Grief is the process that occurs before people come to acceptance. It can be a painful experience involving many different feelings. Losses includes health issues, loss of a career, loss of relationships, an unborn child, and/orability or desire to have children. Experiencing loss and grieving may include physical, emotional, social, and spiritual responses. Grieving is essential for coming to terms with and processing the trauma and resultant losses. Trauma and its accompanying sense of loss may result in a terrible sense of disappointment and failure. Working with mental health professionals and other survivors can be extremely helpful in working through the grieving process. The grieving process involves acknowledgment and acceptance of loss. Psychotherapy is a process of “re-parenting” the inner child who may have had less than ideal caretaking. The neural connections in the brain can heal and change with new experiences.

This chapter aims to help clinicians learn stabilization interventions for use in the Preparation Phase of eye movement desensitization and reprocessing (EMDR) treatment. Using these interventions will aid clients in developing readiness for processing trauma, learning how to manage symptoms of dissociation, dealing with affect regulation, and developing the necessary internal cohesion and resources to utilize the EMDR trauma-processing phase. Earlier negative experiences stored dysfunctionally increase vulnerability to anxiety disorders, depression, and other diagnoses. When assessing a client with a complex trauma history, clinicians need to view current symptoms of post-traumatic stress disorder (PTSD) or depression as reflections of the earlier traumas. The chapter outlines the strategies dealing with dissociative symptoms, ego state work, and internal stability that help clinicians to develop an individualized treatment plan to successfully guide the client through the EMDR phases of treatment.

This chapter describes key steps, with scripts, for the phases of therapy with a dissociative identity disorder (DID) client, and for an eye movement desensitization and reprocessing (EMDR) session with a DID client. In brief, the method employs the artful use of EMDR and ego state therapy for association and acceleration, and of hypnosis, imagery, and ego state therapy for distancing and deceleration within the context of a trusting therapeutic relationship. It is also endeavoring to stay close to the treatment guidelines as promulgated by the International Society for the Study of Trauma and Dissociation. The acronym ACT-AS-IF describes the phases of therapy; the acronym ARCHITECTS describes the steps in an EMDR intervention. Dual attention awareness is key in part because it keeps the ventral vagal nervous system engaged sufficiently to empower the client to sustain the painful processing of dorsal vagal states and sympathetic arousal states.

One way of thinking about procrastination is to regard it as a form of addiction; an addiction to putting things off. As with other addictive patterns, the client will choose a short-term gratification instead of going for a long-term result that might, in the end, be more satisfying or empowering. As with other addictions, a procrastinating client often suffers ongoing erosion of her self-esteem. Quite often, procrastination may function as a defense as a way to avoid other life issues that are disturbing. With this type of problem, we can use a variation of Popky’s addiction protocol, and the level of urge to avoid (LoUA) procedure. It is also important to use resource installation procedures to help the client develop an image of the benefits that would come with being free of this problem.

The important elements of the Eye Movement Desensitization and Reprocessing (EMDR) and Phantom Pain Research Protocol are client history taking and relationship building, targeting the trauma of the experience, and targeting the pain. This protocol is set up to follow the eight phases of the 11-Step Standard Procedure. This chapter presents a case series with phantom limb patients obtained a few before and after EMDR magnetoencephalograms (MEGs) at the University of Tübingen, Germany on arm amputees that show the presence of phantom limb pain (PLP) in the brain images before EMDR and the absence of it after EMDR. In these case series, it is found that PLP in leg amputations is much easier to treat than arm amputations, likely due to the much more extensive and complex arm and hand representation in the sensory-motor cortex compared to the leg and foot representation.

As everyone knows, true creativity comes from simple formulas and the memorization of data. This chapter focuses on divergent thinking tests, which are still the most common way that creativity is measured. Guilford derived the core ideas behind divergent thinking as well as many popular measures. The people who score the Torrance Tests are specifically trained to distinguish responses that are truly original from those that are just bizarre. There are other tests that measure creativity, but most are either a variation on divergent thinking or use some type of raters. For example, the Evaluation of Potential Creativity (EPOC) has begun to be used in some studies and may be promising, but is still largely rooted in a mix of divergent thinking scoring and raters. Another test is the Finke Creative Invention Task, which is clever but also requires raters for scoring.

The Big Five, which this chapter discusses in more detail, are extraversion, neuroticism, agreeableness, conscientiousness, and openness to experience. Each of these five factors represents a continuum of behavior, traits, and inclinations. There are some popular personality measures that use different theories, such as Eysenck’s Personality Questionnaire, which looks at extraversion and neuroticism as well as psychoticism. The personality factor most associated with creativity is openness to experience. Indeed, one way that researchers study creativity is by giving creative personality tests. Being open to new experiences may also help creative people be more productive. King found that people who were creative and high on openness to experience were more likely to report creative accomplishments. DeYoung and S. B. Kaufman, of course, are not the only people to blend or split different factors of personality to present new models. Fürst, Ghisletta, and Lubart suggest three factors: plasticity, divergence, and convergence.

This chapter explores three ’classic’ studies of creativity and mental illness. The first is Jamison whose focus is on the connection between bipolar disorder and creativity. The second is Andreasen, who used structured interviews to analyze 30 creative writers, 30 matched controls, and first-degree relatives of each group. The writers had a higher rate of mental illness, with a particular tendency toward bipolar and other affective disorders. The third major work is Ludwig, who utilized the historiometric technique. All three studies have come under serious criticism. Many of the studies of Big-C creators are historiometric, akin to Ludwig’s work. Some such studies claim that eminent creators show higher rates of mental illness. A much more common approach is to look at everyday people and give them measures of creativity and mental health. Typically, researchers look at what are called subclinical disorders—in other words, they’re not clinically significant.

One school admissions area that already uses creativity is gifted admissions—which students are chosen to enter gifted classes, programs, or after-school activities. Both education and business play great lip service to creativity. Puccio and Cabra review the literature on creativity and organizations and do a nice job of highlighting how every couple of years, a new report from industry emphasizes the importance of creativity. It is important to note that there is a large inconsistency between gender differences on creativity tests and actual creative accomplishment. Although gender differences on creativity tests are minor or nonexistent, differences in real-world creative accomplishment are large and significant. This chapter shows how creativity can play a role in admissions and hiring. Hiring measures tend to have better validity, even the general mental ability (GMA) measures; even if minorities score lower, the accuracy of prediction is consistent by ethnicity.

Creative people are also often seen as being outsiders and eccentric. Sen and Sharma’s examination of creativity beliefs in India tested beliefs about the Four P’s and found that creativity was more likely to be described as a holistic essence of an individual, and less likely to be focused on the product or process. Romo and Alfonso studied Spanish painters and found that one of the implicit theories that the painters held about creativity involved the role of psychological disorders. Plucker and Dana found that past histories of alcohol, marijuana, and tobacco usage were not correlated with creative achievements; familial drug and alcohol use also was not significantly associated with creative accomplishments or creative personality attributes. Humphrey, McKay, Primi, and Kaufman did find that illegal drug use predicted self-reported creative behaviors even when openness to experience was controlled.

Depression is sometimes referred to as the common cold of psy-chopathology. Consistent with this aphorism, epidemiological studies demonstrate that depressive disorders are indeed rather common across the life span. Given the importance of the social relationships and context to understanding depression, it seems likely that culturally informed and diverse research will yield important findings about those critical components of human cognition, emotion, and social relationships that underlie risk for depression, as well as those that serve to aid in recovery from these disorders. Most researchers believe it is unlikely there is a direct effect of hormones on depression, but rather that they indirectly increase risk via any one of several mechanisms, including: the effects of hormones on brain development, the development of secondary gender characteristics that are generated by these hormones, or the hormonal changes that occur during the pubertal transition may interact with life events and the social context.

Depressive disorders are characterized by etiological heterogeneity, which means that many diverse causal factors or causal pathways can lead to the same clinical outcomes. Women are at higher risk for depressive episodes beginning at early adolescence and then throughout the life span. Unipolar depressive disorders can onset at any point in the life span, but are most prevalent in late adolescence through early to mid-adulthood. Bipolar disorder (BD)s generally onset before mid-adulthood; new cases are rare thereafter. More severe cases of unipolar and bipolar disorders are characterized by a chronic/recurrent course. Both unipolar and bipolar disorders are commonly comorbid with other forms of psychopathology; overall severity and poorer outcome over time is associated with comorbidity. If gender differences are of interest, the effects of potential etiological factors are measured in persons of both genders and their associations with depressive disorders are statistically compared across genders.

