6. Reflect similarities in behaviors and thoughts.
7. Check for accuracy of the presenting problem.
8. Ask questions to gain better clarification.

Technique: The Assertive Response

Counseling Intention To communicate needs more assertively and less aggressively.
Description

Step 1: “When . . .” (Concretely describe the other person’s behavior.)

Step 2: “The effects are . . .” (Describe objectively how the other person’s actions have
affected you.)
Step 3: “I feel . . .” (Accurately describe your feelings.)
Step 4: “I prefer . . .” (Suggest what you would like to see happen.)

Example
Step 1: When you are late picking me up for work in the morning. . .
Step 2: I am always late and my boss will probably put it on my evaluation.
 166  Person-Centered Techniques
Step 3: I feel hurt and angry at you.
Step 4: I am hoping that we could make plans so that I don’t have to be late anymore.

Technique: Supporting
Counseling Intention To help others feel better about themselves and eliminate unnecessary
stress.
Description Supporting is a communication skill to help people feel better about
themselves by soothing and reducing tension.

1. Actively listen to the message the person is sending (i.e., listen for the feelings under the
words).
2. Try to empathize with the person’s feeling (i.e., try to walk in his or her shoes).
Downloaded by [New York University] at 04:58 12 August 2016

3. Paraphrase a reply that is in harmony with the other person’s feelings.

4. Support the other person by indicating your willingness to be of help, if possible.

Example
“I’ve been on my fifth interview and I have yet to find a job.”
“I can understand your disappointment; you’ve really worked hard. Let’s practice an inter-
view session and I’ll record it. Then, we can play it back and see how you look in an interview
situation.”

Technique: Describing Feelings and Empathizing

Counseling Intention To communicate your needs and wants effectively to others.
Description Describing feelings is putting your emotional state into words so that
others can understand your perspective.

1. Get in touch with the feelings you are currently experiencing. Identify them specifically—angry,
embarrassed, helpless, tired, lonely.
2. Acknowledge those feelings.
3. Make sure the statement you make to someone else contains the emotion you feel.
4. Share the feeling and your behavioral reaction.

Example:
“I felt rejected and alone when you broke your date with me.”

Empathizing is being able to identify another’s feeling and responding to it as if it were

your own.

1. Listen actively to what the person is saying (i.e., understand the feeling under the words).
2. Try to recall or imagine what you would feel like under those same conditions or
circumstances.
3. Respond with the appropriate feeling words to share your own sensitivity to another per-
son’s circumstance.
 Person-Centered Techniques  167
Example:
“I feel so stupid in Herr Bradshaw’s class; everyone is passing his German vocabulary test but me.”
“Yeah, I can understand, it’s a very helpless feeling. Maybe we can quiz each other for the
next test?”

Technique: Self-Disclosure
Counseling Intention To self-disclose appropriate information to build a more intimate
relationship.
Description Self-disclosure is sharing personal feelings, ideas, and experiences that
are unknown to another person. Personal sharing builds relationships
with others if it is reciprocated. Acceptance by friends and others
increases your self-acceptance and makes you more perceptive, more
Downloaded by [New York University] at 04:58 12 August 2016

extroverted, more trusting, and more positive toward others.

Tell a friend some facts about your family, work, school, or hobbies.
Determine the level of risk. On a scale from 1 to 10, how risky is this
information you disclose to someone else?
If appropriate, move to a deeper level of self-disclosure. Encourage
mutual disclosure from the other person (e.g., “Do you get the same
feeling that I do about Mr. Cohen’s class?”).

1. Refrain from revealing intimate self-disclosures to short-time acquaintances.

2. Start and continue self-disclosure only if the other person reciprocates it.
3. Understand that individuals share personal information differently and people’s attitudes
about disclosure vary.

Example:
While being pressured to try some crack cocaine, Bill responds, “You know my stepfather, but not my
real dad. My real dad is doing time for dealing and doing drugs. I prefer not to end up like him.”

Self-disclosure should include four clear statements:

1. I see the situation this way . . .

2. I conclude . . .
3. I feel . . .
4. I prefer . . .

Technique: “Carefronting” (Confronting Self-Defeating Behavior)

Counseling Intention To confront self-defeating or life-threatening behavior in a caring way.
Description People need to hear that you care about their well-being. It must be a
genuine concern if confronting is to be effective; hence, a better term
is “carefronting.” Examples might include:

“The concerns I have about you are because I care about you and our relationship. I care about
you too much to let this go and not say anything about what I see happening.”

Then state the behavior—how you feel—and then reiterate your caring and concern.
 168  Person-Centered Techniques
Other Guidelines
1. Maintain a sense of calm. Be simple and direct. Don’t circumvent the issue or behavior.
Speak to the point. Don’t become emotional. It is all right to show your feelings, but anger
should not be directed at the person.
2. Keep on the subject and be specific. Talk about the problem and specific ways it has affected
the person’s behavior.
3. Be prepared for promises, excuses, and counteraccusations (especially when confronting
drinking behavior). Denial and resistance to receiving help may occur.
4. Admit the problem and face it.
5. Find a good source of reliable information and learn it.

Technique: Listening with Empathy

Downloaded by [New York University] at 04:58 12 August 2016

Counseling Intention To understand the feelings under the words.

Description Empathy is a skill that can be acquired through practice. It involves
hearing who the person is and how he or she feels about himself or the
situation. It involves four steps:

1. Listen for feeling, both verbal cues and nonverbal cues.

2. Acknowledge his or her feelings. Identify what you see or hear (e.g., you sound irritated,
angry, confused).
3. Clarify feelings. Use phrases like “What I hear you feeling is something like . . . ” or “Can
you give me an example?”
4. Check it out. Paraphrase: “Let’s see if I understand; what you are saying is . . . ”

Technique: Paraphrasing
Counseling Intention To convey to another person that you understand the meaning of
what he or she has said, paraphrase what you heard in your own
words.
Description

1. Listen actively and carefully.

2. Pause to determine what the message means to you.
3. Restate the meaning you got from the message using your own words.
4. Obtain confirmation from the other person that the meaning you conveyed was correct.

Example
Bill says, “My chemistry teacher just assigned three more chapters for the test tomorrow and I am
scheduled to work tonight.”
Jill replies, “If I understand you right, you feel stressed and overwhelmed about what you
need to do.”

Technique: Making Intention Statements

Counseling Intention To express commitments, expectations, and limitations.
Description Intention statements let others know more about your immediate or
long-range commitments or expectations. An intention statement is
a way of being direct about what you would or would not like for
 Person-Centered Techniques  169
yourself, or what you would or would not like to do. Intention state-
ments begin with words like:

“I want . . . ”
“I would like . . . ”
“I intend . . . ”

Examples
• “I want to be with you today, but I don’t want to spend all our time shopping.”
• “I’d like to do my studying in the afternoon, then catch the game this evening.”
• “I’d like to be with you, but I want to be with my family tonight, too, because it’s my
brother’s birthday. And I want to spend this afternoon in the library working on my paper.”
Downloaded by [New York University] at 04:58 12 August 2016

Technique: Confrontation Guidelines

Counseling Intention To gently bring to the attention of someone else that a behavior needs
to be changed.
Description

1. Be flexible and reasonable in your expectations about the outcome of the confrontation.
It is more reasonable to ask for an apology about one’s actions rather than changing his
or her personality: “The most important thing is that he knows what an inconvenience he
caused me.”
2. Confronting at the right time and in the right place is critical to a successful confrontation.
Privacy and easy access to each other will usually improve the impact, unless you are con-
cerned about a physical confrontation.
3. Talk directly to the person you are confronting: “I really need to tell you something impor-
tant that concerns me. Can we talk?”
4. Talk clearly and calmly. If the person is unable to listen, wait until he or she is in a more
receptive emotional state.
5. Refer directly to the issue: “Remember when we were supposed to meet at the mall last
Saturday?”
6. Explain how the person’s behavior affected you. Use “I messages”: “I get frustrated and
impatient when you keep me waiting.”
7. Listen actively to the other person’s viewpoint. Try to put yourself in his or her shoes.
8. Ask for cooperation and openness. This will test the person’s flexibility and receptivity to
improve or change: “Will you hear me out?” or “Would you be willing to change the way
you treat me?”
9. Summarize what you both need to do to resolve the problem: “I need to know that you will
avoid being late again.”

Technique: “I Language” Assertion

Counseling Intention To enhance one’s ability to communicate difficult feelings.
Description “I language” assertion is helpful in expressing difficult negative feel-
ings. It involves a four-part statement:

1. Objectively describe the other person’s behavior or the situation that interferes with you.
2. Describe how the other person’s behavior or the situation concretely affects your life, such
as costing you additional time, money, or effort.
 170  Person-Centered Techniques
3. Describe your own feelings.
4. Describe what you want the other person to do, such as providing an explanation, changing
behavior, apologizing, offering suggestions for solving the problem, or giving a reaction to
what was said.

Example
“When you cancel a meeting with just a few hours’ notice, I don’t have enough time to make
other arrangements and I’m left with empty downtime. I feel irritated and unproductive. We
need to make other arrangements about changing meetings at the last minute.”

Technique: “I Want” Statements

Downloaded by [New York University] at 04:58 12 August 2016

Counseling Intention To clarify what all parties want in a situation.

Description “I want” statements help you to clarify to both yourself and others
what you really want. It gives the other person information that is
necessary to know how to fulfill your wants. It relieves you from the
conflict of wanting, being afraid to ask, and worrying about whether
the other person will do what you want.
Use “I want” statements when you say, “I want to do this” or
“I want you to do this” while referring to a specific behavior.

Example
“I want to know what I did to make you so angry, but I don’t want you to call me names.”

“I want” statements can be framed as follows:

1. Instead of going to the movies, I want to just stay home and rent a video.
2. Rate your want on a scale of 1 to 10: “I want to go to the movies in the mall. It’s a strong
preference—about an 8.”
3. State what your “I want” statement means and what it doesn’t mean: “I want to go to the
movies sometime in the next two weeks. That’s just for information; no pressure if you can’t
make it this weekend.”

Technique: Empathic Assertion

Counseling Intention To assertively communicate empathic understanding.
Description Empathic assertion can be used to convey some sensitivity toward a
person. It consists of a two-part statement. The first part states your
recognition of the other person, making a recognition statement
involving one of the following areas:

• His or her situation (e.g., pressures, difficulties, lack of awareness).

• His or her feelings (e.g., sad, mad, angry, scared).
• His or her wants (e.g., to get a higher grade or a better job).
• His or her beliefs (e.g., that he or she has been unfairly treated or singled out).

A recognition statement simply indicates that you see, hear, acknowledge, and realize the situ-
ation, feelings, wants, desires, or beliefs of the other person. The second part of the empathic
assertion is describing your situation, feelings, wants, or beliefs. Describe what you understand.
 Person-Centered Techniques  171
Example:
“I can understand you are upset with me and probably not in the mood to discuss this right now.
I would very much like to talk it over when you’re ready.”

Technique: Mirroring
Counseling Intention To understand the thoughts and feelings of a complaint.
Description One method for effective emotional listening is called “mirroring.”
One person makes a complaint; the other person repeats it back in his
or her own words, trying to capture not just the thought, but also the
feelings that go with it. The partner mirroring checks with the other
to be sure the restatement is on target and, if not, tries again until it is
right.
Downloaded by [New York University] at 04:58 12 August 2016

Technique: Communicating Feelings in a Nonblaming Manner

Counseling Intention To increase negotiation skills.
Description Negotiation language proceeds as follows:

“When you said or did_________, I felt _______. Can you tell me what you meant?”
“What I would like is _______.”
“How can we work this out?”

Technique: Interpretive Confrontation

Counseling Intention To gain better insight into oneself.
Description Interpretive confrontation can provide insight into one’s self—a criti-
cal component of mental health. Interpretation can enhance personal
growth if the information is communicated with skill, integrity, and
empathy.

Characteristics of an Interpretive Confrontation

Empathy. Understand the issues that are central to the other person’s behavior and
lifestyle.
Timing. The confrontation should be timed to prevent the receiver from becoming
defensive.
Relatedness. The confrontation should be related to the situation in which both parties are
engaged.
Concise. The confrontation should be concisely stated and to the point.
Genuine. The person who is confronting must be able to communicate with genuine interest
and concern for the well-being of the other party.
Tentative. The interpretation is a suggestion about the other person’s behavior, not an
absolute fact.

Technique: Self-Talk to Maintain Composure

Counseling Intention To manage stress with positive self-talk.
Description Self-talk statements should be generated and internalized before, dur-
ing, and after the situation:
 172  Person-Centered Techniques
Before: Take a minute to become more centered: “What is it that I want to do?”
During: Take a moment to exhale. Take things one step at a time. “People get irritated. It’s
nothing more than that.” Clearly say what you want. Don’t raise your voice.
After: On a scale of 1 to 10, rate the experience: “I handled that with a 7. I’m getting better
at this every time I try.”

Technique: Working through Disappointment When a Mistake Has Been Made

Counseling Intention To make the best of a bad decision.
Description First, a mistake is evidence that someone tried to accomplish some-
thing. View a mistake as an opportunity in disguise rather than a crisis.
Many people have discovered new opportunities by accident. Accept
your mistake and learn to forgive yourself. Obsessing over what you
Downloaded by [New York University] at 04:58 12 August 2016

could have done or should have said is wasted energy. Take a personal
inventory of your personal costs versus benefits. Are you spending
more energy than it is worth?

Technique: The Compassionate Response

Counseling Intention To forgive, accept, and lower expectations.
Description It is important to recognize that if we have no expectations, we will not
be disappointed. Responding to someone with compassion requires
understanding, acceptance, and forgiveness. Ask yourself:

What need was the person trying to meet through his or her actions?
What personal beliefs influenced his or her actions?
What pain, hurt, or other feelings influenced his or her actions?
Am I judging someone because of my own expectations?
You can let go and forgive this person for his or her actions, or you can hold on to the anger
and destroy the relationship.

Technique: Paraphrasing Responses

Counseling Intention To gain insight about how others are feeling.
Description Paraphrasing means to state in your own words what the person has
actually said using a lead-in such as, “What I hear you saying is,” “In
other words,” “So, basically, how you feel is,” or “Let me understand
what is going on with you.”
The benefits of paraphrasing in relationships are that:

1. People deeply appreciate feeling heard.

2. Paraphrasing deescalates anger and cools down a crisis.
3. Paraphrasing stops miscommunication, false assumptions, and errors in meaning.
4. Paraphrasing helps you remember what was said.
5. Paraphrasing inhibits blocks to listening.

Technique: Turning “You Statements” into “I Statements”

Counseling Intention To expressed repressed feeling and emotions.
 Person-Centered Techniques  173
Table 9.2  “You Statements” versus “I Statements”
Examples of “You Statements” Examples of “I Statements”
Blaming “I feel angry.”
“You tick me off”
Judging and Labeling “I feel hurt when you
“You are an arrogant jerk.” criticize.”
Accusing “I feel neglected.”
“You don’t care about anyone.”
Ordering “I feel hurt when you yell.”
“You shut up.”
Arguing “I feel this option is possible.”
“You don’t know anything.”
Threatening “I’d like it if you would.”
“You had better.”
Downloaded by [New York University] at 04:58 12 August 2016

Moralizing “I think this would be . . .”

“You should do. . .”
Analyzing “I feel disappointed that you
“You can’t stand to leave.” are reluctant to leave.”

Description Suppressing or denying feelings leads to several problems:

(1) increased irritability and conflicts with others, (2) difficulty resolv-
ing interpersonal problems, and (3) distorted perceptions. “I state-
ments” do not judge, blame, or threaten; they essentially clarify how
you feel (Table 9.2).

The Psychoeducational Life Skill Intervention Technique

The Psychoeducational Life Skill Intervention Model (P.L.S.I.M.) enhances social, emotional,
and cognitive skills. The indicators of emotional deficits manifest themselves in increased inci-
dents of violence, suicide, and homicides. Social deficits manifest themselves as poor peer rela-
tions and an inability to resolve conflicts and to manage anger. Cognitive deficits place clients
at a disadvantage academically and reduce their career options, making them more vulnerable
to criminal influences because they do not have the marketable skills to compete in a global
economy.
The Psychoeducational Life Skills Intervention Model follows a five-step learning model:
(1) instruction (teach), (2) modeling (show) (3), discussion of the skill (things that may
help or hinder implementation) (4) role-play (practice), (5) feedback (reinforce), and (6)
“ownwork” (apply the skill outside the group setting). Modeling, feedback, role-playing,
instruction, situation logs, and ownwork assignments are used to reinforce desired behavior.
The term ownwork is used rather than homework to reinforce one’s responsibility for chang-
ing behavior, as the term homework is often associated with isolated drudgery. The Psychoe-
ducational Life Skill Intervention Model is a more comprehensive and systematic approach
to the remediation and enhancement of interpersonal and intrapersonal effectiveness. This
comprehensive skill delivery system emphasizes a psychoeducational life skill promotion and
enhancement model in which (1) help is provided by a counselor or therapist, (2) a client’s
difficulties are seen as gaps in knowledge or experiences rather than being viewed as mala-
daptive behavior through a deficit lens, and (3) the client is active in the design of his or her
life skill development and management plan. An experiential group approach rather than a
didactic one-on-one approach is the most successful way to diminish self­-defeating behavior.
The instructional psychoeducational intervention techniques are derived from social learning
 174  Person-Centered Techniques
theory. Social skills are acquired primarily through learning (e.g., by observing, modeling,
rehearsing, and providing feedback) and are maximized through social reinforcement (e.g.,
positive responses from one’s social environment). Behavioral rehearsal and coaching rein-
force learning.

The Psychoeducational Life Skill Intervention Process

The psychoeducational group leader assumes the role of director, teacher, model, evaluator,
encourager, motivator, facilitator, and protector. Role-playing within the Psychoeducational
Life Skill Intervention Model provides several opportunities: (1) to try out, rehearse, and prac-
tice new learning in a safe setting; (2) to discover how comfortable new behaviors can become;
(3) to assess which alternative actions work best; and (4) to practice and repractice new learn-
ing by reality testing. Role-playing is a fundamental force of self-development and interpersonal
Downloaded by [New York University] at 04:58 12 August 2016

learning.

Six-Step Process to the Psychoeducational Life Skill Intervention Model

The steps are outlined according to what the group leader should say and do to help the client
integrate social, emotional, and cognitive skills into his or her behavioral repertoire.

Step 1: Present an Overview of the Social, Emotional, or Cognitive Skill

In the instructional portion of the process, a vignette (5 to 10 minutes) is presented to teach
the social, emotional, or cognitive skill. Introduction to the benefits of the skill in enhancing
relationships, as well as the pitfalls for not learning the skill, are also presented. The following are
suggested instructional overviews for the social skill of assertiveness.

Example: Social Literacy Skill: Understanding Your Assertive Rights

We all have rights:

• To decide how to lead our lives.

• To express thoughts, actions, and feelings.
• To have our own values, beliefs, opinions, and emotions.
• To tell others how we wish to be treated.
• To say, “I don’t know” or “I don’t understand.”
• To ask for information or help.
• To have thoughts, feelings, and rights respected.
• To be listened to, heard, and taken seriously.
• To ask for what is wanted.
• To make mistakes.
• To ask for more information.
• To say “no” without feeling guilty.
• To make a decision whether to participate.
• To be assertive without regrets.

Social Literacy Skill: Components of Assertiveness

Very often, people who are aggressive do not have within themselves the interpersonal rep-
ertoire to express themselves assertively. There are essentially six attributes that are specific to
assertiveness:
 Person-Centered Techniques  175
1. Self-awareness: A developed knowledge of one’s goals, aspirations, and interpersonal
and intrapersonal behavior, and the reasons for them. Realize where changes are needed
and believe in your rights.
2. Self-acceptance: Self-awareness that acknowledges one’s own particular strengths and
weaknesses.
3. Honesty: Congruency between verbal and nonverbal thoughts, feelings, actions, and
intentions.
4. Empathy: Sensitivity and acceptance of others’ feelings, behaviors, and actions—the ability
to walk in the other person’s shoes.
5. Responsibility: Assuming ownership for thoughts, feelings, actions, needs, goals, and
expectations.
6. Equality: Accepting another person as equal with a willingness to negotiate with his or her
needs, wants, or desires.
Downloaded by [New York University] at 04:58 12 August 2016

After the overview, a question can help the members define the skill in their own words. Use
language such as:

• Who can define assertiveness? What does being assertive mean to you?
• How is assertiveness different from aggressiveness?

Make a statement about what will follow the modeling of the skill:

• After we see the examples of the skill, we will talk about how you can use the skill.

Distribute skill cards and ask a member to read the behavioral steps aloud. Ask members to
follow each step as the skill is modeled.

Step 2: Model the Behavior Following the Steps Listed on a Flipchart or Chalkboard
Moving into the experiential component, the leader models for the group members what he or
she considers to be appropriate mastery of the skill. This enables group members to visualize the
process. The model can be a live demonstration or a simulation media presentation. Identify and
discuss the steps.

Example: Social Literacy Skill: Assertiveness

Lack of assertiveness is one reason why conflicts occur in relationships. To foster understanding
and cooperation rather than resentment and resistance:

• Be direct. Deliver your message directly to the person with whom you are in conflict, not to
a second party (avoid the he said/she said trap).
• Take ownership for your message. Explain that your message comes from your point of
view. Use personalized “I-statements,” such as “I don’t agree with you” rather than “You’re
wrong.”
• State what you want, think, and feel as specifically as possible. Preface statements with:

“I have a need.”
“I want to . . . ”
“Would you consider . . .?”
“I have a different opinion; I think that . . . ”
 176  Person-Centered Techniques
“I don’t want you to . . . ”
“I have mixed reactions for these reasons . . . ”

Here is an example:

Step 1: Concretely describe the other person’s behavior: “When you are late picking me up for
school in the morning . . .”
Step 2: Describe objectively how the other person’s actions have affected you (the effects):
“I am always late for first bell and I always get detention.”
Step 3: Accurately describe your feelings: “I feel hurt and angry with you.”
Step 4: Suggest what you would like to see happen: “I am hoping that we could make plans so
that I don’t have to be late anymore.”

• Ask for feedback to correct any misperceptions. Encourage others to be clear, direct, and
Downloaded by [New York University] at 04:58 12 August 2016

specific in their feedback to you: “Am I being clear?” “How do you perceive the situation?”
“What do you want to do about this?”

Step 3: Invite Discussion of the Skill that is Modeled

Ask clients, “Did any of the situations you observed remind you of times that you had to use the
skill?” Encourage a dialogue about skill usage and barriers to implementation among group members.

Step 4: Organize a Role-Play Between Two Group Members

Designate one member as the behavior-rehearsing member (i.e., the individual who will be
working on integrating a specific social, emotional, or cognitive skill). Go over guidelines for
role-playing:

1. Role-playing gives a perspective on troublesome behavior.

• It is a tool to bring a specific skill and its consequences into focus.
• By rehearsing a new skill, a client will be able to feel some of the same reactions that will
be present when the behavior occurs outside the group in a real setting.
2. Role-playing is intended to give clients experience in practicing skills and in discussing and
identifying effective and ineffective behavior.
3. Practice will enhance confidence and comfort level in real-life settings.
4. The more real the role-playing, the more the emotional involvement, which will increase
what is learned.
5. Real-life situations make it possible for clients to try ways of handling situations without suf-
fering any serious consequences if the methods fail.

Ask the behavior-rehearsing member to choose a partner—someone in the group who reminds
him or her of the person with whom the behavior-rehearsing member would most likely use the
skill. For example, ask, “Which member of the group reminds you of that person in some way?”
or “Which member of the group would you feel most comfortable doing the role-playing with?”
If no one is identified, ask someone to volunteer to rehearse the skill with the behavior-rehearsing
member.
Set the stage for the role-play, including setting, props, and furniture, if necessary. Ask ques-
tions such as, “Where will you be talking?” “What will be the time of day?” and “What will you
be doing?”
 Person-Centered Techniques  177
Review with the behavior-rehearsing member what should be said and done during the
role-play, such as, “What will be the first step of the skill?” and “What will you do if your partner
does . . . ?”
Provide final instructions to the behavior-rehearsing member and the partner:

• To the behavior-rehearsing member: “Try to follow the steps as best you can.”

• To the partner: “Try to play the part the best that you can by concentrating on what you
think you would do when the practicing member follows the steps.”

Direct the remaining members of the group to be observers of the process. Their role is to
provide feedback to the behavior-rehearsing member and the partner after the exercise. When
the role-play begins, one group member can stand at chalkboard or flipchart to point out each
step for the role-playing team. Coach and prompt role-players when needed.
Downloaded by [New York University] at 04:58 12 August 2016

Step 5: Elicit Feedback from Group Members and Processes after the Exercise Is Completed
Generous praise should be mixed with constructive suggestions. Avoid blame and criticism. The
focus should be on how to improve. Suggestions should be achievable with practice. The social
literacy skill of giving constructive feedback is an integrated part of every psychoeducational life
skill intervention model. The suggested dialogue for giving constructive feedback on another
social literacy skill is as follows:

1. Ask permission; that is, ask the person if he or she would like some feedback. (If no, wait for
a more appropriate time; if yes, proceed.)
2. Say something positive to the person before you deliver the sensitive information.
3. Describe the behavior.
4. Focus on behavior the person can change, not on the person’s personality.
5. Be specific about the behavior and make sure this information is verifiable. (Have other
people complained?)
6. Include some suggestion for improvement.
7. Go slowly. True behavior change occurs over time.

Important Considerations for the Feedback Process

The behavior-rehearsing member is instructed to wait until everyone’s comments have been
heard. The partner processes his or her role, feelings, and reactions to the behavior-rehearsing
member. Observers are asked to report on how well the behavioral steps were followed, as well
as on their specific likes and dislikes and comments about the role of the behavior-rehearsing
member and the partner.
Process the group comments with the behavior-rehearsing member. The behavior-rehearsing
member is asked to respond to how well he or she did in following the behavioral steps of the
skill. For example, “On a scale from 1 to 10, how satisfied were you about following the steps?”

Step 6: Encourage Follow-Through and Transfer of Learning to Other

Social, Emotional, or Cognitive Settings with “Ownwork”
This is a critical component: participants need to transfer newly developed life skills to person-
ally relevant life situations. The behavior-rehearsing member is assigned “ownwork” to prac-
tice and apply the skill in real life. (Ownwork is like homework, a task that is assigned for the
behavior-rehearsing member to try out between sessions.)
 178  Person-Centered Techniques
OWNWORK

Group members are assigned to look for situations relevant to the skill they might role-play dur-
ing the next group meeting. Ask the behavior-rehearsing member how, when, and with whom he
or she might attempt the behavioral steps prior to the next group meeting. Assign the Ownwork
Report (Figure 9.1), a written commitment from the practicing member to try out the new skill
and report back to the group at the next group meeting. Discuss how and where the skill will be
used. Set a specific goal to use the skill outside the group.
Ownwork is assigned to enhance the work of the session and to keep behavior-rehearsing
members aware of the life skills they wish to enhance. Effective counseling requires that a cli-
ent leave all interventions and interviews with a firm idea about what he or she is going to do
differently to become a more fully functioning person. The ultimate goal is to practice new
behaviors in a variety of natural settings. Ownwork puts the onus of responsibility for change
on the behavior-rehearsing member—he or she must do ownwork to resolve the problem. The
Downloaded by [New York University] at 04:58 12 August 2016

following examples are appropriate ownwork assignments:

• Experiential/behavioral assignments. Assignments to perform specific actions between ses-

sions. A behavioral assignment for lack of assertiveness may be to instruct the behavior-
rehearsing member to say “no” to unreasonable requests from others.
• Interpersonal assignments. Assignments to enhance perceived communication difficulties by
writing down unpleasant dialogues with others. These dialogues can be reviewed during the
next session to show how someone inadvertently triggers rejection, criticism, and hostilities
in others.
• Thinking assignments. Assignments such as making a list of things that are helpful to
think about and practice thinking these new thoughts throughout the day. A person
with low self-esteem can be instructed to spend time thinking about his or her proudest
accomplishments.
• Writing assignments. Assignments such as writing in a journal or diary help participants
develop an outlet for their feelings while away from the sessions. A diary can list for each day
the frequency of new behaviors that are practiced.
• Solution-focused assignments. Assignments that actively seek solutions to problems identified
in the sessions. Clients could seek a resolution to an interpersonal problem by negotiating
or resolving a conflict with another person.

Example: Psychoeducational Session

Teaching the Social Skill: Maintaining Impulse Control
1. Instruction
• Question: How would you define impulse control? Impulse control is learning to stop
and look at the consequences of your actions before you commit yourself to something.
It is the ability to stop and think who else is going to be affected by your actions and
what the consequences will be. Is it worth it?
• Simulation: Shelly is constantly overcommitting herself by being impulsive. She has a
problem saying no and working within the boundaries that are comfortable for her.
When she is asked to do something, she will say yes even if she does not have the time
or resources to complete the task. Shelly was looking at the course schedule book for the
fall, saw a class that looked interesting, so she signed up for it. She was already taking 15
graduate hours and working 20 hours per week. She is feeling extremely stressed because
of her overload of classes, and she is not sure if she will get her assignments completed
on time. How can we help?
 Person-Centered Techniques  179
• Signs of Loss of Control
1. Acting impulsively consumes lots of energy and resources.
2. You feel driven, impelled, and think of nothing else.
3. You feel like the decision is the only possible answer, and you let it take over all
rational thinking.
• Control Strategies
1. Ask yourself who else is going to be affected by this behavior?
2. How are they going to be affected by what you do?
3. Delay the action. Give yourself some time to think through the decision so that you
can see the consequences and alternatives. Remember, choice is important.
4. Find a way to buy time so that you can think about your actions.
5. Think back to the past and consider the situations you had to get yourself out of
because of being too impulsive.
Downloaded by [New York University] at 04:58 12 August 2016

2. Modeling
• Self-Help Strategies
1. Reward yourself each time you stop and think through a situation instead of acting
impulsively.
2. Keep a journal and record your feelings about decisions you make and whether you
made those decisions impulsively.
3. Write yourself a bill of rights and read it when you get ready to make decisions.
• Reminders for Yourself
Having a choice is critical. It allows you freedom to act or not to act. It puts you in
charge of yourself. If you always do what you’ve always done, you will always get what
you’ve always gotten.
• Consequences of Acting Impulsively
1. The consequences of acting impulsively are confusion, self-loathing, and feeling out
of control.
2. The results of acting impulsively are that you spend a tremendous amount of time
trying to resolve conflicts, mend relationships, or balance time and money.
3. Role-Play Simulation
Shelly: Hey, Beth, I just saw this great course in the fall catalog. I think I will take it.
Beth: Shelly, how many hours of classes are you already taking?
Shelly: Fifteen, but this course sounds interesting and I really want to take it.
Beth: Shelly, I realize you really want to take it and it sounds interesting, but is it something
that you can handle right now with work and school?
Shelly: It will mean more homework and being up late at night, but I really think I can do it.
Beth: Shelly, remember last semester how stressed you were during finals? Do you want that
again?
Shelly: No, but, Beth, you don’t understand. I really want to take this class.
Beth: Look at your “plus versus minus” ratio. How is it going to benefit you and how is it
going to affect your family?
Shelly: It’s going to help me with general knowledge, but not toward my degree. I hadn’t
thought about my family.
Beth: Shelly, do you think you could wait until tomorrow and make your decision? That way
you could talk it over with Brian and the kids and think more about it.
Shelly: I guess I could, but what if it’s full by then?
Beth: Shelly, what if it is? Will you still be able to graduate and could you take it later?
Shelly: You’ve got a point. I’ll think about it and talk it over with Brian.
 180  Person-Centered Techniques
Table 9.3  Decision-Balance Matrix
Personal Time Commitment for Self and Others
Positive Consequences (+) Negative Consequences (–)
Social and family relationships
Academic responsibilities
Job and career responsibilities
Leisure-time pursuits
Church/synagogue/community obligations

4. Feedback
Elicit feedback from group members as outlined in the previous process, focusing on the
Downloaded by [New York University] at 04:58 12 August 2016

behavior, not the personality of the role-playing member.

5. Ownwork Assignment
Assign Shelly to complete a decision-balance matrix (Table 9.3). Have Shelly look at
the aspects of her life and determine how her decision to take on more coursework would
affect her.
Have Shelly analyze the time commitment for the course requirements: how many research
papers per class, readings per class, and special projects. Merge those commitments with family
and job responsibilities. Bottom line: Are there enough hours in the week to do everything she
will be obligated to do? Ownwork assignments serve to strengthen behavior-rehearsal of skills
between sessions.

Figure 9.1 Life Skill “Ownwork” Form

Ownwork Form
Name:
Date Assigned:
Date Completed:
Instructions: Your social, emotional, or cognitive skills “ownwork” is an assignment that fol-
lows the lesson that has been taught. You need to practice the social skill five times with other peo-
ple. (1) Write a description of what happened, when it happened, and where it happened in each
practice example. (2) Record what you said and did. (3) Record what the other person said and did.
Behavioral Definition————————————————————————

What Happened?
When Did It Happen?
What You Said and Did What the Other Person Said and Did
1.
2.
3.
4.

Ownwork in a psychoeducational group is different from homework in academic domains.

Ownwork in a psychoeducational group is perhaps more critical to provide generalization, trans-
fer, and reinforcement to other social settings to bring back to the group to share successes.
Tables 9.4, 9.5, and 9.6 illustrate a plethora of social, emotional, and cognitive skills that all
clients need.
 Table 9.4  Social Literacy Skills
DESCA inspirations* Listening more effectively How to apologize
Perception checking Responding to another Coping with anger in public
person’s anger
Mediation process Handling conflict among Peer pressure refusal skills
team members
Documenting a generalization Indexing a generalization Responding with praise
about something about something
Giving constructive criticism Being socially responsible Giving and accepting
compliments
Starting a conversation Keeping a conversation going Becoming more outgoing
Asking someone out Steps in negotiating a conflict Conventional arbitration
of interest
Your assertive rights Components of assertiveness Assertiveness and conflict
Downloaded by [New York University] at 04:58 12 August 2016

Becoming more assertive and Assertiveness Changing someone’s

less aggressive undesirable behavior
Problem solving Dealing with conflict fairly Problem-solving acronym
and without violence
Anger management How to say “no” and still Negotiation
keep your friends
Defusing anger Social skills homework form Rules for conflict resolution
Formula for active listening Sending an effective Using elements of the
communication message “I message” to change behavior
Self-awareness through “Carefrontation” Peer mediation process
feedback from others
Giving constructive feedback Negotiating Assertiveness and negotiating
Assertive one-liners Enhancing friendship skills Momentary delay
Poor and good listening Using “I messages,” Asking for social support
characteristics “you messages,” and “we
messages”
Persuading others to accept Confirming your interpersonal How to win the cooperation of
your ideas hunches about others others
Interpersonal relationship Clarification and reflection Active listening
skills
*
DESCA inspirations are communicating with D = Dignity; E = Energy; S = Self-Management; C = Community;
A = Awareness
Source: Rosemary Thompson (2006) Nurturing Future Generations: Promoting Resilience in Children and Ado-
lescents Through Social, Emotional, and Cognitive Skills. New York, NY: Routledge.

Table 9.5  Emotional Literacy Skills

Inner processing of how you Processing how another Handling peer pressure
feel person might feel
Dealing with fear and anxiety Dealing with deadline disorder Toning down heated remarks
Enhancing relationship skills Steps to overcome your fear of Coping self-talk for stressful
speaking in public situations
Positive affirmations Changing inner beliefs Nine ways to handle stress
effectively
Dealing with rumors and false Supporting Preparing for a difficult
accusations conversation
Describing feelings and Self-disclosure Confronting self-defeating
empathizing behavior
How to let someone know he Listening with empathy Paraphrasing what someone
or she is bothering you has said

(Continued)
 Table 9.5  Continued
Making intention statements Making action statements Confrontation guidelines
How to handle a verbal “attack” Increasing your frustration Rules of fair fighting
tolerance
3R strategy Coping thoughts for anger Positive self-statements
reactions
Preparing for a potential conflict Confronting a conflict Coping with the feeling of
being overwhelmed
Coping with agitation Seven skills to handle conflict Using the “I language”
and anger assertion
Using “I want” statements Empathic assertion Confrontive assertion
Estimating logical consequences Stop the action/accept the Avoiding conflict by
feelings paraphrasing
Reframing a conflict Dealing with teasing What to do when you are
Downloaded by [New York University] at 04:58 12 August 2016

angry
The xyz formula for a complaint Mirroring The art of the critique
Fair fighting rules Communicating feelings in a Setting boundaries
nonblaming manner with others and taking
responsibility for yourself
Strategies to manage anger Interpretive confrontation Self-talk to maintain
appropriately composure and deal with
situations more effectively
Maintaining your personal Don’t take it personally Getting out of the middle of
power dueling relationships
Working through Using self-control techniques
disappointment when you make
a mistake
Aggression control methods Writing a learning history of Three quick questions to
angry reactions suppress or express anger
Psychological forces that block Twelve distressing emotional Confronting irrational
intelligent decision making myths thoughts
Solutions to the big seven Specific steps to resolve Changing thinking patterns
cognitive distortions anxiety and “internal conversations”
The anxiety formula: knowness The act formula: accept, The ABCs of stopping
versus importance choose, take action unhappy thoughts
Daily activities to reduce Disputing irrational beliefs Disputing irrational beliefs
irrational thinking (DIBS) (A-FROG)
Rational self-analysis Paraphrasing responses to Different ways to refuse a
others request
Turning “you statements” into
“I statements”
Source: Rosemary Thompson (2006) Nurturing Future Generations: Promoting Resilience in Children and Ado-
lescents Through Social, Emotional, and Cognitive Skills. New York: Routledge.

Table 9.6  Cognitive Literacy Skills

Graphic organizers Agree/disagree strategy Analyzing for bias: EOIOC
ASSUME Attribute web BET
Brainstorming Summarizing CLUES
Clustering DOVE DRAW
Fact/opinion chart Flow chart IMAGES
INFER The newspaper model People search
Pencil ranking Problem solving RULE
SCAMPER Scientific method Sequential thinking model
 Person-Centered Techniques  183

Targeting Thought tree Venn diagram

Reducing test anxiety Turning negative thoughts about Cornell University
studying into positive thoughts note-taking method
Rules for taking tests and Mnemonic devices S2ROS instructional strategy
exams
A blueprint for taking notes Taking quality notes Higher-order thinking skill
using analysis
Higher-order thinking skill Higher-order thinking skill using Higher-order thinking skill
using synthesis evaluation using application
Higher-order thinking skill Higher-order thinking skill: Analyzing for assumptions
using critical skills analysis for bias
Drawing conclusions from Analyzing for personification Teaching for thinking
evidence
Creative problem solving Academic growth group and Strategies and attitudes in
mentoring problem solving
Downloaded by [New York University] at 04:58 12 August 2016

Helpful acronyms for thinking Personal abbreviation system Taking multiple-choice tests
Tips for specific tests
Source: Rosemary Thompson (2006). Nurturing Future Generations: Promoting Resilience in Children and Ado-
lescents Through Social, Emotional, and Cognitive Skills. New York: Routledge.

Conclusion
Person-centered, client-centered, or Rogerian therapy was conceived, nurtured, and articulated
by the ambitious work of a single man, Carl Rogers. Therapists and counselors have incorpo-
rated the constructs of empathy, congruence, and unconditional positive regard in all counseling
genres. They are the fundamental foundation for a therapeutic relationship and truly “a way of
being.” Also, the psychoeducational life skills model is the most comprehensive approach to
the remediation and enhancement of interpersonal effectiveness for all developmental stages
throughout the life span. It is interactive and didactic and is a most successful way to diminish
self-defeating behavior from children to adults.
 10 Improving Relationships
with Our Environments
Conflict Resolution and Stress
Management Techniques

Individuals who witnessed or experienced excessive conflict in their families of origin, such as in
Downloaded by [New York University] at 04:58 12 August 2016

abusive, dysfunctional, or alcoholic homes, are particularly prone to view conflict as only destruc-
tive. They either may become aggressive when resolving conflicts or retreat completely from a
conflict situation. Conflict is destructive when it:

• Results in no decision or new coping behaviors and the problem remains.

• Diverts energy from more important activities and issues.
• Destroys the morale of individuals or groups.
• Reinforces poor self-concept.
• Divides people even more and polarizes groups.
• Produces irresponsible behavior.

Conflict is constructive when it:

• Increases the involvement of everyone affected by the conflict.

• Opens up discussion of issues resulting in clarification.
• Identifies alternative solutions.
• Results in the solution of a problem.
• Serves as release of pent-up emotions, anxiety, and stress.
• Builds cohesiveness among group members.
• Helps individuals and groups to grow personally and apply their knowledge to future conflicts.

Main and Roark (1975) and Roark (1978, p. 402) outlined a five-step process of conflict reso-
lution for dealing with emotion-laden interpersonal conflict:

1. At the beginning, each conflictee describes the situation from his or her perspective. Partici-
pants should restrict their account of the situation to cognitive descriptions, strictly avoid-
ing emotional connotations. The outcome of this step is to achieve consensus and mutual
understanding regarding the description of the conflict situation as the starting point for
conflict resolution.
2. Next, each conflictee describes his or her feelings regarding the conflict. It is important
to avoid escalating the conflict with statements of blame or bringing up the past, which is
disrespectful. The outcome of this statement is to have conflictees understand one another’s
feelings and needs.
3. Prefaced by information and understanding from the first two steps, conflictees formu-
late and describe a situation acceptable to everyone. The outcome of this step should be
(a) agreement on perceptions of the conflict, (b) understanding of one another’s feelings
regarding the conflict, and (c) agreement on what the situation would be if the conflict was
significantly reduced.
 Improving Relationships with Our Environments  185
4. At this juncture, changes necessary to achieve the desired situation are agreed upon. Each
conflictee should list the changes he or she is willing to make, as well as verbalize and under-
stand what the other is willing to do.
5. Finally, a detailed agenda should be formulated, including follow-up plans and specific
dates for the accomplishment of all tasks. Table 10.1 captures the multifaceted shades of
meaning in which what a particular client feels or means requires a large vocabulary of
feeling words.

Table 10.1  Vocabulary of Feeling Words

Unhappy Dejected, low, sad, depressed, down, lost, blue, melancholy, brood, flat, joyless,
words downhearted, somber, gloomy, dreadful, dismal, empty, grim, desolate, hopeless,
Downloaded by [New York University] at 04:58 12 August 2016

mourning, desperate, blah, glum, disappointed, aching, grieving, rotten, barren,

awful, teary, and terrible.

Affection Love, friendly, caring, like, fond of, respect, admire, trust, close, adore, devoted,
words regard, tenderness, attachment, yearning, longing, infatuated, fellowship,
attraction, favor, prize, hold dear, fall for, precious, passionate, woo, revere, cherish,
and idolize.

Guilt words Blame, regret, shame, embarrassed, at fault, reprehensible, wrong, remorseful,
crummy, rotten, humiliated, unforgivable, mortified, ashamed, and disgraceful.

Anger words Resentment, irritation, rage, fury, annoyance, provoked, infuriated, inflamed,
displeasure, animosity, wrath, indignation, exasperation, miffed, sore, bitter,
temper, hate, fumed, dander, ferment, tiff, sullen, bristle, sulk, pout, frown, chafe,
seethe, boil, rage, offend, rile, aggravate, rankle, worked up, cross, burning, pissed
off, ticked off, hateful, vengeful, and mad.

Fear words Timid, diffident, anxious, worried, apprehensive, misgiving, doubt, qualm,
hesitant, fright, terror, horror, dismay, panic, consternation, scared, nervous,
restless, trepidation, quivering, shaking, trembling, intimidated, cold sweat, dread,
despondent, creeps, shivers, jitters, cower, afraid, vulnerable, butterflies, jumpy,
worried, uneasy, and unsure.

Confused Bewildered, puzzled, flustered, overwhelmed, mixed up, muddled, perplexed,

words tumult, chaos, jumbled, uncertain, undecided, ambivalent, drifting, baffled,
trapped, in a quandary, tangled, scrambled, unraveled, disjointed, swamped,
drowning, and frustrated.

Happy words Content, joyous, ecstatic, glad, cheerful, glee, optimistic, hopeful, alive, lively,
merry, exhilarated, jovial, satisfied, comfortable, animated, inspired, elated,
encouraged, heartened, refreshed, light, bright, saucy, jolly, playful, pleased,
grateful, zest, bliss, thrilled, tickled, sensational, terrific, euphoric, enthusiastic,
glowing, neat, good, and fine.

Hurt words Neglected, put down, rejected, demeaned, scorned, used, criticized, belittled, shot
down, cast off, let down, disappointed, devastated, humiliated, betrayed, harmed,
embarrassed, dumped on, ripped off, disillusioned, laughed at, exploited, and
conned.

Strength Responsible, confident, adequate, powerful, certain, sure, efficient, important,

words competent, effective, superior, cope, potent, able, lucid, adaptable, forceful,
effectual, incisive, influential, growing, moving forward, and alive.
Source: Martin, D. G (2011) Counseling and therapy skills. Long Grove, IL: Waveland Press. Reprinted with
permission.
 186  Improving Relationships with Our Environments

Technique: DESC Script (Describe, Express, Specify, Consequences)

Counseling Intention To develop a formula for conflict resolution, negotiation, and
assertiveness.
Description Bower and Bower (1976) provided the following technique or guide-
lines for handling interpersonal conflicts. It consists of four key elements:
(D) Describe, (E) Express, (S) Specify, and (C) Choose consequences.

Describe: Begin your dialogue by describing as specifically and objectively as possible the
behavior or situation that is bothersome to you. Use concrete terms. Describe a specified time,
place, and frequency of action. Describe the action, not the motive.
Express: Say what you feel and think about this behavior. Explain the effect of this behavior on
you. Empathize with the other person’s feelings. Express them calmly. State feelings in a positive
Downloaded by [New York University] at 04:58 12 August 2016

manner, for example, as relating to a goal to be achieved.

Specify: Ask for a different, specific behavior, or specify what behavior you would prefer or
need in this particular situation. Request only one or two changes at one time. Specify the con-
crete actions you want to see stopped and those you want to see performed. Take into account
whether or not the other person can meet your request without suffering large losses. Specify (if
appropriate to the situation) what behavior you are willing to change to make the agreement.
Choose consequences: State concretely and simply what positive and negative consequences you are
prepared to carry through if your preferences are not met. Make the consequences explicit. Give a
positive reward for change in the desired direction. Select something that is desirable and reinforcing.
Consider the impact of these consequences on yourself and on others involved in the situ-
ation. Sometimes you have to specify the negative consequences of not following changes. In
one example situation, Jessica’s father tries to give her advice (to the point of nagging) about
what she should do in school, who she should and should not date, and who she should have
as friends. Jessica loves and respects her father’s concern for her, but she would like to make her
own decisions without her father’s constant nagging and interference. Jessica decides to outline
a DESC script to use in dealing with her dad.
Describe: (The description should be concise, accurate, directed toward a single point, care-
fully worded, objective, and nonaccusing.) “Dad, you have been giving me detailed advice about
what you think I should study in school, how you think I should choose my friends, and what
guys I should date.”
Express: (Express how it makes you feel; be positive and focus on common goals; do not pro-
voke feelings of guilt.) “I know you want the best for me, and your intentions are well meaning.
I feel like you are treating me like a child. I’m older now, and I can think for myself.”
Specify: (Specify an alternative behavior instead of the current one.) “Please stop giving me
advice unless I specifically ask for it. Trust me to be responsible for myself and allow me to learn
on my own.”
Consequences: (Let the other person know how you intend to follow through on your
request for behavior change. The consequences consist of two parts: rewards if he or she accedes
to your request and punishments if the individual fails to go along with it.) “We will get along
much better if you will let me have more freedom to make my own decisions. I think you will be
proud of how responsible I can be” (positive consequence). If you continue to give me advice
when I don’t ask for it, I will gently remind you of our agreement the first time. If you continue
after this, I will just turn and leave the room” (negative consequences).
In most cases, if a DESC script is prepared and followed through with a clear, calm statement,
the other person will listen and probably respond favorably. If the script does not provide the
desired result, the client can follow through on the consequences without feeling frustrated or
helpless.
 Improving Relationships with Our Environments  187

Technique: Locating “Pinch Points” that Provoke Aggressive Responses

Counseling Intention To help the client stop the internal process that triggers aggressive
behavior.
Description One way to keep track of aggressive behavior is to keep a log. In the
daily log, the client should note the following:

1. Aggressive comments or actions

2. A precise description of what the other person did or said just before the aggression
3. In addition to anger, any other feelings experienced
4. Thoughts and internal dialogue
5. Body language just prior to the aggressive reaction
Downloaded by [New York University] at 04:58 12 August 2016

Technique: Guided Conflict Imagery

Counseling Intention To facilitate awareness of strategies for dealing with conflict situations;
to examine methods of responding to conflict.
Description Ask the client to get comfortable, close his or her eyes, get in touch
with himself or herself at the present moment, and relax. The guided
imagery is as follows:

“You are walking down a long hallway and begin to notice a familiar face coming in your
direction. Suddenly, you recognize that it is the person with whom you are in most conflict
at the present time. You realize that you must decide quickly how to respond to the person.
As he or she comes closer, a number of alternatives flash through your head. Decide right
now what you will do and then imagine what will happen.”
(Pause to allow the images and the response to develop.)
“It’s over now. The person has gone. How do you feel? What did you say? How satisfied
were you with how the interchange went? What did you say to yourself?”
(Pause to allow the client to process and identify the internal dialogue.)
“Return to the present. Gradually become aware of any tension in your body . . .
your breathing . . . the sounds in the room . . . and finally open your eyes when you feel
ready.”

Ask the client (or group members) to spend 5 minutes writing (1) the alternative ways of
acting he or she had considered, (2) the one the client chose to act upon, and (3) the level of
satisfaction he or she felt as to the outcome of the choice on scale of 1 to 10.

Technique: When Words Are Not Enough

Counseling Intention To encourage a dramatic acting out of conflicting roles or polarization
of an individual’s personalities to open the door for change.
Description

“Take a minute to close your eyes and take a few deep breaths to center yourself.
Now imagine for a moment that you are in a tug of war with someone or possibly some
part of yourself. What do you see? Who is pulling whom? What is being said? Is anyone look-
ing on? What does the onlooker see? Can you reverse roles and visualize yourself now on the
other side? Take a moment to see the dialogue that is taking place (Levy, 2014 p. 7). When
you are ready, open your eyes.”
 188  Improving Relationships with Our Environments
Ask the client to spend a few moments writing about who he or she was in a tug of war with,
who was he or she engaged with? Who was the onlooker(s)? How satisfied was he or she with
the outcome? A variation would be to take a small rope with a knot at each end and have the
client take a conflict situation and pull one end describing the competent aspects of his or her
personality and then pull the other end to discuss some barriers that may prevent him or her from
accomplishing his or her goal.

Technique: Resolving Conflicts Cooperatively

Counseling Intention To assist clients in conflict to express feelings and interpersonal conflict.
Description The two individuals who are angry with each other sit opposite each
other with knees touching. Instruct them to look at each other in the
eyes as they talk, talking directly to each other and not about the other.
Downloaded by [New York University] at 04:58 12 August 2016

Each will state his or her viewpoint and feelings. One person begins by
stating the problem as he or she sees it and says how he or she feels:
“I feel [description of feeling] when you [description of behavior].”
The other person is not to share his or her viewpoint at this time. He
or she is only to repeat what he or she heard the other person say. The
listener who repeated the problem and feelings is to confirm with the
other person that everything was stated basically as the other said it.

The second person is provided with the same chance to state the problem. Encourage the two
to do any of the following: agree to disagree, compromise and come to a solution, seek forgive-
ness if wrong or forgive if wronged, or accept the other’s viewpoint.

Technique: Assuming Responsibility for Choices and Actions

Counseling Intention To shift the center of responsibility or ownership of a problem.
Description Direct the client to think of an incident that really made him or her
angry or resentful, one about which he or she still has strong feelings.
In writing, describe the incident as if others were completely responsi-
ble for bringing it about. Blame them. Make it clearly their fault. Now
have the client rewrite the incident as if he or she were solely responsi-
ble for starting, developing, and getting stuck with the problem. Have
the client take full account of what he or she could have done so that
the whole problem would not have arisen. Process with the client the
issues of blame, responsibility, and victimization.

Technique: Resent, Expect, Appreciate

Counseling Intention To work with bipolarities, or splits in the personality, by bringing each
side into awareness; to become aware of expectations and mixed feel-
ings held about others.
Description Have the client list three of his or her closest friends. For each individ-
ual, have the client think of one thing that he or she resents, one thing
that is expected that the offending person change, and one thing that
is appreciated about the person (Table 10.2). Process how to resent
and appreciate a person at the same time, how to be aware of the
mixed feelings he or she may have toward others, and how to integrate
opposing thoughts or feelings.
 Improving Relationships with Our Environments  189
Table 10.2  Resent, Expect, Appreciate
“I Resent” “I Expect” “I Appreciate”
“That you break a lot of promises.” “You to keep your word.” “How easy going you are”

Technique: How to Handle a Verbal Attack

Counseling Intention To maintain composure during a conflict.
Description Internally process the following:

1. Find out where the other person is coming from.

• “What are your feelings about?”
• “What would you like me to know?
Downloaded by [New York University] at 04:58 12 August 2016

• “How can I help?”

2. Study the other person’s power:
• “You seem upset because I hear/see…”
• “What I hear you saying is. . .”
3. Hold onto this power, step out of the way, and encourage it to move past you without let-
ting it get to you.
• “You want me to hear that you are feeling X about Y because Z?”
4. If this fails, walk away without saying another word.
• Stay quiet for a moment. If you can’t walk away, at least say nothing, and keep your cool
until you can talk it out with the support of another person.
• Simply say, “We’ll talk later.”

Technique: Coping with Anger

Counseling Intention To maintain self-control.
Description First, accept your emotional arousal and try to assess your personal
condition (accept that you are upset). Second, pause to collect your-
self and try to gain your composure through a relaxation response
(counting from 1 to 10). Third, think about your choices of emotional
expression. Fourth, do something to express the emotional tension.

Technique: Inner Processing How Another Person Might Feel

Counseling Intention To use empathy to resolve conflict.
Description

1. Observe the other person’s behavior and actions.

2. Pause and listen to gain an understanding of what the other person is saying.
3. Identify with your inner dialogue the feelings you think the other person is having. (Inner
dialogue to self: He must feel embarrassed.)
4. Mentally list specific feelings you think the other person is experiencing.
5. Decide if you need to do a perception check to verify his or her experience.
6. Use reflection skills to verify the feelings the other person is having to show that you understand.
 190  Improving Relationships with Our Environments

Technique: Toning Down Heated Remarks

Counseling Intention To diffuse a potential conflict.
Description When people are angry and emotional, they often use strong, negative
feelings to talk about an individual. To create a greater state of calm, it
is helpful to restate the information in more neutral words.

Example
“I hate Jim. He makes me sick. He can never make a decision and he always berates col-
leagues in staff meetings.”
Restate: “I am upset with Jim because he is indecisive and sometimes critical of others.”

Technique: Steps to Anger Management

Downloaded by [New York University] at 04:58 12 August 2016

Counseling Intention To maintain control of behavior.

Description “I can keep my power. I can choose what I think and how I act. I am
responsible for my day. Peace begins with me.”

  1. Recognize that you are angry.

  2. Accept your feelings.
  3. Stop and do a quieting response (QR) relaxation.
  4. Think about ways to express the anger.
 5. Prepare.
  6. Problem solve.
 7. Plan.
  8. Evaluate the consequences.
  9. Identify and invite alternatives.
10. Instead of insults, imagine successes.
11. Choose the best way; name your feeling; negotiate.
12. Express the anger in a helpful way.

Technique: Enhancing Relationship Skills

Counseling Intention To identify roadblocks to healthy relationships.
Description

  1. Problems can be defined and thought about carefully.

  2. Problems are different from people, and peoples’ problems are different.
  3. Roadblocks to communication can be eliminated.
  4. Specific skills can help remove conflict: using “I messages,” helpful criticism, problem solv-
ing, brainstorming, anger management, and assertiveness.

Friendliness helps reduce conflicts and improve relationships.

Technique: Dealing with Rumors and False Accusation

Counseling Intention To eliminate incongruency between actions and intentions.
Description

• Acknowledge the rumor. Is it accurate or is it false?

• Is it intended to hurt you or help you? Was the motivation constructive or destructive?
 Improving Relationships with Our Environments  191
• Maintain your composure. Evaluate if someone else started the rumor.
• Think about the ways to answer the accusation(s) without being defensive or angry. You can:
l. Deny it and walk away.
2. Express your side of the rumor and explain your own behavior.
3. Correct perceptions held by others.
4. Assert yourself.
5. Apologize for what has occurred.
6. Express your regrets and offer to make up for what happened.
7. Review your options and choose the best one for the situation.

Technique: Preparing for a Difficult Conversation

Counseling Intention To anticipate actions that result from conflict.
Downloaded by [New York University] at 04:58 12 August 2016

Description

1. Prepare what you are going to say. Write it down. Read it and revise it for tone and content.
2. Think about how you will feel during the conversation (e.g., tense, nervous, afraid).
3. Plan your self-talk (your inner dialogue). What will you say to yourself to keep calm and
composed?
4. Think about how the other person will feel (e.g., angry, cold, aloof, inattentive).
5. Practice what you want to say.
6. Think about what the other person might say back to you.
7. Think about other issues that may come up during the course of the conversation.
8. Choose your best approach and do it.

Technique: How to Let Someone Know They Are Bothering You

Counseling Intention To explain your needs to someone else.

  1. Keep a serious facial expression and straight posture. Maintain eye contact. Use a serious
tone of voice.
  2. Ask if you could talk to the person for a moment.
  3. First say something positive: “I like ____”
 4. Tell the person what’s bothering you—make it an “I message”: “When you do [specify
behavior], I feel [emotion] because I [consequence].”
  5. The other person responds (may be defensive or deny the problem).
  6. Do some active listening—let the other person know you heard what he or she said.
• Paraphrase—repeat what he or she said in a little different way.
• Reflect feelings—say how you think he or she feels (e.g., “You really seem to be angry.”)
• Ask for more information (how, what, when, where).
• Check out your understanding of what he or she said (“Do you mean . . . ?”).
  7. Ask if the person understood what you said and, if not, explain again.
  8. Problem solve—give the person suggestions for changing. Be specific. Ask for a small behav-
ior change. Work toward a compromise.
  9. Give the person a reason for changing. Tell the person what the positive consequences will
be if he or she agrees to your request and what the negative consequences will be if he or
she doesn’t (optional). Do not make threats or offer a reward that you can’t or do not want
to give.
10. Thank the person for listening.
 192  Improving Relationships with Our Environments

Technique: Making Intention Statements

Counseling Intention To provide statements that let others know more about your immedi-
ate or long-range commitments or expectations.
Description An intention statement is a way of being direct about what you would
or would not like for yourself, or what you would or would not like to
do. Intention statements begin with words like:
• I want.
• I would like.
• I intend.
• I need.

Example
Downloaded by [New York University] at 04:58 12 August 2016

• “I want to be with you today, but I don’t want to spend all our time shopping.”
• “I’d like to do my studying in the afternoon, then catch the game this evening.”
• “I’d like to be with you, but I want to be with my family tonight too, because it’s my
brother’s birthday. And I want to spend this afternoon in the library working on my
paper.”

Technique: Making Action Statements

Counseling Intention Making action statements simply involves describing your behaviors to
others—what you have done, are doing, or will do.
Description An action statement puts words to some of your behaviors in a simple,
descriptive way. Action statements refer to your past, current, or future
actions and are expressed using “being” verbs: was, am, will. It is a skill
because it requires:
1. Awareness of your own behavior.
2. Awareness of the possible impact of this behavior on others.
3. Remembering to do it.

Action statements about the future are particularly important because they involve a commit-
ment to do or not do something.
Statements of commitment to action start with “I will” rather than “I might.”

• “I will call you this morning.”

• “I will do it by Friday.”
• “I will be there at 6:00 PM, sharp.”

Technique: Confrontation Guidelines

Counseling Intention To be more assertive about expectations and behavior.
Description

1. Be flexible and reasonable in your expectations about the outcome of the confronta-
tion. It is more reasonable to ask for an apology for peoples’ actions than to change
their personality. “The most important thing is that he knows what an inconvenience he
caused me.”
 Improving Relationships with Our Environments  193
2. Confronting at the right time and in the right place is critical to a successful confrontation.
Privacy and easy access to each other will usually improve the impact, unless you are con-
cerned about a physical confrontation.
3. Talk directly to the person you are confronting. “I really need to tell you something impor-
tant that concerns me. Can we talk?”
4. Speak clearly and calmly. If the person is unable to listen, wait until he or she is in a more
receptive emotional state.
5. Refer directly to the issue. “Remember when we were supposed to meet at the mall last
Saturday?”
6. Explain how the person’s behavior affected you. Use “I messages.” “I get frustrated and
impatient when you keep me waiting.”
7. Listen actively to the other person’s viewpoint. Try to put yourself in that person’s shoes.
8. Ask for cooperation and openness. This will test the person’s flexibility and receptivity to improve
Downloaded by [New York University] at 04:58 12 August 2016

or change: “Will you hear me out? Would you be willing to change the way you treat me?”
9. Summarize what you both need to do to resolve the problem: “I need to know that you will
avoid being late again.”

Technique: Fair Fighting

Counseling Intention To resolve conflicts more constructively.
Description The sequence of the process of fair fighting fosters better relationship
skills.

1. Ask permission to fight. Jessica says, “Ryan, I’d like to share something that is really
upsetting me.”
2. Present one specific complaint. “I’m really angry at you for not taking me to the mall
with you.”
3. Ask the other person for feedback. “Okay, I understand that you’re really mad at me because
I didn’t take you to the mall.”
4. Thank the person for listening and understanding how you feel. “Thank you for listening
to me.”
5. Make a specific request for a change in behavior. “Next time, I’d like you to ask me if I want
to go to the mall instead of taking it for granted that I don’t want to go.”
6. Ask the person for feedback. Be sure you were understood. “Okay, Jessica, next time I’ll ask.”
7. Reaffirm your feelings of appreciation.

Technique: Negotiating a Conflict of Interest

Counseling Intention To assess the amount of conflict in a relationship.
Description When striving for the same goals, sometimes there are conflicts of
interest. Cooperators resolve conflicts as partners, not as adversaries.
The following are six steps in negotiating conflicts of interest:

1. Describe what each person wants.

2. Describe how each person feels.
3. Exchange reasons for positions.
4. Understand each other’s perspective.
5. Invent options for mutual benefit.
6. Reach a wise agreement.
 194  Improving Relationships with Our Environments

Technique: Conventional Arbitration

Counseling Intention To increase the mediation process.
Description Mediation is an extension of negotiation; the mediator assists dispu-
tants in negotiating a constructive resolution. In contrast, with arbi-
tration, an outside person makes a judgment; the arbitrator does not
assist the disputants in improving their conflict. Disputants leave the
decision to the arbitrator, who hears both sides and then makes a deci-
sion. It goes as follows:

1. Both persons agree to abide by the arbitrator’s decision. Agreement is based on the assump-
tion that after disputants have presented their sides of the conflict, the arbitrator will be able
to make a fair decision. The arbitrator should be familiar with the subject matter of the case
and have access to all available documents and evidence.
Downloaded by [New York University] at 04:58 12 August 2016

2. Each person defines the problem. Both have the opportunity to tell his or her side of the
conflict.
3. Each person presents his or her case, with documented evidence to support it. No interrup-
tions are allowed.
4. Each person has an opportunity to refute the other’s contentions. After one person has pre-
sented his or her case, the other may attempt to refute the person’s contentions. Both have
a turn to show the arbitrator a different perspective on the issues.
5. The arbitrator makes a decision. After both persons have presented their case, refuted the
other person’s case, and given a closing statement, the arbitrator decides what to do. Usu-
ally, the decision is a win-lose situation—one side wins, the other loses. Winning or losing is
secondary to having had the fair opportunity to be heard.

Technique: Negotiation
Counseling Intention To outline the process of negotiation in a relationship
Description The following apply to negotiation:

Ground Rules
1. Each person takes a turn saying the rules.
• No interrupting.
• No name calling.
• Be honest.
• Work hard to solve the problem.

Defining the Problem

2. Decide who will talk first.
3. Person 1 tells what happened. Person 2 restates and asks how Person 1 feels.
4. Person 2 tells what happened. Person 1 restates and asks how Person 2 feels.

Finding Solutions
5. Person 1 gives a solution.
6. Person 2 agrees or gives another solution.
 Improving Relationships with Our Environments  195
7. Each person continues to give solutions until agreement is reached. (There must be a solu-
tion for each part of the problem.)
8. Each person says what the solutions are.
9. Each says what can be done to keep the problem from happening again.

Technique: Maintaining Peace during Conflict Resolution Situations

Counseling Intention To create a win-win situation.
Description Use the acronym RESOLUTION:

R Respect the other person’s right to disagree.

E Express your honest concerns.
S Share common interest.
Downloaded by [New York University] at 04:58 12 August 2016

0 Open up to different points of view.

L Listen attentively.
U Understand the major issues.
T Think about all the consequences.
I Investigate alternatives and solutions.
0 Offer a compromise.
N Negotiate for mutual benefits.

