In 1920, in America, psychology was dominated by two main currents. The first was a tendency to reduce life to habit, and the second was to establish differences between humans by test. The second tendency, toward testing, had burst suddenly on the scene with the coming of the Binet tests to America in 1905. The idea of contextualized relationships determined by perceptual interpretation challenged the notions that had sprung up around behaviorism that the brain was empty, functioning only as a router between environmental stimulus and motor response. The idea, still vivid in American psychology during the 1920s, that psychology was “the science of mental life” was reinforced and extended by the diffusion of Gestalt psychology through American psychology over the coming decades, as the rest of these reviews of theory and practice will show.
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Gordon Allport, addressing the American Psychological Association (APA) as its president in September 1939, observed that psychology, over the preceding 50 years, had divided into its pure and applied aspects. Troland was a socialist, and proposed that a “technology of behavior” be devised to maximize human happiness. In his comprehensive psychological system, Troland proposed a hedonic theory of motivation: Behavior depends on the quantity of pleasure to which it is related. Taken together, Troland and Miles represent the flowering, during this decade, of two persisting areas of psychological applications: consultation on the design of technologies in which human sensory and perceptual characteristics interact with equipment and devices, and the study of the effects of drugs of various kinds on human performance. Within psychiatry, psychology had long had allies, and during the 1930s some powerful ones became associated with psychology and supported its aims to develop a parallel nonmedical psychotherapy system.
The year 1945 saw the culmination of many developments in psychology since the 1920s, which led to two major coalitions being formed. The first of these was represented in the reorganization of the American Psychological Association (APA). The most important aspect of this reorganization was the consensus that theory, applications, and clinical activities, formerly represented by separate organizations and carrying on their affairs at a distance from each other, were indeed all parts of a unitary entity, psychology. Psychologists advanced their own comprehensive views of behavioral science as a complex system. The perception that psychology was a united front continued to be a successful strategy, which further confirmed its presence within the spectrum of physical and social sciences. Social psychology, which in previous decades was a melange of crowd psychology and anthropological ideas, acquired a perceptual and cognitive focus.
The 1950s, in American society as well as psychology, were characterized by two pairs of opposites: liberty versus repression and conformity versus creativity. Repression of suspected Communists and other left-leaning individuals was in full swing at the beginning of the decade, driven by long-standing partisan enmity as well as fresh anger over the loss of atomic superiority to Soviet Russia. Many of those who had been instrumental in the creation of the bonds between them had died or retired to other interests, and a new generation of psychiatrists emerged to question the qualifications of what they saw as psychiatrists practicing without medical licenses. Cognition and internal states also emerged in the 1950s versions of theories of motivation. Applied cognitive psychology, in its 1950s incarnation, interested Eddie, Helen’s husband, and he occasionally read articles by aviation psychologists working on contract for the Office of Naval Research.
The 1960s were brought to the United States on television. In ensuing decades, psychologists would engage in inconclusive debates about whether violence on TV had social effects. Ultimately, psychologists’ isolation in the academy, their cultural backgrounds, and their focus on integrating individuals by adjustment and assimilation rather than on managing immediate mass social change pushed psychology, as a field, to the periphery of civil rights, at least as they pertained to color. The pages of psychology’s journal of record, the American Psychologist, recorded few traces of the Vietnam conflict, a central feature of American life in the second half of the 1960s. Counseling psychologists concentrated on civilian problems. Hospital clinicians worked to develop ways to implement the new community mental health system. The combined effect of the Community Mental Health Act and the Great Society’s medical programs was a further infusion of energy and resources into rapidly developing clinical psychology.
By any measure, the 1970s and 1980s were marked, for psychology, by a continual upward change in professional self-designations as indicated by membership in the American Psychological Association (APA), a marker of the increase in the number of practicing psychologists now well distributed in all areas of U.S. culture. Psychology entered the 1970s as a well-established, lucrative coalition of professions. While some of its activity over the rest of the decade could be understood as directed toward meeting the challenge of selfless public service, for the most part psychologists were interested in career advancement. The response of officially organized psychology in the 1970s to these political and social events was the same as it had been during the preceding two decades the creation of further interest groups reflected as new divisions in the APA. Clinical psychology continued to contend with medical psychiatry for authority in treating mental illness.
One of the reflections of the rise of postmodernism in the American Psychological Association (APA) was the inclusion, for the first time, of psychoanalysts as official members of its coalition in Division 39 (a reflection of the gradual decoupling of psychoanalysis from medicine). The APA added a division of clinical neuropsychology, another specialty area where the advances in both cognitive and brain studies translated into an acceptable medical support occupation for psychologists. Psychologists increasingly found employment, during the ‘80s, advising clients, for a fee, of the best way to present themselves to juries, recommending with indifferent success changes in legal language in the direction of more accessibility and understandability, and offering expert testimony on clients’ mental states, as psychiatrists had been doing for at least a century. The theoretical models of health psychology that began to emerge about this time share characteristics with both Bandura and Cialdini.
In psychology, it was a prosperous year. It was 6 years since President George H. W. Bush signed a proclamation designating the 1990s as “The Decade of the Brain”, and 4 years before the American Psychological Association (APA) would pronounce the succeeding decade “The Decade of Behavior”. Since 1990, Peace Psychology, Group Psychology and Group Psychotherapy, and Society of Addiction Psychology had also been added. The Human Genome Project was about halfway through the process of mapping the entire human genome. For years, the sentiment in much of psychology, especially among the more senior members of the profession, was that as Howard Kendler put it in a 1999 article psychology could not scientifically prescribe correct moral behavior, and that psychologists should separate their scientific activity and their roles as private citizens, speaking out for social causes only outside of the official structure of the psychological coalition.
This chapter focuses on consideration of two kinds of abuse: abuse that takes place within a church and abuse that takes the place of a church. In the first, the pastor is usually unaware of the abuser, and in the second, the pastor often is the abuser. The spiritual ramifications when trusted religious leaders use people for sexual gratification are enormous. Gartner described how children abused by spiritual leaders can develop a crisis of faith, believing that somehow they have betrayed God. There is also a problem of the heterosexual abuse of children and adults by clergy of all denominations. Psychotherapists can perform preventative and even ameliorative work in churches by meeting with church leadership to help train them in identifying and dealing appropriately with sex abuse in the church. With regard to spirituality and religion, it’s important that the abused person is treated psychologically and also spiritually.
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.
Acceptance and commitment therapy (ACT) is a behavioral intervention designed to increase and improve psychological flexibility. Psychological flexibility, from the ACT perspective, is defined as contacting the present moment fully, as a conscious human being, experiencing what is there to be experienced and working to change behavior such that it is in the service of chosen values. The therapeutic work explored in ACT counters the problem solving approach. Clients are taught to be aware of their thoughts and emotional experiences. An important feature of the therapy is that the therapist approaches these issues with humility and compassion for the client’s experience. Many clients who have experienced military sexual trauma (
MST) have limited their lives in a number of ways in an effort to control or prevent fear or fear-related experiences such as anxiety or difficult memories.
Traumatic brain injury (TBI) causes two injury types: primary and secondary. In infants and young children, nonaccidental TBI is an important etiology of brain injury and is commonly a repetitive insult. TBI is by far the most common cause of acquired brain injury (ABI) in children and is the most common cause of death in cases of childhood injury. In 2009, the Pediatric Emergency Care Applied Research Network (PECARN) issued validated prediction rules to identify children at very low risk of clinically important TBI, which is defined as TBI requiring neurosurgical intervention or leading to death. The range of outcomes in pediatric TBI is very broad, from full recovery to severe physical and/or intellectual disabilities. Children and adolescents who have suffered a TBI are at increased risk of social dysfunction. Studies show that these patients can have poor self-esteem, loneliness, maladjustment, reduced emotional control, and aggressive or antisocial behavior.
