,,when ,,you ,,don',t ,,know ,,where ,,to ,,turn ,a ,self-,diagnosing ,guide to ,counseling and ,therapy ,steven ,j4 ,bartlett1 ,ph4,d4 ,contemporary ,books1 ,inc4 ,chicago -- ,new ,york 99 99 99 99 99 ,,also ,,by ,,steven ,,james ,,bartlett ,normality ,does ,not ,equal ,mental ,health3 ,the ,need to ,look ,elsewhere for ,standards of ,good ,psychological ,health ,the ,pathology of ,man3 ,a ,study of ,human ,evil ,reflexivity3 ,a ,source ,book in ,self-,reference ,self-,reference3 ,reflections on ,reflexivity 7co-edited with ,peter ,suber7 ,conceptual ,therapy3 ,an ,introduction to ,framework-,relative ,epistemology ,metalogic of ,reference3 ,a ,study in the ,foundations of ,possibility ,,validity3 ,a ,learning ,game ,approach to ,mathematical ,logic ,as editor of these books by ,paul ,alexander ,bartlett3 ,voices from the ,past -- ,a ,quintet of ,novels3 ,sappho's ,journal ,christ's ,journal ,leonardo da ,vinci's ,journal ,shakespeare's ,journal ,lincoln's ,journal ,library of ,congress ,cataloging-in-,publication ,data ,bartlett1 ,steven ,j4 ,when you don't know where to turn4 ,bibliography3 p4 #a4 ,psychotherapy4 #b4 ,counseling4 #c4 ,consumer education4 ,i4 ,title4 ,,rc#dfj4;,b#bh #aihg #faf4hi'ad #hg-bjjde ,,isbn #j-hjib-dhbi-h ,copyright #aihg by ,steven ,j4 ,bartlett1 ,ph4,d4 ,all rights reserved ,published by ,contemporary ,books1 ,inc4 #ahj ,north ,michigan ,avenue1 ,chicago1 ,illinois #fjfja ,manufactured in the ,united ,states of ,america ,library of ,congress ,catalog ,card ,number3 #hg-bjjde ,international ,standard ,book ,number3 #j-hjib-dhbi-h ,published simultaneously in ,canada by ,beaverbooks1 ,ltd4 #aie ,allstate ,parkway1 ,valleywood ,business ,park ,markham1 ,ontario ,l#c,r #d,t#h ,canada ,project ,gutenberg #bjad edition ,note that this is a copyrighted ,project ,gutenberg e,book2 it is not in the public domain4 ,its license1 see below1 allows for free non-commercial distribution and prohibits its sale or use in derivative works by anyone without the copyright holder's written consent4 ,when ,you ,don't ,know ,where to ,turn was originally published in #aihg by ,contemporary ,books4 ,all rights to the book have now reverted to the author1 who has decided to make the book available as an open access publication1 freely available to readers through ,project ,gutenberg under the terms of the ,creative ,commons 99,attribution-,non,commercial-,no,deriv s license991 which allows anyone to distribute this work without changes to its content1 provided that both the author and the original ,,url from which this work was obtained are mentioned1 that the contents of this work are not used for commercial purposes or profit1 and that this work will not be used without the copyright holder's written permission in derivative works 7i4e41 you may not alter1 transform1 or build upon this work without such permission74 ,the full legal statement of this license may be found at http3_/_/creativecommons4org_/licenses_/ by-nc-nd_/#c4j_/legalcode ,illustration3 ,creative,commons,logo4jpg ,this book is dedicated to ,karen1 my love1 wife1 and friend4 ,preface to the ,project ,gutenberg ,edition ,nearly three decades have passed since ,when ,you ,don't ,know ,where to ,turn was first published4 ,in that time1 psychiatry1 clinical psychology1 and counseling have changed a good deal4 ,psychiatry has continued on a now well-worn path leading to a more and more inflated universe of diagnostic labels1 the majority of which have no known organic basis4 ,few readers who are not themselves mental health professionals realize that these diagnostic classifications are voted into existence by committees of psychiatrists whose pronouncements magically summon into being a lengthening list of so-called mental disorders4 ,these pronouncements are then applied to people in order to label their problems 7as well as the people who have them71 to match their problems with allegedly effective treatments1 and in the process to give the impression that a respectable medical process of diagnosis and intervention has been undertaken4 ,and yet these so-called mental disorders do little more than equate designated patterns of behavior1 emotion1 or thought--called syndromes--with alleged psychological malfunctioning4 ,such syndromes are no more than sets of symptoms that can be collected together in a wide variety of different ways1 but depending upon how they are grouped1 distinguishable syndromes can be pointed to and named4 ,this is a highly arbitrary process very much like fortune-telling using tea leaves1 which depends on the pattern seen or imagined in the tea leaves at the bottom of a cup4 ,during the past three decades1 clinical psychology and its less formal cousin1 counseling1 have also undergone noticeable change4 ,they have been the traditional sources of a large number of diverse approaches to psychotherapy and counseling4 ,but in the past thirty years1 the large number of approaches to psychotherapy and counseling has1 in practical reality1 shrunk considerably4 ,this has been due to the rapid dominance and virtual monopoly that has been gained by cognitive-behavioral therapy1 also known as rational-emotive therapy4 ,insurance companies have been attracted like flies to the sweetness of the comparatively brief treatment period touted by cognitive-behavioral therapy1 and practitioners have similarly been attracted by the ease of using its one-size-fits-all approach4 ,and so where the changes in psychiatry have been inflationary in its authorized catalogue of mental disorders known as the ,,dsm 7,diagnostic and ,statistical ,manual of ,mental ,disorders71 clinical psychology and counseling have been on a deflationary course that has progressively narrowed the treatment options available to many people4 ,despite the passage of time1 ,when ,you ,don't ,know ,where to ,turn remains the only step-by-step self-diagnosing guide to counseling and therapy1 a guide that seeks to direct individuals--by respecting and responding to the very great differences that exist among individuals--to approaches to counseling and therapy that may be most likely to benefit them--taking into account the nature of their own individual problems1 their different degrees of willingness and abilities to learn and to change1 and their differing individual situations in life1 including their financial resources and the amount of time that they are willing to devote to therapy4 ,such a customized1 individually-centered perspective is not popular today4 ,the human population continues inexorably to expand while our healthcare system insists on general applicability and streamlined efficiency4 ,individual problems in living are more easily and rapidly processed when they can be subsumed under specifiable diagnostic and treatment codes4 ,in this increasingly mechanized process1 the individual person and the individual problems of living he or she is attempting to cope with tend more and more to be ignored or neglected1 and his or her diagnosable disease entity becomes the object of attention4 ,these comments are not a polemic against current trends and fashions2 they are rather intended to place in perspective the changes that have occurred in the mental health field during the past three decades since the first edition of this book came off the press4 ,what a reader might take away from these preliminary remarks are these suggestions3 99 to recognize that1 like so much that is a human production1 today's classification system of mental disorders is unlikely to be the final word about the human condition1 but that its proliferating list of mental disorders should be taken by the humble at least with a grain of salt1 and rejected wholesale by those who are more critically inclined2 99 to accept the fact that it is becoming harder with the passage of time to find one's way to a mental health clinician who is not recipe-oriented1 due to the in-fashion monopoly that prescribes cognitive-behavioral therapy1 and due to the pressures on the healthcare system to process people and their problems faster and at lower cost2 and1 finally1 99 to realize that1 when it comes to problems of living1 those who are willing to accept a healthy measure of responsibility for their own choice of practitioner and treatment are most likely to find a practitioner and a treatment that meet their individual needs4 ,from this point of view1 ,when ,you ,don't ,know ,where to ,turn continues to offer readers a heightened consciousness of alternatives to treatment that do still continue to available1 though they can be somewhat harder to find in some areas of the country1 and to give readers a sense of what those alternatives have to offer and for which kinds of problems and personalities they may best be suited4 ,readers interested in learning more about the author1 his research1 and publications by him1 many of which can now be downloaded at no cost1 may like to visit the author's website3 http3_/_/www4willamette4edu_/sbartlet ,steven ,james ,bartlett ,salem1 ,oregon #bjad 99 99 99 99 99 ,this book offers counseling observations based on the author's experience only and makes no specific recommendations for any individual or group4 ,it is intended and has been written to offer the author's understanding and opinions in regard to the subject matter4 ,the author and publisher are not here engaged in providing personal psychological or psychiatric or other professional advice4 ,for such advice1 the reader should seek the services of a qualified professional4 ,the author and the publisher cannot be held responsible for any loss incurred as a result of the application of any of the information contained in this book4 ,,contents ,before ,we ,begin 444 xi ,acknowledgments xv ,the ,purpose of ,this ,book #a ,,part ,i3 ,,getting ,,started #g #a ,prisons ,we ,make for ,ourselves #i #b ,paths to ,help #ag #c ,bridges from ,here to ,there #bi #d ,the ,therapeutic ,jungle1 ,part ,i3 ,social ,workers1 ,psychologists1 and ,psychiatrists #ci #e ,the ,therapeutic ,jungle1 ,part ,,ii3 ,outside the ,mainstream #dh #f ,where ,you ,can ,find ,help #ed #g ,self-,diagnosis3 ,mapping ,your ,way to a ,therapy #ei #h ,emotional ,problems ,that ,may ,have ,physical ,causes #ii ,,part ,,ii3 ,,experiencing ,,therapy #aaa #i ,psychoanalysis #aac #aj ,psychotherapy1 ,part ,i3 ,client-,centered ,therapy1 ,gestalt ,therapy1 ,transactional ,analysis1 ,rational-,emotive ,therapy1 and ,existential-,humanistic ,therapy #abc #aa ,psychotherapy1 ,part ,,ii3 ,logotherapy1 ,reality ,therapy1 ,adlerian ,therapy1 ,emotional ,flooding ,therapies1 ,direct ,decision ,therapy #aej #ab ,behavioral ,psychotherapy #agc #ac ,group ,therapy #ahd #ad ,marriage and ,family ,therapy #aid #ae ,channeling ,awareness3 ,exercise1 ,biofeedback1 ,relaxation ,training1 ,hypnosis1 and ,meditation #bjd #af ,drug and ,nutrition ,therapies #bbg ,,part ,,iii3 ,,important ,,questions #bci #ag ,locating a ,therapist #bda #ah ,should ,you ,be ,hospitalized8 #beb #ai ,confidentiality3 ,your ,privacy #beg #bj ,does ,therapy ,work8 #bfg #ba ,life ,after ,therapy #bhb ,,part ,,iv3 ,,appendixes #bhg ,appendix ,a3 ,agencies and ,organizations ,that ,can ,help 7,united ,states and ,canada7 #bhi ,appendix ,b3 ,suggestions for ,further ,reading #bih ,index #cjg ,,about ,,the ,,author #cac xi ,,before ,,we ,,begin 444 99 ,a recent study by the ,national ,institute of ,mental ,health shows that one ,american in five suffers from some type of psychiatric disorder3 #ej4e million ,americans have one or another of eight serious psychiatric disorders1 ranging from anxiety disorders and phobias to depression and schizophrenia4 99 ,of these1 only one person in five seeks professional help4 ,more than #dj1djj1jjj severely troubled people do not receive any treatment4 99 ,an unknown number of healthy1 emotionally untroubled ,americans enter therapy for reasons of self-development4 99 ,more than #acj distinguishable therapies now exist4 99 ,these therapies are offered by a variety of health care professionals1 including social work counselors1 clinical and counseling psychologists1 psychiatrists1 biofeedback therapists1 and others4 ,their backgrounds1 training1 fees1 and durations of treatment vary considerably4 99 ,these professionals practice in a number of different settings3 in private practice1 group sessions1 public and private agencies1 hospitals1 newly established nonhospital xii inpatient facilities1 and in the context of educational programs4 99 ,most people who enter therapy do not know what alternative approaches to therapy exist or how to choose among them4 ,they usually locate a therapist in a more or less random way4 99 ,most people fear the idea of entering counseling or psychotherapy4 ,they do not have a clear conception of what to expect3 they do not know in advance what the experience of therapy is like4 99 ,for a variety of reasons1 many people who think of going to a therapist are concerned about whether their relationship with the therapist will really be confidential4 ,if you are especially concerned about privacy1 you should be aware of several ways that confidentiality may be broken1 what the laws concerning confidentiality are1 and1 in particular 7what few people realize71 how insurance claims for psychological care can invade an individual's privacy4 99 ,counselors and therapists tend to specialize in one or a small number of alternative approaches to therapy4 ,some approaches to therapy are most appropriate for treating certain problems or responding to certain personal interests2 others are better suited to providing help with other problems and concerns4 ,choosing a therapist with an orientation that is right for you can be extremely helpful and can help you save much time1 money1 and energy4 ,these facts highlight the situation in counseling and psychotherapy that anyone faces who enters therapy today4 ,from them1 you can see that there is a bewildering array of counseling professions1 of distinct approaches to therapy1 and of settings in which help is offered4 ,this guide's intention and hope is to help you understand the alternatives1 and to help you form your own judgment how it may be best to proceed4 ,the book hopes to give you real assistance so you may make a good choice--thereby saving you emotional investment1 time1 money1 and the potential discouragement of avoidable false starts with therapies that may not help because they are not relevant to your goals1 values1 and personality4 xiii ,be patient4 ,take the time to think about yourself1 your life1 and your hopes for a better life4 ,this book was written for you1 to help you to improve your life1 your self-esteem1 and your relationships with others4 ,they are worthy goals4 ,nothing in this world can mean as much4 ,may you have the energy1 courage1 and perseverance to achieve them6 xv ,,acknowledgments ,i would like to express my gratitude to ,dr4 ,william ,altus1 then ,professor of ,psychology at the ,university of ,california1 ,santa ,barbara1 who went out of his way to encourage my first interests in psychotherapy when ,i was a graduate student there twenty years ago4 ,to ,professor ,paul ,ricoeur1 ,i would like to express my admiration for his original contributions to ,freud scholarship and my enduring gratitude for his willingness to direct my doctoral research at the ,universit de ,paris4 ,i am indebted to ,dr4 ,raphael ,becvar1 ,professor1 ,marriage and ,family ,therapy1 ,saint ,louis ,university1 both for making it possible for a faculty colleague to learn from him in several of his excellent seminars and for his later comradeship4 ,to my good friend1 ,dr4 ,thomas ,maloney1 clinical psychologist in ,clayton1 ,missouri1 ,i want to extend my warmest appreciation for his personal guidance and voluntary supervision of my first efforts in counseling4 ,if ever the qualities of compassion1 depth of understanding1 humor1 and genuine care are to be found in one person1 they are in him4 ,i would also like to thank ,professor ,lillian ,weger1 ,george ,warren ,brown ,school of ,social ,work1 ,washington ,university1 ,st4 ,louis1 for generously welcoming me into her fine seminar in psychodynamic models4 xvi ,i especially thank ,dr4 ,renate ,tesch and ,professor ,hallock ,hoffman1 of the ,psychology ,faculty of the ,fielding ,institute in ,santa ,barbara1 for making possible a writer's retreat in the ,california desert3 the loan of their home in ,sky ,valley made writing the last group of chapters a special and memorable pleasure4 ,one is fortunate to have such friends4 ,if this book became more readable after its first draft1 it was due in great part to the conscientious energy of my wife1 ,karen1 in spotting the weeds of obfuscation that seem to grow effortlessly in an academic's garden4 ,i want to thank her for her patience1 with both me and the book4 ,i would also like to take this opportunity to thank ,miss ,libby ,mc,greevy1 ,assistant ,editor1 ,contemporary ,books1 ,inc41 for her helpful suggestions and for her regular doses of encouragement that made writing this book a happy experience4 #a ,when ,you ,don't ,know ,where ,to ,turn ,,the ,,purpose ,,of ,,this ,,book ,i would like to introduce this book by telling you what happened to a real and likable person who ran into some very difficult times and as a result entered therapy4 ,frank is a large man1 a former college football player1 powerfully built4 ,he has always prided himself on his strength and determination4 ,he used to be friendly and outgoing4 ,he had a pleasant smile1 complemented by his clear blue eyes4 ,frank had worked for eleven years for a manufacturer of tools4 ,not long ago1 he was promoted to the position of managing the company's sales division in a large midwestern city4 ,soon after ,frank and his wife moved1 his wife became pregnant with their third child4 ,frank had a well-paying job1 excellent benefits1 a pleasant home they had just bought1 and a contented relationship with his wife4 ,but in spite of these things1 he became severely depressed4 ,and he began to feel terribly frightened3 he had to leave his desk several times each morning and again in the afternoon4 ,he would go to the men's room1 lock the door1 turn on the water faucets1 and cry4 ,frank lost fifteen pounds in three months4 ,he had a poor appetite1 slept badly1 and was very anxious around his #b co-workers4 ,he couldn't understand what had happened to him1 and he was unwilling to let others know how unhappy he felt4 ,he was ashamed of what he took to be a weakness in himself3 like many men1 he was raised to believe that men shouldn't cry1 and his crying bouts shook his sense of identity and stability4 ,his marriage began to suffer4 ,frank and his wife seldom made love4 ,frank was irritable and impatient with his wife and his children4 ,frank's wife knew he was very troubled1 but he refused to talk to her about it4 ,for several months1 ,frank fought against his depression4 7,if only he had been aware of the strength that he mustered to do this67 ,then he reached a crisis and could not force himself to go to work4 ,he stayed home with a bad cold1 slept as much as he could1 and was very short-tempered4 ,he was crying a good deal4 ,frank's wife persuaded him to see a doctor4 ,the doctor referred him to a psychiatrist4 ,the psychiatrist saw ,frank twice a week for two-and-a-half months1 but ,frank was troubled by side effects from the antidepressant medication he took under the psychiatrist's supervision4 ,he resisted the idea of taking drugs1 so he decided to see a psychotherapist who1 in cooperation with the psychiatrist1 monitored ,frank's condition as he gradually went off the antidepressants4 ,however1 after five months1 ,frank did not feel he was making any real progress4 ,he changed to another therapist who1 his wife had heard1 specialized in the treatment of depression4 ,together1 ,frank and his new therapist came1 over a period of months1 to recognize that ,frank's depression had resulted from two conflicts3 ,frank had hated his job but had refused to admit this to himself1 and now his wife was pregnant again1 and because of this added financial responsibility he felt forced to stay with his present job1 where he had seniority1 good salary1 and benefits4 ,once the basis for his depression was made clear1 it was possible to begin to treat ,frank's problem4 ,his wife was very willing to encourage him to plan for a change of jobs1 even though this would mean a temporary reduction in his income4 ,frank saw a vocational therapist and received guidance that led him to take some evening classes and then to become a computer programmer for a rapidly growing local company4 ,his #c depression faded away1 and he now seems genuinely to be content4 ,,what ,,you ,,can ,,expect ,,from ,,this ,,book ,i knew ,frank personally1 as his therapist in a group4 7,his name1 like all others in this book1 has been changed1 along with certain details about his situation47 ,with professional help1 ,frank was able to improve his life--his sense of self-esteem1 his marriage1 and his family life4 ,it was a long and painful process1 as much self-change can be4 ,but perhaps ,frank's experience might have been less painful1 perhaps ,frank might have felt less devastating isolation1 and perhaps his path to a resolution of his difficulties could have been shortened if a practical guide to counseling and therapy had been available to him when he first decided to find help4 ,,making ,,intelligent ,,choices ,this book is about how you can get the most appropriate kind of help for your problems1 goals1 and personality4 ,specifically1 ,when ,you ,don't ,know ,where to ,turn sets out to help you become adequately informed about the range of therapists and therapies--as these relate to your own assessment of your goals and interests--so that you will be able to make intelligent decisions about these issues3 99 the kind of professional to seek out 99 the type of therapy most likely to help you with a certain complaint or set of interests and values 99 how to locate the form of therapy that seems most promising to you at a price you can afford and with an expected duration you can live with 99 what setting to look for in which the help you would like is offered ,this book uses two approaches1 both presented here for the first time and both based on common sense and intelligent advance planning4 #d ,first1 you will be able1 through a series of carefully organized questions and easily followed instructions in ,part ,i1 to pinpoint one or more approaches to therapy that may be most promising given your initial objectives1 problems1 or interests4 ,for the first time1 a self-diagnosing map to the major approaches to therapy is made available4 ,second1 you will have the opportunity to glimpse what typically happens during the sessions of counselors1 psychologists1 and psychiatrists as they treat clients or patients using the different main approaches to therapy4 ,you will come to see what the experience of therapy is like in these different approaches4 ,in other words1 the self-diagnosing map will point you in the direction of one1 and sometimes more than one1 approach to therapy that may be most promising for you to begin the process of self-change1 and you will then be able to gain an insider's perspective on that approach so that you can judge how well suited to you the approach is and how it compares to the other main approaches to therapy4 ,if this guide helps you choose a path to the kind of therapy that will be appropriate and useful to you1 it will have done something worthwhile4 ,a guide to counseling and psychotherapy should1 however1 do more than this4 ,,overcoming ,,isolation ,,and ,,getting ,,started ,people who are troubled tend to try to hide it4 ,they frequently isolate themselves when they are distressed1 so overcoming the desire to withdraw is the first order of business if they are to improve their lives and feelings4 ,one of the things this book sets out to do is to help you see that very likely the problems you are facing are not one of a kind4 ,you have a lot of company2 the difficulties you are having are probably very familiar to counselors and therapists4 ,realize that there are ways of resolving most problems and that doing so often is easier with the sympathy1 empathy1 moral support1 friendship1 or direction of a counselor or therapist than by yourself4 ,,can ,,you ,,help ,,yourself8 ,however1 sometimes it is possible to help yourself a great deal #e through your own initiative4 ,this book will describe ways that you can be your own source of help and will pay particular attention to when it may be appropriate and safe to rely upon inner resources4 ,,clearing ,,the ,,confusing ,,jungle ,most people are not familiar with the differences among the main kinds of psychosocial helping professionals--the various types of counselors1 clinical psychologists1 psychiatrists1 psychotherapists1 psychoanalysts1 social workers1 etc4 ,another purpose of this book is to clarify these labels1 to describe how the approaches used by their practitioners are distinct and how they are similar1 and to give an idea of how their fees and durations of treatment vary4 ,individual chapters in ,part ,,ii are devoted to describing the main varieties of therapy available today3 psychoanalysis2 psychotherapies2 behavior-changing therapies2 marriage and family therapy2 group therapies2 exercise1 biofeedback1 relaxation1 hypnosis1 and meditation2 and drug therapy4 ,each approach will be described in the context of experiencing professional help and in terms of how and when it may be possible to apply the approach on your own4 ,these chapters will help you understand what in general to expect if you choose a particular kind of treatment1 how the course of treatment may go1 and what point of view is shared by professionals who use it4 ,,finding ,,someone ,,to ,,help ,part ,,iii of this book will describe how you can go about locating good professional care1 whether from a family therapist1 an analyst1 a social worker1 a psychiatrist1 a clinical psychologist1 or another kind of therapist4 ,you will learn how you can find a reputable professional with a particular specialization1 and you will be encouraged to ask him or her some useful questions before beginning treatment4 ,as we will see in detail later on1 there are numerous settings in which counselors and therapists work4 ,many are in private practice1 but many also work for a variety of agencies1 both public and private1 for hospitals and newly established nonhospital residential facilities1 and even for educational institutions4 ,we #f will discuss each of these settings in ,part ,,iii so that you will have a clear idea both of the alternatives that exist and of important factors to consider when deciding among them4 ,,should ,,you ,,be ,,hospitalized8 ,should ,i consent to hospitalization8 ,what will ,i encounter if ,i accept hospitalization8 ,is it necessary1 is it desirable8 ,another chapter in ,part ,,iii is devoted to answering these and related questions4 ,,is ,,your ,,privacy ,,protected8 ,in many ways it will be1 and in other ways it may not be4 ,confidentiality as it relates to the treatment of emotional or psychological difficulties is a thorny issue1 one that worries many people4 ,in ,part ,,iii1 a chapter is devoted to a discussion of this potentially important area of personal concern4 ,,does ,,therapy ,,work8 ,you may1 of course1 feel a certain amount of skepticism about the real utility and effectiveness of any one of the many therapies that now exist4 ,this is1 in my judgment1 a healthy skepticism4 ,a chapter in ,part ,,iii will review what you may be able to expect1 and perhaps should not expect1 in the light of recent evaluations of the effectiveness of the main therapies4 ,to complement these as yet incomplete scientific findings1 ,i will emphasize a measure of ordinary common sense as we go along4 ,,life ,,after ,,therapy ,the last chapter in this book deals with what to expect after therapy4 ,recurrences1 future crises--they often come with the package3 life6 ,relapses--re-experiencing feelings of distress--have received too little attention4 ,often1 old habits and feelings remain with us and reappear during times of stress4 ,too1 we know that as life goes on1 we need to be able to tackle new problems and new situations and sometimes must handle unexpected crises4 ,chapter #ba tells you how the experience of therapy will help you cope with possible setbacks and the uncertainties of the future4 #g ,,parti ,,getting ,,started #i #a ,,prisons ,,we ,,make ,,for ,,ourselves ,which of us is not forever a stranger and alone8 ,thomas ,wolfe1 ,look ,homeward1 ,angel ,what other dungeon is so dark as one's own heart6 ,what jailer so inexorable as one's self6 ,nathaniel ,hawthorne1 ,the ,house of the ,seven ,gables ,when you have shut your doors1 and darkened your room1 remember never to say you are alone1 for you are not alone1 but ,god is within1 and your genius is within4 ,epictetus1 ,discourses ,when people are in pain and most need others1 many wall themselves in4 ,this very human tendency is illustrated by a famous story4 ,in #aicd1 ,admiral ,richard ,byrd led an expedition to ,antarctica1 where he established a base on the edge of the ,ross ,ice ,barrier1 #gjj miles north of the ,south ,pole4 ,byrd then decided to set up a small weather observation post closer to the pole1 which he chose to man alone4 ,he would stay in a one-room cabin1 a box #aj that measured nine feet by thirteen feet1 lowered into a rectangular hole cut into the ice to protect the cabin from gale-force winds during the coming winter months4 ,byrd was committing himself to a degree of personal isolation few men have ever taken on4 ,what happened to him in the months ahead reveals something important to psychologists that all of us should bear in mind4 ,byrd's men left him in his tiny station and returned across the ice to the main base #abc miles to the north4 ,winter blizzard conditions soon surrounded ,byrd4 ,he knew he was in for a long period of solitary confinement1 with no hope of returning to the base1 even if a medical emergency demanded this4 ,he could never make the return trip to the base on his own1 and it would be too dangerous for a team of men to try to get to him in the winter darkness across the miles of ice4 ,after several months of isolation1 ,byrd became very ill4 ,he was distressed and confused about his condition--nausea1 vomiting1 terrible headaches1 blurred vision1 great weakness4 ,days would go by1 and he would cling to life by a thread1 his mind wandering1 drifting in and out of the dizzying incoherence of frequent comas4 ,he would1 by sheer force of will1 gather his reserve of fading energy and stagger across the tiny room to light the stove and open a can of food1 which he soon lost from his stomach4 ,gradually1 he came to realize that the fumes from his kerosene stove and from the gasoline-powered generator for the telegraph were poisoning him4 ,but if he turned off the stove1 he would freeze to death1 and the telegraph was his only contact with others4 ,he knew his life was in real danger1 yet he refused to let his men know of his desperate situation4 ,nor could he admit to himself that he was in trouble4 ,listen to his own words1 written half a century ago1 in his snow-buried room with the air heavy with fumes and the inside walls encrusted with glistening ice3 ,it is painful for me to dwell on the details of my collapse4444 ,the subject is one that does not easily bear discussion1 if only because a man's hurt1 like his love1 is most seemly when concealed4 ,from my youth ,i have believed that sickness was somehow humiliating1 something to be kept hidden4444 ,to some men sickness brings a desire to be left alone2 animal-like1 their instinct is to crawl into a hole and lick the hurt4 #aa ,there were aspects of this situation which ,i would rather not mention at all1 since they involve that queer business called self-respect4444 ,for a reason ,i can't wholly explain1 except in terms of pride1 ,i concealed from my men1 as best ,i could1 the true extent of my weakness4 ,i never mentioned and1 therefore1 never acknowledged it4444 ,i wanted no one to be able to look over the wall4444#a #a ,richard ,e4 ,byrd1 ,alone 7,new ,york3 ,g4 ,p4 ,putnam's ,sons1 #aich71 pp4 #aff1 viii1 #bid-bie4 ,in spite of his efforts to keep his condition to himself1 ,byrd's radio operator at the main base seems to have intuited that ,byrd was in danger4 ,a rescue party was sent as the winter weather became less harsh1 and ,byrd was brought back to the base1 probably just in time1 before the fumes killed or permanently injured him4 ,in many ways1 ,byrd's ,antarctic experience parallels that of many of us who1 because of our own pain and hardship1 isolate ourselves from others4 ,our lives become cold1 desolate1 despairing4 ,our suffering is real1 but for one reason or another we cannot or will not reach out to others4 ,,walling ,,yourself ,,off ,,from ,,others ,most of us are aware of a need for human company and companionship4 ,but when we are in pain or are severely troubled1 we often forget what has been recognized for a long time3 ,frederick ,,ii1 the thirteenth-century ruler of ,sicily1 believed that all children were born with a knowledge of an ancient language4 ,when they were taught the language of their parents1 however1 he theorized1 their knowledge of the older language was overridden and blotted out4 ,king ,frederick hypothesized that if children were raised without being taught a language1 they would1 in time1 spontaneously begin to speak in some ancient tongue4 ,he therefore appointed a group of foster mothers1 had new-born infants taken from their natural mothers1 and ordered the foster mothers to raise the children in silence4 ,the upshot of this early experiment--as the legend goes--was #ab that ,frederick never found out whether his theory was true4 ,all of the babies died4 ,they could not live without affection1 touching1 and loving words4 ,apparently1 the foster mothers withdrew all human warmth when they sought to obey the king's order4 ,today1 we are aware of a baby's vital need for affection1 for human contact--and even so1 in our adult lives1 when human contact is equally essential1 we sometimes cut ourselves off from others4 ,,the ,,myth ,,of ,,self-,,sufficiency ,as adults1 we tend to emphasize self-control4 ,we think of ourselves as responsible--to ourselves1 our parents1 our employers1 our children4 ,all this responsibility can sometimes be a heavy load6 ,during periods of illness or emotional crisis1 the emphasis on control can be excessive4 ,it can create the bars of a prison1 a grillwork of defenses that stands between us and others who are able to offer encouragement1 warmth1 understanding1 and direction4 ,there is no lonelier person than someone who has decided to take his or her own life4 ,the decision is the ultimate form of self-isolation4 ,it is the ultimate admission that one's imprisonment is final and that there is no escape4 ,fortunately1 the decision to take one's life is reversible1 if the person is helped in time4 ,the help may come from within or from without1 but it always involves the recognition of hope that the self-imprisonment may not be final1 that there are others who would help1 that1 even for someone who is terminally ill1 there may be periods of satisfaction and joy that make living worthwhile4 ,western ,european1 ,american1 and ,japanese societies are very control-oriented4 ,there is much evidence that when members of these societies are emotionally troubled they often perceive a fault within themselves4 ,they see their troubles as springing from a loss of self-control3 ,just pull yourself together6 ,it's just a matter of self-discipline1 of will6 ,the greater our sense of responsibility--the more we emphasize personal control over our inner and outer affairs1 the more we see ourselves as individualists whose individualism is based on strength of will1 discipline1 guts--the more we are trapped by the myth of self-sufficiency4 #ac ,people who as children were forced to become independent too early1 who lacked a long enough period of closeness to their mothers1 whose parents were immature and self-absorbed frequently develop what is called pseudo-self-sufficiency or premature ego development4 ,such a person is the neurotically extreme form of the do-it-yourselfer4 ,he or she refuses to relinquish control1 whether to the car mechanic1 the sewer cleaner1 or a lover4 ,there is an urgent and obsessive need to maintain control1 never to be out of control4 ,for such people1 anxiety1 depression1 and loneliness can be especially devastating because they have walled themselves in to such an extent that emotional growth and change are blocked4 ,yet most of us share1 to some extent1 this belief in self-sufficiency4 ,it is one of the most tenacious forms of self-imprisonment that we have available to us1 literally at our own disposal4 ,it is a prison we often take great pride in4 ,pride1 control1 and self-sufficiency are usually close friends4 ,they keep us from having real friends and stand in the way of our being good friends to ourselves4 ,,the ,,fear ,,of ,,being ,,labeled ,,emotionally ,,disturbed ,it is woven into the fabric of our society that we should conform4 ,a young teenager from ,australia now in a ,california high school tries as quickly as possible to lose the accent that differentiates her1 that makes her the object of laughter4 ,the same pressures motivate the stutterer to keep quiet1 speaking only when absolutely necessary4 ,the ,national ,merit ,scholar says ain't among his school friends to be one of them4 ,children are especially sensitive to covert expectations1 the implicit shoulds that are handed down from the adult world and are frequently refashioned to fit the stages children move through4 ,at each stage1 the implicit maxims are dress alike1 talk alike1 think alike4 ,be in4 ,especially1 have the same feelings1 values1 and hopes4 ,most of us are raised to fear being different because we might come to be a lonely minority of one4 ,but when we become ill1 especially if we are emotionally troubled1 the rules change radically4 ,animals1 from the aquarium angelfish to the household dog or cat1 seem to have an instinct to #ad seek isolation when ill4 ,this tendency probably has evolved because it contributes to survival3 the sick animal can more easily rally its energy for self-healing in quiet1 undisturbed by others of its kind4 ,and going off to be alone reduces the chance that the animal will spread any disease it has4 ,added to an animal's self-isolating tendency is the tendency to hide the very signs of illness or injury4 ,an animal that shows signs of injury or illness is immediately a target for predators who look for the weaker members of the species4 ,we human beings also tend to choose solitude and to hide the revealing symptoms of sickness or injury4 ,admiral ,byrd admitted to these defenses only in his loneliness4 ,but it is important to realize that hiding our feelings and isolating ourselves frequently are not in our best interests4 ,animals do not practice medicine1 though many species are capable of offering moral support and even a certain amount of physical assistance1 as in the case of a sick whale who may be supported by its fellows in the water in order to breathe4 ,but only we have developed medicine1 and we have more recently begun to develop ways to treat problems that affect our emotions1 attitudes1 and behavior4 ,when individuals1 perhaps instinctively1 distance themselves from others and bottle up their malaise1 they turn their backs on the educated assistance and goodwill that are available4 ,sometimes we do so out of fear of treatment coupled with fear of admitting that we are not as self-sufficient as we want to believe4 ,but more often in the case of problems that directly affect our moods--i4e41 psychological problems--we feel ashamed and afraid of the stigma1 the disgrace1 that our society attaches to those who admit they have unhappy or confused feelings4 ,there can be little doubt that society is unbalanced in legitimating physical sickness while reacting with alarm and repugnance to problems of a psychological nature4 ,think of the discrimination against psychological disorders1 in favor of physical complaints1 practiced openly by nearly all health insurance companies1 offering reduced benefits for mental health4 ,psychological pain does not hurt any less because it is emotionally based4 ,even so1 emotional distress is held suspect1 and insurance coverage for it1 if not ruled out completely1 is frequently only partial4 ,it was1 after all1 not more than a century ago that our mental hospitals were run with an inhumanity that #ae still can send shivers down one's spine4 ,unhappily1 it is clear that we have not entirely left this phase of our development3 the film ,one ,flew over the ,cuckoo's ,nest1 for example1 points to continuing inhumanity in some psychiatric hospitals4 ,and there is the alleged case of a ,ukrainian woman who was involuntarily committed and held for some thirty years in a mental hospital4 ,she was thought to be insane because1 unfortunately1 no one involved in her case recognized her gibberish as ,ukrainian6 ,emotional and mental problems are still not accepted by many4 ,there is a fear of the unknown and a skepticism that psychological problems are nothing more than signs that a person is malingering1 simply does not want to try to get better4 ,and there is a gut-level anxiety when confronted by someone who1 we worry1 may be close to going over the edge4 ,,tearing ,,down ,,prison ,,walls ,what undue hardship this causes6 ,as wonderful as the body is1 we accept its imperfections1 its susceptibility to disease and injury4 ,but our brains1 our minds1 our spiritual dimension--how less well we understand these in their greater complexity6 ,is it so strange and unacceptable that they should be prone to their own problems1 that they1 too1 may bring suffering8 ,because society does not legitimate emotional pain1 many people are not able to see their own pain as legitimate4 ,so they deny it1 to themselves and to others4 ,but pain is usually a healthy signal2 it tells you that something is wrong3 ,withdraw your hand from the fire6 ,move your cramping legs6 ,do something about your abusive1 alcoholic husband6 ,get help for your depression6 ,every one of these pains is a warning4 ,to ignore all except those that are physical would be like saying that we are only bodies1 without feelings1 without humanity4 ,when you are in pain1 whatever its source and kind1 pay attention to it6 ,pain is often what points to a better life4 ,it is surely better to cope with a label applied in ignorance by some members of society1 if this must be1 than to live an unsatisfying and painful life4 ,you must not manage your life just to avoid the potentially critical judgment of people who are ignorant of1 or who refuse to acknowledge1 the realities of human psychology4 ,you can feel sure that among well-informed people1 if you have had to deal with alcoholism1 drug abuse1 a difficult #af marriage1 job depression1 or any other psychological problem1 you will be thought to be just as respectable as if you had coped with major surgery after an automobile accident4 ,in fact1 since overcoming a psychological difficulty demands a great deal more of your own voluntary effort1 coming up a winner will increase your own self-respect and the respect1 and even admiration1 of those whose judgment is meaningful4 ,the first step to freedom from pain is to become aware of the walls of the prison that shut you in4 ,only then can you begin to tear them down4 #ag #b ,,paths ,,to ,,help ,to wrench anything out of its accustomed course takes energy1 effort and pain4 ,it does great violence to the existing pattern4 ,many people want change1 both in the external world and in their own internal world1 but they are unwilling to undergo the severe pain that must precede it4 ,rivers in extremely cold climates freeze over in winter4 ,in the spring1 when they thaw1 the sound of ice cracking is an incredibly violent sound4 ,the more extensive and severe the freeze1 the more thunderous the thaw4 ,yet1 at the end of the cracking1 breaking1 violent period1 the river is open1 life-giving1 life-carrying4 ,no one says1 ,let's not suffer the thaw2 let's keep the freeze2 everything is quiet now4 ,mary ,e4 ,mebane1 ,mary1 ,wayfarer ,if you decide to enter therapy1 your therapist will probably ask you to think about two interrelated questions 7they may be expressed in a variety of ways73 ,where are you now8 and ,where do you want to go8 ,your therapist or counselor will1 as he comes to know you1 often be able to help you to answer these by sharing his perceptions of you4 ,one of the main tasks of the counseling process is to help a person gain improved self-understanding that embraces both present problems and future goals4 #ah ,yet if you can gain a certain measure of self-understanding and self-direction before entering counseling or therapy1 it will be easier for you to choose an approach to counseling or therapy that more closely fits your problems1 values1 objectives1 available time1 and even your financial needs4 ,you should find in this book a basis for preliminary self-counseling that will give you a sense of how and where best to begin therapy4 ,it is important to recognize that none of us ever reaches a final state of self-knowledge3 as long as we live1 our self-understanding is capable of growing4 ,what we really understand about ourselves and what we believe ourselves to need and want are never more than provisional1 tentative4 ,additional experience1 just the fact of living longer1 very likely will lead you to perceive yourself differently and motivate you to modify your priorities and change your goals4 ,,where ,,are ,,you ,,now8 ,late in #aihd1 the ,national ,institute of ,mental ,health released the first published results of the largest mental health survey ever conducted4 ,the results are startling and are an unhappy commentary on our society and world4 ,the report shows that #bj percent of ,americans suffer from psychiatric disorders4 ,yet only one in five of these seeks help4 ,the others live with their suffering4 ,the most common problems are these3 ,millions of ,americans ,psychiatric ,name of ,condition with ,this ,disorder ,anxiety disorders #ac4a ,phobias #aa4a ,substance abuse 7alcohol1 drugs1 etc47 #aj4j ,affective disorders 7including depression and manic depression7 #i4d ,obsessive-compulsive disorders #b4d ,cognitive impairment #a4f ,schizophrenia #a4e ,antisocial personality #a4d ,the ,,nimh study also shows that women are twice as likely to seek help as men4 ,two interrelated inferences are commonly made from this previously known fact3 women are often more accepting of their emotional state 7men in our society are taught to disregard their feelings1 part of machismo71 and women are less willing to allow pride to stand in their way of getting help 7women are less affected by the myth of self-sufficiency74 #ai ,the ,,nimh report indicates1 too1 that the incidence of psychological problems drops by approximately half after the age of forty-five4 ,the below-forty-five years are usually those of highest stress4 ,above forty-five1 individuals tend to become psychologically better integrated4 ,this probably reflects increased maturity and a more accepting1 calmer attitude toward life4 ,the lowest rate of emotional disturbance appears to be in people over sixty-five4 ,yet there are many thousands of individuals over forty-five1 and indeed over sixty-five1 for whom life remains a difficult inner struggle4 ,the statistics from the ,,nimh study reveal how very wide-spread personal psychological difficulties are4 ,given the degree of complexity of our mental1 emotional1 and spiritual makeup1 this should be understandable1 especially when we take into account twentieth-century stresses that wear us down4 ,caught up as most of us are in our jobs1 families1 and daily worries1 we are unaware that1 in a very real sense1 mental and emotional health problems have assumed epidemic proportions4 ,if you bear in mind how fearful our society encourages us to be of admitting such difficulties1 you can perhaps imagine how substantial the iceberg of psychological suffering is3 most of it lies below the waterline of public consciousness4 ,the ,,nimh study results should encourage you1 if you suffer from personal emotional difficulties1 to realize that you are not alone in the problems you face4 ,knowing that there are many good and fine individuals with very likely similar problems may urge you to take an honest look at where you are now and then to try to decide what changes may be helpful to you3 where you want to go from here4 ,if you are fortunate1 you may already be aware of the main things in you and in your life that bring you distress4 ,if so1 you are one step closer to being able to do something about them4 ,many of us1 however1 have become so clever and effective in denying what we really feel that we have lost touch with our true selves4 #bj ,desires to repair an unhappy marriage are shelved while the children are growing up2 the unrewarding nature of a job is ignored because priority is given to financial security2 you may be unable or unwilling to face the pain you bring to yourself and others as a result of a drug- or alcohol-abuse habit4 ,in most cases1 it is not possible to gain the motivation and means to solve a problem until you are willing to accept that there is a problem that needs to be solved4 ,because of the blinding nature of the habits you may have established1 and because of your defensive desires to disregard what disturbs the equilibrium of habit1 it may be hard to acquire a clear picture of where you stand right now4 ,sometimes it can be useful to check with others3 how do they see you8 ,a close friend of mine1 after years in her profession1 began rather suddenly to feel how unrewarding her job was1 and she began to suspect that she may have hidden these feelings for a long time4 ,she had maintained a regular1 almost once-a-week exchange of letters with her mother for twelve years4 ,she knew that her mother kept her letters1 so she went to visit her and asked if she might skim through them1 paying attention to comments she had made over the years about her work4 ,it quickly became clear to her that1 consistently1 she had had only very negative things to say about her job4 ,after skimming through dozens of letters written over a period of years1 she became convinced of her real and enduring feelings and changed her line of work4 ,such self-knowledge does not usually come this easily4 ,we may pride ourselves on honesty1 but there are few of us who permit ourselves self-honesty to any real degree4 ,existential-humanistic psychologists have paid much attention to these ways that we live in bad faith--each of us trying to be a person he or she really is not and denying the person he or she really is4 ,we live in a society that emphasizes conformity1 being somebody1 gaining status and wealth and a good position--yet these values may not coincide with being true to ourselves4 ,parental influences can be strong1 as can expectations from our spouses4 ,we internalize many of these values so that it becomes difficult to see who we really are and what we really want from life and from our efforts4 ,there are no easy routes to self-realization4 ,we must all do a certain amount of hunting in the dark--or1 as a colleague of mine #ba likes to say1 scrabbling about--for a sense of real identity4 ,recognizing that your self-understanding is probably always imperfect does not mean that it is of little value4 ,it is1 in the end1 all any of us has to go on4 ,it may be useful to ask people close to you what they perceive about you4 ,reading through a group of old letters1 keeping a journal1 or simply setting aside a few minutes for self-appraisal at the end of each day or week may also be enlightening4 ,if you do this self-examination1 gradually where you are and what you feel will become clearer1 and then it will be natural and appropriate to ask what the next step is4 ,,where ,,do ,,you ,,want ,,to ,,go8 ,,what ,,kind ,,of ,,person ,,do ,,you ,,want ,,to ,,become8 ,influences from society1 your parents1 your spouse1 or your close friends make it difficult for you to know yourself4 ,defensive habits and fear of change also stand in the way4 ,these are significant blocks to self-understanding4 ,when you turn your attention to the future1 to what kind of person you want to become1 you will encounter more blocks to overcome4 ,life is like that6 ,it seems that few things come without effort and perseverance4 ,there are two major obstacles to designing the model of the person you would like to become4 ,because they can be so important1 ,i want to introduce them early in this book4 ,they are blame and guilt1 and they are like the two ends of a seesaw4 ,when we appraise what we have done in our lives1 we usually find reasons to blame others1 or perhaps to blame limited educational opportunities1 or social pressures1 or discrimination--in short1 our past environment3 all the factors that limited our lives1 interfered with the attainment of our hopes1 and were not under our control4 ,on the other end of the seesaw sits guilt4 ,and guilt is really blame turned inward4 ,if we try to pinpoint the factors that have been responsible for our lives not having turned out better1 we tend to blame environmental limitations1 or else we feel guilt for what we see as our own failings4 ,usually1 we locate responsibility in both areas4 ,most of us1 however1 have unbalanced seesaws4 ,we usually #bb blame things outside ourselves for our disappointments4 ,doing so is a habit that allows us to avoid responsibility for ourselves and1 in turn1 limits our future development4 ,on the other hand1 some of us blame ourselves much too readily3 we carry an exaggerated burden of responsibility1 which weighs us down and also limits our growth as individuals4 ,ideally1 psychotherapy would like us to let go of so-called past negative conditioning--blame as well as guilt--so that we are free to choose who we are and will become4 ,even though this is certainly a desirable attitude1 most of us cannot really forget and let go4 ,we are all inheritors of a tenacious past3 the influences of past events have a certain power over us1 and we must either resign ourselves to being controlled by the past or fight its influence4 ,the attitude we take toward the past will usually affect how we meet the future1 often diminishing our freedom to change old habits and undermining our hope and faith in ourselves4 ,for example1 if ,jeff blames his limitations today on his parents1 on the ways they influenced him1 he may set goals for himself that are far from being freely chosen4 ,jeff may choose them in reaction to domination by his parents years ago4 ,his parents may have tried to influence him to be a gentle1 courteous person with artistic interests4 ,but as a result of other past influences--for example1 because of frequent moves of the family and repeatedly being bullied as the new kid at different schools--,jeff may feel hostile toward others1 so 7in reaction to his parents' influence and because of pent-up hostility7 he decides to go into science 7rather than art1 for which he perhaps has a talent7 and rejects gentle1 courteous qualities in himself4 ,it is difficult to choose freely4 ,some psychologists do not believe it actually is possible4 ,and yet1 whether we are ever truly free or not1 we still try to plan our lives1 and we believe our plans 7and frequently the lack of them7 have something to do with what we make of living4 ,most people who enter counseling or psychotherapy want to improve some aspect of their living4 ,individuals whose seesaw is weighted on the side of blaming outside influences too often come to feel it is too much work and quit therapy because they cannot accept the need to make choices and decisions in spite of past influences4 ,on the other hand1 people who blame #bc themselves may be so guilt-ridden that they are impaired in their openness to the future and feel unable to initiate fundamental changes in their lives4 ,when you ask yourself1 ,what kind of person do ,i want to become81 try to be aware of the extent that your answer may be weighed down by feelings of blame and guilt4 ,all too often we continue to perpetuate1 unknowingly1 the same old unsatisfying patterns because we are trapped by our habits of blaming others or ourselves4 ,if you feel bogged down by feelings of guilt or burdened by the limitations of an unfair past1 it may be difficult for you to develop a freely chosen sense of direction4 ,but perhaps you will be able to acknowledge that the guilt or blame you feel is an obstacle to be overcome4 ,if so1 you have defined an objective that you may use to decide what type of counseling or therapy may be a most promising first step4 ,what ,i am suggesting is that an obstacle that makes it hard for you to gain a sense of direction can itself point you in a direction4 ,if there are blocks1 it can be helpful to meet them head-on4 ,in therapy1 the phrase working through a problem often means exactly this4 ,choosing what kind of person you wish to be is a process1 not an event4 ,it is not something that happens and then is over4 ,choice is something implicit in each day of your life2 sometimes it is quite conscious1 but it is often dulled by the unconsciousness of habit4 ,your personal goals may undergo gradual or abrupt change4 ,psychological growth is your response to these changes in outlook4 ,,what ,,does ,,therapy ,,try ,,to ,,do8 ,individual therapy or counseling 7therapy for groups and families will be discussed in detail later7 is really an attempt to build a bridge between answers to these two now familiar questions3 ,where are you now1 or what kind of person are you now8 and ,where do you want to go1 or what kind of person do you want to become8 ,think of therapy as an attempt to build a bridge so that you can pass from a present situation to a desired way of being4 ,carl ,rogers defines therapy as a relationship in which at least #bd one of the parties has the intent of promoting the growth1 development1 maturity1 improved functioning1 improved coping with life of the other4#a #a ,carl ,rogers1 ,on ,becoming a ,person3 ,a ,therapist's ,view of ,psychotherapy 7,new ,york3 ,houghton ,mifflin1 #aifa71 pp4 #ci-dj4 ,psychiatrist ,allen ,wheelis takes this definition further3 ,therapy may offer insights into bewildering experience1 help with the making of connections1 give comfort and encouragement1 assist in the always slippery decision of whether to hang on and try harder or to look for a different way to try4444 ,the place of insight is to illumine3 to ascertain where one is1 how one got there1 how now to proceed1 and to what end4 ,it is a blueprint1 as in building a house1 and may be essential1 but no one achieves a house by blueprints alone1 no matter how accurate or detailed4 ,a time comes when one must take up hammer and nails4444#b #b ,allen ,wheelis1 ,how ,people ,change 7,new ,york3 ,harper and ,row1 #aigc71 pp4 #aja1 #ajg4 ,therapy involves a three-fold relationship among a helping professional1 the approach to therapy used by him or her1 and1 what is most important1 the outlook of the individual client4 ,in this book we will examine each of these three dimensions of therapy in some detail1 but here we will concentrate on the one therapists generally agree is the most important3 you--the kind of person you are1 what your attitudes and outlook are1 and1 of course1 how much you really want to develop or change4 ,your attitudes will determine1 probably more than anything else1 what variety of therapy you will most benefit from4 ,therapists1 like teachers 7which they really are71 find that their clients or patients can be divided into two groups3 active and passive learners4 ,when you go to a doctor with a broken arm1 your relationship to your doctor is a passive one3 you need only to cooperate as he examines your arm1 perhaps administers an anesthetic1 and sets the break4 ,you may take medication for pain1 and then you simply wait until1 thanks to the body's automatic healing processes1 the break is fused4 ,the public's conception of medicine is predominately a passive one4 ,to be a patient is for the most part to be a passive bystander3 the physician is the active agent who brings about healing4 ,there are occasional #be exceptions--for example1 physical therapy and rehabilitation therapy after a serious injury or illness1 when the patient must become more active and accept more responsibility4 ,as we will see1 a few approaches to counseling and psychotherapy preserve1 to some extent1 the traditionally passive role of the patient4 ,most of them1 however1 require a good deal of initiative and just plain hard work on the part of the patient or client4 ,in building the house of one's life or in its remodeling1 one may delegate nothing2 for the task can be done1 if at all1 only in the workshop of one's own mind and heart1 in the most intimate rooms of thinking and feeling where none but one's self has freedom of movement or competence or authority4 ,the responsibility lies with him who suffers1 originates with him1 remains with him to the end4 ,it will be no less his if he enlists the aid of a therapist2 we are no more the product of our therapist than of our genes2 we create ourselves4 ,the sequence is suffering1 insight1 will1 action1 change4 ,the one who suffers1 who wants to change1 must bear responsibility all the way4 ,must because so soon as responsibility is ascribed outside oneself the forces resisting change occupy the whole of one's being1 and the process of change comes to a halt4 ,a psychiatrist may help1 perhaps crucially1 but his best help will be of no avail if he is required to provide a degree of insight which will of itself achieve change4#c #c ,wheelis1 ,how ,people ,change1 pp4 #aja-ajb4 ,,why ,,is ,,it ,,so ,,complicated8 ,for better or for worse1 human nature is a many-splendored thing4 ,it doesn't take an advanced degree in psychotherapy to know that people can have many different kinds of personal problems4 ,this fact1 if we appreciate it fully1 makes more understandable why there are so many alternative approaches to helping people with their difficulties4 ,in the world of theory1 a model is a simplified representation of reality4 ,your checking account record is a model1 in just this sense1 of how many real dollars and cents you have in the bank4 ,here is a much simplified model that represents five main psychological1 emotion-laden dimensions of a person3 #bf ,illustration3 ,five main psychological dimensions of a person3 feelings1 hopes1 abilities1 relationships with others1 and behavior ,we see right away that1 for the same reasons that there are specialties in medicine--e4g41 orthopedy for bones1 neurology for nerves1 dentistry for teeth--there should be special approaches that focus on different psychological dimensions of the person4 ,something else you may see is that the five dimensions in the model are not isolated from one another4 ,they interrelate and overlap a good deal4 ,just as a dentist must know about the orthopedy of the jaw and skull and the neurology of the teeth a neurologist and an orthopedist are expected to know something1 though not in great detail1 about dentition4 ,each of us is a unity of what all the medical and psychological specialties study in different ways1 plus a good deal more1 as artists1 writers1 theologians1 and musicians make evident4 ,that more than #acj distinguishable therapies have now been developed may perhaps strike us1 even so1 as excessive4 ,but efforts are being made to unify many of these approaches1 and this book is one of them4 ,rather than talking about #acj different approaches1 we will center our attention on the main categories into which the many approaches can be sorted4 ,one of the interesting and hopeful things that can be said #bg about the multiplicity of approaches to therapy and counseling is that treatment by any one of them can often be of some help4 ,for example1 ,helen may wish to stop drinking 7a habit in the behavior category71 and she may be helped by means of behavior modification4 ,she may then find that1 as a direct result1 her self-concept 7feeling category7 has grown stronger1 while her marriage 7relationship category7 has also improved4 ,or1 ,ralph may go to a vocational counselor who helps him define a direction 7hope category7 in keeping with his interests and aptitudes4 ,ralph goes back to school and develops a background 7abilities category7 that reflects these aptitudes and interests4 ,the sense of direction he has gained helps ,ralph stop using drugs 7behavior71 reduces his hostility and anxiety 7feelings71 and improves his relationships with others4 ,in other words1 a helpful change in one direction can often lead to noticeable changes in others4 ,however1 there also are risks that we should not ignore3 ,sue goes to an analyst and learns over a period of months that her marriage to ,fred was based on a sense of inadequacy ,sue learned during her childhood4 ,her father was so highly controlling and critical of her that she was never able to develop a sense of her own value4 ,her husband1 ,fred1 is also domineering and authoritarian1 and he abuses ,sue frequently1 usually mistreating her through criticism1 but he has sometimes also beaten her physically4 ,sue has accepted this without question for a long time1 but due to the emotional support received from her analyst1 she is beginning to develop a sense of self-esteem4 ,as her self-esteem grows1 she comes to realize that her marriage is a self-destructive relationship and decides to divorce ,fred4 ,her therapy has been helpful to ,sue1 but it has1 indirectly1 resulted in a breakdown of her admittedly unhappy marriage4 ,a change in one dimension can sometimes lead to an initially unintended change in another area4 ,,if ,,it ,,hurts1 ,,don',t ,,procrastinate6 ,one of the marvelous things about human nature is the ability to feel pain4 ,this may seem like an odd thing to say1 but reflect for a moment4 ,pain is frequently what spurs us on from an unsatisfying and even destructive situation to a better future4 ,pain tells you to jerk your hand away from a hot stove4 ,a different kind of pain tells you it is time to get on with living1 time to #bh initiate some positive changes4 ,anxiety1 sleeplessness1 irritability1 resentment1 depression--they all can be painful inner feelings that tell us that all is not well in our inner selves4 ,it is well-known to counselors and therapists that1 in general1 the longer these signs of need are ignored1 the longer it may take to help a person resolve the difficulties that have been pressing for attention4 ,distress is not easily buried4 ,when suppressed1 it tends to pop up again later1 sometimes with increased severity4 ,we can1 ironically1 choose to be strong and ignore these messages from within1 or we can listen to our feelings1 pay attention to our hopes1 develop needed abilities1 seek to improve our relationships with others1 and work to change some ways we behave that block our happiness4 ,problems that concern your inner well-being and the health of your relationships with others who are important to you are better resolved than buried1 and the earlier they are given the attention they deserve1 the easier your path through change to a better life will be4 #bi #c ,,bridges ,,from ,,here ,,to ,,there ,,an ,,overview ,,of ,,the ,,field ,,of ,,therapy ,,the ,,helping ,,professional ,professionals in the fields of counseling and psychotherapy have a wide range of different backgrounds and perspectives4 ,they can be broken down into these categories3 ,social work counselors3 counselors for individuals2 marriage and family counselors2 group counselors2 and vocational guidance counselors ,psychologists3 clinical psychologists2 counseling psychologists2 and psychometrists ,psychiatrists ,other therapists3 religious counselors2 biofeedback therapists2 hypnotherapists2 relaxation and meditation instructors2 holistic therapists such as bioenergetics therapists1 yoga instructors1 and exercise therapists2 etc4 ,the education1 supervised training1 and outlooks of these professionals vary greatly1 as do their fees and the average length of time therapy can be expected to last4 ,we will look more closely at these differences later on4 #cj ,,the ,,range ,,of ,,approaches ,,to ,,therapy ,because of their differences in training and personal or theoretical preferences1 the distinct classes of therapists represent a diversity of approaches to therapy4 ,there are numerous schools of psychoanalysis1 psychotherapy1 behavioral therapy1 group therapy1 and marriage and family therapy1 and a range of approaches to personal adjustment1 including exercise therapies1 relaxation techniques1 forms of meditation1 and drug and nutrition therapies4 ,from any one of these1 a multitude of schools of thought branches out4 ,for example1 psychoanalysis has1 since ,freud1 developed along a number of different lines3 each major psychoanalyst has formulated his or her own approach to analysis that distinguishes itself from ,freud's4 ,psychotherapy1 to take another example1 is not a single approach to therapy1 but rather makes up an entire field4 ,it is the largest and most rapidly growing area relating to mental health4 ,in it are included distinct approaches1 such as client-centered therapy1 ,gestalt therapy1 transactional analysis1 rational-emotive therapy1 existential-humanistic therapy1 reality therapy1 logotherapy1 ,adlerian therapy1 emotional flooding therapies1 and direct decision therapy4 ,in later chapters1 we will look at these approaches to psychotherapy more closely4 ,the goal throughout this book will be to enable you to understand enough about each of the major therapies to make an informed decision in choosing an approach 7and there may be more than one7 that will be most useful in relation to your own understanding of your objectives1 whether they are long-range or focused on the need to eliminate immediate obstacles to growth4 ,,the ,,difference ,,between ,,counseling ,,and ,,psychotherapy ,counseling and psychotherapy have developed a great deal in recent years--so much so that their boundaries have often overlapped4 ,clear-cut distinctions between the two fields are increasingly hard to draw4 ,nevertheless1 some professionals prefer to call themselves by one name and some by the other4 ,in general terms1 counseling tends to be a short-term process the purpose of which is to help the client1 couple1 or family #ca overcome specific problems and eliminate blocks to growth4 ,counseling gives individuals a chance to resolve personal problems and concerns4 ,most counselors attempt to help their clients become aware of a widened range of possibilities of choice2 from this perspective1 counseling tries to free clients from rigid patterns of habit4 ,habits can be useful1 but they can also interfere with life4 ,the technical habits of a pianist1 for example1 are essential in performance4 ,similarly1 only when language skills become habitual does a speaker of a foreign language achieve command of it4 ,on the other hand1 fears can also become habitual1 and they may come to interfere with everyday activities4 ,anxiety over public speaking may become habitual4 ,there are many personally destructive habits--alcoholism1 smoking1 over- or under-eating1 abusive behavior1 shyness and social withdrawal--and all can become self-perpetuating patterns4 ,counseling can help people break out of these habits1 often in part by helping clients become aware of unrecognized alternatives4 ,psychotherapy tends to be more concerned than counseling with fundamental personality-structure changes4 ,frequently1 psychotherapy is a longer-term process4 ,frequently1 too1 the problems treated in psychotherapy are hard to pin down and are less specific4 ,they include chronic depression1 pervasive 7free-floating7 anxiety1 generalized lack of self-esteem1 and