Kurt Adler describes the cause and treatment of Depression according to Individual Psychology, his father's groundbreaking theory on human motivation and pathology.
Psychological resilience is defined as an individual's ability to properly adapt to stress and adversity. Stress and adversity can come in the shape of family or relationship problems, health problems, or workplace and financial worries, among others.
Recognizing Differences in Gender: Looking at all dimensions; a psychological...Thrive 4-7
Emotional health and well-being is more than just psychology, all aspects of individual health play a role. This series provides overall insights on how to ensure the programs and services you offer align consider all dimensions of health.
An overview of evidence-based therapeutic components that aid in the reduction of the rate of return or recidivism of ex-offenders going back to prison.
These slides contain detailed description of family therapy including : Introduction, Definition, Aims/Goals, Indication, Contraindication, Functions, Types, Nursing diagnosis and interventions, Nursing responsibilities, Research.
3rd Draft version of Presentation for 11/19/2009 - KU Palliative Care Fellowship Lecture Series. Uploaded to show the evolution of creating a slide presentation
Kurt Adler describes the cause and treatment of Depression according to Individual Psychology, his father's groundbreaking theory on human motivation and pathology.
Psychological resilience is defined as an individual's ability to properly adapt to stress and adversity. Stress and adversity can come in the shape of family or relationship problems, health problems, or workplace and financial worries, among others.
Recognizing Differences in Gender: Looking at all dimensions; a psychological...Thrive 4-7
Emotional health and well-being is more than just psychology, all aspects of individual health play a role. This series provides overall insights on how to ensure the programs and services you offer align consider all dimensions of health.
An overview of evidence-based therapeutic components that aid in the reduction of the rate of return or recidivism of ex-offenders going back to prison.
These slides contain detailed description of family therapy including : Introduction, Definition, Aims/Goals, Indication, Contraindication, Functions, Types, Nursing diagnosis and interventions, Nursing responsibilities, Research.
3rd Draft version of Presentation for 11/19/2009 - KU Palliative Care Fellowship Lecture Series. Uploaded to show the evolution of creating a slide presentation
Advanced Methods in Counseling & Psychotherapy July 2023.pptxDemetriosPeratsakis
Training series on clinical theory, practice, and methods in outpatient counseling and psychotherapy for supervisors. Clinical supervision modules on Depression, PTSD, Psychosis, Addiction, and Paraphilia.
This ppt presentation discusses about the various models of mental illness. I found it useful to download as it gives a fair idea about various models which are generally not found in books.
Reply Reply to 2 other classmates by offering 1 new piece of info.docxsodhi3
Reply: Reply to 2 other classmates by offering 1 new piece of information to add to their discussion of family systems.
As you provide feedback to peers, you are not grading their assignment, but you are enlarging the conversation to prod a bit more on what could be added to clarify the paper substantively. Please be very specific and share what you would like to see added or what was not clear as you read the paper of your peers. Additionally, please note that I will be providing corrective information for each student to take the assignment to the "finish line". The feedback is not an act of judgment nor an indication of grade. It is simply feedback that each of you can use moving forward.
250 words or more for each feedback along with one reference
Discussion board feedback #1:
Trauma can affect individuals in many ways depending on the type that has occurred. The age of the person experiencing the trauma can determine lasting effects. Trauma can occur from anywhere utero to adulthood. It is important to know what trauma is and the lasting effects the come with this exposure. Treatment for the traumatized individual can be significantly enhanced depending on the person’s level of spirituality development.
Trauma can occur from any of the following events physical, sexual, or emotional abuse, natural disasters, wartimes and terrorist attacks (Song, Min, Huh, & Chae, 2016). Trauma can be any event that is extremely alarming or upsetting experience that causes physiological anxiety, and impacts the neurological and psychosocial development processes (Song, Min, Huh, & Chae, 2016). Trauma affects individuals differently. Cultural differences around the world may lead in some cases being more socially acceptable in one country and not in others.
One neurological disorder that can develop from trauma is Post Traumatic Stress Disorder or PTSD. “For a diagnosis of PTSD, a person must have experienced, witnessed, or been confronted with an event so traumatizing that its results in symptoms of re-experiencing, hyper-arousal, cognitive alterations and avoidance (Broderick & Blewitt, 2015 p.528).” Studies have shown that a person suffering from PTSD will have a decrease in volume of the hippocampus. The hippocampus is the part of the brain “plays a role in our emotions, ability to remember, and compare sensory information to expectations (Broderick & Blewitt, 2015p.59) There is an ongoing discussion amongst physicians as to whether PTSD being a curable or just a treatable one. With the reduction of volume in the hippocampus and the memory of the traumatic event that never goes away, most doctors are leaning toward the treatable instead of curable.
Treatment for PTSD and other neurological disorders can come in the form of medications or therapies. People can choose to do one or the other with the most recommended choice being a combination of both. A combination of cognitive behavioral therapy (CBT) and the use of an antidepressant, more specifi ...
This is an example of what you are being asked to do in Weeks 2, 3.docxjuliennehar
This is an example of what you are being asked to do in Weeks 2, 3, 4, 6, 7, 8 and 9.
DO NOT apply psychoanalytic to any of the case studies.
Case of Deidre: Conceptualization of Problem through Psychoanalytic Theory
A case conceptualization is a report that is written to explain a client’s presenting problems, establish goals as they relate to a theory, plan interventions, and explain the rationale for the interventions and expected outcomes for the client. The interventions chosen will reflect the theory being focused on this week and will include citations from a minimum of two of the week’s resources.
Presenting Problem
From a psychoanalytic perspective, Deidre appears to be experiencing anxiety because of unconscious conflicts originating from her early childhood experiences (e.g., parents’ divorce and mom’s moods), her complicated family relationships, the untimely death of her father, and her abortion. Additionally, Deidre is experiencing a high level of guilt indicating that her ego is struggling to balance between the instinctual drives of her id and the drives of her superego (i.e., the aspect of self that looks at the morality of choices) (Johnson, 2016). It could be that Deidre is experiencing unconscious psychological conflicts surrounding the secret of her abortion, her desire to feel safe with her boyfriend, Tom, and her need to remain loyal to the values she learned from her childhood (i.e., to kill is wrong).
Deidre is using some defense mechanisms—including repression, which blocks these conflicts from her awareness, avoidance, and rationalization—that help her cope with her fears of abandonment. According to Johnson (2016), these defense mechanisms, unconsciously employed to bolster Deidre’s fragile ego, could be linked to Freud’s concept of death instincts that might be related to her father’s early death and her fear of losing Tom.
Goals
According to Johnson (2016), the primary goal of a psychoanalytic approach is to bring Deidre’s unconscious processes into her conscious awareness to illustrate how she is blocking past experiences to help herself cope with her present experiences. The overarching goal of psychoanalysis is to help the client gain self-awareness, so she will be able to understand how past experiences and relationships are causing emotional and cognitive distortions (Johnson, 2016).