Acquired brain injury (ABI), at any age, is a significant public health concern. It is particularly problematic in the elderly considering the increased rates of mortality and morbidity following ABI in this population. The aging brain demonstrates changes in the synthesis of key neurotransmitter, including dopamine and serotonin, and other chemicals important to brain health, such as brain-derived neurotrophic factors (BDNF). Formal diagnosis of various ABI causes may be relatively simple when given proper history and diagnostic tools. Prognosis following ABI is largely dependent on the etiology and the severity of injury and lesion location in the brain. Microvascular changes in the aging brain lead to attenuated cerebral blood flow, reduced vascularization of brain parenchyma, and increased cerebrovascular risk. Prevention of TBI for older adults should include behavioral and environmental adjustments to reduce fall risk.
This chapter explains paradigms of neurorehabilitation and explores the interdisciplinary and transdisciplinary nature of brain injury rehabilitation. Optimal rehabilitation of acquired brain injury (ABI) requires a multidisciplinary approach of trained rehabilitation specialists at appropriate timing and with appropriate intensity. Brain injury rehabilitation requires a comprehensive treatment program to reduce impairments and to restore function, participation and quality of life. Vocational rehabilitation specialist assesses an individual’s functional level and vocational potentials. Guiding principles for rehabilitation include all areas of therapy, namely, physical, occupational, cognitive, and speech-language therapy. Early functional rehabilitation in poststroke and traumatic brain injury (TBI) patients has been shown to improve functional outcomes and may decrease “learned nonuse.” Neurorehabilitation in the context of ABI continues to be a demanding challenge, which requires clinical translational approaches involving a multidisciplinary team.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) identifies 10 separate classes of substances related to significant substance abuse concerns. Of the 10 separate substance classes, four have more clearly documented patterns of pathophysiological sequelae and demonstrated impact on cognitive functioning. These substance categories include alcohol, inhalants, sedatives/hypnotics/anxiolytics, and stimulants. The remaining six substance clusters include caffeine, cannabis, opioids, hallucinogens, tobacco, and other or unknown substances. This chapter discusses the specific impact of each of these separate classes of drugs and related acquired brain injury on cognitive and emotional functioning. The clinical presentation associated with acquired brain injury related to substance use/misuse is variable. Most importantly, the patient will need to gradually reduce his benzodiazepine use so as not to facilitate “rebound anxiety.” Consideration should be given to anxiolytic medications that are not benzodiazepines, as well as to cognitive behavioral therapy, potentially including interceptive exposure.
This chapter explains the process of solution focused narrative therapy (SFNT) and offers suggestions for the therapist’s use of conversational questioning. SFNT therapy comprises six steps: best hopes, mapping the effects of the problem, constructing the preferred story, exception gathering, preparing the presentation of the preferred future and moving up the scale, and summarizing and inviting clients to watch for success. The most important step is beginning therapy. The therapist begins the session by introducing himself, learning the names of those attending, and asking the same question of all present. The chapter also presents an exercise, which may help to identify traits, values, and actions that help readers present their best self to their clients, particularly clients that are challenging.
Action Research (
AR) is a “form of collective, self-reflective enquiry undertaken by participants in social situations in order to improve the rationality, coherence, adequacy or justice of their own social or educational practices, as well as the understanding of these practices and the situations in which these practices are carried out”. ARis a rich methodology and is a powerful approach for counselors to consider while improving their personal lives, counseling practice, and work with communities. This chapter introduces counselors to historical influences, key concepts, and essential approaches to AR. It discusses various approaches to inquiry in ARincluding first, second and third person approaches, participatory AR, and practitioner AR. First-person inquiry is a uniquely reflective process of inquiry. Through first-person inquiry one can develop their personal lives or professional practice through cycles of reflection, action, and evaluation.
- Go to chapter: Adaptations for EMDR Reprocessing and Desensitization in Attachment-Focused Trauma Therapy for Adults
Adaptations for EMDR Reprocessing and Desensitization in Attachment-Focused Trauma Therapy for Adults
This chapter addresses application of Eye Movement Desensitization and Reprocessing (
EMDR) therapy within the three prongs of past, present, and future for bringing memories of attachment trauma to an adaptive resolution. Therapists are provided methods that help ensure safety and efficiency during desensitization and reprocessing of traumatic memories and triggers. For example, therapists can narrow the focus and restrict the associations to additional traumatic memories as needed to ensure safe reprocessing. Therapists may alter the sequence of past, present, and future prongs if it’s clinically necessary to ease clients into addressing the past. Attachment-Focused Trauma Therapy for Adults ( AFTT-A) therapists apply cognitive interweaves that assist clients with accessing aspects of the healthy internal system developed through AFTT-A to assist clients with bringing painful memories to an adaptive resolution.
- Go to chapter: Adaptations for the Implementation of EMDR Therapy With Infants, Toddlers, and Preschoolers
This chapter explores the unfolding of the phases of EMDR therapy as children go through developmental stages. Infants, toddlers, and preschoolers may express significant variation simply because of developmental processes and achievements. The chapter summarizes adaptations that may be helpful to consider through each phase of child development as the client and therapist simultaneously move through the phases of EMDR therapy. Mentalizing in parent-child relationships is a co-occurring theoretical and clinical intervention that is included through all the phases of EMDR therapy. With infants, toddlers, and preschoolers, the history taking, case conceptualization, and treatment planning are integrated with the goals of the preparation phase. Young children are often brought to therapy by parents who are concerned about clinical, emotional, behavioral, regulatory, and situational issues. Therapists and parents are active participants in the child’s therapy. Alternating bilateral stimulation can be taught in many ways using toys.
This chapter discusses the modifications of using Eye Movement Desensitization and Reprocessing (EMDR) therapy with preteens and adolescents while staying true to the eight phases. The difference between employing EMDR therapy with adults versus preteens and teens lies primarily in history taking, preparation, pacing of the phases, the therapist’s attunement to the client, and the therapeutic relationship. Many of the clinical decisions and procedural considerations for working with preteens and adolescents occur within the first two phases: the History Taking, Case Conceptualization, and Treatment Planning Phase and the Preparation Phase. In order to guide the EMDR therapy process, gathering a thorough history from both the client and caregiver is necessary. Exploring the client’s positive relationships, including favorite teachers, coaches, and beloved family members, can be used as resources and cognitive interweaves (CI) during EMDR therapy. Pacing refers to the timing of when to apply the various phases of EMDR therapy.
This chapter presents a review of adaptive behavior assessment from conceptual, technical, and practical perspectives. Although adaptive behavior is a construct with relevance across multiple disability populations served by rehabilitation professionals, its greatest relevance concerns persons with intellectual disabilities (
ID). This chapter presents adaptive behavior assessment within an IDcontext. It begins by describing the population of persons with IDand how they are defined through federal legislation and professional associations. Specific focus is placed on the growing importance of adaptive behavior in the process of identifying persons with this disability. The chapter then presents a review of standardized and informal approaches to adaptive behavior assessment. To illustrate its professional importance and use of best-practice approaches, the chapter then addresses three practice areas where adaptive behavior assessment plays a key role in contemporary practice with persons with ID, including death penalty evaluations, community-based habilitation, and culturally responsive assessment.
This chapter considers addiction generally without reference to the specific chemical to which an addiction develops. It discusses the neuroscience of addiction. The chapter presents the story on how addictive chemicals change the brain. Research on brain changes with addiction does provide useful information on when recovering persons are more susceptible to relapse. The chapter discusses the understanding based on animal work, and considers the heterogeneity of addictive patterns in people. It explores some of the findings on genetic variations associated with the risk of addiction to drugs of abuse. The chapter then provides specific information on how to screen and initiate treatment. In the United States, opiate agonists like buprenorphine and methadone are legal and considered to be treatment. Mandated treatment is as effective as voluntary treatment, probably because alcoholics often get convinced of the wisdom of change in the course of treatment.
This chapter focuses on conceptualizing addiction in relationship to the experience of trauma. It briefly covers some of the major theoretical orientations used to understand how addiction develops in individuals with diagnosable substance use disorders and co-occurring trauma. The chapter highlights the importance of social neuroscience and identifies stigma-related obstacles to recovery. The chapter concludes with discussions of treatment approaches and strategies as well as the counseling implications of co-occurring substance use and trauma disorders.
