Theories of Counseling and Psychotherapy [2 ed.] 9780132286527, 2007046223, 0132286521

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Digitized by the Internet Archive in

2017

https://archive.org/details/theoriesofcounseOOmurd

Theories of Counseeing AND Psychotherapy A Case Approach

Second Edition

Nancy

L.

Murdock

University ofMissouri—Kansas City

Merrill is

an imprint of

Upper Saddle

River,

New Jersey

Columbus, Ohio

Library of Congress Cataloging-in-Publication Data Murdock, Nancy

L.

rheories of counseling and psychotherapy p.

:

a case

approach

/

Nancy

L.

Murdock.

— 2nd

ed.

cm.

Includes bibliographical references and index.

ISBN 978-0-13-228652-7 1

.

Counseling.

2.

Psychotherapy.

3.

Counseling

— Case

studies. 4.

Psychotherapy

— Case

studies.

I.

Title.

BF637.C6M846 2009

15873—dc22 2007046223 Vice President and Executive Publisher: Jeffery W. Johnston Publisher: Kevin

M. Davis

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Merrill is

an imprint of 10

987654321 ISBN- 13: 978-0-13-228652-7 ISBN-10:

0-13-228652-1

To

my parentSy

Mary Elizabeth Frojd Murdock and Sandlan John Murdock

Who

taught

me

to love life

and learning

Preface

There

is

nothing so practical as a good

theory.

— Kurt Lewin WHY WROTE THIS BOOK I

The quote from Kurt Lewin ory.

I

aptly captures

my

philosophy on the role and use of the-

have been teaching about counseling theory for longer than

consider myself something of a theory freak. ever, over the years

to apply

I

have learned that theory

application

it;

teach the application of theory to

along the way.

Knowing

that

it

is

my

I

practical

if

students, trying different

sometimes

difficult for

me,

is

you don’t

and good.

I

and

care to say,

think theory

not very useful

is

what makes theory

is

admit that

I

I

1

Howknow how

fun.

have struggled to

methods and models

how

can

I

expect the

application process to be easy for students just learning the basics of counseling theory? That’s its

why wrote I

application.

The

pitfalls

this

book;

Theory comes

it is

an effort to demonstrate the value of theory through

alive

when

and strengths of an approach

it is

used to understand a client presentation.

are never

more evident than when

it is

put to

use in this way.

The

task of understanding a client presentation in a theoretical structure creates a

situation in

knowing to

its

which you need to know the thory in a way that is different from simply constructs and techniques. At times it is tempting to give up the attempt

apply a theory to a given client presentation, because the theory under consideration

just doesn’t

seem

to

fit

as well as

some other one.

this situation occurs, the potential for learning

job to

do the best you can

essence,

you need

situation in

which

I

happened here?”

chaotic.

in their

understand that language

own in

language, and

ways that

have found theory most useful

My

is

when my

clients

it is

your

have

Another

me

con-

am forced to ask, “Now what on earth me calm down and sort out what initially seems

on automatic

theory helps

when

are helpful. In

to interpret the client’s presentation in theoretical terms.

fused. Instead of operating just

to

experience has been that

great. Clients don’t offer their prob-

is

lems in theory-laden terms. They tend to speak

My

pilot,

I

PREFACE

VI

In each chapter of this book,

have tried to present the various theories in a straight-

I

forward, understandable way.

What

ately illustrate the application

of a construct or process by showing

case described at the beginning of the chapter.,

chapter for at least two reasons.

book from

distinguishes this

First,

I

wanted

I

others

how

that

is

it

immedi-

I

relates to a client

chose to use different client cases for each

show

to

that theory could apply to clients

who range across the broad spectrum of individual and cultural diversity and present with many kinds of distress. Second, I did not want my readers to lose interest from reading about the same case chapter engaging

I

case, so

I

have tried to make

I

compromising the

possibly could without

However,

tations.

same

as

after chapter. In essence,

intellectual quality

this

book

as

of the presen-

an engaging and useful exercise to apply different theories to the

it is

would urge the

book

users of this

to undertake this task as a

way of com-

paring the approaches in a meaningful way.

THE THEORIES A

question always arises about which theories to include in a text like this one.

choices are obvious; others analysis

may

not be

and the springboard

much I

CHOSE

I

love

and hate

less so.

common for

included

I

these days

many other

as Freud’s

classical

— because

it is

is

work

used by professionals in the

ing of the counseling process even (c)

comprehensiveness

—

you have

did,

if

real

true

the foundation of the profession

something important.

really created criteria: (a)

currency

—whether

the

world; (b) potential to contribute to understand-

the reader does not adopt the theory wholesale; and

the extent to

well as guidelines for counseling

—even though

systems. If you ever write something that generates as

chose other theoretical approaches based on several

theory

psychoanalysis

Some

which the theory provides

a conceptual structure as

and associated techniques.

MY PHIEOSOPHY I

am

a

Counseling Psychologist and a scientist-practitioner, and these aspects of my pro-

and content of the presentations

fessional identity influence the structure

in this book.

Counseling psychologists attend to individuals’ strengths and are oriented toward health as

much

as (or

more than) they

are

toward dysfunction.

a positive lens, seeing personal strength

To

focus primarily

on

deficits

seems to

and the potential

me

phasis leads to the use of terms such as disorder.

I

also include sections in

prefer to look at people through

I

to

change

to be a disservice to the

in every life

human

spirit.

moment. This em-

instead of patient dind dysfunction rather than

each theory chapter that describe the theory’s version of

the healthy personality.

An

important element of the identity of a Counseling Psychologist

to the scientist-practitioner model.

theoretical structure rather,

I

is

valid.

This

is

The

me

scientist in

not to say that

consider myself an intellectual pragmatist.

and

to help

my

clients.

The

theory chapter grew out of this empirical bent. If say that, philosophically, Frank’s (1991)

work and

I

I

a

commitment

wants some confirmation that a

I

endorse the idea of one true

I

simply want some evidence that the

version of reality presented by a given theoretical structure actually helps the counseling process

is

sections

me to

understand

on research support

were to be

reality;

totally honest. I’d

in each

have to

lean toward the contextual perspective, rooted in Frank

further supported

and elaborated by Bruce Wampold.

and

You’ll find

PREFACE this

Vll

model described

now

but for

I

Chapter

in

16.

It

would be nice

think that that possibility

is

if

we could

one true theory,

find the

remote, and the data seem to support this

lairly

position.

Another defining feature of Counseling Psychology

We

cultural diversity.

are

all

aware that our world

is

is

attention to individual and

changing and

that, historically,

counseling and psychotherapy have been mired in a Caucasian, Western European,

male model. The

failure to recognize the biases inherent in this

on individualism,

a lack of attention to social

be blunt, unethical. chapter.

and

model

(e.g.,

emphasis

cultural forces in people’s lives)

have attempted to address these issues systematically

I

in

is,

to

each

have also selected clients and counselors of diverse backgrounds for the case

I

presentations.

My concern

about the

effects

nating the singular pronouns used in this

match those of the client issues

therapist

is

and counselor

client

and processes

text.

to the solution of alter-

In the theory chapters the pronouns used

in the case study. If the client

in the discussion

is

female, references to

of theory employ feminine pronouns.

If the

male, reference to therapist activities or processes employ masculine pronouns.

The

diverse cases include

and

1

pronouns

6,

me

of sex bias in language has led

men and women

in

both

client

and counselor

roles. In

Chapters

I

are alternated randomly.

PREFACE TO THE SECOND EDITION I

am

very excited to introduce the second edition of this book. Having never experienced

the process of revision,

was quite overwhelmed by the task

I

updating the content throughout the book,

erally

adjusting chapter selection based

on input from

I

tion,

which

I

In addition to gen-

had two other goals

instructors

research evidence relevant to each theory. We’ve also

initially.

added

for this revision:

and students and updating the several

new

features to this edi-

will briefly describe here.

New Chapters You

will find three

apy,

MRI

new

chapters in this edition: Neoanalytic Approaches, Existential Ther-

and Narrative Therapy. The chapter on Interpersonal Theory, which described the approach and the interpersonal

circle,

has been dropped.

Some of the

content in that

moved to Chapter 13, Family Systems Theory (for example, the section on Ordeal Therapy). The choice of the chapters to add was based on several factors. The chapter has been

staff at Merrill listened carefully to

about what was missing

Of the

in the text

feedback from reviewers, instructors, and students

and these three

three chapters, Neoanalytic Approaches

neoanalytic theory

is

topics were

is

mentioned most

the most difficult to read

increasingly recognized as useful to know.

Most

frequently.

and

use, but

psychoanalytically

oriented therapists are aware of and draw on these perspectives. Existential Therapy was

added

for similar reasons.

of these that

is

issues.

in

Chapter

Many individuals opined

that

any therapist needed an awareness

15, Narrative Therapy, discusses a relatively recent

tune with the constructivist orientation that will be evident

if

development

you make even

a

quick review of major journals in our profession. Narrative therapy happens to be the bestformulated version of constructivist therapy around, in tion-Focused Therapy, which of course

is

my

opinion (not counting Solu-

already in the book).

.

Preface

Vlll

Original Source Readings Texts such as this one, in which the same author or authors write about

have the advantage of consistency in the

level

many

approaches,

and structure of the presentations, but the

disadvantage of depriving the reader of the opportunity to truly experience the voice of the original proponent(s) of the theory Believing that this experience

of counseling,

we added

a

new

valuable to students

is

feature to each chapter: an excerpt

from

a

major theorist

associated with that approach.

General Updating, with an Emphasis on In

what was

In

many

is

daunting

task,

I

updated the research evidence sections

I

added these

as well.

theory and solution-focused therapy) classic psychoanalysis)

A Video

Series:

new

As you might expect, lots

in

some

of the chapters.

cases (such as cognitive

of material was available. In others (most notably,

research directly relevant to the approach

Theories

in

Perhaps the most exciting addition to

Then-editor Kevin Davis and

I

was

scant.

Action

this edition

discussed this idea

is

the video series. Theories in Aetion.

when I was

he wisely decided to hold off at that time, knowing that 1

in all

much more research was available than could be summarized, so my review Where new sources were available on advances in basic constructs and princi-

of theory,

pleting

Research

cases

selective.

ples

a

New

I

writing the

first

would be exhausted

4 chapters. However, we revived the idea for the second edition, and

will share

edition but

comhope you

after I

my excitement and enthusiasm for this project. The DVD that accompanies each

copy of the

text contains six

20-minute sessions with the

oretical perspectives: Classic Psychoanalysis, Gestalt

client,

Helen, from different the-

Therapy, Feminist Therapy, Cognitive

Therapy, Narrative Therapy, and Family Systems Therapy. Following each session review in which the counselors answer two questions:

was most characteristic of their approach and

(b)

(a)

what they did

what they would do

with Helen. Adopting instructors will also be able to access the

from which the sessions on the

DVD

full

is

a brief

in the session that

in the next session

50-minute sessions

were derived by searching www.pearsonhighered

.com under ISBN 0-13-5025 17-6.

Companion Website: A Virtual Learning Environment Readers can access chapter summaries, self-assessment items, weblinks, and ing questions based

on the

Theories in Aetion video series at

critical

think-

www.prenhall.com/murdock.

Instructor’s Materials The Online Instructor s Manual with material includes chapter outlines

questions.

Rank free to adopters of this text. This electronic and a test bank with multiple choice and short answer Test

The Online PowerPoint Slides

access these supplements

on the

'xs

provide lecture outlines. Adopting professors can

Instructor’s

Resource Center with an access code by

searching www.pearsonhighered.com under the

ISBN

0-

1

3-228652- 1

PREFACE

IX

ACKNOWLEDGMENTS my

All of

teachers

— both

students and professors

names would be

so lengthy

Commonwealth

University and

my

cant educators in

back.

am

I

must simply acknowledge of the students over

all

chapters of this book, and

also deeply indebted to

all

My fortune

cookie really

week at a fortunes coming once

will be rich (e.g.,

loom

me no warning doubt

knocked on because

if I

that

I

am

my way.

whom

students have

I

have been fortunate to

Usually,

ahead”), but

my life was

my

I

day almost 10 years ago when

fall

showed up unexpectedly

my cookies

try to turn into self-fulfilling

I

was looking out

I

prophecy

was Kevin

I

(e.g.,

On

meaningful, or

at

the ones that say “you

me something I

tell

pay attention nonetheless.

want

don’t

this day,

to hear

my cookie gave

about to change.

my office window wishing

door. In retrospect,

it

my office. tend to eat that my fidelity results in

in

am sure tell me something I

am

I

glad that

I

I

who

me

helped

had not succumbed

see that

I

when Kevin

could be outside

had, you might not be reading this book. Although

writing a book, one.

the sunny

and famous”). Occasionally, the cookies

“troubles

No

Numerous

truly appreciate their helpful feed-

I

Chinese restaurant, and

local

a

something that

least

of

my graduate program at Virginia my postgraduate career as signifi-

of the clients with

me down on

let

Merrill Executive Editor Kevin Davis

special

list

my career.

work over

at least

deserve mention; however, the

journey to becoming a teacher of theory.

commented on

read and

I

—

I

my

to

impulses

had vaguely contemplated

had an idea that might turn into

very grateful for the support, encouragement, and

wisdom

that Kevin con-

tributed throughout the writing process.

Numerous this

reviewers are responsible for significant improvements in the

book, and

drafts:

I

am

thankful for their willingness to read and

James Archer,

Oklahoma; Kevin A.

first

comment on

edition of

the chapter

University of Florida; Jerry Chandler, University of Central

Jr.,

Fall,

Loyola University— New Orleans; Marijane

Fall,

University of

Southern Maine; Mary A. Herman, Mississippi State University; James W. Lichtenberg, University of Kansas; Christopher Parker, University of Florida;

Thomas

J.

McCarthy, University of Texas

Herman

Scofield, University of

at Austin;

Woodrow

C. Salzberg, University of South Carolina; and

Nebraska

at

Women’s

Kearney. Roberta Nutt, of Texas

University provided extra input on Chapter 13, Feminist Therapy. Second edition reviewers include:

Dulin Clark, Penn State University; James Kreider, Kansas University; Marcy

Marinelli, University of Maryland;

David Powers, Loyola College; Charles

Indiana University; Edward H. Robinson,

Northern It

were

Illinois University;

was important

to

me

fairly representative

III,

L.

University of Central Florida; Jim

and Heather C. Trepal, University of Texas

at

Sells,

San Antonio.

to have client cases for study that, while interesting in content,

of the clients

we

see

and covered

a diverse

spectrum. In

identifying information was changed to protect the identity of the individuals. these cases were loosely based a counselor.

Ridley,

on

my own

clients,

who

have taught

me much

all

cases,

Some of

about being

Others were contributed by students, and so special thanks go to Shawn

Roberson, Natalie Wilcox, Laura Shaughnessey, and Meredith Porter. Thanks also to

me to use the case of Theo for Chapter 3 and to and David Donovan, who created the case of Helen, used in Chapter 6.

Aaron Rochlen, who allowed Forristall

Kate

— PREFACE

X

In the preface to the

and support. a few more.

am

I

first

edition of this text

fortunate that

The support group

I

many

thanked

I

can again express

individuals for their help

my appreciation

that attempted to keep

me sane and

to these folks,

put up with

and add

me moan-

ing about being frustrated and behind schedule includes (in no particular order): Julie and

Mike Horton (and

Riley and Conner),

Tamera Murdock,

Logan, Phil and Genie Reid, and Bob Lewis (who

who as

had the patience and perseverance

actually

good

a friend as she

to Jeffrey

The

is

to read

a photographer, provided the

vom Drache

Bentley and Jezebel

J.

is still

patience and support of the faculty,

and Educational Psychology

at

Amy Winn,

Holly Garcia, Laura

the only person other than editors

all

of the chapters). Heidi Hancock,

photo

for

Chapter

1

.

Special thanks

Feld for their love and encouragement.

staff,

and students of the Division of Counseling

UMKC and Dean Linda Edwards were also instrumental in

the revision process. April Connery, doctoral student in Counseling Psychology, was heroic in her role as research assistant, tracking

typo in the spelling of Scarlett’s

name

down an amazing range of resources and Chapter

in

1

.

She and three other members of my

search group contributed interesting content for boxes

Once

again, the staff at Merrill has been fabulous.

uated to a higher plane, worked with tion,

and was extremely patient with

who assumed

me

you

will find in

Chapters

3, 6,

and

re9.

Kevin Davis, although he has grad-

to develop the

my struggles

finding the

new

ideas

and

features in this edi-

to finish this revision.

Meredith

Fossel,

editorship in August of 2006, has been equal in her support, creativity,

and

patience.

The video

project represents the

individuals, to

sor of

whom

extend

I

Communication

my

Studies at

combined most

Kate

of a group of hard-working, talented

sincere gratitude. Peter Morello, associate profes-

UMKC served as producer, working closely with Kevin

Mullin, instructor and studio engineer in iting expert.

efforts

Forristall, the actress

Communication

who

Studies, our ace

camera and ed-

portrayed Helen the client, was magnificent

many who viewed the rough cuts of the video had no idea that she was not a “real” client. Huge thanks go to David Donovan, who you will see as the psychoanalyst, for his help in finding Kate and many of the other therapists you will see in the series. It is also his office backdrop

that provides the lovely

words

to express

my

for the counseling sessions.

appreciation (and awe) for the hard

difficult to find the right

work and enthusiasm of

— Anderson, Eundgren, Jim Stelmach —without them, my dreams

David, and the other therapists

Moore, and Shelley

It is

Paul

Jennifer

Kate,

Kreider, Einda

for this project

would have

remained unrealized. Finally,

I

pay tribute to

Murdock, and

to

my

my sisters,

parents,

Mary

Murdock and Sandlan John Niemann, for helping me to become

Elizabeth Erojd

Kathy Winn and Cecelia

who could write this book. One of my fondest memories involves asking my mother why cats purr. She sent me off to complete my first literature search in the hope of answering this question. Among other things, my sisters taught me to swim, dance, and the person

write in cursive, important tant,

my

family taught

necessary to

becoming

skills at

me

which

I

have had varying

rates

of success. Most impor-

the value of relationships and attention to others that

is

so

a professional helper.

Nancy

L.

Murdock

Discover the Companion Website

Accompanying This Book

THE MERRILL COMPANION WEBSITE: A VIRTUAL LEARNING ENVIRONMENT Technology

is

a constantly

growing and changing aspect of our

need for content and resources. To address

this

field that

—

to support

book already

offers.

— Companion

our textbooks.

Companion

In creating a

creating a

emerging need, Merrill has developed

an online learning environment for students and professors alike Websites

is

For

Website, our goal this reason, the

is

to build

on and enhance what the

text-

content for each user-friendly website

is

organized by chapter and provides the professor and student with a variety of meaningful resources.

Common

features of a

—

•

Chapter Objectives

•

Interactive Self-quizzes

Companion Website

include:

outline key concepts from the text.

—complete with

hints

and automatic grading that

provide immediate feedback for students. After students submit their answers for the interactive self-quizzes, the

Companion Website

Results Reporter computes

a percentage grade, provides a graphic representation of how

were answered correctly and analysis

incorrectly,

and

many

gives a question-by-question

of the quiz. Students are given the option to send

their quiz to

four e-mail addresses (professor, teaching assistant, study partner, •

Essay Questions

—

questions

up

etc.).

these questions allow students to respond to themes

objectives of each chapter

by applying what they have learned

to

and

to real

classroom situations. •

Web

Destinations

—

links to

www sites

that relate to chapter content.

many available resources, please visit the ing and Psychotherapy: A Case Approach Companion Website at

To

take advantage of the

www.prenhall.com/ murdock

Theories of Counsel-

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1

1

Brief

Contents

THEORY IS A GOOD THING

Chapter

1

Chapter

2

PSYCHOANALYSIS

Chapter

3

NEOANALYTIC APPROACHES

1

29

64

Chapter 4

INDIVIDUAL PSYCHOLOGY

Chapter

PERSON-CENTERED THERAPY

5

1

05 1

47

Chapter 6

EXISTENTIAL THERAPY

Chapter 7

GESTALT THERAPY

Chapter

8

BEHAVIOR THERAPY

Chapter

9

RATIONAL EMOTIVE BEHAVIOR THERAPY

Chapter 10

COGNITIVE THERAPY

Chapter

REALITY TH ERAPY

1

1

1

79

98

232

314

352

Chapter 12

FEMINIST THERAPY

Chapter

13

FAMILY SYSTEMS THEORY

Chapter

14

SOLUTION-FOCUSED THERAPY

Chapter

15

NARRATIVE THERAPY

Chapter 16

CONCLUSION

REFERENCES

R-1

NAME INDEX

I-l

SUBJECT INDEX

273

376 405

460

490

514

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9

8

Contents

Chapter

THEORY IS A GOOD THING

1

Theory of the Person and Development of the Individual 26

I

What What

Why

Theory?

Is

Psychotherapy?

2

Is

to

4

Lost

Your Task: Find Your Characteristics of

Precision

and

Map

How Do

I

A

to

Human a

Theory?

1:

Step

2:

Know Your Theory 23 Know Your Client 24

Step

3:

Put

Human

in

Symptoms

35 35 35

This Book

The Big Three

25

as

Symbols

26

39 39

4l

Nature of Therapy

26

37

Theory of the Person and Development of the Health and Dysfunction

25

36

38

Defense Mechanisms

Individual

25

Central Constructs

29

34

Theory

Repression

24

Together

Motivation

28

30

Structural Model:

23

Step

Basic Philosophy

Use Theory

Topographic Model: The Iceberg Approach

21

Step-by-Step Guide

Background

to

PSYCHOANALYSIS

Motivation

Instinct

How Theory Is Presented A Case Study 25

27

28

Central Constructs

1

21

Use Theory

27

28

Basic Philosophy

17

It

The Case Study Summary 28

Background

Choose

27

of Individual and Cultural Diversity

Chapter 2

8

17

What About Me?

Issues

Closing Remarks

6

17

Practicality

27

7

Testability

Stimulation

Process of Therapy

Another Resource on Learning

5

Good Theory

Empirical Validity

Parsimony

26

Evaluation of the Theory

Fluman Life 4 Don’t Use Theory May Get

Who

Counselors

How

3

Nature of Therapy

Therapeutic Techniques

Fun 3 Theory Works 3 Theory Is Essential

So

2

Bother with Theory?

Theory

26

Health and Dysfunction

Is

Assessment

43

48

48

Overview of the Therapeutic Atmosphere

48

XV

1

1

Contents

XVI

49

Roles of Client and Counselor

Coals Process

50

Individual

50

Resistance

Transference

5

Countertransference Phases of Therapy

53

Evaluation of the Theory

56

57

Theory

3

Background

98

Process of Therapy

99

Qualities of Theory

Issues

Background

72

Human

73

76

Motivation

110

77 78

111

111

Lifestyle

112

Social Interest

113

Inferiority Feelings

78

Basic Tasks

Object Relations: The Lego Approach

79

115

Basic Mistakes

116

Theory of the Person and Development of the

79

Central Constructs

82

Individual

d heory of the Person and Development of the Individual

109

Central Constructs

75

105

106

Basic Philosophy

Therapeutic Techniques

116

Health and Dysfunction

Nature of Therapy

84

Health and Dysfunction

Assessment

85

120

124

124

Nature of T herapy

86

Overview of the Therapeutic Atmosphere

Process of Therapy

88

Roles of Client and Counselor

Therapeutic Techniques Self

Psychology

Overview

—

90

103

103

PSYCHOLOGY

72

Process of Therapy

101

INDIVIDUAL

Id Eoses the Limelight,

Health and Dysfunction

00

64 Chapter 4

Theory of the Person

1

of Individual and Cultural Diversity

The Case Study Summary 103

65

Nature of Therapy

100

101

Research Support

Central Constructs

Overview

61

62

Temporarily

Overview

Nature of Therapy

98

Evaluation of Neoanalytic Approaches

58

NEOANALYTIC APPROACHES

Ego Psychology:

97

Therapeutic Techniques

57

of Individual and Cultural Diversity

Chapter

96

Health and Dysfunction

Analysis of the Transference

The Case Study Summary 63

96

96

Individual

53

Research Support

95

Theory of the Person and Development of the

Analysis of the Resistance

Qualities of the

95

Central Constructs

52

Analysis

Process of Therapy

Overview

52

53

Interpretation

94

Relational Psychoanalysis

51

Free Association

Nature of Therapy

92

Therapeutic Techniques

51

Therapeutic Techniques

Issues

91

Health and Dysfunction

50

Insight

91

Theory of the Person and Development of the

50

of! herapy

Dream

Central Constructs

It’s

All

89

About

Goals

Me

90

1

3

Process of Therapy

132

Therapeutic Techniques

1

34

131

1

30

11

Contents

XVll

134

Interpretation

Encouragement

Therapeutic Techniques

135

Evaluation of the Theorv

Natural and Logical Consequences

Acting As

136

Catching Oneself Creating Images

Someone

Pleasing

Paradoxical Intention

Evaluation of the Theory

Research Support

138 1

177

EXISTENTIAE

Chapter 6

39

THERAPY

140

of Individual and Cultural Diversity

The Case Study Summary 146

172

138

Theory

Qualities of the

Issues

The Case Study Summary 178

137

144

Background

Basic Philosophy

145

Human

183

Motivation

Modes 5

PERSON-CENTERED THERAPY 147

184 184

Background

156 1

Nature of Therapy

156

Assessment

157 1

Goals

Nature of Therapy

160

Dream

Roles of Client and Counselor

163

Process of Therapy

192

1

62

193

Analysis

Bracketing

1

93

Guided Fantasy

193

Congruence

Qualities of Theory

164

Research Support

165

Unconditional Positive Regard

166

166

Eourth Condition?

Issues of Individual

Diversity

Stages of the Therapeutic Process

1

167

Summary

197

1

1

93

194 195

and Cultural

96

The Case Study

167

9

192

Evaluation of the 4 heory

163

1

192

Dereflection

Overview of the Therapeutic Atmosphere

A

190

Paradoxical Intention

162

189

90

Self-Disclosure

162

Assessment

1

Attention to Nonverbal Behavior

159

Health and Dvsfunction

89

Therapeutic Techniques

159

Theory of the Person and Development of the Individual

1

Process of Therapy

158

Conditions of Worth

Empathy

188

Roles of Client and Counselor

158

Regard and

for Positive

Self-Regard

Coals

188

Atmosphere

Tendency

187

Overview of the Therapeutic

57

158

Self-Actualizing

Need

187

Health and Dysfunction

Organismic Valuing Process Self

186

Individual

56

Actualizing Tendency

185

Theory of The Person and Development of the

155

Central Constructs

Experience

185

Defenses

Motivation

184

The Ultimate Concerns

147

Basic Philosophy

Human

of Being

Anxiety

179

80

1

Central Constructs

Chapter

7

175

Diversity

137

1

and Cultural

Issues of Individual

137

170

Theory

Qualities of the

Research Support

Pushing the Button

'

135

136

II

169

97

192

Contents

xviii

GESTALT THERAPY

Chapter 7 Background

Overview of the Therapeutic

254 Roles of Client and Counselor Atmosphere

207 Polarities 209

Needs

Contact Disturbance

255 Process ofTherapy

Exposure Therapy

214

Roles of Client and Counselor

215

Punishment

222

Polarities

Covert Conditioning

223

Modeling

224

224 Taking Responsibility 224 Evaluation of the Theory

Theory

Evaluation of the Theory Qualities of the

225

Issues

of Individual and Cultural Diversity

229

230

Background

BEHAVIOR THERAPY

The Case Study Summary 272

Basic Philosophy

Human

Motivation

Central Constructs

232

242

Human

244

244

RATIONAL EMOTIVE BEHAVIOR THERAPY 274

Central Constructs

ABCs

Operant Conditioning

245

Beliefs

Observational Learning

278

Motivation

244 249

280 280

Goals (Gs)

270

271

Basic Philosophy

Conditioning

Classical

9

Background

233

267

267 of Individual and Cultural Diversity

Chapter

Chapters

Theory

266 266

Research Support

225

226

Research Support

265

265

Behavioral Self-Control

Rounds

263

264

Stimulus Control

223

The Case Study Summary 230

263

Assertiveness Training

223

262

262

Extinction

222

Awareness Training or Bodywork

Issues

Reinforcement

Differential

Playing the Projection

261

Reinforcement

221

221

Qualities of the

260

261

Shaping

220

Therapist Self-Disclosure

the

259

260

Intention

218

Therapeutic Techniques

Making

Systematic Desensitization

“Blow-Up” Technique or Paradoxical

217 Process of Therapy

Working with

258

Aversive Techniques

216

Goals

Dream Work

258

Flooding

Overview of the Therapeutic Atmosphere

Reversals

257 257

Relaxation Training

212

214

Nature of Therapy

Exaggeration

256

Therapeutic Techniques

211

Health and Dysfunction

255

Goals

210

Theory of the Person and Development of the

Dialogues

252

Assessment

207

207

Assessment

250

252

Nature of Therapy

206

Central Constructs

Individual

250

Health and Dysfunction

205

Motivation

Contact

Theory of the Person and Development of the Individual

199

Basic Philosophy

Human

198

282

279 280

273

1

1

Contents

XIX

Human Worth

Ratings and

Secondary Disturbances

USA

283

The Cognitive Model

283

Theory of the Person and Development of the Individual 284 Health and Dysfunction 285 Nature of Therapy 287 Assessment 287 Overview of the Therapeutic Atmosphere 289 290

Roles of Client and Counselor

Goals Process

320

322 Automatic Thoughts Beliefs

Modes

292

Therapeutic Techniques

Theory of the Person and Development of the 326

Individual

Assessment

331

331

Atmosphere

332 Roles of Client and Counselor

295

296 Recording Therapy

333 Process ofTherapy

296

Sessions

296 Stop and Monitor 296 Rational Coping Statements 297 Rational Emotive Imagery 297 Flamboyant Therapist Actions 298 Reframing

334

338

Questioning

Downward Arrow

339

Thought Recording

339 340

Activity Scheduling

Coping Statements and Taped Disputing 298 Role-Playing 300

Assertiveness Training

Rational-Irrational Dialogues

301

Imagery

Reinforcements and Penalties

301

Graded Tasks

Acting on Rational Beliefs

Homework

34

342 Role Playing and Other Behaviorally-Oriented 342

Techniques

Evaluation of the Theory

302 302

Theory

Qualities of the

Shame Attacking

303 Evaluation of the Theory 303 Qualities of the Theory 306

Issues

343 343

344

Research Support

303

307 of Individual and Cultural Diversity

34

342

Problem Solving

302

Vivo Desensitization

340

Behavioral Experiments

Forceful

In

336

Therapeutic Techniques

298

Training

333

Goals

Proselytizing

Skill

327

Overview of the Therapeutic

293

294

Bibliotherapy

323

324

Nature ofTherapy

ofTherapy

Humor

Schemas

320

Health and Dysfunction

291

Disputing

320

Central Constructs

of Individual and Cultural Diversity

The Case Study Summary 350

348

350

Research Support Issues

The Case Study Summary 313

313

311

Chapter

II

Background

REALITY THERAPY 353

Basic Philosophy

Human Chapter 10 Background

COGNITIVE THERAPY 314 315

Basic Philosophy

Human

Motivation

319 319

355

356

Motivation

357

Central Constructs Basic

Needs

357

Quality World

359

Total Behavior

359 360

Choice Theory

352

Contents

XX

Theory of the Person and Development of the 363

Health and Dysfunction

Evaluation of the Theory

Roles of Client and Counselor

365

Issues

The Case Study Summary 403

366 367

368

Bibliotherapy

Chapter 13

Doing the Unexpected

368

The

369

Self-Disclosure

370 Allowing or Imposing Consequences 370 and Meditation

Evaluation of the Theory

Theory

Qualities of the

Research Support

371

371

373

374

408

Central Constructs

409

409

Self-Esteem

411

Communication 411 Primary Triad 412 Family Rules 413 Theory of the Person and Development of the Individual

4 14

Health and Dysfunction

Nature ofTherapy

Chapters FEMINIST THERAPY Background

Goals

385

Personal

Is

Political

386

Family Sculpting

386

Health and Dysfunction

Nature of Therapy Assessment

417 418

Therapeutic Techniques

Theory of the Person and Development of the Individual

415

416 Process ofTherapy

384 385

Central Constructs

The

415

Roles of Client and Counselor

381

Motivation

Gender

Assessment

4 14

Overview of the Therapeutic Atmosphere and

377

Basic Philosophy

Human

376

389

392

392

Overview of the Therapeutic

Atmosphere

393 Roles of Client and Counselor

394 Process ofTherapy

405

408

Approach

SelfMandala

370

of Individual and Cultural Diversity

The Case Study Summary 375

Satir

Overview

369

Physical Activity

FAMILY SYSTEMS 406

Background

369

Metaphors

403

THEORY

369

Reframing

Issues

402

368

Questioning

Humor

399 of Individual and Cultural

Diversity

365

Therapeutic Techniques

399

Research Support

364

Process of Therapy

Theory

Qualities of the

Overview of the Therapeutic

Goals

397 398

Assertiveness Training

364

Atmosphere

397

Self-Disclosure

364

Nature of Therapy Assessment

397

Gender-Role Analysis

361

Individual

397

Therapeutic Techniques

Goals

395

394

Family

Stress Ballet

418 418

Communication Analysis 418 Therapist Communications 419 Touch 419 Family Thermometer 419 Parts Party 420 Structural Therapy 420 Overview 420 Central Constructs 423 Family Structure 423

4l6

1

1

Contents

XXI

Subsystems

424

Boundaries

424

446

Sibling Position

Theory of the Person and Development of the

Theory of the Person and Development of the Individual 425

Health and Dysfunction

Health and Dysfunction

Nature ofTherapy

Nature ofTherapy

425

427

Roles of Client and Counselor

Process

Issues

431

432

Overview of the Therapeutic Atmosphere and Roles of Client and Counselor

437 ofTherapy

436

Goals

439

Human

Motivation

Central Constructs

Exceptions

467 468

468

Change Talk 468 Solutions 468 469 Theory of the Person and Development of the Strengths and Resources

469

Nature of Therapy

442

442 444

470

471

471

444

445

446

Emotional Distance

44

Atmosphere

471

Roles of Client and Counselor

442

473 Process ofTherapy Goals

473

Therapeutic Techniques

Differentiation of Self

Triangles

463

Basic Philosophy

Overview of the Therapeutic

Bowen's Family Systems Theory

Chronic Anxiety

460

Assessment

Pretend Directives

Central Constructs

Background

Health and Dysfunction

Exaggerating the Hierarchical Problem

Overview

SOLUTION-FOCUSED THERAPY 460

Individual

437

Therapeutic Techniques

44

458

Chapter 14 433

Communication 433 Hierarchies 434 Theory of the Person and Development of the Individual 434 Health and Dysfunction 435 Nature ofTherapy 436 Assessment 436

Reframing

456

432

Central Constructs

439

453 of Individual and Gultural Diversity

The Gase Study Summary 459

432

Directives

453

Research Support

430

432 Teaching Complementarity

Process

451

452 Qualities of the Theory

Unbalancing

Overview

451

Approaches

Boundary Making

Therapy

450

Evaluation of the Family Systems

429

430

Achieving Intensity

Strategic

Roles of Client and Counselor

Therapeutic Techniques

430

Focusing

448

Goals

429

Therapeutic Techniques

Enactment

448

450 Process of Therapy

428

428

ofTherapy

448

Overview of the Therapeutic Atmosphere and

Overview of the Therapeutic Atmosphere and Goals

447

Assessment

427

Assessment

Individual

Questions

477

Normalizing the Problem

Compliments 446

476

477

Miracle Question

478

477

472

1

Contents

XXll

478

Scaling Questions

479

Prediction Tasks

479

Asking About the Problem

479

479 First Session Formula Task Generic Task 480

Taking

480

Do Something

Qualities

482

Solution-Oriented Hypnosis

Issues

483

484

487

15

NARRATIVE

Human

490

494

496 Thinness and Thickness

496

Unique Outcomes

497 Person and Development of the 497 498

Clients: Diversity

Is

and Integrative Approaches

to

526

Change 528 Stages of Change 528 Levels of Change 529 Therapy 530 -

Techniques

530

533

499

REEERENCES

500

R-1

500

ofTherapy

500

Therapeutic Techniques

Questioning Visualization

NAME INDEX

I-

503

503

SUBJECT INDEX

504

Note: Every effort has been it

Approach and

499

Roles of Client and Counselor

posted on

518

526

to Stay

Conclusion

Overview of the Therapeutic Atmosphere

Process

Behavior

Summary and Evaluation 531 The Contextual Model 532

499

Nature of Therapy

Goals

522

518

Processes of

Stories

Assessment

Technique

Psychotherapy

496

Human

Style:

Eclectic

495

Health and Dysfunction

About

Your Personal

Here

Central Constructs

Individual

517

The Role of Your

491

Motivation

Theory of the

Beliefs

514

517

Your Philosophical Assumptions

Basic Philosophy

511

517

Practical

489

THERAPY Background

of Individual and Cultural Diversity

Stimulating

Your

Chapter

509

510

Empirically Valid

484

of Individual and Cultural Diversity

The Case Study Summary 489

ofTheory

Chapter 16 CONCLUSION Is This a Good Theory? 516

483

Theory

Research Support

508

482

Different

Qualities of the

507

The Case Study 512 Summary 512512

482

Burn

506

Practices

Research Support Issues

Evaluation of the Theory

Back

Evaluation

480

Structured Fight

It

Written Artifacts

481

Write, Read, and

505

Reflection Practices

Externalizing

Surprise Task

505

Accountability Practices

Fast-Forward Questions

Breaking Patterns

504

Outsider Witness Practices

made

to provide accurate

are constantly changing, so

it is

and current Internet information

inevitable that

some of the

in this

1-9

book. However, the Internet and information

Internet addresses listed in this textbook will change.

gha=ptEr:i •u.

*

Scarlett comes to counseling because she

seems that her husband, Rhett, turn her love

and has,

old daughter, Bonnie, to

whom

is

troubled about an important relationship. It

she realizes that she loves deeply, does not seem to re-

in fact, vanished. Scarlett

is

also

mourning

6 months ago. Sad and angry at the same

the death

of her 6-year-

time, Searlett feels helpless

do anything about her situation. She blames Rhett for the problems in their relationship.

Scarlett reports that she

ing

spells

is

not eating or sleeping

almost on a daily

well,

and she

and faint-

has panic attacks

basis.

ofa farmer; she has two younger sisters. Her father died 8 years ago in a fall fom a horse. There is some evidence that Scarlett s father was drinkmg at the time; he was berefi because his farm had been plundered by an invading army and Scarlett

his wife

is

the eldest daughter

had died ofscarlet fever.

This invasion cost the formerly wealthy family much, cre-

ating a situation in which Scarlett

and her sisters had to

ofyears. Eventually,

Scarlett started a successful business

three times; Rhett

her third husband.

Scarlett has

is

known Rhett for a

with Scarlett; she did not respond

scratch out a living for a

on her own. She has been married

long time. For years, Rhett to

him because she was

Scarlett lost her second husband, she agreed to

marry

ship with Rhett as distant, but reports that both she

number

had professed

to

in love with another

be in love

man. Afier

Rhett. Scarlett describes her relation-

and Rhett doted on

their daughter,

Bon-

During the years of the marriage. Scarlet did not feel that she loved Rhett; she simply tolerated him because he could support her and their daughter. Six months ago, Bonnie died in a fallfrom her pony. Rhett and Scarlett were devastated nie.

and uncharacteristically

took comfort in each other. In the grip of this grief Scarlett finally

realized that she loved Rhett. However, Rhett into a is

dark foggy

night.

struggling with hurt

became angry at

Scarlett

Although Scarlet at the time vowed tomorrow

and anger along with

is

and

disappeared

another day, ’she

her griefabout Bonnie. 1

THEORY

2

You

She looks

are Scarletr’s counselor.

How

you going

are

to help her?

you address these symptoms with her love (which

A

is

What

GOOD THING

and having panic

crying, fainting,

or help her

is

A

you, imploring you to help her get Rhett back.

make

attacks.

Should

Rhett and bowl him over

a plan to find

How do you help Scarlett with

what she wants most)?

is

the loss of her daughter?

more

first

She

at

IS

her grief over

the contribution of Scarlett’s family background and

recent history to the current situation? consistent, coherent approach to helping Scarlett

of counseling theory.

Although

am

I

do not mean

I

pretty smart,

the nature of change

I

direct

work

your attention to

most

as counselors.

part, over

I

found

in the careful application

make up

down my

don’t think that writing

scrutiny, for the

be helpful in our

any theory that

going to produce a system that

is

beginning therapist. Rather,

much work and

I

just

is

off the top of my head. ideas about people

and

guide your work

as a

will reliably

a set

of theories that have received

many years. These

theories are

Before addressing them, however,

I

known

to

some

will offer

basic definitions.

WHAT On

IS

the surface, defining theory seems easy.

posed of a

set

Most

definitions specify that a theory

of concepts and their defined relationships,

nomenon of interest. “to foster

THEORY? all

intended to explain some phe-

Why do we theorize? According to Maddi

understanding of something hitherto not understood”

theories, in a perfect world,

com-

is

(1996), theories are meant (p.

485). Put another way,

should explain and predict behavior. In the counseling profes-

we also hope that they tell us how to help our clients. The theories you are most interested in are theories of counseling

sion,

or psychotherapy. All

of these theories attempt to explain the process of helping clients change; they

some

sort of prescription for

son, the client,

who

what one person, the

therapist, can

do

all

offer

to help the other per-

To complicate matters, however, some theories made (psychologically), developmental issues, and

has sought assistance.

of counseling address

how

people are

and unhealthy psychological functioning. Other theories bypass

descriptions of healthy

these issues as simply not relevant to helping the client change.

WHAT Although swer to

am

I

it,

it

is

IS

PSYCHOTHERAPY?

guessing that almost everyone

who

reads the previous question has an an-

probably useful to offer a definition of counseling or psychotherapy

starting point for further discussion of the link

between theory and therapy. Here

as a

are a few.

Division 17, the Society of Counseling Psychology of the American Psychological Association, described counseling as “helping to overcome obstacles to their personal

growth, wherever these

ment of

be encountered, and toward achieving

their personal resources”

Psychology, 1956,

Wampold

p.

a client

who

optimum

(Committee on Definition, Division

develop-

of Counseling

283).

(2001) took a slightly different view: “Psychotherapy

sonal treatment that

and

may

is

is

a primarily interper-

based on psychological principles and involves a trained therapist

has a mental disorder, problem, or complaint;

apist to be remedial for the client’s disorder,

it is

intended by the ther-

problem, or complaint; and

it is

adapted or

dividualized for the particular client and his or her disorder, problem, or complaint”

in-

(p. 3).

THEORY Which knows

GOOD THING

A

IS

definition

do you think

not necessarily

is

3

so.

better?

is

What are

As you can

see,

what we assume everyone

the implications of using language such as “overcome

obstacles to their personal growth” versus “remedial for the client’s disorder, problem, or

complaint”? These kinds of philosophical differences supply the underpinnings for the various theories of psychotherapy that will be presented in this book.

One

nagging question always surfaces

and psychotherapy?

seling

and

sonality change”

Traditionally, psychotherapy

''depth

problem-focused, and

at this point: Is there a difference

much

between coun-

was considered the realm of “per-

work,” whereas counseling was seen

as shorter in

duration,

most people do not differentiate between counseling and psychotherapy, acknowledging that the difference between the two activities

more

is

Currently,

less intense.

ideology of the speaker than in the actuality of the event.

in the

therefore use counseling ot therapy

{‘tind

I

will

counselor, psychotherapist, or therapisi) interchange-

ably in this book.

WHY BOTHER WITH THEORY? Once

you’ve tentatively decided what counseling

do

A

it.

long-standing tradition, dating from

chotherapy

the next step

is,

Sigmund Freud,

is

is

how

to consider

to

that the practice of psy-

guided by the use of a theory. For Freud, of course, there was one theory. In

is

we can count over 400 different approaches to counseling (Corsini & Wedding, The situation may seem bewildering, and you may be wondering. Do have to have

the 2000s,

2005).

I

a theory?

We’ve

all

heard the phrases

message seems is

“that’s just theoretical” or

to be that theory

is

one thing,

reality

from

ory works. Theory

is

I

believe that theory

essential to

to get lost in their very

genuine

human

is

life.

practical

I

plays a critical role in your

Is

Looking

who

those of us

Now

ing,

well

known

they

live

is

fun.

The-

don’t have theory are likely

efforts to help their clients. this chapter,

work with

clients.

I

and indeed

in the rest

of this

—

that theory

statement, but

really, for

me, theory

human

is

entertaining to

who

are always ask-

make some

will explain a little

sense

more.

Fun

You probably think fun.

who

intend to convince you that these observations

Theory

it is

general

something that

and important. Theory

Counselors

These claims may seem pretty extravagant. In book,

and

is

The

reality.

respectfully differ.

I

Theory

another.

the concern of ivory-towered fuzzy-headed intellectuals,

their lives far

is

is

“Theoretically ...”

I

at all

am

exaggerating a

little in this

of the different ways to understand

are people watchers, or even worse,

why did he or she do

activity

nosy busybodies

that?

Theory Works As you

will see before this

theories are effective.

how ftil,

to help

critical

chapter

is

Each of the theories

them grow, and how

to

we

over, I

are pretty certain that the

present explains

change aspects of their

why

lives

major cotmseling

people behave

if

as

they wish to do

they do, so. C>are-

application of these principles seems to result in decreases in psychological

toms and other

signs of psychological health.

I’d

also risk saying that

symp-

good psychotherapy

THEORY

4

A

IS

GOOD THING

and, ultimately, can produce changes in

results in increased self-understanding

lives that

increase happiness.

Theory

Is

suppose

will

I

I

Human

Essentiae to admit

to a

exaggeration in

little

ing about theory in a very general less

Life

way

my choice of the

What

here.

mean

I

is

they have ways of organizing the bath of information in

moment and

Stop reading for a

physical environment

—

are

What about your body?

Cold?

Is

this

am

I

talk-

humans can’t exist unwhich we constantly splash. that

around and

just attend to everything

you reading

above heading.

book outside on

your stomach growling?

a grassy lawn?

What

Note your

in you.

warm?

Is it

thoughts are going

through your head? I

think you might be getting

which

to

my point

—how do we know which

put in the background? IHow do

we

stimuli to attend to

the difference between a

tell

dog and

and

a horse?

The answer to these questions, of course, is theory, or put another way, some structure into which we fit information to create meaning. We sometimes call these structures schemas, which are defined as cognitive structures that help us organize information. The interesting thing about schemas

that they can be both helpful

is

and harmful.

First, a

organize information into a coherent whole (think about “elephant” and

We

elephant).

do

Schemas make

us

We

municate.

this

instantaneously because our schema

more

efficient processors

are real or

consistent with our

is

we tend

that

make

despite these dangers,

and

forget information that

I’d

argue that

the assumptions

efficient

What about Consider If

those

human

and directed

experience,

proceed?

I

to travel

do

will leave this

United

As

I

the universe,

and our

our work. Fiowever, theory can also

in

sort.

The problem

is

that

in

some kind of theory-like formal theory simply makes

working with explicit

clients.

and open

Using

a

to examination.

Don’t Use Theory May Get Lost don’t think about theory or, even worse, reject

outright?

it

from Lake Lotawana, Missouri,

to

Key West,

Florida,

how would

consider flying on a plane, and then reject that notion in favor of

old Miata, which thing, but

who

life,

metaphor.

a

wanted

I

Who

consistent.

is

equally impossible to avoid using

it is

and predictions

Counselors

is

probably impossible to avoid using schemas in information pro-

it is

and assumptions

structures

I

more

us

to quickly identify information that

our perceptions, seducing us into tunnel vision of the worst

cessing,

mind world). The

of schema theory for counselors. Theory, our professional

schema, help us organize information about

bias

already present in our minds.

is

of information. Schemas also help us to com-

schema and may ignore or

see the implications

can

the qualities of

simply agreed-upon interpretations of the

downside of schematic processing

clients. It

list

can talk to other people because they have similar schemas (never

whether these things

You can

schema helps us

I

have always wanted to drive

I

just

pack

my

bags and

sail

down

my

the 7-mile bridge. So driving

out the door? Well, some folks might

approach for another paragraph.

trusty

What

I

would do

is

find a

is

the

— but we

map

of the

States.

scrutinize

my

map,

highways) would seem very

I

discover several things. First,

efficient,

many major

roads (interstate

well-trodden paths. There are also the back roads.

THEORY

GOOD THING

A

IS

5

scenic, but perhaps less ehlcient. In essence,

it

many ways

appears that there are

Lake Lotawana to Key West. Depending on the

you use

criteria

to get

from

(speed, beauty, traffic),

each has strengths and weaknesses.

my view,

In

and

selor

counseling theory provides the counselor with a map.

client

can locate where they are right

The theory

to go.

theory

tells

specifies the

perience are important, and

see the path to

this

map, coun-

where they want

“good” way to go. In the blooming wild of the world, the

which of the

the therapist

now and

On

how

to organize

human

of information presented in

zillion bits

ex-

them.

some form of theory is to be driving around without a map. Consider what would have happened if I had packed my bags, hopped in the car, and just started driving. Would I have gotten to Key West? Who knows? I could have ended up in To

refuse to adopt

California or Boston.

However, you might accurately point out that south and east of Lake Lotawana. That

is

a

good

probably had some idea that Key West point,

and by analogy, beginning

have some ideas about what directions to take with their

apists often

some

a

is

I

ther-

There

clients.

are

potential problems, though, with this loose sense of understanding. Proceeding with

vague idea

probably lead to a

will

You might even

longer to get there.

of wrong turns;

lot

at best,

will

it

probably take

much

get lost.

If you are a risk-taking, adventurous, free-spirited type,

much more

you might be tempted

to argue

that

maps

map

keeps you from seeing out-of-the-way places that are interesting and potentially en-

riching.

are stultifying;

it is

have three responses to that argument.

I

have to take the interstate. You

still

Second, you can always take side sue:

You

helpful to

clients,

beginning therapist,

first client. I recall

that

any particular one.

I

I

does not

mean

that

you

trips.

Third, and most important, there client

is

in the car

is

an ethical

is-

with you and expects that you

wandering might be

free-spirited

could be very dangerous for others.

it

YOUR a

map

using a

and where you’re going. Although

to drive

some

First,

have the option of taking the less-frequented roads.

Your

are not traveling alone.

know how

As

exciting to set out unfettered. Sticking to the

I

TASK: FIND

remember being

had

pretty nervous as

of theories in

lots

YOUR MAP

my head,

but

I

I

thought about greeting

did not

feel

my

very secure with

was wandering around with too many maps and no idea which one

to use.

The

best advice

I

can give you

is

to find a

map

that

you can

live

of the established theories of psychotherapy. As a beginner, you learn that to

from the masters than

you become

to invent

your own theory. Taking

a thick-headed, single-minded devotee of

do so because the unique needs and

what

flexible.

approaches

be dangerous to

start

will find

this

in a critical way,

it

form of one

much

easier to

approach does not mtAW

dogma.

In fact,

it is

you

unethical

to be

some-

with the recognition that other

(and are apparently valid, too) and that theories contain biases that can clients. Also, starting

with that theory forever. In

your career

in the

characteristics of the client require

Theory should be applied

exist

with

as a therapist.

and what map you

fact

you

What am I

will follow.

with one good theory does not mean you

will

will stay

probably change orientations several times over

suggesting

By doing

so,

is

that

you

you

deliberately choose

will learn

how

where you

to apply a theory while

THEORY

6

same time having some comfort

at the

years of scrutiny

Am

by those

who

adhering to an approach that has survived some

in

have more experience than you have.

advocating that you pick one theory and relentlessly

I

gardless of the feedback

you

get? Aren’t there times

when

not stipulated by your theory would be more helpful? a

—

on one

pound your clients with

it,

re-

other approaches or techniques

Of course there are.

In fact,

support

I

you gain

experi-

two or more similar approaches) but using techniques from

others,

kind of technical eclecticism

ence, an integration of

GOOD THING

A

IS

relying

theoretical structure (or as

with a clear idea about why these techniques help you toward your theoretically defined goals.

What

don’t advocate

I

is

theory-hopping, treating theories

discarded depending on the occasion.

we

tually is

are able to

one that

to find

Second,

I

because an important part of choosing a theory life.

Theories differ along these

lines.

think that theory-hopping can lead to a very superficial understanding of theo-

Sometimes you just have

to

hang

know a theory.

in there to really get to

other consideration about flexibility in theoretical approach

client, particularly in

and

ness,

so forth.

is

extremely impor-

with the

client,

Never

Now

terms of ethnicity, culture, sexual orientation, gender, physical able-

You must be very sensitive

you pick up that the

client

is

problems in

not comfortable with your approach, check

theory that seems problematic to your

it

out!

Consult

client confidential-

client.

you have accepted the challenge of finding your map, the next hurdle looms

review several in this chapter, and then

number of ways

revisit this

CHARACTERISTICS OF You may be thinking

that the

way

starting our examination of theory reality

is

(however you define

practice of counseling

that); that

is

is, its

simply to pick the best one.

measure theory.

ideas are accurate

of the world

and psychotherapy has

chapter.

Of

One way of

with the notion that good theory corre-

to begin

dictions. Testing theory against the qualities

my final

1

GOOD THEORY

choose a theory

to

to look at this question.

complicated issue in

course! Unfortunately, there are several yardsticks proposed to

sponds to

Any time

this realm.

your supervisor, your peers (being careful to maintain

persist in using a

that

to potential

ahead: what theory should you pick? There are a will

not sure that psychologically or intellec-

Theories have biases, and sometimes these interfere with the understanding of your

tant.

ity).

easily

am

I

with your assumptions about

fits

retical perspectives.

One

change theories

First,

like clothes that are easily

its

is

and so

are

its

pre-

the business of science, and the

roots in the scientific tradition.

For a very long time the ideals and products of science have been an important part of the enterprise of counseling retical

and psychotherapy. Sigmund Freud, arguably the

psychotherapist, considered himself a scientist, and this tradition

the scientist— practitioner model, the gists (i.e.,

respect lor the scientific roots of intervention

Does

it

search

mean

that

you have

and do counseling

Questions

model

is

What

is

The same kind of

evident in other counseling professions as

and

a therapist?

Do

you have

to

conduct

re-

to qualify?

individuals

model have raged

interpreted to

today in

does the scientist— practitioner model mean?

to be a scientist

about whether

scientist— practitioner

alive

theo-

dominant training model of professional psycholo-

counseling, clinical, and school psychologists; Raimey, 1950).

well (e.g., professional counseling).

is

first

mean

can

truly

integrate

the

for years (Nathan, 2000).

elements

of the

At one extreme, the

that professionals should routinely engage in both science

THEORY

IS

and practice

GOOD THING

A

everyday

in their

to find that very

7

activities.

few practitioners engage

indicates that individuals

who

are

Proponents of

mainly

scientists

—do

Over

60%

view have been disappointed

in scientific research. Interestingly,

teach counseling and psychotherapy

1993).

this

practice

—

college

of a sample of university faculty reported that they regularly worked

practical reasons, very

it is

at least possible to re-

practitioners to

This perspective

and

the one

is

I

who are

mostly counselors or ther-

work with

their

their clients firmly in

to read

work with

their

a sci-

advocate, given the lack of incentives for most

What does being mode understand the

and willing

are able

They approach

that those

research.

that individuals in this practice

is

group of scientist-practitioners) should approach

do

appears that, for

it

few professionals do.

A more moderate position on the model entific attitude.

& Brooks,

what they preach (Murdock

both components of the scientist-practitioner model, although

apists (the largest

research

and university professors who

with clients in some form (mostly individual counseling). Thus, alize

some

a “scientific practitioner”

relationships

among

mean?

theory, research,

and evaluate research relevant

and

to their practice.

and with the

a critical, evaluative attitude

propose

I

best interests of

mind.

Now that you understand the basic orientation, we can proceed to examine some of the qualities that

cision

and

have been identified

testability,

as

important in determining what a good theory

is;

pre-

empirical validity, parsimony, stimulation, and practicality.

Precision and Testability

A theory should have clearly defined constructs and should clearly specify the relationships among them (Maddi,

1996;

Monte

& Sollod, 2003). This kind of arrangement makes the

theory easier to use. Because scientist-practitioners like to

mates our current view of

reality,

test

theory to see

if it

approxi-

the constructs should be easy to measure, or to use the

professional word, they should have operational definitions or be easily operationalized.

An

operational definition

“in terms that differ

is

a statement that describes

from the data

it is

meant

how the

to explain”

construct

(Maddi, 1996,

is

to be

p.

measured

486).

Take the notion of defense mechanisms. Eiow would you measure the presence or absence of a defense mechanism? For example,

nism causes some behavior

(say,

if

you were thinking

aggression), you’d

want

to

that a defense

measure the

level

mecha-

of the defense

mechanism and then measure aggressive behavior. To rely on aggression as the measure of the defense mechanism is problematic because other constructs could possibly explain the occurrence of aggressive behavior (habit, situational cues, an angry personality type). Let’s

consider the Rational Emotive Behavior Therapy construct of rational belief Skip

quickly to Chapter 9 and read the section on defined? easily

fense tive,

How would you identify the presence of a rational or irrational belief?

measure whether an individual had rational or

Good

of rational belief clearly

beliefs. Is the idea

Could you

irrational beliefs?

theory generates predictions about behavior that are testable. For example,

mechanisms

you should be able

de-

are operative, aggressive behavior results. If distorted thoughts are ac-

then psychological distress

Another quality

if

results.

related to testability to

is

refutability

(Monte

& Sollod, 2003). In essence,

deduce what kind of information would lead

the theory. However, because a theory

is

refutable does not

mean

it

to disconfirmation of will

be abandoned

if

1

1

THEORY

8

TABLE

1

IS

GOOD THING

A

.

Disgredited Psyghologigal Treatments

Mean Rating(SD)

Treatment

Angel therapy

Percent Not Familiar

treatment of mental/behavioral disorders

4.98 (.14)

46.4

energy

4.98 (.13)

28.0

4.97 (.17)

16.9

Crystal healing for treatment of mental/behavioral disorders

4.95 (.21)

21.0

Past lives therapy for treatment of mental/behavioral disorders

4.92 (.27)

7.2

Future lives therapy for treatment of mental/behavioral disorders

4.88 (.33)

30.5

4.85 (.40)

20.5

4.75 (.46)

4.8

4.68 (.62)

50.6

4.61 (.72)

4.8

Use

of

for

pyramids

Orgone therapy

Treatments

for

for restoration of

for

treatment of mental/behavioral disorders

PTSD caused

by alien abduction

Rebirthing therapies for treatment of mental/behavioral disorders

Color therapy

for

treatment of mental/behavioral disorders

Primal scream therapy for treatment of mental/behavioral disorders Note:

SD = standard

deviation; percent not familiar indicates the proportion of participants in the poll

who were

unfamiliar

with the particular treatment.

from Norcross,

Source: Tests:

A

Delphi

J.

& Garofalo, A.

C., Koocher, G. R,

Poll. Professional Psychology:

Research

and Practice

disconfirming evidence emerges.

what

to discard a theory because

(Kuhn, 1970).

An

The

(2006). Discredited Psychological Treatments and

37, 5

1

5—522

(p.

518).

Adapted with permission.

history of science shows us that

constitutes

good evidence

interesting illustration of this

is

indeed

it is

difficult

often a topic of debate

phonemenon can be

seen in Norcross,

Koocher, and Garofalo’s (2006) report on discredited psychological treatments. In study, Norcross et ah, using a technique called to rate a set of psychological treatments

ings were

shows

made on

a scale

of

their top 10 results.

1

(not at

With

this

Delphi polling, asked a sample of experts

on the degree

all

this

to

which they were

discredited. Rat-

discredited) to 5 (certainly discredited). Table

1

.

evidence in mind, the issue of empirical validity will

be taken up more extensively in the next section.

Empirical Validity

A

good theory should have some empirical support (Maddi, 1996). From

practitioner perspective, this

One

theorist’s

(Haaga

& Davison,

Sigmund

a given.

(e.g.,

1989,

p.

The question

What constitutes empirical support?

nondirective discussion)

after the fact.

much

bias

another’s favorite treatment,

own

case descriptions,

These days, uncontrolled methods such

(Heppner, Kivlighan,

trolled case studies, in

is

502)

good empirical support because they

subject to

is.

Freud’s idea of empirical support was his

wrote mostly sidered

placebo

is

which

specific,

reflect

as these are

one person’s views and

which the

Over the

therapist faithfully

which he not con-

are therefore

& Wampold, 2007). More appropriate are con-

standardized measurements are

made

over the course

of counseling, and the interventions performed are well defined and verified tent to

a scientist-

(i.e.,

the ex-

performed the treatment

is

ascertained).

about what evidence

is

considered acceptable in

years, great debate has raged

terms of validating the psychotherapy enterprise. In 1952

Hans Eysenck

raised eyebrows

THEORY

and tempers

GOOD THING

A

IS

9

then-young profession of psychotherapy. Eysenck,

in the

which

to study the effects of psychotherapy,

a behaviorist, set out

time was roughly categorized

at that

as either

psychoanalytic or eclectic (note that behavioral methods were not considered in the “ther-

apy” grouping). Eysenck (1952) compared the rates of improvement of clients in the two

two groups of “untreated”

types of counseling to

individuals

who had made

and

individuals, state hospital patients

with their insurance companies on the basis of

disability claims

psychoneurosis. Over 2 years, the improvement rate for the untreated individuals was

72%.

64%

44%

found that only

In contrast, Eysenck

of clients in eclectic therapy improved.

and

of clients in psychoanalytic therapy

He

concluded that these data

“fail to

prove

that psychotherapy, Freudian or otherwise, facilitates the recovery of neurotic patients.

They show

that roughly two-thirds of a group of neurotic patients will recover or improve

marked extent within about two years of the onset of their illness, whether they treated by means of psychotherapy or not” (Eysenck, 1952, p. 322). to a

Of course,

this

kind of conclusion greatly disturbed professionals

Numerous

benefits of therapy.

recalculations of his data

and

about Eysenck’s original study was that

more was needed Over the test

to

the effects of psychotherapy, is

probably safe to say that the most useful thing

it

caused professionals to realize that something

back up their statements regarding the effectiveness of psychotherapy.

years since Eysenck’s article,

psychotherapy

huge numbers of studies have been conducted

and there

indeed effective (Lambert

is

Ogles (2004) conclude that “providers

when

offered

by

1952 challenge

nal

is

The

I

call

is

on psychotherapy outcome, Lambert and

and

can be assured that a broad range

stable therapists, are likely to result in ap-

sheer

amount of data gathered

overwhelming, but can generally be

meta-analytic studies, what

to

within the profession that

2004; Wampold, 2001). In what

as well as patients

skillful, wise,

preciable gains for the client (p. 180).

now agreement

& Ogles,

generally cited as the authoritative reference

of therapies,

Without summarizing

criticisms of his “control” groups. it is

believed in the

Eysenck were published that included various

rebuttals to

these sometimes tedious arguments,

who

are

classified

since the origiinto three sets;

“exemplar” outcome studies, and perhaps most contro-

consumer survey data (Seligman, 1995). Meta-analysis is a statistical technique that combines the

versial,

results

of a selected

ies

into an overall index of effectiveness, called effect size. Effect size

all

studies, the treatment being observed

treated

is

proaches. For example, the earliest meta-analyses effect sizes in the

Miller, 1980). client in

&

equal

0.75 to 0.80 range (Smith

&

80%

no treatment

to

Glass, 1977, Smith, Glass,

of clients

to,

who were

not treated is

at

and perhaps more powerful than, antidepressant medication (Gloaguen,

& Blackburn,

1998; Robinson, Berman, is

variety of client presentations

(Lambert

& Neimeyer,

a disappointing finding for

ious theoretical orientations have been repeatedly

call

&

compiled, the average

Ogles, 2004). Meta-analysis has also demonstrated that psychotherapy

brueck. Maxwell, &C Howard, 1983). In what

I

theoretical or treatment ap-

results indicate that across the research studies

Cottraux, Cuchherat,

What

us whether, across

compared counseling

psychotherapy improved more than about

(Lambert least

These

of stud-

associated with significant differences between

and untreated groups, or differences between two

and found

tells

set

& Ogles,

shown

1990; Stein-

some, the var-

to be equally effective

with

a

wide

2004; Wampold, 2001).

“exemplar” studies are those that are generally recognized as stringent

comparisons of psychotherapy groups

to

no treatment groups following the

best scientific

THEORY

10

They are

procedures.

also called efficacy studies

and

are based

on the

A

IS

GOOD THING

clinical trials

approach

adopted from pharmacy research. Efficacy studies involve random assignment of

partici-

pants (clients) to treatments, rigorous controls, carefully specified treatments, fixed

num-

bers of sessions offered to clients, narrowly defined entrance criteria (e.g., clients having

only one identified disorder), and independent raters to assess client dysfunction and im-

An

provement.

important feature of these kinds of studies

uals that detail the expectations for

what the

is

that they use treatment

Of the

therapist will do.

man-

exemplar studies

I

describe here, the National Institute of Mental Health Treatment of Depression Collaborative

Research Program

(TDCRP) and

the

trials (efficacy) studies;

the Project

MATCH

Temple study was not because

it

studies are true clinical

admitted

clients presenting a

wide range of concerns.

The Temple study

&

Whipple, 1975) compared short-term Psychoanalytically Oriented Therapy and Behavior Therapy with a minimal (Sloane, Staples, Cristol, Yorkston,

contact control group. Experienced therapists provided the treatments to 90 clients over a

4-month period who were randomly assigned

to

one of the three groups. Therapist adher-

ence to their approaches was assessed, and independent observers rated client outcomes, did the participating counselors and clients.

along with pre- and posttherapy

improved

treated groups

the

significantly

Critics of meta-analysis

and the

1-year follow-up assessment was included,

of symptoms. Across

tests

two therapeutic approaches were

A

as

more than

all

measures of outcomes, the

the control group. Differences betw'een

negligible.

exemplar research suggest that the problem in

early

finding differential effectiveness of counseling approaches can be attributed to ignoring significant client factors in these studies.

Such

diagnosis as exemplified in the Diagnostic

client factors are usually operationalized as

and

Statistical

Manual of Mental

Disorders,

Fourth Edition, (DSM-IV-TR, American Psychiatric Association, 2000). Perhaps specific approaches will work best for specific diagnoses.

A

second exemplar study adopted

philosophy, attempting to assess psychotherapy for depression.

Mental Health

CRP)

(NIMH)

Institute ol

Treatment of Depression Collaborative Research Program (TD-

focused solely on depression and compared psychotherapeutic treatment to antide-

pressant

and placebo groups. The antidepressant and placebo groups

management, which apparently amounted 1994,

The National

this

p.

135).

The two treatment

to

also received clinical

“minimally supportive therapy” (Elkin,

types were interpersonal psychotherapy, a variant of psy-

choanalytically oriented therapy (see

Box

1.1 lor

an overview), and cognitive behavioral

therapy (most similar to Beck’s Cognitive therapy; Chapter 10). Thus, clients were randomly assigned to one of lour treatment groups: interpersonal psychotherapy, cognitive-behavioral therapy, antidepressant plus clinical

Ten experienced sites across

bipolar,

management, or placebo plus

clinical

management.

therapists, carelully trained, administered the counseling at three research

the United States.

A total of 239

clients participated, exhibiting a range ol

non-

nonpsychotic depression.

Using multiple outcome measures, the study lound virtually no dillerences among

showed improvement lollowing treatment, even the placebo group. What remains unclear is whether the unexpected improvement in the placebo-clinical management group was a result ol the placebo pill or the clinical management. Thus, this study clearly supports the elfectiveness ol psychotherapeutic

the lour treatment groups. All groups

1

THEORY

A

IS

GOOD THING

1

Box

1

.

Klerman and Weissmans Interpersonal Psychotherapy

THEORY The

interpersonal psychotherapy (IPT) approach

apy that was developed

communications

for clients

theories

who

is

a present-oriented, short-term ther-

present with depression. Based in attachment and

and with recognition of the importance of

social factors in

everyday functioning, IPT includes a medical model of depression used to educate

but then focuses on current interpersonal issues

clients,

as the targets

of intervention.

Four Relationship Problems

IPT theory

identifies four basic interpersonal problems: grief, interpersonal role dis-

and interpersonal

putes, role transitions,

Chevron, 1984; Markovits

&

death of a person significant to the viduals disagree

another

is

ally struggling

Role disputes

relationship.

who

are

when two

are in the midst of a

major

of interpersonal

deficits or lack

these clients (Markowitz

IPT does not

the last-resort category.

indi-

is

are gener-

as divorce, retirement,

The interpersonal

It signifies

of relationships. Prognosis

& Swartz,

more

change

life

job change, or being diagnosed with a major physical illness. is

or

are distinguished: renegotiation,

with role transition, which includes events such

deficits category of problems

defined as the per-

is

Current overt or covert conflict with

Three general phases of role dispute

impasse, and dissolution. Clients

&

normal period of mourning following the

a

client.

on the nature of their

present.

(Klerman, Weissman, Rounsaville,

Swartz, 1997; Stuart, 2006). Grief

symptoms beyond

sistence of depressive

deficits

a

long-term pattern

considered to be poor for

1997).

present a causal theory of depression; depression

is

probably the result

many factors. Interpersonal problems can either cause or exacerbate depressed mood. What is important in IPT is that the client accept a conceptualization that her depresof

sion eas

is

linked to a specific area of interpersonal functioning, one of the four problem ar-

&

(Weismann

Markowitz, 1994).

THERAPY Two kinds of (DSM-IVTR) (Klerman

assessment are important in IPT. diagnosis.

et ah,

A

First,

the counselor confers a formal

complete medical evaluation of the

client

is

recommended

1984). Second, the counselor conducts an interpersonal inventory with

the client (Stuart, 2006). All of the important interpersonal relationships in the client’s life

are reviewed with the goal of establishing a link

these relationships

tic

is

is

one or more of

historical events. In this approach, the

an active problem solver and advocate for the

relationship

in

and the onset of the depression.

Counseling focuses on current problems, not therapist

between changes

used

Clients are expected to actively to solve their

as a vehicle for

become

client.

Although the therapeu-

change, no transference interpretations are used.

experts on depression

problems (Markowitz

&

and

to use this expertise to

Swartz, 1997).

work

1

THEORY

12

Conceptualized

as a

IPT

dowitz, 1994),

symptoms and

The

with the depression.

client

remedy the interpersonal

to

& Mar-

difficulties associated

and counselor must agree on the conceptualization of the

agreement promotes the therapeutic relationship and

this

and goals of the therapy (Markowitz

strategies

IPT

time-limited (12—16 weeks) weekly therapy (Weissman

has two basic interlocking goals (Klerman et ah, 1984): to reduce

the client’s depressive

problem;

GOOD THING

A

IS

has three stages (Klerman

& Swartz,

& Weissman,

also signals the

1997).

1993). In stage

1

(the first three sessions

or so), assessment, diagnosis, and conceptualization are the focus.

The medical model

conceptualization of depression

presented to clients, and they

is

are given the “sick role.” Clients are told that depression results

biological

that

and environmental

(i.e., life

making psychological dysfunction

overwhelming responsibility from

factors

clients’

cant because

it

relieves clients

1

from

commitment

to

Advocates of

events).

this

approach argue

partly biological in nature relieves clients of the

problems and allows separation of the problems

& Swartz,

sense of self (Markowitz

creates in clients a

Stage

for their

from the interaction of

1997). Adopting the sick role

and

significant social responsibilities

working

in therapy

(Weissman

also involves giving clients the conceptualization

signifi-

is

stressors,

but also

& Markowitz,

1998).

of their depression in one of

the four areas: role dispute, role transition, grief, and interpersonal deficits.

Only one of

these areas should be identified for each client. In stage 2, attention

(Markowitz

&

is

focused on the problem area that was identified in stage

Swartz, 1997). Counselors with grieving clients help

then support them in establishing role disputes

new

activities

and

attempt to help clients in role transition negotiate the

The

interpersonal deficits category

ing to Markowitz and Swartz (1997), because clients

tend to have

lots

it

is is

them mourn and

relationships. Clients experiencing

examine the nature of the dispute and devise ways

best outcomes.

1

life

the

to resolve

it.

Counselors

changes smoothly and to the

most

difficult to treat, accord-

basically a default category.

These

of interpersonal problems and very few supportive relationships.

Clients are encouraged to understand the connection between depression and social difficulties

and

to learn

Stage 3 of

IPT

is

new

termination and comprises the

and counselor discuss the tic relationship.

The

social skills.

client’s

& Swartz,

few sessions of therapy. Client

progress and acknowledge the ending of the therapeu-

potential for relapse

discussed (Markowitz

last

and

triggers that

might be associated with

it

are

1997).

TECHNIQUES IPT

is

basically an eclectic approach.

The

following seven categories of intervention are

presented; example of specific techniques within the categories are excerpted from Kler-

man, and colleagues (1984, pp. 142—153), which manual for IPT.

is

generally considered the treatment

Exploration: Nondirective exploration of the problem; supportive

Encouragement ofajfect: acceptance of painful emotion;

acknowledgement

facilitating

suppressed affect

Clarification: rephrasing; attending to contradictions

Communication

analysis: identifying

problems

in

communication such

understood; communicating ambiguously on nonverbal channels

as

assuming that one

is

— THEORY

GOOD THING

A

IS

13

Use of the therapeutic relationship: encouraging client to reveal thoughts and feelings about the therapist

and the therapeutic relationship; used

to help client learn

about other relationships

Behavior-change techniques: advice and suggestions; education; modeling Adjunctive techniques: forming a therapeutic contract

interventions, but also calls into question the specificity of these effects because the therapies did not

outperform the reference conditions (the drug and placebo groups).

MATCH

Project

represented yet another step in

search project was specifically designed to see effects for a specific

problem, in

outcome

research. This elaborate re-

if client characteristics

moderated treatment

dependence and abuse (Project

this case alcohol

MATCH

Research Group, 1997). In this very large and powerful study, over 1,500 clients received either cognitive behavioral treatment (12 sessions), motivational sions), or a

treatment designed to help clients begin to work on the Alcoholics

12 steps (12 sessions and clients were encouraged to attend acteristics (e.g.,

(4 ses-

Anonymous

AA meetings). Ten client char-

thought to predict client response to the type of treatment were carefully assessed

alcohol involvement, gender, motivation).

The

results

of Project

MATCH

were consistent with previous

differences in the effectiveness of the three treatments,

clients

and

studies.

virtually

no

There were no

effects

of client

fac-

Of the client characteristics, only one significant difference was apparent

were found.

tors

enhancement

who were

relatively

low

in psychological distress did better

approach than the others did. These differences were not evident Several other carefully conducted studies have

shown

in

with the 12-step

more

distressed clients.

similar outcomes.

One

of these

et al.s

(1999) study of treatments for cocaine dependence, in which

clients received individual

drug counseling plus group drug counseling (GDC), cognitive

was Crits-Cristoph therapy plus

GDC,

counseling conditions used nonprofessional counselors.

drug counseling produced the best

ual

results.

Shapiro

namic interpersonal and cognitive-behavior therapy approaches equivalent. Generally, then, the

results

GDC alone. The drug Surprisingly, GDC plus Individ-

CCD,

supportive-expressive therapy plus

et

or

(1994) compared psychody-

al.

and found the

depression

for

of exemplar studies tend to confirm

meta-analytic findings that there are no differences in the effectiveness of theoretically-

based treatments.

A

final,

and

been called the

controversial, approach to studying counseling ejfectiveness

ficacy or clinical trials

most famous ness

was

method (Seligman, 1995). The Consumer and

in fact, the distinction

was proposed by Seligman, who consulted with to assess the

community

in the

American

outcomes of counseling

man, 1995). Fixed numbers of

ment

involves

approach to emphasize the difference between

effectiveness study,

to the psychological

outcome

as it

sessions, strict

are serious distortions of

what

actually

is

Reports

this

and the

(CR) study

between efficacy and

CR on

the research

Psychologist.

The

what has

Is

ef-

the

effective-

and presented

intent of the

it

CR study

actually practiced in the real world (Selig-

adherence to manuals, and random assign-

happens when

real

people go to therapy.

THEORY

14

more than one

Further, clients usually have

DSM-IV

and the

diagnoses),

specific

problem (which they don’t present

and the counselor

client

GOOD THING

A

IS

are

concerned with overall

functioning, not just improvement in specific symptoms. This approach versial, for

does away with control groups,

it

hard-core scientific

stuff. Instead, effectiveness studies

riences using a large-scale survey

Imagine having

folks rate therapy the

did.

way

CR sent

als to

complete the section on mental health

stress

or emotional difficulties.

some kind

client

is

quite contro-

all

of that other

simply ask clients about their expe-

method.

what the Consumer Reports sindy

fessional help of

random assignments, and

as

they do washing machines. Actually,

that’s

out 180,000 surveys instructing individu-

if in

the past 3 years they had sought help for

A total of4,100 respondents reported having obtained proattended support groups, visited physicians or mental

(e.g.,

health professionals); of these, 2,900 reported having received the services of a mental health professional. Twenty-six specific questions explored the participants’ experiences

with counseling. Without getting too detailed, the efficacy studies

were perhaps right

—

results

the vast majority of the respondents reported improv-

The amount of improvement was

ing as a result of counseling.

of counseling. Most relevant for our study of theory was

approach was found

to be superior to

Even long before the

any

Dodo

have prizes”

Fiowever, this verdict

psychotherapy research (Ollendick support a movement to develop a ported treatments, or ESTs. cific

state

The

is

& King,

list

once again, no theoretical

trials,

and

effectiveness studies,

of psychotherapy outcome research by quot-

bird from Carroll’s Alice in Wonderland:

(p. 5).

that,

correlated with the length

other.

era of meta-analyses, clinical

Rosenzweig (1936/2002) captured the ing the

of this study suggested that the

'''

Everybody has

not fully accepted by 2006). In

fact, a large

of treatments that work

idea behind the

is

must

all

scholars involved in

group of psychologists

— known

EST movement

treatments that are efficacious for specific problems

all

won and

is

as empirically

sup-

that identifying spe-

the solution to the

Dodo

bird

dilemma.

The EST movement began

in Division 12

of the American Psychological Association

(APA), the Society of Clinical Psychology. Later, a special issue of the Journal of Consulting and Clinical Psychology was published presenting a review of literature in focused areas

with the intent of identifying ESTs. In the special ified psychological

treatments

shown

eated population” (Chambless

&

issue,

ESTs were defined

as “clearly spec-

to be efficacious in controlled research with a delin-

meant

Fiollon, 1998, p. 8). This provision

that the

treatments considered had to be assessed within an efficacy design, specifically a randomized clinical trial study. If two

independent research teams demonstrated that the treatment

was better than no treatment, the treatment was labeled considered ejficacious

and specific

for a given population or

ejficacious.

problem

if

A it

treatment was

produced better

outcomes when compared

to “conditions that control for nonspecific processes” (e.g.,

client expectation or effects

of attention ol an interested other,

p. 8)

or other recognized

treatment approaches. It is

ples

not possible to summarize the results of the entire special issue here.

Some exam-

of the approaches labeled efficacious include Cognitive Therapy for panic disorder and

depression. Exposure

Therapy

for

agoraphobia and obsessive-compulsive disorder

(this

with response prevention), and Cognitive-Behavior Therapy for generalized anxiety disorder (Crits-Cristoph, 1997; DeRubeis

& Crits-Christoph,

1998). Very few approaches were

THEORY

IS

A

GOOD THING

labeled efficacious

and

specific

and

disorder. Efficacious

15

—

that

specific

is,

comparison approaches

better than

for a given

approaches include Cognitive Therapy for generalized

anxiety disorder and panic disorder, exposure plus response prevention for obsessive-

compulsive disorder, and Exposure Therapy for agoraphobia. However, DeRubeis and Crits-Christoph point out that the conclusion that Cognitive Therapy pression relative to other psychological treatments light

of results found

in

behavioral approaches

quirement

(i.e.,

for clinical trials

cific effects

One

the grounds that

(i.e.,

is

Oppo-

biased toward cognitive and

issues are

still

of the bottom line issues

acceptable?

The

strict.

we

to

Various political,

debated heatedly (Norcross, Beutler,

that if we conclude that there are

is

tell

re-

Others reiterated the criticisms

clinical trials don’t represent reality).

of psychotherapy, what are

kind of therapy

it is

in

NIMH TDCRP study.

controversy within professional psychology.

methodology was too

and methodological

Eevant, 2006).

as the

those approaches that are easily manualized) and that the

elaborated by Seligman (1995) philosophical,

specific for de-

probably premature, particularly

is

such careful and powerful studies

The EST movement set off a major nents of the movement criticize it on

is

managed

no

care organizations about

&

spe-

what

who pay for the treatthan we do) free to deter-

lack of such a stance leaves those

ment (and presumably have less knowledge about its intricacies mine the treatment clients receive based on other factors (e.g., length, cost; Beutler, 1998). A different way of looking at empirically supported interventions was proposed by Division 17, the Society of Counseling Psychology (SCP) of the American Psychological Association (Wampold, Eichtenberg, chologist, the division’s Special

& Waehler, 2002). In an issue of The Counseling Psy-

Task Group presented seven principles by which research

concerned with empirical support for interventions could be reviewed; these are shown figure 1.1. In the seling

outcome

apply

at

each

first

principle, the task

research

level.

group proposed four

levels

in

of specificity in coun-

and suggested that the credential “empirically supported” could

Level

1

is

the most general level, the level of types of actions such as

prevention, psychotherapy, and classroom intervention. Level 2 of this system includes

major approaches to

level

1

activities,

tive-behavior therapy. Level 3

is

such

as

group therapy, career exploration, or cogni-

the level of the Division 12 empirically supported treat-

ment, the application of major approaches

(as

in

level

2)

to

specific

problems or

populations. Level 4 interventions are specific approaches (from within the major modalities

1

.

2.

or approaches) to specific populations or problems.

Level of specificity should be considered

when

An example of this

level

would be

evaluating outcomes.

Level of specificity should not be restricted to diagnosis.

needs to be examined in its entirety and aggregated appropriately. Evidence for absolute and relative efficacy needs to be presented. Causal attributions for specific ingredients should be made only the evidence is

3. Scientific evidence

4. 5.

if

persuasive. 6. 7.

Outcomes should be assessed Outcomes should be assessed

FIGURE

1.1

appropriately and broadly. locally

and freedom

of

choice should be recognized.

Society of Counseling Psychology’s Principles of Empiricall Supported

Interventions. Source:

Wampold,

B. E. Eichtenberg,

J.

W, &

Waehler, C. A. (2002). Principles of empirically support:

Intervention in counselling psychology. The Counseling Psychologist, 30, 197-217.

THEORY

16

Characteristic

The SCP

DSM-IV

A

Program

“well-specified Prevention

C” (Wampold

A

IS

GOOD THING

Risk Factor B and Cultural

for persons with

205).

et ah, p.

task force argued that level of specificity should not be defined solely

diagnosis because

client or treatment effects.

many

other dimensions are meaningful in understanding the

For example, differences attributable to individual and cultural

diversity are not considered in the original client characteristics.

A

by

EST

approach, nor are client values or other

important point the task force made was that outcomes

final

should be assessed globally rather than simply in terms of symptom remission, the usual practice in clinical trials studies. Clients ity

of

have

life,

too.

Many

come

people

and counselors,

as

noted

1

earlier, care

about qual-

to counseling for that basic reason, not because they

symptoms.

specific, identifiable

What does this new perspective mean in terms of understanding the empirical support for what we do? Basically, it means that there are different ways of cutting the pie, so to speak. These principles were demonstrated

in three articles in the

&

anger management (Deffenbacher, Getting,

2002; Whiston, 2002). Each

light

issue

of The Counseling Psy-

reviewed empirical support for career counseling, family interventions, and

chologist that

levels

same

of specificity,

of the other

six principles.

&

Alexander,

reviewed the evidence for the intervention on

article

if appropriate.

DiGiuseppe, 2002; Sexton

Each

article also

all

four

considered available research evidence in

These reviews produced

a

broad and informative stack of in-

formation and also highlighted the strengths and weaknesses of the existing research.

A second perspective on the Dodo bird verdict serving the similarities

among

among outcomes

is

called the

approach.

Ob-

has led to the proposal that there are commonalties

curative factors (Lambert

therapies that are the

common

& Ogles,

2004). Lambert and

common factors shown in Table 1.2, and opined factors common across therapies still loom large as 163). One of the most often cited common factors

Ogles (2004) proposed the taxonomy of that “interpersonal, social,

and

affective

stimulators of patient improvement” is

(p.

the therapeutic relationship or alliance. Estimates of the effect of the therapeutic relation-

ship range

up

to

30% of the variance in client outcomes

(Asay

& Lambert,

1999).

Warnpold

(2001) maintained that the therapeutic relationship “accounts for dramatically more of the variability in

outcomes”

(p.

158) than do any specific factors offered based on theoretical ap-

proaches. For example, in the

TDCRP study,

alliance

accounted for up to

ance in outcomes, whereas differences in treatments

(e.g.,

cognitive-behavior therapy, placebo, drug) accounted for only

Other

common

factors that have

been proposed are

that are acceptable to client

and counselor

(Fischer,

Jome,

of the

vari-

interpersonal psychotherapy,

2%.

(a) client

similar views of the world, (b) positive client expectations,

21%

and

and counselor sharing

(c) rituals

& Atkinson,

or interventions

1998). Fischer and

colleagues (1998) suggested that our understanding of counseling relationships between diverse individuals

(i.e.,

as sex, race, ethnicity)

when

client

and counselor

could be understood using a

differ

common

ample, the counselor’s possession of knowledge about the shared worldview, which

may

on

significant

dimensions such

factors perspective. For ex-

client’s culture aids in

in turn contribute to the therapeutic alliance

building

and allow the

counselor and client to formulate culturally appropriate rituals or interventions. Under-

standing the culture of the client

may

also boost client expectations

(hope and

faith)

by

giving the counselor credibility in the eyes of the client. In

summary, the research on counseling and counseling theory suggests

approaches can be taken to helping

clients

grow or

alleviate troubles that

that

many

bring them to

THEORY

IS

A

GOOD THING

17

TABLE

1.2

Common

Lambert and Ogle’s

Factors

Support Factors

Learning Factors

Catharsis

Advice

Behavioral regulation

Identification with therapist

Affective experiencing

Cognitive mastery

Mitigation of isolation

Assimilating problematic

Encouragement

Action Factors

of facing fears

experiences Positive relationship

Cognitive learning

Taking risks

Reassurance

Corrective emotional

Mastery

efforts

experience

Feedback

Modeling

Structure

Insight

Practice

Therapeutic alliance

Rationale

Reality testing

Therapist/client active participation

Exploration of internal

Success experience

Release

of tension

frame

of reference

Changing expectation

Therapist expertness

Working through

of personal effectiveness

Therapist warmth, respect, empathy

acceptance, genuineness Trust Source: Lambert,

Bergin

and

M.

Garfield’s

J.,

& Ogles,

Handbook

M.

B.

(2004).

ofi Psychotherapy

The efficacy and effectiveness of psychotherapy. In M. J. Lambert (Ed.) and Behavior Change, 5th Ed. (pp. 139-193). NY: John Wiley and Sons.

Used by permission.

therapy.

As

I

describe each theoretical viewpoint in this book,

research relevant to the approach.

I

will also provide a

summary of

We will return to the issue of empirical validity in Chapter

1

6.

Parsimony The

principle of parsimony or simplicity (Maddi, 1996) says just that:

nation that can handle the data

one very simple, that

are

both

is

simplest expla-

the best. If comparing two theories, one elaborate

effective,

and

then choose the simple one. Sounds good, right?

Well, there are a few problems with taking such an approach. that say what’s simple

and what’s not? Second, what

morrow

A more complex

or next week.

The

theory

may

is

First,

simple today

be just

who makes the rules may be simplistic to-

right.

Stimulation Good ing,

theories get people excited (Maddi, 1996).

and

research.

Good

The

best theories

theory can also provoke attempts to disconfirm

whether theories can actually be disconfirmed

is

a subject of debate.

about approaches that become “fadlike” and the devotees who, be the best

critics

of their

prompt thought, it,

although

One wonders,

like worshipers,

writ-

though,

may

not

book

are

faiths.

Practicality Practicality implies applicability. For practical;

I

our purposes,

all

of the approaches in

this

chose them because they provide solid conceptual frameworks that are well-known

for their applicability.

Some roadmaps

are easier to use than others,

and

I

will

note that the

THEORY

18

approaches presented to

book vary

in this

which an approach lends

to

some degree on

A

IS

GOOD THING degree

this criterion. Also, the

problems and other modes of counseling

itself to particular

varies considerably.

HOW DO CHOOSE A THEORY?

SO Well, to

I

you have

start,

Once you have

know some

to

theories. That’s

why we

the basics of the major theories, perhaps

you

have books about theory.

will be a step farther

down

the path.

Will you choose based on the “good theory”

an obligation,

is

The (or

not yet

this

Consider Table

book.

Why do

arises.

more) of the major ones? In

The

we have

which we will do

for each

controversy over empirically supported treat-

1.3,

fact,

I

have to pick a theory? Can’t

many

therapists

which shows the

do

this; it

orientation

is

exception

Jensen

eclectic,

30—40%

with about

et ah,

who

TABLE

their

several

a theoretical stance called

found

in six studies

appears that the most popular

it

of the respondents choosing

70%. However,

cited

is

issues.

borrow from

I

theoretical orientations

conducted between 1982 and 2001. Based on these data,

is

scientist— practitioners,

prudent professionals should be conversant with these

settled, so

question always

eclecticism.

As

think, to consider the empirical merits of a theory,

I

of the theories presented in

ments

criteria?

sample

size v/as

this option.

much

The

smaller than

1.3

Theoretical Orientations Over the Years 1982

^

1983 ^

1986 ^

1990 ^

2001

^

2001

^

2003 ^

Eclectic

41

30

40

70

39

36

29

Cognitive

10

8

11

5

21

16

28

Psychodynamic

11

18

10

9

10

21

15

9

8

5

2

7

5

7

Systems

N/A

3

5

3

5

3

3

Interpersonal/Sullivan

N/A

1

2

1

5

3

4

Other

Behavioral

7

6

6

8

4

3

10

Existential

2

4

3

0

3

1

N/A

Person Centered

9

2

8

1

2

2

1

N/A

4

4

1

2

2

1

2

3

2

0

2

2

N/A

N/A

9

2

N/A

1

8

N/A

3

2

2

0

1

N/A

N/A

Humanistic Gestalt

Psychoanalytic Adlerian

N/A means '

^

not assessed.

Smith, 1982;

N—

422, 1/2 Division 12 (Clinical Psychology),

Prochaska &: Norcross, 1983;

Watkins

et ah,

“^Jensen, Bergin,

1986,

&

Murdock, 2001;

Norcross,

Ml

Division 17 (Counseling Psychology)

410, Division 29 (Psychotherapy)

716; Division 17

Greaves, 1990;

N=

N=

122, Division 12

members

691, Division 17 members

& Castle, 2001; N= Karpiak, & Santoro (2005)

Norcross, Hedges, ’’

N=

N=

538, Division 29

I

HEORY

IS

A

GOOD THING

19

those in the other studies, so the higher percentage ple.

This kind of research

me draw

40%

is

be an anomaly related to the sam-

usually cited as evidence that therapists are mostly eclectics. Let

is

your attention to two

less

may

issues. First,

than half of a sample. Over

who

Second, studies of those

even

if

we

consider the high end of the range,

60% of these therapists endorsed a single orientation.

endorse an eclectic orientation suggest that eclectics do

from among the major theoretical approaches. In

identify with particular orientations

Jensen and colleagues’ sample of clinical psychologists,

63%

and

62%

of the eclectics said

they were cognitive or psychodynamic, respectively (they were allowed to choose more

than one approach). Fifty-six percent indicated a behavioral orientation. In

(Murdock

search

choices of orientations. ical

orientation,

15%

we asked

2001),

et ah,

Individuals to identify their

Of the participants who

first

my own

re-

and second

specified eclectic as their primary theoret-

did not specify a second theoretical influence.

Of the 85% who

did

most frequent response was cognitive (39%). Other respondents indicated psychodynamic, systems, and humanistic, ranging from 9% to 12% of the indicate a second theory, the

sample of eclectics. The

proportion of these eclectics (more than

largest

ized themselves as synthetic eclectics, indicating that they integrated ical

approaches.

An

interesting sidelight to this study

therapist chooses for a therapist (see

Box

83%)

character-

two or more theoret-

was our exploration of who the

1.2 for the results).

Box

1.2

Do

Counselors Seek Counseling? With Whom? Some Revelant Data Beginning with Freud, personal therapy has been thought to be important

opment of

counselors.

Whether

for

in the devel-

growth or remediation, mental health professions

have long encouraged counselors and therapists to undertake personal therapy (Ameri-

can Psychological Association, 1992; Geller, Norcross,

& Missar,

Strausser-Kirtland,

&

Orlinsky, 2005; Norcross,

1988). Various studies have looked at the kinds of personal

problems experienced by psychologists, but few have examined their perceptions of their

&

psychotherapy (Good, Thoreson, Tabachnick, 1994).

mel (1986),

An

Shaughnessy, 1995; Mahoney, 1997; Pope

exception was a study by Watkins, Lopez, Campbell, and

who found

that

their counselors’ orientations

66%

most often

Guy

which on average found in personal therapy. likely to

fell

into the category labeled “other,”

among

by

re-

(2005) surveyed the surveys on therapists’ therapies,

72%

also

as “eclectic”

of therapists

in the

United States report having been

found that insight-oriented psychotherapists were more

my

colleagues

and

I

surveyed Counseling Psychologists, asking,

other things, about their experiences with personal counseling (Goodyear et ah,

in press; fied

They

was not identified

which the

have had personal counseling than were therapists of other orientations.

2001 study,

In a

that

Him-

of their sample had engaged in personal counseling;

researchers defined as a mixture of approaches that

spondents. Norcross and

&

Murdock 2001).

themselves

as

We

sent questionnaires to 1,500

APA members who

identi-

Counseling Psychologists; 691 returned surveys. These Counseling

THEORY

20

employed

Psychologists were

in a

wide variety of

settings (e.g.,

IS

GOOD THING

A

independent practice,

university counseling centers, academic faculty positions).

84.5%, reported having been

In our sample, a large percentage of respondents,

sonal therapy. This percentage

comparable to or higher than those reported

is

in per-

in previ-

ous surveys.

We

found that participants who

have engaged in personal counseling than those

likely to (e.g.,

self-identified as “clinical practitioners”

researcher, administrator, academician, supervisor).

and

oretical orientations

work of a

their perceptions

who

identified in other

the-

of the importance of personal counseling to the to those of Norcross

and

col-

endorsed psychodynamic theoretical orientations were the most

have sought personal counseling (97%), followed by humanistic/existential types

likely to

(93%). Behaviorally oriented psychologists were (71%). Psychodynamic respondents

also

least likely to

have undergone therapy

thought that personal counseling was more impor-

tant than did respondents of other theoretical orientations (cognitive therapists est

ways

We looked at participants’

Our respondents were very similar

psychotherapist.

leagues in that those

who

were more

importance

Table

ratings).

A

shows the

had the low-

theoretical orientations of the therapists’

demonstrating that the most popular orientation was psychodynamic or

therapists,

eclectic.

When we compared the theoretical orientations of respondents to those of their counselors, we found that 32% of our respondents had counselors of the same or similar theoretical oriHowever, we found no relationships between a match of theoretical orientations

entations.

and reported

satisfaction

with counseling.

TABLE A Theoretical Orientations of Counselors’ Counselors Percent of Respondents

Orientation

Psychodynamic

24.5

Eclectic

20.1

Humanistic

9.9 -

Cognitive

8.3

Systems

So will

why

work

hasn’t eclecticism taken over the profession? Certainly the idea

best for the client

data,

my hunch

general theoretical

behavior therapy.

domain

A

function, or

do you

when? These

are

it is

is

that eclectics

—

.

.

.

which

borrow from

is,

do you borrow from?

and

ideas about

same

rational emotive

how human

how do you know which

beings

technique to use

questions, particularly for a beginning therapist. I’d also note

difficult to scientifically test eclecticism

because by definition the counselor does

different things with different clients at different times.

would make me

theories

bandwagon. For one

several approaches within the

do you borrow

techniques? If so,

some tough

is

the eclecticism

for example. Beck’s cognitive therapy

second question steal

of doing what

an attractive one. Several factors probably account for the

hard to say exactly what eclecticism

it is

From our

that

is

we have not overwhelmingly jumped on

fact that

thing,

7.1

a little nervous.

I

don’t

know about

you, but that

THEORY

IS

GOOD THING

A

So, whether

you turn out

major approaches

know

21

and psychotherapy

to counseling

the approaches

are

wondering how you

and which

effective,

need

to

ME?

fit

into the picture.

want

just

approach that

to find an

to

choose one

& Schultz,

at

seem

quite a few approaches

random. of therapists’ choices of

to others. Studies

document

theories are rare; those that are available

When

who

relationship between

consistent with your assumptions about people,

is

your values, and your preferred way of relating

theoretical orientation

What is the

approach you choose?

theoretical

you probably don’t

You need

Herron,

eclectics

of this argument about science, empirically supported treatments and so on, you

all

are probably

you

Even

essential.

is

the

from which they borrow.

WHAT ABOUT With

knowing

to be an eclectic or a single-theory proponent,

that personality style

(Murdock, Banta, Stromseth, Viene,

&

is

associated with

Brown; 1998; Tremblay,

1986). For example, Walton (1978) found that psychodynamic types

“perceive themselves as

complex and

serious.

RET

(now Rational Emotive

therapists

Behavior Therapy) maintain a diametrically opposed position, namely, simple and humorous”

(p.

392). Because different studies look at different characteristics,

fully integrate the results,

and

it is

probably risky to apply them

scribe a study of philosophical assumptions

students and

I

your theory (and

needs to

it

fit

is

Box 1.3, I dethat some of my

directly. In

and personality characteristics

did to give you an example. However, what

difficult to

it is

clear

is

that

you need

to

fit

you).

Philosophical assumptions about people are also involved with theory choice, as you

can see from the study described in Box

1.3.

mensions identified by Coan (1979), you

Although you might not want

will

still

want

to consider the assumptions

by different theories about the nature of human beings. To help you with I

to use the di-

this assessment,

have incorporated a section on basic philosophy for each of the theories

this

made

I

describe in

book.

The way we

relate to others

study suggested, the

of theory. Activity

is

core in

way we choose

level

is

also

to relate to others

I

is

would

require

As our

ourselves as counselors.

probably connected to our choice

an important consideration;

never be a psychoanalyst because that

metaphorically).

how we conduct

me

to

as

I

my

tell

sit still

students,

too long

prefer an active approach to helping. For this reason,

I

am

I

could

(literally

and

a family sys-

tems theorist and therapist.

You may also want factor.

living

Although doing

I

present classic psychoanalysis in this book, not

classic analysis exclusively. Psychoanalysis requires a

to engage in therapy for long periods of time.

don’t have a trust fund,

you might want

HOW TO The problem with theory less.

is

that

if you

These

see the connection

comes

clients are

door asking

engage in

many

as

therapists

another

make

a

very special kind of client

few and

far

between.

If you

USE THEORY

don’t

know how

for help.

It is

to

apply

came from

between the theory and what you see

in the

to

to consider a different orientation.

That’s probably where the ivory tower thing

actually

you plan

to consider the type of practice that

my

—

it, it

it is

seems sort of worth-

sometimes

as the “real”

difficult to

world, the client

who

mission in this book to help you learn

THEORY

22

Box

IS

A

GOOD THING

1.3

Joining a Theoretical Club Some

years ago (after gaining

gan to wonder about what

some experience

really

determined

a

study to try to find out.

some students

in graduate

therapists’ choices

of counseling),

We

surveyed more than

1

00

therapists

and counselors,

programs, and some professionals working in the

which they endorsed

1979 model) and

(b) their

a set of philosophical assumptions (derived

field. (a)

theoretical orientations of our respondents

the de-

from Coan’s

affiliation (friendly— hostile).

fell

into five broad groups: psycho-

analytic, cognitive/cognitive-behavior, systems/interpersonal, person-centered,

tential/Gestalt. Here’s

We

perceptions of their interpersonal behavior on the dimensions

of interpersonal control (dominant-submissive) and

The

be-

of theoretical orientation.

asked these therapists to identify their theoretical orientations and then to rate gree to

I

might be an interesting research question, so we devel-

Several students agreed that this

oped

in teaching theories

how our

five

indicating their relative placement

groups

fell

and

out, with the location of their

names

on the dimensions:

Philosophical Assumptions Emphasis on Behavioral Content

Emphasis on Experiential Content

Cognitive/Cognitive behavioral

Psychoanalytic

Systems/Interpersonal

Person-centered >

Existential/Gestalt

Elemental Emphasis

Holistic

Psychoanalytic

Person-centered

Systems/Interpersonal

Existential/Gestalt

Emphasis

Cognitive/Cognitive behavioral

Emphasis on Physical Causation

Emphasis on Psychological Causation

Systems/Interpersonal

Existential/Gestalt

Cognitive/Cognitive-behavioral

Psychoanalytic

Person-centered Interpersonal Behavior: Interpersonal

Dominance

High

Low

Psychoanalytic

Existential/Gestalt

Person-centered Systems/Interpersonal Cognitive/Cognitive behavioral

exis-

THEORY

GOOD THING

A

IS

to actually use theory

vidual counseling

and

23

through applying

to individuals.

I

limit

my

presentation to indi-

and psychotherapy (with the exception of the family systems chapter) of each theory to a

will illustrate the application

ample of the application a start

it

process. Before

you go on

on the application process by providing

This method gives you an ex-

client.

to the theories,

a general

I

think

can give you

I

model of case conceptualization,

or the application of theory to the individual client.

A

Step-by-Step Guide

In the interest of helping

how

scribes

to

do

this.

you

My

learn

now

present one

a series of questions to

model

that de-

answer within three

you answer these questions, the application process

Know Your Theory

1:

fully

1.

If

I

be easier and more accurate.

Step To

to apply theory,

model presents

broad steps to conceptualization. will

how

understand your theoretical perspective, answer the following questions:

What

does the theory say

vary on are.

how

is

the primary or core motivation of human existence? Theories

explicitly they address this issue as well as

Psychoanalysis, for example, rests

on

on what the motivations

model of humans

a

stinctual forces. Behavior therapists are less vocal

on

as

this issue;

actually

driven by conflicting in-

humans

they see

moti-

as

vated to survive and adapt to the environment. 2.

3.

What are the major constructs of the theory? What is the process of development from the theory’s perspective (if it specifies one)? Some theories are very detailed in their descriptions of psychological development, such as Psychoanalysis. Others don’t have much to say about how people grow psychologically

(Solution-Focused Therapy) or offer somewhat vague, general statements about

A

(Person-Centered or Cognitive Therapy). in 4.

development,

What

is

is.

What

stages are key

any?

psychological health?

theory sees

An

if

useful question here

as healthy,

What

is

psychological dysfunction? If you can

you can probably deduce what

important point to note

juncture

at this

that

is

it

I

mean

the term in

its

broadest sense

—

like

part, are pretty blind to these differences.

everyone

else.

differences

among

who

created

sidered psychologically healthy 25 years ago

and so on. Theories,

family systems theory, the perspective

6. Relatively

say

for the

that everyone

may

them and

is

just

the times in which they were

from culture

to culture.

be important in any

speaking,

is

What was

con-

not be so today.

Who are the important individuals in a client’s life? Parents? Siblings? In to

I

people that are a func-

They generally assume

created. Definitions of psychological health vary

thought

When

Worse, theories are inherently biased because they are the products of

the cultural experience of the theorist

5.

what the

you must always take into account

tion of age, race or ethnicity, sex, sexual orientation, religion,

most

tell

sees as unhealthy.

the client’s cultural background in the theoretical conceptualization process. culture,

it

the case ol

Bowen

multigenerational. At least three generations are

client’s presentation.

how important

are behavior, cognition,

and

affect in the client’s situ-

ation? For the rational emotive behavior therapist, thoughts are the

most important aspect

THEORY

24 emotion

ot the person. For Gestalt therapists,

primary.

is

GOOD THING

A

IS

The behavior

therapist

most

is

interested in actions.

When

considering the behavior,

neglect any of the three ory.

What am

components because they

trying to emphasize here

I

and cognition

affect,

are

all

triad,

would be

it

important to understanding

a the-

components can

that the relationships of these

is

mistake to

a

help to define a given theoretical approach.

Step Two to

Know Your

2:

sorts

of information are

Client The

critical here.

understanding the person, such

as

first is

demographics

general information that

things such as family composition, current living situation,

you ask about the

tive therapist,

at the individual’s

client’s

is

essential

(age, sex, race or ethnicity, sexual ori-

entation, ableness, religion, or other cultural information).

The second kind of information you want

is

You probably want and physical health.

to

theoretically oriented. If you are a

know

Cogni-

thoughts. If you are a Reality therapist, you look

current relationships and the relative satisfaction of the other important

needs specified by that theory.

Some

theoretical approaches

seem

stance, the Gestalt therapist doesn’t

perience with the client.

to

deny

want

know

to

kind of information seeking. For

this

“stuff”; she or

propose that even though therapists

I

he wants to have an ex-

may

not seem to actively

search for information in the form of questioning, they are gathering Gestalt therapist

is

in-

it

nonetheless.

The

looking for “holes” in the personality, areas where experience

is

blocked. Person-centered therapists are looking for areas of clients’ experience that do not fit

my opinion,

with their views of themselves. In

it is

wise to acknowledge and

make

ex-

plicit this search.

Step

Now

3:

Put

you have

It

to

fit

Together the knowledge

you have

together, carefully. This step

translating the client’s presentation into the terms of the theory. Fiere

is

is

a process of

another helpful

question: 7.

Does the

client’s

presenting problem

functioning? Sometimes the apist is

fit

with stormy relationships.

fit

with the views of the theory about psychological

seems perfect. The client comes to the interpersonal ther-

The

individual psychology counselor gets the client

who

very insecure.

When

the pieces don’t seem to

fit

well,

you

really struggle. Clients don’t usually

to counseling speaking in theoretical terms. Client

Janey comes to the rational emotive

behavior therapist talking about problems with relationships.

have irrational

beliefs!

will realize that

Fdowever,

your job

is

if

you take

to figure out

a step back,

how

come

and

Oh

really

no. She’s supposed to

know your

theory,

you

these relationship problems are driven by

ir-

The psychoanalyst’s client wants to be more assertive. The analyst does not immediately morph into a behavior therapist. Instead, she thinks about what lack of

rational thinking.

assertion

means

in a psychoanalytic

ships that probably stems

from

framework (something about discomfort

early trauma).

in relation-

THEORY

A

IS

GOOD THING

25

In rare cases, the conflict between the client’s presentation tion of the therapist a different culture

not resolvable. Often,

is

(and again,

I

mean

this situation arises

term

this

in

lack of differentiation to differentiate,

how

about

The

from

problems

therapist

A

I’d

Chinese

see the client’s

because these efforts

individuals relate to parents

of serious mismatch.

because the client

from

is

comes

client

problem

as

Bowen

to a

stemming from

a

family of origin. If the therapist works to get the client

his' in

arise

may

theoretical orienta-

broadest sense) than that from which

its

the theory sprung. Consider this simple example:

family systems therapist.

and the

suggest, as

I

may be

in conflict

and other family members.

did

earlier, that

with Chinese norms

If

you run into

a case

you consult with your supervisor

as a

first step.

HOW THEORY Now

you know the

that

PRESENTED

IS

major approaches

ture for presenting the

know why

BOOK

being a theoretical scientist practitioner,

issues involved in

time to proceed to the theories themselves.

IN THIS

will close this chapter

I

to counseling that

I

my struc-

by explaining

(If you

have chosen.

it is

want

to

chose these, see the Preface.)

I

A Case Study Each chapter begins with clients or

a case study.

Most

clients has

begin with an actual client case because

not just read

it.

my

In

mind, theory

is

tion or heading so that

you can

chosen to use different

clients in

to

former

see

how

I

been changed.

my interest

meant

veloped in an ivory tower. In each chapter

more

my

on

modified from case studies offered by students and helpful professionals. Infor-

mation that could potentially identify the I

are actual clients, either based

is

in teaching

how

to apply theory,

on the ground, even

to be used

if it

was de-

apply the theory immediately after a major sec-

the theory works for the individual client.

I

have

each chapter, partly to keep you from getting bored, but

emphasize the diversity and complexity that you

will face in

your profession.

Background For each theory, theory,

and

websites).

look cases

a

present relevant background information, historical aspects of the

few places you can go to get current information on the approach (mostly

One

at the life I

I

of the more interesting parts of reading background sections, of the person

who

I

think,

developed the theory in relation to the theory. In

is

to

many

provide relevant information about the major proponent of an approach.

Basic Philosophy I

have attempted to capture the view of human nature underlying the approach

tion.

I

believe that

tant basis

'

examining how

from which

Concern about

to start

a theorist or theory views

human

existence

is

in this sec-

an impor-

your exploration of the theory.

sex bias in language leads

me

to the following solution

theory chapters, pronouns match the sex of client and counselor;

feminine pronouns are alternated randomly.

in

about singular pronouns:

Chapters

I

in the

and 16 masculine and

THEORY

26

A

IS

GOOD THING

Human Motivation A very basic quality of a theory is found in man

Sometimes these

behavior.

its

assumptions about the primary motives of hu-

are explicit in the theory; at other times

I

had

to infer

them.

Central Constructs To understand any presents.

theoretical approach,

These constructs

function and

you need

to

understand the central constructs

it

about health and dys-

are essential to the theory’s predictions

into the developmental progression (if any) proposed in the theory.

tie

Theory of the Person and Development of the Individual Many

theories propose a developmental sequence that

havior of the individual. In this section

proposes them

—and some

I

understanding the be-

critical to

is

outline developmental concepts

if

the theorist

don’t.

Health and Dysfunction To help your well as

how

dysfunction

prone to looking tics

is

theory’s ideas

conceptualized. Because

I

am

a counseling psychologist,

of the healthy person from a theoretical perspective

health

and strength

No

pathology or a

matter

now

that

number of other

of seeing folks

how

distressed

your

I

terms.

clients,

is

one way of honoring the

you

will find

some

aspects of

I

do

this for

two reasons. The

to

first relates

Some

are

more on

latter

approaches tend to see dysfunction

I

pre-

the “disorder” end

of the continuum; others simply refuse to use a medical model that conceptualizes

These

my dis-

than emphasizing strengths. Second, the theories

as “sick” rather

as disease.

am

choose the term dysfunction rather than mental disorder or

sent disagree wildly about the nature of dysfunction.

problems

I

as

them.

in

You’ve noticed by

about healthy individuals

an individual’s strengths; emphasizing the nature and characteris-

first at

strengths of a client.

like

you must understand the

clients,

human

as faulty learning,

complaints, or even normal reactions to oppressive environmental conditions.

Nature of Therapy This section

in

each chapter has subsections in which

goes in the approach.

I

attempt to describe

the therapy, including the expectations for the length of counseling

lationship (roles)

therapy

describe assessment, the general atmosphere, and assumptions ol

I

of the counselor. Next,

how

I

and the

activity level

outline the expectations of the participants in the therapeutic re-

and then,

finally,

the goals of the counseling enterprise based in the the-

oretical approach.

Assessment. In this section

informal.

Some

I

attempt to describe two approaches to assessment, formal and

theories use both kinds; others, only one.

ualized kinds of procedures, such as giving tests

structured techniques

(e.g.,

(e.g.,

When

I

say formal,

I

mean

rit-

the Rorschach) or administering

Adlerian early recollections). Informal assessment means

things such as talking with the client or simply observing the client’s behavior during the

counseling session.

THEORY

GOOD THING

A

IS

27

Overview of the Therapeutic Atmosphere. Here I describe the general tenor of the counseling sessions. Issues such as structure of sessions, general approach to the client, and the expected length of therapy are included.

of the Client and Counselor. In many cases, the theory specifies distinct roles for the therapist and client. Some are more “medical” in nature, such as in psychoanalysis, in Roles

which the doctor-patient model between

client

evident.

Other theories

specify egalitarian relationships

and counselor.

The map of your

Goals.

is

theory helps you to determine your destination in terms of its def-

inition of the healthy person.

Process of Therapy In this section

I

attempt to describe any

an approach. Sometimes

this section includes

now

are right

—

you’ll get to

propose stages of counseling. Generally,

from theory

or stages associated with

information on the theory’s conceptualiza-

and countertransference

tion of resistance, transference,

what these

critical events, processes,

worry

(don’t

if

you

don’t

know

them in the next chapter). Theorists sometimes what you see in this section will vary somewhat

to theory.

Therapeutic Techniques After a general introduction, various techniques associated with the theory are presented.

Evaeuation of the Theory I

number of dimensions upon which to evaluate the theories I present. First, general summary of critiques of the approach that are found in the literature.

chose a

vide a

Qualities ofthe Theory. Following this general

on two of the

qualities

of good theory described

and empirical support.

I

work?

What

two

I

review the research that

categories. First,

I

is

kind of outcome research

provement does not mean that

how

1

seem

like a

chose approaches

its

relevant to the theory.

is

Next

available?

explanations of

approaches produce change

Issues of Individual Theories are often, and quite to be ethical counselors,

is

I

chose to

how

as

that

important

I

focus on studies that po-

an approach produces client im-

happens

one way of furthering our knowledge about psychotherapy

standing

doesn’t

review the outcome research on the approach.

tentially test the theory’s explanatory power. Just because

that

it

on these dimensions.

divide the research into it

operationalization (or testability)

earlier,

and stimulation were neglected because

Research Support. In this section

Does

pro-

proceed to evaluate the approach

I

decided not to discuss parsimony because

useful criterion. Practicality

that have high values

summary,

I

as

is

are verifiable.

1

to test the process.

knowing

believe

Under-

that they do.

and Cultural Diversity

rightly, criticized for bias.

many forms, and understand how we could

This bias can take

we must examine approaches we

use to

THEORY

28

A

IS

GOOD THING

go wrong. Clearly, Caucasian individuals, mostly male heterosexuals, developed most

The

counseling theories.

backgrounds

of awareness of the theorists about individuals from other

level

from theory

varies

to theory.

The Case Study which

In this section,

tempt

to assess the

is

probably the

least consistent in

between theory and

fit

terms of what

is

included,

client case presented in the broadest sense. If

some

things were difficult to conceptualize from the theoretical perspective,

them.

If the process

tualization

is

was

easy,

I

not an easy

task.

There

say that too.

from the

struggle to understand

at-

I

One

thing for sure

are almost always

is

going to be

I

describe

that

doing case concep-

bits

and pieces that you

theory’s viewpoint.

Summary To

close each chapter,

I

attempt to summarize the important aspects of the theory, the

rel-

evant research, and the criticisms of the approach.

ANOTHER RESOURCE ON LEARNING TO USE THEORY As

I

made

have probably

of doing so can be

clear

difficult

by now, learning

and

trying.

To

further assist

another resource that should help, the video Theories in Action.

On your DVD, you’ll

Helen.

The

book:

Psychoanalytic,

to use theory

you

series that

is

important, but the process

in this process. I’ve

accompanies

this

find six counseling sessions with the

developed

book, called

same

client,

therapists are experts in six different theoretical orientations presented in the

Cognitive,

Family Systems Theory, Feminist, Narrative, and

Gestalt. After each session, the therapists

and

I

discuss

what they did

in their sessions that

was particularly characteristic of their approaches, and what they would do with Helen the next counseling session. further help

you

to learn

It is

how

my hope that watching these experts work with

Helen

in

will

to apply theory.

CLOSING REMARKS As

I

close this chapter,

I

am remembering my own

struggles to find a theoretical

think that you will find something to offer in each of the approaches

when

I

was a neophyte counselor.

even longer to believe that counseling adventure, process. If I have

the rest of this

Visit

done

book

Chapter

1

I

I

was

It

took quite a while for

really using

my

me

I

to settle

theoretical approach.

present, as

where

good job, you should be

feeling

I

I

I

did

am, and

As you begin your

hope you appreciate the value of counseling theory

a really

home.

in the helping

some excitement about what

offers.

on the Companion Website

chapter-specific resources

and

self-assessments.

at

www.prenhall.com/murdock

for

Sigfnund Freud

Barb

is

a 47-year-old Caucasian female. She has been divorced twice, the second time

6 years ago. Barb speaks rapidly

has a high school education

and in great detail. Barb

sometimes appearing

to

cashier in a grocery store. She

has dijficulty sitting for prolonged periods of time,

be in physical pain during counseling

making eye contact with her counselor. Barb comes to counseling because she bouts of crying

and works as a

and panic

attacks.

is

sessions.

She has

dijficulty

mood swings, and has maladies and complaints. These

depressed, experiences

She has many physical

conditions include arthritis in the hands, repeated sinus infections, headaches, numbness in the face, dizziness without

Barb

is

known

also troubled by her perception that she

and has mixed feelings about '‘stronger person. ”

“tired

neurological causes, fallen bladder,

of catering

her off her feet.

She feels

to

men,

”

is

too

and injured knees.

dependent on her current boyfriend

would like to become a unloved, unwanted, and unneeded. Barb reports that she is the relationship.

but wants

to

Barb

be able

says that she

to trust

men and find someone

to “sweep

”

and sexual abuse. She remembers being fondled by a male family friend around the age of5. Barb’s mother lefi the home when Barb was 10; Barb and her younger siblings (two sisters and a brother) remained with their father. From the age of 10 until about age 16, Barb’s father sexually abused her. At age 17, Barb married her high school sweetheart and had two children in the next Barb

reports that she has experienced physical

3 years. Shortly afier they were married, her husband showed her letters to prove that he had been involved with another woman before their marriage, and he continued to he unfaithful to Barb throughout their 10-year marriage. Barb describes him as “perverted” because he would force her to participate in sexual acts that she perceived as “dirty” and was only concerned with his own sexual satisfaction. She characterized her husband as physically and emotionally abusive.

During these 10 years. Barb attempted suicide

three times. In the first

29

PSYCHOANALYSIS

30

attempt, she overdosed on prescription pain medication. Several months

off a two-story building. In another incident. Barb reports that she

moving car. Barb characterizes her second husband

later,

she jumped

jumped

out of a

and warm, but

as affectionate, protective,

uncommunicative. She married him 5 years afier her divorce from her first husband. Barb reports that she had great difficulty learning to trust this man, and then afier 8 years of marriage he

left her.

Currently,

Barb

is

dating a 50-year-old man. Although she describes him as safe, his lack

ofcommitment, alternately withdrawing and clinging behavior, and critical comments are making Barb feel insecure. She is also involved with a married man, even though she thinks that this relationship

is

not in her best

interests.

Barb has not seen her mother since she

left

when Barb was

the family

10.

She has some

contact with her siblings, but describes her relationships with them as distant. tains that they

other

state.

do not

Barb does

Barb main-

Her father remarried about 8 years ago and moved to annot visit her father, stating that she does not like his new wife. like her.

BACKGROUND Psychoanalysis was founded by the dates of his

Sigmund Freud (1856-1939). Freud was

work span over 45

lifetime he revised his theory

1893

years (from

many

times.

However

to 1938),

a prolific writer;

and during

his professional

controversial this theory

is,

his influ-

ence on the profession of counseling and psychotherapy has been enormous. Consider that before Freud, although

some philosophers had debated

the idea of the unconscious (Gay,

1988), no one had systematically applied the idea to psychological functioning. Also,

Freud and

his colleague

apy approach

and mentor, Joseph Breuer, were the

phies, including his

whom

controller

you

own

interesting character

& Freud,

wounded

1895/1937).

and has been the subject of many biogra-

1925 when he was 69 years old (Freud, 1925/1989). DependFreud is characterized as a meticulous scientist or an arrogant

in

read,

could not tolerate dissent in his ranks. Perhaps the

safest

combination of both. At times he presented himself as the humble

as a

the

who

to explore the “talk” ther-

treatment for psychological dysfunction (Breuer

as a

Sigmund Freud was an ing on

first

view

is

to see

him

times

scientist, at

victim of a rejecting scientific community, and at times in a dogmatic, stub-

known

workaholic (18- to 20-hour workdays were com-

born tone. Freud was

also

mon) who seemed

have neurotic symptoms from time to time. During the

Freud undertook

to

to be a

his self-analysis, the

content of which

is

late

1890s

partially revealed in several

of his

works, including The Interpretation ofDreams

Much

has been

made of Freud’s complex

of his mother, Amalia,

who was

family constellation. Freud was the

first

child

Jacob Freud’s (Freud’s father) second or third wife (there

some controversy surrounding even this simple fact). Jacob’s two sons from his first marriage were about the same age as Freud’s mother (who was 20 years younger than Jacob),

is

and one of these men had early

a son, Freud’s

environment gave him interesting puzzles

theories are a reflection of this

Sigmund Freud

who

nephew,

lived

who was

to investigate,

somewhat unusual family

most of his

life

in

entered the University of Vienna at age

older than Freud. Thus, Freud’s

7.

his

constellation (Gay, 1988).

Vienna, Austria. 1

and some speculate that

He was

After finally deciding

an exemplary student

on

a career in

medicine

—

,

.

PSYCHOANALYSIS

31

dominant interests in the scientific aspects), Freud obtained his medical degree 1881, Although he wanted to continue his already recognized work in the medical

(with in

up the

laboratory, he reluctantly took

his eagerly anticipated marriage to

of medicine

clinical practice

as a

way

to support

Martha Bernays.

Before his marriage in September 1886, Freud journeyed to Paris to study with the

mous sis

neurologist Jean-Martin Charcot, investigator of hysteria and

fa-

champion of hypno-

medical practice. At the time, Charcot was investigating hysteria, the appearance of

in

physical

symptoms

thought

to be

had no physiological

that apparently

also affected

Although the malady was

name comes from “wandering

an exclusively female problem (the

Charcot discovered that hysteria

bases.

uterus”)

males (Gay, 1988). Peter Gay, an eminent

biographer of Freud, maintains that “Freud was amazed and impressed to see Charcot in-

ducing and curing hysterical paralyses by means of direct hypnotic suggestion” (1988, p. 49), a

novel approach to this puzzling syndrome. Freud was quite excited by Charcot’s

work and used

it

as a basis for his

Freud returned from while

still

pursuing his

subsequent theoretical

and began

Paris

to

work

in the

scientific interests. Freud’s first

efforts.

everyday practice environment, published book on hysteria was

coauthored with Joseph Breuer in 1895 {Studies in Hysteria, Breuer

According to Gay (1989) Freud

first

used the word psychoanalysis

& Freud,

m

1896

1895/1937).

One

(p. xxxvi).

of Freud’s most widely acclaimed books, The Interpretation of Dreams, was published in 1899; it is an interesting bit of trivia that this book actually had a copyright date of 1900 (Gay, 1988). Freud’s theories about the sexual origins of the neuroses

quite controversial. If you wish, a selection

from

An

you can begin your excursion

An dream, then,

psychosis. ful

into psychoanalysis by reading

Box

2.

1

2.1

Excerpt from an Outline of Psycho-Analysis a psychosis, with

is

all

A psychosis of short duration,

the absurdities, delusions and illusions of a

no doubt, harmless, even entrusted with

a use-

function, introduced with the subject’s consent and terminated by an act of his will.

None

the

of mental

less it is a

illnesses

psychosis,

life as this

bold, then, to

hope

of mental

and we learn from

it

that even so deep-going an alteration

can be undone and can give place to the normal function. that

life

to

it

must

also

our hypothesis

it is

own

and

too

our influence and bring about their cure?

the ego’s task to meet the

to reality, to the id

Is it

be possible to submit the dreaded spontaneous

We already know a number of things preliminary to such an

its

sexuality in children were

Outline ofPsycho-analysis {\^\I^l\^\T) written by Freud, in

Box

A

and

to the super-ego

organization and maintain

its

demands

—and

raised

undertaking. According to

by its three dependent

nevertheless at the

own autonomy. The

same time

relations

to preserve

necessary precondition of the

pathological states under discussion can only be a relative or absolute weakening of the

ego which makes the fulfilment of is

probably the keeping

its

down of the

tasks impossible.

The

severest

demand on

instinctual claims of the id, to accomplish

the ego

which

it

PSYCHOANALYSIS

32

is

demands

obliged to maintain large expenditures of energy on anticathexes. But the

made by

may become so

the super-ego too

paralysed, as

were, in the face of

it

which

conflicts

If the

become too

other two

ganization, so that

have seen nal world,

Our

plan of cure

to

when

help.

its

decided by the assistance of an

weakened

reality

is

the ego

ally

The

demands of the

super-ego.

us the

most complete candour

which

its

self-perception yields

at his service

conscious.

No

it;

position

is

certain

of the exter-

reality

The ego

is

weakened by the

like that in a civil

internal

war which has

to be

patient’s

band themselves

demands of the

id

to-

and the consci-

We form a pact with each other. The sick ego promises

promises, that

we assure

to

is

make up

provinces of his mental

lost

sooner have

we

to

is,

put

at

our disposal

the material

all

and place

the patient of the strictest discretion

it

may

and

for his ignorance

life.

taken this step than a

must, however hard

it

We

internal world, into psychosis.

the real external world, have to

to give his ego

back

its

This pact constitutes the analytic situation. first

ing against over-confidence. If the patient’s ego

work,

state.

our experience in interpreting material that has been influenced by the un-

Our knowledge

mastery over

—

normal

its

altering the ego’s or-

detached from the

is

gether into a party against the enemies, the instinctual entious

cause

from outside. The analytic physician and the

on

ego, basing themselves

common

disturbed or even brought to an end.

based on these discoveries.

is

and

strong, they succeed in loosening

in dreaming:

and we must go

conflict

cling to reality in order to retain

down, under the influence of the

slips

it

tries to

proper relation to

its

happen

it

which

be

economic

that, in the

and the super-ego often make

arise at this point, the id

against the hard-pressed ego

We may suspect

other tasks.

its

may

powerful and so relentless that the ego

disappointment awaits

us, a first

common

to be a useful ally in our

is

warn-

be pressed by the hostile powers, have retained a

amount of coherence and some fragment of understanding

demands of

for the

\

reality.

But

this

is

not to be expected of the ego of a psychotic;

of this kind, indeed

and the help we

can scarcely enter into one.

it

offer

it

and sent us

It

will very

to join the portions

it

cannot observe a pact

soon have tossed us away

of the external world which no

mean anything to it. Thus we discover that we must renounce the idea of trying our plan of cure upon psychotics renounce it perhaps for ever or perhaps only for the time being, till we have found some other plan better adapted for them. longer

—

There

is,

however, another

chotics very closely

—

determinants of their at least

the vast

class

of psychical patients

number of people

Many

and by what methods we

on the

other.

a secular father confessor.

our patient

is

We

in real

will confine

we make our This looks

But there

know. With

is

this

what we mean by candour.

analysis,

and has become

life.

which

less disor-

These neurotics may show

our interest to them and see

as

pact:

is

how

complete candour on one side and

though we were only aiming

a great difference, for

at the post

what we want

to hear

not only what he knows and conceals from other people; he

too what he does tion of

resistant

are able to ‘cure’ them.

the neurotics, then,

strict discretion

from neuroses. The

of them, in spite of their maladies and the inadequacies resulting from

themselves ready to accept our help.

With

suffering severely

more

them, have been able to maintain themselves

far

clearly resemble the psy-

pathogenic mechanisms must be the same or

illness as well as its

very similar. But their ego has proved

ganized.

who

end

We

henceforward to govern

in

view we give him

a

more

is

to

of

from

tell

us

detailed defini-

pledge him to obey the fundamental rule of his

behaviour towards

us.

He

is

to tell us not

PSYCHOANALYSIS

33

only what he can say intentionally and willingly, what will give him sion, but everything else as well that his self-observatiun yields

comes into

his head,

even

if it is

disagreeable for

unimportant or actually nonsensical

often

its

to say

he can succeed after

even

it,

this

him, everything that

—which

if it

seems to him

injunction in putting his

out of action, he will present us with a mass of material^

self-criticism

recollections

If

him

relief like a confes-

—-thoughts, ideas,

are already subject to the influence of the unconscious,

direct derivatives,

and which thus put us

which

are

in a position to conjecture his re-

we

pressed unconscious material and to extend, by the information

give him, his ego’s

knowledge of his unconscious.

Despite the rejection

of,

or indifference to, his work, Freud persevered and gradually

gathered a group of adherents.

1902

He

Wednesday

established the

purpose of discussing psychoanalytic ideas (Gay, 1988). Over the years, the

for the

among others. Interesting (Freud’s own term) that space pro-

membership of this group included Carl Jung and Alfred stories are to

Psychological Society in

be found in the “politics of psychoanalysis”

hibits telling here (see

Freud remained

London. He was

any of the Freud biographies

in

Vienna

close to death

Adler,

for these).

until the Nazis invaded in

due

to cancer of the

1938, then immigrated to

jaw (probably

of his favorite

a result

own end on September 23, 1939, Freud obtained from his physician a lethal dose of morphine (Gay, 1989). He was survived by his daughter, Anna Freud, whose story is also an interesting one (Monte, 1999). Anna was Freud’s youngest child and was very close to her father. In her 20s, Anna received training analysis from

vice, cigars).

Choosing

his

her father. Without the benefits of any formal training in medicine or psychology, she be-

came an

analyst

Ideas, yet

made

and Freud’s

significant contributions

working with children (You significant that

Anna was a staunch advocate of her father’s of her own in her psychoanalytic approach to

intellectual heir.

will read

more about Anna’s

ideas in

Chapter

Some

authors suggest that this

on “having

violation of analytic rules was a reflection of the importance he placed

worthy and competent

intellectual heir after so

many

181).

p.

as

a trust-

previous failures and betrayals”

Freud’s ideas laid the foundation for the profession of psychology

psychotherapy

indeed

is

Freud was willing to analyze Anna, a serious deviation from the standards

of abstinent conduct that he developed for analysts.

(Monte, 1999,

3). It

we know

it

today.

Most of

the prominent theories of counseling and

psychotherapy either incorporate Freud’s ideas or were formulated Despite some arguments that psychoanalysis

and the practice of

a dated

is

in reaction to

them.

and discarded theory of human

behavior, both ideologically “pure” as well as variations of psychoanalysis thrive currently.

You can watch Action

DVD,

a classic psychoanalytic session

with the client Helen on the Theories in

conducted by Dr. David Donovan.

The American

Psychoanalytic Association has a webpage at http://apsa.org

,

and the

International Psychoanalytical Association can be found at www.Ipa.org.uk Both of these .

sites offer links to

other current Information about psychoanalysis.

division of the

American Psychological Association (Division 39)

divisions of the

APA

and sponsors

a journal, the

The is

Psychoanalysis

one of the

Journal of Psych oatialysis.

larger

PSYCHOANALYSIS

34

BASIC PHILOSOPHY Freud was

and thus psychoanalysis presents

a pessimist,

gloomy view of human

a rather

Arguing against those who characterized human nature

nature.

Freud maintained that “unfortunately what 'history experienced does not speak in this sense but rather

human

‘goodness’ of

nature

be beautified and

lives to

1933/1964,

one of those

made

and what we ourselves have judgement that

justifies a

evil illusions

inherently positive,

belief in the

by which mankind expect

easier while in reality they

their

only cause damage” (Freud,

104).

p.

human

For Freud,

is

us

tells

as

behavior

produced by

is

between genetically built-in

conflicts

drives,

and destruction. vYthough Freud acknowledged the

the instincts of self-preservation, sex,

influence of environmental events and genetic predispositions, in his view the most

dominant

force in

human

behavior

is

the sexual instinct,

In psychoanalytic theory, a great deal about a person

Children are viewed

determined before the age of 6.

is

until

about the sixth

year,

whereupon

much more complex

writing. Fie believed that kids are sexual beings for gratification of primal wishes

1964). According to Freud,

out of conflicts

Our psychoanalytic

among

all

(i.e.,

than the views current

and have murderous

satisfaction of the sexual instinct; Freud,

psychopathology has

its

roots in early

1940/

development and

various psychic entities.

therapist,

of her childhood.

when he was

fantasies in the search

Glenda, begins her work with Barb with the assumption

that her current behavior 'is jointly the result of her genetic inheritance ences

the psycho-

developmental process goes dormant. At puberty, development resumes.

Freud’s views of children were

arises

innate.

enacting a genetically determined developmental sequence, which

as

under normal circumstances progresses logical

which he thought was

First, she is female,

which for Freud

is

an

and

essential

the experi-

determinant

ual abuse as a teenager.

some sexual experience before age 6 and sexFhe trauma of both sequences of sexual abuse would be enough

cause problems on

own, but the nature of her symptoms depends heavily on BarFs

ofpersonality to

structure. Second, she recalls

its

early development.

Freud thought that tions.

We

blissfully

He

as

humans we

are not very

good

at

knowing the reasons

for

our ac-

endorse the comforting myth that our conscious thought directs our

“The truth is that you have an illusion of a psychic freedom within you which you do not want to give up” (Freud, 1920/1952, p. 52). Freud maintained that forces of which we are unaware (the unconscious) are the most powerful sources of bebehavior.

said,

havior. Evidence for the existence of the unconscious

which we

according to Freud, found in

as forgetting, mistakes, “slips

of the tongue,” and dreams. In

typically dismiss as meaningless,

Freud saw the relaxation of the

such everyday occurrences these events,

is,

censor that typically keeps unconscious material from surfacing. a slip

religious

mistake

example of such

man about to be married is queried by his future in-laws about his affiliation. He replies “prostitute” instead of “Protestant.” Freud would see this

when

is

A good

as

evidence of the unconscious sexual urges that are close to the surface because of

the excitement of course).

a

and

stress

of impending marriage (and accompanying sexual gratification,

PSYCHOANALYSIS Glenda

expects

likely attribute

alysts position

from

35

Barb

to

have

little

is

sees

Barb might

and so

her crying, anxiety attacks,

on, to

environmentalfactors, but the an-

that these are likely the result of the inhibitions in development resulting

the early sexual experience

Glenda

awareness of the real sources of her symptoms. Barb will

and later sexual abuse.

evidence of Barb’s unconscious functioning in several ways. For instance.

name

of the family friend who sexually abused her. Such a substitution would be very significant indeed to Glenda. Barb also relates dreams in her analysis, and Glenda looks in these accounts to understand the work“accidentally” use her father’s

ings of Barb’s unconscious. In one dream.

and tormented by a

sea monster.

She

is

Barb

this

an old man

which she

in white robes

is

who

captured is

riding

happens. Glenda realizes that in this dream

of sexual abuse. The monster is the abuser, and water is sexual feelings and actions (think about waves). Glenda under-

reliving her experiences

is

thought

to

be related to

stands Barb’s confusion feelings

describes a scenario in

rescued by

a mule, butfeels confused and tearful when

Barb

in place

of relief, the

loss

resurgence of anxiety esting facet

and

tears in response to her rescue as representing conflicting

ofpossible sexual

and fear connected

of the dream

is

that the scary

to

gratification (which

her abuser,

man

is

unconscious),

is

who was an

older

man.

and

An

the

inter-

riding a mule (an infertile animal).

HUMAN MOTIVATION Freud was convinced that 1940/1964).

human

behavior

is

driven by intrapsychic conflict (Freud,

Specifically, the instinctual urges in the

able by the conscious

mind and

urges at bay. Behavior

is

unconscious are considered unaccept-

society, so the psychic

apparatus exerts energy to keep these

thus a compromise between the warring mental forces.

Glenda knows that Barb’s current behavior

and reality. Her mixedfeelings about her

is

a compromise between unacceptable urges

relationship with her current boyfriend are prob-

ably the result of (a) pleasure due to satisfaction ofsexual urges

ing sexuality. She

is

also involved in

married man), which would also

a

and

(b)

guilt about express-

socially less-acceptable sexual relationship ( with

result from conflicting sexual

and moralistic

a

impulses.

CENTRAL CONSTRUCTS Instinct Theory Freud hypothesized that humans have instinctual urges that are innate, resulting from their evolutionary heritage. These instincts must be expressed or the individual will become dysfunctional (Freud actually used the identified the stinct

from

most

word

ill;

basic instinct as Eros, or

1940/1964, life.

(c)

50). In his early writings he

instinct; Freud,

through satisfaction of the need, instincts can

four other ways (Rickman, 1957,

on the person,

1

Later on he described the destructive in-

(more commonly called Thanatos, or the death direct expression

p.

p.

77):

(a)

1949/1969). Aside also be expressed in

turning into the opposite,

(b)

turning back

repression (or banishment to the unconscious), and (d) sublimation

(expression in socially approved activity).

The (for

life

instincts are

thought

to be

composed of those

directed toward self-preservation

example, hunger and reproduction continue the individual and the species). Although

PSYCHOANALYSIS

36 tempting

it is

that they

to see the life

sometimes can

and death

fuse.

instincts as

opposing one another, Freud indicated

For example, Eros prompts the person to

eat,

which allows

the destructive instinct to be expressed as destroying the food (Freud, 1940/1964). a child

is

learning to control her^ bowel and bladder functioning, the death and love

instincts can fuse into

who

sadism because the child becomes angry

loved caretaker

at the

forces the child to control elimination.

In Barb's

case,

Glenda

sees the destructive

Her depression,

tempts.

crying,

or death instinct as responsible for her suicide at-

and destructive attempts can

be seen as the result ofa need

for punishment for her unacceptable sexual urges. Problems around Eros seem to

When

to

give

rise

her disruptive relationships with men; she simultaneously seeks forbidden sexual gratifi-

cation

and reacts

Freud had

was

angrily to the rejection she has experienced jrom men.

much more

to say

about Eros than he did about Thanatos because the

a late addition to the theory (Freud,

possess a store of energy,

which

become synonymous with more general drive. Libido perpetuation of the

1923/1961). The instincts are unconscious and

in the case

of Eros

is

called libido.

The term

sexual drive even though Freud protested that is

human

latter

considered a very basic drive, because

it is

it

libido has

was

a

much

responsible for the

species.

Instinctual energy always seeks objects in

which

to invest (normally, people); such

attachment discharges the energy of the instinct and creates pleasure. At birth, libido directed only to the

self,

a state

known

as

primary narcissism. Next, and rather quickly, the

mothering one becomes the primary object of the tinues to invest

life

is

libido.

energy in other people or objects

As the child develops, she con-

until, as

an adult, she finds mature

love in the investment of libido in a person of the opposite sex. Further journeys of the libido will be described It is

under the discussion of sexual development.

important to note that problems in development lead to fixation of the libido

that stage of development. Fixation

ues

on

a

is

at

rarely total in the neuroses, so the individual contin-

modified developmental path. Flowever, later-trauma can lead to regression to the

point of fixation, the primary means whereby old, unresolved conflicts

Glenda hypothesizes that Barb's libido ably around the age of 5 or

6.

She

is

is

become symptoms.

fixed somewhere in her early development, prob-

arrested in her development, which explains

why

she

has dijficulty with intimate relationships in her adult years. Glenda thinks that Barb,

to

some

in

life.

extent, reproduces in her current relationships aspects

These immature ways of relating

to others

tend

to

of those she experienced early

get her in trouble.

Topographic Model: The Iceberg Approach In his early work Freud differentiated

among three types of mental content. Beginning with the

most obvious, he recognized the conscious awareness of the individual. To the consternation of

Pronouns in the theory chapters of this book will match the sex of the lemale pronouns in Chapters 1 and 16 are alternated randomly

client

and counselor. Male and

PSYCHOANALYSIS

37

many, however, he denied

stemming from

it

as the source

the unconscious, so that

conscious thought)

only the

is

tip

of most behavior. Instead, he saw most behavior

what we

typically think of as driving

The

of the iceberg.

of the stormy ocean, the instincts in the unconscious.

motivations

real

Some mental

as

our behavior (our

beneath the surface

lie

content moves easily from

conscious to unconscious, and this material Freud termed the preconscious. Even though he

model

later revised his

terminology of the

(see the structural

levels

model

that follows), Freud continued to use the

of consciousness to describe mental events.

Structural Model: The Big Three Later Freud asserted that there were three basic divisions or entities in the mind, which he

termed the

It,

I,

and over-me (Freud, 1933/1964). The more

familiar Latin terms of id,

ego, and superego were evidently substituted in translation to English and have since

become the terms of choice (Karon If you want to see an id, look at

& Widener, newborn

a

1996).

baby.

chic entities, the residence of the instinctual urges. instinctual needs. Consider

me

right

what happens when

id

baby

gets

the

most primitive of psy-

immediate

seeks

It

is

hungry

—

gratification of

the message

its

is.

Feed

“No such

pur-

now!

Freud emphasized that the id has no pose

a

The

as that

of keeping

itself alive

real

contact with

mental processing chic activity.

The

it

seeks pleasure

p.

id’s

version of pleasure

is

means of anxiety

148). Totally unconscious, the id operates

and avoids

primary process because

is

writing,

or of protecting itself from dangers by

can be attributed to the id” (Freud, 1940/1964,

on the pleasure principle;

reality,

it is

pain.

Another term

most

basic, primitive

the

for this type of

form of psy-

the satisfaction of instinctual impulses through

the discharge of energy associated with them. In this process of discharge, the instinctual

energy

The

is

attached to objects, including people.

psychic entity with which

we

are

most

familiar

is

the ego.

The ego

develops out of

the id in response to pressure from the child’s environment to restrain instinctual drives.

Operating according

to

secondary process, or the reality principle, the ego

isfaction of the id impulses while at the

strives for sat-

same time preserving the person. Because of the

nature of the instinctual impulses, outright gratification of them could result in the organism, or even death,

The superego

is

and the

ego’s job

is

to prevent these

the last psychic entity to develop;

parental or other authority figures.

it

We know the superego

to

outcomes.

the internalized version of

is

as

damage

our conscience, and

it is

also

the vehicle for the ego-ideal, or our vision of the perfect ego. Freud maintained that the

superego “observes the ego, gives exactly like the parents

whose

place

Figure 2.1 was proposed by the structural that

all

it

orders, judges it

it

and threatens

has taken” (1940/1964,

Nye (1986)

as

p.

it

with punishments,

205).

an illustration of the relationships between

and functional models of psychoanalytic

theory.

The drawing emphasizes

three psychic entities have unconscious elements, with the id entirely

the unconscious. processes

Note

and

safely in

that portions of the ego are unconscious, primarily the defenses

most intimately

and

related to dealing with the id.

Barb’s ego seems to be struggling with unconscious forces that result in her current dysfmc-

tional behavior.

Her basic id impulses are at war with

the

demanding and rigid superego. She

PSYCHOANALYSIS

38

Conscious

Preconscious

Unconscious

FIGURE

2.1.

An

Models of the

Integration of the Structural and Topographical

From Three psychologies:

Perspectives from Freud, Skinner,

and Rogers 5th

edition by Nye.

©

Personality.

1996. Reprinted with permission

of Wadsworth, a division of Thomson Learning: www.thomsonrights.com. Fax 800-730-2215.

has sexual urges that seek fulfillment, yet the internal voice of her superego

tells

her that sex

and intimacy areforbidden and dangerous. The superego exerts its control in theform ofBarb’s depression and crying. Glenda guesses that this punishment has resulted in a poor self concept and an exceedingly strict ego-ideal. The impulses ofBarb’s id are fightingfor gratification but are so unacceptable that they are not directly expressed in behavior. Her ego, although taxed, is still intact, and therefore Barb is able to participate in the counseling relationship.

Repression One

of the most important processes in psychoanalytic theory

containing or pushing unacceptable psychic material repression

is

unconscious and

repression results in

always involved in

repression, the act of

the unconscious.

symptom

at the

later),

Trom a psychoanalytic perspective,

Freud

it is

also

wrote of it

interesting that

childhood sexual abuse. The symptoms that she

as

as a

Barb

process of

result in the

psychological stage of a traumatic event, a

Although some would characterize repression

defense mechanisms (discussed

The

formation, although not

symptoms. Repression uses psychic energy and can

being developmentally “stuck” called fixation.

is

m

is

all

person

mechanism

one of the most important

more general psychic process.

retains the

memories of her

from the repressed emotion related to the abuse. Early sexual experience, in Glenda’s vieiu, would overgratify the sexual instinct; this overgratification would explain Barb’s pronounced desires to fulfill sexual needs to establish relationships,

safe

is

experiencing likely result

with a safe male. These desires are seen in her

but their dysfunctional nature

men. Barb seems doomed

to repeat

Barb’s psychic processes are repressed,

is

many

attempts

evident in that she does not pick

her early experiences, a sign offixation.

and

the

memories that

trigger

them are

accessible

only through lengthy analysis. Glenda proceeds carefully in conceptualizing these memories.

PSYCHOANALYSIS

39

because one psychoanalytic understanding

would be that

these

memories are wish fulfill-

ments; they represent childhood fantasies ofgratification of the sexual drive. That

may have happened only

abuse

be that the abuse was

the

is,

A

second type of interpretation would Either explanation would lead Glenda to expect fairly signifi-

real.

in Barb’s fantasies.

cant dysfunction in Barb’s relations with men.

Symptoms

Symbols

as

For Freud, symptoms were symbols of psychic conflict. In his described led

by

them

as

and

symptom

should have to affirm that the

desires

of the patient,

we should be and every time we

served the same purpose. This purpose shows

be the gratification of the sexual wishes; the symptoms serve the purpose of sexual

gratification for the patient; they are a substitute for satisfactions in reality”

(1920/1952,

308).

p.

accompanying a wish

Emma E.,

for

which he does not obtain

The most obvious examples of such symbolization

things such as uncontrollable vomiting,

that of

he always

expressions of unacceptable sexual impulses: “Every time

analysis to the sexual experiences

itself to

earlier writings

which was thought

to symbolize

morning

sickness

impregnation (Nye, 1986). In one of his most controversial

Ereud interpreted repeated bleeding from the nose

care of (Masson, 1984). Ereud also said that

symptoms could

are

cases,

wish to be taken

as a

serve as a defense against

unacceptable wishes. In either case they are attempts to keep the unacceptable thoughts or

from surfacing

desires

arm becomes

in the conscious.

Glove anesthesia,

in

which only

a portion of the

paralyzed, was thought to be a defense against masturbation. In addition,

Freud’s later theorizing included the destructive drives as the source of instance, a suicide attempt

Barb’s

symptoms

would

symptoms;

for

represent the activity of the death instinct.

symbolic ofher conflicts around sexual impulses

are, in Glenda’s view,

and

Her depression is the result of her superego punishing her for her unacceptable sexual wishes. Her panic attacks probably result when these wishes come close to the conscious and would be dangerous or socially unacceptable to ex-

fixation at an early developmental stage.

press. Barb’s physiological

sentative

of mental

unconscious sexual

”

drives that are not being expressed.

desires.

Barb’s fainting spells

her ojfher feet,

symptoms, particularly the neurological ones, are probably repre-

may

most

Her face may

be

numb

be reflective of a wish

likely

to

Quite

likely,

they symbolize

because she wishes for forbidden

“swoon” over the

man who

kisses.

will “sweep

her father.

Defense Mechanisms In addition to repression, the ego also has other ways to prevent unacceptable wishes from

emerging into awareness. These noted gered

earlier,

when

repression

is

tactics are called defense

The

defense

(Hall, 1954).

As

often listed as one of the defenses. Defense mechanisms are trig-

anxiety signals that unconscious material

scious mind.

mechanisms

mechanism

is

threatening to break into the con-

distorts reality so that the actual

wish does not enter

consciousness and interfere with the ego’s functioning or the safety of the individual.

The

operation of defenses

is

recognized through their extreme manifestations; the indi-

vidual’s perceptions or reactions

mechanisms, even the

seem extraordinarily strong. Freud cautioned

relatively healthy ones, are

only able to discharge

that defense

a fraction of the

PSYCHOANALYSIS

40

energy attached to the instinctual impulses. For example, transforming aggression into the

approved racquetball game would not

socially

fully satisfy the instinctual drive.

Depending on which source one consults, the list of defenses varies, and Freud himself apparently never enumerated them in one place. Repression, described earlier, is the corner-

A

stone of the psychic defenses. Identification

operating

is

brief description

when

complex (discussed

but

later),

the qualities of another person are taken into the indi-

For males,

vidual’s personality (Fiall, 1954). it

is

of others follows.

this process

is

the key to resolving the Oedipal

also seen in other situations in

threatened by another person. For this reason, this defense

is

which individuals

sometimes termed

tion with the aggressor,” although identification through positive emotions

Displacement occurs when an unwelcome impulse

is

are

“identifica-

also possible.

is

deflected onto another person,

who is less dangerous than the original target. The classic example of displacement is the man who gets angry with his boss, but instead of aggressing against the boss, he comes home and yells at his wife, his kids, the dog, and the goldfish. Projection is the externalization of an unacceptable wish. People who are paranoid, for presumably someone

example, externalize their instinctual rage by perceiving others

as

strategy reduces the anxiety associated with the aggressive drives

by placing the aggression

some

in the external world. In

individual to act

on

these urges

Reaction formation is

cases, the projection

of one’s aggression allows the angry

and thereby achieve some degree of instinctual

when an

is

out to get them. This

unacceptable urge

is

transformed into

its

gratification.

opposite.

Rage

transformed to love, and sexual desire to hate. For example, a man’s rage against his younger

sister that

stemmed from

sibling rivalry could be transformed into an overly solicitous love.

Sublimation, thought to be one of the healthiest of the defense mechanisms,

is

the fun-

neling of the unacceptable impulse into a socially acceptable activity. For instance, Freud

thought

artists

sublimated their libidos into creative products. Football players are likely

sublimating aggressive drives. According to socially

approved other

is

a

sion of incestuous wishes

Regression

is

seen

when

may

represents the disguised expres-

a threatened individual retreats to is

fixated.

resort to

an

earlier stage

of develop-

When'the demands of a current

person’s current defenses

dle the stress, she reverts to earlier for lying to a parent

it

39).

(p.

overwhelming and the

(1996), the expression of love toward a

form of sublimation because

ment, typically to one in which she are

Maddi

and ego operations

ways of dealing with

life.

are unable to

A school-aged

thumb-sucking or curling up

situation

han-

child chastised

in a fetal position to deal

with the attack on the ego.

Barb

is

likely

ality in her

employing several defense mechanisms that revolve around the

life.

issues

ofsexu-

She has repressed her sexual desire for her father and her subsequentfeelings

ofanger and hatred toward men who reject her advances. She may be using reaction formation to deal with some of these feelings that do threaten to emerge into awareness, because she continues to value tion,

abuse

which causes her

and then

and seek to

reject her.

repeat the patterns

When

—

of the past

seeking

is

involved in interpersonal conflict with men, Barb proba-

mechanisms of being passive and distant. Her belief that her her is probably a projection ofher own hostile feelings for them as usurpers

bly regresses to earlier coping siblings don’t like

doomed by her fixamen who will ultimately

intimate relationships. However, she

ofparental attention.

PSYCHOANALYSIS

41

THEORY OF THE PERSON AND DEVELOPMENT OF THE INDIVIDUAL Freud formulated a complex theory of early

human development that locused primarily on

sexual development. Shocking his Victorian professional

humans

are inherently sexual creatures

community, Freud proposed

that

and that even infants and young children have

sex-

proposed that humans are inherently bisexual, with gender

ual urges. Fie further

identifi-

cation resulting from an inherent tendency toward maleness or femaleness, along with the

way

in

which

a

key developmental

resolved (see the later discussion of the Oedipal

crisis is

complex).

According

to psychoanalysis,

opment beginning

at birth

humans

progress through a series of stages of sexual devel-

and ending with mature sexual identity

in puberty.

The

psy-

chosexual stages are identified by the satisfaction of sexual drive via different zones of the body, termed erotogenic zones (Freud, 1933/1964). lead to too

much

investment of the libido

Too much

or too

little

satisfaction can

at a given stage (fixation), resulting in the indi-

vidual having difficulty negotiating subsequent stages. Fixations vary in intensity.

have minor ones, but tal stages,

when

problems can

amount of energy

a large

result later in

is

mothers

the

at

life.

satisfaction quickly

(thereby satisfying

breast

the

dence that sucking was satisfying sexual needs

as well.

sucking on pacifiers, their thumbs, and other assorted

Minor

first

stage of sexual develop-

obtains nourishment from suck-

self-preservation

Think of all objects. The

This

instinct).

for

Freud was

the kids

evi-

you have seen

oral stage lasts roughly

first year.

fixations at the oral stage are seen in such oral activities as nail biting,

and overeating. More intense

Maddi

the

becomes independent from nourishment, which

from birth through the

all

attached at one of the developmen-

The first erotogenic zone is the mouth, and therefore, ment is termed the oral stage. The infant (or little id) first ing

We

smoking,

fixation can result in the oral character types (Maddi, 1996).

described these characters as focused on the activities of taking (oral aggressive) and

receiving (oral incorporative).

The second

stage of

development

is

through the functions of elimination. Freud characterized that the libidinal

which

the anal stage, in

and destructive urges fused

of mine placed hers

at this stage to create sadism. Initially, the

them

as “presents” for

those

in a jar in the refrigerator for her parents to find.

Later in this stage, the infant

young

life

when

comes into

conflict with the

the lessons begin about

only

at certain times,

can have a great impact on

cording to psychoanalysis. Harsh orderly,

and

toilet training

is

for the first time

she can gain gratification

forced to produce urine and

later personality characteristics, ac-

can result in individuals

who

are stingy,

precise (anal retentive characters), whereas excessive praise leads to people

are overgenerous, messy,

The most important ory occurs between ages ification

environment

when and where

of pleasurable urges. Toilet training, in which the child feces

gained

she especially values (Freud, 1920/1952). As an example of this early attitude, a cer-

tain niece

in her

is

this stage as sadistic, suggesting

infant values her excretions, particularly the feces, producing

whom

satisfaction

becomes the

and vague

(anal expulsive characters;

who

Maddi, 1996).

human psychosexual development for psychoanalytic the4 and 6 and is known as the phallic stage. The focus of sexual gratstage of

genitals,

and

little

boys and

girls

begin to notice differences

in their

PSYCHOANALYSIS

42

bodies. Children are sexually curious prior to this age, particularly about the origin of babies,

which they have concluded come from the anus. However, begin to suspect that something else their attentions to the penis.

going on, and both

that boys have

one and

girls don’t.

This realization

according to Freud, turn

sexes,

that both sexes possess a

in the genital areas,

becomes evident

it

often the result of accidental viewing of

is

sexual intercourse. In any case, the discovery that male

point the course of development for boys and

at this

a

boy begins

and female

girls takes

who unknowingly

boy becomes aware that him. Also, the

masturbating

little

killed his father

girls

boy remembers

earlier

Freud maintained that p. 92).

As

terrified

in

his

most

you

Greek

for the mythical

mother. However, the this

his

recall),

little

might happen

to

little

member. Castration anxiety,

boy

a

fears that his father, the rival

mother and

his incestuous desires for his

all,

there are a lot of people in the world

who

boy therefore

represses the desires for his mother,

and

exact the ultimate revenge, castration. After

The

The

might find out about

for his mother’s attention,

critical;

warnings of adults when they caught him

to cut off the offending

powerful force in male development, ensues.

don’t have penises.

and married

named

do not have penises and worries that

— they threatened

is

sharply different courses.

in the oral phase,

mother. At this point, he has entered the Oedipal stage, character

genitals differ

he has fantasies about doing something of the sort with

to masturbate,

primary love object (an attachment established

his

increases, they

or woman’s genitals, but can also be set off by the trauma of observing adult or parental

girl’s

As

knowledge

assumed

to this point, kids have

However, with the awakening of satisfaction

penis.

a

Up

is

as their

cases, the

complex

a result of this process, the superego

makes

“destroyed” (Freud, 1933/1964,

is

its first

appearance, developed out

of the identification with the parents, particularly the father (identification with the aggressor). Identification

compensates

for the necessary loss

of attachment to the mother

while defending against the threatening father.

The development of women was much more this topic,

puzzling to Freud; he devoted a lecture to

although acknowledging therein that “psychology too

dle of femininity” (1933/1964, p. 116). Like

little

boys,

is

unable to solve the

girls’ initial

attachment

is

rid-

to the

mother, yet to become fully female, they turn from her to attach to the father, but then

must seemingly renounce development

in girls

this

second important attachment. Freud maintained that early

was masculine

in nature,

culminating in discovering the

source of pleasure analogous to the penis. However, the

little girl

soon afterward discovers

that she does not truly have a penis, the realization that starts the castration

women. The primary form of

the castration

Freud thought often was never resolved. In

was responsible for homosexuality sions (Freud, 1933/1964).

in

complex among

lact,

women

clitoris as a

girls

is

complex

for

penis envy, which

Freud thought that unresolved penis envy

as well as the pursuit

Both courses of development

of “masculine” profes-

are considered

abnormal and rep-

resent a continued quest for a penis.

The resolution of the female castration complex resulting in normal lemininity begins when the girl renounces clitoral masturbation and seeks to sexually attach to her father as a way to gain the wished-for penis. She becomes hostile to her mother, blaming the mother lor her (the girl’s) lack trated, lather. iety,

is

and so

is

of a penis. However,

this

wish for the penis of her lather

is

frus-

the next transformation of the wish, that lor a “penis-baby” from her

Unfortunately, the press to resolve the Oedipal complex

not present, so

girls are

much

among girls,

slower to resolve the complex,

castration anx-

if at all.

They

are

PSYCHOANALYSIS

43

thereby limited in their superego development and are prone throughout jealousy.

They feel

inferior because their clitoris can’t

tinue to search for a penis of their

Freud is

said,

“A mother

altogether the

(1933/1964, tile

p.

is

own and

really

compare

in

perfect, the

133).

The

girl’s

most

free

from ambivalence of

bearing a male baby.

human

all

mother on the birth of her own

After the Oedipal stage, the individual enters latency, which

relationships”

children.

is

sexual urges are usually repressed; however, Freud cautioned that

some manifestations of sexuality may break through

may remain

sexually active throughout the latency period. In essence, repression

always total during latency, and behavior during this period sexuality,

During

the reproductive function.

The

if

is

or that

some

variable (Freud,

1

individuals is

this phase, the sexual instinct

become

derailed during

from one of the other erotogenic

excessive pleasure has been derived

The

we

becomes integrated with

process toward mature sexuality can

zones during early development.

not

924/ 1 989).

according to Freud, develops during the genital stage, which

enter during adolescence.

the genital phase

of

a usually a period

occasionally

Mature

this

mother remains ambivalent or hos-

relationship with her

unless she reidentiFies with the

The

con-

only brought unlimited satisfaction by her relation to a son;

most

sexual quiescence.

envy and

Women

to a real penis.

only find one

to

life

individual then becomes too invested in foreplay to

the detriment of intercourse, thereby leaving unfulfilled the reproductive function of sex

(Freud, 1924/1989).

Glenda

is

certain that

sexual abuse

is

Barb has unresolved Oedipal

important;

it is

the question

of the early uncertain whether she was actually abused, or whether issues. First,

memories are wish fulfillments of an Oedipal nature. In Freud’s view, the course of development would be very similar in either case. If the abuse was actual, the symbolic these

gratification

Fhis

of the Oedipal complex would

would cause her

results in

search

to

strongly fixate

Barb

in the

Oedipal period.

and husband and

continually for her father as a love object

her duplication offaithless father in her choice of a faithless first

a view of men as untrustworthy. Fhe symbolic attainment of her father would also likely intensify her hatred for her mother, resulting perhaps in stormy relationships with other

women. If the abuse was an Oedipal wish fulfillment, the abuser is transformed into “a family fiend” because the actual representatio?i ofher father in this context is unacceptable. Fhat

Barb

recalls this

memory

indicates that her repressive processes were not at fill strength, a

sign that her psychic system

was overtaxed. In

either case, she emerges from this stage with

an unresolved Oedipal complex. Barb demonstrates her ambivalent, Oedipal relations with men her current boyfriend. She to

is

worried about being too dependent on him, yet wants a

sweep her ojfher feet. Glenda

conflict

and the

in the relationship with

sees these conflictual urges as

incomplete identification with the female

man

evidence of Barb’s unresolved

role.

HEALTH AND DYSFUNCTION Healthy people are able

to love

and work. They have

they have mostly resolved their Oedipal complexes stage

and therefore

less leftover

in

a

minimal

level of repression

ways resulting

unconscious material.

I

because

in less fixation at that

hus, the goal of psychoanalysis

is

PSYCHOANALYSIS

44 unconscious material into the conscious; that

to bring

who

who

successfully complete psychoanalysis are those

scious conflicts

by allowing them

to surface into the

and symptoms.

the sources of current behavior

is,

It is

to reduce repression. Individuals

work through unconconscious and to recognize them as are able to

probably Important to note that one

can never get rid of the id or superego, so the story of life

demands of the

these pressures along with the

external

interpretation of the Freudian psychoanalytic theory

is

the ego’s attempts to

is

environment

(reality).

that a healthy person

is

manage

In fact,

one

the one

who

uses the healthiest defenses (Maddi, 1996).

who

Dysfunctional people are individuals ticularly those

age 6 and

“Among which adult,

is

of an Oedipal nature. Freud maintained that

due

to unsuccessful resolution of the stages

the occurrences

which recur again and again

are scarcely ever absent

and

behavior

have unresolved unconscious conflicts, par-

.

.

.

all

dysfunction originates by

of psychosexual development.

in the youthful history of neurotics

observation of parental intercourse, seduction by an

1917/1963, pp. 368—369). In adults, dysfunctional of fixation due to unresolved conflicts plus some kind of activating,

threat of castration” (Freud,

is

the result

The

traumatic experience.

symptoms

adult trauma reactivates the childhood fixation, resulting in

(Freud, 1920/1952).

Before discussing the psychoanalytic understanding of various psychological dysfunctions,

clients.

note that most of Freud’s work was with a very narrow sample of

critical to

it is

Most of his

clients

were neurotics, and

in the parlance of the day, either suffering

from hysteria or obsessive-compulsive neurosis. Today these dysfunctions would be

called

conversion disorders and obsessive compulsive disorder or personality. Freud’s discussions

of other types of dysfunction were

Anxiety forms the moral, and

basis

far less detailed.

of dysfunction, and Freud identified three kinds: neurotic,

(Freud, 1933/1964). Realistic anxiety

realistic

tion to real danger to the organism. Birth anxiety

Neurotic anxiety

the fear of libido.

is

drives are expressed, danger to the

punitive superego.

The

It is

is

based in

organism could

nature of the response

is

is

the appropriate affective reac-

the original realistic anxiety. realistic

result.

anxiety because

Moral anxiety

identical in

is

if

the libidinal

the fear of the

three types of anxiety, but

all

moral and neurotic anxiety are responses to an internal rather than environmental

By

far the

most important

emerging instinctual urge danger that would

in Freud’s

is

arise If the

close to

threat.

work was neurotic anxiety, which results when an consciousness. The ego, perceiving the state of

demand were

satisfied, allows the

anxiety to surface as an

then does away with the unpleasant

aversive experience. In

most

the unsatisfied urge

relegated back to the unconscious. If the energy of the psychic ap-

paratus

is

is

cases, repression

overtaxed, the drive can be converted Into a

symptom

that

is

state,

and

symbolic of the

conflict that generated the anxiety.

The most common what was then termed

client for Freud,

and perhaps the most

hysterical neurosis,

which was

interesting, presented

originally

with

thought to occur only

in

females (the result of dysfunction of the uterus). Charcot and Freud were the earliest advocates of the psychic determinants of hysteria and sexes. 1

its

Charcot thought that any kind of trauma created

existence In individuals of both hysteria,

whereas

as early as

the

890s, Freud was beginning to assert the sexual origins of hysteria. His Insistence on this

principle disrupted his relationship with

thored his

first

book

mentor Joseph Breuer, with

[Studies in Hysteria; Breuer

&

whom

Freud, 1895/1937).

he had coau-

PSYCHOANALYSIS Early lated

on

45

in his explorations of neurosis,

stories that his clients

the origins of neurotic ever, later

Freud abandoned

The

Fliess,

and

tions as fantasy to the

is

considered

traumas

in these

How-

called the seduction hypothesis.

his first public

The

of his is first

acknowledgement was

decision to treat these client recollec-

understanding and exploration of the Oedipal complex. Box 2.2 presents an

abandoned the seduction hypothesis.

Box 2.2

A Failure

of Courage? Another View of Freud s Abandonment of the Seduction Hypothesis

Freud’s early

work with

hysterical clients initially led

him

to believe that these afflictions

were caused by sexual trauma (mainly sexual abuse by a male

came

theory. In

to be

known, somewhat misleadingly,

1905 Freud changed

mind about

his

This

relative) early in life.

as the

seduction hypothesis or

the reality of his clients’

memories of

childhood seduction, declaring that he “overrated the importance of seduction

in

com-

parison with the factors of sexual constitution and development” (Masson, 1984, p. 129).

He

also wrote, “At that time,

my

include a disproportionately large

material was

still

number of cases

scanty, in

and

it

happened by chance

to

which sexual seduction by an adult

or by older children played the chief part in the history of the patient’s childhood.

I

thus

overestimated the frequency of such events (though in other respects they were not open to

doubt)” (cited in Masson, 1984,

opinion, including

(a)

p.

129). Freud gave several reasons for his altered

the fact that he was not able to cure his clients based

pothesis, (b) the fact that the incidence of hysteria rate

of sexual offenses by fathers,

reality,

and

(d) the fact that in

(c) his

most

would

ions,

on

this

hy-

indicate an unbelievably high

conviction that the unconscious has no sense of

severe psychoses, unconscious content does not sur-

(Masson, 1984). Most analytic writers agree that

face

in

among the adherents of psychoanalysis because it opened

critical

interesting but controversial examination of why Freud

position

re-

initially

renunciation of the seduction hypothesis

Three Essays on Sexuality, Masson, 1984).

(in

were true and located

is

He

relatives.

this notion, seeing these “scenes” as the fantastic creations

seen in an 1897 letter to his confidant,

way

telling

symptoms. This assumption

analysands based on Oedipal longings.

the

were

almost always

his clients

memories of early sexual experience, mostly perpetrated by male

assumed that the

1905

Freud noticed that

if

Freud had not changed

his opin-

he would not have gone on to discover other significant aspects ol psychological

functioning, such as the Oedipal complex and the role of fantasy in

human

Paul Masson, however, painted another picture of the situation.

psychology.

Masson (1984)

maintained that Freud relinquished the seduction theory for reasons other than those stated in his writings. First, Freud was ostracized by the medical sertions that neuroses resulted

community

lor his as-

from childhood sexual experiences. At the time, the Vic-

torian attitudes toward sex precluded discussion ol the topic,

medical authorities dismissed the accounts of sexual abuse

and some number ol

among both

children and

adults as “hysterical lies.”

Even more interesting

is

Masson’s argument that Freud changed his opinion partly to

cover up lor a surgical mistake

made by

his

good

friend,

Wilhelm

Fliess.

One

of Freud’s

PSYCHOANALYSIS

46

Emma Eckstein,

early analytic clients,

menstrual

had come

Both Freud and

difficulties.

to

Freud with stomach complaints and

his colleague Fliess

lems to be the result of masturbation.

considered menstrual prob-

however, believed that sexual problems

Fliess,

(such as masturbation) originated in the nose, and thus could only be cured by a surgical intervention,

removal of the turbinate bone. In early 1885 Freud and

Fliess

appar-

Emma’s problems.

ently decided that this operation was the solution to

After the surgery, great complications arose, including hemorrhaging that threatened

Emma’s

life.

Emma

examined left

Various remedies were

and found

tried, to

no

avail. Finally, a

surgeon called to consult

that in performing the operation, Fliess “had ‘mistakenly’

half a meter of surgical gauze in

Emma’s nose” (Masson, 1984,

p. 66).

Masson

argued that the hemorrhaging was a normal result of a botched surgical procedure, but that Freud

was motivated

to save his friend’s reputation. Instead of publicly

ing the error, Freud conceptualized

Emma’s hemorrhaging

as the result

acknowledgof hysterical

“sexual longing” (Masson, 1984, p. 67).

Masson suggested

was the

that Freud’s rejection of the seduction hypothesis

result

of

community to his theory and the need to protect his friend and colleague. Further, Masson contended that his own investigation into this issue caused the orthodox psychoanalytic community to shun him, rescinding his access to the Freud archives. Masson argued that his motivation was to force psychoanalysts to the reaction of the medical

believe their clients, rather than dismissing their stories as fantasy.

Prominent scholars of the history of psychoanalysis have found

work (Monte

&

lesson learned

from

fault

most important

Sollod, 2003; Roazen, 2002). However, perhaps the

debate

this

is

that sexual abuse has been

and

still is

Counselors would be wise to think carefully before they attribute their

with Masson’s

underreported.

clients’ reports to

need-driven fantasies.

Hysteria,

which

is

now

ual displays physiological ple, a

woman

symptoms

thought to

that

seem

to

is

a condition in

which an individ-

have no valid physical

basis.

For exam-

might display “glove anesthesia,” numBness from the elbov/ downward

the hand, a condition that is

called conversion disorder,

result

from

is

neurologically impossible. As noted

guilt

(probably Oedipal in nature).

earlier,

to

glove anesthesia

about masturbation and the accompanying fantasies

The term

conversion conveys the basic assumption about

such conditions: that they are anxiety converted to symptoms. In Freud’s view, hysteria results

from the anxiety produced by the unacceptable sexual impulses threatening

to break

into consciousness. In the case of adult neurotics, unresolved childhood conflicts have been

triggered in adult

life,

and the

hysterical

symptoms, according

to psychoanalysis, always

symbolize the childhood event.

Phobias are a special

class

of hysteria

in

which sexual impulses

are first repressed,

then converted to anxiety, and finally attached to some external object (Freud,

1920/1952). The phobic then creates structure that keeps the dreaded object tance,

which represents the feared

of the marketplace”)

is

libido.

For example, agoraphobia

the fear of sexual impulses surfacing

herself in a social setting. Freud gives the

urges toward those she passes

when

(literally,

the street.

The

“the fear

the individual finds

example of an individual who

when walking down

at a dis-

feels sexual

individual displaces

PSYCHOANALYSIS

47

the danger (anxiety) into the environment and avoids

thereby protecting herself

it,

(Freud, 1920/1952).

Obsessive-compulsive neurosis

The

stage ol development.

is

conceptualized as having

sadistic urges

developed

at this

its

roots in fixation in the anal

time are a significant feature of

obsessional neurosis and are the result of harsh toilet training. Reaction formation

mon defense of these individuals. der you means nothing else but In the case ol depression,

Freud wrote, “The obsessive thought ‘I

it is

should

like to

enjoy love of you

difficult to reconcile

Freud

”

‘I

should

comto mura

is

like

(1920/1952,

353).

p.

terminology with todays

s

nomenclature. Freud identified two kinds of depressive syndromes: melancholia and

mourning. The contemporary counterparts of these cholia sounds like

classifications are

what we might term major depressive

disorder.

not

Mild

Melan-

clear.

to

moderate

depressions (other than mourning) seem to be the result of a hypercritical superego, as in

melancholia.

Mourning and melancholia both begin with (or

something that

ol libido

is

the loss of an object, often a loved person

representative of a loved object).

from attachment

Mourning

is

the gradual withdrawal

to the object, a process that simply takes time.

Melancholia

is

the result of an extremely critical superego (Rickman, 1957). However, in the case of this

more

severe disorder, the ambivalent feelings toward the lost loved

one

part of the ego through identification. Thus, the superego turns the rage lost object

become

(object) felt

toward the

onto the ego. Freud maintained that the complaints that the melancholic

turns against herself (being worthless, for example) are actually really directed at the

loved person.

The terminology of Freud s time also creates confusion around the subject of the psychoses. The surrounding medical community referred to these conditions as dementia praecox, or with the newer term schizophrenia; Freud called

1957,

p. 105).

Conceptually, however, Freud discussed these conditions

cissism (Freud, 1920/1952). all

them paraphrenia (Rickman,

object attachments

He

thought that psychosis

and instead attaches

to the ego.

and sometimes hypochondriacal (when some of the

results

The

when

of the ego

Glenda

and

sees

id. If the

some of Barb’s symptoms as

numbness. Her ego

is

the libido abandons

libido attaches to a is

body organ).

becomes

In

strongest, the stage

is

coexist

—

those

set for psychosis.

hysterical in nature, such as the dizziness

not strong because of the

amount of energy fixated in her early

opment. Barb does not have a successful work or love

life,

all

a splitting of the ego”

which two separate ideations or impulses

instinctual element

forms of nar-

individual becomes egotistical

psychological dysfunction, but particularly the psychoses, “there (Freud, 1940/1964, p. 202), in

as

and

devel-

which supports the position that

her symptoms are hysterical and reflects libidinal energy at work

and the repression

of mem-

ofsexual abuse orfantasies ofsexual relations with her father. Barb’s panic attacks and headaches likely happen when some event activates her fixation in the phallic stage during ories

which the Oedipal complex was unsuccessfully

resolved.

Her anxiety signals the possible and mood swings result from her

emergence ofa forbidden sexual urge, and her depression superego’s punishment for the unacceptable urges. Glenda also understands Barb’s troubles

ofher unresolved Oedipal complex and the trauma of the sexual abuse she experienced in adolescence, which probably reinforced her fixation. with

men

as

a

result

— PSYCHOANALYSIS

48

NATURE OF THERAPY Assessment Freud considered assessment very important in

what we would

approach to

his clients,

but only had

informal approaches to this task. After determining that his

call

symptoms were psychological trial

his

rather than physiological, Freud

recommended

a

client’s

2-week

period to ascertain that the client was suitable for analysis (Freud, 1912/1958). Pri-

marily,

Freud sought to make a

between hysterical or obsessive

differential diagnosis

and schizophrenia (paraphrenia) because he thought the

neurosis

choanalysis.

A continuing assessment in psychoanalysis

unconscious in the

clients’ free associations,

is

latter untreatable

by psy-

seen in the search for clues to the

dreams, and errors.

more contemporary forms of psychoanalytic therapy, formal assessment is often used to gain some information about the nature of the client’s defenses and unconscious conflicts. The classic (and some would say the only) way to access unconscious material is by using ambiguous stimuli, such as the Rorschach inkblot test (Rorschach, 1942). In these In

methods,

asked to associate to the stimuli, and the therapist records and ana-

clients are

lyzes these productions.

The ambiguity of the

stimuli creates a situation in

which uncon-

and can then be deduced from

scious processes are thought to be projected onto the cards,

the nature of the client’s responses.

Other psychoanalytic writers endorse the idea of doing a mental

status

exam

(a struc-

tured, formal assessment of psychological functioning including orientation to person, place, time, reality testing,

and so

forth)

and an assessment of ego strength

DSM-IV-TR

This evaluation leads, according to Yalof, to both a formal as a “diagnosis”

from

(Yalof,

2005).

diagnosis as well

a psychoanalytic perspective.

Overview of the Therapeutic Atmosphere Freud spent Flis early

many

years searching for the

most

efficient

ways to access the unconscious.

attempts relied heavily on hypnosis because he had observed the famous Char-

symptoms of hysteria through this method. Because he found that some individuals were not very hypnotizable, Freud abandoned the practice in favor of placing his hands on clients’ foreheads to evoke memories. Interestingly, in his early attempts to grasp the unconscious, he would exhort his clients to remember and was quite interpretive and forceful in his approach. Later on he deplored such behavior, terming it “wild analysis” cot recreating the

(Freud, 1910/1957). At one point, Breuer

came

and Freud were

to believe that the source of a cure for hysteria

(the client called

it

“chimney sweeping”; Breuer

Gradually, Freud that the therapist

tionship.

He

is

came upon to

was

catharsis, or

& Freud,

the position with

treating a client together

and

emotional expression

1895/1937).

which we

familiarly associate analysis

remain “abstinent,” or a neutral stimulus, in the therapeutic

rela-

described the attitude of the therapist as one of “evenly suspended

attention” (Freud, 1912/1958, p.

from the interaction, leaving the

1 1

1).

Freud banished the personality of the therapist

client free to project her

unconscious material into the

analytic situation.

One

of the most conspicuous features of

Freud’s couch

was

a gift

from one of his

classical

psychoanalysis

clients (Gay, 1988).

is

the analytic couch.

These and other incidents (such

PSYCHOANALYSIS

49 meals and analyzing his

as inviting clients to

own

daughter) suggest that although Freud

preached abstinence and strong client-counselor boundaries, he

Freud had sitting lyst let

two reasons

at least

behind

it,

out of the

for the use of the

liberally

broke the rules too.

couch and the tradition of the analyst

preventing the client from seeing the ana-

client’s view. First,

helped to maintain the abstentious atmosphere.

The

therapist,

who

admonished

is

to

the client’s unconscious work, might reveal something or otherwise influence the client

through her at for 8

Freud also admitted that he simply did not

facial expression.

hours a day (Freud, 1913/1958,

Psychoanalysis

is

a long-term process.

some of them

days a week),

on

analysts even took their clients along

who

Glenda,

be stared

p. 134).

Freud believed in seeing

Mild

for years.

like to

his clients daily

(i.e.,

cases required 3 days of analysis a week.

six

Some

vacations!

typically performs classical analysis,

would like Barb

a week. However, arrangements might be made for

less

to

come

to therapy

5 days

frequent sessions if financial

concerns interfere. Afier a few exploratory sessions (in which assessment of suitability for

was the focus), Glenda asks Barb

analysis

to lie

on the couch and obey the fundamental

rule” (discussed next).

Freud

on

finally settled

that his clients

free association as his primary analytic technique.

obey the “fundamental rule” of psychoanalysis: The client is

thing that comes into his head, even

him unimportant oi actually

if it is

disagreeable for

Glenda

is

different

make any sense; they were only

to try to

to say

to reveal “every-

even

if it

seems to

from everyday conversation.

to be totally honest with him.

describes the fundamental rule to Barb, even using Freud's

agrees to this contract,

it,

insisted

nonsensical” (italics in original, Freud, 1940/1964, p. 52). Freud

explained to his clients that what happens in analysis

They were not

him

He

Glenda feels she can proceed with the

own

words.

When Barb

analysis.

Roles of Client and Counselor Both the nature of the theory and roles

its

historical roots in

medicine combine to create the

of the client and counselor in psychoanalysis. Freud was

belief that

we

are unable, for the

for the therapist

fundamental

rule,

In addition,

it is

most

and the patient and

first,

and

his

our unconscious led to the doctor role

role for the client.

The

client

must comply with the

in turn, the therapist will correctly interpret the client’s productions.

the therapist

resistance, transference,

take the surgeon as a

part, to access

a physician

who

decides

what

is

real

and countertransference that

model “who puts

aside

all

and not

follow).

his feelings,

real (see the sections

on

Freud urged

his students to

human

sympathy, and

even his

concentrates his mental forces on the single aim of performing the operation as skillfully as possible” (Freud,

1912/1958,

p.

1

15).

Freud believed that to achieve the proper attitude

undergo analyses themselves.

“It

may

to interfere

with his

candidates should

be insisted, rather, that he should have undergone a

become aware of those complexes of his own which grasp of what the patient tells him” (Freud, 1912/1958,

psychoanalytic purification and have

would be apt

as a psychoanalyst,

PSYCHOANALYSIS

50 p.

116). This analysis

termed the training, control, or personal

is

Roazen (2002) presents evidence that Carl Jung

(see

Chapter

3),

analysis. Interestingly,

Freud

s

student and

later

nemesis, originated the idea of the training analysis, not Freud.

Glenda takes the orientation that she

associations in terms of Barb’s unconscious process.

opaque in her

sessions

and understand Barb’s Glenda remains relatively passive and

the expert, able to listen to

is

with Barb, becoming active only when she has something

to inter-

pret to Barb. She expects Barb to cooperate with the analytic goals by freely expressing every-

thing that comes

to

mind.

Goals The

goal of psychoanalysis

and

to strengthen the ego

is

is

to help the client

by redirecting energy

uncover and resolve unconscious conflicts to conscious processes.

not really interested in symptoms; these will go away

if

The

psychoanalyst

the analysis succeeds. In

sim-

fact,

symptom Is useless because the conflict will inevitably be expressed through symptom, a phenomenon known as symptom substitution (Yates, 1960).

ple removal of a

some other

Glenda attempts

Barb understand how her current behaviors and symptoms are

to help

lated to unconscious conflicts in her past.

emotions slowly begin

to surface.

As Barb flee associates, her

memories and

Barb examines her early memories, particularly

relationship with her parents and siblings. ness

repressed

With Glenda’s help. Barb will begin

ofpsychic material and events that have long been unavailable

to

re-

those

to gain

ofher

aware-

her conscious mind.