In addition to the overarching theory goals, one clinical goal the counselor will work on with Deidre is reducing the overall frequency, intensity and duration of her anxiety so that her daily functioning is maximized; this will be accomplished with the use of psychoanalytic interventions.
Interventions
Free Association
During the counseling session, clients are encouraged to state any thoughts or feelings that come to mind without censoring them. Then, in a nonjudgmental way, the counselor assists clients to analyze the underlying unconscious feelings associated with these disclosures (Johnson, 2016). The goal is not to u ...
The human mind, a vast and intricate realm, is
capable of extraordinary resilience and creativity.
However, it is not impervious to the challenges and
complexities of life. Within this intricate landscape,
some individuals navigate a path marked by
psychological disorders, conditions that impact
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significant distress and impairment.
Psychological disorders meaning and treatmentCounsel India
Psychological disorders, also referred to as mental illnesses or psychiatric disorders, encompass a wide array of conditions that affect the way individuals think, feel, and behave.
In this e-book, you can find psychological disorder meaning and treatment-related tips These disorders are not mere quirks or personality traits but are characterized by disturbances in cognition, emotion regulation, and social functioning. They can manifest in various forms, ranging from mild and transient to severe and chronic.
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Psychotherapy is the utilization of mental techniques, especially wh.pdfanupamele
Psychotherapy is the utilization of mental techniques, especially when in light of general
individual collaboration, to help a man change and conquer issues in coveted ways.
Psychotherapy intends to enhance an individual\'s prosperity and psychological well-being, to
determine or relieve troublesome practices, convictions, impulses, considerations, or feelings,
and to enhance connections and social abilities. Certain psychotherapies are considered proof
based for treating some analyzed mental issue.
1. Concentrate on influence and articulation of feeling. Psychodynamic treatment empowers
investigation
also, discourse of the full scope of a patient\'s feelings. The specialist helps the patient depict and
put words to emotions, counting conflicting emotions, sentiments that are upsetting or
undermining, and emotions that the patient may not at first have the capacity to perceive or
recognize (this remains rather than an intellectual concentration, where the more prominent
accentuation is on musings and convictions; Blagys and Hilsenroth,
2002) There is likewise an acknowledgment that scholarly understanding is not the same as
passionate
understanding, which resounds at a profound level and prompts to change (this is one motivation
behind why numerous clever and mentally disapproved of individuals can clarify the
explanations behind their dif-
ficulties, yet their comprehension does not help them overcome those challenges).
2. Investigation of endeavors to abstain from upsetting
considerations and emotions. Individuals do an awesome
numerous things, intentionally and unconsciously, to maintain a strategic distance from
perspectives
of experience that are disturbing. This evasion (in hypothetical terms, protection and resistance)
may take coarse structures, for example, missing sessions, arriving late, or being shifty. It might
take unobtrusive structures that are hard to perceive in normal social talk, for example,
inconspicuous movements of theme when certain thoughts emerge, concentrating on accidental
parts of an affair instead of on what is mentally significant, taking care of truths and occasions to
the rejection of effect, concentrating on outer conditions as opposed to one\'s own part in
forming occasions, thus on.Psychodynamic specialists effectively concentrate on and investigate
shirkings.
3. Distinguishing proof of repeating topics and designs. Psychodynamic advisors work to
distinguish
what\'s more, investigate repeating topics and examples in patients\' contemplations, sentiments,
self-idea, connections, and beneficial encounters. Now and again, a patient might be intensely
mindful of repeating designs that are agonizing or self-vanquishing yet feel not able to escape
them (e.g., a man who over and over finds
himself attracted to sentimental accomplices who are sincerely inaccessible; a lady who
consistently attacks herself at the point when achievement is close by). In different cases, the
patient might be unconscious of the exampl.
Trauma, Loss and Chronic Discord cause emotional pain and psychological injury that result in depression and anxiety, fueled by Guilt, Shame and Anger.
Stem Cell Solutions: Dr. David Greene's Path to Non-Surgical Cardiac CareDr. David Greene Arizona
Explore the groundbreaking work of Dr. David Greene, a pioneer in regenerative medicine, who is revolutionizing the field of cardiology through stem cell therapy in Arizona. This ppt delves into how Dr. Greene's innovative approach is providing non-surgical, effective treatments for heart disease, using the body's own cells to repair heart damage and improve patient outcomes. Learn about the science behind stem cell therapy, its benefits over traditional cardiac surgeries, and the promising future it holds for modern medicine. Join us as we uncover how Dr. Greene's commitment to stem cell research and therapy is setting new standards in healthcare and offering new hope to cardiac patients.
ALKAMAGIC PLAN 1350.pdf plan based of door to door delivery of alkaline water...rowala30
Alka magic plan 1350 -we deliver alkaline water at your door step and you can make handsome money by referral programme
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ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
This document is designed as an introductory to medical students,nursing students,midwives or other healthcare trainees to improve their understanding about how health system in Sri Lanka cares children health.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Feeding plate for a newborn with Cleft Palate.pptxSatvikaPrasad
A feeding plate is a prosthetic device used for newborns with a cleft palate to assist in feeding and improve nutrition intake. From a prosthodontic perspective, this plate acts as a barrier between the oral and nasal cavities, facilitating effective sucking and swallowing by providing a more normal anatomical structure. It helps to prevent milk from entering the nasal passage, thereby reducing the risk of aspiration and enhancing the infant's ability to feed efficiently. The feeding plate also aids in the development of the oral muscles and can contribute to better growth and weight gain. Its custom fabrication and proper fitting by a prosthodontist are crucial for ensuring comfort and functionality, as well as for minimizing potential complications. Early intervention with a feeding plate can significantly improve the quality of life for both the infant and the parents.
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardso...rightmanforbloodline
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
Trauma Outpatient Center is a comprehensive facility dedicated to addressing mental health challenges and providing medication-assisted treatment. We offer a diverse range of services aimed at assisting individuals in overcoming addiction, mental health disorders, and related obstacles. Our team consists of seasoned professionals who are both experienced and compassionate, committed to delivering the highest standard of care to our clients. By utilizing evidence-based treatment methods, we strive to help our clients achieve their goals and lead healthier, more fulfilling lives.
Our mission is to provide a safe and supportive environment where our clients can receive the highest quality of care. We are dedicated to assisting our clients in reaching their objectives and improving their overall well-being. We prioritize our clients' needs and individualize treatment plans to ensure they receive tailored care. Our approach is rooted in evidence-based practices proven effective in treating addiction and mental health disorders.
PET CT beginners Guide covers some of the underrepresented topics in PET CTMiadAlsulami
This lecture briefly covers some of the underrepresented topics in Molecular imaging with cases , such as:
- Primary pleural tumors and pleural metastases.
- Distinguishing between MPM and Talc Pleurodesis.
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Letter to MREC - application to conduct studyAzreen Aj
Application to conduct study on research title 'Awareness and knowledge of oral cancer and precancer among dental outpatient in Klinik Pergigian Merlimau, Melaka'
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...
