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.

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.

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.

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.

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.

As with all structured psychological interventions, particularly those developed out of the cognitive-behavioral tradition, the first session of the mindfulness-acceptance-commitment (MAC) intervention is psychoeducational in nature. This chapter outlines the components of Module 1. It discusses the common obstacles faced during this critical module and addresses considerations for working with clients experiencing performance dysfunction. Performance is improved by learning to practice and train more efficiently and consistently and from the enhancement of psychological skills such as task-focused attention and poise. It is important to stress that a fundamental goal of MAC is to remove the effects of excessive cognitive activity from performance. Some clients may have been overtly or subtly coerced by family, coach, management, staff, or teammates/coworkers to seek out sport or performance psychology as a means of enhancing their performance. There are many possible psychological barriers to performance that do not reach clinical levels.

This chapter presents a combined creative-corrective approach to working with the bereaved by emphasizing on cognitive assessment as a tool for social workers. It determines how best to facilitate an adaptive grief process with individuals who experience traumatic loss or complicated grief. Cognitive therapies (CT) and cognitive behavior therapies (CBTs) were found suitable with individuals suffering from posttraumatic stress disorder (PTSD), anxiety, and chronic or traumatic grief. Grief as a process of reorganizing one’s life and searching for a meaning following a loss through death is a painful experience. The Adversity Beliefs Consequences (ABC) model is based on a cognitive theoretical model to be applied in treatment of bereaved individuals. Like other cognitive models, rational emotive behavior therapy (REBT) emphasizes the centrality of cognitive processes in understanding emotional disturbance, distinguishing between two sets of cognitions that people construct, rational and irrational ones and their related emotional and behavioral consequences that differ qualitatively.

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.

By the final mindfulness-acceptance-commitment (MAC) module, clients should be regularly engaged in exercises to promote MAC skills that are central to optimal human performance. These skills include: mindfulness, acceptance and commitment. The overarching purpose of Module 7 is to prepare the client for the completion of the MAC program by stressing the lifelong nature of these skills and exercises. When reviewing the entire MAC program, this chapter suggests that the consultant begin with a review of the initial stated purpose for the client’s participation in the program, including a discussion of the performance-related issues and goals that existed at the time the MAC program was initiated. The chapter presents the relationship between the formal consultant-guided MAC program and the less formal, self-guided MAC program. Prior to the completion of the MAC protocol, the chapter also suggests that the consultant discuss the unbreakable link between self-reflection and self-correction.

The primary goal of Module 6 is to help the client attain and maintain greater behavioral flexibility. Mindfulness-acceptance-commitment (MAC) module 6 begins with the Brief Centering Exercise (BCE) to reinforce the commitment to and focus on regular mindfulness practice as a core MAC skill. Following the BCE, the consultant introduces the client to the task-focused attention exercise. Enhancing poise is the core goal of Module 6 and requires the client to effectively use his or her developing skills relating to mindfulness, acceptance, and commitment. In Module 6, the consultant continues to help the client move closer to mindful engagement in competition by ensuring that mindfulness practice becomes increasingly utilized in performance-related situations. The most common problems associated with Module 6 center on the client’s willingness or unwillingness to change behavior. Most clients who seek psychological intervention would like to have the outcomes they desire.

Clients need to be aware that the process of eye movement desensitization and reprocessing (EMDR) treatment can be disturbing and that dissociated material may surface during therapy. Because EMDR has the potential for rapid uncovering of this unsuspected material, some of which may be extremely distressing an assessment needs to be made of the client’s ability to handle strong emotions. For some clients there may be ambivalence about recovery from their dysfunction or distress. Common secondary gains include the loss or reduction of a compensation claim or disability pension. It is strongly recommended that EMDR is not used with clients who have dissociative disorders (DD) unless therapists are confident and competent in their EMDR practice as well as in working with this client population. The chapter also presents a snapshot of Emma’s assessment that should be gathered to determine suitability for EMDR.

This chapter reviews the basic tenets of evidence-based practice (EBP), and discusses the potential applications of this model of practice and training for the field of clinical social work. It also presents some actual illustrations of its use. The chapter describes the major forms of clinical outcome studies: Anecdotal Case Reports, Single-System Designs With Weak Internal Validity, Quasi-Experimental Group Outcome Studies, Single, Randomized Controlled Trial, Multisite Randomized Controlled Trials and Metaanalyses that comprise the priority sources of information underpinning EBP. As the human services increasingly develop robust evidence regarding the effectiveness of various psychosocial treatments for various clinical disorders and life problems, it becomes increasingly incumbent upon individual practitioners to become proficient in, and to provide, as first choice treatments, these various forms of evidence-based practice. It is also increasingly evident that cognitive behavior therapy (CBT) and practice represents a strongly supported approach to social work education and practice.

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 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 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.

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 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.

Over the past 25 years there has been a growing recognition of the importance of working with families of persons with severe mental illnesses such as schizophrenia, bipolar disorder, and treatment-refractory depression. Family intervention can be provided by a wide range of professionals, including social workers, psychologists, nurses, psychiatrists, and counselors. This chapter provides an overview of two empirically supported family intervention models for major mental illness: behavioral family therapy (BFT) and multifamily groups (MFGs), both of which employ a combination of education and cognitive behavior techniques such as problem solving training. Some families have excellent communication skills and need only a brief review, as provided in the psychoeductional stage in the handout “Keys to Good Communication”. One of the main goals of BFT is to teach families a systematic method of solving their own problems.