The “Image Director Technique” was developed to target recurring nightmares or bad dreams and those targets that are directly related to a traumatic experience. This technique is a special module that is embedded in the Standard Eye Movement Desensitization and Reprocessing (EMDR) Protocol. The technique begins with the worst image of the dream and then accesses and measures it as in Phase 3 of the Standard EMDR Protocol that includes the image, cognitions, emotions, and sensations. Clients are more likely to work with short clips or films if the subjective units of disturbance (SUD) of the target image is low. This technique can also be considered an imagery exposure method that is based in systematic desensitization, a behavioral approach. Often, clients prefer the tactile bilateral stimulation (BLS) because they can close their eyes in order to be visually undisturbed during the creation of the new images.

This chapter presents the best measures for resilience and community protection for some of the social determinants of digital diseases in the future for further discussion with families, school workers, and allied health professionals. It suggests that high levels of resilience may prevent development of mental health problems, like depression, stress, anxiety and obsessive-compulsive symptoms, supporting the suggestion that fostering resilience may prevent development of mental health problems in adolescents. The chapter presents a case report of a 14-year-old, brought to consultation by his mother, who has been worried about his weight. This case report points out how important it is to build up resilience skills through the development of caring and supportive relationships within and outside the family. The chapter suggests a four-pronged approach to prevent the excessive use and the problems associated with the Internet. It includes regulatory, parental, educational, and technological approaches.

This chapter discusses some of the known risks of the different forms of digital distraction in a vehicle and then considers how to use that information to change the behavior of teen drivers. The Centers for Disease Control and Prevention (CDC) estimates that six teens are killed in motor vehicle crashes every day. Interacting with other passengers, using a cell phone, or looking at or reaching for something in the vehicle were significant sources of distraction for teen drivers. The chapter presents a simple quiz based on the estimated crash risk associated with several multitasking activities. The sum total obtained from the quiz provides an estimate of the risk associated with distracted driving over the preceding week. The chapter also provides some guidance for parents, schools, and policy makers to help teens make good decisions when driving.

One of the best known psychologists of the 20th century was Jean Piaget. The memory he described was from when he was about 2 years old, a kidnapping attempt in which his nurse tried to protect him. According to the storehouse metaphor, memory is kind of a warehouse. When one remembers an event from one’s life, one looks through this warehouse. Remembering a past event is also a kind of simulation, a simulation of what happened in the past, rather than a veridical reproduction of the past. In fact, our best understanding is that brains are massively parallel simulation devices. Constructive theories deal with filling in gaps at encoding as the event transpires, whereas reconstructive theories deal with filling in gaps at retrieval as one tries to remember the event. When thinking about memory illusions it is important to make a similar distinction.

The idea of the therapeutic community (TC) recurs throughout history implemented in different incarnations. In its contemporary form, two major variants of the TC have emerged. One, in social psychiatry, consists of innovative units and wards designed for the psychological treatment and management of socially deviant psychiatric patients within mental hospital settings. In the other form, TCs have taken are as community-based residential treatment programs for addicts and alcoholics. This chapter explores the sources and evolution of these communities to illustrate how they contribute to the theoretical framework of the TC. It describes the direct and indirect influences shaping the essential elements of the modern TC. The early religious influences on the Oxford group and Alcoholics Anonymous (AA) reappear as elements of the modern TC. The search for an “essential TC” reveals a universal idea recurring in various forms throughout history: that of healing, teaching, support, and guidance through community.

This chapter describes the relevance of critical thinking and the related process and philosophy of evidence-based practice (EBP) to cognitive behavior therapy and suggests choices that lie ahead in integrating these areas. Critical thinking in the helping professions involves the careful appraisal of beliefs and actions to arrive at well-reasoned ones that maximize the likelihood of helping clients and avoiding harm. Critical-thinking values, skills and knowledge, and evidence-based practice are suggested as guides to making ethical, professional decisions. Sources such as the Cochrane and Campbell Collaborations and other avenues for diffusion, together with helping practitioners and clients to acquire critical appraisal skills, will make it increasingly difficult to mislead people about “what we know”. Values, skills, and knowledge related to both critical thinking and EBP such as valuing honest brokering of knowledge, ignorance and uncertainty is and will be reflected in literature describing cognitive behavior methods to different degrees.

This chapter describes the Coping Skills Program, an innovative, school-based, universal curriculum for elementary-school aged children that is rooted in cognitive behavior theory. Rooted in cognitive behavior theory, the Coping Skills Program consists of carefully constructed metaphorical fables that are designed to teach children about their thinking; about the connections among their thoughts, feelings, and behavior; and about how to change what they are thinking, feeling, and doing when their behavior causes them problems. The chapter provides a thorough description of the Coping Skills Program and how it is implemented through a discussion of relevant research-based literature, and the theoretical underpinnings underlying this cognitive behavior approach with school-aged children. It also includes the results of preliminary testing of the Coping Skills Program. The research-based literature shows that cognitive behavior approaches are among the interventions commonly used by social workers to help young children in school settings.

This chapter focuses on an area that has been at the center of the debate between the approaches: processing ambiguous words and sentences. Interestingly, an important factor for ambiguity resolution appears to be the frequency of the different meanings of the ambiguous words. Subordinate- bias effect is as follows: in a neutral, nonbiasing context, words that are balanced cause longer reading times than words that are either unbalanced or unambiguous. Different languages impose different rules about how grammatical categories may be combined. In the garden path model, sentence processing happens in two stages: an initial structure building stage in which the only information that is used is syntactic, and then a second stage in which the structure is checked against semantic and pragmatic information. Constraint-based models take a very different approach to how sentences are initially parsed and how mistakes are sometimes made.

This chapter shows the importance, for older persons, of support groups. In spite of the changes that have occurred in the American family, and all the negative things that fill the popular press concerning family relationships, the family is still the backbone of support for most older people. To some extent, the type of family support older people obtain depends on whether they are living in the community or in an institutional setting such as a group home, retirement village, or nursing facility. Whether a person is married, has great impact on that person’s support within a family setting including emotional, financial, and physical support, particularly in times of illness or infirmity. The success of a second marriage depends to a considerable extent on the reaction of the adult children of the elderly couple. Older grandparents, no matter how motivated, can find caring for grandchildren to be very tiring.

This chapter describes the current trends toward greater gender equality in couple relationships, what keeps old patterns of gendered power alive, and why equality is so important for successful relationships. Relationship vignettes like the ones just described are common. Sharing family and outside work more equitably is only part of the gender-equality story. Gender ideologies are replicated in the way men and women communicate with each other and influence the kind of emotional and relational symptoms men and women present in therapy. Stereotypic gender patterns and power differences between partners work against the shared worlds and egalitarian ideals that women and men increasingly seek. The concept of relationship equality rests on the ideology of equality articulated in philosophical, legal, psychological, and social standards present today in American and world cultures. The four dimensions of the relationship equality model are relative status, attention to the other, accommodation patterns, and well-being.

This chapter provides an overview of working with clients who present with more complex trauma. Many of the clients that come for Eye Movement Desensitization Reprocessing (EMDR) will have a history of complex trauma or a chaotic childhood. Clients who have experienced complex trauma may lack basic life skills or have missed out on developmental stages due to a chaotic childhood, for example, parents who were absent, neglectful, or abusive. Clients may not have been taught how to regulate their emotions in early childhood. They may present with impulsive, risk-taking, or suicidal behaviors. Before carrying out the desensitization phase of EMDR, individuals need to have an adequate level of resilience and be sufficiently resourced. Clients with Dissociative Identity Disorder (DID) display at least two distinct and enduring “alters” or identity states that recurrently take control of their behavior.

This chapter shows how the United States and the world are experiencing an aging evolution we are growing older. America is going through a revolution. As a whole, Americans are becoming older, and there are many more older people among people than ever before in our history. Obviously all cohorts of the population youth, young adults, middle-aged, young-old, oldest-old are heterogeneous. When some people think about the elderly as a whole, they picture frail, weak, dependent persons, some in nursing homes and many confined to their homes. The chapter demonstrates the differences the various age categories have in relation to selected chronic health conditions that cause limitations of activity. Widowhood is much more common for elderly American women than for older men. The aging of Baby Boomers will solidify the shift America is experiencing with the aging of its population. Centenarians make up a small percentage of the total U.S. population.