Summer series Psychosis
1. The Philosophy and Practice of Clinical Outpatient Therapy
Demetrios Peratsakis, MSEd, SDSAS, LPC, ACS, Certified Clinical Trauma Professional
2. DISCLAIMER
The purpose of these materials is to help improve on one’s practice
of therapy through a deeper understanding of methods.
This material is intended to augment, not replace, the instruction and practice expectations
of one’s home Community Services Board or Agency.
As such, the ideas presented herein are simply those that assist us in our work
and in our understanding of human motivation and pathology.
____________________ . ____________________
3. 3
1970’s Substance Abuse Counselor, NYC
1980’s - grad work in Counseling, and, School Administration
- community Mental Health, SA and SA Residential
- adjunct professor at Queens College’s M&FT program
1980-1992 Trained with Robert Sherman in Adlerian, Structural and Strategic Family therapies
Adler Institute (K. Adler, B. Shulman, H. Mosak)
12-year Masters Series with founding theorists Jay Haley, Murry Bowen,
Monica McGoldrick, Carl Whitaker, Salvador Minuchin and others
2-year, team therapy model with Richard Belson in Strategic Family Therapy
1995 PD 19 CSB (MH Director)
2000 WTCSB (Executive Director)
4. Working with Delusions from an Adlerian and Narrative Perspective
Western Tidewater Community Services Board
June 16, 2020
4
6. 6
Is it Genetics and
Biology or
Psychology?
Do I use Medication
or Psychotherapy?
What triggers psychosis?
If it can start in the teens,
begin in adulthood or be
triggered by trauma, are
there different kinds of
psychosis?
What’s a “psychotic
break’?!
How does one
“break” from reality?
There is no consensus on
the etiology, development
or treatment of psychosis.
7. 7
Disorganized Speech
Negative Symptoms
Disorganized Symptoms
Grossly Disorganized or
Catatonic Behavior
Positive Symptoms
Hallucinations
Delusions
1
2
3
4
5
Absence or loss of experience
- Isolation; loss of responsiveness
to people, events)
- Decline in self-care,
communicativeness; work or
school performance; difficulty
completing simple tasks
Early Onset (EOP) vs Late Onset (LOP) vs Trauma Triggered Psychosis
8. Several Factors May Contribute to its Onset
1. Genetics
2. Trauma (cause or “trigger”?; form of disassociation?)
3. Substance Use
4. Underlying Neuro-Medical Disorders
5. Mental Health Disorders
a) Mood Disordered SMIs (PTSD, MDD) VS Thought Disordered SMIs (Schizophrenias)
b) Clients have “long-standing social and emotional difficulties that predate their psychosis by
several years”; these “…may contribute to the content of their psychotic experience” -Harrow,
Rattenbury, and Stole noted (1988) as did Rhodes and Jakes (2000).
c) Cameron, N. (1943) noted that delusions form as a result of psychological and social isolation.
The delusion becomes attached to a person or source, thereby reducing anxiety which, in turn,
helps to maintain the importance of the delusion.
8
9. Most fall into 1 of 3 broad categories
1. Psychological Models (Psychosocial)
a) Psychodynamic: unconscious forces shaped by childhood experiences
b) Behavioral: learning and factors within the person’s environment
c) Cognitive: ineffective, inaccurate or problematic thinking
d) Sociocultural: mental illness is the product of broad social and cultural forces
2. Biological/Neuro-genomic Models (Psychiatry)
Disordered behavior is caused by biological conditions, such as genetics, hormone levels, or changes in
structural or neurotransmitter activity
3. Combo or Hybrid Models
a) Diathesis-stress model: a predisposition to a given disorder combines with environmental stressors to
trigger a psychological disorder
b) Bio-psycho-social model: Takes into account predispositions, personal experience, and life
circumstances
10. Neuro-medical Perspective
(Psychiatry)
Cognitive-behavioralPerspective
(Psychotherapy)
1. Disorders are caused by
neuro-biomedical factors;
2. Controlling symptoms by
adjusting biochemistry is
the locus of treatment;
3. Primary intervention is
psychopharmocology
1. Disorders are caused by
psychosocial factors;
2. Changing belief structures
to modify symptoms is the
locus of treatment;
3. Primary intervention is
‘talk therapy’
Perspective drives
1) Assessment
2) Treatment Planning
3) Method of Intervention
11. Psychotherapy
Only
Meds
Only
Psychotherapy +
Meds
1. Antidepressants, most commonly prescribed medication (2005);
2. Concurrent decrease in patients receiving psychological treatment
3. Patient preference, efficacy, and cost-efficacy for psychological treatment
4. Patience don’t obtain psychological treatment -McHughJ Clin Psychiatry. 2013 June ; 74(6): 595–602. doi:10.4088/JCP.12r07757
12. Issues
1. Some clients are simply shopping for meds: SA; ease of care; believe it’s better
2. Medication reduces pain which can effect motivation for other forms of therapy
3. Many clients who take meds, prefer talk therapy
13.
14.
15.
16.
17. 1. Sloppy Science: we simply do NOT know how one affects the other although they do
2. Sloppy Lingo: “Psychological and Biological explanations are not merely different languages for the same
phenomena….Psychological and Biological explanations are not explanations of the same things” – Gregory A.
Miller; Distinguished Professor, Department of Psychology and the Department of Psychiatry and Biobehavioral Sciences at UCLA.
3. Sloppy Thinking: perspectives NOT mutually exclusive, but can be at cross-purposes
1. Choice of Treatment
2. Use of Psychopharmacology
3. Assessment of Volition (degree to which one can exert control over the symptom;
“Can’t” versus “Won’t”
Biological
1. Some common
genetic markers for
Autism, Bipolar,
MDD, ADHD and
Schizophrenia.
2. Many MZ Twin
concordance rates as
high as 45/55%
3. Structural changes
in the brain.
Psychosocial
1. MZ Twin concordance
rates are NOT 100%;
in utero conditions differ
2. Psychosocial factors are
necessary preconditions;
environment/learning?
3. If one can “recover” from
psychosis than it must be a
mental construct, not unlike
cognitive distortions.
18. So, what’s a therapist to do?!!
Irrespective of their roots, symptoms acquire functional, adaptive value.
They acquire meaning, power and purpose to the individual and their relationship system.
20. 20
Mental illness is a myth,
whose function is to disguise and thus render more palatable
the bitter pill of moral conflicts in human relations.
— Thomas Szasz, Existential Psychiatrist
22. 22
Psychosis . . . appears to us as the mental suicide
of an individual who does not believe himself adequate
to the demands of reality and to his own goals.
- Alfred Adler, Founding Theorist
24. 24
What is Consciousness?
1. Self-reflective; Self Concept
and Self Ideal
2. Awareness of death and one’s
own mortality (spirituality)
3. Ability for abstraction and to
predict, make guesses and
imagine the future
4. Ability for targeted deception
5. Ability to innovate (2+2=5)
Consciousness has Purpose!
Perception and/or Interpretation?
“We create the reality in
which we live.”