Over the years, cognitive behavior therapy (CBT) has been applied to a variety of client populations in a range of treatment settings and to the range of clinical problems. This chapter provides a general overview of the cognitive behavior history, model, and techniques and their application to clinical social work practice. It begins with a brief history and description, provides a basic conceptual framework for the approach, highlights the empirical base of the model, and then discusses the use of cognitive, behavior, and emotive/affective interventions. Cognitive behavior therapy is based on several principles namely cognitions affect behavior and emotion; certain experiences can evoke cognitions, explanation, and attributions about that situation; cognitions may be made aware, monitored, and altered; desired emotional and behavioral change can be achieved through cognitive change. CBT employs a number of distinct and unique therapeutic strategies in its practice.

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.

Cognitive behavior theory attempts to deconstruct individual differences in vulnerability, adaptation, and development of psychopathology, through systematic assessment of a client’s thoughts and behaviors, and use of empirically validated interventions. This chapter presents an overview of depression, demonstrates empirical support for CBT and clarifies its potential usefulness in social work settings. Albert Ellis’s rational emotive behavior therapy (REBT) was developed in the 1950s. Albert Ellis’s REBT model uses cognitive restructuring to change irrational thoughts. Behavior therapy is founded on the premise that when environmental consequences are linked to particular behaviors, the consequence either increases or decreases the likelihood of a person responding in the same manner when confronted with similar stimuli in the future. Despite extensive research into variables that might contribute to suicidal behaviors, evaluating suicide risk continues to be both clinically difficult and scientifically imperfect for mental health providers.

This chapter offers a brief and focused review of human development, with specific emphasis on cognition and emotion. It is essential that the reader distinguishes between cognitive development, cognitive psychology, and cognitive therapy. Both short-term and long-term memory improve, partly as a result of other cognitive developments such as learning strategies. Adolescents have the cognitive ability to develop hypotheses, or guesses, about how to solve problems. The pattern of cognitive decline varies widely and the differences can be related to environmental factors, lifestyle factors, and heredity. Wisdom is a hypothesized cognitive characteristic of older adults that includes accumulated knowledge and the ability to apply that knowledge to practical problems of living. Cognitive style and format make the mysterious understandable for the individual. Equally, an understanding of an individual’s cognitive style and content help the clinician better understand the client and structure therapeutic experiences that have the greatest likelihood of success.

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.

This chapter discusses the client’s ability to self-regulate and handle high levels of affect. The maintaining factors of the effects of trauma- or anxiety-based disorders include fear, avoidance, and loss of control. Building or reinforcing coping strategies allows the client to regain some sense of control over what is happening, which, in turn, can have a positive impact on the fear and avoidance. Many novice Eye Movement Desensitization Reprocessing (EMDR) therapists report additional performance anxiety when their client is a mental health professional. Hyperarousal after a traumatic experience is normal. It occurs when a person’s brain believes that person is at risk again because it misreads an external signal or trigger. Grounding techniques can be taught very easily to clients and are another tool to help the client prepare for dealing with a possible abreaction while undergoing EMDR therapy.

Social workers have a long history of working with abused children and adolescents. This chapter focuses on the clinical treatment of the abused child or adolescent using a cognitive behavior approach (CBT). It familiarizes the reader with the treatment of children and adolescents who are experiencing impairment as a result of post-traumatic stress associated with their history of abuse. The chapter focuses on the treatment of children who have been victims of physical and/or sexual abuse. Child abuse is a widespread problem that impacts society on a variety of levels having long lasting effects on the child, the family, and the community. The use of CBT in clinical social work with abused children and adolescents offers an opportunity to utilize treatment that has been shown to be effective in reducing posttraumatic stress disorder (PTSD) symptoms.

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.

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 discusses the treatment of comorbid chronic depression and personality disorders. It then discusses recent treatment advances in the cognitive behavior field relevant to this population. Recently, research has been done comparing schema therapy to Otto Kernberg’s latest model. Because of severe emotional distress, patient often experience suicidal and/or parasuicidal behaviors. The chapter explores the benefits of mode work with these particular difficulties while maintaining a therapeutic approach of connection and compassion; this alliance is crucial for the approach to be effective. It focuses on the five most common modes for those with chronic depression and personality disorders namely the abandoned/abused mode, the detached protector mode, the angry mode, the punitive mode and the healthy adult mode. The interventions described in schema mode therapy have cognitive, experiential, and behavioral components. Identification of the mode the patient is in when suicidal is essential when managing a crisis.

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 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.

Traumatic events adversely affect many people during their lifetime, and the primary focus of support services is on helping the individual, group, or community to recover from the experience. This chapter provides an overview of psychological injury including the constructs of compassion fatigue (CF), vicarious trauma (VT), and burnout. The causal factors involved in developing these injuries are examined with an emphasis on the raised risks for eye movement desensitization and reprocessing (EMDR) practitioners. Compassion stress is the natural outcome that can result from knowing about trauma experienced by a client, friend, or family member. Secondary Traumatic Stress Disorder (STSD) is synonymous with CF and described as “the natural consequent behaviors and emotion resulting from knowing about a traumatizing event experienced by a significant other-the stress results from helping or wanting to help a traumatized or suffering person”.

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.

When Charles, a 46-year-old divorced male with an extensive psychiatric history of depression, substance abuse, and disordered eating resulting in a suicide attempt, erratic employment, and two failed marriages, began treatment with a clinical social worker trained in dialectical behavior therapy (DBT), he was an angry, dysphoric individual beginning yet another cycle of destructive behavior. This chapter provides the reader with an overview of the standard DBT model as developed by Linehan. Dialectical behavior therapy, which engages vulnerable individuals early in its treatment cycle by acknowledging suffering and the intensity of the biosocial forces to be overcome and then attending to resulting symptoms, appears to be the model most congruent with and responsive to the cumulative scientific and theoretical research indicating the need for the development of self-regulatory abilities prior to discussions of traumatic material or deeply held schema.