so on4 ,such difficulties are not well defined2 their causes may be vague or uncertain1 and often much time must be spent to get at their basis4 ,psychotherapy seeks to bring about an intensive self-awareness of the inner dynamics--the internal forces and the principles that govern them--that are involved in chronic forms of personal distress4 ,sometimes1 as in analytical psychotherapy or psychoanalysis1 attention is focused on the role of unconscious processes in inner conflicts2 treatment attempts to resolve these conflicts by understanding the unconscious forces involved4 ,the term psychotherapy is often used to imply more advanced professional training1 whereas counseling is something individuals with more modest academic credentials may practice4 ,whether a professional is called a counselor or a therapist has to do with his or her level of training1 with the setting in which services are offered1 and1 to a certain degree1 with that person's theoretical orientation4 #cb ,in practice1 these differences in outlook frequently amount to differences in emphasis rather than approach4 ,in this book1 ,i will speak of counseling and psychotherapy interchangeably unless there is a need to be especially restrictive4 ,,therapy3 ,,the ,,art ,,of ,,change ,,how ,,we ,,are ,,able ,,to ,,change ,we are what we do 444 and may do what we choose4 ,allen ,wheelis1 ,how ,people ,change ,freud identified five causes of personality development3 99 growth and maturation 99 frustration 99 conflict 99 inadequacy 99 anxiety ,by the time we become adults1 most of us have developed sets of defenses to enable us to cope with everyday problems in spite of feelings of frustration1 conflict1 inadequacy1 and anxiety4 ,but as these feelings become more pronounced1 when we encounter situations that intensify these feelings1 we must put more and more energy into our defenses4 ,they allow us to continue living and acting in habitual ways1 usually by hiding1 by denying1 and sometimes by distorting our perceptions of reality4 ,facing the inadequacies of a marriage1 the unrewarding nature of a job1 the extent of conflicts with a child1 or difficulties relating to friends can cause intense anxiety4 ,so1 to avoid this anxiety1 we frequently defend against these realizations3 we try to uphold the belief that our marriages are just fine1 that things are ,,ok between us and our children1 that our jobs are at least tolerable--that1 in spite of some problems here and there1 we can get along all right4 ,we do1 in short1 try to see our lives through rose-tinted glasses4 ,we continue to do this until our negative feelings become too strong1 until we have expended so much energy to maintain our defenses that we are emotionally exhausted4 ,if we reach such a state of real depletion1 and our defenses can no longer hold against the building pressure of our feelings1 the result is #cc nervous breakdown4 ,this is the layman's name for a variety of psychological conditions that develop due to a burned-out emotional fuse4 ,a fuse is a protective device that prevents an overload of electricity4 ,our defense mechanisms are analogous devices that protect us against emotional overload4 ,when an emotional fuse burns out1 it is often because we have maintained defenses too long in the face of increasing inner frustration and pain4 ,the result may involve severe depression1 incapacitating anxiety1 or serious withdrawal4 ,now1 when you decide to change in some psychologically fundamental way1 you must push against the rigid framework of certain of these protective defenses4 ,when you do this1 you will feel anxiety4 ,you are forcing your emotional fuses to adjust to a different pattern of behavior and feelings4 ,your sense of personal identity is made up of a network of ways you have come to perceive yourself1 your loved ones1 your work1 and your world4 ,any attempt--even if it is your own1 entered into through your own choosing--to change patterns that are psychologically basic to your sense of identity will threaten that established identity and produce a measure of anxiety4 ,the longer these habitual patterns of behavior and feeling have been in force1 the more deeply rooted they become in your sense of identity1 and the more unsettling and anxiety-producing an attempt to change them will be4 ,although your defenses protect against emotional overload1 they also stand in your way of change4 ,they are fundamentally conservative mechanisms3 established habits of thought1 feeling1 and behavior are familiar1 and familiarity reduces the anxiety brought about by uncertainty4 ,if you are considering making significant changes in your life1 your defenses will rally to protect the equilibrium of habits you have formed in the past4 ,if you push yourself to change1 you will face a predictable degree of anxiety4 ,fortunately1 there are1 as we shall see1 many ways of coping with the anxiety brought about by change2 therapy offers some of these1 and some are available to us all if we draw on inner resources4 ,as long as you are alive it is possible to change4 ,ultimately1 the decision to change is an expression of your choice and will4 ,when change is achieved1 it usually comes after long and arduous trying4 ,we are all aware of the heroic efforts some #cd people can and do make to overcome a physical handicap4 ,overcoming deeply entrenched emotional habits can require similar tenacity and commitment4 ,if you want to bring about some basic changes in yourself or in your relationships with others1 your inner strength and resolve will be essential4 ,frequently1 individuals expect a therapist to accomplish change for them3 they are willing to come for an hour's consultation once or twice a week1 and they will be very cooperative during each visit1 but they seem unwilling or unable to develop the initiative to carry on efforts begun in the therapist's office4 ,some clients1 in spite of what they say1 do not really want to change4 ,their habits are deeply ingrained1 serving purposes they may be only dimly aware of at the beginning of therapy4 ,sometimes it becomes necessary in therapy to reappraise the goals that have been set4 ,the decision to pursue a certain course of change may result in so much anxiety and upset that both therapist and client must pause to reconsider4 ,some changes may turn out to be too difficult1 too taxing2 some clients may be unwilling to put in the work required to bring about a certain change4 ,most changes of the kind ,i am referring to--fundamental changes in outlook1 in daily thoughts and feelings1 in behavior--can be made only gradually4 ,since any move in the direction of change will threaten your existing defenses1 resistance and protest are likely to well up from within you4 ,new ways of being will feel intimidating1 unpleasant1 or just plain unnatural4 ,and this is understandable1 is it not8 ,you must confront and do battle against habits that may have been with you for a long time4 ,the longer that undesirable patterns have been in force1 the more control they acquire over you1 and the more your defenses become committed to preserving them4 ,change is made steadily more difficult4 ,always remember1 however1 that change can be brought about4 ,you need to be patient with yourself2 it will not come overnight4 ,long-standing habits take time to be replaced1 ,you must have patience1 and you must feel hope and encouragement4 ,if you are depressed now1 if maintaining your defenses has exhausted you1 then it will be difficult to feel the measure of hope that you need to begin the process of therapy4 ,this1 perhaps more than anything else1 is the most immediate and perceptible benefit of therapy3 a good therapist is a source #ce for hope and encouragement when you cannot sustain these yourself4 ,therapists are trained to help people who want to change1 to bring it about4 ,,the ,,results ,,of ,,therapy ,in the past twenty to thirty years1 there has been a gradual shift away from a medical1 illness-based orientation in therapy to one that focuses on personal growth4 ,by no means everyone enters therapy because of emotional pain4 ,increasingly1 therapists are seeing clients who enjoy psychological and emotional good health but believe that therapy can help them lead fuller1 richer1 more satisfying lives4 ,as a consequence1 the objectives of many current approaches to therapy involve more than only the resolution of personal difficulties and crises4 ,there are many potential benefits of therapy4 ,to varying degrees1 all the therapies we will discuss in this book claim to assist you in achieving the following goals4 ,resilience and ,tolerance to ,stress ,as a consequence of therapy1 you come to be less frustrated by stress1 able to recover from stressful experiences more quickly4 ,you become less defensive and more accepting of others and yourself1 able to adjust more easily to unexpected demands in living4 ,you have a decreased tendency to hold rigid expectations of the world1 so you feel less disappointment and frustration4 ,congruence ,you come to be more unified in the present moment1 aware of your feelings1 and less disposed to ignore1 deny1 or distort your perceptions out of defensive needs4 ,congruence means a close match between what you feel and how you think and act4 ,congruent people are well integrated1 no longer in need of masks4 ,when we admire a person's sense of integrity1 we often feel that the person not only behaves in ways that show self-respect1 but that he or she is self-accepting1 is genuine1 and appears to be comparatively free of inner conflict4 ,such individuals are1 in short1 able to be themselves4 ,people who no longer are engaged in a battle against themselves and against others will tend to show congruence4 #cf ,self-,esteem ,people with high self-esteem can allow themselves to feel modest and to behave with modesty4 ,high self-esteem does not imply pride or arrogance4 ,self-esteem and self-acceptance 7and hence congruence7 are interrelated4 ,individuals with strong self-esteem no longer need to prove themselves4 ,they value the kind of people they are and are not inclined to be self-undermining through perfectionistic self-criticism4 ,openness and ,love ,ideally1 if you undergo therapy1 you become less defensive and less uptight about yourself2 you will therefore have less need for self-absorption1 so you will be able to develop an increased capacity to feel warmth for others4 ,you may become more giving1 and less hooked on the need to recover for what you do give1 tit for tat4 ,there are fewer shoulds to stand in your way1 to use to blame yourself1 or to use to criticize others4 ,you can let go of these requirements and accept others for what they are1 for what they can do1 and for what they may feel4 ,you feel less disappointment and resentment about your relationships and more of a sense of ease and peace4 ,freedom ,since you are less hooked by the expectations and values of others1 and you have reduced the list of requirements that others must fulfill in order to be acceptable1 you gain a great measure of personal freedom4 ,the habitual process of sizing others up and comparing them with yourself1 which many of us expend so much time and energy doing1 is no longer needed4 ,you can more freely set your life goals4 ,you will probably feel more real1 meaningful satisfaction with your life1 since you are no longer imprisoned by uptight standards of judgment4 ,you are able to be much more relaxed because you are able to feel more accepting toward others and toward yourself4 ,displacing the ,negative with the ,positive ,these are among the major potential positive benefits of therapy4 ,they make up one way of describing the ideal outcomes of therapy4 ,they are one side of the coin2 the other side consists of the many negative feelings and ways of behaving that are #cg eliminated when they are displaced by these positive personality qualities4 ,the negatives that make up such a familiar part of normal life include these3 99 fears that stand in the way of desired goals 99 anxiety and depression that cripple normal living 99 low self-esteem1 resentment1 and hostility that poison the formation and development of satisfying relationships 99 incapacity to deal with stress1 and dependence on alcohol1 drugs1 or other means to reduce anxiety 99 inability to accept yourself1 your family1 or your present place in the world--which often leads to bitterness1 withdrawal1 and even the cultivation of fantasies that further isolate 99 confusion1 disorientation1 and perhaps even physical signs of poor health1 as a result of emotions that have assumed a magnitude that can no longer be held in check by tired defenses ,we tend to think of these as the usual reasons for entering therapy4 ,but1 again1 the positive qualities we have described are attracting clients increasingly to therapy4 ,whether you need to eliminate emotional pain or are fortunate to be comparatively untroubled but are searching for certain positive qualities of perspective and character that you believe will bring increased satisfaction to your living1 therapy may offer what you are seeking4 ,,what ,,makes ,a ,,good ,,therapist8 ,according to several studies1 certain qualities in therapists are associated with effective therapy4 ,the kind of person who is able to help others bring about important life changes has these qualities3 99 the ability to understand the client's feelings and life world 99 heightened sensitivity to the client's feelings and attitudes so that the therapist frequently is able to uncover significant aspects of the client's outlook and personality of which the client would probably remain unaware #ch 99 warmth of interest in the client's well-being1 without emotional overinvolvement 99 psychological maturity1 characterized by self-acceptance1 genuineness1 and congruence 99 a sense of acceptance toward the client3 a nonjudgmental1 noncritical1 positive regard for the client1 his separateness1 and individuality 99 an attitude1 conveyed by the therapist's behavior and approach1 that encourages positive change1 independence1 and freely made choices and decisions1 and implicitly discourages the formation of long-term dependence of the client on the therapist ,these studies also identified several attitudes that clients1 regardless of the orientation of their therapists1 felt were especially counterproductive in some therapists3 99 lack of interest 99 remoteness or distance 99 excessive sympathy ,in general1 clients whose evaluations of therapy have been studied appear to be in agreement that the personal character1 attitudes1 and feelings of therapists are more important than a therapist's technique1 procedures1 and theoretical orientation4 ,therapy is an intrinsically human process1 one that is especially sensitive to the human dimensions of therapists4 ,later we will look at objective evaluations of the effectiveness of various approaches to therapy and weigh them against the emphasis that clients place on the personal qualities of therapists4 #ci #d ,,the ,,therapeutic ,,jungle1 ,,part ,i ,social ,workers1 ,psychologists1 and ,psychiatrists ,i have reluctantly come to concede the possibility that the process1 direction1 and end points of therapy may differ in different therapeutic orientations4 ,carl ,rogers1 ,on ,becoming a ,person ,fifty years ago1 people with personal or marital problems had a choice between two main kinds of assistance3 psychoanalysis and religion4 ,freud's approach to psychiatry had gained popularity among physicians1 psychoanalytic training was being made available to clinical psychologists1 and the ideas of ,freudian analysis had come to dominate the public's conception of therapy4 ,and1 sometimes overlooked in this context1 the church--the world's faithful and oldest psychiatrist--continued to offer spiritual and personal guidance4 ,these two basic choices have expanded into an impressive--and confusing--array of different therapies4 ,the more than one hundred varieties of counseling1 even when they are grouped together1 cannot be reduced to fewer than perhaps twenty families of therapies4 ,different counseling professions have evolved that now range from social work to psychotherapy to psychiatry2 religious counseling is still offered2 and there are the newer therapies of #dj relaxation training1 biofeedback1 bioenergetics1 etc41 as well as a renaissance of older approaches such as meditation1 yoga1 and holistic practice4 ,the choices of fifty years ago seem modest1 limited1 and certainly less perplexing4 ,however1 the recent proliferation of therapies has brought with it increased sensitivity1 sophistication1 and effectiveness4 ,in spite of this growth of therapeutic options1 most people who decide to enter therapy are unaware of the choices open to them and so cannot intelligently weigh their alternatives4 ,this and the next chapter will help you to see clearly what alternatives exist4 ,as the book helps you to clarify your personal objectives1 you will be able to home in on one or more approaches to therapy that may be especially promising for you1 your temperament1 interests1 and goals4 ,you will be encouraged to follow a map that will guide you to several approaches to therapy1 to help you find the shortest and most effective route to where you want to go4 ,,social ,,work ,,counselors ,as we have seen1 the four main categories of social work counselors are counselors for individuals1 marriage and family counselors1 group counselors1 and vocational guidance counselors4 ,,orientation ,,and ,,training ,the main purpose of social work is to help people cope with stress from interpersonal or social problems4 ,the focus of the social worker may therefore be on individuals1 families1 or groups or on their social and work environments1 their organizations1 and their communities4 ,social workers are trained to deal with developmental problems1 life crises1 and emotional problems that arise in a variety of social situations4 ,graduate schools of social work require varying periods of supervised internship2 they usually offer specializations within the field--e4g41 drug and alcohol abuse1 developmental disabilities1 child welfare1 correctional approaches1 family services1 care of the aged1 and others4 ,it is now possible to find social workers whose training is quite specialized4 #da ,in some states1 social workers may practice with a bachelor's degree2 in many states1 a master's degree is required4 ,in addition1 counselors are usually required to put in a substantial number of hours of counseling under the supervision of a licensed counselor4 ,,fees ,social workers in private practice normally charge on an hourly basis for their services1 with sessions lasting thirty to fifty minutes4 ,rates vary considerably1 in direct relation to other health care costs4 ,rates are higher in larger metropolitan areas and also higher in ,new ,england and ,california than in the ,south and ,midwest4 ,an approximate range of #ce to #fe per counseling session is normal at the time of this writing4 ,costs for marriage and family counseling and for vocational guidance counseling are similar to rates for individual counseling4 ,the charge for group therapy is frequently made for a block of sessions4 ,the group therapist may1 for example1 recommend that a group meet for ten sessions4 ,the resulting per-session cost is normally significantly lower than is individual counseling4 7,however1 the goals of individual and group therapy are in general different1 as we will see2 neither can automatically be substituted for the other47 ,many social workers offer their services through a counseling agency4 ,some of these are privately run2 others are funded by the county or state4 ,frequently1 agencies charge for counseling services based on a sliding scale1 which takes into account the financial situation of clients4 ,sliding scale rates can be very economical for lower-income individuals4 ,bills for services in some county and state agencies are made on a monthly basis2 individual counseling may cost only a few dollars per session for individuals with restricted budgets4 ,there are many opportunities for clients to obtain economical care1 especially in metropolitan areas where counseling services are widespread4 ,,duration ,,of ,,treatment ,it is impossible to give any hard and fast rules as to how long #db counseling will take4 ,obviously1 much has to do with an individual's objectives1 the severity of the problem1 and1 frequently1 how long the problem has been neglected or ignored4 ,on the other hand1 much also has to do with the counselor's own orientation4 ,today1 many counselors receive training that emphasizes brief therapy4 ,specific goals of therapy are set1 and it is frequently possible to reach those goals within a matter of a few months4 ,on the other hand1 some counselors prefer1 or have been trained1 to offer long-term individual psychotherapy4 ,some counselors have been influenced by the psychoanalytic approach1 which is usually of long duration1 frequently requiring one to several years4 ,there is no reason you1 as a prospective client1 should not ask a counselor what kind of approach he or she uses and approximately how long therapy can be expected to last4 ,you should not hesitate to ask a counselor questions that reflect your concerns4 ,as you read further1 this book will provide you with a frame of reference so that you may evaluate more fully the answers a counselor gives you4 ,,psychologists ,as mentioned in the last chapter1 there are three kinds of psychologists who are involved in different aspects of therapy3 clinical psychologists1 counseling psychologists1 and psychometrists4 ,,orientation ,,and ,,training ,clinical psychology emphasizes the understanding1 diagnosis1 and treatment of individuals in psychological distress4 ,clinical psychology is historically based on laboratory work that stressed psychological assessment tests1 and experimental and statistical analysis4 ,clinical psychologists generally have a ,ph4,d4 and complete a lengthy internship in a clinical setting4 ,most clinical psychologists develop competence in both diagnostics and intervention4 ,the area of diagnostics includes individual interviews1 psychological testing1 and personality assessment 7psychological evaluation to determine what a client's difficulties are74 ,intervention 7the actual approach used to help a person7 includes individual psychotherapy1 group therapy1 and marriage and family therapy4 #dc ,the objective of counseling psychology is to encourage growth in the three major life areas of family1 work1 and education and to prevent excessive psychological stress in them4 ,like clinical psychologists1 counseling psychologists receive training in individual1 group1 and marriage and family counseling as well as in vocational counseling1 assessment1 and rehabilitation4 ,often1 you will find clinical psychologists in private practice1 while many counseling psychologists hold positions in organizations1 schools1 and social service agencies4 ,counseling psychologists generally have a master's degree or ,ph4,d4 and also are required to complete internships in supervised counseling4 ,psychometrists are specifically trained to give and to evaluate psychological tests4 ,they are1 so to speak1 the radiologists of the fields of counseling and psychotherapy4 ,clients may be referred to a psychometrist in order to take one or more psychological tests2 the psychometrist's interpretation of the results is then forwarded to the client's therapist or counselor4 ,increasingly1 psychologists are being trained to do much of this work themselves1 so it has become less common to refer clients to psychometrists unless an extensive amount of testing is desired4 ,if you are advised to take one or more psychological tests1 you may be interested in knowing what to expect4 ,many psychological tests are multiple-choice4 ,you are given a printed list of questions and an answer sheet4 ,there are no right answers4 ,you answer such questions as ,would you rather go to a party or stay home and read a good book8 ,tests like this attempt to provide insight into a client's outlook1 personality1 concerns1 values1 and interests4 ,some tests help to assess concentration1 coordination1 and problem-solving ability4 ,results of psychological tests can be helpful to a counselor in deciding how best to treat a client's problems4 ,testing can be a great time- and money-saver in therapy3 the results of a twenty-minute test can give a counselor information about a client that might otherwise be gained only through a number of sessions4 ,,fees ,because of their more advanced training1 clinical psychologists can be expected to charge fees that are somewhat higher than what social workers in private practice receive4 ,charges for #dd the services of a clinical psychologist are made on an hourly basis2 counseling sessions usually last forty-five to fifty minutes1 although some psychologists will see clients for shorter periods4 ,rates vary considerably according to geographical area4 ,an approximate range of #ej to #hj per private session is normal at this time4 ,group session rates tend to be significantly lower4 ,if you consult a clinical or counseling psychologist who works through an agency1 you will often find that a sliding scale is used to determine charges1 as in social work4 ,if you have limited or no health insurance1 and financial concerns are a problem1 you can telephone counseling agencies in your area to ask whether a sliding scale is used and1 if so1 what charges correspond to your monthly income4 ,later1 we will look at how to locate counseling agencies1 as well as professionals in private practice4 ,fees for psychological testing1 whether through a psychologist or a psychometrist1 are usually billed on the basis of the tests administered4 ,to give some idea1 many tests cost #ae to #bj for a psychologist to administer4 ,this charge is passed on to the client4 ,the test results can sometimes be reviewed during a counseling session so that no additional charge may be made for the evaluation of the results4 ,,duration ,,of ,,treatment ,duration of treatment under a clinical or counseling psychologist is similar to that of a social work counselor4 ,the best way to proceed is to ask prospective therapists how long they believe it will be necessary to see them4 ,most professionals will be open and candid2 if the client's goals are specific and lend themselves to brief therapy1 a psychologist will make this clear4 ,and1 as we have already observed1 much depends on the type of therapy practiced by the psychologist4 ,behavioral therapies tend to be of shorter duration2 psychoanalysis is longer-term4 ,in between these there are1 as we will see1 many therapies that have different emphases1 methods1 and goals4 ,,psychiatrists ,,orientation ,,and ,,training ,before they specialize in psychiatry1 psychiatrists receive the #de training required of any physician4 ,after this1 there is specialized course work followed by a period of psychiatric internship4 ,the educational background of psychiatrists enables them sometimes to identify physical bases for emotional difficulties4 ,a later chapter discusses this growing area of awareness4 ,until fairly recently1 the therapeutic training of psychiatrists emphasized almost exclusively the approach of psychoanalysis4 ,psychoanalysis developed within a medical context3 ,freud was a physician1 and his outlook was influenced by his medical orientation4 ,his approach was therefore felt to be the special province of psychiatric medicine4 ,eventually1 as we have already noticed1 the methods of psychoanalysis came to be used by psychologists and some social workers4 ,but for a long period1 analysis was the primary and exclusive focus of medical psychiatry4 ,the psychoanalytical orientation still dominates much psychiatry1 and many psychiatrists in private practice use psychoanalysis as their therapy of choice4 ,however1 there has been a general broadening of the perspective of psychiatrists4 ,other approaches to psychotherapy are increasingly being used by psychiatrists4 ,cognitive therapy is important among these2 we will discuss its purpose and methods later4 ,psychiatrists are the only therapists who may prescribe medication1 and some of the most important recent advances in psychiatry have come in this area4 ,many emotional problems appear to have a biochemical basis4 ,many forms of anxiety1 panic disorders1 and depression respond well to the growing family of psychopharmaceutical drugs4 ,other emotional difficulties1 including alcohol and drug abuse1 can be moderated by pharmaceutical therapy4 ,psychiatrists1 then1 can be especially helpful in these ways3 99 to provide a medical evaluation for complaints that sometimes have a physical basis 99 to give assistance especially by means of psychoanalysis and by means of an increasing number of alternative therapies 99 to help patients with medication to acquire a degree of emotional equilibrium that will allow them to begin to solve personal problems so that1 in time1 they may no longer require medication #df ,although an ,m4,d4 may call herself or himself a psychiatrist1 most psychiatrists have had specialized advanced training in psychiatry4 ,full qualifications involve completion of a residency in psychiatry1 full membership in the ,american ,psychiatric ,association1 completion of a program of study at an institute of psychotherapy1 and board certification4 ,many psychiatrists who practice are eligible for board certification but simply have not yet taken the national examinations that are required in order to be certified by a national examining board4 ,although apparently many of us need to be reassured of this1 you need not feel that there is anything wrong or embarrassing about asking a prospective psychiatrist1 or his or her secretary1 to describe the doctor's background and training4 ,,fees ,at the time of this writing1 the fees of psychiatrists in private practice range approximately from #ge up to #ajj and occasionally more per session4 ,private psychiatric assistance is therefore largely reserved for the fairly well-to-do or for those who have health insurance with substantial psychiatric benefits4 ,fortunately1 psychiatric care is available through many agencies2 those that are run by counties and states normally have sliding scales 7some private agencies will also take an individual's finances into account when setting fees74 ,rates for consultation with a psychiatrist at a public agency can be very reasonable 7as little as a few dollars per visit1 depending on the patient's income74 ,this makes the services of psychiatrists available to those with modest or low incomes4 ,,duration ,,of ,,treatment ,if a psychiatrist finds that an emotional problem has a physical basis1 or that it is due to biochemical depletion or imbalance in the body1 successful treatment may be relatively short1 sometimes a matter of a few months4 ,if you choose to enter psychoanalysis1 then the duration of treatment generally will be longer1 often lasting a year and more2 during this time1 psychoanalysts may expect you to come for two or three sessions each week4 ,shorter-term therapies1 such as cognitive therapy1 are--in part because of the normal long duration required by psychoanalysis--increasingly advocated by psychiatrists4 ,biofeedback and relaxation training 7see ,chapter #e7 are also among these shorter-term approaches4 ,they may be effective within a period of several months4 ,in this chapter1 we have discussed the professions that make up the mainstream of professional practice in counseling and psychotherapy4 ,however1 beyond the established and more closely regulated professions of social worker1 psychologist1 and psychiatrist1 there are a number of other kinds of therapists who offer services that are sufficiently different in nature that they deserve to be treated in a separate chapter4 ,the next chapter describes their contributions to therapy4 #dh #e ,,the ,,therapeutic ,,jungle1 ,,part ,,ii ,outside the ,mainstream ,outside of any profession's frame of reference that defines what problems it will handle and how1 we usually find a group of approaches that do not completely fit the established mold4 ,they often can contribute creative and innovative ideas1 and yet they often lead to abuses in the name of novelty and experimentation4 ,and sometimes an older approach that fails to fit the newer frame of reference is left behind1 to keep company with more radical approaches4 ,just these things have happened in the practice of counseling and psychotherapy1 as we will see4 ,,religious ,,counselors ,the world's first professional counselors were religious4 ,guidance from priests1 rabbis1 and pastors has a long tradition4 ,the tradition is such an old one1 in fact1 that going to talk to a religious counselor has a respectability that the public has generally not yet extended to other forms of counseling4 ,many people with problems1 even people with a religious attitude or upbringing1 tend to ignore the kind of help religious counselors may be able to give4 ,this probably stems from the #di belief that social workers1 psychologists1 psychiatrists1 and some other certified therapists whom we will discuss in a moment have received special training in helping people with personal1 emotional problems1 whereas religious advisors have not4 ,however1 this is not universally true4 ,many professional religious representatives now do receive training in contemporary therapies4 ,increasingly1 ,catholic1 ,protestant1 and ,jewish educational institutions are incorporating course work and workshops in modern counseling methods into programs of study for priests1 pastors1 and rabbis4 ,individuals who have been trained in this way are easily located within a religious organization2 a telephone call to the organization should give you leads to follow4 ,in spite of the widespread attempt many religious institutions are making to remain up to date on contemporary approaches to counseling1 there is probably something also to be said for traditional guidance4 ,all religious views seek to fulfill the needs of men and women to find meaning in everyday life and to cope effectively with life's hardships4 ,contemporary approaches to psychotherapy and counseling can offer much2 their history1 however1 is comparatively brief1 extending over just the last century4 ,for many people--depending on their inclinations1 values1 and sympathies--traditional religious guidance may provide much that is as yet not to be found in the more scientific and systematic schools of contemporary therapy4 ,if you decide to go to a religious professional for counseling1 you will probably find the process relatively informal and friendly4 ,also1 religious professionals generally expect that their private counseling services will not be remunerated2 contributions to the supporting religious organization are of course hoped for but are often not required in exchange for guidance4 ,in contrast to the authorized community of social workers1 psychologists1 and psychiatrists1 it can be more difficult to locate a religious professional who specializes in a particular approach to counseling4 ,the background in modern approaches to counseling that religious professionals tend to receive is eclectic4 ,they normally receive training in a variety of approaches2 their programs of study are based on the belief that flexibility in counseling is essential1 that nothing works well for everyone4 ,this openness can be of value to many people4 ,but1 as you read this book1 you may decide to locate a therapist who has a certain #ej specific orientation4 ,he or she may be a religious counselor1 a psychologist1 or another qualified professional4 ,in general1 if you have a specific form of therapy in mind1 you will have to ask a prospective therapist whether he or she has the training to give you the kind of help you are looking for4 ,this is especially true of religious counselors4 ,,biofeedback ,,therapists ,biofeedback is a newcomer to the therapeutic world that has grown tremendously in popularity in the last ten years or so4 ,biofeedback therapy gradually enables individuals to become aware of certain physical changes in their bodies4 ,these physical changes are detected by means of sensitive measuring instruments that give information back to clients so they can learn to control a particular physical response4 ,biofeedback is used by therapists who have been specially trained in its use1 as well as by some licensed psychologists1 psychiatrists1 social workers1 physical therapists1 speech pathologists1 and even some dentists4 ,some psychiatrists now work jointly with a biofeedback therapist3 the psychiatrist can prescribe medication and provide psychotherapy or analysis1 while the associated biofeedback therapist can teach patients how to lessen their responses to pain and stress-related problems4 ,the ,biofeedback ,society of ,america is an interdisciplinary group of healthcare professionals2 it is presently developing training standards and guidelines for certification of biofeedback practitioners4 ,,relaxation1 ,,hypnosis1 ,,and ,,meditation ,,therapists ,relaxation training1 hypnosis1 and meditation all seek to bring about a deep sense of relaxation in a person4 ,we will examine each in greater detail later2 a short overview of these approaches is given here4 ,,relaxation ,,training ,relaxation training involves exercises that enable a person to learn to induce at will a state of physical and mental calm4 ,relaxation training is a practical skill--it can be very effective #ea and useful in coping with stressful situations4 ,like any learned skill1 control comes only with practice1 usually over a period of several months4 ,many social workers and psychologists teach clients relaxation techniques4 ,certification standards specifically for relaxation training have not been established4 ,,hypnosis ,hypnosis involves two stages3 7#a7 progressive1 deep relaxation to a point at which an individual is in a peaceful1 trancelike state1 still self-aware but profoundly relaxed2 and 7#b7 suggestion1 which persuades the person to adopt certain future attitudes1 thoughts1 or behavior4 ,hypnosis1 like relaxation training1 can be learned4 ,most people treated by means of hypnosis steadily improve in their ability to be hypnotized so that they can more effectively allow themselves to be influenced by means of carefully planned suggestions4 ,many psychologists and psychiatrists make use of hypnosis in the context of therapy2 some practitioners treat patients exclusively by means of hypnosis4 ,the certification of therapists trained in hypnosis is still unsettled in many states1 where anyone can hang out a shingle4 ,since many licensed psychologists and psychiatrists and some certified social workers do receive professional training in hypnosis1 these are the professions to which it is most reliable to go for hypnotherapy4 ,,meditation ,meditation is still a fringe therapy4 ,techniques of meditation tend seldom to be taught to clients in psychotherapy1 although there is a growing body of evidence that meditation is able to bring about great resistance to stress1 an increased sense of inner calm1 and even actual changes in brain-wave patterns associated with deep relaxation4 ,these effects of meditation are now being studied1 with encouraging results4 ,the practice of meditation is1 in the author's view1 at present best learned on one's own1 although some commercial organizations provide instruction4 ,a later chapter discusses approaches to meditation and suggests some of the ways meditation can be of value4 #eb ,,holistic ,,therapies3 ,,bioenergetics1 ,,yoga1 ,,and ,,exercise ,holism views man as a unity of body and mind4 ,the established approaches to therapy and counseling1 represented by social workers1 psychologists1 psychiatrists1 and to a certain extent by some religious professionals1 all focus attention on our mental-psychological dimension4 ,similarly1 biofeedback1 hypnosis1 and meditation emphasize the central role of mental control4 ,holistic approaches1 on the other hand1 attempt to bring about positive change by means of emphasis on physical factors that are believed to have a close connection to mental processes4 ,although holism sees human beings as integral organisms1 holistic approaches are inclined to have this physical focus4 ,holistic therapies1 like meditation1 are fringe therapies4 ,they are not generally employed by members of the authorized community of health practitioners1 for two reasons3 ,first1 a kind of professional respectability and elitism have come to be associated with the psychological approach2 social work1 psychology1 and psychiatry have an established place in institutions of higher learning1 whereas fringe therapies do not4 ,second1 since physicians treat the body1 there is an institutionalized prejudice against nonmedical treatment that has the same focus4 ,chiropractic has encountered this problem1 as have other forms of holism1 such as bioenergetics1 yoga1 diet therapy1 and rolfing4 ,although much of value may be offered by these fringe therapies1 they have also resulted in abuse to consumers4 ,because of a general absence of licensing standards and of scientific credibility1 people frequently are drawn in by the sometimes extravagant promises of unscrupulous or overly enthusiastic fringe therapists4 ,in this area1 as in all others that affect the consumer1 the proper attitude is one of healthy skepticism and restraint4 ,,bioenergetics ,of these holistic therapies1 bioenergetics is perhaps considered the most respectable because it is used by some psychologists4 ,bioenergetics attempts to diminish an individual's psychological defenses by means of sequences of specially designed #ec physical exercises that1 in a controlled and deliberate way1 stress the person physically4 ,practitioners of bioenergetics believe that physical exercises of this kind rapidly put a person in touch with buried 7repressed7 feelings and speed up the process of inner integration that all holistic practices1 as well as traditional therapy1 wish to achieve4 ,,yoga ,yoga exists in various forms4 ,the two main varieties are hatha yoga and raja yoga4 ,hatha yoga emphasizes physical flexibility2 raja yoga teaches breathing techniques and meditation4 ,hatha yoga1 because of its focus on the body1 belongs to the family of approaches we are considering here4 ,hatha yoga practitioners believe that the physical flexibility and control that are acquired through an extended period of physical training in yoga exercise tend to influence your mental orientation4 ,you become1 in this view1 more flexible1 less rigid1 less defensive1 less subject to stress1 more open1 responsive1 alert1 and capable of warmth in human relationships4 ,,exercise ,,therapy ,counselors and therapists are starting to take very seriously the idea that exercise brings emotional benefits4 ,exercise therapy1 more so than other physically based approaches discussed in this chapter1 has been tested in various ways4 ,many emotional conditions--for example1 anxiety and depression--seem to be significantly reduced thanks to periods of sustained vigorous exercise4 ,tolerance to stress and to pain appears to be increased4 ,physical exercise can be an outlet for pent-up hostility and aggression that1 according to many theorists1 may be turned inward1 then fester1 and eventually take the form of a variety of psychological disorders4 ,furthermore1 vigorous1 sustained aerobic exercise--like running or swimming--appears to have a calming effect as a result of certain chemical compounds that are released into the bloodstream4 ,we will look at some of the interesting recent studies of the therapeutic value of exercise later on4 #ed #f ,,where ,,you ,,can ,,find ,,help ,,private ,,practice ,as we have seen1 social work counselors1 psychologists1 psychiatrists1 biofeedback therapists1 hypnotherapists1 and other therapists may all offer their services through private practice4 ,in general1 there can be definite advantages to counseling in the setting of a therapist's private practice4 ,you are given a degree of personal care that1 as an individual paying customer1 you are less likely to receive in counseling provided by agencies4 ,you become part of a therapist's own practice1 so it is natural for him or her to devote special attention to you4 ,therapists are likely to be more personally involved in their private practice and in the quality of care they try to give their private clients than it is possible or even personally desirable for them to be when they work by the hour for an agency4 ,on the other hand1 private sessions with a therapist tend to be considerably more expensive than counseling can be through many agencies4 ,you ought not to take too seriously general comparisons between therapy as you may encounter it privately and therapy in the setting of an agency4 ,you can often find a counselor who is congenial1 interested1 attentive1 and skilled2 whose services will be easier for you to bear financially2 and who #ee offers his or her services through an agency4 ,if finances are restrictive for you1 you should look into agency-sponsored counseling4 ,many social work counselors1 psychologists1 and some psychiatrists who maintain private practices intended mainly for individual therapy also offer group therapy4 ,often1 a therapist will observe that a number of individual clients share certain problems and experiences1 and he or she will suggest that these people meet together as a group4 ,the per-session price can be expected to be a good deal lower than for individual sessions2 the rate usually reflects the number of people who meet in the group and the length of time the group is expected to continue4 ,some social workers and some psychologists specialize in group therapy4 ,groups are formed periodically1 run a set number of weeks1 and may or may not bring together individuals with common problems4 ,some group therapists believe that diversity in a counseling group is valuable3 in such a group1 you might find one person combating alcoholism1 another trying to cope with loneliness and grief after the death of a spouse1 someone trying to break out of the confines of shyness1 a person suffering from public speaking anxiety1 someone wanting to change careers but who is blocked by fear1 and others4 ,an exchange of views among participants with diverse backgrounds can frequently encourage growth in the group members4 ,most counseling agencies also offer group therapy1 as do many hospitals and schools4 ,we will take a look at each of these settings in turn4 ,,county1 ,,state1 ,,and ,,private ,,agencies ,individual1 marriage and family1 and group counseling are all offered by many counseling agencies4 ,county and state agencies receive public funding and usually have sliding scales for the rates they charge4 ,often1 one or more psychiatrists work in association with counselors1 who may be social workers or psychologists4 ,if you go to a county or state agency1 you will probably be interviewed initially by a receptionist or nurse4 ,you will be asked questions about your financial situation and health insurance coverage1 if you have any1 and you will be asked to agree to a proposed rate for the services of the agency4 ,some county and state agencies make a monthly charge #ef for their services2 you may consult regularly with members of the staff1 counselors and_/or psychiatrists1 in accordance with your individual needs4 ,private counseling agencies function in a similar way4 ,their services tend to be more expensive because they do not receive public financial support1 as do county and state agencies4 ,many health insurance plans that provide psychological benefits can be used to pay for the services of a private or a public counseling agency4 ,,hospitals ,,and ,,other ,,inpatient ,,services ,individuals with severe problems who need complete care can enter private1 county1 or state hospitals that offer psychiatric services4 ,a separate chapter discusses pros and cons of the sometimes frightening alternative of hospitalization4 ,again1 publicly funded hospitals tend to charge on the basis of a sliding scale1 which takes a person's financial situation into account4 ,where financial concerns are not pressing1 private hospitals in general tend to offer a greater degree of individual attention and higher quality of care and physical facilities4 ,in addition to hospital facilities1 many metropolitan areas have established organizations to provide counseling services on an inpatient basis4 ,some are private2 some are public4 ,they offer an alternative to hospitalization4 ,they tend to be more informal and open and are managed by their own staffs of professional counselors and psychiatrists4 ,these residential care facilities usually are intended for stays of from one to several weeks4 ,they have a variety of counseling programs1 ranging from individual therapy to group counseling and vocational guidance4 ,one way to locate such an inpatient organization is to telephone a crisis intervention 7sometimes called suicide prevention7 number likely to be listed at the beginning of your telephone directory4 ,a volunteer probably will answer your call and should be able to direct you to inpatient facilities available in your area4 ,,academic ,,sources ,,of ,,counseling ,counseling is one of the services available to full- and part-time #eg students who are enrolled in junior or four-year colleges and graduate schools4 ,many educational institutions offer individual counseling1 normally by counseling psychologists1 and all colleges offer academic advising in the context of a certain amount of vocational guidance4 ,colleges with programs in counseling and psychology usually also offer certain classes with a practical1 problem-solving focus4 ,although they may not be specifically intended to help individual students with life problems1 this is in fact what they frequently end up doing4 ,it is inevitable for students in a practically oriented counseling class to apply much that they learn to their own problems4 ,many class meetings of this kind tend to be almost indistinguishable from group therapy sessions3 students receive guidance from a professionally trained instructor1 exchange views1 and express personal concerns4 ,you might think of college classes with a practical1 psychological emphasis especially if you are drawn to therapy as an opportunity for general personal growth4 ,classes of this kind may be offered in a college's regular programs1 which are sometimes open only to students working toward a degree4 ,other similar opportunities1 however1 are available through many continuing education1 or adult education1 programs4 ,many secondary school districts offer practical1 psychologically-focused classes for adults who do not choose to enter a degree program4 ,this is also true of community1 state1 and many private colleges4 ,colleges and private professionals offer intensive workshops with a variety of counseling emphases4 ,two-day weekend workshops have become especially popular4 ,topics range from alcoholism1 drug abuse1 child-rearing problems1 and separation and divorce to illness and chronic pain1 marital concerns1 depression1 stress control1 and so on4 ,newspapers announce counseling workshops2 you will often find notices about them posted in public and college libraries4 ,,some ,,reflections ,,on ,,where ,,you ,,go ,,for ,,counseling ,you should bear in mind that where you go for counseling or therapy is nothing more than an address4 ,what is important is what happens in your relationship with your counselor or #eh therapist4 ,if you have found a therapist whom you respect and feel motivated to work with1 it makes little difference1 as far as the benefits you obtain from therapy are concerned1 whether your therapist works in private practice or offers his or her services through an agency1 school1 hospital1 or residential facility4 ,on the other hand1 where you go for counseling will greatly determine the price you will pay for services and frequently whether health insurance will cover your expenses4 ,to some extent1 where you go can sometimes1 as we have noted1 influence the quality of care and individual attention you receive4 ,but this is a generalization2 you frequently will be able to locate excellent care through less expensive facilities4 ,this will depend to some extent on luck1 but more on the amount of effort you put into locating the kind of help you may need4 ,since you are reading this book1 you already have initiative like this3 you have the ability to influence what kind and quality of therapy you will receive4 ,for you1 it will be less a matter of pure luck than it is for people who choose a therapy and therapist arbitrarily4 #ei #g ,,self-,,diagnosis ,mapping ,your ,way to a ,therapy ,this chapter is central to your use of this book as a guide4 ,there are two main ways to use this book to help you to choose a therapy3 #a4 ,you can familiarize yourself with all of the major approaches to therapy1 weigh their advantages and disadvantages in relation to your needs1 and then make a choice4 ,twenty-six approaches to therapy are discussed and evaluated in this book1 so keeping your judgments of their pros and cons clearly in mind can be challenging4 ,although comprehensive understanding has a value of its own1 it may not be essential to you4 #b4 ,you may prefer to go through three simple steps to narrow the alternatives down to a small number of therapies that have been most successful for specific goals1 problems1 and personal attributes that most closely approximate your own4 ,this is a less time-consuming process1 and it will take into account professional evaluations of the different therapies4 ,in either case1 your informed judgment will be the basis for your eventual choice4 ,this chapter is intended to help you if you prefer the second route--to narrow down the alternatives in a clear and logical way4 ,if you prefer1 however1 to become acquainted with all of the major therapies discussed in this book1 #fj you might skim through sections of this chapter to give you a framework for more efficient understanding4 ,the information in this chapter relates to many different sets of goals1 problems1 and kinds of people4 ,not all of this information will be relevant to you1 so you will find instructions to direct you to specific recommendations that take into account your own needs and interests4 ,this chapter is where practical and prudent planning can begin4 ,in fact1 this book represents the first attempt to match you1 your personal qualities1 and your goals with the most effective therapy or therapies available to you4 ,even though nearly all of the main approaches to counseling and therapy are creations of the past century1 it may seem surprising that no unified effort has been made to identify what specific kinds of problems each approach is especially useful for treating and for what types of clients4 ,in this respect1 the field of medicine is much better developed4 ,the discipline of medical diagnostics is now on the verge of becoming scientific1 and it is now possible to identify for many conditions and in individual cases very concrete and well-defined treatment procedures that are likely to be effective4 ,this has not been true in the field of psychology3 most research efforts have so far gone into formulating definitions of the various mental and emotional disorders4 ,but the important work1 from the prospective client's point of view1 had yet to be done3 to make it possible for him to know--in relation to his individual problems1 goals1 interests1 abilities1 and temperament--which approaches to therapy are likely to help him the most4 ,if you are in serious emotional pain1 waiting until all of the research results are in is just not possible2 you need help now4 ,in spite of incomplete knowledge in psychotherapy1 a large body of information has come from studies of the effectiveness of therapies for different problems and for different kinds of people4 ,but until now this information existed only in fragmented form and was familiar only to professional psychologists4 ,enough data are in to begin to draw reasonable guidelines for individuals who seek psychological help4 ,the mapping process described in this chapter is the result of assembling and then organizing large quantities of data from many sources4 ,it was then necessary to design an easily followed #fa step-by-step approach to enable you to narrow down the many therapeutic alternatives to a small number that1 through your efforts and the assistance of a therapist1 can be of help to you4 ,guidelines of this kind are never static2 they will change to some extent as time and knowledge advance4 ,,obstacles ,,to ,,finding ,a ,,therapy ,,that ,,fits ,,you ,there are real obstacles to efficient treatment in psychotherapy4 ,they cost people much time1 energy1 hope1 and money as they try to find appropriate help4 ,psychotherapy is not yet a systematic field4 ,there are three main reasons why it is so difficult to find approaches to therapy that will fit individual clients and their needs3 99 ,emotional and mental difficulties vary tremendously4 ,psychologists and psychiatrists are still in the process of classifying the kinds of emotional and mental problems people have4 99 ,people are individuals4 ,their personalities1 likes and dislikes1 and motivations for entering therapy differ greatly4 99 ,therapists1 too1 are individuals4 ,their personalities1 interests1 values1 and motivations for offering therapy differ greatly4 ,their professional training and preferences in favor of one or several approaches to therapy also vary significantly4 ,as a result1 what works for one patient will not necessarily work for another4 ,what helps and who helps in one person's situation may not help in another's4 ,yet all three of the factors on which effective treatment depends--a patient's goals and problems1 his or her personality traits1 and the approach of the therapist--in many cases can be matched intelligently4 ,you1 as a prospective client1 know a great deal about yourself2 it doesn't make sense to choose arbitrarily among the many therapies4 ,it takes very little time to map your way3 in the process1 you will learn more about yourself1 what to anticipate in therapy1 and in what direction to start4 #fb ,,realism3 ,a ,,good ,,beginning ,in order to identify one or more therapies that may be most promising in relation to your goals1 your problems1 and the kind of person you understand yourself to be1 you must begin your search with a good measure of realism4 ,,setting ,,goals ,it can be very difficult for anyone who is seriously troubled to think clearly and use good judgment4 ,you may find it hard1 perhaps impossible1 at this time to identify your goals4 ,you may feel confused1 anxious1 depressed1 and not know why you feel that way4 ,even so1 you will find as you read on that you can set important goals for yourself4 ,if you are at a loss and have no sense of purpose1 that fact gives you a goal to work toward in therapy3 to develop clearly thought-out goals4 ,though you may not know what precipitated your feelings of confusion1 anxiety1 or depression1 you at least know that you feel confused1 anxious1 or depressed1 and you will find recommendations in this chapter on how to find appropriate help for your suffering4 ,do not judge yourself harshly if you lack a sense of direction or if you are troubled but do not know why4 ,just keep reading4 ,,opening ,,yourself ,,to ,,change ,there is a second thing you should be realistic about when you do know what you want and what your problems are4 ,our experiences and what we learn about ourselves change us4 ,if you enter therapy based on your present perceptions of yourself1 it is likely that these are going to change to some extent as a result of your experiences in therapy4 ,does that mean that you cannot plan or select a therapy intelligently8 ,clearly1 it doesn't4 ,everyone has to start where he or she is4 ,there is no other choice4 ,but you should try to persuade yourself to be open to changes in your views and feelings4 ,if you feel rigid about your own perceptions of yourself1 it is just possible that your rigidity may be contributing to the problems you want to resolve4 ,as in any attempt to learn or to change1 it is important periodically to reevaluate your needs1 values1 and the results you may have achieved so far4 ,if you select a therapy using the structured #fc approach in this chapter1 you may decide to retrace your footsteps a few months in the future4 ,you may find that you would take a different path in the light of what you then see4 ,,being ,,honest ,,about ,,yourself ,there is a third piece of realism that ,i would like you to consider1 and this is very hard for anyone to take to heart4 ,if you can1 you are a very unusual person4 ,answering the following questions honestly takes some real courage4 ,but you must ask yourself3 ,to what extent do ,i need my present symptoms8 ,is it useful to me not to have a sense of direction8 ,am ,i somehow benefiting from feeling depressed8 ,is my anxiety helpful to me in some way8 ,you may think these suggestions are no more than contrived and unkind psychologizing4 ,after all1 who chooses to suffer8 ,does anyone want to wake up at #d3jj ,a4,m4 shaking and crying8 ,yet1 again and again1 therapists who care very much about their patients find that many of them cling to their symptoms with the desperation of a drowning man hanging onto a raft4#a #a ,lewis ,r4 ,wolberg1 ,hypnosis 7,new ,york3 ,harcourt ,brace ,jovanovich1 #aigb71 p4 #bch4 7,in this guide1 see ,chapter #ae1 on hypnosis47 ,for diverse reasons1 many people--even people who are suffering greatly--do not want to change4 ,their unhappiness1 pain1 and confusion can serve numerous functions4 ,you may not believe this right now1 but from time to time as you read this book1 and later in your life1 this question may occur to you1 if only for a moment3 ,how may this unresolved problem benefit me8 ,the plain truth is that even suffering can confer benefits on us4 ,this is at the root of much of the tragedy of emotional problems that prove to be resistant to treatment4 ,the distressed1 despondent1 overwrought1 and trembling person seated before the therapist may have found a way to gain the attention he was unable to get otherwise4 ,or perhaps his suffering is a way to lighten a burden of guilt that eventually caused an inner collapse4 ,there are many benefits1 many very good reasons to want not to change but to try anyway4 ,so1 before you begin to seek a specific type of therapy1 try to be realistic and keep these thoughts in mind3 #fd #a4 ,specifying clear-cut goals and understanding why you feel troubled are not essential now4 ,certainly it will be helpful if you can translate vague complaints into concrete problems1 to help both your own understanding and eventually your therapist's4 ,the more specific you can be about what is troubling you1 what situations especially distress you1 and what has motivated you to come to therapy1 the easier it will be for you to find help and for the therapist you choose to help you4 ,but in times of crisis1 clarity can be very hard to gain1 so be patient4 #b4 ,if you do have clear-cut goals and a good understanding of yourself now1 use these to plan how to proceed1 remembering that openness to change will profit you and that1 in all likelihood1 your initial perceptions of yourself will change as you become involved in therapy4 #c4 ,you may1 at least now1 need your symptoms1 however painful they may be4 ,how successful therapy will be for you may have a great deal to do with your willingness to let go of the possible benefits of being troubled1 in pain1 or disabled4 #d4 ,resist digging ruts for yourself4 ,try to refrain from locking into a particular course of action until you have given yourself time to consider alternatives4 ,once you have chosen a direction1 if after a reasonable time the therapy and the therapist you have selected do not seem to be helping you1 it is essential to try another approach4 ,this is especially difficult once you have invested your time1 energy1 and money and perhaps have developed a good relationship with your therapist4 ,you may like him or her1 feel comfortable and comforted1 but if you are not gaining what you want1 you have to stop and try again4 #e4 ,finally1 have a thorough physical examination before entering therapy1 if you have not had one recently4 ,be truthful and open with your physician4 ,some emotional and mental problems are produced by underlying physical conditions1 many of which can be treated effectively 7see ,chapter #h74 ,,how ,,to ,,map ,,your ,,way ,,to ,a ,,therapy ,the remainder of this chapter presents a three-step process #fe for choosing an approach to therapy that is potentially best-suited to your personal needs and personality4 ,in the first step1 you become familiar with the main kinds of goals and problems that motivate people to enter therapy4 ,you check those that seem to be most relevant to you and then try to confirm the accuracy of your choices4 ,this will point you in the direction of one or more promising therapies4 ,in the second step1 you consider a list of the main personality traits that are relevant to your choice of therapy4 ,again1 you check those that seem most to apply to you and then confirm your self-understanding4 ,step #b will also direct you to one or more therapies4 ,in the third step1 you use your results from ,step #a and ,step #b to select an approach to therapy that most closely matches your needs1 interests1 and personality4 ,let's begin4 ,,step #a4 ,,diagnosing ,,your ,,problems ,,and ,,setting ,,your ,,goals3 ,,identifying ,,appropriate ,,therapies a4 ,read through ,table #a 7pages #fg-fi74 b4 ,check the goals or problems most applicable to you4 ,if you are in doubt1 refer to the numbered short descriptions in the section ,matching ,your ,goals and ,problems with ,most ,promising ,therapies following ,table #a4 c4 ,choose one or two goals or problems that are the most important to you4 d4 ,confirm your choices3 ,refer to the section ,matching ,your ,goals and ,problems with ,most ,promising ,therapies that follows ,table #a4 ,in that section1 read the corresponding short descriptions of the one or two goals or problems you checked in ,table #a and ask yourself whether1 in fact1 these accurately apply to you4 ,for example1 if you checked #g in ,table #a1 then read the corresponding #g in ,matching ,your ,goals and ,problems with ,most ,promising ,therapies4 e4 ,if1 after doing this1 you continue to believe that the goals or problems you checked relate to you1 make a record of the therapy letter codes given at the end of each description4 ,you will find that occasionally letter codes are divided into two groups3 those judged to be generally more effective 7called primary71 and a set of alternatives 7secondary74 ,now go directly to ,step #b4 ,on the other hand1 if you come to feel that the goals or problems you checked really do not apply to you1 go back to ,table #a and consider other alternatives4 #ff ,,step #b4 ,,self-,,understanding3 ,,identifying ,,appropriate ,,therapies a4 ,read through ,table #b 7page #gi74 b4 ,check the personal qualities that seem best to describe you4 c4 ,choose one or two of these that are the most significant to you4 d4 ,confirm your self-understanding3 ,refer to the section ,matching ,your ,personality with the ,most ,promising ,therapies following ,table #b4 ,read the short descriptions of the one or two personal qualities you checked and respond to the questions you will find there4 e4 ,if1 after doing this1 you believe that the personal qualities you checked in ,table #b do1 in fact1 describe you accurately1 make a record of the therapy letter codes given at the end of the questions4 ,now go directly to ,step #c4 ,if1 on the other hand1 judging from your responses to the questions you answered1 you do not feel that the personal qualities you checked are true of you1 return to ,table #b and consider other alternatives4 ,,step #c4 ,,choosing ,a ,,therapy a4 ,compare the two sets of letter codes you recorded as a result of ,steps #a and #b4 ,if one or more letter codes are common to both sets1 make a special note of the common code7s72 otherwise1 group the letter codes together4 b4 ,refer to ,table #c 7pages #hf-hg71 which summarizes the letter codes of all the therapies discussed in this guide4 ,check the code7s7 you just listed4 c4 ,if you feel that you have taken your time1 have been thoughtful about yourself1 and now feel reasonably confident about the tentative conclusions you have reached1 turn to the chapter7s7 in this book that discuss the approaches to therapy you checked4 ,as you read these1 try to imagine yourself as a client in each of the therapy situations described4 ,which approach seems most appropriate given your goals or problems8 ,do you feel that you have the personal traits that the therapy is most suited for8 ,if so1 give that approach to therapy a reasonable trial period4 ,if not1 consider other alternatives you checked4 #fg ,,an ,,example ,,of ,,following ,,steps #a1 #b1 ,,and #c ,suppose you check #c4a1 shyness passivity1 in ,table #a4 ,you refer to the section following ,table #a1 relating to personality trait problems4 ,you feel that shyness is something that interferes significantly with your life1 interests1 and desires1 and you want to do something to overcome it4 ,therapies ,q1 ,c1 ,n1 and ,d are recommended to you as potentially useful4 ,then1 in ,table #b1 you check #g4 ,you refer to #g following ,table #b1 and you decide that you especially need to work on pent-up feelings in need of release4 ,therapies ,c and ,j are suggested there as potentially appropriate for you4 ,you now have two sets of therapy letter codes to consider3 ,q1 ,c1 ,n1 and ,d2 and ,c and ,j4 ,therapy ,c is common to both recommended groups of therapies1 but you are interested in comparing the other therapies with ,c4 ,in addition to reading about ,c1 you decide to read the discussions of therapies ,d1 ,j1 ,n1 and ,q4 ,from ,table #c1 the five letter codes ,c1 ,d1 ,j1 ,n1 and ,q denote ,gestalt therapy1 transactional analysis1 bioenergetics1 counter-conditioning1 and group therapy1 respectively4 ,after reading about these therapies1 you come to feel that ,gestalt therapy probably would challenge you in especially needed ways1 so you decide to locate a therapist with training in ,gestalt therapy4 7,for information on locating a therapist1 see ,chapter #ag47 ,,step #a ,,table #a3 ,,an ,,overview ,,of ,,principal ,,goals ,,and ,,main ,,emotional ,,and ,,mental ,,disorders ,,that ,,lead ,,people ,,to ,,enter ,,therapy #a ,personal development goals #a4a developing new skills and personal traits3 education leading to growth #a4b eliminating self-destructive habits or undesirable personality traits3 re-education leading to change 7see #c below7 #fh #b ,disorders usually first noticed in childhood or adolescence #b4a mental retardation #b4b autism #b4c emotional disturbances3 separation anxiety1 sleep terror and sleepwalking disorders1 etc4 #b4d suffering from childhood pain1 neglect1 or abuse2 traumatic experiences from childhood1 unmet childhood needs #b4e behavior problems3 hyperactivity1 antisocial behavior1 movement disorders 7see #aj below7 #b4f delinquency and criminal behavior #b4g eating disorders3 obesity1 bulimia1 anorexia nervosa #c ,personality trait problems #c4a shyness_/passivity #c4b loneliness_/emptiness #c4c hostility_/overbearing personality #c4d fear of withdrawal of affection and of abandonment #c4e general interpersonal problems #c4f need to improve effectiveness of communication skills #c4g difficulties in coping with persons in authority #c4h loss of faith in oneself or in others1 or in life's purpose or end #c4i low self-worth1 desire for a success-identity 7self-esteem resulting from a sense of achievement7 #c4aj deep discouragement with life 7see #e below7 #d ,neuroses #d4a anxiety disorders1 panic disorders1 post-traumatic stress disorders1 etc4 #d4b phobias #d4c