Transactional Analysis

Definition: The Transactional Analysis refers to the psychoanalytic process wherein the interpersonal
behaviors are studied. In other words, a social psychological model that talks about the personal growth and
personal change, i.e., identifying the ego states of each individual to understand their behaviors and altering them
to solve the emotional problems.

This model was originally developed by Dr Eric Berne, who during his observation found that his patients
behaved in a way as if several different people were inside them. This forced him to study the personality and
dynamics of self and its relationship with others which helped in determining the kinds of behaviors that an
individual shows in different real time situations.
Now, this study has become a well-established approach and is being widely used in several fields such as
psychotherapy, counseling, education, organizational development, etc. The transactional analysis gives birth to
several models that help in explaining the relationship formed between the individuals as a result of their
interactions. It mainly involves:

Johari Window
Definition: The Johari Window is the psychological model developed by Joseph Luft and Harrington Ingham,
that talks about the relationship and mutual understanding between the group members. In other words, a
psychological tool that helps an individual to understand his relationship with himself and with other group
members is called as a Johari Window.

The objective behind the creation of a Johari window is to enable an individual to develop trust with others by
disclosing information about himself and also to know what others feels about himself through feedback.

The Johari Window model is made up of four quadrants that explain the overall relationship of an individual
with himself and with other group members. These are as follows:
 1. Open Self: This quadrant shows the behavior, motives, attitudes, knowledge skills of an individual that
he is aware of and is willing to share it with others. The open self is characterized as a state wherein the
individual is open and straight forward to himself and others about what he is doing, how is he doing and
what are his intentions.
2. Blind Self: The blind self shows the state of an individual known to others but not known to him. It
usually happens, when an individual or a subject copies the behavior of some significant personalities
unconsciously since his childhood.
3. Hidden Self: This quadrant of the Johari window shows the state of an individual known to him but not
known to the others. This is generally seen in the individuals who are introvert and do not like to share
their private lives with anyone. The individual keeps his feelings, ideas or thoughts to himself and do not
disclose it in front of the others.
4. Unknown Self: The unknown self is the mysterious state of an individual neither known to him, nor
others know about it. Ofen the feelings, thoughts or ideas go so deep down the individual that it becomes
difficult for the individual as well for the other people to understand it.

The ultimate need is to enlarge the open self quadrant with the intent to establish a fruitful relationship with the
self as well with others such that the work can be performed efficiently when working as a team.

Ego States
Definition: The Ego States are an important aspect of transactional analysis that talks about how a person feels, behave or
think at any point of time.

According to Dr Eric Berne, people usually interact with each other in terms of three psychological and
behavioral patterns classified as parent ego, adult ego and child ego, often called as a PAC Model. This
classification is not made on the basis of the age group of an individual rather these are related to the ways in
which an individual behaves. Thus, it is observed that a person of any age group may possess varying degrees of
these ego states.

Let’s understand each of these three ego states in detail:

Parent Ego: The parent ego, refers to the behavior and attitude of an emotionally significant individual who acted with
quite a maturity when he was a child. He possesses the parental traits of being overprotective, dogmatic, distant,
indispensable and upright and behaves very judiciously at any time.
There are two types of a parent ego: critical and nurturing. The critical parent ego is one when an individual shows
the critical and evaluative behavior while interacting with the others. Whereas the nurturing parent ego is one, when
individual shows the kind and nurturing behavior, not only towards children but towards all with whom he interacts.

Adult Ego: The adult ego shows the logical thinking and reasoning ability of an individual. The person behaving or
interacting with adult ego seeks all the information properly, validate it using his reasoning skills and then provide it to the
other people. The person possessing the adult ego can be judged through his discussions and the way he thinks about a
situation before arriving at the conclusion.

As the individual grows, he updates his parent data to identify what is valid or not valid, similarly the child data
is also updated to determine which feeling should be expressed and which should be left unspoken. In this way,
the adult ego helps an individual to control his emotional expressions appropriately.

Child Ego: The child ego, refers to the state of an individual when he behaves illogically and takes quick actions to satisfy
the immediate needs without thinking much about its consequences. The creativity, depression, conformity, dependence,
hate, fear, etc. are some of the main characteristics of this ego state. The child ego represents the childhood state when an
individual has not become social and is in its initial stage of development.
The child ego can be natural, adaptive and rebellious. The natural child is sensuous, impulsive, affectionate and does things
that come naturally. Whereas the adaptive child is one, who is trained and instructed by parents to behave in a manner
taught by them. The rebellious child is one who is not allowed to open up and experiences anger, fear and frustration.
Life Positions
Definition: The Life Positions refers to the specific behavior towards others that an individual learns on the
basis of certain assumptions made very early in the life.

The life positions can be categorized as follows:

1. I am O.K., You are O.K.: This life position shows that an individual has several O.K. experiences with
others. This means, an individual encountered no severe problems or issues with others in his childhood
and had a normal relationship with them. People with such life positions about themselves and others
around him can solve any problem very easily and realizes the significance of others being in his life.
This position is based on the adult ego.
2. I am O.K., You are not O.K.: This life position is created when an individual was too much ignored
when he was a child. Here, an individual believes that he is right, and all the others around him are
wrong. These are the individual who possesses the rebellion child ego and put blame on others for
anything that goes wrong with them.
3. I am not O.K., you are O.K.: This life position gets created when an individual feels that others do
things better than him. He feels inferior to others and believes that others can do many things which he
cannot do by himself. These kinds of people always complain about one thing or the other and remain
highly dissatisfied with their lives.
4. I am not O.K., you are not O.K.: This kind of life position is created by those who lacks interest in
living. They feel life is not worth living and are the ones who have been neglected by their parents in
their childhood and were brought up by the servants. Such kind of people commits suicide or homicide to
end their lives.

Thus, the life positions talk about the individual developing his identity, sense of worth and perception about
others during his childhood and believing it to be true until and unless some major experience changes it.

Life Script
Definition: The Life Script refers to the meaning that one attributes to the events that happened to him at the
early stage of life. Psychologists believe that an individual’s life script gets created in his childhood when he
learns things unconsciously from the transactions between father, mother and the child.
Whenever an individual face any situation, he acts with reference to the script created as a result of the past
experiences and the way he views his life positions, i.e. I am O.K you are O.K, I am not O.K. you are O.K., I am
O.K. you are not O.K., I’m not O.K. you are not O.K.

An individual can determine his life script by understanding how his thoughts, behavior, ideas, etc. get
influenced due to his past experiences. Every individual has a life script. A script is a complete plan of living that
offers two structures: a structure that defines a winner or looser and the structure of authoritative warning or
order, prescriptions and consent.

The life scripts can be changed with the time since these are not inborn but rather learned. The life script
resembles the drama or a movie script that includes the characters, dialogues, actions, plays, etc. and move
towards the climax and ultimately reach the end with the closure of curtains.

Analysis of Transactions
Definition: The interactions between people give rise to the Social Transactions, i.e. how people respond and
interact with each other depends on their ego states. The transactions routed through ego states of persons can be
classified as complementary, crossed and ulterior.

Complementary Transactions: A transaction is said to be complementary when the person sending the
message gets the predicted response from the other person. Thus, the stimulus and response patterns from one
ego state to another are parallel. These are:

1. Adult-Adult Transaction: The manager acts with the adult ego state, who tries to clarify and inform
employees about the issues and has a concern for the human needs and facts and figures. I am O.K. you

are O.K is his life position. This is an ideal transaction.

2. Adult-Parent Transaction: Here, the manager tries to implement the information being processed by
him, but rather the employees with the parent ego stick to the clichés and the rules of the past. The
employee tries to control the manager with his parent ego but is temporary.
3. Adult-Child Transaction: Here the employee possesses the child ego state, and this can be effective
only if the manager knows about it and let his employees to be in this state to be creative.

4. Parent-Parent Transaction: Here the manager is in the parent ego, and his life position is I am O.K.
you are not O.K. Reprimand, reward, criticism, rules, praise, etc. will be the sources used by him. This
transaction is effective only if the employee supports him and join forces with him.

5. Parent-Adult Transaction: Here, both manager and employee might be frustrated. The manager may
feel devastated if the employee does not perform as directed while, the employee may feel irritated

because the manager is not acting with the adult ego.

6. Parent-Child Transaction: This is the ideal situation if the manager acts with adult ego while the
employee is in child ego. The employee may find this transaction advantageous as it eliminates the

responsibility and pressure on them.

 7. Child-Parent Transaction: The manager in the child ego might not contribute efficiently towards the
effectiveness of management. Although the child ego is characterized by creativity, it does not suffice the

role of a manager. Here, the employee controls the manager.

8. Child-Adult Transaction: There is a lack of rationality when a manager acts with a child ego. Here, the
employee in the adult ego gets discouraged as he wants to make logical and realistic decisions, but the
manager may land up to the unrealistic decisions made on the basis of whims, fancies and emotions.

9. Child-Child Transaction: The manager acting with child-child ego is inefficient to lead his employees

successfully and hence turn out to be the liability to the firm.

Non-Complementary Transactions: A transaction is said to be non-complimentary or crossed when the person

sending the message does not get the predicted response, or the stimulus and response lines are not parallel.
In the above transaction, The manager is trying to interact on an adult-to-adult basis, but the employee responds
on the child-to-parent basis, this would block the communication, and no further transaction could be done.

Ulterior Transaction: This is the most complex transaction because the communication has the double
meaning. Such as, on the surface level the communication may have a clear adult message, but it may carry some
hidden message on the psychological level and gets misinterpreted.

Thus, when people interact with each other, the social transaction gets created which shows how people are responding and
behaving with each other, the study of such transactions between people is called as the transactional analysis.

Transactional Analysis Core Principles

Transactional Analysis is one way of understanding human personality. It was the brainchild of Eric Berne who
trained as a psychoanalyst but became disillusioned with the methods he was expected to follow and wanted a
more equal approach to the therapist/client relationship.

There are three basic philosophical assumptions in Transactional Analysis:

1) People are OK. This roles off the Tongue easily but I think it’s important to examine what this means. This is
the fundamental acceptance that regardless of what you do, no matter what you think, or despite your feelings
you are a worthwhile, valuable person in your own right. You are special. Everyone is special. We are all as
important as each other. How amazing is that as a first principle?! This principle carries itself directly into the
theraputic relationship between therapist and client. We are both equal. We share the responsibility of cure. To
make sure that both therapist and client are sure of what their goal is, TA therapists work with contracts – a clear
written down agreement between both parties stating the goal of the therapy taking place.

2) We can all think. If we have all got the capacity to think then we have all got the capacity to work out what
we want and work out how to get there. The therapists job is to support and guide you in this task but you do not
need anyone else to decide for you. You know what’s best for you. For many clients entering therapy it may not
feel this way when they start. Some feel confused and unsure and are looking for the therapist to tell them what
to do. The therapist will work with the client on clearing this confusion. It’s a bit like wiping condensation off a
mirror so we can see ourselves once more.

3) People decide their own destiny and have the power to change these decisions at any time . If we got to
where we are today because of the decisions that we made then it’s within our power to change these decisions.
We can be who we want to be and achieve our goals if that’s what we choose to do. I’m not suggesting that this
is always easy. Small changes may start the process and build up to larger changes when it feels safe. It’s about
getting around the barriers to change together. Sometimes they need kicking down, sometimes we go round
them and sometimes we realise that although they look like they are there, when we examine them up close, they
are not there at all!

Basic Assumptions of Behavior Modification

This table provides a comparison of behavior therapy (modification) to a second major approach to therapy
(Psychoanalysis). For brevity's sake, both approaches have been simplified.

Behavior Therapy versus Psychoanalysis

Focus on observable behavior. Rejects traditional notion of "underlying Focus on inferred constructs, especially
causes" or "unconscious." id, ego, superego
The environment and learning cause maladaptive behaviors. (Some behavior Unconscious processes cause behavior.
is explainable by genetics).
Psychological learning principles can modify behavior. Change comes from Uncover "underlying" causes. Change
action. comes from talking, "insight".
Goals are specific and objectively defined.
outcome goals, ex."improve mastery of course material;"
Goals? If any, vague: "feel better."
target behavior, ex. "time spent reading;"
behavioral goal, ex. "read 3 hours daily"
Behavior is situation specific. "Traits," such as "laziness," are invented "Traits" are considered formed by age 5
concepts and unnecessary for change. and set for life.
1 general treatment for every client
Pull from a variety of techniques and adapt them to the individual client.
(talking), eg dream analysis, free
Search for new techniques. Ex. systematic desensitization, token economy,
association
Focus on the present. Is change occurring now? What in the immediate Searches what happened to the client in
environment is contributing to the behavior? the past (typically childhood).

Research a therapeutic technique to determine if it is truly effective. Submit

Reliance on case history (self-report) for
treatment to evaluation. Change if it isn't working. Reject self-report as basis
evaluation of treatment .
for determining worth of treatment.

Behaviorism conceptualize psychological disorders as the result of maladaptive learning, as people are born
tabula rasa (a blank slate). They do not assume that sets of symptoms reflect single underlying causes.

Behavioral therapies (also called behavior modification) are based on the theories of classical and operant
conditioning. The premise is that all behavior is learned; faulty learning (i.e. conditioning) is the cause of
abnormal behavior. Therefore the individual has to learn the correct or acceptable behavior.

An important feature of behavioral therapy is its focus on current problems and behavior, and on attempts to
remove behavior the patient finds troublesome.

This contrasts greatly with psychodynamic therapy (re: Freud), where the focus is much more on trying to
uncover unresolved conflicts from childhood (i.e. the cause of abnormal behavior).

Classical conditioning

The theory of classical conditioning suggests a response is learned and repeated through immediate association.
Behavioral therapies based on classical conditioning aim to break the association between stimulus and
undesired response (e.g. phobia, additional etc.).

Originally this type of therapy was known as behaviour modification but, these days, it is usually referred to as
applied behaviour analysis. Examples include:

Aversion Therapy

This process pairs undesirable behaviour with some form of aversive stimulus with the aim of reducing
unwanted behaviour. For example, alcoholics enjoy going to pubs and consuming large amounts of alcohol

Aversion therapy involves associating such stimuli and behavior with a very unpleasant unconditioned stimulus,
such as an electric shock.

The client thus learns to associate the undesirable behavior with the electric shock, and a link is formed between
the undesirable behavior and the reflex response to an electric shock.
In the case of alcoholism, what is often done is to require the client to take a sip of alcohol while under the effect
of a nausea-inducing drug. Sipping the drink is followed almost at once by vomiting. In future the smell of
alcohol produces a memory of vomiting and should stop the patient wanting a drink.

More controversially, aversion therapy has been used to "cure" homosexuals by electrocuting them if they
become aroused to specific stimuli.

Critical Evaluation

Apart from ethical considerations, there are two other issues relating to the use of aversion therapy.

First, it is not very clear how the shocks or drugs have their effects. It may be that they make the previously
attractive stimulus (e.g. sight/smell/taste of alcohol) aversive, or it may be that they inhibit (i.e. reduce) the
behavior of drinking.

Second, there are doubts about the long-term effectiveness of aversion therapy. It can have dramatic effects in
the therapist’s office. However, it is often much less effective in the outside world, where no nausea-inducing
drug has been taken and it is obvious that no shocks will be given.

Also, relapse rates are very high – the success of the therapy depends of whether the patient can avoid the
stimulus they have been conditioned against.

Flooding

Flooding (also known as implosion therapy) works by exposing the patient directly to their worst fears. (S)he is
thrown in at the deep end. For example a claustrophobic will be locked in a closet for 4 hours or an individual
with a fear of flying will be sent up in a light aircraft.

What flooding aims to do is expose the sufferer to the phobic object or situation for an extended period of time in
a safe and controlled environment. Unlike systematic desensitisation which might use in vitro or virtual
exposure, flooding generally involves vivo exposure.

Fear is a time limited response. At first the person is in a state of extreme anxiety, perhaps even panic, but
eventually exhaustion sets in and the anxiety level begins to go down.

Of course normally the person would do everything they can to avoid such a situation. Now they have no choice
but confront their fears and when the panic subsides and they find they have come to no harm. The fear (which to
a large degree was anticipatory) is extinguished.

Prolonged intense exposure eventually creates a new association between the feared object and something
positive (e.g. a sense of calm and lack of anxiety). It also prevents reinforcement of phobia through escape or
avoidance behaviors.

Critical Evaluation

Flooding is rarely used and if you are not careful it can be dangerous. It is not an appropriate treatment for every
phobia. It should be used with caution as some people can actually increase their fear after therapy, and it is not
possible to predict when this will occur.

Wolpe (1969) reported the case of a client whose anxiety intensified to such as degree that flooding therapy
resulted in her being hospitalized.
Also, some people will not be able to tolerate the high levels of anxiety induced by the therapy, and are therefore
at risk of exiting the therapy before they are calm and relaxed. This is a problem, as existing treatment before
completion is likely to strengthen rather than weaken the phobia.

However one application is with people who have a fear of water (they are forced to swim out of their depth). It
is also sometimes used with agoraphobia. In general flooding produces results as effective (sometimes even more
so) as systematic desensitisation.

The success of the method confirms the hypothesis that phobias are so persistent because the object is avoided in
real life and is therefore not extinguished by the discovery that it is harmless.

For example, Wolpe (1960) forced an adolescent girl with a fear of cars into the back of a car and drove her
around continuously for four hours: her fear reached hysterical heights but then receded and, by the end of the
journey, had completely disappeared.

Systematic Desensitization

Systematic desensitization is a type of behavioral therapy based on the principle of classical conditioning. It was
developed by Wolpe during the 1950s. This therapy aims to remove the fear response of a phobia, and substitute
a relaxation response to the conditional stimulus gradually using counter conditioning. There are three phases to
the treatment:

First, the patient is taught a deep muscle relaxation technique and breathing exercises. E.g. control over
breathing, muscle detensioning or meditation. This step is very important because of reciprocal inhibition, where
once response is inhibited because it is incompatible with another. In the case of phobias, fears involves tension
and tension is incompatible with relaxation.

Second, the patient creates a fear hierarchy starting at stimuli that create the least anxiety (fear) and building up
in stages to the most fear provoking images. The list is crucial as it provides a structure for the therapy.

Third, the patient works their way up the fear hierarchy, starting at the least unpleasant stimuli and practising
their relaxation technique as they go. When they feel comfortable with this (they are no longer afraid) they move
on to the next stage in the hierarchy. If the client becomes upset they can return to an earlier stage and regain
their relaxed state.

The client repeatedly imagines (or is confronted by) this situation until it fails to evoke any anxiety at all,
indicating that the therapy has been successful. This process is repeated while working through all of the
situations in the anxiety hierarchy until the most anxiety-provoking.

Operant Conditioning

Operant conditioning is a method of learning that occurs through rewards and punishments for behavior.
Through operant conditioning, an individual makes an association between a particular behavior and a
consequence (Skinner, 1938). Examples of therapies using the principles of operant conditioning include:

Token Economy

Token economy is a system in which targeted behaviors are reinforced with tokens (secondary reinforcers) and
later exchanged for rewards (primary reinforcers).
Tokens can be in the form of fake money, buttons, poker chips, stickers, etc. While the rewards can range
anywhere from snacks to privileges or activities. For example, teachers use token economy at primary school by
giving young children stickers to reward good behavior.

Systematic desensitization
Systematic desensitization, also known as graduated exposure therapy, is a type of behavior therapy
developed by South African psychiatrist, Joseph Wolpe. It is used in the field of clinical psychology to help
many people effectively overcome phobias and other anxiety disorders that are based on classical conditioning,
and shares the same elements of both cognitive-behavioral therapy and applied behavior analysis. When used by
the behavior analysts, it is based on radical behaviorism and functional analysis, as it incorporates
counterconditioning principles, such as meditation (a private behavior/covert conditioning) and breathing (which
is a public behavior/overt conditioning). From the cognitive psychology perspective, however, cognitions and
feelings trigger motor actions.

The process of systematic desensitization occurs in three steps. The first step of systematic desensitization is the
identification of an anxiety inducing stimulus hierarchy. The second step is the learning of relaxation or coping
techniques. When the individual has been taught these skills, he or she must use them in the third step to react
towards and overcome situations in the established hierarchy of fears. The goal of this process is for the
individual to learn how to cope with, and overcome the fear in each step of the hierarchy.

Three steps of desensitization

There are three main steps that Wolpe identified to successfully desensitize an individual.

1. Establish anxiety stimulus hierarchy. The individual should first identify the items that are causing the anxiety
problems. Each item that causes anxiety is given a subjective ranking on the severity of induced anxiety. If the
individual is experiencing great anxiety to many different triggers, each item is dealt with separately. For each
trigger or stimuli, a list is created to rank the events from least anxiety provoking to the greatest anxiety provoking.
2. Learn the mechanism response. Relaxation training, such as meditation, is one type of best coping strategies.
Wolpe taught his patients relaxation responses because it is not possible to be both relaxed and anxious at the same
time. In this method, patients practice tensing and relaxing different parts of the body until the patient reaches a
state of serenity.[1] This is necessary because it provides the patient with a means of controlling their fear, rather
than letting it increase to intolerable levels. Only a few sessions are needed for a patient to learn appropriate coping
mechanisms. Additional coping strategies include anti-anxiety medicine and breathing exercises. Another example
of relaxation is cognitive reappraisal of imagined outcomes. The therapist might encourage patients to examine
what they imagine happening when exposed to the anxiety-inducing stimulus and then allowing for the client to
replace the imagined catastrophic situation with any of the imagined positive outcomes.
3. Connect stimulus to the incompatible response or coping method by counter conditioning. In this step the client
completely relaxes and is then presented with the lowest item that was placed on their hierarchy of severity of
anxiety phobias. When the patient has reached a state of serenity again after being presented with the first stimuli,
the second stimuli that should present a higher level of anxiety is presented. This will help the patient overcome
their phobia. This activity is repeated until all the items of the hierarchy of severity anxiety is completed without
inducing any anxiety in the client at all . If at any time during the exercise the coping mechanisms fail or became a
failure, or the patient fails to complete the coping mechanism due to the severe anxiety, the exercise is then
stopped. When the individual is calm, the last stimuli that is presented without inducing anxiety is presented again
and the exercise is then continued depending on the patient outcomes[2]

Example

A client may approach a therapist due to their great phobia of snakes. This is how the therapist would help the
client using the three steps of systematic desensitization:
 1. Establish anxiety stimulus hierarchy. A therapist may begin by asking the patient to identify a fear hierarchy. This
fear hierarchy would list the relative unpleasantness of various levels of exposure to a snake. For example, seeing a
picture of a snake might elicit a low fear rating, compared to live snakes crawling on the individual—the latter
scenario becoming highest on the fear hierarchy.
2. Learn coping mechanisms or incompatible responses. The therapist would work with the client to learn appropriate
coping and relaxation techniques such as meditation and deep muscle relaxation responses.
3. Connect the stimulus to the incompatible response or coping method. The client would be presented with
increasingly unpleasant levels of the feared stimuli, from lowest to highest—while utilizing the deep relaxation
techniques (i.e. progressive muscle relaxation) previously learned. The imagined stimuli to help with a phobia of
snakes may include: a picture of a snake; a small snake in a nearby room; a snake in full view; touching of the
snake, etc. At each step in the imagined progression, the patient is desensitized to the phobia through exposure to
the stimulus while in a state of relaxation. As the fear hierarchy is unlearned, anxiety gradually becomes
extinguished.

Specific phobias

Specific phobias are one class of mental disorder often treated via systematic desensitization. When persons
experience such phobias (for example fears of heights, dogs, snakes, closed spaces, etc.), they tend to avoid the
feared stimuli; this avoidance, in turn, can temporarily reduce anxiety but is not necessarily an adaptive way of
coping with it. In this regard, patients' avoidance behaviors can become reinforced – a concept defined by the
tenets of operant conditioning. Thus, the goal of systematic desensitization is to overcome avoidance by
gradually exposing patients to the phobic stimulus, until that stimulus can be tolerated. [3] Wolpe found that
systematic desensitization was successful 90% of the time when treating phobias.[4]

History

In 1947, Wolpe discovered that the cats of Wits University could overcome their fears through gradual and
systematic exposure.[5] Wolpe studied Ivan Pavlov's work on artificial neuroses and the research done on
elimination of children's fears by Watson and Jones. In 1958, Wolpe did a series of experiments on the artificial
induction of neurotic disturbance in cats. He found that gradually deconditioning the neurotic animals was the
best way to treat them of their neurotic disturbances. Wolpe deconditioned the neurotic cats through different
feeding environments. Wolpe knew that this treatment of feeding would not generalize to humans and he instead
substituted relaxation as a treatment to relieve the anxiety symptoms.[6]

Wolpe found that if he presented a client with the actual anxiety inducing stimulus, the relaxation techniques did
not work. It was difficult to bring all of the objects into his office because not all anxiety inducing stimuli are
physical objects, but instead are concepts. Wolpe instead began to have his clients imagine the anxiety inducing
stimulus or look at pictures of the anxiety inducing stimulus, much like the process that is done today. [6]

Recent use

Desensitization is widely known as one of the most effective therapy techniques. In recent decades, systematic
desensitization has been used less and less as a treatment of choice for anxiety disorders. Since 1970 academic
research on systematic desensitization has declined, and the current focus has been on other therapies. In
addition, the number of clinicians using systematic desensitization has also declined since 1980. Those clinicians
that continue to regularly use systematic desensitization were trained before 1986. It is believed that the decrease
of systematic desensitization by practicing psychologist is due to the increase in other techniques such as
flooding, implosive therapy, and participant modeling.[7]

Test anxiety

Between 25 and 40 percent of students experience test anxiety.[8] Children can suffer from low self-esteem and
stress induced symptoms as a result of test anxiety. [9] The principles of systematic desensitization can be used by
children to help reduce their test anxiety. Children can practice the muscle relaxation techniques by tensing and
relaxing different muscle groups. With older children and college students, an explanation of desensitization can
help to increase the effectiveness of the process. After these students learn the relaxation techniques, they can
create an anxiety inducing hierarchy. For test anxiety these items could include not understanding directions,
finishing on time or marking the answers properly. Teachers, school counselors or school psychologists could
instruct children on the methods of systematic desensitization.[10]

Systematic Desensitization
Systematic desensitization is a type of behavioral therapy based on the principle of classical conditioning. It was
developed by Wolpe during the 1950s. This therapy aims to remove the fear response of a phobia, and substitute
a relaxation response to the conditional stimulus gradually using counter conditioning. There are three phases to
the treatment:

First, the patient is taught a deep muscle relaxation technique and breathing exercises. E.g. control over
breathing, muscle detensioning or meditation. This step is very important because of reciprocal inhibition, where
once response is inhibited because it is incompatible with another. In the case of phobias, fears involves tension
and tension is incompatible with relaxation.

Second, the patient creates a fear hierarchy starting at stimuli that create the least anxiety (fear) and building up
in stages to the most fear provoking images. The list is crucial as it provides a structure for the therapy.

Third, the patient works their way up the fear hierarchy, starting at the least unpleasant stimuli and practising
their relaxation technique as they go. When they feel comfortable with this (they are no longer afraid) they move
on to the next stage in the hierarchy. If the client becomes upset they can return to an earlier stage and regain
their relaxed state.

The client repeatedly imagines (or is confronted by) this situation until it fails to evoke any anxiety at all,
indicating that the therapy has been successful. This process is repeated while working through all of the
situations in the anxiety hierarchy until the most anxiety-provoking.

Thus, for example, a spider phobic might regard one small, stationary spider 5 meters away as only modestly
threatening, but a large, rapidly moving spider 1 meter away as highly threatening. The client reaches a state of
deep relaxation, and is then asked to imagine (or is confronted by) the least threatening situation in the anxiety
hierarchy.

The number of sessions required depends on the severity of the phobia. Usually 4-6 sessions, up to 12 for a
severe phobia. The therapy is complete once the agreed therapeutic goals are met (not necessarily when the
person’s fears have been completely removed).
Exposure can be done in two ways:

· In vitro – the client imagines exposure to the phobic stimulus.

· In vivo – the client is actually exposed to the phobic stimulus.

Research has found that in vivo techniques are more successful than in vitro (Menzies & Clarke, 1993).
However, there may be practical reasons why in vitro may be used.

Application

Wolpe (1964) successfully used the method to treat an 18 year old male with a severe handwashing compulsion.
The disorder involved a fear of contaminating others with urine. After urinating, the patient felt compelled to
spend 45 minutes cleaning his genitalia, two hours washing his hands, and four hours showering.

Treatment involved placing the young man in a state of relaxation and then asking him to imagine low anxiety
scenes (such as an unknown man touching a trough of water containing one drop of urine). As the patient’s
anxiety gradually dissipated, Wolpe gradually increased the imaginary concentration of urine.

In addition, a real bottle of urine was presented at a distance and moved closer to the patient in gradual steps.
Finally Wolpe could apply drops of diluted urine to the back of the patient’s hand without evoking anxiety. A
follow-up 4 years later revealed complete remission of the compulsive behaviors.

Critical Evaluation
Practical Issues

The fact that the SD technique can be applied in images means that many of the practical disadvantages involved
in in vivo exposition with this type of phobia can be eliminated.

One weakness of in vitro exposition is that it relies on the client’s ability to be able to imagine the fearful
situation. Some people cannot create a vivid image and thus systematic desensitization is not always effective
(there are individual differences).

Systematic desensitization is a slow process, taking on average 6-8 sessions. Although, research suggests that the
longer the technique takes the more effective it is.

The progressive structure of SD allows the patient to control the steps he/she must make until fear is overcome.
This absence of disturbing elements makes this technique less likely to provoke abandonment of the therapy.

Theoretical Issues

Systematic desensitization is highly effective where the problem is a learned anxiety of specific
objects/situations, e.g. phobias (McGrath et al., 1990) . However, SD is not effective in treating serious mental
disorders like depression and schizophrenia.

Studies have shown that neither relaxation nor hierarchies are necessary, and that the important factor is just
exposure to the feared object or situation.
Systematic desensitization is based on the idea that abnormal behavior is learned. The biological approach would
disagree and say we are born with a behavior and therefore it must be treated medically.

Treats the symptoms not the cause(s) of the phobia. SD only treats the observable and measurable symptoms of a
phobia. This is a significant weakness because cognitions and emotions are often the motivators of behavior and
so the treatment is only dealing with symptoms not the underlying causes.

Social phobias and agoraphobia do not seem to show as much improvement. Could it be that there are other
causes for phobias than classical conditioning? For example, if a fear of public speaking originates with poor
social skills then phobic reduction is more likely to occur in a treatment which includes learning effective social
skills than systematic desensitization alone.

Flooding (psychology)
Flooding, sometimes referred to as in vivo exposure therapy, is a form of behavior therapy and desensitization
—or exposure therapy—based on the principles of respondent conditioning. As a psychotherapeutic technique, it
is used to treat phobia and anxiety disorders including post-traumatic stress disorder. It works by exposing the
patient to their painful memories,[1] with the goal of reintegrating their repressed emotions with their current
awareness. Flooding was invented by psychologist Thomas Stampfl in 1967.[2] It is still used in behavior therapy
today.

Flooding is a psychotherapeutic method for overcoming phobias. This is a faster method of ridding fears when
compared with systematic desensitization. In order to demonstrate the irrationality of the fear, a psychologist
would put a person in a situation where they would face their phobia at its worst. Under controlled conditions
and using psychologically-proven relaxation techniques, the subject attempts to replace their fear with relaxation.
The experience can often be traumatic for a person, but may be necessary if the phobia is causing them
significant life disturbances. The advantage to flooding is that it is quick and usually effective. There is,
however, a possibility that a fear may spontaneously recur. This can be made less likely with systematic
desensitization, another form of a classical condition procedure for the elimination of phobias. [3]

How it works

"Flooding" is an effective form of treatment for phobias amongst other psychopathologies. [citation needed] It works on
the principles of classical conditioning or respondent conditioning—a form of Pavlov's classical conditioning—
where patients change their behaviors to avoid negative stimuli. According to Pavlov, people learn through
associations, so if one has a phobia, it is because one associates the feared stimulus with a negative outcome.

Flooding uses a technique based on Pavlov's classical conditioning that uses exposure. There are different forms
of exposure, such as imaginal exposure, virtual reality exposure, and in vivo exposure. [4] While systematic
desensitization may use these other types of exposure, flooding uses in vivo exposure, actual exposure to the
feared stimulus. A patient is confronted with a situation in which the stimulus that provoked the original trauma
is present. The psychologist there usually offers very little assistance or reassurance other than to help the patient
to use relaxation techniques in order to calm themselves. Relaxation techniques such as progressive muscle
relaxation are common in these kinds of classical conditioning procedures. The theory is that the adrenaline and
fear response has a time limit, so a person should eventually have to calm down and realize that their phobia is
unwarranted.[3] Flooding can be done through the use of virtual reality and is fairly effective.[5][6]

Psychiatrist Joseph Wolpe (1973) carried out an experiment which demonstrated flooding. He took a girl who
was scared of cars, and drove her around for hours. Initially the girl was hysterical but she eventually calmed
down when she realized that her situation was safe. From then on she associated a sense of ease with cars. [citation
needed]
Psychologist Aletha Solter used flooding successfully with a 5-month-old infant who showed symptoms of
post-traumatic stress following surgery.[7]
Flooding therapy is not for every individual, and the therapist will discuss with the patient the levels of anxiety
they are prepared to endure during the session. [1] It may also be true that exposure is not for every therapist and
therapists seem to shy away from use of the technique

What Is Exposure Therapy?

Exposure therapy is a psychological treatment that was developed to help people confront their fears. When
people are fearful of something, they tend to avoid the feared objects, activities or situations. Although this
avoidance might help reduce feelings of fear in the short term, over the long term it can make the fear become
even worse. In such situations, a psychologist might recommend a program of exposure therapy in order to help
break the pattern of avoidance and fear. In this form of therapy, psychologists create a safe environment in which
to “expose” individuals to the things they fear and avoid. The exposure to the feared objects, activities or
situations in a safe environment helps reduce fear and decrease avoidance.

Exposure therapy has been scientifically demonstrated to be a helpful treatment or treatment component for a
range of problems, including:

 Phobias
 Panic Disorder
 Social Anxiety Disorder
 Obsessive-Compulsive Disorder
 Posttraumatic Stress Disorder
 Generalized Anxiety Disorder

There are several variations of exposure therapy. Your psychologist can help you determine which strategy is
best for you. These include:

 In vivo exposure: Directly facing a feared object, situation or activity in real life. For example, someone
with a fear of snakes might be instructed to handle a snake, or someone with social anxiety might be
instructed to give a speech in front of an audience.
 Imaginal exposure: Vividly imagining the feared object, situation or activity. For example, someone
with Posttraumatic Stress Disorder might be asked to recall and describe his or her traumatic experience
in order to reduce feelings of fear.
 Virtual reality exposure: In some cases, virtual reality technology can be used when in vivo exposure is
not practical. For example, someone with a fear of flying might take a virtual flight in the psychologist's
office, using equipment that provides the sights, sounds and smells of an airplane.
 Interoceptive exposure: Deliberately bringing on physical sensations that are harmless, yet feared. For
example, someone with Panic Disorder might be instructed to run in place in order to make his or her
heart speed up, and therefore learn that this sensation is not dangerous.