The nature and specialty of addictions counseling is unique from general mental health counseling and as a result presents distinct ethical concerns for practitioners. This chapter reviews and discusses the unique ethical considerations in addictions counseling. It clarifies the distinction between addictions counseling as a counseling specialty and the field of substance abuse treatment and evaluation. The chapter provides a discussion of considerations for ethical addictions counseling practice. Prior literature has established common ethical issues experienced by practitioners providing addictions treatment. These include ethical issues related to: professional identity and certification; settings issues; privacy, confidentiality, and privileged communication; informed consent; mandatory clients; multiple roles and relationships; settings issues; counseling adolescents and minors; and issues of diversity multiculturalism. Addictions counselors must utilize self-care and consultation (among other behaviors) in order to resolve potential values conflicts that may arise in the provision of substance abuse counseling.
Counselors serve an important role in the lives of youth. They provide safe spaces for children to express their emotions, fears, thoughts, and worries. Supporting children and adolescents of special populations and marginalized statuses requires that counselors (a) recognize how personal bias may impact the counseling process; (b) utilize culturally competent, theory-based techniques in counseling; (c) understand how socioeconomic status, poverty, race, gender, and sexual orientation impact children and adolescents; and (d) utilize practical, strength-based approaches to counseling. Counselors remain committed to the work of building strength-based, culturally competent, and inclusive practices. The counselor’s efforts to provide culturally responsive strategies and interventions will greatly influence the success of counseling diverse populations of children and adolescents. With this in mind, clinicians must remain critically reflective of their worldviews and biases and commit to the life-long process of cultural competence.
- Go to chapter: Addressing the Needs of Children and Adolescents With Disabilities and Those Classified as Gifted
For professional school counselors and clinical mental health counselors to serve students with disabilities and adequately advocate within the comprehensive school and community contexts, they must first understand the legislation that exists. Congress set these legislations in place to protect the rights of students with disabilities and assure them access, inclusion, and a free and appropriate public education. This chapter helps to identify the disability categories under the Individuals with Disabilities Education Act and the common characteristics of giftedness. It recognizes legislative mandates that apply to education of children and adolescents with disabilities and giftedness in grades Pre-K through 12. The chapter describes postsecondary transition issues for adolescents with disabilities entering postsecondary institutions. It expresses the connection between identity and disability. The chapter explains the role of the professional school counselor and clinical mental health counselors when working with students with disabilities and those classified as gifted.
Trauma work with children and adolescents remains challenging on all levels and becomes increasingly complex when violence permeates various domains of life. Counselors must also consider the reciprocal relationships between trauma and neurological, psychological, social, cultural, and systemic factors that alleviate or exacerbate the experience of trauma. Early identification, assessment, and intervention remain critical components of trauma recovery. The inclusion of trauma-informed interventions such as emotional awareness and regulation, as well as mindfulness skills can help children and adolescents diminish symptoms that overwhelm internal coping mechanisms. This chapter helps readers to distinguish the complexity and range of trauma experienced by children, identify the neurobiological, social, psychological, and academic impact of trauma causing events on children, and recognize various trauma-informed and creative interventions when working with children and adolescent clients, as well as important considerations for school counselors.
This chapter opens with a brief discussion of interventions that students who have sustained concussions may receive outside of school in a rehabilitation setting and at home. Students who have sustained concussions typically require short-term adjustments while they are still symptomatic. The chapter discusses appropriate school-based educational plans in relation to symptom clusters. The chapter addresses extracurricular involvement of students and special grading considerations during recovery. It includes guidance to help school teams determine if a child with persistent postconcussion symptoms requires a 504 plan or further evaluation for an individualized education program (IEP). Students who are eligible for IEPs under the traumatic brain injury (TBI) category may require significant modifications to the curriculum in order to be successful academically. Finally, the chapter concludes with a note on dealing with students who may malinger or continue to report symptoms when they have actually resolved.
The individual psychology of Alfred Adler is based on a holistic and phenomenological understanding of human behavior. Adlerians believe that all behavior has a purpose and occurs in a social context, noting that one’s cognitive orientation and lifestyle is created in the first few years of life and molded within the initial social setting, the family constellation. The Adlerian theory purports that humans are all social beings and therefore all behavior is socially embedded and has social meaning. Adlerian psychotherapy is a psychoeducational, present/future-oriented, and time-limited approach. The Adlerian approach is a contemporary therapy as it is cognitive behavioral, culture-sensitive/ multicultural, and integrative. The four stages of Adlerian therapy are as follows: relationship, assessment, insight and interpretation and reorientation. This is believed to be a good strategy because the Adlerian theory gives counselors an overall framework from which to use a host of other methods that might appeal to them.
The Individual Psychology of Alfred Adler provides a rich theoretical foundation for what has developed into Adlerian psychotherapy. This chapter defines the basic tenets of Adler’s theory of personality and therapy. Adler’s theory is grounded on the idea that childhood experiences are crucial to the psychological development, and that children, who are by nature in an inferior position to parents and other adults, strive to achieve some sense of superiority. Adler ’s work represents a psychological theory that acknowledges the influence of social factors on the personality. In efforts toward understanding the lifestyle, Adler viewed humans’ unique approaches to life through the lenses of the life tasks. These tasks included: the work task, the social task, and the sexual task. Adler believed that encouragement, the act of promoting courage within someone else, was the cornerstone of therapy and could inspire clients toward growth, healthy adaptation, and functioning in life.
Many developmental models view human growth from a space of lack or abundance, a perpetual fulcrum swinging from the word survive at one end to thrive at the other. This chapter discusses Urie Bronfenbrenner’s bioecological theory of human development to conceptualize female adolescent and young adult development. The contextual focus of this theory provides a global framework for counselors to view young women as individuals who both influence, and are influenced by, their surroundings. Customs, beliefs, and the government all play a role in the development of children and adolescents. When young females overcome the stigma associated with mental health services, they typically seek treatment in one of two primary settings: community mental health centers and schools. Relational-cultural theory (RCT) is an evolving feminist model of human development that views connection to others as essential to growth and disconnection as a major cause of disrupted functioning.
To set the stage for what counselors need to know, this chapter introduces the reader to an overview of theories that lay a foundation for working with adult clients. It provides a discussion of theoretical perspectives that relate to both individual development and contextual factors. To capture this intersection of influence, the chapter highlights Erikson’s (1950, 1963) psychosocial stage model, along with contextual and life span perspectives of adult development. It introduces the transition perspective, delving into the transition process itself. Adults face times that are increasingly challenging. A central theme in our current social context is change, reflecting the dynamic impact of forces across demographic, social, cultural, technological, political, and historical domains. A theory is a set of abstract principles that can be used to predict facts and to organize them within a particular body of knowledge.
This chapter provides therapists with tools for teaching children advanced affect management skills. The goal for teaching children resourcing, coping skills, enhancing mastery experiences is to assist the child in creating his/her own toolbox of skills to be used in therapy and in daily life for more advanced coping. Therapists can begin by teaching the child about relaxation and then explore with the child current methods that the child already uses to relax. With guided imagery, the child is asked to choose a comfortable place to sit in the office and select a real or imaginary favorite place where the child feels most comfortable. In addition to breathing, guided imagery, progressive muscle relaxation, children can be taught other ways to help calm themselves. If the child becomes overwhelmed by affect, the child is likely to attribute the discomfort to the eye movement desensitization reprocessing (EMDR) therapy and the therapeutic process.
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.
Advertisements differ from fictional media in that they are purposely intended to change behavior. This chapter shows how influential are advertisements on our behavior, what “tricks” do advertisers use to influence behavior, and how do the influences of advertisements compare to fictional media. Advertising is a subset of marketing. Advertisements are designed to make the public aware of a product, as well as to provide a pitch for why that particular product is superior to its competitors. False advertisements tried to entice consumers with lofty but untrue claims of benefits and to hide weaknesses or financial liabilities with their products. One form of advertising that has been controversial is product placement. One other area that is controversial is advertisement directed at children. Children are thought of as being particularly vulnerable given that they are less adept than adults at reality testing.