PROCESS OF THERAPY Arlow (2005)

identified four phases of psychoanalytic treatment.

describing these phases, you should understand

However, before

some important psychoanalytic

constructs

relevant to intervention.

Insight The

goal of psychoanalysis

behavior and symptoms

as

is

insight.

The

client will

understand the sources of her current

stemming from unresolved unconscious

childhood. In essence, the counselor

is

conflicts originating in

teaching the client to think in psychoanalytic terms.

Resistance In

any

analysis,

one

will see the

of resistances. Because

it

apparatus fights to keep

is it

workings of the unconscious ego and superego

dangerous for unconscious material

in the

form

to surface, the psychic

out of awareness, using any means possible. Early forms of

resistance to treatment can be seen in such tactics as having

nothing to

say,

being

late to

or missing sessions, being unable to pay the analyst, and so forth. All of these are “grist for the mill” for the psychoanalyst,

most powerful, and (discussed next).

in the

and they

are eventually Interpreted to the client.

end the most healing,

resistance

is

The

the transference neurosis

PSYCHOANALYSIS

51

Transference Over the key to

came gradually

years of his work, Freud

and the

secret

is

called the transference “ambivalent”

to analyze

and negative emotions toward the

the- role

of the

erotic

mother or

and

(1940/1964,

positive

client’s

special favor.

Much

the

175) because

p.

Most

therapist.

Thus, the

father.

resolve this transference neurosis. Freud

client

composed of both

it is

can

often, the therapist fall

in love

of the transference reaction

is

is

placed in

with the analyst (the

component), but then become angry when the analyst does not return

show her

is

Every client inevitably recreates a pivotal former relation-

sticcessKil psychoanalysis.

ship with the analyst,

to the conviction that transference

this love or

rooted in the Oedipal complex.

number ofsessions, Barb will begin to develop a therapeutic bond with Glenda. At first, this bond is likely to be positive, but as the relationship develops, ambivalence and resistance will start to emerge. Barb may be initially quite loving of her therapist, perhaps After a

wanting

to

recapture the ruptured relationship with her mother.

An

alternate possibility

is

that she will be trying (unconsciously) to recreate her special relationship with her father.

She will want

know

about Glenda, ask for special favors (such as changing the time ofher appointments or not having to lie on the couch). As the analysis progresses and Glenda refuses to gratify such wishes. Barb may become angry with Glenda, refusing to fee associto

all

ate or discounting Glendas interpretations. She toms.

The ambivalent

may also

Barb has toward her

feelings

impulses ofseeing her mother as a competitor

develop

new and troubling symp-

therapist stem

fom

her Oedipal

and responsible for her lack ofa penis. IfBarb

transfers her feelings for her father to Glenda, then Barb’s

anger will duplicate Barb’s rage

at her father’s rejection of her.

Countertransference Countertransference analysis. Conflicts

is

what happens when the

from the counselor’s past

the therapist loses her objectivity.

The

therapist has not

a proper training

are projected into the analytic situation,

becomes

client

had

countertransference), or the therapist begins to

want

and

“special” to the counselor (a positive

to argue or gets

angry with the

client.

The counselor may find herself looking forward to or dreading seeing a particular client. The only way to resolve countertransference is for the analyst to seek the aid of her training analyst or a professional consultant.

At

the conclusion

of her academic

Glenda underwent her training analysis

training,

requirement for her certification as a full-fedged analyst. As a to listen neutrally to Barb’s associations

and avoid responding on

fiets. In the event that

Glenda

and behaviors, Glenda

will seek analysis to

feels

result,

that she

is

Glenda

the basis

is

of her

as

a

now able own con-

reacting emotionally to Barb’s associations

work through her own

difficulties.

Phases of Therapy The

four stages of psychoanalytic treatment are

of transference,

2005,

p.

35).

(c)

working through, and

(a)

the opening phase, (b) development

(d) resolution of the transference (Arlow,

PSYCHOANALYSIS

52 Opening Phase. The are

first

an attempt to see

few sessions with the

if analysis is

client are typically

appropriate (Arlow, 2005).

conducted face-to-face and

The

must have

client

of psychological sophistication to engage in the analytic process, and the problem pre-

level

sented should be suitable from the perspective of psychoanalytic theory serves the client’s presentation is

good candidate

a

a certain

comes

ever

to

analytic couch.

mind and

client’s conflicts

listens to

for analysis, the

on the

take her place

and

and

is

explained and the client

is

asked to

analysis then begins, with the client relating

what-

the therapist observing these productions to get an idea of the

characteristic defenses.

Development of Transference. As the

This stage

lasts

3 to 6

months (Arlow, 2005).

client continues to free associate, she eventually gets

closer to relating her current difficulties to unconscious material.

therapist begins to

counselor ob-

her story If the analyst decides that the client

fundamental rule

The

The

become

a very

important figure in the

At about

client’s life as

this time, the

the client starts to

transfer to the analyst feelings associated with past significant others (Arlow, 2005).

According to Arlow, “the professional relationship becomes distorted

as the patient tries

to introduce personal instead of professional considerations into every interaction” (2005, p. 36).

The

therapist analyzes these interactions

and

interprets

them

to the client, starting

with relatively benign, surface observations and progressing to interpretations involving

deep unconscious material. This process

is

called analysis of the transference.

Working Through. As therapy progresses, the transference appears in analyzed.

Once an

incident

new memories from sis

is

and more elaborate

working through phase, which relationships

When

the analyst

into her conflicts

and the transference

Commonly,

event

client client

for analy-

becoming more confident about the

feelings,

and

and behavior and her

past.

client decide that the client has insight

process, a date

is

set for

termination of the therapy.

marked by a resurgence of the client’s symptoms because the does not want to give up the therapist. This infantile urge is then analyzed by the and therapist. New memories and fantasies can surface during this stage of treatthis

is

ment, which are then interpreted, until the client

what

new material

analysis of the transference constitutes the

results in the client

between her current thoughts,

Resolution of Transference.

is

analyzed and the client accepts the therapist’s interpretation,

the client’s past are likely to surface, providing

(Arlow, 2005). Repeated

many forms and

life

will

be

like

finally deals

with no therapist (Arlow, 2005). At

with her fantasies about

this point,

therapy can end.

THERAPEUTIC TECHNIQUES Very few techniques are available to the therapist quite powerful. Generally, the counselor overt technique

is

is

in psychoanalysis,

but they are considered

to be passive, rather than active, so the lack of

consistent with this attitude.

Eree Association As

I

tion.

indicated

Only

earlier,

the

in the special

scious start to

show

itself

most important weapon

in the therapist’s arsenal

environment created by the fundamental

is

free associa-

rule will the

uncon-

PSYCHOANALYSIS

53

Interpretation The second powerful technique clients material as

it

available to the psychoanalyst

from the

relates to conflicts

mature interpretions evoked resistance

past.

is

interpretation of the

Because Freud had found that pre-

made

he insisted that none be

in his clients,

the client was almost ready to discover the connections herself Further, one

developed a sufficient

level

and deep unconscious material

Interpretation plays a part in the

and dream

resistance

analysis.

Glenda Bards

and

is

client,

is

is

oriented toward

here, analysis of the

Correct interpretations of the transference are is

critical so that

not based in the actual relationship between

but in relationships in the

interested in the associations

past.

Barb produces

as she engages in the analytic process.

initial productions will be not very close to her unconscious urges, so

Glenda

general

and

feelings

about men, but instead ofbringing up Oedipal issues, Glenda will likely talk

cautious in interpreting the material. For instance,

Barb may

aboutfeeling unloved and rejected while at the same time longingfor a savior. could tentatively relate Barb’s feelings about finally to

Glenda (who by then

represents

more

addressed later in the therapy.

two other techniques described

the client can finally see that her behavior therapist

must have

of relationship with the client (the transference) prior to inter-

pretation. In general, interpretation in the early part of therapy

“surface” material,

until

men

to those

talk

is

very

about her

Later,

to

Barb

Glenda

about her father, her abuser, and

a powerful, important person in Barb’s

life).

Analysis of the Resistance The

psychoanalyst must always be alert for signs of client resistance. Minor,

sistances (such as forgetting

appointments or having nothing to

for the client, lest they get in the

the client this

is

may begin

yet another

say)

form of resistance,

is

to disappear,

and

knows

that

getting well. Flowever, the wise analyst

called flight into health.

more threatening material, such and analyzed much more cautiously. In fact,

As

re-

must be interpreted

way of treatment. Symptoms may begin

to think that she

common

analysis continues, resis-

tances connected with

as

terpreted

the transference neurosis will have

to be reinterpreted

At some point in

many

resistances,

times (called “working through”) before the client can resolve

it.

Barb will show signs ofserious resistance. She may openly refute grow silent, or miss sessions. Glenda will remain calm in the face of

the analysis.

Glenda’s interpretations,

such

the transference neurosis, are in-

gathering information

begin to feel better

and want

to

to

make her case

Barb may at some point

convincing.

discontinue analysis. Glenda will interpret this “flight into

health” as Barb’s aversion to dealing with dijficult material. Glenda will then ojfer repeated interpretation

New

of the feelings of being unloved and worthless until Barb begins

information will surface

right,

Glenda will begin

and

to ojfer

be interpreted, perhaps at deeper

more intense

levels.

to

accept

When

these.

the time

is

interpretations involving Oedipal material

Dream Analysis The most

special place of

original

dreams

in

psychoanalytic theory

is

considered to be one of Freud’s

and important contributions. His 1900 book. The

Interpretation

of Dreams,

PSYCHOANALYSIS

54 was probably the work of which Freud was most proud, and

is

considered by

finest.

Freud considered dreams to be symbolic wish fulfillments.

itself a

neurotic

symptom

vantage of occurring in

dreamer reports a

dream

reasons

all

known

is

(i.e.,

the content

healthy people” (Freud, as the

is

1

and

920/ 1 952

p. 87).

The content

which has been disguised by dreamwork

is

symbols” (Freud,

1

that the

for the usual

of the most interest to psychoanalysis. free associate to the content.

interprets the latent content

920/ 1 952,

p. 161).

Box

When

The

a

alert

from the manifest content.

As you might have divined, an “overwhelming majority of symbols ual

is

unacceptable to the conscious). Elements in the dream are only

dream, the analyst then asks her to

analyst then listens

wrote, “A dream

manifest content. However, the most important part of

substitutes for the latent material that client reports a

his

and, moreover, one which possesses for us the incalculable ad-

the latent content, that

is

He

many

2.3 shows a

list

in

dreams

are sex-

of dream elements and their

when examining such lists, remember that and that dream elements may even represent the

hypothesized underlying contents. However,

may have

symbols

multiple determinants,

opposite of what they appear to be. For example, in one of Freud’s most famous cases, the

wolf man) had dreamed that he woke up and saw

client (the

tionless outside

of his window. Freud interpreted

this

dream

a

as

pack of wolves

sitting

mo-

symbolic of the wolf man’s

early observation of vigorous parental sexual intercourse, but the stillness of the wolves

represented the opposite (Freud, 1918/1955).

Box 2.3

The Meaning of Dream Symbols In

A

General Introduction

to Psychoanalysis

(1920/1952), Freud wrote that “the number

of things which are represented symbolically in dreams a whole, parents, children, brothers

more” (here Freud meant

and

sex; p. 160).

sisters, birth,

By far,

ing to Freud, have to do with sex. Following this

is

not great.

The human body

death, nakedness

—and one thing

the majority of symbols in dreams, accordis

a

list

of symbols presented by Freud in

work, along with their possible interpretations.

Symbol

Interpretation

House

With smooth walls, a

man

With ledges and balconies, a Exalted personages (queens.

emperors, kings, Little

Water

Parents

etc.)

animals or vermin (falling into,

climbing out of)

Children, brothers, sisters Birth

Traveling by train

Dying

Clothes, uniforms

Nakedness

The number three

Male genitals

Long and upstanding objects

Penis

(sticks,

umbrellas, trees, etc.)

as

woman

PSYCHOANALYSIS

55

Symbol

Interpretation

Objects that can penetrate

Penis

(knives, fire-arms)

Objects from which water flows

Penis

(springs, taps)

Objects capable of elongation (pencils that slide

in

and out

Penis

of

sheaths)

Balloons, aeroplanes, zeppelins

Penis (the property of erection)

Flying

Erection

Reptiles

and fishes

Penis

Serpent

Penis

Objects that enclose a space

(pits, jars,

Female

genitalia

bottles, boxes, chests, pockets)

Cupboards, stoves

Uterus

Rooms

Uterus

Doors and gates

Opening

Church, chapel

Woman Woman

Snails

and mussels

of the

vagina

Breast

Fruit

Woods and

Pubic hair (both sexes)

thickets

Landscape

Female

Machinery

Male

Jewel case

Female

genitalia

Blossoms or flowers

Female

genitalia

Play

Masturbation

Sliding or gliding

Masturbation

Teeth

Punishment

falling

out or extracted

genitalia

genitalia

(castration) for masturbation

Dancing

Sexual intercourse

Riding or climbing

Sexual intercourse

Experiencing

some

Mounting ladders, steep places,

Windows

Sexual intercourse

violence stairs

Sexual intercourse

Body openings

or doors

Key

Penis

Oven

Uterus

Plow

Penis

Barb

reports to

Glenda that she had the following dream: She

is

at work (in the grocery

the

and is carrying two bags ofgroceries when she trips andfalls, scattering the contents of bag and breaking glass items. What caused Barb to fall was a broom that was carelessly

lefi

in the grocery aisle area by Carlos, one

store)

Most likely, Glenda would see

of the other workers in the store. Barb's dream as Oedipal in nature. The bag

represents her

womb, full ofgoodies. Barb trips over a phallic object (the broom), and everything is broken. Clearly, Barb is expressing her desire for sex or perhaps her fear of it. Glenda has to discover which interpretation

is

correct based on Barb's associations to the dream. Because

Barb

reports

PSYCHOANALYSIS

56 being afraid and anxious in the dream (manifestly attributed

Glenda concludes that Barb’s dream

boss),

with her father. Carlos

is

to fear

represents her fear

ofpunishment by her

offorbidden

sex; that

is,

sex

merely a safe substitute for Barb’s father, inserted into the dream

by the dream censor. Barb’s superego takes the frm of the

boss.

Analysis of the Transference The

ultimate key to a successful analysis

client will unconsciously transfer

is

the analysis of the transference neurosis.

The

onto the counselor qualities of significant individuals

in

her past, particularly parental figures. Feelings associated with these early interactions are evident in the client— counselor relationship, which, in the analyst’s view, are unreal because the analyst has been properly abstinent in the therapeutic environment.

Cautiously, the counselor interprets the client’s behavior and feelings, starting with the

threatening aspects. Early on, the transference

least

would

resulting in clients idealizing the therapists as they

can

enlist this energy,

and

this transference

often affectionate and positive, their

“good” parents. The analyst

encouraging the client to work hard to understand her unconscious

Over the course of the

material.

is

is

therapy, the deeper issues

emerge into the transference,

usually erotic in nature or hostile, resulting in powerful resistance

(Freud, 1915/1958). For example, a female client might perceive a male therapist as unlov-

ing and uncaring, echoing the earlier rejection by her

Male

clients

may

own

transfer to a female analyst feelings

father in the Oedipal phase.

about their mothers, becoming

angry when the therapist refuses to gratify their wishes to be these examples involve cross-sex pairings. Flowever, in

special.

many cases,

You

will

note that

transference feelings are

not dependent on the sex of the analyst. For example, feelings of anger directed

at

an

authority or power figure could be transferred to a therapist of either sex.

The

job of the analyst, then,

feelings that she

is

is

to interpret the transference,

having are not

real,

showing the

but instead rooted in the

and sometimes tedious because transference tends

to

client that the

This process

past.

pop up again and again

is

long

in the rela-

tionship. Analysts call this process “working through.”

As her work progresses, Barb will begin

to feel that

Glenda does not care about

ference of her feelings of being unwanted, mistreated,

unresolved Oedipal complex. Barb

anger

to

is

also likely to

and unloved

a trans-

that result from her

become angry at Glenda, attributing her

Glenda’s uncaring treatment ofher. Glenda interprets these feelings as transference

offeelings

resulting from the longing associated with her father’s abuse

Some of Barb’s feelings might also stem from away. Barb’s transference

is

likely to

and abandonment.

her rage at her mother for stealing her father

be quite ambivalent, however, vacillating between

desperately seeking Glenda’s love (reflecting Barb’s longing for her father)

abandonment early on age)

her,

and his

and anger

at his

ofthe Oedipalfantasies or abuse she suffered at that early abuse of her as a teen. Feelings of distrust of Glenda could also appear as a (the result

of Barb’s feelings about her father or her ambivalent feelings about her mother. Glenda will patiently interpret these feelings for Barb, slowly demonstrating that Barb’s

result

reactions are based in her psychological conflicts rather than in reality.

Eventually,

Barb will come

Glenda are not

real.

Together,

to recognize that the feelings

and

impulses she has toward

Glenda and Barb work through multiple examples of this

PSYCHOANALYSIS

57

transference until Barb understands fully the nature

ofher psychological processes. Barb will

probably always have some of the same tendencies to be angry at men and mistrusting of others, but she will have insight into them and will be more able to operate based on ego rather than id or superego processes. Afier a lengthy analysis,

termination, but shortly after she

and Glenda

Barb

is finally

ready

to

begin

begin to discuss ending the analysis, Barb's

symptoms, which have almost disappeared, reemerge. Glenda helps Barb see that

this resur-

ofBarb's not wanting to give up the safe analytic relationship. When Barb can fully acknowledge this interpretation, she is truly ready to end the analysis.

gence

the result

is

EVALUATION OF THE THEORY There

no doubt

is

and scholarly

that psychoanalytic theory has

most

seling (e.g.,

a

major impact on

and the

disciplines, including literature, psychology,

and psychotherapy Reactions the

had

idolized

admit that

and their

professional

practice of counseling

to psychoanalytic theory are rarely neutral;

criticized theory in existence.

many it

seems to be both

Numerous prominent theorists of coun-

approaches were developed partly in reaction to psychoanalytic theory

individual psychology. Rational Emotive Behavior Therapy, Reality Therapy, Cognitive

Therapy, Person-Centered Therapy). Because of the sheer volume of literature that critiques the psychoanalytic approach,

Thus,

will

I

simply impossible to summarize succinctly in

it is

this section.

attempt to hit only the high points of these evaluations, leaving the interested

scholar a lot of fascinating reading.

Psychoanalysis has also spawned a second generation of analytically oriented theories,

subsumed under the headings psychoanalytic (small p), neoanalytic, or psychodynamic. They are also called self psychology, ego psychology, or object relations

generally

theory

(St. Clair,

2004). Theorists associated with these approaches are Fairbairn, Kohut,

Kernberg, Klein, Jacobson, Mahler, and Winnicott. Their theories share an interest in mental representations of self and others

You

will read

more about

(i.e.,

objects)

and how these influence

relationships.

these theorists in Chapter 3, Neoanalytic Approaches.

Qualities of the Theory Precision

and

Testability.

One

of the most

not very testable. Entities such as the researchers

must be

satisfied

id,

common

ego,

critiques of Freud’s theory

and superego

relates to falsifiability. It

is

that

it is

are not easily observed directly;

with only indirect evidence of their existence.

lem with psychoanalytic theory

is

A second

prob-

very difficult to disconfirm psy-

choanalytic theory. Consider, for example, the idea of resistance. If an analyst makes an interpretation that the client rejects, the client can be said to be resisting because the client is

too threatened to acknowledge

it.

If the client accepts the interpretation,

it is

right,

end

of story. Monte (1999) gives the following example: Imagine six years,

telling the

mythical

his penis. If

us for being offensive,

because he

more we

the street” that

sometime between ages three and

he lusted after his mother, hated his father, and was terrified that his father

would remove cisely

“man on

are

is

our

we must

man on

the street protests that this

point out to

him

repressing these experiences!

prone to assume that he

is

males, has repressedWis Oedipal strivings.

that he

is

is

nonsense or berates

incredulous or offended pre-

And, indeed, the more he

protests, the

threatened by these ideas because he, like

What

possible evidence could the

all

man produce

PSYCHOANALYSIS

58

would disconfirm our

that

1999,

p.

was Oedipal

as a child?

(Monte,

italics in original)

97,

difficult to derive precise predictions

It is

from psychoanalytic theory that might be

eas-

In psychoanalytic interpretation, things are often their opposite (as with the wolf

ily tested.

man

theoretical assertion that he

or defense mechanisms). Further, reading Freud in the original reveals his heavy

reliance

on metaphor

in his descriptions

of psychic functioning. Maddi cautions that such

language impairs the precision and clarity of the theory (1996,

492). Finally, because of

p.

the various revisions of psychoanalytic theory, different interpretations can be

same or

made of the

phenomena.

similar

Other views of the (2005) and Westen

( 1

testability

of psychoanalytic theory are

negative. Borenstein

less

998) have argued persuasively that significant support

exists for

some

of the basic assumptions of psychoanalytic theory. Borenstein contends that other branches of psychology have co-opted psychoanalytic constructs and amassed data in support of

them. Evidence for

this

argument can be found

in

Westen s (1998)

review,

summarized

in

the theory-testing section. Seeing this state of affairs as partially a public relations problem,

Borenstein suggests that psychoanalysts need to reclaim the scientific heritage that was so

important to Freud.

Empirical

Validity.

A

good theory should have some empirical support. As you on psychoanalytic theory

the research support section, the evidence bearing

Research reviewed in Chapter 3

is

will see in is

mixed.

also relevant to psychoanalytic theory.

Research Support \

Outcome Research. As with the other major ally

theoretical approaches,

outcome

supported the efficacy of psychoanalytic psychotherapy (Lambert

ever,

we should

note that most outcome research

the couch) psychoanalysis. For instance, the

is

research has gener-

& Ogles,

2004).

How-

not assessing traditional (5 days a week on

Temple study (Sloane

et al.,

1975) found that psy-

choanalytic psychotherapy (weekly sessions for 3 months) was as effective as Behavioral Therapy,

and

that both were

1992; Svartberg

&

more

effective

Stiles,

than no treatment. Meta-analytic studies (Crits-Christoph,

1991) support the efficacy of short-term psychodynamic therapy

treatment compared to no therapy, but the findings are mixed

apy

is

compared

to alternative treatments. Short-term

based, but tests of this

mode

are

probably not good

when

short-term dynamic ther-

dynamic therapy

tests

is

psychoanalytically

of traditional psychoanalysis.

The Menninger Foundation conducted an intensive study of psychoanalysis, called the Psychotherapy Research Project, or more commonly, the Menninger Project (Wallerstein, 1

986,

1

989).

Funded by several

private

and public

sources, the project investigated various

forms of psychoanalytic psychotherapy, including traditional psychoanalysis. The the p.

Menninger Foundation tended

to be “seriously emotionally

195) and were often sent to the foundation as a

discriminate

among

classic

psychoanalysis,

last resort.

expressive

ill”

clients of

(Wallerstein, 1989,

This project attempted to

psychotherapy, and supportive

psychoanalytic treatment, but generally found that the distinctions between the three

approaches were not

methods

as clear as expected.

A

major aim of the study was

that did not disturb the psychotherapy process. For this reason,

not amenable to summary.

to use naturalistic

outcome data

are

PSYCHOANALYSIS

59

Leuzinger-Bohleber and Target (2002) reported on the “German studies” of psychoan-

which focused on the outcomes of long-term intervention. This

alytic therapies,

conducted clients,

study,

1990s, relied heavily on retrospective reports of therapists and

in the late

Symptom Check

although they did administer the

List-90R (SCL-90R; Derogatis,

1994). Like other large studies of therapy, they found that most clients in analytic ther-

apy of some form reported improvement, that the former clients were mostly

as

did the therapists.

SCL-90R

below the mean score defined

scores revealed

as “clinical”

based on

German norms. Masling, Bornstein, Fishman, and Davila (2002) presented an interesting study of gen-

They wanted

der differences in psychoanalytic research.

given the often-touted bias against

women

to see if there

in analysis, that research

constructs was equally biased. Specifically, they looked to see

more

ipants

any evidence,

on psychoanalytic

research used male partic-

often than female and also, whether psychoanalytic constructs could better

predict the behavior of effect sizes

if

is

men

women.

than

A

meta-analysis of 98 studies revealed that

were stronger for predictions of males’ behavior when both females and males

were included

in studies. Ffowever,

ined (separately), effect

sizes

when

studies that only looked at

one sex were exam-

were roughly the same. These findings are hard to explain, for

they suggest that psychoanalytic theory predicts the behavior of males better than females

when both

sexes are the subject of study but predicts equally well

research are of one sex only. Masling et studies

may be

al.

when

participants in

suggest that investigators in these two types of

considering different questions, but don’t offer any evidence to support this

hypothesis.

Theory-Testing Research.

although

many of the

Theory

testing research does exist in the psychoanalytic realm,

empirical studies of pure psychoanalytic theory are dated and can be

questioned on methodological grounds. For example. Levin (1966) examined penis envy

and found that

“career

women” showed more

penis envy than did married

women who did

not work outside of the home, fdowever, the measure of penis envy was based on the

Rorschach

when

another projective device with debatable psychometric properties,

test,

considering the measurement of penis envy. In yet another

struct,

test

of the penis envy con-

Johnson (1966) expected that more females than males would

fail

to return special

pencils after completing a test in a psychology class, indicating that penis envy tive

among

women.

the

was opera-

Results of the study confirmed Johnson’s prediction.

recent replication of the study failed to support the hypothesis that

more

pencils/penis symbols (Skinner, 1977).

at least

A more

women would

steal

coveting pencils a good measure of penis

Is

envy? You can see the difficulty in operationalizing this psychoanalytic construct.

Eysenck and Wilson (1973) presented an interesting and informative book in which studies testing psychoanalytic theory are presented, each followed by Eysenck and Wilson’s methodological evaluation.

On

the basis of their review, Eysenck

that “the studies looked at in this

and

theories.

.

.

.

volume

give

little if

and Wilson concluded

any support

to Freudian concepts

several of the studies dealing in particular with treatment

and with

‘sin-

gle case’ investigations give results powerfully challenging Freudian hypotheses” (1973, p.

392). However, Eysenck has long been

Other reviews paint

a

more

known

as a critic

of the psychoanalytic approach.

positive picture (e.g., Kline, 1972; Sears, 1943), although these

authors could be accused of the opposite kind of bias.

PSYCHOANALYSIS

60

More

recently,

Westen (1998) summarized the research on

five postulates

of psychoan-

alytic theory:

1

.

The

existence

and

centrality of unconscious processes

2.

Conflicting feelings and motivation that result in ambivalence and compromise

3.

The role of childhood experiences and their impact on adult relationships The importance of mental representations of the self, others, and relationships

4.

in social

interaction 5.

The

development involves learning

idea that

dencies and that

and aggressive ten-

to regulate sexual

progresses from immaturity and dependence to maturity and

it

independence.

Adapted from Westen, 1998, pp. 334—335.

Reviewing an impressive amount of social psychology,

Westen concluded

literature

that there

is

from cognitive, developmental, and

ample support

for the five propositions.

For example, Westen reported that the idea that unconscious processes influence overt behavior

is

“no longer controversial”

(p.

336). Studies of subliminal exposure (exposure to

stimuli in very brief intervals that are not registered in conscious awareness) confirm the

idea that these stimuli can affect emotion, preferences,

and

Westen presented

attitudes.

similar evidence in support of the other psychoanalytic assumptions. Scientists

work had better read this article. centers on constructs that are involved

who want

to dismiss Freud’s theoretical

Other recent research such

as interpretation

in psychoanalytic therapy

and the working alliance (Henry, Strupp, Schacht,

& Gaston,

1994).

Henry and colleagues (1994) concluded that were not related to good therapy outcomes. However, they

In a major review of these research areas,

transference interpretations

noted that client emotionaf expression following such interpretations

outcome, but only affect. is

The

is

linked to positive

more so than nontransference interpretations that induce client on Core Conflictual Relationship Themes summarized in Chapter 3

slightly

research

also relevant to classic psychoanalytic theory.

Of

interest to psychoanalytic theorists

alliance, or the relationship

proceed. seling

The

alliance

is

is

client

is

across

many

the construct of working

and therapist that allows the work of therapy

research assessing the relationship between the

outcome has cut

relationship

between

and researchers

theoretical orientations

working

alliance

and generally

modestly related to outcome in the expected direction

related to better

outcome; Lambert

Ogles, 2004).

(i.e.,

Of note

is

to

and coun-

finds that the

more

positive

that clients’

and

independent observers’ ratings of the alliance are more predictive of outcome than therapists’,

raising a question

with clients (Henry

et ah,

about

therapists’ objectivity

1994).

None of these

when

assessing their relationships

findings are supportive of the theoretical

structure of psychoanalysis specifically.

A

major area of research that bears on psychoanalytic constructs

termed the repressed Kluft

&

memory

is

centered on what

controversy (Enns, McNeilly, Corkery,

Loftus, 2007; Loftus, 1993; Loftus

whether individuals traumatized

at

can repress and then later accurately

&

&

is

Gilbert, 1995;

Ketcham, 1994). This debate centers on

an early age, particularly in the case of sexual abuse, recall

memories of the

incidents.

These questions can

be seen as relevant to the validity of Freud’s construct of repression. Enns and colleagues (1995), in their review of the historical, political, and scientific issues involved in this

PSYCHOANALYSIS

61

debate, discussed Freud’s repudiation of the seduction hypothesis as perhaps the

first inci-

dent of denying the memories of abused women.

The

issues discussed in the area

cal rather

of repressed

The

than scientific (Brown, 1995).

memory

have been characterized

as politi-

recent interchange of opinions has been con-

Memory Syndrome Foundation, an organization what they termed “false memory syndrome,” seen prima-

nected to the establishment of the False

was founded

that

rily in cases in

the abuse.

to investigate

which

a survivor of sexual abuse recovers previously repressed

The proponents of false memory syndrome contend

memories of

that psychotherapists in-

duce such memories via suggestive psychotherapeutic techniques.

At the heart of the repressed memory controversy fact repress

memories of events

in

our

lives, a

the question of whether

is

shown

percentage of victims of sexual abuse report that at some time in their

remember

the other side, research suggests that

ries

(Loftus

& Clancy, 2006).

simple to implant created

memo-

&

self-reports used in the recent

cal

relatively

they were un-

Ketcham, 1994). Briere (1995) pointed out that short of observing someabuse and then following their later reports, establishing the validity of the

one’s

this

it is

that a certain

lives

the abuse (Briere, 1995; McNally, Perlman, Ristuccia,

On

in

question that would certainly be relevant to

psychoanalytic theory Research using retrospective self-report has

able to

we do

memory

studies

is

almost impossible.

controversy for psychoanalytic theory are mixed:

it

The

appears that there

implications of

some empiri-

is

evidence supporting the existence of repression, but support for the ability to accurately

regain

and report repressed memories

is still

ual rather than the

tered by feminist

many other

theories of counseling the position that the individ-

surrounding environment needs to change. This assumption

and

cultural critiques of the theory that insist that

are detrimental to individuals, that oppression of

and that asking individuals Feminists have been

(Enns

& Yasinski,

their

What women envy

anatomy! Feminists

moral, traveling through feriority

(Kaplan

is

1980).

To begin with

& Yasinski,

in 1

coun-

many aspects of society

minorities is

is

debilitating,

wrong.

the obvious, the idea that the

the envy of the penis

is

the traditionally conferred

also criticize Freud’s views life

is

of Freud since the early days of the feminist movement

strongest motivator of female behavior

demeaning.

women and

to adapt to an oppressive social system

critical

1995; Kaplan

et ah,

& Loftus, 2007).

AND CULTURAL DIVERSITY

ISSUES OF INDIVIDUAL Psychoanalysis shares with

a topic of controversy (Kluft

is

seen as outrageous and

power of men

of women

in society,

as passive, inferior,

not

and im-

an endless search for a penis to remedy their inherent

980). Karen

Homey,

in-

own “womb

a psychoananalytic theorist in her

about Freud’s theories, pointing out that he neglected

right,

had

a great deal to say

envy”

as a

source of men’s fear of things feminine (1932, 1930/1967). In an early response

to these criticisms,

Freud characterized them

to force us to regard the p.

two

258). In a larger sense,

complication

in

and the theory ture. Clearly,

role

of the feminists,

sexes as completely equal in position

some of the problems

every theory: a theorist

is

as “denials

is

a

identified

who

are anxious

and worth” (Freud,

by feminists

1

925,

are an unavoidable

product of his or her environment and culture,

directly or indirectly infused with the normative expectations of the cul-

Freud was a participant

of women was restricted and

less

in,

and influenced

by, a culture that

valued than that of men.

was

sexist

—

the

PSYCHOANALYSIS

62

More

recently,

more

the

some

feminists have concluded that psychoanalytic theory, particularly

recently developed offshoots, can be saved (Zanardi, 1990).

identified

two general approaches

Chodorow (1989)

to feminist psychoanalysis: the interpersonal

and the French postmodern approach. The interpersonal approach attempts

approach to revalue

femininity through the use of object relations, self psychology, and Jungian approaches.

A

more

is

postmodern approach

indirect variant of psychoanalysis, the

more often used

From

in literary criticism than in psychotherapy.

a cultural perspective,

it is

might not necessarily

clear that psychoanalysis

translate across cultures.

The

is

are goals in this theory that

& Sue,

levels

a class bias exists:

is

by no means

trea-

2003). Psychoanalysis, in

who have how many

probably only accessible to individuals

pay for intensive treatment. Thus, socioeconomic

rooted in European values.

value of insight

sured in other than European-influenced cultures (Sue

pure form,

is

and individual achievement

Intellectualism, individuation,

its

to psychoanalysis,

the

economic means

to

individuals from lower

have the time and financial resources to devote years to exploring

their inner experiences?

From

(GLB)

a gay, lesbian, or bisexual

perversion,

meaning

that

it

was

perspective, Freud called homosexuality a

a deviation

from what the theory considered normal

GLB

“The most important of these perversions, homosexuality, scarcely deserves the name” (Ereud, 1925/1989, p. 423). Fiowever, the use of the term perversion and the assumption of heterosexuality as normal sexual development suggests, according to some authors, a negative moral judgment (Murphy, 1984). Contemporary authors have noted that given Freud’s notion that humans are inherently bisexual, it is possible to reconceptualize GLB sexuality as a healthy developmental path (Cornett & Hudson, 1986; Murphy, 1984). sexual development. Ffe did not overtly disparage

orientations, saying,

THE CASE STUDY The

client conceptualized in this chapter. Barb, presented

some of

the features often

associated with typical “good candidates” for psychoanalysis. She appeared to be moti-

vated and interested in investigating her psychological processes. Eurthermore, her issues

seemed

to relate to sexual trauma, neatly fitting in with psychoanalytic

the origins of dysfunction in sexual development. fit

thought about

Some of Barb’s symptoms appeared

quite well with a psychoanalytic understanding, such as the fainting and

to

numbness

in the face.

The most

difficult aspect

of Barb’s history from a conceptual standpoint involves the

validity of her early sexual experiences.

would

predict that

most

likely the

As noted

earlier,

memories of the

fantasy born out of Oedipal longings.

To be

fair to

the final version of Ereud’s theory

early abuse

Freud,

it is

by the family friend were important to note that he

did not deny that sexual abuse of children occurred. However, he clearly stated that his clients’ reports it is

of this abuse were mostly untrue. Current data on sexual abuse indicate that

very prevalent, which would lead us to conclude that Barb’s memories are probably

accurate.

However, the

aftereffects

be fixation in the Oedipal stage.

of both

The

point from a practical perspective.

real

abuse and fantasy abuse would presumably

resolution of the validity

dilemma

is

therefore a

moot

PSYCHOANALYSIS

63

Summary Psychoanalytic theory

is

based on the idea that

unconscious and conscious

Thanatos)

is

forces.

The

humans

are motivated

conflicts

expression of instinctual drives

between

(libido

and

not acceptable to society, so the psychic apparatus evolved to suppress them.

Freud proposed that the psyche was composed of three

Dysfunction

by

when

arises

entities: the id, ego,

and superego.

the instinctual urges (most notably libido or sexual drives)

threaten to break into consciousness and are symbolized as symptoms.

Freud proposed an elaborate model of

The most important of these

stages

anatomy of the other

The

the

this stage

is

sex.

complex

the phallic stage, in

is

stages.

which children become aware of

process of resolution of the Oedipal complex arising in

resolved through castration anxiety.

father will find out about his incestuous desires flict

development, the psychosexual

and boys. For boys, who have developed

different for girls

their mothers, the

is

human

through identification with the

and cut off his

father. Girls notice that

a desire to possess

The boy

penis.

He

fears that his

resolves this con-

they have no penis and de-

They turn away from their mothers, but because sex with father is they repress this urge. They continue their lives in search of a penis, most no-

velop penis envy. forbidden,

tably through the birth of a male baby.

Psychoanalysis

is

a long-term process

conducted

projection,

which

client

re-

can project unconscious conflicts onto the therapist. This

typically involves

heart of the psychoanalysis.

model. The client

unconscious material. The therapist

free associates in a process that eventually yields

mains abstinent so that the

in a doctor-patient

The

Oedipal wishes,

is

called transference,

psychoanalytic therapist interprets the

and

client’s

is

at the

uncon-

scious material with the goal of helping the client achieve insight into her conflicts.

Psychoanalysis has long had

many critics.

It is

considered by some to be untestable, and

outcome of traditional psychoanalysis is sparse. The male, western European model, so it draws criticism from femi-

direct empirical support for the

theory also nists

is

based in a

and other scholars of diversity.

Visit

Chapter 2 on the Companion Website

chapter-specific resources

and

self-assessments.

at

www.prenhall.com/murdock

for

Anna Freud

Theo came help,

she

to

counseling after being told by his girlfiend, Tamia, that if he did not seek

would end

their three-year relationship.

American male currently

in his final year

Math and Computer Science. He plans

how

he needs eounseling to

of college at a

to enter the

is

a dd-year-old,

tall,

large university with a

Afican major

in

military afier graduation.

he feels as if he “is going to explode. ” He better understand his problems controlling his anger and

Although he presents calmly, Theo believes that

He

says that

Most recently, Theo became angry with Tamia afier she failed to return his phone call and stayed out “partying” all night. He indicated that Tamia elaimed she had told him about her plans and that his anger felt controlling and threatening. Theo also expressed concern about his inability to control his anger when dealing with his family and professional relationships. it relates to his

Theo

is

behaviors.

the middle child ofthree boys.

When Theo was 10 years

old, his parents

divorced

Two years later, his parents reconciled and remarried. Theo reported that he did not want his parents to remarry and still believes they should not be together because of their regular arguments about finaneial issues and his father’s constant business travel. He noted that his older brother took care of him and his younger brother and tried to maintain peace in the household.

and

Theo’s

mother relocated with the

boys.

Both of Theo’s parents completed college at historically Black colleges. Although supportive of Theo going to college, they wanted him to attend a historieally Black college, especially because most of Theo’s primary

and

secondary school education took place in primarily

White schools. Theo said that even though he chose not identifies strongly

with his African-American heritage.

”

a?id yelling.

64

He

he

still

chose to attend a predomi-

want to follow in his parents’footsteps. He reports was a way ofgetting away from them and, particularly, “a lot offighting

nantly White college because he did not that going to college

to follow his parents’ wishes,

NEOANALYTIC APPROACHES

65

BACKGROUND The

psychoanalytic crowd

Within the group of are a

an interesting subset of the psychotherapeutic community.

is

therapists

number of different

who would

characterize themselves as psychoanalysts, there

from pure

theoretical camps, ranging

orthodox

classicists (i.e.,

Freudians) to a relatively recently developed constructivist approach, relational psycho-

between

analysis. In

are several other identifiable theoretical variants that contribute to

how psychoanalytic therapists and

psychologists,

currently practice. These are the object relations

j'^’^psychologists, interpersonah\\&onsis,

and

the

intersubjectivists. All

of

these theorists/therapists consider themselves direct intellectual descendents of Freud, but all

extend Freud’s theory or deviate slightly or significantly from orthodox psychoanalysis;

hence

my choice

of the label neoanalytic to describe them.

Psychoanalysts like to write about their particular perspectives, and a glance at the

major journals shows that they strains

seem

also

of psychoanalytic theory.

The orthodox

“impure” and “not analytic,” and the

and clinging

to argue a lot

about the validity of the various

analysts criticize the relationists for being

relationists see the traditionalists as living in the past

to outdated ideas. Psychoanalysts like fancy terms

and seem

to favor elaborate

writing styles and so in the midst of the arguments, the variety of names and terms

becomes absolutely bewildering

The

biggest

at times.

bone of contention seems

Freudian theory

is

to be conceptualizations of motivation. Traditional

often referred to as drive theory because of Freud’s conviction that the ge-

netically wired-in instinctual drives (sex

and

aggression) motivated behavior (this

referred to as the genetic or engergic position).

Contemporary

be characterized according to the degree to which they accept or

modern

Eagle, 1997). In fact, a classic in the

which they buy

theorists into the degree to

motivated by the drives or seeing motivation

human

reject drive is

theory (Wolitzky

Greenberg and Mitchell’s

book, Greenberg and Mitchell

classify

(or say they buy) Freud’s notion that behavior as a

&

is

function of an inherent need to relate to other

beings. Across the four approaches presented in this chapter, ego psychologists tend to

be traditionalists, more or

most

this

sometimes

variants of psychoanalysis can

analytic literature

(1983) Object Relations in Psychoanalytic Theory. In

is

less

radical in their rejection

psychology in

this regard,

building on Freud’s original notions. Relational analysts are the

of drive theory. There

because

accept drive theory. Later,

its

originator,

Kohut seemed

in nature (Fosshage, 2003).

to

is

some argument about

Heinz Kohut, seemed

abandon

in his early writings to

this perspective for

Otto Kernberg, according

to

the status of self

one more

relational

Greenberg and Mitchell, liked

to

maintain that he was a drive theorist, but their analysis of his theory suggests otherwise.

Object relations (with the exception of Melanie Klein,

and

relational theorists

Drives is

vs.

who

accepted traditional drive theor)9

adopt the view that humans are motivated by the need to

relationships aside, the

most important relationship

for

all

that with the primary caretaker. Thus, the mother-child relationship

of attention child care). ical

(for the

most

The mother

is

part, they

were writing prior

to

relate to others.

of these theorists is

often the focus

our current enlightened views of

most important because she has the

breast, the source

of biolog-

sustenance for the infant.

Newer

versions of analytic thought go

opment. For example, these systems

are

beyond Freud’s theory

thought to be helpful

severe forms of dysfunction, such as psychosis,

in

in the area

of devel-

understanding more

and borderline (meaning

to psychosis)

and

—

1

NEOANALYTIC APPROACHES

66 narcissistic states.

These types of problems

are

thought to originate

earlier

than the neuroses

with which Freud was concerned. Thus, the neoanalytic theorists discuss “pre-Oedipal”

Some of the

development.

to intervention, relying

on

neoanalytic strains are relatively traditional in their approaches free association, interpretation,

and object

tional ego psychology

relations); others

and an abstinent analyst

(tradi-

emphasize the working alliance (the

psychoanalytic term for the therapeutic relationship) as the primary vehicle of change. All recognize the power of the unconscious. According to Greenberg and Mitchell (1983),

it is

the content of the unconscious that differentiates the drive and relational theorists: for the

and aggression.

drive theorists, the unconscious contains the unacceptable impulses of sex

For the relational theorists, the unconscious “consists of particular images of the self and others

which have been

The view of human

similarly rejected” (Greenberg

nature

among

& Mitchell,

1983

p.

382).

the neoanalytics varies. For instance, Melanie Klein,

considered an object relations theorist, wrote a lot about the aggressive instincts, suggesting a rather negative view. Although she did acknowledge libidinal energy (which leads the infant to a state of love), she characterized the early stages of infant

is

beset by conflicting feelings (particularly aggression)

& Black,

(Mitchell

The

other object

seem

development

and

as scary; the

shifting emotional states

You can read some of Kleins thoughts in the original in Box 3.1. relations theorists, the self psychologists, and relational psychoanalysts 1995).

to offer at least a neutral

view of

human

nature.

The ego

psychologists,

who

turned

away from the battleground metaphor of Freud s system, emphasized the egos adaptive pacities,

perhaps offering a more positive view of humans.

Box

3.

Melanie Klein In

my

breast for

view is

—

as

1

have explained in detail on other occasions

the beginning of superego formation

—

the introjection of the

which extends over years.

We have grounds

assuming that from the

first

feeding experience onwards the infant introjects the

various aspects.

The

core of the superego

breast in

its

good and bad. Owing relations to external in the child’s

of the

life,

infant’s

to the

on becomes

emotional

life

thus the mother’s breast, both

simultaneous operation of introjection and projection,

and internal objects

early

is

interact.

The

father, too,

who soon

part of the infant’s internal world.

that there are rapid fluctuations

It is

plays a role

characteristic

between love and

hate; be-

tween external and internal situations; between perception of reality and the phantasies relating to

it;

and, accordingly, an interplay between persecutory anxiety and idealization

both referring to internal and external objects; the idealized object being a corollary of the persecutory, extremely bad one.

The

ego’s

during these the

growing capacity first

for integration

few months, to

good and bad aspects

second form of anxiety desires towards the

—

states in

and synthesis leads more and more, even

which love and hatred, and correspondingly

of objects, are being synthesized;

depressive anxiety

bad breast (mother) are

—

and

this gives rise to the

for the infant’s aggressive impulses

now

felt to

and

be a danger to the good breast

ca-

NEOANALYTIC APPROACHES (mother) because

as well. In the

67

second quarter ol the

First

year these emotions are reinforced,

at this stage the infant increasingly perceives

person. Depressive anxiety

is

and

introjects the

mother

intensified, for the infant feels he has destroyed or

stroying a whole object by his greed and uncontrollable aggression. Moreover, to the

growing synthesis of

his

emotions, he

now

as a

is

de-

owing

impulses

feels that these destructive

are directed against a loved person. Similar processes operate in relation to the father

and other members of the

family.

tute the ‘depressive position

and whose essence

,

These anxieties and corresponding defences consti-

which comes

head about the middle of the

to a

First

year

the anxiety and guilt relating to the destruction and loss of the

is

loved internal and external objects. It

and bound up with the depressive position, that the Oedipus

at this stage,

is

complex

sets in.

Anxiety and guilt add a powerful impeius towards the beginning of the

Oedipus complex. For anxiety and Figures

and

to internalize (introject)

and reparative tendencies

to

some

guilt increase the

good ones;

objects,

to attach desires, love, feelings

and hate and anxiety

sentatives for internal Figures in the external world.

new

which dominates the

objects

away from the

infant’s needs,

breast towards the penis,

i.e.

need to externalize (project) bad

from

It is,

to others; to Find repre-

however, not only the search for

but also the drive towards new aims:

oral desires

towards genital ones.

factors contribute to these developments: the forward drive of the libido, the

integration of the ego, physical external world.

These trends

are

and mental

skills

bound up with

of guilt,

Many

growing

and progressive adaptation

the process of symbol formation,

to the

which

enables the infant to transfer not only interest, but also emotions and phantasies, anxiety

and

guilt,

from one object

Source: Klein,

M.

What might lytic writers tivistic,

(1952).

The

origins of transference. International Journal of Psychoanalysis, 33,

be considered a very basic philosophical difference

whether they

is

to another.

are objective positivist thinkers (as

constructivist ones. Freud was very interested in

natural science operating

on some objectively

among

433—438.

the neoana-

was Freud) versus

rela-

promoting psychoanalysis

as a

material and discovering laws of

real

nature. In this view, the analyst was the scientist charged with accurately interpreting client material client.

and was thus an expert source who knew the

There was

a clear

and consistent

theorists, for

this

from the observer

— one

in

prompting the notion of the two-person

the client

this).

Some

of the descendents of

and counselor

in

self

philosophy. Simply put: they view

person’s truth

another’s. “Reality” in the therapeutic relationship selor;

for the

approach, but current analysts, particularly the relational and

example, are more constructivist

“reality” as inseparable

and wrong

truth, rooted in physical reality (for Freud, neu-

roanatomy, although he could never demonstrate

Freud tend to take

right

is

may

not be the same

as

constructed by client and coun-

psychology,

which emphasizes the

roles of

therapeutic events. This demise of the totally objective

therapist/observer arose from the revolution of thought in the so-called “hard” sciences

spurred by Einstein’s relativity theory,

quantum

physics,

and Heisenberg’s uncertainty

principle that eventually trickled into the social sciences, and then into psychoanalytic

thought (Curtis

&

HIrsch, 2003).

NEOANALYTIC APPROACHES

68 Neoanalytic approaches do not add any described by Freud.

They do

discuss

new techniques beyond what have been

new ways of viewing the effects of classical

most emphasize the relationship between the (beyond the

effect

dream

Most perhaps

analysis,

and focus on how the

and interpretation

client as curative in

of them (Karon

traditional techniques

are used in the service

and of itself

& Widner,

1995). In this chapter,

I

of free associa-

of the approach described.

draw on one or more of the various

analysts practicing today all

and

technique, and

of insight gained via transference interpretation). Therefore, the techniques

sections in this chapter are brief tion,

therapist

already

analytic strains,

will present four

and

major variants

of neoanalytic thought: Ego Psychology (EP), Object Relations (OR), Self Psychology (SP)

and Relational Psychoanalysis (RP). Although

this delineation

seems logical to me, you should be aware that there

is

of these general orientations

controversy about

how

to divide

up

some see Kohut, whom I separate out from the others, as an OR theorist, whereas others would characterize his approach as relational. Only a deeper study than 1 can provide would allow you to fully understand

current psychoanalytic thought into camps. For example,

these arguments. Eest a

summary of the

in

Box

I

neglect one other important theoretical offshoot of psychoanalysis,

views of Carl Jung, one of the earliest of Freud’s followers,

is

presented

3.2.

Box 3.2

—Carl Jungs Version of

Analytical Psychology

Psychoanalysis

Carl Gustav Jung was born on July 26th, 1875 in Kesswil, a village in northeast Switzerland. Like

many other famous

psychologists (E. G.

and Ivan Pavlov) Jung’s father was the head of Switzerland, although he did

make one

Wilhelm Wundt, Edward Thorndike,

a church.

trip to

America

contributions to the field of psychology, most notably his his

Jung spent most of in 1909.

work on

his life in

Jung made many

personality types and

theory of personality. Originally one of

Sigmund

Freud’s students, Jung* eventually broke

from Freud over

the issue of sexuality as the prime motivator of human behavior. For Jung, sexuality was

only one of the things that could influence psychological process; of equal or more importance was the individual’s quest for individuality and meaning (Raff, 2007).

Although the most well-known influence on Jung’s work was that of Sigmund Freud (Casement, 2002),

like

many people in Europe during the late

1

800s, Jung was fascinated

by philosophy, the occult, myths, and symbols (Douglas, 2005). Jung’s understanding of

common elements of societal symbols led Jung to the perspective that there are common elements of human experience, which Jung called archetypes. Jung was also heavily

the

influenced by eastern philosophies and perspectives, which can be seen in his focus on the

balance of intra-psychic forces, an essential theme throughout Jung’s theory.

TYPOLOGY OF THE PERSONALITY Jung

makeup ol the person the psyche. In the center of Jungian tgo. The ego is the “I,” or the “Me,” and contains the aspects

called the psychological

personality structure

is

the

NEOANALYTIC APPROACHES

69

of the personality of which people are conscious. Fhe persona, also sciousness, las,

2005).

is

the aspect of the personality that

The persona

persons con-

in the

presented to the external world (Doug-

is

essentially acts as a socially appropriate ego

by presenting

to

observers the parts of the personality that the individual judges socially acceptable.

To balance the conscious ego Jung hypothesized the existence of the personal shadow. The personal shadow lies in the individual unconscious and includes the aspects of the person that the individual views

shadow

personal

as negative,

harmful, or painful. Jung believed that the

also could contain positive aspects of a person’s personality that

were

underdevelopecf or unrecognized, and further, that the individual unconscious as a

whole could be

The

a source of creativity anci

collective unconscious

is

for the individual (Douglas, 2005).

a set of knowledge, beliefs,

humans. The most important elements as archetypes.

comfort

Jung believed that the

in the collective

and experiences shared by

unconscious are patterns

known

specific characterization of these archetypes

change over time, and across cultures, but even

if

the visual

and

all

can

culturally specific

changed, the essential characteristics of the specific archetype did not. As an

details

example consider the Hero archetype. For some people image of

a

this

archetype

may

knight in shining armor. For others, the Hero might manifest

Although these images type. Presaging

appear as a

as

an

samurai.

are visually different, they share the essentials of the hero arche-

our current attention to cultural

diversity,

Jung therefore believed that

accurate identification of a client’s archetypal images required an understanding of the client’s

and her or

culture

Two

his personal

understanding of that culture.

other important archetypes are the animus and the anima.

sents the masculine aspects of an individual

The animus

repre-

and the anima the feminine. These arche-

types closely resemble their Chinese counterparts the yang and the yin.

Much

like the

concepts of the yang and the yin, Jung believed that every person had both the animus

and the anima and individuals should

understand and develop both aspects of

strive to

the personality. Such understandings of the archetypes leads to better self-understand-

more

ing and

fulfilling relationships

Jung added

human

with people of the other gender.

to the classic Freudian

conception of the unconscious the realm of

The unconscious did include negative feelings, but for Jung it was also of human potential, creativity, and existential meaning (Douglas, 2005). This

potential.

the seat

view of the unconcious

is

one of the key ways

in

which Jung’s theory was

different than

Freud’s psychoanalysis.

JUNGIAN TYPOLOGY One of the most easily recognizable ality

contributions of Jung has been his theory of person-

typology (Douglas, 2005). Jung theorized that there are three basic dimensions of

the personality. Each of these dimensions has other.

A

two opposite concepts that balance each

person usually will display qualities of both concepts to some degree, but will

typically favor

one over the

other.

As with the

rest

between these aspects of type. Introversion needed

of his theory Jung emphasized balance to be balanced

by extroversion, think-

ing by feeling, sensing by intuition, and judging by perceiving.

Jung theorized that a healthy psyche had a balance between introversion and extroversion. Although most people today understand introversion and extroversion as an orientation towards people, Jung found a deeper

meaning

for these concepts. Introversion

NEOANALYTIC APPROACHES

70

is

the tendency for a person to explore the inner

for this exploration, tions.

which

Introverted people need time alone

self.

primarily directed at understanding their affective reac-

is

Jung hypothesized that the

libido, or driving energy,

of an introvert was oriented

towards a deeper understanding of themselves and a deep understanding of the internal lives of others.

Thus, the introvert has a few

on the other hand,

extroverted person, ships.

The

meaning

libido of

meaning

and

in external objects

An

relation-

an extroverted person pushes the person to be near others and find

personality dimension

thinking diXid feeling Thinking individuals favor

is

cognition, logic, and rational thinking. details

finds

close.

through relationship with other people.

in life

The second

but those friends are very

friends,

A thinking person likes

to

of the options available and then make decisions based on

understand

logic.

all

of the

A feeling person

enjoys experiencing the ebb and flow of emotions and affect. Joy, depression, desire, and satisfaction are the experiential

Sensation will believe

and

intuition

playground of the feeling person.

make up

only what they can

see,

the third dimension.

ition,

on the other hand,

tional

meaning.

A person that

An

intuitive person

body language, changes

An

who

is

favors sensing

They

are skepti-

more oriented towards using

intu-

seeks to understand the missing or mysterious forces that

can not actively perceive. scious cues such as

person

or smell, taste, touch, and so forth.

of things that they can not sense.

cal

A

intuitive person

may

is

often

good

in voice tone,

at

one

picking up on subcon-

and less-than-obvious emo-

be willing to trust a hunch more than his or

her senses.

The most commonly used assessment of types is the Myers-Briggs Type Indicator (MBTI; Myers, & McCaulley, 1985), and it includes a fourth dimension, judging or perceiving. A person who favors judging will often make a decision based on incomplete information and seek imtnediate action. as possible before

making

a decision.

making decisions. Decisions

amount of anxiety as possible,

adapt

later

but

based on

A perceiver

to have as

would be

less

hasty than a judger in

A

be able to make a decision based on incomplete information and

new

information. activities

and has been

to be useful in counseling centered

on helping individuals function

in collabora-

tion with others (Douglas, 2005). Helping individuals understand their ers’

typologies

is

thought to improve a wide range of relationships. Even

never heard of Jung,

own

many people

have completed the

personality type. This widespread knowledge

theories

and work

information

made quickly might also be a source of a large balanced person might seek as much information

Jungian typology has been used in a wide array of counseling

found

much

that need to be

for the perceiver.

still

A perceiver likes

that Jungian analysts since have

is

MBTI

and

own and if

oth-

people have

are familiar

with their

a testament to the veracity of Jung’s

done

to

continue his work.

PSYCHOLOGICAL DYSLUNCTION AND THERAPY Jung believed that a part of human development was the tendency to develop complexes. A complex is a particularly sensitive aspect of the personality. A person can develop a

complex centering on

life

events that he or she does not understand or events that are

too painful to incorporate into the ego; the complex sonal unconscious.

Complexes can

complicated emotions, sensations,

is

formed and relegated

to the per-

symptoms as a person tries to resolve the memories, and meaning behind the complex. To

give rise to

NEOANALYTIC APPROACHES

71

alleviate the

symptoms

corporate

into the ego (Casement, 2002).

To

it

take an example,

Much

a

person needs to bring the complex into consciousness and in-

let’s

say that Peter had an inconsistent relationship with his older

Dan was very nice to Peter, caring for him and having fun with him, but occasionally Dan would get angry and violent and would hit Peter. Peter looked up to Dan, and greatly admired him. Due to Dan’s violent outbursts, how-

sibling,

Dan.

held strong emotions of fear and anger toward Dan.

ever, Peter also

Dan was

ol the time

killed in a car accident. Peter’s feelings

When

was

Peter

12,

about Dan’s death were too painful to

incorporate into his ego, and so the feelings were repressed into the personal uncon-

Now the feelings have become a part of Peter’s shadow. As an adult,

scious.

now out

complex

are a

Peter

may

is

may

number of ways through-

express itself unconsciously in a

may

For example, Peter

Peter’s life.

mentors. Peter tor.

that

unconsciously sabotage close relationships with

unconsciously protecting himself from the anticipated

also project anxiety

doning him. To Peter there

it

as a

Although Jung’s theory of psychotherapy

is

complex

the mentor

it is

in

it is

many ways

ples

of psychological functioning (Douglas, 2005).

what

is

principle was that the psyche

needed

to heal

and

a self-regulating system.

is

is

aban-

to resolve his or her complexes.

focus

its

similar to

approaches. Jung believed that successful therapist understood four

first

who

decidedly psychoanalytic in

istic

The

affecting

is

good mentor.

and transference,

the unconscious, early childhood,

Peter’s

it.

appears to Peter that

no such thing

is

of the men-

loss

and mistrust onto the mentor, making the mentor

uncomfortable with the relationship and tempted to end his relationship, but, consciously,

the emotions

human-

critical princi-

The

The second

on

is

knows

client

that the un-

conscious serves a protective function within the personality, shielding the ego from painful feelings and thoughts. ration

and

The unconscious

a resource for understanding the self

is

also a source for creativity

The

third essential principle

and

inspi-

that the

is

counseling relationship plays a major role in successful therapy. Jung’s final assertion that personal

growth can occur across the

resolved throughout a person’s

Complexes can be created and

lifespan.

life.

Jung divided therapy into four

which the counselor explores the

The

The counselor

mental way. This acceptance

part of therapy

first

called

and unconscious. The

come

to call unconditional

explores the client’s personality

relieves the

is

client’s history, ego,

confession stage emphasizes what Carl Rogers would later positive regard.

musical score these stages

stages. Similar to parts in a

can be solo, or they can occur together in harmony. confession, in

is

and past

in a

non judg-

person of shame and guilt normally associated

with hidden aspects of self Jung indicated that during the confession stage transference will

be strong and essential.

The

client will project

onto the counselor

many

aspects of

the self that are currently being explored (Douglas, 2005). Elucidation, or exploration of the transference

is

the second stage of therapy, in

the counselor begins to point out to the client the transference

and

to explore

its

which

source.

In classical Jungian therapy the counselor explores events in very early childhood, a

period ranging from birth to about 4 years old. Education in

which the

client

and counselor begin

through action. Most

clients

to

implement

do not reach the fourth

is

the third stage of therapy,

insight achieved in elucidation

stage of therapy, transformation. In

the transformation stage, the client nears self-actualization. According to Jung, actualized people value both conscious

self-

and unconscious experiences. People who achieve

NEOANALYTIC APPROACHES

72

self-actualization have achieved a balance as well as

between the external environment and

self-actualized persons

Each

between

ol:

were

their consciousness

their internal psyche.

but he did think

rare,

these four stages of therapy

relationship between the counselor

is

and

it

was

woven

in, out,

client.

Some

and unconscious, Jung believed that

possible.

and around the melody of the

clients

may

only engage one of

these stages of therapy; other clients

may encounter two

Reaching the fourth stage of therapy

unusual, and most often occurs with clients that

are in their later years of

is

or three stages of therapy.

life.

CONCLUSION Jung’s theory focuses

meaning of the

on

the internal conflicts of an individual as well as the existential

individual’s

his intense focus

life.

on balancing

His theories and

He had

and development of psychoanalysis,

chology. Although

are influential partially because

of

internal struggles with the importance of maintaining a

meaningful existence. Jung died in 1961. the growth

life

some of Jung’s

ideas have

survived two world wars and had seen

other schools of psy-

as well as several

been seriously questioned, Jungian analysts

have continued to develop and prosper amongst psychologists today. Through gaining an understanding of Jung’s theory of therapy and personality

one of the great contributors Contributed by

J.

we can

catch a glimpse of

to today’s psychological world.

Rico Drake.

EGO PSYCHOLOGY: LOSES THE LIMELIGHT, TEMPORARILY '

ID

Overview The post-Sigmund father in the years

history of psychoanalysis begins with

1918—1922, Anna was

analysis (along

is

at the

known

as

website of the

It

Anna Freud

infor-

Center,

one of the founders of child psycho-

her intellectual descendents evolved into what

is

chology (EP) school, which dominated American psychoanalysis 2002).

(More

with Melanie Klein) and for her development of theory about defenses.

Anna Freud and stein,

Freud. Analyzed by her

truly her father’s intellectual heir.

mation about Anna Freud can be found http://vvww.annafreudcentre.org/ ) She

Anna

was considered very close

known as the Ego Psyfor many years (Walleradded attention

to traditional psychoanalysis, but

to the adaptive functions of the ego, in addition to the defensive ones described

landmark book, The Ego and

by Anna

Mechanisms ofDefense, 1936. Another important ego psychologist was Heinz Hartmann. Hartman, who was ana-

in her

lyzed by Freud

and studied

the

for a while

important ideas to EP. His best

with sociologist

Max

Weber, contributed

known book was Ego Psychology and the Problem ofAdaptation

(1939), in which he freed the ego from subservience to superego, and

from the

id. Still, his

loyalty to classical drive theory

(1983) to characterize him (pp. 236, 268).

several

as a “transitional figure”

Although some might categorize her

more importantly,

prompted Greenberg and Mitchell and “caught between two models” as

an

OR theorist,

I

also include in

NEOANALYTIC APPROACHES

73

Margaret Mahler’s view of psychological development, because

this section

known model of ego

growth. Other important

Loewald, and Otto Kernberg. However, for the

most

he

part,

relies

upon

EP

work

Hans

OR section, because

in the

more than he does

these constructs

a well-

writers are Joseph Sandler,

discuss Kernberg’s

I

is

it

drive/structural theory.

Wallerstein (2002) writes eloquently of the history of EP in America, the oldest chronologically of the neoanalytic approaches. 1

960s and

its

proponents deemed themselves qualified to determine

and who was “unanalytic” nity). Its stranglehold

psychiatry,

and

really

OR

have integrated

(the latter being a clear

shaken by Kohufs

RP

or

Loewald, Kernberg, and Sandler) but

American psychology

ditional

EP

you

pursue

to

who was

“analytic”

Sullivan’s interpersonal

many EP

a result,

EP

theorists

Wallerstein also

theory (those proposed by Brenner,

what

difficult to decide

it is

1950s and

work (Kernberg, 2005).

traditional

most of what

today. Therefore,

theory, leaving

As

self psychology.

notions into their

EP

in the

excommunication from the commu-

on American psychoanalysis was nudged by

describes several modifications of

in

American psychoanalysis

ruled

It

is

is

truly the state of

presented in this section

EP

tra-

is

this issue further if you wish.

Central Constructs EP

Structural Model.

and superego, along with the sex and aggressive traditional Freudian theory the ing, in

EP

theory, the emphasis

interested in the

is

much more

alive

id,

Chapter

2).

However, whereas

and therefore

(drive)

in

id function-

on ego functioning. Both Anna Freud and Hartmann were

development of the ego, seeing

independently from the is

drives (see

emphasis was on instincts

to control id impulses (Quintar, Lane,

ego

model, composed of id, ego,

theorists retain Freud’s original structural

as

it

& Goeltz,

more than

mere product of the need

1998). For Hartman, at

unlike in Freud’s version in which

and energetic

a

in this approach,

it

least,

ego develops

develops out of the

id.

The

prompting the use of the term

ego

autonomy in these writings.

Hartman contended through

that the ego

transforming

and judgment

EP

store of energy (separate

energy

The EPs examined ego

perspective

includes id and superego

demands

Jezebel, Theo’s

EP

and

The anger he feels

superego.

ego

as well as the defenses

special focus in the

own

its

into

instinctual

neutralization (Fine, 1979). ing,

had

is

Anna Freud

on how the ego adapts

therapist, thinks that

to the

is

intact,

and to a

process

gained

he

called test-

(Wolitzky, 2005).

A

environment, which

those from the external world.

Theo

is

struggling with conflicts between

id, ego,

a transformed version of id impulses, which ego and

superego are fighting. Based on his ability to function in college,

function

a

id)

functions such as cognition, reality

described by

as well as

is

through

from

it

appears that Theo's ego

large extent, adaptive.

Jezebel thinks that she sees evidence of Theo’s conjlicts in his relationships with Tamia

and his parents. His

id,

with all of its sexual and aggressive energy,

is

pushing Theo toward

When she stays out all night partying, Theo men, and aggressive id impulses become prominent in

the potential gratification offered by Tamia.

worries that she could be with other his relationship

with

her.

He lashes out in

anger.

His anger with

in repressed aggressive impulses as well, particularly

them by refusing

to

go

to

an

historically

toward

Black institution for

his parents likely has roots

his father. college.

He

rebels against

NEOANALYTIC APPROACHES

74

On

and ego

the other hand, Theo’s superego

His apparent concern over

That he comes

to

rational decision

Defenses.

counseling

of the ego

As noted

to

is

is

a sign that

the id's impulses.

his superego

is

operating.

probably the result of these superego commands

attempt

in this chapter,

area of ego defenses.

with anger

his difficulty

him from acting out

keep

to better function in his

some of Anna

The major forms of defense

Freud’s

most

and

the

current situation.

significant

are listed in this chapter.

work was

in the

Anna Freud

elab-

orated on the reasons for defenses in identifying three kinds of danger to the ego: the wrath

of the superego, the threat of the drives, and the dangers of the outside world (Monte, 1999). In

Box

Theo seems

3.3,

you can read about Anna’s additional

be dealing with his aggressive impulses through repression, identification with

to

and displacement. He

the aggressor,

defenses.

an incomplete

resolution

of this

is

well past the Oedipal stage, but his behavior suggests

and he

conflict,

is still

experiencing unresolved aggression

which would be dan-

toward his father as a

result.

gerous, he represses

but also damps down the drive by identifying with his father, the

aggressor,

it,

and displacing

Rather than expressing

this aggression,

the aggression onto safer targets, such as Tamia. Jezebel considers

Box

3.3

Anna Freud s Defenses In addition to the defenses formulated

the

list

by her

father,

Anna Freud added

the following to

of the ways we escape threatening psychological material:

— rejection

Denial

of external events

that

are

associated

with

psychically

threatening

material

— becoming

Identification with the Aggressor

like a feared

other

(as in

the Oedipal resolution

for boys)

Asceticism

—

seen mostly in adolescents. Adolescents are so threatened by their emerging sex-

ual desires that they

renounce

Altruistic Surrender a

all

—gratifying

mix of projection and

desires or pleasures

one’s

own

desires

through the fulfillment of another’s; sort of

identification

Turning-against-self—ve:d\vecim^ threatening impulses against the

self rather

than into the

environment Reversal

— changing into the opposite

— removing emotion or meaning from

Isolation

— associated

Undoing

events

with obsessive-compulsive types; use of

thoughts or behaviors

Adapted from Monte, 1999, pp. 204—207.

rituals to cancel

threatening

NEOANALYTIC APPROACHES that Theo sees himself as

75

an angry person because he

However, he displaces his anger onto Tamia

aggressor.

and faculty members who frustrate him

assumption that not ego,

id,

all

ol psychological

and superego. According

pendent ol the

id

&

to

of his ego

is

able

who

is

EP

memory, and learning

(Fine,

a wide range of circumstances, indicating zone. His anger has not created enough problems

It has, hoivever,

adaptive aspects of his ego have prompted

environment to

of ego function that are inde-

as thinking, perception,

in the conflict-free

Hartmann

Average Txpectable Tnvironment.

fant,

driven by conflict between the environment,

to function in

jeopardize his standing in school.

peril, so the

life is

also

put

his relationship

him

to enter counseling.

with Tamia in

added the concept of the average expectable

theory (Fine, 1979). If the average expectable environment

born with the capacity to adapt

in healthy ways. If the infant

is

problems ensue. For example,

to

and use

this

kind of environment,

born into a situation that does not meet if

mother

a

is

exists,

depressed, she will

fail

the in-

will

grow

this level ol support,

to attend to

and nurture

her inlant; this neglect will lead to psychological (and possibly physical) deficits in later

Although

not totally clear fom Theo's presentation, fezebel thinks that there

it is

been some deficits in his early environment, which led

Oedipal

conflict.

EP

Mitchell, 1983).

fezebel observes that Theo the function

such as peers

targets,

(1939), this construct concerns the

to this view, there are areas

and superego, such

1979; Greenberg

and other safer

even in the smallest ways.

Hartmann

Conflict-Free Sphere. Contributed by

with his father, the Oedipal

identifies

However, she expects that

to the

his very early

life.

may have

inadequate resolution of the

environment was

sufficient for

him to grow and develop to a large extent. Departures fom the average expectable environment could include lapses in attention fom his mother, perhaps because of the disruptive, conflicted relationship with his father.

Theory of the Person The

early

EPs

essentially

adopted Freud’s developmental and personality theory

So, they follow the psychosexual

model of development, with

the assumption that personality

is

gratified (or not; see

Chapter

Later EPs started paying

and the phallic stage

2)

more

formed by the ways

all its

implications, such as

which the

in

as a critical

in toto.

child’s instincts are

developmental phase.

attention to earlier stages ol development (such as in

Mahler’s writing, described next).

Although Anna Freud theorized about child development with her work on developmental

lines,

Mahler’s

work

has remained

more prominent

historically.

Mahler described

the “psychological birth of the inlant,” contending that “the biological birth of the infant is

a

and the psychological

birth ol the individual are not coincident in time.

dramatic and readily observable, and well-circumscribed event; the

lolding intrapsychic process” (Mahler, 1972, ol

lile

and completed around age

3,

p.

he lormer slowly un-

333). Beginning at about the 4th

development

symbiosis to separation and individuation.

latter a

1

in this

model

is

human

month

the progression Irom

NEOANALYTIC APPROACHES

76 In the

First

month

after birth, the infant

between

differentiate

and mother. In

self

is

in the state

of normal autism, in which he

classical terms, the infant

Around

is

in a state of absolute

month, what Mahler

primary narcissism

(St. Clair,

symbiosis begins, in

which the infant becomes increasingly aware of the mother but

2000).

The

the second

can’t

normal

called

as a part is

good

enough, the four subphases of separation and individution begin around 4-5 months.

First,

of him, not a separate identity.

infant

the child enters the Dijferentiation physical distance

The this

spective

when

is

fused with the mother. If the mothering

and Body Image

from the mother, but can be seen

next subphase

phase

is

is

Practicing,

period, in

to

which begins

child

in the typical “no” period that

is

is,

tolerates

check back to mother to orient himself

and thus gains

at this point, egotistical

and

The peak of totally new per-

walk.

as the child learns to

the child can walk by himself upright

on the world. The

which he gradually

a

narcissistic, as

often observed in children of this age.

NO!

can be seen

screams the

infant in response to the parent’s directive, the ultimate sign of independence. If

parenting

is

adequate, at about 17 months, the child returns to earth and recognizes

He

that he can’t really be alone without the parent.

experiences separation anxiety. This

event heralds the onset of the Rapprochement suhyi\\2iSt, during which the relationship with the

mother

is

ambivalent.

The

child’s

anxiety. In crisis, the child vacillates

newly found autonomy

conflicts with his separation

between closeness and autonomy. This

crisis

peaks

between 18 and 24 months.

The

final

phase of development

is

Emotional Object Constancy and Individuality.

called

In this subphase, the child internalizes a positive

from

arate

her.

mother image so that he can

truly be sep-

This subphase has no defined endpoint, and involves ego and superego

elaboration.

Jezebel thinks that Theo has negotiated the phases of separation successfully.

conflicts

He appears

to

have an elaborated ego and superego,

more from the Oedipal situation than with

seeing Theo’s presentation might be that he early

development that led

to the

He gets

However, another way of

indeed experiencing difficulties resultingfrom

inadequate resolution of the Oedipal

ambivalent relationship with Tamia with his mother.

is

earlier ones.

and individuation fairly and to be struggling with

is

in essence the recreation

of the

conflict.

The angry,

relationship he has

angry at her when she “disappears’' on him, suggesting that he

stuck in the rapprochement subphase; he has

some strong but mixed feelings about

mother and father. Perhaps both explanations are

useful, thinks Jezebel, in

is

his

helping Theo.

FdEALTH AND DYSFUNCTION EP

most

theorists, for the

part, accept the version

of psychological health proposed by

Freud: healthy repression of instinctual drives, the ability to love and work, and so on (see

Chapter to the

2).

They would add

is

environment (Wolitzky, 2005). Also

plex as the source of

foreshadow the life

that health

much

like Freud, the

EPs consider the Oedipal com-

dysfunction. However, the views of many

OR theorists

and the adequacy

observed in the quality of the ego’s adaptation

of the

in that

EP

theorists

seem

to

they emphasize the quality of the very early stages of

environment around the

infant.

Problems

in the early envi-

ronment can cause dysfunction

later in life.

For example, Mahler contended that

if

mother does not provide

enough base

for the developing child, the child will

show

a secure

the

NEOANALYTIC APPROACHES problems

in establishing

For Hartmann,

ment

if

77

independence, or

not present, the

is

a function

is

child’s

ego.

develop-

of compromise formations. Conflict

in the interplay of four psychic motivations: the pressure

of the superego, the ego’s motivation to adapt to reality

need

ego’s

autonomous

be compromised.

will

found

terms, developing an

the average expectable environment

Brenner (1982) proposed that behavior is

EP

in

to avoid or

of the drives, the push

the external world) and the

(i.e.,

minimize anxiety and depression. To integrate the

Brenner indicates that

all

in essence, relationships

OR

perspective,

object relations are a product of the negotiation of these forces;

and

their internalized representations are

compromise formations

(Wallerstein, 2002).

Jezebel judges that Theo shows adequate ego

and superego

development, although he

is

dis-

playing some oedipal issues that result in compromise formations through the use ofless than optimal defenses such as displacement, displacement ofaggression, and identification with the aggressor.

To some extent, the defensive functions allow gratification

ofi sexual

and

aggressive instincts in modifiedforms directed at less-than-threatening entities (e.g, colleagues

and

Tamia). However, that Theo

sheer

amount ofenergy

ening

to

is feeling

badly enough

(perhaps evoked by the

overwhelm Theo and damage the

happens, Theo’s superego threatens, he

stresses

to seek

of the

college

delicate balance

would be

counseling suggests that the

environment)

is

threat-

of the compromise. If this

annihilated.

Nature of Therapy Assessment. Very

little

formal assessment

stead, the clinical interview serves as the

EP approach (Wolitzky, 2005). Inprimary mode of assessment, with the intent of

is

used in an

observing current and past functioning and to gain information regarding defensive oper-

and core unconscious

ations

However, ability

conflicts contributing to the client’s current presentation.

as in traditional analysis, the

counselor

is

simultaneously determining the suit-

of the client for psychoanalytic therapy. Eormal diagnosis

be used, but the psychoanalytic therapist

is

really

more

(i.e.,

DSM-IV-TR) may

interested in underlying

dynamics

than client symptoms (Wolitzky, 2005).

Jezebel concludes that Theo

cerned about formulating a

how he to his

interacts

with

her,

is

a good candidate for psychoanalytic therapy. She

DSM diagnosis for

and his

descriptions

Theo. She

ofanger

in other aspects of his

more

of his everyday

psychological dynamics, observing that although he

his descriptions

is

life

is

life.

is

not con-

interested in observing

She

is

looking for clues

docile in the early interviews,

suggest conflicted dynamics.

Overview ofthe Therapeutic Atmosphere and Roles of Client and Counselor. It seems difficult to summarize the EP orientation to therapy. In some sources, EPs appear to adopt the neutral,

objective stance of the classic analysts in their work. This stance

traditional

EP

would be taken by

a

counselor, and implies a doctor-patient model, in which the expert thera-

pist interprets the material

pretations see the EPs

provided by the client (Wolitzky, 2005). However, other inter-

moving away from

the authoritarian model. For example, Mitchell

and Black (1995) indicate that the EP understanding of the

resilience of the ego leads these

NEOANALYTIC APPROACHES

78

therapists to be interested in enlisting the client as an ally in therapy,

work of understanding unconscious

The

who

contributes sig-

latter orientation

might

Buckley (2003) maintained that although Hartman’s influence led to an austere,

absti-

nificantly to the

more

suggest a

nent therapist interactive

egalitarian

material.

approach to client-counselor

as in the classic analytic

model,

roles.

later theorists in the

model of therapy. For example, Buckley

interprets

EP group proposed a more

Loewald (1989)

as

promoting

the idea that psychoanalysis produces ego development through internalization of the rela-

tionship between therapist and client, implying a

more

A

Theo with a

contemporary

EP therapist, Jezebel approaches

constructivist view of the process.

warm andfriendly

manner.

She recognizes the importance of his collaboration in the therapeutic endeavor. Theo sponds in kind, discussing his anger somewhat uncomfortably.

Goals.

EP

therapists

still

scious (most importantly, the repressed) conscious (Greenberg ever,

make

accept Freud’s original goal of psychoanalysis: to

re-

the uncon-

and Mitchell, 1983). How-

they would add that a second important goal of EP therapy

to

is

improve the

client’s

adaptation to her world (Wolitzky, 2005).

Jezebel hopes that scious roots

when he

is finished

of his behaviors and the

with therapy that Theo can understand the uncon-

defenses he uses to cope with the unconscious conflicts.

He will gain

insight into the anger he feels

the real roots

ofthis

toward both ofhis parents, and how he repressed anger in the attempt to protect his fledgling psychological structure. She

also intends to try to help

into his

him

to

adapt

environment and hopes that his insight

better to his

dynamics will carYy into future

situations.

Process of Therapy Therapy

in a

EP model

changes depending upon which variant of EP one

Freud seemed to be most interested in

classical

is

tradition, the client free associates

considered very important. Countertransference

Chapter

Anna

as recreating early relationships

emphasized the emotional support or empathy provided therein (Mitchell

EP

reading.

technique: analyzing defense and transfer-

ence (Freud, 1936). Other EPs see the transference

In classical

is

and the analyst is

& Black,

and

1995).

interprets. Transference

considered a very bad thing (see

2).

Jezebel attends to the interpersonal process that she

and Theo

create,

but

is

also

aware that

and interpret drive-related processes. She is aware, as a residt ofher own of her tendencies to countertransference and guards against these.

she needs to observe

training analysis,

Therapeutic Techniques Techniques

in a traditional

EP approach

are the

same

as in classic psychoanalysis. Free

association, interpretation (particularly of the transference),

mainstays. However,

it is

interesting that that free association

goal of analysis, not a technique, for the

and dream

came

analysis are the

to be recognized as a

EPs emphasized the pervasiveness of ego defense

NEOANALYTIC APPROACHES

79

&

and within the therapeutic relationship (Mitchell Anna Freud commented:

processes, both outside In this respect,

Even today many beginners ducing

in the patient

yond this

is

i.e.,

to

essential to succeed in in-

it is

other associations without modifica-

all

rule

The fundamental

of analysis

.

.

.

such docility

rule can never be followed be-

The ego keeps silence for a time and the id derivatives make use of their way into consciousness. The analyst hastens to catch their utter-

a certain point.

Then

the ego bestirs itself again, repudiates the attitude of passive tolerance

has been compelled to assume, and by

it

to give

obey implicitly the fundamental

in practice impossible.

pause to force

ances.

and invariably

their patients really

tion or inhibition,

have an idea that

in analysis

Black, 1995).

mechanisms intervenes

in the

means

of

which

one or other of its customary defense

flow of associations. (1966, pp. 13-14)

As he

Jezebel asks Theo to talk about whatever occurs to him.

does, she looks for evidence

of defenses operating and then, for indications of the accompanying underlying conflicts. As she becomes fairly confident about her hypotheses, she ofljers them to Theo in the form of interpretations, first of the defenses and later of the underlying conflictual themes. Theo initially talks quite

a bit about his anger with Tamia,

ing about his parents

and early

then shifts gradually to speak-

experience ivith them. It takes a while for this shift to hap-

pen, because Theo’s defenses are operating.

emotions become more vivid

and

As he

and eventually,

begins to address his early experiences, his

Theo’s anger becomes directed at Jezebel.

carefully begins to interpret these processes so that

She

Theo can gain insight into them.

OBJECT RELATIONS: THE LEGO APPROACH Overview Within the object

relations

group there

important

are several

theorists.

Most

spectacular

who was considered a heretic by the psychoanalytic establishment as by Anna Ereud and her followers. She accepted drive theory, but still empha-

was Melanie Klein, represented sized the

importance psychic representations of relationships and primitive were considered so deviant that in the

ularly aggressive urges. Eler ideas

European psychoanalytic world

split into the

the Viennese school (Anna Freud et ak). psychoanalysis, even as

it is

London

Still,

Klein

OR

names

are R.

allegiance to drive theory, Fairbairn

1920s, the

seen as having a major impact on

&

Black, 1995).

about the controversy surrounding Klein and Anna Freud

Other important

late

school (Klein and her followers) and is

practiced today (Mitchell

fantasy, partic-

in

Box

You can read more

3.4.

D. Fairbairn, and Donald Winnicott. In terms of

was probably the most

radical

of the

OR group, for he the-

orized that drives were directed at objects, not simply at the pleasure of expressing the drive

or

some combination of

object-seeking and drive release. Fairbarn, Klein, and associates

were considered to be of the British school of object are generally considered distinct

ican school developed,

At

First,

enough

the term object

seem

The

most important objects

it

but Klein and her followers

to be referred to as Kleinians. Eventually, an

and the most prominent of writers

stems directly from Freud’s use of theory, the

relations,

a little

odd

in a

in this

who

realm was Otto Kernberg.

theory that deals with people, but

to describe the targets

are people,

Amer-

of the

it

instincts. In traditional

can satisfy libidinal or aggressive urges.

object relations theorists generally reject classic drive theory and instead argue that

we

NEOANALYTIC APPROACHES

80

Box 3.4 Melanie Klein and Anna Freud: Feuding Leaders of the Development of Child Analysis In 1927,

Sigmund Freud wrote

Ernest Jones. In this

and eventual biographer,

a stern letter to his colleague

Freud accused Jones, then president of the British Psycho-

letter,

Anna Freud

Analysis Society, of masterminding a campaign against his daughter,

(Paskauskas, 1988). Freud reprimanded Jones for publishing the proceedings of the

Symposium on Child-Analysis

in the International Journal of Psycho-Analysis (of

Jones was the editor). Freud maintained that the publication of the proceedings strated that Jones

and the

Anna

demon-

Melanie Kleins ver-

British Psycho-Analysis Society favored

sion of psychoanalysis over

which

and he labeled Jones’

Freud’s (Klein et ah, 1927)

criticisms of Anna’s child analysis as “impermissible” (Paskauskas, 1988, p. 624).

Jones’ criticism of

Anna

and

Freud’s child analysis techniques

praise for Klein’s led

Freud to wonder whether Ernest Jones’ condemnation of Anna Freud was at

him

really directed

(Paskauskas, 1988). However, Ernest Jones was not the only psychoanalyst sid-

ing with Klein.

A decade before the Symposium was published,

child analysis began gradually dividing into

who championed one commanded by

those

two separate camps,

Melanie Klein and the other by Anna Freud. Whereas British Psychoanalysts in London accepted Klein’s theories of child analysis, Viennese analysts supported

Anna

Freud’s

techniques (Donaldson, 1996). Freud’s scolding led Ernest Jones to defend his decision to publish the

Jones stated that he was simply attempting to ensure a Klein’s

and Anna Freud’s

sides

Symposium.

hearing of both Melanie

fair

of the argument (Paskauskas, 1988).

He

contended that

the imbalance resulted from the refusal of the other major psychoanalytic journal.

International Zeitschriji fur Psychoanalyse, to publish Klein’s work.

Symposium

By publishing

the

of Psycho-Analysis, Ernest Jones was trying to allow Melanie Klein the chance to more broadly defend her theories against the assault in his International Journal

of Anna Freud.

Born

in

influential

Anna

Vienna

in

women

psychoanalysts in the history of the discipline.

1

882, Melanie Klein, along with

Freud,

is

among

the

Her contributions

were primarily to developmental theory and specifically regarding the analysis of dren. In response to Ernest Jones’ urging, Melanie Klein began to

ing theories in

London (Grosskurth, 1986), when

in early 1927,

most

chil-

work on her develop-

Anna Freud

published

the Introduction to the Technique of Child Analysis (Freud, 1974). In her book,

Anna

at-

tacked Klein’s methods of child analysis, giving them the dreaded label of “un-Freudian”

(Donaldson, 1996, for

p.

160).

As

a result, the

Symposium

Melanie Klein to respond to Anna Freud’s

of Child-Analysis

was organized

criticisms.

In creating their theories of child analysis,

Melanie Klein and Anna Freud drew

from different components of Sigmund Freud’s work: developmental theory versus therapeutic techniques.

Anna Freud

focused on Freud’s theory of child development,

concluding that the traditional analytic techniques applied to adults could not be applied to children because adult psychoanalysis patient’s free associations

and

is

based on the interpretation of the

free association requires a level

of linguistic capabilities

NEOANALYTIC APPROACHES

81

that children have not yet acquired. Therefore, she developed a

new

therapeutic tech-

nique, a pedagogical form of child analysis that had the goal of developing and

strengthening a child’s ego in hopes of repressing the impulses of the id (Freud, 1974).

Anna’s theory presented no challenge to Freud’s theory of the psychic development of the child. In contrast, Melanie Klein chose to incorporate adult analytic techniques into child analysis, focusing

ment. In

on

fact, part

Freud’s clinical practices

and modifying

his theories

of what was so controversial was that Klein posited that considera-

tion of the death instinct should be incorporated into theorizing about the

of the superego, which she saw plex.

Through

of develop-

as

the analysis of her

emerging prior

own

to the resolution

development

of the Oedipus com-

children and the children of colleagues, Melanie

Klein observed a harsh and punitive superego that emerged very early on, and she theorized that a child’s relationship with the

Oedipal complex

as

mother

is

the foundation of this entity, not the

Sigmund Freud had contended

(St. Clair,

2004). Klein thought that

the aggressive tendencies that the child experienced during the oral

and anal

stages

were

evidence of the child’s sadistic fantasies (related to the aggressive instincts) that were projected onto the mother and then introjected as hostile objects (Klein,

Through

projective identification, these punitive introjects

Klein also believed that in an analytic session, a

full

1926).

became the superego.

transference relationship was

created between the child and analyst. Specifically, Klein contended that the negative transferences were particularly important because the child’s hostile

and aggressive

impulses were what brought the child to analysis to begin with. Klein believed that in order to

make

the negative transference and bring

Anna Freud

must

interpret (sometimes forcefully)

to the forefront

(Donaldson, 1996). In response,

therapeutic progress, the analyst

criticized

Melanie

child’s aggressive fantasies

it

Klein’s ideas, saying that Klein’s

was dangerous because the

child’s

method of analyzing developing ego

is

a

not

strong enough to deal with bringing aggressive impulses out of the unconsciousness (Freud, 1974).

Symposium, in which she describe her views of Anna Freudian child analysis, attacking some of the central aspects of Anna’s theory (Klein, 1927). Klein maintained that focusing on the child ego and relying on an educative approach was inadvisable because it leads children to repress Melanie Klein gave the opening paper

in the fateful

hostile impulses, negating the goal of therapy. Klein also posited that ignoring the

Oedipus complex prevents the analyst from uncovering the

child’s source

of anxiety

The paper ended with Melanie Klein claiming that her own approach was superior to Anna Freud’s, because her technique achieved a stronger and more lasting analysis of the child compared to Anna Freud’s techniques (Klein, 1927). After Klein presented, other speakers gave shorter presentations commending her approach. Ernest Jones’ closing speech made it evident which child psychoanalyst he (Klein, 1927).

personally supported, giving the British

Psycho-Analytic Society’s

approval to Kleinian child analysis (Jones, 1927).

then cemented the

split

The

final

publication of the proceedings

between Kleinism and Freudianism that endured

(Donaldson, 1996). Contributed by Ashley Heintzelman.

vote of

for years

NEOANALYTIC APPROACHES

82

seek objects (mostly other people) in and of themselves, not as tual drives as

Freud thought (Wolitzky

begins very early in

life,

& Eagle,

means

to satisfying instinc-

1997). Because the object-seeking process

the object relations writers focus on early developmental stages

(pre-Oedipal) and the mother-child relationship.

Central Constructs Objects.

The term

object

is

culty in reading these theorists. in the

OR theory,

used in several ways in

The

first

and

this

is

part of the diffi-

use refers to external objects, things and people

environment (ITamilton, 1988). Ultimately, the most important type of object

is

the internal oh]QCi, a psychological structure, formed through the internalization of interactions with important others, early in interest

life

the breast. Internalized objects

is

(Scharff

become

&

The

Scharff, 1995).

first

object of

part of the developing child’s self and the

quality of the child’s relationships with them, particularly affecting the attachment to

them, determine the functioning of the individual.

Kernberg called internal representations of relationships bipolar intrapsychic representations

(Cashdan, 1988). These are composed of three elements: an image ol the

image of the other person, and associated emotions (Cashdan, 1988,

self,

an

The emotion

p. 17).

associated with the internalized object contributed to the development of the instinctual

according to Kernberg.

drives,

Paul

is

Theo’s object relations therapist.

He

speculates on the nature ofTheo’s internal

world, trying to sense the nature of the objects that populate

is

clearly

attached

to these representations,

He

thinks that Theo’s

He has a self representation

parents are certainly represented, as are his siblings.

Anger

it.

as well.

evidence of the aggressive drive. Sex-

ual urges are likely associated with Theo’s internal representations of his mother Tamia.

Projection. Projection, initially

along with introjection and splitting

ways of relating

(St. Clair,

2000).

to the breast

The aim of these

are,

according to

and

OR theorists,

and the primitive emotions associated with

defenses

is

to protect self-integrity

and

at the

it

same time,

the attachment object (Hamilton, 1989, p. 1553). Initially concerned with the relations

with breast and mother, these processes then generalize to other objects (people) important to the infant.

Projection

is

seen

when

the feelings associated with the object are fused with the object

and projected into the external world so that they had

a

meal projects these

feelings

are safer.

onto the breast and

it

The happy

infant

becomes the good

who

has just

breast. Likewise,

Moth-

the hungry, angry infant associates these feelings with another breast, the bad one. ers

and other important individuals

in the infant’s experience

become good and bad

in the

same way.

Paul believes that Theo may project his anger with

and his father. He college),

sees

but this anger

onto them so that

them is

as angry with

threatening.

mothers unsatisfying breast onto her

him for a number

really Theo's primative

it is less

his

of reasons

(e.g.,

his choice

of

anger with the unsatisfying breast projected

NEOANALYTIC APPROACHES Introjectiofi.

internalize

A

second way to make a scary world

them

it

safe

is

and although

world

creates a scary internal

is

Some

for the infant.

it

and

the term used by Klein to

makes the external world

it

bad aspects of

to take the

so that they can be controlled. Introjection

describe this process,

because

83

safer,

it

problematic

is

would say

theorists

good

that

objects are introjecteci as well.

Paul wonders ifTheo has introjected the bad

The anger he shows may be the anger

breast.

bad breast but the projection has resulted in these feelings becoming unconscious and liable to pop out in his current life. For example, his anger at Tamia could be a result

at the thus

of this process. Splitting. Splitting

(Cashdan, 1988).

another process by which the infant manages good and bad affect

is

a

It is

normal process by which dangerous

from pleasant ones and

are separated

good and bad emotion

infant’s

it is

good;

when

it

good or bad, most notably that they will

fail

doesn’t,

easier for the infant to

manage. The

first

When

object.

the breast satisfies the infant’s

bad. This process broadens so that people can be

it is

early on, the mother.

Moms aren’t perfect,

and so

it is

inevitable

and become partly bad. To deal with the anxiety

to gratify the infant

associated with experiencing both the

and impulses

not associated with any specific object; however,

at first

becomes the

the breast (or bottle) quickly

hunger,

is

makes them

this

feelings, objects,

good and the

frustrating breast/mother, the infant

psychologically introjects and then splits the two and so has an inner world populated by

good and bad

objects. Infants tend to repress the

bad

mom, making

the conscious version

of her an idealized one (Cashdan, 1988). Parts of the ego associated with these painful objects are repressed as well. Fairbairn contended that the repressed bad object

und

split into the rejecting

exciting oh]tcts (Scharff

& Scharff,

1985). Rejecting objects are

associated with aggressive urges

and exciting with

Paul thinks that Theo’s

mechanisms have broken down, possibly as a

stress

of being in

college

splitting

and his

and

is

directed toward other objects. That

the real objects

of the angry feelings

Projective Identification. jective identification,

now

and

it is

surely

when

becomes

some

the breast

one that

repression

them back

The anger associated

and father),

some

self,

solution

is

to

identification.

keeping

OR theorists

is

pro-

by

scary feelings outward onto

continue to

relate to the scary

through internalization. The bad object thus

Cashdan (1988) goes on feel

surfacing,

in the unconscious.

in

terms of scary/dangerous

impulses, projective identification can also involve positive feelings, such as

induces the target of this process to

is

difficult to grasp. Originally described

Although most often discussed

are satisfied (St. Clair, 2004).

of the

mother). However, these dangerous impulses are

The only

inside the

a part of the infant.

is

result

is still functioning,

and parents)

the infant projects

as the breast or the

outside and uncontrollable.

object by taking

(i.e,

is,

breast, mother,

Another protective function described by the

Klein, this process begins

another object (such

sexual, or libidinal, drives.

unsuccessful attempts to attach to Tamia.

with the repressed portions of the objects (of the

further

is

and behave

in

when

drives

to indicate that this process

ways consistent with the projective

NEOANALYTIC APPROACHES

84 Through projective

ment andfrustration he feels sexual

Theo has taken the bad breast into

identification,

and angry feelings

The

his self

excite-

related to his mother's inconsistent support has resulted in both

attached

to these objects,

but these feelings are too threatening

to

of him. Similarly, Theo has identified with his father, who abandoned the on. The anger Theo feels related to the abandonment is thus directed back at

leave outside

family early himselfand

is

also bleeding

out into his other relationships.

Theory of the Person and Development of the Individual The self

process of development, according to the

OR theorists,

through fragmentation to whole experiencing

—

is

from

the infant,

if

a primitive, pristine

given the correct envi-

ronment, gradually develops the capacity to resolve splitting and to integrate the various

The

internal objects into wholes.

birth (Scharff

&

Scharff, 1995).

self It

is

human

inherent in the

condition and present

at

develops thorough interaction with others, building

psychic structure through the internalization of objects. Klein’s

view of infant development

writing on this topic in

Box

stinct threatens annihilation

3.1.

The

is

one beset with turmoil. You can read

infant

of the infant

first

a bit of her

experiences anxiety because the death in-

self; this

situation

is

accompanied by

feelings

of

persecution (Klein, 1952). Simultaneously, the feeding and care of the mother result in the

The feelings of persecution and wishes to destroy are projected to the bad breast, which withholds from the infant. To deal with these intense emotions, the infant splits them into two internal objects. The infant vacinternalization

illates

and

between these

ducing anxiety and

which the first

idealization of the

states, shifting

good object, the

from love

and

aggression, the latter feelings pro-

Simultaneously, these are both external objects, as are mother (to

guilt.

breast eventually generalizes),

6 months of the

to hate

breast.

infant’s life

and

is

and

eventually, the father. This phase occurs in the

referred to as the paranoid-schizoid position.

Around 6 months, according to Klein, the infant begins to perceive the mother as a whole person, and as the good and bad objects begin to synthesize, realizes that the aggressive, hateful

brings

emotions associated with the bad breast are directed

on the

at her.

because the child recognizes his terrible hate and aggression

depressive

toward the mother object and wishes to repair the relationship (Scharff Associated with the depressive position, in Klein’s view,

complex, with

its

we

these issues throughout

life.

However, healthy people tend

Paul sees Theds present functioning as resulting fom particularly his mother.

He is probably standing in

function fairly well in his

life.

& Scharff,

the beginning of the

and anxiety

never really outgrow these two positions

depressive than the paranoid-schizoid position (Scharff

to

is

associated feelings of love, aggression, guilt,

Klein thought that

This development

—we

Oedipus

(Klein, 1952).

struggle to resolve

to function

& Scharff,

1997).

more out of

the

1997).

his early experience

with his parents,

the depressive position, because he seems

However, the uncontrollable anger he reports could be

associated with the paranoid-schizoid position; possibly he never fully

made

the transition

and cycles back to it periodically. He may be experiencing Oedipalfeelings about his father, and his anger at his mother could be the result of his conflicting feelings of anger and love for her, never resolved. Later, when she agreed to reunite with his father, she out of this stage

symbolically deprived Theo

of Oedipal satisfaction.

NEOANALYTIC APPROACHES

85

who styled himself as a follower of Klein, had quite a bit to say about child development. He coined the engaging term “good enough mother” to describe a mom that mostly met the infant’s needs, one who created (or is) a safe ho lAing environment & Winnicott,

Black, 1995).

The

mother’s role involves two processes.

needs are met and in doing

First,

she ensures that the infant’s

so, allows the infant to believe that

she has created needed

which helps the infant develop an associated degree of omnipotence necessary

objects,

for

ego development. Second, mother allows the infant periods of quiet time. Failure to provide either of these results in fragmentation of the

reconciliation of internal

An ject.

interesting

and external

self,

for the self develops out

realities.

and unique contribution of Winnecott

A transitional

object

is

of the gradual

something inanimate,

like a

the idea of the transitional ob-

is

teddy bear or blanket, and

in the

words of Greenberg and Mitchell (1983), these entities provide “a developmental way station between hallucinatory omnipotence and the recognition of objective reality” (p. 195).

The

child in his

omnipotence

believes that he’s created the bear because he desires

parent goes along with this notion but at the same time, the object in the external world.

is

a real

it.

one that

The

exists

This ambiguity helps the child make the transition from fantasy to

interacting with a real world.

Paul considers Theo from WinnicotPs perspective and guesses that vide

an adequate holding environment, for

dated

his

anger

is

his

mother did not pro-

evidence that he has not consoli-

a sense of self Because Theo’s mother and father were embroiled in resulting fom their own faulty object relations), quiet times were few,

his objects into

their fights (likely

and the

constant fighting distracted his parents so

his needs. It

too threatening to deal

is

much

that they to some extent neglected

with the anger attached

to his mother, so the inter-

and the bad part repressed. Theo still has his battered old panda bear who was his chum as a small child. He has warm feelings when he glances at Rudy, who is on a shelf in his bedroom. nalized object associated with her

Fairbairn

and other

later

OR

is

likely split,

theorists

saw development

as the process

still

of resolving the

twin pulls of individuation and attachment to others (Hamilton, 1989). In Fairbairn’s view, infants’ strong

emotions are threatening (they might overwhelm the nascent sense of self),

so they externalize these emotions onto the parents. If the parent can accept the Fairbairn’s terms, to contain

it)

and

still

fom

is

so

how

to

do

this

himself (Hamilton, 1989).

Fairbairns perspective: Theo has likely externalized his anger at his

mother's compromised ability to form a

he

(in

maintain a bond with the infant (creating a holding

environment), the infant will eventually learn

Paul thinks

emotion

bond with him onto both ofhis parents.

That's

why

angry with their fighting.

FdEALTH

AND DYSFUNCTION

Broadly speaking,

OR

theorists see psychological dysfunction as the result of faulty early

development, with an emphasis on the object relations that parenting

(i.e.,

result

from less-than-optimal

bad mothering). For instance, Fairbairn thought that infants repressed

NEOANALYTIC APPROACHES

86

threatening objects, but these have effects on the individual nonetheless. essentially

tion

doing away with aspects of the

and negative

feelings

it

reacts

individual

is

yet this repression leaves feelings of frustra-

self,

about the self The person then becomes

ment, and when threatened with

The

terrified

of abandon-

with rage or extreme neediness (Cashdan, 1988).

From Winnicott’s perspective, failures of the mother to provide a holding environment cause the child to experience impingement. The mother either fails the child in the area of omnipotence or in providing quiet time to consolidate. Development stops, and the child doesn’t develop a healthy core sense of self in

Instead, the child develops a false

self.

order to deal with the external world and also to protect what

(Greenberg

& Mitchell,

as

stemming from

of integration of object representa-

a lack

ungainly term, unmetabolized bipolar intrapsychic representations

tions, or in his rather

(Cashdan, 1988). Difficulty in the integration process For example, Kernberg writes a

lot

is

typically

sees these individuals as

intolerable

One

and has

harboring a

lot

of negative

to excessive, defen-

who display borderline DSM-IV-TR terminology.

mostly aggression, which

affect,

is

to be split off (Levy et ah, 2006).

controversial aspect of Kernberg’s theory

ther constitutional

due

about individuals

personality organization, or borderline personality disorder, in

He

has developed

1983).

Kernberg saw dysfunction

sive splitting.

little self

(i.e.,

that this aggression can be the result of ei-

is

inherited) or environmental forces

(e.g.,

experiences of abuse).

What-

ever their origin, these feelings result in a negative emotional tenor that dominates interpersonal relationships,

and

thus, negative objects (actually part-objects) are internalized.

representations can’t be integrated into the

self,

self and

of significant others.

It is

object

resulting in identity diffusion, Kernberg’s

diagnostic label. In Kernberg’s words “identity diffusion

concept of the

The

is

represented by a poorly integrated

reflected in the subjective experience

of chronic

emptiness, contradictory self-perceptions, contradictory behavior that cannot be integrated in

an emotionally meaningful way, and shallow, p. 12).

The

appear in

self

how

is

fragile

and constantly

sees

him and

between good and bad

and very good and behave

Theo as having internalized the bad

states.

These

shifts also

in

ways that convey these perceptions.

objects created by his parents’ treatment

of

the environment that their conflicted relationship created. These feelings have

mostly been repressed, but the tiate the

shifting

impoverished perceptions of others” (1984;

these individuals deal with other people in their lives; they alternate between

seeing people as very bad

Paul

flat,

stress

that Theo experiences in having to

complex interpersonal environment ofcollege

is

taking

its toll.

grow up and nego-

He hasn’t developed

of integrated internal objects. He has used the defenses ofprojection, introjection, and splitting to manage the inadequacies of his early environment, but these defenses are breaking down and his anger is beginning to surface. The surfacing ofthe anger

a healthy self or

is

scary for Theo

set

—

it is

powerful,

and unconsciously Theo fears

that if it comes out,

it

will

destroy important objects, most significantly, his parents.

Nature of Therapy Assessment. lysts,

to

OR

therapists are not likely to use

they are more interested in observing the

underlying dynamic processes.

any formal assessment. As with most ana-

client’s

behaviors and verbal content as clues

NEOANALYTIC APPROACHES Paul simply

Theo and

listens to

Theo’s reactions to

him and

Tamia and others. Paul

87

tries to

of his stormy

listens carefully to his stories

looking for clues

is

He closely

get a sense ofhis internal ivorld.

observes

relationship with

to Theo's object relations.

Overview of the Therapeutic Atmosphere and Roles of Client and Counselor. Like the ER theorists, therapists look very much like orthodox psychoanalysts when they do ther-

OR

apy However, they classic analysts

more

are

— they

likely to attend to the

environment of therapy than do

see the therapy relationship as replicating the early relationship

with the caregiver. Again, however, Klein stands out. According to Walker (1957), Klein’s approach to ther-

apy was influenced by her work with children, and differed from lowing ways.

First,

classic analysis in the fol-

she emphasized the early phases of experience, because she was convinced

that neuroses were seated

development. As noted

much

earlier,

than did Freud, and probably in the oral phases of

earlier

much more

Klein was

interested in the aggressive impulses

She advocated the early use of very deep interpretation (Walker, 1957); instead of proceeding from surface to depth, she would offer interpretations based on early develof the

client.

opmental dynamics much sooner than would

a traditional analyst. Mitchell

and Black

(1995) characterize the relationship between analyst and client in Kleinian therapy

much more

fundamentally enmeshed than in Freud’s view.

simply revealing the contents of her tracted

own mind

as if the patient

when

times, the analyst

is

a

bad

destroying from within

good milk,

breast, deadly

if ingested, (p.

a

good

destructive; interpretations are poisonous,

as

providing the holding environment that the

should avoid impinging on the client so that the true

replace the false self (Kernberg,

breast, magically

nurturing, restorative. At

protective,

an infant (or they otherwise wouldn’t be

as

in

107)

Winnicott saw the analytic situation not experience

and

is

is

dis-

by countertransference) observer; the patient experiences the analytic situation

transformative; interpretations are

pist

not

to a generally neutral (except

terms of her primitive object relations. At times, the analyst

client did

It is

as

&

1984; Mitchell

self

a client).

The

thera-

can then safely emerge and 1995). Likewise, Fairbairn

Black,

thought that analytic change emerged from the new relationship established with the analyst (Mitchell

Of recent ity in

& Black,

interest

1995).

among contemporary analysts

is

the notion of the therapist’s author-

the analytic situation and associated discussions of therapeutic neutrality. Kernberg

(1996) addresses this

on education, therapeutic

issue,

training,

and contends

and

relationship.

skills,

He

that therapists

must

retain their authority based

but they must also recognize their

writes

“technical

neutrality,

in

anonymity, and natural behavior does not imply that the analyst ble, professional role relationship

with the patient.

Nor does

own

short, is

not

input into the

does not imply

in a consistent, sta-

technical neutrality imply that

the psychoanalyst’s personality will not influence the patient, in the

same way

as the patient

necessarily will influence the analyst through countertransference reactions” (p. 146).

Paul takes a moderate approach

ronment with him.

He

to Theo, trying to establish

realizes that

who he

is

a

stable, safe therapeutic envi-

will affect Theo, hut also

is

alert for evidence

that suggests that Theo's object relations are surfacing in the therapeutic relationship.

NEOANALYTIC APPROACHES

88 Goals. For

sense of

was

OR theorists,

good therapy

will restore healthy object relations

Winnicott saw the goal of therapy

self.

for the client to develop

faulty patterns the client

as

new ways of relating

development of the

self,

and the resulting

tinuous sense of self and others, empathize with them, and et ah,

tied to the

abilities to

reflect

as the

maintain a con-

on ones own experience

2006).

Paul hopes that Theo will be able ject

self Fairbairn’s goal

ways that were not

to others,

a solid

brought to therapy. Kernberg would see the goal of therapy

integration of the part-objects within the

(Levy

and thus

world so

they will do.

withstand the necessary surfacing of his internal obthat he can build a more integrated sense of self through the therapeutic work to

He anticipates that it will take a

while for Theo

to

be able to deal directly with

the emotions associated with his parents because they are so scary, so he begins with Theo’s

current relationships, which are the topics of his early free association.

Process of Therapy

OR therapists are very interested in

However, with

insight.

function, the kind of insight expected

a little different

is

clients

who

display severe dys-

than that expected with typical

neurotic clients. As noted in text that follows, transference interpretations with the former clients are restricted initially to

here-and-now events, implying that insight

the dynamics of the therapy relationship;

later,

about

the focus becomes historical events.

OR theorists are also very interested in transference will bring to

is first

They accept

that clients

therapy their old ways of relating, and will unconsciously recreate early

rela-

tionships in the relationship with the analyst. For instance, Fairbairn thought that as hard as the client tried to

old,

do otherwise, he eventually comes

bad object” (Mitchell

& Black,

1995

p.

to experience the therapist as “the

122) from earlier relationships.

In classical analysis, the therapist deals with the transference objectively, interpreting the transference to the client from an unemotional, neutral standpoint (unless the therapist a

bad

analyst,

caught up in countertransference).

accepted this idea of the therapists

having three key components: tation; (c) a goal

(a)

OR theorists, such as Klein,

For example, 'Kernberg characterized analysis

in

as

the analyst’s technical neutrality; (b) the use of interpre-

of developing of a full-fledged transference neurosis, which

through interpretation. Even ( 1

role.

Some of the

is

is

resolved

maintaining technical neutrality, however, Kernberg

984) advocates warmth and empathy, and further, that the therapist must be able to em-

pathize with

what the

client can’t deal

with

Kernberg acknowledged working with neutrality difficult to maintain, clients.

As

a result,

due

in himself.

relatively disturbed individuals

made

to the strong negative transference displayed

he recommended that early

technical

by these

in therapy, transference interpretations

be

confined to only immediate therapeutic situation; genetic interpretations (those based on the client’s

developmental history) are saved for the

later stages

the transference, both within and outside of therapy, the therapist to sacrifice neutrality to

not to be interpreted; instead For is

it is

make

is

of therapy. Acting out of

to be blocked,

sometimes requiring

directive interventions. Positive transference

is

used to build the working alliance (Kernberg, 1984).

OR theorists, what happens in transference with the more severely disturbed clients

best explained

by the nature of the primitive defenses they need

to

employ

to protect

NEOANALYTIC APPROACHES their fragile selves. really quickly,

2004).

The

89

Noting that these primarily negative transferences seem

Kernberg thought that projective identification was behind them

client,

projects these onto the therapist.

him.

The

client

being hostile and

(St. Clair,

because of his unintegrated internalized objects, brings in to therapy the

from

aggressive, scary object representations of the parents left over

fears

to develop

may

As

a result, the client

is

does not trust the therapist, and

then attempt to protect the self in one of two ways: either by

sadistic, or reacting like a

Countertmnsference

and

early experiences,

frightened child.

seen as an aid to understanding the client (Scharff

&

Scharff,

1995). Because the client projects his disordered object relationships into the analytic uation, the therapists reaction to the client client’s internal

sit-

becomes diagnostic information about the

dynamics and ways of operating. However,

in relation to the

more

disturbed clients, the shifting and mostly negative aspects of the transference can

severely

elicit

cor-

responding aggressive and hostile responses on the part of the therapist (Kernberg, 1996; St. Clair,

2004). Kernberg (1996) recommends ongoing peer consultation

therapist to

examine

his

his current relationship problems.

He

relation between his early experiences

Paul will accept

relationship between the two

him

of them, then in

anger threatens

to

in the

way

that he expresses anger

this anger, first discussing it as it applies in the

Theo’s current relationships,

tually as it relates to Theo’s earliest experiences with his his mother. IfTheo’s

and

of his current behaviors and feelings. Paul

thinks that Theo will eventually become angry with life.

for the

will be alert for Theds responses to the therapeutic

relationship, as well as possible historical roots

in his

way

input into the transference.

Paul hopes that he can help Theo understand the

toward others

as a

bad objects,

and then

even-

his parents, particularly

get out of control, Paul will set boundaries on the

ofsuch and will work with Theo to structure his life outside of therapy to minieffects. In this process, Paul remains attentive to his feelings when he is with Theo,

expression

mize

and

its

his possible

input into their relationship dynamics.

believes that his responses are interfering

He

will seek consultation if he

with his work with Theo.

Therapeutic Techniques As

in traditional psychoanalysis, the

ticularly

in

OR

is

interpretation, par-

of transference. Kernberg speaks of the “three-person” model of therapy,

“the analyst ship,

most potent of technique

is

immersed, on the one hand,

and on the

in

which

in a transference-countertransference relation-

other, as maintaining an objective distance,

from which observations and

interpretations of the patient’s enactments of internal object relationships can be carried

out” (2001,

Some

p.

536).

OR theorists believe that the relationship in therapy

actual content. For example,

client,

can get unstuck and

A

who

is

developmentally stuck

move forward (Greenberg et ah,

in the client’s early

at the stage

& Mitchell,

recent approach, based on Kernberg’s work,

chotherapy (TFP; Levy

the curative factor, not the

Winnicott believed that the holding environment created

therapy provides the proper relationship that was missing

environment, the

is

is

known

life.

where parenting

in

In this failed,

1983). as

Transference Focused Psy-

2006). In TFP, a structured approach begins with the

development of a treatment contract specifying the expectations of therapist and

client.

NEOANALYTIC APPROACHES

90

The major

techniques of TFP are clarification, confrontation, and transference analysis of

the here-and-now events of the therapeutic relationship. Clarification refers to the attempts

improve

of the therapist to understand the clients experience, helping the client to ability to self-reflect (difficulties in self-reflection are

integrated self). cations,

TheTFP

thought to

from the poorly

result

therapist also confronts discrepancies in the client’s

which then can be linked

his

communi-

to psychic splits hypothesized to underlie the

problems

in self-integration. Transference interpretations link the therapist-client interaction to

early object relations.

Paul patiently

He

apeutic environment.

lead him

Theo and tries

listens to

to see

how

to his feelings

Paul will

Throughout the therapy

relationship,

ing environment that

essential if Theo

is

maintain a

relatively neutral,

but supportive ther-

and

will interpret expressions ofTheo's anger in the relationship

connected

it is

to

is

about his parents, particularly

try to

provide the

to express his

anger

his mother.

correct, supportive,

andfear on

the

way

to

hold-

gain-

ing insight.

PSYCHOLOGY— IT’S ALL ABOUT ME

SELF Overview As the

label suggests,

SP

focuses

on the development of the

self

Heinz Kohut (1913—1981),

the founder of this approach, was born in Vienna but eventually relocated to Chicago in 1

939, fleeing the invasion of Austria by the Nazis.

ditional analyst, but over the years developed his

He began his professional work as a traown perspective, which was first readily

apparent in his 1971 book. The Analysis ofthe Self: A Systematic Analysis ofthe Treatment ofthe

second book. The Transformation of the Self{\977) Kohut died in 1981 but was in the process of writing his

Narcissistic Personality Disorders. In his

he further developed his ideas. final

How

book.

Does Analysis

Cure?,

which was published

in

1984

2006).

(Strozier,

More

information on Kohut and SP can be found at the website of the International Association for Psychoanalytic Self Psychology, http://www.psychologyoftheself com/kohut/index.htm

SP’s subtitle

through

his

spective

is

seemed

might be

work with

clients

about me,” for Kohut developed

who were

tic

syndromes

his

work

work

as a

(St. Clair,

complement

&

self,

as

you

will see. Originally,

2004). However, toward the end of his as a

life,

Kohut

characterized

contribution separate and parallel to that of

Black, 1995). Nonetheless,

Kohut

is

often seen as trying to have the

best of both worlds: he did not reject classical drive theory completely, but reserved cases in

which the

client presented

called the neuroses). In

doing

so,

with

a relatively intact self

orders, such as narcissism.

system

(i.e.,

it

for

what Freud

he softened the nature of the drives: for instance, the nor-

mal Oedipal stage impulses were joyful and

However, drive theory was not

he

to traditional theory that applied to the narcissis-

more broadly applicable and

Freud (Mitchell

his ideas primarily

labeled as narcissistic personalities, and this per-

very focused on one’s conception of the

to see his

as

all

“it’s

.

assertive rather than libidinous

to be used to

SP was the

and

aggressive.

understand the character or personality

better alternative here because

it

dis-

emphasized prob-

lems in development that predate the Oedipal conflicts that are the focus of drive theory (St.

Clair,

2004). This adaptation prompted Greenberg and Mitchel (1983) to label

Kohut’s theory a mixed model. However, Kohut’s ideas were considered radical enough by

N EG A N A LYT C A P P ROACH ES

91

I

the “mainstream” psychoanalytic crowd to deserve the dreaded label “unanalytic,” be-

stowed by Anna Freud herself (Mishne, 1993).

Central Constructs Kohut coined

Selfobject.

can’t differentiate

difficult to pin

between the

down,

self and other.

I

an individual with a

ally frustrate the infant to tory, the infant’s self will

is

self,

as

who need

it

grows from the primitive

to be

good

selfless

The most

selfobjects but also to occasion-

spur growth (Kohut, 1984). If these relationships are satisfac-

develop in healthy ways (Quintar, Lane,

some problems with

totally integrated self.

gratification

also as individuals

but the need for selfobjects never disappears.

Theo’s selfpsychology therapist. In thinking

ulates that he has

and

Kohut uses the term self-selfobject relabut most other writers simply refer to self-

and support the infant

important selfobjects are the parents,

Sharlene

self

and

will in the following sections.

Selfobjects exist to soothe state to

of the

to be a bit fuzzy

are relevant to the self

tionships to describe the role of the selfobjects,

object relations, as

his position that infants

Although the term tends

selfobjects are referred to as parts

environment that

in the

emphasize

a special term, selfobject, to

about

—

his selfobjects

& Goeltz,

1998).

Theo's presentation, she spec-

he probably has not established a

Sharlene wonders if Theo’s parents provided the optimal

and frustration

as he

was developing

possible that their preoccupation with their

own

—

levels

their stormy history suggests that

issues resulted in

than would be desired, resulting in Theo developing negative

higher

levels

of

it is

offrustration

selfobjects.

Kohut added the conception of disintegration anxiety to analytic maintaining that it is the most basic form of anxiety experienced by human beings.

Disintegration Anxiety. theory,

Although he acknowledges that “the attempt

to describe disintegration anxiety

attempt to describe the indescribable,” Kohut characterizes death (Kohut, 1984,

p.

16).

Mollon (2007) noted

it

as the fear of

is

the

psychological

that the threat of fragmentation

present even in individuals with relatively healthy (cohesive) selves, and that

all

is

psychic

defenses operate to ward off this horrendous, primal, anxiety.

of disintegration anxiety, although largely unconsciously. This anxiety, which stems from faulty object relations that do not support a coherent sense ofself, is terrifying, and he represses it and instead it is expressed as anger toward Theo

is

probably suffering the

important It

is

selfohjects

effects

who failed to provide him

also transferred to

important others in

security

and protect him from

his current situation,

nothingness.

most notably, Tamia.

Theory of the Person and Developmen'l of the Individual As you might expect, Kohufs view of development emphasizes the self

develops through relationships with the selfobjects.

healthy establishment of the

oped:

“Look

i\\Q

at

self,

1

great?” This

2004). 1 he

processes are important in the

mirroring and idealizing and two selfobjects must be devel-

grandiose-exhibitionistic self

me! Aren’t

Two

self (St. Clair,

is

and the idealized parental imago,

battle kids

the operation of the grandiose-exhibitionistic

need to say self,

and

it

NEOANALYTIC APPROACHES

92

The

needs mirroring^xom the parents, which consists of parental approval and admiration.

development of the parental imago requires

him

or her as perfect,

parent and child

(St. Clair,

some disruption

if

because the child’s response

empathy

self develops

he or she

called the

is

enjoying

it.

empathic relationship between

2000). Generally, healthy parents do this well, but inevitably, there

in the process,

met. These disruptions,

tions in

to the child that

and mirroring comprise what Kohut

Idealizing

is

and communicating

idealizing, or the parent allowing the child to see

and the

child’s

needs for idealizing or mirroring are not

mild, push the child toward the development of a cohesive self is

to, in

small steps, take these functions into the self These disrup-

and with

these, gradually, the

through the internalization of the grandiose-exhibitionistic

self and the parental

are called optimalfrustrations (Kohut, 1984)

image through the process Kohut

called transmuting internalization (St. Clair, 2000). If

all

goes well, these representations broaden into good feelings about the self and the idealized

superego (Kohut, 1984). Most importantly, the child develops a coherent sense of self

The

self develops

ality type, for

with two poles, corresponding to the two types of selfobjects. Person-

Kohut,

is

determined by which of the two poles

is

dominant (Greenberg

&

Mitchell, 1983). If the grandiose-exhibitionistic aspects are strongest, the individual will

be assertive and ambitious. If the idealized selfobject

is

dominant, the person

will

hold

strong ideals and values.

Kohut seems ambivalent about really

thought that the kinds of

Freud saw.

He

traditional drive theory

clients

we

are dealing

with

and psychosexual

now

He

from those that

acknowledges, for example, the Oedipal stage of development, but in his

later writings, sees

it

as a

phase of joy and affection for the parents (Kohut, 1984). For

Kohut, the intense sexual and aggressive impulses sometimes seen of faulty development

Theo’s

differed

stages.

(see the following section

mother and father attempted

to

at this stage are a

product

on dysfunction).

he good parental objects for him, at times playing

and admiring the products of his play. For instance, Theo’s panda bear, Rudy, learned to talk, and his mother would engage in animated conversations with him. Theo also idealized his parents, particularly his father, who he saw as important and powerful. with him

Health and Dysfunction In an

SP model, healthy people have healthy

Kohut

plete (Kohut, 1984).

health

is

defined as structurally com-

rejected the traditional Freudian notion that the pinnacle of

who has successfully negotiated the Oedipal stage of “there are many other good lives, including some of the great-

a heterosexual individual

development. est

selves, generally

and most

He wrote

that

fulfilling lives

recorded in history, that were not lived by individuals whose

psychosexual organization was heterosexual-genital or whose major Linamblvalent object love” (1984,

Kohut believed and uses

selfobjects that differentiates

is

lifelong. It

is

the

In possession of available nuclear self-esteem

one hand, and of core

ideals

goals,

on

their response to us

be enlivened by the enthusiasm

we

way

in

which one seeks

between healthy and dysfunctional people.

opined “we must be

and be nourished by

to

p. 7).

that the need for selfobjects

and

commitment was

He

and ambitions, on the

the other, in order to seek out mirroring selfobjects

and

feel for

in

order to seek out idealizable selfobjects and

them” (1984,

p. 77).

NEOANALYTIC APPROACHES According to

93

problem leading

SP, the basic

to dysfunction

and can be

self- related

is

traced to deficits in early experiences with caregivers. Greenberg and Mitchell (1983) put

to parental character a

Kohut

thus: “the cause of pathology, as

it

pathology

355,

(p.

kind of “black hole” where the

self

sees

failure in

it, is

italics in original).

empathy, attributable

These chronic

failures result in

should be, typically observable only through the

extreme emotional reactions associated with threat (Mollon, 2007).

tic

Kohut (1984) recognized three different types of dysfunction: the psychoses, narcissispersonality disorders, and the structural-conflict neuroses. In the psychoses, a rudimen-

tary self has not been developed.

individuals In therapy,

He

would be nearly impossible

it

work with

believed that although one could to help

them

these

create a true self because

doing so would require demolishing the defenses that have been erected

to

compensate

for

the missing self Instead, the analyst can help the client shore up the already existing defenses (Kohut, 1984).

SP theory

is

perhaps best illustrated by Kohut’s analysis of narcissistic personality

turbances (Kohut, 1984). This term the narrow,

of

self has

wrong

DSMIV-R Narcissistic Personality Disorder sense.

The chronic

compared

failures (as

the person’s sense of self

noted

earlier, in

(Kohut, 1984, affection,

{¥jo\\\xty

1984). Disintegration anxiety

all

SP

—

analysis: those

processes

an “enfeebled” is

operative because

emanating from the is

the types of dysfunction that phallic stage of development.

not considered pivotal in the develop-

parents cherish the child’s emerging displays of assertiveness and

be well.

If

they do not serve will

as

good

selfobjects in this phase,

emerge (he used the term complex

from normal oedipal phase

events).

The child will

experience two kinds of anxiety:

anxiety, the fear

more

self can

the loss of one or

primal horror that

humans can

the healthy Oedipal self

selfobjects

Kohut

is

tion anxiety, ptesent in

in boys,

and the wish

all

stages of

Is

is

of the

most

the

what occurs

for a penis

among

life. It Is

the result of faulty parenting

—

—

is

girls.

disintegra-

parents failed

resulting in flawed selfob-

and an incoherent sense of self

Sharlene thinks that Theo's too distracted by their

was a very young not soothing,

exist),

arguing that the motor of psychological disturbance

significantly in either their mirroring or idealizing functions ject relations

not

loss

and the Oedipal sexual and aggressive urges become

lost

prominent, leading to castration anxiety In essence,

without which the

of the

experience (Kohut, 1984). Secondary anxiety is

what Kohut

to distinguish these

primary and secondary. Primary anxiety, or disintegration

when

self

instead, “the child of healthy parents enters the oedipal phase joyfully”

p. 14). If the

will

Kohut meant

theory, the Oedipal stage

termed the Oedipal complex

(i.e.,

really

is

apparent (Mollon, 2007).

is

ment of dysfunction

self

what

In fact,

fragmented. In extreme cases, the “black hole” effect described

is

were the focus of traditional I

it.

to optimal ones) result in

In referring to the structural-conflict neuroses,

As

In these clients, a basic sense

been formed, but there are significant deficiencies in

susceptible to narcissistic injury

earlier,

used in a broad sense in SP theory, rather than in

that the individual has developed neither the idealizing or grandiose aspects of

is

the self

is

dis-

own

child.

and he

issues arise from faulty early parenting.

conflicts to

As a

result,

His parents were

likely

provide enough mirroring and idealization when he

transmuting internalization failed, his

experiences disintegration anxiety. His sense

selfobjects air

ofself is shaky and easily

NEOANALYTIC APPROACHES

94 threatened, as

when Tamia went out all night with fihends. When

she stood up for herself,

Theo erupted, because in doing so, she challenged his sense of himself It seems to Sharlene that although Theo’s problems are the result of much earlier dynamics, they are somewhat attached

to the

lene wonders

Oedipal complex. Theo experiences prominent aggressive

about

urges,

and Shar-

his sexual urges as well.

Nature of Therapy Assessment.

The SP

selor relies

on her observation of the

sion, to

would not be

therapist

determine the nature of the

a fan of formal assessment. Instead, the

upon

client, particularly

self-deficits

Sharlene carefully observes Theo’s behavior in

the client’s behavior in ses-

brought to therapy.

sessions,

watchingfor

his

and tries to gauge the level ofcoherence ofhis self structure. He her at first, when discussions are fairly mundane. to

coun-

her

emotional reactions

relates fairly easily to

Overview of the Therapeutic Atmosphere and Roles of Client and Counselor. Kohut (1984) claimed that the relationship in SP therapy differs from that in traditional psychoanalysis in that

it is

warmer and more

informal.

The SP

therapist

analyst to be emotionally available to the client.

Kohut

is

more

explains this difference in orientation

to the client as resulting

from the expanded concept of empathy

apist (seeing the client’s

problem

neediness and narcissistic repressed.

demands

in

—

SP theory

the

SP

ther-

early deprivation) construes the client’s

welcome appearance of needs

as the

However, the SP counselor does not

take) but does this

stemming from

as

willing than a traditional

gratify these needs (that

that have been

would be

a

huge mis-

empathize with them. In contrast, a traditional analyst might conceptualize

neediness as avoidance of aggressive and libidinal urges associated with Oedipal conflicts.

Despite the assertion that SP analysis in this approach.

The

therapist

is

informal and relaxed, the client

must empathize with the

client,

is still

a patient

but must also provide the

correct interpretation of the client’s transference manifestations.

While attempting to provide an empathic environmentfor Theo, Sharlene

must maintain some

sense

objective stance she can,

Goals.

The

in the title

ofauthority

and does

not respond

goal of SP intervention

of his 1977 book,

it is

in the therapy relationship.

is

to Theo’s bids for

is

aware that she

She maintains the most

admiration or sympathy.

to correct deficits in self structure, or as

Kohut put

it

the restoration of the self (Kohut, 1977).

Sharlene hopes that in providing the correct environment

and interpretations for

Theo, he

can integrate the fragmented aspects of his personality into a coherent self. He will reexperience his rage at his parents (and the associated internal selfobjects), but as Sharlene provides the proper idealizing objects

and

and mirroring

responses,

he will eventually reintegrate these

a more stable sense of who he is. He will initially perceive events as himself and threatening; later, he will use his more stable, objective

establish

totally related to

cognitive processes to objectively evaluate events in his

life.

NEOANALYTIC APPROACHES

95

Process of Therapy Therapy

SP model

in a

is

very similar to traditional psychoanalytic therapy in

many ways.

The key technique used in this approach is interpretation, particularly of transference phenomena. Dream analysis is also used in SP therapy. However, the end goal of therapy is different than that of other forms of psychoanalytic treatment:

it

rebuilding the self

is

rather than insight or expansion of the ego’s capacities.

The

SP model approach ... is

core of therapy in the

the self psychological

were frustrated.

rule governing

that understanding always precedes explanation

(Kindler, 2007, p. 65; italics in original). selfobjects that

empathy; “the most important

is

Therapy

reactivates the client’s early needs for

Essentially, the therapist

must function

as a selfobject to

the client, providing mirroring or idealization functions that were absent in the client’s early

environment (Kohut, 1984). In

transmuting internalization will occur and the client

failures are optimal,

structure. Resistance in the

The

ference (Greenberg client; the process

(Kindler,

these failures,

panying new

self

the client

& Mitchell,

is

that the person of therapist

considered essential

must

either establish a mirroring or idealizing trans-

The

therapist basically serves as a selfobject for the

1983).

2007 Kohut, 1 984) The very human

if

is

of cure thus recapitulates that which went awry in the .

;

therapist

fails

client’s

develop-

the client at times, and

optimally frustrating, lead to transmuting internalization and the accom-

self-structure. Kindler

therapy. This process ference,

—

will build self-

seen as the client’s attempts to avoid a repetition of

is

signature aspect of SP therapy

to the transference process

ment

SP model

on the core of the

early assaults

this process, the therapist will inevitably fail; if these

happens

(2007) discusses the disruption-repair sequence

development of the

in three stages: defense analysis,

and the creation of an empathic relationship between the

self

and

in

SP

trans-

selfobject that

has been split off and repressed (Kohut, 1984).

Sharlene struggles

he needs

it.

When

empathize with Theo, providing mirroring and idealizing as

to

she fails, she

aware that the disruption will prove helpful if she

is

can repair the relationship. Theo transfers his early frustrations into the relationship, getting angry with her

when

she ends a session on time, but

the next session, Sharlene brings this anger up with Theo, early experiences

with his parents.

somewhat

and

tries to

abruptly. In

link

it to

his

The working through of such interpretations

becomes the vehicle by which Theo can integrate the

selfohjects that

he has split offand

repressed.

Therapeutic Techniques Kohut (1984), the most important technique in SP analysis is interpretation. As noted by Kindler (2007), two elements must be in place for the interpretation to be effective: understanding and explanation. Understanding provides the optimal frustration According

to

that leads to

new

self structure

legitimizes the feelings

The empathic bond

because although the empathic response of the therapist

and needs of the

client, the therapist

still

does not gratify the needs.

established (or reestablished) in this process substitutes for the direct

satisfaction of the client’s

nalization brings about

need and

new

in the

self structure.

context of this relationship, transmuting inter-

NEOANALYTIC APPROACHES

96

and

Sharlene empathizes with Theo, knowing that she will fail in the idealizing ing transferences. She talks about these failures with him, defenses

and

repression recede

and he

is

and through

mirror-

this process, Theo's

able to reintegrate the problematic selfobjects he

Transmuting internalization follows the disruptions of the Theo builds new selfstructure. He is less apt to feel slighted by others

carries in his self structure.

alliance

and to

and slowly,

react with anger to these events.

RELATIONAL PSYCHOANALYSIS Overview The

fourth wave of psychoanalytic thought

distant roots of this approach can be

found

is

loosely called the relational school.

work of Sandor

in the

of Freud and for a brief time, his analysand. Also considered key

what he

in establishing lyst

called interpersonal psychiatry in the late

1

was a participant observer rather than an abstentious blank

psychoanalysis

is

confusing because

it is

Franzecki, contemporary

Harry Stack

is

Sullivan,

who

940s argued that the ana-

The term

screen.

sometimes used by some

The most

relational

to describe a point of view

within contemporary psychoanalysis rather than a specific theory (Ghent, 2001). At other times,

it

seems the term

is

used to identify a specific theoretical approach, attributed mostly

who founded

to

Stephen Mitchell,

sis

and Psychotherapy shortly before

the International Association for Relational Psychoanalyhis

death in 2000.

The website of this

organization can

be found at http://www.iarpp.org/html/index.cfm In the inaugural issue of the organiza.

Ghent (2001)

tions newsletter, sis

writes that “the term relational

by Greenberg and Mitchell back

in

1

was

first

applied to psychoanaly-

983 when they abstracted the term from

theory of interpersonal relations and Fairbairn’s object relations theory.

models of psychic development was the notion that psychic structure

—

Gommon

at the

very

aspects of psychic structure that are accessible to psychotherapeutic intervention

the individual’s relations with other people”

approach

is

(p. 7).

Oddly enough,

—

to these

least,

those

derive

from

the “bible” of the relational

Object Relations in Psychoanalytic Theory (1983), written by Jay Greenberg

titled

and Stephen Mitchell. This rendition of relational model, which he

Sullivan’s

calls

analysis focuses

most

closely

on

Mitchell’s

the relational-conflict modeiX (Mitchell, 1988).

Centrae Constructs Self.

RP

across time, along with the

meanings associated with them (Mitchell, 1992). Mitchell,

writing about the self maintains that because of different selves,

some

that

we

because

we

upon

temporal nature,

on anxiety) causes us

fear that authentic expression

significant others

its

in

we each have many

experience as more authentic than others. However, the need

for security (see the following section self

of experiences and behaviors

theorists discuss the self as the repetitive pattern

whom we

are

might cause

to

modulate our expression of

anxiety, anger, or

dependent (Mitchell, 1992). These

withdrawal in

later expressions

are called the inauthentic or false self

Min-Wei, the

relational analyst, considers Theo’s presentation.

therapy a set of meanings

and behaviors based on

He guesses that Theo

brings to

his lifelong relationship experiences.

Wei assumes that Theo experienced anxiety early in

his

life,

perhaps as a

result

Min-

of observing

NEOANALYTIC APPROACHES his parents

stormy relationship. Theo would have also learned a great deal about relation-

and others,

ships in observing his parents, ships are fragile

The

Relational Matrix. is

RP

ofself, which

therapist

on

is

relating,

is

learned that relation-

abandon

to

is

the other. These

some degree inauthentic.

relationship; the client’s presenta-

interpreted through the construct of relational matrix

tional matrix is

often threatening to

Theo’s current version

focus of the

He likely

in his early years.

and conflicted, with partners

meanings and patterns are

tion

97

a hypothetical construct, consisting of the

(St. Clair,

self,

2004).

The

rela-

the object to which the self

and the patterns of interaction between the two (Mitchell, 1988).

Most prominent is the Min-Wei thinks that this pat-

Several relational matrices are relevant to Theo’s current presentation.

one with Tamia, which tern

is

one that

Drive Theory.

don

intermittently stormy

lifelong; probably it

is

RP

is

was learned in the relational matrix with

theory rejects the notion of instinctual drives. However,

and

the notion that conflict, aggression,

ships. Sexuality

is

a vital sphere in

viewed

and angry.

as the result

human

relational events

emerge (Curtis

&

relation-

Hirsch, 2003). Aggression

of frustration or identification with an aggressor. Conflict

found

in relationships

flict is

intrapsychic

(compare

— between

id,

this perspective to the traditional analytic

ego,

that Theo's anger

is

rooted in relationship

lessons are evident in his current relationships.

routinely

view that con-

conflicts,

Min-Wei guesses

and perhaps

Theo learned that

Also,

with them as individuals

—sometimes

his parents

his parents. These early

that feelings of desire

and

strife

anger disrupted his relationships

was turned on him, and at other

the anger

even

is

because in his parents relationship they seemed to result in

to Theo,

and abandonment.

is

is

and superego).

one of the interaction patterns that he learned through observing anger are scary

does not aban-

seen as the most intense form of relatedness (in terms of intimacy) and

which

Min-Wei assumes

sexuality are important in

it

his parents.

times,

anger resulted in one of his parents leaving.

Anxiety. Sullivan

saw anxiety

as

key in the early

life

of the infant; indeed

Beneath Theo’s cool exterior

secure situation.

also lies anxiety,

discomfort with relationship

and

lifelong relationship experiences.

Min-Wei

thinks. This anxiety stems from his

his inauthentic self,

He fears

drives the need

environments, and anxiety on the

to attach (Mitchell, 1988). Infants innately seek secure

part of the infant or caretaker creates a

it

which

intimacy because

it

in turn are related to his

brings conflict.

Theory of the Person and Development of the Individual RP

theorists tend to rely

on developmental theory

that emphasizes the significance of early

RP models accept the nohuman motivation (Greenberg,

events that are thought to lead to the development of the tion of learned

ways of

relating to others as critical in

1999). Mitchell (1988) contends: “There

is

a

self.

powerful need to preserve an abiding sense

NEOANALYTIC APPROACHES

98 of oneself in

as associated with,

terms of actual transactions

in a psychologically (p.

positioned in terms

33).

such

as

There

is,

as well as internal presences”

meaningful sense,

RP

in the

in isolation, outside a

relationship patterns (Curtis

& Hirsch,

and

is

not

‘self,’

matrix of relations with others”

2003).

that Theo's current ways of being in relationships (his self or personality)

He has

therefore,

He

has learned

and also from

observing relationships around him,

easily,

further, “there

some recognition of the genetic or biological influences most important part of personality in this view is learned

are related to his experiences growing up.

late to others.

and

matrix of other people,

system,

temperaments, but the

Min-Wei assumes

of, related to, a

how

to

respond

the consequences

to others

through

of his attempts

to re-

been unsuccessful in his relationships because he fears intimacy, angers

guards himself carefidly, afinid

relationships, particularly

to reveal his real self

and emotions

in

with Tamia.

Health and Dysfunction In

RP

theory, dysfunction

is

seen as resulting from developmental problems that have pre-

vented the individual from forming a coherent, consistent experience of

(Greenberg

& Mitchell,

self

and others

1983). Healthy individuals live rich lives in which the experience

and expression of the authentic

self are

more common than expressions of inauthentic

selves (Mitchell, 1992).

Problems develop when the individual, having experienced dysfunctional relationships

throughout result,

his

development, forms

a

“narrowed relational matrix” (Mitchell, 1988). As a

the person seeks relatedness to others, but does so using old patterns of relationships

that are

narrow and

restricted.

Theo's current struggles are probably linked to his

narrow relationship matrix. His limited

ways ofrelating to others are linked to the environment in which he developed and the consequences ofthese relationships. Theo learned very early on that intimate relationships were dangerous. Intimacy leads to anger, which destroys relationships.

Still,

he has difficulty con-

anger because his sense of self is shaky and he unconsciously fears injuries The way to defend against hurt and abandonment is, paradoxically, to get angry.

trolling his

to

it.

Nature oe Therapy Assessment.

As

in the other neoanalytic

mal assessment or diagnosis. the characteristic

Min-Wei

way

begins his

He

approaches, the

RP

therapist

is

not interested

simply wants to understand the client

as best

he can and

that he relates.

work with Theo simply by asking what brings him

Theo responds openly,

in for-

and Min-Wei

in to counseling.

observes Theo’s presentation carefully.

He

notes

how

Theo interacts with him, feeling simultaneously seduced and pushed away.

of Client and Counselor. According to Curtis and Hirsch (2003) RP practitioners prefer to see clients more than once a week to encourage development of the transference Roles

NEOANALYTIC APPROACHES Modern

relationship. tic

analysts

who adopt

relationship differently than

the therapist

RP

ment.

objective

is

theorists

and

99

more

tend to see the therapeu-

a relational perspective

traditional theorists. In traditional analytic theory,

neutral, striving to stay out of the client’s process in treat-

have abandoned

this notion, preferring instead the

notion of the

tivo

person field. These therapists recognize therapy as an interpersonal encounter that engages

both the client and counselor. Greenberg anci Mitchell (1983) comment: “events within

and unfolding from the dynamic structures of the

the analysis are not understood as preset

between the patient and the

patient’s neurosis. Rather, they are created in the interaction

analyst” (p. 389). Transference client’s conflicts, are

nitions

seem

Min-Wei

is

aware

a

product of the

seen as mutually influenced by both therapist and client. These recog-

imply a

to

and countertransference, rather than being

less

ofi his

model of therapy than

authoritative

in traditional analysis.

He

input in the relationship with Theo.

wonders what

efifiect

his

and how transfierence might develop. Approaching Theo with a warm, congenial manner, Min-Wei attends closely to his own reacperson will have

tions to

Theo as

The

Goals.

o?i

the interaction with Theo,

well.

RP

goal of the

approach

is

change relationship patterns that have

to help clients

proven problematic enough to get them to therapy. The client must give up the old, constricted relationship patterns

developed

earlier in

life.

Ultimately, these changes should

bring about more authentic and fulfilling experiencing of the self

Min-Wei

relating to others. Ifihe can do

tionships

so,

Theo will find that

his life

is

more fulfilling. Min-Wei will focus on helping Theo understand the

macy and anger

important

role

of inti-

what he observed and experienced

in relationships, connecting these to

relation to his parents. It will also be

tion to

new and jreer ways of more meaningful and rela-

hopes that Theo can, through the therapy process, develop

to see

how

these

dynamics play out in

in

rela-

Min-Wei and Tamia.

Process of Therapy One

of the most distinct features of RP

the client

new ways of interacting with

“the patient

is

viewed

as

is

is

having lived in a

which the

when

The

Through

actions based

his

new

interaction with the patient,

and

to

open the patient

analyst attempts to create a safe

client can experience the therapist as a

transference issues

do emerge, the

client

and

new

new

environment

object of relationship

first,

In

so that

therapist can readily identifiable inter-

transference

used by

RP

theorists,

it is

always emphasized that “the

analyst can never function entirely ‘outside’ the transference” (Greenberg p.

to

on these (Greenberg, 1999).

Although the term

(1983,

to offer

As Greenberg and Mitchell (1983) put it: closed world of archaic object relationships which

able to enter that previously closed world

relational possibilities” (p. 391).

is

others.

lead to neurotic self-fulfilling prophecies.

the therapist

that an important goal of the therapy

389, quotes

In original).

It is

acknowledged that the

ship history/patterns to therapy, but the therapist Influences

responds (or doesn’t) to them. For instance,

in

&

Mitchell

client brings his relation-

how

these play out by

how he

Greenberg’s (1999) reformulation of

NEOANALYTIC APPROACHES

100 analytic neutrality, he points out that for

may too

closely replicate

how the

the client to immediately process.

tic

The

make

some

clients parents treated

might consider disclosing some of himself to the

& Mitchell,

and

unique encounter, such that “doing

client in a

RP

fully

of a particular kind

engaged, makes possible a kind of freedom and authenticity that

and precious”

the past. Well

to talk

about whatever he wants,

aware that he

is

in

when

alert for signs

that,

both

rare

of relationship patterns

a relational matrix with Theo, Min-Wei

as authentic as he can in the relationship,

thoughts

is

an

(p. 19).

Min-Wei asks Theo from

involves both the thera-

analysis, either as a patient or as

analyst, involves a struggle to reach a fully authentic experience

when

client’s

1983).

Ultimately, Mitchell (1992) maintains that the process of pist

this stance will cause

premature transference, and thereby better understand the

(Greenberg

relational patterns

them. Taking

the therapist the old object, which disrupts the therapeu-

analyst in this situation

client to prevent this

clients, the aloof, abstentious analytic stance

and

readily admits to his

own

tries to

feelings

be

and

appropriate. Theo tends, at first, to be superficial in his conversations with

Min-Wei, avoiding emotional expression. Min-Wei feels distant from Theo, and comments on

this.

sible,

Theo

contending that Min-Wei does not understand him. As calmly as pos-

erupts,

Min-Wei

tries to

get Theo to talk about these feelings.

Therapeutic Techniques Techniques els.

The

not)

in the

therapist

and the

RP model

are essentially the

and

engage in a discussion (whether

client

same

as in all

therapist interprets the client’s productions.

of the other neoanalytic modit is

called free association or

Dream

analysis

is

used

content emerges. Discussion of the relationship between therapist and client

and the ultimate goal

is

if

dream

common

is

to relate these interchanges to the client’s early interactions

with

significant others.

Theo and Min-Wei work together relationship

works

to

and what might

to sort

out what in their interaction

be coming in

fiom

is

unique

Theo’s previous relationships.

to their

Min-Wei

him and those with Tamia Theo develop new ways of relating to

help Theo see the parallels between his relationship with

and his parents.

In

this process,

others that will help to relate to others

Min-Wei

him feel less

like

he

is

tries to

help

about to explode. Hopefully, Theo can learn how

without the anger that has bothered him before he came

to counseling.

EVALUATION OF NEOANALYTIC APPROACHES My

first

and most vehement comment about these approaches

cult to read! Writers in this area

seem

is

that they are very diffi-

to like very convoluted, complicated styles

of writ-

ing and create nifty-sounding terms that are hard to understand (self-selfobject relations, lor example). at

Even when the terms and concepts

are relatively simple, writers often

very abstract levels or discuss very specific client presentations or problems

sism, envy). Further, the ters,

journal articles),

newer writings seem to be spread about

making the

area

seem

disjointed.

work

(e.g., narcis-

in different sources (chap-

Terminology

varies

from writer

to

NEOANALYTIC APPROACHES

101

writer, creating a perception that there are

many

fact,

many

variants of neoanalytic thought,

when

in

of the ideas and concepts are quite similar to one another. Mitchell (1998)

wrote “there are

psychoanalytic institutions and literature.

cultist features of traditional

Analysts have often claimed for themselves an esoteric knowledge of mysterious realms expressed in a thick jargon that

is

inaccessible to the uninitiated. Because they felt they

singular, proprietary rights over access to the unconscious,

some

traditional psychoanalytic

authors claimed a unique knowledge of the underpinnings of (pp. 5-6).

Although he was

had

referring specifically to traditional

human experience” analyses, many of these all

qualities are seen in neoanalytic writing as well.

The

neoanalytic approaches seem

less

comprehensive than

many

of the other theories

presented in this book. Several of them focus on particular client presentations (such as

Kohut’s focus on narcissism), and at times, are

less easily

applied to other client problems.

Unless they specifically adopt the bulk of classical analysis, which some do, these theorists

seem

to be presenting valuable theory that

However, there ful in

is

some

somewhat

who

fairly recently, the neoanalytics

present with fairly severe disruption in their

were about the only theorists

personality disorders. This tendency

makes

(i.e.,

lives.

Until

about the

to write extensively

sense, because the notion of formal (traditional

diagnosis springs from a medical model, and

physicians

limited in scope.

significant level of agreement that these approaches are very use-

dealing with clients

DSM)

is

many

of the neoanalytic writers are

psychiatrists).

Qualities of Theory The

four groups of theories presented in this chapter are essentially equivalent to classic

analytic theory in terms of precision

and

testability.

Although

it

was

a

major goal of the post-

Freudians to clarify and build upon Freuds work, the constructs they developed and

invoked tend to be still

seem

to rely

difficult to

on

difficult or impossible to directly observe.

single-case analysis,

disconfirm these theories

and uncontrolled

Proponents of these theories

clinical cases at that. It

would be

as well.

Although variants of neoanalytic theory have been

tested in

outcome

research (see

would be erroneous to say that the four approaches presented in this chapter are empirically valid. Most of the outcome research conducted tests further variants of psychoanalytic theory, such as brief dynamic below) and found to be effective in helping

therapy or

clients,

Time Limited Dynamic Psychotherapy

not directly

test

it

(see next section).

These approaches do

the postulates of the approaches in this chapter.

Research Support Outcome

Research. In addressing the effectiveness of the various neoanalytic approaches,

most writers tend relatively

to rely

on the various

dated (see Galatzer-Levy, Bachrach, Skolnikoff,

sive description

that clients generally

improved

interesting that the

EP model

& Waldron,

of these studies). For example, Galatzer-Levy

Psychoanalytic Genter and the

It is

large studies of psychoanalysis, which,

New

by now,

are

2000, for an exten-

et al. describe the

Golumbia

York Psychoanalytic Institute studies, which found

as a result of psychoanalysis.

Menninger

project, discussed in

Ghapter

(Wallerstein, 1986). This project followed clients in

2,

was based

in the

what were conceptualized

NEOANALYTIC APPROACHES

102 as

distinct approaches to treatment: supportive vs. expressive. Supportive therapy,

two

thought to be

powerful than expressive, emphasized support for the

less

client’s

defenses

and the avoidance of deep interpretation. Expressive therapy, on the other hand, more sembled traditional

nificant

who sis

in the effects of these

recent report details the efforts of

seen at the

Anna Freud

improvement

less

in

62%

Fonagy and Target (1996)

to study children

of children treated with intensive psychoanalysis

severely disturbed children

ingly, children

two approaches.

Center. Ratings on a scale of general adjustment showed that sig-

received less-intensive psychotherapy.

(with

The Menninger

with focus on interpretation and insight.

found no differences

project essentially

A more

analysis,

re-

whose mothers received

Improvement was

related to severity of diagno-

improving more), longer treatment, and

analysis

44%

and

interest-

improved more than those who did

not.

and Bogetto (2005) presented a comparison of brief dynamic therapy (BDT), supportive psychodynamic therapy (SPT), and a wait-list conIn a smaller study, Maina, Forner,

trol

group

ered

more

in a

sample of 30

and directive than SPT, and

active

and intrapersonal

patterns of interpersonal to

clients presenting

one of the three groups, and engaged

Some

BDT

is

consid-

emphasizes insight into individuals’ lifelong

were randomly assigned

conflict. Participants

of 15 to 30 sessions.

in a range

sures indicated that both treatment groups as posttest.

it

with depressive symptoms.

Outcome mea-

showed more improvement than the controls

evidence indicated that at a 6-month follow-up,

BDT

produced better

outcome than SPT. Another variant of psychoanalytic treatment

Therapy (SE therapy

in short;

Supportive-Expressive Psychodynamic

is

&

Crits-Christoph

Connolly, 1998). This time-limited

approach places more emphasis on the working alliance and relationships in general than traditional psychoanalytic therapy. In this

tionship patterns,

model, the focus

for

SE

a

client’s

maladaptive

depression. Flowever,

most of these

Theory-Testing Research.

One

to testing analytic theory

is

effort has

studies did not use

aspect of the

the researchers’

rela-

Crits-Christoph

manualized approach, finding evidence

of effectiveness with diverse presenting concerns such

as anxiety, opiate

dependence, and

comparison treatments.

SE therapy research program that is of interest work on Core Conflictual Relationship Themes

been devoted to the measurement of this construct, using actual

client material. Crits-Christoph ies

on the

much like interpersonal or relational approaches to analysis.

and Connolly (1998) present outcome data

(CCRT). Much

is

suggest that clients tend to

and Connolly (1998) report that the

show some

results

of these stud-

similarity in their relationship patterns across the

various relationships they navigate. Although very tentative in nature, this conclusion provides

some support

for psychoanalytic theory. Flowever,

pothesis of consistent relationship patterns

it is

useful to observe that the hy-

would be acceptable

to

many

theoretical

approaches to counseling. This group has also assessed the relationship between therapists’ interpretations client’s

A

CCRT)

and found

and outcome and working

fairly recent

model

Strtipp’sTime Limited Sullivan’s ideas

TLDP

a positive relationship

between accuracy (with respect

alliance (Crits-Christoph

of psychoanalytic therapy that rests

Dynamic Therapy TLDP

on

(Binder, Strupp,

a

& Connolly,

to the

1998).

program of research

& Henry,

is

1995). Using

about individuals’ tendencies to develop stable ways of relating to others,

focuses on cyclical maladaptive patterns,

terpersonal roles in

which

which patients unconsciously

are “central or salient pattern of in-

cast themselves; the

complementary

roles

NEOANALYTIC APPROACHES which they

103

and the maladaptive interaction sequences, self-defeating expectations, negative self-appraisals, and unpleasant affects that result” (pp. 55-56). in

cast others;

many as

Research on attachment theory would probably be cited by alytic

models. Loosely rooted in psychoanalytic models (Mahler

is

supportive of neoan-

sometimes cited

here), this

theory emphasizes the importance of the early child-caretaker relationship and argues that these influences can be seen well into adulthood.

and the

at present,

resulting data

Issues of Individual

seem

Attachment theory

to support these notions (Cassidy

much

& Shaver,

criticized for

vogue

1999).

gender and cultural

practiced today (other than orthodox analysis) can be seen as

it is

in

and Cultural Diversity

Although psychoanalysis proper has been heavily analysis as

very

is

bias,

much more

views of clients from diverse backgrounds and of other-than-heterosexual ori-

flexible in

its

entations.

One

example of this

clear

is

found

in attitudes

toward homosexuality. Although

Freud seemed somewhat ambivalent about homosexuality, traditional psychoanalytic

thought has historically labeled

this orientation as deviant. In contrast,

Chodorow (2002)

points out that as early as the late 1970s, Mitchell (1978) had provided a substantial tique of the pathological view of homosexuality. this position.

GLBT

would tend

analysts today

to take

Kassoff (2004) finds relational psychotherapy, in particular, useful with

clients because the constructivist

views of reality and

is

Taken

emphasis within the theory welcomes multiple

consistent with recognizing diverse sexual orientations.

Certainly, the early theorists’ emphasis as biased.

Most

cri-

to the extreme, the

on the relationship with the mother can be seen

mother can be seen

as the font

from which

all

dysfunc-

tion flows.

With ics

and interpersonal

the exception of perhaps the relational

perspectives, the neoanalyt-

could be charged with the overemphasis on individualism that plagues

psychotherapy. This shortcoming clients

from

ual needs,

cultural

and so

may make

Even from the

for family over individ-

relational perspective, the notion

be culturally encapsulated, for the submission of the authentic self to say, in

response to familial requirements,

theories of

these theories less than optimal for use with

backgrounds that emphasize collectivism, respect

forth.

many

would be seen

as less

of authentic

less

self

may

authentic versions,

than optimal for some

clients.

The Case Study The

case of

Theo seemed

chapter. His primary

approaches. Anger

is

to lend itself well to each of the approaches presented in this

problem was also easy to

relationship,

which

is

a focus of the current neoanalytic

understand through these

African-American and so caution must be taken in applying these tic

However, Theo

lenses.

is

relatively individualis-

approaches with him.

Summary Neoanalytic approaches to counseling and psychotherapy originated in Freud’s models but to

some varying

extent, extend or

modify

it.

Ego

analysts

whereas the relational models deviate most noticeably from

seem the

it.

Almost

closest to tradition, all

of the neoanalytic

NEOANALYTIC APPROACHES approaches emphasize

earlier

forms of experience than did Freud. The neoanalytic

approaches presented here also use essentially the same techniques: pretation (particularly of transference),

dream

analysis,

and so

free association, inter-

forth.

The

goals of these

theoretical systems differ significantly: ego psychology’s resemble traditional psychoanalytic goals (insight, love,

and work), object

changing relationships (and

and

self

Most

The

in the case

of

relations

and

OR theory,

relational perspectives

change

emphasize

in internal objects as well),

psychology the integration of a fragmented self analysts today are probably influenced

theories in the neoanalytic area

seem

less

by more than one of these orientations. comprehensive than traditional analytic

would seem relatively natural. Research support for these theories is about as good as what is found for classic analytic theory. Issues of cultural and individual diversity seem less problematic in the more current approaches, although individualism and gender bias may rear their unpleasant head in some applications. theory; hence using different parts of each at times

Visit

Chapter 3 on the Companion Website

chapter-specific resources

and

self-assessments.

at

www.prenhall.com/murclock

for

Alfred Adler

James

is

a 17-y ear- old African American male who

is

small

Division of Family Services referred James for counseling affect his

around him

He

is

to address

wears

glasses.

problems that may

a new adoptive home. His presenting problems include defiance of stealing, and a history ofinappropriate sexual behavior. Various individuals

adjustment

authority, lying,

and slender and

to

(foster parents, caseworkers)

have commented unfavorably on

currently in high school, but comes to counseling during

summer

his ''attitude. ”

vacation.

ofhis birth mother, Denise, who was 18 years old when he was born. Denise also had three other children, James older sister, Karen, and two younger brothers, Carl andJeff. James’ birth mother andfather were not married, andJames father James

is

the second child

was not the father of any of the other

children. Little

is

known about him

except that he

is

deceased.

When James was

and 3, were placed in foster care as a result of severe neglect. His mother had problems with alcohol and had a "nervous breakdoivn. ” His stepfather lefi the home that same month. Conditions at the home prior to the 8,

he

and his

siblings, ages 9, 6,

time of placement were very poor. Fourteen people were living in a two-bedroom house strewn with dirty clothes and dishes. No meals were prepared, and no one assumed responsibility for the children.

Fhe police had frequently been called

to the

house in response

to

loudfights often involving dangerous weapons. Reportedly, Denise’s method of handling behavior problems was to lock the children in their rooms for extended periods of time. James

was physically abused by

his stepfather

on at

least

Following their initial placement in foster

one occasion.

care,

James and

his siblings

had a long

his-

ofplacements. Between foster homes, James lived in residential treatment centers. His mother and stepfather were sporadically involved with the children, hut eventually,

tory

parental rights were terminated. James was often in trouble at school Jor stealing or Jighting.

His grades were poor. 105

INDIVIDUAL PSYCHOLOGY

106

When he was 15, James was removedfrom the most recentfoster home for violent behavior and placed in emergency foster care. He was told that this was the end of the line for him. He seemed to make more ofan effort to settle doivn and ivas then again placed in a foster home. James apparently got along well with his new family. Conditions seemed ideal. Then, the family started taking in other foster children in addition to their own two children. Now there are five children in the home in addition to the foster parents children and fames. The foster parents are talking about getting a divorce, and there is much turmoil in this household. James is looking forward to getting back to school, mostly for his social life and also to get out of his “crazy” house. He has many friends and seems to be popular with girls. James recently got a job and was very proud ofhimself. However, he was fired when he got drunk and his employer saw his friends carrying him out of the building. In counseling, James is struggling to verbalize his feelings, take responsibility for his own actions, and not blame

He seems

others for his problems.

everyone

James

motivated

work, but admits

to

it

would be a

lot easier if

would change. His goals are to finish school, get a job, and live on his own. wants to continue to work on his temper and getting along with others.

else

also

BACKGROUND Alfred Adler (1870-1937), the founder of Individual Psychology (IP), was born in Vienna, Austria, the second son of a grain merchant.

There were

Jewish family. As a child, Alfred was characterized ets

and problems with

age 5 Adler contracted

his vocal

as frail

six

children in his middle-class

and

fearful, suffering

from

rick-

chords that resulted in stuttering (Manaster, 1977). At

pneumonia and almost

died, an experience to

which he attributed

—

become a physician he was motivated to overcome death (Ansbacher & Ansbacher, 1956; Monte' & Sollod, 2003). Once again, we can see the connections his choice to

between a

theorist’s life

to have set the stage for

and

his creation: Adler’s

both

At age 25 Adler received

his

p.

men and women. later

became

seemed

seems

medical career and his theoretical ideas.

Timolejewna.

It is

interesting that Raissa

an “irreligious political revolutionary” and “an ardent feminist

(Hoffman, 1994,

his early inferiorities

medical degree and began work as a practicing physician.

his

years later he married Raissa

triumph over

who

is

Two

characterized as

disliked domesticity”

48), given Adler’s progressive ideas about the critical need for equality of

Adler and Raissa had four children, two of

psychiatrists

to realize Alfred

and furthered and

whom, Kurt and

Alexandra,

Adler’s work. Milentine, the Adlers’ oldest daughter,

Raissa’s socialist political

ideology

when

she emigrated to

Russia and lived in dangerous opposition to the Stalin regime. Sadly, “Vali” disappeared in

1937, causing her parents, and particularly her father, great worry and anguish. Vali had evidently been imprisoned for espionage and died after 2 years in prison, at age 44. Alfred

Adler died not knowing what had become of his daughter. In 1895, three years after his graduation first

from medical school, Adler published

his

work, which discussed the damage caused by the horrendous working conditions

among

tailors at the time. In this

study he

first

demonstrated

his special interest in

bettering social conditions. Indeed, one of his prominent followers, Heinz Ansbacher,

contended that

“his

most outstanding personal

characteristic

was

his interest in

sympathy with the ‘common man’ ” (Ansbacher & Ansbacher, 1956, original). Adler was a member of the Social-Democratic movement,

p.

and

201; quotes

in

a social reformist

INDIVIDUAL PSYCHOLOGY

107

group, and these values are clearly evident in his theory (K. Adler, 1994). first

began

his

& Ansbacher,

(Ansbacher In

medical practice,

1902 Adler became

it

was

When

neighborhood of Vienna

in a lower-middle-class

1956).

a

member of Freud’s Vienna

Circle.

The

nature of the relation-

ship between these two giants of psychological theory has been the subject of

ment (Ansbacher, 1962;

Fiebert, 1997; Gay, 1988).

and

Freud’s student, Adler

Adler

Although Adler

is

much

typically

argu-

viewed

his followers protested that categorization, pointing

as

out that

Adler had published a preliminary version of his theory prior to his contact with Freud (Sweeney, 1989). There was apparently no contact between Freud and Adler prior to

Wednesday night

Freud’s invitation to Adler to join his

Abraham Maslow,

discussion group (Hoffman,

1

994).

the well-known humanistic psychologist, reported that Adler vehe-

mently denied being a follower of Freud, having established from the beginning of

from Freud’s (Maslow, 1962). According

relationship that his views differed

Adler maintained that Freud spread the story that Adler was a disciple

and he was very angry with Freud (Maslow, 1962,

Vienna Psychoanalytical

The

it is

Society.

between the two

society in 1911.

who had gone astray,

Freud a “swindler” and

so, calling

clear that

Adler was an active

and Freud designated Adler

until 1911,

to develop

By

men

member of

“sly”

had begun

this time, significant theoretical differences

from the

that eventually resulted in Adler’s resignation

under debate was the primary motivation

central issue

&

(Monte

Freud’s group

successor as president of the

as his

make

behavior: Freud, of course, saw this as pleasure or sex; Adler wanted to sonal/social

Maslow,

to

125).

p.

Despite the controversy,

from 1902

doing

for

their

for

human

interper-

it

was not amicable (Gay,

Sollod, 2003). Apparently, this divorce

1988). Adler then established the Society for Free Psychoanalytic Research (Ansbacher,

1929/1969), the

first

later

renamed the Society

and

for Individual Psychology,

in

1914 established

journal devoted to individual psychology, Zeitschrifi fur Individualpsychologie

(Mozdzierz

& Mozdzierz,

1997). The Neurotic Constitution, Adler’s

first

major book, was

published in 1912. After

World War

I,

Adler’s

commitment

establish child guidance clinics in

other laypersons

whom

how

change led him

to furthering social

Vienna schools. In these

clinics

to help

he taught teachers and

understand the behavior of the children with

to use his ideas to

they worked.

With ciates to

the rise of the Nazis, Adler emigrated to America in

do the same (Hoffman, 1994).

to Adler biographer in Austria.

become

By

Raissa, his wife,

Hoffman, continued

the time Adler

moved

to

to the

work as

United

1

929 and encouraged

remained

in

his asso-

Vienna, and according

a central figure of the

Gommunist Party

many American

psychologists had

States,

interested in individual psychology, including

G. Stanley Hall, the founder of the

American Psychological Association (Ansbacher, 1970). Adler accepted

a professorship at

Golumbia University and continued an active teaching schedule. He was on a lecture tour in Aberdeen, Scotland, when he collapsed and died of a heart attack in 1937 at age 67. Although a bibliography of his work is lengthy, most of what bears his name was not truly written lic

lectures

of this

by Adler himself Instead, much of the material was gathered from

and edited and presented by others (Ansbacher,

work

in

Box

4.1

.

Adler’s Ideas have been developed

of talented followers. As noted

earlier,

1

his

929/ 969). You can read 1

and promulgated by

Kurt and Alexandra Adler followed

a

puba bit

number

in their father’s

—

1

INDIVIDUAL PSYCHOLOGY

108

Box

An

medicine.

which

is

Excerpt from Adlers The Science ofLiving

own

In the author’s

The

4.

case the interest in psychology developped out of the practice of

practice of medicine provided the teleological or purposive viewpoint

necessary for the understanding of psychological facts. In medicine

They have

organs striving to develop toward definite goals.

definite forms

we

see

all

which they

upon maturity. Moreover, in cases where there are organic defects we always find nature making special efforts to overcome the deficiency, or else to compensate for it by

achieve

developing another organ to take over the functions of the defective one. Life always seeks to continue,

Now

In

and the

force never yields to external obstacles without a struggle.

life

movement of the psyche is analogous to the movement of organic life. each mind there is the conception of a goal or ideal to get beyond the present state,

and

the

overcome the present

to

for the future.

deficiencies

and

difficulties

By means of this concrete aim or

by postulating

a concrete

aim

and

feel

goal the individual can think

mind

himself superior to the difficulties of the present because he has in

his success

of the future. Without the sense of a goal individual activity would cease to have any

meaning. All evidence points to the fact that the fixing of this goal

must take place

early in

life,

—

giving

the process takes place.

tion

which

cannot

it

bear.

A child,

Hence

being weak,

tion.

that

at this stage

How this goal it

is

dominates the

is

fixed

it

and

chooses for

it

and

finds itself in a situa-

strives to

develop along a line

The

material used for

itself

but

difficult to say,

child’s every

movement.

it is

Little

is

we

is

which

a life

is

tending can

we

of direc-

exists

and

indeed understood about powers,

definitely established only after the child has fixed

see the direction in

line

obvious that such a goal

impulses, reasons, abilities or disabilities at this early period. As yet there for the direction

form

A kind of prototime. We can imagine

important than the goal which decides the

less

it is

feels inferior

strives to develop,

it

of direction fixed by the goal which

development

a concrete

during the formative period of childhood.

type or model of a matured personality begins to develop at this

how

it

guess

what

its

is

really

goal.

no

key,

Only when

steps will be taken in

the future. It is

true that

The

impression.

when

we may

word

“goal”

is

mentioned, the reader

idea needs to be concretized.

to aspire to be like goals, if

the

God. But

to

be

like

God

is

Now

is

in the last analysis to

of course the ultimate goal

development substitutes

a miore concrete

the strongest person in their environment

may

be the

father, or

to imitate his

men

mother

if

When children all

first

and immediate

and make him

perhaps the mother, for

have a goal

—

is

the goal of

we

find that the child

goal.

Ghildren look for

we

their

find that even a

model or

their goal.

It

boy may be influenced

she seems the strongest person. Later on they want to be coach-

because they believe the coachman

and take on

have a hazy

use the term. Educators should be cautious in attempting to educate

themselves and their children to be like God. As a matter of fact in his

likely to

is

the strongest person.

conceive such a goal they behave,

feel

and

the characteristics consistent with the goal. But

dress like the let

coachman

the policeman

lift

a

INDIVIDUAL PSYCHOLOGY

Finger,

109

and the coachman becomes nothing.

.

.

.

on the

Later

ideal

may become

the

doctor or the teacher. For the teacher can punish the child and thus he arouses his respect as a

strong person.

The

child has a choice of concrete symbols in selecting his goal,

goal he chooses

be in

really

later life, said, “I

boy wished to be

is

an index of his social

want

to be a

to be the master of life

more powerful than

of being a doctor

is

also fashioned

death, but here the goal

Adler, A. (1929).

society,

is

realized

The Science ofLiving, H.

interest.

hangman.” This and death

—

A

boy, asked

a role

which belongs

around the god-like

L.

what he wanted

displays a lack of social interest.

and he was thus headed through

and we Find that the to

The

God. He wished

to

for the useless

life.

The

desire of being master of

life

goal

and

social service.

Ansbacher, Ed. and IVans. (Original work published 1929).

NY; Doubleday. Reprinted with permission.

footsteps (Hoffman, 1994).

Rudolph Dreikurs, the founder of the Alfred Adler

Institute

of Chicago, was Adler’s student and instrumental in popularizing and extending Adler’s Ideas

about working with children. Other

prolific writers in IP

theory are Harold Mosak,

Donald Dinkmeyer, Hans Ansbacher, and Rowena Ansbacher. The influence of Adler’s

many

theory can be seen in

theoretical approaches devised since his

—

for example, in

Rational Emotive Behavior Therapy, Family Systems Theory, and Reality Therapy. In

fact,

Sweeney (1989) reported that Albert Ellis, the founder of Rational Emotive Behavior Therapy, was a member of the American Society of Adlerian Psychology. Currently, Adlerians are a relatively small but very active group.

with

Psychology

is

appeared,

among which

filled

articles

on

are those

research

and

practice. Several

The Journal ofIndividual new books have recently

authored by Jon Carlson, Richard Watts, and Michael

Manlacci (2006), and Warren Rule and Malachy Bishop (2006), prominent contemporary Adlerians.

Mosak and

DiPietro presented Early Recollections (2006), an intensive examina-

and technique. The Adler School of

tion of this important individual psychology construct

Professional Psychology can be

found

at the

Web

address

www. adler.edu with ,

Chicago, Fort Wayne, and Vancouver, B.C. There are Adler institutes in

and San Francisco and national and international of Adlerian Psychology

associations, the

branches in

New York, Toronto,

North American Society

and the International Association of Individual Psychology.

BASIC PHILOSOPHY Adler can be considered a growth theorist with an optimistic view of the (Eckstein, Milliren, Rasmussen,

&

tendency to

and that

strive for perfection

Willhite, 2006).

of behavior (Adler, 1929/1969). Equally interest in society, for

this striving

as

Important

believed

condition

humans had an

innate

was the most important motivator in psychological

functioning

is

the

without the support of others, humans would not survive (Dreikurs,

1953). This “social interest” to feel inferior.

He

human

The ways

world of the individual.

is

inherent in the

these

human

two Influences

constitution, but also

are balanced

is

the tendency

determine the psychological

INDIVIDUAL PSYCHOLOGY

110

One watchword

of IP theory

to be a (self-consistent) unity.

unity in each individual

—

is

holistic.

Adler

The foremost

my work,

I

man

found

to prove this

is

In his thinking, feeling, acting, in his so-called conscious

175). Thinking, feeling,

p.

in

task of Individual Psychology

unconscious, in every expression of his personality”

1956,

“Very early

said,

(as cited In

and

& Ansbacher,

Ansbacher

and behaving, and perhaps even physiological function-

an integrated system directed toward pursuit of the individuals goals.

ing, are

Adler

described as a soft determinist (Ansbacher

is

although he did think that

human

& Ansbacher,

1956), which means that

behavior can be understood given general principles and

laws, these understandings are only probabilistic. For Adler, the individual creates his

path, but that very creativity enables

given time.

him

change that path and

to

A very popular quote from Adler

is:

“The important thing is not what one

with, but

what use one makes of that equipment”

1956,

176).

p.

Here Adler

is

saying that

Ansbacher

(Adler, as cited in

what one does

it is

his ultimate goal at

any

born

& Ansbacher,

ones genetic or

that matters, not

biological inheritance. Adler believed that individuals could very well

is

life

triumph over physical

challenge and that these struggles often led to significant contributions to society.

One

of the

rather than

earliest social constructivists,

some

and environment, he

neither heredity nor environment

abilities.

that

uses in his

is,

own

way of using

the interpretation he “creative”

way

words

up

his attitude

his attitude

relationship to the outside world. (Adler, as cited in

Known

as a social activist,

the health of

He

62).

and the

in

toward

Ansbacher

him

certain

which he “experiences”

—

toward

gives

are the bricks life. It is

life,

which he

his individual

which determines

& Ansbacher,

1956,

p.

this

206)

Adler believed that societal change was needed to improve

humankind. For example, he characterized the development of striving

power and superiority p.

manner

makes of these experiences

in building

these bricks, or in other

his relationship to the outside.

Environment only

impressions. These abilities and impressions and the

—

also

had

as the

the

said.

which determines

Heredity only endows him with certain

them

Of

objective external criterion, determined their views of reality.

influences of heredity It is

Adler believed that individuals’ perceptions,

“most prominent

a lot to say

evil

for

of our civilization” (Adler, 1927/1998,

about the cultural phenomena of overvaluing masculinity

belief in the “alleged inferiority of women” (Adler,

1927/1998,

p. 106).

IP counselor assigned to work with James. She begins her work by reflecting on the basically positive nature of humans, and knows that even though James appears very troubled, within him is the strength and potential to work toward a better existence. Although James inherited some things and experienced many others, Sandy sees that he has created his view of the world around him, and also that this picture can be changed. Sandy

is

the

HUMAN MOTIVATION Humans are motivated to strive for superiority. “We all strive to reach a goal by the attainment of which we shall feel strong, superior, and complete” (Adler, as cited in Ansbacher & Ansbacher, 1956, p. 104). IP uses a variety of terms interchangeably for this motive, such as will to power, striving for significance, or wish to

the IP view of

humans

rather than driven

by

is

overcome.

What

that people are seen as being “pulled”

is

most

by

critical to

recognize in

their goals (of superiority)

their instincts (as in the psychoanalytic view; Ansbacher, 1970).

INDIVIDUAL PSYCHOLOGY humans

Paradoxically,

111

by

are also beset

feelings of inferiority.

undeveloped, defenseless form, are smaller and

depend on our to

overcome

Another innate, but

in a relatively

powerful than those around

less

caretakers for existence. Naturally, a child feels

this feeling.

We are born

initially less

weak and

developed

and

inferior

human

around us give us food and water, keep us

are infants, the people

human

Ultimately, the motivation for

behavior

how

is

A

which

superiority, level

known through

person can only be

scheme

carries the

for dealing

is

when

forth.

the individual reconciles the

search for significance and feelings for others. For Adler, this resolution creative process.

and so

safe,

strives

inheritance

the need to belong. Adler thought that the need to belong ensured survival because

we

and

us,

an individual,

is

his or her personal plan to achieve

with feelings of inferiority and a certain

of belongingness.

Sandy thinks that James hides

his feelings

ings,

but he comes ojfas powerful and arrogant (the

sense

of belonging

to society as

He undoubtedly has these feel“attitude J. He doesnt seem to have a

ofinferiority

well.

a whole, but may have a feeling that he

is

connected

to

the friends he hangs with.

CENTRAL CONSTRUCTS Lifestyle According

to Adler,

which Adler of,

everyone develops a plan for his

life

by the age of

in,

the world (Carlson et ak, 2006). Ansbacher and Ansbacher (1956)

several of Adler’s definitions for this

complex construct, including

about oneself and the problems of life, the whole attitude to lifestyle

the child’s

is

“self or ego, a

way of adapting

life” (p.

largely

unaware of

in external reality,

to the circumstances

around him

Dinkmeyer

it is

a fiction,

by which Adler meant that

the individ-

it is

not based

& Ansbacher, 1956). (Ansbacher & Ansbacher,

Thus, 1956;

& Sperry, 2000). A person’s goal arises out of the interaction of two influences,

the only

way

lifestyle.

All behavior

to truly

creative

combines

(b)

referred to as the fictional goal

is

the need for significance

The

and

it,

(a)

(Dreiktirs,

but created by the individual (Ansbacher

sometimes the goal

own

174).

1953). Every lifestyle has a goal, and the goal has two important qualities: is

man’s

list

of the personality, individuality, individual form of creative opinion

personality, the unity

ual

This plan,

called the lifestyle^ guides individuals’ entire lives, including their perceptions

and actions

The

5 or 6.

his

and

feelings of

community, or

understand another

is

purposeful, oriented

human

According to Adler,

social interest.

being

is

to

understand the goal of the

toward achieving the

lifestyle goal.

power of the individual explains how the individual

interprets

environment, genetic inheritance, and experiences into the

lifestyle

and and

associated goal (Ansbacher

&

significance

unique. Take, for example, the case of identical twins. Identi-

cal

(i.e.,

his goal)

is

Ansbacher, 1956,

twins raised in the same family could

from the perspective of creative

177).

The way

have different

a

lifestyles

person strives for

and goals because,

they have different perceptions of the world and/or use their

powers differently given the same basic material. Their perceptions of their

This term latter will

IP,

still

p.

is

in various sources, spelled life style, life-style,

be used

in this chapter.

and

lifestyle

with equivalent meaning.

own

The

INDIVIDUAL PSYCHOLOGY

112 abilities

and

and the surrounding environment may be very

goals.

It is

different, creating different beliefs

entirely possible that even if they look exactly alike, behaviorally they will

be quite different. Alternatively, because they have genetically identical constitutions and physically appear the

same

to those

around them, they might be treated

identically,

which

may, in turn, lead them to very similar perception schemes.

and other family influences

Parental “the family

and

beliefs

the individual’s

is

values.

first

important

are very

society” (Schneider, 2007, p. 43). Parents are

However, Adler warns us not

all,

and pampering

at a

time

when

children. For instance, Adler thought that

little

wrote about the

sees the

world

results

of

attention was being devoted to raising

pampered children grow up with the notion

the world should always provide everything they want, immediately.

abused child

for

the development of the style

a personal, creative, interpretive process. Nonetheless, Adler

abuse, neglect,

models

assume that parental

to automatically

influences singularly “cause” the lifestyle because, above is

development of lifestyle:

in the

as a scary or hostile place.

Children

who

The

that

neglected or

are suppressed

through

overly strict or punitive environments might develop a drive to gain freedom (Adler,

1929/1969).

Sandy

observes that James

was neglected as a

child,

and she guesses

that this early experience

a view of the world as a confusing, hostile place. His naturalfeelings of inferiormay have been magnified by his chaotic early environment. In what Sandy knows is the

resulted in ity

development of lifestyle, it is questionable whether James actually had a family. His situation appears to have been one of neglect, at best. James appears to have critical periodfor the

and goal oriented more toward personal superiority than social contriHis goal probably goes something like this: Others are evil and dangerous so I must

established a lifestyle

bution.

defeat

them

before they hurt me.

his life before

a

He probably

he was placed in foster

care.

learned these methods through experiences in

In other words, James’s current behavior

is

of what he needed to do to survive in a terrible situation. Sandy doesn’t know much about James’ inherited strengths and weaknesses, but

partly

reflection

appear that he had virtually no

does

which has resulted in the absence of developing lifestyle. IfJames was indeed physically

stability in his family,

significant role models to influence his

abused, both the physical abuse

it

and emotional oppression may have

resulted in a feeling

of

may naturally dynamic may contribute to

being suppressed. Sandy knows that Adler thought that suppressed children develop a drive to gain

James’ rebellious

life

release,

and she

hypothesizes that this

pattern.

Social Interest A

very important contribution of IP

human

condition (Carlson

the degree to the

cares

about

its

emphasis on the

p.

25).

The

individual

embeddedness of the

social

2006). For Adler, the measure of the individual was his society.

“We

most important psychological function, both

1927/1998,

Fm

which he

et ah,

is

who

chants,

find adaptation to the

in the individual

“Nobody

loves

and

community

is

in society” (Adler,

me; everybody hates me;

going to go out and eat worms” would definitely be viewed

as

dysfunctional by the

individual psychologist. Adler was so passionate about the importance of social interest that in a chapter entitled

“The Absolute Truth,” he discussed

his conviction that

humans

INDIVIDUAL PSYCHOLOGY

113

can never truly find the absolute truth. Instead, he wrote, “Our sole recourse in

dilemma

communal

of our

to accept the logic

is

life

on earth

as

though

it

were an ultimate,

absolute truth that can be approached step by step” (Adler, 1927/1998, pp. 21-22).

with extroversion, true social interest

to be confused

makes

vidual

Only

the potential for social interest

supported result

community (Ansbacher

to his

problems: those that tal

seen in the contributions the indi-

& Ansbacher,

1956,

p.