Social workers are committed to the protection and empowerment of weak populations, of those people who are least powerful. Gradually, social work started to rely more on problem-solving methods, client-focused therapy, family theories, and, more recently, cognitive behavior theories, constructivist theories, and positive psychology developments. Clinical social work today operates in a variety of settings in the statutory, voluntary, and private sectors. Clinical social workers have always been interested in helping clients change effectively. The importance of empirical study, valid information, and intervention effectiveness has always been accentuated by the social work field’s central objectives of increasing accountability, maintaining exemplary ethics and norms, and establishing clear definitions and goals. Cognitive behavior theory emphasizes several components. First and foremost, human learning involves cognitive mediational processes. Social workers need to look for effective methods for change, and CBT methods are very promising in this respect.

The emotional pain and concomitant psychological and behavioral consequences of couple relationship distress are rivaled by few other life crises and stresses. Negative reciprocity has been found to exist to a degree in both distressed and nondistressed couples. This chapter provides a view of the evolution of Cognitive Behavior Couple Therapy (CBCT) identifying the predominant influence of Behavioral Marital Therapy (BMT) along with the work of early cognitivists. The chapter also provides social workers with effective methods for the treatment of problems in intimate committed relationships. It presents conceptualization of couple functioning and treatment and clinical procedures that are highly relevant for same gendered couples. The chapter depicts the use of cognitive behavior methods to ameliorate problems in intimate relationships. Communication problems have been identified as the greatest area of limitation among unhappy couples. Cognitive behavioral couple therapy is comprised of approaches that are compatible with evidence-based practice.

This chapter focuses on the strategies that use neocortical resources of imagery to increase affective mentalization as well as, possibly reset them to allow increased adaptive, relational, and intersubjectivity capacity. Brain organization reflects self-organization; and human emotions constitute the fundamental basis the brain uses to organize its functioning where parent-child communication with regard to emotions directly affects the child's ability to organize his- or herself. Alexithymia and affective dysregulation play a significant role in that they constitute profound barriers for the effective treatment of traumatic stress syndromes and dissociative disorders by directly interfering with emotional processing as well as contributing to emotional destabilization. Traumatic stress and early childhood trauma has been associated with alexithymia, affective dysregulation, and deficits with regard to affective mentalization. Mentalization has been described as the ability to read the mental states of others through the brain’s mirror system.

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 addresses crises precipitated by problems in the relationships among the patient's internal states. It focuses on increasing awareness of different parts of the self and ultimately creating a more stable sense of self. The chapter describes interventions into instability or crises related to an internal locus of disturbance. An important early-stage approach to increasing patient stability involves the application of ego state therapy's conceptual framework and tools in an effort to reduce conflict among parts of self. A beneficial strategy in the treatment of shame involves approaching the damaged sense of self using object awareness, rather than ego awareness to evoke a tolerably remote, quasi-objective stance. When the locus of an ongoing or acute disturbance in a patient's life is centered in relationships among his or her states, systematically addressing that internal conflict can greatly increase stability.

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 explores how and why mindfulness has emerged in recent years as an important intervention in cognitive behavior theory (CBT) both as a stand alone treatment and woven into more complex treatments. It introduces the core skills of mindfulness as described by Linehan and discussed how they are useful to clients and to social workers. The chapter provides an example of how mindfulness, combined with good social work and other treatments, succeeded with a depressed veteran with chronic pain and a history of heroin dependence. In cognitive behavior theory and research treatment development will continue. How mindfulness is incorporated into existing treatment will change according to the research and new treatments will emerge. The principles of mindfulness, however, will remain. They are ancient and changeless and will always be of use to those seeking shelter from the suffering of life.

The contents of social work interventions in the future will likely be highly determined by technological and medical advances. Modern society has discovered remarkable ways to extend people’s lives, helping them live longer, live with illnesses that caused death in the past, and cope with traumatic threats to their lives. Modern life has enabled a shift from a human preoccupation with basic survival needs to questions about the quality of life. Recognition of the role of emotions in behavioral change and in human functioning has opened a whole new world to social workers, legitimizing a focus on internal events, affects, and awareness rather than a concern with mainly environmental causes for human disorders. Growing consensus in the profession about the need to address subjective well-being and emotional disorders will necessitate new modes of intervention.

This chapter discusses some of the critical issues surrounding culture and cognitive behavioral methods in order to better inform the advancement of culturally responsive social work practice. It focuses on one such treatment modality, cognitive behavior therapy (CBT). The chapter reviews relevant theoretical frameworks, existent empirical studies on CBT with diverse cultural groups, strengths and limitations of this modality across cultures, and suggestions for culturally responsive CBT practice, in order to better inform social work practice. While cognitive behavior therapy was developed with universal assumptions and without consideration to the diversity of the cultural contexts of consumers, it is grounded in theory that is likely to have “some universal basis across populations”. Several studies have described the use of cognitive behavior methods with gay and lesbian clients, particularly the use of rational emotive therapy, cognitive restructuring, and behavior experiments.

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.

The treatment of the suicidal individual is perhaps the most weighty and difficult of any of the problems confronted by the clinical social worker. Some frequent comorbid pathology with suicidal behavior includes alcoholism, panic attacks, drug abuse, chronic schizophrenia, conduct disorder in children and adolescents, impulse control deficits, schizophrenia, and problem-solving deficits. Suicidal harmful behavior appears in all ages and characterizes clients in a large spectrum of life. There are four types of suicidal behavior namely rational suicider, psychotic suicider, hopeless suicider and impulsive or histrionic suicider. This chapter presents some primarily cognitive techniques for challenging suicidal automatic thoughts. Recent reports suggest that individuals suffering from alcohol or substance abuse are at an increased risk both for attempting, and for successfully completing, a suicidal act. The therapist must develop an armamentarium of cognitive techniques, and the skills to use these effectively in ways that are appropriate for each individual client.