compulsions #d4d nogenic neuroses 7resulting from serious conflicts between opposing values7 #d4e psychosomatic disorders1 hypochondria #d4f sexual disorders #d4g impulse control disorders3 e4g41 pathological gambling1 kleptomania1 pyromania #fi #e ,mood disturbances 7affective disorders7 #e4a depression #e4b mania #e4c manic depression #f ,adjustment problems #f4a in relation to a new environment or an already familiar one2 work inhibitions #f4b in persons with counterculture attitudes and values #f4c emotional difficulties arising from poverty and from the deprivations suffered by minority groups #f4d inability to accept realities that limit life3 e4g41 financial limitations1 restricted opportunities1 aging and death 7see #i below71 jobs with no future1 responsibilities that stand in the way of personal development #g ,marital problems #h ,family problems #i ,problems related to aging #i4a emotional problems in facing old age #i4b problems facing the recently widowed #i4c coping with physical pain and disability #aj ,involuntary behaviors #aj4a stuttering #aj4b shaking or motor tic disorders #aj4c insomnia #aa ,crisis intervention3 a need for prompt relief from severe symptoms #ab ,psychoses3 schizophrenia1 manic and paranoid psychoses1 hysterical psychoses1 etc4 #ac ,organic disorders #ac4a senescence1 ,alzheimer's disease #ac4b ,parkinsonism_/,huntington's chorea #ac4c substance-induced3 alcoholism1 drug addiction1 smoking #ac4d organic brain dysfunctions3 epilepsy1 narcolepsy1 amnesia1 dementia1 delirium #gj ,,matching ,,your ,,goals ,,and ,,problems ,,with ,,most ,,promising ,,therapies #a ,personal ,development ,goals ,these may involve either 7#a4a7 adding new skills or qualities or 7#a4b7 subtracting habits or undesirable traits4 #a4a4 ,there are basically two different approaches to achieving the first goal3 99 ,you identify a specific skill or personality trait you would like to develop--see ,table #a1 #c4 ,for example1 you may want to develop a stronger success-identity 7#c4i71 improve your communication skills 7#c4f71 gain a stronger sense of life's purpose 7#c4h71 or become more assertive 7i4e41 overcome a degree of shyness1 #c4a74 ,for references to recommended therapies for these goals1 see #c below4 ,for vocational counseling and therapy3 ,h1 ,i1 ,m 99 ,alternatively1 you decide to approach self-development with a desire for broad-spectrum improvements4 ,therapies with this orientation are not especially concerned with highly specific behaviors or problems but attempt to treat the whole person so that self-esteem is gradually increased1 as are a sense of satisfaction in daily living1 enjoyment of others1 and a feeling of being at ease with them4 ,primary therapy 7judged to be generally more effective73 ,a1 ,b ,secondary therapy 7somewhat less effective73 ,j #a4b4 ,refer to #c below4 #b ,disorders ,usually ,first ,noticed in ,childhood or ,adolescence #b4a4 ,mental retardation3 ,o #b4b4 ,autism3 self-injuring behavior1 withdrawal from reality3 ,o1 ,y #b4c4 ,emotional disturbances in children3 ,s1 ,w #b4d4 ,suffering from childhood pain1 neglect1 or abuse3 traumatic experiences from childhood1 unmet childhood needs 7see #c4d73 ,a1 ,k #ga #b4e4 ,behavior problems in children3 ,o1 ,c ,hyperkinetic behavior3 ,primary3 ,y1 ,o ,secondary3 ,z #b4f4 ,delinquency and criminal behavior3 ,o1 ,e1 ,h1 ,i #b4g4 ,eating disorders3 obesity1 bulimia1 anorexia nervosa3 ,o1 ,w #c ,personality ,trait ,problems #c4a4 ,shyness_/passivity3 ,q1 ,c1 ,n1 ,d #c4b4 ,loneliness_/emptiness3 ,f1 ,q1 ,d ,sense of estrangement1 alienation from others3 ,g #c4c4 ,hostility_/overbearing personality3 ,e1 ,d1 ,n1 ,q #c4d4 ,fear of withdrawal of affection and of abandonment 7also see #c4b above73 ,r or ,s1 ,d1 ,a #c4e4 ,general interpersonal problems3 ,if you are willing to work on these within a wider focus3 ,a ,involved in relating to others on an individual basis3 ,e1 ,p1 ,w #c4f4 ,need to improve effectiveness of communication skills3 ,d ,in groups of people3 ,q #c4g4 ,difficulties in coping with persons in authority3 ,c1 ,d #c4h4 ,loss of faith in yourself or in others or in life's purpose or end3 ,f1 ,g1 ,x #c4i4 ,low self-worth3 ,b ,desire for a success-identity3 ,h1 ,m #c4aj4 ,deep discouragement with life 7see #e below73 ,i #d ,neuroses ,a person is said to suffer from a neurosis if he or she has exaggerated emotional responses or ideas of reality that blow things out of proportion4 ,individuals with neuroses are able to communicate normally or with mild emotional interference4 ,their emotional problems interfere with normal living but do not impair them so that their lives are clearly out of control 7as in psychoses1 alcoholism1 drug addiction1 etc474 #d4a4 ,anxiety disorders1 panic disorders1 post-traumatic stress disorders1 etc43 #gb ,anxiety and panic attacks are characterized by feelings of fear1 dread1 and tension4 ,you may have a sense of imminent disaster or death1 a feeling of helplessness often followed by depression4 7,these are also symptoms of chronic anxiety47 ,other symptoms of anxiety and panic attacks include dizziness1 dry mouth1 sweating1 headaches1 heart palpitations1 increased blood pressure1 rapid breathing1 weakness1 insomnia1 increased urination1 a feeling of unreality1 diminished concentration1 memory difficulties1 indecision1 obsessive thinking about anxiety symptoms1 second-order anxiety 7anxiety that you are or will be anxious71 and desperation to obtain relief4 ,primary3 ,y1 ,h1 ,f1 ,v1 ,t1 ,w1 ,x ,secondary3 ,h1 ,k1 ,u ,post-traumatic stress disorders are frequently misdiagnosed as anxiety disorders4 ,patients suffering from post-traumatic stress have been exposed to situations of great stress--e4g41 battlefront conditions1 rape1 imprisonment in a concentration camp4 ,these situations are perceived as inescapable1 and they leave long-lasting emotional scars4 ,symptoms include reactions delayed until days or months have passed since the trauma situation1 emotional numbing1 chronic anxiety1 restlessness1 irritability1 recurrent nightmares1 increased startle responses1 impulsive behavior1 and depression4 ,primary3 ,y1 in conjunction with therapies recommended for anxiety and panic attacks4 #d4b4 ,phobias3 ,phobias are fears that are disproportionate to the threat of a situation4 ,they are involuntary and cannot be reasoned away4 ,they lead to avoidance of the feared situation4 ,primary3 ,n1 ,l1 ,y1 ,w1 ,v ,secondary3 ,u1 ,a1 ,k1 ,d ,for fears of public speaking1 especially3 ,e #d4c4 ,compulsions3 ,people with neurotic compulsions engage in repetitive rituals that give them temporary relief from anxiety4 ,compulsive behaviors are often motivated by a desire for exactness and perfection--for example1 compulsive hygiene1 washing1 counting1 praying1 reflecting about yourself1 repetitive isolated thoughts1 preoccupation with trifling details1 etc4 ,primary3 ,e1 ,m1 ,o1 ,a ,secondary3 ,y1 ,t1 ,k ,compulsions that arise1 or may be resolved1 in relation to your family3 ,s #gc #d4d4 ,nogenic neuroses3 ,a person can be emotionally disabled by serious conflicts between opposing personal1 ethical1 or religious values4 ,this problem has not gained widespread recognition among psychiatrists and therapists4 ,it is a focus of logotherapy 7see ,chapter #aa73 ,g #d4e4 ,psychosomatic disorders1 hypochondria3 ,physical disorders caused by emotional problems are psychosomatic4 ,examples include some cases of colitis1 stomach cramps1 diarrhea1 constipation1 ulcers1 cardiac arrhythmias1 impotence1 back and neck spasms1 and migraines4 ,hypochondria involves an exaggerated concern over potential and imagined symptoms of disease4 ,physical examination followed by3 ,p1 ,c1 ,n1 ,w1 ,x #d4f4 ,sexual disorders3 ,these include impotence1 frigidity1 vaginismus 7vaginal muscle spasm71 premature ejaculation1 and sexual role disturbances when accompanied by emotional disorders or poor social functioning 7some cases of homosexuality1 transsexualism73 ,p1 ,e1 ,o1 ,n1 ,w2 sometimes with ,y ,if you are willing to work on this within a wider focus3 ,a #d4g4 ,impulse control disorders3 e4g41 pathological gambling1 kleptomania1 pyromania3 ,o1 ,m1 ,e1 ,q #e ,mood ,disturbances 7,affective ,disorders7 ,there are three primary mood disorders3 depression1 mania1 and manic depression4 ,they may be neurotic1 or they may be psychotic1 in which you experience hallucinations1 delusions1 and withdrawal from reality4 ,each disorder may be situational or nonsituational1 depending on the role of precipitating events1 such as the death of a loved one1 loss of a job1 diagnosis of terminal illness1 etc4 ,situational mood disorders usually disappear with time4 ,all three disorders may appear as isolated episodes1 or they may be recurrent4 #e4a4 ,depression3 ,clinical depression is not simple sadness or grief4 ,severely depressed people speak slowly1 laboriously4 ,it is difficult for you to maintain attention and concentration4 ,you may have feelings of hopelessness1 despair1 heaviness1 self-blame1 heightened self-criticism1 great pessimism about the future1 inability to make decisions1 tendencies to think of suicide and sometimes to commit it4 ,dependence on loved ones increases as you feel helpless4 ,interests diminish in work1 hobbies1 and friends4 ,you may cry frequently2 you may be irritable and #gd inclined to have angry outbursts4 ,you probably sleep poorly and awaken frequently1 particularly in early morning4 ,anxiety is common in about #ej percent of patients4 ,there is frequently little appetite for food or for sex3 ,y1 ,e1 ,p1 ,u1 ,t1 ,w1 ,x ,as a sense of deep discouragement with life3 ,h ,depressed as a result of a conflict in personal values3 ,g ,if you are willing to work on your problems within a wider focus 7also see #a4a73 ,a #e4b4 ,mania3 ,you tend to have exaggerated beliefs in your capabilities2 you tend to be euphoric and may fall in love easily and repeatedly4 ,you suffer from impulsiveness1 poor judgment1 racing thoughts1 sometimes explosive anger4 ,milder degrees of mania are often welcomed by you1 family1 and friends1 who admire your enormous energy and your many irons in the fire4 ,only when family and friends become aware of your poor judgment in buying sprees1 delusions of grandeur1 or sexual excesses do they try to encourage you to seek treatment1 usually against your own wishes3 ,y 7especially lithium therapy71 ,e1 ,p1 ,t1 ,w1 ,x #e4c4 ,manic depression3 ,you are trapped on an emotional roller coaster3 at times you are depressed 7see #e4a71 and at other times you experience the highs of mania 7see #e4b73 ,y 7especially lithium therapy71 and therapies listed under #e4a4 #f ,adjustment ,problems ,some critics of psychotherapy have argued that its main purpose is to serve the interests and values of society3 a person is judged to be abnormal if he does not want1 or refuses1 for example1 to work from nine to five all but two weeks of the year2 if he does not accept the responsibilities society claims he should respond to as an adult1 a citizen1 a husband1 or a father4 ,these social demands--so critics of therapy have argued--have been internalized by most therapists so that therapies often do not really serve the individual's needs but rather the prevailing belief-system of society4 ,whatever validity the critics' argument may have1 it relates particularly to this area of emotional suffering that falls under the heading of adjustment disorders4 ,some adjustment disorders clearly lie outside the boundaries of this criticism4 ,for example1 a woman faces the loss of her husband and resulting poverty4 ,she becomes anxious and depressed1 #ge and these feelings do not go away with time4 ,or1 a man agrees to a job transfer1 wants to succeed at his new position1 but is overwhelmed by anxiety in his new environment4 ,his anxiety doesn't go away4 #f4a4 ,in relation to a new environment or an already familiar one2 work inhibitions3 ,h1 ,m1 ,e1 ,p1 ,n #f4b4 ,in persons with counterculture attitudes and values3 ,h1 ,d #f4c4 ,emotional difficulties arising from poverty and from the deprivations suffered by minority groups3 ,c #f4d4 ,inability to accept realities that limit life3 e4g41 financial limitations1 restricted opportunities1 aging and death 7see #i below71 jobs with no future1 responsibilities that stand in the way of personal development3 ,f1 ,h #g ,marital ,problems ,it may be worth mentioning that after a period of therapy some problems turn out to be marital in nature even though both husband and wife believed them to be an individual's emotional problem--the man's problem1 not the wife's1 or vice-versa1 and certainly not a marital problem4 ,sometimes it is only after many individual sessions of therapy that the marital basis of a problem becomes clear4 ,when appropriate1 the expressed willingness of a spouse to become involved in his or her partner's individual therapy can be a real help1 providing emotional and treatment support and also saving time when in fact the marital relationship itself contributes to the individual's problems4 ,general marriage therapy3 ,primary3 ,r1 ,d1 ,e1 ,h1 ,i ,secondary3 ,p1 ,n1 ,i ,for communication problems3 ,r1 ,d #h ,family ,problems ,there is a growing realization among therapists that many individual problems are produced by families torn by conflict4 ,often1 family therapy can provide more effective help to a troubled individual than therapy that treats the individual alone4 ,this seems to be especially true in many cases of schizophrenia 7see #ab below7 and in fears of withdrawal of affection and of abandonment 7see #c4d above74 ,general family therapy3 ,s1 ,d1 ,c1 ,i1 ,n #gf #i ,problems ,related to ,aging #i4a4 ,emotional problems in facing old age3 ,e1 ,g #i4b4 ,problems facing the recently widowed3 ,h1 ,g #i4c4 ,coping with physical pain and disability3 ,u1 ,v1 ,w1 ,y1 ,x #aj ,involuntary ,behaviors 7see #ac below7 #aj4a4 ,stuttering3 ,u1 ,g1 ,i1 ,o1 ,w #aj4b4 ,shaking or motor tic disorders3 ,u1 ,g1 ,i1 ,y1 ,w #aj4c4 ,insomnia3 ,v1 ,u1 ,w1 ,y #aa4 ,crisis ,intervention3 ,a ,need for ,prompt ,relief from ,severe ,symptoms ,crisis telephone hotlines are available in most metropolitan areas for immediate counseling and referrals4 ,if such services do not exist in your area1 your family physician1 minister1 local clinic1 hospital1 and even police can be of assistance4 ,primary3 usually ,y followed by ,b1 ,c1 ,f1 or ,g ,secondary3 ,w1 ,n1 ,o1 or ,p #ab ,psychoses ,if you have a psychosis1 you behave in response to delusions or hallucinations4 ,your behavior is seen by others as strange and inappropriate2 you are inclined to withdraw from social groups4 ,you are severely impaired1 out of touch with reality1 often unable to communicate1 illogical1 rambling1 incoherent4 ,your emotional responses are greatly out of proportion1 even inconsistent1 with external events4 ,there are numerous forms of psychosis1 including types of schizophrenia1 manic and paranoid psychoses1 hysterical psychoses1 and others4 ,since self-diagnosis for these conditions is neither appropriate nor likely to be accurate1 no detailed discussion of the distinct forms of psychosis will be given here4 ,any diagnosis of psychosis requires a careful evaluation by a psychiatrist1 clinical psychologist1 or psychotherapist4 ,primary3 ,y 7antipsychotic drugs7 in conjunction with ,m1 ,o1 or ,h ,secondary3 ,y with ,s or ,a2 ,y with ,t #gg #ac ,organic ,disorders #ac4a4 ,senescence1 ,alzheimer's disease3 ,senescence is associated with aging4 ,three-quarters of persons sixty-five years old and older have a chronic1 disabling condition such as emphysema1 heart disease1 or hypertension4 ,most elderly individuals are able to cope with these disabilities for the rest of their lives4 ,some1 however1 begin to have psychological problems associated with senescence--e4g41 confusion1 depression1 paranoia1 and sometimes delirious states3 supportive therapies3 7e4g41 ,b7 and sometimes ,y ,in ,alzheimer's disease1 which is a distinct disease and not simply a sign of aging1 you may have numerous physical complaints that cannot be traced to a physical illness4 ,you may be irritable1 lack energy1 be apprehensive1 show increasing forgetfulness and changes of personality4 ,family members may complain that you are not yourself4 ,presenile and senile dementia are two forms of ,alzheimer's disease2 both are progressively degenerative3 ,y1 care by family or by nursing home to provide supportive environment1 planning of daily activities1 etc4 #ac4b4 ,parkinsonism_/,huntington's chorea3 ,both are movement disorders that can produce psychiatric problems1 including depression and schizophrenic disturbances4 #ac4c4 ,substance-induced3 alcoholism1 drug addiction1 smoking4 ,alcoholism3 ,y1 ,o1 ,alcoholics ,anonymous ,drug abuse3 ,primary3 ,y1 ,synanon1 ,o ,secondary3 ,m1 ,d1 ,k ,smoking3 ,o1 ,w ,potentially useful for all of the above as adjunctive treatments3 ,t1 ,x #ac4d4 ,organic brain dysfunctions3 epilepsy1 narcolepsy1 amnesia1 dementia1 delirium4 ,there are numerous conditions caused by abnormalities in brain function4 ,they do not lend themselves to self-diagnosis or treatment4 ,the main treatment is3 ,y #gh ,,step #b ,,taking ,,your ,,personality ,,into ,,account ,what is challenging for a therapist is discerning the form of learning that each patient can best utilize and then working to adopt techniques that are best suited for the patient4444 ,an important area of research is a way of detecting in a patient his optimal modes of learning4 ,if we can pinpoint these1 we can then more precisely determine the best means of therapeutic operation4#b #b ,lewis ,r4 ,wolberg1 ,the ,technique of ,psychotherapy1 #b vols4 7,new ,york3 ,grune ,stratton1 #aigg71 vol4 ,i1 p4 #bga4 ,some people are more amenable to certain approaches to therapy than others2 for example1 some people like and benefit from group therapy1 while others hate it4 ,sometimes what a person likes or would prefer needs to be overlooked in favor of treatment that is believed to be effective4 ,but the vast majority of people who enter therapy do this of their own volition4 ,if the therapy they enter is unsatisfying or downright distasteful to them1 they will soon give it up4 ,we simply tend not to learn and profit from experiences we dislike or that don't fit the kinds of people we are4 ,for some time now therapists have recognized that a client's personality often tends to incline him or her toward certain approaches and away from others4 ,in the second step in identifying a potentially promising approach to therapy1 you are encouraged to take traits of your own personality into consideration4 ,it is not merely the goal or problem that suggests a particular approach to therapy1 but--what is often more important--the nature of the person4 ,too little attention is given to the appropriateness of an individual for a given kind of therapy4 #gi ,,table #b3 ,,an ,,overview ,,of ,,main ,,personality ,,traits ,,relevant ,,to ,,the ,,choice ,,of ,a ,,therapy ,choose no more than three of the following that you believe influence most strongly the way you approach day-to-day living3 #a ,self-discipline #b ,commitment to tasks you set for yourself #c ,patience #d ,initiative #e ,tolerance to frustration #f ,rigidity #g ,inhibition #h ,introversion or extroversion #i ,motivation and capacity for physical exercise #aj ,need for acceptance1 human warmth1 and gentle encouragement #aa ,articulateness and analytical attitude #ab ,reflectiveness--thinking about your own feelings1 thoughts1 and behavior #ac ,imagination #ad ,sensitivity to values #ae ,comfort in a group setting #af ,severe impairments--learning1 communication1 or emotional disabilities1 including addictions that seriously disrupt your daily life #hj ,in the following section1 you will find questions relating to the sixteen personal qualities listed in ,table #b4 ,for those qualities you check1 answer the questions as realistically as you can4 ,if1 for the most part1 you answer yes to a given group of questions1 then the approach7es7 to therapy identified there may be especially appropriate for the kind of person you are4 ,if you answer no to most of the questions in a group1 then the listed therapy or therapies may not be especially well suited to you4 ,,matching ,,your ,,personality ,,with ,,the ,,most ,,promising ,,therapies #a ,self-,discipline ,therapies rely on self-discipline in clients in several ways3 ,are you able to stick to a prescribed routine and do practical assignments on your own outside of therapy sessions to practice attitudes1 communication skills1 or behaviors8 ,will you take personal responsibility for coming to regular appointments on time8 ,can you give up any real payoffs of being emotionally troubled8 ,when any approach to therapy is successful1 it is in large measure because a client has strong personal motivation1 a strong will4 ,however1 some approaches to therapy depend more heavily than others on a client's strength of determination4 ,they include3 ,m1 ,o1 ,e1 ,p1 ,i1 ,n1 ,h1 ,a1 ,x1 ,t #b ,commitment to the ,process of ,therapy ,do you believe you can commit yourself to therapy that spans many months and sometimes several years8 ,if you hope to gain long-lasting benefits from your experience in therapy1 you will need to commit yourself to certain practices and ways of thinking after formal therapy has ended4 ,do you feel that you have this kind of tenacity and ability to follow through8 ,these are both qualities related to self-discipline1 but they have more to do with sustaining a process over a long period of time3 in a word1 commitment4 ,do you feel you can develop a strong sense of commitment to long-term therapy8 ,a ,to a long-range plan for life improvement8 ,h1 ,m #ha #c ,patience ,if you are suffering from incapacitating anxiety or depression1 being patient about the process of therapy can be very demanding4 ,long-term therapies require more patience1 endurance1 and tolerance than do short-term therapies4 ,are you able to put your trust in a process where results are noticed only very gradually8 7,if not1 you may feel that what is most urgent now is to obtain prompt relief from symptoms--see the ,summary of ,main ,approaches to ,psychotherapy1 at the end of this chapter1 to get some idea of the average durations of the different therapies47 ,therapies especially requiring patience--with yourself1 with the challenge1 or with the duration of therapy--include3 ,a1 ,h1 ,m1 ,x #d ,initiative ,some approaches to therapy offer very little direction or specific advice from the therapist4 ,do you feel that you have the initiative to proceed without explicit direction from the therapist8 ,if so1 what you probably need in a therapist is primarily the capacity to understand you well1 to accept you as a person1 and to encourage you in a warm and positive way to do what you think is best3 ,b #e ,tolerance to ,frustration ,do you have a fairly high threshold of frustration when your beliefs and ideas are challenged8 ,when you do not immediately get what you want1 can you tolerate fairly well what may seem like a long route to get where you want to go8 7,do you cope well with the frustration of getting lost in your car1 for example87 ,can you tolerate1 without serious irritation1 anger1 or hurt1 being pushed to confront some of the pretenses or distortions or illusions you may have lived by8 ,can you accept1 with some calmness of mind1 having someone point out to you that you have not been as clear about things as you thought1 and that sometimes your attitudes are not consistent1 that you are1 to some extent1 confused8 ,a1 ,c1 ,e1 ,p #f ,rigidity ,do you often find yourself trying to be1 or wishing you were someone you're not8 ,c #hb ,are you perfectionistic8 ,upset when you make even fairly minor mistakes8 ,concerned that things be in their proper place8 ,are you frequently intense and uptight8 ,c1 ,j ,are you overcontrolling--anxious when you do not feel you have things clearly under control8 ,are you depressed 7see #e1 ,table #a7 or phobic 7see #d4b1 ,table #a78 ,do you suspect that other people think that you magnify evils1 blowing negative things out of proportion8 ,are you inclined to be moralistic1 dogmatic1 critical1 or judgmental8 ,are you an uncompromising person8 ,do you feel1 deep down1 that perhaps your expectations and demands 7concerning others1 yourself1 and the world7 may be unrealistic8 ,do you think you are often inclined to confuse what you would like with what you need8 ,e1 ,p1 ,h #g ,inhibition ,do you feel blocked1 inhibited1 or held in check by an overly critical self8 ,b ,do you feel that you have pent-up feelings that are in need of release8 ,do you feel stultified or oppressed by your relationships with your spouse1 friends1 or family8 ,does your life lack emotional intensity8 ,do you obtain little joy or satisfaction from living8 ,c1 ,j ,do you feel that somehow there are blocks in you that are standing in the way of your self-realization1 of fulfilling your potential8 ,h #h ,introversion or ,extroversion ,are you inner-directed8 ,would you rather be alone or with one or two friends than attend a party8 ,are you impatient1 or do you even resent receiving unsolicited suggestions8 ,a1 ,f ,on the other hand1 are you at ease with groups of people8 ,is it important to your self-image what other people think of you8 7,are you perhaps status-oriented87 ,do you often find it useful or helpful to receive advice8 ,q #i ,motivation and ,capacity for ,physical ,exercise ,are you free of physical handicaps8 ,do you like to be physically active1 to exercise8 #hc ,do you begin to feel restless when a week or more goes by and you have been sedentary8 ,if you are not physically fit now but are healthy1 does it appeal to you to work regularly and hard to become physically stronger and to improve your endurance8 ,t1 ,j1 yoga 7see ,u7 #aj ,need for ,acceptance1 ,human ,warmth1 and ,gentle ,encouragement ,do you feel that perhaps no one has ever taken the time to listen to you1 to take a genuine interest in you and in your problems as a person8 ,do you feel1 perhaps because of circumstances or problems over which you've had no control1 that you have received rather little human warmth from others8 ,would you prefer encouragement that is patient and warm rather than a forceful push to change your life8 ,b #aa ,articulateness and ,analytical ,attitude ,can you talk openly and clearly about your feelings1 about what is troubling you8 ,can you fairly readily describe examples of situations that may bother you8 ,if you were asked to describe the personality 7not his or her physical features and behavior7 of someone you talked with last night for half an hour at a party1 could you do this without a lot of hesitation and brow-furrowing8 ,do you like to talk about personal problem solving1 about your feelings1 past events1 and why you have come to feel as you do8 ,do you feel a need to acquire an overall sense of understanding of yourself1 your family1 and how they have influenced you8 ,a #ab ,reflectiveness ,do you often find yourself thinking about your feelings1 about the purpose of life1 and about whether yours has a meaningful direction8 ,do you tend to come home from a visit with friends or family and go over in your mind what went on and wonder why people said and did certain things8 ,do you have a mental habit of standing apart from what you're doing and judging yourself and your work8 ,do you spend much time just thinking about things1 even dwelling on problems that concern you8 ,a1 ,g #hd #ac ,imagination ,as a child1 did you have an imaginary friend8 ,when you sit on a rock by a brook in the woods1 do you quickly begin to feel a special sense of relaxation8 ,or1 watching the waves breaking on the beach1 do you find yourself lulled into a sense of absorption in nature8 ,do you enjoy reading8 ,as you read a descriptive novel1 do you tend to see many of the places and people8 ,do the events come alive for you8 ,do you find yourself thinking about the events in the book as though they make up a real world of their own8 ,w #ad ,sensitivity to ,values ,are personal values very important to you8 ,for example1 do you sometimes find yourself thinking that so much of television programming is mediocre1 trash1 a waste of time8 ,do you feel that there are human values that are more important than how much money you make1 what model car you drive1 and the luxuriousness of your home8 ,are you a religious or spiritual person1 whether you attend church or not8 ,do you like art1 music1 or literature8 ,do you feel1 really feel1 a sense of compassion or empathy for people who face poverty and misfortune8 ,do you sometimes feel guilty because of your own situation1 that there always seem to be others who are worse off8 ,have you ever faced the opportunity to take advantage of someone or of a situation and simply decided not to 7even though you knew you could do this without risk7 because you simply wanted to feel honest or retain a sense of your own integrity8 ,are you in search of a richer meaning in life8 ,do you wonder whether what you are doing with your life is really right for you8 ,g #ae ,comfort in a ,group ,setting ,do you feel comfortable and safe in groups8 ,do you feel friendly when you pass a house where a party is going on8 ,do you enjoy parties or social gatherings8 ,did you come from a family with several children8 ,q1 ,c #he #af ,severe ,impairments ,do you have any learning or communication disabilities8 ,are you so troubled because of emotional upheaval that you cannot work or maintain your family responsibilities8 ,do you have any addictions that are causing grief for you or others close to you8 ,do you sometimes have to let off steam1 even though you know you are hurting others1 damaging their property1 or injuring yourself8 #hf ,,step #c ,,table #c3 ,,the ,,approaches ,,to ,,therapy ,,discussed ,,in ,,this ,,book ,in the left column are the letters used in this chapter to identify each approach to therapy3 ,letter ,code ,approach to ,therapy ,chapter ,a ,psychoanalysis #i ,b ,client-centered therapy #aj ,c ,gestalt therapy #aj ,d ,transactional analysis #aj ,e ,rational-emotive therapy #aj ,f ,existential-humanistic therapy #aj ,g ,logotherapy #aa ,h ,reality therapy #aa ,i ,adlerian therapy #aa ,j ,bioenergetics #aa ,emotional ,k ,primal therapy flooding #aa therapies ,l ,implosive therapy #aa ,m ,direct decision therapy #aa ,n ,counter-conditioning #ab ,o ,behavior modification ,behavioral #ab psychotherapies ,p ,cognitive approaches to behavior change #ab ,q ,group therapy #ac ,r ,marriage therapy #ad ,s ,family therapy #ad ,t ,therapeutic exercise #ae ,u ,biofeedback #ae #hg ,v ,relaxation training #ae ,w ,hypnosis #ae ,x ,meditation #ae ,y ,drug therapy #af ,z ,nutrition therapy #ae ,,how ,,to ,,use ,,the ,,information ,,you ,,now ,,have ,if you have followed the instructions for ,steps #a1 #b1 and #c1 you should have identified a potentially promising therapy1 or group of therapies1 in relation both to your goals or problems and to your own estimation of certain important traits of your personality or character4 ,the therapy or approaches to therapy you have identified now need to be tested1 first1 in your imagination as you read the chapters of this book1 which will give you an idea of what each major approach to therapy is like1 and then1 if you decide to proceed1 in reality1 when you have located a suitable therapist 7see ,chapter #ag74 ,the need for this testing is a matter of simple realism3 you now have a sense of direction1 or perhaps several alternative directions1 to consider4 ,the approach to self-diagnosis described in this chapter is intended to be useful1 but it is not infallible2 much depends on the accuracy of your problem diagnosis1 the appropriateness of the goals you have set1 and your self-understanding4 ,much also will depend on the therapist you locate and how well you are able to work together4 ,the recommended therapies listed by letter codes for ,steps #a and #b reflect evaluations from several sources3 7#a7 ,therapists themselves claim that certain approaches favored by them have been shown to be useful for treating certain problems1 for realizing certain goals1 and for clients with certain personal qualities4 7#b7 ,various studies also have attempted to demonstrate for what and sometimes for whom many of the major therapies are most successful 7see ,chapter #bj74 7#c7 ,primarily in the ordering of letter codes in connection with the specific #hh goals1 problems1 and personal qualities listed in ,steps #a and #b1 ,i have relied on my own experience and judgment4 ,letter codes listed first designate therapies that1 in general1 are commonly regarded by therapists and psychologists as most useful4 ,at times1 when general consensus appeared to be lacking1 ,i have used my own evaluation4 ,the intention in this chapter is to make explicit a simple and reasonable process of choosing a therapy4 ,many therapies are not mentioned in connection with specific goals1 problems1 or personality traits4 ,to be sure1 some of the therapies that are not mentioned can be useful to certain individuals who have a given goal1 problem1 or trait4 ,but the objective of this book is to improve the general reliability of a person's self-diagnosis and self-understanding4 ,the book is a guide1 not a bible4 ,,combining ,,approaches ,there is evidence that combining two therapies for certain problems can frequently be more effective than using either in isolation4 ,treatment for individuals suffering from severe anxiety or depression often will combine drug therapy1 for example1 with one of the fourteen approaches to therapy described in ,chapters #i-ab and #ad 7and listed below1 under ,a74 ,or1 individuals who have problems due to excessive stress may1 for example1 be advised to combine biofeedback1 relaxation training1 hypnosis1 meditation1 or exercise therapy with a form of psychotherapy4 ,usually1 when therapies are combined1 one is a formal psychotherapy and the other is an adjunctive therapy--that is1 a therapy that most often is not relied on exclusively4 ,some adjunctive therapies lend themselves very well to use by individuals on their own4 ,combined treatments tend1 then1 to employ one approach taken from list ,a and one from list ,b3 ,a 7,main ,therapies7 ,psychoanalysis ,client-centered therapy ,gestalt therapy ,transactional analysis ,rational-emotive therapy ,existential-humanistic therapy #hi ,logotherapy ,reality therapy ,adlerian therapy ,direct decision therapy ,behavior modification ,cognitive approaches to behavior change ,marriage and family therapy ,b 7,adjunctive ,therapies7 ,drug therapy ,meditation ,hypnosis ,relaxation training ,biofeedback ,therapeutic exercise ,approaches ,that ,may ,appear ,under ,either ,a or ,b ,bioenergetics ,primal therapy ,implosive therapy ,counter-conditioning ,group therapy #ij ,a ,,summary ,,of ,,the ,,main ,,approaches ,,to ,,psychotherapy ,average ,therapy ,best ,suited ,for3 ,duration99 ,cost9999 ---------------------------------------- ---------------------- ,client's ,personality 7not all traits may apply to a ,problems or ,goals single person7 ---------------------------------------- ---------------------------------------- ----------------------------- 99 #a ,brief therapies1 frequently #ab weekly sessions or less2 #b #c-f months2 #c long-term therapies1 #f months to several years 9999 initially expensive1 then #aj-be_/;hr42 expensive #ej-ajj_/;hr42 moderate1 #be-ej_/;hr42 #j inexpensive1 #aj-be_/;hr42 often available on a sliding scale basis 7see ,chapter #d7 through county clinics1 agencies etc ,a4 ,psychoanalysis self-development3 broad-spectrum self-disciplined #c improvements committed suffering from childhood traumas patient fear of withdrawal of affection tolerant to frustration and of abandonment introverted interpersonal problems articulate phobias analytical compulsions reflective sexual disorders depression mania manic depression psychoses ,b4 ,client-centered self-development3 broad-spectrum inhibited #b improvements possessing initiative low self-worth needing acceptance1 crisis intervention human warmth1 and gentle encouragement ,c4 ,gestalt behavior problems in children tolerant to frustration #a-b to #j shyness_/passivity rigid coping with persons in authority inhibited psychosomatic disorders able to work in a group adjustment problems3 minorities setting and the poor family conflicts crisis intervention #ia ,d4 ,transactional shyness_/passivity interested in effective #a-b #j analysis loneliness_/emptiness communication hostility_/overbearing personality fear of withdrawal of affection and of abandonment improving effectiveness of communication coping with persons in authority phobias adjustment problems marital problems1 especially those involving communication difficulties family conflicts drug abuse ,e4 ,rational- hostility_/overbearing self-disciplined #b emotive personality rigid interpersonal problems anxiety disorders post-traumatic stress phobias compulsions sexual disorders impulse control disorders depression mania and manic depression adjustment problems marital problems delinquency and criminal behavior #ib ,f4 ,existential- loneliness_/emptiness introverted #b humanistic loss of faith in yourself1 sensitive to existential in others1 or in life's purpose issues inability to accept life's limitations crisis intervention ,g4 ,logotherapy estrangement_/alienation from reflective #b others sensitive to values loss of faith in yourself1 in others1 or in life's purpose nogenic neuroses depression due to value conflicts inability to accept life's limitations emotional problems in facing old age problems of the recently widowed stuttering shaking and motor tic disorders crisis intervention ,h4 ,reality desire for a success-identity self-disciplined #a-b anxiety disorders committed post-traumatic stress patient adjustment problems rigid marital problems problems of the recently widowed vocational problems delinquency and criminal behavior psychoses #ic ,i4 ,adlerian deep discouragement with life self-disciplined #a-b marital problems inhibited family conflicts stuttering shaking and motor tic disorders vocational problems delinquency and criminal behavior ,j4 ,bioenergetics self-development3 broad-spectrum inhibited #a-b improvements motivated and able to suffering from childhood pain undertake physical exercise ,k4 ,primal anxiety disorders pent-up feelings #a-b post-traumatic stress phobias compulsions drug abuse ,l4 ,implosive phobias 7nonspecific7 #a ,m4 ,direct decision desire for a success-identity self-disciplined #a compulsions committed impulse control disorders patient vocational problems adjustment problems psychoses drug abuse #id ,n4 ,counter- shyness_/passivity self-disciplined #a-b conditioning hostility_/overbearing personality phobias psychosomatic disorders sexual disorders adjustment problems marital problems family conflicts crisis intervention ,o4 ,behavior mental retardation self-disciplined #a-b modification autism possibly impaired behavior problems in children hyperkinetic behavior delinquency and criminal behavior eating disorders compulsions sexual disorders impulse control disorders stuttering crisis intervention psychoses #ie ,p4 ,cognitive interpersonal problems self-disciplined #a-b approaches anxiety disorders rigid to behavior post-traumatic stress change psychosomatic disorders sexual disorders depression mania and manic depression adjustment problems marital problems crisis intervention ,q4 ,group shyness_/passivity extroverted #a #j loneliness_/emptiness tolerant to group hostility_/overbearing involvement personality improving communication effectiveness impulse control disorders ,r4 ,marriage marital problems supportive therapy for individual 7nonspecific7 #a-b problems fear of withdrawal of affection and of abandonment ,s4 ,family family conflicts 7nonspecific7 #a-b supportive therapy for individual problems emotional disturbances in children fear of withdrawal of affection and of abandonment family-based compulsions psychoses #if ,t4 ,therapeutic depression self-disciplined #b-c #j or exercise anxiety disorders motivated and able to no post-traumatic stress undertake physical cost marital problems exercise alcoholism drug abuse smoking psychoses ,u4 ,biofeedback physical pain and disability 7nonspecific7 #a-b shaking and motor tic disorders stuttering insomnia anxiety disorders post-traumatic stress phobias depression ,v4 ,relaxation anxiety disorders 7nonspecific7 #a-b training post-traumatic stress phobias physical pain and disability insomnia #ig ,w4 ,hypnosis emotional disturbances in imaginative #a-b children trusting eating disorders interpersonal problems anxiety disorders post-traumatic stress phobias psychosomatic disorders sexual disorders depression mania and manic depression physical pain and disability stuttering shaking and motor tic disorders ,x4 ,meditation loss of faith in yourself1 in self-disciplined #c #j or others1 or in life's purpose patient no anxiety disorders cost post-traumatic stress depression mania and manic depression physical pain and disability alcoholism drug abuse smoking #if ,y4 ,drug autism possibly impaired #a-c hyperkinetic disturbances anxiety disorders post-traumatic stress phobias compulsions sexual disorders depression mania and manic depression physical pain and disability shaking and motor tic disorders insomnia crisis intervention ,z4 ,nutrition possibly hyperkinetic behavior no data available -- -- as well as other problems 7see ,chapter #ad7 99 #a ,brief therapies1 frequently #ab weekly sessions or less2 #b #c-f months2 #c--long-term therapies1 #f months to several years 9999 initially expensive1 then #aj-be_/;hr42 expensive #ej-ajj-;f_/hr42 moderate1 #be-ej_/;hr42 #j inexpensive1 #aj-be_/;hr42 often available on a sliding scale basis 7see ,chapter #d7 through county clinics1 agencies1 etc4 #ii #h ,,emotional ,,problems ,,that ,,may ,,have ,,physical ,,causes ,this chapter has a single important purpose3 to persuade you1 if you are in serious emotional distress1 to have a comprehensive physical examination before beginning psychotherapy4 ,imagine how disheartened and frustrated you might feel after a period of unsuccessful therapy1 only to find out afterward that your problems could be traced to a physical cause4 ,it is essential that you eliminate the possibility of a physical basis for your problems before seeking therapy4 ,in fact1 most therapists routinely recommend that you have a complete physical before entering therapy4 ,rest assured that doing so will not be a waste of time4 ,richard ,rada1 ,director of ,college ,hospital in ,cerritos1 ,california1 estimates that between five and ten percent of clients with depression1 anxiety1 or unusual thoughts and behavior may have underlying physical conditions that are responsible1 including gland #ajj dysfunction1 an epileptic abnormality1 heart disease1 cancer1 and so on4 ,the following facts1 too1 should convince you that having a comprehensive physical is paramount3 99 ,as many as one patient in every ten who suffer from serious depression has a thyroid disorder4 99 ,one person in every four who are diagnosed as having psychiatric disorders and who are over sixty-five has an underlying physical illness that is responsible4 99 ,an equal number of individuals over sixty-five have emotional problems that are made worse by underlying physical disorders4 99 ,three percent of people who regularly take prescription medication develop mental symptoms4 ,dr4 ,leonard ,small1 a specialist in the field of neuropsychodiagnosis1 has found that the more severe emotional or mental symptoms are1 the more likely it is that therapists 7and patients7 will overlook the possibility of underlying physical disorders4#a #a ,leonard ,small1 ,neuropsychodiagnosis in ,psychotherapy 7,new ,york ,brunner_/,mazel1 #aihj71 p4 vii4 ,it isn't necessary or possible to give a detailed or comprehensive catalog of physical causes of emotional and mental disturbances here1 but it may be helpful to many people to see some of the principal ways in which psychological symptoms can be produced by physical problems4 ,hopefully1 these illustrations will persuade you1 if you are emotionally or mentally troubled1 of the wisdom of a thorough physical4 ,it is a small price to pay if emotional symptoms can be traced to a physical cause4 ,it is well known that virtually any serious organic illness or injury can produce emotional suffering1 either in the form of physical pain or in the form of anxiety and depression4 ,chronic pain is a chronic stress and can lead to the same emotional problems as prolonged stress of any variety3 anxiety or depression4 ,similarly1 prolonged severe anxiety or depression can cause physical deterioration and make the body more susceptible to disease4 #aja ,there are1 then1 two vicious circles1 or feedback loops1 that can play a role in causing or aggravating emotional disturbance3 ,illustration3 ,the two vicious circle or feedback loops that may exist between physical disorders and emotional disturbances ,in the first loop1 an underlying physical disorder1 which may be a disease or a physical injury1 leads to emotional symptoms 7and very likely to physical symptoms as well1 although these may not be as pronounced74 ,however1 the emotional reactions that are produced can themselves make the physical disorder worse1 and certainly emotional disturbance makes living with and treating the underlying physical disorder more difficult4 ,in the second loop1 emotional disturbances cause certain physical disorders3 a peptic ulcer1 heart palpitations1 ulcerative colitis1 backache1 hypertension1 or high blood pressure1 etc41 and may predispose certain individuals to arthritis1 cancer1 or diseases of the immune system4 ,once a psychosomatic link has been established between a troubled mind and the body1 and an organic disorder has come about1 the physical disorder1 in turn1 can produce stronger or more exaggerated emotional reactions4 ,anxiety or depression may increase because the person is now both physically ill and emotionally troubled4 ,these two so-called positive feedback loops can obviously #ajb lead to a runaway process that becomes worse and worse4 ,psychosomatic medicine focuses on the second of these2 our focus here is on the first3 physical origins of emotional disturbance4 ,underlying physical disorders of this kind include metabolic diseases1 disorders and diseases affecting the brain and nervous system1 head injuries1 other physical disorders and conditions1 infectious diseases1 reactions to medication1 and drug addiction and alcoholism4 ,each is discussed in the remainder of this chapter4 ,,metabolic ,,diseases ,several well-known metabolic diseases can lead to emotional disturbances3 ,,hyperthyroidism ,an overactive thyroid1 known as hyperthyroidism1 is usually caused by the pituitary gland's overproduction of a hormone called ,,tsh1 or thyroid-stimulating hormone4 ,this causes the thyroid1 a butterfly-shaped gland in the lower part of the neck1 to produce an excess of the thyroid hormone thyroxine4 ,hyperthyroidism is eight times more common in women than in men4 ,the emotional symptoms of hyperthyroidism include a more intense and chronic nervousness than in hypothyroidism 7discussed below71 overreactions to minor crises1 moodiness1 frequent fear without knowing why1 a sense of agitation1 dread1 and occasionally trembling or shaking4 ,some patients with serious hyperthyroidism may have symptoms resembling those of schizophrenia1 in which there is little or no contact with reality4 ,physical symptoms include rapid loss of weight1 unusual appetite1 rapid pulse1 diarrhea1 and muscle weakness 7especially in the legs1 as when climbing stairs74 ,the classical symptoms of hyperthyroidism are staring eyes and enlargement of the neck1 but these need not be present4 ,it is interesting to note that certain factors in upbringing and personality seem to predispose people to hyperthyroidism 7this would mean that a feedback loop of the second type may precipitate the disease in some people74 ,individuals who later develop hyperthyroidism often have these characteristics3 #ajc 99 ,they were forced prematurely to become self-sufficient and responsible4 99 ,they felt rejected by one or both parents and feared a loss of emotional support4 99 ,their early dependence needs 7their needs for affection1 mothering1 warmth1 etc47 were frustrated1 and this led to feelings of insecurity and low self-esteem and to the belief that the world is a threatening place4 99 ,they often had dominant1 tight-lipped1 overcontrolling mothers4 ,,hypothyroidism ,an underactive thyroid1 known as hypothyroidism1 is caused by an inadequate production of thyroid hormone4 ,it is most common in middle-aged women4 ,the emotional symptoms of hypothyroidism include mental sluggishness1 nervousness1 depression1 irritability1 impatience1 and frequently dislike of everyday activities4 ,physical symptoms include a sense of heaviness and lethargy1 dry skin1 sensitivity to cold1 constipation1 and thinning hair4 ,,hyper- ,,and ,,hypoparathyroidism ,the parathyroid glands1 which are four bean-size glands located on top of the thyroid gland1 manufacture hormones that regulate phosphorus and calcium levels in the body4 ,excess hormone raises the calcium level too high1 and psychotic-like behavior can result4 ,too little hormone lowers the calcium level to the point that a person may behave like an alcoholic4 ,these conditions are comparatively rare4 ,,diabetes ,diabetes1 or hypoinsulism1 which at the time of this writing affects as many as #b4e million ,americans1 results from underproduction of insulin1 which in turn causes an excess of sugar in the blood and urine4 ,diabetes takes two forms3 juvenile onset 7or insulin-dependent7 and adult onset 7or noninsulin-dependent7 diabetes4 ,the first type starts in childhood or young adulthood1 and is caused by the body's failure to produce enough insulin4 ,juvenile onset diabetes is #ajd usually controlled by means of regular injections of insulin4 ,adult onset diabetes is less serious than juvenile diabetes2 it occurs more often in the elderly and especially in people who are overweight4 ,diabetes can appear in a person after a traumatic event3 great stress1 a physical accident1 surgery1 infection1 or a severe emotional disturbance4 ,it may also appear after a person has gone through a long period of fatigue1 depression1 indecision1 or sense of hopelessness4 ,those who become diabetic may be individuals who felt strong resentment toward their parents while growing up or who were spoiled children4 ,diabetic men often were dominated by their mothers while being excessively dependent on them4 ,adult onset diabetes is usually controlled without insulin injections1 particularly during the early stages of the disease4 ,treatment in about one-third of noninsulin-dependent diabetics is possible by diet alone2 in others1 it is necessary to take oral hypoglycemic drugs that stimulate the release of insulin4 ,the emotional symptoms of both forms of diabetes may include apathy1 depression1 personality disorders1 or even psychosis as a result of undersecretion of insulin4 ,physical symptoms include the need to urinate frequently1 day and night1 unusual fatigue and weakness1 tingling in hands and feet1 reduced resistance to infections 7especially of the urinary tract71 blurred vision1 impotence in men1 and lack of menstrual periods in women4 ,,hypoglycemia ,hypoglycemia1 or hyperinsulism1 which affects perhaps as many as five million ,americans1 is caused by overproduction of insulin4 ,excess insulin leads to low blood sugar 7literally1 hypoglycemia74 ,sometimes this overproduction of insulin is caused by a tumor of the pancreas2 the growth can often be removed surgically to correct the condition4 ,the emotional symptoms of hypoglycemia include depression and anxiety4 ,physical symptoms include fast pulse1 palpitations1 dizziness1 general weakness1 faintness1 stomach pain1 blurred vision1 and sweating4 ,these symptoms often occur a few hours after eating and disappear after eating again4 #aje ,hypoglycemia has become almost a fad disease among psychonutritionists4 ,the condition is believed by most physicians1 however1 to be confined mainly to diabetics who have not kept to a prescribed routine and have allowed their levels of insulin to become too high4 ,sometimes stomach surgery1 liver disease1 pregnancy1 and periods of high fever can cause attacks of hypoglycemia4 ,,disorders ,,and ,,diseases ,,affecting ,,the ,,brain ,,and ,,nervous ,,system ,,epilepsy ,the second most common physical cause of emotionally distressing symptoms1 after the metabolic disorders we have just discussed1 is epilepsy4 ,approximately #g percent of mentally disturbed patients have some form of epilepsy4 ,epilepsy affects between #a and #b percent of the ,u4,s4 population4 ,of people who have epilepsy1 two-thirds appear to have no structural abnormality of the brain2 in the remaining third1 the disease can be traced to brain damage at birth1 a severe head injury1 an infection that caused brain damage1 or a brain tumor4 ,the emotional symptoms of epilepsy can involve either anxiety or depression or both4 ,once a person has had a convulsive seizure1 he or she may live in constant apprehension that another seizure will occur4 ,there may be occasional1 transient feelings of unreality4 ,physical symptoms include peculiar stomach sensations1 distorted vision1 occasional bizarre behavior such as laughing for no apparent reason or sudden and unprovoked anger1 loss of consciousness1 and convulsions4 ,,parkinsonism ,parkinson's disease often causes anxiety or depression4 ,physical symptoms early in the course of the disease include slowing of movement and inability to write one's name without the handwriting becoming smaller and smaller4 ,later symptoms include tremors1 muscle stiffness or rigidity1 nervousness1 and tension4 #ajf ,,multiple ,,sclerosis ,multiple sclerosis usually begins in people between the ages of twenty and forty1 affecting slightly more women than men4 ,symptoms may disappear after one or a number of attacks1 or they may get progressively worse and cause severe disability4 ,emotional symptoms include anxiety1 panic attacks1 and depression4 ,physical symptoms may involve a feeling of numbness or tingling affecting one limb or one side of the body1 temporary blurring of vision1 slurred speech1 and difficulty or lack of control in urinating4 ,,brain ,,tumors ,brain tumors may cause severe headaches1 blurred or double vision1 vomiting without the warning of nausea1 general weakness1 and1 in some cases1 epileptic seizures4 ,emotional symptoms may involve nervousness1 irritability1 memory problems1 and personality changes4 ,,head ,,injuries ,head injuries that damage the brain generally cause headaches and dizziness4 ,emotional symptoms usually involve nervousness and sometimes confusion4 ,in more serious injuries1 there may be loss of memory1 depression1 and decreased alertness4 ,severe damage to the brain can cause unconsciousness that may persist for days or weeks4 ,,other ,,physical ,,disorders ,,and ,,conditions ,,pancreatic ,,cancer ,cancer of the pancreas can cause severe depression and insomnia4 ,these emotional symptoms can occur early in the course of the disease4 ,this kind of cancer kills nine out of ten of its victims within a year of being diagnosed4 ,one reason for this tragedy is that pancreatic cancer frequently reaches an advanced stage before the appearance of its physical symptoms3 loss of appetite and loss of weight1 nausea1 vomiting1 and upper abdominal #ajg pain that may spread to the back4 ,it is believed that alert psychiatrists can save many lives that otherwise would be lost as a result of pancreatic cancer by detecting the disease in its early stages4 ,,anemia ,anemia is caused by an abnormal drop in either red blood cells or hemoglobin 7the main constituent of red blood cells74 ,iron deficiency can cause anemia1 as can vitamin ,b#ab or folic acid deficiency4 ,inherited blood disorders such as sickle-cell anemia can also lead to anemia4 ,the main emotional symptom of anemia is depression4 ,physical symptoms include weakness1 breathlessness1 and heart palpitations1 which may occur as the heart attempts to compensate for anemia by circulating blood faster than normal4 ,,heart ,,conditions ,mitral incompetence is a heart condition in which the flaps of the mitral valve1 separating the upper and lower chambers of the heart1 do not close properly4 ,the heart of a person with this disorder must therefore work harder than normal4 ,physical symptoms may involve shortness of breath and fatigue4 ,paroxysmal tachycardia is another heart condition1 in which the heartbeat suddenly speeds up to #afj beats per minute or more4 ,an attack may last for from several minutes to several days4 ,physical symptoms include breathlessness1 fainting1 chest pain1 and awareness of the rapid heartbeats4 ,the emotional symptoms of both mitral incompetence and paroxysmal tachycardia may involve anxiety and panic attacks4 ,,menopause ,menopause is not a disorder but a natural condition of aging that involves changes in hormone levels in the body4 ,menopause in women can cause intermittent periods of strong anxiety1 chronic nervousness1 depression1 irritability1 lack of confidence1 and headaches4 ,physical symptoms include hot flashes1 sweating1 and palpitations4 ,male menopause is increasingly being recognized by doctors2 symptoms most frequently appear when a man #ajh is in his fifties4 ,emotional symptoms may involve anxiety and depression2 physical symptoms include hot flashes1 sweating1 fatigue1 and insomnia4 ,,infectious ,,diseases ,frequently1 emotional symptoms are the first warnings of infectious disease4 ,for example1 fatigue and nervousness maybe the only early complaints of patients who have hepatitis1 infectious mononucleosis1 tuberculosis1 and many other diseases4 ,anxiety and tiredness are symptoms that deserve careful diagnostic judgment2 they are not always innocuous4 ,,reactions ,,to ,,medication ,both over-the-counter and prescription medications can sometimes produce emotional or mental side effects4 ,too1 as the number of manufactured drugs increases1 the potential for interactions among different medications increases greatly4 ,certain drug interactions produce symptoms of marked agitation1 restlessness1 and anxiety4 ,furthermore1 patients who have regularly taken a particular medication may sometimes find that it begins to cause unexpected side effects4 ,false senility in elderly patients1 for example1 is often induced by medication2 when the medication is stopped1 the undesirable symptoms disappear4 ,,drug ,,addiction ,,and ,,alcoholism ,both are runaway habits that can cause nervousness and overreactions to small crises4 ,ironically1 individuals are usually first attracted to narcotics or alcohol in order to obtain relief from anxiety4 ,but once the addictions have become firmly established1 emotional symptoms of depression1 irritability1 sudden changes of mood1 nervousness1 and paranoia are common1 as are memory loss and difficulty in concentrating4 ,caffeine is an emotionally habit-forming drug4 ,real addiction--i4e41 physical dependence with withdrawal symptoms--appears to be rare4 ,nevertheless1 coffee1 tea1 and cola drinkers can become emotionally dependent on caffeine4 ,the drug is a #aji frequent cause of chronic nervousness in habitual caffeine users4 ,smoking is a habit that causes a person to lose approximately #e minutes of life expectancy for each cigarette smoked4 ,beyond this1 smoking is also a common but unrecognized cause of chronic nervousness1 in spite of the fact that many smokers believe smoking will help steady their nerves4 ,by now it should be evident that the two main signs of emotional distress--anxiety and depression--can sometimes be the symptoms of undetected physical disorders4 ,especially in cases of severe anxiety or depression without physical complaints1 both therapists and clients tend to overlook the possibility of physical illness4 ,it is true that1 at present1 the majority of such cases cannot be traced to underlying physical causes2 they are therefore treated by means of psychotherapy or psychiatric drug therapy4 ,as medicine and biochemistry develop1 however1 mental and emotional complaints are increasingly being understood in more physical terms4 ,emotional distress clearly does sometimes mask or camouflage the presence of physical disorders4 ,if you are suffering from serious anxiety or depression1 it is important to have a comprehensive physical before beginning psychiatric treatment4 ,this is true especially when the onset of emotional symptoms was sudden--within a period of days or one to two weeks4 ,it may be most useful to see a diagnostic specialist--for example1 a doctor of internal medicine4 ,but bear in mind that physicians1 even those who are familiar with psychiatric problems1 vary considerably in their diagnostic skills1 and sometimes a second opinion can be worthwhile before you decide that the most appropriate treatment is psychotherapy4 #aaa ,,part ,,ii ,,experiencing ,,therapy ,in ,part ,,ii you will be able to develop an overall understanding of the main approaches to therapy available today4 ,we will look at psychoanalysis1 the first of the psychotherapies1 developed by ,freud at the beginning of the twentieth century2 and then1 in the next two chapters1 discuss ten major psychotherapies4 ,because of their widespread use and value1 individual chapters will then focus on approaches to behavioral psychotherapy1 group therapy1 and marriage and family counseling4 ,the two final chapters in this section deal with the therapeutic value of exercise1 biofeedback1 relaxation methods1 hypnosis1 meditation1 psychopharmacology or the use of drugs in therapy1 and dietary approaches4 ,in the discussion of each approach to therapy you will find3 99 a concise description of its special perspective 99 information on the kinds of problems it is thought to be most useful in treating--and closely connected with this1 but seldom taken into account-- 99 a description of the kinds of individuals who tend to profit most from that approach2 and 99 an account of a successful experience in therapy1 reconstructed from the reports of clients as they look back on their treatment #aab ,,how ,,to ,,use ,,part ,,ii ,there are two ways you may find it profitable to use this section of the book4 ,perhaps you may decide to combine both of them4 ,first1 you can use the map in ,chapter #g to define your goals and to suggest specific approaches to therapy that1 based on your own self-diagnosis1 you might find most beneficial4 ,on the other hand1 you may not feel that mapping out your problem or goals in the way that ,chapter #g suggests is for you4 ,perhaps you are simply curious about the field and would like to learn more about it1 or perhaps you are considering counseling or psychotherapy as an opportunity for personal growth and do not have particular difficulties or issues that you want to focus on4 ,for you1 it may be more relevant to read about a wide range of approaches and by so doing gain a clearer understanding of what the alternatives are1 how they work1 and what they may offer you4 ,this window-shopping can then form the basis for a more informed decision later on if you want to enter counseling or psychotherapy4 ,,the ,,experiences ,,of ,,clients ,,in ,,therapy ,the reports in this book that describe the personal lives and experience of real individuals in therapy have all been deliberately recast to mask all traces of their identities4 ,their names1 life situations1 ages1 and other characteristics have been changed4 ,descriptions of the experiences of clients in therapy have been greatly abbreviated and sometimes simplified4 ,as we have already seen1 counseling and psychotherapy last varying lengths of time4 ,even a very short period of therapy1 over a period of weeks1 will bring to light much more detail than it would be useful for us to discuss here4 ,the personal lives of the real persons that are portrayed here are immeasurably more complex and multifaceted than short reports can bring out4 ,sometimes we will use a time-lapse strategy1 describing the evolution of a person's therapy over a period of many months by skipping over weeks at a time4 ,always the intent will be to try to convey to you how real people with real problems have come to deal with their difficulties more effectively and often1 in the process1 have been able to reach a richer understanding of themselves and of others4 #aac #i ,,psychoanalysis ,for wide-range improvements in individuals who are not severely impaired and who are articulate1 reflective1 patient1 self-disciplined1 and able to make a potentially long-term commitment to therapy4 ,the past hides but is present4444 ,bernard ,malamud1 ,a ,new ,life ,psychoanalysis is the root from which the large family of different theories of psychotherapy and counseling has grown4 ,sigmund ,freud's first efforts to develop psychoanalysis began in the #ahhjs4 ,he lived a long life and was active into his eighties2 he died in #aici4 ,freud left behind one of the most important contributions to the field of mental and emotional health4 ,it formed the historical basis for the diversity of approaches that would follow4 ,even when later thinkers took issue with ,freud1 their work in different ways relied on the foundation of his pioneering work4 ,many of ,freud's ideas have worked their way into our everyday vocabulary3 the unconscious1 the ego1 repression1 the ,oedipus #aad complex1 and so forth4 ,his work has influenced the study of anthropology1 sociology1 history1 philosophy1 and literature4 ,,freud',s ,,theory ,during ,freud's early medical training1 he went to ,paris to study with a well-known neurologist1 ,j4 ,m4 ,charcot4 ,charcot had begun to use hypnosis to treat patients with certain physical disorders--paralysis1 for example--for which there was no apparent physical cause 7so-called hysterical symptoms74 ,working with ,charcot1 and later with a physician1 ,joseph ,breuer1 ,freud began to suspect that these symptoms were motivated by earlier traumatic experiences that so distressed the patients that they were forgotten 7repressed74 ,freud's theory of emotional and mental illness began then to take shape around this central idea that neurotic behavior has a purpose3 there is an underlying motive1 the motive itself is very upsetting to the person1 and so it is repressed from awareness4 ,but it continues to gnaw away below the level of conscious awareness and eventually leads to the disturbance that brings the patient to the point at which he or she is in need of professional help4 ,freud believed that recovery would occur if a patient could be helped to gain insight into these painful events and feelings that had been forgotten or suppressed4 ,in a moment1 we will look at two real examples4 ,freud's theory has several dimensions4 ,first1 his theory offers an explanation of how the mind operates through its defense mechanisms3 as we have noted1 excessively painful feelings and memories are repressed4 ,second1 his theory tries to identify the different psychologically critical stages children go through on their way to adulthood3 the oral1 anal1 and genital stages4 ,and third1 his theory seeks to distinguish the parts of the psyche1 which together underlie an individual's personality3 the ego 7the rational portion of the mind that deals with reality71 the id 7made up of basic instincts that press for gratification71 and the superego 7formed from parental influences that have been internalized74 ,,how ,,psychoanalysis ,,is ,,done ,together1 these three so-called dynamic1 developmental1 and #aae intrapsychic dimensions of ,freud's theory make up the general framework of psychoanalysis4 ,the central technique of psychoanalysis is to help the patient become aware of motives that are unconscious4 ,psychoanalysis1 or analysis for short1 is basically an attempt to extend self-control1 bringing disturbing feelings and behavior under a person's conscious management4 ,one of the principal techniques is free association4 ,the patient is made to feel relaxed and comfortable--one reason a couch is sometimes used4 ,he is encouraged to talk in an uninhibited way about his concerns and feelings4 ,during this process1 the analyst usually remains detached and restrained so as not to interfere with the patient's free expression4 ,from time to time1 the analyst shares with the patient certain of the interpretations he has developed on the basis of the patient's reports and behavior4 ,the analyst's objective is to help the patient recover lost and painful memories that are responsible for the conflicts1 weaknesses1 or inabilities that cause the patient to suffer4 ,this process can be very hard on the patient3 he or she must revisit experiences that may be very painful4 ,analysis requires perseverance1 endurance1 and courage4 ,it is not1 as we will see1 for everyone or every problem4 ,one of the most important developments in psychoanalysis has to do with the increasing popularity of psychoanalytic psychotherapy 7also called dynamic psychotherapy71 meaning psychoanalysis that is extremely brief 7#ab to #bj sessions1 for example74 ,considerably more patients are now treated with psychoanalytic psychotherapy than with traditional1 intensive psychoanalysis4 ,,two ,,examples ,,of ,,psychoanalysis ,other than the length and intensity of treatment1 the main difference between ,freudian psychoanalysis and brief analysis has to do with the amount of emphasis that is placed on sexual matters4 ,freud believed that an infant's relationship to his environment and parents is predominantly sensual3 a baby seeks oral gratification2 his attention is absorbed by what he puts into his mouth4 ,later1 attention is focused on excretory processes2 toilet-training requires the child to exercise self-regulation for the first time4 ,later1 genital sexuality becomes the dominant #aaf interest4 ,these sexual phases of development identify the dominant areas of attention that influence the infant1 the child1 and then the adult in their behavior toward others4 ,brief psychoanalysis generally does not affirm ,freud's sexually based 7libido7 theory of motivation4 ,the second example that follows illustrates this shift of emphasis4 ,the first example was described by ,freud himself#a2 the second illustrates brief psychoanalysis4 #a ,sigmund ,freud1 ,lecture #ag1 ,general ,introduction to ,psychoanalysis 7,new ,york3 ,garden ,city ,pub4 ,co41 #aidc74 ,a ,,case ,,from ,,freud ,freud describes the analysis of a girl who has repressed a strong desire for sexual intercourse with her father and has1 as a result1 developed a bizarre pattern of behavior4 ,unconsciously1 the dread of actually making love with him has generalized to a dread of sexual activity of any kind4 ,without any conscious intent on her part1 an association is formed between sexual intercourse and breaking a vase4 ,she is not aware of the unconscious symbolic connection she has established between these acts4 ,similarly1 she begins to associate the bolster at the head of her bed with her father and identifies her mother with the headboard4 ,the pressure of this repressed material impels her to go through an elaborate ritual each night before she can get to sleep4 ,first she arranges the several vases in her room so that she feels they are well protected against being broken 7thereby guarding against sexual intercourse74 ,then she makes sure that the bolster does not come into contact with the headboard 7in this way she gains the substitute satisfaction of keeping her mother and father apart74 ,as her analysis proceeds1 and the analyst is able--and here1 timing is important--to encourage her to become conscious of her repressed feelings and generalized dread of sex1 her need for the nightly ritual is gradually eliminated4 ,it is not difficult to think of other problems1 sometimes of a handicapping kind1 that1 because of their obsessive or compulsive nature1 interfere with normal living4 ,compulsive handwashing is a classical example2 compulsive overeating1 