14 1).

must be nurtured and

innate; these feelings

of social

levels

arise

Adler identified two general classes of

interest.

from physical

and those stemming from environmen-

disability

influences such as faulty parenting or social factors such as sexism, racism, or classism

When

1927/1998).

(Adler,

a child has physical

problems (such

as

slow development or

physical disability), society does not typically react in nurturing ways,

opment

stunted. Children

is

race, or class

may

who

learn that the

and thus

ships.

Healthy children

way

are those

to survive

who

tribute to society as a whole. In

individual,

it is

Ansbacher

is

to look out for

number

1956,

Sandy thinks that James grew up social interest. In fact, his early

fighting

and

are

one. Parents can

sum, “in order

in

Sandy

understand what goes on

man”

an

in

(Adler, as cited

an environment that did not support and encourage

environment was at

possible abuse point

best neutral

on

this

dimension, but the

toward a situation that was antithetical is

experienced some of the racism or oppression to

to

p. 127).

development ofsocial feeling. Because James regard

social relation-

encouraged to empathize with others and con-

necessary to consider his attitude toward his fellow

& Ansbacher,

his devel-

experience negative reactions from others based on sex,

pamper, neglect, or suppress children, resulting in distorted attitudes about

in

Not

During development, problems encountered by children usually

in children.

diminished

in

is

is

this

the

to

African American, Sandy wonders ifhe has

still

present in our

society,

particularly with

young African American men. encouraged by the glimmers ofsocial feelings evident in James recent behavior.

is

Judging from engaged in

his history,

James was uncooperative, and at times openly

socially useless behaviors such as stealing, aggression,

he shows interest in interacting with his peers, which

is

ground. Sandy will attempt

and

to

nurture these feelings

and lying. However,

a very positive to help

sign,

He

rebellious.

lately

given his back-

James channel them

into

socially useful acts.

Inferiority Feelings The

familiar term inferiority complex

was

in

likelihood not Adlers (Ansbacher

all

&

Ansbacher, 1956). Adler used the word feelings rather than complex, probably to avoid the

Freudian aura conveyed by the

latter

term (Brachfeld, 1951,

as cited in

Ansbacher, 1956). Adler apparently discovered the power of the term

when he found out

p.

typically reserved for

complex

as cited in

Ansbacher

256). After Adler finally adopted the inferiority complex.

abnormal

Inferiority feelings are a (Adler, as cited in

inferiority

&

(while touring the United States) that he had been called the “father

of the inferiority and superiority complex” (Brachfeld, 1951, Ansbacher, 1956,

Ansbacher

was

inferiority feelings.

normal part of life because

Ansbacher

It

&

& Ansbacher,

1956,

p.

“to be

115).

human means

We are always

to feel inferior”

moving up from

INDIVIDUAL PSYCHOLOGY

114

down, or from minus feelings “are the cause

example, can future; to all

when people

Sollod, 2003).

These

itself,

for

feel their

ignorance and their need to foresee the

human

beings to improve their whole situation,

the result of the strivings of

it is

&

of all improvements in the position of mankind. Science

only

arise

our self-estimates (Monte

to plus in

know more of the universe, and to be able to control it better. Indeed, it seems that human culture is based upon feelings of inferiority” (Adler, as cited in Ansbacher &

Ansbacher, 1956,

117).

p.

Feelings of inferiority begin at a very early age,

smaller and weaker than those around him. interprets

demand

and

reacts to the situation

much

too

of the child, he

is is

when

Fiow the

critical

child

(Ansbacher

is

treated

by others

& Ansbacher,

is

is

1956). If others

repeatedly confronted with his inferiority. If he

treated like a piece of precious china, he surely has a different interpretation. relate to children

much and how he

the child realizes that he

very important, and

some

Fiow

is

adults

cultural traditions are harmful, such as the

idea that children are not to be taken seriously (Adler, 1927/1998). “Ridicule of children is

practically criminal,” cautioned Adler, because

(1927/1998,

inferior

who seem

to be entirely lacking in inferiority feelings?

icance, devoid of social interest.

who

display this

Although the term

complex

is

used

all

or another.

those

The

who

& Ansbacher,

usual manifestation of the superiority

“We

it.

It is

as if

to gain

by

will always discover ...

they were trying to

this easy

Individuals

who

that everyone else sion, neglect

1956,

p.

and

are

260). In

have inferiority feelings also have superiority complexes in one form

method

lift

complex

some adolescent

Consider, for example, the arrogance of

Adler said,

Adler maintained

less often,

are merely signaling that they feel inferior

using these behaviors to escape their problems (Ansbacher a sense,

The

the superiority complex, in which the individual builds a false sense of signif-

lies in

that people

causes the child to feel insignificant and

p. 61).

But what about people answer

it

is

the show-off or braggart.

males.

Of

aggressive children,

an inferiority complex and a desire to overcome

themselves on their toes in order to appear greater and

success, pride

and superiority” (1929/1969,

present themselves as helpless or

weak

around them must take care of them.

p. 29).

are also signaling superiority in

Similarly, the display of depres-

of one’s appearance, and extreme grief can create power for the individual

because these behaviors

Sandy thinks that James

demand

is

that others pay attention.

surely revealing his feelings

of inferiority through

his superiority

complex. Presenting as cool and unflappable, he uses socially useless ways to gain power such as stealing

and aggression,

ing others.

A

thereby building a feeling

second aspect of his social presentation

ofsignificance that is

his ability to be

is

based on defeat-

charming with the

Both of these faces, Sandy knows, are defenses against the very real sense of discouragement James hides. It is a good sign that now and then James reveals these feelings in ladies.

counseling. In the past James has apparently fought ojf these feelings by seeking power over others in his

environment through angry, violent behavior.

ing others through

deemed

lies

'Inappropriate.

He

and ”

theft

and

builds a sense

However, James seems

to

He finds superiority

of power through sexual behavior

be in the midst of a reconsideration of

shows signs of social feelings and verbalizes the intent significance through friendships and continued education. these means.

in deceiv-

to

begin to seek

INDIVIDUAL PSYCHOLOGY

115

Basic Tasks “For a long time

now

have been convinced that

I

nated to the three major problems

Adler wrote

—

Ansbacher, 1956,

solved in socially useful or useless ways because, in

One

interest.

work

without

can’t love

a

the questions of

the problems of communal

&

Ansbacher

(as cited in

all

life,

reality, all

can be subordi-

of work, and of love,”

These problems can be

131).

p.

life

three tasks involve social

wish to contribute to the betterment of another, and

some degree (if it is not criminal activity). task of communal life, or society, is achieved through

usually contributes to society to

Adler believed that solving the

&

cooperation (Ansbacher

Ansbacher, 1956). Society cannot exist without

this attitude,

and the task of society flows naturally into that of occupation because society without division of labor

Most people succeed

among some

to

its

members.

extent at the occupational task (Dreikurs, 1953). People

dimension of social

are typically able to find an occupation, although they vary along the

usefulness. For example, teaching children

is

an occupation with high

whereas trading on the stock market would seem vocational guidance counselors, saying,

occupation

is

going to be, and

his

is

a

good indication of the

whole

style

& Ansbacher,

an aerospace engineer or as “the

1956,

p.

& Ansbacher,

world expressed when a

(b) a

431).

The

1956,

we can

431). Think, for

p.

says that she

little girl

Ansbacher

First,

Adler

& Ansbacher,

p.

432).

refers to the “other” rather

wants

fashion model.

most intimate devotion towards

1956,

life

observe

a partner of the other sex,

expressed in physical attraction, comradeship, and the decision to have children” in

earliest

choice of one’s

“In a child’s choice of occupation

of life” (Adler, cited in Ansbacher

Adler described love

Adler was one of the

an advantage to ask children early what their

“it is

lifestyle.

instance, of the different views of the to be (a)

less so.

social interest,

often put this question in schools so that the children are

I

led to consider the point” (Ansbacher

work

can’t exist

Two

(as cited

features of this important task are notable.

than the “opposite”

using this terminology,

sex. In

Adler sought to downplay the so-called competition between the

Second, for Adler,

sexes.

only heterosexual relationships were worthy; homosexuality was a reflection of fear of accepting the challenge of a male— female relationship. against the

demands of social

(as cited in

Ansbacher

&

life,

and aims

Adler

Ansbacher, 1956,

p.

425).

He was

said, “it

Contemporary Adlerians do not

Mosak and Dreikurs maintained with the

self

and

from the masculine protest (discussed

“means nothing more or

less

101). This fight arises

These

and

(Mosak

&

two other

life tasks:

Dreikurs, 1977a, 1977b).

than to stop fighting with oneself” (Mosak

is

good and

evil,

is

The

bad and good, moral and immoral,

is

that the culture in

which we

live gives

very

coping

first 1

task

977a,

therefore to find ourselves

lazy

a

and

won. Further

little

about our individual value, and hence we are constantly uncertain of our task

(a)

& Dreikurs,

dualities are false, leading only to an internal battle that can’t be

complicating the problem

in addition,

from the deeply embedded notion of dualism, encouraging

belief that within each of us

strong.

& Ansbacher,

to love ourselves (Carlson et ak, 2006).

that Adler alluded to

(b) the existential task

a revolt

even more specific about

take this perspective, of course,

add that the task of love includes learning

is

founded triumph”

or the wish to gain power by taking on the masculine role (Ansbacher

1956).

p.

latter,

at a fictitious, subjectively

lesbian orientations, saying that they could result later)

Of the

own

information

worth.

worthy despite occasional human imperfection.

Our

INDIVIDUAL PSYCHOLOGY The

existential task

terms with religion this task

part of this task.

is

Mosak and Dreikurs (1977b)

The

human

beings,

existential task includes

coming

to terms

has

having some

is

had

dijficulty in

to

to

discussed negotiating

in

but she

is

Sandy has already noted that James showing

signs

that he enjoys his friends. James seeks

and

job (getting drunk). Reportedly popular with the

of love, but

afterlife,

1977b).

but she also observes that he

others,

contribute to society

life tasks.

way

obtains employment, a good sign, but then finds a

easily,

Coming

developing a general picture of the na-

& Dreikurs,

each of the

with

dijficulty cooperating

of wanting

the task

cosmos.

with the existence or nonexistence of an

and considering the meaning of life (Mosak

James

in the

through traditional religious paths, but also acknowledged the existence of athe-

ism and agnosticism. ture of

concerned with Finding one’s place

is

ladies,

to lose it

by failing

James seems

to

is

to cooperate

on the

be experimenting with

only in the early stages of work on this problem. Sandy cant see

also guesses that

James

struggling to

is

come

terms with himself.

to

He

it

has

and this is bound to affect his selfSandy suspects that he has not had the

received some consistently negativefeedback from the world, view. Because

of the immediate turmoil

in his

life,

leisure to consider existential questions.

Basic Mistakes Shulman (1973)

Within the

lifestyle,

beliefs, that

can lead to problems in

1.

distorted attitudes about self

2. distorted attitudes

get

worm) hostile

is

and people

are out to

me)

4. distorted

6. distorted

I

must

rule

all)

methods of operation (overdoing)

distorted ideals (the “real

(c)

a worthless

about the world and people (the world

3. distorted goals (perfectionism,

5.

living:

am

(1

identified six classes of basic mistakes, or erroneous

conclusions

man”)

(a)

pessimism,

cynicism (you can’t trust anyone),

conquers

(b)

(d) fanaticism

all

(e.g., love,

reason, money),

(Shulman, 1973, pp. 40—42)

harboring more than one ofthe basic mistakes. He seems to have the idea that the world should change, not him, although he is beginning to recognize the

Sandy thinks that James problem with

and it is

is

this attitude.

likely that

He has in

the past pursued the distorted goal ofruling the world,

he has dijficulty trusting anyone. Although he does not show

ably believes that he

is

he prob-

not a very worthwhile person. His methods of operation have been

faulty (for instance, physical aggression

and stealing).

—

holds a stereotypical picture of masculinity (discussed later).

it,

He probably

the “real

These behaviors also suggest that he

man image of the ’

thinks that power conquers

masculine protest

all.

THEORY OF THE PERSON AND DEVELOPMENT OF THE INDIVIDUAL As noted As

earlier,

Adler believed that the pattern of an individual’s

a result of heredity, environment,

developed very early on and

is

and the

relatively

individual’s

immune

to

own

life

was

creative

set

by about age

work, the

lifestyle

change (Ansbacher, 1929/1969).

5. is

INDIVIDUAL PSYCHOLOGY The

child begins

prompted Adler

own

his

lifestyle.

a small

and

assume that we

& Ansbacher,

(Ansbacher forms

to

as

life

117

begin

all

with significant inferiority feelings

life

1956). As the child observes the environment around him, he

impressions (interpretations of

Looking around

at the

how

of adults and figures out

which

life),

to gain

power within

how

most important

is

these problems. Because children are immature, they often

which

interpretations,

The

this system.

child’s physical

he meets the problems of life, but Adler

emphasized that the creative power of the individual

own

are the beginnings of the

immediate environment, the child observes the ways

condition and family situation contribute to

stead resorting to their

This observation

relatively helpless creature.

do not use

more

are

how he

common

solves

sense, in-

idiosyncratic in nature. This

reasoning Adler called private logic (Adler, 1929/1969) and sense (Carlson et ah, 2006). Such misunderstandings

in

is

may

contrasted with

common

lead to mistaken goals of

superiority (for those with low social interest) such as the need to always be taken care

The

of or to defeat others. over horrible

life

when

opposite situation also occurs

individuals triumph

circumstances and become socially contributing people. Adler gave the

following example:

One man with unhappy experiences behind him will not dwell on them except as they show him something which can be remedied for the future. He will feel, “We must work to remove such unfortunate

situations

and make sure

that our children are better placed.”

man will feel, “Life is unfair. Other people always have the best of it. If the world treat the world any better?” ... A third man will feel, treated me like that, why should “Everything should be forgiven me because of my unhappy childhood.” In the actions of

Another

I

all

three

men,

their interpretations will

be evident. (Ansbacher

& vAnsbacher,

1956,

p.

209;

quotes in original)

Family influences therefore are very important fall

under the general term family

IP theory

is

constellation.

in the

Perhaps the most familiar construct from

birth order. Adler believed that the position of a child in the family could

have a marked impact on his development. There are

phenomenon of second system

is

—

at least

two ways

to look at the

&

Mosak, 1977). First, we can consider whether the child was born first, second, third, and so forth.

family position (Shulman

simple ordinal position

A

development of children and

that of birth order

&

the second system (Ansbacher

—

first,

middle,

last,

Ansbacher, 1956), and

or only. Adler tended to use it

important to note that

is

Adler emphasized the psychological posmon of the child, not the actual ordinal position (Stein

& Edwards,

1998). For example,

if for

some reason

the first-born child becomes

may take over that role (Dinkmeyer, Dinkmeyer, & children who are born many years after their eldest sibling are

incapacitated, the second-born Sperry, 1987). Likewise,

thought to constitute a “new” family (Adler, 1931/1998).

remember

that Adler

“tendencies; there

such

as

is

saw the

Therefore,

it

is

also very

important to

characteristics typical of the different birth orders only as

no necessity about them”

the sex of the child

It is

and the

size

with some trepidation that

(Adler,

1

929/ 1 969,

p.

92).

Other variables

of the family also influence birth order. I

present a

summary

of the characteristics

thought to be associated with the various birth orders. First-born children are monarchs, basking in the undivided attention of their parents.

Because they receive so

much

attention, they are generally very

good

at interacting

with

1

INDIVIDUAL PSYCHOLOGY

18

adults.

They

first child’s

are then “dethroned”

a

new

perspective (Adler, 1929/1969,

clude that power

is

1956). Paradoxically, Adler thought that

most

comes when the

to rebel

a result, the first

born

first

may

born

then con-

often given responsibility

is

first

in his first

approach to

first

is

born tends

& Ansbacher,

(Ansbacher

life

borns were the most likely to be problem

troublemakers being youngest children.

likely

born

1927/1998). The

later in life (Adler,

and may be quite conservative

children, with the next

As

p. 12).

taking care of later siblings. These factors create a tendency for

as

borns to seek positions of authority

to love rules

from the

child, a very unfortunate occurrence

important thing. Also, the

a very

within the family, such first

by

The tendency

&

unable to accept his changed situation (Ansbacher

Ansbacher, 1956).

The

usurpers, the second borns, spend their lives trying to catch

are likely to live their lives in opposition to the first

competition can be that the second born surpasses

the

first

too outstanding, the second child

is

to the first born.

They

born (Sweeney, 1989). The outcome of

this

born

up

others in the family. However,

all

may

give

if

up and become discouraged

(Sweeney, 1989).

Middle-born children often

feel

“squeezed” between older and younger siblings

(Sweeney, 1989). Lacking access to the advantages

(e.g.,

elder children) offered to the other children, they

Sweeney (1989) maintained younger, sibling,

much

like

that

middle borns

whom

likes to

may

especially disadvantaged.

feel

are likely to react to the elder, not the

second-born children.

Youngest children are the center of attention, but out that “no child

parental attention, caretaking by

be the smallest, the one

one has not confidence,

all

still

the smallest, and Adler pointed

whom

one does not

trust, the

one

in

the time” (Adler, 1927/1998, p. 150). Thus, although

may develop extreme power urges trying to be the very best. A second type of youngest is the one who does not have the selfconfidence to strive, or whose older siblings are unsurpassable. This child may give up and become cowardly and evasive (Adler, 1927). Sometimes this child, because he has so many these kids

occupy

a privileged position in

parents,

becomes pampered

and

being the center of attention.

like

children (Stein

Only

& Edwards,

(Stein,

one

sense, they

Only children grow up in the world of adults They may not learn how to cooperate with other

2000).

1998).

children have a competitor, but

it is

not a sibling;

it is

father (Adler, 1931/1998).

Often, they are very sophisticated, using advanced language and interacting well with adults (Stein, 2000).

Some of these

children

may grow up

in a very conservative environ-

ment, according to Adler, because their parents have experienced

1927/1998,

p.

dangerous (Adler,

155). These children are often overprotected, resulting in their having

difficulty achieving

1927/1998;

life as

independence; they lead self-centered, socially useless

lives

(Adler,

Stein, 2000).

Other aspects of family constellation include family values and atmosphere, examples by parents, and the it

child’s role in the

was the mother’s job

1931/1998,

human The

being.

p.

& Shulman,

to teach the child cooperation, yet she

and the world around her (Adler,

family (Peven

as well, facing all

father’s influence

comes

1986). Adler asserted that

must

also relate to her

of these tasks “calmly and with

101). She gives the child his

first

set

husband

common

sense”

experience with a trustworthy

into play later in the child’s

life,

and

his role

is

to “prove

himself a good companion to his wife, to his children, and in society” (Adler, 1931/1998,

INDIVIDUAL PSYCHOLOGY p.

He

106).

ing the

119

needs to be aware of the overvaluing of the male position and avoid perpetrat-

myth

that his

work

Adler maintained that

is

it

superior to his wife’s.

was the parents’ job

“learn to lessen the family egoism” (Adler, 1927, p. 122). Mistakes

come back

to

haunt

in later

life;

failing to learn

and

to teach children social interest,

made

to

in the family will

cooperation and courage will result in the

development of problems.

The

parental relationship “sets a pattern for

&

(Dinkmeyer

interpersonal relationships in the family”

all

Dreikurs, 1963). In addition, Adler argued that what children see in their

and the nature of the other

parents’ relationship will influence their views of partnership (Adler,

1931/1998). Adler pointed out that children

will

be quick to exploit differences

between parents, so parents must model cooperation with each

Gender

is

and condemnation of the male

discussions first

how

another very important influence in

feminist (Nelson, 1991). At

bias in society

equated superior and inferior to masculine and feminine. describing gle

with

how

society perceived the sexes

this social pressure in the

mainly a masculine

civilization,

to

The

What

is

sexist

1977). Both sexes strug-

resolves, “I’m

imply that he

this societal attitude

had grave consequences.

the difficulties under

which

reconciliation with

long

as

women

life,

with the

He

facts

adults en-

going to be a is

real

it is

man,” and he

not and thereby not superior

women’s part

p.

“one must therefore keep in mind

place.

We cannot expect a complete

with men” (Adler, 1982,

may

in

98) and argued that

of culture and the forms of our living together,

biases of society, girls

protest can be transformed, so that

said,

development takes

are not granted equal rights

Confronted with the

all

is

both sexes are prompted to declare

role,

secondary” (Adler, 1931/1998,

a girl’s

civilization

superior to the woman’s” (Dreikurs, 1953, p. 47).

boy

little

as

because he

he was really doing was

(Dreikurs, 1953, p. 47). Adler pointed out that “almost everywhere the

undervalued and treated

very

(1977), what Adler meant by the confusing use of the

protests against anything that seems to

life is

like the

gets the impression that while

term protest was that because of the valued male (protest) their masculinity.

seem quite

& Schneider,

(Mosak

and the child

Mosak and Schneider

makes him seem

form of the masculine protest. “Our

joy superior powers the man’s position

According

other.

kids develop. Adler’s frequent

glance, Adler can

first

sex

as

p. 15).

take several paths.

The masculine

“covered and changed, and [she] seeks to triumph

with feminine means. Very often one finds during the analysis the wish to change into a

man”

(Adler, 1982, p. 36).

Other

women become

resigned to their inferior status.

others dislike and resist the traditional female role and

(Ansbacher

& Ansbacher,

may become

1956). According to Dreikurs (1953),

to accept their defined roles are

lesbians as a result

women who

they desire strength and power. This

last

position

some form of a masculine

is

power (Nelson, 1991). Further, not

all

goal because

the one Adler eventually

concluded that the masculine protest was a special case of the more general

protest;

are unwilling

adopting masculine goals.

Dreikurs, however, added that most people have

to strive for

came

to;

he

human tendency

individuals are beset by the need to

some

are quite comfortable

with their respective genders, presumably those

low

in inferiority feelings

and high

relatively

Still

in social interest

(Mosak

who

& Schneider,

are

1977).

Adlerian theorists recognize four types of personalities that are the function of social interest

and the

descriptive,

I

individual’s activity level. Because the terms used to label these are fairly

will

simply

list

them

here, following

(Monte

& Sollod, 2003, p.

181):

(a)

1 he

INDIVIDUAL PSYCHOLOGY

120 ruling-dominant type (b) the getting-leaning type, socially useful type.

I

am

sure that

you recognize

(c)

the avoidant type, and (d) the

one

that the last

is

considered to be the

healthiest in IP theory. y •

*

James

is

t

*

a second-born male: His situation, in Sandy's view,

is

a good

James does not exhibit the

dangers of taking birth order ‘hypotheses as

literal truth.

striving ofthe second born. Instead, he looks

more like a first born who

and his siblings

power. James

which

The

of the typical

rebelling to achieve

is

experienced a chaotic family environment until James was

would have confused

clearly

illustration

roles

and

responsibilities

among

and

children

8,

adults.

offoster placements following James seventh year probably exacerbated his confusion and at the same time reinforced his rebellion against the hostile environments he experienced. His acting out gained him power and attention. Sandy guesses that James first series

family environment provided

man

role

models for masculinity that demonstrated the typical

ofphysical force to gain power. In fact, his stepfather physically abused him, suggesting that James learned early that physical aggression was a ‘Je

way

to

'picture, including the use

and control over others. Sandy

gain notice

ruling-dominant

type,

thinks that James

although at times he seems

do a

to

little

is

mostly displaying the

getting- leaning.

HEALTH AND DYSFUNCTION Healthy people, according’ to individual psychology, have well-developed

and therefore contribute to

to society as they

go about solving the tasks of life. They are able

meet problems head on, courageously, and

ways. Adler wrote, find

new openings

cited in

Ansbacher

“The

them

solve

in socially constructive (“useful”)

nearer to health and normality an individual

for his strivings

& Ansbacher,

when

1956,

social interest

is,

the

more he can

they are blocked in one particular direction”

p.

190).

The

(as

healthy person succeeds at the tasks

of life, contributing to the community and finding a partner of the other sex and socially useful work.

normal

state

The healthy person has the courage of human life (Dreikurs, 1953).

“All failures

perverts,

and

—

to be imperfect because that

neurotics, psychotics, criminals, drunkards,

prostitutes

&

wrote (Ansbacher

—

problem children,

is

the

suicides,

are failures because they are lacking in social interest,” Adler

Ansbacher, 1956,

p.

156).

The

individual

unhealthy has the goal of personal superiority, and the

lifestyle

is

who

is

psychologically

consequently aimed

2006). Psychological dysfunc-

protecting self-esteem, a process called safeguarding

tion equals discouragement, because the individual has lost the “courage to proceed

the useful side of

life”

(Adler, as cited in

Ansbacher

&

Ansbacher, 1956,

individuals have underdeveloped social interest and strive for

ways that are

socially useless.

than a task-centered

common

“Problems are solved

at

p.

on

255). These

power and superiority

in

in a self-centered private sense rather

sense fashion” (Ansbacher

& Ansbacher,

1956,

p. 2;

quotes

deleted).

Safeguarding, the defense against inferiority feelings and discouragement, can take

many forms safeguarding.

(Carlson et ak, 2006). Psychological

Forms of safeguarding

excuses, aggression, distancing possibilities in

life.

from

that are

more

symptoms

are

nonconscious forms of

accessible to consciousness are

tasks perceived as threatening,

and

making

restricting one’s

INDIVIDUAL PSYCHOLOGY

121

Adler discussed a variety of psychological dysfunctions, but he saw

mistaken

lifestyles that

were

selfish rather

erally,

by

Adler saw neurosis (anxiety, depression)

their hesitating attitudes,

of

than socially oriented and characterized by a drive

power or value

to protect the person’s sense of

as the result

all

in the face

of challenging

(Ansbacher, 1970). Identified

as failure in life

marked tendency

neurotics display a

Most gen-

life tasks.

to evade

life

tasks

As Dreikurs (1953) put it, “Neurosis is like a mock battle field outside the long way behind the front of life, a side show” (p. 88). Adler called the neurotic

(Dreikurs, 1953).

war zone

—

a

the “yes, but” personality cited in

& ^Ansbacher,

Ansbacher

life tasks, at

ing from

—always wanting

which

to achieve,

The

1956).

to avoid the

why

him he

will

The

fail.

neurotic tolerates suffer-

plans lack social interest,

life

& Ansbacher,

they choose to walk on the “useless” side of life (Ansbacher

1956), pursuing

goals that are individualistic rather than contributing to the collective good.

function of neurotic behavior in

which

the self-esteem

Ansbacher, 1956, Neurosis has lose courage.

&

p.

its

roots in childhood. In

p.

The

some way,

the child

first is is

factor,”

he believes he

on

can’t

who

their bodies

others.

and

if

The

who

which

is

to be neurotic

The

(Ansbacher

third potential neurotic

become troubled depends on an

demands cooperation (Ansbacher & Ansbacher, overwhelmed by a challenging cooperative task that

a task that is

experience physiological problems, or organ inferiority,

and have

difficulty seeing that life

meaning

natural process of comparing one’s self to others

& Ansbacher, & Ansbacher,

The pampered

&

meet, neurosis will surface.

1956).

social training for the child

(Ansbacher

to provide safeguards for

experiences organ inferiority early in his

others pity, ridicule, or avoid the child, the situation

(Ansbacher

.

become overburdened and

children

the pampered, or spoiled, child.

296). If the child or adult

Children

.

the hidden goal of superiority” (Ansbacher

the neglected child. However, whether these children

1956,

.

Three general kinds of children have high potential

Ansbacher, 1956).

“exogenous

is,

“The com-

263).

development. The second is

varied forms

all its

bound up with

is

(as

even more traumatic outcome of failure.

Neurotics are striving for superiority, but because their

mon

he can’t

neurotic uses excuses to evade responsibility for

his inferiority feelings tell

symptoms

but finding reasons

is

achieved by contributing to

may make

the situation worse,

becomes even more damaging

takes exceptional creativity

It

become focused

and the presence of strong

with organ inferiority to grow up psychologically healthy

1956).

child achieves superiority

by having others do everything

for

him.

how to tackle and solve life problems, Also, many pampered children develop be-

Experiencing instant gratification, he never learns

and thus

his feeling

of inferiority

is

intensified.

haviors that are disliked by adults but compel attention, such as extreme discouragement, oversensitivity,

(Ansbacher

pampered

&

and physical and psychological disturbances that indicate the need

Ansbacher, 1956). Adler cautioned against blaming the parents for the

child’s style

even where there in

Ansbacher

parenting

The

is

for help

&

is

because

“it

is

the creation of the child,

and

is

very frequently found

no evidence whatever of pampering by another person”

Ansbacher, 1956,

illustrated in

Box

p.

242).

An example

(Adler, as cited

of the IP conceptualization of

4.2.

neglected child never had the chance to learn about love and cooperation

(Ansbacher

& Ansbacher,

1

956).

He

sees the

never found a trustworthy other. As a

world

result,

as hostile

and ungiving because he has

neglected children are likely to

resist

the

INDIVIDUAL PSYCHOLOGY

122

Box 4.2

The Case of Little Hans: or

When we

examine the

facts

Fear of Castration

Pampered Child?

they

us only that the

tell

chosen; the complex characterizes a pampered child his

who

is

poorly

does not want to give up

mother. (Adler, as cited in

One

name Oedipus

Ansbacher

& Ansbacher,

of Sigmund Freud’s most discussed cases was that of

about childhood

Hans’

sexuality, served as a consultant to

a kind of psychoanalytic treatment of his son.

The

Hans, the boy

Little

who was

developed a phobia of horses (Schoenewolf, 1990). Freud,

1956, p. 185)

who

seeking information

Max, who attempted

father.

father recorded

what Hans

said

and

reported to Freud. Based on advice from Freud, the father would interpret Hans’ state-

ments or behaviors signs.

He became

significant distress

Hans. For Freud, Hans showed

to

would

of the normal developmental

obsessed with his “weewee- maker” at about age 3 and evidenced

upon

after his sister’s birth (at

the horse

all

bite

Working through

the birth of his sister around the

about age

him

or

fall

the father.

Hans developed

4),

down

a

same time. During the year

phobia of horses, fearing that

while pulling his cart and

Max, Freud proceeded

kill

him.

Hans and

to analyze

eventually

published the story of the analysis as “Analysis of a Phobia in a Five-Year-Old Boy” (Freud, 1909). Concluding that the horses represented the father, Freud interpreted

Hans’ symptoms horse)

as

stem'ming from the Oedipus complex. Hans’

stemmed from

his sexual desires for his

Hans’ feelings about mother, he might go so particular fear of horses falling (a)

that the kicking

and

father to die

down

mother.

far as to bite

his father

him

(i.e.,

castrate him). Hans’

and thrashing of the prone horse represented the

(b) that the

found out about

while pulling a cart was given two interpretations: boy’s

overturned cart represented his mother’s

the competitor (other possible siblings)

who would

Tatib (1995) reconceptualized the case of Little perspective.

If

of his father (the

fears

As you might expect based on the

fall

out

if

Hans from

the cart

wish for

womb,

his

carrying

fell.

the individual psychology

different views of

development held by

Adler and Freud, Tatib’s conceptualization emphasized striving for significance rather than Oedipal drives. Hans was a very pampered child birth of his

little sister.

to regain his throne,

His

lifestyle

which was

formed around

lost

when

who was

his efforts to

his little sister

greatly affected

by the

do everything he could

was born. Tatib described

a

hypothetical course of individual therapy for Little Hans, beginning with two sessions

with his parents and progressing to play therapy for Hans.

Counseling with the parents revealed that Hans had been told that sion of his curiosity about sex (masturbation)

doctor removing

it.

it

to

result in his penis falling off or the

This information scared Hans and

preoccupation with weewee-makers. His (relating

would

Hans’ wish to sleep with

at the

same time

father’s interpretation

his

a natural expres-

mother and

intensified his

of Hans’ fear of horses

his resultant fear of

dad) further

INDIVIDUAL PSYCHOLOGY

123

conlused and scared Hans. At the same time, Hans’ a “family project” (Taub,

Hans

said

about

sex,

1995,

p.

tears

and

curiosity about sex

339). His lather dutilully wrote

and he received much parental attention

down

became

everything

for his behavior.

From an

individual psychology perspective, Hans’ anger and anxiety were understandable because

they were associated with the loss ol his superior position in the family and his bed

being

on

moved out of his

room. As a

parents’

result

of his

his every

behavior and he became a pampered child.

Looking

at

the lamily environment in

Hans’ parents focused

distress,

which Hans’ behaviors appeared, Taub

conjectured that his mother encouraged Hans’ increased desires for comfort and

cuddling because she wished to avoid her relationship with Hans’

father.

The

was

father

understandably upset with the disruption Hans caused in their sexual relationship. Hans’

mother was upset about the

father’s criticism

of her affection for Hans and generally

Taub maintained that if the parents ignored some of Hans’ behaviors (i.e., masturbation) and worked out their own relationship, the overall situation would improve. Hans also needed to be given age-appropriate, accurate angry about the

father’s critical behavior.

information about weewee-makers and the origins of babies. Play therapy would allow

Hans

to experience a safe

and nonjudgmental

relationship.

Hans

liked play therapy

because in this environment he was special and was allowed to express his fears and

ousy about

However, the therapist took care not

his sister.

jeal-

to excessively praise or dote

him with “respect, confidence, and encouragement” (Taub, 1995, p. 343). Working with Hans and his family allowed the therapist to encourage in Hans both social interest and other modes of seeking significance.

on Hans, and

to treat

Psychoanalysis and individual psychology thus generate two very different views of Little

We

Hans.

are fortunate to

have such exemplar cases to provide us with very

lessons about the effects of theoretical structure

on our thoughts about

deed exemplary of Freud that he was willing to expose scrutiny.

famous

It is

his clinical

clients. It

work

is

real

in-

to public

courageous ofTaub to present the individual psychology perspective on

this

case.

attempts of others to influence them, and are often openly rebellious. In other instances, they

become

Unlike

passively resistant (Dreikurs, 1953).

many

counseling theorists, Adler proposed an understanding of the most difficult

cases, the psychotics.

“The

loftiest goals are to

in the psychoses” (Adler, as cited in

and

particularly paranoiacs

(it is

be found in the most pathological

Ansbacher

& Ansbacher,

1956,

p.

cases, that

is,

314). Schizophrenics,

not clear whether Adler was including paranoiacs under the

general heading of psychoses), have the goal to be godlike in order to fend off their very deep inferiority feelings.

so lose their est

The

goal

is

so high that they almost completely lose interest in others

common sense and contact with

reality as seen

degree of isolation” (Adler, as cited in Ansbacher

by most of us. “Insanity

& Ansbacher,

1956,

p.

is

the high-

316). Adler por-

trayed the psychotics’ withdrawing from others as the result of being badly unprepared for

Psychotics lack interpersonal in everything,

skills

and occupational

interests

and

and

are afraid that they will

including relations with the other sex. Finally they retreat so

far that

life.

fail

others

INDIVIDUAL PSYCHOLOGY

124

cannot understand them. In the case of the paranoid person,

oppose

to

(Ansbacher

James

& Ansbacher,

1956,

first family

ment so that he did not

Some

strives

reality, politics,

and impoverished,

thinks that to trust

it is

tell

lack-

remarkable that James

someone in

his early environ-

totally lose his faith in others.

—

for self-esteem at the expense of others.

to

Sandy that he

is

is

visible in

a

little

On

the surface,

James, but

of the

little

when he

of unworthiness

hesitating,

relaxes in therapy ses-

scared to really try hard in school or to become

more deeply involved with people around him. Sandy knows that he the tasks

religion

James has displayed a disinterest in contributing to society, walking on oflife. Sandy knows that this life pattern would classify James as neurotic

he admits

feelings

and

evidence indicates that he has been abused, both in his

discouraged attitude of the neurotic sions,

own

circumstances were chaotic

life

Perhaps he was able

is.

his

recently,

the useless side

he

by creating

and in subsequent foster families. Sandy

not more hostile than he

Until

reality

of others leads him

318).

p.

a neglected child. His early

is

ing a stable family structure.

is

of

socially accepted views

his distrust

is

harboring the

of neurotics, and that he is afraid to fully engage in Instead, he puts up his macho front so that no one can

characteristic

oflife because he mightfail.

that he truly feels inferior

and at

the

same time

is

angry at the world for treating him

so badly.

NATURE OF THERAPY Assessment Individual psychologists advocate two types of assessment, formal and informal. Each will

be discussed separately even though the informal certainly occurs during formal assessment.

Formal Assessment. Formal assessment understand the

lifestyle

through

the lifestyle assessment process alliance. Several

consists of obtaining information that helps to

relatively structured is

means. Schneider (2007) notes that

typically a significant contributor to the therapeutic

techniques are used.

Adler developed an interview structure for assessing

lifestyle

(Ansbacher

& Ansbacher,

1956). Formulating different interview guides for use with children and adults, Adler

recommended using

a series

of questions covering various

tionships, interests, discouraged behaviors) only loosely client is

(Ansbacher

shown

& Ansbacher,

1956,

p.

405).

in Figure 4.1. Eckstein, Milliren,

nowadays, some IP therapists a less structured

and

“The question” 1999). The client

briefer

life

areas (e.g., assets, social rela-

when attempting

to

understand a

A sample of the questions Adler suggested

Rasmussen, and Willhite (2006) indicated that

will use the full

formal interview method, but others will use

method.

is

another important IP assessment technique (Mosak and Maniacci,

is

asked,

disappeared)?” (Mosak

counselor two things.

“What would be

& Maniacci, First, if

1999,

p.

different in your

life

if (the

symptom

135). Responses to the question can

the client says something vague such

as,

“Ed

tell

the

feel better,”

the counselor should consider the possibility of a physical basis for the presenting

problem. However,

many

times the

client’s

response will not involve such responses;

For

Use

with Children

Disorders 1

.

Since when has there been cause

and psychological, was the

The

child

for

complaints?

when

change

In

the disorder

what

was

sort of situation, objective

first

noticed?

environment, beginning of school, change of school, change of teacher, birth of sibling, failure in school, new friendships, diseases of the child or of the parents, divorce, remarriage, or death of the parents. 2.

following are significant:

Was

of

already at an earlier age? Was this through mental or physical weakness, cowardliness, carelessness, reserve, clumsiness, jealousy, dependence on others when eating, dressing, washing, or going to bed? Was the child afraid of being alone or of darkness? Does he understand his sexual role, the primary, secondary, or tertiary sexual characteristics? How does he regard the opposite sex? How far has he been enlightened on his sexual role? Is he a stepchild, illegitimate, foster child, or orphan? How did his foster parents treat him? Is there still a contact? Did he learn to walk and talk at the right time? Without difficulty? Was the teething normal? Were there striking difficulties in learning to write, draw, do arithmetic, sing, or swim? Did he attach himself very particularly to a single person? To either his father, his mother, a grandparent, or nurse? the child conspicuous

in

some way

One

should notice hostile attitudes toward life, causes for the awakening of inferiority feelings, tendencies to exclude difficulties and persons, and traits of egotism, sensitivity, impatience, heightened affects, activity, greediness, and caution. 3.

Did the child give

much

trouble?

What and whom does he

fear the

most? Did he cry out

he domineering? Towards weaker children or towards stronger children as well? Did he show a strong desire to lie in the bed of one of the parents? Was he intelligent? Was he much teased and laughed at? Is he vain about his appearance in regard to his hair, clothes, shoes? Does he pick his nose or bite his nails? Is he greedy when eating? Has he stolen? Has he difficulties with bowel movements? at night? Did

he wet the bed?

Is

These questions aim to clarify whether the child strives for preeminence with greater or lesser activity, and furthermore, whether defiance has prevented the adaptation of his drives to the culture.

Social Relationships 4.

make friends easily? Or was he quarrelsome, and did he torment persons and animals? Does he attach himself to younger or older boys or girls? Does he like to be the leader or is he inclined to isolate himself? Does he collect things? Is he stingy or greedy for money? Did he

These questions concern the

child’s ability to

make

contact and the degree of his

discouragement. 5.

How

he now in all these respects? How does he behave in school? Does he like to go? Does he come in late? Is he excited before school and does he get into a rush? Does he lose his books, or school bag? Is he excited about homework and examinations? Does he forget or does he refuse to do his schoolwork? Does he waste is

(continued)

FIGURE

4.1.

Lifestyle interview.

he lazy and indolent? Does he concentrate little or not at all? Does he disturb the class? How does he regard the teacher? Is he critical, arrogant, indifferent? Does he ask others to help him with his lessons, or does he wait until help is offered? Is he ambitious in gymnastics and sports? Does he consider himself entirely or partially talented? Is he a great reader? What sort of literature does he prefer? Does he do time?

poorly

Is

in all

subjects?

These questions

reveal the preparation of the child for school, the result of the going-

to-school “experiment,” and his attitudes toward

Correct information about his

6.

home

difficulties.

conditions, diseases

in

the family, alcoholism,

criminal tendencies, neuroses, debility, lues, epilepsy, the standard of living, deaths

he an orphan? Who dominates the family? Is the upbringing strict, nagging or pampering? Are the children made afraid of life? How is the supervision? Are there step-parents? in

the family, and the age of the child

Through these questions one sees the impressions were conveyed to him.

What

7.

is

the child’s position

in

when

they occurred.

Is

child in his family position

the sibling

sequence?

the only child, the only boy, the only girl? Are there

Is

and can appraise what

he the oldest, the youngest,

rivalry,

much

crying, malicious

laughter, blind depreciation tendencies toward others?

This

significant for the character of the child

is

and

his attitude

toward people

in

general.

Interests

8.

What thoughts has the child had on the choice of occupation? What occupation have his family members? How is the marriage of his parents? What does he think about marriage?

These questions allow conclusions regarding the courage and confidence in

of the child

the future.

9.

What

are his favorite games, stories, characters

to spoil other children’s

thinker

and does he

games? Does he

give hints regarding the

Recollection and

Dreams

What

models

are the child’s earliest recollections?

Falling, flying,

get lost

history

in

and

fantasy?

Is

fiction?

Does he

like

he a cool-headed

reject fantasy?

These questions

10.

in

powerless, missing the

of superiority the child

What

may

have.

dreams? anxiety dreams?

are his impressive or recurring

train, racing,

being a prisoner,

these experiences one often finds an inclination toward isolation, voices warning toward caution, impulses of ambition, tendency to passivity, preferences for certain persons. In

Discouraged Behavior 11

.

In

to

what respect is the child discouraged? Does he feel neglected? Does he respond attention and praise? Has he superstitious ideas? Does he avoid difficulties? Does

FIGURE

4.1.

Continued.

he

try his

hand

his future?

at various things only to give

Does he

believe

in

the injurious effect of

discouraged by his environment?

Is

he uncertain about heredity? Was he systematically

life

Is

pessimistic?

for the fact that the child

has

lost his self-

direction.

Are there further bad habits? Does the child make faces? Does he act stupid, childish, or funny?

These are Organ 13.

on

his outlook

These questions yield important viewpoint confidence and seeks his way in an erring 12.

them up again?

not very courageous attempts to attract attention.

Inferiorities

Has

the child speech disabilities?

he awkward, ugly, club-footed, knock-kneed, or bow-legged? Did he have rickets? Is he poorly developed? Is he abnormally stout, tall, or small? Has he eye or ear defects? Is he mentally retarded? Is he left-handed? Does he snore at night? Is he remarkably handsome? Is

These questions refer to life-difficulties which the child usually overrates. Thus he may arrive at a permanent mood of discouragement. One finds a similar faulty development also in very handsome children. They come to believe that they should be given everything without effort and thus they miss the proper preparation for

life.

Inferiority

14.

[Symptom] Complex

Does

the child speak openly of his

For work? Or for

inability, his

Does he have thoughts

“lack of talent” for school?

any connection in point of time between his defeats and his disorders (waywardness, gang formation)? Does he overrate outward success? Is he submissive, bigoted, life?

of suicide? Is there

rebellious?

expression of extensive discouragement. They often occur after attempts to get ahead have come to grief, not only on account of their inherent inappropriateness, but also on account of insufficient understanding on the part

These questions

of the

refer to

forms

of

environment. The symptoms are substitute satisfactions

in

a “secondary theater of

operations.” Positive Assets 15.

Name

the things

These are important

in

which the child

hints, for

it

is

is

successful.

possible that the interests, inclinations and

preparations of the child point to a different direction from that which he has taken

so

far.

For Use with Adults

have found the following interview schedule to be valuable. By adhering to it the experienced therapist will gain an extensive insight into the style of the life of the individual already within about half an hour. My own inquiries take the following sequence, although they do not always adhere to it. Those who are not familiar with In

case

of adult failures

I

(continued)

FIGURE

4.1.

Continued.

INDIVIDUAL PSYCHOLOGY

128

medical questioning will not fail to notice the similarity between this and our sequence. For the Individual Psychologist, thanks to the system by which he works, the answers will yield many a glimpse that would otherwise have remained unnoticed. 1.

2. 3.

4. 5.

6.

7.

What are your complaints? What was your situation when you What is your situation now? What is your occupation?

first

noticed your

symptoms?

Describe your parents as to their character, and their health. If not alive, what illness caused their death? What was their relation to yourself? How many brothers and sisters have you? What is your position in the birth order? What is their attitude toward you? How do they get along in life? Do they also have any illness? Who was your father’s or your mother’s favorite? What kind of upbringing did you

have? 8.

Inquire for signs of

pampering

in

childhood

shyness,

(timidity,

difficulties in

forming

friendships, disorderliness). 9.

10. 1 1

.

12.

What illnesses did you have in childhood and what was your attitude toward them? What are your earliest childhood recollections? What do you fear, or what do you fear the most? What is your attitude toward the opposite sex? What was in childhood and later it

years? 13. What occupation would have interested you the most, and

if

you did not adopt

it,

why not? 14.

Is

the patient ambitious, sensitive, inclined to outbursts of temper, pedantic,

domineering, shy, or impatient? 15.

What

sort of

persons are around you

at

present? Are they impatient, bad-tempered,

or affectionate? 16. 17.

18.

How do

you sleep? What dreams do you have? (Of examinations, missing a

train)

What

in

FIGURE

illnesses are there

4.1.

From The L.

your family background?

Individual Psychology of Alfred Adler hy Heinz L. Ansbacher

©

1956 by Basic Books,

Inc.

&

Rowena

will instead

call

a

L.L.C.

be more detailed and give hints to the

Adlerians tend to

R.

Copyright renewed 1984 by

and Rowena R. Ansbacher. Reprinted by permission of Basic Books,

member of Perseus Books

it

recurrent dreams, prophetic, and

Concluded.

Ansbacher. Copyright

Heinz

falling, flying,

preferred

movement

client’s lifestyle goals,

or

what

(Schneider, 2007).

IP counselors are very interested in family constellation, or the characteristics of clients’ families, 1

including birth order, parental influences, and family dynamics (Shulman,

973). These qualities can be assessed casually or through a structured interview developed

by Dreikurs (1952—53). The interviewer asks the

and

his parents

client to describe himself, his siblings,

and includes questions about relationships among family members.

INDIVIDUAL PSYCHOLOGY

129

informal mode ofassessing lifestyle and family constellation. She gently encourages James to talk about his family life, both before his foster placements and

Sandy prefers

to use the

She looks for

clues

centered, aggressive

style.

after.

success such behaviors

of important

others.

about how James learned

to strive

These hints are found in his very early environment

had

in

James getting what he wanted, particularly

Because James

sees his

problems as mostly the

and therefore does not present symptoms, Sandy asks James would be

Td

for significance in his

dijferent in your

life

result

self-

and

the

the attention

of other people

the question this way: ‘‘What

iffolks got ojfyour backi” James initial response

is,

“Then

what I want whenever I want without anyone hassling me. ” Sandy sees this answer as reflecting James self-centered lifestyle, because he wishes to pursue his own agenda without consideration for, or contribution to, others. However, when James begins to relax and trust Sandy, he indicates that hed like to finish school, get a job, and maybe find a real girlfriend. These goals seem much more responsible and be able to do

socially useful.

Adler believed that “there

1927/1998, Carlson

p.

et ah,

is

no such thing

as a

41). Thus, the IP counselor

is

random

or meaningless recollection” (Adler,

very interested in early recollections (ERs;

2006; Mosak Sc Di Pietro, 2006). The

client’s

memories of his

early child-

hood are considered reflective of his current views on life, or lifestyle (Mosak & Di Pietro, 2006). It does not matter if they are real they nonetheless provide valuable clues about the individual’s life plan and goals (Ansbacher & Ansbacher, 1956). Early

—

recollections also reveal information about the person’s level of social interest. For instance,

Eouise remembers building a sand castle at the beach. If she remembers helping her brother build the castle, her social interest would be more evident than

building

it

alone. If you are interested in using ERs,

and Di Pietro (2006) who give

you would be wise

a detailed treatment of the assessment

if

little

she remembers

to consult

Mosak

and interpretation

of these.

One ofJames

earliest

memories

threw a chair across the room

of his mother and

is

and

then stormed out of the house.

playing in a field with his older sister Karen kissed the toe

Sandy

is

and made

stepfather fighting.

andfalling down

A

The stepfather

second

memory

after stubbing his toe.

is

oj

Karen

it better.

both disturbed

and encouraged

by these early recollections. The first

memory

ofadult relationships and a view that problems are solved through fighting and physical aggression. The second memory, however, suggests that James can recindicates a negative view

ognize

and accept caring in

others because it takes

others.

Maybe he does know something about cooperation with

some cooperation for two children

to

play together.

Adler carefully distinguished his theory about dreams from that of the psychoanalytic perspective. Rather than dealing with the past, in the IP system,

oriented.

and

Dreams

are

dreams

are seen as future

thought to represent some problem currently confronting the person

are filled with private logic (Bird, 2005).

They often

these solutions are sometimes simplistic (Ansbacher

offer solutions to the

& Ansbacher,

problem, but

1956). For instance,

if

INDIVIDUAL PSYCHOLOGY

130 you dream about Hying, Adler would contend that you a particular action.

The dream

can do what others cannot

(Ansbacher

& Ansbacher,

you

gives

Thus,

(fly).

1956,

are struggling

you

a sense of buoyancy, as well as the sense that

dream conveys an

this

inflated sense of superiority

363). Because of the influence of the individual’s private

p.

on dreams, dream symbols can not be interpreted through

logic

with whether to take

a fixed

system such

as

Freud’s (Bird, 2005).

Sandy that he had a dream that he was Dennis Rodman. Because James does not play sports at all, much less basketball, Sandy assumes that his dream reflects his

James

tells

Rodman, an unconventional player

exaggerated superiority feelings. That he picked Dennis to say the least,

would be

Informal assessment.

interesting to Sandy.

From an

individual psychology perspective, assessment begins the

instant the counselor meets the client. Adler thought that every action of the client pro-

vides information about the client’s person, right

counselor watches carefully

all

of the

The first time James appears for She notices that he

sents himself.

he

dressed in a hip fashion.

is

sits

his

client’s

to the client’s

behavior, verbal

appointment, Sandy

carries

He

down

and nonverbal.

closely observes the

way he pre-

and that

himself in a confident, almost cocky way,

does not ojjer to shake hands with Sandy,

down, he leans back and crosses

Although he

his legs.

not actively

is

The

handshake.

and when he

hostile,

he does not

seem engaged in the counseling process. Sandy tentatively hypothesizes that James has some stake in appearing “cool”

you.

”

She wonders if he

and that

manner of relating to others keep people away fom him.

his general

uses this display to

is

“cooler

than

Overview of the Therapeutic Atmosphere Mosak (2005)

identified three important factors in IP counseling: faith, hope,

must develop

client

This attitude

faith in the counselor.

confidence in herself and her willingness to

The

also essential for the discouraged client.

accept the challenges of

life

listen

is

in the

establishing this condition, but she

must avoid the

come from

also

most general

The

his lifestyle.

To

this end, IP

“pitfalls

is

to

&

show

client.

such

client

is

must

feel

important

as infantilizing,

in

oversup-

p. 70).

client’s

ways of operating

in the

Maniacci, 1999). level of

cooperation displayed

However, “An Individual Psychology treatment, properly carried out, should

at least a perceptible partial success in three

cited in

The

understand the client through

Adler thought that the length of therapy depended on the

by the

is

counselors use active listening, empathy, and

observation in their attempts to build a picture of the

world (Mosak

therapist’s

understood by

feeling

counselor’s empathic listening

goal of the therapist in IP counseling

understanding

The

to the client. Fdope

sense, of course.

porting or becoming a victim of the patient” (Mosak, 2000, critical

love.

counselor should encourage the client to

that the counselor cares for him.

A

encouraged by the

nonjudgmentally

and therapy. Fdope may

the counselor. Love for the client

is

and

Ansbacher

&

Ansbacher, 1956,

p.

344).

months, often even sooner” (Adler,

as

INDIVIDUAL PSYCHOLOGY Sandy works very hard

and

to

131

understand James' views on

uses her basic counseling skills to let

enter his world as best as she can. Telling

Sandy

ter,

to

tries to

James know that she

him

that she

actively trying to

is

sure that his

is

to tell his story

can get bet-

life

give James a sense of hope for his future. She has faith in his ability

him and

change. Sandy's confidence in

and

She asks him

life.

true expression of acceptance, understanding,

caring create a relationship in which James can begin

himself and his

to trust

counselor.

Roles of Client and Counselor The

relationship in Adlerian counseling

is

egalitarian (Sweeney, 1989); the therapist

must avoid any semblance of superiority (Dreikurs, 1953). Manaster (1990) asserted that IP counseling is a “face-to-face, cooperative learning endeavor with, it might be said, two experts the patient, the expert on himself or herself; and the therapist; the expert on helping the patient to relate to the theory and its emphasis on social

—

interest” (p. 46).

The

IP counselor

an educator (Dreikurs, 1953) and encourager.

is

The

educational

function requires the counselor to be active and directive (Carlson et ah, 2006). To be a

good encourager, the counselor should be warm and human (Peven As part of being human, the counselor admits her own approach to

life

by being willing

to

make

fallibility

&

Shulman, 1986).

and models

of counseling (Schnieder, 2007).

he must recognize

first

courageous

mistakes and acknowledge them.

Despite the egalitarian roles espoused by the IP approach, the client in the process

a

his faulty lifestyle.

The

The

is

still

client has choices in his

therapist’s job

is

a learner life,

but

to point out the client’s

mistakes.

Goals Adler wrote, “In practice

and

we attempt

to reduce these further until

Ansbacher, 1956, his faulty lifestyle

p.

187).

and

An

undo the great errors, to substitute smaller errors, they are no longer harmful” (as cited in Ansbacher & to

IP therapist

selfish goals so that

Dreikurs (1953) observed that the

way

attitude to their fellow beings” (p. 85) in psychological in life

tries to

help the client understand and change

he can achieve success

to psychological health

out of timid and discouraged people” (Dreikurs, 1953,

of IP counseling are to give the client insight Into his

change et al.

in the direction

of Increased social

lifestyle,

Four

life.

“their

goals. Further, “success

make

fearless

85). In

co-operators

summary, the

goals

allowing the possibility of

criteria are

named by Carlson

(2006): decreasing symptoms, increasing functioning, increasing the client’s sense of

humor, and producing

a

change

Sandy approaches James with any

Interest.

p.

of

was correction of

and the modification of life

treatment depends on the therapist’s ability to

in the tasks

other.

She

treats James as

in client’s perspectives (p. 130).

respect,

an

assuming that he has choices in

this relationship as in

equal, even though she krioivs that part of her job

him understand his faulty lifestyle. Working in a

cooperative

is

to

help

and encouraging manner with

INDIVIDUAL PSYCHOLOGY

132

James to

him

helps

assume

to

responsibility for his situation

a relationship high in social

and at the same time exposes him

interest.

PROCESS OF THERAPY Adlerians see counseling as progressing through four phases: “(1) establishing the clienttherapist relationship; (2) collaborating to understand the client’s lifestyle

of movement; (4)

anchoring

generating insight into useful and

(3)

a reorientation

(Schneider, 2007, that “it

p.

of lifestyle choices to the

less useful lifestyle patterns;

current

client’s

empathy

39). In the relationship phase,

and patterns

is

life

critical;

and

task challenges”

Adler maintained

essential for the practitioner to possess, in a considerable degree, the gift ol

is

putting himselfin the other persons place' (Adler, 1929/1969,

p.

25;

italics in original).

The

IP counselor uses attending behavior and active listening to develop a trusting relationship with the client that that the client has the

based on the client feeling understood. Conveying the certainty

is

power

the very start of therapy

(Dinkmeyer

to

and

change is

also critical;

is

encouraging the client begins from

an important process throughout the relationship.

1987). Clear goals need to be agreed on because a mismatch between

et ah,

client

and counselor goals can lead

later).

Dinkmeyer and

to resistance (the sources of resistance are discussed

colleagues (1987) suggested that in this

first

stage the counselor

can also begin to offer some tentative hypotheses about the purpose of the ior as

client’s

behav-

one form of empathy.

James would be most happy if people would just let him do what he pleases. Sandy begins her work with him in an accepting way, trying very hard to understand his perspec-

and actively commuriicating her understanding to James. She tries to determine how she andJames can agree on goals for their meetings and concludes that she can go along with tive

James idea

to get people ‘hjfhis

bility for his actions

back” because that probably involves his taking responsi-

and acting in more socially

contributing ways.

The second phase of counseling is lifestyle analysis and assessment (Dinkmeyer et ah, 1987). The IP counselor asks questions about the life tasks and tries to understand the

client’s

clients’ lifestyles

The

therapist

is

lifestyle

come

and associated

into the therapy session with

ever alert for the client’s

— that

movement

include speaking negatively about himself

movement toward

responsibility for

them (Mosak is,

she

a goal that

life tasks.

After

The

is

1999).

always watching the

IP therapist might interpret this behav-

included being the center of attention, or avoiding

all, if

the client

is

a

worthless unit, he can hardly be

expected to attempt to tackle the serious, difficult challenges of the client

is

& Maniacci,

achieve his goals. For instance, a depressed client’s behavior will

client’s efforts to

ior as

goals. Adlerian counselors recognize that

achieving the socially useless goal of superiority by

life.

At the same time,

commanding

the undi-

vided attention of others.

Dinkmeyer and priority”

is

colleagues (1987) suggested that discovering the person’s

helpful in understanding lifestyle

(p.

96).

“number one

According to these authors, there are

lour types of priorities: ruling, getting, avoiding, and socially useful

(p.

97).

The

client’s

INDIVIDUAL PSYCHOLOGY and

goals

133

basic mistakes are connected to the relative importance he places

on

these

priorities.

Sandy works

understandJames’ ways ofachieving signifieance. In his very early environment, he probably was praisedfor being the dough guy” or was ignored. He likely felt to try to

neglected and scared.

James’ past behavior seems

result,

Now

James apparently received parental attention ivhen he acted out. As a

he appears

forefront.

to

He wants

have prioritized ruling and getting over other

to

things.

and placing more socially usefid goals in the get a job, and learn to relate more productively with

be changing his focus to finish school,

These goals clearly indicate a shift in priorities.

others.

The third stage of counseling is insight, lifestyle, and become aware of how he

in

which the counselor helps the

chooses to function and

is

usually offered tentatively, in a

eling the courage to be imperfect,

(Dinlomeyer

&

understand

why (Dinkmeyer

&

his

Sperry,

To be most facilitative, questioning manner. “The counselor is mod-

2000). Interpretation therefore plays a major role in interpretation

client

which often teaches

as

this phase.

much as an

insightful interpretation”

Sperry, 2000, p. 101). Occasionally, the counselor will offer a deliberately

exaggerated version of the

client’s life goals

or priorities, hoping to get the client to laugh at

himself

Sandy approaches James gently and tentatively with empathizes with his tough early environment

became abuse.

so active

and

had to

about

She

his lifestyle.

how he neglect and

indicates that she understands

a way of ojfsetting the feelings induced by ''Y’ know, it seems a little bit like in the past you’ve felt cornered,

rebellious as

Sandy might say,

so that you

and

interpretations

'get’folks

before they

'got’

you

—you had

to

be the most powerful, so they

him about his presentation as a really cool dude, showing the world that nothing affects him. She would only very carefully approach the feelings offear that he experienced early on; in the best case, she would let James express wouldn’t mess with you. ’’She might joke with

these

himself before working with them.

If the insight stage client,

is

successful, the counselor

and

client enter the reorientation phase.

The

accepting the counselor’s interpretations and aware of his mistakes and faulty goals,

works with the counselor

to find

ways

socially appropriate goals are established

James slowly becomes aware of how

his

to

behave

New, more

differently.

(Dinkmeyer

& Sperry,

mistaken goals have led

2000).

to

a troubled

concedes that he has btdlied people, trying to boost his sense of power

though James has difficulty acknowledging struggling with his

Resistance

s

life

and tells him

IP counseling

is

this

and

realistic,

and

existence.

He

worth. Even

motivation, Sandy senses that he

is

truly

so.

seen as arising from several possible situations. Adler thought

resistance represented “lack of courage to return to the useful side of life” (Ansbacher

&

INDIVIDUAL PSYCHOLOGY

134 Ansbacher, 1956,

when

can also arise ple,

338). Other individual psychologists have suggested that resistance

p.

and therapist

the client

the client tends to continue

are

working toward

moving toward

his faulty goals,

wish to discuss the underlying dynamics of the 1986).

A

second source of

which can

Peven and Shulman, forth

call

some

exam-

and the counselor may

&

behaviors (Peven

client’s

resistance, according to

therapist’s challenging interpretations,

different goals. For

Shulman,

found

is

in the

animosity toward

clients’

society.

Because Adler was interested in child development, he devoted to

much thought

to

how

understand and help the parents of dysfunctional children. Fie emphasized that parents

who

consult the counselor should never be blamed for the misbehavior of the child

& Ansbacher,

(Ansbacher

1956).

The

parents

come

to the counselor already feeling inse-

cure and inferior, and Adler advised that the counselor support and encourage them. This

support allows the counselor to create an atmosphere in which she can offer suggestions tentatively to the parents.

James may

resist

He

rushes him.

Sandy s attempts

has been neglected

He

attempts to control him.

toward taking more might be

better to

him understand his lifestyle, and abused and is probably very

to help

does not trust

responsibility for

work

easily.

himself

James

and

in this area at first with

sensitive to others

verbalizes that he

his actions;

James

particularly if she

to

is

working

Sandy thinks that

avoid engaging

it

his rebellious

tendencies.

THERAPEUTIC TECHNIQUES \

Although the it

is

list

of techniques available to the IP counselor in

this section

is

quite lengthy,

not totally inclusive. IP therapists are technical eclectics because “Adlerian theory

demands, that

allows, if not

can be understood

Carlson

et

conflict.

The

as in

therapists use

any and

all

techniques that hold promise and

keeping with the theory” (Manaster, 1990,

p. 46).

For example,

(2006) suggest using a two-chair dialog to help clients resolve decisional

al.

client switches

back and forth between chairs expressing the pros and cons of

the situation. Interestingly, these authors maintain that the client’s real choice

by the chair

With

In

which she

that said,

I

is

indicated

finally stops.

present a brief description of some of the major techniques endorsed

by IP counselors. Further and more elaborate discussions of IP techniques can be found Carlson

et al.

(2006) or

Mosak and Maniacci

in

(1998).

Interpretation Interpretation of the client’s behavior arsenal.

The counselor

about the

uses

client’s lifestyle

all

Is

one of the key interventions

in the

IP counselor’s

of the information she has collected to form hypotheses

and associated

goals,

and then

carefully

and

tentatively offers

these insights (Sweeney, 1989). Adler cautioned that hitting the client over the head with

would not be helpful, saying, “nobody who has understood anything of Individual Psychology would attempt to cure by upbraiding the patient, as if we could do good by taking up a moralistic attitude. A patient has to be brought into such a state of interpretation

INDIVIDUAL PSYCHOLOGY feeling that he likes to listen, to live

135

and wants

what he has understood”

Only then can he be influenced

to understand.

Ansbacher

(as cited in

&

According to Dinkmeyer and Sperry (2000), interpretation of “(1)

and intentions, and

James will not

movement and

current psychological

lifestyle, (2)

and how

(4) private logic

it

easily accept that his '‘attitude’'

in the world, devoid ofi courage

works”

is

is

its

(p.

Ansbacher, 1956,

335).

p.

intended to create awareness

direction, (3) goals, purposes, 99).

a dysfunctional way

and social interest. Sandy must

to

gain significance

be very careful in helping

James to see that he seeks power over others to defy the feelings of inferiority he harbors. Sandy will gently and carefully help him to see that his lifestyle has been one in which he had to

gain power by deceiving or hurting others before they hurt him. His

to

what they get. However, verbalizing more responsibility for

be that others are evil anyway, so they deserve

movement seems a

little

more

Sandy would be sure

useful goals.

more

he

useful;

is

to

point

logic seems

his current his life

and

part out and encourage James

this

to

do more.

Encouragement Equally

own et ah,

as

important

strengths

as interpretation

and recognize

1987; Eckstein

et ak,

encouragement because

is

power

his

not the same

is

pens before the client attempts a desired change or action

Encouragement can

also

helps the client find his

world through choice (Dinkmeyer

to affect the

2006). Encouragement

it

as praise; ideally,

it

hap-

& Rudolph, 2000).

(Thompson

be used to combat the sense of discouragement that some clients

bring to counseling. Eor example, an IP therapist can help a client to distinguish between failingdind being a failure {}Aos 2k

& Maniacci,

1998).

Sandy would let James know that she has confidence that he could achieve the goals he talks about, but too

much emphasis on

takes actions directed

for instances in his instance,

them. She

is

him

in

better at school

She thinks

being.

him up by placing ofhim, encouraging him when he

and

Sandy might compliment James on getting

She searches

in relating to others.

that were successful so that she can help

life

human

careful not to set

is

genuinely supportive

toward doing

as a

his

him build on

these.

For

job or getting through a day at

school without fighting.

Natural and Logical Consequences One way

to

encourage

clients to

assume responsibility

for their choices

is

to allow'

them

to

experience the consequences of their behaviors. Natural consequences refer to simply letting events take their course; that

we

try to “save” others

let

the world imposes these consequences.

by preventing negative consequences. Parents

to excuse Suzy’s missing

comfort to

is,

homework

are

doing

just this.

Often we have

natural consequences happen. Eor instance,

which the parents were very upset with

on the bathroom

floor.

Even though

it

their teenage

who

I

call

Too

the teacher

to stand a

once counseled

often

little dis-

a family in

daughter for leaving her dirty clothes

was not pleasant

for the parents to

do

so,

the natural consequence of simply leaving the clothes where the daughter had

I

advised

left

them.

INDIVIDUAL PSYCHOLOGY

136 Imagine the

effect

on

a 13-year-old of not being able to

because they were dirty! This young

them

place

in the

laundry hamper,

I

woman

wear her favorite items of apparel

quickly learned to pick up her clothes and

can assure you.

Logical consequences are those resulting from an intervention by another person

(Sweeney, 1989).

They

teach the social rules of

previous example, the parents

where

to place

who

life

(Mosak

&

Maniacci, 1999). In the

decide to pick up their teens clothes could also decide

them, thereby depriving her of the valuable

articles for

some period of time.

Logical consequences are different from punishment (in which Adlerians do not believe)

because they are based on social rules logically related to the undesirable behavior.

imposed with

a friendly attitude

and an emphasis on the

choice (Sweeney, 1989).

target’s

Adler maintained that “punishment, especially corporal punishment children.

Any

(1931/1998,

They are

is

teaching that cannot be given in a spirit of friendship

always harmful to

is

wrong teaching”

p. 106).

James experienced the natural consequences of his irresponsible behavior when he lost his job after getting drunk at work. His foster parents, if they caught him stealing something, could take something of his away for a period of time as a way of imposing logical consequences.

Acting As Many

If

clients excuse their behavior

by saying,

designed for this situation. Whatever the true (Watts, Peluso,

&

“if only”

Lewis, 2005). Tracy might

and confident, explaining why she has time. Jerry, the IP counselor,

confident.

“if only

Then he would

is,

.

.

.”

The technique of acting

the client

bemoan

so few friends

and

is

the fact that she

is

way for the

as if

is

act if she

it

is

were

not pretty

therefore miserable

might then ask her how she would

direct her to act that

asked to act

as if

all

of the

were pretty and

next week. This technique helps

the IP counselor to change the client’s view of herself and also to learn or exhibit previously

unexplored behaviors.

James is not a good candidate for the '‘acting as if’' technique because he presents a tough guy front. He tends to blame others for his behaviors, rather than saying, "ifonly I Initially,

was, I could do better. ” However, over time James becomes

and is able to

trust her.

At this point he is able

to

more comfortable with Sandy

acknowledge that he feels insecure in "nor-

mal” social situations, such as at work or school. He says, "Ifonly I was more confident with people, I wouldn’t have to dis them so much. ’’Sandy asks James to act as if he is confident for the next week, just to see what happens.

Pushing the Button Mosak (1985)

devised the push-button technique for clients

have control of their emotions.

and

to study the

The

accompanying

client

feeling.

is

who

think that they don’t

instructed to visualize a pleasant scene or event

Next, the client imagines a scene that evokes

INDIVIDUAL PSYCHOLOGY negative feeling client

is

137

pain, embarrassment, anger)

(e.g.,

and attends

to that feeling. Finally, the

asked to revert back to the original, pleasant emotion. Thus, the counselor teaches

the client that he creates his emotions by choosing

what

Sandy

when

asks

James

conjure up the feelings he has

to

to focus on.

he’s

around a

Then

girl he likes.

him to think about beingfiredfrom his job andfocus on those emotions. Next, him to refocus on the first set offeelings. Sandy and James then discuss how he

she instructs

Sandy

asks

was able

to

change

his

mood by changing his

thoughts.

Catching Oneself Once

the client has accepted the counselor’s interpretation, he can practice catching

himself in his unique self before

sports

way of achieving power. With

a little practice, he can even catch

him-

beginning to engage in the undesirable behavior. Tamera tends to avoid playing

by putting herself down. In

catch herself

when

this

way, she avoids the failure that she

fears. If she

she begins to disparage herself and reorient herself with

“it’s

could

OK

if

I’m not perfect,” she might improve her relationships with others, not to mention her physical

skills.

James has a tendency

to

fly into

temper tantrums

—

and throw

things.

Sandy thinks that

this

one way he fights ojf his inferiority feelings by proving how powerful he is. He also verbally puts others down, with the same motive. Sandy asks James to observe his thoughts

is

and feelings closely, has put him down. he

relates to others

to

perhaps learn

to recognize

when he

is feeling

inferior or that

Eventually, he might be able to interrupt his patterns

someone

and change how

when feeling insecure.

Creating Images Mosak (2005) discussed helping the client use imagery to exemplify his faulty goals. many cases, these images can even be used humorously, allowing the client to laugh himself For example, a client

who

controls others through constantly failing

In at

and needing

Brown who battles the tree-eating somehow wins. Then he has to visit

help could be instructed to think of himself as Charlie kite.

Every time Charlie

tries to fly his kite,

the tree

Lucy, the 5-cent psychiatric professional!

Sandy has James think of himself as Arnold Schwarzenegger any time he feels the impulse to overpower others through intimidation. She winks and calls him Arnold when he starts speaking in these ways,

and says

”

“hasta la vista.

Pleasing Someone Adler advocated confronting the

about

how

to please

client’s faulty lifestyle

someone (Ansbacher

& Ansbacher,

by advising him 1956,

p.

to think daily

347). If the client obeys

INDIVIDUAL PSYCHOLOGY

138 this directive

in

immediately (which

rare,

is

according to Adler), the counselor has succeeded

turning his interest toward others and thereby increasing social interest. If the client

motivations (purpose) behind the symptoms emerge. Rather than con-

refuses, the real

fronting those motivations, the counselor continues to insist on attending to others. For instance, Adler related an instance in

which the

others by objecting that others did not please

client

responded to the directive

him (Ansbacher

& Ansbacher,

simply told the client not to worry about others, but that he (the the task for his

Sandy decides

own

to

health

with what

to

1956). Adler

must accomplish

347).

have James do a pleasing

for James, she asks him struggles

(p.

client)

to please

Even though

task.

it

might be

dijficult

and new

do something nice for his foster mother in the nextfew days. James

this task

might

around the household, taking out

be,

but finally

settles

on offering

He surprises Sandy

the garbage.

be willing to take on this duty on a permanent

on a small task

to take

by saying that he might

basis.

Paradoxical Intention In this counterintuitive technique, sometimes called antisuggestion (Carlson et ah, 2006),

encouraged to intensify their symptom. For instance,

clients are

practice his

temper tantrums

to

tantrums are very effective

his

bility for ale

is

household

what Adler

tasks,

become even

Billy

better at them. Billy

in distracting his

could be asked to

might

also be told that

mother from making him take responsi-

and so he should practice even

harder.

Using

this

kind of ration-

called “spitting in the soup” or exposing the function of the

symptom

Mosak & Maniacci, 1998). The idea behind paradox is to increase the client’s awareness of the symptom and its consequences (Dinkmeyer et ah, 1987). Also, paradox can help clients give up symptoms because they begin to look absurd. (Carlson et ah, 2006;

Sandy cant think ofa tice

really good paradoxical directive for James.

She could have him prac-

getting angry, only at a certain time of the day. IfJames complied, the social function

of the anger would be removed. IfJames did not comply, hed have a smooth day, which might not be a bad thing for him. Another option is to tell James that he is cool, but not quite cool enough, since others seem not to fully appreciate

how

cool he

is.

She asks him

to

find some ways to be even more cool and observe others' reactions to him. Sandy hopes that James will start to examine what cool means and how putting others down prevents him

from

truly connecting with them.

EVALUATION OF THE THEORY IP theory of

its

is

a “grand” theory that, like psychoanalysis, tries to explain everything.

assumptions are

however,

is

difficult to test.

An

busily advancing Adler’s work.

active

The

community of

level

researchers

and

Many

writers,

of devotion of these adherents could

be considered either a strength or a weakness. Adler’s thoughts

Rogers, Albert

had

Ellis,

significant influence

on many subsequent

theorists, including Carl

and Abraham Maslow (Hoffman, 1994). The influence of

Adler’s

INDIVIDUAL PSYCHOLOGY

139

description of the basic mistakes can be clearly seen in contemporary cognitive and

cognitive-behavior theory.

Perhaps Adlers greatest contribution

even emphasized the effects of social

Adler was in

ahead of

far

our increasingly

Some (Mosak

&

class,

the highest

and

racism,

on the behavior of individuals.

sex

and

this sense,

and

his ideas are

even more salient

pluralistic society. is

Maniacci, 1999). All behavior

striving for power,

that he developed a theory that recognized

contemporaries in

his

contend that IP theory

critics

is

and

Of

social interest.

too simple and that

it

is

only

common

sense

explained by referring to inferiority feelings,

is

course, Adler

would

common

reply that

sense

is

form of reasoning.

The changing

nature of families

is

a potential

problem

for classic IP theory.

Developed

may

have more

mostly around the conventional two-parent nuclear family, the theory difficulties in validly explaining

what happens

in a single-parent family that includes

parents in the household, for example. Stepfamilies

(i.e.,

grand-

multiple family units) might also

pose similar problems.

Qualities of the Theory Precision

and

Testability.

terms of testability. measure,

at best.

IP theory has

Many of the

Monte and

many

of the same weaknesses

as

psychoanalysis In

constructs in IP theory are difficult to operationalize and

Sollod (2003) observed that the major ideas in IP theory (for

instance inferiority feelings or safeguarding strategies) are not very open to disconfirmation.

Much

IP theory can explain almost any pattern of behavior. If a client

like psychoanalysis,

acts out.

It

is

because of a superiority complex that

Inferiority. If a client

is

passive,

it is

because she

No

naturally because she feels inferior. specify

which behavior

IP theory

is

that

compensating

which,

Both stem from the in the

noted

bunch. Adler seems to have

most people think they understand, rather than

earlier,

On

was defined

in

many

those

who

clear,

and predictions can be generated about them. For

followed him.

the other hand,

some

would

basic inferiority complex.

For instance, what exactly constitutes pampering?

as

different

relied

seem

to agree

on the

right

way

to

measure

on

clearly defining

Many of IP theory’s An example would be

ways by both Adler and

aspects of the theory are definitionally Instance, Adler provided very clear

predictions about the behaviors of children In the various birth orders. Unfortunately, can’t

of

afraid to risk exposing herself to failure,

constructs are so broad that they are difficult to define or measure. lifestyle,

for feelings

specific predictions can be derived that

not the most precise theory

commonsense terms his constructs.

will result.

is

is

these. Social interest has

been measured

we in

several different ways, as has lifestyle.

In spite of these problems, researchers have

worked hard

constructs, mostly through self-report measures (Watkins

to define

&

some

of the IP

Guarnaccia, 1999). For

instance, researchers have developed measures of social Interest, early recollections, lifestyle.

General hypotheses can be derived from the theory, but

not always

as

precise

as

we would

like.

When more

as

specific

and

earlier,

they are

predictions

can be

noted

derived, such as those about the personality correlates of the various birth orders, there is

often great disagreement about

this

how

to define

and measure the constructs.

Illustrating

controversy, Jordan, Whiteside, and Manaster (1982) presented seven different

INDIVIDUAL PSYCHOLOGY

140 schemes

for birth order, based

on the number of children and the

sex of sibling as well as

ordinal position.

Empirical

Some

Validity.

research seems to support the major constructs

and predictions of

Most of this research is published, however, in the Journal ofIndividual Psychology rather than more generic psychological journals, leaving questions of potential interpretive bias open. Very little organized outcome research has appeared in the literature, and IP counseling has not been a subject of the major psychotherapy outcome studies. Major conIP theory.

structs

such

as superiority

and

complexes have received

inferiority

little

attention, probably

because they are so hard to measure.

Research Support Outcome studies

I

Outcome

Research.

research testing IP counseling

is

few outcome

scarce; the

could locate were very dated. For instance, Shlien, Mosaic, and Dreikurs (1962)

reported on an outcome test of time-limited therapy

(maximum of 20

one of the approaches was IP (the other was person-centered therapy). was used to measure outcome, their “real” selves

that these

two

and concluded

and one

sorts

in

clients sorted adjectives into

A

which

Q-sort method

two

piles,

one

for

and colleagues (1962) reported counseling compared to before counseling

for their “ideal” selves. Shlien

matched more

that IP theory

in self-ideal are supportive

which

sessions) in

closely after

was supported. Although

of IP theory,

more

it is

a case could be

directly predicted

made

that increases

by person-centered

theory.

Several smaller studies have provided

some support

for IP theory. Zarski, Sweeney,

Barcikowski (1977) examined the relations between counselor social interest, client tion with counseling,

and

client

outcome

as

and

satisfac-

measured by the California Psychological

Inventory (CPI). Results showed a positive correlation between counselor social interest and counseling outcome

and

sociability as

in that

as

measured by a

client satisfaction inventory

measured by the CPI

scales.

and

outcome and

this

(b)

between counselor

client self- acceptance

This study would seem to support IP theory

good counselors would be those with high

to note that (a) client self-acceptance

and

social interest.

sociability

may

However,

it is

important

not be the best measures of client

study was not experimental in nature so no causal relationships

social interest

and

client

outcome can be assumed.

Krebs (1986) and Burnett (1988) reviewed the literature on the effectiveness of Adlerian parenting programs and found some support for these interventions, but the majority of the studies reviewed could be criticized

on methodological grounds.

and Guarnaccia’s (1999) contention and more rigorous outcome research. agree with Watkins

Overall, then,

I

that IP researchers need to

Theory-Testing Research. Watkins and Guarnaccia (1999) reviewed research

constructs of IP theory: birth order, social interest, early recollections, and

concluded that the research evidence supports IP theory. In an

tend to

do more

on four major lifestyle;

earlier review,

they

Watkins

(1982) came to a similar conclusion. However, overall, most of the research on IP theorists is

conducted by IP advocates and

As noted

earlier,

much of

is

therefore subject to potential investigator bias.

the research has been published in the Journal of Individual

INDIVIDUAL PSYCHOLOGY

141

Psychology, an obviously IP-oriented journal. suffer will

Irom

a lack ol specificity

Many of the

seem

studies of IP constructs

of predictions based on the theory. That

to

an investigator

is,

study a construct (early recollections, for instance), find some findings (that account-

more

members than music students’), and then explain how these fit the theory. More convincing results would be obtained if strong theoretical predictions could be made at the outset. Finally, significant ing students’ recollections include

methodological problems can be found IP theory.

That

The

said,

I

references to nonfamily

in

many of the

studies that are cited in support of

current state of research in the IP arena seems to be similar.

think

it is

to testing, extending,

areas identified

and applying

commend

the Adlerians for the energy they devote

To

illustrate,

I

With few

their theoretical approach.

around other counseling theories

investigative activity theorists are doing.

important to

will briefly review

by Watkins and Guarnaccia (1999)

exceptions, the

what the IP

pales

by comparison

some

of the research in each of the

to

as well as research in the area

of

career/vocational behavior, a topic of recent interest to IP advocates.

CareeriVocational Behavior. Watts and Engels (1995) surveyed research relevant to the task of work or vocation.

life

and

lifestyle,

Examining

concluded that although the research

social interest, they

dence for IP theory could be gleaned.

Swank, 1988;

examined

Amerikaner,

Elliot,

studies investigating birth order, early recollections,

Elliot,

& Swank,

tory). In a

recent study, Kasler

Elliot,

&

and found

that

ERs

ER codings predicted career choice as well

traditional predictors of career choice

more

evi-

1987) presented two interesting studies. They

early recollections (ERs) as predictors of vocational choice

more

some

sparse,

Amerikaner, and Swank (Amerikaner,

could be coded for vocational themes. Further, the as other,

is

the Vocational Preference Inven-

(i.e.,

and Nevo (2003) reported similar

findings, only they

used the Self-Directed Search.

Amerikaner and colleagues (1988) reasoned that individuals higher would,

in general, be

more

contention that social interest

and

satisfaction

with work

They based

satisfied vocationally. is

this prediction

vital to success in life in general,

in particular.

Amerikaner and

in social interest

and

on

Adler’s

to vocational success

colleagues’ results

confirmed the

predicted relationship between social interest and career satisfaction, lending support to IP theory.

Other

erence and

studies have failed to support IP theory, such as a study of vocational pref-

lifestyle

by Gentry, Winer, Sigelman, and

found no relationship between

lifestyle

Phillips (1980).

These investigators

and vocational preferences, which should

logically

be linked according to IP theory.

Social Interest.

Three instruments have been developed

to

measure

social interest: the

Social Interest Scale (SIS; Grandall, 1981), the Social Interest Index (SI I; Greever, Tseng,

Friedland, 1973),

and the Sulliman Scale of Social

Interest (SSSI; Sulliman, 1973).

Each

of the instruments has identifiable weaknesses (Watkins, 1994). Even more troubling Bass, Gurlette, Kern,

and McWilliams’ (2002) finding that across

five

interest, correlations

were very small (0.08-0.22) suggesting that the

different constructs.

When measurement

tools are

weak,

it is

about the theoretical predictions tested using these instruments.

On

is

measures of social

scales

difficult to

&

were measuring

draw conclusions

the other hand, one

could take the pragmatic position and say that these measures are the best we have right

now, and only cautiously

rely

on the findings. Taking

this

second perspective, then, we

INDIVIDUAL PSYCHOLOGY

142 find that overall, social interest as measured by

all

three major scales has been

found

correlate positively with altruism, trustworthiness, religious belief, increasing age,

teerism, vigor, marital adjustment,

Smith,

and

a

number of other

& Nelson, 2003; Leak, 2006; Sweitzer,

to

vohm-

personality variables (Johnson,

2005; Watkins, 1994). Also,

social interest

has been found to be negatively related to characteristics such as narcissism, depression,

and

hostility.

To

one example of a study testing IP predictions, Crandall (1981) found

give

that the Social Interest Scale (SIS) scores of a

group of convicted felons were significantly

lower than those of a comparison group of college students and university employees. This

would seem

finding

to directly

who

confirm Adler’s contention that individuals

violate

the law have low social interest.

Psychometric arguments aside, research continues on social provided by Johnson characteristics,

and

et ah,

who

(2003),

tested the relations

social interest, using the SIS.

social interest, family characteristics

such

as levels

in a

social interest

in

by

far the

is

for the theory.

most controversial area of IP

theory. Large

related to personality but that

many

other factors are involved

between birth order and other variables (Monte

Because there

much

so

research in this area,

I

will

amounts

generally con-

it is

in the relationship is

related to

found that the relationship

of research have been conducted on the effects of birth order, and cluded that birth order

order, family

conduct disordered adolescents than

comparison group, again providing some support

is

is

of conflict and cohesiveness, were. Thus,

and self-concept was weaker

Birth Order. Birth order

between birth

Although birth order was not

these results partially support IP theory. Sweitzer (2005)

between

One example

interest.

&

Sollod, 2003).

proceed to present only a selective

review.

Watkins (1992b) reviewed 25 studies of birth order published Individual Psycholo^ from 1981 to 1991.

He

in the

concluded that although

Journal of

many of

these

studies could be criticized for not accounting for intervening variables (e.g., sibling sex,

age spacing, cultural factors, and socioeconomic status), support was found for birth order predictions.

The

clearest

support

is

found

consistent with the theory, generally found to be

(Watkins, 1992b,

of first to

later

p.

in studies of first

borns

borns are risky because these birth positions tend to be confounded with

of some of these other

factors,

first

and

later

many

borns

may

other

be the result

not birth order.

(1972) reviewed a large collection of birth order studies and concluded that

borns tend to show greater educational achievement, are more

dependent than than

are,

365). However, as Ernst and Angst (1983) pointed out, comparisons

Thus, differences that are found between

Adams

— they

more dominant and responsible

socioeconomic status (higher SES families tend to have fewer children) and factors.

some

later borns.

their siblings. Further, they tend to be

Some of these

and

more conforming and

are

more

responsible

conclusions seem directly related to Adler’s ideas (conser-

vatism, responsibility, academic achievement in the sense that

and the adoption of “adult”

affiliative,

first

roles

and

contrary to predictions from IP theory

values),

it

represents responsibility

whereas others seem either unrelated or

(e.g., affiliation,

dependence). For example, Eaird

and Shelton (2006) thought that later borns would be more dependent, and as a result, would engage in more problematic drinking behavior than first borns. This hypothesis was confirmed

in Eaird

and

Shelton’s study, but

it

should be noted that they did not

assess for

INDIVIDUAL PSYCHOLOGY dependency,

just alcohol use behaviors

theoretical basis for the link

One

143 and

birth order. Also less than clear

was the

between dependency and problem drinking.

greatly debated aspect of birth order research revolves

around the use of actual

ordinal position versus psychological position.

As noted

conception of

not the actual order of birth. Unfortunately,

most

studies ol birth order

An

order.

Birth

ical

his ordinal position mattered,

do not

earlier,

Adler argued that the

assess psychological position, relying

child’s

only on actual birth

instrument has been developed to assess psychological birth order, the Psycholog-

&

Order Inventory (Cambell, White,

Stewart, 1991).

It

yields scores that

mea-

sure psychological characteristics thought to be associated with the various ordinal positions (e.g., it

the “oldest” scale measures feelings of powerfulness

and

desire to achieve).

some

studies report

also a

problem with

appears that this instrument has not been used a great deal, and

less-than-desirable psychometric qualities

(i.e.,

low

reliability).

Neglecting the sex of siblings and intervals between children the birth order research (Jordan et ak, ling

is

female or male would seem to

or affdiated with them. to address this issue,

One

1

982; Watkins,

make

fairly recent

However,

1

is

992b). Whether your older sib-

a difference in

study (Lawson

how you

&

related,

competed,

2004) attempted

Brossart,

examining sibling structure and relationship with parents. These

authors found that younger brothers of brothers were more intimate with their parents,

more intimidation from them. Older females with brothers were observed to be less intimate and to experience less parental intimidation. As you probably have noted, these results do not seem to directly bear on IP theory except in a very yet experienced

general way.

Other

difficulties in birth order research include the issue

of the overall frequencies of

the different birth orders. Studies that examine the relative proportions of a particular birth

order in an expected situation (for example, are

first

borns more likely to become

not distributed equally

cians?) often overlook the fact that, in general, birth orders are

the population

than

(i.e.,

later borns;

in a

politi-

country with an increasing population, there are more

in

borns

first

Adams, 1972).

Early Recollections. Early recollections (ERs) have been the subject of some attention in the research literature, with inconclusive results (Watkins, 1992a).

At

argue that attempting to create standardized scoring systems for

a very basic level,

ERs

is

some

contrary to Adler’s

conception of the individualistic, holistic approach to people (Kal, 1994). Others disagree (e.g..

Bishop, 1993), and

it is

noteworthy that attempts have been made

measurement of ERs. The most often-used system

in this research

to standardize the is

the Manaster-

Perryman Manifest Content Early Recollection Scoring Manual, which includes 42 variables that

form seven

clusters: characters (family,

mother, father), themes, concern with

setting, active/passive, internal/external control,

and

affect (positive/negative)

detail,

(Manaster

&

Perryman, 1974). Note that these variables do not seem especially linked to IP theory, except in very general ways.

Watkins (1992a) maintained that the the

ERs of counseling

clients are

uals not in counseling,

and

ER

research was supportive of IP theory in that

more negative and anxiety ridden than those

further, that they tend to

ment, becoming more positive

in

theme. Watkins

supportive of IP theory, but also points out a

change when

cites

of individ-

clients receive treat-

other findings that are somewhat

number of weaknesses

in the current research.

INDIVIDUAL PSYCHOLOGY

144 including the lack of theoretical specificity noted

earlier.

ER construct

So, support for the

can be said to be weak, at best.

Lifestyle.

As noted

by the same

part,

set

LSIQ

measure, the

lifestyle

have been developed, for the most

of researchers. In what seems to be the

Kern (1976) developed the

style,

measures of

earlier, several

earliest

attempt to measure

Life Style Inventory Questionnaire (LSIQ).

one of eight categories of lifestyle study of Catholic

intellectualizer, rebel, getter, driver, superior). In a

priests,

Mansager (1986) found that judges using this instrument classified the a lifestyle termed “the right, superior, or good life-style” (p. 369). seven

Life-Style Personality Inventory (LSPI; Wheeler, Kern,

lifestyle

A self-report

provides information about birth order, sibling relationships, and

so forth, that allows judges to classify people into

The

life

(e.g.,

Newton and

priests reliably into

& Curlette,

1991) measures

themes (conforming/active, conforming/passive, controlling/active, control-

ling/passive, exploiting/active, exploiting/passive, also includes a

measure of social

acceptable; validity data are

more

and displaying inadequacy). The LSPI

interest. Reliability

An

sketchy.

Scales for Interpersonal Success-Adult

data for the scales were found to be

extension of the LSPI

form (BASIS-A; Wheeler, Kern,

Both the LSPI and the BASIS-A ask respondents

to

the Basic Adlerian

is

& Curlette,

answer items

as

1993).

they recollect

childhood experiences rather than in reference to current functioning. The assumption that

by asking about childhood perceptions, defensiveness

social desirability bias in

maintained that the

it

responding (Wheeler, Kern,

&

is

is

reduced, thereby avoiding

Curlette, 1991). Also, Adler

was the person’s interpretation of his or her

life

that mattered rather than

reality.

Research using the

seems inconsistent, probably because of the

lifestyle inventories

differing structures of the instruments. Lifestyle has been related to coping styles, patterns of substance use,

&

McCarthy,

&

Curlette,

and relationship functioning (Herrington, Matheny, Curlette,

Penick, 2005;

&

Matheny, 1996; Lewis

1993). In general, this research

modest support

&

Keene

is

Wheeler,

1994; Kern, Gfroerer, Summers,

Osborn, 2004; Logan, Kern, Curlette, in the preliminary stages

still

lor IP theory. Lor example,

belonging/social interest lifestyle theme correlated with problematic alcohol use

(as

and provides only

Lewis and Osborn (2004) found that the

measured by the BASIS-A) was positively

among

counter to the theoretical prediction that

& Trad,

college students.

this relationship

They saw

would be

this result as

negative.

However,

they did note that one possible explanation for the finding was that the belonging/social interest scale

construct.

between

was actually measuring extraversion or

In contrast,

lifestyle

Herrington

et

al.

sociability, instead

(2005) confirmed expected relationships

(belonging) and anxiety.

ISSUES OF INDIVIDUAL Adler was probably one of the

and he was certainly an

first

AND CULTURAL DIVERSITY

theorists to recognize the effects of class differences,

early advocate of equality

socially-based constraints that

women

between the

sexes.

we could

He

recognized the

experienced and clearly acknowledged the deval-

uation of the lemale role in the majority culture of his time. then,

of the Adlerian

say that his theory might be

somewhat

less

Prom

this perspective,

biased than other approaches

INDIVIDUAL PSYCHOLOGY in

145

terms of gender considerations. However, he did have

women’s

roles, characterizing

them

as

fairly stereotypical

demonstrating “masculine” goals

male occupations. Feminists would see these values

traditionally

if

views of

they pursued

upholding the

as

patriarchy.

IP theory’s focus on social involvement and the importance of relationships would be

compared

consistent with the values of cultures that hold collectivistic as

worldviews such ple,

as

Asian or Native American (Thompson

to individualistic

& Rudolph, 2000).

For exam-

Johansen (2005) argued that the basic philosophy of IP was consistent with that of

individuals

who

are of Islamic faith. Adler

was aware of the negative

him from

classism; this quality clearly differentiated

his contemporaries.

therapeutic relationship and emphasis on cooperation

among

individuals

when working with women and

are also strengths of this theory

effects

of racism and

The

egalitarian

and with society

clients

from diverse

and

responsibility,

backgrounds.

At the same time, the theory emphasizes individual choice, constructs that are Western in orientation. Insight (into lifestyle) seling; this orientation

(2005) argues that several principles of IP

American

families,

such

a multigenerational legacy,

make

it

and

(c)

in IP

coun-

(e) flexibility

of intervention

lifestyle as

&

work with African

social interest, (b)

emphasis on collaborative goal

these lifestyles as perversions (Ansbacher

GLB

important

appropriate for

significant criticism of Adler refers to his views

choice of a

also

& Sue, 2003). On the other hand, Perkins-

concept of collective unity and

as “(a)

placed on the family atmosphere,

One

is

may be inconsistent with the values of cultures that are action oriented

(such as the African American community; Sue

Dock

control,

importance

setting, (d) influence

of

strategies” (p. 235).

on homosexuality. Referring

to

Ansbacher, 1956), Adler characterized the

More

evading the task of love.

recently, his intellectual descen-

dents have argued that Adler’s conceptualization needs revision (Chernin

&

Holden,

1995) and have offered strategies for helping lesbian and gay couples (Fischer, 1993).

some evidence that Adler was more tolerant would suggest. McDowell related an anecdote (in Manaster, There

is

than his writings

in his views

also

Painter, Deutsch,

1977) in which a social worker consulted Adler about a client

who was

gay.

upon learning that the client was homosexual, Adler inquired happy. When McDowell responded that he was, Adler replied, “Well leave him alone? Eh?” (1977, p. 82). this

account,

.

.

& Overholt,

According to

if the client .

why

don’t

was

we

THE CASE STUDY IP theory

fits

James’ presentation well because of

environment and on the

seem

to help in

client’s

ways of operating

understanding James’

story.

emphasis on the influence of the early

its

James

in the world, or lifestyle. Adler’s ideas is

African American, and Adler’s recog-

nition of racism clearly applies to this case. IP theory

African American male, James has likely experienced ple that

were largely based on

of life goals before the age of 6

his race.

influential in

insist that

determining

it

some

that as a

young

aversive interactions with peo-

this theory’s

emphasis on the development

may overlook the effects of experiences James had subsequent

to his first foster placement. Adler

but he would

However,

would recognize

had

little

to say

about nontraditional family structures,

was James’ interpretation of

his current functioning.

his

environment that was most

INDIVIDUAL PSYCHOLOGY

146

Summary IP theory teaches that

human

life is

intricately tied to

for power, or superiority,

and the need

develops a unique

which

Is

lifestyle,

formed by the age of 6 and

order, sex, family values).

is

is

for belonging, or social interest.

the blueprint for

—

the striving

An

individual

two basic motivations

how

these needs are met.

The

influenced by the early environment of the child

However, what the individual makes of his experience

process; the influences of family, physical environment,

and heredity

lifestyle

(i.e.,

is

birth

a creative

are only part of the

equation. Individuals are

who

are healthy fulfill the basic tasks

of life:

courageous and able to take responsibility for their

are discouraged. useless side

The

They

are selfish

and often timid,

love,

work, and community. They

lives.

Dysfunctional individuals

“yes but” personalities.

They walk on

the

of life and avoid challenge and responsibility.

goal of IP therapy

is

to help the client

takes an optimistic outlook,

understand

and the relationship

Is

his faulty lifestyle.

The

egalitarian. Faith, hope,

counselor

and love

are

important qualities of the counseling relationship. Numerous techniques are available to the IP counselor.

Adler was the

first

major theorist of counseling to recognize the power of social conditions.

However, IP theory has been

criticized for

major assumptions of IP theory are is

being commonsense and simplistic.

difficult to test,

and the research evidence

Many

of the

for the system

questionable methodologically.

Visit

Chapter 4 on the Companion Website

chapter-specific resources

and

self-assessments.

at

www.prenhall.com/murdock

for

ghapter:5

Carl Rogers

Richard

is

a 48-year-old male Caucasian.

an insurance

salesperson for the past

He

3 years.

is

a high school graduate and has worked as

Prior

to this

period he worked at the manage-

ment levelfor a teleeommunication company, but lefi this job because he found it too stressfid. Richard presents with depressed

He

functioning.

mood that affects

his physical, social,

reports experiencing this depression for

and occupational

about the past 2 years. During

period, Richard characterizes himselfas ofien fatigued, socially withdrawn, in work. His

for having

Sandy

income has dropped signifieantly during the

to rely

on

his wife, Sandy, as the primary

last

this

and ineffective

2 years. Richard feels guilty

income provider. According to Richard,

ofhim nonverbally, such as when she is writing checks for The couple argues quite frequently about financial matters.

ofien expresses disapproval

the monthly

bills.

Richard and Sandy have two adult ehildren (Natalie and fames) who have completed college

within the past 5 years. Richard reports that both children currently earn more than

his present income.

This situation makes

him feel inadequate. As a

and James, and sees them as typically involve his wife and are

emotionally distant from Natalie Richard's social activities

spare time with his computer or reading.

He

reports

having no

result,

Riehard feels

closer to Sandy.

work-related.

He spends

his

close friends.

During counseling sessions Richard seems uncomfirtable, has

difficulty

maintaining eye

during the shortest periods of silence, and comments on his discomfort with the lack of structure. Although he seems motivated to change, Richard seems contact, laughs nervously

to

have

diffieulty discussing his situation.

BACKGROUND Person-centered therapy

is

over a span of over 40 years, the approach has first

called his

Ransom Rogers (1902—1987). Developed been known by three different names. Rogers

the creation of Carl

model nondirective

therapy.

As

his ideas

continued to evolve, he renamed

it

147

.

PERSON-CENTERED THERAPY

148

client-centered therapy. In the 1980s he began using the term person-centered approach in

recognition that the theory had been applied far beyond the counseling situation teaching, group leadership, international affairs; Rogers, 1980;

Rogers was born into what he describes strict

and uncompromising

religious

as “a

and

home marked by

close family ties, a very

His family moved to a farm

He

majored

Seminary

New York.

in

to a

when sci-

in agriculture in his first 2 years of college, but

then found his interests changing; he eventually began theological training ological

1992).

Carl became interested in agriculture, particularly the

as a result,

entific aspects (Rogers, 1961).

p. 5).

& Raskin,

and what amounted

ethical atmosphere,

worship of the virtue of hard work” (Rogers, 1961, Rogers was 12, and

Zimring

(e.g.,

However,

Union The-

at

Columbia University in psychology program there.

after taking courses at

psychology, he changed his path again and entered the clinical

Receiving his degree in 1931 (from a program that emphasized traditional experimental

psychology and

was

testing), Rogers’ first job

Department of the Society

as a staff psychologist in the

Child Study

New York.

of Cruelty to Children in Rochester,

for Prevention

There the beginnings of Person-Centered Therapy were established

Rogers struggled to

as

help the underprivileged clients of this agency. Finding the traditional psychoanalytic meth-

ods favored his

at this clinic increasingly unsatisfactory in his

theory of counseling.

He

described several incidents that spurred his development, and

perhaps the most touching occurred boy’s mother.

work, Rogers slowly began to form

when he had all but given up on

a troubled

boy and the

He had struggled mightily to get them to understand the Oedipal roots of their

problems, and had finally become resigned to his inability to help them. At the end of what

was to be the

if Rogers

successful

—

clude that it.

he was explaining the situation to the boy’s mother. Suddenly, she

would accept adults for counseling and launched into an anguished descripof her troubles. As Rogers put it, “Real therapy began then and ultimately it was highly

asked tion

final session,

it

and

for her

was

really the client

This assumption Rogers

for her son”

moved

96 1

,

p. 11).

who knew what

These

early experiences led Rogers to con-

the problem was

and where

to

go to solve

to the University

of Chicago

the foundation of the person-centered approach.

is

to

( 1

Ohio

State University in

1940 and then

(1945—1957), where he established the Student Counseling Service, Counseling and Psychotherapy Center.

An

later

renamed the

account of the development of the center and

of the beginnings of Rogers’ research program can be found in Cornelius-White and Cor-

An interesting tidbit:

nelius-White (2005).

the technology at the time was so primitive that

the famous first-ever recording of a therapy session (in

which the

therapist

was anonymous

but according to Patterson, 2000, surely Rogers) was accomplished using glass disks, and it

took ten of these to record Rogers’

(1957-1963). California,

traditional

last

He

and

then

later

ONE therapy session.

academic appointment was

moved

prominent of which

for Studies

are probably Counseling

and

his

articles

Jolla,

La

Jolla,

where

his

and books, the most

Psychotherapy (1942), Client-Centered

On Becoming a Person (1961), and A Way from On Becoming a Person in Box 5.1

Broadening

Institute in

of the Person in La

Along the way he wrote many

Therapy (1951),

movement

Western Behavioral Sciences

founded the Center

professional career ended.

an excerpt

to the

of Wisconsin

at the University

of Being

.

You can read

approach, Rogers became one of the leaders of the encounter group

in the late

1960s and ’70s (Kirschenbaum, 2004). In the

Rogers led large workshops

all

last

years of his

life,

over the world aimed at resolving conflict, for which he was

PERSON-CENTERED THERAPY

149

Box

5.1

A GENERAL HYPOTHESIS One

brief way of describing the change

early professional years this

person?

ship

which as

It is I

I

Now this

I

would phrase

person

is

have had meaning for experience, since

Perhaps

me

that

I

may

own

me

my

in

start

this

How can

my human

this

ing and direct that

I

I

I

I

realize that

feel it is possible that

a

more

working with

you

for

has gradually been driven

It

whatever

the learnings

may have some meaning human relationships.

which your

in

home

to

troubled person by means of any intellectual or

is

of any

use.

many

of them.

mode of life. But

satisfying

experience, futile and inconsequential.

The most

training,

upon

the

These approaches seem so tempt-

have, in the past, tried a great

knowledge about

provide a relation-

relationships, not just to

explain a person to himself, to prescribe steps which should lead in

my

or cure, or change

experience

taught,

is

to say that in

is

No approach which relies upon knowledge, upon

acceptance of something that

him

me

treat,

I

second way that

with a negative learning.

cannot be of help to

training procedure.

of

of us are involved in

all

should

I

all

in

personal growth?

for this reason that

It is

can

the question in this way:

use for his

applicable to

with problems.

How

was asking the question,

have come to put the question in

have learned

clients

I

which has taken place

him

It is

possible to

forward, to train

such methods

they can accomplish

are, in

my

some tempo-

is

which soon disappears, leaving the individual more than ever convinced of

rary change,

inadequacy.

his

The failure of any such approach through the intellect has forced me to recognize that change appears to come about through experience in a relationship. So I am going to try to state very briefly and informally, some of the essential hypotheses regarding a helping relationship

and I

which have seemed

to gain increasing confirmation

both from experience

research.

can state the overall hypothesis in one sentence,

as follows. If

I

can provide a certain

type of relationship, the other person will discover within himself the capacity to use that relationship for growth,

and change and personal development

will occur.

THE RELATIONSHIP But what meaning do these terms have? Let in this

ful

I

would

have found that the more that

it

will be.

ble, rather

This means that

I

like to I

What

is

this

provide?

can be genuine in the relationship, the more help-

my own

need to be aware of

feelings, in so far as possi-

than presenting an outward facade of one attitude, while actually holding

another attitude

deeper or unconscious

at a

ingness to be and to express, in titudes

which

reality

seems deeply important

reality

which

I

take separately the three major phrases

sentence and indicate something of the meaning they have for me.

certain type of relationship I

me

have found

exist in

is

in

me.

It is

my words

only

in this

as a first

level.

Being genuine

also involves the will-

and

my

way

that the relationship can have reality,

behavior, the various feelings and at-

condition.

It is

only by providing the genuine

me, that the other person can successfully seek for the

this to

be true even

when

the attitudes

I

and

feel are

reality in

him.

not attitudes with which

PERSON-CENTERED THERAPY

150

I

am

extremely important to be

As

ter

a

warm

what

more

be creating a

him

regard for

as a

person of unconditional self-worth

as a separate person, a willingness for

means an acceptance of and regard

him

means

him

own

to possess his

—of

a respect

and

value no matliking for

own way. It moment, no matter how neg-

for his attitudes of the

attitudes he has held

This acceptance of each fluctuating aspect of this other person makes

a relationship of

warmth and

and the

safety,

him

feelings in his

no matter how much they may contradict other

ative or positive,

seems

It

more acceptance and liking I feel toward this relationship which he can use. By acceptance I

his condition, his behavior, or his feelings. It

in the past.

relationship.

find that the

I

will

I

good

to a

real.

second condition,

a

individual, the

mean

which seem conducive

pleased, or attitudes

safety of being liked

it

and prized

for

as a

person seems a highly important element in a helping relationship. I

also find that the relationship

sire to

understand

cations as they

—

a sensitive

seem

him

to

involves understanding.

is

continuing de-

client s feelings

and communi-

empathy with each of the

at that

only

It is

feel a

significant to the extent that

as

moment. Acceptance does not mean much I

see

until

it

understand the feelings and thoughts which seem

so horrible to you, or so weak, or so sentimental, or so bizarre

you

I

them, and accept them and you, that you

—

it is

feel really free to

only

as

explore

I

all

see

them

as

the hidden

nooks and frightening crannies of your inner and often buried experience. This freedom is

an important condition of the relationship. There

oneself at both conscious and unconscious this

dangerous quest. There

nostic evaluation, since

Thus

parency on person

my part,

as a separate

in

I

am by no means

me

perceive

what

is

I

own

is

characterized by a sort of trans-

right;

by an acceptance of this other

and by

world through

companion which he now a

I

feel

I

have achieved

have described, and

occur

embark on

my

to

deep empathic under-

his eyes.

client,

feels free to

a

When

these condi-

accompanying him

in the

undertake.

always able to achieve this kind of relationship with another, and

rience these attitudes, then will invariably

to

believe, always threatening.

I

feelings are evident;

being offered to him. But

kind of attitudes.

one can dare

rapidly as

have found helpful

to see his private

become

when

sometimes, even

are,

person with value in his

frightening search for himself, I

I

my real

which

standing which enables tions are achieved,

which

implied here a freedom to explore

complete freedom from any type of moral or diag-

such evaluations

all

the relationship

also a

is

levels, as

is

—and

when

believe that

I

I

I

it

in myself,

would

may when

he

say that

be too frightened to I

the other person can to

hold in myself the

some degree expe-

change and constructive personal development

include the

word

“invariably” only after long

and

careful

consideration.

Rogers, C.R. (1961).

On

becoming a Person. (Boston; Houghton Mifflin).

posthumously nominated

for a

Nobel peace

prize

(Kirschenbaum, 2004).

He died

in

1987

of a heart attack during surgery to repair a broken hip (Weinrach, 1990). Rogers was survived by two children; his wife had died in 1979. His daughter, Natalie, became a therapist,

eventually writing her

own book combining

person-centered counseling with other

expressive therapeutic techniques (N. Rogers, 1993).

PERSON-CENTERED THERAPY Carl Rogers was a pioneer in to is

many ways.

someone seeking psychotherapy. one

who comes

of surrendering

actively

his

own

significant contribution

151 Rogers was the

first

to use the

term

“The

In explaining his use of this term, he said,

and voluntarily

on

to gain help

a problem, but

client to refer

client

submit the counseling process to the

his willingness to

.

.

without any notion

most

responsibility tor the situation” (1951, p. 7). Perhaps Rogers’

was

.

rigors

of

He was the first to record counseling sessions, and he used these recordings as a basis to test his ideas. Many times the transcripts or recordings used in research and publications featured Rogers as the counselor. One of these recordings was the basis for the book Counseling research.

and Psychotherapy

which presented the

ever printed. Braving the psychotherapeutic

first

complete transcription of a counseling case

unknown, Rogers designed and conducted an

extensive study of person-centered therapy with schizophrenics while he

was on the

the psychology and psychiatry departments at the University of Wisconsin (see Rogers’ impact

5.2).

on the profession of psychology was recognized by the American Psycholog-

when in 1956 he was chosen as one of the first three individuals awarded

ical

Association (APA)

the

American Psychological Association award

for distinguished scientific contribution. Later

Box

5.2

The Wisconsin Schizophrenia In

Box

faculty of

1957 Carl Rogers was looking

for

new

challenges.

Project

He moved

to the University

Wisconsin and became a member of the departments of psychology and psychiatry.

wondered

In collaboration with the

would work with schizophrenic

The study took

would be

as helpful

with other kinds of clients.

members of the Psychotherapy Research Group

of Wisconsin Psychiatric Institute, he

tially

He

client-centered therapeutic approach that was so successful with the col-

if the

lege students at the University of Chicago

sity

of

set

out to

test

at the

Univer-

whether client-centered therapy

clients (Rogers, 1967).

place over a 5-year period. Eight therapists,

all

of whom were essen-

person centered in their orientations, volunteered to provide counseling. Rogers

was one of the

therapists.

Three groups of participants were

phrenics, chronic schizophrenics,

dysfunction).

A

total

and normal persons (not

identified: acute schizo-

hospitalized, reporting

no

of 48 participants entered the study and were randomly assigned

to therapy or control groups. Multiple

measures were used, including a battery of psy-

chological tests (the Rorschach and the Minnesota Multiphasic Personality Inventory,

among oped thy,

to

others)

and measures of the therapeutic

relationship. Rating scales

were devel-

measure the important constructs of person-centered theory, including empa-

unconditional positive regard, and therapist congruence. Measures of the therapy

process included the level of client experiencing and the ability of the client to engage in relationships. Overall, this study

was

a

tremendous undertaking.

Unfortunately, the study did not flow as well as Rogers had planned.

of the research team committed an ethical violation.

It is

One member

not absolutely clear what hap-

pened from Rogers’ account, hut some of the data apparently disappeared, and much of the statistical analysis had to be repeated (Rogers, 1967). Discord was rampant

among

the research team, and although the study was eventually completed and published,

PERSON-CENTERED THERAPY

152

Rogers characterized the period period in

The

my whole

professional

“without doubt the most painful and anguished

as

(Rogers, 1967, p. 371).

life”

study were mixed. Analyses showed some isolated differences

results of the

between the treatment and control groups slightly higher release rate

treated hospitalized clients

‘(e.g.,

than nontreated hospitalized

clients),

group showed no greater improvement when compared talized individuals

showed

centered counseling.

positive

better

was found

for the theory

outcomes on two indicators (objective

who

but overall, the therapy

change regardless of whether they received person-

Some support

cians) than did clients

a

to the control group. All hospi-

perceived higher degrees of two of the therapeutic conditions,

showed

showed

who

that clients

in

empathy and congruence,

test scores

and

perceived low levels of these conditions.

by

ratings

One

clini-

interesting

finding was that clients’ and independent observers’ ratings were similar in their evaluations of the therapeutic relationship, but therapist ratings were negatively correlated

with the ratings of the other two groups. That

when

is,

tended to be high

therapists’ ratings

the clients’ (or raters’) were low, and vice versa.

Rogers and his colleagues found the results of the study somewhat encouraging.

The

between the relationship conditions and outcome seemed promising, and the

fact

link

that the researchers were able to develop reliable measures of these indicators icant.

signif-

Rogers concluded that the same conditions of good therapy work with schizo-

phrenic clients as well

clients

were more

like the typical clients

(Rogers, Gendlin, Kiesler,

& Truax,

(1972) he was recognized with the

becoming the only person ever

one of the most

In fact, Rogers suggested that

as neurotics.

important insights gained from the study might be

in

was

1967,

APA

to receive

schizophrenic

that, generally, the

he worked with than they were different p.

award

93).

for distinguished professional contribution,

He

both awards.

of the

APA

autobiography.

The

also served as president

1946.

Seeman (1990) argued

that a theory

is

by necessity the

comparability between Rogers’ theory and his

life

theorist’s

was quite evident

ingness to reveal his person in both his writings and in his

in his increasing will-

work with

clients.

fessional career he

became more and more convinced

was

therapeutic process, and he applied this assertion to his

least

critical to the

Over

his pro-

that the genuineness of the therapist

four times (in 1961, 1972, 1980 and 1987; see Kirschenbaum

&

life as

well.

At

Henderson, 1989)

he wrote accounts of his personal experiences, which are excellent demonstrations of the person-centered philosophy in action. ness of Rogers’ approach likely

had

its

Monte (1999) commented

that the nondirective-

roots in reaction to his strict early environment.

Carl Rogers applied person-centered concepts in areas beyond counseling and psychotherapy,

coming

to see his theory as

more of an approach

to interpersonal relations

and learning

than simply as a theory of client change. For instance, he wrote about marriage (Rogers, 1972)

and education (Rogers in the interests

Approaches

to

with a client

& Freiberg,

1

994), and conducted encounter groups

of contributing to world peace (Rogers, 1980). Rogers

all

lives

over the world

on

in the Three

Psychotherapy videotapes, in which he demonstrated person-centered therapy

named

Gloria (Shostrom, 1965; see Box 5.3).

The

session with Gloria

ered a classic demonstration of the ideal therapeutic relationship, and

is

still

is

consid-

the topic of

PERSON-CENTERED THERAPY

153

Box

3.3

The Meaning of the Missing 249 Words In

1965

film

a

series

was presented that changed the world of counseling and

psychotherapy. In the Three Approaches

woman named Albert

Ellis.

to

Psychotherapy (Shostrom, 1965), a courageous

Gloria served as a client for three therapists, Carl Rogers, Fritz

Each of the three segments begins with the

Peris,

and

theorist explaining his views,

proceeds to a 20-minute counseling session with Gloria, and then concludes with the theorist’s evaluation

of his work. At the end of the third interview, Gloria presents her

reactions to the three theorists. Gloria’s interaction with Rogers has been characterized as

exemplifying his incredible ability to form intense, satisfying relationships with

people, a demonstration of his almost

uncanny therapeutic

ability

(Weinrach, 1990).

Gloria and Carl corresponded for 15 years after the interview, up to her death at age 45,

and met once

in this period.

One section of the Gloria— Carl interaction has the

end of the

look to

me

mentions that

you

film, Gloria tells Carl, “I’d like

like a pretty nice daughter.” In his this interaction

been the subject of controversy. Toward for

my

“You

father.” Carl responds,

taped discussion after the session, Rogers

might be labeled transference and countertransference, but

dismisses that conceptualization as intellectualizing and a disservice to the value of the relationship.

As

a result of a rather surprising discovery,

meaning of Gloria and

the

Carl’s

interchange was the topic of a hot debate in the journal Psychotherapy (Bohart, 1991;

Weinrach, 1990). Six months

word segment of the interview

after Carl Rogers’ death,

that

was not included

Weinrach (1990) located

a

249-

in the film. Evidently, the film ran

out, but a separate audio recording of the session continued. In the segment, Gloria

and

Carl had continued their conversation, and Gloria indicated that her search for a loving father figure

was

a “neurosis.”

Weinrach suggested that

Gloria’s longing was, for her, a typical pattern, “or

need” (1990,

from the

p.

283), Rogers

film. Instead,

would have

worse

if

had been known

it

yet, a

long-standing neurotic

lost the therapist-guru status that

Rogers would have been seen

as

that

merely a

human

he gained

therapist

who

missed the boat in failing to interpret Gloria’s transference reaction. Even more problematic, in

Weinrach’s view, was the fact that Rogers appeared to be

transference feelings for Gloria, transference. Also,

which was what caused

Weinrach maintained that

if

bound up

his failure to

in

counter-

respond to her

Rogers had acknowledged these dynamics,

he would have been supporting a theory against which he had argued for a long time (psychoanalysis),

thereby questioning his own. In essence, Weinrach implied that

had the missing 249 words been included

in

the film,

Rogers would have been

discredited.

Bohart (1991) defended Rogers, contending that Weinrach’s views are based

in a

theoretical perspective (psychoanalytic), not absolute truth. Agreeing with Rogers that

reference to transference processes

Weinrach

is

really

saying

is

is

that he

not productive, Bohart maintained that “what prefers

Rogers-Gloria interaction” (Bohart, 1991,

p.

a

transferential

interpretation

of the

497). Eurther, he wrote, “to accuse Rogers

PERSON-CENTERED THERAPY

154

of

making

a therapeutic mistake because he did

to saying that

made

Rogers

a

is

equivalent

mistake because he did not operate in terms of the theo-

constructs that Weinrach

retical

not deal with transference

.

.

.

ascribe(s) to” (p. 497). Pointing out that Gloria

tends to discount her experience (when she

calls

her wish for an accepting male Figure

would

neurotic), Bohart noted that classifying Glorias feelings as transferential

validate

her mistrust of her person, a damaging event from a person-centered perspective. regard to Rogers’ responses to Gloria, Bohart questioned

and

to like (p.

501,

if it is

With

“‘countertransferentiaf

respect one’s client, or (heaven forbid) to actually express such sentiments”

italics in

the original).

Weinrach (1991) defended his conceptualization of the nature of the Rogers— Gloria interaction. He acknowledged that Rogers had

In responding to Bohart, transferential

him

always elicited in

a

wish to have such a grandfather and wondered “what feelings

Rogers’ persona has evoked in Bohart that influenced

defense of Rogers” (1991,

p.

him

to write such

an impassioned

505). Further, Weinrach wrote, “Bohart appears to be

applying the therapeutic principle of unconditional positive regard to everything Rogers

demonstration with Gloria” (Weinrach, 1991, pp. 505—506). Weinrach concluded by suggesting that the film be only regarded as an historical artifact did, including Rogers’

at best,

and

example

a negative

at worst. Evidently,

Bohart chose not to respond to

Weinrach’s rebuttal.

This entertaining interchange

way

is

probably best viewed

as a

good demonstration of the

theoretical lenses can influence the interpretation of events.

Working from

a

psychoanalytically influenced view, Weinrach saw Gloria and Carl’s interaction as transference

and countertransference. This

counselor interaction

change

as a negative

and intervene. In

its

attention to client-

of early experience, would evaluate the inter-

as a recapitulation

therapeutic event because Rogers did not recognize the processes

contrast, Bohart endorsed a person-centered approach, seeing the

Gloria— Carl interaction

from

perspective, with

as

an authentic exchange of intimate

this perspective. Until the unlikely

feelings, a positive event

time that one ol these two theories

the “truth” of psychotherapy, the lesson to be learned

is

that

what we know

is

elected as

as “reality”

can be viewed from multiple perspectives.

discussion

and the stimulus

Bohart, 1991; Weinrach,

work and

990, 1991).

The Center for Studies of the .

for

).

the Association for the

Approach (http://www.adpca.org

),

(

http:// users. powernet. CO. tik/bapca

(

http://

Person continues Rogers’ sites

Development of the Person Centered

)

Approach

and the Person-Centered Expressive Therapy ),

founded

by Rogers’

daughter,

scholarly journal Person-Centered Review, launched in 1986, apparently

1990, but the World Association currently publishes Person-Centered Psychotherapies. in the

of interest are the

the British Association for the Person-Centered

members.aol.com/exartspc/index.htm

The

It

(e.g.,

Person-Centered and Experiential Psychotherapy and Counseling

http://www. pce-world.org

Rogers.

contemporary professional counseling

has a website at www.centerfortheperson.org Other Internet

World Association (

1

for research projects in

and

Institute

Natalie

ended

in

Experiential

appears that the prominence of the person-centered approach has decreased

United States over recent

years,

but

in

Europe,

PC

theory

is

one of the most dominant

PE

RSON-CHNTERED

r

H

ERAPY

15 S

& Jourdan, 2005).

theoretical approaches of late

(Kirschenbaum

and intervention continue

Germany and the United Kingdom Person-Centered organizations in many countries around the

(Lietaer,

1

in other countries,

990) and there are

world (Kirschenbaum

& Jourdan,

can also be clearly seen

in

skills

such

2005, present a

as

of

list

18).

contemporary programs of training

(Egan, 2006; Hill, 2004; Ivey

Lively programs of research

Elements of Rogers’ approach

for interpersonal

and counseling

& Ivey, 2007).

BASIC PHILOSOPHY The hallmark

of Person-centered (PC) theory

is

human

the basic premise that

beings are

inherently good. Carl Rogers was quite clear about this conviction, writing that “the basic

human

nature of the

We

do not need

open

to

all

of

when

being,

to ask

who

functioning

freely,

is

constructive and trustworthy.

need to be liked by others and

his

tendency to give

He will

tion will be as strong as his impulses to strike out or to seize for himself.

which aggression

sive in situations in

runaway need

is

realistically appropriate,

for aggression” (Rogers, 1961, p. 194).

were developed

in the late

1950s and 1960s mostly

The major

in reaction to

.

.

he becomes more

will control his aggressive impulses; for as

his impulses, his

.

affec-

be aggres-

but there will be no portions of

two

PC

theory

influences: (a) the

psychoanalytic model that dominated the atmosphere at Rogers’ job (Rogers, 1961) and (b) the positivistic, behaviorist tradition that

was becoming prominent

in

psychology

in

the 1960s (Rogers, 1977).

human

In Rogers’ view,

common road to

to

full

living

all

human

behavior

is

the result of an innate need to

organisms (Rogers, 1980).

potential,

If left alone, the

grow and develop

person will follow the

showing none of the negative tendencies postulated by

other theorists (for example, Freud’s aggressive instinct). Rogers wrote, “contrary to those therapists destructive,

I

who

see depravity at men’s core,

have found that

free to actualize his nature as

when man

is

who

truly free to

see men’s deepest instincts as

become what he most deeply

an organism capable of awareness, then he clearly appears

move toward wholeness and integration” (1966, p. 193). The PC therapist that humans sometimes act in destructive or antisocial ways but maintains to

recognizes that these

tendencies are a product of experience in the environment, not built in to the

psyche (Merry

& Tudor,

human

2006).

Daryl, Richard's person-centered therapist, begins with the assumption that Richard inherently a positive, forward-moving individual. Even though Richard

emotion

and behavior

is,

is

is

exhibiting some

that might be labeled by others as dysfunctional, Daryl

is

sure that

grow and actualize, establish meaningful and productive relationships with others, and work effectively. He sees glimmers of this in Richard's evident willingness to engage in counseling and small sparks of hope that appear when within Richard

is

the potential to

Daryl responds supportively

to

him.

Person-centered counselors are committed to the notion that clients are self-directing and able to accept

full

responsibility for their actions (van tier Veen, 1998). F’ach person has

within him the resources and strengths to grow and become

a better

person.

I

his respect

PERSON-CENTERED THERAPY

156 for the individual’s

and

this

autonomy

leads to an attitude of equality in the therapeutic interaction,

mutuality of involvement

is

critical in

any context

to

which

PC

theory

applied

is

(van der Veen, 1998). Rogers spoke of freedom as an important element of the counseling relationship.

He believed

that the client (and the counselor as well) should be free to explore

complete

every aspect of the self within the therapeutic environment. “There

is

dom

such evaluations are

from any type of moral or diagnostic evaluation, since

all

also a

free1

believe, always threatening” (Rogers, 1961, p. 34).

therapy

Person-centered

characterized

is

as

and

humanistic

phenomenological

(Ruthven, 1992). Proponents of humanistic approaches trust the individual, viewing people as oriented logical in that is

toward growth and harmony with others. Rogers’ approach

is

phenomeno-

he argued that the most important factor in understanding a given individual

his (the individual’s) perceptions

Daryl approaches Richard

of reality, because for the person, perception

an equal and encourages him

as

He relies on

content of the counseling relationship.

is

reality.

determine the nature

to

and

Richard to provide the basic material of

what he wants to discuss. Although this attitude seems somewhat surprising to Richard and tends to make him a little uncomfortable, Daryl persists in his gentle support ofRichard’s choices and decisions within the counseling session. In no way does Daryl assess, diagnose, or evaluate Richard; he simply does his best to understand counseling, asking Richard

Richard’s world.

HUMAN MOTIVATION Person-centered theorists believe that the only motivation of

dency

to

grow

human

(a

are detrimental to

it.

PC

theorists see

no inherent

destructive tendencies in people, although aggression or assertion

enhances

the ten-

to grow,

such

his existence.

sive act directed

max-

term used by Rogers to mean the whole person or other living entity)

and avoid experiences that

means

is

to full potential in constructive, positive ways. Living beings strive to

imize the organism

as a

behavior

as

when an

aggressive or

may sometimes

be used

individual asserts himself to obtain something that

For example, killing animals for food would be seen

as

an aggres-

toward the actualization of the organism.

Daryl knows that Richard

is

motivated

to

with his environment, which includes Richard’s behavior

may

not seem

grow and enhance himselfand live in harmony other people. At the beginning of counseling,

to consistently

—

stem from

this

—he

tendency

seems some-

what stuck at present but Daryl knows that it is there and only needs to be releasedfrom interference. Daryl will constantly look for and respect Richard’s growth tendencies throughout the counseling interaction.

CENTRAL CONSTRUCTS Experience Rogers used the term experience in two ways. Experience is

going on

in the individual at a given

experience are emotions because

moment

we tend

as a

noun

(Rogers, 1959).

refers to

everything that

Of particular importance in

to suppress, deny, or distort these in the service of

PERSON-CENTERED THERAPY

157

Although Rogers recognized that unconscious processes might

social rules.

exist,

they are not

considered in the definition of experience because they cannot be studied objectively (Rogers, 1959); thus, experience

The is

is

confined to events that are potentially available to consciousness.

use of the term experience as a verb

means the process of the person

receiving

what

going on around and within him, the “sensory or physiological events which are happen-

moment” (Rogers, 1959, p. 197). This term is special to PC theory because in order to grow, humans must experience accurately, discriminating between events that contribute to the organisms well-being and those that are harmful. The degree to which ing at the

experience ual’s

is

perceived without distortion or disruption determines the level of the individ-

functioning.

aware that the accurate perception and symbolization of experience is critical to Richard’s psychological well-being. Richard is clearly attending to what is going on in the environment around him as well as his psychological experience (he can report feelings of Daryl

is

depression).

However, Richard’s desire

to

come

depressed suggest that Richard’s experiencing

is

to

counseling

and his

admission that he

is

derailed in some way.

Actualizing Tendency The most

basic

human

process

of the organism to develop

is

the actualizing tendency,

all its

capacities in

which

is

ways which serve

the “inherent tendency

to

maintain or enhance

the organism” (Rogers, 1959, p. 196). This process involves both the person’s biological

and psychological growth. Growth to internal regulation

is

always in the direction of

of the individual’s existence. Growth

is

autonomy and

also

thus leads

toward greater

levels

of

complexity (Rogers, 1980).

Daryl looks for signs ofthe actualizing tendency in Richard. Even though Richard’s uncomfortable presence and evident depression seems less than growthful, when Richard talks about live

a

his struggles,

Daryl can

sense the presence

ofa tendency

to

grow

in Richard’s desire to

better, less isolated life.

Organismic Vaeuing Process Rogers thought that humans engaged in an ongoing process of evaluating experience,

measuring it.

it

event by event to determine

if

it

Humans move toward growth-producing

contributes to one’s growth or detracts from

experiences and

away from those

that

do not

contribute to or interfere with growth. In the healthy person, the basis for this constant evaluation of experience

is

the actualizing tendency.

To

take a simple example,

touches a hot stove, she snatches her hand away because

it

when

a child

does not promote the growth

of her organism to get burned!

Ideally,

Daryl would look for

signs

of the operation of the organismic valuing process

in

Richard’s behavior. Signs of this process are observable at times, bitt other times Richard’s

behavior might seem to fully

to

be motivated by other considerations. For example, Richard seems

enjoy his leisure pursuits (reading

and working on

his computer),

but he avoids his

PERSON-CENTERED THERAPY

158

family and other social relationships. Because healthy interpersonal relationships are growth enhancing, Daryl hypothesizes that in those situations, Richard

is

not acting in accordance

with his organismic valuing process. Daryl knows that fluctuations of this type are natural, and perhaps even more pronounced in individuals coming to counseling because the need for counseling suggests that some processes are awry.

Self As humans grow and experience the world, as the self All

a portion of this experience

experiences that the person recognizes as “me” and the values that are at-

tached to them become the self concept

good

at

becomes labeled

doing the tango,

this

1959). For instance,

if I

discover that

am

I

experience becomes a part of my self-concept. If I value tango

dancing, then this experience contributes to a positive self-concept.

Rogers thought that tively valued,

if

experiences were inconsistent with our self-concepts, or nega-

we would have

difficulty allowing ourselves to perceive

them. For example,

me to get up in the morning, then my self-concept could include the am not a morning person. If there are negative values associated with not

if it is difficult for

construct that

I

being a morning person, degree to which

up

I

this

allow myself to acknowledge

5:00 a.m., but none of

at

PC

tant in

theory

experience will contribute to a negative self-concept to the

is

my friends

would

it.

I

could, in fact, insist that

believe me!

the ideal self the self the person

would

A third

I

always get

self-construct impor-

like to be.

My ideal

self

contain the characteristics “tango dancer” and “morning person,” only one of which sistent

with

my actual

con-

experience.

Richard probably has a negative self concept. ative” aspects of himself

—he

is

He is able to

recognize and reveal several “neg-

withdrawn and ineflective at work. Because he un-

socially

favorably compares himself with his children, Richard feels inadequate. Very

and Daryl also guesses unobtainable by a human being.

Richard's self-description seems positive, close to perfection as to

is

may

be

little

in

that Richard's ideal selfis so

Self-Actualizing Tendency An

aspect of the general actualization tendency, the self-actualizing tendency, refers to the

propensity of the self to grow and maximize. actualizing

ganism

is

for the

self.

and

self- actualizing

also perceived as

When

the individual

tendencies function in concert.

good

for the

Eiugging another person

self;

is

what

good

for

is

bad

me

for the

is

functioning well, the

What

is

good

organism

is

for the or-

therefore

both physically and in terms of

bad self

needs.

Need for Positive Regard and Self-Regard All

human

beings have a need for positive regard, and this need extends to the self-system.

We value the love of others and also have a need to positively value ourselves. clear

whether the need

for regard

is

innate or learned, but he

the need for positive regard of the self

is

portant to the individual (Rogers, 1959).

is

Rogers

is

not

quite specific in saying that

learned through experiencing

it

from others im-

PERSON-CENTERED THERAPY Richard's needfor positive regard

He

is

is

159 evident in his reactions to his wife Sandy's disapproval.

falling short in the area ofpositive self regard, as seen in his feelings of inadequacy

when he compares

his

achievements

to those

of his

children.

Conditions of Worth The need

for positive regard motivates individuals to seek love

around them (Rogers, 1959). (whether

it is

When

from important others

some aspect of himself evaluated positively by someone important

the individual perceives that

perception, feeling, or behavior)

is

him and other aspects are not, conditions of worth arise. The need for love is so intense that we will deny parts of our experience that are deemed unacceptable (unlovable) by significant others. A classic example of this dynamic is when Suzy becomes frustrated and angry. From a PC perspective, anger is a natural part of human existence. It does not detract to

from the growth of the organism. Suzy’s anger, she will tend to

begin to

feel

deny or

her parents consistently display negative reactions to distort the experience

of anger in the future. She

will

when she begins to get angry, and in an attempt to align her may even start to view herself as someone who never gets angry.

anxious or “bad”

perceived and ideal selves, In contrast.

If

If Suzy’s

parents accept her anger nonjudgmentally, she will have

no need

to dis-

disown the experience. She can experience the anger and then go about her business.

tort or

Initially,

conditions of worth are external; that

is,

they are the reactions of others (such as

who value behaviors differentially, often based on societal norms (e.g., boys don’t cry, don’t shout). What happens quite often, however, is that individuals are reinforced for

parents) girls

behaviors that are consistent with conditions of worth, and after a while the conditions are

When

internalized as parts of the self (Rogers, 1959).

vidual

is

is

transformation happens, the Indi-

not evaluating experience through the organismic valuing process; rather, he values

experiences based F^e

this

on whether they

said to be operating

on an

are consistent with the internalized conditions

of worth.

externalXocxxs of evaluation (because his values are not self-

generated) rather than an internal locus of evaluation (the organismic valuing process).

Because conditions of worth are based on societal

rules,

they are not always consistent with

the actualizing tendency. In fact, they are often at odds with the actualizing tendency.

Daryl knows that Richard's self is conditional. His guilt and depression are

likely the result

of aspects of his experience that are inconsistent with his internalized conditions of worth. For example, Richard apparently holds the value that to he worthwhile, he should earn a certain ily.

He

That self.

amount of money; is

specifically,

that he should he the primary provider for his fam-

not fulfilling the condition that

his children

Daryl also

men

make more money than he

are strong a?id provide for their families.

does only confirms his negative perceptions of

guesses that Richard's decision to change occupations

his conditional self,

'‘weak" emotions.

He

which is just

dictates that

men

don't huckle

under

was inconsistent with

stress

and do

not show

not good enough.

THEORY OF THE PERSON AND DEVELOPMENT OF THE INDIVIDUAL Life

is

an active process (Rogers, 1980,

p.

1

18). “In short,

organisms are always seeking,

always initiating, always ‘up to something’” (Rogers, 1980,

p.

123, quotes in original).

PERSON-CENTERED THERAPY

160 Even

worst conditions,

in the

all

organisms

grow

strive to

in positive directions.

So begins

the journey of the infant.

The

infant,

motivated by the actualizing tendency, evaluates experience based on the

organismic valuing process. “Experiences which are perceived the organism are valued positively.

enhancement

or

Those which

as

maintaining or enhancing

are perceived as negating such

are valued negatively” (Rogers,

1959,

p.

maintenance

222). Babies naturally

move

toward the positive and away from the negative.

As the child grows, part of the experience becomes defined tion of self is an offshoot of the actualizing tendency

involves developing a sense of

tial

defined self-concept.

With

who one

is.

—

that

is,

The differentiafull human poten-

as the self

reaching

Further experience leads to establishing a

the development of the

self,

the need for positive regard from

others emerges along with the need for positive self-regard.

Gradually, the child becomes aware that certain self-experiences are valued positively or negatively by others around him. Parents, teachers,

have reactions to the

child’s life girl.”

ized,

are consistent

example, (i.e.,

Mary might

so compelling, these evaluations are internal-

is

are established.

with the conditional

self

figures in the

behaviors that are essentially “good boy” or “bad

child’s

Because the need for positive regard

and conditions of worth

and other important

The

child begins to seek self-experiences that

and avoid or deny those

that are inconsistent. For

experience of playing in squishy

initially find the

consistent with the organismic valuing tendency). However, Mary’s

mud

pleasurable

mom berates her

messing up her beautiful white dress and shoes. The pleasurable experience of

for

playing then becomes a negative one because

mother. Eventually,

Mary

experienced negative regard from her

internalizes this condition

might develop

dirty; in fact, she

Mary

a

mud-

of worth and can never again be

compulsive tendency to wash her hands.

In the perfect world, individuals could develop in an atmosphere of unconditional positive regard.

Rogers was careful to say that unconditional positive regard does not

positively valuing

value equally

all

all

of

of a

child’s behaviors.

his behaviors”

(1959,

“A parent

p.

‘prizes’ his child,

mean

though he may not

208). Given an accepting environment, chil-

dren could develop unfettered by conditions of worth, and the needs for positive regard

and

positive self-regard

Richard is

would not be

odds with the.organismic valuing process.

clearly conditional in his self-regard.

Richard’s early experiences, but life

at

Daryl does not have much information about

Daryl speeulates that people important

to

Richard early in

his

were conditional in their evaluation ofhim. For example, Richard’s current discomfort with

his occupational situation (the

and ineome) probably results fom his early an important definition of who he is as a man. The

change in jobs

of the value that work is change ofjobs, whieh eould be pereeived as taking care ofhimself, is probably viewed as ineonsistent with traditional values of 'never give up” and "tough it out. ” Daryl guesses that Richard internalization

might have been raised in an environment in whieh feelings were ojflimits, and therefore he hesitant

and uneomfortable

diselosing

them

to those elose to

is

him, including Daryl.

HEALTH AND DYSFUNCTION The “good

life,”

healthy person

is

according to Rogers, a congruent ^eiXS>ow\

is

a process,

not a destination (Rogers, 1961).

put simply, his perception of self

is

The

consistent with

PERSON-CENTERED THERAPY what he experiences. He

is

open

organismic valuing process).

by

161

and has an

to experience

The

internal locus of evaluation (the

individual trusts himself to follow the right paths, guided

organismic valuing process (Rogers, 1961). Because the individual has no internal-

his

ized conditions of worth, experiences can be accepted freely into awareness

on the

basis

The

of the needs of the organism.

unconditional self-regard. All experience

and evaluated

individual has a positive self-concept and

perceived accurately, without distortion; the

is

person naturally orients toward experiences that actualize and away from those that do not contribute to the maximization of potential.

Healthy individuals are creative and take

and he would almost

justed’ to his culture,

and

any culture he would

in

risks in life.

“He would not

live constructively, in as

with

much harmony with p.

at

any time

his culture as a

An

194; quotes in original).

the authentic expression of the

self,

defined as incongruence between self and experience.

The

is

of the feelings that accompany being human.

all

In

of one’s experience

all

But

certainly not be a conformist.

balanced satisfaction of needs demanded” (Rogers, 1961,

important part of accepting

necessarily be ad-

PC

theory, dysfunction

individual’s self

tions of worth.

individual

is

is

is

conditional;

The

some experiences

actualizing

and

are inconsistent

with internalized condi-

self-actualizing tendencies are in conflict because the

busily trying to evaluate self-relevant experiences according to conditions of

worth rather than

via the organismic valuing process.

The

conditional self and the organ-

ismic experience are inconsistent, and therefore the actualizing and self-actualizing tendencies are

divorced from each other.

When

a person encounters experiences that are inconsistent

the experiences are generally “subceived”

—

that

with the conditional

only dimly perceived.

is,

A clear

self,

recogni-

tion of the incongruent thought, emotion, or perception could cause a change in the self-

who

concept, and people as these are

are conditional

do not welcome such changes. Experiences such

threatening to the self because they endanger the person’s ability to obtain pos-

regard from others (and to positively regard the

itive

results in anxiety.

As

a result, the individual

or distorting the experience. Defensiveness

consistent;

sometimes

his

behavior

The deemed

becomes

is

is

ing against experiences

unacceptable.

locus

of evaluation

is

is

and

rigid, either

denying

incongruent person’s behavior self and

vulnerable because he

individual

The

defensive

guided by the conditional

organismic valuing process.

concept.

The incongruent information

the hallmark of the person traditionally de-

my quotes). The

scribed as “neurotic” (Rogers, 1959;

self).

He

external

is

(i.e.,

in-

sometimes by the

constantly defend-

anxious, rigidly protecting the

(paradoxically,

internalized conditions of worth) rather than internal

is

is

because

it

self-

in

resides

the organismic valuing process;

Rogers, 1959). If the

and

if

person

is

very incongruent

(i.e.,

a lot

of experiences are unacceptable to the

self)

incongruent experiences are very powerful or sudden, the individual’s defenses can

become overwhelmed, and the experience is symbolized in awareness (Rogers, 1959). The self-structure is damaged and so the individual becomes disorganized. Similar to the neurotic,

self

sometimes

(i.e.,

his

behavior

is

guided by the conditional

the organismic valuing process)

much more

severe.

The

result looks

rallies

much

like

and

self,

and

at

directs behavior,

what we

other times the “real”

but these swings are

typically describe as psychosis.

Rogers (1959) gives the example of the acute psychotic exhibiting sexual behavior that typically

deemed inappropriate

in social situations.

Such

a

person

is

simply following

is

his

PERSON-CENTERED THERAPY

162 actualizing tendency

him

to

deny

(i.e.,

his sexuality.

sex

good

is

When

the self

shattered by too

is

much

haviors are expressed because the need for sexual experience

(Rogers,

1

as neurotic

traditional diagnostic procedures

symbolized

Rogers did not have

psychotic,

and systems. Referring

in

awareness

fundamental

classification

ering treatment.

It

use for

seems to be a more

said, “this

than those usually employed, and perhaps more

also avoids

much

to the previously discussed catego-

of individuals into defensive versus disorganized, Rogers

which we

is

incongruence, these be-

959).

Despite his use of terms such

rization

of worth have led

for the organism), but conditions

any concept of neurosis and psychosis

fruitful in consid-

as entities in themselves,

and misleading conception” (1959, p. 228). the roots of all dysfunction are found in incongru-

believe has been an unfortunate

Translating a

bit,

then, in

PC

ence. Depression, for example, that resulted

theory,

would be seen

as

probably involving negative self-concept

from an excess of conditions of worth. Experiences inconsistent with the con-

would be subceived, and the extent of the depression would depend on the type and nature of the experiences perceived. Anxiety would be seen as resulting from the subception

ditions

of incongruence and the need to defend the conditional self

Richard is incongruent.

of anxiety

He

behaves in his session with Daryl uncomfortably, showing signs

in his nervous laugh.

He seems

unwilling

to reveal

himself possibly because his

internalized conditions of worth disallow the authentic expression offeelings. talk

about his

anxiety, or the feelings

behind it, because they are contrary

He dares

to his

not

conditional

view of himself, which probably involves being strong. He is fearful ofshowing Daryl who he really is because he fears conditional reactions from others and as yet has no reason to believe that

Daryl

is

He

difrerent.

reports being depressed,

and Daryl sees

sulting from Richard's inability to realize his conditional

this sadness as re-

self.

NATURE OF THERAPY Assessment Person-centered counselors do not use any form of assessment. tidiagnosis. Rogers

thought that assessing and diagnosing

clients

Many

are

adamantly an-

turned them into objects

and distanced the counselor from the therapeutic interaction.

After welcoming Richard to counseling, Daryl asks

how he can

help.

Daryl does not con-

duct an ‘"interview" or direct the flow of Richard's conversation in any way.

Overview oe the Therapeutic Atmosphere Rogers saw therapy

as

an encounter between two Individuals.

Idea that the counselor was an expert

and argued that the

phy, was critical to the success of the relationship. In his

He vehemently

rejected the

therapist’s attitude, or philoso-

book On Personal Power

Rogers presented the following analysis of the counseling process:

Most procedures control. At

in

psychotherapy

one end of the

may be

scale stand

placed on a scale having to do with power and

orthodox Freudians and orthodox behaviorists.

PERSON-CENTERED THERAPY believing in a politics either to

163

authoritarian or

of-

elitist

control of persons “For their

own

good,”

produce better adjustment to the status quo or happiness or contentment or

productivity or

of these. In the middle are

all

most of the contemporary schools of

psychotherapy, confused, ambiguous, or paternalistic in the politics of their relationships

may

(though they of the scale

be very clear regarding their therapeutic strategies). At the other end

the client-centered, experiential, person-centered approach, consistently

is

stressing the capacity will-

move

and autonomy of the person, her and her ultimate

in her behavior,

right to choose the directions she

responsibility for herself in the therapeutic

relationship, with the therapist’s person playing a real but primarily catalytic part in

that relationship, (pp. 20—21. Reprinted

by permission of Sterling Lord

Literistic, Inc.

Copyright by Carl R. Rogers.)

Roles of Client and Counselor PC

In

counseling, the counselor and client are equals, with the therapist serving as a

companion Rogers the

in the client’s search for

said, “As a therapist,

pathway

I

do not want

to the sources of her pain.

a step behind, occasionally a step

taking a leap ahead only

The

He

—

role

rience as

.

What I wish

ahead when

theory as

Is

I

is

I,

to be at her side, occasionally falling

we

can see more clearly the path

intuition” (Rogers, 1986a, pp.

are on,

and

207—209).

to provide the climate that will release the client’s

an expert or guide

in

any way.

Two

tasks

of the thera-

as

is

own experience in the therapeutic relationship. to be who he is. He is expected to be in contact with

to his

of the client

much

.

knows, better than

that of struggling to understand the experience of the client, while at the

same time being open

The

PC

does not function

pist are critical

.

to lead the client, since she

when guided by my

counselor’s job In

potential.

himself (Rogers, 1986a). Describing his experience,

is

possible

degree to which the client

is

and

is

the guide in the therapeutic journey.

able to experience

of incongruence present. Clients

who

are in

verbalizing their experiences than those

and express

is

are

Initially,

the

directly related to the level

extreme incongruence

who

his expe-

will

be

less

comfortable

more congruent.

Daryl approaches Richard as a partner in an interpersonal encounter. In no way does Daryl take a teaching, evaluating stance or offer any advice to Richard. Instead, Daryl attempts to

engage with Richard in a personal, authentic way

much

as possible.

and to understand Richard’s

experience as

Richard is expected to reveal himself to the extent he feels comfortable.

Goals The

goal of

PC

therapy

is

to facilitate the client’s journey

toward

full potential. If

conditions are achieved, the client experiences the counselor’s acceptance and accept his experience tendency.

more

fully

A narrower version

and thereby become more

in

is,

touch with

the right

in turn, able to his actualizing

PC counseling Is for the client to move from being Successful PC counseling should result in diminishing or

of the goal of

Incongruent to being congruent.

eliminating conditions of worth, and thus, incongruence between

self

and experience.

Daryl hopes that Richard can become aware of the experiences that are incongruent with conditional

self

and accept

these experiences as valuable aspects

of himself.

his

If counseling

is

PERSON-CENTERED THERAPY

164 Richard will embrace

successful,

and

subceives

all aspects

ofhimself, freely

ofhimself that he

living aspects

denies or distorts, such has his failure’' to live up to the ideal

of the

strong,

supportive male. Getting in touch with his natural organismic valuing process will allow

Richard

evaluate his experiences as negative or positive based on whether they contribute

to

For example, taking care of himself by changing jobs to reduce stress would be something Richard would value, rather than feel bad about. Once Richard is able

to his actualization.

to experience to

and express

his feelings to others authentically (because

he

is

not rejecting them

achieve positive self-regard in concert with his internalized conditions of worth), he

will be able to relate in

more unconditional and open ways with

others,

including his wife

and kids.

PROCESS OF THERAPY Dryden and Mytton (1999) ory.

The

earliest stage

the 1940s

a cathartic model, the client expresses

of

The

PC

attitude of the therapist

theory

(late

ing advice) were as

client.

1950s and early 1960s). During (e.g.,

becoming the approach.

this stage,

in the

development

Rogers decided that the

repeating the client’s words, avoiding giv-

Dissatisfied with this interpretation of his ap-

mechanical and passive, Rogers began to focus on the attitude of the counselor

in relation to the client, particularly the belief that the client.

emotion, and

releases

was the emphasis of the second stage

“techniques” of the nondirective approach

proach

and

(in

counselor, through his reflection of the client’s feel-

conveys understanding and acceptance of the

The

the-

prohibited from offering any advice or interpretation. Insight was to be

is

achieved by the client on his own. ings,

PC

emphasized the nondirective nature of the counseling interaction

and 1950s). In

the therapist

identified three historical stages in the evolution of

The

impetus for change was within the

counselor only needed to accurately understand and support the client in his

journey inward.

Dryden and Mytton maintained that the spark for the third transformation of PC theory (in the mid- to late 1960s) came out of Rogers’ experience as a therapist. They explained that Rogers was working with a very disturbed client that he did not like; he felt “trapped by her dependence upon him” (1999, p. 64). Eventually, Rogers realized that he felt so immersed in the relationship that he could not separate himself from the client. The crisis was so severe that he referred the client and found a temporary geographic cure. After

literally fleeing

with his wife for a period of time, Rogers then en-

tered therapy with a colleague. This incident led to his recognition that

be honest in the therapy relationship. client, the relationship

PC

He

believed that

if

it

was

critical to

he had been honest with his

might not have become so destructive. Rogers’

later versions

of

theory therefore placed great emphasis on the congruence, or genuineness, of the

therapist.

For Rogers,

all

that

was needed

for the therapist to provide the

to release the innate

growth tendencies of the

optimum atmosphere and

client

for the client to perceive

it.

was

The

counselor creates this environment by holding the right attitudes toward the client and the counseling venture. Simply put, the counselor works to create the the client’s growth by providing for change:

what Rogers

called the necessary

facilitative

and

climate for

sufficient conditions

congruence, unconditional positive regard, and empathic understanding

(also

PERSON-CENTERED THERAPY

165

sometimes termed the “core conditions”; Rogers, 1957). Because these concepts they will be discussed separately.

vital to the theory,

Before discussing the conditions of therapy, however, cursor to counseling

When

are so

is

and the counselor must be

that the client

two individuals “make

necessary to note that the pre-

it is

a difference” (Rogers,

1959,

p.

in psychological contact.

207) in the experiential

field

of each other, they are in contact.

Congruence Also called genuineness, transparence, or realness (Rogers, 1980), congruence

moment. “The

the counselors freely flowing awareness of his experience in the therapeutic

more the

therapist

is

himself or herself in the relationship, putting up no professional front

or personal facade, the greater

manner

constructive

is

the likelihood that the client will change and

is

grow

in a

the therapist aware of his

own

apparent in both verbal and nonverbal expression;

feel-

Not only

(Rogers, 1980, p. 115).

experience, but this awareness

and reactions can be communicated

ings

refers to

is

to the client if this

seems helpful. As

his theory

developed, Rogers became convinced that congruence was key to good therapy, writing,

more than

“for

a

decade

1

have been trying to

the expression of such genuineness,

state that genuineness, or

congruence, and

probably the most important part of the therapeutic

is

relationship” (Rogers et ak, 1967, p. 511).

Rogers attempted to clarify what he meant by congruence, writing.

might be well

It

to state

some

of the things that

it

does not imply.

the therapist burdens his client with the overt expression of

mean

that he blurts out impulsively anything

which comes

the therapist discloses his total self to the client.

deny to himself the feelings that he

is

It

all

to

a

It

p.

101;

to

adopt

mean

feelings. It

does not

that

does not

mean

that

experiencing, and that he

is

let

willing transparently to these be

known

to present a facade or hide

to the

behind

a confessional-professional relationship. (Rogers 1967,

italics in original)

Although Rogers thought persistent negative feelings

it

would be

about the

best

client, if

To hide negative

feelings

would be

to put

up

if

the therapist did not experience any

they happen, these too should be expressed

because negative feelings would be more harmful

by the

It

does not

does mean, however, that he does not

means avoiding the temptation

mask of professionalism

of his

mind.

be any persistent feelings which exist in the relationship and to client if appropriate.

It

if they

were hidden (Rogers,

a false front,

1

966,

p.

1

85).

which would surely be picked up

client.

Rogers did recognize that

it

is

impossible to be congruent every minute of one’s

(Rogers, 1959, 1980).

He

no therapy” (1959,

215) because no one can be completely aware of his experience

of the time.

the

What

moment

p.

is

said,

critical

is

“indeed

if this

of interaction with the

to

a necessary condition there

client: “thus

it is

human

that imperfect

human

beings” (Rogers, 1959,

be fully himself in his sessions with Richard.

communicating, both verbally and nonverbally, but

is

also

would be

and aware of his experience

that the therapist be present

of therapeutic assistance to other imperfect

Daryl strives

were

life

He attends

to

all

in

beings can be p.

215).

what Richard is

aware of his own experience

in

PERSON-CENTERED THERAPY

166

At times Daryl reveals to Richard what he is feeling as, for example, when he tells Richard that he feels distant from him.

the relationship with Richard. interaction,

in the

Unconditional Positive Regard The counselor approaches

and caring (Rogers, 1980).

the client with complete acceptance

Rogers spoke often of “prizing” to describe perience these feelings because

we

fear

and added that

this attitude,

being trapped by them.

ing in others because they could disappoint us, or they

It is

it

was

risky to ex-

scary to invest such feel-

may become demanding.

In fact,

Rogers thought that these fears were primarily responsible for our adoption of the “professional attitude”

toward

clients,

which

protects against hurt (Rogers, 1961, p. 52). learn,

even in certain relationships or

to care, that

He said,

“It

is

client

person for

and

achievement when we can

a real

times in those relationships, that

at certain

safe to relate to the other as a

it is

between counselor and

creates distance

whom we have positive

it is

safe

feelings”

(Rogers, 1961, p. 52). Rogers did note one exception to the rule of unconditional positive regard. In

may

gard

working with the “extremely immature or regressed individual, be more effective in getting a relationship under

way

.

.

.

a conditional re-

than an unconditional

positive regard” (Rogers, 1966, p. 186).

In order to be effective, Daryl must accept Richard without any conditions or evaluations.

He finds

himself prizing Richard as another

human

being,

and communicates

this to

Richard in a genuine, caring way.

Empathy \

Empathy if

is

achieved

when one

individual perceives the internal experience of another as

he were that person, “without ever losing the

In his later

as iP

works Rogers conceived of empathy

condition” (Rogers, 1959,

as a process, rather

than a

p.

210).

saying

state,

meant “temporarily living in the others life, moving about in it delicately without making judgements” (Rogers, 1980, p. 142). If the counselor achieves truly accurate emthat

it

pathy, he can even perceive

meanings and

feelings

with which the client

is

not totally In

touch.

The counselor must communicate empathic understanding to the client. However, Rogers warned against trying to make the client aware of totally unconscious feelings because that would be too threatening (Rogers, 1980, to dip

from the pool of implicit meanings

1966,

p. 190).

just at the

p. 142). Instead,

edge of the

client’s

the counselor “aims

awareness” (Rogers,

Unfortunately, according to Rogers (1980), the early concept of accurate empathy

grew into

on the counselor’s responses. “Reflecting the

a rigid focus

came synonymous with

the

PC

client’s feelings”

approach. Teaching reflection of feelings

as a skill

be-

became

popular, and Rogers thought that this approach often led to robot responses (Rogers,

1986b).

When

I

was

graduate school,

in

“I

hear you saying

...” was

a

kind of joke

phrase. Rogers said, “I was so shocked by these complete distortions of our approach that for a

was

number of years,

to stress

I

said almost

nothing about empathic listening, and when

an empathic attitude, with

mented” (Rogers, 1980,

p.

little

comment

as to

how

this

139). Instead, Rogers emphasized that

I

did

it

might be imple-

when he appeared

PERSON-CENTERED THERAPY

167

what he was

to be “reflecting feelings”

doing was trying to check whether

really

“understanding of the clients inner world [was] correct” (Rogers, 1986b,

and Tudor (2006) further

clarify that the

PC

376).

Merry

counselor would never focus on feelings

of other aspects of the clients experience, such

to the exclusion

p.

his

as thoughts, physical

sensation, or fantasy.

Daryl' strives

to fully

Richard's shoes” as

At

Richard.

understand what

much

be Richard.

it is like to

He

attempts

to

“walk in

as possible without losing the boundaries between himself and

times Daryl finds himself wanting to mention to Richard something he

—feelings that Richard has denied or distorted.

quite sure Richard has recognized

is

not

For in-

of inadequacy around his role as husband and provider. Richard becomes anxious if these feelings and their meaning start to surface. In Daryl

stance,

senses Richard's feelings

the supportive atmosphere

oftheir

experiencing these feelings.

He does not,

ings or in

any way

Daryl tries

relationship,

to help

Richard to move toward

however, push Richard into experiencing these feel-

Richard acknowledge them ifRichard

insist that

not ready.

is

A Fourth Condition? In his last writings, Rogers began to discuss a fourth characteristic of helping relationships

Acknowledging

(Rogers, 1986a).

tained that

when he was

that he

had no

at his best as a therapist,

tered state of consciousness

.

.

full

.

of healing”

( 1

scientific basis for his idea,

he believed that he entered a “slightly

986a,

p.

1

moments it seems

that

of the other” (Rogers, 1986a,

p.

al-

98) This transcendent state leads .

to behaviors that are impulsive, but they almost magically

“At those

Rogers main-

fit

with the

client’s

experience.

my inner spirit has reached out and touched the inner spirit 199). Despite Rogers’ discussion of this transcendent state,

subsequent treatments of his theory have paid

attention to this fourth condition.

little

Stages of the Therapeutic Process Rogers saw the counseling process

as a

gradual progression from incongruence to congru-

ence and observed stages through which clients passed on note

is

this journey.

An

interesting side

that Rogers developed this “process conception” (1958, p. 142) at a time

was preparing

his address to

be given

guished scientific contributions.

wanted

to take a

new look

He

when he was awarded

the

APA

award

when he

for distin-

did not want to discuss his previous work; instead, he

at personality

change, and what emerged was a view of the

change process from an observer’s perspective (Rogers, 1961). Spending numerous hours reviewing audiotapes of counseling sessions, Rogers said that he was “trying to listen as naively as possible. process, as to

I

have endeavored to soak up

what elements

all

the clues

I

could capture

are significant in change” (1958, p. 142).

Through

Rogers identified seven stages of the change process (Rogers, 1958). As the following sections,

I

quote

liberally

from Rogers’ (1958) writing

in

I

as to the

this study,

describe these in

an attempt to con-

vey the rich and vivid description for which he was known.

Stage

1.

The

voluntarily.

problems

individual in this stage

Change

exist.

is

is

not likely to show up in the counselor’s office

not on the agenda because he typically does not see that any

“Feelings and personal meanings are neither recognized nor

owned”

PERSON-CENTERED THERAPY

168

(p.

and the person

143),

externals, not himself

Stage 2.

“When

is

afraid of intimate relationships.

and has

made, but once

He

a rigid self-structure.

a person in the first stage can experience himself as fully received then the

second stage follows” (1958,

encing.

moves

the individual

it is,

was not certain about how

144). Rogers

p.

a little further along the

contact

this

continuum

is

of experi-

begins to talk about subjects that are not related to the self but he displays no

sense of responsibility for problems

when

to counseling

Stage 3.

This person tends to talk about

Many

— they

are external to

him. Although people do come

they are in this stage, Rogers considered

clients

who come

to counseling

on

person continues on the path established in stage experiencing and expression. In stage

their

2,

them very tough customers.

own power

are in this stage. If the

he takes small steps toward more fluid

but in a largely distant and objectified manner; he does not experience them are perceived, but as

bad

Although the

things.

and

3, the client discusses self-experiences

self

is still

rigid,

it is

fully.

feelings

Feelings

dimly recognized. The

client also recognizes contradictions in experience.

more intense feelings, but they are still largely from past experience. The client begins to become aware of incongruence between the self and experience and begins to take some responsibility for his difficulties. Sometimes feelings even sneak into the present, but this experience is scary, and the perStage

In this stage the individual begins to express

4.

son has difficulty accepting them.

Stage 5. If the proper climate of acceptance tion

still

further loosenings,

established, the fourth stage then “sets in

is

and the freedom of organismic flow

Stage 5 clients experience feelings and express

experiencing

is

not completely without

fear,

them

and the

feelings that

The

ings” (Rogers, 1958, p. 145)

and an accompanying urge

The

The

6.

to be authentic in accepting the

an internal frame of reference (the organismic valuing

Rogers described stage 6

(p.

146).

longer an object,

awareness”

(p.

The it

hundred psychological

stage described” (p. 145).

first

client experiences “with

“stuck”

them. This

sneak through are some-

process) for experience. Rogers characterized this stage as “several

Stage

144).

(p.

person more frequently expresses “ownership of self feel-

client begins to sense

miles from the

increased”

freely as they experience

times surprising to the client.

feelings.

is

mo-

feeling

“A this

146;

as a “very distinctive

immediacy and is

This

italics in original).

matically symbolized in awareness, and

is

a

by the

client. In this

moment,

being in the moment, with

Incongruence between is

(p.

146).

richness” a feeling that has been previously

fully accepted

feeling.

and often dramatic phase”

self

little

the self

is

no

self-conscious

and experience

is

dra-

thereby transformed to congruence. In essence,

the client becomes the aspect of the self that was denied because of conditions of worth. Ac-

cording to Rogers, once the client experiences

Stage

7.

The

relationship.

last stage identified

“There

is

a

by Rogers

is

this process,

it is

irreversible.

seen both within and outside of the counseling

growing and continuing sense of acceptant ownership of

ing feelings, a basic trust in his

own

process”

(p.

148).

The

client,

.

.

.

chang-

having learned to trust

PERSON-CENTERED THERAPY

169

himself, consistently uses the organismic valuing process as the basis for living. T^he self

becomes the process of experiencing ing of effective choice of

new ways of being”

and constructs loosely

values

rather than a perceived object. “There

held, generated

the experienc-

is

149). Conditions of worth are replaced

(p.

from within. “The

client has

now

incorporated

the quality of motion, of flow, of changingness into every aspect of his psychological (p.

149). Genuineness

Not

and

free, consistent,

and

communication

clear

by

life”

characterize relationships.

every client will reach the final stage of change (Rogers, 1961). In

fact,

Rogers was

aware that some people do not value fluidity and would disagree with his ideas altogether. Rogers indicated that

If a client started at stage 1,

that this progression

2 and end

would be

a rare event.

More

it

could take years to get to stage 7 and

likely, clients

come

to counseling at stage

4 with both parties in the relationship being justifiably

at stage

outcome.

this

Rogers (1987) recognized two kinds of client resistance to the therapy process. there

is

The second

reason.

First,

the natural reluctance to avoid the painful experience of divulging to ones self and

to the counselor feelings previously denied. After

type of resistance, however,

result of “offering interpretations, p.

with

satisfied

all,

is

these feelings have been denied for a

created by the counselor

and

arises as a

making diagnoses and other judgments” (Rogers, 1987,

186). If the counselor creates a safe relationship through providing the core conditions,

no need

the client will have

Richard appears

to

to protect himself

be in stage 3.

by

resisting.

He experiences depression andfeelings ofinadequacy,

'had”

Uncomfortable with the lack ofstructure and apparently avoiding self relevant topRichard seems hesitant to make real contact with Daryl. IfDaryl is able to remain accept-

feelings. ics,

ing,

genuine,

from

and empathic, Richard

will begin to lose the rigid structure that protects

experiences not allowed into his conditional self.

the present (such as pain or anger)

and will begin

He

him

will begin to experience feelings in

to accept these experiences into himself.

THERAPEUTIC TECHNIQUES There

are

no techniques

view them (things such

in Person-centered therapy! In fact, techniques as

as

As noted

thus, solutions.

flection

of feeling”

as the

more important the Over the

ory has been perceived

of allowing him to find

client, instead earlier,

when

own

his

experience,

the professional world began to focus on “re-

primary technique in

attitude

years, lack

typically

challenging the client, interpretation, and so forth) are seen as

guiding and objectifying the

and

we

PC

counseling, Rogers objected, seeing as

conveyed by the counselor

as the truly critical

element.

of specific technique connected to the nondirectiveness of PC theas a significant

weakness of

this

approach. Recent evolutions of

person-centered theory involve the use of directive, active interventions by the counselor that are intended to increase clients’ levels of experiencing (e.g., Gendlin,

Watson, acteristic pists

& Lietaer, perhaps

—

at least in

European countries

further discuss the role of activity in

They call

996; Greenberg,

1998). Lietaer (1990) described these innovations, saying, “most char-

have shaken off their phobia of directing”

therapists.

1

the

first

PC

—

is

the fact that client-centered thera-

(p. 33).

Josefowitz and

Myran (2003)

counseling and identify two general “types” of

“experientialists”

and include here those

PC

interested in Gendlin’s

(1996) focusing approach and proponents of Process-Experiential Therapy

(Fdliot,

Watson,

PERSON-CENTERED THERAPY

170

Goldman, and Greenberg, 2004). These therapists are likely to allow for greater therapist activity and directiveness, as compared to the “non-directive client-centred group” which,

name

as the

implies, emphasize the need to give the client control of the direction of ther-

&

apy (Joseofwitz

and

Gestalt,

Myran, 2005,

existential

p.

330). Process-Experiential therapy weaves together PC,

approaches

(see

Chapter

7,

Box

7.3 for a brief description of this

approach) and draws techniques from each of these approaches, including interventions

such

as

empty

chair dialogues (Greenberg et ah, 1998).

PC

grates classic

Another group of

theorists inte-

theory with cognitive psychology, emphasizing the role of information

processing in client change (Sachese, 1990; Wexler

emphasized the experience of the 1990, 1996). Again,

all

& Rice,

1974; Zimring, 1990). Gendlin

developing a technique called focusing (Gendlin,

client,

of these techniques are aimed

at intensifying client

experiencing

within counseling sessions with the goal of loosening up “stuck” feelings.

On the other end of the spectrum is Prouty s Pre-therapy. Noting that the first problem of PC counseling is to establish psychological contact, Prouty focused on these processes in individuals

who

389)

are “contact impaired” (Prouty, 1998, p.

—

those

who

are labeled

schizophrenic and mentally challenged. This interesting theory presents a detailed description of the types of reflections that are helpful in establishing contact (e.g., situational,

word-for-word, body). Further, Prouty distinguished

facial,

characteristic of successful pre-therapy: reality, affective,

Another interesting approach that

among

three kinds of contact

and communicative

situates itself within the

PC camp

is

contacts.

Motivational

Interviewing (Ml; Miller, 1983). Developed primarily for use with individuals

Ml combines

substances.

the unconditional acceptance and empathic stance of

abuse

PC with

a

of Socratic questioning designed to help individuals become motivated to change

sort

(Hettema,

&

Steele,

Focused Therapy

Miller, 2005).

(see

Chapter

MI counselor “seeks to evoke sons, p.

who

and need

for

change

92; quotes in original).

change and

Daryl

is

Richard. rience

it

.

.‘change talk’

—

a short-term

he will attempt

to

be genuine

two

thoughts and feelings, the

the

2005,

sessions.

try to

provide the right conditions for

and strive

him. Therapist congruence

and in

Solution

approach designed to enhance commitment to

will unconditionally accept Richard this to

little like

reflective listening”(F3ettema et ah,

PC therapist and will simply

and communicate

sounds a

expressions of the client’s desire, ability, rea-

— and responds with

It is

also

14), for in exploring the client’s

usually consists of one to

a traditional

He

.

Oddly enough, MI

moment with

to

understand Richard's expe-

is

also importa?tt to Daryl, so

Richard.

EVALUATION OF THE THEORY PC

theory has been one of the most influential theories in the

chotherapy.

It

can be seen

as

forming the

basis for

field

of counseling and psy-

most approaches

to counseling, because

almost every approach to therapy acknowledges the impact of the therapeutic relationship

on counseling outcome. Beginning counselors

are taught

often drilled in responses that convey active listening and

2004; Ivey

&

Ivey,

good

empathy

listening skills (e.g.,

and

Egan, 2006;

are

Elill,

2007).

Despite his impact on the profession, Rogers has also been criticized for wearing “rose-colored glasses”; his view of people

is

characterized as overly positive and Ignorant

PERSON-CENTERED THERAPY of the “darker side of

human

nature” (Coleman, 1988,

“unconditional positive regard a scientific perspective,

of thoughts, feelings,

know

most

171

is

impossible in any

of Rogers’ theory rests

&

our perceptions or unrealistically positive 1988). These questions relate to a

on

their

relationship” (p. 401).

his observations

of client reports

own

more

Lynn, 1999) and that we are self-serving

in

basic concern about

would

PC

gued that is

set

of criticisms

say that he was

on shaky ground,

methods of

relates to the

PC

PC

inconsistent with

my experience

in other

teaching this approach,

activity level

ory’s necessary

do

is

(1988)

ar-

PC

theory.

ways attempt I

They

and

of the therapist

is

it

become impatient

often feel a need to add tools

to accelerate the process of therapy.

have similarly found that students struggle with

directly tied to

want

to “do something.”

arguments about whether

sufficient conditions are really that: sufficient implies that

PC

all

the-

one has

be empathic, congruent, and provide unconditional positive regard, and the client

will get better.

Tudor and Worrall (2006), recent

PC

writers in the

“Rogers’ therapeutic conditions are neither necessary nor sufficient” ical

Combs

counseling.

the concept of trusting the client’s growth tendencies; instead, they

to

scientifically.

ideology. Fie noted that quite often counselors

drawn from other approaches or

The

on the reports

therapists neglect the important educational role of the counselor because

with the slow pace and nondirectiveness of

In

Brown,

processes (Nye, 1986). Psychoanalytic theorists, of course,

of

second

in

whether people can accu-

no! Because Rogers claimed to base his theory

his clients, these critics

&

our views of ourselves (Taylor

would shout an emphatic

A

From

and behaviors. Some research suggests that we sometimes don’t

the causes of our behavior (Kirsch

rately report

human on

Seager (2003) argues that

p. 23).

data that suggests that

many variables, and most

realm, state flatly that (p. 10).

Citing empir-

especially the resources of the client,

outcome of therapy, Tudor and Worrall conclude helpful and often implicated in therapeutic growth”

influence the

that “the conditions are

intrinsically

(p.

20).

Qualities of the Theory Precision

and

and he and

Testability.

Rogers was a pioneer of research on the psychotherapy process,

his associates generated

disagreements abound over testability

how

to

many

measure

clients

and experts

gruent

self,

(e.g.,

PC

PC

constructs,

& Neufeldt,

of the theory (Beutler, Machado,

early research, congruence, for instance,

of the

studies testing

theory. Despite this legacy,

which bears

1994;

was measured by

IHill

Flowever,

& Corbett,

on the

1993). In

differentials in adjective sorts of

the client description was assumed to be of the distorted, incon-

whereas the observing experts could discern the more

client).

directly

it

could be argued that

this

realistic self-experience

approach does not adequately capture

the internal processes that create incongruence; observation by others, even experts, will

not yield an accurate picture of an individual’s self-experience because

this

can only be ex-

perienced by the individual. Other early efforts to measure empathy, unconditional regard,

and congruence seemed successful because

raters

could generally agree on what they were

1967). However, the reports of

observing (Rogers

et ah,

sometimes found

to be discrepant, as they

were

in the

raters, clients,

and therapist were

Wisconsin Schizophrenia Study

(Rogers et ah, 1967, see Box 5.2).

PC

theory provides clear and simple predictions. For example,

clients receive

empathy and unconditional

positive regard

PC

theory predicts that

from a congruent

if

therapist, they

PERSON-CENTERED THERAPY

172 will

change

in favorable directions.

However, the theory has been

because the predictions derived are too general (Lietaer,

1

990). For instance,

the core conditions are differentially effective depending

might be much more important

criticized as imprecise

on the

it is

possible that

—

they

Few

pre-

stage of counseling

in the early rather than later stages (Lietaer, 1990).

dictions are offered about the other constructs of the theory, except in general ways

(e.g., if

parents are not accepting of children, children will develop conditions of worth).

Empirical efforts

Validity.

PC

theory has received a good deal of research attention. Most of these

have focused on the predictions about therapy rather than those derived from the

personality theory. In general, research has supported

PC

theory, but Rogers’ core condi-

tions are considered necessary but not sufficient.

Research Support Outcome

Research.

Over the

years,

many

outcome

reviews of the

of

effects

PC

have

appeared. In their classic meta-analytic study of psychotherapy approaches. Smith, Glass,

and Miller (1980) found that PC counseling produced average effect sizes, meaning that it fell among a group of therapies that produced client change (including Adlerian therapy, behavior modification, transactional analysis, and psychodynamic therapy), but that did not produce as

much change

as

some kinds of cognitive

therapy.

Bozarth, Zimring, and Tausch (2001) present a traditional research, breaking

into four time periods

it

common

maintain that recent tic

relationship

1)

supports

PC

client in

review of

PC

emphasizes the power of the therapeu-

producing positive outcomes

They conclude

theory’s basic assumptions.

summary

and describing research within each. They

factors research that

and the resources of the

PC

(see

Chapter

that “the clear message of five

decades of research identifies the relationship of the client and therapist in combination

with the resources of the client (extratherapeutic variables)

30%

and

40%

of the variance in successful psychotherapy”

.

(p.

.

.

respectively account for

168).

and Lietaer (1994) meta-analysis of studies of experiential-humanistic psychotherapies demonstrated that clients in PC therapy showed significant change from Greenberg,

Elliott,

pre- to post-therapy,

and that these changes were comparable

to those

found

in other ther-

apeutic approaches. However, this review covered treatments that included elements

beyond those

specified in

PC

counseling

(e.g.,

active interventions such as therapeutic

dialogues and directed experiencing) because very few large-scale studies of “pure”

PC

therapy have been conducted. Similarly, Elliot (2002) conducted a meta-analysis of 99 studies of humanistic therapies

and reported

amounts of change. These gains were found analysis

was of

that overall, clients demonstrated significant to be

a set of studies that included a

maintained for up to

number of approaches

a year. Again, this

that can be called

humanistic, such as person-centered therapy or the emotion-focused hybrid approaches

developed recently

(e.g.,

process-experiential or emotionally focused therapies for couples).

In this regard, the research relevant to In

PC

on Process Experiential Therapy reviewed

&

Chapter 7

is

theory, too.

two major studies that included

1990; Stuhr

in

Meyer, 1991),

PC

PC

treatment groups (Grawe, Caspar,

therapy was found to be

as effective as

&

Ambuhl,

broad spectrum

behavior therapy and psychodynamic therapy. DiLorento (1971) compared the effectiveness

of Person-centered therapy. Rational Emotive therapy, and systematic desensitization for the

— PERSON -CENTERED THERAPY

173

treatment of interpersonal anxiety, and found that

An

no-treatment control.

all

three groups

interesting aspect of this study

improved compared

to a

was that the systematic desensitiza-

showed more general anxiety reduction than the other groups, but when examining

tion

interpersonal activity outside of treatment, the Rational Emotive therapy group fared best,

followed by the systematic desensitization group and then the Person-centered group.

A

recent, large-scale study that included

PC

counseling was conducted by

Stiles,

Barkham, Twigg, Mellor-Clark, and Cooper (2006). They compared the outcomes of over 1,300 clients in the

UK who

received either

and found no differences

therapy,

PC, psychodynamic, or cognitive-behavioral

in the effectiveness

of these three approaches. Note that

study more resembled an effectiveness rather than a controlled clinical

this

Chapter

1)

so

it

could be criticized for

checks of treatment

An

The

manualized

who

case

lack of

random assignment

project (see

and

to treatment

fidelity.

interesting case study

(2004).

its

trial

was presented by Goodman, Morgan, Juringa, and Brown

was part of a

larger study (an

PC and cognitive-behavioral

RCT)

that

compared the

emergency workers

therapies with families of the

died in the 2001 World Trade Center attacks.

Goodman

effectiveness of

described the case of a

et al.

young woman and her mother, who participated in 16 sessions of PC therapy. young woman and her mother reported improvement across time, and objective

15-year-old

Both the

measures collected matic

stress

at posttest,

show

at a posttesting session

demonstrated a decrease

symptoms. However, global functioning,

showed

a decided

little

drop

at

as rated

in posttraumatic trau-

by an independent

change from pretreatment assessment, although

mid-treatment and a return to pretreatment

used in Project Match

(see

72 studies of MI and found

Chapter

1).

effect sizes

Hettema

et al.

ple,

they report that the average effect size right after treatment over a year, the effect size drops to 0.1

Theory-Testing Research. tions of

PC

Much

to

1. It is

first

will briefly

I

white client samples (Hettema

a

Although

few examples of Rogers’ and

intensive study of clients in counseling that exemplified

of experimental design. Twenty-nine

his test

et ah,

and

is

strong.

How-

MI

were

2005).

clients

sufficient conditions.

and

transcripts of

this research

is,

coun-

of course,

his colleagues’ early efforts.

At the University of Chicago Counseling Center, Rogers and

assessed,

which

energy has been devoted to testing the theoretical proposi-

investigator to systematically use recordings

summarize

it is

months. For exam-

interesting that effect sizes for

seling sessions to understand the counseling process.

dated,

to 12

0.77,

is

theory, at least those pertaining to the necessary

Rogers was the

theory as

were generally positive but they varied across samples

and decreased rapidly over follow-up periods of up

compared

PC

(2005) conducted a meta-analysis of

therapists,

stronger in minority as

did

MI was one of the therapeutic approaches

and

ever,

this rating

levels at posttest.

Studies of Motivational Interviewing (MI) can be seen as relevant to practiced in the United States currently. Recall that

clinician

his colleagues designed

some of the most important

an

tenets

and a matched control group (no treatment) were

and audio recordings and other measures were gathered. Raskin (1952) reported

of the locus of evaluation hypothesis on 10 of these

cases.

PC

theory predicts that

the locus of evaluation should shift from external (based on others’ perceptions) to internal

(based

on the

client’s

client statements

own

perceptions) over the course of therapy. Using ratings

of evaluation, Raskin demonstrated that the

external dimension

among

the clients was significant

and

in

shift

made of

along the internal

the predicted direction.

PERSON-CENTERED THERAPY

174 That

is,

clients

were rated

having

as

end of counseling compared

made judgments based more on

their

Using the same 10

to the beginning.

cases,

own

Bergman (1951)

studied counselors’ responses to client requests for evaluation by the counselor

of progress,

lor advice, evaluation

values at the

(e.g.,

requests

After classifying counselor responses to these

etc.).

Bergman demonstrated that when the counselor responded with reflection of feelclients were more likely to continue significant self-exploration than when counselors

requests, ing,

chose other responses (Bergman, 1951).

many

Rogers and his associates conducted

other studies of the process of counseling

over the years, and most supported the basic tenets of

were Barrett-Lennard’s

PC

theory.

1959).

Lennard’s doctoral dissertation and produced a measure that

Rogers argued, with some justification, that the

measured was,

interest

by creating the Barrett-

efforts to operationalize the core conditions

Lennard Relationship Inventory (Barrett-Lennard,

Of particular

This study was

is still

Barrett-

used in research today.

fact that these conditions

could be reliably

support for the theory (Rogers, 1967).

in itself,

PC

Early studies conducted by other investigators also supported

theory.

Truax and

Carkhuff (1965) experimentally manipulated levels of empathy and unconditional positive

re-

gard in a small sample (three clients) case study. Their examinations of levels of client experiencing supported

PC predictions

tandem with the decrease

—

of experiencing appeared to decrease

clients’ levels

The Wisconsin

in therapist conditions.

Project (see

Box

in

5.2)

provided a wealth of data on person-centered theory and supported the contention that the level

of the

regard) texts,

PC therapeutic conditions

was

related to client

outcome

(Rogers, 1967; van der Veen, 1967). In nontherapy con-

Cramer (1988, 1994) demonstrated

having a close friend

who

empathy, congruence, and unconditioned positive

(e.g.,

that individuals’ levels of self-esteem were related to

provided unconditional acceptance, empathy, and congruence.

Later research focusing

bn Rogers’ statement of the necessary and

generally finds that these conditions are correlated with client cient. Patterson (1984), a articles sary,

that,

outcome but

that

we can be

they are neces-

fairly certain that

they are sufficient. Greenberg and colleagues (1994) indicated

as positive that

broadly construed, therapist facilitativeness was. related to client outcome. Beutler,

Machado, and Neufeldt (1994) suggested

that empathy, congruence,

positive regard were aspects of the therapeutic relationship (going

these as therapist characteristics)

therapeutic relationship

on

that the relationship

is

and

client

probably agree that one of the

that

ample evidence

The support

for the

only weak support for

safest

essential to client progress.