This chapter provides a general overview of substance-related disorders and the diagnostic criteria. It discusses cognitive behavior therapy (CBT) techniques for treating as well as a review of the neurophysiologic basis of addiction and reward pathways. The chapter examines the impact of substance use and misuse on the patient, the family, and social worker in the therapeutic process. The social worker should be familiar with general assessment guidelines for substance misuse spectrum disorders with and without confounding comorbid conditions such as medical and psychiatric problems. The chapter then discusses the biological-psychological-social components that must be in place for a substance disorder to be diagnosed. According to Freeman and Dolan the five-step stages of change (SOC) model widely accepted in substance misuse treatment settings lacks the specificity that is an essential part of the cognitive behavior treatment model, namely precontemplation, contemplation, preparation, action, and maintenance.

The term genius is peculiar. It can be applied to a diversity of phenomena or confined to just one or two. The tremendous range in usage reflects the fact that genius is both a humanistic concept with a long history and a scientific concept with a much shorter history. The word genius goes way, way back to the time of the ancient Romans. Roman mythology included the idea of a guardian spirit or tutelary deity. This spiritual entity was assigned to a particular person or place. Expressed differently, geniuses exert influence over others. They have an impact on both contemporaries and posterity. The exemplars of intelligence have a feature in common: They are called as exceptional creators. The favored definition is that creativity satisfies few separate requirements. First, to be creative is to be original. In main, genius in the leadership domain of achievement appears to fall into several groups.

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.

This chapter describes two of the frequently occurring and important peritraumatic responses, namely, peritraumatic dissociation (PD) and tonic immobility (TI). It focuses on the definition of each phenomenon and their associations with posttraumatic psychopathology as it considers the relevant neurobiology. Dissociative reactions that may occur during trauma exposure include emotional numbing or detachment, reduced awareness, and distortions of reality. The main feature of TI is reversible physical immobility and muscular rigidity, which can last from a few seconds to many hours. Research regarding the basis, function, and mechanisms underlying the TI response has resulted in the acceptance of the fear hypothesis (FH), a multidimensional model of TI. Researchers have also examined the brain structures involved in the expression of TI, and three regions appear to be the most relevant to the induction and inhibition of this phenomenon: the frontal lobes, the limbic system, and the brainstem.

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 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.

Creativity, like genius, was once viewed as a spiritual phenomenon. In ancient times, to be creative was to be divine. Almost every human culture had its creation myth recounting the miraculous accomplishments of some spiritual power. The immortal Muse provided a guiding spirit or source of inspiration for the mortal creator. As Western civilization became more secular in emphasis, and especially during the enlightenment, the concept of creative genius lost its sacred accoutrements. Francis Galton argued that geniuses are those who possess an exceptional amount of natural ability. That is, geniuses would score in the upper tail of the normal distribution in intelligence, enthusiasm, and perseverance. Galton was the first to inquire about the impact of birth order, an unmistakably environmental variable. This chapter discusses the effect of environmental factors and the effect of genetics. Behavioral genetics is the scientific discipline committed to understanding how genes affect behavior in animals.

This chapter discusses four sub disciplines of psychology: cognitive, developmental, differential, and social. It shows that psychologists need a four-pronged attack on the phenomenon known as genius. The cognitive neurosciences have made major advances using a diversity of techniques, from evoked potentials to functional magnetic resonance imaging (fMRI). Moreover, such methods have shed some light on many processes connected with genius, such as problem solving and insight. The age-achievement relationship is the oldest topic in the scientific study of genius, the first study having appeared in 1835. For most domains of achievement, the greatest geniuses are distinguished by the longest careers. The empirical data on the age-achievement connection are well established. Undoubtedly the relationship between age and achievement is partly rooted in basic human physiology and neurology. This connection is most obvious in the case of athletic champions.

This chapter highlights the neurobiology of the whole spectrum of defense responses to threats: near or distant, immediate or potential, physical or social. It focuses on vigilance, fight, flight, freeze, hide, cringe, submit, and avoid behaviors. When survival is threatened by physical injury, death, or social exclusion, the brain has well-established responses, immediate and sequential, to promote safety. These defense responses are based in the emotion-generating regions of the brainstem but are rapidly modified and modulated by the more developed and evolved cortical capacities. The chapter focuses on clinical observations, brain imaging studies in humans, and animal studies of responses to trauma to promote testable conclusions on the likely neurochemical mediators of the key components of posttraumatic stress disorders (PTSD). Chronic characterological changes arising from alterations in self-perception with guilt and shame, self-blame, feelings of ineffectiveness, and loss of trust are part of the long-term damage caused by early trauma.

There is a range of immediate orienting and defense responses available when a threat is perceived, and a separate but overlapping system of vigilance when there is awareness of a potential threat. Vogt, Aston-Jones, and Vogt propose that the reduced anterior cingulate functioning repeatedly demonstrated in posttraumatic stress disorder (PTSD) during emotional tasks facilitates the firing of locus coeruleus (LC) neurons to create a state of hyperarousal. The noncognitive suppression of emotions in young trauma sufferers is based in the areas of the ventral prefrontal cortex (PFC), which has outputs to the defense response and threat evaluation regions of the amygdala, the periaqueductal gray (PAG), and the nucleus accumbens, among others. Deep brain stimulation can be used clinically without activation of a fearful freeze response, so ventral areas of the PAG are also involved in physiological states of relaxation, comfort, and soothing from pain.