Exposure therapy can also be paced in different ways. These include:

 Graded exposure: The psychologist helps the client construct an exposure fear hierarchy, in which
feared objects, activities or situations are ranked according to difficulty. They begin with mildly or
moderately difficult exposures, then progress to harder ones.
 Flooding: Using the exposure fear hierarchy to begin exposure with the most difficult tasks.
 Systematic desensitization: In some cases, exposure can be combined with relaxation exercises to make
them feel more manageable and to associate the feared objects, activities or situations with relaxation.

Exposure therapy is thought to help in several ways, including:

  Habituation: Over time, people find that their reactions to feared objects or situations decrease.
 Extinction: Exposure can help weaken previously learned associations between feared objects, activities
or situations and bad outcomes.
 Self-efficacy: Exposure can help show the client that he/she is capable of confronting his/her fears and
can manage the feelings of anxiety.
 Emotional processing: During exposure, the client can learn to attach new, more realistic beliefs about
feared objects, activities or situations, and can become more comfortable with the experience of fear.

Aversion therapy
Definition

Aversion therapy is a form of behavior therapy in which an aversive (causing a strong feeling of dislike or
disgust) stimulus is paired with an undesirable behavior in order to reduce or eliminate that behavior.

Purpose

As with other behavior therapies, aversion therapy is a treatment grounded in learning theory—one of its basic
principles being that all behavior is learned and that undesirable behaviors can be unlearned under the right
circumstances. Aversion therapy is an application of the branch of learning theory called classical conditioning.
Within this model of learning, an undesirable behavior, such as a deviant sexual act, is matched with an
unpleasant (aversive) stimulus. The unpleasant feelings or sensations become associated with that behavior, and
the behavior will decrease in frequency or stop altogether. Aversion therapy differs from those types of behavior
therapy based on principles of operant conditioning. In operant therapy, the aversive stimulus, usually called
punishment, is presented after the behavior rather than together with it.

The goal of aversion therapy is to decrease or eliminate undesirable behaviors. Treatment focuses on changing a
specific behavior itself, unlike insight-oriented approaches that focus on uncovering unconscious motives in
order to produce change. The behaviors that have been treated with aversion therapy include such addictions as
alcohol abuse, drug abuse, and smoking; pathological gambling; sexual deviations; and more benign habits—
including writer's cramp. Both the type of behavior to be changed and the characteristics of the aversive stimulus
influence the treatment—which may be administered in either outpatient or inpatient settings as a self-sufficient
intervention or as part of a multimodal program. Under some circumstances, aversion therapy may be self-
administered.

Precautions

A variety of aversive stimuli have been used as part of this approach, including chemical and pharmacological
stimulants as well as electric shock. Foul odors, nasty tastes, and loud noises have been employed as aversive
stimuli somewhat less frequently. The chemicals and medications generate very unpleasant and often physically
painful responses. This type of aversive stimulation may be risky for persons with heart or lung problems
because of the possibility of making the medical conditions worse. Patients with these conditions should be
cleared by their doctor first. Often, however, the more intrusive aversive stimuli are administered within
inpatient settings under medical supervision. An uncomfortable but safe level of electric (sometimes called
faradic) shock is often preferred to chemical and pharmacological aversants because of the risks that these
substances involve.

In addition to the health precautions mentioned above, there are ethical concerns surrounding the use of aversive
stimuli. There are additional problems with patient acceptance and negative public perception of procedures
utilizing aversants. Aversion treatment that makes use of powerful substances customarily (and intentionally)
causes extremely uncomfortable consequences, including nausea and vomiting. These effects may lead to poor
compliance with treatment, high dropout rates, potentially hostile and aggressive patients, and public relations
problems. Social critics and members of the general public alike often consider this type of treatment punitive
and morally objectionable. Although the scenes were exaggerated, the disturbing parts of the Stanley Kubrick
film A Clockwork Orange that depicted the use of aversion therapy to reform the criminal protagonist, provide a
powerful example of society's perception of this treatment.

Parents and other advocates for the mentally retarded and developmentally disabled have been particularly vocal
in their condemnation of behavior therapy that uses aversive procedures in general. Aversive procedures are used
within a variety of behavior modification strategies and that term is sometimes confused with the more specific
technique of aversion therapy. Aversive procedures are usually based on an operant conditioning model that
involves punishment. Advocates for special patient populations believe that all aversive procedures are punitive,
coercive, and use unnecessary amounts of control and manipulation to modify behavior. They call for therapists
to stop using aversive stimuli, noting that positive, non-aversive, behavioral-change strategies are available.
These strategies are at least as, if not more, effective than aversive procedures.

Description

A patient who consults a behavior therapist for aversion therapy can expect a fairly standard set of procedures.
The therapist begins by assessing the problem, most likely measuring its frequency, severity, and the
environment in which the undesirable behavior occurs. Although the therapeutic relationship is not the focus of
treatment for the behavior therapist, therapists in this tradition believe that good rapport will facilitate a
successful outcome. A positive relationship is also necessary to establish the patient's confidence in the rationale
for exposing him or her to an uncomfortable stimulus. The therapist will design a treatment protocol and explain
it to the patient. The most important choice the therapist makes is the type of aversive stimulus to employ.
Depending upon the behavior to be changed, the preferred aversive stimulus is often electric stimulation
delivered to the forearm or leg. This aversive stimulus should not be confused with electroconvulsive therapy
(ECT), which is delivered to the brain to treat depression. Mild but uncomfortable electric shocks have several
advantages over chemical and pharmacological stimuli. A great many laboratory research studies using animal
and human subjects have used electrical shock and its characteristics are well known. In addition, it has been
widely used in clinical settings. Electric shock is easy to administer, and the level of intensity can be preselected
by the patient. The stimulation can be precisely controlled and timed. The equipment is safe, battery-powered,
suitable for outpatients, portable, easy to use, and can be self-administered by the patient when appropriate.

Case example #1 : What would a treatment protocol look like for a relatively well-adjusted patient specifically
requesting aversion therapy on an outpatient basis to reduce or eliminate problem gambling behavior? The
therapist begins by asking the patient to keep a behavioral diary. The therapist uses this information both to
understand the seriousness of the problem and as a baseline to measure whether or not change is occurring
during the course of treatment. Because electric shock is easy to use and is acceptable to the patient, the therapist
chooses it as the aversive stimulus. The patient has no medical problems that would preclude the use of this
stimulus. He or she fully understands the procedure and consents to treatment. The treatment is conducted on an
outpatient basis with the therapist administering the shocks on a daily basis for the first week in the office,
gradually tapering to once a week over a month. Sessions last about an hour. A small, battery-powered electrical
device is used. The electrodes are placed on the patient's wrist. The patient is asked to preselect a level of shock
that is uncomfortable but not too painful. This shock is then briefly and repeatedly paired with stimuli (such as
slides of the race track, betting sheets, written descriptions of gambling) that the patient has chosen for their
association with his or her problem gambling. The timing, duration, and intensity of the shock are carefully
planned by the therapist to assure that the patient experiences a discomfort level that is aversive and that the
conditioning effect occurs.

After the first or second week of treatment, the patient is provided with a portable shocking device to use on a
daily basis for practice at home to supplement office treatment. The therapist calls the patient at home to monitor
compliance as well as progress between office sessions. The conditioning effect occurs, the discomfort from the
electric shock becomes associated with the gambling behavior, the patient reports loss of desire and stops
gambling. Booster sessions in the therapist's office are scheduled once a month for six months. A minor relapse
is dealt with through an extra office visit. The patient is asked to administer his or her own booster sessions on
an intermittent basis at home and to call in the future if needed.

Case example #2 : What would the treatment protocol look like for an alcohol-dependent patient with an
extensive treatment history including multiple prior life-threatening relapses? The patient who is motivated to
change but has not experienced success in the past may be considered a candidate for aversion therapy as part of
a comprehensive inpatient treatment program. The treating therapist assesses the extent of the patient's problem,
including drinking history, prior treatments and response, physical health, and present drinking pattern. Patients
who are physically addicted to alcohol and currently drinking may experience severe withdrawal symptoms and
may have to undergo detoxification before treatment starts. When the detoxification is completed, the patient is
assessed for aversion therapy. The therapist's first decision is what type of noxious stimulus to use, whether
electrical stimulation or an emetic (a medication that causes vomiting). In this case, when the patient's problem is
considered treatment-resistant and a medically-monitored inpatient setting is available, an emetic may be
preferable to electric shock as the aversive stimulus. There is some research evidence that chemical aversants
lead to at least short-term avoidance of alcohol in some patients. An emetic is "biologically appropriate" for the
patient in that it affects him or her in the same organ systems that excessive alcohol use does. The procedure is
fully explained to the patient, who gives informed consent .

During a ten-day hospitalization , the patient may receive aversion therapy sessions every other day as part of a
comprehensive treatment program. During the treatment sessions, the patient is given an emetic intravenously
under close medical supervision and with the help of staff assistants who understand and accept the theory.
Within a few minutes following administration, the patient reports beginning to feel sick. To associate the emetic
with the sight, smell and taste of alcohol, the patient is then asked to take a sip of the alcoholic beverage of his or
her choice without swallowing. This process is repeated over a period of 30–60 minutes as nausea and vomiting
occur. As the unpleasant effects of the emetic drug become associated with the alcoholic beverage, the patient
begins to lose desire for drinking. Aversion therapy in an inpatient program is usually embedded within a
comprehensive treatment curriculum that includes group therapy and such support groups as AA,
couples/family counseling, social skills training , stress management, instruction in problem solving and
conflict resolution, health education and other behavioral change and maintenance strategies. Discharge planning
includes an intensive outpatient program that may include aversive booster sessions administered over a period
of six to twelve months, or over the patient's lifetime.

Preparation

Depending upon his/her customary practice, a therapist administering aversion therapy may establish a
behavioral contract defining the treatment, objectives, expected outcome, and what will be required of the
patient. The patient may be asked to keep a behavioral diary to establish a baseline measure of the behavior
targeted for change. The patient undergoing this type of treatment should have enough information beforehand to
give full consent for the procedure. Patients with medical problems or who are otherwise vulnerable to
potentially damaging physical side effects of the more intense aversive stimuli should consult their primary care
doctor first.

Aftercare

Patients completing the initial phase of aversion therapy are often asked by the therapist to return periodically
over the following six to twelve months or longer for booster sessions to prevent relapse.

Risks

Patients with cardiac, pulmonary, or gastrointestinal problems may experience a worsening of their symptoms,
depending upon the characteristics and strength of the aversive stimuli. Some therapists have reported that
patients undergoing aversion therapy, especially treatment that uses powerful chemical or pharmacological
aversive stimuli, have become negative and aggressive.

Normal results

Depending upon the objectives established at the beginning of treatment, patients successfully completing a
course of aversion therapy can expect to see a reduction or cessation of the undesirable behavior. If they practice
relapse prevention techniques, they can expect to maintain the improvement.

Abnormal results

Some clinicians have reported that patients undergoing aversive treatment utilizing electric shocks have
experienced increased anxiety and anxiety-related symptoms that may interfere with the conditioning process as
well as lead to decreased acceptance of the treatment. As indicated above, a few clinicians have reported a
worrisome increase in hostility among patients receiving aversion therapy, especially those undergoing treatment
using chemical aversants. Although aversion therapy has some adherents, lack of rigorous outcome studies
demonstrating its effectiveness, along with the ethical objections mentioned earlier, have generated numerous
opponents among clinicians as well as the general public. These opponents point out that less intrusive
alternative treatments, such as covert sensitization , are available.

Aversion Therapy Uses and Effectiveness

Aversion therapy is a type of behavioral therapy that involves repeating pairing an unwanted behavior with
discomfort. For example, a person undergoing aversion therapy to stop smoking might receive an electrical
shock every time they view an image of a cigarette. The goal of the conditioning process is to make the
individual associate the stimulus with unpleasant or uncomfortable sensations.

During aversion therapy, the client may be asked to think of or engage in the behavior they enjoy while at the
same time being exposed to something unpleasant such as a bad taste, a foul smell, or even mild electric shocks.
Once the unpleasant feelings become associated with the behavior, the hope is that the unwanted behaviors or
actions will begin to decrease in frequency or stop entirely.

Uses of Aversion Therapy

Aversion therapy can be effectively used to treat a number of problematic behaviors including the following:

 Bad habits
 Addictions
 Alcoholism
 Smoking
 Gambling
 Violence or anger issues

Aversion therapy is most commonly used to treat drug and alcohol addictions. A subtle form of this technique is
often used as a self-help strategy for minor behavior issues. In such cases, people may wear an elastic band
around the wrist. Whenever the unwanted behavior or urge to engage in the behavior presents itself, the
individual will snap the elastic to create a slightly painful deterrent.

Effectiveness

The overall effectiveness of aversion therapy depends upon a number of factors including:
  The treatment methods and aversive conditions that are used.
 Whether or not the client continues to practice relapse prevention after treatment is concluded.
 In some instances, the client may return to previous patterns of behavior once they are out of treatment and no
longer exposed to the deterrent.

Generally, aversion therapy tends to be successful while it is still under the direction of a therapist, but relapse
rates are high.

Once the individual is out in the real-world and exposed to the stimulus without the presence of the aversive
sensation, it is highly likely that they will return to the previous behavior patterns.

Problems With Aversion Therapy

One of the major criticisms of aversion therapy is that it lacks rigorous scientific evidence demonstrating its
effectiveness. Ethical issues over the use of punishments in therapy are also a major point of concern.

Practitioners have found that in some cases, aversion therapy can increase anxiety that actually interferes with
the treatment process. In other instances, some patients have also experienced anger and hostility during therapy.

In some instances, serious injuries and even fatalities have occurred during the course of aversion therapy.
Historically, when homosexuality was considered a mental illness, gay individuals were subjected to forms of
aversion therapy to try to alter their sexual preferences and behaviors. Depression, anxiety, and suicide have
been linked to some cases of aversion therapy.

The use of aversion therapy to "treat" homosexuality was declared dangerous by the American Psychological
Association (APA) in 1994. In 2006, ethical codes were established by both the APA and the American
Psychiatric Association. Today, using aversion therapy in an attempt to alter homosexual behavior is considered
a violation of professional conduct.

Biofeedback
What Is Biofeedback?

Biofeedback is a type of therapy that uses sensors attached to your body to measure key body functions.
Biofeedback is intended to help you learn more about how your body works. This information may help you to
develop better control over certain body functions and address health concerns.

Biofeedback is built on the concept of “mind over matter.” The idea is that, with proper techniques, you can
change your health by being mindful of how your body responds to stressors and other stimuli.

Chronic stress can have dramatic effects on your body. This may include elevated blood pressure, increased body
temperature, and disruption of brain function. By promoting a more effective mental and physical response to
stress, biofeedback aims to help you control body processes like your heart rate and blood pressure. These body
processes were once thought to be completely involuntary.

Types of Biofeedback

The three most common methods of biofeedback include:

 electromyography (EMG) biofeedback: measures muscle tension as it changes over time

 thermal or temperature biofeedback: measures body temperature changes over time
 electroencephalography: measures brain wave activity over time
Other types of biofeedback include:

 galvanic skin response training: measures the amount of sweat on your body over time
 heart variability biofeedback: measures your pulse and heart rate

The Purpose of Biofeedback

Biofeedback is aimed at combating stress through relaxation techniques. You consciously manipulate your
breathing, heart rate, and other usually “involuntary” functions to override your body’s response to stressful
situations.

Biofeedback appears to be most effective for conditions that are heavily influenced by stress. Some examples
include: learning disorders, eating disorders, bedwetting, and muscles spasms.

Biofeedback may be used to treat numerous physical and mental health issues, including:

 asthma
 incontinence
 constipation
 irritable bowel syndrome
 side effects from chemotherapy
 high blood pressure
 Raynaud’s disease
 chronic pain
 stress or anxiety

Some people prefer biofeedback as a form of treatment for these conditions because it’s noninvasive and doesn’t
rely on medications. Other people pair biofeedback with more traditional treatment options to improve overall
wellness.

What is biofeedback therapy and who can benefit?

Biofeedback therapy is a non-drug treatment in which patients learn to control bodily processes that are normally
involuntary, such as muscle tension, blood pressure, or heart rate.

It may help in a range of conditions, such as chronic pain, urinary incontinence, high blood pressure, tension
headache, and migraine headache.

As it is noninvasive and does not involve drugs, there is a low risk of undesirable side effects.

This could make it suitable for those who wish to avoid medications, or those who cannot use them, such as
during pregnancy.

It is often combined with relaxation training.

How it works
Biofeedback therapy can help people change unhealthful habits by interpreting factors such as electrical brain activity.

There are three common types of biofeedback therapy:

 Thermal biofeedback measures skin temperature.

 Electromyography measures muscle tension.
 Neurofeedback, or EEG biofeedback focuses on electrical brain activity.
EEG biofeedback may help patients with attention deficit hyperactivity disorder (ADHD), addiction, anxiety,
seizures, depression, and other types of brain condition.

During a biofeedback session, the therapist attaches electrodes to the patient's skin, and these send information to
a monitoring box.

The therapist views the measurements on the monitor, and, through trial and error, identifies a range of mental
activities and relaxation techniques that can help regulate the patient's bodily processes.

Eventually, patients learn how to control these processes without the need for monitoring.

How many sessions will I need?

Sessions typically last less than one hour.

For some conditions, patients experience relief in eight to 10 sessions. For other conditions, such as high blood
pressure, improvements may take 20 sessions to appear.

Alongside these sessions will be mental and relaxation activities that the individual will complete at home for 5
to 10 minutes a day.

Uses

It remains unclear why or how biofeedback works, but it appears to benefit people with conditions related to
stress, according to The University of Maryland Medical Center (UMM).

When a person experiences stress, their internal processes — such as blood pressure — can become irregular.
Biofeedback therapy teaches relaxation and mental exercises that can alleviate symptoms.

Migraine

People often seek biofeedback and relaxation techniques to treat headaches and migraine, but studies into its
effectiveness have produced mixed results.

In 2015, a Japanese study found that biofeedback therapy reduced the frequency and severity of symptoms in
people with migraine headaches.

However, in 2009, other researchers reported that while relaxation appears to benefit people with migraine
headaches, combining relaxation with biofeedback does not seem to produce additional benefits.

The authors note:

"Biofeedback is an extremely costly and time-consuming treatment modality that, in our study, provided no
additional benefit when compared to simple relaxation techniques alone, in the treatment of migraine and
tension-type headaches in adults."

The Michigan Headache and Neurological Institute (MHNI) suggest that biofeedback therapy improves
symptoms of headache and migraine in 40 to 60 percent of patients, similar to the success rate of medications.

They propose that combining biofeedback with medication may increase the effectiveness of both. However,
while biofeedback may help relieve stress-induced migraine, migraines due to other triggers may be less
responsive.
ADHD
Some studies have suggested that EEG biofeedback, or neurofeedback, may help people with ADHD. According to authors
of a systematic review published in The BMJ in 2014, growing evidence indicates that neurofeedback could help with
ADHD.However, they call for further investigations to confirm its effectiveness, because of the weak design of many
studies.

Post-traumatic stress disorder

Monitoring the body's reactions can help a person learn about their stress levels and how to reduce them.Some types of
biofeedback therapy may help patients with post-traumatic stress disorder (PTSD). One study found that adding heart-
variability biofeedback to standard PTSD treatment did not bring any benefit.

Urinary incontinence
The Agency for Health Care Policy and Research currently recommend pelvic floor muscle training with biofeedback
therapy for the treatment of urinary incontinence, based on findings in clinical studies.

Chronic constipation
A team from the University of Iowa found that biofeedback treatment showed better results that the use of laxatives for
chronic constipation, and that biofeedback can successfully retrain the muscles that cause chronic constipation.

Other conditions

Electrodes pick up signals from different parts of the body. Interpreting these can give insight into various
conditions and how to reduce their impact.

Other conditions that may benefit from biofeedback include:

 back pain
 depression
 anxiety
 asthma
 high blood pressure
 diabetes
 chronic pain
 anorexia nervosa
 learning disabilities
 muscle spasms
 motion sickness

Biofeedback therapy can help to optimize performance in sports participants.

Assertiveness training
Definition
Assertiveness training is a form of behavior therapy designed to help people stand up for themselves—to empower
themselves, in more contemporary terms. Assertiveness is a response that seeks to maintain an appropriate balance between
passivity and aggression. Assertive responses promote fairness and equality in human interactions, based on a positive
sense of respect for self and others.
Assertiveness training has a decades-long history in mental health and personal growth groups, going back to the women's
movement of the 1970s. The approach was introduced to encourage women to stand up for themselves appropriately in
their interactions with others, particularly as they moved into graduate education and the workplace in greater numbers.
The original association of assertiveness training with the women's movement in the United States grew out of the
discovery of many women in the movement that they were hampered by their inability to be assertive. Today, assertiveness
training is used as part of communication training in settings as diverse as schools, corporate boardrooms, and psychiatric
hospitals, for programs as varied as substance abuse treatment, social skills training , vocational programs, and responding
to harassment.
Purpose

The purpose of assertiveness training is to teach persons appropriate strategies for identifying and acting on their
desires, needs, and opinions while remaining respectful of others. This form of training is tailored to the needs of
specific participants and the situations they find particularly challenging. Assertiveness training is a broad
approach that can be applied to many different personal, academic, health care, and work situations.

Learning to communicate in a clear and honest fashion usually improves relationships within one's life. Women
in particular have often been taught to hide their real feelings and preferences, and to try to get their way by
manipulation or other indirect means. Specific areas of intervention and change in assertiveness training include
conflict resolution, realistic goal-setting, and stress management. In addition to emotional and psychological
benefits, taking a more active approach to self-determination has been shown to have positive outcomes in many
personal choices related to health, including being assertive in risky sexual situations; abstaining from using
drugs or alcohol; and assuming responsibility for self-care if one has a chronic illness like diabetes or cancer.

Precautions

There are a few precautions with assertiveness training. One potential caution would be to remain within
assertive responses, rather than become aggressive in standing up for oneself. Some participants in assertiveness
training programs who are just learning the techniques of appropriate assertiveness may "overdo" their new
behaviors and come across as aggressive rather than assertive. Such overcompensation would most likely
disappear with continued practice of the techniques.

One additional precaution about assertiveness training is that it should not be regarded as the equivalent of
martial arts training or similar physical self-defense techniques. It is important to distinguish between contexts or
situations in which verbal assertiveness is appropriate and useful, and those in which it is irrelevant. In some
situations, a person's decision to leave the situation or seek help because they sense danger is preferable to an
encounter with a criminal.

Description

Assertiveness training is often included within other programs, but "stand-alone" programs in self-assertion are
often given in women's centers or college counseling centers. Corporate programs for new personnel sometimes
offer assertiveness training as part of communication or teamwork groups, or as part of a program on sexual
harassment.

Assertiveness training typically begins with an information-gathering exercise in which participants are asked to
think about and list the areas in their life in which they have difficulty asserting themselves. Very often they will
notice specific situations or patterns of behavior that they want to focus on during the course. The next stage in
assertive training is usually role-plays designed to help participants practice clearer and more direct forms of
communicating with others. The role-plays allow for practice and repetition of the new techniques, helping each
person learn assertive responses by acting on them. Feedback is provided to improve the response, and the role-
play is repeated. Eventually, each person is asked to practice assertive techniques in everyday life, outside the
training setting. Role-plays usually incorporate specific problems for individual participants, such as difficulty
speaking up to an overbearing boss; setting limits to intrusive friends; or stating a clear preference about dinner
to one's spouse. Role-plays often include examples of aggressive and passive responses, in addition to the
assertive responses, to help participants distinguish between these extremes as they learn a new set of behaviors.

Assertiveness training promotes the use of "I" statements as a way to help individuals express their feelings and
reactions to others. A commonly used model of an "I" statement is "when you _________, I feel ___________",
to help the participant describe what they see the other person as doing, and how they feel about that action. "I"
statements are often contrasted with "you" statements, which are usually not received well by others. For
example, "When you are two hours late getting home from work, I feel both anxious and angry," is a less
accusing communication than "You are a selfish and inconsiderate jerk for not telling me you would be two
hours late." Prompts are often used to help participants learn new communication styles. This approach helps
participants learn new ways of expressing themselves as well as how it feels to be assertive.

Learning specific techniques and perspectives, such as self-observation skills, awareness of personal preferences
and assuming personal responsibility are important components of the assertiveness training process. Role-play
and practice help with self-observation, while making lists can be a helpful technique for exploring personal
preferences for those who may not have a good sense of their own needs and desires. Participants may be asked
to list anything from their ten favorite movies or pieces of music to their favorite foods, places they would like to
visit, subjects that interest them, and so on.

Preparation

Preparation for assertiveness training varies from person to person. For some participants, no preparation is
needed before practicing the techniques; for others, however, individual counseling or therapy may help prepare
the individual for assertiveness training. For participants who may be more shy and feel uncomfortable saying
"no" or speaking up for themselves, a brief course of individual therapy will help to prepare them
psychologically and emotionally to use assertive techniques.

Aftercare

Aftercare can involve ongoing supportive therapy, again based on the individual's level of comfort in using the
assertive techniques. For those who are comfortable using the techniques on their own, a supportive social
network or occasional participation in a support group will be enough to help maintain the new behavioral
patterns. The ultimate goal is for each participant to self-monitor effectively his or her use of assertive techniques
on an ongoing basis.

Risks

There are minimal risks associated with assertiveness training. Personal relationships may be affected if those
around the participant have difficulty accepting the changes in their friend or family member. This risk, however,
is no greater than that associated with any other life change.

Another potential risk is that of overcompensating in the early stages of training by being too aggressive. With
appropriate feedback, participants can usually learn to modify and improve their responses.

People who are very shy or self-conscious, or who were harshly treated as children, may also experience anxiety
during the training as they work toward speaking up and otherwise changing their behaviors. The anxiety may be
uncomfortable, but should decrease as the person becomes more comfortable with the techniques and receives
encouragement from others in the program.

Normal results

An enhanced sense of well-being and more positive self-esteem are typical results from assertiveness training.
Many participants report that they feel better about themselves and more capable of handling the stresses of daily
life. In addition, people who have participated in assertiveness training have a better sense of boundaries, and are
able to set appropriate and healthy limits with others. Being able to set appropriate limits (such as saying "no")
helps people to avoid feeling victimized by others.

A healthy sense of self-determination and respect for others is the ultimate outcome of assertiveness training.
Such a balance helps each person work better with others, and make appropriate decisions for themselves.
Abnormal results

Unusual results may include becoming too aggressive in setting boundaries, as if the individual is
overcompensating. With appropriate training, role-play, and feedback, this response can be re-learned.
Alternatively, for very shy individuals, a heightened sense of anxiety may be experienced when using the
techniques initially. The nervousness or anxiety is usually due to the individual's concern about others' reactions
to their assertive responses. Over time, the anxiety will usually decrease.

How to Be Assertive
Asking for What You Want Firmly and Fairly

Debra's patience is beginning to wear thin with her colleague Ronan. A few days earlier he had undermined her
yet again, this time in front of other colleagues during the weekly team meeting. So, she decided to tell him how
he made her feel. But just as she was about to approach him, she lost her nerve.

Ronan made similar comments again yesterday. And, once again, Debra felt humiliated and frustrated at his
inability to see the effect that his comments had. But she still couldn't bring herself to speak to him about it. She
feels cross with herself, but resigned to the situation.

It's possible that you've been in a situation like Debra's and, like her, you might have felt unable to do anything
about it. But by learning how to be more assertive, you can stand up for yourself, and become a strong and
confident communicator.

In this article, we look at why assertiveness is important in the workplace, and explore some strategies that you
can use to become more assertive.

Click here

to view a transcript of this video.

What Is Assertiveness?

It's not always easy to identify truly assertive behavior. This is because there's a fine line between assertiveness
and aggression, and people can often confuse the two. For this reason, it's useful to define the two behaviors so
that we can clearly separate them:

 Assertiveness is based on balance. It requires being forthright about your wants and needs, while still considering
the rights, needs and wants of others. When you're assertive, you are self assured and draw power from this to get
your point across firmly, fairly and with empathy.
 Aggressive behavior is based on winning. You do what is in your own best interest without regard for the rights,
needs, feelings, or desires of other people. When you're aggressive, the power you use is selfish. You may come
across as pushy or even bullying. You take what you want, often without asking.

So, a boss who places a pile of work on your desk the afternoon before you go on vacation, and demands that it
gets done straight away, is being aggressive. The work needs to be done but, by dumping it on you at an
inappropriate time, he or she disregards your needs and feelings.

When you, on the other hand, inform your boss that the work will be done but only after you return from
vacation, you hit the sweet spot between passivity (not being assertive enough) and aggression
(being hostile, angry or rude). You assert your own rights while recognizing your boss's need to get the job done.

Warning:

Assertive behavior may not be appropriate in all workplaces. Some organizational and national cultures may
prefer people to be passive and may view assertive behavior as rude or even offensive.

Research has also suggested that gender can have a bearing on how assertive behavior is perceived, with men
more likely to be rewarded for being assertive than women. So, it pays to consider the context in which you
work before you start changing your behavior.

The Benefits of Being Assertive

One of the main benefits of being assertive is that it can help you to become more self-confident, as you gain a
better understanding of who you are and the value that you offer.

Assertiveness provides several other benefits that can help you both in your workplace and in other areas of your
life. In general, assertive people:

 Make great managers. They get things done by treating people with fairness and respect, and are treated by others
the same way in return. This means that they are often well-liked and seen as leaders that people want to work
with.
 Negotiate successful "win-win" solutions. They are able to recognize the value of their opponent's position and
can quickly find common ground with him.
 Are better doers and problem solvers. They feel empowered to do whatever it takes to find the best solution to
the problems that they encounter.
 Are less anxious and stressed. They are self-assured and don't feel threatened or victimized when things don't go
as planned or as expected.

Tip:

The LADDER mnemonic is an effective way of assertively resolving problems. You can read about it in our
Bite-Sized Training™ session on Assertiveness, here.

How to Become More Assertive

It's not easy to become more assertive, but it is possible. So, if your disposition tends to be more passive or
aggressive, then it's a good idea to work on the following areas to help you to get the balance right:

1. Value Yourself and Your Rights

To be more assertive, you need to gain a good understanding of yourself
, as well as a strong belief in your inherent value and your value
to your organization and team.
This self-belief is the basis of self-confidence
and assertive behavior. It will help you to recognize that you deserve to be treated with dignity and respect, give
you the confidence to stick up for your rights and protect them, and remain true to yourself
, your wants and your needs.
Tip:

While self-confidence is an important aspect of assertiveness, it's crucial that you make sure that it doesn't
develop into a sense of self-importance. Your rights, thoughts, feelings, needs, and desires are just as important
as everyone else's, but not more important than anyone else's.
2. Voice Your Needs and Wants Confidently

If you're going to perform to your full potential then you need to make sure that your priorities – your needs and
wants – are met.

Don't wait for someone else to recognize what you need. You might wait forever! Take the initiative and start to
identify the things that you want now. Then, set goals so that you can achieve them.

Once you've done this, you can tell your boss or your colleague exactly what it is that you need from them to
help you to achieve these goals in a clear and confident way. And don't forget to stick to your guns. Even if what
you want isn't possible right now, ask (politely) whether you can revisit your request in six months time.

Find ways to make requests that avoid sacrificing others' needs. Remember, you want people to help you, and
asking for things in an overly aggressive or pushy way is likely to put them off doing this and may even damage
your relationship.

3. Acknowledge That You Can't Control Other People's Behavior

Don't make the mistake of accepting responsibility for how people react to your assertiveness. If they, for
example, act angry or resentful toward you, try to avoid reacting to them in the same way.

Remember that you can only control yourself and your own behavior, so do your best to stay calm and measured
if things get tense. As long as you are being respectful and not violating someone else's needs, then you have the
right to say or do what you want.

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4. Express Yourself in a Positive Way

It's important to say what's on your mind, even when you have a difficult or negative issue to deal with. But you
must do it constructively and sensitively.

Don't be afraid to stand up for yourself and to confront people who challenge you and/or your rights. You can
even allow yourself to be angry! But remember to control your emotions and to stay respectful at all times.

5. Be Open to Criticism and Compliments

Accept both positive and negative feedback graciously, humbly

and positively.

If you don't agree with criticism that you receive then you need to be prepared to say so, but without getting
defensive or angry. The Feedback Matrix

is a great tool that can help you to see past your emotional reactions to feedback, and instead use it to achieve
significant, positive change.

6. Learn to Say "No"

Saying "No"
is hard to do, especially when you're not used to doing it, but it's vital if you want to become more assertive.

Knowing your own limits

and how much work you are able to take on will help you to manage your tasks more effectively, and to pinpoint
any areas of your job that make you feel as though you're being taken advantage of.

Remember that you can't possibly do everything or please everyone, so it's important that you protect your time
and your workload by saying "no" when necessary. When you do have to say "no," try to find a win-win solution

that works for everyone.

7. Use Assertive Communication Techniques

There are a number of simple but effective communication techniques that you can use to become more
assertive. These are:

Use "I" Statements

Use "I want", "I need" or "I feel" to convey basic assertions and get your point across firmly. For example, "I
feel strongly that we need to bring in a third party to mediate this disagreement."

Empathy

Always try to recognize and understand

how the other person views the situation. Then, after taking her point of view into consideration, express what
you need from her.

For example, "I understand that you're having trouble working with Arlene, but this project needs to be
completed by Friday. Let's all sit down and come up with a plan together."

Escalation

If your first attempts at asserting yourself have been unsuccessful, then you may need to escalate the matter
further. This means becoming firmer (though still polite and respectful) with the person who you are requesting
help from, and may end in you telling him what you will do next if you still aren't satisfied.

For example, "John, this is the third time this week I've had to speak to you about arriving late. If you're late
once more this month, I will activate the disciplinary process."

However, remember that, regardless of the consequences that you communicate to the person in question, you
may still not get what you want in the end. If this is the case, you may need to take further action by setting up a
formal meeting

to talk about the problem, or escalating your concerns to Human Resources (HR) or your boss.

Ask for More Time

Sometimes, it's best not to say anything. You might be too emotional or you might not know what it is that you
want yet.
If this is the case, be honest and tell the person that you need a few minutes to compose your thoughts. For
example, you might say "Dave, your request has caught me off guard. I'll get back to you within the half hour."

Change Your Verbs

Try using verbs that are more definite and emphatic when you communicate. This will help you to send a clear
message and avoid "sugar-coating" your message so much that people are left confused by what it is that you
want from them.

To do this, use verbs like "will" instead of "could" or "should," "want" instead of "need," or "choose to" instead
of "have to."

For example:

"I will be going on vacation next week, so I will need someone to cover my workload."

"I want to go on this training course because I believe that it will help me to progress in my role and my career."

"I choose this option because I think it will prove to be more successful than the other options on the table."

Be a Broken Record

Prepare the message that you want to convey ahead of time.

If, for instance, you can't take on any more work, be direct and say, "I cannot take on any more projects right
now." If people still don't get the message, then keep restating your message using the same language, and don't
relent. Eventually they will likely realize that you really mean what you're saying.

For example:

"I'd like you to work on the Clancy project."

"I cannot take on any more projects right now."

"I'll pay extra for you to do it."

"I cannot take on any more projects right now."

"Seriously, this is really important. My boss insists that this gets done."

"I cannot take on any more projects right now."

"Will you do it as a personal favor?"

"I'm sorry, I value our relationship but I simply cannot take on any more projects right now."