— James Turrel; Artist
25. The desire to feel belonging to others is the fundamental motive in man.
- Adlerian Pschology; Rudolf Dreikurs, 1949
25
The purpose of consciousness is to keep society together;
to predict, assess and effectively navigate complex social relationships.
- Social Intelligence Theory, Anthropology
What is the Purpose of Consciousness?
26. 26
1. We behave and feel in a manner consistent with our beliefs. Believing is Seeing!”
2. Others react to our actions which, in turn, reaffirms our beliefs about how to act.
3. In part, we drive the behavior and emotions of others in order to obtain the very reactions
that reaffirm our own belief systems.
4. Together, we create constructs and shared imaginings called patterns and structures, such
as roles, rules, alliances, collusions, legacies and myths. These help us organize and
operationalize social functions. These acquire purpose, meaning and power.
5. All psychological symptoms, syndromes and ‘presenting problems’ emerge as social
constructs that must be unbalanced and redefined in order for change and growth to occur.
27. 1. Narratives reinforce our preferred interpretation of reality
thematic
reaffirming
reconcile self-concept and self-ideal
2. Membership groups create shared cognitive distortions
amplify
add solidity, resiliency and duration
create intimacy, affinity and mutual dependency/co-dependency
increase resistance to change
27
Dad’s ideas about
women
(ie. OK to hit her)
Joe’s friend’s
ideas about
women
(ie. OK to hit her)
Son (Joe) ideas
about women
(ie. OK to hit her)
“Shared” cognitive-distortions are sections of an inter-
woven narrative or shared imagining.
For example: Dad, Joe, and Joe’s friend each hold a similar
belief or cognitive-distortion about women
28. 1. Cognitive Distortions
Mistaken (Erroneous) Beliefs: Bernard Shulman, MD (1973); 6 categories based on Adler’s work;
Irrational Beliefs: Neo-Adlerian Albert Ellis (REBT);
Cognitive Distortions: Neo-Freudians Aaron Beck and David Burns;
2. Shared Cognitive Distortions
Pillari’s Family Myths
Theology
Nationalism
Racism
More Complex Forms
Obsessions; Fanaticism
Delusions, Voices and Hallucinations
Addiction; Criminality
Major Mood Disorders (MDD, Bi-Polar)
Schizophrenias
28
32. Self-concept narrative becomes fragmented, a collection of seemingly unrelated, at times contradictory, themes
The longer the illness, the greater the fragmentation, the steeper the climb toward normalcy
Extreme social withdrawal and isolation results in severe cognitive impairment
To mend, explore “who and what existed before the illness, and who and what endure during and after?” (S.
Estroff, 1989). Three parts:
1. World-view: How I View the World (Demands of Life *)
Life is ; People are ; The world is ; How I View the World?; How I View Others?; How I View Men/Women?;
How I View Love/Sex?
2. Self-concept: How I View Myself (including through the eyes of others)
I am ; I am not ; How I View Myself?
Valuation by others, achievement, and mastery over the demands of life (adulthood)
3. Self-ideal: The Perfection I strive to Become (self-actualization)
I should be ; and I should not be .; People should be ; Life should be . It is wrong to
; It is right to ______.
.
32
33. Re-affirming Message
1. I am important and powerful, even though I
don’t feel so
2. I am stronger, more righteous and better than
others
3. Others betray you; don’t trust others
4. I don’t matter; Don’t trust others; Others will
hurt you
5. I don’t matter
33
1. Superior Achievement/Leadership:
Preoccupation with grandiosity, aggrandizement
or impressing others
2. Control/Dominance Aversion:
Preoccupation with religiosity; avoiding others’
attempts to control or dominate them
3. Intimacy/Sexuality:
Absence of an intimate relationship or conflict and
jealousness, a belief that that one’s friend or lover
has been unfaithful or betrayed them
4. Social Alienation/Inferiority
Preoccupation with diminished sense of worth,
persecution, or being an outsider
5. Annihilation Anxiety (preoccupation with death,
injury or vulnerability) * Jakes, Rhodes and Issa, 2004
Category or Theme of Preoccupation
* Jakes, Rhodes and Issa, 2004
34. 34
1. Meaning gives purpose to behavior
2. Behavior has logic and is directed toward one of two goals:
Self-actualization – adaptation and growth through connection, cooperation, and
assertion with others (Social Interest)
Self-protection - greater safety through aggression, manipulation, or avoidance*
3. The behavior constitutes the line of movement toward those goals. *Robert Sherman (1991)
A B
Outcome/Goal;
what the behavior
“accomplishes”.
Look at reaction of
others (ie. fear and
withdrawal)*
Behavior or Emotion
(ie odd behavior)
Purpose of the Behavior
* Odd or bizarre behavior results in distancing and isolation by others.
That is it’s goal; the Goal of Psychosis: “Leave me alone!” “Don’t get too close to me!”
35. Trauma
Life Cycle
Life Tasks
Trauma
Normative and para-normative hardships
including Loss; Betrayal; and natural or
manmade Disasters and Tragedies
Life Tasks
Work; Love; Friendship
(Alfred Adler)
Life-Cycle Changes
Normative and para-normative
developmental changes that
occur across the life-span
(Monica McGoldrick)
36. 36
Socialization places continuous pressure on the need to adapt to change. Individuals that do not believe they
are capable of successfully meeting the demands of life seek to avoid playing by the rules. Adler categorized
these strategies as Neurosis, Sociopathology and Psychosis
Strategies for Life’s Demands
Neurosis
“Yes, but…”
Exempt from the Rules:
I know the rules but want
to be excused from them.
The Goal is to escape
judgment or to be
judged less harshly.
Sociopathology
“F-You!”
Defy the Rules:
I’m above the rules;
they’re for chumps!
The Goal is to feel that
one has got over,
or got even.
Psychosis
“No!”
Negate the Rules:
I will create my own
rules so that I do not fail.
The Goal is ostracism;
to be left alone and
isolated. Expulsion.
Tip #1: Self-esteem (Worth) = Self-ideal – Self-concept
Tip #2: The more extreme the behavior, the lower the Self-esteem
Tip #3: To increase Self-esteem, reduce isolation/increase Social Interest
37. 37
We are social beings.
When we withdraw, isolate or are cutoff from social activation
it increases tension and mars our capacity to engage.
It is an aggressive form of avoidance.
The isolation is at once stress reducing and tension increasing.
See Bowen’s “Emotional Cut-off”
38. Assuming that organicity has been ruled out, Adlerian Psychology sees neurosis and psychosis as
purposive syndromes created by the individual to protect themselves from the risk of failure at the
demands of life. This, remarkable perspective normalizes our understanding of these conditions as
complex, safe-guarding strategies whose onset may be facilitated by such factors as stress, drug use,
biomedical conditions or trauma, but not determined by them. They protect a fragile sense of self wherein
the individual does not believe they are capable of successfully meeting the demands of life and either seek
to be exempted from the rules (neurosis), defy the rules (sociopathology), or negate the rules and substitute
ones of their own creation (psychosis).