This chapter concentrates on the nature of intelligence and the nature of domain expertise. It examines three alternative positions on the nature of cognitive ability: unified intellect, diverse intellect and hierarchical intellect. Historiometric studies suggest that historiometric genius correlates at between.25 and.35 with estimates of psychometric genius. Whether intelligence is unified or multiple, all budding geniuses must go through some sort of apprenticeship period in which they acquire the expertise that will enable them to make original and exemplary contributions to their chosen domain of achievement. To understand the difference between algorithms and heuristics, and to appreciate their relevance to an understanding of the nature of genius, the chapter takes a glance at two kinds of computer programs that engage in problem solving of a rather high order: expert systems and discovery programs. In any case, most expert systems operate according to algorithms rather than heuristics.

Working toward an understanding of the nature of information processing, as purported to occur in eye movement desensitization and reprocessing (EMDR) can ultimately enhance our understanding of traumatic stress syndromes and dissociative disorders. Impaired information processing reflects the inability of the brain to recognize and integrate external stimuli. The hyperpolarization of the thalamus is likely associated with profound effects on brain wave activity. The adaptive information processing (AIP) model is a neurobiological heuristic based on the notion of neural networks and represents a paradigm shift from psychological theory toward neuroscience. Shapiro argues that pathology results when traumatic or stressful events interfere with information processing and the forging of connections between different neural networks. This chapter reviews the literature on sensory stimulation and suggests that sensory stimulation and associated sensory awareness are involved in modulating oscillatory activity in the brain, which has been linked to information processing.

A posttraumatic disruption of personal memory in dissociative amnesia has also been linked to underactivity in the right inferolateral prefrontal cortex (PFC), an area described by the authors as strongly interconnected with the amygdala and participating in the retrieval of negatively valenced autobiographical memories. The role of endocannabinoids in stress-induced analgesia (SIA) was confirmed by studies of brief, continuous electric foot shock applied to rats. Many trauma survivors have somatoform features that, by their subjective nature, are difficult to study in animal models. A severe pain etched in the mind/brain through the emotional memory system embodies a compartmentalization, which allows life to continue otherwise as apparently normal. The medically unexplained symptoms are the result of trauma-induced changes in pain and inflammation mediators at diverse parts of the interoceptive loops instantiated at different developmental stages. The memory system for emotionally charged uncompleted sequences of movements overlaps with procedural memory.

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 case studies of installation, body scan, closure, and reevaluation of eye movement desensitization and reprocessing (EMDR). The installation phase is concerned with integrating the positive cognition (PC) with the targeted memory. The PC should be checked for ecological validity and rated on the validity of cognition (VOC) scale. Closure is important at the end of any therapy, and particularly so after EMDR desensitization. As such, it is important to allow sufficient time for closure, debriefing, safety assessment, and homework. As with any therapy, clients will sometimes find that something occurs that disrupts the therapeutic plan. Modeling, education on social skills, and testing out new behaviors will now be the focus of therapy. This may be an unexpected crisis, such as a relationship breakdown or being diagnosed with cancer, and clients will need support in making adjustments in their present life.

This chapter describes different approaches to fractionating and titrating trauma processing to facilitate efficient information processing. Fractionation in the treatment of dissociative disorders specifically refers to the direction of attention to aspects of traumatic experience to attenuate the intensity of abreaction. In eye movement desensitization and reprocessing (EMDR) parlance, refers to setting up a "target" for trauma processing specifying the image, cognitions, affect/emotions, and sensations associated with the traumatic memory. A strategy in somatic work involves oscillation between the traumatic state and the resourced state. Bottom-up processing is characterized by an absence of higher level direction in sensory processing, whereas top-down processing reflects higher level neocortical processes such as cognitions. TOTEMSPOTS uses channels as described in the approaches noted earlier to fractionate an intense traumatic memory, to make it more manageable. Somatosensory processing is bottom-up, as it is suggested that sensation is foundational to the experience of emotion.

This chapter describes an approach to fractionation and titration of traumatic material, specifically the use of the time domain. The approach is informed by our understanding of neural development and the integration of mental experience using developmental time sequence. The chapter explains the early trauma (ET) approach of complex cases, specifically dissociative disorders. Maladaptive lessons learned at very early ages will effect decisions for a lifetime and form the basis for certain Axis I and Axis II symptom configurations. Temporal integrationism is the term established by Paulsen to describe the approach to resolving very ET and attachment injury, including neglect in the absence of declarative or explicit memories. For eye movement desensitization and reprocessing (EMDR) practitioners, it is challenging to obtain subjective units of disturbance (SUD) levels and usually impossible to derive cognitions or narratives for very ET and neglect.

This chapter presents the definitions, prevalence, prognosis, warning signs, and treatment for anorexia nervosa (AN), bulimia nervosa (BN), eating disorder not otherwise specified or atypical eating disorder (AED), and binge-eating disorder (BED). The distinctive core psychopathology for both anorexia nervosa (AN) and bulimia nervosa (BN) is a person’s constant concern and evaluation of his or her shape and weight. Psychological symptoms of AN include depression, anxiety disorder, irritability, mood swings, impaired concentration, loss of sexual desire, and obsessive thoughts. Some people who suffer with BN complain of stomach flu symptoms or complain that certain foods do not digest well. The distinguishing factor between BN and BED is the absence of compensatory purging in BED. BED shares the core eating disorder psychopathology, including preoccupation with shape and weight, the degree to which self-worth is influenced by weight, low self-esteem, poor social adjustment, and high rates of comorbid psychiatric disorders.