(Greenberg

et ak,

existed for the impact of the

we can make about psychotherapy Therefore, in some ways, PC theory

PC

theory because this effect

best to

how

is

is

as

seen across theoretical orientations

to operationally define the constructs

the empirical support for the theory

—

that

is,

researchers dis-

measure empathy, unconditional positive regard, and congruence

1994; Hill

& Corbett,

1993). Nonetheless, Klein, Michels, Kolden, and

Chisholm-Stockard (2001) reported that of 77 studies they reviewed, a positive relationship

is

in existence.

impact of the therapeutic relationship, however, can also be seen

PC theory further weaken how

beyond the notion of

conclusions that

(Beutler et ah, 1994). Worse, arguments about

agree about

and unconditional

outcomes. Most researchers in psychotherapy would

one of the best-supported theories of psychotherapy

in

are not suffi-

well-known advocate of PC therapy, reviewed nine major review

on the conditions, and concluded

but not

sufficient conditions

between therapist congruence and

client

34%

demonstrated

outcome. None of the

PERSON-CENTERED THERAPY studies they reviewed

showed negative

relationship between congruence

By

far the

&

relate

where

relationships;

results

were not positive, the

and outcome was simply nonexistent.

most popular and controversial construct has been empathy. There

how to define,

disagreement about

(Duan

175

Hill,

empathy

1996; Hill

&

Corbett, 1993). Generally,

outcome, these

to

and measure

operationalize,

have produced

efforts

this

when

important

is

much

PC construct

research has attempted to

results

PC

supportive of

theory

(Bachelor, 1988; Barrett-Lennard, 1986). For example, Greenberg, Elliott, Watson,

Bohart (2001) reported that ratings of empathy from observers

all

correlated with client outcomes.

client ratings

47

studies of

effect

and outcome. Bohart,

in evaluating

Greenberg, and Watson (2002) meta-analyzed

to effect size estimates for all

of this research,

and independent

clients, counselors,

strongest relationship was found between

empathy and outcome, finding an

and comparable

However,

Elliott,

The

and

of 32, considered a

medium

outcome and the therapeutic

alliance.

effect size

we should probably heed

Beutler and colleagues’

(1994) warning that because the definitional problems are so intense, conclusions can only be drawn cautiously from the research on empathy and outcome (Hill

ISSUES OF INDIVIDUAL

& Corbett,

1993).

AND CULTURAL DIVERSITY

PC theory has been both villainized and praised in addressing its utility with individuals from diverse backgrounds. Like many theories of counseling, PC theory can be criticized for placing too

much emphasis on

cultural effects Poyrazli,

on

and paying

the individual

fail

collectivistic

individual”

to realize that

and Pedersen (1996) noted that “many psythe majority of societies and cultures in the world have a more Ivey,

notion of identity; they do not define the psychosocial unit of operation

(p. 5).

on the

internal locus of evaluation prized

Poyrazli (2003) flatly states that “despite is

as the

Values such as duty to family and cultural groups are largely neglected given

the strong emphasis

and

and

and behaviors (Holdstock, 1990; McDougall, 2002;

people’s lives

2003; Spangenberg, 2003). Sue,

chologists

relatively little attention to family

inappropriate for Turkish culture”

noticed by others in

PC

theory: emphasis

(p.

its

by PC

therapists (Usher, 1989).

popularity, Rogerian therapy clashes with

111). She cites

most of the major problems

on individualism and emotional expression,

dis-

regard of the power of the family, and the lack of structure and authoritative stance on the part of the counselor. Similar to other critics, however, Poyrazli cites the utility of the core

conditions in working with Turkish clients. Spangenberg (2003) agrees that these conditions are useful in

working with South African

seling with these clients

and

would focus on

culture. In contrast to Poyrazli,

selor as respectful to the client, to give advice

The

stress

clients

and notes that

the client in the context of family,

Spangenberg

and cautions

sees the nondirectiveness

therapists not to

succumb

and suggestions without providing the opportunity

on Individualism

in

PC

successful

coun-

community,

of the

to the

to process

PC

PC coun-

temptation

them.

theory can lead to an attitude that the person must

change, not the environment, organization, or society in which he

exists.

The notion

that

an individual can actualize without the recognition that sometimes social structures oppress

is

seen as detrimental to

women,

racial,

and ethnic minorities, and individuals who

are gay, lesbian, or bisexual.

Chantler (2005) joins

in these

kinds of criticisms of

PC

theory,

and suggests an extension

of the concept of conditions of worth to include “racialised and gendered conditions of worth”

PERSON-CENTERED THERAPY

176

254). In doing so, the internalization of societal stereotypes and the often negative impact

(p.

would be recognized. Chantler

that they have

group backgrounds working of privilege and

eftects

how

an enlightened

in

also advises counselors

PC mode

these factors influence their

to

examine

work with

who

are

their

own

clients.

of dominant lives for

the

Consistent with

feminist theory, Chantler emphasizes the issue of socially-conferred power, particularly

when

counseling those of backgrounds other than the dominant group. She points out that although

PC

therapists attempt to create a symmetrical therapeutic relationship, “the desire to equalize

counseling relationships does not

mean

that they will be equal” (p. 253).

may expect and

more guidance from the counselor than is provided by traditional PC therapists. MacDougall (2002) suggested that this lack of direction may produce frustration for these clients, and suggested that PC counselors consider alternative behaviors such as giving advice and making suggestions. Sue and colleagues (1996) also noted that the emphasis on self-disclosure in psychologiClients from cultures other than white European

theory can be problematic for clients from non-European cultures. Clearly, self-disclosure

cal is

desire

a cornerstone of

PC

and

theory,

clients

from cultures that do not value such disclosure

may not respond well to this approach. Also, clients who for good “majority” individuals may also be reluctant to invest in PC counseling.

(such as Asian individuals) reasons mistrust Insight

is

highly valued in the

PC

approach; individuals from cultures or groups other than

European and of lower socioeconomic ticularly,

may

PC

may not share

be more concerned with concrete

Sue, for example, note that

much

status

can create problems

many Asian

(p.

life

The

this value.

problems (Sue

latter clients, par-

& Sue,

elders believe that thinking

2003). Sue and

about something too

110).

theory does have some strengths that are relevant to working with clients

The assumption

diverse origins.

who

are of

that the client, rather than the therapist, determines the

goals of counseling avoids the imposition of culturally-based notions of the healthy personality (Usher,

1989). In

would

ing the individual

and personal

fact,

Rogers probably would have argued that the

create an

atmosphere of respect

history. Essentially, the

Roller, Piason,

and da

Silva (2005) provided

and adolescents

had participated 1

2)

.

Initially,

in this

for clients’ culturally-based values

Improvements

an example of such work in their description

PC approach with 98 lower socieonomic status,

in Brazil.

At the publication of Friere

et al.’s report,

clients

ongoing program attending a range of 1-39 sessions (average was

in interpersonal,

that this study in

emotional, and academic functioning were noted by these

no data are presented

to

support these contentions and

it

no way approached the standards of controlled outcome

valuing of

real, egalitarian

relationships in this approach

is

should be noted studies.

consistent with the

values of a feminist approach to counseling (Waterhouse, 1993). However,

point out that

PC

reside (Chantler,

women from

feminists

theory can be seen as ignoring the social and political context in which

2005; Waterhouse, 1993). The emphasis on autonomy and

individual responsibility for change ignores the fact that social roles and

vent

98

neg-

they quickly began to learn to use the unique relationship to their benefits.

authors. However,

women

Freire,

the clients in this project were puzzled by the nondirective approach, but Friere

et al. report that

The

of trust-

PC counselor wants to walk in the client’s world.

of the process and outcomes of using a lected children

PC credo

realizing their potential

and can

problems. According to Waterhouse (1993), “there

result in is

blaming

norms often

women

pre-

for their

within the Rogerian perspective a

PERSON-CENTERED THERAPY

177

strong faith in the transformative powers of counselling which

and

at

worst reckless and irresponsible”

problematic

—

overambitious

empathy

62). Further, the construct of

(p.

women

empathize with a

to

at best

is

members of other

or

is

historically oppressed

groups requires not just awareness in the here and now, but also an understanding of the historical influences

on current

social contexts.

From a GLBT perspective, many of the criticisms and strengths elaborated here apply. The total acceptance of the client by the counselor would be a positive. Flowever, GLBT advocates would also criticize the theory for ignoring cultural and historical influences that contribute to discrimination and prejudice. The conditions of worth construct might need to be broadened to include societal conditions of worth. Lemoire and Chen (2005) emphasized this latter idea in their discussion of the use of

counseling with

GLBT

Allowing that the core conditions provided by the therapist create

lescents.

situation in

note that this

PC

which the adolescent can explore

at least three

his sexual identity,

elements need to be added to

PC

munity

in

Toward large

ways appropriate

end of his

the

and

counseling

life,

Rogers became

much more

social

groups (such

and

book On Personal Power, Rogers discussed the

ual individuals; Chicanos; Filipinos; feel

heard. This does not

and many

others. Fie

that

it

the white needs to listen to his ‘unjust’ accusations” (1977, pp.

own

To

South

social factors in

utility

of the

PC ap-

and

bisex-

acknowledged that “minority

simply needs to be listened

taken within and understood empathically. ...

as in

gay, lesbian,

tremendous rage and bitterness towards whites.

mean

GLBT com-

involved politically, conducting

proach with a wide variety of people, including African Americans;

group members

and

risks

to the ages of clients.

Africa and South America), suggesting a greater awareness of group behavior. In his

also

when working with

socialization into the

encounter groups with individuals from conflicting

human

a safety

Lemoire and Chen

group: deliberate validation of the adolescent’s sexual identity, discussion of

benefits associated with disclosure of sexual identity,

ado-

to. It

.

.

.

Rage needs

to be

needs to be accepted,

achieve this kind of empathic listening

feelings too, his feelings

133-134; quotes and

of anger and resentment

italics in original).

writers maintain that these experiences with diverse cultures

had

little

at

However, some

on Rogers’

influence

thinking because he did not fully recognize the implications of cultural norms of interde-

pendence and community (Holdstock, 1990). Long-time

PC

advocate Patterson (2000) opines that the recent emphasis on cultural

diversity leads to an excessively technique-oriented position in

what they do on the mental because

it

basis

we

increasing interrelations

ings together as

a

client’s

background. Arguing that

this stance

is

also detri-

only emphasizes differences between people, he says “this approach only

ignores the fact that

mogeneity and

of the

which counselors modify

are rapidly

among

becoming one world, with rapid communication and

persons from varying cultures, leading to increasing ho-

worldview representing the

one species” (2000,

p.

common humanity that

binds

all

human

be-

310).

THE CASE STUDY Richard presents with depressive and anxiety symptoms, probably very the clients with

common among

whom Rogers worked as he was developing his theory. The theory accounts

particularly well for anxiety

and

is

generally useful in understanding individuals

who

have

PERSON-CENTERED THERAPY

178 difficulty processing

and expressing emotion. Richard

that values individual choice

with the

sistent

PC

and

approach.

is

a

member of a culture

(Caucasian)

striving for betterment of the person, values that are con-

Once Richard

gets past his hesitance to discuss

ence emotion, he might be quite comfortable with

this

approach and

its

and experi-

goals.

Summary Person-centered therapy begins with an optimistic view of people.

growthful beings that attempt to maximize their potential. periences that contribute to our growth and tualizing tendency,

which

is,

in turn,

it

The

are seen as

We inherently move toward ex-

away from those

that don’t, following our ac-

guided by the organismic valuing process.

Part of actualization of the organism

of the actualizing tendency.

Humans

is

the development of the

self,

which adopts part

urge to self-actualize can create problems, however,

runs into the need for positive regard. In wanting the love of others,

we may

when

internalize

may

conditions that brand aspects of the self as worthy or bad; these conditions of worth

be counter to the self-actualizing tendency. worth, he

is

of his experience that do not

counselors do not diagnose or assess.

trust the client to lead the way. Therapist tive regard are the necessary

and

ditions, the client will progress

become

PC

individual internalizes conditions of

incongruent; he has a discrepancy between self and experience.

distorts aspects

PC

Once an

denies or

the conditions of worth.

fit

They simply provide

the right atmosphere

and

congruence, empathy, and unconditional posi-

sufficient conditions for client change.

from

He

Given these con-

incongruence to one of congruence and

a state of

fully functioning.

theory has been criticized for being simplistic and oblivious to the true qualities of

human

Outcome research supports the The core conditions are likely to be

nature.

convincing.

theory, but theory-testing research

is

less

necessary but not sufficient, according to

the data.

The

individualistic emphasis within

experienced oppression.

may

The

PC

theory can be detrimental to clients

lack of attention to familial

and

cultural factors in

be problematic in dealing with clients from other cultures.

theory’s trust in the individual to clients

know what

is

On

who

PC

have

theory

the other hand,

needed can be helpful

in

PC

working with

from diverse backgrounds.

Visit

Chapter

5

on the Companion Website

chapter-specific resources

and

self-assessments.

at

www.prenhall.com/murdock

for

Irvin Yalom

Helen

is

a 43-year-old Caueasian

her marriage. Helen holds an

husband Steve have

named

woman who presents for

MFA

counseling due to problems in

in Play writing from Yale University.

three children, a 10-year-old boy

named

She and her

Luke, a 12-year-old girl

and a l4-year-old boy named Charlie. Helen met Steve, attending Yale and he was working in New York City as a bond trader. Grace,

48, while she was

Helen greiv up in suburban Chicago, the third offive children. Helens family had the appearance of the f erfecU family. Dad was a very successful surgeon, but not involved in the childrens lives on a daily basis.

she was perhaps

Mom was loving and steady yet also somewhat reserved;

more concerned with what

others thought than she

would have

admit. In some ways the family environment was one of benign neglect

behaved well and

of Helens

sisters

so

had

—

liked to

the children

no one thought there could possibly be anything wrong. In fact, two eating disorders

and

her brother has battled an alcohol addiction

offand on. Steve

and Helen

lived in

New

York City after they married. Helen

job with a theatre and wrote some at

had an

night, although she stopped writing

administrative

when

they

had

They had plenty ofmoney, but Steve began to gamble during a period ivhen work was not going as well as he would have liked. Helen was 8 months pregnant

their son Charlie. his

when

she learned that Steve

had gambled away

large

amounts of money, including most of

their savings.

Helen was devastated, but having grown up in a family where you matter what, she immediately began looking for treatment for Steve for their young family. Unable assistance in spite

to

less

of the fact that she

pressure than

New

out no

and housing

options

deal with the strain, Helen called on her parents for believes that they never truly accepted Steve.

suggested she look in the Chicago area because

haps

stick it

it

They

would have job options for Steve and per-

York City. Helens parents offered financial assistance in the

179

EXISTENTIAL THERAPY

180

form of a down payment on a house and although it was never stated, it was understood that it was for a house in Chicago. The family moved and has lived in the same house now for 10 years.

On a recent trip to New York with some fiends, Helen ran into a former professor from Yale. He asked about her work and she was pleased, but also embarrassed that she’s done nothing, although in her mind this is no great loss because she isn’t all that talented. He reminded her that she won a competition during graduate school and shared a couple of things faculty members said about her in which they praised her talent and insight. He is

and very handsome. He asked her to meet him for a drink and gave her his business card. She didn’t call him, but kept the card and did not tell Steve about the encounter. Having survived a crisis in her marriage she now feels resigned to the humdrum existence of a woman whose husband does not support her career ambitions and has never really confronted his own demons. Helen is a ''good girl, ” a though ful woman and a good mother, who has no interest in destroying her family by having an ajfair. However, she is troubled deeply by the way she feels right now, that her husband can "do no right” and her fear that this is a permanent divorced,

state for the rest

dured the

older than Helen,

8 years

crisis

of her marriage. She

is

surprised by the fact that for

caused by her husband’s gambling without

her

and in

she has en-

sounding the death knell of

of the blue, she bumps into a former professor who displays interher work and her reaction to this her interest in him, irritation that her

their marriage. Yet, out est in

its

10 years

husband doesn’t do

the

—

children are older

—

same

thing,

worry about the aimlessness she

is feeling

now

that her

brings her to a place where she decides to seek help. \

BACKGROUND Existential approaches to psychotherapy

(ET) are more philosophy than pragmatics; more

attitude than specific theoretical orientation.

ET s roots are in existential philosophy, or the

study of being and phenomenology, which emphasizes that

own

experience (Cooper, 2003).

The

ideas of

many

all

we can

are represented in

really

know

is

ET, yet they hang

together quite well, as Fischer, McElwain, and DuBoise (2000) so aptly pointed out is

correctives to determinism, materialism,

and realism”

draw on

often

ET

ideas, at least occasionally,

existential ideas

when

an approach of like-minded persons looking for

they asserted that “existential psychology

probably employ

our

(p.

245). Therapists of many stripes

and some

writers

contend that therapists

without conscious recognition that they are doing so

(Norcross, 1987).

Norcross (1987) warns us that “existential therapy’s process

You may

widely misunderstood”

(p.

43).

your study of ET, but

am

hopeful that things will soon get

I

(an important existential therapist) defines cuses

on concerns

believe that this

ET as

“a

is

is

frequently ill-defined and

a less-than-promising start to clearer.

This

dynamic approach

may

to therapy

that are rooted in the individual’s existence” (1980, p. 5).

be two general orientations within the

ET school. The

first is

help:

Yalom

which

There seem

fo-

to

the Continental or European,

rooted in an analytic orientation (although not exactly accepting the content of psychoanalytic theory), that tends to emphasize the limitations

1980).

The second

and tragedy of the human condition (Yalom,

arose in the United States in the 1960s,

and emphasizes human

potential

EXISTENTIAL THERAPY and encounter.

It is

closely related to the humanistic school exemplified

Rogers, James Bugental, and

May exemplify

Rollo

The major writers far

181

Abraham Maslow.

In

Box

by the work of Carl

6.1, the views of Carl Rogers

and

these differences. in

back you want to go

ET are numerous,

and who you consider important depends on how

Most

sources trace the approach back to the founder of

historically.

Soren Kierkegaard (1813-1855), and acknowledge other

existential philosophy,

existential

philosophers, including Friedrich Nietzsche, Martin Buber, Martin Heidegger, and Jean-Paul Sartre (Fischer et

al.,

who

2000). Contributors

are specifically

concerned with psychotherapy

Rollo May, and

Emmy van Deurzen-Smith, Victor Frankl, Eric Fromm, R. D. Eaing, Ernesto Spinelli. A particularly moving contribution to ET Frankl’s book

Mans

Meaning (first published

include James Bugental,

Search for

is

Nazi concentration camps and

in the

logotherapy.

You can read

in

how

1

946) in which Frankl describes

these experiences contributed to his theory of

a section of Frankl’s

Box

Humans

his experiences

book

in

Box

6.2.

6.1

Good

are Basically

Views from Two

— and

Evil:

Existentialists

In the early 1980s, Carl Rogers wrote an article praising Rollo May’s work,

edged May’s contributions to the humanistic movement. In

and acknowl-

this article,

Rogers also

pointed out a fundamental philosophical difference between the two men, a difference that centered on the question: Does the nature of the

human

individual inherently include evil?

Rogers believed that individuals were inherently good, and that they would always

choose to actualize the destructive behavior

phenomena cial

given the necessary conditions. In Rogers’ view,

self,

was not consistent with the goal of

like senseless violence, the

pointed to cultural influences

humans were

as the

To

primary factors

“essentially constructive in their

in

evil

or

explain

looming arms race of the 1970s and 80s,

and other manifestations of seemingly

behaviors,

self-actualization.

evil

antiso-

behavior, Rogers (1982)

promoting

evil.

Rogers said that

fundamental nature, but damaged by

their experience” (p. 8).

May’s (1982) response to Rogers was to note the obvious, that culture individuals.

To

assign

blame

for the evil in the

scious actions of the individual

of the individual;

it

world to the group

is

members of the group. May accepted

was inherent

in the

stand and balance both good and

human

evil in

made of

is

to ignore the con-

that evil

was

a part

condition that individuals must under-

themselves.

May

viewed Rogers’ position

as

naive and possibly a disservice to clients, and he illustrated his point by directly address-

ing person-centered counseling.

To May,

it

was of fundamental importance

against the therapist.

He

for the client to be able to take a stand

maintained that person-centered therapy took away

tunity by overemphasizing the goodness of client and counselor.

May wrote,

“.

centered therapists did not (or could not) deal with the angry, hostile, negative evil

—

feelings

of the clients” (1982,

p. 15). Essentially,

there

is

a

oppor-

this .

.

—

client-

that

tendency to be too

is,

nice,

-

EXISTENTIAL THERAPY

182

almost naive, and that

this stance robs the client

of independence. Further, the therapist’s

anger toward a client can be an important tool in helping clients understand

May was

behaviors affect their relationships in general,

This means that aspects of evil

need to be brought out

evil

—

it.

this issue

their

when he wrote:

anger, hostility against the therapist, destructiveness

in therapy. Personal

but by directly confronting

own

—

on

clear

how

autonomy occurs not by avoiding

—

evil,

Therapists need to be able to perceive and admit their

hostility, aggression,

anger

—

they are to be able to see and accept these

if

experiences in clients. (1982, p. 17)

May

believed that failing to accept and confront the reality of evil was a significant

movement and

error of the humanistic

quences for the world.

May

believed that people

that individuals are only good; that

tween good and is

my

and ultimately triumph

experience

it

be lulled to inaction by the belief their capacity to

in the world,

it

will

me,

a challenge

throw the

is

May wrote:

this polarity, this dialectical interaction, this oscillation

is

not a requirement to

Contributed by Sean

to

human

life.

out a preordained pattern of goodness, but

live

coming down through the

centuries out of the fact that each of us can

toward good or toward

lever

if evil

be through the inaction

between positive and negative that gives the dynamic and the depth Life, to

choose be-

end up doing nothing. In May’s view,

of individuals. Stressing our agency in the world, In

may

by not acknowledging

individuals will

evil actions,

to gain strength

a denial that could have potentially dire conse-

evil.

(1982,

p. 19)

Comeau

Box 6.2

An

Excerpt from Frankl

Mans

s

Search for

Meaning

Let us

first

ask ourselves what should be understood by “a tragic optimism.” In brief

means

that

one

is,

and remains, optimistic

in spite

of the “tragic

logotheraphy, a traid which consists of those aspects of

circumscribed by:

How

is it

differently,

can

tion,

“saying yes to

German book

(1) pain; (2) guilt;

possible to say yes to lile life

ol

retain

its

in spite

mine

is

and life

potential

(3) death.

in spite

meaning

of

couched, presupposes that

capacity to creatively turn

best,” however,

is

that

of a tragic optimism, that

human

potential

which

at

of

in spite

its

life is

which may be

to pose the question

tragic aspects? After

its

title

potentially meaningful

And

this in

all,

of a

under

turn presupposes the

negative aspects into something positive or

what matters

which is,

life’s

called in

in fact, raises the ques-

How,

that?

all

it is

of everything,” to use the phrase in which the

constructive. In other words,

“The

existence

This chapter,

any conditions, even those which are most miserable.

human

human

traid,” as

it

in Latin

is is

an optimism

to

make

called

the best of any given situation.

— hence

optimum

in the face

the reason

I

speak

of tragedy and in view of the

best always allows for: (1) turning suffering into a

human

EXISTENTIAL THERAPY

183

achievement and accomplishment;

and

oneself for the better;

(3)

(2)

deriving from guilt the opportunity to change

deriving from

transitoriness an incentive to take

life’s

responsible actiond It

must be kept

or ordered.

One

odds, against

all

mind, however, that optimism

in

is

commanded

cannot even force oneself to be optimistic indiscriminately, against

And what

hope.

true for

is

hope

is

also true for the other

nents of the triad inasmuch as faith and love cannot be

To

not anything to be

the European,

it is

a characteristic of the

commanded

American culture

all

two compo-

or ordered either.

and again,

that, again

commanded and ordered to “be happy.” But happiness cannot be pursued; it must ensue. One must have a reason to “be happy.” Once the reason is found, however, one becomes happy automatically. As we see, a human being is not one in pursuit of happione

is

become happy, last but not least, through actualizing the potential meaning inherent and dormant in a given situation. This need for a reason is similar in another specifically human phenomenon laughter. ness but rather in search of a reason to

—

you want anyone

to

him a joke. In no way is it possible to evoke real laughter by urging him, having him urge himself, to laugh. Doing so would be the same as urging people posed

or

to laugh

you have

him with

you have

If

to provide

a reason, e.g.,

tell

front of a

camera to say “cheese,” only

in

photographs their faces

to find that in the finished

are frozen in artificial smiles.

FrankI V. E. (1984) 'This chapter University,

is

Mans Search for Meaning, NY:

based on a lecture

I

Pocket Books.

presented at the Third

World Congress of Logotherapy, Regensburg

West Germany, June 1983.

Perhaps the most coherent and readable formulation of existential theory,

purposes of doing counseling, ter

is

that presented

by Irvin Yalom. For

at least for the

chap-

this reason, this

draws heavily from Yalom’s work, with the ideas of other writers occasionally inserted.

Yalom, a for his

He

is

psychiatrist,

work as group also

is

well

known

for his

therapist (Yalom,

1980 book.

& Leszcz, 2005; Lieberman, Yalom, & Miles,

an entertaining writer of fiction that

such books

as

mund Freud,

When

his

Existential Psychotherapy, but also

is

1973).

based on the psychotherapy process, in

Nietzche Wept (1991), which involves the interesting characters Sig-

mentor Joseph Bauer, and the existential philosopher Friederich Nietzsche.

A particularly notable book for therapists

is

a compilation of tips for psychotherapists, called

The Gift of Therapy (2003). Yalom’s webpage, is, of course, www.yalom.com Other resources in existential psychotherapy are the International Society .

tial

Psychology and Psychotherapy, which can be found on the

existentialpsychology.org/ Existential Psychology

tion

of

interest

.

The

society’s official journal

and Psychotherapy, which debuted the

is

analysis.co.uk/index.htm

Society

for

Existential

is

Web

at

for Existen-

http://www.

the International Journal for

in July

2004.

A

second organiza-

http://www. existential

Analysis

.

BASIC PHILOSOPHY The

basic philosophy of

and have the potential

FT theorists

is

that

humans

are free, responsible lor their

for self-actualization (Norcross, 1987).

It

own

lives,

can sometimes appear to

EXISTENTIAL THERAPY

184

when asked what ET

be a rather gloomy approach. Cooper (2003) reports that

sometimes

resorts to

“it’s

similar to person centred therapy.

ET

Randall (2001) suggests that underlying

being is

a finite

is

not at

all

willfulness

drama enacted

given, but

to suffer, to survive

On

the other hand,

ET

meaning

Lars,

.

.

the salvation

.

Helens

life

alone”

of man

is

is

purpose of

(p.

life

acts

may

close a person

of

feel

260). Frankl (1984) adds “to live

human

capacity for creativity and love.

man

the ultimate and the highest goal to which

and in

through love

ET counselor approaches

human

of each

life

(p. 1).

in the suffering” (p. 11).

theorists recognize the

Frankl (1984) wrote that “love aspire

a philosophy that “the

and that no matter how

responsibility,

to find

is

only more miserable!”

by each individual through conscious

selected afresh

toward another, each ultimately must face is

.

in a hostile or indifferent universe; that the

must be

tempered by

is

.

he

is,

can

love (p. 57; italics in original).

her with the attitude that she

is

a free, responsible

who has the potential to grow andflourish. Helen may seem stuck right now, but her distress and sadness are signs of the potential within her to be creative and loving. being

HUMAN MOTIVATION Frankl (1984) contended that the principal motivation of

meaning and most

ET theorists would agree.

source of this meaning. For Frankl, meaning

—and

has an ultimate, true calling

2003). For other

ET

theorists,

we

Frankl maintained that

work or doing a deed; attitude

(2)

it

is

meaning discover

human

ITowever, there is

is

beings

is

the search for

some disagreement about

inherent in each individual

—

each individual

the task of the individual to discover is

created; there

is

three routes: “(1)

by creating

by experiencing something or encountering someone; and

we take toward unavoidable suffering”

some accuse Frankl of implicitly endorsing

(p.

1

(Cooper,

it

no discovery involved.

meaning through

life

the

33). Despite statements like the

a religious aspect to

(3)

a

by the

one above,

meaning (Yalom, 1980).

Proponents of ET generally accept the idea of the unconscious and the dynamic nature of psychological functioning, but the content of the unconscious as

Freud proposed (May

& Yalom, 2005).

the true nature of our existence: that

we

Instead,

what

is

is

not instinctual drives,

relegated to the unconscious

are finite beings alone in a meaningless

is

world

(Cooper, 2003).

Lars wonders about Helens search for meaning.

meaning through her

writing, her marriage,

He guesses

that in the past, she has found

and raising her children.

Lars guesses that the

vague sense ofanxiety that Helen is experiencing stems from her sense of mortality, which just beneath the surface ofawareness right now.

is

CENTRAL CONSTRUCTS Modes of Being ET

theory

is

focused on the being of humans.

ET

theorists recognize distinct

being although they often use different names for them and the

(Bauman

& Waldo,

1998; van Detirzen-Smith, 1997).

physical world. Mitwelt

is

The

classic

first is

terms are in

ways of

German

Umwelt, or being

in the

being in relation to others, the social/interpersonal world, and

EXISTENTIAL THERAPY Eigenwelt

refers to the

185

inner psychological world (being in one’s subjective experience).

Truly authentic existence means attending to

two ways of being with which we

Helen appears

to

are

all

realms. However,

we

typically have

one or

most comfortable (van Duerzen-Smith, 1997).

be functioning primarily in the mitwelt

—

or at least attending to that

of her being at the expense of Umwelt and Eigenwelt. She has spent much time worrying about her family until the recent encounter with her former professor. She is

aspect

tempted

but her early training in her family of origin leads her be uncomfortable with a selffocused orientation. to enter the Eigenwelt,

to

Anxiety ET

theorists

assume that everyone experiences anxiety; indeed

gued that “anxiety our being”

assert

from our personal need

arises

soon

shall

see.

is

& Waldo,

May and Yalom fits

evoked

it.

is

by some,

is

life,

as

a significant

not accompanied by any of the usual psychological symptoms

1998). For these theorists, anxiety lives

is

not to be banished or avoided;

it

(van Deurzen, 2006).

(2005) distinguished between normal and neurotic anxiety. Normal

events and

Normal

processes.

ar-

our being, and to

determining psychological

existential anxiety

element in coming to terms with our

a critical

anxiety

critical in

This kind of anxiety, called

feeling of disease that

(Bauman

to survive, to preserve

(2005)

271). Certain kinds of anxiety, for example that associated with the

(p.

awareness of one’s fmiteness are normal, and

we

May and Yalom

makes

sense. It

is

not threatening enough to engage repressive

anxiety also serves as a signal that

Existential anxiety

is

we need

one form of normal

seems exaggerated for the person’s situation.

It is

to attend to

some situation

that

anxiety. In contrast, neurotic anxiety

destructive

and

paralyzing,

and tends

to be

repressed.

Lars notes Helens clear sense of loss ofpurpose

of her

existential anxiety,

and

unrest. Clearly, she

is

becoming aware

which he thinks stems fom her sense offmiteness.

The Ultimate Concerns Yalom (1980) identified four existential themes of human existence: death, freedom, lation, and meaninglessness (May & Yalom, 2005; Yalom, 1980).

iso-

The ultimate concern, “death itches all the time,” according to Yalom (1980, p. 29). We humans have a great propensity to avoid really facing the idea of our own mortality, but when we are able to, we experience the ultimate terror. As a result, much of our psyDeath.

chological

life is

built

triggers are the source

gives

meaning

Ereedom.

notion, according to

—

his or her

truly facing our fates: death

and the anxiety that

it

of most psychological dysfunction. However, the awareness of death

to life (Strasser

From an ET

author of

around avoiding

& Strasser,

1997).

perspective, an essential aspect of

Yalom

own

that “the individual

world,

life

is

human

existence

is

entirely responsible for

design, choices,

and actions” (1980,

—

the

is,

the

May

and

freedom

—

that

p. 9).

EXISTENTIAL THERAPY

186

Yalom (2005) point out the terrifying consequences of accepting one’s freedom: if we totally free to choose and act, then we must recognize that “there is no ground beneath there

is

only an abyss, a void, nothingness”

sibility for ourselves;

failures to act.

Awareness of our freedom implies responsibility of

we

it,

The

are constantly

to choose.

making choices and our actions

Even

if

we

are not

aware

reflect these (Norcross, 1987).

of freedom, choice, and responsibility brings to us the notion of existential

reality

we experience about possibilities unavoidable, because every time we make a choice we

guilt,

us:

280). Ultimately, freedom implies respon-

(p.

our actions, but also our

are

that

guilt

unfulfdled.

Existential

guilt

is

are discarding other possibilities

(Cooper, 2003).

What

if

one

last

his

He wrote movingly about

is

really

prisoners in the concentration

camps

that gave their

food away to others, saying that “they offer sufficient proof that everything can be

taken from a in

no way out? Frankl (1984) has thoughts were highly influenced by his experience in the

trapped in a situation and there

we know,

the answer; as

holocaust.

is

any given

man set

Meaninglessness.

but one thing: the

of circumstances, to choose

Most ETs accept

& Strasser,

—

human freedoms to one’s own way” (p. 86).

of the

last

human

that

choose one’s attitude

existence does not

come with

built-in

would be the exception to this philosophy, described above; however, he believed that each individual’s meaning was unique and found only as a result of a difficult search and perhaps unavoidable suffering. meaning

Isolation.

(Strasser

1997). Frankl

We are always and ultimately alone,

mortality, freedom,

and

according to

ET theorists.

as is

If one accepts one’s

responsibility to create meaning, the realization of our isolation

is

many ways, but it presents quite a dilemma, for through merger may result in damage to the self; still,

unavoidable. People deal with aloneness in “trying too hard to achieve security

abandoning the

effort to

Helen, Lars thinks, the least

is

connect

at all leads to

struggling with all

aware of her death

anxiety,

but

emptiness” (Randall, 2001,

p.

261).

of these concerns simultaneously. She

it is

is

probably

surely the font for her discontent in the other

of ultimate concern. Helen feels trapped in her current situation and yet guilty for feeling this way. Her sense of meaning has been for a long time invested in raising her areas

and although she verbalizes her sense of self worth tied to this aspect of her existence, now she finds that something is missing. She now recalls the sense ofi meaning and purpose she found in her work as a playwright. Lars think that because ofthese realizations, Helen probably feels isolated from others and a vague sense ofguilt. children

Defenses No

matter

how

hard

we become aware

of

we

try to avoid

one of these

inevitably, defense (Yalom, 1980).

that

we

rescuer.

use to If

we

it,

awareness of ultimate concerns

issues,

we

According

experience anxiety. to

ward off the awareness of death:

it

will save us

possible.

When

result of anxiety

is

Yalom (1980) there are two major defenses specialness and the notion of the ultimate

are special, death does not apply to us as

magical rescuer, he or she or

The

is

from the

it

does to others.

possibility

If

of nonexistence.

we have

a

EXISTENTIAL THERAPY

187

Lars thinks that Lielens sense of specialness

and

disappointment with her husband

rescuer, tier

not as prominent as her belief in the

is

her surge of discontent after meeting

her former professor would support this hypothesis.

THEORY OF THE PERSON AND DEVEEOPMENT OF THE INDIVIDUAE ET

counselors are not interested in theories of personality because of their orientation

toward the

human

essential issues of

on

has the choice,

a

existence.

moment-to-moment

They would contend determine

basis, to

personality and development are contrary to the notions of

who

ET

that each individual

they

Theories of

are.

because they are based on

normative patterns and therefore do not capture the unique experience of the individual client. In addition, the

ET

therapist

ET

than her past. However, some

is

more

interested in the client’s present experience

theorists recognize the

attachment to separation or individuation

developmental sequence from

dilemma of

as inherently tied to the existential

aloneness (Yalom, 1980). Thus, neoanalytic ideas such as those presented in Chapter 3

would

Lars

with the

fit

more

is

ET

perspective.

interested in understanding

scheme describing personality early

environment in the

types.

beliefs

He

Helen from her perspective than through any

does, however, recognize the influence

and ideals she

holds as a

woman,

of Helens

and spouse.

mother,

HEALTH AND DYSFUNCTION A good

definition of health

from an

ET

perspective

Authenticity involves courage and determination;

own

it

would be authentic (Maddi, 2005). involves the willingness to face our

anxiety about not being (Cooper, 2003). Health, in this view,

to live

is

with

neurotic anxiety as possible, but also to be able to deal with the anxiety that

as little

is

surely

unavoidable

as part

of being human. Being authentic means to not deceive oneself; such

deception

known

as acting in

is

bad

faith (Sartre,

1956, cited in Yoder, 1981).

For Yalom (1980), the major source of psychological dysfunction death.

He

the awareness of

proposes that instead of the psychoanalytic notion that the surfacing of instinc-

tual drives leading to anxiety, is

is

and then

and dysfunction,

to defense

that the correct sequence

the following: the awareness of ultimate concerns (particularly death) raises anxiety, which

More simply put, people of a confrontation with harsh facts of the human condition (Yalom, 2002, p. xvi). In dealing with the notion of our own then triggers the defense mechanisms.

“fall

—

two important defense mechanisms, described ultimate rescuer

(May

&

Yalom, 2005,

p.

into despair as a result

the ‘givens’ of experience” deaths,

earlier, feeling special

283).

Yalom

we

rely

mostly on

and believing

links the defense

in

an

of specialness to

paranoia, and, not surprisingly, narcicissm.

The Yalom,

belief in an ultimate rescuer can also lead to dysfunction, it is

a less effective defense

than specialness. Investing oneself in the ultimate

cuer can cause the loss of self and a likely to is

break

threatened.

down

in the face

and according

lifestyle that

of personal

is

illness,

restricted.

when

res-

also

more

a special

other

This defense

or sometimes,

to

is

EXISTENTIAL THERAPY

188

Another way of looking Bracke (1987).

at psychological

They argued

dysfunction was presented by Bugental and

that popular culture in recent years has encouraged emptiness

and narcissism by focusing on individual achievement without

We

a sense of purpose or meaning.

experience emptiness because of this lack of meaning, which stems partially from the

of connection associated with current

loss

lifestyles

We

and norms.

define ourselves

through the eyes of others, and “are seduced into search for direction, completion, and

meaning by seeking more

things, desperately fabricating a fashionable

looking almost exclusively to others ... to define ourselves (Bugental p.

29,

italics in original).

being”

(p.

29),

(p.

108).

is

least severe

form of dysfunction

prone to take severe

is

risks to establish life

or physical adventures. als fall

an authentic self

The most severe form

anger, because the individual, paradoxically, finds

The

for

no sense of life meaning. Nihilism

individual has virtually

ing.

Bracke, 1987,

goes even further, to identify three types of meaninglessness: vegetativeness,

and adventurousness

nihilism,

&

In their version, the healthy person has a “centered awareness of

which involves searching inwardly

Maddi (2005)

appearance, and

Maddi maintains

is

vegetativeness, in

which the

involves feelings of disgust

meaning in

insisting that life has

and

no mean-

adventurousness. In this presentation, the client

meaning, such

that

“many

gambling, substance abuse,

as in

respected industrialists and profession-

into this category, regardless of the socially acceptable nature of their activity” (p. 108).

Frankl

(1984)

contrasted

explicitly

and

neuroses

“traditional”

existential

neurosis.

Traditional or psychogenic neuroses have their origins in the psychological processes identi-

by other

fied

theorists. Frankl

is

much more

interested in

difficulties related to existential frustration, or the lack

approach, derives

its

name from

Spinelli (2001) presented finitive

the

word

logos,

what he

called

noogenic neurosis,

of life meaning. Logotherapy, Frankl s

which means meaning.

an existential take on psychosis. Arguing that we have no de-

proof for biological explanations for these client presentations, Spinelli suggests

abandoning

traditional diagnosis in favor of understanding the

of severely disturbed

clients. Fie identifies

two types of

frightened by her mental turmoil and the second latter client

is

more

difficult to help

who

meaning of the experiences

clients in this regard:

adopts the experiences

one

who

as truth.

is

The

than the former, according to Spinelli.

Lars speculates on Helens recounting of her current experience. She clearly presents a sense of aimlessness,

a feeling that her existence

is

“humdrum.

”

These elements

add up

to

meaningless-

At present, Helen is not very authentic, because she refuses to face up to her existential tasks and have the courage to live without self deception. However, that she comes to counselness.

ing suggests that she to

is

moving in

the right direction

—

with some support she will likely begin

confront her sense ofdespair and the reality ofherfinite existence. Helen does not seem to be lives

more according

to the

very difficult feelings. She seems a

little vegetative,

yet Lars

very centered right

now; she

needs of others sees

and neglects

movement starting to

her

own

build.

NATURE OF THERAPY Assessment ET

therapists don’t

creates distance

do much formal assessment; most would agree

between

for effective therapy.

client

and counselor,

that to assess

and diagnose

interfering with authentic encounter necessary

EXISTENTIAL THERAPY Lars does his best

to

get to

189

know

Helen, to enter her world while maintaining his

own

authenticity.

Overview oe the Therapeutic Atmosphere ET

an experiential approach and

is

focused intently on the immediate subjective

is

experience of client and therapist (Schulenberg, 2003). Because this approach

you might expect the

philosophical,

thoughtful, passive, turned inward. their relationships

As

(Yalom

ET counselor to act like your stereotypic philosopher: You would be wrong: ET therapists are quite active in

with clients (Fischer

active as they are,

& Bugental,

et ah,

2000).

ET therapists do not attempt to give clients solutions to their problems

1997). In

fact,

they are more likely to challenge

respect, care

is

encouraged and

and understanding” (2006,

ET

For Yalom, several years,

does not

fit

therapists practice in conditions

There

ble.

is,

in fact, at least

a

“an

it,

283).

in a short-term

and sometimes twice

encouraging them

not mollycoddled, though treated with

clients are

p.

clients,

As van Deurzen puts

to have the courage to face the ultimate concerns (Cooper, 2003).

attitude of openness

very

is

model.

He

typically sees clients for

week. However, he readily acknowledges that

under which longer-term psychotherapy

one time-limited model of

ET

is

many

not possi-

in existence (Strasser

&

Strasser, 1997).

Lars begins the counseling relationship with Helen with a sure sense ofwho he energy to devote to the process.

He is

unsure what

has faith in Helen to be able to handle

is

to

is

and a

ready

come, but welcomes the challenge

and

it.

Roles oe Client and Counselor The

therapist in the

ET tradition has been described as a consultant who has a very real,

caring for the client (Bugenthal the counseling process

and

& Kleiner,

1993).

The

therapist also attempts to demystify

relate authentically to the client. Part

for the counselor to have attended to his

own

deep

of relating authentically

existential issues, for as

is

van Deurzen-Smith

points out, the counselor should not be “existentially lazy” (1997, p. 195).

The

therapist

who

has accomplished this existential scrutiny will not hide behind authority or therapeutic neutrality

and

will treat the client as

an equal.

Walsh and McElwain (2001) emphasize

that the client

and counselor have

investment and

risk in the therapeutic encounter. Similarly, Spinelli

a challenge for

both therapist and

client.

He

shaken by experiences with

herself in

all

clients.

aspects. Spinelli describes

The

mutual

(1997) sees therapy

as

maintains that the therapist must be an

active participant, not an observer of the process, beliefs

a

and thereby

client

is

risks

having

his values

and

challenged to clarify the nature of

an attitude of “un-knowing” on the part of the ther-

apist that facilitates the therapeutic relationship as the “therapist’s willingness to explore

the world of the client in a fashion that seeks not only to remain accessible to, and respectful

of,

the client’s unique

being-in-the-world, but also to be receptive to the

own biases and assumptions exploration may well provide” (p. 8).

challenges to the therapist’s or both) that the

way of

(be they personal or professional,

EXISTENTIAL THERAPY

190

Lars engages in the relationship with Helen relying on an attitude of un-knowing

acknowledgement that what he brings authentic as he can possibly

be.

He

is

to the relationship will

prepared

lenged by the paths ofexploration she chooses

to care deeply

and the

only be evident if he

about Helen and

likely sense

and the is

as

to feel chal-

ofsuffering and pain that

will emerge.

Goals Perhaps the simplest statement of the goal of ET comes from Norcross, “the purpose of psychotherapy

and

is

to set people free: free of symptoms

to experience one’s possibilities” (1987, p. 48).

A

more

who opined

and

free to

that

be aware

detailed description

comes

from van Deurzen-Smith:

The aim of Problems

counseling

existential

is

to clarify,

confronted and

in living are

life’s

upon, and understand

reflect

possibilities

and boundaries

life.

are explored.

Existential counseling does not set out to cure people in the tradition of the medical

model. Clients are considered to be not ple are confused

and

What

is

they need

lost the last

some

ill

bu

sick of life or

thing they need

counselors want to help the client

the ultimate concerns of being; (Strasser

& Strasser,

live

p.

at living.

to be treated as

assistance in surveying the terrain

route so that they can again find their way. (1988,

ET

is

clumsy

and

ill

When

peo-

or incompetent.

in deciding

on the

right

20)

an authentic

most importantly, the

life,

which involves accepting

inevitability of

our

own

deaths

1997).

way out of her current “stuckness’’ into She must accept her own sense offreedom and the responsibility that

Lars hopes that Helen, ultimately, can find her authentic experiencing. is

hers alone for

what she

her limited existence

does with this freedom. Lars believes that Helen will acknowledge

and

the aloneness that will first catapult her into existential terror.

However, eventually, Lars

is

ining her current existence

way out ofthe abyss by examdev£lop new meaning in her life.

certain that Helen willfind her

and moving forward to

PROCESS OF THERAPY Bugental and Kleiner (1993) presented the following basic principles of ET: 1.

An

existential orientation recognizes that psychological distresses overlie

deeper (and

often implicit) existential issues 2.

An

existential orientation maintains

humanness of each 3.

An

primary regard for the unique individuality and

client

existential orientation gives central attention to the client’s

own

beingness, awareness,

or subjectivity 4.

ET

An existential orientation emphasizes the atemporalit)^

—

the lived present

—of

subjective

life,

and thus

all

other time frames are seen chiefly in relation to the immediate (pp. 105—106).

Fischer et

al.

(2000) pointed to three general themes that can be seen in

approaches: relationship, understanding, and flexibility

engage

in the relationship

and attend

to

its

(p.

248).

all

The

contemporary therapist

must

nuances. Understanding means the counselor’s

EXISTENIIAL THERAPY

191

sincere attempt to enter into the clients world. leads to the conclusion that the therapist to

The

must be

idea of the uniqueness of the individual

flexible in

approaching clients and

change approach or orientation across or within sessions (Walsh

Although

ET

Yalom reminds

us that these concerns are not in the forefront for all

times.

He warns

relationship-driven” (2002, p.

ET

& McElwain, 2002).

therapists always keep their versions of the ultimate concerns in

particular client at

All

may need

all

mind,

clients, or for a

us that “therapy should not be theory-driven but

xviii).

therapists see the relationship as an existential encounter,

which should be

authentic and trusting. Bugental writes about presence, or the quality of being fully engaged

moment

in the

need to be

(Bugental

fully present

& Bracke,

1992). For the best therapy, both therapist and client

(Cooper, 2003).

Some proponents of the ET approach

take an interpersonal approach, seeing the client’s

pattern of interpersonal relationships as reflective of her stance toward

world, or in other words, her

would

translate to a focus

selfhood.

The

way of being

in the

their focus

on the here-and-now

being “us,”

as

(p.

1

and

as

others,

and the

2002). This orientation

an indicator of the

client’s

becomes the center of

client often

ET approaches are distinctly different from others

therapy. Spinelli (2002) suggests that

it

(Spinelli,

on the therapeutic relationship

relationship between therapist

he puts

world

self,

relationship of therapist

and

client, the

in

experience of

13).

Bugental and Kleiner (1993) identified four stages of the therapy process: Developing the alliance, deepening the client’s concern, inner exploration,

working through the

resistance (pp. 107—108). In this view, resistance results

individual’s efforts to shield herself

job

is

to

do

his best to

and disclosing and

from the ultimate threat of nonbeing. The

understand the client

as a

unique individual

who exists

from the

therapist’s

in the

world

(Norcross, 1987). Spinelli (1997) presents

an interesting perspective on transference and countertransference.

He maintains that labeling events real

in these terms allows the therapist to escape the essence

encounter by locating them in the

be viewed

as

past. Instead, these resonances, as

he

calls

of the

them, should

evidence of the “values, beliefs and emotions that present themselves in the current

encounter between therapist and clienf

(p.

37,

italics in original).

Lars anticipates that his encounter with Helen will change both of them. enter her world as best he can, staying present in the

moment and true

He

attempts

to himself.

to

However,

Lars anticipates that there are times that he will get offtrack, distracted, or will experience

emotions that are connected with their encounter.

When

this

happens, Lars will try to be

authentic in dealing with these experiences.

Therapeutic Techniques Van Deurzen (2006) opines “the existential approach is in principle against techniques, as these might hamper human interaction at a deep, direct and real level” (p. 283). Other ET writers accept that although for the most part EEs do not advocate any specific techniques, they do tend to draw from a wide array of interventions fotind in existing counseling approaches (Fischer et ah, 2000); Yalom (1980; May & Yalom, 2005) would advocate that any intervention that helps the

client gain awareness of the

EXISTENTIAL THERAPY

192 anxiety associated with the four ultimate concerns

ET

techniques mentioned most often by

might be used

to address

ET

is

fair

game.

will present a

I

advocates below, with emphasis on

how

few they

goals.

Attention to Nonverbal Behavior Because the emphasis in

observing the

in

client’s

ET is on awareness of ones being, ET counselors are very interested

nonverbal expression and calling their attention to

Lars observes Helen for nonverbal signs ofher current state.

(Cooper, 2003).

He notes that she clasps her hands

and try to describe what she is experiencing is feeling isolated and alone, and the clasp of her hands is a way of

body and asks her

across her

it

Helen responds that she

to notice this

soothing herself

Sele-disclosure It is

common

quite

for

(Fischer et ah, 2000).

and

ET practitioners

Stemming from

present, self-disclosure

is

to share their personal reactions with their clients

the

ET value

that the counselor

must be authentic

seen as deepening the therapeutic encounter.

can disclose in one of two ways: about the process of therapy relationship) or about the therapist’s

own

(i.e.,

The counselor

the client-counselor

existential struggles (Colledge, 2002).

moment arise. For instance, he might respond to the feeling that he is distant from Helen and express his real wish to more fully encounter her. Lars might also reveal some aspect of his own search for life meaning. Lars

is

willing to open himself to Helen, should the

Paradoxical Intention One

of the best

known ET

techniques, paradoxical intention, originated with Frankl

(1984). Used mainly for what Frankl terms neurotic fear fear

of unbeing),

it

it is

we

compared

to the realistic

involves encouraging the client to*“go with” a troublesome

or problem and experience

whatever

(as

it

deliberately (Cooper, 2003).

greatly fear allows us to engage the

unique

symptom

By facing and experiencing

human

capacity to laugh at

and thereby gain distance from our symptoms. Fischer (1991) adds that practicing the symptom allows the client and the therapist to understand its meaning to

ourselves

the client.

Because Helen does not report a

specific,

traditional symptom, paradoxical intention

not be a good choice, thinks Lars. However, he does consider asking Helen experience

“humdrum'do more fully

explore this sense

may

to deliberately

ofstuckness.

Dereflection Another strategy oflered by Frankl, dereflection, consists of directing the

combat the tendencv that Frankl saw focus too intently on internal processes (Cooper, 2003).

attention out to the world. distressed individuals to

client to turn her

It is

meant

to

in

some

— EXISTENTIAL THERAPY

193

Lars observes that Lielen does not seem excessively self-focused at

more intent on meeting the needs of others, and concludes that using dereflection it

might be useful

later

is

a long-time pattern for

this is

not advisable but

is

this time. Rather, she

always open

seems

her.

to the possibility

Lars that

on in therapy.

Dream Analysis Yalom (1980)

a big fan

is

between psychic

of dream analysis. Rather than looking for unconscious conflicts

entities as a psychoanalytic therapist

looking for manifestations of the

Helen

relates

a dream

the banks, passively.

client’s issues

The

college professor

away by a

also

is

therapist

is

around the four ultimate concerns.

Lars about being swept

to

ET

would, however, the

Her family watches from but seems to be upset and

river.

on the banks,

and Helen explore the meaning of this dream, finding that it symbolizes her feelings ofpowerless and the state of her relationships with her family. The professor is the only hope, the dream seems to say. He may be the ultimate follows her progress

rescuer; however, it

Together, Lars

closely.

is

likely that

part of Helen that wants

to

on a deeper

level,

take action to find

new

the professor-figure sources

of meaning

is

a

reflection

in her

of a

life.

Bracketing The ET counselor must standing the

client’s

Lars works hard

However, he

is

learn to suspend her

world

aware that

remains aware that

it is

& Strasser,

(Strasser

to clear his

own

mind ofhis own this

is

beliefs

and

biases in favor of fully under-

1997). This process

beliefs

is

called bracketing.

and values when he

encounters Helen.

not entirely possible, so he brackets his material but

there without focusing on

it.

Guided Fantasy Yalom

describes using imagery to increase death awareness (1980, p. 175).

The

client

is

asked to meditate on her death in some way; picturing her funeral, write her obituary,

on where, how, when.

speculate

Lars considers having Helen contemplate her death. She exercise

but goes on

to

paint a vivid picture. She

is

cries as she

at first very afraid of this

connects with the feelings of

aloneness.

EVALUATION OF THE THEORY ET is criticized on a number of counts. it

First, it is

not

really a cohesive

theory of psychotherapy

seems more a collection of components of existential philosophy upon which to base a techni-

cally eclectic practice.

of ET.

A

The very diversity of viewpoints makes

second criticism

use abstract terms, readers, the

is

it

difficult to

form

a coherent sense

that writers in this area are often difficult to read.

and sometimes, convoluted language and

borrowing of terms from German

is

often difficult.

rationales.

They tend

to

For English-speiiking

EXISTENTIAL THERAPY

194 According

Cooper (2003),

ro

relativism: if everything

human

existence?

isn’t this

a

is

ET

suffers

from something akin

individual and unique,

how

can

we

theorize about the givens of

How can one advise authenticity and courage?

philosophy of “anything goes”

(p.

the paradox of

to

If everything

is

subjective,

31)?

Qualities of Theory Precision

You have probably divined by now that the ET approach is not because of its philosophical nature and variations in theoretical structures

and

Testability.

very testable

camp. However,

across theorists within this

psychology

a recent line of research in social

Management Theory, or the ways in which humans avoid evidence of their Box 6.3, I provide a brief summary of this line of theory and research.

explores Terror mortality. In

Box 6.3

Management Theory:

Terror

in Despite claims by

many

Existential

an Experimental Paradigm

that existential theory could not he studied in traditional scientific

paradigms, in the early 1980s, three graduate students decided to

and Tom Pyszczynski, reviewing the current

Jeff Greenberg,

cluded that

was quite elegant

it

about why. Soloman

et

mainstream psychology: 1.

2.

Why are Why do

Theory

al.

in describing

how we

(2004) identified two

state

try.

Sheldon Soloman,

of social psychology, con-

function, but lacking in explanation

critical

questions that were neglected by

'

people so intensely concerned with their self-esteem? people cling so tenaciously to their

a difficult time coexisting with others different

own

and have such

cultural beliefs

from themselves?

14)

(p.

They set out to study these issues, developing what they later named terror management theory (TMT). Early research efforts found a less-than-warm reception from their social

psychology colleagues, but they were not dissuaded. Based partially

theory,

our

Soloman

own

et al. postulated that

mortality.

To compensate

because

and

science),

we

are also

we developed

aware of

culture. Culture

members of a meaningful

symbolic immortality through preserving cultural

security,

(e.g., art

are self-aware,

for the resulting terror,

gives us a sense of self-worth (we are valuable

and

humans

in evolutionary

artifacts

and protecting children. Sometimes culture implies

venture), safety

and

traditions

religion,

which

assures us of the “real” immortality of an afterlife.

Hie need culture, for

for self-esteem, in this view,

it is

cultural rules. is

is

universal (p. 17). Self-esteem

is

connected to

derived through membership in the meaningful culture and adherence to

However, the existence of other cultural groups

who

have different values

inherently threatening: to acknowledge the validity of beliefs at odds with our

to perceive that ours

two

is

which

is

not the true, protective cloak that protects us from mortality. Thus,

essential processes protect us

views,

own

from the

terror

leads to (b) self-esteem attained

of death:

(a)

belief in

through meeting our

our cultural world

culture’s standards.

EXISTENTIAL THERAPY

Soloman research

et al. set

195

out to

test their theory,

and

that involving the mortality salience

is

and self-esteem provide

a particularly interesting aspect of this

(MS) hypothesis:

about the nature of

beliefs

cultural worldviews

“if

reality that

function to assuage

anxiety associated with the awareness of death, then asking people to ponder their

own

mortality should increase the need for the protection provided by such beliefs”

20).

(p.

MS interventions, for example, should produce positive affect for those similar to us (who hold the same beliefs) and denigration of those who are different. Typical MS interventions ask participants to write

down

feelings

management hypotheses have

Terror

example, Greenberg

who were

MS

They found

own

deaths.

since been confirmed in a series of studies. For

(1990) asked participants

et al.

target individuals

intervention.

invoked by thoughts of their

who were

Christian to evaluate

either Christian or Jewish after receiving or not receiving an

more

that these Christian participants reported

more

reactions to the Christian target and

positive

when

negative reactions to the Jewish target

MS intervention (these effects are called “worldview defenses”). No such differences were found in the control (no MS intervention) condition. Subsequent they had received the

studies confirmed these attitudinal effects,

MS

research has demonstrated that self-esteem

and that

relatively

and found behavioral differences

Other

too.

interventions create activity directed at bolstering

high self-esteem appears to reduce the need to enact

worldview defenses. So, terror

management

you would have theory). a client

Empirical

is

alive

and

well, if you believe

Soloman

et

al. s

research (but

to be of a culture that values such scientific activity, according to the

You might want

to give these ideas

some thought

the next time

you

are facing

of a different worldview.

Validity.

ET

folks are not too enthusiastic

According to Norcross (1987),

about traditional empirical research.

this reluctance has to

do with the perception among

proponents that the reductionistic and deterministic nature of empirical study to the basic

philosophy of ET. Further, the general lack of structure and

clarity

is

ET

contrary

of ET

as a

theoretical orientation contributes to the difficulty.

Research Support Outcome

Research. Elliot (2001)

therapies

and reported

conducted a meta-analysis of 99 studies of humanistic

amounts

that overall, clients demonstrated significant

These gains were found

to be

maintained for up to

a year. Fiowever,

of change.

most of the studies

included in the meta-analysis were of person-centered therapy or the emotion-focused

hybrid approaches developed recently

(e.g.,

process-experiential or emotionally focused

therapies for couples).

Lantz and his colleagues have reported on the outcomes of ET therapy with

of different client problems. For example, Lantz and Raiz (2004) presented of

ET

therapy with 29 older adult couples.

They found

therapy on the Purpose in Life Test (Crtimbatigh

&

significant

a

number

a 5-year

improvement

study

dtiring

Maholick, 1964) and on perceptions

of the couples’ relationships. Lanz and Cregoire (2000a) studied couples dealing with breast cancer

who were

seen in

ET

therapy over a 20-year period. This study of 27 couples

EXISTENTIAL THERAPY

196 revealed eight

common

control, recollection

anger

us?,

at

themes

and

in these couples’ lives:

grief, guilt

God, anger

at

mindfulness of being,

loss

of

and abandonment, communication disruptions, why

medical personnel (due to perceived coldness and distance),

and worries about future sexual performance. Eighteen of the couples provided 3 measurements on the Purpose in Life Test and a measure of relationship functioning. Overall these couples showed improvement over the course of therapy, and maintained these changes at follow-up. Similarly, positive outcomes were reported with couples in which one

was

research, however,

&

Vietnam War (Lantz

a veteran of the

member

Gregoire, 2000b). In evaluating Lantz’s

important to note that these are not controlled outcome studies

it is

(with standardized intervention and control groups), so conclusions from these should be treated carefully.

Theory-Testing Research. to research,

ET theorists generally advocate case study or qualitative approaches

although Yalom (1980) reviews research from general psychology that he

supports ET. Schneider (2003) also notes that support for tors research that looks at the therapeutic alliance,

process-experiential therapy (Elliot, Watson,

relevant to ET, although

ET can be found in common fac-

empathy, genuineness and in research on

Goldman,

& Greenberg, 2004; see Chapter 7,

“Gestalt Therapy,” for a discussion of this approach

McElwain (2002) came

and research

results).

As

noted

I

and a sense of life meaning is

earlier, terror

saw

as

not explicitly seated in existential principles. For example, they

cited research based in the constructivistic notions about the role of narrative in

that links storytelling

Walsh and

to similar conclusions after reviewing research that they it is

asserts

management theory

support of ET.

also offered as evidence in

explores

human lives

some hypotheses developed from

existential theory.

Norcross (1987) conducted a survey of

which can loosely be construed

practice,

ET

therapists to determine

as a test

of

ET

theory.

teen psychologists responded to a survey that identified 14

The top-ranked

intervention for

and warmth, followed psychological testing.

closely

ET

ET proponents

attention to nonverbal behavior,

and

authenticity.

in

Three hundred and nine-

components of practice

counselors was “Rogerian

by therapist

what they did

skills,”

activity.

meaning empathy

Lowest ranked were flooding and

also reported using

more

relationship-building

self-disclosure than psychoalanalytic

skills,

and behavioral

respondents in this sample.

AND CULTURAL DIVERSITY

ISSUES OF INDIVIDUAL ET

is

seen as very useful with a wide range of clients. Burlin and Guzzetta (1977) contend

that the

themes of ET are particularly relevant

“people are subjects, not objects” encourages

for

women. For example,

women

the

ET value

that

to discover value within themselves

rather than through the culturally endorsed dimension of physical attractiveness (p. 262).

Likewise, Vontress (1985) sees

“although

it

is

of the

as

viable for use across cultures.

He

writes that

important to consider specific cultures and their impact on individuals

socialized in them,

members

ET

it

same

is

more

species,

become fully aware of the human condition. As individual members of Homo sapiens face conspecific and useful to

culture specific problems simultaneously”

(p.

211).

— EXISTENTIAL THERAPY However,

197 emphasis on individualism

for others, the

in

ET

theory

problematic in

is

A

considering people from cultures other than the white. Western European variety. particular

problem might

arise in cases

where the

client

is

from one of the groups who have

historically experienced oppression (e.g. gay/lesbian, African

American, Native American)

they might find the emphasis on free will and choice to be counter to their views of the world.

However, Frankl (1984) would contend that even

if there is

no choice, meaning can be found

in suffering.

THE CASE STUDY The

case of

stage in her

Helen was in

life

which she

Because she

tions.

is

from an

relatively easily conceptualized

from

reevaluating meaning,

is

a social situation

which

fits

ET

perspective.

perfectly with

She

is

at a

ET assump-

where she has the means and support

engage in such reflection, the application of ET theory was

to

fairly straightforward.

Summary ET theory is grounded in

philosophy more than perhaps any other theory of counseling.

advocates unite in the contention that

humans

are motivated to seek

meaning

in

life.

Its

Yalom

(1980) presents the four ultimate concerns of life: death, freedom, isolation, and meaninglessness. Psychological health

plight as

ET

human

therapy

is

beings.

is

seen as an encounter between two beings, focused on the present.

relationship between therapist

such

as

when

seen in authentic living and awareness and acceptance of our

and

client

is

central

and

is

The

often the vehicle for interventions,

the therapist self-discloses to the client. Very few specific techniques are

identified in this approach.

ET makes

theory it

research

is

criticized for

being

difficult to read

and understand and

difficult to test directly in traditional scientific is

its

paradigms. Case study or qualitative

often used along with drawing supportive information from the

studies of psychotherapy or psychological functioning.

ET

is

responsibility

may

not

fit

more

general

a flexible approach, so

often characterized as helpful to a wide range of clients. However,

and individual

diverse nature

its

it

is

emphasis on freedom

with the worldview of clients

who

are

members of

groups that have been oppressed.

Visit

Chapter 6 on the Companion Website

chapter-specific resources

and

self-assessments.

at

www.prenhall.com/murdock

for

jil

. .

Fritz Peris

Jessica fit,

is

a 30-year-old African American

woman who

works as a police

officer.

She

is

physically

and appears open to counseling. Jessica has a 5-year-old son. Dale, from a previous Jessica and Dale have had no contact with Dales father fior several years.

verbal,

marriage.

Jessica seeks counseling because she

whom

is

troubled in her current relationship with Randy,

had a serious fight involving physical contact. Jessica- had been trimming Randy s hair, and she moved his head too abruptly. Randy became angry and Jessica apologized. Randy remained agitated and got up, threatening to leave their apartment. Jessica, who feared that Randy would not return, took Randy’s car keys. Randy reacted by locking the door, closing the blinds, and grabbing Jessica by the neck, shoving her against a wall. Randy then retreated to the bedroom. The couple did not speak about the incident afterward, and they have not discussed it since then. with

she has been living fior

2 years.

Recently, the couple

This altercation was the fourth episode of violence in Jessica’s relationship with Randy.

offour children. Her parents divorced when Jessica was 12, and her mother remarried shortly afterward. She has two step-siblings as a result of this marriage, but she is not close to them. Jessica reports a ''normal” childhood and some emoJessica

is

the oldest in a family

tional turmoil as a teenager (in reaction to the divorce), but overall, says the household in

which she lived was

relatively calm. Jessica characterizes her

mother as distant and busi-

and reports that she has difficulty relating to her. Jessica had a positive relationship with her biologicalfather, who has not remarried, up until she decided to become a police officer. Her biological father reacted very negatively when Jessica told him, saying, "Cops are pigs. Ifyou become a cop, I never want to see you again. ’’Jessica pursued her wishes despite this reaction and has spoken with her father only nesslike,

three times in the last Jessica

8 years.

admits that she

is

afraid of Randy

have a good relationship. Jessica seems her relationship.

198

Randy sees no

to

when he gets

angry, but that otherwise they

take responsibility for anything that goes

real problem with the violent incidents in the past

wrong in

and does

GESTALT THERAPY not want

come

to

199

to counseling.

relationship, specijying Jessicas son Jessica

get into as

how and when

Dale generally get

wants

According

how

to learn

he

to Jessica,

things get

much

very

is

in charge

of their

done around their apartment. Randy and

along, hut are not close. to create

a better relationship with Randy

many fights. She sees herselfas responsible for many ofthe problems in

ship. Jessica thinks that ifshe tries

harder

to

do not

so that they

the relation-

meet Randy s expectations, things will get

better.

BACKGROUND Gestalt

of

Therapy (GT)

GT

often center

(1893—1970).

was 76:

Peris

is

“1 believe that

the world.

How

is

in

is

some ways

on the

a difficult topic to approach. Historical descriptions

practice of the flamboyant

and

controversial

Fritz

captured well by his statement in his autobiography, written I

am

this for

the best therapist for any type of neurosis in the States,

megalomania?”

(Peris,

1969b,

p.

when he maybe in

228).

Others have contributed to the theory and practice of GT, including

confrontive,

which

“Perlism,”

and

Insiders speak of “splits” within the

workshop format

GT community,

(Parlett

“East and

writers

of doing therapy: showy,

refers to Peris’ distinctive style

typically in a very public

Laura,

Peris’ wife,

and the theory has evolved considerably from the approach he developed. Often,

comment on

Peris

& Hemming,

West Coast

1996a).

New York

and

Cleveland Gestalt Therapy, Gestalt Therapy with the empty chair and Gestalt Therapy face to face. Gestalt

Therapy and body work. Gestalt Therapy and psychoanalysis. Gestalt Ther-

apy of the early Peris and Gestalt Therapy of the later, ern variants are generally

less

Practitioners of these styles of Peris at the

end of his

more may look more

confrontive and

GT

career. In this chapter,

I

will

etc., etc.”

(Friedman, 2003,

p. 60).

Mod-

attentive to the therapeutic relationship. like traditional

psychoanalysts than did

attempt to convey the approach

practiced currently, but also describe the defining features of Peris’ approach to

as

it is

GT.

Probably because Peris was a very colorful character and prone to providing showy public

demonstrations of GT, the credit (or blame) for the theory

He was

a very controversial figure, a self-confessed “dirty old

prompted Clarkson and Mackewn (1993)

Who

Peris

was depends upon

to

is

usually placed with him.

man”

(Peris,

1969b), which

comment.

whom you speak with,

and when. To some he was

a hero,

some cruel, to others tender; to some generous, to others the world’s biggest taker; to some a genius, to others a near-illiterate non-intellectual; to some he seemed sociable and happy, to others lonely and poor at making genuine contact with the people around him; to some he was a beautiful sensuous man, to others an ugly toad, a dirty lecherous old man; to some a narcissistic exhibitionist, to others a shy, to others a bastard; to

withdrawn Peris

was

introvert too

proud

to ask for love. (p. 30)

initially trained in classic psychoanalysis,

and

his first theoretical

attempts

replaced Freud’s sexual drive with the hunger drive (Harman, 1990). In Ego, Hunger, Aggression (1942), Peris’

first

book, he attempted to integrate these ideas with traditional

psychoanalytic theory. Aspects of the “oral metaphor” can be seen in later

emphasis on assimilating swallowing whole.

Peris’

and

(or digesting) experience

and the

GT

theory’s

rejection of introjection, or

subsequent writings retained some of the flavor of psychoanalytic

theory, but progressively diverged both in theory

and technique.

GESTALT THERAPY

200

A

major influence on

thought was Gestalt psychology,

Peris’

psychology that explored

how humans

branch of perceptual

a

meaning out of perceptual

create

The of human

stimuli.

influence of this approach can be seen in the ideas about the holistic nature

experience and the primacy of figure— ground relationships (see the section on needs later in this chapter).

GT theory evolved, however, 'the influence of the purely perceptual Gestalt

As

theory diminished. Peris acknowledged that he was not wholly committed to classic Gestalt theory because he was uncomfortable with the traditional scientific approach used by these theorists.

“The academic

Gestaltists

of course never accepted me,” he wrote (1969b,

GT theory was also shaped by Peris’

background

therapy and Rolfing, and existentialist and

p. 62).

in theater, his stints in Reichian

Zen philosophy.

Reich,

who

body

believed that psy-

chic energy, including emotion, was stored in the body, was Peris’ analyst for 2 years (from

1931 to 1933).

Born

Germany. He was the youngest of three children; whereas

grew up

to a progressive Jewish family in 1893, Peris

his father

reportedly had closer to his

his

mother than

(Glarkson

affairs

suburb of Berlin,

mother was devoted

was more distant emotionally and physically

numerous extramarital

in a

to his father until about age 10,

to her children,

(traveling for business)

and

&

Mackewn, 1993). Fritz was when his relationships with both

parents, along with his scholastic performance, deteriorated. Rebellious throughout his

managed to find a second school that affirmed his independence, from which he graduated. Throughout his adolescence he pursued theater work, and his emphasis on nonverbal behavior in GT counseling is said to stem from these experiences (Glarkson & Mackewn, 1993). After serving in World War I, Peris received his medical degree in 1920. He began his practice of medicine as a neuropsychiatrist (Clarkson & Mackewn, 1993). At age 31, still living at home with his mother. Peris began psychoanalysis with Karen Homey. Although brief, this analysis started Peris on the road to becoming an orthodox analyst, despite a very adolescence, he was expelled from school once, but

negative experience with his second analyst,

who

said almost

scraped his feet on the floor to signal the end of sessions to Frankfurt,

Germany, and

nothing during sessions and

(Peris,

1969b). In 1926 he

moved

was there that he became familiar with Gestalt psychology.

it

After Peris completed his training analysis, he established himself as a psychoanalyst and practiced in Berlin from 1928 to 1933.

According to Clarkson and Mackewn, the

came by way of Laura Posner gists

Peris,

Buber and Husserl. Laura and

children, Renate Fritz

and

and Laura

(Clarkson

who had Fritz

met

existentialist influences in Gestalt

Therapy

studied with the well-known phenomenolo-

1926 and married

in

in

1929.

They had two

Steve.

left

& Mackewn,

Berlin in

1993).

1933

They ended up

South African

Institute for Psychoanalysis.

a conference,

hoping

to

in

him

little

as

this

period Peris returned to Europe for

He was

disappointed

when

his

work was

attention. Shortly thereafter, the International

Psychoanalytic Association decreed that analysts

Europe could not be recognized

South Africa, where they established the

During

meet Sigmund Freud.

poorly received and Freud paid

was appointed chancellor of Germany

as Hitler

who had

not served

as training analysts in

such in other parts of the world. This invalidation of

work in South Africa was a powerful event in Peris’ development. After World War II, in which Peris served as a physician in the South African army. Peris moved to America, followed a year later by Laura and their children (in 1947). Settling in Peris’

GESTALT THERAPY

201

New York, the couple established a practice and eventually established the Gestalt Institute of New York. The participants in the institute were diverse people with wide-ranging interests

and strong

religion

and psychodrama,

result

encountered Eastern

first

life

situations.

consider to be the foundation text of Gestalt Therapy,

and Growth

Excitement

time period, Peris

this

form of psychotherapy invented by Jacob Moreno that

a

required the client to act out

What many

During

personalities.

in

of the vigorous and

Human

among

the early

&

Goodman, 1951), was a members of the Gestalt Institute.

Personality (Peris, Hefferline,

lively discussions

Gestalt Therapy:

Hemming (1996a), the book originated from a 50-page manuscript that Peris asked Goodman to transform into a book. Goodman, described as a “quirky, brilliant and

According to

Parlett

thinker”

91), took the challenge

(p.

Goodmans

(Wheeler, 1991).

who

tributed by Hefferline,

to as “Peris, Hefferline,

acknowledge that the

The

and ran with

it;

some authors

and Goodman,” and

basic elements of the

GT

phenomenological approach, experiments), but

merits are

its

still

The book

was diagnosed with a heart condition

Florida, at age 63. Tension

had

arisen in Fritz

& Hemming,

in

It

was

Miami

in

that Fritz

and Lauras

relationship,

and although they never

&

Mackewn

Moving

to the

It

ended when

West Goast

Big Sur, Galifornia, in 1964. ally treated Peris

He was

became

affiliated

poor physical health

in

was known

for the freewheeling styles of teachers

including Rollo May, Virginia the

workshop

tradition for

which he

Therapy on

sisting largely

of edited transcripts of

is

found

From Island,

sions

An in

down

chronic tension his

human

and

potential

is

well

movement.

participants, including sexual

many well-known

known

at

individuals,

& Mackewn,

Esalen in which he

1993).

demon-

stage in front of large crowds. Gestalt Therapy Verbatim, conPeris’

interesting account of Peris’

and

workshops, was published others’ antics at Esalen,

in

which

1969 still

(Peris,

operates,

Anderson’s (2004) The Upstart Spring.

Easlen, Peris

Ganada,

in

moved on

community at Gowichan Lake, Vancouver Peris was happy there, leading training ses-

to start a Gestalt

1969. According to reports.

and working on

several other books. Rather quickly, however, his health declined,

and he died of a heart attack

after surgery in

March 1970.

Miller, in his Introduction to Gestalt Therapy Verbatim, pointed out that

uct of the 1960s, lious; the

969b).

Rolf eventu-

at the time. Ida

and Abraham Maslow (Glarkson

Satir,

strated Gestalt

1969a).

1

psychological dynamics are translated into physical problems.

encounters and drug use. At Esalen, Peris was exposed to

He began

(Peris,

as the

responded favorably, perhaps further supporting

Peris

Esalen became famous in the 1960s as a center of the It

Fromm

with

with the Esalen Institute in

with her approach, which emphasized breaking

many

of Marty Fromm. This

lover,

Fromm fell in love with a younger man

In 1960, Peris

through deep muscle massage. conviction that

and then

p. 23). Peris characterized his relationship

(1993,

most important in his life.

therapist,

Mackewn,

was a controversial one, labeled “irresponsible and unethical” by

relationship, needless to say,

Glarkson and

became the

1996a).

1956 and moved by himself to Miami,

divorced, they never lived together again for any significant period (Glarkson

1993).

holism, the

(e.g.,

has been characterized both as dense and un-

readable and as multilayered and deeply meaningful, like poetry (Parlett Fritz Peris

often referred

is

the subject of debate. All

approach were in the book

it

as

book were con-

exercises in awareness in the first half of the

used them with his university students.

work

refer to the

mood

which he described of the

sixties

was

as

GT was

a prod-

“outrageously playful, promiscuous, utopian, rebel-

alternatively

good-humored and

angry,

and somehow

1

GESTALT THERAPY

202 managed

to be at

once sophisticated and naive”

professional career. Peris’ philosophy evolved

(Miller, 1989, p. 19).

from

Over the

traditional consei'vative psychoanalysis to

the freedom-loving, spectacular approach of GT, rebelling against authority

999), which rejected traditional

of

shown

Prayer”

Box

in

7.1.

I

norms

To

remember

seeing the prayer

colors against a black

background so that

Anderson (2004), the

last line

the ‘60s

and

of experiments

in favOr

“free” sex.

which were drug use and

and emphasizing

and GT, became icons of the hippie generation (Crocker,

a return to innocence. Peris himself, 1

years of his

was often

catch

it

some

in living, the

of the flavor of

on

a poster,

GT, read

done up

would be cool under black because

left off,

it

most prominent

in psychedelic

lights.

was too gloomy.

the “Gestalt

According to

What

people in

was the “do your own thing” message.

‘70s resonated to

Second- and third-generation students of Gestalt Therapy such

as

Erving

Polster,

Miriam

Fromm, and Gary Yontef continue to practice and promote the approach. You selection about the therapist’s tasks in Box 7.2, written by Joen Fagan. These later

Polster, Isadore

can read a

versions have (Parlett

scribes

promoted

& Hemming,

a

more moderate form of GT than

1996a,

“modern Gestalt Therapy” method, there

tion (Parlett

& Hemming,

1992).

Wagner-Moore (2004)

GT theory

is little

1996a).

is

that although there are core principles

orthodox doctrine about

A survey of 225

how

compared

how

it

is

practiced

(i.e.,

attendees at the American Association

spontaneous, authentic, creative,

to content orientation) rather than

Miller (1989) observed that “Gestalt tic

establishment where

apists

have heard of

it,

it

by

and

these are put into ac-

of Gestalt Therapy’s second international conference in 1997 revealed that defined by

de-

However,

as “a gentler, ‘Rogerian-ized’ version” (p. 183).

one of the confusing things about a broad sense of

& Greenberg,

95; Rice

p.

the confrontive, stagey “Perlism”

its

GT

alive, a

theory (Bowman, 1998,

p.

is

largely

process as 105).

Therapy remains on the margins of the therapeu-

no longer generates much heat or controversy; most psychother-

but relatively few

rather grim assessment, there

still

know

very

much about

it” (p.

20). Despite this

seems to be significant activity around

this theoretical

and Jacobs (2000) reported that there is a GT and many other countries in the world. Parlett and Hem-

orientation, particularly in Europe. Yontef

major U.S.

institute in every

ming (1996b) suggested

that

city

GT in Great Britain has raised eyebrows by becoming almost

too establishment! In the United States and Ganada, Process Experiential Psychotherapy

Box

The 1

do

my

am not And you I

You

And

thing,

in this

If not,

From E

world

to live

up

Gestalt Prayer

thing. to

your expectations.

to live

up

to mine.

by chance we find each other,

it’s

beautiful.

are not in this

are you, if

and you do your

7.

it

I

can’t

S. Peris,

am

world

I,

be helped.

(1969). Gestalt Therapy Verbatim. Reprinted by permission ol the Gestalt Journal Press.

GESTALT THERAPY

203

Box 7.2

The Tasks of the Therapist

Gestalt

Therapy

PATTERNING The

therapist

informed ot

first

is

of

symptom

a

and responding

patient

diagnosis

is

a perceiver

all

him, he begins

to

it

a process that

is

and demands ol the environment As the therapist begins

and

which

ol theory

tion that have large emotional

some-

interaction with the mate-

example, in the creation ol a mobile, in

as, for

largely cognitive in nature, a

number of awarenesses and

a

arriving at a specific label.

an overall unity and balance.

with the patient requesting help, he has available

his contact

is

is

skills in

a variety ol pieces or systems are interconnected into

body

is

While

that of artistic creation, involving

times cognitive, sometimes perceptual and intuitive

a

he

as

has the disadvantage of provoking the analogy of the

A better analogy lor the process ol patterning

which

As soon

refer to as patterning.

I

medical model and implying that the purpose ol the process

rial

patterns.

or a request lor change, and begins listening to and observing a

more common term,

a

and constructor of

background ol past experience,

personal responses derived from the ongoing interac-

and

intuitive

components. From

these,

which may be

given varying degrees of importance by a specific therapist, he begins to form an under-

standing of the interaction ol events and systems that result in a given supports a given

happen

symptom

of existence, such

specific level

The

systems, etc.

patient

cellular, historical,

all

those interlocking events that interact on a

economic,

family

as biological systems, self-perception systems,

visualized as a focal point of

is

etc.

The more

tion, or be sensitive to the possible effects

that

happened or do

pattern. Events refers to the things that have

to the patient; systems includes

life style

many

systems, including the

the therapist can specify the entire interac-

of systems he

is

not directly concerned with

(such as the neurological), or intuit the connecting points between systems where the

most level

strain exists, the

and

more

he can be in producing change.

effective

point that promises the most positive change in

at a

He

symptoms

can act on a

or conflicts at

the least cost of effort, and where the least disruptive change will occur to other systems.

An example may clarify some

of the above description.

A mother refers her son whose

home from school. The therapist shortly begins to accumulate information of various sorts. He learns that: the boy also has stomachaches that keep him from going to camp or from visiting relatives; the mother increasing stomach distress causes

has few interests outside the illnesses;

the

mother and

telligence; the

tease

him

mother

through a long tains

ing

some

to

is

made many

is

considered

changes,

etc.

his voice

ol responses, observations,

also has frequent

boy has average

is

Through

the school system has a

therapist observes that the

in-

boy and

in

which the

his family to

processes

a

su-

boy waits

weak when he does answer; and

and experiments

these

new so

on

therapist ob-

respond to vary-

picture

emerges with

The boy, his stomach, his family, his peer group, the school, the community come into locus with varying degrees ol explicitness.

clarity.

system, and the

pressures.

strict;

The

sort ol assessment ol the abilities ol the

and

and

very interested in his becoming a doctor; the other children

answer lor him; that

list

suggestions

increasing

has

father does not like his job

lather have intercourse very infrequently; the

grandmother

who

frequently to stay

home; the

for being a sissy; his teacher

perintendent lor his

him

school

GESTALT THERAPY

204

The

on cognitive theory and

Gestalt contribution to patterning involves a de-emphasis

provides extensive assistance with the therapists

own

awareness. Enright, in chapters 8 and

21, describes this process in detail, emphasizing the clues to underlying events styles that

word

choice, etc.,

or interviewing.

and suggesting some appropriate techniques is

worked out

The meanings

dream work,

that result, as in

of much importance do

However, the Gestalt therapist

upon one specific behavior such in the point

his posture

and the person he

of are the focal points.

of various environmental

effects as

communication

style.

The

is

his body,

between

his

are designed to bear

and dreams.

interested in a global

may

upon

the point of intersection,

how

skills in

ing awareness and change. Since these are

is

make

member

a

inferences

ask the patient to reenact his

Most

Gestalt procedures

and the nature of the other system

the patient perceives or reacts to

including the patient’s

in-

tone of voice, between

Gestalt therapist does not hypothesize nor

important than

itself,

past events

nor in focusing

talking to, between himself and the group he

In other words, the patterning emphasis in Gestalt teraction

is

his

perceptions of them, as in a dialogue with his father, for example.

as less

gestures,

forces,

Rather, he

words and

about other systems that he cannot observe, though he

viewed

Of course,

patient’s previous history.

of contact between the various systems available for observation. The

between a person and

teractions

are specified in

not interested in the historical reconstruction of the pa-

is

nor in weighing the

tient’s life,

from the

are very different

from the process of exploring posture,

arise

of

than by history-taking

where certain meanings

traditional analytic interpretive approaches

Much

for exploration.

in the therapy process itself rather

advance by theory or predicted from the

way

life

can be uncovered by awareness of the person’s movements, tones, expressions,

Gestalt patterning

more

and

fostering

Therapy and

is

is

it.

on the process of

in-

risking interaction, or block-

of importance in the intersection of any

skills

systems from the biological through the social, the Gestalt therapist sees himsell as

preparing the individual to interact more effectively in cerning a therapeutic community, which he

is

presently formulating, represent a possi-

ble extension

of Gestalt thinking to a more extensive system.

Fagan,

The

(1970).

J.

tasks of the therapist. In

(pp. 88-106). Palo Alto,

(see

Box 7.3

J.

Eagan and

I.

I

am

(Elliot,

it

Watson, Goldman,

pleased to invite

a

number

you

of

www.gestalt.org ). This

Gestalt

Gestalt therapy

is

research

watch the work of a contemporary Gestalt

to

theories,

& Greenberg, 2004; Greenberg & Rice,

DVD.

organizations

site

Enough supportive

on

is

this

1997).

therapist, Shelley

Other sources of current information on

and

journals,

such

as

the

Gestalt

GT page

a joint project of the Gestalt JournaT^xt^ the International

Therapy Association. That the International Association held

ference in

2002 demonstrates

therapists.

An electronic journal.

glish-language

now

to be referred to as evidence-based experiential psy-

Stelmach, on the Theories in Action include

Shepherd (Eds.)

which combines Gestalt and Person-Centered

for a description),

approach has accumulated for chotherapy

L.

CA: Science and Behavior Books.

considered a respected theoretical development.

(

aspects of life. Perls’s ideas con-

all

GT journals are

that Gestalt Gestalt!,

Therapy

is

can be found

still

at

its first

of interest

annual con-

among

practicing

www.g-g.org/ and two other En,

Gestalt Review 2ind British Gestalt Journal.

The

Association

GESTALT THERAPY

205

Box 7.3

Emotion Focused Therapy: The Process-Experiential Approach A recent approach,

Process Experiential

Therapy (PET)

also

known

Emotion Focused

as

Therapy, fuses aspects of the Person-Centered (PC) Gestalt, and existential approaches.

PET

is

based on the assumption that

what

is

important and prepare us for action. Dysfunction

bolizing experience,

dysfunction.

The

see the influence of

PC

and

goal of therapy in this approach

is

therapist in

results

from problems

PET

first strives

GT

among

these are chair dialogs similar to those used in

can productively explore their experiences. Techniques in

PC

Once

PC

the rela-

GT.

PET

and the power clients is

sim-

theory (focusing, systematic evocative unfolding, narrative retelling, and

creation)

all

which

include a set that

and dialogs reminiscent of Gestalt Therapy (two-chair and empty

chair). Focusing, systematic evocative unfolding, narrative retelling

ation are

strategies.

to create a therapeutic climate similar to that in

of the therapist’s empathic prizing of the client in creating a situation in

meaning

new ways of

more adaptive coping

PET emphasizes the importance of a collaborative therapy relationship

ilar to

sym-

established, the therapist can then use interventions that help reprocess the

is

emotions;

in

us

versions of psychological

therapy in order to evoke and understand client emotional experience. tionship

tell

of the experi-

to help clients learn

processing emotion that lead to different meanings and

The

are adaptive signals that

and accompanying distorted emotional processing

you surely

ence. Edere

human emotions

and meaning

cre-

interventions that support client exploration of feelings and the transforma-

tion of these feelings in

ways that promote

effective client responses to

them. In

two-chair dialog, clients experience aspects of themselves as they shift between two chairs.

Two

types of dialogs are identified: those between conflicting aspects of the self

and those between the experiencing

self

and an aspect of the

self that

is

blocking the ex-

pression of emotions or needs. Resolution of the conflict generally requires the two aspects to be accepted by the client so that they can

Adapted from “Humanistic Approaches” by N. S.

Lease (Eds.) Encyclopedia of Counseling,

for the

Advancement of

dedicated to “governing

GT itself

is

L.

work

together.

Murdock and D. C. Wang

Thousand Oaks, CA:

(in press), in

Sage. Reprinted

H.

E. A. Tinsley

&

by permission.

an organization that includes professionals and laypeople

through adherence to Gestalt Therapy principles enacted

an organizational level” (Yontef

& Jacobs,

at

2000).

BASIC PHILOSOPHY humans are growth oriented. A very basic value is holism (Yontef & Jacobs, 2005): humans can’t be separated from their environments, nor can they be divided into parts (such as body and mind). Physical and Gestalt

Therapy (GT)

theorists begin with the notion that

psychological functioning are inherently related; thoughts, feelings, and physical sensations are

all

a part

of a unified being.

GT

theorists often use the

the inseparable psychological and physical aspects of

human

term organism to convey

nature; the process of being

GESTALT THERAPY

206 in

touch with one’s experience (defined

regulation (Yontef

GT and

in the broadest sense)

known

as organismic self-

& Jacobs, 2005). and

a humanistic/existential approach,

is

is

as such,

it

emphasizes individual choice

GT theorists sometimes use the term response1970a). One can see the GT view of humans as

responsibility (Clarkson, 1989). In fact,

ability to reinforce this perspective (Peris,

seemed

neutral. Peris

humans

to see

as

simply another form of biological

yet the

life,

emphasis in the theory on growth and actualization would seem to support a positive view of human nature (Clarkson, 1989). According to

GT theory,

organisms have an innate

all

tendency to grow toward fulfillment and actualization (Crocker, 1999).

we

oriented approach in which

are not focusing

growth process” (Edward Smith, cited

An

is

in conflict

with societal norms

gone a process that has moved

so far

it

Paralleling

developments

on the inherent

phasis

creativity, spontaneity,

interdependence in Enrico

1970a). Peris wrote, “Society has under-

grow

together any more.

becomes doubtful whether

it

our insane society” (1970a,

GT theorists

human

actualization.

Yet,

to

and

of late have placed great em-

condition (Yontef

GT

a healthy

p. 16).

theorists focus

& Jacobs,

2005). In

more on

the role of

He

begins his

existence

work with her from

embedded in

the premise that she

accept responsibility for herselfand

make

a

world around

her.

choices that are true to her

Enrico notes that allowing Jessica’s true potential

some commonly accepted social

is

the environment. Jessica has the poten-

in creative ways, actualizing herself in relationship to the

She has the capacity

trary to

fit

life.

growing organism living an tial to

until

GT, contemporary

GT counselor.

is Jessica’s

exist in

relatedness of the

human

and

expected that healthy behavior will

It is

(Peris,

in psychoanalysis,

contrast to Peris’ versions of

growth-

from healthy functioning, natural functioning, that

Again and again we come into such conflict

and honest person can

“a

p. 19).

our needs and the needs of society and the needs of nature do not

fully sane

is

pathology and cure, but on the

an emphasis on

conformity to convention (Tibet, 1994).

sometimes be

a cure,

Harman, 1990,

GT mentality

important aspect of the

resisting

in

on

GT

to surface

may

be con-

rules.

HUMAN MOTIVATION Human

behavior

is

motivated by the drive to

logical needs are important.

Although

biological needs are clearly important,

one very important need

Another way to regulate the

mony with

is

GT theory does

organism so that

it

from

can grow.

a

Enrico itates

not present a specific

human

GT

list

of needs,

literature suggests that

beings (Hycner, 1987).

GT perspective

The goal of the

is

to see

humans

as striving

process of self-regulation

is

har-

the environment, maturity, or actualization. Self-regulation involves the process is

good and bad

for the organism,

ance of the good and rejection of the bad (Rice is

Both biological and psycho-

and further reading of

interaction with other

to look at motivation

of discriminating what

regulate

satisfy needs.

innate,

and humans adapt

sees Jessica as striving to

& Greenberg,

easily to the

meet her needs

which should lead toward accept1992).

The tendency to

self-

changing environment (Crocker, 1999).

so that she

can grow

and mature. She grav-

toward experiences that maximize her growth, including wanting contact with other

people. Jessica strives to

adapt

to

her environment in a harmonious way.

GESTALT THERAPY

207

CENTRAL CONSTRUCTS Contact Contact

is

the central feature of life, according to

GT

defined

It is

as

meeting the environ-

ment, which can be either external to the person or aspects of the self Seeing, hearing, touching, moving, talking, smelling, and tasting are

ment

(Polster

&

Healthy contact

Polster, 1990).

all

ways of contacting the environ-

results in assimilation

of novel elements

things not already a part of the organism) and hence, growth (Peris et ah, 1951). Fol-

(i.e.,

lowing contact, the organism withdraws for a period of

rest to “digest” the results

of the

contact (Crocker, 1999). Assimilation involves aggression and destruction, which are nat-

making new experiences

ural processes essential to

growth

(Peris et ah, 1951).

healthy part of

Effective contact

essential to

is

in a fully

or in the sort of automatic

kind of contact

latter

The

p.

mode

because

and

such

state,

that

we

as

use in

necessary to the satisfaction of needs.

it is

when we

is

daily living.

An

someone

else,

example of the

which we make contact with the environment.

breathing, during

or I-it contact”

deliberately touch

most of our

important aspect of the contact boundary

The “I-thou

other.

is

aware

life,

makes contact with the environment

individual

An

1995).

a result. Gestalt therapists see aggression as a natural

rather than as an antisocial behavior.

life,

Contact can occur

As

part of the organism, thereby creating

is

at the contact

boundary (Yontef,

the differentiation between self and

essential in establishment

of the

I

(Yontef, 1995,

263). Yontef and Jacobs (2005) note that the contact boundary should be recognized as

having two functions: to connect one to others, but also to allow us to be separate from them.

Jessica

is

able to

make

basic contact with her environment.

She

is

healthy, indicating that

she obtains the basic substances she needs. Enrico observes that she has a tionships, indicating that she

beings. Jessica appears to

is

number of rela-

human

able to establish some kind of contact with other

have a sense ofself; Enrico has a hunch that that sense varies from

relationship to relationship.

Needs Life

a process of

is

tion of Gestalt, a

Greenberg, 1992).

German word roughly meaning “whole”

A Gestalt has a figure,

describe this process. is

&

need satisfaction (Rice

the rest of experience

(i.e.,

in Figure 7.1.

figural to you. If

another basic aspect of the

ness; ficult

GT it it

theory, a need

becomes

figure,

would be

is

becomes ground. Look

this picture

(a

is

clear

and

at the picture

depends on what features become will see that

two

different

young woman and an old woman). Figure 7.2

theory of perception

(Do you

see the horse

—

the fact that

and

we

strive to

rider?).

an incomplete Gestalt that emerges into the organisms aware-

and the

rest

to concentrate

would probably keep

else

your attention, you

GT

integrate pieces into a complete Gestalt In

of

are able to shift

perceptions of this drawing are possible illustrates

or “pattern” (Crocker, 1999) to

the background). In perceptual terms, the figure

What you make

you

theorists use the no-

or feature that stands out, and a ground, which

compelling to our attention, and everything

shown

GT

of experience becomes ground. Think about

on

this

paragraph

drifting to images of pizza!

Once

how

dif-

if

you were very hungry. Your mind

a

need has become

figural, the

person

208

FIGURE

7.1.

A Figure-Ground

FIGURE

7.2.

A

Exercise.

Perceptual Integration Task.

GESTALT THERAPY

FIGURE

7.3.

209

The Cycle of Awareness.

then initiates behavior aimed isfying the need, the Gestalt

at

is

meeting the need.

completed and

need becomes background rather than

figural

another incomplete Gestalt emerges to take

organism

at a given

GT

life.

successful at sat-

said to be destroyed (Wallen, 1970); the

(Wagner-Moore, 2004). Very quickly,

place.

Whatever need It is

is

most urgent

draw

this natural

important to note that

rhythm of figure-ground

is

the

cycles. In

and Clarkson (1989) acown version of the cycle and name for it.

pictures of the cycle of experience,

that everybody seems to have their

in this spirit that

to the

critical to this cycle.

Healthy growth requires

theorists like to

knowledged It is

is

is

continual process of need emergence, satisfaction, and Gestalt destruction

essence of fact,

its

the organism

time becomes figure (Yontef, 1995).

awareness (of the need)

The

it is

When

have created Figure 7.3.

I

Enrico makes some very basic observations in his early interactions with Jessica.

He sees that

aware of the environment around her; he assumes that the degree to which she is aware varies from situation to situation. She appears to be meeting physiological needs ad-

Jessica

is

deduce current needs from Jessica’s presentation and wonders ifone figure for her is a need to be loved. Her work and relationships with intimates

equately. Enrico tries to

thing that

is

Randy seem

other than

to

be

ground at present.

Polarities

GT emphasizes the holistic nature of human functioning, and this allows the recognition of the

power of polarities.

plies dark,

and

If something exists, the

right creates left (Peris, 1969a).

good cop and bad cop,

passive

and

aggressive,

opposite must as well; for instance, light im-

Other relevant

polarities are life

and death,

and masculine and feminine (Levitsky

& Peris,

1970). Peris maintained that Freud partly described one of the most important polarities

when he acknowledged

the superego. However, Freud did not label the other

dimension, which Peris called the infraego polarity top to the

list

(Peris,

dog and underdog. Contemporary

of important

polarities (Yontef

1969a).

More commonly.

end of the

Peris called this

GT theorists would add connection/separation

& Jacobs, 2005).

GESTALT THERAPY

210 of

Polarities are a natural part polarities. ify

them

life,

and we have within our psyche both ends ol the

However, sometimes we don’t want

into dichotomies

and

to accept

one end of the polarity so we

rigid-

one end of the continuum (Yontef & Jacobs, 2000).

reject

number ofpolarities operating in her experience. seem to be bad—good and strong— weak. In her

Enrico suspects that Jessica can recognize a

Some

particularly critical polarities

relationship with Randy, she seems to reject the strong part

of the strong-weak polarity.

Contact Disturbance When

the cycle of awareness

disrupted, problems are seen at the contact boundary. Peris

is

and colleagues (1951) identified some basic ways that contact is interrupted; these processes are called contact disturbances or boundary problems. They are also some-

GT

times called resistances (to awareness). Traditional

these ways of

chronically and inappropriately (Peris et ah, 1951). For ex-

if used

operating dysfunctional

deem

practitioners

ample, in discussing introjection, or the swallowing whole of experience. Peris and colleagues declared,

healthy

.

.

.

“On

but in

this

point

should be seen

differ

he was obviously

this

and assimilation” (1951,

tion

we

as styles

He

make

failing to

Other

190).

p.

with Freud.

GT

held that

some

introjections are

the distinction between introjec-

theorists maintain that these defenses

of contact and are sometimes adaptive and even healthy (O’Leary,

1997; Wheeler, 1991).

The most

primitive contact disturbance

without digesting titudes (Polster

spitting out,

teeth

1

is

some

to

bite

and chew, she

—

by society

not really considered

we

and

in

sit

on the

example of projection

is

that

or in the typical

is

are for-

which an unwanted part of the

projection, in

we

are

sell is

aware of the im-

we conclude that It has to come from outside of us. A good when we avoid the experience of our own hate for someone

is

on

Introjection because the “shouldn’t”

probably an introject (Polster

is

that

it is

ing with the others’ experience, and one

Confluence

GT way of saying

and then assimilated them. They

Projection can be based

functional view of projection

guide (Parlett

of shoulds that

so

us.

prompts the projection

basis

and psy-

our stomachs.

seen

by believing that they hate

the child develops

is

expelled Into the environment. According to Peris and colleagues, it,

vomiting or

& Greenberg, 1992). You should accarding to GT theory, that we have

up, digested them,

counterpart to introjection

pulse but can’t cope with

at-

of introjection (Rice

The problem, whether these are our own values,

eign, alien things that

Once

is

assimilate both physically

often operate

rules!

we have not chewed them

The

of nourishment.

itself

able to digest

is

a sure sign

be nice, quiet, and obey the

it,

and the introjection of the

973). For the infant, the only alternative to introjection

chologically (Clarkson, 1989). For example, are dictated

experience or food

extent an unavoidable feature of early childhood

by which the infant deprives

and can

introjection, or taking in

Infants survive by introjection of food,

it.

and values of parents

& Polster,

is

essential to

way

to

do

Hemming,

is

similar to Introjection, except that

Polster, 1973).

A less

dys-

empathy. Empathy involves Identify-

that

&

&

Is

to use one’s

own

experience as a

1996b).

which the individual cannot separate

herself

it

relers to a

complete

from the environment

Yontef and Jacobs (2005) point out that confluence occurs

when

loss

of

self In

(Peris et ah, 1951).

the individual

is

unable

GESTALT THERAPY to

withdraw when

it

21

is

appropriate to do

so.

An

individual in confluence with another

own beliefs and values. A good example of confluence gang member and adopts the identity (self) of the gang. As

person has trouble expressing her

might be with

all

who becomes

a kid

boundary disturbances, confluence can be

of the

relationships.

a

healthy, particularly in intimate

O’Leary (1997) maintained that empathy represents healthy confluence,

which she defines

as

aware or deliberate confluence.

In retroflection the unacceptable impulse

tenses his muscles to resist slapping

is

turned toward the

someone. For

this reason,

it is

GT

Awareness is,

is

as

when John

counselors are often

sometimes dangerous

impulses (such as hitting someone); the extent to which the retroflection

on whether the individual has

such

where awareness has been

interested in the physical expressions of their clients as clues to

interrupted. Retroflection can be healthy because

self,

is

to express

our

adaptive depends

a rational reason for restraining the impulse (Peris et ah, 1951).

the key to understanding healthy retroflection. Unaware, chronic retroflection

according to Peris and colleagues (1951), equivalent to repression and therefore neurotic. Various writers have identified several other defenses or contact disruptions (Yontef,

1995). self

An

individual can

losing contact with both the environment

iso late

Although withdrawal can be healthy

lation

is

at

times

dysfunctional (Yontef, 1995; Yontef

blunted or dampened, such (Yontef, 1995). Deflection

is

(e.g., to

and the

avoid bad things), persistent

& Jacobs, 2005).

iso-

In deflection the impulse

is

when Kathy smiles to soften the expression of her anger also seen when we avoid or interrupt interaction with another as

person (O’Leary, 1992).

Jessica seems to be

demonstrating several interruptions

mandate that women cant be

introjected cultural values that

appears

to

is

Enrico thinks that she has

assertive

and angry. She also

be very critical of herself, suggesting retroflected feelings that might have origi-

nally been directed at Randy.

she

to contact.

Allowing Randy

to control the

household may be evidence that

in confluence with him.

THEORY OF THE PERSON AND DEVEEOPMENT OF THE INDIVIDUAE Originally, Peris revised the developmental theory of psychoanalysis, shifting the focus

from the sexual

instincts to the

hunger

instinct (Clarkson, 1989). Infants progress

from

sucking to biting; development culminates with the ability to chew food thoroughly so that it

can be digested and assimilated. Peris and his followers

later

de-emphasized

this

model,

although elements of it can be seen in the descriptions of the process of need satisfaction destructive,

Current

and the use of eating-related metaphors

GT

has relatively

little

(e.g.,

introjection as swallowing whole).

developmental or personality theory (Miller, 1989).

Miller (1989) maintained that the anti-intellectual bias of

1960s influences) said, “

ILAyand

is

responsible for this indifference to the

becausetixe: dirty

words

in Gestalt

Even though they lack an elaborate theory, of childhood events. According to

mental support to self-support”

from the environment,

(1

as

Peris,

970a,

as well as love

why

(largely a

GT

theorists is

To grow

product of the

of behavior.

Therapy” (1969a,

“Maturation

p. 17).

GT

p.

44;

Peris himself

italics in original).

acknowledge the importance

the development from environ-

healthfully, children

and respect (Yontef, 1995). Events

in

need support

childhood that

1

GESTALT THERAPY

212 need

are related to the frustration of

satisfaction can live

on

adulthood and create

in

trouble for the individual (see the later discussion of unfinished business). Peris noted that

children need to learn to deal with frustration and overcome

independence. either

He

self

simply the organism

is

former of experiences. The

self

at the

organism/environment interaction, but

meanings that we grow by”

life.

It is

1951,

child

spoiled” (1969a, p. 32). it is

seen as an active trans-

only a small factor in the

plays the crucial role of finding

it

(Peris et ah,

it is

contact boundary, yet

“the artist of

is

The

of growing up, there are two choices.

said, “In the process

grows up and learns to overcome frustration, or

The

thereby increasing their

it,

total

and making the

235).

p.

Jessica has developedfrom

needing complete environmental support to a level ofself-support that allows her to function adequately as an adult in her community. However, Enrico sus-

pects that

some

of needfrustration are

early childhood experiences

still plaguing her.

HEALTH AND DYSFUNCTION Healthy people are those

who

live in

harmony with

the environment, according to

GT theory.

The

process of self-regulation guides the individual to be aware of shifting needs of the organ-

ism,

which then organize behavior (Yontef

& Jacobs, 2005). The organism simply follows

natural tendencies to self-regulate, taking in lating

it

is

good

is

for

digesting

it,

it,

and then

assimi-

(Clarkson, 1989).

The healthy individual she

what

recognizes her interconnection with the environment, so although

self-supporting, she strikes a balance between taking care of herself and attending to

and her community (Mackewn, 1997). Creative adjustment a counselors to describe this balance between changing the environment

the needs of other people

term used by to

its

GT

\s>

meet the needs of the organism and changing the organism

to

fit

the environment (Yontef

&

Jacobs, 2005).

Healthy contact with the environment

from an empty background”

(Peris et

results in a “clear bright figure freely energized

al.,

1951,

terms, “good health has the characteristics of a

p.

good

255). In Yontef and Jacob’s (2005) Gestalt.

perceptual field organized with clarity and good form”

most important, and the person can then attend fied.

Once

the need

is

satisfied, the Gestalt

Health can also be described

as living

finished business does not pile up, he

he

is

closed

it,

312).

(p.

It is

Gestalt describes a

clear

which need

and the bright shiny need

and another

when he

individual

is

is

free to

do and be quite

fully

and intensely whatever

p.

120;

italics in original).

spontaneous, emotionally responsive, and expressive and can

choices she makes in

Dysfunction in

life

and

relate authentically.

much more The healthy

make

direct in-

She takes responsibility

for the

and the meaning she makes of those experiences (Mackewn, 1997).

GT counseling

is

called “dis-ease” to

emphasize the view that the person

not in harmony with the environment (Glarkson, 1989,

p. 41).

Neurosis

from the interruption of the cycle of awareness

“growth disorder” that

results

Wagner-Moore (2004)

identifies a rather

due

aware of a need

to a failure to be

satis-

an authentic existence (Yontef, 1995). “Since un-

with them” (Enright, 1970,

terpersonal contact with others

is

is

figure emerges.

doing or being, and people around him often report a sense of his being

with them

is

is

is

to

The good

narrow view of this process

—and

a second, broader

—

that

all

is

seen as a

(Peris,

1969a).

disruptions are

view associated with the

GESTALT THERAPY

GT

contemporary

can also happen

213

theorists. In this enlarged view, disruption

when

the need or goal

is

in

of the cycle of awareness

awareness but the person

acts,

but

fails

to satisfy

the need.

When

the continuous process of Gestalt formation and destruction has failed in

way, the result

unfinished business because the need that

is

is

some

not met hangs around to

bother the person (Glarkson, 1989). Significant unmet needs organize the person’s perception

and behavior, interfering with the healthy processes of awareness and contact (Mackewn, 1997).

The person

does not clearly perceive her current needs and

uncertain of what she wants. She that her behavior fulfilled

GT in

an

may

may appear confused

or

also display stereotypic or rigid behavior, signaling

governed not by the organismic search for homeostasis but by the un-

is

need (Glarkson, 1989).

counselors recognize that dysfunctional behavior was a creative adjustment

earlier difficult situation (usually

ent (Yontef or pain or

childhood) that

is

no longer functional

made

in the pres-

& Jacobs, 2005). Probably these behaviors protected the organism from injury

somehow

allowed a limited form of need satisfaction in what was then an emer-

gency. Unfortunately, the use of this neurotic self-regulation in the present prevents the per-

son from responding spontaneously and creatively to the environment organismic self-regulation ing

it

(Yontef

Peris

is

as

it

now is. Healthy

replaced by the will to control experience instead of accept-

& Jacobs, 2005).

contended that modern society (defined

as the

kind existing in the United States

or other Western European countries) contributes a great deal to the development of un-

healthy functioning (1969a). Western culture encourages people to

mind and body (Glarkson havior,

which according

Other “shoulds”

to

& Mackewn, GT theorists

are introjected at early

artificially separate

1993). Social norms often punish aggressive beis

a

normal and helpful kind of human behavior.

and these

life stages,

are not necessarily in align-

ment with healthy organismic self-regulation. If we focus on our experience long enough, we will eventually come across something uncomfortable or unpleasant. We inherently want to avoid such experience, so we interrupt our awareness of the now (Peris, 1970a). Many times what we don’t want to experience is our own cruelty or aggression, and we disown the experience rather than tolerate it in our awareness. Society doesn’t help by encouraging us to reject these experiences. By interrupting our experience, according to Peris, we reveal ourselves as frightened children who instead of assuming adult responsibilities retreat into phony social roles. “These phony roles are meant to mobilize the environment for support instead of mobilizing one’s

own

potential.

We

manipulate the environment by being helpless, by playing stupid, ask-

ing questions, wheedling, flattering” (Peris, 1970a, If the client

can get past the phony

point where she

is

stuck.

roles,

p. 18).

she might be able to observe the impasse, the

She no longer has support from the environment but does not

have sufficient self-support to function adequately acterized the impasse as the point

(Peris,

where growth and

1969a).

resistance to

Yontef and Jacobs (2005) describe the experience of impasse

as

Mackewn

growth

(1997) char-

are in a deadlock.

one of terror.

We avoid pro-

longed contact with our impasses because they force us to “take existential responsibility for

our

own

stuckness and our ability to choose to experience things differently and

we

we

are

have often not had sufficient environmental or self support to face these choices. paralysed by the fear of the

unknown” (Mackewn, 1997,

p.

171).

.

.

GESTALT THERAPY

214

GT

forms of dysfunction, such as signals to the self

sition

is

energy discussing what might be called traditional

and so

as depression, anxiety,

They

forth.

about unmet needs or danger (Cole, 1998).

that anxiety

cognitive. Anxiety

much

spend

theorists don’t

is

exception to this po-

seen as resulting from two possible processes.

“futurizing”

is

An

—

remain centered

failing to

recognize emotions

The

first

process

in the present (Yontef

is

&

Jacobs, 2005, p. 315). Peris, in his characteristically flamboyant way, called anxiety “stage fright” (Peris, 1969a).

dividual

and

becomes aroused, deep breathing

quickly,

(e.g.,

likely

is

is

is

& Jacobs,

an in-

required. If the individual breathes shallowly

symptoms

experience

to

hyperventilation; Yontef

Jessica

and

she

When

Anxiety can also be created through faulty breathing.

that feel

like

an anxiety attack

2005).

not optimizing her integration with her environment. She has interrupted contact

appears

be carrying around some unfinished business, with associated behavior

to

patterns. Enrico guesses that her early experiences with her withholding

mother may have

created an unfulfilled needfor love for Jessica. She responded, he thinks, by burying her need

because to allow

it

into awareness

was painful.

Jessica learned to

ings in intimate relationships through this early solution.

about becoming a police

is

ojficer

Her

deny her needs and feel-

experience with her father

another piece of unfinished business. Jessica felt

close to

herfather, yet she has almost completely isolated herselffrom this relationship in recent years.

with Randy

Jessica's relationship

experience in

it

about how she and Randy

societal rule that girls

—

problematic because she

by using old patterns ofdefense. She

ings that she has

andfather

is

and women should be

relate, “nice.

that uncompleted needfor love

is

denying aspects of her

not experiencing some very vividfeel-

is

probably because she has introjected the

"Further, her experiences with her mother

and acceptance

—

are active in her relationship

with Randy. Instead ofexperiencing and expressing herfeelings and needs, she dissatisfaction to herself,

becoming critical ofher own behavior

shows confluence with Randy in her failure

to assert

her

own

retroflects

in the relationship.

needs

She

her also

and wants.

NATURE OF THERAPY Assessment No formal assessment is used in GT, although Yontef (1995) ory absolutely forbids

it.

More

powers of observation to

his

therapist sees assessment

generally, the

assess

how

and treatment

GT

counselor

tact

forth).

The

is

the assessment tool, using

the individual functions in her

as

life.

The

an integrated process that attends to

of the individual’s experience (physiology, ethnicity,

and so

noted that nothing in the the-

all

Gestalt aspects

social context, family relationships,

GT counselor looks most specifically at the individual’s patterns of con-

with the environment,

level

of awareness, and

how much

support she has, both envi-

ronmental and personal (Yontef, 1995). Enright (1970) observed that the Gestalt therapist tells

the client to

“sit

down and

Traditional diagnosis

is

start living,

also rejected

then note(s) where and

by hard-line

how

he

fails” (p.

GT advocates based on

1

13).

the humanis-

dehumanizing (Glarkson, 1989). Others take the position that diagnostic terminology helps in communication with other professionals and can tic

idea that labeling people

facilitate

is

therapy (Yontef, 1995; Yontef

&

Jacobs, 2005). Melnick and Nevis (1998)

GESTALT THERAPY

215

advocate the use of diagnosis, pointing out that,

him

anxiety in the therapist by allowing

emerge.

The

among

other things,

and allow the

to distance a bit

process of diagnosing gives the therapist something to

and Nevis’ system

understanding

for

DSM-IVTR diagnosis

it

can reduce

client’s figure to

do while waiting. Melnick

uses the cycle of experience as

a conceptual basis. For example, they see borderline personality disorder as originating in

the very beginning of the cycle; the individual simply can’t

manage

the sensory input. Their

conceptualization leads to the caution that awareness-heightening interventions should

not be used for these clients cific

phobia

(e.g.,

empty chair,

connected to problems

as

tion (or assimilation in

The most common do you experience

my

stress disorder as a

function of demobiliza-

Figure 7.3).

GT

assessment/diagnostic question used in

now?” (Yontef, 1995,

right

to describe spe-

in mobilization, histrionic personality disorder as

and posttraumatic

related to the contact phase

They go on

confrontation).

p.

272). That

counseling

“What

is,

the Gestalt therapist

is,

interested in assessing the client’s current state of awareness (Parlett &C

Hemming,

is

most

1996b).

came in. He listens and observes her closely as she relates her story about the fight with Randy. As she talks, he notes her tone ofi voice and physical reactions. Jessica pauses in her narrative, and Enrico inquires, “What are you expeEnrico greets Jessica

and simply

asks

why

she

riencing right nowE Jessica stijfiens and looks surprised. She then tentatively begins to describe

her feelings

ofianxiety

about being in

and a feeling ofibeing alone.

therapy, herfear ofiRandy,

Overview of the Therapeutic Atmosphere The

essence of

GT

counseling

is

observed in the therapist’s emphasis on the immediate

A famous GT slogan

experience of the client.

is

“I

and Thou, Here and Now,” which

Peris

borrowed from the philosopher Buber (Yontef

& Jacobs, 2000). Polster and Polster (1973)

maintained that “the therapeutic experience

not merely a preparatory event, but a valid

moment

per

is

needing no external referent to confirm

se,

inherent relevance to the

its

patient’s life” (p. 5).

The

dictate to

remain

the subject of therapy;

ent (Parlett

&

it

in the present does not

means

Hemming,

1996b). Laura

Therapy does not deal with the life

that these are

mean

that the past or the future

examined

as

never

they are experienced in the pres-

Peris, reacting to the

past or future, wrote,

is

“The

misperception that Gestalt

past

is

ever present in our total

experience, our memories, nostalgia, or resentment, and particularly in our habits and

hang-ups, in

all

The

the unfinished business, the fixed gestalten.

future

is

present in our

preparations and beginnings, in expectation and hope, or dread and despair” (1992,

p. 52).

Traditional Gestalt therapists are very suspicious of intellectual activities because they

than experiencing and acting. Another famous Perlism

tend to lead to talking about is

“Lose your mind and

come

to

your senses”

understanding (asking the why question) that “In

modern

life

up on explanations;

we it

suffer

is

(Peris,

avoiding

1970a,

GT

life.

from too many explanations.

became impatient

for

something

to

p.

.

.

.

38). Seeking intellectual

counselors tend to believe Peris’

Gestalt

Therapy gave

happen. Happening,

after

all, is

the best explanation” (Miller, 1989, p.l2). Emphasizing action rather than talking often leads to the construction of experiments in awareness, in client to actively experience

some disowned

aspect of her

which the counselor

life in

asks the

the session (Zinker,

1

977).

GESTALT THERAPY

216

Because experiencing the unfinished situation in the therapy session arouses anxiety, Peris characterized

therapy as a “safe emergency” (Peris et ah, 1951

,

286).

p.

The

reexperi-

encing of the rejected experience in the safe environment of counseling allows the completion of the Gestalt and, thus, the assimilation of the experience. is

the balance between support from the counselor (safety)

(risk).

The

client

is

not allowed to stay in

“safe

exposed to experiences too threatening (bolster

The

current approach to

Support of the the building

client

is

GT

counseling

important consideration

and the therapeutic emergency

infertile territory,”

& bolster,

1990,

p.

Peris

and

more moderate than what

is

considered very important and

GT

The

Peris presented.

counselors tend to emphasize therapist

and

client

Gestalt therapist strives to create an authentic

contact with the client, a true encounter (Rice (2004), the contemporary is less

she

is

are less rejecting of the intellectual elements of counseling (Rice &C

Greenberg, 1992; Yontef, 1995).

of therapy and

but neither

104).

and exploration of the here-and-now relationship between

more than did

Moore

but

An

likely

than

& Greenberg,

1992). According to Wagner-

GT views the therapeutic relationship as a critical aspect

GTs of the 1970s

sociated with the approach. Yontef and Jacobs

add

to use the techniques stereotypically as-

that

good therapy involves

and-forth shifting on the therapist’s part from attention to the

client’s

a fluid back-

process to focus

on

the relationship between therapist and client.

The

GT counselor

perience (Rice

is

active, directing the client’s attention to various aspects

& Greenberg,

1992). Empathic reflection

aware of her experience (Yontef, 1995). The

is

used to help the client become

GT counselor often proposes experiments that

are designed to help the client heighten awareness (Grocker, 1998).

primary task of the therapist

is

of her ex-

At the same time,

a

observation in the interest of discovering where the client

has interrupted her experience (Rice

& Greenberg,

1992).

GT counseling can be either short or long term (Yontef & Jacobs, 2000). Although Peris maintained that group psychotherapy using the “hot seat” method (discussed superior to

all

&

was

other forms of counseling, contemporary Gestalt therapists disagree, prac-

ticing individual, couples, family, group,

Wheeler

later)

and organizational

GT

(bolster

& bolster,

1973;

Backman, 1994).

Enrico endeavors

to help Jessica stay in the here

and now without sacrificing his support of

He makes observations about how he feels in relation to her in an honest, open way. He asks many how and w\\ 2it questions and no why questions. Enrico encourages Jessica to

her.

reveal her present experience as she talks about her relationship with Randy. If she brings

up her father, mother, or family, Enrico will encourage Jessica

to explore

her feelings about

them as they are present in the here and now.

Roles of Client and Counselor As

is

the case with Albert Ellis

counselor in

and Rational Emotive Behavior Therapy, the

GT often gets confused with the person of Eritz Peris.

role of the

In Peris’ version of

GT

counseling, the role of the counselor was to frustrate the client’s avoidance of self-support (Peris,

1970a).

take care of her

The

client

was often confronted with her attempts

and her reluctance

to be authentic.

One of Peris’

to get the counselor to

favorite labels

(Nelson-Jones, 2000). Glearly, confrontation was the hallmark of

Peris’

was “phony”

approach to

GT

GESTALT THERAPY (Yontef

& Jacobs,

217

2000). Friedman (2003)

commented

that the therapist in this version

was something of a stage director or coach, and related that Laura

this

the extent to In

more

extreme approach

patient” (p. 63).

many GT counselors currently, among GT practitioners.

used varies greatly

is

recent versions of GT, the abrasive style of Peris

is

GT counselors are

softened.

expected to be authentic and transparent in their relationships with their

approach

is

sometimes called dialogic or

Gestalt therapists are seling, using

admonished

such awareness

as

is

GT

relational

to stay in

(Yontef

clients.

This

& Jacobs, 2000). own

touch with their

experiences in coun-

(Mackewn, 1997). “Exclude nothing;

diagnostic tools

What

miss nothing as irrelevant.

in

probably not used by

is

which confrontation

maintained that

away from the

interacting with clients in this way, Fritz Peris “turned

Although

Peris

your body doing involuntarily

of

in the presence

disthis

other person? Are your muscles tightening up or relating and opening? Does your attention

wander or

is

your

daydream, when do you do so and what

interest riveted? If you begin to

you daydreaming?” (Mackewn, 1997, p. 47; italics in original). To maintain this level of awareness, a Gestalt therapist must have a significant emotional commitment, accord-

are

ing to Glarkson (1989). Gandidates should undergo personal psychotherapy, similar to the training analyses of psychoanalysts, only is

from

GT counselor, of course.

a

not an approach which can be applied by people

their

own

The (Rice

GT counseling

& Greenberg, fits

1992). She

(Yontef,

ment (and even

1

better, anger)

GT counselor wants

Enrico

a moderate

is

expected to engage actively in the process of self-discovery

is

a student

who

is

learning to test

with the therapist because

thing the

207).

p.

is

The Gestalt therapist respects

995).

1996b,

Therapy

unaware of

are themselves largely

& Flemming,

contact style or bodily experience” (Parlett

client in

to see if it

who

“Gestalt

is

what

offered in therapy,

is

the client’s expression of disagree-

demonstrates self-support.

it

The last

the client to introject the values or opinions of the therapist.

GT counselor.

His first goal

relationship. Enrico observes Jessica as she talks

is

to

connect with Jessica in an authentic

about her experience and

also

pays atten-

he has a fantasy of her in her police uniform that quickly alternates with an image of a small child). Enrico also notices that his muscles are tensing and that he has impulses to rescue Jessica. tion to his responses to her

(e.g.,

Jessica, eager for the therapist's help, to

engage with Enrico. Jessica has a

openly discloses about her situation. She

little difficulty

expressing her

is

willing

own wants and prefer-

ences in counseling, but Enrico helps her stay with her experience until she

is

able to expe-

rience her needs.

Goals The one

big goal in

curative"

GT

is

awareness. Peris said, “Awareness per se

p. 16; italics in original).

two kinds of awareness: “microawareness awareness of the awareness process” apist

wants the

client to be

(p.

—

Yontef (1995) pointed out (i.e.,

275).

and of itself— can

by

that, really, there are

awareness of a particular content area) and

The

point

aware of a current situation

is

that,

although the Gestalt ther-

in therapy,

he

is

also interested in

the client understanding the process or event of awareness so that she can apply situations. bility for

An added

benefit of this kind of awareness

behaviors enacted

when one

be

is

that

it

it

to other

promotes taking responsi-

has awareness (Yontef, 1995). Parlett and

Hemming

GESTALT THERAPY

218 (1996b) described the goal ot

“promote self-support

GT

a little differently, saying that the process

sufficient for the person to live a

increasing his or her ‘response-ability’)”

Awareness

harmony with

will result in better

of freedom and choice (thus

205).

(p.

will ultimately result in the

life

should

growth of the individual,

the environment and

for increased awareness

enhancement of the organism

through assimilation of needed things. Thus, a goal of GT could be said to be growth. In

many

Gestalt therapists maintain that people

of

for the facilitative aspects

tion of

Polster

and

help Jessica become

to

to counseling not for remediation, but

Polster (1973)

GT counseling when they said “therapy

Enrico hopes

Hed

GT

come is

emphasized the growth orienta-

too good to be limited to the sick”

aware of the unfinished business she

like to help her recognize the

fact,

(p. 7).

carrying around.

is

ways she avoids contaet with the environment and

of herself Enrico has no predetermined ideas about what she should do about her situation or relationships; hed like her to become aware so that she can decide for herself aspects

Ideally, fessica will

out of therapy

come

value awareness

to

and responsibility

in her

taking these

life,

tools

to use in future life experiences.

PROCESS OF THERAPY GT counseling has three central elements: relationship, awareness, and experiment (Glarkson, engagement, whether 1989). According to Yontef and Jacobs (2005) the method of GT is

between therapist and

that

is

first

step

ship

is

is

for the

between

client

and aspects of her experience. The

GT counselor client to establish an authentic

medium through which

often the

desire to be

client or

awareness

is

this

This relation-

explored. For example, the client’s

dependent on the therapist can be brought up

and describing

relationship.

with the client living

explicitly,

experience in the session. Awareness, of course,

is

critical

because inter-

ruptions in the awareness process are what bring the client to counseling.

Experiments \n awareness are often used in

GT counseling.

Mackewn

(1997) explained

that experiments are intended to help clients try things out in the safe

counseling. She identified several goals of the experim*ent, including ness of the self

and how

experience, and

(c)

it

(a)

environment of increased aware-

of cognition and body

relates to others, (b) the integration

helping the client reach the impasse and experience

it.

The

client

and

counselor should agree on, or even construct together, the experiment (Zinker, 1977). Levitsky and Peris (1970, pp. 140—144) described the rules and games of Gestalt

Therapy.

The games

The most

will

be described later in the discussions of the various techniques. staying in the now; (b)

critical rules are (a)

aware and authentic communication; sibility for all

using “1” not

(c)

statements; and (d) asking no questions

something of the counselor and therefore

The

client

is

I

and thou, or the emphasis on

“it”

language, or taking respon-

— because they

are seen as asking

as aspects of the client’s passivity

or laziness.

urged to turn questions into statements. Glients

in

therapy groups are

one must speak directly

to

any person present,

expected to follow the “no gossip”

rule:

not about them.

An

aspect of

GT

that sets

it

apart from other approaches

body sensation and functioning ness

is

often seen in the

body

emphasis on physical or

human existence. Unfinished busiThus, Parlett and Hemming (1996b) suggested

as a critical aspect

of the client.

is its

of

GESTALT THERAPY

219

G F counseling “the body

that in

is

regarded as a source of wisdom, a provider of organismic

truth” (p. 200).

Gestalt therapists refer to the “paradoxical theory of change” (Yontef

&

Fuhr, 2005,

By this term, they mean that the more you try to change, the more you stay the same. Ghange is, instead, accomplished by becoming aware of and accepting who you are. The Gestalt therapist needs to be aware of this dictate so that he will not align with p. 82).

aspects of the client that pressure the client for change. Peris

ommended

that the

and colleagues (1951)

GT counselor adopt a stance of creative indijference

This somewhat confusing term does not mean that the counselor the client, only that he

is

his

rec-

work.

truly indifferent to

is

not intensely invested in some particular outcome or process

in ther-

apy (Mackewn, 1997).

Gontemporary

Gestalt therapists are prone to referencing the “field,” a

construct that includes everything that selor (Parlett, 2005).

is

somewhat vague

around and goes on between the

The notion of field

suggests that the therapist

client

and coun-

an integral part of

is

the therapy, not a detached observer. Further, according to Parlett, the field has inherent structure,

which should be examined

phasis in current

that

to this they

field perspective

any change

Ghent

These

ideas connect to the relational

GT theory— the therapist and client both

now situation and of the

in therapy.

is

must attend

(Parlett,

in the field will affect the rest

resistance

is

have input into the here-and-

2005). Another important implication

systems theorists,

that, similar to family

of

it

GT therapists are aware

(Yontef, 2005).

not to be fought, eliminated, or overcome

Instead, resistances are identified as the energy of the

in

organism placed

stem from adaptive responses

earlier

(i.e.,

neurotic adaptation). Instead of overcoming

client to experience the resistance,

encourage

bring

it,

it

GT

counseling.

of protect-

in service

ing the person from an experience that might be harmful (Yontef Typically, these behaviors

em-

&

Jacobs, 2000).

to past experience, as described It,

the

GT

counselor wants the

to the center of awareness. In this

way, resistances, which are ways of avoiding meaningful contact, can be used to resolve

unfinished business (Enright, 1970).

Although Gestalt

therapists will

phenomena

they see these

acknowledge transference and countertransference,

them (Mackewn, 1997). Transference ceiving the world, although rience. Gestalt therapists

particularly itself

when we

pist

not seen

seen as a clue to

as

purely the

how

the client habitually structures expe-

carry around unfinished business. F^owever,

to being

therapist’s input to the interaction

being wrong (Yontef

changed

is

situations,

GT theory distinguishes considered, too, and the

In the therapeutic encounter,

The

and ready

to

thera-

admit

to

& Jacobs, 2005).

kinds of countertransference are identified in countertransference

in relationship

see

way of per-

client’s distorted

needs to be ready to examine his contributions to the situation.

must be open

Iwo

it is

is

acknowledge that we do bring the past into current

by Instructing that the

GT counselor

from the way traditional psychoanalysts would

differently

with the

GT

theory (Mackewn, 1997).

when the counselor’s unfinished business is activated while The GT counselor must be alert to this event and be able

is

client.

to set these responses aside (termed “bracketing”) to be dealt with in supervision or per-

sonal therapy

(Mackewn, 1997,

p.

95).

conn ter transference

selor responds to the client’s transference behavior.

is

These responses

when

the

GT coun-

are taken as data for

the analysis of the interaction of client and counselor in the here and now.

GESTALT THERAPY

220

GT theorists have begun

Contemporary relationship

comes

and

primed

makes the

for help

outcomes (Yontef, 2005). According

its

to therapy

for

shame because she

situation worse.

that will exacerbate shame, that contributes to

it

The

Awareness

is

sica

counselor must be alert to anything in the field

become aware

responsibility for anything he does

her,

GT counseling with Jessica.

but Enrico

As time goes

and

is

He

is

relatively easy to

becomes more authentic.

endeavors

be aware

to

everything he does in eounseling

ofi his

own

talking about her mother,

is

Enrico notices that she assumes a rather fiat tone ofvoiee. Enrico asks Jessica ofi

how

ifishe is

aware

her voice has changed.

Enrico

is

sure that he will devise

ing that she agrees sica,

experience

directed toward helping Jes-

is

Eor example, when she

ofi her experience.

It

at first, to the relatively superficial

sensitive,

on, the relationship

always eentralfor Enrico.

in relation to Jessica,

to ask

(Yontef, 2005).

a relationship with

level ofi their contact.

Yontef and Fuhr, the client

to

bad about herself and needing

feels

and most importantly, take

Enrico focuses on the three elements of establish

to discuss the role of shame in the therapeutic

to

He

them.

is

some experiments for Jessica

not

although he does encourage her

presence, noting that

when

adamant about

to try

out in

reciting the rules

to use “E’ language.

He

session,

assum-

of therapy with Jes-

also attends to her physical

she talks about her fight with Randy, she seems to shrink into

and crosses her arms across her ehest. He asks her ifishe is aware ofithese sensations. Enrico sees Jessica resist contact around her feelings for her mother andfather. When he

her ehair

asks questions, attempting to get Jessica to experience these in the session, he notes that she

becomes more closed physically tance, Enrieo asks Jessica

If she

still

and helps

shows a need

and less

responsive verbally. Attempting to explore the resis-

toHecome aware ofhow she to protect herself,

her verbalize this

to

is feeling,

Enrico accepts

this as

Gestalt Therapy to explore

be vigilant in loo kingfor signs that his

Noting that he experiences decides that this

is

and e7notionally.

a sign ofJessicas strength

him.

Enrico notes no proactive countertransference, although he

He has recently returned to

physically

own

Jessica as

reactive transferenee.

issues

is

aware that this could happen.

some ofhis own

interruptions.

He will

are intruding on his interactions with Jessica.

wanting him

He finds

ways

to direct to

and

support

her,

Enrico

share this awareness with Jessica.

THERAPEUTIC TECHNIQUES GT

has often been perceived as

synonymous with

techniques or the “empty chair” (discussed reject this perspective, saying,

later).

its

techniques, particularly dialogue

Current Gestalt theorists and therapists

“Techniques are only a part of the therapy; Gestalt Ther-

apy theory would also encompass the dialog between therapist and patient” cited in Hycner, 1987, p. 31). In reality,

nique that fosters awareness (2005)

comment

growth

to

“Our

GT counselors are technically eclectic;

GT

forms.

any tech-

considered acceptable (Enright, 1970). Melnick and Nevis

goal

is

to support uncertainty.

We

create the conditions for

occur without having any commitment to a specific outcome”

this reason,

many

that

is

(E. Polster,

techniques can be broadly construed

as

(p.

107). For

experiments that happen to take

GESTALT THERAPY As

noted

I

221

toward the end of

earlier,

his career, Peris

began

work

to

groups and thought that individual therapy was becoming obsolete the late 1960s, Peris did most of his

which he would was

really

The ness.

work

members of the audience

invite

1970a). During

(Peris,

workshops

in large training

increasingly with

for professionals, in

to participate as his clients. Essentially, he

doing one-session individual counseling with the

client in front

of an audience.

would assume the “hot seat,” and Peris would create various exercises in awareOther Gestalt therapists used a more traditional group therapy format (Leiberman,

client

& Miles,

Yalom,

GT techniques and games into these groups. What

1973), but integrated

follows are descriptions of some of the techniques used in both individual seling;

many

are applicable to couples

and family therapy,

and group coun-

too.

Therapist Self-Disclosure Often, the Gestalt therapist, attending closely to his experience, will disclose his awareness

& Jacobs, 2000). “Sometimes the therapist

to the client (Yontef

is

bored, confused, amused,

angered, amazed, sexually aroused, frightened, cornered, interrupted, overwhelmed and on

and on.

All of these reactions say

much of the

they comprise p. 18).

The

GT

it

in the

immediacy of the

to diselose his

She bursts into

data of the therapy experience” (Polster

&

Polster,

1973,

counselor authentically discloses an experience, and then the client and

counselor discuss

Enrico decides

vital

something about both the patient and the therapist and

relationship.

alternating images ofjessiea as a child and police offieer to

her.

saying that she feels like the child in the moment. Enrico replies that

tears,

he feels like taking care of her.

Dialogues In the Interest of increasing awareness

and finishing unfinished

business,

GT

counselors

often ask the client to create a conversation, or dialogue, in the counseling session. These

dialogues can be

(a)

among

individual in the clients

between the

“splits”

life,

self, (b)

with the therapist, and

or polarities in the client’s personality (Levitsky

dog and the whiny, excuse-using underdog. These inherent to humans, and according to Peris, as a

way of torturing

& Peris,

we

are the

gration (Miller,

but integrated this version critic into

989). That

as parts

of dialog

one

If the critic

1

is

full

end points of a

critical polarity

use the conflict between the top

chair,

is

to have these

dog and

dog and whines

two aspects of the

self listen to

self will result In their inte-

the two aspects will no longer be “split off” from each other,

of the personality. Most modern as

Peris,

demanding top

expression of these aspects of the is,

&

ourselves (Peris, 1969a). In top-dog— underdog dialogue,

underdog. The goal of the dialogue

each other. Ultimately,

1970).

critical,

the client alternates between playing the two poles. She bosses like the top like the

with some other

top dog and underdog (Levitsky

is

970). In this experiment, the client plays two parts of herself, the

underdog

(c)

past or present (Eiycner, 1987). Dialogues are also created

one well-known dialogue

Historically, 1

parts of the

outdated.

They

GT

therapists

would

likely reject

favor splitting off the harsh, judgmental, inner

and the person experiencing the

self into the

other (Kellogg, 2004).

the introjection of someone from the past (such as a parent), this can be noted

GESTALT THERAPY

222 and emphasized with the

client

—what

she’s

dealing with

Perversion of the parent, not

is

actually the “real” one.

A

contemporary perspective on dialog

Greenberg (2004). Dialog Experiential

Therapy

(see

is

presented by Elliot, Watson, Goldman, and

an important feature of their hybrid approach. Process

is

Box

7.3 for a brief description) that combines aspects of

Person-Centered and Gestalt Therapy. They differentiate between two-chair and empty chair dialog. Two-chair dialogs are

aimed

at

healing split aspects of the

chair dialogs are interventions for unfinished business.

empty

the

chair,

and the

whereas empty

Anything or anyone can be put

client talks to the entity. Often, the client

of the person or projection in the chair and switches

self,

is

seats as she

in

asked to play the part does this enactment.

GT counselor plays the entity in the empty chair. This approach has many uses from the GT perspective, including creating a situation in which unfinished business Sometimes the

can be completed with significant others, helping the client to resolve internal conflicts, or allowing the client to experiment with behavior that

is

very threatening and scary

(Crocker, 1999).

Enrico asks Jessica if shed like to talk to her mother, guessing that Jessica has unfinished business with about love and belonging Hesitant at fiirst, Jessica agrees to try the

Mom

experiment. Enrico: Tell your Jessica:

E:

E:

what you re experiencing

/ wish 1 could get

right now.

close to you.

What are your fieelings?

lam sad. Em

]:

mom

angry. I

want

to

hurt you.

Say that again.

Tm ANGRY!!

J:

Playing the Projection To

increase the experience of

client to play the role

one

as

disowned

The

herself (Levitsky

self,

the

GT

counselor might ask the

of the projection (Sapp, 1997). For instance,

angry and hateful toward

hateful person.

parts of the

her, the therapist

might ask her

if

the client sees some-

to act out

an angry and

therapist could then ask the client if she could find these qualities in

& Peris,

1970).

Because Jessica does not seem not a technique he will

to

be projecting, Enrico decides that playing the projection

is

use.

Exaggeration If the client

the

appears to be unaware of some (typically nonverbal) aspect of her experience,

GT counselor guides her through the process of exaggerating the movement (Levitsky &

Peris,

1970). Often, the original expression of the client

apist helps her

The

astute

make

the

movement more

authentic.

is

The

incomplete or stunted; the therclient

GT counselor asks her to exaggerate the wiggle,

increase her awareness of this expression

and

create

might be wiggling her

leg.

attempting to get the client to

meaning. This technique can

also be

GESTALT THERAPY

223

used with client statements

and

says

asks her to repeat

When Jessica

it,

the counselor hears the client glossing over something she

perhaps more forcefully.

about her mother, Enrico

talks

asks Jessica if she notices

tension

—

this.

notices that she

hunches up her shoulders.

He

Jessica says “not really, ” so Enrico asks her to exaggerate the

and describe what it is

like. Jessica reports

that she

is

protecting herselffrom psycho-

logical blows from her mother.

Reversals Recognizing that observable behavior (i.e.,

the opposite

(Levitsky

end of a

& Peris,

is

polarity), the

sometimes the opposite of underlying impulses

GT counselor directs

the client to act the reverse

1970). For instance, a shy client could be asked to play the extrovert.

Enrico has observed (from watching her dialogue with him in the empty chair) that Jessica is

He asks Jessica

passive in her relationship with Randy, always trying to please him.

Randy back

in the chair

and play

the bossy, bitchy, overbearing

to

put

woman.

Dream Work dream the “royal road to integration” (Peris, 1970b); in fact, dreams are the most spontaneous form of human expression (Peris, 1970b). Despite the allusion to Peris called the

Freud’s position

its

(“the royal road to the unconscious”), the

are han-

is

own

speech and experiences. Peris insisted that the client “play”

persons in the dream, giving

them

pects are ones that the client has

all

of the objects and

voice and action, because this represents experiencing

aspects of the self symbolized in the

life

way dreams

GT very different from the way they are handled in traditional psychoanalysis. GT dream work, the client takes on the role of the parts of the dream, giving each

dled in In

on dreams

dream elements

1970b). Most

(Peris,

likely,

disowned or represent important people

(Staemmler, 2004). Kellog (2004) notes that the aspects of the dream

important polarities for the individual; dreamwork

is

another

way

these as-

in the client’s

may

represent

to help the client inte-

grate these.

Jessica

dreams that she

is

a gardener. She has her hoe and her spade and gardening gloves.

She gleefully plants flowers and vegetables and watches them grow. Enrico asks Jessica

Then she

is

to

the spade,

protect. Elowers

play the parts in the dream. Eirst she

moving

what

is

of polarities identified in

The

is

The gloves

into sunlight.

present in the client’s presentation, but are often

missing (Parlett

or “disowned” one aspect of the

responsible.

it belongs.

soil.

Polarities

GT counselors are aware of what interested in

the hoe, turning up the

things around, carrying soil to where

and plants struggle against soil and emerge

Working with

is

self,

& Hemming,

which tends

GT theory are

more

1996b). Likely, the client has repressed

to be

one end point of a

polarity.

Examples

messy— tidy, strong— weak, love— hate, dependent-

Gestalt therapist brings the polarities to the client’s attention, often using

— GESTALT THERAPY

224 language for them (Parlett

less roxic

polarity similar to the

way in which

& Hemming,

1996b). Clients can also ask to play the

playing the projection

is

used.

to take the role

of each of the ends of the polarity identified

One ofJessicas

key polarities appears to be strong— weak. She

cer,

That

is,

the client

is

asked

as critical for her.

is

a tough, strong police

offi-

yet a weak, dependent person in her relationship. Enrico decides to have Jessica play

both of these polarities to help her increase her awareness of this

split.

Awareness Training or Bodywork In one sense, selors

all

work with

GT counseling

is

become more aware of their

their clients to

GT coun-

awareness training. In a more specific sense,

physical sensations, because

these are often clues to aspects of experiences blocked out of awareness.

The

client

might

be asked to attend closely to any body sensation that the counselor thinks important breathing, tone of voice, physical gesture, and so on.

Enrico notices that Jessica clenches her fist when she talks about Randy.

tend to

this

motion and experience what the tensing is

He asks

He might even

like.

that she at-

ask her to flay''

Making the Rounds If a

group therapist notices that

might ask the

member group

that expresses the

scares

specific

him, the

bers “you scare

seems to be focused on a particular theme, she

“make the rounds” of the group by saying

client to

add something

a client

theme (Daniels, 2003; Levitsky

about each person

& Peris,

For example,

as well.

a sentence to

if

each group

The

1970).

client

GT counselor would ask him to say to each of the other group mem-

me” and then add an

as a

way of making

extra phrase pertinent to that individual.

Nonverbal

me

because

.

member

contact.

IfJessica was working in group, she might be asked that you will reject

to

the client says that the

expression could be used in this way, too; for example, a client might touch each

of the group

is

.

.

to

"and then finish

make

the rounds saying “/ am affaid

the sentence to fit each

of the members.

Taking Responsibieity The

client

(Levitsky

is

asked to follow her statements with this phrase:

& Peris,

1970). For example,

he would be asked to follow

his

remark

if

Bob

is

“I don’t

in a

“I

take responsibility for

quandary about

know what

if’

his life circumstances,

to do” with

“and

I

take respon-

sibility for it.”

Jessica could be

Enrico.

she says

He

asked

to use the

thinks he might

it is

hard

difficult to express

remind her

to express

how

phrase “/ take responsibility" in her interactions with

I feel,

to use it every

time she uses

'It"

language. So

her feelings to Randy, Enrico will ask her to

and I

take responsibility for

" it.

say,

when

“/ find it

GESTALT THERAPY

225

EVALUATION OF THE THEORY GT

Responses to that

GT

had

are

numerous and

reputation as “an intrinsically

a

Crocker (1999) commented rude and confrontational method,

rarely moderate!

lacking in both gentleness and a respect for clients, and practiced by people with questionable moral standards”

—

GT has also been characterized as “wild,

(p. 7).

uncontrolled,

word, dangerous” (Smith, 1991, p. 62). These criticisms seem to stem from two sources. First, the approach is highly identified with Peris and his conundisciplined

in a

frontive, abrasive approach.

GT in

the classic form overemphasized the individualistic.

Moreover, Peris acted unethically and was sometimes abusive (Clarkson 1993). However, a second issue was that after being captivated by style,

havoc

many

(Parlatt

A second to

its

insufficiently trained people put

&

Hemming,

reason that

GT

on

&

Mackewn,

Peris’

charismatic

their Gestalt therapist hats

and created

1996a). is

thought to be wild and dangerous seems to be connected

adoption of the rebellious, antiauthoritarian stance of the mid- to

Numerous people who had

background

little

in

late

1960s.

psychology or the formal education

typically associated with the profession of psychotherapy

were “trained”

as Gestalt ther-

apists (Sapp, 1997).

This reaction also seems to be the result of GT’s emphasis on raw experiencing

and lack of experiment

structure. is

Modern

not simply a

Gestalt therapists are careful to explain that “the

technique to be applied indiscriminately” and to

facile

caution counselors to provide support in conjunction with challenge (Polster

1990,

& Polster,

p. 104).

The

lack of supporting theory

is

also seen as a failing

of GT; the approach

is

seen as

lit-

gimmicky techniques, the most notorious of which is the empty- or two-chair dialogue (Miller, 1989; Wagner-Moore, 2004). Miriam Polster (cited in Hycner, 1987) argued that the excessive reliance on technique is seen only among inexperienced or narrow-minded GT counselors. tle

more than

a collection of

Qualities of the Theory Precision

and

Testability.

Gestalt theory (the perception theory) was based

constructed laboratory research. Gestalt theory, and (e.g.,

some

The

constructs of

GT

They

contact) and observe, partly because they are so broad

same time, some success has been found by Greenberg and

GT

Rice, Rennie,

& Toukmanian,

well-

theory diverge from classic

are very difficult to operationalize.

ing particular

on

are difficult to define

(e.g.,

awareness). At the

associates in operationaliz-

techniques such as chair dialogues (Elliot

et ah,

2004; Greenberg,

1991; see Box 7.3 and the discussion of research in the

following sections).

Empirical

Validity.

Although fewer studies on the outcome of

conducted compared therapy

which

is

to other theoretical approaches,

GT

counseling have been

support for the effectiveness of the

evident (Strumpfel, 2004). Less support exists for the theoretical structure on

GT counseling rests,

possibly because

exception to this generalization Experiential

Therapy

is

(Elliot et ak,

it is

so difficult to operationalize. Again, the

the research of Greenberg

2004).

and

associates

on Process

GESTALT THERAPY

226

Research Support Outcome

Outcome

Research.

research

other theoretical approaches

(e.g.,

on

GT

exists,

but not to the extent that

it

does for

cognitive or behavior therapy). In their early, classic

study of encounter groups, Leiberman, Yalonf, and Miles (1973) examined the outcomes

of group leaders.

Two

GT leaders were included in

this study.

These two leaders produced

very different outcomes, although they were characterized similarly as active, energizing

One leader produced

leaders.

atively affected

had no

leader

the highest

by the group experience)

casualties.

The second

number of casualties (participants who were negamong all of the leaders, whereas the second GT

leader tended to produce mild to moderate change

among members. Yontef (1995) maintained ples

first

leader did not follow the princi-

of GT; he was “abrasive, insensitive, and charismatic rather than dialogic and experi-

mental”

(p.

Elliott

290).

(2001) conducted a meta-analysis addressing humanistic therapy, which in-

cluded seven studies of tial,

that the

GT

and emotionally focused

size (average

of client-centered, process experien-

as well as investigations

therapy.

He

located 86 studies and found an overall effect

change) of 1.06, suggesting that the average client in humanistic therapy

improved from the 50th

to the

85th percentile on outcome, compared to pretreatment

measures. This study also demonstrated no significant differences in effectiveness between

humanistic and nonhumanistic approaches and that humanistic psychotherapy was superior to

no-treatment conditions.

found

that

for the entire

38 studies conduced by

The

seven

GT

studies

produced an

group of humanistic therapies.

An

effect size similar to

earlier meta-analysis

of

and Schmitz (1994) found similar results. Strumpfel and Goldman (2001) reviewed huge amounts of research on GT, including studies conducted in Europe, and document impressive support for the approach. For exBretz, Heekerens,

ample, they described an Austrian study that included 431 outpatients, citing improve-

ment

70 percent (Schigl, 1998, cited in Strumpfel and Goldman). This was an effectiveness study modeled on the Consumer Reports study (Seligman, 1995, see rates of over

Chapter

1),

so did not involve

Individual studies of

all

the trappings of a

randomly controlled

clinical trial.

GT outcome are of varied sophistication and quality. Johnson and

Smith (1997) studied snake-phobic university students, randomly assigning them Gestalt empty-chair dialogue

(ECD), systematic

objective measures of phobia, both the in

comparison

group and 22

ment, those it.

At

first

health in a

in the

in the

two

On

OTeary, Sheedy, O’Sullivan, andThoresen con-

GT group

therapy and a no-treatment (assessment

Comparing

these rather small groups (21 in the con-

ducted a randomized study comparing

trol

no treatment.

ECD and systematic desensitization groups improved

to the control participants.

only) control group with older adults.

desensitization, or

to

GT treatment groups), they found that at the end of the treat-

GT groups reported expressing more anger and having less control over

glance, this

GT model

might look is

like a scary finding,

to experience

but then

and express emotions

recall that

freely.

one indicator of

Thus, O’Eeary

et al. in-

terpreted this finding as an indication that the clients in the therapy group were possibly living

more

in the present

because the treatment had allowed them the opportunity to deal

with unfinished business.

An

interesting study tested the effects of Gestalt

ophrenics

in Israel

(Serok

&

group therapy with hospitalized

Zemet, 1983). Matched

pairs (on age, sex,

schiz-

and education) of

GESTALT THERAPY

111

randomly assigned

patients were

GT group

to 10 sessions of

treatment or

a

no-treatment

control group. Using two indexes of reality testing derived from the Rorschach inkblot

Serok and Zemet found that clients ing

compared

to those

who

in Gestalt

group therapy showed improved

Zemefs

Elliot,

of stimuli for which scoring

set

Because the Rorschach was the only measure of

results

reality test-

no treatment. Some researchers would question the

received

psychometric validity of the Rorschach (an ambiguous difficult).

test,

reality testing used,

is

Serok and

could be called into question.

Greenberg, and colleagues (Elliot

et ah,

2004; Greenberg

et ah,

1991; Paivio

&

Greenberg, 1995) have established a respected research program that investigates Process-

Therapy (PET),

Experiential

directly intended to test

that looks at both process

outcome

wait

list,

these investigations are

summary, they summarize

a recent

and outcomes

studies, three

in

PET

(Elliot et ak,

compared

PET

& Watson,

1998; Watson

to result in reduced levels of depression

styles.

In other studies reviewed by Eliot et

al.

and

(2004) do point out that

of PET, warning that allegiance

Some of

Theory-Testing Research.

the

dialog

(ECD) on

testing

and outcome assessment, so

sent

here because

it

a

num-

using either

2003). For example, Watson

and found both

& et

treat-

increases in the use of adaptive coping

is

GT

theory.

However,

to their credit,

conducted almost entirely by advocates (see

Chapter

1).

research directly assesses the effects of chair

outcome, and other studies combine elements of theory-relevant

client

it

They describe

could play a part in the process

PET

program of research

(2004), the results were similar, demonstrat-

this research

effects

relevant to

Greenberg, Goldman,

(e.g.,

et ah,

ing significant empirical support for this variant of al.

still

clinical trials,

to cognitive-behavioral treatment for depression

ments

Elliot et

their

2004).

of which were true randomized

no treatment, or comparison group controls

Angus, 2001; Greenberg al.

Emotion-Eocused Therapy. Although not

as

GT outcomes and theory,

our understanding of GT. In

ber of

known

also

it

does not

fit

neatly into

my research

categories.

I

pre-

does seem to be some of the only research that bears directly on the

theory of GT. Greenberg and his colleagues have conducted quite a bit of research on this

approach, finding supportive

results, so

I

only sample a few studies in the following

will

section. Interested readers can consult Elliot et

al.

(2004) for further

Greenberg and Dompierre (1981) compared the

effects

detail.

of one session of

ECD and one

on 16 psychotherapy clients. Each client received both interventions. Results indicated that ECD produced deeper levels of emotional experiencing

session of

empathic

reflection

and more client-perceived changes

in awareness, progress,

the empathic reflection. Although supportive of early study

Looking

GT theory,

conflict resolution than did

the measurements used in this

were somewhat primitive. at the process

of conflict resolution more

(1996) examined the performances of 22 clients ful in

and

resolving unfinished business using

and Foerster found that

ECD.

successful resolution

closely,

who were

Greenberg and Foerster

rated as successful or unsuccess-

In a detailed study of these

was more

likely to

LCDs, Greenberg

be accompanied by intense

emotional expression, need expression, and positive expressions about the “other” dialogue (whether

GT assumption

it

was

self or

someone

else).

These findings would seem

that increased experiencing or awareness

dysfunction (unfinished business).

is

to

in the

support the

necessary for the resolution of

GESTALT THERAPY

228

and Greenberg (1995) studied the effects of treatment containing ECD compared to a group educational experience that introduced information about unfinPaivio

ished business. Seventeen clients (recruited via newspaper advertisements) completed

each intervention. Pretests and posttests on

symptom

variables as well as measures of

unfinished business were administered to both groups, and the

lowed up

at

4 months and

groups on a number of the

symptom

group was

fol-

were found between the

year. Significant differences

1

ECD

measures; most significantly, the

ECD

group

re-

ported more resolution of unfinished business than did the group experience group.

This finding supports the

GT

of

utility

ECD

interventions and

is

indirectly supportive of

theory.

However, we must keep two other considerations First,

in

mind when reviewing

these results.

ECD in only 53% of the sessions. Thus, strategy to symptom change. A related concern

the individual counseling sessions used

of

difficult to directly link the use

that the

this

it is

ECD group and the educational group differed in the number of sessions and,

course, the level of individual attention

and support

received.

is

of

Thus, differences between

the groups could be attributable to the very different kinds of treatment received rather

than any specific effects of ECD.

and Horowitz (1998) studied the use of ECD in resolving grief following the loss spouse. Participants completed a dialogue, and then self-rated the amount of unre-

Field

of a

solved grief they had

felt

during the dialogue. The degree of resolution was related to symp-

toms 6 months and 14 months

showed higher

resolution ories

levels

who had more

than those

That

after the study.

who

participants

is,

of depression, avoidance of the

grief,

and

indicated

intrusive

less

mem-

fully resolved their grief

Tyson and Range (1987) found that

ECD

had no

specific effects

on mild

depression.

They compared a no-treatment control group to three other treatment groups. Two treatment groups engaged in dialogues; the difference between the two was that in one group, the dialogues were personally relevant, and in the other, they were enactments of Shakespeare’s plays. In a third

place. Analyses

treatment group, affective expression was encouraged but no dialogues took

of pre-, post-, and follow-up measures of depression indicated that

all

of the

groups, including the control, improved over time. Ty§on and Range concluded that their

study demonstrated that mild depression dissipated over time whether

However,

and the small number of participants

perimental conditions (about 10 in each), which can lead to low differences. Also,

it is

possible that

was treated or

not.

of the findings can be offered, including the brevity of

several other explanations

the treatments (weekly for 4 weeks)

it

ECD

is

more

effective

when

statistical

conflict

of the ex-

in each

is

power

to detect

present than for

mild depression.

Other research bearing on

GT

has attempted to explore boundary or contact distur-

bances. For example. Mills (1997) attempted to develop a self-report scale to measure projection, introjection, retroflection, confluence,

and

deflection. Unfortunately, these efforts

have not been very successful (Caffaro, 1991 Mills, 1997). ;

this area

is

whether individuals can

by these kinds of investigations.

rate their

Still

own

A question that can be raised in

contact disturbance

styles, as

is

other investigators have attempted to create a

for rating the quality of contact in an interpersonal relationship, but the reliability

of the ratings seriously hampered the usefulness of Kaplan, 1986).

this

assumed

method

and range

attempt (Leonsky, Kaplan,

&

GESTALT THERAPY

229

AND CULTURAL DIVERSITY

ISSUES OF INDIVIDUAL Many

have pointed to the individualistic bias of GT. Saner (1989) opined that

critics

“most American Gestalt Therapy theorists and practitioners are unaware of being enced by culture values or fixed gestalten best described neurosis.

tic is

My claim

that the

is

individualism or individualis-

contemporary form of Gestalt Therapy made-in-U.S.A.

not universally valid and needs theoretical and methodological revisions

and meaningful”

truly c.ross-culturally valid

noted

this bias, attributing

Mackewn

(p.

(1997) maintained that because

working with

clients

from

all

walks of

GT

client’s

emerging

be

in his theory.

counselors strive to understand the

awareness, the approach

“Gestalfs insistence

life.

in order to

Wagner-Moore (2004)

59). Similarly,

to the personality of Peris

it

person in the environment and explore the to

as

influ-

upon

is

well suited

the fact that the

individual cannot be understood in isolation but only as a part of their historical and social context

means

that in theory at least

we have

the capacity to take into account and

attend to cultural difference, historical background and social perspectives” (Mackewn,

1997, pp. 50—51). However, Kareem and Littlewood (1992) differed in their review of the applicability of

GT

counseling; they pointed out the inherent biases introduced by the

origins of the theory in Jewish

Western

address cultural issues with the client

if

culture.

They recommended

that the counselor

they seem relevant to the progress of therapy.

The emphasis in GT on verbal, emotional, and behavioral expressiveness is counter to the values of many cultural groups (Sue & Sue, 2003). Traditional Hispanic/Latino and Asian individuals may see the control of emotions and behavior as signs of wisdom. Also, GT’s emphasis on self-disclosure may be in opposition to these groups’ values. At the same time, GT’s disavowal of insight may be consistent for individuals who want action, such as individuals from lower socioeconomic status. The relative lack of focus on content and the ambiguous structure of GT, on the other hand, may be disconcerting to clients of diverse cultural backgrounds, such as Hispanic/Latino clients (Sue

GT writers

have paid attention to the issues of individuals

who

& Sue,

2003).

are gay, lesbian, or bi-

and Singer (1994) presented chapters on GT with gay and couples. Singer provided a good description of issues specific to gay couples, while

sexual (GLB). Gurtis (1994) lesbian also

acknowledging that

GT counseling with

GT

most

cultures,

clients in counseling,

Enns (1987) presented many ways consistent with

such

as

on GT. She maintained

a feminist orientation because

women

the

Enns pointed out

‘shoulds’ with a reliant

as

issues likely to

it

that

GT

is

in

emphasizes awareness and per-

can be encouraged to become aware of parts of them-

of anger).

GT can

also

support

they go against existing norms in defining themselves separately from others. At

same time, the emphasis on

lematic.

such

shame.

selves that are culturally discouraged (e.g., intense feelings as

not that different from

GT constructs to

and applied

a feminist perspective

sonal power. In this system,

women

is

a straight couple. Gurtis discussed critical issues for lesbians,

the strong heterosexist bias in

emerge with lesbian

counseling with a gay couple

new and at best,

intellectualizing or

and individuality found

that “the singular focus of Gestalt

potentially dangerous ‘should’:

and self-determining’”

mental factors

responsibility

and

(p.

‘1

in

Therapy

must be

fully

GT can be probreplaces the old

autonomous,

self-

94). This kind of approach neglects the role of environ-

at worst, characterizes the

making excuses

(p. 94).

examination of these factors

as

GESTALT THERAPY

230

Enns (1987) also highlighted GT’s neglect of the fundamental interrelatedness of humans. Autonomy in the GT model looks very much like a male value, counter to the female valuing of relationships that time,

women

is

discussed by

many

and maintaining the love

traditionally equate their self-worth with gaining

and approval of

others.

GT

s

same

feminist writers. At the

support for growth and personal responsibility

may

help

female clients find their worth in themselves rather than in others’ perceptions of them.

Fernbacher (2005) argues that the emphasis on awareness in

GT

is

ing with clients from diverse backgrounds provided that the therapist process.

She

also points to the field theory construct

of GT

is

(e.g.,

culture, society, po-

systems). However, Fernbacher also cautions that the heavy reliance

observation and intervention in

GT calls for attention

own

aware of his

promoting the understand-

as

ing of the client and counselor as indivisible from their contexts litical

work-

facilitative in

on nonverbal

to differences across individuals to

understand the meaning and impact of these expressions.

THE CASE STUDY Jessica presents

with troubled feelings about her relationship, for which she blames herself

This internalization

fits

well with a

GT

approach because

it

suggests that she

is

denying

her personal dissatisfaction with the encounter. She has lost contact with her aggression

and anger,

as well as

her need for love. Jessicas history also seems to be amenable to a

GT

viewpoint, especially her unfulfilling relationships with her parents. Potential problems with a

GT approach to Jessica would seem to involve her feelings of

responsibility for the relationship with Randy.

take care of relationships, difficulty for her.

That

and so

Jessica

is

Women

are taught

by Western culture to

insisting that she violate these cultural rules could create

African American could also be a factor in employing a

GT framework because the emphasis on individualism may be counter to the more collectivistic

approach of African American culture.

Summary GT

counseling

is

an existential/humanistic approach to

are seen as functioning holistically tional support. cle

Needs

are

and

striving to

human

meet needs such

met through contact with

as physical

the environment in an

of need emergence, activity by the individual aimed

satisfaction,

functioning. Individuals

retroflecting, or

we sometimes avoid

moving

into confluence.

GT counseling

is

self)

is

is

cy-

need

sometimes

contact by introjecting, projecting, deflecting,

When we avoid

create unfinished business, holes in the personality,

environment (which includes the

unending

at satisfying the need,

and disappearance of the need. Gontact with the environment

scary or painful so

and emo-

contact and needs go unmet,

and psychic

splits.

we

Our awareness of the

disrupted and contributes to further dysfunction.

conceptualized as an encounter between two individuals.

No

formal

The counselor is to be authentic in the relationship and will self-disclose if it seems helpful. The goal of GT is to support the client so that she can freely experience herself and her environment. Numerous techniques are employed, and most GT counseling involves some form of experiment in awareness. assessment or diagnosis

is

used.

GESTALT THERAPY

GT has been faulted for may are

231 its

extreme emphasis on individual responsibility. This orientation

lead to problems in using this approach with individuals

more

relationship or group oriented.

to psychotherapy,

who

Outcome research supports

are

from cultures that

GT as a viable approach

and some research supports the link between increased experiencing and

client progress.

Visit

Ghapter 7 on the Companion Website

chapter-specific resources

and

self-assessments.

at

www.prenhall.com/murdock

for

B.

F

Skinner

Shirley

a VS-year-old

is

single

Caucasian female. She has been married twice; both

husbands are deceased. Shirley has no children and no surviving work; she

lives

Shirley

on social security

was ordered

to

come

to

counseling by the municipal court because she has been

to see

was a last-born

ship with her mother, describes

was

alterna-

recently arrested.

if she was watched; instead, she just grabbed some items

out the door of the department Shirley

Mandated counseling was assigned as an

Based on her description of the counseling, it appears that Shirley was an ineffective thief. She

tive to traditional sentencing after she

did not check

does not

and income from pensions.

caught shoplifting on multiple occasions.

incident that brought her to

relatives. Shirley

store.

child, raised in Chicago.

whom

and headed

She describes a very unhappy relation-

she characterized as unloving, harsh,

and domineering. She

a good relationship with her father, although she resented that he never stepped in

to protect

her from her mother. Shirley graduatedfrom college with a degree in finance

and

was one of the few women working in business in the 194 Os. She describes herself as very successful at her job managing investments, despite being in a male-dominated career. Her first

husband was a military

officer.

and moved with United States and Southeast Asia.

After they married, Shirley

left

her job

number ofassignments across the Shirleys second husband owned an auto parts store. During this marriage, Shirley focused on her role as a homemaker and was involved in volunteer work in her community. Shirley portrays both of her marriages as very happy and rewarding. Currently, Shirley reports being involved in community service with the elderly, helping her husband through a

out at a senior citizens center about once a week. She no longer drives a ing on the bus for transportation. Shirley

lives

alone in an apartment

has few social contacts outside of her volunteer work.

232

car,

instead rely-

and reports

that she

BEHAVIOR THERAPY As

233

she reluctantly discusses her shoplifting, Shirley says that she has recurrent obsessive

thoughts about stealing

when

She describes a feeling of anxiety that does something and lefi the store. Shirley immediately feels guilty

she

not subside until she has stolen

in a store.

is

about her actions. She says that she never steals anything particular; she takes. Shirley reports that she first began to steal things

when

does not matter

it

was in her

she

what

40s, afier

Her first husband knew about the shoplifting, but she was better back then. Her second husband apparently never knew about it. Shirley

the death ofiher mother.

able to control

it

has never experienced legal difficulties as a result of her stealing until Shirley

is

unhappy about being

referred to counseling.

She

one who can prevent her “compulsive stealing’ as she terms tle to

help her. Shirley

is

extremely embarrassed to

recently.

believes that she

the only

is

and that therapy can do litsee a counselor and expresses a good deal it,

ofshame about her behavior.

BACKGROUND Behavior Therapy (BT) different perspectives

is

actually a cluster of

on human

models and techniques that involve

learning. In this chapter,

I

will review the

models and

techniques of traditional BT, but will also include techniques based on what called Cognitive-Behavior Therapy.

sometimes used

ing one;

it is

tion for,

and modification

refer to

of,

The term

Cognitive-Behavior Therapy

to refer to a behavioral

cognitive influences

any of the cognitive approaches (such

cditi

several

is

generally

be a confus-

approach that includes the apprecia-

on behavior. Other

as Rational

times,

used to

it is

Emotive Behavior Therapy and

Cognitive Therapy, Chapters 9 and 10). Most therapists in the behavioral tradition today

would acknowledge the influences of cognition, cates (for

of BT

who

still

a

few hard-core advo-

maintain that the target of change should be behavior, and behavior only

example, the

out there in the

yet there are

classical “real

applied behavior analysts, see the following sections). However,

world” of practice, you

will

mostly see

a

pragmatic approach that

blends aspects of the material in this chapter along with assumptions and interventions

more

closely resembling Cognitive

What

the

BT

approaches share

Therapy and Rational Emotive Behavior Therapy. is

the

commitment

approach that

to a scientific

is

con-

cerned with “the application of principles broadly derived from psychological research (across experimental, social, cognitive,

tional intrapsychic or disease

and developmental psychology),

model of disordered behavior, and with an emphasis on the

empirical evaluation of treatment effectiveness” (Glass

add that Behavior Therapy

is

& Arnkoff,

BT

has such a long history,

hensive historical perspective

1992,

p.

609). Others

characterized by a concern with current causes of behavior

rather than those rooted in the individual’s history (Franks

Because

rejecting a tradi-

is

many

influences,

beyond the scope of this

shots of important figures in BT; readers

who would

& Barbrack,

and many chapter.

like a

1990).

influencers, a

What

compre-

follows are snap-

more complete review should

consult Glass and Arnkoff (1992) or Kazdin (1978).

Behavior Therapy was developed very therefore early Behavior

much

in reaction to the psychoanalytic

Therapy emphasized observable behaviors

events or client history (Goldfried

“Behavior therapy began in the

& Davison, late

1950s

alternative to the prevailing disease-oriented

model, and

rather than internal

1994). As Franks and Barbrack (1990) put as

it,

an antimentalistic, somewhat blinkered

model of psychodynamic psychotherapy”

(p.

551).

1

BEHAVIOR THERAPY

234 Contemporary forms

BT are more flexible in admitting cognitive and emotive factors

of

explanation of human

activity.

Fishman and Franks (1997) noted that “with the exception of

tradition;d applied behavior analysis, prevailing behavioral approaches

cognitive mediational concepts, and, to greater or lesser degrees,

of principles derived from traditional learning theory

from cognitive and for

social

psychology”

all

is

embrace the use of

emphasize the integration

144). In contrast, read the statement of the Association

(p.

two kinds of variables:

the product of

all

and conditioning with those stemming

Behavior Analysis International (ABAJ) that “behavior analysts

behavior

in the

biological

make

the assumption that

and environmental” (vABAJ,

Understanding behavior analysis). T\\ow^x.s, and feelings (those things that folks

all

n.d..

commonly see as

the causes of behaviors) are merely other behaviors to be counted.

The most

distant origins of Behavior

Therapy

are usually located with Russian scientist

Ivan Pavlov and his experiments on classical conditioning. In studying the eating behavior

of dogs, Pavlov discovered that pairing food, which resulted in the dogs salivating, with a bell eventually resulted in the

be explained more fully in a

Joseph Wolpe used

dogs salivating in response to the

bell only.

This model

will

later section.

conditioning model

this classical

as the basis for his

approach

to the

understanding and treatment of anxiety, which he called reciprocal inhibition (more on this

model

later).

Fishman and Franks (1997) noted

that the important technique

by the theory of reciprocal inhibition, systematic desensitization, was the tive to the

Most

spawned

first real

alterna-

psychoanalytic approaches in vogue in the 1940s and 1950s.

sources trace the beginnings of American behaviorism to John B.

1913 Psychological Review

2irnc\t,

“Psychology

as a Behaviorist

Views

It.”

Watson and

Watson,

his

who had

been influenced by Pavlov’s work, was vehement about erasing “mentalism” from psycholapproach to understanding

ogy, thereby eliminating the study of consciousness as a viable

human

behavior (Glass &' Arnkoff, 1992). Watson and his graduate student (and

later,

second wife) Rosalie Rayner applied Pavlov’s ideas about conditioning to create conditioned fear in their

famous report about Little Albert

Mary Cover

Watson’s student,

3-year-old boy, Peter (see

(see

Box 8.1; Watson

& Rayner,

1920/2000). Later,

Jones (1924, 1960a), used these ideas to eliminate fear in a

Box 8.2).

It is

also interesting that Jones

(

1

924/ 1 960b) acknowledged

the usefulness of observational learning in her discussion of eliminating children’s fears.

Box

The John

B.

Watson was

a

Rayner, decided to see that

famous if

Story of Little TUbert

behaviorist. In

they could create

Watson had outlined

in

an

and unemotional” (Watson

Watson and Rayner presented loud noise was

made by banging

signs of distress

conducted, and

1920 he and

human

earlier article

their subject of study Little Albert, “stolid

8.

was

&;

Morgan, 1917). They chose

whom

an 11 -month-old infant

&

Rayner, 1920/2000,

to Albert a white rat.

a steel bar

p.

as

they described as

313).

When

Albert touched the

rat, a

with a hammer. Albert immediately showed

and on the second pairing, began it

through conditioning principles

fear

(Watson

graduate student, Rosalie

his

to cry.

Seven subsequent pairings were

clear that the presentation of the rat

produced

a

strong reaction.

BEHAVIOR THERAPY

on the

so that

235

Albert ''raised himself on all fours

last trial

and began

rapidly that he was caught with difficulty before reaching the edge

crawl away

to

of the

so

314;

table' (p.

italics in original).

Watson and Rayner

whether the conditioned emotional response would

also tested

transder to other stimuli.

They presented Albert with

a rabbit, dog, sealskin coat, cotton

wool, and a Santa Claus mask. All of these presentations evoked responses from Albert, as

did Watson’s

looked tions

hair. Albert’s reactions

at the effect

still

were similar

5 days later. Finally, the researchers

of time on the conditioning, finding that 31 days

later the fear reac-

without any further pairing of the noise and stimuli.

persisted,

Unfortunately for Albert, he was mysteriously removed from the hospital a day after

Watson and Rayner never had

the tests of persistence were made.

the chance to decon-

dition him, although they speculated that pairing feared objects with food or sexual

stimulation, or simply repeatedly presenting the feared stimuli until habituation

cause the “fatigue” of the

True in

tive

reflex.

Watson (and Rayner) took on the Freudian perspec“The Freudians twenty years from now, unless their

to his behaviorist ideology,

the report’s discussion.

hypotheses change, that he

comes

which upon

when

they

come

their analysis will

show

to analyze Albert’s fear

—

to analysis at that age

the pubic hair of the

will

violently for

it” (p.

317). Rilling (2000) pre-

Watson was

of defeating psychoanalytic

Box

Mary Cover Jones was

A Pioneer

a graduate student

founder of Behavior Therapy. In two

ideas,

8.1). In

an

article

Watson

(p.

clearly stated,

317).

The

result

actually supported them.

in

Eliminating Fear in Children

who worked with John

articles,

B.

Watson, the American

she described her work, which was based in infants (the Little Albert study; see

published in the Journal ofExperimental Psychology {l^lAlX^GOf

Jones relates her efforts to eliminate fear classically

attempting

8.2

on Watson and Rayner’s (1920/2000) study of fear

Box

really

Watson and Rayner

“Emotional disturbances in adults cannot be traced back to sex alone”

Mary Cover Jones:

of a dream

recital

about transference, but to make the construct more

general, rather than specific to sexual emotions. In fact,

that, instead

—assuming

that Albert at three years of age attempted to play with

mother and was scolded

to scientifically verify Freud’s ideas

of a sealskin coat

probably tease from him the

sented another view of the Little Albert study, arguing that

was

would

in children, fear that

had presumably been

conditioned.

Jones selected 70 children from a group in an institution that

These children were

in this institution

we might

call

day

care.

temporarily because they could not be cared for

homes (e.g., a parent was ill, a mother worked). Jones selected kids who showed “a marked degree of fear under conditions normally evoking positive (pleasant) or mildly negative (unpleasant) responses” (Jones, 1924/ 1960a, p. 39). The children’s fears in their

included such things imals

(rats, rabbits,

as

being

snakes).

left

alone, loud sounds,

and the sudden presentation of an-

BEHAVIOR THERAPY

236

Jones tested a

number of techniques

that “verbal appeal,”

in a case study format. For example, she

which consisted of talking about the feared object

found

in a pleasant way,

did not work. “Social repression” in which the feared object was presented to a child in the presence of other children, was equally ineffective. Presaging Bandura’s (1969) ideas,

Jones did find that social imitation showed promise as an intervention for Jones maintained that the best

which she detailed (Jones,

method of eliminating

in a separate article,

Eiowever,

direct conditioning,

“A Laboratory Study of Fear: The Case of Peter”

1924/1960b).

Peter

was

a 2-year-old

boy who demonstrated

(whereupon he screamed and

rat to Peter

fears

very similar to Little Albert’s

and other white furry

a rat, fur coat, rabbit, cotton wool,

white

was

fear

fear.

fell

—of

objects. After presenting a

over), Jones observed the following

reactions in a subsequent testing period:

Play-room and crib

Selected toys, got

White

Picked

ball rolled in

it

into crib without protest

up and held

it

Fur rug hung over crib

Cried

until

it

was removed

Fur coat hung over crib

Cried

until

it

was removed

Cotton

Whimpered, withdrew,

Hat with feathers

Cried

Blue woolly sweater

Looked, turned away, no fear

White toy rabbit

Wooden

of

rough cloth

doll

(Jones, 1924/1 960b,

No

interest,

no fear

No

interest,

no fear

cried

p. 46.)

Jones used two kinds of conditioning with Peter and reported that his fear was com-

and

pletely eliminated

of the study. In the

first

ence of other children

that he even

showed

signs of affection toward a rabbit at the

stage of conditioning, Peter

who were

not afraid of

it.

was exposed

end

to the rabbit in the pres-

Gradually, situations were introduced

that required Peter to be closer to the rabbit. In a second stage of the procedure, a rabbit in a cage

was brought

as close as possible to Peter

while he was eating, without dis-

turbing his eating. Presumably, the rabbit was brought closer and closer every day.

Jones reported extinction of the fear behavior, not only of the rabbit, but also in

sponse to the white cotton, fur coat, and the other objects to which he Peter also lears

seemed

re-

initially reacted.

to be less fearful of new animals or unfamiliar situations.

Although

his

appeared to be gone, Jones reported that Peter returned to a rather diminished and

discouraging

home environment,

in

which

his

mother used

(“Come inside Peter, someone might steal you!” nately, we have no further information about the

fear to control his behavior

Jones, 1924/ 1960b, p. 51). Unfortufate

of

Peter.

The second model of learning, the operant model, originated with the work of E. L. Thorndike, who studied the behavior of cats. He would put cats in a puzzle box and entice them to figure out how to get out of the box by placing food outside. Thorndike noticed that in repeated

trials

the cats

became

faster

and

faster at getting

out of the box.

BEHAVIOR THERAPY From is

his observations

learned through B.

F.

Skinner

proach, which

The focus

its

237

he formulated the law of effect, which proposed that behavior

consequences (Kazdin, 2001).

probably the most famous

is

sometimes

is

of this approach

is

name

associated with the operant ap-

called radical behaviorism or applied behavior analysis.

on the consequences of behavior. Skinner, who performed

most of his research with laboratory animals

and pigeons), was not

(rats

particularly in-

terested in applying his science of behavior to developing intervention techniques for

people, although he recognized the potential to In fact, Skinner

and

& Arnkoff,

(Glass

on behavioral lined

who

more

to

use of the term behavior

first

interested in broad applications

Walden Two, in which he describes a community based

went on

principles (Skinner, 1976). Others

by Skinner

& Guevremont, 2003).

principles with hospitalized schizophrenics

1992). tdowever, Skinner was

of his work, such as in his novel

so (Spiegler

were credited with the

his colleagues

on using conditioning

therapy in a report

do

to apply the principles out-

working with psychological dysfunction, such

as

& Arnkoff,

Ayllon and Azrin,

You can read some of Skinner’s views in the sections from Beyond Freedom and Dignity in Box 8.3. A third force in behavior therapy came from the work of Albert Bandura, who recogdeveloped the notion of token economies (Glass

nized the power of observation in learning (Spiegler

developed

such is

social learning

as the observation

called the

of others in learning.

The

approach

this

is

Box

is

sneezes

from

sometimes referred to

as

as

modeling

and

its

frees his respiratory passages

and Dignity A kind of freereflexes. A person

from

irritating substances. Fie

indigestible or poisonous food.

hot object.

More

He

pulls

back

his

vomits and

hand and

frees

elaborate forms of behavior have similar effects. free.

When

in

danger they

flee

frees it

When

from or

source. Behavior of this kind presumably evolved because of its survival value;

much

a part

respect to novel objects

we

call

the

to

genetic

which could have played no

doubt minor instances of the struggle

them

human

endowment as breathing, sweatAnd through conditioning similar behavior may be acquired with

of what

ing, or digesting food.

attribute

theory.

8.3

confined, people struggle (“in rage”) and break

it is

demonstrates a behavior

achieved by the relatively simple forms of behavior called

a sharp or

attack

who

living things act to free themselves from harmful contacts.

stomach from

his

individual

Excerpt from Skinner s Beyond Freedom

Almost all

dom

Guevremont, 2003). Bandura

theory (1969, 1974), which emphasizes the role of social events

model, and hence,

An

&

1992).

role in evolution.

These

to be free, but they are significant.

any love of freedom; they

are simply

We

are

no

do not

forms of behavior which have

proved useful in reducing various threats to the individual and hence to the species in the course of evolution.

A much more another way.

It is

important role

is

played by behavior which weakens harmful stimuli in

not acquired in the form of conditioned

a different process called operant conditioning.

certain kind of consequence,

it is

more

likely to

When

but as the product of

reflexes,

a bit of behavior

occur again, and

a

is

followed by a

consequence having

BEHAVIOR THERAPY

238

this effect

called a reinforcer. Food, for example,

is

anything the organism does that

followed by the receipt of food

is

done again whenever the organism

is

hungry.

Some stimuli

any response which reduces the intensity of such be emitted

when

moves under

the stimulus recurs. Thus,

he

cover,

more

is

likely to

a stimulus

sun

it

follows.

move under

Operant conditioning

—when, roughly

more

is

likely to

cover

it is

also occurs

be

are called negative reinforcers;

—

or ends

it

—

is

more

when

the sun

is

“contingent upon”

when

again

—

that

likely to

when he hot. The

person escapes from a hot sun

if a

reduction in temperature reinforces the behavior havior

hungry organism;

a reinforcer to a

is

is,

the be-

a person simply avoids a hot

speaking, he escapes from the threat of a hot sun.

Negative reinforcers are called aversive in the sense that they are the things organisms “turn

away from.” The term suggests

— but

from something

a spatial separation

the essential relation

is

— moving

or running

away

temporal. In a standard apparatus used to

study the process in the laboratory, an arbitrary response simply weakens an aversive stimulus or brings

it

an end.

to

A great

deal of physical technology

kind ol struggle for freedom. Over the centuries, in erratic ways, a world in

stimuli

which they

are relatively free of

—extremes of temperature,

many

is

the result of this

men

have constructed

kinds of threatening or harmful

sources of infection, hard labor, danger, and even

those minor aversive stimuli called discomfort.

Escape and avoidance play a

when

much more important

the aversive conditions are generated by other people. Other people can be aver-

sive without, so to speak, trying:

they can be rude, dangerous, contagious, or annoying,

and one escapes from them or avoids them accordingly. They may ally” aversive

Thus, a ing

—

that

they

is,

may

treat other

slave driver induces a slave to

work

ver’s

freedom

role in the struggle for

the slave escapes

also be “intention-

people aversively because of what follows.

work by whipping him when he

stops;

by resum-

from the whipping (and incidentally reinforces the

behavior in using the whip).

A parent

slave dri-

nags a child until the child performs a task;

by performing the task the child escapes nagging (and reinforces the parent’s behavior).

The

blackmailer threatens exposure unless the victim pays; by paying, the victim escapes

from the threat (and reinforces the

practice).

A

teacher threatens corporal punishment

or failure until his students pay attention; by paying attention the students escape from the threat of punishment (and reinforce the teacher for threatening

another intentional aversive control

the pattern of

most

In one form or

social coordination

government, economics, education, psychotherapy, and family

ethics, religion,

A

is

it).

—

in

life.

person escapes from or avoids aversive treatment by behaving in ways which rein-

force those

who

For example, he igrate or defect

treated

may

from

him

simply move out of range. a

is

as

A

person

government, desert from an army, become an apostate from a

ligion, play truant, leave

Such behavior

may escape in other ways. may escape from slavery, em-

aversively until he did so, but he

much

home, or drop out of a

a culture as a hobo, hermit, or hippie.

product of the aversive conditions

ditions were designed to evoke.