Technique: Knowing When, Where, and How to Resolve Conflicts: A Self-Assessment

Counseling Intention To prepare for a conflict situation.
Description Steps to consider when you are planning how to handle a situation
that upsets you to perform a self-assessment.

1. Have a chosen time and place where both of you can feel free to discuss the problem.
2. Ask yourself, “Have I tried to find out how the other person sees and feels about the con-
flict?” Ask questions to get his or her point of view. Put yourself in the other person’s shoes.
Understanding will begin to replace anger.
3. Ask yourself, “Have I asked the other person to listen to my point of view?” Be specific and
accurate about what was said and done, explaining why you are upset. Use “I statements”:
“I feel X when you Y because Z.”
4. Ask yourself, “Have I made it clear to the other person exactly what I want to be different?”
Did you make it clear that you are willing to change too?
5. Ask yourself, “Have I asked the other person to tell me exactly what he or she would like me
to do differently?” (Do not imply that you will do whatever he or she wants.)
6. Have the two of you agreed on a mutually acceptable solution to your difficulty? Are you
sure he or she knows exactly what you have in mind? Do you know exactly what he or she
thinks the plan is? Should you put the agreement in writing?
7. Do you have a plan to check with each other after a given time to make sure your compro-
mise is working out?
8. Have you shown your appreciation for the positive changes the other person has carried out?

Technique: 3R Strategy
Counseling Intention To eliminate long-standing resentment.
 196  Improving Relationships with Our Environments
Description This structured technique is useful in cases of long-standing disa-
greement and dislike. There are three steps: resentment, request, and
recognition.

1. Resentment. Each person states what he or she dislikes about the other and outlines every-
thing done to cause the resentment.
2. Request. Each person tells the other what to do to solve the problem.
3. Recognition. Both parties negotiate which requests they would be willing to meet. The ses-
sion ends with each party stating what qualities they like or find admirable in each other.

This strategy requires a firm mediator to manage exposed emotions. It is very useful for clear-
ing the air when individuals have built up a lot of resentment toward one another.
Downloaded by [New York University] at 04:58 12 August 2016

Technique: Coping Thoughts for Anger Reactions

Counseling Intention To internalize skills when responding to someone’s anger.
Description

1. Prepare for an anger reaction.

• This is going to upset me, but I know how to deal with it.
• What is it that I have to do?
• I can work out a plan to handle this.
• If I find myself getting upset, I’ll know what to do.
• Try not to take this too seriously.
• This could be a testy situation, but I believe in myself.
• Time for a few deep breaths for relaxation.
• Easy does it; remember to keep my sense of humor.
2. Conflict occurs.
• Stay calm. Just continue to relax.
• As long as I keep my cool, I’m in control.
• I don’t need to prove myself.
• There is no point in getting mad.
• I’m not going to let him get to me.
• Look for the positives: I won’t assume the worst or jump to conclusions.
• There is no need to doubt myself. What he says doesn’t matter.
• I can’t change him with anger; I’ll just upset myself.
• I’m on top of this situation, and it’s under control.

Technique: Preparing for a Potential Conflict

Counseling Intention To avoid a conflict.
Description The following self-talk can help prepare for and avoid a conflict:

• What is it that you have to do?

• You can work out a plan to handle this.
• You can manage this situation. You know how to regulate your anger.
• If you find yourself getting upset, you’ll know what to do.
• There won’t be any need for an argument.
• Time for a few deep breaths of relaxation. Feel comfortable, relaxed, and at ease.
• This could be a testy situation, but you believe in yourself.
 Improving Relationships with Our Environments  197

Technique: Confronting a Conflict

Counseling Intention To resolve a conflict.
Description The following statements can help resolve a conflict:

1. Stay calm. Continue to relax. Breathe deeply.

2. As long as you keep your cool, you’re in control.
3. Don’t take it personally.
4. Keep focused on what you need to do.
5. You don’t need to prove yourself.
6. There is no point in getting mad.
7. Don’t let the situation get the best of you. This, too, will pass.
Downloaded by [New York University] at 04:58 12 August 2016

Technique: Coping with Agitation

Counseling Intention To internalize coping skills.
Description Being agitated is part of life. Handling agitation will increase your
well-being. The following self-statements may help:

• Your muscles are starting to feel tight. It’s time to relax and slow down.
• Getting upset won’t help.
• It is reasonable to get annoyed, but keep it in control.
• Time to take a deep breath.
• Your anger is a signal of what you need to do. It’s time to talk yourself out of being agitated.
• Try a cooperative approach. Maybe both of you are right.

Technique: Skills to Handle Conflict and Anger

Counseling Intention To gain control of a situation.
Description There are seven skills to process when angry and in conflict. It is
important to RETHINK to gain control of the situation.

R - Recognize
• When you feel angry.
• What makes your parents, teachers, friends, and siblings angry.
• When anger is a cover for other emotions such as fear, stress, anxiety, embarrassment, humil-
iation, or shame.

E - Empathize
• Try to see the other person’s point of view; step into his or her shoes.
• Learn to use “I messages”: “I feel X because Y.”

T - Think
• Anger comes from our perception about situations or events.
• Think about how you interpreted what the other person said.
• What can you tell yourself about what you feel?
• How can you handle your frustration and disappointment?
• Can you change your outlook?
• Can you reframe the situation to find a constructive solution?
 198  Improving Relationships with Our Environments
H - Hear
• Listen to what the other person is saying to understand where he or she is coming from.
• Show that you are listening by establishing eye contact and giving feedback.

I - Integrate
• Integrate love and respect when conveying your anger (e.g., “I’m angry with you, but
I want us to remain friends.”

N - Notice
• Your body’s reaction when you become angry.
• How you gain control of your behavior and how you calm yourself.
Downloaded by [New York University] at 04:58 12 August 2016

K - Keep
• Keep your attention in the hear-and-now.
• Keep from bringing up the past. Bringing up the past is disrespectful.
• Focus on the behavior that is causing difficulty, not on the personalities involved

Source: National Institute of Mental Health (Reprinted with permission).

Technique: Confrontive Assertion

Counseling Intention To have others follow through on their commitments.
Description The confrontive assertion is helpful when you have previously asserted
yourself and the other person has agreed to change his or her behavior
but has not followed through with the agreement. You point out the
discrepancy rather than confront the person. It is appropriate to use
this technique when a person’s words contradict his or her actions or
behaviors. The confrontive assertion has three parts:

1. Objectively describe what the other person said would be done.

2. Describe what the other person actually did do.
3. Express what you want.

Example
“I was supposed to review the article before it was sent to the typesetter. But I see the typesetter is
working on it as we speak. Before he finishes it, I want to review the article and make the correc-
tions I think are needed. In the future I want to have the opportunity to review the article before
it goes to the typesetter.”

Technique: Stop the Action/Accept the Feelings

Counseling Intention To contain outbursts of hostile behavior.
Description When confronted with an outburst of hostile behavior, the recom-
mended assertion procedure is to act quickly.

1. Stop the action.

2. Don’t become emotionally involved yourself.
 Improving Relationships with Our Environments  199
3. Accept the feeling.
4. Suggest alternative behaviors, if possible.

Technique: Avoiding Conflict by Paraphrasing

Counseling Intention To clarify points of view.
Description Paraphrasing in conflict mediation clarifies the views of the problem
and the feelings about it. It is important to listen attentively and sum-
marize accurately using the following techniques:

• Restate the facts and summarize the events. Follow paraphrasing rules: Put yourself in the
other person’s shoes; state the other person’s ideas and feelings in your own words; use you
to begin your statements (e.g., you want, you feel, and you think); and show understanding
Downloaded by [New York University] at 04:58 12 August 2016

and acceptance through nonverbal behaviors such as tone of voice, facial expressions, ges-
tures, eye contact, and posture.
• Reflect feelings. Pay attention to the emotional element in each person’s position. Use the
statement, “You feel [name the feeling] because [explain why].”
• Offer alternatives.
• Reach a compromise.
• Agree on a solution.

Technique: Reframing a Conflict

Counseling Intention To reframe perceptions between people.
Description Reframing means thinking of the conflict and the other person’s
actions from another angle. There are a number of ways to reframe
perceptions:

• View the conflict as a mutual problem to be jointly solved rather than a win–lose situation.
• Change perspectives.
• Distinguish between the intent of an action and the actual result of the action.
• Continue to differentiate between one’s interest and reasoning. Seeking information about
the other person’s reasoning will result in a new “frame” emerging.
• Explore the multiple meanings of any one behavior. Ask: “What else might that behavior
mean?”

Technique: Dealing with Teasing

Counseling Intention To diffuse teasing or bullying behaviors.
Description People tease other for a variety of reasons such as anger, revenge, power,
attention, or feeling important. Teasing can be handled as follows:

• Use an “I message.”
• Have a ready answer.
• Walk away.
• Go somewhere near friends or adults.
• Don’t tease back.
• Don’t overreact.
• Don’t join a group in teasing.
• Don’t be afraid to help someone who is being teased.
• Change your inner dialogue with positive affirmations.
 200  Improving Relationships with Our Environments

Technique: What to Do When You Are Angry

Counseling Intention To recognize and process angry feelings.
Description

1. Recognize angry feelings. Identify how your body feels.

2. Try to calm down.
• Take in three deep breaths.
• Count backward slowly.
• Think pleasant thoughts.
• Tell yourself to stay calm, that it is not worth it.
3. Talk aloud to solve the problem.
4. Think about the situation later.
Downloaded by [New York University] at 04:58 12 August 2016

• What exactly made you angry?

• Were you in control? Or was the situation out of your control?
• Were you pleased with what you did?
• Could you have done things differently?
• Did you do your best under the circumstances?

Technique: The XYZ Formula for a Complaint

Counseling Intention To describe offensive behavior constructively (Goleman, 1999).
Description Criticisms are usually voiced as personal attacks rather than complaints.
They create defensiveness or passive resistance that comes from feel-
ing unfairly treated. Such criticism displays an ignorance of the feel-
ings it will trigger in those who receive it and the devastating effect
those feelings will have on motivation, energy, and confidence in doing
things well.

Example
“When you did X, it made me feel Y, and I’d rather you did Z instead.” “When you didn’t
call to tell me you were going to be late for dinner, I felt unappreciated and angry. I wish
you would call to let me know you’ll be late.”

Technique: The Artful Critique

Counseling Intention To specify behavior change.
Description
The artful critique is as follows:

• Be specific. Pick a specific incident that needs changing. Focus on the specifics, saying what
the person did well, what was done poorly, and how it could be changed.
• Offer a solution. Point to a way to solve the problem.
• Be present. Deliver the critique in private, face to face.
• Be sensitive. Use empathy to structure the impact of what you say and how you say it.

Technique: Communicating Feelings in a Nonblaming Manner

Counseling Intention To express feelings and negotiate change.
 Improving Relationships with Our Environments  201
Description Negotiation language proceeds as follows:

• “When you said or did X, I felt Y.”

• “Can you tell me what you meant?”
• “What I would like is. . .”
• “How can we work this out?”

Technique: Setting Boundaries with Others

Counseling Intention To set limitations to enabling behaviors.
Description Setting boundaries includes the following:

• I have the right to say “no,” “I don’t know,” or “I need to think about that.”
• I have the right to act without providing excuses or justifications.
Downloaded by [New York University] at 04:58 12 August 2016

• I have the right to change my mind.

• I have the right to put myself first when it feels appropriate.
• I have the right to make mistakes and be responsible for them.
• I have the right to ignore the advice of others.
• I am not responsible for anticipating the needs of others.
• I have the right to ask for help or emotional support.
• I have the right to ask for information.

Technique: Strategies to Manage Anger More Appropriately

Counseling Intention To use more appropriate ways to manage anger.
Description Anger is a strong emotion that needs to be expressed in an appropriate
manner. Anger management is a life skill to cope with angry feelings.
Some useful strategies follow:

1. Acknowledge to yourself that you are angry.

2. Get in touch with your feelings and physical sensations.
3. Take a few deep breaths and try to calm yourself using some coping self-statements:
• “I’m under control. I can handle this.”
• “I can stay calm. I can relax.”
• “Don’t get bent out of shape.”
• “Just roll with the punches.”
4. Think about ways to suppress or express the anger.
• Are you overreacting?
• Could you lighten up?
• Have you looked at the other person’s point of view?
• Are you blaming others when you are really angry with yourself?
• Could you delay your angry response in order to give yourself time to cool off?
5. Use this formula to express your anger in a helpful way:
“When X happens, I feel Y. I would feel better if Z would happen.”

Example:
“When you read while I’m talking to you, I feel that you aren’t listening to me. I would feel bet-
ter if you would look at me when I am talking to you.”
 202  Improving Relationships with Our Environments

Technique: Interpretive Confrontation

Counseling Intention To gain insight into oneself and to enhance personal growth.
Description Interpretive confrontation can provide insight into oneself—a criti-
cal component of mental health. Interpretation can enhance personal
growth when the information is communicated with skill, integrity,
and empathy. The characteristics of an interpretive confrontation are:

• Empathy. Understand the issues that are central to the other person’s behavior and lifestyle.
• Timing. The confrontation should be timed to prevent the receiver from becoming
defensive.
• Relatedness. The confrontation should be related to the situation in which both parties are
engaged.
• Concise. The confrontation should be concisely stated and to the point.
Downloaded by [New York University] at 04:58 12 August 2016

• Genuine. The person who is confronting must be able to communicate with genuine inter-
est and concern for the well-being of the other party.
• Tentative. The interpretation is a suggestion about the other person’s behavior, not an
absolute fact.

Technique: Self-Talk to Maintain Composure

Counseling Intention To maintain self-control.
Description Self-talk statements should be generated that would be useful before,
during, and after the situation.

Before: Take a minute to become more centered. “What is it that I want to do?”
During: Take a moment to exhale. Take things one step at a time. “People get irritated. It’s
nothing more than that. Clearly say what you want. Don’t raise your voice.”
After: On a scale of 1 to 10, assess your reactions. “I handled that with a 6. I’m getting better
at this every time I try.”

Technique: Maintaining Your Personal Power

Counseling Intention To identify your personal anger responses.
Description It is not easy to maintain your personal power when you are being
taunted to fight by friends. Learn to identify your personal anger
response components by answering the following questions:

• What are they doing that is getting to me? (Assess the environmental triggers.)
• How am I feeling inside? (Note the physiological feelings of anger.)
• What am I saying to myself? (Cognitive—stay cool, and he’ll be the fool.)
• What am I going to do? (Behavioral—keep your distance but maintain eye contact.)
• Will this make a difference next week?

Technique: Don’t Take It Personally

Counseling Intention To gain more control of the way you think about situations.
Description Sometimes it is helpful to modify your cognitive set (the way you think
about situations) to gain more control of your feelings. When envi-
ronmental demands are uncontrollable, anger management needs to
 Improving Relationships with Our Environments  203
be focused on changing your cognitive set so that the situation can
be tolerated more easily. Consider the following self-questions:

• What need of hers might be making her say those things to me?
• What values might be influencing what he says?
• How does her background influence how she treats me?

Coping Self-Statements to Remain Calm

• You can take anything he says.
• She can’t get to you unless you let her.

Technique: Getting Out of the Middle of Dueling Relationships

Downloaded by [New York University] at 04:58 12 August 2016

Counseling Intention To free oneself from enmeshed relationships.

Description Sometimes, with all good intentions, you become caught in the middle
of the needs of two people you care about. You may try to rescue both
people to the detriment of your relationship with each person. To leave a
triangulated relationship gracefully, it may be helpful to destress, defuse,
detach, and distance yourself from an otherwise toxic relationship.

1. Destress. Is your involvement with each individual stressful? Is your anxiety level increasing?
It may be time to make a decision to get out of the triangle.
2. Defuse. Are you constantly reacting to what the other person is saying and revealing? Is
your energy level depleting needlessly? Perhaps it is time to calm down and stop reacting
emotionally to the needs of both parties. Step back and be a listener and observer.
3. Disengage. Are you trying to fix things? Are you trying to control people? Take your focus
off the other two sides of the triangle. Consider your own emotional needs, your own
importance, and your opportunity for personal growth.
4. Distance. Leave the relationships and get the emotional distance to separate and reorganize
your position. Be prepared for a pull on your “heart strings” to put you back into the middle
of things again.

Technique: Using Self-Control Techniques

Counseling Intention To maintain self-control.
Description Maintaining self-control is a skill that may take some time and practice
to learn. It is not easy maintaining grace under fire. The following are
some self-control techniques:

• Avoid frustrating situations by noting where you have become angry in the past.
• Reduce your anger by consciously taking time to focus on other emotions that are more
passive, avoiding the weapons of aggression.
• Respond calmly to an aggressor with empathy, unprovocative comments, or no response
at all.
• If angry, concentrate on the undesirable consequences of becoming aggressive. Tell yourself
that you are not going to give anyone the satisfaction of seeing you get upset.
• Review your present circumstances and try to understand the motives or point of view of the
other person.
• Teach yourself to be empathetic, forgiving of others, and tolerant of individual differences.
 204  Improving Relationships with Our Environments

Technique: Aggression Control Methods

Counseling Intention To maintain composure.
Description Prevention of anger and control of anger are methods that can be
learned.

• Reduce your frustrations. Try to avoid topics of conversation, personal opinions, or situa-
tions that grate on you.
• Reduce the environmental settings. Avoid aggressive subcultures, gangs, hostile friends,
television violence, or violence in other forms of media such as the movies or music.
• Cultivate new friends. Associate with people who are not quick tempered, hostile, preju-
diced, or agitators.
• Disclose some of your own anxiety. Rather than being abrasive or rude, try a comment such
as “I’m having a bad day,” “I’m stressed out,” or “I’m upset” to change the context and
Downloaded by [New York University] at 04:58 12 August 2016

soften your remarks.

• Control anger through stress management. Use problem-solving methods, “I messages,” or
positive self-talk.
• Stop hostile fantasy building. Preoccupation with frustrating situations increases anger.
Move out of the situation or use thought-stopping techniques.

Technique: Writing a Learning History of Angry Reactions

Counseling Intention To assess personal reactions to anger.
Description Have the client take two weeks to carefully and systematically record
anger-causing thoughts to become aware of the common but sub-
tle triggers of emotional reactions and how to avoid future conflict.
A learning history of the behavior or angry reactions should include
the following:

1. Record the specific situations that “set you off.”

2. Record the nature and intensity of your anger.
3. Note your thoughts and feelings of the situation immediately before and during the
anger.
4. List what self-control methods you used and how well they worked.
5. Record the consequences and how others responded following your emotional reaction.

Evaluate the payoffs you get from your anger, clarify to yourself the purpose of your aggres-
sion, and give up some of your unhealthy payoffs.

Technique: Three Quick Questions to Suppress or Express Anger

Counseling Intention To gain control of anger reactions.
Description Have the client ask himself or herself the following questions:

1. Is this worthy of my attention?

2. Am I justified in being angry?
3. Can I do something about it without anyone getting hurt?

If yes, express your feelings and try to do something. If no, suppress your feelings by attending
to something else, meditating, or using thought stopping or positive imagery.
 Improving Relationships with Our Environments  205

Technique: Self-Control Techniques for Anger Management

Counseling Intention To increase feelings of control.
Description There are two distinct ways of managing anger: prevent it or control
it. Strategies that may be helpful are as follows:

• Avoid frustrating situations by noting where and when you got angry in the past.
• Reduce your anger by taking time to focus on pleasurable emotions, avoiding weapons of
aggression, and attending to other matters.
• Respond calmly to an aggressor or make no response at all.
• If your inner anger begins to escalate, concentrate on the undesirable consequences of
becoming aggressive. You self-talk could be “Why give him the satisfaction of knowing I’m
upset?” or “It isn’t worth it.”
• Try to understand the motives of the other person, to be tolerant of differences, and to be
Downloaded by [New York University] at 04:58 12 August 2016

sensitive to human weakness.

Technique: How to Calm an Angry Person

Counseling Intention To help others maintain control.
Description The National Institute of Mental Health provides a brief list of strate-
gies to use to calm an angry person:

• Reduce the noise level.

• Keep calm yourself.
• Lower your voice.
• Acknowledge that the irate person has been wronged (if true) or acknowledge his or her
feelings without passing judgment.
• Ask him or her to explain the situation so that you can diplomatically correct errors.
• Listen to his or her complaints without counterattacking.
• Explain your feelings with nonblaming “I statements.”
• Show that you care, but set limits on violence. (“I’d like to work it out with you, but I’ll call
security if you can’t control yourself.”)

Technique: How to Handle a Bully

Counseling Intention To avoid being victimized.
Description Victims of violence often use poor “survival strategies” such as (1)
denial of the abuse (“It didn’t happen”); (2) minimizing the action
(“It doesn’t matter, I’m OK”); or (3) self-blame (“It’s my fault”).
Repeated abuse leaves the victim more helpless and more willing to
accept the blame. As the abuse cycle escalates (such as in battered
women), the victim may kill their abuser (often in kill-or-be-killed
situations).

If someone seriously threatens you, protect yourself immediately.

How to Handle a Bully

• Avoid the person.
• Be assertive: “If you continue to harass me, I will notify [human resources, the manager, the
police].”
 206  Improving Relationships with Our Environments
• Find a support network and jointly confront the bully, demanding that he or she stop.
• Practice the social skills of assertiveness.
• Join a self-defense class to build self-confidence and strength.

Technique: How to Express Anger Without Hurting a Relationship

Counseling Intention To learn to express anger in a controlled way.
Description Fair fighting strategies allow people to express their anger clearly and
directly without hurting the relationship.

Step 1: Make sure there is a conflict. Ask yourself, “What behavior do I want changed?”
Step 2: Arrange a specific time for a fair fight for change: “I want to take some time after class
to share my feelings and see if we can make some changes.”
Downloaded by [New York University] at 04:58 12 August 2016

Step 3: Clearly state what problem behavior you want to see changed: “I want to discuss this
bill for $300.”
Step 4: Make “I statements” to express your current feelings and to accept responsibility for
your feelings in the here-and-now.
Step 5: State what specific change of behavior you would like to happen. Make fair changes
that are practical and specific. “Don’t run the bill up so high. Try to use your e-mail
more.”
Step 6: Indicate the reasons and consequences for the requested changes. Give your ration-
ale for the changes you want made. Also, express how you feel and what you will do if the
changes are not made. “Our budget can’t afford such high monthly bills. If you continue
to run the phone bill up, we won’t be able to afford to go to Texas for spring break.”
Step 7: Negotiate a compromise and make sure the agreement is understood. The listening
partner responds and proposes his or her own changes or conditions so that a fair and
workable agreement can be made.
Step 8: Put the incident in the past. Show appreciation for each other and for the efforts made
for change.

Technique: Aggression and Self-Assertion I

Counseling Intention To see how participants handle self-assertion and conflict resolution.
Description Members take turns portraying one of the following situations:

______A customer in a restaurant complains about the food.

______A customer complains to a hairdresser that her or his hair has been cut badly.
______An employee comes to the personnel department and asks for a raise.
______A telemarketer tries to sell a timeshare.
______A train conductor discovers a passenger whose pass has expired.
______A father shouts at his daughter for coming home late.
______An unemployed son asks his parents for pocket money.
______Parents catch their daughter smoking marijuana.
______A gang of teenage girls gets caught trying to steal something from a store.
______A girl is tormented by some friends of her brothers.
______A group of boys bullies a boy who is much younger.
______Several people have an argument because they all want to watch different television
shows.
______Two drivers have a slight collision. They argue about how it happened. Some witnesses
join in.
______A family has an argument because the front door key is lost.
 Improving Relationships with Our Environments  207
Process how the conflicts were resolved. Do some people assert their own interests without
considering others? Do some people sacrifice their own interests? Do people compromise? How
do people express their individual needs—objectively, clearly, humorously, hurtfully, or angrily?

Technique: Aggression and Self-Assertion II

Counseling Intention To observe how members reach their goal.
Description Members divide into two groups of equal size and stand facing each
other with their backs against the wall. At a given signal, players in
one group try to reach the opposite wall, while members of the other
group try to stop them.
Process the experience. How do players individually or jointly attempt to reach the wall or
prevent their opponents from reaching it?
Downloaded by [New York University] at 04:58 12 August 2016

Technique: Aggression and Self-Assertion

Counseling Intention To make one’s interests clear and assert self against the group.
Description All members except one link arms and form a tight circle. The lone
member stands in the middle and tries to get out. Process how the
member tried to get out. Does he or she use persuasive argument,
bribes, or physical force?

Technique: The Human Machine

Counseling Intention To observe aggression and self-assertion.
Description The group has to produce a machine. First, members choose an inven-
tor who has the idea for the machine and then an engineer and several
workers who build the machine out of the rest of the members accord-
ing to the inventor’s instructions.

The machine is then set into motion; members accompany and punctuate their movement
with noises. One player then destroys the machine.
Process the experience. Who chooses to destroy the machine? How does he or she do it? How
do group members react to the destruction? Do they defend themselves, try to stay together,
or allow it to happen?

Technique: The Pushing Encounter

Counseling Intention To observe aggression and self-assertion.
Description Two players stand facing each other; they place the palms of their
hands together and clench their fingers. At a given signal, they try to
push each other backward, away from the spot where they are stand-
ing. They may break off the struggle any time they choose.

Process
• Why is the struggle broken off—because of exhaustion, satisfaction, sense of inferiority, or
resignation?
• How does the member who gave up feel?
• How does the winner behave?
 208  Improving Relationships with Our Environments
Conclusion
Our country is becoming more and more culturally diverse. Increasing diversity often encour-
ages intolerance, as well as ethnic and racial profiling. It is estimated that by the year 2050, less
than 50% of the population will be of Anglo ancestry. In addition, advances in technologies have
increased each person’s ability and likelihood of interacting with people of cultural backgrounds
quite different from his or her own. To understand how many different subcultures exist in the
United States, one must consider that subcultures exist according to gender, socioeconomic
status, age, race, religion, ethnic heritage, and sexual orientation. The difficulty for many subcul-
tures is that if they do not have the same physical characteristics, values, customs, or beliefs as the
dominant culture, their culture is devalued and members may even be oppressed or subjugated
by the dominant cultural structure.
Downloaded by [New York University] at 04:58 12 August 2016

Stress and Stress Reduction Techniques

The Link between Life Stress and Psychopathology
The National Institute of Mental Health has concluded that the link of “life stress” to psychopa-
thology is well supported in the literature. The current quest, however, is to delineate how life
stress impairs one’s health and well-being. As a conceptual framework, Klerman and Weissman
(1985, p. 56) provided a working definition of stress and its related nomenclature:

• Stress—hypothesized psychological, emotional, or physical changes as the result of the stressor.

• Stressors—stressful environmental changes, particularly circumstances requiring changes in
patterns, routines, or interactions.
• Stress response—the behavioral, psychological, emotional, physical, or cognitive responses
experienced in an attempt to cope, adapt, or survive.
• Adverse health consequences—increased susceptibility to physical illness or emotional disorders.

The estimate is that the average American will spend 3 years sitting in meetings, 5 years wait-
ing in lines, over 17,000 hours playing telephone tag, 4,000 hours stopped at red lights, and a
lifetime . . . trying to wind down. Yet, life without a little stress can be incredibly dull and boring.
However, life with too much stimulus can become unpleasant and tiring, ultimately damaging
your health and well-being. Too much stress can seriously interfere with your ability to perform
effectively. The art of stress management is to keep a level of stimulation that is healthy, produc-
tive, and enjoyable.
Stressors become a causative or moderating influence, interacting with personal dispositions
and factors in the social environment (Dohrenwend & Dohrenwend, 1985). Stress management,
stress reduction, and stress relief procedures are viable intervention strategies. An individual’s risk
of psychopathology is intensified by the presence of debilitating stress and physical handicaps and
is diminished if an individual has reliable coping skills, a positive sense of self, and perceives the
existence of social support in the immediate environment. From the perspective of the individual,
wellness can be assessed with the equation shown in Table 10.3. There also is an environmentally
centered analog equation, shown in Table 10.4, that focuses on risk of psychopathology in a
population (Albee, 1982).

Table 10.3  The Equation of Emotional or Behavioral Disorder

Incidence of emotional or behavioral disorder = Stress + Physical, emotional, social,
and cognitive vulnerability
Coping skill + Social support + Self-esteem
 Improving Relationships with Our Environments  209
Table 10.4  Likelihood of Emotional Disorder in a Population
Likelihood of disorder in a population = Stressors + Risk factors in the environment
Socialization practices + Social support resources + Opportunities for connectedness

Table 10.5  Symptoms of Stress

Nervous tic Muscular aches
Increase or decrease in appetite Increased smoking
Sleep disorder Increased perspiration
Stammering or stuttering Nausea or gastrointestinal distress
Grinding teeth Headaches
Skin disorders Crying spells
Downloaded by [New York University] at 04:58 12 August 2016

Constipation or diarrhea Decreased libido

High blood pressure Dry mouth
Irritability Lethargy or fatigue
Cold, clammy hands Depression
Fear, panic, or anxiety Restlessness
Other coping manifestations

Psychopathology is less likely to occur in a population if there are socialization practices that
teach and promote social competence, supportive resources available in the environment, and
opportunities available for people to form constructive, positive social bonds and identities
connected with the mainstream of society. Both equations are interdependent and reflect the
paramount need for stress-related interventions that are multidimensional (Elias, 1989). Some
symptoms of stress are found in Table 10.5.

Stress of Therapeutic Work
Psychotherapy often creates stress for practitioners. Among the most stressful aspects of therapy
according to Hellman, Morrison, and Abramowitz (1986) were doubt about one’s effectiveness,
problems in scheduling, becoming too involved in work, becoming depleted, and having dif-
ficulties in managing relationships with clients. The five types of client behaviors that cause the
most stress for therapists were suicide threats, resistance, expression of negative feelings, passive­
aggressive behavior, and psychopathological acts.

The way we feel and behave under these multiple stressors is determined in part by what we
think (self-statements such as the “shoulds” and “oughts”) in a given situation along with
the perceptions held by others of our behaviors. The stress reaction involves major elements:
heightened physical arousal (increased heart rate, rapid breathing, or muscular tension), anx-
ious thoughts (e.g., a sense of helplessness), and panic from being overwhelmed, or a desire
to escape. Some therapists call it “fight or flight”—others call it “fight, flight, or freeze.”
Since behavior and emotions are learned and controlled by inner thoughts or expectations,
the best way to exert control over them is by assimilating the appropriate skills (such as
(Continued)
 210  Improving Relationships with Our Environments

progressive relaxation or cognitive restructuring) to change the sensation, the emotion, and
the thought(s).
On the other hand, stress in small amounts can be a very positive life force. It is the
impetus for growth, change, and adaptation. To alleviate negative stress on a routine basis
capitalize on existing professional and personal networks to form support groups. Some-
times it is very helpful to use a peer network or support group to share ideas, diffuse stress,
or access opportunities for personal growth.

• If you feel socially isolated, try to share your concerns, experiences, or situations with
a peer network or with other professionals you can trust.
• If you feel unrecognized or unappreciated, inventory what you have accomplished in
the past year. Identify your strengths and successes. Share these with a confidant for
Downloaded by [New York University] at 04:58 12 August 2016

feedback and validation.

• If you feel emotionally overextended, isolated, or overloaded, make an effort to do
more non-work-related activities for yourself.
• When everything seems to be out of control, make a list of what is going right in your
life. Include those things to be thankful for. Dwell on the positive things to regain a
proper perspective on your life.
• If you are intellectually stagnant or understimulated, attend workshops, seminars, or
cross-disciplinary courses; take a course in business management or horticulture.
• If worries and concerns are keeping you awake at night, try writing down what you’re
worrying about before going to bed, telling yourself you’ll address these concerns the
next day. Your mind will be encouraged to let go of the thoughts, knowing they are
written down and won’t be forgotten.
• If you have influence but virtually little power to change things, identify the for-
mal and informal networks and influence that you actually have, and note positive
change.
• If you are alienated administratively, have one or two professional friends in which you
can confide to discuss ways to make positive contributions.
• Stress triggers cravings for fats, salts, and simple carbohydrates, that is, nervous
food—the kind that is found in vending machines. Don’t bring change or a dollar bill
to work. Substitute fruit and vegetables instead.
• Learn to say no to obligation overload. If you’re feeling drained or overwhelmed by
your commitments, start taking steps to unload as many things as needed to invest in
your own well-being and regain some peace of mind.
• Alter what you can; avoid what you can, and adjust yourself to the rest.

Some Strategies to Incorporate into Everyday

Living to Reduce Stress
• Plan down time or debriefing time every day.
• Grab a folder (preferably empty) and get out of the office periodically. People will not
interrupt you, because with a folder in hand you look like you are on an important
mission.
• Avoid irritating and overly competitive people early in the morning, prior to lunch, or
at the end of the day.
• At least three days a week, have lunch conversations that are not work related.
 Improving Relationships with Our Environments  211

• Design your daily schedule so you have a chance to perform at least one activity each
day that makes you feel successful or that completes a goal.

A support group should be based on the willingness and ability to listen, share problems,
give assistance, admit mistakes, and develop trusting relationships.
Other stress reduction strategies could include the following:

• Interact at least once each day with someone in your work place who makes you laugh.
Try to avoid or at least spend less time with people who are constantly angry, pessi-
mistic, intimidating, or critical. Work on setting boundaries to reduce the number and
frequency of stressful interactions.
• Learn to plan a free weekend to “kick back” at least once a month.
Downloaded by [New York University] at 04:58 12 August 2016

• Do a small but in-depth, one-to-one activity with each family member during the
course of each month. This helps to renew close interpersonal relationships.
• Develop a “vacation attitude” after work; treat your home as your vacation home.
• Get involved with a friend, spouse, or child in an activity that will teach you a new
concept, skill, or process—an opportunity to learn an unrelated work skill in itself is
refreshing.
• Make a date for self-preservation. Periodically plan ahead and mark your calendar
scheduling time to be alone with yourself or significant other. Perceive these planned
occasions as genuine meetings. Make yourself unavailable to the needs and manipula-
tions of other people. Practice saying, “I have a date” or “I’m sorry, I already have
other plans” as a way of saying no without feeling guilty.
• Use positive affirmation to reduce negative thinking. Examples:
• I can do this.
• I can achieve my goals.
• I am completely myself and people will like me.
• I am completely in control of my life.
• I learn from my mistakes. They increase the experience on which I can draw.
• I am a good, valued person in my own right.

Being at the constant mercy of other people’s needs often creates frustration, fragmen-
tation, overextension, and burnout. This healthy schedule alternative will make you feel
focused and back in control over your time, i.e. boundaries are important for your own
well-being! Ultimately, you are more likely to face a challenge with equanimity when you
plan some rewarding time for yourself.
Have a holistic approach to physical and mental well-being. Physical exercise does make
us feel better and gives us energy, especially if it occurs at the beginning or end of a stressful
day. Treat your brain as if it is a muscle and exercise it routinely as well.

Taking Your Own Advice: Using Guided Imagery to

Reduce Stress
Use imagery to track down the reasons behind anxiety and to help you say no to unreason-
able or unwanted requests for your time. Lazarus (1993) suggested that you concentrate
on any unwanted or unreasonable request from a person to whom you generally say yes

(Continued)
 212  Improving Relationships with Our Environments

although you want to refuse. Be specific as to the task. Then picture yourself tactfully but
firmly declining. As you picture yourself saying no, you may become aware of some tense
feelings. Concentrate on these tensions and see what other images emerge. To counter the
tension, imagine your family and the relaxed relations you would have with them if you
were not overextended.

Strategies for Leaving Stress at the Office

At the end of day leave the office as calmly and smoothly as possible. Make it a habit to
wind down a half-hour before you leave. Leave unfinished business at your desk. Bring-
ing work home (into your family space) on a daily basis is a bad habit. Ask yourself, Is
this project an emergency? Can it wait until tomorrow? Can this be delegated? If you feel
Downloaded by [New York University] at 04:58 12 August 2016

you’ll spend the evening worrying about the unfinished business from the end of the day,
try the following exercise. Make a list of all outstanding tasks. Imagine your feeling of
accomplishment when every item is completed to your satisfaction. Then forget about it
until the morning.
How many days have you lost trying to control what is beyond your control? Making
a list relieves the stress of worrying about forgetting something and helps you feel more
in control. The satisfaction of being able to notice progress as you begin crossing items
off the list is intrinsically rewarding. If you are a more compulsive type, you might try
securing three folders (preferably high-tech plastic) in green, red, and yellow. Red is for
“hot” projects that need your attention now, green is for ongoing projects that need
your daily attention; and yellow is for items that will need your attention soon. On the
outside of each folder, stick a post-it note of prioritized items that must be accomplished.
Smaller lists on three tracks (red, green, and yellow) will give you a better feeling of hav-
ing things under control. You also will be able to “put your hands on things” when you
need them.
Use your commute home as a decompression time. As therapists we are overwhelmed
by emotion and information overload. Don’t listen to the news or rock ‘n roll on the
radio because they both tend to overstimulate our senses. Instead, make this a quiet time
to let the thoughts of the day filter out of your head. And, since you can’t utilize guided
imagery on the road, pop one of those “new age” music or self-help audio books in your
CD player.
At home, take a few minutes alone, change clothes, or rinse your troubles down the
drain with a quick shower. Don’t make dinner (or make children’s homework) into an
ordeal. Turn off the television and turn on the answering machine. Learn to maintain
a healthy perspective. Despite the day’s worst disasters—you arrived late because the
bridge was up, spilled coffee on the computerized answer sheets, worried about how
well you did in an important presentation, and spent an hour trapped in a meeting with
someone you despise—it really could have been worse. You could have come to work
with two different colored shoes, which your burned-out colleagues wouldn’t notice
until midday.
Finally, encourage humor within and without. “Humor is serious business.” It can serve
as a powerful tool for people at all levels to prevent the buildup of stress to improve
communication, to enhance motivation and morale, to build relationships, to encour-
age creative problem solving, to smooth the way for organization change, and to make
workshops fun.
 Improving Relationships with Our Environments  213

The use of humor decreases problems with interpersonal relationships, increases listen-
ing and attention on the part of participants, decreases the pressure on people to be per-
fect, increases retention, and increases the comfort level of others. The resulting positive
attitude can greatly contribute to achievement and productivity. Humor makes it easier to
hear feedback and new information. Humor gives us perspective on problems and helps us
to get away from a problem situation in order to see the situation and possible solutions
from a different perspective. This is a very important skill for therapists.

Compassion Fatigue: The Professional Liability

of Caring Too Much
Helping professionals who listen to the stories of fear pain and suffering of others may
Downloaded by [New York University] at 04:58 12 August 2016

feel similar fear, pain, and suffering because by their profession they care for others. Help-
ing professionals in all therapeutic and institutional settings are especially vulnerable to
“compassion fatigue” and include emergency health care workers, professional school
counselors, teachers, school administrators, mental health professionals, clergy, advocate
volunteers, and human service workers. According to the American Psychological Associa-
tion, professionals who absorb another person’s pain and carry it with them are experienc-
ing compassion fatigue.
There are a number of definitions that need to be understood to differentiate between
the following: 1) burnout, 2) secondary traumatic stress, 3) compassion fatigue, and
4) compassion satisfaction.
Burnout or cumulative stress is the state of physical, emotional, and mental exhaustion
caused by a depletion of the ability to cope with one’s environment (e.g., work demands,
family demands, and community demands) resulting from our responses to the ongoing
stressors of our daily lives (Maslach, 1982). Symptoms such as exhaustion, frustration,
anger, depression and self-medication are typical of burnout (Thompson, 2012, p. 482).
Bottom line: eat right and drink right (and don’t overdo either).
Secondary traumatic stress is exposure to extreme events directly experienced by another
and overwhelmed by this secondary exposure to trauma. For example, if you are exposed to
others’ traumatic events as a result of your work, such as in an emergency room, working
with child protective services, or being the student assistance counselor for the school, this
is secondary exposure. Symptoms are usually of rapid onset and are associated with the par-
ticular event and may include being anxious or afraid, having difficulty sleeping, visualizing
reoccurring images of the event, or avoiding things that remind you of the event.
Compassion fatigue is a condition that develops over time—taking weeks, sometimes
years to surface. Essentially it is a low level, chronic clouding of caring and concern for oth-
ers. Over time, the ability to feel and care for others becomes eroded through the overuse
of skills expressing compassion. Compassion fatigue occurs when caregivers become emo-
tionally drained from hearing about being exposed to the pain and trauma of the people
they are helping. Compassion fatigue can affect seven domains: 1) cognitive, 2) emotional,
3) behavioral, 4) spiritual, 5) personal relations, 6) somatically, and 7) work performance.
Common symptoms of compassion fatigue include: low morale, reduced ability to con-
centrate, guilt, appetite changes, intolerance, depleted energy, insomnia, immune system
impairment, apathy, depression, negativity, isolation, perfectionism, rigidity, regression,

(Continued)
 214  Improving Relationships with Our Environments

feeling of pervasive hopelessness, loss of purpose, questioning the meaning of life, shock
decreased interest in intimacy and sex, anger and mood swings.

Strategies for Taking Care of Self and Others

Self-Awareness and Self-Care

1. Know your own emotional or psychological “triggers” and areas of vulnerability.

Learn how to defuse or divert them in constructive ways (e.g. exercise, talking to a
special friend, or learning a new leisure activity).
2. Recognize and resolve your own personal or interpersonal issues with others and
become aware of your own reactions to other people’s pain and suffering.
Downloaded by [New York University] at 04:58 12 August 2016

3. Develop realistic expectations about the rewards as well as the limitations of being a
therapist. You cannot be all things to all people. Challenge your irrational thoughts
and beliefs. Set boundaries for yourself and others.
4. Balance your work with other professional activities that provide opportunities for
positive growth and personal renewal.

Don’t Hesitate to Accept Help from Other Professional Colleagues

1. Seek out opportunities to acknowledge, express, and work through difficult experi-
ences in a supportive environment with colleagues you trust. Debrief on a routine
basis and build healthy support groups.
2. Delegate responsibilities and get help from others for routine work when appropriate.
3. Develop a healthy support system to protect yourself from further fatigue and emo-
tional exhaustion.

Stress Healthy Living and a Balanced Life

1. Eat nutritious food, exercise on a regular basis, rest, meditate, pray, and take care of
yourself as a whole being.
2. Set and keep healthy boundaries at work. Ask yourself, “Would school or work fall
apart if I stepped away from my responsibilities for a day?”
3. Think about the notion that if you never say no to a request, what is your “yes” really
worth, especially if you have already overextended yourself.
4. Find avenues to provide yourself with emotional and spiritual renewal for strength for
the future.
5. Develop and reward a sense of humor. Expose yourself to humorous situations like
comedy shows or videos. Learn to laugh at mistakes, see solutions rather than prob-
lems, enjoy life, and maintain healthy personal relationships.

Strategies for Taking Care of Yourself to Prevent Compassion Fatigue

1. Spend quality time alone. Learn mindfulness meditation is an excellent way to ground
yourself in the moment and keep your thoughts from pulling you in different direc-
tions. The ability to reconnect with a spiritual source will also help you achieve inner
balance.
 Improving Relationships with Our Environments  215

2. Recharge your batteries daily. A regular exercise regimen can reduce stress, help you
achieve outer balance and re-energize you for time with friends and family.
3. Hold one focused, connected, and meaningful conversation with someone you care
about each day. Time with family or close friends renews depleted batteries; unfortu-
nately it often becomes the first thing we cut out of our life in times of stress.

Compassion Fatigue Also Comes with Some Important “Don’ts”

1. Don’t make important decisions immediately. Caregivers who are suffering from com-
passion fatigue should not try to make any major life decisions until they have recov-
ered physically, emotionally, cognitively, and spiritually. Such actions like quitting a
job, getting a divorce, having an extramarital affair or spending money you don’t have
Downloaded by [New York University] at 04:58 12 August 2016

only complicates issues in the long-term.

2. Don’t try to find blame in others. Blaming the administration, faculty, supervisors,
support staff or the “system” will not be productive. Being adversarial will only
create further exhaustion and hinder the healing and moving on that needs to take
place.
3. Don’t spend energy complaining. It is self-defeating. Also, avoid commiserating with
discontented or disgruntled colleagues. It’s easy to succumb to the tendency to com-
plain when experiencing compassion fatigue, but it will only make things feel worse.
There are other more constructive environments to share and express feelings. The
universality of knowing that everyone is experiencing the same emotions or feelings
can be a catharsis in itself. So, support groups can be helpful.
4. Don’t try a quick fix. Compassion fatigue often makes one vulnerable to addic-
tive behaviors. Many helping professionals with compassion fatigue try to deal with
clients by working longer and harder. Others self-medicate with food, alcohol, or
prescription drugs. Don’t fall prey to a quick fix because it always ends up compli-
cating an already overburdened life, escalating the downward spiral to burnout and
depression.

Source: Thompson, Professional School Counseling, pp. 473–483.

Improving Relationships with our Environment

Techniques for Managing Stress
Techniques like progressive muscle relaxation training (PMRT), biofeedback, self-hypnosis,
rhythmic breathing, mindfulness, and exercise can elicit the relaxation response. Relaxation
training can reduce physiological arousal and attenuate the effects of chronic stress. Various
meditative techniques for therapeutic purposes have been studied (Benson, 1974; Goldman,
1976; Goldman & Schwartz, 1976; Heider, 1985; Maharishi, 1972).

Technique: Meditation
Counseling Intention To reduce stress among clients; to empower them to gain control
over self-defeating behaviors that manifest a chronic stress response; to
evoke the relaxation technique with meditation (Devi, 1963, p. 126).
 216  Improving Relationships with Our Environments
Description The client uses a candle as a fixation point.

1. Now keep your eyes upon the flame and don’t let them wander.
2. Start breathing rhythmically.
3. Next close your eyes and try to retain the impression of the flame. You can visualize it clearly
and hold the picture, but if the light eludes you, open your eyes for another look at the light.
4. Close them again and see if you are able to envision the flame this time. Repeat this until you
are able to capture and hold the impression.

If you are still unsuccessful, try the same procedure again the following day, and continue
trying until you have succeeded. Do not hurry or force anything—do not try too intensively.
Remember that it is most important to remain inwardly relaxed and motionless.
Downloaded by [New York University] at 04:58 12 August 2016

Technique: Harvard Meditation for Relaxation

Counseling Intention To evoke the relaxation response using the Harvard meditation tech-
nique (Benson, 1974).
Description Have the client do the following:

1. Select a quiet environment where you will not be distracted or disturbed.

2. Select two times during the day when you can afford 10 or 20 minutes of uninterrupted
time. For some people, a good time is before breakfast or before dinner. A particularly good
time is when you are experiencing stress.
3. Find a comfortable chair, or sit in a position in which you feel at ease.
4. Loosen any tight clothing; take off your shoes or related clothing that may be uncomfortable.
5. Close your eyes. Begin to relax by thinking of relaxing while successively thinking about
your feet, legs, trunk, body, arms, neck, and head.
6. Breathe through your nose and become aware of your breathing.
7. Say a simple one- or two-syllable word to yourself as you breathe out. Almost any word will
do. Words some people like are gohum, carim, shaim, or sharin. A word without meaning
works best.
8. Breathe easily and naturally. Ignore worries, ideas, or anxieties as you meditate. Keep repeat-
ing your word. After you have finished meditating, sit quietly for a minute with your eyes
closed, then with your eyes open.

Technique: Increasing Sensory Awareness

Counseling Intention To heighten sensory awareness.
Description Have the client do the following:

1. Go to a location where you feel comfortable, preferably outside.

2. Focus your eyes on an object—a tree, a rock, a picture—as if you have never seen it before.
3. Become aware of its size, shape, color, and texture.
4. Now allow it to fade away and let the background come into focus.
5. Repeat this with other objects or, if you are calm, stay there and let your mind and senses rest.
6. Focus your attention on listening to the sounds around you. Which sounds are constant?
Which are intermittent? Be aware of their intensity, pitch, and rhythm.

Try repeating these experiments every day for at least 10 minutes. Choose different settings
and objects to contemplate. Active observing and listening allow the client to become more
 Improving Relationships with Our Environments  217
aware of odors, tastes, and textures as well. Heightening your sensory awareness is a form of
meditation that will not only help you to relax, but will also allow you to appreciate more fully
the world around you.

Technique: Evoking Relaxation Techniques Autogenically

Counseling Intention To evoke the relaxation technique autogenically.
Description With autogenic, or self-directed, relaxation techniques, the client is
urged to relieve tension by saying that he or she feels calm, relaxed,
or warm. The client is guided to use his or her creative awareness and
repeat self-statements as he or she feels and experiences deep relaxation.

The following outline of self-statements (to repeat at least two times each) is directed to the
Downloaded by [New York University] at 04:58 12 August 2016

client’s entire body, beginning with legs and arms:

l. Slow breathing. “I take a slow deep breath.”

2. Slight tension, then release. “I feel slight tension in my foot, and now I am completely
relaxed.”
3. Feeling warm and heavy. “My foot feels warm and heavy.”
4. Flow of warmth. “Warmth flows from my arm to my chest.”
5. Rate of heartbeat. “My heartbeat is calm and regular.”
6. Quiet mind. “My mind is quiet and still.”
7. Separation from surroundings. “I withdraw my mind from my environment. I feel calm
quiet, still. My thoughts are turned completely inward.”
8. Peace and harmony. “My body and my mind are in perfect harmony.”
9. Closing statement. “I am now calm, quiet, and renewed with energy.”

Autogenic relaxation can be used in mental training (Zilbergeld & Lazarus, 1993); for tension
release leading to better sleep; in management of stress and increased efficiency (Carrington,
1977); in treatment of neurotic, compulsive, and depressive disorders (Romen, 1981); and in
achieving a state of optimum health (Pelletier, 1980).

Technique: Self-Management through Biofeedback

Counseling Intention To integrate self-management through biofeedback.
Description Biofeedback refers to a continuous aural or visual report of changes in
bodily reactions brought about by changes in thoughts and emotions
(Marcer, 1986). After they have been provided information about a
bodily state frequently enough, clients can learn to recognize the link
between thoughts, feelings, and physical reactions. Self-management
is a technique developed to empower people to feel better by chang-
ing destructive habits or inefficient patterns of coping into positive
behaviors.

It is essentially a step-by-step process for self-control and makes use of many of the same
techniques used by behavior therapists. Biofeedback involves providing people with informa-
tion about physiological process of which they are normally aware. With the benefit of this
information, people can learn to bring under voluntary control physiological conditions that
may be harmful to their health. Biofeedback training can be thought of as a three-step learning
process:
 218  Improving Relationships with Our Environments
1. Developing increased awareness of body states.
2. Learning voluntary control over these states.
3. Learning to use these new skills in everyday life.

The goal is for individuals to eventually learn to exercise this voluntary control without the
use of biofeedback instruments so that they can apply their newly acquired skills to their daily
lives in a manner that allows them to control their stress responses. From this perspective, bio-
feedback is basically a return of responsibility for one’s health to the individual rather than to a
caregiver.
Biofeedback and relaxation training techniques have found wide application and success
in the treatment of anxiety states, diabetes, tension headaches, and migraine headaches. Bio-
feedback and relaxation techniques also are being applied in treating such varied conditions
as hypertension, cardiac arrhythmia, stroke, epilepsy, asthma, psoriasis, chronic pain, and
Downloaded by [New York University] at 04:58 12 August 2016

insomnia.

Technique: Progressive Muscle Relaxation Training

Counseling Intention To evoke the relaxation response through PMRT.
Description PMRT is perhaps the most widely used of all cognitive-behavioral
interventions. It is a procedure to enhance the ability to learn to relax
by making the individual aware of the sensations of tensing and relax-
ing major muscle groups. Bernstein and Borkover (1973) provided
the following directions for progressive relaxation.

Steps for Progressive Relaxation

1. Make sure that you will not be interrupted.
2. Lie down on a comfortable bed or couch, flat on your back, arms at your sides, and legs
uncrossed.
3. Close your eyes gradually over a period of 3 to 4 minutes.
4. Spend only a few minutes recognizing tension in your muscles.
5. Never contract a muscle to relax it.
6. Do not shift your position or try to hold still. Just let go.

If any step seems difficult, it is probably because you are holding a muscle under tension some-
where. Sensations should seem to fall away if you are relaxing properly. Relaxing muscles often
feel warm at first; later, possibly, they feel cool, tingly, or have no sensation.
Note: Straining and tensing your muscles before relaxing them is not progressive relaxation.
In progressive relaxation, the client starts by placing enough tension on a muscle so that he
or she can recognize and learn when to let go. Muscle relaxation is passive, a letting-go of all
tension.

Technique: Evoking Relaxation through Tension–Inattention

Counseling Intention To evoke the relaxation response through tension–inattention
techniques.
Description Steps for the tension–inattention relaxation technique were developed
by White and Fadiman (1976). This technique can be learned in three
to four practice sessions and assists in daily situations.
 Improving Relationships with Our Environments  219
Exercise 1
1. Sit at the edge of your bed or floor.
2. Close your eyes and keep them closed for all six exercises.
3. Let your shoulders and neck be as loose as possible.
4. Rotate your head slowly in a clockwise direction four times, making the muscles still looser.
5. Reverse direction and rotate your head in a counterclockwise direction four times.

Exercise 2
1. Lie down and raise your right foot about 12 inches.
2. Make your leg muscles as stiff and tense as possible.
3. Visualize the muscles in your leg from toes to hip. Keep your attention on them and try to
make them tight and tired.
Downloaded by [New York University] at 04:58 12 August 2016

4. Hold your leg up as long as you can. Let it get so tired that you can’t hold it up anymore.
5. Let your leg go completely limp and loose as you let it drop quickly.

Exercise 3
1. Raise your left leg and divert all your attention to it.
2. Now repeat all the steps for Exercise 2 using your left leg.

Exercise 4
1. Raise your right arm, fist clenched in a salute position.
2. Stiffen and tighten the muscles.
3. Keep your thoughts on this arm only.
4. Let your arm fall limp to your side when it is completely tired.

Exercise 5
1. Immediately raise your left arm and repeat all steps as in Exercise 4.

Exercise 6
1. Imagine a circle about 4 feet in diameter on the ceiling above you.
2. Keeping your eyes closed, follow this circle with your eyes four times in a clockwise direc-
tion. Do this slowly.
3. Reverse direction and follow the circle in a counterclockwise direction.
4. Imagine a square instead of a circle.
5. Go around the square four times in each direction.
6. Lie for a few minutes and enjoy the relaxation.
7. Divert your attention from your eyes by thinking of anything pleasant.

PMRT has demonstrated effectiveness in treating insomnia, asthma, tension, headache, mus-
cular tension, hypertension, increased heart rate, chronic anxiety, and phobias.

Technique: Evoking Relaxation through Yoga

Counseling Intention To evoke the relaxation response through basic yoga.
 220  Improving Relationships with Our Environments
Description Yoga is a Hindu practice that can take any of five forms: (1) raja yoga,
meditation through contemplation on universal truths; (2) jnana
yoga, meditation on the nature of self; (3) karma yoga, active yoga in
the service of others; and (4) bhaki yoga, meditation using prayer and
chanting.

The fifth form of yoga used most in the Western world is hatha yoga. It is more often used as
a form of exercise to promote good health, to alleviate stress, to energize, and to relax the body
and mind. Maitland (1975) provided the following suggestions for basic yoga:

1. Let the movements compress or expand your lungs.

2. Do one, two, or three repetitions of each movement.
3. Move in both directions, clockwise and counterclockwise.
Downloaded by [New York University] at 04:58 12 August 2016

4. Keep your attention on the muscles under tension.

5. Hold your position until your muscles are extended.
6. Maintain a continuous awareness of your body as you proceed through your exercises.

Technique: Changing One’s Awareness through Silva Mind Control

Counseling Intention To change one’s awareness from everyday consciousness via Silva
Mind Control.
Description Silva Mind Control is a process of changing one’s present awakened
consciousness (beta) to a lower-frequency consciousness (alpha) for
better problem solving and increased memory, efficiency, and crea-
tivity. The technique “uses the mind to mind itself: by first physical
and mental relaxation, then affirmation, visualization, and anchoring”
(Silva & Stone, 1983, p. 93). The relaxation method consists of turn-
ing the eyes upward and counting back from 10 to 1. The anchor is
to put three fingers together. The vision process consists of seeing the
situation first as it is; then to see the situation in the process of posi-
tive change, viewing the second image on the left to activate the right
brain; and finally to see the situation resolved (Silva & Stone, 1983).
This strategy has been used to accomplish personal goals and to main-
tain energy and enthusiasm.

Technique: Creating Experiences through Visualization

Counseling Intention To use visualization to create experience in one or more sensory
modes.
Description Visualization uses the imagination to create experience. Receptive
visualization works to reduce the analytical activity of the brain, allow-
ing subconscious thoughts, emotions, ideas, or insights to emerge.
A classic example of this type of visualization is having a solution to a
complex problem emerge in a state of quiet. Active visualization works
by giving form to thought (Gwain, 1982). An example of active visu-
alization is creating an image of a new job or the successful transition
through a stressful period. Repeated visualization works to change
one’s view of self. The most powerful visualizations are specific, tangi-
ble, repeated, and self-rewarding.
 Improving Relationships with Our Environments  221

Technique: Enhancing One’s Mind, Behavior, and Beliefs through Affirmations

Counseling Intention To direct one’s mind, behavior, and beliefs through positive
affirmations.
Description Inherently, beliefs present in one’s mind create emotions, which influ-
ence actions, which in turn influence one’s outlook on life, which fos-
ters negative or positive self-talk. The intensity of the results or effects
on one’s life will be proportional to the depth of the belief and the
intensity of the feeling (Helmstetter, 1986; Robbins, 1986). Chang-
ing negative beliefs and self-talk to positive beliefs and self-talk can
change the circumstance of a client’s life. A positive affirmation such as
“I deserve this and much, much more” replaces “I’ll never amount to
anything.”
Downloaded by [New York University] at 04:58 12 August 2016

Imagery Techniques
Imagery provides a way to communicate with the subconscious mind. When one “sees” an
image in the mind, it is collaboration between the conscious and subconscious. The image
seen will always be different from what others see because it is formed from one’s own memo-
ries and experiences. Imagery is like a personalized, guided dream with emotions. Everyone
is capable of using imagery, but like other skills, it must be practiced. Imagery is not just
visualization—it involves other senses (taste, smell, hearing, and touch) as well. Scientists are
discovering that the mind actually helps maintain balance by controlling the immune system.
Susceptibility to diseases increases when the normal balance becomes disturbed. Imagery helps
create and maintain this balance while reducing stress. Many scientists believe that when you
visualize the problems within your body, the unconscious mind then triggers your body’s
natural defenses.
As a counseling technique, imagery can be used as a primary psychological tool for assess-
ment, intervention, and enhancement of human potential. Over the past two decades imagery
has been cited as an effective treatment medium for a wide spectrum of psychological maladies:
uncovering emotional blocks or inhibiting them (Anderson, 1980); reducing anxiety; improving
memory and achievement; increasing self-esteem (Lazarus, 1977; Sheikh & Sheikh, 1985); and
relieving insomnia (Sheikh, 1976), depression (Schultz, 1994), obesity (Bornstein & Sipprelle,
1973), sexual malfunctioning, chronic pain (Jaffe & Bresler, 1980), and psychosomatic illness
(Shorr, 1974; Lazarus, 1977; Simonton, Mathews­Simonton, & Creighton, 1978).
Currently, there is a renewed interest in imagery as a tool for counseling, with the shift-
ing paradigm away from strict adherence to schools of counseling and psychotherapy toward
a more integrated cognitive-behavioral approach. Furthermore, contemporary developments
in brain research and health psychology have legitimized nontraditional approaches (Kom &
Johnson, 1983). Imagery is a natural function of the human mind and does not have to be
taught.
Witmer and Young (1985, p. 187) outlined the areas in which imagery can be used to expand
human possibilities:

• Increasing awareness of self and others.

• Future planning and career or lifestyle development.
• Gaining control over undesirable behavior.
• Treating illnesses.
• Improving learning, skill development, and performance.
• Reducing stress and enhancing health.
• Enhancing creativity and problem solving in everyday living.
 222  Improving Relationships with Our Environments
The clinical use of imagery as a tool for therapeutic intervention was outlined by Sheikh and
Jordan (1983):

1. Imagery can act as a source of motivation for future behavior. Guided imagery can produce
fresh data and new solutions. Goals and solutions rehearsed through imagery during therapy
can be applied more easily outside the therapeutic setting.
2. Imagery can facilitate the access to important events occurring early in one’s life. Early recol-
lections are a therapeutic component of a more Adlerian perspective to ascertain individual
attitudes, beliefs, and motives.
3. Imagery provides a focus that can uncover very intense affective states or emotional reac-
tions, fostering greater communication by moving the discussion to a more meaningful
level. It also facilitates the expression of more difficult feelings. Through imagery, empathy
and interpersonal relationship skills can be developed.
Downloaded by [New York University] at 04:58 12 August 2016

4. Imagery can be used to resolve dilemmas by circumventing defenses or inhibitions that may
occur in verbal blockage, as well as to produce therapeutic change in the absence of any
interpretation by the therapist or intellectual insight by the client.

Witmer and Young (1985) also outline a number of prerequisites for imagery development
that can increase effectiveness:

• Readiness. A quiet environment with few distractions, a comfortable position, and a mental
device that functions as a point of focus—such as sound, word, phrase, or a spot at which to
gaze—are helpful. All imagery exercises should begin by creating a safe place in the client’s
imagery world (e.g., a warm beach, a special room, a quiet path). If images become too
anxiety provoking or uncomfortable, the client can return to his or her safe place to process
or work through threatening images.
• Vividness. A certain degree of vividness is essential to creating images. The greatest effective-
ness is reported when multiple sensory experiences are experienced (e.g., visual, sound, or
emotional components).
• Controllability. Imagery control ensures therapeutic effectiveness. A technique that assists in
controlling the imagery is cuing—giving the person an instructional set to focus on, either
the desired outcome or the process. When the outcome image is established, the mind intui-
tively creates a script or scenario to achieve the imagined outcome.

Cautela and McCullough (1978) concluded that control can be improved further by empha-
sizing to clients that (1) the imagery is theirs—they create it and they are free to change it;
(2) imagining the desired response inhibits an unwanted response; and (3) keeping a log of
incidents and accompanying images that evoke tension will enable them to identify or modify
subsequent images.

Technique: Wise Person Exercise

Counseling Intention To enable the client to experience through imagination a conversation
with a wise person (Witmer & Young, 1987, p. 8).
Description The image that appears may be a stranger, a friend, or a spiritual being.
Relax and let go of all tension and worrisome thoughts. Allow the
face or figure of a very wise, loving person to appear. You may ask a
question. Listen and be receptive to whatever comes. You may want to
hold a conversation. The wise person may have a special message for
you, something you did not ask.
 Improving Relationships with Our Environments  223
If you are willing to receive this, tell the wise person and wait for a response.
Allow yourself to see the situation as the wise person sees it. Now see how this fits or makes
sense in your life. It is time to leave the wise person. You can return at any time and find guid-
ance and strength.

Technique: Visualization for Physical and Mental Relaxation

Counseling Intention To enable the client to gain physical and mental relaxation through
visualization (Witmer & Young, 1987, p. 9).
Description Suggest the following to the client:

1. Visualize your body relaxing by using a rag doll image.

2. Visualize your favorite quiet place.
Downloaded by [New York University] at 04:58 12 August 2016

3. Blow away bad feelings and thoughts like bubbles that break or float way.
4. Imagine the light and warmth of sunlight entering your body and flowing to all parts, bring-
ing relaxation.
5. Visualize a trip and scenes from nature (e.g., mountains, beach, woods, field, or stream).
6. Use phrases that elicit heaviness, warmth, and an inner quietness.