bulimia1 #aag and its opposite1 anorexia nervosa1 as well as nymphomania1 a need for sexual promiscuity1 are a few others4 ,,an ,,example ,,of ,,brief ,,psychoanalysis ,dr4 ,richard ,chase is a psychiatrist who specializes in emotional problems of children4 ,john and ,rachel ,edmonton have come to see him about their twelve-year-old son1 ,bobby1 their only child4 ,john is an evangelical minister in his early forties who travels a great deal1 taking his family with him4 ,when ,bobby was eight years old1 he began to have strange and violent nightmares4 ,he would go to sleep and then apparently awaken about an hour later1 asking for a drink of water or expressing a need to go to the bathroom4 ,a few minutes later1 ,bobby would seem to lose his balance and stumble over furniture1 sometimes running into walls1 crying aloud that he was turning inside out and was dying4 ,often his parents would have to restrain him to keep him from hurting himself4 ,after a few minutes1 the nightmare would end and ,bobby would come out of it1 a terrified1 confused little boy in tears4 ,so far1 ,john and ,rachel1 with their frequent moves1 had not been able to get professional help that had made a difference4 ,bobby had been examined by a neurologist1 and an electroencephalograph test was done to determine if some kind of epileptic disorder might be involved4 ,the test was negative4 ,they had also taken ,bobby to a child psychologist1 who said that ,bobby was bright1 sensitive1 and precocious1 that this kind of nightmare was called a night terror 7pavor nocturnis71 and that the problem would eventually subside4 ,four years passed1 and the night terrors did not4 ,the family of three was becoming battle-scarred4 ,bobby hated to go to bed at night1 fearing the inevitable4 ,his parents1 sometimes patient1 sometimes not1 used whatever ways they could1 even a prescribed sedative for ,bobby1 so he could relax and get to sleep1 to no avail4 ,could ,dr4 ,chase help8 ,dr4 ,chase decided to meet with ,bobby by himself4 ,he found that ,bobby was very willing to talk about his bad dreams4 ,dr4 ,chase asked him to describe what happened each night4 ,oh1 ,doctor1 ,bobby began1 it's really awful4 ,i know it's going to happen1 but ,i can't do anything to stop it4 ,i stay up as late as #aah ,i can1 and ,i will do anything not to go to sleep4 ,but when ,i do1 ,i'll kind of wake up a little later1 and ,i'll see ,mother and ,dad looking very worried4 ,at the same time1 ,i'll see a box1 with white walls1 glowing brightly1 but not in the room where ,mother and ,dad are4 ,it's in some space1 ,i guess it's in my mind1 a black space1 with that white-colored cube just floating there4 ,and then it begins to turn inside out4 ,my stomach feels like it's turning inside out1 and it hurts and scares me4 ,it feels awful4 ,i really think if the cube turned all the way inside out1 ,i'd die4 ,but it never does2 ,i always wake up first4 ,dr4 ,chase began to meet with ,bobby three times a week4 ,he gradually gained his trust4 ,at a session during the third week of treatment1 he asked ,bobby if he would play a word association game with him4 ,,dr4 ,,chase3 ,tell me what you think of when ,i say1 dog4 ,,bobby3 ,cat4 ,,dr4 ,,chase3 ,black4 ,,bobby3 ,white4 ,,dr4 ,,chase3 ,chair4 ,,bobby3 ,cushion4 ,,dr4 ,,chase3 ,box4 ,,bobby3 ,house4 ,,dr4 ,,chase3 ,angry ,,bobby3 ,mad4 ,dr4 ,chase spent about fifteen minutes writing down some of ,bobby's associations4 ,bobby gave back associations in the rapid-fire way ,dr4 ,chase asked1 doing this almost automatically1 leaving no time to deliberate4 ,gradually1 ,dr4 ,chase felt he saw a pattern emerging1 and he was able to confirm this from ,bobby's associations in later sessions4 ,toward the end of the sixth week1 ,dr4 ,chase sketched for ,bobby's parents the interpretation he had developed during ,bobby's short-term experience in psychoanalysis3 ,i believe ,bobby has unconsciously been trying to tell you something in a highly symbolic form3 often the mind expresses deep-seated fears in the imagery of dreams4 ,i've tested ,bobby in a variety of ways4 ,always1 he appears to associate the box in his dream with home or with a house4 ,i'm fairly certain that 'being turned inside out' symbolizes for him the process of moving out of all the houses you have moved away #aai from4 ,a house really is turned inside out when you move3 all of its contents are taken out1 usually in boxes4 ,i believe ,bobby is hurting because of your frequent moves4 ,i think if you will stay in one place1 even though ,i realize that you1 ,john1 would probably have to give up evangelical work1 you will gradually see a real improvement in ,bobby4 ,dr4 ,chase's advice was received with a good deal of disbelief by ,john and ,rachel1 but they did1 eventually1 decide to try it4 ,john became assistant minister at a local church4 ,two years later1 ,dr4 ,chase received the following letter3 ,dear ,dr4 ,chase3 ,maybe you'll remember treating our son1 ,bobby1 for what you called his recurrent night terrors4 ,my wife and ,i followed your advice3 ,we told him we had decided to stay in ,atlanta1 so that he could go to the same high school for all four years4 ,in about two months1 ,bobby's night terrors were down to about one a week4 ,after three months had passed1 the suffering our family has endured for more than five years came to an end4 ,bobby hasn't had another episode since then4 ,he's doing well in school1 has friends1 and seems quite happy4 ,we all are4 ,it's sure a pleasure to be freed from the experience that terrorized us all4 ,bless you1 ,john and ,rachel ,edmonton ,,an ,,analyst ,,looks ,,back ,,at ,,his ,,own ,,psychoanalysis ,psychoanalysis is unique among approaches to counseling and psychotherapy in that it requires analysts1 as a part of their training leading to certification1 to undergo psychoanalysis themselves4 ,not only is this intended to be an educational experience1 but it is considered essential to their competence in later professional practice3 it is important that they be completely aware of what are called countertransference feelings toward patients4 ,just as patients develop toward their therapists feelings they had toward significant persons in the past--called transference--the analysts1 no less human1 do the same4 ,their relationships with their patients can revive some of the analysts' own conflicts4 ,they will be unable to understand the patient clearly1 free from distortions created by their own #abj countertransference tendencies1 unless they have come to understand themselves as thoroughly as it is possible to do so by means of their own psychoanalysis4 ,after undergoing a long and intensive period of personal analysis while in psychoanalytic training1 ,dr4 ,tilmann ,moser referred to his analysis as a successful life-saving operation for my soul4 ,he sought relief from depression1 caused1 he now believes1 by a troubled relationship with his parents4 ,he describes his experience in these terms3 ,psychoanalysis is a piece of the work of conciliation with one's own origins4 ,the important ability to be implacable1 attached to the wrong place in the neurotic unforgivingness toward 444 my parents1 has been freed for aspects of life where it can be used for efforts directed toward social change1 the changing of conditions that cause avoidable suffering to countless human beings4 ,the longtime impassable road of affection toward my parents1 based on humor1 has been re-opened4#b #b ,tilmann ,moser1 ,years of ,apprenticeship on the ,couch3 ,fragments of ,my ,psychoanalysis1 trans4 by ,anselm ,hollo 7,new ,york3 ,urizen ,books1 #aigg71 p4 #ah4 ,,applications ,,of ,,psychoanalysis ,in general1 psychoanalysis is successful in bringing about what are called broad-spectrum improvements4 ,it is less intended for abatement of specific symptoms4 ,in other words1 those with highly specific goals they wish to achieve through therapy tend not to be good candidates for analysis4 ,for example1 a person seeking specific and prompt relief from depression1 public-speaking anxiety1 or shyness may not be appropriate for psychoanalysis4 ,long-term1 intensive psychoanalysis1 because it is long-lasting and very detailed1 can lead to very broad improvements3 a sense of increased satisfaction in daily living2 a stronger1 more positive sense of self-esteem2 a greater capacity to enjoy and be at ease with others4 ,in the process1 specific symptoms often do subside or disappear1 but the focus is general1 and the patient must be willing to embrace a commitment to general improvement4 ,on the other hand1 brief psychoanalysis may begin by focusing on specific problems experienced by a patient1 but treatment quickly widens in scope to touch on matters that affect the #aba patient's life in a general way4 ,we saw this in ,bobby's case1 where recurrent night terrors revealed his general need for the greater emotional stability that comes from feeling settled1 having friends1 etc4 ,psychoanalysis is best suited to problems that fall into two categories3 99 ,problems that are clearly neurotic in nature3 they interfere with living to some degree but do not totally impair you so that your life is clearly out of control1 as in cases involving psychoses 7where you are no longer able to distinguish reality from fantasies and hallucinations71 alcoholism1 or drug addiction 99 ,problems that involve sexual difficulties1 mood disturbances1 and impairment of personal relations1 assuming that you are willing to work on these problems within the wider focus that analysis usually requires ,psychoanalysis is not generally considered to be the treatment of choice for severe impairments1 such as alcoholism1 drug abuse1 and psychotic disturbances1 when your life is clearly out of control4 ,analysis is also not generally an appropriate form of treatment for immediate problems arising from sudden environmental changes1 such as the loss of a job1 or loneliness after a transfer to a new job location1 or after a divorce or separation4 ,in some instances1 if problems of this kind are not resolved after a reasonable adjustment period1 analysis might then be considered4 ,other approaches to therapy lend themselves better to specific and immediate adjustment problems1 as we will see4 ,we have been describing the appropriateness of psychoanalysis for the treatment of certain kinds of problems1 but there is an equally important1 and frequently overlooked1 question3 whether psychoanalysis is appropriate for the kind of person you are4 ,psychoanalysis is best suited to individuals with these characteristics3 99 ,they are verbally articulate4 99 ,they have a sense of curiosity about themselves4 99 ,they have a good reflective capacity and an interest in achieving insight through a careful analysis of their thoughts1 feelings1 behavior1 and past history4 #abb 99 ,they are comparatively unimpaired in their abilities to form relationships4 99 ,they are able to tolerate the frustration1 and endure the pain1 of re-experiencing disturbing feelings and memories4 99 ,they are willing to be patient through a potentially long period in treatment and can sustain a commitment to that process4 #abc #aj ,,psychotherapy1 ,,part ,i ,client-,centered ,therapy1 ,gestalt ,therapy1 ,transactional ,analysis1 ,rational-,emotive ,therapy1 and ,existential-,humanistic ,therapy ,the approaches to therapy we will look at in this chapter are called humanistic therapies4 ,they include client-centered therapy1 ,gestalt therapy1 transactional analysis 7or ,,ta71 cognitive therapy1 and existential 7or existential-humanistic7 psychotherapy4 ,these approaches share the view that an effective therapist must be able to become conscious of the world as it is for the client4 ,doing this requires the therapist to have a heightened sensitivity to others1 feel a fundamental measure of respect for them1 and ideally be able to adjust to their very individual needs and concerns4 ,all of the therapies we will examine in this chapter place priority on the client's subjective feelings and experiences4 #abd ,,client-,,centered ,,therapy ,for people who have not developed a sense of personal worth2 who are in need of acceptance1 human warmth1 and gentle encouragement2 and who have the initiative to proceed both in therapy and outside of therapy without explicit direction from the therapist4 ,the development of client-centered1 or nondirective1 therapy has largely been the work of ,carl ,rogers 7#aijb-aihg74 ,his clinical experience as a child psychologist and his later work in training students in therapy led him to believe that people frequently come to have personal problems as a result of the conditional love of their parents4 ,to receive love and approval from their parents1 children must satisfy certain conditions of worth the parents lay down4 ,if the children do not live up to the parents' demands1 they are punished by the withdrawal of the parents' affection--a far more serious and emotionally scarring punishment than a physical spanking4 ,raised in this way1 people later in life will tend to link their self-worth to internalized parental standards4 ,rogers observed that the more the love expressed by parents is conditional in this sense1 the more it is likely that a person will experience emotional difficulties later on4 ,as a result1 ,rogers gradually developed an approach to therapy that emphasizes unconditional positive regard4 ,ideally1 a client-centered therapist is able to express a sense of complete acceptance and respect toward the client4 ,the therapist does not associate positive regard with implicit conditions of worth that the client must satisfy4 ,in other words1 client-centered therapy attempts gradually to reverse a habit that has come to undermine the client's sense of self-worth4 ,it is a habit that we all1 to differing degrees1 develop as parents and society teach us to relinquish self-acceptance in favor of the conditional love or appreciation of others4 ,eventually1 the habit becomes so ingrained that it can jeopardize our own feelings of self-esteem4 ,client-centered therapy encourages a client to grow in several ways3 #abe #a4 by feeling comfortable enough in the company of the therapist to express feelings freely and openly #b4 by coming to recognize his own feelings of incongruence1 of being divided against himself1 often due to experiences that have encouraged a negative or insecure sense of self-worth #c4 by perceiving that the therapist is an integrated1 accepting person1 able to convey acceptance and warmth toward the client #d4 by reintegrating a sense of self1 freeing himself from the distortions of self-worth brought about by love that has strings attached ,,an ,,example ,melissa ,adams is twenty-eight years old1 the district manager of a large pharmaceuticals marketing division in the ,midwest4 ,she is slender1 immaculately dressed1 and--as ,dr4 ,feldman could see immediately--rigid and very uptight about herself4 ,melissa came to see ,dr4 ,feldman1 a clinical psychologist1 because of a growing sense of estrangement toward her husband and tension and anxiety at work4 ,she described her upbringing in an extremely rigid1 judgmental atmosphere in which her self-worth was implicitly tied to her parents' conditions of achievement4 ,she was apparently encouraged by her parents1 who realized ,melissa was a bright child1 to skip a grade and then to complete her undergraduate work in three years by attending summer school each summer4 ,her parents were very proud of her4 ,she admitted to having had little fun and would turn a vacation into an opportunity for achievement4 ,she frequently could not enjoy television or the movies because it felt frivolous4 ,she was free from self-doubts only when hard at work1 so she worked virtually all the time4 ,her husband wanted a family1 but ,melissa believed that children would be an undesirable interruption and distraction4 ,melissa quickly lost her fear of the weekly meetings with ,dr4 ,feldman4 ,she was able to relax in his company4 ,she felt that he cared about her as a person1 whether she achieved or did not4 ,he would not make active1 directive suggestions1 but rather listened #abf to her in a genuine1 positive way4 ,during one session1 ,melissa asked him if he would give her some straight advice about her relationship with her husband4 ,dr4 ,feldman declined4 ,he felt that telling another person what to do did not show respect for that person's individuality4 ,he could see that ,melissa was intelligent4 ,he believed that she could trust her own decision-making abilities1 and he would encourage her to believe in herself4 ,over a period of a little more than a year1 with weekly visits1 ,melissa's personality began to soften4 ,she dressed more casually4 ,she was more relaxed4 ,she was beginning to enjoy herself more1 although occasionally the old self-doubts would come back to assail her4 ,but she usually was able to fend them off4 ,her marriage was improving1 she looked forward to a real vacation in the near future1 and she was not closed to discussing the possibility of children with her husband1 although they had not yet made a decision on that issue4 ,,applications ,,of ,,client-,,centered ,,therapy ,client-centered therapy focuses especially on difficulties that stem from a client's negative feelings of self-worth4 ,client-centered therapy may be the therapy of choice especially for individuals who feel anxiety1 uncertainty1 and pain because of a low sense of self-esteem4 ,a client-centered therapist can be expected to value personal genuineness1 integrity1 and honesty4 ,the approach can be helpful to persons who suffer from loneliness and isolation4 ,client-centered therapy is most effective for individuals with these characteristics3 99 ,they are able to exercise initiative1 both in expressing their difficulties to the therapist and in attempting to make desired changes4 ,most client-centered therapists will refrain from giving direction4 99 ,they are interested primarily in personal growth rather than the removal of specific symptoms4 99 ,they are blocked1 inhibited1 or rigid because they are too self-critical4 99 ,they are not severely impaired in their abilities to relate to others4 #abg ,,gestalt ,,therapy ,for very rigid people who are always trying to be someone they are not1 who will commit themselves to a challenging and usually frustrating process of growth leading to personal integration and genuineness4 ,,gestalt ,,psychology ,gestalt therapy has its roots in ,gestalt psychology1 which was established early in this century by the ,german psychologists ,wolfgang ,khler 7#ahhg-aifg71 ,kurt ,koffka 7#ahhf-aida71 and ,max ,wertheimer 7#ahhj-aidc74 ,the main contribution of ,gestalt psychology consisted of studies of human perception4 ,gestalt psychologists demonstrated that perception reveals the existence of organized wholes that cannot be reduced to the sum of their parts4 ,they called such an organized totality a ,gestalt4 7,outside of psychology1 ,gestalt in ,german means form47 ,a famous example1 shown below1 demonstrates how an object that you see can be closely linked to its background4 ,here1 the figure and the ground can oscillate1 depending on whether you concentrate on the faces or the vase4 ,the figure depends on its background for its identity1 and vice versa4 ,illustration3 ,a famous illustration of a white vase set between the black silhouettes of two faces in profile2 at one moment you perceive the vase1 at another you see the two faces #abh ,,gestalt ,,therapy ,frederick 7,fritz7 ,perls 7#ahic-aigj7 brought together certain of the basic concepts of ,gestalt psychology1 psychoanalysis1 and psychodrama1 an approach to therapy developed by ,j4 ,l4 ,moreno 7#ahhi-aigd7 that emphasizes role-playing1 acting out of fantasies1 and group interaction4 ,perls transformed the ,gestalt psychologists' central idea so it would serve as a basis for his approach to psychotherapy4 ,let's look at an example4 ,a man has been stranded in the desert and has become severely dehydrated4 ,he has wandered for several days in search of water4 ,he stumbles along1 nearly blinded by the sun1 seeing only vaguely defined shapes of rocks and cacti4 ,suddenly1 out of this hazy world1 something becomes clearly defined3 he sees a watering hole1 surrounded by low bushes4 ,it is clearly etched in his eyes1 set against the indistinct background of the hot desert4 ,once he has plunged his head into the water and quenched his thirst1 his ,gestalt is closed3 the need that caused him to struggle for days has performed its purpose4 ,in this derivative sense1 ,gestalt means a problem 7figure7 that arises out of a situation 7background7 which motivates an individual to action4 ,if his action is successful1 his ,gestalt is closed3 the problem is resolved1 and the motivation is fulfilled4 ,like the ,gestalt of the psychologists1 the closed ,gestalt of therapy signifies an organized whole4 ,in the example1 the man suffering from thirst in the desert has a ,gestalt that impels him to find water4 ,when he does1 his thirst is satisfied1 and the ,gestalt is resolved into a whole that no longer stands in need of completion4 ,perls saw life as a succession of unfinished situations1 incomplete ,gestalts4 ,no sooner is one closed than another takes its place4 ,to cope effectively with living1 we must be able to deal with life's problems and challenges1 yet not all of us can4 ,perls used the term growth disorders to refer to what other therapists might call personality disorders or neuroses4 ,he believed that emotional problems result from getting stuck in the natural process of growth4 ,people get stuck in childish patterns of dependency because of a variety of childhood experiences4 ,for example1 a mother and father may withdraw the support of a stable environment1 while a child relies on this for a sense of security4 7,the example of ,bobby in the chapter on #abi psychoanalysis may come to mind47 ,or1 parents may force a child to accept adult responsibilities prematurely4 ,it is as if a child were asked to walk before his sense of balance and leg strength had developed sufficiently4 ,the child will learn uncertainty2 his natural early fear of falling becomes pronounced and will leave a mark that can stand in his way later4 ,perls called such experiences impasses1 and they form blocks to a person's growth4 ,for ,perls1 human personality is like a multilayered onion3 ,from the most superficial1 outside layer1 moving inward1 there is the usually insincere clich layer 7,how are you81 asked without real interest71 the role-playing layer 7the habitual masks of father1 mother1 businessperson1 homemaker1 therapist1 client71 the impasse layer 7the person stripped of clichs and masks1 often very frightening71 the implosive layer 7where emotions are either vented or explode inward71 and the innermost layer1 which makes up the genuine personality as it is1 freed from learned pretensions4 ,the goal of ,gestalt therapy is to reach this last layer4 ,in a word1 ,gestalt therapy seeks to encourage the growth of authenticity--a combination of a balanced sense of reality1 of inner integration complemented by its outward expression1 personal integrity1 and of independence from the need for the approval of others4 ,in ,gestalt therapy1 self-change seems paradoxical4 ,as long as inner conflicts continue1 you try not to be the person you are2 you cannot be genuine and are divided against yourself4 ,change1 the ,gestalt therapist claims1 is possible only when you give up1 at least for a time1 trying not to be the person you are4 ,there must be a firm place to stand from which to initiate change1 and that place can only be the person you are right now4 ,,what ,,gestalt ,,therapy ,,is ,,like ,gestalt therapy as it was developed by ,perls is individual therapy done in a group setting4 ,gestalt therapists since ,perls most commonly continue to practice therapy this way3 individual members of a group are asked to volunteer to take the hot seat2 the volunteer then becomes the focus of attention4 ,this is not group therapy where relationships among members of the group are most important 7see ,chapter #ac74 ,in ,gestalt therapy1 emphasis is on the individual1 who is pushed to drop his or her masks and pretensions4 ,other members of the group form an #acj audience and try to learn by example until it is time to occupy the hot seat themselves4 ,perls would ask for someone in the group to sit in a chair1 facing him and the audience4 ,then ,perls would launch an attack on the client's defenses4 ,at times1 he could be almost merciless4 ,he did not believe in mothering clients2 this served only to keep their defenses intact4 ,perls would notice nonverbal clues to the client's feelings4 ,if the client was an inhibited woman1 he would comment about her thighs1 which were pressed firmly together4 ,if the client was shy1 he would remark about how the client held one hand in the other3 ,did he feel a need to have his hand held by ,mother8 ,if the client burst into tears1 ,perls would make no attempt to stop the tears with reassurance but would try to make the client aware of his motivation in crying3 ,was it to elicit pity8 ,were the tears a way of hiding from self-responsibility8 ,were the tears another mask1 standing in the way of self-acceptance1 authenticity1 and growth8 ,the objective of ,gestalt therapists is to tear away clients' defensive masks and roles that usually keep them from real1 sometimes painful or frightening1 feelings4 ,in this1 the therapists' main technique is to frustrate the clients' attempts to hide behind their masks and roles and to block their attempts to control their therapist4 ,clients often do this by trying to make the therapist feel sorry for them1 give them parental warmth1 respond to their inadequacies1 and so on4 ,instead1 ,gestalt therapy is comparatively tough4 ,perls used these instructions in beginning a workshop3 ,so if you want to go crazy1 commit suicide1 improve1 get turned-on1 or get an experience that will change your life1 it's up to you4 ,i do my thing and you do your thing4 ,anybody who does not want to take responsibility for this1 please do not attend this session4 ,you come here out of your own free will4 ,i don't know how grown up you are1 but the essence of a grown-up person is to be able to take responsibility for himself--his thoughts1 feelings1 and so on4 ,any objections8 444 ,o4,k4#a #a ,frederick ,perls1 ,gestalt ,therapy ,verbatim 7,lafayette ,,ca3 ,real ,people ,press1 #aifi71 p4 #gi4 #aca ,by refusing to give unnecessary emotional support even when clients cry for it1 ,gestalt therapists convey through their behavior that clients do have what it takes to stand on their own two feet4 ,ideally1 ,gestalt therapists are genuine1 mature people2 they refrain from interfering in the lives of others and expect them to be self-supporting4 ,they try to impress on their clients that they do not exist to live up to the expectations of others1 nor do others exist to live up to theirs4 ,,applications ,,of ,,gestalt ,,therapy ,gestalt therapy is most effective in treating persons with these characteristics3 99 ,they tend to be very rigid--restrained1 overcontrolled1 perfectionist--or depressed1 or phobic4 ,that is1 they have certain well-defined fears2 for example1 fear of public speaking1 of insects1 of sexual intercourse4 99 ,they have become stultified in their relations with others and have pent-up feelings in need of release4 99 ,they obtain little joy or satisfaction from living2 their lives lack emotional intensity4 99 ,they are not excessively frightened by group activity4 ,specific conditions ,gestalt therapy often treats include these3 99 psychosomatic disorders1 such as stomach pain1 colitis1 back and neck spasms1 and migraines 99 behavior problems in children 99 difficulties in coping with persons in authority 99 shyness and passivity 99 emotional difficulties arising from poverty and from the deprivations suffered by minority groups 99 rigid1 conflict-torn family situations 99 crisis intervention3 treating individuals in despair who have lost the will to live or are suicidal ,gestalt therapy is not generally the treatment of choice for people whose lives are out of control or who show signs of psychosis4 ,gestalt therapy relies on your capacity to make your #acb own practical life decisions1 to tolerate the stress and frustration of being in the hot seat1 and to benefit from being challenged by the therapist to confront your own pretenses1 distortions1 and confusions4 ,people who have lost these capacities for the time being due to problems such as alcoholism1 drugs1 and loss of touch with reality tend not to benefit from ,gestalt techniques4 ,,transactional ,,analysis ,for less troubled people who want to improve the effectiveness of their communication skills and break free from frustrating1 self-destructive patterns4 ,transactional analysis has perhaps done more than any of the other main approaches to therapy to increase the sensitivity of the public to the psychological dimensions of human relationships4 ,it has achieved widespread popularity in a short time largely because of its simple1 commonsense vocabulary that is easy to apply to personal1 family1 and group situations4 ,eric ,berne 7#aiaj-aigj7 completed his medical training in #aice1 then finished his psychiatric residency at ,yale in #aida4 ,he soon separated himself from psychoanalysis and began to formulate his theory of transactional analysis 7,,ta74 ,by the mid-sixties1 ,,ta was gaining in popularity3 ,berne wrote his book1 ,games ,people ,play1 primarily for professionals1 but it became a best-seller filling a need for an easy-to-understand and easy-to-apply approach to therapy4 ,,ta is based on the premise that human personality has three parts3 ,berne called them the ,parent1 ,adult1 and ,child4 ,although similar in meaning to ,freud's superego1 ego1 and id1 ,berne's terms were intended to name dimensions of personality that could be observed directly2 his three ego states are not theoretical constructs4 ,the ,child ego state is the source of fun1 humor1 creativity1 wishful thinking1 and irresponsibility4 ,it is impulsive and resists control4 ,the ,parent ego state is the repository of values1 attitudes1 and expectations inherited from one's parents4 ,shoulds1 oughts1 #acc hands-on-hips1 and finger-wagging gestures are common expressions of the ,parent4 ,the ,adult ego state is the source of reason1 logic1 and unemotional evaluation4 ,it forms the basis for decision making and predicting outcomes4 ,only one ego state can be in control of our emotions or behavior at a time4 ,berne observed that many emotional difficulties in individual clients result from problems involving their ego states4 ,some personality problems come about because a person cannot separate his or her ego states and switches from one to another erratically and uncontrollably4 ,for example1 a young mother begins--in a calm rational way--to describe the behavior of her nine-year-old son4 ,she talks about his impertinent and disrespectful behavior1 and1 as she does1 she becomes enraged1 her face turns beet-red1 and she yells at her therapist that someday she is going to give her boy a beating he'll never forget6 ,transactional analysis would try to show her that she tends to slip from her reasonable ,adult state to the state of an angry ,parent who demands complete respect and subservience4 ,berne called this structural problem of the personality confusion4 ,illustration3 ,,personalities3 ,normal ,personality1 ,confused1 ,excluded1 ,contaminated ,exclusion is another structural problem4 ,an individual rigidly adheres to one ego state1 locking out the other two4 ,a ,don ,juan gives free expression to his ,child1 while his ,adult and ,parent states are suppressed4 ,a workaholic1 on the other hand1 permits #acd his ,parent to block the expression of his ,adult and ,child ego states4 ,contamination is a third personality problem4 ,one ego state subverts another4 ,a woman cannot commit herself fully to her chosen profession because her ,child has undermined her sense of determination by persuading her that a wealthy knight in white armor will soon appear to relieve her of the need to exert herself4 ,,what ,,transactional ,,analysis ,,is ,,like ,transactional analysis normally begins with structural analysis in which clients are taught how to distinguish ego states that may be confused1 excluded1 or contaminated4 ,this phase of therapy is sometimes done on an individual basis and sometimes in a group workshop or classroom environment4 ,therapy then proceeds to transactional analysis proper1 in which frustrating or painful forms of communication and unsatisfying life directions are discussed4 ,most commonly this is done in a group setting1 since a group encourages a variety of different styles of communication4 ,,ta teaches clients to determine which ego state is active at a given moment--in themselves and in others with whom they are trying to communicate4 ,transactions or communication patterns between people are the focus of ,,ta4 ,some typical transactions are diagrammed on the facing page4 ,in 7a7 on the facing page1 person #a communicates in an ,adult mode and receives an ,adult response from person #b3 ,where are you going8 ,to the cleaner's4 ,in 7b71 a ,parental boss receives a petulant response from the ,child ego state of an employee3 ,what took you so long8 ,my little boy is sick1 and there's just too much work for one secretary4 ,in 7c71 an ,adult-to-,adult message receives a ,child-to-,parent reply2 this is an example of crossed transaction4 ,it is one of the most common sources of frustration and conflict in family and professional life4 ,for example1 a therapist says1 ,you seem to be late for your appointment today4 7,adult-to-,adult1 or ,a-,a47 ,the client replies1 ,you're just like my father1 always picking on me4 7,c-,p47 #ace ,illustration3 ,,diagrams ,,of ,,typical ,,transactions #acf ,diagram 7d7 illustrates communication that involves an ulterior message4 ,for example1 a psychologically clever salesman is showing hair driers to a woman4 ,she tells him how much she is prepared to spend and then asks1 ,how much is that one8 ,the salesman 7arrow #a in the diagram7 replies3 ,you wouldn't be able to afford that model4 ,his response is based on his customer's stated budget limitations and appears to be ,adult-to-,adult4 ,however1 the hidden message 7dotted arrow #a7 is directed to his customer's ,child state1 which1 as he predicts1 causes her to reply rebelliously 7arrow #b71 ,that's the one ,i want4 ,in 7e71 another example of this class of communications that are not what they appear to be1 there are two ulterior transactions4 ,a secretary returns a few minutes late from lunch4 ,her boss asks1 apparently ,adult-to-,adult 7arrow #a71 ,what time is it8 ,they both know what the hidden message is4 ,the secretary answers sharply 7arrow #b73 ,it's #a3ae4 ,the ulterior message from the boss is ,are you late again8 7,p-,c3 arrow #a47 ,the secretary's covert or hidden reply is ,get off my back3 you're always criticizing4 7,c-,p3 arrow #b47 ,the central objective of ,,ta1 then1 is to make clients aware of these and other patterns or games that their habitual ways of communicating reveal4 ,by doing this1 clients find that communication becomes less problematic and more effective as they learn to control their responses4 ,,an ,,example ,joyce was forty-one when she decided to take her seventeen-year-old only son1 ,joe1 to see ,dr4 ,goldstein1 a transactional analyst4 ,for about five years1 ever since his father died1 ,joe and his mother had quarreled a great deal4 ,dr4 ,goldstein met with ,joyce1 then with her son1 and then with them both4 ,after he listened to their complaints about one another1 he agreed to try to help4 ,for six weeks1 ,joe and his mother met once a week with ,dr4 ,goldstein as ,,ta students4 ,they were to put family problems on a back burner2 their energy was devoted to learning to apply the concepts of transactional analysis4 ,dr4 ,goldstein had them #acg analyze many examples of communication4 ,during a second six-week period1 ,joyce and her son were coached to learn to talk to one another more effectively4 ,here are some samples of their automatic patterns of response before they began to use ,,ta3 ,,son3 ,the soup's too salty4 7,a-,a or ,c-,p7 ,,mother3 ,i don't know why ,i work so hard6 ,all you do is complain6 ,i'm just not appreciated6 7,c-,p7 ,,son3 ,mom1 here's the sports jacket ,i bought for graduation4 7,a-,a7 ,,mother3 ,you can't go in that6 ,we're taking that jacket back4 ,i can't trust you to buy clothes for yourself4 ,let's go6 7,p-,c7 ,,mother3 ,we're going to dinner tonight at ,esther and ,gary's4 ,get out of those jeans2 we have to leave in fifteen minutes4 7,p-,c7 ,,son3 ,but ,mom1 ,i told you last ,wednesday that ,fred and ,i are going camping this weekend4 ,we're leaving in ,fred's car in just an hour4 7,a-,a or ,c-,p7 ,,mother3 ,i don't remember anything like that4 ,esther and ,gary are expecting us4 ,you're always wrecking our plans6 7,c-,p7 ,,mother3 ,mmm1 isn't this the most delicious souffl you've ever tasted8 7,c-,p7 ,,son3 ,that's it1 compliment yourself6 7,c-,p7 ,,mother3 ,well1 if ,i don't1 no one else will6 ,you don't know how lucky you are1 having a mother who really knows how to cook4 7,c-,p7 ,,son3 ,i sure hope ,i don't learn how to be modest from you6 7,c-,p7 ,the problems weren't hard for ,dr4 ,goldstein to spot3 ,joyce had low self-esteem1 was easily hurt1 and1 when she was1 put her son down 7the salty soup74 ,she wanted to be indispensable to him and was unwilling to let him grow up 7the sports jacket74 ,she had little respect for ,joe's plans1 especially if they interfered with her desires 7,joe's camping trip74 ,she felt unappreciated and had grown to be resentful of her role as mother 7the souffl74 ,joe1 on the other hand1 was feeling the natural rebelliousness #ach of a seventeen-year-old4 ,he needed some free rein1 even if he made some mistakes4 ,his mother was always getting in his hair or getting under his skin4 ,the sample transactions above led each of them to anger and hurt4 ,seldom did ,dr4 ,goldstein see ,joe and his mother communicate ,adult-to-,adult4 ,instead1 their transactions crossed and re-crossed1 and resentments piled up4 ,joyce saw ,dr4 ,goldstein without ,joe present for several weeks4 ,she learned from ,dr4 ,goldstein that her expectations toward her son were inappropriate2 she needed to strengthen her sense of self-worth outside of her family role4 ,she was excessively dependent on her son for recognition and appreciation4 ,especially since her husband died1 she was easily hurt when her desires for appreciation were not satisfied by ,joe1 so she put him down4 ,what she needed to do was to strengthen her ,adult and weaken the domination of her self-pitying ,child and overcritical ,parent ego states4 ,dr4 ,goldstein then met with ,joe for several sessions4 ,joe began to see his mother in a different light4 ,dr4 ,goldstein made him aware of his mother's sadness in being left alone and of her needs to feel worthwhile4 ,during the joint sessions that followed1 ,dr4 ,goldstein typically would ask them to recall recent conversations or exchanges that had been unpleasant4 ,he would ask them to analyze these in ,,ta terms and then would push mother and son to imagine more appropriate and less uptight ways of responding4 ,after several months of joint therapy1 their former pattern of transactions began to look very different3 ,,son3 ,mom1 there's too much mustard on the ham4 7,a-,a or ,c-,p7 ,,mother3 ,well1 then it's ,,ok with me if you want to scrape some off4 7,a-,a or ,p-,c7 ,,son3 ,how do you like my new tie8 7,a-,a7 ,,mother3 ,i'd need a lot of courage to wear it myself1 but ,i'm not you6 7,a-,a or ,c-,c7 ,,son3 ,mom1 your roast is delicious4 ,it's great to have a mother who's a good cook6 7,a-,a7 ,,mother3 ,thanks1 ,joe4 ,i guess now ,i've learned that you really hate souffl6 7,a-,a7 #aci ,,applications ,,of ,,transactional ,,analysis ,,ta has been used in individual and group therapy1 in nonclinical settings to help business executives improve communication skills1 and also in prisons4 ,it has been used to treat a wide range of problems1 including these3 99 personality trait problems3 e4g41 shy1 lonely1 depressed1 overbearing1 or hostile individuals 99 troubled relationships in couples and families 99 fears of withdrawal of affection and of abandonment 99 drug abuse 99 phobias 99 difficulties in relating to authority figures1 such as a boss1 a teacher1 a parent 99 adaptation problems in individuals with counterculture attitudes and values ,few controlled evaluative studies have been done to determine how effective ,,ta really is4 ,at this time1 and in this author's judgment1 ,,ta is most useful as an educational therapy to assist less severely troubled individuals with communication problems by helping them sharpen their perceptions of their own ego states and the ego states of others4 ,,ta is most effective for clients who are able to exercise responsibility for themselves4 ,,ta appears to be especially useful in helping individuals who are caught in frustrating relationships to break free from self-destructive patterns or games4 ,,cognitive ,,therapy3 ,,rational-,,emotive ,,therapy ,for people who tend to think and judge in very rigid ways1 who are frequently intense and uptight1 and who tend to magnify and exaggerate evils4 ,man is not disturbed by events1 but by the view he takes of them4 ,epictetus1 ,enchiridion #adj ,it is absolutely essential to you to be loved by members of your family and to be appreciated by your friends and employer4 ,you must be consistently competent and nearly perfect in all your endeavors4 ,some people are really bad1 their actions should be restricted1 and they should be punished when they do wrong4 ,it is terrible when things are not the way you would like them to be4 ,events outside your control are largely responsible for how you feel4 ,you should be anxious in relation to what is uncertain1 unknown1 or potentially dangerous4 ,it is much easier to avoid problems than to face life's difficulties and responsibilities4 ,it is necessary to have something greater or stronger than yourself to rely on4 ,the present is largely determined by past events4 ,happiness comes when one has complete leisure4 ,if you don't work hard to please others1 they will abandon you4 ,if people don't approve of you1 you ought to question your self-worth4 ,by telling ourselves things like these1 we create our own unhappiness1 frustration1 and anger2 that is the point of view of cognitive therapy4 ,during the #aiejs1 ,albert ,ellis 7#aiac-bjjg7 developed a theory of personality that claims that people are largely responsible for their emotional reactions4 ,they tell themselves that things ought to be different1 that people should do certain things1 and that what they desire they must have4 ,life1 for people whose thoughts are filled with shoulds1 oughts1 and musts1 is full of disappointment1 annoyance1 and hurt4 ,ellis observed that1 as time goes by1 we tend to reinforce an emotional pattern that amplifies our sensitivities more and more4 ,the emotional reactions we create in ourselves become more exaggerated1 distorted1 and self-destructive4 #ada ,but1 like any habits1 these mental 7or cognitive7 habits can be broken4 ,cognitive therapy attempts to do this4 ,ellis called his own approach rational-emotive therapy4 ,by this1 he acknowledged that people have both rational and emotional dimensions4 ,their emotions and thoughts 7cognitions7 are so thoroughly intertwined that they cannot be clearly separated4 ,yet mental evaluations and ideas are given so much power that cognitive habits are responsible for emotional responses4 ,it is thinking that makes it so4 ,rational-emotive therapy is the most widespread approach to cognitive therapy1 so we will examine ,ellis's approach in some detail4 ,the main technique of rational-emotive therapy1 and of cognitive therapy in general1 is to focus clients' attention on their belief systems1 their views about what should and ought to be1 their cognitive filters through which they interpret1 in a semiautomatic way1 the world around them4 ,if the activating event is a failure or a rejection1 for example1 a client's rational belief system will lead to feelings of regret1 sorrow1 disappointment1 or annoyance2 if an individual's beliefs are irrational1 on the other hand1 he or she may instead feel depression1 worthlessness1 futility1 and severe anxiety4 ,for rational-emotive therapy1 emotional good health depends on the rationality of the way a person receives and interprets events4 ,,what ,,rational-,,emotive ,,therapy ,,is ,,like ,therapy usually begins with individual sessions4 ,once clients have learned how to identify mental habits that create disturbing emotions1 therapy is sometimes continued in groups1 where new attitudes and forms of behavior can be practiced in a kind of microcosm of the larger world4 ,rational-emotive therapy that is done in a group context is not1 however1 group therapy1 since the therapist's focus is on individual styles of thinking1 not on relationships among members of the group4 ,during therapy1 clients are very quickly challenged to give evidence for their irrational beliefs4 ,the rational-emotive therapist will openly and ruthlessly oppose the foolish absolutes that clients express and make it clear how they are upsetting themselves emotionally by insisting on such nonsense4 ,it is not considered essential that the therapist be a kind1 warm1 #adb supportive person4 ,in fact1 rational-emotive therapy encourages therapists to show their impatience with irrational beliefs that cannot be defended empirically or logically4 ,once clients are shown that many of their beliefs cause them misery and disappointment1 they are asked to dispute--silently1 in their own minds--their irrational beliefs whenever they find the old habits taking over4 ,it takes time to extinguish old habits2 it doesn't happen overnight4 ,clients need patience and tenacity to oppose their old reflexes and replace them with rational1 realistic beliefs4 ,an hour a week in rational-emotive therapy is really1 then1 like a tutorial session with a teacher4 ,the client-students talk about their feelings2 the therapist criticizes underlying irrational beliefs and makes it clear to the clients what a rational response would be4 ,then the clients are asked to practice applying rational beliefs on their own1 outside of therapy4 ,gradually1 a more rational way of looking at things takes the place of the old habits4 ,,an ,,example ,joan ,hendley is single1 twenty-nine years old1 and assistant manager of a bank4 ,she has come to ,dr4 ,kovac because of chronic depression1 a sense of low self-worth1 and feelings of insecurity and anxiety4 ,lately1 she has begun to drink heavily and regularly feels the need to use sleeping tablets4 ,the following is a sample of their dialogue during their first session of rational-emotive therapy3 ,,dr4 ,k43 ,well1 what would you like to start on8 ,,joan3 ,it's hard to put it into words4 ,i guess it's that ,i've been depressed a lot1 about everything4 ,i feel like there's no purpose to my life4 ,i don't know where to go or how to decide4 ,,dr4 ,k43 ,so1 right now you don't know where you're headed4 ,what's so terrible about that8 ,it would be nice if you knew1 but you don't4 ,is that awful8 ,,joan3 ,yes1 it is6 ,everybody should have a purpose6 ,,dr4 ,k43 ,why should they8 ,most people go through life without much of a sense of purpose4 ,,joan3 ,well1 that's what ,i believe in4 ,,dr4 ,k43 ,look1 ,joan1 you appear to me to be an intelligent person4 ,you and ,i can agree that it would be more satisfying for you to have a sense of direction1 but you take this #adc one more step1 and it's a very big step6 ,you think it's terrible that you don't feel there's a purpose to your life right now4 ,you think you should have a purpose1 and ,i suspect you're punishing yourself because you don't live up to that should4 ,,joan3 ,but most people believe in things like that4 ,,dr4 ,k43 ,and a lot of them end up feeling miserable6 ,i know3 ,i've seen dozens of people sitting where you are1 and their thinking is chock-full of oughts1 shoulds1 and musts4 ,and that's what makes them feel upset4 ,they feel much better when they can come to say to themselves1 ,it would be nicer1 or more pleasant1 or better if things were different4 ,,joan3 ,you mean1 if ,i can get rid of shoulds and musts in my thinking1 ,i'd feel better8 ,,dr4 ,k43 ,that's exactly what ,i'm saying4 ,if you were to follow what ,i've told you1 you'd seldom be upset again1 and probably never enough to get yourself really depressed4 ,,joan3 ,uh-huh4 ,i'm not sure ,i really see how that can be4 ,i feel pretty stupid4 ,,dr4 ,k43 ,so here you go again6 ,you think of yourself as a pretty bright person1 and so you say to yourself1 ,i ought to be able to catch on to anything pretty fast4 ,and now here you are1 and you're not all that sure you've followed everything already1 and so you tell yourself1 ,oh my1 ,i must be stupid4 ,,joan3 ,nods appreciatively1 laughs4 ,,dr4 ,k43 ,you don't have to upset yourself4 ,you can choose what you tell yourself1 and then you'll have control over what you feel4 ,tell me about your job4 ,you're in the role of a leader1 aren't you8 ,,joan3 ,yes4 ,,dr4 ,k43 ,but you don't think you're doing a great job8 ,,joan3 ,no1 ,i don't4 ,,dr4 ,k43 ,but they think you're doing ,,ok1 isn't that correct8 ,,joan3 ,yes1 but my job seems to be taking more and more out of me4 ,begins to cry4 ,,dr4 ,k43 ,well1 it seems like you're doing your job ,,ok2 it's just that you1 from your point of view1 aren't perfect6 ,so therefore it's all just empty pretense3 you're just faking it6 ,but1 if you'll give up your nutty perfectionism1 you'd be in the clear1 because you're obviously satisfying people at work2 you're satisfying their expectations4 ,but since you feel bad about yourself1 you say to yourself1 ,well1 they just haven't found me out6 ,when #add they do1 ,i'm in for it4 ,and so you live in a state of fear4 ,,joan3 ,that's it4 ,,dr4 ,k43 ,it's all because of your unreasonable expectations4 ,can you see that8 ,,joan3 ,at least temporarily convinced4 ,yes1 ,i think ,i can6 ,,dr4 ,k43 ,this is what ,i'd like to work on with you4 ,it's going to take some self-discipline on your part1 but together we can help you get rid of some mental habits that bring you unhappiness4 ,they don't serve a useful purpose1 and they drag you down4 ,why don't you tell me more specifically what upsets you at work8 ,,applications ,,of ,,rational-,,emotive ,,therapy ,although rational-emotive therapy has been used to treat many different kinds of problems1 ,ellis admits that his approach is most effective for the treatment of clients with a single major symptom or clients who are only moderately disturbed4 ,in addition1 ,ellis does advocate rational-emotive therapy for individuals whose patterns of irrational thought are severe1 but for such individuals--when they can be helped--therapy is a long-term process4 ,from evaluative studies completed so far1 it appears that rational-emotive therapy is especially effective in reducing anxieties resulting from such things as public speaking1 relating to others on an individual basis1 and facing old age4 ,other specific applications of rational-emotive therapy include these3 99 problems of maladjustment1 where you have increasing difficulty coping with either an already familiar environment or a situation new to you 99 marital problems and sexual difficulties 99 psychosomatic problems 99 anxiety 99 depression 99 problems of criminals and delinquents ,individuals who are most effectively treated with forms of cognitive therapy tend to have one or more of these personal characteristics3 #ade 99 ,they tend to think in very rigid ways4 99 ,they are inclined to think in all-black1 or all-white terms4 ,they are absolutists who think in terms of what is right and what is wrong4 ,life1 for them1 is an uncompromising affair4 99 ,they are often perfectionists about themselves1 so they tend to have unrealistic expectations of others as well4 ,they are idealistic4 99 ,their behavior is frequently uptight1 intense1 judgmental1 and intolerant or shy1 self-effacing1 and inclined to self-condemnation4 99 ,they tend to think that if there is one bad apple1 the whole bushel must be rotten4 ,they tend to magnify and exaggerate evils4 99 ,they confuse what they would like to have with what they believe they absolutely need4 ,they are demanding and exacting4 ,,existential-,,humanistic ,,psychotherapy ,for individuals who suffer from feelings of acute loneliness and emptiness1 who have lost faith in themselves or others1 and who tend to be analytical and introverted4 ,there is no single1 well-defined theory accepted by most existential therapists4 ,instead1 existential psychotherapy is a point of view1 a general philosophy that attempts to describe what it means to be human and to live meaningfully in the world4 ,there is1 nevertheless1 a consensus among existential therapists concerning the objectives of the approach4 ,existential therapy seeks to help clients achieve these goals3 99 to accept and make constructive use of their own personal freedom 99 to become authentic individuals1 shedding the conventions and conformities that obscure the real persons they are 99 to establish human relationships based on honesty and personal integrity 99 to be fully present in the immediacy of the moment #adf 99 to learn to accept the natural limits of life ,existential therapy cannot be described in terms of a group of techniques commonly used by therapists4 ,in fact1 existential therapists are inclined to resist the formulation and application of specific techniques of therapy1 believing that psychotherapy is essentially a human endeavor and that the drive to formulate techniques is basically a dehumanizing1 objectifying interest4 ,to understand existential therapy1 then1 we ought not to expect to encounter a set of specific techniques4 ,what really characterizes existential therapy are its self-consciously endorsed attitudes about life4 ,they include these realizations3 99 ,anxiety frequently motivates individuals to change their lives4 ,anxiety often is present to tell you that you need to change2 it is not necessarily a bad feeling from which no good will come4 99 ,eventually each of us will die1 and clutching life anxiously will stand in the way of finding real meaning in living4 99 ,past events need not control what you feel and do now2 you are free to change old1 unsatisfying patterns4 99 ,guilt is often a sign that you have missed opportunities for personal growth3 you have not been true to yourself and have sinned against yourself in some important way4 99 ,if you are to become a mature and genuine person1 you must discard the lies you have cultivated4 ,among these is living the lie of trying not to be the person you really are2 another is the lie of trying to be a person you are not1 and there are many others4 99 ,to be content within the limitations of life1 it is vital that you have a sense of your own value4 ,you become inauthentic if you base your sense of self-esteem on what others think of you4 ,it is obvious that individual responsibility is central to existential therapy4 ,you are responsible for the person you choose to become4 ,you may choose to be genuine1 or you may choose to lie to yourself and others4 ,it is when you abdicate responsibility for becoming authentic that you will often come to feel anxiety and a sense of guilt4 ,anxiety and guilt are often present1 in other #adg words1 when there is a fundamental lack of congruence1 of being whole1 of being in accord with yourself4 ,the main contributors to existential psychotherapy have been the ,swiss analysts ,ludwig ,binswanger 7#ahha-aiff7 and ,medard ,boss 7#aijc-aiij71 along with ,rollo ,may 7#aiji-aiid71 who was the founder of existential psychotherapy in ,america4 ,today1 existential psychotherapy is practiced under a variety of names3 humanistic psychology1 experiential psychotherapy1 and also in the context of the related approaches1 logotherapy and reality therapy 7see ,chapter #aa74 ,,what ,,existential ,,therapy ,,is ,,like ,existential psychotherapy is usually individual therapy1 with sessions commonly scheduled a few times a week1 as in psychoanalysis4 ,existential therapy often shows its psychoanalytic origins3 as in analysis1 existential psychotherapy focuses largely on anxiety and the suppressed issues that anxiety veils4 ,existential therapists will push clients to confront anxiety directly2 they will try to understand the clients' anxiety in relation to the lies that clients tell themselves in order to protect themselves from more anxiety4 ,as we have already seen1 existential therapists very commonly regard anxiety and depression as promising symptoms because they can shake clients out of unfulfilling patterns of living4 ,anxiety and depression1 instead of being viewed as undesirable symptoms to be eliminated1 can motivate people to change and grow4 ,consequently1 existential therapists tend to disapprove of the use of drugs in therapy4 ,if clients take pills to reduce anxiety1 for example1 they will reduce the awareness of motivating pain that1 if faced squarely1 may bring about a more meaningful1 satisfying life4 ,here is an example of the way an existential therapist forces a client to face issues head-on4 ,what the therapist is thinking is in brackets4 ,,client3 ,i don't know why ,i stay with my job4 ,it just makes me depressed4 ,all ,i do is tell you the same things over and over4 ,i'm not getting anywhere4 ,,therapist3 ,she is complaining because ,i'm not curing her4 ,she has to do this herself4 ,to be frank1 ,i'm impatient1 #adh too4 ,we talk1 but you're not able to act4 ,she has to see that ,i can't take responsibility for her procrastinating4 ,,client3 ,what do you think ,i ought to do8 ,i can't keep living like this4 ,,therapist3 ,i can't make her decisions for her4 ,i can't tell you which way to go4 ,i do know that you've been avoiding a decision4 ,i believe you're going to take charge of your life but1 until then1 we may both feel impatient4444 ,what do you want to do8 ,she has to be pushed to make up her mind4 ,she's ready now to decide but is understandably scared4 ,,client3 ,i want to stop worrying1 stop feeling so anxious and upset4 ,,therapist3 ,she'd like me to mother her4 ,look1 ,diane1 you've been coming to see me for three months now4 ,you know what ,i think about feeling upset3 if you're upset1 there's something bothering you that you need to pay attention to4 ,we both know you dislike your job and that you stay on mainly because you're afraid of a change4 ,we can talk a long time about your unhappiness at work and about your fear of change1 but eventually it will be time to stop talking and to try some alternatives4 ,do you think you're ready8 ,i think you are4 ,,client3 7,sighs47 ,i guess you're right4 ,i seem to be dragging my feet4 ,if ,i want a satisfying job1 ,i'm just going to have to try something else4 ,can we talk about some of my alternatives1 then1 and ,i'll try to stop complaining6 ,,therapist3 ,now she's starting to face up to the challenge4 ,,applications ,,of ,,existential ,,psychotherapy ,these are some of the difficulties existential psychotherapy is designed to treat3 99 feelings of real estrangement or alienation from others--from your immediate family and friends or from neighbors or colleagues at work 99 a sense of acute loneliness1 of being cut off from humanity and from normal everyday activities and interactions 99 an awareness that your life has become an empty pattern #adi of habit1 that your activities or work no longer feel meaningful or valuable 99 an inability to accept the realities that limit life2 for example1 anxiety experienced by older persons as they become more aware of the need to face the reality that life will end or anger and frustration experienced by individuals who must cope with real limitations--persons with physical impairments and chronic pain1 individuals whose opportunities are limited by poverty1 by their ties of responsibility to others1 or by social disadvantage ,individuals who benefit most from existential psychotherapy tend to have these characteristics3 99 ,they are reflective and analytical4 99 ,they tend to be introverted4 99 ,they have lost faith--in their sense of social commitment1 in their identity and role within their families1 in their belief that their work is of value1 or in their religion4 #aej #aa ,,psychotherapy1 ,,part ,,ii ,logotherapy1 ,reality ,therapy ,adlerian ,therapy1 ,emotional ,flooding ,therapies1 ,direct ,decision ,therapy ,in this second chapter devoted to major approaches to psychotherapy1 we will look at logotherapy1 reality therapy1 ,adlerian therapy1 the family of emotional flooding therapies1 and direct decision therapy4 ,like the five psychotherapies described in ,chapter #aj1 these focus special attention on a client's personal style of relating to the world and others4 ,they all seek to help a person to free himself or herself from troubling feelings and negative attitudes and to replace these with a stronger and more confident self-concept4 ,each therapy is a different path to that goal4 ,,logotherapy ,for reflective individuals who are sensitive to values and who are in search of a richer sense of meaning in life4 ,he who has a why to live for can bear with almost any how4 ,friedrich ,nietzsche #aea ,viktor ,frankl 7#aije-aiig7 is worthy of much respect and admiration4 ,out of three terrible years of suffering in a concentration camp1 during which his mother1 father1 brother1 and wife were taken from him1 ,dr4 ,frankl developed logotherapy 7from the ,greek logos1 roughly equivalent to meaning74 ,logotherapy is an approach to therapy that addresses our inherent need for meaning and value in living4 ,the belief that sustained ,dr4 ,frankl during this period of intense suffering was the conviction that people1 in spite of great adversity1 anguish1 and the loss of all they hold dear1 can remain free within themselves and are able to maintain1 and even to strengthen1 their sense of self-respect and integrity4 ,to communicate how it is possible to do this became ,dr4 ,frankl's lifework4 ,logotherapy is a therapy of meaning for those who are unable to find a reason for living4 ,it is a form of therapy related to existential analysis 7see ,chapter #aj71 but it is specific in its concern for helping clients find what it is that really matters to them1 that makes hardships and pain worthwhile4 ,if ,freudian psychoanalysis looks to the past for insight1 logotherapy focuses instead on the future1 on a person's life task4 ,in this1 there is no abstract and general answer to the question ,what is the meaning of life8 ,for the meaning of life differs from man to man1 from day to day and from hour to hour4 ,what matters1 therefore1 is not the meaning of life in general but rather the specific meaning of a person's life at a given moment4 ,to put the question in general terms would be comparable to the question posed to a chess master1 ,tell me1 ,master1 what is the best move in the world8 ,there simply is no such thing as the best or even a good move apart from a particular situation in a game and the particular personality of one's opponent4 ,the same holds for human existence4444 ,everyone has his own specific vocation or mission in life2 everyone must carry out a concrete assignment that demands fulfillment4444 ,ultimately1 a man should not ask what the meaning of life is1 but rather must recognize that it is he who is asked4 ,in a word1 each man is questioned by life2 and he can only answer to life by answering for his own life2 to life he can only respond by being responsible4#a #a ,viktor ,e4 ,frankl1 ,man's ,search for ,meaning3 ,an ,introduction to ,logotherapy 7,new ,york3 ,washington ,square ,press1 #aifc71 pp4 #agj-aga4 #aeb ,dr4 ,frankl liked to compare logotherapy to the role of the eye specialist3 the logotherapist's role is to help the patient see more clearly the range of lived values and meaning available to him4 ,,what ,,logotherapy ,,is ,,like ,an elderly physician came to ,viktor ,frankl to ask for help with severe depression4 ,his wife1 whom he loved above all else1 had died two years before4 ,his sense of loss would not heal4 ,could ,dr4 ,frankl help him8 ,dr4 ,frankl responded with a question3 ,what would have happened1 ,doctor1 if you had died first1 and your wife had had to survive you8 ,oh1 he said1 for her this would have been terrible2 how she would have suffered6 ,you see1 ,doctor1 such a suffering has been spared her1 and it is you who have spared her this suffering2 but now1 you have to pay for it by surviving and mourning her4 ,the physician said nothing1 but rose to his feet1 shook ,dr4 ,frankl's hand1 and calmly left his office4 ,suffering ceases to be suffering in some way at the moment it finds a meaning1 such as the meaning of sacrifice4#b ,it is the basic concern of logotherapy to help patients see the meaning in their lives4 #b ,frankl1 ,man's ,search for ,meaning1 pp4 #agh-agi4 ,logotherapy is known for two techniques endorsed by ,viktor ,frankl4 ,he called them dereflection and paradoxical intention4 ,many emotional problems have their roots in what psychotherapists call anticipatory anxiety3 a woman who is afraid of blushing when she enters a room filled with people will tend to blush4 ,a man who fears impotence and who tries to achieve an erection will often fail4 ,a woman who willfully tries to achieve orgasm also will frequently fail4 ,these are examples of excessive1 or hyper-1 reflection4 ,excessive1 anxious attention is paid to what we fear or wish1 bringing about the very thing we are trying to avoid4 ,frankl developed specific ways of refocusing or rechanneling this excessive attention4 ,dereflection could take the form1 for example1 of persuading the blushing woman to concentrate on particular things when she enters a crowded room3 to look for acquaintances1 to admire what someone may be wearing1 or to #aec look for objects in the room to appreciate1 for example4 ,in the case of impotence or frigidity1 often a shift of attention from yourself to your partner's pleasure will eliminate anticipatory anxiety4 ,frankl describes an attempt to help a bookkeeper who was in real despair and close to suicide4 ,for several years he had suffered from writer's cramp3 very real muscular cramps that reduced his legible script to an illegible scrawl4 ,he was in danger of losing his job4 ,he was treated with paradoxical intention4 ,he was asked to write in an intentionally illegible scrawl4 ,but he found that when he deliberately tried to scrawl1 he could not4 ,within two days1 his writer's cramp had vanished4 ,similar approaches have been very effective--and long-lasting--in certain cases of severe stuttering1 uncontrolled shaking1 washing compulsions1 insomnia1 sexual difficulties1 and other problems4 ,logotherapists tend to be warm1 accepting individuals4 ,they will often use humor4 ,yet they are trained to confront individuals3 to push their clients to face their inner feelings of futility and despair1 and then1 out of their often overlooked and underestimated inner resources and moral strength1 to will that their lives become meaningful4 ,logotherapists try to encourage clients to see more clearly what it is that gives them a sense of value in living and to use what they see to direct themselves toward more satisfying and personally fulfilling lives4 ,,applications ,,of ,,logotherapy ,as we have already observed1 logotherapy has been used to treat a wide range of individual problems involving a loss of faith in the value of living1 behavior that no longer is under voluntary control1 or behavior that frustrates your desires4 ,logotherapy is especially well-suited to helping individuals with nogenic neuroses1 ,frankl's term for personal problems that have their basis in conflicts between opposing values4 ,nogenic 7from the ,greek nous1 meaning spirit or mind7 neuroses have their origin in personal moral or spiritual1 but not necessarily religious1 conflicts4 ,they lead to a feeling of existential frustration3 a person's will to find meaning is blocked4 ,when sufficient pressure is built up1 anxiety and depression can follow4 ,you can imagine how pressure might build up in the inner lives #aed of a business executive who wishes she had a family instead of a career identity1 a university professor who yearns to be an independent artist1 or a financially successful businessman who despises his own pretenses and opportunism4 ,i asked the poor creatures who listened to me attentively in the darkness of the hut to face up to the seriousness of our position4 ,they must not lose hope but should keep their courage in the certainty that the hopelessness of our struggle did not detract from its dignity and meaning4 ,i said that someone looks down on each of us in difficult hours--a friend1 a wife1 somebody alive or dead1 or a ,god--and he would not expect us to disappoint him4 ,he would hope to find us suffering proudly--not miserably4#c #c ,frankl1 ,man's ,search for ,meaning1 p4 #acb4 ,,reality ,,therapy ,for persons able to make a commitment to a plan for life improvement1 whether they have emotional or behavioral problems or simply want to develop a success-identity4 444 ,unhappiness is the result and not the cause of irresponsibility4 ,william ,glasser1 ,reality ,therapy ,reality therapy was developed in the #aiejs by psychiatrist ,william ,glasser 7#aibe-bjac74 ,his approach to therapy evolved as a result of his work with delinquent teenage girls1 with clients in private practice1 and with severely troubled patients in a ,,va hospital4 ,reality therapy1 as the name implies1 attempts to help by strengthening a person's practical understanding of reality and by encouraging concrete planning that will bring about an improved sense of personal adjustment to reality4 ,it emphasizes a very practical1 feet-on-the-ground focus on the present3 a person's past experience cannot be rewritten4 ,reality therapists do not believe in the essential value of psychoanalytic interpretation1 dream analysis1 nondirective counseling1 or intellectual #aee insight4 ,a reality therapist focuses on the present1 specifically on attempts patients may now be making to become more successful from their own points of view4 ,if a patient is not able to make definite plans of this kind and cannot sustain a commitment to them1 the focus of reality therapy will be to encourage the patient to begin to do this4 ,it is an approach that believes that a strong sense of personal identity can come only from doing3 if an individual is able to develop a degree of self-responsibility that is solid and enterprising1 a feeling of personal success and effectiveness will follow4 ,reality therapists are opposed to making diagnoses4 ,a diagnostic label frequently adds a burden to individuals who are already burdened by emotional1 family1 or adjustment problems4 ,glasser notes1 for example1 that being labeled a schizophrenic can be worse than the disease as far as incapacitating one in the course of life's activities4#d #d ,william ,glasser and ,leonard ,m4 ,zunin1 ,reality ,therapy1 in ,raymond ,j4 ,corsini1 ed41 ,current ,psychotherapies 7,itasca1 ,,il3 ,f4 ,e4 ,peacock ,publishers1 #aigi71 p4 #cbi4 ,reality therapists can resist diagnosing and labeling their clients because their approach claims that personal psychological difficulties1 except those due to physical illness 7see ,chapter #h71 result from a lack of personal discipline and responsibility4 ,people are often caught in the habit of blaming their failures on their families1 their lack of opportunity1 their race1 poverty1 and other outside forces4 ,it is a habit with a dead end3 it ignores the potential success that can come from initiative motivated by responsibility and moral courage4 ,as ,ernest ,hemingway said when asked if he ever anticipated failure1 ,if you anticipate failure1 you'll have it4 ,,the ,,experience ,,of ,,reality ,,therapy ,it isn't hard to gain a feeling for what reality therapy is like4 ,these are the basic principles of the approach3 ,the relationship between therapist and client must be personal4 ,the therapist tries to make clear that he is a genuine person who has1 in some areas of his life1 been able to plan effectively and to develop a sense of personal success4 ,the focus of individual sessions is on what the client does1 not on what he or she may feel4 ,behavior can be changed much more #aef directly than feelings1 and feelings soon fall into place once behavior is more satisfying4 ,what is important is for the client to develop intelligent plans and then to work to carry them through4 ,if certain goals are not realized1 the therapist's concern is to encourage the client to take the next practical step1 rather than to spend time and energy analyzing what went wrong4 ,the reality therapist accepts that the first steps are often halting ones4 ,it is important not to be disconcerted by occasional stumbling and a few falls4 ,what is essential is a commitment to self-discipline and progress1 refusing to punish yourself when a plan may not succeed1 but going beyond it with a positive attitude that eventually can become a habit4 ,glasser gives this illustration of the persistent refocusing on practical issues that characterizes reality therapy3 a teenage girl expresses to her therapist that she would like to look for a job4 ,the therapist does not respond1 ,good1 let me know how it works out1 but instead begins the following exchange4#e ,,therapist3 ,what day next week8 ,,girl3 ,i don't know4 ,i thought ,monday or ,tuesday4 ,,therapist3 ,which day8 ,monday or ,tuesday8 ,,girl3 ,well1 ,i guess ,tuesday4 ,,therapist3 ,you guess1 or will it be ,tuesday8 ,,girl3 ,tuesday4 ,,therapist3 ,what time ,tuesday8 ,,girl3 ,well1 sometime in the morning4 ,,therapist3 ,what time in the morning8 ,,girl3 ,oh1 well1 #i3cj4 ,,therapist3 ,fine1 that is a good time to begin looking for a job4 ,what do you plan to wear8 #e ,glasser and ,zunin1 ,reality ,therapy1 ,current ,psychotherapies1 p4 #cbd4 ,in another example of reality therapy1 a patient says1 ,i feel depressed and miserable4 ,instead of responding1 ,how long have you felt this way8 or ,what have you been feeling depressed about81 a reality therapist might ask1 ,what have you been doing that continues to make you depressed8 or ,why aren't you even more depressed8 ,with both of these responses1 the therapist makes it clear that he believes the client can influence his or her feelings4 ,often therapists1 no matter what their approach1 will say to #aeg clients who are going through a difficult time that they may phone after hours if there is an emergency4 ,a reality therapist may1 in addition1 also say1 ,i hope you'll call me if you have had a special success4 ,,applications ,,of ,,reality ,,therapy ,reality therapy has been used in connection with these types of problems3 99 individual problems involving anxiety1 marital conflicts1 maladjustment1 and some psychoses where a person is comparatively out of touch with reality and may have hallucinations or delusions 99 teenage delinquency 99 difficulties faced by women who have recently been widowed 99 designing school programs that stress the development of individual identity based on a sense of personal success ,reality therapists believe that their approach is of value to people who want to develop a more successful pattern of living1 of managing their own affairs1 and of coping effectively with challenges at work and with problems of everyday living4 ,reality therapy has also been used in industry with organizational problems and with difficulties experienced by individual employees4 ,reality therapy is not useful in treating problems in which there is severe withdrawal 7as in autism7 or cases involving serious mental retardation4 ,to be effective1 reality therapy presupposes that clients are able to communicate and are both willing and able to cultivate habits of self-discipline and personal responsibility4 ,,adlerian ,,psychotherapy ,for individuals interested in personal growth1 especially in social directions1 and for persons with low self-esteem who feel blocked and discouraged about life4 #aeh ,the greatest principle of living is to love one's neighbor as oneself4 ,rabbi ,akiva1 writing #b1jjj years ago ,alfred ,adler 7#ahgj-aicg7 was a contemporary of ,freud4 ,early in his career1 ,adler was invited by ,freud to participate in his special circle of professionals interested in the development of psychoanalysis4 ,adler's already formulated views were not in accord with ,freud's1 their differences became more pronounced1 and ,adler eventually separated himself from psychoanalysis4 ,freud was embittered and became a lifelong enemy of ,adler4 ,in contrast to ,freud's technical and abstract theory1 ,adler's is humanistic1 open1 and concrete4 ,where ,freudian analysis believes that emotional disturbances have a sexual basis1 ,adlerian therapy claims that neurosis comes about through distorted perceptions and from habits and attitudes that are learned4 ,in ,adler's system of individual psychology1 there is no concern for unconscious processes or for internal divisions of the self into id1 superego1 and ego4 ,adlerians stress that a person forms a unity and must be treated as a whole4 ,adler's approach to psychotherapy is based on the view that feelings of inferiority are normal4 ,they exist in children1 and they continue to be present in adults who may feel weak psychologically1 socially1 or because of physical limitations4 ,to compensate for feelings of inferiority1 adults strive for superiority by dealing effectively with the world1 or they become deeply discouraged 7however1 they are not considered to be sick7 and lose contact with positive1 constructive activities4 ,adler also postulated that emotional difficulties come about when you are convinced that you simply cannot solve the problems of life in a way that is compatible with a need to be superior in some way4 ,certain attempts to compensate for feelings of inferiority can lead to emotional problems later4 ,they include seeking a feeling of superiority by requiring attention from others1 striving for power over others1 taking revenge1 and giving up--declaring that you cannot cope because of personal deficiencies and weakness4 ,children from families where there is distrust1 domination1 abuse1 or neglect tend to choose these paths4 ,another facet of ,adler's approach is that individuals who #aei cannot compensate for feelings of inferiority are inclined to make a number of basic mistakes in perceiving the world4 ,they will overgeneralize 7,nobody cares about me471 depreciate their worth 7,i'm just a housewife471 set unrealistic goals 7,i should please everyone471 distort 7,you have to lie to get ahead471 and hold faulty values 7,win1 even if you have to climb over others474 ,finally1 ,adler felt that1 over the course of their lives1 many people strengthen these basic mistakes while in pursuit of the ultimately unsatisfying desires for attention1 power1 revenge1 or escape4 ,their styles of living may lead to depression1 chronic anxiety1 crime1 alcoholism1 drug abuse1 and other problems4 ,,what ,,adlerian ,,therapy ,,is ,,like ,adlerian therapists try to help people change unfulfilling patterns of living in several ways4 ,first1 and perhaps most important1 is the belief that therapy should do more than help clients with immediate problems4 ,it should help them develop an adequate philosophy of life1 encourage them to cultivate an approach to living that is self-sustaining1 positive1 and inherently social in focus4 ,the paradox of inferiority and low self-esteem is that the suffering they cause disappears once people can forget themselves and begin living to some extent for others4 ,adler would remind his clients to consider from time to time how you can give another person pleasure4#f ,adlerian therapy stresses the importance of social goals4 ,for ,adler1 we are foremost social creatures2 our individual identities can be developed and our problems resolved only in a social context4 #f ,alfred ,adler1 ,problems of ,neurosis 7,new ,york3 ,harper and ,row1 #aifd71 p4 #aja4 ,since ,adler believed that most emotional difficulties we experience result from feelings of inferiority that have led to discouragement1 the second goal of ,adlerian therapists is to offer encouragement4 ,they are as much concerned with mirroring clients' strengths as they are with analyzing their problems4 ,adlerian therapists will devote a good deal of attention to identifying and encouraging the personal assets of each client4 ,adler suggested several techniques that have also come to be used by other schools of psychotherapy3 #afj ,acting ,as ,if ,frequently1 clients express a wish to begin acting in new ways--to be more assertive1 to make an effort to break out of confining patterns of living1 to conquer certain fears4 ,however1 they usually feel that the new behaviors are phony1 so they are reluctant to try4 ,adler suggested that clients try a new behavior for the next week only as they would try on new clothing3 they need only act as if4 ,adler found that1 as clients began to act differently1 they would begin to feel differently4 ,when their feelings were positive1 they tended to make new ways of behaving part of themselves4 7,behavior modification1 described in the next chapter1 builds on this idea47 ,paradoxical ,intention ,we encountered this technique1 also called negative practice1 in the preceding section on logotherapy4 ,it can be a very effective technique when certain habits can no longer be controlled4 ,if you suffered from insomnia1 you would be asked to focus your attention on staying awake3 to put an end to the habit1 you would be asked to amplify it4 ,oddly enough1 in many cases1 this judo-like dropping of resistance and redirection of attention can bring involuntary behavior back under control4 ,the ,push-,button ,technique ,many of us have unpleasant thoughts and emotions that refuse to leave us4 ,we find ourselves on familiar tracks that we know lead to sadness1 regret1 anger1 panic1 or frustration4 ,but we can't seem to subdue what ,zen calls these chattering monkeys of the mind4 ,adler taught clients that they could create whatever feelings in themselves they wished1 simply by deciding what to think4 ,it is possible1 with some practice1 to imagine a happy or peaceful memory or scene and to direct your attention to it when negative thoughts try to dominate4 ,we all have this push button available4 ,like all exercises in self-discipline1 it strengthens us the more we use it4 7,cognitive therapy1 discussed in ,chapter #aj1 is especially concerned with this influence of thoughts on emotions47 ,,settings ,,for ,,therapy ,adlerians use a variety of settings for therapy4 ,individual #afa therapy is common1 but sometimes two therapists may work together with one client1 an approach that gives clients an experience of cooperation between professionals who may perceive them differently4 ,adlerian workshops are popular with parents concerned with problems in rearing children4 ,other workshops exist for married couples4 ,adlerians have often been innovative3 ,rudolf ,dreikurs1 a well-known student of ,adler1 was1 for example1 one of the first therapists to use group therapy in private practice4 ,,applications ,,of ,,adlerian ,,psychotherapy ,because ,adler did not view human problems as forms of sickness1 ,adlerians see emotional and behavioral difficulties as blocks that people encounter in their attempts to realize themselves4 ,many of the problems ,adlerian therapists treat are therefore considered to be normal problems of living faced by normal people4 ,many clients enter therapy to learn about themselves and to grow4 ,adlerians have worked with a wide range of clients with a wide range of human problems3 99 clients interested in personal development 99 individuals who have become deeply discouraged about their lives 99 couples and families 99 delinquents and criminals ,,emotional ,,flooding ,,therapies ,today there are three main varieties of emotional flooding therapies3 bioenergetics1 primal therapy1 and implosive therapy4 ,they share the central belief that1 by taxing you1 pushing you to experience frustration1 anger1 or anxiety1 the therapist may help you achieve a lasting sense of emotional relief and well-being4 ,these three therapies do1 however1 vary a good deal in the techniques they use to encourage clients to experience strong emotions4 ,bioenergetics makes use of an unusual approach to physical exercise4 ,primal therapy encourages clients to relive early painful memories4 ,implosive therapy asks clients to use imagery to increase1 in a controlled manner1 feelings that cause emotional distress4 ,these approaches share the assumption that #afb emotional difficulties can be helped by a direct release of feelings that have come to be blocked4 ,,bioenergetics ,for rigid1 inhibited people who have pent-up feelings in need of release4 ,alexander ,lowen 7#aiaj-bjjh7 was trained as a physician and then as a psychoanalyst under the direction of ,austrian psychoanalyst ,wilhelm ,reich 7#ahig-aieg74 ,reich believed that emotional problems resulted from sexual repression4 ,he was a social revolutionary in his attempts to bring about sexual freedom4 ,he became a controversial figure and was not able to put his ideas on a serious and professionally respectable footing4 ,lowen was interested in the therapeutic implications of ,reich's work4 ,he developed an approach to therapy that emphasizes not sexual liberation and pleasure as ,reich did1 but a sense of freedom that he felt could result only from an approach to the body that allows you to drop tense muscular armor and to feel integrated and fully alive4 ,lowen found that emotionally troubled people were physically knotted and rigid and tended to breathe in a shallow and constricted way4 ,lowen devised a variety of physical exercises1 such as holding your body in an arched position until exhaustion sets in1 making contact with the floor only with hands1 head1 and feet4 ,these exercises can cause enough stress to arouse intense emotions3 crying out1 collapsing1 feeling rage or tenderness4 ,as these pent-up feelings are released1 many clients often discover an increase in positive emotional strength4 ,bioenergetic therapists offer individual therapy as well as workshops4 ,they tend to act as teachers1 pointing out very bluntly how a client's physical rigidities reflect rigid qualities of personality3 ,your chest muscles are this tense because you have been defending yourself so long1 like a boxer1 or ,your jaw muscles ache because you've been biting back angry impulses4 ,because of its physical approach to human emotions1 bioenergetics is sometimes regarded as the ,west's therapeutic version of yoga4 7,for a discussion of yoga1 see ,chapter #ae47 #afc ,applications of ,bioenergetics ,bioenergetics appears to be most useful for people with any of these characteristics3 99 ,their feelings are markedly inhibited1 or they feel deadened emotionally4 99 ,they feel impaired sexually or do not experience orgasm for nonphysical reasons4 99 ,they are rigid1 uptight1 and inclined to be obsessive perfectionists4 99 ,they have pent-up feelings of anger1 hostility1 or grief that are in need of an outlet4 ,bioenergetics is not the treatment of choice when deeper insight and self-knowledge are important4 ,bioenergetic therapists are not in general especially concerned with a client's personal history1 family and work environment1 or specific adaptation problems4 ,,primal ,,therapy ,for individuals who continue to suffer from childhood pain4 ,arthur ,janov 7#aibd- 7 was psychoanalytically trained as a clinical psychologist and psychiatric social worker4 ,he had been practicing for seventeen years when a shy and withdrawn client in a group therapy session let out a piercing1 primitive scream4 ,the inhibited client experienced a sense of release and insight4 ,this event fascinated ,janov and eventually transformed his professional perspective4 ,he developed an approach to therapy that encourages patients to re-experience repressed painful memories from childhood4 ,janov calls these primal pains3 they come about when a child's emotional needs repeatedly are not met4 ,the inner suffering that results is suppressed2 the pain cannot be dissipated4 ,it takes energy to continue to block out painful feelings4 ,the constant expenditure of energy then shows up in conscious tension4 ,janov came to believe that emotional problems in adults stem from #afd their unwillingness to experience feelings that a child would find crushing but--though painful--can now be faced4 ,when primal pain is faced1 ,janov claims1 individuals gain a degree of freedom and maturity they could not otherwise achieve4 ,janov's primal therapy is best known for the primal scream we mentioned above that some patients let out when they confront the pain they have suppressed for so long4 ,primal therapy encourages a repeated cathartic release of pent-up feelings4 ,during the first three critical weeks of therapy 7which normally cost in excess of #b1jjj71 the primal therapist is on call twenty-four hours a day for a single patient4 ,the patient is isolated for the first week in a hotel room1 without ,,tv1 cigarettes1 alcohol1 sex1 or companionship1 and has daily therapy sessions with the therapist that last from two to three-and-a-half hours4 ,patients then spend six to twelve months in a primal therapy group4 ,janov has been criticized for his apparent desire for public charisma and for capitalizing on advertising hype4 ,he tends not to reveal in writing details of his procedures in therapy and will share his professional secrets only with initiates at his primal therapy institute4 ,comparatively few therapists have had this special training4 ,however1 many therapists offer what they claim is the equivalent of primal therapy1 which they call intensive feeling therapy4 ,they have the same format for therapy3 isolation in a hotel room1 three weeks' exclusive attention to each client1 and the resulting high fees4 ,applications of ,primal ,therapy ,primal therapy has been used to treat these problems3 99 chronic depression and anxiety 99 compulsions 99 phobias 99 drug addiction 99 problems of homosexuals 99 marital problems ,like bioenergetics1 primal therapy is best suited for individuals who have repressed or pent-up feelings they have not found ways to release4 #afe ,it is important to bear in mind that primal therapy is initially one of the most expensive therapies1 since it devotes exclusive attention to each client at the beginning of therapy4 ,it may not be the therapy of choice for more verbal1 intellectual clients who want to develop an understanding of themselves beyond an experience of catharsis4 ,,implosive ,,therapy ,for people with phobias4 ,this emotional flooding therapy was developed by ,thomas ,stampfl 7#aibc- 74 ,stampfl was trained as a clinical psychologist at ,loyola of ,chicago and was influenced by both psychoanalysis and the psychology of learning4 ,early in his career1 he became convinced that clients with phobias tend to reinforce their fears by automatically avoiding what they fear4 ,he developed an approach to help people face the situations1 feelings1 or memories they most fear4 ,stampfl's approach is most easily understood in the light of recent experimental work on animal avoidance behavior4 ,a dog1 for example1 is confined in a cage that is divided in two4 ,a low wall separates the two halves of the cage1 over which the dog can jump4 ,on one side there is a bell that rings just before the dog receives an electric shock4 ,the dog promptly learns that he can avoid the shock by jumping to the other side of the cage4 ,soon he will learn to do this automatically1 whenever the bell rings4 ,what is significant from a psychologist's point of view is that the dog will continue for a long time to jump to the opposite side of the cage1 even once no further shocks are given4 ,the dog's fear is maintained in force only by his own memory4 ,animal psychologists have found a quick way to end the dog's fear3 ring the bell1 but prevent the dog from jumping to the other side of the cage4 ,once the anxiety-stricken animal realizes that he is no longer going to be shocked1 the old habit based on fear simply disappears4 ,implosive therapists make use of an equivalent technique with human beings4 ,patients are asked to imagine1 as vividly as #aff possible1 that they are facing the very thing they chronically have tried to avoid4 ,for example1 an individual may have suffered from a terrifying fear of elevators for years4 ,the therapist tries to use exaggerated imagery to produce maximum anxiety4 ,he might ask the patient to imagine being stuck in an elevator fifty floors up1 having the elevator shake and abruptly fall a foot1 then have the lights go out1 and so on4 ,by maintaining this contrived elevator nightmare long enough1 implosive therapists claim that1 frequently1 the level of anxiety of patients quickly and dramatically falls1 and they lose their exaggerated fears4 ,implosive therapists are therefore not primarily concerned with being genuine1 sympathetic1 or mothering4 ,they focus their energy and attention on pushing clients to confront the worst fears and catastrophes they can imagine4 ,all the while1 clients are aware both that the intense anxiety they experience is an intended goal of therapy and that the therapist is convinced they are much stronger than they have thought4 ,implosive therapy is usually done on an individual basis and is comparatively brief1 usually lasting less than a dozen sessions4 ,it should be mentioned that1 when not successful1 implosive therapy may occasionally sensitize clients to feel even more anxiety than they did at the outset4 ,it therefore tends to be a higher-risk treatment1 but it can be remarkably effective4 ,visualizing anxiety-producing events also has successfully been used by individuals on their own4 7,for more information1 see ,appendix ,b3 ,suggestions for ,further ,reading47 ,applications of ,implosive ,therapy ,implosive therapy is especially appropriate for the treatment of phobic individuals who characteristically tend to avoid certain kinds of behavior1 situations1 or objects because of the severe anxiety and agitation these produce in them4 ,implosive therapy1 when effective1 can be dramatically effective in a comparatively short time4 ,however1 less arduous approaches to therapy can often be as effective and may involve less risk of increasing a client's existing anxiety4 ,alternative short-term therapies especially well-suited to the treatment of phobias include behavior modification 7,chapter #ab71 ,gestalt therapy 7,chapter #aj71 reality therapy 7earlier in this chapter71 primal #afg therapy 7earlier in this chapter71 and biofeedback1 relaxation training1 and hypnosis 7,chapter #ae74 ,,direct ,,decision ,,therapy ,for individuals capable of exercising determination and self-discipline who earnestly desire to change4 ,if there's one thing my experience as a psychotherapist has taught me1 it is that no one has to be a victim4 ,however important external factors like health1 physical appearance1 and upbringing may be1 they don't have to determine the happiness quotient in anyone's life story4 ,the way we experience our lives is1 quite simply1 up to us4 ,harold ,greenwald1 ,the ,happy ,person ,at the time of this writing1 the majority of academic and research psychologists regard themselves basically as ,freudians4 ,yet most psychiatrists1 psychotherapists1 social workers1 and counselors have moved beyond ,freud's formal categories and made use of their own common sense and interpretive abilities4 ,harold ,greenwald's emphasis on the central role of choice in making fundamental life decisions implicitly represents the approach of a great many therapists and counselors today4 ,his conception of therapy is casual1 simple1 and often good-humored4 ,greenwald 7#aiaj-bjaa7 was originally trained as a psychoanalyst4 ,as ,greenwald gained professional experience1 however1 his perspective began to change4 ,he gradually came to believe that many patients had1 at some critical moment1 made a decision to go crazy4 ,there was a point when they could exercise control1 and at that moment1 they chose to be depressed or anxious1 to withdraw completely into catatonia1 to become schizophrenic1 alcoholic1 or whatever their decision might be4 ,i discovered in working with people who have had psychotic breaks 444 that most of them described a particular moment when there was a choice of whether to stay in control or let go4444 ,you will find1 again and again1 if you speak to patients who have broken down1 and if you search for it1 that there is always #afh a point at which they had a choice1 and it is at that point that they still have the possibility of controlling themselves4 ,if they have confidence in their ability to control themselves they can exercise it4#g #g ,harold ,greenwald1 ,treatment of the ,psychopath1 in ,raymond ,j4 ,corsini1 ed41 ,readings in ,current ,personality ,theory 7,itasca1 ,,il3 ,f4 ,e4 ,peacock ,publishers1 #aigh71 p4 #cee4 ,this choice point that people experience became the focus of ,dr4 ,greenwald's direct decision therapy4 ,,an ,,example ,here is one of the most dramatic examples of his approach3 ,dr4 ,greenwald had been invited to give a demonstration of direct decision therapy at a mental hospital in ,norway4 ,he asked for a volunteer from the inmates1 someone who could speak ,english4 ,a twenty-year-old patient named ,marie came forward4 ,she had the appearance of a back ward schizophrenic4 ,she was haggard1 wild-eyed1 and unkempt4 ,here is ,dr4 ,greenwald's description of their opening conversation3#h #h ,harold ,greenwald and ,elizabeth ,rich1 ,the ,happy ,person 7,new ,york3 ,stein and ,day1 #aihd71 pp4 #ahj-aha4 ,i gestured toward a chair4 ,won't you sit down1 please8 ,when ,i'm ready4 ,i'll sit when ,i'm ready4 ,would you tell me your name8 ,she waved an arm toward the staff member seated behind me4 ,you heard him4 ,marie1 my name is ,,marie6 ,i'm sorry1 ,marie1 ,i didn't catch it at first4 ,now ,i wonder if there is anything ,i can do for you4 ,would you like me to help you8 ,you can't help me1 none of you can help me4 ,why don't you leave me alone8 ,,why ,,are ,,you ,,always ,,at ,,me8444 ,she rushed on1 shouting at the top of her voice and using a mixture of expletives and obscenities that showed an admirable command of ,english as well as ,norwegian4 ,nothing ,i could do could make the situation worse1 so ,i decided to try something drastic4 ,i outshouted her4 ,,cut ,,it ,,out1 ,,marie6 ,,you ,,know ,,you ,,don',t ,,have ,,to ,,talk ,,like ,,that4 ,she stopped suddenly and focused on me for the first time4 ,the muscles in her face relaxed ever so slightly1 and her eyes #afi showed awareness and intelligence4 ,how'd you know8 ,i stared at her for a minute1 giving her my best foxy-grandpa look4 ,it takes one to know one1 ,i said finally--at which point ,marie's face broke into a grin4 ,you mean you're crazy8 ,you too8 ,perhaps4 ,and perhaps the only difference between you and me is that ,i know how to act sane4 ,marie seemed to like the sound of that4 ,she tightened the sash of her bathrobe and sat down4 ,as ,marie calmed down1 she agreed that she would like ,dr4 ,greenwald to help her4 ,she wanted badly to leave the institution4 ,,dr4 ,g43 ,if you really want to get out1 ,marie1 you'll have to make a very simple decision4 ,,marie3 ,what's that8 ,,dr4 ,g3 ,decide to act sane4 ,dr4 ,greenwald asked her to think of the benefits1 the payoffs1 that came to her as a result of her crazy behavior4 ,there were a number of major payoffs3 she didn't have to look after herself1 didn't have to look for a job1 didn't have to listen to her mother4 ,the upshot was that ,marie decided to give up being crazy and to return to everyday living4 ,it would have been easy for ,dr4 ,greenwald to conclude that she had been faking all the years she was in the mental institution4 ,but she had not been play-acting4 ,yet her illness began through a choice she had made1 and it ended the same way4 ,leaving the hospital world was not easy for her4 ,in fact1 it was often very difficult4 ,but she stayed with her decision and often had to reaffirm it4 ,she married and had a child4 ,she wrote to ,dr4 ,greenwald3 ,i found myself beginning to drift off1 drift out of my life1 the way ,i used to4 ,and--,i didn't6 ,i decided to be the kind of person1 the kind of wife and mother1 that ,i want to be4 ,not perfect1 just what's possible4 ,and if ,i drift off1 ,i won't be able to hear my daughter1 ,i'll be just like my mother was with me4 ,marie went back to school and earned a degree in psychology4 ,after her experience1 she was1 she felt 7as did ,dr4 ,greenwald71 in #agj a special position to be helpful to other people in suffering4 ,,what ,,direct ,,decision ,,therapy ,,is ,,like ,on your own or with professional help1 the truth about you--whoever you are--is that you carry within yourself the resources to heal your most grievous pains1 overcome your most paralyzing fears1 devise ingenious solutions to your most burdensome problems4 ,harold ,greenwald1 ,the ,happy ,person ,during the first session with a client1 ,dr4 ,greenwald often says something like1 ,do you want me to concentrate on your problems1 or would you like us to work together in making you happy8 ,immediately1 he suggests to clients that in fact they are able to change and become happier4 ,dr4 ,greenwald describes seven phases that direct decision therapy involves3 #a4 ,decide what you want in order to be happy 7or happier74 #b4 ,find the decision behind the problem3 what has your implicit decision been in your life that has established an unhappy1 or less happy1 pattern8 ,greenwald calls these life decisions3 they form the center around which you organize your life4 ,they are responsible for your attitudes1 perceptions1 what you value most1 and your behavior4 ,if your life decision is to suffer1 you will interpret everything that happens to you as more suffering-to-be-endured4 ,if you are praised1 you may question whether the praise has an ulterior motive4 ,sufferers 444 have the ability to snatch disaster from every victory4#i #c4 ,when was the original decision made8 ,did your life decision come from your upbringing8 ,did you inherit it from your parents8 #d4 ,identify the payoffs for the decision4 ,even extreme unhappiness--chronic clinical depression--can have real payoffs3 release you from responsibilities1 gain you attention from others1 allow you to return to the comfort of childhood dependency1 etc4 ,anxiety can give you good reasons for #aga disqualifying yourself from stressful situations and reinforce your belief that you cannot cope4 #e4 ,what are your alternatives to the behavior that is causing a problem8 ,it is often hard to see that you are not really trapped in a state of unhappiness4 ,there are always alternatives4 #f4 ,choose your alternative and put it into practice4 ,trust yourself4 ,happy people have a sense that whatever happens1 things will eventually work out4 ,in short1 they trust themselves to react in their own best interest4#aj #g4 ,support yourself in carrying out your decision4 ,habits die slowly4 ,you must be patient4 ,your decision has to be made over and over again1 just as an overweight person who loves food must decide again and again to say ,no to this dessert today1 the baked potato tomorrow4 ,gradually1 the strength of your decision builds as you build strength into it4 #i ,greenwald and ,rich1 ,the ,happy ,person1 p4 #bi4 #aj ,greenwald and ,rich1 ,the ,happy ,person1 p4 #bi4 ,,applications ,,of ,,direct ,,decision ,,therapy ,as we have seen1 direct decision therapy is based on the assumption that you are able to begin to exercise self-discipline and that you are willing to give up the real payoffs that being emotionally troubled frequently does achieve4 ,these interrelated things--ability and willingness to change--simply are not present in many people who enter therapy4 ,they come to therapy for a variety of other1 often unconscious1 reasons3 for temporary comforting1 for escape from an upsetting situation or environment1 or for a chance to release painful feelings and to express painful thoughts4 ,clients come in order to procrastinate2 they come to prove to themselves that they simply can't change and that the therapist just isn't good enough4 ,they come out of anger1 frustration1 despair4 ,but comparatively few enter therapy because they really are persuaded they can change and are committed to bringing change about4 ,these people are unquestionably the most promising candidates for any approach to psychotherapy4 ,clients who come to therapy for other reasons make up the daily challenge and the daily frustration1 concern1 worry1 and hope of the therapist4 ,the therapist believes that1 in time1 and with proper treatment1 #agb people who are imprisoned within walls of their own habits can rally the determination and faith to tear them down and to gain a measure of personal freedom4 ,in this author's judgment1 direct decision therapy1 perhaps more than any other approach1 relies on a client's determination and perseverance4 ,if these personality qualities are there1 or if they can successfully be encouraged by a good therapist1 the approach can be effective with a very wide range of problems4 ,what 444 many 444 patients proved to me is that1 given the choice to be happy1 many unhappy people are able to decide that happiness is what they want4 ,then 444 they develop the ability to experience their problems in a different way4#aa #aa ,greenwald and ,rich1 ,the ,happy ,person1 p4 #ec4 #agc #ab ,,behavioral ,,psychotherapy ,for people who want prompt relief from specific symptoms and who have the incentive and discipline to practice new patterns of behavior4 ,much of our suffering is just so obscure 444 frigidity1 social anxiety1 isolation1 boredom1 dissatisfaction with life--in all such states we may see no correlation between the inner feeling and the way we live1 yet no such feeling can be independent of behavior2 and if only we find connections we may begin to see how a change in the way we live will make for a change in the way we feel4 ,alan ,wheelis1 ,the ,desert ,many of us today feel forced to adapt to ways of living that will lead to unhappiness1 loneliness1 fear1 and illness4 ,is unlocking all five bolts on one's apartment door in the morning1 checking that the can of ,mace is in your purse1 joining the sidewalk crowd to the subway1 hoping you are not mugged 7or worse71 and then spending the daylight hours in a windowless office1 in an atmosphere of tension1 pressure1 competitiveness1 and cigarette #agd smoke1 with time out for caffeine 7or1 again1 worse7 and then a lunch soaked in alcohol a desirable and healthy way to live8 ,behavioral psychotherapy seems to have been developed to respond especially to present needs4 ,clients usually respond 444 with a great sense of relief on finding they are not seen as sick or weak2 they appreciate the positive orientation toward changing the problematic situation rather than dwelling on it4#a #a ,dianne ,l4 ,chambless and ,alan ,j4 ,goldstein1 ,behavioral ,psychotherapy1 in ,raymond ,j4 ,corsini1 ed41 ,current ,psychotherapies 7,itasca1 ,il43 ,f4 ,e4 ,peacock ,publishers1 #aigi71 p4 #bcd4 ,behavioral psychotherapy is best known for focusing on symptoms as its main target1 rather than viewing symptoms as signs of underlying problems4 ,like most generalities1 this one has its exceptions2 some behavioral psychotherapists are very much concerned with understanding the underlying causes of an individual's difficulties4 ,nevertheless1 behavioral therapies do tend to aim for concrete1 specific1 and prompt relief of symptoms4 ,they frequently are effective1 and they are based on techniques that have been tested extensively4 ,,the ,,three ,,schools ,today there are three main schools of behavioral psychotherapy3 ,,counter-,,conditioning ,also called reciprocal inhibition1 this approach was developed by ,joseph ,wolpe 7#aiae-aiig71 a ,jewish psychiatrist trained in ,south ,africa4 ,anxiety is offset by means of desensitization1 assertiveness training1 and sex therapy4 ,as the basis for desensitization1 deep relaxation is used to inhibit anxiety4 ,assertiveness training is used to counteract anxiety due to excessive shyness or aggressiveness by helping individuals form balanced habits of assertiveness that are neither submissive nor hostile4 ,sex therapy makes use of techniques of relaxation and desensitization to permit clients to feel sexual arousal and1 in this way1 to overcome sexual anxiety4 #age ,,behavior ,,modification ,this approach was derived from the work of ,american behaviorist ,b4 ,f4 ,skinner 7#aijd-aiij7 and others1 who attempted to show that a great many emotional problems result from situations in which a person has been punished4 ,he or she comes to fear these situations and develops emotional symptoms in an effort to escape from them4 ,in behavior modification1 attempts are made to change behavior through the use of rewards or punishments4 ,,cognitive ,,approaches ,,to ,,behavior ,,change ,these approaches make use of techniques developed outside of behavioral psychotherapy1 especially those of ,albert ,ellis's rational-emotive therapy 7see ,chapter #aj74 ,these cognitive approaches are based on the belief that a person can gain control over undesirable behavior and psychosomatic problems by learning new habits of thinking4 ,these three schools of behavioral psychotherapy claim that the problems leading people to enter therapy are learned and can be unlearned through systematic training4 ,in particular1 anxiety--the primary source of emotional discomfort--can become a learned habit4 ,when this happens1 anxiety is linked to stimuli that in themselves are usually harmless4 ,a person may come to feel extremely anxious1 for example1 when in the presence of people in authority1 when in bed with a sex partner1 when near dogs or insects1 when criticized by others1 when in a confined space1 or in any number of other situations4 ,anxiety in these situations is learned1 and it gradually becomes an involuntary habit4 ,but the habit frequently can be broken and eliminated4 ,,what ,,behavioral ,,psychotherapy ,,is ,,like ,,counter-,,conditioning ,when you are exposed to a situation that you believe is threatening1 your blood pressure and pulse rate go up1 your muscle tension increases1 the blood supply to your large muscle groups increases1 circulation to your stomach and genitals is #agf reduced1 your pupils may dilate1 your mouth may get dry4 ,a startling noise or a physical shock can produce these symptoms4 ,they are the physical manifestations of anxiety1 and they are the focus of counter-conditioning techniques4 ,anxiety generalizes very easily4 ,if you were repeatedly punished for playing with dirt as a child1 dirt can evoke strong anxiety in you as an adult4 ,if you were bitten by a dog1 the sight of a dog years later may make you feel anxious4 ,anxiety can come to be associated with almost any experience4 ,what is particularly destructive about this is that you soon find yourself caught in a vicious circle3 a certain situation makes you anxious1 you try to avoid the situation and the anxiety it produces in you1 and as you do this1 you build up secondary anxiety--you get anxious that you'll get anxious4 ,so anxiety compounds1 feeding on itself1 fueling itself4 ,counter-conditioning therapists have found that1 to varying degrees1 we are all capable of inhibiting anxiety4 ,a behavior therapist tries to teach you how to do this1 eventually so that you can use relaxation techniques on your own4 ,the following are the main phases of desensitization therapy--assertiveness training and sex therapy are similar1 gradual1 and reassuring processes3 #a4 ,you are taught how to achieve a state of relatively complete physical relaxation4 ,many therapists will tape relaxation instructions so that you can practice daily at home for twenty to thirty minutes4 ,some therapists will instruct you to tense your arms1 hold the tension for ten seconds or so1 then relax and feel the resulting sense of relaxation1 the sense of relief from tension and strain4 ,or1 some therapists use suggestion1 asking you to imagine that your arms are becoming heavier and heavier1 encouraging you to relax deeply4 ,each of your major muscle groups is relaxed in turn until you feel fully relaxed4 ,this first phase of therapy usually takes from two to six sessions4 #b4 ,next a hierarchy is constructed by the therapist for each individual client1 ranking situations or stimuli from most to least anxiety-producing4 ,a person who fears to leave the sense of security of home already is aware of such a hierarchy3 low anxiety may be felt on the front steps1 greater anxiety when going out to the mailbox1 more #agg anxiety in walking around the block1 and extreme anxiety when facing a trip or a move to another residence4 #c4 ,the last phase is the actual process of desensitization4 ,you are asked to relax deeply with eyes closed1 usually in a recliner in the therapist's office4 ,you are asked to imagine a scene taken from the low-anxiety end of your hierarchy4 ,the therapist tries to describe the scene as realistically and vividly as possible4 ,if you begin to feel anxious1 you can raise an index finger1 and then the therapist will shift away from the imagined scene and will turn back to relaxation instructions4 ,when you are again relaxed1 the process continues until1 in time1 you are able to imagine a scene high on the hierarchy1 but still sustain deep relaxation4 ,once this process of desensitization can be accomplished in the office1 you begin anew1 but now with actual situations--first with those low on your hierarchy and then working your way toward situations that used to cause you high anxiety4 ,frequently1 behavior therapists will accompany their clients outside the office1 helping them to remain relaxed--e4g41 while riding elevators1 in crowds1 even sometimes on airline flights if fear of flying is the problem4 ,,behavior ,,modification ,the central idea behind behavior modification is that undesirable habits of behavior will gradually be eliminated if1 consistently1 they are not rewarded or even are punished4 ,conversely1 desirable habits are encouraged when they consistently are reinforced or rewarded4 ,therapists who use behavior modification techniques may recommend both punishments and rewards to clients4 ,if you are a chronic smoker or overeater1 for example1 you may be given a small device with which to shock yourself moderately each time you reach for a cigarette or a second helping4 ,or1 you may be asked to deposit #ajj with the therapist1 and a certain amount will be donated to your most disliked political group each time you go astray4 ,rewards1 on the other hand1 include material rewards that clients may promise themselves once a habit is successfully under control for a certain length of time4 ,most therapists #agh encourage you eventually to substitute inner satisfactions3 pride in your slim appearance or improved health1 strengthened self-confidence1 growth of sexual satisfaction1 and1 most importantly1 a developing sense of self-respect as you learn to gain control over anxiety1 frustration1 or dissatisfaction4 ,behavior therapists also use distraction techniques4 ,they encourage you to do things that are incompatible with the problem you wish to resolve4 ,bicycling or lovemaking may prove to be good antidotes for some individuals who overeat4 ,hiking or jogging1 or physical reassurance1 massage1 or relaxing baths may lessen anxiety4 ,laughter releases tensions and offers its own special kind of encouragement and healthier perspective4 ,behavior modification requires strong initiative and discipline on the part of the client4 ,more than these1 it requires that you be willing to let go of old habits that have been unsatisfying or destructive and work to form new1 more rewarding habits4 ,in the beginning1 forcing yourself to behave in new ways may feel like pretense or dishonesty4 ,this is a common experience and should not be allowed to block your desire to change4 ,unfamiliar and even uncomfortable ways of behaving do become familiar and more comfortable the more they are practiced4 ,if these new ways of behaving come to offer satisfactions or compensations that old habits did not1 they will gradually be absorbed into your own sense of personal identity4 ,what at first may feel to you like an act slowly is made a part of your personality until a habit is established that feels entirely natural4 ,this takes time1 patience1 practice1 and more practice4 ,,cognitive ,,approaches ,,to ,,behavior ,,change ,behavioral psychotherapists use a variety of techniques designed to help clients control their own behavior and individual physical responses more effectively4 ,biofeedback ,biofeedback can help many people gain control over habitual1 automatic processes4 ,biofeedback equipment can be used to teach you how to reduce tension1 develop skills to bring about relaxation1 or cope more successfully with chronic pain4 7,for a detailed discussion of biofeedback1 see ,chapter #ae47 #agi ,thought ,stopping ,thought stopping can help you break chains of negative and self-undermining thoughts4 ,thought stopping is a technique that begins by having you think out loud during therapy sessions4 ,if you repeatedly express negative1 troubling thoughts1 the therapist shouts1 ,stop6 ,in this way1 you are made acutely aware of self-destructive thinking habits4 ,you gradually learn to stop yourself from trapping yourself in upsetting thoughts by silently commanding your mind to stop6 ,it is a simple but often effective technique1 related to two techniques we have already discussed3 the push-button technique of ,adlerian psychotherapy 7see ,chapter #aa7 and the technique of disputing your own irrational beliefs in rational-emotive therapy 7see ,chapter #aj74 ,problem ,solving and ,decision ,making ,these techniques have been developed to help clients solve personal problems and make life decisions more effectively4 ,behavioral therapists who offer assistance of this kind emphasize the importance in problem solving and decision making of several factors4 ,one is refraining from implementing solutions or decisions until you have clearly defined and understood your problem or situation4 ,another is becoming aware of emotional blocks to solving problems and making decisions4 ,for example1 procrastinating serves to protect people from facing risks4 ,individuals are frequently also deterred from solving practical problems because they are emotionally distracted by other difficulties that demand attention first4 ,and people are inclined to jump at one possible solution that then acts as a blinder to seeing other potentially more promising alternatives4 ,behavioral therapists also believe you must realize that1 often1 difficulties you experience when trying to solve problems or make decisions are due to conflicts between incompatible goals or values4 ,sometimes one objective cannot be achieved without compromising another4 ,they also believe you must develop abilities to imagine a wider range of alternatives4 ,and finally1 they believe you must become better able both to foresee likely personal consequences of implementing a particular solution or decision and to evaluate these in relation to what is personally most important4 #ahj ,,an ,,example ,,of ,,behavioral ,,psychotherapy ,anne ,holt was thirty-two when she came to see ,dr4 ,cantwell4 ,she was noticeably anxious1 wringing her hands1 tense1 and easily startled1 as when a car's exhaust backfired in the street below4 ,she complained of feeling unloved by her husband and was always in dread of his criticisms4 ,she also felt her mother-in-law was very critical of her4 ,anne wanted to get away from the house but had quit two jobs in succession1 in each instance when her boss's criticism of her work upset her4 ,dr4 ,cantwell explained the rationale behind desensitization to her and taught ,anne how to practice systematic muscle relaxation1 beginning by tensing her hands1 then relaxing them1 tensing them1 then relaxing them again1 and doing this with her arms1 shoulders1 calf muscles1 thighs1 abdomen1 jaw1 neck muscles1 cheek1 and mouth muscles4 ,he recorded his instructions on a tape for her to use at home4 ,after five weeks of daily practice1 ,anne was usually able to relax deeply in less than a minute4 ,dr4 ,cantwell1 in the meantime1 had gained a clearer idea of what troubled ,anne1 and he had made up the following hierarchy3 ,criticism directed at ,anne from3 ,high anxiety ,her husband ,his mother ,a boss ,anne's mother ,low anxiety ,anne's neighbor ,dr4 ,cantwell decided to use a combination of desensitization and assertiveness training with ,anne4 ,during half of each weekly session with ,dr4 ,cantwell1 ,anne was asked to relax in a recliner with her eyes closed1 and ,dr4 ,cantwell would then describe situations low on her hierarchy4 ,anne was to try to maintain her sense of relaxation in spite of ,dr4 ,cantwell's description of an imagined situation involving ,anne's neighbor4 ,she was to imagine that her neighbor1 who was very fastidious about her own yard1 knocked at ,anne's door to complain about ,anne's habit of setting the trash out the night before pickup4 ,gradually1 in a similarly concrete way1 ,dr4 ,cantwell had ,anne imagine her mother criticizing ,anne for using the same sponge for wiping up #aha in the kitchen as for washing the dishes2 a boss asking ,anne to retype a business letter using another format that he preferred2 ,anne's mother-in-law dropping the hint that her son liked to have his ,t-shirts ironed2 ,anne's husband complaining because ,anne always overcooked the soft-boiled eggs4 ,during the second half of each session with ,anne1 ,dr4 ,cantwell played roles with ,anne in which he taught her how to assert herself more in situations involving criticism4 ,in one session1 for example1 he took the part of ,anne's mother and chose a typical remark she might make3 ,annie1 dear1 don't you think it would be smarter to use a different sponge for wiping the kitchen counter8 ,you should use a separate one for the dishes4 ,dr4 ,cantwell then asked ,anne to think of a way she could reply to her mother's nice criticism1 without feeling bad about herself1 without getting hooked4 ,,anne3 ,well1 one way you've taught me would be to use humor3 ,i could say to her1 ,mom1 anytime you'd like to come over to do the dishes1 it would be fine with me4 ,and then laugh4 ,,dr4 ,c43 ,that's a good approach4 ,but you don't want to be offensive2 you don't want to laugh mockingly4 ,how you do this is important4 ,you want to set a good-natured feeling4 ,humor can be very useful to offset the sting of criticism4 ,can you think of a different way to reply to your mother1 in addition to humor8 ,,anne3 ,well1 let's see4444 ,yes1 well1 ,i could go with her suggestion and not interpret what she says to me as criticism at all4 ,i could say1 ,mom1 thanks for the idea4 ,maybe ,i'll do that4 ,,dr4 ,c43 ,sounds very good4 ,that's another way4 ,the more alternatives you can prepare yourself with ahead of time1 the less likely she will hook you1 leaving you with nothing to say and simply feeling bad4 ,would you try to think of one more alternative8 ,what other tack could you take8 ,,anne3 7,after a moment of silence47 ,i can't think of another4 ,,dr4 ,c43 ,how about telling your mother how you actually feel when she criticizes you8 ,how do you feel8 ,,anne3 ,well1 ,i wish she'd say some positive things instead1 at least sometimes4 ,that would be nice4 ,,dr4 ,c43 ,great4 ,how could you tell her that8 ,,anne3 ,well1 ,i could say1 ,mom1 you know1 you give me a lot of suggestions4 ,some are ,,ok1 now and then1 but1 to be #ahb honest1 ,i'd really like to hear some praise sometimes4 ,do you think you could find some things to compliment me on8 ,i don't want any false praise1 but ,i need to hear some encouraging things from people ,i love4 ,,dr4 ,c43 ,anne1 you're doing very well3 444 ,humor1 reinterpreting so you don't feel criticized1 and talking about criticism from a more detached point of view4 ,you're definitely learning how to cope with criticism much better4 ,,applications ,,of ,,behavioral ,,psychotherapy ,desensitization is normally used in the context of individual therapy4 ,behavior modification and cognitive approaches to behavior change are frequently used in groups4 ,people with problems in common--smoking1 obesity1 phobias1 etc4--are sometimes grouped together4 ,often1 however1 a mixture in groups is desirable4 ,for example1 it is frequently helpful for shy people to be part of a group in which they may watch others who can model more assertive ways of acting4 7,for more about group therapy1 see ,chapter #ac47 ,behavioral approaches to therapy must be tailored to the individuality of each client2 whatever goals are established have to be in accord with the client's own desires4 ,behavioral psychotherapy presupposes that clients will practice instructions and new behaviors between sessions and that they can maintain an adequate level of motivation1 both while in treatment and after treatment ends1 so that new habits of behaving or thinking can become effective and reliable parts of their own personalities4 ,in general1 behavioral approaches to therapy have been less effective in treating panic attacks1 chronic depression1 substance abuse 7smoking1 for example1 is one of the habits most resistant to formal therapy71 and psychosis4 ,,counter-,,conditioning ,this approach1 which includes desensitization1 assertiveness training1 and sex therapy1 has been used effectively in treating these problems3 99 phobias 99 psychosomatic complaints #ahc 99 sex1 marriage1 and family problems 99 passivity and shyness 99 personality trait problems3 lonely1 anxious1 hostile1 or overbearing individuals ,,behavior ,,modification ,this approach has been used successfully in connection with these problems3 99 sexually deviant behavior 99 children's problems1 school discipline1 academic performance1 and juvenile delinquency 99 problems of the mentally retarded and of psychotically regressed individuals 99 some instances of obesity1 alcoholism1 and smoking 99 schizophrenia 99 stuttering ,,cognitive ,,approaches ,,to ,,behavior ,,change ,these approaches have1 for example1 been used to treat such problems as3 99 anxiety and depression 99 adjustment problems 99 marital and sexual difficulties 99 psychosomatic problems ,the popular conception of behavioral therapists is that they tend to be coldly scientific and mechanical4 ,yet a number of studies show that they are inclined to be warm individuals who show positive regard for their clients4 ,in general they tend to be empathetic and self-congruent4 ,these qualities are very much needed if we as clients are to feel encouraged to face one of the most difficult challenges life can pose for us3 to change ourselves4 #ahd #ac ,,group ,,therapy ,especially well-suited to people who are outer-directed but lonely1 who want to develop their interpersonal skills1 and who would like to learn about themselves from the perceptions of others4 ,group therapy is ancient4 ,for as long as men have gathered together to share their experiences1 thoughts1 and feelings and to give one another comfort1 group therapy has existed4 ,as an approach to modern psychotherapy1 however1 it was in its infancy fifty years ago4 ,no single great mind stands behind group therapy2 it has been and continues to be innovative1 flexible1 and free from ties to any particular orthodox school of thought4 ,clients who are attracted to group therapy and who often benefit from group experience tend to have these characteristics3 99 ,they are passive in their interactions with others4 ,they are more comfortable being told what to do than facing the need to decide for themselves4 99 ,they are often lonely or socially isolated4 ,individual #ahe therapy1 with its one-to-one relationship between therapist and client1 does not encourage some clients enough for them to feel like members of humanity4 ,they tend to feel sorry for themselves while in individual therapy or to judge themselves harshly for their need for help4 ,being with other clients in a group situation answers their needs better4 99 ,they are outer-directed people3 what others think of them is crucial to how they think about themselves4 ,inner-directed individuals are likely to feel more interested in and comfortable with individual therapy4 ,for people who are relatively passive1 lonely1 yet outer-directed1 group therapy has some distinct advantages3 99 ,it gives them a place within a group of people--they are no longer alone4 99 ,it gives them opportunities to express themselves freely1 confront other people1 and say things that they otherwise might not be able to express1 thanks to the close and confidential environment of the group4 99 ,they can hear how a variety of other people perceive them4 ,they are not limited to the observations1 ideas1 and recommendations of a single therapist4 99 ,they often feel more at ease in a group4 ,they feel less fear or intimidation in the presence of the authority figure the therapist represents4 99 ,they may benefit from the experiences of other group members who have similar problems or who have very different kinds of difficulties4 ,knowing that they are not troubled minorities of one can be a comfort2 knowing that other people have problems in areas where they don't can be reassuring4 ,in general1 group therapy can give you insight provided by the thoughts and perceptions of others2 it can help you develop social ties if you feel isolated2 and it can offer group support if you need emotional bolstering in order to cope with difficult situations1 undertake decisions that may frighten you1 and face more calmly and confidently the many challenges life can present4 ,but it can also help you deal with more specific problems1 such as facing an especially stressful situation--the death of #ahf someone very close to you1 divorce or separation1 serious illness1 unemployment1 drug addiction1 or alcoholism4 ,or perhaps you have problems relating to others1 such as having a history of being fired from job after job despite your efforts to hold them4 ,for that matter1 group therapy can even offer information about job opportunities1 how to develop occupational skills1 how to apply for a job1 and how to keep a position you hold4 ,some psychologists have commented that the popularity and the need for the kind of experience that group therapy offers are due to the decline of community life and to the virtual disappearance of extended families living physically and emotionally close to one another4 ,group therapy is offered in private practice1 in hospitals1 and in halfway houses2 in psychiatric and counseling centers1 in clinics and hospital wards for patients with diabetes1 ,,aids1 epilepsy1 arthritis1 heart conditions1 paralysis1 blindness2 in prisons and juvenile detention centers2 and in schools1 for students with behavior problems and truancy4 ,group therapy is often used for marriage1 family1 and child-guidance counseling and to help families in which a member is physically or emotionally disabled4 ,group therapy is used by churches for family guidance and for spiritual counseling4 ,it is used in virtually any area where people share problems3 victims of crime and physical abuse1 former patients1 the aged1 children of the aged1 those who are discriminated against--the list goes on4 ,so1 group therapy cuts across virtually the whole range of human problems4 ,because it is used in so many areas1 it is impossible to define it as a single approach--many distinct approaches actually may be involved4 ,many of the approaches to psychotherapy we have already looked at are used in groups4 ,there are psychoanalytically oriented groups1 ,adlerian groups1 ,gestalt groups1 groups that use behavior modification1 and others4 ,perhaps the most useful way to understand group therapy is to liken it to education4 ,many sorts of things can be taught1 and many can be learned4 ,group therapy may be understood most clearly in relation to what kinds of learning and teaching really go on in it4 ,since group approaches to problem solving include many applications beyond our scope here--in industry1 religion1 schools1 etc4--we will look more closely at the following forms of group therapy that are used in the context of psychotherapy3 brief group psychotherapy1 ,t-groups1 #ahg human potential groups1 self-help groups1 and the use of specialized approaches to psychotherapy in a group setting4 7,marriage and family therapy1 which are special forms of group therapy1 are of interest to a large number of people1 so they are discussed separately1 in ,chapter #ad47 ,,brief ,,group ,,psychotherapy ,also known as short-term encounter groups1 brief group psychotherapy is intended for people who face life crises1 who are motivated to change1 and who are comparatively free of individual emotional disorders4 ,normally1 there are about ten sessions4 ,people who find short-term group therapy useful generally have well-defined problems to solve4 ,their experience in group therapy encourages them to become involved in new activities1 join clubs1 perhaps do volunteer work after being recently widowed1 divorced1 or separated2 to take specific steps to find employment2 or to practice new ways of behaving--to become more assertive1 to implement a weight-loss plan1 to return to school after raising a family1 or to change careers4 ,t-,,groups ,training groups were an outgrowth of the ,national ,training ,laboratories1 an organization formed in #aidg by social psychologists who were interested in improving education4 ,t-groups were made up of normally adjusted people who were interested in improving their communication skills so they could become more competent in difficult interpersonal situations4 ,t-groups gradually widened their focus and became the basis for the practical orientation of many therapy groups today4 ,clients who feel isolated or alienated1 find it hard to relate to others1 lack a sense of meaning and direction1 and do not have strong self-discipline often are attracted to ,t-groups4 ,,human ,,potential ,,groups ,these groups have probably done the most to give group therapy its popular image4 ,growth centers are usually rural retreats where psychological growth of participants is encouraged4 ,visits last from a weekend to several weeks4 ,the first #ahh center was called ,lifewynn1 organized in the #aibjs at a summer camp in ,new ,york's ,adirondack ,mountains4 ,the best-known growth center is the ,esalen ,institute in ,big ,sur1 ,california1 formed in #aifb by ,michael ,murphy4 ,its program combines ,gestalt therapy with ,eastern meditation 7see ,chapter #ae74 ,other similar growth centers have sprung up across the country4 ,in addition to these1 the est 7,erhard ,seminars ,training7 organization has attracted a good deal of public attention and controversy4 ,the est approach is eclectic1 combining ,eastern thought1 ,gestalt therapy1 transactional analysis1 psychoanalysis1 ,jungian philosophy1 positive thinking1 meditation1 and other approaches4 ,some est leaders have been described as charismatic1 proselytizing personalities who claim to be able to lead participants to salvation4 ,,self-,,help ,,groups ,there are self-help groups to aid you with many different kinds of problems4 ,they provide group moral support for members with shared problems4 ,they are not intended to bring about deep-seated personality change4 ,alcoholics ,anonymous 7,,aa71 founded in #aicd1 probably is the most well-known self-help organization4 ,recovery1 ,inc41 also known as the ,association of ,nervous and ,former ,mental ,patients1 was formed in #aicf by psychiatrist ,abraham ,a4 ,low4 ,meetings focus on members' conscious control of symptoms2 ,recovery1 ,inc41 frequently encourages members to become involved in volunteer social work4 ,there are many other self-help organizations--for the handicapped1 widows1 battered wives1 diabetics1 victims of ,,aids1 hemophiliacs1 homosexuals1 drug addicts1 and others4 7,for further information see ,appendix ,a3 ,agencies and ,organizations ,that ,can ,help47 ,,psychotherapy ,,in ,a ,,group ,,setting ,most of the approaches to psychotherapy that we have discussed provide treatment in the form of group therapy in addition to individual therapy4 ,group therapy is frequently offered1 for example1 by psychoanalysts1 client-centered therapists1 ,gestalt therapists1 transactional analysts1 rational-emotive therapists and general cognitive therapists1 existential-humanistic #ahi therapists1 reality therapists1 ,adlerian psychotherapists1 emotional flooding therapists1 and behavior modification therapists4 ,in the remainder of this chapter1 we will discuss how group therapy is handled by the main psychotherapies4 ,,what ,,group ,,therapy ,,is ,,like ,although your experience with group therapy will vary depending on which school of therapy you have chosen1 you will find some common elements regardless of the approach4 ,initially1 there is likely to be a period of group confusion1 awkward periods of silence1 some polite superficial conversation1 and often a frustrating lack of overall organization and continuity4 ,different group members will speak up1 and what they say may have absolutely nothing to do with what the previous speaker has said2 people are waiting for the chance to talk about themselves and tend to concentrate so much on what they are preparing to say that they don't pay attention to what others have been saying4 ,gradually1 a more organized style of interacting comes into being through the directive efforts of the therapist or as a result of general group frustration over the lack of coherence4 ,at the same time1 group members will begin to feel more at ease with one another and will in time begin to lift their public masks and reveal more of their private selves--their often hard-to-admit feelings of loneliness1 pain1 anxiety1 depression1 etc4--and to express their personal needs4 ,frequently1 the first steps in the direction of expressing private feelings will involve attacks on the therapist for not structuring the group's interactions more or attacks on one member for monopolizing group sessions4 ,experienced group therapists realize that these common negative attacks are understandable tests of the trustworthiness and the safety of the group as a place to express personal feelings4 ,if an atmosphere of acceptance is established1 and these initial complaints are allowed to occur without catastrophe1 some group members will usually then begin to open up1 to reveal some deeper feelings4 ,one member may begin to talk about her unhappy marriage1 a man about his gambling obsession1 another about his loneliness since his wife died4 ,at about this time it is common for group members to begin to #aij tell one another how they feel about each other1 how they see one another4 ,some of these comments will be positive1 some negative4 ,here are some examples3 ,you have a really nice smile4 ,you remind me of my father1 all these shoulds1 oughts1 and rules6 ,you never say much1 so ,i feel you're just sitting there judging us4 ,you make me nervous1 biting your nails all the time4 ,every time you say something1 you put yourself or somebody else down4 ,as this process continues1 one or two group members will begin to take an interest in the personal problems of some of the others and express a desire to help4 ,they will ask questions for more information1 express sympathy or empathy1 and begin to offer suggestions4 ,it is at this point that the process of group interaction begins to acquire a focus on healing and problem solving4 ,frequently1 these expressions of desire to help one member will encourage him or her for the first time to begin to accept the kind of person he or she has been1 to realize that ,i have been too hard on myself because ,i'm so damned perfectionistic1 ,i am a controller2 ,i want other people to do things my way1 or ,i live in a suit of armor2 ,i'm just afraid of other people4 ,as members of the group come to know one another as real personalities1 they tend to become impatient whenever anyone tries to put on his public mask again4 ,the group demands and expects members to be honest about themselves4 ,feelings can run hot whenever ,fred tries to make ,alice accept his suggestions because he knows what she really needs4 ,group members can show quick impatience with ,judy whenever she tries to persuade herself1 even though her husband has severely beaten her several times1 that her marriage is really ,,ok4 ,group members quickly gain a good deal of information about how others see them and feel about them4 ,as a result of an implicit commitment to honesty1 some members' ways of behaving gradually change3 a rough tone of voice becomes less abrasive and calmer2 offensive gestures and judging looks #aia disappear2 self-centeredness gives way to a certain amount of sympathy and interest in other people4 ,some of the values of group therapy are sensitively expressed in this passage from a letter written by a client to his group3 ,i have come to the conclusion that my experiences with you have profoundly affected me4 ,i am truly grateful4 ,this is different from personal therapy4 ,none of you had to care about me4 ,none of you had to seek me out and let me know of things you thought would help me4 ,yet you did1 and as a result it has far more meaning than anything ,i have so far experienced4 ,when ,i feel the need to hold back and not live spontaneously for whatever reasons1 ,i remember that twelve persons 444 said to let go and 444 be myself and of all the unbelievable things they even loved me4444 ,this has given me the courage to come out of myself many times since then4444#a #a ,quoted in ,carl ,r4 ,rogers1 ,carl ,rogers on ,encounter ,groups 7,new ,york3 ,harper and ,row1 #aigj71 p4 #cc4 ,,the ,,risks ,unfortunately1 like many healing processes1 group therapy is not for everyone4 ,there are recognized risks of entering group therapy4 ,when members leave the intimacy of their group and return to the real world1 they may feel disappointed and discouraged4 ,their experience has given them the opportunity to dispense with social masks1 to become more authentic1 to see the lies and pretenses of others more clearly4 ,but the vast majority of people outside the group have not learned these things and do live behind masks they are not even conscious of4 ,when you gain from a learning experience a perspective you can share with comparatively few people1 you're likely to feel discontented and alienated4 ,you should also be aware that some of the changes that occur in group therapy simply may not last very long after the group stops meeting because the emotional and moral support offered by the group are no longer there4 ,or1 group therapy may make you aware for the first time of personal problems you had ignored or evaded1 leaving you hanging when the group terminates4 ,so group therapy may bring about a need to solve problems that1 before the group experience1 you didn't even #aib know you had4 ,these problems may then motivate you to enter individual therapy4 ,finally1 if you enter group therapy but your spouse does not1 your experience could bring marital tensions into the open1 leaving your spouse at a disadvantage4 ,your spouse1 who is unfamiliar with what transpired during your group sessions1 may react defensively and without empathy to your desire to talk about your feelings4 ,,group ,,techniques ,the techniques discussed below are commonly used in group therapy4 ,content ,analysis ,a member of the group describes a problem he or she is having1 and the therapist and other members make problem-solving suggestions4 ,their focus may be on why the person does not want to solve the problem or on how the person brought the problem on and