This chapter explores the relationship between gender and power. Gendered power in couple relationships arises from a social context that has given men power over women for centuries. When practitioners fail to take account of social context, however, they may run the risk of inadvertently pathologizing clients for legitimate responses to oppressive experiences. The term gender is a socially created concept that consists of expectations, characteristics, and behaviors that members of a culture consider appropriate for males or females. Consequently, an individual’s ideas about gender may feel deeply personal even though they are a product of social relationships and structures. Strong social forces work to keep social power structures, including gender inequality, in place. The continued presence of gendered power structures in economic, social, and political institutions still limits how far many couples can move toward equality. Today, ideals of equality compete with the institutional practices that maintain gender inequality.

The primary purpose of Module 3 of the MAC program is the understanding and exploration of values as a central orienting concept. In the context of understanding the important role of values in enhanced performance and quality of life, the functional and dysfunctional role of emotions is also considered. This chapter suggests to clients that their personal values will be the anchor point for all behavioral decisions that need to be made in the course of enhancing performance and achieving goals. The concepts of mindful awareness, mindful attention, and cognitive fusion and cognitive defusion become integrated with the concept of values-directed versus emotion-directed behavior. The Relevant Mindful Activity Exercise is intended to connect the mindfulness concept to a relevant performance situation in the client’s life. The question of personal values is particularly salient when confronted by the variety of emotions and internal rules that client confronts on a daily basis.

The researchers were specifically interested in whether they would get more incorrect responses depending on the type of sentence. From a certain perspective, passive sentences are more complicated than active sentences and so perhaps it is the case that passives are more difficult simply because they are more complicated. It appears that the important difference between subject cleft and actives on one hand, and passives on the other, is that the order of the roles is reversed between them: in active sentences, the agent comes first. Indeed, there is a growing body of evidence that languages allow English speakers to structure their utterances in a way that can flag certain parts of the sentence as particularly important or worthy of special attention. Recently, psycholinguists have been interested, too, in how information structure influences language processing.

The therapeutic community (TC) is a culture of change. All of the activities, social roles, interpersonal interactions, and community teachings focus upon the theme of individual change. The perceptions that are considered to be essential to recovery are interrelated, although they can be organized into classes to clarify their contribution to the process. Perceptions related to treatment reflect the individual’s motivation, readiness, and suitability to engage in the process of change in the TC. Self-control is indicated when individuals perceive the problem as internal rather than external, as one of regulating their impulses. Perceptions of self-management of patterns of behaviors, attitudes, and feelings depend upon previously learned control of specific behaviors in various situations. Assessing and affirming individual progress is a central activity in the TC. Staff evaluations formally assess the levels of self-change, while peers and staff assess them informally.

This chapter examines the cultural and relational contexts of postpartum depression. Postpartum depression (PPD) is a debilitating, multidimensional mental health problem that affects 10"-15” of new mothers and has serious consequences for women, children, families, and marriages. Although women’s experience of postpartum depression has been the subject of considerable recent study, nearly all of this work has been interpreted within a medical or psychological frame. The chapter looks at a social constructionist lens to this body of research through a meta-data-analysis of recent qualitative studies of PPD. Though hormonal changes as a result of childbirth are related to depressive symptoms after childbirth, biological explanations alone cannot explain postpartum depression. A social constructionist approach to postpartum depression focuses on how the condition arises in the context of ongoing interpersonal and societal interaction. Climbing out of postpartum depression is an interpersonal experience that requires reconnection with others.

Clinical social workers have an opportunity to position themselves at the forefront of historic, philosophical change in 21st-century medicine. As is so often true for social work, the opportunity is associated with need. For social workers, in their role as advocates and clinicians, this unmet need would seem to create an obligation. This chapter argues that, if choosing to accept the obligation, social workers can become catalysts for vitally needed change within the medical field. While studies using the most advanced medical technology show the impact of emotional suffering on physical disease, other studies using the same technology are demonstrating Cognitive behavior therapy’s (CBT) effectiveness in relieving not just emotional suffering but physical suffering among medically ill patients. While this chapter discusses the clinical benefits and techniques of CBT, it also acknowledges the likelihood that social work will have to campaign for its implementation in many medical settings.

The study of the properties of language can be divided up into roughly five, somewhat overlapping categories: sound system, word structure, sentence structure, meaning, and real-world use. In spoken languages, segments are sounds—each language has a set of sounds that are produced by changing the positions of various parts of the vocal tract. The sound system of language is actually studied in two main parts: phonetics, phonology. Phonemes can be combined to make words, and words themselves have an internal structure and can even be ambiguous based on this structure. Syntax is the study of how sentences are formed. There are two noun phrases (NPs) in the sentence—the artist and a paintbrush. The field of semantics is concerned with meaning in language and can be divided into two major parts: lexical and propositional.

From a social and psychological perspective the therapeutic community (TC) can be distinguished from other institutional or treatment settings in that its social environment is the treatment model. The main elements of this model, its social organization, and social relationships are utilized for a single purpose the reintegration of the individual into the larger macrosociety. The social organization of the TC model may be described in terms of four major components: program structure, systems, communication, and the daily regimen of schedule activities. In the TC, however, each component is utilized to facilitate the socialization and psychological growth of the individual members. This chapter provides an overview of these components and how they contribute to the TC treatment approach. Each of these components of the social organization reflects an understanding of the TC perspective and each is used to convey community teachings and promote self-examination and self-change.

The long-term use of benzodiazepines causes severe cognitive and neurological impairments, atrophy of the brain, and dementia, and the newer sleep aids should be considered a potential but unproven risk in this regard. Some of the most severe cases of chronic brain impairment (CBI) occur after years of exposure to benzodiazepines. This chapter examines the risk of increased mortality associated with benzodiazepines and closely-related sleep aids when given in relatively small doses for short periods of time in the treatment of insomnia. All of the benzodiazepines and the more common prescribed sleep aids are addictive. Opiate and opioid withdrawal tends to be more predictable than psychiatric drug withdrawal. Like the abuse of stimulants and benzodiazepines, abuse of opiates and opioids can result in unlawful acts. The chapter addresses legally used opioids, involving mild-to-moderate abuse or dependence as found in patients who can often be safely withdrawn in an outpatient setting.

This chapter presents a case study on performance dysfunction in the case of a 21-year-old African American female basketball player entering her senior year at a major Division I-level university. She described regret about not working out harder during the off-season, which she blamed for a poor start to her current season. In addition, she also reported feeling a great deal of worry over the possibility that she may have a poor season and ruin her chance to be drafted in the first round of the WNBA entry draft. According to the case formulation model, there are 10 elements that are necessary to consider prior to making an intervention decision contextual performance demands; skill level; situational demands; transitional and developmental issues; psychological characteristics/performance and nonperformance schemas; attentional focus; cognitive responses; affective responses; behavioral responses; and readiness for change and level of reactance.

In the therapeutic community (TC), recovery is viewed as a change in lifestyle and identity. It is a view that can be contrasted with the conventional concept of recovery in medicine, mental health, and other substance abuse treatment approaches. In the public health experience of treating opioid addiction and alcoholism, drug abuse is viewed as a chronic disease, which focuses treatment strategies and goals on improvement rather than recovery or cure. The TC view of recovery extends much beyond achieving or maintaining abstinence to encompass lifestyle and identity change. This chapter outlines this expanded view of recovery and details the goals and assumptions of the recovery process. It presents the TC view of right living, which summarizes the community teachings guiding recovery during and after treatment. The terms “habilitation” and “rehabilitation” distinguish between building or rebuilding lifestyles for different groups of substance abusers in TCs.

The idea of the mad genius persisted all the way to modern times and was even promulgated in scientific circles. Not only was genius mad, but it was associated with criminality and genetic degeneration. The empirical research relevant to the mad-genius issue uses three major methods: the historiometric, the psychometric and the psychiatric. The historical record is replete with putative exemplars of mad genius. The mental illness adopts a more subtle but still pernicious guise-alcoholism. In fact, it sometimes appears that alcoholism is one of the necessities of literary genius. Psychopathology can be found in other forms of genius besides creative genius. Of the available pathologies, depression seems to be the most frequent, along with its correlates of suicide and alcoholism or drug abuse. Family lineages that have higher than average rates of psychopathology will also feature higher than average rates of genius.

This chapter talks about questions related to how speakers and hearers influence each other. It looks at research on dialogue, and especially how a dialogue context influences speakers. Speakers have an impact on their listeners. The goal of a dialogue is successful communication and so it would make sense that a speaker would pay careful attention to the needs of a listener and do things like avoid ambiguity and package information in a way that flags particular information as important or new to the listener. Ambiguity may be avoided depending on the speaker’s choice of words and so a natural question is whether, and when, speakers appear to avoid ambiguous language. In terms of pronunciation, speakers reduce articulation and intelligibility over the course of a dialogue. There are some constraints and preferences on how to interpret pronouns and other coreferring expressions that appear to be structural or syntactic in nature.