This chapter sheds light on how the managed care system works as well as the counselor's role in managed care and the importance of advocacy and issues related to payment and reimbursement. It offers a starting point to understand the system, and counselors must continue to seek more resources, join organizations and build networks with other counselors and change makers to become active members of the professional community. Managed care is an integral part of the healthcare system, and it is imperative for counselors to be able to understand the system in order to navigate it better. Counselors can anticipate the issues that are related to cost and payments and can provide more efficient service to the clients, if they understand how managed care system operates. The chapter demystifies the issues of payment for counseling services, specifically third-party billing, managed care, medical assistance programs, and other issues therein.
Emotional dysregulation is a key component of posttraumatic stress disorder (PTSD). It is important to understand the basic neurophysiology of stress and how it influences a survivor’s ability to cope. The mechanism involved in stress includes the connections among the hypothalamus, the pituitary gland, and the adrenal gland. Glucocorticoids influence metabolism and immune function, and send signals back to the brain about the stressor. Low cortisol levels immediately after a trauma may also be a risk factor for developing PTSD. The sympathetic nervous system (SNS) secretes catecholamines during stress, which help to consolidate memories. When military personnel have a history of childhood abuse and subsequent military sexual trauma (
MST), they may be particularly vulnerable to developing PTSD. Anticipatory anxiety is also one of the greatest barriers in engaging clients in treatment. Mindfulness can be described as any practice that brings clients back to the present moment.
One reason mainstream providers shy away from treating sexual issues is that they want to avoid feeling possible discomfort if a client or couple reports that they engage in kink, or sexual practices outside of what is considered by many people to be “normal”; that is, penis-vagina intercourse between a heterosexual man and heterosexual woman, or what is sometimes referred to as “vanilla” sex. These fears are reflective of a centuries old, deeply held myth that sexual activity conducted without purpose of reproduction is “deviant” or “perverse.” Alternative sexual practices, or what the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition labels as paraphilias, may include
BDSM(letters that can stand for bondage/domination, domination/submission, sadism, sado-masochism, or masochism), sexual acts involving articles of clothing or particular objects, fetishistic cross-dressing, and/or sexual role-play. Education regarding kinky sex and its devotees can help providers become more accepting and empathic when people who practice kink seek treatment.
Ideas and attitudes about gender and orientation have been rapidly transforming, challenging mainstream thinking about what it means to be male or female; gay, straight, bisexual, or asexual; or having a fluid identity, that is, having a gender identity or orientation that changes. Affirming therapy does not simply mean the provider is merely “
LGBTQ+-friendly.”.The affirming provider must understand at a much deeper level the experience of being a member of a sexual minority group who may face social stigma, discrimination, homo-and/or transphobia, and fears related to coming or being out to family friends, and coworkers, and who have increased risk of anxiety, depression, substance abuse, and attempting or succeeding in suicide. This chapter focuses on a selection of the particular issues that providers must attend to in themselves as well as the LGBTQ+client or couple. It describes sexual dysfunction and treatment in the sexual minority population.
This chapter describes what happens after a concussion, from the immediate changes in neurochemistry to the signs and symptoms that may be present in the days, weeks, and months following the event. It discusses the neuropsychological effects, including cognitive, physical, emotional/mood, and sleep symptoms. This chapter also describes dangers signs, which could be indicative of a more serious brain injury. It explains possible long-term effects of concussion, including complications associated with multiple concussions, postconcussion syndrome, second impact syndrome, chronic traumatic encephalopathy (CTE), and suicide. Concussion symptoms provide clues related to what is going on in the child’s or adolescent’s brain. Concussions often go unreported because individuals are unaware that an injury has occurred. Some may also consider the injury not severe enough to warrant medical attention. In some cases, the effects of concussions are so intense, and individuals become so distraught, that they become suicidal.
This chapter guides one forward after the third week of sleep therapy. It presents a chart called Calculating Your Week 3 Sleep Efficiency. By entering the sleep diary answers for Questions 1 to 7 in the top section of the chart one can calculate the sleep efficiency. The chapter also presents Six Steps to Solid Sleep for week 4: go to bed only when sleepy and not before your threshold bedtime; maintain a regular threshold rise time in the morning; use the bed only for sleeping; leave the bed if one can’t fall asleep or go back to sleep within 10–15 minutes, return when sleepy, and repeat this step as often as necessary during the night; if sleepiness is overwhelming, one may take a short nap (set aside no longer than 45 minutes) in the afternoon, between 1:00 and 4:00 p.m; and maintain a sleep diary.
A psychologist must confront many prejudices against older adults that are manifested in most people in non-older adult cohorts. Clinical psychologists specializing in geropsychology work with individual older adults; family members of older adults, including spouses/partners, siblings, and adult children; and caregivers when treating the psychological problems experienced by older adults and dealing with issues of caregiving to older adults experiencing mental illness, dementia, and/or psychological reactions to co-occurring medical illnesses. Unfortunately, despite the fact that older adults are affected by the forces of ageism and stigma, and the fact that community psychologists strive to understand and improve social inequalities and to enable empowerment of marginalized people, there is a significant dearth of research in the field of community psychology. There are four types of ageism: personal, institutional, intentional, and unintentional. The majority of older adults have experienced age discrimination and stigmatization at some time after the age of 65.Source:
- Go to chapter: Alexithymia, Affective Dysregulation, and the Imaginal: Resetting the Subcortical Affective Circuits
Alexithymia, Affective Dysregulation, and the Imaginal: Resetting the Subcortical Affective Circuits
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.
Based on public opinion polls, a substantial number of people worldwide don’t only think about aliens, but think they exist and have visited our planet. The aliens are defeated not by man, but by nature: they are killed by exposure to Earth’s bacteria. The War of the Worlds was massively more popular in helping the image of “aliens” become ensconced in our cultural consciousness. The story of Betty and Barney Hill is both an archetypal story of an otherworldly encounter and the prototypical story of an alien abduction. One of the popular television programs on the History Channel is Ancient Aliens, which purports to use archaeological and historical analyses to demonstrate how human culture and development has been extensively shaped by contact with extraterrestrials. The claims of governmental conspiracies over a crashed unidentified flying objects (UFO) and ancient visitation from aliens have both been thoroughly examined and found wanting.
Allied and clinical mental health case management is a systems-of-care and strength-based model of care that transcends professional affiliations. Systems-of-care and strength-based approaches are framed by addressing the full scope of the health needs of the patient or client across areas of activity and participation and capitalizing on the patient or client's resources for health recovery while maintaining the efficient use of treatment care resources. The successful implementation of a systems-of-care and strength-based model of care by allied and clinical mental health case managers depends on the use of appropriate training, and skills as well as a case referral system that minimizes service discontinuities. This chapter presents a systems-of-care and a strength-based approach to allied health case management likely to result in superior mental health function and well-being for patients or clients, their families or significant others, and care providers.
This chapter focuses on some of the more commonly utilized complementary and alternative medicines (CAMs) that are purported to cure various physical health problems. It explores some of the history and background of the treatments then delves into what the research says about their effectiveness for various problems. The chapter covers chiropractic manipulations of the spine, which are often used not only for neck and back problems, but a myriad of physical ailments. It describes the ancient art of acupuncture, in which needles stuck into our skin in specific locations reportedly help to increase health. The chapter talks about the pills and remedies of homeopathy, and reviews vitamins and herbal supplements. Acupuncture is a Non-evidence-based treatment (non-EBT) for any and all conditions. To maintain patient trust, choice and safety, the Government should not endorse the use of placebo treatments, including homeopathy.
Alzheimer’s disease (AD) presents one of the most urgent health care issues of our time. AD is a disease of the brain and mind, and as such, neuropsychology has an essential and evolving role to play in addressing this growing public health concern. Measurement of key cognitive functions, such as delayed recall of recently presented information, is crucial in the diagnosis and monitoring of the disease. In addition to the importance of advancing scientifically informed disease-specific measurement of cognition, neuropsychology has a growing role to play in the design and implementation of nonpharmacological interventions for AD. The neuropathological hallmarks of AD are senile plaques (SP), neurofibrillary tangles (NFTs), and cell and synapse loss in multiple brain areas. Granulovacuolar degeneration (GVD) has long been recognized to be present in the brains of AD patients.