Technique: Imagery for Sensory Expansion

Counseling Technique To use imagery to deepen concentration and profound relaxation.
Description After achieving a relaxed state, practice the following image:

Woods Scene (Fezler, 1990)

You are walking through a forest of pine trees on a beautiful summer day. See that the sky above is
brilliant blue. Feel the warmth from the sun against your face. Hear the soft, low rustle of the wind
through the pine boughs. Blue jays fly from branch to branch, sounding out in loud, high cackles.
Reach up and pick a pine needle. Break it in half. A drop of fluid falls from the needle onto
your palm. Sniff the drop. It smells of bitter pine. Lick the drop. Taste the bitter flavor of pine.
Now you come to the edge of the forest. Pass into an orchard of apples, brilliant red in the sun-
light, against deep green foliage. Pick an apple. Take a jackknife from your pocket and slice the
apple in half. Beads of apple juice sparkle on the metal of the knife blade. Sniff the sweet scent of
apple. Carefully lick the juice. Sweet taste of apple. Next you pass into a grove of lemon trees, yel-
low fruit in chartreuse leaves gleaming in the summer sun. Pick a lemon. Peel it. Smell the sour
lemony fragrance of the rind. Bite into the lemon. The sour lemon juice squirts into your mouth.
Your cheeks pucker, the saliva flows, as you suck the sour lemon juice. And you continue walking.
Come out of the lemon grove onto a sandy ocean beach. Dazzling turquoise water stretches as far
as you can see. Smell the salt in the air. Lick your lips. You can taste the salt from the ocean spray.
Walk out onto the hot, dry sand. Move closer to the shimmering sea, standing where water
has been splashed. Remove your shoes and socks. Feel the cold, wet sand beneath your bare feet.
Walk back up on the beach. Lie down in the warm sand. A gentle breeze begins covering you
with sand. Feel it dry and light . . . Safe, secure, protected, in a warm cocoon of sand.
Now the sun is setting on the ocean. The sky is a throbbing orange, turning fiery red on the
horizon. As the sun sinks into the water, you are enveloped in a deep violet twilight. Look up
at the night sky. It is a brilliant starry night. The sound of the waves, the taste and smell of the
salt, the sea, the sky, and you; and you feel yourself carried upward and outward into space,
one with the universe.
(pp. 99–100)
 224  Improving Relationships with Our Environments

Technique: Determining One’s Sensory Modality

Counseling Intention To enable the client to explore his or her sensory imagery.
Description Mental images can be visual, auditory, proprioceptive (feelings and
skin sensations), kinesthetic (body movements), or olfactory and gus-
tatory (smell and taste). Although visual imagery is dominant for most
people, many people respond more readily to auditory, kinesthetic,
or olfactory images. Weinhold (1987, p. 9) developed the following
exercise to determine one’s sensory modality:

1. Visual
• Close your eyes and imagine all the colors in a box of paints or crayons—pink, orange,
yellow, purple, brown, white, red, and green.
Downloaded by [New York University] at 04:58 12 August 2016

• Close your eyes and imagine yourself walking or driving through a familiar street. Be
aware of all the things that you see.
• Close your eyes and take a trip through your own house or apartment; see everything
you can in each room.
2. Proprioceptive
• Close your eyes and imagine the feel of the water on your body as you take a bath or a
shower. Imagine an egg breaking in your hand; feel the slipperiness of it. Imagine hold-
ing a snowball in your bare hands, and imagine the wind nipping at your nose and ears.

3. Auditory
• Close your eyes and imagine a church bell ringing. Imagine an orchestra or group play-
ing or singing a favorite tune. Imagine the sound of an emergency siren.

4. Kinesthetic
• Imagine yourself swinging on a playground swing or going in a circle on a merry-go-round.
• Imagine yourself climbing a hill with a backpack on your back.
• Imagine yourself dancing or playing some sport.
5. Olfactory and Gustatory
• Imagine yourself ready to sit down to Thanksgiving dinner.
• Imagine tasting honey or bananas or your toothpaste.
• Imagine smelling your favorite cologne or perfume.

Guided imagery is most helpful in developing cognitive flexibility, imagination, and creativity.
Zilbergeld and Lazarus (1987) found that their clients have experienced success in using visualiza-
tion to deal with stressful situations and to accomplish their goals. It also can be used to rehearse
mentally for events, to imagine alternative futures, to synthesize facts, and to visualize getting well.

Technique: Favorite Quiet Place

Counseling Intention To help learn how to relax through imagination.
Description Repeat to the client the following:

No matter where you are, you can always go to a special place in your mind. Picture a place,
real or imagined, where you feel safe, calm, and happy. Close your eyes and go to that place. See
 Improving Relationships with Our Environments  225
yourself as free to do whatever you want. Notice everything around you. Hear the sounds. Feel
what is happening to your body. Just enjoy this feeling. You can go to this place to rest, think,
be alone, and feel good, no matter where you are. Slowly return to the place where your body is.
Gently open your eyes. The place will always be there for your return.

Technique: Creative Problem Solving

Counseling Intention To develop problem-solving strategies through visualization.
Description Repeat to the client the following:

Try to imagine your mind as a movie or television screen. You are the producer, actor, and
viewer, all at the same time. You can allow pictures to appear spontaneously on this screen with-
out consciously willing or controlling them.
Downloaded by [New York University] at 04:58 12 August 2016

Step 1: Relaxing. Begin to free your mind of distractions by closing your eyes or gazing at
a spot in front of you. Relax your body from your head to your toes. Pay attention to your
breathing, take a deep breath or two, and let go of your tension each time you breathe out.
Your mind is calm and clear. You are ready to tum your attention to pictures on the screen of
your mind.
Step 2: Spontaneous imagery. Allow images or pictures to come to your mind. Let them come
and go. Now picture a problem or situation that has been puzzling you. Do not force yourself to
look for an answer. Just see a clear picture of the situation or problem. Open your mind to pos-
sible answers and solutions. Let them come and go. Keep picturing the problem and solution,
and then wait. You will know whether one of the pictures fits your question or situation. It will
feel right and you will have a tingle of satisfaction. It may be an answer to a problem.
Step 3: Directed imagery. Continue feeling relaxed and quiet. Now you are directing the pictures.
You will take charge. Put the problem or situation on your screen. Explore in your mind’s eye ways
you might answer the question that appears on your screen. Notice how the story ends. Create
another story with a different ending. You are trying different ways to reach a solution. You see
yourself doing things to find out whether they work. Store these pictures in your memory for later
use. If no ideas or answers appeared, be satisfied that you were able to picture the problem. The
answer may come later. Write your ideas, draw them, or tell someone else so you will remember.
When processing, sometimes answers come immediately, but other times they may need time
to develop over a few days or months. All problems and questions must be explored, however,
so that the mind can consider alternative and potential solutions.

Solutions to problems often are inhibited because of restrictive or convergent thinking that
is emphasized in seeking the prescribed right/wrong, ready-made answer. Thinking about
possibilities or divergent thought can be encouraged by picturing oneself trying a solution
and considering all the possible consequences.
(Witmer & Young, 1987, p. 46)

Technique: Stress Management—Quieting Response

Counseling Intention To provide a systematic plan to eliminate or greatly reduce stressors.
Description Quieting response (QR) is a systematic, practical technique that can be
used any time. It can empower a client to gain control of a stress reac-
tion within minutes of the event. Instruct the client to do the following:

  1. Learn and practice the following steps: Recognize your stress symptoms (rapid breathing,
heart palpitations, rapid heartbeat, lump in throat, knot in stomach); breathe in slowly
 226  Improving Relationships with Our Environments
through the imaginary holes in the bottom of your feet (Byrum, 1989); begin to exhale;
relax the jaw and lower tongue; permit warm air to leave through the imaginary holes in
your feet; and imagine warmth and heaviness simultaneously with the exhalation as warm air
descends through your neck, shoulders, arms, and chest.
  2. Process why QR is an effective stress reduction technique and how it can be used in one’s
daily experiences.
  3. Compare feelings of tension and relaxation in various muscle groups; use QR to initiate the
relaxation state.

DAILY STRESS REDUCTION TIPS

Naturally, there will be times when these tips cannot be used, but one should try to gradually
incorporate them in life where possible.
Downloaded by [New York University] at 04:58 12 August 2016

  1. Add something beautiful to your life on a daily basis (e.g., flowers).

  2. Do some enjoyable activities whenever possible.
  3. Walk, work, and eat at a relaxed pace.
  4. Take a short break after meals to relax.
  5. If possible, go outside at least once per day and notice the simple things such as the weather
and scenery.
  6. During the day, whenever you remember, notice any tension in your body (jaw, neck, dia-
phragm, shoulders, etc.). Breathe deeply and gently stretch and relax any tense areas.
 7. If you notice your mind racing or worrying about the past or future, take a minute to
breathe deeply and gently focus on something in the moment, such as your breath, the
scenery, or birds.
  8. Take breaks during the workday to relax.
  9. Wear comfortable and loose clothing when possible. Take off your shoes when you can.
10. Avoid holding in feelings day after day, but instead find a safe place to feel, express, and
embrace them.

Some people find themselves falling back into excessively stressful habits from time to time.
That is perfectly normal. Simply notice that change in a nonjudgmental way and move back to
the stress reduction practices and tips that promote a healthy way of life.

Technique: Draining—A Frustration Management Exercise

Counseling Intention To enhance participants’ relaxation response (Glasgow, 1999).
Description Have a small group of people tense their muscles and breathe in:

  1. They should then stay tense for 5 seconds.

  2. They should start to relax, starting with the head and moving down to the feet, exhaling as
they do so.
  3. Repeat from Steps 1 to 3 several times.
  4. Once they have the knack, have them think of someone at whom they are angry or some-
thing that has frustrated them.
  5. Have them tense up, thinking of the anger or frustration.
  6. As they relax, tell them that the anger is draining out of them—all emotion is leaking out of
the tips of their toes and is now in a puddle at their feet.
  7. Once they have drained the anger, they should stand aside, out of the puddle, and leave the
anger behind.
 Improving Relationships with Our Environments  227
 8. Hold a discussion with the group to establish when it is appropriate to drain; have
them describe how they feel and discuss when it is wise to step aside from anger or
frustration.

Technique: Relieve Stress with the Pencil Drop

Counseling Intention To use an object to relieve stress (McKay & Fanning, 1999).
Description Have participants close their eyes and get in a comfortable position.

When localized areas of high-pressure air meet low-pressure air, they can spawn a whirl-
wind that sucks up dirt and trash and moves across the landscape, spreading disorder and
destruction.
When a high-pressure lifestyle meets a low ebb in energy level, an emotional whirlwind
Downloaded by [New York University] at 04:58 12 August 2016

makes everything that is valued—loved ones, career, hopes, and dreams—seem like debris swirl-
ing around aimlessly. Before taking off across an emotional landscape, spreading disorder and
destruction, take a moment to relax and center.
When life seems like a whirlwind, the image of the calm center is important.
At the exact center of a whirlwind, there is a spot of perfectly calm air. Self-talk should consist
of the following: “I am the calm center of the whirlwind. I can take a moment to right myself, to
return to center. At my core is a calm spot that does not tum with every gust of wind.” Paradoxi-
cally, when you take your place as the calm center, the whirlwind slows, the dust settles, and your
life seems more orderly and manageable.
An ordinary pencil can help find the calm center. This is something that can be done at a desk
or table, when working on the bills or doing homework, whenever there is a need to return to
the calm center quickly and get on with work:

  1. Pick up a pencil by the point end. Hold it very lightly between your thumb and fingertip,
letting the eraser end hang down a couple of inches above the tabletop. Cradle the head in
the other hand and get as comfortable as possible.
  2. Breath slowly and concentrate.
  3. When you are sufficiently relaxed, the pencil will slip out of your fingers and drop. That will
be the sign to let go completely, to just relax and feel peaceful for 2 minutes.
  4. Imagine the calm center of a whirlwind. Hear the cold wind whistling everywhere but the
calm center. The sun is shining. You are feeling warm and secure; imagine all cares and wor-
ries receding. The whirlwind expands and slows down. The calm center gets larger and more
relaxed.
  5. Continue breathing slowly, thinking about calming and relaxing all tight muscles. If a worry
or doubt intrudes, think, “That’s okay. I can let that go for now and relax. I’ll just sit here,
calm and centered, deeply, deeply relaxed.”
  6. Continue to enjoy the calm center for a couple of minutes. Then return to the task at hand
with renewed energy, feeling calm, relaxed, and focused.

Conclusion
One of the most important things we can do for our clients and ourselves is implementing
ways to manage stress and understand compassion fatigue, a professional liability of caring too
much. Stress is an unavoidable consequence of life. Fortunately, stress management is largely a
learnable skill. One technique discussed to decrease the effects of stress is imagery and visualiza-
tion. Thinking peaceful thoughts makes one feel relaxed. In imagining a peaceful place, clients
will also distract themselves from stressful thoughts. This focus embraces the basic premise of
 228  Improving Relationships with Our Environments
cognitive-behavioral psychology—that feelings and behaviors are largely caused by thoughts.
The best way to manage stress is to learn to change anxiety to concern. Concern means that
the client has the skills and motivation to take care of real problems in life and avoid panic and
anxiety. Changing feelings is largely a matter of learning to identify and change the upsetting
thoughts that are the immediate cause of upset emotions.
Downloaded by [New York University] at 04:58 12 August 2016
 11 Trauma, Loss, Grief, and
Post-Traumatic Stress
Debriefing Strategies

As violence, suicide rates, substance abuse, depression, self-injury, and post-traumatic stress disor-
Downloaded by [New York University] at 04:58 12 August 2016

der (PTSD) continue to increase in our society, therapists will be increasingly called upon to help
clients with the emotional and psychological stress that is a response to a sudden loss due to sui-
cide, homicide, anticipated loss, or sudden unexpected death. Clients experience the direct effects
of a sudden death and the residual long-term effects of a significant loss. Crisis management,
crisis intervention, emergency response, disaster preparedness, catastrophic events, tragedy, trau-
matic events, critical incidents, and random acts of violence have become common occurrences
in today’s society. In addition to natural and manmade disasters such as earthquakes, hurricanes
and fires, clients experience violence and death related to the suicide or sudden death of friends
and significant adults, gang activity, bullying, harassment, rape, murder, and threats of terrorism.
Violent behavior has more than doubled in the last decade, and violent acts are becoming
significantly more dangerous and insidious (CDC, 2013). Regretfully, within this context some
clients react with severe emotional responses such as fear, grief, blame, anger, guilt, depression,
anxiety, acute stress disorder, PTSD, and isolation. In some incidents, such experiences and other
events can threaten a child’s or adolescent’s sense of worth and well-being, which can induce the
type of intense personal turmoil that lead youth to think about hurting themselves or hurting
others. Today, this is demonstrated by increased incidents of gang violence, relational aggression,
self-injury, cyber bullying, suicide ideation, and other self-destructive or self-defeating behaviors.
Nothing in life is perhaps more painful than experiencing the loss of a friend or a loved one.
Even though most people experience varying degrees of loss, the grief cycle is not fully under-
stood until it comes closer to the heart. When sudden death comes with no time for anticipa-
tion, many additional feelings are involved in the grief process. The grief work normally will be
longer, lonelier, and more debilitating to lasting emotional stability because of the intensity of
the anguish experienced when someone is taken suddenly or senselessly. Grief work is not a set of
symptoms, but rather a process of suffering that marks a transition from an old lifestyle to a new
one, punctuated by numbness, denial, anger, depression, and eventually recovery. Post-traumatic
loss debriefing offers a therapeutic structure to “work through” the experience of traumatic loss
and accompanying stress. Talking about the death and related anxieties in a secure environment
provides a means to “work through” the experience and serves to prevent destructive fantasy
building. Because loss is so painful emotionally, however, our natural tendency (personally or
professionally) is to avoid or to deny coming to terms with loss. Inherently, loss is a process that
extends over time and more often than not has a lifelong impact.

Tasks of Mourning and Grief Counseling

The aftermath of severe or repeated trauma, or prolonged trauma, and/or trauma that is not
processed by the victim with sympathetic others can lead to unhealthy adaptations in understand-
ing the world, maintaining connections with others, and meeting needs in mature ways, as well
 230  Trauma, Loss, and Grief
as a disruption in central psychological assumption (cognitive schema) and memory processing
(Nicholas & Forrester, 1999, p. 323). The tasks of mourning and grief counseling include the
following:

• To accept the reality of the loss and to confront the fact that the person is dead. Initial denial
and avoidance are replaced by the realization of the loss.
• To experience the pain of grief. It is essential to acknowledge and to work through this pain,
or it will manifest itself through self-defeating behavior(s).
• To adjust to an environment in which the deceased is missing. The survivor(s) must face the
loss of the many roles the deceased person filled in his or her life.
• To withdraw emotional energy and reinvest it in another relationship. Initial grief reaction
to loss may be to make a pact with oneself never to love again. One must become open to
new relationships and opportunities.
Downloaded by [New York University] at 04:58 12 August 2016

• To accept the pain of loss when dealing with the memory of the deceased.
• To express sorrow, hostility, and guilt overtly, and to be able to mourn openly.
• To understand the intense grief reactions associated with the loss; for example, to recognize
that such symptoms as startle reactions, including restlessness, agitation, and anxiety, may
temporarily interfere with one’s ability to initiate and maintain normal patterns of activity.
• To come to terms with anger, which often is generated toward the one who has died, i.e.,
toward self, or toward others.
• To redirect the sense of responsibility that somehow one should have prevented the death.

Strategies for Processing Loss

The sudden, unexpected death by suicide or the sudden loss from an accidental death often
produces a characteristic set of psychological and physiological responses among survivors. Per-
sons exposed to traumatic events such as suicide or sudden loss often manifest the following
stress reactions: irritability, sleep disturbances, anxiety, startle reactions, nausea, headaches, diffi-
culty concentrating, confusion, fear, guilt, withdrawal, anger, and depression (Thompson, 1990,
1993). PTSD can result from three types of events: (1) natural disasters like floods, fires, earth-
quakes, hurricanes, and tornados; (2) accidents such as a car crash, bombing, or shootings; and
(3) human actions such as rape, robbery, assault, abduction, or abuse.
Goldenson (1984) profiled stress disorder as an anxiety disorder produced by an uncommon,
extremely stressful life event (e.g., assault, rape, military combat, flood, earthquake, hurricane,
death camp, torture, car accident, or head trauma) and characterized by (1) re-experiencing
the trauma in painful recollections or recurrent dreams or nightmares; (2) diminished respon-
siveness (emotional anesthesia or numbing) with disinterest in significant activities and with
feelings of detachment and estrangement from others; and (3) such symptoms as heightened
startle response, disturbed sleep, difficulty in concentrating or remembering, guilt about surviv-
ing when others did not (i.e., survivor guilt), and avoidance of activities that call the traumatic
event to mind (p. 573).
Diminished responsiveness to one’s immediate environment with “psychic numbing” or
“emotional anesthesia” usually begins soon after the traumatic event. Sometimes the stress reac-
tions appear immediately after the traumatic event, or a delayed reaction may occur weeks or
months later. With acute post-traumatic stress, the counseling intention is to help the client
return as rapidly as possible to full activity, especially on returning to the setting or circumstances
in which the trauma occurred.
With chronic PTSD, anxiety and depression are also prevalent. The particular pattern of the
emotional reaction and type of response will differ with each survivor, depending on the rela-
tionship of the deceased, circumstances surrounding the death, and coping mechanisms of the
 Trauma, Loss, and Grief  231
survivors. Grinspoon (1991a, b) provided 17 suggestions for counselors dealing with a client
who is experiencing PTSD:

• Provide a safe environment for confronting the traumatic event.

• Link events emotionally and intellectually to the symptoms.
• Restore identity and personality.
• Remain calm while listening to horrifying stories.
• Anticipate one’s own feelings or responses and coping skills—dread, disgust, anger at clients
or persons who had hurt them, guilt, or anxiety about providing enough help.
• Avoid overcommitment and detachment.
• Avoid identifying with the client or seeing oneself as rescuer.
• Tell the client that change may take some time.
• Introduce the subject of trauma to ask about terrifying experiences and about specific
Downloaded by [New York University] at 04:58 12 August 2016

symptoms.
• Moderate extremes of reliving and denial while the client works through memories of trauma.
• Provide sympathy, encouragement, and reassurance.
• Try to limit external demands on the client.
• During periods of client numbing and withdrawal, pay more attention to the traumatic
event itself.
• Help the client bring memories to light by any means possible, including dreams, associa-
tion, or fantasies.
• Examine photographs and old medical records; for children, employ play therapy, dolls,
coloring books, and drawings.
• Employ special techniques, systematic desensitization, and implosion to eliminate condi-
tioned fear of situations evoking memories and to achieve catharsis.
• Facilitate group therapy.

Critical Incident Stress Management (CISM)

Critical Incident Stress Management (CISM) is an integrative multicomponent crisis inter-

vention system originally developed by Everly & Mitchell (1999) and empirically validated
through quantitative analysis and controlled investigations. A critical incident is a sudden
powerful event, which is outside of the realm of ordinary experience with the potential of
overwhelming the coping skills of the individual or the group. Critical incidents in a school/
community setting can include: 1) death of a youth or adult in a school, community or
work setting; 2) accident or highly unusual injury; or 3) random acts of violence (such as a
shootings, stabbings, gang violence or a terrorist act). Critical Incident Stress Management
(CISM) is the use of deliberate and structured interventions with youth or adults who have
witnessed a traumatic or extremely stressful event with the intent to lessen the critical inci-
dent and accelerate the recovery process. CISM would be a strategy that the Crisis Response
Team would use with affected individuals. The debriefing usually takes one and a half hours
to three hours in length to accelerate the recovery process and contains seven phases:

(1) Introduction: This phase clarifies the process and sets the ground-rules and expecta-
tions for the debriefing. Confidentiality is a key component to this introductory phase
and must be clarified. It important for therapists to remember that youth in particular

(Continued)
 232  Trauma, Loss, and Grief

are minors and that parents or guardians have the right to any information regarding
their child especially if it concerns their health or well-being.
(2) Fact Phase: Provide facts about the incident and offer general information about the
incident. This is to control rumors and stop destructive fantasy building, especially in
adolescents. Each participant shares the nature of their experience. What happened?
What did you see, touch, hear? What is the last thing you remember? The purpose is
to regain memory and put things back into sequence.
(3) Thought Phase: Review the thoughts each person had at the time of the incident and
the time since the incident. What were your thoughts after the incident, what stands
out in your mind?
(4) Reaction Phase: Review the reactions each person had at the time of the incident and
in the time since the incident. What was the worst thing about the event? If you could
Downloaded by [New York University] at 04:58 12 August 2016

erase or change just one thing, what would it be? This opens up discussion about
potential guilt, regrets or missed opportunities that could have prevented the violence
from happening. For example, many youth leave clues in classroom essays or on social
media sites.
(5) Symptom Phase: The purpose is to identify personal symptoms of distress and exami-
nation of the physical and psychological after effects of the incidents in the areas of
cognitive (concentration and thinking), physical (fatigue and headaches), emotional
(panic and anxiety), behavioral (withdrawal from family and friends), and spiritual
(questioning faith). These are similar to PTSD symptoms, but do not last as long.
Clients need to know that these are normal reactions to an abnormal event.
(6) Teaching Phase: Educate about normal reactions and adaptive coping mechanisms,
such as encouraging stress management and reinforce that what clients are experienc-
ing is a normal response to an abnormal event. Provide information and handouts
regarding the specific incident as well as resources for counseling and treatment.
(7) Reentry Phase: Clarify any ambiguous information or issues not raised or addressed
and potentially repressed. Ask if anything has been left out. Frequently, clients will bring
unfinished business to the surface especially when they realize the debriefing is com-
ing to a close. Provide a summary statement and prepare for termination. Clients may
begin some planning such as memorial activities. The therapist should be cautioned that
planning memorial activities too soon may signal that the grieving process is over. Some
clients may not be ready to move on. In such cases memorials may be premature.

Source: Thomspon, Professional Counseling, pp. 425–428.

Seven Phases of CISM in Brief

(1) Introductions: Clarify time limits; confidentiality

(2) Facts: Everyone makes a brief statement regarding their relationship to the deceased
and what they heard; to share the same story and deter destructive fantasy building on
the part of the client
(3) Thoughts: How they heard about it and circumstances surrounding the event.
(4) Feelings: Ask “How were you feeling then, how are you feeling now?” to show that
things are getting better.
 Trauma, Loss, and Grief  233

(5) Symptoms: Explore physical and emotional reactions to traumatic event (e.g., diffi-
culty sleeping, intrusive dreams, inability to concentrate, flashbacks of the event)
(6) Teaching: Teach that symptoms are normal reactions to abnormal events
(7) Re-entry: Closure; some activity like notes or cards to the family; memorials, etc.
(assess those that need referral resources)

CISM debriefing is best used in small groups of clients directly affected by the critical
incident or loss. It is also appropriate with the increases in violence that many clients expe-
rience in their neighborhoods, their schools and their workplace. All these incidents are
barriers to individual well-being, needing to be addressed in a structured timely manner.
Not processing a loss or violent incident communicates to others that the victim’s lives
were not important or valued. It is not therapy, it is simply a structured debriefing proce-
Downloaded by [New York University] at 04:58 12 August 2016

dure to restore the recovery process and to restore normalcy.

Adaptive Family Debriefing

“The Adapted Family Debriefing Model (AFDM) was specifically developed as an assess-
ment and intervention method for young clients and their families exposed to violence
such as school shootings or terrorism (Juhnke & Shoffner, 1999). Evolved from CISM’s
single group experience, the Adapted Family Debriefing Model for young clients requires
two separate debriefing experiences. The first debriefing experience is with young client’s
parents only. The second is a joint debriefing experience with both young clients and their
parents. Additionally, unlike the CISM process which utilizes nonprofessional, adult peer
facilitators, the Adapted Family Debriefing Model for clients requires the use of trained
professionals who have specific knowledge regarding youth’s developmental needs and
reactions to traumatic events” (Thompson, 2012, p. 427).

Roles of the Debriefing Team

“There are three primary team members within the Adapted Family Debriefing Model:
(1) leader, (2) co-leader, and (3) doorkeeper. The leader explains the debriefing process,
creates a supportive environment, identifies those experiencing excessive levels of emo-
tional discomfort, and directs team members to intervene with distraught students or
parents. In addition, the leader discusses with parents and students common symptoms
experienced by youth who:

(a) Have personally experienced terrorist acts or have suffered loss as a result of such acts
(e.g., the death of a grandparent, parent, sibling, or other relative resulting from ter-
rorism or violence, etc.);
(b) Have witnessed via the media terrorist acts (e.g., experiencing vicarious traumatization);
(c) Understand the potential for continued terrorist acts; or
(d) Experience the cumulative effects of multiple terrorist acts.

The leader attempts to normalize manifested symptoms (i.e., these are normal reac-
tions to abnormal events) and encourages parents to recognize more severe symptomatol-
ogy in their children which may require additional counseling (e.g., recurrent encopresis,

(Continued)
 234  Trauma, Loss, and Grief

persistent outbursts of anger, chronic hypervigilance or regressive behaviors). Co-leaders

add relevant comments and supportive information during the session and give immediate
assistance to students and parents who become emotionally distraught. The doorkeeper
prevents nonparticipants, such as self-serving news journalists, politicians, or other indi-
viduals that want to further sensationalize the event from entering the session and redirects
them to another meeting time. Doorkeepers also prevent severely distraught students or
parents from leaving the sessions prematurely.

Separate Debriefings for Parents and Children

Parents and youth have different needs and want different kinds of information, so the first
session is conducted with parents only. It is important to keep the number of parents’ small
(i.e., fewer than 12). Parents often express frustration and anger regarding their inability
Downloaded by [New York University] at 04:58 12 August 2016

to adequately protect their youth from acts of terrorism or other forms of violence. Many
will perceive the situation as “hopeless” and “out of their control.” These feelings of pow-
erlessness undermine parents’ innate need to protect and adequately care for their children
and adolescents. Thus, it is imperative that the team keeps parents focused on attending to
the immediate needs of their children. Parents need to be reminded that the goals of this
session are to:

(a) Learn about possible symptoms their child or adolescent may exhibit,
(b) Obtain available referral sources if needed, and
(c) Learn to validate and normalize their child or adolescent concerns.

During the joint child-parent debriefing, two circles are formed. No more than five or
six youth of similar ages should sit in the inner circle with friends or familiar peers present-
ing with similar concerns or fears. Parents should sit behind their children, promoting a
perception of stability, unity, and support. The seven steps follow similar steps that were
outlined in CISM:

1. Introduction step. During the introduction step, the leader introduces team mem-
bers and establishes rules for the debriefing experience. Confidentiality, is a critical
component of this process and is explained in terms that are developmentally under-
standable to the youth. Participants are encouraged not to discuss what is said within
the session outside the debriefing room when the session is over. The leader states that
the purpose of the session is to help youth better understand their feelings about the
specific terrorist act and increase their coping skills related to the potential of future
terrorist or violent threats.
2. Fact gathering step. The second step of the process is fact gathering. The leader will
ask the youth to report what the experience of the terrorist or violent act was like for
them. Each youth is encouraged to speak about what they experienced. Should the
debriefing be related to terrorist or violent acts which the youth indirectly observed
via media coverage, the leader may begin by asking about what the youth observed
on television, other media outlets, or social media. Those speaking are encouraged to
state what they did when they first saw or heard about the terrorism or violent act.
Emphasis is placed upon telling the facts of what each child encountered, in an effort
to observe discrepancies in what was observed and to share the same story. Parents
should be advised to limit media viewing for their youth.
 Trauma, Loss, and Grief  235

3. Thought step. This transitional step helps participants move from the cognitive to the
affective domain. The leader asks questions related to what thoughts occurred when
the terrorism or violence erupted. During this step it is crucial to continue to validate
and normalize each child’s reported thoughts and perceptions.
4. Reaction step. The thought step can quickly move into the more emotionally
charged reaction step. Here, the focus should be kept upon participants’ reac-
tions to the terrorism. Typically, the leader will start with a question like, “What
has been the most difficult part of seeing the planes fly into the Twin Towers
during September 11, 2001?” or “What was the most difficult part of seeing
your teacher or friend get shot at the school shooting at Sandy Hook, Newtown,
Connecticut?”
5. Symptom step. During this step, the leader helps direct the group from the affec-
Downloaded by [New York University] at 04:58 12 August 2016

tive domain back to the cognitive domain. The leader uses age appropriate language
to ask youth about any physical, cognitive, or affective symptoms experienced since
the violent episode. Symptoms such as nausea, sleep difficulties, inability to concen-
trate, or feelings of anxiety should be explained and those who have encountered such
experiences should raise their hands. A show of hands helps normalize the described
symptoms and often helps survivors experience relief in knowing that they have shared
the same experiences and feelings.
6. Teaching step. Symptoms experienced by group members are reported in age appro-
priate ways as being both normal and expected. Possible future symptoms can be
briefly described (e.g., reoccurring dreams of being attacked, nightmares, or difficulty
falling asleep). This helps both parents and their children better understand symptoms
that they may encounter and gives permission to discuss such symptoms. During this
step the group leader may ask, ‘What have you done or noticed your friends, teachers
and parents doing that have helped you handle this situation?’ This question helps
them begin to look for signs of returning to normal. Sometimes older children will
express feelings of support from peers, teachers, or parents. Younger children may use
active fantasy, such as pretending to be a hero, to help them better cope with their
fears or concerns.
7. Re-entry step. The re-entry step attempts to place some closure on the experience
and allows participants to discuss further concerns. The leader may ask students
and parents to revisit pressing issues, which might help the debriefing process come
to a more successful end. After addressing any issues, the debriefing team makes a
few closing comments related to group progress or support. A hand-out for stu-
dents and another written for adults discussing common reaction symptoms can
be helpful. Younger children may prefer drawing faces which depict how they cur-
rently feel (e.g., anxious, sad, frightened). Later, parents can use these pictures as
conversation starters with their children at home. Hand-outs should list a 24-hour
helpline number and include the telephone number for the child’s professional
school counselor and other support personnel in the community. The promotion of
peer support (both parent and child) is important. Children and parents should be
encouraged to telephone one another over the next few days to aid in the recovery
process.

Source: Juhnke, G. A. (2002). Intervening with school students after terrorist attacks. In G. R. Walz &
C. J. Kirkman (Eds.), Helping people cope with tragedy & grief (pp. 13–17). Greensboro, NC: CAPS
Publications.
 236  Trauma, Loss, and Grief
The Adapted Family Debriefing Model described earlier is a structured debriefing opportunity
for helping both youth and their families cope with negative psychological and social effects
by formally educating them about what to expect (this is especially critical with the increase in
school shootings). The model has distinct differences from traditional CISM because it processes
parents separately and then together with their children. This is a very therapeutic intervention.
The model is relatively easy to implement and can be modified to meet the needs of both chil-
dren and parents collectively. The Adapted Family Debriefing Model for children is a means of
helping both survivors of terrorism and violence to cope with negative psychological and social
effects by formally educating them about what to expect and that these social, emotional, and
physical reactions are normal reactions to abnormal events.

Ten Ways to Recognize Post-Traumatic Stress Disorder

Post-traumatic stress disorder is, in many ways, a normal response to an abnormal situation.
Downloaded by [New York University] at 04:58 12 August 2016

Clearly, the tragedies that occurred on September 11, 2001, were unprecedented. After such a
tragic event, it is likely that many will experience a variety of symptoms and emotions. Some-
times these symptoms surface several weeks or months after the tragedy in the form of PTSD.
Recognizing these symptoms is the first step toward recovery and finding appropriate treatment:
  1. Re-experiencing the event through vivid memories or flashbacks.
  2. Feeling “emotionally numb.”
  3. Feeling overwhelmed by what would normally be considered everyday situations and dimin-
ished interest in performing normal tasks or pursuing usual interests.
  4. Crying uncontrollably.
  5. Isolating oneself from family and friends and avoiding social situations.
  6. Relying increasingly on alcohol or drugs to get through the day.
  7. Feeling extremely moody, irritable, angry, suspicious, or frightened.
  8. Having difficulty falling or staying asleep, sleeping too much, and experiencing nightmares.
  9. Feeling guilty about surviving the event or about being unable to solve the problem, change
the event, or prevent the disaster.
10. Feeling fears and sense of doom about the future.

The child/adolescent assessment of post-traumatic stress (Table 11.1) can be used as a tool to

normalize terrifying feelings and identify potential high-risk youth. It is important to explain that
these are normal reactions to a traumatic or catastrophic event.
Table 11.1  Some Common Symptoms of Psychological Trauma for Critical Incidence Stress Manage-
ment, the Family Debriefing Model, and Post-Traumatic Stress Disorder
Physical Hypervigilance
Symptoms Exaggerated startle response
Difficulty sleeping
Difficulty with concentration and memory
Mood irritability—especially anger, depression, or emotional outbursts
Intrusive Recurring distressing recollections (thoughts, nightmares, memories, dreams,
Symptoms flashbacks)
Physical and psychological distress or the event that symbolizes the trauma, grief, or
survivor guilt
Acting and feeling as if reliving the event
Avoidant Avoiding specific thoughts, feelings, activities, or situations that may trigger the
Symptoms previous trauma
Diminished interest in significant activities
Restricted range of emotions
Source: Flannery, R. B. (2004). Posttraumatic Stress Disorder: The Victim’s Guide to Healing and Recovery, 2nd
edition. New York: American Mental Health Foundation, p. 11. Reprinted with permission.
 Trauma, Loss, and Grief  237

Therapeutic Approaches to Process Post-Traumatic Stress Disorder

Both medication and psychotherapy can be helpful. The most effective treatment approaches are
“cognitive-behavioral” because they focus both on the way traumatized persons view the trauma
and on their resulting behavior. Exposure therapy includes systematic desensitization (training to
relax in the face of frightening reminders of the trauma) and imaginable, in vivo techniques such
as flooding or the process of putting the client back into the trauma psychologically. The most
effective treatment for PTSD includes a variety of anxiety management training strategies. Some
of these include rational emotive therapy (RET), various kinds of relaxation training, stress inoc-
ulation training, cognitive restructuring, breathing retraining, biofeedback, social skills training,
and distraction techniques. Innovative therapists are successful in combining various techniques
to fit the trauma and the patient’s unique needs and requirements.
Downloaded by [New York University] at 04:58 12 August 2016

Phases of Recovery
Peter and Straub (1992, pp. 246–247) classified the recovery process as four phases:

1. Emergency or Outcry Phase. The survivor experiences heightened “fight or flight” reac-
tions to the life-threatening event. This phase lasts as long as the survivor believes it to last.
Pulse, blood pressure, respiration, and muscle activity are all increased. Concomitant feel-
ings of fear and helplessness predominate. Termination of the event itself is followed by relief
and confusion. Preoccupation centers around questions about why the event happened and
the long-term consequences.
2. Emotional Numbing and Denial Phase. The survivor shelters his or her psychic well­being
by burying the traumatic experience in subconscious memory. By avoiding the experience,
the victim temporarily reduces anxiety and stress responses. Many survivors may remain at
this stage unless they receive professional intervention.
3. Intrusive-Repetitive Phase. The survivor has nightmares, mood swings, intrusive images,
and startle reactions. Overreliance on defense mechanisms (e.g., intellectualization, pro-
jection, or denial) or self-defeating behaviors (e.g., abuse of alcohol or other drugs) may
become integrated into coping behaviors in an effort to repress the traumatic event. At this
juncture, the delayed stress becomes so overwhelming that the survivor may either seek help
or become so mired in the pathology of the situation that professional intervention becomes
necessary.
4. Reflective-Transition Phase. The survivor is able to put the traumatic event into perspec-
tive. He or she begins to interact positively and constructively with a future orientation and
exhibits a willingness to put the traumatic event behind him or her.

Perspective for the Therapist: On Loss and Grief

The only cure for grief is action.
—George Henry Lewes

Technique: Clinical Interventions

Counseling Intention To help clients through phases of grief and loss.
Description Rando (1984) provides the following clinical interventions for car-
egivers when confronting dying, grief, and death:

• Be present emotionally as well as physically to provide security and support.

• Do not allow grievers to become socially isolated.
 238  Trauma, Loss, and Grief
• Make certain that grievers have the appropriate medical evaluation and treatment available if
symptoms warrant.
• Encourage the verbalization of feelings and recollections of the deceased.
• Help grievers identify any unfinished business with the deceased and look for appropriate
ways to assist closure. (One way that comes to mind is having the client write a letter to the
deceased.)
• Help grievers find a variety of new sources of personal satisfaction following the loss. Encour-
age grievers to be patient and not set unrealistic expectations for themselves.
• Help grievers to recognize that loss always brings about change and the need for new
adjustments.
• Assist grievers in getting and maintaining a proper perspective on what the resolution of
grief will mean.
• Encourage grievers, at the appropriate time, to find rewarding new things to do and people
Downloaded by [New York University] at 04:58 12 August 2016

to invest in.

Technique: Multiple Strategies to Process Grief and Loss

Counseling Intention To meet the diversity of needs when processing loss (Miller, 2003).
Description Many strategies are available to help people who are mourning a loved
one’s death. Different kinds of losses dictate different responses, so
not all strategies will suit everyone. Equally, no two people grieve
alike, so what works for one may not work for another.

Carry or Wear a Linking Object. Carry something that belonged to the one who died—a keep-
sake, a small object, or a memento. Wear a piece of his or her jewelry in the same way. Look at
the keepsake and remember what it signifies.
Create a Memory Book. Compile photographs that document a loved one’s life. Arrange them
into some sort of order so they tell a story. Add other elements such as diplomas, newspaper
clippings, awards, accomplishments, and reminders of significant events. Put all this in a special
binder and keep it out for people to look at if they wish. Go through it and reminisce about posi-
tive experiences of the past.
Ask for a Copy of the Memorial Service. If the funeral liturgy or memorial service held special
meaning because of what was spoken or read, ask for a copy of the words. Whoever participated
in that ritual will feel gratified that what they prepared was appreciated. Some people find these
thoughts provide even more help weeks and months after the service.
Start a Journal. Write out thoughts and feelings. Do this at least several times a week, if not
several times a day. Don’t censor what is written. Let feelings flow. In time, go back over what
was written and notice change and growth. Write about that, too.
Write to the Person Who Died. Write letters or other messages to the deceased, especially
thoughts that were not expressed when that person was alive. Preserve what you write in a jour-
nal. The urge to write the deceased will eventually diminish. Initially, writing serves to release
important emotions and to provide a connection to the deceased.
Light a Candle at Mealtime. Consider lighting a taper at the table in memory of a loved one.
Pause to remember the deceased and keep him or her nearby.
Create a Memory Area at Home. In a space that feels appropriate, arrange a small table that hon-
ors the person: a framed photograph or two, perhaps a prized possession or award, or something
he or she had created or loved. This might be placed on a small table, a mantel, or a desk. Some
people like to use a grouping of candles, representing not just the person who died, but others who
have died as well. In that case, a variety of candles can be arranged, each representing a unique life.
 Trauma, Loss, and Grief  239
Structure Alone Time. Structure time to be alone. A large part of the grieving process involves
what goes on inside—absorbing the thoughts, feelings, memories, hopes, and dreams. Allow the
opportunity to go inside in order to grow inside.
Do Something the Deceased Would Enjoy. Remember the one who died in a unique way. For
example, prepare a loved one’s favorite dish on significant holidays. The meaning and satisfaction
don’t have to end with the death of that person.
Engage the Soul. Some people meditate, some pray, and some spend time alone in nature.
Some worship with a congregation, and others do it on their own. Many grieving people begin
to sense that all of the human race, living and dead, are connected on a spiritual level in a way
that defies understanding.
Change Some Things. As soon as it seems right, alter some things in the home environment to
make clear a significant change has occurred. Rearrange a room, replace a piece of furniture, or
give away certain items that will never be used again. This does not mean to remove all signs of
Downloaded by [New York University] at 04:58 12 August 2016

the one who died. It does discourage treating the home as a shrine, which would be unhealthy
grieving.
Talk to the Deceased Loved One. If it helps, talk with the one who died while driving, walking,
or when needing the courage to make an important decision. This self-talk serves the need to talk
things over or to process unfinished conversations. This inclination to converse will eventually go
away when the time is right.
Create a Memory Quilt. Sew or invite others to sew a memory quilt. Put together a wall hang-
ing or a bedroom quilt that remembers the important life events of the one who died. Take time
and make it what it is: a labor of love.
Read How Others Have Responded to a Loved One’s Death. Look at the ways others have pro-
cessed grief, try Judith Viorst’s Necessary Losses (1986), C. S. Lewis’s A Grief Observed (1963),
Lynn Caine’s Widow (1974), John Bramblett’s When Good-Bye Is Forever (1991), and Nicholas
Wolterstorff’s Lament for a Son (1982). There are many others. Check with a counselor or a
librarian.
Reward Personal Growth. Do things that are personally rewarding. Indulge in a favorite
meal or delicacy. Get a massage. Buy some flowers. Do something frivolous and soak up those
moments.
Write Down Lessons Learned. The grief experience is a learning process. Reflect upon what has
been learned. State it plainly and review it routinely.

Technique: Make a “Tear Jar”

Counseling Intention To process grief in a productive way.
Description In the dry climate of ancient Greece, water was a precious commod-
ity. Giving up water from one’s own body when crying tears for the
dead was considered a sacrifice. They caught their precious tears in
tiny pitchers, or “tear jars.” The tears became holy water and could be
used to sprinkle on doorways to keep out evil or to cool the feverish.
The clay tear jars were kept unpainted until the owner had experienced
the death of a parent, sibling, child, or spouse. After that, the griev-
ing person decorated the tear jar with intricate designs. This ancient
custom symbolizes the transformation that takes place in people who
have grieved deeply. They are not threatened by the grief of people in
pain. They have been in the depths of pain themselves and returned.
Like the tear jar, they can now be with others who grieve and catch
their tears.
 240  Trauma, Loss, and Grief

Technique: Resolving Grief by Remembering Positive Feelings

Counseling Intention To create an “associated experience” that gives the grieving person a
sense of a loved one’s “felt presence” (Andreas & Andreas, 1989).
Description The first step in resolving grief is to find out how the client repre-
sents a loved one’s “felt presence.” Ask the client to think of a loved
one who is not physically present. Ask the client to visualize the time
the valued relationship actually occurred and identify the “present-felt
sense of love and comfort.” Use this information as a “template” to
transform the grief experience into the felt presence in which the client
can enjoy previously felt good feelings.
Next, have the client focus on the special qualities of the relation-
ship that he or she had with the deceased—the love, comfort, stabil-
ity, companionship, or whatever special experiences existed between
Downloaded by [New York University] at 04:58 12 August 2016

them. Use the template of the felt presence to transform the loss
experience into an “associated image” from which the client can
re-experience the good feelings previously felt. The client regains
access to all the special feelings he or she previously had with that
person.

Loss, Crisis, and Grief: Special Considerations for Children

The intense anxiety and fear that often follow a disaster or other traumatic event can be especially
troubling for children and adolescents. Some may regress and demonstrate younger behaviors
such as thumb sucking or bed wetting. Children may be more prone to nightmares and fear
of sleeping alone. Performance in school may suffer. Other changes in behavior patterns may
include throwing tantrums more frequently or withdrawing and becoming more solitary. There
are several things parents and others who care for children can do to help alleviate the emotional
consequences of trauma:

• Spend more time with children and let them be more dependent on you during the
months following the trauma. For example, allow the child to cling to caregivers more
often than usual. Physical affection is very comforting to children who have experienced
trauma.
• Provide play experiences to help relieve tension. Younger children in particular may find it
easier to share their ideas and feelings about the event through nonverbal activities such as
drawing.
• Encourage older children to discuss their thoughts and feelings with one another. This helps
reduce their confusion and anxiety related to the trauma. Respond to questions in terms
they can comprehend. Reassure them repeatedly that you care about them and that you
understand their fears and concerns.
• Keep regular schedules for activities such as eating, playing, and going to bed to help restore
a sense of security and normalcy.

Parents should be alert to these changes in a child’s behavior:

• Refusal to return to school and “clinging” behavior, including shadowing the mother or
father around the house.
• Persistent fears related to the catastrophe (such as fears about being permanently separated
from parents).
 Trauma, Loss, and Grief  241
• Sleep disturbances such as nightmares, screaming during sleep, and bed wetting, persisting
more than several days after the event.
• Loss of concentration and irritability.
• Startling easily and jumpy behavior.
• Behavior problems, for example, misbehaving in school or at home in ways that are not typi-
cal for the child.
• Physical complaints (stomachaches, headaches, dizziness) for which a physical cause cannot
be found.
• Withdrawal from family and friends, sadness, listlessness, decreased activity, and preoccupa-
tion with the events of the disaster.

It is important to use the language of death when working with children. Stating that a
loved one has “gone away,” “is lost,” or “is sleeping” can be very frightening to children and
Downloaded by [New York University] at 04:58 12 August 2016

delays their accepting and understanding that the person will not come back. Children must
have clear and concise information regarding the death of the loved one, or they may construct
their own stories to fill in their emotional holes. This is destructive fantasy building. Children
must not be denied the opportunity to express their feelings in ways that are appropriate to
them. There is considerable evidence of the resilience of children. Nourished by love, protec-
tion, guidance, and attention, they can spring back after even the most horrendous traumatic
events (Johnson, 1998). The parent is often the most influential factor in the recovery of the
child. When considering the developmental and social factors that determine the suitability of
including the child in therapy, the therapist should assess the parents as carefully as the chil-
dren, because the role the parent plays will determine whether their children can benefit from
therapy (Nader, Dubrow & Stamm, 1999). One of the goals for treatment of traumatized
children is to help the child face the truth of what has happened. This involves enabling the
child to draw, sing, dance, talk, or engage in some other form of self-expression that is also a
self-soothing activity.

Technique: How to Help a Child or Adolescent through Denial

Counseling Intention To open the door to confront the loss of a loved one.
Description As a counselor or therapist, do not refute or debate the child or adoles-
cent’s current reality. Identify with the child’s or adolescent’s feelings
by saying, “You really must be missing now” or “You must be feeling
really lonely now.”

If the child doesn’t want to talk, provide or suggest activities with continuity such as a scrap-
book of photos or artwork portraying “the way things were then and the way things are now.”
Include normal routines such as home, school, family, dinner time, weekends, bedtime, time
alone, and holidays.

Technique: How to Help a Child through Acceptance after a Traumatic Event

Counseling Intention To reestablish a sense of control.
Description Make toys available to encourage reenactment play. Dolls, puppets,
building blocks, cars, fire trucks, ambulances, or other imaginative
toys or props can be used to duplicate the recent crisis. Help the child
to find positive outcomes in his or her play.
 242  Trauma, Loss, and Grief

Technique: How to Help an Older Child with Fear after a Death

Counseling Intention To process loss.
Description Help older children tell their story. Discuss what happened to the
deceased and how people survive a major loss. Remind them of their
support of people around them. Remind them of the strengths they
used in the past when a friend moved away or a pet died.

Technique: Providing Permission and Structure to End the Mourning Process

Counseling Intention To help with leaving the mourning period behind.
Description Dealing with loss differs for each client. However, one aspect that holds
true is that the closer the attachment to the deceased, the greater the loss.
Downloaded by [New York University] at 04:58 12 August 2016

l. At the appropriate time, give the child or adolescent permission to cease the mourning
period.
2. Help the child or adolescent choose a ritual to say goodbye.
3. Remind the child or adolescent that the memory of the relationship will never end, just the
deceased’s presence.
4. Explore what has been learned from the life of the deceased.
5. Help the child or adolescent plan how to make that memory a part of his or her life, such as
with a linking object.
6. Encourage a reinvestment in new or forgotten activities.

Technique: Using a Group Mural to Deal with a Traumatic Loss

Such as the Loss of a Classmate
Counseling Intention To integrate a tragedy in a positive way.
Description Have children or adolescents in a group depict a common tragic event
they shared. Each person’s idea for inclusion in the picture should be
drawn by that person. Allow the group to reach a consensus about
what should be in the mural. Hang the mural in a common area and
don’t take it down until there is a collective discussion to remove it.
This provides an opportunity to make the tragedy tangible so that
survivors can integrate the loss and move on with their daily lives.

Technique: Circle of Trust to Identify Support during Grief

Counseling Intention To reassure children that they have people around them whom they
can count on (Goldman, 2001, pp. 109–110).
Description The trust circle strategy (Figure 11.1) can act as a preventive tool to
be used as needed to create awareness of present support during a
grief period and as a vehicle for discussion and communication about
thoughts, feelings, and emotions children harbor within themselves
about people in their lives.

1. The child pastes his or her picture in the center of the circle.
2. Help the child identify people in his or her life that he or she cares about and with whom feel-
ings can be trusted.
I can call on these people if I need to talk or ask for something. My very most trusted people
are: __________________________________________________________________
 Trauma, Loss, and Grief  243
Downloaded by [New York University] at 04:58 12 August 2016

Figure 11.1  Circle of Trust

Their phone numbers are: ________________________________________________

Have the child write these peoples’ names, draw their pictures, or paste photos of them in
the innermost circle.
3. Help the child identify other people who can help, such as family, friends, teachers, neighbors,
coaches, etc.
There are even more people in my life I can depend on. They are: _____________________
____________________________________________
Their phone numbers are: ______________________________________________________
____________
Write their names, draw their pictures, or paste photos of them in the middle circle.
4. Help the child identify other adults who he or she likes, such as the school nurse, the school
counselor, or a friend of the child’s parents.
Sometimes there are people I like in my life, but I am not sure I can call them for help. They
are: _____________________________________________
I would (or would not) like to be able to call on them. I will ask them for their numbers and
tell them why I would like their phone numbers.
Write their names, draw their pictures, or paste their photos in the outer circle.

Loss, Crisis, and Grief: Special Considerations for Families

The family’s loss history provides the template for their present grieving and mourning. A death
is often an “emotional shock wave” experienced by the family. This shock wave flows through
the generations. Previous loss will directly and indirectly affect how a particular family copes and
 244  Trauma, Loss, and Grief
adapts. It is important to understand the social, spiritual, gender, and ethnic contexts within
which the family lives, as these contexts define how the family will relate to their grief. The fam-
ily’s previous experiences and family traditions regarding loss and death, as well as methods of
coping, are areas that should be addressed:

• What type of losses has the family experienced? What are the dates?
• How did they or their parents or grandparents historically handle situations involving loss?
• How has the family discussed bad news?
• How has the family expressed sadness in the past?
• Are outward expressions of emotions considered a weakness? Is there a gender distinction?
• How has the family managed loss? Have they put it in the past and moved on?

Have those members who wished to talk about their loss been able to talk openly?
Downloaded by [New York University] at 04:58 12 August 2016

• Do family members take on specific roles in the bereavement process?

• Is there a gender-based difference in the ways that family members cope?
• How have children been included in the bereavement process?
• What types of rituals of mourning were used in their families of origin?

Framing the Problem

Listen carefully to how family members describe both the traumatic memories and their responses
as individuals and as a family. Traumatic memory management varies among individuals and
within families. Some family members have vivid recollections of the traumatic event and recall it
in a clear and direct manner; others either have difficulty remembering or do not wish to discuss
it with others. In this early phase of treatment there are six guidelines in the treatment protocol:
1. Telling the family’s stories. Each member of the family is encouraged to explain his or her
experience with the trauma, focusing on the worst parts and explaining his or her thoughts, feel-
ings, emotions, and kinesthetic reactions.
2. Promoting new rules of communication. The fundamental principle for trauma treatment is
for clients to feel safe, respected, and supported so that they can tell their story, become desen-
sitized to the trauma, and help collaboratively construct a method to enable the family cope and
thrive. Drawing lessons from the traumatic event can often foster more love and respect for each
other.
3. Promoting understanding and acceptance. Sometimes families in crisis, particularly couples,
emotionally withdraw as a result of distress and the fragmented nature of family relationships.
Given this challenging reality, the therapist must work to keep clients together in order to reach
a level of understanding and acceptance about the trauma and the complexity of family member
reactions.
4. Listing wanted and unwanted consequences. While the family is struggling to understand and
accept what has happened to them, the therapist should attempt to also get them to articulate
their incentives. Sometimes the family has difficulty identifying a clear and reachable objective.
They most often start with rather vague and broad goals, such as “to understand why this hap-
pened to us.” This may not be possible under some circumstances. It is more therapeutic to help
the family get along better so that they are not fighting and blaming but rather healing after
the loss.
5. Preventing victimization and blaming. It is very normal and natural to simplify the situation
by using a scapegoat in the family to shift the blame away from the family. It is critical to help
family members express their feelings, attitudes, and physical reactions in a way that does not
hurt another family member.
 Trauma, Loss, and Grief  245
6. Shifting attention to the family. The therapist must strive to shift the discussion to how
the family plays a role in maintaining the trauma in their thoughts, feelings, and behaviors. It is
important that the family realize that the cause of the trauma may be beyond their control, but
the consequences and interpersonal relationships can be controlled.

Creating Meaningful Rituals

Creating and participating in a ritual after the immediate time period acknowledges the loss
in a way that is personally significant for the bereaved. Additionally, when there is unfinished
business, issues involving other types of closure, or when the family simply wants to develop a
personal way of remembering, rituals provide a method of accomplishing these ends. Some of the
saddest words in the English language are “If I had only had a chance to tell him.” These words
are heard countless times from the bereaved. One more chance to say goodbye, or one more
Downloaded by [New York University] at 04:58 12 August 2016

opportunity for closure, often haunts the bereaved for months, if not for years and generations
(Cook & Dworkin, 1992). The development of the ritual must come from the client’s frame of
reference. It is important for clinicians to understand which religious and cultural beliefs hold
particular significance for their clients and not assume that each member of the family believes
in the same way. In helping the bereaved construct a meaningful ritual, the therapist may make
suggestions, such as writing a letter to say goodbye, having a conversation at the graveside, or
role-playing a last conversation and creating a different ending. For the ritual to have meaning,
the ultimate decision and design must come from the bereaved.

Finding Closure and Preparedness

The final phase is a time for shifting to post-treatment, in which the family will return at some
specified number of months as a way of assuring that the family has healed and is better prepared
for life’s losses. There are four useful criteria for working with traumatized families:

1. Did they reach their treatment goals?

2. Did the family develop a healing theory that all members embrace?
3. Did new rules and skills of family communications emerge?
4. Did the family experience a sense of accomplishment?

A sign of success and the end of weekly sessions is when the family members begin to act like
the session is routine and regularly talk much more than the therapist. This is a sign that clients
are now empowered to take back control of their lives. This places the therapist in the advan-
taged role of consultant, providing advice, assistance, and consultation as family members work
together toward a common goal.

Taking Care of the Caregivers: A Neglected Survival Technique

The therapist who listens to others’ stories of fear, pain, and suffering may feel similar fear, pain,
and suffering because he or she cares. Helping professionals in all therapeutic settings are espe-
cially vulnerable to compassion fatigue, including emergency care workers, counselors, mental
health professionals, medical professionals, clergy, advocate volunteers, and human service work-
ers. The concept of compassion fatigue emerged only in the last several years in the professional
literature. It represents the cost of caring about and for traumatized people.
Compassion fatigue is the emotional residue of exposure to the suffering, particularly those
suffering from the consequences of traumatic events. Professionals who work with people, par-
ticularly people who are suffering, must contend not only with the normal stress or dissatisfaction
 246  Trauma, Loss, and Grief
of work, but also with the emotional and personal feelings for the suffering. Compassion fatigue
is a state of tension and preoccupation with the individual or cumulative trauma of clients as
manifested in one or more ways, including re-experiencing the traumatic event, avoidance of or
numbing to reminders of the event, and persistent arousal. Although similar to critical incident
stress (being traumatized by something you actually experience or see), with compassion fatigue,
helping professionals absorb the trauma through the eyes and ears of clients. It can be thought
of as secondary post-traumatic stress.
There are human costs associated with compassion fatigue. It reflects physical, emotional, and
spiritual fatigue or exhaustion that takes over a person and causes a decline in his or her ability
to experience joy or to feel and care for others. Compassion fatigue is a one-way street, in which
individuals are giving out a great deal of energy and compassion to others over a period of time,
yet aren’t able to get enough back to reassure themselves that the world is a hopeful place. It’s
this constant outputting of compassion and caring over time that can lead to these feelings.
Downloaded by [New York University] at 04:58 12 August 2016

Compassion fatigue comes from a variety of sources. Although it often affects those working in
caregiving professions—nurses, physicians, mental health professionals, clergy, and others—it
can affect people in any kind of situation or setting where they’re doing a great deal of caregiving
and expending emotional and physical energy day in and day out. Compassion fatigue develops
over time, taking weeks, sometimes years, to surface. Basically, it’s a low-level, chronic cloud-
ing of caring and concern for others. Over time, the ability to feel and care for others becomes
eroded through overuse of the skills of compassion. Caregivers may also experience emotional
blunting, reacting to situations differently than others would normally expect.
When caregivers become emotionally drained from hearing about and being exposed to the
pain and trauma of the people they are helping, self-care strategies can inhibit the fatigue of car-
ing too much.

Self-Awareness and Self-Care

1. If you are dealing with a community tragedy, learn as much as possible about the event and
deal with and articulate the powerful emotions and reactions related to it.
2. Know your own “triggers” and vulnerable areas and learn to defuse or avoid them.
3. Resolve your own personal issues and continue to monitor your own reactions to others’ pain.
4. Be human and allow yourself to grieve when bad things happen to others. Remember that
“normal responses to abnormal situations” is true for helpers as well as victims.
5. Develop realistic expectations about the rewards and limitations of being a helper. Set
boundaries for yourself. Become aware of and alter any irrational beliefs about the helping
process.
6. Balance your work with other professional activities that provide opportunities for growth
and renewal.
Ask for and accept help from other professionals:

1. Find opportunities to acknowledge, express, and work through your experience in a sup-
portive environment. Debrief yourself regularly and build healthy support groups.
2. Seek assistance from other colleagues and caregivers who have had experience with trauma
and have remained healthy and hopeful or have learned from their experience. Take their
advice.
3. Delegate responsibilities and get help from others for routine work when appropriate.
4. Develop a healthy support system to protect yourself from further fatigue and emotional
exhaustion.
5. Remember that most victims of trauma do grow and learn from their experiences and so can
their helpers.
 Trauma, Loss, and Grief  247
Live a healthy, balanced life:

  1. Eat nutritious food, exercise, rest, meditate, or pray and take care of your whole self.
  2. Set and keep healthy boundaries for work. Ask yourself, “Would the world fall apart if I step
away from my work for a day or a week?”
  3. Think about the idea that, if you never say “no,” what is your “yes” worth?
  4. Find professional activities that provide opportunities for growth and renewal.
  5. Take an honest look at your life before a crisis strikes. Find help to identify your obvious risks
and work to correct or minimize them.
  6. Find ways to provide yourself with emotional and spiritual strength for the future.
  7. Develop and reward a sense of humor. Expose yourself to humorous situations. Learn to
laugh, enjoy life, have healthy personal relationships, and breathe deeply.
  8. Avoid chaotic situations and learn simplicity.
Downloaded by [New York University] at 04:58 12 August 2016

  9. Take time to return to normal activities regularly.

10. Avoid additional stressful situations.

Debriefing Those Who Debrief: An Often Neglected Follow-Through Procedure

In the aftermath of a major school-wide crisis, violence, suicide, homicide, disaster, or terrorist
attack, mental health professionals have articulated feelings of guilt, sadness, anger, self-doubt,
and concern about the potential risk of clients, as well as awareness of impending doom or
uncertainty about the future. These feelings can become intrusive and debilitating for years after
the event if they are not processed in a structured manner in an accepting environment (LaFay-
ette & Stern, 2004; McAdams & Foster, 2000, 2002). The potential for psychological, social,
emotional, and professional impairment is especially susceptible for new or novice therapists,
especially if counselor preparation programs have failed to address crisis intervention and crisis
management strategies (McAdams & Foster, 2002; Trimble, Jackson & Harvey, 2000). There-
fore, it is critical that those who intervene with crisis process the experience and debrief too.
The debriefing of those who debrief others is a process and a variation of the International
Critical Institute Stress Foundation (ICISF) Model. It consists of three phases, and is essential
for debriefing caregivers.

Technique: Review, Response, and Remind

Counseling Intention To help first responders debrief after a critical incident.
Description The review phase is essentially a combination of the introduc-
tion/fact/thought phase of the regular debriefing. It utilizes
questions designed to have members think about and discuss
the debriefing and their participation in it. Processing, sharing
and self-disclosing can be an effective mediation between expo-
sure and prevention of secondary traumatic stress as well as the
prevention of compassion fatigue. The following questions are
examples of this phase:

• How did it go?

• How do you think you did?
 248  Trauma, Loss, and Grief

• What thing(s) did you do, that you think went well?

• What thing(s) did you feel did not go so well?
• What themes emerged?
• Is there anything you are worried about?

During this phase, the leader focuses the discussion on what made the debriefings go
well. Most participants will have a more vivid idea on what went wrong (i.e. that is human
nature). So, it is important to be prepared to give examples of other ways to have handled
some of the problems experienced. The intent, however, is to providing constant positive
feedback on the work that was done. It is critical to validate their reactions to the experi-
ence and providing guidance on handling personal and interpersonal reactions after the
event.
Downloaded by [New York University] at 04:58 12 August 2016

The response phase is a condensation of the reaction/symptom phase of the ICISF

Model and works to elicit comments on the self-perception of the team members and any
reactions they may have. The following types of questions seem to work well:

• “What did you say that you wish you hadn’t?”

• “What didn’t you say that you wish you had?”
• “How has this experience affected you?”
• “What is the hardest part of this experience for you?”
• “It what areas did you feel the most useful?”
• “On a scale of 1 to 10 how well do you feel the students, faculty and staff are
adjusting?”
• “Are there any needs of the school/community that you feel need further attention or
follow-up?”
• “Are there any special referral needs of students, faculty or staff?”

During this phase, the leader guides some group discussion of the member’s self-
impressions. If the person is blaming themselves for something or is worried that they did
something really wrong, it usually comes out during this phase. What then usually follows
is reassurance by the other team members that no major errors occurred and like in every
event some mistakes will inevitably occur. This is also an opportunity for the team leader
and team members to reassure each other that each individual contributed to the process
and to offer alternative methods for handling problem issues. This is the prime time to
teach new techniques or reinforce what the team actually did.
The remind phase correlates to the teaching/re-entry phase of the Everly and Mitchell
(1999) model. Questions in this step serve to help the team remember to do the same sort
of things that debriefees are encouraged to do.

• “Is there any follow up to be done?”

• “What are you going to do to take care of yourself in the next 24–48 hours?”
• “What will it take for you to eventually “let go” of this experience?”
• “How are you going to manage your stress?”
• “Is there anyone that you know who needs some additional assistance?”