Tip:

Be careful with the broken record technique. If you use it to protect yourself from exploitation, that's good. But if
you use it to bully someone into taking action that's against their interests, it can be manipulative and dishonest.
Scripting

It can often be hard to know how to put your feelings across clearly and confidently to someone when you need
to assert yourself. The scripting technique can help here. It allows you to prepare what you want to say in
advance, using a four-pronged approach that describes:

1. The event. Tell the other person exactly how you see the situation or problem.

"Janine, the production costs this month are 23 percent higher than average. You didn't give me any
indication of this, which meant that I was completely surprised by the news."

2. Your feelings. Describe how you feel about the situation and express your emotions clearly.

"This frustrates me, and makes me feel like you don't understand or appreciate how important financial
controls are in the company."

3. Your needs. Tell the other person exactly what you need from her so that she doesn't have to guess.

"I need you to be honest with me, and let me know when we start going significantly over budget on
anything."

4. The consequences. Describe the positive impact that your request will have for the other person or the
company if your needs are met successfully.

"If you do this we will be in a good position to hit our targets and may get a better end-of-year bonus."

Key Points

Being assertive means finding the right balance between passivity (not assertive enough) and aggression (angry
or hostile behavior). It means having a strong sense of yourself and your value, and acknowledging that you
deserve to get what you want. And it means standing up for yourself even in the most difficult situations.

What being assertive doesn't mean is acting in your own interest without considering other people's rights,
feelings, desires, or needs – that is aggression.

You can learn to be more assertive over time by identifying your needs and wants, expressing them in a positive
way, and learning to say "no" when you need to. You can also use assertive communication techniques to help
you to communicate your thoughts and feelings firmly and directly.

It likely won't happen overnight but, by practising these techniques regularly, you will slowly build up the
confidence and self-belief that you need to become assertive. You'll also likely find that you become more
productive, efficient and respected, too.

Rational Emotive Behavior Therapy

What is rational emotive therapy?

Rational emotive behavior therapy (REBT) is a type of therapy introduced by Albert Ellis in the 1950s. It’s an
approach that helps you identify irrational beliefs and negative thought patterns that may lead to emotional or
behavioral issues.
Once you’ve identified these patterns, a therapist will help you develop strategies to replace them with more
rational thought patterns.

REBT can be particularly helpful for people living with a variety of issues, including:

 depression
 anxiety
 addictive behaviors
 phobias
 overwhelming feelings of anger, guilt, or rage
 procrastination
 disordered eating habits
 aggression
 sleep problems

Read on to learn more about REBT, including its core principles and effectiveness.

What are the principles of REBT?

REBT is grounded in the idea that people generally want to do well in life. For example, you probably want to
achieve your goals and find happiness. But sometimes, irrational thoughts and feelings get in the way. These
beliefs can influence how you perceive circumstances and events — usually not for the better.

Imagine you’ve texted someone you’ve been dating for a month. You see they’ve read the message, but several
hours pass with no reply. By the next day, they still haven’t replied. You might start to think that they’re
ignoring you because they don’t want to see you.

You might also tell yourself that you did something wrong when you last saw them, you may then tell yourself
that relationships never work out and that you will be alone for the rest of your life.

Here’s how this example illustrates the core principles — called the ABCs — of REBT:

 A refers to the (a)ctivating event or situation that triggers a negative reaction or response. In this example, the A is
the lack of reply.
 B refers to the (b)eliefs or irrational thoughts you might have about an event or situation. The B in the example is
the belief that they don’t want to see you anymore or that you’ve done something wrong and that you will be alone
for the rest of your life.
 C refers to the (c)onsequences, often the distressing emotions, that result from the irrational thoughts or beliefs. In
this example, that might include feelings of worthlessness or not being good enough.

In this scenario, REBT would focus on helping you to reframe how you think about why the person didn’t
respond. Maybe they were busy or simply forgot to respond. Or maybe they aren’t interested in meeting you
again; if so, that doesn’t mean there’s something wrong with you or that you will spend the rest of your life
alone.

What techniques are used in REBT?

REBT uses three main types of techniques, which correspond with the ABCs. Each therapist might use a slightly
different combination of techniques depending on both their past clinical experiences and your symptoms.

Problem-solving techniques

These strategies can help address the activating event (A).

They often include working to develop:

  problem-solving skills
 assertiveness
 social skills
 decision-making skills
 conflict resolution skills

Cognitive restructuring techniques

These strategies help you to change irrational beliefs (B).

They might include:

 logical or rationalizing techniques

 guided imagery and visualization
 reframing, or looking at events in a different way
 humor and irony
 exposure to a feared situation
 disputing irrational thoughts

Coping techniques

Coping techniques can help you better manage the emotional consequences (C) of irrational thoughts.

These coping techniques may include:

 relaxation
 hypnosis
 meditation

Regardless of the techniques they use, your therapist will also likely give you some work to do on your own
between sessions. This gives you a chance to apply the skills you learn in a session to your daily lie. For
example, they might have you write down how you feel after experiencing something that usually makes you
feel anxious and think about how your response made you feel.

How does REBT compare to CBT?

There’s some debate among experts about the relationship between REBT and cognitive behavioral therapy
(CBT). Some see REBT as a type of REBT, while others argue that they’re two very distinct approaches.

While CBT and REBT are based on similar principles, they have several key differences. Both approaches work
to help you accept and change irrational thoughts that cause distress. But REBT places a little more emphasis on
the acceptance part.

The creator of REBT refers to this element of treatment as unconditional self-acceptance. This involves trying to
avoid self-judgement and recognizing that humans, including you, can and will make mistakes.

REBT is also unique because it sometimes uses humor as a therapeutic tool to help you take things less seriously
or look at things differently. This might involve cartoons, humorous songs, or irony.

REBT also makes a point of addressing secondary symptoms, such as becoming anxious about experiencing
anxiety or feeling depressed about having depression.

Rational emotive behavior therapy

 Rational emotive behavior therapy (REBT), previously called rational therapy and rational emotive
therapy, is an active-directive, philosophically and empirically based psychotherapy, the aim of which is to
resolve emotional and behavioral problems and disturbances and to help people to lead happier and more
fulfilling lives.[1] REBT was created and developed by the American psychotherapist and psychologist Albert
Ellis, who was inspired by many of the teachings of Asian, Greek, Roman and modern philosophers.[2][3] REBT is
the first form of cognitive behavioral therapy (CBT) and was first expounded by Ellis in the mid-1950s;
development continued until his death in 2007.[4][5][6] Ellis became synonymous with the highly influential
therapy. Psychology Today noted, "No individual—not even Freud himself—has had a greater impact on modern
psychotherapy.[7]

History

Rational emotive behavior therapy (REBT) is both a psychotherapeutic system of theory and practices and a
school of thought established by Albert Ellis. Ellis first presented his ideas at a conference of the American
Psychological Association in 1956[8] then published a seminal article in 1957 entitled "Rational psychotherapy
and individual psychology", in which he set the foundation for what he was calling rational therapy (RT) and
carefully responded to questions from Rudolf Dreikurs and others about the similarities and differences with
Alfred Adler's Individual psychology.[9] This was around a decade before psychiatrist Aaron Beck first set forth
his "cognitive therapy", after Ellis had contacted him in the mid 1960s. Ellis' own approach was renamed to
Rational Emotive Therapy in 1959, then to the current term in 1992.

Precursors of certain fundamental aspects of rational emotive behavior therapy have been identified in ancient
philosophical traditions, particularly Stoicism.[10] In his first major book on rational therapy, Ellis wrote that the
central principle of his approach, that people are rarely emotionally affected by external events but rather by their
thinking about such events, "was originally discovered and stated by the ancient Stoic philosophers". [11] Ellis
illustrates this with a quote from the Enchiridion of Epictetus: "Men are disturbed not by things, but by the views
which they take of them." Ellis noted that Shakespeare expressed a similar thought in Hamlet: "There's nothing
good or bad but thinking makes it so." [12] Ellis also acknowledges early 20th century therapists, particularly Paul
Charles Dubois, though he only read his work several years after developing his therapy.[10]

Theoretical assumptions
See also: Cognitive therapy § Cognitive model

A fundamental premise of REBT is humans do not get emotionally disturbed by unfortunate circumstances, but
by how they construct their views of these circumstances through their language, evaluative beliefs, meanings
and philosophies about the world, themselves and others. [13] This concept has been attributed as far back as the
Roman philosopher Epictetus, who is often cited as utilizing similar ideas in antiquity. [10][14] In REBT, clients
usually learn and begin to apply this premise by learning the A-B-C-D-E-F model of psychological disturbance
and change. The A-B-C model states that it is not an A, adversity (or activating event) that cause disturbed and
dysfunctional emotional and behavioral Cs, consequences, but also what people B, irrationally believe about the
A, adversity. A, adversity can be an external situation, or a thought, a feeling or other kind of internal event, and
it can refer to an event in the past, present, or future.[15]

Where the following letters represent the following meanings in this model

A – The adversity

B – The developed belief in the person of the A Adversity

C – The consequences of that person's Beliefs i.e., B

D – The person's disputes of A, B, and C. In latter thought

 E – The effective new philosophy or belief that develops in that person through the occurrence of D in their minds
of A and B

F – The developed feelings of one's self either at point and after point C or at point after point E.

The Bs, irrational beliefs that are most important in the A-B-C model are explicit and implicit philosophical
meanings and assumptions about events, personal desires, and preferences. The Bs, beliefs that are most
significant are highly evaluative and consist of interrelated and integrated cognitive, emotional and behavioral
aspects and dimensions. According to REBT, if a person's evaluative B, belief about the A, activating event is
rigid, absolutistic, fictional and dysfunctional, the C, the emotional and behavioral consequence, is likely to be
self-defeating and destructive. Alternatively, if a person's belief is preferential, flexible and constructive, the C,
the emotional and behavioral consequence is likely to be self-helping and constructive.

Through REBT, by understanding the role of their mediating, evaluative and philosophically based illogical,
unrealistic and self-defeating meanings, interpretations and assumptions in disturbance, individuals can learn to
identify them, then go to D, disputing and questioning the evidence for them. At E, effective new philosophy,
they can recognize and reinforce the notion no evidence exists for any psychopathological must, ought or should
and distinguish them from healthy constructs, and subscribe to more constructive and self-helping philosophies.
[16]
This new reasonable perspective leads to F, new feelings and behaviors appropriate to the A they are
addressing in the exercise.

The REBT framework assumes that humans have both innate rational (meaning self-helping, socially helping,
and constructive) and irrational (meaning self-defeating, socially defeating, and unhelpful) tendencies and
leanings. REBT claims that people to a large degree consciously and unconsciously construct emotional
difficulties such as self-blame, self-pity, clinical anger, hurt, guilt, shame, depression and anxiety, and behaviors
and behavior tendencies like procrastination, compulsiveness, avoidance, addiction and withdrawal by the means
of their irrational and self-defeating thinking, emoting and behaving.[17] REBT is then applied as an educational
process in which the therapist often active-directively teaches the client how to identify irrational and self-
defeating beliefs and philosophies which in nature are rigid, extreme, unrealistic, illogical and absolutist, and
then to forcefully and actively question and dispute them and replace them with more rational and self-helping
ones. By using different cognitive, emotive and behavioral methods and activities, the client, together with help
from the therapist and in homework exercises, can gain a more rational, self-helping and constructive rational
way of thinking, emoting and behaving. One of the main objectives in REBT is to show the client that whenever
unpleasant and unfortunate activating events occur in people's lives, they have a choice of making themselves
feel healthily and self-helpingly sorry, disappointed, frustrated, and annoyed, or making themselves feel
unhealthily and self-defeatingly horrified, terrified, panicked, depressed, self-hating and self-pitying. [18] By
attaining and ingraining a more rational and self-constructive philosophy of themselves, others and the world,
people often are more likely to behave and emote in more life-serving and adaptive ways.

Albert Ellis[18] posits three major insights of REBT:

Insight 1 – People seeing and accepting the reality that their emotional disturbances at point C are only partially
caused by the activating events or adversities at point A that precede C. Although A contributes to C, and
although disturbed Cs (such as feelings of panic and depression) are much more likely to follow strong negative
As (such as being assaulted or raped), than they are to follow weak As (such as being disliked by a stranger), the
main or more direct cores of extreme and dysfunctional emotional disturbances (Cs) are people's irrational
beliefs—the "absolutistic" (inflexible) "musts" and their accompanying inferences and attributions that people
strongly believe about the activating event.

Insight 2 – No matter how, when, and why people acquire self-defeating or irrational beliefs (i.e. beliefs that are
the main cause of their dysfunctional emotional-behavioral consequences), if they are disturbed in the present,
they tend to keep holding these irrational beliefs and continue upsetting themselves with these thoughts. They do
so not because they held them in the past, but because they still actively hold them in the present (often
unconsciously), while continuing to reaffirm their beliefs and act as if they are still valid. In their minds and
hearts, the troubled people still follow the core "musturbatory" philosophies they adopted or invented long ago,
or ones they recently accepted or constructed.

Insight 3 – No matter how well they have gained insights 1 and 2, insight alone rarely enables people to undo
their emotional disturbances. They may feel better when they know, or think they know, how they became
disturbed, because insights can feel useful and curative. But it is unlikely that people will actually get better and
stay better unless they have and apply insight 3, which is that there is usually no way to get better and stay better
except by continual work and practice in looking for and finding one’s core irrational beliefs; actively,
energetically, and scientifically disputing them; replacing one's absolute "musts" (rigid requirements about how
things should be) with more flexible preferences; changing one's unhealthy feelings to healthy, self-helping
emotions; and firmly acting against one’s dysfunctional fears and compulsions. Only by a combined cognitive,
emotive, and behavioral, as well as a quite persistent and forceful attack on one's serious emotional problems, is
one likely to significantly ameliorate or remove them, and keep them removed.

Insight 4 – That in order for point D to occur in ones life often circumstances need to occur or transpire in order
for the dispute in ones self and ones own emotions to happen. This way the dispute is reinforced by actions taken
by the self if the action is strong enough. However if this is not executed by others with the person in affect not
aware of what is going on the situation could become dangerous or life threatening by the person being treated.

Regarding cognitive-affective-behavioral processes in mental functioning and dysfunctioning, originator Albert

Ellis explains:[18]

"REBT assumes that human thinking, emotion, and action are not really separate or disparate processes, but that
they all significantly overlap and are rarely experienced in a pure state. Much of what we call emotion is nothing
more nor less than a certain kind — a biased, prejudiced, or strongly evaluative kind — of thought. But emotions
and behaviors significantly influence and affect thinking, just as thinking influences emotions and behaviors.
Evaluating is a fundamental characteristic of human organisms and seems to work in a kind of closed circuit
with a feedback mechanism: First, perception biases response, and then response tends to bias subsequent
perception. Also, prior perceptions appear to bias subsequent perceptions, and prior responses appear to bias
subsequent responses. What we call feelings almost always have a pronounced evaluating or appraisal element."

REBT then generally proposes that many of these self-defeating cognitive, emotive and behavioral tendencies
are both innately biological and indoctrinated early in and during life, and further grow stronger as a person
continually revisits, clings and acts on them. Ellis alludes to similarities between REBT and the general
semantics when explaining the role of irrational beliefs in self-defeating tendencies, citing Alfred Korzybski as a
significant modern influence on this thinking.[19]

REBT differs from other clinical approaches like psychoanalysis in that it places little emphasis on exploring the
past, but instead focuses on changing the current evaluations and philosophical thinking-emoting and behaving
in relation to themselves, others and the conditions under which people live.

Psychological dysfunction

One of the main pillars of REBT is that irrational and dysfunctional ways and patterns of thinking, feeling and
behaving are contributing to much, though hardly all, human disturbance and emotional and behavioral self-
defeatism and social defeatism. REBT generally teaches that when people turn flexible preferences, desires and
wishes into grandiose, absolutistic and fatalistic dictates, this tends to contribute to disturbance and upset. These
dysfunctional patterns are examples of cognitive distortions.

Rigid demands that humans make

REBT commonly posits that at the core of irrational beliefs there often are explicit or implicit rigid demands and
commands, and that extreme derivatives like awfulizing, frustration intolerance, people deprecation and over-
generalizations are accompanied by these.[15] According to REBT the core dysfunctional philosophies in a
person's evaluative emotional and behavioral belief system, are also very likely to contribute to unrealistic,
arbitrary and crooked inferences and distortions in thinking. REBT therefore first teaches that when people in an
insensible and devout way overuse absolutistic, dogmatic and rigid "shoulds", "musts", and "oughts", they tend
to disturb and upset themselves.

Over-generalization

Further REBT generally posits that disturbed evaluations to a large degree occur through over-generalization,
wherein people exaggerate and globalize events or traits, usually unwanted events or traits or behavior, out of
context, while almost always ignoring the positive events or traits or behaviors. For example, awfulizing is partly
mental magnification of the importance of an unwanted situation to a catastrophe or horror, elevating the rating
of something from bad to worse than it should be, to beyond totally bad, worse than bad to the intolerable and to
a "holocaust". The same exaggeration and overgeneralizing occurs with human rating, wherein humans come to
be arbitrarily and axiomatically defined by their perceived flaws or misdeeds. Frustration intolerance then occurs
when a person perceives something to be too difficult, painful or tedious, and by doing so exaggerates these
qualities beyond one's ability to cope with them.

Secondary disturbances

Essential to REBT theory is also the concept of secondary disturbances which people sometimes construct on top
of their primary disturbance. As Ellis emphasizes:[18]

"Because of their self-consciousness and their ability to think about their thinking, they can very easily disturb
themselves about their disturbances and can also disturb themselves about their ineffective attempts to overcome
their emotional disturbances."

Mental wellness

As would be expected, REBT argues that mental wellness and mental health to a large degree results from an
adequate amount of self-helping, flexible, logico-empirical ways of thinking, emoting and behaving. [17] When a
perceived undesired and stressful activating event occurs, and the individual is interpreting, evaluating and
reacting to the situation rationally and self-helpingly, then the resulting consequence is, according to REBT,
likely to be more healthy, constructive and functional. This does not by any means mean that a relatively un-
disturbed person never experiences negative feelings, but REBT does hope to keep debilitating and un-healthy
emotions and subsequent self-defeating behavior to a minimum. To do this, REBT generally promotes a flexible,
un-dogmatic, self-helping and efficient belief system and constructive life philosophy about adversities and
human desires and preferences.

REBT clearly acknowledges that people, in addition to disturbing themselves, also are innately constructivists.
Because they largely upset themselves with their beliefs, emotions and behaviors, they can be helped to, in a
multimodal manner, dispute and question these and develop a more workable, more self-helping set of
constructs.

REBT generally teaches and promotes:

 That the concepts and philosophies of life of unconditional self-acceptance, other-acceptance, and life-acceptance
are effective philosophies of life in achieving mental wellness and mental health.
 That human beings are inherently fallible and imperfect and that they are better served by accepting their and other
human being's totality and humanity, while at the same time they may not like some of their behaviors and
characteristics. That they are better off not measuring their entire self or their "being" and give up the narrow,
grandiose and ultimately destructive notion to give themselves any global rating or report card. This is partly
because all humans are continually evolving and are far too complex to accurately rate; all humans do both self-
defeating / socially defeating and self-helping / socially helping deeds, and have both beneficial and un-beneficial
 attributes and traits at certain times and in certain conditions. REBT holds that ideas and feelings about self-worth
are largely definitional and are not empirically confirmable or falsifiable.
 That people had better accept life with its hassles and difficulties not always in accordance with their wants, while
trying to change what they can change and live as elegantly as possible with what they cannot change.

REBT intervention

As explained, REBT is a therapeutic system of both theory and practice; generally one of the goals of REBT is to
help clients see the ways in which they have learned how they often needlessly upset themselves, teach them
how to "un-upset" themselves and then how to empower themselves to lead happier and more fulfilling lives. [13]
The emphasis in therapy is generally to establish a successful collaborative therapeutic working alliance based
on the REBT educational model. Although REBT teaches that the therapist or counsellor is better served by
demonstrating unconditional other-acceptance or unconditional positive regard, the therapist is not necessarily
always encouraged to build a warm and caring relationship with the client. The tasks of the therapist or counselor
include understanding the client’s concerns from his point of reference and work as a facilitator, teacher and
encourager.

In traditional REBT, the client together with the therapist, in a structured active-directive manner, often work
through a set of target problems and establish a set of therapeutic goals. In these target problems, situational
dysfunctional emotions, behaviors and beliefs are assessed in regards to the client's values and goals. After
working through these problems, the client learns to generalize insights to other relevant situations. In many
cases after going through a client's different target problems, the therapist is interested in examining possible
core beliefs and more deep rooted philosophical evaluations and schemas that might account for a wider array of
problematic emotions and behaviors.[15] Although REBT much of the time is used as a brief therapy, in deeper
and more complex problems, longer therapy is promoted.

In therapy, the first step often is that the client acknowledges the problems, accepts emotional responsibility for
these and has willingness and determination to change. This normally requires a considerable amount of insight,
but as originator Albert Ellis[18] explains:

"Humans, unlike just about all the other animals on earth, create fairly sophisticated languages which not only
enable them to think about their feeling, their actions, and the results they get from doing and not doing certain
things, but they also are able to think about their thinking and even think about thinking about their thinking."

Through the therapeutic process, REBT employs a wide array of forceful and active, meaning multimodal and
disputing, methodologies. Central through these methods and techniques is the intent to help the client challenge,
dispute and question their destructive and self-defeating cognitions, emotions and behaviors. The methods and
techniques incorporate cognitive-philosophic, emotive-evocative-dramatic, and behavioral methods for
disputation of the client's irrational and self-defeating constructs and helps the client come up with more rational
and self-constructive ones. REBT seeks to acknowledge that understanding and insight are not enough; in order
for clients to significantly change, they need to pinpoint their irrational and self-defeating constructs and work
forcefully and actively at changing them to more functional and self-helping ones.

REBT posits that the client must work hard to get better, and in therapy this normally includes a wide array of
homework exercises in day-to-day life assigned by the therapist. The assignments may for example include
desensitization tasks, i.e., by having the client confront the very thing he or she is afraid of. By doing so, the
client is actively acting against the belief that often is contributing significantly to the disturbance.

Another factor contributing to the brevity of REBT is that the therapist seeks to empower the client to help
himself through future adversities. REBT only promotes temporary solutions if more fundamental solutions are
not found. An ideal successful collaboration between the REBT therapist and a client results in changes to the
client's philosophical way of evaluating himself or herself, others, and his or her life, which will likely yield
effective results. The client then moves toward unconditional self-acceptance, other-acceptance and life-
acceptance while striving to live a more self-fulfilling and happier life.
Efficacy

REBT and CBT in general have a substantial and strong research base to verify and support both their
psychotherapeutic efficiency and their theoretical underpinnings. A great quantity of scientific empirical studies
has proven REBT to be an effective and efficient treatment for many kinds of psychopathology, conditions and
problems.[18][20][21][22] A vast amount of outcome and experimental studies support the effectiveness of REBT and
CBT.[23][24] Recently, REBT randomized clinical trials have offered a positive view on the efficacy of REBT. [25]

In general REBT is arguably one of the most investigated theories in the field of psychotherapy and a large
amount of clinical experience and a substantial body of modern psychological research have validated and
substantiated many of REBTs theoretical assumptions on personality and psychotherapy.[21][25][26]

Limitations and critique

The clinical research on REBT has been criticized both from within and by others. For instance, originator
Albert Ellis has on occasions emphasized the difficulty and complexity of measuring psychotherapeutic
effectiveness, because many studies only tend to measure whether clients merely feel better after therapy instead
of them getting better and staying better. [17] Ellis has also criticized studies for having limited focus primarily to
cognitive restructuring aspects, as opposed to the combination of cognitive, emotive and behavioral aspects of
REBT.[21] As REBT has been subject to criticisms during its existence, especially in its early years, REBT
theorists have a long history of publishing and addressing those concerns. It has also been argued by Ellis and by
other clinicians that REBT theory on numerous occasions has been misunderstood and misconstrued both in
research and in general.[25]

Some have criticized REBT for being harsh, formulaic and failing to address deep underlying problems. [26]
REBT theorists have argued in reply that a careful study of REBT shows that it is both philosophically deep,
humanistic and individualized collaboratively working on the basis of the client’s point of reference. [13][26] They
have further argued that REBT utilizes an integrated and interrelated methodology of cognitive, emotive-
experiential and behavioral interventions.[13][21] Others have questioned REBTs view of rationality, both radical
constructivists who have claimed that reason and logic are subjective properties and those who believe that
reason can be objectively determined. [26] REBT theorists have argued in reply that REBT raises objections to
clients' irrational choices and conclusions as a working hypothesis and through collaborative efforts demonstrate
the irrationality on practical, functional and social consensual grounds. [18][26] In 1998 when asked what the main
criticism on REBT was, Albert Ellis replied that it was the claim that it was too rational and not dealing
sufficiently enough with emotions. He repudiated the claim by saying that REBT on the contrary emphasizes that
thinking, feeling, and behaving are interrelated and integrated, and that it includes a vast amount of both
emotional and behavioural methods in addition to cognitive ones.[27]

Ellis has himself in very direct terms criticized opposing approaches such as psychoanalysis, transpersonal
psychology and abreactive psychotherapies in addition to on several occasions questioning some of the doctrines
in certain religious systems, spiritualism and mysticism. Many, including REBT practitioners, have warned
against dogmatizing and sanctifying REBT as a supposedly perfect psychological panacea. Prominent REBTers
have promoted the importance of high quality and programmatic research, including originator Ellis, a self-
proclaimed "passionate skeptic". He has on many occasions been open to challenges and acknowledged errors
and inefficiencies in his approach and concurrently revised his theories and practices. [18][26] In general, with
regard to cognitive-behavioral psychotherapies' interventions, others have pointed out that as about 30–40% of
people are still unresponsive to interventions, that REBT could be a platform of reinvigorating empirical studies
on the effectiveness of the cognitive-behavioral models of psychopathology and human functioning.[25]

REBT has been developed, revised and augmented through the years as understanding and knowledge of
psychology and psychotherapy have progressed. This includes its theoretical concepts, practices and
methodology. The teaching of scientific thinking, reasonableness and un-dogmatism has been inherent in REBT
as an approach, and these ways of thinking are an inextricable part of REBT's empirical and skeptical nature.
Applications and interfaces

Applications and interfaces of REBT are used with a broad range of clinical problems in traditional
psychotherapeutic settings such as individual-, group- and family therapy. It is used as a general treatment for a
vast number of different conditions and psychological problems normally associated with psychotherapy.

In addition, REBT is used with non-clinical problems and problems of living through counselling, consultation
and coaching settings dealing with problems including relationships, social skills, career changes, stress
management, assertiveness training, grief, problems with aging, money, weight control etc. More recently, the
reported use of REBT in sport and exercise settings has grown, [28] with the efficacy of REBT demonstrated
across a range of sports.

REBT also has many interfaces and applications through self-help resources, phone and internet counseling,
workshops & seminars, workplace and educational programmes, etc. This includes Rational Emotive Education
(REE) where REBT is applied in education settings, Rational Effectiveness Training in business and work-
settings and SMART Recovery (Self Management And Recovery Training) in supporting those in addiction
recovery, in addition to a wide variety of specialized treatment strategies and applications.

Cognitive therapy
Cognitive therapy (CT) is a type of psychotherapy developed by American psychiatrist Aaron T. Beck. CT is
one of the therapeutic approaches within the larger group of cognitive behavioral therapies (CBT) and was first
expounded by Beck in the 1960s. Cognitive therapy is based on the cognitive model, which states that thoughts,
feelings and behavior are all connected, and that individuals can move toward overcoming difficulties and
meeting their goals by identifying and changing unhelpful or inaccurate thinking, problematic behavior, and
distressing emotional responses. This involves the individual working collaboratively with the therapist to
develop skills for testing and modifying beliefs, identifying distorted thinking, relating to others in different
ways, and changing behaviors.[1] A tailored cognitive case conceptualization is developed by the cognitive
therapist as a roadmap to understand the individual's internal reality, select appropriate interventions and identify
areas of distress.

History

Becoming disillusioned with long-term psychodynamic approaches based on gaining insight into unconscious
emotions and drives, Beck came to the conclusion that the way in which his patients perceived, interpreted and
attributed meaning in their daily lives—a process scientifically known as cognition—was a key to therapy.[2]
Albert Ellis had been working on similar ideas since the 1950s (Ellis, 1956). He called his approach Rational
Therapy (RT) at first, then Rational Emotive Therapy (RET) and later Rational Emotive Behavior Therapy
(REBT).

Beck outlined his approach in Depression: Causes and Treatment in 1967. He later expanded his focus to
include anxiety disorders, in Cognitive Therapy and the Emotional Disorders in 1976, and other disorders and
problems.[3] He also introduced a focus on the underlying "schema"—the fundamental underlying ways in which
people process information—about the self, the world or the future.

The new cognitive approach came into conflict with the behaviorism ascendant at the time, which denied that
talk of mental causes was scientific or meaningful, rather than simply assessing stimuli and behavioral responses.
However, the 1970s saw a general "cognitive revolution" in psychology. Behavioral modification techniques and
cognitive therapy techniques became joined together, giving rise to cognitive behavioral therapy. Although
cognitive therapy has always included some behavioral components, advocates of Beck's particular approach
seek to maintain and establish its integrity as a distinct, clearly standardized form of cognitive behavioral therapy
in which the cognitive shift is the key mechanism of change.[4]

Precursors of certain fundamental aspects of cognitive therapy have been identified in various ancient
philosophical traditions, particularly Stoicism.[5] For example, Beck's original treatment manual for depression
states, "The philosophical origins of cognitive therapy can be traced back to the Stoic philosophers". [6]

As cognitive therapy continued to grow in popularity, the Academy of Cognitive Therapy, a non-profit
organization, was created to accredit cognitive therapists, create a forum for members to share emerging research
and interventions, and to educate consumer regarding cognitive therapy and related mental health issues. [7]

Basis

Therapy may consist of testing the assumptions which one makes and looking for new information that could
help shift the assumptions in a way that leads to different emotional or behavioral reactions. Change may begin
by targeting thoughts (to change emotion and behavior), behavior (to change feelings and thoughts), or the
individual's goals (by identifying thoughts, feelings or behavior that conflict with the goals). Beck initially
focused on depression and developed a list of "errors" (cognitive distortion) in thinking that he proposed could
maintain depression, including arbitrary inference, selective abstraction, over-generalization, and magnification
(of negatives) and minimization (of positives).

As an example of how CT might work: Having made a mistake at work, a man may believe, "I'm useless and
can't do anything right at work." He may then focus on the mistake (which he takes as evidence that his belief is
true), and his thoughts about being "useless" are likely to lead to negative emotion (frustration, sadness,
hopelessness). Given these thoughts and feelings, he may then begin to avoid challenges at work, which is
behavior that could provide even more evidence for him that his belief is true. As a result, any adaptive response
and further constructive consequences become unlikely, and he may focus even more on any mistakes he may
make, which serve to reinforce the original belief of being "useless." In therapy, this example could be identified
as a self-fulfilling prophecy or "problem cycle," and the efforts of the therapist and patient would be directed at
working together to explore and shift this cycle.

People who are working with a cognitive therapist often practice the use of more flexible ways to think and
respond, learning to ask themselves whether their thoughts are completely true, and whether those thoughts are
helping them to meet their goals. Thoughts that do not meet this description may then be shifted to something
more accurate or helpful, leading to more positive emotion, more desirable behavior, and movement toward the
person's goals. Cognitive therapy takes a skill-building approach, where the therapist helps the person to learn
and practice these skills independently, eventually "becoming his or her own therapist."

Cognitive model

The cognitive model was originally constructed following research studies conducted by Aaron Beck to explain
the psychological processes in depression.[8] It divides the mind beliefs in three levels:[9]

 Automatic thought
 Intermediate belief
 Core belief or basic belief

In 2014, an update of the cognitive model was proposed, called the Generic Cognitive Model (GCM). The GCM
is an update of Beck's model that proposes that mental disorders can be differentiated by the nature of their
dysfunctional beliefs.[10] The GCM includes a conceptual framework and a clinical approach for understanding
common cognitive processes of mental disorders while specifying the unique features of the specific disorders.
Consistent with the cognitive theory of psychopathology, CT is designed to be structured, directive, active, and
time-limited, with the express purpose of identifying, reality-testing, and correcting distorted cognition and
underlying dysfunctional beliefs.[11]

Cognitive restructuring (methods)

Cognitive restructuring involves four steps:[12]

1. Identification of problematic cognitions known as "automatic thoughts" (ATs) which are dysfunctional or negative
views of the self, world, or future based upon already existing beliefs about oneself, the world, or the future [13]
2. Identification of the cognitive distortions in the ATs
3. Rational disputation of ATs with the Socratic method
4. Development of a rational rebuttal to the ATs

There are six types of automatic thoughts:[12]

1. Self-evaluated thoughts
2. Thoughts about the evaluations of others
3. Evaluative thoughts about the other person with whom they are interacting
4. Thoughts about coping strategies and behavioral plans
5. Thoughts of avoidance
6. Any other thoughts that were not categorized

Other major techniques include:

 Activity monitoring and activity scheduling

 Behavioral experiments
 Catching, checking, and changing thoughts
 Collaborative empiricism: therapist and patient become investigators by examining the evidence to support or
reject the patient's cognitions. Empirical evidence is used to determine whether particular cognitions serve any
useful purpose.[14]
 Downward arrow technique
 Exposure and response prevention
 Cost benefit analysis
 acting 'as if[15]’
 Guided discovery: therapist elucidates behavioral problems and faulty thinking by designing new experiences that
lead to acquisition of new skills and perspectives. Through both cognitive and behavioral methods, the patient
discovers more adaptive ways of thinking and coping with environmental stressors by correcting cognitive
processing.[14]
 Mastery and pleasure technique
 Problem solving
 Socratic questioning: involves the creation of a series of questions to a) clarify and define problems, b) assist in the
identification of thoughts, images and assumptions, c) examine the meanings of events for the patient, and d)
assess the consequences of maintaining maladaptive thoughts and behaviors. [14]

Socratic questions are the archetypal cognitive restructuring techniques. These kinds of questions are designed to
challenge assumptions by[16][17]:

 Conceiving reasonable alternatives:

‘What might be another explanation or viewpoint of the situation? Why else did it happen?’

 Evaluating those consequences:

‘What’s the effect of thinking or believing this? What could be the effect of thinking differently and no longer
holding onto this belief?’
  Distancing:

‘Imagine a specific friend/family member in the same situation or if they viewed the situation this way, what
would I tell them?’

Examples[18] of socratic questions are:

 ‘Describe the way you formed your viewpoint originally.‘

 ‘What initially convinced you that your current view is the best one available?‘
 ‘Think of three pieces of evidence that contradict this view, or that support the opposite view. Think about the
opposite of this viewpoint and reflect on it for a moment. What's the strongest argument in favor of this opposite
view?‘
 ‘Write down any specific benefits you get from holding this belief, such as social or psychological benefits. For
example, getting to be part of a community of like-minded people, feeling good about yourself or the world,
feeling that your viewpoint is superior to others', etc Are there any reasons that you might hold this view other than
because it's true?‘
 ‘For instance, does holding this viewpoint provide some peace of mind that holding a different viewpoint would
not?‘
 ‘In order to refine your viewpoint so that it's as accurate as possible, it's important to challenge it directly on
occasion and consider whether there are reasons that it might not be true. What do you think the best or strongest
argument against this perspective is?‘
 What would you have to experience or find out in order for you to change your ‘mind about this viewpoint?‘
 Given your thoughts so far, do you think that there may be a truer, more accurate, or more nuanced version of your
original view that you could state right ‘now?‘

False assumptions are based on ‘cognitive distortions’, such as [19]:

 Always Being Right: “We are continually on trial to prove that our opinions and actions are correct. Being wrong
is unthinkable and we will go to any length to demonstrate our rightness. For example, “I don’t care how badly
arguing with me makes you feel, I’m going to win this argument no matter what because I’m right.” Being right
often is more important than the feelings of others around a person who engages in this cognitive distortion, even
loved ones.”
 Heaven’s Reward Fallacy: “We expect our sacrifice and self-denial to pay off, as if someone is keeping score. We
feel bitter when the reward doesn’t come.”