The

latter

re-

as the

behavior the con-

can be guaranteed only by sharpening the con-

tingencies or by using stronger aversive stimuli.

Another anomalous mode of escape

and weaken or destroy

we

their power.

is

who arrange aversive conditions those who crowd us or annoy us, as

to attack those

We may attack

attack the weeds in our garden, but again the struggle for freedom

toward intentional controllers

— toward

those

who

is

mainly directed

treat others aversively in order to

.

BEHAVIOR THERAPY

239

may stand up to his parents, a citizen may overthrow a government, a communicant may reform a religion, a student may attack a teacher or vandalize a school, and a dropout may work to destroy a culture. It is possible that man’s genetic endowment supports this kind of struggle for freedom: when treated aversively people tend to act aggressively or to be reinforced by signs induce them to behave in particular ways. Thus, a child

of having worked aggressive damage. Both tendencies should have had evolutionary advantages, and they can easily be demonstrated. If two organisms which have been coexisting peacefully receive painful shocks, they immediately exhibit characteristic patterns of aggression

toward each other. The aggressive behavior

toward the actual source of stimulation; person or object. Vandalism and gression.

An

riots are often

organism which has received

access to another organism toward

human

may

it

be “displaced

it

not necessarily directed

”

toward any convenient

forms of undirected or misdirected ag-

a painful

which

is

shock will

also, if possible, act to

gain

The extent to which and many of the ways in

can act aggressively.

aggression exemplifies innate tendencies

is

not

clear,

which people attack and thus weaken or destroy the power of intentional

controllers are

quite obviously learned.

New York:

Excepted from Beyond Freedom and Dignity hy B. E Skinner, 1971.

Bantam/Vintage.

Recognizing the power of observation was a revolution because to cognitive processes in learning.

Bandura discovered

it

turned our attention

that his participants could learn a

behavior through observation and then, placed in the same situation, refuse to perform

This finding led to the assumption that the learning (Kazdin, 200 1 ). In current applications, modeling ioral techniques,

teaching

it

such

as

when

a counselor

to the client (Kazdin, 2001).

is

models

The

is

stored cognitively in

typically

it.

some way

combined with other behav-

a desired social skill as a prelude to

label Social Cognitive Theory

is

often used to

describe the current version of social learning theory (Wilson, 2005). It is

difficult to discuss the history

Eysenck and

his wildly controversial

of

BT

study of psychotherapy, which

Psychotherapy was the term that Eysenck, a refer to

from Eysenck

is

but regards neurotic symptoms

have eliminated the neurosis' (I960, Behavior Therapy

of these counselors

which was

I

conditioning behaviorist, used to

classical

until

A

latter.

particularly rabble-rousing quote

is

is still

as

simple learned habits; there

symptom

itself

and the prominent professional association

the Association for Behavioral as the

no neurosis

p. 9; italics in original).

a vital approach,

2005 known

is

Get rid of the symptom and you

and Cognitive Therapies (ABCT),

American Association of Behavior Therapy, formed

in

name change should tell you something). The Behavior Therapist \s the official of the ABCT. An organization for the applied behavior analysts is the Association

(the

journal for

reviewed in Chapter

the following: “Eearning theory does not postulate any such ‘unconscious

underlying the symptom, but merely the

1966

I

approaches other than behavioral, and he expended a great deal of energy attempt-

ing to discredit the former and promote the

causes,’

without pointing to the influence of Hans

Behavior Analysis International ( http://www.abainternational.org/ ).

BEHAVIOR THERAPY

240

The

first

journal exclusively devoted to Behavior Therapy was originated by Eysenck

and Rachman, Behavior Research and Therapy, and the

first

to

was the Journal of Applied Behavior Analysis, which debuted 1992), There are many journals devoted to Behavior Therapy,

promote operant in

principles

& Arnkoff,

1968 (Glass

Advances in Behav-

and Therapy and Behavior Modification. Division 25 of the American PsychoAssociation is the Division of Behavior Analysis, and has a homepage at

ior Research

logical

www.apa.org/divisions/div25 In testimony to

its

.

B.

R Skinner award

for

new

on

research

Hayes, Luoma, Bond, Masuda, and that are cognitively-oriented, but focus specific content is,

of it

(as

historical roots. Division

(2006) identify a third wave of BT approaches

Lillis

more on the context and function of thought than

does, for example classic Cognitive Therapy, see Chapter 10).

and Commitment Therapy, look

tion in

which thoughts occur and the effects of the thoughts

to

satisfaction.

These most recent developments

in

in terms

BT

provide brief descriptions of three newer

Psychotherapy, Acceptance and

BT

the

That

at the situa-

of behavior and beyond,

are interesting in that they are

much more attentive to the therapeutic relationship than traditional BT I

(Lejuez et ah, 2006).

approaches in Box 8.4, Functional Analytic

Commitment Therapy, and

Dialectical Behavior Therapy.

Box 8.4

NOUVEAU BEHAVIOR THERAPY Recent versions of Behavior Therapy have presented some unusual twists and turns

when compared

to traditional approaches.

Here

will describe three

I

of these newer

approaches.

DIALECTICAL BEHAVIOR THERAPY (DBT) Developed by Linehan (1993),

DBT was originally oriented to dealing with clients who

present with fairly severe levels of dysfunction

Combining BT,

personality disorder).

Zen Buddhist philosophy, sessions,

group

skills training,

warm, accepting tive feelings,

a

DBT

more balanced,

an intensive approach, including weekly individual

and frequent telephone consultation. In the context of a

dialectical process. Like

levels

aspects of

The

goal

ACT

and acceptance into

apists also teach their clients

rocal

cognitive therapy techniques, and elements of

therapist validates.

principles of mindfulness

Two

self-injurious behavior, borderline

(e.g.,

relationship, clients are allowed to vent

which the

with significant

is

for the client to

(described next),

its

approach

DBT

skills,

which

life

with

incorporates the

philosophy and treatment.

emotional regulation

of dysfunction (Robins

is

about and tolerate their nega-

DBT ther-

are critical for clients

& Chapman, 2004).

DBT are particularly interesting: contingency management and recip-

communication. In contingency management, the therapist uses her approval,

warmth, and caring

to reinforce desired client behavior in sessions,

and “breaks” from

the relationship are sometimes used as punishers (Lejuez et ah, 2006). Reciprocal

munication

refers to the use

a

a yearly basis.

these approaches, particularly Acceptance

life

25 sponsors

com-

of therapist self-disclosure (often about the therapeutic

BEHAVIOR THERAPY

relationship)

and

241

irreverent

the patient says in an

communication, which

described as “reframing something

is

unorthodox way or adopting the opposite

of intensity of the

level

patient” (Lejuez et ah, 2006, p. 462). For example, Lejuez et ah describe responding to a client

who

complains about role-playing with “Great,

personal relationships have improved?”

(p,

I

assume that

of your inter-

all

462).

ACCEPTANCE AND COMMITMENT THERAPY (ACT) Based on the notion (and experimental findings) that avoiding unwanted thoughts,

and physiological experiences can

ings,

create

worse problems,

ACT

is

feel-

a behaviorally-

oriented approach that encourages clients to simply accept and observe these (Bach

Hayes, 2002). focus

Once

the client stops trying to banish these experiences, he or she can

on overt behaviors

for Accept,

directed at desired outcomes.

Thus

Choose, and Take Action (Hayes, Strosahl,

the

its

acronym ACT also stands

& Wilson,

elaborate underlying theory of cognitive process (Relational

of ACT (particularly

1999). Based on an

Erame Theory), proponents

founder, Stephen Hayes) have generated volumes of literature,

much of it empirical, supporting the approach. The overall goal of ACT is to increase psychological flexibility (Hayes et ah, What is unusual about ACT is that it draws from ancient spiritual traditions in

2006).

em-

its

on acceptance and mindfulness (Hayes, 2002). Clients are taught to observe thoughts and accept them as just that something that happens that need not be phasis

their

—

For example, you might teach a client to think another planet” rather than

“I

am from

“I

am

having the thought that

I

true!

am from

another planet.” This loosening of thoughts

allows the client the freedom to concentrate

on

life

values

and make

actions that advance toward these goals. Techniques used in ioral

&

ACT

a

commitment

to

include basic behav-

techniques (for the committed action part) but some that look more like Buddhist

rituals (e.g., passively

observing thought, repeating a thought out loud).

FUNCTIONAL ANALYTIC PSYCHOTHERAPY Functional Analytic Psychotherapy (FAP), developed by Kohlenberg and Tsai,

is

Be-

havior Therapy that puts the focus on the therapeutic relationship. In this approach, the assumption tions, etc.)

is

made

that

“all

people act (do, think,

feel, see,

know, follow instruc-

because of the contingencies of reinforcement they have experienced in

&Tsai, 1995, p. 638). Therefore, the FAP therapist is happiest when she can operate on material produced by the client in the therapy sespast relationships” (Kohlenberg

sion,

which FAP advocates

call clinically

relevant behavior

(CRB; Hopko

&

Hopko,

1999). There are three types of CRBs: problem behavior, behavioral improvements are observed in session

and

client interpretations

o{\o^ 2n\o\: (which

therapist

two occur and

is

to

watch

either

fail

for each of these, to reinforce or

times they even evoke these behaviors

(Hopko

present with relationship problems and tionships, as

it

many

times

FAP

it is

therapists focus

occurs in the counseling session.

and provide reinforcement when the

punish the

first

& Hopko,

The last

(problem behavior). Some1999). Because

assumed that contingencies

on the

2

indicate client un-

derstanding of the contingencies and consequences associated with behaviors).

FAP

^X

many clients

reside in rela-

actual client-therapist relationship

BEHAVIOR THERAPY

242

BASIC PHILOSOPHY BT

Because contemporary

more of

is

a general orientation than a specific theoretical

approach, the assumptions behind the orientation are helpful in understanding currently practiced (Antony ciples of

&

how

it is

Roemer, 2003). Martell (2007) outlined eight basic prin-

Behavior Therapy; these are

Box

listed in

8.5.

I

will present here a general

overview of the philosophy of the approach, which will touch on these principles. Behaviorists tend to take a neutral view of

human

genetic influences, ultimately, they believe behavior

humans

to rate

“good” or “bad”

as inherently

Behavior therapists tend to emphasize, people rather than to describe trait

as

descriptions (Spiegler

trait

how someone

is

is

nature.

determined by the environment, so

useless (Skinner, 1971).

you might

expect, behavioral descriptions of

& Guevremont, 2003). They are more likely

talks (e.g., she speaks very precisely)

description (she’s snotty).

Although they recognize

At the extremes, BTs would

than to characterize using

rather discuss behavior disorders

or problems in living than traditional diagnostic categories because the latter are imprecise

and involve

language (Wilson, 2005). However, a review of BT resources will demon-

trait

strate that traditional diagnostic categories are often

used for organizational purposes.

Ullmann and Krasner (1965), pointed out that traditional behavior change were based on what they called the “medical model” (p. 2).

Early behaviorists, such as

approaches to

In this approach, also called the disease model, a person experiencing psychological difficulties

is

factor or

viewed

mechanism

changed, then, get

as sick or diseased,

is

symptom

the underlying cause, not the

substitutiqn.

The .

symptom.

different ones, but

Taking

a medical

Box

1

results

from some underlying causal

inside the individual (such as repressed conflicts).

more symptoms, perhaps

called

and the sickness

is

needs to be

If you don’t treat the cause,

symptoms approach

just the

same;

you

this process

Therapy

strengthened or weakened by

its

consequences.

2.

Behaviors that are rewarded are increased; those that are punished will decrease.

3.

The approach

4.

Neutral stimuli, paired with positive or negative environmental stimuli, can take on

functional rather than structural.

is

the properties of the environment in

which they

are presented

and be conditioned

to be positive or negative. 5.

Behaviorism

6.

Behavior therapy

7.

Changes

8.

Insight alone

From

is

antimentalist.

clients is

is

data driven and empirically based.

make

in

therapy must generalize to their day-to-day

not beneficial to

"'Behavioral Therapy”

by C. R. Martell,

lives.

a client.

in A.

Rochlen,

ed.,

is

to psychological dysfunction

8.5

Principles of Behavioral

Behavior, whether public or private,

What

Applying Counseling Theory:

Case Based Approach, pp. 143-1 56, 2007. Upper Saddle River, NJ: Prentice Hall.

An

On-line,

BEHAVIOR THERAPY

243

knows best” attitude because the real causes of behavior can’t be seen. Diagnosis becomes central in the medical model, which should then guide treatment. In stark contrast to the medical model, BT adopts the psychological or learning model ol dyslunctional behavior, which focuses on overt behavior, and in the case of cognitive behaviorists, cognition, too. In this model, the symptom is the focus of attention, rather than leads to a “doctor

the assumed underlying causal factor(s). Behavior

defined

as

pathological because

selors see themselves as scientists w\\o rely

to help their clients.

know

essary to folks

do not

They do not

from

deviates

it

is

seen as simply behavior, which gets

on the

results

it

coun-

of experimental studies of learning

search for deep, hidden causes of behavior;

the origins of a problem to solve

BT

norms (Bandura, 1969).

social

(Wilson, 2005). In

fact,

not nec-

it is

some of these

term Behavior Therapy, instead preferring alternatives such

like to use the

as

behavior modification or the environmental analysis of behavior (Sherman, 1973). Historically, a controversy within the ranks

human

of behavior therapists has centered on the

roles

of cognition

and emotion

eral varieties

of Behavior Therapy, ranging from radical behaviorism to cognitive behavior mod-

ification.

in

These arguments allow the

behavior.

Radical behaviorism, rooted in the ideas of

identification of sev-

Watson and Skinner, would totally exclude

&

cognitive or otherwise inferred processes from causal explanations of behavior (Goldfried

Davison,

do not

1

see

994).

That is, although

them

as

more moderate that there

“outer

is

a

these theorists recognize that thoughts

and feelings exist, they

determinants of behavior, instead seeing only the environment as

position

mind

is

the one presented

apart from the body”

by Martell (2007)

(p. 1 47).

that “behaviorists

At the extremes, these

critical.

A

do not accept

theorists adhere to

an

model of psychopathology” and accuse cognitively oriented behavior therapists of adopt-

ing the medical model because they pay attention to events inside people that cannot be observed directly (Reitman, 1997, p. 342). generally

On

known

who

version of radical behaviorism

and

the cognitive behavior therapists

fall

social learn-

allow for the influence of internal events such as cognition and imagery

understanding and changing behavior. Most behavior therapists today probably

the cognitive behavioral camp; in fact, as early as 1983, a sample of members of

fact,

Graighead (1990) reported that

69%

of respondents to an

fall

into

ABCT re-

ported that a majority of them used cognitive techniques (Gochman, Allgood, 1983). In

is

applied behavior analysis.

the other end of the spectrum

ing theorists, in

as

The contemporary

&

Geer,

ABGT member-

ship survey characterized themselves as cognitive behavioral in orientation. Last and

Hersen (1994) noted that “the importance of cognitions ioral

and emotional responses

(1994,

p. 8; italics

Therapy

will rely

is

now

JaNelle

is

my presentation

classic discussions

that current practices are pragmatic

the behavior therapist

and

who

She

is

Shirleys behavior with a to

therapists

in

mind

integrative (Martell, 2007).

accepts Shirley as her client. She

JaNelle assumes that Shirleys behavior

aware that some

of the principles of Behavior

of the theory; readers should keep

ior therapist who, at times, attends to cognitive processes. tral attitude,

mediating maladaptive behav-

accepted by most practicing behavior therapists”

added). For these reasons,

mostly on

in

is

is

a moderate behav-

Approaching Shirley with a neu-

mostly environmentally determined.

(and indeed, some behavior

therapists)

would

associate

DSM-IV diagnosis ofobsessive-compulsive disorder. JaNelle prefers

simply describe the behavior

and look for

the elements that support

terested in the cognitions that Shirley has at the times

when

the

it.

JaNelle

is

problem behavior

also inoccurs.

BEHAVIOR THERAPY

244

HUMAN MOTIVATION Behaviorists see

means

humans

survival; thus,

our behavior

then become valuable to

promote

survival,

motivated to adapt to the environment. Adaptation in

as

us,

in service

is

of obtaining things that help us survive, which

or reinforcing, and

which become

away from behaviors or experiences According

aversive experiences.

process of operant conditioning presumably evolved sensitively affected

when

that don’t

to Skinner (1971), “the

those organisms which were

by the consequences of their behavior were better able

On

view

this

more

to adjust to the en-

Wolpe (1990) defined adaptive behavior as that which “actually results in satisfying the individual’s needs, brings him or her relief from pain, discomfort, or danger, or avoids undue expenditure of energy” (p. 8).

vironment and survive”

JaNelle

sees Shirleys

114).

(p.

a

more

general level,

behavior simply as the most recent

way she has adapted to

the environ-

and avoids aversive situations. In this way, Shirley survive and moving away from experiences that might

ment. Shirley seeks positive stimulation is

seeking the resources she needs to

be harmful. Unfortunately, Shirleys behavior has become maladaptive for her because places her in opposition to society. Getting resources in

some ways, but social

rules

(i.e.,

items from the store)

have determined that Shirleys behavior

is

is

it

adaptive

dysfunctional.

CENTRAL CONSTRUCTS To understand contemporary BT, classical, or Pavlovian;

is

helpful to

know the

three major models of learning:

operant, or Skinnerian; and observational, or modeling.

two approaches generate learning

it is

a distinct set of techniques,

generally applied as a

way

to

first

whereas the theory of observational

enhance operant and

classical interventions

on behavior (Bandura, 1969). between the models can be fuzzy and the connections between

through adding attention to cognitive and

Although the distinctions

The

models and techniques not

as

social influences

simple as one would

basic understanding of learning principles

is

like,

helpful in

I

present the models because a

many

situations.

Classical Conditioning Classical conditioning

is

thought to be an involuntary,

reflexive process

1965). In this model, a relation between a stimulus and response that for evolutionary reasons gets associated

response. For Pavlov, this sequence

diagram

this relation in

humans

Conditioned Stimulus

Taco

Bell sign

to

new

do with a

stimulus, bell,

food,

& Krasner,

presumably “wired

which can then and dog

saliva.

as follows:

Unconditioned Stimulus

Food

had

with a

is

(Ullmann

Unconditioned Response Salivation

Conditioned Response Salivation

(Do you salivate when you drive by the Taco Bell?)

elicit

We

in”

the

could

BEHAVIOR THERAPY This

classical

behavior, iety

is

conditioning model

which he

is

the basis

ofWolpes approach

called reciprocal inhibition (Wolpe, 1960, 1990).

to

changing dysfunctional

Wolpe reasoned

that anx-

when it occurs in circumstances in which there is no objective (Wolpe, 1960). The idea is that anxiety (the unconditioned stimulus, or

a dysfunctional behavior

threat to the person

UCS)

245

gets conditioned to

some stimulus

that

normally not anxiety provoking (the condi-

is

tioned stimulus, or CS). In other instances, anxiety

“autonomic response pattern or patterns that

tack because

it is

snake, for example,

not harmful to

me

a natural

and adaptive response, or the organisms

are characteristically part of the given

response to noxious stimulation” (Wolpe, I960,

A little green garden

is

is

p. 88).

not

(provided

I

really

an occasion for

a

major anxiety

have correctly identified

it).

So

at-

why do

I

jump and scream when I see one of these little critters? Using a classical conditioning model, we would see the snake as a conditioned stimulus, having been paired with some other natural event that

we

event (and

was indeed threatening or noxious, the unconditioned stimulus. That other often don’t

know what

it is) is

what

evoked the

originally

anxiety.

The snake

now evokes anxiety because of its earlier association with the unconditioned stimulus. The association between a conditioned stimulus and a conditioned response can be weakened or eliminated by repeated presentation of the CS in the absence of the UCS, a process called extinction (Wolpe, 1990). For example, Pavlov could repeatedly ring his bell

and never present food

when is

to the dog. Eventually, the

the bell rings because

extinguished.

an individual

is

it

hasn’t gotten

dog will stop responding with

any food

in a long

time

—

salivation

the salivation response

Some BT techniques are based on the principle of extinction, such as when made to sit in a room with a garden snake until her anxiety goes away.

Because Shirleys problem behavior involves anxiety^ JaNelle considers the possibility that classical

conditioning

store for Shirley,

involved.

is

and it

disappears

Somehow, anxiety has been associated with being

when

she steals something

and leaves

in a

the store. JaNelle

wonders if Shirley has somehow associated being in a store with a truly threatening situation that woidd logically lead to anxiety. Perhaps she experienced a life-threatening event in a store in

some distant past. In terms ofintervention,

it

does not matter

how or when

original conditioning occurred, except that JaNelle needs to be sure that the anxiety

ditioned Shirley

to the store,

not something

else.

is

the

con-

For example, the problem could be more general.

might experience anxiety every time she

leaves her

home. JaNelle knows that she

needs to explore this issue with Shirley, as well as the abrupt cessation ofthe anxiety that she experiences

upon leaving the

store.

Operant Conditioning Developed most elegantly by behavior

is

maintained by

its

B.

F.

Skinner, the operant learning

consequences.

The term

model

starts

operantis used because

behavior operates on the environment to produce consequences that,

ideally,

with the idea that it

emphasizes that

contribute to the

person’s adaptation (Nye, 1986; Skinner, 1953), in contrast to respondent (classically condi-

tioned) learning, in

which the behavior considered

In the operant model, behavior

1971). Reinforcement

That

is,

is

is

seen as sort of automatic.

said to be contingent

upon

its

consequences (Skinner,

the formal term for consequences that maintain a given behavior.

reinforcers are consequences that increase the probability that a behavior will

BEHAVIOR THERAPY

246

Whether a particular event is reinforcing is a function of an “ individual’s biological endowment, learning history, and current situation” (Milan, 1990, p. 71). To take a simple example, some people like salty foods, and others like sweet foods. The reinforcement occur.

value of potato chips

Two

is

higher for

me

than that of chocolate.

kinds of reinforcers can be distinguished

—

and negative (Skinner, 1953).

positive

Positive reinforcers increase the likelihood of a behavior occurring because something

good

is

presented following the appearance of the desired behavior. Negative reinforcers

Keep

increase the probability of behavior through the removal of aversive stimuli.

Behavior Therapy language, positive

whereas negative

ior to increase,

refers to the addition

refers to the

When Mom

in behavior (Nye, 1986).

pats

her tantrum. Dad’s cookie-giving behavior

assuming that she

likes

Note

typically use them. In

of something that causes behav-

removal of something resulting in an increase

Johnny on

little

wheel, she has employed positive reinforcement.

sive stimulus (the tantrum).

we

not used in the ways

here that the terms positive 2ind negative

mind

in

the head after he does a cart-

When Dad

gives Laura a cookie to stop

negatively reinforced;

is

that Laura’s tantrum behavior

is

terminated an aver-

it

positively reinforced,

Box 8.6

cookies and has not just eaten a truckload of them.

gives

another example of positive and negative reinforcement.

Box 8.6 Behavior Modification in 1

have a

cats,

used to

Skat, also

is

roaming the neighborhood or sleeping on

my feet.

Sometimes Skat the Cat wants inside when he patient,

and one way of demonstrating this

someone, sometime must have ior,

let

him

is

in fact outside.

As

a

in the

some

1

would never

visitor(s) have, this

mittent schedule of reinforcement with a very long interval. thus accounts for Scat’s persistence in the behavior

hours

What ulus, so is I

.

is

.

.

despite

it

impulse

is

to yell at him.

extinguished very quickly, because

it

could opt for an extinction approach

— he

I

me

because

Skat might just find

bed and

all

1

must

positively reinforce

has been

is

on an

inter-

intermittent schedule

known

to keep

my part,

This behavior on

is

fun!

as

you might

it

up

Mayhe

(i.e.,

never opening the door), but because he it

would

a positive reinforcer! I

guess,

produces no change in the noxious stimulus.

can get her to do

“Hey

it

is

take a very long time and

him away

is

get out of bed in the middle of the night to

my chasing him

upset! This

was not me, of

behavior

The

screen replacements to extinguish his behavior. Chasing

aversive to

(it

consider screen-scratching an aversive stim-

apparently on a long-interval intermittent schedule,

many

not very

being 3 a.m.

my response to Skat’s behavior?

my first

is

house following screen-scratching behav-

good student of behavior modification,

screen-scratching behavior, yet because

He

through screen-scratching behavior. Clearly,

is

thereby positively reinforcing his screen-scratching behavior

course).

for

Felines

known as the Cat from Hell. Skat the Cat is, like most going where he wants to when he wants to. Skat is equally comfortable

His name

cat.

Humans and

look!

again!”

I

got

even more

do

so. Also,

Mom out of

BEHAVIOR THERAPY

One

night

I

had

hand and, perhaps vaguely remembering some between Skafs behavior and the experience of getting wet, decided

a glass

observed relationship to

247

of water

at

throw the water thorough the screen. Bingo! Skat was gone

ing behavior was negatively reinforced.

terminated

what

I

.

.

my water-throw-

and

stimulus of screen scratching was

of my water-throwing behavior. The next time he appeared

as a result

screen, guess

The noxious

.

did?

(I

at the

threw the water, of course.)

But what of Skafs behavior? Because screen scratching was immediately followed by a

consequence that decreased the probability of that behavior, we conclude that he ex-

Now we know that punishment merely suppresses

perienced punishment.

could have some other problematic consequences, such

and food too much

side

to avoid

ior for screen scratching, a

immediately

him

let

havior). Every

inside

now and

me

as

avoidance, but Skat likes in-

altogether. Instead, he substituted another behav-

very loud meow. Choosing the lesser of two

when he yowls

we have

come

Reinforcers

in

evils,

now

I

(thus positively reinforcing the yowling be-

then he delicately puts a few claws on the screen to show

we

he has not forgotten his power and then yowls. Mostly, though, contingencies

behavior and

me

that

are satisfied with the

established.

all

shapes and forms.

The most

basic reinforcers are food

and

sex,

because they relate to the evolutionary goals of survival and reproduction (Nye, 1986).

Skinner (1953) called these primary reinforcers.

Many

things are reinforcers because they

have been historically linked with survival. Skinner (1971) gives the example of a person

moving out of the hot sun

The behavior of moving

into the shade.

reduction in temperature that follows

it,

which

is

presumably good

for the

Unfortunately for neophyte behavior modifiers, though, what

son

may not be

to another.

The power of a given

things affect whether a given consequence

ing just after a big gourmet meal.

of a reinforcer

lem of

all

is

is

is

reinforced by the

is

organism s

reinforcing to one per-

reinforcer can also vary across time.

reinforcing; for example, food

Too much of a good thing

is

things not being reinforcing across persons or time,

Hopko,

is

To

BT

get

Many

not reinforc-

called satiation; the

decreased in these circumstances (Skinner, 1953).

to the notion of establishing operations (Lejuez,

survival.

power

around the prob-

theorists have referred

Levin, Gholkar,

& Collins, 2006).

Establishing operations are defined as “environmental events, operations, or stimulus conditions that affect an organism’s behavior

by altering the reinforcing or punishing

effective-

ness of other environmental events

and the frequency of occurrence of that part of the

organism’s repertoire” (Lejuez et ah,

p.

Many things become sired

457).

positively reinforcing because they are associated with gaining de-

outcomes; they are not the desired consequence

become

itself.

reinforcing because they tend to occur at about the

These conditioned

same time

reinforcers

that reinforcement

occurs (almost in a classical conditioning sense; Reynolds, 1968; Skinner, 1953). stimuli occur in the presence of generalized.

Is

kinds of reinforcers, and these stimuli become

good example of a generalized conditioned reinforcer. The paper or not in itself positively reinforcing, but it becomes so because it is asso-

Money

metal substance

many

Some

is

a

ciated with getting reinforcing things (food, clothes, or other things that support survival).

Attention from others

is

a

conditioned reinforcement, presumably because babies have to

get someone’s attention to get things that

meet

survival needs, such as food or clothing

BEHAVIOR THERAPY

248

& Krasner,

(Ullmann

many

because

Sometimes This

1

965). Manipulating the environment

the light

is

(getting to

a stimulus in the

environment

where one wants (i.e.,

ered punishment,

I

and you.can think of it

you could

think).

When

to go).

As we

get hit

the light

by

is

contingency

on

are

operative.

of sorts.

as a stoplight

red,

it is

When

a signal that behavior will

you can

a traffic light

still

not truly a discrimi-

is

walk across the

a drawbridge. If you

go against the red

light,

you

will

on

street

receive the reinforcer of getting to the other side. Perhaps a better

a light

is

and smushed, which would be consid-

a car

know, however,

all

native stimulus because if you are careful,

you

signals that a given

green, a behavior such as walking across the street will result in reinforcement

not be reinforced

and

a generalized reinforcement

kinds of reinforcers only occur following such behavior (Skinner, 1953).

called a discriminative stimulus,

is

is

a red light

example would be

not be reinforced; instead,

probably punished unless you are a very good swimmer!

When

behavior becomes controlled by discriminative stimuli,

stimulus control. Discriminative stimuli can

become conditioned

it

is

said to be

under

reinforcers, as in the case

The acquisition of money becomes reinforcing because it signals that the behavior money to others gets us desired things (food, swimming pools, shoes; Ullmann &

of money.

of giving

Krasner, 1965).

Once

a discriminative stimulus

is

and the

established, generalization can occur,

rein-

forced behavior will appear in situations in which a stimulus similar to the discriminative

stimulus

is

present. For example, if Laura receives cookies

temper tantrum.

may

Dad becomes

from Dad when she throws

a discriminative stimulus for

tantrum behavior. Laura

a

also

begin to show tantrum behavior in the presence of other male adults, or in the pres-

ence of adults in general. Extinction a response

is

said to occur

becomes

less

when

the reinforcement maintaining behavior

frequent and finally disappears (Skinner, 1953).

extinguished because the contingencies supporting

it

are

no longer

is

removed and

The

in effect.

behavior

An

is

important

know about extinction, however, is that early in the process, “emotional behaviors” may occur, such as anger or frustration (Skinner, 1953, p. 69). Also, the target behavior may intensify (i.e., increase in frequency or strength) under extinction conditions (Sherman, 1973). For example, Sam exhibits loving behavior toward Sally, one form of

thing to

which his

is

calling her daily

and

She reinforces him by cooking

dinner and allowing sexual contact. However, Sally suddenly decides that she no longer

desires relationship behaviors

At

visiting her in the evenings.

first,

his

phone

every night. If Sally

He

with

Sam and

discontinues reinforcing his loving behaviors.

calling behavior intensifies; he calls her hourly

and

probably displays some emotional behavior, such

drives

as

by her house

anger or sadness.

continues to ignore Sam, the calling and driving by behavior will eventually

decrease and then disappear.

Reinforcements can be given after

some responses and not

after every response (called continuous reinforcement) or

reinforcement). Resistance of the target

others

behavior to extinction varies depending on the schedule of reinforcement (Skinner, 1953).

Behavior reinforced intermittently schedules produce

much

is

extremely resistant to extinction, whereas continuous

less resistance.

In the laboratory, behavior can be maintained in

pigeons on a one-in-ten-thousand response schedule (Skinner, 1953). scratching behavior

is

clearly

inforcements (see Box 8.6).

on an intermittent schedule, with long

My

intervals

cat’s

screen-

between

re-

BEHAVIOR THERAPY Punishment

is

249

the opposite of reinforcement; a punisher

probability of a behavior occurring. For example,

middle of January,

am

I

if

I

is

anything that reduces the

strongly punished for this behavior because

extremely aversive event (exposure to cold weather).

my

lock myself out of it

results in (for

unlikely that

It is

house in the

me) an

will repeat this

I

behavior, for sure.

Operant behavior

behavior that the organism freely emits. However, a desired behav-

is

can be created by a process called shaping, in which responses that gradually more

ior

closely resemble the desired behavior are reinforced in a progression.

From

JaNelle wonders ifoperant learning could accountfor Shirleys stealing behavior. perspective, stealing behavior

would be

guess that the stealing behavior

reinforced by something Normally, JaNelle might

reinforced by

is

that

Shirley has indicated that she does not steal

what Shirley acquires

any particular

object,

as

a

which

objects themselves are not reinforcing. JaNelle guesses that the cessation

result.

However,

suggests that the

ofanxiety

is

highly

negatively reinforcing to Shirley, so that leaving the store becomes a highly reinforced behavior. It

is

possible that on

an

a

earlier occasion, Shirley experienced anxiety while in

store

and

ofpicking something up in a wild, almost random She then fled the store. In a chaining process, the anxiety

resorted to a previously learned behavior

attempt

to decrease

her anxiety.

reduction reinforced the leaving the store behavior, which then became a conditioned reinforcer that reinforced the stealing behavior.

Observational Learning The

idea that people can learn

Bandura (1969, 1974). Also

by viewing the behavior of others was developed by

called social learning theory (Bandura, 1969), this

incorporates the cognitive aspects of learning because what

and

later

is

learned through observation

performed must be retained somehow, presumably

in the brain. Observational

learning plays a large part in the acquisition of new behaviors; learn a behavior vicariously than to

randomly emit behaviors

approach

it is

to be

much more

efficient to

shaped by the environ-

ment (Bandura, 1969). Consider learning to bowl. You’ve never bowled before, and your buddies drag you to the bowling the lanes.

alley.

Trying to be a good sport, you put on your bowling shoes and take to

Almost automatically the

of your buddies

is

first

a teacher-type, she

ing you step by step

how to wind

up,

thing you do

is

watch someone

practice to

bowl

bowl. If one

may take you through the process of a turn by showmove forward, and release the ball. Your buddy is the

model. You learn the basic fundamentals without ever picking up the

may need some

else

a perfect

ball.

Of course, you

game.

Both dysfunctional and functional behavior can be learned through modeling. For ample, a phobia can be acquired by watching someone event (Bandura, 1969; Wolpe, 1990). This

phenomenon

Modeling theory combines with operant theory

modeled behavior for If,

for example,

more

likely to

Mary

the

else

ex-

experience an anxiety-provoking

is

called

conditioning.

readily because the consequences of the

influence the observer’s behavior as well (Bandura, 1969).

sees other children praised for speaking

up

in class, she

would be

speak herself (provided she values the teacher’s positive reinforcement).

Likewise, punished behavior can be learned observationally and displayed

when

the

BEHAVIOR THERAPY

250 punishment contingencies

are not

known

Bandura (1969) pointed out

to be in effect.

role-playing interventions often involve modeling because the client

havior on the part of the counselor before performing

first

that

observes the be-

it.

JaNelle wonders ifmodeling plays a role in Shirleys behavior. Certainly, aspeets ofthe stealing behavior could have been learned through modeling, but the observation that Shirley

Had

not a successful thief would suggest otherwise.

is

might have learned

be inconspicuous in her behavior

to

good

Shirley observed a

and to

thief, she

hide the object stolen!

THEORY OF THE PERSON AND DEVEEOPMENT OF THE INDIVIDUAE Behaviorists are not interested in personality theory or developmental stages. to a clients past using the construct of a learninghiistory.

They

Reynolds (1968) maintained that

understanding reinforcement contingencies operative in an individual’s past makes sible to

implement

different contingencies in the present and, thus, to

Ferster (1983) provided a detailed discussion of

and diminished behavioral

when

occur

mother

learn as

many

BT

Other

According to

repertories.

fails

these, to give

more observant

theorists are less reluctant to discuss

pos-

change behavior.

his view, disruptions in

one example. The

behaviors as might the child of a

it

depressed individuals develop faulty

to notice subtle changes in the child that

and thus does not reinforce

ity

is

the

how

attend

reinforcement

might lead

to activ-

child, therefore, does

not

parent.

childhood events. They maintain that

it

simply more efficient to study the current conditions of a behavior to be changed.

JaNelle

of the

is

not very interested in

stealing behavior

and asks

Shirley to recount

being in a store shortly after her mother’s death

saw

she

(a really nice fountain

and ashamed,

guilty

She

Shirley’s childhood.

how

Shirley

it first started.

remembers

and getting panicky. She grabbed thefirst thing

pen) and left the

store immediately. Afterwards, she felt very

of returning

as well as fearful

however, interested in the history

is,

to the store

because they might catch

her.

HEAETH AND DYSFUNCTION In the behavioral tradition, psychological health

havior

is

that

which promotes the

Psychological dysfunction as

adaptive behavior

symptom functional

is

— namely,

is

chopathology

from iors

classical

as in the

it

learned (Ullman

is

it

is

&

it

arises

is

learned.

from the same processes

The

Krasner, 1965).

Whether

a

behavior

is

“so-called

considered dys-

adaptive or maladaptive for a given situation

not considered to be equivalent to mental

illness

or psy-

medical model.

conditioning perspective portrays psychological dysfunction

as resulting

faulty conditioning of anxiety (or fear; the terms are used interchangeably) to behav-

(Wolpe, 1990). Essentially, fear

a previously neutral

that

maladaptive behavior, and

dependent on whether is

seen as adaptive behavior. Adaptive be-

survival of the person. All behavior

the problem” (Sherman, 1973, p. 18).

(Sherman, 1973). Behavior

A

is

is

is

an unconditioned response that gets associated with

conditioned stimulus (Wolpe, 1990). Although he did acknowledge

some behavior was unrelated

to anxiety (e.g, nail-biting,

extreme stinginess, nocturnal

BEHAVIOR THERAPY

251

enuresis, 1990, p. 9), for

Wolpe, the majority of neurotic behavior

habit learned in anxiety-provoking settings.

Wolpe (1990) saw

in essence,

is,

simply

schizophrenia, antisocial

personality disorder, and drug addictions as primarily biological in nature, although con-

some behavior

ditioning procedures could be used to alter

Wolpe defined neuroses feature

is

maladaptive learned habits in which the foremost

as “persistent

anxiety” (1990, p. 23). These habits can be established in a variety of ways. First,

on simple

neurosis can be based

This association can be established in one ample, the anxiety

The

in a battle situation

individual

knows

extreme

when

fear response to a stimulus

very fearfully to the sight of a

the situation

The

is

traumatic enough. For ex-

Doberman

If,

she hears

might

Danny,

result in the observer acquiring a clas-

as a child,

pinscher, he

observed his mother reacting

might develop the same neurotic

In a similar process, neurotic fears can be brought about

1990).

associated with the anxiety.

them in a nonbattle situation. conditioned, according to Wolpe (1990). Observing some-

conditioned fear of that stimulus.

sically

trial if

is

that the sounds oi gunfire or sirens are not immediately threat-

Fear can also be vicariously else’s

in the situation

aroused by a

is

can become conditioned to the sound of gunfire, or

ening, but becomes anxious nonetheless

one

conditioning, in which anxiety

classical

some stimulus

threatening situation, and

sirens.

patterns in these presentations.

old fear of masturbation causing blindness

is

a

fear.

by misinformation (Wolpe,

good example of this neurotic

mechanism. Although the

conditioning approach appears to focus heavily on anxiety and

classical

the maladaptive behavior associated with

it,

depression were based in anxiety as well. In neurotic,

which

in his

Wolpe (1992) maintained

fact,

When

that she doesnt

many forms of

60% of depressions were

he estimated that

view meant anxiety based.

JaNelle considers the possibility that Shirleys anxiety in

somehow.

that

she asks Shirley about the history

remember anything

stores

classieally

is

of her anxiety

in stores, Shirley relates

in particular triggering the anxiety.

get panicky while in a store one day. Although

it is

conditioned

She just started

to

interesting that Shirley mentions that

the attacks started shortly after the death oft her mother, JaNelle does not eonsider this in-

formation particularly

From an operant

useful.

perspective, dysfunctional behavior

reinforcement (Iwata, Kahng, Wallace,

broad

classifications

is

maintained by contingencies of

& Lindberg, 2000). Sherman (1973) suggested two

of maladaptive behavior, surplus and deficiency. Surplus behaviors are

inappropriate or ineffective for a given situation. Deficiency problems occur to learn behaviors appropriate to situations.

uals

fail

iors

would be viewed

reinforcers. Deficiency just never learned

as

this perspective, surplus

problems would involve a lack of desirable behaviors

them.

A

deficit in

behavior can also result

when

—

is

the contingencies in a

do not reinforce the behavior.

learning perspective

fits

with the operant perspective because dysfunctional beIf

not exposed to the right models, she will not learn certain behaviors

important to a given cultural group, for example. in

which multiple forks

behav-

the individual

havior can be learned, maintained, and suppressed by observations of models. vidual

individ-

maladaptive responses maintained by existing environmental

situation punish or simply

A social

From

when

are used, for instance, she

with a formal place setting.

If

a child

were never exposed

would not know what

to

the indi-

deemed

to a

dinner

do when faced

BEHAVIOR THERAPY

252 Operant such

as

theorists

when

sometimes discuss maladaptive behaviors using general

they theorize about social

skills deficits

classifications,

or depression. Operant theorists view

depression as stemming from problems in the person’s range of actions, or what

is

called the

behavioral repertory. Ferster (1983) conceptualized depression as resulting from an overuse

of passive behaviors and decreased incidence of adaptive, active behavior. Consequently, the depressed person receives

little

positive reinforcement

from her environment

(Ferster,

1983). Additionally, the depressed person has distorted perceptions of the environment, in-

cluding faulty perceptions of the self (negative self-concept) and overblown ideas about her responsibility for events (excessive self-blame). in positive reinforcement. Ferster, in fact,

view of the world,

ited

(2) a ‘lousy’

Beck’s

Still

other behaviorists point out that depression can result

no control over the world, or more tingencies between her behaviors

accurately,

control the world” (Goldfried

Social skills deficits,

when

ple lack of behaviors

when an

she perceives that there are no con-

& Davison,

1994,

p.

deemed

[sic] abil-

234; Seligman, 1975).

from an operant perspective, could be the

(i.e.,

individual perceives

“the person’s perception of his

is

the individual was reinforced for behaviors

(i.e.,

an unchanging view of the

and outcomes. This “helplessness” view of depression

suggests that the critical factor in affective states ity to

(3)

that this triad sounds a lot like that proposed in

379).

p.

to further reductions

proposed that depressed people have “(1) a lim-

view of the world, and

You will discover Cognitive Therapy (Chapter 10).

world” (1983,

These distortions lead

result

of faulty learning

socially inappropriate) or a sim-

the individual never learned social behaviors).

Some

social

behaviors might have been punished.

may be reinforced by the cessation ofanxiety; When she enters a store, Shirley becomes anx-

JaNelle thinks that Shirley\ stealing behavior that

is,

ious

and then

the stealing steals

negatively reinforced.

is

something so that she has

to exit the store, thereby

escaping the anxiety.

NATURE OF THERAPY Assessment Assessment

is

very important in BT.

seen as a scientific process that focuses on “what

It is

the client does rather than the traits the client has' (Glass in original).

Both formal and informal assessment

& Arnkoff,

1992,

p.

599;

are used, but behaviorists are

italics

most em-

phatic that they are not doing personality assessment or looking for underlying causes of

symptoms. Kuehnel and Liberman (1986) pointed out include client strengths as well as deficits.

ment

(e.g.,

DSM-IV)

based on a medical model and thus

as

BT counselors also

Flowever,

when

setting

BT

far

is

not consistent with the

from

required by third-party payers or

(Watson

BT model

because

it

is

a functional analysis of an individual’s behav-

counselors are likely to use formal diagnoses for pragmatic reasons, such

& Gross,

In BT, assessment

is

when working within

a

medical treatment

1999).

closely linked to intervention,

behavior, with specific attention paid to antecedents

/

look for sources of reinforce-

that can be used to facilitate behaviors.

Formal diagnosis

ior.

that a behavioral assessment should

and

it

focuses

on

and consequences

the individual’s current (Last

& Fiersen,

1994).

— BEHAVIOR THERAPY Some BT

counselors

factors (Goldfried

over time,

is

&

often

253

would add organismic Davison, 1994).

established so

A

that

variables such as cognitions

and physiological

baseline, or

frequency count of the target behavior

change

behavior can be clearly documented

in

(Kazdin, 2001).

A more global term for what BT counselors do before they intervene is functional analysis

(Antony

& Roemer, 2003). The actual assessment phase

followed by the creation of

is

hypotheses about the conditions maintaining the behavior of interest. Baseline patterns tablished in earlier phases of assessment

may suggest

hypotheses about what

es-

controlling

is

the behavior (Kazdin, 2001, p. 104).

A variety of methods retically

can be used to assess behavior in

pure form of assessment

is

raters across various life situations

sive

Even

& Davison,

(Goldfried

(e.g.,

theo-

by independent, trained

1994). Glearly, this

samples are used

in institutional settings,

The most

an expen-

is

rarely used except perhaps in institu-

it is

observation taken eight times per day). Instead, observations

counseling.

direct observation of the client

and cumbersome form of assessment, and

tional settings.

BT

BT

(for instance, a

counselors

more

10-minute

often use their

own

in-session role-play or imagery techniques), those of the client’s signif-

icant others, or simply the client’s self-report.

The

method is the informal assessment, (Kazdin, 2001). More structure can be added by

simplest and most cost-effective assessment

which involves interviewing the

client

using existing structured interview guidelines, such as the Anxiety Disorders Interview

Schedule (DiNardo, Brown,

&

Barlow, 1994).

role-play scenarios, such as social

skills.

The

Some

behaviors can be assessed through

therapists can then either simply observe, or

record the presence or absence of targeted behaviors.

Behavior therapists often ask clients to log the frequency of a behavior between counseling sessions, a technique called self-monitoring. There are three potential problems with self-monitoring. First, there estly

is

the question of whether the client can accurately

and hon-

monitor her behavior. Second, monitoring may disrupt normal routines, causing the

become aggravated. Third, behavior has been known to change when monitored most notably, unwanted behavior tends to decrease (Spiegler & Guevremont, 2003). Formal assessment in BT often involves the use of standardized instruments or symptom checklists. Wolpe (1990), for instance, was adamant that the use of the Willoughby client to

Neuroticism Questionnaire and the Fear Survey Schedule

He said cians’

“failure to use these

instruments

nonuse of the electrocardiogram

is

is

essential in

Behavior Therapy.

a serious deprivation of data, parallel to a physi-

in suspected heart disease” (1990, p. xi).

Behavioral checklists and surveys are often used in cognitive behavior forms of

BT

& Guevremont, 2003). Clients might be asked to complete the Beck Depression Inventory (Beck, Ward, Mendelson, & Erbaugh, 1961), the Reinforcement Survey Schedule (Cautela & Kastenbaum, 1967), or the Test Anxiety Behavior Scale (Suinn, 1969). Many (Spiegler

other such inventories

exist.

JaNelle begins with a simple interview approach with

Shirley.

about Shirleys current situation, including her living situation,

She asks a

lot

social activities,

of questions

andfinan-

community service, she wishes she JaNelle thinks that an assessment of

cial supports. Shirley reports that although she enjoys her

had more friends with whom Shirleys social

skills,

spend off hours. with some focus on assertive behavior, to

is

warranted. To

start,

JaNelle

BEHAVIOR THERAPY

254

and Shirley interact. She contact and speaking very softly.

avoiding eye

Gently, JaNelle asks Shirley

about the incident that got her

tant, Shirley responds to JaNelles

admits that

about

tions

live

shy at times,

to counseling. Initially reluc-

basis.

many specific ques-

JaNelle asks

gain a step-by-step picture of Shirleys behavior. observation of Shirleys stealing behavior, but then decides to have her

these incidents,

She considers a

little

approach and tells JaNelle about the recent incident. She

behavior happens about on a weekly

this

a

notes that Shirley seems

closely observes as she

attempting

to

role-play the behavior in the counseling session.

Overview oe the Therapeutic Atmosphere Behavior therapists assume that behavior variables,

and consequences, so

(Goldfried

&

Davison, 1994,

predictable from antecedents, organismic

is

form of experiment”

“clinical interaction constitutes a

p. 4).

in

BT

for,

the

This emphasis on the scientific approach

has led, at times, to significant disagreement about the nature

of,

or necessity

relationship in Behavior Therapy. At one extreme, Eysenck (1960) dismissed the trans-

ference-based relationship of psychoanalysis, saying, “behavior therapy has no need of this adjunct,

nor does

it

admit that the evidence

for

its

existence

is

remotely adequate

... In certain cases, of course, personal relationships

at the present time.

may

be

re-

quired in order to provide a necessary step on the generalization gradient; but this

not always true”

(p. 19).

In contrast, others emphasize that the therapeutic relationship

example, Wolpe (1985) maintained that the patient are part

Davison put

it,

“a

is

“trust, positive regard,

and parcel of behavior therapy practice”

tough-minded approach

to conceptualizing

is

essential to BT.

For

and serious acceptance of

(p.

127).

As Goldfried and

human problems

in

no way

warm, genuine, or empathic interaction with clients” (1994, p. 7). Last and Hersen (1994) added that it would be asking a great deal of a client to do all of the selfmonitoring and practicing required in Behavior Therapy in the absence of a good theraprecludes a

peutic relationship.

Most contemporary behavior therapists see a good relationship as important in producing good client outcome (Antony & Roemer, 2003; Keijsers, Schaap, & Hoogduin, 2000).

The BT

counselor has the potential to reinforce the client for desired behavior (Goldfried

& Davison, to the

BT

1994). In what might be seen as a surprising development, recent adaptations

approach have emphasized the therapeutic relationship

for therapeutic

much selor

ment

change” (Lejuez

et ah,

like a return to classic analytic

must form

a close

the case of Dialectical Behavior

and

458; see also Box 8.4). In what sounds very

client (using positive reinforce-

closely observe the client’s interpersonal behavior. In

Therapy (DBT), counselors engage

self-disclosure.

DBT

may go

therapists

“primary vehicle

thought, these behaviorists maintain that the coun-

which can include

traditional BT,

p.

and genuine attachment with the

to strengthen the alliance,

nication,

2006,

as the

Although

sell-disclosure

in reciprocal is

not unheard of in

as far as to disclose their feelings

and reactions

the client’s interpersonal behavior in the therapy setting (Lejuez et ah, 2006).

BTs

are careful to ensure that such disclosure

selor.

is

in the interests

DBT practitioners also use “irreverent communication”,

unorthodox ways of responding

to the client (Lejuez et

al., p.

of the

commu-

client,

to

Of course,

not the coun-

or the use of exaggerated or

462).

BEHAVIOR THERAPY

255

Because Shirley does not really believe that she belongs in counseling, JaNelle knows that is

some kind of rapport with

essential that she establish

and caring in

genuine,

her.

JaNelle

it

be supportive,

tries to

her interactions with Shirley.

Roles of Client and Counselor The counseling

relationship in Behavior

cotherapist (Sweet, 1984).

The

counselor

994) and takes the role of a consultant,

1

Therapy is

collaborative,

model

a

who

is

is

own behavior therapist (Sweet, 1984). The client in BT is just that, a client rather

and the

client

for the client (Goldfried

teaching the client the

skills

seen as a

is

&

Davison,

necessary to be

her

expected to contribute actively to the

homework

faithfully.

She

BT

client

is

assessment and goal setting and to complete her

a learner of the

is

The

than a patient (Sweet, 1984).

knowledge presented by the teacher/counselor.

JaNelle approaches Shirley as a collaborator, acknowledging that Shirley has not voluntar-

come

ily

She

to counseling.

offers herself as

some ideas that might help Shirley JaNelle will expect Shirley

and homework

to

a consultant

to Shirley, suggesting that she

has

better her life conditions.

be a partner in

BT

If Shirley accepts this offer, counseling, participating in goal setting

assignments.

Goals The

goal in

BT

is

simple

— reduce

or eliminate maladaptive behavior

the incidence of adaptive responses. Picking behaviors to is.

Traditionally,

and

and teach or

modify sounds

easier

increase

than

it

really

BT has targeted very specific behaviors such as smoking, weight gain or loss,

specific phobias.

clients often present

These behaviors

much more

are easily observable

and

quantifiable. Fiowever,

complicated pictures and often do not present their con-

cerns in terms of specific, observable behaviors. For example,

many clients come to

ing saying that they want to get rid of their depression, or that they are

counsel-

unhappy with

their

relationships.

and Guevremont (2003, p. 56) presented the ''dead person rule: never ask a do something a dead person can do.” Only dead people can avoid behaving alto-

Spiegler client to

gether, so

it is

generally better to prescribe behavior than to try to delete

would be better for Robert to ask Steve to pick up his clothes admonish “don’t leave your clothes on the bathroom floor.” it

The

increasing recognition within the ranks of

BT

after his

it.

For example,

shower than

to

counselors that client problems are

we would wish has led to new considerations about selecting (Marsh, 1985; Thompson & Williams, 1985). Target behaviors in modern

usually not as simple as

behavioral goals

BT "

include cognitions and emotions, and

significant

of the

In other words, the

BT may

BT

client’s overall

it

is

important that the targets involve some

functioning” (Marsh, 1985,

p.

66;

italics in original).

counselor should be aware that the traditional, specific targets of

not coincide with the desired outcomes of the

Thompson and Williams

client.

(1985) presented an even more radical view in observing that

“behavioral therapists, simply because of the ease of their available technology, often treat rather than think” (p. 48). client

problems are

They argued

that behavior therapists need to accept that

existential in nature, requiring a different perspective,

some

one that admits

BEHAVIOR THERAPY

256

oV long-term

the possibility

on the therapeutic

therapy 2.nd focusing

relationship' (p. 49,

italics in original).

and JaNelle set two goals for counseling: stealing behavior, and increase social skills,

Shirley

decrease anxiety that seems to be connected

to

particularly assertive behavior. They also

agree that some problem solving

around Shirleys

desire to

have more social contact in her

would be helpful. The specific goals they establish are as follows: (a) Shirley will be able to enter a department store and purchase an item (or just browse) without stealing anything, (b) Shirley will learn new social behaviors, including increased eye contact and voice volume. (c) Shirley will life

increase her social contacts (outside

ofher volunteer work)

to

at least three times per week.

PROCESS OF THERAPY BT practitioners see therapy as composed of two distinct phases:

assessment and intervention

(Wolpe, 1990). After the therapist has performed a functional analysis of the

and

ior

specified a target behavior or behaviors,

this process, the client

tion of

how

and Davison to assess

the ( 1

BT

is

client’s

time to intervene. At an early point in

it is

oriented to BT, which usually consists of giving her a brief explana-

counselor views problems and interventions (Wolpe, 1990). Goldfried

994) were very clear that the

client’s

and address because misconceptions can

expectations about therapy are important get in the

way of treatment.

Clients

expect detailed explorations of childhood events, dream analysis, or free association.

counselor should be empathic about the necessarily accede to

them (Goldfried

client’s

in behavioral terms. In essence, the

counselors see the

first

1994).

comments

The

to help the client redefine the

session of counseling as critical.

about the behavioral approach to treatment and

At the end of this

a written therapeutic contract (Goldfried tains information tails. It

about

&

fees, cancellations,

and outside of the counseling sessions (such

When

clients

the feet of the

It

behave

BT

—whether

has four goals: “(1) estab-

problem and selecting

and

(4)

a tar-

educating the client

of confidentiality” (Spiegler

session, the client

Davison, 1994).

and counselor may

The

&

create

contract typically con-

frequency of sessions, and other procedural de-

as the

and counselor’s behavior both within

expectation that the client will complete

sessions). in

ways that suggest resistance

to BT, the fault

is

laid squarely at

and Davison (1994) mainaccepts the assumption that behavior is

counselor. In discussing this issue, Goldfried

tained that 'dhe client lawful

Issues

also outlines the expectations for the client’s

homework between

problem

behavior therapist teaches the client the behavioral model.

get behavior, (3) gathering data about maintaining conditions,

p, 83).

The BT

counselor can listen to client

lishing rapport with the client, (2) understanding the client’s

Guevremont, 2003,

may

reasons for these assumptions, but should not

& Davison,

history empathically, while also inserting

BT

behav-

it

is

never wrong. If one truly

be deviant or nondeviant

— then any

dilficultles

occurring during the

course of therapy should more appropriately be traced to the therapist’s inadequate or in-

complete evaluation of the case”

(p. 17; italics in original).

ularly of a psychoanalytic persuasion)

BT

calls

would

call

stimulus generalization (Beach, 2005).

What

transference

other therapists (partic-

and countertransference, the

The person of the

therapist, for

example

BEHAVIOR THERAPY in the case

257

of “transference”

and she responds

client’s life,

similar to a stimulus person in another realm or time of the

is

to the therapist in the

same way

that she responded to the

previous person.

JaNelle explains the basics behavior are learned reluctant client,

ofBT to

and can

Shirley.

She explains that Shirleys anxiety and stealing

be unlearned if Shirley

is

willing to work on

Shirley, the

it.

not very happy about the ordeal oftherapy, but she grudgingly agrees that

is

getting rid of her stealing behavior might be a

JaNelle also talks

to Shirley

good

about the social

thing.

isolation she experiences

and

her desire to

increase social contact. Describing assertiveness training, JaNelle asks if Shirley

would like

and JaNelle agree on goals for counseling, which are (a) to decrease or eliminate the stealing behavior and (b) to increase Shirleys social contracts through learning new social skills. JaNelle gives Shirley a written contract that states these goals, the duties of both parties, and the expected outcomes of counseling. to consider

addressing this

issue.

Shirley

THERAPEUTIC TECHNIQUES A variety of techniques are

used in

on overt behavior, but some,

Some of these

(Wolpe, 1990).

to

BT

counseling.

some

The

extent, focus

majority of these techniques focus

on

internal events like cognition

techniques are implemented by the counselor, and others

are taught to the client so that she can use

them on her own. Many of the techniques

pre-

sented have cognitive aspects.

Relaxation Training The

basis for several other techniques in

relaxation training

cles,

one

also

(e.g,

systematic desensitization), progressive

thought to be therapeutic by

itself

(Goldfried

& Davison,

1994;

1929). Goldfried and Davison (1994) described two types of relaxation

E. Jacobson,

training.

is

BT

One

approach alternates between tensing and relaxing

at a time.

specific

groups of mus-

For example, the counselor might begin by having the client tense her

right hand, then relax

it

and study the

difference. After several repetitions of this se-

quence, the therapist might then direct the client to tense her arm, and so forth, progressing through

all

of the various major muscle groups in the body.

It is

important that

clients

practice their relaxation training, so in the past, they were given audiotaped instructions to use at

home between

sessions.

Nowadays iPods and podcasts might be used

for this

purpose.

The second approach Davison, 1994),

have learned

is

how

really

to

to relaxation training, relaxation

by

letting

go (Goldfried

an advanced form of the tensing— relaxing procedure. After

do the

first

&

clients

version, they either spontaneously, or are encouraged to,

simply relax progressive muscle groupings without the tensing

part.

JaNelle teaches Shirley progressive relaxation training, beginning by giving her an intro-

and why it is helpful. She then guides Shirley through a Shirley takes home an audiotape so that she can practice.

duction about the process relaxation session.

complete

BEHAVIOR THERAPY

238

Flooding Flooding, typically used with phobias, involves prolonged exposure to a feared or aversive

&

stimulus (Marshall therapy.

The

idea

Gauthier, 1983). This technique

to reduce or eliminate

is

pleasant stimulus. Traditionally, flooding feared stimulus. Fiowever,

when

it

is

completely the

is

— involving

done

flooding can be used. For example, a client

who

called exposure

distress associated

in vivo

not possible to use an

is

sometimes

also

real

in vivo

with the un-

exposure to the

approach, imaginal

obsesses about maintaining a clean house

can be exposed to a very dirty house using imagery.

Although some consider flooding feared stimuli, Marshall

behavioral techniques.

to be a risky technique because

and Gauthier (1983) maintained that

They identified

it is

it

exposes clients to

no more

so than other

several critical considerations in the success of flood-

ing techniques, including an accurate assessment and conceptualization by the therapist,

proper client preparation, and involvement of the

must

also be ready to deal

with the

nating the exposure too soon the anxiety (Marshall to

BT when

flooding

may

good idea

to teach the client

Depending on

& Gauthier,

who

is

fearful

it is

because termi-

important to add

skills

training

1983). For example, imaginal or in vivo

of public speaking, but

some public speaking

it

might

also

be a

skills.

Shirleys preferences, either in vivo or imaginal flooding could he used to

extinguish Shirleys anxiety connected with being in store,

client,

counselor

of the technique, or even worsening of

1983). Sometimes

used (Marshall

flooding can be used with a client

experienced by the

result in failure

& Gauthier, is

real distress

The

client’s significant others.

JaNelle can attempt

to use

imagery

Ifshe

stores.

refuses

an

in vivo visit to the

experience in the counseling session.

to recreate the

Exposure Therapy' Used widely

for phobias fears,

and compulsive behavior,

this

technique requires that the client

encounter the anxiety-provoking stimulus and not respond Franklin, 1999). Similar to flooding, exposure can be

as

she typically does (Foa

done imaginally or

in vivo

(Emmelkamp,

2004). Sometimes, the therapist even accompanies the client in these situations to response dure.

I

is

prevented. In other instances, a significant other

once had a client who had a

nique of “just not doing light switches in his

it.”

home.

light switch

is

make sure the

recruited to help with the proce-

On his own, he discovered the tech-

compulsion.

Even though he was anxious, he would

He was

&

refrain

from touching the

doing self-directed exposure and response prevention. This

technique was very successful for him; his light-switching behavior was virtually eliminated.

Exposure therapy matic

stress

is

also used to intervene

when

clients

disorder (PTSD). Although this technique

Massad and Hulsey (2006) warn that the prudent

is

show symptoms of

posttrau-

theoretically based in extinction,

BT therapist should know that exposure

does not eliminate underlying conditioning in associations established by trauma;

merely weakens them. Thus, they suggest that exposure therapy take place that are as similar as possible to the situation in

JaNelle thinks that exposure Shirley. Shirley will

have

and

to enter

which the

response prevention

a

store,

is

and JaNelle makes

conditions

original learning occurred.

a potentially useful technique for

and refrain from stealing She and Shirley enter numerous

experience her anxiety,

anything. JaNelle begins by taking a fleld trip' with Shirley. stores,

in

it

sure that Shirley does not take anything.

BEHAVIOR THERAPY

259

Systematic Desensitization This technique evolved from Wolpe’s idea that iety (or other undesirable behavior)

cally

conditioned to

1990). ited

by

He a

fear,

response that

become

the fear will

incompatible with anx-

one response (anxiety)

presumably opposite one. Deep muscle relaxation

&

classi-

disassociated with the stimulus (Wolpe,

called this process reciprocal inhibition because

as pleasant imagery,

is

can be produced in the presence oi a stimulus

in systematic desensitization (Spiegler

such

if a

is

inhib-

is

the response most often used

Guevremont, 2003). However, other responses,

humor, and sexual

arousal, have been used in this procedure,

along with drugs (tranquilizers) and carbon dioxide inhalation.

The

first

steps in systematic desensitization are (a) teaching the client progressive relaxation

procedures and

(b)

constructing an anxiety hierarchy to be used in the procedure (Wolpe,

1960). Progressive relaxation, as described

earlier, consists

of teaching the client to alternatively

contract and relax muscle groups in the body, progressing from one part of the

The from

anxiety (or fear) hierarchy

least to

mended least

of situations that evoke fear

is

a

list

most threatening, on

a

1

to

jumps between items

are ideally 10 points or less; if a

that

100

scale.

body

in the client,

to

ranked

Goldfried and Davison (1994) recom-

gap

is

more than

one additional item should be constructed to bridge the gap. Hierarchies

composed of 12

to another.

10, at

are usually

24 items.

Once these tasks have been accomplished, the actual desensitization procedure begins. The client is relaxed and is instructed to imagine the item or scene lowest on her fear hierarchy. If she experiences anxiety, she signals, usually by raising one finger. The counselor then helps the client get back to the relaxed state. The idea is to keep the level of anxiety relatively low, so that it is counteracted by the relaxation (Sherman, 1973). The item is then presented again until the client can visualize the scene for anxiety (Goldfried Sc Davison, 1994).

on the

Wolpe (I960) maintained

hierarchy.

counseling session and that est

Then

it

the client

that

two

is

1

0 to 15 seconds without

asked to visualize the next item

to four items could be presented per

usually took between 10

and 30

sessions to get to the high-

items on the hierarchy without disturbance.

JaNelle decides that systematic desensitization would be idealfor Shirleys anxiety episodes connected with her stealing behavior. She explains the procedure

100 Standing

in

a store by herself

95 Walking through the door of the store 90 Getting off the bus near the store 80 Riding the bus

to the store

75 Getting on the bus 65 Walking

to the

to

go

40

Telling

at

8.

someone she

1

.

to

go the store

an item she has stolen

30 Thinking about going

FIGURE

to the store

bus stop

55 Leaving her apartment 50 Looking

and

they

work on

As expected, Shirleys mostfeared image is ofbeing in a store by herrates as a 100. The remainder ofShirleys hierarchy is shown in Tigure 8. 1.

Shirleys anxiety hierarchy self This scene she

to Shirley,

is

going to the store

to a store

Shirleys hierarchy of anxiety.

BEHAVIOR THERAPY

260 JaNelle begins the procedure in the next

session,

asking Shirley

through a progressive relaxation sequence. She then asks Shirley

apartment and thinking about going to a JaNelle asks her the

to

again relax

and to

to relax

to

and

taking her

imagine being in her

Immediately, Shirleys finger shoots up,

store.

and

out ofyour mind. 'faNelle presents

‘‘wipe the picture

image repeatedly until Shirley no longer indicates

anxiety,

and

then progresses

to the

next item in the hierarchy.

Aversive Techniques Aversive techniques are considered a

last resort in

BT

(Wolpe, 1990). Sometimes called

aversive counterconditioning, these techniques consist of pairing

some noxious stimulus

The most commonly used

aversive stimuli are elec-

with an unwanted emotional reaction. tric

shock or nausea-inducing drugs.

As you might

guess, these techniques have

been the subject of controversy.

One

“problem” to which these techniques were applied was homosexuality. In the 1960s,

and many times

there was a flurry of interest in changing sexual orientation,

approached by showing ministering shock.

clients

same-sex erotic stimuli

The shock was terminated when

(e.g.,

this

was

photographs) while ad-

heterosexual erotic materials were

Of course, the ethics of such treatment were eventually even when used with men who voluntarily sought such treatment. The eth-

presented (Haldeman, 1994). questioned, ical issues,

arguments about whether these techniques

really

lack of support for their effectiveness resulted in their

produced aversion, and

abandonment

in the

1970s

(Haldeman, 1994; LoPiccolo, 1990). Aversive techniques have also been employed to treat alcoholism (Wilson, 1987).

Mostly, these approaches have used nausea-inducing drugs, although shock has also been used.

Concerns about the usefulness of these interventions beyond traditional interven-

tions for

problem drinking have

One problem Often seen

in

been raised (Wilson, 1987).

that seems to justify aversive techniques

is

self-injurious behavior (SIB).

developmentally disabled individuals, these individuals often place their

danger by banging their heads or performing other dangerous behaviors.

lives in

attached to the

client’s

wanted behavior.

ment

also

arm

or leg,

is

delivered

upon

& Hanson,

is

typically required to begin such a

of last

often by govern-

program

(e.g.,

Nord,

1991).

JaNelle does not think that aversive techniques are advised in Shirleys are techniques

is

the occurrence of an un-

A detailed review of the necessity for such procedures,

regulatory committees,

Wieseler,

and shock

A pad

resort,

and Shirley

is

a reluctant

case.

Afier

all,

they

client.

“Blow-Up” Technique or Paradoxical Intention Lazarus (1996) described the blow-up technique, in which clients are encouraged to actively practice,

and even elaborate on,

nique

as particularly helpful for clients

client

would be encouraged

to dwell

most disastrous conclusion, much

their

who

symptoms. Lazarus described the techare plagued

by obsessive thoughts. The

on the thoughts and images, taking them

as in

implosive therapy.

I

to their

infer that the behaviorist

BEHAVIOR THERAPY

261

rationale behind these techniques

is

to disconnect the

problematic behavior from

its

discriminative stimulus. Frankl (1963) also advocated prescribing the symptom, which he called paradoxical in-

Emphasizing the humorous element of the approach, Frankl would encourage

tention.

clients to

be the world’s best

at their

his

symptoms!

JaNelle considers the use ofa modified paradoxical technique with

Shirley.

She could have

how to become a better shoplifter. Shirley could go to stores and watch for other shoplifters and see how they perform. She could also write her findings down, creating a manual about how to be a better shoplifier. Ifshe were able to go to the store and look for other shopliflers rather than getting anxious and stealing, Shirley might find that her anxShirley study

iety decreases.

JaNelle could accompany her on these outings. Shirley might also be engaged

by the humorous bent ofJaNelle s prescriptions, thus reducing some of the anxiety around

Another application of this technique would be to have Shirley imagine the worst possible outcome ofher stealing behavior being taken off to jail, tried in court, and

the behaviors.

—

placed in prison.

Shaping The

new

process of teaching a

client to

is

called shaping. First, the

BT

counselor gets the

respond in some way, usually by using verbal prompts. Modeling can

in this stage.

The

therapist can demonstrate the behavior, or the client could

tape. After the initial response

move

behavior

is

also

be used

watch

a video-

established, the therapist will reinforce only responses that

a step closer to the desired response (Sherman, 1974).

Shaping could be used

to

address Shirleys social

skills deficits,

JaNelle thinks. She plans

to

and appropriate voice tone for Shirley and then praise her ivhen she attempts these behaviors. At first, Shirleys attempts will be tentative, but JaNelle will reinforce them and coach Shirley to improve them. She will then reinforce Shirleys improved model

eye contact

behaviors.

Reinforcement The BT

counselor can use positive and negative reinforcement to increase the occurrence

of a desired behavior. For instance, praising the client for completing an assigned activity

would tend

forcement

is

to increase the probability of

probably used

ative stimulus

often because

it is

getting done. Negative rein-

difficult to find a situation in

could be discontinued on the appearance of a desired behavior.

source of reinforcement in calls

less

homework

verbal conditioning

BT

He

is

the counselor’s verbal responses to her,

opines that the therapist must be alert

—

tion to the kind of verbal behavior she

is

verbalizations about problems (by “uh

hming” every time the

reinforcing

which

a

neg-

An important

which Beach (2005)

in the

counseling situa-

for instance differentially reinforcing client speaks of these

responding to nonproblematic or successful behavior) might make the

worse (Beach, 2005).

homework

and not

client’s situation

BEHAVIOR THERAPY

262

Often, clients are taught to self-reinforce. If the client, for example, went to the

and worked out, she would reward herself with Another example of self-reinforcement

baum, 1977). Clients

are taught to use

to self-reinforce their successful use

is

a hot bath or a low-fat ice

gym

cream sundae.

seen in stress inoculation training (Meichen-

coping cognitions

in stressful situations

through Covert verbal statements (“Hey,

I

and then

did a great

job getting through that!”).

JaNelle thinks that positive reinforcement would be a good technique

She praises Shirley for coming

Shirley.

her

teach Shirley assertive

She will a

and head skills and will

with attention

life

to

counseling

and

nods. JaNelle

when

with

use

reinforces Shirleys discussions

will use positive

reinforce her for completing

also use positive reinforcement

to

homework

an

Shirley survives

reinforcement

of to

assignments.

in vivo experience in

store.

Differential Reineorcement This technique, sometimes called dijferential reinforcement of other hokiNiox: (DRO), consists of reinforcing one behavior (a desired one) and subjecting an undesired

same time (Milan, 1990). Any behavior other than the response can be reinforced during a specified time interval, or a response incom-

behavior to extinction target

at the

patible to the undesirable behavior stance, if

reading a

is

&

reinforced (Nemeroll

Karoly, 1991). For in-

Mother wants Hillary to watch less TV, she could reinforce Hillary for book or playing outside of the home or almost any behavior other than

watching TV.

JaNelle

go

to

a

is

not quite sure about

store

with Shirley

how

to use

DRO with Shirley.

She supposes that she could

and reinforce her for walking through

She could also reinforce her for talking

to

the store without stopping.

a salesperson.

Extinction Extinction involves removing a reinforcement that

common The

example

is

when

parental attention

is

it is

maintaining a behavior.

A

When

using extinction procedures

important to be sure one can tolerate the possible intensification

target behavior that

might

result

when

very

reinforcing a child’s tantrum behavior.

parent simply does not respond to the tantrum.

in isolation,

is

the intervention

is

first

in the

implemented (Sherman,

1973). For the parent tolerating a tantrum, this can be a very stressful experience, you

can guess!

For

Shirley,

applying extinction

to

her stealing behavior would

mean

thing as in vivo exposure, because JaNelle thinks that the stealing

is

the store.

—picking up an item

same

partly maintained by

the anxiety reduction Shirley experiences. However, operant extinction Shirley perjorm a very difficult behavior

virtually the

would

in the store

require that

and not leaving

BEHAVIOR THERAPY

263

Punishment Punishment, remember,

is

when

the consequences of an event are linked to a decrease in or

disappearance of the behavior. For the purposes of intervention, two kinds of punishment

can be identified (Milan, 1990; Skinner, 1953).

First,

and most

event can be applied following the undesirable behavior, which

ment by

A

contingent stimulation (Milan, 1990). Spanking a kid

second kind of punishment

when

results

familiar to us, an aversive

is

sometimes called punish-

falls

under

this category.

a desirable set of conditions

is

terminated

when an unwanted behavior occurs. For instance. Dad can turn off Liza’s favorite television show if she is slapping her little brother. Because this kind of punishment can be seen as the termination of a positive reinforcer, (Milan, 1990).

it is

A similar procedure is

render something reinforcing, such as

punishment by contingent withdrawal

referred to as

response

cost,

which an individual

in

is

required to sur-

when you pay a fine at the bank for bouncing a check.

Time out from reinforcement is another form of punishment, in which positive reinforcers are removed for a specified period of time. A familiar example of this procedure is seen in classrooms,

room. The

critical

when

a child displaying disruptive behavior

element

is

that

all

removed

to a time-out

sources of reinforcement are unavailable to the child

(Kazdin, 2001). Usually, the access to reinforcers (e.g., a

is

minute or two) because longer

intervals

is

only removed for a short period of time

do not increase the

effectiveness of the

time-out intervention (Kazdin, 2001).

Punishment

as a

behavior change technique has drawbacks.

only suppresses behavior, such behavior longer in effect (Skinner, 1971). Also, ditions, so

punishment can

is

likely to reappear

humans

First,

when

because punishment

the contingencies are

are motivated to escape or avoid aversive con-

create these behaviors; the best

way

to avoid

avoid the punisher. Punishment can also result in aversive emotional anger, frustration, anxiety, or depression (Milan, 1990). Individuals

(e.g.,

punishment

states,

may

tional behaviors to avoid these aversive states, such as refusing to think

behaviors

no

such

as

is

to

shame,

resort to dysfunc-

about the punished

“repression”) or engaging in risky behaviors such as drinking alcohol or doing

drugs to blunt these feelings (Milan, 1990). Finally, these negative feelings

may become asso-

ciated with the agents of punishment, such as parents, school, or law enforcement officials

(Kazdin, 2001). Consider also that using punishment models the use of aggressive behavior.

For these reasons, punishment should be a If

A

punishment must be used,

consistent, continuous schedule

it is

last resort

and used very

carefully (Kazdin, 2001).

should be immediate to the undesired behavior.

most

effective, rather

than intermittent punishment

(Kazdin, 2001).

JaNelle doubts that punishment would work for Shirleys stealing behavior, unless Shirley

would agree to selfpunish. In a sense, she already does that by making herselffeel guilty and ashamed afier she steals, and this has not been effctive in deterring her behavior. Getting arrested can be seen as a punishment, but not one that is likely to happen every time, making it

an

inejfective punisher.

Assertiveness Training In Wolpe’s view, assertive behaviors are called for

when

anxiety in interpersonal situations. vAssertive behavior

the client

is

is

experiencing dyshinctional

defined as “socially appropriate verbal

BEHAVIOR THERAPY

264

and motor expression of any emotion other than anxiety” (Wolpe, 1990, thought that anxiety got cal inhibition, assertive

p.

135).

Wolpe

conditioned to social responding, and through recipro-

(classically)

responding should compete with the anxiety and weaken the condi-

tioning. Assertiveness training involves teaching the client to express the resentment that she

experiences in interpersonal relationships because anger, for example,

is

thought to inhibit the

expression of anxiety (Wolpe, I960).

Other

BT theorists would probably take an operant The

technique.

prompted ior,

to

assertive behavior

modeled

is

(i.e., skills

deficit)

view

for the client, or she could be verbally

perform the behavior. The behavior therapist then shapes the

reinforcing better

could use praise

and

Assertiveness training

with more volume,

work (such

is perfect for

and

client’s

behav-

better assertiveness responses. Primarily, the behavior therapist

as the reinforcer, unless

kinds of reinforcers might

in using this

she was working with a child, in which case other candy).

as

Shirley.

JaNelle will teach her

to

make eye contact, speak

ask for things she wants. For example, JaNelle will help Shirley

practice asking a fellow volunteer to go out to a movie or dinner with her.

Stimulus Control Many behaviors

are

under the control of a

as finishing a big

bed may cause you

these stimuli are

to feel

meal. If you eat popcorn in bed at night, just get-

an urge to

viduals often eat in response to cues in the

Once

earlier,

stimuli.

smoking behavior, such ting in

of stimuli. As noted

The most commonly used examples of these types of behavsmoking and eating. People who smoke tend to have specific triggers for

termed discriminative ior are cigarette

set

eat.

In fact,

it is

thought that overweight indi-

environment rather than

in response to hunger.

the discriminative stimuli associated with a behavior have been clearly specified

(and there usually are more than one), the environment can be manipulated to either produce, increase, or reduce the behavior. Typically, the behavior therapist teaches the client this process

works and helps the

(Kazdin, 2001).

The

client

is

If a stimulus

the stimulus at

can

resist

is

help the client

controlling an

first.

make

the desired changes in the environment.

unwanted behavior, the

A gradual approach to the stimulus

is

client

one or more stimuli

has a problem with eating too full

meals at a

set table.

much

to get

too often,

it

it

is

usually urged to avoid

then developed so that the client

performing the behavior (Kazdin, 2001). In other

associate a behavior with

only to

clients to identify discriminative stimuli or the lack thereof

then charged with putting the program into place. Sometimes,

BT counselor would even

the

how

cases, the client

might need

under control. For example,

might be helpful

She would not be allowed

to

if Julie

for her to limit eating

to eat while

watching television

or in any other location.

JaNelle decides that Shirleys stealing behavior

is

cued by the stimulus ofa department store.

Shirley reports that she rarely steals at the grocery store, or in other kinds

decides that to extinguish the association between store

department store for a while. She for a week. The first day she

second day she

is

to

is

to

is

and stealing,

ofstores. JaNelle

Shirley will avoid the

assigned the task ofgoing to the grocery store once a day

only walk into the store

walk down one

aisle

and

and immediately walk

then out of the

store.

out.

The

After each of these

BEHAVIOR THERAPY forays, she

is

265

of time she spends

in the grocery store

JaNelle then transfers

to steal.

some way.

to positively reinforce herselfin is

prescribed until she reports no anxiety or impulses

program

this

A gradual progression in the amount

to the

department store.

Covert Conditioning Covert conditioning procedures employ imagery in the service of changing behavior. The

term covert to be

is

used because the client imagines rather than really experiences the behavior

changed, along with the consequences of maintaining

tion, the

(Cautela, 1994). In addi-

manipulation of consequences to change the imagined behavior

Cautela (1994, be used

it

p. 3) identified a

covert.

is

number of covert conditioning procedures

that can

sensitization, extinction, covert positive reinforcement, covert negative

(e.g.,

BT techniques using

reinforcement, response cost); most of these are simply applications ol

imagery.

The

self-control triad or

steps. First, the client

a

procedure

is

a

seen as aiding the relaxation and also as

2).

is

checked;

Step 3

is

is

She then takes

imagine a pleasant scene, which

to

as follows (Cautela,

1994):

The

client

client’s ability

is

then asked to

imagine the scene of the target behavior. In the case of covert positive reinforcement, for stance, the client

(she indicates

is

asked to imagine successful behavior.

by some

signal,

such

imagine a pleasant scene (the reinforcer). This sequence session,

and

it is

also assigned as

homework, using

Covert conditioning could be used

ment

stores

Once this scene

as raising a finger), the

to

is

is

(Kearney, 1994).

imagery exercises are assigned. The

if necessary,

consisting of three

a target behavior occurs.

self- reinforcement

A general outline of covert conditioning image

when

mentally shouts “stop”

deep breath, exhales, and relaxes (Step

to

more complex intervention

is

in-

clear to the client

counselor instructs the client to

repeated a

number of times

in the

a specially prepared audiotape.

extinguish Shirleys anxiety associated with depart-

through using covert desensitization. JaNelle would guide Shirley through an

imaginary sequence ofgoing into the store, staying there while the anxiety becomes intense, and then leaving the store without taking anything. Reinforcement could also be added; after Shirley imagines

a successful

trip to the store, she

would imagine a pleasant scene.

Modeling combined with other kinds of interventions. The most basic form of modeling is simple observation, in which the client watches a model perform a target behavior (Rosenthal & Steffek, 1991). The model will typically Modeling

is

a flexible technique that often

progress through harder a

model standing on

rail

ol a 20-story hotel.

might observe the balcony

and harder

Another version of modeling this

is

tasks.

is

For example,

a step-stool

if

and so on,

a client

is

until the

participant guidance (Rosenthal

afraid of heights, she

model

&

is

looking over

Steffek, 1991). In

approach, the client actually practices the target behavior after the model has demon-

strated

The

it.

The model coaches

the client through successively

more

dilficult behaviors.

counselor often serves as a model for the client, demonstrating problem solving or

social skills. In assertiveness training, for skills for a client in a role-play.

example, the counselor might

first

model

assertive

BEHAVIOR THERAPY

266 JaNelle uses modeling

to help Shirley learn

new

social

She demonstrates appropriate

skills.

and eye contact, and then asks Shirley to practice these in the counseling session. Together, JaNelle and Shirley identijy situations in which Shirley might have behavioral deficits and then generate new responses for Shirley. JaNelle first models these behaviors, and vocal tone

them out for herself. JaNelle considers using modeling as an

then Shirley

initial step in desensitizing Shirley to

She could videotape a model entering a

stores.

and

tries

then leaving the

store.

Shirley could

choosing an item

store,

to buy,

department

purchasing

watch the videotape between counseling

it,

sessions

until she could do so without experiencing anxiety.

Behavioral Self-Control Not

really a specific technique, behavioral self-control refers to

teaching the client to ap-

and Karoly (1972) pointed out that in using commit to the process and her designated goals. They

ply behavioral techniques to herself Kanfer this

approach, the client must really

specified factors that are

more

itive (e.g.,

likely

when

reinforcement

when

promote “intention statement making” the client

available)

is

the person

probability of

is

is

is

4l

1; e.g.,

these statements

experiencing the negative effects of behavior or

when

pos-

and those that decrease the likelihood of these statements

likely to receive

punishment

(p,

high for

punishment

for

making the statements or the

failure).

Almost any of the behavioral techniques described

can be used in a behavioral

earlier

self-

You might remember the television ad campaign in which the celebrity model (Larry Liagman) snapped a rubber band around his wrist when he experienced the urge for

control model.

a cigarette. This

is

an example of an aversive self-control procedures (based either in aversive

A few other examples of ways in which the behavioral

counterconditioning or punishment). self-control

approach

is

used include teaching the client stimulus control procedures.

In cognitive behavior approaches, therapists teach clients coping cognitions to use

while in the midst of the flooding experiences. uses these statements out loud,

The

and then fades

client first rehearses these statements, to private rehearsal of the thoughts

(Meichenbaum, 1977).

EVALUATION OF THE THEORY Behavior Therapy has evoked a great deal of controversy over the years, comparable to that associated with psychoanalytic theory. Behavior therapists have been accused of be-

ing cold-hearted because of their scientific approach and language (Goldfried

1994).

The emphasis on

prediction and control of behavior has led to accusations that

Behavior Therapy denies the rights and freedom of clients (Franks

and that it,

it

Ignores the importance of emotion in

“Behavior Therapy

viously tested fashion”

(p.

Is

viewed

on sub-human

as the

species,

human

&

Barbrack, 1990),

behavior. As Sweet (1984) put

cold and mechanical application of techniques, pre-

and often delivered

in a

dangerous and impersonal

254).

Behavioral approaches are seen as simplistic and

rowly defined problems, such

as phobias.

with extremely dysfunctional clients for a

& Davison,

(e.g.,

The

first

fit

for interventions for discrete, nar-

applications of Behavior

Therapy were

mentally challenged or psychotic), so

wider range of clients was questioned (Franks Si Barbrack, 1990).

Its

utility

BEHAVIOR THERAPY BT

criticized for

is

feeling.

However,

as

267

its

emphasis on observable behavior

we have

seen,

most behavior

other inferred events as important aspects of 1994). Neglect of the client’s past

which the behaviorists would

expense of thought and

therapists today attend to cognition

human

also cited as a

is

at the

behavior (Goldfried

&

and

Davison,

weakness of behavioral approaches, to

retort that reinforcement (learning) histories are very

impor-

tant in understanding the client’s current presentation.

Behavior therapists are also said to ignore the role of interpersonal relationships in the

&

generation and maintenance of psychological dysfunction (Marshall

BT procedures could

For example, Marshall and Gauthier (1983) suggested that failures in result

when improvement

results in decreased

dependence of the

Gauthier, 1983).

client

on family members

or other significant others.

Qualities of the Theory and

Precision

because p.

Testability.

BT

theorists maintain that theirs

the most scientific approach,

rooted in “established principles and paradigms of learning” (Wolpe, 1997,

it is

633). Certainly,

it is

very precise to count behaviors following the institution of a reinforcer

and observe changes from baseline clearly this behavior

rates

of behavior. If one

can be operationalized

in client presentations

and

is

and

studying nodding behavior,

The complex

fairly easily.

in the counseling process,

is

behaviors involved

however, are not

as easily specified

targeted.

Arguments abound about the exact

Some critics

assert that the definition

Something

that

makes behavior

reinforced.

The

classical

definition of some

of reinforcement

increase.

Why did

is

BT terms,

circular:

such

as reinforcement.

What is a reinforcement?

that behavior increase? Because

it

was

conditioning model has also been criticized, particularly by advo-

cates of social learning theory (Bandura, 1969).

They maintain

that the effects of classical

conditioning procedures are simply that the person builds a mental image that affects her behaviors rather than establishing a relatively permanent conditioned thors note that attempts to tal

tie

BT techniques

to the principles

as

explanations

McGaugh,

performance

Empirical

Validity. Overall,

tant to note, though, that

BT

learning even

for 1

(e.g.,

though they can

reinforcement) are times

at

predict

973; Jacobson, 1997).

outcome research. It is imporcognitive Behavior Theory (in a multitude of

has received support from

many

studies test

BT (if such a thing really exists). of BT Is much less clear.

forms) rather than pure the theoretical bases

other au-

of learning from experimen-

laboratory study are fruitless and that these very principles

questionable

reflex. Still

As

I

noted

earlier,

the validity of

Research Support Outcome

Research.

The

Numerous outcome

literature

on the

efficacy of

BT

is

enormous (Emmelkamp, 2004).

studies have supported the efficacy of BT, although the evidence to

support the claims for the superiority of the approach over others

is

not

as robust.

I

review a few meta-analyses and then several studies that provide examples of research ing BT. However, because of the sheer to provide a

comprehensive summary.

amount

of research relevant to

B T,

it is

shall test-

Impossible

BEHAVIOR THERAPY

268

Chapman, Forman, and Beck (2006) reviewed 16 meta-analyses on outcome of cognitive-behavioral therapy (CBT). They found that CBT was effective over a

Butler,

studies

wide range of dysfunction and that

who were analyses

BT

was

as effective as

CBT

in the treatment

of adults

depressed or displaying signs of obsession and compulsion. Earlier, simple meta-

had found similar

results,

slight superiority for behavioral

beginning with Smith and Glass (1977)

suggested a

and cognitive behavioral approaches. Idowever, these

when methodological

tend to disappear

who

variables are controlled (Smith, Glass,

&

Miller,

1980). These methodological issues involve the reactivity of the measures used responsive the

outcome measures

& Ogles, 2004).

are to the

situation

Behaviorally oriented studies generally use measures that are

tible to these influences. Also,

when

allegiance of the study’s authors),

(Wampold, 2001). In another that cognitive therapy

analyses found

demands of the experimental

no

allegiance effects are controlled

— how

(Lambert

more suscep-

the theoretical

between approaches tend

differences

to

disappear

and Shapiro (1982) found evidence systematic desensitization. However, later meta-

meta-analysis, Shapiro

was superior

differences

(i.e.,

effects

to

between the approaches, and the data suggest that the

& Massman,

can be accounted for by researcher allegiance (Berman, Miller,

Berman, 1983; Robinson, Berman,

& Neimeyer,

277 treatment comparisons, Wampold and

more

1990). In a

effects

1985; Miller

&

recent meta-analysis of

colleagues (1997) specifically tested for varia-

among theoretical orientations and also found no significant differences. those who argue that meta-analysis is comparing apples and oranges, exemplar studies

tions in efficacy

For

can be informative. As early

as

1975, the Temple Study (Sloane, Staples, Criston, Yorkston,

Whipple, 1975) reported no differences

in efficacy

between

BT

and psychoanalytically

ented therapy, but both produced more improvement than a wait-list control group. fully described in

sound

cally

in the

Chapter

1

,

this

study

is still

psychotherapy outcome

ori-

More

considered to be one of the most methodologi-

literature

(Lambert

& Bergin,

1994).

The

NIMH

Collaborative Treatment of Depression study compared cognitive-behavior therapy (Beck’s

approach; see Chapter 10), interpersonal psychotherapy, placebo-clinical management, and

psychopharmacological treatment with

comes

BT

clinical

across the four conditions (Elkin et

has been

shown

to be effective

al.,

management and found no

differences in out-

1989).

with a wide range of client problems. Exposure ther-

apy has loads of empirical support (Emmelkamp, 2004). Eor example, Rothbaum

et al.

(2006) described an interesting study comparing the use of virtual reality exposure (VE), traditional in-vivo exposure

and

traditional exposure

ments agreed

to

and

a control

treatment for fear of flying.

produced similar good

go on a posttreatment

flight

results

with other

symptom

constellations

20%

of control participants.

to

readily

BT and CBT

and have found

found

in the literature.

(cognitive-behavior therapy)

positive results.

reports that the literature supports the use of BT for anxiety disorders ever,

he notes that interventions for sexual dysfunction have been

Emmelkamp

recent meta-analysis of studies of substance use disorders

bacco) demonstrated that contingency

management procedures

manipulating reinforcers and punishers) produced positive Finney, Greenwell,

& Roll, 2006).

(e.g.,

(2004)

and depression. How-

little

studied in the

decade and that there are doubts about the effectiveness of BT interventions in

A

VE

the clients in these treat-

compared

tested the effectiveness of

that

—76% of

Other examples of the success of exposure therapy can be Other research has

They found

last

this sphere.

drugs, alchohol, and to(the general

term for

results (Prendergast,

Benton and Schroeder (1990) presented

Podus,

a meta-analysis

BEHAVIOR THERAPY

269

of 27 studies that assessed the

found strong evidence self-rated assertiveness

Zimmerman,

effects of social skills training

improvement on what they

for

and discharge

rates)

and moderate

among

clients

more

se; it is

learning theory),

it is

BT

difficult

on

difficult to separate theory-testing research

on the

effects

get behavior. Very few attempt to test the

assumed based on the

is

is

as schizophrenic.

because

BT

is

not a

theories of learning. If

testing behavioral interventions (rather than that testing basic

investigations are focused

evidence

psychotropic medications in

a collection of techniques said to be based

you consider only research

from outcome

research.

of a given technique on the incidence of a

tar-

assumed mechanisms underlying the technique

original, nonclinical research).

research could be cited as indirect support for the it is

effects for relapse rates. Similarly,

diagnosed

Theory-Testing Research. Discussing the role of theory in

(this

They

called behavioral indexes (such as

CBT interventions were useful as adjuncts to

reducing hallucinations and delusions

Most

clients.

Favrod, Trieu, and Pomini (2004) used a meta-analytic technique and

determined that

theory per

with schizophrenic

Although outcome

model of learning underlying the technique,

clearly indirect, at best.

As

I

noted

earlier,

tioned (Breger

the theoretical formulations of BT as models of learning has been ques-

& McGaugh,

1973). For example,

some

discussion has centered

on Wolpes

reciprocal inhibition explanation for the effects of systematic desensitization (1990). Recall

Wolpe thought that pairing an incompatible state (e.g., relaxation) with the undesirable one (e.g., anxiety) would cause deconditioning. Because research seems to show that relaxation is not necessary, Wolpe’s causal scheme is undermined (Emmelkamp, 1990). Similarly, that

studies of flooding indicate that in

producing extinction, which

low

is

levels

of anxiety are

as effective as

high

levels

of anxiety

contrary to conditioning theory, which would predict that

the high levels of anxiety are necessary. Finally, Steketee and Cleere (1990) maintained that there

was not good support

for the acquisition

of anxiety-related dysfunction via the pairing

of a neutral object with a stimulus that naturally evokes sure

and response prevention seem

seem

to help

when

fear

Bell

(1990) concluded that there

is

Fiowever, the fact that expo-

avoidance responses are present would

maintained by avoidance conditioning.

to support a hypothesis that these behaviors are

Wadden and

fear.

virtually

no empirical support

for a be-

model of obesity. For example, one prediction of the behavioral model of obesity obese people are more responsive to environmental cues for eating (discriminative

havioral is

that

stimuli) than are

nonobese individuals. This hypothesis led

control programs for weight reduction. Fiowever, is

no

solid evidence that obese individuals are

external cues.

At the same time,

nificant weight loss

Dismantling

(Wadden

studies, in

which

might be seen

as

effects

of

BT

in

Wadden and

more

Bell

sensitive than

for obesity has

& Bell,

and administered separately or about the specific

BT

to the institution of stimulus

maintained that there

nonobese individuals

been shown to produce

to

clinically sig-

1990).

BT

techniques are broken

down

into

component

parts

combination, are one attempt to answer the question

techniques. Clear answers to the specific effects question

evidence of the validity of

BT

theory; however, they

do not constitute

direct tests of theoretical predictions.

Some BT

researchers

would point

to single-subject intensive case studies as providing ev-

idence for the theoretical underpinnings of BT. Historically, these designs have been used quite often in

BT

studies.

A

baseline

is

established

on

a target behavior,

an intervention

is

BEHAVIOR THERAPY

270

made

instituting reinforcement or extinction),

(e.g.,

drawn. Changes

in behavior

and then the intervention

with-

is

with the presentation and withdrawal of the intervention are

thought to be evidence of the validity of behavioral techniques. Again, these types of study can demonstrate relationships between interventions and performance of a given behavior, but they provide

little

evidence for the theoretical foundations of BT.

AND CULTURAL DIVERSITY

ISSUES OF INDIVIDUAL

Hoffman (2006) notes that because culture shapes our perceptions of the environment and how we seek to understand it, it will surely influence how clients respond to cognitive and Behavior Therapy. Several characteristics of BT make it an attractive approach to use with clients from diverse backgrounds. First, the structure inherent in BT would appeal to clients from Asian backgrounds, as would the relative de-emphasis on expression of emo-

& Sue, 2003). In addition, African American clients might respond positively to

tion (Sue

the collaborative nature of the therapeutic relationship once they have established that the

counselor

may

trustworthy. However, clients from Asian or Hispanic/Latino backgrounds

is

expect a

more formal approach from

archy found in these cultures.

would

fit

well for

oriented (Sue

The

the counselor because of the emphasis

BT

concrete and immediate nature of the

American Indians and Alaskan Natives because they tend

on

hier-

approach

to be present

& Sue, 2003). On the other hand, the future orientation implicit in the BT

emphasis on goal setting could create discomfort.

and Guevremont (2003) discuss issues of diversity relative to BT and maintain emphasis on the role of the environment in problematic behavior is particularly suit-

Spiegler that

its

able to clients

who

dividual clients

are

of diverse backgrounds. Interventions are specifically designed for

and can be

tailored to

fit

the client’s background

in-

and current circumstances.

Chambless (1986) maintained that African American clients would respond more positively to Behavior Therapy’s active, directive, and problem-focused approach (p. 7) than they would to traditional, more passive approaches to counseling. She argued that avoids the pitfall of

many

BT

counseling approaches that blame the victim for psychological

problems, presumably because in BT, causal factors are located in the environment. For clients

who

are

members of

traditionally oppressed groups, such as African Americans,

Latinos/Latinas, or Asians, this approach

Some

aspects of Behavior

Therapy

are

may

be a relief

compatible with feminist values.

nists reacted positively to the behavioral principle that learning

mental

from

factors, seeing this as a departure

individual for his or her problems (Kantrowitz

&

is

a function

traditional approaches that

Ballou, 1992; Worell

&

femi-

Initially,

of environ-

blame the

Remer, 2003).

Behavior Therapy’s emphasis on self-help and encouraging client self-direction are consistent with feminist philosophy

ment and Behavior Therapy’s is

(Hunter

&

Kelso, 1985).

goal of giving the client

An

emphasis on

more control over

skills

develop-

the environment

consistent with feminist ideology.

At the same time, the behaviorists can be text

of their

havior that the

clients’ lives.

is

adaptive

is

criticized for ignoring the sociopolitical

Kantrowitz and Ballou (1992) argued that defining health problematic.

norms of the dominant

social

Who decides what

group

(i.e.,

is

adaptive?

con-

as be-

They maintained

white males) define adaptiveness, which

that is

an

BEHAVIOR THERAPY

271

unfair, biased standard, particularly for

The broader control

—

that

issue underlying the controversy

OK

is it

is,

D’Andrea,

Ivey,

would

nation

&

other historically oppressed groups.

about definitions of health

social or cultural forces that are very

Simek-Morgan, 2002)? Clients who misunderstood

likely feel

probably

is

for a behavior therapist to “engineer” changes in clients’ behav-

without taking serious note of

ior

women and

if

powerful

are facing prejudice

and discrimi-

these issues were not addressed as part of the

counseling process. Further, BT’s emphasis on a rational, scientific approach to behavior

a reflection of

is

women and members

(Ivey,

human

White, male, European values, which are not appropriate

of other ethnic or cultural groups (Kantrowitz

&

for

Ballou, 1992).

Hunter and Kelso (1985) noted that in a review of 100 articles in which Behavior Therapy was used with female clients, many goals were addressed (weight loss, depression, sexwas paid

ual problems, etc.), yet very little attention clients.

Thus, feminists urge behavior therapists to take

their clients, studying

within the

and respecting the

client’s culture that

a social learning perspective

women.

social roles that constrain

could be damaging

(i.e.,

McNair (1986) pointed out

&

with

Reinforcers

those that support submissive,

deprecating behavior) should also be addressed (Hunter Collins and

environment of the

to the social

self-

Kelso, 1985).

that although Behavior

the environmental determinants of behavior, interventions

Therapy emphasizes

most often

target individual

behavior. This bias can be seen as supporting the oppressive forces in society that affect

women and

individuals from non-Caucasian cultures, lower socioeconomic status,

diverse sexual orientations

and

ablener.

women and

interventions with

They

specifically point to the use

argue that treating the

inforces traditional sex-role behavior, such as

the roles of mothers active

who

coping

of skills-training

rather than the culture re-

parent training focuses primarily on

and children. Further, Collins and McNair suggested that the more

strategies

of minority

women

could be deemed maladaptive by therapists

endorse traditional sex-role stereotypes. However, others argue that recent versions of

behaviorism are

were

when

woman

and of

much more

earlier versions

In the late 1960s

attuned to environmental aspects of client presentations than

(Spiegleman

BT

& Guevremont,

as a profession

2003).

supported the use of conditioning procedures to

&

change the sexual orientations of homosexuals (Glass

Arnkoff, 1992). However, in

1974, the president of AABT, Gerald Davidson, declared in his presidential address that

was unethical

to

it

continue these attempts (Davidson, 1976). According to Glass and

Arnkoff (1992), Davidson’s plea was one of several that prompted the elimination of homosexuality as a diagnostic category in the Diagnostic and Statistical Manual ofthe American Psychiatric Association.

THE CASE STUDY The

story of Shirley

is,

in

many ways, an

lem behavior, the shoplifting, less clear

to

that

BT

approaches

make some sense

this

is

fairly

ideal

fit

for the

specif c, and

BT

BT

approaches are easily applied.

will directly affect Shirley’s loneliness,

that increasing Shirley’s social contacts

problem. However,

approach. Her primary prob-

if Shirley’s

loneliness

is

although

would help

to

it

It is

does seem

some degree with

associated with feelings that are not ad-

dressed by increased social contacts, such as mourning, this approach might be

less useful.

BEHAVIOR THERAPY

Summary BT counseling rests on a psychological model that emphasizes the learned nature of behaviors,

whether they be adaptive or maladaptive. Three general models of learning are iden-

tified (classical,

operant, and social learning)', although the validity of these models and

their direct connections to

associated with BT,

BT

some techniques can be questioned.

and most have been found

A variety of techniques are

to be effective.

counseling has been the target of criticism and controversy.

The

traditional ap-

BT emphasizes behaviors and their environmental rather than personal determiThis emphasis, less common today, may lead to less attention to emotional and

proach to nants.

cognitive factors in behavior. In

some ways,

fully applied.

BT seems to be an approach that is applicable to a range of clients,

Some

client

groups

may respond

if care-

favorably to the problem-focused, direct

techniques used in BT. However, BT’s lack of attention to societal norms that influence

behavior in ways that discriminate against some groups this

a potential pitfall associated

with

www.prenhall.com/murdock

for

is

approach.

Visit

Chapter 8 on the Companion Website

chapter-specific resources

and

self-assessments.

at

Albert Ellis

Alan

a 27-year-old Caucasian male.

is

He

works in a warehouse managing workers who

an Asian woman who is 30 years old. The only child of devout Catholic parents, Alan is a committed Catholic, as is Teresa. Teresa and Alan are active in their church, and most of their social activity is church related. Alans parents live in another city 2 hours away, and Teresas live on the West Coast. The cou-

move

stock.

Alan

is

married

to Teresa,

ple has no children.

Alan comes

to

counseling because he

anxiety-driven behavior.

He

is

reports that

anxiety ridden

when he

leaves

run over someone with his car

and retraces

his car

his route to

it.

Alan

is

repetitive,

a room in his home, he has

return several times to be certain that he has turned ojfthe light switch; other times he just looks at

and showing some lights.

to

Sometimes he flips the

also troubled by the

worry that he has

way home from work and frequently gets hack in make sure he has not. Most troubling to Alan is disturb-

on

his

ing mental imagery of a religious nature that he believes he cannot control. Alan itant to describe these images, but he says they involve the Virgin

is

hes-

Mary and

sexual

5 years. He

recalls

content.

Alan

reports that he has

had

variants of these symptoms for at least

being almost immobilized by his fears shortly before he counseling at that time

was

still

andfotmd some

relieffrom his

and

Teresa married.

symptoms but

Alan went

to

says that his anxiety

bothersome. Since that time, Alan has experienced briefperiods of compulsive be-

havior, but

ofthe

least

disturbing kind, such as checking the light switches.

He became more

concerned when the religious images began about a month ago, along with the worries

about hitting someone with

his car.

When he comes to counseling, Alan appears uncomfortable and nervous. He speaks quickly and softly and seems motivated, but is at a loss about what to do about his symptoms.

273

1

RATIONAL EMOTIVE BEHAVIOR THERAPY

274

BACKGROUND The

and flamboyant Albert

colorful

Behavior Therapy (REBT).

(1913—2007) thought up Rational Emotive

Ellis

who

sex therapist

Ellis, a

retrained as a psychoanalyst, freely

admits that he developed his theory out of his frustration with the passive, slow methods of psychoanalysis

He

1994a).

(Ellis,

acknowledges that

also

sonal anti-neurosis campaign” of his youth this

did

I

become

(really)

76; see

p.

product of the “per-

Box

9.1).

1

begin

shall

who

primarily

wanted

I

fought

to help

to

world be a better

to help the

me, me, me! (2004,

1991 to acknowledge the behavioral element that

cial to

RET but had not been widely recognized.

Box

and no such

it.

He had already conquered his

to

myself me.

When

fear

If in vivo desensitization

Ell try

it

with

my

.

p. 71).

Ellis

the

then decided to apply

this

.

.

With

technique to his

go to the gardens every day

beside them, and talk

women

that

—

for

month, and

in July, find

one whole minute!

to his great surprise,

police. Ever the scientist, Ellis reported that

before

I

even got going! But,

hundred

ple of an even

Of

the

first

Ellis persisted

dates.

He

I

hundred,

Ellis

(p.

this

girl

forevermore, he can talk to

own

words, “Shit,

II

I

said

I

good enough

die of discomfort,

now

experiment, the technique to be successful.

phobia.

He

lived, at the time, near

park often but

flirted

with

72), Ellis assigned himself the

girls

home-

women sitting alone on benches, sit down Ellis carried

out his assignment with 130

not one screamed, threw up, or called the

“30 of them waltzed away. They rejected

That

leaves

me

a

me

sam-

for research purposes!’ ” (p. 72).

managed

to

make one

date, hut then she didn’t

and reported that of the second hundred

claims that this

in his

said to myself, strongly, ‘that’s okay.

—good

a mis-

criterion exists (Ellis, 1999c). If

I fail, I fail.

this beautiful

only in fantasy. Telling himself “do, don’t stew” to

—

and was found

Bronx Botanical Gardens and frequented

work

was

Ellis said,

for little children, ifs

terror of public speaking. If

Too damned bad!” (Ellis, 1997a, known as shame attacking was born

maintains has always been cru-

he was 19, he decided to do something about

good enough

die!

The B was

Heal Thyself!

of public speaking

is

1994a).

(Ellis,

Emo-

9.

REBT Therapist a fear ol girls.

Ellis

and

really

I

his theory Rational

Using the term rational

take because rational 'm\pX\t^ an absolute criterion

had

But

the original)

emphasize the emotional elements of the approach

Ellis

to help

with healthier and

place,

renamed

In 1961 Ellis

in

for

italics in

73;

p.

added

Young A1

primarily wanted to

like hell to create better, better conditions.

REBT was first known as rational therapy. Therapy

I

I

other people, too, and

happier people

word, because

a psychotherapist? In a

much less anxious and happier individual. Oh, yes, wanted

help myself become a

I

1997a,

a

is

chapter with a quote that will give you a good flavor of Ellis: recently, he wrote:

“Why

tive

(Ellis,

REBT

first

expedition into

women

any

place,

women

REBT

any time.

he talked

to,

show

up.

he got three

was entirely successful, so that

RATIONAL EMOTIVE BEHAVIOR I'HERAPY name

he had ro

would

the theory today, Ellis

275 the approach cognitive-emotive-Behavior

call

Therapy, except that cognitive therapy and cognitive-Behavior Therapy got there Albert

He was

Ellis

was born

raised in

Ellis’s

early childhood experience

nign neglect”; his father was a salesperson uninterested in parenting (Yankura

was

12. After that, his father

was

who

& Dryden,

rarely seen

traveled a

1994,

good

was characterized by “be-

and

deal,

devouring books and

12, Ellis

articles

launched

mother seemed

His parents divorced

p. 2).

when

Ellis

financially.

in his early years that required periods

of hospitalization and reduced activity during convalescent periods

Dryden, 1994). At age

his

and did not support the family

number of physical maladies

experienced a

Ellis

of three children.

in Pittsburgh, Pennsylvania, in 1913, the oldest

New York City.

first.

his writing career,

home (Yankura

at

and around age

about philosophy and psychology, which

16,

&

he began

set the stage for the

development of his theory.

As

and young

a child

him

habits served

speaking

(Ellis,

adult, Ellis

when

well

1997a).

He had

himself the task of giving

began

at the

socially avoidant. Ellis’s voracious reading

age of 19 he decided to overcome his fear of public

read the early works of several behaviorists

(Mary Cover Jones and John Watson;

in vivo desensitization

ally

was shy and

many

public speeches.

to enjoy public speaking (Ellis, 1997a). Subsequently,

women

(see

Box

succession of jobs, planning to support himself with these while

He

wrote voluminously during

this time,

and assigned

8)

he applied

but had

little

this desensiti-

9.1).

After receiving his bachelor’s degree in business administration,

writer.

advocated

found, to his surprise, that he actu-

Ellis

zation technique to his anxiety about relating to

Chapter

see

who

Ellis

went

becoming

to

work

a professional

success getting published.

At the same time, he was extensively reading and studying many resources on sex duce

his

came somewhat of an authority on

sex

among

a small consulting practice (Blau, 1998). sity,

&

manuscript The Case for Sexual Promiseuity (Yankura

training as a marriage, family,

Ph.D. degrees

Working

his friends

Dryden, 1994).

associates,

to pro-

He

and even

be-

started

Columbia Univereventually earning his master’s and

At the age of 28,

and sex

and

at a

therapist,

Ellis

entered

in clinical psychology.

in his first job, Ellis increasingly

thoritative, advice-giving

became aware of the weaknesses of the au-

approach he was taught

in graduate school. Ellis

embarked on

a

course of traditional psychoanalytic study, complete with a training analysis and supervised practice.

He learned to

rosis in his

change

work. Anticipating that

in his clients, Ellis

tations.

dream

use the psychoanalytic couch, this

analysis,

“depth” therapy would create more profound

was disappointed

to find that the results did not

Becoming

his expec-

skeptical about the efficacy of traditional psychoanalysis, Ellis

began experimenting with variants of psychoanalytic theory, such

Harry Stack Sullivan, Karen Homey, and Otto Rank. to his liking because,

the slow, laborious

methods such

than standard psychoanalysis,

He began

to

Ellis

as free association

Ellis still

experiment with

those proposed by

found these approaches much

and dream

found himself a fusion

(Ellis,

1994a). In 1954

analysis.

to create client dissatisfied

change more quickly

with the

results

of

his

of psychoanalytic and Behavior Therapy

and became convinced that insight alone was not enough change was needed, too

as

although they used psychoanalytic theory, they dispensed with

Although these variants of psychoanalysis seemed

therapy.

meet

His clients simply did not change in the profound ways promised by psychoana-

lytic theory.

more

and transference neu-

Ellis

to “cure” his clients

began

to integrate his

—

behavioral

knowledge of

RATIONAL EMOTIVE BEHAVIOR THERAPY

276

behaviorism, philosophy, and psychology, and by January 1955 he began practicing Ratio-

Therapy (RT;

nal

He

1992a).

Ellis,

presented his

RT

paper on

first

American

at the

Psychological Association (APA) annual convention in 1956. In 1959 he founded the Institute for

Rational-Emotive Therapy

(Ellis,

1992a) and in 1962 published his landmark

book. Reason and Emotion in Psychotherapy.

These events marked the beginning of Ellis’s long and controversial no-nonsense

for his

style

and

his free use

career took place in a psychological

conservative attitudes about sex;

community

The

is

known

largely

dominated by psychoanalysis and

ideas ran counter to both of these cultures. In fact,

Ellis’s

approved because the faculty thought

He

of profanity in professional contexts. His early

idea for his doctoral dissertation about love

Ellis’s first

career.

it

among

college

was too controversial (Yankura

women

was not

& Dryden,

1994).

profession of psychology was not very accepting of his Rational Emotive Therapy,

either;

reported that

Ellis

“its

except the Adlerians” (1992a,

component

strong cognitive

Eventually, however,

p. 9).

horrified almost everyone

Ellis’s

persistence paid off,

and

contributions have been recognized by several professional organizations (American

his

Counseling Association; American Humanist Association). In 1985 he was awarded the APA’s award for distinguished professional contribution to knowledge. Today, international in

its

influence and

REBT

is

generally considered one of the major approaches to

is

psychotherapy (Smith 1982; Yankura

& Dryden,

1994).

A close study of REBT theory will reveal similarities to the ideas of the intellectual descendents of

Sigmund

Harry Stack

Freud.

acknowledges the influence of Alfred Adler, Karen Homey,

Ellis

and Otto Rank on

Sullivan,

his

work, along with the existential philosophers

(Heidegger, Kierkegaard, Buber, Sartre, and others).

He

Will Schutz and Fritz Peris and the 1960s encounter unflinchingly “I

could

idealist.

door.

of other

theorists.

fairly easily see that Socrates

That Freud was an arrant

FFB

but an Ellis

movement

The following quote

was something of a

1994a).

(Ellis,

is

overgeneralizer.

sophist.

That Plato was often

That Jung was

a silly

in the

back

a brilliant but sloppily mystifellow,

a fearful fucking baby” (Ellis, 1997a, p. 70).

probably the most prolific psychologist of the 20th century.

articles

and more than 70 books. For many

demonstration of

REBT

at the

Albert

years,

Ellis Institute.

for Ellis In the session.

Even

in his 80s,

ducting individual and group ing. In

August 2000,

at the

APA

at the

convention.

repartee between the Ellis

REBT

He has

on Friday nights

Admission was

might even be one of the lucky two individuals chosen

Albert

Ellis is also

That Wilhelm Reich was pretty psychotic. That Carl Rogers was a nice

—

of

illustrates Ellis’s distinctive style:

That Kant courageously threw out God and then cravenly brought him

cal thinker.

800

critical

also recognizes the contributions

to serve as the

published over

Ellis

conducted a

five dollars,

and one

demonstration client

he maintained an 80-hour work week schedule, con-

and

REBT

and of course

supervision, lecturing,

writ-

age of 87, he and Aaron Beck staged a debate on their approaches

The

event diew an overflow crowd

two giants and

particularly with

who were

Ellis’s lively

delighted with the

presentation.

passed away in July 2007. His work, however, will be continued on at the

Albert

Ellis Institute,

REBT

journal,

was

founded by

first

Ellis in

(

published by the institute in 1966; in 1983

of Rational Emotive Therapy,

and then

in

& Cognitive-Behavior Therapy (Neenan & book The Myth

1955 www.rebt.org ). Rational

oj Self-Esteem in

Box

9.2.

it

Living, the first

became the Journal

1988 became the Journal of Rational-Emotive Dryden, 1996). Read a section from Ellis’ 2005

— RATIONAL EMOTIVE BEHAVIOR THERAPY

277

Box 9.2

An

Except from

Self-Esteem a Sickness^

Is Is

The Myth of SelfEsteem

Ellis’s

way you

self-esteem a sickness? That’s according to the

defined by people and by psychologists,

known

disturbance

I’d

say that

man and woman: Even

to

seems somewhat worse, but

is

perhaps a

it is

define

it.

way

In the usual

it is

probably the greatest emotional

which

greater than hating other people,

little better.

Why does hating and damning other people seem worse than self-esteem, which almost always leads to self-hatred? Well,

it

obviously results in fighting, acting against, war, and

more

genocide. Pretty dramatic! While self-hatred produces

subtle results

—

like despising

yourself but not necessarily committing suicide. Living with your self-lambasting.

me

Let

won’t be

spend some time trying to

easy, since definitions

for the purposes

clearly define self-esteem

and

self-disesteem. This

have been vague and overlapping for the past century. But

of this book, here goes!

You rate your self, your being, your personality, your essence, your totalterms of two main goals: (1) Your achieving success or effectiveness in your ac-

Self-esteem:

in

ity,

complishments. Your school, your work, your projects.

what you want (and avoiding what you also rate yourself

and

your achievement

When

(2)

win

your goal

— then you

son!” If you

your

goals,

their approval, if

person

selfdis

fail

tell

to

Worse

is

say,

you

is

you

tie

up your

yourself, “

That

is

likely,

clear

—and

to satisfy

relate well

and

—your worth

as a

good and worthy

per-

your self-esteem

good!” and

also, “I

work and

clearly gets

at love, so

you know

others,

you

am

a

you then

your anxiety

make

As

into trouble.

your self-esteem

this after awhile,

rate

your

eff>rt diXid

is

at best

a fallible

human, you

temporary. Even

and of plummeting down

and you know

that your

worth

as a

when again.

person

yourself anxious about important achievements

interferes

do. Unless, of course,

Realizing this

always

fail

with your performances and makes you more

fail.

when you

among

you

and you actually

relating to

Rotten go! Your need for self-esteem makes you ious

When

bad; and / am bad.”

relating well to other people

depends on your success, you

likely to

“That

But you

that is good. Great!

for succeeding!”

are in real danger of failing next time

yet, since

and, very

good person

you say

succeed in getting

urmonhy.

can’t help failing at

high,

you

a

win the approval of significant

That seems quite

it is

am

say, “I

don’t want),

When you

some

centuries ago,

self-acceptance.

is

are perfect

decidingx.0

it

said

is

it

and more anx-

unlikely.

you could constructively

self-acceptance

called

achieve

—which highly some philosophers —Asian and Greek and Roman, you

— invented They have what unconditional have — and keep Simple! others

less likely to

choose to

(USA) by merely strongly

it.

—

— —

To achieve USA, you still pick an important goal such as work or love and you evaluate its achievement as good or bad, successful or unsuccessful. But watch it now! you refuse to rate or measure your self, your being, as “good” or “bad.” You realize, along with a modern philosopher, Alfred Korzybski, that your performance

—

RATIONAL EMOTIVE BEHAVIOR THERAPY

278

part of you, but certainly not

is it.

is

But

a single performance, can easily

it is

—

always

always

yes,

You did

you.

all of

and

it

are largely responsible for

change (be better or worse) tomorrow, and

— one ever-changing

aspect of you.

As Korzybski

not your behavior. You are that and thousands of other behaviors

said,

—good,

you are

bad, and

indifferent.

So you accurately not do bilities

itself] I

did

it

tell

with

—do many more who

a person

rate or

little

desirable

hatchet;

and

I

will

— because of my

and undesirable behaviors. But

I

certainly did

and

talents

falli-

am not my acts-— just

evaluate the efficacy of your thoughts, feelings, and actions; but

measure your

You

individual.

my

It

behaves well and badly.”

You

Period.

yourself, “I did that desirable or undesirable act.

you

total st\^ or efficacy. In fact,

You grow, develop,

are not static.

can’t

—because you — and

progress

you don’t

are a changeable

retrogress.

Why?

Be-

cause you do. the only

Is this

fairy

godmother, your mother,

would have it

get unconditional self- acceptance?

by convincing yourself that somebody

directly,

your

way you can

gives

it

to

No. You can get

you gratuitously

—which, fortunately, you can do. Instead of saying that God

ditional self- acceptance

(or the devil!)

you did? That’s more honest! You saw

say that

(CSA) wouldn’t work,

you decided

so

to give

USA

that con-

to yourself

Why not?

^//^conditionally.

Excerpted from The

God,

someone else. But, first of all, you you USA. Otherwise, you really give

to prove that that spirit or person gives

USA, why not merely

say

in-

a therapist, or

to yourself

gave you

—

it

Myth ofSelf-Esteem by A.

Ellis;

2005.

New York:

Prometheus. Used with permission.

BASIC PHILOSOPHY REBT

can be summarized in one sentence by

philosopher:

control their

never the events that happen that

“It’s

them” (2005a,

p.

own

Ellis’s

259). This assumption

lies at

them feel a certain way, Ellis has been known to can make you feel almost anything except with Ellis sees his

and the

his reality

— by

theory as constructivist

fact that the individual’s

When

is

us disturbed, but our view of

this

his clients say

No

one

a baseball bat” (2002, p. 110).

he emphasizes the individual’s creation of

perception of reality

inclined to say that philosophically,

someone “made”

reply “That’s really impossible.

determining behavior, not some externally validated ings, Ellis

make

the heart of REBT theory, that people can

thoughts, feelings, and behaviors.

—

paraphrase of Epictetus, the stoic

is

the deciding factor in

reality (Ellis, 1998a). In his later writ-

REBT has much

in

common with Tibetan

Buddhism (2005a). Ellis

is

best characterized as a soft determinist (Ziegler, 2000). Individuals have

choice in their Ellis

lives,

some

but inherited or innate potentials also exert substantial influence. In

fact,

80% of the variability in human behavior was atonly 20% to environmental influence (Ellis, 1979a,

once wrote that he thought that about

tributable to biological factors, leaving p. 17). If

sense at

so

all

much of behavior

to

is

biologically determined,

attempt behavior change.

Ellis

would

one might wonder

if it

makes any

reply that innate characteristics can be

RATIONAL EMOTIVE BEHAVIOR THERAPY changed your

—

theory

tially evil

there

is

much

is

nor actualizing; in

a little

of"

terms of

fairly neutral in

God and

REBT

fact,

the devil in

all

human

make them, construct them

and

Ellis,

of us.

Ellis identified

is

The standard

for

and preferences

to constructively

“bad” or “good,”

good and bad

—

p.

188;

and society-serving or

self-

a consensual

is

REBT

of

we

can

They

theory

is

to

to be strongly for the better”

Ellis,

to be

&

both

Terjesen,

determine

if

and society-defeating.

self-

one based on community standards

really

(Ellis,

behaving

(Ellis,

be measured, because their being 'm-

an ever-changing present and future. There-

ever rate them while they are

still

alive

and changing?”

(Ellis,

1994a,

italics in original).

REBT

is

Alans

Raphael

is

thinking that Alan

weaknesses.

counselor.

He

like

is,

greets

Alan and

asks

himself only human,

Alan will probably show some

signs

of

mind is

that the world

is

as

Alan currently views

him what

brings

him

in.

have both strengths

likely to

At other times, ofAlan. What Raphael keeps

irrationality.

Raphael will discern very forward-moving, productive aspects most in

and

.

that the behavior should never be equated with

are a process

Raphael

and

.

.

programmed

one’s behavior can be said to be bad, but not the person

cludes their becoming.

how

change things

beings are biologically

2005). “People’s intrinsic value or worth

fore,

and the “propensity

are seen as responsible for their behavior; they can easily

A centerpiece

the person

two powerful human ten-

2005b).

that behavior

1994a).

(push

are neither essen-

and self-defeating (Barnard,

rational, self-actualizing

REBT, people

In

human

1994a, pp. 14—15). Thus,

2006;

PYA

of

advocates would probably acknowledge that

into absolutistic musts”

and impelled

proactive: to be motivated

irrational

tactic

Humans

nature.

dencies, the “innate tendency to take their strong desires

(Ellis,

REBT

use of the

1998b).

ass; Ellis,

REBT

just very difficult, requiring

is

it

279

it.

HUMAN MOTIVATION REBT

counselors assume that people have the overall goals of “surviving and being

reasonably happy to a

(a)

when

few selected people,

and

tively,

(f)

alone, (b) socially, with other people,

(d)

gathering information and education,

having recreational

tertainment, and sports”

(Ellis,

interests,

1994a,

p.

such

currently involved in

seeks

(and has

Teresa,

human

working produc-

music, literature, philosophy, en-

humans should be

motivation

is

to obtain pleasure

pain.

ofsurvival and happiness. Raphael notes that Alan behavior directed toward satisfying intrinsic human goals. He

Raphael sees Alan as a person is

(e)

18). Ellis believes that

long-range hedonists, implying that the basic

and avoid

as art,

intimately relating

(c)

in search

established) social

and friends

and

intimate relationships in that he has a partner,

at work as well as at his church.

He and

Teresa play

softball team.

Alan mostly works productively, but

He also finds

that his anxiety leads to socially avoidant behavior,

ing more time at home.

lately his anxiety

is

on the church

getting in the way.

and he

has been spend-

RATIONAL EMOTIVE BEHAVIOR THERAPY

280

CENTRAL CONSTRUCTS ABCs REBT counseling

is

as

simple

as

ABC. The A

stands for the antecedent event or activating

we

experience, or something that happens to us that

1999d).

to adversity (Ellis,

The

A, in

Sometimes the

find relevant.

A

refers

can stand for almost anything. As can be

fact,

thoughts, fantasies, emotions, or other people;

it

whatever the person

is

upset about

is

(Wolfe, 2007).

The

C

the consequence, or

is

what we normally think of as the

result

of the A. Cs can

be emotional events (sadness, happiness, anxiety, depression) or behaviors (persisting task,

avoidance, compulsive behavior). Cs can take the form of healthy emotions (such as

sadness or happiness) or unhealthy emotions (depression, anxiety, or rage; If

at a

you have had the good fortune

tional emotive behavior therapist,

to be

exposed to

you know

that

Ellis,

Epictetus, or

Ellis,

1999a).

some other

what makes the difference

ra-

in experienc-

A event. A not directly connected to C, but instead is filtered through B, our belief about A (Bernard et ah, 2006). An important, but conceptually difficult aspect of REBT is that even though the ABC model seems very straightforward (i.e., A activates B and then B causes C, or Ax B = C; ing healthy or unhealthy emotions

Ellis,

1999d),

Ellis

is

is

what you think about the

clear that emotions, beliefs,

is

and behaviors

interact (Ellis, 1994a).

components and vice versa. Behaviors are intertwined with thinking and feeling. Let’s assume that I believe very strongly that the world must be fair and just. When someone cuts in front of me in line at the grocery store (an A), I am likely to perceive this slight as much more catastrophic than someone who does not hold the same belief. The A becomes much more negatively valenced based on my B system. Another example of the interrelatedness of human experience is That

is,

feelings usually involve cognitive

that extremely powerful or unusual As (a hurricane, for example) can cause Cs (Ellis

&

Dryden, 1997).

Raphael begins

what

brings

some of the As, Ba and C^ ofAlans presentation. The Cs are counseling, so Raphael starts by looking at them: anxiety, unwanted

to identify

him

to

repetitive checking behavior (oflight switches

ing imagery. The As ofAlans situation seem itive behavior,

he has thoughts

simple sentences

like,

have run someone it is

and images

‘‘Something

over. ”

less clear.

Alan

work),

and disturb-

reports that prior to his repet-

associated with danger that seem to trigger

bad might happen

ifI leave the lights on,

The C ofexperiencing religious imagery

connected to theCs ofanxiety, shame,

selves

and his path home from

and guilt.

It

is less

is

clear

also

”

it,

or “I might

an A event because

where the images them-

come from.

Beliefs Beliefs are simple, declarative sentences

we

say to ourselves, or images

have special meaning to

our

beliefs

“run

— and

There

ruin!

are

us. Collectively,

most of our

lives” (Ellis,

1994a,

two kinds of beliefs, according

tional beliefs (iBs).

On

to

p.

form our

life

and symbols that

philosophies, which then

46).

REBT theory,

rational beliefs (rBs)

and

irra-

a descriptive level, rational beliefs are those that express preferences

RATIONAL EMOTIVE BEHAVIOR THERAPY and wishes. Rational'm

281

REBT language means “effectively self helping” They

rational beliefs are ones that help people achieve their goals.

moderate emotions (Bernard assumption,

1994a, p.25);

(Ellis,

generally lead to mild to

2006). Despite what might seem to be a straightforward

et ah,

REBT writers are careful to

note that rational beliefs don’t have to be logical or

supported by empirical evidence.

Dryden and Neenan (2006)

identify four kinds of rational beliefs: “flexible prefer-

ences, anti-awfulizing beliefs, high frustration tolerance beliefs, (p. 2).

These

will

make much more

you

sense to

after

and acceptance

you read the sections on

beliefs”

irrational

beliefs next.

demanding musts

Irrational beliefs are rigid,

usually illogical

and

unrealistic,

or shoulds (Bernard et ah, 2006).

but not always. Depending on which source you consult,

various classifications of irrational beliefs can be found, so classic three categories

1.

of irrational

times, perform well (or outstandingly well!) in these

fail

important

2.

fairly.

me

Otherwise,

badly and

abominably

conditions and at

terrible 2a\d

it is

who do

you

all

life

ble

horrible,

and quickly and

and

and hardly worth

cant stand

fall

me

a

deserves xo suffer.”

nicely, considerately,

unworthy people

will always

and

UQ 2iX

for acting so

(my environment,

the ecology,

I

live

it.

easily enjoyable, I

can’t ever

and

if

be favor-

they are not that

enjoy myself at

by Albert

Ellis.

My life

all.

Copyright

is

way

it’s

impossi-

©

1994 by Birch

Reprinted by permission of Citadel Press/Kensington Publishing )

people rely on irrational thinking a

lot (or

musturbate, in

Ellis’s

terms), they

into other kinds of thinking that are thought to be derivatives of the musts.

irrational conclusions are (a) awfulizing, or seeing things as

(b) I-can’t-stand-it-itis,

others, or the

and

world

much more

than bad;

or low frustration tolerance (EFT), the belief that bad things

should never happen and

ratings);

am

and should be severely punished

in Psychotherapy [rev. ed.]

www.kensingtQnbooks.com

When These

I

Press. All rights reserved.

Corp.

1

living!”

(From Reason and Emotion Lane

who

awful

of sig-

relate or associate, absolutely

I

times, treat

is

love!)

political conditions) absolutely must, at practically all times,

able, safe, hassle-free,

awful and

complete

all

me!”

to noble

economic and

(or

respects, that

whom

are rotten, bad,

not deserve a good

—

conditions and at

all

probably always^dA and

World-demandingness. “The conditions under which the

can

all

practically

sacred!

Other-demandingness. “You, significant people with must, under practically

3.

under

and win the approval

—and

who will

bad, incompetent, unworthy person,

(1994a)

will here present Ellis’

I

musturbatory headings:

beliefs or

Self-demayidingness. “I, myself, absolutely must,

nificant others. If I

They are

I

can’t stand

it if

they do;

(c)

damnation, or rating ourselves,

as absolutely, totally horrible (see the

(d) allness or overgeneralization

(Bernard

discussion on

&

human worth

DiGiuseppe, 1989;

Ellis

&

Dryden, 1997).

We are

not always aware of our iBs because they can operate on both conscious and un-

conscious levels

(Ellis,

1994a). Because

humans

are in the habit of hanging

on

to their iBs,

they tend to repeat these again and again to themselves. Eventually, they are transformed into basic (irrational) philosophies that feel like the truth sent

from on high

These dysfunctional basic philosophies

number of ways. Elrey They use circular reasoning

lead to strong negative emotions,

are then reinforced in a

which makes them

feel true.

(Ellis,

1

994a).

— RATIONAL EMOTIVE BEHAVIOR THERAPY

282 (If

I

fail,

I

leads to

am

bad.

I

failed, dierefore

explicit

little

I’m bad).

examination of them

They tend

be pre- or unconscious, which

1994a).

(Ellis,

Raphael thinks that Alans iBs are fairly easy

to

to guess,

although Alan might not consciously

think about them. Raphael thinks that Alan seems to have some kind of extreme belief

around

the light switches: “If I

dont turn

off all light switches,

and that would be awful!'' Similarly, he might

some

happen

disaster will

be thinking, “I absolutely must not ever hit

my car.

IfI did that, it would be terrible and I would be an absolutely rotten person!" Although Raphael is wondering what the imagery is about, he suspects that Alan

anyone with

is

also telling

does makes

himself that he should never have images such as

him an unworthy worm, a

beliefs is Alan's

perfect.

and the fact

these,

that he

definite no-goodnik! Underlying these specific

and most particularly

adoption of the three musts,

Because he has such difficult symptoms that sometimes seem

the first

—

must

/

be

cause other people to

to

—

him badly, Alan probably harbors the other two musts as well others must treat me well, and the world must be an easy place to live or I just can't stand it. Clearly, Alan is awfulizing, rating himself as worthless, and is beset by low frustration tolerance. He sees himselfas all bad because of the symptoms he experiences. treat

Goals

(Gs)

According to REBT, people have goals portant As happen

when

and be happy, but these

(

Gs) that they carry with them,

those goals are thwarted.

are translated into

more

We

have the general goals to survive

all

goal

is

we share with other may be idiosyncratic.

specific subgoals that

people (for instance, the desire for a successful career), or some goals

One common

and the most im-

to be loved (Ellis, 1995a).

When we

receive information that indi-

unhappy with us, the goal of being loved is blocked, and we experience an antecedent event. Other specific goals mentioned by Ellis are to be comfortable and successful (Ellis, 1995a). “We naturally want love, power, freedom and fun for they often add to our enjoying of life and help us survive” (Ellis, 1999d, p. 8). cates that

someone important

Alan's goal of being reasonably

terrupt his

is

happy

normal life rhythms

because he must go back

to

is

threatened by his compulsive behavior.

check the light switches,

and check

to see ifhe

and he cayi

has hit anyone with his

depression he experiences also interfere ivith his goal to be comfortable

having

difficulty at

He has to

never relax at home, car.

The anxiety and

and successful. He

work because of his anxious, compulsive behavior, Raphael

His coworkers sometimes react

to his

apparent discomfort

in-

is

discovers.

and anxiety, and he sometimes

and rechecks small details of their work. Raphael also suspects that Alan's goals to be accepted by others and loved by his wife are also frustrated to some extent because his sometimes odd, anxious behavior puts others off, and Teresa is getting quite frustrated with his “checking" behavior (the light switches and retracing his route home from work). He is most checks

concerned about the Teresa

is

with

Teresa.

(Raphael wonders, as an

aside, if

experiencing some I-can't-stand-it-itis about Alan's behaviors). Raphael also knows

that Alan's religion ates

strife in his relationship

is

very important to

him and guesses

that the imagery Alan reports cre-

a perception that Alan can't possibly achieve his goals of being ivorthwhile in the

God and his

church.

eyes

of

— RATIONAL EMOTIVE BEHAVIOR THERAPY

Human Worth REB T,

In

good or

human worth

global

1999b).

undesirable

—

Ellis

act. It certainly

Instead of

—

making

option

is,

someone else as an allbehavior must be separated one

seeing yourself or

itself.

I

did

it

—do many more

just a person^\\o

—

(a rotten

tell

person [RP] or a worm;

yourself

with

my

USA

(Ellis,

hatchet;

little

USA

and

will

I

and undesirable behaviors.

desirable

behaves well and badly’

2004a).

did that desirable or

‘I

”

(p.

5; italics in original).

1

global judgments of worth, individuals should

to fight

Is

did not do

fallibilities

ditional self-acceptance, or

One

that

(2005a) opined “So you accurately

am not my acts

I

—

are a no-no.

because of my talents and

But

ratings

USA

The person and the but that does not make one a bad person

all-bad person

can behave badly, Ellis,

Ratings and

283

work toward uncon-

can be achieved

in

one of two ways.

your natural tendencies to self-evaluate and instead choose

yourself as a good person just because you are alive and

human

(Ellis,

to see

1999e).

—

The problem with viewing yourself as inherently good is that it is definitional anyone could come along and disagree with your definition of yourself and say that you are a worm. You have no way of proving that your assertion is right. Also, “you, alas, are a fallible and often screwed-up human” (Ellis, 1999e, p. 54) so you would be constantly confronted with your own imperfection. The better option to global goodness is to refuse to make such evaluations of the self at all. Simply evaluate your behavior, thoughts, and feelgood or bad according

ings as

achieve your goals;

This Ellis

REBT

whether they help you

rule applies to our self-ratings as well as to our appraisals of others. it is

best to practice

2004b). Because others are

may even

(i.e.,

1999b).

Ellis,

maintains that

(Ellis,

to the standard of rationality

believe that

same standards

you

UAO,

human

too, or unconditional acceptance of others

most

too, they will

deserve to be treated that way!

to others that

you apply

certainly treat

UAO,

you badly and

then, involves applying the

—hate the behavior, not the person.

to yourself

Similarly, Ellis (2004a) argues that unconditional life-acceptance

(ULA)

is

necessary to

achieve a state of minimal disturbance.

Alan

is

rating himself as a worthless

human

being particularly because of the uncomfort-

able religious images he experiences that he feels he cannot control. tionally accept himself Because he has experienced the anxiety

a long time, he a

Raphael that he

tells

100% bad person. He

also sees

believes that there

is

He

does not uncondi-

and repetitive

behavior for

something wrong with him; he

is

most other people as uncaring and mean because they

would not accept him and his dysfunctional

behavior.

Secondary Disturbances It’s

bad enough that we create our own unwanted negative

Whafs worse

is

that,

according to

REBT, we go even

feelings

further

and behaviors

(Cs).

and believe that we "'must

notx\\m\s crookedly, must not\\2.Yt disturbed feelings, must rwth^YQ dysfunctional behaviors” (Ellis,

1999b,

p.

81).

When we

have an upsetting

ABC

Cs as activating experiences themselves (/12s) and then get

them.

Ellis calls

sponse to the

all

wound up

ABC

sponse to A\. Then

we

sequence, which create

we have mishandled by

more trouble by adding an

relying

treat the

with Bs about

come

in re-

on an IB

in re-

these kinds of upsets secondary disturbances because they

first

we

experience, then

iB in response to

A2

(or the

RATIONAL EMOTIVE BEHAVIOR THERAPY

84

Q. When we tell ourselves that we must whatever, we are creating secondary disturbance

have lousy thinking, or get anxious,

original

or

For example,

if

my

mother

she didn’t do that, but

some annoyance

result in

Alternately, is

does not

it

I

me (Al), make me or

yells at

second

Mom).

immediately respond with the iB that

my

cool or be

mean

to

ary disturbance. Cl, that Ellis

my

is

C would

case, the

anyone or shame,

I

“I

am

guilt,

emotion.

part, a healthy negative yell at

me

—

I

stand

can’t

it

and she

probably be anger, and even some an-

If I shout,

must be

then

I

perfect at

worrdA

a

1999b).

stress (Ellis,

her a rotten person.” This sequence might

might respond with the iB “She must not

a rotten person!” In this

lose

symptom

can respond with the rB “Well, Ed rather

I

or mild discomfort on

gry behavior (such as shouting back at I

or

have created an all

A2

because

times, absolutely never

have then constructed the second-

I

or depression.

(1999b) also noted that clients can even create

tertiary disturbances

have to do

t\\ 2.t

with musting about doing well in therapy and expecting that the counselor will help

and quickly! These

perfectly, significantly,

tertiary disturbances

need to be discovered and

disputed while, or even before, the counseling addresses the primary or secondary ones.

Raphael thinks that Alan

and performs

anxious

must not be

his

compulsive behavior (Cl

like this (iB2),

ways (iB2). Further,

life

evidencing significant secondary disturbances.

is

and he

and also K2), he

tells

absolutely should not ever act in such

—he

should not be so difficult

(iB2). These B.^ are likely creating feelings

When he gets

himself that he

immature

silly,

just cant stand how hard

it is to live

of rage and depression (C2s).

THEORY OF THE PERSON AND DEVEEOPMENT OF THE INDIVIDUAE REBT does

not present a personality theory; nor does

REBT

cussion.

As noted

fluences

and environmental teaching.

at

one point he

earlier,

postulates that Ellis

it

humans

offer a detailed

are a

developmental

product of both inherited

dis-

in-

does not discuss any developmental progression;

called Freud’s psychosexual stages figments of his (Freud’s) obsessive

need

for perfection.

Biological influences include things such as individual differences in the tendency to think irrationally, react emotionally,

and

conversely, to

grow and

actualize.

Tendencies toward be-

havior (such as compulsive behaviors) can also be innately determined

The most important environmental

influences are other people.

(Ellis,

1994b, 1997b).

We absorb

rules, stan-

dards of behavior, and goals from those around us, including parents, siblings, teachers, peers,

and

religious or political

born ‘musturbator’ and foolishly is

make them

will

groups

1995a). “You, like almost

(Ellis,

into imperatives. So

to internalize these rules, but

really

it is

our

her parents, for example,

mean, according

most

— not —of your profound musturbation

human

all

tell

Julie that she

to Ellis (1995a), that

is

born with

should” and turns

it

it

should be getting better grades, they

would be still

so.

Most

preferable 'F she got

all

As.

love Julie even if she gets

all

C grades.

human mind, Julie takes the preferential “you demand that runs something like this: “I absolutely

a twisted little

into an absolute

Of course, we don’t have

nature to tend to do

parents then proceed with business as usual and

Because she

people, are a

almost inevitably take parental, societal and personal rules and

self-constructed, self- repeated, self-learned” (Ellis, 1995a, p. 4).

When

all

RATIONAL EMOTIVE BEHAVIOR THERAPY must^^l rotten

all

As and be

perfect.

It

will

285

be positively horrible \^\ don’t, and

will be a worthless,

1

worm''

Much of this construction of musts and shoulds happens when we are children and have immature

We

(bad, rigid, crooked) thinking processes (Ellis, 1995a).

irrational ideas into adulthood, constantly reindoctrinating ourselves

we

ing what

today.

is

without

really realiz-

are doing.

Raphael and Alan don't spend a

how he

then carry these

of time discussing Alan's childhood or how he got to be Raphael knows that although some ofAlan's behaviors and belief probably

originated early in his

life,

lot

some things about Alan may be the

result

of biological

influences.

HEALTH AND DYSFUNCTION In the

REBT view,

who

healthy people are those

rely

mostly on rational

beliefs in their daily

Healthy folks tend to use strong preferential thinking rather than absolutistic musts and

lives.

shoulds (Dryden, 1996). Unconditional self-acceptance

is

uals because they take responsibility for their psychological functioning

themselves even with

all

of their imperfections. They will

fulize,

should, musturbate, and do

dency

to be irrational,

all

still

needing)

is

flexibility

1994a). Relativistic thinking and desiring

a core characteristic of psychological health. Self-interest

1985,

them

also

p.

want

(as is

to live happily in a social group. If they act in

Acceptance, or

USA

(rather than damnation),

is

opposed

when selor’s

who

else will?”

most of

to the group’s good,

live happily.

an important characteristic of the

human

fallibility

and the

complicated and sometimes influenced by factors outside of one’s control.

acceptance does not

ever,

to absolutely

a primary value because

ways counter

healthy person, in the sense of accepting one’s and others’ life is

they can job

is

(Ellis

mean

ten-

and open-mindedness

108). However, they balance self-interest with social interest because

they are not likely to create an environment in which they can

that

human

1995a).

(Ellis,

healthy people realize that “if they do not primarily take care of themselves, (Ellis,

to accept

have the inclination to aw-

but mostly they will defeat these tendencies

(Ellis,

and choose

of those other things associated with the

Healthy people have healthy basic philosophies that value

and oppose bigotry

of healthy individ-

characteristic

fact

How-

resignation; healthy people actively change their worlds

& Dryden,

1997). In

fact, Ellis

(1999d) argued that the

REBT coun-

not only to help clients deal with iBs around social injustice, but also to

encourage them to work to change these unhealthy As.

Healthy people endorse the philosophy of REBT. The values

in the

REBT

philosophy

include long-range hedonism, self-interest, social interest, self-direction, tolerance of others,

the acceptance of life’s ambiguity and uncertainty, flexibility and openness and change,

and the value of scientific thinking one’s self is important,

emphasizes

Ellis

(2003) wrote

REBT

beliefs or, “I

Commitment

is

perspective

more

globally,

is,

to

something outside of

to people, things, or ideas.

nonperfectionism, and nonutopianism

Dysfunction from an of irrational

2005a).

whether that commitment

risk taking,

basis

(Ellis,

(Ellis,

most simply, operating

on the

basis

have stubbornly insisted that

1985,

p.

in the

world on the

vital

1

10).

of an irrational philosophical system.

human

disturbance

is

environmental pressures, including our childhood upbringing, but that

and

REBT also

contributed to by

its

most important

source originates in our innate tendency to indulge in crooked thinking”

(p.

205).

RATIONAL EMOTIVE BEHAVIOR THERAPY

286

who

People

to absolute

experience

life difficulties

have taken their preferences and elevated them

demands. “Anxious, depressed, and enraged people have many dysfunctional

ideas or irrational beliefs

by which they

and

largely create their neurotic disturbances;

as

the theory of REBT holds, these beliefs almost always seem to consist of or be derived from unrealistically, illogically,

and

into godlike absolutist musts, shoulds,

They

awfulize, engage in damnation,

“The

three

main neurotic

processes

poor performances and rejection; 2)

mances and unkind

reactions);

and

3)

demands, and commands

and have textbook

may be

(Ellis,

EFT

obtained, achieved, or so forth. Sacredizing

is

is

because to

p.

poor perfor-

damning

things

and

when one makes something one deems it is

so

important,

it

absolutely

must be

be distinguished from importantizing, which

importantize anything, as long as you don’t sacredize

most

for

479). Sacredizingh an important

the healthier form of making something a priority in one’s

In the

477).

p.

downing (damning oneself for

1) self

1999a,

1999a,

cases of I-can’t-stand-it-itis.

(low frustration tolerance;

(Ellis,

insists that

(Ellis,

and rage (damning others

1999b). Sacredizing

important an absolute must and

is

seen as

hostility

the world for poor, dislikable conditions)”

contributor to neurosis

nondisturbing wishes and preferences

rigidly raising their

In other words,

life.

it (Ellis,

it is

OK to

1999b).

when

specific sense, psychological dysfunction originates

a person experi-

ences an activating event or adversity that frustrates the attainment of a goal. This experi-

ence engages the irrational belief system, with

The

result

is

the

unwanted

C,

Ellis

feel

shoulds, demands, musts, and so forth.

an unhealthy emotion or behavior. Worse, the person, per-

ceiving the negative C, then turns zFinto an A,

have symptoms,

its

which spurs

iBs about

how one

should not

bad, and so forth, creating a negative secondary C.

acknowledged that severe psychological dysfunction, such

profound depression, obsessive-compulsive disorder, or psychosis, influence of traumatizing' early experience

and

as personality disorders,

likely

stems from the joint

innate, organic deficits (Ellis, 2002). Individu-

who display these syndromes probably are inherently more emotionally reactive and behaviorally disorganized than “nice normal neurotics” (Ellis, 1997b, p. 198). They may experience

als

more

frustration

and

criticism in

life

because of their sometimes odd behavior

Even worse, individuals with severe dysfunction tend about their very ing that

real deficits.

having such

deficits (Ellis,

of dysfunction

VDCs

so upsetting

1994b).

to create severe secondary disturbances

They easily develop severe low frustration

“my symptoms must not be

(Ellis,

tolerance (EFT), insist-

and handicapping.” They self-down about

1994b). These problems tend to

make

individuals with these kinds

(very difficult customers; Ellis, 1994b, 1997b).

Raphael thinks that some ofAlans thoughts and behaviors stem from biological tendencies, such as the propensity toward anxiety and compulsive behaviors. Alan might even be seen as

having obsessive-compulsive disorder (OCD). Alans tendencies

and compulsive

to

be anxious, reactive,

are likely to be partly biologically rooted. Raphael has identified the irra-

tional beliefs that Alan connects with light switches, running people over with his car, the scary sexual religious imagery. life

Raphael can

also see

with thought processes that are self-defeating.

gence of his compulsive behavior, Alan seems

flawed like this,

this! I

to

responds to events in his

He is self-downing. With be holding beliefs such

as,

the recent resur“/

must not be

cant stand it that I am not perfect in every way! Further, when

everyone disapproves of me. Fll never be loved

really intolerable!

how Alan

and accepted

and

by everyone,

lam

and

like

that

is

I cant sta?2 d this anxiety or the rejection of others! I am a rotten, flawed

RATIONAL EMOTIVE BEHAVIOR THERAPY human, and I

will never lose these symptoms,

or the love of those important to me. This ego

and discomfort disturbance;

He

images.

believes that

and

287 I can never have a happy

therefore

just too hard!” Clearly, Alan

is

is

showing both

he downs himselffor his anxiety, compulsive behavior,

he cant stand the pain

and trouble

in his

life

and

life.

NATURE OF THERAPY Assessment REBT

/

model of assessment,

rejects the traditional (medical)

to a lengthy

Instead,

in

which

clients are subjected

comprehensive assessment procedure prior to therapy (DiGiuseppe, 1995a).

REBT counselors see assessment as a continuous process

ing experience

(Ellis

&

MacLaren, 2005). Despite

(1991a) reported that clients at the Albert

throughout the counsel-

this ideological stance,

Ellis Institute

DiGiuseppe

complete a formal assessment bat-

tery that includes traditional assessment instruments (e.g., Millon Glinical Multiaxial In-

ventory

and the Beck Depression Inventory, among

II

weeks for progress reviews. Eiowever, DiGiuseppe (1991a) emphasized

are used every 4

that the

first

others). Several of these instruments

task of the therapist

forming a relationship with the

is

In addition to standardized assessment,

REBT therapists use several structured techniques

that are directed at assessing clients’ belief structures.

times called vivid

REBT,

not diagnosis.

client,

These more formal techniques, some-

are discussed later in the context

of the assessment of specific

Informal assessment involves simply asking what brings the client to therapy.

and

selor then listens for As, Bs,

REBT

Cs, as well as other characteristics

treatment, such as cognitive

flexibility,

problem-solving

skill,

deemed

what

gets the client to counseling. After the client

portant C,

it is

time to get to A.

Einally, the

the client tion

is

(Ellis,

with an

T

1994a).

When

the client

B (Ellis

& MacEaren, 2005).

difficult to

determine what iBs

is

thinking

(in

reflec-

conjunction

or C), he will usually report automatic thoughts or inferences (DiGiuseppe, iBs.

ficient route. Instead, the

REBT

(DiGuiseppe, 1995a). In

this

thought or inference response

is

is

true

to dispute these thoughts, this

is

not the most

ef-

therapist uses inference chaining to get to the core beliefs

procedure, the counselor asks the client to assume that the

and then

asks,

“Then what?”

or “That

would mean

.

then followed by further questioning, until the process reveals

emotional or behavioral problem). At

this point, the

.

.”.

a

The

C (an

counselor then asks why, to further

on the As properties (Dryden, 1995a).

for example, Earry does not

like to

out and boogie. Their relationship his

sometimes

simply asked what he

is

Although the counselor can proceed

elaborate

because

first

holding because iBs are often not immediately available to conscious

1995a) rather than the core

client’s

it is

relevant to

and counselor agree on the most im-

counselor assesses

Advocates of REBT do acknowledge that

The coun-

and indicators of sec-

ondary emotional disturbance (DiGiuseppe, 1995a). The Cis usually explored it is

iBs.

REBT

counselor to help.

The

is

dance

Td be petrified,

Pam wants

(a

C)

A)

to

and Larry

following might be a typical assessment dialogue:

Why?

Larry: Because

but his girlfriend

deteriorating because of this argument,

Larry: / just cant go out dancing, (an

Louise:

in public,

go

asks

RATIONAL EMOTIVE BEHAVIOR THERAPY

288

What would you

Louise:

Larry: That other people

be petrified about?

would watch me dance, (an

inference)

Louise: If that happens, then what?

Theyd see what a

Larry:

And if other people saw

Louise:

Theyd laugh at me.

Larry:

Louise:

And if they

Larry: That

Louise: Larry:

terrible

dancer I am. (inference) that you were a terrible dancer?

(inference)

laughed?

would be

absolutely awful, (an iB)

What would be awful about the

Td feel really stupid,

laughing?

(an iB connected to a

C—embarrassment)

In this example, the counselor has clearly gotten to a part of the

problem

— Larry

is

awfulizing about looking bad in public. However, she has not yet really helped Larry to see the core underlying belief,

which

is

probably

“I

absolutely

must be

perfect”

(i.e., “I

must never appear stupid or imperfect”) or “Others must always approve of me.” Fur-

would

ther questioning

illustrates, clients also

reveal this

more

significant philosophical idea.

have iBs about inferences

Larry dance would laugh

is

(e.g,

As

example

this

the inference that others seeing

connected with the idea that

it

would be awful)

that con-

tribute to emotional upset; these should be assessed along with the ultimate, core iB

(Dryden, 1995a). This example also faulty

and

—who knows

if folks

illustrates that the inferences clients

make can be

watching Larry would laugh? They might instead applaud

cheer!

Some

clients

have difficulty labeling emotional experience or relating emotions to

A events. Dryden

(1995b) recommended the use of vivid methods in these

cases,

when

traditional dialogic metho'ds of assessment are ineffective. Vivid assessment can take a

number of forms.

First,

the counselor can try using language that

is

the

any of

much more emotional

and colorful than normal. Guided imagery about A events might help the

client experience

more fully his emotions and cognitions. Clients can be asked to bring photographs or mementos that relate to the problem situation into sessions. Finally, Dryden (1995b) described the interpersonal nightmare technique, in script, as if for a play,

about

his

most feared

which the

event.

The

client

is

script can be

asked to write a brief

audiotaped and then

played for the client in the counseling session, and the counselor and client can examine the beliefs revealed.

Dryden (1995b) problem situation

Kanus

& Wessler,

also described riskier techniques that involve either recreating the

in the

counseling session (rational emotive problem solving, REPS;

1976) or in vivo assessment. In REPS, for example, the therapist might

criticize the client, recreating the

nique can be very

behavior of a

difficult for the client,

the client’s reaction to

immediately explain

it.

critical other.

As Dryden noted,

and the counselor must be

If the client finds the

his rationale for using

this tech-

careful to fully assess

approach negative, the counselor should

it.

In vivo assessment involves a field trip. Client

and counselor actually take the

assess-

problem.

A client

with an animal phobia, for instance, might be taken to the zoo or an animal

shelter.

ment

process out of the office and into the setting

most relevant

to the

Again, the counselor must be very careful to monitor the effects of this technique on the client.

RATIONAL EMOTIVE BEHAVIOR THERAPY Raphael decides not asking Alan what

standardized testing with Alan. Instead, he proceeds by

to use formal,

bringing

is

289

him

and

in,

guessed quite a few of Alans irrational

andQs. Raphael has situation are less clear. Some

then looks for the Ks,

The As of the

beliefs.

perception of threat seems to set offAlans irrational beliefs about checking light switches

and driving in someone with

The As could be thoughts, seeing

his car.

Another explanation could be that Alan

his car.

posed to anxiety, which then ondary C. The

Cjt for

and probably some

light switches, or images

sets

is

anger, although

is

thinking before

Alan

is

and during this

ofAlans

the specific content

is

acting like a sec-

anxiety, repetitive behavior, depression, shame, guilt,

not expressing that

directly.

Raphael might use some imagery assessment around Alans

what he

simply biologically predis-

offhis beliefsystem, so that the anxiety

Alan include

of hitting

would provide clues to chaining might be useful around the light-

behavior. This approach

Inference

beliefs.

repetitive behavior to see

switching behavior, creating a dialogue such as the following:

and check

R: So you get the notion to go back

have A:

Yes.

R:

Why

left it on. (the

do you think you have

What

if the switch

is off,

that you might

A) check to seel

to

A: Because I become unsure ifI did R:

to see

it.

ifyou didn’t turn off the switch?

A: Something bad would happen, (inference)

What kind of bad?

R:

Maybe

A: I don’t know, fust something bad. R:

the house

would burn down,

(inference)

And if it did?

A: It would be awful,

terrible,

and

it

would be my fault. (iB

resulting in

C,

anxiety,

compulsive behavior) It

would be

but Raphael could use the interpersonal nightmare technique

risky,

plore Alan’s fears about hitting someone with his

done

car.

This kind ofassessment could also be

would probably blend it with Alan through the experience.

in vivo, but ifRaphael chooses this approach, he

ofsome coping statements

(discussed later) to help

to ex-

the use

Overview of the Therapeutic Atmosphere REBT is

counseling

is

namby-pamby,

is

distinctive in

its

Boy Scout-ish

whether the therapist

active, directive nature. Ellis wrote, “If the therapist

or Girl Scout-ish, as lots of therapists are,

will be too helpful. Unless

you use your own personality

have a good deal of push and drive to help your greatly help those

The

who

are

pushing very hotly

Ellis

The

counselor

is

humor with

you

will

and not

added that “unlike Rogerians, moreover, they unconditionally (1995a,

p.

16;

encouraging and supportive of the client and projects

confidence that the client can change his ways counselor often uses

traits

wrong direction” (Ellis, 1992b, p. 95). REBT is combined with unconditional ac-

actively, forcefully teach their clients to accept themselves italics in original).

clients,

doubt

in the

authoritative stance of the counselor in

ceptance of the client (Wolfe, 2007).

many unpushing

I

clients

(Ellis,

1994a; Garfield, 1995).

The REBT

because one of the major reasons they are clients

RATIONAL EMOTIVE BEHAVIOR THERAPY

90 is

that they take themselves, their problems,

1997). However,

and the world too seriously

Dryden and Neenan (2006) caution

that the

REBT therapist needs to

interpersonally flexible, willing to be formal or informal, self-disclosing or not,

unfunny depending on what most promotes the therapeutic

or

OLis

As

most current approaches, the therapeutic

in

REBT work

(Bernard

2006).

et ah,

alliance

The REBT counselor

& Dryden,

(Ellis

be

and humer-

relationship.

considered important in

is

uses active listening

and em-

pathic responding, conveying unconditional acceptance of the client. Although Ellis rec-

ognizes the value of the therapeutic relationship, he also cautioned that, depending on the relationship, too

much emphasis on

changing their behaviors;

(i.e.,

can lead to clients feeling

tend to be dependent.

in Cs

as “sidetracking” (Ellis,

it

of the Cs, the

Although whether

it is

1979c,

The

considered nonproductive.

is

not getting better

The REBT counselor

ting the client get into lengthy descriptions of As, because he tory, seeing

better,

1996a). Also, he warned that a very close relationship

Ellis,

who

can be damaging for clients

it

let-

not very interested in

his-

Likewise, allowing the client to wallow

p. 95).

real deal

is

avoids

is

to guide the client

back to the source

iBs.

Ellis

REBT

claims that

a brief approach

was born and reared with

more

is

efficient

questionable. Ellis

is

is

than other therapeutic approaches,

fond of saying that “poor Sigmund Freud

a propensity for //^efficiency, while

reared with a gene for efficiency”

( 1

996a,

seem

1

p. 4; italics in original)

to have

been born and

Despite this humorous claim,

.

no evidence has been presented indicating the average number of sessions of

REBT

clients.

(1996a) maintained that most normal neurotic clients are helped within 20 sessions.

Ellis

and acceptance ofAlan. He approaches the relationship in a straigh forward, honest way and expects Alan to do the same. Raphael responds empathically to Alans presentation and conveys understanding of Alans discomfort about his bothersome and scary symptoms. Raphael

is

an

energetic, active counselor,

who demonstrates

respect

Roles of Client and Counselor An

interesting

REBT:

it

quandary

arises

when attempting

seems that even more than other approaches,

it is

easy to confuse the role of the

therapist with the personality of Albert Ellis (Garfield, 1995). tive

and

directive style threatens to

that a softer,

lieves

more

indirect

therapists are honest, direct, clients izes a

more

warm

phasize

You theory,

become

and

the “manual” for

approach

Ellis’s

how

to

First

pist

all!” (Ellis,

on the part of the therapist

don’t have to

mimic Albert

you can implement

1994a,

p. 54). Ellis

(2005b) character-

it

em-

for the client.

Ellis to

with a softer

be a

REBT

style.

therapist.

As long

Wolfe (2007) goes so

as

you know the

far to say that

words

“you

in order to be a

practitioner” (p. 188).

and foremost, the

&

most

relationship as preferable, but not essential to therapy. However, he does

must teach the

C(Ellis

do REBT, and he be-

active they are likely to achieve better results with

of the time. But not with

USA

REBT

distinctive confron-

probably an ineffective approach. “If

is

definitely don’t have to use an exhortative voice tone or four-letter

good

of the counselor in

to -describe the role

REBT

counselor

is

an active teacher

client to identify iBs because

MacLauren, 1998).

most

clients

(Ellis,

want

2005a).

The

thera-

A

causes

to think that

RATIONAL EMOTIVE BEHAVIOR 'EHERAPY The REBT

client

a student of the counselor,

is

work hard

ergetic one. Clients have to

291 but needs to be a very involved and en-

REBT. Although

in

only hard

—and keep them

2005b,

corrected

Raphael approaches Alan as a friendly to this

(Ellis,

p.

168,

ir-

italics in original)

an expert on the ABCs. Alan responds well

teacher,

and works hard as

structured approach

we can change

work and practice W\\\ correct

our ways of thinking, emoting, and behaving, rational beliefs

Ellis believes that

the

REBT student.

Goals REBT

has two major goals:

(a) to

eliminate irrational thinking and thereby the associated

REBT

dysfunctional emotions and behaviors and (b) to teach the client

At the simplest tional beliefs. tors

is

REBT

the goal of

“REBT holds

that

is

to help clients

change

irrational beliefs into ra-

showing disturbed people that they

most probably the most important thing

p. 80). Ellis

are

level,

a therapist can

do

philosophy.

are

to help

profound musturba-

them”

(Ellis,

1

999b,

maintains that you can change your As, Bs, or Cs. However, he warns that As

sometimes

change because we have

difficult to

little

control over them. Sometimes

we change our B first (Ellis, 1994a, p. 22). target of many REBT interventions. However,

it is

impossible to change a Cunless Beliefs, therefore, are the

wants the

apist also

client to learn unconditional self acceptance,

and unconditional acceptance of others (Bernard

ance,

et ak,

the

REBT ther-

high frustration toler-

2006). Further, the

counselor strives to help clients change their dysfunctional basic philosophies.

“Moreover,

if

you

modify some of your basic musturbatory

radically

Ellis

attitudes,

REBT wrote,

and thus

make a profound philosophical change, REBT hypothesizes that you can thereby change many of your self-defeating feelings and behaviors as well as your negative, antiempirical automatic thoughts, keep them healthfully changed, and actually make yourself less disXMi\oablE

(Ellis,

1994a,

p.

23;

italics in original). Ideally,

losophy of the healthy person described

To change their philosophies, “(1) Acknowledge that they mainly ings

and

actions,

environment. lessly

Finally, clients in

ently (Ellis

&

clients

need to accomplish three major objectives:

are responsible for their

disturbed thoughts,

feel-

how they are thinking, feeling, and behaving when they needWork hard, forcefully, and persistently to change their neurotic

and performances”

REBT

must have

(Ellis,

1985, pp.

1

10-1

1

1).

are expected not just to feel better, but to get better, too.

insight into the

ABCs

of

life,

but also must work to behave

The

differ-

MacEaren, 2005).

bat his specific iBs to

own

their parents, their culture, or their

Raphael’s goals for Alan could he stated in several ways.

portant

adopts the phi-

(2) Clearly see

cognitions, emotions

client

REBT client

earlier.

and stop copping out by blaming

upset themselves. (3)

REBT

the

and change them

work with

into

First,

more rational beliefs.

the secondary disturbance

he hopes It

to help

Alan com-

would be particidarly im-

Alan harbors because without addressing

ofAlans distress, a new philosophy is unobtainable. Alan really needs to change how he thinks about life because it is possible that he will always experience some kinds of sympthis aspect

toms

(anxiety,

a tendency

to obsess).

He

will need to develop a philosophy that emphasizes the

RATIONAL EMOTIVE BEHAVIOR THERAPY

292 need

to accept

himself (with his symptoms), work hard

and accept

accept others,

the ambiguity

of human

to defeat his irrational tendencies,

existence.

Raphael also wants behavior change for Alan. In the

best case,

Alan will be able

to fight

off his urges to engage in the repetitive behaviors.

PROCESS OF THERAPY REBT

ABCDE

follows an

D stands

model.

philosophies must be disputed so that he will give

then he will experience a

iBs,

philosophy

There

REBT

therapy

if

are

is

new

effect,

up.

1995a;

Ellis

and

client’s inferences that result

of the

validity

client’s

from

When the client surrenders

his

(Ellis,

& Dryden,

1997).

preferential, or elegant. Inelegant

consists of using cognitive behavioral interventions

problems

and

client’s faulty beliefs

E element also stands for effective new

general, or inelegant,

nitive therapy to help the client solve

on the

them

The

or E.

really successful (Ellis,

two kinds of REBT:

The

for dispute.

common

to other

2005b). Inelegant

iBs; for instance, the therapist

statement that everyone would laugh

at

him

if

forms of cog-

REBT often focuses might confront the

he danced poorly.

REBT, in contrast, is aimed at the shoulds, musts, and I-can’t-stand-its of the client. The therapist helps the client adopt a more functional basic philosophy, the REBT philosophy (Ellis, 2005b). In elegant REBT, therapists teach clients Elegant, or preferential,

about the difference between preferences and musts, and the goal of their

lives,

essence, learn to be their

make

work, or a

to “arrange, for the rest

that they rarely (not never) change their preferences to grandiose

and thereby make themselves clients

is

a serious

significantly less upsettable” (Ellis, 1995b, p. 71). Clients, in

own REBT

co'mmitment

One outcome

therapists.

REBT

of elegant

something outside of themselves, such

to

is

that

as family,

political cause (Ellis, 1991).

Wolfe (2007) maintained that the to reduce his

first

task of the therapist

emotional disturbance. She sounds a

little

is

usually to help the client

un-REBT-like when she writes

that the second phase of therapy should address self-actualization.

means by

demands

self-actualization essentially involves setting short-

volve cognitive, emotive and behavioral changes,

all

However, what she

and long-term

goals that in-

of which are consistent with an

REBT

philosophy.

Client resistance

is

seen as stemming from several influences. Sometimes, clients

because they believe that the therapist

look at resistance

some

that

hard!

do

It

clients

is

that

it is

may hold

simply

beliefs

is

mistaken

difficult to

such

as “It’s

absolutely should not be that hard!

(DCs;

Ellis,

1987).

2002). However, another

change. For instance,

not only hard for

How

awful!

so!” (p. 27; italics in original). Ellis calls clients

too) difficult customers

(Ellis,

I

who

guess

resist

me

I’d

to change,

he

is

resistance include the client’s

but

too

it’s

up trying

source of resistance

human tendency to think irrationally, to be short-range hedonists pleasures of the moment rather than of the future” (1987, p. 365).

Other sources of client

to

to

(and other therapies,

innate the

way

(2002) suggests

better give

REBT

The most important

Ellis

resist

is

the

“obsessed with

embarrassment about the problems

experiencing, unwillingness to give up secondary gains resulting from symptoms, the

client’s belief that

Transference-like

he must punish himself, and perfectionism/grandiosity

phenomena, such

as

client— therapist mismatching,

(Ellis,

2002).

traditional client

RATIONAL EMOTIVE BEHAVIOR THERAPY

293 and

transference in the psychoanalytic sense, or genuine attraction between client

known

can also feed resistance. Finally, clients are also

to resist out of rebellion

therapist

and

reac-

tance or hopelessness, or in response to a judgmental, moralistic therapist.

Not

Wolfe (2007) indicated that coutertransference is a direct function of therapist cognition. She recommends disputing irrational beliefs (“I can t stand it when my client

surprisingly,

drones on and on”), even resorting to using the

9.5. Ellis

way of therapy.

should carefully read

—You,”

in

do you

of your clients most of the time?

Raphael knows that he needs do

this as well.

article,

which he describes

susceptible. For instance,

The

D

to

own low

If you really

(2003)

Ellis’

desire

and motivation

frustration tolerance (and attraction to

want

“How

to

good

to be a

REBT counselor,

you absolutely must be

you have some disputing

new

which

therapists are

successful with

most

to do.

and

dispute Alans irrational thinking

will lead to E, a

you

Deal With Your Most Difficult

particular irrational beliefs to

believe that If so,

The

irrational aspects.

example, can be beneficial in therapy. In contrast,

client, for

(2001) described a case in which his

the client) got in the

to

and

helpful)

(i.e.,

of the counselor to help the

Client

form, shown in Box

(2001) presented a similar view, but also pointed out that countertransference

can have both rational

Ellis

REBT self-help

effect (less anxiety,

to help

shame,

Alan learn

and anger),

as

new effective philosophy. At first, the fiocus ofi counseling will be on Alans sympand the duo will work to modijy the iBs that lead to the dysfunctional emotions and

well as a toms,

compulsive behaviors. philosophy

An

elegant solution will involve Raphael helping

ofiselfi-tolerance,

long-range hedonism,

tolerance ofi others, acceptance ofi life’s ambiguity

and the value ofiscientific his partner and church.

to change, to

IfAlan seems reluctant this resistance. is

selfi-interest,

Alan

to

adopt a

social interest, selfi-direction,

and uncertainty, flexibility and openness

thinking. Raphael will encourage Alan’s

to accept the task ofi therapy,

commitment

Raphael will look for the sources

Raphael will examine his own behavior, but also

test

ofi

the hypothesis that Alan

embarrassed about his situation or that he feels hopeless or that he can’t change.

tration tolerance could also be creating Alan’s unwillingness to work, or he

Low frus-

might be pun-

ishing himselffor his awful thoughts that are in violation ofi his religious values.

THERAPEUTIC TECHNIQUES d'he major technique used in

REBT

is

D, or disputing. Albert

disputation very quickly. However, other

REBT

Ellis typically

begins using

counselors would argue that teaching

comes before disputing. Wolfe (2007) suggested that the first task of the therapist is teachwhat is expected of client and therapist and the general ing the client about REBT

—

process of the therapy. Resources exist that can be given to the client to read, such as Grieger’s (1989) client guide. For

Ds, and Es.

(most

The

likely iBs),

some

clients,

it is

also useful to directly teach the

therapist patiently teaches the client

and then

how

ABCs,

to identify As, search out Bs

link these to Cs. Ultimately, the client learns to dispute his iBs

Dryden and Neenan (2006) emphasize that the client should be taught how to generalize what he learns in counseling, so that it can be applied to new situations without resorting to the company of an REBT therapist. to reach E, the

new

effective philosophy.

RATIONAL EMOTIVE BEHAVIOR THERAPY

294

REBT,

In

behavioral

techniques, are usually divided into three categories: cognitive, emotive, and

(Ellis

& MacEaren, 2005). In the sections following,

review a selection of these.

I

Disputing Cognitive disputes often begin with asking the client to assume that the

Neenan, 2006). For instance,

Larry’s therapist

in public, others will laugh at you.”

challenging

it

if the

of getting to the

in the interest

Dryden (1994) cautioned

A

is

very

beliefs

the client

illogical,

if you

&

dance

the counselor should avoid

presenting a very traumatic experience, such as

is

you need

to explain to her that

is

assume that

let’s

(Dryden

true

beyond the A.

rape or other forms of physical or sexual abuse. “Your

second task

“So,

say,

is

that counselors should be sensitive in their use of disputing

when

techniques, particularly

Even

would

A

task

first

to be

is

empathic and your

to join together to help her give

up her ad-

ditional disturbance, but not her healthy upset” (Dryden, 1994, p. 57).

and MacEaren (2005) identify four kinds of disputing: functional, empirical, logand philosophic. Cognitive disputing can be accomplished through a Socratic ap-

Ellis ical,

proach, in which the therapists asks the client questions, or through the presentation of

ABC

mini-lectures about the

process (Yankura

& Dryden,

to detach the client

Pragmatic, or functional, disputes sizing the consequences of the belief

The

idea in this dispute

accomplishment of life goals

belief

is

interfering with the

client

is

asked what will happen

1994).

if he

is

from to

man and you

likely to have,

your

beliel that

client if his belief logically that if

work I

because Steve

is

you

on the

one

fail

the client

did,

the lottery?”

is

a client

1

Now, because

Philosophical so

I

(p.

di\s]pt\t&s

immersed

who

dumped

you, you are a

test in

one

class that

you

evidence

failure, a rotten

The

amusing:

there

person?”

counselor asks the

will always fail tests?”

An

it

follow

example

“I

217,

focus in

italics in original).

on

life

satisfaction (Ellis

problems that he is

fat

and

&

loses sight

MacEaren, 2005). Sometimes,

of the bigger issues in existence.

ugly, the therapist

unhappy with your weight. Do you suppose

your

that are meaningkil

might say

that there

“I realize

that

you

might be other things

in

and important?”

Raphael uses all of the disputing methods with Alan.

down

is

I

believes that she

ifthe house burns

“What

would very much like to win the might win 10 million dollars. Wow, I would never have to very much want to win the lottery, does it follow logically that is

are very life

his be-

on which we operate

consistent or logical. Kathy’s therapist might ask her, “Does

Lottery. If

again.

The

are a really rotten

what evidence supports

faulty logic of the client’s iBs.

by Beal and colleagues (1996)

mustWm

To

up you

1996a). For example, Lisa might be asked,

Ellis,

Logical disputation focuses

Kentucky

2005).

and how often? Because we know you’re hu-

disputing involves asking the client

realistic,

most of the time;

cited

the client that the

continues to hold the belief Jim’s counselor asks him,

Usually, iBs are counter to reality (defined as the social consensus

to support

by empha-

willscvtw up!”

Empirical, or liefs.

you

feelings are

show

& MacEaren,

(Ellis

“Well, as long as you think that every time you screw something

worm, what

his beliefs

it is his fault

stop flipping light switches, he

is

and he is

He asks Alan what evidence exists that

worthless^

a reprehensible worm?

Where

is it

written that ifhe cant

RATIONAL EMOTIVE BEHAVIOR THERAPY Logical disputes include Does

295

it logically follow

that if he has these disturbing images

a totally worthless personl If a friend had these beliefs, would Alan find them reasonable? Yes, it might be preferable to banish those disturbing images, but does that

he

is

mean he absolutely has to or he cant live a meaningful life? Pragmatic disputes are What do you do to yourself by continuing to believe that it would be absolutely the end of the world and your existence ifyou did hit someone with your car on the way home from work? Where is it going to get you ifyou continue to believe that you must always be perfect?

Bibliotherapy Clients in

REBT

in various forms.

are very often assigned readings,

One

and very often these

are Ellis’ writings

of Ellis’ books was written specifically for the general public rather

than clients or therapists,

How

to

Make

Yourself Happy

and Remarkably

Less Disturbable

(1999e; see Box 9.3).

Alan

likes to read, so

Raphael loans him a copy of Wow

encourages Alan to go materials there.

On

to

to

Make

Yourself Happy.

of the Albert Ellis Institute and look at the Raphael asks Alan what he has learned from his

the website

a weekly

basis,

studies.

Box

Thinking the

Positive In his

1

How

999 book.

Ellis

argued, as he has

and

practice,

mended 1

.

2.

right attitude.

Always the proponent of

self-help, Ellis

recom-

I

am

mainly a

self-disturber,

my irrational

I

can definitely stop disturbing myself

thinking that sparks

my emotional

and behav-

problems.

Although think,

4.

Five Self-Starting Beliefs

to

definitely can reduce

ioral 3.

REBT Way: The

the following beliefs as the keys to happiness:

Because I

9.3

Make YourselfHappy and Remarkably Less Disturbable, Albert many times, that you can change if you want to. It just takes work

and the

am

I

feel,

and

My emotional

distinctly lallible act differently

and

easily disturbable,

and thus

to reduce

my

I

also have the ability to

disturbances.

upsets include thoughts, feelings, and actions that

I

can observe and

change. 5.

Reducing

Adapted from Albert P.O.

my

How

to

Ellis Institute.

upsetness almost always requires persistent

Make

Yourself Happy

Reproduced

Box 6016, Atascadero,

CA

He

and Remarkably

Less Disturbable,

for Pearson Education, Inc.

work and by Albert

ehort.

Ellis.

©

1

999 by the

by permission ol Impact Publishers®,

93423. Further reproduction prohibited.

RATIONAL EMOTIVE BEHAVIOR THERAPY

296

Proselytizing Albert

Ellis

wants you

become

to

word, to try to help friends and this

approach

that

is

relatives

work on

may

their iBs (Ellis, 2002).

sometimes identifying. and analyzing someone

than identifying and analyzing your own. ers

go out and spread the

a disciple! Clients are often told to

not uniformly respond positively.

else’s

Of course, you must warn I

guess then

The

problem

your

you have created

idea behind is

easier

client that oth-

a shame-attacking

exercise (discussed later).

Raphael encourages Alan

to try to

help his wife or friends in his social group at church with

their difficulties if the opportunity arises.

For

instance, if it

might address Teresas idea that she cant

not a really “hot” topic, Alan

is

his (Alans) repetitive behavior.

Recording Therapy Sessions Clients are often given tapes of their therapy sessions to study between appointments (Ellis

&

MacEaren, 2005). Several things

remember

all

happened during

that

are helpful

about

this

approach. Clients don’t usually

their sessions, so tape review can reveal aspects they’ve

how

forgotten. Reviewing tapes also gives clients the chance to really listen to

and they might become more objective about

Alan routinely tice his

takes his counseling tapes

they think,

their situations as a result.

home for

review.

He says

that

changed thinking and philosophy. Sometimes Alan even plays

it

helps

him prac-

these tapes for Teresa.

Reframing \

Reframing involves helping be encouraged to view As

MacEaren, 2005). that the client be

much

self and Teresa safe.

and

as challenges rather

For example, clients can

than pains in the you-know-what

(Ellis

&

Self-criticism can be reframed as self-help, but of course, this requires less

Raphael encourages Alan both Alan

clients see things a little differently.

to

dogmatic about

it.

understand his “checking” behavior as an

Of course,

Teresa to relax

this is

a

little

a drastic way of doing about the symptom.

so,

effort to keep

him-

but the reframe may help

Stop and Monitor Because some clients have great difficulty noticing their cognitions, ful to is

it is

sometimes help-

have them place cues in the environment. Every time the client notices the cue, he

to stop

and observe

be anything

—

Alan decides

a string

to

his

thoughts

around

wear a ring on

at that

moment

(Ellis

a finger or a yellow sticky

his right

hand that he

& MacEaren,

on

a

2005). Cues can

computer monitor.

has not worn in years. Tvery time he

and records his thoughts. He can then analyze them forfaulty Raphael and Alan also use the thought log in their sessions to track

glances at the ring, he observes beliefs.

When

they can,

the sequences leading

up

to

Alans

repetitive behavior or the disturbing imagery.

RATIONAL EMOTIVE BEHAVIOR THERAPY

297

Rational Coping Statements As

clients dispute their iBs, they create Es, effective

rational

as part of

working

coping statement might live

change

to

his

ways

be, “I never absolutely

reasonably happily even

if

I

am

world, and revised as necessary.

realistic,

It

want.

it” (Ellis,

I

example of a rational

only, only prefer

1995a,

p. 19). Ellis

it

and

(2002)

checked against what happens

to use.

wont

He asks Alan

his discomfort saying

turn off the light switch, something could happen. It it.

I

An

in the

^

and talk himself through

pened, I can deal with

1995b).

need what

Raphael teaches Alan rational coping statements behavior

(Ellis,

deprived of

cautions that these mantras should be kept

itive

philosophies. Part of the Es are

coping statements, which are sentences the client constructs that he should review

and practice can

new

is

to restrain his repet-

something

like 'dfl forgot to

but ifsomething bad hapor awful, and I wont be a terrible

unlikely,

be absolutely terrible

and awful person. ” Similar statements could be developed about driving home from work and the troubling images. Alan could practice these statements first using imaginal techniques, and then in vivo.

Rational Emotive Imagery Rational emotive imagery (REI) (Maultsby

putation technique (Yankura

and conjure up the

& Dryden,

& Ellis,

1974)

is

an important emotional

1994). In REI, the client

is

asked to close his eyes

terrible, awful,

dysfunctional emotion that has been targeted in collab-

When

the client has fully achieved the emotional experience,

oration with the counselor.

he signals the counselor,

who

then instructs the client to change the feeling into a healthy

negative emotion. After the client has achieved this transformation, he ally return to the

dis-

therapy situation.

He

change from the unhealthy to healthy

is

asked

feelings.

how

he

A bonus

feels

now, and

second emotion (the therapist

the client choose

it).

just insists

on

if the

asked to gradu-

how

in this technique

can learn to distinguish between healthy and unhealthy emotions client to pick the

is

is

he managed to that the client

therapist allows the

a healthy

emotion and

lets

and tries to feel the anxiety that would result ifhe did not check the switches afier leaving a room. When he indicates that he is fully experiencing this emotion, Raphael asks him to change it to a healthier emotion. Alan has great difficulty doing this. At first, he does not know what emotion to turn to. Raphael suggests concern. Afier Alan has made the emotional transformation, Raphael asks him to open his eyes. They talk about what Alan did to change his feeling ofanxiety to concern, and Alan reports that he changed his thoughts; for example, he changed the thought “Something tacnhla is going to happen, and it will be all my fault. Because I did not keep the terrible thing from happening, I am imperfect and a terrible, horrible person' to “Something terrible could happen. Ifit does, it does not mean that I am worthless because I did not prevent it. I would like to prevent terrible things from happening, but I don't absolutely have to, and sometimes I cant. This failure does not make me a rotten person. " He also reported thinking that the connection between light switches and awful events was probably not based in reality. Raphael and Alan

start

with the light switch behavior. Alan

closes his eyes

RATIONAL EMOTIVE BEHAVIOR THERAPY

298

Flamboyant I^herapist Actions This intervention can be verbal or nonverbal., Ellis used this either

by swearing (and thereby modeling that he

him) or

in the

is

one often,

in a verbal

mode,

not affected by what others think of

choice of language used (terms such as rotten person, worm, no-goodnick, and

so forth). Nonverbal flamboyance

is

even more dramatic.