School social workers provide direct treatment for a multitude of problems that affect child and adolescent development and learning; these problems include mood disorders, attention deficit hyperactive disorder (ADHD), disruptive behavior disorders, and learning disorders, as well as child abuse and neglect, foster care, poverty, school drop out, substance abuse, and truancy, to name but a few. This chapter examines four constructs that are important when working with students. These constructs include: assessment and cognitive case conceptualization, the working alliance, self-regulated learning, and social problem solving. The chapter discusses the development of attainable and realistic goals is a critical component both of self-regulated learning and social problem solving. The chapter examines the problem of academic underachievement and four constructs that are critically important when working with children and adolescents in school settings. Academic underachievement is a serious problem affecting the lives of many children.

Therapeutic communities (TCs) are designed to enhance the residents’ experience of community within the residence. This chapter explores how the physical environment of the TC, its setting, facilities, and inner environment, can contribute to this perception and affiliation with community. Its separateness from the outside community in addition to its living spaces, furnishings, and décor are all utilized to promote affiliation, a sense of order, safety, and right living. TCs for the treatment of addiction are located in a variety of settings, which may be determined by funding sources and the external resistance to or acceptance of rehabilitation programs. Within the context of the TC perspective, privacy is considered an earned privilege based on the individual’s social and psychological growth. There are four physical features of the inner environment that instantly identify what is unique about a TC program: the front desk, the structure board, wall signs, and decorative artifacts.

This chapter presents the theoretical and empirical rationale for the development of an innovative intervention for the enhancement of performance. The mindfulness-acceptance-commitment (MAC) approach to performance enhancement is based on an integration of mindfulness and acceptance-based approaches and is specifically tailored for high-performing clientele. The predominant psychological approaches have emphasized the development of self-control of internal states such as thoughts, emotions, and physical sensations and have been commonly referred to as psychological skills training (PST) procedures. The self-regulatory PST procedures most often discussed are goal-setting, imagery/mental rehearsal, arousal control, self-talk modification, and precompetitive routines. The efficacy of psychological skills training techniques and procedures for performance enhancement has been most carefully evaluated within the context of athletic performance enhancement. Mindfulness can be seen as the process that promotes greater awareness of internal experiences and the defusion of one’s thoughts, emotions, and bodily sensations.

This chapter explains a set of guidelines to help mental health professionals and clients move away from the gender stereotypes that perpetuate inequality and illness. Identifying dominance requires conscious awareness and understanding of how gender mediates between mental health and relationship issues. An understanding of what limits equality is significantly increased when we examine how gendered power plays out in a particular relationship and consider how it intersects with other social positions such as socioeconomic status, race, ethnicity, and sexual orientation. To contextualize emotion, the therapist draws on knowledge of societal and cultural patterns, such as gendered power structures and ideals for masculinity and femininity that touch all people’s lives in a particular society. Therapists who seek to support women and men equally take an active position that allows the non-neutral aspects of gendered lives to become visible.

This chapter presents how eye movement desensitization and reprocessing (EMDR) therapy and Theraplay can be used together when treating children with a history of complex trauma. Theraplay focuses on the parent-child relationship as the healing agent that holds within it the potential to cultivate growth and security in the child. The chapter shows some core concepts that help define and illuminate the application of Theraplay. Now that a clear review of basic Theraplay principles has been provided, people need to look at EMDR therapy and the adaptive information processing (AIP) model in conjunction with Theraplay and Theraplay core values. Early in its development, Theraplay integrated parental involvement into its therapeutic model. During the reprocessing phases of EMDR therapy, Theraplay can be very helpful in providing different avenues for emotion regulation and for the repairing of the attachment system.

This chapter presents a conceptual framework of the treatment process in the therapeutic community (TC). The essential elements of the perspective, model, and method are reformulated into the three broad components of the treatment process. First, the multiple interventions in the process consist of the program structure, the people, daily regimen of activities, and social interactions in the TC. Second, individual change is multidimensional, described in terms of objective social and psychological domains as well as subjective perceptions and experiences. Third, social and behavioral learning principles and subjective mechanisms such as critical experiences, perceptions, and internalization are integral in the process itself. The main elements of the treatment process in the TC have been described in terms of community interventions, behavioral dimensions, and the essential perceptions and experiences. All change in the TC is viewed from a behavioral orientation in terms of learning and training.

This chapter and the intervention protocol that follows seek to better understand and ultimately influence human performance through understanding how internal processes interact with external demands. Many factors determine the effectiveness of human performance. The myriad of factors contributing to functional as well as dysfunctional human performance can be summarized as follows: instrumental competencies, environmental stimuli and performance demands, dispositional characteristics, and behavioral self-regulation. The chapter presents the model of functional and dysfunctional human performance that involves three broad yet interactive phases, namely performance phase, postperformance response, and competitive performance. The professional literature in both clinical and cognitive psychology suggests that individuals develop an interactive pattern of self and other mental schemas. The accumulated empirical evidence has led to similar findings in studies across many forms of human performance. Chronic performance dysfunction is much more likely to be associated with an avoidant coping style.

This chapter helps readers to understand the main characteristics of the three major types of eating disorders: anorexia nervosa, bulimia nervosa, and binge eating. It also examines each disorder from a neurobiological perspective, including genetic factors when known, neuroimaging results, the understanding of neurotransmitter dysregulation, cognitive performance, and various types of treatment. The chapter then presents the consideration of the unique challenges associated with comorbidity, societal pressure, and medical implications. Eating disorders are increasingly common, debilitating, and potentially life-threatening disorders that are clearly linked in their neurobiological basis. Mental health professionals should be aware of the signs and symptoms of eating disorders, as individuals might not disclose their eating habits as readily as their mood, anxiety level, or other symptoms. Treatment is complex, as no medication has been shown to be consistently effective, and each eating disorder will bring with it specific goals.

This chapter describes a systematic approach to intervention planning in performance psychology. It presents a case formulation method for a comprehensive understanding of the client, and an appropriate multilevel classification system for sport psychology (MCS-SP) classification that subsequently either guides the proper delivery of the mindfulness-acceptance-commitment (MAC) program or leads to the determination that the performer’s needs are beyond the scope of the MAC program. The MCS-SP categorizes the issues and barriers facing the performer into four classifications: performance development (PD), performance dysfunction (Pdy), performance impairment (PI), and performance termination (PT). In the case formulation method suggested in the chapter, the practitioner’s first goal is to conceptualize performance needs and barriers based on the information systematically collected during the assessment process.

In the recovery perspective of the therapeutic community (TC), lifestyle and identity changes reflect an integration of behaviors, experiences, and perceptions. The essential experiences can be conceptualized under three broad themes: emotional healing, social relatedness and caring, and subjective learning. Emotional healing refers to moderating the various physical, psychological, and social pains that residents experience in their lives directly or indirectly relating to their substance use. The essential experiences reflecting psychological safety are blind faith and trust, and understanding and acceptance. Trust problems are prominent in the lifestyles of substance abusers. Hallmark characteristics of substance abusers in general are their lack of self-understanding and self-acceptance. Personal isolation or unhealthy attachments with others characterize the past social relationships of residents in TCs. The key social relatedness and caring experiences are identification, empathy, and bonding. In the TC, social learning unfolds as an interaction between the individual and the community.

This chapter examines in detail the various components that are conducive to setting the stage for progressive, developing, and productive supervision to occur. It explores the characteristics of “good” supervisees, supervisors, and training sites that serve as templates for providing effective, research-based supervision. The chapter discusses other factors associated with setting the stage for the best practice of supervision, including: exploring the learning process, creating positive expectations, getting the most from supervision, and creating a framework for reflective and intentional supervision. One of the goals of clinical supervision is for supervisees to learn to think psychologically and to begin to develop awareness of what to pay attention to and work with from among the thousands of data points of information contained in each therapy session. The “Pygmalion effect” refers to the finding that leader expectations for subordinate performance can subconsciously affect leader behavior and consequently impact the performance of subordinates.

Most Behavioral Group Therapy (BGT) with children and adolescents include aspects of problem solving or social skills training or both. This chapter describes group workers can make an important contribution to children, families, and schools through preventive and remedial approaches. Social skills training grew out of the clinical observation and research that found a relationship between poor peer relationships and later psychological difficulties. The social skills program taught the following four skills: participation, cooperation, communication, and validation/support. The chapter focuses on the unique application of behavioral treatment using groups with an emphasis on assessment, principles of effective treatment, and guidelines for the practitioner. It also focuses on the use of the group in describing these aspects of BGT. The primary goal of using BGT with children is enhancing the socialization process of children, teaching social skills and problem solving, and promoting social competence.