Types
Cognitive therapy

based on the cognitive model, stating that thoughts, feelings and behavior are mutually influenced by each other.
Shifting cognition is seen as the main mechanism by which lasting emotional and behavioral changes take place.
Treatment is very collaborative, tailored, skill-focused, and based on a case conceptualization.

Rational emotive behavior therapy (REBT)

based on the belief that most problems originate in irrational thought. For instance, perfectionists and pessimists
usually suffer from issues related to irrational thinking; for example, if a perfectionist encounters a small failure, he
or she might perceive it as a much bigger failure. It is better to establish a reasonable standard emotionally, so the
individual can live a balanced life. This form of cognitive therapy is an opportunity for the patient to learn of his
current distortions and successfully eliminate them.

Cognitive behavioral therapy (CBT)

a system of approaches drawing from both the cognitive and behavioral systems of psychotherapy. [20]
Unlike Psychodynamic approaches, CBT is transparent to the individual receiving services. At the end of the
therapy, an individual will often have learned the cognitive therapy skills well enough to "be their own
therapist," decreasing dependence on a therapist to provide the answers.

Application
Depression
See also: Beck's cognitive triad

According to Beck's theory of the etiology of depression, depressed people acquire a negative schema of the
world in childhood and adolescence; children and adolescents who experience depression acquire this negative
schema earlier. Depressed people acquire such schemas through a loss of a parent, rejection by peers, bullying,
criticism from teachers or parents, the depressive attitude of a parent and other negative events. When the person
with such schemas encounters a situation that resembles the original conditions of the learned schema in some
way, the negative schemas of the person are activated.[21]

Beck's negative triad holds that depressed people have negative thoughts about themselves, their experiences in
the world, and the future.[22] For instance, a depressed person might think, "I didn't get the job because I'm
terrible at interviews. Interviewers never like me, and no one will ever want to hire me." In the same situation, a
person who is not depressed might think, "The interviewer wasn't paying much attention to me. Maybe she
already had someone else in mind for the job. Next time I'll have better luck, and I'll get a job soon." Beck also
identified a number of other cognitive distortions, which can contribute to depression, including the following:
arbitrary inference, selective abstraction, overgeneralization, magnification and minimization.[21]

In 2008 Beck proposed an integrative developmental model of depression [23] that aims to incorporate research in
genetics and neuroscience of depression.[24] This model was updated in 2016 to incorporate multiple levels of
analyses, new research, and key concepts (e.g., resilience) within the framework of an evolutionary perspective.
[25]

Other applications

Cognitive therapy has been applied to a very wide range of behavioral health issues including:

 Academic achievement[26][27]
 Addiction
 Anxiety disorders[28]
 Bipolar disorder[29]
 Low self-esteem[30]
 Phobia[31]
 Schizophrenia[32]
 Substance abuse[33]
 Suicidal ideation[34]
 Weight loss[35]

Criticisms

A criticism has been that clinical studies of CBT efficacy (or any psychotherapy) are not double-blind (i.e.,
neither subjects nor therapists in psychotherapy studies are blind to the type of treatment). They may be single-
blinded, the rater may not know the treatment the patient received, but neither the patients nor the therapists are
blinded to the type of therapy given (two out of three of the persons involved in the trial, i.e., all of the persons
involved in the treatment, are unblinded). The patient is an active participant in correcting negative distorted
thoughts, thus quite aware of the treatment group they are in.[36]
Definition

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

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

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

Carl Rogers

Carl Rogers, Creator of Client-Centered Therapy

Client-centered therapy was developed in the 1930s by the American psychologist Carl Rogers. Rogers was a
humanistic psychologist who believed that how we live in the here-and-now and our current perceptions are
more important than the past. He also believed close personal relationships with a supportive environment of
warmth, genuineness, and understanding, are key for therapeutic change. Rogers used the term 'client' instead of
'patient' to refer to the equal nature of the relationship between the therapist and client in client-centered therapy.
Rogers believed people are capable of self-healing and personal growth, which leads to self-actualization, an
important concept in client-centered therapy. Self-actualization refers to the tendency of all human beings to
move forward, grow, and reach their full potential. Rogers believed self-actualization is hindered by negative,
unhealthy attitudes about the self.

Client-Centered Therapy

Client-centered therapy differs from other forms of therapy because client-centered therapy does not focus on
therapeutic techniques. What's most important in client-centered therapy is the quality of the relationship
between the therapist and the client. Client-centered therapy was not intended for a specific age group or
subpopulation, but has been used to treat a broad range of people. It has been applied for use with people
suffering from depression, anxiety, alcohol disorders, cognitive dysfunction, schizophrenia, and personality
disorders.

When people enter client-centered therapy, they are in a state of incongruence, meaning there is a difference
between how they see themselves and reality. Having an accurate self-concept (the thoughts, feelings, and
beliefs people have about themselves) is key to client-centered therapy. For example, a person may consider
himself helpful to others but often puts his own needs before the needs of others. It is the hope of client-centered
therapists to help clients reach a state of congruence or a match between self-concept and reality. Which just
means for people to see themselves as they actually are. For example, if a person considers herself a good chef,
she would not doubt herself when it comes to cooking meals. In client-centered therapy, the therapist does not
attempt to change the client's thinking in any way. The therapist merely facilitates self-actualization by providing
a comfortable environment for clients to freely engage in focused, in-depth self-exploration.
In client-centered therapy, the therapist's attitude is more important than the therapist's skills. According to
client-centered therapy, there are three therapist attitudes that determine the level of success of therapy: (1)
genuineness, (2) unconditional positive regard, and (3) empathy.

Client-centered therapy – also known as Rogerian therapy or person-centered therapy – was developed by
American psychologist Carl Rogers in the 1940s. Rogers’ impact on psychological thought and theory – as well
as clinical practice – was significant. In fact, he is regarded by many today as one of the most distinguished and
influential psychologists of the 20th century. His views on and approach to psychotherapy were considered
radical by many of his contemporaries.

Client-centered therapy is humanistic in nature. It’s based on the premise that therapy clients – rather than the
therapist – are the expert in their own lives and have the ability find their own solutions. Rather than focusing on
diagnosing their clients and probing them with questions, the primary goal of a Rogerian therapist is to help them
learn to trust themselves in finding their own way in life. The therapist focuses on helping clients become more
self-aware by acknowledging and experiencing emotions they’ve been avoiding or denying. This process is
facilitated by providing a therapeutic environment that enables clients to discover the answers they’ve been
seeking.

In client-centered therapy, the therapist believes that striking a balance between the real self (who a person is)
and the ideal self (who a person wants to be) is the key to a person’s psychological wellbeing. When there’s a
significant discrepancy between these two selves it causes problems for the person, such as unhappiness,
dissatisfaction with life, and unhealthy behaviors.

Client versus “Patient”

One of the radical aspects of Rogers’ approach to treatment was his use of the term “client” for those who came
to him for treatment. He intentionally avoided referring to them as “patients”. This was because, unlike man of
his contemporaries, Rogers’ didn’t see his therapy clients as sick individuals desperately in need of a cure for
whatever ailed them. Rather, he saw his clients as people who wanted someone to help them find their own
solutions (which he referred to as “self-direction”).

Non-directive to Client-Centered

Early on, Rogers referred to his approach to therapy as “non-directive”; in other words, the therapists’ role
wasn’t to direct the client towards a specific goal. However, he gradually recognized that a truly non-directive
stance wasn’t realistic. Most clients desire some direction from the therapist, and therapists inevitably guide
them to at least a subtle degree by virtue of the therapy process. This realization led Rogers to change the name
for his approach to “client-centered therapy”.

Unlike psychoanalysis, in which the therapist unearths and interprets clients’ unconscious conflicts, client-
centered therapists refrain from providing interpretations. They don’t attempt to give clients advice or offer
solutions. Instead, they take a non-judgmental and non-directive stance, allowing the client to steer the process
and find his or her own solutions. In fact, one of the most important aspects of client-centered therapy is the
therapists’ unconditional positive regard for their clients.

Therapy Goals

As with all forms of therapy, one of the primary goals is to decrease or, hopefully, eliminate feelings of distress.
In client-centered therapy, additional goals include:

 An increase in self-awareness
 Improved ability to use self-direction to make desired changes
 Increased clarity
  Improved self-esteem
 Greater reliance on self

Key Assumptions in Person-Centered Therapy

Rogers’ humanistic approach to therapy is evident in his assumptions about humans. He believed they are:

 Fundamentally good (rather than inherently flawed and in need of “treatment”)

 Genuinely desire to heal and make positive changes, and possess the resources within themselves to change their
attitudes, behavior, and self-concept
 Have an innate desire (or tendency) and capacity to reach their potential in life (Rogers referred to this as the “ self-
actualizing tendency”.

Aspects of a person’s personal potential include:

 An inherent desire and need to socialize with other people on a truly personal level
 Compassion towards others
 Creative expression
 Curiosity about the world
 Trusting others and being trustworthy oneself
 An openness to different experiences in life

Essential Traits of Client-Centered Therapists

In order to client-centered therapy to be optimally effective, Rogers believed that therapists need to possess the
following three traits:

 Genuine empathy – This refers to the therapist’s ability to see and understand things from the client’s perspective.
When the therapist shows an empathetic understanding of what the client is experiencing, it helps the client have a
better understanding as well.
 Unconditional positive regard – Therapists must maintain a positive and non-judgmental view of their clients.
Rogers’ believed that conditional acceptance and support from others led to some of the problems clients were
experiencing. When they felt accepted unconditionally and the fear of rejection was eliminated, clients could
openly and honestly talk about their feelings.
 Congruence – This involves the therapist’s ability to be genuine, honest, and authentic with clients. It not only
helps create a positive and comfortable atmosphere, but also provides a beneficial role model for the client.

When therapists have these traits it helps clients make positive, self-directed changes and see the world – as well
as themselves – in a more realistic and positive light.

Benefits of Client-Centered Therapy

There are multiple potential benefits for anyone who participates in client-centered therapy. They include (but
aren’t limited to):

 An increased ability to self-direct desired changes in one’s life

 Increase in self-awareness
 Much less discrepancy between the client’s real self and ideal self
 Increase in happiness and general wellbeing
 More positive and fulfilling relationships with others
 Overall reduction of negative emotions
 Greater sense of calm / reduction in overall anxiety
 Improved mood / significantly fewer or no symptoms of depression
 More positive self-esteem
 Improved ability to express oneself openly and authentically
 Increased willingness to experience new things
  Greater ability to handle stress effectively
 Healthier and more balanced perception of the world
 Greater openness to new concepts
 Decrease in maladaptive behaviors
 Stronger sense of trust in oneself
 Decrease in feelings of regret or guilt due to past mistakes

Advantages of Client-Centered Therapy

There are several advantages of client-centered therapy. They include:

 A very safe, accepting atmosphere, which is especially vital for clients who have experienced a trauma
 A strong focus on the here and now, which helps clients stop dwelling on the past or worrying about the future
 Unconditional positive regard has a powerful impact on clients, enabling them to feel – perhaps for the first time in
their life – accepted and valued for who they are rather than judged for their perceived shortcomings
 The view that the client is the expert encourages clients to search for solutions within themselves and become more
self-reliant and self-directing
 The non-directive approach greatly reduces therapy clients’ tendency to become dependent on the therapist for
answers
 Self-awareness, self-understanding, and personal growth are emphasized
 Clients are not regarded as patients who are sick and in need of being fixed or cured
 The therapeutic environment supports and promotes change
 The client – rather than the therapist – steers the therapy process
 Clients are responsible for discovering their own solutions and making changes – this empowers them, encourages
personal responsibility, and helps eliminate the victim mindset

Disadvantages and Limitations of Client-Centered Therapy

Although client-centered therapy is highly regarded by many, it’s not without its limitations and disadvantages.
Critics of this particular approach to therapy point out the following:

 It’s more beneficial for clients who are educated.

 The approach relies on an overly optimistic view of people
 The belief in people’s ability to change – especially within the context of a non-directive approach – is overly
generous
 Therapists, in their efforts to be non-directive, fail to gather sufficient information from the client to truly help
them reach their goals. Along these same lines, there is too much emphasis and reliance on the belief that the client
is the expert and has the answers within.
 Unconditional positive regard – especially when it is coming from the therapist (a person whom clients regard as
an expert or authority figure) – may inadvertently encourage or enable a client’s maladaptive behavior
 The assumption that people are fundamentally good is viewed as fundamentally flawed (and even dangerous) by
many critics of person-centered therapy. History has shown time and again that people are often selfish and don’t
always want or try to what would be considered right or moral by the general population
 Only a small number of therapists have the genuine ability to be truly humanistic in their practice
 Many therapists find it difficult to be as non-directive as this approach requires; there’s a natural tendency that
stems from the desire to help people that makes therapists vulnerable to influencing the direction and decisions of
their clients
 Unconditional positive regard, while ideal, may be hindered at times by the therapist’s own countertransference
(e.g. when clients trigger negative feelings in the therapist); it’s also not always realistic as some clients are very
difficult to work with and will challenge even the most self-aware and well-meaning therapist
 There’s a lack of empirical evidence that supports the efficacy of client-centered therapy
 Too much empathy on the part of the therapist may interfere with the therapist’s ability or willingness to challenge
the client when appropriate or necessary
 Many people seek therapy for the wrong reasons, such as validation for bad choices in attempt to alleviate guilt or
shame. Person-centered therapy doesn’t really allow therapists to challenge inappropriate, self-destructive, or
immoral behavior (It should be noted that, at least in the U.S., therapists are required by law to break
 confidentiality and take appropriate measures under circumstances, such as when a client is an imminent danger to
himself (e.g. actively suicidal) or others.)
 The actual practice of client-centered therapy is challenging for therapists due to 1) a lack of therapeutic techniques
and 2) a heavy reliance on the therapist’s ability to consistently be non-judgmental, unconditionally accepting, and
empathetic with their clients

Disorders, Condition, and Problems that may Benefit from Client-Centered Therapy

Despite the criticisms of client-centered therapy, it can be beneficial to clients who are struggling with a wide
range or psychiatric disorders or other issues, including:

 Depression
 Relationship problems
 General anxiety
 Phobias
 Panic attacks
 Substance abuse and addiction (when the client is actively involved in rehab)
 Personality disorders
 Low self-esteem associated with depression
 Schizophrenia (not indicated for individuals who are actively psychotic)
 Eating disorders
 Managing stress
 Dual diagnosis clients (when actively involved in rehab)
 Trauma recovery

It should be noted that although client-centered therapists don’t diagnose their clients or address specific
disorders per se, the approach can still be very beneficial. This is why it’s often used as part of a more
comprehensive residential or outpatient program for problems such as alcoholism, drug addiction, and eating
disorders.

Client-centered therapy can also be valuable when used in crisis intervention situations. The focus on creating a
safe, accepting atmosphere for clients makes them feel supported while helping to reduce some of the acute
stress they’re experiencing.

Who can Benefit from Client-Centered Therapy?

Rogers’ approach to treatment was designed to benefit a broad range of individuals in terms of their age,
background, and presenting problem. Individuals who are reluctant to go to therapy because they fear the
therapist will judge, confront, or criticize them often find client-centered therapy to be a welcome and more
comfortable approach. Also, individuals who prefer to have a strong say in the direction and pace of therapy find
client-centered therapy to be a good fit for them. Of course, this could be counter-productive for a client whose
primary issue is a need for control.

Client-centered therapy is also a good fit for clients who truly desire to improve their self-awareness, enhance
their self-reliance and innate problem-solving abilities.

Where to Find a Client-Centered Therapist

If you’re interested in working with a client-centered therapist, probably one of the best ways to find one is to
search online. You may need to try a few different searches, as different therapists use different terms to describe
their approach. For example, if you live in Chicago, you could search for client-centered therapy Chicago, as
well as person-centered therapy Chicago and Rogerian therapy Chicago (you can also do searches using
“therapist” in place of “therapy” when you search if needed for more results).
Carl Rogers was truly a brilliant psychologist. Despite the many criticisms and alleged disadvantages of client-
centered therapy, it’s worth considering if you feel like it may be a good fit for your personality and needs.

What is MBCT? + 28 Mindfulness-Based Cognitive

Therapy Resources
Mindfulness-based cognitive therapy is one tool that can help us learn to recognize and understand our thought
and feeling patterns, with the goal of creating new, more effective patterns.

What is Mindfulness-Based Cognitive Therapy?

Mindfulness-based cognitive therapy (MBCT) is a type of therapy born from the union of cognitive therapy and
meditative principles.

 Cognitive therapy aims to help clients grow and find relief from symptoms of mental illness through the
modification of dysfunctional thinking (Beck Institute, 2016).
 Mindfulness can be summed up as the practice and state of being aware of our thoughts, feelings, and emotions on
a continuous basis (Greater Good Science Center, 2017). Mindfulness also contributes to an acceptance of the self
as it is, without attaching value judgments to our thoughts.

The marriage of these ideas is MBCT, a powerful therapeutic tool that can be successfully applied to depression,
anxiety, bipolar disorder, and more.

For a closer look at MBCT, see one of the founders of the technique describe how MBCT can be applied to
depression.

MBCT For Treating Depression

MBCT is thought to be effective for many clients, but it has been found to be especially effective for one group
in particular: people who have suffered from multiple episodes of depression (Mental Health Foundation).

The official jury is still out, so to speak, on the effectiveness of MBCT for individuals with less chronic
depression and those who suffer from other mental ailments, but the preliminary evidence is encouraging (see
sources above).

How Does it Work?

MBCT can effectively treat mental health obstacles by applying mindfulness in all steps:

1. Mindfulness helps the client discover their own thought and mood patterns.
2. Mindfulness helps the client learn how to be present and appreciate the small pleasures of everyday life.
3. Mindfulness teaches the client how to stop the downward spiral that can emerge from a bad mood or thinking
about painful memories.
4. Mindfulness allows the client to “shift gears” from their present state of mind to one which is more aware, more
balanced, and less judgmental.
5. Mindfulness gives the client access to another approach to dealing with difficult emotions and moods
(MBCT.com).

In particular, MBCT is effective in helping clients deal with depression. The website MBCT.com lays out the three
steps through which MBCT can help:
 1. It will help you understand what depression is.
2. It will help you discover what makes you vulnerable to downward mood spirals, and why you get stuck at the
bottom of the spiral.
3. It will help you see the connection between downward spirals: High standards that oppress us or feelings that we
are simply “not good enough”, ways we put pressure on ourselves or make ourselves miserable with overwork and
ways we lose touch with what makes life worth living.

Popular MBCT Exercises and Techniques

As we’ve written about before, there are a lot of exercises to cope with mental illness and stress based on
mindfulness. In addition to exercises like mindful seeing, acceptance, and mountain meditation, there are many
techniques specifically for MBCT.

The most popular course of MBCT treatment was developed by Jon Kabat-Zinn. This treatment is an 8-week
group-based therapy program created to help clients cope with both mental and physical symptoms (Good
Therapy, 2016). Groups meet once a week for two hours and complete homework outside of class for six days a
week. Homework includes meditation practice, audio-guided mindfulness exercises, and techniques like the
three-minute breathing space (Good Therapy, 2016).

Three-Minute Breathing Space

The three-minute breathing space is a quick exercise that is undertaken in three steps:

 The first minute is spent on answering the question, “how am I doing right now?” while focusing on the feelings,
thoughts, and sensations that arise and trying to give these words and phrases.
 The second minute is spent on keeping awareness on the breath.
 The last minute is used for an expansion of attention from solely focusing on the breath, to feeling physical
sensations and how they affect the rest of the body..

Other recommended MBCT techniques are discussed below.

Body Scan

The Body Scan exercise begins with the participants lying on their backs with their palms facing up and their
feet falling slightly apart. This exercise can also be done by participants sitting on a comfortable chair with their
feet resting on the floor.

The facilitator asks the participants to lie very still for the duration of the exercise, and move deliberately and
with awareness if it becomes necessary to adjust their position.

Next, the facilitator begins guiding participants through the Body Scan. Participants begin by bringing
awareness to the breath, noticing the rhythm, and the experience of breathing in and expelling out. The facilitator
explains that participants should not try to change the way they are breathing, just hold gentle awareness on the
breath.

The facilitator guides attention to the body next: how it feels, the texture of clothing against the skin, the
contours of the surface on which the body is resting, the temperature of the body and the environment.

Participants are instructed to bring their awareness to the parts of the body that are tingling, sore, or feeling
particularly heavy or light. The facilitator asks the participants to note any areas of their body where they don’t
feel any sensations at all or, conversely, areas that are hypersensitive.

A typical body scan runs through each part of the body, paying special attention to the way each area feels. The
scan typically moves in this order:
  Toes of both feet
 The rest of the feet (top, bottom, ankle)
 Lower legs
 Knees
 Thighs
 Pelvic region- buttocks, tailbone, pelvic bone, genitals
 The abdomen
 Chest
 Lower back
 Upper back- back ribs & shoulder blades
 Hands (fingers, palms, backs, wrists)
 Arms (lower, elbows, upper)
 Neck
 Face and rest of head (jaw, mouth, nose, cheeks, ears, eyes, forehead, scalp, back & top of head)
 Blow hole (Fleming & Kocovski, 2007)
After the Body Scan is complete, participants are instructed to bring awareness back to the room when they are
ready. It is recommended that participants open their eyes slowly and move naturally to a comfortable sitting
position.

Mindfulness Stretching

Mindfulness can be practiced in many situations throughout the day, including exercise. However, rushing
straight to the exercise can be a missed opportunity to prepare both mind and body for physical exertion.

Stretching before a workout is important for several reasons, including (Crain):

 It’s a natural and instinctive movement for humans.

 Regular stretching improves flexibility and range of motion.
 Stretching improves and increases circulation by bringing a rush of oxygen to the muscles.
 It feels good to stretch!

Mindful stretching adds even more benefits, such as increased awareness and a sense of balance. You have
several options to choose from if you would like to practice mindful stretching, a few of which are listed below.

Pandiculation

Pandiculation is a fancy term for a fairly simple stretch. To try this stretch, put your palms on your shoulders (or
as close to your shoulders as you can get), raise your elbows up to shoulder height, open your mouth, and let out
a big, satisfying yawn (Crain).

Proprioceptive Neuromuscular Facilitation (PNF)

PNF is a set of guidelines rather than a specific technique. This type of stretching is based on four principles:

(1) avoid pain in your stretches,

(2) stretch slowly to avoid injury,
(3) exercise caution when stretching, and make sure to stretch the correct muscle, and
(4) stretch carefully to avoid affecting other muscles or joints (Berg, 2011).

The six parts of PNF are as follows:

 Assume the correct starting position

 Stretch until you reach the point where you feel a sting or pain in the muscle
 Relax the muscle(s)
 Tighten the muscle without moving it
 Relax again
  Stretch to the new point where you feel a sting or other pain
 You can repeat steps three through six up to six times, depending on what is right for you at the time (Berg, 2011).

Yoga Poses

There are several yoga poses that facilitate mindful stretching, and these four are recommended in particular:

 Gomukhasana: This pose involves opening the chest through the extension of the triceps and shoulders, and is
typically performed while kneeling or sitting with crossed legs.
 Side to side neck stretch: This stretch is performed by sitting and gently using your hand to pull your head to one
side at a time.
 Pigeon Pose: This pose is a fairly complicated pose, with your hips to the floor and one leg in front of you,
perpendicular to the mat, and the other leg straight out behind you. For more information on correctly executing
this pose, see the detailed explanation here.
 The Scorpion: To practice this pose, lie flat with your arms straight out to the side. Next, lift your right foot as
high as you can with the sole straight up to the ceiling. Finally, lift your right hip and reach your right foot over to
the outside of your left leg, while keeping your chest and arms on the floor. Switch legs to experience both
stretches (Crain).
Whatever technique you use, mindful stretching can be an excellent addition to MBCT.

Daily Mindfulness

Sometimes the most simple exercises can be the most helpful. In the case of MBCT, this is especially true.
Practicing mindfulness throughout the day is the best way to make sure it is woven into your life.

Mindful Showering

This exercise is an easy one for beginners. While showering, direct your attention to the temperature of the water
as it hits your body, the feel of the spray, the smell of the shampoo, and the sensation of lathered soap against
your skin. If your mind begins to wander, a common problem during showers, gently bring it back to the present
with thoughts about what you are seeing, hearing, smelling, and feeling.

Mindfully Brushing Your Teeth

Similar to mindful showering, bring your awareness to the sensations evoked by the feel of the brush. Ask
yourself how the bristles feel against your teeth, your gums, and your tongue. Focus on the taste of the toothpaste
to keep yourself in the present moment.

Mindful Eating

As mentioned earlier, we have covered mindful eating before. One helpful tip that has not yet been mentioned is
to turn off any distractions, like the computer, TV, radio, and smartphone, and allowing all of your senses to
focus on.

Mindful Dishwashing

Try this mindfulness exercise when you have only a few dishes to wash. Watch as you scrape or sponge the dirty
dishes. Notice the textures, sights, and sounds of washing dishes. You can even focus your attention on the
smell, although the desirability of this move is up for debate.

Mindfully Making Your Bed

Instead of making your bed quickly and carelessly, put effort into making the bed. Move deliberately and with
purpose. Pay attention to what you are seeing and doing. Notice the way the sheets slip across the bed and the
way the pillows look underneath the cover. Feel the different textures of the bedding, and above all, try to
immerse yourself in your current task, as mundane as it may seem.

Mindful Exercising

As covered earlier, mindful exercising is a great way to incorporate mindfulness into a healthy lifestyle. Turn
off the TV and music and bid farewell to friends and family for a few moments. Focus your awareness on how
your muscles feel, how you are moving, and the changing rate of your breath. Give yourself a full experience of
exercising without the distractions from the pain or heavy breathing that we often find ourselves trapped
with.Taking the opportunity to practice mindfulness whenever one is presented will help you to maintain a
healthy sense of awareness and balance throughout your day.

MBCT Courses, Teacher Trainings, Certification Programs

MBCT is still a relatively new treatment, but it has grown quickly in popularity. There are numerous courses,
trainings for MBCT teachers, and programs for certification in MBCT available for mental health and social
service professionals who want to incorporate MBCT into their work.

MBCT Courses

There are many classes based on the MBCT program offered in many different locations.

 For anyone living near Oxford in the UK who is interested in learning about MBCT, a course is held at the Oxford
Mindfulness Centre. This course is conducted in groups of 25 participants. It lasts eight weeks and meets for two
hours per week plus six hours on one Saturday. The Oxford Mindfulness Center also offers a course that meets
for five to six hours every two weeks. This course also caps participants at 25 per group and is offered to all adults.
 If you are not located near Oxford, there are other courses around the country and the world. The Brighton
Buddhist Centre in the UK also hosts a mindfulness course based on MBCT for anyone who experiences
depression or anxiety, as well as courses on mindfulness-based stress reduction and mindfulness for living with
pain and illness.
 The Atlanta Mindfulness Institute holds an eight-week MBCT class for up to 10 people at a time. This course
also includes a six-hour “retreat” day on a weekend day during the eight-week run.
 Finally, the University of California, San Diego (UCSD) Center for Mindfulness offers public programs for those
wishing to learn how to apply MBCT to their own lives, including a course for youth, a course on self-compassion,
a 5-day program designed to help participants learn to cope with life’s challenges, and a resilience training course
for first responders.

The Mindfulness-Based Cognitive Therapy Manual (+PDF)

If you’d rather read about MBCT yourself or start out with a good introduction to MBCT, check out the
Mindfulness-Based Cognitive Therapy Implementation Resources. This PDF [MBCT Implementation
Resources] is a great resource for learning about and setting up your own MBCT practice.

This section provides a general outline and highlights some of the most informative and helpful parts of the
document. If you want a more detailed look at this excellent resource, click the link above to open the PDF and
read it at your convenience.

After a description of MBCT and how it is applied in the UK, this document outlines the guiding principles for
implementing MBCT:

1. Research needs to be translated and accessible to clients.

2. Ownership of the research or implementation process is critical.
3. People who are enthusiastic about the practice are vital for promoting it.
4. Conduct an analysis of context to ensure you can be fully prepared to meet the challenges that will arise.
5. Ensure credibility by providing credible evidence and figures.
 6. Provide leadership at each level to give strategic support and authority.
7. Provide adequate support/resources (including financial, human, and equipment).
8. Develop opportunities for integration into clients’ daily lives.

In addition to these general guidelines:

 there is a chapter on setting up an MBCT service with information ranging from criteria for inclusion and
exclusion to an assessment of participants to post-class follow-up tasks for teachers. The last section in this chapter
covers the risks that both participants and teachers face when meeting for MBCT (including emotional intensity, a
possibility of trauma, conflict in the group, and challenges from participants), and provides some great advice for
working around these risks.
 Another chapter covers how to conduct MBCT reunions for course “graduates,” with information on different
formats, an example invitation, and a sample session plan.
 Next, the manual covers the important topic of training and supervision for MBCT teachers. This chapter provides
guidelines on best practices, reading materials for teachers and trainers, and required qualities and qualifications
for teachers and trainers of MBCT.
 Another great chapter focuses on why evaluating the outcomes of MBCT courses is important and how to engage
in a proper evaluation. Taking a good look at what went right, what went wrong, and how to incorporate more of
the good and less of the bad can drastically improve outcomes for both participants and teachers.
 Finally, this manual provides a list of further resources that anyone who wants to teach MBCT should read. If you
are interested in learning more about setting up your own MBCT practice, click the link above to open the PDF
and find the additional resources listed at the end.

MBCT Retreats

Retreats are great opportunities to mingle with colleagues, learn new skills, and keep up to date on any changes
in your field. There are many retreats offered that both clients and practitioners of MBCT can take advantage of
in order to further their personal or professional practice. Retreats for clients allow them to continue practicing
the techniques learned in MBCT, while retreats for teachers provide an opportunity for personal development,
professional development, or both.

5 Major Differences Between REBT & CBT

Albert Ellis introduced Rational Emotive Behavior Therapy (REBT) in 1955, a radical change from the
traditional therapies popular at the time. It has since spawned a number of offshoots, usually called cognitive-
behavioral therapy (CBT). REBT and CBT coincide in a variety of ways. Their core notion affirms human
emotions and behavior are predominantly generated by ideas, beliefs, attitudes, and thinking, never by events
themselves. Consequently changing one’s thinking leads to an emotional and behavioral change.

There are also major differences between REBT and CBT:

1. Philosophic. REBT addresses the philosophic basis of emotional disturbance as well as the distorted
cognitions (the focus of CBT), which makes it more powerful. As you uproot your absolutistic demands, your
cognitive distortions get corrected.

For example, suppose you plan to ask someone for a 2nd date and you're feeling anxious. You tell yourself, “She
didn’t talk or smile much on our first date. I know she’s not interested.” Since there are multiple other
explanations for her reserved behavior, which you don’t know by her actions, CBT calls this conclusion “mind-
reading” and dismisses it as a cognitive distortion. Instead, REBT looks at the underlying reason you jump to
this conclusion, for example telling yourself, “I absolutely need her acceptance and if she rejects me this would
be awful, I could not stand it and proves I’m a loser who’ll never succeed with any woman.” Giving up your dire
need for acceptance would not only ameliorate your fears of rejection in future dating situations but in virtually
all interpersonal interactions. Going the CBT route of avoiding mind-reading proves to be significantly more
limited.
REBT posits three core demands fueling cognitive distortions and underlying emotional disturbance: 1. “Because
I strongly prefer to, I absolutely must do well in life and get the approval of significant others or else I’m no
good,” 2. “Because I keenly desire it, others absolutely must treat me well or else they’re no good,” and 3.
“Because I passionately wish it, life absolutely must go well and or else it’s no good.” These demands create
anxiety, depression, guilt, anger, resentment, procrastination, and addictions.

The simple yet profound philosophic solution involves unconditional acceptance (UA): unconditionally
accepting yourself with your flaws, unconditionally accepting others with their imperfections, and accepting life
unconditionally with its discomfort, hassles, and unfairness.

2. Secondary disturbance. REBT highlights the significance of secondary disturbance. Disturbing yourself
about your disturbance is often the major factor in life-long (endogenous) depression, severe anxiety, and panic
attacks. Most CBT ignores secondary disturbance. For example, you feel anxious about appearing anxious when
requesting the date. You are worrying about worrying.

3. Unconditional Self Acceptance (USA). REBT presents an elegant solution to the self-esteem problem. It
teaches unconditional self-acceptance (USA) rather than any type of self-rating. Most CBT therapists focus
on bolstering their clients’ self-esteem by reinforcing some of their positive qualities. This strategy has many
pitfalls including having low self-esteem when you do poorly, making invidious comparisons to others, avoiding
risk-taking, smug-complacency, and preoccupation with proving, rather than enjoying, yourself.

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USA and avoiding the self-rating trap avoids the many problems with self-rating. USA consists of the
philosophy of unconditionally accepting yourself as the imperfect human you are whether you do well or poorly,
or others love or hate you. If you get fired, for example, rate your job performance as poor, but never
overgeneralize to conclude you’re a poor or worthless person. You’re then able to evaluate your deficient (and
positive) behaviors to focus on how to improve in the future.

4. Helpful negative emotions. REBT is unique among CBT therapies in differentiating between self-destructive,
inappropriate negative emotions vs. helpful, appropriate negative ones. Anxiety, depression, and anger are
examples of the first type and intense sadness, deep sorrow, great concern, and regret instances of the second.

For example, if you feel slightly anxious about arriving 5-min late, this is an inappropriate negative emotion
because, in part, it comes from rigid, absolutistic thinking characterized by demands (musts, shoulds, have tos:
“I absolutely must never be late for an appointment”). Alternatively, if you feel intensely sad, you cry, grieve,
and mourn the loss of a loved one, these are appropriate negative emotions. They come from passionate desires
and preferences such as, “I strongly wish my lover had not died, how very, very sad and most unfortunate."

4. All anger inappropriate. CBT views some anger as healthy and appropriate. Counter to this, REBT
maintains all anger has a commanding and condemning, dictatorial, philosophic core. This can be
expressed as “others absolutely must treat me well or else they’re no good and deserve to roast in
hell.” This philosophy is unhelpful, feels bad, and sometimes quite destructive. Even in mild forms, this
perspective is inappropriate. REBT teaches individuals effective assertiveness, problem-solving, and
other appropriate alternatives to anger. Although CBT also teaches assertiveness, it fails to uproot the
philosophic root of anger.

Gestalt Therapy
Gestalt therapy is a form of psychotherapy, based on the experiential ideal of "here and now," and relationships
with others and the world. Drawing on the ideas of humanistic psychology, the school of Gestalt therapy was co-
founded by Fritz Perls, Laura Perls Ralph Hefferline and Paul Goodman in the 1940s-1950s. It is related to but
not identical to Gestalt psychology and the Gestalt psychology-based Gestalt Theoretical Psychotherapy of
Hans-Juergen Walter.