Each takes a very different path:
Neurosis, is defined as a “Yes, but…” condition. The individual recognizes the requirements and
demands of living (“Yes, I see what is required of me…”) but seeks an exemption (“but I can’t or
don’t want to do it because…”) through various pretexts, including the development of symptoms.
Viewing behavior from this perspective provides the clinician with remarkable clarity into the control
and power issue that earmark such passive-aggressive conditions as addiction, depression or eating
disorders. A more aggressive stance is taken by those we term “sociopathic”, who acknowledge the
demands of life but choose to defy them as a false measure of their own superiority.
38
39. Psychosis, is defined as a “No!”, an abject refusal to participate in the demands of life. The
psychotic negates the common sense of the community and plays by their own rule-book. They
escape into a world of their own creation, continuously reinforcing its rules, roles and outcomes
through delusions and hallucinations. The individual does not believe themselves adequate to the
demands of reality and have developed a means by which to retreat from it.
Neurosis and psychosis both mask a perceived sense of inadequacy. The feelings of
vulnerably and worthless are real, as is the acute suffering the individual experiences. It is,
in fact, this very experience that adds legitimacy to the individual’s plight and ties others into
excusing or enabling their conduct. Their sense of guilt, shame and sorrow, as well as their
constant experience of dread and fear of exposure, fuel their sense of inadequacy and while
“unwelcome” preserves their sense of control.
39
40. 40
1. Metaphors
2. Reaffirm Belief Structures
3. Amplify Power and Prestige
4. Self-guarding Measures; stress reducers
5. Chaotic behavior is a form of distraction from the experience of pain
6. Disorganized behavior is a method of controlling others
5. Avoid Responsibility
6. Bizarre behavior assures isolation
44. 1. Psychotherapy
2. Medication Management: typical (first generation; block dopamine) and atypical (second
generation; block dopamine/affect serotonin levels) antipsychotics, including
aripiprazole (Abilify), asenapine (Saphris), cariprazine (Vraylar), clozapine (Clozaril),
lurasidone (Latuda), olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal)
ziprasidone (Geodon)
3. Alt-therapies: Ayurvedic, Music and Aroma therapies
4. Electroconvulsive Therapy (ECT) and Deep Brain Stimulation
5. PACT or Intensive Community Treatment Team approaches that bundle
Case management
Family support and education
Psychotherapy
Medication management
Supported education and employment
Peer support
Socialization activities such as Mental Health Support and Psychosocial Rehabilitation Day Programs
44
45. STEP 1: Global Assessment
Standard instrument (ie DLA-20) or core realms of functioning:
1. Relationship System (genogram not history)
2. Unresolved Trauma
3. Open Discord/Power Struggles/Abuse
4. Drug Use and Addiction
5. Overall social functioning with Love/Sexual Relations, Work, Friendships
STEP 2: Rule Out*
Exclude the possibility of a neurobiomedical condition
Psychosis: Assess for extent of Cognitive Impairment
STEP 3: Explore the PP or Symptom
1. Track the Sequence of beliefs and interpersonal transactions surrounding the Presenting Problem
(PP), Identified Patient (IP) or Symptom(s);
2. Test the rigidity of the belief system, unbalance existing convictions and introduce new
possibilities;
3. Return to the Presenting Problem/Contracting, refocus on the goal of treatment and
solidify agreement to work. Psychosis work can be long term; change is incremental
45
46. STEP 4: Goals
1. Cognitive Restructuring/Rebuilding the Narrative
2. Psychosis: Habilitate/Rehabilitate Skill Deficits
3. Lift Depression*
1. Resolve open discord and power-struggles
2. Heal trauma’s guilt, anger and shame
4. Build Self-worth
STEP 5: Relapse Work and Recovery and Supports
1. Psychosocial and Socialization activities for decreasing isolation, improving
ADLs, and increasing;
2. Integration in Meaningful Activity
3. Relationship Building (old and new)
46
47. 1. Duration of treatment (change may be slow and incremental)
2. Dosage
3. Avoid confrontations
4. Expect emotions to escalate
train emotional regulation (revise faulty strategies such as rumination and physical agitation)
stress intensifies symptoms (it’s an important barometer of duress)
5. Accept the client’s need to portray an attitude of superiority
6. Use Cognitive Restructuring
modify meaning to modify messages
modify experience to restructure cognition
use delusions, voices and hallucinations to restructure narrative
7. The greatest impediment to change is the clinician’s own fears
47
48. 8. Socialization is critical!
Be realistic; cognitive impairment and social skill deficits may be extensive
One may have missed a great number of opportunities to experiment with societal
demands and experiences.
One may have lost immeasurable opportunities to fine-tune the nuances of social
expression and interaction.
Longer, more profound isolation or social withdrawing behavior results in
a) Cognitive impairment
b) Social skills deficits
o ADL skill development essential (Habilitation over Re-habilitation)
o Increase Social Integration: increase involvement in communal life, friendship, work and
love. (Love/Intimacy + Work/School + Socialization = Self-Worth)
48
49. a) Stay Structured (reduces anxiety; adds predictability, models norm, improves cognitive skills)
b) Check In
Joining; connect, reaffirm and strengthen therapeutic alliance
Check on mood and symptoms; scale mood and symptoms
Bridge from last session
c) Plan Jointly
Agree on session agenda and order of discussion
Review homework, tasks or assignments (if applicable)
d) Explore
Examine progress, explore challenges, re-evaluate therapeutic alliance
Nibble at edges; mildly suggest/introduce new possibilities; reframe; create new symptoms
Connect session discussion to 1) prior session; next session; 3) overall treatment plan
e) Experiment (to change meaning, change experience)
f) Button-up
Review session
Make plans for next session
Temp Check/Feedback: client’s view of session; mood check/scaling; helpful/less helpful
Assign homework or tasks (if appropriate)
Cautions to move slow (set-backs are common and routine)
Reaffirm client’s courage and dedication; express appreciation for working relationship
49
50. 50
1. Congenital Brain Damage (CBD): genetic (pre-birth) or birth trauma
2. Acquired Brain Injury (ABI)/Neurological and Medical Illnesses: i.e.. stroke, tumors, aneurysms,
thyroid disease, cancer, vitamin D deficiency, poisoning, exposure to toxic substances, infection,
choking, complications due to alcoholism, substance misuse or medications.
3. Traumatic Brain Injury (TBI): head/skull injury to brain (accidents, sports injuries, falls, violence)
What to look for:
Evidence of Progressive Decline in Cognitive Performance
Selectivity of the Impairment
Attitude toward Impairment by Caregivers
“The Miracle Question”
Things to Consider
Formal Testing; Coordination with PCP or other primary healthcare providers
“Can Do” vs “Can’t Do” ; “Can’t Do” vs “Wont Do”
Institutional Behavior
Chronic Duress/Severe Emotional Distress
Symptom Purpose and Intent*
51. What Life Should Mean to You (1937), p. 14
Meaning Drives Interpretation
52. 52
Narrative
(Life Style)
Voices
Triggers/
AT
Messages
Changing the Narrative
1. Personification Modify the
Messengers or Voices
2. Message
Massaging the Message(s)
3. Triggers: Modify Experience
a) Modify the Activating Events
(people, places, or things) or
b) their Sequence
53. Personification
Use of Externalization and
Projective Technique as well as
Expressive Arts to concretize
the messenger(s) and then
change its features
(Empty Chair, Fantasy, Guided
Imagery, My Life Story, My
Position Map, Free
Association, Psychodrama,
Art, Dance, Sculpting, Music)
53
Adding Flesh to the Bones
Details make it Real!