This chapter describes maneuvers to access the internal system of the patient as well as means to accelerate or decelerate the work in that process of accessing the self-system. Eye movement desensitization and reprocessing (EMDR), ego state therapy, and somatic therapy fit together like hand and glove. An extended preparation phase is often necessary before trauma processing in complex traumatic stress presentations and attachment-related syndromes, particularly when dealing with the sequelae of chronic early trauma. Clinical practice suggests that the adjunctive use of body therapy and ego state interventions can be useful, during stabilization and later on in increasing the treatment response to EMDR. Traditional treatment of complex posttraumatic stress disorder (PTSD) and dissociative disorders has usually included hypnoanalytic interventions, during which abreaction is considered an important part of treatment.

In the therapeutic community (TC) perspective, the substance abuse disorder is not distinct from the substance abuser. A picture of dysfunction and disturbance of individuals entering treatment reflects a more fundamental disorder of the whole person. This chapter presents the TC view of the disorder in the context of current biomedical, social, and psychological understanding of chemical dependency. Overall, the picture that individuals present when entering the TC is one of health risk and social crises. In the TC perspective, drug abuse is a disorder of the whole person, affecting some or all areas of functioning. In the TC view, social and psychological factors are recognized as the primary sources of the addiction disorder. Substance abusers themselves cite a variety of reasons and circumstances as causes of their drug use. TC policy on the use of pharmacotherapy is currently undergoing modifications.

This chapter integrates elements and strategies of internal family systems (IFS) psychotherapy into eye movement desensitization and reprocessing (EMDR) therapy with complexly traumatized children. It shows a description of healing a part using in-sight with a child. In-sight involves having the client look inside to find and work with parts that he or she sees or senses and describes to the therapist. The IFS therapist starts by ensuring the client’s external environment is safe and supportive of the therapy. In a self-led system, polarizations are absent or greatly diminished, leaving more harmony and balance. However, when and how the self is formed may be seen and conceptualized through different lenses in adaptive information processing (AIP)-EMDR and IFS. According to the AIP model, the human brain and biological systems are shaped by the environmental experiences they encounter.

This chapter provides insight into the dilemmas couples face when ideals of equality intersect with societal structures that maintain gendered power. It examines how Iranian couples construct gender and negotiate power within their culture, political structure, and Islamic values. Gender equality may express itself differently in a culture such as Iran that not only emphasizes collective goals and achievements, strong feelings of interdependence, and social harmony. Collectivism typically maintains social order through a gender hierarchy. Contemporary Iranian couples draw from diverse cultural legacies. Although some couples seemed to accept the traditional gender hierarchy and a few others appeared to manage relatively equally within it, other couples were quite aware of gendered-power issues and attempted to address them in their personal lives. Some couples describe trying to maintain an equal relationship in their personal lives despite men’s greater legal authority.

Beginning with Module 5 of the mindfulness-acceptance-commitment (MAC) protocol, this chapter seeks to enhance the client’s commitment to attaining performance-related values through the activation of specific values-directed behaviors. In this portion of MAC, the intent is to help clients distinguish between goals and values and explicate specific behaviors that will optimize what really matters to them in their individual performance domain. The chapter reviews the role that emotion plays as a barrier against necessary performance behaviors and, conversely, the concept of poise as a necessary ingredient in optimal performance. It identifies specific behaviors that, if engaged in regularly and consistently, are likely to result in enhanced performance. In Module 5, the consultant continues to help the client move ever closer to mindful engagement in competition by focusing more heavily on mindfulness practice.

This chapter examines how 12 White, middle-class couples negotiated the issue of equality in their relationships during their first year of marriage. The social context both supports and inhibits the development of marital equality. To be included in the present study, complete transcripts with both the husband and wife present had to be available, both members of the couple had to express ideals of gender equality, and both had to express commitment to careers for wives as well as husbands. Most of the couples classified as creating a myth of equality, spoke as though their relationships were equal but described unequal relationship conditions. The other couples classified in the myth-of-equality category described similar contradictions between their ideals of gender equality and their behavior. Gender-equality issues raise political and ethical concerns for all of us who are family practitioners and teachers.

This chapter differentiates intelligence and related constructs such as creativity and intellectual giftedness, which helps people to better understand each construct. Sternberg proposed a way to classify the various approaches to studying the intelligence-creativity relationship. Guilford’s Structure of the Intellect (SOI) model is probably the most explicit, with divergent thinking specifically identified as one of his five cognitive operations. The relationship between intelligence and giftedness has also received substantial attention. Every gifted education program has a formal assessment procedure to identify potential participants, and creativity assessments are often included in the battery of measures in these identification systems. The Marland Definition suggests that giftedness and talent are manifest in six areas: general intellectual ability, specific academic aptitude, creative or productive thinking, leadership ability, visual and performing arts, and psychomotor ability. It has been extremely influential and is still used by many school districts in their identification of talented students.

This chapter focuses on the assessment phase and importance of negative cognitions (NCs) drawing heavily on illustrative case vignettes. Janoff-Bulman introduced the notion of an “Assumptive World Theory” to describe how individuals make assumptions about themselves and the world they live in. According to McCann and Pearlman’s Constructionist Self-Development Theory (CSDT), people give meaning to traumatic events depending on how, as individuals, they interpret them. Person-centered counseling refers to “self-concept” describing the individual’s self-image largely based on life experience and attitudes expressed by significant others, such as family, teachers, and friends. Therapists should familiarize the client at an early stage with the mechanics of DAS and allow them some control in choosing the technique to be used. In choosing the target memory, the therapist and client need to determine the touchstone event, that is, the earliest memory linked to the current pathology.

The inclusion of parents and family caregivers throughout the phases of eye movement desensitization and reprocessing (EMDR) therapy is essential for best treatment outcome with highly traumatized and internally disorganized children. Parental responses that create dysregulation in the child’s system also appear to be related to the parent’s capacity to reflect, represent and give meaning to the child’s internal world. This chapter shows a case that exemplifies how the caregiver’s activation of maladaptive neural systems perpetuates the child’s exposure to multiple and incongruent models of the self and other. Helping parents arrive at a deeper level of understanding of their parental role using the adaptive information processing (AIP) model, attachment theory, regulation theory and interpersonal neurobiology principals will create a solid foundation. The thermostat analogy is designed to assist parents in understanding their role as external psychobiological regulators of the child’s system.

This chapter presents an overview of the issues and challenges that confront the consultant when utilizing the mindfulness-acceptance-commitment (MAC) in a group or team setting, and how these issues were reflected with the lacrosse team. The stated goal of the MAC program was to promote enhanced performance through the development of greater poise and concentration. One of the challenges to engaging in an experientially intensive program like the MAC is ensuring that all participants are both completing and receiving maximum benefit from their between-session forms and exercises. Given the central place of mindfulness exercises in the MAC program, it is particularly important that sufficient time is allotted for in-session mindfulness practice. Prior to beginning the group program, the consultant can recommend to clients with performance dysfunction (Pdy) that they not join the group, but instead engage only in individual sessions.

This chapter shows an overview of the techniques that are used to measure language processing. It shows at the things psycholinguists do when designing experiments in order to ensure that their results are valid. Online measures include any measure considered to give information about language processing as it happens. The prototypical off-line measure is the questionnaire—literally asking people for their judgments about what they’ve just encountered. In fact, all kinds of data can be collected from questionnaire studies. The button press task is perhaps the most versatile of all the things that people can do to collect data involving response times. The conscious responses discussed about here are vocal response. Like eye-tracking, event-related brain potentials (ERPs) help to understand the technique if people know a bit about the response measured—in this case, the brain. In many ways, functional magnetic resonance imaging (FMRI) can be considered the complement to ERPs.

So here the authors are, caught between two worldviews. In one camp, they have educators and academics, attempting to overthrow the “old guard”—those of them who define giftedness through the narrow lens of IQ tests. They are hoping to establish a raison d’etre for gifted education—a field with a wobbly foundation. In the other camp, the authors have parents and the psychologists who specialize in working with the gifted, railing against the externalizing of giftedness. They want the inner world of the gifted to be recognized and appreciated. Controversy has dogged the study of giftedness since its inception, and is likely to continue into the foreseeable future. Multiple views will somehow have to learn to coexist. The psychology of giftedness is a fledgling. An impressive number of people think they know more about the gifted than one does and they are delighted to share their opinions.