maintains it4 ,group ,process ,after a series of interactions1 comments1 suggestions and personal observations by group members1 the therapist will ask the group to stand back and look at the pattern of their communication4 ,the group may become aware of the way one member is consistently overlooked and is not given a fair share of attention because of shyness or because another more forceful member dominates the group's attention4 ,models ,one member can work on personal problems in group therapy by noting how another member goes about handling a similar problem and then trying to learn from that example4 ,analysis of ,nonverbals ,the group therapist and members of the group can often help make an individual better aware of how his or her behavior has contributed to personal problems4 ,for example1 ,jim tends to be shy1 makes poor eye contact with people1 has bad posture1 and speaks indistinctly because he has a habit of covering his mouth #aic with his fingers4 ,the impression he makes on people is weak4 ,by helping him pay attention to these nonverbal habits1 group members can encourage ,jim to change so he will be more successful1 for example1 at job interviews and generally feel more confident4 ,,applications ,,of ,,group ,,therapy ,as we have seen1 group therapy is most helpful to people with these characteristics3 99 ,they are lonely1 socially isolated1 or passive4 99 ,their sense of worth depends greatly on what others think of them4 99 ,they would like to improve their interpersonal skills4 99 ,they may be drawn to group therapy for the practical reason that it tends to be less expensive than individual therapy4 ,group therapy has the distinct advantage of providing clients with multiple points of view2 they receive feedback from the therapist as well as from other members of the group4 ,group therapy is potentially useful for a very wide range of problems4 ,this is evident from the fact that most approaches to psychotherapy offer therapy in a group setting4 ,group therapy is generally not the treatment of choice for these individuals3 99 persons lacking communication skills 99 those who lack the motivation to attend group sessions regularly or who refuse to keep information about other group members confidential outside of the group 99 people who are severely disturbed 99 individuals who are intellectually impaired 99 those suffering from chronic depression 99 psychopathic or sociopathic adolescents 7who do not have a sense of social conscience7 ,group therapy1 as we have noted1 also appeals less to inner-directed individuals and is therefore less likely to be helpful to them4 #aid #ad ,,marriage ,,and ,,family ,,therapy ,for couples and families with problems of communication1 strain1 and conflict1 and for individuals whose difficulties are best resolved with the participation of other family members4 ,the family is the basic source of health or sickness4 ,vincent ,d4 ,foley1 ,current ,psychotherapies ,during the last forty years there has been a gradual shift away from an emphasis on individual therapy to a belief that many emotional difficulties people experience have their roots--and often1 also their solutions--in their marriages or families4 ,as this shift in emphasis grew1 many therapists saw that marriage and family relationships make up units1 or systems1 each with a personality of its own4 ,members of a family gain their identities from their roles in the family system4 ,this systems view made it possible for therapists to understand families and marriages more clearly as interdependent1 interlocking1 functioning wholes4 #aie ,marriage and family therapy treats emotional disorders in terms of the interdependent relationships among members4 ,the marriage or family system is thought of as a unit with properties that reach beyond the sum of the personal qualities of the individuals who make it up4 ,usually1 one person in a family or marriage is more troubled2 his or her symptoms are more pronounced4 ,the husband tends to feel his wife has the problem1 or vice versa4 ,mother and father feel that little ,richard is the problem4 ,however1 therapists believe that the problems experienced and expressed by the sick person are really signs that something is wrong with the whole system4 ,a heart problem is frequently part of a larger problem1 such as poor diet or excessive stress1 and the same is true for couples or families4 ,one person's distress tells the therapist that1 often1 something is troubling both husband and wife or all the members of a family4 ,this interdependence between partners of a marriage or members of a family system frequently leads to a complex situation in which emotional difficulties are contagious1 one person's improvement is connected with another's getting worse1 or treating one person separately draws the members of a relationship apart4 ,one of the very difficult problems troubled couples or families face is that emotional disturbance can often spread4 ,repeatedly1 therapists observe that there is a kind of subtle transmission from one generation to the next of inner conflicts and difficulties in coping with life4 ,and beyond this1 there are intimate connections between the emotional makeup and emotional balance of married partners or family members4 ,for example1 it is all too common for the partner of a chronically depressed person also to fall into a serious depression4 ,marriage and family therapists are therefore inclined to see the emotional disturbance of one member in terms of a troubled1 ineffective pattern of interaction4 ,because of their close ties1 sometimes one person's behavior1 attitudes1 or feelings get better while another family member develops new symptoms or problems4 ,we will look at a real example of this in a moment4 ,marriage and family therapists have noticed that1 when one person in a marriage or family is treated separately1 the family members frequently are drawn apart instead of brought closer #aif together4 ,therefore1 therapists generally feel it is essential to see husband and wife together or to involve both parents and children in therapy4 ,the purpose of marriage or family therapy is not only to resolve existing problems but also to help clients cultivate a new way of communicating and interacting together4 ,marriage therapy and family therapy of course seek to relieve emotional distress by helping to reduce or end conflicts and to lessen anxiety1 frustration1 anger1 or resentments4 ,but beyond these1 marriage and family therapists try to show clients how to complement one another's personal needs4 ,they also attempt to strengthen bonds between them so that they are able to face crises and emotional upsets with greater strength1 balance1 and courage4 ,and they try to redirect clients' values in a way that will support the personal growth of each person4 ,how long marriage or family therapy will take depends primarily on the goals of the couple or family4 ,here are some estimates3 99 to reduce tensions3 perhaps six sessions 99 to reduce symptoms such as emotional distress or behavioral problems3 ten to fifteen sessions 99 to improve communication habits3 twenty-five to thirty sessions over six to eight months 99 to restructure relationships so that members of the family system will have more independence and will cultivate an awareness that they do have separate identities3 forty sessions or more ,,what ,,marriage ,,and ,,family ,,therapies ,,are ,,like ,marriage therapy and family therapy are distinct from group therapy in two important ways4 ,first1 unlike in group therapy the clients in marriage or family therapy have a shared history and1 if therapy is successful1 will often be able to enjoy a shared future4 ,second1 in marriage and family therapy1 the therapist is more active and directive than in group therapy4 ,any changes made by members of a group come about because of interactions among the group members2 a group therapist acts as a moderator or facilitator1 while the role of a marriage or family therapist resembles that of a teacher4 #aig ,marriage and family therapy focuses on present interactions between husband and wife or among family members4 ,it is not that the past is judged to be unimportant1 but it is not generally useful to pay a great deal of attention to what has already happened4 ,what causes problems now are the current patterns and habits of interaction in the family or marriage4 ,a wife may have been drinking for fifteen years because her mother undermined her sense of self-confidence1 but the fact is that she no longer lives with her mother4 ,however1 she did choose to live with a man who continued her mother's pattern of undermining abuse4 ,a marriage therapist will focus on present difficulties and1 by doing this1 may be able to help her resolve her drinking problem by improving a troubled relationship with her husband4 ,jay ,haley 7#aibc-bjjg71 a leading marriage and family therapist1 has expressed the belief that concentrating on feelings and thinking will not lead to change1 that empathy on the part of the therapist does not correct problems1 and that insight often just provides an excuse for intellectual rationalization and game-playing4#a #a ,jay ,haley1 ,marriage ,therapy1 in ,gerald ,d4 ,erickson and ,terrance ,p4 ,hogan1 eds41 ,family ,therapy3 ,an ,introduction to ,theory and ,technique 7,monterey1 ,,ca3 ,brooks_/,cole1 #aigb71 pp4 #ahj-baj4 ,because the patterns of behavior of a troubled couple or family tend to be very rigid1 therapists have found that strongly directive techniques are most effective4 ,their focus is on developing interventions--or therapeutic strategies--that will have a real impact on the complex patterns of interaction that have come to paralyze a couple or a family4 ,what seems to help in marriage and family therapy is ingenuity on the part of the therapist that will give him or her power or control over a situation that is out of control4 ,one way to do this is to force clients into a paradoxical situation4 ,for example1 the therapist may prescribe that a couple or members of a family continue their present unsatisfying behavior4 ,as a result1 they may 7and very likely will7 rebel so that desired change comes about4#b #b ,as we have seen1 logotherapy and ,adlerian therapy both make use of this technique1 as do family therapists1 as we will see later on4 ,all family therapy is marriage therapy to a certain extent4 ,and so1 suppose we first look more closely at what marriage therapy is like4 #aih ,,marriage ,,therapy ,marriage therapy is generally advisable#c when the husband or wife has sought help in individual counseling but this has not been helpful4 ,sometimes the marital relationship itself inhibits1 or even undermines1 the improvement of the most troubled person4 ,for example1 individual therapy did nothing to help one woman who was suffering from severe chronic anxiety4 ,when her husband was asked to participate in treatment1 it was found that he abused his wife continuously but subtly4 ,whenever she spoke1 he would criticize her views and indirectly slight her worth2 when he lost something1 he would often accuse her of misplacing it4 ,the problem she had come for help with turned out to be marital rather than individual4 #c ,see ,jay ,haley1 ,marriage ,therapy1 pp4 #ahj-baj4 ,if you are unable or unwilling to communicate openly and adequately with a therapist1 marriage therapy may encourage your spouse to become more involved in the process of therapy4 ,often1 having the other marital partner present will stimulate an otherwise silent client to express himself or herself1 especially to correct what the other partner has to say6 ,if you suddenly become severely troubled at the time of a marital conflict1 marriage therapy may be useful4 ,a spouse who falls into a deep depression immediately after a quarrel may be troubled in a way that marriage therapy can treat4 ,finally1 marriage therapy is of course essential if a husband and wife are in conflict and serious distress and cannot resolve their differences4 ,frequently1 one spouse 7usually the wife7 will want marriage therapy2 the other will come1 but reluctantly4 ,however1 both often will come1 because if one is in distress the other is affected4 ,conflicts in marriage frequently come about because of disagreements having to do with the couple's rules for living together1 especially regarding how each is to treat the other4 ,who sets the rules is often another area of conflict1 as are incompatible rules4 ,for example1 a wife insists that her husband stop being a mama's boy and demeans him for being dominated by a woman2 yet it is she who seeks to dominate her husband by insisting that he be more domineering4 ,in marriage therapy 7and also in family therapy71 therapists #aii encounter a great deal of resistance to change on the part of their clients4 7,alas1 so do all other therapists67 ,a main reason for resistance is that1 in a marital relationship or family system1 change in one member's feelings and behavior will tend to affect another's1 often in unsuspected ways4 ,change disturbs the established balance of their system1 a balance that does serve some purposes4 ,jane ,dowland1 for example1 went to see ,dr4 ,carlton because of her husband's depression4 ,phil had lost his job and now spent most of his time at home1 feeling sorry for himself and collecting unemployment benefits4 ,jane was easily upset and felt terribly insecure4 ,dr4 ,carlton recommended that ,phil accompany ,jane to the next session4 ,after seeing ,phil1 ,dr4 ,carlton referred him to a psychiatrist1 who was able to treat ,phil's depression effectively in four months' time with medication4 ,jane1 however1 continued to feel severely 7and perhaps even more7 anxious1 although ,phil's symptoms were now under control and he was back at work4 ,dr4 ,carlton recommended marriage therapy to ,jane and ,phil4 ,they saw ,dr4 ,carlton once a week for three months4 ,it became clear to ,dr4 ,carlton1 and eventually clear to ,jane1 that without realizing it she had used ,phil's depression as an excuse for her own anxiety so that she could evade responsibility for herself4 ,she came to realize that she had been unable to resolve her own conflicting needs--whether to have children in spite of ,phil's disinterest in children or whether to commit herself to developing a career4 ,treating ,phil's depression led ,jane to become aware of her own problems4 ,the balance in their relationship was changed by therapy3 ,jane found out that ,phil's depression was really a problem that served a purpose for her--without it1 she needed help for herself4 ,because of the complex1 interwoven nature of a marital relationship1 it is often difficult to separate the problems each partner may experience4 ,one partner's symptoms may mask the other's problem4 ,or1 one person's problem may be perpetuated by the other's behavior1 interfering with the resolution of the problem4 ,further1 each partner may encourage distress in the other as a result of differing expectations concerning rules of living together and who sets them4 #bjj ,,family ,,therapy ,in family therapy1 the identified patient is seen as but a symptom1 and the system itself 7the family7 is viewed as the client4 ,vincent ,d4 ,foley1 ,current ,psychotherapies ,very often1 one family member is labeled the one with the problem1 the one who is sick4 ,when the family decides to enter therapy1 it is usual for family members to feel troubled1 scared1 and confused4 ,they realize that something is wrong1 but they are uncertain about what is amiss and don't know what to do4 ,the usual response to this perplexity is to push the identified patient forward--usually a child who is the problem--and try to make him or her the focus of treatment4 ,as the members of the family are interviewed1 individually and together1 the therapist is able to assemble a coherent picture of the family1 its typical ways of interacting1 the habitual1 automatic patterns of response of one family member to another1 the family's values and beliefs4 ,what one member tries to hide another often will express4 ,the family therapist has a difficult double role1 as both observer and participant4 ,he or she needs to be able to notice what the styles of interaction of individual family members are and at the same time interact with members of the family4 ,the therapist tries to bring about meaningful emotional interchange1 create an atmosphere of trust and rapport1 and reduce the feeling that family members are threatened4 ,over time1 the therapist seeks to show the members of a family how they tend to interrelate inappropriately1 how their own ineffective defenses cause them to hurt one another4 ,to do this1 the therapist has to be able to cut through the vicious circles of resentment1 anger1 blame1 frustration1 and intimidation that frequently hold families in a death grip4 ,,the ,,therapist',s ,,functions ,in both marriage and family therapy therapists must3 99 establish a sense of rapport and trusting communication between clients and themselves #bja 99 use this rapport to bring out the conflicts1 frustrations1 and inadequate means of communication that burden their clients 99 see through denials1 rationalizations1 and excuses 99 push family members to put out in the open feelings and pains they have kept from one another 99 bring to a halt the family's tendency to focus on one person as a scapegoat1 the problem 99 act in understanding1 calm1 and emotionally supportive ways and help supply the emotional stability that the couple or family temporarily lacks 99 try to exemplify or personify for clients what it is to be adult1 mature1 caring1 and able to relate openly and without feeling threatened ,,marriage ,,and ,,family ,,therapy ,,techniques ,marriage and family therapists may use a variety of techniques to encourage their clients to change in constructive ways4 ,for example1 it is becoming more common to videotape sessions so that couples and families may become more aware of their automatic1 self-destructive patterns of interaction--which makes it easier to change them4 ,family therapists also sometimes make home visits3 often1 being in their own familiar surroundings will encourage family members to let down their defenses and more clearly define the problems that need to be resolved4 ,another innovation that is becoming more widespread is multifamily therapy4 ,two or three families participate together in an especially modified form of group therapy so that each family can see its own problems in clearer perspective and learn by seeing more or less troubled interactions among members of another family4 ,techniques drawn from behavior modification are frequently used in family therapy1 especially when family difficulties seem to be localized around the behavior of rebellious or delinquent children4 ,paradoxical intention1 discussed in ,chapter #aa1 can also be very helpful in marriage and family therapy4 ,instead of trying to restore a state of balance between husband and wife or among family members--something that usually stimulates the couple or family to fight to hold on to its old habits--a therapist #bjb encourages a state of imbalance so that the unbalanced system falls of its own weight4 ,the cure1 paradoxically1 may lie in intensifying the problem4 ,for example1 a wife has migraines that prevent her from doing her family chores4 ,a child throws up when he is forced to go to school4 ,both claim that they just can't help it4 ,the therapist's response might be1 ,i realize you can't help it4 ,what ,i want you to do1 ,alice1 when you feel household chores are just too much1 is to go to bed and permit yourself to have a migraine4 ,don't fight it4 ,go ahead and have a bad headache4 ,it gives you some relief1 so ,i want you to do this through your own choice4 ,and you1 ,johnny1 ,i want you to go into the bathroom before you leave for school and throw up4 ,it is unpleasant1 but it hasn't hurt you4 ,if you need to1 stick your finger down your throat4 ,i want you to take control and make yourself throw up each morning before going to school4 ,and you1 ,alice1 you won't interfere or try to mother him2 let him alone4 ,but do remind him to go and throw up4 ,in a very short time1 the results of these paradoxical strategies can be surprisingly effective4 ,,applications ,,of ,,marriage ,,and ,,family ,,therapy ,as in all approaches to therapy1 the effectiveness of marriage and family therapy depends on the strength of the clients' desire to overcome the difficulties that have motivated them to ask for help4 ,goodwill and commitment to change may or may not be there4 ,sometimes a therapist can help clients become aware of their deep-seated but habitually ignored feelings of warmth toward one another4 ,at other times1 marriage therapy may lead to separation and divorce1 if a couple comes to realize that their goals really are not compatible and what each needs or wants from the relationship the other is not able or willing to give4 ,marriage therapy and family therapy are not magic wands that can be waved over trouble to make things better4 ,therapists can make specific recommendations1 they can help a couple or family become explicitly aware of destructive patterns1 they can point to and illustrate constructive ways of interacting1 and they can sometimes use therapeutic strategies to break old habits and make room for care and sensitivity to the needs of wife1 husband1 and children4 ,these interventions from a therapist can be very #bjc helpful1 perhaps even crucial1 but they are1 at most1 catalysts for change3 real and lasting changes can only come from clients themselves4 ,marriage or family therapy is ideally an educational experience4 ,what wife1 husband1 and children do with what they have learned is1 in the end1 up to them4 ,family therapy has been especially effective in dealing with these problems3 99 problems due to conflicts among family members 99 emotional disturbances in children 99 some cases of schizophrenia where members of the family are frequently not well-individuated--each person's identity is so bound up with the outlooks and behavior of other family members that no one has a clear sense of his or her own personal identity and separateness 99 problems that are interlocking1 where the difficulties of one member of the family cannot be resolved without the cooperation of the others 99 problems experienced by a family when a child becomes old enough to leave home ,family therapy has been much less effective in treating paranoia in one member of the family1 and behavioral problems stemming from sexual disorders4 ,marriage therapy has been effective in helping couples with any of these characteristics or problems3 99 ,they communicate and interact in ways that lead to conflict1 frustration1 anger1 and unhappiness4 99 ,they are insufficiently sensitive to one another's needs4 99 ,they have unstated and conflicting expectations concerning their relationships4 99 ,they will work together to help one partner overcome individual difficulties4 #bjd #ae ,,channeling ,,awareness3 ,exercise1 ,biofeedback1 ,relaxation ,training1 ,hypnosis1 and ,meditation ,all of these approaches to therapy serve to channel awareness in particular ways1 to provide a point of focus for the mind4 ,they are all processes that eliminate distractions and enable you to direct your awareness in ways that are basically different from normal1 everyday waking consciousness4 ,special kinds of absorption or concentration characterize the therapeutic uses of exercise1 biofeedback1 relaxation training1 hypnosis1 and meditation4 ,,the ,,psychotherapy ,,of ,,exercise ,for some individuals who already are or who are willing to become physically fit1 sustained vigorous exercise can significantly decrease symptoms of tension1 anxiety1 and depression4 ,it is my contention that1 just as prayer1 meditation1 dream analysis and some drug experiences open doors into these areas not usually accessible to us1 under the appropriate circumstances slow long-distance running opens similar doors4 ,the subjective experience of the runner appears the same1 and he becomes revitalized or reenergized in a psychological #bje or spiritual or creative sense4444 ,it is clear to me that this is a distinct form of psychotherapy4 ,thaddeus ,kostrubala1 ,the ,joy of ,running ,many studies have been made and a small mountain of literature has accumulated about the physical effects of exercise4 ,however1 little attention has been paid to its psychological aspects1 particularly in connection with the kinds of symptoms and problems that bring people to psychotherapy4 ,psychiatrist ,thaddeus ,kostrubala 7#aicj- 7 has been one of the pioneering contributors to the study of exercise as a form of psychotherapy4 ,dr4 ,kostrubala is a dedicated runner who has completed many marathons and who uses running as a therapeutic approach in his practice4 ,much of the modest amount of research on the psychotherapeutic value of exercise has focused on running1 probably for the following reasons3 ,first1 slow long-distance running seems to be an anatomically natural activity for us1 with our species' two relatively long legs4 ,second1 running appears to be an especially effective way to derive specific therapeutic benefits from an aerobic activity4 ,and1 of course1 running has recently become very popular4 ,most exercise physiologists claim that the physical1 and very likely also the psychological1 effects of other aerobic forms of exercise1 such as bicycling1 swimming1 and cross-country skiing1 are essentially equivalent to running4 ,so1 until we know otherwise1 we will assume that what is true of running is likely to be true of other types of exercise that make similar demands on the body1 and we will focus here on running4 ,dr4 ,kostrubala has attempted to describe a particular approach to running that seems to have definite psychotherapeutic value4 ,more is involved than donning a pair of running shoes and starting out1 as we will see4 ,dr4 ,kostrubala has found that running is emotionally or mentally therapeutic under certain conditions4 ,first1 you need to make sure that you are in medically good condition to begin a therapeutic running program4 ,it would be prudent to have a thorough physical and1 if you are over forty1 also a stress test4 ,you need to do warm-up exercises1 which any good book on running describes in detail1 and then you need to build up your endurance--gradually and patiently--until you can run a minimum of three times a week for an hour each time1 without stopping1 and #bjf with a pulse rate of at least #ge percent of your maximum heart rate4 7,your maximum heart rate is #bbj beats per minute minus your age4 ,if you are #dj years old1 your maximum heart rate is #ahj4 ,seventy-five percent of #ahj yields a pulse rate of #ace beats per minute4 ,if you are #dj1 you would want to run for an hour so as to maintain a pulse rate of #ace beats per minute during your run4 ,by way of encouragement1 you may want to know that #ge percent of a person's maximum heart rate represents1 for almost everyone1 a slow1 easy jog47 ,second1 you must have a noncompetitive attitude toward running4 ,whether you're comparing yourself to others or just trying to beat your own running record1 a competitive drive rivets your attention on a goal separate from yourself4 ,this misplaced emphasis will undermine the therapeutic value of the activity4 ,you also should either run alone or with someone who won't distract you by talking4 ,direct your attention within--to the rhythm of your pace1 the regularity of your breathing1 maintaining relaxation in your shoulders1 back1 and feet4 ,to prevent distraction it is also important to run in an area or around a track that is familiar to you4 ,for slow long-distance running to have a therapeutic effect1 you cannot be a sightseer4 ,the novelty of unfamiliar surroundings will distract you from being inner-directed1 which is therapeutically important4 ,finally1 be aware of the physical risks4 ,if you begin to feel dizzy1 stop running4 ,in hot weather1 dizziness is a first warning sign of heat exhaustion1 which can lead to heatstroke4 ,if you feel a snap in one of your running muscles1 stop4 ,an internal snapping or popping noise can mean that a muscle or tendon has torn1 or a small bone has broken4 ,make sure you are all right before resuming4 ,if you have a cramp-like pain in your side1 which is very common1 try slowing down1 exhaling forcefully1 giving a yell1 or singing4 ,you can often keep going1 and the pain will subside4 ,if it does not1 or it gets worse1 you'll need to stop to rest4 ,,what ,,running ,,as ,,therapy ,,feels ,,like ,the psychological effects of regular1 slow long-distance running can be impressive if you follow the directions above4 ,during the first twenty minutes1 you may feel slow and stiff and not very inspired about the run4 ,you may find yourself in a sour mood4 7,there is even a term for this phase3 dysphoria47 #bjg ,persuade yourself that it is not important and keep going4 ,between twenty and thirty minutes1 if you are dysphoric1 that feeling may peak2 some people even begin to cry4 ,this is not necessarily depression2 it may actually feel good4 7,another reason to run alone3 other people won't understand and may want to rescue you from your therapeutic endeavor47 ,at some point1 after about thirty minutes of running1 you will probably find that your mind refuses to do any more problem solving4 ,you stop worrying1 problems you may have been dwelling on simply begin to feel distasteful1 and your mind clears4 7,after a good run1 when you do return to the problem1 you may well find that it is less difficult to think through47 ,between thirty and forty minutes1 many people begin to feel more open--their breathing begins to come more freely1 and their whole system seems to work more smoothly and with less effort4 ,this can be a wonderful feeling4 ,after you have been running for forty minutes1 the first alterations in your consciousness may begin4 ,your senses begin to feel more alert1 more alive4 ,things seem more vivid--the colors of leaves1 the song of a bird1 the freshness of the air4 ,runners who have experienced this say that this natural1 vivid1 fresh sense of perception is unique2 to some extent it may resemble the experience that comes from meditation1 biofeedback1 or drugs4 ,this experience seems not to occur before forty minutes of running4 ,it may be an experience of mild euphoria1 or you may feel it as a marked increase in aesthetic sensitivity or as a sense of growing inner serenity4 ,,applications ,,of ,,exercise ,,as ,,psychotherapy ,i'm sure that these experiences are closely related to meditation4 ,the clearing of consciousness1 the ability to find a central focus within1 the delight of a clear mind1 the sense of refreshment of the soul are reported both by those who practice meditation and by long-distance runners4 ,the difference between the two techniques is in the physical effects of the running4 ,it is as if those who meditate have found one half of the picture4 ,the runners who just compete and do not reach for the psychological aspects have found the other half4 ,the runners who are able to slow down and search for the psychic aspects will have both--the soul and the body4 ,thaddeus ,kostrubala1 ,the ,joy of ,running #bjh ,even though aerobic exercise such as slow long-distance running can produce a feeling of moderate depression during the first thirty minutes1 people who have moderate1 lingering depressions in daily life often find that1 as described above1 depression disappears after about forty minutes4 ,anger and hostility also seem to be much reduced after about thirty minutes of running4 ,the repetitive rhythm and sustained exertion of slow long-distance running appear to tire the conscious mind4 ,many anxieties1 tensions1 worries1 feelings of guilt1 anger1 and depression lift4 ,the easily distracted1 constantly nervous and shifting focus of everyday consciousness gives way to a sense of integration1 of being one with yourself and the activity of running4 ,o chestnut tree1 great rooted blossomer1 ,are you the leaf1 the blossom or the bole8 ,o body swayed to music1 ,o brightening glance1 ,how can we know the dancer from the dance8 ,w4 ,b4 ,yeats1 ,among ,school ,children ,the therapeutic use of running appears to offer the following benefits3 99 increases mental energy1 acuity1 and concentration 99 strengthens self-confidence and a sense of personal worth 99 increases a capacity for work so that you feel less tired at the end of the day 99 diminishes smoking1 drinking1 and other unhealthy habits 99 helps those with eating disorders--who either are overweight or dangerously underweight--change their eating habits 99 lessens or lifts depression 99 improves relationships that were destructive or motivates people to separate 99 reduces or eliminates confused and irrational thought processes in some schizophrenic patients ,treating ,depression ,in particular1 running as described here appears to be especially effective in treating depression3 444 it's hard to run and #bji feel sorry for yourself at the same time4#a ,running tends to increase your sense of independence and self-confidence1 which have been weakened if you have been depressed4 ,psychotherapy and drug therapy1 in contrast1 may encourage dependency on the therapist or psychiatrist4 #a ,james ,fixx1 ,the ,complete ,book of ,running 7,new ,york3 ,random ,house1 #aigg71 p4 #af4 ,dr4 ,kostrubala has noticed that long-distance running often greatly reduces or even eliminates the typical early morning awakening and insomnia of the chronically depressed person4 ,this particularly painful symptom involves jarring awake to a new day to be faced--a day of anxiety1 fears1 and hopelessness to be combated4 ,if you have experienced this1 you are probably familiar with waking up too early1 at what the ,swedes call the hour of the wolf1 lying in bed1 exhausting yourself with crushing worries1 despair1 and tears1 and beginning the day in a state of emotional exhaustion4 ,kostrubala has found that as depressed people cultivate the habit of long-distance running1 these early morning ordeals often gradually subside and disappear4 ,a ,british medical group led by ,dr4 ,malcolm ,carruthers discovered that individuals who exercise vigorously produce increased levels of the hormone epinephrine1 which counteracts depression4 ,apparently1 strong exercise for even ten minutes doubles the normal level of epinephrine2 the effects of the heightened level of the hormone can be fairly long-lasting4 ,another study1 by psychiatrist ,john ,greist at the ,university of ,wisconsin1 revealed that one group of seriously depressed patients benefited more from a ten-week session of therapeutic running than another group benefited from traditional therapy4 ,to summarize research findings on exercise as a treatment for depression3 99 ,to be effective1 vigorous exercise must be done regularly no less than three times a week1 and preferably at least five times a week1 for periods lasting between thirty minutes and an hour4 7,dr4 ,kostrubala uses an hour as a goal47 99 ,although running and running combined with walking are the most commonly used therapeutic forms of exercise1 any regular aerobic exercise is likely to produce the same #baj antidepressant effects when done for proportional periods of exertion4 99 ,studies over the past ten years show that lessening depression by means of exercise is most successful for persons with mild to moderate depression1 but vigorous exercise tends not to benefit patients with severe depression4#b #b ,john ,h4 ,griest and ,james ,w4 ,jefferson1 ,depression and ,its ,treatment 7,washington1 ,,dc3 ,american ,psychiatric ,press1 #aihd71 p4 #fc4 ,lessening ,anxiety ,therapeutic running also tends appreciably to lessen anxiety4 ,a research study conducted by ,dr4 ,herbert ,a4 de,vries of the ,university of ,southern ,california ,school of ,medicine and ,gene ,m4 ,adams of ,,usc's ,gerontology ,center found that fifteen minutes of moderate exercise diminished anxiety more in people aged fifty-two to seventy than did #djj-milligram doses of meprobamate1 a widely prescribed tranquilizer4 ,for ,schizophrenics ,therapeutic running also seems to benefit schizophrenic patients4 ,schizophrenia is a complex1 difficult-to-treat illness that affects approximately #a percent of the world's population4 ,it is no respecter of particular cultures4 ,there are many forms of the illness1 but all are characterized by disabling blockages to normal human interrelation1 strange behavior1 loss of contact with reality1 and withdrawal1 paranoia1 or hallucinations4 ,again1 ,dr4 ,kostrubala has attempted to help patients with this condition through a combined program of medication1 psychotherapy1 and therapeutic running4 ,although he is careful to emphasize that controlled studies have yet to be made1 his judgment about the patients he has treated is that 444 using this form of running therapy 444 ,i have seen them change dramatically4 ,they begin to lose their symptoms2 medication can be reduced and often discontinued2 and they have picked up the course of their lives until several are no longer recognizable as schizophrenics at all--even by professional observers4#c #c ,thaddeus ,kostrubala1 ,the ,joy of ,running 7,philadelphia3 ,j4 ,b4 ,lippincott1 #aigf71 p4 #abi4 #baa 444 ,i have come to the conclusion that running1 done in a particular way1 is a natural form of psychotherapy4#d #d ,kostrubala1 ,the ,joy of ,running1 p4 #aai ,the ,risks ,since therapeutic running appears to be of psychiatric value1 it is not surprising that it1 like any attempt to heal1 may have potential risks4 ,aside from the obvious potential for sports-related injuries1 there is a specific risk3 physical addiction4 ,dr4 ,william ,glasser1 whose approach to psychotherapy we discussed in the section dealing with reality therapy 7,chapter #aa71 agrees with ,kostrubala that therapeutic running is addictive4 ,glasser calls it a positive addiction1 since--unlike the use of alcohol1 barbiturates1 and opiates--running is constructive and therapeutic4#e ,however1 like alcoholism and drug addiction1 therapeutic running does produce very real withdrawal symptoms if a dedicated runner cannot continue to run1 whether temporarily because of an injury or illness1 or permanently4 ,withdrawal symptoms can be surprisingly severe3 primarily1 strong anxiety and insomnia1 but sometimes also restlessness1 sweating1 weight gain or loss1 and_/or depression4 #e ,william ,glasser1 ,positive ,addiction 7,new ,york3 ,harper and ,row1 #aigf71 ,chapter #e4 7,chapter #f of his book is devoted to another positive addiction1 meditation47 ,,biofeedback ,in psychotherapy1 especially useful for clients with problems involving anxiety1 depression1 phobias1 and insomnia1 who will benefit from learning how to lessen their own tension4 ,most of us can draw a relatively clear line between the physiological processes we can control and those we cannot4 ,unless an illness or accident or handicap interferes1 we have voluntary control over many muscles1 but there are many that1 fortunately1 work without our conscious intercession3 the heart beats day and night1 our lungs fill and empty1 our digestive processes are automatic4 ,except for people who have voluntary control over the muscles that move their ears1 we are all more or #bab less equally endowed1 and equally limited1 in what physical processes we are able to influence4 ,until the development of biofeedback1 there was only one way to extend self-control beyond the normal range3 through a disciplined and time-consuming practice such as yoga4 ,experienced practitioners of yoga claim that studying yoga over a period of years has given them a sense of personal integration and mental centering similar to what we will see in connection with the practice of meditation4 ,physical and emotional flexibility also seem to result from long-term yoga practice4 ,some yogis have extended their range of control over inner1 normally involuntary processes in dramatic ways4 ,some can cause their heart rate to increase to five times its resting rate4 ,some are able to cause a ten-degree temperature difference between the thumb and little finger of the same hand3 one side is flushed and hot1 the other side cool and pale4 ,many other forms of self-control have been documented1#f but acquiring these special skills through the practice of yoga takes years of discipline1 concentration1 and tenacity4 ,but the years of dedication seem also to be indispensable if one is to develop the qualities of inner tranquility and strength sought by yogis4 #f ,see1 e4g41 ,mircea ,eliade1 ,yoga3 ,immortality and ,freedom 7,princeton1 ,,nj3 ,princeton ,university ,press1 #aieh74 ,biofeedback has greatly shortened the yogis' road to conscious control of some physical processes1 and1 in turn1 it has become the main contribution technology has made so far to psychotherapy4 ,many of the physical processes that biofeedback training can help you learn rather quickly to control influence your emotional well-being4 ,biofeedback equipment can enable you to learn1 for example1 how to will a state of muscular relaxation1 how to gain a measure of control over your physical response to stress or pain1 even how to raise or lower your blood pressure or heart or respiration rate4 ,to use biofeedback equipment1 electrodes are taped to the areas of your body that are to be monitored4 ,they may measure such things as skin temperature1 skin moisture1 muscle tension1 pulse and breathing rates1 or brain wave patterns4 ,the feedback from which you learn to control normally involuntary processes occurs when the measurements made by the instruments are externalized for you3 you are able to see a pattern on a computer #bac monitor or oscilloscope or hear a changing tone that gives you immediate information about your physical responses4 ,in other words1 biofeedback is an electronic way of representing inner processes externally that are usually automatic1 involuntary1 and unconscious4 ,,physical ,,applications ,frequently1 and relatively quickly1 many people are able to learn how to control many of their internal responses very well4 ,biofeedback can sometimes be an alternative to using medication to reduce tension or pain4 ,its range of applications has grown tremendously4 ,here are some examples of its uses3 ,a woman was badly injured in an automobile accident4 ,on one side of her face her facial nerve was severed1 leaving her unable to move any part of the left side of her face and unable to close or blink her left eye4 ,surgeons decided to splice the severed facial nerve to a nerve in her neck-shoulder muscle4 ,once this was done1 the woman could shrug or twitch her shoulder1 and in this way cause the paralyzed side of her face to move1 and blink her left eye4 ,however1 the movements of the left side of her face were uncoordinated1 spastic1 and not synchronous with the movements of the uninjured right side of her face4 ,biofeedback training seemed to offer a possible solution4 ,electrodes were taped to the injured side of her face4 ,the electrical activity of muscles in the damaged area was displayed on a screen1 along with the pattern that would be produced by undamaged facial nerves and muscles4 ,the woman's task was to watch the two patterns and somehow learn by inner experiment how to control the left side of her face so its movements would match the normal pattern and would then coordinate with movements of the other side4 ,her training lasted for several months4 ,because of her persistence and hard work1 she was successful in learning to match the normal pattern2 she was now able to move the two sides of her face in symmetrical harmony4 ,other successful physical applications of biofeedback therapy include these3 99 controlling high blood pressure 99 learning to raise blood pressure in cases of spinal injuries #bad that block the automatic raising of blood pressure when a person stands up 7excessively low pressure causes them to faint7 99 coping more effectively with asthma attacks 99 eliminating migraine headaches 99 helping children with cerebral palsy control muscle spasms 99 helping stroke victims with proprioception problems 7in which they lose the sense of where their arms and legs are in space7 99 teaching patients with circulation problems 7e4g41 blood clots in the legs7 to dilate their blood vessels1 regaining movement and reducing pain 99 assisting stutterers by helping them become aware of unnecessary and interfering muscle contractions they have come to make habitually when they speak and teaching them how to relax these muscles 99 reducing tension and pain in arthritis patients ,to date1 of all the areas to which it has been applied1 biofeedback has been most successful for patients who are physically paralyzed or have movement disorders4 ,,psychotherapeutic ,,applications ,biofeedback has been used successfully in psychotherapy in these ways3 99 teaching general relaxation methods1 which can be useful to many people who have problems that involve anxiety1 depression1 or phobias 99 assisting people with insomnia1 also through relaxation techniques 99 teaching people how to recognize effective meditation by making them aware of periods during sessions of meditation when their brainwave patterns slow 7see the last section in this chapter1 on meditation7 ,increasingly1 biofeedback is being used to treat emotional disorders in conjunction with both psychotherapy and medication4 ,it is one of the ways available to us to enlarge the range of our conscious control over ourselves and our lives4 #bae ,,relaxation ,,training ,primarily a coping strategy to help people continue to function in an environment of stress4 ,the pervasive phenomenon of stress is the hidden epidemic of the ,united ,states and other highly industrialized countries4 ,it is associated with high blood pressure1 hardening of the arteries1 strokes1 ulcers1 colitis1 and a host of other physical conditions4 ,and severe stress endured too long leads to emotional breakdown4 ,all physical materials can be loaded or stressed to a certain point beyond which they distort1 snap1 fracture1 or break4 ,stress loads human beings physically as well as emotionally4 ,any change--whether for good or for ill--is a stressor4 ,as human beings1 we are not simple engineering materials that form simple cracks or breaks1 and when stressful events are strong enough1 we begin to crack or break in ways that are considerably more complex4 ,physical disease1 emotional disorders1 and mental illnesses are the cracks or breaks that occur in human material4 ,statistics show that common forms of severe stress do cause us to break4 ,for example1 compared with others the same age1 ten times more people die during the year following the death of their husbands or wives4 ,in the year after a divorce1 ex-spouses have an illness rate twelve times higher than married people the same ages4 ,in addition1 chronic anger1 anxiety1 and depression appear to weaken the body's immune system1 increasing the likelihood of serious disease4 ,individuals do1 of course1 have different emotional breaking points1 but we know that prolonged high levels of anxiety erode a person's psychological integration4 ,what results is nervous breakdown--a term that is vague and means little more than a blown fuse due to emotional overload4 ,the aftermath of such an overload may leave a person with depression1 anxiety1 and the inability to function as usual for a considerable period of time4 ,relaxation training1 along with the other therapies discussed in this chapter1 is an antidote or prevention for human breakage brought about by excessive stress4 ,the central belief on which relaxation training is based is that you cannot be tense and anxious if you are physically very relaxed4 #baf ,there are two main approaches to relaxation training4 7,we have already briefly discussed them in ,chapter #ab in connection with desensitization47 ,in both approaches you begin by reclining or lying down in a quiet room4 ,relaxation can then be achieved through tension and release or through suggestion4 ,in the former1 you tense a given muscle group1 holding the tension for five to ten seconds1 then release the tension and experience the relief from tension1 or relaxation4 ,in the latter1 you consciously suggest to yourself that a group of muscles feels warm1 heavy1 very heavy1 and relaxed1 sinking into the recliner or bed or floor4 ,both approaches aim to achieve two things3 to bring about deep1 progressive muscular relaxation and to increase your sensitivity to the presence of tension in your body when it exists4 ,relaxation training is a learned skill4 ,if you practice it regularly--that is1 daily1 for at least several weeks--you can gain increased control over your major muscle groups--those of the arms1 legs1 shoulders1 back1 abdomen1 neck1 and face4 ,you gradually learn to recognize even low levels of tension in these muscles so that the tension can be eliminated consciously4 ,eventually1 as you learn how to control physical relaxation1 you are able to achieve deep relaxation in increasingly shorter periods of time4 ,after regular practice over a period of months1 many people1 when they face a suddenly upsetting situation1 can quickly offset their emotional and physical reactions to stress by inducing a calm and relaxed state in themselves4 ,they are able to neutralize the stressor's potential for doing damage4 ,if you can learn to do this1 you have learned a skill in controlling your own life that is of great value4 ,it is a survival skill that can help you protect yourself against being worn down by stressful events that otherwise eventually lead to learned habits of anxiety and tension4 ,once formed1 these habits can be very difficult to get rid of4 ,for emotionally disturbed persons1 relaxation training techniques are useful primarily as an adjunct to psychotherapy or drug therapy and can be helpful in reducing tension and anxiety4 ,they are ways of treating symptoms2 they can help you continue to cope with stressful situations4 ,it is another question whether it is in your best interest to continue in a situation that causes you enough stress that relaxation training becomes a needed crutch4 ,sometimes it is wiser to change an unsatisfactory situation or to attempt to change your attitudes1 values1 or behavior #bag than it is to learn skills so that you can keep doing the same stressful and perhaps unsatisfying thing day after day4 ,relaxation training is a coping strategy4 ,by itself1 it cannot resolve the fundamental question3 whether it is better to learn how to numb yourself to an unhappy situation1 to leave it1 or to face the possibility that your stress is caused by inner conflicts and unrealistic attitudes rather than external factors4 ,if you cannot or do not want to leave a stressful environment1 techniques of relaxation training may benefit you4 ,if you feel the main problems are within you1 then psychotherapy may be the best alternative4 ,and sometimes1 throwing in the towel1 deciding in favor of a change of career1 marriage1 place to live1 or way of life may be most therapeutic and personally fulfilling4 ,it can often be hard to know which alternative is best4 ,counseling may help4 ,talking with good friends may help4 ,letting time pass may help4 ,usually1 ignoring discomfort will not help2 stress has a way of compounding and wearing you down4 ,waiting too long1 usually out of fear of facing a need for some form of change1 is itself a source of internal stress--of worry and anxiety that will not go away until you do something to put a stop to doing nothing4 ,,hypnosis ,an approach to therapy that can have far-reaching beneficial effects for people with many different kinds of problems1 especially useful for persons who are strongly motivated to change and can feel a deep sense of confidence in the humanity and competence of their therapist4 ,hypnosis is very old4 ,ancient ,egyptian records indicate that priests maintained temples of sleep devoted to healing the ill and troubled4 ,the priests are thought to have used hypnotic induction of sleep and to have offered assurance that patients would get well4 ,many centuries later1 ,franz ,anton ,mesmer 7#agcd-ahae7 developed a method for inducing a hypnotic trance state 7he associated it with sleepwalking7 and claimed that therapy often #bah was more effective when patients were in a trance4 ,hypnosis was later used by ,jean-,martin ,charcot 7#ahbe-ahic7 at the ,paris ,hospital of ,salptrire2 ,charcot was one of ,freud's teachers4 ,during ,world ,war ,,ii1 hypnosis was used to treat soldiers with amnesia1 paralysis1 and pain4 ,since then1 it has been used frequently by clinical psychologists and psychotherapists4 ,much is still not understood about the mental and physiological mechanisms involved in hypnosis4 ,they are difficult to define because they seem to assume many different forms in different people1 depending on their personalities and their moods at the time4 ,hypnosis probably occurs in daydreaming to some extent2 it probably is also involved when a mother lulls her child to sleep or when a customer succumbs to suggestions from a salesperson4 ,we all seem to be--vaguely and to some degree--familiar with the phenomenon1 yet we remain1 paradoxically1 ignorant of its existence4 ,,what ,,hypnosis ,,is ,,like ,for most people1 the experience of hypnosis is something of a letdown4 ,they anticipate that they will have an extraordinary experience in a trance state1 and yet what actually happens is very similar to their probably familiar experience of drifting into a state of relaxed distraction from time to time when daydreaming4 ,often what happens when we daydream is that our attention is focused on an object1 and we gradually relax and begin to drift into a state of partial awareness4 ,the phone may then ring1 but for a moment it can be unclear whether we are just imagining this4 ,the hypnotic state induced by a trained hypnotherapist is very similar4 ,when in a hypnotic trance1 you never become unconscious2 your mind continues to be active4 ,as you go gradually into a deeper trance1 your breathing and heart rates tend to slow1 and you feel increasingly more deeply relaxed4 ,usually1 the experience is one of being lulled into a state of calm repose4 ,sometimes--for example1 in former surgery patients who have had unpleasant experiences with anesthesia--hypnosis may cause people to become anxious or frightened and to refuse to continue4 ,you relax physically while in a hypnotic trance4 ,you will slump in your chair2 your breathing becomes slow and deep2 you move very little4 ,in other cultures1 however1 trance states take very #bai different forms4 ,behavior may become ecstatic1 even violent2 individuals may begin to dance frenetically and to spin about1 as in the case of ,algerian dervishes4 ,but in ,western society1 hypnotic trance usually takes the form of deep1 passive relaxation4 ,after their first experience with hypnosis1 most people tend to disbelieve that they have really been in a trance state4 ,they realize they have been pleasantly relaxed1 but they feel that hypnosis has not occurred4 ,clients who are suspicious1 hostile1 or feel threatened by the experience1 or who do not trust the therapist1 tend to resist hypnosis4 ,frequently1 on the other hand1 clients who are extremely anxious and feel greatly in need of help turn out to be especially good candidates for hypnosis4 ,if their first experience with hypnosis is comfortable1 safe1 and pleasant1 clients will usually allow themselves to drift into a deeper trance state in subsequent sessions4 ,many techniques exist to induce hypnosis4 ,commonly1 they make use of the well-known method in which you are asked to fix your attention on an object--a coin1 a stone1 a pendant--while the hypnotherapist speaks softly in a monotone1 suggesting that you are relaxing ever more deeply1 that your eyes are getting heavy1 and so on4 ,milton ,h4 ,erickson 7#aija-aihj7 has been one of the leading ,american contributors to recent developments in clinical hypnosis4 ,his ideas have been among the most creative1 imaginative1 and subtle in the field4 ,he is well known for his indirect induction techniques1 which1 because of the complex and unusual perspective they reflect1 we cannot deal with at any length here4 ,they are techniques that frequently induce a trance state without the client's being in the slightest way aware that this is happening4 ,dr4 ,erickson is often able to induce hypnosis only by means of a handshake4 ,an example may give some general idea of his approach4 ,dr4 ,erickson describes this technique3 ,when ,i begin shaking hands1 ,i do so normally4 ,the hypnotic touch then begins when ,i let loose4 ,the letting loose becomes transformed from a firm grip into a gentle touch by the thumb1 a lingering drawing away of the little finger1 the faint brushing of the subject's hand with the middle finger--just enough vague sensation to attract the attention4 ,as the subject gives attention to the touch with your thumb1 you shift to a touch with your little finger4 ,as your subject's attention follows that1 you shift to a touch with your middle finger and then again to the thumb4444 #bbj ,the subject's withdrawal from the handshake is arrested by his attention arousal1 which establishes 444 an expectancy4 ,then almost1 but not quite simultaneously 7to ensure separate neural recognition71 you touch the undersurface of the hand 7wrist7 so gently that it barely suggests an upward push4 ,this is followed by a similar utterly slight downward touch1 and then ,i sever contact so gently that the subject does not know exactly when--and the subject's hand is left going neither up nor down1 but cataleptic4 ,sometimes ,i give a lateral and medial touch so that the hand is even more rigidly cataleptic4444 ,there are several colleagues who won't shake hands with me1 unless ,i assure them first1 because they developed a profound glove anaesthesia when ,i used this procedure on them4 ,i shook hands with them1 looked them in the eyes1 444 rapidly immobilized my facial expression1 and then focused my eyes on a spot far behind them4 ,i then slowly and imperceptibly removed my hand from theirs and slowly moved to one side out of their direct line of vision4#g ,here is a characteristic reaction of one of ,erickson's colleagues to his procedure3 ,i had heard about you and ,i wanted to meet you and you looked so interested and you shook hands so warmly4 ,all of a sudden my arm was gone and your face changed and got so far away4 ,then the left side of your head began to disappear1 and ,i could see only the right side of your face until that slowly vanished also4444 ,your face slowly came back1 and you came close and smiled4444 ,then ,i noticed my hand and asked you about it because ,i couldn't feel my whole arm4 ,you said to keep it that way just a little while for the experience4#g #g ,milton ,h4 ,erickson1 ,ernest ,l4 ,rossi1 and ,sheila ,i4 ,rossi1 ,hypnotic ,realities3 ,the ,induction of ,clinical ,hypnosis and ,forms of ,indirect ,suggestion 7,new ,york3 ,irvington ,publishers1 #aigf71 pp4 #ajh-aji4 ,,applications ,,of ,,hypnosis ,it is much easier to bring about a hypnotic trance than to know how to make effective therapeutic use of the trance state once it is produced4 ,depending on the depth of trance that you will accept1 these are the kinds of goals that can be achieved3 ,in a light trance1 your eyes are closed1 you are physically #bba relaxed1 and it is possible to convey to you1 for example1 that you are unable to move an arm4 ,at this stage1 the therapist can often be effective in offering you support and encouraging you to begin to make changes in your behavior4 ,in a medium trance1 relaxation is still deeper4 ,a partial anesthesia of a hand or arm can be achieved1 and you will comply in a slow1 semiautomatic way with instructions from the therapist4 ,in this state1 many clients can learn rather quickly how to bring about self-hypnosis1 which they can then practice on their own4 ,at this stage1 it is sometimes possible to suggest gradual personality changes4 ,in a deep trance1 more extensive anesthesias are possible4 ,a therapist can encourage you to experience emotional changes1 to hallucinate1 and to regress to a younger age--i4e41 to re-experience memories of past events and to feel and behave as you did at that time4 ,in a deep trance state1 it is possible to use hypnotic desensitization techniques to help you overcome anxieties and fears4 ,hypnotherapy lends itself well to use on your own4 ,once you have learned how to induce light trance states on your own1 you can begin to suggest certain attitudes1 feelings1 or behavioral changes you would like to bring about in yourself4 ,being successful at this--as with any skill--requires regular practice and regular and gradual strengthening of the habits that are being formed4 ,some psychotherapists will make a audio recording for the individual client to use at home on a daily basis4 ,hypnosis has been used to treat many problems1 including these3 ulcers frigidity impotence headaches and migraines insomnia arthritic pain colitis tachycardia obesity depression phobias antisocial behavior #bbb disturbed children amnesia stuttering nervous tics sexual inhibitions dental anxiety and pain heart palpitations abdominal cramps tension and anxiety overeating reduction or elimination of smoking ,both men and women are equally hypnotizable4 ,children are generally better subjects than adults4 ,as already noted1 clients who are more anxious tend to accept hypnotic suggestion more readily4 ,clients who are motivated to change respond best to hypnotic suggestion4 ,individuals who are imaginative1 who had fictitious companions in childhood1 who read a good deal1 and who can become readily absorbed in nature are inclined to make good subjects4 ,good rapport between client and therapist and a sense of trust in the therapist's goodwill and ability contribute greatly to successful hypnotherapy4 ,russian-born ,lewis ,r4 ,wolberg 7#aije-aihh7 was a leading ,new ,york hypnotherapist originally trained as a psychoanalyst4 ,he is recognized for the comprehensiveness and eclecticism of his approach4 ,after forty years of practice1 he came to see its main limitation3 ,because hypnosis is so dramatic a phenomenon1 it is easy to overestimate its potential4 ,a great many things may be accomplished with a subject in a trance1 even the removal of psychologically determined symptoms4444 ,but almost immediately after hypnosis has ended1 or shortly thereafter1 the symptoms will return if the subject has a psychological need for them4 italics added 444 ,quite often patients on disability compensation are sent to me by insurance companies for hypnotic examination and treatment4 ,almost invariably1 these casualties cling to their symptoms with the desperation of a drowning man hanging on to a raft4444 ,there are other secondary gains a person may get out of holding onto his symptoms4 ,the need to punish himself for his guilt feelings1 the desire to abandon an adult adjustment and #bbc return to the protective blanket of infancy in order to be taken care of4444 ,symptoms do not magically vanish2 they must be worn down4 ,it is essential to replace them with productive habits4#h #h ,wolberg1 ,hypnosis1 pp4 #bcg-bci4 ,,meditation ,for individuals who are able to make a long-range commitment to the practice of a discipline that1 over a period of many months and years1 can strengthen them and help them to become more fully integrated and centered4 _/99 ,don't go outside yourself1 return into yourself4 ,the dwelling place of truth is the inner man4 ,saint ,augustine1 ,the ,true ,religion ,meditation is a systematic discipline that attempts to help people move toward the goal of self-realization4 ,it is not the creation of one individual or group4 ,techniques of meditation have evolved over many centuries and in different parts of the world4 ,and yet these techniques bear striking similarities to each other1 whether they originated in the temples and monasteries of ,india1 ,japan1 ,europe1 or the ,middle ,east4 ,meditation is not a relaxed act of contemplating one's navel2 it more closely resembles athletic training4 ,it is a form of progressive mental exercise that has as its goal a strengthening of a person's self-confidence1 inner strength1 and the mind's ability to focus and concentrate4 ,meditation takes considerable endurance4 ,it is essentially a discipline4 ,it requires fortitude1 perseverance1 and a strong will4 ,like athletic ability1 skills in meditation cannot be developed without regular practice4 ,because its effects are felt only gradually1 meditation needs a long-term commitment to sustain it1 and this ultimately must be based on faith in its eventual value4 ,the disciplined and regular practice of meditation over a period of many months appears to lead to a sense of personal integration1 a sense of being more firmly centered in yourself1 #bbd more confident and aware of your connection with all that is4 ,experienced practitioners of meditation claim to feel a greater degree of personal security2 they feel more at ease with themselves4 ,they claim to feel serenity1 zest in living1 and inner peace and joy in work1 which they seem to be able to do more efficiently1 with greater energy and interest4 ,,what ,,the ,,practice ,,of ,,meditation ,,is ,,like ,techniques of meditation share the goal of disciplining the mind to do one thing at a time4 ,until you have made a serious attempt to meditate1 you will very likely be unaware of how perpetually distracted your attention is4 ,we seldom make the effort to stand apart from our thoughts1 to take note of how numerous and varied they are and how chaotically they tumble into and out of our consciousness4 ,it is exceedingly hard work to quiet these chattering monkeys of the mind4 ,quieting the overactive and undisciplined mind is a challenging task4 ,it takes energy and a great deal of practice4 ,there are many approaches to meditation4 ,here1 we will look at three4#i #i ,see the excellent introduction to the practice of meditation by ,lawrence ,le,shan1 ,how to ,meditate3 ,a ,guide to ,self-,discovery 7,boston3 ,little1 ,brown ,co41 #aigd74 ,dr4 ,le,shan is a psychotherapist in ,new ,york ,city who teaches many of his clients meditation as part of their therapy4 ,breath ,counting ,breath counting is one way to train your mind to control and focus attention4 ,the object is to be doing one thing1 and one thing only1 becoming fully involved in that single purpose4 ,start by finding a comfortable position1 sitting or lying down4 ,place a clock or watch where you can see it without having to turn your head4 ,usually with eyes closed1 you then begin to count your breaths1 silently3 one as you slowly exhale the first breath1 two as you exhale the second1 etc4 ,after you get to four start with one again4 ,the purpose is to be doing only this1 only breathing and counting4 ,you will quickly find that your mind rebels2 it will stray and wander whenever your concentration and attention falter4 ,it is a recalcitrant entity4 ,you will be doing well in the beginning if you can succeed for only a few seconds #bbe at a time in being conscious only of your counting4 ,distractions will subvert your will in a split second4 ,you will find yourself thinking of a host of things3 what to do tomorrow morning1 whether you are doing well or badly at meditation1 whether it is silly to be doing this1 what's for dinner1 taxes1 work1 or that itch on your forehead4 ,again and again you will have to return your mind to the task at hand4 ,very quickly1 you'll begin to realize that meditation is hard work4 ,it is frustrating and demanding4 ,practice doing this for fifteen minutes a day4 ,after a few weeks1 increase to twenty minutes4 ,after another four weeks1 spend twenty-five to thirty minutes a day4 ,once you can do this1 continue to practice daily for another month4 ,it will take that long before you will begin to sense whether this approach to meditation is going to be useful to you4 ,the ,meditation of ,contemplation ,this is an alternative approach to meditation4 ,again1 the purpose is to discipline your mind by means of focused attention4 ,in this approach1 you try to focus attention on a physical object4 ,pick a natural object--a shell1 a small stone1 a pressed leaf4 ,now1 with the object a foot or two from you1 simply look at it4 ,the purpose is to look at the object actively1 to keep your attention fixed on it1 but to be wakeful and alert4 ,do not stare at one place on the object or strain your eyes4 ,explore the object1 look at it1 attend to it4 ,as usual1 you'll find plenty to distract you--stiffness1 the need to move1 sleepiness1 slipping into thinking about problems you need to solve4 ,each time your mind drifts out of track1 gently bring your attention back to the object4 ,try this for ten minutes a day for two weeks1 then fifteen minutes a day for a month1 then twenty minutes for the next month4 ,by then1 you will know if this approach will help you4 ,be prepared for some effective sessions and some discouraging ones4 ,remember that no one said meditation would be easy4 ,the ,meditation of the ,bubble ,this is an ancient form of meditation that1 again1 seeks to discipline the mind by developing your ability to focus on one thing at a time4 ,in this meditation1 you concentrate on your own stream of consciousness4 ,imagine yourself sitting quietly on the bottom of a clear lake4 ,each of your thoughts and feelings forms a bubble that slowly rises to the surface of the lake4 ,as each #bbf comes to your mind1 watch it closely and think only of it for the five seconds or so that it takes to rise to the surface4 ,be aware of the slow rhythm of the bubbles4 ,try to spend approximately equal amounts of time attending to each bubble4 ,if the same thought1 the same bubble1 rises several times1 this is ,,ok4 ,if you continue1 the repetition will pass4 ,if nothing comes to mind for a time1 this1 too1 is ,,ok4 ,form an empty bubble4 ,try this meditation for ten minutes a day for two weeks1 then increase to twenty minutes a day for one or two months4 ,by then1 you will know if this approach to meditation is beneficial to you4 ,,the ,,benefits ,,of ,,meditation ,how will you recognize whether an approach to meditation has value for you8 ,any changes that occur in you will be gradual2 you must be patient4 ,if1 after most sessions of meditation1 you feel generally more integrated1 calmer1 more at ease1 this is a good sign4 ,over a period of time1 if you are working hard at an approach to meditation that seems to fit your temperament1 these periods of feeling peaceful1 alert1 and comfortable in the world will gradually become more evident to you4 ,physiologically1 meditation appears to lead to a deeply relaxed state of alert concentration4 ,your respiration and heart rates slow1 the level of lactate in the blood 7associated with tension and anxiety7 drops lower1 and there is an increase in slow alpha brain waves1 associated with profound relaxation4 ,what is important1 no matter what approach to meditation you try1 is to stay with that approach long enough to determine its potential value for you4 ,doing a meditation once or a few times is like jogging once or twice3 you can't expect to derive any benefit from exercising a couple of times4 ,meditation is the practice and expression of discipline2 deciding to practice regularly and then carrying out your decision are just as important as the approach you take to meditation4 #bbg #af ,,drug ,,and ,,nutrition ,,therapies ,,drug ,,therapy3 ,,balancing ,,emotions ,,with ,,chemistry ,often especially helpful to people who are emotionally very upset so that they may begin to benefit from psychotherapy4 ,during the past thirty years1 biochemistry and pharmacology have made many important contributions to the treatment of mental and emotional disorders4 ,there is no question that psychotropic--literally mind-turning or mind-influencing--drugs can help many people during periods of emotional or mental suffering4 ,psychotropic drugs