Is the voice happy, sad or scary?
Does it criticize, threaten, advise or
comfort? What is it telling you?
Describe it? What is it’s tone, pitch,
volume, texture; male/female, gay/
straight, single/married, dressed?
What famous person, good or evil,
living or dead, does the “ghost”
remind you of?
Pretend you know them; who is it?
What is different when the voice is
not present? Does it ever change?
If the voice said something new, never
said before, what would that be?
If you could talk back, what would
you say? When the voice goes away,
where is it?
54. Modify the meaning attached to people, presenting problems and events by exploring the beliefs, patterns
or sequences of interaction surrounding them and softly introducing new possibilities:
Explore
o rigidity and inflexibility in rules, expectations and outlook
o conflict (guilt and shame) created between ideal and actual performance
o extremes such as “Must” and “Should”, “Never” and “Always”
Build the Narrative/Connect the Dots: craft a narrative with the client that connects all the seemingly
unconnected beliefs, nodal events, persons, emotions and related stories
Experimentation to modify or manipulate the narrative/experience.
Socratic dialogue: introduce doubt, pose new possibilities, and undermine or attack the underlying logic
Re-enactment: role-play, behavior rehearsal or active re-enactment
Projective Technique: use fantasy, imagery, free association, early recollections, empty chair,
externalization, visualization, sculpting, writing, and psychodrama.
Re-Build the Narrative as a new central story or over-arching theme
Brainstorm alternative scenarios, themes, stories and interpretations
Develop an alternative account that reframes experiences as acceptable and understandable
Chi (centering) training: mindfulness, meditation, relaxed breathing/progressive relaxation, yoga, martial arts,
games, art, journaling, behavior rehearsal or skills training to reduce fragmentation and anxiety, still panic,
integrate body and mind and improve focus
54
55. 55
Massaging the Message
Change the transactional pattern or sequence of behaviors surrounding the symptom or problem
Change the role(s), rule or way of being organized
Trace beliefs related to a) self, b) others; and c) preoccupations/fears and vulnerabilities in the family
lineage/genogram; i.e. “Whose rule is that?”
“Spit in the Client’s Soup” to undermine the narrative by interpreting the motive or making its covert
intent, overt, then frustrate its inherent sense of “nobility” or personal gain
Examine “Pluses” and “Minuses” to broaden narrow perspectives
Examine how the narrative is used to reaffirm loyalty to family
Examine how it reaffirms convictions; what does “breaking” the rule means
Examine the Pros and Cons; assess the negative consequences and scale or assess its cost
Weaken a strongly held by pitting it against an equally strong opposite belief
Point to disparities and logical inconsistencies, especially between beliefs or values
Inflate, exaggerate or dramatize the belief to make it extreme, trivial or silly
Create or reframe a narrative or story that puts the situation in a more favorable context (reframing)
Examine the family rule or “voice” behind the assumption and attend to the loyalty issues
Use of the “Miracle Question”, Time Travel or Time-outs to imagine and explore freedom from AT
56. 1. Create a new symptom (i.e.. “I am also concerned about
________; when did you first notice her doing that?”)
2. Switch to a more manageable symptom (one that is
behavioral and can be scaled; i.e.. chores vs attitude)
3. I.P. another family member (create a new symptom-bearer
or sub-group; i.e.. “the kids”, “the boys”)
4. I.P. a relationship (“the relationship makes her depressed”)
5. Push for recoil through paradoxical intention (caution!)
6. “Spitting in the Soup” –make the covert intent, overt,
then frustrate its inherent sense of “nobility”
7. Increase symptom intensity by describing worse-case
scenario or what could happen if things went unchecked
8. Add, remove or reverse the order of the steps (having the
symptom come first)
9. Remove or add a new member to the loop
10.Inflate/deflate the intensity of the symptom or pattern
11.Change the frequency or rate of the symptom or pattern
12.Change the duration of the symptom or pattern
13. Change the time (hour/time of day/week/month/year)
of the symptom or pattern
14. Change the location (in the world or body) of the
symptom/pattern
15. Perform the symptom without the pattern; short-
circuiting
16. Change some quality of the symptom or pattern
17. Perform the pattern without the symptom
18. Change the sequence of the elements in the pattern
19. Interrupt or prevent the pattern from occurring
20. Add (at least) one new element to the pattern
21. Break up any previously whole elements into smaller
elements; cut sequences into smaller steps
22. Link the symptoms or pattern to another pattern or goal
23. Reframe or re-label the meaning of the symptom
24. Point to disparities and create cognitive dissonance
25. Disengage the power-play that fuels the symptom and
tap the underlying anger
26. Surface Guilt and Shame and mobilize the underlying
anger and desire for revenge
Note: 1-4, Minuchin/Fishman; 5-6, 22, 23, Adler; 8-21, O’Hanlon; 7, 25, 26, Peratsakis
Pattern or element may represent a concrete behavior, emotion, or family member
3) Modify Experience: Sequences and Triggers
56
57. There is no greater privilege, then to share in the suffering of another!
60. 1. The source of the injury (Loss; Betrayal; Natural/Manmade Disaster or Tragedy) affects the type of
psychological damage and preoccupation (replacement; revenge; safety)
2. Challenge the manner in which the pain is distracted or suppressed.
3. “Enter Anger and Blame, Exit Guilt and Shame” (GASh = Guilt, Anger and Shame)
4. The goal of psychosis is isolation, which deepens trauma; need to increase social belongingness
As a rule,
a) Review need for meds (to modulate mood extremes) and safety plan
b) End and repair discord, conflicts or power-struggles and cut-offs; increase socialization activities
c) Give voice to the hurt and anger; tell the story, then re-narrate it
d) Work through self-pity, passivity and victimhood (guilt, shame, self-blame)
e) (Symbolically) quench the thirst for revenge
f) Enhance Self-worth through competencies and things that promote social well-being
g) Work toward Forgiveness and Redemption; forgiveness comes only with genuine remorse
60
64. References
1. Adler, A., The Individual Psychology of Alfred Adler, H. L. Ansbacher and R. R. Ansbacher (Eds.) (Harper
Torchbooks, NY 1956
2. Adler, A., The Practice and Theory of Individual Psychology, translated by P. Radin (Routledge & Kegan
Paul, London 1925; revised edition 1929, & reprints
3. Cognitive Restructuring: Gladding, Samuel. Counseling: A Comprehensive Review. 6th. Columbus:
Pearson Education Inc., 2009.