This chapter suggests that multiple animal models are relevant to our understanding of the phenomenology of traumatic dissociation. It includes the literature of learned helplessness (LH), stress-induced analgesia (SIA), as well as tonic immobility (TI). The opioid-mediated stress response is evident in all humans, though the extent and severity of it ultimately determines to what extent structural and pathological dissociation arises. The peritraumatic opioid activation is a probable functional mechanism for the development of phenomena related to pathological dissociation, structural dissociation, and somatoform dissociation. The endogenous opioid system is part of a stress-response mechanism that has its origins in the invertebrate nervous system. Prolonged stress appears to exacerbate the organism’s response to endogenous opioids. Catalepsy is a phenomenon related to immobilization that can be induced by emotional shock. The autonomic nervous system will respond to stress with both sympathetic and parasympathetic activation.

Safe embodiment is a concept that is at the core of successful treatment of traumatic stress syndromes and dissociation. Therapy with eye movement desensitization and reprocessing (EMDR) requires a potential patient or client to have access to an imaginary safe place to support calming if there is a danger of overwhelm. The experiences of belonging, safety, mindful awareness, and compassion for self and others create or restore the body state of security displaced by trauma, abuse, or neglect. Neuroplasticity can also promote some degree of repair to the brain, not only through altered function of specific brain areas but also through neurogenesis. The primary advanced human awareness may be that engendered in the anterior insular cortex (AIC) with the experience of one’s own existence as a sentient being. The evolution of the cortical mantle provides ample scope for the compartmentalization of areas of conscious awareness in the dissociative disorders.

Conditioned emotional responses are generated by the actions of the hippocampus and septum on the amygdala, which induces physiological change through its midbrain projections. An emotional response to a social threat involves the appropriate sensory cortices, frontal cortex, hippocampus and septum, midbrain, and hypothalamus. The affective experience of abandonment can be followed by the separation distress sequence of protest and despair or it can initiate shame. Shame recruits circuits formed for hiding from physical danger for avoidant responses to the failure of social belonging. Attachment typically begins in the mother-infant dyad but broadens to promote and reward inclusion in a larger social group as the individual grows. The social attachments, fears of ostracism, and feelings of distress at loss of inclusion have their neurobiological bases in brain systems designed to ensure healthy attachment, learning of emotion regulation, and development of socialized behaviors, from infancy onwards.

This chapter highlights mesolimbic dopamine (ML-DA) system as central to the experiences of affiliation, attachment urge when under threat, attachment urge during experience of safety, and to the distress of isolation and/or submission. As the midbrain defense centers hold the capacity for stress-induced analgesia (SIA), the tendency to dissociation, which is established with disorganized attachment in very early life, is considered to be secondary to modifications of their sensitivity. Trauma survivors have a default setting that keeps them in threat mode, whether triggered easily by memories of physical danger or separation distress. In a secure attachment relationship, the child can learn the rewards of interaction without threat. The frozen indecision is replaced by a disconnection from the experience of the moment, which relieves the distress. Environmental stress alters the nursing behavior of the mother rat so that she ceases to do so much licking/grooming.

Geniuses have been around for a very long time. Genuine scientific inquiries into the psychology of genius came much later. The investigators engaged in these inquiries adopted two main approaches: psychometrics and historiometrics. Not only was Francis Galton the first psychometrician to study genius, but he himself was a genius. Psychometric research represents the most common way that research psychologists investigate genius. The principal alternative is a technique known as historiometrics. Frederick Woods also conducted historiometric research of his own. In 1906, he had studied the inheritance of intellectual and moral genius in royal families, and in 1913 he examined the influence of political genius on the welfare of the nations ruled. Lewis M. Terman had also explored a method of calculating intelligence quotient (IQ) scores using historiometric methods. Unlike psychometrics and historiometrics, psychobiography constitutes a single-case qualitative approach.

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.

This chapter discusses five topics: cultural stimulation, interactive relationships, collaborative groups, disciplinary zeitgeist, and sociocultural context. It discusses how the individual and social levels of analysis can be integrated into a unified sociopsychological conception of genius. Individuals were creatures of culture rather than slaves to their genes, and peoples were ethnic groups rather than biological races. When delineating the various contemporary relationships that can augment genius, the author included collaborative interactions. Genius is heavily contingent on the availability of predecessor geniuses who can serve as role models and mentors. This cross-generational influence is then amplified or dampened by other factors, such as political fragmentation, civil disturbances, and political anarchy. Contemporaries and compatriots may display equal magnitudes of genius and yet exhibit that genius in contrasting domains of achievement. The level and type of genius is determined by numerous variables that are inherent in the individual human being.

This chapter focuses on the relationship between dissociative parts of the self or personality and discrete psychobiological behavioral or "action" systems that are aroused in response to conflicting demands of defense and avoidance. Psychobiological systems that organize responses to both internal and environmental stimuli can help unravel the complexity of trauma-related dissociation. The chapter presents approaches from sensorimotor psychotherapy (SP) that highlights the use of controlled actions to help overcome traumatic repetitions and fixed defenses. Each daily life action system is characterized not only by specific behaviors but also by emotions typical of that system. The curiosity of the exploration system fuels seeking and orienting movements that enable the investigation of novelty: learning opportunities, challenges at work, the tasks of parenting. In traumatogenic environments where attachment figures are abusive and/or neglectful, full engagement in daily life action systems is disrupted by dysregulated arousal and animal defenses.

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.

This chapter focuses on how to effectively integrate somatic interventions during the different stages of trauma treatment, such as stabilization, trauma processing, and reconnection, and how to integrate their use to maximize the effectiveness of eye movement desensitization and reprocessing (EMDR). Ventral vagal connectedness between and within people is the name of the game to enhance association and integration. The EMDR standard protocol integrates cognitive, emotional, and sensory information. Information processing breaks down, likely due to significant peritraumatic dissociation (PD) that co occurs with the apparent hyperarousal. Social engagement reflects a ventral vagal response that results in increased self-regulation and calming, thereby decreasing the likelihood of a dorsal vagal response. To facilitate both dual focus and body mindfulness, both exteroceptive and interoceptive awareness are required. Olfactory pathways travel directly to the limbic system and amygdala, and from there olfactory information is likely conveyed to lower brain structures.