The

therapist could proceed to

stand on his head in session and then ask the client to evaluate the behavior. client indicates that this stunt

with, “Well, does that

a little

is

make me

When

the

weird (or stupid), the therapist can then respond

weird or stupid person?”

a

Raphael, in the midst of a discussion with Alan about his embarrassing need to check light switches,

jumps

to his feet

hardly stand. All the while he

and proceeds

is

to

turn in

circles until

he

is

he can

so dizzy

me out to the b allgame. ” Alan, at first, is When Raphael, exhausted and dizzy, is able

singing, ‘‘Take

and then begins to laugh at Raphael. to talk again, he and Alan discuss what happened, with Raphael modeling rational thinking and emphasizing that maybe his behavior is silly, but that doesn’t make him a stupid

shocked,

or worthless person.

Humor REB'f counselors

One must

make fun of the

never

RERT

some

believe in having

some fun

client,

tunes just for this purpose

.

.

.

gently (DiGiuseppe, 1995b;

only of his (Ellis

silly

to

about

He could gently jest with Alan about

his troubles.

times does he do

behavior or thinking.

2005b).

Ellis

devised

& MacLaren, 2005; see also Box 9.4).

Raphael will have

be careful using

Ellis,

humor with Alan

because he

is

clearly very sensitive

the light switch issue

(How many

a particular switch or one ofa certain color? Would he like to work on the switch in Raphaels ojfice?). However, Raphael wjould have to be certain that he and Alan had a solid relationship before trying anything like this. iti Is it

Forceful Coping Statements AND 'Faped Disputing Rational coping statements can be state

them

forcefully,

maybe even

made

yelling

into an emotive technique

them

at full

volume

(Ellis

by having the

&

client

MacLaren, 2005).

Forceful coping statements and forceful disputing statements can also be recorded for the client to listen to

between

sessions.

Raphael will encourage A Ian

to practically

shout at himselfwhen he has the thought that

be might not have turned off the lights and something bad could happen, rather prevent something badfrom happening, hut I am jiot worthless if something bad does hap” pen! If he has an experience in which he believes

Td

that others disapprove, he should

forcefu ly tell himsdf, "rd rather that others accept me, but I

am OK!

statements

/

dont have

and listen

to

to

he perfect; /

am

a fallible

fthey don't, / can stand

human

them every morning before going

to

being.

work.

it

"Alan can tape

and

these

— RATIONAL EMOl'lVE BEHAVIOR THERAPY

299

Box 9.4 Sing Along with Albert Perfect Rationality

(Tune: “Funiculi, Funicula” by Luigi Denza)

Some think the world must have a right direction, And so do and so do I! Some think that, with the slightest imperfection They can’t get by and so do I! I

—

—

For

have to prove

I, I

And

Fm

superhuman.

better tar than people are!

To show

And

have miraculous acumen

I

always rate

among

the Great!

Perfect, perfect rationality

of course, the only thing tor me!

Is,

Fiow can If

must

I

I

ever think of being

live tallibly?

Rationality

must be

a perfect thing tor

me!

Love Me, Love Me, Only Me! (Tune: “Yankee Doodle Dandy”)

Love me, love me, only

me

Or I’ll die without you! Make your love a guarantee So

can never doubt you!

I

Love me, love But I’ll

if

me

totally

you demand

hate you

till

Love me, love

—

really, really try

dear;

love, too

die, dear!

I

me

all

the time

Thoroughly and wholly! Life turns into slushy slime

‘Less

you

Love

me

With no If

love

me

solely!

with great tenderness ifs

or buts, dear.

you love me somewhat

I’ll

hate your

goddamned

You for

Just

And

you upon

you

for

guts, dear!

Me and Me for Me

(Tune: “Tea for Picture

less.

Two” by Vincent Yotimans)

my

me, and

then you’ll see

knee

me

tor me!

Ellis

— ——

——

RATIONAL EMOTIVE BEEIAVIOR THERAPY

300

How

happy

I

Though you

am

1

As any

And

autistic

real mystic!

only relate to

Mysed with If

You’ll see

a great to-do, dear!

to try to care

you dare

For

me me

beseech

will reach

You never For

will be, dear!

my

caring soon will wear.

can’t pair

I

want

If you

and make our sharing

a family.

baby

We’ll both agree you’ll

Then

you’ll see

/

how happy

I

wish

me

I

will be!

Wish I Were Not Crazy!

(Tune: “Ldixie” by

Oh,

I

were

really

Dan Emmett)

put together

Smooth and fine as patent leather! Oh, how great to be rated innately But I’m afraid that

To be

I

I

I

wish

was fated

I

mad

to be

my Mom

as

and

my

Dad!

were not crazy! Hooray! Hooray!

mv mind

wish

To be

1

sedate!

rather aberrated

Oh, how sad Oh,

fair!

were

inclined

less

the kind that’s hazy!

could, of course, agree to be less crazy

But

alas,

I,

am

just

too

goddamned

From Rational Emotive Behavior lor Pearson Education, Inc.

A

Therapy:

lazy!

Therapists

Guide© 1998 by The Albert

Ellis Institute.

by permission of Impact Publishers®, P.O. Box 6016, Atascadero,

Reproduced

CA 93423.

Further reproduction prohibited.

Role-Playing Role-playing

is

used

in several

ways

in

REBT. Wolfe (2007)

indicates that role playing can

be used to problem solve around the practical problems that bring clients to therapy

how

to assertively express one’s feelings). Role-playing

beliefs

by asking the

is

useful after the client has learned

1 he client takes the counselor role apist

should play

1995b).

If

it

a naive client,

seems

as

I

am

such

a

Oh

wimp!”

and disputes the

client

therapist’s IBs.

poor

might respond

little

consequences.

something about disputing

presenting a problem that

though the

overdo the whiny thing: because

can also be used to assess Irrational

client to enact the situations that elicit dysfunctional

Rational role reversal

(e.g.,

is

For best

effect,

IBs.

the ther-

close to the client’s (Dryden,

well, the therapist

can humorously

miserable me. Everyone should be nice to

me

RATIONAL EMOTIVE BEHAVIOR I’HERAPY Raphael could play the

client

frightened about driving.

and have Alan

301

dispute his iBs about light switches

and being

He could also present as a clientfeeling guilty about having

“bad”

thoughts in some context.

Rational-Irrational Dialogues Dryden (1995c) described several techniques under this heading, all of which involve interchanges based on iBs and rBs. In the zigzag approach, the client lists a rational belief,

and then attacks the rB with an

then formulated, which

is

irrational

belief.

is

done on paper with the

typically

Figure 9.1. chair

is

rational

defense

is

attacked via irrational belief This process continues until

the client has exhausted his irrational attacks. This technique it

A is

called zigzag because

client filling in blocks like the ones

The same kind of dialogue can be done with

shown

two-chair role-playing.

the rational chair, the other the irrational, and the client

in

One

moves back and forth

between them.

Reinforcements and Penalties REBT

therapists often assign reinforcements that are self-administered

For example, at

if Jenny

(Ellis

&

completes her shame attacking assignment of making funny faces

people in the mall, she can then go eat

If she fails to

the client

MacEaren, 1998). Likewise, penalties are things the doing, and they are activated if the client does not complete his task.

completes a “work” task client doesn’t like

when

do her homework, she has

food heaven (Jenny loves french

at fast

to

spend an hour cleaning her basement

fries).

(a task

that she hates).

Rational belief

Irrational

attack

Rational

defense

Irrational

attack

Rational

defense

FIGURE Source:

9.1.

Zigzag Dialogue Form.

Adapted from BriefRational Emotive Behavior Therapy

fohn Wiley

& Sons, Limited. Copyright ©

1995 John Wiley

(p.

1

52) by

W. Dryden, 1995,

& Sons Limited.

New York:

Reproduced with permission.

RATIONAL EMOTIVE BEHAVIOR THERAPY

302

the next day Raphael tells Ala ?2 that ifhe goes without touching a light switch one evening, light switches, no solitaire he gets to play computer solitaire for 20 minutes. Ifhe checks the tlte

next day at

all.

Skill Training Somcnnies even their pursuit

if

clients

of their

have

the right beliefs, they

all

REBT

goals.

therapists

have

still

would not

working on

fit

life

well in the second stage of therapy, in

that hinder

hesitate to teach their clients

assertive behavior or other social or interpersonal skills (Ellis,

nique would

skill deficits

which

2005b). In

client

fact, this

tech-

and therapist might be

enhancement.

Because Alan sometimes feels

awkward

some interpersonal communication

in social situations,

skills.

devise responses for Alan. These listening

They role-play

Raphael decides

common

him and

to teach

social situations

and response skills should also

help in his relation-

ship with Teresa.

In

Vivo Desensitization

Borrowed from Behavior Therapy,

in vivo desensitization

is

simply asking the client to

experience the feared situation. Typically, forceful cognitive coping and dispute statements are

employed (Dryden

& Yankura,

in a difficult situation,” repetition

1993). Basically similar to a technique called “staying

is

important

—

the client

peatedly (somewhat like Ellis and his 130 encounters with ten used with phobias,

version

is

too threatening.

rehearse disputes

Alan

is

and

it

The

must encounter the

women). This technique

could also be used in an imaginal approach client

would simply visit the

and coping statements

stressor re-

if

is

of-

the in vivo

feared situation in fantasy

and

verbally.

the perfect candidate for in vivo desensitization.

He

the urge to turn off light switches.

that he can talk himself through requests that

Alan not

Raphael asks him to simply deny explains that Alan will experience anxiety, but

it

using his rational coping statements. Raphael also

retrace his route

home from

work, using the same rationale

and

strategies.

Actfing 1

his

on Rational.

technique

is

Beeiees

similar to the

Reasoning that we often spend

as

if

a lot of

technique used in Individual Psychology therapy.

time on

iBs,

it

makes sense

to

the basis of rBs developed in conjunction with the counselor (Ellis

Alan

have the client act on

&

MacLaren, 2005).

act as though he truly believes that ifhe is not perfect, that is simply too bad, not a total catastrophe. If the house burns down, that is tough luck. Alan is to proceed with his life

is

to

as if he believed that he

would not he

totally worthless if he

did not prevent this event happening. from The next time he experiences a disturbing image, Alan is to behave as if it doesnt make him a no-good, evil person, simply one who has some faults.

RATIONAL EMOTIVE BEHAVIOR THERAPY

303

Homework REBT

counselors almost always give clients

that

the client’s problems and

Fit

may

homework (Dryden,

1994). Tasks are devised

include techniques described here, such as shame at-

homework assignment is the MacLaren, 2005). The client is in-

tacking exercises or bibliotherapy Another frequently used

REBT

self-help form,

shown

Box

in

&

9.5 (from Ellis

structed to complete the form daily, and then counselor and client review the results in the

next counseling session.

Raphael would give Alan homework such as monitoring dijficult situations.

He might use the REBT self-help form

his thoughts, particularly

with Alan

to

during

get him to chart and

dispute his iBs. In fact, almost anything directed at Alans beliefs could he usedfor homework.

Shame Attacking Shame

attacking

2002)

(Ellis,

is

a notorious

knew what he was doing

REBT

technique that

The

(see

Box

9.1)!

and do something dreadfully embarrassing.

We

can think of

before he ever

standing backward in an elevator or singing joint. It

uation.

is

best,

The

however,

if

the

it is

not absolutely

is

Raphael devises a shame attacking

of examples, such

as

directly relates to the client’s

sit-

that the client will discover that he won’t die of

100%

Rational coping statements can also (and

instructed to go out

is

lots

used on himself

while standing in line in a burger

shame attacking behavior

rationale for this technique

embarrassment, that

“My Way”

client

Ellis

worse than had

maybe had

better) be

He

exercise for Alan.

'd

others think he

combined with

instructs

Alan

to stop

is

weird.

this task.

at every stop

way home stick his head out the car window, and yell, ‘Hid I run over anything yeE” IfAlan can see the humor in this task, it might be quite successful. Raphael must be careful in assigning it, though, so he devises a few less risky shame attacking exercises first. sign on his

Alan could tell his buddies about his

and

and even demonstrate for them. He

light switch thing,

Teresa could take turns switching lights

on and offin their living room for a designated

period of time.

EVALUATION OF THE THEORY REBT

has evoked a great deal of controversy over the years.

probably attributable to the personality of Albert if

you did not

like

attitudes about sex

him

Ellis

or agree with his opinions!

may offend some, and

— but of

Ellis’

if therapists

Some of the

controversy

course he would not care

use of salty language

adopt

is

and

his style in blueprint

liberal

manner,

they’d better be ready for these kinds of criticisms (Garfield, 1995, p. 114).

On less

the

most general

useful for clients

level,

REBT

below certain

has been accused of being too intellectual, levels

of education and intelligence

making

(Ellis,

it

1990;

Garfield, 1989). Ellis himself specified that clients should be over the age of 8 and of

average intelligence

some,

(Ellis,

inappropriately

1985).

The emphasis on

de-emphasizes the

role

cognition in REIBT,

of client

history,

in the

emotion,

views of

and the

client— counselor relationship (Ellis, 1990). Lazarus (1989) also pointed to an over-reliance

on cognitive disputation

at the

expense of other techniques.

RATIONAL EMOTIVE BEHAVIOR THERAPY

304

Box

9,5

(REBT) Self-Help Form

Rational Emotive Behavior Therapy

A (ACTIVATING EVENTS OR ADVERSITIES)

•

• •

summarize the situation you are disturbed about (what would a camera see?). An A can be internal or external, real or imagined. An A can be an event in the past, present, or future. Briefly

IBs (IRRATIONAL BELIEFS)

D (DISPUTING

To identify IBs, look for: • Dogmatic Demands (musts,

To dispute, ask youself: •

absolutes, shoulds) •

Awfulizing

(It’s

awful, terrible,

•

horrible) •

Low

Frustration Tolerance

stand •

Where me? Is Where

holding this belief getting

is it

helpful or self-defeating

is

can’t

it)

Self/Other Rating (i’m/he/she worthless)

is

I"

the evidence to support the

existence of (I

IBs)

my

irrational belief? Is

consistent with social reality? •

my belief logical? Does from my preferences?

•

Is

bad,

Is

it

really

awful (as bad as

be)? •

Can

I

it

really not

stand W?

follow

it

could

it

RATIONAL EMOTIVE BEHAVIOR THERAPY

305

C (CONSEQUENCES) Major unhealthy negative emotions: Major self-defeating behaviors:

Unhealthy negative emotions include: •

Anxiety

•

Depression

•

Rage

•

Low

•

Shame/

•

Hurt

•

Jealousy

•

Guilt

Frustration Tolerance

Embarrassment E (EFFECTIVE E (EFFECTIVE

NEW

PHILOSOPHIES)

EMOTIONS

AND BEHAVIORS) New

healthy

negative emotions:

New

constructive

behaviors:

To think more rationally, strive for: • Non-Dogmatic Preferences (wishes, wants, desires) •

Evaluating Badness

(it’s

bad,

High Frustration Tolerance like

•

it,

but

I

•

Concern Annoyance Sadness

•

Regret

•

Frustration

• •

unfortunate) •

Healthy negative emotions include: • Disappointment

can stand

don’t

(I

it)

Not Globally Rating Self or Others (I

— and others —are

fallible

human

beings)

From Rational Emotive Behavior Reproduced

CA

Therapy:

for Pearson Education, Inc.

A

Therapist’s

Guide© 1998 by The

Albert

Ellis Institute.

by permission of Impact Publishers®, P.O. Box 6016, Atascadero,

93423. Further reproduction prohibited.

RATIONAL EMOTIVE BEHAVIOR THERAPY

306 Weinrach (1996) discussed

shortcomings of

several

REBT

He

theory.

believes that the

theory has neglected to attend to cultural differences that affect definitions of rationality and

He

the conduct of counseling.

pointed out that sometimes what

labeled rational could

is

be counter to values from cultures other than the Westernized European American (for

members seems to drive emotions and behavior is deemed irrational). Weinrach lamented that some REBT counselors have inadequate interpersonal skills, being more “tough minded than tenderminded” (Weinrach, 1996, p. 68). Neenan and Dryden (2000) add that REBT is often critinstance,

icized because

48).

(p.

the avoidance of the disapproval of parents or other family

when

These

REBT

therapists talk too

it

REBT is authoritajian (Kleiner, numerous

its

could promote very effective sociopathy (Weinrach, 1996; Wessler 1996; Woolfolk

&

or

human

CBT

—

REBT promises more than it can deliver that preREBT may not be the best approach for some clients

Weinrach noted that fail

to note that

or problems. Noting that “there

about which

“anything you can do

is

Ellis

hardly a topic in the area of counseling, psychotherapy, has not written, spoken or sung,”

Weinrach found

can do better” ideology self-defeating (Weinrach, 1996,

1

energetically defends his theory against

all critics

at

any opportunity

maintains that the theory

is

flexible

not a harmful philosophy;

it

enough

requires social interest

and be happy, people typically choose to I

&

he strengths of REBT

Alford, 1989).

(Ciarfield, 1989).

These

lie

in

its

(Ellis,

qualities are

many

live in social

groups

Ellis’s

(Mahoney

to survive

1989).

and method (Mahoney, Eyddon,

a

wide variety of techniques, so

different kinds of client presentations.

of Cognitive-Behavior Therapy.

Eong-term hedonism

probably appreciated by clients and therapists alike

data to support the brevity of REBT, EEis maintains that

credence to the theory

(Ellis,

1979b,

REBT, but

and cooperation because

simple, clear-cut theory

REBT also sanctions

the counselor to meet

to apply across cultures.

this

p. 72).

1989, 1996b). Ele acknowledges the need for attention to cultural issues in

is

1979).

existence; at

has been seen as problematic by

philosophy can lead to ignoring the interrelatedness of

sentations of the theory

Fdlis

mouths At

Sass, 1989). Finally,

REBT

clients’

authors.

least, this

worst,

and, worse, put words in

with the idea that

criticisms are consistent

The concept of long-range hedonism the

much

activity

it

its

flexibility allows

Although there

are

no

takes less time than other forms

and professional

energy and

visibility lent

1989).

et ak,

Qualities of the Theory I reciswn cind Testability.

Although on the

cise predictions (e.g., irrational beliefs

surface,

REBT offers some fairly simple and pre-

should lead to psychological dysfunction),

many

have identified problems with the testability of REBT theory. First of all, defining exactly what happens in REBT is difficult (Haaga Davison, 1989). As 1 noted earlier, Ellis distinguished between two types of REBT, elegant and inelegant, and the latter is equated with all other forms of cognitive-Behavior Therapy. However, these two interventions would be difficult to separate and assess because the former certainly contains a great deal of the latter. In adcfition, a concrete description of the elements of elegant, or preferential, REBT has not been offered.

&

Haaga and Davidson (1993) pointed out Rf.B ating (i.e.,

1,

to

confusion

mean

illogical

it is

difficult to define that

key term

in

many writings, Ellis gave numerous definitions of the iB, creabout the construct. The term irrationaTs not used as it typically is

irrational belief.

much

that

\\-\

his

or unreasonable; Oei, Hansen,

& Miller,

1993). In his later writings,

RATIONAL EMOTIVE BEHAVIOR THERAPY

307

defined irrational beliefs as those that lead to unproductive outcomes

Ellis

1994a;

(Ellis,

and colleagues (1993) pointed out that this definition is circular, and further, that using this definition would force researchers to wait to observe an individual’s outcomes to get any research done.

Wessler, 1996). Oei

and Wessler (1996) pointed out that

Ziegler (1999)

the formulation of clear-cut hypotheses about

his theory, Ellis

central constructs

The problem

cognition, emotion, and other consequences.

he has been refining

its

together,

it

is

p. 30).

& Dryden,

Validity. is

Many studies

et ah,

labeled this the

and the

Irrational Beliefs Test

report positive findings for

& Smith,

REBT. However,

1987).

the value of

often suspect because of questions regarding the operationalization of vari-

ables (most particularly, iBs;

&

Zurawski

Smith, 1987). However,

REBT

is

generally efficacious (David, Szentagotai, Eva,

1993) even

if

the exact

lished that

and

and behaviors blend

feelings,

(IBT), seem to measure beliefs and emotions simultaneously (Zurawski

these findings

that As, Bs,

1996; Smith, 1989). For instance, the major measures of irrational

belief used in research, the Rational Behavior Inventory (RBI)

Empirical

events,

that over the years that

Bond and Dryden

Because thoughts,

is

impossible to precisely measure any one of the primary constructs of the

is

(Bond

theory’

here

theory

—antecedent

became more and more emphatic

Cs overlap significantly and are mutually influential.

“interdependence principle” (1996,

REBT

a big challenge to

mechanisms

Haaga and Davison (1989) commented traindicated for any type of patient”

(p.

fairly well estab-

& Macavei,

2005; Oei

that lead to change are not specifiable. Indeed,

“RET

that

On the other hand,

choice for any disorder.

it is

there

cannot be considered

is little

evidence that

a

treatment of

RET would

be con-

494).

Research Support Outcome studies,

Research.

Although

many studies

REBT

has not been used in the major psychotherapy

have addressed the outcomes of REBT. For the most

outcome

part, the findings

have been supportive, but methodological problems often complicate the interpretation of results.

for

Using standard summary review format, McGovern and Silverman (1986) concluded,

example, that their review of research published between 1977 and 1982 provided

icant support for

REBT

theory.

A

similar review

by Silverman, McCarthy, and McGovern

(1992) found that 49 out of 89 studies they reviewed favored

and that many not included comparison approaches. In

come measures and

used.

It

in the favorable

all

seems

REBT

over other approaches,

effects. In contrast, in a

tion with

it,

REB

differences between

E and

widely based on the types of out-

employing measures of

produce more positive

results,

comparison of drug treatment alone and

rationality,

whereas those using

stable (theoretically) measures (self-esteem or self-concept; Silverman et

weaker

al.,

REi-B

I

1992) show in

combina-

Macaskill and Macaskill (1996) found that combination treatment was superior

for depressed individuals

used a small sample (20

some

results varied

relatively clear that studies

to a smaller extent, transient anxiety,

more

49 showed no

of these reviews,

signif-

who had clients),

it

high

levels of cognitive

employed

a

dysfunction. Although this study

wide range of outcome measures, including

that could be considered less reactive.

Hajzler and Bernard (1991) reviewed 21 stuciies that investigated the outcomes of rational

emotive education (REE), an educational approach that involves teaching the principles of

.

RATIONAL EMOTIVE BEHAVIOR THERAPY

308

REBT

to students in

cluded measures of anxiety.

The most

the results for

classroom settings.

in the 21 studies in-

The outcome measures used

irrationality, self-esteem, internal versus external locus

robust finding supported the hypothesis that

outcome on other indexes were

less

of control, and

REE decreased

irrationality;

convincing. Elajzler and Bernard generally

concluded that their review supported the effectiveness of REE; however, questions remain

commonly used

about the validity of the measures

to assess irrationality.

completed on studies of REBT. Gonzales et al. (2004) with children and adolescents, finding a moderate effect size

Several meta-analyses have been

analyzed

1

9 studies of

REBT

(0.50). Extrapolating, this value

69%

means

Woods

of the control group. Lyons and

found that

REBT

was

effective in

that the average treatment client scored better than

(1991) reviewed 70 studies of outcome and

comparison

to baseline or control conditions, but not

from cognitive behavior modification or Behavior Therapy. In selecting the studies they used, Lyons and Woods only required that the treatment group have “elements of RET” (p. 358), thus illustrating one of the major problems with research

significantly different

on

REBT

—defining

the treatment.

and Diekstra (1993) used more stringent selection criteria, reviewing (covering the period from 1971 to 1987) that tested interventions that were

Engles, Garnefski,

28 studies

specifically described as rational or rational-emotive.

similar to those of

Lyons and

Woods

(1991). Clients receiving

those in control or placebo groups, but

compared

REBT

results

very

were better off than

REBT was found to be no different in efficacy when

to other kinds of psychological intervention (e.g., systematic desensitization or

combinations of tiveness

Their meta-analysis found

REBT

and

specific behavioral elements). Further,

no

differences in effec-

were found across client problem types or types of outcome measured.

Two

obser-

when evaluating Engles and colleagues’ results: (a) the small sample size of many of the studies may have reduced the power to detect significant differences between treatments, and (b) the client sample across the studies was biased towards the YAVIS vations suggest caution

(young, attractive, verbal, intelligent, and social) client and milder levels of disturbance.

Soloman and Haaga (1995) questioned whether meta-analytic results can be generalized to the routine practice of REBT and noted several other methodological limitations of the research (such as a lack of follow-up studies

Engles and colleagues and Lyons and

and documentation of attrition

Woods

rates)

reviewed by

(1991).

Gossette and O’Brien (1992) presented one very negative view of the efficacy of REBT.

These authors reviewed comparisons of REBT with wait-list, placebo, or other treatment groups and concluded that “RET has little or no practical benefit for either children or adults, normal or troubled (p. 20). Even though they found evidence for changes in irrational beliefs and, to a

turbance, Gossette and

somewhat

O

lesser extent,

reductions in self-reported emotional dis-

Brien maintained that these observations paled in the light of

the lack of behavioral changes demonstrated in studies of

REBT. They explained

that the

observed changes could be attributed to the verbal training (conditioning) inherent in REBT, which can be conceptualized as a rather crudely designed verbal training history, in

which

weak

forceful punitive pressures await

irrational’ statements,

while only relatively

positive reinforcement follows espousal of ‘rational’ statements” (p. 19).

Three observations can be made about the Gossette and O’Brien (1992) review. was published in Journal ofBehavior Therapy and Experimental Psychiatry

First, it

Presumably, the

authors are behaviorists and thus

may have

an ideological stake in defeating

REBT, much

in

RATIONAL EMOTIVE BEHAVIOR THERAPY same way

the

that

REBT

309

may overpromote

theorists

the approach. Second, a large

number

of comparisons in Gossette and O’Brien’s review were obtained from dissertation research,

which they maintained was probably

as

the detailed description of treatments

and the overriding faculty supervision provided

However,

efforts.

because

good

as or better

does not meet the prevailing methodological standards of the profession. Further,

it

ological characteristics of the studies they reviewed,

number of significant

used a simple count of the

many of these Finally,

results

and Joffe randomly

rate), Ellis

and found that whereas no

obtained across studies. Notice that

study has

history that

is

Ellis

and Joffe (2002), in which were summarized (see the

all

78%

few years

selected the responses of 100 volun-

19%

be not helpful,

thought that they were very helpful.

kinds of obvious flaws and bias,

I

find

it

to be

an aspect of

difficult to leave out.

Theory- Testing Research. the important

REBT research.

clients reported these sessions to

responded that they were somewhat helpful and

Ellis

or other method-

for a description of these sessions). After collecting data for a

response

this

levels,

rather than using meta-analysis, they

Friday-night session participant-clients

Ellis’

Background section

Although

and

an interesting outcome project was described by

40%

power

sizes,

criticisms could be applied to the other reviews of

the opinions of

teers

in these

could be countered that dissertation research mostly goes unpublished

it

Gossette and O’Brien did not take into account sample

(with at

than published research because of

Most of the

research that bears

REBT

on

theory has focused on

REBT proposition that cognitive processes lead to emotional distress. Many

of these studies have used nonexperimental methods; most simply measure the relationships between

some

theoretically important

tional beliefs, frustration tolerance) with briefly review a

measure (unconditional

self acceptance, irra-

some measure of psychological

distress.

will

1

few of these.

Davies (2006) reported on a study of the relations between unconditional acceptance and irrational

beliefs. Elsing

both the IBT and

a short version

Attitudes and Belief Scale (GABS), Davies found support for

REBT

of the General

theory.

Ghamber-

and Haaga (2001) found that after controlling for initial levels of self-esteem, was related to low propensity for depression and found that participants higher in lain

were more objective lower in poorly.

USA

and

However,

in evaluating their

less likely to

performances (on

denigrate individuals

at issue in these studies

is

who

USA USA

than individuals

evaluated their speeches

the measure of USA;

lated with self-esteem (around the 0.5 level) really

a speech)

self-

it is

found

to be corre-

which questions whether the construct

is

being accurately measured.

Macavei (2005) compared the

beliefs

of depressed, mildly depressed and nondistressed

groups, and found that the groups differed in expected ways on various dimensions of irrationality.

These

results

instrumentation and

were seen

statistical

as

analyses

supporting

support

GT

than

REBT

theory, but questions about

compromise the degree

certain about this conclusion. In contrast, Jones

hypotheses from

REBT

to

and Trower (2004)

and Gognitive Therapy about

anger, finding

which we can be tested

competing

more evidence

to

REBT.

Harrington (2006) developed a multidimensional measure of frustration intolerance, the Frustration Discomfort Scale (FDS),

which contains subscales

comfort intolerance, entitlement, and achievement.

for

emotional intolerance,

He then assessed the

dis-

relationship between

RATIONAL EMOTIVE BEHAVIOR THERAPY

310

and depression, anxiety and anger in a clinical sample. As would be predicted by RKBd’ theory, frustration intolerance was positively related to psychological distress, even after statistically controlling for negative affect and self-esteem. Subscales on the FDS

scores

on

this scale

were uniquely related to the various measures of dysfunction: anxiety was most related to emotional intolerance, discomfort intolerance to depressed mood, and entitlement to anger.

The

trouble with

of these studies

all

is

nonexperimental nature. Because no

their

manipulations are used, cognitive processes could be causing the psychological distress, as predicted by theory, or the other way around. Another possibility is that the measures are tapping the same global process or that an unknown, third variable could be responsible for the relationships found. Across these studies, there

capture the

is

wide variation

in attempts to

by using measures of other constructs.

last possibility

Further controversy centers on the nature of the measures used to assess the endorse-

ment of iBs. As supporting

early as 1987,

REBT when

Zurawski and Smith

cast

doubt on much of the

they found that two often-used measures of iBs (the

Rational Behavior Inventory, RBI; Shorkey

& Whiteman,

same thing

affectivity.

measures of general negative

as

struction of the General Attitude

Robin, 1988, cited erties

of

this

in

David

measure and found them to be acceptable. Scores on the measure differenti-

with psychological

REBT

and individuals who

are not

irrationality

be treated unfairly by people in

thing, this

my life”

this study, as well as others that

good

REBT

tests of

method

assertion that irrational beliefs are associated

fdowever, a review of the items

distress,

may be some confounding between

However,

Leaf, Exner, &c

2005). Bernard (1998) tested the psychometric prop-

were not, presumably supporting the

terrible to

the

These concerns prompted the con-

ated between those from individuals receiving couples counseling

still

IBT and

1977) seemed to be tapping the

and Belief Scale (GABS; DiGiuseppe,

et ah,

literature

on the

and emotionality

A

(e.g., “it is

awful and

for example, Bernard, 1988, p. 189).

simply correlate irrational

theory, according to Szetagotai

leaves out the

GABS suggests that there

beliefs

and

distress,

and Kallay (2006). For one

(activating event), an essential

component of the

the-

ory. Secondly, these

authors point out that low levels of irrational belief do not necessarily

correspond to high

levels

Other

of

tests

REBT

of rational

belief.

theory have attempted to experimentally manipulate

beliefs.

For ex-

ample, Gramer and Buckland (1995) had participants read and repeat rational or irrational statements, and then assessed state anxiety

and

of irrational

levels

ticipants in the rational beliefs condition reported lower levels tional condition; scores

same

mand

pattern.

on the

One problem

characteristics

that

expects. Fypically, participants

the other groups, difficulty,

and

also

however, with

it is

pect. Also, this

& Schutte,

1986) followed the is

possible de-

what the experimenter

not clear that they were successful. Similarly, Harris, Davies,

showed marked

at pretest,

to

one of three conditions

and then subjected them

held irrational beliefs

this research

on blood pressure readings

(Malouff

irra-

obey these messages. Although Cramer and Buckland attempted

irrational belief, or irielevant belief)

who

that par-

of anxiety than those in the

cues that lead participants to figure out

and Dryden (2006) randomly assigned participants found that participants

They found

with studies that use experimental manipulations

is,

to control for this problem,

Irrational Beliefs Scale

beliefs.

is

it

to a stressful situation.

Fhey

showed more anxiety and concern than did

increases in

that

(rational belief,

blood pressure from pre- to

posttest.

A

appears that the groups were possibly different

making conclusions based on

pre-

and post-changes

study would be subject to the guessing effect described previously.

sus-

RATIONAL EMOTIVE BEHAVIOR THERAPY

311

Smith, Houston, and Zurawski (1984) assessed participants’ endorsements of irrational

and then exposed them

beliefs (via the Irrational Belief Test),

interviews,

to stressful or nonstressful

and afterwards, measured psychological and physiological

distress. Results sug-

gested that only cognitive variables (preoccupation with cognitive processes, denigration of

performance) were related to endorsement of iBs, and that further, a measure

self or one’s

of fear of negative evaluation (FNE) was more powerful than iBs in predicting emotional distress.

this

These findings

model

is

may behave

Smith and colleagues

to suggest that “it could be argued that

metaphor but an inaccurate

a useful

as //^they

led

endorsed various irrational

In a comprehensive review.

theory. Emotionally distressed persons

(1984,

beliefs”

p.

200;

Smith and Allred (1986) concluded that

measurement problems may have created

a situation in

quately tested. However, they also noted that

“it

may

which

italics in original).

at best,

REBT

method and

has not been ade-

also be, however, that

RET

provides

an effective intervention but a misleading account of maladjustment and the process of change.

The ABCD framework may be a useful metaphor but an

David

et

al.

inaccurate theory”

(p. 82).

(2005) came to the opposite conclusion, arguing that there was significant

evidence in support of REBT theory and outcome. These disparate conclusions are likely

due

to a

number of

review and David et research

is

lacking in

al.’s.

that although

many

published between Smith and Allred’s

factors, including research

On the other hand, my assessment of the sophistication of REBT it

has improved somewhat, methodological rigor

found

results

main unconvinced of the

in tests

validity of the

of REBT theory,

REBT

intervention for a variety of target problems, there in

RET

is

due

to

changing

claimed that he was the

p. 10).

He did,

Homosexual

“first

when

REBT’s emphasis on

REBT

humans,

easily

REBT is

safest to re-

“an effective therapeu-

no evidence

to

show

to advocate

that improve-

gay liberation”

book on homosexuality was very taboo.

this subject

tolerance of self and others

(Corey’s

1

( 1

992a,

95 1 The

history of sexual

Ellis’s

would

lead

him and

his

does not perpetuate bias based on sexual orientation.

Writing on the issue of multiculturalism, like all

is

prominent psychologist

in America) at a time

advocates to argue that

probably

AND CULTURAL DIVERSITY

in fact, write the preface to a classic

liberalism as well as

it is

irrational beliefs to rational beliefs” (p. 199).

ISSUES OF INDIVIDUAL Ellis

much

predictions about beliefs and emotions.

Thus, Oei and colleagues (1993) concluded that although

ment

very

of published studies.

Given the conflicting

tic

is still

succumb

to

Ellis

(2002) acknowledges that “therapists,

narrow-mindedness and intolerance”

continues by adding that the emphasis on

USA

and

UOA

in

REBT

(p.

203).

practice

Still,

he

promotes

openness to cultural difference.

On

a theoretical level, the

importance placed on personal responsibility and assump-

tion that problems reside within the person (in the

underemphasis on the targets

role

of social or cultural factors

of negative stereotypes and oppression, such

lesbian, or bisexual

prejudicial behavior,

would appear

(GEB) and

form of

to

as

them

to

women,

is

not

fair

can lead to an

Groups who

are the

ethnic minorities, and gay,

by these biased attitudes and

change the ways they think about these influences

to be detrimental to their functioning,

assumption that the world

REBT

in people’s lives.

individuals, are greatly affected tell

iBs) in

if

not discriminatory.

REBTs

(inherent in the third musturbatory attitude) could

— RATIONAL EMOTIVE BEHAVIOR THERAPY

312 be seen

acceptance of prejudicial attitudes and discrimination in behavior.

as

would maintain

course,

and that

it is

REBT

that

teaches clients to see the situation as bad, not awful,

1999d).

Ellis

(2005b) says

cept themselves and other individuals adversities.

life

REBT

which

particularly

.

.

.

it

this

clients

from

to rely

on constructs

all

and most multicultural

works against”

195).

(p.

is

an appropriate intervention for

found

in

more construct-laden

They

further argued that

of tolerance and acceptance are compatible across such di-

is

not compatible with some foundational cultural values

Robin and DiGiuseppe

spirituality),

asserted that

(for

it is still

^Cconnection and allow clients the choice information. They recommended that when working with clients from

culturally respectful to point out the

non-Western

clients

REBT

emphasize

of whether to use the

REBT

REBT

Western European, Asian, and Native American. Acknowledging that the

instance, those that

for therapy

and intolerance

issues involve bias

that are essentially untested, such as those

empiricist perspective of

and

when

REBT s empirical base, they argued that REBT does not need

stoic philosophical values

verse cultures as

helpful

frustration tolerance

psychoanalysis) that are liable to be culturally biased.

(e.g.,

REBT’s

cultures. Citing

way: “clients can unconditionally ac-

and can achieve high

Robin and DiGiuseppe (1997) maintained that

theory

of

very appropriate to encourage clients to change the As through working for

social justice (Ellis,

faced with

Ellis,

cultures, the counselor

and

is

(b) find

out what the

active, directive,

do two

things: (a)

client’s

from many non-Western cultures (Sue

more

the client about his expectations

expectations are.

and short term, which

recognized that indirect methods are

tell

is

consistent with the expectations of

& Sue, 2003; Wolfe, 2007).

effective

with some

Still, Ellis

and points

clients,

(2005a)

to the use

and parables of examples of suitable interventions in these situations. Chen (1995) contended that the values underlying REBT (the emphasis on logical thinking, cog-

of stories,

fables,

nitive control

of emotion, the counselor

as teacher,

and the

active directive nature of ther-

apy) are very consistent with those of the Chinese culture, so that

REBT may be better than

other theories for use with this cultural group. Disputing methods, however, probably need to be

modified because the confrontive approach could create negative reactions in Chinese clients, who, although comfortable with the student role, become distressed about not knowing the answer to the teachers questions. Instead, ing, in

which

therapists provide clients with

Chen recommended

more

using didactic disput-

alternatives. Also,

emotive techniques

should be used cautiously because of the normative Chinese reluctance to express feeling. As with most of the other major theoretical approaches, REBT focuses on the individual.

Healthy people are independent and autonomous. These values

of cultures that are more collectivistic groups) and those to

whom

&

tance of individuality (Sue clients ily

who

spirituality

&

RI.BT, again because within the person

(i.e.,

clash with those

some Asian and Hispanic/Latino/Latina very important and that downplay the impor-

(e.g., is

Sue, 2003). If the counselor does not recognize these biases,

are collectivistic can be labeled as

or others (Sue, Ivey,

may

dependent, immature, and fused with fam-

Pedersen, 1996).

mostly locates problems and the responsibility for change cognitions), can be accused of being sexist as well. Women are it

devalued by our cultural norms, and to buy into these and to tell women to “deal with it and stop whining” is to ignore very real factors that influence women’s mental health.

Wolfe (1986) argued that the goals of

number

of reasons.

REBT

targets

REBT

are consistent with feminist ideals for a

and disputes the shoulds, musts, and “love-slobbism”

RATIONAL EMOTIVE BEHAVIOR THERAPY that are the basis of sex-role stereotypes (p. 401).

and autonomy

in

313

An

emphasis on personal responsibility

determining the goals of therapy and the encouragement of assertiveness

are also supportive of feminist values.

Wolfe

maintained that

also

women (and others) to fight for A-changes, or changes women and other groups down (1986, p. 401).

REBT

encourages

in the societal conditions that

keep

THE CASE STUDY many

In

ways, the case of Alan

REBT theory,

ripe for the application of

is

and the cognitive behavioral

slant

REBT. Anxiety

central in

is

of the approach seems helpful in working

with Alans behavioral disturbances. Alan shows symptoms of obsessive-compulsive disorder

(OCD), about which

easy to identify, although changing

presented by this case

zle

might attempt apist

is

some of them might be tough

likely see

(e.g.,

to be fairly

the images).

A puz-

the origin of the religious/sexual images. Other approaches

mental pictures, but the

to locate the source of these troubling

would more

ABCs seem

theorized (1994b, 1997b). Alan’s

Ellis

them

as

connected to biological

deficits inherent

REBT therin OCD.

Summary Rational Emotive Behavior Therapy starts with the premise that

emotions

and

Cs.

(Cs). Beliefs

Humans

about the events

(irrational

5s or

events (As) don’t cause

rational Bs) are

what

both rationally and

are innately predisposed to think

these tendencies can extend to color an individual’s

life

life

link the

and

irrationally,

philosophy. That

is,

As

healthy peo-

ple tend to think in terms of preferences, whereas dysfunctional people think in terms of

demands. Healthy people have

rational

philosophies that include tolerance for self and

life

and community

others, acceptance of uncertainty, rational self

standing of

how one makes

REBT

in terms

follows an

and an under-

oneself disturbed. Dysfunctional people harbor

tional beliefs that include musts,

They think

interest,

many

irra-

low frustration tolerance, and self-downing thoughts.

of absolutes and are conditional in their acceptance of self and others.

ABCDE

model. After the

ABCs

are identified, the

disputes the irrational beliefs to help the client achieve a

new effect

REBT

counselor

or an effective

new

phi-

losophy. Cognitive, behavioral, and emotive techniques are applied in a teacher— student

The

model. client.

He

REBT

therapist, typically active

teaches the client the

ABC

and

directive,

The emphasis on

unconditionally accepting of the

model without focusing too much on the As or

has been criticized for being too intellectual

events in clients’ past.

is

rationality,

and ignoring emotions and

Cs.

significant

independence, and self-determination

may

be inconsistent with the experiences of clients from cultures other than those of Western

European fair

origins, those

and we

can’t

expect

who it

are not heterosexual, or

to be

may convey

women. The

idea that the world

a tolerance of discrimination

Visit

REBT

Chapter 9 on the Companion Website

and

test the

are less supportive.

^

chapter-specific resources

not

and oppression.

Research evidence supports the effectiveness of REBT. Studies attempting to theoretical assumptions of

is

self-assessments.

at

www.prenhall.com/murdock

for

Aaron 7 Heck .

Steve

a 38-year-old Caucasian male.

is

recovering substance abusers

He

lives in

and participates

a residential treatment facility for

in a work-therapy

program sponsored by a

local hospital.

Steve

IS

the only child

He

of an upper-middle-class family.

as Swell, ” like “Beaver Cleaver. ” Steve reports that his father their relationship

When he was

was

distant.

His relationship

in third grade, Steve

was sent

ivith his to

characterizes his family

life

was a great provider but that

mother was

similar.

a private military academy. In seventh

grade, he switched to public school, but

a bikini

to

school one day).

was subsequently expelled for “acting up” (he wore After he was expelled, Steve reentered the military academy,

from which he eventually graduated.

When mother,

Steve was

1 1,

and

his parents separated,

who remarried when he was

the divorce, hut that she ‘put

17.

then divorced. Steve lived with his

He remembers his mother as

up a strong font,

”

assuring

him

being very sad about

that “things

would be

all

”

right.

After graduating

4 years.

fom

the military academy, Steve entered the navy, where he servedfor

After his discharge, he was working in an auto body shop

when he discovei’cd blood

in his urine.

He

reports that his father sent

have a

on

his left renal tube. Steve reports that his first episode

lesion

at this time

and

psychiatrist,

he was diagnosed as bipolar

In

1990

that his first episode of

Steve was engaged to he

automobile accident that resulted

m

him

to the

Mayo

mania occurred

Clinic,

shortly

where he was found to

ofdepression occurred thereafter. After seeing a

and treated with lithium. married. Around that time he was involved

in

an

the death of the driver

of the other vehicle involved. Steve reports that he does not remember the accident because he was intoxicated (alcohol) hut that the police deterynined that the accident was the other driver’s fault. Nonetheless, he wab chaiged with manslaughter, placed on probation,

314

and

ordered

to

pay $10,000

in

COGNITIVE THERAPY

315

During this period, Steves father was supportive, but his grandparents told him mother had announced to friends and family that she had 'disowned” Steve.

restitution.

that his

him with

Afier these events, Steves fiancee presented alcohol again she Steves fiancee

would leave him. He

lefi

himself voluntarily

to the local

ultimatum that if he drank

About 4 months

drinking.

later,

Steve

that he

is

too

Steve admitted

He is currently med-

of his participation in the work-therapy program.

immature and that he

and others

sacrifices self-

Steve reports that he basically accepts himself as he parents’ point

later,

and lithium.

in counseling as part

is

year

Veterans Administration Alcohol and Drug Abuse Treatment

Unit. Steve has subsequently relapsed and returned to treatment twice.

icated with antabuse

A

reports that he stopped drinking easily.

and he resumed

him,

the

—

of view

their son

is

an

and saddens him. He sometimes gets

“alcoholic

is,

and a

respect

”

when he

“acts out.

but that sometimes he imagines

his

manic-depressive” and this frightens

depressed about his situation. Steve

good job, and become

that he wants to get back on his feet, get a

He says

tells

his counselor

self-supporting.

BACKGROUND The proper

title

Cognitive Therapy (CT)

developed by Aaron

T

is

typically reserved for the theoretical structure

Beck, beginning in the late 1960s.

The development of this

theory

can roughly be divided into two phases: the period of schematic processing (pre-1 990) and a

newer variant of the theory that was proposed beginning

the “modal” perspective; Beck, 1996, 1999; Clark

& Beck,

in the

1999).

mid-1990s (what 1

will review

I

both

vari-

ants of the theory because the older theory has received significant research support

attention in clinical circles. Although the newer theory sion,

it

has received far

Before

1

less critical

and empirical

proceed to further background,

between Behavior Therapy (Chapter

8),

it is

and intervention. These approaches

worth noting that

a

skills

fact,

combination of techniques from

the Becks,

you

will see that there

D. Ltindgren do

classic

is

all

1

Temkin,

his

is

often used as

that emphasize the role of cognition in dysfunction

known

& Glass,

Cognitive-Behavior Therapy,

as

solving, self-instructional training,

1995). In the real world,

three approaches. However,

il

a very clear pure version of CT;

many therapists

you can watch Dr. Jennifer

Cognitive Therapy with Helen on the Theories in Action

mother, wanted to be a physician, but

this

use

you follow the writings of

Aaron Temkin Beck was the son of Russian immigrants. According Lizzie

someone other than

the term Cognitive Therapy

are also generally

approaches (Arnkoff

in practice, the distinctions

least if you are

and include Rational Emotive Behavior Therapy, problem and coping

an extension of the earlier ver-

Rational Emotive Behavior Therapy (Chapter 9), and

Judith or Tim Beck (see next paragraph). In

number of systems

and

attention.

Cognitive Therapy (Chapter 10) can get really blurry, at

a general label for a

is

call

DVD.

Weishaar (1993),

to

was unheard of in the

early

900s. Lizzie married Harry Beck, a commercial printer with socialist leanings, and Aaron

Beck was the youngest of

their five children (born in 1921).

The

family was Jewish and

very devoted to their religion.

Two

of

Becks

siblings died as children, leading to significant depression in his

abated only with Aaron’s birth. As a

result.

Beck was overprotected by

his

mother

that

mother (Weishaar,

1993). Beck almost died during his seventh year from sepsis that resulted from an infected

broken bone. According

to

Weishaar (1993),

this

prolonged

illness,

hospitalization,

and

COGNITIVE THERAPY

316

difficulties because surgery resulted in Beck developing anxieties and phobias. He also had dumb and of missed school and was held back a year in the first grade. He thought he was

These

that others thought so, too.

an excellent student, graduating quired his nickname,

Tim

(for

beliefs

challenged Aaron to

first in his

Temkin,

his

high school

work

hard,

During

class.

middle name), which

is

and he became

this

period he ac-

used by his close friends

and wife (Weishaar, 1993). Beck put himself through college

He

door salesperson (Weishaar, 1993).

Brown, delivering papers and working

at

majored

with a career counselor suggested that he should be a systems enforced against Jews, Beck in

1

still

and

in English

political science,

as well,

such

— he wanted

as

door-to-

and

a consult

YMCA counselor! Warned about quota

applied to medical school at Yale and received his

946. According to Weishaar, Beck admitted that his anxiety was one reason

medical school

as a

to defeat his blood-injury phobia.

He

why he

of psychotherapy, attempting to

fears

p. 13).

and was

After flirting with a career in neurology, he turned his attention to psychiatry classically trained as a psychoanalyst.

chose

acknowledged other

of abandonment, public speaking, and heights (Weishaar, 1993,

MD

Early in his career Beck was engaged in the science

Freud s hypothesis that depression was anger turned

test

inward. Instead he found that depressed individuals sought the approval of others (Arnkoff Glass, 1995).

depression to be

A

subsequent

more

series

of studies investigating the construct of masochism in

of depression seemed

clearly revealed that a distinguishing characteristic

pessimism and negativity rather than masochism (Clark

same time.

Beck’s clinical

&

work was informing

& Beck,

his theoretical

1999). At about the

development.

He

began to

notice that his clients had thoughts during free association that they did not report (Beck,

1997a).

Most of

what the

therapist thought of the client, for example),

these thoughts

had

the client’s current emotional state.

to

do with the analytic relationship (worries about

Beck turned

and they were

his attention to these

closely associated with

thoughts

(later labeled

automatic thoughts) along with what he called the internal communication system, and Cognitive Therapy was launched (Beck, 1997b).

Beck acknowledges the contributions of other psychologists to tains that

he learned very

little

his system,

from existing theories of psychotherapy.

Among

ences Beck recognizes are the philosopher Kant, and cognitive theorists

George

Kelley,

He

and Albert Bandura.

but mainthe influ-

Magna

characterized Albert Ellis as a pioneer

Arnold,

whose

ideas

provided support for his (Beck’s) break from traditional psychoanalytic ideas (Beck, 1991). Beck even uses the famous Epictetus quote usually associated with Ellis’s REBT in his well-

known 1976 book.

Cognitive Therapy

and

the

Emotional Disorders (“Men are not moved

by things but the views which they take of them” Epictetus, cited in Beck, 1976, p. 47). Beck is a prolific writer and researcher, having published hundreds of journal articles

and many books. Both the medical and psychological communities have recognized his work. In 1989 Beck was awarded the American Psychological Association’s Distinguished

Award for the Applications of Psychology. He has also received the Association for the Advancement of Behavior Therapy Lifetime Achievement Award (1998) and the American Psychological Society James McKeen Cattell Fellow Award in Applied Psychology Scientific

Beck

currently Professor Emeritus of Psychiatry at the School of Medicine at the University of Pennsylvania. (

1

)T3).

is

Beck founded the Beck its

website

Institute for Cognitive Therapy

at ywv'w. beckinstitute.org

.

Other websites of

and Research

in 1994.

You can view

interest include the International

COGNITIVE THERAPY

317

Association for Cognitive Psychotherapy at http://www.cognitivetherapyassociation.org which ,

An International Quarterly.

publishes the Journal of Cognitive Therapy: Beck’s daughter, Judith,

Beck

director of the

a psychologist

is

Institute. Judith’s

and cognitive

therapist.’

She

currently

is

books Cognitive Therapy: Basics and Beyond (1995)

and Cognitive Therapy for Challenging Problems (2005) present structured, easy-to-follow guidelines for the conduct of CT. If you want to try the CT approach to that diet you’ve

you could acquire Judith Beck’s 2007 book. The Beck Diet Solution. Read from Basics and Beyond m Box 10.1.

been putting a selection

off,

Box

10.1

Judith Beck on Automatic Thoughts Automatic thoughts are a stream of thinking that coexists with a more manifest stream of thought 1964). These thoughts are not peculiar to people with psychological distress;

though with just a

these thoughts,

consciousness. ity

common

they are an experience

check

if

When we become

we

are not suffering

A reader of this

have the automatic thought,

productive way:

“I

aware of our thoughts, we

understand

this,”

who

me

oC\x.\ let

reality testing

Sally, for

example,

when

she

and

and responding

treme, however: feels

“And

is

when

feel slightly

in a

to negative thoughts

may

not engage in

a

is

this

com-

kind of

it.”

Her thinking becomes even more She accepts these thoughts

quite sad. After learning tools of cognitive therapy, however, she for, identify,

to

it

crucial to

when

my

this.

I’m fresher,

survival,

and

it’s

if

can ask someone

Although automatic thoughts seem

to

able to use

else to explain

it

I

reread

it

to

me

if

The

is,

it isn’t

fairly pre-

cognitive therapist

cerned with identifying those thoughts that are dysfunctional, that

come

need be.”

pop up spontaneously, they become

dictable once the patient’s underlying beliefs are identified.

or

understanding

I

I

as correct

not necessarily true that

am having some trouble now. But may understand it more. Anyway,

I

is

ex-

and evaluate her thoughts and

thereby develop a more adaptive response: “Wait a minute, never understand

in

they are upset.

this.”

understand

I’ll

her negative emotion as a cue to look

reality,

He may,

anxious.

reading an economics chapter, has the same thought

understand

as the reader above. “I don’t

back

may

just reread this section again.”

are in distress, however,

a conscious, structured way, especially

I’ll

real-

examination. Cognitive therapy teaches them tools to evaluate their thoughts

critical

and

automatically do a

without conscious awareness) respond to the thought

do understand some

experience. People

may

from psychological dysfunction.

“I don’t

(i.e.,

This kind of automatic

mon

little

all.

example, while focusing on the content of this chapter,

text, for

however, spontaneously

Most of the time we are barely aware of training we can easily bring these thoughts into

to us

is

con-

those that distort

that are emotionally distressing and/or interfere with the patient’s ability to reach

her goals. Dysfunctional automatic thoughts are almost always negative unless the patient is

manic or hypomanic, has

’To minimize confusion, where

a narcissistic personality disorder, or

I

reference

Aaron

T

Beck's work, no

is

a substance abuser.

initials are used.

COGNITIVE THERAPY

318

more aware of the Automatic thotights are usually quite brief, and the patient is often in session, emotw 7 she feels as a result of the thought than of the thought itself Sitting i

be somewhat aware of feeling anxious, sad, irritated, or emtherapist questions her. barrassed but unaware of her automatic thoughts until her emotion the patient feels is logically connected to the content of the automatic

may

for example, a patient

The

thought. For example, Sally thinks, therapist]

saying,”

is

and

I

m such a dope.

dont

I

Another time she thinks,

feels sad.

therapy doesn’t work?

if this

Automatic thoughts

^

[My

therapist]

Sally feels anxious.

when

meaning of the thought. For example. Oh, no! may be

trans-

is

form but can be

I

my

Automatic thoughts may be

easily spelled

much homework. Damn! may be the my appointment book at home and I cant schedule

going to give

another appointment with

desk

do next?”

I

Fdes watching the clock.

out

expression of an idea such as

to her verbal

will

are often in “shorthand”

the therapist asks for the lated as

What

understand what [my

W^hen she has the thoughts,

I’m just another case to him,” and feels slightly angry.

“What

really

left

me

too

therapist today;

Fm

so stupid.”

in verbalform, visualform (images), or both. In addition

automatic thought (“Oh, no!”) Sally had an image of herself, alone

late at night, toiling

homework

over her therapy

(see

Chapter

at

her

3 for a description

1

of automatic thoughts in image form).

Automatic thoughts can be evaluated according The most common type of automatic thought objective evidence to the contrary.

conclusion the patient draws

[my roommate]”

ised

person,”

A

is

is

may

A

this.

I’ll

their

utility.

distorted in

some way and occurs

despite

second type of automatic thought

a valid thought,

I

do what

was studying

for

is

also accurate

and

I’ve

it;

I

prom-

an exam and thought,

but decidedly dysfunctional. For exam“It’s

me

going to take

hours to finish

be up until 3:00 a.m.” This thought was undoubtedly accurate, but

can do

I

not.

thought would address

able,

accurate, but the

but the conclusion “Therefore, I’m a bad

her anxiety and decreased her concentration and motivation. this

is

be distorted. For example, “I didn’t

third type of automatic thought

ple, Sally

is

and

to their validity

done

it

its utility. “It’s

before.

won’t concentrate

true

Dwelling on

as well.

It’ll

it

how

will take a

long

it

A

it

increased

reasonable response to

long time to finish

will take

makes me

probably take even longer to

this,

but

feel

miser-

finish. It

would

be better to concentrate on finishing one part at a time and giving myself credit for having finished tively

it.”

Evaluating the validity and/or utility of automatic thoughts and adap-

responding to them generally produces a positive

To summarize, automatic thoughts

coexist with a

shift in affect.

more manifest stream of thoughts,

spontaneously, and are not based on reflection or deliberation. People are usually

arise

more aware

of the associated

emotion but, with

a little training, they

can become aware

of their thinking. The thoughts relevant to personal problems are associated with specific emotions, depending on their content and meaning. They are often brief and fleeting, in

shorthand form, and

their ing,

may occur

automatic thoughts

and responding

to

as true,

in verbal

and/or imaginal form. People usually accept

without reflection or evaluation. Identifying, evaluat-

automatic thoughts

(in a

more adaptive way)

usually produces a

positive shift in affect.

INcerpred from Cognitive Therapy: Basics and Reyondhy].

S.

Beck, 1995.

New York:

Guilford.

COGNITIVE THERAPY

319

BASIC PHILOSOPHY CT theory generally takes a neutral position on the properties of human nature. When the human

overall qualities of

perspective,

existence are discussed at

which portrays humans simply

Alford and Beck (1997a) characterize that a critical aspect of

human

it

from an evolutionary

constructivist because

meaning from

the creation of

is

is

organisms adapting to the environment.

as

CT theory as

existence

all,

it

recognizes

experiences.

Unlike radical constructivist approaches (those that recognize no single objective

CT

however,

assumes both an external, objective

phenomenological one (Clark

Beck would

like to see his

theory that can explain

cal

the roots of the theory ioral roots

lie

& Beck,

theory

a personal, subjective,

1999).

as the great integrator

& Beck,

—

that

is,

One

the “one” psychologi-

all

others (Alford

in

both behavioral and psychoanalytic approaches. The behav-

1997a).

point in his favor

of CT theory are evident in the techniques used in intervention, and in

versions of the theory that placed

The

and

reality

reality),

cognitive

model was

psychoanalysis.

The

from and

The

earlier

in part a reaction against classical

components consisted of the emphasis on meanings, the

of symbols and the generalization of reaction patterns across diverse situations

role

that

emphasis on processes out of awareness. Beck wrote:

little

in part derivative

derivative

is

.

.

.

“reaction against” consisted of eschewing the predominately motivational model,

the notion of an unconscious cauldron of taboo drives defended against by repression

and other mechanisms of defense, and the

psychosexual stages of development. (Beck, 1991, Recently,

CT theorists

importance attached to the

critical p.

192)

have begun to discuss the childhood origins of core

to parallel psychoanalytic notions

CT

awareness

automatic thoughts, cognitive schemas; these are discussed

this

way

A

(e.g.,

much

attention to cognitive processes that are not fully in later)

and

are in

reminiscent of Freuds ideas about the unconscious determinants of behavior.

final

point to note about

dysfunction. Because

it

1979) and also because to focus

seeming

of the origins of dysfunction (Padesky, 2004). Also, cur-

rent versions of

theory pay

beliefs,

CT

theory

is

that

it

is

mostly a theory of psychological

originated as a theory of depression (Beck, Rush, Shaw, it

& Emery,

has been intimately tied to therapeutic practice, this theory tends

on the dynamics of psychological maladjustment

rather than

on healthy functioning.

Mia is Steves counselor, and shefollows a Cognitive Therapy approach. Assuming that Steve is a human like any other, she begins her work with him without any preconceived notions about

his goodness or badness;

he

simply a person striving

is

ment. His behavior, in Mia’s view,

is

and how

his cognitive process

make

sense

of his environ-

of his environunderstand the way he thinks about

in response to his current perceptions

ment, which are tied to his early learning. She seeks things

to

is

to

related to his current situation.

HUMAN MOTIVATION CT theory

is

probably best characterized

theory to locate the motivation for survival

as

an adaptive theory. Beck draws on evolutionary

human

behavior in two major evolutionary goals:

and reproduction (Beck, Freeman, Davis, and

Associates, 2004). Cognitive processes

evolved to enhance adaptation to the environment, and hence, survival (Clark

&

Beck,

COGNITIVE THERAPY 1999 )

Humans

comprehend

struggle to

the world

and

they can develop effective adaptive strategies (Alford

&

meaning

assign

to

life

events so that

Beck, 1997a). “Cognition

is

impli-

consequences (both shortcated in controlling or directing behavior so as to maximize positive term and long-term)” (Alford

& Beck,

to be preservation, reproduction,

1997a,

p. 64).

dominance, and

The

basic needs of humans are thought

sociability (Clark

& Beck,

1999,

p. 67).

a result of many influences, but at the most basic level, he is struggling to adapt to his environment. He seeks positive consequences (survival, social contact, dominance or control of his situation, and intimate relationships). Mia looks at

Mia

assumes that Steves situation

Steves ways

behavior

is

of construing the world

in order to

how

understand

his

meanings

relate to his

and feelings.

CENTRAL CONSTRUCTS The Cognitive Model Simply put, the cognitive model, which

and behavior

are the

is

the foundation of

product of our perceptions

CT, proposes

S\xu2iXAO\\s (J. S.

view of behavior assigns primary importance to the self-evident

& Beck,

1

978,

p.

525;

els

how you

Beck, 1995). “The cognitive

fact that

people thinH (Kovacs

Cognition, in this model, means both the process and

italics in original).

content of thinking, or

that our emotions

think and what you think (Kovacs

& Beck,

1978). Three lev-

of cognitive processing are seen in humans: the automatic or preconscious, the conscious,

and the metacognitive (Alford

& Beck,

1997a).

The automatic

level consists

of thoughts and

other cognitive organizations that are based in survival processes (see the later discussion of

modes) that thinking,

of awareness.

are largely out

and the metacognitive

level refers to

Mia

Ofprimary

importance

the content

of his thinking, and

accessible to

him

to

The

is

how

conscious level

our

ability to

is

what we normally think of as

think about our thought processes.

Steve thinks about things. She

is

also interested in

aware that some of his thoughts might not be very

is

at present. Steves emotions

and behaviors are clues

to his

thought processes.

Schemas Schemas (sometimes

also called

information with which

we

schemata) are cognitive structures that organize the barrage of

are constantly confronted

(Beck

& Emery,

2005).

They

help us

meaning out of what otherwise would be a bewildering array of stimuli, both internal and external. Schemas are the most basic unit of psychological function. Beck compares them

create

to electrons in that they are theoretically critical

(Alford

(1999):

& Beck,

1

997b,

Schemas

p.

282).

are relatively

elements that can only be indirectly observed

A formal definition of schemas is provided by Clark and Beck enduring internal structures of stored generic or prototypical

features of stimuli, ideas, or experience that are used to organize hil

new information

in a

meaning-

way thereby determining how phenomena are perceived and conceptualized” (p. 79). Schemas can be dormant or active. To intuitively understand schematic processing,

simply think of the word librarian. set of

I

am

certain that

you almost

images or words associated with the term. Further,

if

I

came up with you someone was

instantly

a

told

a

COGNITIVE THERAPY

321

TABLE

10.1

Examples of Adaptive and Maladaptive Schemas Adaptive

Maladaptive

No matter what happens,

can manage

I

must be perfect

I

to

be accepted.

somehow. If

work

I

I’m

at

something,

I

can master

it.

If

a survivor.

Others can

I

I’m

to

do something,

I’m stupid.

People respect me.

People can’t be trusted.

like

must succeed.

a fake.

I’m lovable.

I

I

Without a woman. I’m nothing.

me.

trust

choose

The world

challenge.

is

frightening.

Adapted from “Cognitive Therapy” by J. H. Wright and A. T. Beck, 1996, in R. E. Hales & S. C. Yudofsky (Eds.), The American Psychiatric Press Synopsis ofPsychiatry (p. 1015). © 1996 American Psychiatric Press,

www.appi.org. Reprinted with

be expecting the person to display those qualities. Your “librarian” schema

librarian, you’d is

activated

permission.

and

is

influencing

Schemas influence the

how you respond

selection, encoding,

to information.

and

of information in the cognitive

retrieval

They contain general knowledge, core beliefs, and emotional elements relevant to particular domain of experience (Reinecke & Freeman, 2003). If your librarian schema

system. a is

activated,

librarian

you

are likely to observe features of

schema, and you

may

someone

that are consistent with your

have great difficulty recalling features that are inconsistent

some emotion stemming from your past experience with librarians (did you get yelled at for talking in the library when you were a kid?). Some schemas are more easily activated than are others because they are broader, have more with the schema. You might also

feel

more complex; Clark & Beck, 1999). Adaptive and maladaptive schemas can be distinguished, as shown in Table 10. 1. Box 10.2 illustrates an important schema dynamic, stereotype threat. elements, and apply to

more

situations

(i.e.,

are

Box 10.2

The Power of Schemas As you have

read,

schemas

are the

most

basic unit of thinking

and

are developed either

through personal experience with the world or through vicarious learning (watching

what others

do).

Schemas

are

formed very

early in

life,

even

as early as infancy.

When

new events, we store away information about those events for future use. For example, when Alexandra pets the family cat she discovers that the cat is soft, warm, and purrs. The next time Alexandra encounters a cat out in the environment, her “cat

we

experience

schema,” which contains information about

cats

being

soft,

warm, and purring

will

COGNITIVE THERAPY

activiited.

iiLitoniaticiilly

quite complex. Each

Although schemas

schema

are the basic unit

we hold is based on one or more core beliefs about the we are also if we hold faulty core beliefs about something,

that

world. So as you can imagine,

If Alexandra

going to activate faulty schemas that effect behavior. her family cat, she might then hold a core belief that

would

As you can

see,

all

cats

want

that includes scratching

schema

activate a negative cat

sees a cat.

of thinking they can be

had been scratched by

to hurt her,

which then

and danger each time she

schemas can be very powerful and can be accurate or inaccu-

based on the experience the individual has in the world.

rate

Another example of the power of schemas

a

is

dynamic

called stereotype threat.

Stereotype threat can be defined as anxiety aroused by the prospective risk of believing

and confirming

has been negatively stereotyped.

The

relevant to the stereotypic behavior. that society has

about yourself because you belong to a group that

a negative stereotype

come

to accept

(innately) have poorer

math

threat then interferes with

Although there

and advocate

skills

are

a troubling

than males.

A

performance on tasks

many examples one

in particular

of stereotypes is

that females

study done by Keller (2002) showed

when males and females were given a math test, they performed relatively equally. However, when students were informed before the test of the stereotype that males typically scored higher than females, the females performed more poorly than males. Similar results were found when Steele and Aronson (1995) examined racial stereo-

that

White and African American students on intelligence tests. In this study it was found that if African American students were primed with a racial stereotype about test performance before taking the test, they did more poorly than White students on types with

the

However,

test.

if

American students were not reminded of the

the African

stereotype before taking the

test,

no differences

in

racial

performance were observed.

Another example of stereotype threat that has been documented

in the literature

by

common stereotype that women are more socially sensitive than men. In this experiment, men who were warned that the test they were taking tapped this social skill and that women were generally superior in this domain, scored Koenig and Eagly (2005) addresses the

lower compared to

men who were

In light of this information,

Contributed by April

Mias C

L.

l perspective

told that the test

measured information processing.

what schemas do you have, and how might then

affect

you?

Connery.

tells

her that Steve

is

surely

harboring some maladaptive schemas,

how he sees the world, including what he pays attention to and how he behaves and feels. Mia thinks that Steve probably operates, at times, from schemas such as, Im a fake and a failure but also from some manic schemas that are grandiose ( I am strong and powerful and can get away with a lot. I should take advantage of this. I can drink and act up and why notif. rijese

schemas are influencing

B ELI ITS As

just

noted, beliefs are important

C.ognitive

1

heiapy, aie

components of schema, and as critical targets of discussed extensively. Judith Beck (2005) distinguished between

COGNITIVE THERAPY

323

two kinds of cognitions that attitudes.

Our schemas

are

important

and

are usually self- referent (Clark

S-.

as

course, then

&

we

and

hold,

beliefs

I

are largely

or

and automatic thoughts

Beck, 1999). These beliefs include “should” and “must” be-

of an assumption

might

am dumb.” The

used by individuals

am

roles

1999). Assumptions, rules and attitudes, also

well as conditional beliefs that are influential in creating

An example

“I

& Beck,

intermediate beliefs, are situated between core

Beck, 2005; Clark

liefs as

ing

and assumptions,

thought to be the hardest to modify. They tend to be overgeneralized and absolute,

are

(J.

beliefs,

contain our core beliefs, which are the most basic beliefs

and

known

CT: core

in

be, “If

1

don’t get an

meaning from experience.

A in my Theories

of Counseling

intermediate beliefs also include rules or coping strategies

in reaction to

other beliefs

(J. S.

Beck, 2005). These coping strategies

automatic and can be clearly distinguished from other forms of problem solv-

coping responses. For example, an individual could hold the core

a failure”

which

is

connected

to

and the

rule “I

must

get

all

As.”

belief

A coping strategy

would be, “I will achieve perfection in all of my coursework so that get As.” Clark and Beck (1999) added the most specific form of schema, the simple schema. Simple 1

schemas deal with physical objects or very

distinct,

simple ideas, such

as dogs,

books,

computers, and so forth.

associated attitudes, rules,

Mia

of his core beliefs and and assumptions. Because he does not appear to be psychotic, his

As she begins her work with

Steve,

looks carefully for evidence

may be, ‘Im a goof-off and ” therefore nobody loves me” and paradoxically, “/ am cool and can do what I want. Steve may bounce back and forth between these beliefs and associated schematic processing. Steves intermediate beliefs are linked to his core beliefs and schemas. Mia discovers that Steve thinks that he should please people so that they will love him and that that will make him worthwhile. When his manic schemas are activated, he probably thinks that the world must be good to him and allow him anything he wants. If it doesn’t, he gets angry.

simple schemas are intact. She thinks that some core

beliefs

Automatic Thoughts Automatic thoughts (ATs)

are a

normal feature of our cognitive process

(J. S.

Beck,

1

995).

more conscious thoughts. ATs tend to occur in shorthand rather than in full sentence form and often seem to just pop up out of nowhere (hence their name). Depending on their content, these

They

are swift, evaluative statements or images that exist alongside our

thoughts can be functional or distressing, but the thinker (Beck, 1976). Usually, likely to

we

in either case,

are not particularly aware of

be aware of the emotion associated with them. In

core and intermediate beliefs. or core beliefs

(J. S.

They

they tend to be reasonable to

are

thought

reality,

to be easier to

our ATs we are more

AFs

are the result of

our

change than intermediate

Beck, 1995).

Judith Beck (1995) identified three general types of automatic thought. torted thoughts that are contrary to available objective evidence

(“1

First arc the dis-

never do anything

Most ATs are of this type. A second type of AFs can be accurate, but the conclusion drawn is distorted (“1 upset my boyfriend. Now he’ll never love me again!”). A third type of ATs is accurate but dysfunctional (p. 77). Fhis kind of thought either contributes right!”).

COGNITIVE THERAPY approach a task or increases anxiety so that focus and concentration are going to take a longtime disrupted. For example, I could have the automatic thought, “Its to write, hnish this book! This thought is true, but it may decrease my motivation to a reluctance to

to

or

it

may

me from my

distract

current writing activity because

definitely increases

it

my

anxietv.

Mia

is

interested in the automatic thoughts that

Im

he has some negative APs, such as " ‘7

others,

am

thoughts such

stand

it

not loved, as,

"and so forth. His drinking behavior

‘What the hell, "

without a drink.

If he

"and

“Others cant touch me,

worthless,

might influence Steves behavior. Probably Lfl P too hard, I must not disappoint

"

is

“I can

handle

" it,

a manic swing,

in

“People

is

probably accompanied by

“No use in trying to his

ATs are

things

quit, like,

"and “I cant 7 am great,

"

had

better be nice to me.

Modes To more fully capture the complexity of human behavior, Beck proposed the concept of the mode, which is defined as “networks of cognitive, affective, monvational, and behavioral schemas that compose personality and interpret ongoing situations” (Beck & Weishaar, 2005, p. 239). Modal information processing is largely automatic and global, that is, schema-driven, particularly in the primal modes described later. Like schemas, modes are either active or dormant; when activated, modes tend to dominate behavior in a rather automatic way.

The conscious control system can system

is

modal processing (Beck, 1996). This metacognition and intentional behavior, such as that based on

responsible lor

override

personal goals and values. Logical reasoning and long-term planning are also products of the conscious control system.

CT proposes three major mode categories: primal, constructive, and minor. Primal modes are the

most

procreation,

basic kinds of opetation

and

sociability

(Beck

and function

& Clark,

to

meet the evolutionary goals of survival,

1997). Because they are so basic to survival, they

operate rapidly and automatically. Thinking in the primal

(Beck

&

modes

is

distorted

and

rigid

Weishaar, 2005). Clark and Beck (1999) identified four primal modes, although

other sources seem to suggest others. For example, in their revised treatise

on anxiety disorder.

Beck and Emery (2004) stated that modes are “designed to consummate certain adaptational principles relevant to survival, maintenance, breeding, self-enhancement,

and

so on. Thus,

we

have a depressive mode, a narcissistic mode, a hostility mode, a fear (or danger) mode, an erotic

mode, and so on

(p. 59).

modal theory (Clark tim,

According to what

& Beck,

I

identify as

1999), the four primal

and self-enhancement. Each mode contains

affective, physiological, motivational,

in lable 10.2.

The

first

three

against threats to survival.

modes

modes

modes

earliest

formulations of

are threat, loss or deprivation, vic-

a cluster of schemas: cognitive—conceptual,

and behavioral.

(threat, loss,

one of the

A description

of these modes

and victim) evolved

The self-enhancement mode works

to protect the

in the opposite

is

shown

organism

manner

to the

enhance the survival and adaptation of the person. Beck (1996) argued that primary modes are not inherently dysfunctional because they serve to enhance human survival. For example, it is very adaptive to mobilize the organfirst

three

ism to fight or

to

flee in

the face of threat. Unfortunately for us, our

environment has

COGNITIVE THERAPY

325

TABLE

10.2

The Four Primal Modes Mode

Characteristics

Threat

Perception of threat Feelings of anxiety or anger Physiological arousal

Loss

Perception of possible or actual loss of

vital

resources

Feelings of dysphoria (depression) or sadness Fatigue or physiological deactivation

Perception of injustice or offense against the self and self-interests

Victim

Feelings of anger Physiological activation

Self-enhancement

Perception of achieved or anticipated personal gain Feelings of happiness Physiological activation

& A. T.

Beck (1999), Scientific Foundations of Cognitive Theory and Therapy ofDepression (pp. 89—91). Copyright © 1999 by John Wiley & Sons, Inc. This material used by permission of John Wiley & Sons, Inc.

Adapted from D. A. Clark

changed

from that

a bit

in

which the primary modes evolved, causing

times in which modal behavior

we encounter

plex situations

is

a

is

“mismatch”

at

not necessarily the best strategy to deal with the com-

(Beck,

1

we think of as

996). Even what

enhancement) can become exaggerated,

as

in

mania

positive

modes

(or bipolar disorder),

(self-

and

are

therefore dysfunctional.

The second These modes

class

of modes

is

termed the constructive modes (Clark

are developed primarily

sources available to the individual. characteristics

and

(d)

and include

(a)

through

They

life

&

Beck, 1999).

experience and serve to increase the

life re-

with positive emotions and adaptive

are associated

the capacity for intimacy, (b) personal mastery,

(c) creativity,

independence. As you can observe from Table 10.2, one of the primal modes

is

constructive as well, the self-enhancement mode.

The minor modes

are the third category of thinking

scious control than the other modes.

They tend

to be

and tend

to be

under more con-

narrowly focused on situations and

include everyday activities such as reading, writing, social interaction, and athletic or recreational activities (Clark

&

Beck 1999).

She thinks that he operates out of several of the primal modes that periodically dominate his cognition and behavior. First, his feelings about his

Mia

listens very carefully to Steve.

parents

and perhaps some ofhis drinking behavior seem

sometimes drinks because he

is

depressed or upset.

He

is

to flow

fom a loss mode because he

unhappy with

his irresponsible be-

poor self concept associated with the loss mode, as well as weak constructive modes. At other times Steve shows overactivation of the self enhancement mode in havior, indicating a

COGNITIVE THERAPY

326

During these episodes he is likely to be hyperactive, show irrational capacities. Steves drinking positive emotion, and have an inflated view of himself and his can also occur when he is functioning in a manic fashion, because the grandiose schemas his

manic

behavior.

associated with this

mode

include thoughts of invincibility.

him as he wishes, angry and aggressive. not treat

It

evident

is

to

Mia

his victim

that Steve

is

mode

is

activated.

When he fails or the world does At these times, he can become

able to use his conscious control system sometimes to

The operation of this system is what gets him to treatsubstance use. It is also what helps him evaluate his acting-

override his activated primal modes.

ment afier he has out behavior

relapsed into

and set goals for

the future.

THEORY OF THE PERSON AND DEVEEOPMENT OF THE INDIVIDUAE In discussing

CT

human development,

human

theorists conceptualize

functioning as the

product of learning and genetics. Drawing on literature in developmental psychology,

Beck and

his associates start

with the notion that certain personality tendencies can be ge-

netic in origin, such as sensitivity to rejection

As children, we others) create

strive to

and organize

this

make

by others or dependency (Beck

of schemas

is

Beck, 2005).

(J. S.

sponding views of ourselves and the world. set

A kid who

we

gets a lot

have,

and

The tendency

thought to be innate (Clark

Based on the amounts of positive and negative experiences

develop a positive

2004).

sense of our environments (including our selves

information into schemata

meaning through the use

et ah,

& Beck,

we develop

1999). corre-

of glowing feedback will

of schemata about himself and the world and will therefore be

Modal theory

to

less

likely to

develop faulty cognitive processes.

struct of

schemas with that of protoschemas, which are innate patterns that interact with

(Beck, 1996) replaces the con-

experience to develop the modes. Previous versions of

CT theory did not elaborate a theory of personality.

two general dispositions have been

identified,

Beck and Weishaar, 2004). Individuals in relations

with others.

Autonomous

who

autonomy and sociotropy

life

individuals emphasize mastery

&

experiences, then, will differentially affect individuals

one dimension or the

other. For example,

autonomous

acknowledge that pure types are

tendencies of both sociotrophy and

autonomy (Beck

Under normal circumstances, we tend

(Beck, 1997b;

and independence

Beck, 1999). Different

who

are oriented

an interpersonal conflict would have

ferent ramifications for a sociotrophic than for an associates, however,

recently,

are high in sociotrophy find their self-worth

and build self-esteem through achievement and control (Clark kinds of

More

individual.

relatively rare;

toward

much

Beck and

dif-

his

most people display

& Weishaar, 2004).

to operate via

simple schematic processing and

with our conscious control system (Beck, 1996). We cruise along, using minor modes to attend to everyday activities. I hese schemas are activated and have some cognitive, affective (usually mild),

(or often,

schema

if

that

you is

and behavioral

effects,

but these effects dissipate quickly. Occasionally

are dysfunctional). Information

linked to a primal mode.

When

activated, the cognitive, affective, behavioral,

eigized,

and primary modal processing

is

is

a

present that matches an orienting

match

is

made, the primal mode

and physiological systems or schemas

seen (Beck, 1996).

The

is

are en-

kinds of behavior, affect.

COGNITIVE THERAPY and cognition observed

modes

constructive

Steve appears to be

327 depend on whether the primary mode

will

love

ofothers.

is

one of the

or one of the defensive or protective modes.

more sociotrophic than autonomous

He likely grew up

wanting close

Mia

in his orientation.

his early experiences in his family resulted in the formation

ofthe

activated

thinks that

ofschemas emphasizing the value

relationships with his parents, but never

He may also have experienced the loss ofthese relationships because ofhis par-

achieved these.

ents conditional acceptance

and behavior suggest that as he and so even now, this mode and ac-

behavior. Steve's cognition

ofhis

mode may have been very alive, companying schemas are sensitive and easily activated. Also, it appears that early on, his selfenhancement primal mode was hyperactive, as evidenced by his acting-out behavior at school. loss primal

matured, the

HEALTH AND DYSFUNCTION common

“Contrary to

among

belief

psychopathology does not-ASSume: that a well-adjusted individual solves

problems rationally” (Kovacs

& Beck,

ple can function with illogical beliefs

approach to depression and

clinicians, the cognitive

and

1978,

p.

irrational

528;

is

one who thinks

italics in original).

thoughts

long

as

as

logically

Presumably, peo-

they are not creating

dysfunction. For example, one of my clients, Alex, believed that he was a flexible person.

my observation

that his cognitive

feedback from others to worth, so

this inaccurate

CT

Although functioning,

it

this effect. Fortunately, (i.e.,

appears that the

is

The

was limited. Alex had

Alex did not see

spend a

lot

flexibility as crucial to his self-

of time discussing healthy psychological

meet

his goals

on

a lot

constructive

of survival, reproduction, and

of primary

mode

are

more

show

in evidence,

and

his collaborators

many

innate, biological, developmental

one another, and so there cus in most of

CT

theory

is

no

is,

and the

J. S.

modifying the cognitive

chemical changes that

in turn

set.

The

is

ultimately

factors interacting with

single ‘cause’ of psychopathology” (p. 246).

However, the

Beck (2004) writes “the

assumes that the individual’s primary problem has to do with in

The

have emphasized an interactive view.

and environmental

predictably, cognition.

a lot

skills, too.

For instance. Beck and Weishaar (2005) contend that “psychological distress

lies

We can

able to use the conscious control system to moderate schematic processing.

In viewing dysfunction. Beck

remedy

processing

sociability.

processing and don’t

modes of processing

healthy person probably has fairly good problem-solving

caused by

also received

CT version of health would include information

infer that healthy folks don’t rely

of distorted thinking.

flexibility

was

It

not consensually validated) belief was not dysfunctional for him.

theorists don’t

that allows the individual to

individual

and behavioral

and

his construction

fo-

cognitivist

of reality. The

psychological modification then produces bio-

can influence cognitions further”

(p.

200). Despite this strong

statement. Beck does allow that pharmacological interventions can cause cognitive-neuro-

chemical change. Writing specifically about depression. Young, Beck, and Weinberger (1993)

put

it

this

way: “The pharmacotherapist intervenes

apist intervenes at the cognitive, affective,

when we change behavior,

depressive cognitions,

at the

biochemical

and behavioral

we

levels.

Our

level;

the cognitive ther-

experience suggests that

simultaneously change the characteristic mood,

and (we presume) biochemistry of depression. The exact mechanism

however, remains a target of considerable investigation and debate”

(p.

241).

of change,

COGNITIVE THERAPY Very early

Beck (1976) identified

in his theoretical journey,

number of

a

problems that are characteristic of depressed individuals

(see Figure 10.1).

distortions remain important theoretical constructs in

CT

outlined in Figure 10.1

much

is

Each of the problems

theory.

was oriented

concept

to depression, another useful

cognitive triad, which refers to the depressive’s negative views of the

&

These cognitive

followed by an example of Steve’s cognitive distortions. Because

of Beck’s early thinking

the future (Kovacs

cognitive

the

is

the world, and

self,

Beck, 1978).

Distorted thinking results from faulty schemas and their associated core beliefs.

Young

and colleagues (1993) described the “deepest” type of schemas, the early maladaptive schemas (p. 242). These cognitive structures develop very early in life as a result of

most notably those with

interactions with the surrounding environment,

After the

schema

created,

is

it

can be activated by environmental or internal events, and

information processing becomes selective is

— information

that

admitted to awareness, whereas inconsistent information

way, the maladaptive schema

These schemas

examined by the

is

is

is

consistent with the

schema

distorted or rejected. In this

maintained.

connected to significant emotional responses, and

are resistant to change,

client,

significant others.

perceived as absolute truths (Young et

aJ.,

1993).

A client would sim-

way I am!” An example of such a schema might be called the rotten son schema. This person would be totally convinced that he can’t do anything right and ply say, “That’s just the

others hate him. that

J. S.

would be seen

Beck and

Beck (2005)

broad categories of negative core

identifies three

in a rotten person

colleges, over the years,

if

perthat

self-beliefs

schema: helplessness, unlovability, and worthlessness.

have identified specific ways of thinking and perceiving

Beck

that are characteristic of various psychological dysfunctions.

calls

this

idea the

cognitive specificity principle (Beck, 2005). In anxiety disorders, for example, the individual

is

hypervigilant, focused

on

signs of danger or threat (Beck

Automatic thoughts of threat and harm come specific beliefs are seen in

stand the

easily

drug-abusing clients

boredom without

my

and

who

often.

&

Emery, 2005).

Other examples of dysfunction-

harbor “need”

drug” (Beck, 1993). Individuals

beliefs

who

order are thought to have both depressive beliefs and beliefs such

such

as, “I can’t

display bipolar dis-

as, “I

have exceptional

powers and should use them” (Beck, 1993).

The

idea of cognitive specificity allows the extension of

psychological dysfunction.

&

panic disorder (Beck disorders (Edgette

&

Much

Emery, 2005). Other conceptualizations have focused on eating

Prout, 1989), substance abuse (Beck, Wright,

&

1

996; Clark

of psychological dysfunction in overactive primal

the protoschemas for primal modes. 1

and endowed with energy

it,

A

particular

(or

mode

is

mode

;

Beck, 1996,

generally silent or latent at

some psychopathological conditions

for

chronically but stibliminally charged so that

minor

stressful

&

Eiese,

1

999) locates the source

(Beck, 1996).

We are all born with

p. 8).

are constructed

A series of experiences relevant to

being fully activated and operative. As Beck explains

periences can receive incremental charges until

tively

modes

& Beck,

hrough experience, the primal modes

charged

will result in the

Newman,

Rector, 2000; 2005).

Fhe revision of CT proposed by Beck (Beck,

mode

theory to various kinds of

attention has been paid to anxiety disorders, including

1993), and even schizophrenia (Beck

a specific

CT

event (the kindling

it

first,

but through successive relevant ex-

reaches the threshold for

full activation.

example, recurrent depression it

—

the

mode

In is

can become fully activated after a compara-

phenomenon)” (Beck, 1996,

p. 8).

1

.

All

dichotomous thinking). Life is gray are allowed. Steve believes that he must

or nothing thinking (black-and-white, polarized, or

seen in rigid categories; no shades of be perfect in the eyes of important others 2.

The

maintain self-respect.

to

viewed as a disaster; other kinds of outcomes are not considered as even remote possibilities. Steve is sure that the future holds nothing but gloom; he will never get a job he likes nor regain his Catastrophizing (fortune

telling).

future

is

relationship with his mother. 3.

Good

does not count! Steve downplays his previous successes. He does not acknowledge that, despite his slips, he has been Disqualifying or discounting the positive.

able to get himself to treatment

and is

stuff just

currently doing well in the work-therapy program.

4.

Emotional reasoning. Because of the emotional investment in an idea, it is seen as true, regardless of discrepant information. Steve is deeply hurt by his mother’s disowning him and feels certain that she is right; he is worthless.

5.

Labeling.

6.

Magnification/minimization. Negative information

A

made

Although Steve says he accepts himself, his reports that he worries about the opinion of his parents suggest that he may not be as self-accepting as he says he is. He may be rating himself negatively, which would be consistent with his early experience. global rating

is

(of self or other).

ignored or minimized. This kind of thinking

is

is

highlighted; positive information

is

the opposite of wearing rose-colored

Steve makes a mistake at work, he worries terribly that he’ll be perceived as a bad worker and get fired. He does not attend to the things he does well at work.

glasses.

If

7.

Mental filter (selective abstraction). One negative detail is attended to, resulting in a conclusion that does not consider other factors in a situation. Steve’s supervisor was curt with him, and Steve concludes that his supervisor is angry or unhappy with him. He does not consider that his supervisor has many other demands on her, and that she was brisk with other workers as well.

8.

Mind reading. Need this one be described? Steve believes he knows exactly what mother and father think of him.

9.

Overgeneralization. justified

The conclusion (usually negative) becomes larger than is by an event. Because Steve has not succeeded in staying “dry” previously,

he concludes 10.

that

he

will

never be able

to

achieve his goal of sobriety.

Personalization. Another person’s behavior

is

attributed to oneself without

considering alternative explanations. Steve’s supervisor announces a

work

—anyone who gets angry must leave

was made 1 1

.

his

in

response

to his

outbursts

for

and

one

hour. Steve

new

assumes

rule at

that the rule

feels depressed.

Should and must statements. Rigid rules for life, which, if not met, create a catastrophe. Steve believes that he must be perfect so that others will love him. Others must not show disapproval of him.

A narrow

focus on the negatives. Steve sees his life in terms of his immature behavior, substance abuse, and cycles of mania and depression. He fails to recognize his strength in getting help and trying to turn his life around. He also

12. Tunnel vision.

ignores his successes

FIGURE

in his

current working environment.

Cognitive Distortions. Adapted from Cognitive Therapy: Basics and Beyond (p. The Guilford Press. Adapted with permission. 10.1.

1

19) by

J. S.

Beck, 1995,

New

York:

329

COGNITIVE THERAPY

330

TABLE

10.3

Modes and Diagnostic Categories: Primal Systems Cognitive

Affective

Behavioral

Features

Features

Impulse

Disorder

Physiological Activation

Specific phobia

Specific danger

Anxiety

Escape

General fear

Generalized

Anxiety

Escape, avoid,

danger

Autonomic nervous system

inhibit

Threatened,

Hostility

Autonomic nervous system

or avoid

Anger

Punish

Autonomic nervous system

Sad

Regress

Parasympathetic activation

wronged Depression

Loss

Adapted from “Beyond P.

M.

Belief:

A Theory ot Modes,

Personality,

Salkovskis (Ed.), Frontiers of Cognitive Therapy, 1996,

According the

DSM-W,

and the

and Psychopathology,”

New York: The

to Beck, the various categories of psychological for

example) can be understood

characteristic “goal” of the

mode

threatens the organism’s livelihood,

in

(1996,

in

Guilford Press.

dysfunction

terms of the specific primal

(as classified in

mode involved

For example, in depression, the

p. 8).

and the behavioral inactivation so

common

loss

to depres-

means of preserving the organism. Further, depression is typically accomweak constructive mode, so the individual probably has poor self-concept and

sion represents a

panied by a

a decreased ability to

think constructively (Beck, 1996). Table 10.3 shows Beck’s (1996)

conceptualization of the psychological disorders and associated that

Beck includes

for excessive violence

Recently,

diagnosed

as

CT

among

hostility

modal functioning. Note

these because he believes that

it is

needed

to

account

and homicide.

theorists have

become

work with invoke modal

interested in the struggle to

having personality disorders. Although she doesn’t

clients

theory,

Beck (2005) notes that “cognitive therapists view the development of Axis II disordeis as the result of an interaction between individuals’ genetic predispositions toward

J. S.

ceitam personality

traits

have been born with a

Mia

and

flair

their early experiences.

dim view ofhimself

him,

and his

Mia

guesses that although Steves loss

perception that the world

charged because he evidences mild depression. Because

for example,

may

for the dramatic” (p. 4l).

thinks that Steves most active schema

negative triad in his

A histrionic patient,

is

He

shows the

his perception that others dorit like or

approve of

the depressogenic schema.

diffcult

mode to

is

is

and the future

somewhat

intermittent

is

uncertain or negative.

active at present,

and

it is

not fully

moderate, rather than severe,

of Steves apparent sociotropic orientation,

Mia

will be on the lookout

f)} interpersonal situations that could set off more extreme modal processing. Steves loss primal mode was probably sensitized by his early experiences with his parents. They were distant in their interactions with him, and he interpreted the distance as rejection based on his inadequacy and had behavior. The

victim

mode might

Steves situation as well because he sometimes sees himselfas the scapegoat (for instance, in the automobile accident). Steve

may

tendencies toward passive, depressive types

of behavior.

also

be relevant

to

ofan unfair world

have been born with genetic

COGNITIVE THERAPY When

Steves

loss

331

mode

withdraws and drinks

activated, he

is

to escape.

He

shows

why

evidence ofcognitive distortion in this situation fids no use; I cant do anything right;

bother to try

to stop

drinking when the ivorld is so awful”), low motivation,

inactivation. If Steves victim

mode

may feel threatened and angry, Occasionally, Steve enters a

mode. At these times, he

too.

is

these times,

he

may seem

manic phase that resultsfrom

may drink

ofsome

also activated by his perception

At

and behavioral injustice,

energized by the anger.

activation

ofthe self enhancement

He

because he believes himself invincible.

because he has an exaggerated sense of his power. If his victim

he

mode becomes

acts out

activated at

may physically attack the person or entity perceived to be threatening him. When the manic mode is active, he probably has automatic thoughts such as, “what the ” ” hell, “one drink is fine, ” and “everyone loves me. the

same

time, he

NATURE OF THERAPY Assessment Both formal and informal assessment

used in

is

CT Newman

and Beck (1990) strongly

encouraged a formal comprehensive diagnostic evaluation for three reasons: understand the psychological picture of the

drome

involved, and

is

(c) to assess

the goal of the assessment

2005; Persons

is

& Tompkins,

determine

client, (b) to

if

(a) to fully

any organic syn-

the need for medication or hospitalization. Ultimately,

a structured cognitive case conceptualization

1997). Often, a special session

prior to the official start of counseling

(J. S.

(i.e.,

Beck, 1995).

intake)

The

initial

Beck,

(J. S.

1

995,

used for assessment

is

evaluation generally

DSM-W diagnosis. Formal assessment in CT often involves using standardized self-report inventories such

results in a

as

formal

the Beck Depression Inventory (BDI; Beck, Ward, Mendelson,

Beck Anxiety Inventory (BAI; Beck, Epstein, Brown,

&

Steer,

& Erbaugh,

1961), the

1988), the Automatic

Thought Questionnaire (ATQ; Hollon & Kendall, 1980), or the Dysfunctional Attitude Scale (DAS; Weissman & Beck, 1978), which measures schema-related core beliefs and assumptions. The latest of these tools seems to be the Beck Cognitive Insight Scale (Beck, Baruch, Balter, Steer, & Warman, 2004). Numerous other instruments have been constructed for cognitive assessment; an excellent review of these and their psychometric properties

presented by Blankstein and Segal (2001). These instruments are often used

is

intermittently throughout counseling to assess progress (Persons

CT

& Tompkins,

1997).

counselors are most interested in assessing their clients’ thoughts, and they do this

continually throughout therapy.

The

simplest

way

to

make

this

assessment

the client, “what was going through your mind?” either in reference to a session, or In helping clients reconstruct situations outside

the Dysfunctional Attitude Scale or Automatic

to

is

simply ask

mood change

of therapy. As

noted

I

Thought Questionnaire can

In

earlier,

also

be used

session ol

Cd, the

for this purpose.

Cognitive assessment leads to client

is

a

formal treatment plan. In the

asked to establish goals; the therapist helps the client to

concrete.

The

perspective

CT

(J. S.

first

make

these specific

counselor then takes each problem or goal and analyzes

Beck, 1995; 2005).

J. S.

it

from

a

and

CT

Beck’s recent writings emphasize the creation of

a formal cognitive conceptualization for each client, using a format she specifies in her

recent

book (2005).

COGNITIVE THERAPY Depression Inventory to assess his current level ofdysphoria. She

Mia gives Steve the Beck finds that he

moderately depressed. She also spends time in the first (and later sessions)

is

and later his core beliefs. She considers using the Dysfunctional Attitude Scale to assess his core beliefs and assumptions. helping Steve identify his cognitions, first his automatic thoughts,

Overview of the Therapeutic Atmosphere

CT

Advocates of

&

(Reinecke

CT

is

agree that

it is

and psychoeducational

structured, active, collaborative,

Freeman, 2003). Cognitive, behavioral, and imaginal techniques are used.

characterized by a collaborative relationship between client

and counselor (Beck

&

Emery, 2004). Cognitive therapists recognize the importance of the therapeutic relationship,

sounding trust,

much

like

person-centered theorists in their emphasis on warmth, genuineness,

and respect (Newman

& Beck,

1990).

J. S.

Beck (2005) and Beck and Emery (2005),

however, note that the therapist must be alert to signs from the client that the nature of the relationship needs to be modified. For example, highly sociotropic clients

might need more

warmth from the therapist than would those lower on this dimension (Beck & Emery, 2005). The CT relationship is seen as different from other counseling relationships because it emphasizes a scientific approach (Beck, 1997a); the relationship

on

said to be based

is

& Weishaar, 2005). Client and counselor are co-investigators the scientific study of the client’s difficulties (Reincke & Freeman, 2003). The client’s

collaborative empiricism (Beck in

schemas,

beliefs,

and automatic thoughts

scientists

(Young

et ah,

ducted to

test

1993). Evidence

are treated as hypotheses to be tested

gathered and experiments are designed and con-

is

the hypotheses.

Alford and Beck (1997c) discussed the role of interpersonal support in CT. tained that the therapist to

become

feelings,

must create “responsible dependency”

passive in the relationship (p. 107).

of the client to learn efforts to

by the two

and implement the

Support

in

in the client; the client

are

is

not

CT means support of the efforts

CT model in his life. The therapist makes genuine

understand the client and accepts the client in the sense that

and behaviors

They main-

all

client cognitions,

openly examined for their advantages and disadvantages (Alford

&

Beck, 1997c). Fiowever, the cognitive therapist does not accept certain client actions and goals

when

they are considered antisocial

Beck (1976)

calls

CT

a

(e.g., illegal acts,

common-sense therapy

abuse of others).

that simply helps the client apply

problem-solving techniques that he has used in the past to correct the current faulty thought processes.

CT

is

typically a short-term intervention, ranging

Beck, 1996). For

more

from 10

to

severe problems (e.g., personality disorders),

20

sessions (Wright

CT can

&

be longer, but

considered a comparatively brief approach to these dysfunctions. Booster sessions are often scheduled after formal termination to help prevent relapse S. Beck, 1995). it is still

(J.

Mia

approaches Steve in a friendly,

sponds empathically

warm

to his description

way. She

of his

ings

and

behavior.

Mia

accepting of him

troubles, hopes,

build a relationship based on the idea that she world, testing out the conclusions he draws

is

and

Steve

re-

and dreams. Mia attempts to will look at how he views the

and determining

expects that if Steve becomes

and sometimes

engaged

their relationship to his feel-

m

their scientific counseling

he will he in therapy for about 6 months. However, the length ofSteves counseling will likely depend on what goals he sets.

project,

COGNITIVE THERAPY

333

Roles of Client and Counselor who

In

CT, the counselor

&

Beck, 1997c). In this way, the relationship somewhat resembles that of doctor-patient.

an expert

is

Theory (Alford

teaches the client about Cognitive

Judith Beck characterized the cognitive therapist as simultaneously caring, collaborative,

and competent (1995,

p.

The

304).

the therapy process (Wright

&

counselor typically

is

very active, particularly early in

Beck, 1996). Cognitive therapists ask their clients a lot of

questions and are very likely to assign tasks related to the clients’ identified problems. the client

Initially,

is

a student

who

is

expected to work hard to learn about CT.

rect

input

is

&

(Wright

Beck, 1996). As therapy progresses, the client

what happens

and behaviors,

the client

Mia

setting the session agenda,

is

homework assignments

CT

explanations for his

and developing homework

CT theory applies to

di-

expected to take more and more

developing

in counseling sessions,

becomes an expert on how

whose

a collaborator in the counseling process

always solicited in setting session agendas and selecting

responsibility for feelings

is

is

homework

expected to devote energy to examining his thought process, and to complete assignments. At the same time, the client

He

him

(Alford

tasks. In essence,

& Beck,

1997c).

takes a straightforward, educative approach with Steve. She explains the cognitive

model

to

him

in the first session, attempting to get

him

to

understand and accept the system

and engage collaboratively with her in the process ofCT. She gives Steve a pad ofpaper and a pen and encourages him to take notes about the model. Mia is very aware that it will be important type

who

is

to establish

a good working relationship with Steve because he

sensitive to the evaluations

ofothers. She

is

is

a sociotropic

supportive ofhis efforts to learn

and

apply the model.

If Steve responds well

of CT. Steve will work

to

in

Mias

invitation to participate, he will become a

tandem with Mia

good student

to identify his cognitive processes

and

to

how they relate to his feelings and behavior. He will follow Mias instructions his sessions and complete his homework assignments. The two will engage in collaborative

understand in

empiricism, testing Steve’s ideas in a

CT model.

Goals The

goals of

beliefs that

CT

are to identify

and change

faulty information processing

(J.

to

modify

support psychological dysfunction to ones that are more adaptive (Beck

Weishaar, 2005). Typically, a good deal of this work focuses on the

thoughts

and

S.

Beck, 2005).

client’s

Through addressing automatic thoughts,

schemas are sometimes accessed, but significant change quire longer-term therapy than

is

typical in

CT.

A

in these

automatic

basic beliefs or

deeper structures

broader goal of

CT

&

is

may

re-

to teach clients

problem-solving strategies that they can use across situations. Altering faulty core beliefs and the associated schematic change, although difficult,

should prevent relapses (Young based on

et ah, 1993).

reflective, constructive processes

The

idea

to be deactivated

is

& Clark,

1997).

and the more adaptive modes need

Weishaar, 2005). Modifying the content of the modes adaptive behavior, which

to get the individual to operate

through the use of the conscious control system,

or metacognition, rather than primitive schemas (Beck

modes need

is

is

yet another

I

he dysfunctional

to be built

way

(Beck

to achieve

achieved through addressing core beliefs and schemas.

&

more

COGNITIVE THERAPY

334 Steve

is

harboring some faulty

beliefs

Mia

that need to be modified.

helps

him

identify

and then replace them with more fiunctional beliefs. For drastic. instance, the AT that 'ho one loves me” needs to be replaced with something less Mia is sure that Steves self enhancement primal mode needs to be strengthened. This

his

automatic thoughts (ATs) first,

mode gets exaggerated (when he

is

is

between these two

trol system to discriminate

ways

aware that sometimes Steves functioning based in this manic). Steve will need to learn to use his conscious con-

Mia

process will be tricky because

deactivate or de-energize his primal

to

states.

loss

Mia

decides that Steve needs to

and victim modes and to

find

use his conscious

modal processing when it occurs. Mia targets Steves problematic ATs and intermediate beliefs as a way to start this process. Later in therapy, he can begin to examine his core beliefs, schemas, and primal mode content and process.

control system to interrupt this

PROCESS OF THERAPY CT can

be seen

moving through

as

sessions, behavioral activation

is

three general stages

turns to specific automatic thoughts Finally (and

some

Once

important.

and

(Dobson

& Shaw, some

the client has

work

energy, the focus

emotion and behavior.

their relationship to

clients never get to this stage), the

1988). In early

turns to the

more complex

level

of schematic processing. In the

first

session of therapy, three goals are considered critical: establishing the

ing relationship, goal setting,

and

socializing the client

and colleagues (1993) added that rapport the therapist can create

enhanced and the

is

some quick symptom

&

(Newman

Beck, 1990).

client’s suffering

problems and improve their mood” (2005,

Each

CT

is

if

is

to help patients

A second

important part

teaching the client about the structure of counseling sessions.

session can he partitioned into seven segments

date, (b) bridge

reduced

p. 67).

Socialization involves directly teaching the cognitive model.

of the educative process

Young

meeting. Judith Beck agreed,

relief in the first

writing that “one of the best ways to strengthen the therapeutic alliance solve their

work-

from the previous

(e)

discussion of the issues,

(p.

25).

(f)

(J. S.

Beck, 1995):

session, (c) setting the agenda, (d) review

devising

new homework, and

Although most of these segments

are easily

(g)

(a)

brief up-

of homework,

summary and feedback

understood given their

labels,

two

comment. In the “bridging” stage, the counselor checks to see if the client understood what happened in the previous session. The summary and feedback segment

deserve extra

includes the therapists

summary of the

session, but also the

evaluate the session. According to Judith Beck, the Is

there anything

(1995,

I

said today that

opportunity for the client to

CT counselor

is

likely to ask the client.

bothered you? Anything you think

I

got wrong?

’’

p. 58).

Guided discovery has an idea (based

describes the process of

CT

(Beck

& Weishaar, 2005). The therapist

on her cognitive conceptualization) about where she wants the

client to

end up, and through her questioning helps the client to get there (Beck, 1997a). Persons and lompkins (1997) put it another way: The goal here is for the patient to discover the answers she needs, guided by the therapist (p. 328). Along the way, the therapist checks with the client often to see seling

(I

ersons

&

they are in agreement on the goals and activities of the counlompkins, 1997). In Judith Becks (1995) model, the counselor asks for

the client’s feedback at the

if

end of each therapy

session.

COGNITIVE THERAPY As counseling

what happens

335 and the

progresses, the counselor takes less responsibility

in sessions.

The

therapist begins to take

on an advisory

become

his

therapy terminates

Beck, 1995).

(J. S.

CT therapists recognize the existence of transference, the goal in CT

Although

these reactions to a

minimum

therapist explore the cognitive process

Beck and

noncompliance.

it

& Associates, They

the therapist

reactions in therapy,

may wonder “why

and

is

and

suggested

it is

and unclear or

many

possible reasons for

unrealistic therapy goals.

important for the therapist to be attuned to the clients

modify her

many clients

wasting

style to

match the

proclivities

my time

telling J.

me

Beck

S.

about

his

problems?”

discusses difficulties in the

when

a specific belief about the therapist or

and avoid bonding with the

one about people

be overly protective and defensive.

therapist, or

intervene with standard

construct of transference”

CT techniques. Reinecke and Freeman (2003)

(p.

241)

—

that

is,

is

there are times

employs outside of therapy.

If this

similar to the

when

become more aware of these

reactions

happens, the

and change them (Reinecke

CT

therapist does not

tries to

help the client to

& Freeman, 2003). and

also discusses therapists’ dysfunctional reactions to clients in

which these can be addressed, such

as

psychodynamic

the client behaves in ways

attempt to deepen and elaborate upon the transference, but instead

number of ways

the ther-

For example, the client might harbor the core belief of helplessness,

in general.

similar to those he

the client’s

When the problem is found to be the client’s belief system, it is

of the

but some

like counselor-self disclosure,

note that “the cognitive construct of schema activation

Beck

it.

social-

to correspondingly

determine whether

The therapist can then

J. S.

refutes

both believe the situation to be hopeless), poor

client

this therapist

beliefs affect the alliance.

vulnerable,

and

1990) discussed client resistance

therapeutic alliance, recognizing that these can stem from therapist errors or

feel

client

beliefs

book on Challenging Problems (2005),

and the world

& Beck,

about change), client and therapist dysfunctional

For example, she maintains that

apist needs to

keep

Among these are lack of collaborative skills on the part of the client or coun-

Beck (2005) emphasized that

In her

—

and the evidence that supports or

ization of the client, mistiming of interventions,

client.

any other hypothesis

treated like

in collaboration.

selor, client factors (stress, beliefs (e.g.,

around

Freeman,

his colleagues (Beck,

under the heading of problems

it is

to

is

through the use of collaborative empiricism (Wright

1996). If client transference does appear,

J. S.

to help

is

own counselor (Newman & Beck, 1990). Clients are even encourconduct their own “self-therapy” sessions, following proper CT structure, after

the client

match

for

con-

role as the client

ducts therapy (Young et ah, 1993). Ultimately, the aim of the cognitive therapist

aged to

more

client

identifies a

attending to the competence of

the therapist, assessing one’s expectations for clients (are they too high or low?) giving feed-

back and setting

limits,

and practicing good

referred to a different therapist

Mia and

Steve begin their

(J. S.

self-care. In

work with Steve learning

and behaviors (the cognitive model). Mia asks counseling, and he replies that he wants to get his life what

(b) acting in

“getting his life together” means. Steve

more mature ways,

(c)

cases, the client

lists

the relationships

be

among

what he wants to get out of together and get a good job. Mia

the following (a) staying abstinent,

being less depressed and lethargic (ivhich

his initial presentation

thoughts,

Steve

with his drinking), (d) establishing a better relationship with his parents,

about himself (despite

may

Beck, 2005).

feelings,

explores

extreme

ofself acceptance), and

(f)

is

also

(e)

connected

feeling better

getting a job.

COGNITIVE THERAPY

336

^€t St€V€ to bc spocijtc dbout his dijjiculttcs. She usks hiw. whut uctifi^ ''immature” behavior are. He gives several examples: He yells at coworkers when

Ivfiu stTu^^lcs to

out”

and

he

frustrated.

is

He has walked off the job when unhappy

when his way

example,

his supervisor

not get

in

Although

would like

his

to

is

dissatisfied

with

how

with his performance).

things were going (for

He pouts when

group discussions at the residence facility where he lives. current level of depression is not as severe as it has been in the past, Steve

work on ways

to

deal with possible intensifications ofdepression in the future.

He and Mia decide that setting some goals about depression would be Mia and Steve establish the following treatment plan: Develop

1.

and automatic others,

beliefs

including his parents.

Problem-solve about

3.

mode, primarily). Evaluate dysfunctional

loss

beliefs

thoughts associated with drinking.

Help Steve identify and evaluate with

appropriate.

strategies to help Steve stay abstinent from drinking. Identify situations that trig-

ger drinking (those that activate the

2.

he does

and

thoughts about himself and his relationships

Work on ways

“acting-out” behavior.

associated with situations in

which he feels

Construct alternative strategies

to

improve these

Identify

criticized

beliefs

(i.e.,

the

relationships.

and automatic thoughts victim mode is operative).

to use in these situations.

and evaluate cognitive structure and processes that are active when he is depressed (the depressogenic schema and associated belief and automatic thoughts). Develop job-search behaviors and implement them. Examine cognitions around these behaviors. Examine Steves depression.

4.

5.

Identify

Mias cognitive case conceptualization is shown in Figure 10.2, which guides her work with Steve. She helps him with his struggles, asking questions that orient his explorations (guided discovery). Mia gently encourages Steve to take responsibility for choosing topics to put on the agenda, and to take the lead in applying the cognitive model. In each session, they follow the

steps

of the

CE model:

(a) Steve gives

a brief update on his situation, (b)

Steve relate the previous session to the present,

review the homework,

homework, the session.

(e)

They discuss the

(c)

issues

Mia and Steve set on the agenda,

Mia and

the agenda, (d) They

(f)

They construct new

—how he

Mia summarizes the session and asks for Steves feedback Both Steve and Mia offer input. (g)

felt

about

THERAPEUTIC TECHNIQUES Beck advocates the

flexible use

dyshmctional thought

is

& highly eclectic, but not theoretically ‘neutral’” (Alford &

appropriate

Beck, 1990).

Cognitive therapy

Beck, 1997a,

p. 90).

oped

of techniques; almost any ethical technique that attacks

is

if

the counselor

and

client agree

on

its

use

(Newman

Techniques are selected to serve the overall conceptualization devel-

via cognitive theory (Alford

&

Beck, 1997a).

Techniques can be selected from other psychotherapeutic approaches, provided that the following criteria are met: (I)

and

The methods

are logically related to the theory

are consistent

with cognitive therapy principles

of therapeutic change;

(2) the

choice of techniques

is

based on a comprehensive case conceptualization that takes into account the patient’s characteristics

(introspective capacity, problem-solving abilities, etc.);

empiricism and guided discovery are employed; and

(4) the

(3)

collaborative

standard interview structure

is

Counselor: Mia

Client: Steve

Presenting Problems

Date: 6-12-06’

Alcohol use, immature behavior, acting out,

sadness/depression, unsatisfactory relationships.

Relevant History

school (“acting up”), family turmoil (distant

Difficulty in

parents, parental divorce), diagnosis of bipolar

disorder at age 25, serious automobile accident, alcohol problems resulting in multiple courses of inpatient treatment,

Modes, Core Beliefs, and Schemas

breakup

Loss, victim, overactive self-enhancement modes.

Self-schema negative the world

is

won’t treat

(“I

am

me

well anyway”).

Others disapprove “If If

I

don’t

a Situational Factors

keep

my

is

will

Values the approval of get it (“I must be loved.

of me.”).

parents happy, then

others don’t treat

world

worthless”). Believes that

generally hostile and unforgiving (“Others

others but doubts that he

Conditional Beliefs

of significant relationship.

me

a rotten place.

they are

well, If

am

I

I

am

evil

worthless.

and the

not perfect at work,

I

am

failure.”

When

others

criticize, interactions

with parents,

perceived failure of any kind.

Automatic Thoughts

and Beliefs

Associated with loss mode: “No one loves me; I’m a failure and worthless; must be perfect; must not get angry; it’s no use; can’t do anything right.” Associated with victim mode: “Others are mean to me; others won’t give me a break.” Associated with self-enhancement mode: “I’m invincible; others can go to hell.” I

I

I

Emotions

Sadness and depression, anger and environment, exhilaration

in

irritation in

work

manic phases.

When

depressed, becomes lethargic and may drink. In victim mode, can behave angrily and disrespectfully to

Behaviors

others. Social/assertiveness skills

may be

weak?

Integration/Cognitive

Bipolar tendencies

Construction of Current Presentation

They are associated with loss, victim, and selfenhancement modes. Negative self-schema is a function of sociotrophic tendencies combined with early family environment and relationship with parents. Primal modes were also shaped by these factors. Different modes, when activated, are associated with emotions, behaviors, and cognitions as indicated earlier.

partly biological in origin.

Alcohol use appears

in

either loss or self-

enhancement modes.

FIGURE

10.2.

CT Case

Formulation for Steve.

337

COGNITIVE THERAPY

338

Followed, unless there are factors that argue strongly against the standard format. (Alford

Beck, 1997a

p.

91)

Both cognitive and behavioral techniques are used in CT. that changes client cognitive structure are used in the interest

is

Homework is

in this section

The beliefs,

new

(i.e.,

skills

and automatic thoughts

CT focus

(e.g.,

Leahy,

mov-

(such as assertion or problem-solving

many of the

techniques described

homework assignments (Beck

can be transformed into

term for anything

to get a severely depressed client

considered essential in CT, and

majority of presentations of

A general

cognitive restructuring. Behavioral techniques

of behavioral activation

ing as in activity scheduling) or to teach training).

&

& Emery, 2005).

on modifying or eliminating schemas, core Beck,

J. S.

&

Beck, 2005;

Beck, 1995;

J. S.

2005). Beck and Weishaar (2005) identified 3 ways to deal with dysfunctional modes: “(1) deactivating

them,

more adaptive modes

modifying

(2)

to neutralize

their content

them”

(p.

and

structure,

and

(3)

constructing

240). According to Beck (1996), corrective

information from the counselor activates a “safety”

mode that contains more

functional be-

and pleasure

Basic cognitive-behavioral interventions that emphasize mastery

liefs (p. 16).

modes (Beck, 1996). Other interventions are oriented toward protective primal modes. Routes to modal change include changing the situation (e.g., from dangerous to benign), distraction, and reassurance

build or strengthen adaptive

deactivating the appraisal of the

from the counselor the situation).

(i.e.,

corrective information leads to

The most

significant

ing the underlying beliefs in the

change

mode, the

in primal

&

and

is

client interprets

through chang-

modes and deactivation of dysfunctional

who

impending heart attack changes two

beat always leads to heart attack

how the

modes, however,

Weishaar, 2005). For example, a client

heartbeat as the sign of an

in

rules the individual uses to interpret the world,

rhis belief change results in activation of adaptive

modes (Beck

change

(b) that

he

is

a

initially interprets a rapid beliefs: (a) that

good candidate

rapid heart-

for a heart attack

(when

he has very few risk factors).

Following are descriptions of some of the techniques typically used in CT.

Questioning One

of the most prominent techniques in

interventions in

when

CT

is

to ask the client,

CT

is

questioning. In

one of the most

“What was going through your mind

the counselor notices a change in the client’s affective state

1 he idea

fact,

(Newman

basic

right

now?”

& Beck,

1990).

emotions are good indicators of the presence of automatic thoughts. Socratic questioning refers to the strategy of asking leading questions so that the client

comes

is

that

to the

Cognitive Therapy conclusion (Beck

cognitive therapists

is,

“Where

is

& Emery, 2005). A favorite question of

the evidence for this thought/belief?”

It is

the counselor’s

job to devise questions that help clients alter their current views to “a state of inquisitiveness and curiosity” (Wright Beck, 1996, 1021).

&

p.

Six types of questions are considered effective in helping clients test (J. S.

Beck, 1995,

p.

109):

(1)

What

is

the evidence? (2)

Is

automatic thoughts

there an alternative explanation?

What is the worst that could happen? Could live through it? What is the best that could happen. What is the most realistic outcome? (4) What’s the effect of my believing the automatic thought? What could be the effect of changing my thinking? (5) What should do aboLit it. (6) What would tell [a friend] if he or she was in the same situation?” (3)

I

1

I

COGNITIVE THERAPY

339

Mia

asks Steve

after

some consideration, that sometimes he

about what goes through

his

mad at

head when he gets

thinks, “they are

mean” and

“Do you deserve the

the job. up.

and are mean. He criticisms'” asks

replies Steve.

Mia

what evidence

replies that they criticize his performance

Mia.

“Well, yes, ” Steve replies,

“But does that automatically mean that they hate you?” Mia

”,

reports,

“they hate me. ” At

other times he thinks, “I screwed up” or “I cant do this job. ” Mia asks Steve

he has that others hate him

He

work.

“I

asks. “Well,

on

did screw

I guess not,

”

then follows with “Whads the effect of thinking that people at work are

mean and hate you?” Steve acknowledges

that his belief leads to easily triggered anger

and

subsequent “immature” behavior. Aferward, he finds himself depressed.

Downward Arrow This technique

used to identify core

is

amining thoughts

beliefs. It

relatively close to the “surface”

a key automatic thought

is

is

so-named because the

therapist starts

and proceeds downward

identified that the counselor thinks

is

counselor then asks the client what this thought means, assuming

related to a core belief true.

it is

lief

to

Repeating

asks Steve to

examine the belief that

directs Steve to

means that

assume

this

is

true

his parents think

he

”

is

an

and asks him what it means

his parents think badly

a person and worthless.

ques-

Beck (1995) noted

client leads to a core belief (p. 145).

of him. “OK, so assume that mean, that they might think badly ofyou?” Steve replies, as

this

The

the client often leads to an intermediate be-

whereas asking what the thought means about

Mia She

what the thought means

ex-

to core beliefs. First,

tion for each client response will eventually lead to the core belief Judith that asking the client

by

alcoholic manic-depressive.

to

him. Steve divulges that

that’s true,

“Well, it

”

Mia

“What

says,

it

does

means that I am a failure

Mia and Steve have identified a dysfunctional core

beliefor schema.

Thought Recording Cognitive therapists almost always instruct clients in some form of thought recording

(Wright

&

Record (DTR), which client the

One commonly

Beck, 1996).

DTR

used instrument

is

the Dysfunctional

shown in Table 10.4 (J. S. Beck, 1995). The counselor gives the home, asking him to record various occurrences of ATs between

is

to take

counseling sessions. At the next session, counselor and client review the client

s

Thoughts

responses to the ATs, and

work on

DTR,

evaluate the

alternatives, if necessary.

Steve records his automatic thought that occurred afier disagreeing with a coworker. Sue.

Thinking

“she hates

me” leads

to Steves sadness.

Mia and Steve

review the form

and

find that Steve did not really convince himself with the adaptive response he devised, although he did feel less sad. Mia and Steve work to find a response that will help Steve further reduce the sadness or eliminate

it entirely.

Behavioral Experiments Behavioral experiments are assignments that are tailored to a specific

and

belief.

client design a task or activity that challenges a faulty cognition

2005). For example, Nancy, activity that

who

believes that she has

might possibly be fun, such

as

no fun

in

going to the zoo. She

life, is is

The

(Beck

therapist

&

Emery,

asked to pick one

asked to go to the zoo

COGNITIVE THERAPY

340

TABLE Steve’s

10.4

Dysfunctional Thought Record

Automatic

Date/Time

Thoughts

Situation 1

.

What

event,

1.

What

1.

image, or

thoughts/

recollection

images?

What

1.

emotion did you

led to the

Outcome

Adaptive Response

Emotions

(optional)

What

1.

cognitive distortion did

How much do believe your

you now

AT?

you make?

feel?

emotion? 2.

Any

physical

2.

sensations?

How much did

2.

you

How

2.

at

2.

bottom to form a response to the AT.

intense?

(0-100%)

believe

Use questions

intense?

them?

(0-100%) 3.

6/19/06

1.

Disagreed with coworker

1

.

What emotions do you feel now? How

She hates

1.

Sad

1.

me

How much do

you believe the response? (0-100%)

3.

What

will

you do

(or did

you do)?

Magnification?

1.

40%

2.

Still

3.

Nothing

Overgeneralization? (not sure) 2.

80%

2.

Just because

I

sad, but less

disagreed with Sue doesn’t necessarily

mean she 3.

(Questions to coTisidcY (lb out A.T'. (1) ^0Uha.t

is

the evidence

hates

me

70%

tha^t

the

AT

is

true? (2)

nation? (3) What’s the worst that could happen? (4) What’s the effect of

should

From

1

do about

it?

(6) If

Cognitive Therapy: Basics

[a friend]

and Beyond

was

126) byj.

in the situation,

S.

Beck, 1995,

my

what would

New York:

there an alternative expla-

Is

believing the I

Guilford.

tell

©

AT?

(5)

What

him/her?

1995 by The Guilford

Press.

Adapted with permission.

and report what happens. If she has fun, then her belief is disconfirmed. any fun, then the thoughts she has at the zoo can be examined.

Mm and Steve develop a behavioral experiment for him that wants

m his

to

tests

his beliefthat

right. ”

Steve

be able to see a certain show on TV, but

about It (the

have

“it’s no ttse; I They identify something that would he “righT’—he could negotiate a living situation without getting so angry that he “blows up. “For example,

cant do anything conflict

If she doesn’t

is

afraid to ask the others in the residence

TV IS communal). Mia and Steve work on strategies to help Steve ask this

question.

Activity Scheduling When e (

{.

Li

clients ate very depressed or for other reasons to ave t create a daily schedule,

ewman

em

& Beck,

1

990).

on paper,

The counselor may ask

activities at first to establish baseline

have low motivation, to follow

it

is

often

between therapy sessions

the client to simply keep a record of daily

information. After reviewing these data, the client and

COGNITIVE THERAPY

341

counselor then work together to

fill

in the blocks

of the week across the top and hours along the

of an activity chart, which

left

side

(J. S.

ing daily activities often involves rating each on a scale of

& Weishaar, 2005). This technique

(Beck

particularly

when

Because Steve

is

activities are

sometimes

is

the days

Beck, 1995). Part of record-

to 10 for mastery

1

called mastery

and pleasure

and pleasure therapy,

developed to create successful outcomes (Beck, 1976).

in the work-therapy program, he does not

the week. However, he does

lists

admit that he has

need to

activity schedule

on the weekends.

dijficulties

during

Mia and Steve

develop a schedule for Saturdays that includes important errands that Steve would like to

accomplish (go shopping, for example) along with some fun activities (watch a Little League

and Steve

baseball game). Specific times are set up for the activities, tion

of each, along with

to

is

record his comple-

of mastery and pleasure.

ratings

Graded Tasks When work

what seems

a client faces

make

to

it

less

to be

an overwhelming

intimidating by breaking

it

called creating a graded task assignment (Beck

mulated to reach the agreed-upon

goal,

focusing on the achievement of each. the client

is

not overwhelmed and,

Schrodt, Gilson,

& Ludgate,

and the

The

first

fact.

into smaller steps. This procedure

& Weishaar, client

is

2005). Concrete steps are for-

then works on the steps one

at a time,

steps devised should be relatively easy so that

some

experiences

ideally,

1993). In

down

counselor and client can

task, the

Beck

also called this

initial

success (Freeman,

technique success therapy

(Beck, 1976, p. 272). Self- and therapist reinforcement are important in this process.

Mia and Steve examine Steve, they

step

is

to

break

it

Steve’s

down

goal

to get

a job. Because

number ofsteps using

into a

this

the

is

an intimidating

graded task approach. The first

have Steve read a good reference book on job searching. Next, Steve constructs

resume and brings dustry, so

he

it to

Mia for review.

and Mia problem

solve

about how

to

get a job there given his lack of back-

engage in some chitchat with one or two staffmembers about how

are just a beginning, but Steve

amine

his cognitions

task for the week,

and Mia

about them.

and she makes

Mia

his

Steve decides he wants to go into the restaurant in-

ground. They decide that he should have lunch in a moderately priced restaurant to

task for

write them down,

is

to

and as he

careful to praise Steve

and

try

get a job. These steps

tackles each, they ex-

when he accomplishes

his

sure that Steve does something nice for himself, too.

Assertiveness Training Borrowed from behaviorism, their rights

assertiveness training involves teaching clients skills that support

without violating the rights of others. Role-play

training, along with simple, concrete teaching

Mia

teaches Steve

his

it

frequently used in assertiveness

of information about

rights

and

responsibility.

about assertive behavior. She suggests that he read a hook on

training. Together,

because

is

Mia and

Steve decide that assertiveness training

should help his relationships at work

immature behavior

is

not assertive because

and in

it is

is

assertiveness

in order for Steve

the residentialfacility.

He notes that

either passive (he walks out) or aggressive

COGNITIVE THERAPY

342

and yells). They

(he gets ang}-y

generate a

list

ofproblem

situations

and examine

Steves

They then generate alternative thoufjts, feelings, arid behaviors while in the situations. ones. Mia helps Steve reassertive behaviors to replace Steves previously passive or aggressive hearse these

new

behaviors in session.

Problem Solving Problem-solving techniques involve identifying and clarifying the problem, generating alternatives, evaluating the alternatives, implementing an alternative, and then assessing the utility

&

new approach (Newman

of the

to evaluate dysfunctional beliefs,

such

Beck, 1990). In CT, this approach

as

when

the benefits

and

is

often used

costs of maintaining a

given belief are explored.

and Mia problem solve around his desire to remain abstinent from alcohol. One thing they decide is that when Steve gets depressed, he is likely to drink. They examine hts cognitions and behaviors and devise alternative responses to use when Steve notices that he is down.

Steve

Imagery When

a client

to using

having difficulty identifying automatic thoughts, the counselor can resort

is

imagery or role-playing to vividly conjure up the problem situation (Wright

&

Beck, 1996). Because these techniques are likely to evoke the emotions associated with the

problematic situations, they should help the client identify cognitions associated with the feelings.

The turn-off technique can be used

images (Beck

&

Emery, 2005). In

to sharply disrupt the image, also facilitate the in session or as

Steve wants to to

such

this as

to help clients learn that they can control

technique, the therapist and client think up a

way

clapping his hands or blowing a whistle. Images can

development of adaptive cognitions, and then the

client can practice this

homework.

work on feeling good about

his interactions

He is terrified Mia helps Steve

with his parents.

contact his mother because he has heard that she has “disowned’' him.

imagine making a phone

call to his

mom, and they examine

his thoughts

and responses.

Role Playing and Other Behaviorally-Oriented Teghniques Also

known

as

behavioral rehearsal, role playing can be used to help the client practice be-

haviors useful in social situations (Beck particularly with clients

who

&

Weishaar, 2005). Exposure

also

used in CT,

present with anxiety-related problems (Beck

2005). lypically, a graded approach

is

used, in

which the

feared situation or object. Self-instruction can be

pared

is

added

client takes

baby

steps

&

Emery,

toward the

to exposure: the client uses a pre-

sell-coaching statements to help the client cope with the stress of confronting the feared situation (Beck Emery, 2005). set of

&

Mia and Steve what he

role-play the telephone call to his mother.

Mia plays mom;

Steve practices

will say, using adaptive thoughts rather than negative automatic ones.

COGNITIVE THERAPY

343

EVALUATION OF THE THEORY many

Cognitive Therapy has evoked criticism from

and psychoanalysts

the behaviorists that cognition

was superfluous

alike

(Arnkoff

to behavior change.

subgroup of behavioral therapists threatened

to

&

fronts. Early on,

it

was attacked by

Glass, 1995). Behaviorists thought

According

throw the

Meichenbaum

to

(1993), a

“cognitivists” out of the Associ-

Advancement Behavior Therapy. Psychoanalytic folk tend to dismiss CT as surface oriented, dealing with symptoms rather than the important issues. Behaviorists, at least, seem to have changed their opinions; in a 1990 survey 69% of the members of the American Association of Behavior Therapy reported that they use cognitive techniques ation for

(Craighead, 1990).

On

first

CT appears relatively simple to use.

examination,

It

provides clear explanations

problems and allows the use of a wide variety of techniques (Arnkoff

for

However,

may

counselors

thoughts,

not

is

simple

as

said to ignore the clients

CT

as

it

common

Paradoxically, a

accuse

find

may

criticism of

CT

that

is

emotions and history

by pointing out that the

tant in determining schemas

it is

too simple and mechanistic.

in favor

of the

client’s

It is

thinking. Others

&

and core

Gotlib, 1986).

client’s early

beliefs

(Beck

CT

theorists

at-

respond to

experiences are seen as very impor-

et ah,

2004; Beck

& Weishaar,

2005).

of modes to activation (which determines the degree of dysfunc-

relative sensitivity

also linked to early experience.

is

A

automatic

particularly

theory of ignoring environmental influences and the effects of individuals’

these criticisms

tion)

1995).

seem.

tempts to cope with their situations (Coyne

The

cognitions,

identifying

that

& Glass,

strength of

CT

and advanced the

summary,

theory.

see Beck,

CT

tion to

that

is

theory,

Beck and

his associates

have continually evaluated, modified,

Loads of outcome research supports

this

approach

(for a recent

2005 or Leahy, 2004). The modal perspective is an interesting addialthough it makes the theory sound a lot more psychoanalytic. I per-

sonally find the addition of recent constructs such as modes, personality types,

confusing because

it is

not clear

how they relate

to earlier

CT theory.

and so on,

Depending on which

modes and personality types might or might not be discussed. For example, J. S. Beck is silent about modal processing. Also, the specific modes hypothesized by the theory seem to change depending upon what source you consult. source you consult, the

Qualities of the Theory and

Precision

Testability.

To

his credit.

Beck was one of the

leaders in the

treatment manuals; Beck, Rush, and colleagues (1979) presented the for

CT

als).

The

valid. ory’s

(it

should come

as

no

is

a massive

amount of data

that tests the

apparent simplicity, the testability of CT

that the

(1986,

CT

p.

plagued

treatment manual

surprise that the behaviorists developed the very

presence of treatment manuals makes the testing of

There

first

development of

constructs were difficult to

Is

test,

CT outcome easier

outcome

of

manuand more

first

CT, but despite the

the-

Coyne and Gotlib (1986) argued them “slippery and indeterminate”

debated.

calling

697). In addition, Oei and Free (1995) suggested that measurement problems

CT theory In that the standard measures of cognitive dysfunction

DAS) might be specifically.

(the

AFQ and the

assessing general psychological dysfunction rather than cognitive distortion

Hayes, Luoma, Bond, Mastida, and

Lillis

(2006) maintained that although there

COGNITIVE THERAPY

344

much

is

rcsciirch

on Cl, the on

established (more

Empirical

proach

between cognitive change and improvement

link

this later).

Cognitive Therapy

Validity.

not well

is

is

perhaps the most well-researched counseling ap-

with an overwhelming amount of empirical support for

in existence,

its

effective-

ness with a variety of client

problems (Beck, 2005; Leahy, 2004). However, evidence for

the theoretical assumptions

and structure

is

less

impressive.

Research Support Outcome

Outcome

Research.

research has uniformly supported

have examined the efficacy of CT, probably because treatments and also because good the Beck Depression Inventory

Numerous most

the

part,

outcome measures

it

CT. Hundreds of studies

was one of the

exist, particularly for

and the Hamilton Depression Rating

studies have tested the efficacy of

earliest

manualized

depression

(e.g.,

Scale).

CT with various diagnostic categories.

CT has been found to be as effective as other treatments, more effective than

no-treatment controls, and in some cases more effective than placebo control groups. surprisingly, a significant

best

known

Chapter

1.

of

trials

amount of this

CT

As you may

NIMH

the

is

recall,

the treatment approaches relative to the

For

research has focused

on depression. One of the

treatment of depression study, summarized in

the results of the

(CT and

Not

NIMH

study were disappointing because

interpersonal therapy) did not produce

improvement

placebo group.

Meta-analytic studies h.ave generally supported the efficacy of CT. Butler,

Chapman,

Forman, and Beck (2006) reviewed 16 meta-analyses on outcome studies of cognitivebehavioral therapy (CBT). They found that CBT was effective over a wide range of dysfunction, including depression, anxiety, posttraumatic stress disorder, anger, chronic pain,

and marital

distress.

Dobson (1989) conducted

a meta-analysis

of 28 studies of

depression, each of which used Becks treatment

Inventory (BDI) control groups,

come

as

CT

manual and the Beck Depression the outcome measure. When compared to no-treatment or wait-list achieved an effect size of 2.1 5, which is large by psychotherapy out-

standards and indicates that the average client in

the control clients.

Dobson

also reported that

CT was

CT

more

was better off than effective

98%

of

than behavior ther-

apy or pharmacotherapy, although the effect sizes were much smaller (about 0.50). A comparison of CT and placebo treatment was not included this study. Reinecke, Ryan, and DuBois (1998) found that CT was effective interventions for depression

m

m

among

adolescent clients.

Because depression

m

this area

is

commonly

have been interested

m

analysis addressing this question

including 48 1

))8). In

and drug treatment.

A

meta-

examined studies published between 1977 and 1997,

& Blackburn,

Gloaguen and colleagues

CT

produced better

be more effective.

Behavior

CT

consisting of 2,765 clients (Gloaguen, Cottraux, Cucherat, of these studies, the outcome measure was the BDI.

pressant drug treatment.

as

the relative efficacy of

trials

all

found that

treated with antidepressant medication, investigators

I

results

than waiting

lists,

placebo treatments, and antide-

Comparisons with a set of “other” therapies also showed CT to However, CT was found to produce about the same amount of change

herapy.

COGNITIVE THERAPY Studies

345

documenting the superiority of

CT

to other approaches, however,

must be

viewed with caution. Some evidence suggests that studies conduced by proponents of given approach tend to

show

affairs true for studies

of investigator allegiance and found

effects

When

of depression.

allegiance

and behavioral approaches appeared

tive behavioral,

approach. Robinson, Berman, and

results favorable to that

Neimeyer (1990) examined the

was

to

this state

produce better outcomes than other

when

investi-

gator allegiance was controlled, these effects disappeared. In addition, as a group,

improve on the

effects

of

controlled, cognitive, cogni-

approaches (labeled general verbal therapy by these investigators). However,

apies did not significantly

a

of placebo treatments.

When

all

ther-

comparing

psychotherapy to pharmacological treatments, Robinson and colleagues also found

investi-

gator effects: an initial apparent superiority of psychotherapy disappeared once allegiance effects

were taken into account. Gaffan, Tsaousis, and Kemp-Wheeler (1995) replicated

effect,

but found

ies

less

evidence of allegiance effects in a set of more recently published stud-

that were not included in

Robinson

et

al.’s

Wampold and

analyses. Similarly,

colleagues

(1997) meta-analyzed 277 treatment comparisons, specifically testing for variations in

among

cacy

this

and

also

found no

are available,

CT

appears to be effective for anxiety disorders,

theoretical orientations,

Although fewer studies

effi-

significant differences.

including generalized anxiety, panic disorder, agoraphobia, and social phobia (Chambless

1993; Clark

Gillis,

&

Ehlers, 1993;

&

Wenzel, Sharp, Brown, Greenberg,

many

such

CT

is

An

interesting finding

&

Yap, 1997;

should be noted that in

CT with

standard behav-

biofeedback.

effective for these disorders (particularly agoraphobia)

on

its

It is

not clear

own, nor that

it is

from Wenzel, Sharp, Brown,

(2006) was that beliefs specific to panic decreased over

seem

it

combined pure

as relaxation training, desensitization, or

superior to behavioral approaches. al.

Beck, 2006). However,

cases these trials involved treatments that

ioral techniques,

that

Gould, Buckminster, Pollack, Otto,

CT

treatment, which

results,

Earlier,

Chambless and

Gillis

et

would

to partially support the cognitive conceptualization of anxiety disorders proposed

Beck and Emery (2005; 1985).

&

by

(1993) had found similar

but also noted that cognitive changes are produced by approaches other than CT,

so these results can not be construed as robust support for

Beck and example of

CT

his colleagues are also very interested in suicidal

CT

a recent study that assessed the effects of

theory.

behavior (Beck, 2005).

An

in reducing repeated suicide

Brown et al. (2005). In this randomized controlled trial of CT (TAU) with clients who had been evaluated at a hospital for at-

attempts was reported by

and treatment tempted

as usual

suicide, those

who

of self-reported depression

received

at a

CT were

6-month follow-up compared

also reported less hopelessness than the

TAU

effectiveness of CT, only cautious conclusions

clients.

about the

can be drawn, however, because of the differences istered.

Chapter

Studies of

1

discusses

CT

reattempt and had lower rates

less likely to

some of the

in the

to the

Although

TAU clients. CT clients

this

study

relative superiority

ways that

issues involved in

attests to the

of CT over TAU

CT and TAU are admin-

TAU-treatment comparisons.

with a wide range of diagnostic categories have been reported.

Abramowitz (1997) reviewed interventions for Obsessive Compulsive Disorder (OCD) and concluded that CT was found to be as effective as the behavioral treatment exposure and response prevention (ERP), considered studies,

CT was

found

to be superior to

to be the 'gold standard” for

ERP, leading Abramowitz

approaches lead to the disconfirmation of dysfunctional

OCD.

In a

to speculate that

beliefs associated

with

lew

both

OCD.

COGNITIVE THERAPY

346

ERP and CT

Clark (2004) opined that the results comparing “at this time, there

is

component

a cognitive

no evidence that adding

were inconclusive, writing to

ERP

produces

more symptomatic improvement than ERP alone” (p. 175). However, Clark maintains that there may be some subtypes of OCD that respond better to CT than ERP Pretzer and Beck (e.g., obsessional ruminative) but comparative data are scarce. Similarly,

significantly

(2004) summarized the research the effectiveness of CT for clients diagnosed as personality

one such

disordered, and concluded that positive evidence existed. In

(2004) found that der in an open

is

was

study

trial

CT

evidence that

CT

diagnosed

effective for clients (i.e.,

not a randomized

study.

Brown

et

al.

as borderline personality disor-

Rector (2004) presents

clinical trial).

helpful in treating schizophrenia.

when

Jamison and Scogin (1995) took an interesting approach

they tested the effective-

David Burns’ book Feeling

ness of cognitive bibliotherapy with adults. Participants read

Good (1980). Half of the participants served in a delayed bibliotherapy group as controls. Using multiple outcome measures (including the BDI and the observer-rated Hamilton Rating Scale for Depression), these investigators demonstrated that therapists are not absolutely necessary! Moreover, the significant changes in depression observed at posttest

were maintained Jakes and

at a

3-month follow-up.

Rhodes (2003) reported on an

and cognitive-behavioral

strategies

who had

with clients

sively studied at baseline (no treatment)

focused and 2

interesting small

and

N study of solution focused

delusions. Pive clients were inten-

they were then treated with a solution

as

CT interventions (Schema-Focused Cognitive Therapy and Cognitive Therapy

focused on challenging the delusion) in that order.

were diagnosed with chronic psychosis

They observed

delusion for at least

as well as

positively to treatment in terms of decrease in negative beliefs

predicted by

CT theory.

However, because

this

be cautious in drawing causal inferences from Research has also looked at whether

that these clients

was

a multiple case

(i.e.,

CT

showed lower

Compulsive Disorder maintained

et

difference between groups receiving

rates

outcomes

CT

clients

of relapse

methods

only.

CT vs.

CT was superior in terms

(2005) found that clients diagnosed

al.

their

of CT,

5 trials of the long-term effects of

antidepressant medication (tricyclic antidepressants), finding that

Oppen

trials

treated with psychopharmacological

Uhlenhuth (2004) compared

of preventing relapse, van

self, as

CT helps clients retain the gains made in counseling.

symptoms) than those

Hensley, Nadiga, and

responded

its results.

alone or In combination with antidepressants

return of

year)

would be study design, we must

about the

Hollon, Shelton, and Davis (1993) reported that in four major clinical receiving

1

(who

5 years after treatment,

as

Obsessive

but there was no

and exposure treatment alone and those receiving

psychological treatment plus antidepressant medication. However, they cautioned that because there are very few good studies of the long-term effects of and other therapies,

CT

strong statements about prevention effects associated with

1 heory- Testing Reseurch. Overall, research

Much

of the controversy has focused

CT should be avoided at present.

support for the validity of CT theory

on the

is

mixed.

CT

model of depression. In the 1980s C.oyne and Ciotllb (1983, 1986) declared that the evidence for the causal role of cognitions m depression was unconvincing, and they criticized CT theory for its neglect of environmental factors and individual coping strategies.

They added

depressed patient

is

probably a

woman

with marital

difficulties,

and

that “the

modal

glib attempts to

COGNITIVE THERAPY

347

reduce her problems to a matter of distorted cognitions have potentially pernicious

703-704).

social implications” (1986, pp.

Haaga, Dyck, and Ernst (1991) also reviewed the evidence relevant to the

and distinguished between CT’s

ol depression

sives are a certain

way) and

CT

theory

of depression (that depres-

descriptive x\\tovy

theory of depression (that cognitions cause depression).

its

Depressed individuals, according to theory, are thought to display more negativity, which involves their views of self, the world,

and the future

biases or distortions in information processing

CT

In addition,

(the cognitive triad), as well as other

when compared

nondepressed people.

to

theory predicts that positive thoughts are practically nonexistent in

depressed individuals. Further, the cognitive triad should be evident in

and

sion,

in

depressed people.

all

The

all

types of depres-

degree of negative thinking should be positively

associated with the severity of noncognitive depressive features

(e.g.,

somatic symptoms,

depressed mood). Finally, the cognitive specificity hypothesis implies that depressed indi-

show

viduals should

different cognitive patterns than individuals displaying other types of

psychological dysfunction.

Haaga and colleagues (1991) found support for the negativity hypothesis, the cognitive triad, and bias in information processing. Individuals who are depressed seem to display more negative thoughts than people who are not depressed do, and this effect extends to views of the self, world, and In reviewing evidence relevant to the descriptive model,

future.

Evidence for the other hypotheses was weaker and often was compromised by

methodological problems or theoretical fuzziness. For instance, the elements of the

seem

cognitive triad

to be overlapping

—

the negative view of the world seems to

empha-

size self-related aspects.

Evidence for the causal model of CT (that cognitions cause depression) (Bieling is,

convincing

& Kuyken, 2003; Hayes et ah, 2006). Controversy has long been evident, and

around the

fancy

less

is

name

is

for the idea that

nitive systems)

Hagga and

of what

issues

generally

known

both cognitive vulnerability

and an external

stressor are required to

colleagues (1991) asserted that

posed relationships tional beliefs, stress,

among

as the diathesis-stress

no

(i.e.,

model, which

produce dysfunction. Early on,

single study has completely tested the pro-

personality dimensions (sociotrophy and autonomy), dysfunc-

convincing support for causal hypotheses of cognitive theory, but to

the

activation of negative cog-

and depression. Haaga and colleagues concluded, “We thus find

would be premature

is

still

abandon them”

(p.

231).

More

at the

recently, Zuroff,

little

same time,

it

Mongrain, and

Santor (2004) reviewed the literature specific to sociotrophy and autonomy, and con-

cluded that the picture was

less

gate the diathesis-stress model.

bleak,

An

and that there was merit

in

continuing to investi-

attempt to perform such research

is

represented by

Dozois and Backs-Dermott s (2000) study of sociotrophy and negative outcomes. This was an experimental study in which participants listened to an audiotape depicting an interpersonal rejection and then completed checklists of self-relevant adjectives and a reaction

time

task.

Consistent with predictions, participants high

ative reactions than those

low

in sociotrophy.

in

sociotrophy showed more neg-

Studying more generalized dysfunctional

and D’Alessandro (2003) found some support that such attitudes predicted depression for students who had received

attitudes in an experimental design, Abela for the

model

in

negative feedback

on

a college

admissions decision. Although the experimental nature of

these designs appears to be a far cry from actual depressive processes in the “real world,’

COGNITIVE THERAPY nonetheless the study yields Grazioli

some support

and Terry (2000) found similar

Oei and Free (1995) looked

more iji

closely

GT

for

CT

results in

theory.

studying postpartum depression.

However,

this

evidence

theory because the same kind of change

in depressed individuals as particularly

not considered

is

is

CT

theory

who

engage

of -outcome research in validating

at the role

and found that cognitive change occurs

therapy.

Using a longitudinal design,

documented among

supportive of

CT

individuals in other psy-

and wait-list groups. In

chological therapies as well as in psychopharmacological treatment

explaining these findings, Oei and Free offered the circular process model, which suggests that the changes in biological processes induced by drug treatment create changes in cog-

The

nition (reduced negative thinking).

process

cognition leads to biochemical change. Even

ond hypothesis, the

fact that these

is

reversed in verbal therapy; change in

if research

data existed that supported the sec-

changes occur in other therapies

process found in counseling rather than one specific to

CT theory.

still

suggests a general

In contrast, Beevers and

Miller (2005) used a longitudinal design, and found that the relationship between cognitions

and depressions was weaker

for clients

who had completed

Cognitive Therapy than

family therapy (in both cases, pharmacological interventions were used).

Recent research in treatment contexts also provides some evidence for the hypothesized links

between cognition and dysfunction. Wenzel, Sharp, Sokol, and Beck (2006) demoncompleting a

strated that individuals

of

trial

CT

for panic disorder differed in the degree

who

of attentional fixation depending on their treatment outcomes. Clients criteria for

who no

met the

panic disorder at the end of treatment showed higher levels of fixation than those

longer could be diagnosed. Because attentional fixation

retically predicted

However,

still

this

element of panic disorder,

study

this research

considered to be a theo-

is

can be seen

as

supportive of CT.

probably subject to the same criticisms that Oei and Free offered. In

is

women, Evans, Hernon, Lewis, Araya, and Wolke (2005) documented that women who had the most negative self-schemas were more likely to become depressed after childbirth when compared to women with less negative schemas. Once

a

study of postpartum

again, because of the design of this study, causal conclusions are risky, although the longi-

tudinal design In

makes

somewhat more convincing than would

it

summary, research generally supports the

clients.

effectiveness of

a cross-sectional

CT with

However, claims of its superiority to othet treatments are

some evidence has suggested support

less

CT

wide vatiety of

convincing. Although

for the theoretical propositions

difhcult to really test the underlying assumptions of the

a

method.

of CT,

it is

extremely

model.

ISSUES OF INDIVIDUAL

AND CULTURAL DIVERSITY Hoffman (2006) noted

that an individual’s culture will influence

the world, including ones

count.

Drawing on

own

literature

from non-Western culture

are

behavior,

from

and

are westerners. For example, explaining anxiety as

client

from

a

Western culture. This

nation. In contrast, a

suggests that individuals

thoughts or ideas than

worry about an upcoming job-related

impending heart attack might be acceptable

client

non-Western

Hoffman

likely to accept contradictory

presentation rather than as a sign of an

he or she perceives

thus, interventions should take this into ac-

social psychology,

more

how

could pick the

client

first

to a

rather than the second expla-

might be much more comfortable

in

holding

COGNITIVE THERAPY

349

both explanations simultaneously. Differences such portant implications for cognitive restructuring

Other Western-based principles of cultures.

CT

CT

assumes that the individual

vidualistic outlook

may

as this

one

clearly

could have some im-

efforts.

conflict with the values

and norms of other

largely responsible for his

is

found

clash with collectivistic values such as those

Hispanic/Latino/Latina, or American Indian cultures. Clients

who

own

fate; this indi-

in

some

Asian,

are highly spiritual

may

not respond well to the emphasis on individual choice and control because they believe in the influence of higher powers in

human

activity.

At the same time,

and Simek-Morgan (2002) argued that the structure and minority

on

sis

of

D’Andrea,

CT may

Ivey,

appeal to

Chen’s (1995) comments about the consistency of REBT values (empha-

clients.

logical thinking, cognitive control

much agreement

of emotion, counselor

and Chinese culture probably apply

directive nature of therapy) to be

clarity

Ivey,

that

as teacher,

and the

active

CT as well. There seems

to

CT can be adapted to a wide range of client diversity (Hays &

Iwamasa, 2006).

and Reinke-Scorzelli (1994) collected data that illustrated the problem with the individualistic stance of CT. They surveyed a group of graduate students in India about Scorzelli

the

fit

CT (REBT

of

identified

Hindusim

and CT) with as their

primary

religion.

CT was inconsistent with their cultural values, that one’s destiny

is

fixed.

Most of the students were female and About 87% of these students judged that

theit culture.

These students

most prominently with the

also

saw

CT

as conflicting

belief in karma,

with values such

as

obedience to family and other cultural values, including sex role expectations. In contrast,

Wong, Kim, Zane, Kim, and Huang (2003) found

identified with Asian culture,

dynamic

CT was viewed as

therapy. In this study, Asian clients

who

more

that for clients

who were

credible than time-limited psycho-

varied in ethnic identity were exposed to

treatment rationales fot depression based on the two approaches. Asian participants identified rationales,

mote

strongly with Western culture did not diffet in their reactions to the two

whereas those lower in Western identity tesponded more favorably to the

rationale. Also, individuals

who wete more Clients

with more independent self-construals

CT

interdependent) evaluated

gested that the emphasis fects.

who

who

on individual control

are less

Anglo

more in

favorably.

stress

extrapetsonal factors. Independence, which

is

Wong

compared

to those

and colleagues sug-

CT was responsible for both of these ef-

in their orientations

Asian culture) prefer interventions that

(as

CT

(presumably more identified with

individual adaptation

thought to be

unchanging

to

relatively unrelated to cultural

would fit well with the individual focus of CT. Davis and Padesky (1989) suggested that the collaborative nature of the

identity,

ship

promoted the egalitatianism

Encouraging the

that

is

CT

important when working with female

client to evaluate therapy sessions, set the counseling agenda,

the client the opportunity to discuss diagnoses, should

On

who

are stigmatized

would seem

endorsed by Davis and Padesky.

by society may

of cultutal pressure. Individuals

and giving

the other hand, the

presentation of the counselor as an expert, almost in the doctor— patient mode,

Clients

clients.

empower women who may have

experienced cultural pressure to be passive and submissive to men.

to conttadict the egalitarian spirit

relation-

who

members of groups who have been

also

develop negative self-schemas

are gay, lesbian, bisexual, or transgender

the subject of prejudice or discrimination

particularly vulnerable in this respect.

Although the

as a result

(GEBT)

or

would seem

sensitive cognitive therapist could help

COGNITIVE THERAPY

350 modify

a client’s self-schema, this intervention

pressures (Davis

ward helping the

&

Padesky, 1989).

client deal

who

therapist

would

also

client

from

social

have to direct attention to-

with cultural disapproval.

of environmental factors and influences in

In general, the neglect

problematic

The

would not immunize the

CT

theory

may

be

and individually diverse individuals. People discrimination, and oppression might have more diffi-

when working with

culturally

have experienced prejudice,

culty locating the sources of their discomfort solely in their cognitive processes.

THE CASE STUDY Aspects of Steve’s presentation

fit

Caucasian male, so cultural issues

well with a

may

CT

approach, and others do not. Steve

CT

stance abuse, which

of affect

in general

problem-focused Beck’s

clearly a central issue for Steve. In fact, Steve

and seems

to be

more focused on changing

modal view describes

Steve’s

his diagnosis

manic behavior

raises

the question about

as

of bipolar disorder

and self-enhancement modes. Mia hypothesized that

which

is

not reporting a

his life situation.

lot

Thus, the

approach works well for him.

enhancement mode. Thus, loss

The classic client for CT is one some depression, it does not seem

has been applied to a variety of client dysfunctions, including sub-

is

CT

a

not be paramount.

with prominent depression. Although Steve does report severe. Elowever,

is

how many modes

hyperactivation of the is

self-

captured by activity in the

his victim

mode was

also active,

are likely to be sensitized for a given

person.

Summary CT proposes

the cognitive

model of therapy: our behaviors and

feelings are a result of

our

cognitive process and structures. Specifically, clients’ automatic thoughts, intermediate beliefs,

and core schemas

are associated

with depression, anxiety, and a variety of other kinds

of psychological dysfunction. Automatic thoughts are

brief, telegraphic

ages that are related to core beliefs or schemas. Beliefs structures that

and schemas

statements or im-

more sometimes function outside of our everyday awareness. Schemas

plex cognitive structures that aid in the organization of experience

ways we interpret events. tures the cognitive triad

One

important schema

of a negative view of

self,

is

are

elaborate are

com-

and can influence the

the depressogenic schema,

which

fea-

world, and future.

—

Cognitive therapists help clients by engaging them in collaborative empiricism the process of examining their thoughts, assumptions, and beliefs as hypotheses rather than truths.

The cognitive therapist

is

an expert and the client a learner

who

is

expected to take

increasing responsibility for counseling as he learns the system. Both cognitive behavioral techniques are used in CT, and clients are almost always given

and

homework.

C.

I

has the strength of being relatively straightforward

appealing to clients

who

and structured.

expect the therapist to be an expert.

The

established; however, the support for the theoretical predictions

of

It is

probably

efficacy of

CT

CT

impressive.

is

less

is

well

COGNITIVE THERAPY Concerns can

also be raised that

may clash with

sibility

cultures, female, or of for instance). clients

who

Visit

351

the views

GLBT

CT’s emphasis on internal process and individual respon-

and values of clients who

are

members of groups

and

CT can

be empowering to

at

www.prenhall.com/murdock

for

self-assessments.

For ease of expression, throughout Beck’s authorship.

in

that have been historically subject to oppression.

Chapter 10 on the Companion Website

Aaron

from non- Western European

orientation or in other ways diverse (physically challenged,

However, the collaborative relationship found

chapter-specific resources

refer to

are

this

chapter references to Beck (without

initials) will

Donald

is

separated,

he

is

a 31 -year-old male Caueasian who

and he

is

currently living alone.

has recently been fired from a job as a financial advisor.

experiencing financial stress but does not

want

to

He and

his wife are

Donald reports

take just any oldjob. ”

He has a

that

history

offrequent job changes. Donald’s appearance

His manner

is

is

neat and appropriate.

He speaks very quickly and appears agitated.

somewhat grandiose. Donald appeared

to

with his female counselor and becomes extremely anxious

Donald says

that he has no close friends but that he

a volunteer group at a local hospital).

He

difficulty

when asked to is

active in

reports that he gets

by carefully presenting an image that he wants others to

have

making

talk

about hisfeelings.

community

service

(e.g.,

along well in these situations

In his spare time

to see.

eye contact

Donald likes

read magazines

and watch

Donald was

and several step-siblings. His when he was young and was imprisonedfor some time. Donald does not

movies. His favorite topics are mystery

and science fiction.

raised in a large family with three brothers

fither was violent

know why his father was in prison. His mother filed for divorce while his father was in prison and remarried soon after. After his father was released from prison, Donald went to live with him. At the time, his father was self-employed, but Donald does not know in what kind of business or work. Donald expressed resentment when talking about his mother and sees her as being weak and a Valium addict. He says that his father is his idol. Donald’s current marriage

is

his second.

He

divorced his

first

wife after catching her in

bed with another woman. Donald present relationship has lasted years. His wife, Tammy, s 4 moved out about a month ago, saying that she no longer loved or respected Donald. He wants

much for his wife to come back to their relationship. Donald is seeking counseling because of his job loss and marital difficulties. He believes he functions well in other aspects of his life. He says that physically he is OK, but he does very

3S2

REALITY THERAPY

353

complain of weariness, occasional nausea, and a cause “migraines.

Donald

He

is

conflict with his wife, to

what

it

and

tense neck muscles that

a failure

tends to

move from job

to

job

an impulsive spender, and his spending habits are part of the Tammy. Donald sees himselfas a superficial person who is unable

and unable

share his feelings with his wife

feels like

back

and

says that he feels addicted to excitement

this reason.

for

‘lived”

”

and

that there

is

to sustain relationships.

He

says that he

something wrong with him and he wants

to

know

is.

BACKGROUND William Glasser developed Reality Therapy (RT) out of his

dissatisfaction with traditional

psychoanalytic theory. Glasser, a son of immigrant parents, was born in 1925 and grew up

Ohio, during the Depression

in Gleveland,

young person,

He

years.

up

certain that he did not measure

described himself as very shy as a

A first-generation

to other people.

lege student, Glasser obtained his bachelor’s degree in engineering

and worked

col-

for a year

afterward as a chemical engineer (Wubbolding, 2000). Realizing that he was

thought that

his

unhappy

poor grades

wanted

in his job, Glasser

to

go to medical school, but

an undergraduate would prevent

as

his admission. Instead,

Glasser obtained his master’s degree in clinical psychology from Gase Western Reserve University in

1948 and began work toward

by one of his psychology professors

who

of six or seven students

meantime, he was persuaded

his doctorate. In the

to apply for medical school

and was admitted

as

one

did not have the usual qualifications to be admitted to Gase

Western’s program (Wubbolding, 2000). Glasser survived medical school and was board

1961 (Howatt, 2001).

certified in psychiatry in

Howatt (2001)

related an interesting story

During

tion that people choose their behaviors. veteran’s unit, Glasser decided to target.

Knowing

that the clients

games into one area and decreed 2001,

p. 8).

about the early origins of Glasser’s convic-

conduct

a

his psychiatric residency at

quick study to determine

on the ward loved

pinball, he

that “no crazy behavior”

if his ideas

moved

was allowed

an inpatient

all

were on

of the pinball

in this area

(Howatt,

Glients could hallucinate, yell at invisible people, or engage in other nutty

behavior anywhere

else,

What happened? Most

but

if

they did so in the

game

area,

they would be asked to leave.

of the clients were able to abide by the

rule,

suggesting that they

chose to play games over acting crazy. Also during his psychiatric residency, Glasser became a consultant to the Ventura School, a state institution for troubled

1965)

is

girls.

based on Glasser’s experiences in

The

best-selling

RT

this school.

book

Reality Therapy (Glasser,

principles were the basis for the

conduct of this school: punishment was eschewed, and relationships among the

girls

were

nurtured (Glasser, 1965). Glasser closed his practice in 1986 in favor of teaching and writing about RT. His best

known book

Unhappy Psychiatry

Teenagers:

is

probably Reality Therapy (1965). His most recent books are

A Way for Parents and Teachers

Can Be Hazardous

most recent version of

New Reality in

Box

11.1.

to

to

Reach Them (2002) and Warning:

Your Mental Health (2003).

Glasser’s theory

is

found

in

The

best description of the

Counseling with Choice Theory: The

Therapy (Glasser, 2000a). You can read part of the

first

chapter in this book

REALITY THERAPY

3^4

Box

An

Exercpt from Glasser s Choice Theory

Suppose you could ask

who seem

ple

to

blame someone

who

the people in the world

all

a lot to live for, to give

have

are you?” Millions

11.1

would

say,

else for their

you an honest answer

to the question,

“I’m miserable.” If asked why, almost

misery

me

been heard saying, “You’re driving

how

I

—

lovers, wives,

work

teachers, students, or people they

have any consideration lor

are not hungry, sick, or poor, peo-

feel?

with. There

crazy. .

.

.

.

.

of them would

all

husbands, exes, children, parents,

who

hardly a person alive

is

That

really upsets

You make me

.

“How

mad,

so

me.

.

.

.

hasn’t

Don’t you

can’t see straight.” It

I

never crosses their minds that they are choosing the misery they are complaining about.

Choice theory explains including the misery

we

we choose everything we do, make us miserable nor make us

that, for all practical purposes,

Other people can neither

feel.

we can get from them or give to them is information. But by itself, information cannot make us do or feel anything. It goes into our brains, where we process it and then decide what to do. As explain in great detail in this book, we choose all our actions and happy. All

I

thoughts and, indirectly, almost

may

feel,

mtich of what goes on in

and thoughts you choose or have chosen every day of your

result of the actions

also

I

much of our physiology. As bad as you your body when you are in pain or sick is the indirect

our feelings and

all

show how and why we make

these painful, even crazy, choices

life.

and how we can

make better ones. Choice theorv teaches that we are much more in control of our lives than we realize. Unfortunately, much of that control is not effective. For example, you choose to feel upset

not

with your child, then you choose to

Taking more

better.

yell

and

means making

effective control

threaten,

and things get worse,

better choices as

you

relate to

your

how people actually function: how we combine what is written in our genes with what we learn as we live our lives. he best way to learn choice theory is to focus on why we choose the common miseries that we believe just happen to us. When we are depressed, we believe that we have

children and everyone

else.

You can

learn through choice theory

1

no control over our

suffering, that

we

are victims

and hence that we need brain drugs, such ance. Little of this belief

the victims of

1

to

true.

what happened

our brain chemistry feel better,

is

is

normal

of an imbalance in our neuro-chemistry

our chemistry back into bal-

as Prozac, to get

We have a lot of control over our suffering. We are

to us in the past, and, as will for

what we

are

be explained in Chapter

4,

may make

us

choosing to do. Brain drugs

but they do not solve the problems that led us to choose to

he seeds of almost

encounter people

unfortunately,

what

tradition that has

all

who

is

our unhappiness are planted early in our have discovered not only what

right for us.

Armed

with

dominated our thinking

for

this

is

rarely

feel

lives

right for

miserable.

when we

begin

them— but

also,

discovery and following a destructive

thousands of years, these people

feel obli-

gated to try to force us to do what they force

is,

by

far,

the greatest source of

I-know-what s-i ight-for-yoti

know is right. Our choice of how we resist that human misery. Choice theory challenges this ancient

tradition.

1

his entire

book

is

an attempt to answer the

impoitant question that almost all of us continually ask ourselves low can figuie out how to be free to live my life 1

along

1

w'ell

the

with the people

I

need?

way

I

when we

want

to live

are it

all-

unhappy:

and

still

get

REALITY THERAPY

From

me

that

355

the perspective of forty years of psychiatric practice,

unhappy people have

all

the

same problem: They

with the people they want to get along well with. but ever

my

keep hearing

I

known,

saying, “If

would hardly note that

if

mentor, Dr. G.

to

counseling successes,

skillful psychiatrist I’ve

the professionals in our Field suddenly disappeared, the world

all

He

their absence.”

the goal of psychiatrists

human

many

Harrington, the most

L.

become apparent

are unable to get along well

have had

1

has

it

to reduce the misery

is

He was

was not disparaging what we do.

rampant

world and

in the

saying to help

beings get along with each other, their efforts have hardly scratched the surface.

To begin

to

approach that

to each other than

understand, so

goal,

most of us

we need

are able to

can be taught to anyone

it

once we understand

it.

Our

a

new psychology that can help us get closer do now. The psychology must be easy to

who wants

to learn

We

present psychology has failed.

along with each other any better than

we

And

it.

must be easy

to use

do not know how

to get

it

we have em-

ever have. Indeed, the psychology

braced tends to drive us apart. In the area of marriage alone,

it is

clear that the use

of this

traditional psychology has failed. I

universal psychology that destroys relationships because

call this

sonal freedom external control psychology.

The

ing glance or as forceful as a threat to our

lives.

do what we may not want

force us to

actually

make

way we

us feel the

personal freedom

we

feel

to do.

We

destroys per-

it

control can be as slight as a disapprov-

But whatever

an attempt to

it is, it is

end up believing that other people can

or do the things

we

do. This belief takes

away the

need and want.

all

Excerpted from Choice Theory:

A New

Psychology ofPersonal Freedom. 1998.

New York:

Harper Collins.

Reprinted with permission.

1967 Glasser established the

In

William Glasser

WWW. wglasser. com The .

sive training

hold

The

worldwide.

many

RT

Therapy Certified”

institute is

is

internationally

countries around the world

known

for his public

He

wife,

is

(e.g.,

He

also

as the

Wide Web

at

demonstrations of RT.

who

is

still

RT

practiced, with

Australia,

1981 and

He

is still

counselors

Hong

Kong).

published.

often does counseling ses-

lectures, writes,

active in the

and consults on

RT community (his first

in 1992).

Glasser radically revised ships.

1996

earned by completing an inten-

Norway, Sweden, initiated in

married to his second wife, Carleen,

Naomi, died

is

known and

sions for professional audiences. Currently, Glasser

RT.

since

(Wubbolding, 2000). Currently, over 5,000 people

International Journal of Reality Therapy

Glasser

known

can be found on the World

institute

“Reality

title

program with the

this title

active in

The

Institute.

Institute for Reality Therapy,

RT

theory in 1996 to emphasize the importance of relation-

changed the name of the theory underlying

choice theory (Wubbolding, 2000).

I

RT

from control theory

will present the revised version of

RT

to

in this chapter.

BASIC PHILOSOPHY RT

theorists believe that the essential nature

1995).

They

of humans

is

positive (Glasser

& Wubbolding,

are careful to point out, however, that they are not naive in their approach;

'

REALITY THERAPY

356

humans can be

alrhoLigh

beguiled, bedeviled to

others.

&

that

is

tivity

1998,

also “can be

and horrifying

and self-aggrandizing”

self-absorbed, self-indulgent

p. 48).

acknowledges the existence of a

“real

world”

defined by consensual agreement. At the same time, he recognizes that total objeca

figment of our imaginations;

it

could only exist

need (Glasser, 1998).

levels ol

The

Brickell,

selfish,

and productive, they

actions can be hesitant, halting

a social constructivist theory. Glasser

is

is

RT

Our

and bewildered

... We can be

(Wubbolding

RT

altruisric, forgiving, loving,

theory places people firmly in the driver’s seat

if

we

all

had the same values or

— they choose

belief that folks are helpless in the face of forces outside of them

their is

own

behaviors.

an element of what

Glasser calls external control theory (Wubbolding, 2007). Recently, Glasser has challenged the traditional psychiatric

toward understanding mental

illness

community,

within a biological model.

“What

criticizing the trend

alarms

me the most is

the present direction of psychiatry, to replace psychology altogether with the pseudoscience ofbrain

Gounselors

p. 2; italics in original).

chemistrf (Glasser, n.d.,

unsuccessful attempts to get connected to another criticizes the psychiatric

take this view are oblivious

of lonely people engaged in a wide variety of

to the idea that “they are staring at the brains

(2003)

who

community on

human

being” (Glasser, n.d.,

the grounds that “there

is

p. 2).

Glasser

no longer any

concerted effort ... to establish a doctor-patient relationship and counsel you about what’s on

your mind. You are told that the mental istry that

illness is

can only be corrected with drugs”

caused by an imbalance in your brain chem-

(p. 2).

Further, Glasser, maintains that prescribed

psychotropic medications have the potential to be harmful and that the emphasis cal

causation of psychological distress creates the situation in

with a mental illness there

who

Glasser (2004), this

dilemma

is

nothing you can do

to help yourself

biologi-

which ''when you are diagnosed (2003,

p. 3; italics in original).

claims to have never prescribed a psychotropic drug, sees the solution to

choice theory, which you will read about

is

on

later.

Mei Ling is Donald's RT counselor. Her basic orientation toward Donald is that he is a person who has the potential to take charge of his life. Over their time together, Mei Ling is confident that she will see the goodness in Donald, as well as aspects of his behavior that may seem less desirable. However, Mei Ling realizes that the way Donald sees the world will be a major factor in how he behaves and that she needs to understand this in order to help him.

HUMAN MOTIVATION 1 he most obvious (Cilasser,

human

is

to

maximize pleasure and minimize pain

1998). The source of these feelings of pleasure or pain

satislaction) of basic needs.

and fun

motivation

(Glasser, 2004).

The

basic needs are survival, love

When we manage

is

the satisfaction (or non-

and belonging, power, freedom,

we feel really good. When we experience a need that is unmet, we feel lousy. The gap between what we want and what we have is the most concrete motivator of our behavior (Wubbolding, et ah, 2004). Donald seems some of his

to

need

satisfied,

be currently in pain, which suggests that he has not

needs.

Donald s needs

to get a

are

Mei Ling knows that unmet and help him to

to

help Donald, he

satisfy

them.

managed

to satisfy

must discover which of

REALITY THERAPY

357

CENTRAL CONSTRUCTS Basic Needs The

five basic

human

needs

—

innate and universal (Glasser the ability to

remember

and belonging, power, freedom, and fun

survival, love

& Wubbolding,

the behaviors that

1995). As a part ol being

made

good or bad

us feel

human, we

—

are

inherit

that satisfied or

(i.e.,

did not satisfy needs), and these memories guide our future choices of behavior (Glasser, 1998).

other

It is

interesting that Glasser (2004) sees only

mammals do

the need for power;

not, in his view.

All of our behavior represents 1

humans having

our best

needs (Glasser,

effort, at the time, to satisfy

998). Individuals meet their needs in different ways, and the specific people or things that

they identify as need-satisfying are sometimes called wants (Wubbolding, 2000). For

example,

may

I

have a need for power that

accomplishment derived from writing

book becomes,

Finishing the

Love and belonging

for

me,

to

is

some

book and possibly helping people help want that helps to satisfy a need.

others.

this

a

The need

the most important need.

is

extent satisfied by the sense of

and

to give

receive love

extends to family, friends, and intimate partners (Peterson, 2000). Glasser distinguishes

among is

love, belonging,

not synonymous with

and friendship and cautions that it

Most people have no the process

is

that this

because

is

likely to

sometimes involved

in love,

(Glasser, 1998).

through friendships;

difficulty fulfilling belonging needs

Love

fairly easy.

sex,

we tend

is

much more

to believe

and Glasser maintains

difficult to find,

we “own” our

lovers,

and

use external control psychology (discussed later)

are therefore

more

these relationships

in

(Glasser, 1998).

The need for fun capacity of humans

is

satisfied

through play (Peterson, 2000), but

to learn. Glasser (2002)

good

feeling,

most

easily satisfied needs because

is

can be

observed that successful relationships ing and laughter (which

Wanting power humans, according their

is

The need for fun is one of the many ways (Glasser, 1998). Glasser

need for fun because they involve learn-

are having fun).

to Glasser (2004). People inherently

want

way

to survive,

to feel

stuff,

to

do (and watching them do

and punishing others when they

aspect of our

power need often

of power needs. (Glasser, 2002).

We

will

feelings

by important others, we

we

work hard

Power needs feel

“wrong”

unique

to

it),

also satisfied

by

being right, getting

(Glasser, 1998).

This controlling

leads us to try to coerce others.

Other ways of satisfying power needs

good of others. The good

are

is

important and to have

importance recognized by others (Peterson, 2000). Power needs are

what

a very

20).

for the sake of power, rather than as a

getting our way, telling others

more

(p.

fulfilled in

satisfy the

one sign you

also related to the

wrote “having fun, which produces

our genetic reward for learning” it

it is

get

are less malevolent, such as

from

a job well

done

result

doing things

from the

for the recognition that satisfies

also lead us to

want others

powerless, and that

is

for the

satisfaction

our power needs

to listen to us; if

we

are ignored

painful.

we have control of our lives (Peterson, 2000). We are most concerned with freedom needs when they are threatened (Glasser, 1998). Freedom to make choices is an important aspect of this need, although we sometimes forget we have this power.

The need

for

freedom

is

satisfied

when we

believe that

REALITY THERAPY

358

The

relationships

fied simultaneously,

among the needs are complex. Sometimes several needs can be satisas when relationships satisfy needs for love and fun. On the other

hand, fulf lling our need for love and belonging (Glasser, 2002). to

“Power destroys

be bossed around. In Box

love,”

1.2,

1

I

is

often complicated by our need for

wrote Glasser, (1998,

summarize

42) because

p.

power

nobody

likes

about two types of person-

Glasser’s ideas

that are troublesome in relationships.

alities

Our

basic survival

faction of love

ships in

need for sex

may

lead us to unloving sex,

and belonging needs. Freedom and belonging needs can

simultaneously. Successful relationships are those in

conflict in relation-

which partners negotiate

so that needs

Mei Ling that Donald is failing to satisfy a number of

to

Love and belonging needs seem

Tammy. Power needs

also

seem

upsetting. Impulsive spending,

to

be central in that he wants to reconnect with

The Two

Mei Ling knows,

can also be

1 1

.2

Long-Term

Personalities Unsuitable for

The Sociopath and

Relationships: Glasser (1998) maintains that

Donald says that his job loss is a way to satisfy power, fun, and

be important; for example,

to

Box

most individuals have

Significant

the Workless

significant needs for love, loving

and belonging. However, he does recognize that two kinds of individuals

sex,

both

by both partners.

Donald's presenting problems suggest his needs.

us of satis-

different levels of these needs yet seek to satisfy

which partners have

are satisfied

which deprives

are not

very successlul in committed, long-term relationships: sociopaths and the workless. Sociopaths

seem

to care only

about power and freedom. Glasser maintains that they

male because he thinks males genetically have lower needs for love and

are likely to be

belonging and higher needs for power than females. According to Glasser, the sociopath will tell a

woman

that

he s been looking

Rut you have not been looking for a

man

all

his life for a

like

him”

(

1

woman

998,

p.

1

like

07).

you, and

He

is

that’s true.

out to get what

he can and does not care about his victim, exiting as soon as she expresses any belonging needs.

A

sure sign of a sociopath

The workless individual

more prevalent

in

our

is

is

that he has

more puzzling on

society,

but

may

no

first

friends.

glance.

be because

Male workless types seem

more acceptable for a woman to be unemployed than it is for a man. Workless people seem to have low needs for survival and high needs for power. They have some belonging needs (compatible with their power needs), which lead them to want to talk about themselves and how wonderful they are. The prominent dynamic is the mismatch between their strong needs for power and the

this

lack of energy to institute the

power

it

is still

strivings that

is

the result of the low

survival need.

Adapted from Choice Theory: A

New

York: HarperGolIins.

New

Psychology of Personal Freedom, in 1st ed by

W.

Glasser, 1998.

REALITY THERAPY freedom

needs. In the context

attempt to to his

him

359 of his

satisfy freedom needs.

relationship with

Donald's tendency

needfor fyeedom. Mei Ling also

to try to control

to

Tammy,

this

move from job

spending to job

suspects that Donald's power needs

is

probably an

may also

be related

have been tempting

Tammy's behavior and therefore play a part in the troubled

relationship.

Quality World The

we

quality world refers ro a place in our brain where

things or people (Glasser

or objects

make and

are born,

& Wubbolding,

us feel good.

it is

The

we

1995). Because they satisfy needs, these people

construction of the quality world begins shortly after

desire,

For the most part,

and

we

we want

beliefs or ideas that

to be with, things that

guide our

lives (Glasser,

we

mother

aware of them (Glasser, 1998). Glasser (2002) goes so

are

the

is

food and

love. Parents also

forever” (1998, p. 195).

Sometimes we put

the loss of that image of himself

is

when

is

your

the source of

worlds

our quality worlds, such

when he

but doing so can be a painful process.

desperately wants to be a pro football player will have difficulty

as

by the

far to say that

a professional football player

We can remove images from our quality world,

such

are there

are stuck in each other’s quality

unrealistic pictures in

young man carrying an image of himself as benchwarmer on his high school team.

ficult,

p. 45).

put their children in their quality worlds almost automatically,

as a

who

who

person that you put in your quality world because she

first

and Glasser maintained that “parents and children

kid

1998,

consciously choose to put these people or objects in our quality

worlds, with the exception of our parents or other primary caretakers,

time

we

we maintain in our we want to possess,

revised continuously over our lifetimes. Images that

quality worlds are those of individuals

experiences

store images of need-fulfilling

Removing people from our

coming

quality worlds

a significant intimate relationship ends. Liowever,

repeatedly experienced as contrary to our needs, he, she, or

it is

when

is

is

a

The

to terms with

particularly dif-

a person or object

banished (Glasser, 1998).

Donald's quality world probably includes his father, Tammy, spending money,

and

the

and science fiction magazines and movies are there as well because they satisfy his fun need. These people, things, and behaviors contribute to the satisfaction ofDonald's needs, making him feel good. Mei Ling is not sure whether Donald's mother is in his quality world. The hostility he expresses about her suggests that she may have repeatedly denied his needs for love and belonging as a child. As a result, Donald may have objects

obtained by spending. Mystery

engaged in the painful process of removing a parent from

his quality world.

Total Behavior The term ior.

All behavior

(Glasser,

tionships rear

total behavior \s is

2000b,

composed of four components:

p. 3).

among

used to accentuate the multidimensional nature of human behavacting, thinking, feeling,

Glasser used the image of a front-wheel-drive car to explain the rela-

these components.

The

front

two wheels

wheels are feeling and physiology. Steering the car

the direction of the front wheels, points:

and

(b) feelings

(a)

and the

acting and thinking are

two

and physiology

rear

is

are thinking

and

acting,

and the

accomplished through changing

wheels generally follow. This image makes

more under our control than

feeling

and physiology can be influenced by acting and thinking

and physiology

(Glasser, 2002).

REALITY THERAPY

360

Mei Ling knows that Donald's total behavior is composed of his actions, thoughts, feelings, and physical sensations or state. The way he thinks about his situation has great influence on how he feels, as does his behavior. He may be thinking that Tammy should obey his wishes and come back to their marriage. Thinking this way connects to anger and then depression and loneliness. He behaves in a depressed way, gets fired from work, and feels even more depressed.

feeling

is

So Donald's actions are sitting at home,

depression or anger,

and his physiology

is

his

thinking

that his neck

that he

is

is

worthless, his

and head ache.

Choice Theory Choice theory

is

the ideological basis for RT.

The

10 axioms of choice theory are listed in

The most important tenet of choice theory is that “we choose everything^Q do, including the misery we feel” (Glasser, 1998, p. 3; italics in original). We therefore have control over our own behavior, but we cannot control the behavior of others. We can only Box

1

1

.3.

give others information.

Choice theory ise

that

human

is

which

contrasted with external control psychology,

existence

is

rests

on the prem-

controlled by the environment (including other people;

Box

1 1

.3

The Ten Axioms of Choice Theory 1

.

2.

The only person whose behavior we can All we can give or get Irom other people

3. All

is

is

our own.

information.

long-lasting psychological problems are relationship problems.

4.

The problem

5.

What happened

10.

control

relationship

is

always part of our present

in the past that

was painful has a great deal

today, but revisiting this painful past can contribute

need to do 6.

We

now

are driven

— improve an important,

by

lives.

little

to

do with what we

or nothing to

are

what we

present relationship.

five genetic needs: survival, love

and belonging, power, freedom,

and fun. 7.

We

can

satisfy these

needs only by satisfying a picture or pictures in our quality

worlds.

we can do from birth to death is behave. All behavior made up of four inseparable components: acting, thinking,

8. All

9. All total

behavior

is

designated by verbs

.

.

.

is

total

feeling,

behavior and

is

and physiology.

and named by the component that

is

most recognizable. All total behavior

is

chosen, but

thinking components. rectly

From

“'I'he

through

We

we have

direct control over only the acting

can, however, control our feelings

how we choose

to act

and physiology

and

indi-

and think.

Ten Axioms of Choice Theory” from Choice Theory by William

©

Glasser. Copyright 1 998 by William Glasser, Joseph Paul Glasser, Jana Dolores Glasser, Nathaniel Alan Thompson, Jullianne Kay Thompson, Martin Howard Glasser. Reprinted by permission of HarperCollins

Publishers Inc.

.

REALITY THERAPY

361

Wubbolding, 2007). “The simple operational premise ol the external control psychology

who are doing wrong, so they will do what we say is right; then reward them, so they keep doing what we want them to do” (Glasser, 1998, p. 5). External control psychology persists because it is sometimes effective those who have the power to control others sometimes get what they seek. Those who are powerless are aware the world uses

is:

Punish the people

—

that external control

who

aware that fighting would

Three basic

I

me; and

to

make the situation worse

whether they meet

can (c)

make

other people do what

my

it is

Also, those

submit (wrong) and

(often right; Glasser,

1

998)

want them

do and they can do

to

obligation to punish and reward others depending

my standards for behavior

of external control psychology are

and punishing or rewarding

I

to

it.

my behavior is controlled by

beliefs underlie external control psychology: (a)

external factors; (b)

same

likely

one day employ

to

no choice other than

are controlled (a) believe that they have

(b) are

the

sometimes does work, and they hope

(Glasser, 1998, p. 16).

The

on

seven deadly habits

blaming, complaining, nagging, threatening,

criticizing,

2000b,

to control (Glasser,

Contrast these to the “seven

p. 6).

connecting habits: caring, trusting listening, supporting, negotiating, befriending, and encouraging” (Glasser, 2002, Glasser

is

psychology

is

adamant a

p. 14).

in his assertion that living

major mistake.

This psychology

is

He

by the principles of external control

warns:

a terrible plague that invades every part of our lives.