Source: Myers, D. (1994). Disaster Response and Recovery: A Handbook for Mental Health Professionals.
Rockville, MD: Center for Mental Health Services. Reprinted by permission.
 Trauma, Loss, and Grief  249

Conclusion
Let the person in need of comfort talk! Let him or her talk about people . . . events . . . feelings. One of
the major tasks of grief is for the loss to become real. Listening to someone talk will aid this process. Each
time the story is repeated, the reality becomes more realized. Listen particularly for feelings. Accept these
feelings without judgment.
—Hardy Clemons, Saying Goodbye to Your Grief: A Book Designed
to Help People Who Have Experienced Crushing Losses
Survive and Grow Beyond the Pain, 1999, p. 14

Suicide, homicide, violence, disasters, and terrorism have become recurring crises that disrupt
the equilibrium of people and society across the world. Coping skills reduce the negative effects
of a stressful event. Helping professionals must be able to cope with their own post-traumatic
stress. Daily crisis response team debriefings should be held to review and modify plans and
Downloaded by [New York University] at 04:58 12 August 2016

communication to both promote accountability and assess any symptoms of compassion fatigue.
 12 Psychodynamic Techniques

Sigmund Freud and Psychoanalysis

Downloaded by [New York University] at 04:58 12 August 2016

The central hypothesis of Freudian psychoanalysis is that human behavior is determined in large
part by unconscious motives (Freud, 1961). Our personality and our actions, argued Freud,
were in large part determined by thoughts and feelings contained in the unconscious. Repressed
content of the unconscious inadvertently slips through into our words or deeds, resulting in
what is commonly called a Freudian slip. If most activities are governed by the unconscious,
the individual may have limited responsibility for his or her actions. Psychoanalytic/psychody-
namic practitioners who use this approach tend to view psychological distress as being related
to unconscious mental processes (Jacobs, 1998). Freud’s contribution has been developed by
others; some have followed his basic assumptions, and others have developed more independent
approaches. The term “psychodynamic” offers a wider perspective, which encompasses the dif-
ferent analytical approaches. As Jacobs (1998) suggested, psychodynamic implies that the psyche
(mind/emotions/spirit/self) is active, not static. These internal mental processes are dynamic
forces that influence our relations with others.
The structural concept of Freud’s theory of personality consisted of the id, ego, and superego.
The id consists of everything present at birth, including instincts. The ego is the executive of the
personality, because it controls the gateways to action, selects the features of the environment to
which it will respond, and decides which needs will be satisfied and in which order. The superego
is the internalized representative of the traditional values, ideals, and moral standards of society.
The superego strives for perfection.
Under the pressure of excessive anxiety, the ego is forced to take extreme measures to relieve
the pressure. These measures are called defense mechanisms, because they defend the ego against
anxiety. The principle defenses are repression, projection, reaction formation, intellectualization,
denial, rationalization, displacement, and regression. These defense mechanisms have crept into
contemporary therapy as denial and regression. Hence, someone is in denial because he or she
is unable to accept a tragic death, or a child regresses to a previous developmental stage as a way
of dealing with a tragic death.
Defense mechanisms protect the individual from being consciously aware of a thought or feel-
ing that he or she cannot tolerate. The defense only allows the unconscious thought or feeling to
be expressed in a disguised form. For example, an individual who is angry at a demanding boss
might cloak or transform that anger as follows:

Denial. You completely reject the thought or feeling: “I’m not angry with him or her!”
Suppression. You are vaguely aware of the thought or feeling, but try to hide it: “I’m going to
go out of my way to be nice to him or her.”
Reaction formation. You reverse the feeling: “I think she’s really great!”
Projection. You project your thought or feeling onto someone else: “That man hates me.”
“I hate that woman.”
 Psychodynamic Techniques  251
Displacement. You redirect your feelings to another target: “I hate her secretary.”
Rationalization. You come up with various explanations to justify the situation (while deny-
ing your feelings): “He’s so critical because he’s trying to help us succeed.”
Intellectualization. You rationalize more intellectually: “This situation reminds me of how
I was treated in nursery school.”
Undoing. You try to reverse the feeling by doing something that indicates the opposite feel-
ing. It may be an “apology” for the feeling you find unacceptable within yourself: “I think
I’ll write the boss a thank-you card.”
Isolation of affect. You “think” the feeling but don’t really feel it: “I guess I’m angry with her,
sort of.”
Regression. You revert to an old, usually immature behavior to ventilate your feeling: “Let’s
make prank calls to people.”
Sublimation. You redirect the feeling into a socially appropriate activity: “I’m going to write
Downloaded by [New York University] at 04:58 12 August 2016

a poem about anger.”

Defenses may hide any of a variety of thoughts or feelings: anger, fear, sadness, depression, greed,
envy, competitiveness, love, passion, admiration, criticalness, dependency, selfishness, or grandiosity.

Outcome Studies of Psychoanalysis

There have been many, often conflicting, claims concerning the desired aim or effect of psycho-
analytic treatment, as well as claims about the curative aspects of the psychoanalytic process that
may bring about these changes. It is easy to be critical of psychoanalytic studies, as no defini-
tive studies show psychoanalysis to be unequivocally effective relative to an active placebo or an
alternative method of treatment. Although no methods are available to definitively indicate the
existence of a psychoanalytic process, Fonagy (1999) has conducted a comprehensive analysis of
outcome studies. Fonagy found that:

• Longer treatment has better outcome.

• Psychoanalysis can bring the functioning of a clinical group to the level of the normal
population.
• Superiority of psychoanalysis over psychotherapy sometimes only becomes apparent some
years after the treatment has ended.
• Psychoanalytic treatment can lead to a reduction in the use of psychotropic medication
among inpatients.
• Long-term psychoanalytic therapy can reduce borderline symptomatology in the long run,
and these improvements are maintained.
• Psychoanalysis may be an effective treatment for severe psychosomatic disorders.
• More severe disturbance specifically benefits from psychoanalysis rather than psychotherapy.
• Behavioral disorders respond less well to psychoanalysis than do emotional disorders.
• Younger children benefit more from psychoanalysis than do older ones.
• Analytic problems are better dealt with in psychotherapy; introjective problems in
psychoanalysis.
• Psychosomatic disorders respond particularly well to psychoanalysis.
• Successful psychoanalytic treatment of severe personality disorder may require a combina-
tion of supportive and expressive techniques.
• Anxiety, guilt, and idealization in the transference may be associated with successful treatment,
whereas shame, humiliation, and existential anxiety are associated with failed treatments.

More recently, object relations have emerged as a psychodynamic approach to understand-

ing human behavior, development, relationships, psychopathology, and psychotherapy. An object
 252  Psychodynamic Techniques
relation intuitively reflects certain truths about all human relationships, from the early relation-
ships of infancy, to friendships, marriage, and the therapeutic relationship. Freud originally used
the term object to mean anything an infant directs its drives toward for satiation. Drives are of two
types: libidinal and aggressive. Accordingly, objects became a key component of Freud’s drive/
structural model of the human psyche.
Since Freud, however, many theorists such as Klein (1932, 1959, 1963), Winnicott (1965),
Kernberg (1984), and Kohut (1959, 1971, 1977) have moved, in varying degrees, toward a
relational/structural model of the psyche in which an object is the target of relational needs
in human development. Within contemporary object relations theory, objects can be people
(mother, father, others) or things, such as transitional objects, with which we form attachments.
These objects and the developing child’s relationship with them are incorporated into a self, and
as such become the building blocks of the self-system. This blueprint of a self-structure is formed
early in life out of our relationships with the objects (significant others and parts of significant
Downloaded by [New York University] at 04:58 12 August 2016

others) around us. Once formed, the blueprint can be modified, but our basic tendency is to
seek out others (friends, spouses) who will reaffirm these early self-object relationships. Psycho-
analytic object relations theory focuses on the mutual influence of internalized interpersonal
relations and intrapsychic conflict. Beginning with the mother–infant dyad, relationships are pri-
mary, and intrapsychic, interpersonal group experiences lay the foundation for the development
of individual identity. One’s unconscious striving to reenact conflicted parent–child relations
emerges through a particular object choice. In summary, the term object relations refers to the
self-structure we internalize in early childhood, which functions as a blueprint for establishing
and maintaining future relationships.

Carl Jung and Analytical Psychology

In Jungian psychology, the whole personality is referred to as the psyche. The psyche is made up
of three components: the conscious ego, the personal unconscious and its complexes, and the col-
lective unconscious and its archetypes. Jung also devised a typology that has been very influential.
It consists of the attitudes of extraversion and introversion and the psychological functions of
thinking, feeling, sensing, and intuiting. Extroverts turn their attention to the outside world with
an active interest in people and the events around them. Introverts are more absorbed in their
private world, tend to be less sociable, and lack confidence in dealing with other people.

Technique: Childhood Memories

Counseling Intention To understand the dynamics and significance of childhood
memories.
Description Write down one or two early childhood memories. Create a title
for each memory, as if they were a newspaper article with a head-
line that captures its essence. Process the dynamics and signifi-
cance of childhood memories with the following questions:

1. Does the memory reveal important themes in your past as well as present life? The title
of the story often helps clarify the nature of your relationships with significant others,
predominant issues, conflicts, emotions, and attitudes.
2. Is the memory accurate? Are the details of the memory meaningful? Do they come
from other memories? Is this memory really a composite of several memories?
 Psychodynamic Techniques  253

3. How would significant others remember the event? If there are differences from how
you remember it, what is the meaning of those differences? Why do people remember
the same event differently? What does it say about them?
4. Do memories accurately depict reality, or subjectively “create” the past? Is there really
a “reality” at all?

Source: Suler, 2003.

Technique: Specific Tactics for Dismantling Old Traumas

Counseling Intention To provide the opportunity to process past childhood traumas.
Downloaded by [New York University] at 04:58 12 August 2016

Description Some traumas will be released by sound. A person may need to let
loose with a ferocious scream that reverberates up from the depth of
the body. There are all kinds of sound deep in the heart of traumas, and
no list can be adequate. Rather, an individual needs to be given per-
mission to express, with sound, what is deep within the body. Another
tactic is for the person to tell the trauma to you all over again while
occasionally taking breaths as if he or she was on a seashore enjoying
nature. Sometimes the person needs to do deep breathing and have
the body experience, for a new, redeeming time, what needed to be
felt long ago and far away. An individual can:

• Yell it out.
• Breathe it out.
• Emotionally express it out.
• Imagine it away.

Process with questions that need to be asked about the following five feelings: Is there any
sadness still left back there? Anger? Fear? Happiness? Excitement? Tenderness?

Technique: Visualize an Elevator Descending to an Earlier Age

Counseling Intention To capture old memories.
Description Visualize an elevator with 21 floors. The buttons on the elevator num-
ber from 1 to 18, which represent the first 18 years of your life. Push a
button and feel yourself descend to that “floor,” to an age in your life.
When the elevator doors open, step out to the floor and remember
yourself at that age.

1. Retrieve a memory of yourself at that age. Take whatever memory comes to you about that
particular age. It can be as simple as a dress or suit you wore, a remembered snapshot, a
particular smell, or music.
2. Get back on the elevator and push a lower button. Visualize yourself going down gently and
safely. When the door opens, step out into that age and retrieve another memory. Bring it
back with you and get onto the elevator again.
3. Push a button lower than 6. If possible, go down in the elevator as far as 1 or 2 or even “B”
for the basement (or born). Feel yourself descend slowly, floor by floor, into the safe dark-
ness. When the elevator stops, get out and walk around and see what comes to you.
 254  Psychodynamic Techniques
4. Choose one of the earlier memories to work with. When you have retrieved a memory that
seems important to you, stay with it and keep visualizing it.
• “Where are you?”
• “Who’s with you?”
• “How are you feeling?”
• “What kinds of colors and shapes do you see around you?”
• “What sounds and smells?”
• “What are you most aware of?”
5. Stay with the scene until you have retrieved buried details. Continue to watch the scene with
eyes closed and focus on the detail of events:
• “What is going on around you? What did you notice that you didn’t notice before?”
• “What can you hear being said by others?”
Downloaded by [New York University] at 04:58 12 August 2016

• “At what point does the scene end?”

6. Return to the elevator and come back slowly to the surface, bringing with you the memories
you retrieved.
7. Get back on the elevator, allow the doors to close, and push the button marked 21. Feel
the elevator rise. Take your time returning. Before opening your eyes, ask yourself these
questions:
• “Why is this particular memory important to me?”
• “What does it still evoke in me?”
8. Now try to capture in writing the things you saw, heard, and felt. Tell your story as a very
young child would see it:

• Focus on one short incident, something that happens in minutes.

• Keep the child’s point of view.
• Use present tense as if it’s happening in the moment.

Technique: The Shadow Exercise(Suler, 2003)

Counseling Intention To identify suppressed parts of identity.
Description Think of someone you know whom you don’t like very much.
Maybe you even hate this person. On a piece of paper, write
down a description of that person. Write down what it is about
this individual’s personality that you don’t like. Be as specific as
you can.

Draw a box around what you have written—and at the top of the box write “My
Shadow.” What you have written down is some hidden part of yourself—some part that
you have suppressed or hidden. It is what Jung would call your shadow.
Maybe it’s a part of you that you fear, can’t accept, or hate for some reason.
Maybe it’s a part of you that needs to be expressed or developed in some way. Maybe
you even secretly wish you could be like that person you hate.
Process how suppressed parts of ourselves are projected onto others, and how we some-
times choose these “hated” people for close relationships.
 Psychodynamic Techniques  255

Technique: I-Ching
Counseling Intention To gain self-insight.
Description The I-Ching is one of the cornerstone texts of Chinese taoism.
It consists of 64 “hexagrams,” each hexagram being an image or
symbol that applies to a specific but complex social, psychologi-
cal, and/or spiritual situation. Consult the I-Ching as if it were
a wise advisor and oracle. After posing a question about an issue
or situation in life, toss coins or randomly sort short sticks; the
resulting configuration points to a corresponding hexagram in
the I-Ching. The hexagram will help clarify current situations,
state of mind, and predict the future outcome, as well as offer
advice.
Downloaded by [New York University] at 04:58 12 August 2016

Carl Jung was fascinated by the I-Ching, and proposed “synchronicity” as the actual
mechanism by which one’s mind, the coins or sticks, and the hexagrams become intercon-
nected. Synchronicity occurs when two events that are related in meaning occur at the
same time without being the cause of the other. For example, a person may dream of the
death of a relative, and learn later that the relative died at the same time he or she had the
dream. Mental telepathy, clairvoyance, and other forms of paranormal experiences can be
explained by the principle of synchronicity.

Technique: Show and Tell (Suler, 2003)

Counseling Intention To discover more about personal identity and sense of self.
Description Ask members to bring in some personal item that is important
to them—an item that reveals something significant about their
identity (in psychoanalytic psychology terms, a self object). Give
feedback about what they think the item says about the mem-
ber, as well as share how they relate to the other members’ self
objects.

The Subconscious and Altered States of Consciousness

Technique: Understanding Our Dreams
Counseling Intention To gain interpersonal/intrapersonal insight.
Description Dreams have been part of the human psyche since before recorded
time. The scientific studies of dreaming and dream content that have
accumulated gradually over the past 50 years do not support any
of the ideas about dreams that are specifically “Freudian” or “Jun-
gian,” but they do support the general notion that many dreams
have meaning in the sense of coherence, correlations with other
psychological variables, and connections with waking thoughts
(Domhoff, 1996; Fisher & Greenberg, 1977, 1996; Foulkes, 1985,
 256  Psychodynamic Techniques
1999). In the networks of the brain, dreaming makes connections
more broadly than waking. Dreaming also conceptualizes a domi-
nant emotion. This is demonstrated most clearly in dreams after
trauma: the trauma resolves, but can still be seen in dreams under
stress, pregnancy, and other situations where the dominant emo-
tional concern is known.

Three general ideas remain from Freudian and Jungian theory after sifting through the scien-
tific evidence developed by empirical dream researchers. First, dreaming is a cognitive process
that draws on memory schemas, episodic memories, and general knowledge to produce reason-
able simulations of the real world (Antrobus, 1993; Foulkes, 1985, 1999), with due allowance
for the occasional highly unusual or extremely memorable dream (Bulkeley, 1999; Hunt, 1989;
Knudson & Minier, 1999; Kuiken & Sikora, 1993). Second, dreams have psycho­logical mean-
Downloaded by [New York University] at 04:58 12 August 2016

ing in the sense of coherency, correlations with other psychological variables, and correspond-
ences with waking thought (Domhoff, 1996; Foulkes, 1985; Hall, 1953b). Third, the unusual
features of dreams, such as unlikely juxtapositions, metamorphoses, and impossible acts, may be
products of figurative thought (Hall, 1953a; Lakoff, 1997). Other aspects of dreaming in the
literature include:

• Traumatic dreams that reflect a preoccupation with problems we have not resolved.
• Recurrent dreams are most often reported to begin in childhood.
• The most frequent content theme of recurrent dreams is being attacked or chased.
• Anxiety dreams feature the dreamer being threatened or pursued.
• Recurrent dreams are often reported to begin at times of stress, such as the death of a loved
one, separation from parents, or the divorce of parents.
• Recurrent dreams are very similar to the dreams of post-traumatic stress disorder.
• Dreams relate to our emotional preoccupations.
• People dream about emotional hang-ups, fixations, and unfinished personal business.
• Dreams objectify that which is subjective, they visualize that which is invisible, they trans-
form the abstract into the concrete, and they make conscious that which is unconscious.

Technique: Dream Work: Writing Dreams Down

A dream is a personal letter to one’s self. It might be helpful to record the following types of
information:

1. Record anything remembered about the dream itself, even if only fragments.
2. Record small details in the dream, even if they seem insignificant. Record the feelings or
sensations experienced during the dream.
3. Record events from life that come to mind when thinking about the dream.
4. Record the thoughts that were mindful when falling asleep.
5. Record any other thoughts, feelings, memories, or sensations that arise when reflecting on
the dream.

The Hall/Van de Castle System of Dream Interpretation

The Hall/Van de Castle system is an application of the general methodological strategy called
content analysis. Content analysis is an attempt to use carefully defined categories and quantita-
tive methods to extract meaning from a “text,” or dream report (Figure 12.1). The original
 Psychodynamic Techniques  257
Hall/Van de Castle system consisted of eight general categories, most of which are divided into
two or more subcategories. Those eight general categories are:

1. Characters (subdivided into animals, humans, and mythical figures)

2. Social interactions (subdivided into friendly, aggressive, and sexual)
3. Activities (often analyzed in terms of physical and nonphysical activities)
4. Striving: Successes and failures
5. Misfortunes and good fortunes
6. Emotions (anger, apprehension, sadness, confusion, and happiness)
7. Physical surroundings: Settings and objects
8. Descriptive elements (modifiers, temporality, and negativity)

The Hall/Van de Castle system in effect treats a dream report as a story or play in which there are:
Downloaded by [New York University] at 04:58 12 August 2016

• A cast of characters (animals, men and women, friends, strangers).

• A series of social interactions (aggressive, friendly, sexual).
• Activities (thinking, talking, running).
• Successes and failures.
• Misfortune and good fortune.
• Emotions (happy, sad, embarrassed).
• One or more settings (indoors vs. outdoors, familiar vs. unfamiliar).
• Objects (chairs, cars, streets, body parts).
• Descriptive modifiers (tall, fast, crooked).
• Temporal references.
• Elements from the past.
• Food and eating references.

There are almost no elements in a dream report that cannot be classified somewhere, and
some fit into more than one category (e.g., hugging someone is both a friendly interaction and
a physical activity). Then, too, parts of categories can be used or two or more categories can
be combined to create new indicators (e.g., the degree to which the dreamer initiates aggres-
sive, friendly, and sexual interactions, as opposed to being the recipient of such actions, can be
thought of as a measure of “assertiveness” in dream reports). Table 12.1 and Figure 12.1 present
an overall view of the various coding symbols employed for characters.

Table 12.1  Hall/Van de Castle System: Summary of Coding Symbols

Number Sex Identity Age
1 individual M male F father I infant A adult
Hv2 group F female M mother Y family members T teenager
H3 individual dead J joint X parents R relative C child
4 group dead I indefinite B brother K known B baby
5 individual T sister P prominent
6 group) imaginary H husband O occupational
7 original form W wife E ethnic
8 changed form A son S stranger
D daughter C child U uncertain
Source: Domhoff, G. W., College Eight, UCSC, Santa Cruz, CA. dreamresearch.net. 9/22/12. Reprinted with
permission.
 258  Psychodynamic Techniques

Age
Gender
Date Today

We would like you to write down the last dream you remember having, whether it was last
night, last month, or last year.

oFirst please tell us the date this dream occurred: o Then tell us what time

of day you think you recalled it: o Then tell us where you were when
you recalled it:

Please describe the dream exactly and as fully as you remember it. Your report should
contain, whenever possible: a description of the setting of the dream, whether it was familiar
to you or not; a description of the people, their age, sex, and relationship to you; and any
animals that appeared in the dream. If possible, describe your feelings during the dream and
Downloaded by [New York University] at 04:58 12 August 2016

whether it was pleasant or unpleasant. Be sure to tell exactly what happened to you and the
other characters during the dream. Continue your report on the other side and on additional
sheets if necessary.

Series Dream#: Words:

Char. Aggression Friendliness Sexuality Settings Modifiers

Objects

Activities

Success Failure Misfortune Good Fortune Emotions

Figure 12.1  Hall/Van de Castle System: Recording Dreams

Source: Domhoff, G. W., College Eight, UCSC, Santa Cruz, CA dreamresearch.net. 9/22/02. Reprinted with
permission.

Hypnotherapy
With its ability to enhance the power of suggestion, hypnosis has been found effective for a vari-
ety of problems that hinge on emotions, habits, and even the body’s involuntary responses. It is
also helpful against anxiety, tension, depression, phobias, and compulsions, and can sometimes
help break an addiction to smoking, alcohol, or drugs. It has successfully alleviated an amazing
variety of symptoms, including those of asthma, allergies, stroke, multiple sclerosis, Parkinson’s
disease, cerebral palsy, and irritable bowel syndrome. It can control nausea and vomiting from
 Psychodynamic Techniques  259
cancer medications, reduce bleeding during surgery, steady the heartbeat, and bring down blood
pressure. It has helped some people lose weight, control severe morning sickness, or gain much
relief from muscle spasms and even paralysis.
People who have undergone hypnosis describe their experiences in very different ways (Far-
thing, 1992, p. 349):

“I felt as if I were ‘inside’ myself; none of my body was touching anything . . . ”
“I was very much aware of the split in my consciousness. One part of me was analytic and
listening to you [the hypnotist]. The other part was feeling the things that the analytic part
decided I should have.”

Hence, it is very difficult to arrive at a single definition for the state of hypnosis. It appears
that consciousness has been altered; however, how hypnosis occurs, the way it is experienced,
Downloaded by [New York University] at 04:58 12 August 2016

and even susceptibility vary from one person to another. Ways of measuring susceptibility for
hypnosis include some of the following exercises:

• The eye-roll test. Open the eyes wide, then roll them up. Then lower the eyelids without
rolling the eyes down. Ability to complete these tasks is not, however, a foolproof predictor
of the ability to be hypnotized.
• The light test. Stare at a small spot of light in a dark room. Most people will be convinced
that the light is moving, but those who see it change direction most frequently are suppos-
edly the best subjects for hypnosis.
• The lemon test. Some therapists ask first-time patients to imagine looking at, feeling, picking
up, and slicing a lemon in half. They must then picture themselves squeezing some of the
juice into a container, smelling it, and drinking a little. Those who are aware of salivating
after performing the exercise once (or, in some cases, more than once) are likely to be better
candidates than those who do not salivate more than usual.

The therapist can use several techniques to put the client into a hypnotic trance:

• Asking the client to watch a moving object as it swings back and forth, then suggesting in a
monotonous, soothing voice that your eyes are getting so heavy you can’t keep them open.
• Telling the client to concentrate on the therapist’s voice as he or she gives you instructions.
• Having the client count backward slowly from 30 to 0.

When performing self-hypnosis, sit or lie in a quiet, comfortable place, such as your favorite
chair. Then try to relax completely, letting all your muscles go limp and allowing all tension
to flow away. To induce the hypnotic trance, or focused state of mind, imagine walking down
a long path or descending a long staircase; concentrate on an object and breathe slowly and
deeply; count backward from 10 to 0; repeat over and over that your eyes are heavy, your limbs
are numb, or your face is warm or cool; or repeat a word or phrase. Once you have achieved a
hypnotic state, tell yourself how you want to feel, or listen to a tape on which you have recorded
the message. To wake up, count slowly upward from 0 to 10, or reverse the image you used to
put yourself under—for example, walk up the staircase. Tell yourself you will awaken feeling
wonderful.
One of hypnotherapy’s greatest benefits may be its ability to reduce the effects of stress. Many
physicians and psychologists believe that the mind has a direct impact on physical well-being.
According to this theory, tension, anxiety, and depression can undermine immunity and com-
promise your health, while a positive attitude can reinforce the immune system, enabling it to
better fight infections, toxins, and other immune system invaders. Hypnosis can alleviate stress by
 260  Psychodynamic Techniques
putting you into a relaxed state, offering positive suggestions, and ridding the mind of negative
thoughts. As tension in your muscles and even your blood vessels recedes, the theory goes, your
circulation improves and your entire body feels healthier.

Technique: Four Ways to Reach a State of Inner Peace

Counseling Intention To maintain a state of calm and to relax effortlessly.
Description Sometimes maintaining inner peace is not convenient. Here are four
ways to achieve inner peace that can be used anywhere.

1. PERIPHERAL VISION

Look at the opposite wall and find a point that is straight ahead and a little above eye level. Con-
Downloaded by [New York University] at 04:58 12 August 2016

tinue to look at this point in soft focus throughout this exercise. After you have concentrated
for a while on this point, the rest of the room should go a little dark, vague, or fuzzy, creating a
kind of tunnel vision.
Keep your eyes on that point and begin to broaden the field of vision and notice more and
more of what is at either side of that point, so that attention is given to what you see out of the
corners of the eyes on each side. By staying in peripheral vision, notice that breathing has moved
lower down in the chest and may be slowed down or become deeper; that the muscles of the face
have relaxed, especially the jaw muscles. To relax even more, stay in peripheral vision until both
hands and feet become warmer.
Peripheral vision seems to activate the parasympathetic nervous system, the part of your nerv-
ous system that produces a calming effect. It allows the mind, body, and emotions to come back
into balance.
Peripheral vision is particularly useful when speaking in public; its calming effect enables the
speaker to see the whole audience, become more aware of any little movements they make, and
gauge how they are reacting. There is only a need to go into peripheral vision a little way to
contact that deep reserve of peace and tranquility.

2. CENTERING

Particular attention to the body has a big effect on feelings and perceived strength. This is rec-
ognized in the ancient traditions of yoga and the martial arts.
Begin by paying attention to a point that is a few inches below the navel and halfway between
the front and the back to the center of the body. At the same time look straight ahead and go
into peripheral vision. Let the body relax, and make sure the knees aren’t locked. The ability to
maintain this focus on the center of the body can be done anywhere. Focusing on the center
point eliminates anxiety and is useful for confrontations and pressure situations.

3. PROJECT AN ENERGY BUBBLE

Imagine a bubble of energy projecting out from the central point and surrounding the body like
a science fiction force field. Everything stressful that happens outside this bubble bounces off
and away from the central point, instilling a calm inside the bubble. So the more stressful it is on
the outside, the calmer it is on the inside. The unconscious mind doesn’t distinguish between
imagination and reality. Being shielded from chaos becomes, not imagination, but reality. This
is another resource for dealing with pressure situations. When giving a presentation, extend the
energy bubble all the way out to the back and side walls of the room, and then pull it in slightly
to embrace and include the whole audience. The audience will notice the difference.
 Psychodynamic Techniques  261
4. FLOAT UP ABOVE YOURSELF

Sometimes in emotionally fraught situations, it can be a good idea to detach from the circum-
stances to calm down and get things in perspective. A good way to do this is to float up above
the situation.
Imagine floating out of the body, higher and higher, and looking down at yourself. Float up
until you reach a height at which you are completely comfortable. You’ll notice that the higher
up you float, the more detached you feel.
You can do this with memories or with imagined future situations as well. If the memory
involves other people, float up above the memory of yourself as you interact with them. Observe
the scene as a whole system—notice how they react to what you do and say, and how you react
to what they do and say. What do you learn from this new perspective?
Downloaded by [New York University] at 04:58 12 August 2016

Technique: Breath Work
Counseling Intention To become more relaxed through breathing.
Description A few nice deep breaths can be so relaxing. It can be a quick and easy
stress reliever. It can be done at any time, and it is not visible to others.

The client will feel less stressed and will be able to handle things more easily. Clients who are
stressed tend to take short little breaths rather than deep, relaxing ones. Try the following:

• Sit down or lie down.

• Inhale slowly and say to yourself, “I am . . . ”
• Exhale slowly and say to yourself, “ . . . relaxed.”

Breathing is not something done. Rather, it is something that is allowed. Allow breathing to
occur smoothly and naturally.

Technique: Experiencing a Full Breath

Counseling Intention To extract life force from the air.
Description It is not possible or necessary to fully expand the lungs with every
breath, but it is vital in heightening awareness to experience how a
really complete breath feels. This exercise uses the lungs to capacity
and extracts great amounts of “life force” from the air. Because breath-
ing is normally unconscious but can be controlled consciously, chang-
ing your breathing, or just becoming aware of it, is an easy way to
change your physiological state.

Try this exercise sitting, standing, or lying down.

1. Exhale deeply, contracting the belly.

2. Inhale slowly and expand the abdomen.
3. Continue inhaling and expand the chest.
4. Continue inhaling and raise the shoulders up toward the ears.
5. Hold for a few comfortable seconds.
6. Exhale in reverse pattern, slowly. Release your shoulders, relax your chest, and contract your
abdomen.
7. Repeat.
 262  Psychodynamic Techniques
This exercise will require gentle practice so that inhalation and exhalation become smooth and
balanced. Beginners should only do it two or three times continuously.

Conclusion
All the techniques in this chapter represent an emphasis on the unconscious and altered states
of consciousness for client self-understanding and interpersonal mastery. The influence of the
unconscious on human behavior cannot be minimized, nor can the influence of childhood
trauma and the importance of early relationships. Dream work, breathe work, hypnosis, and
meditation are techniques that focus on reaching a level of higher consciousness and inner peace.
Jungian theory does not view psychopathology as a disease or as being abnormal because of
perpetuated cultural norms that are consistently changing. Rather, Carl Jung’s approach can
appeal to a wide range of clients from different cultural and ethnic backgrounds. In contrast,
Downloaded by [New York University] at 04:58 12 August 2016

“symptoms are considered messages from the person’s unconscious that something is off center
and that something different is needed to bring fulfillment to the individual”(Kaufmann, 1989,
p. 132). Walker (1992) maintains that the Jungian analyst is fully aware of the changing nature
of society and culture and, perhaps more than any other professional working in the realm of
the human dilemma, is able to understand the unique emotional world of feelings, pressures,
and needs of clients, regardless of their cultural or ethnic backgrounds. Estes (1992) has further
formulated unique ways of describing the female psyche in Jungian terms by using multicul-
tural myths, fairy tales, and stories and other narrative approaches as a creative avenue to help
women and minorities reconnect with lost or unfulfilled instinctual, imaginative, and resourceful
attributes.
 13 Eclectic Techniques for Use
with Family Systems and Family
Development

In the past two decades, family therapy from a systems perspective has gained momentum as an
Downloaded by [New York University] at 04:58 12 August 2016

innovative force in counseling. It has profoundly influenced therapeutic inventions in the lives
of client and their families (Schafer, Briesmeister, & Fitton, 1984; Stanton, 1984). Marriage and
family therapists treat clients with a wide array of disorders in various stages of crisis. Treatment
typically involves not only the individual, but may also draw upon the strengths and dynamics of
the family system for working toward problem resolution. The issues marriage and family thera-
pists face are complex and run the course of the life cycle, from childhood and adolescent issues
to difficulties faced by the aging population. The goal is not only to resolve the immediate prob-
lems presented for treatment, but also to build a foundation of wellness and to understand and
accept transgenerational issues. Marriage and family therapy is one of the nation’s most rapidly
advancing disciplines. Academic and professional study areas include human development; per-
sonality theory; psychopathology; assessment, diagnosis, treatment, and intervention methods in
marriage and family therapy; family life cycle and development; interactional and behavioral pat-
terns; cross-cultural, minority, and gender issues; human sexuality; research design, methods, and
statistics; and ethics and professional studies. Marriage and therapists can be found at the cutting
edge of development knowledge in mental health. Marriage and family therapists work with:

• Families facing depression, major mental illness, or emotional disorders.

• Custody mediation for families facing divorce.
• The alcohol or drug abuser and his or her family.
• Persons with chronic illness and disability and their families.
• Crime victims struggling to reclaim their lives, and their family members.
• Patients and the family members who care for them.
• HIV-positive individuals, people living with AIDS, and their family members.
• Veterans, fire fighters, police officers, and emergency medical technicians seeking counseling
following a devastating traumatic event.
• Military personnel and their family members.
• Families facing possible loss of their children to out-of-home placement.
• The homeless and homeless mentally ill.
• Abuse victims and perpetrators.
• Immigrants adjusting to a new life in the United States.
• Adolescents at risk for incarceration (and their families).
• Families in the foster care system.
• Those who need treatment alternatives to prison.
 264  Eclectic Techniques for Couples and Families
Systems theory, for example, provides both a conceptual and practical framework for organiz-
ing diagnostic information and evaluating presenting problems. Family systems theory is appro-
priate when evidence of family dysfunction exists.
Fundamentally, the systems theoretical framework views the family as a self-regulating system
joined together by unspoken rules whose purpose is to maintain itself. Psychological symptoms
are perceived as manifestations of a dysfunctional family. The focus of treatment becomes the
family system, not the problem or symptomatic family member. The goal of counseling and fam-
ily therapy is to engender human and systematic growth.
Therapists always have understood that the problems they deal with arise largely in families
and take their form from family relationships. A number of theoretical models have evolved with
their respective counseling techniques. Many therapists, however, are eclectic and use the model
and technique most appropriate for a particular family and treatment setting. A brief synopsis of
11 models follows.
Downloaded by [New York University] at 04:58 12 August 2016

 1. Psychodynamic therapy is an object-relations approach to family therapy pioneered by Ack-

erman (1958) and originally described by Fairbairn (1967) and Klein (1959) and applied
to marital relationships by Dicks (1967). It views dysfunction as the result of inappropriate
behavioral attempts to work out issues of the past. Since the 1980s there has been a resur-
gence of interest in psychodynamics among family therapists, spurred on by object relations
theory and self-psychology integrating depth psychology and systems theory (Kirschner &
Kirschner, 1986; Nichols, 1987; Sander, 1989).
 2. Family systems therapy focuses on the importance of differentiation, relationships between
generations, transgenerational dysfunctions (such as alcoholism), and triangulation
(Bowen, 1978; Kerr, 1980), with a focus on multigenerational family systems, that is, how
interlocking triangles connect one generation to the next. The idea of intergenerational
conditions has been very influential in the counseling field. According to Bowen (1971,
1974, 1975), the major problem in families is emotional fusion. The fundamental solu-
tion is differentiation. The triangle is the primary focus of analysis in both principle and
practice. Like Freud, Bowen believed in the important impact of early family relationships.
The primary relationship between the self and parents is described as a triangle and has
major implications for life.
 3. Experiential family therapy is designed to change family members. Families are treated as
groups of individuals more than as systems. Interpersonal change and growth is empha-
sized more than problem solving. Therapists seek intense emotional awareness, expressive
techniques, and interventions that take the form of self-disclosure, teasing, sarcasm, humor,
personal confrontation, paradoxical intention, and modeling (Duhl, 1983; Duhl & Duhl,
1981).
 4. Communications therapy describes pathology manifested in dysfunctional communication
patterns (Bateson, 1972; Jackson & Weakland, 1961; Satir, 1967; Satir & Baldwin, 1983).
Treatment focuses on changing interpersonal interaction patterns to promote growth and
to increase self-esteem, conflict resolution, and new adaptive responses to dysfunctional
communication.
 5. Structural family therapy views family dysfunction as a consequence of family structure
(Haley, 1976, 1984; Minuchin, 1974; Taylor, 1984). Wisdom and insight come only after
structural change. Structural family theory has become one of the most widely used concep-
tual models in the field. The fundamental tenet of this approach is that every family has a
structure that is revealed only when the family is in action. The basic structural concepts are
boundaries, subsystems, alignments, and complementarity. Therapists take into account the
individual family and social context, providing a clear organizing framework for understand-
ing and healing families.
 Eclectic Techniques for Couples and Families  265
 6. Systems therapy emphasizes the influence of networks of relationships on individuals. Relation-
ships can be understood as any unit of interaction or communication between individuals.
 7. Strategic intervention therapy is a brief treatment model of therapeutic change designed by the
Ackerman Institute, Haley (1976, 1984), and Selvini-Palazzoli (1978). Strategic intervention
is aimed at changing the powerful rules in families that are particularly resistant to change.
 8. Transactional analysis, created by Eric Berne (1961, 1964), deals with aspects of the person-
ality that other techniques may exclude: the behavioral, the interpersonal, and the intrapsy-
chic. It is a contractual form of therapy that focuses on ego states of parent, adult, and child,
and aspects of rescripting for redecision and change.
 9. Multiple family group therapy was first put forth by Bahatti, Janakiramariah, and Channabas-
vanna (1982). It employs multiple family group therapy as a means for establishing support
and helping a family. The family benefits through an extended family living experience.
Mutual support and belongingness are common goals; the entire group serves as a resource
Downloaded by [New York University] at 04:58 12 August 2016

for problem solving, generating alternatives, and developing action plans for change.
10. Cognitive-behavioral family therapy is used primarily to teach parents how to apply learning
theory to control their children, to help parents substitute positive for aversive control, and
to diminish anxiety in couples with sexual problems. Treatment is usually time limited and
symptom focused, based on social learning theory. Behaviorists have developed a wealth of
reliable and valid diagnostic and assessment methods and applied them to evaluation, treat-
ment planning, and monitoring progress and outcomes.
11. Narrative therapy is organized around two simple metaphors: a client’s personal narrative
and social construction (i.e., challenging the notion of an objective basis for knowledge
shaped by culturally shared assumptions). By challenging rigid and pessimistic versions of
events, therapists make room for flexibility, optimism, and hope. The strategies of narrative
therapy fall into three stages: (1) recasting the problem as a misfortune by focusing on the
effects rather than the causes, (2) finding exceptions or partial triumphs over the misfortune
and instances of successful experiences, and (3) some kind of public ritual to reinforce new
and preferred interpretations (Brunner, 1991; Freedman & Combs, 1996; White & Epston,
1990; Zimmerman & Dickerson, 1996).

As families journey through developmental stages, coping skills during important transitions
may become impaired (Klimek & Anderson, 1988). Members of dysfunctional families can
become fixated on self-perpetuating pathological patterns. Common characteristics of such fami-
lies may include the following:

• One or more symptomatic members.

• Blurred generational boundaries.
• Confused communication patterns.
• Overprotection.
• Enmeshment.
• Denial.
• Inability to resolve conflict.
• Submerged tension.
• Scapegoating.
• Low tolerance for stress.
• Fragmented, disjointed, isolated individuals.
• Noncohesive, pseudo-closeness.
• Skewed relationships, for example, isolation of one member.
• Extreme positions by all members in an effort to differentiate.
• Lack of respect for individual differences.
 266  Eclectic Techniques for Couples and Families
In response to these pathological tendencies, Notarius and Markman (1993, pp. 272–273)
offer these simple truths to promote respect and understanding among couples:

Simple truth 1: Each relationship contains a hidden reservoir of hope. “I know that we can
work it out.”
“I know he or she means well.”
“He’s not intentionally trying to be difficult.”
Simple truth 2: One put-down will erase 20 acts of kindness. “With anger, I’ll rarely get
what I want.”
“Criticism is rarely constructive.”
“One put-down a day will keep the doctor in business.”
Simple truth 3: Little changes in you can lead to huge changes in the relationship.
Downloaded by [New York University] at 04:58 12 August 2016

“Partner change follows self-change.”

“Make a little behavior change today for a big feeling change tomorrow.”
Simple truth 4: It’s not the differences between partners that cause problems, but how the
differences are handled when they arise.
“When it doubt, listen and try to relate—don’t suggest and resolve.”
“When we are happy, our differences didn’t matter. I won’t let them matter now, either.”
Simple truth 5: Men and women fight using different weapons but suffer similar wounds.
“We’re both human.”
“We need to work together as a team.”
Simple truth 6: Partners need to practice relationships skills in order to become good at them.
“Practice makes perfect, and to err is human.”
“Better talk is a path, not a destination.”

Concurrently, Strong and Claiborn (1982) identified four destructive linear attributional tac-
tics in couples that become underlying themes in the manner that they relate to one another:

1. Justification is the practice of assigning the negative or harmful effects of one’s behavior
onto external causes (e.g., “I cannot help the way I act because of my crazy family.”).
2. Rationalization is the practice of denying that one’s internally controlled behavior was
intended to be harmful (e.g., “I just did it [it is being controlling] to help you.”).
3. Debilitation involves assigning hurtful behavior to causes inside of one but beyond one’s
control (e.g., “I cannot help it, when you do that, I go off . . . you should know that and
stop what you are doing”).
4. Vilification, in which the other person is made a villain by attributing negative intent to him
or her. Consequently, the partner’s behavior is justified as a response to hurtful behavior
(e.g., “You just have to put me down in front of your family so you can feel superior”)
(Weeks & Treat, 2001, p. 15).

Gottman (1994) found that couples were more inclined to divorce when they showed “more
negativity than positivity in their emotional behavior and marital interactions.” Four distinct
negative interactions were most predictive of divorce:

1. Complaint/criticism
2. Contempt
 Eclectic Techniques for Couples and Families  267
3. Defensiveness
4. Stonewalling

Gottman labeled these interactions the “Four Horseman of the Apocalypse” and defined them
as follows:

1. Complaint/criticism: Complaint as an expression of disagreement or anger about a specific

issue, which may escalate into criticism becoming more judgmental, global, and blaming
after repeated and frustrating attempts to resolve the issue(s).
2. Contempt: A mockery, insult, decision, or sarcasm of another individual indicating incompe-
tence or absurdity (e.g., disapproval, distain, judgment, putdowns, etc.).
3. Defensiveness: An attempt to ward off or protect self from perceived attack. A response may
be denial of responsibility for a problem, a counterattack, or a whine.
Downloaded by [New York University] at 04:58 12 August 2016

4. Stonewalling: The listener does not provide any cues to the speaker that a “stonewall” is being
placed between the listener and the speaker. Emotionally, the speaker perceives the listener as
being detached, smug, hostile, disapproving, cold, or disinterested (Gottman, 1994, p. 110).

These tenets serve to anchor couples into a philosophy of relating to one another; to pro-
mote communication, respect, and mutual problem solving, but they also highlight some of the
impediments that can occur so that the therapist has a better understanding of the dynamics and
interaction within the relationship and the conflicts they are trying to resolve.

Technique: Lifeline
Counseling Intention The purpose of the lifeline is to assist individuals and couples in exam-
ining their past and present and making projections for the future
(Coleman, 1998, p. 52).
Description

1. Draw a lifeline of yourself. The lifeline should be how the client perceives his or her self. The
line can take a variety of shapes and forms, dips and valleys.
2. Begin somewhere in the past, and project to some point into the future. The client should
start with his or her earliest memory and project to at least one year from the current date.
3. Note significant events that have shaped the client’s life.
4. For clarification, use the following symbols to further illustrate the lifeline:
1 = a risk or chance the client took
X = an obstacle, something (or someone) that prevented the client from getting or doing
what he or she wanted
0 = a decision made for the client by someone else
+ = a positive, satisfying, or appropriate decision
– = a negative, unsatisfying, or inappropriate decision
? = a decision that the client anticipates in the future (i.e., up to 2 years from now)
Discuss the lifeline in detail. The therapist should ask for feedback and clarification of various
events and statements made on the lifeline.

Technique: Constructing a Compromise that Both Parties Can Live With

Counseling Intention To get both partners to yield a little and find their common ground
so that they can arrive at a compromised position on an issue. These
strategies work with solvable problems (Gottman, 1999, p. 233).
 268  Eclectic Techniques for Couples and Families
Description In this exercise, spouses work together to try to develop a common
way of thinking about an issue and start to construct a compromise
that they can both live with. They should ask their partner these
questions:

1. How can we understand this issue? Can we develop a compromised view?

2. What are common feelings or the most important feelings here?
3. What common goals do we have?
4. What methods can we agree upon for accomplishing these goals?

Technique: Sharing Meaning in Family Rituals

Counseling Intention To build or strengthen shared meaning around rituals (Gottman,
Downloaded by [New York University] at 04:58 12 August 2016

1999, p. 261).
Description Couples explore the following questions to develop their own family
rituals:

1. How do we eat dinner? What is the meaning of dinner time? How was dinner time done in
each of our families growing up?
2. How should we part at the beginning of each day? What was it like in our families growing
up? How should our reunions be?
3. How should bedtime be? What was it like in our families growing up? How do we want this
time to be?
4. What is the meaning of weekends? What was it like in our families growing up? What should
they be like?

Questions can continue regarding vacations, holidays, sickness, time alone, work, children,
and so on.

Technique: Building Shared Meaning in Family Roles

Counseling Intention To build shared meaning around roles (Gottman, 1999, p. 262).
Description Couples explore the following questions to develop their own family
roles:

1. How do you feel about your role as husband or wife? What does that role mean to you? How
did your father or mother view this role? How are you similar or different? How would you
like to change this role?
2. How do you feel about your role as a father or mother? What does it mean to you? How did
your father or mother view this role? How are they similar or different? How would you like
to change this role?

Questions continue focusing on issues such as role as son or daughter, as work and
career, as friend to others, in the community, and how to achieve balance among all of these
responsibilities.

Blended or Stepfamily Configurations

The “blended family” or “stepfamily” is no longer an aberration in American society: it’s a
norm. Today, more than 33 percent of all U.S. children are expected to live in a stepfamily
 Eclectic Techniques for Couples and Families  269
before age 18. Born of conflict and loss, newfound commitments, and often abrupt transi-
tions, these families confront a multitude of lifestyle adjustments and challenges. Children of
stepfamilies face a higher risk of emotional and behavioral problems and are less likely to be
resilient in stressful situations, psychologists’ research has found. Walsh (1992) identified four
basic categories of issues in remarriage or stepfamilies: (1) initial family issues, (2) developing
family issues, (3) feelings about self and others, and (4) adult issues. Within the four catego-
ries, he cited 20 major issues that are significant contributors to family disharmony. Counselor
sensitivity to these concerns may lead to more accurate assessments and more timely interven-
tions (p. 714).

Initial Family Issues

  1. Name to call the new parent—issues of power and authority
Downloaded by [New York University] at 04:58 12 August 2016

  2. Affection for the new parent and absent parent—issues of loyalty or allegiance
  3. Loss of natural parent—issues of loss and grief
  4. Instant love of new family members—issues of emotional bonding
  5. Fantasy about the old family structure—parental reconciliation fantasies, especially for chil-
dren whose identification with the absent parent is strong

Developing Family Issues

  6. Discipline by the stepparent—issues of being inattentive, disengaged, or overly restrictive
 7. Confusion over family roles—issues of role assignments in cultural, personal, and legal
spheres creating ambiguity
  8. Sibling conflict—issues of stepsibling relationships
  9. Competition for time—issues about contact with absent parent, competition of the custodial
parent, and jealousy of the stepparent
10. Extended kinship network—issues of expectations, different values and lifestyles, belonging-
ness, and visitations during significant holidays
11. Sexual conflicts—loosening of sexual boundaries
12. Changes over time—issues of remarriage, organization, and boundaries
13. Exit and entry of children—influence on home, school, and peer relations of children shut-
tling between their permanent home and the home of the noncustodial parent

Feelings about Self and Others

14. Society’s acceptance of the remarriage family
15. The connotation of stepfamily
16. Individual self-concept and lower self-esteem

Adult Issues
17. Effects of parenting on the new marital relationship
18. Financial concerns and obligations
19. Continuing adult conflict from previous relationships and communication with children
20. Competition of the noncustodial parent in child rearing and over material possessions

Successful family transitions must confront all these issues.

 270  Eclectic Techniques for Couples and Families

Technique: Counseling Techniques for Dysfunctional Families

Counseling Intention To help family members demonstrate how they normally deal with
situations.
Description Anderson (1988) encapsulated several techniques that can be useful in
assessing how families work together, their developmental stage, and
their real versus presenting problem.

Sequencing. Ask questions such as who does what, when? When the kids are fighting, what is
the mother or father doing?
Hypothetical questions. Who would be most likely to stay home if a child became ill? Which
child can you visualize living at home as an adult?
Scaling reports. On a scale of most to least, compare one another in terms of anger, power,
neediness, and happiness.
Downloaded by [New York University] at 04:58 12 August 2016

Family map. Organize information about the generational development of the family that
reveals the transmission of family rules, roles, and myths (Bowen, 1978).
Tracking. How does the family deal with a problem? “What was it like for you when X?” rather
than “How did you feel when X?” Such questions help keep the focus on the family rather than
on the individual.
Sculpting. Create a still picture of the family that symbolizes relationships by having members
position one another physically. This technique can be used to cut through defenses and helps
nonverbal members express themselves.
Paradoxical intervention. Instruct the family to do something unexpected; observe how the
family changes by rebellion or noncompliance. This is often most appropriate with highly resist-
ant or rigid families.

Technique: The Family Safety Watch

Counseling Intention To provide a family network for crisis intervention; to provide an
intervention strategy for self-destructive behavior.
Description The Family Safety Watch (Stanton, 1984) is an intense intervention
strategy to prevent self-destructive behavior of a family member (e.g.,
a suicidal adolescent). The safety watch also can apply to such prob-
lems as child abuse, self-mutilation, eating disorders, and drug or alco-
hol abuse. The procedure is as follows.

Family members conduct the watch. They select people to be involved in the watch from
among their nuclear family, extended family, and network of family friends. An around-the-clock
shift schedule is established to determine what the adolescent is going to do with his or her time
over a 24-hour period—that is, when he or she is to sleep, eat, attend class, do homework, play
games, or view a movie—according to a structured, planned agenda.
The intervention team leader consults with the family in (1) determining what the family
resources and support systems are, (2) figuring out ways for involving these support systems in
the effort (e.g., “How much time do you think Uncle Harry can give to watching your son/
daughter?”), (3) designing a detailed plan for the safety watch, and (4) figuring out schedules
and shifts so that someone is with the at-risk child 24 hours per day.
A backup system also is established so that the person on watch can obtain support from oth-
ers if he or she needs it. (A cardinal rule is that the child must be within view of someone at all
times, even when in the bathroom or when sleeping.) The family is warned that the at-risk youth
may try to manipulate situations to be alone (e.g., pretend to be fine) and that the first week will
be the hardest.
 Eclectic Techniques for Couples and Families  271
A contractual agreement is established that if the watch is inadvertently slackened or compro-
mised and the at-risk youth makes a suicide attempt or tries to challenge the program in some
way, the regime consequently will be tightened. This is a therapeutic move that reduces the fam-
ily’s feeling of failure should a relapse occur during the year.
The primary goal of the watch is to mobilize the family to take care of their “own” and feel
competent in doing so. With tasks surrounding the watch, the family, adolescent, and helping
professionals, as a team, collaborate in determining what the adolescent must do in order to
relax and ultimately terminate the watch. Task issues should focus around personal responsi-
bility, age-appropriate behavior, and handling of family and social relationships, such as the
following:

1. Arise in the morning without prompting.

2. Complete chores on time.
Downloaded by [New York University] at 04:58 12 August 2016

3. Substitute courteous and friendly behavior for grumbling and sulking.

4. Talk to parents and siblings more openly.
5. Watch less TV and spend more time with friends and significant others.

The decision to terminate the watch is made conjointly by the family and the therapeutic team.
It is contingent upon the absence of self-destructive behavior, as well as the achievement of an
acceptable level of improvement in the other behavioral tasks assigned to the adolescent. If any
member of the therapeutic team feels there is still a risk, the full safety watch is continued.
This approach appeals to families because it makes them feel potent and useful, and reduces
the expense of an extended hospital program. It also reestablishes the intergenerational bound-
ary, opens up communication within the family, reconnects the nuclear and extended families,
and makes the adolescent feel cared for and safe. In addition, it functions as a “compression”
move that pushes the youth and family members closer together and holds them there and awaits
the rebound or disengagement that almost inevitably follows. This rebound is often a necessary
step in bringing about appropriate distance within enmeshed subsystems, opening the way for
a more viable family structure; a structure that does not require a member to exhibit suicidal or
self-destructive behavior.

Technique: Airing Grievances Constructively

Counseling Intention To provide a constructive way to build a new relationship.
Description The following guidelines provided by Bach and Wyden (1968) are
designed to provide a constructive way of rebuilding relationships
between couples. It can be adapted for any two people with conflict
or resentment toward each other. Make an appointment to confront
each other. Many conflicts and accompanying dialogue are unproduc-
tive because only one individual is ready to confront the issues and
the other may refuse to fight. Designating a time without distractions
provides a more equitable advantage.

• Take turns expressing resentments. Let one person talk for 5 minutes without interruption.
Reciprocate the process.
• When all issues are presented, have your partner repeat the concerns as you outlined them.
Check for understanding. Reciprocate the process.
• Clearly state your expectations of each other—the behavior you will not resent.
• Determine together if your expectations are realistic, negotiable, or both. Then proceed
with a mutually satisfactory agreement about the future. Be as specific as possible about
compromises and expectations.
 272  Eclectic Techniques for Couples and Families

Technique: Exercises to Open Communication

Counseling Intention Satir (1967) provided a strategy for helping couples reach a deeper
level of communication and understanding.
Description Instruct couples to do the following:

• Stand back to back and talk to each other. This simulates what frequently occurs when one
partner wants to talk finances or schedules and the other is reading the newspaper, is fixing
dinner, or is otherwise preoccupied.
• Stand face to face and look at each other without talking. What do you think your partner is
thinking and feeling? When discussing, check for the accuracy of your perception.
• Now eyeball each other and communicate without talking. See how much more communi-
cation gets through.
• Close your eyes and communicate without talking.
Downloaded by [New York University] at 04:58 12 August 2016

• Eyeball each other and talk without touching.

• Use all forms of communication (talk, touch, look at each other).

Most couples find it difficult to argue with each other without looking away or withdrawing
physically. Touch and eye contact creates more intimacy.

Technique: The Total Truth Exercise

Counseling Intention To acknowledge pent-up feelings (Marston, 1994).
Description Releasing pent-up feelings can help gain control of emotions. The total
truth technique helps free excess emotional baggage in conflictual rela-
tionships. Write a letter to the person with whom you have a conflict to
express the full range of your emotions, starting with anger and ending
with forgiveness. If you proceed to the section on forgiveness but still
have feelings of anger or sadness, go back to the angry part of your let-
ter and keep writing until you feel free of that particular emotion.

Anger and Resentment

I’m angry that _______.
I hate it when _______.
I’m fed up with _______.
I resent it when _______.
I can’t stand it when _______.

Hurt
I feel hurt when _______.
I feel rejected when _______.
I feel sad when _______.
I feel jealous about _______.
I feel disappointed about _______.

Fear
I feel scared when you _______.
I feel scared that you don’t _______.
 Eclectic Techniques for Couples and Families  273
I’m afraid that _______.
I feel insecure about _______.
I’m afraid that I _______.
Remorse and Regret
I’m sorry that _______.
I regret that I _______.
Please forgive me for _______.
I didn’t mean to _______.
I feel sad that _______.

Wants
All I ever wanted was _______.
Downloaded by [New York University] at 04:58 12 August 2016

I want you to _______.

I wish that _______.
I deserve _______.
I want us to _______.
What I really want is _______.

Love and Forgiveness

I forgive you for _______ and I forgive myself for _______.
What I love most about you is _______.
I understand that _______.
I appreciate you for _______.
Thank you for _______.

This exercise can be used when a client feels stuck in emotions. Feelings need to be expressed
in order to be released and for healing to occur. This is a safe and highly effective method for
releasing and confronting feelings.

Technique: Actualizing Individual Strengths

Counseling Intention To actualize the positive strengths of partners or family members.
Description Abraham Maslow maintained that we should be more concerned
with enhancing a person’s potential rather than dwelling on his or her
weaknesses. The following exercise will identify the positive strengths
of people in the group.

Step 1. Each person writes his or her name on a slip of paper; one person’s name is chosen at
random. A volunteer takes notes on the strengths seen in this person.
Step 2. The person who has been chosen expresses to the family all the strengths he or she sees
in himself or herself.
Step 3. The person who has been chosen then asks the group, “What other strengths or poten-
tialities do you see in me? What do you see keeping me from using these strengths?”
Step 4. The members now share with this person their perception of his or her strengths and blocks.
Step 5. The members then fantasize what this person would be like if he or she were using these
strengths in the next 5 years.
Step 6. The volunteer gives the notes to the chosen person, who discusses how the session has
been of value to him or her. The same procedure may be repeated for another person.
 274  Eclectic Techniques for Couples and Families

Technique: Enhancing Interpersonal Communication

Counseling Intention To actively listen to what another person is saying.
Description Demonstrate the art of listening to the couple or family.

Step 1. Before person A can respond to person B or begin a new topic, A must repeat what B
has said.
Step 2. B must confirm that A has rephrased what he or she said (and felt) before A can make
his or her point.
Step 3. The counselor then asks the group if any person thinks B communicated something
(verbally or nonverbally) that A did not hear, or if anyone has a different interpretation of what
A said. A should check this with B; that is, A should tell B what he or she heard to see if this is
what B meant to communicate.
Process the fact that we usually hear only part of what another person says and then begin to
Downloaded by [New York University] at 04:58 12 August 2016

form our own response, counterargument, or rebuttal. We often respond to the words people
express rather than their feelings.

Technique: Using Confrontation to Improve Relationships

Counseling Intention To enable couples to express honest feelings of anger in a safe way.
Description Each couple or family takes turns to discuss the following:

• “The things you do to make me angry are ______”

• “The things you do that most block our relationship are ______”
• “The things you do to improve the relationship are ______”

Each individual is provided with the opportunity to confront each other. Process whether the
confrontation exercise enabled them to express honest feelings of anger in a safe way.

Technique: An Exercise to Deescalate Conflict

Counseling Intention To create more positive communication.
Description (1) Identify the issues that are causing the conflict. (2) Discuss the pain
and concerns of the issue. (3) Identify the consequences of each other’s
actions. (4) The offender in the relationship asks for forgiveness and
apologizes. (5) The offended agrees to forgive and not use the issue in
the future or bring up the past in the present. (Note: Bringing up the
past is disrespectful.) The offender agrees to change his or her behavior.

Technique: Problem Solving for Couples

Counseling Intention To resolve conflict and disagreements.
Description Nine ways to resolve conflicts in relationships:

1. Show respect. Don’t belittle your mate or call him or her names.
2. Focus on the problem. Describe behavior, not aspects of the other’s personality.
3. Tackle one problem at a time. Stay on task and don’t bring in other issues.
4. Use a time-out. When losing control, call for a time-out and resume discussing the issue later.
5. Listen for the feelings under the words. Everything discussed is important and should be
valued.
 Eclectic Techniques for Couples and Families  275
6. Don’t try to be a mind reader. Clarify what your partner thinks and feels.
7. Try to see your partner’s point of view. Validate your partner’s feelings by acknowledging his
or her viewpoint.
8. Try to solve the problem. Say: “What can we do to solve the problem?” and “I am willing to
do the following . . . ” Say it—and do it.
9. Forgive and accept each other.

Technique: How to Conduct a Couples Meeting

Counseling Intention To air grievances without conflict (Notarius & Markam, 1993, p. 204).
Description The following guidelines can foster a climate of respect and shared
understanding:
Downloaded by [New York University] at 04:58 12 August 2016

1. Make a date. Set up a regular weekly time for half an hour to talk with each other.
2. Focus on the problem. Sit down face to face with no distractions (i.e., no children, television,
computer, or telephone) and talk about one subject at a time.
3. Use the speaker–listener tool. Decide what will be talked about and who is the speaker. Write
on a piece of paper the world “FLOOR.” Rotate the FLOOR back and forth and speak only
when the FLOOR is in possession. The speaker should keep his or her statements short so
that the listener can follow them.
4. Don’t blame and attack. Remember the problems that interfere with a more positive rela-
tionship are between the couple. The clients should focus on how each feels and their role
in the problem.
5. Reserve the right to take a break. When the discussion starts to not go well (e.g., one partner starts
to blame, attack, or escalate the conflict), either partner can call a stop to the action. At that point
in the meeting, agree to stop talking and pick up the conversation again within 24 hours.

Technique: Using the Speaker–Listener Tool in a Couples Meeting

Counseling Intention To provide structure in expressing concerns to one another (Notarius &
Markam 1993, pp. 208–209).
Description The following speaker–listener tool provides structure and outlines
expectations for couples as they seek to resolve problems

Step 1: One partner, as speaker, states his or her thoughts, feelings, or concerns about issue or
event X and then asks politely for the other partner to show understanding.
Step 2: The listener tries to communicate a sincere understanding of the speaker’s thoughts and
feelings about event X without being defensive, apologizing for any role he or she may have had in
X, or dismissing what the speaker has to say by simply saying “I understand.” (This promotes respect
between each other.) The listener concludes by asking the speaker, “Is that how you are feeling?”
giving the speaker a chance to clarify anything that the listener might have missed. The listener is
directed not to introduce his or her side of the matter until the roles switch and he or she is the
speaker.
Step 3: If the speaker feels the listener has sincerely understood, it should be acknowledged:
“Yes, that’s how I’m feeling.” Steps 1 and 2 continue until feelings about event X are under-
stood. Partners then may switch roles and carry on the same steps. Better talking skills can also
be enhanced with the following responsible speaker guidelines:

1. The client should share his or her side of things.

2. The client should keep statements short and not deliver a long, detailed monologue.
 276  Eclectic Techniques for Couples and Families
3. The client should use declarative sentences, not questions that entrap his or her partner by
blaming or attacking and escalating conflict.
4. The client should be polite.

Technique: Let’s Make a Date

Counseling Intention To provide more enjoyable activities in a couple’s life (Notarius &
Markam, 1993).
Description Clients should make a list of fun activities to be enjoyed during an
agreed-upon time period.

• Plan a surprise weekend for your spouse/lover, making sure the other person does not know
the destination.
Downloaded by [New York University] at 04:58 12 August 2016

• Spend a night at a bed-and-breakfast.

• Go on a one-day cruise to nowhere.
• Learn a new sport or game to play together (e.g., golf lessons, tennis lessons, dance lessons,
backgammon, or sailing).
• Take a limo ride to a favorite restaurant.
• Go browsing through antique shops.
• Decide not to watch television for a week. Tape the shows and watch them all at one sitting,
leaving more time for fun activities.
• Pack a picnic dinner and watch the sun set.
• Leave love notes, candy, or other surprises in his or her briefcase or purse. The list is endless
and can be individualized to couples’ needs and resources.

Technique: Listening for Understanding

Counseling Intention To improve communication between partners.
Description The following listening skills can improve communication:

Paraphrase: Restate what you heard your partner say by restating what she or he said in your
own words.
Clarify: Ask questions and ask for clarification on anything that is not understood. Ask your
partner to explain his or her feelings.
Constructive feedback: Tell your partner what your reaction is to what has been said. Feedback
must be immediate, honest, supportive, and something that the person can legitimately
change.

Technique: Receiving Family Feedback

Counseling Intention To provide structured exercises for feedback from family members.
Description Lewis and Streitfeld (1970) provided the following strategies to solicit
feedback from members of the family:

• Stranger on a Train. Imagine that a stranger is coming to visit you. He has never met your
family, and someone is to meet him at the train. How would each member of your family
describe the others? Be specific: go beyond what they might be wearing to a personality or
behavioral trait.
• Biography. Imagine that somebody is writing a biography of each member of your family.
When interviewed, what would each member say about the other—likes/dislikes, turn-ons/
turn-offs, values/goals, and so on.
 Eclectic Techniques for Couples and Families  277
• Self-portrait. After everyone has had a chance to describe everyone else, describe yourself.
1. How would you tell someone to find you at the station? What would you tell your
biographer?
2. Discuss the differences that turn up between self-impressions and family’s impressions
of you. What have you found out about yourself?
• Family Adjectives. If you could choose just one adjective to describe each member in
your family, what would it be? Check for discrepancies and congruencies among family
members.
• Sculpturing. Go up to each member of the family in turn and arrange his or her body in a
position that you feel characterizes him or her. Give the sculpture a title.
• Family Classified. Write a classified ad for your ideal family (e.g., “father wanted” and
“daughter wanted”) in which you describe, in 20 or 30 words, what you would like in a
Downloaded by [New York University] at 04:58 12 August 2016

family member. Compose the ad in which you list your attributes. Describe the kind of rela-
tive you are and how you may improve. Examples follow:

Father Wanted
“To be more involved with my teenager. Be attentive, warm, and understanding. Let daughter
be herself and trust her more. Listen without putting others down or without shouting.”

Daughter Available
“Warm and concerned about others when not hassled. Has made mistakes but is willing to learn.
May be strong willed and assertive, but very honest.”

Technique: Time-Limited Intercommunication

Counseling Intention To treat marital discord; to achieve more equitable levels of under-
standing and communication.
Description The couple is instructed to set aside at least three separate hour­long
appointments each week for prescribed communication. A timer is set
for 5 minutes. During those 5 minutes, the first speaker discusses any
topic of choice. The listener may not interrupt. The listener may take
notes in preparation for a rebuttal, but no verbal response may occur
until the 5 minutes elapse and the timer sounds.

The timer is set for another 5 minutes, and the other partner repeats the process under the
same ground rules. Each partner has six 5-minute intervals in which to talk and six to attend to
the other person’s verbalizations. At the end of the hour, the couple is to embrace each other and
to cease further communication on the issues until the next one-hour appointment.

Technique: The Simulated Family Approach

Counseling Intention To explore family roles and gain insight into one’s behavior and its
effect on others.
Description The various family members simulate each other’s behaviors; for
example, the daughter plays the father, the father plays the stepson.
The members may also be asked to pretend they are a different family.
The therapist and family discuss how they differ from or identify with
the roles they project.
 278  Eclectic Techniques for Couples and Families

Technique: “Family Sayings”

Counseling Intention To encourage self-awareness, expectations, and transgenerational
belief systems.
Description Every family has its own favorite expressions, belief system, slogans,
warnings, or counsel. Have members list all the repetitive expressions
they recall from their childhood. For example, “Father knows best”
may be interpreted as you have no opinion of your own; “What will
the neighbors think?” may be interpreted as not to let anything tarnish
our public façade; or “One man’s trash is another man’s treasure” may
be warning not to discard anything!