This chapter helps the reader to understand the history of the Americans with Disabilities Act (ADA), specific components of the ADA and how the ADA provides resources to older adults and people with disabilities. The ADA, while groundbreaking, was not initially intended for people with disabilities rather than for older adults. As time progressed, however, the benefits of the ADA were much more far-reaching than originally intended, especially for aging adults with disabilities. The individual titles of the ADA have had some dramatically positive and specific impact for older adults wishing to remain in their homes or in their communities as long as possible. Although the ADA is still in its young adulthood, the benefits of the ADA have only grown as new and further linkages, such as the ADRCs, have developed in all regions of the United States.
This chapter focuses on anxiety disorders and deals with a discussion of the physiology of anxiety, including the major structures involved in the creation of a fear memory. It considers the mechanisms for extinction of conditioned anxiety. The chapter discusses the basic physiology of fear conditioning, specific anxiety disorders namely generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD), and explains treatments. It then reviews the literature about how clients can talk about their fears to minimize them and how relabeling or reappraising of past events can be helpful. There is evidence suggesting that the basal ganglia, structures associated with the control of movement, are involved in the expression of OCD behaviors in subsets of those with OCD. Cognitive behavioral therapy is effective in the treatment of generalized anxiety. Selective serotonin reuptake inhibitors are also used in the treatment of anxiety disorders.
This chapter provides an overview of the neurophysiology underlying the innate human response of anxiety. Knowledge regarding the brain’s response to normal levels of stress and how it responds in a healthy manner will help clarify the various ways the brain can misfire and produce debilitating symptoms and outcomes. Posttraumatic stress disorder (PTSD) is an unhealthy emotional reaction to the experienced trauma. Inability to control stress can lead to release of neurochemicals and alterations in the hypothalamic-pituitary-adrenal (HPA) axis, which can result in both central nervous system (CNS) and parasympathetic nervous system (pNs) dysregulation. The mental health provider should be familiar with various anxiety disorders, so to diagnose more accurately, because treatment differs depending upon the specific anxiety disorder diagnosis. Generalized anxiety disorder (GAD) is the most frequently diagnosed anxiety disorder in general clinics, but it is one of the least frequently diagnosed anxiety disorders in specialized anxiety clinics.Source:
While the occasional experience of anxiety is a typical part of life, people with anxiety disorders often have intense and persistent worry and fear about everyday situations. This chapter contains three cases of anxiety disorders in two adult males and one adolescent female. Generalized anxiety disorder is highlighted in this chapter as well as the less common, selective mutism diagnosis. While the clients in these cases have symptoms that lead to a
DSM-5(Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition) diagnosis in the same category, these cases highlight how cultural factors and family of origins issues may exacerbate anxiety-related symptoms. Questions for consideration are also included.
Meeting academic demands, getting along with roommates, dealing with new social pressures, questioning career choices, managing finances, and other new responsibilities of the college experience can give rise to unexpected and undesired stress and anxiety. While event-related stress does not cause anxiety disorders on its own, it can worsen symptoms of a preexisting anxiety disorder or trigger an anxiety disorder in someone who may be predisposed. The symptoms of anxiety disorders generally involve disturbances in mood, thinking, and behavior. This chapter assesses the different classifications of anxiety disorders. Types of anxiety disorder includes generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), panic disorder, posttraumatic stress disorder (PTSD), social anxiety disorder, and specific phobias. The chapter evaluates effective treatment and intervention strategies for college student population. Among other psychotherapy approaches, cognitive-behavioral therapy (CBT), relaxation therapy (RT), and mindfulness-based stress reduction (MBSR) have received considerable empirical support in the treatment of anxiety disorders.
- Go to chapter: Applications of Attachment-Focused Trauma Therapy for Adults With a Dissociative Identity Disorder Diagnosis
Applications of Attachment-Focused Trauma Therapy for Adults With a Dissociative Identity Disorder Diagnosis
Clients who have a diagnosis of dissociative identity disorder (
DID) are on the severe end of the dissociative continuum. The internal system of the client with DIDis usually complex and may include more than one Adult part as well as multiple Child/Adolescent parts. At least some parts may operate autonomously with dissociative barriers between themselves and other parts, resulting in lack of co-consciousness and creating significant complications in adult life. Clients who live with severe dissociation experience fragmentation of both time and sense of Self. Attachment-Focused Trauma Therapy for Adults ( AFTT-A) is not designed to be a comprehensive treatment for the DIDclient; however, with adaptations and consideration for the increased complexity of the internal personality system, the protocols of the AFTT-A model can create stabilization through work with the internal personality system and the emotionally corrective therapeutic relationship during the preparation phase of Eye Movement Desensitization and Reprocessing ( EMDR) therapy.
In the current chapter, there are a number of case illustrations that will be used to highlight various topics discussed throughout the preceding chapters of this text. All of these cases provide opportunities to examine group leadership; however, the reader will be asked to consider reflecting on these cases from either a practitioner, a counselor educator, or a clinical supervisor perspective. First, we discuss timely issues facing our society and counseling profession. These topics help to situate the case illustrations that are dispersed throughout this chapter. Next we draw upon guiding documents within the counseling profession to highlight areas that aspiring culturally sustained group leaders should become deeply knowledgeable about. We conclude this chapter with implications for future group counseling research, training, and practice. We are unable to determine exactly what will emerge in the future, but we use the current trends, recommendations from professional organizations (e.g., Association for Specialists in Group Work [
ASGW]) and our own personal and professional experiences, and clinical haunches as guideposts for what might unfold.
A family systems approach to understanding anxiety within a family or couple is complex. The Diagnostic and Statistical Manual of Mental Disorders (5th ed.) provides a framework for identifying and understanding anxiety disorders. This chapter reviews the
DSM-5 Anxiety Disorders through a systemic perspective. Considering that a core concept of family systems theory is that individuals are embedded in larger systems, it is still important to understand the individual and internal factors that may influence anxiety disorders. The majority of research on the etiology and treatment of anxiety disorders focuses on individual variables or individual therapy. The research on family therapy for anxiety disorders is limited. The most well-researched family therapy model for anxious adults and children is family cognitive behavioral therapy. In order to further understand a systemic case conceptualization of a family impacted by anxiety disorders, a case example is provided.Source:
Relationships are important to our happiness but, as it turns out, things are not quite as straightforward as this proposition would seem to imply. The first important observation that we can make of this association is that the perception of social support appears to be more significant to happiness than objective indicators of social support. Objective indicators of social support such as number of friends and frequency of social activity show small and sometimes nonsignificant relationships with happiness. One possibility is that the correlation between satisfaction with one’s relationships and satisfaction with life is simply a product of method invariance. The chapter focuses on how different types of relationships affect happiness. But this approach has a tendency to ignore the common relationship dynamics that might impact happiness across relationships. It also focuses on three dynamics of happy relationships: capitalization, gratitude, and forgiveness.Source:
This chapter describes many of the theories that involve taxonomies. Most taxonomies of love begin in the same place: The language of love is examined, whether through an examination of film, literature, music, or firsthand accounts of people about their love life. The three primary love styles are eros, storge, and ludus. Eros is a passionate kind of love that is characterized by strong emotions and intense physical longing for the loved one. With storge, should the lovers break up, there is a greater chance than with other love styles that they remain friends. Ludus commonly is displayed by people who prefer to remain single and who see love as a game of conquest and numbers. A pragmatic lover hesitates to commit to a relationship until he or she feels confident of finding the right partner. The different love styles also correlate with some other personality traits.Source:
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.
Assessing fidelity or adherence to the phases of Eye Movement Desensitization Reprocessing (
EMDR) therapy is important for a variety of reasons, both for clinical purposes and for research purposes. Treating therapists need to assess fidelity in clinical practice in order to ensure that the therapist is using all eight phases of EMDR therapy without omitting important words, procedural steps, or phases of the treatment. By using a Fidelity Questionnaire, the therapist can monitor his or her own adherence to the phases in order to improve practice and prevent therapist drift. In spite of the positive treatment outcomes reported in the studies of EMDR therapy with adult clients, methodological concerns have contributed to a mixed response to the assessment of the efficacy of EMDR therapy. Therapists who make any changes to the protocol or omit any pieces of the protocol should document their clinical decision making for the modification or deletions.