It

destroys our

happiness, our health, our marriages, our families, our ability to get an education, and

our willingness to do high-quality work.

drug abuse, and unloving sex that Do?iald,

who

is

the cause of

make him spend

most of the

society.

(1998,

violence, crime,

p. 7)

relationship, has likely fallen into believing

possible that others have used external control psychology to

He blames othersfor his situation andfeelings rather than He feels bad because Tammy lef. However, he resents that she

infuence his behavior as

realizing that he has choices.

is

our

are pervasive in

having trouble with a significant

external control psychology. It try to

It is

well.

money when they were together. They probably used the seven at work fred deadly habits on each other. Donald is feeling inadequate because those him for no reason. He is sitting around because he is depressed and deserves better than just any oldjob. Donald sees himselfas a supefcial person who is “unable” to relate to others and tried to

believes that

something

Mei Ling

is

less

definitely

wrong with him.

believes that if Donald

ofhis behavior

is

chosen,

would adopt

and he can make

choice theory, he

better choices.

No

would

realize that all

magical entity can make him

human being. Turther, he cant control other! behaviors, and trying to do so is simply fustrating and drives them away. When others try to control his behavior, he gets mad and uncooperative, such as at work.

depressed, addicted to excitement, or in general a faulty

THEORY OF THE PERSON AND DEVEEOPMENT OF THE INDIVIDUAL According

to

RT, “personality”

(Glasser, 1998). Glasser

is

based on the relative strengths of a person’s basic needs

maintained that the

relative strength

of the needs

thus, personality does not change. For example, Irene’s strong need for

seem

like a

very different person from Casey,

who

is

much

less

is

fixed at birth;

freedom makes her

interested in

freedom and

REALITY THERAPY

362

and belonging. 1 hese two individuals may have difficulty negotiatmight be able work out ing a relationship because of the differences in their needs. They some compromises. However, when two people in a relationship have high needs for power, negotiation is more difficult because negotiation implies that one petson has to give in.

more

interested in love

R'f does not have a fotmal theoty of personality development. Howevet, Glasser admitted that the “seeds of almost

who

gin to encounter people

unfortunately,

what

is

all

out unhappiness ate planted eatly in our

have discovered not only what

is

lives

when we

them

right for

but

be-

also,

This kind of behavior on the part

right for us” (Glasser, 1998, p. 4).

of patents or other powerful people (the use of external control theory) leads to poot telationships charactetized by mistrust of the child on the patt of the patents. This misttust will affect futute telationships (Glasset

An

1998).

extreme example of

with abused children. If you can’t be safe with your parents,

who

Ghildren

ers?

are

how

this process

as a result,

had

tices (Glasser, is

a great deal to say

about parenting

1968, 1990, 1998, 2002).

our needs” (1998,

satisfy

p.

their children, not

on

choices.

He

as well as

own

their

with

our current educational prac-

maintained that the early experience of trust is

crucial to learning

how

to

219). Ghoice theory parents reject the use of punishment and

instead give their kids massive ents should evaluate their

own

to use choice theory rather than external control theory

healthy development because “learning to trust

critical in

have great

1998). Using external control the-

ory with children also prevents them from learning to be responsible for their

Emphasizing the need

seen

can you be safe with oth-

abused never learn to trust their parents, and

difficulties establishing relationships in general (Glasser,

kids, Glasser

is

amounts of love, which

is

not conditional on behavior. Par-

more closeness with an expression of power needs and

behaviors based on whether they bring

need to be

“right,”

which

is

an endorsement of external control theory. According to Glasser, this criterion (“will this choice bring

me

closer to this

important other?”)

is

helpful in any relationship.

However, Glasser does concede that the parent must a child

school that

times hold her ground because

not ready to handle making a choice. For example, the decision about going to

is

not negotiable for an 8-year-old.

is

it is

at

safe to allow the child to

On

be around the

parents or other responsible adults present),

the other hand, as soon as

you determine

home without direct supervision

you can allow him

to

choose

his

(but with

bedtime.

The

child will learn responsibility through experiencing the consequences of his choice about

how much

sleep he needs.

Of course, waking-up

time

is

not negotiable because he must

attend school.

Donald seems job

to job

shows

he relatively high in his needs for power

and compulsive spending are probably

choices

interest in relationships, suggesting relatively

and fin self as

to

needs seem weaker.

being addicted

Donald clearly

to

meant

to

is

these needs.

He also

characterization of him-

related to his need for fun or power.

with him some

issues

with his parents. Although his father appears

Donald lepoited (and may have

meet

high belonging needs. Donald's survival

Mei Ling wonders whether Donald’s

excitement

carries

andfreedom. His movement from

around trust that stem fom

to

his relationships

be in Donald’s quality world, the violence

experienced) could have influenced his views

of relation-

and his level of trust in others. Clearly, he has great difficulties relating to his mother, and Mei Ling is unceitain about whether Donald’s mother is in his quality world. Because

ships

Donald’s parents divorced,

Mei Ling

guesses that they both probably endorsed external

REALFFY THERAPY

363

control theory because this kind of separation suggests

may have

occurred in response

an

escalation

attempt by the parties

to the

offreedom needs that

to control

each other.

how he behaves in his current relationships. He demonstrates a needfor love and belonging but may be trying to force Tammy into his version oftheir relationship in an attempt to satisfy his freedom and power needs. Also, Mei Ling suspects that Tammy has tried to use external control theory on Donald andforce him to change his behaviors through punishment (yelling, criticizing, leaving) and reward. Donald’s history of relationships

is

probably related

to

HEALTH AND DYSFUNCTION Healthy people, from the

RT

perspective, are advocates of choice theory.

They

happy

are

because they have found ways to satisfy their needs without violating the rights of others (Glasser,

2000b); most important, they have satisfying personal relationships.

Originally, the source of dysfunction in

needs. Glasser contended that

“when we

RT theory was seen

how to satisfy one or more are the source of all human

are unable to figure out

of the five basic needs built into our genetic structure that

we sometime choose

motivation, illness”

(2000b,

tive

in

ways that

are currently labeled

mental

p. 1).

Glasser’s revision

an individual

behave

to

as the failure to satisfy one’s

feels

of

RT

theory makes the matter simpler: dysfunction happens

disconnnected from others and,

behavior (2000b,

logical problem. Either

p. 4).

As Glasser put

a person

suffers

it,

chooses painful and destruc-

as a result,

“I believe that there

is

only one basic psycho-

fom a present unsatisfying relationship

no satisfying relationships at air (Glasser, n.d.,

when

or he or she has

p. 1; italics in original).

We are always in the business of choosing behavior aimed at satisfying our needs. To more clearly

emphasize the power of humans to choose

fix ing\s>

(Glasser,

added 1

to traditional behavioral labels. Depression, for

You

998).

1

.

bad choices

you

realize that expressing

it

like

we

the relationships

need, our

—

Choosing

civilization

would not have survived

to depress avoids

tion (Glasser,

2000b,

first

response is

is

to

important

might further damage what relationships we do have.

People learn that choosing such behavior, particularly depression,

angering

are simply the

depression restrains the anger, which

help. Also, depressing (or other maladaptive behavior)

3.

These choices

for three reasons:

Choosing funky behavior

we

because

are headaching.

example, becomes depressing

time; clients are not to be criticized for their choices.

When we get lonely because we don’t have get angry.

2.

don’t have a headache,

we perceive at a given

best alternatives

We make

their psychological dysfunctions, the suf-

tougher alternatives

if

we

—

all

is

an effective way to get

much more

is

acted on our

like facing

functional than

initial anger.

problems and risking

rejec-

p. 5).

The typical RT diagnosis is unhappy person. “All unhappy people have the same problem: They are unable to get along well with the people they want to get along well with” (Glasser, 1998,

p.

Further, “barring grinding poverty, incurable illness, or living under tyranny,

5).

unhappiness lead people

is

the only

down two

unhappy person

He

(Glasser,

2002,

distinct roads (Glasser, 1998).

p. 2).

The

is

tries to

seen

when

the

This kind of unhappiness can

first

tries to find relationships that are satisfying

The second option altogether.

human problem”

road

is

the obvious one

so that he can be

unhappy person decides

to give

up on

happy

— an

again.

relationships

find happiness or pleasure without relationships, which, according to

REALITY THERAPY

364 Glasser,

impossible. These individuals often replace pictures of people in their quality

is

worlds with other sources of pleasure such

Even psychotic behavior

as drugs,

unloving

sex,

and

violence.

seen as our bad choices in attempting to meet needs.

is

Glasser wrote.

But when we are unhappy we are capable of bizarre and unrealistic creativity as commonly seen and labeled schizophrenia, bipolar disorder, obsessive compulsive disorder, relentless phobia, disabling panic attacks or clinical depression. But as

much

as these creative

symp-

toms, which include hallucinations, delusions, obsessions, compulsions, disabling fear

and severe depression, appear as if

him

they are happening to

Donald

is

clearly displaying

with his wifoy

Tammy He

is

or her

establish

control

— they seem

are not. (Glasser,

2000b,

to materialize

p. 4)

lonely because he fails to connect in other life relationships

belonging needs are going unmet. to

—they

client’s

unhappiness that stems from an unsatisfactory relationship

Mei Ling knows

for instance, he has no close fiends.

appears

beyond the

to be

He

has chosen

that he

to depress

is

in

pain because

about

be headaching as well. Donald’s depressing behavior

a relationship with others or

to

get

Tammy

to

continue

is

to

his love

this situation,

—

and

and also

probably also a bid attend

to

to

him. Under-

fom the dissatisfaction he experiences. Mei Ling guesses that Donald’s job loss resultedfom his depressing behavior. He was mef

neath the depression

fctive on his job

is

and listless with

compromised Donald’s

feedom

the angering resulting

needs are

f

ability to satis

unmet because he

and missed a

ofdays at work. These behaviors his power needs through work accomplishments. His

his clients,

can’t

lot

spend money because he doesn’t have any.

NATURE OF THERAPY Assessment No

assessment

is

used in

RT

problematic. Given his views

counseling, other than figuring out

on

what

traditional psychiatric approaches,

relati 9 nship(s) is (are)

it is

probably no surprise

that Glasser does not advocate the use of formal diagnosis except for insurance purposes (Corey,

2001). illnesses

I

—

strongly believe that are not only

all

psychiatric diagnoses

—

usually thought of as mental

wrong, they are harmful to the people so labeled” (Glasser,

n.d., p. 1).

Mei Ling would not use any formal assessment with Donald. She would simply try to understand what relationship or lack thereof was related to his troubles (i.e., his loss of the relationship with Tammy). Mei Ling diagnoses Donald as an unhappy person.

Overview of the Therapeutic Atmosphere 1

he client— therapist relationship

wants to become

is

very important in RT. Ultimately, the

RT

counselor

a picture in the client’s quality

ing relationship can also be seen as a

world (Wubbolding, 2000). The counselway of meeting the client’s love and belonging needs.

Further, the therapist approaches the client with the confidence that he can learn to better satisfy his needs, and this confidence becomes part of the client’s view of himself (Wubbolding et ah, 2004).

REALITY THERAPY To achieve

365

the quality relationship needed in RT, the counselor displays empathy,

genuineness, and positive regard (Wubbolding

&

Brickell, 1998).

The RT

counselor

is

way of being genuine, has the option of self-disclosing to the client (Wubbolding, 2000). Although some might call the RT counselor confrontational, Glasser said that “reality therapists are among the least pushy of all people” (1992b,

straightforward and, as a

He meant

28-2).

p.

RT

that

counselors, while directly addressing the client’s current

choices, take great care to avoid using external control theory with their clients, encourag-

ing

them

RT

is

instead to

make

their

own

choices.

very active, focused on behavior and thinking.

firmly centered in the present

It is

ABCDE to describe the RT

(Wubbolding, 2007). Wubbolding (2000) devised the acronym relationship,

which stands

for “Always

Be Courteous, Determined, and Enthusiastic”

RT as short term in nature;

Glasser sees

most clients need 1 0

However, Glasser cautioned that the length of counseling

is

(p. 93).

sessions or so (Glasser, n.d.).

ultimately determined by

how

quickly the therapist can establish a good relationship with the client (Glasser, 2000a).

Mei Ling

work hard

will

to enter

Donald's world and

to

genuinely relate

to

him. She will

him as a human being, working hard to convey this positive regard in an unconditional way. Her enthusiasm and determination will give Donald hope that he can change his life. Mei Ling will be honest and direct in asking Donald about his current situation. appreciate

Roles of Client and Counselor RT

counselors ask lots of questions and challenge the client to evaluate his behavior

(Wubbolding, 2000). Because the counselor of doctor— patient. the client

is

The

counselor

is

is

directive, the relationship

an expert on choice theory and

there to receive this knowledge. Clients in

RT

is

the only one

bility in the if

role.

However, the

of external control theory makes the client the expert

who

can determine what

is

right for him.

behavior,

and

The

client

RT coun-

in the sense that

he

must accept responsi-

counseling sessions, because he must evaluate his current situation and decide

and how he

will institute change.

Wubbolding and

Brickell (1998) suggested that the effective

a positive

view of human nature, energy, and the

They

added that the

also

human

are often taught the principles

of choice theory, necessitating the use of the teacher— student selor’s rejection

can resemble one

RT

RT counselor needs to have

ability to see the bright side of situations.

counselor must have “some degree of mental health”

(p.

47).

Mei Ling is energetic and active in her sessions with Donald. She teaches him about choice theory and points out the ways external control theory can be detrimental to human relationships. Mei Ling expects Donald to listen to her ideas, but accepts that he may disagree or decide not to put them into action. She appreciates his ability to evaluate and choose for himselfand does not pressure him to do things her way. At the same time, Mei Ling expects that Donald will take some responsibility for what happens in counseling sessions.

Goals RT counselors them and

are interested in helping their clients

make

better choices that are helpful to

don’t interfere or hurt others (Glasser, 20()()a). Ultimately, the reality therapist

REALITY THERAPY 366 relationship(s) that is central to the clients teaches the client to reconnect in the critical (Glasser, 2000b). As a part of or establish new, more satisfying relationships

discomfort

in the ideal RT, he learns choice thecounseling, the client learns about bad choices, and 1998). Thus, the client learns to take so that he can use it in future situations (Glasser,

ory

responsibility for his choices satisfying relationships.

effective choices that will reestablish effective,

and make more

further clarifies that the

Wubbolding (2007)

RT

counselor can

needs. help the client determine specific wants related to the basic Ghanging leelings is a goal of interest to most clients. RT counselors believe that feelings can (Glasser, 2000b). Acbe changed only by making more effective acting and thinking choices depressing [we must] cording to Glasser, when we want to stop choosing a painful behavior like

change what we want,

(1)

(2)

change what we are doing, or

Mei Ling will help Donald evaluate his

current situation

(3)

change both” (1998,

and decide

ifhe

p. 71).

would like

to in-

way of relating to her. If he decides to attempt to regain his relationship with Tammy, Donald needs to choose behavior other than that is, he depressing. He should use the criterion of closeness to choose his new behaviors should always ask himself “Will this behavior bring me closer to Tammy or noT” Mei Ling reminds Donald that despite his new choices, Tammy might still choose to end their relationship. Donald needs to begin thinking in terms ofhow he could change his thoughts and vest in his relationship

Tammy

with

by changing his

—

of how

actions, not in terms

Tammy

should

be, act, think,

that ifDonald chooses behaviors based on choice theory,

more loved and he more able

to relate to

or feel differently. Lt

is

possible

Tammy wouldfeel less coerced and

Donald.

PROCESS OF THERAPY RT

is

present oriented,

(Glasser, n.d., p. 1).

to

RT counselors see dwelling on

RT counselors engage in no faultfinding or blaming. The emphasis

do now and how the

Good

the past as a bad thing. Glasser re-

people can only be helped by endless visiting and revisiting past misery”

jects “the idea that

what

and

reality therapists

client

should

can

let

make new

go of the past and help the client get to work on the

helpless in the face of their circumstances,

is

doesn’t like to

spend

2000b,

stuff the client can’t control (the

life is fair;

process.

1

he

RT

and what they

of time talking about symptoms the client

There

is

real

no sense

them.

problem, the major unsat-

in devoting a lot

of time to

behavior of others, or the past). If the client protests that

is

is

likely to tell the client that there

that

presents the

are currently doing. if

you

are the only person

acronym

WDEP

is

no guar-

you can change.

to describe the counseling

Most important, the

plans.

Once

the plan

through on the plan.

no perfect plan (CRasser, 1992a).

If

is

made, the

lives

therapist helps the client self-

his current actions are effective. Glients are

and attainable action

for not following

clients as

counselor helps clients explore wants, describe the direction of their

evaluate by asking ple

view

a lot

p. 9).

the only sure thing

Wubbolding (2000, 2007)

therapists

are therefore unlikely to help

these externals are important, the therapist

antee that

Bad

and

choosing because doing so allows the client to avoid the

isfying relationship (Glasser,

on

choices (Wubbolding, 2000).

present interpersonal relationship problem (Glasser, n.d.).

The RT counselor

is

then helped to

make sim-

RT counselor accepts no excuses

one plan doesn’t work, another

is

tried

—

there

is

REALITY THERAPY

RT

367

counselors do not relate to psychoanalytically based constructs such as transference

and countertransference. The ference ship.

is

reality therapist

should

just

be herself

Any

talk

about trans-

simply the client and counselor avoiding responsibility for the current relation-

According

Corey (2001), Glasser

to

says that

Freud created transference to avoid

getting personally involved with his clients.

and

Fuller

309—317) presented an eight-step approach to RT. Not all instead, some are cautions or admonitions to the counselor.

Fuller (1999, pp.

of these steps are truly stages; Step 1 : Involvement.

The

counselor makes friends with the lonely

Step 2: Focus on Present Behavior. Step 3:

Counselor and

Value Judgment. Client and counselor

client.

client describe

work

what the

client

Step 6:

Step 7:

doing now.

to evaluate the client’s current choices.

Step 4: Planning Responsible Behavior. Plans should he reasonable, specific, Step 5:

is

and

positive.

Commitment to the Plan. The counselor asks the client, “Will you do it or do you want to make another plan?” Accept No Excuses. The client is not punished if he does not follow the plan, but the counselor doesn’t listen to why either. The counselor asks, “When will you do it?” Do Not Punish. RT counselors believe in allowing the consequences of the client’s behavior to happen rather than imposing negative outcomes, or punishment. In

fact, all

of the seven deadly habits of external control theory are forbidden. Step 8: Never Give Up.

RT

can be solved, even

counselors always endeavor to send the message that the problem takes

if it

many

tries.

Adapted from “Reality Therapy Approaches” by G. D.

T.

Brown

(Eds.), Counseling

1999 John Wiley

After she

is

and

B. Fuller

and D.

Psychotherapy with Children

& Sons, Inc. This material

sure that she has established a

is

Prout

L. Fuller. In FI. T.

and Adolescents. Copyright

used by permission of John Wiley

& Sons,

& ©

Inc.

good relationship with Donald, Mei Lingfocuses on

and asks him to describe what he is currently doing. She asks him if his current behavior is getting him what he wants. Donald, with a little squirming and discomfort, acknowledges that his current situation is not the best, and that bed like things to be different. Mei Ling teaches Donald that the only thing he can change is his own behavior and proceeds to help Donald look at new choices and develop a plan to better meet his needs. Ifhe decides to pursue his relationship with Tammy, Mei Ling helps him develop a plan to choose different behaviors in relating to her. Alternatively, Donald may decide that trying to recapture the relationship isfutile, and Mei Ling will then help him plan to go through the painfid process of removing Tammy from his quality world and, eventually, establish new relationships. No matter what Donald does, Mei Ling will not give up on him. Ifhe tries to talk to Tammy and blows up, Mei Ling will not criticize this behavior. She will only ask how Donald wishes the current situation

to

be the next time he talks to Tammy.

THERAPEUTIC TECHNIQUES Unlike some other approaches, selor.

The

tification

practice of

of

(a)

RT

is

RT does not identify a host of techniques available to the coun-

more

aptly described as a process of discussion leading to the iden-

the client’s current need-related behavior that

which more functional behavior can be chosen I

will present several interventions that

that

still

is

meets the

have been discussed by

problematic and client’s needs.

(b)

With

reality therapists.

ways

in

that said,

REALITY THERAPY

368

QUES riONlNG Howatt (2001, p. 9) identified four that are commonly used: (a) What do you want or what do you really want? (b) What are you doing? (c) What is your plan? and (d) What will happen if you continue to do what you are doing? Another key question is, “Is what you are now choosing to do (your actions and thoughts) getting you what you want?” (Glasser, 1992a, R'r counselors are quite likely to ask the client a lot of questions.

p.

The

277).

reality therapist

1992a). Ghoices

(Glasser,

very interested in being specific rather than general

is

made need

to be described in detail so that the client

can

evaluate them.

Questions are aimed

at identifying

needs and current behavior, and they serve to rein-

force the client’s choice in maintaining

The

clients self-evaluate.

ple plan to take charge

One

is

hope and

Met Ling

asks

acknowledges that he ship with

much

going right in his

is

and

is

are intended to help

to help the client develop a sim-

unhappy and that to

RT counselors. The RT counselor almost life

(Wubbolding, 2000). This question

might be used

to

make new

choices.

him what he wants. Donald he wants a new job and to fix his relation-

if his current behavior

Tammy. In response

of anything

Tammy

is

identifies client strengths that

Donald

two questions

life.

of great importance to

always asks the client what builds

last

general motive of the therapist

of his

further question

The

it.

Mei Lings

is

getting

question, he reports that he

that if he continues, he’ll go to the poorhouse

is

and

not doing never get

back.

Mei Ling guides Donald through a specific, detailed description ofhis current functioning. She asks what his plans are to be different. Donald says that he will do two things over the next week: call Tammy and ask her out for a date, and start to explore job options. Mei Ling insists that Donald create a more specific plan to look at job opportunities.

Bibliotherapy Clients in (Glasser,

RT are often encouraged to

1998)

is

read books, particularly Glasser’s books. Choice Theory

the most general of these. Glasser has written other books directed toward

understanding relationships and working with kids (Glasser, 2002; Glasser

Mei Ling

& Glasser, 2000).

Donald the books Choice Theory and Getting Together and Staying Together. Donaldjokes that he likes science fiction better, but he agrees to read one them gives

of

prior to the next counseling session.

OoiNC, THE Unexpected Rather than a specific technique, doing the unexpected helping clients assume responsibility for their lives.

is

Under

would consider using paradoxical techniques tom.

II

the client can perform the

doesn’t perform the

the choice to cry

symptom,

now

an admonition to be creative this

the

problem

is

heading, a reality therapist

that require the client to

symptom, he acknowledges

in

perform the symp-

his choice

and control.

If he

solved. For example, a child could be given

or wait until later (Glasser, 1998).

REALITY THERAPY

369

Reframing Reframing

is

perspective

on

“careful

and

Mei Ling

approach that involves helping the client find

a paradoxical his situation.

For instance, compulsive client behavior could be reframed

as

deliberate.”

reframes Donald's ''addiction to excitement" as energy that he could use in his

work. She could prescribe this behavior by having

ment

a different

him

15 potential places of employ-

visit

in one day.

Humor RT

counselors are likely to poke fun at themselves and, carefully, at the

For example, in Glasser’s (2000a) fantasy client’s girlfriend

RT

Melvin Udall

Jerry, the

problem.

client, the

spontaneously adapts the tune “Ring around the Mulberry Bush” to

describe Jerry’s compulsive behaviors: “This locks the door”

(p.

of the behavior

is

Mei Ling gently

with

client’s

is

the

way he

locks the door, locks the door,

problem becomes funny while

96). Jerry’s

at the

same time

his control

emphasized.

teases

Donald about his shopping

"addiction. "Referring to his "black belt

in shopping, " she suggests that the perfect job for

department store, or

better yet, as

Donald would be

as a buyer for a

a personal shopper for a very rich person.

Self-Disclosure RT

counselors are encouraged to be

disclose to the client.

warm and human, and one way

Wubbolding (2000) maintained

mation about yourself is

that disclosing

a great path to a closer relationship

to

some

with your

do

that

is

to

relevant infor-

client.

I

would add

that self-disclosure needs to be used carefully to ensure that the relationship stays focused

on the

client, rather

than on the therapist.

Mei Ling considers how to use self disclosure with Donald. She is very careful in her approach and decides simply to tell him that she thinks that relationships are one ofthe best and worst things we have to experience in life. She does not reveal her own struggles specifically.

She could

self-disclose

more

specifically

about her attempts

program, particularly about the things that helped

to set

up an

exercise

her.

Metaphors Adopting and using the standing of the like the

client’s

client’s

own metaphors

perceptions of his world. For example, a client

lamb being taken

to the lions

when

then ask what the lamb could do to seem

could do to befriend the

Donald uses little

the image

motivation,

can be very helpful in conveying under-

she goes to work.

less tasty to

may say that she

feels

The RT counselor might

the lions, or better,

what the lamb

lions.

ofa slug

and very

m describing himself. Lie

rarely has fun (he

is

and slow moving, has have no fun in life). Mei

lethargic

maintains that slugs

REALITY THERAPY

370 Ling thinks about because he

this

really

is

briefly

and

a caterpillar that

He

indeed have fun).

image

going

to

Donald

to (a)

make

is close,

but not quite,

turn into a butterfly (and butterflies do

simply going into his cocoon right now.

is

Donald what he can do

is

then decides that

the best cocoon

and

(b)

Mei Ling

become the

begins to ask

best butterfly.

Physical Activity and Meditation Glasser and reality therapists have long endorsed the benefits of physical activity. In his

book

running

Positive Addiction (1976), Glasser identified

very

as a

is

the mental one; these activities induce an extremely pleas-

urable trancelike state. Glasser believes that this mental state allows the

and the

and

result

is

a joining

of mind and body that leads to unusual

creativity (Glasser, 1976).

It is

not easy to get to the

Glasser maintained that meditation

addiction (Glasser, 1976). As

truly addicting

mental

is

is

the second

to

used

levels

to “spin free,”

of performance

of positive addiction;

most

common way

the case with exercise, not

It

takes

all

meditators achieve the

to meditate, so

ALei Ling encourages

think of some form ofphysical activity that he could tolerate.

to like boxing.

of achieving pos-

state.

Donald does not think he can focus long enough ald

level

mind

6 months of daily running, for instance.

at least

itive

form of

The key component of

positive addiction, but other activities can induce this state, too.

positively addicting activities

common

Mei Ling asks Donald if he could find a way

Donald says

Don-

that he

do some boxing, and

to

he agrees that he could start by visiting some gyms over the next week.

Allowing or Imposing Consequences The

consequence of problem behavior

typical

is

the temporary loss of freedom or a privi-

lege (Fuller

&

Fuller, 1999).

seem fuzzy

at

times (Wubbolding, 2000) so this approach must be used carefully. Advo-

cates of

RI

happens when

aie tive

distinction between consequences

say that the attitude of the

should be seen

sites

The

who

allows consequences

is

critical.

Mistakes

chances to learn; the individual has been told about the rules and what they are broken (Fuller Fuller, 1999). Punishment embodies the oppoas

&

ol those characteristics

imparted

one

and punishment may

and

is

often delivered in an angry way, whereas consequences

manner, according to Fuller and Fuller (1999). The most effecconsequences are probably those that happen naturally, such as being too sleepy bein a friendly

cause you stayed up too late the night before. Second best are consequences based on social rules. An example ol the latter would be when a disruptive child is removed from the class-

room

to a special

room and

is

helped to evaluate her behavior.

Donald has already experienced the consequences ofhis

depressing in that he lost bis job.

He

ea7i also see

that his spending behavior has some undesirable consequences (having no money, hurting his relationship with Tammy),

FVALUATION OF THE THEORY R1 has the great strength of being ticularly, writes

III

a friendly,

relatively

simple and easy to understand. Glasser, par-

com monsense manner

that can be quite entertaining to read.

REALITY THERAPY

He

371

also devotes a great deal of attention to illustrating his ideas using client case studies or

applying his ideas to characters in popular movies and books. Critics have charged that

RT is

too simple, or simplistic. Although

guage was deliberately chosen to make

RT easy to

understand,

its

commonly used

lan-

advocates warn that this

when it comes to putting the theory into action (Glasser & Wubbolding, 995; Wubbolding & Brickell, 2000). Glasser argued that “the fact that what we do is relatively clear-cut and understandable does not make it easy. It takes a skilled simplicity

deceptive

is

1

counselor to persuade clients that they are choosing what they are complaining about or

doing and total

that

it is

to their benefit to

behavior” (Glasser, 1992a. Copyright 1992 by

The Second Conference

Psychotherapy:

Routledge/Taylor

RT is often seem

them

further, to persuade

& Francis Books,

[pp.

with the crowd

is

K. Zeig. (Ed.), The Evolution of

270—278]. Reproduced by permission of

Inc.).

faulted for ignoring social influences

to take these

J.

choose a more effective

on behavior

(Zeig, 1992).

RT does

not

phenomena into account. Glasser would probably say that going along more a result of a failure to wake up and make choices than to any

magical power of social forces.

Qualities of the Theory

—

and Testability. Operationalizing some RT constructs the quality world, for would seem quite difficult. This set of photos could never be observed directly, instance and it would seem difficult to devise a way to clearly observe its effects on behavior. Other Precision

—

aspects of RT

seem

as the idea that

Empirical

to be general

we choose our

Validity.

assumptions that are not amenable to empirical

tests,

such

behavior.

Research has not been the strong point of reality therapy.

tions of the theory are not often directly tested,

Sansone (1998) reported that only

9%

of the

and outcome research

is

The

proposi-

sketchy at best.

articles in the International Journal

of Reality

Therapy were research related.

Research Support Outcome

Research.

Outcome

theory’s effectiveness.

21

RT

studies

studies of

RT

counseling exist and are supportive of the

Radtke, Sapp, and Farrell (1997) conducted a meta-analysis of

and found

a

medium

effect size.

The

widely in methodological sophistication, sample presenting concerns of participants.

evidence for the effectiveness of utility

of

RT

as

Many

RT

studies included in the analysis varied sizes,

treatment characteristics, and

are school based, suggesting that there

in these settings,

but

far

is

some

fewer studies support the

an approach to counseling more generally.

Wubbolding (2000) presented a traditional review (that is, not meta-analytic), a long list of outcome studies, which varied considerably in quality. Many were case studies, either of individuals or of schools

favorable to

RT

However, few

if

methodology generally accepted

implementing

etc.).

principles. Generally, the results

were

any of these studies approached the highest standards of in the

more than one condition, treatment adherence,

RT

study of therapy outcome (random assignment to

vs.

control group comparisons, checks on therapist

REALITY THERAPY

372

Many son,

They randomly

Peterson and colleagues found that the the no-treatment group. Fuller

implemented some kind of

Using self-concept

RT groups

did not

and Fuller (1999) reviewed

RT

Taiwanese university

as the

outcome measure,

but were better off than

differ,

a

RT

number of other

studies that

treatment (and these varied greatly) and found inconsis-

tent results in affecting self-concept. Overall, Fuller

RT were

RT among

assigned students to instruction about choice theory, group

therapy, or a no-treatment control group.

of research on

self-concept. For example, Peter-

efficacy of

Chang, and Collins (1998) tested the

students.

RT on

studies attempt to assess the effect of

mixed. This conclusion

and Fuller concluded that the

results

not surprising given the typical lengths

is

of the interventions studied (8 weeks of group RT, for example). Such brief interventions are not likely to have a serious impact on such a global, psychologically powerful construct as self-concept.

Other

studies have looked at the effects of

These studies

variables.

also varied in

RT

interventions

on

outcome

a variety of

methodological sophistication. Loyd (2005) looked

at

the effects of giving high school students five sessions of teaching about RT. In this quasi-

learned about

RT

of satisfaction of power, freedom, and fun needs after treatment

(in

who

experimental study done in the school, students levels

control group the lack of

who

fifth

and

to treatment conditions

sixth graders.

of victimization

to a

somewhat compromises

does the lack of psychometric information on the measure of needs.

method was used by Kim (2006) 6

comparison

did not receive the intervention), but not in belonging needs. However,

random assignment of students

this study, as

1

reported higher

in the

to study the effects of a

A similar

RT bullying prevention program on

Although differences were found

in self-responsibility

and frequency

expected direction, pretreatment differences on these variables and

design concerns decreases confidence in the results of this study. Likewise, Lawrence (2004) assessed the efiects of

RT

group intervention

comparison to a support group control

(in

He found

condition) for individuals with developmental disabilities.

that scores

on

self-

determination were significantly higher for the treatment group than for the control group.

Kim

(2002) evaluated the effects of an 8-week

and

graders locus of control there were only

two groups

social responsibility.

in the study, control

RT

intervention program on fifth

Thfs study

is

notable because although

and treatment (and they were very small

groups of 12 and 13), students were randomly selected and assigned to groups. Analysis of changes in the variables from pretest to posttest verified that the RT treatment group

changed

in the

expected directions and the control group did not. Thus, this very small

study supports the effectiveness of

Most of which

raises

the research

scripts.

A

critical analysis

ment versus

RT

is

some question about

traditional tenets

is

of the

at least for these

two measures.

published in the International Journal of Reality Therapy, the objectivity of the review process applied to the

RT

literature suggests that

of experimental design such

control, or

administered control.

on

RT

as the

many of

manu-

these studies violate

random assignment to treatthe length or amount of treatment

absence of

comparison conditions. In addition,

often too limited to expect changes in such variables as self-concept or locus of

These problems probably contribute

Theory-Testing Research.

Reports of direct

to the

tests

mixed

of

RT

results

found

in

RT research.

theory are few and

far between. proponents argue that research not specifically conducted as a test of RT theory provides support for their approach. For instance, Sansone (1998) maintained that

Instead,

RT

REALITY THERAPY

373

Deci’s (1995) research

firms the idea that intrinsic motivation in

comparison

a powerful

is

and

lasting

theory because

con-

it

determinant of behavior

to extrinsic motivation.

LaFond (2000) described relative intensity

the development of an instrument intended to measure the

of an individual’s basic needs. Called the Choice Theory Basic Needs

instrument

Scale, this

RT

on self-determination theory supports

may spur

the theory-testing research that

is

badly needed to support

RT. Data from LaFond’s stud)' did lend some support to RT’s need theory in that analyses

documented fortunately,

Un-

the predicted five-factor structure corresponding to the five basic needs.

LaFond found

many of the

that psychometric analyses indicated that

the scale need to be revised before

its

utility

items of

can be fully assessed and that the concurrent

validity data she collected (correlation with a

measure of marital

were weak.

satisfaction)

Harvey and Retter (1995) also developed a measure of basic needs for use with children, the Basic Needs Survey, which showed adequate retest reliability. However, they provided no validity information for this measure.

AND CULTURAL DIVERSITY

ISSUES OF INDIVIDUAL Most

RT

on

writings seem to have a heavy emphasis

and

heterosexuality,

particularly

married heterosexuality. Glasser’s book. Counseling with Choice Theory (2000a) presents cases that deal exclusively with heterosexual couples.

Garleen,

Getting Together

and

Staying Together (Glasser

Solving the Mystery ofMarriage. In the core to focus

on marital

ships exist.

The book

relationships with

RT literature,

little

&

Glasser wrote with his wife

icant emphasis

bias,

it is

acknowledgment

important to note these leanings

on relationship over other

aspects of

is

subtitled

discussions of relationships

human

seem

that other types of relation-

Although the emphasis on heterosexual relationships does

with an inherent

2000)

Glasser,

in light

itself,

equate

of the theory’s

signif-

not, in

functioning. Recognition of

other forms of relationships, including those involving gay, lesbian, bisexual and trans-

gender (GLBT) individuals, would broaden

The assumption

of oppression and mistreatment by the white male establishment (Ballou, 2006;

Linnenberg, 2006). In tain

humans have choice is subject to criticism from the perspectives women, GLBT individuals, and other groups that have been the

that

of cultural minorities, targets

this theory’s appeal.

fact,

members of these groups have been

forced to behave in cer-

ways under the threat of punishment or even physical harm; Glasser would agree and

would

characterize these events as perfect examples of the use of external control theory.

For example, external control theory was clearly demonstrated choices of African Americans were limited

when

it

came

when

1960s the

in the

to dining, riding the bus, or even

drinking from public water fountains.

RT only

theorists

how

would respond by saying

they react to

it

(Howatt, 2001;

that individuals cannot control the environment,

Tham,

2001). Individuals can choose

respond to adverse circumstances, and those choices psychologically. For example, in an article in

Albanian women,

Tham

will

how well

they

they function

which she describes teaching choice theory

(2001) maintained that these

spite the perception that, for Albanians,

determine

how

women

freedom of choice seems

found the ideas like

an

illusion.

to

useful, de-

Wubbold-

ing (2007) points out that “seeing clients, especially minorities, as victims disem powers

them, demeans them, and condemns them to a mental

state characterized

by

self-talk

such

REALITY THERAPY

374 as “I can’t

because they won’t

me.” Reality therapists believe that no matter what people

let

have suffered they need not remain in the position of victim” (p. 203). 'Fhe needs identified in RT theory could be.seen as culturally bound (especially, for in-

power and freedom). Facing these criticisms, its advocates would argue that there not dictated are many ways to meet needs, and the way in which an individual does this is by RT, but by the individual’s own quality world. The quality world is influenced by the stance,

Wubbolding

1998).

et ah,

1998). For example, cies

A

counselor respects these choices (Sanchez, 1998;

brief review of the

RT

seems to support

literature

among RT proponents

of diversity

tivity to issues

RT

and the good

person’s culture,

&

(Mickel

this sensi-

Boone, 2001; Sanchez,

colleagues (1998) endorsed the cultural competen-

Wubbolding and

of the Association for Multicultural Counseling and Development (Arrendondo

et ah,

RT counselors and further elaborated on ethical issues relevant to the applications of RT in a diverse world. Other evidence suggests that RT may be a very acceptable approach for some diverse 1996) for

clients

(Wubbolding

reported

that

et ah,

2004). For example, Okonji, Ososkie, and Pulos (1996)

sample of African American adolescents

a

responded more favorably to a videotape sample of person-centered counseling, particularly male. However,

it is

Corps

participants)

counseling than to one depicting

the counselor was an African

American

always risky to draw conclusions based on one research study. Also,

these clients did not actually experience

Wubbolding

when

RT

(Job

et al.

RT

counseling; they only watched

it.

(2004) suggested that in working with clients from other than the

Western European cultures,

a safe therapeutic relationship

who

becomes

critical,

writing that

them can be helped when they realize that the reality therapist is genuinely empathic and concerned about their welfare and committed to assisting them” (p. 223). Wubbolding (2000) “clients unfamiliar

with the nature of counseling and

detailed other modifications to

suggested that

RT

RT

that are necessary with diverse clients. For example, he

They should

also recognize that the individualistic values

Western society are inappropriate for these

community

based on family or

ever,

Wubbolding

well-being.

clients; evaluation

is

silent

as

issue

life is

of

more commonly this

kind of

African Americans, Puerto Ricans,

differences in perspectives based

on the

of

Wubbolding (2000) performed

from other diverse groups, such

He mentioned

and Koreans.

as foreign to

it

counselors working with clients of Japanese heritage should use gentle,

indirect questioning styles.

analysis for clients

see

on

spirituality as well.

How-

of sexual orientation.

Sanchez, Perez-Prado, and Cadavid (1998) discussed the application of RT to Puerto Rican clients. They identified specific elements of Puerto Rican culture that are critical in

working with

clients

of

this origin,

including respeto (respect), dignidad (dignity), and

personalismo (personalism). Sanchez and colleagues maintained that these and other characteristics of Puerto Rican culture were essential aspects of the quality worlds of these individuals,

and account

and

to sensitively

conduct

RT

with them, counselors needed to understand

for these differences.

THE CASE STUDY Donalds presentation

fits

with the

RT

assumption that relationships are the core of

psychological dysfunction. His grandiose presentation and addiction to excitement might

REALITY THERAPY seem

375

consistent with

less

fun needs,

RT

assumptions, but, conceptualized

inconsistency seems

this

less

making bad behavior

to

meet power or

troubling. Generally, the details of Donald’s pres-

entation are easily understood through choice theory erally

ways

as

— he

is

angering, depressing, and gen-

choices.

Summary Reality therapy

based on the assumption that people are motivated to meet their basic

is

needs of survival, love and belonging, fun, freedom, and power. these needs

which

is

a

that for love

is

and belonging. Each individual constructs

his quality world,

mental collection of need-satisfying people, experiences, and objects. Behavior

represents the best effort of the individual at a given time to

Psychological dysfunction results

problems

The most important of

is

a

key relationship

longing needs.

When

—

when we make bad

the individual

is

meet

his needs.

At the root of

choices.

all

having difficulty satisfying love and be-

these needs are frustrated, the person

becomes angry, but

typically

turns to other behaviors because angering behavior can have very severe consequences.

Dysfunctional behavior, particularly depressing, usually gets the person attention from others and allows the person to avoid trying other behaviors that might be

The RT counselor

is First

interested in establishing a

warm, emparhic

riskier.

relationship with

the client. She avoids blaming or criticizing the client, instead helping the client to ine his current behavior in light of what he really wants. Together, the client

exam-

and counselor

formulate a plan for the client to choose different ways to meet his needs.

Very

little

research exists that directly tests

RT

theory.

The outcome

research that has

appeared, for the most part, does not meet the current methodological standards for empirical

validation.

tion that social

ignore

all

RT

has been characterized as simplistic and culturally bound.

behavior

is

chosen has been the target of criticism because

and environmental

GLBT

Visit

factors influence behavior.

relationships in favor of an emphasis

Ghapter

11

on the Gompanion Website

chapter-specific resources

and

self-assessments.

The

on at

writings of

it

The assump-

ignores the fact that

RT

theorists

seem

to

traditional marriage relationships.

www.prenhall.com/murdock

for

Femin

Susan

is

a 30-year-old Korean American women who

is

recendy divorcedfrom her husband of

2 years. She is a fdl-time student beginning her thirdyear ofmedical school and lives with

her

mother. Susan arrives for sessions neatly dressed, usually in hospital scrubs. She generally ap-

pears younger than her stated age, demonstrates poor eye contact,

and shows

very

little

emotion.

Susan was referredfor counselingfollowing an incident in which she verbally confronted another student during class and was asked to leave the classroom. The counselor at the medical school who referred her suggested that she

may have

appropriately expressing anger; Susan does not agree that this

is

difficulty

managing and

a problem. She says that she

was justified in her anger because the other student, a man, had called her “crazy. ” Susan is adopted. She has no knowledge of her biological parents. Susans adoptive father

is

Caucasian; her adoptive mother

is

Asian. She

died 2 years ago, had a history ofalcohol abuse. a good childhood. She described her mother as

Initially,

is

an only

child.

Her father, who

Susan reported having

“the disciplinarian,

“basically

hard working and lov-

She further stated that although her father abused alcohol, this was not a stressor; she iidored him and he was very good to her. In later counseling sessions, Susan described

ing.

her

home

life

growing up

as uncomfortable; her

further disclosed feelings of resentment

Susan reported having problems husband,

who

lives in

another

city,

and guilt

mother and father argued fi'equently. She related to her father s alcohol abuse.

ivith interpersonal relationships for

recently told her that she

many years. Her ex-

should seek counseling because

she has difiiculty letting go

of relationships. She agreed with his assessment, characterizing heibclf as iodependent. Susan reports a lack of self-confidence, feelings of numbness during conflut, insecurity with authority figures, and a desire to avoid uncomfortable situations. SiLsan^ piovided an example of her difficulty with relationships in describing a long-term female fi-iend. Susan and her fi-iend Leah met during their year first

they immediately

376

became friends, studying

together, shopping,

ofi high school,

having lunch

together,

and and

FEMINIST THERAPY

377

Susan described her relationship with Leah as

so forth.

right from the begin-

''very close

ning, ” saying that they were "practically inseparable. ” They decided to pursue careers in

and now are in medical school together. Susan reported protective of her and that when Susan had a problem with

medicine, attended the same college, that Leah was always very

another acquaintance or family member, Leah was there

Susan recalled a time when she was dating a

defend

to

her.

man and believed that he was cheating on

She discussed her suspicions with Leah, who convinced her that the two ofthem should slash the tires on his car and spray paint the windshield to "teach him a lesson. '’Susan and her.

Leah went through with

their plan

and vowed never to

disclose

what they had done. Susan

reported that they engaged in other activities similar to this one throughout the years

and

that she felt "somewhat guilty” about some of the things they have done to other people.

Susan further reported currently feeling "smothered” by Leah; she would friendships with other people. LLowever, Susan reports being unable to

with Leah because she feels

With men, Susan

and describes

it is

says she

is

herself as fearing

like to

pursue

end her friendship

necessary to remain loyal to her.

unable

to express

her feelings

abandonment. She

when

she senses disagreement,

says these kinds

of things happened

in

the relationship with her ex-husband. Susan reports that a previous significant relationship

was physically abusive. She felt

responsible for the abuse because she was, at times, verbally

abusive toward the man. During the abuse she wouldfeel calm,

would simply

leave the situation. She

had great difficulty ending

of her feelings of loyalty to this man. Susan comes to counseling somewhat suggested

it),

it

was

over, she

because

this relationship

reluctantly (mostly because the counselor at school

although she recognizes her

with relationships. She says that shed

difficulties

work on her "temper” and her feelings ofabandonment.

like to

Note: In tribute to the egalitarian spirit of feminist therapy, the image the

and when

many

I

chose lor this chapter

is

intended to represent

diverse contributors to this theoretical approach.

BACKGROUND Traditionally, psychotherapy has let

empowered groups. Created by

women down. The same

is

true for

members of dis-

the mainstream to serve the mainstream, psychotherapy

has failed marginalized people in fundamental ways. This

minority-group members have never received help or

felt

selling or therapy but, rather, that therapy they received

is

not to say

more

made

women and

other

able to cope after counlittle

attempt to address

the root causes of their problems. In focusing narrowly on the personal and individual,

which mainstream psychotherapists and miss the point. A therapy which

insist fails

is

their

domain, they ignore the big picture

to address

power

automatically, to reinforce oppression. (McLellan, 1999,

Feminist therapy (FT) ical

is

p.

is

a

good

illustration

works,

325)

a rather different approach to counseling;

approach than a specific theory and technique (Wyche

quote

issues in people’s lives

& Rice,

it is

more

1997).

a philosoph-

The preceding

of the ideology of a radical feminist approach to counseling.

However, feminist philosophy spans an ideological continuum that ranges from radical to more conservative positions. These variations of feminist philosophy will be described later in the chapter. If

you’d like to see a feminist therapist in action, watch Dr. Linda

work with Helen on

the Theories in Action

prominent feminist therapist Laura Brown

DVD. You in

Box

can also read part of an

12.1.

Moore

article

by

1

FEMINIST THERAPY

378

Box Still

Is

feminist practice

brings to

still

subversive?

2.

Where

Is this

Is

the Evidence?

practice

still

viable as an approach to psy-

Not only in my opinion are the answers to both of these would also like to argue that what feminist practice in the affirmative, but the table has become more salient and increasingly necessary for the soul of

chotherapy questions

Subversive?

1

after all these years?

I

psychological practice in the twenty-first century. Let us discuss, beginning with the

hoary old feminist cliche about the personal being

maxim applying

to the evidence

political,

why and how

I

see that

of the power of feminist therapy.

Feminist therapy continues to be one of the few approaches to practice that owns and

names the

politics

teacher, researcher

of the

and

realities affecting us all, client

and participant, and makes that

Other postmodern therapies such

as

meeting

clients

and

political analysis central to theory.

Narrative and Constructivist models join feminist

and diagnostic

practice in disowning the notions of objective truth claims nist practice also

therapist, student

labels.

Femi-

converges with person-centered therapies around the importance of

where they

are

and valuing the clients voice

in the therapeutic discourse.

Feminist practice, however, continues to be one of only a handful of therapy domains in

which

therapists are called

upon

to

acknowledge

as central the politics

the impact on practice of the politics of gender, power,

and work of 2003; Aron sights

all

&

of us. Feminist practice

Come,

is

social location

on the

lives

joined by liberation psychology (Almeida,

1994), which has been brilliantly svnthesized with feminist in-

by Comas-Diaz (2000). Yet

in the

textbooks on systems of psychotherapy studied

by our beginning students (Corey, 2004; Prochaska perspectives are included at

knowledgment of political

When

and

of practice and

all,

& Norcross, 2003) when liberatory

feminist practice stands alone representing the

realities in the

psychotherapy

call to ac-

office.

feminist therapists speak of the politics of the personal,

we speak

of the expe-

power and powerlessness in people’s lives, experiences that interact with the bodies and biologies we bring into the world to create distress, resilience, dysfunction, riences of

and competence. Foregrounding power and its absence as a central issue in the efficacy of psychotherapy seems particularly necessary today, speaking as I did in Washington, nC not far from places where people with the power to do so are attempting to legislate away from me rights that, as a lesbian citizen of the United States, I have not yet attained. 1

wiite this revision a

mg

that

week

powei lessness

is

Hurricane Katrina came to the Gulf Coast, exemplifythe defining element in the terrible trauma affecting the poor, after

the people of coloi, the old, and the very

young who were

behind as waters rose. Foregrounding the coriosive effects of powerlessness, as feminist therapy has always done by focusing on how to bring “power to the powerless,” and as Adrienne Smith and Ruth Siegel described two decades ago in their chapter in The Handbook of Feminist 'Fherapy (Smith & Siegel, 1985), seems to gain new urgency at a moment left

in

U.S. history

when

the

hope of empowerment seems

to be drifting ever further

out of

reach for most ordinary people. Feminist therapy, speaking out loud about power, disrupts the trance of despair that has become so common in today’s culture. Feminist therapy requires its practitioners to think in a complex and

nuanced manner about

FEMINIST THERAPY

how power and ceases to

379

powerlessness are roots of distress. Failing to do so, feminist practice

mission and loses

ftdfill its

subversive potentials.

its

This insistence on the personal being intimately personal,

when we look at what we are teaching our work of psychologists. Students in training to

practitioners are learning that their tasks are to offer empirically supported

treatments for disorders that are in turn defined by the because: is

being deeply and

political

especially meaningful

is

next generations about the nature of the

become

and the

political,

(a) it is

the

wave of the future

in health care

DSM.

Clinicians are to

—everyone (meaning

do

this

physicians)

doing evidence-based practice and so should we, particularly given our heritage of

being based in the science of psychology (Task Force, 1995) and

managed

(b)

care

requires these treatments of psychotherapists, thus providing empirically supported

treatments

is

required to

make

a living. Resistance

is

futile;

we

are being assimilated

and

should stop injuring ourselves by fighting back.

Th is

discourse of constraints on practice, our powerlessness to

resist

these trends,

the anxieties that these constraints create in our next generation permeated

questions that

my students

when we

feminist therapists

porting feminist practice ally rejecting

salient if

still

do not

how can

how will

they

bill

of the

themselves

call

trials

sup-

and gener-

as efficacious? If feminist therapists are critical of,

in their lives,

give

and me. Fiow can they

have such a small base of randomized clinical

of DSM diagnostic categories,

and immediate

feminists

raised with their peers

some

and

more competency exams

for their services (or

they pass their clinical

DSM diagnoses)? In addition, what managed care company will who

pay for feminist therapy (an important question for someone

is

graduating from

school with over $100,000 in student loan debt)?

Feminist practice and theory steps in at this juncture to be subversive to the domi-

nant discourse and

I

hope

a little reassuring to

our next generation.

We

have both

evidence and a diagnostic strategy, both of which give feminist therapists powerful tools.

They

are different sorts

of evidence, and radically different ways of conceptualizing pain

and dysfunction, but they Excerpted from

“Still

are not absent.

Subversive ...” by L.

S.

Brown

(pp.

1

5—24) 2006. Psychology of Worrier}

(Quarterly, 30.

Feminist therapy developed out of deep dissatisfaction with traditional approaches to

psychotherapy (Gilbert, 1980), the emergence of a psychology of women and gender, and the feminist

movements of

Kincade, Marbley, Dialogs, Laura

&

and

leads both therapist

resistance, transformation,

and

with the

in relationships

individual

2005; Evans,

feminist therapy in the following way:

advancing feminist

one

Rossier,

Johnson, 2001). In her book Subversive

in the multicultural feminist scholarship

and gender. This approach

No

&

the practice of therapy informed by feminist political philosophy and

is

grounded

and 1970s (Contratto

Seem, 2005; Worell

Brown (1994) defined

Feminist therapy analysis,

&

the 1960s

social,

developed

client

and

on the psychology

of

women

toward strategies and solutions

social

change

in daily personal life

emotional, and political environment, (pp. 21-22)

FT;

rather,

feminist political philosophy (Brown, 1994).

it

It

is

emerged

from

the

application

considered a grassroots

of

phenomenon

FEMINIST THERAPY

380

&

(Brown

Liss-Levinson, 1981), and

(Brown, 1994). Feminism Adler,

who

in

proponents generally eschew the idea of “experts”

its

counseling actually has a long history, beginning with Alfred

recognized the cultural effects on women’s behavior (but

who

needing to adjust to the role of mother). Another early feminist was Karen

as

psychoanalyst

who

rejected the idea of penis

women

saw

still

Homey,

envy and substituted the woman’s envy of

Many

men’s privileged, power-wielding position in society (Forisha, 1981; Nutt, 1979). writers

and therapists

would

here

are currently active in the

surely lead to leaving

would be contrary

a list

FT

world, and producing a

out, not to

to the egalitarian principles

mention the

list

psychology of women.

Women

in

of them

fact that creating

and the

Psychological Association (APA) established the

The American

Psychology in the 1970s, and

such

of FT.

organizations are devoted to feminist psychology, psychotherapy,

Numerous mittee on

someone

a

this

committee

initiated the

Com-

APA Task

Force on Sex Bias and Sex Role Stereotyping in Psychotherapeutic Practice. Division 17 of

APA,

the

the Society of Counseling Psychology, established a

produced

Principles

Committee on

Women

Concerning Psychotherapy of Women (APA, 1979; Fitzgerald

&

and

Nutt,

1986) which have been recently revised as the Guidelines for Psychological Practice with Girls

and Women (APA, 2007). Division 35 of the APA

is

the Society for the Psychology of Women,

which sponsors the journal Psychology ofWomen Quarterly. Division 35 can be found online at

www.apa.org/divisions/div35 In 1993, Division 35 was instrumental in holding the .

first

National Conference on Education and Training in Feminist Practice, which produced the

Core Tenets

of Feminist

I’he Association of

Therapy shown

Women

Box 12.2 (Worell

in

organization to the American Psychological Association.

tors

meeting

at the

APA.

1969 convention

Its

to argue for

Another famous hotbed of feminism

Women

Centers for

think tank,

is

(

Is

The

AWP was

members picketed

AWP created the first Feminist Therapy Roster in ley

1997).

Psychology (AWP) emerged in 1969

in

the creation of Division 35 of the

& Johnson,

its

creation

(

the

is

instrumental in

board of direc-

www.apa.org/divs/div35 ).

1971 (Brown

& Liss-Levinson,

1981).

Wellesley College, which sponsors the Welles-

www.wcwonline.org ). The Stone Center,

also at Wellesley, as

APA

as a parallel

a

well-known feminist

the Jean Baker Miller Training Institute,

which

produces research and training centered on the relational model of women’s development (see the section

“Theory of the Person and Development of the Individual”).

Box 12.2

Core Tenets of Feminist Therapy 1.

Feminist therapy recognizes that being female always occurs in a cultural, social, political,

2.

3.

economic, and

historical context

and

affects

development across the

life

span.

Feminist theiapy focuses on the cultural, social, political, economic, and historical factors of worn [e] ns lives as well as mtrapsychic factors across the life span. 1

eminist therapy includes an analysis of power and

ways

women

tation, age

its

relationship to the multiple

are oppressed; factors such as gender, race, class, ethnicity, sexual orien-

and ablebodiness, singly or

in

combination, can be the basis for oppression.

FEMINIST THERAPY

4.

381

Feminist therapy acknowledges that violence against

women,

overt and covert,

is

emotionally, physically, and spiritually damaging. 5.

Feminist therapy acknowledges that misogyny tionally, physically,

6.

and

spiritually

womens

lives

and

is

emo-

damaging.

Feminist therapy’s primary focus

women’s behaviors

exists in all

on strengths

is

rather than deficits. Therefore,

are seen as understandable efforts to

respond adaptively to

oppressive occurrences. 7.

Feminist therapy

8.

Feminist therapy

is

committed

to social

change that supports equality

forever.

based on the constant and explicit monitoring of the power

is

balance between therapist and client and pays attention to the potential abuse and

misuse of power within the therapeutic relationship. 9.

Feminist therapy

toward an egalitarian and nonauthoritarian relationship

strives

based on mutual respect. 10. Feminist therapy lish 1 1

.

is

a collaborative process in

which the

therapist

and

client estab-

the goals, direction, and pace of therapy.

Feminist therapy helps societal beliefs

and

girls

values.

women

and

The

therapist

understand

how

they have incorporated

works collaboratively with them

to chal-

them

lenge and transform those constructs that are destructive to the self and helps create their 1

2.

and

collective

life

women

and

girls

power

Feminist therapy expands across the

14.

perspectives.

Feminist therapy empowers individual

13.

own

as girls

to recognize, claim,

their

and women.

and women’s

girls’

and embrace

alternatives, options,

and choices

span.

Feminist therapy

is

a demystification process that validates

and diverse experiences of girls’ and women’s 15. Feminist therapy involves appropriate types

self-disclosure

may be

harmful,

it

and affirms the shared

lives.

of self-disclosure. However, because

must be both value and theory driven and always

in the client’s best interest. Therapists

must develop methods of continually moni-

toring their level of self-awareness. 16. Feminist therapists are

distortions,

and

economic, and

committed

to continually

monitoring their

own

biases,

limitations, especially with respect to cultural, social, political,

of girl’s and women’s experiences.

historical aspects

From Shaping the Future of Feminist Psychology

(p.

69) by K.

E Wyche

&

J.

K. Rice,

1

997. Copyright

©

1997 by the American Psychological Association. Reprinted with permission.

BASIC PHILOSOPHY Feminism

according to Laura

is,

Brown

that aims to overthrow patriarchy

and end inequities based on gender through

transformation and radical social change” of

most cultures

that favor

privilege, particularly

keeping them

in

men

(1994), “the collection of political philosophies

over

(p. 19).

Patriarchy refers to the pervasive

norms

them power automatically (i.e., male while at the same time devaluing women and

women,

white male privilege)

cultural

give

subordinate positions. This political perspective translates into

a core

FEMINIST THERAPY

382 belief for feminist therapists that the ultimate cause

of psychological dysfunction resides

m

by society (McLellan, 1999). Women, particularly, are exof expectations, and both overadherence and deviation from

the oppression of the individual

pected to adhere to a rigid set

these behaviors are labeled mental illness (Chesler, 1972).

Feminists,

therapists, tend to

and feminist

be

activists

example, Laura Brown, the self-proclaimed subversive

and

the

(as in

about

are pretty noisy title

it.

For

of her book Subversive

Dialogs [2002]) evaluates the current state of feminism in this way: the

most subversive thing that feminist practice

we know

a belief that the civilization

is

colonizing, occupying,

and violent

Ballou (2005)

the problem, for

is

attention to the

calls

brings to the table after

and the

lab,

which feminist activisim one solution. (2006,

is

hegemony of

sees the

swing

in

dominance of these

our current

their efforts to see that

lives as

in

and

22)

p.

the medical model, traditional

science, health insurance industry, professional associations,

She

these years

all

as racist, sexist, heterosexist, classist, neglectful,

outside of the therapy office, the classroom

Mary

still

and licensing boards

(p.

202).

institutions as well as the increasing conservative political

limiting the visions of therapists, feminist or otherwise, in

understand and help others. So given even these limited examples, you can

FT writers

are not shy in their critical evaluations

of the current

of our world.

state

Feminists are always aware of power differentials and are attentive to features of human interaction that

ence

is

promote such

language;

how we

differentials (Gilbert

speak

is

assumed

to

both

& Rader, 2007). One important influreflect

and influence our views of the

world. Thus, you will not hear a feminist using the pronouns he or sexes.

More

referred to

As

their last

names, whereas

women and

consequence, feminist writers often use both

a

others’ writings.

To be

FT

true to

ideology,

I

to refer to

power (men)

subtly, feminists argue that those traditionally in

by

him

typically are

children are called by their

first

will use

and

last

names

both

first

names.

in their references to

both names in the

first

reference to

writers in this chapter (other than in parenthetical references).

Feminist theory, which forms the basis of FT counseling, encompasses a wide range of perspectives.

Next

1

will review

some

feminist philosophies, but

boundaries between these categories are not tion of them.

as distinct as

you should keep

in

mind

you might gather from

my presenta-

Complicating matters, different writers sometimes use different terms when

apparently referring to a similar feminist stance. For example, one variant of feminism,

of color feminism, can be enacted from the

most

unique (c)

that the

part, the feminist stances

qualities

of women,

(b)

integrate issues of culture

liberal, radical,

woman

or cultural feminist perspectives. For

v 2ory primarily in the degree to which they

(a)

emphasize

advocate the rejection of masculine, or patriarchal, models, and

and class

into their viewpoints. For a

more detailed review of these

philosophies and their histories, read Carolyn Zerbe Enns’ (2004) book. Feminist Theory a^td Feminist Psychotherapies ox Laura Brown’s Subversive Dialogs Liberal feminists emphasize

womens

equality within a rational

Johnson, 2001). Also called reformist feminists, advocates of equality of to

women and men and

promote

(i.e.,

access for

women.

framework (Worell

this perspective

&

emphasize

tend to focus on changing legal structures and interventions

Betty Friedan,

the malaise of the traditional 1960s

cause she meant by this phrase that

women

that the patriarchal society did not

want

who

identified 'dhe

problem that has no name”

housewife’), can be seen as a liberal feminist be-

were blocked from reaching their potentials, and

to discuss these issues (Friedan, 1963). Friedan

was

FEMINIST THERAPY

383

Women (NOW),

instrumental in establishing the National Organization for

worked

for the passage of the

The ERA, of course, the right of

women

like

(Brown, 1994, Radical

gender

women

initiatives

to

did not (such as paid maternity leave and

men” because

this

It is

dangerous, in

women

(or socialist feminists are those

who

on Marxism, add

women and would

emphasize equality of work

communal

men and women

(Brown, 2000) because

is

power

this practice

is

rights.

likely to

.

Socialist feminists,

on all

who

in the

environments that would

(Enns, 2004). Radical and socialist

women,

The

in society are seen

more

1 )

to eliminate

second major factor

a

living

that society represses

harassment and restricting their reproductive into positions of

& Johnson, 200

that capitalism

prefer

roles for

many ways

feminists point to the

mote women

are deficient

see oppression based

most fundamental and stubborn form of injustice and seek

oppression of

women

p. 54).

base their arguments

including violence and

liberal feminists’ efforts to pro-

by these feminists

change the

than to change the patriarchal, capitalist system. Nothing is

this view, to teach

view inherently assumes that

forms of male domination (Enns, 2004; Worell

systems

to the U.S. Constitution.

The liberal position is criticized by other become members of the male club and, by doing so,

in societal structures.

and social change

as the

Amendment (ERA)

to control reproduction).

denying the paternalism

“more

but other

failed,

feminists for encouraging

to be

Equal Rights

which

less

woman

to

fit

as

tokenism

male norms

than abolishing patriarchal

acceptable to the radical and socialist feminists, so they are likely to advocate

separatism, or the refusal to participate in institutions that perpetuate the patriarchy. For instance, engaging in

all-women events, businesses, and consciousness-raising groups

seen as refusing to conform to male-favoring cultural values (Enns, feminists

would add heterosexism

to the

list

the heteropatriarchy (Brown, 1994; Worell

1997). Lesbian

of cultural dominations, defining

& Remer,

is

this bias as

2004).

Cultural feminists revere women’s unique qualities such as relatedness and cooperation.

They tend

(Moradi

et ah,

to

2002). Unlike radical and socialist

femininity, cultural feminists celebrate (e.g.,

what they would

connectedness, cooperation; Worell

Woman of color feminism, lect

men and women in feminists, who are critical

emphasize the differences between

of the experiences of

&

or womanism,

women

see as qualities

such values

of norms of

unique to

women

Remer, 2004). is

a reaction to

of color, or to put

it

mainstream feminism’s neg-

a little

more

bluntly, the racism

inherent in early feminism. These feminists reject the primacy of gender as a category of oppression, arguing that the gender interacts with race, social in affecting individuals’ lives

anist with Black feminism,

broadly, to refer to one

who

(Evans

et ah,

all

and other categories

2005). Although some authors equate

Enns (2004) points out loves

class,

that this term

is

also used

wommore

woman. Some woman of color feminists way of emphasizing that people of color are

things

prefer the term colonization to oppression as a

pressured to adopt the values and norms of white, Eurocentric culture (Comas-Diaz,

1994,

p.

288). Lillian

Comas-Diaz argued

that “colonized individuals are not only

exploited and victimized for the benefit of the colonial power, but also serve as the quin-

Much as other feminists might emphasize examining woman of color feminists advocate distinguishing between

tessential scapegoats” (p. 289).

one’s internalized sexism,

and external colonization (Comas-Diaz, 1994). Supporters of this orientation sometimes see men and women of the same race or ethnicity as more similar to each internal

FEMINIST THERAPY

384

women from

other thiin

endorsed

in recent years

Another

FT

different ethnij:ities. This position

(Moradi

ideology

et ah,

Postmodernists reject the idea that there Instead, postmodernists

often determined by as filling into

a

contend that

who

is

power.

in

one

is

reality

is

Rice, 1997).

feminism (Brown, 2000; Enns, 2004).

labeled postmodern

is

&

Wyche

2002;

probably the most widely

is

real,

objective truth out there in the world.

constructed in relationships and that truth

is

Some versions of lesbian/queer feminism can be classified

postmodernist approaches.

Finally,

Enns (2004)

describes third-wave feminism,

postmodern approach that although appreciating the contributions of

struggles to deal with the backlash against

earlier

feminisms,

feminism and to push for further progress

in

com-

bating violence, problems in health care, and economic and environmental concerns.

Postmodernism radical

is

difficult to describe,

on the notion of whether there

ernist

approaches are those

reality

only shifting views)

who view

as

is

because within

a reality to

from mild

are views that vary

to

be comprehended. Ajmong the postmod-

radical relativism

problematic because

it

it

(i.e.,

the view that there

no one

is

would disallow statements about

histor-

(and present) oppression of women and other marginalized individuals. Social construc-

ical

tivists

adopt

this perspective so that

problematic constructions of gender, race, and so forth,

The point of all postmodernists, as I see it, can bring many ideas in to counseling that we treat as

can be addressed (Enns, 2004). that

we and our clients

be profitably considered

as

Chandra, Susans feminist itage in

therapist,

anistfeminist in the broadest sense,

feminisms, Chandra recognizes

to her.

emphasize

“truth” that can

products of social reality training (Fiare-Mustin, 1994).

is first

woman and ofAsian herCharacterizing herselfas a wom-

aware that Susan

a culture infused with the values ofEuropean men.

significant

to

is

impact on who she

who also

is

a

ofradical and cultural that Susans female sex and Korean heritage will likely have a

is

respects the contributions

and how she operates

Chandra assumes that Susan

and that the behavior that others

in the world,

and how

experiences the power disparity in

label “dysfunctionaE

is

a reaction

the world reacts

mainstream

culture,

to these inequities.

HUMAN MOTIVATION F

I

counselors dont spend a lot of time discussing

intervening. According to

F

1

human

motivation

Mary Brabeck and Laura Brown

can be partly attributed to the fact that

FT

— they

are too

busy

(1997), the lack of theory in

developed in the

field rather

than within

the confines of academia. In considering motivation,

FI counselors might draw their views from an existing theory of human behavior, provided that it was not sexist. Nancy Chodorow modified classic psychoanalytic theory to eliminate the “penis envy” bias (Chodorow, 1978, 1989). She focused on the role ol mothering in child development and particularly on the individuation of boys and girls. Modern versions of psychoanalytic theory such as attachment the-

ory have received feminist criticism, as has the evolutionary perspective (Contratto, 2002). Ultimately, the issue of motivation partly turns on the question of the origins of sex differences (if they exist), which is a controversy far from settled as you will see from the following discussion under development.

Another way of addressing motivation might be iLimanistic

(e.g.,

(jestalt

or

Person-Centered)

to

adopt

orientation

a

system associated with

because an

actualization

FEMINIST THERAPY perspective

385

compatible with a feminist orientation (Enns, 1997). However, Person-

is

Centered Theory, for example, has been faulted for factors that contribute to the

development of the

women’s experiences

Chandra

sees

self Also, the

emphasis placed on indi-

reflective

of traditional American values

Wayne syndrome) and

can obscure commonalties in

vidualism in humanistic/existential approaches

(rugged individualism or the John

lack of attention to the social

its

is

in the oppressive culture (Enns, 2004).

Susan as motivated

to

grow

to

humanism, Chandra views Susan from a social influences that are significant in

An

her full potential as a human.

positive perspective but

Susans

advocate of

careful to attend to

is

life.

CENTRAL CONSTRUCTS Gender No

matter what

ET

ideology one adopts, gender, considered the social manifestation of sex,

is

a critical construct. Eeminist therapists use the term j'cxwhen biological differences are the subject

(such as anatomical ones). Gender

men and women text are

the term used to emphasize that differences between

the product of biology

and

important inffuences on what our cultures define

As you might culture

more than

are

is

and

most apparent psychological

differences

are parents

and

who

aggressive

are

and

convinced that raising boys

girls are

sweet and compliant

enon. Liberal feminists would point out that entially reinforced

by parents when children

infants are treated very differently

and

girls,

some

from

—you know, kits,

young and

con-

a construction of

I

are a prod-

have friends

raising girls.

early on.

girls are

who

Boys are active

known

(Paludi, 2002).

to

phenombe

differ-

Female and male

Baby boys wear blue

given dolls or kitchen

extent radical and socialist feminists are is

social

the “boys will be boys”

from one another from very

differences as inherent to the sexes. This position

1999).

of these behaviors are

are very

is

men and women

& Scher,

different

many

pink; boys are given toy trucks or tool

Cultural and to

is

that gender

between

uct of societal inffuence rather than biological sex (Gilbert

and

“male” and “female” (Yoder, 2003).

adamant

suspect, liberal feminist therapists are

that

as

that social learning

more

likely to see

sometimes called the

sets.

gender

essentialist

(Brown, 1994). For instance, the traditional female emphasis on relationships

is

to be

celebrated, not to be treated as an artifact of socialization (Enns, 2004).

Janice Yoder (2003) presents an integrationist perspective that although biology seems to be

she asserts that research

is

lieve that as the ffexibility

chologists will find

it

more

“basic” than

on

these arguments.

environment and so more immutable,

amassing that experience can

affect physiology.

She writes

useful to let go of the

presumed distinction between

intertwined so that a holistic understanding of

and gender

women and men,

sex

be-

and gender,

as inseparable

and

and boys,

will

girls

include biology (sex) and what our culture makes of our biological sex

In

“I

of biology becomes more and more acknowledged, feminist psy-

nature and nurture. This opens the door to regarding sex

(2003,

Noting

(i.e.,

gender)”

p. 17; italics in original).

any

case,

all

feminist therapists recognize that society has devalued

qualities typically associated

most cultures

in the

women and

the

with them. Power and gender are therefore tightly bound

world (Brown, 1994).

in

FEMINIST THERAPY

386 Chandra works

to identify

who Susan

multiple influences on

factors are her biological sex, family background, social

Chandra does not know how much each ofthesefactors

I’liE

Personal

of behavior,

is

Korean.

influences Susan, but she guesses that

Political

Is

this basic principle

which tends

political,

status are

and

norms and

in social

are very conscious ol the traditional

power and

p. 50). In

tion of the social

political rules

Chandra assumes that

and

her environment exists.

She

is

dictates that

as resulting

(Worell

theo-

from

social,

& Johnson, 2001).

the lived version of political reality” (Brown,

and norms of the culture

woman in

(the personal)

which she

is

a func-

lives (the political).

a product offactors in the cultural context in which she was raised and now

especially

disempowerment of women, and some ofher current behavior very real feelings of helplessness. For example, her low self-

likely in reaction to these

surely influenced by the societal devaluing

is

which

FT

the dijficulties Susan brings to counseling are

suffers from society’s

confidence

women

other words, the distress of the Individual

and

internal determinants

society,

bestowed on men. Women’s problems are seen

Feminists believe that the “personal experience

1994,

on

traditions (Enns, 2004).

gender imbalance in

systems that oppress and disempower

legal

to focus

of FT emphasizes that women’s experiences are connected to

them, embedded

factors external to

is

and the fact that she

is

In contrast to traditional psychological theory,

rists

Some of the important

now.

a powerful influence. Susan has probably been reinforcedfor exhibiting traditionfemale’' behaviors and punished for displaying traditionally ‘male” behaviors.

gender ally

class,

is

of women.

THEORY OF THE PERSON AND DEVEEOPMENT OF THE INDIVIDUAL 1

number

liere are a

spective. First, the

of

FT

ways of examining personality and development from the FT perapproach attends closely to theory and research on sex differences.

assume that males and females do not differ in any important psychologbirth (Brown & Liss-Levinson, 1981). Subsequent experiences in the social

Liberal feminists ical

ways

at

enviionment

What typically,

IS

are

the

men

thought to account for any

outcome of this are

later

lifelong process

thought to be independent,

vested in then careers.

Women

observable differences.

of learning to be a gendered person? Stereoassertive, competitive,

unemotional, and in-

are seen as emotional, relationship oriented, passive,

and

willing to put others (paiticularly are submissive.

Aiguments continued to

Men

aie career

ovei the

this

mens) needs before theirs. Men are dominant, and women and work oriented; women are family and child oriented.

of gender differences began as early as 1914 and have day (Llyde, 2005). Alice Eagly (1995) maintained that enough evidence reality

existed to conclude that there are real sex differences

stereotypes (for instance,

women

independent and controlling

I

In the directions indicated

more relationship oriented than men; men than women). are

In contrast, in a recent review, Janet Sliibley

of such ditlerenccs

and

and found that

78%

of

he categories she reviewed included ones

Hyde (2005) looked

the,se

in

at

are

by

more

46 meta-analy,ses

differences were in zero to small range.

which differences are traditionally expected,

FEMINIST THERAPY such

as

math and

387 two

verbal ability; in these latter

nonexistent. Three general areas did

cases, differences again

show moderate

or large differences:

mance, some sexual behaviors/attitudes (but not sexual ticularly physical aggression. Surely

are not)

done with

important question that

perfor-

and aggression, par-

satisfaction),

many feminists is Hyde’s assertion that between men and women (women are nurturers

not supported by the data. Yoder (2003) also summarized a large body

is

and she concludes that

of these difference-testing efforts

research has been

motor

of interest to

the reported difference in relationality

and men

were small or

so

little

in this debate

men and women

from

are

is,

agreement about the

what causes the

different planets

it

is

results.

differences?

—we need

much

frustrating that so

She noted that the

really

not enough to

know

It is

workings of the

to look at the

spaceships in which they fly around.

Evidence opinion that

exists that children are treated differently

this learning,

in the behaviors

termed sex-role

(2003) summarized

responsible for observed differences

is

and teachers tend

(although

as well

it

means

to be a

to treat children accordingly.

Yoder

For example, parents are likely to describe their male

differently (e.g., girls are

appear to be sex-consistent “girl” toys, so

peers,

this research as well.

and female children

more

it is

delicate); parental preferences for toys

noted that overall “boy” toys are more fun

parents sometimes will cross boundaries here). Berk (2007) noted that par-

ents’ reactions to violations

of stereotypical behavior are more negative for boys than for

and the same pattern appears among strates that

sex, giving rise to the

of men and women. Cultures endorse clear values of what

male or a female, and parents,

than

socialization,

based on their

boys and

girls are

children’s peers. Yoder’s (2003)

treated differently

by

their teachers; for

summary

girls

demonexample, boys get more also

attention and corrective feedback, whereas girls are generally advised to not fuss about mistakes. Finally, the in

media, although somewhat more balanced than In the

more prominent and dominant

past,

still

depicts males

many

than females. Perhaps you’ve noticed that

roles

car-

toon characters are male (think about the Road Runner and Scooby Doo). Shannon Davis (2003) content analyzed cartoons and found that major characters were more likely to be male,

and they were more in

likely to

be depicted in an occupational

setting. Fots of central characters

popular movies for kids are typically male (think Harry Potter Mid Star Wars). So, the next

time someone a Saturday

tries to tell

you

that our society

morning watching

A second

perspective

at Wellesley College.

television or to

on development

The Stone Center

intervention. Miller (1991) proposed a called “self-in-relation.”

women,

the

Although

girls first

is

Is

now gender-neutral, you can tell them to spend

go to a

kid’s

movie.

offered by Jean Baker Miller of the Stone Center

known

for

its

studies of women’s issues

model of feminine development

that could be loosely

to Include

all

human

develop a sense of self that

is

emotional

state,

for boys as they develop because they are

In contrast, girls are

but the link of relationship to

Oedipal conflict

“We may ask whether one

crisis

of cutting off’ anything,

this stage in girls

and

d he

infant learns

self largely

disappears

feelings of others.

1

mom.

he

girl’s

maintaining relationships. Miller wrote about the

becomes linked

to

and

Hartling,

encouraged to become active and separate from

sense of self-esteem thus

have had such trouble delineating

girls

tied to relationships because par-

encouraged to maintain their focus on the

in girls:

&

experience (Jordan

ents (most likely mothers) are continually attending to the Infant’s well-being, to attend to the caretaker’s

and feminist

developed to explain the experiences of

initially

model has been broadened

2002). Both boys and

Is

reason that people, beginning with Freud, Is

that

it

may

not

exist.

especially relationships” (1991; p. 18).

There

is

no major

However,

at this

.

FEMINIST THERAPY

388 sta^e, girls likely get the

men

ship Focus to

message, based on cultural

beliefs, that

they should turn their relation-

(check out the cartoon).

encouraged to explore and expand their sense of self. Girls, contract their identities because achievement and sexuality are not

In adolescence, boys are

however, are taught to

These natural

acceptable.

she

is

strivings are diverted to relationships, so that a girls sense

and how she achieves

is

once again linked

very different paths to adult identity for acteristics consistent

with traditional

to relationships.

of who

Thus, Miller described

men and women, which produce

values

and char-

roles.

Another perspective on female development is Feminist Identity Development Theory (FIDT; Downing & Roush, 1985; Moradi, et ah, 2002). In this model, women are thought to traverse five stages in the journey to a feminist identity. It is important to note that

can recycle through the progression multiple times (Downing

women

1985).

The

first

stage

is

passive acceptance, in

women

which

ognizing or denying oppression and discrimination.

&

Roush,

accept the status quo, not rec-

They tend

to endorse traditional gen-

der roles and gender-based (patriarchal) power structures.

Women move

into the revelation stage, according to

experience either positive feminist experiences adverse experiences that seem gender related

A

primary characteristic of

sexist society

The the

first

and

at

third stage of

women

basis,

in this stage

FIDT

phase, embeddedness,

of identity development

is

anger

at the

composed of two

it is

phases. In

and become involved

women

in very close relationships

are involved

men on

with

with female

a daily, if not intimate,

they realize that uncritical adherence to feminist theory and the associated anger

relativistic

and

flexible,

life

but are

flexible perceptions

Their reactions to

uations of

men

still

of

to the

life

are evident as

women move

and they

are

more

ANDY

into the synthesis

flexible in rheir eval-

The hallmark of this

stage

forms of oppression through social change action.

I TTOUOHT YOU

0(9MFTFilN& TO P[2JNK.

men.

attribute sexism.

reach the final stage of FIDT, active commitment. all

may

emanation phase, becoming

tentative in their relationships with

less likely to

the energy devoted to eliminating

AUNT JOAN

They move on

are less “automatic,”

events and therefore

Few women is

divorce, denial of a credit application).

women tend to immerse themselves in women’s culture, adopt

However, because most

Even more stage.

consciousness-raising groups) or

embeddedness— emanation, and

is

not be the most productive stance to take.

more

(e.g.,

they

themselves for their participation in the system.

feminist ideology wholesale, friends.

(e.g.,

Downing and Roush, when

INERT HELTINO

HIM PAINT

JAM.'

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Eliot.

All rights reserved.

Reprinted with permission of

UNIVERSAL PRESS

FEMINIST THERAPY Chandra

sees

389

evidence ofsex-role socialization in Susans behavior, but also notes that some of

her behavior is contrary to stereotypical norms. The angry outbursts, for example, are not within

of being sweet and nice. On the other hand, low self-confidence, worries about abandonment, and loyalty to relationships (even “bad” ones) are embodiments

the traditional female role

woman. Chandra

ofithe stereotypically fieminine

guesses that Susans parents reinforced these

behaviors as unwitting agents of the paternalitic

Susan grew up

is

fraught with sexism

pressures, feeling insecure acts in

ways contrary

and oppression. Susan

and helpless.

may

complies to some extent with these

Occasionally, though, her anger comes through,

be in the passive acceptance or the revelation stage

identity development, but she clearly

is

and she

This behavior tends to get her in trouble with others,

to traditional roles.

even the authorities. Susan

In addition, the world in which

society.

not in the embeddedness—emanation

ofifeminist

stage.

HEALTH AND DYSFUNCTION An

important aspect of the

logical dysfunction

A

FT approach

critique of traditional approaches to psycho-

is its

and intervention (Ballou

&

&

Brown, 2002, Worrel

powerful statement was offered by Phyllis Chesler in her

Remer, 2003).

book Women and

classic

Madness (1972):

What we

consider “madness,” whether

out of the devalued female role or the

it

women

appears in

or in men,

total or partial rejection

is

either the acting

of one’s sex- role stereotype.

Women who fully act out the conditioned female role are clinically viewed as “neurotic” or “psychotic.” When and if they are hospitalized, it is for predominantly female behaviors such

as “depression,” “suicide

Women who

reject or are

much Such women are

society so

attempts,” “anxiety neuroses,” “paranoia,” or “promiscuity.”

ambivalent about the female role frighten both themselves and

that their ostracism also assured

and

self-destructiveness probably begin very early.

of a psychiatric label and,

if

they are hospitalized,

“female” behaviors, such as “schizophrenia,” “lesbianism,” or “promiscuity.”

FT

theorists charge that society devalues traits

women,

with

labeling

them

as

and behaviors

in

male

56)

that are typically associated

unhealthy in comparison to male-associated

Johnson, 2001). Thus, the standard of health resides

(p.

for less

it is

qualities,

such

as

&

(Worell

traits

independence,

competition, assertiveness, objectivity, and activity (Chesler, 1972), Also, both Chesler and

more ities

recent

FT writers

and behaviors

recognize that gender

is

not the only influence on perception; qual-

stereotypically associated with

women from

nonwhite, non— middle-class

backgrounds are deemed dysfunctional by traditional psychotherapeutic approaches. Generally, is

society views the problems of women as

wrong with

her) rather than

from

social

stemming from

and

internal factors

cultural inequality (Worell

(i.e.,

& Johnson, 2001).

Traditional diagnostic categories, such as those found in the Diagnostic

Manual of Mental Disorders see as problematic the is

(Z937V/-1V-TR) are also the targets of

assumption that every form of distress

is

FT

something

and

Statistical

criticism. Feminists

abnormal, when

in fact,

it

often a normal response to the problems inherent in an oppressive society (Brown, 2000).

For example, the proposed diagnosis masochistic personality disorder personality disorder) was rejected by feminists because

many women

(a.k.a. self-defeating

in

abusive relation-

ships display the characteristics of this category Pathologizing this behavior ignores the

adaptive value of passive or pacifying behavior in abusive relationships (Enns, 2000). disorder was eventually removed from the

DSM-W.

1

his

FEMINIST THERAPY

390 Equally reprehensible

is

the late luteal phase dysphoric disorder,

known as psychiatric commu-

which

is

also

premenstrual dysphoric disorder. Critics contend that the patriarchal nity makes women’s hormones a source of mental disorders while at the same time ignoring the influence of

hormones on men

an analogous disorder in

men

be

(Tavris, 1993).

named

pathological arrhythmicity

controversy around premenstrual dysphoric disorder,

among

D5A/-IV,

Terry Kupers (1997) suggested that

it is

345). Because of the

(p.

included only in the appendix of

&

disorders in need of further study (Ross, Frances,

Others have provided critiques of the personality disorders, such

Widiger, 1997).

dependent,

as histrionic,

and borderline personality disorders (Kaplan, 1983; Kupers, 1997; Walsh, 1997). esting perspective on the common label ^independent” is described in Box 12.3.

FT

sees psychological distress, or “dis-ease,” as a

&

(Brabeck

Brown, 1997,

attempts to

resist

Consequently, feminist therapists focus on

(Wyche

&

Rice, 1997).

They

see

human

behavior

clients’

as resulting

complex combination of factors, both internal (biological and psychological) and

a

external to the person. to

communication about unjust systems

Symptoms are seen as normal responses to oppressive 2004). They are signs of health and strength because they

patriarchy.

strengths, not dysfunction

from

inter-

p. 28).

environmental conditions (Enns, are

An

The

latter set

of variables, the social context^

considered

is

critical

understanding individual experience.

Box 12.3

Low

Codependent, Female, or Simply Laura Brown and other feminists have

critically

examined

throw around, codependent. The term was coined in the alcoholics were part of a system,

some

lypically, the

Based on

term we

late

all

seem

to love to

1980s to recognize that

and that those around them, the codependents, shared

responsibility for the drinking behavior.

consequences of

a

Power?

his or her abuse,

By protecting

the alcoholic from the

the codependent enabled the drinking behavior,

codependent was a white, middle-aged wife of a white male alcoholic.

this conceptualization, the focus ol

intervention

became both the

and codependents behaviors. Since that time, the term has been used way. Feminists have taken exception to this term. Ffere

I

present

in a

some

alcoholic’s

much

broader

ol their views,

based mostly on the writings of Laura I

here are

carry a

many

common

Some

of the characteristics offered are as follows:

Sacrificing one’s needs for those of others

.

2.

A

3.

Cjaining self-worth through being needed by others

4.

Low

5.

Avoidance of conflict 1

cial

these definitions

thread of descriptions of relationship dynamics of the codependent and

significant others.

1

definitions of

Brown and Kay Leigh Fiagan. codepencency, but most commonly,

sense of powerlessness

self-esteem

he problem, according to Laura Brown (1994),

and

that no attempt is made to take socultural fictors into account in understanding the “codependent’s” behaviors. She is

FEMINIST THERAPY

pointed out that

391

women

in a sexist society are

awarded responsibility

emotions ol men, and that codependent behavior very erosexual female behavior.

The womans sense of failure in

significant personal feelings ol guilt tural rules rather racist

much

and shame, but

lor taking care

resembles the expected het-

may indeed cause

the relationship

dynamic

again, this

than on some delect in the individual. Also,

of the

is

based on the cul-

this “diagnosis”

is

likely to

be

because the behaviors described are very typical lor individuals in cultures of color.

Kay Hagan (1993) began her

dissection ol the term by linking

codependency and

family dysfunction. Dysfunctional families are characterized as oppressive; they have rigid rules, discourage

the

members. These

as

qualities

might

logically result in

among

low self-esteem and other charac-

with codependency. However, she noted, “Most American families

teristics associated

might qualify

honest expression of feelings, and emphasize perfection

dysfunctional in that they practice similar oppressive rules whether or

not a chemical addiction

is

present”

(p.

Thus, codependency

31).

becomes

really

convenient label for submissive roles inculcated by traditional Western family

life.

a

“The

oppressive rules of the patriarchal family system train us to accept and expect the para-

digm of dominance and subordination. Even the most benign of patriarchal families operates in a manner that cultivates the characteristics of co dependency, a term that is

much more

acceptable than internalized oppression, which might encourage us to ques-

tion authority or even to rock the boat” (p. 32; italics in original).

Another way of saying ble those of individuals in

it is

that behaviors labeled as

low-power groups toward the powerful (Brown, 1994). The

members

behavior of the subordinate group reading, enabling,

and

codependent very much resem-

will

look like overattentiveness, mind-

so forth. In reality, this approach

ual survive because survival

is

dependent on the

Nowadays, the term codependent

\s>

rules

is

and

adaptive; desires

it

helps the individ-

of the powerful.

used very globally to describe anyone

who seems

dependent, or “addicted,” to relationships. Unfortunately, Brown maintained, because of the description’s resemblance to stereotypical female the diagnosis. Sadly, the term has

when

the set of behaviors

of a low-power group. ing

women

it

become

roles,

thousands of women adopt

a stigma associated with addiction

and

describes appear to be those that are adaptive lor

disease,

members

One can also see the use of this term as one more instance of blam-

(wives) for their partners’ problems.

Codependency

is

no accident, nor

is it

a disease or an individual character disorder

random manner, as popular sell-help books and current therapeutic treatment would have us believe. A society ol dominance trains the oppressed to be subordinate so that dominance may continue. For women this conditioning begins when we are born and extends throughout our lives via our family models, the images we see in the media, and interactions with institutions infused with male dominance. When we do not recognize the relationship codependency has to the culture, we risk lading prey to another aspect of our training in which we accept afflicting us in a

personal responsibility and blame for having

macy From Kay

patterns.” In a culture ol

L.

Hagan

somehow developed “unhealthy

dominance, the oppressed

is

always at

[1993], Fugitive Information: Essays from a Feminist Hothead,

HarperCollins. Reprinted with permission of the author.

p.

34.

fault.

New

York:

inti-

FEMINIST THERAPY

392 For example, depression

is

diagnosed more often in

women

pointed to several possible explanations for this finding, self-esteem.

Is it

teristics that are

possible that

deemed

women

women

toward relationship, cooperating

by society? Yet another explanation focuses on the

Achievement behaviors

face.

of which are linked with low

more often than men because charac-

typically female (e.g., orienting

rather than competing) are devalued

crimination

get depressed

all

than in men. Yoder (2003)

are typically less acceptable in

dis-

women

moment about an aggressive woman. Is she evaluated differently from a man labeled aggressive? The stress of maintaining multiple roles is also exacerbated for women. When was the last time you heard anyone ask whether a man could “have it than in men. Think for a

all,”

meaning

Not

a successful career

FT theorists are also

surprisingly,

and have advanced

and family

several hypotheses

life?

interested in the

about these types of behavior (Enns, 2004). For an

individual client, a combination of these factors tural pressure

of the thin body

erless position,

development of eating disorders,

as ideal,

might be operative, which include the

body control

as a

way

to gain

power from

a

cul-

pow-

ways of coping with achievement-related anxiety, and remaining small to

avoid threatening men.

The shelters

origins of the feminist

and rape

attentive to are linked

crisis

movement

lie

in the establishment

of battered

womens

centers in the 1960s. Thus, feminist therapists are especially

problems that are more

likely to affect

women

than

men and

problems that

with patriarchal cultural norms, and particularly with physical, sexual, and

emotional violence.

Susan appears

to

be experiencing some distress associated with the pressure

ditional female roles

and

behaviors.

Chandra

will not use

to

maintain

tra-

any formal diagnostic system

to

understand her presentation because she believes these to be androcentric. Instead ofseeing Susan as dysfunctional, Chandra sees Susans strengths in expressing herself when treated badly by others (the guy in

Susan

class)

and

in her persistent attempts to care for others.

That

pursuing a traditionally male-dominated career is not lost on Chandra, either. Chandra wonders what effects Susans experiences with her alcoholic father have had on is

her perceptions of the nature of women and men. Her struggles in relationships with men are probably connected in some way because she likely learned very early that men cant be

Susan has been the object of both verbal and physical abuse by men, of these traumas cannot be ignored. trusted.

and the effects

NATURE OF THERAPY Assessment counselors are unlikely to use formal assessment methods. In fact, radical feminist therapists would completely reject formal assessment and diagnostic systems, seeing them as 1

I

rooted in the patriarchal system that controls access to services and reinforces hierarchical systems within society (Enns, 1995). Other FT counselors, most likely liberal feminists, might use traditional diagnosis if it is a means to provide services to their clients.

Judith Worell and

Pam

Renter (2003) point out that traditional approaches to diagnosis and assessment minimize the effects of environment and culture. Further, as noted

FEMINIST THERAPY earlier, traditional

393

approaches compare women’s behavior to a male standard. Carolyn

Enns (2000) gave the examples of “women have low self-esteem” as compared to “men are more conceited than women” (p. 619). Traditional approaches may also support the

women and men are biological in nature. Just think for popular book Men Are jrom Mars, Women Are from Venus (Gray, women and men unalterably different, but they are possibly differ-

notion that differences benveen a

minute about the

1992).

Not only

ent kinds of

life

are

forms!

Laura Brown (1993) proposed an alternative, a biopsychosocial model of distress, with emphasis on the social. This model emphasized the strengths of the client while also

acknowledging the influences of culture, such

social structures (e.g., heterosexuality, notions

tional diagnosis.

used by

FT

Brown (2006) contends

counselors,

it

is

as political forces

about “normal”

that although

in the context

DSM-W

approach that includes the factors above and an awareness of the

traditional

As

families).

much more

of a

and

labels are

for tradi-

sometimes

and broader

detailed

therapists’

own

input

into the process.

Chandra does no formal assessment or diagnosis with Susan. She sees these systems as confining and limiting, probably distorting the role ofcultural norms in Susans current distress.

Overview oe the Therapeutic Atmosphere Traditional approaches to psychotherapy are assumed to maintain the androcentric, patriarchal status

quo by

oppression (Worell

women

assisting

& Johnson,

to “adjust” rather than to challenge stereotypes

2001). In Phyllis Chesler’s words, “For most

(middle-class-oriented) psychotherapeutic encounter

unequal relationship, to be ‘helped’

just

by being

one more opportunity

(expertly)

to be

dominated” (1972,

just

is

the

one more instance of an

rewarded for expressing p.

women

and

distress

and

108).

Marecek and Kravetz (1998) suggested that, in fact, the feminist therapist is really in a dilemma because she is supporting an enterprise that focuses on the self apart from history and culture, assumes free choice, and assumes that individualism is realistic and to be desired. Feminist therapists

who

see therapy as a patriarchal, class-bound system that

simply perpetuates the status quo advocate consciousness-raising groups and instead of traditional psychotherapy (Enns, 1995). Laura

social action

Brown (1994), on

the other

hand, carefully considered the merger of feminist politics and therapy and concluded that feminist therapy

Some FT

is

not an oxymoron.

counselors argue that therapy

minimizes power

differentials

is

best

done

between therapist and

in

groups because

clients (Enns, 1995).

this

approach

Worell and Re-

mer (2003) add that groups allow women to become empowered through helping each other and collectively engaging in efforts to promote social change.

heal

Chandra has given a great deal of thought to the feasibility offeminist therapy. She has examined her own beliefs about what counseling is about, and blends an empowerment approach with a relational one. She seeks while at the same time accepting her

to

help Susan accept her feminine" tendencies,

own power as a person.

FEMINIST THERAPY

394

Ropes of Ceien One

thini^

therapist

all

and

FT

f

and Counselor

theorists agree on: the

client

is

essential to

FT

promotion of an

it

between

Because of the therapist’s professional qualifications,

an inlierent power imbalance in therapy

imbalance and discuss

egalitarian relationship

is

assumed; the counselor must acknowledge

this

with the client (Enns, 2004). That the counselor determines the

time and place of meetings and that clients pay counselors for their time means that egalitarian does not mean totally equal. At the same time, the client and counselor are

assumed

to be equally expert (Enns,

2004; Gilbert, 1980). The client

is

an expert on her-

and the therapist owns her professional knowledge and expertise. The therapist’s power temporary and lies in knowledge of the change process and assisting client empowerment

self, is

(Brown, 2000).

Brown (2000) pointed out that “the empowerment of the client, is not, after all, the disempowerment of the therapist” (p. 372). She suggested that one of the ways in which feminist therapists

power

see

use power

is

in the ability to

Acknowledging dictate that

this

remind

clients

of their

own

power. Also, feminist therapists

nurture and care and to listen calmly to the terrifyingly painful

(Brown, 2000).

stories of their clients

Part of the client’s

to

power stems from her willingness

to enter the therapy relationship.

temporary form of dependency represents resistance to the patriarchal

dependency needs be expressed only indirectly or

(Brown, 2000). Further, the client

is

Chandra

and

know

power

to define herself within

(Brown, 2000).

own sense ofpower to Susan, saying that she will do her best to help own way in life. Emphasizing Susans strengths and struggles, Chandra lets

discloses

Susan find her her

cultural context

sanctioned ways

seen as possessing unique knowledge of herself (Enns,

1995). Feminist therapists emphasize that the client has the a personal

in socially

her

that she respects Susans willingness to

knoiv that she (Susan)

is

the expert on her

life

come for

and that she

help.

Chandra

expects

Susan

to

also lets

Susan

contribute this

expertise to the counseling process.

Goals 1

he most important objective of

2007).

FT

them the

counselors

work

difference between

FT

is

simple: to

empower

to help clients accept their personal

clients (Gilbert

power

in life

&

and

Rader,

to teach

power within and coercive power, or power over others (Enns,

hey do not encourage the client to adjust to circumstances, unless the client has carefully explored her options and freely chooses to do so. Thus, an important part of em2007).

1

poweiing the

client

the therapists acceptance of the client’s goals. However, the therapist helps the client explore a wide range of life possibilities. is

Eauia Blown (2000) offered a more radical view when she argued that “each act of feminist therapy must have as a goal the uncovering of the presence of the patriarchy as a source of distress, in order to name, undermine, resist, and subvert such oppressive influences” (p.

367).

XXoman

of color feminists see the

development of conscientizacao, or critical consciousness, as the goal of counseling (Gomas-Diaz, 1994). Increasing the client’s awareness of colonization and accompanying internalized racism leads them to be aware of their

FEMINIST THERAPY location in society

395

and consciously

environment aimed

in the

Chandra

is

at

lifie

norms and

structures.

They

take action

transformation.

committed to helping Susan find her way

she has the personal power to do

her

criticize social

so.

Part ofiher task

in is

and helping her recognize that

lifie

Susan look at the forces in

to help

that both support and hinder her journey, particularly societal attitudes

tures that keep

women and

these clear

ofi non-Caucasian cultures oppressed.

individuals

Chandra's general goals; she also

is

very careful to discover

and concrete, and devise ways

Susan wants

to ''get the

world

ojfi her

and struc-

to

what Susans

These are

make

goals are,

reach them.

back. ”

Chandra empathizes with Susan and sup-

ports Susans goal.

PROCESS OF THERAPY The

principles of feminist therapy, as developed

Education and Training

Box

by the 1993 National Conference on

in Feminist Practice (Worell

&

Johnson, 1997) are shown

in

12.2.

FT counselors believe that value-free counseling is impossible (Enns, 2004). Therefore, the FT counselor must be aware of her own values and beliefs, particularly those that involve sex, gender, race, and

ded

in

a

heterosexist culture

communicate

Yet another important realization

class.

(Enns, 2000).

Some

that

we

are

embed-

feminist therapists will directly

their feminist perspective to their clients; others hesitate to use the

feminist htcdiUSQ of the stereotypes associated with

FT

is

it.

Most important, however,

term

that the

is

counselor not impose her value system on clients (Enns, 2004).

One

important way the feminist therapist attempts to enhance equality and collabora-

tion with her clients

is

about

to give the client information

FT

counseling and request the

informed consent (Enns, 2000). The therapy contract

client’s

nist therapists

developed

and has since been widely adopted by adherents of other

tations (Brown, 1994). Contracting involves the client

and

counselor,

and other

intent of informed consent

To make the FT (Wyche

client

& Rice,

is

and contracting

and counselor, and of all

deems

relevant (Enns, 2004).

FT

is

to demystify

women and

ex-

and

These

is

meant

\k\e.

therapeutic process.

counselors avoid jargon. Another

the careful use of self-disclosure

1997). Such disclosure

The FT counselor

be put in writing or handled more informally.

process accessible to the client,

to demystify the therapy process pist

may

theoretical orien-

benefits of counseling, the roles of client

features of the process that she

points, along with agreed-upon goals,

One

and

by femi-

therapist in a collaborative

process of determining the goals and pace of the counseling process. plains her approach to helping, the costs

first

to

to equalize

on the

way

part of the thera-

emphasize the shared experiences of

power

in the relationship (Worell

&

Remer, 2003). However, the counselor must be careful not to discount the very significant effects

of other factors associated with oppression, such

In FT, resistance

(Brabeck

&

is

Brown, 1997).

atic.

and therapy

Instead,

FT

and

ableness.

defined as the person’s healthy attempt to defeat oppression

resistance to the patriarchy as

therapist

as race, sexual identity,

In fact, Faura

Brown (1994) endorsed teaching

one aspect of FT. Client

feelings

are not typically labeled as “transference”

about or reactions

clients to the

and considered problem-

counselors welcome client feedback about the process, and especially.

FEMINIST THERAPY

396 expressions of anger because

women

are taught to supress

such expression (Worell and

Remer, 2003).

men

I1ie question often arises whether for

men. Box

1

2.4 presents a perspective

can be feminist therapists, and

on

this question.

if

FT

Radical feminists

emphatically no! In 1994, Laura Brown, for example, suggested that although truly be feminist therapists, they

p. 20).

She

come

now asserts

power, and social location, and

gender of the person thinking

to see this position as “essentialist

that the therapist

is

following agreements 1.

2. 3.

men

could not

and problematic”

constructed, then neither the biology or the

if gender is socially

like a feminist in the therapist position

women

of the same ethnic or

Chandra and Susan develop a therapy they have jointly developed.

would answer

that “if one can think as a feminist, think about gender,

Espin (1994) argued that the best therapy for

means

appropriate

could be profeminist and antisexist in their approaches to

counseling. However, she has since

(Brown, 2006,

is

racial

of color

is

(p.

“ethno-specific,”

background

contract, in writing,

The contract

is

ought to matter”

which

as the client (p.

20).

which 275).

specifies the goals that

written in everyday language

and includes

the

and goals:

Susan and Chandra will actively work toward a useful therapy relationship with input from both parties.

ofsocial and political factors in Susans distress will be explored. Susan and Chandra will explore Susans thoughts and feelings about relationships, The

role

with the goal of helping Susan assume her

own power

in relationships so that her

rights are not violated. 4.

Susan and Chandra will explore the sources ofSusans anger, with special attention to its roots in social structures, attitudes,

or practices that contribute to

it.

Box 12.4

Can Men be Feminist Therapists? At

first

glance, the terms feminist

and male seem

discussions of feminist therapy suggest that

men,

to

be contradictory. However, recent

too, can

adopt feminist perspectives

that inform their counseling behaviors.

Szymanski, Baird, and therapists

were

like.

Kornman (2002) decided

They surveyed 91 male

to find out

what these feminist male

counselors, finding that 18 of these coun-

selors self-identified as feminists.

They found that feminist male counselors differed from nonfeminist counselors on attitudes toward the women’s movement and gender-

hey also endorsed counseling behaviors associated with feminist therapy. Self-identified feminist male counselors were more liberal in their gender-role attitudes, role attitudes. 1

more

positive toward the

women’s movement, and more

likely to

endorse therapy inter-

ventions such as establishing egalitarian relationships with clients and emphasizing the social construction of gender. Basically, these male therapists looked very much like female feminist therapists!

FEMINIST I'HERAPY

397

THERAPEUTIC TECHNIQUES FT

has few unique techniques.

way

gender-fair theories to

fit

(Enns, 1995).

feminist principles. Thus, there are psychodynamic, Jungian, and cognitive-

FT

behavioral approaches to

most

are the

Any technique or approach is acceptable if it is used in a Some therapists adopt and modify traditional counseling

(Enns, 1995). In this section

I

present several techniques that

closely identified with FT.

Gender-Role Analysis Gender-role analysis

is

practically

synonymous with FT.

Clients are supported in a personal

examination of cultural rules about female and male behavior and distress (Worell

how

these relate to client

& Remer, 2003). Socialization processes are discussed in terms of how they

relate to the client’s current behaviors in the interest

of detoxifying them. For example, what

might be labeled “dependent” behavior can be construed

as

behavior that

is

powerfully rein-

forced by our society as being appropriate to the female role (Philpot, Brooks, Lusterman,

Nutt, 1997).

The

client

helped to understand the origins of her behaviors in social norms

is

and oppressive environments, and the

Chandra

is

very interested in Susans belief that she has trouble letting go

of relationships. charaeterization and its potential roots in an

exaggeration of traditional sex roles that are reinforced by the

ditional

dominant

culture.

Chandra

ofSusans adoptive mother, who was raised in a very trainfluences shaped Susans view of herself and her behavior are

also explore the values

society.

How

these

examined in an attempt lem

them (Enns, 2004).

possible consequences of changing

She guides Susan through an analysis of this

and Susan

&

to

depathologize Susans behavior

and move

the locus

of the prob-

to the political realm.

Self-Disclosure Another approach

to equalizing

disclosure (Enns, 2004).

power imbalances

Wyche and

in

FT

is

for the therapist to use self-

Rice (1997) suggested that there

sensus on the use of this technique. As noted

is

no current con-

earlier, therapist self-disclosure

is

helpful in

demystifying the counseling process and in emphasizing the shared experiences of women.

Any

self-disclosure

satisfy

by the therapist must be

any need of the therapist (Wyche

in the interests

& Rice,

of the client rather than to

1997).

would be helpful to Susan. She decides that because Susan doesn’t seem to have a sense ofcommunity with other women, some disclosure is appropriate. Briefly, Chandra speaks of her struggles with autonomy in a world

Chandra

considers whether disclosure on her part

that gives power to males. Susan reacts positively to this disclosure tive

and goes on

to

a produc-

examination of her own experiences.

Assertiveness Training Popular

in the

1970s, assertiveness training teaches the pursuit of one’s rights without

violating the rights of others (Jakubowski, 1977a). Assertiveness

is

distinguished from

FEMINIST THERAPY

398 which involves the violation of

a^^ression,

others’ rights,

and nonassertiveness, which

is

own rights to be violated. Patricia Jakubowski, a well-known writer in this commented that assertiveness “is a direct,.honest, and appropriate expression of one’s

allowing one’s area,

thoughts, feelings, and beliefs” (1977a,

p.

147). Respect for self and other

is

an important

element of assertive behavior. You might have noticed that nonassertive behavior fits the stereotypical female behaviors such as putting the needs of others first, withholding opinions,

and “being

nice.”

women

Assertiveness training was developed to teach

to

abandon

their culturally

approved nonassertive behaviors. Most often, assertiveness training was conducted in groups (and

typically,

women-only

groups), although

ing as well. Jakubowski (1977b) identified lour (a)

teaching the distinctions

helping clients observe their

factors that inhibit assertive behavior;

A

169).

differences

components of

and

(d)

(c)

among

assertive, aggressive,

Many

training, including role-playing

teaching assertive is

skills

and self-observation. Systematic desensitization

new

is

some-

behaviors (Jakubowski, 1977b).

assertive behavior

the angry, aggressive behavior that she occasionally displays. However, is

promote

as well as to

Behavior Therapy techniques are used in assertiveness

work with Susan on increasing her

aware that Susans anger

through practice

used to teach clients the

and nonassertive behavior

times used to reduce the anxiety around the

decides to

assertiveness training:

removing or reducing the salience of

combination of teaching and group discussion

basic assertive philosophy.

Chandra

can be used in individual counsel-

among assertive, nonassertive, and aggressive behavior and own behaviors; (b) teaching clients a philosophy that respects

individual rights and supports assertive behavior;

(p.

it

and decreasing

Chandra

a form of strength and stems from her resistance

to

is

very

confining

Chandra does not want to take Susans anger away; it is a valid and healthy emotion. Susan and Chandra role-play situations in which Susan is

societal norms.

For

this reason,

likely to be nonassertive as well as those in

which she

is

prone

to anger.

EVALUATION OF THE THEORY Criticisms of

FT come from

both within and outside of the women’s movement. Most of you are probably familiar with the so-called backlash against feminism: feminists are manhaters

engaged

in

male bashing.

than a theory of therapy. clear

what

FT

actually

The

is,

FT can

also be criticized for

diversity of views within

beyond

FT

being a political stance rather

leads to the charge that

it is

not

a set of beliefs.

FT because anyCmd of therapy is a tool of the patriarchal, oppressive society (Chesler, 1972). Cultural feminists charge that FT is based on the experiences of white, middle-class women and therefore neglects discrimination and disempowerment Radical feminists reject

based on race, social

class,

sexual orientation,

and other

factors (Alleyne, 1998).

Sharon Baron Spiegel (1979) questioned the usefulness of a special, separate set of principles for counseling women. Arguing that such an approach was not yet justified empirically, she pointed out that other client characteristics could be

than gender

(e.g.,

social class).

more important

L9eveloping separate sets of principles for the various groupings of clients could prove divisive to the profession of counseling, according to Spiegel. Also, nonsexist values and knowledge about women’s experience is important for

FEMINIST THERAPY men,

399

advocated a generalist model for counseling that adopts nonsexist

too. Spiegel

values, but that does not replace

one

set

of biases with another.

Qualities of the Theory Precision

and

Testability.

FT

is

not very testable in terms of a theory of human behavior.

does rely on volumes of research on sex roles and gender

and have been operationalized, such

Empirical

Validity.

Outcome

however. Aspects of FT can

issues,

as assertiveness training,

some of these

therapist self-disclosure. IHowever,

on

research

FT

activities are

and

tenets of the approach, such as sex-role issues

gender-role analysis, and

not unique to FT.

counseling approach

as a

It

is

sparse.

The

basic

socialization, are empirically supported.

Research Support Very of

little

research has been conducted

upon what

major factor

FT

I

so, will

FT

is

my

arguments on a

FT

usual distinction between out-

not unique

—

it is

simply good therapy

2001). Nonetheless, Worell and Johnson maintained that

identifiable approach, basing their clients.

dispense with

that

is

broad selection of research relevant to

will present a

come and theory-testing research. Some of its proponents would argue

& Johnson,

propo-

difficult for

of research bearing directly on the theory and practice of

in the lack

approach, and in doing

(Worell

it is

exactly constitutes the theory of FT. This situation, of course,

(Murray, 2006). For these reasons, the

outcome of FT. Because

actual practice or

philosophical basis and tendency to be technically eclectic,

its

nents to agree a

on the

series

Using an instrument called the Therapy with

FT

is

an

of survey studies of therapists and

Women

Scale (based

on the

princi-

Box 12.2), differences in philosophy and goals can be documented between feminist and nonfeminist therapists (Worell & Johnson, 2001). Important factors underlying these differences were (a) affirming the client, (b) women-centered activism, (c) the use of ples in

self-disclosure, (d)

Andrea Chester and Diane Bretherton (2001) found

trast, tial

elements of

largest area

85%

in their

sample of Australian feminist

& Zetzer,

agreement about the essen-

therapists. In their research, the (e.g.,

sociopolit-

and Carolyn Enns (Enns

& IHackett,

either feminist or not

In

Enns and Hackett’s (1990)

viewed either

study, college

liberal feminist, radical feminist, or

on videotape. The

researchers also varied the type of

which participants were judging the acceptability of the counselor. Somewhat

ingly,

Enns and Hackett found

that

all

harassment, or assault was the

issue.

mode of presentation of the

effect

women human-

problem surpris-

participants, regardless of attitudes, preferred the

feminist counselors to the nonfeminist counselors

ied the

1990;

1992) demonstrated that feminist therapists are perceived posi-

istic-nonfeminist counselors

no

less

involved woman-centered concerns

at client perceptions, Gail IHackett

by samples of college students.

who were

an egalitarian stance. In con-

of problems, understanding sex-role stereotypes, critique of the patriarchy),

Hackett, Enns,

for

FT

(e)

oI their sample listing these issues as essential to FT.

Looking

tively

FT

of agreement was that

ical analysis

with

adopting a gender-role perspective, and

Using

a similar

when

career decision making, sexual

method, Hackett and colleagues var-

counselor (videotape or written niaterials) and found

of presentation. Overall, the

liberal

FT

counselor was perceived more favorably

FEMINIST THERAPY

400

Of course,

than nonscxist or radical FI’ counselors.

beyond

these studies

college

women

is

the generalizability of the results of

risky.

Rader and Lucia Albino Gilbert (2005) attempted to test whether counselors who identified as feminist exemplified their orientations in terms of egalitarianism, here jill

defined as power sharing and collaboration. Forty-two female therapists were recruited, and

34

clients

were asked

about

therapists’

50%

if their

asked in

if

Box

The

this

no

differences

identifying as feminist

who

to therapists

study was that

when

they used the behaviors considered characteristic of

12.2),

as feminists; interestingly,

study confirmed the centrality of egalitarianism to

when compared

Another interesting aspect of

FT

all

raising

and

also

did not identify as

of the therapists were

(similar to those identified

were found between the groups of therapists, mainly because

of them reported that they consistently acted in those ways with their

Some of the

not return

were feminists, their identifications matched their

more frequently by therapists

of these therapists,

clients

feminist.

therapists

of the time.

FT: power sharing was reported

by the

clients recruited did

Nineteen of the therapists identified themselves

their materials).

when

(some of the

as well

of these therapists participated

clients

research that

is

relevant to

FT

all

clients.

focused on the effectiveness of consciousness-

groups and assertiveness training. This research

dated and can be criticized on a

is

number ot methodological grounds (Enns, 1993). In one study of actual FT, Ronald Mancoske and colleagues (Mancoske, Standifer, & Cauley, 1994) produced somewhat disappointing

results for

advocates of FT. Groups of battered

counseling or feminist counseling (after statistically significant

However,

this

clients

FT

did not

show

who underwent grief counseling did.

study used a very small sample of clients (20 per group), and two therapists (the all

of the therapy groups. These factors (plus the lack of definition

of the approaches) very likely limited the

power of the study

Studies of feminist identity development theory often used as the basis for thinking about

scales are supportive, other data

instruments (Moradi

women

factor structure

Development

One

Scale;

in counseling. Several

measures of

some psychometric data on

these

built into the

&

Hyde, 1991) produces

a different

traditional white Caucasian female groups

&

Good, 2006). measurement problems, then

(Flores, Carftibba,

because

study suggested that an often-used measure

Bargad

when used with other than

FT

indirectly address

do not confirm the proposed stage structure

& Stibich, 2002a).

(the Feminist Identity

to find significant differences.

(FIDT)

F1F)1 have been developed, but unfortunately, although

Given the

were offered either grief

intervention). Clients in

crisis

improvement, whereas the

study s authors) conducted

it is

women

the results of studies of

One

FIDT should be viewed women psychotherapists

study related to the feminist therapy behaviors of (Junttinen, Atkinson, Reyes, Gutierrez, 1 994) found that revelation stage attitudes were the

cautiously.

&

best predictor of

whether

a therapist self-identified as a feminist therapist. Further, therapists

who had

high scores on synthesis and revelation attitudes and low scores on passive acceptance endoised more feminist therapy behaviors than did those with the opposite pattern. Studies of feminist identity development inconsistent results. For instance,

looked

at the relationships

and psychological distress have produced Bonnie Moradi and Linda Mezydlo Subich (2002b)

among

the stage of feminist identity development, experience with sexist events, and psychological symptoms. Passive acceptance attitudes, which these lesearchers conceptualized as evidence that the participant sexism, were related to greater occurrence

was denying the existence of

of symptoms given the occurrence of

sexist

FEMINIST THERAPY

401

events over the past year. Natalie Sabik and Tracy Tylka (2006) also examined the relations

between

FIDT and

eating patterns.

eating (that

and these

Only

Synthesis and Active

women

is,

Ann

issues.

Commitment

attitudes predicted problematic

lower on these scales tended to score high on disordered eating),

attitudes explained

and the eating cal

perceived sexist events, but they were interested in dysfunctional

some of the

Fischer

relationship between experiencing sexist events

and Glen Good studied FIDT, anger, and psychologi-

symptoms, and found that only the identity

Anger was associated with Revelation

attitudes but not with the other

except for Revelation, did not explain the relationship between trary to Fischer

symptoms.

stage of Revelation related to

FIDT

FIDT and

stages,

distress,

and con-

and Good’s expectations. However, the authors noted that the anger mea-

sured was general, not specific to the patriarchy or other relevant targets. Kendra Saunders

and Susan Kashubeck-West (2006) found that feminist identity was reported psychological well-being: Active tively.

That

is,

of well-being

women who than women

reported lower levels

scored higher

related to self-

Commitment positively, and Revelation on Active Commitment reported higher

women higher on of psychological well-being compared to women lower on lower on this dimension and

negalevels

Revelation Revelation

attitudes.

In a study that bears tested

on feminist identity and

intervention, Rachel Peterson

and colleagues

whether teaching female college students feminist views on body image could

their levels

affect

& Bedwell,

of body satisfaction and feminist identity (Peterson, Tantleff-Dunn,

2005). Participants were pre- and posttested, and then exposed to a 15-minute audiotape of traditional psychoeducation

No

effects

about body image, a feminist intervention, or no intervention.

of treatment were observed on body image dissatisfaction but the feminist

intervention did appear to create change in satisfaction with appearance (without going into tedious detail, these two measures were different in content and form). Although participants

showed increased

self-identification as feminists

when compared

to the other

two groups,

only one effect of intervention was observed for feminist identity: contrary to hypothesis, participants in the feminist intervention

Peterson et

al.

Gommitment scores. FIDT may have made them realize how

group decreased

speculated that simply completing the

in their Active

inactive they really were, thus causing a decline in the scores at posttest.

Before you read the next paragraph, look at

Box

12.5.

Much research has focused on whether counselors are sexist. The “grandmother” of this line of investigation was a study conducted by Inge Broverman and her colleagues (Broverman,

Broverman, Glarkson, Rosenkrantz, scribe a healthy

man,

a healthy

& Vogel,

woman, and

1970).

They asked

practicing therapists to de-

a healthy person, sex unspecified.

To

the horror

of many, they found that the qualities of the healthy person most resembled the qualities of the healthy male. Healthy turousness, aggression,

women were rated lower on qualities such as

independence, adven-

and competitiveness than were men. In addition, healthy women were

seen as easier to influence,

more excitable, and submissive in comparison

to

men. As you might

guess, this study incited great controversy.

Broverman and Gilroy, 1985;

colleagues’ study has been criticized for a

Widiger

& Settle,

1987).

On

a

most basic

number of reasons

level,

(Phillips

&

the study could be faulted

because the counselor participants were rating hypothetical individuals, not responding to

Mso, Widiger and

(1987) provided convincing evidence that the findings of Broverman and colleagues could be almost entirely attributed to characteristics of

a “real” client.

Settle

FEMINIST THERAPY

402

Box 12.5 Consider the following adjectives: Independent Assertive

Strong

Confident

Do

words describe a male or a female? Are they healthy

these

Here

are

some more words

qualities or not?

to consider:

Passive

Easily excited

by minor events

Dependent Cautious

Ask yourself what picture came These selors

are

some

to

mind

you read these words.

as

famous study of sexism among coun-

ot the adjectives presented in the

conducted by Broverman, Broverman, Clarkson, Rosenkrantz, and Vogel

in 1970.

method used. Subsequent studies have been inconsistent in their findings, and are now somewhat dated. Since overt sexism in society is thought to be decreasing (Campbell, Shellenberg, & Senn, 1997), it would seem that counselors would be unlikely to respond in sexist ways to research stimuli. Whether this evenhandedness is a result of a true change the

in attitudes or

that sexism 1

“underground sexism”

may

996; Turner

still

exist

& Turner,

among

is

up

would seem obvious

radical feminists

would

&

Slusher,

1991).

that

FT

is

a

AND CULTURAL DIVERSITY

good approach

object to using a liberal

upholding the patriarchal status quo. lor

few studies have suggested

therapists (Powers, Applegate, Tredinnick,

ISSUES OF INDIVIDUAL It

for debate.- Also, a

example, has been criticized

as

A

FT

to use

with women. However, some

approach because they would see

it

as

major bedrock of early FT, assertiveness training,

based on a model that views stereotypically female

behavior as deficient (Fodor, 1985). b

I

is

grounded

in sensitivity to oppression, so

It

can be considered to be very appro-

priate lor use with individuals

from diverse backgrounds. Earlier versions of FT, based on White, middle-class experience, have been accused ol racism, but contemporary feminist therapists recognize the influence ol other important dimensions on the experiences ol women, such as class, age, ableness, sexual orientation, and race/ethnicIty (Brown, Riepe, Cofley, 2005). Feminism recognizes the heteropatriarchy, and lesbian

&

feminism

is

an alternative for

women who

are lesbian. Indeed, feminist scholars have

FEMINIST THERAPY

403

always attended to issues relevant in theory and practice with lesbian and bisexual

women (Brown

2005). Increasing attention to issues of diversity have resulted in

et ah,

explorations of the implication of feminism for African American (Williams, 2005),

Latina (Lijtmaer, 1998), biracial (Nishimura, 2004), and Japanese (Matsuyuki, 1998) clients,

among

female bias present in

The

However, some

others.

FT

of

critics

FT

continue to remind us of the White

(Espin, 1993).

question always arises about the appropriateness of FT for male clients.

argue that

inist therapists

it is

existence, particularly for the privileged

men

the recognition that

men

very helpful for

examine the

to

White male. These

Some fem-

social aspects

of their

types of concerns, along with

experience significant gender-role conflict, have prompted the

development of gender-aware or gender-sensitive therapy (Good, Gilbert,

& Scher,

1990;

Philpot et ah, 1997). These approaches integrate feminist principles with a broad exami-

nation of gender.

Men in gender-aware therapy are encouraged to explore the ramifications

of traditional male

on

sis

career

roles,

develop stronger interpersonal

skills,

and decrease

their

empha-

and work aspects of identity.

THE CASE STUDY Susan seems to be an

male-dominated

She

is

engaged

of a traditionally

in the pursuit

However, the adoption of this career goal may be partly

career.

norm of Asian

the

FT

ideal client for

culture that values scholastic achievement above

all.

a result of

Susan reports

rela-

tionship difficulties that seem to involve both extreme expressions of femininity and vio-

norms

that

predict a

good

lations of the cultural characteristics

would

women fit

with

should not be angry or aggressive. These

FT

injustice that lies at the heart of the feminist

She has

also

been the victim of abuse, an

movement.

Susan’s Asian heritage raises questions about applying

FT

If her

adoptive mother heavily

reinforced the “proper” characteristics of women in the Asian culture, ignoring this influence

would be a serious mistake. The goals of empowerment and liberation may be Susan’s culturally linked values.

ated to the United States,

if

However,

in other ways,

Susan seems to be

the adoption of her nontraditional career goal

is

in conflict

with

fairly accultur-

any indication.

Summary Feminist therapy

is

more of a philosophical approach

working with

to

fined theoretical structure. Feminist therapists are attentive to the

confer power and status on

how

means

oppress

women. The

man

norms

of society that

social pressure to

woman

than a de-

conform

to

important

influ-

people behave. Feminist therapists also recognize the effects of social

class,

stereotypical notions of

ences on

men and

clients

what

race/ethnicity, ableness,

it

to be a

and sexual orientation on

or

are seen as

individuals’ lives; individuals

who

are

not of the “majority” on these dimensions are subject to oppression by society.

FT

counselors believe that the personal

is

political

and that women’s (and other

oppressed groups’) struggles are the result of societal structures and norms that are disparaging of

women and

celebratory of men.

The norm

stereotypically male qualities (e.g., rational, independent, ally

female qualities are seen

as

less

valuable

(e.g.,

for “healthy person”

and so

forth),

is

based on

whereas tradition-

emotionality and connectedness).

FEMINIST THERAPY

404

Women

are

damned

if

they do and

expressions of female traits

damned

and masculine

if

they don’t

traits

—

social penalties are

imposed

for

by women.

Feminist therapists approach counseling with an egalitarian attitude, recognizing that true equality will not exist in the therapy relationship.

They attempt

to recognize

and min-

imize power imbalances in therapy by forming therapy contracts and demystifying the

therapy process. goals.

The

goal of

Few techniques

FT

is

empowering the

are specific to FT,

client so that she

can achieve her

although one very closely tied to

this

life

approach

is

the analysis of social roles.

FT

has been criticized for being anti-male

theoretical system. Radical feminists

the emphasis within

FT on

societal

valuable approach for individuals

Visit

may

and

for being a political stance rather than a

totally disagree

and

FT

power imbalances and oppression,

who

are

at

all.

Because of

likely to

be a

www.prenhall.com/murdock

for

it is

of diverse backgrounds.

Chapter 12 on the Companion Website

chapter-specific resources

with doing

self-assessments.

at

Virginia Satir

Jean and Derril, mother and Derril’s

father

angry behavior. Jean

is

son,

is

come

counseling because jean

to

is

concerned about

and Derril is of multiracial heritage;

AJrican American

Caucasian. Derril, age 12,

is

his

Jeans only son with his father, Al, but she has a

daughter from a previous relationship who

is

20 years

old and married with children. Jean

42 years old, currently single, and not dating anyone. Jean and Al, Derril’s father, were married for about 6 years. They divorced 2 years ago. Last year Al moved in with a woman who has three children. Dejril lives with his mother, is

but spends Sunday mornings at church with his father. Lbe reports having no real desire see his father

and Al

and says

that he does not get along with his father’s girljriend or her kids. Jean

divorced because of severe relationship

conflict,

abuse offean.

On some occasions,

and Al are on

speaking terms, but do not appear

comfortable ifshe

is

to

Derril stepped in to

to

which often resulted in physical

interrupt the abuse. Currently, Jean

get along well. She reports feeling un-

alone with Al.

Jean has a bachelor’s degree in business and works as an administrator in a government agency.

Her family

lives in the

immediate

vicinity,

time together, they recently have not done

so.

but although they used

to

spend a

lot

of

Jean says she has few friends. She does not

spend much time with her daughter, although Derril sometimes spends the night with the daughter

and her

children.

Both Jean and Derril report that they spend much of their

time together. Derril’s behavior

became increasingly troublesome, according

to

Jean, after his father

moved in with his girlfriend. The incident that actually brought Jean and Derril into counseling involved an altercation with the security guard at school. Derril reportedly

ing back” to the ojficer

and became more and more angry as

guard eventually shoved Derril against a was suspended from school for 10 days.

security

locker.

the guard

As a

residt

‘'got

of this

was talk-

m his face.

”

The

incident, Derril

405

FAMILY SYSTEMS THEORY

406

More

DerriFs problematic behavior appears to have become

recently,

less severe,

but

happen about every other week. For example, Jean reported that Derril was expelled from the extended day program at school because he slapped a boy who was "talking about his mama. ” Jean says that she is not sure how to handle such behavior and

something seems

that she

to

afraid of the

is

respect for his elders,

way her son

and that she

treats

women and adults. She

has been unable to find any

way

says that Derril has

no

change his behavior.

to

BACKGROUND At

glance,

first

it

might seem

a little strange to include a chapter

on family systems (FS)

theory in a book otherwise devoted to theories focused primarily on individuals. Even

my

weren’t First,

favorite set of theories, though. I’d

family systems theory

still

if it

include this chapter for several reasons.

considered one of the major schools of counseling and psy-

is

chotherapy. Second, an FS approach can be used with individual clients; family systems

can best understand the individual through understanding his

theorists believe that they

experiences as a

member of the

family.

out the complete family group will

1

Opinions vary

effective,

is

as to

whether doing FS therapy with-

however.

review four major approaches to family systems intervention in this chapter: struc-

tural, strategic, the

family systems theory of Murray Bowen, and the existential/humanistic

approach of Virginia Satin There are others, including the most recent additions, the consuch

structivist theorists,

as the

Narrative and Solution-Focused approaches, described in

Chapters 14 and 15. Nichols (2006) future.

However, they

approaches so

1

ever,

I

most

as the

wave of the

acknowledge that family therapists readily borrow from various have chosen to present the four approaches in this chapter because they are

FS theory and

will describe the

therapists probably

to cover in the four

ture similar to that

influence

many

counselors currently. In this

in a social constructivist

have chosen,

I

I

will use

part.

How-

in their day-to-

framework. Because there

is

much

an abbreviated form of the struc-

used to present the neoanalytic theories in Chapter

the Theories in Action

most

draw from one or more of these approaches

approaches 1

still

versions of these approaches for the

classic

day work, integrating these ideas

On

two approaches

also

the historical bedrocks of chapter,

classifies these

3.

DVD,

you can watch Dr. Paul Anderson do family systems therapy with the client Helen. Although Dr. Anderson s style is primarily Bowenian (see Section on Bowen theory later in this chapter), he draws from other systemic approaches, too. A detailed history of family therapy and FS theory is beyond the scope of this chapter. Interested readers should consult Nichols (2006) or

nating read

is

Guerin and Chabot (1995). A fasciSimons (1992) book, Dne on One, which reprints interviews with the lead-

of the fimily therapy

ers

movement, including Jay Haley, Cloe Madanes, Salvador

Minuchin, and Virginia Satin 4'he professional

community

in

are family systems advocates, but

porate ical

1

some knowledge of systems

peispectives,

affiliations.

They

fimily therapy

think

it is

in their

is

very active.

Not

all

family counselors

safe to say that the majority

probably incor-

work. More so than advocates of other theoret-

seems, family systems therapists have a wide variety of professional may identify themselves as psychologists, professional counselors, social it

woikers, or simply as couples/family therapists.

One

of the major organizations for family

.

FAMILY SYSTEMS THEORY systems adherents

the

is

407

American Association of Marriage and Family Therapists

(AAMFT), which can be found at www.aamft.org AAMFT publishes the Journal of Marital and Family Therapy and the Family Therapy Magazine. The American Psychological .

Association has a division of Family Psychology (43), which publishes a newsletter, The

Family

and has an

Psychologist,

APA

official

haps the most prestigious FS journal

is

The Journal of Family Psychology. PerFamily Process, founded in 1967. The first editor of journal.

Family Process was Jay Haley, and the board of directors of the Family Process

which publishes the

journal, reads like a family systems who’s

Salvador Minuchin, Virginia

Murray Bowen was

the

Don

Satir,

my

begin

some important

among

Jackson, and Gregory Bateson,

and

others.

practitioners devoted to family systems issues. This

organization can be found at www.afta.org I

who, including Peggy Papp,

president of the American Family Therapy Academy, an orga-

first

nization of teachers, researchers,

Before

Institute,

.

description of the four family systems approaches,

by family systems

ideas shared

tualization of the family as a system.

From

fined as a group of interrelated people

theorists. First

way

plus the

and foremost

family

this perspective, a

I

is

will highlight is

the concep-

seen as a system de-

they function' (Nichols,

2006,

p.

374;

my italics).

Family systems theorists are adamant that the best way to approach helping

dividuals

to see

is

them

among

relationships

of a larger system, and they tend to focus on the

in context, as a part

who

individuals

are

members of the system (Becvar

For family systems theorists, the family the system will affect other parts.

is

The image of a mobile

the sailboat.

Much

family in any

way

no

you touch one of the

movement

will create

clear start or finish to the

also that factors other as a

it

speedboats and a cruise

common

sailboats,

it

supporting structure

floats in the direction

in other parts

as easily

seem

tem) can differentially influence

its

—

the cruise ship

to be pursuing the speedboats.

than your fingers can influence

group and that the influence of other

member of

a

of the system. Also note that there

sequence of movements in the mobile

could just

of

sailboat causes the speedboats to chase

mobile, argue the FS theorists, moving one

like the

not leading the sailboats;

and

If

helpful to illustrate this idea.

sailboats, three

same time, your touching the

the cruise ship. At the

is

is

of the elements of the mobile are connected by a

from which they hang.

& Becvar, 2006).

interconnected, and influences on one part of

Imagine that you have a mobile that consists of two ship. All

in-

this system’s

is

Note

elements individually

factors (such as the social context of the sys-

elements. For instance, a sharp breeze might cause

all

of the boats to move, but the sailboats might be more responsive than the cruise ship.

Consider

we

common

often observe that

If the child

In

this a

is

situation

from the human sphere: when

on the surface the parents

“fixed,” however,

FS terms, one of two things

all is

are

is

acting out,

calm and intent on helping

their child.

a child

of the sudden the parents begin to have serious

happening

here: the friction

diffused by or channeled into the acting-out kid.

When

between the parents

the pressure

is

appearance of the symptom, the conflict between the parents becomes

Most

families present with an individual

who

has been labeled by

battles. is

either

released by the disclear.

them

as the

“one with

the problem.” Because systems theorists resist the idea of problems within individuals,

most FS

therapists call this person the identified patient

[W)

Systems thinking leads to the attitude that the causes of a given behavior or problem are irrelevant because the system

causal to another

is silly.

is

an interlocking chain of events. Designating one event

Doing

so

is

kind of

like

as

asking whether the chicken or the egg

FAMILY SYSTEMS THEORY

408 came tion.

this view of interacSystems theorists use the term circular causality to describe A (of the IP) causing Contrast this circular view with a typical linear view of behavior dress B (parent’s rage, grief, etc.). For example, Amy, an adolescent girl, likes to First.

behavior

reminiscent of Britney Spears (or Cher, for you older folks).

in a style

Amy

that

chinos?

looks horrible in these clothes.

Of course

not.

Does

Amy

back

Her

down and wear

to lavor her usual provocative things,

She continues

mom

shrieks

golf shirts

and

and even man-

more extreme examples, or perhaps even threatens to shave her head. Mom the first place? Unlikely, say the yells more, and so on. Did Amy cause the mom’s yelling in systems theorists. Mom’s focus on Amy may have led in the first place to her attempts to ages to acquire

individuate by dressing like her peers. In this simple case,

who

caused what, and that

reason, family,

is

the point that the systems theorists

want you

to get. For this in a

&

which the

parts are interactive

& Schwartz, 2006).

and thus the

inability to

this

that

is,

systems are those in easily.

impermeability leads to rigid-

change and adjust with the environment.

Another important quality of systems that family therapy

—

Open

and information flows into and out of the system

Closed systems don’t allow information in or out, and

ostasis

clearly difficult to say

FS therapists usually are more interested in the process, or how things happen Becvar, 2006). what) of the happenings (Becvar than the content

Systems can be open or closed (Nichols

ity

is

it

theorists

emphasized

Is

home-

the idea that systems tend to self-regulate and, therefore, to resist change.

Even more important,

view Implies that

this

if you

member

change one

in isolation,

when

they return to the system, the system will attempt to get the individual to change back.

Nichols (2006) suggested that early in the history of systems theory, this tendency was

overemphasized, causing theorists and therapists to overlook the inherent flexibility and

growth displayed by

The

families.

Approach

Satir

OVERVIEW Although most the

human

refer to this

approach

as the Satir

approach, Satir herself called her system

validation process model. Virginia Satir

family therapist

when

-

(1916-1988) began her career

she enrolled in the master’s degree program at the School of Social

Service Administration at the University of Chicago in 1941

One

of the original

began

in

group of researchers

at the

(McLendon

Mental Research

& Davis, 2002).

Institute

(MRI) when

it

1959, Satir published her influential book. Conjoint Family Therapy in 1967.

Prior to her

move

to

MRI,

she had been seeing families in Independent practice, and then

directed the formation of a family therapy training Institute (Nichols, 2006).

of

as a

It is

MRI

formally

teresting things going

on

In

at the Illinois State Psychiatric

an interesting tidbit that she had also been reading the works

Murray Bowen and had met him Satir left

program

in

1938 (Brothers, 2000).

1964. For quite some time, she had been Involved In the In-

at the

Esalen Institute in Big

Stir,

California, then

human potential movement (Anderson, 2004; McLendon & of the movement came through Esalen at that time, including

one of the

hotbeds of the

Davis, 2002).

Many

Fritz Peris.

leaders

became more experiential and humanistic than those of the other famtherapy schools and Incorporated attention to emotional and physical experience into

a result, Satir ily

As

s

ideas

FAMILY SYSTEMS THEORY

409

her work. Satir emphasized the uniqueness of people and that “contact with the self and the other was a sacred, spiritual event” (Haber, 2002, p. 23).

From

1970s, and she eventually

Schwartz, 2001).

moved away from

A pivotal public debate in

stream family therapy. During

Minuchin argued

warmth and

that

1974

truly

faith,

According to

to alienate Satir

that the

it

this

Gurman and

&

from main-

way:

main job was

to fix

broken

humankind through

for the salvation of

Fraenkel (2002), Satir

field, (pp.

174-175)

“unappreciated and marginalized

felt

by the newer waves of (male) family systems engineers”

rather than just

skills

families. Satir stuck to her be-

turned out that Minuchin was speaking for the

It

the

Salvador Minuchin criticized her humanistic

this debate,

power of love, and spoke out

the healing

family therapy.

and

seemed

(family therapy) was a science that required

it

less influential in

the family therapy profession (Nichols

and Schwartz (2001) summarized

stance. Nichols

lief in

became

a professional/theoretical standpoint, Satir’s ideas

215).

(p.

moving large groups while demonstrating her work. Her 1972 book Peoplemaking, according to McLendon and Davis (2002) “became Satir

a

was renowned

household guide

as a therapist

adept

at

to healthy family living” (p. 177). Satir

Minuchin, and that

really saying

is

was

something.

In 1977, Satir created Avanta, an educational organization,

and

still

functioning.

can be found

It

Institute of the Pacific

(

as naturally charismatic as

at

satirpacific.org )

now

international in scope

http://www.avanta.net/

.

In 2006,

launched a new journal.

The

Satir

The Satir Journal:

Transformational Systemic Therapy.

CENTRAL CONSTRUCTS Self-Esteem The

cornerstone of

Satir’s

Satir’s

approach

is

self-esteem or self-worth. In

manifesto about self-esteem. Self-esteem

is

Box

13.1

you can read

defined as the degree to which the indi-

vidual values himself regardless of the opinions of others (Satir

& Baldwin,

1983). Loving

the self is a precondition for loving others (Satir, 1988). People with low self-worth are anxious

and uncertain about themselves and overly concerned with

Low

self-esteem

is

thought to be catching.

Satir

others’ evaluations of them.

and Baldwin (1983)

asserted that “of-

ten a person with low self-esteem selects to marry another person with low self-esteem.

Their relationship their feelings

based on a disregard of inner feelings, and any

of low self-esteem. Children growing up

low self-worth” Parents

is

who

1988). Parents

(p.

Satir,

individual.

environment usually have

have good self-esteem are able to teach what they already

who

know

(Satir,

have shaky senses of self-worth cannot teach what they don’t have.

self-esteem resides in the

She wrote, “You

are a

as

an adult,

if

one

member of the human (Satir,

race,

1978,

willing.

and

as such,

p. 9; italics

Alice considers herself to be a proponent of Satir’s approach.

and Jean,

is

acknowledgment of the uniqueness and worth of each

Furthermore, you are a “one of a kind” miracle”

with Derril

tends to augment

195).

However, one can learn self-esteem even For

in that

stress

As she

you are a

and quotes

miracle.

in original).

begins her relationship

she assumes that they are unique individuals with great potential.

FAMILY SYSTEMS THEORY

410

Box

My I

am

all

the world, there

is

no one

else exactly like

me, but no one adds up exactly

parts like

me is authentically mine because own everything about me my

I

I

cluding feelings,

ment;

like

me. There are persons

who

have some

me. Therefore, everything that comes out

alone choose

it.

my mind, — body, including everything they behold; my images of including my thoughts and disappointment, whatever they may be — it

the

eyes,

ideas;

all its

does;

in-

all

excite-

anger, joy, frustration, love,

my

mouth, and

or incorrect; to

Declaration of Self-Esteem

me.

In

of

13.1

my

the words that

all

voice, loud or soft;

come out of it,

and

my

all

polite, sweet, or

actions,

rough, correct

whether they be

to others or

myself

own my fantasies, my dreams, my hopes, my fears. own all my triumphs and successes, all my failures and mistakes. Because own all of me, can become intimately acquainted with me. By so doing can love me and be friendly with me in all my parts. I can then make it possible for all of me to work in my best interests. know there are aspects about myself that puzzle me, and other aspects I do not know. But as long as am friendly and loving to myself, I can courageously and hopeI

I

I

I

1

I

I

more about me. Elowever I look and sound, whatever I say and do, and whatever I think and feel at a given moment in time is me. This is authentic and represents where I am at that moment in time. fully

look for the solutions to the puzzles and for ways to find out

When I

review later

how

I

some

parts

may

thought and

unfitting, I

I

felt,

looked and sounded, what turn out to be unfitting.

and keep that which proved

fitting,

I

I

said

and

did,

and how

can discard that which

and invent something new

for that

is

which

discarded. 1

can

ers, to

see, hear, feel, think, say,

be productive, and to

make

and do.

I

have the tools to survive, to be close to oth-

sense and order out of the world of people

and things

outside of me. I

1

own me, and therefore am me and am okay.

can engineer me.

I

Reprinted with permission from C.elestial Arts, Berkeley,

CA.

Making Contact by

Virginia

Satir.

Copyright

Available from your local bookseller, by calling

2665, or by visiting us online

at

©

1

976 by Virginia

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Satir,

800-841-

www.tenspeed.com.

Because they are experiencing esteem. Likely Jean

I

life dijficulties,

and Al have

she suspects that both

dificulty talking about their

those of otheis. It appears to Alice that Derril has learned his parents.

of them have low

own feelings and

self-

respecting

some of this orientation fom

FAMILY SYSTEMS THEORY

Mandala

Self

maintained that

Satir

411

human

essence has eight aspects: the body, thoughts, feelings, senses,

relationships, context, nutrition,

and soul

None

1988).

(Satir,

independently. Attention to each of these spheres

of these parts functions

both

critical for individuals’ health,

is

psychological and physiological.

Alice sees her clients as multifaceted, hi this case, she notes that Derril

preoccupied with thoughts areas text,

and feelings and seem

of the self She thinks that nutrition,

it

and Jean

to neglect attention to

might help Derril and Jean

to focus

are very

other important

on body,

con-

senses,

and soul.

Communication For

the process

Satir,

and outcome of communication

is

critical to

family

1967).

life (Satir,

We must be able to communicate with others to survive. Functional communication

is

clear,

complete, and assertive. Congruent communication refers to communication in which verbal

and nonverbal messages match;

2000). Metacommunication

(i.e.,

in

incongruent communications, they don’t (Brothers,

communication about communication) can affirm or dis-

and often conveys something about the

qualify a message,

At the most basic

level, a

communication between two individuals

idation of one by the other. If Tammy’s supervisor

me, her

friend, to validate her experience

When

(Satir,

nerability. All

placator

ingratiates

Satir

ion,

by saying, “That

woman

is

Tammy wants

impossible!”

is

and apologizes.

stretch

you

who

is

usually have a pre-

always trying to get others to approve of him.

He communicates

get

we

1983).

the “yes person,”

that

whiny tones. To experience this stance, down on one knee, stretch one hand out in begging fashin

your neck and head upward.

The blamerh

the bossy dictator. She has a loud, shrill voice

stance of the blamer

Is

one hand on

hip,

and

is

tense

and

with the other forming the pointing

Computers analyze everything and show very

little

feeling

but distant and cool to others. Physically, the computer

is

tight.

The

finger.

about anything. Sometimes

referred to as the “superreasonable” (Brothers, 2000), these folks are sensible

a

59). In

product of low self-esteem and are attempts to cover up vul-

& Baldwin,

recommended and

acting unpredictably,

is

of us usually can communicate in these modes, but

ferred stance (Satir

He

a request for val-

1972): placating, blaming, computing, and distracting

cases, these stances are the

The

is

individuals are stressed, they usually resort to one of four problematic patterns

of communication all

relationship between interactants.

stiff

and

still,

as

and

rational,

though she has

long metal rod running from the base of the spine to the nape of the neck.

The

distractor

is

the buzzbrain.

He makes no

sense, has a singsong voice,

and never

addresses a point directly. Satir provided the image of a lopsided spinning top, with arms,

body, and

mouth moving almost randomly, going

Healthy

folks,

contended

Satir,

in

many

directions at once.

operate from the stance of leveling. This person

municates coherently, and body, words, and vocal tone healthy communication that Satir used

is

congruent.

all fit

One who

together. is

high selTesteem and thus has no need to hide; communication

Another term

congruent and is

free

comfor

levels has

and honest.

Of all

FAMILY SYSTEMS THEORY

412

or only the leveling one has any chance to heal ruptures, break impasses,

of the stances,

build bridges between people” (Satir, 1972, p. 73).

Alice watches Jean

and Derril interact

in the counseling session. It seems clear to Alice that

jean and Derril are taking a blaming stance in relation to each other a lot of the time. In relation to talking with Jean, Alice decides that Jean and Al probably take this stance in each other as well. However, every

changes between Jean

and Derril,

many

messages in

Alice senses Derril.

ful

to

this

Jean

tells

him. Derril says he wants is

then, Alice observes authentic, caring inter-

ofthe very real connection that sustains both ofthem. the communication that she observes between Jean and

signs

with a very bossy tone of voice that is not respectact like a grown man, but something in the way he says

to respect others

Derril

conveys that he

now and

to

not really convinced that he can.

Primary Triad The concept of the

triangle

is

an important one in

all

family systems theories.

any grouping of three family members, or for that matter, any three people. mother-father-child triangle the primary triad, and this relationship influence

on an

individual’s

life

functioning

is

is

Satir labels the

the

most important

&

Gomori, 1991).

Banmen, Gerber,

(Satir,

A triangle

how to cope with the world, the nature of relationand how to understand communication.

Ghildren learn from the primary triad ships (whether

one can

Inconsistencies in

trust others),

communication

(i.e.,

channels) are inevitable in the family, and

form of

early learning. For example, if

discrepancies between verbal

how

Mom

children interpret these

and nonverbal is

an important

comes home from work mad, she may say

nothing’s wrong. Little Kevin, however, picks

up on the nonverbal message of anger.

confused kid mistakenly thinks Mom’s anger

is

dermined. According to

day

a rotten It is

at

work and

it

would be

that the boss

the nature of triangles that

the other two. critical. If

The (Satir

Satir,

How the child

Mary

&

better for

Mom

likely to

be un-

had

a jerk.

one person often

is

is

to simply explain that she

feels

excluded from the relationship of

interprets the occasional exclusion

believes that she

child’s ideas

is

his fault, his self-worth

If the

being rejected, she

is

from the parental dyad

likely to

is

develop low self-worth.

about personal power are also formed in relation to the primary triad

Baldwin, 1983). Parental interactions demonstrate power operations. Also, kids

often learn that they can persuade one parent to take their side against the other parent.

This pattern

is

often seen

when one

parent disciplines the child and the other breaks in to

rescue him. Satir

emphasized that although

tive aspects

of the triangle,

be positive, too (Satir

person configuration.

&

many

theories of family

life

seem

to

promote the nega-

important to remember that the power of the triangle can Baldwin, 1983). Much support can be gained from the threeit is

If the three parties in

the triad have

good

self-esteem, they can

work

together to use the resources in the relationships.

Alice concludes that the

primary triad is critical in understanding Jean, Derril, and Al. Deiul learned much about relationships fom watching Jean and Al mostly that blaming

—

FAMILY SYSTEMS THEORY

413

and arguing are what relationships are made tion, and occasionally physical force is used.

Power

of.

is

ofien expressed in verbal interac-

Alice wonders ifDerril felt very excluded by his parents. It

two people who are alternating between fighting and the

some

signs that Derril

Derril

is

caught between his mother

hard to be

is

in contact with

silent treatment.

and father

There are also

want

in that Jean seems to

with her against Al. Derril admits that his parents physical confrontations

to side

frightened him very much.

He would try

to yell

vened and prevented his father from hitting

at them

to stop, until the

one day he inter-

his mother.

Alice guesses that DerriPs response to the years ofexposure to this triangle has ajfected his relationship with both parents

and his

self-esteem.

He

has learned that the most powerful

communications are ones that are shouted and angry, and that physical force bal anger. Derril has also learned that

have influence with others (and

to

bolsters ver-

worth-

thus, be

while) one presents a noisy, blaming front, rather than communicating in an authentic leveling way.

Family Rules The

rules

by which

Debbie’s bedtime

whining

a lot.

when

there

as

a family operates can be overt or covert. For example, the rule for

8:00.

is

More is

The

covert rule might be that she could stretch

serious examples of covert rules are

to 8:30

in troubled families,

by

such

a rule not to speak of Auntie Marne’s drinking.

Rules should be doable, or as Satir put p.

found

it

it,

“humanly

& Baldwin,

possible” (Satir

1983,

members must always be happy. Abiding by members to conceal their feelings, resulting in iso-

202). She gave the example of a rule that

this rule

is

clearly impossible

and emotional

lation

ent; this assessment

leads

distance. In addition, if

must adjust the

for a 6-year-old, but

rules to

would be

are also

also

not happy, one

important to family

silly for a

bad and disobedi-

is

rules.

As children grow, P.M.

might be

OK

12-year-old.

among members’ ways of operating

should allow for members to share information

in the Satir

freely.

in the world,

Family secrets are a no-no

approach. Feelings and opinions should also be accepted, including the expres-

sion of intimacy

The

is

match. For instance, a bedtime of 7:00

Rules should also allow for diversity

and

one

can lead to low self-worth.

and age appropriateness

Flexibility

families

and

and anger

(Satir

& Baldwin,

rules in DerriPs family are not

but dangerous. Jean struggles

1983).

immediately evident to Alice, except that anger

to teach

Derril not

to express anger,

is power,

yet she often does so her-

and clearly did so with Al. When Jean or Derril expresses anger, than leveling manner, and it gets them into trouble.

selfin relationship to Derril,

in a volatile rather

it is

The

He

is

rules

asked

around DerriPs

to

comment on

On him

seem unclear, or at the

least, inconsistent.

home and is assigned many household tasks taking out the garbage, and mowing the lawn). He also feels free

take a lot of responsibility in the

(e.g, cleaning, laundry, to

role in the family

his mother's appearance, critiquing her clothing choices

on a daily

the other hand, Jean seems at times to treat Derril as younger than he

close to her,

than as a young

much

man

as one

is.

would an 8-year-old child. She addresses him more

entering adolescence.

basis.

She keeps as

a child

FAMILY SYSTEMS THEORY

414

THEORY OF THE PERSON AND DEVELOPMENT OE THE INDIVIDUAL proposed no formal theory of personality dr personality development. She did see

Sarir

as a journey,

to

describing Five basic

conception to birth, birth to puberty, puberty

stages:

life

life

adulthood, adulthood to senior status, and senior status to death (1988,

p.

306).

Families are the crucibles of individuals. According to Satir, adults are “people makers”

(1972,

p. 3),

and the parents

are “the architects

of the family” (1988,

sions of family are important: the individual self-esteem of the patterns, the rules of the family,

and

its

between

power (using personal power competence), and loving saying, “1 believe in love love,

is

the

(p.

—

and

self

to rely

on

own

self),

and

human

soul

in

and

any

relationship to society as

are both facing growth in the areas

tion

and love for

1

spirit curdle

human need

for love,

think that love, including sexual

being can experience. Without

and

and

die” (1988, p. l4l).

rules.

She would describe jean

guarded and protective. She thinks that Derril and Jean

ofdijferentiation and

and to find his personal power.

he autonomous

to

to con-

self-esteem (feeling worthwhile),

human

Alice has assessed this family’s selfesteem, communication,

and Derril’s

1988): dif-

behavior), productivity (demonstrating

being loved.

feeling

(Satir,

(knowing how

307). Satir particularly emphasized the

most rewarding and fulFlling

loving and being loved, the

human

others), relationships

to direct one’s

in loving

dimen-

relation to society (Satir, 1972).

autonomy (how

nect with self and others),

I4l). Four

members, communication

Seven dimensions or processes are essential to becoming fully ferentiation (distinguishing

p.

each other, but that sometimes

It

it is

is

relationships. Derril

clear that these

hard to

learning

is

how

two share a deep connec-

express.

HEALTH AND DYSFUNCTION Satir,

because she was a humanist, had something to say about healthy

view,

“all

human

Baldwin, 1983,

them

beings carry with

p.

208). Behavior

is

&

terly

exist,

“evil”

—

the destructiveness

—

lay,

In her

the resources they need to Fourish” (Satir

&

motivated by good intentions and represents the best Martin, 1984). Brothers (2000) wrote of Satir, “ut-

that the individual

knows (Woods convinced that no evil people

all

human beings.

she was passionately devoted to showing

instead, in the process

between people”

(p. 5;

how

the

quotes in

original).

Fhe healthy person

is

open and honest with

self and others, takes risks

and

is

creative,

can change and accommodate to the healthy person stands

described

earlier,

self-worth

new situations (Satir, 1972). Playful, loving, and on his own and can “love deeply and fight fairly” is

very prominent in Sadr’s view of people. Satir et

and

authentic, 3).

(p. al.

As

(1991)

point to congruence and high self-esteem as major indicators of psychological health. In the healthy, or nurturing, family, communication is open, individual self-worth is strong, and rules are flexible and humane and can change if appropriate. For the most part, communication is congitient, although Satir recognized that nobody, no family, was perfect (Satir, )75). 1 tirther, the healthy family s connection to society is open and hopeful 1

(Satir,

1972,

^

^

p. 4).

Just the opposite

and self-esteem

is

is

true in dysfunctional or troubled families.

Communication

low. Fhese Emilies are fearful in relationship to society

is

fuzzy,

and can be blaming

FAMILY SYSTEMS THEORY

415 members

or placating in response. Family rules tend to be set in stone and inhuman. Family are not friends.

symptoms

In Satir’s system, tional,

and these things

When

Baldwin, 1983).

are signs that

communication

one or more family members’ growth

are blocking

individuals are stressed

beyond

and develop primitive methods of survival that

ful

2002). That

is

why

(cited in Haber,

Satir said that the

2002,

adult.

doing

is

At the same

two are having great

time,

difficulty

rides

the problem

is

Jean

is

mother and be-

struggling to be the best parent that she can. These

communicating at times and talk communication seem

to

each other in blaming,

to replicate those

between Jean

of Derril, and

feeling as though she

is

losing control

and blaming as ways of trying to get him

to

behave. She also seems to alternate the

Derrids father. Jean

yelling

not the problem; coping

is

fear-

cope (Flaber,

are their best attempts to

his best to grow, to dijferentiate from his

disrespectful ways. These problems in

and

problem

become

their capacities, they

&

(Satir

p. 28).

Alice thinks that Derril

eome an

faulty or rules are dysfunc-

is

of their

is

sometimes treating Derril as a

relationship,

much younger

child

resorts to

and some-

times as her partner. Alice thinks that Derril’s angry behavior his family,

He

between his parents.

manage

conflict in

him almost

“hope. ” These

nizing

it,

very

and Al were

weak

senses

ways other than yelling,

Jean often has very criticizes

had

little to

continuously.

At

and

his

the

quick

so

whom

to

labeling,

same

and is

he loved attack each

take offense at each other’s

of self-worth. They

say about Derril that

communications are very

Derril

no real surprise given what he observed in

watched two individuals

other angrily. Alice thinks that Jean

behavior because they

is

also

did not know how

blaming.

positive. In counseling sessions, she

time, she calls

him her “baby” and her

inconsistent. Alice thinks that

without

mother are both suffering from the lack ofgenuine

because they have difficulty expressing

to

really recoglove,

mostly

it.

NATURE OF THERAPY Assessment A

counselor practicing the Satir approach

perform als to

critical

relies greatly

on her powers of observation

assessments of the family. She observes the relationships

among

individu-

gauge communication patterns. Self-presentations of members can give information

&

Baldwin, 1983), and interactions

about self-esteem

(Satir

yield information

about covert and overt family

among

family

members can

rules.

In Conjoint Family Therapy, Satir (1967) discussed the use of formal diagnosis,

about the tendency to

treat individuals solely in

terms of such

the client, “You are behaving

now with

But

this time, in this place,

this label

only applies at

behavior which

and contexts may show something quite different”

Alice carefully observes Jean rates

to

and

I,

and

(Satir,

labels.

The

warning

therapist can

tell

as a clinician, label schizophrenia.’

in this context. Future times, places,

1967,

p.

103; emphasis in original).

Derril as they interact in the counseling

session.

Jean be-

Derrilfor his lack of respect; Alice notes Derril’s sulky response. Sometimes Derril will

FAMILY SYSTEMS THEORY

416 Hoth

TcsoYt to bhiYtiiti^^ Jctifi j'OT his hchdvioT. iieviibility

thdt results Jyoui shuky senses

for her son

and her

oj^

scoyh to bo usiti^ these styles to covet

up vul-

selj~woTth A-t other times, Jeun expresses her love .

concern that he will get into big trouble.

Overview oe feie Therapeutic Atmosphere AND Ropes of Ceient and Counselor Satir believed that

anyone can change

look leads to a therapeutic approach that for Satir

was to create

a safe

any point

at

is

environment

in his life (Satir, 1988).

optimistic,

in

which

This positive out-

A primary concern

warm, and

positive.

clients feel

valued (Loeschen, 1998).

all

Elumanistic approaches typically emphasize the use of the therapist’s person in counseling,

and

Satir

was masterful

in this respect.

The

use of the self of the therapist

therefore considered critical to this approach (Satir, 2000).

implementation of the approach

difficult

is

What sometimes makes

that, like Ellis

Behavior Therapy, for example, the person of Satir

the

and Rational Emotive

practically

is

is

synonymous with her

therapeutic approach.

A

prime criterion

for the therapist following Satir

is

that she

must be

accepting of herself, which allows her to be authentic in the session.

non judgmental and genuine approach while responding

take a

communications of the family

(Satir

&

In Satir’s approach, the therapist p. 67).

Although

judge”

(p. 67).

A

The

communicate more elements 1

.

to

therapist

to the overt

is

must

and covert

characterized as a resource person (Satir, 1967,

of humility

is

an expert, she

is

required to be a

not “God, parent, or

good family

an experienced observer and a model for functional

is

teacher role

According

amount

certain

The

touch with and

Baldwin, 1983).

Satir recognized the therapist as

Elowever, the counselor cation.

is

in

therapist.

communi-

approach because families need to learn to

essential to Satir’s

effectively.

Woods and Martin

(1984),

Satir’s

approach can be summarized

in four

(p. 8):

Ehe warmth and acceptance of Carl Rogers

2.

I

3.

I

4.

I

he strong experiential here-and-now techniques reminiscent of Fritz Peris he “detective” genius of Satir he comfortable, humanistic presence of Satir

Alice tries to be authentic in her relationship with Jean

and Derril. She knows that she is an imperfect human being, but she has had good training and has devoted a lot of energy to self-exploration. Alice sees the strength in Jean and Derril and is optimistic about the outcome ofthe counseling. She is accepting and warm in her relationship with Jean and Derril.

CiOAES 1

heiapy

(Woods

is

essentially an

& Martin,

1

984,

experientially based educational p. 8).

There

are a

program

number of interlocking

for families in pain”

goals of this approach;

they center on leleasmg the blocked potential of families and engaging the healing powers of the client (Satir,

2()()()).

Gne

important goal of therapy

is

to

enhance the self-esteem of

FAMILY SYSTEMS THEORY

417

members (Woods & Martin, 1984). As members become more aware of themselves and others, they become more congruent and authentic. Communication becomes clearer and more functional (Satir, 1967). family

Alice intends to help Jean

and Derri I grow,

to

acknowledge their strengths, uniqueness, and

She hopes that they gain in self-worth. She expects that their ways of communicating with each other and those outside of their relationship will change and become

individuality.

more

congruent communication described by the

like the leveling or

theory.

PROCESS OF THERAPY Satir

tended to emphasize the process of therapy over

its

She believed that the major curative element in therapy

and giving them new experiences talking or arguing about

is

not

as

how they

is

& Martin,

1

984).

how the family relates What they are actually

changing

is

in the counseling relationship.

important

as

content (Woods

Sadrs approach generally involves three stages of counseling

are

doing

(Satir

it.

& Baldwin,

1

983,

p.

209).

many times before they leave counseling, although as 1 outbecome apparent that stage 1 is different after the first cycle. The follow-

Families can cycle through the stages line the stages,

ing

is

Stage

it

will

summary of the

a 1.

stages based

who come

Contact. Families

tempt

to create

edged

as

on

comfortable, she

is

and Baldwin, the

member of

The counselor’s first job is to atEvery family member is greeted and acknowlAs the therapist works to make the family

trust.

the group.

information by observing family patterns. According to Satir

also gathering

therapist’s

description.

to therapy are in pain.

an atmosphere of hope and

an important

and Baldwin’s (1983)

Satir

main goal

is

to

“make manifest

observed and to make explicit what family members often times, but not always, a specific therapy contract

is

for family

know

members what

implicitly” (p. 213).

she has

Some-

established.

The second stage of therapy appears when one family member ventures into risky territory. The therapist helps the individual to reveal hurt, pain, and/or anger that has previously remained hidden. The therapist also helps the client to stay in the present (rather than Stage 2. Chaos.

focusing on past fears or uncertainty about the future). Also, the therapist must support other

members of the family

if

necessary. Often, the family feels stuck

Stage 3. Integration.

When

The

family

stage 3 begins.

and hopeless.

move on the develops new ways of being, and some the family finds a

way

to

issue that created the chaos,

closure

is

gained on the piv-

otal issue.

Alice anticipates that she, Jean, Initially, they

get to

know

Jean and Derril relate

to

and Derril

will journey through the three stages

each other in the first stage,

and Alice may point out the ways

each other (blaming, disrespecful). After a

that either Derril or Jean will take the risk to reveal the hurt, pain,

ing behind the bossy

for both

clients.

exterior.

The one who

No

matter

risks

who

eventually this pair will find a

risks, this

ofthe

way out of the

ivhile,

Alice

and anger

unknown

territory,

risk taker, as vulnerable. Alice

chaos.

is

that

confident

they are hid-

sequence of events will be very scary

has taken a big leap into

will have to tolerate a dijferent experience

of therapy.

but the other is

certain that

FAMILY SYSTEMS THEORY

418

THERAPEUTIC TECHNIQUES Describing specific techniques in

Satir’s

approach

is

somewhat

difficult

because of her

emphasis on uniqueness and also the experiential bent characteristic of this theory. Satir was adept at devising experiences for the family that changed the way they experienced life. 1

attempt to describe experiences that Satir and others have most

will

their

work with

commonly

used in

clients.

Family Sculpting Satirs

emphasis on the integration of the physical,

intellectual,

and emotional

led to the

development of sculpting, which involves having family members physically take positions

Most commonly, family members would take the poses reflective of one or more of the four communication types (e.g., blaming, appeasing, computing, or distracting) and Satir would help them explore their thoughts, emotions, and physiological reactions (Haber, 2002). Placing members higher or lower than one that exemplify the family’s interactions.

another can denote power relation (Satir

et ah,

1991), such as

when

a superreasonable par-

Somewhat reminiscent of Gestalt Therapy, the therapist then directs questions to the various members, such as, “What are you feeling right now? What body feelings do you have? Can you exaggerate that movement?” However, sculpt-

ent

is

asked to stand on a chair.

ing

is

not restricted to posturing the communication stances.

Family members can be used ily,

a creative adolescent, say,

as sculptors (Satir et ah,

1991).

One member

can be asked to place family members in positions that

resemble his view of the family atmosphere. In this approach, the sculptor

commentary on what he

is

of the fam-

is

asked to give

doing.

and Derril to assume the pose of blamers, facing each other. She asks them to exaggerate their accusing vocal tones and to shake theirfingers really hard at each other. Then she asks them to change how they talk and try to relax their bodies. Afterwards, Alice, Jean, and Derril talk about how it felt to be in the various positions, and how it felt to change.

Alice asks Jean

Family S'lress Ballet In the family stress ballet,

an extension of sculpting, the family

that illustrate their experience.

what

fiimilies

choose to do

Alice asks Jean

and

Derril

The

(Satir

to

&

therapist can direct the

Is

asked to

movement

move

in

ways

or simply observe

Baldwin, 1983).

act out

what happens when Derril comes home

after getting

in trouble at school.

Jean immediately takes the blamer pose, and Derril alternates between blaming others and going silent. 1 hey move in a dance around each other with tense bod-

ies

and shrill

voices. Alice

then asks them to talk about

how

this ballet felt.

Ca)m mun ic:a'li()n Analysis Sati.

spent

of time

examining family communication and creating experiences that promoted healthy communication, including support and validation of each individual in a lot

FAMILY SYSTEMS THEORY (Woods

the family ings

& Martin,

419 members

1984). Family

are

encouraged

to express their feel-

and respect these communications.

Alice asks Jean

and Derril to

talk

about

respect.

Alice notes that Jean does not seem very val-

idating ofDerril during this discussion; she accuses him, spectfor his mother! Derril responds by getting

Jean

to describe

demanding that he always show

mad and then quiet. Alice intervenes and asks and to own

her experience during this conversation,

her frustrations rather

than accusing Derril. Once Jean communicates in a congruent way about her feelings

what shed like that

in her relationship with Derril, Derril

it

must be done through owning

it

and

asked to respond in a dijferent way

is

mother. In this interaction, Alice emphasizes that

to his

re-

it is essential to

rather than laying

it

express anger,

but

at the feet of the other person.

Therapist Communications Therapists in the Satir tradition are very deliberate in their use of language. Reframing can be

used to help families view things in a different

Metaphors

employed.

are often

discussing self-worth

(Satir,

light.

Humor can also be used to the same end.

One well-known metaphor

1988).

The pot can be

full

is

the notion of the “pot”

when

or close to empty, boiling or calm.

In talking about the recent incident in which one of his peers reportedly dissed DerriTs mother, Alice reframes Derril’s reaction as a

might be some

way of caring for

his mother.

active ways that he could have used to demonstrate his caring.

less

Another way Alice intervenes value in this family

is respect.

is

around the

Derril

is

of respect. She points out that a strong only trying to get respect in his own world by reactissue

ing when someone gets in his face. She uses a metaphor of the bull Derril’s behavior,

She asks if there

but then also applies

this

metaphor

to

and

red flag

to describe

Jeans interactions with Derril.

Touch One of Satir s trademarks was that she often physically connected with her clients (Nichols, 2002). Of course, care must be taken when using touch so that the client’s boundaries are not violated. Satir often began her work with families by taking every member’s hand, and in this

way

established her special contact with each of

Alice greets Jean

and

Derril with a firm handshake. She

Derril in her work with them, such as she

is

helping them

Family

them

make family

when she wishes

to

is

(Satir

&

Baldwin, 1983).

not afraid

to

touch Jean or

he particularly supportive or

when

sculptures.

Thermometer

In her revision of the classic Peoplemaking

Satir described the construction of the

family thermometer. Five themes are discussed by the family in this process: appreciation, negatives of life, puzzles, are

encouraged

them

new

information, and hopes and wishes (pp. 190—191). Families

to physically construct the

thermometer and hang

that they should periodically take readings

it

in the

on each of the themes.

home

to

remind

FAMILY SYSTEMS THEORY

420

and Jean, because it offers an opportunity to For discuss many things they have not ever touched on, and some areas that are tricky. instance, in the hopes and wishes zone, Derril admits that when his mother calls him her hope he feels very pressured and scared. Derril and Jean discuss this issue in a careful way rhe family thermometer

is

perfect for Derril

with Alice as their guide.

Parts Party Really a group technique, the parts party (Satir et ah, 1991) requires at least 10 people. client

is

identifies

between 6 and 10 people

him; these should be individuals

sive to (e.g.,

and

the host

who

who

are either attractive or repul-

interaction.

The

and

interact,

The

client/host perceives them.

how

asked to change

rest

of the group

is

asked

with the counselor (the guide) observing and directing the

must understand the

players

most people

are readily recognizable to

Martin Luther King, Hillary Clinton, John Travolta). The

to play these parts

The

meet and

parts

qualities

interact (and

of their respective

sometimes

they deal with each other. Finally, the host

is

roles as the

conflict),

and can be

asked to ceremoniously

accept each of the parts, while verbalizing his feelings.

A

parts party doesn’t seem to be efficient or particularly helpful with Derril

and Jean.

Al-

ice thus decides to bypass this intervention.

Structural Therapy

OVERVIEW The name most

associated with Structural Family

& Family

book Families

Fherapy (1974)

is

Therapy

is

Salvador Minuchin. His

considered a classic in the

field,

and Nichols

(2002) contended that Structural Family Therapy “owned” the profession of family ther-

apy

the 1970s.

in

uchin

is

a charismatic figure

with families. In

more

You can read some of the lact,

who

softer,

with families.

and more I

that the

Min-

working

power of Minuchin’s theory can be attributed

than to the system per se (Nichols, 2002). Minuchin freely ac-

knowledges the influence of

grown

chapter of this book in Box 13.2.

uses his personal qualities to boost his impact in

some argue

to his personality

first

his

person in his work; he says that over time

effective.

feel free to

I

my

have learned to use

life

use

“my style has my compassion and humor in joining

experiences and

my

fellow feeling for families

Having made my share of mistakes in my life, I don’t be perfect” (Minuchin & Fishman, 1981, p. 289). guy, Minuchin is the son of Russian Jewish immigrants who were

as part of the therapeutic processes.

expect

my

patients to

Quite the colorful

transplanted to Argentina.

He was

ambivalent about Argentina as his psychological

home

and aligned himself more with Zionism (Simon, 1992). In 1943 Minuchin was arrested in a student piotest of Argentinean dictator Juan Peron. Minuchin served in the Israeli army for two years during that country s struggles for independence. After he earned his medical degree,

Minuchin began work at the Wiltwyck Center, a school for troubled inner-city youths. Here Minuchin, in league with his able colleagues, began to think about Emily therapy in his work with poor African American families. He eventually wrote his influential book Families of the Slums (Minuchin, Montalvo, Gurney, Rosman, & Schumer, 1967).

FAMILY SYSTEMS THEORY

421

Box 13.2

An

Except from Minuchins Families and Family Fherapy

Robert Smith,

for their first consultation

He

and

his wife, his twelve-year-old son,

his father-in-law are sitting

with a family therapist. Mr. Smith

is

with

me

the identified patient.

has been hospitalized twice in the past seven years for agitated depression and has

recently requested rehospitalization.

Minuchin: What

the problem^ ... So

is

Mr. Smith: / think

its

Minuchin: Don’t be so Mr. Smith: Well

Minuchin:

.

.

.

my problem. Fm sure.

Fm

Never be

the one that

Yeah, that doesn’t,

still,

who wants

to start?

the one that has the problem

.

.

.

so sure.

was

tell

in the hospital

me

and everything.

your problem. Okay, go ahead. What

it is

is

your problem?

Mr. Smith: Just

nervous, upset all the time

.

.

seem

.

to

and I asked them to put me in the hospital Minuchin: Do you think that you are the problem? Mr. Smith: Oh, I kind of think so. I don’t know if it .

.

be never relaxed

.

.

.

I get uptight,

.

is

caused by anybody, but

Fm

the

one that has the problem.

Minuchin:

.

.

Let’s follow

.

your

something outside ofyourself,

Mr. Smith: You know.

Minuchin:

Let’s

of thinking. If it would be caused by somebody or what would you say your problem is? line

I’d be very surprised.

think in the family.

Who makes you

Mr. Smith: I don’t think anybody

in the family

Minuchin: Let me ask your

Okay?

The to the

wife.

upset?

makes me

upset.

consultation that began with this exchange was the beginning of a

new approach

problem of Mr. Smith. Instead of focusing on the individual, the therapist focused

on the person within

his family.

The

therapist’s statement,

“Don’t be so sure,” challenged

the certainty that Mr. Smith alone was the problem or had the problem

which had been shared by Mr. Smith, sionals he

The

his family,

—

-a

certainty

and the many mental health profes-

had encountered.

therapist’s

framework was

structural family therapy, a

body of theory and

tech-

niques that approaches the individual in his social context. Therapy based on this frame-

work

directed toward changing the organization of the family.

is

the family group accordingly.

The is

As

is

transformed, the positions of

the structure of

in that

group

are altered

man

not an

isolate.

a result, each individual’s experiences change.

theory of family therapy

an acting and reacting

on both

members

When

internal

is

predicated on the fact that

member of social

groups.

What

is

he experiences

as real

He

depends

and external components. The paradoxical duality of the human per-

explained by Ortega y Gasset in a parable: “Peary relates that on his polar trip he traveled one whole day toward the north, making his sleigh dogs run

ception of reality

briskly.

is

At night he checked

his bearings to

determine

his latitude

and noticed with great

FAMILY SYSTEMS THEORY

422

surprise that he

was

much

Further south than in the morning.

He had

been toiling

day

all

toward the north on an immense iceberg drawn southwards by an ocean current. Human beings are in the same situation as Commander Peary on the iceberg. Man’s experience

do

determined by

is

man

say that

his interaction

not new;

is

mental health techniques on

to base

dynamics. This preoccupation dominated the exploring the intrapsychic.

Of necessity,

on the individual, apart from

drawn between the individual and ognized

as artificial,

but in practice

was familiar

it

Homer. But

to

it is

concept.

this

Idle traditional techniques of mental health

clusively

may a new

influenced by his social context, which he also influences,

is

seem obvious. Certainly the concept approach

with his environment.

grew out of a fascination with individual

and

Field

on

led therapists to concentrate

the resulting treatment techniques focused ex-

An

his surroundings.

artificial

his social context. In theory, this

“boundary” was

boundary was

rec-

was maintained by the process of therapy. As the

it

patient was treated in isolation, the data encountered were inevitably restricted to the

way he alone

felt

and thought about what was happening to him; such individualized

from

material in turn reinforced the approach to the individual apart

provided

little

The

possibility for corrective feedback.

discouraged other approaches. As a

result,

his context

and

very richness of the data available

the individual

came

to be

viewed

as the site

of

pathology.

A

therapist oriented to individual therapy

still

tends to see the individual as the

site

of

pathology and to gather only the data that can be obtained from or about the individual. For instance, an adolescent boy might be referred to therapy because he in class.

He

is

a loner, with difficulty relating to his peers.

vidual sessions

people in

would explore the

and

about

feelings

establish contact

boys relationship with

on

nication and

this conflict into extrafamilial,

shy and daydreams

A therapist who operates

in indi-

and the

his present life

the historical development of his conflict with parents

it,

compulsive intrusion of

would

boy’s thoughts

is

and

and the

siblings,

seemingly unrelated situations.

He

with the family and the school, but to understand the boy and the

his family,

transferential

he would

phenomena.

rely

An

mainly on the content of the boy’s

commu-

internal cognitive-affective rearrangement

is

regarded as the necessary step to facilitate improvement of the presenting problem.

A

therapist

worKing within

this

framework can be compared

to a technician using a

magnifying

glass.

A

working within the framework of structural family therapy, however, can be

therapist

compared

The

details

to a technician

of the

with a

wishes to study the mtrapsychic If

the

same boy were

field are clear,

zoom field,

lens.

He

but the

can

zoom

who

in for a closeup

life

whenever he

would explore

contexts. In family interviews, the therapist

his

would

mingled closeness and hos-

its

when the boy talks in the presence of his parents, he rarely that when he does talk to his father, he tends to do so through his

see that

addresses his fuher, or

mother,

severely circumscribed.

but he can also observe with a broader focus.

observe the relationship of the boy and his mother, with

He might

is

referred to a family therapist, the therapist

interactions within significant

tility.

field

translates

and explains her son

He might notice that other seem more spontaneous, interrupt the parents, and talk to the father and mother alike. hus, the therapist does not have to depend on the boy’s descriptions of his father, mother, and siblings to postulate the introjection of the to her

husband.

siblings 1

familial figures.

The

family

FAMILY SYSTEMS THEORY

members

demonstrating behavior

are present,

The broader

tionally described.

enhance the

423

in relation to the

boy

that can be opera-

focus and the greater flexibility opened to the therapist

possibilities for therapeutic intervention.

The

therapist

not restricted to

is

the family interaction as internalized by the boy, but can himself experience the

which the family members support and qualify each tional theory to explain the

phenomena he

boys school, since the presenting problem

and techniques

ories

He

other.

way

in

then develops a transac-

He can

also be in

touch with the

is

observing.

is

related to school performance,

of family therapy lend themselves readily to

and the

work with

the-

the individ-

ual in contexts other than the family.

Thus, the family therapist does not conceive of an

unchanged throughout the the

boy as

a

cept of the

and circumstances. He

vicissitudes of different contexts

S.

Minuchin, 1974. Cambridge,

MA; Harvard

University

Reprinted with permission.

Press.

Leaving Wiltwyck, Minuchin assumed the position of director

Guidance

Clinic.

He

greatest claim to

fame

is

his

the families of anorexic

now known

is

work with very

girls.

difficult clients,

&

conducts training, but functions more

theorist or practitioner (Simon, 1992)

From Symptom

to

and

and

work with

in particular, his

Minuchin

Minuchin

refine his

two recent books

a writer:

He

retired in 1986.

commentator on the profession than

as a

are Assessing Families

& Lee, 2007) and a second ediColapinto, & Minuchin, 2007),

System (Minuchin, Nichols,

1998 with wife

Minuchin,

Patricia as

one of the authors. The Minuchin

Center for the Family ( http://www.minuchincenter.org/index.php ) training professionals

Child

approach. Probably his

families” helped

Baker, 1978).

as a

tion of Working with Families of the Poor (P originally published in

as the structural

These “psychosomatic

theory considerably (Minuchin, Rosman,

Couples:

at the Philadelphia

hired Jay Haley as director of research, and along with Haley and

Btaulio Montalvo, developed what

and

sees

member of different social contexts, acting and reacting within them. His consite of pathology is much broader, and so are the possibilities for intervention.

Excerpted from Families and Family Therapyhy

still

remaining

“essential” personality,

and consulting with

families

is

in

New

York

City,

and organizations.^

CENTRAL CONSTRUCTS Family

S

lructure

“Family structure

is

the invisible set of functional

which the family members is

a set

of rules that

and so

become

forth.

tells

talks to

close buddies, so to speak).

tionalized,

'

become

everyone

whom, who

Family members can join together

important. Interaction patterns are

how

(Minuchin, 1974,

interact”

who

is

Who

critical

part of the family’s

to behave.

demands

sides

that organizes the

p. 51). In essence,

plays with

whom

in coalitions

with

whom

in

ways

in

family structure

(and

in

what ways),

(two or more members

arguments

is

particularly

because they tend to be repeated and institu-

and individual members’

Patterns of interaction also

tell

identities,

and determine

you about hierarchy, or

For ease of reading, references to Salvadore Minuchin's work are cited without an

initial.

FAMILY SYSTEMS THEORY

424 power, in families

Minuchin

(P.

2007). In essence, these repeated patterns of

et al.,

interaction are the family structure. Certain forms of family structure are conducive to

on health and

individual and family dysfunction, as will be described in the section

dvsfunction.

and Derril, first notes that there are sevMother and son clearly have formed a coali-

Jo/m, the structural therapist working with Jean

immediate household.

eral structures in their tion.

Father

is

distant from the family.

He decides

to look

at these in terms

ofisubsystems.

Subsystems Families naturally differentiate into subsystems, or smaller groupings within the family

(Minuchin, 1974). Subsystems help to get the work of the family done, such

An

adult partners form a parental subsystem to raise children.

as

when

the

individual can even be a sub-

system, and larger subsystems can be formed according to sex, generation, interest, or function

(Minuchin, 1974,

p.

subsystem, and further, a

woman

can be

a

An individual can member of subsystems in 52).

be a

member of more

than one

multiple families. For example, a

youngest daughter, a spouse, a mother, an aunt, and so forth. If she and

her brother-in-law like to ride horses, they can form a subsystem around this interest.

John

sees the

subsystems of kid (Derril),

woman

(Jean),

and parental

and

(Jean

in

some

and Al). Jeans daughter is yet another relevant subsystem, and her family has spousal, parental, and kid mbsystems, too. John thinks that Derril and Jean also are a subsystem ofi sorts. Although the interaction seems limited, Jean is a member ofi subsystems ofi ways, Jean

her family

ofi origin

—

the sibling subsystem.

Boundaries Critical to structural therapy

is

the idea of boundaries, or the rules that specify

who

par-

subsystem (Minuchin, 1974). Boundaries protect the integrity of a subsystem and should be flexible but clear. A too-rigid boundary around a subsystem creates ticipates in a

of those individuals, depriving them of the protection of the family and opportunities to learn about life from other members. Very blurred boundaries between subsysisolation

tems create a situation

in

which everyone s business

become overwhelmed and the system

is

beyond

stressed

said to be disengaged,

of

a

capacities.

a teenage girl

is

else’s.

Such a system can

W^hen boundaries are very unclear,

acting out, yet

are too rigid,

it is

when

said to be

her mother

correct her, her father interferes.

weak boundary between the

Minuchin would say that this pattern is indicative parental subsystem and the daughter the father and

—

daughter are in coalition or enmeshed. Boundaries in a system can be observed 1981).

everyone

and when boundaries

enmeshed (Minuchin, 1974). For example, tries to

its

is

Where

family

members

subsystem functioning. parents.