Have members list all the repetitive expressions that they can recall from childhood. Process
the underlying messages. What values do they represent? How do they influence growth or
Downloaded by [New York University] at 04:58 12 August 2016

impede independence?

Technique: Family Sculpture

Counseling Intention To assess communication and relationships.
Description Ask someone in the family to describe a typical family argument, and
then have the person sculpt the argument by placing each family mem-
ber in appropriate positions—complete with gestures, facial expressions,
and touch. This can be followed by asking each of the other members
how he or she would change it and letting each make the changes.

Technique: “All Tied Up”

Counseling Intention To better understand the complexity of relationships and crossed
transactions.
Description Each family member takes some long ropes, one for each of the oth-
ers in the family, and ties all the ropes around his or her waist. Next,
instruct them to tie one rope to each of the other family members.
Process the resulting tension and mass of ropes to help the family
understand the complexity of its relationships and crossed transactions.

Technique: Constructing a Family Genogram

Counseling Intention To recognize closed/distant relationships, transgenerational issues,
enmeshed boundaries, communication patterns, family rituals, and
family dysfunctions. Genograms can be very useful for organizing,
conceptualizing a case, and treatment planning

Figure 13.1  Genogram

 Eclectic Techniques for Couples and Families  279
Description The genogram is a format for constructing a family tree and can
provide structure as a diagnostic and treatment technique (Wachtel,
1982). A genogram is a visual and graphic representation of a family
tree displaying the interaction of generations within a particular family.
It allows the client to analyze family, emotional, social, and interper-
sonal relationships by identifying repetitive patterns of behavior and
hereditary predispositions.

It reflects the clinical perspective that the self originates within a family context. Systems mod-
els, self-psychology, and object relations theories all hold that personal identity is intricately
intertwined with intergenerational family—past, present, and future (Bowen, 1978; Erlanger,
1990; Kohut, 1971; Scharf & Scharf, 1987). Transgenerational issues play an important role in
family dynamics. Families have different “scripts,” and in any one family there can be several sets
Downloaded by [New York University] at 04:58 12 August 2016

of directions and expectations.

The genogram provides an enormous amount of information in a relatively short period of
time. There are three types of genograms: (1) the basic genogram, (2) the distance genogram,
and (3) the details genogram. The basic genogram focuses on individuals: gender, date of birth,
career, marriage, divorce, remarriage, or death. The distance genogram focuses on interpersonal
relationships within family systems. The details genogram provides a more comprehensive dia-
gram of a family over three generations, focusing on personality traits, unusual circumstances,
family themes, family roles, traditions, belief systems, and interpersonal hierarchies.
A number of therapeutic aspects can occur when completing a genogram. First, the process of
creating a genogram provides a focus for the interview while fostering an empathic relationship
between the client and the counselor. Second, the genogram may take the focus off the identi-
fied client and subtly reframe the situation as a “family problem.” Third, the genogram provides
a natural framework for a life review, presenting problems in wider context while identifying
psychological resources that may link the past with the future. Another analysis could include a
distance genogram to identify emotional links as well as generational lines. The counselor also
may want to focus on a client’s relationships or family “scripts.” In any one family, there may be
several sets of directions.

Group Variation
1. Have everyone in the group bring in their family diagram.
2. Create a circle in the middle of the room and place them there.
3. Have everyone close his or her eyes and move into meditative awareness.
4. Ask everyone to call in the favorite beings they use for support.
5. Ask that the negative energies, bonds, entities, and issues represented in each family diagram
be released and transmuted into the universe for the good of all concerned.
6. Ask each participant to silently request that any particular problems she or he is aware of in
his or her family be healed, or any particular person needing healing receive it.
7. Imagine the light burning away negativity and bringing healing and protective energies to
each family member.
8. Know that the healing energy you have sent to the family diagram will be transmitted to
everyone in it.
9. When you are ready, open your eyes.

Technique: Eco-map
Counseling Intention To provide a flow diagram that maps family and community showing
relationships over time.
 280  Eclectic Techniques for Couples and Families

Strong
Social welfare
Health care Strong-energy flow in both directions
Food stamps Work
Housing night watchman on medical
Tenuous
-Owned odd jobs free clinick’s
poor inconsistent Stressful
rooms crowded car repair Culture/
disorganized health care
Religion Stressful-energy flow from 1 to 2
sewer
Stressful-energy flow from 2 to 2
problem
Stressful-energy flow in both directions

Friends Family
hunting Friends
cronies
39
Car repair 45 Wil Cra Kids
Friends bully Josh
Fon Darlene
22 11 9 7
Recreation 3
Will-goes Will Jr Daryl Josh
Deer hunting Dawn

Extended family
Extended family
In Kentucky Ora’s Parents
wills are dead
School mother stomach
Transportation
Fon- cancer
lacking
Downloaded by [New York University] at 04:58 12 August 2016

poor school Sibling were

car not
placement adopted out
running
Darlene in
DD class

Figure 13.2  Eco-map. Adapted from Hartman and Laird (1983), p. 172, Family-Centered Social Work
Practice, The Free Press, New York.

Description Give a visual representation of an analysis of the transactional rela-

tionship between the individual/family and their environment (see
Figure 13.2). Special attention should be given to 1) social supports
(e.g., family, friends, religious organizations, support groups, neigh-
bors, pets, etc.; 2) community resources (e.g., housing assistance,
daycare, financial assistance, health and dental care, mental health,
substance abuse services, legal assistance, transportation, employment
opportunities, nutrition, etc.); and 3) stressors (legal difficulties, fam-
ily dynamics, financial problems, domestic issues, employment obsta-
cles, parenting and discrimination, etc.

Technique: Developing a Family History

Counseling Intention To see how family members evaluate the impact of major events in the
family (Richardson, 1987).
Description Using index cards, chronologically list the major events in the history
of the family. Beside the dates, list any major world events that coin-
cide with family events. Also, note the impact that any particular event
had on the family.

Have the client show the cards to as many family members as he or she can. Can the cli-
ent account for any discrepancies in the dates that different family members assign to different
events? How do different family members evaluate the impact of major events on the family?

Technique: Helping Survivors of Abuse

Counseling Intention To help cleanse the survivor of negative family energy.
Description Have everyone write down on small pieces of paper the names of fam-
ily members who hurt them or with whom they feel they have negative
ties. Have one participant put his or her pieces of paper in the trash
 Eclectic Techniques for Couples and Families  281
can and then set them on fire. As the papers burn, tell that person to
imagine the negative energies, issues, and improper bonds going up
to the universe with the rising smoke. When the paper is burnt, empty
the cauldron. Ashes should be given back to the participant to be dis-
posed of as she or he wishes. Once everyone is finished, affirm that the
negative energies of the family members listed and burned are now as
ephemeral as the smoke.

Technique: Draw a Rose

Counseling Intention To help survivors of abuse project themselves in a rose.
Description Bring out a large piece of paper for each member of the group and a
box of crayons. Ask them, “If you were a rose, what would you look
Downloaded by [New York University] at 04:58 12 August 2016

like?” Have them draw a picture of the rose they would be. When
everyone is done, have everyone hold their pictures up so that all can
view them. Isn’t it interesting how many different interpretations can
be made of a rose? Are some roses in pots and some out in nature? Are
some big and others small and timid looking? Do some have thorns
and others not? Did some people draw an environment for their rose
or is the rose alone in the picture? Are some roses growing by walls,
trees, or some other protected situation? Now ask each member to
present the picture to the group, telling the others why he or she drew
the rose the way he or she did. How the pictures are drawn can provide
clues to each person’s self-image. What insights can the group provide
about each picture? Let the group have fun with their interpretations,
but each artist should have the final say about what a picture means.

Technique: How to Resolve Family Conflicts

Counseling Intention To resolve conflict collaboratively.
Description Clarify the problem. The parent moderator should introduce the gen-
eral nature of the problem, then use the “go-around” technique to get
each person’s view of the problem.

1. Go-around questions: What is the problem as you see it? How does it affect you? What is
your contribution to the problem?
2. These are challenging questions. The family should listen to each speaker with respect and
an attempt at understanding. Avoid interrupting or becoming defensive.
3. The moderator should write down the points of agreement and disagreement as they arise.
4. Brainstorm solutions: Go around as many times as necessary to come up with a list of pos-
sible solutions to the problem. Don’t analyze the solutions now; just write them all down.
5. Go through the list of possible solutions to narrow them down to the best solution for all
family members.
6. Use the “go-around’ technique to get each person’s view on what is the best solution for eve-
ryone. Ask, “Which of these do you think is the best solution? Why? Is it fair to everyone?”
7. Select the best solution. Get commitment from each person to make the solution work.
8. Decide what each person will do to implement the solution. This is the time to come up with
responsibilities, rewards, limits, consequences, and other agreed-upon commitments.
9. Go around one more time, with each family member stating what specific action he or she
will take to solve the problem.
 282  Eclectic Techniques for Couples and Families

Technique: The Family Floor Plan

Counseling Intention To identify information in a nonthreatening way; to use as a diagnostic
tool about the family system (Coppersmith, 1980).
Description Parents might be asked to draw the family floor plan for the family of
origin. Information across generations is then gathered in a nonthreat-
ening manner, focusing on meaningful issues related to one’s past.

Another adaptation of this technique is to have members draw the floor plan for their nuclear
family. The importance of space and territory is often revealed in the family floor plan. Levels of
comfort between family members, space accommodations, and rules are often revealed. Indica-
tions of enmeshment, differentiation, operating family triangles, and subsystems often become
evident.
Downloaded by [New York University] at 04:58 12 August 2016

Technique: Reframing
Counseling Intention To join with the family and offer a different perspective on presenting
problems (Sherman & Fredman, 1986).
Description Reframing involves taking something out of its logical context and
placing it in another category. For example, a mother’s repeated ques-
tioning of her daughter’s behavior after a date can be seen as genu-
ine caring and concern rather than as a nontrusting parent. Through
reframing, a negative often can be reframed into a positive.

Technique: Tracking
Counseling Intention To join the therapy process with the family (Minuchin & Fishman,
1981).
Description The therapist listens intently to family stories and carefully records
events and their sequence. Through tracking, the family therapist is
able to identify the sequence of events operating in a system that is
keeping it the way it is. What happens between point A and point B or
C to create D can be helpful when designing interventions.

Technique: Family Sculpting

Counseling Intention To re-create the family system (Duhl, Kantor, & Duhl, 1973) and to
evaluate family dynamics in a nonthreatening manner.
Description As a group, family members one at a time sculpt their families in terms
of who feels closest to whom. This is done nonverbally. Ask how
each feels about himself or herself and who is closest to or rejected
by whom. Allow other group members to assume auxiliary ego roles
of family members; instruct the family sculptor to give each “statue”
one line to say to the family to describe what he or she sees. Process
the experience. Sculpting provides for re-creation of the family system,
representing family members’ relationships to one another at a specific
period of time. The therapist can use sculpting at any time in therapy
by asking family members to physically arrange the family. Adolescents
often make good family sculptors, as they are provided with a chance
to nonverbally communicate thoughts and feelings about the family.
 Eclectic Techniques for Couples and Families  283

Technique: Family Sociograms

Counseling Intention To discover patterns of relationships in the group (Suler, 2003).
Description Explain to the group how sociograms work. Circles represent peo-
ple in a group. A solid line with an arrow at the end represents that
one person “likes” or feels close to another (there may be arrows at
both ends if the feeling is mutual). A broken line represents a person
“not liking” or being in conflict with another. The patterns created
by the lines indicate the patterns of relationships and subgroupings
within the group, as well as the overall cohesion of the group. So
in Figure 13.3 there is an alliance between B and C; and the A-D-E
subgroup; conflicts between A and B, and C and D; and B serves as a
bridge between the dyad and triad groups. The overall cohesion of the
group is moderate in strength.
Downloaded by [New York University] at 04:58 12 August 2016

Ask group members to draw a sociogram of their family. Process issues about the sociogram
drawing that might be significant in revealing the person’s feelings and attitudes about his or her
family.

1. What circles did you draw first?

2. How do the sizes of the circles compare to each other?
3. How are the circles placed in relation to each other (close, far away, on top, below, or next
to each other)?
4. How complex or simple is the drawing, or parts of it?
5. Was anything erased or changed?

Technique: Family Photos

Counseling Intention To provide a wealth of information about past and present functioning.
Description One use of family photos is to go through the family album together.
Verbal and nonverbal responses to pictures and events are often quite
revealing. Adaptations of this method include asking members to bring
in significant family photos and discuss reasons for bringing them, and
locating pictures that represent past generations. Through discussion

Figure 13.3  Family Sociogram. Source: Suler, J. R. (1996). Teaching Clinical Psychology: Family Socio-
grams. (Reprinted with permission.)
 284  Eclectic Techniques for Couples and Families
of photos, the therapist often more clearly sees family relationships,
rituals, structure, roles, and communication patterns.

Technique: Draw Your Family Table

Counseling Intention To have family members examine the impact of their family of origin
and/or current family dynamics on their personality and interpersonal
dynamics (Trotzer, 1986).
Description

1. On a large sheet of paper, draw the shape of the table your family ate at when you were
growing up, between the ages of 7 and 18.
2. Place members of your family around the table in their usual places, using squares to rep-
Downloaded by [New York University] at 04:58 12 August 2016

resent males and circles to represent females. Identify each person by name and role (e.g.,
mother, brother, grandfather).
3. Next to each member of the family at the table, write a descriptive phrase or comment that
describes each family member’s personality.
4. On the surface of the table, write descriptors (words or phrases) that describe the atmos-
phere of the family and what it was like living with that family.
5. Have each member share his or her table with the group. Process the impact of the family of
origin.

Technique: Healthy Family

Counseling Intention To explore family dynamics, both functional and dysfunctional.
Description

1. Instruct the group to picture in their mind a scene that symbolizes a healthy family
interaction.
2. Ask each person to identify a family member role that he or she would like to assume and to
share his or her thoughts with the rest of the group.
3. Ask for volunteers.
4. Let the interaction flow. When the action has reached a natural conclusion, invite members
of the group to share.
5. Move other members of the group in and out of the role-playing situation (i.e., replace
characters or introduce new characters such as aunts, uncles, or grandparents).

Technique: Family-o-Gram
Counseling Intention To examine communication dynamics in the family (Trotzer, 1986).
Description Using the family table drawing, have a group member represent each
person at the table, including the client who drew the table. Have
the person who drew the table give a verbal description of each fam-
ily member and specify typical statements that family members would
make. Each “family member” is to remember the statement and pre-
sent it in the character of the family member described.

1. Once the description and statements have been assigned, place the person who drew the
table in the center and form the other members around him or her in the manner depicted
by the family table.
 Eclectic Techniques for Couples and Families  285
2. Starting with a parent figure, have the table’s drawer face that person and make eye contact.
When the drawer does this, the family member must make the statement in character. The
table drawer then rotates to the next person on the right, repeating the procedure until each
family member has given his or her statement to the table drawer in the center. Repeat the
rotation at least three times without interruption.
3. After three rotations, have the family members move in closer to the table drawer in the
center. Instruct him or her to close his or her eyes and then have all the family members
make their statements once, trying to get the attention of the table drawer in the center.

After 15 to 20 seconds, stop the procedure and process the experience with the table drawer.
Process the experience with all participants.

Technique: Family Choreography

Downloaded by [New York University] at 04:58 12 August 2016

Counseling Intention To reflect real and ideal family relationships.

Description In family choreography, arrangements go beyond initial sculpting;
family members are asked to position themselves as to how they see
the family and then to show how they would like the family situation
to be. Family members may be asked to reenact a family scene and pos-
sibly resculpt it to a preferred scenario. This technique can help a stuck
family and create a lively situation.

Technique: Family Council Meetings

Counseling Intention To assign families homework to follow through on therapy between
sessions.
Description Family council meetings are organized to provide specific times for
the family to meet and share with one another. The therapist might
prescribe council meetings as homework, in which case a time is set
and rules are outlined. The council should encompass the entire fam-
ily, and any absent members have to abide by decisions. The agenda
may include any concerns of the family. Attacking others during this
time is not acceptable. Family council meetings help provide struc-
ture for the family, encourage full family participation, and facilitate
communication.

Technique: Strategic Alliances

Counseling Intention To encourage a family member to change.
Description This technique, often used by strategic family therapists, involves meet-
ing with one member of the family as a supportive means of helping
that person change. Individual change is expected to affect the entire
family system. The individual is often asked to behave or respond in a
different manner. This technique attempts to disrupt a circular system
or behavior pattern.

Technique: Positive Action Tags: Using Therapeutic Symbols in Family Therapy

Counseling Intention To reveal how the lack of given virtues cause family disruption, disre-
spect, and dysfunction (Cox, 1973).
 286  Eclectic Techniques for Couples and Families
Description

1. Have a family member discuss how he or she would have felt if a given virtue had been
extended and attempt to get others to discuss how they felt a given virtue was withheld from
the situation (e.g., when someone was impatient).
2. Find a phrase, poem, passage, or virtue that articulates interpersonal dignity (e.g., virtues
such as self-discipline, compassion, responsibility, friendship, work, courage, perseverance,
honesty, loyalty, or faith).
3. Have small metal plates made (like army dog tags) and place them on neck chains. Instruct
each family member to wear their “positive action tag” for 1 week and agree to practice
the virtue on the tag every day with all other family members. Dad, for example, agrees to
practice “compassion,” mom agrees to practice “patience,” and daughter agrees to practice
“respect.”
Downloaded by [New York University] at 04:58 12 August 2016

4. At the next family session, have each family member discuss their experience with practicing
their designated virtue on their positive action tag and how it felt practiced on them.
5. Have family members exchange positive action tags for the following week.

Tags are exchanged by drawing them out of a hat. Family members have no choice in the tag
they get.

Technique: Getting Rid of the Seven Deadly Habits of Unhappy Couples

Counseling Intention To help clients see that all purposeful behavior is chosen and to under-
stand choice theory (Glasser, 1999).
Description Choice theory explains that because clients can only control their own
behavior, when a client is having difficulty with another person, he or
she tries to choose behaviors that would bring them closer. The thera-
pist explains that there are seven deadly external control habits that
eventually will destroy the happiness in any relationship. It is almost
certain that they are both using one or more of these habits in their
marriage: (1) criticizing, (2) blaming, (3) nagging, (4) complaining,
(5) threatening, (6) punishing, and (7) rewarding to control or bribe.

Assign homework to the couple that they should complete separately, writing down examples
of when each uses one or more of the seven habits consistently in their marriage.
Once they believe they understand the difference between using external control language and
choice theory language, they should together discuss how they could rewrite the examples they
had written down. Their task would be to change their words from external control to choice
theory language. Process how their lives and their marriage will improve significantly.

Technique: Mission and Legacy

Counseling Intention To encourage couples to write about some aspects of their life and
personality that will help them as spouses to understand each other
better (Gottman, 1999, p. 211).
Description Imagine that you are standing in a graveyard looking at your own
tombstone. Think of the epitaph you would like to see there. Imagine
your own obituary in the newspaper following your death. Write this
obituary of yourself—it does not have to be brief. How do you want
people to think of your life, to remember you?
 Eclectic Techniques for Couples and Families  287
Next, write the mission statement for your life. What are you trying to accomplish? What is
your larger struggle? What is your dream? What legacy would you like to leave this world when
you die?
What are your life dreams? What is that you definitely want to do in your life that you have
not yet fulfilled? This can be creating something or an experience that you want to have, such as
learning to sail, climbing a mountain, or parachuting out of an airplane.”
Process the fact that involvement in what is wanted most is a process of becoming. “What kind
of person would you like to be? What have been your struggles in trying to become that person?”

Technique: Deposits in an Emotional Bank Account—Stress-Reducing Conversations

Counseling Intention To enhance the couple’s ability to create a peaceful home by learning
how to have a stress-reducing conversation on a daily basis (Gottman,
Downloaded by [New York University] at 04:58 12 August 2016

1999, p. 214).
Description Tell the couple that this exercise deals with the management of daily
external stress, like job stress. Ask spouses to commit to having a con-
versation like this one every day, for at least 20 minutes at the end of
the day. Ask the spouses to discuss a recent or upcoming stress in each
of their lives that is not related directly to a marital issue (i.e., upcom-
ing visit from toxic in-laws, or a business venture). They take turns,
allowing about 15 minutes for each. In the last five minutes of the
exercise, ask the partners to discuss how and when they could build in
this kind of conversation into each day.

Technique: Diffusing Physiological Arousal by Taking a Structured Break

Counseling Intention To introduce a “withdrawal ritual” or “time-out” procedure in the
marriage to manage stress (Gottman, 1999, p. 231).
Description Have the couple discuss the following questions. There is no blaming.

1. What makes me feel flooded (overwhelmed)? What are the feelings inside me when this hap-
pens? What am I thinking usually?
2. How do I typically bring up issues or complaints?
3. Do I store things up?
4. Is there anything I can do that soothes you?
5. Is there anything I can do to soothe myself?
6. What signals can be developed for letting the other know when one of us is feeling flooded?
Can we take breaks? (This is the most important part of the exercise.)

Technique: Working as a Team: The Paper Tower

Counseling Intention To help the couple work as a team by turning toward each other rather
than away from one another, and giving and accepting influence in an
equitable sharing of power on a task that is unrelated to marital issues
(Gottman, 1999, p. 293).
Description The couple is given a box containing assorted materials such as news-
papers, magazines, construction paper, tape, sparkling glue, magic
markers, stickers, straws, string, stapler, and anything else to make the
box interesting. They are instructed to build a paper tower. It must be
tall, strong, and beautiful, and has to be able to stand unsupported.
 288  Eclectic Techniques for Couples and Families
They can earn up to 25 points for size, 25 points for strength, and 50
points for beauty. The points are awarded by the therapist, who also
gives the spouses feedback on how they worked together as a team.
The most influential team member is the one who draws out the other,
asks questions, and gives support, rather than the one who dominates.

Technique: Solution-Focused Family Techniques

Counseling Intention To identify and amplify solution patterns (de Shazer, 1982, p. 42).
Description Increase cooperation by accepting the clients’ goals framed in a realis-
tic, positive way. Maintain an overtly supportive, accepting therapeutic
stance. Stay solution focused:
Downloaded by [New York University] at 04:58 12 August 2016

1. Initial changes are small.

2. Clients’ intermittent return to problem talk is not a failure.
3. Measure success by goal attainment, not by number of sessions.

Ask solution-focused questions and expand the answers with the following questions:

1. Exceptions: “What things are different when the problem is not happening?”
2. Miracles: “Let’s pretend a miracle occurred while you were sleeping. What would you notice
when you awoke that would tell you the problem was gone?”
3. Scaling: “On a scale of 1 to 10, where are you now? What would you prefer?

What could you do to advance 1 point?”

4. Coping: “What do you do to keep things from being worse? How did you get through such
a difficult thing?”
5. Increasing readiness to notice change: “It will be interesting to see how things change for
the better this week.”
6. Solution tasks: “Between now and the next time we meet, notice what is going right that
you do not want to change (p. 42).”

Technique: Mapping Your Emotional Relationships

Counseling Intention To map out changes in emotional relationships over a life span (Rich-
ardson, 1987, p. 18).
Description Draw a diagram, using circles for females and squares for males, of
your family of origin when you were 12 years old. Include each family
member and yourself. Place them either close or distant to each other,
depending on what you think the emotional relationships were at that
time in your life. See Figure 13.4 for an example.

self 0 brother

sister 0 mother 0 father

Figure 13.4  Emotional Relationship Map

 Eclectic Techniques for Couples and Families  289
Draw a similar diagram for ages 16 and 21. Note any changes of relationships over the years.
Draw a diagram of your present relationship with your family of origin. Then draw a diagram
of your current family of spouse and children, if any. Are there any similarities or differences in
these family diagrams?

Conclusion
The typical family relationship has changed dramatically in the last two decades. Family organi-
zational structures include blended, common-law, single-parent, communal, serial, polygamous,
cohabitational, and homosexual families (Goldenberg & Goldenberg, 1985). One of the latest
family structures is that of skip-generation parents—grandparents who are raising their chil-
dren’s children. Taken in perspective, these kinds of family relationships are having a tremendous
impact on schools, communities, child care, health care, and the workforce. With changing
Downloaded by [New York University] at 04:58 12 August 2016

demographics and the accompanying diversity, it becomes even more futile to rely on one model
as an all-inclusive intervention approach with families. With the focus on healthy family func-
tioning, therapists cannot allow themselves to be limited to a prescribed operational procedure,
a rigid set of techniques, or set of hypotheses. Therefore, creative judgment and personalization
of application are encouraged.
 14 P
 lay Therapy Techniques for Children
and Adolescents

In the last two decades, play therapy and art therapy have gained tremendous momentum in
Downloaded by [New York University] at 04:58 12 August 2016

professional development initiatives and have become the preferred mode of child treatment
in clinical practice. Children in particular have not developed the abstract reasoning abilities
and adequate verbal skills necessary to adequately articulate their feelings, thoughts, actions,
and reasons for their behavior. For children, toys become their words, and play becomes their
conversation.
Play therapy has become the model of therapy for children and adolescents according to the
Association of Play Therapy (APT), which defines play therapy as “the systematic use of a theoreti-
cal model to establish an interpersonal process wherein trained play therapists use the therapeu-
tic powers of play to help clients prevent or resolve psychosocial difficulties and achieve optimal
growth and development” (1997, p. 4). Carmichael (2006) maintains that play therapy is “an
intervention, based on theoretical premises and recognized as therapy” (p. 2). Schaefer and Drewes
(2009) have generated a list of the therapeutic powers of play. Some of these therapeutic factors are

self-expression, access to the unconscious, direct and indirect teaching, abreaction, stress
inoculation, mastering of fears and counterconditioning of negative affect, catharsis, positive
emotion, competence and self-control, sublimation, attachment formation, rapport build-
ing, and relationship enhancement, moral judgment and behavioral rehearsal, empathy, and
perspective taking, power/control, sense of self, creative problem solving, reality testing,
and fantasy compensation.
(p. 3–15)

There is a growing body of empirical research on the efficacy of play therapy with specific
populations.

By acting out through play a frightening or traumatic experience or situation symbolically,

and perhaps changing or reversing the outcome in the play activity, children move toward an
inner resolution, and then they are better able to cope with or adjust to problems. The use
of toys enables children to transfer anxieties, fears, fantasies, and guilt to objects rather than
people. In the process, children are safe from their own feelings and reactions because play
enables children to distance themselves from traumatic events and experiences.
(Landreth, & Bratton, 1999, p. 1)

Kottman (2001), a prominent researcher in the field, has significantly outlined the major contrib-
utors to play therapy over the last two decades and has demonstrated the significant momentum that
this medium has garnered in the field when working with children and adolescents. The most poign-
ant demonstrations are those that are empirically based. As a result of managed behavioral health
care, mental health professionals are being held accountable to use well-established, theoretically
 Table 14.1  Research Support for Play Therapy with Specific Populations
Categories of Presenting Problems for Authors
Play Therapy
Abuse and Neglect Benoit, 2006
Hall, 1997
Kelly & Odenwalt, 2006
Knell & Ruma, 2003
Mullen, 2002
Palmer, Farrar, &Ghahary, 2002
Pelcovitz, 1999
Strand, 1999
Tonning, 1999
Adoption and foster care-related issues Booth & Lindaman, 2000
Bruning, 2006
Downloaded by [New York University] at 04:58 12 August 2016

Kolos, 2009
Kottman, 1997
Rubin, 2007
VanFleet, 2009
Aggressive, acting out behavior Bay-Hinitz & Wilson, 2005*
Crenshaw & Hardy, 2007
Crenshaw & Mordock, 2005
Davenport & Bourgeois, 2008
A.Levy, 2008
Ray, Blanco, Sullivan & Holliman, 2009*
Riviere, 2009
Schumann, 2005*
Tyndall-Lind, Landreth & Giordano, 2001
Anxiety and/or withdrawn behavior Brandt, 2001*
Danger, 2003
Knell & Dasari, 2009
Ray, Schottelkorb & Tsai, 2007*
Shen, 2002*
Behavior Problems Fall, Navelski & Welch, 2002*
Flahive, 2005*
Garza & Bratton, 2005*
Meany-Whalen, 2010*
Packman & Bratton, 2003*
Paone & Douman, 2009
Rennie, 2003*
Riviere, 2009
Siu, 2009*
Snow, Hudspeth, Gore, & Seale, 2007
Chronic and Terminal Illness Boley, Ammen, O’Conner & Miller, 1996
Boley, Peterson, Miller & Ammen, 1996
Goodman, 2006
M.Johnson & Kreimer, 2005
Jones & Landreth, 2002*
Kaplan, 1999
Ridder, 1999
VanFleet, 2000
Depression Briesmeister, 1997
Tyndall-Lind, Landreth & Giordano, 2001*
Developmental Delays Garofano-Brown, 2007

(Continued)
 Table 14.1 (Continued)

Categories of Presenting Problems for Authors

Play Therapy
Divorced Parents Cangelosi, 1997
Ludlow & Williams, 2009
Pedro-Carroll & Jones, 2005*
Robinson, 1999
Siegel, 2006
Family violence and other related family Green, 2006
problems Huth-Bocks, Schettini, & Shebroe, 2001
Kot & Tyndall-Lind, 2005*
Malchiodi, 2008
Tyndall-Lind, Landreth & Giordano, 2001*
VanFleet, Lily & Kaduson, 1999
Downloaded by [New York University] at 04:58 12 August 2016

Webb, 1999
Weinreb & Groves, 2006
Fetal Alcohol Syndrome Liles & Packman, 2009
Grief Issues Bluestone, 1999
Bullock, 2006
Griffin, 2001
Webb, 2006
Homelessness Baggerly, 2003, 2004, 2006
Baggerly & Jenkins, 2009*
Baggerly, Jenkins, & Dewes, 2005
Newton, 2008
Hospitalization Kaplan, 1999
Li & Lopez, 2008*
Rae & Sullivan, 2005
Natural Disasters Baggerly, 2006
Felix, Bond, & Shelby, 2006
Green, 2006
See, 2006
Shelby, 2007
Shen, 2002*
Parental alcoholism Emshoff & Jacobus, 2001
Parental military deployment Herzog & Everson, 2006
Solt & Balint-Bravo, 2008
Parenting Stress Doughherty, 2006
Ray & Doughherty, 2007
Perfectionism Ashby, Kottman, & Martin, 2004
Selective Mutism Cook, 1997
Knell, 1993
Sexual Abuse Dripchak & Marvasti, 2004
Gallo-Lopez, 2009
Gil, 2002, 2006
Green, 2008
Reyes & Asbrand, 2005*
Scott, Burlingame, Starling, Porter, & Lilly, 2003*
Social problems Blundon & Schaefer, 2009
Fall, Navekski, & Welch, 2002
Hetzel-Riggin, Brausch, & Montgomery, 2007*
Karcher, 2002
Lawrence, Condon, Jacobi, & Nicholson, 2006
 Play Therapy Techniques  293

Categories of Presenting Problems for Authors

Play Therapy
Trauma Carden, 2005
Cattanach, 2006
Drewes, 2001
Fong & Earner, 2006
Frey, 2006
Kaduson, 2009
Martin, 2008
Morrison, 2009
Ogawa, 2004
Reyes & Asbrand, 2005*
Ryan & Needham, 2001
Shelby & Felix, 2005
Webb, 1999, 2006
Downloaded by [New York University] at 04:58 12 August 2016

Williams-Gray, 1999
Witnessing violence Nisivoccia & Lynn, 2006
Attachment Disorder Benedict & Mongoven, 1997
Hough, 2008*
Jernberg & Booth, 199
Ryan, 2004
Wenger, 2007
Attention-deficit/hyperactivitity disorder Gnaulati, 2008
Kaduson, 1997, 2009
Ray, 2007*
Reddy, Spencer, Hall, & Rubel, 2001, 2005*
Schottelkorb, 2007*
Autism spectrum disorders Carden, 2009
Godinho, 2007
Kenny & Winick, 2009
Mastrangelo, 2009
S. Rogers, 2006
Scanlon, 2007
R. Solomon, 2008
Mood Disorders Briesmeister, 1997
Newman, 2009
Learning Disabilities Kale & Landreth, 1999
Speech difficulties Danger & Landreth, 1999*
Residential Treatment Centers Crenshaw & Forearce, 2001
Robertie, Weidenbenner, Barrett & Poole, 2007*
Severe Conduct disorders/Signs of Anderson & Richards, 1995
psychosis
Source: Kottman, T. (2001). Play therapy basics and beyond. Alexandria, VA: American Counseling Association.
(Note: asterisks indicate empirical research.) Reprinted with permission.

based, and flexible interventions (Reddy & Savin, 2000). Issues that are important to the devel-
opment of children and adolescents range from abuse and neglect to severe conduct disorders, as
outlined in Table 14.1. Outcome studies on the effectiveness of play therapy include social malad-
justment, withdrawn behavior, conduct disorder/aggression/oppositional behaviors, and maladap-
tive school behavior. Play therapy is based upon the fact that play is the child’s natural medium of
self-expression. It is an opportunity that is given to the child to “play out” his or her feelings and
problems, just as in certain types of adult therapy, an individual “talks out” his or her difficulties.
 294  Play Therapy Techniques

History and Theoretical Approaches to Play Therapy

It is not the intent of this chapter to give a detailed explanation of each theoretical approach to
play therapy. Ethically, the reader is encouraged to obtain further training and even become certi-
fied as a play therapist through the APT (www.a4pt.org) and its affiliates.
Psychoanalytic/Psychodynamic Play Therapy: Sigmund Freud first recognized the value
of play therapy with children. However, Anna Freud (daughter of Freud) and Melanie Klein
(student of Freud) both recognized the richness and complexity of childhood development and
valued play therapy as a means of understanding and healing the child. Klein (1975) focused on
free association with children through spontaneous play to understand subconscious processes
and a young child’s experiences of abandonment, envy, and rage—universal concepts that are rel-
evant today. Anna Freud’s (1974) approach focused on helping children consciously understand
why they thought, felt, and behaved to encourage personal change. She observed defenses that
were used to cope with their anxieties, trauma, and life experiences of growing up. She was the
Downloaded by [New York University] at 04:58 12 August 2016

first therapist to provide parent education and school consultation as an important component to
child therapy. Psychoanalytic play therapy focuses on alleviating anxiety, depression, and resolv-
ing complicated grief; overcoming trauma; adjusting to life events such as divorce and separation;
overcoming phobias; becoming more competent as a learner in school; managing personal anger,
conflict, and aggression; and learning to adjust to a learning disability or physical handicap.
Structured Play Therapy: This is based on psychodynamic conceptualizations of children
and adolescents with a more structured, goal-oriented process when interacting with children.
The therapist plays a more active role in outlining the focus and goals of therapy. Within this
context, Levy (1938) developed Release Therapy for children under the age of 10 years old who
had experienced some specific trauma (e.g., loss, violence, bullying). The therapist uses play to
re-enact the stressful situation in an effort to bring about the release of troubling emotions, acute
stress, or post-traumatic stress disorder (PTSD) symptoms. Hambridge (1955) expanded Levy’s
work by re-creating the anxiety-producing situation and encouraging free play to resolve issues
connected with the traumatic event.
Relationship Play Therapy and Experiential Play Therapy: Taft (1933) and Allen (1942)
created Relationship Play Therapy. Their focus was to de-emphasize past events and concentrate
on present positive relationships to bring about healing. The essence of therapy with children
and adolescents is the establishment of an authentic relationship in the here-and-now and to
learn to transfer these skills to function better in relationships in everyday situations. A more
contemporary approached based on the curative factors between therapist and the child or ado-
lescent is Experiential Play Therapy (Norton & Norton, 2008). The fundamental premise for
Experiential Play Therapy is the principle that children and adolescents “encounter their world
in an experiential style as opposed to a cognitive one, i.e., children do not think about their
encounters; rather they involve their senses as a means of incorporating information about their
environment” (Norton & Norton 2006, p. 29). Essentially, through the relationship with the
play therapist, the child will gain a sense of empowerment.
Nondirective, Child-Centered Play Therapy: Carl Rogers is the major proponent of Nondi-
rective Therapy, also acknowledged as Person-Centered Therapy (Rogers, 1951). Axline (1947)
applied Rogerian concepts to play therapy and pioneered Nondirective or Child-Centered Play
Therapy. She promoted essential prerequisite conditions such as a warm relationship, acceptance,
establishment of a feeling of permissiveness, recognition and reflection of feelings, and the dem-
onstration of a deep respect for children’s ability to solve their own problems. In many circles,
Axline is considered the major proponent of play therapy. In child-centered play therapy, the play
therapist creates a therapeutic relationship of unconditional positive regard, empathy, and accept-
ance. Through the therapeutic relationship, the child or adolescent actualizes his or her innate
potential for development and growth.
 Play Therapy Techniques  295
However, Garry L. Landreth is internationally known for his writing and work in promoting
the development of the child-centered approach to play therapy today. He is one of the most
recognized and most respected proponents and innovators in play therapy. He is a Regents
Professor in the Department of Counseling and founder of the Center for Play Therapy at the
University of North Texas. According to Landreth (1991):

Play therapy is interacting with a child on her own terms, providing the opportunity for the
free expression of herself with the simultaneous acceptance of this feeling by an adult. I now
find interest in those child activities which previously seemed dull. I have learned patience,
no longer expecting the child to unfold immediately and dramatically, bursting forth with
startling insight. Removing my expectations increases my acceptance of children. I find grat-
ification in the changes which children can bring about from within themselves, sometimes
beyond, and notably without, my own understanding.
Downloaded by [New York University] at 04:58 12 August 2016

(p. 103)

Limit-Setting Therapy: Bixler (1949) and Ginott (1959) professed that the development
and enforcement of limits are necessary for change in therapy. Bixler (1949) maintained that
“limits are therapy” (p. 1). By setting limits, especially with aggressive or acting-out behavior, the
therapist can more easily maintain a positive attitude toward children and adolescents in therapy.
Setting time limits can often get children to move more expediently to the working stage.
Theraplay: This approach to play therapy is most useful for children who have attachment
issues. Directive in its delivery mode, it attempts to duplicate interactions typically present in
parent–infant interactions to enhance impaired parent–child relationships (Bundy-Myrow &
Booth, 2009). With theraplay, one or more therapists work with the child or adolescent and
another therapist works with the parents. The design is time limited and focuses on structure,
challenge, intrusion, and nurturing with the use of co-therapists.
Developmental Play Therapy: This is another directive approach to also improve attachment
issues in parent–child relationships. The emphasis is on the developmental process (Short, 2008)
with the therapeutic approach to provide nurturing that was neglected by children in the early
attachment to their parents. The developmental play therapist may hold, stroke, or rock children,
nurturing to move them forward in their developmental process.
Object Relations Play Therapy: Winnicott (1965) briefly explored the concept of object
relations, that is, the relationship of the child with his or her caregiver. Essentially, when the car-
egiver is warm, caring, and nurturing, the child develops trust and assumes that others will also
be caring. When caregivers are cold, unattached, and distant, the child will assume and perceive
others to be the same. This approach is also effective with children with attachment disorders
(Benedict, 2006). The therapist attempts to modify how the child conceptualizes the world, tries
to change the worldview, and teaches the child how to discriminate between people who are
trustworthy and those who are not trustworthy.
Adlerian Play Therapy: Adlerian therapy was adapted from working with adults and applied
to children, combining both individual psychology and a child-centered focus. It is structured
into four phases: 1) building a mutual and equal relationship, 2) exploring the child or adoles-
cent’s lifestyle, 3) promoting education and insight, and 4) providing reeducation (Kottman,
2010). Adlerian play therapists use play, art, sand tray, music, and other experiential interven-
tions to build relationships with children and adolescents. The intent is to provide insight and to
develop more constructive ways of thinking, feeling, and behaving in relationships with signifi-
cant others. Adlerian play therapists also work with parents and teachers to reduce emotional and
behavioral problems that may be barriers to learning.
Cognitive-Behavioral Play Therapy: Borrowing from the tenets of Aaron Beck,
cognitive-behavioral play therapy is directive and goal oriented. Therapists use behavioral
 296  Play Therapy Techniques
techniques and cognitive strategies in an effort to teach children better ways of thinking about
themselves, their relationships with others, and the problem situation. Play scenarios are set
up that parallel the emotional, social, and behavioral dilemmas currently experienced by the
child and to then learn new coping skills and practice alternative appropriate behaviors (Knell &
Dasari, 2009). All behavior is learned. The intent of the therapist is to give positive reinforce-
ment to desirable behaviors and to extinguish those that are identified as undesirable.
Gestalt Play Therapy: The founder of Gestalt therapy was Fritz Pearls (1973). His focus was
humanistic and on staying with the child or adolescent in the here-and-now, gaining an aware-
ness of emotions and behaviors in the present rather than dwelling on the past. A nonjudgmental,
authentic, and relevant dialogue between the child or adolescent and the Gestalt therapist exists
as the center for the medium of change. Children and adolescents become aware of problems
through play, role-play, drama, storytelling, and music to project feelings in a nonthreatening
manner to gain better self-awareness and new insights. Oaklander (1994) used Gestalt therapy
Downloaded by [New York University] at 04:58 12 August 2016

to focus on the child’s concept of self-regulation, boundaries, and sense of self, along with the
therapeutic role of awareness, experience, and resistance.
Jungian Analytical Play Therapy: Numerous therapists use sand tray play therapy using Jun-
gian principles. Lowenfeld (1950) developed a system called “the World” and asked children and
adolescents to pick miniature objects to represent various aspects of their world to put in the sand
tray to tell their stories. Kaliff (1980) took a more direct approach and expanded Lowenfeld’s
work by choosing special miniature objects for each child or adolescent and asking him or her
to arrange the miniatures in a sand tray and develop a narrative or story to describe the scenes.
Exploration of the child’s collective unconscious in both verbal and nonverbal communication
is the goal of Jungian analytical play therapy. Green (2009) and Lilly (2006) expanded sand tray
work to include art and play strategies to help children and adolescents explore the ego, the self,
and the collective unconscious.
Narrative Play Therapy: Narrative play therapy (Cattanach, 2008) is centered on Michael
White’s approach to narrative therapy (White, 2005). Fundamentally, people’s lives are made
up of stories that they tell themselves and that provide a frame of reference through which they
interpret their lives. The goal of therapy is to separate the person from the problem and external-
ize it so that it becomes something that the child or adolescent can master and control rather
than being consumed by the story. Story telling is a way of helping children and adolescents
process their feelings with an empathetic adult, with the purpose of creating new choices for their
presenting stories.
Ecosystemic Play Therapy: Ecosystemic play therapy integrates multiple theoretical concep-
tualizations and therapeutic strategies used with adults and families. O’Connor (2009) recom-
mended that play therapy shift its focus from individual aspects of children’s and adolescents’
lives and include the multiple subsystems that have a significant effect on them, such as the
family, the school, the community, and the peer group. In a more directive approach, the thera-
pist assesses the cognitive, social, emotional, and physical developmental level of the child or
adolescent and plans therapeutic experiences designed to control the setting, the materials, and
activities to remediate deficits in the child’s or adolescent’s development.
Family Play Therapy: This approach to play therapy focuses on family system problems rather
than exclusively focusing on the child or adolescent. The entire family is the client (Ariel, 2005;
Gil, 2003; Sori, 2006). The therapist assimilates the role of educator, play facilitator, role model,
and a more directive therapist to help parents and children make changes in the way they see
themselves and others within the family system and how they interact with one another. Harvey
(2006) integrated more techniques into family play therapy such as expressive arts therapies (art
therapy, dance therapy, and drama therapy). Therapists use themes and metaphors to develop
and prescribe the creation of a new family metaphor and coaching, as well as providing “own-
work” to encourage more appropriate ways of interacting with one another, enhancing relation-
ships and resolving conflicts.
 Play Therapy Techniques  297
Filial Family Therapy: Filial Therapy was developed by Bernard Guerney (1964) and Lou-
ise Guerney (1975) in response to the unavailability of mental health services for children ages
3 to 10 and their families by teaching parents important play therapy techniques. The primary
goal is to help parents become the therapeutic change agents in their children’s lives by maximiz-
ing the natural existing bond between parent and child. This approach reduces parental stress,
increases parenting skills, and provides the parents insight in understanding and accepting their
child while decreasing the presenting problem. The focus is on the relationship between the par-
ent and the child rather than on the therapist and child. The format is vicarious learning through a
support group of eight parents who meet for 2 hours over a 10- to 12-week period to learn basic
child-centered play therapy principles. This dynamic didactic process is unique for filial therapy and
distinguishes it from other play therapy programs that are exclusively educational in nature. Filial
therapy has also demonstrated in a number of empirical studies that it can increase parental empa-
thy and acceptance and diminish distress. It has also shown to be applied across cultures and diverse
Downloaded by [New York University] at 04:58 12 August 2016

socioeconomic backgrounds. It is applicable to a wide range of child and family problems related to
trauma and maltreatment; witnessing or being exposed to violence, anxiety, depression, separation,
and divorce; grief and loss; attachment disorders; parental incarceration; and other related issues.

Family-Related and Nurturance Toys

• Doll family (mother, father, brother, sister, baby).
• Doll house/furniture.
• Puppet family and animal puppets.
• Baby doll.
• Dress-up clothes.
• Baby bottles.
• Container with water.
• Bowls for water.
• Kitchen dishes.

Aggression-Related Toys
• Bop bag.
• Dart guns with darts.
• Small plastic soldiers and/or dinosaurs.
• 6- to 10-foot piece of rope.
• Foam aggression bats.

Expressive and Construction Toys

• Crayons or markers and drawing paper.
• Play-Doh, Sculpey, or other modeling substance.
• Sand tray with miniature toys.
• Plastic telephones.
• Scarves or bandanas.
• Blocks or construction toys.
• Heavy cardboard bricks.
• Blackboard.
• Mirror.
• Masking tape.
• Magic wand.
• Masks.
 298  Play Therapy Techniques
Other Multiuse Toys
• Cars, trucks, police cars, ambulances, fire trucks, school buses.
• Playing cards.
• Play money.
• Ring-toss or similar game.
• Doctor’s/nurse’s kit.

Animal-Assisted Therapy (AAT): Specially trained canines are gradually making a significant
impact in play therapy, serving as co-therapist. The presence of an animal facilitates trust between
the therapist and child, relieving tension and anxiety, and facilitates the sharing of feelings and
emotion. Chandler (2005) and Thompson (2009) identified some of the fundamental therapy
techniques: (1) allowing the child to pet, touch, or hug the animal; (2) using the animal to
enhance the therapeutic alliance and therapeutic relationship; (3) using the therapy dog and child
Downloaded by [New York University] at 04:58 12 August 2016

to strengthen the interaction between the child as co-therapist to reflect, paraphrase, clarify, and
summarize important issues; and using the therapy dog to provide access to the child’s emotions.

Technique: Interactive Techniques for Working with Children

Counseling Intention To build rapport and enhance relationships.
Description Interactive techniques with children can include therapeutic game play
(Corder, 1986; Nickerson & O’Laughlin, 1982; Schaefer & Reid,
1986; Serok, 1986), stories and metaphors (Brooks, 1985, 1987;
Gardner, 1986), and role-play and simulation (Larrabee & Wilson,
1981; Renard & Socko1, 1987).

Games
The use of games as a structured therapeutic tool in child therapy is beginning to gain momen-
tum within professional circles. Many counselors are familiar with psychologically therapeutic
games such as the “Talking, Feeling, and Doing Game” (Gardner, 1986) and the “Ungame”
(Parker Brothers). Checkers or chess also can be used as either a diagnostic or a therapeutic tool.
By observing how the child plays the game, the counselor can gain insight into the child’s atti-
tude, viewpoint, and behavior toward self and others.
The counselor can use the interaction during the game as a means for making therapeutic
comments and suggestions. The counselor also may use the context of the game to make inter-
pretations of children’s behavior, thought patterns, and feelings. For example, Gardner (1986)
revealed that children who lack self-esteem may hesitate to play checkers because they are afraid
they may lose. Rather than risk ineptitude, they may suggest a game of chance such as blackjack.
Kottman (1990) found that games can provide the counselor with a therapeutic tool for deep-
ening the therapeutic relationship in a relatively short period of time. Playing games allows a safe
manner of expression for feelings, thoughts, and attitudes. It also offers a structured format for
exploring children’s concerns and interactional patterns. Games like checkers or chess also can be
used to encourage children and to help them learn and assimilate new behaviors.

Stories and Metaphors

Stories and metaphors can facilitate the expression of threatening emotions with a minimum
of risk to the child. One method that the counselor may find useful is the mutual storytelling
technique (Gardner, 1986). Gardner developed this technique to communicate with children
using their own language and to help them gain insight into their own behavior and interactions.
 Play Therapy Techniques  299
In the mutual storytelling technique, the therapist tells the child that they are going to do a
Make-Up-a-Story Television Program. To start this television program, the child must tell a story,
with a beginning, middle, and end. The child invents the characters, the setting, the themes, and
the plot of the story. The therapist listens to the story, attempting to grasp the symbolic mean-
ing of the setting, the characters, and the plot. Then the therapist chooses one or two important
ideas from the original story and tells a different story, using the same setting and characters. The
characters in the therapist’s story, however, should resolve their differences in a more mature,
adaptive way than do the characters in the original story (Kottman, 1990).
In the creative characters technique, Brooks (1987) used stories to represent different aspects
of a child’s interpersonal life, such as self-esteem, relationships, beliefs, values, feelings, learning
style, and coping style. The therapist could record the beginning of the story before the therapy
session. The therapist establishes characters, setting, and some general themes in the beginning.
Each story contains significant characters that represent the child and significant others in the
Downloaded by [New York University] at 04:58 12 August 2016

child’s life. The therapist takes on the active role of a key character (such as “wise owl” or “super-
hero”) to communicate to the child about the dynamics of the problem situation and about pos-
sible alternative solutions to difficulties (Brooks, 1987). After the initial segment of the story in
which the structure for the setting and characters is established, the child becomes the storyteller,
responsible for the plot and themes from his or her point of view. Many times, simply by listening
to the child describe various significant others, the counselor can generate metaphors that “will
resonate with the client’s inner world and a significant level of understanding will be established”
(Brooks, 1985, p. 765). Kottman (1990) maintained that “communication through metaphors
allows children to experience and express threatening emotions directly. This sanctioned distanc-
ing may help decrease some of the stress involved in the therapeutic process and convert resist-
ance to cooperation” (Kottman, 1990, p. 142).

Role-Play and Simulation

Role-play and simulation provide a means for trying new skills or creating self-awareness in a non-
threatening manner. Renard and Sockol (1987) have suggested that creative dramatics (role-playing
and simulations) can be used by counselors to promote thinking, learning, and social skills:

  1. Increasing one’s ability to communicate feelings and thoughts.

  2. Developing listening skills, concentration, and the ability to observe and discuss.
  3. Fostering imagination, spontaneity, and visualization skills; encouraging increased original-
ity, flexibility, and elaboration of thinking; creating an atmosphere in which children can
begin to feel successful; sharpening abilities in cooperation, planning, decision making, and
evaluating; and having fun.

Using simulations and role-playing, the counselor frames an initial situation, outlines any rules
that have implications in the situation, and asks the child to act out the particular situation. After
the entire interaction is completed, the counselor processes the experience with children, focus-
ing on reactions and observations. Simulations and role-playing have been successful for promot-
ing peer­pressure refusal skills; communication; feeling-processing skills; decision-making skills;
moral dilemmas; skills for establishing positive behavior; and assertiveness, family relationship,
or interpersonal skills.

Play Therapy Techniques Applicable for Children and Adolescents

For children, toys and art in play therapy are their words, and play is their articulation of concerns
and their conversation. Youth have not yet developed the abstract reasoning and verbal skills
needed to adequately articulate their feelings, thoughts, or reasons for their behavior. Hence,
 300  Play Therapy Techniques
play and art therapy represent a critical means to understand children and adolescents because
traditional talking therapies are not appropriate. It is also important to understand the play of
healthy children and those who are disordered or sexually abused. Table 14.2 provides some
distinctions in play between these two dichotomies of children and adolescents.

Table 14.2  Comparison of the Dynamics Involved in the Play of the Healthy Versus Disordered/
Abused Child

The Healthy Child The Disordered or Sexually Abused Child

1. Relationship with the Therapist: 1. Relationship with the Therapist: Disordered or
Healthy children will enter into a more abused children will be aware of the therapist’s
open, direct relationship with the thera- presence but may ignore the therapist. They
pist. They will engage in direct conversa- will have little, if any eye-to-eye contact
Downloaded by [New York University] at 04:58 12 August 2016

tions, including eye-to-eye contact. They (however, note that in some cultures such as
may engage you with questions such as Asian cultures it is considered disrespectful
“What am I doing here and why are we to make direct eye.) They may display
playing?” or “Why are those pictures on inappropriate behaviors like sitting in your lap
the wall?” “What can I play with?” “Are at the first meeting. They will also not want to
you married, do you have any kids like me, engage with you and continually change the
or how old are you?” topic.
2. They will exhibit spontaneity, curiosity, 2. They will manifest one of two styles:
and genuine emotions in their (a) They will appear uncomfortable in the
interactions. They will be willing to presence of the therapist.
talk about everyday life experiences and (b) They will simply sit and wait for
attitudes. For example, “Oh, yeah last instructions from the therapist, but
week we went to the aquarium. Did you try to engage them to lead. They may
know that otters can swim on their backs become overly involved with the therapist
and we saw a pair holding hands?” immediately, before a rapport has been
established.
3. Healthy children will interact in one or 3. Disordered or abused children will interact in
more of the following relational styles: one or more of the following relational styles:
(a) Independent. They will be equally (a) Dependent. They will wait for the therapist
comfortable at playing alone or to do things for them, want to be told
moving in and out of mutual play with what to do, and tend to bombard the
the therapist. They will be happy in therapist with questions such as, “What is
their play, often singing or humming. this?” “How do you play with it? “What is
They may sing their own song and it supposed to do?”
then try to engage you to sing a song (b) Competitive. Because of a lack of trust,
also. disordered or sexually abused children
(b) Co-operative. Although many may want involvement with the therapist,
children struggle with their self- while at the same time almost being driven
esteem, and it feels good to complete to maintain control of the relationship.
and win, these children will be These children want to win every time
more likely to accept the fact that and will do whatever is necessary in
sometimes they’ll lose. Consequently, order to win, even if it means quitting
they do not exhibit strong styles of before completion of an activity when
competitiveness or dependency. When it becomes inevitable that the therapist
playing a game, sometimes it is for the will be victorious. Again, in situations like
therapist to lose on purpose. this, the therapist may lose on purpose
to give the child or adolescent a sense of
control. When dealing with siblings, they
may compete with each other and for the
therapist’s attention, so it important to set
up ground rules and boundaries.
 The Healthy Child The Disordered or Sexually Abused Child
4. Interactive. These children will feel free 4. Aggressive. The play of these children will
to question the therapist. They may begin often be aggressive from the first moment of
to questioning the limits of the playroom therapy, requiring the therapist to set frequent
right away. limits in the beginning of the therapy process.
(c) In becomes important to set rules and Once past this testing stage, however, the
boundaries for the play therapy room therapist will not have to set as many limits,
such as: although from time to time it may still be
1. Put toys back in their places when you are necessary. These children may even aggress
done playing with them. against the therapist. Children of this nature
2. Don’t deliberately destroy a toy. also tend to play the same games over and over
3. Have a five minute rule: “In five minutes
we will be done with this activity.” A timer
would be useful to stay on task.
4. Don’t put toys in your mouth.
Downloaded by [New York University] at 04:58 12 August 2016

5. Keep your hands to yourself and do not

throw items unless appropriate, e.g.,
throwing a ball back and forth between
therapist and child for rapport building,
5. Flexibility in Play: Healthy children will 5. Rigidity in Play: These children will tend
feel free to acquaint themselves with the to focus only on toys that enable them to
playroom. They will utilize a wider variety reconstruct their world and the events of their
of toys and materials. If they are working abuse numerous times. Driven internally to
on building a scene and a vital part of the play out the scene of their abuse, they are
scenario cannot be located, they can be unable to use these toys in other scenes. If they
flexible enough to use a dissimilar toy and cannot locate the exact toy to replicate the
pretend that it is the desired toy. When desired scene, they will give up on the whole
finished playing out the scene, they may use scenario.
the same toys to reconstruct a new scenario.
6. Intensity Level: Healthy children will 6. Intensity Level: There is a high level of
exhibit mild to moderate intensity toward intensity in the play, movements, and speech
their play or specific items within that of disordered and sexual abused children.
play. They will utilize play as a means of Although their activities may change quickly,
exploring feelings and temporary tensions the intensity remains inherent in the different
or conflicts that cannot be expressed easily play contexts. By the end of the session, the
or safely in school or at home. therapist may feel exhausted.
They may occasionally play silently. Even
in the silence, though, the atmosphere
remains at a comfortable level of intensity.
Their play simulates what these children
observe in their world and becomes a
rehearsal for life.
7. Openness: Healthy children will be able 7. Diffuse Play: These children will exhibit more
to express negative feelings and attitudes diffusion in their play (i.e., their play will
directly. This may occur in play, the not be a direct expression of their feelings).
characters will express their displeasure Fantasy play will be tangential, confused, with
with other characters openly. Since no order or pattern, or it will focus on one
themes in play are focused expressions of emotion only such as aggression, or sometimes
the child’s feelings, they are more easily they repress their anger and can only express
discernible. These children will continue happy emotions as a defense to their internal
to expressing such feelings until relief and rage. These traits make it difficult to identify
satisfaction are achieved. any themes. Although this is frustrating to
the therapist, it is important to keep in mind
that it may not always be possible to translate
the metaphor of the child’s play into adult
cognitions. Fortunately, this is not necessary in
order to be therapeutic with these children.

(Continued)
 302  Play Therapy Techniques
Table 14.2 (Continued)

The Healthy Child The Disordered or Sexually Abused Child

8. Integration: Healthy children may express 8. Splitting: With abused or disordered children,
both negative and positive attitudes about the therapist will see splitting in their play
the same person, issue, experience, or scene. characters. A character will be either all good
For example, the sister doll and the brother or all bad (e.g., black or white—there are no
doll are playing together and fight over gray areas or flexibility). These children will
something. Once the fight is over, they play not be able to see both good and bad within
together again, “Come on, why don’t we the same being (Shapiro, 1992). Also, there is
go together and build…,” which is a more often a pattern of play scenes with numerous
accurate depiction of real life. Their negative bad characters, one victim, and maybe (as the
feelings also tend to be milder than those child progresses in therapy) a character that is
of the disordered or abused child—mild to a hero(ine).
moderate as opposed to severe.
Downloaded by [New York University] at 04:58 12 August 2016

9. Dissociation 9. Dissociation
Some dissociation is a normal part Abused and disordered children at times
of childhood and is not necessarily a dissociate. This dissociation will be displayed in
predictor of Dissociative Identity Disorder frequent shifts from one uncompleted activity
(Putman, 1991). In contrast this may be to another, impulsivity or carelessness, amnesia
the tool which allows children to engage for previously initiated play, an obvious trance-
in constructive fantasy play in order to like state or marked changes in behavior and
resolve internal struggles for themselves. play styles (Putnam,1991)
Source: Norton, C. C. & Norton, B. E. 1997. Reaching Children Through Play Therapy: An Experiential Approach.
Denver, CO: The Publishing Cooperative. Reprinted with permission.

Technique: Feelings Pick-Up Sticks (McDowell, 2004)

Counseling Intention Children are very visual, and this activity is designed to help children
express various emotions and affective states:

Yellow = happy
Blue = sad
Black = very sad
Red = angry
Purple = rage
Green = jealous
Brown = bored
Orange = excited

Description Each time a stick is removed from the pile, the child or adolescent
describes a time when he or she felt that emotion. It is important to
pay attention to both the content of the child’s responses and the
choice of sticks or colors he or she avoids. This technique encourages
children and adolescents to be more open, as well as recognizing and
expressing the appropriate emotion. Caveat: children and adolescents
who are impulsive, demonstrate weak fine motor skills, or have low
frustration tolerance may not enjoy this game.

Technique: The Feeling Word Game (Kaduson, 2001)

Counseling Intention To allow children to express and communicate their feelings in an
enjoyable, nonthreatening manner.
 Play Therapy Techniques  303
Description Materials needed are eight 4" × 6" pieces of paper, marker, and tin
filled with poker chips.

Sit at the same level as the child and announce that you are going to play the feeling word
game. Ask, “What are some feelings you have?” (Pictures of feeling words can also be used.)
“Here are the feelings you described from my poker chip can,” and the therapist lines them up
on the eight pieces of paper in front of the child.
First, the therapist tells a story about himself or herself with both positive and negative feelings.
At the completion of the story, the therapist puts down a poker chip on the appropriate feeling.
Second, the therapist tells a nonthreatening story about the child, allowing for both positive
and negative feelings. The child is given the tin of “feelings” and told to put down what she or
he might feel under those circumstances.
Third, the child tells the next story for the therapist to put down his or her feelings. This con-
Downloaded by [New York University] at 04:58 12 August 2016

tinues until the major issues of the presenting problem are discussed. This approach is success-
fully used with all children, including conduct problems, attention deficit hyperactivity disorder
(ADHD), or anxiety problems

Technique: The Gingerbread Person Feelings Map (Drewes, 2001)

Counseling Intention This technique can be used with children who have difficulty identify-
ing and integrating their feelings.
Description Use the shape of a gingerbread man, with eyes, nose, and a smile, with
the words happy, sad, angry, worried, love, and afraid. Ask children to
try to add one or two more feelings to expand their emotional vocabu-
lary and gain a better understanding of the child’s cognitive skills and
underlying concerns.

Ask the child to choose a color for each feeling listed and make a small line with a marker,
crayon, or colored pencil next to the feeling word. Use an emotionally upsetting situation he or
she was talking about as a reference, or have them think of an emotional setting at home or at
school. Then ask the child to color inside the gingerbread person where he or she may experience
each feeling listed. Process the drawing where the body expresses anger, for example, and how it
may be played out in the child’s world.
This is useful in the initial stages of play therapy to help assess how emotionally constricted the
child might be and how connected or disconnected he or she may be from his or her body and
to lessen anxiety. Do the drawing later in therapy to assess awareness and integration of feelings
and change.

Technique: Clay Sculptures (Weitzmen, 2007)

Counseling Intention This procedure reveals something about who the child is and what
he or she does or does not like. It is often helpful for the therapist to
make his or her own sculpture.
Description Materials: Paper, pencil, Play-Doh

This is written in a poetic form. The colors chosen will represent emotions, but it is
advised not to inform the child until the end. Once the sculpture is complete, ask the fol-
lowing questions:

• What do you want to title your sculpture?

• What does each color represent in the sculpture?
 304  Play Therapy Techniques
• What would you say to the sculpture (it could be a person, place or thing)?
• What is the sculpture’s favorite food or activity?
• What does the sculpture like or not like to do and why?
• What does the sculpture want others to know or not know about it?

This unique projective technique places the child’s feelings onto an object, elevating the pres-
sure to express direct feeling and giving the therapist a safe way to attend to some of the key
themes that may occur in future sessions. The sculpture can serve as a concrete representation of
the child’s inner feelings and in a nonthreatening manner allows the child to use the creative arts
as a forum for expression in formative way.

Technique: Saying Good-Bye: Breaking the Links in a Chain (Lawrence, 2001).

Downloaded by [New York University] at 04:58 12 August 2016

Counseling Intention Endings for children are difficult and painful. They often feel anger,
abandonment, unfairness, and lack of control. However, children can
adapt to changes when they are given ample time and warning of what
is coming.
Description Construct together a simple chain out of colored paper. On each
link is written a date. On the first link is the present date and on the
last link is the date of the last session. Links are stapled together.
Each time a child comes to a session, he or she breaks away the link
for that session. On the final session, he or she breaks the last link.
Using this technique, the ending is not a surprise to the child. This
technique is especially good for young children and those with sepa-
ration anxiety.

Technique: My Brain (Fortier, 2003)

Counseling Intention To look at the positive and negative aspects of the child’s life; to focus
on the child as the expert in therapy; and to encourage the child’s fas-
cination with his or her brain and how it works; to reduce the child’s
defenses by focusing first on thoughts in his or her head versus feelings
about his or her life.
Description Sitting on the floor with a big piece of paper and an assortment of
markers, the therapist draws the profile of the child’s head covering
the left three quarters of the paper and writes across the top of the
page: My Brain Thinks About. . .?