Clients’ sexual complaints vary greatly, from those that arise from the need for sex education to those that require psychotherapy for 6 months to a year or more. As with all presenting problems, the provider needs to determine what, exactly, are the client's symptoms, when they appeared, and what has been tried to resolve them. The provider also needs a framework to guide inquiry and treatment planning. Most sex providers use a broad theoretical approach because of the need to sort out biological factors from psychological factors, the effect of the client's relationship and social environment on symptoms, and the intersection of culture and religion. This chapter features a sexological ecosystemic approach that is both developmental and biopsychosocial in its scope. It describes in detail the five subsystems—microsystem, mesosystem, exosystem, macrosystem, and chronosystem. The sexual history taking form at the end of this chapter is based on ecosystemic theory.
The Council on the Accreditation of Counseling and Related Education Programs (
CACREP) standards are composed of both common core standards and counseling specialty standards. Assessment and Research are two of the common core areas required in the training of master’s level counselors. Due to the emphasis on assessment, this chapter focuses primarily on assessment via distance counseling ( DC) and telemental health ( TMH), yet also addresses common concerns and guidelines in conducting distance research. The Association of Assessment and Research in Counseling is the professional counseling organization devoted to research and assessment. Neither TMHnor DCis specifically mentioned in the Assessment and Research CACREPstandards, yet both standards require students to be trained in “ethical and culturally relevant strategies” for assessment and research. TMHhas been found to be effective with diverse and hard-to-reach populations, including rural populations, persons with disabilities, veterans, and individuals who don’t readily access counseling.
This chapter focuses on practical assessment issues related to the effective implementation of problem-solving therapy (PST). When comparing an individual’s Social Problem-Solving Inventory-Revised (SPSI-R) scores with the normative data provided in the manual, raw scores are converted to standard scores such that the total SPSI-R score as well as each of the five major scale and four subscale scores have a mean of 100 with a standard deviation of 15. If the referral problem is specific, or if PST is being provided to a group that was constituted around a common diagnosis, other checklists may exist or can be developed that include common problems related to that diagnosis or group theme. Group treatment can be preferable in those situations where multiple clients are able to serve as sources of feedback to each other regarding both problem-solving skill acquisition and implementation.
- Go to chapter: Assessment, Diagnosis, and Treatment Planning in Psychotherapy With Children and Adolescents
This chapter reviews the types of assessment tools that cover all phases of development, including emotional, social, developmental, educational, and psychological. In developmentally grounded psychotherapy, a multimodal approach to assessment is necessary. A multimodal approach covers direct interviews of parents and children, interviews of parents and other caregivers, observations in the office and in the child’s natural environment, and the implementation of standardized measures. Child and adolescent personality assessment tools are more likely than adult tools to look at emotional, social, and behavioral functioning because personality disorders are not diagnosed until at least age 18, when children reach adulthood. Ultimately, assessment tools are used to verify the therapist’s clinical impressions to guide diagnosis and treatment planning. The diagnosis only benefits the clinical process because it guides treatment planning and clinical interventions.
The out of control sexual behavior (OCSB) assessment plan provides an opportunity to deliberately and comprehensively examine the worries and fears surrounding a client’s sexual world. An OCSB assessment offers a unique situation for therapist and client to have a sexual health conversation. Most therapists have experienced their own psychotherapy or completed a range of psychological or personality tests in their personal mental health care or throughout their professional training and career. The Hypersexual Behavior Consequences Scale (HBCS) is the more detailed review of the explicit linkages between sexual behavior and the many potential negative consequences the behavior causes. Clinicians treating sexual dysregulation assume that attention deficit hyperactivity disorder (ADHD) prevalence among men concerned with controlling sexual behavior derives from their predisposition toward the hyperactive and impulsive behavior associated with ADHD. Recent studies confirm a high prevalence of mood disorders and anxiety disorders among patients seeking help for hypersexual behavior.
There are essentially three sectors of private rehabilitation counseling: the public sector, the private nonprofit sector, and the private-for-profit sector. This chapter helps the reader to learn the differences between nonforensic versus forensic private-sector vocational assessment and to learn about forensic life care planning and types of assessment used in the development of such reports. It differentiates the nuances of private vocational rehabilitation, forensic vocational consulting, and forensic life care planning are differentiated. The chapter also describes about the types of vocational assessment measures in non—private-sector versus private-sector vocational rehabilitation. It then discusses the various assessment measures and resources used in private-sector rehabilitation, including transferable skills analysis, labor market analysis, and functional capacity evaluations. The chapter finally describes the various life care planning assessments, including activities of daily living, day-in-the-life videos, comprehensive intake interviews, and multidisciplinary expert consultant assessment.
Psychological trauma is complex and sometimes difficult to understand, and its various manifestations can be challenging for the treating counselor. Psychological assessment and testing can provide the counselor with tools to hone clinical judgment and understanding of clients’ trauma experiences beyond what is available in the counseling interview. After providing an overview of psychological assessment in general, we discuss the types of assessment methods available and provide specific instruments that can be of use in the assessment of psychological trauma. These methods include structured interviews, trauma-specific tests, and broad-based personality assessment tests, including self-report and performance-based methods. The chapter ends with a discussion of best practices in the psychological assessment of trauma along with recommendations for integrating assessment into counseling practice.
Assessment interviewing often takes place during the early stages of helping, which includes obtaining information about the client related to the client’s problem or area of change desired. During this stage of helping, the counselor is involved in “conceptualization or formulation” of the problem within counseling sessions or specifically within the assessment interview. Interviewing to assess entails a focus on all aspects of clinical concern, including physiology, cognition, behavior, duration, severity, relationships, and context. A detailed and thorough assessment interview that clarifies the problem holistically leads not only to accurate assessment but also, in later stages of helping, to amelioration. Assessment interviewing is viewed as the foundation of the therapeutic, counseling, and/or rehabilitation process. This chapter is on the assessment interview. It covers types and formats of assessment interviews. This overview is intended to orient the reader to the importance of depth, detail, and thoroughness within the assessment interview.
This chapter explains the importance of age-appropriate transition assessments and recent amendments to federal legislation that support the use of transition assessments. It then describes various formal and informal academic assessments and appropriate uses of alternative assessments with students with significant disabilities. The chapter describes essential assessment tools used in transition-to-work via supported and customized employment processes, including how to use situational assessments. It also describes the various community assessment domains along with methods for mapping available community resources and assessing skills needed to use identified resources. When used effectively, transition assessments for academics, employment, and community living inform transition planning. The selection of assessment measures should be dependent on the individual’s goals and plans for the future. The ultimate goal should be to identify appropriate assessments that help youth with disabilities better understand their strengths, skills, and needs in order to achieve their own personal life goals.
- Go to chapter: Assessment of Client Readiness and Treatment Planning for EMDR Therapy in Attachment-Focused Trauma Therapy for Adults
Assessment of Client Readiness and Treatment Planning for EMDR Therapy in Attachment-Focused Trauma Therapy for Adults
A detailed and comprehensive initial assessment in Eye Movement Desensitization and Reprocessing (
EMDR) therapy phase 1 is essential to therapists’ ability to establish clients’ readiness for EMDRtherapy. The initial assessment includes evaluating clients in multiple areas in addition to the EMDRreadiness criteria. Such an assessment provides therapists with an overall estimation of clients’ past and current physical and mental health status, level of functioning, social support, family, and experiences of abuse and/or neglect and offers the context in which clients will be participating in EMDRtherapy. Three main barriers to clients starting phases 3 to 8 of EMDRtherapy are lack of social support, emotion over- or under-control, and other issues that may interfere with clients’ ability to regulate affect or emotions such as significant mental illness, drug or alcohol problems, and safety issues. Clients with a history of attachment trauma tend to need an extended period of time in the preparation phase of EMDRtherapy prior to reprocessing traumatic memories. Phase-based trauma treatment utilizing a team approach is an example of an intervention that prepares clients to move into phases 3 to 8.