can be used by themselves or in conjunction with psychotherapy4 ,frequently1 drugs are used to help reduce the severity of symptoms in patients so that they may benefit from psychotherapy4 ,effective psychotherapy requires you to be comparatively calm1 rational1 and able to make well-thought-out decisions4 ,these things are not possible if you are terribly agitated1 are despondent and crying much of the time1 or #bbh may1 for example1 have disturbing hallucinations and are no longer in touch with reality4 ,the aim of drug therapy is1 eventually1 to eliminate the need for medication4 ,in this respect1 psychopharmacology is similar to psychotherapy3 both would like to help the patient so that he or she no longer needs either one4 ,it is not always possible to do this1 however4 ,some disorders are1 at present anyway1 chronic conditions4 ,people with parkinsonism or epilepsy may have to take medication indefinitely4 ,but the general trend is to use psychotropic drugs as temporary measures to bring symptoms quickly under control so that psychotherapy can be started4 ,the only professionals who are legally authorized to prescribe psychotropic drugs are physicians and1 in particular1 psychiatrists4 ,however1 psychotherapists are now being trained to be sensitive to conditions that may have an organic basis4 ,certainly1 it is wise to have a thorough physical exam to rule out organic problems that can cause emotional or mental upset 7see ,chapter #h74 ,numerous studies have shown that up to half of the individuals who are referred to a psychotherapist have undiagnosed organic problems4#a ,this is an important caution to bear in mind4 #a ,see1 for example1 ,l4 ,small1 ,neuropsychodiagnosis in ,psychotherapy 7,new ,york3 ,brunner_/,mazel1 #aihj74 ,,types ,,of ,,psychotropic ,,drugs ,there are nine main classes of psychotropic drugs3 ,antianxiety1 or ,anxiolytic1 ,drugs ,these are the so-called minor tranquilizers4 ,they are sedatives for the waking hours that are prescribed for people who have excessive tension and anxiety4 ,neuroleptics1 or ,antipsychotics ,psychosis is a disorder that impairs a person's abilities to think1 remember1 communicate1 respond with appropriate emotions1 and interpret reality without great distortion4 ,people who have these difficulties can often be treated effectively with neuroleptic or antipsychotic drugs1 also known as the major tranquilizers1 which have specific effects on the brain's activity4 #bbi ,sedative-,hypnotic ,drugs ,these drugs act as sedatives at low doses and produce a hypnotic action at higher doses4 7,the word hypnotic as used by pharmacologists does not refer to a hypnotic trance but means simply that a drug causes drowsiness and reduces motor activity47 ,in even larger doses1 these drugs act as anesthetics4 ,antianxiety drugs1 the minor tranquilizers1 can be grouped with these drugs because of their sedative effect4 ,antidepressants ,these drugs are used primarily to treat what psychiatrists call endogenous depression--that is1 major1 incapacitating depression that is not associated with an outside event or situation4 ,depressions that occur after the loss of a job1 the death of someone close1 or some other external event are called exogenous depressions4 ,they can sometimes be treated effectively with antidepressants1 but drug therapy for situation-induced depression generally is less successful4 ,lithium therapy is a specific treatment primarily for manic-depressive disorders4 ,lithium carbonate is a naturally occurring mineral salt4 ,for manic-depressive patients--with wide swings of mood from feeling extremely energetic and emotionally high to feeling seriously depressed--lithium therapy may offer help as a mood stabilizer4 ,stimulants ,caffeine and nicotine are the best known of the stimulants4 ,in therapy1 stimulants are used in the treatment of narcolepsy 7individuals suddenly fall asleep for short periods of time1 even when engaged in activities71 some forms of epilepsy1 and1 paradoxically1 hyperkinetic children 7who are excessively active and have short attention spans and explosive irritability74 ,antiepileptic ,drugs ,for many of the two million ,americans with epilepsy1 these antiseizure drugs are very helpful4 ,epilepsy does not tend to shorten an individual's life1 but it is a severe1 troubling1 and often disabling condition for which drug therapy can be a blessing4 ,antiparkinsonian ,drugs ,these drugs have helped the lives of many people who are #bcj affected by the characteristic involuntary tremors of this disease1 which can cause abnormalities in gait and trembling of the voluntary muscles4 ,psychedelics ,psychedelic drugs are also called hallucinogens4 ,they produce altered states of consciousness and sensory distortions4 ,psychedelics have no established use in psychiatry at present in the ,united ,states4 ,great ,britain and ,canada1 however1 have experimented with psychedelics in the treatment of alcoholics1 whom they sometimes appear to help4 ,psychedelics have also sometimes been used for the terminally ill and in certain cases of autism4 ,drugs for ,headache1 ,migraine1 and ,neuralgia ,drugs for these common kinds of pain are widespread4 ,migraines 7which may cause blurred vision1 vertigo1 and even temporary deafness7 and cluster headaches 7which cause severe pain around the eyes1 tearing and reddening of the eyes1 and runny nose7 frequently can be treated successfully with specific drugs4 ,neuralgias are recurrent knifelike facial and head pains that can last for days and even months4 ,they can be difficult to treat successfully4 ,,what ,,drug ,,therapy ,,is ,,like ,in this section1 we'll look at some of the main emotional and mental symptoms that are often helped by means of drug therapy4 ,since all medications have potential side effects1 we will look at these as well4 ,anxiety ,excessive anxiety causes very unpleasant symptoms3 dizziness or light-headedness1 sweating1 pounding heart1 vomiting1 diarrhea1 shaking1 muscle tension1 inability to sleep4 ,many of these symptoms can be controlled by antianxiety drugs4 ,all of these drugs can lead to psychological dependence when they are used regularly over periods of time that vary with the person and the medication4 ,for this reason1 they are normally used for short periods1 often at the beginning of psychotherapy4 #bca ,the most commonly prescribed antianxiety drugs include these 7trade names73 ,atarax ,ativan ,centrax ,clonopin ,dalmane ,doriden ,equanil ,librium ,loxitane ,paxipam ,restoril ,serax ,tranxene ,tybatran ,valium ,valmid ,xanax ,although relatively small percentages of patients experience them1 as with most drugs1 there may be side effects1 including drowsiness1 impaired judgment and performance1 nausea_/vomiting1 ataxia 7loss of voluntary muscle coordination71 and agitation 7paradoxical restlessness74 ,patients who have taken an antianxiety drug for a period of time are often instructed to reduce their dosage gradually to avoid mild1 infrequently severe1 withdrawal symptoms4 ,antianxiety drugs can reduce agitation and produce a relative sense of calm4 ,but1 unfortunately1 patients usually develop a tolerance to any antianxiety drug after three to four months1 and then the drug loses its effectiveness4 ,antianxiety drugs are usually limited1 then1 to short-term treatment4 ,long-term recovery from the symptoms of anxiety is the task of psychotherapy3 to help clients change their attitudes1 behavior1 or way of life4 ,depression ,depression can be a seriously incapacitating emotional disorder4 ,depression can range from a lingering sense of sadness or grief to a feeling of utter hopelessness1 guilt1 despondency1 uncontrollable crying1 and suicidal thoughts4 ,the following symptoms are typical3 insomnia or early waking1 loss of appetite and loss of interest in sex1 inability to concentrate1 great difficulty in making decisions1 and a reduced desire and ability to assume job and family responsibilities4 ,though depression is called the common cold of emotional illness1 it is not to be taken lightly1 since severe depression is life-threatening1 as many #bcb suicides testify4 ,depression affects one out of five people during their lifetimes2 more women suffer from depression than men4 ,at the time of this writing1#b the most widely prescribed antidepressants are the tricyclics4 ,they are most effective in treating endogenous depressions2 ,,mao inhibitors 7see below7 are more useful in cases of atypical depression1 which frequently is associated with a situation the patient cannot come to terms with1 such as the loss of a job or of a loved one4 #b ,since this book was published1 ,s,s,r,is or selective serotonin reuptake inhibitors1 have become the most commonly prescribed antidepressant medication in the ,u4,s and many other countries4 ,for readers interested in more information about ,s,s,r,is1 see ,wikipedia's article1 http3_/_/en4wikipedia4org_/wiki_/,select ive-serotonin-reuptake-inhibitor4 ,tricyclic antidepressants include these 7trade names73 ,avenyl ,elavil ,norpramin ,pamelor ,sinequan ,surmontil ,tofranil ,vivactil ,approximately #gj percent of patients who take tricyclics improve4 ,several newer drugs--the tetracyclics1 dibenzoxapines1 and triazolopyridenes--are similar to the tricyclics in their effects4 ,they include these 7trade names73 ,asedin ,desyrel ,ludiomil ,if tricyclics do not help1 ,,mao inhibitors 7monoamine oxidase inhibitors7 are usually tried4 ,,mao inhibitors must be used with great caution because they can interact with certain foods1 beverages1 or drugs to produce severe high blood pressure4 ,many foods and beverages are prepared by fermentation processes2 e4g41 cheese1 anchovies1 pickled herring1 pastrami1 olives1 beer1 and wine1 all of which patients who take ,,mao inhibitors must avoid4 ,these foods and beverages contain a chemical compound1 an amine called tyramine1 which can cause dangerously high blood pressure1 a hypertensive crisis1 in people taking an ,,mao inhibitor4 ,furthermore1 ,,mao inhibitors cannot be taken with antihistamines2 patients who take ,,mao inhibitors may be warned to avoid other drug interactions4 ,these warnings should be taken seriously because ,,mao inhibitors are one of the most potentially toxic groups of psychoactive drugs4 ,yet they can make the difference between night and day for many cases of depression4 #bcc ,there are common side effects caused by all the antidepressants we've mentioned1 including an uncomfortably dry mouth1 dizziness1 especially when standing up quickly1 headaches1 difficulty in urinating1 nausea_/vomiting1 constipation or diarrhea1 impotence1 inability to reach orgasm1 agitation_/shaking1 and rapid heartbeat4 ,some of these side effects can be annoying but will often diminish or disappear once the patient becomes accustomed to the medication4 ,when side effects are not tolerable1 the physician or psychiatrist will usually prescribe a different antidepressant that may have fewer1 or no1 side effects for a given patient4 ,one of the drawbacks of antidepressants is that there is a waiting period of days or weeks before physician and patient know whether a particular drug is going to help4 ,if1 after four to six weeks1 an antidepressant has not reduced a patient's depression1 then a second drug may be tried1 and1 again1 there will be a delay of days or weeks before it is clear whether the medication is going to work4 ,one needed area of research in psychopharmacology is to devise tests that will help to tell a doctor what antidepressant is most likely to be effective for the individual patient4 ,at present1 though some general guidelines exist1 matching patient with an effective and tolerable medication is a process of intelligent trial and error4 ,lithium has been used to treat manic depression since #aied4 ,lithium is absorbed quickly from the gastrointestinal tract1 but it acts slowly1 so it also takes time to know if it is going to be of value4 ,blood levels of lithium need to be checked once or twice a week during the first month1 twice a month for the next month or two1 and then once every one to two months4 ,lithium is sometimes helpful in treating chronic simple depression1 that is1 depression that is not associated with periodic highs4 ,unlike most drugs used in psychiatry1 lithium usually has few noticeable side effects and does not tend to produce a feeling of sedation or stimulation4 ,when side effects occur1 it is usually because the lithium level in the blood has become excessive4 ,side effects then can include vomiting1 lack of coordination1 muscular weakness1 or drowsiness4 ,in addition to antidepressant drugs1 electroconvulsive therapy 7,,ect7 is sometimes used to treat severe depression1 as it is to treat some other conditions1 including schizophrenia4 ,although ,,ect is not itself a form of drug therapy1 it is important to #bcd mention it here since it is one of the main medical treatments 7as opposed to the talk therapies of psychotherapy7 used by psychiatry today4 ,,ect is administered after a patient has been sedated and given a general anesthetic4 ,the main advantage of ,,ect is that it acts much faster than any of the antidepressants4 ,for a seriously suicidal patient1 this can be important4 ,the main disadvantages of ,,ect are that it can cause temporary memory loss1 temporary disorientation and confusion after treatment1 and possible permanent changes in brain function--regarded by many psychiatrists as subtle1 i4e41 fairly minor4 ,another discouraging finding is that depression recurs after ,,ect in many patients--in up to #df percent within six months after ,,ect4 ,,ect has received poor press4 ,as now administered1 the actual treatment is painless4 ,it is1 nevertheless1 a forceful1 invasive approach1 so many psychiatrists prefer not to use it if medication can be successful4 ,as more biochemical methods of treatment are discovered1 ,,ect very likely will be used less and less4 ,psychosis ,psychosis is the most serious and incapacitating degree of mental illness4 ,emotional problems with symptoms of anxiety or depression1 or both together1 are called affective disorders4 ,people who have affective disorders make up the majority of clients seen by most psychotherapists2 these clients are not out of touch with reality4 ,the problems that they have--though painful and sometimes obstacles to normal living--are essentially different from the difficulties that patients with psychoses have4 ,though there is no unanimity about this among health care professionals1 we will distinguish between these two kinds of problems by calling a psychosis a mental illness1 as opposed to an emotional disorder4 ,it is a matter not only of degree but of kind4 ,a person who is severely depressed or extremely anxious is usually still able to communicate rationally1 and distinguish what is real from what is fantasy or delusion4 ,psychoses1 on the other hand1 are disorders that impair a person's abilities to think1 remember1 communicate1 respond with appropriate emotions1 interpret reality coherently1 and behave in a reasonably normal way4 ,people with psychoses #bce often have difficulty controlling their impulses1 and their moods may change quickly and radically4 ,psychotic individuals often believe things to be true that are not1 and they may hear sounds or voices that are not there4 ,there are many theories about the causes of psychosis4 ,recently1 research studies in psychiatry have shown that psychosis may be due to an excess of certain chemical substances called neurotransmitters 7such as norepinephrine or dopamine7 in the brain4 ,another theory is that the brain of a psychotic person may be excessively sensitive to the action of certain neurotransmitters4 ,the antipsychotic drugs1 or neuroleptics1 reduce the brain's sensitivity to one or more of these chemical substances4 ,some of the best-known antipsychotic drugs are these 7trade names73 ,compazine ,haldol ,mellaril ,prolixin ,stelazine ,thorazine ,trilafon ,vesprin ,antipsychotic drugs frequently can clear thought processes1 reduce or end hallucinations1 relieve agitation and anxiety1 and generally help patients return to the world of reality1 communicate with others1 and behave in a more reasonable and stable way4 ,antipsychotic drugs have many possible side effects4 ,they may produce drowsiness1 dizziness and nausea1 fainting1 muscle tremors1 a shuffling gait1 blurred vision1 insomnia1 sensitivity of the skin to sunlight1 and other effects4 ,particularly disturbing side effects can often be avoided by changing to a different medication4 ,some people with psychotic symptoms may need to take antipsychotic medication for only a few weeks or months4 ,recurrent or chronic illnesses1 however1 may require drug treatment over a long period4 ,,when ,,drug ,,therapy ,,is ,,appropriate ,since psychotropic drugs can be prescribed only by a physician or psychiatrist1 his or her judgment will determine whether a patient's difficulties seem to lend themselves to drug therapy4 ,in cases involving serious anxiety1 depression1 or psychosis1 it is #bcf routine to expect drug therapy to be used1 often in conjunction with psychotherapy4 ,as we noted earlier1 it is the hope of drug therapy that it will be needed only temporarily1 but some chronic or periodically recurring conditions may be best treated by continued medication for a number of years4 ,since many of the psychotropic drugs are new1 it is not known whether long-term use by some patients may ultimately affect their health adversely4 ,unless we decide to do without medication that can be a blessing in relieving great suffering1 until long-term studies can be completed1 the potential risks are there4 ,it is a matter of weighing alternatives3 on the one hand1 perhaps incapacitating emotional or mental distress1 and on the other1 side effects that cannot be fully predicted4 ,,therapy ,,through ,,nutrition ,there is no question that nutritional deficiencies can influence the functioning of the brain and affect the personality4 ,there are clear-cut cases1 for example1 of vitamin deficiencies that result in symptoms of psychological disturbance4 ,the majority of these cases involve people who suffer from very evident malnutrition4 ,unfortunately1 the connection between nutrition and mental health is still vague2 biochemists are becoming more aware of the need to take into account individual variations4 ,it is not always possible to specify exactly how much of a mineral1 a vitamin1 or an amino acid a person requires for good health4 ,some people1 for many different reasons1 cannot effectively utilize the food they eat4 ,others have allergic reactions to certain foods2 some allergic reactions appear to be subtle1 affecting a person's moods4 ,still other people seem to be especially sensitive to only moderate changes in their blood sugar levels4 ,we have a great deal in common as biological organisms4 ,yet our biochemistries may be finely tuned in individual ways that would require a detailed and sophisticated understanding of an immense number of interrelated factors that boggle the mind in complexity4 ,psychonutrition has a long road to follow before it will be a science4 ,so-called holistic or orthomolecular 7the right molecule7 physicians and psychiatrists attempt to take individual variations and sensitivities into account4 ,the need to do this may be essential in many cases1 but dependable and exact methods of #bcg evaluation and treatment simply do not exist as yet4 ,except in cases of outright malnutrition1 finding connections between nutrition and emotional health is still an art4 ,some orthomolecular psychiatrists appear to have been dramatically successful in helping some patients with certain mental or emotional problems4 ,but because psychonutrition is still a borderline discipline1 it is an area where controversies abound and results are often open to question4 ,many physical conditions can be influenced greatly by nutrition4 ,among these are the metabolic disorders diabetes and hypoglycemia1 both of which can affect a person's emotional life 7see ,chapter #h74 ,in addition1 relationships have recently been discovered between lowered blood pressure1 reduced cholesterol and triglyceride levels1 and a diet high in fiber4 ,a thiamine 7vitamin ,b#a7 deficiency--which causes pellagra1 a chronic disease that leads to skin lesions and gastrointestinal distress--can produce depression1 mania1 and paranoia4 ,another example is pernicious anemia1 in large part due to vitamin ,b#ab shortage1 which can cause moodiness1 difficulty in remembering and concentrating1 violent behavior1 depression1 and hallucinations4 ,but the fact that many physical disorders1 some of which can cause psychological disturbances1 are treatable in part through nutrition does not1 unfortunately1 imply that emotional disorders in general can be treated by means of diet4 ,this may be the case for some individuals for whom special diets can influence a specific biochemical imbalance4 ,but research is just beginning to develop tests that can detect these sensitive individual variations4 ,once they can be identified a more difficult step has to be made3 to determine how this information can be used to select an effective treatment4 ,nutritionists and physicians agree that good physical and mental health depend on a combination of proper body weight1 adequate exercise1 good diet1 and decreased stress4 ,but beyond this1 an emotionally disturbed person who seeks help through dietary therapy--for example1 through megavitamin doses--should realize that he or she is really involved in self-experimentation4 ,some orthomolecular psychiatrists may be very talented in treating some of their patients4 ,these patients are very fortunate2 it is hard to avoid saying they are lucky4 ,the main problem that faces this new area of psychonutrition is one of general reliability and credibility4 #bci ,,part ,,iii ,,important ,,questions #bda #ag ,,locating ,a ,,therapist ,america is overcrowded with helpers2 there are so many helpful people out there1 they are literally bumping into each other1 and must be regulated by laws and organizations to keep them from helping so much that the average client in need of help isn't torn to shreds4 ,paul ,g4 ,quinnett1 ,the ,troubled ,people ,book ,this chapter assumes that you have used one of the two methods described in ,chapter #g1 ,self-,diagnosis3 ,mapping ,your ,way to a ,therapy1 and have now chosen an approach to therapy that seems most promising in relation to your goals or problems and your personality4 ,you now face the practical problem of how to locate a therapist with the professional expertise to offer you the kind of help you desire4 ,there are three factors that you need to take into account in order to find a suitable therapist3 #a4 the degree of seriousness of your problem or need #b4 any financial limitations you may have #c4 the resources available where you live 7or how far you are willing to travel if you cannot locate the help you want in your area7 #bdb ,the seriousness of your problem or need may fall into one of three general categories3 ,very urgent need3 ,you are severely upset1 perhaps suicidal or dangerous to others4 ,or1 you are suffering from extreme changes of mood or personality1 major depression1 delusions1 or hallucinations4 ,in either of these cases1 you should see a professional immediately4 ,you or a friend or relative should contact your family physician for a referral to a psychiatrist or call a crisis intervention center for a referral to a psychiatrist4 7,crisis intervention centers1 sometimes called suicide prevention centers or crisis hot lines are listed among the emergency numbers on the inside front page of your ,white ,pages directory2 otherwise1 dial #iaa for assistance47 ,serious personal1 marital1 or family problems or goals3 ,you1 you and your spouse1 or members of your family need help soon but can wait for an appointment1 if necessary1 for a number of weeks4 ,moderate need3 ,there is no urgency4 ,you are interested1 before you consider formal therapy1 in exploring some alternatives--perhaps by talking with a minister1 priest1 or rabbi or by trying one of the adjunctive approaches to therapy 7such as therapeutic exercise1 meditation1 relaxation training7 on its own1 without individual therapy4 ,this chapter is intended primarily for people in the well-populated middle category1 people who have serious problems or goals and are able to weigh alternatives carefully and without extreme pressure4 ,the seriousness of the problem and the cost of treatment go hand in hand4 ,the range of treatment alternatives is shown in the table below4 ,condition ,cost ,treatment by3 ---------------------------------------- ----------------------------- more serious more expensive ,psychiatrists ,psychologists ,social work counselors ,adjunctive therapists3 biofeedback1 bioenergetics1 exercise1 meditation1 etc4 ,religious counselors less serious less expensive ,self-help #bdc ,in general1 the less serious the problem1 the lower the potential cost of treatment4 ,also1 the more serious the condition1 the more advisable it is to have at least a preliminary evaluation by a psychiatrist4 ,similarly1 the settings within which therapy is available vary widely3 ,condition ,cost ,setting3 ---------------------------------------- ----------------------------- more serious more expensive ,hospitals ,residential treatment centers ,private practice ,agencies3 private1 state1 county ,academic sources3 individual counseling for enrolled students vocational guidance counseling classes or workshops adult extension or continuing education less serious less expensive programs ,,finding ,a ,,therapist ,,with ,a ,,particular ,,specialization ,during a time of increasing specialization in health care1 many psychotherapists have unfortunately been attracted to eclecticism--that is1 knowing a reasonable amount about a number of different forms of therapy1 but resisting specialization in any one of them4 ,for some individuals1 especially people interested in wide-spectrum growth and personal development1 an eclectic therapist can be very beneficial4 ,eclectic therapists believe that they are able to bring a wider scope of understanding to bear on a problem and a more flexible outlook4 ,if you have fairly well-defined needs and interests1 however1 eclecticism makes it difficult to locate a therapist who has formal training and extensive experience specifically in treating1 for example1 depression1 alcoholism1 family conflicts1 or adjustment problems4 ,no therapist today can be an expert in the whole range of human #bdd emotional problems and in the many specialized techniques that have been developed to help4 ,,referrals ,there are a number of ways of going about locating a therapist4 ,you can start by asking for a recommendation from any of these sources3 99 your family doctor1 who will most likely suggest a colleague1 another ,m4,d41 a psychiatrist 99 your minister1 priest1 or rabbi1 who again will suggest someone he or she happens to know or to have heard of 99 personal friends 99 referral services ,all of these alternatives are1 however1 limited by the scope of acquaintance of the person or service you have gone to4 ,referral services commonly are run by groups of subscribing psychologists 7or social workers71 so if you call one1 you will be referred to a participating psychologist 7or social worker74 ,sometimes referral services 7which usually charge nothing for their referrals1 unless you request a preliminary consultation7 maintain a listing of the areas of specialization of their professional members1 and this information can be helpful4 ,if you have a specific approach to therapy in mind and want to find a therapist with strong credentials in that approach1 there are two usually more promising roads to follow3 ,,by ,,mail1 ,,or ,e-,,mail 7,,google ,,any ,,of ,,the ,,names ,,of ,,organizations ,,that ,,follow73 ,first1 depending on your own judgment of the seriousness of your problems or goals and the extent to which the cost of treatment is important to you1 you can request a list of therapists in your area from these organizations3 ,american ,psychiatric ,association #adjj ,k ,st41 ,,nw ,washington1 ,,dc #bjjje ,canadian ,psychiatric ,association #bbe ,lisgar ,st41 #ajc ,ottawa1 ,,on ,k#b,p #j;,c#f 7for psychiatrists7 #bde ,american ,psychological ,association #abjj #agth ,st41 ,,nw ,washington1 ,,dc #bjjcf ,canadian ,psychological ,association #eeh ,king ,edward ,ave4 ,ottawa1 ,,on ,k#a,n #g,n#f 7for psychologists7 ,national ,association of ,social ,workers #giha ,eastern ,ave4 ,silver ,spring1 ,,ma #bjijg ,canadian ,association of ,social ,workers #ee ,parkdale ,ave41 #cl#f ,ottawa1 ,,on ,k#a,y #a;,e#e ,corporation ,professionnelle des ,travailleurs ,sociaux du ,quebec #egeg ,decelles ,ave41 ,ch4 #cce ,montreal1 ,,qc ,h#c,s #b;,c#c 7for social work counselors7 ,ask for a list that shows their specialties4 ,if none is available1 ask for the address of the branch office nearest you1 which you then can contact for this information4 ,if writing by mail1 be sure to enclose a stamped1 self-addressed envelope to ensure a response4 ,,by ,,telephone ,a second way to locate a therapist with specialization in a particular area is through careful use of your telephone directory4 ,this may take you some time1 and also some preliminary calls1 but it can give you a good deal of information3 ,psychiatrists ,psychiatrists are listed in the ,yellow ,pages under ,physicians and ,surgeons4 ,in larger metropolitan directories1 you will usually find separate headings after the general listing1 according to specialties4 ,look there for ,physicians-,psychiatrists or similar heading4 ,many psychiatrists today will list their special focus there--for example1 psychoanalysis1 psychoanalytic psychotherapy 7brief analysis71 marriage and family therapy1 hypnosis1 chemical dependency treatment1 child and adolescent therapy4 ,if you want to see a psychiatrist and do not find one who indicates the specialized approach you want to try1 then you will need to make some calls4 ,most psychiatrists' secretaries or receptionists are happy to tell #bdf you what the doctor specializes in4 ,if the list of his or her areas of specialization is impressively and overly long1 perhaps it is best to look elsewhere for a more realistic professional4 ,if1 after locating a psychiatrist with the background you are looking for1 you want to double-check his or her credentials1 ask the secretary if the psychiatrist is a member of the ,american ,psychiatric ,association 7or1 if in ,canada1 the ,canadian ,psychiatric ,association71 whether he or she completed a program of study at an institute of psychotherapy or psychoanalysis1 and whether he or she is board certified4 7,remember1 any ,m4,d4 can call himself or herself a psychiatrist1 but not all have the full qualifications of a certified psychiatrist47 ,clinical ,psychologists ,clinical psychologists are listed in the ,yellow ,pages under ,psychologists4 ,their specialties are often identified--e4g41 marriage and family therapy1 group therapy1 bereavement1 alcoholism1 eating disorders and addiction1 psychological assessment 7testing71 learning disorders1 sexual dysfunction1 depression1 panic syndrome4 ,again1 if the list below a given psychologist's name is unreasonably long1 you may have come across either a genius or someone who favors advertising4 ,psychologists less often mention the particular approach to therapy they use1 but some do2 for example1 behavior therapy1 ,gestalt1 hypnosis1 or analytical approach may be listed4 ,again1 it will probably be necessary to make a few telephone calls4 ,if1 after locating a psychologist with the background you are looking for1 you want to double-check his or her credentials1 you can frequently find a copy in your public library of the ,national ,register of ,health ,services ,providers or1 in ,canada1 either the ,canadian ,registry of ,health ,service ,providers in ,psychology or the ,international ,directory of ,psychologists4 ,they list licensed psychologists with ,ph4,d4s who have completed internships of supervised therapy4 ,psychologists will often print their state license numbers in their telephone directory listings4 ,social ,work ,counselors ,social work counselors are listed under ,social ,workers in the ,yellow ,pages4 ,usually1 their listings are less specific than those for psychiatrists and psychologists4 ,most commonly1 you will see listings indicating licensed ,,mfcc 7marriage1 family1 #bdg and child counseling71 ,,msw 7master's degree in social work71 ,,lcsw 7licensed clinical social worker71 etc4 ,state licensing numbers are often also given4 ,the ,register of ,clinical ,social ,workers1 published by the ,national ,association of ,social ,workers1 lists members whose degrees and supervised training were in counseling2 it is available in many public libraries4 ,specific credentials you may also see in directory listings include the following3 ,for therapists with ,affiliation3 specialties in3 ---------------------------------------- ----------------------------- ,membership in ,american ,psychoanalysis ,psychoanalytic ,association 7all members are ,m4,d4s7 ,in ,canada3 ,membership in ,canadian ,psychoanalytic ,society ,membership in ,international ,psychoanalytical ,society ,membership in ,national ,psychological ,association for ,psychoanalysis ,training from ,center for ,studies ,client-centered therapy of the ,person1 ,la ,jolla1 ,,ca ,training from ,gestalt ,therapy ,gestalt therapy ,institute of ,,la 7or ,san ,diego1 ,san ,francisco1 ,new ,york1 ,boston1 ,chicago1 ,cleveland1 ,dallas1 ,miami1 ,hawaii1 etc47 ,training from ,institute for ,rational-emotive therapy ,rational-,emotive ,therapy 7which maintains a register of psychotherapists who have received training in ,,ret4 ,address3 #de ,e4 #feth ,st41 ,new ,york1 ,,ny #ajjba47 ,training from the ,institute for ,reality therapy ,reality ,therapy 7in ,,la1 with branches in other cities in the ,u4,s47 #bdh ,membership in ,north ,american ,adlerian therapy ,society of ,adlerian ,psychology ,membership in ,association for ,behavioral psychotherapies the ,advancement of ,behavior ,therapy ,membership in ,american ,marriage and family ,association of ,marriage and therapy ,family ,therapists ,membership in ,biofeedback ,biofeedback therapy ,society of ,america ,membership in ,american ,hypnosis ,society of ,clinical ,hypnosis ,in ,canada3 ,membership in ,canadian ,institute of ,hypnotism ,membership in ,american ,treatment of sexual ,association of ,sex ,educators1 disorders ,counselors1 and ,therapists ,,harder-,,to-,,find ,,therapies ,it can be especially difficult or confusing to locate therapists with certain orientations1 either because these approaches are less widespread or because you do not know which kinds of health-care professionals make the greatest use of them4 ,frequently1 an effective way to locate an existential-humanistic therapist or logotherapist is through religious organizations4 ,call to ask for the names of ministers1 priests1 or rabbis with training in psychotherapy or counseling4 ,these individuals1 in turn1 will often be able to put you in touch with either existential-humanistic therapists or logotherapists who may or may not be affiliated with the religious organization in question4 ,emotional flooding therapists are usually found among psychologists1 whose telephone directory listings will normally indicate whether they offer one of these therapies4 ,the same is true for psychologists with experience in direct decision therapy4 ,biofeedback therapists can be found in private practice2 they will also be found at pain and stress centers 7which are often run by hospitals on an outpatient basis74 ,these offer private or publicly funded programs to help people with chronic pain or #bdi stress-related difficulties4 ,a number of counseling agencies have begun to include biofeedback therapists on their staffs4 ,biofeedback therapists in private practice1 as well as pain and stress centers1 are listed in telephone directories4 ,try looking under ,biofeedback ,therapy and ,training and under ,psychologists for those who indicate that they offer biofeedback4 ,relaxation training 7and sometimes also meditation7 is frequently offered by biofeedback therapists 7as well as by many psychologists and social workers74 ,therapists who use hypnosis are often listed under ,hypnosis in telephone directories4 ,you will usually find a wide variety of educational backgrounds represented among therapists in these listings4 ,some are in private practice2 some work for agencies4 ,you will probably see an array of credentials advertised1 perhaps ranging from therapists without degrees1 to those with ,ph4,d4s and ,m4,d4s4 ,here1 especially1 is an area in which to exercise consumer caution4 ,unfortunately1 hypnotherapy is well populated by therapists who lack professionally recognized credentials4 ,it is wise to remember that ,ph4,d4s can be granted in all sorts of fields--in education1 theology1 librarianship1 etc4--as well as psychology4 ,some therapists practice with a ,ph4,d4 after their names1 yet their ,ph4,d4s may be in fields totally unrelated to counseling and psychotherapy4 ,ph4,d4s who are licensed psychologists and who are members of the ,american ,society of ,clinical ,hypnosis offer professional credibility as hypnotherapists4 ,the certification of therapists trained in hypnosis is still unsettled in many states1 where anyone can hang out a shingle4 ,since many licensed psychologists1 psychiatrists1 and some certified social workers do receive professional training in hypnosis1 these are the professions to which it is most reliable to go for hypnotherapy4 ,meditation techniques may be learned on your own 7see ,chapter #ae71 or you can seek out commercial or religious organizations that teach meditation4 ,they are sometimes found in the ,yellow ,pages under ,meditation ,instruction4 ,transcendental ,meditation 7,,tm7 programs have been popular and are widespread4 ,yoga instructors 7raja yoga rather than hatha yoga7 also teach meditation4 ,relatively few psychologists or social workers have actually received training in the use of therapeutic exercise1 since this area is relatively new and its proponents are still small in #bej number4 ,however1 most psychologists and many social workers are aware of the exercise programs advocated by ,kostrubala and ,glasser 7see ,chapter #ae7 and can help you plan intelligently4 ,,about ,,the ,,cost ,,of ,,treatment ,most health insurance plans offer at least partial coverage for psychotherapy and counseling4 ,consult your policy to find out what providers 7psychiatrists1 psychologists1 or social workers7 you may go to for covered treatment and for how long4 7,if you have special concerns about confidentiality in connection with treatment under an insurance plan1 see ,chapter #ai47 ,as we noted earlier1 it is possible to obtain treatment from many psychiatrists1 clinical psychologists1 and social work counselors at reduced cost1 if you have definite financial limitations 7see ,chapter #d74 ,many clinical psychologists and social workers indicate in their directory listings in the ,yellow ,pages if fees are set on the basis of a sliding scale-on the basis1 that is1 of ability to pay4 ,it is worth a telephone call to find out4 ,many public and some private counseling agencies also set fees in this way4 ,reduced fees from psychiatrists are more likely through agencies that offer psychiatric care than from psychiatrists in private practice4 ,for public agencies1 look in the ,white ,pages under the name of your county2 then look for the heading ,mental ,health ,services or ,county ,mental ,health1 or the equivalent4 ,you will frequently find one or more mental health centers or clinics listed4 ,in the ,yellow ,pages1 look under ,clinics for a listing of private and sometimes also public clinics4 ,it is usually clear from their descriptions whether they offer psychotherapy or counseling or only treatment for physical illness or injury4 ,again1 it may be worthwhile to mention that the costs of group therapy1 whether through a clinical psychologist or a social work counselor1 may be expected to be substantially less than the costs of individual therapy4 7,on the appropriateness of group therapy1 see ,chapter #ac47 ,,once ,,you ,,have ,,located ,a ,,therapist ,if you believe you have found a therapist whose background1 fees1 and location meet your needs1 ,i recommend that1 when you #bea telephone for an appointment1 you ask for an initial consultation4 ,this will make it clear1 in the therapist's mind and your own1 that your appointment is for a trial session4 7,the fee is normally the same as for a regular appointment1 but check on this47 ,when you go to this first session1 it is very tempting to launch into what is troubling you4 ,if you can hold yourself back in order to ask a few preliminary questions about the therapist's background1 experience1 approach1 and a likely duration of treatment--in other words1 encourage the therapist to talk to you a little bit about himself or herself--you will get a better idea of the person behind the professional title4 ,this will help you decide whether you want to continue with future sessions4 ,however1 it may take several weeks1 or even months1 for you to know that the relationship will in fact benefit you4 #beb #ah ,,should ,,you ,,be ,,hospitalized8 ,there are two main reasons for psychiatric hospitalization3 #a4 ,you would be better off away from home4 ,many things can play a role here4 ,perhaps there is too much family conflict at home1 too much emotional strain1 for you to improve4 ,or1 your family may simply not be calm enough to handle the crisis4 ,or1 perhaps you have too many strong and upsetting associations at home--e4g41 if your spouse has just died or your daughter just committed suicide at home4 ,or1 you may just have too little privacy at home2 you feel forced to maintain a stiff upper lip in front of children1 your spouse1 or other family members1 but you simply can do this no longer4 #b4 ,your condition may be too serious to be treated appropriately on an outpatient basis4 ,if you are no longer in touch with reality1 are unable to communicate coherently1 are hallucinating or have delusions1 you cannot be relied on to take care of yourself4 ,if you are psychotic1 your behavior may hurt others or yourself4 ,if you are suffering from a major1 incapacitating depression1 you may become suicidal4 ,finally1 if you are unable to control an addiction to drugs or alcohol1 inpatient care is more likely to be effective4 ,you may1 of course1 have reasons to resist hospitalization4 ,most likely1 your resistance will be based on fear--of the unknown1 of #bec the later stigma of having been hospitalized for a psychiatric condition1 or of the inner stigma3 that you must have been terribly ill 7or weak7 to justify hospitalization4 ,furthermore1 if you have been hospitalized before1 you may recall that the hospital's supportive environment encouraged you to feel dependent on it and to resist returning to normal living1 and you may fear falling prey to this again4 ,all of these are good reasons to proceed cautiously4 ,only the first fear can be reasoned with in an objective way1 by understanding what psychiatric hospitalization is really like1 something this chapter will help you to do4 ,certainly1 the other fears also may have some basis4 ,discrimination does still exist against former psychiatric hospital patients4 ,they may find it difficult1 for example1 to enter military service or serve in an important political capacity4 ,the inner stigma can be even more damaging1 if you are a highly self-blaming person4 ,if you are going to hold hospitalization as yet another black mark against yourself1 then you may want to avoid hospitalization unless it means you are withholding treatment from yourself that really is essential to your well-being4 ,if you have been hospitalized before for psychiatric care1 the last reason is very likely the most important one for you to weigh carefully4 ,in the light of your past dependency needs1 you must decide whether the problems you now face are serious enough to motivate you to walk into a situation that in the past you found difficult to leave4 ,most hospital admissions for psychiatric conditions today are voluntary4 ,usually1 either your own judgment leads you to accept hospitalization1 or you are persuaded by family1 friends1 family doctor1 minister1 or psychiatrist that doing so is in your own best interest4 ,involuntary hospitalization is legally difficult and occurs primarily in cases in which1 over a period of time1 there is evidence that a person's behavior is not responsible1 that he cannot take care of himself1 or that he may injure himself or others4 ,,what ,,hospitalization ,,is ,,like ,several kinds of hospitalization are available to individuals who are emotionally troubled3 #bed 99 private or public hospitals in which there are special floors or sections for psychiatric patients 99 hospitals that treat only psychiatric problems 99 inpatient programs that specialize in stress management or the treatment of depression1 alcoholism1 drug abuse1 and other problems ,typically1 fifteen to twenty-five patients of both sexes will reside in a hospital unit4 ,often a ward is divided1 with men living on one side and women on the other4 ,in private and many public hospitals1 private and semiprivate rooms are available1 depending on your ability to pay or your insurance coverage4 ,frequently1 patients dress in everyday clothes rather than in hospital gowns and pajamas4 ,there is usually a common dining area where patients can eat at tables seating two to four people4 ,day rooms are common--large areas with comfortable chairs and couches1 a television1 stereo1 books1 and games4 ,if you were admitted to a hospital unit specializing in psychiatric care1 you would probably see a psychologist or psychiatrist two or three times a week in individual sessions4 ,it is likely1 since your condition was serious enough to warrant hospitalization1 that you will receive medication during at least part of your stay 7see ,chapter #af74 ,if you are a voluntary admission1 you will be asked to sign consent forms for treatment that is recommended to you4 ,you do have a right to refuse treatment you do not want4 ,a complete physical examination is routinely required to rule out underlying physical disorders4 ,you may also be asked to take some written psychological tests1 most being of the multiple-choice variety4 ,group sessions in hospitals are common4 ,in forming groups attempts are made to choose people in ways that will be mutually beneficial4 ,in part1 these periods in group help to offset feelings of being alone in a strange environment4 ,activities are planned to combat monotony4 ,they may1 for example1 include arts and crafts1 sports1 dancing1 and day trips to museums or the movies4 ,staff members with whom you would have the most personal contact are members of the psychiatric nursing staff4 ,often1 when former patients are asked who helped them while in the hospital1 instead of mentioning the therapist1 they name a #bee member of the nursing staff4 ,psychiatric nurses have received special training in psychiatry and often are a major source of human warmth and caring4 ,depending on your progress1 you may be encouraged to return home during the day1 or overnight1 or for a weekend4 ,as it becomes clear that you are improving1 these periods may be lengthened to see how you handle the transition from the hospital1 before being discharged4 ,although hospitals expect patients to choose to remain until they are discharged1 few hospitals actively confine voluntary psychiatric patients to prevent them from leaving early--and then generally only in cases judged to be very serious4 ,the only restrictions and rules you would likely encounter are those of any hospital3 to respect the rights of others1 to be considerate1 to refrain from taking drugs unless they are prescribed1 to smoke only in smoking areas1 and to maintain socially acceptable behavior4 ,inpatient hospital programs specializing in stress management1 depression1 eating disorders1 and so on1 are normally intended for one- to two-week stays4 ,residential treatment centers for problems requiring longer treatment--e4g41 drug and alcohol rehabilitation programs--are less formal than hospitals4 ,often1 residential treatment centers are located in the country and may consist of a cluster of cottage-like buildings4 ,the program is usually under the direction of a psychiatrist4 ,hospital care and residential treatment are very expensive4 ,most health insurance programs cover most of the costs of inpatient psychiatric hospitalization1 for several weeks or months4 ,public psychiatric hospitals must be relied on by many people for longer stays1 unless they bear the costs of private hospital treatment themselves4 ,physical conditions at state psychiatric hospitals have in general improved in recent years but still tend to fall short of private facilities1 for lack of adequate public funding4 ,,leaving ,probably the most difficult experience if you are hospitalized for a psychiatric condition is leaving1 not entering1 the hospital4 ,there is frequently a sense of relief and comfort that comes once you have made the decision to enter a hospital4 ,you have a #bef legitimate reason for leaving your normal responsibilities2 you may feel rescued from family or work situations you could no longer cope with4 ,once you have begun to feel more at home in the hospital setting1 you begin to relax1 to participate in activities with less restraint or reluctance4 ,then1 as you improve1 thanks in great part to the concentrated attention and care you are receiving1 you realize that you must begin to think of reentering life outside4 ,returning to your familiar life can be frightening4 ,it is usual to wonder whether it will1 perhaps again1 prove to be too much of a strain4 ,leaving the hospital frequently means returning home or going back to work1 to shoulder the same burdens again1 trying to pick up where you left off4 ,hospitalization is often a positive1 reassuring experience4 ,patients become aware that others do care and that1 if life becomes especially stressful1 there are sources of professional help and encouragement available to fall back on4 ,most hospitals encourage former patients to maintain contact through follow-up services of some kind4 ,leaving the hospital is made easier for many people1 for example1 knowing that the psychologist or psychiatrist is still there and that they will be seen on an outpatient basis4 ,to help former hospital patients ease back into more normal lives1 groups that were formed in the hospital sometimes will also continue to meet on an outpatient basis for a time4 ,the decision to be hospitalized is difficult for anyone4 ,hospital care may help turn your life around and put you back on your feet4 ,or it can1 if you are your own worst critic1 give you another burden to carry4 ,it is important to try not to block potentially helpful treatment with excessive pride and to try to listen to people who care about you4 ,if they are in favor of the decision1 their convictions should be considered4 ,if your doctor or minister agrees1 this adds weight to their advice4 ,once you have listened1 try to make your decision your own1 not anyone else's4 #beg #ai ,,confidentiality ,your ,privacy ,,the ,,negative ,,label ,,of ,,emotional ,,illness ,society has attached an undeniable stigma to so-called emotional or mental illness4 ,the public is afraid of conditions that are not concrete and physical and are less easily understood4 ,emotional or mental difficulties seem more hidden and mysterious4 ,the body is tangible1 and we feel we have more control over it4 ,setting a broken leg1 having your appendix removed1 even open-heart surgery--they are not difficult for the public to grasp4 ,however1 depression1 anxiety1 intolerance to stress1 disorientation1 unsettling fears1 unusual behavior--these are much less readily understood by nonspecialists4 ,there is a tendency for many people to judge rather harshly what they do not comprehend4 ,when many individuals who are ignorant of psychology hear of someone in emotional distress1 the inclination is often to condemn4 ,condemnation is frequently an expression of fear--fear of what is not understood4 ,during the last two to three decades1 society has gradually become more psychologically aware and more intelligent about nonphysical problems4 ,and yet1 the stigma of emotional or mental illness has still not been erased4 ,it will take time4 #beh ,as a result1 many people who are in serious emotional distress hesitate to go to a therapist4 ,they are afraid of the negative label that others may apply to them1 if information about them ever got out4 ,sometimes this is a justifiable worry4 ,some employers are bigoted and may discriminate against employees with known emotional problems 7even though this is blatantly illegal74 ,and some families1 in which there is little psychological understanding and much fear1 may withdraw from a family member who lets it be known that he or she is in emotional distress4 ,on the other hand1 most people like to feel that they have a certain degree of compassion and openness--even those who are judgmental6 ,if you are willing to face ignorant attitudes head-on1 unflinchingly 7and this can take a great deal of courage71 you will frequently gain the respect of others through your honesty4 ,they will perceive your unwillingness to judge yourself negatively and may even come to admire the strength and determination you have to improve your life4 ,if you are in emotional distress1 you may have to face a dilemma3 whether it is prudent to try to conceal your difficulties from people because you believe that some of them may judge you harshly and critically if they find out you are in therapy1 or whether it is likely that they would understand1 and perhaps even sympathize1 if you were able to be open and had the courage and self-confidence to help educate others on a psychological level4 ,unfortunately1 people in real emotional distress don't have the energy1 the courage1 or the self-confidence to fight social battles6 ,it therefore usually seems to be a great deal easier to try to keep your own affairs private4 ,but this is not always simple to do4 ,,the ,,confidentiality ,,of ,,psychotherapy ,confidentiality as it relates to counseling and psychotherapy is not a straightforward thing2 much that has to do with confidentiality is still an unsettled and still debated issue4 ,in reality1 there are as yet few laws that fully and genuinely protect personal privacy4 ,there are two central questions relating to confidentiality that ,i want to raise here4 ,the first is a question only you can answer4 ,i will try to discuss some of the answers to the second4 #bei ,,how ,,important ,,is ,,confidentiality ,,to ,,you8 ,only you can answer this4 ,it may be reassuring to know that1 usually1 the safeguards observed by therapists are sufficient to protect the personal affairs of clients4 ,and it is unusual for any real or lasting harm come to a client if information about him or her is released4 ,many individuals1 when they are trapped in a prison of self-concern and self-involvement1 are prone to exaggerate or magnify the ultimate significance of being discovered in therapy1 believing that a release of information about them will be potentially explosive and damaging4 ,individuals who are emotionally very upset are inclined to focus on threatening aspects of therapy4 ,we have already looked at some of the ways that a heightened sensitivity to maintain secrecy about your problems can lead to self-imprisonment1 to blocks that stand in the way of positive change 7see ,chapter #a74 ,most of the information you may want kept secret may not really be as damaging as you first were inclined to think4 ,much depends on how you respond to information that might be released about you4 ,let's look at an example4 ,a little more than a year ago1 ,george ,malcolm became seriously depressed4 ,he was forced to resign from his job1 and then he received disability income for ten months4 ,during this time he entered therapy4 ,his experience helped him to understand a number of important things about himself that he had ignored in the past4 ,he discovered that he had felt very unsatisfied in his previous job2 he had buried his frustrations and had suppressed the anger he felt at being trapped in a situation he disliked4 ,it was a situation he felt he had no control over because of his concern for his and his family's financial security4 ,he was also worried about his mother1 who would probably have to be admitted to a nursing home in the near future4 ,her situation was an added reason for ,george's financial worry4 ,he also came to realize that his marriage was suffering because of his insistence that his wife not work4 ,she1 on the other hand1 felt overcontrolled by her husband3 she felt that he stood in the way of her personal growth4 ,as a result of his increased awareness1 ,george came to see that losing his former job was really a blessing in disguise4 ,his marriage began to improve when ,george's depression for the #bfj first time put him in a dependent position2 he needed his wife's emotional support1 and she1 in turn1 began to see him as a person1 with weaknesses of his own1 and not as she had idealized him4 ,george's depression allowed him to understand and appreciate his wife's previously frustrated sense of initiative4 ,he now encouraged her to do what she had long wanted to do1 to develop a career4 ,because ,george received disability during his depression1 his insurance company had information about him on file4 ,when ,george was interviewed for a new job a year after he became depressed1 he was asked at the interview if he had been ill during the preceding year1 when he had not worked4 ,george decided to be truthful and said that he had become depressed and that as a result of the experience had learned much about himself4 ,in particular1 he had learned what kind of work really interested him and gave him a sense of satisfaction4 ,although it had been a difficult period1 ,george said that he felt he had gained a great deal from the experience4 ,george's prospective employer was impressed by ,george's honesty and evident sincerity4 ,george got the job--in large part because of the attitude he took toward his depression4 ,,what ,,laws ,,protect ,,confidentiality8 ,to what extent is your privacy protected8 ,what situations legally justify your therapist to release information about you8#a #a ,since the first edition of this book1 the ,health ,insurance ,portability and ,accountability ,act 7,,hipaa7 was passed in #aiif1 bringing with it a mass of complexities relating to patient privacy4 ,there remain many still unsettled legal questions and issues relating to the so-called ,privacy ,rule1 which there is not space here to discuss4 ,if you wish to know more about the legal status and interpretation of patient privacy1 see ,wikipedia's article about ,,hipaa at3 http3_/_/en4wikipedia4org_/wiki_/,,hipaa 4 ,these questions do not always have clear-cut answers4 ,there may or may not be special laws in your state to protect the confidentiality of psychotherapy4 ,the legal status of therapy is still ambiguous in many states4 ,even in those where laws have been passed1 legal protection is sometimes not reliable unless your therapist is willing to face a jail sentence if need be to maintain the confidence you have entrusted in him4 ,if you feel a situation is likely to arise that would put legal pressure on your therapist to release information about you 7for example1 in a child-custody hearing71 you should ask your therapist what his or her commitments to confidentiality are4 ,leaks ,more frequently1 confidentiality is broken due to informality #bfa rather than due to an intentional release of information4 ,for example1 if you are referred to another therapist or to a physician1 the chances are that information about you will be shared by your original therapist with the new therapist or doctor4 ,you can ask your therapist not to release information in this way1 but if you do1 the care you receive as a result of the referral cannot benefit from your first therapist's understanding of you4 ,on the other hand1 if you do permit your file to be shared with a new therapist or doctor1 you will probably not know in advance know what his or her own policies about confidentiality are4 ,there is a second way that information about you may be released4 ,often1 therapists discuss information about their clients with colleagues in an effort to provide better help for them4 ,it is often to your definite advantage to have other therapists share their assessments and ideas with your therapist4 ,but if you ask your therapist to refrain from discussing your case with professional colleagues1 he or she will very likely agree to cooperate with you4 ,if you believe you have special reasons to be concerned about protecting the confidentiality of your relationship with your therapist1 it will help him or her to know this1 and it may be possible to request that special precautions be taken to protect your file from access by others4 ,accidental or inadvertent breaks of confidentiality sometimes can also occur4 ,for example1 billings may be mailed to your address and then be opened by a spouse1 child1 or parent whom you may not have wanted told that you were in therapy4 ,here is another example3 ,if you enter group therapy1 other members of the group are not professionally bound by rules governing confidentiality4 ,because they are not counseling #bfb professionals themselves1 they will be less attentive to matters involving confidentiality--although most group therapists try1 when a group is first formed1 to get group members to agree not to disclose privileged information outside of sessions4 ,exceptions ,beyond the kinds of possible breaks of confidentiality that are due to inattention1 informality1 and access of information about you by others1 there are a number of legal exceptions to confidentiality4 ,examination by court order is one4 ,if a judge orders you to be examined by a psychiatrist or psychologist1 his findings will be transmitted to the court and so be made public4 ,if a client reveals his or her intention and decision to commit a crime1 a therapist is legally required to report this to authorities4 ,if a patient plans to commit homicide1 therapists are required by law to take whatever action is necessary to prevent the murder4 ,in ,california1 in addition to warning the police of the homicidal intentions of a client1 therapists must also take steps to warn the intended victim1 if this is possible4 ,if a patient is seriously suicidal--that is1 has decided on a means to commit suicide1 has decided when to do this1 and cannot be persuaded to hold off while in therapy--the therapist is legally bound to take whatever action may be necessary to prevent the patient's suicide1 including the disclosure of pertinent information to public officials4 ,similarly1 in cases of child abuse or neglect1 the law requires that a client's confidential relationship with his or her therapist be set to one side in order to provide adequate protection and care for the child4 ,,threats ,,to ,,privacy ,,from ,,health ,,insurance ,,companies ,there is another way that privacy can be invaded1 and for many people it is little known and more significant than the breaks of confidentiality we have already discussed4 ,it comes about as a result of recently formed data banks that are maintained and continuously updated by insurance companies4 ,information about insurance claims and payments not only are kept on file by individual insurance companies1 but a number of national data banks have been established to provide insurance #bfc companies with information about the health histories of individuals4 ,for example1 if you file a health insurance application or a claim for benefits with many insurance companies1 they often will run a check on your health history through a national computerized clearinghouse that maintains insurance information4 ,this information includes data about previous insurance claims you may have made4 ,insurance companies believe that they have a right to data of this kind1 since the information protects them from having to pay for health care costs that come about due to preexisting conditions1 which many insurance policies limit or exclude4 ,too1 if you have suffered from poor health in the past1 and were covered by insurance1 there are probably data about your health history on file in such a national computerized clearinghouse2 by accessing information about you1 an insurance company is able to form a judgment as to whether you are an excessive risk4 ,like any information about you that has been compiled and is furnished without your consent1 these data about your health history--maintained by agencies that service insurance companies--are subject to possible abuse4 ,information on file can and is used to protect the interests of subscribing insurance companies2 your own interests may not be served in the process4 ,not only might you be denied future insurance benefits1 but the information maintained about you is subject to whatever use the insurance clearinghouse believes is appropriate4 ,as yet1 laws to secure a true measure of personal privacy have not been passed4 ,this has been one of the goals of organizations like the ,american ,civil ,liberties ,union4 ,there is a second insurance-related issue that has to do with confidentiality4 ,if you have group health insurance through your employer1 it will be necessary for your therapist to complete reports about you in order for you to receive benefits under your insurance plan4 7,i am assuming here that your insurance offers coverage for counseling1 psychotherapy1 or psychiatry47 ,the reports filed by your therapist with the group health insurance company are sometimes filed through your employer1 and sometimes employers require their group health companies to provide them with information about health care supplied to their employees4 ,in either way1 the fact that you are in therapy and the general reasons for your need for therapy may come to the attention of your employer4 #bfd ,if your employer is a large company or organization1 such information will probably be filed in your employer's business or insurance office and laid to rest2 it will probably not come to the attention of individuals you actually deal with in your work4 ,but it may4 ,in a smaller company1 there is a greater risk4 ,if you are really concerned about this possibility1 ask your insurance officer how health claims are handled and whether health information is requested by your employer from the insurance company4 ,if you are then still concerned and feel that you need to avoid potential complications at work1 you may prefer to see a therapist on your own and refrain from using your employer's insurance coverage4 ,if you see a therapist in private practice1 your decision to pay your own bill may be expensive for you4 ,if finances are a problem1 bear in mind that you can frequently locate competent help through county1 state1 or private counseling agencies4 ,if you go to an agency1 remember that you will almost certainly be asked whether you have insurance coverage4 ,if you admit that you do1 you will have defeated your purpose in going to an agency on your own to protect your privacy4 ,it is1 after all1 your right to obtain treatment that you elect to pay for4 ,,magnifying ,,your ,,need ,,for ,,secrecy ,after reviewing these ways in which confidentiality may be broken--by accident or sometimes excessive informality1 by legal requirements1 or by what to many of us constitutes an invasion of personal privacy by insurance companies--you may wonder to what extent information that you disclose in therapy really is protected4 ,in fact1 very seldom are the details of therapy divulged to others without a client's advance consent4 ,most of us do not need to be worried by legal exceptions to confidentiality3 most of us are not actually homicidal 7though we may feel very angry at times672 most of us are not determined to take our lives 7though we may at times feel very disheartened72 most of us are not concerned that a court will order us to be examined by a psychiatrist4 ,i have tried to give a realistic picture of confidentiality in therapy4 ,the fact that you receive mental health counseling or therapy may inadvertently be disclosed by such things as a billing that goes astray or #bfe by a fellow group member's inclination to talk too much outside of the group4 ,if you decide to make use of insurance coverage1 there are possible consequences you ought to be aware of4 ,i have tried to underline the fact that most people who enter therapy blow out of proportion the real significance of these possible1 but comparatively infrequent1 leaks4 ,karl ,a4 ,menninger1 a renowned and original contributor to psychiatry1 quotes one of his patients who shared her intelligent reflections with him3 ,when ,i look back upon the many months ,i pondered as to how ,i might get here without anyone knowing1 and the devious routes ,i considered and actually took to accomplish this1 only to realize that some of the symptoms from which ,i suffer are respectable enough to be acknowledged anywhere and valid enough to explain my coming here1 it all seems so utterly ridiculous4 ,i looked furtively out of the corner of my eye at the people ,i met here1 expecting them to betray their shame or their queerness1 only to discover that ,i often could not distinguish the patients from the physicians1 or from other visitors4 ,i suppose it is such a commonplace experience to you that you cannot realize how startling that is to a naive layman1 like myself1 even one who thinks he has read a little and laid aside some of the provincialism and prejudice which to some extent blind us all4 ,i see how there is something emotional in it2 if the patient feels only depressed or guilty or confused1 then one looks upon his consulting the psychiatrist as a disgraceful recourse2 but if some of the symptoms take form in one of the bodily organs1 all the shame vanishes4 ,there is no sense to it1 but that's how it is4 ,i have written a dozen letters to tell people where ,i am1 the very people from whom in the past six months ,i have tried to conceal my need of this4#b #b ,karl ,a4 ,menninger1 ,man ,against ,himself 7,new ,york3 ,harcourt1 ,brace and ,company1 #aich71 pp4 #dee-def4 ,,don',t ,,let ,,exaggerated ,,worries ,,hold ,,you ,,back ,when you stop for a moment to consider how widespread personal problems are--#bj percent of ,americans have serious emotional difficulties--isn't there something silly1 ridiculous1 and1 frequently1 self-defeating in being overly concerned about #bff keeping others from knowing that1 for a time1 you were depressed1 anxious1 unsatisfied1 and frustrated to the point that you decided to do something about these unhappy feelings8 ,to be sure1 discretion is sometimes prudent4 ,an employer1 your family1 or some of your friends may be so provincial or bigoted as to think that counseling is close to a misdemeanor4 ,ignorant or uninformed people do tend to judge hastily and to condemn4 ,but often1 if you do have the endurance1 many of them are also willing to change their minds when they have the opportunity to understand a little bit about what they fear4 ,you cannot live for the approval of others4 ,if you believe therapy may help you improve your life1 don't allow yourself to be held back by exaggerated worries4 ,it usually is possible to keep confidential the fact that you have entered therapy when there are especially compelling reasons to exercise foresight and caution4 ,explain your concerns to your therapist2 he or she can then make every effort to help you4 #bfg #bj ,,does ,,therapy ,,work8 ,whether or not therapy works is a question that has hounded psychotherapists for more than thirty years1 when evaluative studies began