The therapist talks about how the brain thinks all the time and encourages the child to come
up with some things he or she thinks about and write them down along the side of the paper.
Children often think about family members they miss, love, or worry about; people and pets
who have died; school achievement and related issues such as being bullied; illness or handicaps;
things they have nightmares about; or an offender who may have abused them and others finding
out about the abuse.
When the child is satisfied with the list, the therapist asks the child to pick a different color
marker for each item on the list. Now that the thought has a color, the child is invited to use the
color to draw inside his or her head and reflect the intensity of thoughts by the amount of space
he or she use inside his or her head. Process how the child struggles with spending so much brain
power on negative events, especially those that cannot be changed by the child.
 Play Therapy Techniques  305

Technique: Balloons of Anger (Horn, 2001)

Counseling Intention To help children and adolescents understand what anger is and how to
release it appropriately. To allow children and adolescents to see how
anger can build up inside them and how to release it slowly so that it
does not explode and hurt themselves or others.
Description The child blows up a balloon and the therapist ties it. The therapist
explains that the balloon represents the body and the air inside the
balloon represents anger. The therapist asks the child: “Can the air get
out of the balloon?” “What would happen if the air (anger) became
stuck inside you?” “Would you have room in your head to think
clearly?” The therapist says “Now, stomp on the balloon and let all the
air out.” The explosion of the balloon represents an aggressive act and
could hurt someone or his or her feelings.
Downloaded by [New York University] at 04:58 12 August 2016

Next, the therapist has the child or adolescent blow up another balloon and just pinches the
balloon closed. Now, release some of the air a little at a time. The therapist asks, “Is the balloon
smaller?” “Did the balloon explode?” “Did the people around the balloon stay safer when the anger
was released?” “Does this seem like a safer way to let the anger out?” When talking about what
makes us angry and releasing slowly, there are opportunities to problem solve; otherwise, it grows
and explodes. The therapist can then follow up with various anger management techniques. Bal-
loons of anger is a technique that is appropriate with aggressive children with anger management
issues, as well as with children who have difficulty expressing their anger and hold everything inside.

Technique: The Mad Game (Davidson, 2001)

Counseling Intention The Mad Game was created to demonstrate to children that anger is a
common, acceptable feeling and allows them to verbally and physically
express their anger.
Description The therapist divides wooden or plastic blocks evenly between himself
or herself and the child or adolescent. Each person will put a block on
top of the previous one, alternating turns. Each time a block is placed,
the person expresses something that has made him or her angry or
seemed unfair. The therapist may bring up innocent or more specific
issues that have been progressing in therapy. Once all the blocks are
stacked, the child or adolescent is asked to think of one thing that makes
him or her really angry, make a “mad face,” and knock them all down.

This can also be used for expressing other feelings, such as sadness, anxiety, or fear.

Technique: Safe Place Drawing (Gallo-Lopez, 2000)

Counseling Intention To assess the feelings of safety, especially if the child has been neglected
or abused, and to help a child feel more protected.
Description Ask the child to draw a picture of a place where he or she feels safe and
then talk about the drawing. If the home is not a safe place, the school
may be perceived as the safe place or maybe the home of an extended
family member. It is essential to strengthen the relationship between
the child and the nonoffending parent or caregiver.
 306  Play Therapy Techniques

Technique: Self-Portrait (Gallo-Lopez, 2000)

Counseling Intention To provide a closer examination of how children view themselves.
Self-portraits offer valuable information about issues such as strength
and vulnerability, self-stability, and self-worth.
Description Children or adolescents are given papers and markers to draw a picture
of themselves. It is important for children to draw their full bodies,
not just their faces, to give the therapist more information regard-
ing body integrity and self-image. These portraits should elicit more
information regarding body integrity and self-image and offer valuable
information about issues such as strength and vulnerability, grounded-
ness, and self-worth. Size and placement of the figure and body parts,
colors, clothing, and facial features and expressions deepen our under-
standing of how children view themselves. It is helpful to repeat the
Downloaded by [New York University] at 04:58 12 August 2016

exercise toward the end of treatment to compare and contrast a child’s

or adolescent’s self-view over time.

Technique: Privacy Boxes (Gallo-Lopez, 2000)

Counseling Intention Many children who are sexually abused do not understand the concept
of having privacy.
Description To reinforce the idea that everyone is entitled to privacy in certain
situations, children are asked to decorate a cardboard box, such as a
shoe box, which is used to hold the child’s individual or group pro-
jects. The boxes are painted or colored with markers, glitter, feathers,
buttons, fabric, pictures from magazines, stickers, or gems. The boxes
are kept in the therapist’s office or a closet. The box is symbolic of a
private place to store projects. Discussion revolves around examples of
privacy, secrecy, and surprises. Children are presented with “what if”
scenarios and asked to determine whether the scenario describes an
issue of privacy, secrecy, or surprise.

Technique: Body Tracing (Gallo-Lopez, 2000)

Counseling Intention To guide children and adolescents to understand and make connec-
tions between emotions and what they feel in their bodies.
Description First, begin by discussing and listing different emotions, such as
anger, excitement, jealousy, love, happiness, sadness, worry, loneli-
ness, anxiety, fear, abandonment, and confidence. Second, give the
child stickers printed with the feeling words. Third, using a large roll
of paper, trace the child’s body by either having him or her lie on his
or her back or standing against the role of paper taped on the wall.
Finally, children take the tracing and fill in facial features, clothes,
and anything else they may like. Using the feeling stickers, children
are guided to identify their physical response to a given emotion.
Stickers are then fixed to the body, tracing in areas representative
of the physical response, connecting the emotional and physical
increases to acknowledge feelings. Children can then employ newly
acquired coping strategies and problem-solving skills to manage and
appropriately express emotions.
 Play Therapy Techniques  307

Technique: Paper Doll Body Figures (Gallo-Lopez, 2000)

Counseling Intention To understand appropriate versus inappropriate touch and provide
children with strategies for self-protection.
Description Utilizing a felt board, display male and female figures representing
adults and children. The figures are used to identify private parts of
the body and help children distinguish appropriate and inappropriate
touches. Clothing can be made for the figures in order to help children
grasp the concept that private parts are the parts of their bodies that
are covered by underwear or bathing suits. The focus is on establishing
distinct boundaries to minimize stimulation and anxiety.

Technique: The Nightmare Wall (Gallo-Lopez, 2000)

Downloaded by [New York University] at 04:58 12 August 2016

Counseling Intention Nightmares and sleep disturbances are common problems in sexually
abused children, and they need a safe opportunity to address and con-
front their fears and work toward resolution.
Description The therapist encourages and may assist the child to draw the night-
mare and gives specific drawing directions such as location, size, shape,
color, etc. The child is asked to tell the story about the nightmare
while the therapist transcribes it onto a separate piece of paper or on
the back of the drawing. The pictures are then displayed on the wall
under the sign that reads THE NIGHTMARE WALL. Displaying the
drawings serves to diminish the nightmare’s power over the child and
diminishes his or her fears and anxiety.

Following the activity, children are asked to draw or list things they can do to feel safe when
they have nightmares, such as sleeping with a stuffed animal, favorite blanket, using a nightlight,
and so on. The drawings or lists should also be posted on “The Nightmare Wall.”

Technique: Parent–Child Combined Session: Safety Shield (Gallo-Lopez, 2000)

Counseling Intention The goal of this session is for the parent and child to have a conversa-
tion about the child’s fears and to problem solve to determine ways
the child can feel a greater sense of safety and security.
Description Cut the shape of a shield from a sheet of poster board approximately 18"
× 24." Draw a line across the shield about a third of the way down from
the top. The parent and child should work together to draw pictures
representing the child’s fears on the top portion of the shield. On the
bottom, the parent and child work together to identify and draw things
that help the child feel safe. The shield is a symbol of safety and protec-
tion. Together, the child, parent, and therapist discuss the content.

Technique: The Rosebush (Oaklander, 1988)

Counseling Intention To use guided fantasy and imagery to help children express blocked
feelings, wishes, needs, wants, and thoughts in safe, nonintrusive
manner.
Description Have the child close his or her eyes, take a few deep breaths, and imag-
ine that he or she is a rosebush:
 308  Play Therapy Techniques
“What kind of rosebush are you? Are you very small? Are you large? Are you a full rosebush or
skinny? Do you have flowers? If so, what kind? What color are they? Do you have many or just
a few? Are you in full bloom or do you only have buds? Do you have leaves? What do they look
like? What are your stems and branches like? What are your roots like? Or maybe you don’t have
any. If you do, are they long and straight? Are they twisted? Are they deep? Do you have thorns?
Where are you: In a yard? In a park? In the desert? On the moon? You can be anywhere. Are you
growing in a pot or in the ground or growing through the cement? What is around you? Are
there other rosebushes around, or are you alone? Are there trees? Animals? Birds? People? How
do you survive? Who takes care of you? What is the weather like for you right now? Is there a
fence or maybe rocks around you?”
Then ask the child to open his or her eyes and draw the rosebush, including the scene it is in.
Then the child describes the rosebush in the present tense, as if she or he were the rosebush. Ask
questions speaking directly to the rosebush in the present tense as if he or she was the rosebush,
Downloaded by [New York University] at 04:58 12 August 2016

such as “Who takes care of you? Are you lonely? Who lives in your house?” etc.
The therapist asks the child if anything she or he said as a rosebush fits in any way for his or her
life or reminds him or her of anything.
Adolescents particularly respond to this exercise. For example, a 17-year-old young man said
his rosebush had fallen to the ground and was dying and he revealed for the first time to the
therapist that he felt he needed to die.

Technique: Anger Fortune Cookies (Kagan, 1998)

Counseling Intention One of the three effective ways to help children and adolescents with
anger-related treatment issues is to use the three Cs of coaching,
cheerleading, and counseling. Coaching provides the youth feedback
and encouragement. Cheerleading gives the youth positive reinforce-
ment. Counseling involves treatment approaches that provide insight
development and coping skills.
Description The therapist can prepare fortune cookies and insert various quota-
tions about anger that are developmentally appropriate for that age
group. Some examples might be:

“Anger is only one letter short of danger.”

“For every minute you’re angry, you lose 60 seconds of happiness.”
“Speak when you are angry and you will make the best speech you will forever regret.”
“Always write angry letters to your enemies. Never mail them.”
“Anger is a killing thing: it kills the man who angers, for each rage leaves him less than he had
been before—it takes something from him.”
“Anger is an acid that can do more harm to the vessel in which it is stored than to anything
on which it is poured.” –Mark Twain
“Bitterness is like cancer. It eats upon the host. But anger is like fire. It burns it all clean.”
–Maya Angelou
“Every time you get angry, you poison your own system.” –Alfred A, Montapert
“Get mad, then get over it.” –Colin Powell
“Holding on to anger is like grasping a hot coal with the intent of throwing it at someone
else; you are the one who gets burned.” –Buddha

Youth open the fortune cookie and discuss how that quote might apply to them. Coach them
how to replace negative self-talk with the positive messages from the fortune cookie. The partici-
pants can then eat the fortune cookie.
 Play Therapy Techniques  309

Technique: Fist Friends (Frey, 2003)

Counseling Intention To show alternative ways of dealing with anger.
Description This is an individual hand puppet technique. The child or adolescent
is asked to draw a face on his or hand in the area where the thumb
and first finger meet. The mouth can be can be formed by moving the
thumb up and down. The youth is asked to draw an angry face on one
hand and a calm face on the other. Ask the fist friends to talk to each
other. For example, the angry fist might say, “It’s not my fault I hit
him; he was calling me names.” The calm fist could help the angry fist
by saying, “Maybe next try ignoring or calming down by counting to
10 and taking deep breaths before you do anything physical.”
Downloaded by [New York University] at 04:58 12 August 2016

Technique: The Card Story Game (Leben, 1994)

Counseling Intention To aid in diagnosis and assessment; to enhance communication skills;
and to provide cognitive-skills training.
Description Putting down a stack of standard playing cards, the therapist explains
to the group that each player may flip over two cards during his or her
turn. Each player will make up a story line incorporating the number
or letter of the card. The therapist begins first to set the climate and
the stage. If the therapist flips a Q and a 4, the therapist might say,
“There once was an outstanding quarterback who played on a winning
team surrounded by four watchful running backs.” The next player
then flips over two cards and continues the imaginative story, building
on what the previous player said. As the story progresses, the cards
are arranged in a spiraling pattern. The therapist listens to the player’s
storylines and gives positive therapeutic interventions or a therapeutic
remark of assurance when it is her or his turn.

This is useful with youth with ADHD, oppositional defiant disorder (ODD), low self-esteem
or who are aggressive, withdrawn, or depressed.

Technique: Art or Verbal Metaphors for Children Experiencing Loss (Short, 2001)

Counseling Intention To cause children to begin to reason and identify their feelings and
to provide an opportunity to express their feelings through drawing
pictures and to elicit further expression when the child explains the
picture to the therapist.
Description The child is asked about his or her feelings and life before the loss. He
or she is asked to express feelings he or she remembers about life and
even tell stories about life before the loss.

He or she is then asked to discuss how the loss has changed his or her life and what he or she
is feeling now. Stories are appropriate here also.
The therapist reflects back the child’s feelings and asks the child to think of something in
nature and draw a picture to show how his or her life was prior to the loss and how it is now.
A picture before the loss may show the sun, flowers, and green grass with a happy home in
bright colors prior to the divorce of parents. The second picture after the loss may be merely a
 310  Play Therapy Techniques
picture of a flower with no color and labeled “dead flower.” The primary feelings the child was
depicting and experiencing after the loss were sadness, hopelessness, and powerlessness.

Technique: The Personality Pie (Sinclair, 2001)

Counseling Intention To explore different aspects of a child’s or adolescent’s personality in
an effort to promote self-disclosure and self-awareness and to serve as
a good assessment tool for therapists.
Description We all act differently in different settings: one way in school, another
way with family, and yet another way with friends. Have the child draw
a picture in each quadrant that represents a different part of his or her
personality. Is there anything that is forgotten or needs to be added to
the pie? The eye is placed in the middle of the personality pie because
Downloaded by [New York University] at 04:58 12 August 2016

we all have an inner eye, which gives us the power to be aware of each
part of our personality so that we can see how we’re feeling and what
we are doing, and we have the power to make choices about how to
deal with our feelings and actions.

A variation: The four quadrants of the Personality Pie can be designated as follows:

1. The Public Self: the part of yourself that you show to others.
2. The Private Self: the part of yourself that you don’t want others to see.
3. The Inner Child: the part of yourself that carries your deepest feelings, both positive and
negative, and that still feels like a child, even though you’re growing up.
4. The Inner Critic: the part of yourself that may put you down, call you names or judge what
you’re doing (Sinclair, 2001, p. 75).

Technique: Using a Puppet to Create a Symbolic Client (Narcavage, 2001)

Counseling Intention Puppets are useful because they provide opportunities for spontaneity
that are easily manipulated and provide an opportunity for a symbolic
process of self-expression. They are also nonthreatening, and children
have the tendency to identify with the characters involved and project
their feelings and interpersonal conflicts onto them. Children are able
to communicate their distress without having to directly claim trau-
matic experience and painful emotions as their own (Webb, 1991).
Description To eliminate symptoms of a withdrawn child, the therapist facilitates
projection of the child’s feelings onto a puppet. For example, if the
therapist experiences the child as being frightened, the puppet may be
presented as being scared—acknowledge the fear and reassure it of its
safety. Next, the therapist enlists the child’s help in attending to the
puppet’s needs. For example, the therapist might ask the child to hold
and comfort the “frightened” puppet. By encouraging projection and
enlisting the child’s help in the caring process for the puppet, the thera-
pist is able to achieve three important goals: (1) to respond to the child’s
feelings in a nonthreatening manner; (2) to activate the child’s participa-
tion in the therapeutic process; and (3) to foster a positive, collaborative
alliance with the child. As therapy progresses, the puppet often becomes
a safety object for the child and facilitates a primary means of emotional
expression as well as greater interaction with the therapist.
 Play Therapy Techniques  311

Technique: Lifeline (Bruner, 1963; Hobday & Ollier, 1998)

Counseling Intention To learn more about the child’s life experience from his or her per-
spective; to develop a child’s ability to express feelings and his or her
choices in creating the future.
Description Materials needed are a large piece of paper, markers, scissors, glue,
magazines, and scrap items that can be used for art activities.

1. Give the child a large piece of paper and ask him or her to draw a horizontal line across the middle
of the paper.
2. At the right, write the date of birth; on the left end, project the end of the child’s living
time. The therapist breaks the line into 5-year segments. The child then illustrates significant
life events on the lifeline by writing words, drawing pictures, creating a collage, pasting on
personal photographs, and so on. The therapist facilitates the process by asking questions
Downloaded by [New York University] at 04:58 12 August 2016

about important events, milestones, and significant people in the child’s or adolescent’s life.
The child will slowly recall the easy events such as birthdays, preschool, or births of siblings,
and other, more difficult events gradually will be remembered.

The therapist processes the activity by asking about events, feelings that are experienced, and
significant people experienced in the lifeline. It is critical to explore the child’s or adolescent’s
perceptions about the past and to simulate into the present. For example, “How did you feel
when this happened?” “How do you feel now?” This activity helps a child or adolescent see that
events change and improve with time and empowers them with resilience.

Play Therapy from a Family Systems Perspective

The family systems perspective for play therapy maintains that the most effective way to work
with children and adolescents is in the context of their current family, their community, and their
current support network. Keith and Whitaker (1981) revealed that “families change less and
more slowly when children are not part of therapy” (p. 244). Involving all the children in the
family provides the therapist with a more accurate assessment and evaluation of family dynamics,
interactional patterns, boundaries, and specific roles held in the family constellation, as well as a
better understanding of family rules and unrealistic expectations or cultural stipulations, which
is an increasing concern for therapists. Including all the children and the family in the session,
rather than just the identified child or adolescent, removes the focus and exclusive attention
away from the identified child or adolescent and magnifies the perspective that it is a family
interactional problem, rather than the fault of the identified child or the adolescent, which many
times may represent the scapegoat in the family. This represents more of a systems approach to
understanding family dynamics, that is, looking at how everyone in the family relates to one
another as a whole. It also removes the stigma that it is one person’s fault that the family is in
conflict or experiencing discord, which can be perceived as scapegoating one individual as being
the source of the problem. Further, children and adolescents contribute unique insights and
reveal underlying dynamics in family sessions that may be denied or ignored by other members
of the family. Gil further emphasized that “play techniques can engage parents and children in
enhanced communication, understanding, and emotional relatedness, and can assist therapists
in their important work, and thus be considered a viable and pivotal part of the family therapy
work” (1994, p. 42). Concurrently, Bailey and Sori (2000) revealed that “[f]amily play therapy
moves treatment from the intellectual, cerebral, abstract world familiar with adults, to the world
of imagination, spontaneity, metaphor, and creativity that is familiar to children” (p. 488). Art
therapy is also an effective technique to use with children, adolescents, and families, especially
for those families that do not know how to express feelings directly (Klorer, 2006). When family
 312  Play Therapy Techniques
members engage in the medium of art or play, they are given the opportunity to express feelings,
behaviors, or thoughts that they may not feel comfortable expressing in traditional family talk
therapy. Play and art therapy engage emotions in a more direct way, which generates creative
energy as a healing force, which in turn enables family members to express their problems, con-
flicts, or discord (Malchiodi, 2005).

Technique: Colored Candy Go-Around (Arkell, 2010)

Counseling Intention To use with families in the initial session to minimize resistance and to
get all family members involved.
Description Colored candies such as M & Ms or Skittles are needed for this activ-
ity. Distribute seven candies to each family member. Have them sort
them by color and not to eat them. Ask one member to pick a color
Downloaded by [New York University] at 04:58 12 August 2016

and tell how many they have (e.g., two greens). Ask them to give two
responses to the following questions:

Green: Words to describe your family

Purple: Ways your family has fun
Orange: Things you would like to improve about your family
Red: Things you worry about
Yellow: Favorite memories with your family

After one person has answered a question, have him or her choose the next person to answer
the same question based on the number of candies that person has. Process a discussion after
each person has responded to all questions, such as:

1. What did you learn?

2. What was the most surprising thing you learned about someone else in your family?
3. How will you work towards making some changes or improvements?

This opening activity facilitates open communication and provides insights into individual and
family dynamics. It also gets them working together in a therapeutic alliance with the family and
the therapist.

Technique: The Family Gift (Lowenstein, 2010)

Counseling Intention To provide a systematic assessment of the family system in order to
develop an appropriate treatment plan
Description This is an art-based family assessment activity. Provide the family with
a variety of craft supplies and a gift bag. Introduce the activity and say,
“I want you to create a gift for your family using any of the supplies
you have available to you. It should be a gift that everyone in the fam-
ily wants. It can be only one gift, and you must all agree what the gift
should be and how it might be used in your family. Once you have
created the gift, place it in the gift bag. You have 30 minutes to decide
on your gift and to create your gift.”

After the family has completed the gift, ask the following process questions:

1. Describe your gift.
2. Tell how you each felt as you were creating your gift.
 Play Therapy Techniques  313
3. Who made the decisions, that is, who decided what the gift should be?
4. Were two or more people in your family able to work well together?
5. Did anyone cause any difficulties or disagreements, and, if so, how was this handled?
6. Is there anything about the way you did the activity that reminds you of how things work in
your own family at home?
7. How can the gift help your family? What else can help your family?

This assessment activity provides the therapist with the opportunity to discuss both process
information and content information within family interactions. Process information focuses
on how the family relates to one another, how they interact, verbal and nonverbal expressions,
tones of voice, energy level, amount of enjoyment, degree of engagement, and any relationship
idiosyncrasies. Content information focuses on what is being said and to whom, including the
symbolic meaning of the gift for the family (Gil & Sobol, 2000; Sori, 2006).
Downloaded by [New York University] at 04:58 12 August 2016

Technique: Boat–Storm–Lighthouse (Landgarten, 1987)

Counseling Intention An art-based family assessment activity
Description Family members are given a poster board and directed to draw a boat,
a storm, and a lighthouse. They are to complete the assignment silently
(i.e., no talking). Upon completion of the drawing, each member is
asked to write a story about what she or he thinks happened before,
during, and after the storm. After each member of the family shares
his or her story, the therapist facilitates a discussion involving fears,
anxiety, helpfulness, hopelessness, danger, rescue, and how to access
family support when needed. The therapist may help prompt the fam-
ily experience with the following questions:

1. What do you think it would have been like to be in the boat with your family during the storm?
2. Who would have been most helpful to you during the storm?
3. Can you name three feelings you might have had during the worst part of the storm?
4. If you believed that a rescue would occur, how did you think it would happen?
5. In what ways could you have asked for help?

This activity provides some insight into each family member’s inner world, including personal-
ity traits, attitudes, temperament, behaviors, and personality strengths and weaknesses. It enables
the therapist and family members to see who tends to be optimistic and resourceful or who might
be more pessimistic or hopeless. It also reveals who can mobilize inner resources and can access
or suggest external support when faced with potential danger, threats, and conflict.

Technique: The First Session Family Card Game (Lowenstein, 2010)

Counseling Intention Talk is used and integrated into an engaging card game.
Description Using a standard 52-card deck, the therapist explains that they are
going to play a game that will help him or her get to know the family
better. The rules are as follows:

1. Take turns picking the top card from the deck of cards.
2. If you get a card with an even number, pick a card from the question card pile and answer
the question.
3. If you get a card with an odd number, pick a card from the question pile and ask someone
in the family to answer the question.
 314  Play Therapy Techniques
4. If you pick an ace, ask someone in your family to give you hug.
5. If you pick a jack, queen or king, you get to pick something from the surprise bag. At the
end of the game, everyone who played gets to pick something from the surprise bag.

Examples of questions for the First Session Family Card Game include:

1. True or false: When families seek therapy, they often feel nervous, embarrassed, and/or
overwhelmed.
2. Fill in the blank: A good therapist is someone who. . .
3. What would need to happen in the session today to make you feel like it was worthwhile
coming?
4. What do think needs to change in your family?
5. True or false: Everyone in your family plays a part in making it better.
6. How will you feel if your family gets the help you need?
Downloaded by [New York University] at 04:58 12 August 2016

During this exercise, the therapist has the opportunity to observe family dynamics, which also
promotes treatment planning.
The activity can be repeated in the last session as the Last Session Family Card Game with the
following questions:

1. What is a positive change someone in your family has made during your time in therapy?
2. What is the family able to do better or how does it function better now?
3. Tell about something you have learned about someone in your family during your time in
therapy.
4. Tell about a skill you learned in therapy that you can use to deal with everyday problems that
may occur in the future.
5. What advice would you give to another family member who is experiencing a similar prob-
lem that brought you to therapy?
6. Families often teach therapists unique valuable lessons. Ask your therapist to tell something
your family had taught him or her.

Technique: Toss the Ball (Post-Sprunk, 2010)

Counseling Intention To provide a playful intervention to encourage family interaction and
cohesiveness. Beginning a session by expressing nice things directly
to each family member fosters cohesiveness with the potential of
increasing levels of emotional intimacy and a change in communica-
tion style.
Description First, instruct family members that they are going to take 5 minutes
and take turns gently tossing the ball to other family members. As they
toss the ball to someone, they are to say something nice to that family
member. The process is repeated for 5 minutes or until every family
member has heard at least two nice things about themselves.

Process the experience and what other family members said that was nice to them, such as:

1. What was it like to say nice things to everyone?

2. How did you feel when another member in your family said something nice to you?
3. Did you receive any unexpected comments or were surprised by what you heard?

Second, as family members throw the ball, ask them to tell the receiver something they enjoy doing
but are not currently doing. Continue for 5 minutes, followed by processing the experience again.
 Play Therapy Techniques  315
Third, the process is repeated again, but the family member who catches the ball is instructed
to say something he or she would like to change about himself or herself and what prevents his or
her ability to make that change. Provide some time for the family to process and develop strate-
gies for change. Possible processing questions could include:

1. List two things that would serve as a vehicle to make the change that would you would like to see
happen.
2. On a scale of 1 to 10, how important would this change be for you and others in your
family?
3. In what ways would your family life be enhanced and improved after these changes
were made?

Finally, when one tosses the ball to another, the recipient shares an idea or plan about what
he or she could do to improve his or her current family life. After another 5 minutes, encourage
Downloaded by [New York University] at 04:58 12 August 2016

family members to consider all the suggestions and determine how and if these suggestions can
be incorporated into their current family life.

Technique: Family Strengths Genogram (Cavett, 2010)

Counseling Intention To challenge the family to focus on the positive qualities within the
family and create a more positive atmosphere.
Description The genogram is a technique that provides a graphic picture of the
family history. It reveals the family’s basic structure, relationships, and
demographics (McGoldrick, Gerson, & Petry, 2008). Gil (2006) was
instrumental in developing the play genogram where the child or ado-
lescent uses miniature objects to reflect his or her view of family mem-
bers. Explain the concept of genograms to the family, and play a role in
assisting them in drawing their own on a large sheet of paper. After the
genogram is completed by the family, the family is introduced to a variety
of miniature objects. The family is then asked to pick a miniature object
for each person on the genogram that represents that person’s posi-
tive attributes or something that everyone likes about that person or an
attribute that he or she is especially good at. The family members must
decide together on one object for each person on the genogram. The
miniature object is placed on the paper where the person is represented.

The following questions should be used to process the experience:

1. Explain the miniature objects that you chose to represent the strengths of each person in the
genogram.
2. Do all the family members have some positive characteristics?
3. Do you have the tendency to focus more on the strengths of family members or on their
weaknesses?
4. What could you change in your family if you focused more on the strengths of individual
family members?

Technique: The Family Sculpting and Puppets Exercise (Haslam, 2010)

Counseling Intention To explore and support a positive experience for the family and allow
family members to express their feelings and perceptions in a creative,
multisensory, and symbolic way.
 316  Play Therapy Techniques
Description The family sculpting and puppets exercise assists family members to
express their feelings and perceptions in a creative, stressless, multisen-
sory, and symbolic manner. The therapist should introduce the activity
by saying:

“I would like each person to take turns and pick a puppet that represents each member of
your family, even if those members are not here, and place the puppet somewhere in the
room. Puppets can be close together or far apart; some can be high or low, out in the open
or hidden. Place the puppets in ways that show what things feel like in your family.”

After each member of the family has completed sculpting the puppets, gather more informa-
tion from them by asking the following questions:
Downloaded by [New York University] at 04:58 12 August 2016

1. What can you tell me about this scene you have created with these puppets?
2. What kinds of feelings exist between them? Are any of them close friends? Or do some of
them fight? Are any scared of each other? Do any of them feel isolated, lonely, or left out?

Technique: Magic Key (Crenshaw, 2004, 2006, 2008; Crenshaw & Garbarino, 2007; Crenshaw &
Hardy 2005; Crenshaw & Mordock, 2005)
Counseling Intention To increase awareness of losses; to verbally express denied feelings; to
discuss the issues that matter the most to the child.
Description Paper, markers, and colored pencils are needed for this exercise. Read
the following instructions to the child:

“Imagine that you have been given a magic key that opens one room in a huge castle. There
are four floors in the castle, and since the castle is huge there are many rooms on each floor,
but your magic key only opens one of the many rooms. You go from floor to floor and door
to door to see if your magic key opens the door. Then you finally come to the door that your
key opens. Because you have been given the magic key that only opens this door, what you
see is the one thing that money can’t buy that you always thought would make you happy.
Pretend you are looking in the room. What do you see? What is the one thing that has been
missing that you think would make you happy? When you have a clear picture, draw it as
best you can.”
“The Magic Key” is a projective drawing strategy to evoke themes of loss, longing, and
missing things in their lives. Some children draw a missing or deceased parent, a safe place
that isn’t full of violence. The strategy focuses the child on the essential emotional needs
that have not been met or on important losses. This drawing strategy is useful with children
whose lives are filled with multiple losses. Many severely aggressive children have suffered
profound multiple losses. This strategy is one of the ways to access these feelings. Tools such
as the “The Magic Key” are meant to enrich the therapy and aid in the healing process. It
will serve as a springboard to elicit more of the child’s feelings, wishes, fears, dreams, and
hopes and serve as a vehicle of entry in the child’s inner life.
(Crenshaw, 2006, p. 19–21)

Technique: Feel Good File (Walker, 2011)

Counseling Intention To increase self-awareness; to promote positive self-talk; to decrease
negative self-talk and improve self-esteem.
 Play Therapy Techniques  317
Description Materials needed are manila folders; markers; craft supplies such as
glitter, scrapbooking papers, glue sticks, paper, and pen or pencil.
Introduce the activity as follows: “This will be a simple but effective
activity to combat negative thinking and create a storage place for
positive, loving words to challenge those negative thoughts you have
about yourself.”

Have the child or adolescent write his or her name on the manila file folder, for example, “Jes-
sica’s Feel Good File.” Encourage the child or adolescent to use the craft supplies to create a
positive and uplifting design on the front of the manila file folder.
Next, have the child or adolescent write ten of his or her positive qualities on a piece of paper.
Have the child or adolescent place this in the file.
Then have the child or adolescent come up with a list of three people who he or she can iden-
Downloaded by [New York University] at 04:58 12 August 2016

tify and ask to write a note of affirmation that includes a list of five positive things about him or
her. It would be helpful to provide examples of potential people such as parents, siblings, friends,
teachers, or extended family members. Assign this task as “ownwork” to bring to the next session
(this is the author’s term for homework, which often has a negative connotation). If the session
permits, this task could be completed as a family therapy activity, allowing the child or adolescent
to invite the family members to make this list during the session.
As the letters of affirmations accumulate, they should be placed in the Feel Good File. Encour-
age the child or adolescent to look through his or her Feel Good File at least once a week or
when he or she becomes aware of that negative self-talk. This focuses on the child’s or adoles-
cent’s strengths.

Technique: Feelings Hide and Seek (Kenney-Noziska, 2008)

Counseling Intention To provide a safe environment for children, adolescents, and families
to verbalize and discuss their feelings; to increase open communica-
tion regarding various emotional situations; to strengthen family rela-
tionships through direct communication.
Description Materials for this exercise include index cards with various feelings
written on them (such as happy, sad, angry, scared, jealous, guilty,
brave, excited, disappointed, etc.), tape, and prizes such as stickers or
small individually wrapped candies. Using tape, the index cards are
hidden around the room at varying levels of difficulty.

The therapist explains that in many situations, people ignore their feelings and hide them
instead of dealing with them. Unfortunately, “hidden” feelings still exist and continue to irritate
the person until the feelings are brought out into the open and addressed. Sometimes the feel-
ings are hidden for so long that they may explode when least expected. In this exercise, feelings
start out hidden and over the course of hide and seek are found and discussed as a group. During
the intervention, players take turns finding the hidden feeling cards and processing a time they
experienced the feelings written on the card.
At the end of the game, process the following questions:

1. What was the easiest feeling to discuss?

2. What was the most difficult feeling to discuss?
3. Is it better to hide or to talk about your feelings? Why could this be?
4. Who is the easiest person in the family for you to talk to about your feelings? Why is it easier
for this particular member?
 318  Play Therapy Techniques
5. Who is the hardest person in the family for you to talk to about your feelings? What makes
it difficult?
6. How do you think your family can make communication about your important feelings bet-
ter or easier?
7. What did you learn from this exercise?

This exercise helps build the child’s or adolescent’s emotional vocabulary and promotes
healthy emotional expression. By avoiding distressing emotions, this technique can more effec-
tively facilitate emotional expression of “hidden” feelings that might not be recognized by the
family. Throughout the exercise, normalize and validate the emotions discussed by the family. As
an additional positive component, coping skills to manage emotional distress can be identified,
processed, and discussed.
Downloaded by [New York University] at 04:58 12 August 2016

Technique: Feelings Ring-Toss (Dyson, 2012)

Counseling Intention To increase the expression of feelings with individuals, groups, or fam-
ilies; to increase feeling vocabulary and express at least four feelings.
Description Materials needed for this activity: four plastic of bottles; rice, sand, or
beans; clear packaging tape (wide enough to cover feeling faces); two
each of four different feeling faces; four rings (made from 2 yards of
clear tubing or 4 paper plates); glue gun and glue sticks; colored paper;
and markers or crayons and scissors.

The feeling faces (Happy, Sad, Mad, and Scared) can be copied onto colored paper or colored
with markers or crayons. Use scissors to cut them out or use a craft punch if available. Add
two feeling faces to each bottle and cover them with clear packaging tape to secure the rings.
The rings can be made from clear piping purchased from a hardware store. Cut the piping into
18-inch lengths and connect the ends with clear packaging tape.
The game is played by setting the bottles in an open area and placing a length of tape several
feet away. While standing on the taped line the client takes the four rings, one at a time, and tries
to toss them around the bottles. When the client gets a ring around a bottle, he or she calls out
the name of the feeling face on that bottle. That feeling is then processed and discussed. For
example, the therapist can say, “Share a time when you had that feeling,” “What would make a
kid feel scared?” “Show me what your face looks like when you’re feeling mad.”
Identifying and discussing feelings can be difficult for some children. This game is a fun and
nonthreatening way for therapists to engage a child who may be resistant to discussing emotions.
If the therapist observes a child avoiding ringing a specific bottle, explore whether that feeling
might be disturbing to the child or adolescent. The exercise can be modified to apply to specific
presenting problems. For example, “What is something that makes you sad about your parents
getting a divorce?” This game can be used in group or family therapy with players taking turns
identifying the feeling faces on the bottles.

Technique: Paparazzi (Budd, 2008)

Counseling Intention To identify personal strengths and challenges; to create a personal
story using pictures; to explore the significance of people and items in
a child’s or adolescent’s life.
Description Materials needed for this activity are a disposable camera, scrapbook,
pens, markers, and stickers. In the age of social media, this is a very
relevant exercise especially for middle school students and adolescents.
(Please note this activity will require two sessions to complete.)
 Play Therapy Techniques  319
Explain the fun concept of phototherapy, that is, using a camera to tell a story. Give the child
or adolescent a disposable camera and encourage him or her to take pictures of meaningful
people, places, and other points of interest in his or her life. The child or adolescent will act as
his or her own paparazzi by taking pictures of the many different aspects that make up his or
her life. Encourage the child or adolescent to take pictures of his or her home and friends and
include some of the following themes: strengths, special abilities, support people, hobbies and
capture all aspects of his or her life. Have the child or adolescent develop the pictures before
the next session.
At the next session give the child or adolescent a scrapbook to put the photos in accompanied
by stickers, stencils, rubber stamps, and other decorative supplies to decorate the scrapbook in
his or her own unique way. Have the child or adolescent create a tabloid magazine of himself
or herself with captions and short descriptions to describe what they are about. The first page
should be blank because it will be designated as the cover page. After all the pictures have been
Downloaded by [New York University] at 04:58 12 August 2016

inserted along with their captions, the child or adolescent should be encouraged to look through
the pages and then create a cover and a title for the scrapbook that captures the theme of his or
her life. Process with the child or adolescent the themes that are represented in the photographs,
focusing on strengths and challenges that are revealed in the photos. What does the child or
adolescent notice is missing (if anything)? And what seems to influence a large part of his or her
life, for example, family, school, or friends?

Technique: Popsicle Stick Stack (Gardner & Spickelmier 2010)

Counseling Intention To provide challenge and structure to evaluate group/family function;
to improve the child’s or adolescent’s ability to work collaboratively;
to increase positive verbalizations toward family members.
Description Materials needed for this therapeutic exercise are 30 to 50 Popsicle
sticks, a coffee mug, and a smaller drinking glass.

Popsicle sticks are divided evenly among participants. The coffee mug is set in the center of the
group with participants seated in a circle. The therapist introduces the game and gives the fol-
lowing instructions:

1. As a group, your challenge is to balance all the Popsicle sticks on top of this coffee mug.
2. You will take turns placing one Popsicle stick at a time until all sticks are in place.
3. You can only touch your own Popsicle stick—you cannot touch or move another member’s
stick.
4. The first go-around there is no talking, directing others, grunting, rolling of the eyes, or
noise of any kind.
5. If a Popsicle stick falls off the mug, the game starts over.
6. Before we start the activity again, we will process as a group what happened during the first
experience.

This activity provides the therapist with a wealth of information on family dynamics and
individual functioning during a stressful situation and how to ensure successful outcomes.
What does the child or adolescent view as his or her strengths or challenges? What seems to
influence a large part of his or her life? Brainstorm together positive comments. Process nega-
tive comments to other members. If someone in the family directs, bosses, or says something
negative to another member, the process starts over again. But if they are successful with plac-
ing the Popsicle sticks on the mug the first time, then they proceed to do the same thing on
the small glass.
Process the experience with the following questions:
 320  Play Therapy Techniques
• How did it feel to do this right the first time?
• Did you think your family could do it?
• Did you ever feel the urge to tell someone in your family what to do?
• How did you feel when you completed the game with no mistakes?
• What did it feel like when you were not allowed to talk?

This is a good opportunity to discuss not giving up and how there is more than one way to
achieve a goal or accomplish a task together.

Technique: Focusing on Positive Attributes (Swank, 2008)

Counseling Intention To improve by expressing and receiving positive attributes from oth-
ers, especially family members; to promote positive self-talk through
Downloaded by [New York University] at 04:58 12 August 2016

the outward verbalization of positive self-qualities.

Description Materials needed are construction paper, colored paper, crayons or
colored pencils, and colorful Post-it notes. The therapist asks the child
or adolescent to draw an outline of his or her body. Then the therapist
asks the child or adolescent to think about positive qualities about him-
self or herself and write each different quality on a Post-it note. When the
child or adolescent has completed the task, the therapist asks the child or
adolescent to read them aloud and then stick them to his or her outline.
The therapist can also place positive comments that the child or adoles-
cent may not realize he or she has. Family members, teachers, or other
significant adults may also be encouraged to provide positive notes.

Process the experience with the child or adolescent. Praise him or her for working hard on
this exercise and say, “Think about times when you thought about only negative feelings about
yourself such as feeling angry, frustrated, or disappointed. The next time you have these negative
feelings, I want you to pull out your positive feelings that you gave yourself and received from
others and concentrate on them during that particular time.” This is particularly helpful when
families constantly focus on each other’s negative qualities. Children or adolescents should be
encouraged to place their positive notes in a special place to look at when they are having dif-
ficulty obsessing about negative feelings.

Technique: Termination—How I Felt the First Day versus the Last Day of Therapy (Kelsey, 2008)
Counseling Intention To review therapeutic progress and the mixed feelings about
termination.
Description Materials needed are colored pencils or pens and a piece of paper
folded in half. Introduce the activity as follows: “Today represents our
last day of therapy. On the top of the first side of your paper, please
write ‘How I felt the first day I came to therapy.’ Now, using words,
symbols, or pictures show how you felt the very first day you came to
this office.”

When the child or adolescent is finished, instruct, “On the other side of the paper, please write,
‘How I feel today.’ On this side, once again use words, symbols, or pictures to show how you
feel today.” This activity helps the child or adolescent see the therapeutic gains of treatment. One
child who did this activity put a big question mark in the first panel and a big happy face in the
second panel.
 Play Therapy Techniques  321

Technique: Self-Esteem Mandala (Curry & Kasser, 2005)

Counseling Intention The self-esteem mandala is a twist on the commonly used mandala
activity, which has been shown to reduce anxiety and promote physi-
cal and mental well-being. The word mandala is Sanskrit for “cir-
cle” or “completion” and represents wholeness. Mandalas are circles
with patterns inside, and are used in therapy to reflect the inner self.
They have been represented in the literature as an art therapy activ-
ity used to promote healing and creativity in youth with histories of
trauma (Green, 2007) and attention deficit hyperactivity disorder
(Smitheman-Brown & Church, 2006). Jungian theory respects sym-
bolic communication as a way to promote ego stability (Jung, 1959).
Description Clients that self-harm have difficulty identifying things about them-
selves that they like, often focus on the negative, and fail to manage
Downloaded by [New York University] at 04:58 12 August 2016

their anxiety. Mandalas are also useful with children and adolescents
who have attention deficit disorder (ADD) or ADHD. Instruct the
client to choose a mandala pattern that he or she will color. Any color
that he or she chooses to use will be representative of a characteristic
about himself or herself that he or she likes. Over several weeks, begin
the sessions by identifying something he or she likes about himself or
herself and color in a mandala using a color to symbolize that trait.
Characteristics such as being independent, not afraid to ask for help,
a good friend, creative, and determined can be explored. When it is
finished, the realization of the beauty in all the traits makes the client
beautiful. Have the client hang it somewhere visible in the home as a
daily reminder. Refer to it in future sessions, and have the client incor-
porate the mandala when coping with anxious thoughts and feelings
and the desire to self-harm.

Technique: Distraction Box Therapy (McKay, Wood, & Brantley, 2007)

Counseling Intention Distraction box therapy (DBT) teaches the skill of distraction as a way
to help manage overwhelming emotions. Distraction is, quite liter-
ally, doing other things to keep oneself from self-harming. Distraction
techniques can help take clients’ focus off of the pain and give clients
time to find an appropriate coping skill.
Description Clients are taught to calm the urge to harm themselves by learning to
match the healthier behaviors to how they are feeling in the moment.
For example, a client who self-harms when sad may consider a sooth-
ing behavior, such as taking a bubble bath or making tea, whereas
the client who self-harms when angry might try to tear a phone book
or stomp her or her feet. Then, the therapist helps the client iden-
tify a list of distracting actions, called a “distraction plan.” This plan
also encompasses pleasurable activities that can be done in place of
self-harm. The “big list of pleasurable activities” (McKay et al., 2007)
lists over 100 enjoyable activities that can be done instead of self-harm.

A distraction plan is often written down, but for children and adolescents, adding creativity to
this process can be useful. A client struggling to remember the distraction plan as it was written on a
piece of paper needs to create a distraction box. In this box, have the client place items that remind
 322  Play Therapy Techniques
him or her of steps in the distraction plan. For example, include a rock to represent a walk on a trail
by his or her house, a washcloth to represent taking a bath, a CD to represent relaxing music, and
movie stubs to represent a social activity. Also have the client write cognitive distraction ideas on slips
of paper, including counting, various coping thoughts, and the phone numbers of several friends.
This should create an increased sense of commitment to the plan. The client should keep the box
in a place where he or she is often, perhaps by the bed. Over time, he or she can add mementos of
positive experiences in his or her life, such as a thank-you card from a teacher and/or a ribbon or
letter or award. These reminders help generate coping thoughts and promote self-esteem.

Technique: My Body Needs (Shapiro, 2008)

Counseling Intention For an adolescent who self-injures, learning to treat her or his body
better is an important part of treatment. The “My Body Needs . . . ”
Downloaded by [New York University] at 04:58 12 August 2016

activity allows for the therapist to learn more about the client’s body
image while also promoting elements of self-care that the client has
already incorporated into daily life. This activity can take more than
one session to complete, depending on the discussions that ensue.
Description First, the client is instructed to draw a picture of how her or his entire
body looks. Then the clinician asks questions related to body image,
such as:

• What parts of your body do you like?

• What parts of your body do you wish were different?
• When you look at yourself in the mirror, what do you see?
• What do you think others see when they look at you?

Following this discussion, the therapist helps the client identify ways in which she or he cares
for different parts of the body. These are written or drawn on the picture and are meant as direct
opposites to the self-harm. For example, a client may draw or write about nutrition and nourish-
ment near the mouth or stomach. Near the arms or legs, exercise may be identified. Dental care,
medical care, sleep, personal hygiene, mental health treatment, and dressing appropriately for the
weather may also be included.

Technique: Self-Esteem Sticky Notes (Hollander, 2008)

Counseling Intention The two most common reasons adolescents cite for self-harm are to
control overwhelming emotions and/or escape from feeling numb or
empty. Thus, self-harm is used as a coping skill where what normally
brings physical pain conversely brings relief from emotional pain.
Other reasons that adolescents self-harm may include:

• To exhibit control over something in their lives

• To punish themselves
• To upset parents
• To avoid putting feelings into words (Shapiro, 2008)

It is important for clinicians to understand that although self-harm is not a healthy means of
coping, it can be an effective means of managing difficult emotions. For these teens, emotions
are felt deeply, and self-harm may feel like the only way to regain control over these emotions
and restore balance. Furthermore, adolescents who resort to self-harm lack more adaptive skills
to manage and express their feelings (Hollander, 2008). Another self-esteem activity that can be
 Play Therapy Techniques  323
useful with this population is the self-esteem sticky notes. This activity involves the client and
important individuals in his or her life.
Description T
 he client takes two pads of sticky notes home. On the first pad, the
client identifies things he or she likes about himself or herself. Each
sticky note has one characteristic or trait on it. The client and therapist
can make a game out of this and work toward a reward (i.e., one point
per sticky note). The second pad is for people in the client’s life. The
client will give sticky notes to others and ask them to identify things
they like about this client. The client then posts these notes in places
he or she will regularly see them: in the room, locker, car, refrigerator,
and/or bathroom.

Technique: Care Tags (Smith, 2008)

Downloaded by [New York University] at 04:58 12 August 2016

Counseling Intention The goal of “Care Tags” with self-harming adolescents is to help them
identify clues to their feelings and what it is that they need when these
feelings occur. The idea behind the activity is that, unlike clothes that
come with a tag to inform the owner of the care instructions, individu-
als do not have such care instructions.
Description With the help of the therapist, the client creates care tags that include
the following statement:

“When I ___________ (behavior, action, or situation), I am feeling ______________, and

I need ___________.”
(Smith, 2008, p. 57)

This activity can be particularly useful with clients who do not have a clear understanding of
either their feelings or what they need when they feel certain emotions. For some clients, this
activity will prove difficult. The client may be able to identify their feelings but not the behavior/
action/situation or the needs associated with the emotion. The therapist will then help the client
work backwards by asking questions such as, “How would I know you were feeling sad?” and
“What would help the sadness go away?” Over time, this activity will allow the client to better
understand the urges to cut. The client may find that sometimes the urge to cut came when he
or she was angry or sad. In therapy, the client will be able to determine that when feeling sad, he
or she just needed to find a way to get the sadness out. This then could lead to the distraction
plan that could include journaling and creating a distraction box.

Conclusion
Identifying effective techniques, treatments, and treatment plans for children and adolescents
who suffer from emotional, behavioral, or traumatic disorders has become a growing field with
some empirical studies to demonstrate its edification with children and adolescents. The many
maladies that today’s youth manifest such as eating disorders, substance abuse, self-injury, school
shootings, suicide ideation, violence, and increased gang activity have increased, mandating that
we intervene for the well-being of our youth and our country’s future. Play therapy has increased
as the medium for treating children and adolescents because of their unique and varied cultural
and developmental needs. Play therapy has gained a tremendous amount of momentum in the
last decade as a viable means to remediate children’s and adolescent’s dysfunctional behaviors
as a primary prevention initiative. To become a play therapist requires both a minimum of 150
continuing education hours from a registered play therapist who is also a supervisor, along with
additional hours of supervision.
Downloaded by [New York University] at 04:58 12 August 2016

Page Intentionally Left Blank

 References

Ackerman, N. (1958). The psychodynamics of family life. New York, NY: Basic Books.
Albee, G. W. (1982). Preventing psychopathology and promoting human potential. American Psychologist, 37,
Downloaded by [New York University] at 04:58 12 August 2016

1043–1050.
Alberti, R. E., & Emmons, M. L. (1986). Your perfect right: A guide to assertive living (5th ed.). San Luis Obispo,
CA: Impact.
Allen, D. M. (1988). Unifying individual and family therapies. San Francisco, CA: Jossey­Bass.
Allen, F. (1942). Psychotherapy with children. New York, NY: Norton.
American Dance Therapy Association (ADTA). (2009). What is dance/movement therapy? Retrieved from http://
www.adta.org/.
American Psychiatric Association (APA). (1994). Diagnostic and statistical manual of mental disorders (4th ed.).
Washington, DC: Author.
Anderson, D. (1992). A case for standards of counseling practice. Journal of Counseling and Development, 71(2),
22–26.
Anderson, E. M., & Lambert, M. J. (1995). Short-term dynamically oriented psychotherapy: A review and
meta-analysis. Clinical Psychology Review, 9, 503–514.
Anderson, M. (1988). Counseling families from a system perspective. Ann Arbor, MI: ERIC/CAPS Digest.
Anderson, R. F. (1980). Using guided fantasy with children. Elementary School Guidance & Counseling, 15, 39–47.
Andreas, C., & Andreas, S. (1989). Heart of the mind. Moab, UT: Real People Press.
Andrews, J.D.W. (1989). Integrating visions of reality: Interpersonal diagnosis and the existential vision. American
Psychologist, 44(5), 803–817.
Antrobus, J. (1993). Dreaming: Could we do without it? In A. Moffitt, M. Kramer, & R. Hoffman (Eds.),
The functions of dreaming (pp. 549–558). Albany, NY: SUNY Press.
Apolinsky, S. R., & Wilcoxon, S. A. (1991). Symbolic confrontation with women survivors of childhood sexual
victimization. The Journal of Specialists in Group Work, 16(2), 85–90.
Ariel, S. (2005). Family play therapy. In C. Schaefer, J. McCormick & A. Ohnogi (Eds.), International handbook
of play therapy (pp. 3–24). Lanham, MD: Rowman & Littlefield.
Arkell, K. (2010). Colored candy go around. In L. Lowenstein, (Ed.). Assessment and treatment activities for chil-
dren, adolescence, and families: Practitioners share their most effective techniques (n.p.). Toronto, ON: Champion
Press.
Aston, J. (1998), Aston postural assessment workbook: Skills for observing and evaluating body patters, New York,
NY: Academic Press.
Axline, V. (1947). Play therapy: The inner dynamics of childhood. Boston, MA: Houghton Mifflin.
Bailey, C. E. & Sori, C.E.F. (2000). Involving parents in children’s therapy. In C. E. Bailey (Ed.), Children in
therapy: Using the family as a resource (pp. 475–502). New York, NY: W. W. Norton.
Bankoff, E. A., & Howard, K. I. (1992). The social network of the psychotherapy patient and effective psycho-
therapeutic process. Journal of Psychotherapy Integration, 2(4), 273–294.
Barbanell, L. (1997). Clinical report: The management of resistance using time-out technique. International Jour-
nal of Group Psychotherapy, 47(4), 509–512.
Barker, P. (1985). Using metaphors in psychotherapy. New York, NY: Brunner/Mazel.
Bartenieff, I. (1980). Body movement: Coping with the environment. The Netherlands: Gordon and Breach
Publishers.
Bartlett, D., Kaufman, D., & Smeltekop, R. (1993). The effects of music listening and perceived sensory experi-
ences on the immune system. Journal of Music Therapy, 30, 194–209.
Bateson, G. (1972). Steps to an ecology of mind. New York, NY: Random House.
Beaulieu, D. (2003, July/August). Beyond just words: Multisensory interventions can heighten therapy’s impact.
Psychotherapy Networker, 27(4), 69–77.
Beck, A. T. (1976). Cognitive therapy and emotional disorders. New York, NY: International Universities Press.
Beck, A. T., & Emery, G. (1985). Anxiety disorders and phobias: A cognitive perspective. New York, NY: Basic Books.
Bedrosian, R. C., & Beck, A. T. (1980). Principles of cognitive therapy. In M. J. Mahoney (Ed.), Psychotherapy
process (pp. 115–135). New York, NY: Plenum.
 326  References
Beitman, B. D. (1997). A model of psychotherapy for the 21st century. Psychiatric Times, 14(4), 202–210.
Belfer, P. L., Munoz, L. S., Schacter, J., & Levendusky, P. G. (1995). Cognitive behavior therapy for agoraphobia
and panic disorder. International Journal of Group Psychotherapy, 45(2), 185–205.
Benedict, H. (2006). Object relations play therapy. In C. Schaefer & H. Kaduson (Eds.), Contemporary play
therapy: Theory, research, and practice (pp. 3–27). New York, NY: Guilford.
Benson, H. (1974). Your innate asset for combating stress. Harvard Business Review, 52, 49–60.
Berg, I. K., & Miller, S. D. (1992). Working with the problem drinker: A solution-focused approach. New York, NY:
W. W. Norton.
Bernard, M. E., Kratochwill, T. R., & Keefauver, L. W. (1983). The effects of rational­emotive therapy and
self-instruction training on chronic hair pulling. Cognitive Therapy and Research, 7, 273–280.
Bernau-Eigen, M. (1998) Rolfing: A somatic approach to the integration of human structures. Nurse Practitioner,
9, 235–242.
Berne, E. (1961). Transactional analysis in psychotherapy: A systemic individual and social psychiatry. New York,
NY: Grove Press.
Berne, E. (1964). Games people play: The psychology of human relations. New York, NY: Grove Press.
Bernstein, D. A. & Borkover, T. D. (1973). Progressive relaxation training: A manual for helping professionals.
Champaign, IL: Research Press.
Beutler, L. E., & Clarkin, J. (1990). Systematic treatment selection: Toward targeted therapeutic interventions. New
Downloaded by [New York University] at 04:58 12 August 2016

York, NY: Brunner/Mazel.

Beutler, L. E., Clarkin, J. F., & Bongar, B. (2000). Guidelines for the systematic treatment of the depressed patient.
New York, NY: Oxford University Press.
Beutler, L. E., Goodrich, G., Fisher, D., & Williams, R. E. (1999). Use of psychological tests/instruments for treat-
ment planning. In M. Maruish (Ed.), Use of psychological testing for treatment planning and outcome assessment
(2nd ed., pp. 81–113). Hillsdale, NJ: Lawrence Erlbaum.
Bixler, R. (1949). Limits are therapy. Journal of Consulting Psychology, 13, 1–11.
Bloch, S., & Crouch, E. (1985). Therapeutic factors in group psychotherapy. Oxford, England: Oxford University
Press.
Blocher, D. H. (1974). Developmental counseling (2nd ed.). New York, NY: Ronald.
Boldt, S. (1996). The effects of music therapy on motivation, psychological well-being, physical comfort, and exercise
endurance of bone marrow transplant patients. Journal of Music Therapy, 33(3), 164–188.
Bornstein, P. H., & Sipprelle, C. N. (1973, April 6). Clinical applications of induced anxiety in the treatment of
obesity. Paper presented at the Southeastern Psychological Association Meeting, Atlanta, Georgia.
Bowen, M. (1971). Family therapy and family group therapy. In H. Kaplan & B. Sadock (Eds.), Comprehensive
group psychotherapy (pp. 106–136). Baltimore: Williams & Wilkins.
Bowen, M. (1974). Toward the differentiation of self in one’s family of origin. In F. Andres & J. Lorio (Eds.),
Georgetown Family Symposium (Vol. I, pp. 222–242). Washington, DC: Department of Psychiatry, Georgetown
University Medical Center.
Bowen, M. (1975). Family therapy after twenty years. In S. Arieti (Ed.), American handbook of psychiatry (Vol. 5).
New York, NY: Basic Books.
Bowen, M. (1978). Family therapy in clinical practice. New York, NY: Jason Aronson.
Bowlby, J. (1982). Attachment. (2nd ed.). New York, NY: Basic Books.
Boy, A. V., & Pine, G. J. (1983). Counseling: Fundamentals of theoretical renewal. Counseling and Values, 27,
248–255.
Brabeck, M. M., & Welfel, E. R. (1985). Counseling theory: Understanding the trend toward eclesticism from a
developmental perspective. Journal of Counseling and Development, 63(6), 343–348.
Bramblett, J. (1991). When good-bye is forever: Learning to live again after the loss of a child. New York, NY:
Ballantine.
Brammer, L. M., & Shostrom, E. L. (1968). Therapeutic psychology: Fundamentals of counseling and psychotherapy
(2nd edn.). Englewood Cliffs, NJ: Prentice-Hall.
Brammer, L. M., & Shostrom, E. L. (1977). Therapeutic psychology: Fundamentals of counseling and psychotherapy
(3rd edn.). Englewood Cliffs, NJ: Prentice-Hall.
Brammer, L. M., & Shostrom, E. L. (1982). Therapeutic psychology: Fundamentals of counseling and psychotherapy
(4th ed.). Englewood Cliffs, NJ: Prentice-Hall.
Brigman, G., & Earley, B. (1990). Peer helping: A training guide. Portland, MA: J. Weston Walch.
Brooks, R. (1985). The beginning sessions of child therapy: Of messages and metaphors. Psychotherapy, 22,
761–769.
Brooks. R. (1987). Storytelling and the therapeutic process for children with learning disabilities. Journal of Learn-
ing Disabilities, 20, 546–550.
Brown, N. W. (1996). Expressive processes in group counseling. Westport, CT: Praeger.
Bruner, J. S. (1963). “Man: A Course of Study.” Occasional Paper No 3. In Educational Developmental Center.
Cambridge, MA: Educational Services, Inc.
Bruner, J. S. (1991). The narrative construction of reality. Critical Inquiry, 18(1), 1–21.
Bruscia, K. (1998). Defining music therapy (2nd ed.), Gilsum, NH: Barcelona Publishers.
Budd, D. (2008). Empowering adolescents to realize their potential: Innovative activities to engage the “I don’t
know, I don’t care” responsive youth through expressive arts and play. In L. Lowenstein, (Ed.). Assessment and
treatment activities for children (pp. 34–36). Toronto ON: Champion Press.
 References  327
Bulkeley, K. (1999). Visions of the night: Dreams, religion, and psychology. Albany, NY: State University of New
York Press.
Bundy-Myrow, S. & Booth, P. (2009). Theraplay: Supporting attachment relationships. In K. O’Conner & L. M.
Braverman (Eds.), Play therapy theory and practice: Comparing theories and techniques (2nd ed., pp. 315–366).
Hoboken, NJ: John Wiley & Sons.
Burns, D. D. (1989). The feeling good handbook: Using the new mood therapy in everyday life. New York, NY:
William Morrow.
Butler, A. C., & Beck, J. S. (2000). Cognitive therapy outcomes: A review of meta-analyses. Journal of the Norwe-
gian Psychological Association, 37, 1–9.
Byrum, B. (1989). New age training technologies: The best and the safest. In J. W. Pfeiffer (Ed.), The 1989 annual:
Developing human resources (pp. 79–89). San Diego, CA: University Associates.
Caine, L. (1974). Widow. New York, NY: Morrow.
Canfield, J., & Wells, H. C. (1976). 100 ways to enhance self-concept in the classroom: A handbook for teachers and
parents. Englewood Cliffs, NJ: Prentice-Hall.
Cantwell, D. P., & Carlson, G. A. (1983). Affective disorders in childhood and adolescence. New York, NY: Spectrum.
Caple, R. B. (1985). Counseling and the self-organization paradigm. Journal of Counseling and Development, 64,
173–178.
Carkhuff, R. R., & Berenson, B. G. (1967). Beyond counseling and psychotherapy. New York, NY: Holt, Rinehart &
Downloaded by [New York University] at 04:58 12 August 2016