This chapter provides a brief historical overview to explain how neuroscience has evolved to what we know it as today. It focuses on the modern history of some of the most relevant aspects of neuroscience. The chapter examines specific, important clinical cases, significant neuroscience milestones, and important treatment modalities that have been implemented and that have led us to this point in our history. Modern neuroscientists have strongly influenced the collective understanding of brain-based functioning and have guided the field to where it stands today. The chapter discusses important ethical considerations in the neurosciences, as well as special areas of focus that generate an increased level of consideration, from the public and often from the media. There are thousands of individual cases that have contributed to neuroscientific understanding throughout history. Examination of behavior and follow-up analysis of brain tissue have helped neuroscientists understand brain-based functioning.

The brain plays a role in influencing the immune system, controlling our sleep, and developing our personality. This chapter provides a straightforward overview of our current knowledge and understanding of normal brain functioning. The nervous system is divided into the central nervous system and peripheral nervous system. The peripheral nervous system communicates with the central nervous system to allow for interaction with the environment. The somatic nervous system is responsible for responding to environmental stimuli by connecting the voluntary skeletal muscles with cells that are responsive to sensations, such as touch, vision, and hearing. It comprises afferent nerve cells that connect the eyes, ears, skin, and skeletal muscles to the central nervous system, allowing sensory information to be transmitted to the brain. Healthy brain functioning requires a multitude of stable neurochemicals, structural anatomy, communication among different brain regions in different hemispheres, and an overall healthy nervous system.

At the core of the change process in the therapeutic community (TC) is the relationship between the individual and the community. Internalization is a familiar psychodynamic concept connoting learning that involves “taking in” the behavior and teachings of others. In the TC, internalization is evident when new learning becomes a “natural” part of the individual’s repertoire. In the TC internalization is inferred from patterns of behavioral, experiential, and perceptual change occurring over time. These may be described in terms of several broad characteristics: cognitive dissonance and behavioral conflict, generalization, learning to learn, and confirmatory experiences. The course of internalization can be characterized as a gradient that depicts changing levels or stages of internalization. Four stages refer to changes during treatment, compliance, conformity, commitment to program, and commitment to self. A change in identity is the distinctive marker of the integration stage.

This chapter presents a case study on performance development with the case of a man who reported that he had been “ultra successful” in every facet of his business life and was happily married and living with his wife of three years in a large suburban home. He described himself as “feeling stuck”, which he described as the belief that he had gone as far as he could go without improving in fundamental areas in his life. The consequences of the avoidant behaviors led him to feel quite overwhelmed. Preintervention psychological functioning was assessed with a standard semi-structured interview and three self-report measures selected based on specific processes that appeared most likely to be relevant to the performer’s referral issue. The measures utilized included the Young Schema Questionnaire-Short Form, the Acceptance and Action Questionnaire-Revised, and the Profile of Mood States.

Psycholinguist is someone who studies phenomena in the intersection of linguistics and psychology. The whole endeavor of psycholinguistics often finds a home in the broader research field of cognitive science—an interdisciplinary field that addresses the difficult question of how animals, people, and even computers think. The centrality of language in the daily lives means that any disruption to the ability to use it may be keenly felt—the worse the disruption, the more devastating the impact. From the beginning of psychology, there has been an interest in language. In psychology, behaviorism was a movement in which the study of mental states was more or less rejected, and the idea that one could account for human behavior in terms of mental states or representation was discounted. This book covers a number of topics that are very much relevant in current psycholinguistics, including child language acquisition, sign language, language perception, and grammatical structure.

To truly understand how important and central memory is to us, it is important to understand what life is like for people who experience memory loss, or amnesia. This chapter examines the amnestic syndrome, which has been widely studied and the knowledge of which has significantly influenced theories of memory. The abilities and nonabilities of those with amnestic syndrome demonstrate that there are multiple independent systems of memory. The chapter also examines two controversial diagnoses, the main feature of which is memory loss dissociative identity disorder (DID) and psychogenic or dissociative amnesia. It discusses a form of memory loss that does not fit the technical definition of amnesia because it eventually affects not just memory but all cognition: Alzheimer’s disease (AD). AD is common among older adults and demonstrates how a worsening loss of memory and cognition can lead to a complete disruption of everyday life.

This chapter explains the third toolkit, Healthy Thinking and Positive Imagery, and addresses two significant barriers to effective problem solving: that of negative thinking and feelings of hopelessness. The two activities in this toolkit to help people overcome negative thinking habits include: the “ABC” model of healthy thinking, and reverse advocacy role-plays. The “ABC Model of Healthy Thinking” was introduced as a means by which to better identify one’s negative thinking in order to eventually dispute such inaccuracies with more positive self-statements. A second tool to help individuals overcome their negative thinking involves an in-session role-play procedure and is aimed at helping patients change their maladaptive beliefs and distorted perceptions of external stimuli. Other potential barriers to coping effectively with stressful problems are feelings of hopelessness and poor motivation characteristic of a negative problem orientation.

The clinical social worker typically interfaces with older adult clients and their families in a variety of settings, providing diverse services ranging from assessment to clinical treatment to referral. This chapter discusses the ways in which cognitive behavior therapy (CBT) techniques can be used by social workers across different milieu to assist elderly clients who may be suffering from depression. These settings include the client’s home, an inpatient or outpatient mental health facility, a hospital or medical setting, a long-term care facility, or a hospice setting. The chapter provides an overview of how cognitive behavior techniques can be integrated throughout the range of services social workers may provide to elderly clients. Clinical examples demonstrate the use of CBT in a variety of settings. For many older adult clients, issues related to the need for increasing dependence on family, friends, and paid caretakers may become the central focus of counseling.

This chapter focuses on the often overlooked parts of the ethical equation, that of translating information and knowledge into action. It addresses both the vulnerabilities we are all prone to and also examines the ways to facilitate ethical “resiliency” to help us and our supervisees more effectively address the human tendencies that can land even the most well-intended supervisee or clinician into ethical quicksand. The chapter explores some of the various ways that supervisees and all mental health professionals are likely to be prone to ethical improprieties and suggests ways that “ethical resilience” can be enhanced. Certainly having a good working knowledge of professional ethics codes, state laws, and risk-management principles is a very important resource to have in the ethical resilience tool kit. The chapter highlights a handful of the issues that might arise in clinical supervision.

This chapter presents several strategies, analogies, and metaphors to address dissociation from different angles and perspectives. Clinicians will have a wide range of methods of introducing and explaining dissociation to children. Analogies and stories that help children understand the multiplicity of the self may be presented during the preparation phase of eye movement desensitization and reprocessing (EMDR) therapy. A good way of introducing the concept of dissociation is by using the dissociation kit for kids. Stimulating interoceptive awareness is a fundamental aspect of the work needed during the preparation phase of EMDR therapy with dissociative children. Visceral, proprioceptive, as well as kinesthetic-muscle awareness should be stimulated. The installation of present resolution (IPR) was inspired by an exercise developed by Steele and Raider. In this exercise, the child is asked to draw a picture of the past traumatic event followed by a picture of the child in the present.

In our success-oriented culture, optimal development of giftedness often is construed as fulfilling one’s potential for greatness. In humanistic psychology, optimal development has been conceptualized differently. Self-realization can be understood in terms of Maslow’s self-actualization, Dabrowski’s secondary integration, Jung’s individuation, or other theoretical perspectives of human development. The goals of inner development involve deepening the personality, overcoming conflicts, and actualizing one’s potential for becoming one’s best self. Many parents of the gifted complain that their children are the ones exerting the pressure. Their speed of learning and quest for knowledge often exceed their parents’ comfort level. The purpose of parent guidance is to foster “optimal development” through early intervention and prevention of social and emotional problems. Assessment can act as a prelude to family therapy. Family therapy usually involves a commitment to several successive sessions to deal with family interactions.

This chapter focuses on the modulatory role of the neuropetides in attachment as well as autonomic regulation, discussing sympathetic and parasympathetic arousal, particularly dorsal vagal and ventral vagal regulation as suggested by polyvagal theory. The probable role of the endogenous opioid system in the modulation of oxytocin and vasopressin release is discussed with a view toward the elicitation of both relational and active defensive responses are reviewed. Porges’ Polyvagal Theory delineates two parasympathetic medullary systems, the ventral and dorsal vagal. Brain circuits involved in the maintenance of affiliative behavior are precisely those most richly endowed with opioid receptors. Avoidant attachment is commonly associated with parental figures that have been rejecting or unavailable and refers to a pattern of attachment where the child avoids contact with the parent. The similarity of severe posttraumatic presentations to autism suggests that the research with regard to social affiliation in autism spectrum.