to cast doubts on its effectiveness4 ,since then1 several hundred studies of the effectiveness of psychotherapy have been made4 ,some of them appear to show that psychotherapy is highly successful1 and many have pointed to evidence that psychotherapy is no more effective than no treatment at all4 ,the ambiguity about this issue has been very troublesome to therapists and tends not to be openly discussed with clients1 for obvious reasons4 ,why reports about psychotherapy's effectiveness have been so contradictory and ambiguous has never been made clear4 ,but understanding the reasons behind these opposing claims will give us a basis for optimism4 ,,claims ,,against ,,the ,,effectiveness ,,of ,,psychotherapy ,if people who are emotionally troubled get well through psychotherapy in about the same length of time as those who are not given any treatment at all1 we would be inclined to say that #bfh psychotherapy didn't help4 ,several studies have shown that the majority of people with neurotic disorders improve spontaneously1 on the average1 in one to two years4#a ,when people with similar problems are treated with psychotherapy1 the outcome is virtually the same3 the spontaneous remission rate for all practical purposes is the same as the rate of success due to therapy4 ,psychotherapy doesn't seem to make a difference4 ,we'll call this the spontaneous remission criticism and will come back to it in a moment4 #a ,s4 ,rachman1 ,the ,effects of ,psychotherapy 7,new ,york3 ,pergamon ,press1 #aiga7 p4 #ah4 ,most studies of the effectiveness of psychotherapy make use of placebo treatments3 a group of emotionally troubled individuals is treated with one of the major approaches to psychotherapy by well-trained therapists1 and another group of similarly troubled people is treated by untrained therapists who offer their clients a therapy that is simply made up but is carefully presented so as to be believable4 ,and1 again1 it turns out that clients treated with the legitimate therapy improve1 but not significantly more than those in the placebo group4 ,we'll call this the placebo criticism and will come back to it1 too1 in a moment4 ,a few studies have shown that psychotherapy can actually be injurious to clients4 ,a disorder brought about by medical treatment is called an iatrogenic disturbance4 ,iatrogenesis is the ,greek word for brought about by doctors4 ,if the iatrogenesis criticism is valid1 then therapy may be not only ineffective but sometimes actually harmful4#b #b ,see1 for example1 ,thomas ,j4 ,nardi1 ,psychotherapy3 ,cui ,bono81 in ,jusuf ,hariman1 ed41 ,does ,psychotherapy ,really ,help ,people8 7,springfield1 ,,il3 ,charles ,c4 ,thomas1 #aihd71 pp4 #aed-afd4 ,together1 these three criticisms have made therapists feel very defensive--and rightly so4 ,if fictitious treatment by a mock therapist works as well as treatment provided by a man or woman who has trained long and hard for a ,ph4,d4 or ,m4,d41 wouldn't you feel ill at ease--perhaps very much ill at ease6--charging your clients #ge to #ajj an hour for your time for a service that is no better than none at all and may even cause your clients to get worse8 ,these are not trumped-up charges against psychotherapy that we can afford to ignore4 ,therapists don't like to confront them4 ,here are some of the results of research studies3 #bfi 444 ,as compared with spontaneous remission1 there is no good evidence to suggest that psychotherapy and psychoanalysis have effects that are in any way superior4#c #c ,hans ,j4 ,eysenck1 ,the ,battle over ,therapeutic ,effectiveness1 in ,j4 ,hariman1 ed41 ,does ,psychotherapy ,really ,help ,people81 p4 #ei4 444 ,most of the verbal psychotherapies have an effect size that is only marginally greater than the effect size for 444 a placebo treatment4#d #d ,edward ,erwin1 ,is ,psychotherapy ,more ,effective ,than a ,placebo81 in ,does ,psychotherapy ,really ,help ,people81 p4 #ci4 ,most writers 444 agree that the therapeutic claims made for psychotherapy range from the abysmally low to the astonishingly high and1 furthermore1 they would tend to agree that on the average psychotherapy appears to produce approximately the same amount of improvement as can be observed in patients who have not received this type of treatment4#e #e ,rachman1 ,the ,effects of ,psychotherapy1 p4 #hd4 444 ,using placebo treatment as a proper control 7which it undoubtedly is71 we find that the alleged effectiveness of psychodynamic therapy i4e41 psychoanalysis vanishes almost completely4#f #f ,eysenck1 ,the ,battle over ,therapeutic ,effectiveness1 p4 #ef4 ,there is still no acceptable evidence to support the view that psychoanalytic treatment is effective4#g #g ,rachman1 ,the ,effects of ,psychotherapy1 p4 #fc4 444 ,there is no relationship between duration of therapy and effectiveness of therapy4#h #h ,eysenck1 ,the ,battle over ,therapeutic ,effectiveness1 p4 #eg4 ,psychotherapy of any kind applies techniques that are based on certain theories1 and these theories demand not only that there should be correlation between success and length of treatment1 but also that the training and experience of the therapist should be extremely important4 ,to find that neither of these corollaries is in fact borne out must be an absolute death blow to any claims to have demonstrated the effectiveness of psychotherapy4#i #i ,ibid4 ,the pessimism produced by these conclusions was summed up by ,hans ,j4 ,eysenck1 professor at the ,institute of ,psychiatry in ,london3 #bgj ,i have always felt that it is completely unethical to subject neurotic patients to a treatment the efficacy of which has not been proven1 and indeed1 the efficacy of which is very much in doubt--so much so that there is no good evidence for it1 in spite of hundreds of studies devoted to the question4 ,patients are asked to spend money and time they can ill afford1 and subject themselves to a gruelling experience1 to no good purpose at all2 this surely cannot be right4 ,at least there should be a statutory warning to the effect that the treatment they are proposing to enter has never been shown to be effective1 is very lengthy and costly1 and may indeed do harm to the patient4#aj #aj ,eysenck1 ,the ,battle over ,therapeutic ,effectiveness1 in ,does ,psychotherapy ,really ,help ,people81 p4 #ei4 ,,why ,,pessimism ,,is ,,unfounded ,i hold all contemporary psychiatric approaches--all mental-health methods--as basically flawed because they all search for solutions along medical-technical lines4 ,but solutions for what8 ,for life6 ,but life is not a problem to be solved4 ,life is something to be lived1 as intelligently1 as competently1 as well as we can1 day in and day out4 ,life is something we must endure4 ,there is no solution for it4#aa #aa ,thomas ,szasz1 interviewed in ,jonathan ,miller1 ,states of ,mind 7,new ,york3 ,pantheon ,books1 #aihc71 p4 #bij4 ,we must grab the bull by the horns4 ,thousands upon thousands of people continue to enter psychotherapy4 ,how long would any service last if it failed to serve the needs of its market8 ,it is tempting to suppose that something constructive1 at least sometimes1 happens as a result of psychotherapy to justify the time1 expense1 and faith of clients4 ,or is their faith really misplaced8 ,one of the most outspoken critics of psychotherapy is psychiatrist ,thomas ,szasz4 ,his views are an unlikely source for a defense of psychotherapy1 but its defense1 oddly enough1 can be found there4 ,szasz argues that psychology has been influenced by the disease model that dominates medicine4 ,medicine bases its conception of treatment on the fact that there are diseases 7or #bga injuries7 that can be helped by means of drugs or surgery4 ,illnesses and injuries are treatable conditions4 ,treatment is applied from outside by the physician1 and the condition1 when the treatment is effective1 improves4 ,but psychiatry goes a step too far when it claims that people who become emotionally helpless1 hopeless1 lonely1 or agitated are actually sick4 ,szasz claims that they are not sick2 they are helpless1 hopeless1 lonely1 or agitated4 ,these are not illnesses but1 rather1 some of the tragic conditions of life4 ,they are problems of living4 ,for ,szasz--and for therapists like ,viktor ,frankl and ,alfred ,adler--psychological problems resemble moral problems much more than they do physical diseases4 ,they involve discouragement1 loss of morale1 loss of moral courage4 ,they are states of demoralization4 ,now1 demoralization is not a treatable condition--not1 certainly1 in the medical sense4 ,you cannot apply treatment from without and expect that the patient will get better4 ,the situation is much more complex than this4 ,the patient--let's shift at this point to calling him or her the client--is much more actively involved in the process of psychotherapy than is a patient in medicine4 ,a woman who contracts pneumonia can be cured with antibiotics while she lies in bed watching television or sleeping4 ,but an emotionally troubled woman--who has had a succession of unhappy marriages1 who has lost job after job1 whose personality is offensive to others1 who has a low sense of self-worth1 and who has lost a sense of meaning and direction in life--cannot be cured while she lies in bed and is treated with appropriate medication4 ,effective treatment just isn't possible2 too much is up to the client herself4 ,basically1 this is why studies of the effectiveness of psychotherapy have generally led to discouraging results4 ,most psychological conditions 7there are exceptions1 as we will see7 are not1 at least at present1 treatable in the medical sense4 ,to combat them requires of the client a great deal of his or her own effort and even exertion4 ,they require self-discipline1 moral courage1 faith in oneself--all the things emotional distress tends to undermine4 ,no approach to psychotherapy can itself be medically effective in treating conditions like these4 ,somehow1 the client must reach a point where he can lift himself by the bootstraps4 ,he can be encouraged by the therapist1 he can be reasoned with1 he can be #bgb manipulated in strategic therapeutic ways1 the therapist can exhort him to be rational1 but the focus always comes back to the client4 ,is he or she motivated to learn how to change8 ,is he or she an effective learner--that is1 a good student8 ,the hundreds of attempts to evaluate the effectiveness of approaches to psychotherapy have1 incredibly1 left out this essential reference to the clients themselves3 ,what kind of people are they8 ,what encourages them8 ,what can act as a source for their motivation1 for the strength they have lost8 ,ironically1 the answer to these questions also lies unwittingly in the hands of psychotherapy's harshest critics4 ,the worst blow to fall on the shoulders of psychotherapists was dealt by placebo studies4 ,experiments were designed that would convince a group of emotionally troubled clients that taking a pink pill 7in reality1 a sugar-filled placebo7 would reduce their symptoms4 ,in fact1 their symptoms were1 in general1 reduced1 and often by as much as treatment in formal psychotherapy4 ,this fact has been interpreted by most therapists to mean that psychotherapy must therefore have been ineffective4 ,if a pink and useless pill could equal the effects of therapy1 then therapy was equally useless4 ,but this involved a huge oversight and a mistake in logic4 ,the therapy did work1 as did the placebo4 ,but why8 ,the placebo effect has become increasingly interesting to psychological as well as medical researchers4 ,apparently1 a client's or patient's strong belief in the therapeutic value of a process sometimes has a measurable influence on his future health4 ,the way belief can act in this way is not necessarily mysterious or mystical4 ,if we are prepared to see emotional difficulties in terms of demoralization1 then belief in therapeutic effectiveness is the most clear-cut counterbalancing force4 ,strong belief of this kind may be enough--if the client really wishes to change and if the therapist and the approach to therapy together can inspire the client's confidence in his own ability to regain control of his life--to help the client begin to lift himself by the bootstraps4 ,just what the necessary ingredients are to make this possible is not yet definitely known4 ,some approaches to therapy1 however1 seem to be more successful than others in inspiring confidence in clients with certain personality traits and with certain goals or problems4 ,the best evidence for this comes from clients themselves1 whose evaluations #bgc of their own experiences in therapy we will look at in a moment4 ,the second blow that fell on psychotherapy came from the spontaneous remission critics4 ,again1 studies demonstrated certain facts3 99 ,how long it takes for spontaneous remission to occur depends greatly on what sorts of emotional difficulties clients have4 ,people with depressive or anxiety reactions tend1 for example1 to have spontaneous remissions faster than persons with obsessive-compulsive or hypochondriacal symptoms4 99 ,the percentages of clients who do experience spontaneous remissions are related to the period of time a study uses as a basis4 7,the follow-up periods of different studies vary a great deal1 from months to many years4 ,as one researcher commented1 ,it is doubtful whether life can guarantee five years of stability to any person4#ab7 #ab ,eisenbud1 quoted in ,h4 ,h4 ,mosak1 ,problems in the ,definition and ,measurement of ,success in ,psychotherapy1 in ,werner ,wolff and ,joseph ,a4 ,precker1 eds41 ,success in ,psychotherapy 7,new ,york3 ,grime ,stratton1 #aieb71 p4 #ac4 99 ,spontaneous remissions frequently happen to clients whose lives improve because of fortunate events1 such as an improved position at work1 successful marriages and personal relationships1 and periods during which pressing problems become fewer and life more stable4 ,given these facts1 spontaneous remission critics argued that1 since many troubled individuals will get better anyway1 without psychotherapy1 we cannot know that psychotherapy caused any beneficial effects4 ,again1 poor logic4 ,it is like saying that since certain bone fractures will eventually heal themselves in correct alignment1 without being set in a cast1 we cannot know for these cases that a cast had any beneficial effects4 ,well1 for many people1 a suitable psychotherapy serves much the same function as a cast does for a broken bone3 it supports1 lessens vulnerability1 reduces pain1 and makes life a little more comfortable until natural healing can take place4 ,again1 whom do we ask to determine whether this is the case8 ,we must ask the person with the fractured arm whether the cast made him or her more comfortable4 #bgd ,,how ,,psychotherapy ,,can ,,be ,,injurious ,,to ,,your ,,health _/ ,is there substantial evidence that psychotherapists sometimes harm1 as well as benefit1 their clients8 ,i think that there definitely is and that this has been fairly well demonstrated4#ac #ac ,albert ,ellis1 ,must ,most ,psychotherapists ,remain as ,incompetent as ,they ,now ,are81 in ,j4 ,hariman1 ed41 ,does ,psychotherapy ,really ,help ,people81 p4 #bdj4 ,even love can harm1 and psychotherapy is no exception4 ,ellis identifies some of the main ways psychotherapists can make clients worse3#ad #ad ,ibid41 pp4 #bd-cf4 99 ,therapists may encourage clients to be dependent on them4 ,directly or indirectly a therapist can convey to a client1 ,you cannot get along without me1 ,you will probably need to spend at least two more years in therapy1 etc4 99 ,therapists may overemphasize the significance of the client's past experience to the point that they persuade the client to feel unjustifiably weighed down and controlled by past events and circumstances4 99 ,therapists may become so hooked on the importance of modeling positive personal qualities 7warmth1 positive regard1 congruence1 empathy7 for a client that they will not provide any active-directive leadership during a time when the client is floundering and needs strong recommendations4 99 ,therapists may place too much importance on the role of insight4 ,the search for insight can be never-ending4 ,it is useful only to some clients2 for others1 insight is irrelevant to helping them change4 99 ,many therapists feel that therapy gives clients a chance to vent their feelings4 ,but catharsis by itself is not enough to replace destructive patterns of behavior and thinking with constructive ones4 99 ,therapists may rely excessively on distracting the client from issues that trouble him2 e4g41 relaxation training1 meditation1 or therapeutic exercise can help clients break out of a cycle of self-preoccupation4 ,self-absorption #bge perpetuates emotional suffering2 distractions can therefore be invaluable4 ,but if a client's underlying self-defeating attitudes are not confronted1 distraction alone will not be enough to bring about lasting change4 99 ,therapists may rely too heavily on getting clients to think positively4 ,positive thinking can undermine a client's already shaky confidence if he fails to achieve the goals that positive thinking led him to expect4 ,these are undeniable shortcomings of therapy4 ,they can reduce the effectiveness of therapy1 or negate its constructive effects1 or even cause clients to accept the therapist's belief that their condition is worse than they thought and so persuade them to feel1 and to be1 even more troubled4 ,it is important to be aware of these signs of what ,ellis rightly calls incompetence in therapists4 ,it is also important to realize that psychotherapy is not unique in having to deal with professional incompetence4 ,physicians can and do fall victim to many of the same excesses3 needlessly alarming patients1 misdiagnosing their conditions1 and sometimes treating them in ways that lead to a general worsening of their health4 ,iatrogenesis exists in medicine as well as in psychotherapy4 ,until the day when the world is a perfect place1 we simply have to take caveat emptor to heart--let the buyer beware4 ,a ,ph4,d4 in clinical psychology1 certification in marriage and family counseling1 or an ,m4,d4 with specialization in psychiatry unfortunately does not guarantee against human fallibility and lack of wisdom4 ,,when ,,psychotherapy ,,is ,,successful ,it might be argued1 then1 that the worth of psychotherapy to the consumer 7the client7 does not depend on its being superior to a placebo4 ,whether it is or is not superior is a theoretical question of interest to theoreticians2 in judging the practical worth of psychotherapy1 what matters is consumer satisfaction4 ,judged by the latter criterion1 psychotherapy is indeed worthwhile4#ae #ae ,edward ,erwin1 ,is ,psychotherapy ,more ,effective ,than a ,placebo81 in ,j4 ,hariman1 ed41 ,does ,psychotherapy ,really ,help ,people81 p4 #dh4 #bgf ,there is a world of difference between popularity and effectiveness4 ,is psychotherapy only popular and simply ineffective8 ,all approaches to therapy have a built-in expectation that positive change will result4 ,this belief implicitly is communicated to clients1 and it can provide them with a sense of hope that replaces the helpless and demoralized state that has motivated them to seek therapy4 ,this happens in several ways4 ,for example1 paying attention to a person increases his morale and self-esteem4 ,this is called the ,hawthorne effect4 ,anyone who has been in therapy can appreciate the gratification that comes from having a competent professional give undivided attention for an hour4#af ,also1 the expectation on the part of a therapist that positive results will follow itself can influence a client's attitudes and his belief that he will get better1 that emotional suffering will lessen and end4 #af ,james ,o4 ,prochaska1 ,systems of ,psychotherapy3 ,a ,transtheoretical ,analysis 7,homewood1 ,,il3 ,the ,dorsey ,press1 #aigi71 p4 #e4 ,the strength of a client's belief that he can change1 that he can improve1 is the major single force in psychotherapy4 ,the client has to feel that his belief is warranted4 ,many factors play a role here3 the client's education level and the respect he may feel toward the therapist's training and experience2 the intangibles of therapy--the therapist's integrity1 authenticity or convincingness1 the client's sense that he is understood1 that the therapist cares1 that the therapist himself has learned how to cope with living and can communicate this1 etc4 ,psychotherapy can be successful when this sense of promise is present in therapy sessions4 ,,clients ,,look ,,back ,i know myself better than any doctor can4 ,ovid ,if most emotional difficulties are not illnesses at all but problems of living1 and if problems of living cannot be treated medically1 then the hundreds of evaluative studies of therapeutic effectiveness have been looking for something that simply is not there3 an objective standard against which to judge therapeutic #bgg success4 ,it makes very little sense to speak of standards in connection with problems of living that come about from demoralization4 ,the only standard we can reasonably appeal to is the subjective judgment of clients themselves1 who have experienced periods in therapy4 ,therapy is a purely individual affair and can be measured only in terms of its meaning to the person1 child1 or adult1 of its value1 not for happiness1 not for virtue1 not for social adjustment but for growth and development in terms of a purely individual norm4#ag #ag ,j4 ,taft1 ,the ,dynamics of ,therapy in a ,controlled ,relationship 7,new ,york3 ,macmillan1 #aicc71 quoted in ,h4 ,h4 ,mosak1 ,problems in the ,definition and ,measurement of ,success in ,psychotherapy1 in ,wolff and ,precker1 eds41 ,success in ,psychotherapy1 p4 #g4 ,a few representative and specific evaluations of their experiences in psychotherapy by former clients follow4 ,they are included here not as proof of the effectiveness of psychotherapy1 because to search for objective proof in this area is a mistake1 but rather as illustrations of different ways people believe themselves to have been helped3#ah #ah ,most evaluative studies of psychotherapy have attempted in some way to take into account the judgment of clients4 ,one study in particular1 however1 has made clients' evaluations of their experiences in therapy its main focus1 in fact1 for a book-length treatment4 ,that is ,hans ,h4 ,strupp1 ,ronald ,e4 ,fox1 and ,ken ,lessler1 ,patients ,view ,their ,psychotherapy 7,baltimore3 ,johns ,hopkins ,press1 #aifi74 ,some of the patient evaluations included here are based on transcripts from the ,strupp-,fox-,lessler study2 they have been paraphrased and condensed for use here4 ,after being in therapy1 ,i have learned to accept myself more easily and believe that many of the people whose opinions about me matter to me also accept me for what ,i am4 ,i have come to realize that what ,i have in my life1 in the way of my marriage1 my children1 my work is what ,i have decided to settle with4 ,it is easier and more satisfying for me to do this than always to be fighting the present and straining for things ,i haven't got4 ,i still have problems with my own self-confidence4 ,i accept some volunteer work at my church1 in spite of these feelings of self-doubt1 believing that ,i really am mentally capable and feeling that ,i can1 in time1 and with patience1 overcome my feelings of inadequacy4 #bgh ,i now love my daughter without qualifications4 ,i have much less hostility toward my mother4 ,i'm much less afraid now to feel unpleasant emotions and feel less guilt than ,i did4 ,i'm not afraid to stand up for myself and say what ,i feel4 ,i feel more patient now with myself and with others4 ,i lose my temper much less often4 ,i enjoy life much more1 feel more content and happy over small things4 ,i'm much more aware now of the feelings of others4 ,i didn't like being around people4 ,now ,i actually can enjoy their company4 ,even parties do not make me nervous like they used to4 ,i am less inclined to condemn others when they are not like me1 and ,i find myself offering suggestions and advice less frequently4 ,the greatest change that therapy has brought me has been to help me get my confidence again4 ,i have gone through periods of grief three times since ,i left therapy1 when members of my family have died4 ,i do not feel ,i could have maintained a sense of balance during these times if ,i had not had the experience of therapy4 ,i feel ,i am better able to trust my judgment now and can cope with living more effectively4 ,i feel better about myself1 though ,i do often still feel a sense of guilt4 ,my problems having to do with a strong father who has condemned the client because of her style of living and has cut off relations with her are still with me1 but ,i feel that ,i have learned to face life more squarely and head-on without so much fear4 ,i'm sure that therapy was the most important part of this change4 ,i feel much more able to relate to my fussy and neurotic parents4 ,their dark moods and bitterness don't plunge me into the dumps like they used to4 ,now1 when ,i do get depressed1 instead of just wanting to give up1 ,i ask myself what it is that has depressed me1 and often ,i can reason my way out of the negative state ,i'm in4 ,i can cope with responsibilities much better now4 ,i have fewer doubts now about my abilities4 ,i feel more inner calm and can cope with daily problems more easily4 ,i have learned that it doesn't pay for me to be a perfectionist about everything4 ,i still admire my desire for perfection in some things that are really important to me1 but ,i no longer fuss with doing a perfect job1 for example1 patching the trash can4 #bgi ,i've accepted myself as a homosexual1 and am happy at work1 and feel productive4 ,i am less anxious in relationships with others now4 ,although ,i still feel negative judgment from my family1 ,i no longer have suicidal thoughts4 ,i realize that ,i should live in a way that is true to myself and that others may differ1 but ,i'm ,,ok myself4 ,i sometimes will give myself a treat1 something ,i never used to do4 ,i will buy myself something that maybe is a little bit frivolous1 but ,i think of this as my own therapy4 ,i feel better about myself and deny myself less4 ,i was almost a stoical nun before4 ,now ,i care more about myself4 ,i used to think that spending money to have my hair done was silly and a waste of money4 ,now ,i think that if it makes me feel good about myself1 and ,i want to treat myself to it1 why not8 ,i used to analyze everything to the point that ,i didn't enjoy much and was always asking myself1 like the bumper-sticker1 am ,i having fun yet8 ,now1 ,i just let some things be4 ,it doesn't pay for me to question everything all the time4 ,now1 when ,i don't like a person1 ,i just accept this4 ,i don't feel guilty because ,i couldn't see their better side1 and ,i don't feel hostile just because for me the person isn't more likable4 ,,what ,,makes ,,psychotherapy ,,successful ,it is not so much the teacher who teaches but the student who learns4 ,whether or not the client gets value for fee paid to a psychotherapist depends largely on the client4 ,don ,diespecker in ,does ,psychotherapy ,really ,help ,people8 ,psychotherapy is much more like education than it is like medicine4 ,in education1 certain students--no more or less intelligent than others--will nevertheless be more successful4 ,they have well-known characteristics3 they are interested in what the experience of education can offer them1 and they work hard and regularly4 ,very much the same thing holds true in psychotherapy3 some clients simply get more from therapy than others4 ,why8 ,in part it has to do with how well matched a client and the approach of the #bhj therapist are4 ,in part it is the amount of confidence the client comes to feel toward the therapist as a person4 ,beyond these1 the qualities of a successful client are very similar to those of a successful student4 ,specifically1 clients who have successful experiences in therapy tend to share these characteristics3 99 ,while in therapy1 they are motivated to change3 ,they feel considerable internal pressure to do something to resolve their problems4 ,they come to feel a sense of initiative and determination4 ,they come to believe in the process of therapy and feel it can be of help to them4 99 ,they are self-disciplined4 ,they keep appointments regularly1 they attempt to implement the therapist's recommendations1 and they are less incapacitated by their difficulties than other clients with similar problems4 99 ,they have a level of emotional maturity that is high enough to withstand some of the painful feelings or frustrations they encounter in therapy4 99 ,frequently they come to enjoy therapy4 ,obviously1 a great deal does depend on the therapist4 ,and yet1 while a good student can learn much in spite of a poor teacher1 a poor student learns little from an excellent teacher4 ,successful therapy depends primarily on the client4 ,other factors can affect your ability to succeed in therapy1 but these are factors over which you have no control3 99 whether you have the emotional support and sympathy of an understanding and tolerant spouse or family 99 whether you have had a long history of emotional problems in connection with work and interpersonal relations 7deeply ingrained habits are harder to break7 99 whether precipitating factors brought about your present difficulties or they just appeared out of the blue 99 how long you have had your present problem 99 what the problem is3 whether it is purely emotional or it has affected your capacity to think coherently and realistically 99 whether there have been fortunate or unfortunate events in your life before and during therapy #bha ,what the future holds in store for you after therapy relies greatly on many of these same factors and on many of the personality qualities that helped you1 or hindered you1 as a client in therapy 7see ,chapter #ba74 ,,so1 ,,does ,,psychotherapy ,,work8 ,yes1 for certain clients and under certain circumstances4 ,the main changes that psychotherapies aim for are either to eliminate destructive habits of thought1 attitude1 or behavior or to establish new1 constructive habits4 ,neither one can be accomplished by means of a medically effective treatment that is applied to the patient until a cure occurs4 ,a few emotional problems fall under the heading of true psychiatric disorders and result from physical causes4 ,they include1 for example1 epilepsy1 drug addiction1 and ,alzheimer's disease4 ,but these conditions are in the minority2 most emotional disorders have not been traced to underlying organic causes4 ,there are several currently competing hypotheses relating to possible biochemical bases of schizophrenia1 mania1 depression1 and anxiety disorders4 ,as time goes by and medical research progresses1 more emotional conditions will very likely be tied to underlying physical problems4 ,until that time1 however1 they remain medically incurable conditions4 ,at present1 the possibility of overcoming them depends heavily on clients themselves1 their ability to find an approach to therapy that is appropriate for their personality and their goals or problems1 and their good fortune in locating a therapist who is able to help them to summon the faith1 energy1 determination1 and courage necessary to overcome their sense of demoralization4 #bhb #ba ,,life ,,after ,,therapy ,theoretically1 psychotherapy is never-ending1 since emotional growth can go on as long as one lives4 ,lewis ,r4 ,wolberg1 ,the ,technique of ,psychotherapy ,it can be difficult to know when to terminate therapy3 difficult for you1 the client1 and sometimes also difficult for the therapist4 ,some periods in therapy do not lead to a successful outcome4 ,you may become dissatisfied with the process of therapy or with the therapist4 ,or1 the therapist may become disappointed in your willingness to work and to change4 ,an impasse may be reached where it seems no progress can be made4 ,when this happens1 it can be hard to know when to draw a line1 to say3 ,we've tried1 but we have to face the fact that we're not getting anywhere4 ,but sometimes this has to be said1 and then you may decide to look elsewhere for help4 ,on the other hand1 when your therapy has been successful and has led to clear1 constructive results1 it may also be difficult to know when to stop4 ,to most clients1 what tends to be most important is relief from symptoms4 ,when this is achieved1 you may be tempted to terminate4 ,but relief from troubling symptoms is not always a sign that problems have been resolved4 #bhc ,frequently1 relief from distress comes about because of problem avoidance4 ,you may have structured your life in a way that circumvents1 rather than faces1 the things that trouble you4 ,there are times when this is indeed the best solution4 ,however1 the tendency is for clients to associate relief with effective therapy1 and often this is not the case4 ,the therapist1 on the other hand1 may have certain personal values that he wishes to satisfy before ending therapy with you3 he may favor1 for example1 qualities of assertiveness and ambitiousness 7or qualities of submissiveness and compliance71 want you to develop these traits1 and feel reluctant to end therapy until you have done this4 ,in general1 the decision to terminate therapy should be made with a number of objectives in mind3 99 ,have your troubling symptoms disappeared or at least been reduced to a level that is tolerable8 99 ,have you improved your understanding of yourself so that you feel a healthy measure of self-acceptance8 99 ,do you now have a greater tolerance to frustration8 99 ,have you developed realistic life goals8 99 ,are you able to function relatively well in social groups8 99 ,are you better able to enjoy life and work8 ,these goals need always to be tempered2 they all involve comparative judgments that should take into account where you started and what you have accomplished4 ,there is no perfection here1 only degrees of adjustment1 compromise1 and a willingness to accept yourself as a mixture of human weaknesses and strengths4 444 ,we have to content ourselves with the modest objective of freedom from disturbing symptoms1 the capacity to function reasonably well1 and to experience a modicum of happiness in living4#a #a ,lewis ,r4 ,wolberg1 ,the ,technique of ,psychotherapy1 vol4 #b1 p4 #gdg4 ,,facing ,,relapses ,some therapists believe that therapy cannot be called successful until you have had a relapse and have been able to get #bhd through it on your own4 ,shadows of old habits linger on4 ,they are especially likely to resurface during periods of insecurity1 disappointment1 and frustration4 ,they represent a part of you--perhaps a part you would just as soon were not there1 but a part of you1 nonetheless1 that you cannot expect to eradicate completely4 ,you are much better prepared to face the challenges of the future1 of events that cannot be anticipated1 and of uncertainties that cannot be avoided1 if you do not demand a total change in yourself to the point that old reactions never recur4 ,you are better prepared if you realize that it is likely some will return for brief visits during periods of particular stress4 ,if and when this happens1 you can render these visits less distressing and less able to throw you by using the understanding you have gained from therapy4 ,you are apt to get a flurry of anxiety and a return of symptoms from time to time4 ,don't be upset or intimidated by this4 ,the best way to handle yourself is first to realize that your relapse is self-limited4 ,it will eventually come to a halt4 ,nothing terrible will happen to you4 ,second1 ask yourself what has been going on4 ,try to figure out what created your upset1 what aroused your tension4 ,relate this to the general patterns that you have been pursuing4444 ,old habits hold on1 but they will eventually get less and less provoking4#b #b ,wolberg1 ,the ,technique of ,psychotherapy1 vol4 #b1 p4 #ged4 ,,how ,,to ,,carry ,,on ,therapy is a temporary crutch or a cast in which to heal1 a comfort1 a source for renewed faith in yourself1 and an experience of learning4 ,it cannot solve all the problems of future living1 for these pose new challenges that require of us all that we readjust our goals and expectations1 become more resilient and less easily troubled or broken4 7,the flexible bamboo is more likely to survive a storm than the mighty oak47 ,reducing an individual's rigidity is an objective of all psychotherapies4 ,becoming less rigid allows you to accommodate to changes and to tolerate external stress more easily4 ,decreased rigidity helps you adjust to new demands placed on you by your surroundings4 #bhe ,but there is another side to living successfully1 and that is1 first1 the ability to recognize situations and circumstances that cause you excessive stress and1 second1 the willingness to leave them before it is too late4 ,we tend to place all of the responsibility for adjustment to stress on ourselves1 on our inner strengths4 ,but often this is unnecessary1 unreasonable1 and even self-destructive4 ,often it is the situation that is not desirable or tolerable1 not a weakness in ourselves in being unable to cope with it4 ,it can sometimes take more strength and courage to break free from a pattern of frustration and unhappiness than to remain on1 slowly wearing down your resources and growing older fast4 ,much of successful living after therapy is a matter of prevention3 of being aware when you begin to tax yourself more than you need to1 when your body and mind begin to tell you that you are developing new habits of anxiety or depression or are starting to reinforce old ones4 ,at these times1 take stock of what you are doing1 of how your daily living may be in conflict with your values and attitudes4 ,prevention here means being willing to change an undesirable situation1 not just enduring it while trying to change its consequences in you4 ,this is largely a matter of knowing and respecting yourself1 of not requiring yourself to accept conditions that you feel will lead you to grief4 ,therapy may help you tolerate stress more easily1 but this is one-sided if you do not also learn to protect yourself from stress that is excessive4 7,even bamboos can be broken47 ,therapy is an opportunity for you to learn how to cope better with the problems of living4 ,you learn that you can face the demands of life successfully in these ways3 99 through belief in yourself and through strength of will 99 by diminishing your preoccupation with yourself and developing interests outside yourself 99 by understanding your reactions and accepting them rather than fighting yourself 99 by living in the present 99 by taking yourself less seriously1 by developing a sense of humor and perspective ,having learned these things1 you then simply do the best you can within the limitations of life4 #bhg ,,part ,,iv ,,appendixes #bhi ,n4,b4 ,since the first edition of this book1 the majority of the groups and organizations listed in the following appendix may be readily contacted by e-mail4 ,for current e-mail addresses1 ,google the names of any organizations you wish to contact4 ,,appendix ,a3 ,agencies and ,organizations ,that ,can ,help 7,united ,states and ,canada7 ,,part ,i3 ,,united ,,states ,,self-,,help ,,organizations ,for ,general ,information ,self-help groups exist for many different kinds of problems4 ,they are listed in many communities by local branches of the ,self-,help ,clearinghouse4 ,if a branch is not listed in your telephone directory and you would like a listing of self-help groups in your area1 contact3 ,national ,self-,help ,clearinghouse #be ,w4 #dcrd ,st4 ,new ,york1 ,,ny #ajjcf 7#bab7 #hdj-abei ,a fact sheet on self-help groups prepared by the ,national ,institute of ,mental ,health is available at no charge from3 ,consumer ,information ,center ,department #fji,k ,pueblo1 ,,co #hajji #bij ,also1 you may wish to contact3 ,national ,self-,help ,resource ,center #agbi-ca ,connecticut ,ave41 ,,nw ,washington1 ,,dc #bjjji 7#bjb7 #chg-jaid ,for a detailed guide to self-help groups1 consult ,,help3 ,a ,working ,guide to ,self-,help ,groups1 by ,alan ,gartner and ,frank ,riessman 7,new ,york3 ,new ,viewpoints_/,vision ,books1 #aihj74 ,for ,specific ,problems ,for alcoholics3 ,alcoholics ,anonymous ,world ,services ,,po ,box #dei1 ,grand ,central ,station ,new ,york1 ,,ny #ajafc 7#bab7 #fhf-aajj ,for families of alcoholics3 ,al-,anon ,family ,group ,headquarters #a ,park ,ave4 ,new ,york1 ,,ny #ajjaf 7#bab7 #fhc-agga ,for individuals with emotional problems3 ,emotions ,anonymous ,international #aeie ,selby ,ave4 ,st4 ,paul1 ,,mn #eeajd 7#fab7 #fdg-igab ,neurotics ,anonymous #cfcf #afth ,st41 ,,nw ,washington1 ,,dc #bjjje 7#bjb7 #fbh-dcgi ,for individuals who have been treated for emotional or mental difficulties3 ,recovery1 ,inc4 #hjb ,n4 ,dearborn ,st4 ,chicago1 ,,il #fjfjc 7#cab7 #ccg-effa #bia ,national ,alliance for the ,mentally ,ill #aija ,n4 ,fort ,myer ,dr4 ,ste4 #ejj ,arlington1 ,,va #bbbji 7#gjc7 #ebd-gfjj ,autism3 ,national ,society for ,autistic ,children ,information ,referral ,service #abcd ,massachusetts ,ave41 ,,nw ,washington1 ,,dc #bjjje 7#bjb7 #ghc-jabe ,epilepsy3 ,epilepsy ,foundation of ,america #dcea ,garden ,city ,dr4 ,landover1 ,,md #bjghe 7#cja7 #dei-cgjj ,learning disorders3 ,council for ,exceptional ,children #aibj ,association ,dr4 ,reston1 ,,va #bbjia 7#gjc7 #fbj-cffj ,for families who have children with behavior problems3 ,families ,anonymous ,,po ,box #ebh ,van ,nuys1 ,,ca #iadbf 7#hah7 #ihi-ghda ,for single parents with children3 ,parents ,without ,partners ,international #giaj ,woodmont ,ave4 ,washington1 ,,dc #bjjad 7#cja7 #fed-hhej ,for parents of abused children3 ,parents ,anonymous #gabj ,franklin ,ave4 ,los ,angeles1 ,,ca #ijjdf 7#bac7 #hgf-ifdb #bib ,for pathological gamblers3 ,gamblers ,anonymous ,,po ,box #agagc ,los ,angeles1 ,,ca #ijjag 7#bac7 #chf-hghi ,for families of pathological gamblers3 ,gam-,anon ,,po ,box #dedi ,downey1 ,,ca #ijbda 7#bac7 #dfi-bgea ,for individuals with phobias3 ,,terrap #ajaj ,doyle ,st4 ,menlo ,park1 ,,ca #idjbe 7#dae7 #cbi-abcc ,for obesity3 ,overeaters ,anonymous #baij ,w4 #aijth ,st4 ,torrance1 ,,ca #ijejd 7#bac7 #cbj-gida ,weight ,watchers ,international #hjj ,community ,dr4 ,manhasset1 ,,ny #aajcj 7#eaf7 #fbg-ibjj ,for narcotics addicts3 ,narcotics ,anonymous #hjfa ,vineland ,ave4 ,sun ,valley1 ,,ca #iaceb 7#bac7 #gfh-fbjc ,national ,association on ,drug ,abuse ,problems #afj ,n4 ,franklin ,hempstead1 ,,ny #aaeej 7#eaf7 #dha-jbbj #bic ,,professional ,,associations ,american ,academy of ,psychoanalysis #cj ,e4 #djth ,st4 ,new ,york1 ,,ny #ajjaf 7#bab7 #fgi-daje ,american ,association for ,marriage and ,family ,therapy #agag ,k ,st41 ,,nw ,suite #djg ,washington1 ,,dc #bjjjf 7#bjb7 #dbi-ahbe ,american ,association of ,sex ,educators1 ,counselors and ,therapists #aa ,dupont ,circle1 ,,nw ,suite #bbj ,washington1 ,,dc #bjjcf 7#bjb7 #dfb-aaga ,american ,psychiatric ,association #adjj ,k ,st41 ,,nw ,washington1 ,,dc #bjjje 7#bjb7 #fhb-fjjj ,american ,psychological ,association #abjj #agth ,st41 ,,nw ,washington1 ,,dc #bjjcf 7#bjb7 #iee-gfhf ,association for ,advancement of ,behavioral ,therapy #ae ,w4 #cfth ,st4 ,new ,york1 ,,ny #ajjaa 7#bab7 #bgi-gigj ,national ,association of ,social ,workers #giha ,eastern ,ave4 ,silver ,spring1 ,,md #bjijg 7#cja7 #efe-jccc #bid ,,part ,,ii3 ,,canada ,,self-,,help ,,organizations ,for ,general ,information ,the ,centre for ,service to the ,public publishes the annual ,index to ,federal ,programs ,services1 which contains descriptions of more than #a1ajj programs and services administered by federal departments1 agencies1 and ,crown ,corporations4 ,the ,centre also operates the ,canada ,service ,bureaus throughout ,canada1 which provide telephone referral services for individuals interested in locating federal agencies and programs4 ,contact3 ,centre for ,service to the ,public #cfe ,laurier ,ave41 ,w4 ,ottawa1 ,,on ,kl,a #j,s#e 7#fac7 #iic-fcdb ,also1 you may wish to contact3 ,department of ,national ,health and ,welfare ,social ,service ,programs ,branch ,national ,welfare ,grants ,program1 #gth fl4 ,brooke ,claxton ,building ,tunney's ,pasture ,ottawa1 ,,on ,k#a;,a #a;,b#e 7#fac7 #iij-iefc ,canadian ,mental ,health ,association #bafj ,yonge ,st4 ,toronto1 ,,on ,m#d,s #b,z#c 7#daf7 #dhd-ggej ,for information about community services1 contact3 ,voluntary ,action ,department of ,secretary of ,state #ae ,eddy ,st41 ,hull ,ottawa1 ,,on ,k#a;,a ,,om#e 7#hai7 #iid-bbee #bie ,for ,specific ,problems ,for alcoholics3 ,alcoholics ,anonymous ,intergroup ,office #bgb ,eglinton ,ave41 ,w4 ,toronto1 ,,on ,m#d,r #a;,b#b 7#daf7 #dhg-eeia ,,addics 7,alcohol ,drug ,dependency ,information ,counselling ,services7 #hah ,portage ,ave41 #bji ,winnipeg1 ,,mb ,r#c;,g #j,n#d 7#bjd7 #gge-abcc ,for individuals who are mentally or physically disabled3 ,disabled ,peoples' ,international 7,,dpi7 #bjg-bid ,portage ,ave4 ,winnipeg1 ,,mb ,r#c;,c #a,k#b 7#bjd7 #idb-cfjd ,for individuals who have been treated for emotional or mental difficulties3 ,mental ,patients ,association #badf ,yew ,st4 ,vancouver1 ,,bc ,v#f,k #c;,g#g 7#fjd7 #gch-eagg ,autism3 ,autism ,society ,canada ,box #dgb1 ,sta4 ,a ,scarborough1 ,,on ,m#a,k #e;,c#c 7#daf7 #ddd-hebh ,epilepsy3 ,epilepsy ,ontario #bafj ,yonge ,st41 #ast fl4 ,toronto1 ,,on ,m#d,s #b;,a#i 7#daf7 #dhi-bhbe #bif ,learning disorders3 ,canadian ,association for ,children and ,adults with ,learning ,disabilities #cbc ,chapel ,st4 ,ottawa1 ,,on ,k#a,n #g,z#b 7#fac7 #bch-egba ,for families who have children with emotional and behavior problems3 ,ontario ,association of ,children's ,mental ,health ,centres #dj ,st4 ,clair ,ave41 ,e41 #cji ,toronto1 ,,on ,m#d,t #a,m#i 7#daf7 #iba-baji ,for single parents with children3 ,one ,parent ,families ,association of ,canada #bbgi ,yonge ,st41 #ag ,toronto1 ,,on ,m#d,p #b;,c#g 7#daf7 #dhg-gigf ,for narcotics addicts3 ,,addics 7,alcohol ,drug ,dependency ,information ,counseling ,services7 #hah ,portage ,ave41 #bji ,winnipeg1 ,,mb ,r#c;,g #j,n#d 7#bjd7 #gge-abcc ,,professional ,,associations ,canadian ,psychiatric ,association #bbe ,lisgar ,st41 #ajc ,ottawa1 ,,on ,k#b,p #j;,c#f 7#fac7 #bcd-bhae ,canadian ,psychoanalytic ,society #gjjj ,cte des ,neiges ,rd4 ,montreal1 ,,qc ,h#c,s #b;,c#a 7#ead7 #gch-faje #big ,canadian ,psychological ,association #eeh ,king ,edward ,ave4 ,ottawa1 ,,on ,k#a,n #g,n#f 7#fac7 #bch-ddji ,council of ,provincial ,associations of ,psychology #eeh ,king ,edward ,ave4 ,ottawa1 ,,on ,k#a,n #g,n#f 7#fac7 #bch-ddji ,ontario ,psychological ,association #adjg ,yonge ,st41 #djb ,toronto1 ,,on ,m#d,t #a,y#g 7#daf7 #ifa-eeeb ,ontario ,association for ,marriage and ,family ,therapy #bga ,russell ,hill ,rd4 ,toronto1 ,,on ,m#d,v #b,t#e 7#daf7 #ifh-gggi ,canadian ,association of ,social ,workers #ee ,parkdale ,ave41 #cl#f ,ottawa1 ,,on ,k#a,y #a;,e#e 7#fac7 #gbh-ahfe ,corporation ,professionnelle des ,travailleurs ,sociaux du ,quebec #egeg ,decelles ,ave41 ,ch4 #cce ,montreal1 ,,qc ,h#c,s #b;,c#c 7#ead7 #gca-bgdi ,canadian ,guidance ,counseling ,association ,faculty of ,education ,university of ,ottawa #fea ,cumberland ,st41 ,rm4 #dbg ,ottawa1 ,,on ,k#a,n #f,n#e 7#fac7 #bcd-begb #bih ,,appendix ,b3 ,suggestions for ,further ,reading ,,general ,,information ,greenberg1 ,bette4 ,how to ,find ,out in ,psychiatry3 ,a ,guide to ,sources of ,mental ,health ,information4 ,new ,york3 ,pergamon ,press1 #aigh4 ,powell1 ,barbara ,j4 ,a ,layman's ,guide to ,mental ,health ,problems and ,treatments4 ,springfield1 ,,il3 ,charles ,c4 ,thomas1 #aiha4 ,russell1 ,bertrand4 ,the ,conquest of ,happiness4 ,new ,york3 ,bantam1 #aifh 7first published in #aicj74 ,one of the most psychologically perceptive attempts to identify the basic ingredients for a happy life1 by a philosopher who made original contributions to whatever subjects he touched4 ,strupp1 ,hans ,h4 ,patients ,view ,their ,psychotherapy4 ,baltimore3 ,johns ,hopkins ,press1 #aifi4 ,evaluations by patients of their experiences in psychotherapy4 ------4 ,psychotherapists in ,action4 ,new ,york3 ,grune ,stratton1 #aifj4 ,focuses on what the therapist actually does in the therapy relationship4 ,watson1 ,robert ,i41 ,jr4 ,psychotherapies3 ,a ,comparative ,casebook4 ,new ,york3 ,holt1 ,reinhart and ,winston1 #aigg4 ,a collection #bii of cases treated by means of different approaches to psychotherapy4 ,wheelis1 ,allen4 ,how ,people ,change4 ,new ,york3 ,harper ,row1 #aigc4 ,an insightful book about the process of therapy4 ,a4 ,,psychoanalysis 7,,chapter #i7 ,brenner1 ,charles4 ,an ,elementary ,textbook of ,psychoanalysis4 ,new ,york3 ,international ,universities ,press1 #aigc4 ,a world-famous introduction to analysis that has now been translated into nine languages4 ,hall1 ,calvin4 ,a ,primer of ,freudian ,psychology4 ,new ,york3 ,new ,american ,library1 #aied4 ,perhaps the clearest and most concise summary of psychoanalytic concepts4 ,jones1 ,ernest4 ,the ,life and ,work of ,sigmund ,freud4 ,new ,york3 ,basic ,books1 #aiec-eg4 #c volumes4 ,a biography of ,freud that describes his personal development and summarizes his main contributions4 ,b4 ,,client-,,centered ,,therapy 7,,chapter #aj7 ,rogers1 ,carl ,ronsom4 ,client-,centered ,therapy4 ,boston3 ,houghton ,mifflin1 #aiea4 ,a good introduction to ,rogers's approach to therapy4 ,it was his first major exposition of his theory4 ------4 ,on ,becoming a ,person3 ,a ,therapist's ,view of ,psychotherapy4 ,boston3 ,houghton ,mifflin1 #aifa4 ,perhaps ,rogers's best-known book4 ,it gives a very personal view of his approach4 ,c4 ,,gestalt ,,therapy 7,,chapter #aj7 ,pagan1 ,j41 and ,i4 ,l4 ,sheperd1 eds4 ,gestalt ,therapy ,now4 ,palo ,alto3 ,science and ,behavior ,books1 #aigj4 ,new ,york3 ,harper and ,row1 #aiga4 ,a collection of articles on ,gestalt theory1 technique1 and applications by well-known ,gestalt therapists4 ,perls1 ,frederick ,s4 ,gestalt ,therapy ,verbatim4 ,moab1 ,,ut3 ,real ,people ,press1 #aife4 ,probably the most widely read of ,perls's books illustrating the ,gestalt approach4 #cjj ,d4 ,,transactional ,,analysis 7,,chapter #aj7 ,berne1 ,eric4 ,games ,people ,play4 ,new ,york3 ,grove ,press1 #aifd4 ,a simply written summary of the main concepts of ,,ta3 ego states1 transactions1 games1 etc4 ------4 ,what ,do ,you ,say ,after ,you ,say ,hello8 ,new ,york3 ,grove ,press1 #aigb4 ,published after ,berne's death1 this is an outline of his approach to therapy1 focusing on his notion of life scripts4 ,e4 ,,rational-,,emotive ,,therapy 7,,chapter #aj7 ,ellis1 ,albert4 ,humanistic ,psychotherapy3 ,the ,rational-,emotive ,approach4 ,new ,york3 ,mc,graw-,hill1 #aigc4 ,a clear statement of the way people can choose to make1 or not make1 themselves emotionally disturbed4 ------1 and ,robert ,a4 ,harper4 ,a ,new ,guide to ,rational ,living4 ,englewood ,cliffs1 ,,nj3 ,prentice ,hall1 #aige4 ,one of the best-known self-help books dealing with rational-emotive therapy4 ,f4 ,,existential-,,humanistic ,,therapy 7,,chapter #aj7 ,arbuckle1 ,d4 ,counseling and ,psychotherapy3 ,an ,existential-,humanistic ,view4 ,boston3 ,allyn ,bacon1 #aige4 ,a good introduction to this approach to therapy4 ,binswanger1 ,ludwig4 ,being-in-the-,world3 ,selected ,papers of ,ludwig ,binswanger4 ,new ,york3 ,basic ,books1 #aifc4 ,a less readable book that nevertheless gives the reader a sense of how existentialism has been applied to psychotherapy4 ,may1 ,rollo1 ,ernst ,angel1 and ,henri ,ellenberger1 eds4 ,existence4 ,new ,york3 ,basic ,books1 #aieh4 ,a collection of essays dealing with basic topics of existential-humanistic psychotherapy4 ,g4 ,,logotherapy 7,,chapter #aa7 ,frankl1 ,victor4 ,man's ,search for ,meaning3 ,an ,introduction to ,logotherapy4 ,new ,york3 ,washington ,square ,press1 #aiei4 ,a clear and gripping description of the development of logotherapy as a result of concentration camp suffering4 #cja ------4 ,the ,doctor and the ,soul4 ,new ,york3 ,knopf1 #aifc4 ,a further description of logotherapy4 ,h4 ,,reality ,,therapy 7,,chapter #aa7 ,glasser1 ,william4 ,reality ,therapy4 ,new ,york3 ,harper and ,row1 #aife4 ,glasser describes his view that1 because of loneliness and feelings of inadequacy1 people tend to refuse to take responsibility for fulfilling their needs for love and worth4 ,see also ,glasser's book1 ,positive ,addiction1 listed under ,t4 ,therapeutic ,exercise4 ,i4 ,,adlerian ,,therapy 7,,chapter #aa7 ,adler1 ,alfred4 ,problems of ,neurosis3 ,a ,book of ,case-,histories4 ,new ,york3 ,harper ,torchbooks1 #aifd 7first published in #aibi74 ,these are case examples illustrating ,adler's theory of neurotic development4 ,the book contains an introduction by ,h4 ,l4 ,ansbacher that summarizes basic ,adlerian theory4 ------4 ,social ,interest3 ,a ,challenge to ,mankind4 ,new ,york3 ,capricorn ,books1 #aifd 7first published in #aibi74 ,this is the last exposition given by ,adler of his thought4 ,it is a good and simply written summary of ,adlerian psychology4 ,j4 ,,bioenergetics 7,,chapter #aa7 ,keleman1 ,s4 ,sexuality1 ,self and ,survival4 ,san ,francisco3 ,lodestar ,press1 #aiga4 ,lowen1 ,alexander4 ,the ,betrayal of the ,body4 ,new ,york3 ,collier1 #aifg4 ,k4 ,,primal ,,therapy 7,,chapter #aa7 ,janov1 ,arthur4 ,the ,anatomy of ,mental ,illness3 ,the ,scientific ,basis of ,primal ,therapy4 ,new ,york3 ,g4 ,p4 ,putnam1 #aiga4 ------4 ,primal ,scream4 ,new ,york3 ,dell1 #aiga4 #cjb ,l4 ,,implosive ,,therapy 7,,chapter #aa7 ,stampfl1 ,thomas ,g41 and ,d4 ,levis4 ,implosive ,therapy3 ,theory and ,technique4 ,morristown1 ,,nj3 ,general ,learning ,press1 #aigc4 ,m4 ,,direct ,,decision ,,therapy 7,,chapter #aa7 ,greenwald1 ,harold4 ,decision ,therapy4 ,new ,york3 ,peter ,h4 ,wyden1 #aigc4 ------1 and ,elizabeth ,rich4 ,the ,happy ,person4 ,new ,york3 ,stein and ,day1 #aihd4 ,a very readable summary of direct decision therapy4 ,n4 ,,counter-,,conditioning 7,,chapter #ab7 ,o4 ,,behavior ,,modification 7,,chapter #ab7 ,p4 ,,cognitive ,,approaches ,,to ,,behavior ,,change 7,,chapter #ab7 ,alberti1 ,r4 ,e41 and ,m4 ,l4 ,emmons4 ,stand ,up1 ,speak ,out1 ,talk ,back4 ,new ,york3 ,pocket ,books1 #aige4 ,on assertiveness training4 ,burns1 ,david4 ,feeling ,good3 ,the ,new ,mood ,therapy4 ,new ,york3 ,signet1 #aihj4 ,a good self-help account of the general cognitive approach to behavior change4 ,kanfer1 ,f4 ,h41 and ,a4 ,p4 ,goldstein1 eds4 ,helping ,people ,change4 ,new ,york3 ,pergamon ,press1 #aige4 ,this large book discusses operant1 cognitive change1 and self-control methods4 ,the emphasis is on how these techniques of behavior change are used in a clinical setting4 ,wolpe1 ,joseph4 ,the ,practice of ,behavior ,therapy4 ,new ,york3 ,pergamon ,press1 #aigc4 ,one of the major contributors to behavioral psychotherapy describes the use of techniques to encourage behavior change4 ,q4 ,,group ,,therapy 7,,chapter #ac7 ,grotjahn1 ,martin1 ,frank ,m4 ,kline1 and ,claude ,t4 ,h4 ,friedman1 eds4 ,handbook of ,group ,therapy4 ,new ,york3 ,van ,nostrand1 #aihc4 ,helmering1 ,doris ,w4 ,group ,therapy3 ,who ,needs ,it8 ,millbrae1 ,,ca3 ,celestial ,arts1 #aigf4 ,a good informal summary of group therapy4 #cjc ,r4 ,,marriage ,,therapy 7,,chapter #ad7 ,s4 ,,family ,,therapy 7,,chapter #ad7 ,fay1 ,allen4 ,making ,things ,better by ,making ,them ,worse4 ,new ,york3 ,hawthorne ,books1 #aigh4 ,a variety of applications of therapeutic paradoxical strategies in marriage communication1 as well as in connection with the treatment of anxiety1 depression1 fears1 etc4 ,foley1 ,vincent ,d4 ,an ,introduction to ,family ,therapy4 ,new ,york3 ,grune ,stratton1 #aigd4 ,haley1 ,jay1 ed4 ,changing ,families3 ,a ,family ,therapy ,reader4 ,new ,york3 ,grune ,stratton1 #aiga4 ,watzlawick1 ,paul1 ,john ,weakland1 and ,richard ,fisch4 ,change3 ,principles of ,problem ,formation and ,problem ,resolution4 ,new ,york3 ,norton1 #aigd4 ,a readable and entertaining description of the tendency of family and marriage systems to resist change and a good explanation of the use of paradoxical strategies to encourage constructive change4 ,t4 ,,therapeutic ,,exercise 7,,chapter #ae7 ,fixx1 ,james ,f4 ,the ,complete ,book of ,running4 ,new ,york3 ,random ,house1 #aigg4 ,see ,chapter #b1 ,what ,happens to ,your ,mind4 ,glasser1 ,william4 ,positive ,addiction4 ,new ,york3 ,harper and ,row1 #aigf4 ,glasser proposes that some activities such as running and meditation are positive addictions2 their practice can help a person grow emotionally stronger4 ,glover1 ,bob1 and ,jack ,shepherd4 ,the ,runner's ,handbook4 ,new ,york3 ,viking ,press1 #aigg4 ,see ,chapter #ae1 ,stress and ,tension1 and ,chapter #af1 ,running ,inside ,your ,head4 ,kostrubala1 ,thaddeus4 ,the ,joy of ,running4 ,philadelphia3 ,j4 ,b4 ,lippincott1 #aigf4 ,see ,chapters #f1 #g1 and #h on ,psychological ,effects1 ,theory1 and ,running and ,therapy4 ,u4 ,,biofeedback 7,,chapter #ae7 ,brown1 ,b4 ,b4 ,stress and the ,art of ,biofeedback4 ,new ,york3 ,harper and ,row1 #aigg4 ,reviews the effectiveness of biofeedback4 ,weiss1 ,anne ,e4 ,biofeedback3 ,fact or ,fad8 ,new ,york3 ,franklin ,watts1 #aihd4 ,a clear1 informal presentation of biofeedback4 #cjd ,v4 ,,relaxation ,,training 7,,chapter #ae7 ,benson1 ,herbert4 ,the ,relaxation ,response4 ,new ,york3 ,morrow1 #aige4 ,jacobson1 ,e4 ,progressive ,relaxation4 ,chicago3 ,university of ,chicago ,press1 #aicj4 ,one of the first studies to examine systematic muscle relaxation4 ,w4 ,,hypnosis 7,,chapter #ae7 ,erickson1 ,milton1 ,ernest ,l4 ,rossi1 and ,sheila ,i4 ,rossi4 ,hypnotic ,realities3 ,the ,induction of ,clinical ,hypnosis and ,forms of ,indirect ,suggestion4 ,new ,york3 ,irvington ,publishers1 #aigf4 ,wallace1 ,benjamin4 ,applied ,hypnosis3 ,an ,overview4 ,chicago3 ,nelson-,hall1 #aigi4 ,a general description of hypnosis4 ,wolberg1 ,lewis ,r4 ,hypnosis3 ,is ,it for ,you8 ,new ,york3 ,harcourt ,brace ,jovanovich1 #aigb4 ,a good1 general description of hypnosis and its use in the context of psychotherapy4 ,x4 ,,meditation 7,,chapter #ae7 ,carrington1 ,patricia4 ,freedom in ,meditation4 ,garden ,city1 ,,ny3 ,anchor ,press1 #aigg4 ,by a clinical psychologist who uses meditation with her patients1 a practical and comprehensive discussion of meditation and its connection with the human problems that bring people to psychotherapy4 ,glasser1 ,william4 ,positive ,addiction4 ,new ,york3 ,harper and ,row1 #aigf4 ,see ,chapter #f1 ,meditation4 ,le,shan1 ,lawrence4 ,how to ,meditate3 ,a ,guide to ,self-,discovery4 ,boston3 ,little1 ,brown ,co41 #aigd4 ,an intelligent and modest practical approach to meditation4 ,y4 ,,drug ,,therapy 7,,chapter #af7 ,leavitt1 ,fred4 ,drugs and ,behavior4 ,new ,york3 ,wiley1 #aihb4 ,physician's ,desk ,reference to ,pharmaceutical ,specialties and ,biologicals4 ,new ,jersey3 ,medical ,economics1 ,inc4 ,published annually with quarterly supplements4 ,gives detailed information about drugs1 side effects1 potential risks1 etc4 ,swonger1 ,alvin ,k41 and ,larry ,l4 ,constantine4 ,drugs and ,therapy3 ,a ,psychotherapist's ,handbook of ,psychotropic ,drugs4 ,boston3 ,little1 ,brown ,co41 #aigf4 #cje ,z4 ,,diet ,,therapy 7,,chapter #af7 ,fredericks1 ,carlton4 ,psycho-,nutrition4 ,new ,york3 ,grosset ,dunlap1 #aigf4 ,watson1 ,george4 ,nutrition and ,your ,mind3 ,the ,psychochemical ,response4 ,new ,york3 ,harper and ,row1 #aigb4 ,,on ,,legal ,,issues ,,in ,,psychotherapy 7,,chapter #ai7 ,cohen1 ,ronald ,jay4 ,legal ,guidebook in ,mental ,health4 ,new ,york3 ,free ,press1 #aihb4 ,gutheil1 ,thomas ,g41 and ,paul ,s4 ,appelbaum4 ,clinical ,handbook of ,psychiatry and the ,law4 ,new ,york3 ,mc,graw-,hill1 #aihb4 ,hofling1 ,charles ,k41 ed4 ,law and ,ethics in the ,practice of ,psychiatry4 ,new ,york3 ,brunner_/,mazel1 #aiha4 ,,on ,,the ,,effectiveness ,,of ,,psychotherapy 7,,chapter #bj7 ,eysenck1 ,hans ,j4 ,the ,battle over ,therapeutic ,effectiveness1 in ,jusuf ,hariman1 ed41 ,does ,psychotherapy ,really ,help ,people8 ,springfield1 ,,il3 ,charles ,c4 ,thomas1 #aihd1 pp4 #eb-fa4 ------4 ,the ,effects of ,psychotherapy4 ,new ,york3 ,inter-,science ,press1 #aiff4 ,hariman1 ,jusuf1 ed4 ,does ,psychotherapy ,really ,help ,people8 ,springfield1 ,,il3 ,charles ,c4 ,thomas1 #aihd4 ,a collection of evaluative articles about psychotherapy4 ------4 ,the ,therapeutic ,efficacy of the ,major ,psychotherapeutic ,techniques4 ,springfield1 ,,il3 ,charles ,c4 ,thomas1 #aihb4 ,a collection of papers about the therapeutic effectiveness of a variety of approaches to psychotherapy4 ,rachman1 ,s41 and ,g4 ,t4 ,wilson4 ,the ,effects of ,psychological ,therapy4 ,oxford3 ,pergamon ,press1 #aihj4 ,wolff1 ,werner1 ed4 ,success in ,psychotherapy4 ,new ,york3 ,grune ,stratton1 #aieb4 #cjg ,,index ,,ndx ,adjunctive therapies1 #hi ,adjustment problems1 #fi1 #gd ,adler1 ,alfred1 #aeh ,adlerian therapy1 #ib1 #aeg-fa ,aerobic exercise1 #bje-h ,affective disorders1 #fi1 #gc-gd drug therapy and1 #bcd ,agencies1 #bhi-ig public1 #ee ,aging1 problems of1 #fi1 #gf ,alcoholics ,anonymous1 #ahh ,alcoholism1 #gg1 #ajh ,alzheimer's disease1 #gg ,anemia1 #ajg ,anesthesia1 hypnosis and1 #bba ,antianxiety drugs1 #bbh1 #bca ,anticipatory anxiety1 #aeb ,antidepressants1 #bbi1 #bcb side effects of1 #bcc ,antiepileptic drugs1 #bbi ,antiparkinsonian drugs1 #bbi ,antipsychotic drugs1 #bbh1 #bce ,anxiety anticipatory1 #aeb counter-conditioning and1 #agf drug therapy and1 #bbh1 #bcj running and1 #baj ,anxiety attacks1 #gb ,articulateness1 #hc ,associations1 professional1 #bdg-dh1 #bic1 #bif ,behavior modification1 #id1 #age1 #agg1 #ahj family therapy and1 #bja ,behavioral therapy1 #agc-hc case history of1 #ahj-hb ,belief systems1 #ada ,berne1 ,eric1 #acb ,bioenergetics1 #eb1 #ic1 #afb ,biofeedback1 #ej1 #if1 #agh1 #baa-ad how to find1 #bdh ,blood sugar disorders1 #ajc-e ,board eligibility1 #df ,brain dysfunction1 organic1 #gg ,brain tumors1 #ajf #cjh ,breath counting1 #bbd ,bubble1 meditation of1 #bbe ,byrd1 ,richard1 #i-aa ,caffeine1 #ajh1 #bbi ,cancer1 pancreatic1 #ajf ,childhood disorders1 #fh1 #gj psychoanalysis and1 #aag ,children1 conformity and1 #ac ,choice point1 #afh ,client-centered therapy1 #ij1 #abd-bf ,clinical psychology1 #db1 #bdf ,cognitive therapy1 #ie1 #aci-de behavior change and1 #age1 #agh-gi1 #ahj ,commitment1 #hj ,compulsions1 #gb ,conditional love1 #abd ,confidentiality1 #beg-ff ,conformity1 #ac ,congruence1 #ce ,contemplative meditation1 #bbe ,content analysis1 #aib ,coping strategy1 #bag ,cost of therapy1 #bej ,counseling1 academic1 #ef ,counseling psychology1 #dc ,counselors social work1 #bi1 #dj-db1 #bdf-dh religious1 #dh-ej ,counter-conditioning therapy1 #id1 #agd-gg1 #ahb ,countertransference1 #aai ,county counseling agencies1 #ee ,crisis intervention1 #fi1 #gf ,decision making1 #agi ,defense mechanisms1 #cc ,delusions1 #gf ,demoralization1 #bga ,depression1 #gc-gd drug therapy and1 #bbi1 #bca-cd electroconvulsive therapy and1 #bcc logotherapy and1 #aeb running and1 #bjh ,dereflection1 #aeb ,desensitization1 #agg1 #baf ,diabetes1 #ajc ,diagnosis1 self4 ,see ,self-diagnosis ,direct decision therapy1 #ic1 #afg-gb case history of1 #afh how to find1 #bdh ,distraction techniques1 #agh ,drug addiction1 #gg1 #ajh ,drug therapy1 #bbg-cf appropriateness of1 #bce drugs used in1 #bbh-cj ,see also ,medication ,dynamic psychotherapy1 #aae ,dysphoria1 #bjf ,ego1 development of1 #ac ,ego states1 #acb ,electroconvulsive therapy1 #bcc ,ellis1 ,albert1 #adj ,emotional flooding therapies1 #afa-fg how to find1 #bdh ,encounter groups1 #ahg ,endogenous depression1 #bbi ,epilepsy1 #aje drug therapy and1 #bbi ,erickson1 ,milton ,h41 #bai ,esalen ,institute1 #ahh est1 #ahh ,exercise1 #hb ,exercise therapy1 #ec1 #if1 #bjd-aa how to find1 #bdi ,existential-humanistic therapy1 #ib1 #ade-di how to find1 #bdh ,exogenous depression1 #bbi ,extroversion1 #hb ,family problems1 #ge ,family therapy1 #ie1 #aid-bjc ,feedback loops1 #aja #cji ,frankl1 ,viktor1 #aea ,free association1 #aae ,free choice1 #bb ,freedom1 psychological1 #cf ,freud1 ,sigmund1 #aac-ad ,frustration1 #ha ,gestalt therapy1 #ij1 #abg-cb ,glasser1 ,william1 #aed ,goals family therapy and1 #aif personal1 #ba1 #fg1 #gj setting of1 #fb ,greenwald1 ,harold1 #afg ,group process1 #aib ,group settings1 reaction to1 #hd ,group therapy1 #ie1 #ahd-ic confidentiality and1 #bfa risks of1 #aia ,growth disorders1 #abh ,habits1 #cc changes in1 #cd ,haley1 ,jay1 #aig ,hallucinations1 #gf ,hallucinogens1 #bcj ,hatha yoga1 #ec ,hawthorne effect1 #bgf ,head injuries1 #ajf ,headache drugs1 #bcj ,health insurance1 confidentiality and1 #bfb ,heart conditions1 #ajg ,helpfulness of therapy1 #bfg-ha ,holism1 #eb ,home visits by therapist1 #bja ,hospitalization1 #ef1 #beb-ef ,human potential groups1 #ahg ,humanistic therapies1 #abc-di ,huntington's chorea1 #gg ,hyperthyroidism1 #ajb ,hypnosis1 #ea1 #ig1 #bag-bc how to find1 #bdi ,hypnotic drugs1 #bbi ,hypoglycemia1 #ajd ,hypothyroidism1 #ajc ,iatrogenic disturbances1 #bfh ,illness1 solitude and1 #ac ,imagination1 #hd ,implosive therapy1 #ic1 #afe-fg ,indirect induction hypnosis1 #bai ,infants1 need for contact1 #aa ,infectious diseases1 #ajh ,inferiority1 ,adlerian therapy and1 #aeh ,inhibition1 #hb reciprocal1 #agd ,initial consultation1 #bea ,initiative1 #ha ,injuries1 head1 #ajf ,inpatient therapy1 #ef1 #beb-ef ,insurance1 confidentiality and1 #bfb ,intensive feeling therapy1 #afd ,introversion1 #hb ,involuntary behavior1 #fi1 #gf ,janov1 ,arthur1 #afc ,jogging1 therapeutic1 #bje-g ,kostrubala1 ,thaddeus1 #bje ,law1 confidentiality and1 #bfj ,life decisions1 #agj ,lithium therapy1 #bbi1 #bcc ,logotherapy1 #ib1 #aej-ed how to find1 #bdh ,long-distance running1 #bji ,love1 #cf conditional1 #abd ,lowen1 ,alexander1 #afb ,mania1 #gd ,manic depression1 #gd lithium therapy and1 #bbi ,,mao inhibitors1 #bcb ,marital problems1 #ge ,marriage therapy1 #ie1 #aid-bjc case history of1 #aii ,medication1 #de1 #ih reaction to1 #ajh ,see also ,drug therapy #caj ,meditation1 #ea1 #ig1 #bbc-bf how to find1 #bdi ,menopause1 #ajg ,metabolic diseases1 #ajb-e ,migraine drugs1 #bcj ,mitral incompetence1 #ajg ,model1 psychological1 #be-bg ,mood disturbances1 #fi1 #gc-gd ,multifamily therapy1 #bja ,multiple sclerosis1 #ajf ,need for therapy1 #bdb ,negative practice1 #afj ,negative traits1 #cf ,nervous breakdown1 #cc ,nervous system disorders1 #aje-f ,neuralgia drugs1 #bcj ,neuroleptic drugs1 #bbh ,neuroses1 #fh1 #ga nogenic1 #gc1 #aec ,nicotine1 #bbi ,night terror1 #aag ,,nimh mental health survey1 #ah ,nonverbal communication1 #aib ,nogenic neuroses1 #gc logotherapy and1 #aec ,nursing1 psychiatric1 #bed ,nutrition1 #ih1 #bcf-cg ,organic disorders1 #fi1 #gg ,organizations1 #bhi-ig ,orthomolecular psychiatry1 #bcf ,outer-directedness1 group therapy and1 #ahd ,pain biofeedback and1 #bac emotional1 #ae1 #bg hypnosis and1 #bba ,pancreatic cancer1 #ajf ,panic attacks1 #gb ,paradoxical intention1 #aec1 #afj family therapy and1 #bja ,parkinsonism1 #gg1 #aje drug therapy and1 #bbi ,paroxysmal tachycardia1 #ajg ,patience1 #ha ,perfectionism1 #hb ,perls1 ,frederick1 #abh ,personality development of1 #cb model of1 #be-bg therapy selection and1 #gh-he ,personality traits1 #gi-he disorders of1 #fh1 #ga ,phobias1 #gb1 #afe ,physical illness1 #ii-aji ,placebos1 #bfh1 #bgb ,post-therapy life1 #bhb-h ,post-traumatic stress disorders1 #gb ,premature ego development1 #ac ,primal therapy1 #ic1 #afc-fe ,privacy1 #beg-ff ,private practice1 #ed ,problem avoidance1 #bhc ,problem solving1 #agi ,professional associations1 #bdg-dh1 #bic1 #bif ,pseudo-self-sufficiency1 #ac ,psychedelic drugs1 #bcj ,psychiatrists1 #bi1 #dd-dg how to find1 #bde ,psychoanalysis1 #de1 #ij1 #aac-bb brief1 #abj case histories in1 #aaf-bj children and1 #aag ,psychological disorders age and1 #ai ,,nimh study of1 #ah social views towards1 #ad women's response to1 #ai ,psychological tests1 #dc ,psychologists1 #bi1 #db-dd how to find1 #bdf ,psychometrists1 #dc ,psychonutrition1 #bcf ,psychoses1 #fi1 #gf drug therapy and1 #bbh1 #bcd ,psychosomatic disorders1 #gc ,psychotherapy4 ,see ,therapy listings ,psychotropic drugs1 #bbh-cj ,see also ,drug therapy #caa ,rational-emotive therapy1 #ia1 #aci-de case history of1 #adb ,reality therapy1 #ib1 #aed-eg ,reciprocal inhibition1 #agd ,recovery1 ,inc41 #ahh ,referrals to therapist1 #bdd ,reflectiveness1 #hc ,reich1 ,wilhelm1 #afb ,relapses1 #bhc ,relaxation training1 #ej1 #if1 #agf1 #bae-ag how to find1 #bdi ,religious counselors1 #dh-ej ,responsibility1 #ab ,reward and punishment1 #agg ,rigidity1 #ha ,rogers1 ,carl1 #abd ,role-playing1 #abh ,running1 therapeutic1 #bje-g ,schizophrenia1 running and1 #baj ,schools1 counseling services in1 #ef ,secrecy1 client's need for1 #bfd ,sedatives1 #bbi ,self-control1 #ab ,self-diagnosis1 #ei-ih obstacles to1 #fa self-evaluation and1 #fb-fd ,see also ,therapy selection ,self-discipline1 #hj ,self-esteem1 #cf client-centered therapy and1 #abf ,self-evaluation1 #fb-fd ,self-help groups1 #ahh1 #bhi-ib1 #bid-if ,self-sufficiency1 #ab ,senescence1 #gg ,sexual disorders1 #gc marriage therapy and1 #bjc ,short-term encounter groups1 #ahg ,shortcomings of therapy1 #bgd ,skinner1 ,b4 ,f41 #age ,smoking1 #gg1 #aji ,social work counselors1 #bi1 #dj-db how to find1 #bdf-dh ,spontaneous remission1 #bfh1 #bgc ,stampfl1 ,thomas1 #afe ,state counseling agencies1 #ee ,stimulants1 #bbi ,stress1 #ce post-traumatic1 #gb relaxation training and1 #bae ,structural analysis1 #acd ,substance abuse1 #gg ,suicide1 #ab ,symptoms1 behavioral therapy and1 #agd ,szasz1 ,thomas1 #bgj ,tachycardia1 #ajg ,tests1 psychological1 #dc ,t-groups1 #ahg ,therapeutic goals1 #ag1 #bc-be ,therapeutic results1 #ce-cg ,therapists1 #bda-ea categories of1 #bi cost of1 #bej need for1 #bdb private vs4 public1 #ed qualities of1 #cg-ch referral to1 #bdd specialization by1 #bdc ,see also under specific therapy ,therapy effectiveness1 #bfg-ha ,therapy selection disorders and1 #fh-gg personal goals and1 #fg1 #gj personality and1 #gh-he steps in1 #fe-eg ,therapy types1 #hf-ih4 ,see also specific name of therapy ,thought stopping1 #agi ,thyroid disorders1 #ajb ,tolerance1 #ha ,trance1 hypnotic1 #bah ,tranquilizers1 #bbh ,transactional analysis1 #ia1 #acb-ci case history of1 #acf #cab ,transference1 #aai ,trauma1 stress following1 #gb ,tumors1 brain1 #ajf ,values1 personal1 #hd ,vitamins1 #bcg ,wolberg1 ,lewis ,r41 #bbb ,wolpe1 ,joseph1 #agd ,yoga1 #ec ,,endx #cac ,,about ,,the ,,author ,steven ,james ,bartlett was born in ,mexico ,city and educated in ,mexico1 the ,united ,states1 and ,france4 ,he did his undergraduate work at the ,university of ,santa ,clara and at ,raymond ,college1 an ,oxford-style honors college of the ,university of the ,pacific4 ,he received his master's degree from the ,university of ,california1 ,santa ,barbara2 his doctorate from the ,universit de ,paris1 where his research was directed by ,paul ,ricoeur2 and has done post-doctoral study in psychology and psychotherapy4 ,he has been the recipient of many honors1 awards1 grants1 scholarships1 and fellowships4 ,his research has been supported under contract or grant by the ,alliance ,franaise1 the ,american ,association for the ,advancement of ,science1 the ,center for the ,study of ,democratic ,institutions1 the ,lilly ,endowment1 the ,max-,planck-,gesellschaft1 the ,national ,science ,foundation1 the ,rand ,corporation1 and others4 ,bartlett brings to the present work an unusual background consisting of training in clinical psychology1 pathology1 and epistemology4 ,he is the author and editor of fifteen books and monographs1 and more than a hundred papers and research studies in the fields of psychology1 epistemology1 and philosophy of science4 ,he has taught at ,saint ,louis ,university and the ,university of ,florida1 and has held research positions at the ,max-,planck-,institute in ,starnberg1 ,germany and at the ,center for the ,study of ,democratic ,institutions in ,santa ,barbara4 ,he is currently ,visiting ,scholar in ,psychology at ,willamette ,university and ,senior ,research ,professor at ,oregon ,state ,university4 ,willamette ,university hosts a website that provides information about the author and his research1 and makes available a large number of his publications in free downloadable form3 http3_/_/www4willamette4edu_/sbartlet