4. Conte, Christian. Advanced Techniques for Counseling and Psychotherapy, Springer Publishng, New York
5. Dinkmeyer, D., Pew, W. and Dinkmeyer, D. Jr. 1979. Adlerian Counseling and Psychotherapy, Monterey,
CA: Brooks/Cole.
6. Dreikurs, R., Gould, S. and Corsini, R. 1974. Family Council, Chicago: Henry Regnery.
7. Emotional Regulation; Karen Livingstone, Sean Harper, and David Gillanders (2009)
8. Erford, Bradley T., 2015, 2010. Forty Techniques Every Therapist Should Know, 2nd edition, Merrill
Counseling Series, Pearson
9. Hope D.A.; Burns J.A.; Hyes S.A.; Herbert J.D.; Warner M.D. (2010). "Automatic thoughts and cognitive
restructuring in cbt group therapy for social anxiety disorder". Cognitive Therapy Research. 34: 1–12.
10. Manual For Life Style Assessment, Bernard H. Shulman and Harold H. Mosak; Routledge, 1988
11. Narrative CBT for Psychosis, John Rhodes and Simon Jakes; Routledge, 2009
12. Richard Leakey; The Origin Of Humankind, Master’s Series, Orion Publishing, 2013 (1994)
13. Sherman, R., Oresky, P., Rountree, Y. 1991. Solving Problems in Couples and Family Therapy,
Brunner/Mazel. New York
14. Sherman, R., Fredman, N., 1986. Handbook of Structured Techniques in Marriage & Family Therapy,
Brunner/Mazel, NY
15. Sherman, R., Dinkmeyer, D.,1987. Adlerian Family Therapy, Brunner/Mazel, New York
64
67. Change occurs when the meaning, power or purpose of a belief is modified
1. The most common method for countering negative, self-limiting and counter-productive thoughts is to use
Critical Reasoning or a process known as Cognitive Restructuring (Doyle, 1998; Hope, 2010) to
“unbalance” and redefine the belief structure. There are four generally recognized steps:
a) Identify problematic images or mental activity that occur as a response to some trigger, like an action
or event. These "automatic thoughts" (ATs) convey negative assumptions and predictions about the
self, others, the world and ways to belong and function socially;
b) Isolate the distorted, irrational, or mistaken assumption that underlies the automatic thought;
c) Use a Socratic dialogue (through interviewing, role-play or imagery) to introduce doubt, pose new
possibilities, and undermine or attack its underlying logic (“unbalancing”). Examples include,
Examine the Pros and Cons; assess the negative consequences and scale or assess its cost
Weaken a strongly held belief by pitting it against an equally strong opposite belief
Point to disparities and logical inconsistencies, especially between beliefs or values
Inflate, exaggerate or dramatize the belief to make it extreme, trivial or silly
Create or reframe a narrative or story that puts the situation in a more favorable context
(reframing)
Examine the family rule or “voice” behind the assumption and attend to the loyalty issues
Use of the “Miracle Question”, Time Travel or Time-outs to imagine and explore freedom from AT
d) Develop, reframe or re-narrate a rational rebuttal to the automatic thought
67
68. 2. Thought Stopping: short-circuiting negative ideation; Self-Talk: positive self-affirmation
3. “Spitting in the Soup”: undermine the narrative by interpreting the motive or making its covert intent,
overt, then frustrate its inherent sense of “nobility” or personal gain
4. What if this wasn’t so? Explore a scenario in which the idea was no longer true or applicable. Explore
“worse-case” scenarios; “What’s the worst thing that would happen if…?”
5. Empty Chair: externalize the belief as an opponent or “demon”, then encourage rebellion against it
6. Use imagery, visualization, role-play, sculpting, drawing or other projective techniques to gain
perspective, elongate the narrative or directly manipulate some part of it
7. Use free association, analysis of dreams, early recollections, or fantasy exercises to undermine the power
of the belief or myth or to foster imagery-based exposure
8. Mindfulness meditation, relaxed breathing, yoga or progressive relaxation to reduce fragmentation and
anxiety, still panic, integrate body and mind and improve focus
9. Activity Scheduling to intentionally experience activities typically avoided
10. Graded Exposure or desensitization to feared or toxic experience, increasing comfort
11. Successive Approximation or breaking large steps into smaller ones
12. Journaling or thought record of moods and/or thoughts, especially noting the time, the extent of the
mood or thought, and what led to it
13. Skills Training (i.e.. assertiveness, communication, social skills) designed to remedy skills deficits
through modeling, coaching and direct instruction, and role-play training
14. Flagging the Minefield ((Sklare, 2005) or anticipating and preparing for relapse and pitfalls
68
69. It is important to continually test the rigidity of the beliefs surrounding the Presenting Problem and the
Identified Patient. Introducing new possibilities, reframing and resequencing existing interactional
patterns or re-organizing roles, rules and organizational structures or patterns increases flexibility and
expands the client’s perspective and ability to interpret -and then respond, in a different way.
1) History of Presenting Problem (PP): major nodal events surrounding the problem onset,
including trauma, betrayals, losses, anniversary dates and major transitional events such as
retirement, divorce, graduations or beginning school, leaving home, et al. The difficulties adapting
to change, hardships or periods of heightened stress often foster the creation of problematic or
symptomatic behavior patterns. The symptom onset often clues you in on the possible purpose the
symptom or problem serves.
2) Pattern of Interaction This refers to the sequence of behavior surrounding the Presenting
Problem or problem occurrence (who does what, when and where). This repetitive, interactional
loop maintains the presenting problem and highlights who participates in maintaining it.
Manipulating its components, introduces new possibilities and fosters a revised perspective on the
problem, its etiology and purpose.
b) Unbalancing the Symptom
69
Change occurs when the meaning, power or purpose of the P.P. is modified
70. 70
1. Behaviors, feelings and thoughts surrounding the presenting problem (PP) or
symptom harden over time becoming interactional patterns that acquire history with
well-defined roles and rules and expectations.
2. In essence, a pattern or “structure” around which communication and membership is
organized, boundaries defined, and power expressed and reconciled.
3. In particular, the emerging pattern fulfills the mutual purposes of its participants,
providing a vehicle for communication and attachment and the open expression of
love, anger, trust, and responsibility.
4. Underlying this, we often find a prolonged and deeply embedded power-struggle,
fueled by concomitant feelings of hopelessness, resentment and rage. It is often
passive-aggressive.
How Psychological Symptoms Form
71. 71
Shared Distortion
Shared values and opinions, represented by the overlapping shaded areas, mirror a part of each member’s
belief structures thereby reaffirming (concretizing) their ‘truth’and purpose.