In the therapeutic community (TC), peers are the primary change agents. In their varied social roles and interpersonal relationships, residents are the mediators of the socialization and therapeutic process. This chapter details how peer roles and relationships are utilized by the community to facilitate the goals of socialization and psychological change. The socialization history of serious substance abusers is marked by negative peer influences. Functional roles in the TC are those involving performance demands, prescribed skills and attitudes, and defined relationships with others. Three prominent community member roles are peers as managers, as siblings, and as role models. A defining element of the TC model is the use of peer roles for social learning. The chapter describes how the various community and functional roles in the social organizations are utilized by peers to change themselves and others and how socially conditioned race-ethnic and gender roles and issues are addressed.

During the installation phase, the child can experience a felt positive belief about himself or herself in association with the memory being reprocessed. Children with history of early and chronic trauma have difficulty tolerating positive affect. Enhancing and amplifying their ability to tolerate and experience positive emotions and to hold positive views of the self are pivotal aspects of eye movement desensitization reprocessing (EMDR) therapy. This chapter shows a script that may be used with children during the body scan phase. Assisting children in achieving emotional and psychological equilibrium after each reprocessing session as well as ensuring their overall stability are fundamental goals of the closure phase of EMDR therapy. The reevaluation phase of EMDR therapy ensures that adequate integration and assimilation of maladaptive material has been made. The future template of the EMDR three-pronged protocol is a pivotal aspect of EMDR therapy.

Community-based epidemiological studies find that when grouped together, anxiety disorders are the most common mental health conditions in the United States apart from substance use disorders. Anxiety disorders are also associated with substantial impairments in overall health and well-being, family functioning, social functioning, and vocational outcomes. This chapter includes a brief description of the anxiety disorders followed by a more detailed review of the cognitive behavior interventions indicated for these conditions. Social phobia is the most common anxiety disorder in the United States. Panic attacks are sudden surges of intense anxiety that reach their peak with 10 minutes and involve at least 4 of a list of 13 symptoms. Another somewhat less common anxiety disorder is obsessive compulsive disorder. The chapter discusses the posttraumatic stress disorder (PTSD). Two anxiety management procedures, breathing retraining and deep muscle relaxation, have been subject to some level of empirical investigation for certain anxiety disorder.

In the therapeutic community (TC) perspective, changing the whole person unfolds in the continual interaction between the individual and the community. This chapter provides the multidimensional picture of social and psychological change in terms of behaviors, cognitions, and emotions. Four major dimensions reflect the community’s objective view of individual change. The dimensions of community member and socialization refer to the social development of the individual specifically as a member of the TC community and generally as a prosocial participant in the larger society. The developmental and psychological dimensions refer to the evolution of the individual as a unique person, in terms of personal growth, personality, and psychological function. Each illustrates typical indicators of individual change in terms of objective behaviors, cognitions, and emotions. Changing the “whole person”, however, includes how individuals perceive and experience the program, the treatment, and themselves in the process.

Work is one of the most distinctive components of the therapeutic community (TC) treatment model. Indeed, the telling mark of the TC social environment is the vibrancy of its work activities. Work in the TC is a fundamental activity used to mediate socialization, self-help recovery, and right living. This chapter describes how work mediates essential educational, therapeutic, and community goals. For disadvantaged, antisocial, or nonhabilitated substance abusers, many of whom have few work skills, social identity and self-esteem are first acquired through participation in the work structure of the TC. Work in the TC addresses characteristics of the person and the disorder. These characteristics can be classified into related categories: personal habits, work habits, work relations, self-management, and work value. Job functions are utilized in three main ways: for skills training and education, for therapeutic change, and to enhance the peer community.

The primary purpose of Module 4 of the MAC protocol is the development of an understanding of the costs associated with experiential avoidance. This chapter highlights the contrasting benefits of experiential acceptance in pursuing performance desires within the context of a values-based life. The essential goal of the MAC program is to convey the idea that emotions are not the enemy of effective performance, but rather it is the things that people do to eliminate or otherwise control emotions that are counterproductive to high-level performance states. A consultant and client explore the workability of the client’s past efforts to control negative thoughts, emotions, and bodily sensations. Mindfulness exercises should be used as a means of enhancing the capacity to observe and describe internal processes and external events. The chapter concludes with a discussion on the issue of the consultant’s comfort with and understanding of the basic acceptance model.

As components of the therapeutic community (TC) treatment model, the stages define the program’s plan for moving individuals toward the goals of social and psychological change. This chapter describes the process of change in the TC in terms of participation and levels of involvement. It focuses on participation and community as method through the program stages. The chapter outlines some relations between the social and psychological dimensions of individual change and the community expectations for participation. It also describes the process of multidimensional change through treatment in terms of levels of involvement in the community. Participation and involvement link community as method to the individual in the change process. The terms engagement, immersion, and emergence label the individual’s level of involvement in the community. Perceptions related to self and identity are incremental through the levels of involvement.

Cognitive behavioral therapy (CBT) with children addresses four main aims: to decrease behavior, to increase behavior, to remove anxiety, and to facilitate development. Each of these aims targets one of the four main groups of children referred to treatment. This chapter suggests a route for applying effective interventions in the day-to-day work of social workers who are involved in direct interventions with children and their families. An effective intervention is one that links developmental components with evidence-based practice to help enable clients to live with, accept, cope with, resolve, and overcome their distress and to improve their subjective well-being. CBT offers a promising approach to address such needs for treatment efficacy, on the condition that social workers adapt basic CBT to the specific needs of children and design the intervention holistically to foster change in children. Adolescent therapy covers rehabilitative activities and reduces the disability arising from an established disorder.

This chapter focuses on the desensitization phase during which the therapist processes the dysfunctional material. It explores a range of issues that are frequently raised in this phase, including therapist anxiety and abreactions and explores challenges during the desensitization phase, such as blocked processing and the use of cognitive interweaves. It is not only the client who gets anxious about the desensitization phase. It can be very daunting to the new EMDR practitioner. Performance anxiety can be a block for the therapist as well as for the client. The therapists’ role is distinct in this phase and involves supporting the client verbally with minimum intervention unless the client is stuck. They should help the client to focus on the flow of feelings, thoughts, and body sensations as they unfold. The therapist will observe the nonverbal signs, troughs and peaks of sensations, and will monitor the changes.

The primary goals of the assessment phase are to access the memory network containing traumatogenic material and to access and activate the cognitive, affective, and somatic aspects of the memory. Since the reprocessing phases of eye movement desensitization and reprocessing (EMDR) therapy follow immediately after the assessment phase, the clinician should have prepared potential interweaves in case the child’s processing of the memory gets blocked. Children with complex trauma histories may already have sensitized sympathetic systems that make them prone to being in fight flight mode even in the face of safety. The chronically traumatized children present with sensitized dorsal vagal systems. Current caregiving and attachment behaviors have the potential for activating the attachment system, and with it past dysfunctional attachment experiences. One of the best adjunct approaches that can be used within a comprehensive EMDR treatment is sandtray therapy.

This chapter presents the therapy manual detailing the specific treatment guidelines encompassing problem-solving therapy (PST). It is important during the initial sessions with a new client to develop a positive therapeutic relationship. Upon obtaining a brief version of the client’s story, it becomes important early in treatment to provide an overview of PST that includes a rationale for why it is relevant to, and potentially effective for, this individual. Problem solving can be thought of as a set of skills or tools that people use to handle, cope with, or resolve difficult situations encountered in daily living. Research has demonstrated that social problem solving is comprised of two major components. The first is called problem orientation. The second major component is one’s problem-solving style. The chapter also presents the case of a 27-year-old woman suffering from multiple concerns, including anxiety, depression, fears of “going crazy”, and prior alcohol abuse.

This chapter focuses on the practical ways to use the strength and potential of diversity in supervision, while also addressing the challenges that differences can impose. Diversity is evident in all aspects of people’s interactions and is involved in every therapeutic and supervisory interaction. Although much of the research on diversity focuses on race and ethnicity, authors take a broad perspective of diversity in the chapter, choosing to think of diversity as any meaningful way in which the clinician and client or supervisee perceive themselves to be different from each other and have a different perspective on life and the world. The chapter provides opportunities for reflection, food for thought, and some ideas on working within a diverse population using a strength-based perspective, all the while recognizing the potential and opportunities contained through diversity.