This chapter focuses on educational purposes for the promotion of research. It helps the practitioners to study the available evidence and use professional discretion in their prescribing decisions, being fully aware of known potential risks as well as benefits. The literature describes the use of opioid antagonists in a number of different disorders, some of them traumatic stress and attachment-related disorders, as well as dissociative disorders. Self-injurious behavior is common in the more severe traumatic stress syndromes. It also happens to be one of the diagnostic criteria of borderline personality disorder (BPD), a diagnosis that has been associated with childhood abuse and attachment conflicts. Pathological gambling is thought to provide rewards through endogenous opioid effects on the mesolimbic dopamine system. Fibromyalgia is a chronic pain disorder that is thought to result from the type of autonomic system dysfunction to which traumatic stress disposes.

This chapter reviews a range of tools and approaches for the stabilization of traumatized patients and the containment of eruptions of traumatic material until they can be effectively addressed in a later phase of treatment. The International Society for the Study of Trauma and Dissociation (ISSTD) Treatment Guidelines describe the consensus model in three phases, to include stabilization, trauma metabolization, and integration phases of treatment. Many patients experience continuous swings from one extreme of arousal to the other or have lives characterized by chronic shutdown, punctuated with occasional explosions of high arousal. Consistent with the theory of optimal arousal level, the patient must have the capacity to tolerate somatic sensation and affective awareness in order to process through any channels of information that comprise traumatic memory. Therapy will often need to help establish resources for traumatized patients through basic psychoeducation, an essential feature of preparation for poststabilization trauma reduction work.

This chapter suggests neurobiological mechanisms to account for dissociative symptoms in general and structural dissociation in particular. Peritraumatic dissociation (PD) is associated with the release of endogenous opioids and other anesthetic neurochemicals that alter communication between lower and higher brain structures. MacLean's triune brain model provides a structure for the understanding of emotional functioning and dissociation. The integration of brain functioning both horizontally and vertically at different levels of the brain is at the core of information processing. The thalamus also plays a role in cortical oscillations, a phenomenon that has been related to cognitive-temporal binding and information processing, thus affecting cortical connectivity. The corpus callosum is the largest connective pathway in the human brain, constituted of nerve fibers that connect the left and right hemispheres, thus facilitating interhemispheric communication. Disruption of thalamocortical communication is a key component of anesthetic-induced unconsciousness.

The work directed toward increasing the child’s ability to tolerate and regulate affect, so that the processing of traumatic material can be achieved, is initiated during the preparation phase. The process of providing the neural stimulation to improve the child’s capacity to bond, regulate, explore, and play should begin during the early phases of eye movement desensitization and reprocessing (EMDR) therapy. The Polyvagal theory presents a hierarchical model of the autonomic system. In complexly traumatized children, the development of this system has been compromised due to the early dysregulated and traumatizing interactions with their environments and caregivers. When describing the various forms of bilateral stimulation (BLS), go over the different options and practice with the child. If the child went through the calm-safe place protocol successfully, motivating the child to actually use it when facing environmental triggers is an important goal.

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.

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.

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.

Students and professionals in the field of psychology are encouraged to understand diverse populations. Life scripts are formed in childhood, and feelings of alienation seeded in their early years can haunt the gifted throughout their lifespan. Gifted individuals need professionals who understand their striving, their search for meaning, their yearning for connection, and their complexity, sensitivity, and intensity. They need professionals alert to the issues of giftedness—who use this template to help their clients develop greater self-awareness. Those who are interested in success equate giftedness with eminence. The Great Divide in the field of gifted education and psychology stems, in part, from polarized perceptions of IQ testing. Gifted behavior occurs when there is an interaction among three basic clusters of human traits: above-average general and/or specific abilities, high levels of task commitment, and high levels of creativity.

Eye movement desensitization and reprocessing (EMDR) therapy was independently designated as a psychotherapy approach, and was validated by twenty randomized controlled clinical trials. Results of meta-analyses show EMDR as an effective and efficacious treatment for posttraumatic stress disorder (PTSD) in adults and children. Childhood complex trauma refers to the exposure of early chronic and multiple traumatic events. The adaptive information processing (AIP) model constitutes the central piece and foundation of EMDR therapy. Affective neuroscience brings up the importance of PLAY as a healing agent. The polyvagal theory emerged out of the work of Stephen Porges on the evolution of the autonomic nervous system (ANS). Interpersonal neurobiology (IPNB) brings a viewpoint that integrates objective realms of scientific findings and subjective realms of human knowing. The structural dissociation theory of the personality is based on Pierre Janet’s view of dissociation as a division among systems that constitute the personality of an individual.

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.

International Society for the Study of Trauma and Dissociation (ISSTD)’s professional training institute offers comprehensive courses on childhood dissociation that are taught internationally and online. This chapter briefly cites some of the theories that have emerged in the dissociative field. One system, the apparently normal personality (ANP) enables an individual to perform necessary functions, such as work. The emotional personality (EP) is action system fixated at the time of the trauma to defend from threats. As with the Adaptive Information Processing Model (AIP) in eye movement desensitization and reprocessing (EMDR), each phase brings reassessment of the client’s ability to move forward to effectively process trauma. There are many overlapping symptoms with Attention Deficit Hyperactive Disorder (ADHD) and dissociation that often mask the dissociation. The rate of diagnosis of pediatric bipolar disorder has increased 40 times in the last ten years.

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.