Shared Cognitive Distortions
Father
S2
S1Mother
D1
72. 1. Create a new symptom (i.e.. “I am also concerned about
________; when did you first notice her doing that?”)
2. Switch to a more manageable symptom (one that is
behavioral and can be scaled; i.e.. chores vs attitude)
3. I.P. another family member (create a new symptom-bearer
or sub-group; i.e.. “the kids”, “the boys”)
4. I.P. a relationship (“the relationship makes her depressed”)
5. Push for recoil through paradoxical intention (caution!)
6. “Spitting in the Soup” –make the covert intent, overt,
then frustrate its inherent sense of “nobility”
7. Increase symptom intensity by describing worse-case
scenario or what could happen if things went unchecked
8. Add, remove or reverse the order of the steps (having the
symptom come first)
9. Remove or add a new member to the loop
10.Inflate/deflate the intensity of the symptom or pattern
11.Change the frequency or rate of the symptom or pattern
12.Change the duration of the symptom or pattern
13. Change the time (hour/time of day/week/month/year)
of the symptom or pattern
14. Change the location (in the world or body) of the
symptom/pattern
15. Perform the symptom without the pattern; short-
circuiting
16. Change some quality of the symptom or pattern
17. Perform the pattern without the symptom
18. Change the sequence of the elements in the pattern
19. Interrupt or prevent the pattern from occurring
20. Add (at least) one new element to the pattern
21. Break up any previously whole elements into smaller
elements; cut sequences into smaller steps
22. Link the symptoms or pattern to another pattern or goal
23. Reframe or re-label the meaning of the symptom
24. Point to disparities and create cognitive dissonance
25. Disengage the power-play that fuels the symptom and
tap the underlying anger
26. Surface Guilt and Shame and mobilize the underlying
anger and desire for revenge
Note: 1-4, Minuchin/Fishman; 5-6, 22, 23, Adler; 8-21, O’Hanlon; 7, 25, 26, Peratsakis
Pattern or element may represent a concrete behavior, emotion, or family member
Introducing New Possibilities
72
73. Social structures, includes rules, roles, sub-systems, alliances and collusions exist through shared convictions
and belief systems. These organize function and interaction and contribute to long-standing beliefs about the
system, its membership and guidelines for interacting; modifying these, change perspective and, in turn,
interpretation, opinion and prediction. Restructuring intwilleraction, modifies reality. Below are some
common tactics.
1. Disengage and redirect existing power-plays; implement “truce” and reconcile unresolved conflict and
cut-offs. Approach the conflict through sequential interpretations (same problem highlighted through
different points of view) and track the sequence of interactive behavior (“…and then what happens?”)
until the loop comes to a close.
Re-enact problem scenarios or use role-play and sculpting to illuminate family or relationship
structures and roles, then rescript their narratives and practice revisions
Separate people who are sitting together
Block interruptions or inappropriate requests for confirmation, to control or to censor
Discourage use of one member as a repository for another’s memories, feelings or thoughts
Approve descriptions of competence. Encourage members to reward competence in session
Tell one member to help another to change
If one controls, confront another for encouraging their dominance
Direct individuals to speak to each other
73
Change occurs when the meaning, power or purpose of transactions are modified
74. 2. Use of ‘empty chair’ to represent absent members, hidden rules, secrets or taboos; manipulate and use
space, to connect and disconnect, to show closeness or distance; use props and furniture (concrete
reminders) to illustrate relational components
3. Unbalance alliances, coalitions and collusions; fashion new ones, or temporarily join a subsystem, to
adjust the balance of power and improve communication patterns
4. Establish, strengthen, or weaken boundaries; empower the executive sub-system
5. I-Messages; increase differentiation of self, personal space and independence of members
6. Block inappropriate roles or role behavior; model appropriate behavior. Prescribe role reversals; revise
roles, strengthen existing natural roles, or assign new ones
7. Temporarily shift power and authority structure: Queen for a Day; King of the Castle
8. Provide more structure in a chaotic organization; reduce rigidity in an inflexible structure
9. Take a “one-down” position to force the client or family into the “one-up”
10. Create celebrations, honorifics or exorcisms to modify, up or down, the power surrounding a member;
introduce new customs, rituals, practices or ordeals
11. Hold an exorcism or funerary rite for the old belief, family myth or legend; create a ritual or
assignment to be practiced that mirrors the new belief. Create a new point in time (“then” versus”
from here forward”) or establish a “truce” for moving forward
74
75. 12. Use of a Genogram, Socio-map or Family Floor Plan to examine truisms and taboos
13. Establish a Family Council so that grievances and supports can be materialized
14. Spread out a symptomatic role among all family members to expose the family secret or remove or
rotate the symptomatic member from the scapegoat position
15. Introduce other clients or families to session and foster interfamilial organization
16. Time-travel or regrow the client or family from scratch and have them “act as if” they are the person or
persons they wish to be
17. Use Behavior Rehearsal; “Acting As If”; Guided Imagery; and Fantasy techniques to work on self-
empowerment and explore fears and dreads to success and failure
18. Work through issues of Guilt, Anger and Shame (GASh); focus on desires and acts of revenge and move
toward acts of forgiveness and redemption
19. Connect with each member and affirm their value; create Caring Days,
20. Identify and validate strengths; encourage recognition by the family of each other through celebrations,
boasting, awards and acts of praise. Promote “New Talk”
21. Refer clients to additional educational materials and resources, experts and trainers
22. Assign tasks and functions based on abilities. “What is she good at?”
23. Help members with assertiveness and improve mediation and negotiation skills. Curtail acts of
aggression, back-biting, complaining, rivalry, subterfuge and revenge
75
76. 24. Identify choices and make joint decisions. “Doom” clients to success by setting small, common
workable goals and anticipating obstacles, sabotage and possible failure
25. Identify and emphasize positive changes and movement; examine what worked
26. Reframe negative meanings and negatively charged events
27. Recall incidents that worked successfully in the past or solutions from TV, Movies or others
28. Increase self-esteem, personal worth and mutual respect and valuation; connect in a meaningful way.
Improve self-image through boasting and self-esteem worksheets
29. Challenge underlying “nobility” of self-defeating behaviors (“Spitting in Client’s Soup”)
30. Use paradox (with caution) to prescribe existing roles, rules, and patterns of interaction
31. Add or detract family members from session
32. Bring other families into session and pair subsystems, foster interfamily competitions or use members in
similar roles as co-therapists
33. Place the symptom on vacation or write a prescription to schedule it at given times
34. Have the clients experience each other in a different, fun, way or varied venue
35. Explore what each member is willing to do to alleviate the current problem, change the rule, alter the
belief, or help create, through a change in their own behavior, a new interactional paradigm
76
77. 36. Use of the Therapeutic Alliance to foster change. Few components of the therapy process are as
potentially transformational as the relationship that, clients have with the therapist. By
continuously demonstrating acceptance and positive regard, active listening, and support and
encouragement, the therapist provides a safe milieu for the experimentation and trial of new
ways of thinking and behaving. Moreover, a seasoned therapist may use their own way of being,
their own style of interacting with the client to both frustrate and promote behavior change.
Even by simply responding in a manner that is different then what is expected -or routinely
experienced with others, the therapist has created the opportunity for change. Finding a balance
between support and confrontation, at times even provocation, is an important attribute of the
experienced therapist. So, too, is the ability to disengage and redirect the power-struggles that
arise between the therapist and client and that are common to the therapeutic relationship. In
this regard, the greatest agent of change is often the clinician, themselves.
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