The incorporation of a skill-building phase and eye movement desensitization reprocessing (EMDR) games can greatly enhance and facilitate the utilization of EMDR therapy with children who have a history of complex trauma. Some EMDR games work with cognitive skills, others work with emotional skills, while others work with the body and the language of sensation. The use of positive cognition cards offers a great opportunity to play and use a wide range of card games. This chapter exemplifies how to use negative cognition games. Feeling cubes contain different basic emotions appropriate for children. Clinicians can purchase plain wooden cubes and write different feelings on the cube. A wide range of card games can be used with the feeling cards. The memory wand offers another playful approach to the process of identifying traumatic events with children. The chapter shows a playful way of exploring and identifying parent-child interactions.

In the therapeutic community (TC) perspective, the core of addiction disorder is the “person as a social and psychological being” how individuals behave, think, manage emotions, interact, and communicate with others, and how they perceive and experience themselves and the world. This chapter details the TC view of the person in terms of typical cognitive, behavioral, emotional, social, and interpersonal characteristics. Residents in TCs display a variety of cognitive characteristics associated with their substance abuse and lifestyle problems. Residents in TCs have difficulties experiencing, communicating, and coping with feelings. Their lack of emotional self-management is associated with much of their self-defeating social behavior. The social and interpersonal context of community life in the TC provides a setting for the emergence of all varieties of guilt. Although the TC view of the person pictures a typical profile of characteristics and problems, it does not necessarily depict an addictive personality.

The basic goals of phase one are to develop a working relationship and a therapeutic alliance and to determine if the level of expertise of the eye movement desensitization and reprocessing (EMDR) clinician is adequate for the complexity of the case. Other goals are to develop a comprehensive treatment plan and case formulation. EMDR therapy was developed as a form of treatment to ameliorate and heal trauma. Clinicians working with complex trauma must have substantial understanding of the adaptive information processing (AIP) model and the EMDR methodology. During phase one, the clinician works on creating an atmosphere of trust and safety so a therapeutic alliance can be formed with the child and the caregivers. This chapter shows an example of how medical issues can affect the quality of the parent-child communications. The adult attachment interview (AAI) gives us the view of the presence of the experiences in the parent’s life.

Social work professionals are in key roles for providing effective education, treatment, training, and services for adult survivors. This chapter helps the social workers to equip with an evidence-based treatment framework to effectively enhance their work with this population of adult survivors. A community study of the long-term impact of the sexual, physical, and emotional abuse of children concluded that a history of any form of abuse was associated with increased rates of psychopathology, sexual difficulties, decreased self-esteem, and interpersonal problems. There is well-established and increasing empirical evidence that cognitive and cognitive behavior therapies are effective for the treatment of disorders that are typical among adult survivors of sexual and physical abuse. The chapter presents some basic cognitive behavior therapy (CBT) strategies that social workers can use in whatever roles they play in working with the multidisordered adult survivor. There are three types of schema avoidance: cognitive, emotional and behavioral.

The primary intent of mindfulness-acceptance-commitment (MAC) Module 2 is an expanded introduction to the importance of mindful awareness and mindful attention in promoting behavior change in general and enhanced performance in particular. This chapter suggests that Module 2 and all subsequent modules begin with the ‘Brief Centering Exercise’. During Module 2, the practitioner describes mindfulness as a process and points out that mindfulness exercises are a means to develop specific skills of self-regulated attention, cognitive defusion, and personal awareness. The primary means of promoting self-awareness throughout the MAC program is the during- and between-session use of a variety of mindfulness exercises intended to enhance awareness of internal and external events and enhance the self-regulation of attention. One of the key elements to the successful completion of the MAC protocol is adherence to the between-session exercises.

This chapter focuses on identifying and working with dissociative symptoms and dissociative disorders in a therapeutic context, providing a road map to assist with the pacing and planning of clinical interventions. Rapid eye movement (REM) sleep can be conceptualized as a household strength processor that can accommodate the usual processing requirements of daily life. Posttraumatic stress disorder (PTSD) has been historically defined as requiring a trauma that is outside the range of normal human experience. Hypoarousal and parasympathetic activation that are an intrinsic part of dissociative symptoms are much more difficult to assess. The original painful memories live on in flashbacks and nightmares as well as in reenactments of the unconscious dynamics captured from the family of origin’s enactments of perpetration, victimization, rescuing, and neglect. Excessive sympathetic nervous system activation is easily construed to be an indicator of psychopathology.

Privileges and sanctions constitute an interrelated system of community and clinical management through behavioral training. The management of the community is the responsibility of peers and staff. This chapter details the formal system of community privileges and sanctions prescribed by staff and the informal system of verbal affirmations and correctives implemented primarily by peers. Privileges are used to promote individual socialization and personal growth. It confirms the resident’s overall personal autonomy and ability for self-management. Money is a major problem in the lives of substance abusers. However, money difficulties also reflect social and psychological problems among substance abusers in therapeutic communities (TCs). Sanctions may be grouped into verbal correctives and disciplinary actions. Sanctions promote community awareness and peer self-management and maintain social order through addressing individual and collective infractions. Sexuality is approached differently from the other rule-governed behaviors in the TC.

Community is the primary means of teaching and healing in the therapeutic community (TC). This chapter presents an overview of the four main facility-wide community meetings, namely, morning meeting, seminar, and house meeting, and general meeting, as organized components of the daily regimen. The common purpose of the main meetings in the TC is to enhance the perception of community among the participants. These differences reflect community and clinical management as well as psychological considerations. Each meeting focuses on a specific component of community business and clinical transactions involving a large number of residents. This provides oversight of the physical security of the house and facilitates assessment of overall clinical status of the residents. Changes in individual or collective mood, attitude, and behavior can be quickly detected within a single day’s observation. Overall the various meetings are essential for efficient community as well as clinical management of the facility.

This chapter reviews the disturbances in self-referential processing and social cognition in posttraumatic stress disorder (PTSD) related to early-life trauma. It talks about the neural underpinnings of self-referential processing and examines how they may relate the integrity of the default mode network (DMN). The chapter describes the deficits in social cognition, with a particular focus on theory of mind in PTSD and the neural circuitry underlying direct versus avert eye contact. It then addresses the implications for assessment and treatment. Johnson demonstrated that self-referential processing is associated with the activation of cortical midline structures and therefore overlaps with key areas of the DMN in healthy individuals. Healthy individuals exhibited faster responses to the self-relevance of personal characteristics than to the accuracy of general facts. Less activation of the medial prefrontal cortex (PFC) was observed for the contrast of self-relevance of personal characteristics relative to general facts as compared to controls.

In the therapeutic community (TC), the therapeutic and educational component that focuses specifically on the individual consists of the various forms of group process. The groups that are TC-oriented, such as encounters, probes, and marathons, retain distinctive self-help elements of the TC approach. This chapter provides an overview of general elements and forms of group process in the TC. Conventional psychotherapy and group therapy have not been particularly effective with substance abusers entering TCs for various reasons. Group tools are certain strategies of verbal and nonverbal interchange that are employed by participants to facilitate individual change in group process. There are two main classes of group process strategies: provocative tools and evocative tools. Provocative tools, hostility or anger, engrossment, and ridicule or humor, are most pointedly used to penetrate denial and break down deviant coping strategies such as lying.

A theoretical framework of the therapeutic community (TC) grounded in clinical and research experience can maintain the unique identity of the TC and the fidelity of its wider applications. This chapter illustrates several broad initiatives: generic TC model, general guidelines for adapting and modifying the TC for special settings, special populations, and funding limits; the codification of principles and practices of the TC into explicit standards to maintain the integrity of the program model and method, training and technical assistance, and research agenda. Staffing compositions have changed to reflect a mix of traditional professionals; correctional, mental health, medical, educational, family, and child care specialists; social workers; and case managers to serve along with the experientially trained TC professionals. The evolution of the contemporary TC for addictions over the past 30 years may be characterized as a movement from the marginal to the mainstream of substance abuse treatment and human services.

Encounter group is a profoundly significant component of the therapeutic community (TC) approach, illustrating by example some of the TC’s basic teachings: compassion and responsible concern, the necessity for confronting reality, absolute honesty, and self-awareness as the essential first step in personal change. The encounter group is pre-eminently a verbal forum employing everyday personal and social vernacular. All encounter groups in the TC are similar in their preparation, structure, and process. An encounter unfolds as a process characterized in terms of four phases: the confrontation, the conversation, the closure, and the socializing phase. Ideally, each encounter accomplishes its general purpose of strengthening group cohesion and its goals for specific individuals. Depending upon its purpose or group composition, the encounter can be modified in intensity and format and the extent of staff involvement as facilitators.