General description

The school of Gestalt therapy was co-founded by Fritz Perls, Laura Perls- both of whom were originally
traditional psychoanalysts , Ralph Hefferline a university psychology professor , and Paul Goodman political
writer and anarchist, in the late 1940s to early 1950s. The seminal work was Gestalt Therapy, Excitement and
Growth in the Human Personality published in 1951.They take approaches from a wide variety of psychological
and philosophical disciplines, integrating them into a therapeutic approach based on the idea of a complete
organism (mind and body as an integrated whole). The objective of this therapy is, to help the person to obtain a
greater independence (seen as freedom and responsibility) in their actions, and the ability to face up to the
blockages that prevent them developing naturally.Based initially on the insights of Gestalt psychology and
traditional psychoanalysis, Gestalt therapy has developed as a humanistic psycho-therapeutic model, with a well
developed theory that combines phenomenological, existential, dialogical, and field approaches to the process of
transformation and growth, of human beings.At the centre of Gestalt therapy lies the promotion of "awareness".
The individual is encouraged to become aware of his or her own feelings and behaviours, and their effect upon
his environment in the here and now. The way in which a he or she interrupts or seeks to avoid contact with the
present environment is considered to be a significant factor when recovering from psychological disturbances.
By focusing the individual on their self-awareness as part of present reality, new insights can be made into the
their behaviour, and they can engage in self-healing.

Principal influences

 Wilhelm Reich's psychoanalytic developments, especially the concept of character armor and its focus on
the body.
 Jacob Moreno's Psychodrama, principally the development of body experimentation techniques for the
resolution of psychological conflicts
 Max Wertheimer's Gestalt Psychology , which this therapy derives its name from, influences the
application of the concepts about perception to a broader theory about the necessities of humans, and the
relation of humans with their surroundings.
 Kurt Goldstein's theory of the organism, based on Gestalt theory.
 Martin Buber's existential philosophy of relationship and dialogue ("I - Thou").
 Carl Gustav Jung's psychology, particularly the polarities concept
 Some elements from existentialism and Zen Buddhism

Being human

The practice of Gestalt therapy is based firmly in the personal experience of both the client and the therapist;
furthermore, Gestalt therapy is based on an elaborate theory that developed over many years since the 1940s.
Consequently, the following points can give no more than a rough impression.

The human being seen as a whole

The human being is seen as an indissoluble entity; we cannot work with the mind without also taking account of
the body. The two are closely related with, for example, particular emotions being associated with certain
postures.Self-actualization, proceeds by the individual becoming gradually aware of the entirety of themselves
and of all that that implies. Generally we are not aware of the greater part of ourselves and we only identify with
a lesser part.For example, in the extreme case of someone over-identified with their job, a person would define
themselves through their professionalism, position, authority, responsibility, ability, organization, etc. They will
rarely mention other aspects of their identity, such as relationships with a partner or friends. Conversely, they
will be strongly influenced by success in their career area, and events like being fired, jobless or retired, could
trigger a crisis.The problem in identifying with a limited number of aspects of ourselves is that the we do not use
much of our potential. By assuming we lack of inner resources we look for external support, creating
dependencies.

Formation of Gestalt

In the German Gestalt psychology, developed by Max Wertheimer, the mind is considered to function by
realizing the distinction between the figure (that which attracts attention or protruding) and the ground (that
which dwells in the background/ second plane). Perls uses this distinction of figure-ground to establish a
principle of human need. He conceived that needs are part of a continuum. The most pronounced need manifests
as a figure until its resolution. This type of Gestalt is called a Gestalt controller since it guides the mental
process.An extreme example of the mental function of this mechanism is the case of a toothache. When we have
a toothache, our whole world revolves round the pain. We do not care about other concerns. Until we solve our
problem of pain, we can not attend to any other affairs with clarity.With psychological needs something similar
happens; a need is considered in this plane to be like an unresolved situation or an unclosed gestalt. This is
manifest as thoughts that seize the mind most of the time in involuntary ways. (For example our conscience may
compulsively dialogue with us over an issue). Or it may manifest as a filter that makes us blind to certain
information in our environment. (For example, someone who has had a history of abuse in childhood might fail
to observe issues of power and abuse in relationships in the present day. These aspects are effectively left in the
second plane/background and never come to the fore).

The formation process and Gestalt closing is a natural process that works without human intervention or the
control of our will. We go through Gestalt processes everyday that form and close naturally in time.
Nevertheless, situations sometimes occur which do not get resolved as they are supposed to, sometimes to a
point that we forget the original problem exists or we believe that it has been resolved. This class of perpetuatal
problem can cause psychological difficulties.

The Gestalt psychotherapist works with this unfinished mental content or filter forms. They help the individual
to recognise them and work towards the closing of the Gestalt using various techniques suggested by the
psychotherapist.

Contact boundaries

The human being establishes a relationship with his or her surrounding environment; this relationship defines a
boundary. This boundary is what allows a distinction to be made between self and non self, but it is also the area
where contact takes place. In Gestalt therapy, it is defined as the ego boundary or the contact boundary. In
Gestalt therapy it is considered that the relationships with other people are made at this boundary. When it
happens in a healthy manner, then the boundary is flexible, which means that we are capable of distinguishing I
from you, but also of forming a we. We are capable of coordinating the appropriate needs with those that
surround us and we can see each other as a complete person, and not only as a function of our needs and wishes.

Generally, in a relationship with another person, we are each subject to number of conflicts of interest. In most
cases, the individual-societal conflict faces us with a conflict between our needs and the demands of others.
Concepts of obligations like must do transform themselves into ideals as to what we must do in a particular
situation. We then create rigid formulae for relationships which correspond to these must do obligations. In time
these become more and more rigid. In Gestalt therapy, this rigidity is called the character. The structure of a
character is an inflexible form of relating which transforms, in the long run, into an obstacle to communications
with others.

Another important aspect of the contact boundary is the function of those phenomena known as identification
and alienation. Gestalt therapy proposes that we often identify with only small parts of our own true selves. This
affects the way we see what is in ourselves and what is in others. We make assumptions that certain
characteristics of ourselves belong to others, a process known as identification. We may consider some good
qualities as only belonging to others when in reality they are also parts of ourselves. This also produces the
phenomenon known as alienation; for example, when we have no capacity to see some defect in ourselves, we
tend to criticize it when we see it in others.

Organismic self-regulation

Finally, it is possible to emphasize beforehand that as a basic principle to all the described processes, that Gestalt
therapy relies on the naturalness of crux of the psychological processes. Considering organisms as intelligent,
any attempt to control or manipulate causes organic imbalance. It is believed that a majority of psychological
problems arise from this manipulation or the need of control. The therapeutic principle first kills off control to
allow the organism to self regulate naturally. At the base is the belief in that any attempt of directing a change is
accostomed to producing the opposite effect, in which the controller part of the person attempts to obtain the
objective, but faces another party that refuses that control.

The difference between decisions and preferences, are that decisions are voluntary choices, guided for a form of
control (external or internal), and preferences are the choices that in each moment the organism shows as
important (through the process of the formation of Gestalt)

Psychotherapeutic bases

The goal of Gestalt therapy is to facilitate the removal of obstacles that lie between a person and the utilization of
their full potential. Gestalt therapy's techniques and attitude create a space in which the patient can recover his or
her capacity for living. In this way a person can learn to be aware of the self and aware of his or her interactions
with others, living in the moment and assuming responsibility for their actions. For Perls, the appropriate
experience, further on from the whole explanation or possible interpretation, is therapeutic or corrective in this
sense.

It is in this way that Claudio Naranjo systemitizes Gestalt therapy along three basic principles: attitude, attention
and responsibility, and constantly brings the patient back to these principles throughout their therapy.

Actuality(Here and now)

Excessive concentration on the past (memories) or on the future (plans) is a form of escapism with respect to the
present. These fantasies with both often occur as a form of escape from the present moment when we can not
resolve something or we can not totally experiment. Nevertheless, nothing exists outside the present moment.

By this, Gestalt therapy focuses on the here and now in two ways: on the one hand, it insists on expressing
everything that is within the field of the awareness of the client, and working with that; and on the other hand, by
means of presentification of the past or future—or of fantasy in general—dramatizing past scenes—even those
from dreams—or fantasies of the future. This is made real through gestural, postural, and verbal forms.

Attention(Self-realization)

Assuming the figure-ground game as a basis for perception, Gestalt therapy attempts to achieve permeability
between the two. This permits softening of rigid methods of relating with society (character) with which
unknown capacities are recovered to form the grounds of attention.

In this manner, the client is encouraged to be aware of his or her feelings, thoughts, body posture, breathing
rhythm, physical sensations, etc., enhancing day-to-day experience. In the next stage, the client is directed to
experiment across the dramatization of feelings, thoughts, body posture, etc., of other people (fathers, friends,
intimate partners, those who appear in dreams) who are brought as significant material to the session.

Responsibility
The principal idea is to replace the concept of blame (related to shoulds and musts) with responsibility (related to
organismic self-regulation). This creates a flexibility with the relationship with the medium, allowing natural
equilibrium between needs and the environment, permitting the natural equilibrium between one's own needs and
those of the environment.

Gestalt therapy emphasizes the independence of the client, leaving him or her in charge of his or her own
development. This contributes to a great measure the role of Gestalt therapy, understood more as a facilitator or
guide to the therapeutic process rather than making the Gestalt responsible for the client's well being or pretend
to create confidence in the client and his capacity. In this manner it avoids generating a relation of dependency
with both and creates a model for a positive relationship for personal growth.

In this light, the therapist does not have the truth about the client, and neither inteprets nor offers solutions. The
therapist's role is to generate a space for the client to experiment by himself/herself in a sufficiently protected
atmosphere.

Wider influence of Gestalt therapy on other schools

Gestalt therapy, along with transactional analysis (TA)—most specifically, Michigan Transactional Analysis—
strongly influenced Neuro-linguistic programming (NLP)

Moral functions of Gestalt therapy

 Live now, stay in the present.

 Live here, be with the present.
 Stop imagining, experience reality.
 Stop unnecessary thinking.
 Express, rather than manipulating, explaining, justifying, or judging.
 Give in to unpleasantness do not restrict your awareness.
 Accept no "should" or "ought", other than your own.
 Take full responsibility for your own actions, feelings and thoughts.
 Surrender to being who you are right now.

What Are Gestalt Therapy Techniques

What Is Gestalt Therapy?

GT centers around the present. The client focuses on the here and now instead of worrying about the past or the
future.This is quite an interesting turn for therapy. Most therapies tend to focus on someone's past. The past
impacts how the client feels today, after all. So it's an intriguing approach. Any mentions of the past tend to be
re-enacted and re-experienced in the present day.The goal is for clients to be more self-aware. To learn what
negative thoughts are preventing them from living a productive life.

History

Gestalt therapy is the product of three founders: Laura Perls, Paul Goodman, and Fritz Perls. They developed the
process in the 1940s through the 1950s, releasing a titular book about GT in 1951. The therapy took a long time
develop because it was a product of different experienced the founders had. They traveled the world, looking at
Eastern religions, the physics of the world, systems theory, psychoanalysis, and so much more, creating a
therapy system they thought was foolproof.In the next couple of decades, GT began spreading. It became
popular enough to have centers all across the globe. It's been quite an influential form of therapy, and for a good
reason.The word gestalt is a German word that means "shape, form," or "whole." In other words, it focuses on
the entirety of a person. The founders of GT believed that humans are creatures who should be looked at fully
and not just by certain parts of them. They're focused on how the whole person is feeling in the present day, and
this can hopefully help relieve internal issues that are unresolved.These emotions are believed only to be relieved
if the person can discuss them in the present day. They're not going to be settled if the person just talks about
them through old-school therapy. If the person doesn't let out their emotions, they may suffer consequences both
internal and external.The idea is that we shouldn't live up to all our expectations, but instead learn to understand
ourselves and what we want. This can help people to be more confident about themselves and build themselves
up to be people who can make it work.

Who It Can Help

GT can help quite a few contenders who need therapy. Here is a list of a few who have seen benefits.

Anxiety and depression: GT is a good way to help people realize just what it is in the present that's causing
their anxiety or depression to flare up.

Self-Esteem: Those with low self-esteem seem to benefit from some GT. It allows them to overcome the issues
that make them feel bad about themselves, whether it's internally influenced, like bad thoughts, or externally,
such as jealousy of someone.

Relationship troubles: GT is a good way for people who are having relationship difficulties to work out their
differences. The individual may benefit from some solo therapy too, as they deal with their insecurities about the
relationship.

Headaches: Those who have migraines seem to have good results from a bit of GT.

Other physical ailments like back problems and ulcerative colitis.Besides those, GT works well for people who
want to improve their self-awareness. We all would like to think we're self-aware people, and yet many don't
know why they do the things they do. GT can help you figure that out, making you more aware of your actions
and helping you conquer your self-issues.They also help people who don't quite understand how they are a part
of their negative emotions. Sure, unhappiness can be caused by other people, but the self can also be to
blame.GT is good for the artist as well and works wonders with art therapy.

Techniques of GT

GT uses a handful of techniques to get their clients talking. A few examples include:

Asking Questions

A therapist may ask the client questions, especially ones pertaining to the present. It's not uncommon to hear the
therapist ask you, "What's going on right now?" or "How do you feel about this issue right now?" Questions
about the present are what GT is all about, but that's not the only tricks they have up their sleeves.

Role Playing

You may have to play someone else in order to get your feelings across. As mentioned earlier, GT is great for
those who are art-minded, so it works in harmony with those who are aspiring actors or involved with
theatre.You may find yourself playing the role of your spouse, your boss, or anyone else who you have a
problem with. This can allow you to get your frustrations out and also see the other side, adding nuance and self-
awareness to your arsenal.

Confrontation
This works similar to role-playing, where you must confront whoever it is that's been bothering you. Getting
your emotions off your chest can help you to move on from whoever it is that's been bothering you.

Dream Working

This therapy involves, of course, your dreams. Dreams are something that's been an enigma to the psychological
world for ages. Sometimes, dreams are just random movies playing in your mind. Other times, they can be the
key to whatever it is you have on your mind.

They'll also use quite a few other techniques as well. All GT therapists work differently, and they'll gladly help
you find the therapy that's right for you.

Other Gestalt Therapy Concepts

Gestalt Therapy also has a few other concepts, including

Wholeness

With GT, it's all about the whole person. GT believes that the person's mind and body are not together, and GT is
all about helping to reunite them. Being whole allows you to be more self-aware, and that's the next concept.

Awareness

We talked about self-awareness before, and being aware lets, clients deal with their environment.

Awareness tends to fall due to being preoccupied with the past or having low self-esteem.

However, you can be able to fix your awareness through a few ways, such as environmental contact. The person
must observe the world around them. We all are present in the world, but have we sat down and observed what
the world has to offer? From listening to all the small noises to smelling something you normally wouldn't have
noticed, GT helps with becoming more aware of the here and now.

GT can also help you with taking responsibility. Sometimes, you're to blame for your problems, or at least
partially. GT can help you to realize this and can help you critique yourself fairly.

GT also deals with the idea of unfinished business. We all have something we regret not finishing, or we all have
an event that didn't have a proper conclusion. This is a big obstacle when it comes from moving on with the past,
and GT is there to help those who want to move on. This can mean helping people to finish their business, or
instead worry about the business of the present.

Effectiveness Of Gestalt Therapy

When it comes to therapies, some are backed up by science, while others seem to border on mysticism. How
does GT stack up when under scientific scrutiny?

As it turns out, GT has been quite effective for many clients. There is truth to the idea of focusing on the here
and now rather than the past. This goes by many names and has different ways of achieving it, but the basic idea
is still the same, in that you have to be more mindful of yourself, your surroundings, and be aware of the
thoughts that are swimming in your head.

Of course, there isn't one therapy that works for everyone. If you don't see results right away, you can try another
GT technique. Everyone has positive results from something different, and because of this, there is no therapy
right for everyone.
Gestalt therapy
Definition

Gestalt therapy is a complex psychological system that stresses the development of client self-awareness and
personal responsibility.

Purpose

The goal of Gestalt therapy is to raise clients' awareness regarding how they function in their environment (with
family, at work, school, friends). The focus of therapy is more on what is happening (the moment-to-moment
process) than what is being discussed (the content). Awareness is being alert to what are the most important
events in clients' lives and their environment with full sensorimotor, emotional, cognitive, and energy support.
Support is defined as anything that makes contact with or withdrawal from with the environment possible,
including energy, body support, breathing, information, concern for others, and language, for example.

In therapy, clients become aware of what they are doing, how they are doing it, and how they change themselves,
and at the same time, learn to accept and value themselves. Individuals, according to this approach, define,
develop, and learn about themselves in relationship to others, and that they are constantly changing.

Gestalt therapy is "unpredictable" in that the therapist and client follow moment-to-moment experience and
neither knows exactly where this will take them. Gestalt therapy is complex and intuitive, but it is based on the
following principles:

 Holism. Gestalt therapy takes into account the whole person including thoughts, feelings, behavior, body
sensations, and dreams. The focus is on integration, that is, how the many parts of the person fit together, and how
the client makes contact (interacts) with the environment.
 Field theory. According to this theory, everything is related, in flux, interrelated, and in process. The therapist
focuses on how the client makes contact with the environment (family, work, school, friends, authority figures).
 The figure-formation process describes how individuals organize or manipulate their environment from moment to
moment.
 Organismic self-regulation is the creative adjustment that the organism (person) makes in relation to the
environment. The person's equilibrium with his or her environment is "disturbed" by the emergence of a client
need, sensation, or interest and is related to the figure-formation process in that the need of the person organizes
the field. For example, if an individual wants coffee, this coffee need is what comes out of the defused background
and becomes "figural" (comes to the forefront of the client's environment or field) and when the individual enters a
room, the "figural" will be related to the coffee need. The therapist is interested in what is "figural" for a person
because it may provide insight into the person's need(s).
 The Now. The concept of the here and now is what is being done, thought, and felt at the moment, and not in the
past or the future.
 Unfinished business is defined as the unexpressed feelings that are associated with distinct memories and fantasies.
These feelings may be resentment, rage, hatred, pain, anxiety, grief , guilt, and abandonment that are not fully
experienced in awareness, linger in the background, and are carried into the present life and cause preoccupations,
compulsive behaviors, wariness, and other self- defeating behaviors. Unfinished business will persist until the
person faces and deals with these denied or alienated feelings.

The current practice of Gestalt therapy includes treatment of a wide range of problems and has been successfully
employed in the treatment of a wide range of "psychosomatic" disorders including migraine, ulcerative colitis,
and spastic neck and back. Therapists work with couples and families, and with individuals who have difficulties
coping with authority figures. In addition, Gestalt therapy has been used for brief crisis intervention , to help
persons with post-traumatic stress disorders , alcohol and drug abuse, depression, or anxiety disorders; with
adults in a poverty program; with seriously mentally ill individuals with psychotic disorders; and those with
borderline personality disorders .
Description

The relationship between the therapist and the client is the most important aspect of psychotherapy in Gestalt
therapy. In Gestalt therapy, the interaction between therapist and client is an ever changing dialogue marked by
straightforward caring, warmth, acceptance, and self-responsibility. There are four characteristics of dialogue:

 Inclusion, in which the therapist puts him- or herself, as much as is possible, into the experience of the client. The
therapist does not judge, analyze, or interpret what he or she observes.
 Presence refers to the therapist expressing his or her observations, preferences, feelings, personal experience, and
thoughts to the client.
 Commitment to dialogue allows a feeling of connection (contact) between the therapist and the client.
 Dialogue is active and can be nonverbal as well as verbal. It can be dancing, song, words, or any modality that
expresses and moves the energy between the therapist and the client.

Gestalt therapy holds the view that people are endlessly remaking or discovering themselves; therefore,
individuals are always in constant transformation. The therapist's approach is to help clients: to increase or
deepen their awareness of themselves and with aspects of themselves and their relationship with others, by
attending and engaging with the client; to explore the client's experience; and to describe what is. All techniques
used within the therapeutic relationship help clients to work through and move beyond painful emotional blocks
and is an ongoing process. This allows the client to explore new behavior, first, in the context of the therapeutic
relationship and then, as appropriate, in the outside world.

The therapeutic process begins at the first contact between client and therapist. The assessment method for the
Gestalt therapist has been unique to Gestalt therapy theory, as well as some psychodynamic treatments, and other
humanistic treatments. Assessment and screening are usually done as part of the ongoing relationship with the
client and not as a separate period of diagnostic testing and history taking. Assessment information is obtained
by beginning the therapeutic work and includes: the client's willingness and support for work in the Gestalt
therapy framework, the match between the client and the therapist, diagnostic and personality information, the
decision regarding the frequency of sessions, the need for adjunctive treatment (such as day treatment,
biofeedback training), and the need for medication and medical consultation.

Gestalt therapists now make use of the traditional diagnostic categories to obtain necessary information to help
patients with serious mental illnesses (such as psychotic disorders and borderline disorders) and because of
administrative and insurance reimbursement procedures. Despite these changes, it is believed that Gestalt
therapy assessment techniques will continue to be varied since Gestalt therapists draw on other therapeutic
systems.

In therapy, the Gestalt therapist is active and sessions are lively and characterized by warmth, acceptance, caring,
and self-responsibility and promote direct experiencing of a situation or event rather than passively talking about
the event. Events recalled from the past are explored and felt in the here and now of the therapy session. Clients
can see, hear, and be told how they are seen, what is seen, how the therapist feels, what the therapist is like as a
person, and how client awareness is limited by how they and the therapist interact with or engage each other—
that is, make contact.

The Gestalt therapist has a wide range of active interventions (cognitive and behavioral) at his or her disposal
and may use any technique or method as long as it is (a) aimed toward increasing awareness, (b) arises out of the
dialogue and the therapist's perception of what is going on with the client (sensing, feeling, thinking) in the
immediate therapy session), and (c) within the parameters of ethical practice.

Exercises and experiments

Many therapeutic interventions called exercises and experiments have been developed to enhance awareness and
bring about client change. Exercises are defined as ready-made techniques that are sometimes used to evoke
certain emotions (such as the expression of anger) in clients. Experiments, on the other hand, grow out of the
immediate interaction (dialogue) between client and therapist. They are spontaneous, one-of-a-kind, and relevant
to a particular moment and the particular development of an emerging issue such as the client's reports of a need,
dream, fantasy, and body awareness. Experiments are done with full participation and collaboration with clients
and are designed to expand clients' awareness and to help them to try out new ways of behaving rather than to
achieve a particular result. These experiments may take many forms. According to Gerald Corey, some are:
"imagining a threatening future event; setting up a dialogue between a client and some significant person in his
and her life; dramatizing the memory of a painful event; reliving a particularly profound early experience in the
present; assuming the identity of one's mother or father through role-playing; focusing on gestures, posture, and
other nonverbal signs of inner expression; carrying on a dialogue between two conflicting aspects within the
person."

While participating in experiments, clients actually experience the feelings associated with their conflicts or
issues in the here and now. Experiments are tailored to each individual client and used in a timely manner; they
are to be carried out in a context that offers safety and support while encouraging the client to risk trying out new
behavior. The Gestalt therapy focus is on the entire person and all parts—verbal and nonverbal behaviors,
emotional feelings— all are attended to.

Gestalt therapists are said to rely on spontaneity, inventiveness, and "present-centeredness" and a range of
possible therapeutic encounters, interactions that leads to exercises and experiments that are potentially infinite
but can be categorized as follows.

THE USE OF STATEMENTS AND QUESTIONS TO FOCUS AWARENESS. Many interventions have to
do with simply asking "what the client is aware of experiencing;" or asking simple and direct questions as,
"What are you feeling?" "What are you thinking?" The client may be instructed to start a sentence with "Now, I
am aware..." or is asked to repeat a behavior, as in, "Please wring your hands together again." A frequent
technique is to follow the client's awareness report with the instruction, "Stay with it!" or "Feel it out!"

CLIENT'S VERBAL BEHAVIOR OR LANGUAGE. Awareness can be enhanced and emphasized through
the client's verbal behavior or language since client speech patterns are considered to be an expression of their
feelings, thoughts, and attitudes. Some aspects of language that might indicate the clients' avoidance of strong
emotions or of self-responsibility are the general pronouns such as "it" and "you." Clients are instructed to
substitute, when appropriate, the personal pronoun "I" for these pronouns to assume a sense of responsibility for
his or her feelings or thoughts (ownership). Sometimes clients may be asked to change their questions into direct
statements in order to assume responsibility for what they say. Other examples of helping clients to be more in
control using language are to have them omit qualifiers and disclaimers such as "maybe," "perhaps," or "I guess"
from their language patterns. This changes ambivalent and weak statements into more clear and direct
statements; to substitute "I won't" for "I can't" because often "can't" gives the feeling of being unable to do
something. It may be more accurate to say "I won't" meaning "I choose not to do this for any of various reasons,"
or use the word, "want" instead of "need" which is considered an indication of urgency and anxiety, and is less
accurate. Other changes might be to change "should" and "ought" to "I choose to" or "I want to" increasing the
clients' power and control of their lives.

NONVERBAL BEHAVIOR. Awareness can also be enhanced by focusing on nonverbal behavior and may
include any technique that makes the clients more aware of their body functioning or helps them to be aware of
how they can use their bodies to support excitement, awareness, and contact. The parts of the body that therapists
may attend to include the mouth, jaw, voice, eyes, nose, neck, shoulders, arms, hands, torso, legs, feet, and the
entire body. The therapist, for example, may point out to and explore with the client how he or she is smiling
while at the same time expressing anger.

SELF-DIALOGUE. Self-dialogue by clients is an intervention used by Gestalt therapists that allows clients to
get in touch with feelings that they may not be unaware of and, therefore, increase the integration of different
parts of clients that do not match or conflicts in clients. Examples of some common conflicts include "the parent
inside versus the child inside, the responsible one versus the impulsive one, the puritanical side versus the sexual
side, the 'good side' versus the 'bad side,' the aggressive self versus the passive self, the autonomous side versus
the resentful side, and the hard worker versus the goof-off." The client is assisted in accepting and learning to
live with his or her polarities and not necessarily getting rid of any one part or trait.

The client is engaged in the self-dialogue by using what is called the empty-chair technique. Using two chairs,
the client is asked to take one role (for example, the parent inside) in one chair and then play the other role (for
example, the child inside) in the second chair. As the client changes roles and the dialogue continues between
both sides of the client he or she moves back and forth between the two chairs. Again according to Corey, other
examples of situations in which dialogues can be used include "one part of the body versus the other (one hand
versus the other), between a client and another person, or between the self and object such as a building or an
accomplishment."

ENACTMENT AND DRAMATIZATION. Enactment increases awareness through the dramatizing of some
part of the client's existence by asking him or her to put his or her feelings or thoughts into action such as
instructing the client to "Say it to the person ( when in group therapy)," or to role-play using the empty chair
technique. "Put words to it" is also often said to the client. Exaggeration is a form of enactment in which clients
are instructed to exaggerate a feeling, thought or a movement in order to provide more intensity of feelings.
Enactment can be therapeutic and give rise to creativity.

GUIDED FANTASY. Guided fantasy (visualization) is a technique some clients are able to use more
effectively than using enactment to bring an experience into the here and now. Clients are asked to close their
eyes (if comfortable) and, with the guidance of the therapist, slowly imagine a scene of the past or future event.
More and more details are used to describe the event with all senses and thoughts.

DREAM WORK. Dream work is most important in Gestalt therapy. The aim is to "bring dreams back to life
and relive them as though they are happening now." Working with the clients' dreams requires developing a list
of all the details of the dream, remembering each person, event, and mood in it and then becoming each of these
parts through role-playing, and inventing dialogue. Each part of the dream is thought to represent the clients' own
contradictory and inconsistent sides. Dialogue between these opposing sides leads clients toward gradual insight
into the range of their feelings and important themes in their lives.

AWARENESS OF SELF AND OTHERS. An example of how this technique is used by the Gestalt therapist is
having the client to "become" another person such as asking "the client to be his mother and say what his mother
would say if the client came in at 2:00 A.M." This provides more insight for the client rather just asking what the
client thinks his mother would say if he came home at 2:00 A.M.

AVOIDANCE BEHAVIORS. Awareness of and the reintegration the client's avoidance behaviors are assisted
by the interventions used to increase and enhance awareness of feelings, thought, and behaviors.

HOMEWORK. Homework assignments between therapy sessions may include asking clients to write dialogues
between parts of themselves or between parts of their bodies, gather information, or do other tasks that are
related to and fit with what is going on in the therapy process. Homework may become more difficult as the
awareness develops.

Therapy sessions are generally scheduled once a week and individual therapy is often combined with group
therapy , marital or family therapy , movement therapy, meditation , or biofeedback training. Sessions can be
scheduled from five times a week to every other week and session frequency depends on how long the client can
go between sessions without loss of continuity or relapsing. Meetings less frequent than once a week are thought
to diminish the intensity of the therapy unless the client attends weekly group with the same therapist. More than
twice a week in not usually indicated except with clients who have psychotic disorders, and is contraindicated
with those who have a borderline personality disorder .

Weekly group therapy may vary from one and one-half to three hours in length, with the average length of two
hours. A typical group is composed of ten members and usually balanced between males and females. Any age is
thought to be appropriate for Gestalt therapy. There are groups for children as well.
Gestalt therapy is considered by its proponents to have a greater range of styles and modalities than other
therapeutic systems and is practiced in individual therapy, groups, workshops, couples, families, and with
children, and in agencies such as clinics, family service agencies, hospitals, private practice, growth centers.
According to Corey, "The therapeutic style of therapists in each modality vary drastically on many dimensions
including degree and type of structure; quantity and quality of techniques used; frequency of sessions,
abrasiveness and ease of relating, focus on body, cognitions, feelings; interpersonal contact; knowledge of work
within psychodynamic themes; and degree of personal encountering."

Risks

Gestalt therapy is considered to have pioneered the development of many useful and creative innovations in
psychotherapy theory and practice. However, there is some concern regarding abusing power by therapist, as
well as the high-intensity interaction involved. The concern is in the nature of therapists being enchanted with
and using the techniques of Gestalt therapy with other theories of therapy without having the appropriate training
in Gestalt therapy theory. Gestalt therapists are very active and directive within the therapy session and therefore,
care must be taken that they have characteristics that include sensitivity, timing, inventiveness, empathy, and
respect for the client. These characteristics, along with ethical practice, are dependent on the skill, training,
experience, and judgment of the therapist. The intensity of the therapy might not be suitable for all patients, and
even disruptive for some, despite the competence of the therapist. In addition, there is a lack of monitored,
scientific research evidence supporting the effectiveness of Gestalt therapy.

Normal results

Gestalt therapists expect that as result of their involvement in the Gestalt process clients will improve in the
following ways: have increased awareness of themselves; assume ownership of their experience rather than
making others responsible for what they are thinking, feeling, or doing; develop skills and acquire values that
will allow them to satisfy their needs without violating the rights of others; become aware of all their senses
(smelling, tasting, touching, hearing, and seeing); accept responsibility for their actions and the resulting
consequences; move toward internal self-support from expectations for external support; to be able to ask for and
get help from others and be able to give to others.

An Overview of Viktor Frankl's Logotherapy

Viktor Frankl is the founder of logotherapy, a form of psychotherapy that he developed after surviving Nazi
concentration camps in the 1940s. After his experience in the camps, he developed a theory that it is through a
search for meaning and purpose in life that individuals can endure hardship and suffering.

A Brief History of Viktor Frankl

Viktor Frankl was born March 26, 1905 and died September 2, 1997, in Vienna, Austria. He was influenced
during his early life by Sigmund Freud and Alfred Adler, earned a medical degree from the University of Vienna
Medical School in 1930. From 1940 to 1942, he was the director of the Neurological Department of the
Rothschild Hospital, and from 1946 to 1970 was the director of the Vienna Polyclinic of Neurology.

In 1942, Frankl was deported to a Nazi concentration camp along with his wife, parents, and other family
members. He spent time in four camps in total, including Auschwitz, from 1942 to 1945, and was the only
member of his family to survive. In 1945, he returned to Vienna and published a book on his theories, based on
his records of observations during his time in the camps. By the time of his death, his book, "Man's Search for
Meaning" had been published in 24 languages.
During his career as a professor of neurology and psychiatry, Frankl wrote 30 books, lectured at 209 universities
on 5 continents, and was the recipient of 29 honorary doctorates from universities around the world. He was a
visiting professor at Harvard and Stanford, and his therapy, named "logotherapy," was recognized as the third
school of Viennese therapy after Freud's psychoanalysis and Alfred Adler's individual psychology. In addition,
logotherapy was recognized as one of the scientifically-based schools of psychotherapy by the American
Medical Society, American Psychiatric Association, and the American Psychological Association.

Understanding Logotherapy

Frankl believed that humans are motivated by something called a "will to meaning," which equates to a desire to
find meaning in life. He argued that life can have meaning even in the most miserable of circumstances, and that
the motivation for living comes from finding that meaning. Taking it a step further, Frankl wrote:

Everything can be taken from a man but one thing: the last of the human freedoms—to choose one's attitude in
any given set of circumstances.

This opinion was based on his experiences of suffering, and his attitude of finding meaning through the
suffering. In this way, Frankl believed that when we can no longer change a situation, we are forced to change
ourselves.

Fundamentals of Logotherapy

"Logos" is the Greek word for meaning, and logotherapy involves helping a patient find personal meaning in
life. Frankl provided a brief overview of the theory in "Man's Search for Meaning."

Core Properties

Frankl believed in three core properties on which his theory and therapy were based:

1. Each person has a healthy core.

2. One's primary focus is to enlighten others to their own internal resources and provide them tools to use their inner
core.
3. Life offers purpose and meaning but does not promise fulfillment or happiness.

Methods of Finding Meaning

Going a step further, logotherapy proposes that meaning in life can be discovered in three distinct ways:

1. By creating a work or doing a deed.

2. By experiencing something or encountering someone.
3. By the attitude that we take toward unavoidable suffering.

An example that is often given to explain the basic tenets of logotherapy is the story of Frankl meeting with an
elderly general practitioner who was struggling to overcome depression after the loss of his wife. Frankl helped
the elderly man to see that his purpose had been to spare his wife the pain of losing him first.

Basic Assumptions

Logotherapy consists of six basic assumptions that overlap with the fundamental constructs and ways of seeking
meaning listed above:

1. Body, Mind, and Spirit

The human being is an entity that consists of a body (soma), mind (psyche), and spirit (noos). Frankl argued that
we have a body and mind, but the spirit is what we are, or our essence. Note that Frankl's theory was not based
on religion or theology, but often had parallels to these.

2. Life Has Meaning in All Circumstances

Frankl believed that life has meaning in all circumstances, even the most miserable ones. This means that even
when situations seem objectively terrible, there is a higher level of order that involves meaning.

3. Humans Have a Will to Meaning

Logotherapy proposes that humans have a will to meaning, which means that meaning is our primary motivation
for living and acting, and allows us to endure pain and suffering. This is viewed as differing from the will to
achieve power and pleasure.

4. Freedom to Find Meaning

Frankl argues that in all circumstances, individuals have the freedom to access that will to find meaning. This is
based on his experiences of pain and suffering and choosing his attitude in a situation that he could not change.

5. Meaning of the Moment

The fifth assumption argues that for decisions to be meaningful, individuals must respond to the demands of
daily life in ways that match the values of society or their own conscience.

6. Individuals Are Unique

Frankl believed that every individual is unique and irreplaceable.