Winston.
Carmichael, K. D. (2006). Play therapy: An introduction. Upper Saddle River, NJ: Pearson Merrill Prentice Hall.
Carrington, P. (1977). Freedom in meditation. Kendall Park, NJ: Pace Educational Systems.
Carroll, M. R., & Wiggins, J. (1990). Elements of group counseling: Back to the basics. Denver, CO: Love Publishing.
Cattanach, A. (2008). Narrative approaches in play with children. Philadelphia, PA: Jessica Kingsley.
Cautela, J., & McCullough, L. (1978). Covert conditioning: A learning-theory perspective on imagery. In J. L.
Singer & K. S. Pope (Eds.), The power of human imagination (pp. 227–254). New York, NY: Plenum
Cavett, A. (2010). Family strength genogram. In L. Lowenstein, (Ed.).Creative family therapy techniques: Play,
art, and expressive therapies to engage children in family sessions (pp. 20–22). Toronto, ON: Champion Press.
Centers for Disease Control and Prevention (CDC) (2013). Understanding and preventing violence: Summary of
research activities. Atlanta, GA: National Center for Injury Prevention and Control, Division of Violence Preven-
tion. Retrieved from www.cdc.gov/violenceprevention.
Chandler, C. K. (2005). Animal assisted therapy in counseling. New York, NY: Routledge.
Clayton, B. (2010). Music therapy activity ideas [Blog post]. Retrieved from http://musictherapyac
tivities.blogspot.com/.
Clen, S. L., Mennin, D. S. & Fresco, D. M. (2011). Major depressive disorder. In M. J. Zvolensky, A. Bernstein &
A. A. Vujanovic (Eds.), Distress tolerance: Theory, research, and clinical applications (pp. 149–170). New York,
NY: Guilford Press.
Coleman, V. D. (1998). Lifeline. In H. G. Rosenthal (Ed.), Favorite counseling and therapy techniques (pp. 51–53).
Washington, DC: Accelerated Development.
Cook, A. S., & Dworkin, D. S. (1992). Helping the bereaved: Therapeutic interventions for children, adolescents, and
adults. New York, NY: Basic Books.
Cooley, L. (2009). The power of groups: Solution-focused group counseling in schools. Thousand Oaks, CA: Corwin
Press.
Coppersmith, E. (1980). The family floor plan: A tool of training, assessment, and intervention in family therapy.
Journal of Marital & Family Therapy, 6, 141–145.
Corder, B. (1986). Therapeutic games in group therapy with adolescence. In C. E. Schaefer & S. E. Reid. (Eds.),
Game play: Therapeutic use of childhood games (pp. 279–290). New York, NY: Wiley.
Corey, M. S., & Corey, G. (1987). Groups: Process and practice (3rd ed.). Monterey, CA: Brooks/Cole.
Corsini, R. J. (1989). Introduction. In R. J. Corsini & D. Wedding (Eds.). Current psychotherapies (4th ed.,
pp. 1–16). Itasca, IL: Peacock.
Corsini, R. J., & Wedding, D. (1989). Current psychotherapies (4th ed.). Itasca, IL: Peacock.
Cox, R. H. (1973). Religious systems and psychotherapy. Springfield, IL: Charles C. Thomas.
Crawford, T., & Ellis, A. (1989). A dictionary of rational-emotive feelings and behaviors. Journal of Rational-Emotive
and Cognitive Therapy, 7, 3–28.
Crenshaw, D. A. (2004) Engaging resistant children in therapy: Projective drawing and storytelling strategies.
Rhinebec, NY: Rhinebeck Child and Family Center Publications.
Crenshaw, D. A. (2006). Evocative strategies in child and adolescent psychotherapy. New York, NY: Jason
Aronson.
Crenshaw, D. A. (2008). Therapeutic engagement of children and adolescents: Play, symbol, drawing and storytelling
strategies. New York, NY: Jason Aronson.
Crenshaw, D. A., & Garbarino, J. (2007). The hidden dimension: Profound sorrow and buried human potential
in violent youth. Journal of Humanistic Psychology, 47, 160–174.
Crenshaw, D. A., & Hardy, K. V. (2005). Understanding and treating the aggression of traumatized children in
out-of-home care. In N. Boyd-Webb (Ed.).Working with traumatized youth in child welfare (pp. 171–195). New
York, NY: Guilford.
Crenshaw, D. A., & Mordock, J. B.(2005). Handbook of play therapy with aggressive children. New York, NY: Jason
Aronson.
 328  References
Crose, R. (1990). Reviewing the past in the here and now: Using Gestalt therapy techniques with life review. Jour-
nal of Mental Health Counseling, 12(3), 279–287.
Cross, T. L., Bazron, B. J., Dennis, K. W., & Isaacs, M. R. (1989). Toward a culturally competent system of care.
Vol. 1: A monograph on effective services for minority students who are severely emotionally disturbed. Washington,
D.C.: Georgetown University, Child Development Center, Child and Adolescent Service System Program,
Technical Assistance Center.
Cummings, N., & Sayama, M. (1995). Focused psychotherapy: A casebook of brief, intermittent psychotherapy through-
out the life cycle. New York, NY: Brunner/Mazel.
Curry, N. N., & Kasser, T. (2005). Can coloring mandalas reduce anxiety? Art Therapy: Journal of the American
Art Therapy Association, 22(1), 81–85.
David-Ferdon, C. & Kaslow, N. J. (2008). Evidence-based psychosocial treatments for child and adolescent
depression. Journal of Clinical Child & Adolescent Psychology, 37(1), 62–104.
Davidson, P. (2001). The mad game. In H. G. Kaduson & C. E. Schaefer (Eds.), 101 more favorite play therapy
techniques (pp. 224–225). Northvale, NJ: Jason Aronson, Inc.
Davis, H., & Fallowfield, L. (1991). Counselling and communication in health care. Chichester, England: Wiley.
Davis, T. E. & Osborn, C. J. (2000). The solution-focused school counselor: Shaping professional practice. Philadel-
phia, PA: Accelerated Development.
De Jong, O., & Berg, I. K. (2008). Interviewing for solutions (3rd ed.) Belmont, CA: Thomson Brooks/Cole.
Downloaded by [New York University] at 04:58 12 August 2016

de Shazer, S. (1982). Patterns of brief family therapy. New York, NY: Guilford.
de Shazer, S. (1985). Keys to solution in brief therapy. New York, NY: W. W. Norton.
de Shazer, S. (1991). Putting difference to work. New York, NY: W. W. Norton.
de Shazer, S. (1994). Words were originally magic. New York, NY: W.W. Norton & Co.
de Shazer, S. & Berg, I. K. (1997), What works: Remarks on research aspects of solution-focused brief therapy.
Journal of Family Therapy, 19, 121–134.
de Shazer, S., Dolan, Y. M., Korman, H., Trepper, T. S., McCollum, E. E., & Berg, I. K. (2006), More than mira-
cles: The state of the art of solution focused therapy. New York, NY: Haworth Press.
Devi, I. (1963). Renew your life through yoga. New York, NY: Prentice-Hall.
Dicks, H. (1967). Marital tensions. New York, NY: Basic Books.
Dies, R. R. (1994). The therapist’s role in group treatments. In H. S. Bernard & K. R. MacKenzie (Eds.), Basics of
group psychotherapy (pp. 60–99). New York, NY: Guilford.
Dies, R. R., & Dies, K. T. (1993). The role of evaluation in clinical practice: Overview and group treatment illustra-
tion. International Journal of Group Psychotherapy, 43, 77–105.
Dinkmeyer, D. C., & Losoncy, L. E. (1980). The encouragement book: Becoming a positive person. Englewood Cliffs,
NJ: Prentice-Hall.
Dinkmeyer, D. C., Pew, W. L., & Dinkmeyer, D. C., Jr. (1979). Adlerian counseling and psychotherapy. Monterey,
CA: Brooks/Cole.
Dohrenwend, B. S., & Dohrenwend, B. P. (1985). Life stress and psychopathology. In H. Goldman & S. I.
Goldston (Eds.), Preventing stress related psychiatric disorders (DHHS Pub. No., ADM 85–1366, pp. 37–51).
Rockville, MD: NIMH.
Domhoff, G. W. (1996). Finding meaning in dreams: A quantitative approach. New York, NY: Plenum.
Downing, J. (1988). Counseling interventions with depressed children. Elementary School Counselor, 22(3),
296–301.
Drewes, A. A. (2001). The gingerbread person feeling map. In H. G. Kaduson & C. E. Schaefer (Eds.), 101 more
favorite play therapy techniques (pp. 92–97). Northvale, NJ: Jason Aronson, Inc.
Duhl, B. S. (1983). From the inside out and other metaphors. New York, NY: Brunner/Mazel.
Duhl, B. S., & Duhl, F. J. (1981). Integrative family therapy. In A. S. Gurman & D. P. Knniskem (Eds.), Handbook
of family therapy (pp. 236–258). New York, NY: Brunner/Mazel.
Duhl, F. S., Kantor, D., & Duhl, B.S. (1973). Learning space and action in family therapy: A primer of sculpt-
ing. In D. Bloch (Ed.), Techniques of family psychotherapy: A primer (pp. 119–139). New York, NY: Grune &
Stratton.
Dunne, P. (2014). Life size dolls, masks, life scripts, narradrama, photo and drama therapy. Los Angeles, CA: The
Drama Therapy Institute. Retrieved from http://www.dramatherapyinstitutela.com.
Dyer, W. W., & Vriend, J. (1977). Counseling techniques that work. New York, NY: Funk & Wagnall.
Dyson, P (2012). Feelings. Ring toss. Retrieved from www.pamdyson.com and www.stlplaytherapy.com.
Egan, G. (1990). The skilled helper: A systematic approach to effective helping (4th ed.). Pacific Grove, CA: Brooks/
Cole.
Elias, M. J. (1989). Schools as sources of stress to children: An analysis of causal and ameliorative influences.
Journal of School Psychology, 27, 393–407.
Ellis, A. (1973). Humanistic psychotherapy: The rational-emotive approach. New York, NY: McGraw-Hill.
Ellis, A. (1975). How to live with a neurotic. North Hollywood, CA: Wilshire Books.
Ellis, A. (1979). The theory of rational-emotive therapy. In A. Ellis & J. M. Whiteley (Eds.), Theoretical and
empirical foundations of rational-emotive therapy (pp. 33–60). Monterey, CA: Brooks/Cole.
Ellis, A. (1985). Expanding the ABC’s of rational-emotive therapy. In M. J. Mahoney & A. Freeman (Eds.), Cogni-
tion and psychotherapy (pp. 313–323). New York: Plenum.
Ellis, A. (1988). How to stubbornly refuse to make yourself miserable about anything, yes anything. New York, NY:
Kensington.
 References  329
Ellis, A. (1989). Comments on my critics. In M. E. Bernard & R. DiGiuseppe (Eds.). Inside rational-emotive
therapy: A critical appraisal of the theory and therapy of Albert Ellis (pp. 199–260). San Diego, CA: Academic
Press.
Ellis, A. (1990). How can psychological treatment aim to be briefer and better? The rational-emotive approach to
brief therapy. In J. K. Zeig & S. G. Gilligan (Eds.), Brief therapy: Myths, methods, and metaphors (pp. 291–302).
New York, NY: Brunner/Mazel.
Ellis, A. (1992). Group rational-emotive and cognitive-behavioral therapy. International Journal of Group Psycho-
therapy, 42(1), 63–80.
Ellis, A., & Dryden, W. (1990). The basic practice of RET. In W. Dryden (Ed.), The essential Albert Ellis
(pp. 145–183). New York, NY: Springer.
Ellis, A., & Harper, R. A. (1975). A new guide to rational living. Hollywood, CA: Wilshire.
Ellis, A., Sichel, J., Yeager, R., DiMattia, D., & DiGiuseppe, R. (Eds.). (1989). Rational­emotive couples therapy.
New York, NY: Pergamon.
Emery, G., & Campbell, J. (1986). Rapid relief from emotional distress. New York, NY: Fawcett Columbine.
Erlanger, M. A. (1990). Using the genogram with the older client. Journal of Mental Health Counseling, 12(3),
321–336.
Estes, C. P. (1992). Women who run with the wolves: Myths and stories of the wild woman archetype. New York, NY:
Ballantine Books.
Downloaded by [New York University] at 04:58 12 August 2016

Everly, G. S., Jr., & Mitchell, J. T. (1999). Critical Incident Stress Management (CISM): A new era and standard
of care in crisis intervention. Ellicott City, MD: Chevron.
Fagan, J., & Shepherd, I. L. (1970). Gestalt therapy now: Theory, techniques, applications. New York, NY:
Harper & Row.
Fairbairn, W.R.D. (1967). An object relations theory of personality. New York, NY: Basic Books.
Falvey, E. (1989). Passion and professionalism: Critical rapprochements for mental health research. Journal of
Mental Health Counseling, 11, 86–105.
Farthing, C. W. (1992). The psychology of consciousness. Englewood Cliffs, NJ: Prentice­Hall.
Feldenkrais, M. (2002). The potent self: A study of spontaneity and compulsion. Berkeley, CA: Frog Ltd.
Ferran, L (2010). James Ray arrested in Sedona sweat lodge deaths. ABC News Internet:
Yahoo!News, Inc. Sunnyvale, CA. Retrieved from http://abcnews.go.com/GMA/spiritual-leader-
james-ray-arrested-sweat-lodge-deaths/story?id=9741781.
Fezler, W. (1990). Imagery for healing, knowledge, and power. New York, NY: Simon & Schuster.
Fiebert, M.S. (1983). Ways of growth (3rd ed.). Lexington, MA: Ginn.
Fisch, R., Weakland, J. H., & Segal, L. (1982). The tactics of change: Doing brief therapy. San Francisco, CA:
Jossey-Bass.
Fisher, S., & Greenberg, R. (1977). The scientific credibility of Freud's theories and therapy. New York, NY: Basic
Books.
Fisher-Turk, E. (2005). Phototherapy. Wholistic Healing Publications, 5(3), 1–10.
Flannery, R. B. (2004). Posttraumatic stress disorder: The victim’s guide to healing and recovery (2nd ed). New York,
NY: American Mental Health Foundation.
Foa, E. B., Stekette, G. S., & Ascher, L. M. (1980). Systematic desensitization. In A. Goldstein & E. B. Foa (Eds.),
Handbook of behavioral interventions: A clinical guide (pp. 46–63). New York, NY: Wiley.
Fonagy, P. (1999). Report prepared by the Research Committee of the International Psychoanalytic Association at
the request of the President Editor and Chair. London: International Psychoanalytic Associations.
Fortier, J. (2003). My brain. In H. G. Kaduson & C. E. Schaefer (Ed.), 101 more favorite play therapy techniques
(pp. 96–101). Lanham, MD: Rowman & Littlefield.
Foulkes, D. (1985). Dreaming: A cognitive-psychological analysis. Hillsdale, NJ: Lawrence Erlbaum.
Foulkes, D. (1999). Children’s dreaming and the development of consciousness. Cambridge, MA: Harvard University
Press.
Freeman, A., & DeWolf, R. (1989). Woulda, coulda, shoulda. New York, NY: Silver Arrow Books.
Freedman, J., & Combs, G. (1996). Narrative therapy: The social construction of preferred realities. New York, NY:
Norton.
Freud, A. (1974). The methods of child analysis. In The writings of Anna Freud. New York, NY: International
Universities Press.
Freud, S. (1961). The psychopathology of everyday life. New York, NY: Signet. (Original work published 1901).
Frey, D. (2003). Play therapy strategies for the treatment of anger. Dayton, OH: Mandala Publishing.
Fuhriman, A. & Burlingame, G. M. (1990). Consistency of matter: A comparative analysis of individual and group
process variables. The Counseling Psychologist, 19, 1, 6–62.
Gallo-Lopez, L. (2000). A creative play therapy approach to the group treatment of young sexually abused chil-
dren. In H. G. Kaduson & C. E. Schaefer (Eds.), Short-term play therapy for children (pp. 278–281). New York:
NY: Guilford Press.
Gardner, R. (1986). The game of checkers in child therapy. In C. E. Schaefer & S. E. Reid (Eds.), Game play:
Therapeutic use of childhood games (pp. 215–232). New York, NY: Wiley.
Gardner, B. & Spickelmier, M. (2010). Working with adolescents. In A. Munns & Atkinson, N. (Eds.), Applica-
tions of family & group theraplay (pp. 249–264). Lanham, MD: Jason Aronson.
Garfield, S. L., & Bergin, A. E. (Eds.). (1986). Handbook of psychotherapy and behavior change (3rd ed.). New York,
NY: Wiley.
 330  References
Gelso, C. J., & Carter, J. A. (1985). The relationship in counseling and psychotherapy: Consequences, compo-
nents, and theoretical antecedents. The Counseling Psychologist, 13, 155–243.
Gibson, R. L., & Mitchell, M. M. (1990). Introduction to counseling and guidance (3rd ed.). New York, NY:
Macmillan.
Gil, E. (1994). Play in family therapy. New York, NY: Guilford.
Gil, E. (2003). Family play therapy: “The bear with short nails.” In C. Schaefer (Ed.), Foundations of play therapy
(pp. 192–218). New York, NY: Wiley.
Gil, E. (2006). Helping abused and traumatized children: Integrating directive and nondirective approaches. New
York, NY: Guilford.
Gil, E., & Sobol, B. (2000). Engaging families in therapeutic play. In C. E. Bailey (Ed.), Children in therapy: Using
the family as a resource (pp. 341–382). New York, NY: W. W. Norton.
Ginott, H. (1959). The theory and practice of therapeutic intervention in child treatment. Journal of Consulting
Psychology, 23, 160–166.
Ginter, E. J. (1988). Stagnation in eclecticism: The need to recommit to a journey. Journal of Mental Health
Counseling, 11, 77–85.
Gladfelter, J. (1990). Integrated psychotherapy. In J. K. Zeig & M. M. Munion (Eds.), What is psychotherapy?
(pp. 336–340). San Francisco, CA: Jossey/Bass.
Gladfelter, J. (1992). Redecision therapy. International Journal of Group Psychotherapy, 42(3), 319–334.
Downloaded by [New York University] at 04:58 12 August 2016

Glasgow, A. (1999). Sample activities: Anger management exercise: Draining. Retrieved from http:www.therapeu-
ticresources.com/sampleactivity.html.
Glasser, W. (1982). Interview by D. B. Evans, What are you doing? An interview with William Glasser. Personnel
and Guidance Journal, 61, 460–462.
Glasser, W. (1985). Control theory. New York, NY: Harper & Row.
Glasser, W. (1999). The language of choice theory. New York, NY: HarperCollins.
Gleick, J. (1988). Chaos: Making a new science. New York, NY: Penguin.
Goldenberg, I., & Goldenberg, H. (1985). Family therapy: An overview. Monterey, CA: Brooks/Cole.
Goldenson, R. M. (1984). Post-traumatic stress disorder. In Longman dictionary of psychology and psychiatry. New
York, NY: Longman.
Goldman, D. J. (1976). Meditation helps break the stress spiral. Psychology Today, 9(9), 82–84.
Goldman, D. J., & Schwartz, G. E. (1976). Meditation as an intervention in stress reactivity. Journal of Consulting
and Clinical Psychology, 44, 456–466.
Goldman, L. (2001). Breaking the silence: A guide to helping children with complicated grief-suicide, homicide, aids,
violence and abuse. New York, NY: Brunner-Routledge.
Goleman, D. (1999). Emotional intelligence. New York, NY: Bantam.
Gorski, P.C. (2014). Circles of my multicultural self. Retrieved from http://www.edchange.org/mul
ticultural/activities/circlesofself_handout.html.
Gottman, J. M. (1994). What predicts divorce? The relationship between marital process and marital outcomes. Hills-
dale, NJ: Erlbaum.
Gottman, J. M. (1999). The marriage clinic: A scientifically-based marital therapy. New York, NY: W. W. Norton.
Green, E. (2009). Jungian analytical play therapy. In K. O’Connor & L. M. Braverman (Eds,), Play therapy theory
and practice: Comparing theories and techniques (2nd ed., pp. 83–125). New York: NY: Wiley.
Green, E. J. (2007). The crisis of family separation following traumatic mass destruction: Jungian analytical play
therapy in the aftermath of Hurricane Katrina. In N. B. Webb (Ed.), Play therapy with children in crisis: Indi-
vidual group and family treatment (3rd ed., pp. 368–388). New York, NY: Guilford Press.
Grinspoon, L. (Ed.). (1991, February). Post-traumatic stress: Part I. Harvard Mental Health Letter, 7(8), 1–4.
Guerney, B. (1964). Filial therapy used as a treatment method for disturbed children. Evaluation, 3, 34–35.
Guerney, L. (1975). Filial therapy program. In H. L. Benson (Ed.), Treating relationships (pp. 67–91). Lake Mills,
IA: Graphic Publishing.
Gutterman, T. J. (1992). Disputation and reframing: Contrasting cognitive-change methods. Journal of Mental
Health Counseling, 14, 440–456.
Gutterman, T. J. (2006). Mastering the art of solution-focused counseling. Alexandria, VA: American Counseling
Association.
Gutterman, T. J. (2013). Mastering the art of solution-focused counseling (2nd ed.). Alexandria, VA: American
Counseling Association.
Gwain, G. (1982). Active visualization: Creating what you want. Professional Psychology: Research and Practice, 13,
211–216.
Haley, J. (1976). Problem solving therapy. San Francisco, CA: Jossey-Bass.
Haley, J. (1984). Ordeal therapy: Unusual ways to change behavior. San Francisco, CA: Jossey­Bass.
Hall, C. S. (1953a). A cognitive theory of dream symbols. The Journal of General Psychology, 48, 169–186.
Hall, C. S. (1953b). A cognitive theory of dreams. The Journal of General Psychology, 49, 273–282. Abridged
version in M. F. DeMartino (Ed.). (1959). Dreams and personality dynamics (pp. 123–134). Springfield, IL:
Charles C. Thomas.
Hambridge, G. (1955). Structured play therapy. American Journal of Orthopsychiatry, 25, 304–310.
Handly, R., & Neff, P. (1985). Anxiety and panic attacks: Their cause and cure. New York, NY: Ballantine.
Hansen, J., Stevie, R., & Warner, R. (1986). Counseling: Theory and process (4th ed.). Boston, MA: Allyn & Bacon.
 References  331
Hansen, J. C., Warner, R. W., & Smith, E. J. (1980). Group counseling: Theory and practice (2nd ed.). Chicago,
IL: Rand McNally.
Harvey, S. (2006). Dynamic play therapy. In C. Schaefer & H. Kaduson (Eds.), Contemporary play therapy
(pp. 55–81). New York, NY: Guilford.
Haslam, D. (2010). Family sculpting with puppets. In L. Lowenstein, (Ed). Creative family therapy techniques:
Play, art and expressive therapies to engage children in family sessions. Toronto, ON: Champion Press.
Hartman, A. & Laird, J., (1983). Family centered social work practice. New York, NY: The Free Press.
Heider, J. (1985). The Tao of leadership. Atlanta, GA: Humanics New Age.
Hellman, C. A., Morrison, B. K., & Abramowitz, L. M. (1986). The stress of therapeutic work. Journal of Mental
Health Counseling, 8, 36–40.
Helmstetter, S. (1986). What to say when you talk to yourself. New York, NY: Pocket Books.
Henry, W. P., Schacht, T. E., & Strupp, H. H. (1986). Structural analysis of social behavior: Application to a study
of interpersonal process in differential psychotherapeutic outcome. Journal of Counseling and Clinical Psychol-
ogy. 54, 27–31.
Herr, E. L. (1989). Counseling in a dynamic society: Opportunities and challenges. Alexandria, VA: American Asso-
ciation of Counseling and Development.
Hershenson, D. B., Power, P. W. & Seligman, L. (1989a). Mental health counseling theory: Present status and
future prospects, Journal of Mental Health Counseling, 11, 44–69.
Downloaded by [New York University] at 04:58 12 August 2016

Hershenson, D. B., Power, P. W. & Seligman, L, (1989b). Counseling theory as a projective test. Journal of Mental
Health Counseling, 11, 273–279.
Hill, H. (1992). Fairy tales: Visions for problem resolution in eating disorders. Journal of Counseling and Develop-
ment, 70, 584–587.
Hobday, A., & Ollier, K. (1998). Creative therapy with children and adolescent. Atascadero, CA: Impact Publishers.
Hollander, M. (2008). Helping teens for who cut: Understanding and ending self-injury. New York, NY: Guilford.
Horn, T. (2001). Balloons of anger. In H. G. Kaduson & C. E. Schaefer (Ed.), 101 more favorite play therapy
techniques (pp. 250–253). Northvale, NJ: Jason Aronson, Inc.
Horvath, A. O., & Greenberg, L. S. (1994). The working alliance: Theory, research, and practice. New York, NY:
Wiley.
Howard, M., Nance, D. W., & Myers, C. (1986). Adaptive counseling and therapy: A systematic approach to select-
ing effective treatments. San Francisco, CA: Jossey-Bass.
Howe, L. W., & Howe, M. M. (1975). Personalizing education: Values clarification and beyond. New York,
NY: Hart.
Hunt, H. (1989). The multiplicity of dreams: Memory, imagination, and consciousness. New Haven, CT: Yale Uni-
versity Press.
Ivey, A. E. (1989). Mental health counseling: A developmental process and profession. Journal of Mental Health
Counseling, 11, 26–35.
Ivey, A. E., & Simek-Downing, L. (1980). Counseling and psychotherapy: Skills, theories, and practice. Englewood
Cliffs, NJ: Prentice-Hall.
Jackson, D. P., & Weakland, J. H. (1961). Conjoint family therapy: Some considerations on theory, technique, and
results. Psychiatry, 24, 30–45.
Jacobs, M. (1998). The presenting past: The core of psychodynamic counseling and therapy. London, England: Open
University Press.
Jaffe, D. T., & Bresler, D. E. (1980). Guided imagery: Healing through the mind's eye. In J. E. Shorr, G. E.
Sobel, P. Robin, & J. A. Cannella (Eds.), Imagery: Its many dimensions and applications (pp. 253–266). New
York, NY: Plenum.
Jamison, K. R. (1995). An unquiet mind. New York: Alfred A. Knopf.
Johnson, C., & Maddi, K. (1986). The etiology of bulimia: Biopsychosocial perspectives. In S. Feinstein (Ed.),
Adolescent psychiatry, developmental and clinical issues (Vol. 13, pp. 253–273). Chicago, IL: University of Chi-
cago Press.
Johnson, D. W., & Johnson, F. P. (2009). Leading growth and counseling groups. Joining together: Group therapy
and group skills. (10th ed., pp. 501–502). Upper Saddle River, NJ: Pearson.
Johnson, K. (1998). Trauma in the lives of children: Crisis and stress management techniques for counselors, teachers,
and other professionals. Alameda, CA: Hunter House.
Juhnke, G. A., & Shoffner M. F. (1999). The family debriefing model: An adapted critical incident stress debriefing
for parents and older sibling suicide survivors. Family Journal: Counseling and Therapy for Couples and Families
7, 342–348.
Juhnke, G. A. (2002). Intervening with school students after terrorist attacks. In G. R. Walz & C. J. Kirkman
(Eds.), Helping people cope with tragedy & grief (pp. 13–17). Greensboro, NC: CAPS Publications
Jung, C. G. (1959). The archetypes and the collective unconscious. Princeton, NJ: Princeton University Press.
Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present and future. Clinical Psychology
Science and Practice, 10(2), 144–156.
Kaduson, H. G. (2001). The feeling word game. In H. G. Kaduson & Schaefer, C. E. (Eds.), 101 favorite play
therapy techniques (pp. 19–21). Northvale, NJ: Jason Aronson, Inc.
Kagan, J. (1998). How to become who you are. Family Therapy Networker, 98, 52–63.
Kaliff, D. M. (1980). Sandplay: A psychotherapeutic approach to the psyche. Boston, MA: Sigo Press.
 332  References
Kaplan, K J., Capace, N. K., Clyde. J.D. (1984). A bidimensional distancing approach to transactional analysis:
A suggested revision of the OK corra1. Transactional Analysis Journal, 15, 114–119.
Kaufmann, Y. (1989). Analytical psychotherapy. In R. J. Corsini & D. Wedding (Eds.), Current psychotherapies
(4th ed.) (pp. 118–132). Itasca, IL: F. E. Peacock.
Keat, D. B. (1985). Child-adolescent multimodal therapy: Bud the boss. Journal of Humanistic Education and
Development, 23, 183–192.
Keith, D. V. & Whitaker, C. A. (1981). Play therapy: A paradigm for work with families. Journal of Marital and
Family Therapy, 7, 243–254.
Kelly, K. R. (1988). Defending eclectism: The utility of informed choice. Journal of Mental Health Counseling,
10, 210–213.
Kelsey, S. (2008). How I felt the first day. In L. Lowenstein, (Ed.). Assessment and treatment activities for children
(pp. 27–29). Toronto, ON: Champion Press.
Kernberg, 0. (1984). Severe personality disorders. New Haven, CT. Yale University Press.
Kenney-Noziska, S. (2008). Techniques-techniques-techniques: Play-based activities for children, adolescents & fami-
lies. West Conshohocken, PA: Infinity Publishing.
Kerr, M. (1980). Emotional factors in physical illness: A multigenerational perspective. In R. R. Sagar (Ed.),
Georgetown family symposia: Vol. 4 (1977–78) (pp. 47–63). Washington, DC: Georgetown University.
Kerr, M., & Bowen, M. (1988). Family evaluation: An approach based on Bowen theory. New York, NY: W. W.
Downloaded by [New York University] at 04:58 12 August 2016

Norton.
Kirschner, D., & Kirschner, S. (1986). Comprehensive family therapy: An integration of systemic and psychodynamic
treatment models. New York, NY: Brunner/Mazel.
Klein, M. (1932). The psychoanalysis of children. New York, NY: Delacorte Press/Seymour Lawrence.
Klein, M. (1959). Our adult world and its roots in infancy. London, England: Tavistock.
Klein, M. (1963). Our adult world and other essays. London, England: Heinemann Medical Books.
Klein, M. (1975). The psychoanalysis of children. New York, NY: Delacorte.
Klerman, G., & Weissman, M. (1985). Affective responses to stressful life events. In H. Goldman & S. Goldston
(Eds.), Preventing stress-related psychiatric disorders (DHHS Pub. No. ADM 85–1366, pp. 55–76). Rockville,
MD: NIMH.
Klimek, D., & Anderson, M. (1988). Inner world, outer world: Understanding the struggles of adolescence. Ann
Arbor, MI: The University of Michigan. (ERIC Clearinghouse on Counseling and Personnel Services No. ED
290 118.)
Klorer, P. G. (2006). Art therapy with traumatized families. In L. Carey (ed.), Expressive and creative arts, methods
for trauma survivors (pp. 115–132). London, England: Jessica Kingsley Publishers.
Knell, S. & Dasari, M. (2009). CBPT: Implementing and integrating CBPT into clinical practice. In A. Drewes
(Ed.), Blending play therapy with cognitive behavior therapy: Evidenced-based and other effective treatments and
techniques (pp. 321–353). New York, NY: Wiley.
Knudson, R. M., & Minier, S. (1999). The on-going significance of significant dreams: The case of the bodiless
head. Dreaming, 9(4), 235–245.
Kohut, H. (1959). Introspection, empathy, and psychoanalysis. Journal of the American Psychoanalysis Association,
7, 459–483.
Kohut, H. (1971). The analysis of the self. New York, NY: International Universities Press.
Kohut, H. (1977). The restoration of the self. New York, NY: International Universities Press.
Kom, E. R., & Johnson, K. (1983). Visualization: The use of imagery in the health professions. Homewood, IL:
Dow-Jones/Irwin.
Kottman, T. (1990). Counseling middle school students: Techniques that work. Elementary School Guidance and
Counseling, 25(2), 138–145.
Kottman, T. (2001). Play therapy: Basics and beyond. Alexandria, VA: American Counseling Association.
Kranzow, K. (1973). Deliberate psychological education. The Personnel and Guidance Journal, 48(6), 72–78.
Krumboltz, J., & Krumboltz, H. (1972). Changing children's behavior. New York, NY: Prentice­ Hall.
Krumboltz, J. D., & Thoresen, C. E. (1976). Counseling methods. New York, NY: Holt, Rinehart & Winston.
Kuiken, D., & Sikora, S. (1993). The impact of dreams on waking thoughts and feelings. In E. A. Moffitt, E. M.
Kramer, et al. (Eds.), The functions of dreaming (pp. 610). Albany, NY: State University of New York Press.
LaFayette, J. M., & Stern, T. A. (2004). The impact of a patient’s suicide on psychiatric trainees: A case study and
review of the literature. Harvard Review of Psychiatry, 12, 49–50.
Lakoff, G. (1997). How unconscious metaphorical thought shapes dreams. In D. Stein (Ed.), Cognitive science and
the unconscious (pp. 89–120). Washington, DC: American Psychiatric Press.
Lambert, M. J. (1989). The individual therapist’s contribution to psychotherapy process and outcome. Clinical
Psychology Review, 9, 469–485.
Lambert, M. J., Shapiro, D. A., & Bergin, A. E. (1986). The effectiveness of psycho­therapy. In S. L. Garfield &
A. E. Bergin (Eds.), Handbook of psychotherapy and behavior change (pp. 111–141). New York, NY: Wiley.
Lampropoulos, G. K. (2000). Evolving psychotherapy integration: Eclectic selection and prescriptive applications
of common factors in therapy. Psychotherapy, 37(4), 285–297.
Landgarten, H. B. (1987). Family art therapy: A clinical guide and casebook: New York, NY: Routledge.
Landreth, G. L. (1991). Play therapy: The art of the relationship. Levittown, PA: Accelerate Development.
Landreth, G., & Bratton, S. (1999). Play therapy. ERIC Digest. Greensboro, NC: ERIC Clearinghouse on Coun-
seling and Student Services. (ERIC Document Reproduction Service No. ED430172).
 References  333
Larrabee, M., & Wilson, B. (1981). Teaching teenagers to cope through family-life simulations. The School Coun-
selor, 28, 117–123.
Lawrence, B. (2001). Saying good-bye: Breaking the links in a chain. In H. G. Kaduson & C. E. Schaefer (Eds.),
101 more favorite play therapy techniques (pp. 77–79). Northvale, NJ: Jason Aronson.
Lazarus, A. A. (1977). In the mind's eye: The power of imagery for personal enrichment. New York: Guilford Press.
Lazarus, A. A., Beutler, L. E., & Norcross, J. C. (1992). The future of technical eclecticism. Psychotherapy, 29,
11–20.
Leben, N. Y. (1994). Directive group play therapy—60 structured games for the treatment of ADHD, low self-esteem,
and traumatized children. Pflugerville, TX: Morning Glory Treatment Center for Children.
Lemons, H. (1999). Saying goodbye to your grief: A book designed to help people who have experienced crushing losses
survive and grow beyond the pain. Macon, GA: Smyth & Helwys Publishing.
Levitsky, A., & Perls, F. S. (1973). The rules and games of gestalt therapy. In J. Fagan & I. L. Shephard (Eds.),
Gestalt therapy now (pp. 140–149). Palo Alto, CA: Science and Behavior Books.
Levy, D. (1938). Release therapy for young children. Psychiatry, 1, 387–389.
Levy, F. J. (2014). Integrating the arts in psychotherapy: Opening the doors of shared creativity. American Journal
of Dance Therapy, 36, 6–27. Retrieved from www.Springerlink.com.
Lewis, C. S. (1963). A grief observed. Greenwich, CT: Seabury Press.
Lewis, H. R., & Streitfield, H. S. (1970). Growth games: How to tune in yourself, your family, your friends. New
Downloaded by [New York University] at 04:58 12 August 2016

York, NY: Bantam Books.

Lieberman, M. (1986). Art therapy for groups. Cambridge, MA: Brookline.
Lilly, J. P. (2006, September). Jungian play therapy. Paper presented at the Iowa Association for Play Therapy
Annual Conference, Iowa City, IA.
Linden, W., & Wen, F. K. (1990). Therapy outcome research, health care policy, and the continuing lack of accu-
mulated knowledge. Professional Psychology: Research & Practice, 21, 482–488.
Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York, NY: Guilford.
Lipsey, M., & Wilson, D. (1993). The efficacy of psychological, educational, and behavioral treatment: Confirma-
tion from meta-analysis. American Psychologist, 48, 1181–1209.
Lowenfeld, M. (1950). The nature and use of the Lowenfield world technique in work with children and adults.
Journal of Psychology, 30, 325–331.
Lowenstein, L. (Ed.). (2010). Creative family therapy techniques: Play, art and expressive therapies to engage chil-
dren in family sessions: Toronto, ON: Champion Press.
Luborsky, L., Crits-Cristoph, P., Mintz, J., & Auerbach, A. (1988). Who will benefit from psychotherapy: Predicting
therapeutic outcomes. New York, NY: Basic Books.
Maharishi, M. Y. (1972). The science of living and the art of being. New York, NY: Signet.
Main, A. P., & Roark, A. E. (1975). A consensus method to reduce conflict. Personnel and Guidance Journal, 53,
754–759.
Maitland, R. (1975). Essentials of meditation. Lakemont, GA: CSA Press.
Malchiodi, C. A. (2005). Expressive therapies. New York, NY: Guilford.
Maletic, V. (2010). Dance dynamica: effort and phrasing. Columbus, OH: Grade A Notes.
Marcer, D. (1986). Biofeedback and related therapies in clinical practice. Rockville, MD: Aspen Publishers.
Marquis, J., Morgan, W., & Piaget, G. (1973). A guidebook for systematic desensitization (3rd ed.), Palo Alto, CA:
Veterans Workshop.
Martin, D. G. (2011). Counseling and therapy skills. Long Grove, IL: Waveland Press.
Marston, S. (1994). The divorced parent. New York, NY: William Morrow.
Marziali, E. A. (1992). People in your life. Development of a social support measure for predicting psychotherapy
outcome. Journal of Nervous Mental Disorders, 175(6), 327–338.
Maslach, C. (1982). Burnout: The cost of caring. New York, NY: Prentice-Hall.
Maultsby, M. C. (1975). Help yourself to happiness. New York, NY: Institute for Rational Living
McAdams, C. R. & Foster, V. A. (2002). An assessment of resources for counselors coping and recovery in the
aftermath of client suicide. Journal of Humanistic Counseling, Education, and Development, 41, 232–241.
McBride, M. C., & Martin, G. E. (1990). A framework or eclecticism: The importance of theory to mental health
counseling. Journal of Mental Health Counseling, 12, 495–505.
McCaffry, B. L. (2002). The privilege exercise. Sonoma State University, Rohnert Park, CA. Retrieved from
https://userpages.umbc.edu~korenman/wmst/privilege1.html, pp. 4–6.
McDowell, B. (2004). The pick-up-sticks game. In H. Gerard Kaduson & C. E. Schaefer (Eds.), 101 favorite play
therapy techniques (pp. 145–149). Lanham, MD: Rowman & Littlefield.
McGoldrick, M., Gerson, R., & Petry, S. (2008). Genograms: Assessment and intervention (3rd ed.). New York,
NY: W. W. Norton.
McKay, M., Davis, M., & Fanning, P. (1983). Messages: The communication skills book. Oakland, CA: Harbinger.
McKay, M., Wood, J.C., & Brantley, J. (2007). Dialectical behavior therapy skills workbook: Practical DBT exercises
for learning mindfulness, interpersonal effectiveness, emotion regulation, & distress tolerance. Oakland, CA: New
Harbinger Publications.
McKay, M. J., & Fanning, P. (1999). Sample activities: An exercise from The Daily Relaxer. Retrieved from
http:www.therapeuticresources.com/sampleactivity.html.
McMullin, R., & Giles, T. (1981). Cognitive behavior therapy: A restructuring approach. New York, NY: Grune &
Stratton.
 334  References
Meichenbaum, D. (1977). Cognitive behavior modification: An integrated approach. New York, NY: Plenum.
Metcalf, L (2008). Counseling toward solutions: A practical solution-focused program for working with students,
teachers, and parents (2nd ed.). San Francisco, CA: John Wiley & Sons, Inc.
Miller, J. E. (2003). Grief tips. Fort Wayne, IN: Willowgreen Publishing.
Minuchin, S. (1974). Families and family therapy. Cambridge, MA: Harvard University Press.
Minuchin, S., & Fishman, H. (1981). Techniques of family therapy. Cambridge, MA: Harvard University Press.
Molnar, A. & de Shazer, S. (1987). Solution-focused therapy: Toward the identification of therapeutic tasks. Jour-
nal of Marital and Family Therapy. 13(4): 349–358.
Moore, C. L. & Yamamoto, K. (2012). Beyond words: Movement, observation and analysis (2nd ed.) New York,
NY: Routledge.
Moos, R. H. (1990). Depressed outpatients’ life contexts, amount of treatment and treatment outcome. Journal
of Nervous Mental Disorders, 178(2), 105–112.
Morris, D. (1994). Bodytalk: The meaning of human gestures. New York, NY: Crown Publishers.
Morris, R., & Kratochwill, T. (1983). Treating children’s fears and phobias: A behavioral approach. New York, NY:
Pergamon Press.
Murphy, J. J. (1997). Solution-focused counseling in middle and high schools. Alexandria, VA: American Counseling
Association.
Myers, D. (1994). Disaster response and recovery: A handbook for mental health professionals. Rockville, MD: Center
Downloaded by [New York University] at 04:58 12 August 2016

for Mental Health Services.

Myers, R. (2000). The family chip system. Villa Park, CA: Child Development Institute. Retrieved from http://
www.practicalparent.org.uk/chip.htm.
Nader, K., Dubrow, K., & Stamm, B. H. (Eds.). (1999). Honoring differences: Cultural issues in the treatment of
trauma and loss. Philadelphia, PA: Brunner/Mazel.
Nance, D. W., & Myers, P. (1991). Continuing the eclectic journey. Journal of Mental Health Counseling, 13(1),
119–130.
Narcavage, C. J. (2001). Using puppets to create a symbolic client. In H. G. Kaduson & C. E. Schaefer (Eds.),
101 more favorite play therapy techniques (pp. 224–225). Northvale, NJ: Jason Aronson.
Nicholas, M., & Forrester, A. (1999). Advantages of heterogeneous therapy groups in the psychotherapy of the
traumatically abused: Treating the problem as well as the person. International Journal of Group Psychotherapy,
49(3), 323–328.
Nichols, M. P. (1987). The self and the system. New York, NY: Brunner/Mazel.
Nichols, M. P., & Schwartz, R. C. (2005). The essentials of family therapy. New York, NY: Allyn & Bacon.
Nicholson, R. A., & Berman, J. S. (1983). Is follow-up necessary in evaluating psychotherapy? Psychological Bul-
letin, 93, 261–278.
Nickerson, E., & O’Laughlin, K. (1982). The therapeutic use of games. In C. E. Schaefer & K. J. O’Conner (Eds.),
Handbook of play therapy (pp. 174–187). New York, NY: Wiley.
Norcross, J. C. (Ed.). (1986). Handbook of eclectic therapy. New York, NY: Bruner/Mazel.
Norcross, J. C., & Goldfried, M. R. (Eds.). (1992). Handbook for psychotherapy integration. New York, NY: Basic
Books.
Norcross, J. C. (Ed.). (1986). Handbook of eclectic therapy. New York, NY: Brunner/Mazel.
Norton, C. C., & Norton, B. E. (1997). Reaching children through play therapy: An experiential approach. Denver,
CO: The Publishing Cooperative.
Norton, C. C., & Norton, B. E. (2006). Experiential play therapy. In C. Schaefer & H. Kaduson (Eds.), Contem-
porary play therapy: Theory, research and practice (pp. 28–54). New York, NY: Guilford.
Norton, C. C., & Norton, B. E. (2008). Reaching children through play therapy: An experiential approach. Denver,
CO: White Apple Press.
Norcross, J. D., & Prochaska, J. O. (1983). Clinician’s theoretical orientations: Selection, utilization and efficacy.
Professional Psychology: Research and Practice, 14, 197–208.
Notarius, C., & Markman, H. (1993). We can work it out: Making sense of marital conflict. New York, NY:
Putman.
Oaklander, V. (1988). Windows to our children: A Gestalt therapy approach to children and adolescents. Highland,
NY: Gestalt Journal Press.
Oaklander, V, (1994). Gestalt play therapy. In K. O’Conner & C. Schaefer (Eds.), Handbook of play therapy (Vol. 2,
pp. 143–156). New York, NY: Willey.
O’Conner, K. (2009). Ecosystemic play therapy. In K. O’Connor & L. M. Braverman (Eds.), Play therapy theory
and practice: Comparing theories and techniques (2nd ed., pp. 367–450). New York, NY: Wiley.
Okum, B. F. (1990). Seeking connections in psychotherapy. San Francisco, CA: Jossey-Bass.
O’Malley, S. S., Suh, C. S., & Strupp, H. H. (1983). The Vanderbilt psychotherapy process scale: A report of the
scale development and a process outcome study. Journal of Consulting and Clinical Psychology, 51, 581–586.
Pallaro, P. (Ed.) (1999). Authentic movement: essays by Mary Starks Whitehouse, Janet Adler & Joan Chodorow.
Philadelphia, PA: Jessica Kingsley Publishers.
Patterson, C. H. (1986). Theories of counseling and psychotherapy (4th ed.). New York, NY: Harper & Row.
Pelletier, K. R. (1980). Holistic medicine. New York, NY: Delacorte.
Perls, F. S. (1969). Gestalt therapy verbatim. Lafayette, CA: Real People Press.
Perls, F. S. (1973). The Gestalt Approach and Eyewitness to Therapy. Palo Alto, California Science and Behavior
Books, New York: Bantam Books.
 References  335
Perry, W. (2008). Basic counseling techniques: A beginning therapist toolkit (2nd ed.). Bloomington, IN: Author
House.
Peterson, S., & Straub, R. L. (1992). School crisis survival guide: Management techniques and materials for coun-
selors and administrators. West Nyack, NY: Center for Applied Research in Education.
Pollack, H. B., & Sian, J. B. (1995). Reflections and suggestions on leadership of psychotherapy groups. Interna-
tional Journal of Group Psychotherapy, 45(4), 507–519.
Post-Sprunk, T. (2010a). Boat-storm-lighthouse assessment. In L. Lowenstein, (Ed.). Creative family therapy
techniques: Play, art and expressive therapies to engage children in family sessions (pp. 12–13). Toronto, ON:
Champion Press.
Post-Sprunk, T. (2010b). Toss the ball. In L. Lowenstein, (Ed.). Creative family therapy techniques: Play, art and
expressive therapies to engage children in family sessions (p. 250). Toronto, ON: Champion Press.
Powers, R. L., & Haln, J. M. (1977). Creativity in problem-solving: The double dialogue technique. Individual
Psychologist. 14(1), 22–32.
Prochaska, J. O., DiClemente, C. C., & Norcross, J. C. (1992). In search of how people change. American Psy-
chologist, 47(9), 1102–1114.
Prochaska, J. O., & Prochaska, J. M. (1994). A transtheoretical model of change for addictive behaviors. In M.
Gossop (Ed.), Psychological treatment for addictive behaviors (pp. 222–242). Barcelona, Spain: Cevron.
Purkey, W. W., & Schmidt, J. J. (1990). Invitational/earning for counseling and development. Ann Arbor, MI:
Downloaded by [New York University] at 04:58 12 August 2016

ERIC/CAPS Select.
Putnam, F. W. (1991). Dissociative disorders in children and adolescents: A developmental perspective. Psychiatric
Clinics of North America, 14(3), 519–531.
Rando, T. A. (1984). Grief, dying, and death: Clinical interventions for caregivers. Cambridge, IL: Research Press.
Rathus, S. A., & Nevid, J. S. (1977). BT: Behavior therapy strategies for solving problems in living. New York, NY:
Signet.
Reddy, L. A., & Savin, H. (2000). Designing and conducting outcome studies. In H. A. Savin & S. S. Kiesling
(Eds.), Accountability systems of behavioral health care (pp. 132–158). San Francisco, CA: Jossey-Bass.
Renard, S., & Sockol, K. (1987). Creative drama: Enhancing self-concepts and learning. Minneapolis, MN: Edu-
cational Media.
Rhyne, J. (1970). The gestalt art experience. In J. Fagan & I. Lee (Eds.), Gestalt therapy now (pp. 274–284). New
York, NY: Harper & Row.
Richardson, R. W. (1987). Family ties that bind. Bellingham, WA: Self-Counsel Press.
Roark, A. E. (1978). Interpersonal conflict management. Personnel and Guidance Journal, 57, 400–402.
Robbins, A. (1986). Unlimited power: The new science of personal achievement. New York, NY: Fawcett Columbine.
Roberts, C. G., & Guttormson, L. (1990). You and stress: A survival guide for adolescence. Minneapolis, MN: Free
Spirit Press.
Robertson, M. H. (1995). Psychotherapy education and training: An integrative perspective. Madison, CT: Inter-
national Universities Press.
Rogers, C. R. (1951). Client-centered therapy: Its current practice, implications, and theory. Boston, MA: Houghton
Mifflin.
Rogers, C. R. (1986). Client-centered therapy. In I. Kutash & A. Wolf (Eds.), Psychotherapist’s casebook: Theory and
techniques in the practice of modern therapies (pp. 197–208). San Francisco, CA: Jossey-Bass.
Romen, A. (1981). Self-suggestion and its influence on the human organism. Armonk, NY: M. E. Sharpe.
Rosen, M., & Brenner, S. (1993). The Rosen method of movement. New York, NY: Random House, Inc.
Rychlak, J. F. (1985). Eclecticism in psychological theorizing: Good and bad. Journal of Counseling and Develop-
ment, 63(6), 351–353.
Sabatino, J. A., & Smith, L. M. (1990). Rational self-analysis. Journal of Counseling and Development, 69, 167–172.
Safran, J. C., Segal, Z. V., Vallis, T. M., Shaw, B. F., & Samstag, L. W. (1993). Assessing patient suitability for
short-term cognitive therapy with an interpersonal focus. Cognitive Therapy and Research, 17, 23–38.
Sanders, F. M. (1989). Marital conflict and psychoanalytic therapy in the middle years. In J. Oldham & R. Liebert
(Eds.), The middle years: New psychoanalytic perspectives. New Haven, CT: Yale University Press.
Satir, V. (1967). Conjoint family therapy. Palo Alto, CA: Science and Behavior Books.
Satir, V., & Baldwin, M. (1983). Satir step by step: A guide to creating change in families. Palo Alto, CA: Science
and Behavior Books.
Schaefer, C. E., Briesmeister, J. M., & Fitton, M. E. (1984). Family therapy techniques for problem behavior of chil-
dren and teenagers. San Francisco, CA: Jossey-Bass.
Schaefer, C., & Drewes, A. (2009). The therapeutic powers of play and play therapy. In A. Drewes (Ed.), Blend-
ing play therapy with cognitive behavioral therapy: Evidenced-based and other effective treatment and techniques
(pp. 3–15). Hoboken, NJ: Wiley.
Schaefer, C. E., & Reid, S. (Eds.). (1986). Game play: Therapeutic use of childhood games. New York, NY: Wiley.
Scharf, D., & Scharf, J. S. (1987). Object relations family therapy. Northvale, NJ: Jason Aronson, Inc.
Scheidlinger, S. (1997). Group dynamics and group psychotherapy revisited: Four decades later. International
Journal of Group Psychotherapy, 47(2), 141–159.
Schimmel, C. J., & Jacobs, E. (2011). Ten creative counseling techniques for helping clients deal with anger. Retrieved
from http://counselingoutfitters.com/vistas/vistas11/Article_53.pdf.
Schriner, C. (1990). Feel better now: 30 ways to handle frustration in three minutes or less. Rolling Hills Estates, CA:
Jalmar Press.
 336  References
Schultz, K. D. (1984). The use of imagery in alleviating depression. In A. A. Sheikh (Ed.), Imagination and healing
(pp. 129–158). Farmingdale, NY: Baywood.
Seligman, M.E.P. (1995). The effectiveness of psychotherapy: The Consumer Reports study. American Psychologist,
50, 965–974. Retrieved from http://www.apa.org/journals/seligman.html.
Seltzer. L. F. (1986). Paradoxical strategies in psychotherapy: A comprehensive overview and guidebook. New York,
NY: Wiley.
Selvini-Palazzoli, M. (1978). Paradox and counterparadox. New York, NY: Jason Aronson.
Serok, S. (1986). Therapeutic implications of games with juvenile delinquents. In C. E. Schaefer & S. E. Reid
(Eds.), Game play: Therapeutic use of childhood games (pp. 311–329). New York, NY: Wiley.
Sexton, T. L., & Whiston, S. C. (1991). Review of the empirical basis for counseling: Implications for practice and
training. Counselor Educations and Supervision, 30(6), 330–354.
Shapiro, D. A., & Shapiro, D. (1982). Meta-analysis of comparative therapy outcome studies: A replication of
refinement. Psychological Bulletin, 92, 581–604.
Shapiro, L. E. (2008). Stopping the pain: A workbook for teens who cut & self-injure. Oakland, CA: New Harbinger
Publications.
Shapiro, S. (1992). Trauma, ego defenses and behavioral reenactment. In S. Shapiro & G. M. Dominiak (Eds.).
Sexual trauma and psychopathology: Clinical intervention with adult survivors (pp. 61–63). New York, NY:
Lexington Books.
Downloaded by [New York University] at 04:58 12 August 2016

Shapiro, S. L. (2009). The integration of mindfulness and psychology. Journal of Clinical Psychology, 65(6),
555–560. Retrieved from www.interscience.wiley.com.
Sheikh, A. A. (1976). Treatment of insomnia through eidetic imagery: A new technique. Perceptual and Motor
Skills, 43, 994.
Sheikh, A. A., & Jordan, C. S. (1983). Clinical uses of mental imagery. In A. A. Sheikh (Ed.), Imagery: Current
theory, research, and application (pp. 391–435). New York, NY: Wiley.
Sheikh, A. A., & Sheikh, D. S. (Eds.). (1985). Imagery in education. Farmingdale, NY: Baywood Publishing.
Sherman, R., & Fredman, N. (1986). Handbook of structural techniques in marriage and family therapy. New York,
NY: Brunner/Mazel.
Shorr, J. E. (1974). Psychotherapy through imagery. New York, NY: Intercontinental Medical.
Short, G. (2008). Developmental play therapy for very young children. In C. Schaefer, S. Kelly-Zion,
J. McCormick, & A. Ohnogi (Eds.), Play therapy for very young children (pp. 367–377). Lanham, MD: Jason
Aronson, Inc.
Short, G. F. (2001). Art or verbal metaphors for children experiencing loss. In H. G. Kaduson & C. E. Schaefer
(Eds.), 101 more favorite play therapy techniques (pp. 40–43). Northvale, NJ: Jason Aronson.
Silva, J., & Stone, R. B. (1983). The Silva mind control method for business managers. Englewood Cliffs, NJ:
Prentice-Hall.
Simon, G. M. (1989). An alternative defense of eclecticism: Responding to Kelly and Ginter. Journal of Mental
Health Counseling, 11, 280–288.
Simon, G. M. (1991). Theoretical eclecticism: A goal we are obligated to pursue. Journal of Mental Health Coun-
seling, 13(1), 367–378.
Simon, S. B., Howe, L. W., & Kirschenbaum, H. (1972). Values clarification: A handbook of practical strategies for
teachers and students. New York, NY: Hart.
Simonton, O. C., Mathews-Simonton, S., & Creighton, J. S. (1978). Getting well again. Los Angeles, CA: Tarcher.
Sinclair, T. M. (2001). The personality pie. In H. G. Kaduson & C. E. Schaefer (Eds.), 101 more favorite play
therapy techniques (pp.72–76). Northvale, NJ: Jason Aronson.
Sklare, G. B. (2005). Brief counseling that works: A solution-focused approach for school counselors (2nd ed.), Thou-
sand Oaks, CA: Corwin Press.
Smith, D. (1982). Trends in counseling and psychotherapy. American Psychologist, 37, 802–809.
Smith, J. (2008). Care tags. In L. Lowenstein (Ed.), Favorite therapeutic activities for children and teens: Practi-
tioners share their most effective interventions. Toronto, ON: Champion Press.
Smith, R., Moallem, M., & Sherrill, D. (1997). How preservice teachers think about cultural diversity: A closer
look at factors which influence their beliefs towards equality. Educational Foundations, 11(2), 41–61.
Smitheman-Brown, V., & Church, R. P. (2006). Mandala drawing: Facilitating creative growth in children with
A.D.D. or A.D.H.D. Art Therapy: Journal of the American Art Therapy Association, 13(4), 252–260.
Sori, C. F. (2006). Engaging children in family therapy: Creative approaches to integrating theory and research in
clinical practice. New York, NY: Routledge.
Spinelli, E. (1994). Demystifying therapy. London, England: Constable.
Spivack, G., Platt, J., & Shure, M. (1976). The problem-solving approach to adjustment. San Francisco, CA:
Jossey-Bass.
Stanton, M. D. (1984). Fusion, compression, diversion, and the workings of paradox: A theory of therapeutic/
systemic change. Family Process, 23, 135–167.
Stockton, R., & Morran, D. (1982). Review and perspectives of critical dimensions in therapeutic small group
research. In G. M. Gazda (Ed.), Basic approaches to group psychotherapy and group counseling (3rd ed., pp. 47–68).
Springfield, IL: Charles C. Thomas.
Strong, S. R., & Claiborn, C. D. (1982). Change through interaction: Social psychological processes of counseling and
psychotherapy. New York, NY: Wiley.
Strupp, H. H. (1981). Clinical research, practice and the crisis of confidence. Journal of Consulting and Clinical
Psychology, 49, 216–219.
 References  337
Strupp, H. H., & Bergin, A. E. (1969). Some empirical and conceptual bases for coordinated research in psycho-
therapy. International Journal of Psychiatry, 7, 68.
Suler, J. R. (1996). Teaching clinical psychology: Family sociograms. Retrieved from www.rider.edu/sites/suler/
sociogram.html.
Suler, J. (2003). In class exercises. Retrieved from http://truecenterpublishing.com/tcp/inclassex.html.
Suler, J. (2008). Image, word, action: Interpersonal dynamics in photo-sharing community. CyberPsychology and
Behavior, 11(5), 555–560.
Swank, J. M. (2008). The use of games: A therapeutic tool with children and families. International Journal of Play
Therapy, 17(2), 154–167.
Taft, J. (1933). The dynamics of therapy in a controlled relationship. New York, NY: Macmillian.
Talmon, M. (1990). Single session therapy. San Francisco, CA: Jossey-Bass.
Taylor, J. W. (1984). Structured conjoint therapy for spouse abuse cases. Social Casework, 65, 11–18.
Thompson, M. J. (2009). Animal-assisted play therapy: Canines as co-therapist. In G. R. Walz, J. C. Bleuer, &
R. K. Yep (Eds.), Compelling counseling interventions, NISTA 2009 (pp. 199–209). Alexandria, VA: American
Counseling Association.
Thompson, R. A. (1990, February). Strategies for crisis management in the schools. National Association of Sec-
ondary School Principals Bulletin, 14(6), 54–58.
Thompson, R. A. (1993). Post-traumatic stress and post-traumatic loss debriefing: Brief strategic intervention for
Downloaded by [New York University] at 04:58 12 August 2016

survivors of sudden loss. The School Counselor, 34, 133–138.

Thompson, R. A. (2012). Professional school counseling: Best practices for working in the schools (3rd ed.). New
York, NY: Routledge.
Tillett, R. (1984). Gestalt therapy in theory and practice. British Journal of Psychiatry, 145, 231–235.
Trimble, L., Jackson, K, & Harvey, D. (2000). Client suicidal behavior: Impact, interventions, and implications for
psychologists. Australian Psychologist, 35, 227–232.
Trotzer, J. P. (1986). Marriage and family: Better ready than not. Muncie, IN: Accelerated Development.
Truax, C. B., & Carkhuff, R. R. (1967). Towards effective counseling and psychotherapy. Chicago, IL: Aldine.
Van De Riet, V., Korb, M. P., & Gorrell, J. J. (1980). Gestalt therapy: An introduction. New York, NY: Pergamon
Viorst, J. (1998) Necessary Losses: The Love, Illusions, Dependencies and Impossible Expectations that all of us have to
give up in order to grow. New York: Fireside.
Visser, C. (2011). 21 Solution-focused techniques: the progress-focused approach. Retrieved from www.progressfo-
cused.com. Reprinted with permission.
Vriend, J. (1985). Counseling powers and passions: More counseling techniques that work. Alexandria, VA: American
Association of Counseling and Development.
Wachtel, E. R. (1982). The family psyche over three generations: The genogram revisited. Journal of Marriage and
Family Therapy, 8, 335–343.
Walen, S. R., DiGiuseppe, R., & Wessler, R. L. (1980). A practitioner’s guide to rational emotive therapy. New York,
NY: Oxford University Press.
Walker, K, (2011). Feel good file. In E. Lowenstein (Ed.), Children, adolescents & family practitioners share their
most effective techniques (pp. 58–59). Toronto, ON: Champion Press.
Walker, W. (1992, November 16). Jungian analysis. Audio Cassette Recording, 4–92. Memphis, TN: Center for
Counseling and Education.
Walsh, W. M. (1992). Twenty major issues in remarriage families. Journal of Counseling and Development, 70(6),
200–203.
Walter, J. L., & Peller, J. E. (1992). Becoming solution focused in brief therapy. New York, NY: Brunner/Mazel.
Walters, V. (1981). The living school. RETwork, 1(1), 136–144.
Webb, N. B. (1991). Playing for their lives: Helping troubled children through play therapy. New York, NY: Free
Press.
Weeks, G. R. & Treat, S. R. (2001). Couples in treatment: Techniques and approaches for effective practice (2nd ed),
New York: NY: Brunner-Routledge/Taylor and Francis.
Weinhold, J. (1987). Altered states of consciousness. Journal of Humanistic Psychology,12, 14–17.
Weitzman, S. (2007). Seven essential skills to teach children. Belleville, ON: Self-Published.
White, J., & Fadiman, J. (Eds.). (1976). Relax: How you can feel better, reduce stress, and overcome tension. New
York, NY: Dell/Confucian Press.
White, M. (2005). An outline of narrative therapy. Retrieved from www.massety.ac.nz.
White, M., & Epston, D. (1990). Narrative means to therapeutic ends. New York, NY: Norton
Wilde, G. (1992). Rational counseling with school-aged populations: A practical guide. Muncie, IN: Accelerated
Development.
Wilde, G. (1996). Treating anger, anxiety, and depression in children and adolescents: A cognitive-
behavioral perspective. Washington, DC: Accelerated Development.
Williams, W. C., & Lair, G. S. (1991). Using a person-centered approach with children who have disabilities.
Elementary School Guidance and Counseling, 25(3), 194–203.
Winnicott, D. W. (1965). The maturational process and the facilitating environment. New York, NY: International
Universities Press.
Witmer, J. M., & Young, M. E. (1985). The silent partner: Uses of imagery in counseling. Journal of Counseling
and Development, 64(3), 187–190.
Witmer, J. M., & Young, M. E. (1987). Imagery in counseling. Elementary School Guidance and Counseling, 22(1),
5–15.
 338  References
Wolpe, J. (1982). The practice of behavior therapy (3rd ed.). New York, NY: Pergamon.
Wolterstorff, N. (1982). Lament for a son. Grand Rapids, MI: Eerdmans.
Wright, J., Coley, S., & Corey, G. (1989). Challenges facing human services education today. Journal of Counseling
and Human Service Professions, 3(2), 3–11.
Wubbolding, R. (1991). Understanding reality therapy. New York, NY: Harper-Collins.
Wubbolding, R. (2000). Reality Therapy for the 21st Century. New York, NY: Routledge.
Yalom, I. D. (1985). The theory and practice of group psychotherapy. New York, NY: Basic Books.
Yontef, G. M. (1993). Awareness, dialogue and process: Essays on Gestalt therapy. Gouldsboro, ME: The Gestalt
Journal Press, Inc.
Zilbergeld, B., & Lazarus, A. (1987). Mind power. Boston, MA: Little, Brown.
Zimbardo, P. G. (1977). Shyness: What it is and what to do about it. Menlo Park, CA: Addison Wesley.
Zimmerman, J., & Dickerson, V. (1996). If problems talked: Narrative therapy in action. New York, NY: Guilford.
Zirpoli, T. J., & Melloy K. J. (1993). Behavior management: Applications for teachers and parents. New York, NY:
MacMillan.
Downloaded by [New York University] at 04:58 12 August 2016
 Bibliography

Akeroyd-Guillory, D. (1988). A development view of anorexia nervosa. The School Counselor, 36, 24–33.
Armeniox, L. (2000). Dance therapy recognized as counseling specialty. The National Certified Counselor, 17(1), 3.
Downloaded by [New York University] at 04:58 12 August 2016

Arrindell, W. A., Sanderman, W. J., Hogeman, J. H., Pickersgill, M. G., Kwee, G. T., Van der Molen, H. T., &
Lingsma, M. M. (1990). Correlates of assertiveness. Advances in Behavior Research and Therapy, 12, 153–182.
Association for Play Therapy. (1997). Play therapy definition. Association for Play Therapy Newsletter, 16(2), 4.
Attneave, G. S. (1990). A network model for helping. Journal of Mental Health Counseling, 12(1), 24–30.
Attwood, A. J. (1998). Clinical change in adolescent aggressive behavior: A group therapy approach. Journal of
Children and Adolescent Group Therapy, 8, 1, 23–33.
Babensee, B. A., & Pequette, J. R. (1982). Perspectives on loss: A manual for educators. Evergreen, CO: self-published.
Basco, M. R. (2005). The bipolar workbook: Tools for controlling your mood swings. New York, NY: Guilford.
Bayles, F. (2000, April 13). War on an eyesore that wrecks city life. USA Today, p. 3A.
Beck, A. T. (1976). Cognitive therapy and emotional disorders. New York, NY: International Universities Press.
Beitman, B. D. (1994). Stop exploring! Start defining the principles of psychotherapy integration: Call for a con-
sensus. Journal of Psychotherapy, 4(3), 203–228.
Belkin, G. S. (1988). Contemporary psychotherapies (2nd ed.). Monterey, CA: Brooks/Cole.
Bellack, A. S., & Hersen, M. (1988). Behavioral assessment: A practical handbook (3rd ed). New York: Pergamon.
Berger, C. R. (1985). Social power and interpersonal communication. In M. L. Knapp & G. R. Miller (Eds.),
Handbook of interpersonal communication (pp. 439–499). Beverly Hills, CA: Sage.
Bergman, J. S. (1985). Fishing for barracuda: Pragmatics of brief systemic therapy. New York, NY: W. W. Norton.
Bettelheim, B. (1976). The uses of enchantment. New York, NY: Knopf.
Blatner, A. (2000). Foundations of psychodrama: History, theory and practice (4th ed.). New York: Springer.
Blocher, D. H. (1987). On the uses and misuses of the term theory. Journal of Counseling and Development, 66,
67–68.
Bloom, B. L. (1981). Focused single-session therapy: Initial development and evaluation. In S. H. Budman (Ed.),
Forms of brief therapy (pp. 66–82). New York, NY: Guilford.
Blum, M. D. (1988). The silent speech of politicians. San Diego, CA: Brenner Information Group.
Boscolo, L., Cecchin, G., Hoffman, L., & Penn, P. (1987). Milan systemic family therapy: Conversations in theory
and practice. New York, NY: Basic Books.
Bricker, D. C., & Young, J. E. (1993). A client’s guide to schema-focused cognitive therapy. New York, NY: Cogni-
tive Therapy of New York.
Brooks-Gunn, J., Burrow, C., & Warren, M. P. (1988). Attitudes toward eating and body weight in different
groups of female athletes. International Journal of Eating Disorders, 7, 749–757.
Budman, S. H. (1992). Models of brief individual and group psychotherapy. In J. L. Feldman & R. J. Fitzpatrick
(Eds.), Managed mental health care: Administrative and clinical issues (pp. 231–248). Washington, DC: Ameri-
can Psychiatric Press.
Burgoon, J., David, H., Buller, B., & Woodall, W. G. (1989). Nonverbal communication: The unspoken dialogue.
New York, NY: Harper & Row.
Burlingame, G. M., & Fuhriman, A. (1987). Conceptualizing short-term treatment: A comparative review. Coun-
seling Psychologist, 15(4), 557–595.
Christiansen, A., Johnson, S. M., Phillips, S., & Glassgow, R. E. (1980). Cost efficiency in family behavior therapy.
Behavior Therapy, 11, 208–226.
Cook, E. P. (1987). Characteristics of the biopsychosocial crisis of infertility. Journal of Counseling and Develop-
ment, 65, 465–470.
Daniluk, L. D. (1991, March/April). Strategies for counseling infertile couples. Journal of Counseling and Devel-
opment, 69(4), 317–320.
Davis, J. M. (1985). Suicidal crises in schools. School Psychology Review, 14(3), 313–322.
de Shazer, S. (1988). Clues: Investigating solutions in brief therapy. New York, NY: W. W. Norton.
DeVito, J. A., & Hecht, M. L. (1990). The nonverbal communication reader. Prospect Heights, IL: Waveland Press.
Dinkmeyer, D. (1988). Marathon family counseling. Individual Psychology: Journal of Adlerian Theory, Research,
and Practice, 44, 210–215.
 340  Bibliography
Dobyns, S. (1997). Best words, best order: Essays on poetry. New York, NY: St. Martins Griffin.
Dunlap, K. (1946). The technique of negative practice. American Journal of Psychology, 55, 270–273.
Duttweiler, P. C. (1984). The internal control index: A newly developed measure of locus of control. Educational
and Psychological Measurement, 36(2), 209–226.
Dysinger, B. J. (1993). Conflict resolution for intermediate children. The School Counselor, 40(4), 113–118.
Edwards, S. S., & Kleine, P. A. (1986). Multimodal consultation: A model for working with gifted adolescents.
Journal of Counseling and Development, 64(9), 598–601.
Eibl-Eibesfeldt, I. (1970). Ethology: The biology of behavior. San Francisco, CA: Holt, Rinehart, & Winston.
Eisenberg, G. M. (1981). Midtherapy training: Extending the recent system of pretherapy training. Dissertation
Abstracts International, 41, 2754B.
Ekman, P. (1980). The face of man: Expressions of universal emotion in a New Guinea village. Garland STPM Press.
Ekman, P. (1992). Telling lies. New York, NY: W. W. Norton.
Ekman, P. (1998). Commentaries. In Darwin, C. (1872). The expression of the emotions in man and animals (3rd
ed.). New York, NY: Oxford University Press.
Erickson, M. (1954). Special techniques on brief hypnotherapy. Journal of Clinical and Experimental Hypnosis, 2,
109–129.
Ewer, R. F. (1968). Ethology of mammals. New York, NY: Plenum.
Figley, C. R. (1998). Burnout as systemic traumatic stress: a model for helping traumatized family members.
Downloaded by [New York University] at 04:58 12 August 2016