Do

whom, and who

number of ways (Minuchin

&

Fishman,

counseling session can provide hypotheses about the children sit next to each other, or does one sit between the

How the family talks

interrupts

in a

is

is

sit

in a

also indicative

tjuiet.

of boundaries

—who speaks

for

whom, who

FAMILY SYSTEMS THEORY

425

John sees that there are boundary issues in Jean and Derril’s situation. The boundaries are weak between the parental and child subsystems (i.e., Jean and Derril have more of a sibling relationship than a parent— child one). This family seems to be enmeshed. Also,

pears that this

seems

new

subsystem has rigid boundaries around

it:

Dad does

not join

it,

it

ap-

and it

be impervious to any input from the surrounding environment.

to

Earlier in thefamily s history, the parental subsystem seems to have involved Derril at times,

when Al and Jean were fighting. Now the spousal subsystem is nonexistent, and the parental subsystem is disengaged in that Al is not taking a parental role with Derril.

particularly

THEORY OF THE PERSON AND DEVEEOPMENT OF THE INDIVIDUAE more interested in the development of the family than that of the individual. Minuchin and Fishman (1981) proposed four main stages of family development: couple formation, families with young children, families with school-age or adolescent children, and families with grown children (p. 23). Each of these transition Structural family theorists are

points involves either the addition of a subsystem or a challenge to already established ones.

When becoming the

new

ment

is

a couple, partners

some

shift loyalties

(Minuchin, 1974).

entity, the partnership

that at

must

A

from

their families

natural feature of

of origin to

human

develop-

more from the family college or moving out of the

point, an adolescent will begin to differentiate

of origin. Ultimately, he will separate from them by going to

home for other reasons. This change will seriously affect the family subsystems. If was a member of the kid subsystem, his role and function will be missing. If he was a

family

he

caretaker for younger children, his parents will need to adjust to his absence. If he was in coalition with either parent, his loss will be traumatic.

brought on by these

stresses

These

are just a

few examples of the

transitions.

Minuchin (1974) maintained that the individual’s personal identity is composed of a balance between individuality and belonging. Families are a critical source of the individual’s sense of separateness and togetherness, primarily through subsystem membership (remember, an individual can be considered a subsystem, too).

One

thing that structural theorists are sure about

families, social service agencies, hospitals, or

periods of (P.

stability,

Minuchin,

Derril Derril.

is

et

al.,

but because

human

is

that systems change. If you

any other kind of system, you

watch

will observe

systems are open-ended, times of transition

2007).

entering adolescence. John notes that this transition seems difficult for Jean

They are both struggling with the change from small child who

is

and

always near

mother (belonging) and an adolescent developing his own personhood (individuality). Part

of this process

is

DerriPs struggle

to strengthen his

subsystem boundaries.

HEALTH AND DYSFUNCTION At the most general

level, structural

family therapists discuss dysfunction in terms of

the ways in which the family relates (Aponte

Families tend to experience difficulties

namics are particularly evident

when

in times

&

Dicesare, 2002;

Minuchin

et al.,

2007).

old patterns of relating don’t work. These dy-

of transition whether the transitions are “normal”

FAMILY SYSTEMS THEORY

426 parts of the cycle of P.

Minuchin

More

life (e.g.,

child) or not (such as natural disaster;

2007).

et ah,

among

(Minuchin, 1974).

to speak in terms of too-rigid or too-blurred

Minuchin tended

specifically,

boundaries

new

the birth of a

enmeshment Aponte and VanDeusen (1981) provided a more subsystems, or in other words,

or disengagement elegant defnition:

“Functional and dysfunctional levels are determined by the adequacy of the

313). Something about the structure

enmeshment

or disengagement

not adaptive to the events of

is

sys-

m a set of circumstances

tem’s structural organization to the requirements of an operation (p.

of a

fit

life,

and

often,

not helping the family (although sometimes these pat-

is

terns are fine).

When

the disengaged family

is

stressed

and needs

the rigid boundaries in the system keep the stress

to adapt,

it

does not respond because

from being transmitted

to

all

members

of the system. In enmeshed families, the blurred boundaries between subsystems enable the immediate

and intense transmission of

stress

and potentially

excessive reactions

(Minuchin, 1974). In essence, the enmeshed family responds instantly to threat by freaking out. In contrast, the disengaged family seems not to care about families tend to allow a lot of individuality,

and

loyalty

members. Disengaged

whereas enmeshed families expect conformity

(Minuchin, 1974).

Minuchin and tion

its

his colleagues learned valuable things

from observing psychosomatic

children present with

symptoms

families.

that are

more

about family structure and func-

Psychosomatic families are those in which severe than

would be expected based on the

asthma or anorexia nervosa. These observations

biological aspects of the disorder, such as

Minuchin, Rosman, and Baker (1978) to theorize that these families had five important similarities. Although originally intended to describe the psychosomatic families,

led

these qualities have acquired a

more

general usage in describing family structure.

Minuchin and colleagues maintained that psychosomatic families are enmeshed, overprotective of members, rigid in the face of change, and have difficulties resolving conflict. However, the key characteristic

in these families

relationship. In essence, the child’s in the

terize

symptom

is

the child’s involvement in the parental

serves as the regulator in the system, assisting

avoidance of conflict between the parents. Three such situations generally characthe types of alignments found in families (Aponte VanDeusen, 1981). Although

&

these alignments

may temporarily relieve

stress,

they have long-term consequences because

they negatively affect the functioning of the children (Kerig, 1995). In

focus

one

common

on the

pattern, parents

who

are in conflict

afflicted child, a pattern called

and

can’t deal

with

it

bind together to

detouringox scapegoating

1974).

The

couple system looks calm and united, but they are channeling their stress to the child. 1 he child is defined as the family problems, becomes a victim, and develops symptoms. The s

process

is

Two coalition

perpetuated

when

the parents in

other patterns are evident

when

some way

reinforce the

the parental

dyad

and

is

symptom.

openly

split,

parent— child

m

triangulation. Parent— child coalition refers to the situation which the child is recruited into a stable partnership with one parent in opposition to the other. In triangulation, the child finds himself caught in the middle he can’t risk expressing his feelings or opinions because to do so would be to side with one parent over the other. Essentially, the parents are competing for the validation of the child, and a parent

—

may attack the

child

FAMILY SYSTEMS THEORY if

427

he or she perceives the child

as joining

with the other parent (Mintichin, 1974).

important to note that although these patterns are often described relations, triangulation

such

when two

as

sisters triangulate their little brother.

which

in

& VanDeusen,

when

a

new

spousal systems (Becvar

and belonging

Derril

woman

the system

In struc-

of this family

is

He

not adaptive.

is

is

to

also

has an idea that

a factor in the parental sub-

be done with Derril, a sign that

incorporated in that subsystem. The weak boundaries around the child and adult

subsystem are allowing is

stress to

mother and father.

Al,

to

who

be a facet of this struggle is

fected by the processes in the family; he

and

vice

identity.

His

be transmitted freely from Jean to Derril

stressed by Derriks attempts to establish

angry acting-out behavior appears his

& Becvar,

from the support of the parental and

involved in a coalition with his mother, but he

versa. Further, the system

from

are balanced (Becvar

can maintain a good balance between individuation

Jean and Al argue quite a bit about what is

appropriately bound-

is

to the family.

John knows that somehow system.

dyad

& Becvar, 2006). Children feel free to explore and grow.

tural theory, the healthy individual

is

imminent

spouses are supportive and accommodating of each other.

In a healthy family, the kid subsystem benefits

Derril

is

1981). Minimal levels of triangling, detouring, and parent— child

Within the spouse system, togetherness and distance

The

Thus,

flexible.

development

stage of

coalition are present in healthy families because the parental

2006).

and

structures are clearly defined

these systems can change as needed, such as

aried.

terms of parent-child

in

and detouring occur among other family member configurations,

Healthy families are those

(Aponte

It is

to

a clearer

become a person separate

disengaged from the family, seems relatively unafis

the outsider in the Derril-Jean-Al triangle.

NATURE OF THERAPY Assessment The

first

methods such

as:

thing the structural therapist does are used; the therapist

Who

son and why?

is

is

assess family structure.

simply asks himself a

the spokesperson of the family?

Who

is

series

No formal assessment

of questions (Minuchin,

1

974),

Who selected or designated the spokesper-

the true executive of the family?

What

are the other

members doing

while the spokesperson talks? Are they attentive or dismissive? Aponte and Dicesare (2002) note that contemporary structural therapists have been

what Minuchin section on

et

al.

(2007)

Bowen theory

call

for a

known

to use

genograms

to assess

the structurally oriented historical explanation (see the

more

detailed description of genograms).

John watches Jean and Derril interact and wishes that he hadAl in the room as well. However, Jean conteyids that she and Al would fight too much to make sessions productive. Jean and DerriJs interaction mostly

consists

ofJean

telling Derril hoiv disrespectful

understand why he does what

is.

She does most of the

talking, explaining that she doesn’t

he

does. Derril responds

minimally unless he gets angry. Then he

in hisjace.

he

tells

Jean and Derril report that they sometimes 'Jlay” with each

his

mother not

other,

to get

hut that when

FAMILY SYSTEMS THEORY

428

Jean gets angry. John also infers that Jean and Derrilare in an enmeshed system, based on the report that they spend most oftheirJree time together, Derril’s role in the home, and his freedom to comment on his mothers appearance.

Jean asks Derril

A

mother-child

to stop

and he

doesn’t,

generational coalition has been formed, probably having

cross

the conjlict between Jean

its

roots in

andAl.

Overview of the Therapeutic Atmosphere AND Roles of Client and Counselor Structural therapy

is

and present focused. Minuchin (1974) wrote, “The

active

tool of this

modify the present, not to explore and interpret the past” (p. 14). Although risk being obvious here, it is important to keep in mind that the target of the structural family therapist’s intervention is the family, not the individual member. therapy

is

to

1

The

role

of the counselor in structural family therapy

(more on joining

joins the family

ing process. apist

A

is

Minuchin

therapist

logistician,

ways

isn’t fair

not

all

or

knowing. The therapist

up

a family,

(p.

13; quotes in original)

and by the demands

personality of Minuchin

Minuchin

what

counsel-

a structural ther-

is

a practitioner of change.

But change

is al-

is

for

change that family members make on each other.

often confused with the qualities

a very charismatic

is

make

guy who

is

and

roles

of the struc-

not afraid to be pushy. Obvi-

not a requirement that one be pushy to be a structural family therapist, but one

must be willing

to be very active,

ing to violate social

their

easier to say

things are, by the competitive tension between the “selves in relation” that

tural therapist.

John

as a leader in the

by the familiarity of well-traveled pathways, by a family’s conviction about

resisted:

it is

therapist

or a politically correct practitioner; not an ethicist, not a

just,

way

ously,

it is

The

writing

is,

the

The

that of expert.

but maintains a stance

(2007) contend that

et al.

NOT than what he

later),

is

an

norms

and

(at least

as

you can

see

from the foregoing quote,

at

time will-

according to Minuchin).

Jean and Derril, asking questions and generally directing conversation. He joins with both of them in small ways, identifying with Jeans frustakes

tration

active role with

and with

Dernl’s attempts to be an individual.

Goals I

he structural therapist

is

on changing the structure of the family system, and members (Minuchin, 1974). The problem presented is to be

intent

thereby the experiences of its

solved, but structural therapists does so terns of thinking

and

relating

by joining the family in “ways that impede old patand build on their strengths to generate new patterns lead-

ing to immediate, palpable results” (Aponte

Johm

goal

mothei

is

&

Dicesare, 2002, p.

1).

Jean and Derril become individuals but still remain connected as In e^^ence, he wants to rearrange the boundaries in this system, tightening

to help

and son.

around the individual subsystems (Jeans and DerriTs personal spaces) and creating a stronger boundary between the parental and child subsystems. those

FAMILY SYSTEMS THEORY

429

PROCESS OF THERAPY The of

structural family therapist

it,

and Fishman put

helmsman”

the

Minuchin

a process that

29). Joining

(p.

&

called joining

the “therapist

it,

must become

the leader of the system but also

is

is

not a technique, but a mental

is

apist that conveys to the family that

he

is

on

their side

member

Fishman, 1981). As Minuchin

same boat with the family but he

in the

a

and

on the

set

[sic]

part of the ther-

work with and

will

must be

for

them.

Structural family therapists join the family by disclosing similarities with them, by sup-

porting family members, or by conveying understanding of their perspectives. However,

Minuchin

is

careful to point out that family therapists

family interaction

—sometimes

observer (Minuchin, Lee,

Minuchin step

1,

& Simon,

able to

pseudomember of the

move

Opening Up

reframe the problem

1996).

the Presenting Complaint, the therapist’s job

is

to help the family

Step 2, Highlighting Problem-Maintaining Interactions,

as systemic.

and emphasizing the thing that the family does

oriented historical exploration

The

and out of

family, other times as an

to maintain the prob-

A

lem, with particular attention to interactions that support the problem.

Past.

in

(2007) outline a four-step model of family assessment (pp. 9—12). In

et al.

involves clarifying

acting as a

must be

in order in step 3, Structurally

is

structurally-

Focused Exploration of the

how their experiences have shaped their and others. The structural counselor is most inter-

adults in the family are asked to look at

present (restricted) views of themselves

ested in keeping this conversation focused

problem.

Finally, in step 4,

An

on history that bears

Exploration of Alternative

directly

Ways of

on the presenting

Relating, clients

and

therapist the explore alternatives to the present problem-maintaining interactions. P.

Minuchin and

colleagues point out that

ally stressed families, to recognize

counselors realize that

tempted

(P.

ently

and

John

carefully joins

in

important, particularly working with

and acknowledge family

strengths.

It is

re-

also critical that

inevitable that the counselor, as he joins the system, will be

Minuchin

your job to keep

it is

view of the problem and their version of

et ak,

mind

how problems

2007). If you are working from a structural perspec-

that the task

is

to help the client(s) see the

world

differ-

act accordingly.

Derril’s future. ketball.

is

to also join the family’s

should be solved tive,

it

it is

Jean and Derril in their plight.

He talks

Because John

is

He

understands Jeans worries about

with Derril about their mutual interest in

sports, particularly bas-

African American, his personal qualities are a joining point with

this family.

THERAPEUTIC TECHNIQUES According to Minuchin and Fishman (1981), three general therapy: challenges are (c)

family reality

(p.

made

to the (a)

67). Because

strategies are used in structural

view of the symptom,

(b)

family structure, and

Minuchin and Fishman’s presentation

is

so clear

and organ-

summary in this section relies mainly on their comments, unless otherwise noted. A number of techniques can be used in the service of the three general strategies. used to influence how the symptom is viewed. Three techniques are identiReframing

ized, this

\s>

fied to

change the

family’s

view of the symptom: enactment, focusing, and achieving

FAMILY SYSTEMS THEORY

430

family structure, the therapist engages in boundary making,

intensity. 'lb challenge the

unbalancing, and teaching the family about the complementarity of roles and functions 69). '\\\t family reality

(p.

interventions,

is

challenged through paradoxical techniques, using cognitive

and emphasizing the strengths the family already

possesses.

Enactment Minuchin strategy

is

is

famous

for

having families perform interactions in the therapy session. This

based on the notion that families

wont

often

tell

the counselor about their prob-

lems in relating to one another, so watching their interaction in session

is

instructive.

The

therapist can simply observe or intervene in the sequences the family demonstrates

(Minuchin

Minuchin

&

Fishman, 1981). For example,

will ask the parents to solve the

if

the children in a session are acting out,

problem. Observing

with their children provides valuable information about operate. If one parent

is

how

the parents interact

how the parental and kid subsystems

abdicating her role, the counselor can step in and ask the parent to

engage, thereby encouraging the reestablishment of the two-person parental subsystem.

He accomplishes

this

by talking to each alone after sending the other out of the room. Sometimes he simply

tells

John thinks that mini-enactments are going the other that the topic

and everyday

eas

to Derril,

is

to help

not his or her business.

Jean and Derril.

He also

has them talk about problem ar-

things, directing the conversation so that Jean

is

parental in her approach

and making reasonable decisions and rules. Speaking calmly accusing sibling mode helps to establish the parent-child boundary.

keeping her cool

rather than in her

Focusing any counseling session, the therapist must choose a focus for his attention because the family presents a wide array of data about how they function. Basically, the therapist In

chooses the most important element in the family’s presentation, and that choice tated

vision

and

by structural theory.

(Minuchin

A

& Fishman,

sensitive to the effects

potential pitfall,

1981).

is

his focus.

dic-

theoretical tunnel

The counselor must be aware of his

of narrowing

light off the identified patient

warned Minuchin,

is

choice of focus

Focusing can be used to take the spot-

by examining other dynamics

in the family, such as the

relationship between the parents or the caretaking efforts of a sibling.

John Jocuses on parenting with Jean, asking her IS.

He

to discuss

what she thinks good parenting

asks ifshe can talk these things over with Al,

wondering ifshe wants to get Al more asks a lot about DerriSs social life, implying

involved with the parenting process. John also that he needs to develop a network ofsupports outside of the family.

Achieving Intensity Because families have a shared way of looking at the world, they often have difficulty hearing the therapists message. Hearing the message really means that the family experiences the therapist’s reality in a

way

that will help the family structure shift. Achieving

FAMILY SYSTEMS THEORY intensity

is

431

not a separate operation; several interventions can be used to achieve

and they vary depending on the

goal,

level

of involvement veith the family (Mimichin

may simply therapist may decide

Fishman, 1981). The counselor

repeat her message

sion. For example, the

that 6-year-old

statement

many

and

times,

many

James

is

will also ask

all

of the participants

how

&

times during a ses-

acting incompetent

about themselves. The counselor

to help others in the family feel better

this

make

will

this

they experience this

sequence. Intensity can also be at

which they tend

at

which things

to

“hang

enhanced when the counselor asks

to interrupt stressful interactions.

get too hot

and the interaction

in there” at that point will

is

families to go

Most dyads

beyond the point

or families have a point

discontinued. Asking the participants

continue the heat, and

this

new

journey into

terri-

new perceptions and patterns. Changing the distance and family members (e.g., getting down on one’s knees to talk to

tory has the potential to create

between the therapist

an adult) can also increase

a small child or getting very close to

intensity.

Although

marily used as a boundary-creating maneuver, changing the seating arrangements family

members can

pri-

among

(Minuchin

also be used to intensify the counseling process

&

Fishman, 1981).

John

repeats his contention that Derril

from

the world as he has protected her from his father at times.

is still

trying to take care

ofMom

—protecting her

He asks Derril to

talk

about

how he does this, and he asks Jean how that makes her feel. When Jean and Derril are talking about a recent fight he had at school, Derril becomes sulky and quiet. John jumps in and helps Derril continue the conversation with his mother, encouraging him

to talk

more

like

a grown-up.

Boundary Making Another well-known

structural technique involves tactics that create better boundaries

within a family system. Boundary interventions can be very simple, such selor insists that the person to

someone classic

a chair

else in the family).

example

is

when

whom who

when

the coun-

he asked a question answer the question (rather than

Members of the

a child

as

is

family can also be asked to change places.

psychologically between the parents

between them to one next to the

therapist,

who

sits

is

The

moved from

facing the couple.

Many ofijohns interventions could be described as boundary making. When John helps Jean and

Derril speak

to

each other

differently, it

is

a boundary intervention. John stops Jean

firom interrupting Derril and vice versa. This allows each to speak his or her

own piece arid

become more ofian individual. When John talks with Jean or Derril individually, this is a boundary intervention. He asks Jean or Derril to complete some task or attend a social event separately over the period between sessions. Ifijohn succeeds in bringing Al into therapy, he

will try to establish a

more

effective

Derril

to sit

boundary around the parental subsystem. This intervention might be

John sends Derril out

ifi

off to the side

and observe.

enting Derril would be helpful.

room for some period of time or if he asks Hoivever, just having Al and Jean talk about parofi the

FAMILY SYSTEMS THEORY

432

Unbai.ancing intended to change the hierarchy within the family. The structural famthe system, or with a subsystem, and ily counselor sides with a less powerful person in thereby steals the power of the more powerful. Alternately, a family member or system can rhis technique

is

be ignored. Needless to

about the potential

say,

effects

these are tricky interventions,

and they

raise ethical issues

on the family and individual members. Minuchin and Fishman

(1981) cautioned that the counselor must always be aware of the stress level of family members, particularly when siding with one member against more powerful others.

John considers siding with Derril in an attempt to gain him more autonomy. He could do this by telling Jean that he and Derril are going to have a heart-to-heart about what

grow up. John thinks that this intervention would be stressful for both Derril and Jean. Derril would feel not only the stress ofabandoning his mom, but also the pressure ofgrowing up. It is possible that Jean could become anxious and then angry in Derril should do

to

reaction to this intervention.

Teaching Complementarity Simply put, the structural family therapist wants to give family members a sense that they are part

of something bigger than themselves (Minuchin

intervenes to teach the

members how

their behaviors

fit

& Fishman,

many

problem

(that

it is

A

ways.

therapist

together to create the system and

define their collective worldview. Increasing members’ senses of belonging ing can be accomplished in

The

1981).

challenge to the family’s

and contribut-

way of viewing

the

inside the identified patient, or IP) can establish a new, but shared, ex-

perience for the family. For example, the IP can be described as the family healer (Min-

uchin

&

Fishman, 1981,

controlling them. instance, that

John

195).

The

family can rethink

The problem can be expanded

dad and daughter

helps Derril

and Jean

appropriate to DerriFs age.

than he

p.

and at others

are having

see that they

He observes

to include

its

conviction that the IP

more than one person

—

is

for

“problems in their relationship.”

must work as a mother—son team, but

that Jean sometimes treats Derril as

times, as her partner. Derril

sometimes

in

ways

much younger

mother as ifhe were addressing an age mate. John makes interventions that redefine “the problem” (i.e.y

is

Derril) as one that involves Jean,

John talks to Derril andJean about the kind reorient them into one that is more complementary.

too. Also,

oj relationship they have, intending to

Strategic

reacts to his

Therapy

OVERVIEW herapy evolved from the work of the early systems theorists, primarily the “Palo Alto group at the Mental Research Institute (MRI), a collection of researchers studying Strategic

I

communication

processes,

most notably

Chabot,1995; Watzlawick, Beavin, Ciregory Bateson, Jay Haley,

&

in

the families of schizophrenics (Guerin

&

The MRI

researchers included

Don Jackson, and John Weakland, and

they are perhaps most

Jackson, 1967).

FAMILY SYSTEMS THEORY famous

for their description

433

of double-bind communication. Observed to happen repeat-

edly in families of schizophrenics, double-bind

member gives a message

to another that

really

is

communication occurs when one family two contradictory messages, one conveyed

on the verbal channel, the other on the nonverbal channel of communication. The of

this

communication

unable to escape the situation, and

is

ops psychological symptoms

A

2006);

as a

over time devel-

way of dealing with an impossible predicament

way

she says

to do; as a matter

“Of course you should go

to the quilting party.”

conveys “Going to the quilting party

it

of fact,

I

will fall apart if you

sages are expressed, but they conflict.

do go and

What do you

is

will

it

I

want you

fault.”

Two mes-

the last thing

be your

to

nent of Strategic Therapy (Carlson, 2002). Haley, to say the

become least,

the foremost propo-

was

a bit of a maverick.

Rather than the traditional degree in psychology or medicine, Haley’s degree

and communication (Becvar

& Becvar,

skewering the traditional psychotherapy club.

How-

do?

MRI group’s work and went on

Jay Haley extended the

in arts

(Nichols,

simple example of double-bind communication might be the following. Imag-

ine your partner or parent saying ever, the

as a result,

target

is

a master’s

2006). Haley has consistently delighted in

One

of his books. The Power

Tactics

ofJesus

Christ and Other Stories {\9G9) does quite a bit of this skewering of entrenched institutions (as

you could guess by

analysis

its title),

including an analysis of the power dynamics of psycho-

and of the mental hospitals of the 1950s and 1960s. Haley died

website can

still

be found

at

www.jay-haley-on-therapy.com

2007, but

his

Chapter 14

for

in

.

Haley was much influenced by master therapist Milton Erickson

(see

more information). It is also helpful to know that he spent 10 years working with Minuchin developing Structural Family Therapy. The definitive statement of Strategic Therapy is probably Haley’s book Problem-Solving Therapy (1987), which actually has first and second editions. Another leading proponent of Strategic Family Therapy is Cloe Madanes, who was at one time married to Haley. Madanes’ book Strategic Pamily Therapy (1981) is considered an excellent resource on this approach. Another relatively recent source on this approach is Haley and Richeport-Haley’s 2003 book The Art of Strategic Therapy.

Strategic therapists, like structural therapists, are interested in family hierarchy;

within the family

is

an essential way of understanding symptomatic presentations. The

ference between strategic

(1981),

is

and

structural therapists, according to

that strategic therapists pay

more attention

nication and behavior within the family than

This theory

is

power

shorter

is

way

to

change

is

Haley and Madanes

to the repetitive patterns of commustructuralists.

on concepts and techniques than

strategic therapists believe that the

vidual problem. There

do the

dif-

others, possibly because the

to design specific tasks for each indi-

no theory of personality associated with

this

approach.

CENTRAF CONSTRUCTS Communication Strategic therapists are interested in the repetitive sequences ol interaction that are seen in

and dyads (O’Connor, 1986). Communication happens on two levels: the digital and the analogic, or metaphoric (Haley, 1987). Digital communication occurs when statements have only one meaning a sort of yes/no or on/off situation. Everyone mostly families

—

FAMILY SYSTEMS THEORY

434

understands the meaning intended, and things are rational and precise. For example,

1

can

count the number of times Jenny has temper tantrums in a day. Analogic communication is the kind that happens between people, and the hallmark

meanings on multiple

that statements can have fight over

who

bathroom, the fight

to clean the

is

probably also a statement about

how

they

happen on the

tionships between people

For example,

levels.

Sara and John

overtly about the cleaning, but

is

According

relate.

when

it is

to the strategic therapist, rela-

of analogic communication. For example,

level

Haley (1987) maintained that the symptom or problem bringing the client to therapy

metaphor

really a

Haley

( 1

tual

command

The command

relationship between the interactants. says to

the content level

sage

is

family has a

school.

am

“I

is

level

communication

report level

is

pie: into report (or

concerned with the

largely nonverbal,

is

(she

is

tired

remind you

and

it

conveys the

to clean the

to clean, a clear statement that she

wonders how Derrihs behavior

ofgetting

ac-

if

the tense

bathroom”

of reminding), but the relationship mes-

that the metaphor resides in the

history, it seems,

Morgan

The

so tired of having to

you read

strategic therapist,

blame or

cut the

Using the example of Sara and John above,

John that he has

tell

One possibility

distress.

other, or

John

exactly what

that Sara gets to

Morgan, the ily’s

is

way to

(or relationship) aspects.

content of a verbal message.

and angry Sara

is

for his current relationship situation.

987) also recognized another

content) and

is

in each other’s faces.

is

in charge.

is

a metaphor for the fam-

‘‘in

yoi^r face” routine. This

When one

tries to coerce the

somewhat like Derril’s behavior at communication patterns to see what the

label, the other retaliates in kind,

looks closely at Derril

command level is suggesting about

and Jean’s

their struggles.

Hierarchies Any organization and thus,

this

has hierarchies, and families are no exception. Hierarchies involve power,

concept

defines the parental ally, this

is

dyad

often seen as problematic.

The

traditional hierarchy in a family

charge of the kids (Madanes, 1981). Even more tradition-

as in

structure often implies that the

man

is

in

charge and

all

must obey him. Haley

987) protested that although we must accept the existence of hierarchies, this admittance does not dictate that a particular structure must exist. He cautioned that simply seeing an ( 1

un)ust hierarchy

m

a family

changed when necessary

Morgan

sees

to

is

not justification for changing

Hierarchies are to be

change symptoms, and only then.

that the hierarchy in this family

ofen she seems

it.

is

not entirely

clear.

Jean

mom, yes, but much younger and

is

a teenager with Derril. Derril sometimes acts sometimes much older than he is in relationship to his mother. Dad’s role to act like

the

is

that ofoutsider.

THEORY OF THE PERSON AND DEVELOPMENT OE THE INDIVIDUAL Strategic therapists

dont have

formal theory of personality. They have some ideas about development, but generally they attend to points of transition in the life span. According to

Haley

( 1

a

973), the important

life

stages in Strategic

Therapy

are (a) the courting period.

FAMILY SYSTEMS THEORY

435

(b) early marriage, (c) childbirth

ing parents from children, and ods,

Uncommon

(e)

(e)

wean-

Erickson’s

meth-

middle marriage,

(d)

retirement and old age. In his

book on

Therapy (Haley, 1973), Haley devoted a chapter to each of these stages,

them with examples from

illustrating

Morgan

and dealing with the young,

notes that Derril

showing signs ofgrowing

is

Erickson’s work.

on the verge of adolescence. Although Derril

is

only 12, he

is

up.

HEALTH AND DYSFUNCTION Strategic therapists see dysfunction

(Becvar

& Becvar, 2006; Haley,

1

is

987).

defined as rigid, repetitive interactive behavior

They evolve

over time as people try to

manage

their

relationships with others (Carlson, 2002).

For Madanes (1981) and Haley (1987; Haley

from problematic

families result

& Richeport-Haley,

what Madanes

hierarchies, or

chical organization in the family” (1981, p. 67).

These

hierarchies,

tricably linked to the rigid interactive behavior of family

George has

symptom and

a

relationship, he

is

calls

2003), problems in

“incongruous hierar-

it is

implied, are inex-

members. For example, when

thereby distracts the parents from difficulties in the couple’s

assuming inappropriate power within the family system. The parents

focus on George and do “more of the same” with him, trying the same responses to his

behavior time and time again (and typically, escalating each time). If there

is

a

problem child

in a family,

according to Haley, then someone has crossed a

become too involved with a child (not necessarily the symptomatic one, although that is common; 1987). The situation is at its worst when the dysfunctional coalition is denied or concealed. Also, the ganging up process is repeated that is, cross-generational coalitions are not necessarily problematic unless they become routine (Haley, 1987). Haley and Richeport-Haley (2003) also point to two other common prob-

generational boundary and

—

lems seen in family hierarchy: parents forming coalitions in opposition to one another, and in-laws violating boundaries. Ironically, the

solve the

symptom

is

seen as a metaphor for the problem but also as an attempt to

problem (O’Gonnor, 1986). Kids cooperate with feuding parents by appearing

with symptoms that distract them from the conflict (Gheung, 2005). So George’s temper

tantrums express the rage between the two parents, but are also attempts to distract ents

from

his par-

this painful situation.

You might have guessed by now

that strategic therapists spend

little

time discussing

healthy people and families. Haley (1987) noted that even confused or distorted hierarchies can reside in healthy families. Stanton (1981) gave

“Healthy families are

less

one

preoccupied with themselves and their

lems, showing less interest in any kind of ‘search for insight’”

By deduction, we would assume

would have in

which

observed

It

that healthy families,

clear hierarchies that are consistent lives;

in these

transitions in the terns are clear

strategic version

own

(p.

from

of health:

motivations or prob-

363). a strategic perspective,

with the family’s context

(i.e.,

the culture

Few entrenched cross-generational coalitions would be families. These families would somehow figure out how to navigate the family life cycle without confusion or collusion. Gommunicatlon pat-

Stanton, 1981).

and

flexible.

FAMILY SYSTEMS THEORY

436

Morgan

teamwork

this

household

Morgan

cross-generational coalition. However,

and Derrilseem to have a denied, and in some instances,

observes that Jean

not

is

it is

adaptive, such as in completing

However, Derril's b eh avior^ suggests that something

chores.

guesses that his acting-out behavior

parents (in your face!)

is

is

and

not working,

both symbolic of the conflict between his

and also a way of distracting Jean from

her loneliness

and pain.

NATURE OF THERAPY Assessment No

Formal assessment or diagnosis

in the past

were seen

that “to label

as radicals

someone

because they were

critical

problem that the therapy must

problem, so that the solution

Even more outrageous

used in Strategic Therapy. In

to

is

some was

made more

lish

less

adamant about

The will

&

is

suggesting to partici-

Sometimes the

solve.

label cre-

(Madanes, 1981,

it

p. 20).

med-

defines the client as “mentally

Nowadays,

strategic therapists

these issues, advocating that the therapist should

good relationships with other

ing medication (Haley

labels,

the strategic camp’s insistence that psychoactive

instead of simply misbehaving (Madanes, 1981).

much

of diagnostic

difficult to cure”

immediately discontinued because

ication should be

fact, strategic therapists

as ‘schizophrenic,’ ‘delinquent,’ or ‘manic-depressive’

pate in the creation of the ates a

is

professionals, including psychiatrists

work

who

to estab-

are prescrib-

through observation of interactions, which

provide information about hierarchies and where they might be dysfunctional.

observing

how

it

seem

Richeport-Haley, 2003).

strategic therapist assesses the family

strategic therapist

ill”

The

can also gain information by deliberately intervening in the family and

responds (Stanton, 1981).

Morgan watches carefully as Jean and Derril discuss what brings them to counseling. She looks at who presents the problem (Jean), how Derril responds to this presentation (by presenting his own version), and how Jean reacts to DerriJ's presentation. The actual content of these presentations

not as important as the quality of their interaction; the two seem be operating from approximately the same level ofpower. is

to

Overview of the Therapeutic Atmosphere AND Roles of Client and Counselor Strategic family therapy

is

generally brief,

and the

(O Connor, 1986). The focus of counseling

is

therapist

generally

is

on the

very active and directive present,

and the

therapist

assumes responsibility for the structure of the counseling process (Carlson, 2002). Unlike most other approaches. Strategic Therapy considers the social context of the presenting problem to include professionals who have influence and control over the clients, such

as

medical professionals

who

and administer inpatient treatment (Haand individuals can be problematic because

prescribe drugs

1987, Madanes, 1981). These institutions they “not only focus on an individual, but are also antifamily” (Haley, 1980, p. 53). Strategic therapists are flexible in their use of locations and time frames for therapy (Haley, 1987). Sessions can be held in homes, in schools, or in the traditional office space. Sessions are known to range from the sacred 50 minutes to multiple hours (Haley, 1987). ley,

FAMILY SYSTEMS THEORY The

therapist in Strategic

437

Therapy shoulders the

total responsibility for the

outcome of

therapy (Carlson, 2002). Relatively few expectations are expressed about the role of the clients in Strategic

Therapy.

Morgan takes charge of the therapy situation. She is active and begins her Jean and Derril define a solvable problem. Although she is aware ofi the

task

of helping

role ofi Derrids

school in this situation (defining Derril as a problem kid), she decides that she will not

intervene there unless at some point

it

seems necessary.

Goals The

goal of the strategic therapist

is

very simple and straightforward: to resolve the pre-

The problem “should be something one can count, observe, measure, or in some way know one is influencing” (Haley, 1987, p. 39). Ultimately, the strategic counselor wants people to behave dijferently; she doesn’t care much about insenting problem (Madanes, 1981).

Haley and Richeport-Haley (2003) point out that pushing for problem, because many clients are not comfortable with interpretations.

sight (Haley, 1987). In fact,

insight can be a

Another way

to look at the goal of therapy

from

individuals navigate the transition between the

because they have experienced a fore to

move

crisis in

this perspective

life stages.

That

is

is,

that counseling helps clients

one stage of development and

become

clients

are unable there-

Haley (1980) maintained that adolescents behaving difficulty leaving home.

to the next stage. For example,

come schizophrenic because they are The strategic therapist’s interest in

patterns of

communication

that support distorted

hierarchies also leads to interest in changing the routine patterns presented

by the

clients.

more complex ways of communicating and interacting with their systems (Madanes, 1981). As Stanton (1981) put it, “Strategic therapists more commonly use the family’s overtly expressed goals or target com-

Thus, the

strategic therapist strives to help the clients learn

plaints as rallying points for actually altering dysfunctional sequences” (p. 366). In other

words, the therapist appears to be digital in his focus on the presented problem, but logic in conceptualization

and thereby avoid power

ical directives as a

discussed in

more

ana-

and intervention.

Strategic therapists deal with client resistance in a ily

is

unique way

struggles (Stanton, 1981).

way of inducing change by

They

— they

“go with” the fam-

also use indirect or paradox-

using resistance. These interventions are

detail later.

of trouble. The number of times he gets in trouble at school can be counted. Morgan thinks that to do this, she will help Derril grow The agreed-upon goal

is

to

up and help Jean develop a requires changing

how

this

help Derril stay out

life

outside

pair

ofher

relates to

relationship with Derril. Achieving these goals

each other

and to

the outside world.

PROCESS OF THERAPY One

of the

first

problem that

is

tasks

of the strategic therapist

solvable (Haley, 1987).

is

to

work with

the family to formulate a

Therapy can then proceed, but beware, because

Haley and Richeport-Haley (2003) warn us that “what makes therapy

difficult for trainees

FAMILY SYSTEMS THEORY

438 is

that

so

life is

innovative”

complex that you have

thought that

it

a bit to say

was important

first

session (1987), saying, “It

skill

required

is

view

often too

much

— he opined

Haley (1987) divided the action, goal setting,

have everyone

to is

to ask

first

selor also uses the behavior

tions,

The

ing.

at least the

by seeing him alone, but the (p. 11).

Carlson (2002) had

happen without everyone

setting. In the social stage, the therapist chitchats It is

are

important to get everyone to talk

there.

with the

in this stage

important to the counseling process. The coun-

of the family in the social stage to observe important family

mood, and the

strategic therapist formulates tentative

roles

and power

structures in

hypotheses based on these observa-

these to the family (Haley, 1987).

but does not

The problem

stage begins

when

the therapist asks

Family members’ responses to

what brought the family

to counsel-

question are informative. Everyone must have a

this

chance to give his or her views on the problem, but Haley recommends that the adult Is

involved with the identified problem be queried

least

He

counseling session into five stages: social, problem, inter-

processes, such as parenting, general family

the family.

session of counseling.

household present for

in the

of the average therapist”

members.

the

first

possible to change a person

members know they

family

all

about the conduct of the

that effective therapy could

and task

know

family, getting to

so that

to be

(p. xv).

Haley had quite

a different

and you have

to design therapy for each case

first.

who

Fiowever, the counselor must

be very careful to be respectful and courteous to the individual

who

has the most power to

bring the family back to therapy. These individuals are typically not the same people!

Haley

also cautions that

it Is

inadvisable to start with the problem child because he might

conclude that the counselor blames him.

problem

In the

1987,

p. 27).

He

stage, the therapist

should have an attitude of “helpful interest” (Haley,

should not offer advice, even

if

someone

requests

it.

Family members

Ml

should be asked for their opinions, not their feelings, about the situation.

the time, the

making observations about the family, but again, she is not to convey these or any interpretations about what she sees. The discussion of the problem should move from counselor

is

more

general statements to a

specific construction,

and the

latter

should ideally involve

more than one person.

The

next stage ol the

first

session

are directed to talk to each other is,

ideally, to actually see

is

the interaction stage (Haley,

1

987). Family

members

about the problem. The Intent of the strategic therapist

the problem in

Its lull

glory. If

someone

in the family

is

anxious,

she can be asked to get anxious In the session so that the counselor can observe what happens. 1 he therapist can also get a good view of the family’s hierarchy through this process.

Once lem

is

the family has interacted, they

move

way (Haley, know when things are

clearly defined in a solvable

and therapist

the family to reduce

Johns

anxiety, the therapist

to the goal-setting

1987).

which the prob-

in

The problem must be

observable so

getting better. Rather than setting the goal

wants more specific goals, such

as

stopping John’s

stuttering, increasing

Johns excursions outside of his home to three per week, and so on. Sometimes, but sometimes not, a final stage of the first session is entered, called task (Haley, 1987).

for the family to

Strategic

I

If

the counselor

is

clever

enough, she

will prescribe

some homework

complete before the next session. Directives of this sort are essential to herapy and will be discussed in more detail in the section on techniques.

FAMILY SYSTEMS THEORY

When Morgan ically,

asked Jean

saying that

it

439

bring Al to the first therapy

to

would be of no

use because he

session,

Jean reacted very emphat-

was not part of the family. Although

Morgan thought that this arrangement was not quite ideal, she accepted it. Morgan greets Jean and Derril and chats with them a little about everyday stujf. She asks ifthey had any dijficulty finding her office, where they live, and so forth. Fairly quickly, though, Morgan proceeds to asking Jean and Derril what brings them in. Jean mostly describes the problem, with Derril remaining silent. At one point, Derril gets angry and breaks into his mothers monologue. Morgan observes these events and begins to form hypotheses. She moves Jean and Derril into the interaction phase by asking them to talk to each other about the problem. Observing this discussion, Morgan notes that the two relate as equals rather than as mother and son. Mother blames a lot, and Derril blames others for his

behavior

Morgan

—

they get in his face.

struggles to help

Jean and Derril define the problem as

and Derril to

She defines

solvable.

him out of trouble at school. Jean needs to take charge in this process ofhelping Derril to grow up and take responsibility for his own behavior. Perhaps ifhe grows up, he willfind some new ways to deal with conflict. Privately, Morgan decides that Derril is taking care ofhis mother at the expense of taking care of his own life. Jean needs to help Derril see that she doesn’t need to be taken care of. If Morgan can create a more functional hierarchy for Jean and Derril, this problem the problem as a joint effort ofJean

keep

should take care of itself.

THERAPEUTIC TECHNIQUES Directives The

strategic therapist

formed

at

home

almost always issues directives to the family, often

over the intervals between sessions. Directives are used to accomplish the

therapeutic goal of getting people to behave differently.

with the therapist

—

it is

gather information.

They

also

change the relationship

intensified because the clients live with the therapist in the

her directives for a whole

Two

be per-

as tasks to

week

Whether

(Haley, 1987).

The

form of

use of directives also helps the counselor

the clients obey or disobey, they are

still

communicating.

kinds of directives are used in Strategic Therapy: direct, or straightforward, and

indirect, or paradoxical (Haley, 1987;

Haley

&

Richeport-Haley, 2003). Direct inter-

ventions are those in which the counselor simply

when

tells

the client

what

to do.

They

are

comply (O’Connor, 1986). Directives are not the same as giving advice. Haley (1987) noted that “giving good advice means the therapist assumes that people have rational control of what they are doing. To used

the therapist expects that the family will

be successful in the therapy business, advice

is

what everyone

it

may

be better to drop that idea”

(p.

61).

Good

gives the family, so that, for example, “telling people that they

should treat each other better

is

not useful to them” (Haley, 1987,

are directives that alter the patterns of

p.

61).

More

useful

communication, and hence the hierarchy,

in

the family.

One example

of a straightforward directive

2003). This form thing to do that

is

is

used

when

clients feel sorry

helpful to others (p. 9).

is

penance (Haley

and awful; the

&

Richeport-Haley,

therapist gives

them some-

FAMILY SYSTEMS THEORY

440

Two

a direct intervention.

the therapist thinks the family will probably resist

when

Paradoxical directives are used

general forms of paradox are described by Haley

and Richeport-

Haley (2003): restraining orders (which instruct the client notio change) and symptom prescription. These interventions are designed to place the client in a no-win situation. To

dilemma, O’Connor (1986) described the directive given to a child obsessing about vomiting. The 10-year-old was told to sit for an hour each day in the family kitchen and think about vomiting (and only then). If Charlie obeys, then he demonstrates control illustrate this

symptom.

over his

Any

If

Charlie disobeys, the

must be

directive given

should

clarlly,

very often)

it is

Of course,

not confuse, hierarchies.

someone

on the

family’s

performance

fine. If they

members of the fam-

Haley noted that sometimes (but not

at the

in the family

should be

is

made

responsible

next counseling session. If the family has

have not, they should not be

form of paradoxical directive

special

all

helpful to give confusing directives, involve less than the complete family,

followed the directive,

A

gone!

the family should have a part in the task. Directives

or confuse the family hierarchy. Finally, for reporting

is

and understood by

clear, precise,

members of

(Haley, 1987). All

ily

symptom

the ordeal

The

let

off easily (Haley,

goal of the ordeal

is

1

to

987).

make

symptom more trouble than it is worth in terms of controlling relationships with others. The client will then voluntarily give up the symptom. The assumption behind this approach is that the Individual who gives up her symptom will then have to find new ways the

of relating to others that are

Haley

( 1

more

adaptive.

984) described three characteristics of ordeals.

First, as

noted

the ordeal

earlier,

must be worse than the symptom. Second, the ordeal must be something the person is able to do and not object to on moral or ethical grounds. Third, the ordeal must not harm the anyone

client or

A

(1984,

else

As with

7).

p.

the client is

best

and

exercising, cleaning house,

(e.g.,

il

is

told to

the ordeal

perform the ordeal is

two kinds of

ordeals.

the performance of an unpleasant but “good for you” task

straightforward ordeal

upon occurrence of the symptom. Clients of

directives, there are

performed

in the

are asked

about things that they should do more

Once the symptom is clearly specified, symptom occurs. Haley (1984) noted that it

so forth).

if

the

middle of the night!

I

once gave a

client

an ordeal

him with insomnia. He decided that he needed to clean out his garage. I instructed him that if he could not sleep 20 minutes after getting in bed, he should get up and clean to help

his garage. Fhis client

weeks and that

found that he had very

his garage

Paradoxical ordeals

2.VQ

remained

tactic

is

to require the

aspect of paradoxical ordeals tary,

trouble getting to sleep in the next few

dirty.

demand the performance of the symptom. From perform the symptom could be considered an ordeal.

directives that

one peispective, simply having

Another

little

is

to

performance under aversive conditions. that if the client complies, the

One

interesting

symptom becomes volun-

under the clients control (Haley, 1984). The alternative, noncompliance with the

rective,

is

to give

up the symptom.

In addition to straightforward

ordeals, therapy itself can be theyapibt the ordeal

inadequacies

di-

On

in front of

and paradoxical

viewed

as

directives,

which can

an ordeal. There are numerous ways to make the

a very basic level, the fact that the client has to

what seems

be, at times,

to be a problem-free

pay

to discuss her

person makes the therapist trou-

blesome. Haley described several instances of using payments to the therapist as ordeals, with the agreement that the therapist can do whatever he wants to with the money. In one

FAMILY SYSTEMS THEORY case,

441

each time a client binged and vomited, she had to pay the therapist, beginning with

amount doubled (Haley, 1984). The penny, the second time 2 cents. The third time the client

a penny. Every time she repeated this behavior, the First

time she vomited, she owed a

threw up, she owed 4 cents, then

up

1

8,

then 16 cents, and so on. For the client

who

throws

0 times a day, this can be a very expensive contract. She went from vomiting from 4 to

25 times

a

day to vomiting only 6 times

in the first

week

ond week, she vomited only once and then stopped

after the assignment. In the sec-

completely.

Confrontation and interpretation of the clients behavior by the therapist often result in clients

having to acknowledge things they’d rather not. Reframing or redefining the

client’s

behaviors in ways the client does not like constitutes an unpleasant experience. Anger can

be redefined as a

way of caring about someone.

counselor can characterize this behavior

If the client

resisting a certain task, the

is

being protective of herself or others.

as the client

This reconceptualization puts the client in charge of her behavior.

when

Ordeals involving two or more persons 2we: typically used ticipate.

of

The

ordeal of the binging

client described earlier

mother of a bed-wetting child

get

options are telling Jean to get a

life (i.e.,

good example

autonomy when

it

and Derrii Some

is

having the

comes

help her out in to school,

this.

1984).

straightforward

directing her to do something on her

and devising a way for Derrii to

give Derrii more

own

over the

She considers having Jean

not calling his teachers weekly as she

has been. Derrii must comply by giving his mother a daily

home fom

a

him up at dawn to practice his handwriting (Haley,

considers the directives she could give Jean

next week)

is

of ordeal (because the therapist was involved). Another example

this type

Morgan

and vomiting

families are available to par-

summary ofevents when

she gets

work.

Paradoxical alternatives might involve moving Jean

and Derrii closer

together,

hoping

Morgan considers asking Jean and Derrii to devise more ways to spend time with each other and could intensijy this directive into an ordeal by having them play

for noncompliance.

cards for

2

hours every night. She also thinks about having Jean go

to

school with Derrii

every day. She could get detailed daily reports on his behavior.

Reframing Sometimes, changing the way the ing can be one

way

to transform a

clients perceive the

problem

problem from intractable

is

to solvable. Obsessions can be

transformed into worrying or even thinking about, which seems

Morgan can

reframe DerriPs acting out as a

busy with his problems, distracting her

helpful. In fact, refram-

much

less

way of taking care ofhis mother

fom

her struggles

to

be a single

threatening.

—he

keeps her

mom who

has

few fiends.

Exaggerating the Hierarchical Problem Directives can be used to exaggerate the hierarchy identified as distorted. Haley (1987)

noted that two such approaches can be used. In the charge of a child

who

is

in coalition

first,

the

more

distant parent

is

put

in

with the involved parent. However, interventions of

FAMILY SYSTEMS THEORY

442 this first

ship.

An

disrupt

type can be problematic because they can induce conflict in the couple’s relationalternative is to exaggerate the involvement of the family members in coalition to

it.

Haley (1973) described

which Erickson intervened with

a case in

a

mother con-

cerned about her 12-year-old son’s bed-wetting. Erickson prescribed an ordeal, insisting If it was wet, she that the mother get up at 4:00 A.M. every night and check her sons bed.

was a

wake him, and he was

to

book

improve

handwriting by copying passages out of

his

The bed-wetting disappeared

7:00 A.M.

until

to then

very quickly.

Pretend Directives Madanes (1981) contributed the gested that

It

was useful

son pretend to have the

to use these directives in

symptom

symptomatic child pretend to

idea of pretend directives to the strategic arsenal. She sug-

to

serves the

same function

as

having

it.

Morgan

if

the situation

is

Thus, the

an adult

as

to

have the parents of a is

directed to pretend

need help, the child

less real,

client can give

might be more

framed

(b)

directed to give a critical analysis of the pres-

is

symptom becomes

(Nichols, 2002). Also, the individual

kinds of behaviors

When

which the parents pretend

pretend to help. In this approach, the it

child’s help.

have a symptom, the partner or spouse

entation. In the second instance, in

have the symptomatic per-

(a)

counseling session or

in the

need the

two ways:

likely to

play (Becvar

and pretending

up the

“real”

is

to

to have

symptom

experiment with different

& Becvar,

2006).

considers using a pretend directive in session, telling Jean to ask for DerriFs help

on developing a social

life.

Bowen’s Family Systems Theory

OVERVIEW 1

it

his version of

PS theory

is

the brainchild of Murray

from other systems approaches,

(BEST). This approach

is

I

will refer to

widely acknowledged

it

Bowen (1913—1990). To

Bowen’s Family Systems Theory

as

as the

distinguish

most elegant

theoretical construc-

(Gurman & Kniskern, 1981). Bowen, a psychiatrist, began his theoretical work working with schizophrenics at the Menninger Clinic from 1946 to 1954. He later moved to the National Institute of

tion

among

the family system theories

Mental Health

(NIMH) and

then to Georgetown University.

development of Bowen’s thought

Bowen while at

is

known

best

for

Is

found

in

A

detailed history of the

Kerr (1981).

two pioneering advances

in the family

therapy area.

First,

NIMH,

he experimented with hospitalizing the entire families of schizophrenics, practicing what Kerr (1981) called family group therapy (p. 230). In these studies, he began to note the intense emotional processes in these families, but his concurrent outpatient

work suggested

dysfunction was

A his

a

between these families and those with

a little bit

of

it

in

less

severe

matter of quantity, not quality.

second contribution of Bowen was his analysis of his

family of oiigin

orists

that the differences

(a

Box

own

version of this paper can be found in 1

3.3).

Bowen

journey to differentiate from

Bowen, 1978 and you can read

presented this analysis to a group of family therapy the-

and lesearchers and then soon began teaching

this

approach to

his students.

FAMILY SYSTEMS THEORY of BFST

443

some authors distinguish between traditional and nontraditional BFST, or Bowen and Bowenian variants, according to Guerin and Guerin (2002). The traditional form is that practiced by Bowen himself was long-term, and focused on getting the client to work on family of origin issues. Bowenian If you read a lot

therapy ent

a

is

literature,

you

will find that

broadened version of the therapy, and seems

intervene in the pres-

as likely to

with the current family system, or focus on the presenting symptom)

(e.g.,

focus on multigenerational issues (Murdock, 2007). In this chapter,

I

will

as

it is

attempt to offer

points from both perspectives.

Box 13.3

An

Bowens On

Excerpt from

the Differentiation

ofSelf

work at this time was the one between my mother, my second brother, and me. I had worked very hard on the triangle with my parents and me, assuming that my problem would be solved. Now a new version of the problem had been displaced onto the new triangle. When conflict arose in the business, my mother would communicate by some means, if not directly, that I was on her side, and my brother would react as if this was reality. I began to perceive some of this development on trips. The process would emerge in the form of gossip-type stories which in an emotional system communicate, “We two are together on this issue. We are in agreement about that

An important

triangle at

other third person.”

communication

is

One

of the better ways to disengage from such a triangling “secret”

to go to the third person

my

out of effective contact with

was

and

to I

tell

my

mother

that

Action

is

required

in a neutral

second brother then and the only move

react as if

neutral about

was on her

I

when words

fail

me

with others.

1

way.

I

was

could make

1

was neutral. She would say that she respected

I

would assume she was acting

and the family would

and report the message

my

would

position

leave

town

side.

emotional systems.

to detriangle in

My mother has

always used “secret” communications to facilitate her position in the emotional system.

One listen

of

my

early responses to her

without taking

my early

sides. In retrospect, this

is

one of the better

stories.”

on the

turned the tide

some

from

in that area.

negative story about

his wife

had

just told

of telling him.

me

more

little

my

father,

he

one was

first

I

several exchanges

father. In the next mail

this story

was neutral.

a letter in

about him, and

I

I

could

triggers for

When

as,

“

effective. In retrospect, I

Fhat’s I

un-

had worked much

mother, and myself and

There had been

I

I

communications without

began using comments such

that.

my

He showed

I

kidded myself that

I

triangle with

effective in detriangling

thought

I

maneuver was one of the key

effective,

This method was a

doubtedly was responding while actively

and

not involved, does not fool an emotional system.

was aware that “no response” was not

more

to listen,

fusions into the emotional system. Listening to such

response, pretending that one I

communication was

I

had been more

about

“secrets” that

which mother communicated wrote

to

my

father to say that

wondered why she

to

told

me

instead

the letter to her, and she fussed about not being able to

FAMILY SYSTEMS THEORY

444

such

trusr

me. Several

ents,

had been reasonably

letters

when

I

was with both par-

me from them. During that much between the lines, and

effective at detriangling

mother made comments about

my

reading too

comments about her writing too much between The triangling pattern

exchanges

as this, plus similar

in

period, I

made

the lines.

my family of origin, which

is

the usual one in

all

emotional

members were grouped grouping would be somewhat dif-

systems, was most intense during stress periods. Various family

on the corners of the primary ferent,

gle

triangle, except that the

depending on the emotional

would

talk

The two on

issues.

about the outsider. With various versions of different issues being

discussed in four separate households, and with

them

all, it

the togetherness side of a trian-

was possible to keep

a

me

in reasonably

good contact with

good reading of the family emotional

tension.

My first

brother has hardly been mentioned in this report. His lifelong position in the family has

been one of moderate involvement and acting uninvolved, with statements that he

would be

willing to help anytime if he

was needed but that he did not want

Excerpted Irom Family Therapy in Clinical Practice hy

M. Bowen,

1978.

New York:

to “just talk.”

Jason Aronson.

Reprinted with permission.

CENTRAL CONSTRUCTS Differentiation of Self The most

basic construct in

According to Bowen,

it is

BFST

is

differentiation of self

an inherent feature of

all

living

from the family of

origin.

organisms that they must bal-

& Piercy, 1996). Differentiation of (Kerr & Bowen, 1988).

ance pulls of togetherness and separateness (Wetchler self

is

a lifelong process

Ldifferentiation teristic levels

is

of balancing these forces

both an individual and a family construct. Individuals have charac-

of differentiation, but the overall

levels

of differentiation of their families of

origin mostly determine the individual’s level. Differentiation should be

continuum; people and families tively

fall

along a range from very low differentiation to

high differentiation. For purposes of explanation, though,

characteristics of individuals

Individuals

who

thought of

with low and high

levels

are relatively well differentiated

we tend

to

as a

rela-

compare the

of this construct.

have a solid sense of self. They are clear

about where they end and others begin. They are able to distinguish thought from feeling, and theii behavior is guided by their own principles and cognitions rather than emotional factors (CiLieim Guerin, 2002). Individuals who display low levels of differentiation are said to be reactive; they respond based on emotions as compared to individuals with higher

&

levels of diffeientiation,

who

respond on the basis of objective thought, or what some term “clearheadedness” (Friedman, 1991). In relationships. Individuals

with higher

of differentiation are able to stay in intimate contact with others while maintaining a solid sense of self (Kerr, 1984). This quality, termed emotional autonomy, should not be confused with denying one’s needs for other people. Distancing on the basis of such denial is termed a “pseudo independent posture” (Kerr, 184, p. )) and is evidence of a lack of emotional autonomy. 1

levels

FAMILY SYSTEMS THEORY The term fusion have

almost synonymous with low differentiation of self, and

is

two meanings

at least

445

BFST

in

Bowens

In

early writing, he

seems to

it

spoke of fusion

as

mean-

ing that the individual’s emotional and intellectual systems are inseparable (Bowen, 1978).

The emotional system by anxiety

tends to dominate behavior, and usually the emotionality

an important other or in a

in

A second definition “common

into a

in intimate relationships

such

(Bowen, 1978,

as marriages.

One

but

it is

self

and becomes dominant, or

difficult to maintain.

weaker-appearing individual

we

are

472). This process

Such fusion

is

self

seen most clearly

creates “emotional bliss” (p. 473),

and looks weaker. The

The emphasis

then likely to develop symptoms.

is

& Guerin, 2002).

tendency to fuse the

stronger, whereas the other adapts

or weaker because

with significant others

who

are at

Bowen maintained

about the same

level

here

that

on

is

we tend

of differentia-

(Bowen, 1978). The borrowing of self in the fusion process makes one indi-

vidual look

more together than

Jacob, Jean

and DerriJs BFST therapist,

and Derril are

the other looks.

starts his

work with

the premise that both Jean

low on the range ofdijferentiation ofself They appear to be fused neither has a strong sense ofselfseparate from the other. Both seem

relatively

in their relationship to

p.

activated

individual in the dyad tends to absorb higher levels of

terms such as looks 2in{!1

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Worell,].,

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Woolfolk, R.

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1

(1995).

1

Name Index

Abela,

R. Z.,

J.

Abramowitz,

Adams,

J.

347 S., 345

Aronson,

143

B. N., 142,

322

J.,

331, 332, 333, 334, 335, 336, 338, 339, 340, 341, 342, 343, 344, 345, 348

Arrendondo, P, 374

Adler, A., 107, 109, 110, 112,

Beck,

J.,

Association lor Behavior Analysis

Beck,

J. S.,

International,

113, 114, 117, 118, 119,

234

334, 335, 338, 339, 341

Adler, K., 107

Alexander,

Beck,

453

R, 16,

J.

Beckvar, D.

336, 338

216

S.,

Baird,

M.

Baker, L.,

Bedwell, J.,

347

Beevers, C. G.,

396 423, 426 K.,

416, 417, 418, 419 Baldwin,

Amerikaner, M., I4l

Ballou, M., 270, 271, 373, 382,

Anderson,

Balter, J.

S.,

455

Anderson, W. T, 203, 408

453

268 461, 487, 488

Berg,

I.,

Berg,

I.

K.,

K., 461, 471, 472, 473, 477, 478,

484 74 387

Bergman, D.,

1

Bandura, A., 236, 237, 243, 244, 249, 250,

Berk, L. E.,

267 Banmen, J., 412 Banta, J., 22

Berman,

J. S., 9,

Bernard,

M.

114, 115, 116, 117, 118, 119, 120,

Barbrack, C. R., 233, 266

Bertolino, B.,

121, 122, 123, 124, 128, 129, 130,

Barcikowski, R.

131, 133-134, 135, 137, 138, 145

Bargad, A., 400

Bender, L.

Beyebach, M., 485, 487

122, 123, 124, 128, 129, 130, 131,

Barkham, M., 173 Barlow, D. H., 253 Barrett-Lennard, G. T, 174, 175

133-134, 135, 137, 138, 145

Bartle-Haring,

Angst,

142

J.,

Angus,

L.,

227

Ansbacher, H. L,

Ansbacher, R. R.,

1

1

06,

06,

1

1

07,

07,

1 1

1

1

0,

0,

1 1 1

1 1

1

,

,

1

3,

1

1 1

3,

114, 115, 117, 118, 119, 120, 121,

Antony, M. M., 242, 253, 254 Aponte, H.

J.,

425, 426, 427, 428

Baruch, Bass,

E.,

M.

S.,

S.,

140

456

331

L.,

B.,

51,52 233, 234, 237, 240, 252,

271, 315, 316, 343

Beal, D.,

294

Beck, A. T.,

P. J.,

J. L.,

Bird, B. E.

253, 268, 315, 316, 319-320,

323, 324, 325, 326, 327, 328, 330,

171, 174, 175, 527

347 02 1

129, 130

1.,

Bishop, D. R., 143

Black,

Beach, D. A., 256, 261

A., 50,

Bieling,

Binder,

E., 15,

184, 185

Araya, R., 348 J.

510

Besa, D.,

Bishop, M., 109

S.,

268, 345 280, 281, 290, 291, 307,

484

141

Bauman,

Arnkoff, D,

E.,

310

Applegate, B., 402

Arlow,

M.

Benton,

389

M., 331

501

348

T, 269

Bell, S.

American Psychological Association, 19

S. A.,

401

J. S.,

Beels, C. C., 193, 494, 499, 500,

Baldwin, M., 409, 411, 412, 413, 4l4, 415, Association, 12

407, 408, 422, 427, 433, 435,

J.,

453

Backs-Dermott, B.

311

454M55

Alpert, A.,

Beckvar, R.

Bachrach, H., 101

Backman,

407, 408, 422, 427, 433,

S.,

435, 453

Bachelor, A., 175

J., 306 Alleyne, A., 397 Allgood, B. A., 243

Alford, D.

Ambuhl, H., 172 American Psychiatric

T, 346

J.

Bach, R, 24

Alford, B. A., 319, 320, 332, 333,

Allred, K. D.,

317, 318, 320, 322, 323, 326,

327, 328, 329, 330, 331, 332, 333,

Atkinson, D. R., 16, 400

129, 136

338

Asay, T. P, 16

M.

J.,

Blackburn,

66, 77, 78, 79, 85, 87, 90

1.,

9,

344

Blankstein, K. R., 331 Blaske,

Blau,

D. M., 454

S.,

275 I-l

NAME INDEX

1-2

Bogerto, R, 102

Carkhuff, R., 174

Bograd, M., 457, 458

Carlson,]., 109,

Boharr, A.,

53,

1

1

54

Bohart, A. C., 175

Corkery,

1 1

1,

1

12,

1

15,

438

Cornelius-White,]. H. D., 148

Borden, A., 512

Carter,

Borenstein, R. R, 58

Carter,

Borkovec, T. D., 532

Casement,

Bornstein, R. R, 59

Cashdan,

Bourduin, C. M., 454

Caspar, R, 172

Bowen, M., 442, 444, 445, 446, 447, 448, 449, 450, 451, 452 Bowman, C. R., 204

Cassidy,]., 103

J.

M.

Castonguay,

456 H., 456 L., 267, 269

Bray,J. Breger,

Breuer,

30, 31, 44,

J.,

Bricked, Briere,

J.,

48

356, 365, 371

J.,

Crocker,

].

Crumbaugh,

414 J-, Broverman, D. M., 401, 402 Broverman, I. K., 401, 402 1

1

,

Curlette,

W,

Curtis, R,

229

Curtis, R. C., 67, 97,

D’Alessandro, D. U., 347

145

].,

Cheung, S., Chevron, R.

397

Davidson, G. C., 271 10

Chisholm-Stockard,

Chodorow, N.

S.,

174

103, 384

62,

].,

M.

Davies, Davila,

59

].,

409 B. T., 454-455 D., 349, 350 D. D., 319, 346 S. N., 387

Davis, B., 408,

Davis,

Davison, G.

T. A., T.

253

325, 326, 328, 333, 346

Clarkson, R, 401, 402 Clarkson, R, 201, 202, 203, 209, 210, 211,

212, 213, 214, 217, 218, 225

269

Cleere, L.,

M., 22

Davis,

Clark, D. A., 315, 316, 319-320, 323, 324,

Coan, R.

W,

Davis, Davis,

C,

8,

233, 243, 253, 254, 255,

256, 257, 259, 266, 267, 306, 307 Day, H. D., 456 Deci, E., 373

510

deParia, N.,

21, 22

310

R, 309,

Clarke, D. A., 325

6l

S. A.,

176

Silva, R. B.,

David, D., 307, 311

399 435 S.,

da

Clark, D. M., 345

Brown,

98

Chen, C. R, 177, 312, 349

Brown, L, 384, 390, 395 Brown, L. S., 61, 94, 379, 380, 381, 383,

Brown,

144

W. L, l4l, 144 Curry, C. ]., 456

Clancy,

395, 396, 402

344

9,

Curlette,

Brown, R. J., 173 Brown, G., 331 Brown, G. K., 345, 346, 403 Brown, J. D., 171

384, 385, 386, 389, 390, 391, 393,

195

].,

Chang, C., 372 Chang, T. H., 457, 487

Chester, A.,

408, 4

R, 203, 206, 207, 216,

S.

Cucherat, M.,

Brooks, R. R, 7

D. R, 143

268

222, 225

M., 309

Chesler, R, 382, 389, 393,

Brothers, B.

243, 343

E.,

Crits-Christoph, R, 13, 14, 58, 102

Brooks, G. R., 397

Brossart,

346

C., 343,

].

Chambless, D. L, 14, 270, 345, 487, 532

Chernin,

61

J.,

344

511

R.,

Cristol, A. H., 10,

Chapman, A. L., 240 Chapman, ]. E., 268, 344 Chatwin, A., 487

399 226

Bretherton, D.,

H.

532

406, 432

R.,

].,

Craighead, W.

86

62

3

]., 9,

Coulehan,

Chantler, K., 175, 176

Brenner, C., 77

Bretz,

Cottraux,

253, 265

]. R.,

Corsini, R.

Cramer, D., 174, 310 Crandall,]. E., I4l, 142

L. G.,

Chamberlain,

188, 189, 190, 191

L.,

-

Cauley, C., 400 Cautela,

W,

Cornett, C. .

Coyne,

82, 83,

S.,

Bracke,

R.,

D.,

A., 68, 71

Chabot, D.

P.

506

400 B., 450, 457 R. A., 450, 452

Carrubba,

Brabeck, M., 384, 390, 395

Braverman,

Cormier, H. C., 510 Cornelius- White, C. R, 148

Carr, A., 494, 499, 500, 503,

D., 172

17, 120,

129, 131, 134, 138, 433, 436, 437,

Bond, R W., 240, 307, 343 Boone, C., 374

Bozarth,

1

M., 60

].

Deffenbacher,

16

]. L.,

457 498, 500 Buboltz, C., 455 Buckland, N., 310

Coffey, R. L.,

402 ]., 423 Cole, P. H., 214 Coleman, R. Z., 171

De]ong, R, 471, 472, 477, 478, 484, 485-486 DeRubeis, R.

].,

Buckley, R, 78

Colledge, R., 192

de Shazer,

461, 463, 468, 469,

Brudner- White, Bubenzer, D.

L.,

L.,

W

S., 345 R T, 189 T, 188, 189, 190, 191

Colapinto,

Derogatis, L. R., 59

247 372

S.,

14

Buckminster,

Collins, L. M.,

470, 471,472, 473,474,

Bugental,

J.

Collins,

478, 479, 480, 482, 483,

Bugental,

J.

Burlin,

R

Burnett,

G., 140

Bush, N. R, 455

344

Cadavid, M., 374 Cade,

B.,

Calfero,

461, 469, 473, 474, 478

J.,

228

L.,

Deutch,

L., 94,

378, 383

Combs, A. W, 171 Combs, G., 503, 506 Comeau, S., 182 Connery, A. L., 322 Connolly, M. B., 102 Consoli, A.

Contratto,

].,

S.,

527 379, 384

Cooper, M., 173, 180, 184, 186, 187, 189,

Cain, H., 486

Cambell,

484, 485, 487

Collins, R. L., 271

Comas-Diaz,

Burns, D. D., 346

Butler, A. C., 268,

L.,

Colucci, R, 458

D., 196 P.

P.

192, 194

143

Corbett,

402

Campbell,

B.,

Campbell,

V. L.,

1

Carey, M., 502, 504, 505

M. M.,

Diamond,

487 453, 454

H.,

G.,

Dicesare, E.

].,

Dickerson, V.

425, 426, 427, 428

C,

490, 496, 497, 501, 502,

503, 505, 506

DiClemente, C. C., 527, 528 Diekstra, R. R,

DiGiuseppe,

R.,

308 281, 287, 298, 310, 312

DiGiuseppe, R. A., 16 DiLorento, A. O., 172

171, 174, 175

]., 487 Corey, D. W., 312 Corey, G., 364, 367

Corcoran,

145

].,

De Vega, M.

DiNardo,

R.

A.,

Dinkmeyer, D.,

253 1

19

Dinkmeyer, D. C.,

Dinkmeyer, D. C.,

1

17, 132, 135,

]r..

138

Ill, 117, 133, 135

1

1

NAME INDEX

1-3

348

DiPietro, R., 109, 129

Evans,

Division of Counseling Psychology,

Evans, K. M.,

Committee on Definition, 2 Doan, R. E., 495, 498 Dobson, K. S., 334, 344 Dolan, Y., 463, 478, 483 Dolan, Y. M., 477

Exner, T.,

Dozois, D.

Drake,

J.

388

A.,

347

Favrod,

269 E, 446

287, 288, 290, 292, 293, 294, 297, 300, 301, 302, 303, 306, 307, 310

Field,

S.,

J.

Gerber,

].,

412

Getting, E. R., 16

Gholkar, R., 247

403

Gilbert, L.,

Gilbert, L. A., 379, 382, 385, 394,

461

M. S., 60 M. M., 345

Gillis,

T, 180,

Fischer, C.

J. T, 180 Dyck, M. J., 347 Dzelme, K., 487

181, 189, 190,

E

Gilroy,

191, 192

M.

N., 65, 82 Eagly, A. H., 322, 386

486

234

B.,

431,432

Glass, C. R., 233, 234, 237, 240, 252, 271,

315, 316, 343

59

I.,

340 W. J., 485 Glad, A. C., 456

Gingerich,

Fishman, H. C., 420, 424, 425, 429, 430,

Fishman,

D., 401

Gilson, M.,

145

Fischer, S. K.,

Fishman, D.

G.

Glass,

380 Flores, L. Y, 400 Foa, E. B., 258 Fodor, I. G., 402 Foerster, E S., 227 Fogarty, T. E, 446

172, 268

V., 9,

Fitzgerald, L.,

Eckstein, D., 109, 124, 135

Edgette,

Efran,

328

J. S.,

Edwards, M.

E., 117,

118

509

J. S.,

Egan, G., 155, 170

345 Eisengart, S., 485 Eliot, J., 388 Elkin, I., 12, 268

Glasser, C., 368,

360, 361, 362, 363, 364, 365, 366, 368, 369, 370, 371, 373

Fonagy, P, 102

380

Forisha, B. L.,

Forman,

E.

M., 268, 344

Forner, E, 102

Fosshage,

Elliott,

D., I4l

Elliott, R., Ellis,

172, 175

274-275, 276, 278, 279, 280, 281,

A.,

282, 283, 284, 285, 286, 287, 289,

297, 298, 301, 302, 303, 306, 307,

309, 311, 312, 313 Emery, G., 319, 320, 324, 328, 332, 338, 340, 342, 345 P.

M., 258, 267, 268, 269

Engels, D. W., 141 Engles, G.

308

I.,

Enright,

J. B.,

J. B.,

212, 214, 219, 220

500

M.

43, 44, 46, 47, 48, 49, 51, 54, 56, 61, 62, 122

502, 503, 506, 507, 508, 510, 512

253, 331

Ernst, C., 142

347 Escobar, M., 455 Espin, O. M., 396, 403 Etchison, M., 510 Eva, K., 307

M.

L.,

Fi.,

454, 455, 51

444, 445

Friedman, N., 201, 217 Frosch, C. A.,

455

Fuller,

D.

L.,

367, 370, 372

Fuller,

G.

B.,

367, 370, 372

Ernst, D.,

M.

R.,

233, 243, 253, 254, 255,

226, 227

R.,

R. N., 169, 170, 196,

R. E, 173

Goodyear, R. K., 19

455

A.,

P.

308 H., 343, 346

Gossette, R. L., Gotlib,

I.

Gould, R. A., 345 Gozez,

L.,

Grawe,

K.,

Gray,

Friedman, E.

453

S.,

Goodman,

Friedland, B. U., l4l

Friedlander,

J.,

382

Friedlander, M., 51

Epston, D., 490, 491, 494, 496, 497, 501,

91

Gomori, M., 412 Gonzales,]. E., 308 Good, G., 19 Good, G. E., 400, 403 Goodman, P, 202

Gore,

30, 31, 34, 35, 36, 37, 39, 41, 42,

Epstein, N., 331

Erbaugh,

176

Freud, A., 78, 79, 80, 81

Friedan, B.,

B., 73,

204, 222

258

E.,

Freire, E. S.,

394, 395, 397, 399, 400

Golann,

I.,

344 243

256, 257, 259, 266, 267, 526, 530

Freeman, A., 319, 320, 332, 335, 340 Freiberg, H. J., 1 52

384, 385, 386, 389, 390, 392, 393,

S.

Goldman, Goldman,

266 Free, M. L., 306, 343, 348 Freedman,]., 503, 506

Enns, C. Z., 60, 61, 229, 230, 382, 383,

Gochman, Goeltz, W.

Goldfried,

Franks, C. M., 233, 234,

S.,

V., 9,

J.,

Frankl, V. E., 181, 183, 184, 186, 192, 261

Freud,

Enron,

65

402 Fraenkel, P, 409 Frances, A., 390 Frank, J. B., 532

Franklin,

290, 291, 292, 293, 294, 295, 296,

Emmelkamp,

J. L.,

Fowers, B.

226, 227

Gloaguen,

Gold,]., 526, 531

169, 170, 172, 195,

196, 204, 222, 225,

373

Glasser, W., 353, 355, 356, 357, 358, 359,

Ehlers, A.,

Elliot, R.,

400

Gilbert,

DuBois, D., 344

Eakes, G.,

M., I4l

Gentry,

Gfroerer, K., 144

75 268

J.,

D., 19

J.

Fischer, A. R., 16

DuBoise,

Eagle,

230

S.,

Fine, R., 73,

Fisch, R.,

C., 175

Gay. P, 30, 31, 33, 48, 107

Gendlin, E. T, 152, 169, 170

107 N. P, 228

Finney,

258, 267

j.,

Geer, C. R., 243

C. B., 250, 252

M.

60

L.,

Gauthier,

371

C.,

J.,

Fiebert,

306

Garofalo, A., 8

Geller,

Ferster,

Dryden, W., 164, 275, 276, 280, 281, 285,

457

532

Fernbacher,

123, 128, 131, 140

8-9, 59, 239, 254

J.,

W.

Dreikurs, R., 109, 111, 115, 116, lk9, 120,

Duan,

C.

Farrell,

Fay, L.

72

R.,

J.

E.,

Garfield, S. L., 289, 290, 303,

Garnefski, N., 308

J.,

D.,

J.

Douglas, C., 68, 69, 70, 71

Downing, N.

379

Gaston, Falicov,

509

Garfield, L. E.,

310

Eysenck, H.

Fank,

Donaldson, G., 80, 81

J.,

].,

453 172

393

Grazioli, R.,

348

Greenan, D.

E.,

458

Greenberg,]., 195

Greenberg,

].

R., 65, 66, 72, 75, 78, 85, 86,

88, 89. 90, 92, 93, 95, 96, 97, 98, 99,

100 172, 174

Greenberg,

L.,

Greenberg,

L. S., 169, 170, 175, 196,

204,

Gaffan, E. A., 345

206, 207, 210, 216, 217, 222, 225,

Galatzer-Levy, R. M., 101

227, 228

NAME INDEX

1-4

67, 97, 98

310

Clrecnbcrg, R. L.,

345 456 Grcenwell, 1.., 268

Hirsch,

Cireene,

Hoffman, Hoffman,

Greever, K. B., 14

Holden,]. M., 145

Kantrowitz, R. E., 270, 271

Holdstock,

Kanus, W., 288

Cl. J.,

Gregoire,

195, 196

r.,

293 455 Gross, A. M., 252 Cjrosskurth, P., 80

Hollon,

Grieger, R.,

W.

Griffin,

Guerin, K., 443, 444, 445 Guerin, R, 443, 444, 445 406, 432, 446, 452

P. J.,

Guevremont, D.

G., 237, 242, 253, 255,

256, 259, 270, 271

Kallay, E.,

E., 106, 107, 109,

G., 270,

S.

348

537

Kaplan, M., 390

228

L.,

Kaplan, N. R., 228

Kareem,

229

J.,

266

Karoly, R, 262,

Karon, B. R, 37, 68

Kashubeck-West, Kasler,

S.,

J.,

Howatt, W. A., 353, 368, 373

Kastenbaum,

Huang, ]. S., 349 Hudson, P. O., 470 Hudson, R. A., 62 Hulsey, T. L., 258

Kautto,

Guzzetta, R. A., 196

Hunter, R, 270, 271

Kearney, A. B., 265

Hycner, R. H., 206, 220, 221

Keene, K. K., 144

Haaga, D. A., 347

Hyde,

Gurman,

A.

409, 442

S.,

420 Guterman, J. T, 471, 473, 474, 477, 487 Gutierrez, M., 400, 457 Gurney,

Guy,

B.,

D., 19

J.

Haaga, D. A. E,

Imber-Black,

Haber, R., 409, 415, 418

Ivey,

A.

Hackett, G., 399

Ivey,

M.

Hajzler,

J.,

307

Iwata, B. A., 251

C.,

440, 441, 442, 453, 461, 481

40

Hamilton, N. G., 82, 85

Hampton,

453 Hanson, R. H., 260 Hare-Mustin, R. T., 384 Harman, R. L., 201 Harrington, N., 309 Harris, S., 310 Hartling, L. M., 387 Hartmann, H., 72 Harvey, D. M., 456 Harvey, V.

Hayes,

B. R.,

349

Jacobs, L., 205, 206, 207, 210, 21

Jensen,

399 B.,

Jome,

Hemming,]., 201, 202, 203, 204, 210, 215, 217-218, 223, 224, 225

Jones, E., 81 Jones,

J.,

Henderson,

Jones,

M.

Henggeler,

1

52

W., 454

S.

Henry, W. R, 60, 102 Hensley,

R.

Heppner,

Hernon,

L.,

J.,

346

R.,

J. V.,

J.,

Juriga, S.,

1).,

19

K.,

372

-

Kirsch,

J.,

I.,

14

171

483

Kivlighan, D. M.,

8

84

L., 10, 11,

12

L.,

Kluft, R. R, 60, 61

Kniskern, D. R, 442

Koenig, A. M., 322

453, 454

400

173

S.

Jr.,

D. M., 510

Kohut, H., 91, 92, 93, 94, 95 Kolden, G. G.,

W., 251

Kal, E. E, 143

1

74

Kolenberg, R.

J.,

Roller, S. H.,

176

241

Koocher, G. R, 8

Kornman, C.

Kahng,

52

Knauth, D. G., 455

170, 173 155, 170, 171, 174, 175

Himmell, G.

236

387

Hersen, M., 243, 252, 254 J.,

1

349 I. J., 349 J., 372, 484

Kleist,

Jordan, E. W., 139, 143

Juntunen, G.

E.,

V.,

M. H., 174 Kleiner, E B., 306

487

Herrington, A. N., 144

G.

D.

B. S.,

Kline, R, 59

Herron, W. G., 22

Hill,

Kim, Kim, Kim, Kim,

Klein,

226

C., 234, 235,

Jourdan, A., 155

Hetrcma,

Kiesler,

K., 60, 61

Klein, M., 67, 80, 81,

309

Jones, R. A.,

Jordan,

442, 444, 445, 446, 447, 448,

Klerman, G.

Josephson, A.

348

Ketcham,

Kiser, D.,

Josefowitz, N., 169, 170

R, 8

R.

59

M., 16

Heintzelman, A., 81

V. L.,

E.,

449,450,451

Kirschenbaum, H., 148, 150, 152, 155

Johnson, W. L.

M.

King, N.

Johnson, T. W., 458

202

Kerr,

Johansen, T. M., 145

Heatherington,

Hefferline, R. E,

455

Kincade, E. A., 379

Johnson, R, 142, 455

L., 51

C.,

88, 89

309

Johnson, N. G., 380, 395

Heekerens, H., 226

K., 426,

Kernberg, O. E, 73, 86, 87,

R, 19

J.

Joffe, D.,

240, 241, 343, 347

A.,

P.

Kerig,

Kern, R. M., I4l, 144 1,

212, 213, 214, 218, 219 Jacobson, E., 257 Jacobson, N. S., 267 Jacobvitz, D.^ B., 455 Jakes, S. C., 346, 485 Jakubowski, P. A., 397 Jamison, C., 346 Jenkins, A., 493

Johnson, G.

P.

33

Kendall, P.

M., 345

Kern, R. K., 144

349 Hayward, M., 509

Hays,

S.

Kern, R., 144

Johnson, D., 379, 382, 383, 386, 389, 393,

373

S.,

S. C.,

Kemp- Wheeler,

312

260

433, 434, 435, 436, 437, 438, 439,

Hall, C. S., 39,

Y.,

221, 223

S.,

Kelso, E. N., 270, 271

457

55, 170

1

Iwamasa, G.

D.

J.,

B.,

391

455

322

Keller, J.,

155, 170, 175,

E.,

L.,

Haldeman, D. Haley,

E.,

233, 237, 239, 253,

E.,

Keala, D. K.,

Kellogg,

Haaga, D. E, 308

Hagan, K.

J.

R.,

263, 264

306, 307, 309

8,

253 G., 446

Kazdm, A.

386, 400

]. S.,

401

l4l

Kassoff, B., 103

9

S.,

M.

Kaplan,

B. K., 31

Howard, G.

266

H.,

Kaplan, A. G., 61

.

G., 532

Hopko, D. R., 241, 247 Hopko, S. D., 24 Hops, H., 454-455 Hopwood, L. E., 485-486 Homey, K., 6l Horowitz, M., 228 Houston,

E

Kanfer,

175, 177

L.,

M.

Kamsler, A., 493

138

D., 14, 331, 346, 487,

S.

Holtforth,

A.,

Guarnaccia, G. A., 139, l4l

CXierin,

I.,

L.,

396

Kosek, R. B., 456 Kovacs, M., 320, 326, 328

9

1

NAME INDEX

1-5

455 Krasner, L, 242, 244, 248, 250 Kravetz, D., 393 Krainz,

S.,

Krebs, L. L., 140 Krieder,

J.,

Kuehnel,

Kuhn,

J.

London,

LoRiccolo,

Maxwell,

527

R,

EG.,

Lopez,

May,

19

M., 252

Ludgate,

Lund,

454

Kurtines, W.,

Kuyken, W., 347

LaFond,

B. A. G.,

Laing,

493

373

M.

240, 343

McElwain,

Lusterman, D. D., 397

McGaugh,

Lyddon, W.

J.,

McGoldrick, M., 450, 457

Lynn,

171

J. B.,

S. J.,

306

16, 17, 58, 60,

268, 487

McNair,

456

T. R,

Lawrence, D. H., 372

Lawson, D. M., 143

Mackewn,

Last,

195, 196

C. G., 243, 252, 254

Lazarus, A. A., 260, 303,

527

MacLaren, C., 287, 290, 294, 296, 298, 301, 302, 303 Madanes, G., 433, 434, 435, 436, 437, 442

310

Leaf, R.,

Leahy, R.

338, 343, 344

L.,

Maddi,

Leak, G. K., 142 Lee,

M.

485, 488

Y.,

Lee, W., 423, 429,

457

Maholick,

S.,

L.,

Mahoney, M.

Lejuez, G. W., 240, 241, 247,

254

75 195

306

19,

J.,

Maina, G., 102

409

271 61

].,

L.,

60

H. G., 456, 457 Leszcz, M., 183 Leuzinger-Bohleber, M., 59

Mallinckrodt, B., 485

Lerner,

Malouff,

Manaster, G.

139, 143, 145

J.,

106, 131, 134

Levant, R. E, 15

Manaster,

Levin, R. B., 59

Mancoske, R.

247

E., 510 Meichenbaum, D., 262, 266, 343

Meakes,

Mellor-Glark,

Melnick,

J.,

Mangelsdorf,

173

].,

214, 220

J.,

Mendelson, M., 253, 331 Merry, T, 155, 167 Meyer, A. E., 172 Michels,

174

J. L.,

Mickel, E., 374

M. A., 245, 262, 263 M. B., 183, 221, 226

Milan,

W,

Miller,

1.

Miller,

J. B.,

Miller,

M.

348 387

V.,

203, 204, 211,215,

400

].,

S. C.,

268

455

456

Miller, R. B., 455,

Miller, R. C.,

M., 310

J.

E., 141

221, 225

Maisel, R., 506, 512

S.,

A., 408,

McWilliams, A.

Miller, R.,

Leonsky, E. M., 228

Levine,

40, 41, 44, 58,

Maisael, R., 510

177

S. ].,

J.

L. D.,

McNeilly, G.

Miles,

M.

Mahler,

487

Lemoire,

S. R., 2, 7, 8, 17,

187, 188

Leiberman, M. A., 221, 226 Leite, N.,

201, 202, 203, 212, 213, 217,

].,

218, 219, 225, 229

527

Lazarus, A.,

307 377, 382

Macaskill,

Lane, R. C., 73, 91 J.,

267, 269

T. E.,

B.,

McNally, R.

307

Macaskill, A.,

N. D., 307 Macavei, B., 307, 309 Macdonald, A. J., 484 MacDougall, C., 175, 176 Machado, R. R. R, 171, 174

Lantz,

j. L.,

McGovern, McLellan,

189, 191, 196

B., 180,

McLendon,

Mabee,

J., 9,

144

].,

McGarthy, M., 307 McGaulley, M. H., 70

Lyons, L. G., 308

142

Laird, T. G.,

187, 191

500

T. W.,

Luoma,

297

Jr.,

9

S. E.,

McGarthy, G.

W., 340

J.

C.,

R., 181, 182, 184, 185, 186,

260

].,

M.

Maultsby,

Loyd, B. D., 372

Kupers, T. A., 390

Lambert,

144

E.,

513

T. S., 8

L.,

Logan,

268

Miller, S. D., 483, 486, 487,

W.

Miller,

R.,

488

268

Miller, T. L, 9, 172,

170

Milliren, A., 109, 124

228 Minuchin, R, 423, 424, 425, 426, 427, 428, 429 Minuchin, S., 420, 423, 424, 425, 426, Mills, B.,

Levitsky, A., 209, 218, 221, 222,

223, 224

M.

Maniacci,

Mann,

348

B.

454

J.,

Lewis, T. E, 136, 144

Mansager,

Liberman, R. R, 252

Maramba, G.

Lichtenberg, Liddle,

H.

W.,

J.

A.,

1

485

5,

Lillis,].,

Marbley, A. E, 379

Marecek,

172

403

C., 10, 11, 12

J.

Markowski, M., 486 Marsh,

E.

].,

456

Linnenberg, D. M., 373

Martell, C. R., 242,

Lipchick, E., 461

Martin, D., 4l4, 416, 417, 419

Liss-Levinson, N., 380,

W.

Marshall,

483

Masling,

386

J.

Massad,

Lock, A., 510

Massman,

416

Loewald, H. W., 78 l.ofgren,

L.,

486

Loftus, E. E, 60, 61

Logan,

B.,

512

L.,

258, 267

243

1

85, 86, 87, 88, 89, 90, 92, 93, 95, 96, 97, 98, 99, 100, 101, 103 L.,

488

Masson,

Masuda,

M., 258

R.

R. j.,

268

M., 39, 45, 46

J.

A., 240,

Matheny,

Molnar, A., 485

Mongrain, M., 347

Monk,

G., 501

Montalvo,

B.,

Monte, G. E,

M., 59

Maslow, A. H., 107

Littlewood, R., 229

S.,

M., 91

Mollon, R, 91, 93

255

Marshall, D. D.,

Loeschen,

J.

Mjelde-Mossey,

25 Linehan, M. M., 240 J. S.,

Lipchik, E.,

Mishne,

Marts, A., 511

240, 343

Lindberg,

509

Mitchell, S. A., 65, 66, 72, 75, 77, 78, 79,

393

J.,

Markowitz,

328

Lijtmaer, R. M.,

G., 532

Marcotte, D., 532

453

Lietaer, G., 155, 169,

427, 428, 429, 430, 431, 432, 457,

144

E.,

Missar, G. D.,

Lieberman, M. A., 183, 226 Liese, B.,

R, 124, 130, 132, 134, 135,

136, 138, 139

89

Levy, K. N., 86, 88,

Lewis, G.,

Maniacci, M., 109

K.,

343

144

Matheny, K. B., 144 Matsuyuki, M., 403

107,

1

420, 457 7, 33, 46,

14,

1

57-58, 74, 106,

19, 139,

142, 152

Moradi,

B.,

383, 384, 388, 400

485

Morejon, A.

R.,

Morgan,

495, 496, 499, 501

A.,

Morgan, A. V., 173 Morgan, j. J., 234 Mo.sak, H., 117

NAME INDEX

1-6 Range,

350

L.

M., 228

129, 130, 132, 134, 135, 136, 137,

Padesky, C., 349, Padesky, C. A., 319

138, 139

Painter, D., 145

Rasmussen,

228 Palenzuela, D. E., 485 Paludi, M. A., 385 Papero, D. V., 446, 447

Rayner, R., 234, 235

Mosak. H. H., 109, 115, 116, 119, 124,

Paivio, S. C., 227,

Mosak, H. M., l40 Mozdzierz, A. B., 107 Mozdzierz, G.

Murdock, N.

Murphy,

107

J.,

7, 19, 22,

1..,

205, 443, 455

62

T. K,

Myran, D., 169, 170 Mytton, J., 164

Nathan,

Neenan, M., 276, 281, 290, 293,

Remer, R, 270, 383, 389, 392, 393, 395,

Neimeyer, R. A., Nelson,

M. M.

P.

Penick,

J.,

Peris,

O., 119

Nelson-Jones, R., 216

Neufeldt,

262

J.,

171, 174

S. A.,

Peris,

220

Nevis, S. M., 214,

E

C. E, 328, 331, 332, 334, 335,

336, 338, 340, 342

Newman, M. Newton,

G.,

M. P., 406, 407, 408, 409, 419, 421,423,433,442,450,451,456

Nichols,

G., 8, 15, 19,

J.

1

80,

1

83,

1

Richert, A.

Perosa, S. L.,

Rickman,

455 455

Perryman, T.

B.,

Northey,

Nunnally,

E

A.,

2

512

M., 207, 210, 215, 216, 218, 221,

269

V., S.,

Prochaska,

J.

479, 480, 481, 484 O’Hanlon, W. H., 461, 464, 465,

466, 469, 470, 471

,

473, 474, 475,

476, 477, 478, 479, 480, 481, 483 O’Eeary,

E.,

210, 21

I). E.,

Osborn, C.

Research Group, 13

1,

J.

19

144

J.,

N., 374

226 Otto, M. W., 345 B.,

145

L., 388 Rowan, T, 469, 474, 479 Rowe, C. E., 453, 454

Rudolph,

Pulos,

Rule,

S.,

328 374

W.

Rush, A.

226

10

J.,

Roush, K.

Prout, M.,

L. B., 135, R., 109,

Quintar, B., 73, 91

J.,

Ruthven, A. Ryan, N.

Rader, Radtke, Raff,

J.,

J., E.,

120

J.,

E.,

1

56

344

382, 394, 400 371

68

Sabik, N.

J.,

401

Sachese, R., 170

532

Raimey, V. C., 6

Safran,

Raiz, L., 195

Salkovskis,

Randall, E., 184, 186

Sanchez, W., 374

J.

145

319, 343

Russell, S., 502, 504,

1

O’Sullivan, K.,

Overholt,

MATCH

M. M., 450, 452

Orlanidis,

Ososkie,

531 Project

B. O.,

Rounsaville, B.

O., 378, 527, 528, 529, 530,

488 268

Rossiter, A., 474,

Rothbaum,

374

A.,

Ollendick, T. H.,

Orlinsky,

268

L.,

390 379

175

O’Hanlon,

463, 467, 469, 470, 474,

265 Rosenzweig, S., 14, 526 Rosman, B., 420 Rosman, B. L., 423, 426 Rossier, R.,

Pretzer, E,

A.,

Rorschach, H., 48

Ross, R.,

486 346

E

50

1

268

19

Prendergast, M., Prest,

Roll,].,

Rosenthal, T.

225

Poyrazli, S.,

M.

Rogers, N.,

H., 345

O’Brien, R. M., 308 O’Connor, J. J., 433, 435, 436, 439, 440 Oei, T. P. S., 306, 307, 311, 343, 348 Ogles, B. M., 9, 16, 17, 58, 60, 268, 487

J.

174, 181

221, 225

Pope, K.

Okonji,

163, 165, 166, 167, 168, 169, 171,

483

207, 210, 215, 216, 218, 220,

Polster, E.,

Pomini,

B.,

156, 157, 158, 159, 160, 161, 162,

510

R, 444, 447, 450,

M.

Pollack,

240

L. A., 9, 268,

Rogers, C. R., 148, 150, 151, 152, 154, 155,

T, 477v

Polster,

Nylund, D.

403

Piason, A., 176

E

J.,

345 Rodriguez-Arias, J. L., 485 Roemer, L., 242, 253, 254

Robinson,

401

Philpot, C. L., 397,

246, 247 1

61

S.,

M. W., 310, 312

Robins, C.

14

L.,

510 Podus, D., 268

Nye, R. D., 37, 38, 39, 171, 245,

5

372

Piran, N.,

Nutt, R. L, 380, 397

Nylund, D.,

Ristuccia, C.

Robin,

Piercy,

Nutt, R., 380

M., 235

Rilling,

Peven, D. E., 118, 131, 134

Pickering, M.,

461, 471

E.,

l43

Roazen, R, 46, 50

K.,

S.,

J.,

Riepe, L. E.,

331

J. B.,

503 35, 47 402

J.,

Peterson, R. D., 401

Pichot,

486 455

Nordstrom,

217, 225

Perosa, L. M.,

528, 529, 530, 531

Nord, G., 260

395, 397

440

86,

190, 191, 195, 196, 378, 526, 527,

346, 485

J. E.,

Race,]. K., 377, 381, 384, 390,

Richeport-Haley, M., 435, 436, 437, 439,

Phillips, R. D.,

Norcross,

Rhodes,

145

E.,

247, 250

S.,

224 E., 215

Phillips,

Nishimura, N., 403

400

Reynolds, G.

374

Peterson, A. V., 357,

144

B.

487

Rice, L. N., 170, 204, 206, 207, 210, 216,

Persons,

532

373

207, 209, 210, 211, 212, 213, 215, 216,217,218,219, 221,222, 223,

Nevo, O., 141

Newman,

L.,

Retter, K.,

199, 201, 202, 203, 204, 206,

S.,

225

Rennie, D.

Reyes, C.,

144

Perlman, C. A., 6l

D., 142

Nemeroll, C.

136

R.,

Perkins-Dock, R.

268, 345

9,

396, 397

Reuterlov, H., 486,

Perez-Prado, E. M.,

294, 306

Nelson,

Peluso,

M.

349

D., 481

Reitman, D., 243

312

175,

B.,

P.

6

E.,

P.

Reinke-Scorzelli, M., Reiter,

Payne, M., 496, 507, 509,511 Pedersen,

346

A., 328,

Reinecke,

Patterson, C. H., 148, 174, 177

Nadiga, D., 346

124

R., 109,

P.

W. L., 487 M. A., 320, 332, 335, 344

Reimer,

217-218, 219, 223, 224, 225 Paskauskas, A., 80

70

B.,

I.

148, 173

J.,

N.

Rector,

M., 201, 202, 203, 204, 210, 215,

Parlett,

Murray, K., 399 Myers,

Raskin, N.

D., P.

M., 330

505

1

1

1

NAME INDEX

1-7

229

Saner, R.,

Silverman,

M.

S.,

307

Sulliman,

I4l

R.,

J.

Summers, Y, 144

San tor, D. A., 347

Simon, G. M., 429, 457 Simon, R., 406, 420, 423, 456 Singer, A., 229

Sapp, M., 222, 225, 371

Skinner, B. E, 237, 239, 242, 244, 245, 246,

Swanson, M., 486

Sansone, D., 371, 'ill Santisteban, D. A.,

454

187

Sartre, J. R,

416, 417, 418, 419, 420 Saunders, K.

401

J.,

Smith, A.

402

403 226 Schmitz, B., 226

Smith, E. W.

M.

Szabo, R, 461

Szapocznik,

E.,

Smith,

196

M.

Smith, T.

225, 226

L.,

172,

L., 9,

Taub, R. R., 122, 123 Taush, R., 172

390

Tavris, C.,

Schneider,

119

S.,

Sollod, R. N., 7, 46, 106, 107,

Schoenewolf, G., 122

Schoppe,

455 Schrodt, G. R., 340 Schroeder, H. E., 268 Schulenberg,

S. E.,

A.,

308

Soloman,

S.,

194, 195

Spangenberg,

189

J. J.,

Schwartz, R. G., 408, 409, 450

St. Clair,

349

59

Seem,

379

S. R.,

Seeman,

532

Segal, Z. V., 331,

M.

Seligman,

Thoresen, C., 226

Thoreson,

M.. 57, 76, 81, 82, 83, 89, 90, 91,

97

456 St. James-O’Connor, T, 510 Staemmler, EM., 223 Standifer, D., 400 Stanton, M. D., 435, 436, 437 Staples, E R., 10, 268 Steele, C. M., 322

E. R, 9, 13, 15, 226,

252

Tompkins, M. A., 331 Toukmanian, S. G., 225 Trad, A., 144

Tredinnick, M., 402

Tremblay,

Senn, G. Serok,

495, 500, 504, 51

L.,

R.

402 226, 227

Truax, C., 152, 174

401

Settle, S. A.,

Stein,

453 Shadish, W. R., 453 Shafter, K. C., 471, 473 Shapiro, D., 268 Shapiro, D. A., 13, 268 Sharp, L R., 345, 348 Sexton, T.

Stiles,

Strieker, G., Strieker, J.,

Shelton, R. D.,

Sherman, A.

Stromseth,

142

J.,

R.,

Strozier,

243, 248, 250, 251, 259,

261, 262 Shlien,

J.

Shulman,

B. H.,

153

117

22 241

90

B.,

Strumpfel, U., 225, 226

1

1

16,

378

Sigelman, C. K., 141

1

18, 128,

Uhlenhuth,

Ullmann,

E. H.,

L. R,

346

242, 244, 248, 250

Usher, C. H., 175, 176

van derVeen, R, 155, 156, 174 van Deurzen,

E.,

185, 189, 191

van Deurzen-Smith,

E.,

184, 185, 189

VanDeusen, J. M., 426, 427 Viene, D., 22 Vira, R., 456 Vontress, C. E., 96 1

Subich, L. M., 400 Sue, D., 62, 145, 176, 229, 270,

131, 134 Siegel, R.,

J.,

Stuhr, U., 172

E. L., 152, B.,

C.

40

531

Stuart, S., 10,

Shorkey, G., 310

Shulman,

193

Strupp, H. H., 60, 102

M., 140

Shostrom,

193

526

Strosahl, K. D.,

346

173

Tyson, G. M., 228

Strausser-Kirtland, D., 19

454-455

E.,

Tylka, T. L,

173

B.,

Strasser, E, 185, 186, 189, 190,

Sheedy, G., 226 Shelton, A.

W.

Twigg,

Strasser, A., 185, 186, 189, 190,

Shaw, B. E, 319, 334 Sheeber, L.,

402 Turner, C. B., 402 Turner, B. E,

269 58

Stiles, T, C.,

103

R.,

R.

Tudor, K., 155, 167, 171

Stewart, A., 143

Shaughnessy, R, 19 Shaver,

265

H. T, 117, 118 S. M., 9

Steketee, G.,

345

I.,

M. S., I4l Tuason, M. T, 455 Tseng,

Steinbrueck,

L., 16,

M., 241

Tsaousis,

331

Steffek, B. D.,

269

Trower, R, 309

170

Steer, R. A.,

Y.,

S.,

Steele, J.,

M., 22

J.

Trieu, V. H.,

Tsai,

Semmler,

R., 19

206 Toman, W., 446

191

St. Clair, S.,

152

J.,

397

D., 237, 242, 253, 255, 256,

Spinelli, E., 188, 189,

92,

Sears, R. R.,

348

J.,

Tillet, R.,

346 E,

135

259, 270, 271

M., 171

Seager,

M.

Spiegler,

D.

Tham, E., 373 Thompson, C. L., 135, 145 Thompson, J. K., 255

175

Sperry, L., Ill, 117, 133, Spiegel, S. B.,

J.

Taylor, S. E., 171

Ternstrom, A., 486

Soloman,

22 Schuman, M., 510 Schumer, E, 420 Schutte, N. S., 310

Scorzelli,

14, 119,

Terry,

Schultz, C. L.,

Scogin, E,

1

139, 142

S. J.,

310

Target, M., 59, 102

510

E.,

Sokol, L., 348

131, 132

454

Tabachnick, B. G., 19

268

Smith, T. W., 307, 311

E, 112, 124, 128,

J.,

Szentagotai, A., 307,

206

Smith,

Schneider,

Syzmanski, D. M., 396

142

J.,

Schigl, B.,

J->

Sweitzer, E. M., 142

Smith, G., 497, 499

Sober, M., 385,

Schneider, K.

268

J., 402 Smith, A., 378

82, 83, 84, 89

Schellenberg, E. G.,

107, 109, 118, 131, 134, 136,

140

Slusher,

89

J.,

Sweet, A. A., 255, 266

455

E. A.,

Sloane, R. B., 10, 58,

Scharff, D. E., 82, 83, 84, J. S.,

Sweeney, T.

Skolnikoff, A., 101

Skowron,

Schacht, T. E., 60

Scharff,

Swartz, H. A., 10, 11, 12

Skinner, N. E, 59

409, 410, 411,412, 413, 4l4, 415,

Satir, V.,

Swank, R, l4l

247, 248, 263

306

Sass, L. A.,

Svartberg, M., 58

312, 457 Sue, D. W., 62, 145, 175, 176, 229, 270,

312,457 Suinn, R. M., 253

Wadden,

T. A.,

Waehler, C. A.,

1

269 5

Wagner-Moore, L., 204, 209, 216, 225, 229 Waldo, M., 184, 185 Waldron,

S.,

101

NAME INDEX

1-8

Walker, N., 87 Wallace,

M.

D., 251

Wallen, R., 209 Wallerstein, R.

Walsh,

M.

S.,

58, 72, 73, 77, 101

Walsh, R. A., 189, 191, 196

Walsh,

486

S.,

Walton, D.

Wheeler, G., 202, 210, 216

Yalom,

M.

144

S.,

Whipple,

K., 10,

Whiston,

S. G.,

16

Yalom, Yap,

Whiteside,

V.,

].,

Widiger, T. A., 390, 401

Ward, C, 253, 331 Warman, D. M., 331 Waterhouse, R. L., 176

Wieseler, N. A.,

Watkins, C.

Williams, D.

E.,

Williams, R.

E.,

142, 143

Watson,

252

S.,

J. B.,

234, 235

Watson,]. C., 169, 170, 175, 196, 204, 222, 227

Yoder,]. D., 187, 385, 387, 392 Yontef, G., 205, 206, 207, 210,

211, 212, 213, 214,

218, 219

255 527 Wilson, G. D., 59 Wilson, G. T, 239, 242, 243, 260 Wilson, K. G., 241 L.,

215, 216, 217, 219,

220, 226

289, 290, 292, 293, 300, 312,

313 73, 76, 77, 78, 82

Wolitzky, D.

Weinberger, A., 326

Wolke, D., 348

Weiner-Davis, M., 464, 465, 466, 471,

Wolpe,]., 244, 245, 249, 250, 251, 253, 254,

Weinrach,

S.,

Weinrach,

S.

G.,

Weishaar,

M.

E.,

Woolfolk, R.

Wright,

307

West,]. D., 498, 500

Weston, D., 58, 60 Wettersten,

Wetzel, B.

E.,

444, 447, 450

486

485

].,

Wright,

E.

].

10,

S.,

349

140

].,

]. K., 371 Zemet, R. M., 226, 227

H.

399

A.,

307 Zimmerman, G., 269 Ziegler, D.]., 278,

Zimmerman,

306

270, 379, 380, 382, 383, 386,

342

Wubbolding, R., 355, 357, 359, 371 Wubbolding, R. E., 353, 355, 356, 357, 361, 364, 365, 366, 368, 369, 370, 371,

373, 374 Wyche, K. E, 377, 381, 384, 390, 395, 397

]. L.,

490, 496, 497, 501, 502,

503, 505, 506

Zimmerman,

T. S.,

486

Zimring, E, 170 Zimring,

D.,'328 H., 320, 332, 333, 335, 339,

W.

Zeig,

Zetzer,

Worrall, M., 171

1

Wessler, R. L., 288, 306,

K. B.,

Worell,

L.,

E.,

Zanardi, C., 62

,

389, 392, 393, 395, 396, 397, 399

Wenzel, A., 345, 348

]. L.,

256, 257, 259, 260, 261, 267, 269

315, 316, 324, 326, 327,

332, 333, 334, 338, 341, 342, 343

326, 328, 332, 333,

Zarski,

306

Weissman, A. N., 331 Weissman, M. M., 10,

Wetchler,

L., 65,

Wong, E. G., 349 Woods, M. D., 414, 416, 417, 419 Woods, P. ]., 308

150, 153, 154

].,

Young,].

Zane, N.

Wedding, D., 3

481,483

268

Yorkston, N.

334, 335

Wolfe,

]. L.,

Yontef, G. M., 207, 209, 211, 212, 214,

I4l

Watzlawick, R, 461, 467

473, 474, 475, 476, 477, 479, 480,

50 457, 487

Willhite, R., 109, 124

Winer,].

H., 461

].,

L.,

Williams, G. B., 495, 500, 504, 511

Winton, M., 510

j.

Yeh, R.

260

Watts, R. E., 109, 136

Weakland,

345

L.,

Yashioka, M., 510

Yates, A.

37, 68

Wang, D. C, 205

E.,Jr., 19, 139, 140, 141,

275, 276, 294, 297, 302

].,

Yasinski, L., 61

M. M., 139

Widener, A.

532, 533

310

189

V.,

White, M., 193, 490, 491, 494, 495, 496,

Whiteman,

B. E., 8, 9, 15, 16, 268, 345,

Watson, G.

221, 226

Yankura,

Wampold,

D., 180, 183, 184, 185, 186, 187,

I.

White,]., 143

Walts, R. E., 141

48

].,

191, 193, 196, 197,

268

497, 499, 501, 502, 503, 504, 507, 508

22

E.,

Yalof,

Wheeler,

390

R.,

Wexler, D. A., 170

Zinker,

E.

].,

M., 148, 172

215, 218

Zurawski, R. M., 307, 31 Zuroff, D. C.,

347

1

Subject Index

ABCDE model, 292 ABC model, 280, 287-288 329

Abstraction, selective,

Acceptance and 241. See

Commitment Therapy,

also

240,

Behavior Therapy (BT)

if”

commitment

stage,

disintegration, 91,

Individual Psychology, 145

existential,

Narrative Therapy, 504

Existential Therapy, 185

Reality Therapy,

374

Albert

neurotic, 44, 185

clients,

Ellis Institute,

270

normal, 185

276, 287

Alcoholism, aversive techniques

Adaptive schemas, 321

All or nothing thinking,

realistic, for,

260

329

Alternate stories, 496, 500

212

creative,

74 American Association of Marriage and Altruistic surrender,

Adler, Alexandra, 106, 107, 109 Adler, Alfred. See also Individual Psychology

Family Therapists, 406—407

(IP)

assessment, 124,

129-130

basic philosophy,

109-1 10

central constructs. 111,

112-113, 114,

115 diversity issues,

feminism

in counseling,

American Family Therapy Academy, 407 American Indian clients, 270, 488 Analogic communication, 434 Anal stage, 4l Analytical psychology, 68-72. See also

144-145

Psychoanalysis

380

health and dysfunction, 120, 121, 123

jungian typology, 69-70

human

psychological dysfunction and therapy,

motivation,

on other 106-107

influence life of,

photograph

of,

1 1

theorists,

138—139

133-134 108—109

44 97 236-239, 243,

Relational Psychoanalysis,

Applied behavior

analysis,

245-249, 251-252 Archetypes, 68, 69 Artifacts, written,

507—508

Asceticism, 74

Asian clients Behavior Therapy, 270 Cognitive Therapy, 349

Family Systems Theory, 457 Gestalt Therapy,

229

Person-Centered Therapy, 176 Solution-Focused Therapy, 487—488 “As if” technique,

1

36

Asking about the problem technique, 479

48—49 Anderson, Paul, 406 Anima, 69 Analytic couch,

process of therapy, 132, Science of Living, The,

70-72 topology of the personality, 68-69

105

44 214

moral, 44

Actualizing tendency, 157

Adjustment,

93

185

Gestalt Therapy,

207

Alaskan Native

388, 401

66-67

Freud’s views on,

Agoraphobia, 46—47

340—341

Activity scheduling,

Family Systems Theory, 457

Aggression,

technique, 136

Action stage of change, 528, 529 Active

depressive,

Solution-Focused Therapy, 487

Accountability practices, 505 “Acting as

Behavior Therapy, 270

Assertiveness training,

263—264, 341—342,

397-398, 402 Assessment Behavior Therapy, 252—254

Sigmund Freud and, 107

Animus, 69

Bowen’s Family Systems Theory, 448-450

theory of the person and development of

Ansbacher, Heinz, 106

Cognitive Therapy, 33 1 -332

Anti-Anorexia League, 506

Ego Psychology, 77

Antisuggestion, 138

Existential Therapy,

Anxiety

Gestalt Therapy,

the individual, 116, 117, 118, 119

therapeutic atmosphere, 130 therapeutic techniques, 134—135,

137-138

Adler, Kurt, 106, 107, 109

Behavior Therapy, 245, 250—251, 259

Adler, Valentine, 106

castration,

Adventurousness, 188

chronic, 445,

African American clients

Cognitive Therapy, 345

42

448

188-189 214-21 S Individual Psychology, 124-130 Narrative Therapy, 499 Object Relations, 86-87 Person-Centered Therapy, 162

1-9

I-

SUBJECT INDEX

10

Psychoanalysis,

48

Rational Emotive Behavior Therapy,

principles of,

287-289 364

Relational Psychoanalysis, 98

94

neoanalytic approaches, 64, 103 overview, 25

the individual,

in

427-428

theory selection and, 523

257-266

Assimilative Psychodynamic Psychotherapy,

531 Association lor Behavioral and Cognitive

T herapies, 239, 243

ofWomen

in Psychology,

380

Attachment theory research, 103 Authenticity, 187, 212 Autism, normal, 76

of cognitive processing, 320

level

Automatic thoughts, 316, 317—318, 323—324

Autonomy, 73, 326, 444 Average expectable environment, 75

238-239 260

Aversive conditions, Aversive techniques,

modes

7-2 1

core,

323

323 irrational, 281—282, 287—288, 290-291, 306-307 musturbatory, 281, 284-285 rational, 280-281, 302 in Rational Emotive Behavior Therapy, 280-282, 291 Berg, Insoo Kim, 461 Beyond Freedom and Dignity (Skinner), 237-239 BFST. See Bowen’s Family Systems Theory (BFST) BFTC (Brief Family Therapy Center), 461, 471, 484-485

in,

1,

clients

Bandura, Albert, 237, 239, 249

Bowen’s Family Systems Theory (BFST)

Barrett-Lennard Relationship Inventory, 174

Bowen’s Family Systems Theory (BFST),

442-452. See Theory

253

Basic Adlerian Scales for Interpersonal

also

Family Systems (FS)

357-359, 373 Needs Survey, 373 Basic tasks, 115-116

BASIS-A

process of therapy, 451

1

16

Basic needs, Basic

(Basic Adlerian Scales for

Interpersonal

9.

447

1

8

.

See also Cognitive

Therapy (BT) Center for Studies of the Person, 148, 154

Change levels of,

paradoxical theory

Brief

Behavioral rehearsal, 342

451—452

48

dynamic therapy, 102 Therapy Center (BFTC), 461, 471, 484-485

Behavioral self-control, 266

Brief Interpersonal Therapy,

Behavior Therapy (BT), 232-272

BT.

485

244—250 diversity issues, 270-271 evaluation of 266-270 health and dysfunction, 250-252 human motivatioir, 244

528

snowball metaphor

466

of,

528-529

stages of,

Change 101 (O’Fdanlon), 463, 470 Change talk, 468

417

stage,

Charcot, Jean-Martin, 31

,

44

Children

362 creation in, 234-235 elimination in, 235-236

choice theory fear fear

first-born,

1

for,

17-1 18

41-43

Freud’s views on, 34,

114

1 1

neurotic, 121, 123 only,

1 1

pampered/spoiled, 121

primary

412

triad,

second-born, 118 social interest and,

Chinese

13

1

clients, 25,

312, 349

354-355, 358, 360,

{G\2iSSCT),

368 Christian clients, 195

Chronic

anxiety, 445,

Circular causality, Clarification,

448

408

90 234—236, 244-245,

Classical conditioning,

250-251

Behavior Therapy (BT)

background, 233-241

232-233, 271

219

Choice Theory

Brief Family

central constructs,

of,

Brazilian clients, 176

Behavioral experiments, 340

242-243

529-530

Choice theory, 354-355, 358, 360-361, 362 Choice Theory Basic Needs Scale, 373

Breuer, Joseph, 30, 31, 44,

case study,

268, 269, 485. See also Behavior

Bteaking patterns technique, 480—481

,

408

(Cognitive-Behavior Therapy), 233,

youngest, 118

42

Beck Depression Inventory, 253, 331 Bed-wetting, 441 442

basic philosophy,

CBT

Bracketing, 193

Boys, Freud’s views on,

Therapy (CT) Beck, Judith, 3 7-3 Therapy (CT)

Causality, circular,

in

455^56

therapeutic techniques,

See also

48

neglected, 121, 123

the individual,

Cognitive

Catharsis,

middle-born,

432—433

Beck, Aaron, 314, 31 5—3 17, 31

Catching oneself technique, 137

diversity issues,

theory of the person and development of

Success-Adult), 144

Catastrophizing, 329

central constructs,

research support,

Bateson, Gregory, 407,

Castration, 42, 122

inferiority feelings and,

444—447 457 health and dysfunction, 448 nature of therapy, 448-451 overview, 442—444

Success-Adult (BASIS-A), 144 Basic mistakes,

theory selection, 514-515

Chaos

1

Blow-up technique, 260—261 Bodywork, 224 Boundaries, 210-211, 228, 424-425, 431 Bowen, Murray, 407, 442, 443—444. See also

228

352-353, 374-375 Solution-Focused Therapy, 460, 489 theory introduction, 1-2 Reality Therapy,

processes of,

17-118, 142-143, 446-447

and transgender

Awareness training, 224

Baseline patterns,

1

Blamers, 4l

218, 220, 225

210-21

resistances to,

368

Bisexual clients. See Gay, lesbian, bisexual,

36-37 212-213

62

273, 313

Bipolar intrapsychic representations, 82

cycle of, 209,

experiments

Psychoanalysis, 29—30,

Rational Emotive Behavior Therapy,

Cognitive Therapy, 322-323

Birth order, 1

184-185

Bibliotherapy, 295, 346,

Awareness benefits of, 2

of,

intermediate,

531-532

Assimilative integration,

conscious,

Person-Centered Therapy, 147, 177-178

250

Beliefs

436

Structural Family Therapy,

Narrative Therapy, 490, 512

theory of the person and development of

Being,

Solution-Focused Therapy, 471 Strategic I'herapy,

Automatic

256-257

therapeutic techniques,

Sell Psychology,

230

summary, 272

approach (family systems theory),

415-416

Association

242

Gestalt Therapy, 198-199,

Individual Psychology, 105-106, 145

process of therapy,

Reality I'herapy,

Satir

252-256

nature of therapy,

Client-Centered Therapy. See Person-

Centered Therapy

Case studies Behavior Therapy, 232-233, 271

Client

Cognitive Therapy, 314—315, 350

Clients. See also African

control

of, 8

role.

Asian

and counselor American clients;

See Roles of client

clients;

Gay, lesbian, bisexual,

Fxistentiarrherapy, 179-180, 197

and transgender

Family Systems Theory, 405-406, 458

Hispanic/Latino clients

Feminist Therapy, 376-377, 403

clients;

Alaskan Native, 270

1 1

95

SUBJECT INDEX American Indian, 270, 488 Brazilian, 176 Chinese, 25, 312, 349

455-456 Japanese, 374 Filipino,

I-ll

Communication analysis, 418—419 Complainants, 472 Complementarity, teaching, 432 Complexes inferiority,

4l3 212 Creative indifference, 219 CT. See Cognitive Therapy (CT) Cultural discourse, 496 Covert family

knowing, 24

Oedipus, 67

Korean, 374

superiority,

70-71

Cultural diversity. See Diversity issues

114

Cultural feminists, 383, 385, 398

Mexican American, 487

Compliments, 477-478

475 mismatch with counselor, 25 Muslim, 145

Compromise formations, 77 Computing (communication pattern), 4l Conditioned reinforcers, 247-248

Puerto Rican, 374

Conditioning

miracle,

Customers

(client type),

Cycle of awareness, 209, 212-213 Cycle of experience, 209

putting together with theory, 24

classical,

Dead person

covert,

Death

475^76

234-236, 244-245, 250-251 265 operant, 23(^239, 243, 245-249, 251-252

South African, 175

verbal,

487 Taiwanese, 373

vicarious, 249,

Spanish,

as

term, 151

261

255

rule,

35—36

instinct,

Deconstruction, 502 Defenses, 39—40, 74,

25

186-187

Defensiveness, I6l

Conditions of worth, 159

Deficiency problems, 251

Confession, 71

Deficits, interpersonal, 11, 12

Conflict-free sphere, 75

Definitional ceremony,

Clinically relevant behavior, 241

Confluence, 210-21

Deflection, 211

Closed systems, 408

Confrontation, 90, 216—217

Denial, 74

Coaching, 450

Depression

Cognitive bibliotherapy, 346

Congruence, 160-161, 165—166 Congruent communication, 411-412 Conjoint Family Therapy (Satir), 408, 4l5 Conscious awareness, 36-37 Conscious control system, 324 Conscious level of cognitive processing, 320

Cognitive distortions, 328, 329

Consequences

Turkish, 175

Coalitions,

423

Codependency, 390-391 Cognitive-Behavior Therapy (CBT), 233, 268, 269, 485. See

also

Behavior Therapy (BT)

in

Cognitive restructuring, 338

in

Cognitive specificity principle, 328

logical,

317-318, 329 Cognitive Therapy (CT), 314-351

natural,

background, 315-318

319 case study, 314-315, 350 central constructs, 320-326 diversity issues, 348-350 evaluation of, 343-348 health and dysfunction, 327-331 human motivation, 319-320 nature of therapy, 331-334 process of therapy, 334—336, 337 summary, 350-351 theory of the person and development of the individual, 326—327 therapeutic techniques, 336, 338-342 Cognitive triad, 328 Collaborative, Competency-Based basic philosophy,

Solution-Focused

Counseling.

Therapy (SF Therapy) Collaborative empiricism, 332 Collective unconscious,

Common

69

factors approach, 16, 17, 484,

532-533

Communal

life,

15

Communication digital, 433-434 double-bind, 433 functional, 4l

1

incongruent, 4l

1

reciprocal, 240-241, 254 in Satir approach (family systems theory), 411-412, 414—415, 419 in Strategic

Therapy, 433—434

329, 330, 344-345, 346-348

Feminist Therapy and, 392 Freud’s views on,

47

66—67

Depressogenic schema, 330

Therapy, 370

Desensitization,

Contextual model, 532-533

Contingency management, 240 Contingent stimulation, 263 Contingent withdrawal, punishment

192-193 259-260, 274, 302 de Shazer, Steve, 460, 461, 462—463 Detouring, 426 Detriangling, 452 Development of the individual. Ace Theory of the person and development of the Dereflection,

Consumer Reports study, 13-14 Contact, 207 Contact boundary, 207 Contact disturbances, 210-21 1, 228 Contact stage, 417 Contemplation stage of change, 528, 529

by,

263

Continuous reinforcement, 248

individual

Development of transference phase, 52 Dialectical Behavior Therapy, 240-241, 254. See also Behavior Therapy (BT) Ditilogic GT, 2 7. See also Gestalt Therapy (CT) 1

Dialogues

empty

Contracting, 395 analysis,

10-12

Depressive position, 84

135-136

49-50

chair,

222, 225, 226, 227-228

rational-irrational,

Conversations, externalizing, 502

two-chair, 134,

Conversion disorder, 31, 44, 45, 46-47, 48 Coping with the self, 1 1

zigzag,

301

221-222, 225

301

347 477

Diathesis-stress model,

Core beliefs, 323 Core Conflictual Relationship Themes, 102 Counselor role. See Roles of client and counselor

Difference questions,

Counselors

Differentiation

mismatch with, 25 counseling of, 19-20, 49-50, 217 flamboyant actions of, 298 Counterconditioning, aversive, 260

Digital

Countertransference

Discredited psychological treatments, 8

client

1

Cognitive Therapy and, 316, 327—328,

Person-Centered Therapy and, 162

Constructive modes, 325

Control

Behavior Therapy and, 252

Depressive anxiety,

136

in Reality

504-505

Interpersonal Psychotherapy and,

ABC model, 280, 287-288 Individual Psychology, 135-136

Cognitive model, 320

Cognitive Therapy

472

446

Cutoff, emotional, 1

same or worse, 476 so-so,

rules,

Creative adjustment,

113

Jung’s views on,

Jewish, 195

Covert conditioning, 265

262 Body Image subphase, 76 of self, 443-445

Differential reinforcement,

Differentiation and

communication, 43.5—434

439 439-441 442

Direct directives, Directives,

,

Discourse, cultural/dominant,

264-265

Ego Psychology, 78

Discriminative stimuli, 248,

Existential Therapy, 191

Disengagement, 424, 426

Gestalt Therapy, 2

Disintegration anxiety, 91, 93

1

496

Object Relations, 89

Displacement, 40

Psychoanalysis, 51

Disputing, 292, 293, 294-295, 298

Rational Emotive Behavior Therapy, 293

Disqualifying/discounting the positive, 329

SUBJECT INDEX

1-12

Disruption-repair sequence, 95

Albert. See also Rational

446

Distance, emotional, Distractors, 41

Ellis,

Behavior fherapy Alfred Adler and,

1

Disturbances, 210-211, 228,

283—284

1

(REB l

09

278-279 constructs, 280

basic philosophy,

central

Diversity issues

Behavior Therapy, 270-271

evaluation of his theory, 303,

Cognitive Therapy, 348-350

health

Existential Therapy,

Yourself Happy

402^03

human

and

144-145 Narrative Therapy, 511-512

life of,

neoanalytic approaches, 103

nature of therapy, 289, 290

Person-Centered Therapy, 175—177

photograph

Individual Psychology,

61—62

303,306-311

Aaron Beck, 316 274-276

Myth ofSelf-Esteem, of,

370-373

Reality Therapy,

Solution-Focused Therapy,

The, 277—2.7^

Exceptions, 468

273

therapeutic techniques, 296, 298

Exciting objects, 83

9-10, 12-13

Exemplar

Embeddedness-emanation stage, 388 Emotional autonomy, 444 Emotional distance, 446 Emotional Object Constancy and

Existential anxiety, 185

Doing the unexpected technique, 368 Dominance, interpersonal, 524 Dominant discourse, 496 Dominant stories, 496 Do something different technique, 482 Double-bind communication, 433 Downward arrow technique, 339 Dreams, 53-56, 129-130, 193, 223

Individuality subphase, 76 Emotional reasoning, 329 Emotion Focused Therapy, 169-170, 204,

Existential

Drive theory, 65, 97. See

Empirical validity

Behavior Therapy, 311—313

Reality Therapy,

373-374

Solution-Focused Therapy, 487-488 theory selection and, 526

Dodo

Drug

bird verdict, 14, 16

also Psychoanalysis

Dysfunction,

as

term, 26. See also Flealth and

532

Eclectic

Emma,

and

39,

45-46 526-533 531—532

integrative approaches,

assimilative integration,

common

Cognitive Therapy, 344

process of therapy,

Existential Therapy, 195

summary, 197

Family Systems Theory, 453

theory of the person and development of

225

factors

model, 16, 17, 484,

526-527 527-531

law

of,

237

Effectiveness studies,

13-14

and

awareness, 218, 220, 225

Person-Centered Therapy, 172

behavioral, classical

Reality Therapy, 371

Expressive therapy,

theory characteristic, 8-10, 12-17, 517

chair dialogue, 222, 225, 226,

conditioning, 234,

244

Exposure Therapy, 258, 268 1

02

‘External control psychology, 360-361, 362,

Emptiness, 188

Empty

340

227-228

373

479—480, 501-502 External objects, 82 Extinction, 245, 246, 248, 262 Externalizing,

Enactment, 430

Extroversion versus introversion,

Encounter groups, 226

Eysenck, Hans, 8-9, 239

69—70

Encouragement, 135

Effect size, 9 Efficacious

191-193

209

neoanalytic approaches, 101

as

theoretical integration,

of,

Experiments

1

Solution-Focused Therapy, 484

technical eclecticism,

90- 1 9

therapeutic techniques,

Experience, cycle

Psychoanalysis, 58

overview, 18-19, 20

Effect,

509-5

1

the individual, 187

Rational Emotive Behavior Therapy, 307

532-533

motivation, 184

nature of therapy, 188-190

Narrative Therapy,

Eating disorders, 392, 401 Eckstein,

184—187 diversity issues, 196-197 evaluation of, 193-196 health and dysfunction, 187—188

Behavior Therapy, 267

Gestalt Therapy,

143-144

183-184

basic philosophy,

human

Individual Psychology, 140 Early recollections, 129,

Therapy (ET), 179-197

background, 180—183

Feminist Therapy, 399

Dysfunctional Thoughts Record, 339, 340

16

central constructs,

Empirically Supported Treatment, 14-15,

dysfunction

1

case study, 179—180, 197

Empirical disputing, 294

Dulwich Centre, 491, 494, 495, 51 Dyadic Adjustment Scale, 486

188

Existential neurosis, Existential task,

205, 225, 227

344

treatment, 327,

studies,

Existential guilt, 186

Empathy, 166-167, 175, 210, 21

16,

483^87

441-442

Exaggeration, 222-223,

Elucidation, 71

Ratiomil

1

Rational Emotive Behavior Therapy,

motivation, 279

influence on

Emodve

-

Remarkably Less Disturbable, 295

Gestalt Therapy, 229-230

Psychoanalysis,

306

and dysfunction, 286

How to Make

196—197

Family Systems Theory, 456-458 Feminist Therapy,

93-196 Family Systems Theory, 452-456 Feminist Therapy, 398-402 Gestalt Therapy, 225—228 Individual Psychology, 138-144 Narrative Therapy, 508-5 1 neoanalytic approaches, 100-103 Person-Centered Therapy, 170-175 Psychoanalysis, 57—62 Existential Therapy,

Emotive

specific treatment, defined, 14

Efficacious treatment, defined, 14 Efficacy studies,

9-10, 12-13

Ego, 37, 68-69, 73

Ego autonomy, 73 Ego Psycholog}^ (EP), 72-79. See

also

Neoanalytic approaches

73-75 and dysfunction, 76-77 nature of therapy, 77-78 overview, 72-73

Enmeshment, 424, 426 EP. See Ego Psychology (EP) Epictetus, 278, 280, 316 Epston, David, 491, 493-494, 501-502, 506, 507-508 Eirickson, Milton, 433, 435, 442, 461, 466 Eros, 35-36

central constructs,

Erotogenic zones, 4l

health

Esalen Institute, 203,

408

Escape from secrecy meetings, 492, 493 Essentialist stance,

Establishing operations, E'f.

73

75-76 techniques, 78-79

SVe Ivxistential

theory of the person,

European

therapeutic

Evaluation of theory

Brief d’herapy Association, 463,

memory syndrome,

Families

61

& Family Therapy (Minuchin), 420,

421-423 Family constellation, 117—119, 128-129

407 413 Family sculpting, 418 Family

Process,

Family

rules,

Family

stress ballet,

4l 8

423^24

Family Systems (FS) Theory, 405—459. See

247 Therapy (UE)

process of therapy, 78

False

Family structure, 117-119, 128-129,

385

structural model,

Fairbairn, R. D., 79, 85-86, 87, 88

also

Bowen’s Family Systems Theory

(BEST);

486

Satir

approach (family systems

theory); Strategic Therapy; Structural

Family Therapy

Eigenwelt, 185

Behavior fherapy, 266r-270

background, 406-408

Elegant REIVE, 292

Cognitive fherapy, 343-348

case study,

405-406, 458

9

2

1

1

1

1

SUBJECT INDEX

1-13

456—458 452-456

diversity issues,

Flight into health, 53

evaluation

Flooding, 258

ol,

summary, 459

443^44, 452 Fantasy, guided, 193

Fast-forward questions,

479

Fear

Behavior Therapy, 234-236, 245,

250-251,259

ol negative evaluation, 31

Bowen’s Family Systems Theory, 449

Narrative Therapiy, 5

Cognitive Therapy, 331

neoanalytic approaches, 103

Behavior Therapy and, 270-271

Cognitive Therapy and, 349

380

telling,

398 Therapy and, 96 Family Systems Theory and, 456-457 Gestalt Therapy and, 229—230 Existential

1

383 382-383, 385, 386, 392 Narrative Therapy and, 512 Person-Centered Therapy and, 176-177 postmodern, 384 lesbian, liberal,

61—62

and social change, 383, 385, 396, 398, 402 Rational Emotive Behavior Therapy and,

radical

312-313 382-383, 385, 386, 392

Solution-focused Therapy and, 488 of,

329

378-379, 382

384

ol color, 382,

96

78-79

383—384, 394-395

Alfred Adler and,

07 basic philosophy, 34 defense mechanisms, 39-40 dream analysis, 53—55 empirical support

for,

theory of the person and development ol

386-389 techniques, 397-398

the individual,

therapeutic Fields, 2

and dysfunction, 44

46—47

importance of theory, 3 interpretation of client’s material, 53

Fight, structured,

Figures, 207,

482

208

Filipino clients,

lormula

1

Wilhelm, 45-46

480, 485

59

204

205-206

198-199, 230

207-21 diversity issues, 229-230 evaluation of 225-228 health and dysfunction, 212—214

human

motivation, 206

theory of the person and development of

211—212 techniques, 220-224

the individual,

therapeutic

seduction hypothesis, 45—46, 60-61

as

studies” of Psychoanalysis,

Gestalt Therapy [Veds, Hefferline,

scientist-practitioner model, 6

36-37

symbols, 39

&

Goodman), 202-203 Gestalt Therapy Verbatim (Peris), Girls, Freud’s views on,

1

99—200, 203

42-43

Glasser, William. See also Reality

Fherapy (RT)

topographic model, 36-37

356 Choice Theory, 354-355, 358, 360, 368 health and dysfunction, 363-364

transference, 51

life

theory of the person and development of the individual, 41-43,

Freudian

slips,

80-81

382-383 Fromm, Marty, 203 Frustration Discomfort Scale, Frustrations, optimal,

basic philosophy,

of 353, 355 photograph of 352

34

Positive Addiction,

Friedan, Betty,

also

17-1 18 task,

Fixation, 38, 4 Fliess,

67 31-33

photograph of 29 repression, 38, 40

symptoms

“German

process of therapy,

Outline ofPsycho-Analysis, An,

structural model,

Genuineness, 160-161, 165—166

nature of therapy,

122—123

GLBT clients. 309-310

Behavior d’herapy (B’F)

Functional communication, 4l

370

bVeGay, lesbian, bisexual, and

transgender clients Gloria (client of Carl Rogers), 152-154

92

Functional Analytic Psychotherapy, 241. See

455—456

First-born children, First session

case,

task,

214-218 218-220 summary, 230-231

of 30-31, 33

Hans

480 Genital stage, 43 Genograms, 449 Generic

central constructs,

motivation, 34, 35

hysteria,

General REBT, 292

case study,

FS I’heory. See Family Systems (FS) I'heory Feminist Fherapy (FT) FT.

1

54-55

Generalization, 248

basic philosophy,

as objective positivist thinker,

381-384 case study, 376—377, 403 central constructs, 385-386 diversity issues, 402-403 evaluation of, 398—402 health and dysfunction, 389-392 human motivation, 384-385 nature ol therapy, 392-395 process ol therapy, 395-396 summary, 403-404 tenets of, 380-381

A

Therapy (GT), 198-231. See also Process Experiential Therapy (PET) background, 199-205

8

nature of therapy, 48-50, 81

basic philosophy,

(Freud),

to Psychoanalysis,

Gestalt

family constellation of 30

Feminist Identity Development Theory, 388,

background, 377-381

General Introduction

Gestalt psychology, 201

drive theory, 65

Little

400^01

also

General Attitudes and Belief Scale, 309, 310

“Gestalt Prayer,” 203,

1

Feminist Identity Development Scale, 400

Feminist Fherapy (FT), 376-404

373

Generalized conditioned reinforcers, 247—248

Ego Psychology, 72 79 photograph of 64 process of therapy, 78 Psychoanalysis, 33 Ereud, Sigmund. See also Psychoanalysis

life

Reality Therapy,

Gender, 59, 119, 385-386, 397. See Feminism/feminists

free association,

human

62 Rational Emotive Behavior Therapy, 31 Psychoanalysis,

Relational Psychoanalysis, 103

73

health

1

Person-Centered Fherapy, 177

287

Freedom needs, 357, 358 Freud, Anna. See also Ego Psychology (EP) defenses, 74 development of child analysis, 79, 80-81 ego,

cultural, 383, 385,

subversiveness

124—130

Individual Psychology,

Freedom, 185-186

Feminism/feminists

woman

Individual Psychology, 145

Free association, 49, 52,

253 Feeling femo' thinking, 70

third-wave,

Behavior Therapy, 253

Franzecki, Sandor,

Fear Survey Schedule,

229

Gestalt Therapy,

Frankl, Victor, 181, 182-183, 184, 186

122—123

Psychoanalysis and,

Feminist Therapy, 402-403

Assessment;

Inlormal assessment

Fortune

46^7

Freud’s views on,

reformist,

ij/to

Family Systems I'heory, 458

298

Rational Emotive Behavior Therapy,

ol castration, 122

in counseling,

Cognitive Fherapy, 349-350

Forcelul coping statements,

Formal assessment.

Family thermometer, 4 1 9-420

ol horses,

Behavior Therapy, 260, 271

Focusing, 430

Family Therapy in Clinical Practice

in

Gay, lesbian, bisexual, and transgender clients

1

Glove anesthesia, 39, 46 Goals Behavior 1 herapy, 255-256 Bowen’s Family Systems

f

hcory,

Cognitive Fherapy, 33.5-334

Functional disputing, 294

Figo Psycholog)',

Fun needs, 357 Fusion, 445

Existential 1 herapy,

78 1

90

Feminist Fherapy, 394-395

450-451

SUBJECT INDEX

1-14

217-218 Psychology, 131-132

human

Solution-Focused I’herapy, 488

Gestalr Therapy,

motivation,

1

10-1

1

nature of therapy, 124-132 process of therapy,

Narrative Therapy, 500

Holding environment, 85 Holism, 1 10, 205—206, 209 Homeostasis, 408

Object Relations, 88

Homework, 303, 304-305, 338

theory of the person and development of

Person-Centered Therapy, 163-164

Homosexual

Individual

Interpersonal Psychotherapy,

Psychoanalysis,

1

1

49-50

bisexual,

Rational Emotive Behavior Therapy,

282, 291-292 Reality Therapy,

365-366

Relational Psychoanalysis, 99 Satir

approach (family systems theory),

416-417 Sell Psychology,

94

Structural Family Therapy,

295 Human development. S’ee Theory of the person and development of the

428

Assessment;

Formal assessment Behavior Therapy, 253 Bowen’s Family Systems Theory, 448-449

Cognitive Therapy, 33 Individual Psychology, 130

“Good enough mother,” 85

Feminist Therapy, 384-385

Graded

Gestalt Therapy,

91—92

111,1 13—1 14

Informal assessment.

Cognitive Therapy, 319-320

34

1

complex, 113

Inferiority feelings,

motivation

Existential Therapy,

self,

Inferiority

Behavior Therapy, 244

theory selection and, 524

Grandiose-exhibitionistic

16-120 therapeutic techniques, 134-138 Inelegant REBT, 292 Inference chaining, 287-288 the individual,

individual

Goal-setting stage, 438

tasks,

clients

Less Disturbable (Ellis),

Human

437

and transgender

Homey, Karen, 380 Horses, fear of, 122-123 Hot seat method, 216, 221 How to Make Yourself Happy and Remarkably

Solution-Focused Therapy, 473 Strategic Therapy,

Gay, lesbian,

clients. See

132-134

summary, 146

Rational Emotive Behavior Therapy, 287

Informed consent, 395 Infraego, 209

184

206

Inhibition, reciprocal, 234, 245, 259,

Individual Psychology,

10-1

1

1

In Search ofSolutions

(O’Hanlon and Weiner-

Grief, 10, 11

Narrative Therapy, 495

Ground, 207, 208

neoanalytic approaches, 65

Group counseling, 216, 221, 224, 226-227, 393 GT. See Gestalt Therapy (GT) Guided discovery, 334 Guided fantasy, 193

Person-Centered Therapy, 156

Instinct theory,

Psychoanalysis, 34, 35

Integration, theoretical,

Rational Emotive Behavior Therapy, 279

417 430-431 Interaction stage, 438 Intermediate beliefs, 323 Intermittent reinforcement, 248

Guilt, existential,

356

Therapy

Harrington, G.

L., 355 Hartmann, Heinz, 72, 73, 75, 77, 78

Health, flight into, 53

Health and dysfunction Behavior Therapy, 250-252

181-182

nature, 34, 66,

validation process model. See Satir

approach (family systems theory)

Human

worth ratings, 283 Humor, 183,^298, 299-300, 369 Hunger drive, 201 Hypnosis, solution-oriented, 483

Ego Psychology, 76-77 Existential Therapy, 187—188 Feminist Therapy, 389-392 Gestalt Therapy, 2 2-2 1 Individual Psychology, 120-124 Narrative Therapy, 498—499 Object Relations, 85-86 Person-Centered Therapy, 160-162 Psychoanalysis, 43-47 Rational Emotive Behavior Therapy, 285-287 Reality Therapy, 363-364

Idealized parental imago,

approach (family systems theory),

414-415 Self Psychology,

92-94

Strategic Therapy,

435-436 425-427

Therapy Association,

204 International Journal ofPsycho-Analysis, 80

355, 372

self,

International Society for Existential

Psychology and Psychotherapy, 183

92

Idealizing,

Ideal

91-92

1

58

Interpersonal deficits, 11, 12

74 407

Interpersonal nightmare technique, 288

Identified patient,

Identity diffusion,

86

Interpretation

Identification, 40,

Interpersonal Psychotherapy,

Imagery, 137, 193, 265, 297, 342

Individual Psychology,

Imaginal flooding, 258

Object Relations, 89

Impasse, 213 Impingement, 86

Self Psychology,

10-12

134-135

Psychoanalysis, 53, 60

95

Importantizing, 286

Interpretation

Incongruence, 161-162

Interview structure for assessing

Incongruent communication, 4l

124,

1

219 440

ofDreams,

77?^ (Freud), 31,

125-128

(Freud), 80

Theory of the

Individual development.

Introjection, 83,

210

person and development of the

Introversion

individual

Intuition fmwjr sensation,

theory selection and, 520-521, 522

Individual Psychology (IP),

105—146

background, 106-109

Hero archetype, 69 Hierarchies, 434 Hindu culture, 349

case study, 105-106, 145

Hispanic/Tatino clients

central constructs,

basic philosophy,

diversity issues,

Family Systems Theory, 454, 457, 458

evaluation

of,

1

1-1 16

144-145 138-144

Behavior I’herapy, 270

health

109-110

1

53-54

lifestyle,

Introduction to the Technique of Child Analysis

Indifference, creative,

Individual diversity. See Diversity issues

229

92

82

International Gestalt

Structural Family Therapy,

Gestalt Therapy,

Internal objects,

37

Indirect directives,

Solution-Focused Therapy, 470

Internalization, transmuting,

International Journal of Reality Therapy, Id,

Satir

Integration stage,

Psychoanalysis and Psychotherapy, 96

Bowen’s Family Systems Theory, 448

Relational Psychoanalysis, 98

527-531

Intetnational Association for Relational

48

Hysteria, 31, 44, 45, 46-47,

Cognitive d’herapy, 327-331

1

35—36

Intensity, achieving,

theory selection and, 519-520

Human Human

475 133

Insight, 50, 88,

Solution-Focused Therapy, 467

186

Haley, Jay, 406, 407, 432-433. See also Strategic

Reality Therapy,

Davis),

269

and dysfunction, 120-124

extroversion,

In vivo assessment,

70

288

In vivo desensitization, 274, In vivo flooding, IP.

69—70

302

258

Individual Psychology (IP)

I-position,

452

Irrational beliefs,

281-282, 287-288,

290-291, 306-307 Irrational Beliefs Test, 307, 309, Isolation, 74, 186, 21

310

1

1

3

1

1

SUBJECT INDEX

1-15

Don, 407, 432^33 Japanese clients, 374

Leveling, 4

Jackson,

Jewish

clients,

Joining,

382-383, 385, 386, 392 Liberation psychology, 378 Libido, 36, 4 Liberal feminists,

195

429

Jones, Ernest, 80, 8

Mary

Jones,

1-412

1

Life instinct,

235-236

Cover, 234,

Journal ofIndividual Psychology, 140-141, 142

1

Lifestyle,

35-36

Little

Hans

234-235 122—123

case,

Logic, private,

Jung, Carl

Logical consequences, 136

life of,

68,

72

69—70

personality typology,

70-72 topology of the personality, 68-69

Modeling, 237, 239, 243, 249-250, 252,

265-266 Modes

294

of being,

Love and belonging needs, 357, 358

in

Low

constructive,

325

in Existential

Therapy, 184-185

286

frustration tolerance,

1

Magnification/minimization, 329

loss,

Mahler, Margaret, 72-73, 75-77

minor, 325

324, 325

324-325

Maintenance stage of change, 528, 529

primal,

self-enhancement, 324, 325

health and dysfunction, 86

Making Contact (Satir), 410 Making the rounds technique, 224 Making the therapist the ordeal technique, 440-441

nature of therapy, 87

Maladaptive schemas, 321

Object Relations, 79

Managed

Kernberg, Otto drive theory, 65

Ego Psychology, 73 goals of therapy, 88

objects,

Key

84-1 85 Cognitive Therapy, 324-326, 330

Loss mode, 324, 325

training analysis, 50

Jungian typology, 69-70

16

1

Mitchell, Stephen, 96

Logo therapy, 188

psychological dysfunction and therapy,

91-92

Mistakes, basic,

17

Logical disputing,

Mirroring,

Mitwelt, 184-185

Judging r'mwr perceiving, 70

1

Therapy Miracle clients, 475

Miracle question, 462—463, 478

111-112, 124, 125-128, 144

Little Albert case,

09,

Minuchin, Salvador, 406, 407, 409, 420, 421-423. Structural Family

82

379

care,

Manaster-Perryman Manifest Content Early

process of therapy, 88, 89

Recollection Scoring

therapeutic techniques, 89

& Perryman),

level strategy,

530

Manual (Manaster

143

Mans Search for Meaning (Frankl), 182-183

drive theory, 65

Masochistic personality disorder, 389

human

nature,

Masson, Paul,

anxiety,

“More of the same” syndrome, 467, 474, 476, 482 More Than Miracles (de Shazer and Dolan), 461, 462-463

Human

motivation

Motivational Interviewing, 170, 173

Mourning, 47 Movement, 132-133

Masculine protest,

66—67

325 44

victim, 324,

Moral

Motivation. See 181,

approach to therapy, 87 development of child analysis, 79, 80-81

1

324, 325

Mortality salience hypothesis, 195

Manifest content, of dreams, 54

Klein, Melanie

threat,

19

45-46

MRI

(Mental Research

408,

Institute),

432-433,461

Mastery and pleasure therapy, 340-34

Multigenerational transmission process, 447

Object Relations, 79

Masturbation, 39, 42, 46

theory of the person and development of

Maximum

Multimodal Therapy, 527 Multisystemic Therapy, 454

introjection,

83

impact

strategy,

531

May, Rollo, 181—182 Meaninglessness, 186, 188

Muslim clients, 145 Must statements, 329

central constructs, 91

Medical model, 199, 242-243, 532

Musturbatory

development, 91-92

Meditation, 370

Myers-Briggs Type Indicator, 70

Melancholia, 47

Myth of Self Esteem, The (Ellis), 277—27^ Myths of “traditional” therapy, 463, 464

the individual, 84

Kohut, Heinz

90

drive theory, 65,

Men, and Feminist Therapy, 396, 403 Menninger Project, 58, 101-102 Mental disorder, as term, 26 Mental filter, 329

health and dysfunction, 92, 93

nature of therapy, 94 Self Psychology,

90-9

therapeutic techniques, 95

Mental Research

374 Korzybski, Alfred, 278 Korean

clients,

Institute

(MRl), 408,

281, 284-285

beliefs,

93

Narcissistic injury,

Narcissistic personality disorders,

Narrative

Means

to

93

Therapeutic Ends (White

and Epston), 491, 501-502

432-433,461

Landscape of Action questions, 504

Cognitive Therapy, 344

490-513 background, 49 -494 basic philosophy, 494—495

Landscape of Consciousness questions, 504

Existential Therapy, 195

case study, 490, 5

Family Systems Theory, 453

central constructs,

Narrative Therapy (N’F),

Meta-analytic studies Labeling,

Behavior Therapy, 268—269

329

Late luteal phase dysphoric disorder,

390

Latency stage, 43

Gestalt I’herapy,

Latent content, of dreams, 54

226

1

1

2

496-497

1—512 508-51 1

diversity issues, 51

overview, 9

evaluation

Person-Centered Therapy, 172

health and dysfunction,

Law of effect, 237

Rational Emotive Behavior Therapy, 308

human

Learning

Reality Therapy, 371

nature of therapy,

Latino

clients. See

Hispanic/Latino clients

observational, 237, 239, 243,

249-250,

252 Pavlovian model

of,

234-236, 244-245,

250-251 of,

236—239, 243,

245-249,251-252 clients. See

level of

cognitive processing,

320 Metacommunication, 41 Metaphors, 201, 369-370, 419, 466 Mexican American clients, 487 Middle-born children, 18 1

Skinnerian model

Lesbian

Solution-Focused Therapy, 484 Metacognitive

Gay, lesbian, bisexual, and

transgender clients

Lesbian feminists, 383

1

Mind

329 Minor modes, 325 reading,

of,

498-499

motivation, 495

process of

499-500 therapy, 500-503

summary,

5

1

2-5

1

theory of the person and development of the individual,

497—498 503-508

therapeutic techniques,

National Institute of Mental

I

lealth

Freatment of Depre.ssion Collaborative Research Program, 10, 12—13, 16, 268,

344

SUBJECT INDEX

1-16

Pampered

Natural consequences, 135-136

Noogenic

Nature of therapy

Normal anxiety, 185 Normal autism, 76

Paradoxical directives,

Normalizing the problem, 477

Paradoxical ordeals,

Normal symbiosis, 76 NT. See Narrative Therapy (NT)

Paradoxical theory of change,

Behavior Therapy, 252-256 Bowen’s Family Systems Theory,

448^51

Cognitive Therapy, 331-334

Ego Psychology, 77-78 Existential Therapy, 188-190 Feminist Therapy, 392-395 Gestalt Therapy, 214-218 Individual Psychology, 124—132 Narrative herapy, 499—500 Object Relations, 86-88 Person-Centered Therapy, 1 62- 1 64 Psychoanalysis, 48-50 1

Rational Emotive Behavior Therapy,

287-292

364—366

Relational Psychoanalysis,

approach (family systems theory),

415^17 94

Self Psychology,

Obesity, behavioral

Structural

Needs

model

of,

269

Participant guidance,

Neoanalytic approaches central constructs,

82—84 85—86 86-88

health and dysfunction,

nature of therapy,

79—82

357

in Gestalt

Therapy, 207-209

and belonging, 357, 358 power, 357, 358 in Reality Therapy, 357-359, 373 survival, 358 love

219 84

Parts party,

88-89 theory of the person and development of the individual, 84-85 therapeutic techniques, 89—90 249-250, 252

265

420

Passive acceptance stage, 388,

400-401

26 381-382, 393 Patterning, 199—200 Pathology, as term, Patriarchy,

244-245, 250-251

PC

theory. See Person-Centered

Penalties,

345-346

Therapy

301—302

Penis envy, 42-43, 59, 61, 380,

Peoplemaking

{Sd^nr),

384

409, 419

70 Therapy (GT)

Perceiving versus

Obsessive-compulsive disorder/ neurosis, 47,

Only

426

Pavlovian model of learning, 234-236,

Peris, Fritz. See also Gestalt

206 constructs, 209

basic philosophy,

stage, 42—43, 90, 92, 93 Oedipus complex, 67 O’Hanlon, Bill, 461, 463, 464 On Becoming a Person (Rogers), 148, 149-150

357-359, 373

freedom, 357, 358 fun,

Parent-child coalition,

(Greenberg and Mitchell), 65 Object Relations (OR), 79-90. See also

Oedipal

basic,

Paranoid-schizoid position,

Parsimony, 17

Solution-Focused Therapy, 471-473

436-437 Family Therapy, 427-428

260-261

440

Object Relations in Psychoanalytic Theory

Observational learning, 237, 239, 243,

Strategic Therapy,

440

Paradoxical intention, 138, 192,

process of therapy,

98-99

children, 121

Paraphrenia, 47, 48. See also Schizophrenia

overview,

Reality Therapy,

Satir

neurosis, 188

children, 118

On Personal Power Open systems, 408

,

162—163, 177

central

225 Gestalt Therapy Verbatim, 199-200, 203 health and dysfunction, 213 life of, 201-203 nature of therapy, 2 1 5-2 1 evaluation of his theory,

opinion of himself, 199

photograph

of,

198

theory of the person and development of

Negative reinforcers, 238, 246, 247

Operant conditioning, 236-239, 243, 245-249, 251-252

Neglected children, 121, 123

Operational definitions, 7

therapeutic techniques, 221

Neoanalytic approaches, 64-104. See

the individual,

211—212

Operations, establishing, 247

Peris,

Person, theory of

background, 65-68

Optimal frustrations, 92 Optimism, tragic, 182-183 OR. See Object Relations (OR)

Persona, 69

case study, 64, 103

Oral metaphor, 201

Personal, politics of the,

also

Psychoanalysis Analytical Psychology,

diversity issues,

68-72

Oral stage, 4

103

Ego Psychology, 72-79 evaluation of, 100—103

Ordeals,

Object Relations, 79-90 Relational Psychoanalysis,

96-100

Self Psychology, 90-96 summary, 103-104

in

Behavior Therapy, 250

existential,

in Gestalt

Therapy, 188

Therapy, 212-213

in Individual

Psychology, 121 — 123

noogenic, 188 in

Other-demandingness, 281

Person-Centered Therapy, l6l

in Rational

Emotive Behavior Therapy,

286 structural-conflict,

research. See also Research support;

Theory-testing research

Behavior Therapy, 101—

188

in Existential

Personalization,

inferiority, 121,

Outcome

Neurosis

93

traditional/psychogenic, 188

Neurotic anxiety, 44, 185 Neurotic children, 121, 123

Neuroric self-regulation, 213 Neutralization, 73

Nihilism, 188

Nondirective Therapy. See Person-Centered

Therapy Nonverbal behavior, 192

Cognitive Therapy, 344-346

195-196 Family Systems Theory, 453—454 Gestalt Therapy, 226—227 Existential Therapy,

Individual Psychology, 140

Narrative Therapy, 5

.See Theory of the person and development of the individual

Personality disorders,

440—441

122—123 Organismic self-regulation, 205—206, 213 Organismic valuing process, 1 57-158 Orienting schema, 326-327

Organ

Laura Posner, 201, 202, 203, 215, 217

1

378-379, 386 93, 330, 389

329

Personal shadow, 69

Person-Centered Therapy, 147-178. See aPo Process Experiential

Therapy (PET)

background, 147-155

155—156 case study, 147, 177-178 central constructs, 156-159 diversity issues, 175-177 evaluation of, 170-175 evil and, 181-182 health and dysfunction, 160—162 basic philosophy,

human

motivation, 156

nature of therapy, 162-164 process of therapy,

164-169

neoanalytic approaches, 101-102

summary, 178

Person-Centered Therapy, 172-173

theory of the person and development of

58-59 Rational Emotive Behavior Therapy, 307-309 Reality Therapy, 371—372 Outcomes, unique, 497, 500 Outline of Psycho-Analysis, An (Freud), 31-33 Outsider witness practices, 504-505 Overgeneralization, 329 Overt family rules, 413 Psychoanalysis,

159-160 therapeutic techniques, 169-170 Peter (patient of Mary Cover Jones), 234, 235-236 the individual,

PET

(Process Experiential Therapy),

169-170, 204, 205, 225, 227 Phallic stage,

41-42

Pharmacological interventions, 327, 344 Philosophical disputing, 294

1

1

0 1

1

1

SUBJECT INDEX

1-17

Phobias. See Fear

370

Physical activity, Placators, 4l

Pleasing

1

someone technique, 137-138

Individual Psychology,

Narrative d'herapy,

Ego Psychology, 78

neoanalytic approaches, 101

Therapy, 190-191

Existential

Pleasure principle,

Eeminist Therapy, 395—396

Polarities,

Gestalt Therapy, 2 1

Politics

37 209-210, 223-224

of the personal, 378-379, 386

370

Positive Addiction (Glasser),

Positive regard, 71,

158-159, 160, 166

Positive reinforcers,

246

Possibility Therapy. See

Solution-Focused

Therapy (SF Therapy)

Therapy, 378-379, 382, 394

in Narrative

needs

Power

Quality world, 359 Questions/questioning

Stories,

The (Haley), 433 Practicality,

17-18, 517—518

Precision

and

437-439 Family Therapy, 429

MATCH,

Proselytizing,

Protoschemas, 326. See

Gestalt Therapy,

225

neoanalytic approaches, 101

57-58

Rational Emotive Behavior Therapy,

306-307 Reality Therapy, 371

theory characteristics,

7-8

relative influence, 501, also

Schemas

Precontemplation stage of change, 528-529

34-35 case study, 29-30, 62 central constructs, 35—40 diversity issues, 61-62 evaluation of, 57—62 fundamental rule of, 49 health and dysfunction, 43^7 motivation, 34, 35

Hans

122

case,

48-50 process of therapy, 50—52 structural model, 37-38

500-501

41-43

the individual,

52—57

Premenstrual dysphoric disorder, 390

therapeutic techniques,

Preparation stage of change, 528, 529

topographic model, 36-37, 38

Presuppositional questions,

477

Psychogenic neurosis,

1

88

Pretend directives, 442

Psychological Birth Order Inventory, 143

Pre-Therapy, 170

Psychosis, 47, 93,

Primal modes, 324-325

Psychosomatic

Primary process, 37 Primary reinforcers, 247

Psychotherapists. See Counselors

161-162, 188

families,

426

Psychotherapy, defined, 2

412—413

Psychotherapy Research Project, 58, 101-102

117

Psychotics,

Proactive countertransference,

219

123—124, 364

374 Punishment, 247, 249, 263 Punishment by contingent withdrawal, 263 Push-button technique, 136-137 Puerto Rican

Problem, normalizing the, 477 stories,

496

Problem solving, 288, 342

clients,

stage,

438

Process Experiential

385, 396, 398,402

245-249, 251-252 Rapprochement subphase, 76 Rational beliefs, 280-281, 302

297 Rational Emotive Behavior Therapy (REBT), 273-313 background, 274-278 basic philosophy, 278-279 case study, 273, 313 central constructs, 280-284 diversity issues, 311-313 evaluation of, 303, 306-31 health and dysfunction, 285-287 human motivation, 279 nature of therapy, 287-292 process of therapy, 292-293 self-help form, 303, 304-305 summary, 313 theory of the person and development of the individual, 284-285 therapeutic techniques, 293-303, 304—305 Rational emotive education, 307-308 Rational emotive imagery, 297 Rational emotive problem solving, 288 Rational coping statements,

Rational Emotive Therapy. See Rational

Emotive Behavior Therapy (REBT) Rational-irrational dialogues, 301

Behavior Fherapy (RFiB F)

Qualities, theory

Therapy (PET),

169-170, 204, 205, 225, 227. Therapy (GT); Person-

Radical behaviorism, 236-239, 243,

Rational Therapy. See Rational Emotive

Problem-Solving Therapy (Haley), 433

Problem

338

Radical and social change feminists, 383,

theory of the person and development of

Preferred stories, 497, 498,

Problem-saturated

503

478-479

Solution-Eocused Therapy, 477

summary, 63

479

REBT, 292

Private logic,

scaling,

Socratic,

nature of therapy,

Preconscious level of cognitive processing, 320

triad,

368

477

relationship,

Psyche, 68-69, 71

Little

Preconscious, 37

Primary

Reality Therapy,

Psychoanalysis, 29—63. See also Neoanalytic

human

Solution-Eocused Therapy, 484

Preferential

296

45

process,

basic philosophy,

Person-Centered Therapy, 171-172

Prediction tasks,

173

background, 30-33

Narrative Therapy, 509

as

222 83

503-504 477

approaches

139-140

Individual Psychology,

Psychoanalysis,

presuppositional,

10, 13,

Behavior Therapy, 267

194—195

462-463, 478

Narrative Therapy,

Project

Feminist Therapy, 399

Landscape of Consciousness, 504

Structural

Cognitive Therapy, 343—344 Existential Therapy,

Individual Psychology, 124, 128

miracle,

Projective identification,

testability

477 fast-forward, 479

Strategic Therapy,

Projection, 40, 82, 210,

Pragmatic disputing, 294

theory selection and, 523

Landscape of Action, 504

95

Process questioning, 45

76

Practicing subphase,

99-100

Solution-Focused Therapy, 473—476

and Other

ofJesus Christ

37

difference,

approach (family systems theory), 417

Self Psychology,

357, 358

for,

Tactics

Therapy, 494—495

Satir

Reality Therapy,

Solution-Focused Therapy, 484

Cognitive Therapy, 338-339

366-367

Relational Psychoanalysis,

in Feminist

57—58 Rational Emotive Behavior Therapy, 306-307

Rational Emotive Behavior Therapy,

Reality Therapy,

Power

Person-Centered I'herapy, 171-172 Psychoanalysis,

8-220 132-134 Narrarive Therapy, 500-503 Object Relations, 88-89 Person-Centered Therapy, 1 64- 1 69 Psychoanalysis, 50-52 Individual Psychology',

292-293

Postmodern feminism, 384 Pot metaphor, 419

139-140 509-5 1

Bowen’s Eamily Systems Theory, 45 Cognitive Therapy, 334-336, 337

See also

Rayner, Rosalie,

Reaction formation, 40

194-195

Reactive countertransference, 219

Gestalt

Existential Therapy,

Centered Therapy

Family Systems Theory, 453

Readiness

Feminist Fherapy, 399

Realistic anxiety,

Process of therapy

Behavior Therapy, 256-257

234-235

Behavior Therapy, 267 Cognitive Therapy, 343-344

Gestalt Therapy,

225

Realistic

508 44 disputing, 294 letters,

SUBJECT INDEX

1-18

Reality principle, Reality

memory

Repressed

37

controversy,

60-61

Narrative Therapy, 500

Repression, 38-39, 40

Therapy (RT), 352-375

background, 353-355

Research support. See

355-356 case study, 352-353, 374-375 central constructs, 357-361 diversity issues, 373-374 evaluation of, 370-373 health and dysfunction, 363-364 human motivation, 356 nature of therapy, 364—366 process of therapy, 366-367

Outcome

also

Person-Centered Therapy, 163 Psychoanalysis,

Cognitive Therapy, 344-348 Existential Therapy, 195-196 Family Systems Theory, 453—456 Feminist Therapy, 399—402 Gestalt Therapy, 226-228 Individual Psychology, 140—144

Rational Emotive Behavior Therapy,

Narrative Therapy, 5 1 0-5

Self Psychology,

Person-Centered Therapy, 172-175 Psychoanalysis,

371—373

210-21

in Feminist Therapy,

1,

228

in Gestalt

in Individual Psychology,

in

Reframing

in Psychoanalysis, 50,

Strategic Therapy,

Regression,

429—430

40

Rei n fo rcem en t/ rei n fo rcers in

Behavior Therapy, 237—238,

245-248, 261-262, 267

positive,

in Rational

Emotive Behavior Therapy,

Rejecting objects, 83 Relational-conflict model,

GT, 217. See (GT) Relational matrix, 97 Relational

Gestalt

Therapy

Relational Psychoanalysis (RP), 96-100. See

Neoanalytic approaches

central constructs,

224 440

9G-97

overview,

Restraining orders,

process of therapy,

process of therapy,

therapeutic techniques,

basic philosophy, 155,

Scaling questions,

Schemas adaptive, 321

Cognitive Therapy, 320-322

nature, 181

147-148, 150-152

defined, 4,

the individual,

depressogenic,

On Becoming a Person, On Personal Power, 162-163, 177

maladaptive, 321

photograph

power

477

Relative influence questioning, 501,

257

Reorientation phase, 133

503

orienting,

47

166-169

on psychotherapy process, 171, 173-174 theory of the person and development of the individual, 71 to

,

simple,

Schema

152-154

342

328

323

theory, 4

Schizophrenia, 151-152, 171, 174,

268-269, 433

160

Psychotherapy

of,

330

326-327 321-322

rotten person,

research

Roles of client and counselor

therapeutic techniques, 100

Relationship questions,

1

Role disputes, 10, 11-12

97-98

320

nature of therapy, 162-163

of,

108-109 Scientist-practitioner model, 6—7 Secondary disturbances, 283-284 Science of Living, The {A.d\ct),

Secondary process, 37 Second-born children, 118 Seduction hypothesis, 45-46, 60—61

Behavior Therapy, 255

Selective abstraction,

Bowen’s Family Systems Theory, 450

Self

329

Cognitive Therapy, 333

coping with

Ego Psychology, 77-78 Existential Therapy, 189-190

differentiation of,

Feminist Therapy, 394 Gestalt Therapy,

418-420

478-479

Scapegoating, 426

156

156-157, 158

Role-playing, 300-301,

theory of the person and development of

414

the individual,

Rogers, Natalie, 150, 154

99-100

417

theory of the person and development of

223

videotapes,

and dysfunction, 98 nature of therapy, 98-99 overview, 96

408-^09

Responsibility, taking,

Three Approaches

health

Relaxation training,

nature of therapy, 4 1 5-4 1

cost,

process of therapy, 164-165,

96

Family Systems (FS)

409-413 414-415

central constructs,

206 263

148, 149-150

time out from, 263

also

Response

life of,

301-302

also

408—420. See Theory

health and dysfunction,

human

246

405, 406, 407, 408-409

approach (family systems theory),

95

health and dysfunction, 160—161, 162

primary, 247

247

Response-ability,

central constructs,

247

476

or worse clients,

Therapy, 437

Rogers, Carl. See also Person-Centered Therapy

247—248

286

Satir, Virginia,

Resolution of transference phase, 52

Reversals, 74,

248

negative, 238, 246,

Same

Revelation stage, 388, 400, 401

generalized conditioned, intermittent,

Sacredizing,

Retroflection, 211

247-248 continuous, 248 differential, 262 conditioned,

Therapy (RT) 413

Reality

Rules, family,

Satir

in Strategic

7-8

S’ee

Satiation,

53

Emotive Behaviot Therapy,

in Rational

in Self Psychology,

44

48, 59

test,

Rotten person schema, 328

Safeguarding, 120

Person-Centered Therapy, 169

292-293

Structural Eamily Therapy, Refutability,

133—134

503

in Narrative Therapy,

Solution-Focused Therapy, 477

203

Therapy, 2 1

Reformist feminists, 382-383, 385, 386, 392

369

428

Role transition, 10-11, 12

RT.

395-396

Recycling stage, 529

Reality Therapy,

436-437

Strategic Thetapy,

RP. See Relational Psychoanalysis (RP)

to awareness,

Recording therapy sessions, 296

Rational Emotive Behavior Therapy, 296

94

Solution-Focused Therapy, 472-473

Rorschach inkblot

Resistance

505-506

approach (family systems theory),

4l6

Rolf, Ida,

Solution-Focused Therapy, 484-487

269

Satir

98-99

Structural Family Therapy,

307-311

Reciprocal communication, 240-241, 254

Relational Psychoanalysis,

58—61

Rational Emotive Behavior Therapy,

Reality Therapy,

365

Reality Therapy,

101-103

neoanalytic approaches,

361—363 therapeutic techniques, 367-370 Realness, 160-161, 165—166 Re-authoring, 500-501 REBT. See Rational Emotive Behavior I’herapy (REBT)

290-291

1

theory of the person and development of the individual,

49-50

Behavior Therapy, 2G7-27Q

summary, 375

Reciprocal inhibition, 234, 245, 259,

Object Relations, 87

research;

Theory-testing research

basic philosophy,

Reflection practices,

Individual Psychology, 131

216

in

the,

1 1

443-445

Person-Centered Therapy, 158

in Relational Psychoanalysis,

structurally complete,

92

96-97

2

SUBJECT INDEX nature of therapy,

373

Self-control, behavioral,

Self-control triad,

471-473 process of therapy, 473—476 summary, 489

292

Self-actualization, 158,

Self-concept, 158,

1-19

266

265

theory of the person and development of

Self-defeating personality disorder,

389

the individual,

469

Feminist Therapy, 395, 397

476-483 Solution-oriented hypnosis, 483 Songs, 299-300 So-so clients, 475—476

Gestalt Therapy, 221

South African

Person-Centered Therapy, 176

SP. See Self

Self-demandingness, 281

therapeutic techniques,

Self-disclosure Existential Therapy,

Reality Therapy,

1

92

369

Spanish

Self-enhancement mode, 324, 325

as

symbols, 39

Synthesis stage, 388, 400, 401

Systematic desensitization,

487

Taiwanese

Taking

83

it

Stereotype threat, 322

basic,

387-388

Stimulation, 17, 263, 517

existential,

Stimulus control, 264-265

first

Selfobjects, 91

Stimulus generalization, 256—257

generic,

Self Psychology (SP), 90-96. See also

Stop and monitor technique, 296

graded, 341

Self

mandala, 4l

1

Tasks

nature of therapy, 94

496-497, 498, 500-501 Straightforward directives, 439 Straightforward ordeals, 440 Strategic Structural Systems Engagement, 454

overview, 90-91

Strategic Therapy,

Neoanalytic approaches central constructs, 91

health and dysfunction,

92-94

theory of the person and development of the individual,

91-92

therapeutic techniques,

Stories,

432^42.

See also Family

Systems (FS) Theory

process of therapy, 95

95-96

205-206, 212, 213 Sensation fmwr intuition, 70 Self-regulation,

433-434 458 health and dysfunction, 435—436

115-116

479 surprise, 481-482 Task setting stage, 438 prediction,

Technical eclecticism, 526-527

Temper Tantrum Control Programme, 507-508 Temple study, 10, 58, 268 Termination Terror

529

stage,

Management Theory,

Tertiary disturbances,

436^37

284 and

Testability. See Precision

432-433

485

480

diversity issues,

nature of therapy,

116

session formula, 480,

central constructs,

overview,

373

clients,

back practices, 506-507

Spoiled children, 121

Self-in-relation model,

259-260

Systems thinking, 407—408

277-278, 409-410 260

Self-esteem, 194-195,

Self-injurious behavior,

80, 81

Psychology (SP)

clients,

Splitting,

Symptoms

175

clients,

358 Swedish clients, 486-487 Symbiosis, normal, 76 Symbols, symptoms as, 39 Symposium on Child-Analysis, Symptom prescription, 440 Survival needs,

1

94-195

testability

Thanatos, 35—36

437-439 support, 455

process of therapy,

Theoretical integration, 527—531

Sexual abuse, 60—61

research

Theoretical orientations

Shame, 220, 274, 303

theory of the person and development of

387

Sex-role socialization,

Shaping, 249, 261

434-435 therapeutic techniques, 439—442 Stress inoculation training, 262

530 Should statements, 329 Sibling position, 117-118, 142-143,446—447

Structural-conflict neuroses,

Simple schema, 323

Structural Family Therapy, 420—432. See

Shifting levels strategy,

mismatch with

client’s

also

defined, effectiveness of,

Snowball metaphor of change, 466 Social Cognitive Theory, 239. See also

research support,

455 theory of the person and development of the individual, 425

schemas and, 4

Behavior Therapy (BT)

of the tongue, 34

Sneaky Poo

case,

501-502

Behavior Therapy (BT) Social interest,

112-113, 120, 141-142

Socialist feminists,

383, 385, 396, 398, 402

Socialization, 334,

387

therapeutic techniques,

429-432

Structurally complete selves,

as fun, as

for counselor,

21,22,518 scientist-practitioner model,

using,

Theory

characteristics

empirical validity, 8—10, 12-17, 517

92

6-7

249-250, 252 438 Society of Counseling Psychology, 14-16

Structured fight, 482

parsimony, 17

Sublimation, 40

practicality,

Subsystems, 424

precision

Sociopaths, 358

Subversive Dialogs (Brown), 379,

326

Subversiveness, 378-379,

338

Solution-Focused Therapy (SF Therapy),

460^89

Suicidal behavior, Sullivan,

6-7

22-25

overview,

Socratic questioning,

4-5

philosophical assumptions underlying,

Structural model, 37-38, 73

Sociotropy,

3—4

3

map

Social learning theory, 237, 239, 243,

Social stage,

24—25

choosing among, 5-6, 18-19, 20

423-425 456-457 health and dysfunction, 425-427 nature of therapy, 427-428 overview, 420—423 process of therapy, 429

Slips

presentation,

3-5

benefits of,

diversity issues,

302

Skinner, B. F, 232, 237-239, 245. See also

9-20

Theory

93

central constructs,

Skill training,

1

over time, 18-19

Family Systems (FS) Theory

Simplicity, 17

categories of, 21

of counselors’ counselors,

the individual,

382

382

345

Harry Stack, 96

17-18, 517—518

and

testability of,

7—8

517 the person and development

stimulation, 17,

Theory

of

of the individual

Behavior Therapy, 250

Superego, 37, 66

Bowen’s Family Systems I hcory, 447

background, 460—463

Superiority complex, 114

Cognitive Therapy, 326-327

basic philosophy,

463-467 489 central constructs, 468-469 diversity issues, 487-488 evaluation of, 483—487 health and dysfunction, 470 human motivation, 467

Support groups, 501

Figo Psycholog)',

case study, 460,

Supportive-Expressive Psychodynamic

Fixistential

Supportive therapy,

1

02

Surplus behaviors, 251 Surprise task,

481-482

75-76

herapy, 187

386-389 211-212 16-120 Individual P.sychology, Narrative Therapy, 497-498 Object Relations, 84-85 Feminist

Therapy, 102 Supportive Psychodynamic Therapy, 102

1

1

herapy,

Gestalt Therapy,

1

SUBJECT INDEX

1-20

Person-CTntered Therapy, 159-160 Psychoanalysis,

41-43

Psychoanalysis,

284-285

Reality Therapy,

Reality Therapy,

361-363 97-98

Satir

91-92

329

clients,

175

approach (family systems theory),

Two-chair dialogue, 134, 221-222, 225

Two

person

field,

99

Two-person psychology, 67

95—96

Self Psychology,

Solution-Focused Therapy, 476—483

Strategic Therapy,

Strategic Therapy,

Umwelt, 184—185 Unbalancing, 432

Structural

Structural

Uncommon

Solution-Focused Therapy, 469

434—435 Family Therapy, 425

Theory

selection,

case study, 5

1

514—526 4-5 1

human

personal

style,

526

518-522

522-525

philosophical assumptions, 518

Theory-testing research. See also

Outcome

research; Research support

Behavior Therapy, 269-270

Cognitive Therapy, 346-348 Existential Therapy,

1

96

454^56

Family Systems Theory,

227-228 Psychology, 140—144

Cestait Therapy,

Individual

Narrative Therapy, 5 1 0—5

Therapy as ordeal technique, 440^4 Therapy contract, 395 Therapy with Women Scale, 399 Thick stories, 496—497 Thinking feeling, 70 Thin stories, 496^97 Third-wave feminism, 384

102-103 Person-Centered Therapy, 173-175 Psychoanalysis, 59-61 Rational Emotive Behavior Therapy, 309-311 Reality Therapy, 372-373

Therapeutic atmosphere overview Behavior Therapy, 254—255

Three Approaches

to

project,

Psychotherapy videotapes,

152-154

Cestait Therapy, 2 1 5-2 health and dysfunction, 364-365 Individual Psychology, 130-131 1

499—500

Object Relations, 87 Person-Centered Therapy, 162-163

48—49

Rational Emotive Behavior Therapy,

289-290 approach (ftmily systems theory), 4l6

Validity, empirical. See Empirical validity

Timofejewna, Raissa, 106, 107

Verbal conditioning, 261

Toilet training, 4l

Vicarious conditioning, 249, 251

Top dog, 209, 221

Victim mode, 324, 325

Topographic model, 36-37, 38

Virtual reality exposure,

359-360

Total behavior,

Visualization,

Vivid assessment, 288

182-183 49-50

Watson, John

William Glasser

219 Object Relations, 88-89 Psychoanalysis, 51, 52, 56-57 Rational Emotive Behavior Therapy, 292-293 Relational Psychoanalysis, 99-100 Transference Focused Psychotherapy, 89-90 Transformation, 71—72 Gestalt Therapy,

clients. See

Guy, lesbian,

and transgender

clients

Transitional objects, 85

Transmuting

Structural

Transparence, 160—161, 165-166

Therapeutic techniques herapy,

internalization,

Transtheoretical

257—266

234-235

Existential Therapy, 191

bisexual,

471^72

B.,

Wellesley College, 380

White, Michael, 490,

Transgender

levels

268 472

504

Ego Psychology, 78

94

436-437 Family Therapy, 428

Vegetativeness, 188

Visitors (client type),

Touch, 419'

Strategic Therapy,

T

86

Time Eimited Dynamic Therapy, 102-103 Time out from reinforcement, 263

Transference

Feminist Therapy, 393

Behavior

151—152, 171, 174

Unmetabolized bipolar intrapsychic representations,

Training analysis,

89

Solution-Focused Therapy,

173-174

Service, 148,

Threat mode, 324, 325

Ego Psychology, 77-78

Self Psychology,

Unique outcomes, 497, 500

University of Wisconsin schizophrenia

Traditional neurosis, 188

Satir

Unfinished business, 213, 218-219, 222

Thoughts, automatic, 316, 317-318, 323-324

Tragic optimism,

Psychoanalysis,

Underdog, 209, 221 Undoing, 74

University of Chicago Student Counseling

F.,

Bowen’s Family Systems Theory, 450

Narrative Therapy,

283, 285, 309

Unconscious, 34, 37, 66, 69, 71

236—237 Thought recording, 339-340 Thorndike, E.

Cognitive Therapy, 332

1

Unconditional life-acceptance, 283

Unconditional positive regard, 71, 160, 166 Unconditional self-acceptance, 277-278,

Three-person model of therapy, 89

1

neoanalytic approaches,

Existential Therapy,

530-531

Transtheoretical Therapy,

behavior, beliefs about,

Therapy (Flaley), 435

Unconditional acceptance of others, 283

Therapists. See Counselors

dimensions of “good theory,” 516-518 diversity issues,

439-442 Family Therapy, 429-432

theory selection and, 525

theory selection and, 520, 521

74

Furning-against-self,

418-420

approach (family systems theory), 4l4

vision,

Turkish

Turn-off technique, 342

367—370

Relational Psychoanalysis, 100

Relational Psychoanalysis,

Self Psychology,

Tunnel

293-303, 304-305

Rational Emotive Behavior Therapy,

Satir

52-57

Rational Emotive Behavior Therapy,

92

Therapy (TT), 527-531

of change, 529-530

491^94, 495, 501-502

Institute, 355 Willoughby Neuroticism Questionnaire, 253 Winnicott, Donald, 79, 85, 86, 87, 88 Wisconsin Schizophrenia Study, 151—152,

171, 174 Wolpe, Joseph, 234, 245, 259, 263-264, 269 Woman of color feminism, 382, 383—384,

394-395

Womb

envy, 61

Women,

Freud’s views on, 42—43, 61. See

also

Feminism/feminists

'Women and Madyiess (Chesler), 389 Work, 115, 141 Working alliance, 60 Working through phase, 52, 53, 56 Workless individuals, 358

Bowen’s Family Systems Theory, 451-452

processes of change, 528

World-demandingness, 281

Cognitive Therapy, 336, 338-342

stages of change,

528-529 techniques, 530-531

Worth, conditions

Ego Psychology, 78-79 Existential Therapy, 91-193 1

Feminist Therapy, 397—398

220-224 134-138 Narrative Therapy, 503-508 Object Relations, 89-90 Person-CTentered Therapy, 169-170

therapy,

530

of,

159

Write, read, and burn technique,

Written

artifacts,

482

507-508

Eriads

Cestait Therapy,

cognitive,

Individual ITsychology,

primary, 4

328 2—413

Yalom,

self-control,

265

Triangulation, 426—427,

Irvin, 179, 183, 189. See also

Therapy (FT)

Existential

1

Youngest children,

1

446

FT. 6eeTranstheoretical Therapy (TF)

Zigzag dialogue, 301

1

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C O N

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I

Theories of Counseling and Psychotherapy A Case Approach

NANCY

,

MURDOCK

d.

Clear, Engaging, Applied

Based on a deeply held belief that theory does matter

effective

in

helper-client interactions, this text examines with clarity and wit fourteen

theories of counseling and psychotherapy. At the beginning of each chapter,

new

readers “meet” a

client

through a case example. The author then presents

the theory’s basic philosophical assumptions;

human

behavior;

its

central constructs;

its

beliefs

picture of

its

how humans

about what constitutes mental health and dysfunction; relationships with those

behavior, thoughts, and

about what motivates

its

develop;

perspective on

around us impact our functioning; and

its

view of

its

ideas

how our how our

emotion impact our functioning. Throughout each chapter,

the author immediately illustrates the application of a construct or process by

showing

how

it

relates to the client case described at the beginning of the

chapter, demonstrating the translation of each theory into practice.

NEW to this

edition

Neoanalytic Approaches

Chapter

3,

Chapter

6, Existential

Chapter

1

5,

Theories

Psychotherapy

Narrative Therapy

in

Action

DVD

illustrates six therapists

different theoretical orientations

See applications of theory

“The key strength of

Theories

come

with

working with the same to

client

life!

of Counseling and Psychotherapy

is its

clear design

and readable format. The case study approach works. Students report high of conceptual understanding as a result of reading the book, and

I

levels

seldom have to

explain the book. Rather, discussions have an accelerated effect because of the basic understanding derived

from reading the

text.”

—Jim “I

very

much enjoyed the way the

beginning of the chapters and then subsections....

I

believe this

is

case material

woven

an excellent

is

Sells,

Northern

Illinois

presented at the

into each chapter within particular

way to

tie

theory to practice.”

— David Powers,

airlm'priht of

PEARSON ered.com

University

y

Loyola College