Logotherapy in Practice

Frankl believed that it was possible to turn suffering into achievement and accomplishment. He viewed guilt as
an opportunity to change oneself for the better, and life transitions as the chance to take responsible action.

In this way, this psychotherapy was aimed at helping people to make better use of their "spiritual" resources to
withstand adversity. In his books, he often used his own personal experiences to explain concepts to the reader.

Three techniques used in logotherapy include dereflection, paradoxical intention, and Socratic dialogue.

1. Dereflection: Dereflection is aimed at helping someone focus away from themselves and toward other people so
that they can become whole and spend less time being self-absorbed about a problem or how to reach a goal.
2. Paradoxical intention: Paradoxical intention is a technique that has the patient wish for the thing that is feared
most. This was suggested for use in the case of anxiety or phobias, in which humor and ridicule can be used when
fear is paralyzing. For example, a person with a fear of looking foolish might be encouraged to try to look foolish
on purpose. Paradoxically, the fear would be removed when the intention involved the thing that was feared most.
3. Socratic dialogue: Socratic dialogue would be used in logotherapy as a tool to help a patient through the process
of self-discovery through his or her own words. In this way, the therapist would point out patterns of words and
help the client to see the meaning in them. This process is believed to help the client realize an answer that is
waiting to be discovered.

It's easy to see how some of the techniques of logotherapy overlap with newer forms of treatment such as
cognitive-behavioral therapy (CBT) or acceptance and commitment therapy (ACT). In this way, logotherapy
may be a complementary approach for these behavior and thought-based treatments.
Criticisms

Frankl was not without his critics. Some felt he used his time in the Nazi camps as a way to promote his brand of
psychotherapy, and others felt his support came only from religious leaders in the United States (indeed, he did
recruit ministers and pastoral psychologists to work with him).

In 1961, his ideas were challenged by psychologist Rollo May, known as the founder of the existential
movement in the United States, who argued that logotherapy was equivalent to authoritarianism, with the
therapist dictating solutions to the patient. In this way, it was felt that the therapist diminished the patient's
responsibility in finding solutions to problems. It is not clear, however, whether this was a fundamental problem
of logotherapy, or a failing of Frankl as a therapist himself, as he was said to be arrogant in his manner of
speaking to patients.

In this way, it may be that logotherapy argues that there are always clear solutions to problems and that the
therapist has the task of finding these for the client. However, Frankl argued that logotherapy actually educates
the patient to take responsibility. Regardless, it is clear that in the application of Frankl's theories, it is important
to highlight that the patient must be a participant rather than a recipient in the process.

Evidence

More than 1700 empirical and theoretical papers have been published on logotherapy, and more than 59
measurement instruments developed on the topic. While Frank's early work involved case studies, this eventually
evolved to include operationalization of concepts and estimates of clinical effectiveness. In other words, Frankl
believed in empirical research and encouraged it.

A systematic review of research evidence pertaining to logotherapy conducted in 2016 found correlations or
effects pertaining to logotherapy in the following areas or for the following conditions:

 Correlation between presence of meaning in life, search for meaning in life, and life satisfaction, happiness
 Lower meaning in life among patients with mental disorders
 Search for meaning and presence of meaning as a resilience factor
 Correlation between meaning in life and suicidal thoughts in cancer patients
 Effectiveness of a logotherapy program for early adolescents with cancer
 Effectiveness of logotherapy on depression in children
 Effectiveness of logotherapy in reducing job burnout, empty nest syndrome
 Correlation with marital satisfaction

Overall, not surprisingly, there is evidence that meaning in life correlates with better mental health. It is
suggested that this knowledge might be applied in areas such as phobias, pain and guilt, grief, as well as for
disorders such as schizophrenia, depression, substance abuse, post-traumatic stress, and anxiety. Frankl believed
that many illnesses or mental health issues are disguised existential angst and that people struggle with lack of
meaning, which he referred to as the "existential vacuum."

Logotherapy in Everyday Life

How might you apply the principles of logotherapy to improve your everyday life?

 Create something. Just as Frankl suggested, creating something (e.g., art) gives you a sense of purpose, which can
add meaning to your life.
 Develop relationships. The supportive nature of spending time with others will help you to develop more of a
sense of meaning in your life.
 Find purpose in pain. If you are going through something bad, try to find a purpose in it. Even if this is a bit of
mental trickery, it will help to see you through. For example, if a family member is going through medical
treatments for a disease, view your purpose as being there to support that person.
  Understand that life is not fair. There is nobody keeping score, and you will not necessarily be dealt a fair deck.
However, life can always have meaning, even in the worst of situations.
 Freedom to find meaning. Remember that you are always free to make meaning out of your life situation.
Nobody can take that away from you.
 Focus on others. Try to focus outside of yourself to get through feeling stuck about a situation.

 Accept the worst. When you go out seeking the worse, it reduces the power that it has over you.

Reality therapy
Reality therapy is a person-centred approach that focuses on the here and now rather than issues from the past.
Developed by William Glasser in the 1960s, it promotes problem-solving and making better choices in order to
achieve specific goals.

Central to reality therapy is the idea that mental distress is not the result of a mental illness. Instead it is the result
of a socially universal human condition that occurs when an individual has not had their basic psychological
needs met. These are:

 love and belonging

 power and achievement
 survival (nourishment and shelter etc.)
 freedom and independence
 fun (enjoyment and pleasure).

According to Glasser, whether we are aware of it or not, we are all the time acting to meet these needs. While we
may struggle to choose our feelings and physiology, we are able to directly choose our thoughts and actions.
Sometimes however, we don’t act effectively, and this can have negative repercussions for our health and well-
being.

Reality therapy is therefore designed to find ways of meeting a person's basic needs, whilst facilitating clients to
become aware of, and change negative thoughts and actions. This is to help them take control of their behaviour,
as well as the world around them. Ultimately, reality therapists take the view that changing what we do is key to
changing how we feel and to getting what we want.

How does reality therapy work?

Reality therapy is a collaborative process between therapist and client, and it is unique in the sense that it is
ongoing. This means that if one plan of action fails, new ones will continuously be devised until the therapist and
client are both confident that positive results are taking place, or are a near possibility.

Essentially, the practice of reality therapy depends on several key components:

The counsellor-client connection

A reality therapy counsellor must create and nurture a trusting environment and authentic relationship to ensure
their client(s) feels connected and comfortable about sharing his or her issues. Providing a setting in which
individuals can relate in an open way is considered the foundation of, and the most important step in the practice
of reality therapy.

Choice theory
The successful application of reality therapy also depends heavily on the counsellor's knowledge of Glasser's
choice theory - that human behaviour is chosen and driven by our five basic needs. By asking questions such as
"What do you want?" or "What are you doing to get what you want?" counsellors can help individuals to explore
what needs are not being met and how to go about developing realistic goals to remedy the issues.

Present behaviour

Reality therapy is focused on the here and now and dealing with present behaviour rather than reasons for it.
Excuses are believed to stand directly in the way of progress and change, therefore clients are discouraged from
discussing any problems, complaints, or symptoms. Instead emphasis is placed primarily on the actions and
thoughts that are within the individuals control, rather than blaming or trying to control others.

Value judgement

A reality therapy counsellor will typically conduct an honest evaluation of the client's current choices and
behaviours to determine what (if any) change is needed to help them achieve their goals. Once the individual
judges that their present behaviour is unacceptable, the counsellor can help them to devise a plan of action,
setting realistic goals and outlining the steps that need to be taken to make these solutions a reality.

Plan of action

A plan of action in reality therapy essentially enables the individual to take control of their lives in constructive
ways whilst they fulfil their wants and needs. It involves their absolute commitment and they must take
responsibility for their actions if they do not fulfil this. The counsellor will evaluate the client's progress
throughout therapy, and may suggest amendments where necessary. A plan is always open to revision or
rejection by the client.

No punishment

Reality therapy counsellors are discouraged from punishing or rejecting their clients if they have not carried out
their assigned plan of action. This is because punishment could potentially disrupt the authentic relationship, and
the counsellor's aim to empower and motivate the individual to change their behaviour. Typically a counsellor
will remedy this by going back to the appropriate step where things went wrong. This may take several attempts.

Benefits of reality therapy

The strengths and benefits of reality therapy lie in its focus on solution-building - particularly on changing
thoughts and actions. It provides individuals with a self-help tool to gain more effective control over their lives
and their relationships - helping to boost their confidence and self-esteem and enabling them to better cope with
adversity and grow personally.

This makes the approach particularly useful in helping to treat mental health problems such as addictions, eating
disorders, substance abuse, phobias, anxiety, and other behavioural and emotional issues. It can also prove useful
in treating highly sensitive problems such as racial issues, sexual identity issues and cultural clashes. These can
all cause division and tension, but reality therapy can help bridge the gap between intolerance and ignorance -
helping individuals to recognise how their behaviour is negative and promoting equality.

Additionally, reality therapy has proven successful at helping colleagues, families and other individuals in
specific relationships to better understand difficult situations - i.e. if someone they love is diagnosed with AIDS
or has admitted to an addiction. Reality therapy provides an empathetic and understanding environment for
individuals to open up without feeling shame, regret or embarrassment. This makes it especially valuable for big
groups as everyone can express their needs and desires in order to lay the foundation for a plan of action that will
help foster closer bonds, better understanding and improved conflict resolution.
Reality Therapy
Reality therapy is a client-centered form of cognitive behavioral psychotherapy that focuses on improving
present relationships and circumstances, while avoiding discussion of past events. This approach is based on the
idea that our most important need is to be loved, to feel that we belong, and that all other basic needs can be
satisfied only by building strong connections with others. Reality therapy teaches that while we cannot control
how we feel, we can control how we think and behave. The goal of reality therapy is to help people take control
of improving their own lives by learning to make better choices.

When It's Used

The principles of reality therapy can be applied to individual, parent-child, and family counseling. Studies have
proven the effectiveness of reality therapy in treating addiction and other behavioral problems. It is also an
approach that works with people in leadership positions in education, coaching, administration, and
management, where problem solving, instilling motivation, and a focus on achievement play essential roles in
their connection to others.

What to Expect

Reality therapy focuses on present issues and current behavior as they affect you now and will affect your future.
Little or no time is spent delving into the past. Since reality therapy is solution-oriented, you will examine how
your behavior is interfering with your ability to form stronger relationships and figure out what kind of changes
you can make in your behavior to get what you want out of life. You can learn how to reconnect with people
from whom you have become disconnected and how to make new connections. If you try to make excuses or
blame someone else for your behavior, the therapist will show you how that kind of thinking results in behavior
that prevents you from improving relationships and reaching your goals. You have the opportunity to learn and
practice new behavior and techniques in the privacy of the therapist’s office before you employ them in your life
outside of therapy.

How It Works

Based on the work of psychiatrist William Glaser in the mid-1960s, reality therapy is founded on the idea that
everyone is seeking to fulfill five basic needs, and mental health issues arise when any of these needs are not
being met. The five basic needs are:

1) Power, or a sense of self-worth and achievement

2) Love and belonging, or being part of a family or community of loved ones

3) Freedom, or independence

4) Fun, which includes a sense of satisfaction or pleasure

5) Survival, or the comfort of knowing that one’s basic needs—food, shelter, and sex—are met.

When one or more of these needs go unfilled, the resulting problems occur in present time and in current
relationships, so it makes sense to act and think in the present time. Reality therapy is also based on choice
theory, the principle that humans choose to behave in certain ways and that these choices can help or hamper
your ability to satisfy essential needs and reach individual goals. You cannot change or control others, so the
only sensible approach to solving problems is to control yourself and your own behavior by making choices that
help you achieve your life goals.
 

Human beings are complex, multifaceted creatures. And, as such, our problems are almost always multifaceted
as well. When therapists take this into consideration, psychotherapy is more likely to be effective and lasting.
That’s not to say that therapies that focus primarily on one aspect of human nature (e.g. interpersonal
relationships, cognitions, or behavior) can’t be helpful. However, when the benefits of psychotherapy are only
short-lived, one of the most likely reasons is that the focus was too narrow.

Dr. Arnold Lazarus, one of the most brilliant psychologists of the 20 th century, developed a comprehensive form
of therapy several decades ago to address the multidimensional or “multimodal” nature of people. He named it
multimodal therapy.

Often referred to as simply MMT, multimodal therapy is an eclectic form of psychotherapy. Eclectic therapies
draw from and integrate elements of several disciplines, psychology theories, or therapeutic approaches. It’s
important to note, however, that MMT is technically eclectic but not theoretically eclectic. In other words, the
primary underlying theory on which MMT is based is social and cognitive learning theory. It’s the techniques
and strategies used in treatment that are eclectic in nature.

Originally a behavior therapist and pioneer in the area of cognitive behavioral therapy (CBT), Lazarus noted that
far too many patients treated with traditional CBT for depression, anxiety disorders, and other issues ended up
relapsing at some point. He believed that the reason for this was that the therapy they’d received wasn’t
comprehensive enough. It had missed some distinct key area that was playing a role in their dysfunction or
problem, leaving them vulnerable once treatment ended. They had been treated with what he called “narrow
band” therapy, when what they really needed was a “broad-spectrum” treatment approach.

In order to address this inadequacy in other types of psychotherapy – and to ensure a more comprehensive and
effective approach to treatment – Lazarus came up with the BASIC I.D. This concept plays a central role in
multimodal therapy.

The BASIC I.D.

Multimodal therapy is based on the premise that seven distinct but interrelated dimensions or “modalities” of
psychological functioning, temperament, and personality are assessed and addressed in therapy. These have
come to be known by the acronym “BASIC ID”. These 7 modalities are:

 Behavior
 Affect
 Sensation
 Imagery
 Cognition
 Interpersonal
 Drugs/Health/Biology

Behavior represents everything a person does – actions, habits, gestures, etc. Behaviors can be healthy or
unhealthy, destructive or constructive, moral or immoral, mature or childish, appropriate or inappropriate, law-
abiding or illegal, compulsive, impulsive, or controlled, and so on. Many people seek therapy to change
unwanted behaviors that are causing problems in their life such as overeating, nail-biting, hoarding, acting out,
self-mutilating, or drinking excessively. Traditional behavior therapy focuses on changing the behavior itself
with the use of techniques such as modeling, aversive conditioning, and systematic desensitization.
Unfortunately, practically every unwanted behavior is connected to and interacting with other modalities as well,
such as emotion, sensation, and cognition. When those aren’t addressed as well, relapse often occurs.

Affect essentially refers to a person’s feelings or emotions, such as happiness, sadness, anger, fear, frustration,
and boredom. One of the main reasons people seek therapy is because they don’t like the way they feel. For
example, depression and anxiety are two of the most common psychological problems for which people take
medication or talk to a therapist. Even those who seek therapy for other reasons – e.g. to lose weight, save their
marriage, or overcome a phobia – the underlying motivation is almost always to change the way they feel
emotionally. Most individuals who want to lose weight want to feel happier about their body and in general,
while those struggling to save their marriage are often motivated by anxiety (the uncertainty of life without their
spouse) and the sadness that often accompanies such a loss.

Sensation pertains to our senses – sight, hearing, touch, taste, and smell – and all of our physiological
experiences. Examples of sensations include muscle tension, knots in the stomach, “butterflies”, physical pain,
racing heart, tension headaches, cold hands, crawling skin, shortness of breath, sweating, and nausea.
Hallucinations and illusions are also examples of sensations.

Sensation is one of the modalities that is most often neglected in psychotherapy, even though an unpleasant
sensation can be very troubling. Sensations can provide a lot of valuable information in therapy. For example,
unresolved trauma often manifests in psychosomatic symptoms that may be misinterpreted by the client, leading
him or her to seek medical treatment instead. Also, many individuals attempt to address uncomfortable
sensations with medication or other substances (e.g. alcohol or drugs).

Imagery refers to the mental images and pictures people create in their mind – in other words, what they
visualize fantasize, and daydream about. A person’s self-image would fall into this category. Individuals who
struggle with anxiety often feed their anxiety with exaggerated, fearful images of things that might happen in the
future. People with depression often paint very negative, distorted pictures in their mind. Those battling eating
disorders have distorted body images that play a significant role in their disorders. Learning to adjust one’s
mental imagery can go a long way towards bringing about desired changes.

Cognition refers to thoughts (and thought patterns), beliefs, attitudes, and judgments. Negative thoughts,
including negative “self-talk” and limiting or distorted beliefs almost always play a significant role in depression,
anxiety, and other disorders. Deeply ingrained beliefs about not being worthy or deserving, for example, can
undermine a person’s relationships and level of success in life if those beliefs are never effectively addressed.

Interpersonal refers to people’s relationships with others, as well as their social skills – i.e., how they relate to
and interact with people in general. It also includes their support system, or lack thereof. The ability to develop
healthy and satisfying relationships, and to feel connected with others, is a key element of good mental health.
Many people seek therapy to address relationship issues, such as coping with a breakup or resolving conflict with
a loved one. Others seek therapy because they’ve become isolated or feel disconnected. Interpersonal issues are
almost always closely tied to cognition and affect.

Drugs, health, and biology go together to form the seventh modality. This modality encompasses several
things, including physical health (e.g. illness, health conditions, physical limitations, age-related health issues,
chronic pain), biological factors (e.g. brain chemistry or genetics), and the need for medication or other forms of
medical / biological treatment. Also included in this modality are lifestyle habits that impact one’s health, such
as exercise (or lack thereof), diet and nutrition, sleep habits, overeating, drug and alcohol use, smoking habits,
etc.

In multimodal therapy, these seven modalities are assessed by the therapist in two ways – by interviewing the
client and by having him or her complete a questionnaire known as the Multimodal Life History Inventory.

Multimodal Life History Inventory

This inventory is usually completed by the client at home following the initial session. It is 15 pages long and
includes the following sections:
General Information – This section includes name, address, date of birth, marital status, current and past
employment, living situation, etc. It also asks about personal and family history of suicide attempts, as well as
any family history of mental health problems.

Personal and Social History – In addition to basic questions about parents and siblings, this section also asks
about parents personalities, attitudes, and methods of punishment, the client’s relationship with both parents,
home environment growing up, education (including scholastic strengths and weaknesses), and issues that
occurred during childhood (e.g. bullying, sexual abuse, drug use, medical issues, lack of friends, etc.).

Description of Presenting Problem – This section asks the client to describe his or her main problems, degree of
severity, when they started, what the client has tried, etc.

Expectations Regarding Therapy – This section asks the client to write down what he or she thinks about
therapy, including how long it should last and what traits an ideal therapist should have.

Modality Analysis of Current Problems – This section allows the client to provide more in depth information
about the problems that led him or her to treatment. It covers the 7 modalities in the BASIC I.D. with a
combination of questions, fill-in-the-blank statements, rating scales, and / or checklists for each modality. This
is the longest section of the questionnaire, and is quite thorough in its scope.

The final page of the inventory allows the client to describe any significant experiences or memories (from
childhood or any other time in the person’s life) that he or she feels the therapist should know about.

Once the therapist has assessed the client’s 7 modalities – the BASIC I.D. – he or she will determine the best
therapeutic techniques and strategies to address them, starting with whichever modality is the most problematic.

Even though techniques and strategies play an important role in MMT, the relationship between therapist and
client is also very important. Clients list the qualities of the “ideal” therapist (in their eyes) on the inventory.
Multimodal therapists recognize the importance of adjusting their relationship style depending on the client’s
needs and preferences (information that can usually be obtained from the inventory).

For example, some clients do much better with a therapist who is very warm, personable, and empathetic.
Others, however, prefer a therapist who maintains a more businesslike demeanor. Additionally, some clients
prefer working with a therapist who is very active and direct, while others prefer a therapist who listens very well
and takes a less direct approach. Tailoring therapy, as well as therapy style, to the client will enhance the
positive effects of therapy.

Common Techniques Used in MMT

The techniques and strategies used by the therapist come from many different psychotherapeutic approaches as
well as other disciplines, including Gestalt therapy, classic behavior therapy, cognitive therapy, family therapy,
psychodrama, Logotherapy, guided imagery, bibliotherapy, anger management, relaxation training,
hypnotherapy, biofeedback, and social skills training to name several. Therapists are encouraged to use
techniques that are empirically supported as much as possible. In some cases, the therapist may need to refer
clients to another provider.

Behavior

 Modelling
 Self-monitoring
 Systematic desensitization
 Reinforcement
 Contingency contracts
 Response cost
  Shame attacking
 Paradoxical intention
 Behavior rehearsal

Affect

 Emotion regulation
 Anger management
 Feeling identification
 Pleasant activity schedule
 Identify triggers

Sensation

 Biofeedback
 Relaxation training
 Massage therapy
 Hypnosis
 Meditation
 Sensate focus training
 Yoga

Imagery

 Mastery imagery
 Positive imagery
 Aversive imagery
 Time projection imagery
 Thought stopping imagery
 Coping imagery
 Anti-future shock imagery

Cognitive

 Cognitive restructuring
 Positive self-talk
 Thought records
 Disputing irrational beliefs
 Thought stopping
 Bibliotherapy

Interpersonal

 Assertiveness training
 Social skills training
 Intimacy training
 Communication skills training
 Role reversal
 Fixed role therapy

Drugs / Health / Biology

 Exercise
 Smoking cessation program
  Weight management
 Nutrition education
 Lifestyle changes
 Consult with physician or other healthcare provider (with client’s permission)
 Refer to specialists

Disorders, Conditions, and Problems that Can Benefit from MMT

Following are just some of the problems and disorders that may benefit from multimodal therapy:

 Depression
 Generalized anxiety disorder
 PTSD
 Eating disorders
 Panic disorder
 Social anxiety disorder
 Relationship problems
 Weight problems
 Emotional eating
 Stress management
 Behavioral issues
 Compulsive behaviors
 Low self-esteem
 Insomnia
 Chronic pain

Advantages of Multimodal Therapy

While no therapy is perfect, multimodal therapy has many advantages that are worth considering. These include:

 Multimodal therapy is a very comprehensive and flexible form of psychotherapy. Its “broad-spectrum” approach to
treatment is one of the reasons it’s so highly effective.
 The thorough assessment that plays a key role in MMT helps ensure a more accurate diagnosis and also helps the
therapist select highly focused treatment strategies. Together, these two elements enhance the effectiveness of
treatment and increase the likeliness of lasting results.
 In MMT, treatment is tailored to the client’s needs by using a combination of techniques and strategies from many
different therapeutic approaches and disciplines. The therapist carefully chooses the ones that are appropriate for
the particular client and likely to be the most effective. Because the techniques aren’t limited to a specific
psychological theory or orientation, the range of potential interventions at the therapist’s disposal is much broader
than in other forms of psychotherapy.
 Multimodal therapy addresses the seven key modalities of personality and functioning, and identifies which ones
are the most problematic. This ensures that no modality is overlooked, which would make the client vulnerable to
relapse.
 Multimodal therapy takes into consideration the fact that clients’ problems usually involve an interaction of
several modalities rather than just one or two.
 By assessing a client’s BASIC I.D. and addressing the most problematic areas with appropriate interventions,
MMT helps the client make positive changes that align more closely with his or her ideal self.
 Therapists who use multimodal therapy don’t just customize the techniques and interventions to their clients; they
also tailor their therapeutic style to fit the client’s needs – i.e. the client’s individual manner of thinking and
feeling. Working with a client in a style that suits him or her naturally enhances the therapeutic relationship, which
is a key element of effective therapy.

Multimodal Therapy in Practice

If you’ve read this far, you may still be a bit unsure as to how all the pieces fit together in terms of how MMT
actually works. Following is an example of the way multimodal therapy could be used to address a client who
has problems with emotional eating:
  Behavior: Remove comfort foods from the home and office; make a list of alternative, healthy behaviors you can
do when negative feelings arise (e.g. go for a walk, call a friend, or write in a journal), and choose one to do each
time you feel tempted to comfort yourself with foods
 Affect: Use stress management techniques to lower stress; identify emotional triggers that lead to comforting
yourself with food – i.e. what feelings (e.g. anger, sadness, boredom) tend to be present when you feel the need to
self-soothe with food?
 Sensation: Use relaxation methods to reduce and manage anxiety
 Imagery: Visualize yourself handling conflict and other stressors calmly and effectively
 Cognition: Keep a journal of the negative thoughts that lead to emotional eating (i.e. what are you telling yourself
just before you reach for the bag of cookies?); use constructive self-talk when tempted to eat for comfort
 Interpersonal: Seek support from friends or family when you’re experiencing intense negative emotions; practice
assertiveness skills in order to reduce feelings of powerlessness and inferiority that trigger emotional eating
 Drugs / health / biology: Get some form of exercise each day to help reduce stress; get sufficient sleep so you’re
well-rested each day (as fatigue makes negative emotions even worse)

Another example, for someone dealing with depression:

 Behavior: Keep a regular sleep schedule; do at least one pleasurable activity a day, even if you don’t feel like it
 Affect: Reduce sadness by looking for the joy in small things; express negative emotions in therapy and / or
writing in a journal rather than keeping them inside
 Sensation: Use yoga or massage therapy to reduce muscle tension
 Imagery: Visualize a positive, worthwhile future when bleak images come into your mind
 Cognition: Practice positive self-talk; write down negative beliefs that are contributing to feelings of
worthlessness and hopelessness; challenge their accuracy
 Interpersonal: Avoid isolation by spend more time with people you enjoy or engaging in activities that involve
interacting with other people
 Drugs/ health / biology: Exercise regularly to boost mood; take antidepressant medication to help alleviate
symptoms and improve overall functioning

The interventions used above are just examples of what might be used, but many other interventions and
strategies could be used in their place depending on the specific client and his or her BASIC I.D. The therapist
may use entirely different strategies than those above to address the same basic issue with another client,
depending on multiple factors. This is one of the strengths of MMT – it’s not a cookie-cutter / one-size-fits-all
approach. Rather, the treatment is carefully customized to fit the client’s needs, based on the information
obtained from the initial interview and the Multimodal Life History Inventory.

Contraindications for Multimodal Therapy

There are certainly times when MMT isn’t the best or most appropriate approach for clients. For example,
individuals who are psychotic, actively suicidal or manic aren’t going to be appropriate for this treatment
approach. For starters, they require an intensive crisis intervention that focuses on safety and stabilization first
and foremost. It would also be impossible, or at least extremely difficult, for such individuals to complete the
Multimodal Life History Inventory, since doing so requires the ability to sit still, focus, and think clearly.
Multimodal therapy is generally contraindicated for anyone with a severe psychiatric disorder or in an acute
crisis.

Another contraindication for MMT is active substance abuse. It can be effectively used for individuals who are
in recovery, either as part of a dual diagnosis treatment program (in which mental health issues and substance
abuse or addiction are treated simultaneously) or following drug and alcohol treatment when the patient is clean
and sober. However, when someone is actively using alcohol and drugs, psychotherapy of any kind will have
very limited – if any – benefit.
Brief History of Arnold Lazarus and Multimodal Therapy

Arnold Lazarus (1932 – 2013) was a clinical psychologist, professor, prolific author, and popular lecturer. A
native of Johannesburg, South Africa, he completed his undergraduate and graduate training at the University of
Witwatersrand in Johannesburg. He eventually moved to the U.S. and became a prominent figure in the modern
psychology movement. Credited with coining the term “behavior therapy”, Lazarus also made significant
contributions in the areas of eclectic therapy and cognitive behavioral therapy. He was awarded several honors
for his brilliant work, including the American Psychological Association’s prestigious Distinguished
Psychologist Award of the Division of Psychotherapy.

He developed Multimodal Therapy after noticing limitations with CBT. He had reviewed the outcomes of
multiple patients who had received this particular therapy and found an unusually high relapse rate. He believed
that this was due to the therapy’s failure to address one or more key dimensions or modalities that all humans
inherently possessed (the BASIC I.D.). Part of his approach to developing MMT involved asking therapy
clients what aspects of therapy had been beneficial to them. In 1976 he founded the first Multimodal Therapy
Institute, located in Kingston, New Jersey. He went on to set up additional Multimodal Therapy Institutes in 6
other states.

What Is Sufism?

Sufism is the loving heart of Islam

From the 9th century onwards, Sufism has encapsulated Islamic spirituality. This is the loving heart of Islam,
still alive, thriving and widely influential today. It is not the Islam of fundamentalists: quite the reverse.

From the earliest days, ascetic Muslim contemplatives practised fasting, praying and meditation in seclusion, just
like the desert mothers and fathers of the Christian tradition, the earliest monks and nuns. Perhaps because they
wore rough garments made of wool (suf in Arabic), these people came to be known as ‘Sufis.’

Sufism soon became the name of a mystical path by which people seek the truth of divine love and knowledge
through direct personal experience of God. Sufis are said to take precious care of the ‘spiritual heart’
through ‘muraqaba,’ a practice akin to meditation. Their aim and ambition is to grow increasingly attuned to the
ever vigilant Divine Presence within. Dedicated Sufis are constantly meditating on the words of the the Islamic
holy book, the Qur’an (Koran).

Sufism is often considered external to the mainstream doctrine of Islam, and has at times encountered opposition
and hostility. Many of the great Muslim thinkers were Sufis, however, as were the most successful missionaries.
In addition, these humble living examples of wisdom, compassion and love were held in great esteem and
affection by ordinary people, those less capable of disentangling the legal and theological intricacies of more
formal religion. Two aspects of Sufism well known in western culture are, of course, Rumi and the ‘whirling
dervishes’.

Jalaladdin Rumi (1207–1273) went through a most powerful spiritual awakening as a young man. Influenced by
his beloved teacher, Shams of Tabriz, his heart full of divine light, he became a supreme poet and faithful
interpreter of the truths to be found in the Qur’an. By means of sometimes mysterious language, he was able to
guide others to a love of God. The Qur’an statement, that ‘Allah loves them and they love him’ quickly became
the basis for love-mysticism championed Rumi, as in the following quatrain:

‘Love is here like the blood in my veins and skin,

It has emptied me of myself and filled me with the Beloved,

His fire has penetrated all the atoms of my body.

Of “me” only my name remains; the rest is Him.’

Rumi, known too by the honorary title ‘Mawlana’, also favoured and promoted ‘whirling’. This is a form of
extended rotatory dancing to sacred music in formal groups while repeating inwardly the name of ‘Allah’. It
induces a trance-like state of consciousness, and is a central aspect of Sufi worship performed by the renowned
Dervishes, some of whom are still practising their traditional ‘Sama’ (whirling) ceremonies today. Whirling,
meditation, prayer, ‘dhikr’ (regular study and remembrance of the Qur’an) and reciting poetry, especially love
poetry, are all integral to devotional Sufi spiritual practice.Rumi’s tomb and the Mawlana Museum is in Konya,
in modern Turkey, located in the religious centre with which he was associated (secularized by the Turkish State
in 1926). It is impressive. (I visited there last year.) In addition to the Mevlevi order of Sufism founded by Rumi,
there are others: the Qadiriyya, begun in the 12th century, rooted in Sunni Islam and found across the Muslim
world; the 13th century Bektashiyya order, which previously had a large influence in Turkey and the Balkan
countries; the Chishti in India, and the Naqshbandiyya, from the 14th century, popular in the Muslim world, also
one of the Sufi orders in the Indian sub-continent and Indonesia, whose followers do not dance or sing.

It is not true that Sufism is a men-only tradition. A woman called Rabi’a (d. 801) who lived in Iraq was, for
example, one of the best loved of all the early Sufis. Revered Sufi teacher, Ibn al-Arabi (d. 1240), was first
taught the spiritual path in his native Spain by two female Sufis. Later there were Sisterhoods among the
different orders of Sufism, as well as Brotherhoods. And women attended Bektashiyya ceremonies, without even
wearing veils. Many women follow the Sufi tradition today.

At the heart of Sufism is the idea that humankind, the most honourable of creatures, is bound by covenant to
carry the Divine Trust. It follows that if the ego forgets the Divine purpose of creation, viewing itself as existing
independent of its Creator, it is betraying that sacred Trust. Now, the modern ego continually quests for self-
satisfaction and self-adoration. Sufi practices, like those of many other world religions, enable people to combat
this tendency, seeking to discover and bring forth the higher or ‘true’ self, that spark within each person,
constantly attuned to the spiritual dimension.

The Sufi seeks to live according to eternal, selfless spiritual values, rather than transient, mercenary worldly
ones. Neuro-scientific studies reveal that practices like meditation, chanting and whirling all improve harmony
between the dualist, verbal, intellect of the brain’s left hemisphere and the holistic, silent, poetic intuition of the
right. That Christianity, Judaism, Buddhism, Zen, Taoism, and Hinduism’s Vedanta all promote similar
practices, aimed equally at conquering the tyranny of the ego, indicates a comforting degree of uniformity among
travellers along the pathway to spiritual maturity, whatever their religious origin.

Similar practices form an essential component of what many these days accept as a kind of secular spirituality in
a quest for personal wholeness and integrity that avoids the need to sign up to any particular or partisan religious
tradition. Some, in the USA for example, might even find themselves attending meetings of Sufi Brotherhoods
and Sisterhoods without becoming Muslims. A word of caution seems appropriate: those who think of Sufism as
a liberal path offering individual freedom in the Western sense have understood it wrongly. Personal discipline is
involved. The word ‘Islam’, after all, means ‘submission’—submission, that is, to the Will of God.Although
Sufism may seem rather specialized, there are additional ways to connect it favourably with other spiritual
traditions. For example, Islam, Judaism and Christianity are all monotheist faiths, sharing a single God; and all
three have a common ancestor, Abraham, the father of both Isaac and Ishmael.

Followers of all three faiths can recognize the Divine covenant, even while interpreting it slightly differently.
What seems more important is their kinship—with each other, also with all other humanitarian and spiritual
seekers—rather than the ego’s perceptions of differences and consequent grounds for conflict. These only lead to
delusions—delusions of ignorance, of exclusivity and, fatally, of superiority. The Sufi knows from experience
(as the Bible also tells us: 1 John 4: 16) that the nature of God is love. Would that more Muslims were Sufi’s;
and more non-Muslims were Sufi-like.

Yoga Therapy: Ancient Techniques for Modern Healing

Yoga therapy uses postures and breathing techniques to facilitate healing from psychological and physical
conditions. Meditation also plays a role in achieving improved emotional wellbeing. While yoga is often
associated with physical exercise and relaxation, it can also be used to enhance your overall health. The holistic
approach of this therapy means that it includes aspects of physical therapy as well as psychotherapy.

Yoga Therapy: What is it?

While many people attend yoga classes to exercise, therapeutic sessions are a lesser explored aspect of yoga. If
you’re seeking relief from psychological symptoms, these therapeutics sessions may be the right choice for you.

The difference between therapy and regular yoga is that therapists focus their attention on your symptoms and
how yoga techniques can be used to relieve them. Therapeutic sessions are customized to meet your unique
needs rather than focusing on teaching a general yoga sequence to a group class. During these sessions, the
therapist uses their training, knowledge, and experience to choose yoga practices that will benefit you.

Yoga Therapy Theory

Yoga therapy has a holistic approach to healing which takes into account your mind, body, and soul. The
therapeutic process is used to facilitate the development of self-knowledge which can be used to address the
psychological challenges that you are facing.

Yoga theory incorporates the idea of prana or energy that flows through our bodies. The healing process involves
addressing any energy blockages which can result in emotional and physical imbalances.

The chakras or energy centers are a vital aspect of yoga therapy theory. This theory attributes different health
concerns to blockages in different energy centers. Addressing these blockages may help to alleviate the
underlying causes of emotional imbalances.