In C. R. Figley (Ed.), Burnout in families: The systemic costs of caring (pp. 15–28). Boca Raton, FL: CRC
Press.
Fisher, J., & Byrne, D. (1975). Too close for comfort: Sex differences in response to invasions of personal space.
Journal of Personality and Social Psychology, 32, 15–21.
Fisher, S., & Greenberg, R. (1996). Freud scientifically appraised. New York, NY: Wiley.
Fluegelman, A. (Ed.). (1976). The new games book. Garden City, NY: Doubleday.
Flannery, R. B. (1999). Psychological trauma and posttraumatic stress disorder: A review International Journal of
Emergency Mental Health, 78(2), 135–140.
Frayn, D. H. (1992). Assessment factors associated with premature psychotherapy termination. American Journal
of Psychotherapy, 46, 250–261.
Friedlander, M. L., (1981). The effects of delayed role induction on counseling process and outcome. Dissertation
Abstracts International, 43, 3887–3888B.
Garfield, S. L. (1980). Psychotherapy: An eclectic approach. New York, NY: Wiley.
Garner, D. M., & Garfinkle, P. E. (1980). Socio-cultural factors in the development of anorexia nervosa. Psychologi-
cal Medicine, 10, 647–656.
Gaston, L., Marmar, C. R., & Thompson, L. (1988). Relation of patient pretreatment characteristics to the thera-
peutic alliance in diverse psychotherapies. Journal of Consulting and Clinical Psychology, 56, 483–489.
Gaushell, W. H., & Lawson, D. M. (1989). Using a checksheet with misbehaviors in school: Parent involvement.
The School Counselor, 36(6), 208–214.
Gentner, D. S. (1991). A brief model for mental health counseling. Journal of Mental Health Counseling, 13(1),
58–68.
Gill, S. J., & Barry, R. A. (1982). Group focused counseling: Classifying the essential skills. The Personnel and Guid-
ance Journal, 60(5), 110–118.
Givens, D. B. (2002). Dictionary of gestures, signs and body language. Spokane, WA: Center for Nonverbal Studies
Press.
Gonzales, M., Jones, D, Whitely, R. M., & Whitely, J. M. (1988). The AACD stress management manual. Alexan-
dria, VA: American Counseling Association.
Greenberg, L. S., & Safran, T. D. (1987). Emotion in psychotherapy. New York, NY: Guilford Press.
Greenberger, D., & Padesky, C. A. (1995). Mind over matter. New York, NY: Guilford Press.
Grinspoon, L. (Ed.). (1991, March). Post-traumatic stress: Part II. Harvard Mental Health Letter, 7(9), 1–4.
Gruen, D. S. (1993). A group psychotherapy approach to postpartum depression. International Journal of Group
Psychotherapy, 43(2), 191–203.
Guidano, V. F., & Liotti, G. (1983). Cognitive processes and emotional disorders. New York, NY: Guilford.
Hamachek, D. E. (1992). Encounters with the self. London: Thomas Learning.
Hamilton, J. A., & Harberger, P. (Eds.). (1992). Postpartum psychiatric illness. Philadelphia, PA: University of
Pennsylvania Press.
Hay, L. L. (1987). You can heal your life. Carlsbad, CA: Hay House, Inc. Hayes, S. C., Strosahl, K. D., & Wilson,
K, G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York, NY:
Guilford Press.
Hill, C. E., & O’Grady, K. (1985). List of therapeutic intentions illustrated in a case study with therapists of varying
theoretical orientations. Journal of Counseling Psychology, 32, 3–22.
Holaday, M., & Smith, A. (1995). Coping skills training: Evaluating a training model. Journal of Mental Health
Counseling, 17(3), 360–367.
Hsu, L.K.G. (1989). The gender gap in eating disorders: Why are eating disorders more common among women?
Clinical Psychology Review, 9, 393–407.
Huxley, A. (1946). Silence, liberty and peace. London: Fellowship of Reconciliation/Harpers.
Ivey, A. E. (1990). Developmental strategies for helpers: Individual, family, and network interventions. Pacific Grove,
CA: Brooks/Cole.
 Bibliography  341
Ivey, A. E., & Goncalves, O. F. (1988). Developmental therapy: Integrating developmental processes into clinical
practice. Journal of Counseling and Development, 66, 406–413.
Ivey, A. E., & Rigazio-DiGilio, S. A. (1991). Toward a developmental practice of mental health counseling: Strate-
gies for training, practice, and political unity. Journal of Mental Health Counseling, 13(1), 21–36.
Jacobs, E. (1988). Use of creative techniques and props in individual and group counseling. Breckenridge, CO:
American School Counselors Association (ASCA) Elementary/Middle School Guidance Conference.
Jakubowski, R., & Lange, A. J. (1978). The assertive option: Your rights and responsibilities. Champaign, IL:
Research Press.
Johnson, W. Y., & Wilborn, B. (1991). Group counseling as an intervention in anger expression and depression in
older adults. The Journal of Specialists in Group Work, 16(3), 133–142.
Kalafat, J. (1990). Adolescent suicide and the implications for school response programs. The School Counselor,
37(5), 359–369.
Kaliff, D. (1971). Sandplay: Mirror of a child’s psyche. San Francisco, CA: Browser.
Kaplan, K. J. (1985). A response to Gilbert’s comments. Transactional Analysis Journal, 15, 144–145.
Kaplan, K. J. (1987). Jonah and Narcissus. Self-integration versus self-destruction in human development. Studies
in Formative Spirituality, 8, 33–54.
Kaplan, K. J. (1988). TILT: Teaching individuals to live together. Transactional Analysis Journal, 18, 220–230.
Kaplan, K. J. (1990). TILT for couples: Helping couples grow together. Transactional Analysis Journal, 20,
Downloaded by [New York University] at 04:58 12 August 2016

229–244.
Kaplan, K. J. (1998). TILT: Teaching individuals to live together. Philadelphia: Brunner-Mazel.
Keat, D. B. (1990). Change in child multimodal counseling. Elementary School Guidance and Counseling, 24(4),
192–198.
Kettlewell, P. W., Mizes, J. S., & Wasylsyshyn, N. A. (1992). A cognitive-behavioral group treatment of bulimia.
Behavior Therapy, 23(4), 657–670.
Knapp, M. L., & Hall, J. A. (1992). Nonverbal communication in human interaction (3rd ed.) New York, NY:
Holt, Rinehart & Winston.
Knell, S. (2009). Cognitive behavioral play therapy. In A. Drewes (Ed.), Blending play therapy with cognitive behav-
ior therapy: Evidenced-based and other effective treatment and techniques (pp. 117–134). New York, NY: Wiley.
Kohut, H. (1984). How does analysis cure? Chicago, IL: The University of Chicago Press.
Kolb, D. L., Beutler, L. E., Davis, C. S., Crago, M., & Shanfield, S. (1985). Patient and therapist process variables
relating to dropout and change in psychotherapy. Psychotherapy: Theory, Research, and Practice, 22, 702–710.
Lazarus, A. A. (1981). The practice of multimodal therapy. New York, NY: McGraw-Hill.
Lazarus, A. A. (1985). Casebook of multimodal therapy. New York, NY: Guilford.
Lazarus, A. A. (1992). The multimodal approach to the treatment of minor depression. American Journal of Psy-
chotherapy, 86(1), 50–56.
Lazarus, A. A. (1993). The practice of multimodal therapy. Baltimore, MD: Johns Hopkins University Press.
Lebar, S. (2002). The world in your head: A Gestalt view of the mechanism of conscious experience. Mahwah, NJ:
Lawrence Erlbaum Associates.
Leveton, E. A. (1992). A clinician’s guide to psychodrama. New York, NY: Springer.
Lewy, A. J., Sack, R. L., & Miller, L. S. (1987). Antidepressant and circadian phase­shifting effects of light. Science,
235, 352–354.
Lieberman, M., Yalom, I., & Miles, M. (1973). Encounter groups: First facts. New York, NY: Basic Books.
Link, P. W., & Darling, C. A. (1986). Couples undergoing treatment for infertility: Dimensions of life satisfaction.
Journal of Sex and Marital Therapy, 12(1), 46–59.
Lundholm, J. K., & Littrell, J. M. (1986). Desire for thinness among high school cheer­leaders: Relationship to
disordered eating and weight control behaviors. Adolescence, 21, 573–579.
Madanes, C. (1981). Strategic family therapy. San Francisco, CA: Jossey-Bass.
Mahlstedt, P. P. (1985). The psychological component of infertility. Fertility and Sterility, 43(3), 335–346.
Mahoney, M. J. (1977). Reflections on the cognitive learning trend in psychotherapy. American Psychologist, 32,
5–13.
Malan, D. (1975). Psychodynamic changes in untreated neurotic patients. British Journal of Psychiatry, 32,
110–126.
Maltz, M. (1960). Psychocybernetics. Englewood Cliffs, NJ: Prentice-Hall.
Manley, L. (1986). Goals of misbehavior inventory. Elementary School Guidance and Counseling, 21, 160–162.
Mann, J. (1973). Time-limited psychotherapy. Cambridge, MA: Harvard University Press.
Mann, J. (1981). The core of time-limited psychotherapy: Time and the central issue. In S. H. Budman (Ed.),
Forms of brief therapy (pp. 25–42). New York, NY: Guilford.
Mazza, N. (1981). The use of poetry in treating the troubled adolescent. Adolescence, 16, 403–408.
McAdams, C. R. (2002). Trends in the occurrence of reactive and proactive aggression among children and adoles-
cents: Implications for preparation and practice in child and youth care. Child & Youth Care Forum, 31, 89–109.
McAdams, C. R., & Lambe, G. (2003). The changing face of youth aggression in schools: Its impact and implica-
tions for school counselors. Preventing School Failure, 47, 122–130.
McEwan, K. L., Costello, C. G., & Taylor, P. J. (1987). Adjustment to infertility. Journal of Abnormal Psychology,
96(2), 108–116.
McKay, M., Fanning, P., & Paleg, K. (1994). Couple skills: Making your relationship work. Oakland, CA: New
Harbinger Publications.
 342  Bibliography
McMahon, R. J., & Forehand, R. (1984). Parent training for the noncompliant child: Treatment, outcome, gen-
eralization, and adjunctive therapy procedures. In R. F. Dangel & R. A. Polster (Eds.), Parent training: Founda-
tions of research and practice (pp. 47–67). New York, NY: Guilford.
Mehrabian, A. (1971). Silent messages. Belmont, CA: Wadsworth.
Miller, W. (1994). Family play therapy: History, theory and convergence. In C. Schaefer & L. Carey (Eds.), Family
play therapy (pp. 3–20). Northvale, NJ: Jason Aronson, Inc.
Milne, D. (1986). Training behavior therapists: Methods, evaluation and implementation with parents, nurses, and
teachers. Cambridge, MA: Brookline Books.
Mole, J. (2002). Decoding body language: The four basic modes of body language in business. Retrieved from http://
www.johnmole.com articles18.htm.
Monroe, C., Borzi, M. G., & Burrell, R. D. (1992). Communication apprehension among high school dropouts.
The School Counselor, 39(4), 273–280.
Morris, D. (2012). People watching: The Desmond guide to people watching. London, England: Vintage Books.
Morse, C., & Dennerstein, L. (1985). Infertile couples entering an in vitro fertilization program: A preliminary
survey. Journal of Psychosomatic Obstetrics and Gynecology, 4, 207–209.
Morse, L. A. (1987). Working with young procrastinators: Elementary school students who do not complete
assignments. Elementary School Guidance and Counseling, 21(3), 259–268.
Mosak, H. H. (1971). Lifestyle. In A. G. Kelly (Ed.), Techniques for behavior change (pp. 74–84). Springfield, IL:
Downloaded by [New York University] at 04:58 12 August 2016

Charles C. Thomas.
Nance, D. W. (1995). How therapists ACT: Cases combining major approaches to psychotherapy and the adaptive
counseling model. Washington, DC: Accelerated Development.
Nelson, R. C. (1990). Choice awareness: A systematic eclectic counseling theory. Minneapolis, MN: Educational
Media Corporation.
Nelson, R. L. (1992). Spa in counseling. Journal of Counseling and Development, 71(2), 214–220.
Novaco, R. W. (1975). Anger control: The development and evaluation of an experimental treatment. Lexington,
MA: Lexington Books/DC Heath.
O’Connor, K. (1983). The color-your-life technique. In C. E. Schaefer & K. J. O’Connor (Eds.), Handbook of play
therapy (pp. 251–258). New York, NY: Wiley.
O’Hanlon, W. & Weiner-Davis, M. (1989). In search of solutions: A new direction in psychotherapy. New York, NY:
W. W. Norton.
Ohlsen, M. M. (1977). Group counseling. New York, NY: Holt, Rinehart, & Winston.
Omizo, M. M., & Omizo, S. A. (1988). The effects of participation in group counseling on self-esteem and locus
of control among adolescents from divorced families. The School Counselor, 36(1), 54–58.
Palmer, D., & Hampton, P. T. (1987). Reducing broken appointments at intake in a community mental health
center. Community Mental Health Journal, 23, 76–78.
Pals-Stewart, W., & Lucente, S. (1994). Behavioral group therapy with obsessive-compulsives: An overview. Inter-
national Journal of Group Psychotherapy, 44, 35–51.
Peiser, I. (1982). Similarity, liking, and missed sessions in relation to psychotherapy outcome. Dissertation Abstracts
International, 42, 4587B.
Perls, F. (1973). The Gestalt approach and eyewitness to therapy. Palo Alto, CA: Science and Behavioral Books.
Progoff, I. (1975). At a journal workshop: The basic text and guide for using the intensive journal process. New York,
NY: Dialogue House Library.
Rako, S., & Mazer, H. (Eds.). (1983). Semrad: The heart of a therapist. Northvale, NJ: Jason Aronson.
Rich, P. (1999). The healing journey through grief: Your journal for reflection and recovery. New York, NY: Wiley.
Roback, H. B., Moore, R. F., Bloch, F. S., & Shelton, M (1996). Confidentiality in group psychotherapy: Empirical
findings and the law. International Journal of Group Psychotherapy, 46(1), 117–135.
Rogers, C. R. (1961). On becoming a person. A therapist’s view of psychotherapy. Boston, MA: Houghton Mifflin.
Rogers, C. R. (1980). A way of being. Boston, MA: Houghton Mifflin.
Rosenthal, N. E. (1989). Light therapy: Treatment of psychiatric disorders, Vol. 3. Washington, DC: American Psy-
chiatric Association, Task Force on Treatment of Psychiatric Disorders.
Rosenthal, N. E., Carpenter, J. P., & James, S. P. (1986). Seasonal affective disorders in children and adolescence.
American Journal of Psychiatry, 143, 356–358.
Rosenthal, N. E., Sack, D. A., Gillin, J. C., Lewy, A. J., Goodwin, F. K., Davenport, Y., Mueller, P. S., Newsome,
D. A., & Wehr, T. A. (1984). Seasonal affective disorder: A description of the syndrome and preliminary findings
for light therapy. Archives General Psychiatry, 41, 72–80.
Rosenthal, N. E., & Wehr, T. A. (1987). Seasonal affective disorders. Psychiatric Annals, 17(10), 664–669.
Sapir, E. (1931). Communication. Encyclopedia of the Social Sciences, New York, 4, 78–81.
Schaefer, C. E., & Briesmeister, J. M. (Eds.). (1989). Handbook of parent training: Parents as co-therapists for chil-
dren’s behavior problems. New York, NY: Wiley.
Schaefer, D. (1987). Choices and consequences: What to do when a teenager uses alcohol and drugs. Minneapolis, MN:
Johnson Institute Books.
Schinfeld, J. S., Elkins, T. E., & Strong, C. M. (1986). Ethical considerations in the management of infertility.
Journal of Reproductive Medicine, 31(11), 1038–1042.
Schiraldi, G. R. (2000). The post-traumatic stress disorder sourcebook: A guide to healing, recovery, and growth. Los
Angeles, CA: Lowell House.
Schmich, M. (1997, June 1). Advice, like youth, probably just wasted on the young. Chicago Tribune. Retrieved
from http:www.chicagotribune.com/news/columnists/chi-970601sunscreen.column.
 Bibliography  343
Selvini-Palazzoli, M., Boscolo, L., Cecchin, G., & Prata, G. (1974). The treatment of children through brief
therapy of their parents. Family Process, 13, 429–442.
Shneidman, E. (1985). Definition of suicide. New York, NY: Wiley.
Sifenos, S. P. (1979). Short-term dynamic psychotherapy: Evaluation and technique. New York, NY: Plenum.
Sifenos, S. P. (1981). Short-term anxiety-provoking psychotherapy: Its history, technique, outcome, and instruc-
tion. In S. H. Budman (Ed.), Forms of brief therapy (pp. 45–80). New York, NY: Guilford.
Sori, C. F. (2006). Family play therapy: An interview with Eliana Gil. In C. F. Sori (Ed.), Engaging children in
family therapy: Creative approaches to integrating theory and research in clinical practice (pp. 69–90). New York,
NY: Routledge.
Sowa, C. J. (1992). Understand clients’ perceptions of stress. Journal of Counseling & Development, 71(2),
179–183.
Spitzer, R. L., Endicott, J., & Robins, E. (1978). Research diagnostic criteria: Rationale and reliability. Archives of
General Psychiatry, 35, 773–782.
Squires, R. L., & Kagen, D. M. (1985). Sex-role and eating behaviors among college women. International Jour-
nal of Eating Disorders, 4, 539–548.
Stanton, M. D. (1981). Strategic approaches to family therapy. New York, NY: Brunner/Mazel.
Stefanowski-Harding, S. (1990). Suicide and the school counselor. The School Counselor, 37(5), 328–336.
Striegel-Moore, R., Silberstein, L. R., & Rodin, J. (1986). Toward and understanding of risk factors for bulimia.
Downloaded by [New York University] at 04:58 12 August 2016

American Psychologist, 41, 246–263.

Suter, J. R. (1996). Teaching clinical psychology: Family sociograms. Retrieved from l.rider.edu/sites/suler/socio-
gram.html.
Szmukler, G. I., Eisler, I., Gillies, C., & Hayward, M. E. (1985). The implications of anorexia nervosa in a ballet
school. Journal of Psychiatric Research, 19, 177–181.
Taibbi, R. (2007). Doing family therapy: Craft and creativity in clinical practice (2nd ed.). New York, NY: Guilford.
Taub, D. E., & McLorg, P. A. (1989). Anorexia nervosa and bulimia. In H. Tierney (Ed.), Women’s studies encyclo-
pedia: Vol. I. View from the sciences (pp. 101–121). Westport, CT: Greenwood.
Teusch, R. (1988). Level of ego development and bulimics’ conceptualizations of their disorder. Internal Journal
of Eating Disorders, 7, 607–615.
Thiessen, I. (1983). Using fairy tales during hypnotherapy in bulimerexia and other psychological problems. Medi-
cal Hypnoanalysis, 4, 139–144.
Towers, D., Wollum, S., Dow, E., Senese, R., Ames, G., Berg, J., & McDonald, T. (1987). Metaphor as a tool for
counselors. Paper presented at the Annual Convention of the American Association for Counseling and Develop-
ment, New Orleans. (ERIC Document Reproduction Service No. ED 285096).
U.S. Department of Health and Human Services. (1999). Mental health: A report of the surgeon general-executive
summary. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental
Health Services Administration, Center for Mental Health Services, National Institutes of Health, National
Institute of Mental Health.
Valentine, D. P. (1986). Psychological impact of infertility: Identifying issues and needs. Social Work in Health
Care, 11(4), 61–69.
Vargas, M. F. (1986). Louder than words: An introduction to nonverbal communication. Ames, IA: The Iowa State
University Press.
Vrugt, A., & Kerkstra, A. (1984). Sex differences in nonverbal communication. Semiotica, 50, 1–41.
Waldo, M. (1985). A curative factor framework for conceptualizing group counseling. Journal of Counseling and
Development, 64(1), 46–52.
Watzlawick, P., Beavin, J. H., & Jackson, D. D. (1967). Pragmatics of human communication. New York, NY:
W. W. Norton.
Weight, L. M., & Noakes. T. D. (1987). Is running an analog of anorexia? A survey of the incidence of eating dis-
orders in female distance runners. Medicine and Science in Sports and Exercise, 19, 213–217.
Weinrach, S. G. (1991). Selecting a counseling theory while scratching your head: A rationale-emotive therapist’s
personal journey. Journal of Mental Health Counseling, 13(3), 367–378.
White, P. G. (n.d.). The legend of the tear jar. Retrieved from http:www.webhealing.com/articles/tearjarl.htm.
Wickman, S. A., Daniels, M. H., White, L. J., & Fesmire, S. A. (1999). A “primer” in conceptual metaphor for
counselors. Journal of Counseling and Development, 77, 389–394.
William, T. Grant Commission on Work, Family & Citizenship. (1988). The forgotten half: Pathways to success for
America’s youth and young families. New York, NY: William T. Grant Foundation.
Woodman, M. (1985). The pregnant virgin: A process of psychological transformations Toronto, ON: Inner City.
Yalom, I. D., & Leszcz, M. (2005). The theory and practice of group psychotherapy. New York, NY: Basic Books.
Yapko, M. (1986). Hypnotic and strategic interventions in the treatment of anorexia nervosa. American Journal
of Clinical Hypnosis, 28, 224–232.
Young, J. E. (1999). Cognitive therapy for personality disorders: A schema-focused approach (3rd ed.) Sarasota, FL:
Professional Resource Press.
Zimstrad, S. W. (1989). Brief systemic therapy for families of the close head injured: Therapy with two hands.
Cognitive Rehabilitation, 7(3), 26–28.
Downloaded by [New York University] at 04:58 12 August 2016

Page Intentionally Left Blank

 Index

ABC theory of personality 113 modifying emotional 136 – 7; stopping inappropriate

Abramowitz, L. M. 209 136; strengthening new 135; types of 131
Downloaded by [New York University] at 04:58 12 August 2016

Ackerman, N. 264 behavioral techniques 130 – 53; affirming new

Ackerman Institute 265 positive behavior 137; anger expression 139;
active listening 156 anxiety hierarchy for fear of flying 148 – 50; anxiety
Adapted Family Debriefing Model (AFDM) 233 – 6; management training 139; becoming more
debriefings for parents and children 234 – 5; outgoing 147 – 8; beginning dialogue with stranger
debriefing team, roles of 233 – 4; described 233; 146; behavior rehearsal 139 – 40; confronting
steps for 234 – 5 shyness 144 – 5; coping imagery 141; cost/benefits
Adlerian play therapy 295 of shyness 145; developing new positive behavior
adverse health consequences 208 137 – 8; family chip system 150 – 3; first-time talking
affection words 185 146; giving and accepting compliments 146; goal
Alberti, R. E. 159 rehearsal 141; keeping conversation going 147;
Alcoholics Anonymous (AA) 15 maintaining new positive behavior 138; making
Allen, F. 294 date with opposite sex 148; mystery motivator
altruism 14 153; saying hello 146; self-administered systematic
American Dance Therapy Association (ADTA) 65, 68 desensitization procedure 150; self-instruction
American Music Therapy Association training 141 – 2; self-management 141; shyness
(AMTA) 73 journal 145; starting conversation 147; step-up
American Psychological Association 6, 213 technique 141; stopping inappropriate behavior
Anderson, D. 8 138; systematic desensitization 142 – 4; thought
Anderson, M. 270 stopping/blocking 140; undoing negative self-talk
Andrews, J. D. W. 17 145; writing yourself a letter 145
anger words 185 behavior modification: antecedents/consequences and
animal-assisted therapy (AAT) 298 130 – 1, 153; consequences and 136; contingency
art therapy techniques 63 – 5; advertisements 64 – 5; contract and 136 – 7; defined 130; goals of 130;
childhood memories 65; described 63 – 4; life principles of 135 – 6; stages of 131 – 2; types of
priorities collage 64, 65; melting mirror 64; behavior 131
shield 64 behavior modification program steps 132 – 5; commit
asking “how” and “what,” as Gestalt to/begin program 133 – 4; describe behavior 132;
component 47 graph/review results 134 – 5; identify baseline for
assertiveness attributes 174 – 5 behavior 133; measure behavior 132 – 3
assertive rights 160, 174 Berenson, B. G. 155
Association of Play Therapy (APT) 290 Bergin, A. E. 3, 8, 12 – 13, 17
assuming responsibility, as Gestalt component 47 Berman, J. S. 5
Aston, J. 67 Berne, E. 265
Aston-Patterning Bodywork 67 Bernstein, D. A. 218
attachment therapy 3 biofeedback 217 – 18
Authentic Movement (AM) 66 – 7 Bixler, R. 295
autogenic relaxation 217 blended or stepfamily therapy 268 – 9; adult issues 269;
awareness 49 described 268 – 9; developing family issues 269;
Axline, V. 294 feelings about self/others 269; initial family issues
269; see also eclectic techniques, family systems/
Bailey, C. E. 311 development
Bartenieff, I. 66 blind spots 63
Beaulieu, D. 63 Bloch, S. 13
Beck, A. T. 76, 295 Borkover, T. D. 218
Beck, J. S. 76 Bowen, M. 14, 264
behavior: categories of 131; as communication Bowlby, J. 3
16; complex, laws of 130; developing new Boy, A. V. 2
135; imitative 14; maintaining established 135; Bramblett, J. 239
 346  Index
Brammer, L. M. 2, 156 giving constructive criticism 87 – 8; increased
Brigman, G. 158 activity levels 94; limit inappropriate attention 95;
bringing the past into the now, as Gestalt component mood-monitoring chart 88; nine ways to handle
47 stress effectively 84; overcoming depression 90 – 1;
Brooks. R. 299 psychological forces that block intelligent decision-
Brown, K. 4 making 86; reducing test anxiety 78 – 9; reframing
Brown, N. W. 63 88; reversing the downward depression spiral 93 – 4;
bully, how to handle 205 – 6 self-talk to maintain composure 85; staying with
Burlingame, G. M. 13, 19 anxiety 88 – 9; strategies and attitudes in problem-
burnout, defined 213 solving 80; strategies for overcoming depression 92;
Butler, A. C. 76 stress inoculation 90; teaching coping and changing
skills 95; turning negative thoughts about studying
Caine, L. 239 into positive thoughts 78; using self-control
Caple, R. B. 2 techniques 85; writing learning history of angry
caregivers, grief counseling for: compassion fatigue reactions 86
and 245 – 6; debriefing of those who debrief 247; cognitive-behavioral therapy (CBT) 76 – 7; described
self-awareness/self-care 246 – 7 77; features of 76 – 7; focus of 95; history of 76;
Carkhuff, R. R. 155 SMART goals 78; uses for 95; see also cognitive-
Downloaded by [New York University] at 04:58 12 August 2016

Carmichael, K. D. 290 behavioral techniques

Carroll, M. R. 17 cognitive literacy skills 182 – 3
catharsis 13, 14 communications therapy model 264
Cautela, J. 222 compassion fatigue 213 – 14, 245 – 6; prevention
centering, to reach inner peace 260 strategies 214 – 15
Chandler, C. K. 298 competency, defined 39
change maintenance/relapse prevention, as complaint 267
psychotherapy goal 7 concreteness 158
changing questions to statements, as Gestalt concrete rationale 12
component 46 conflict: constructive 184; destructive 184; resolution,
children: debriefings for parents and 234 – 5; interactive process for 184 – 5; see also conflict resolution
techniques for working with 298 – 9; music therapy techniques
for 72 – 3; play therapy for 290 – 302; play therapy conflict resolution techniques 186 – 208; aggression
techniques for 302 – 11, 312 – 23; post-traumatic and self-assertion 207; aggression and self-assertion
stress disorder assessment of 236 I 206 – 7; aggression and self-assertion II 207;
children, grief counseling for 240 – 1; see also grief aggression control methods 204; artful critique
counseling techniques 200; assuming responsibility for choices and
choice theory 126 – 7; axioms of 126; client options actions 188; avoiding conflict by paraphrasing
126 – 7; described 126; seven caring vs. seven deadly 199; communicating feelings in nonblaming
habits 128; see also choice theory techniques manner 200 – 1; confrontation guidelines 192 – 3;
choice theory techniques 127 – 8; SAMIC 128; confronting a conflict 197; confrontive assertion
WDEP: What, Doing, Evaluate, Plan 127 – 8 198; conventional arbitration 194; coping thoughts
Claiborn, C. D. 266 for anger reactions 196; coping with agitation 197;
clarifying responses 157 coping with anger 189; dealing with rumors and
client-therapist relationships 9 – 16; components of 9; accusation 190 – 1; dealing with teasing 199; DESC
intentions and, therapeutic 10 – 11; interventions script (Describe, Express, Specify, Consequences)
and, therapeutic 11 – 12; psychotherapy effectiveness 186; don’t take it personally 202 – 3; enhancing
and 14 – 15; therapeutic factors and 12 – 14 relationship skills 190; fair fighting 193; getting
client variables, psychotherapy success and 7 – 8 out of middle of dueling relationships 203; guided
cognitive-behavioral family therapy model 265 conflict imagery 187; how to calm angry person
cognitive-behavioral play therapy 295 – 6 205; how to express anger without hurting
cognitive-behavioral techniques 77 – 95; ABCDE’s relationship 206; how to handle a bully 205 – 6; how
of stopping unhappy thoughts 87; ACT formula: to handle verbal attack 189; how to let someone
accept, choose, take action 83; aggression control know they are bothering you 191; human machine
methods 85 – 6; alternative interpretation 81 – 2; 207; inner processing how another person might
alternative solution 83; anti-catastrophic reappraisals feel 189; interpretive confrontation 202; knowing
82; anxiety formula: “knowness” versus importance when, where, and how to resolve conflicts: a
83; changing inner beliefs 84; changing negative, self-assessment 195; locating “pinch points” that
depressive thoughts 91 – 2; changing thinking provoke aggressive responses 187; maintaining
patterns and internal conversations 82, 87; checklist peace during conflict resolution situations
of negative thoughts 91; cognitive focusing 80 – 1; 195; maintaining your personal power 202;
cognitive restructuring 77; cognitive therapy making action statements 192; making intention
process 77 – 8; confronting irrational thoughts statements 192; negotiating conflicts of interest
86 – 7; coping with feeling of being overwhelmed 193; negotiation 194 – 5; preparing for difficult
84 – 5; counterargument to prevent panic attack conversation 191; preparing for potential conflict
89 – 90; create what you want 83; creative problem- 196; pushing encounter 207; reframing a conflict
solving 79 – 80; focus on positive events 92 – 3; 199; resent, expect, appreciate 188 – 9; resolving
gaining confidence and motivation to study 79; conflicts cooperatively 188; self-control techniques
 Index  347
for anger management 205; self-talk to maintain denial phase of PTSD recovery 237
composure 202; setting boundaries with others DESC (Describe, Express, Specify, Consequences) 186
201; skills to handle conflict and anger 197 – 8; steps de Shazer, S. 102, 106
to anger management 190; stop the action/accept detachment 11
the feelings 198 – 9; strategies to manage anger developmental play therapy 295
more appropriately 201; 3R strategy 195 – 6; three Diagnostic and Statistical Manual of Mental Disorders
quick questions to suppress or express anger 204; (DSM-5) 6
toning down heated remarks 190; using self-control dialectic, defined 95
techniques 203; what to do when angry 200; when dialectical behavior techniques 96 – 102; blocks to
words are not enough 187 – 8; writing learning using interpersonal skills 101 – 2; distract yourself
history of angry reactions 204; XYZ formula for a from self-destructive behaviors 99; distress tolerance
complaint 200 action plan 99; eliminating negative judgments
confluence 49 101; keeping emotional record 101; practicing
confrontation 11, 49, 159 mindfulness by focusing on a single object 100;
confused words 185 radical acceptance 96, 98; self-affirming statements
congruence 157 100; take a time-out 100; thought defusion 101;
contempt 267 using self-encouraging coping thoughts 100
content analysis 256 – 7 dialectical behavior therapy (DBT) 95 – 6; behaviors
Downloaded by [New York University] at 04:58 12 August 2016

content focus 12 targeted 96; defined 95; foundational skills 97 – 8;

contingency contract 136 – 7 functions of 96; history of 95 – 6; mindfulness
controllability, imagery development technique 97 – 8; uses for 96, 102; see also dialectical
and 222 behavior techniques
coping strategies development, as psychotherapy goal dialoging 51 – 2
7 dialoguing 49, 58
Corsini, R. J. 17 dichotomy 49
counseling, three-component model of 9 Dicks, H. 264
counseling theory: defined 2; functions of 2; Dies, R. R. 18
multicultural 4; requirements of 2 DiGiuseppe, R. 111
couples therapy 266 – 7; destructive linear attributional disclosure 13
tactics in 266; divorce predictors 266 – 7; “Four distress tolerance action plan 99
Horseman of the Apocalypse” interactions 267; drama therapy 70 – 1; benefits of 70; defined 70; life
respect/understanding among, promoting 266 scripts technique 71; life-size dolls technique 70;
Crawford, T. 116 masks technique 70; narradrama technique 71;
creative arts therapies 63 – 75; art therapy as 63 – 5; photo and 71
dance therapy as 65 – 8; described 63; drama therapy dream interpretation, Hall/Van de Castle system of
as 70 – 1; movement therapy as 65 – 8; music therapy 256 – 8
as 72 – 5; phototherapy as 68 – 9 Drewes, A. 290
crisis see grief counseling dysfunctional families, therapy and 265
crisis stabilization, as psychotherapy goal 6
Critical Incident Stress Management (CISM) 231 – 3; Earley, B. 158
described 231; phases of 231 – 3; uses for 233 eclectic approaches: implementing 1; personality-
criticism 267 matched 1; pluralism and 5 – 6; technical 1; types of
Crouch, E. 13 5 – 6
cultural competency 39 – 42; defined 39; examples of eclectic techniques, family systems/development
39 – 40; eye contact and 41 – 2; hand/arm gestures 267 – 8, 270 – 89; actualizing individual strengths
and 40 – 1; head movements and 40; personal space 273; airing grievances constructively 271; “all tied
and 41; physical postures and 42; tips for, clinicians up” 278; building shared meaning in family roles
and therapists 42; touching and 41; see also cultural 268; constructing compromise both parties can
competency techniques live with 267 – 8; constructing family genogram
cultural competency techniques 42 – 5; circles of my 278 – 9; counseling techniques for dysfunctional
multicultural self 44 – 5; cultural autobiography families 270; deposits in emotional bank account-
43 – 4; face game 44; social class privilege exercise stress-reducing conversations 287; developing
42 – 3 family history 280; diffusing physiological arousal
cumulative stress, defined 213 by taking structured break 287; draw a rose 281;
draw family table 284; eco-map 279 – 80; enhancing
dance/movement therapy (DMT) 65 – 8; approaches interpersonal communication 274; exercises to open
to 66; Authentic Movement and 66 – 7; benefits of communication 272; exercise to deescalate conflict
65, 66; defined 65; Feldenkrais method to 67 – 8; 274; family choreography 285; family council
Laban Movement Analysis and 66; neurokinetics meetings 285; family floor plan 282; family-o-gram
67; people who benefit from 68; Rolfing movement 284 – 5; family photos 283 – 4; Family Safety Watch
integration 67; Rosen Method of Movement 67 270 – 1; “family sayings” 278; family sculpting
Davis, M. 156 282; family sculpture 278; family sociograms 283;
debilitation 266 getting rid of seven deadly habits of unhappy
defense mechanisms 250 – 1 couples 286; healthy family 284; helping survivors
defensiveness 267 of abuse 280 – 1; how to conduct couples meeting
deflection 49 275; how to resolve family conflicts 281; let’s make
 348  Index
a date 276; lifeline 267; listening to understand family systems/development therapy 263 – 7; see also
276; mapping emotional relationships 288 – 9; eclectic techniques, family systems/development;
mission and legacy 286 – 7; positive action tags: cognitive-behavioral family therapy model of 265;
using therapeutic symbols in family therapy 285 – 6; communications therapy model of 264; couples and
problem solving for couples 274 – 5; receiving family 266 – 7; dysfunctional families and 265; experiential
feedback 276 – 7; reframing 282; sharing meaning in family therapy model of 264; family systems therapy
family rituals 268; simulated family approach 277; model of 264; multiple family group therapy model
solution-focused family techniques 288; strategic of 265; narrative therapy model of 265; overview
alliances 285; time-limited intercommunication of 263 – 4; psychodynamic therapy model of 264;
277; total truth exercise 272 – 3; tracking 282; using strategic intervention therapy model of 265;
confrontation to improve relationships 274; using structural family therapy model of 264; systems
speaker-listener tool in couples meeting 275 – 6; therapy model of 265; transactional analysis model
working as team: the paper tower 287 – 8 of 265
eclectic techniques for group therapy see group family systems therapy model 264
therapy, eclectic techniques for Fanning, P. 156
eco-map 279 – 80 fear words 185
ecosystemic play therapy 296 feedback 157
effect size, defined 76 feeling words, vocabulary of 185
Downloaded by [New York University] at 04:58 12 August 2016

ego, in Freud’s theory of personality 250 Feldenkrais, M. 67

Ellis, A. 109, 110, 113, 116, 141 – 2 Feldenkrais method to movement therapy 67 – 8
emergence of the problem stage, Gestalt therapy 47 – 8 Fiebert, M. S. 47
emergency phase of PTSD recovery 237 figure, in Gestalt therapy 46
Emery, G. 82 Filial Therapy 297
Emmons, M. L. 159 float up above yourself, to reach inner peace 261
emotional anesthesia 230 Fonagy, P. 251
emotional literacy skills 181 – 2 “Four Horseman of the Apocalypse” interactions 267
emotional numbing phase of PTSD recovery 237 Freud, A. 294
empathy 155 – 6, 168; assertiveness and 175 Freud, S. 250 – 1, 252, 294
encouragement 12 Freudian slip 250
energy bubble, to reach inner peace 260 Furiman, A. 13, 19
engagement 11
enhancing awareness, as Gestalt component 46 Gardner, R. 298
entity processing 49 Garfield, S. L. 8, 12 – 13, 17
environment relationships, improving see stress general systems theory (GST) 5
management techniques genuineness 156
equality, assertiveness and 175 Gestalt play therapy 296
Estes, C. P. 262 Gestalt techniques 49 – 62; accepting and rejecting
Everly, G. S., Jr. 231, 248 what is offered 61; accept responsibility for
evidence-based practices 6 choices made 49 – 50; an other who is also you
existential factors 14 60; awareness continuum 54; bringing a dream
experiential activities 12 back to life 56 – 7; can you stay with this feeling?
experiential family therapy model 264 55 – 6; centering 50; creating a world that is “you”
Experiential Play Therapy 294 60 – 1; creating yourself with clay 59; described 46;
exploration 12 developing a personal vocabulary of sight, sound,
expressive therapies 63 – 75; art therapy as 63 – 5; dance and movement 58; dialoging 51 – 2; dialoguing 58;
therapy as 65 – 8; described 63; drama therapy as empty chair 49; four magic questions to handle
70 – 1; movement therapy as 65 – 8; music therapy as upsets 50 – 1; giving attention to another person 60;
72 – 5; phototherapy as 68 – 9 hot seat 52; I and thou 54; I take responsibility for
external polarities stage, Gestalt therapy 48 58; making a world together 61; making the rounds
extroverts 252 53 – 4; may I feed you a sentence? 55; mirror 52;
eye contact, cultural competency and monotherapy 53; mothers and fathers/husbands
41 – 2 and wives 57; no gossiping 55; parallel dialogue 55;
eye-roll test 259 parent interview 61 – 2; playing the projection 53;
principle of the now 54; reviewing past experience
Facebook 68 in the here-and-now 57; shuttle between here and
Fadiman, J. 218 there (between reality and fantasy) 56; territoriality
Fairbairn, W. R. D. 264 and group interaction 53; think-feel 53; turning
Falvey, E. 2 – 3 “it” language into “I” language 54; unblocking 52;
families, grief counseling for 243 – 5; creating working through unfinished business 50; yourself
meaningful rituals 245; early treatment phase and an other in space 59
guidelines 244 – 5; finding closure and preparedness Gestalt therapy 46 – 62; aim of 47; components of
245; overview of 243 – 4 46 – 7; described 46, 62; processing tools for 49;
family genogram 278 – 9 stages in 47 – 9; tenants of 47; see also Gestalt
family play therapy 296 techniques
family reenactment 14 Gibson, R. L. 8
Family Safety Watch 270 – 1 Gil, E. 315
 Index  349
Ginott, H. 295 important people in your life 33; three questions
Ginter, E. J. 2 28; twenty questions for the chair inside the circle
Glasser, W. 126 30 – 1; unfinished business 28; value box 36; who
Goldenson, R. M. 230 are you? 36; writing letter aloud 33 – 4
good listening, characteristics of 164 group therapy, eclectic techniques for 17 – 19; cultural
gossiping, defined 55 competency and 39 – 42; goals of 17; personalities
Gottman, J. M. 266 – 7 encountered and 18; questions to ask group and
Green, E. 296 17 – 18; types of groups and 17; see also cultural
grief counseling: Adapted Family Debriefing Model competency techniques; group counseling
and 233 – 6; for caregivers 245 – 7; for children techniques
240 – 1; Critical Incident Stress Management growth-promoting climate, conditions for 154
and 231 – 3; for families 243 – 5; overview of 229; Guerney, B. 297
processing loss strategies 230 – 1; tasks of 229 – 30; Guerney, L. 297
see also grief counseling techniques; post-traumatic guidance 12
stress disorder (PTSD) guilt words 185
grief counseling techniques 237 – 40; circle of trust Guttormson, L. 116
to identify support during grief 242 – 3; clinical
interventions 237 – 8; how to help a child or Haley, J. 265
Downloaded by [New York University] at 04:58 12 August 2016

adolescent through denial 241; how to help a child Hall/Van de Castle system of dream interpretation
through acceptance after a traumatic event 241; 256 – 8
how to help an older child with fear after a death Hambridge, G. 294
242; make a “tear jar” 239; multiple strategies to hand/arm gestures, cultural competency and 40 – 1
process grief and loss 238 – 9; providing permission Hansen, J. C. 14
and structure to end the mourning process 242; happy words 185
resolving grief by remembering positive feelings Harvard meditation technique 216
240; review, response, and remind 247 – 8; using Harvey, S. 296
group mural to deal with traumatic loss such as loss head movements, cultural competency and 40
of classmate 242 Hellman, C. A. 209
Grief Observed, A (Lewis) 239 Hershenson, D. B. 6
Grinspoon, L. 231 honesty, assertiveness and 175
ground, in Gestalt therapy 46 hope, instillation of 13
group cohesiveness 14 humanistic-existential psychotherapies 46
group counseling techniques 19 – 39; actualizing hurt words 185
human strengths 32; affirmations of trust 21; hypnotherapy 258 – 60
best friend 29; breathing and vocalizing 22;
choose an object 29; competitive thumb wrestling I-Ching 255
35; confronting member resistance with chair Id, in Freud’s theory of personality 250
outside circle 32; controlling and influencing identification 13
communication 21; cued sharing 36; deep breaths illogic, hunting for 49
22; double dialogue technique 33; enclosed imagery techniques 221 – 7; creative problem solving
feelings 22; energy warm-up 22; fantasy trips 22 – 3; 225; described 221; determining one’s sensory
feedback with role reversal 23; feelings 23; funeral, modality 224; draining-a frustration management
the 27; group body 23; group checkers 38 – 9; exercise 226 – 7; favorite quiet place 224 – 5;
group consensus on where to begin 20; group imagery for sensory expansion 223; prerequisites
dance 23; group drawings 37 – 8; group feedback for 222; relieve stress with the pencil drop 227;
24; group reentry questions 37; group sculpture stress management-quieting response 225 – 6; uses
24; group tell-a-story 38; growing old 24; hand for 221 – 2; visualization for physical and mental
examination 24; here-and-now face 34; here-and- relaxation 223; wise person exercise 222 – 3
now feedback 24; here-and-now wheel 36; heroes imitative behavior 14
and heroines 25; holidays 25; I am becoming a immediacy 158
person who 35; I have a secret 34; impressions of inner peace, reaching state of 260 – 1
self 37; introspection for individual assessment and insight 13
feedback from others 29 – 30; journal writing 33; Institute of Medicine 6
last people on Earth 25; lifeline 30; life-o-gram integration stage, Gestalt therapy 48
30; life-picture map 34 – 5; living newspaper 25; interactive techniques for working with children
management of resistance using time-out technique 298 – 9; games 298; role-play and simulation 299;
39; map of life 35; mood role-plays 38; nature stories and metaphors 298 – 9
walk 25; obituary 26; object presentation 26; one- internal polarities stage, Gestalt therapy 48
on-one risk taking 21 – 2; opening activities for International Critical Institute Stress Foundation
beginning groups 20; out in the cold 37; picture (ICISF) Model 247
frame 26; positive perceptions 29; risk-taking/ interpersonal groups 17
trust-building 19; role party 27; role reversal interpersonal learning 14
32 – 3; sculpting repressed feelings 28; self-poems interpretation 11 – 12
26; significant other presentation 27; strength introverts 252
bombardment 35; strength test 31; superlatives intrusive-repetitive phase of PTSD recovery
31; talk to yourself 27; think-feel 35; three most 237
 350  Index
irrational beliefs: adolescence and 111 – 12; defined Molnar, A. 106
111; Roberts/Guttormson list of twelve 116 Moore, C. L. 66
Morgan, W. 143
Jacobs, M. 250 Morran, D. 13
Jordan, C. S. 222 Morrison, B. K. 209
Jung, C. 252, 255, 262 mourning see grief counseling
Jungian analytical play therapy 296 movement therapy see dance/movement therapy
justification 266 (DMT)
multiple family group therapy model 265
Kaliff, D. M. 296 music therapy 72 – 5; AMTA definition of 73;
Keith, D. V. 311 described 72; for families and children 72 – 3;
Kelly, K. R. 2, 17 identifying “True Colors” by Cyndi Lauper
Kemberg, 0. 252 technique 73 – 4; “Lean on Me” by Bill Withers:
Kerr, M. 14 tips for building trust technique 74 – 5; rewriting
Klein, M. 252, 264, 294 “What a Wonderful World” by Louis Armstrong
Klerman, G. 208 technique 73; uses for 73; wastin’ time to the song
Kohut, H. 252 “(Sitting on) the Dock of the Bay” by Otis Redding
Kottman, T. 290, 298, 299 technique 74
Downloaded by [New York University] at 04:58 12 August 2016

Krumboltz, J. D. 130 Myers, P. 4

Laban Movement Analysis (LBA) 66 Nance, D. W. 4

Laban Movement Analysis and Harmonic Theory narrative play therapy 296
(Moore and Yamamoto) 66 narrative therapy model 265
Lambert, M. J. 11 National Institute of Mental Health 198, 205, 208
Lament for a Son (Wolterstorff) 239 Necessary Losses (Viorst) 239
Lampropoulos, G. K. 1 negative reinforcement 130, 153
Landreth, G. L. 295 neurokinetics 67
Lazarus, A. A. 142, 211 – 12, 224 Nevid, J. S. 140, 144
lemon test 259 Newmaker, C. 3
Levy, D. 294 Newman, L. 4
Lewis, C. S. 239 Nicholson, R. A. 5
Lewis, H. R. 276 Nondirective Therapy 294 – 5
life stress/psychopathology link 208 – 9 noninterrupted awareness, Gestalt
life-threatening behavior, confronting 167 – 8 therapy and 47
light test 259 Norcross, J. C. 17
Lilly, J. P. 296 Notarius, C. 266
limit-setting therapy 295
Linden, W. 3 Oaklander, V. 296
Linehan, M. M. 95 – 6 object relations play therapy 295
LinkedIn 68 object relations theory 251 – 2
listening: with awareness 158; with empathy 157 – 8; O’Conner, K. 296
for feeling 157; with openness 158 Okum, B. F. 4, 5
long-term pattern change, as psychotherapy goal 7 “one-liners” to peer pressure 162
loss see grief counseling outcome studies of psychoanalysis 251 – 2
Lowenfeld, M. 296 outcry phase of PTSD recovery 237
ownwork 12, 173, 178
Main, A. P. 184
Maitland, R. 220 paraphrasing responses 156 – 7
Markman, H. 266 Patterson, C. H. 3, 156
Marquis, J. 143 Pearls, F. 296
marriage and family therapists see couples therapy; perceptual processing 49
family systems/development therapy peripheral vision, to reach inner peace 260
Martin, G. E. 6 Perls, F. S. 56
Maslow, A. 273 personalities, impeding progress of group therapy 18
Maultsby, M. C. 113 personality-matched eclecticism 1
McBride, M. C. 6 personal space, cultural competency and 41
McCullough, L. 222 person-centered counseling 154 – 9; active listening
McKay, M. 156, 158 and 156; clarifying responses and 157; concreteness
meditation 215 – 16 and 158; confrontation and 159; congruence
Meichenbaum, D. 141 – 2 and 157; counselor-client relationship and 155;
Melloy K. J. 137 described 155; empathy and 155 – 6; feedback
meta-analysis, defined 76 and 157; genuineness and 156; immediacy and
Metcalf, L. 103 158; listening for feeling and 157; listening
mirroring 171 with awareness and 158; listening with empathy
Mitchell, J. T. 231, 248 and 157 – 8; listening with openness and 158;
Mitchell, M. M. 8 paraphrasing responses and 156 – 7; reflective
 Index  351
listening and 156; respect and 158; Rogers loss 309 – 10; balloons of anger 305; boat-storm-
central values and 154; self-disclosure and 158 – 9; lighthouse 313; body tracing 306; card story
unconditional positive regard and 155; warmth and game 309; Care Tags 323; clay sculptures 303 – 4;
159; see also person-centered techniques colored candy go-around 312; distraction box
person-centered techniques 159 – 73; active listening therapy 321 – 2; family gift 312 – 13; family sculpting
165; assertiveness skills 160 – 1; assertive response and puppets exercise 315 – 16; family strengths
165 – 6; “carefronting” 167 – 8; clarification genogram 315; feel good file 316 – 17; feelings
and reflection 165; communicating feelings in hide and seek 317 – 18; feelings pick-up sticks
a nonblaming manner 171; communicating 302; feelings ring-toss 318; feeling word game
to enhance relationships 163; the companion 302 – 3; first session family card game 313 – 14;
159; compassionate response 172; confirming fist friends 309; focusing on positive attributes
interpersonal hunches about others 164 – 5; 320; games and 298; gingerbread person feelings
confrontation guidelines 169; dealing with fear and map 303; interactive techniques for working with
anxiety 162; describing feelings and empathizing children 298 – 9; lifeline 311; Mad Game 305;
166 – 7; different ways to refuse a request 161; magic key 316; my body needs 322; my brain 304;
empathic assertion 170 – 1; handling perennial Nightmare Wall 307; paparazzi 318 – 19; paper doll
dilemma of peer pressure 162; “I language” body figures 307; parent-child combined session:
assertion 169 – 70; inner processing of how another safety shield 307; personality pie 310; popsicle
Downloaded by [New York University] at 04:58 12 August 2016

person is feeling 161 – 2; inner processing of stick stack 319 – 20; privacy boxes 306; role-play
personal feelings 161; interpretive confrontation and simulation 299; rosebush 307 – 8; safe place
171; “I want” statements 170; listening with drawing 305; saying good-bye: breaking the links in
empathy 168; making intention statements 168 – 9; a chain 304; self-esteem mandala 321; self-esteem
mirroring 171; paraphrasing 168; paraphrasing sticky notes 322 – 3; self-portrait 306; stories and
responses 172; peer pressure refusal skills 162; poor metaphors 298 – 9; termination-how I felt the first
and good listening characteristics 163 – 4; positive day versus last day of therapy 320; toss the ball
affirmations 163; repeating the obvious 160; self- 314 – 15; using puppet to create symbolic client 310
disclosure 167; self-talk to maintain composure pluralism 5 – 6
171 – 2; supporting 166; turning “you statements” polarity integration 49
into “I statements” 172 – 3; use of “I messages” Pollack, H. B. 17
159; using I messages, you messages, and we poor listening, characteristics of 164
messages 164; working through disappointment positive affirmations, guidelines for 163
when mistake made 172 positive reinforcement 153
Person-Centered Therapy 294 post-traumatic stress disorder (PTSD): child/
Perspective for the Therapist vignette: creating trust adolescent assessment of 236; events leading to
19; on expectations 46; on loss and grief 237; on 230; recognizing 236; recovery phases for 237;
trust 21 suggestions for counselors treating 231; therapeutic
Peterson, S. 237 approaches to process 237; see also grief counseling
phototherapy 68 – 9; to change women’s negative self- Power, P. W. 6
images 69; drawbacks to 68, 69; social media and pretherapy activities 12
68; therapeutic online photosharing in social media professionalism, in counseling/psychotherapy 1 – 8;
68 – 9 counseling theory and 2; evidence-based practices
physical postures, cultural competency and 42 and 6; goals of psychotherapy and 6 – 8; influencing
Piaget, G. 143 forces of 8; pluralism and 5 – 6; research/practice,
pinch points 63 validating 2 – 4; technical eclecticism and 1
Pine, G. J. 2 progressive muscle relaxation training (PMRT) 218
play therapy, family systems perspective for 311 – 12; psyche 252
see also play therapy techniques for children/ psychic numbing 230
adolescents psychoanalysis 250 – 2; Freud and 250 – 1, 252; Jung
play therapy for children/adolescents 290 – 302; and 252, 255; outcome studies of 251 – 2; see also
Adlerian 295; aggression-related toys 297; animal- psychoanalysis techniques
assisted 298; cognitive-behavioral 295 – 6; defined psychoanalysis techniques 252 – 62; breath work 261;
290; developmental 295; ecosystemic 296; efficacy childhood memories 252 – 3; dream interpretation
of 290; experiential 294; expressive/construction 256 – 8; dream work: writing dreams down 256;
toys 297; family 296; family-related/nurturance experiencing full breath 261 – 2; four ways to reach a
toys 297; Filial 297; Gestalt 296; history/ state of inner peace 260 – 1; hypnotherapy 258 – 60;
theoretical approaches to 294 – 7; Jungian analytical I-Ching 255; shadow exercise 254; show and tell
296; limit-setting 295; multiuse toys 298; narrative 255; specific tactics for dismantling old traumas 253;
296; nondirective 294 – 5; object relations 295; understanding our dreams 255 – 6; visualize elevator
overview of 290; psychoanalytic/psychodynamic descending to earlier age 253 – 4
294; relationship 294; research support for 290 – 3; psychoanalytic/psychodynamic play therapy 294
structured 294; therapeutic factors of 290; theraplay psychodynamic 250
295; see also play therapy techniques for children/ psychodynamic therapy model 264
adolescents psychoeducational groups 17
play therapy techniques for children/adolescents Psychoeducational Life Skill Intervention Model
302 – 11, 312 – 23; anger fortune cookies 308; (P.L.S.I.M.) 173 – 83; components of 173; described
art/verbal metaphors for children experiencing 173 – 4; example of 178 – 83; process overview 174;
 352  Index
step 1, social, emotional, or cognitive skill overview research and practice, validating 2 – 4
174 – 5; step 2, model behavior following steps listed RESOLUTION acronym 195
175 – 6; step 3, discussion of skill modeled 176; step respect 158
4, role-play between group members 176 – 7; step 5, responsibility, assertiveness and 175
feedback from group members and processes 177; RETHINK acronym 197 – 8
step 6, “ownwork” to practice and apply in real life Roark, A. E. 184
177 – 8 Roberts, C. G. 116
psychotherapies, movement to integrate 1 Rogers, C. 154 – 5, 183, 294; see also person-centered
psychotherapy: effectiveness of 14 – 15; goals of 6 – 8; counseling
groups 17 role flexibility 13
Rolf, I. P. 67
quieting response 225 – 6 Rolfing movement integration (RMI) 67
Rolf Institute of Structural Integration 67
Rando, T. A. 237 Rosen, M. 67
Rathus, S. A. 140, 144 Rosen Method of Movement 67
rational beliefs, concepts of 111
rational emotive behavior techniques 113 – 26; charting Satir, V. 272
irrational beliefs 113 – 14; cognitively modeled Schaefer, C. 290
Downloaded by [New York University] at 04:58 12 August 2016

self states to reduce hair pulling 118; collective Scheidlinger, S. 18

identification of irrational thinking and suggested Schriner, C. 116
solutions for panic disorder and depression 117 – 18; secondary traumatic stress, defined 213
conceptual shift 119; daily activities to help the self-acceptance, assertiveness and 175
client give up irrational thinking 121; DEFUSE self-awareness, assertiveness and 175
spelled DPHEWES 125 – 6; depersonalizing self self-defeating behavior, confronting 167 – 8
121; direct questioning 118; disputing irrational self-disclosure 158 – 9, 167
beliefs (DIBS) 123; disputing irrational beliefs self-exploration, as psychotherapy goal 7
by using “A-FROG” 124; eliminating “Big 10” Seligman, L. 6
cognitive distortions 116; Ellis’s A-B-C-D-E Seligman, M. E. P. 14 – 15
paradigm 113; identifying personal rights and Selvini-Palazzoli, M. 265
changing irrational thinking 120; identifying Sexton, T. L. 9, 11
unpleasant emotions 115; internalizing new skills shadow exercise 254
118 – 19; interpersonal cognitive problem solving Sheikh, A. A. 222
120; making mistakes 119 – 20; overcoming panic Shore, J. 4
attacks 124; overcoming resistance to change 122; Shostrom, E. L. 2, 156
perceptions versus reality 119; rational-emotive show and tell 255
imagery (REI) 122 – 3; rational self-analysis (RSA) Sian, J. B. 17
124; systematic rationalization process 120 – 1; Silva Mind Control 220
three R’s 115 – 16; working toward a happier mental Simon, G. M. 5
outlook 124 – 5 skill-building groups 17
rational emotive behavior therapy (REBT) 109 – 13; Smith, E. J. 14
client self-defeating “must” dialogue in 110; clients social literacy skills 181
of 109; differences between, and other schools of social skills, development of 14
therapy 112 – 13; emotional suffering and 109 – 10; Sockol, K. 299
interventionist role in 113; irrational ideas and solution-focused brief counseling (SFBC) 102 – 5;
110 – 11; principles of 109; rational/irrational beliefs attributes of 103; characteristics of 102, 103;
and 111 – 12; therapist role in 109, 110; see also effectiveness of 102; problem talk and 105; stages
rational emotive behavior techniques of 104 – 5; uses for 102; see also solution-focused
rational emotive therapy (RET) see rational emotive brief counseling techniques
behavior therapy (REBT) solution-focused brief counseling techniques 105 – 8;
rationalization 266 flagging the mindfield 107 – 8; mapping the
Ray, J. A. 3 – 4 influences of the problem 105 – 6; more of the same
readiness, imagery development and 222 106 – 7; scaling 106; solution-focused questions
reality testing 13 107 – 8
reality therapy 126; choice theory and 126 – 7; goal of Sori, C. E. F. 311
127; therapist role 127 soul retrieval 49
reciprocity 11 spectator therapy 19
recursion 49 Spinelli, E. 108
redecision therapy 62 stepfamily therapy see blended or stepfamily therapy
re-experiencing 49 Stockton, R. 13
reflection 12 stonewalling 267
reflective listening 156 strategic intervention therapy model 265
reflective-transition phase of PTSD recovery 237 Straub, R. L. 237
reframing 49 Streitfield, H. S. 276
Relationship Play Therapy 294 strength words 185
Release Therapy 294 stress: assessing equation 208; compassion fatigue as
Renard, S. 299 213 – 14; defined 208; environmentally centered
 Index  353
analog equation 209; guided imagery for reducing theraplay 295
211 – 12; leaving, at office, strategies for 212 – 13; therapy: Adlerian play 295; animal-assisted 298; art
reduction strategies, for everyday living 210 – 11, 63 – 5; attachment 3; blended or stepfamily 268 – 9;
226; self-awareness/self-care and 214 – 15; symptoms cognitive-behavioral 76 – 7; cognitive-behavioral
of 209; of therapeutic work 209 – 10; see also stress play 295 – 6; couples 266 – 7; creative arts 63 – 75;
management techniques dance/movement 65 – 8; developmental play
stress management techniques 215 – 21; changing 295; dialectical behavior 95 – 6; drama 70 – 1;
one’s awareness through Silva Mind Control dysfunctional families and 265; ecosystemic
220; creating experience through visualization play 296; expressive 63 – 75; family play 296;
220; enhancing one’s mind, behavior, and beliefs family systems/development 263 – 7; Feldenkrais
through affirmations 221; evoking relaxation method to movement 67 – 8; Gestalt 46 – 62;
techniques autogenically 217; evoking relaxation Gestalt play 296; group, eclectic techniques for
through tension-inattention 218 – 19; evoking 17 – 19; Jungian analytical play 296; limit-setting
relaxation through yoga 219 – 20; Harvard 295; long-term vs. short-term 15; music 72 – 5;
meditation for relaxation 216; increasing sensory narrative play 296; object relations play 295; play,
awareness 216 – 17; meditation 215 – 16; progressive family systems perspective for 311 – 12; play, for
muscle relaxation training 218; self-management children/adolescents 290 – 302; psychoanalytic/
through biofeedback 217 – 18; see also imagery psychodynamic play 294; rational emotive behavior
Downloaded by [New York University] at 04:58 12 August 2016

techniques 109 – 13; reality 126; redecision 62; spectator

stressors, defined 208 19; structured play 294; sweat lodge 3; see also
stress response 208 individual therapies
Strong, S. R. 266 therapy, long-term vs. short-term 15
structural family therapy model 264 Thompson, M. J. 298
structured play therapy 294 Thoresen, C. E. 130
Strupp, H. H. 3 3R strategy 195 – 6
superego, in Freud’s theory of touching, cultural competency and 41
personality 250 toys: aggression-related 297; expressive and
support groups 17 construction 297; family-related and nurturance
sweat lodge therapy 3 297; multiuse 298
symptom reduction, as psychotherapy transactional analysis model 265
goal 7 transference 11
systematic desensitization 142 – 4; anxiety-provoking trauma see grief counseling
situations, identifying 142; anxiety-provoking Truax, C. B. 155
situations, prolonging exposure to 144; Twitter 68
counterconditioning or coping responses 143;
defined 142; generate images, client’s capacity unconditional positive regard 155
to 143 – 4; hierarchy of stimulus situations 143; unfinished business 49
homework/follow-up 144; steps 142 unfixing 49
Systematic Treatment Selection 1 unhappy words 185
systems therapy model 265 universality 14

Taft, J. 394 verbal/nonverbal congruency, as Gestalt

technical eclecticism 1; Simon definition component 47
of 5 – 6 vicarious learning 13
techniques; music therapy; individual techniques: art vilification 266
therapy 63 – 5; behavioral 130 – 53; choice theory Viorst, J. 239
127 – 8; cognitive-behavioral 77 – 95; conflict vividness, imagery development and 222
resolution 186 – 208; cultural competency 42 – 5; vocabulary of feeling words 185
dialectical behavior 96 – 102; eclectic, family Vriend, J. 31
systems/development 267 – 8, 270 – 89; Gestalt
49 – 62; grief counseling 237 – 40; group counseling Walen, S. R. 111
19 – 39; imagery 221 – 7; interactive, for working Walker, W. 262
with children 298 – 9; person-centered 159 – 73; Walsh, W. M. 269
play therapy, for children/adolescents 302 – 11, Walters, V. 112
312 – 23; psychoanalysis 252 – 62; rational warmth 159
emotive behavior 113 – 26; solution-focused Warner, R. W. 14
brief counseling 105 – 8; stress management Weinhold, J. 224
215 – 21; tension-inattention 218 – 19; see also drama Weissman, M. 208
therapy Wen, F. K. 3
tension-inattention techniques 218 – 19 Wessler, R. L. 111
theoretical aura 2 When Good-Bye Is Forever (Bramblett)
therapeutic factors 12 – 14; group process 13 – 14; in 239
individual/group processes 12 – 13 Whiston, S. C. 9, 11
therapeutic intentions 10 – 11 Whitaker, C. A. 311
therapeutic interventions 11 – 12 White, J. 218
therapist self-disclosure 12 White, M. 296
 354  Index
Whitehouse, M. S. 66 working with internal polarities stage, Gestalt
Widow (Caine) 239 therapy 48
Wiggins, J. 17
Winnicott, D. W. 252, 295 Yalom, I. D. 14
within-therapy activities 12 Yamamoto, K. 66
Witmer, J. M. 221, 222 yoga 219 – 20
Wolpe, J. 142, 144 Young, M. E. 221, 222
Wolterstorff, N. 239
working with external polarities stage, Gestalt Zilbergeld, B. 224
therapy 48 Zirpoli, T. J. 137
Downloaded by [New York University] at 04:58 12 August 2016