In conducting psychological assessments to identify psychopathology, it is essential that clinicians continue to engage in activities that help them remain current on the state of the science. The models to conceptualize psychopathology, the diagnostic criteria, and the instruments used to inform clinicians in arriving at diagnoses and treatment plans continue to evolve. The assessment of psychopathology is rooted in knowledge of the empirical evidence of the diagnostic criteria, and a lack of current information of the empirical evidence can lead to faulty application of assessments or incorrect conclusions regarding diagnoses. Interviews, behavioral observations, self-report inventories, psychological testing, historical/medical record review, functional assessment, and clinical judgment are all necessary in the formation of a diagnostic picture that provides an accurate depiction of clients’ current issues and the selection of interventions that are likely to be the most effective.
Substance use disorders (
SUDs) are complex health conditions, which are frequently remitting and relapsing disorders. They can impact many domains of life and require comprehensive knowledge in order to assess in a meaningful way. This chapter conceptualizes people living with SUDsfrom a holistic, ecological, and trauma-informed perspective and discusses the diagnostic criteria for SUD, including assessment for severity of disorder. It first outlines ways to broadly assess clients at risk for SUDor currently struggling with SUDusing an ecological model. Because SUDsare complex and impact many life domains, the chapter includes discussion of health and disability, risk factors, protective factors, and assessments for commonly co-occurring life features, such as trauma, as part of comprehensive SUDassessment practice. This approach aligns with the International Classification of Health, Disability and Functioning model of inclusion of personal and environmental factors known to impact functioning, health, and rehabilitation and recovery efforts.
This chapter describes the third of the eight phases, the Assessment Phase of Eye Movement Desensitization and Reprocessing (
EMDR) therapy that is related to the developmental stages of children from infant to adolescent. It explains the procedural steps with detailed explanations of the techniques and skills necessary for successfully steering a child or teenager. It is essential for the therapist to recognize that eliciting the procedural steps for the phase is impacted by the child/teen’s level of development, and scripts for the procedural steps need to be adjusted into child/teen language. The chapter provides instructions to the therapist with scripts for each of the procedural steps. The assessment phase starts with Target Identification and Organization, which is a continuation of Phase 1 and the therapist continues with image, Negative Cognition (NC) and Positive Cognition (PC), Validity of Cognition ( VoC), emotion, Subjective Units of Disturbance (SUD), and body sensation.
This chapter highlights the out of control sexual behavior (OCSB) assessment treatment elements for enhancing client motivation. Transtheoretical model (TTM) identified and organized principles and processes from every school of psychotherapy into a system that recommends the application based on the individual’s stage of readiness for change. The potential for internalized sociocultural sex negativity or unresolved psychosexual injuries that lead to countertransference is much greater among therapists who have avoided looking closely at their sexual development, sexual attitudes, and sexual health. OCSB treatment offers a self-discrepant model for behavior change. For some partners, OCSB treatment’s lack of a disease model is a significant source of distress. The chapter focuses on synthesizing the assessment information to construct the client’s OCSB Unique Clinical Picture, which is the basis for treatment recommendations.
Assistive technologies or devices are tools for enhancing the independent functioning of people who have physical limitations or disabilities. An assistive technology device (ATD), as initially defined in the Technology-Related Assistance of Individuals With Disabilities Act of 1988, is any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified that is used to increase or improve functional capabilities of individuals with disabilities. ATDs range from low-tech aids such as built-up handles on eating utensils to high-tech, computerized systems to help persons with disabilities live independently and enter the workforce. The goal of rehabilitation and counseling professionals is to match an individual with an ATD that will enhance the person’s capabilities and quality of life. Persons with disabilities want as much emphasis placed on their community participation as on their physical capabilities, creating as much need to change and accommodate the environment as equip the person.
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.
This chapter explores the contributions of attachment theory and the related development of mentalizing as concepts that provide the theoretical cornerstones for clinical interventions with children of substance-abusing parents (COSAPs) of all ages as well as for substance-abusing parents of infants. It describes attachment and mentalization-based treatment programs that have been developed to help people who have difficulty with affect regulation, resulting from insecure attachment with their substance-abusing parents. Attachment patterns developed early in life provide a template through which people approach their interpersonal relationships and regulate their feelings of pleasure and distress. Being unable to regulate feelings is a primary difficulty of people who develop substance-abuse disorders for which COSAPs are at high risk. Mentalization-based treatment holds the promise of providing a way to prevent and ameliorate emotional disturbance in children and adolescents from substance-abusing families and to teach new ways to regulate emotional distress in adult COSAPs.
The neurobiology of posttraumatic stress disorder (PTSD) and the effects of lifetime trauma on an individual have been covered extensively in the literature over the past two decades. This chapter reviews some of the relevant trauma-related neurobiology literature as it applies to military sexual trauma (
MST), both in men and in women. The presentation of premilitary factors is structured around three major areas in the neurobiology of traumatic stress: early life trauma and the emergence of the emotional response; lifetime cumulative effect of trauma and the hypothalamic pituitary axis (HPA); and additional factors contributing to long-term vulnerability or resiliency. The brain and behavioral patterns are molded in parallel with early life experience. When a child develops the ability to recall events, he or she experiences the beginning of autobiographical memory. Primary affective states originate in the reticular activating system (RAS) of the brain.
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.
- Go to chapter: Background and Demographic Profile of People Growing Older and/or People With Disabilities
This chapter highlights some of the current health programs and policies in place and changes in demographic trends for older adults living within American society. In addition, substantial changes within the social, political, and cultural expectations of communities over the past century pose challenges for policies and programs serving older adults. The chapter presents several issues emerge as realities within the context of policy development and program planning for older adults. These issues include changes in living arrangements, education levels, economic well-being, and rural population settings; trends in morbidity and mortality; and changes within the social, political, and cultural expectations of communities. Despite the availability of programs and services resulting from health policies, many programs have focused upon “medically necessary” services and have lacked a health promotion, health education, or community-based focus.
Book bannings and burnings have long been part of authoritarian regimes, whether aristocratic, fascist, or communist. During the 20th century many books, such as Tropic of Cancer, were banned in the United States because of their perceived “obscene” sexual material. Book bannings are intended to prevent others from reading a book. In recent memory, probably few books have come to epitomize the debates on banned books more than the Harry Potter series, written by J. K. Rowling. Books that are challenged are very often books that are targeted toward youth, yet still contain edgy content such as sexuality, violence, occult themes, profanity and drug references. The relative dearth of research on books is probably the result of several factors. Newer media such as video games, social media, and old standbys such as movies and television, tend to get most of the focus.
Program evaluation is systematic collection, analysis, interpretation, and presentation of findings to facilitate stakeholder decision-making regarding the efficacy and efficiency of programs, including, but not limited to, the needs of the organization, the impact of program on outcomes, the cost-effectiveness, and overall utility of a program. This chapter helps the reader to; Identify approaches to the development and use of scores from tests for health-care quality improvement; summarize concepts of test score bias and validity and relationship between health behavior and other observed behaviors; identify approaches to minimize test score bias and interpretation invalidity; and to summarize characteristics of tests that can influence the reliability and validity of scores. Identifying fitting evaluation questions across multiple stakeholder groups, determining the most suitable means with which to gather data, and actively analyzing and using the data to inform continuous program improvement are essential. Ideally, this interactive process will lead to improved outcomes.
Psychometric theory conceptualizes measurement quality in terms of two related properties of scores: reliability and validity. Reliability and validity are properties of scores and not tests (measures), and relevant findings from previous studies may be specific to populations examined in those studies. Thus, one consideration in selecting and justifying measures for a research project is whether evidence is available to support this use of scores in one’s population of interest. Researchers developing and promulgating the use of new measures should give careful attention to what types of reliability are relevant and to nuanced construct definition and theoretical elaboration to allow for accumulation and evaluation of validity evidence. This chapter discusses basic concepts related to reliability and validity of measurement and provides examples derived from the growing literature on core self-evaluations, including empirical data derived from the most popular measure of this construct: the Core Self-Evaluation Scale.