How Does Yoga Therapy Suggest the Mind Works?

Yoga therapy takes a holistic approach to explaining how your mind works by recognizing your mind’s
connection to your body and spirit. In this system, your mental wellbeing is linked to your physical and spiritual
well-being. The yoga practices aim to strengthen your body and facilitate psychological health. Yoga therapy
may help you to change your perspective of the challenges that you are facing as well as to change your attitude
towards them.

How Does Yoga Therapy Cause Change?

The techniques used in yoga therapy include asana, which refers to the physical postures that you can expect to
perform during the session. Another important technique that facilitates healing is pranayama, which refers to the
breathing exercises that you’ll learn. Meditation, as well as guided imagery, are also used to cause change in
yoga therapy. Research has revealed that yoga increases the levels of the neurotransmitter GABA. This is
relevant to its use in the treatment of mental health concerns as people who are struggling with anxiety and
depression typically have low GABA levels. Reduced GABA levels are also prevalent in people who are
struggling with addiction. Yoga therapy helps to reduce stress levels and promote relaxation. The high levels of
stress that accompany our busy modern lifestyles can result in emotional and physical health issues. Prolonged
stress can have a negative impact on your mental health, which means that implementing a regular practice that
reduces stress has far-reaching benefits.

What Happens in a Yoga Therapy Session?

You can expect your yoga therapist to tailor your session to meet your individual requirements. Your therapist
will take your overall health as well as your fitness levels into consideration during the session.
During your first session, your yoga therapist will conduct an assessment which aims to identify your health
issues as well as to review your physical capabilities. You can also expect your therapist to ask you questions
about why you are seeking therapy.

This assessment is used by your therapist to customize a treatment plan to meet your unique requirements.
Together with your therapist, you’ll decide on how often to schedule sessions. After the initial assessment is
completed, you can expect to go through a series of breathing exercises, physical postures, and meditations.
Once you learn these techniques, your therapist will ask you to incorporate them into your daily life.

This type of therapy provides the most benefit if you practice what you learn during the sessions at home. These
sessions differ from a traditional yoga class as they’re usually conducted one-on-one or in small groups.

Techniques Used in Yoga Therapy

During the therapy, you’ll learn a range of breathing exercise that you can incorporate into your everyday life as
needed. Balancing breaths can be used for relaxation if you have an experience that triggers anxiety. You’ll also
learn energizing breathing techniques that you can use when you need to feel revitalized.

Your therapists will also teach you specific yoga postures that can be used to address your specific concerns.

Meditation techniques promote mindfulness, which can help you to identify negative thought patterns as they
arise. Being mindful of your thoughts helps you to address the root cause of emotional disturbances. Meditation
also promotes relaxation which makes it a great addition to your morning routine. You can also use meditation in
the evenings to relieve stress after work and to promote better sleep. Guided imagery is another useful technique
that’s used for relaxation.

Does Yoga Therapy Work?

Studies show that yoga therapy is effective for a range of physical and emotional issues. While yoga therapy can
be used to reduce the symptoms that are associated with various mental health conditions, it can also be used to
manage any symptoms that you continue to experience. The techniques can be used to identify the root cause of
the symptoms so that you can improve the quality of your life.

Implementing a self-care plan is important during the healing process and yoga practices are a valuable tool that
can be used to maintain emotional well-being. Incorporating self-care practices into your daily routine can help
you to learn to love yourself and accept yourself for who you are.

What Kinds of Concerns is Yoga Therapy Best For?

Yoga therapy is useful in the treatment of depression as well as anxiety. Studies have also shown that it may be
effective in helping people who are suffering from posttraumatic stress.

Children with autism may also find emotional relief from participating in yoga therapy sessions.

Yoga therapy is used in the treatment of substance abuse. Yoga has a positive effect on the areas of the mind that
are prone to addiction. Not only is yoga therapy useful in the treatment of mental health issues, these techniques
can help to prevent emotional issues from developing.

Yoga therapy is suitable for all age groups and experience levels.
How Are Yoga Therapy Specialists Trained?

The Biomedical Yoga Trust, as well as the International Association of Yoga Therapists, plays a role in
maintaining consistent yoga therapy standards. Yoga therapists can receive training and certification from IAYT
accredited programs.

Training for Certified Yoga Therapists is offered at the American Viniyoga Institute and the YogaLife Institute.
Phoenix Rising Yoga Therapy also offers training in this type of therapy.

During the training, practitioners learn more about yoga philosophy and techniques. They develop an in-depth
understanding of therapeutic yoga techniques. Anatomy, physiology, and nutrition are also covered during these
programs. The training covers basic first aid as well as the fundamentals of business ethics. Therapists who
complete IAYT accredited programs are expected to uphold high ethical standards.

Concerns/Limitations of Yoga Therapy

While yoga therapy has many benefits, it’s not a quick fix. This therapy has the most impact when it’s used
consistently over time. It’s a gentle approach which is well-known for its long-term effects on maintaining
emotional well-being.

If you’re suffering from severe mental health issues, its best to use yoga therapy in conjunction with the
treatment recommended by your healthcare professional. Yoga therapy should be started slowly and increased
over time.

If you have a physical injury, yoga therapy may not be the right choice for you as it involves physical postures.
While there are physical ailments that can prevent you from using yoga therapy, the sessions can be adapted to
match your physical capabilities. In some cases, your yoga therapist may start you off with one or two physical
postures or one breathing exercise before adding more activities to your session. This approach helps you to
build your fitness levels and physical capabilities over time.

Important Practitioners in Yoga Therapy

Yoga therapy evolved from the practices of yoga which extend back thousands of years. The original yoga
practices were developed in India. Yoga was introduced to the United States during the 1800s and its use in
therapy can be attributed to research conducted by Dr. Dean Ornish. Dr. Ornish’s research showed how a
healthy lifestyle program could be used in the treatment of heart disease. He used therapeutic yoga in his lifestyle
program and the research revealed the benefits of these techniques.

Dr. Ornish’s program was approved by insurance companies during 1990 which paved the way for yoga therapy
to be integrated into the medical field. Dr. Ornish is a note-worthy physician and researcher who has played an
important role in the development of yoga therapy. He founded the Preventative Medicine Research Institute and
he works as a Clinical Professor of Medicine. Dr. Ornish advocates for a holistic approach to overall health
which includes yoga as well as psychosocial support.

19 Narrative Therapy Techniques, Interventions +

Worksheets [PDF]
What is Narrative Therapy? A Definition

Narrative therapy is a form of therapy that aims to separate the individual from the problem, allowing the
individual to externalize their issues rather than internalize them. It relies on the individual’s own skills and
sense of purpose to guide them through difficult times (“Narrative Therapy”, 2017).This form of therapy was
developed in the 1980s by Michael White and David Epston, two therapists from New Zealand (“About
Narrative Therapy”). They believed that separating a person from their problematic or destructive behavior was
a vital part of treatment (“Michael White”, 2015). For example, when treating someone who had run afoul of the
law, they would encourage the individual to see him- or herself as a person who has made mistakes rather than a
felon. White and Epston grounded this new therapeutic model in three main ideas.

1. Narrative therapy is respectful.

This therapy respects the agency and dignity of every client. It requires each client to be treated as an individual
who is not deficient, not defective, or not “enough” in any way. Individuals who engage in narrative therapy are
brave people who recognize that there are issues they would like to address in their lives, which leads to the
second main idea.

2. Narrative therapy is non-blaming.

In this form of therapy, clients are never blamed for their problems, and they are encouraged not to blame
anyone else as well. Problems emerge in everyone’s lives due to a variety of factors, and in narrative therapy,
there is no point in assigning blame to anyone or anything. Narrative therapy separates people from their
problems, viewing them as whole and functional individuals who engage in thought patterns or behavior that
they would like to change.

3. Narrative therapy views the client as the expert.

Finally, in narrative therapy, the therapist does not occupy a higher social or academic space than the client. In
these therapeutic relationships, it is understood that the client is the expert in his or her own life, and both parties
are expected to go forth with this understanding. Only the client knows their own life intimately, and only the
client has the skills and knowledge necessary to change their behavior and address their issues (Morgan, 2000).

These three ideas lay the foundation for the therapeutic relationship and the function of narrative therapy. The
therapeutic process is built off of this understanding and involves taking a perspective that may feel foreign:
placing a firm separation between people and the problems they are having.

Making this distinction between an individual with problems and a problematic individual is important in
narrative therapy. White and Epston theorized that subscribing to a harmful or adverse self-identity could have
profound negative impacts on a person’s functionality and quality of life.

To this end, there are a few main themes or principles of narrative therapy:

1. Reality is socially constructed, which means that our interactions and dialogue with others impacts the way we
experience reality.
2. Reality is influenced by and communicated through language, which suggests that people who speak different
languages may have radically different interpretations of the same experiences.
3. Having a narrative that can be understood helps us to organize and maintain our reality. In other words, stories and
narratives help us to make sense of our experiences.
4. There is no “objective reality” or absolute truth, meaning that what is true for us may not be the same for another
person, or even for ourselves at another point in time (Standish, 2013).
These principles tie into the postmodernist school of thought, which views reality as a shifting, changing, and
deeply personal concept. In postmodernism, there is no objective truth – the truth is what each one of us makes
it, influenced by social norms and ideas.

This idea that we make our own truth and tell our own stories to make sense of the world is an excellent fit for
narrative therapy. The main premise behind this therapy is that an individual is separate from their problems, and
this distance is believed to allow individuals to apply the skills learned in narrative therapy to solve them.

It’s amazing how much easier it can seem to solve or negate a problem when you don’t see the problem as an
integral part of who you are.

5 Commonly Used Narrative Therapy Techniques

Some of the skills applicable to solving problems through narrative therapy are skills that we all already possess,
while others take more effort to learn and apply. The five techniques below are among the most common
techniques used in narrative therapy.

Telling One’s Story (Putting Together a Narrative)

As a therapist or other mental health professional, your job in narrative therapy is to help your client find their
voice and tell their story in their own words. According to the philosophy behind narrative therapy, storytelling
is how we make meaning and find purpose in our own experience (Standish, 2013).

Helping your client develop their story gives them an opportunity to discover meaning, find healing, and
establish or re-establish an identity, all integral factors for success in therapy.

This technique is also known as “re-authoring” or “re-storying,” as clients explore their own experiences to find
alterations to their story or make a whole new one. The same events can tell a hundred different stories since we
all interpret experiences differently and find different senses of meaning (Dulwich Centre).

Externalization Technique

The externalization technique involves leading your client toward viewing their problems or behaviors as
external, instead of a part of him or her. This is a technique that is much easier to describe than to fully embrace,
but it can have huge positive impacts on self-identity and confidence.

The general idea of this technique is that it is much easier to change a behavior that you engage in than it is to
change a characteristic that is a part of you. For example, if you are quick to anger and you consider yourself an
angry person, you must fundamentally change something about yourself to address the problem; however, if you
are a person who acts aggressively and becomes angry easily, you simply need to alter the behaviors to address
the problem.

It might seem like an insignificant distinction, but there is a profound difference between the mindset of someone
who labels themselves as a “problem” person and someone who acknowledges they sometimes engage in
problematic behavior.

As a therapist, this technique is easy to describe, but it may be challenging for the client to fully buy into this
strange idea. Encourage your client not to place too much importance on their diagnosis or self-assigned labels.
Let them know how empowering it can be to separate him- or herself from their problems, allowing them a
greater degree of control (Bishop, 2011).
Deconstruction Technique

This “deconstruction” refers to breaking down the problem or problems the client is having, making it more easy
to understand and address. Our problems can often feel overwhelming, confusing, or unsolvable, but they are
never truly unsolvable (Bishop, 2011).Deconstructing the issue makes it more specific and avoids
overgeneralizing, as well as clarifying what the core issue or issues actually are.As an example of the
deconstruction technique, imagine two people in a long-term relationship who are having trouble. One partner is
feeling frustrated with a partner who never shares her feelings, thoughts, or ideas with him.Based on this short
description, there is no clear idea of what the problem is, let alone what the solution might be. If you, as a
therapist, were to deconstruct the problem with this client, you might ask him to be more specific about what is
bothering him.This might lead to a better idea of what is troubling the man, like feeling lonely and missing a
sense of intimacy with his partner. From here, you might find that intimacy is very important for this man in
romantic relationships, and when his partner doesn’t share with him he is left feeling isolated and like his partner
doesn’t truly trust him.Deconstructing the problem helped us to learn exactly what the problem is (he is feeling
lonely and isolated) and what this means to him (it makes him feel like his partner doesn’t trust him, or perhaps
is not willing to commit to the relationship like he is).This technique is an excellent way to help the client dig
deep into the problem, understanding what is important to them and how this issue threatens that.

Unique Outcomes Technique

This technique is a bit involved and complex, but keep in mind the storytelling aspect of narrative therapy.The
unique outcomes technique involves changing one’s own storyline. In narrative therapy, the client aims to
construct a storyline to their experiences which provides meaning and gives them a positive, functional identity.
We are not limited to just one storyline, though. There are many potential storylines we can subscribe to, some
more negative and others more positive.Instead of continuing to see his or her life from the same perspective as
always, the unique outcomes technique can help a client to change their perspective and perceive more positive
and life-giving narratives.Like a book that switches viewpoints from one character to another, our life has
multiple threads of narrative running through it with different perspectives, different areas of focus, and different
points of interest. Putting the unique outcomes technique to use is simply choosing to focus on a different
storyline or storylines from the one that has been the source of your problems.Using this technique might sound
like avoiding the problem, but it’s actually just reimagining the problem. What seems like a problem or issue
from one perspective can be nothing but an unassuming or insignificant detail in another (Bishop, 2011).As a
therapist, you can introduce this technique by encouraging your client(s) to pursue alternative or new storylines.

Existentialism

You might have a particular association with the term “existentialism” that makes its presence here seem odd,
but there is likely more to existentialism than you think.Existentialism is not a bleak and hopeless view on a
world without meaning.It’s true that, in general, existentialists believe the world holds no inherent meaning, but
they do not take this belief as a license to fall into a deep pit of depression and meaninglessness; rather, they
believe we can create our own meaning.In this way, existentialism and narrative therapy go hand in hand.
Narrative therapy encourages individuals to make their own meaning and find their own purpose rather than
search for some pre-existing, absolute truth.Borrowing some techniques or interventions from existentialism can
provide excellent support for the client working through narrative therapy.

3 More Narrative Therapy Exercises and Interventions

While narrative therapy is more of a dialogue between the therapist and client, there are some exercises and
activities to supplement the regular therapy sessions. A few of these are described below.

Statement of Position Map

This simple handout consists of four areas to be filled in:

 1. Characteristics and naming or labeling of the problem
2. Mapping the effects of the problem throughout each domain of life it touches (home, work, school, relationships,
etc.)
3. Evaluation of the effects of the problem in these domains
4. Values that come up when thinking about why these effects are undesirable

This map is intended to be filled out in concert with a therapist, but it could be explored individually if it is
difficult to find or meet with a narrative therapist.Generally, the dialogue between a therapist and client will
delve into these four areas. The therapist will ask questions and probe for deeper inquiry, while the client talks
through the problem they are having and finds insight into each of the four main areas listed above.There is
power in the simple act of naming the problem, and it is necessary to understand how and in which areas the
problem is having an effect. Finally, it is vital for the client to understand why this problem bothers them on a
deeper level. What values are being infringed upon or obstructed by this problem? Why does the client feel
negative about the problem? These are questions that this exercise can help to answer.

My Life Story

One of the most basic therapeutic principles in narrative therapy is that we find meaning and healing through
telling stories. This exercise is all about your story, and all you need is the printout and a pen or pencil.The
intention of the My Life Story exercise is to separate yourself from your past to gain a broader perspective on
your life. It aims to help you create an outline of your life without diving too deeply into your memories.

First, you write the title of the book that is your life. Maybe it is simply “Monica’s Life Story,” or something
more reflective of the themes you see in your life, like “Monica: A Story of Perseverance.”In the next section,
come up with at least seven chapter titles, each one representing a significant stage or event in your life. Once
you have the chapter title, come up with one sentence that sums up the chapter. For example, your chapter title
could be “Awkward and Uncertain” and the description may read “My teenage years were dominated by a sense
of uncertainty and confusion in a family of seven.”Next, you will consider your final chapter and add a
description of your life in the future. What will you do in the future? Where will you go, and who will you be?
This is where you get to flex your predictive muscles.

Finally, the last step is to add to your chapters as necessary to put together a comprehensive story of your life.

This exercise will help you to organize your thoughts and beliefs about your life and weave together a story that
makes sense to you. The idea is not to get too deep into any specific memories but to recognize that what is in
your past is truly the past. It shaped you, but it does not have to define you.

Expressive Arts

This intervention can be especially useful for children, but many adults may find relief and meaning through
engagement as well.We all have different methods of telling our stories, and using the arts to do so has been a
staple of humanity for countless generations.To take advantage of this expressive and creative way to tell your
stories, explore the different methods at your disposal. You can:

 Meditate. Guided relaxation or individual meditation can be an extremely effective way to explore a problem.
 Journal. Journaling has many potential benefits, and this is yet another. You can consider a specific set of question
s (e.g., How does the problem affect you? How did the problem take hold in your life?) or simply write a
description of yourself or your story from the point of view of the problem. This can be difficult but can lead to a
greater understanding of the problem and how it influences the domains of your life.
 Draw. If you’re more interested in depictions of the problem’s impact on your experience, you can use your skills
to draw or paint the effects of the problem. You can create a symbolic drawing, map the effects of the problem, or
create a cartoon that represents the problem in your life.
 Movement. You can use the simple medium of movement and mindfulness to create and express your story. Begin
by moving in your usual way, then allow the problem to influence your movement. Practice mindful observation to
see what changes when you let the problem take hold. Next, develop a transitional movement that begins to shake
 the problem’s hold on you. Finally, transition into a “liberation movement” to metaphorically and physically
explore how to escape the problem.
 Visualization. Use visualization techniques to consider how your life might turn out in a week, a month, a year, or
a few years, both with this problem continuing and in a timeline in which you embrace a new direction. Share your
experience with a partner or therapist, or reflect on your experience in your journal to explore the ways in which
this exercise helped you find meaning or new possibilities for your life (Freeman, 2013).

Play Therapy: 50+ Essential Techniques, Toys and

Certification Opportunities
Play therapy is a type of therapy that, as the name suggests, involves playing. It has been around for a long time,
even in an academic context.

Recently, play therapy has been refined and targeted to a variety of different disorders, from autism spectrum
disorder (ASD) to attention-deficit hyperactivity disorder (ADHD). Play therapy has also been used in normal
functioning children and adults to great effect.

Read on to learn what play therapy is and some of its benefits, as well as how to become a play therapist if it is
something that interests you.

What is Play Therapy? A Definition

Play therapy is a type of therapy that has been around in psychiatry since the 1930s and may have been around
for hundreds or even thousands of years before then. Academics in the 1930s felt the value of play therapy was

“that the child revealed far more of himself when talking about things he liked to do, his favorite toys, his pets,
his friends, etc., than when he was face to face with a psychiatrist who questioned him first about his troubles”
(Gitelson, 1938).This belief still drives much of play therapy today.

Nowadays, play therapy is defined by the Association for Play Therapy (APT) as“the systematic use of a
theoretical model to establish an interpersonal process wherein trained play therapists use the therapeutic powers
of play to help clients prevent or resolve psychosocial difficulties and achieve optimal growth and development”
(Association for Play Therapy). They also define it in a simpler way by saying“child play therapy is a way of
being with the child that honors their unique developmental level and looks for ways of helping in the
“language” of the child – play”. Based on these definitions, it is clear that the APT considers the healthy
development of a child to be the primary goal of play therapy.

Play therapy can also be adapted to the client, as very young children play in different ways than adolescents and
adults. The idea of play therapy is to let clients settle into a more comfortable situation where they are more
willing to express themselves than they would be in a traditional therapy session.

50+ Play Therapy Techniques, Activities and Interventions

Just as there are many different ways that children play, so are there many different types of play therapy. For
example, according to Allen & Hoskowitz (2017), there is:

 nondirective play therapy

 puppets/dollhouse/other toys for the purpose of pretend play
 interpret play for emotional content
 directive play therapy
 interpret drawings for emotional content
 drawing/painting for the purpose of emotional expression (Allen & Hoskowitz, 2017).
There is also Parent-Child Interaction Therapy (PCIT), which, as the name suggests, involves the parent (Zlomke
et al., 2017). If you really want to see the variety of play therapy techniques that exist in the world today, though,
the book Essential Play Therapy Techniques (Schaeffer & Cangelosi, 2016) is a must-read. The book details 58
different play therapy techniques. For people who do not have time to read through the book, take a look at the
table of contents, grouped by type of play therapy (examples added in and pulled from various parts of the
book):

Toy and Object Play Techniques

Ball Play
For example, in a group therapy session, a therapist might have a group take turns throwing a ball around, and
anytime someone catches the ball they have to say something that makes them happy.

Plush Doll Play

For example, the therapist might present the client with a few stuffed animals (or ask the client to bring their
own) to help comfort the child during a therapy session.

Medical Play
For example, a client who has just undergone a stressful medical procedure might do a play examination on one
of their stuffed animals, so they can feel a sense of control.

Baby Doll Play

For example, a therapist might use a baby doll to model positive, nurturing behaviors for the client, or might let
the client play with the doll to see what the client’s instincts are. If the client starts mistreating the doll, it is
possible that the client is being mistreated by their own parents (though of course, it does not necessarily mean
that).

Baby Bottle Play

For example, a young client who has just had a new baby sibling enter their life might feel unhappy about their
new position in the family. The client’s parent can then play with a baby bottle as if the client was a baby again,
so the client is less resentful of their new sibling.

Toy Telephone Play

For example, the client and the therapist might each have a toy phone, and the therapist can ask therapy-related
questions on the phone. The client might be more comfortable indirectly answering questions like this, and if
they feel uncomfortable they can just hang up.

Magic Wand Play

For example, the therapist might give the client a magic wand and tell them they can make three wishes. At least
one of the wishes is likely to relate to a real-life problem the client has.

Bubble Play
For example, the therapist might simply let the client run around blowing bubbles and popping them for stress
relief reasons or to help a child bond with other children in a group session.

Block Play
For example, the therapist might construct a wall of building blocks and allow the client to throw a ball to knock
the blocks down. This can help the client release anger.

Balloon Play
For example, the therapist might ask a group of children in a group session to keep a balloon up in the air for as
long as possible, to foster bonding and to break the ice in a group session.
Bop Bag Play
For example, the therapist might give the client a phone book, and ask them to tear pages out of the book,
crumple them up, and throw them into a trash can. This can help the client understand how to “throw away”
angry feelings.

Sensory Play
For example, the therapist might let the client play with shaving cream by spreading it around, sculpting it, and
even pretend shaving, so the client can creatively express themselves and feel more relaxed and in control.

Metaphors and Storytelling Techniques

Concrete Play Metaphors

For example, a therapist might present dozens of toys to the client, then ask them to pick out toys that represent
family members. This can help the therapist see what the client thinks and feels about their family members.

Turtle Technique
For example, a therapist might give a client a turtle puppet, and explain that when the turtle is upset about
something it stops, goes into its shell, closes its eyes, and takes three deep breaths. The client can then play out
this process with the turtle puppet, and this can help the client learn anger-management techniques.

Emotion Thermometer
For example, the client might be presented with an “emotion thermometer” showing a range of emotions from 0
(with a smiling face) to 10 (with a frowning face) and asked to list events that make them feel like they are on
different points on the thermometer. This might sound like, “What types of things make you feel like a smiling
face? What about a frowning face? What about a medium face?”

Storytelling
For example, the therapist might ask a client to tell a story starting with “Once upon a time”. The story might
reveal some of the client’s fears and hopes, among other things.

Externalization Play
For example, the client and therapist might work together to create a character that represents one of the client’s
problems, such as a dragon that represents the client’s fear. The therapist can then ask questions about the
problem without directly addressing the client’s fear, by externalizing the problem to the dragon.

Bibliotherapy
For example, the therapist might find a story or book that involves a problem similar to the client’s problem, and
that provides a solution to this problem. While reading this story with the client, the therapist might ask
questions relating the story to the client’s life, such as, “have you ever felt this way?”.

Role-play Techniques

Role-Play
For example, the therapist and client might role-play a situation the client is anxious about, such as the first day
of school, so that the child can work out what they feel anxious about and possibly realize they do not need to be
anxious at all.

Costume Play
For example, the therapist and client might pretend that the client is being crowned the new king or queen of a
land. The therapist can then ask what the new king or queen wants to do with their power, to figure out what the
client likes and dislikes.

Mask Play
For example, the therapist might ask the client to make two collages (masks) out of magazines. One mask (the
“outside mask”) is how they think the world sees them, and one mask (the “inside mask”) is how they see
themselves. This can reveal a lot about how the client thinks of themselves and the world.

Superhero Play
For example, the therapist might ask the client to draw a superhero with superpowers that the client would like to
have. The therapist can then help the client figure out how their personal strengths can be as useful as these
superpowers.

Puppet Play
For example similar to the concrete play metaphors example, the therapist might present the client and the
client’s family with dozens of puppets, then ask the client and the client’s family to each choose a puppet to
represent them. The client and the client’s family then tell a story using the puppets, and the therapist interviews
each family member about the story then discusses the story with the whole group. This can reveal certain family
dynamics that the client is unable or unwilling to directly discuss with the therapist.

Creative Arts Techniques

Color Your Life

For example, the therapist and client might work together to figure out which colors represent which feelings
(such as blue for sad, red for angry, yellow for happy, etc.). The therapist can then ask the client to draw a
timeline of their life, using the colors to represent feelings. The therapist can also ask the client to draw different
aspects of their life, such as school or sports.

Clay Play
For example, the therapist might give the client a ball of clay and let them do whatever they want with it. The
client might simply use the clay as stress relief, or they might sculpt things that are important to them or
troubling them that they can talk about with the therapist.

Free Drawings
For example, the therapist might simply give the client paper and some crayons (or any drawing materials) and
ask them to draw a picture. The therapist can then ask open-ended questions about the picture once it is
completely done.

Trauma Drawings
For example, the therapist might ask the client to draw a traumatic experience in the client’s past, such as an
earthquake. The client can then crumple up the paper and throw it away to feel some sense of control over the
traumatic event.

Mandala Drawings
For example, the therapist might give the client a mandala template (some of which can be found here) and ask
the client to color it in. The client can then make their own mandala and color in it if they wish.
This can help foster creativity and relaxation.

Serial Drawings
For example, the therapist might ask the client to draw a picture (nondirected) every session. After the picture is
drawn, the therapist and client can talk about it, with the therapist not taking notes so it is clear they are present.
These drawings over time might show the client’s state of mind as the therapy process progresses.

Collage
For example, the therapist might ask the client to collage a nightmare they have been having on the inside and
outside of the box. The client can then play with the box to become less scared of it.
Painting
For example, the therapist might ask the client to finger paint whatever they want, after which the therapist can
ask the client to tell a story about the painting.

Dance/Movement Play
For example, the therapist might have a client simply play with a hula hoop, so that they focus and relax, which
might put them in a better state of mind for a therapy session.

Draw a Family
For example, the therapist might ask the client to draw a picture of their family. Once the picture is drawn, the
therapist can ask which drawing is which member of the client’s family and discuss whatever the client wants to
discuss about the drawing. The ways various family members are drawn can be revealing.

Family Sculpting
For example, the therapist might ask the client to use clay to sculpt their family members, including the client
themselves. Once each family member has a clay figure, the therapist might ask the client to place them in
relationship to each other, which can show the therapist how close or far from each family member the client
feels themselves to be.

Musical Play
For example, the therapist might present the client with a number of toy instruments and simply ask the client to
make up a song or play along with another song. This can help the client express themselves, build self-esteem,
and improve the therapist-client relationship.

Imagery and Fantasy Techniques

Guided Imagery
For example, a therapist might ask the client about a nightmare they have been having, then explain to the client
that nightmares are like movies, and tell the client that they can change the nightmare if they do not like it. The
therapist can then work with the client to figure out a happier ending for a nightmare, in an attempt to retrain the
client’s brain to feel more control.

The World Technique

For example, the therapist might give the client a tray half-filled with sand, and dozens of toys, including people,
fantasy figures, and scenery. The therapist then allows the client to build their own world without providing any
guidance or judgment. The therapist then asks the client questions about the world, still without providing any
guidance. The idea is that the world the client builds might involve themes the client deals with in real life so that
the world can be an opportunity to work through some of these issues.

Dollhouse Play
For example, the therapist might give the client a dollhouse and some dolls representing their family members.
The therapist can then ask the client to model four different everyday scenarios in their real house: bedtime,
dinnertime, playtime, and cleanup time, to figure out more of the client’s family dynamics.

Adaptive Doll Play

For example, the therapist might give the client a few dolls to represent themselves and their family members
and ask them to play out a scenario that is similar to a real problem the client is having. The therapist can then
help the client figure out ways the client can respond to these scenarios so that they have more positive
outcomes.

Rosebush Fantasy Technique

For example, the therapist might ask the client to close their eyes, imagine that they are a rosebush, and describe
this rosebush to the therapist, including where it is, who cares for it, and any roots, thorns, or flowers it might
have. The client can then draw the rosebush and tell its story to the therapist, at which point the therapist can ask
which parts of the rosebush and its story the client identifies with. The therapist might find out that one of the
rosebush’s roots relates to a past experience the client had but was not yet ready to talk about in previous
sessions.

Family Relations Technique

For example, the therapist might put a number of mailboxes in front of the client, one for each family member
and one for “Mr. Nobody”. The therapist then gives the client “mail”, which consists of strips of paper that read
things like “loves me”, “hates me”, “protects me”, “hurts me”, and asks the client to put these pieces of mail in
each appropriate mailbox (so if the client thinks their dad loves them, they would put a “loves me” paper in their
dad’s mailbox). This can help the therapist further understand family dynamics.

Worry Dolls
For example, the therapist might give the client a set of Guatemalan worry dolls or help the client make their
own. The therapist can then ask the client to assign a worry to each of these dolls, put the dolls in a box, and
leave the dolls in the therapist’s office so that the dolls can worry about the client’s issues instead of the client
having to worry about them. In future sessions, the therapist can bring these dolls out one-by-one to discuss these
worries and how the client is dealing with them.

Tea Party Play

For example, the therapist might throw a tea party celebration for the client, to commemorate progress the client
is making during therapy sessions or achievements the client has reached outside of therapy. This positive
reinforcement can help raise the client’s level of self-esteem and can help the relationship between the therapist
and the client.

Game Play Techniques

Communication Games
For example, the therapist and client might play “The Talking, Feeling, and Doing Game”. A turn of the game
might look like this: the client draws a card that says “Make believe that something is happening that is scary.
What is happening?” and if the client does what the card says, they get a chip. During the game, the therapist can
see how the client reacts in certain situations and advise them on how to react in these situations.

Self-Control Games
For example, the therapist and client might play “Simon Says”, where the client has to do what the therapist says
(such as jumping on one foot), but only if the therapist started their sentence with “Simon says…”. This can
promote paying attention and self-control, as the client has to pay attention to what the therapist is saying and
only do what the therapist says in certain situations.

Strategy Games
For example, the therapist might simply play a familiar strategy game with the client, such as chess, checkers, or
pick up sticks. This can help the client focus and feel happier, as well as foster a bond between the client and
therapist. These games can be especially useful during early therapy sessions if the client is uncomfortable with
the therapist or the idea of therapy itself. Since they are strategy games, the client can also feel a level of control
and mastery.

Cooperative Games
For example, the therapist might play a cooperative game with the client, such as a game like Max the Cat,
where players have to help a mouse, bird, and chipmunk get home before Max the cat eats them. Playing
cooperative games like this can help the therapist-client relationship, and can also help the client build social
skills, especially if they have trouble working together with their peers.

Chance Games
For example, the therapist might play a game with the client that is mostly determined by chance, such as the
board game Candy Land or the card games War and Go Fish. Like the other types of games mentioned above,
these games are familiar and can help the client ease into a therapy session, as well as help the client build a
relationship with their therapist. Since these games are mostly determined by chance, they also offer the client an
opportunity to cope with unexpected losses that they could not have avoided and give therapists the opportunity
to walk the client through these situations.

Squiggle Game
For example, the therapist might close their eyes and draw a random squiggle on a piece of paper, then ask the
client if the squiggle looks like anything or makes them think of anything. The client can then draw their own
squiggle and ask the therapist if they think it looks like anything. The therapist and client take turns drawing
random squiggles for each other to see if they can find anything in the squiggles. This game can help the client
feel more comfortable in a therapy session, and can also work as a sort of Rorschach test for the therapist to find
out more about how the client thinks.

Other Techniques

Desensitization Play
For example, a therapist might help a client work through their fear of the dark by desensitizing them to
darkness. This might be accomplished by having the client and their parents play fun games at night in a
gradually darker room so that by the end the client is still having fun despite being in the dark. This can show the
client that there is nothing to be afraid of.

Laughter Play
For example, the therapist and client might take turns trying to make each other laugh in any way they can
(without touching each other). The client’s parents can also play a tickling game with the client for the sole
purpose of making the client laugh. Laughter causes lower levels of stress and can improve relationships, so
either of these options are useful since an improved parent-child relationship and an improved client-therapist
relationship are both beneficial.

Stress Inoculation Play

For example, the therapist might have the client play out a future stress-causing situation, such as an upcoming
class presentation. The client can use toys to work out what might happen during the presentation, and the client
might realize that the situation is not as scary as it first seemed. The therapist can also offer coping strategies for
the client based on the client’s fears about the presentation.

Reenactment Play
For example, the therapist might recreate a stressful event for the client, such as a car accident, using toys in the
playroom. The client can then freely play with the toys in a nondirected manner to gain a sense of control over
the situation and start losing some of those lingering feelings of trauma and fear. These recreations often need to
happen multiple times over multiple sessions for optimal results.

Hide-and-Seek Play
For example, a therapist might create hiding spaces in the playroom so they can play hide-and-seek with the
client, and then act sad until they find the client, at which point they should react happily. This shows the client
that the therapist cares for them and wants to find them and play with them. Of course, it is also beneficial
simply by being a fun activity the therapist and client can bond over.

Magic Tricks
For example, the therapist might ask the client if they want to see some magic, show them a magic trick, and
then show the client how to do the magic trick themselves. This is a fun activity that can help the bond between
the therapist and client. Showing the client how to do the trick themselves can also give the client a feeling of
control and mastery, which can raise their levels of self-esteem.

Feeling Faces
For example, the therapist might decorate their playroom walls with “feeling faces”, or faces that demonstrate
different feelings such as happiness or anger. The therapist can then start off the therapy session by asking the
client to point to a face that they identify with at the time, which can give the therapy session some direction.
They can also be helpful for clients to show how they are feeling throughout the session without having to use
words.

Suitcase Playroom
For example, a therapist might create a “suitcase playroom”, which is simply a suitcase filled with the toys and
materials necessary for play therapy. This is helpful for play therapists who do not have dedicated playrooms.
The play therapist can then open up the suitcase to start each session and pack it up at the end of each session.
This is not only practical for smaller therapy spaces, but also shows the client that the therapist cares for them
since they are going out of their way to bring all these toys for the client.

Play Therapy Rituals

For example, a therapist might start every session with the client in the same way, perhaps by saying hello,
asking the client to remove their shoes, and then starting the squiggle game. This predictability can show the
client that play therapy is a safe space for them and can raise their levels of self-esteem and feelings of control.
Rituals can also take place at the end of each therapy session so that the client knows that every session will end
with a free drawing.