Comprehensive assessment enables us to recognize, document, and understand atypical development. It involves evaluation of intelligence, achievement, affective development, and various other elements, depending on the presenting issues. Assessment is indispensable for measuring the extent of learning disabilities. Parents of gifted children decide to have their children assessed for a wide variety of reasons. Some parents who sought assessment at the Gifted Development Center (GDC) responded briefly, for example, to confirm our suspicions that she is gifted. Other parents wrote lengthier responses, revealing more about their children and the issues they faced. Comprehensive assessment of giftedness is an essential first step for advocacy. The best evaluators of gifted children utilize some aspects of qualitative assessment. The talent searches illustrate that what appears as “a relative strength” on one test can turn out to be an astronomical strength on a test with a higher ceiling.

This chapter presents an overview of supervision and a brief introduction to several models of clinical supervision. It discusses the essential tasks and functions of supervision and the roles of the supervisor. Supervisee-centered psychodynamic supervision focuses on the content and process of the supervisee’s experience, examining the supervisee’s resistances and anxieties. As with psychodynamic and person-centered supervision, cognitive behavioral supervision infuses the supervision process with many of the techniques and theoretical concepts of the underlying theoretical orientation. Systemic supervision, based upon the theoretical perspective of systemic family systems therapy, is characterized by focusing importance and attention on the similarities between family systems and supervisory systems. The emphasis is on the supervisor using skills and approaches that correspond with the supervisee’s level of development. Developmental models of supervision are based on the assumption that clinicians in training pass through predictable stages of development as they gain increased knowledge and skill.

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.

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 conclusion presents some closing thoughts covered in the preceding chapters of this book. The book reviews the main topics with the goal of reflection in mind. As with clinical work, the ultimate goal of supervision is to help those authors who are entrusted to learn problem solve and function effectively on their own. Reflection and examination seem to be the solutions to many of the traps and stumbling blocks of professional development. It tries to make clear that, positive psychology is not about just focusing on the positive, although having an eye toward the bright spots that serves as a powerful pull toward expanding effective behavior. The book provides a blend of practical application grounded in empirical research. It takes a multidisciplinary approach and complemented the research from mental health disciplines with information and findings from many other associated fields, ranging from nursing to speech pathology.

This chapter clarifies treatment throughout the similarities as well as the differences between eye movement desensitization reprocessing (EMDR) therapy and sensorimotor psychotherapy in child treatment. Dysregulated arousal and overactive animal defenses biased by traumatic experience are at the root of many symptoms and difficulties observed in traumatized children. Traumatic or adverse experiences are encoded in memory networks in the brain. The adaptive information processing (AIP) looks at different components of the memory network: cognitive, emotional and somatic. EMDR therapy and its phases access not only the cognitive aspects of the memory, but the affective and bodily states. In working with children, microphones may add a playful approach to translating the body’s language. Oscillation techniques are also useful in helping children to shift their focus from dysregulated states to a more resourced experience, which supports flexibility in state shifting and increases awareness of different states.

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.

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.

This chapter presents some of the theoretical-and research-based underpinnings of the strengths perspective, provide suggestions for identifying supervisee strengths, and offer tips for helping supervisees to further develop and capitalize on their potential. It explores why-even though the benefits of focusing on strengths and successes might be intuitively apparent-it is often difficult for us to do so without conscious effort. The chapter also explores ways-both formal and informal-to identify supervisee strengths. It focuses on some informal ways to do so and transition to two formal instruments to consider using as part of the supervision process. Knowledge of our strengths and tendencies as supervisors, combined with knowledge of the strengths and personality styles of our supervisees, can help guide the training process to be the most productive. A strength-based approach to supervision is not about ignoring weaknesses; instead, it is about using strengths to address weaknesses.

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 describes two cases of withdrawal from long-term exposure to multiple drugs. The first case involves withdrawing a patient over a lengthy period from multiple medications such as fuoxetine, clonazepam, quetiapine, and lamotrigine. The second case involves withdrawing a hallucinating alcohol abuser from very long- term exposure to multiple antipsychotic drugs, including aripiprazole. The chapter addresses how to work with other therapists and the use of twelve-step programs. In both cases the withdrawal process was continually modified along the way, depending on how the patient and therapist, or a family member, felt about the progress being made. Therapists who are seeing the same patient should not feel competitive with each other. In a person-centered collaborative approach to therapy, it should be up to patients to pick and choose their therapists, including more than one at a time if they wish.

This chapter presents several models for approaching the problems that can occur during supervision and offers practical suggestions to help supervisor’s and clinician’s challenging situations lead to supervisee growth and a stronger supervisee-supervisory relationship. Problems are inevitable, but unlike customer service at a bank, there is not an outside department charged with solving them; however, successfully resolving problems can lead to more growth and development than a smooth journey ever could. The chapter offers different approaches for ‘thinking outside the box’ and moving things forward when problems and challenges occur in supervision. Narrative therapy helps clients to reauthor or “re-story” their lives to be more in line with their values and hopes instead of constrained by their problems. Narrative supervision is grounded in social constructionism, which emphasizes the postmodern tenets of collaboration, nondirectiveness, and multiple perspectives.

When one knows what to look for, giftedness appears in unanticipated places, expressed in unexpected ways: plaintive graffiti, a very clever reason for not having one’s homework, a really good joke, a fascinating question, a turn of phrase, painstaking absorption in an activity, a drawing of the inside of the pumpkin instead of the outside, an abiding passion, the courage to defend the underdog, stillness in the midst of chaos. Highly intelligent children who live in rural areas are often unseen. Learning style can pose a barrier to the recognition of high abilities. A remarkable number of gifted individuals suffer from disabilities, and both their gifts and disabilities may be hidden. Disabilities come in a variety of shapes and sizes: dyslexia, dysgraphia, dyscalculia, central auditory processing disorder, Asperger Syndrome, disorder of written expression, and more. More often than not, the child is graced with a combination of these labels.

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.