Some of these techniques are designed to help children get rid of their aggression, while others are meant to be
escapist fantasy games. Other techniques on this list involve representational play, where children can detail their
problems to the therapist without doing so explicitly. Some are simply meant to help children pay better attention
to things around them. This wide variety of techniques underscores how valuable play therapy can be to all sorts
of children since there is a technique for just about every type of play a child might prefer. These examples were
all taken from Cangelosi & Schaeffer (2016), and there is plenty more information about these techniques in the
book for anyone who is further interested.

Useful and Fun Toys For Child-Centered Play Therapy

Child-Centered Play Therapy (CCPT) is a type of play therapy most often used with young children, that
involves nondirective play sessions where the child takes the lead and the main role of the therapist is to
acknowledge how the child is feeling and what the child is doing, as well as ensure the child’s safety (Swank et
al., 2015). The main job of the therapist during CCPT is simply to supervise the child’s playing and allow the
child to express themselves however they please, rather than leading the therapy session. It is therefore important
to have a wide variety of toys that appeal to a large range of children’s playing styles.

 Representative toys, like dolls, a bendable doll family, doll bed, clothes and accessories, pacifiers, nursing bottles,
and doll furniture, hand puppets.
 Toys for a play kitchen or grocery store, like a fridge, a stove, a pitcher, pots and pans, dishes, plastic food, egg
cartons, empty fruit and vegetable cans, rags or old towels, play money and cash register.
 Toys for pretend adventures, like toy soldiers and army equipment, toy guns, rubber knives, fireman’s hats and
other hats, masks, trucks, cars, airplanes, tractors, boats, zoo and farm animals.
 Toys for creative, non-directed expression, like play-doh, clay, pipe cleaners, paint, paintbrushes, easels, chalk, and
construction paper.

Play Therapy and Games for Adults

While play therapy might sound like it is for children (since we usually associate playing with childhood), it is
also extremely useful for adults. According to Schaeffer (2002):

“play is a wholistic experience in that it invites our total being into the process”.
Schaeffer goes on to say that play can raise our self-esteem, nurture stress release and allow insight into things
going on in our lives. These are all qualities which are clearly helpful for adults along with children, yet most
people still think of play as something for children. The idea of play therapy for adults is not to force adults to
play, but to offer them the opportunity to work through feelings that they do not have the words for. Some types
of play therapy which Schaeffer recommends for use with adults include dramatic role play and sand play.

Play therapy has also been used successfully in a case study involving elderly adults in nursing homes (Ledyard,
1999). This study found that play therapy led to decreased levels of depression and increased levels of self-
esteem, among other benefits. These benefits, of course, would be desirable for any population, furthering the
idea that play therapy could be as useful for adults as it is for children. The idea of play therapy for children is
that playing is the “language” of children, but this does not mean that adults would not be able to express
difficult ideas while playing as well.

Types of Play Therapy for:

Autism

Play therapy seems like a natural fit for children with autism spectrum disorder (ASD), especially those with
communication issues. LEGO® therapy is one specific type of therapy that is often used for ASD, and it has
been found to be very effective (Lindsay et al., 2017). LEGO® therapy involves three people: a supplier, a
builder, and an engineer, with each person playing a specific role which encourages communication. The specific
benefits of LEGO® therapy include improved:

“social interactions, social initiations, adaptive socialization, play, communication skills, social competence,
social confidence, ASD-specific behaviours, belonging, family relationships, coping, making new friends,
independence, and inter-personal skills”.

Another play therapy intervention being used with children with ASD is Parent-Child Interaction Therapy
(PCIT). PCIT involves a Child-Directed Interaction (CDI), where “parents are taught and coached to ignore
negative attention-seeking behaviors; to provide attention for positive behavior; and to refrain from criticism,
commands, and questions” and a Parent-Directed Interaction (PDI), where “parents are coached to give clear,
direct, and age-appropriate commands and to consistently reinforce child compliance” (Zlomke et al., 2017).

Trauma

Play therapy has increasingly been used with children who exhibit symptoms of post-traumatic stress disorder
(PTSD). One such case involves two children who were traumatized by the effects of Hurricane Katrina in the
Southeastern United States in 2005 (Dugan et al., 2009). One of these children showed fear around water, such
as during bath time or when thunderstorms would appear, and also refused to sleep by himself.

In his first play therapy sessions, he exhibited themes of control, safety, and aggression. After a few sessions, he
started showing nurturing themes in his play, as well as trauma re-creation where he “drowned” characters in the
sandbox. By the eighth session, the child was able to enjoy himself at a water park without being scared of the
water, and after a few additional sessions, he was able to sleep by himself again.

The success of this play therapy can partially be attributed to the repetitious nature of the play, where the child
was able to desensitize himself to the source of his trauma. The child also indicated a higher level of
independence, perhaps due to the fact that he could choose how to work through his issues in play therapy. This
type of repetitious play therapy is especially valuable for young children who might not be able to recover as
well in a traditional cognitive-behavioral therapy program.
Anxiety

Child-Centered Play Therapy (CCPT) has been found to be effective in treating anxiety in six- to eight-year-old
children (Stulmaker & Ray, 2015). Specifically, 12-16 individual half-hour sessions of CCPT over eight weeks
reduced self-reported anxiety symptoms in children more than sessions where children just colored with a
counselor. This is promising, since anxiety is “considered one of the most current and pervasive childhood
disorders, with a poor prognosis if left untreated”, and traditional methods of treating anxiety do not always work
with children (Stulmaker & Ray, 2015).

Cases of childhood anxiety highlight the importance of play therapy. By providing therapy in a lower-pressure
environment where even young children can understand what is going on, play therapy can be an invaluable
resource for parents and schools. The Stulmaker & Ray study also claims that play therapy can be a
preventative factor in childhood anxiety, on top of being an available intervention for existing anxiety.

ADHD

Play therapy has been increasingly used in cases of attention deficit hyperactivity disorder (ADHD), since one of
the challenges that can come with childhood ADHD is difficulty playing with other children (Wilkes-Gillan et
al., 2014). One such study by Wilkes-Gillan et al. in 2014 focused on children who had already undergone a play
therapy program with a licensed therapist. In this study, children underwent a seven-week program which
involved parent-led home sessions and three clinical therapist-led play therapy sessions.

The study showed evidence of increased prosocial behavior during playtime, especially in the clinical, therapist-
led sessions. Parents also reported that seeing their children in the therapist-led sessions helped them lead the
parent-led sessions. This study shows that there is a promising future for parent-led play therapy sessions for
children who have ADHD.

In Schools

The Stulmaker & Ray (2015) study shows the value of play therapy in schools, especially since play therapy had
a preventative effect on anxiety and worry levels. Another study showed that 26 sessions of Child-Centered Play
Therapy (CCPT) led to increased academic achievement long-term in normal functioning first-grade students
(Blanco et al., 2017). Interestingly, these improvements in academic achievement differed from child-to-child,
with some improving more in math and others improving more in reading, for example. This indicates that play
therapy has individualized effects on each child, which makes sense since the way a child plays is unique to
them.

Since one study focused on preventing anxiety symptoms and the other focused on academic achievement in
normal functioning children, this indicates that play therapy can be extremely valuable for schools, since it can
be applied to all children. Play therapy is also valuable for schools since it can easily be implemented, as most
schools have school psychologists and all children enjoy playing in some way or another. Most importantly, play
therapy is effective with extremely young children in a way that other therapies are not (Stulmaker & Ray,
2015).

DANCE THERAPY

Dance therapy is a form of expressive therapy that involves the use dance and movement in order. Also referred
to as dance/movement therapy, the primary goal of this therapeutic treatment approach is to promote emotional,
mental, and physical growth and healing. Like music therapy, art therapy, and other expressive types of therapy,
dance therapy is based on the premise that healing is facilitated and enhanced when people are encouraged to
express themselves openly and freely in a safe and supportive atmosphere.

Creative self-expression not only stems from deeply-felt emotion, it also gives a voice to feelings that are often
difficult to articulate with words. This is one of the reasons dance therapy is especially effective for individuals
who are struggling with unresolved trauma and other deeply painful emotional issues. When those feelings get
trapped within the body, they manifest in a variety of problematic ways. Dance therapy provides a unique
medium for catharsis and healing because it emphasizes the powerful connection between the body and mind.

Since dance therapy doesn’t rely on verbal expression or interaction, it breaks down barriers that traditional talk
therapy and most other types of therapy can’t. This makes it suitable for a wide range of individuals and
conditions, including those with dementia, developmental delays, traumatic brain injury, as well as those who
struggle to find words to express their thoughts and feelings.

Dance therapy is used in a wide variety of clinical and non-clinical settings. It’s appropriate for young children
to the very elderly. Since dance is a universal language, dance therapy is appropriate for individuals from all
backgrounds and walks of life. The ability of dance and movement to touch the soul at the deepest level enables
dance therapy to improve a person’s wellbeing in every way – emotionally, physically, mentally, and socially.

Dance therapists use movement as an intervention – a means to elicit buried emotions, give a voice to taboo
topics, and allow for the processing and release of internal conflicts, worries, and fears. A skilled dance therapist
uses various forms of movement to help therapy clients relax and open up.

Underlying Principles of Dance Therapy

Dance therapy is based on several psychological principles. These include:

 Trauma and other emotional issues are often “trapped” or held in the body, manifesting themselves in a variety of
ways including chronic pain, somatic complaints, restricted movement, and muscle tension
 Both physical and mental health are impacted (in both positive and negative ways) by the body’s current state
 Both personality and unconscious processes are reflected in dance and movement
 Recurrent themes can be identified via expressive movement
 The mind and body are interconnected; treating them together rather than separately helps facilitate healing
 Improvised dance and spontaneous movement allow give individuals an opportunity to explore different ways of
being
 A substantial part of any therapy is non-verbal; dance therapy provides a perfect opportunity for non-verbal
expression, particularly when verbal expression is severely hindered (e.g. due to cognitive decline or severe
trauma)

History

People have been dancing – both for enjoyment and emotional expression – for thousands of years. Much of the
theory behind dance therapy as we know it today originated in the UK. In the U.S., dancer, performer, and
choreographer Marian Chase is often regarded as the pioneer of dance therapy. Trained in New York City and
strongly influenced by the work of Carl Jung, Chase opened a dance studio in Washington, D.C. back in the
1930s. Psychiatrists at a local hospital saw improvements in their patients who were attending her dance
classes. Chase began giving lectures on the benefits of dance in the 1940s. Over time, other professional dancers
followed suit, using dance to help people with a variety mental and physical health issues.

In 1966 the American Dance Therapy Association was established, and dance therapy became recognized as a
viable form of psychotherapy. The ADTA is the only U.S. organization that’s dedicated to the profession of
dance and movement therapy. Members of ADTA hail from all over the U.S. as well as 39 countries throughout
the world.

Today, dance therapy is used in a variety of treatment settings. These include mental health centers,
rehabilitation programs for eating disorders, substance addiction treatment facilities, hospitals and medical
centers, treatment centers for dementia, nursing homes, adult day care centers, assisted living facilities, prisons,
specialized school programs, mental health clinicians in private practice, and other healthcare facilities and
programs.
Types of Dance / Movement Therapy

The types of dance and movement used in this type of therapy will vary, depending on several factors. These
factors include the unique needs of the patients (e.g. elderly patients with limited range of movement versus agile
adolescents or young adults), and may also depend on the therapist’s background and preference. Some
therapists primarily use more traditional types of dance, such as ballroom or Latin dance styles. Others focus
more on the use of freestyle types of dance or yoga. Also, therapists will vary their approach depending on the
client, focusing on one style of dance or movement for one patient, and an entirely different style for another.
Dance therapy typically involves both choreographed and improvised dance.

What to Expect

Dance therapy, like almost all types of therapy, starts with an initial consultation with the therapist. During this
session, you and the dance therapist will discuss why you’re seeking treatment, what your needs are, and what
you’d ultimately like to see change as a result of therapy – i.e., your specific treatment goals. The therapist may
also have you do some form of movement, so it’s important to wear somewhat loose, comfortable clothing. The
therapist will assess how you carry yourself, the way you move (e.g. do you move freely or is there some degree
of constraint). The approximate length of treatment and the nature of dance therapy will also be discussed.

In a typical dance session, the therapist will observe as you dance. You’ll be encouraged to express your
thoughts and emotions through your movement to the music. In order to build a therapeutic connection with you
the therapist may mimic your dance movements at times. This is known as “empathic mirroring”. The success
of almost all types of psychotherapy depends at least in part on a solid therapeutic relationship. If you don’t trust
or feel supported by your therapist, it will hinder your healing and greatly increase the likeliness that you’ll drop
out of treatment prematurely.

If you’re participating in group dance therapy, the therapist will also observe how you interact with other group
members – and how the group works together as a unit. Group sessions often include designating a member to
lead the movement. Group sessions are often centered on a theme, such as boundaries or trust.

Various props are sometimes used in dance therapy. These include things such as balls, scarves, string or yarn,
instruments, costumes, and beanbags. Two goals in dance therapy include getting you involved and helping you
connect to your emotions.

The therapist will observe a variety of things during each session, and guide sessions accordingly. Observations
will include things like how you interact with the therapist and / or other members, whether or not there are any
themes emerging in your movement, and the various emotions that are elicited.

A dance therapy session usually follows four distinct stages:

 Preparation – this initial stage involves getting warmed up for movement and dance; proper warm-up ensures
safety by reducing the risk of injury
 Incubation – this stage focuses on being mindful, relaxed, and open to the process
 Illumination – this stage is where you’ll learn what different movements reveal and represent, and how they impact
you
 Evaluation – the last stage involves processing or reviewing the session (e.g. talking about what occurred and its
significance, what you experienced, the therapist’s observations, reviewing progress towards treatment goals, etc.)

Generally, dance therapy sessions are done on a weekly basis for outpatient treatment. In some settings, such as
a hospital or residential treatment facility, the sessions may occur daily or several times a week. The length of
treatment will vary based on multiple factors, including but not limited to your particular health concern (e.g.
depression, healing from trauma, recovering from addiction, or a physical health concern).
As with all types of therapy, it’s important to have specific goals in mind in order to get the most out of
treatment. Granted, as things emerge during therapy your goals may expand or change to some degree. If you’re
participating in dance therapy as an adjunct to regular talk therapy, your dance therapist and primary therapist
will periodically touch base regarding progress and any issues or concerns that may emerge.

Disorders, Issues and Conditions That Can Benefit From Dance Therapy

One of the greatest things about dance therapy is that it can very beneficial in the treatment of a wide range of
mental health disorders, emotional issues, and physical health conditions. Essentially, it can be helpful for
anyone struggling with almost any life challenge, even if the person doesn’t have a diagnosable disorder.
Following is a list of many conditions and problems that can benefit from dance therapy:

 Anxiety
 Post-traumatic stress disorder / unresolved trauma
 Addiction recovery
 Depression
 Social phobia
 Eating disorders
 Obsessive-compulsive disorder
 Dissociative disorders
 Body dysmorphia
 Autistic spectrum disorders
 Learning disabilities
 Developmental disorders
 ADD / ADHD
 Schizophrenia / psychotic disorders
 Borderline personality disorder
 Low self-esteem
 Chronic stress
 Dementia / cognitive decline
 Grief and loss
 Negative body image
 Chronic pain
 Feelings of loneliness
 Muscle tension
 Arthritis
 Traumatic brain injury
 AIDS patients
 Parkinson’s disease
 Cancer patients
 Stroke patients
 Circulation problems in diabetic patients
 Amputees and individuals with limb deficiency
 Balance problems and disorders
 Coordination problems

Benefits of Dance Therapy

Individuals who participate in dance therapy often experience a multitude of benefits. Following is a list of just
some of the potential benefits from this expressive form of therapy:

 Increased self-awareness
 Improved mood
 Greater sense of joy
 Greater awareness and understanding of the mind-body connection
 Healthier body image
 Greater self-esteem
  Increased self-confidence
 Decrease in feelings of social isolation
 Greater sense of calm
 Reduction in chronic pain
 Increased mobility
 Improved coordination
 Better balance / decreased risk of falling
 Better circulation
 Improved respiratory functioning
 Greater attentiveness
 Reduction in muscle tension and stiffness
 Greater flexibility
 Decrease in anxiety
 Improved ability to handle stress
 Improved communication skills
 Improved overall quality of life
 Better coping for those dealing with recovering from serious medical issues
 Improved overall health
 Enhanced cognitive skills
 Improved memory
 Greater self-trust
 Increased energy
 Enhanced creative
 Greater ability for healthy emotional expression
 Improved motivation
 Greater range of motion
 Stronger neurological pathways

Advantages of Dance Therapy

There are numerous advantages to dance therapy. They include:

Non-verbal emphasis – The emphasis on non-verbal communication makes this an especially beneficial therapy
for individuals who find it difficult to articulate, release, or express their thoughts and feelings verbally. This is
one of primary reasons dance therapy is often used with children and adults who have been severely traumatized
and aren’t ready or able to talk about their experience. It’s also the reason dance therapy can be particularly
useful for individuals suffering from dementia, traumatic brain injury, impaired memory, developmental delays,
learning disabilities, and autistic spectrum disorders.

 Dance therapy can be a useful alternative or adjunct therapy when talk therapy hasn’t been effective.
 Unlike most forms of psychotherapy, dance therapy’s utilization of physical movement adds a unique and powerful
dimension to healing. As such, it provides a host of physiological benefits (e.g. increased flexibility, improved
circulation, decreased muscle tension) that contribute to a person’s overall wellbeing and strengthens somatic
awareness (i.e. being more in touch with one’s body and the mind-body connection).
 Dance therapy can be used for almost any demographic, including children, adolescents, adults, and the elderly
from any race or ethnic background. It can be used effectively with individuals who are visually or hearing
impaired. It can be conducted on an individual basis, with couples and families, or in a group format.
 Dance therapy provides a safe and supportive environment for dignified self-expression via movement, something
that may be foreign to many individuals – especially those who struggle with coordination problems, self-
consciousness, poor body image, and low self-esteem. This element of dance therapy also helps bring people out
of their comfort zone and experience new ways of expressing themselves.
 Dance therapy in a group format promotes social interaction. This can be particularly advantageous for individuals
who have a difficult time talking in a group setting, struggle with social anxiety, or are experiencing social
isolation. The social aspect of group dance therapy can decrease feelings of loneliness, help individuals overcome
shyness, and improve communication and interpersonal skills.
 Dance therapy gives individuals who are struggling with anger, rage, and hostility an opportunity to release
negative emotions through movement while discovering new, appropriate ways to express negative emotions.
  In a group setting, dance therapy can help individuals learn to establish and respect healthy physical boundaries.
This can be particularly helpful to individuals who’ve been sexually or physically abused, have aggressive
tendencies, or struggle with reading social cues from others.
 Dance therapy gives patients an opportunity to deal with painful emotions without having to talk about them. As
such, it can provide an enjoyable and relaxing break from the difficulties they face in their day to day life. This is
one of the reasons it can be particularly beneficial for individuals who are recovering from or struggling to cope
with serious health issues such as cancer, terminal illness, or a life-altering injury (e.g. the loss of a limb).
 Dance therapy is often very relaxing, which is beneficial for both physical and mental health.
 Despite what some may assume about this particular treatment mode, dance therapy doesn’t require prior dance
experience, athleticism, or good coordination skills. Even self-proclaimed clumsy individuals, elderly individuals
with physical limitations, individuals confined to wheel chairs, and anyone else with any movement challenges can
benefit from dance therapy. In fact, for those whose self-esteem has been impacted by a physical disability,
serious illness, or coordination issues, dance therapy can be particularly advantageous. This is because it can help
boost confidence and enable these individuals to see themselves – and their wounded, ill, or “broken” bodies – in a
new, more positive light.

What is Family Therapy? + 6 Techniques & Interventions

We all start this life with a family, whether that family is composed of blood relatives, adopted parents, or a
foster family. This family that we acquire when we are born influences every aspect of our lives, from our first
moments to our last.Our family affects who we are and who we become, both for the better and for worse. We
learn our vocabulary, our habits, our customs and rituals, and how to view and observe the world around us.We
also learn how to love, and how to interact with others from these first important relationships. If we are born
into a healthy family with healthy relationships, we are likely to learn how to maintain healthy relationships. If
we are born into a dysfunctional family that struggles to connect, we may also struggle to connect with
others.While it is certainly unlucky to be born into the second kind of family, it’s not an unchangeable situation.
Nearly all families deal with some sort of dysfunction at one time or another, yet most families retain or regain a
sense of wholeness and happiness.Family therapy offers families a way to do this – a way to develop or maintain
a healthy, functional family.

What is Family Therapy / Family Counseling?

Family therapy or family counseling is a form of treatment that is designed to address specific issues affecting the health
and functioning of a family. It can be used to help a family through a difficult period of time, a major transition, or mental
or behavioral health problems in family members.
As Dr. Michael Herkov explains, family therapy views individuals’ problems in the context of the larger unit: the
family (2016). The assumption of this type of therapy is that problems cannot be successfully addressed or solved without
understanding the dynamics of the group. The way the family operates influences how the client’s problems formed and
how they are encouraged or enabled by the other members of the family.Family therapy can employ techniques and
exercises from cognitive therapy, behavior therapy, interpersonal therapy, or other types of individual therapy. Like with
other types of treatment, the techniques employed will depend on the specific problems the client or clients present
with.Behavioral or emotional problems in children are common reasons to visit a family therapist. A child’s problems do
not exist in a vacuum; they exist in the context of the family and will likely need to be addressed within the context of the
family (Herkov, 2016).It should be noted that in family therapy or counseling, the term “family” does not necessarily mean
blood relatives. In this context, “family” is anyone who “plays a long-term supportive rolein one’s life, which may not
mean blood relations or family members in the same household” (King, 2017).

According to Licensed Clinical Social Worker Laney Cline King, these are the most common types of family
therapy:

 Bowenian: this form of family therapy is best suited for situations in which individuals cannot or do not want to
involve other family members in the treatment. Bowenian therapy is built on two core concepts, triangulation (the
natural tendency to vent or distress by talking to a third party) and differentiation (learning to become less
emotionally reactive in family relationships).
 Structural: Structural therapy focuses on adjusting and strengthening the family system to ensure that the parents
are in control and that both children and adults set appropriate boundaries. In this form of therapy, the therapist
 “joins” the family in order to observe, learn, and enhance their ability to help the family strengthen their
relationships.
 Systemic: The Systemic model refers to the type of therapy that focuses on the unconscious communications and
the meaning behind family members’ behaviors. The therapist in this form of treatment is neutral and distant,
allowing the family members to dive deeper into their issues and problems as a family.
 Strategic: This form of therapy is more brief and direct than the others, in which the therapist assigns homework
to the family. This homework is intended to change the way family members interact, assess and adjust the way the
family communicates and makes decisions. The therapist takes the position of power in this type of therapy, which
allows other family members who may not usually hold as much power to communicate more effectively (King,
2017).

What is a Family Counselor Trained For?

“In this therapy, the therapist takes responsibility for the outcome of the therapy. This has nothing to do with good
or bad, guilt or innocence, right or wrong. It is the simple acknowledgement that you make a difference.” – Eileen
Bobrow

As the different types of therapy described above show, a family therapist may be called upon to take on many
different roles. These many roles require a family therapist to undergo a great deal of training, formal education,
and testing to ensure that the therapist is up to the task.

While therapists may have different methods and preferred treatment techniques, they must all have at least a
minimum level of experience with the treatment of:

 Child and adolescent behavioral problems

 Grieving
 Depression and anxiety
 LGBTQ issues
 Domestic violence
 Infertility
 Marital conflicts
 Substance abuse (All Psychology Schools, 2017)

In order to treat these and other family issues, therapists must:

 Observe how people interact within units

 Evaluate and resolve relationship problems
 Diagnose and treat psychological disorders within a family context
 Guide clients through transitional crises such as divorce or death
 Highlight problematic relational or behavioral patterns
 Help replace dysfunctional behaviors with healthy alternatives
 Take a holistic (mind-body) approach to wellness (All Psychology Schools, 2017)

In order to gain the skills necessary to perform these functions, a family therapist usually obtains a bachelor’s
degree in counseling, psychology, sociology, or social work, followed by a master’s degree in counseling or
marriage and family therapy.

This education and training will allow a therapist to help the clients who come to the therapist for guidance with
a wide range of problems, including:

 Personal conflicts within couples or families

 Unexpected illness, death, or unemployment
 Developing or maintaining a healthy romantic relationship at any stage
 Behavioral problems in children
 Divorce or separation
 Substance abuse or addiction
  Mental health problems like depression and anxiety

This wide range of problems makes it clear that the answer to “What is a family therapist NOT trained to do?”
may be shorter than the question of what they ARE trained to do!To learn more about how marriage and family
therapists are trained and how they practice their craft, the following websites are great resources:

 The American Association for Marriage and Family Therapy website

 The All Psychology Schools website
 The Careers in Psychology website
 The Marriage and Family Therapist Licensure website
 The Learn website

What is the Goal of Family Therapy?

“To put the world right in order, we must first put the nation in order; to put the nation in order, we must first put
the family in order; to put the family in order, we must first cultivate our personal life; we must first set our
hearts right.” – ConfuciusIn a nutshell, the goal of family therapy is:To work together to heal any mental,
emotional, or psychological problems tearing your family apart. In order to help a family work together towards
a healthy family life, family therapists aim to aid family members in improving communication, solving family
problems, understanding and handling special family situations, and creating a better functioning home
environment (Family Therapy, 2017A).

More broadly, the goals of family therapy depend on the presenting problems of the clients. For example, the
goals differ based on the following scenarios:

 A family member is suffering from schizophrenia or severe psychosis:

The goal is to help other family members understand the disorder and adjust to the psychological changes that the
patient may be undergoing.
 Problems arising from cross-generational boundaries, such as when parents share a home with grandparents, or
children are being raised by grandparents:
In this case, the goal is to improve communication and help the family members set healthy boundaries.
 Families deviating from social norms (unmarried parents, gay couples raising children, etc.):
The goals here are not always to address any specific internal problems, but the family members may need help
coping with external factors like societal attitudes.
 Family members who come from mixed racial, cultural, or religious backgrounds:
The goal, in this case, is to help family members further their understanding of one another and develop healthy
relationships.
 One member is being scapegoated or having their treatment in individual therapy undermined:
When one family member is struggling with feeling like the outcast or receives limited support from other family
members, the goal is to facilitate increased empathy and understanding for the individual within their family and
provide support for them to continue their treatment.
 The patient’s problems seem inextricably tied to problems with other family members:
In cases where the problem or problems are deeply rooted in problems with other family members, the goal is to
address each of the contributing issues and solve or mitigate the effects of this pattern of problems.
 A blended family (i.e., step-family):
Blended families can suffer from problems unique to their situations. In blended families, the goal of family
therapy is to enhance understanding and facilitate healthy interactions between family members (Family Therapy,
2017B).

Family Psychotherapy: Taking it One Step Further

We tend to think of therapy and psychotherapy as two different forms of treatment, but in fact, they are the
same thing. This ambiguity is enhanced when we introduce the term “counseling” as well.

In truth, therapy is simply a shortened form of the word “psychotherapy” (www.drpatrick.com). However,
counseling is sometimes called “talk therapy,” blurring the lines even further (Eder, “What is the
Difference”).Generally, counseling is applied in situations where an individual (or, in the case of family
counseling, a family) engages the services of a counselor or other mental health professional to help with a
specific problem or set of problems. Therapy, or psychotherapy, is a more in-depth and usually long-term form
of treatment in which the client or clients discuss a wider range of issues and chronic patterns of problematic
feelings, thoughts, and behaviors (Eder, “What is the Difference”).

A family who is struggling with a situation that brings added stress, such as the death of a family member,
addiction, or dire financial straits, may benefit from counseling to help them through their struggles to emerge on
the other side as a stronger and more cohesive unit.

If a family is struggling with more chronic mental or behavioral problems, such as a father dealing with
schizophrenia, a mother fighting depression, or a child who has been abused, psychotherapy is likely the better
choice.

This type of therapy is appropriate for families with problems such as these because a family therapist has a
different perspective on treatment than an individual therapist. While the individual therapist works with one
client on solving or curing a problem, the family therapist views problems in the context of the “system” of the
family. To solve a problem in a system, you need to consider all parts of the system.Issues within a family are
similar to the car with several problems. A parent struggling with alcoholism is not a problem in isolation; the
parent’s struggle has likely affected their spouse and their children as well. A family therapist believes that
problems must be addressed at the level of the whole family rather than on an individual level (Schwartz, 2009).

What are the Benefits of Family Therapy?

This more holistic approach to treating problems within a family has proven to be extremely effective in
many cases. In family therapy, families can work on their problems with the guidance of a mental health
professional in a safe and controlled environment.

The benefits of family therapy include:

 A better understanding of healthy boundaries and family patterns and dynamics

 Enhanced communication
 Improved problem solving
 Deeper empathy
 Reduced conflict and better anger management skills (10 Acre Ranch, 2017)

More specifically, family therapy can improve the family relationships through:

 Bringing the family together after a crisis

 Creating honesty between family members
 Instilling trust in family members
 Developing a supportive family environment
 Reducing sources of tension and stress within the family
 Helping family members forgive each other
 Conflict resolution for family members
 Bringing back family members who have been isolated (American Addiction Centers, 2017).

In addition, family therapy can enhance skills required for healthy family functioning, including
communication, conflict resolution, and problem-solving. Improving these skills for each member of the family
increases the potential for success in overcoming or addressing family problems. In family therapy, the focus is
on providing all family members with the tools they need to facilitate healing (Teen Treatment Center, 2014).

6 Examples and Exercises

If family therapy sounds like a treatment that would benefit you and your loved ones, the best course of
action is to find a licensed professional with whom you can build a good working relationship and address the
problems your family is facing. However, if you’re not quite ready for this step or there are obstacles between
you and getting treatment, there are many exercises and suggestions that you may find to be a good alternative.
The exercises and techniques below are meant to be used within the context of a therapeutic working
relationship, but some also have applications for those who wish to explore the possibilities of family therapy
before committing to a long-term treatment with a therapist. If you are a therapist or other mental health
professional, you may find these exercises to be useful additions to your therapy toolbox.
The Miracle Question
This exercise can be used in individual, couples, or family therapy, and is intended to help the client(s)
explore the type of future they would like to build. We all struggle at times, but sometimes the struggle is greater
because we simply do not know what our goals actually are.
The Miracle Question is an excellent way to help the client or clients probe their own dreams and desires.
When used in the context of couples or family therapy, it can aid clients in understanding what they significant
other or family member needs in order to be happy with their relationship.
Colored Candy Go Around
If you’re looking for a fun and creative icebreaker or introduction to family therapy, this exercise can be
a great way to start.
To engage in this exercise with your family, you need a package of Skittles, M&Ms, or a similar colorful
candy. Distribute seven pieces to each family member, and instruct them to sort their candy by color (and
refraining from eating it just yet!).
Next, ask a family member to pick a color and share how many they have. For however many candies of
this color they have, instruct them to give the same number of responses to the following prompts based on the
color:

 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

When the first family member has given their answers, tell them to choose the next family member to answer the
same prompt based on the number of candies that person has. Once the prompt has been answered, the candies can be
eaten.
When all family members have responded to these prompts, initiate a discussion based on the answers provided by
the family. The following questions can facilitate discussion:

1. What did you learn?

2. What was the most surprising thing you learned about someone else?
3. How will you work towards making changes/improvements?

Given the high sugar content in this exercise, you can see that this is a great game to play with young children!
If this sounds like a useful exercise that you would like to try with your family, you can find further information
and instructions on page 3 of this PDF from therapist Liana Lowenstein.

Emotions Ball
This is a simple exercise, requiring only a ball and a pen or marker to write with. You may even recognize it, as it
is frequently used with children and teenagers in many contexts, as it takes the pressure off of talking about emotions for
those who may be uncomfortable sharing their feelings.

A beach ball is a perfect ball for this activity, as it is big enough to write several emotions on and it is easy to throw back
and forth in a circle. Write several emotions on the ball, such as “joyful,” “lonely,” “silly,” or “sad.”Gather your family
into a circle and begin to toss the ball back and forth between family members. When a family member catches the ball,
have them describe a time when they felt the emotion facing them. Alternatively, you could have the catcher act out an
emotion, an activity specially suited for children.The intent of this exercise is to discuss emotions with your family and
practice listening to one another and expressing your feelings.
The Family Gift
This exercise can help a therapist to get to know a family better. If you are using it without the guidance of a
therapist, it can help you to further your understanding of your own family and provoke thoughtful discussion.To give this
exercise a try, gather a variety of art supplies and a gift bag. Explain to the family that they are going to create a gift from
the materials provided. This gift will be a gift for the whole family, that everyone in the family wants. They must decide
together on this gift and how it can be used within their family.They have 30 minutes to decide on this gift and craft it.
Once they have created the gift, they must place it in the gift bag.Within the context of family therapy, this exercise
provides the therapist with a look at the inner workings of the family, how they make decisions and complete tasks as a
unit.If you are engaging in this exercise as a family without the presence of a therapist, it can help you to start a meaningful
conversation.

Use these questions or prompts to facilitate the discussion:

1. Describe your gift.

2. Tell how you each felt as you were creating your gift.
3. Who made the decisions? For example, 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 family at home?
7. How can the gift help your family? What else can help your family?

Mirroring Activity

This fun exercise is a great way to help family members relate to each other and work together.The activity can be
explained to a family by the therapist with the following instructions:
“I want you to stand in front of me just right there (pointing to a spot about two feet in front of the practitioner).
You are going to be my mirror. Everything I do you will try to copy, but the trick is to copy me at exactly the same time
that I am doing it, so you are my mirror. I will go slowly so you have a chance to think about where I will be moving so we
can do it exactly at the same time. We can’t touch each other. I will lead first and then you will take a turn leading. Ready?
Here we go!”
First, the therapist can model this exercise with one of the family members, then that person can take a turn leading
another. This is an especially useful exercise for children, but it can be used with family members of any age.
Engaging in this exercise requires the family members to give each other their full attention, cooperate with one
another, and communicate with both words and body language. It allows the family members to become more in tune with
one another and can be applied with siblings, a parent, and child, or even couples in marriage counseling.

Genogram
A genogram is a schematic or graphic representation of a client’s family tree. However, unlike the typical family tree, the
genogram provides far more information on the relationships among members of the family.It can be used to map out
blood relations, medical conditions in the family, and, most often in the case of family therapy, emotional relationships.
Genograms contain two levels of information, that which is present on the traditional family tree and that which provides a
much more comprehensive look at the family:
 Basic Information: name, gender, date of birth, date of death (if any).
 Additional Information: education, occupation, major life events, chronic illnesses, social behaviors, nature of
family relationships, emotional relationships, social relationships, alcoholism, depression, diseases, alliances, and
living situations (GenoPro, 2017).
By including this additional information, the therapist and client(s) can work together to identify patterns in the family
history that may have influenced the client’s current emotions and behaviors. Sometimes the simple act of mapping out and
observing this information can make clear things which were previously unnoticed.The information on emotional
relationships can include points of interest and any aspects of the relationship that may have impacted the client(s), such
as whether the relationship is marked by abuse, whether a marriage is separated or intact, if a relationship is characterized
by love or indifference, whether a relationship could be considered “normal” or dysfunctional, etc.