Child psychotherapy is different than any other type of adult-child relationship. A trained mental health professional is using clinical skills to help a child find the answers to the problems he or she has encountered. This chapter outlines the most common symptoms in child psychotherapy. Anxiety is one of the most common symptoms of childhood, but the etiology and manifestation of anxiety varies. Anxiety is a symptom of many other disorders, including generalized anxiety disorder (GAD), separation anxiety, obsessive-compulsive disorder, panic disorder, social phobia and other specific phobias, selective mutism, mood disorders, and post-traumatic stress disorder. Gifted children tend to have higher levels of anxiety because they can think about things they are not yet emotionally prepared to manage. The chapter discusses clinical interventions for common issues of childhood, along with resources for children, directions for parents, and references for parents, caregivers, educators, and therapists alike.
This chapter provides a general overview of the cognitive behavioral history, model, and techniques and their application to counseling practice. Cognitive behavior therapy (CBT) originally evolved out of two traditions, the behavior therapy tradition and the psychodynamic tradition. Behavior therapy was one of the first major departures from the more traditional, psychodynamically oriented approaches to therapy. Through the use of Socratic questioning, CBT involves an ongoing assessment of the person and the problems throughout the therapy experience and is very sensitive to the idiosyncratic nature of an individual’s problems. Once cognitive, behavioral, and emotive patterns are identified for change, the CBT therapist begins to introduce a variety of focused techniques to facilitate this process. Behavioral interventions can be especially helpful in promoting change in individuals who have a harder time making elegant core belief changes through cognitive methods.
Women are very familiar with the experience of being evaluated by their physical attractiveness. This socialization intersects across all stages of a woman’s development beginning in early childhood. Too often, college women’s beliefs about their own attractiveness influence their self-worth. This chapter provides an overview of the “beauty pageant effect”, a phenomenon in which college women compete against one another based on their physical appearance. In addition, exploration of the beauty pageant effect suggests that social comparison theory, evolutionary psychology, and realistic comparison theory play a significant role in the interactions of college women. The chapter presents negative impacts of this type of competition and discusses a brief overview of clinical implications. Prevention work needs to target all women on campus and especially any at-risk populations, such as women with a history of mood disorder, socially isolated students, and those with a personal or family history of eating disorders.
This chapter presents cognitive behavioral therapy (CBT)-based techniques specifically for practicum and internship students and other trainee clinicians. The author explains how he introduces behavioral activation to a kid. It is harder for a kid to be depressed if he is doing fun things, and easy for kids to understand having fun. The brain releases higher doses of mood-lifting neurotransmitters when we socialize, are physically active, and are doing novel, fun things. Behavioral activation is a tried-and-true stable of CBT. A common presenting complaint among depressed or stressed kids is poor sleep. In the author’s practice, kids most complain about a difficulty falling asleep, followed by a difficulty staying asleep. A good starting point is to consider what a good sleep schedule looks like. This chapter shows some of the strategies for combating insomnia. Collectively, the recommendations try to create a comfortable context, a relaxed body, and an unfettered mind.
The practice of behavior therapy has many features in common with that of other forms of psychotherapy, for example, the development of a collaborative working relationship between client and therapist. Behavior therapy is distinguished by its use of particular techniques to address specified problems, by its allegiance to psychological experimentation, and by its commitment to empirical validation. In application to the treatment of anxiety and related disorders, behavior therapy drew inspiration from studies of classical conditioning and experimental neurosis. Systematic programs of gradually confronting feared situations therapeutically, in the imagination or in real life, are familiar features of contemporary behavioral practice with anxious clients. Behavioral assessment is designed to provide detailed information that focuses and directs behavioral treatment. Treatment techniques involving self-control and self-management are viable because clients can alter the contingencies affecting their own behavior.
This chapter introduces a behavioral therapy as a psychological approach to treatment that assumes that mental health problems derive from external forces that impinge the individual. It focuses on the empirical works of two major researchers, Ivan P. Pavlov and Burrhus F. Skinner, who developed learning theories that have serious implications for the treatment of emotional concerns. The chapter addresses the cognitive behavioral therapy movement, both historically and practically. Cognitive behavioral therapy, or CBT, has taken the behavioral therapy movement the internal versus external locus of influence boundary. It addresses how cognition, which is an internal psychological process involving language and perception, can be associated with behavioral techniques to improve case conceptualization and to affect treatment outcomes positively. The Cognitive Behavioral Therapist will first and foremost address the cognition and will try to change the thoughts that are associated with problem behaviors.
- Go to chapter: The Best of Intentions: What Goddard Teaches us about the Development of Intelligence (and the Rough-and-Tumble World of Science)
The Best of Intentions: What Goddard Teaches us about the Development of Intelligence (and the Rough-and-Tumble World of Science)
This chapter presents a balanced overview of the man and his work to illustrate the complicated history of intelligence theory and testing. In 1904 the French government commissioned a group of experts to create a mechanism for identifying low-achieving students who would benefit from special education services. Henry Herbert Goddard brought the Binet-Simon scale to the United States and translated it into English, replacing mental level with mental age. Feeble-minded was the original term for the highest of the low-performing groups, but the descriptor came to be an all-encompassing term that confounded low intellectual functioning with other problems including epilepsy, substance abuse, and evidence of moral deficiency. Obama signed Rosa’s Law, mandating that the phrases mental retardation and mentally retarded be removed from federal health, education, and labor policy and replaced with intellectual disability and person with an intellectual disability.Source:
- Go to chapter: Beyond Traditional Group Counseling: Moving Toward Healing, Catharsis, and Social Action
While this book presents the fundamentals of group counseling, this chapter explores ways to push the boundaries of traditional group counseling. This chapter lays out the emerging trends in group counseling across specializations, while providing the context for healing engagement and asset-based group counseling. Additionally, this chapter examines the ways in which group counseling can be used for personal growth and social action. Furthermore, reflecting on one’s own group facilitation skills, this chapter explores how the same skill sets can extend beyond group counseling interventions and be utilized to build capacity within communities.
Bipolar disorder is a mental disorder that causes unusual shifts in mood, energy, concentration, and the ability to perform daily tasks. This chapter contains three cases of bipolar disorder in adults. These cases illuminate how the same disorder manifests in different people with different backgrounds, including an African American woman, a Caucasian man, and a young Caucasian woman. Discussions of intersectionality, substance use/abuse, and questions for consideration are also included.
This chapter examines a history of bipolar disorders so that the dramatic differences in the prevalence of this disorder over time will make some sense. It provides the rationale for the addition of the bipolar II category in 1994 to the Diagnostic and Statistical Manual of Mental Disorders (DSM). The chapter discusses the history of the bipolar category, and reviews its neuroscience and genetics. It then reviews current pharmacological treatments and their outcomes. It then provides the case for kindling, because part of the rationale for early treatment of bipolar disorder derives from the kindling hypothesis. The chapter covers alternative, nontraditional treatments. Lithium, anticonvulsant and atypical antipsychotics are used in the treatment of bipolar disorders. Keeping a regular schedule for eating and sleeping improves outcome for both those with bipolar I and II. All of the drugs used to treat bipolar I induce depressive symptoms.
Blocking beliefs questionnaire can be used by therapist to discern the Blocking Beliefs of children and adolescents. It is adapted from questions in Thought Field Therapy and the Blocking Belief Questionnaire. Frequently, therapists are not aware when children and teens are saying things that are actual Blocking Beliefs and are slowing down, looping or preventing processing. The adult statements/Blocking Beliefs are listed first in the questionnaire followed by examples of words that a child/teen might use to express his or her Blocking Beliefs. Children and teenagers often state their issues in more concrete and specific ways than adults. It is the therapist’s job to identify the child/teen’s Blocking Belief and translate it into more generalizable terms. Once therapists have identified possible Blocking Beliefs, the beliefs can be targeted directly with the Assessment Phase and then reprocessed to enable continued processing on previous targets.
The goal of the Body Scan Phase is to guide the child/teen through the steps to achieve a clear body scan. The therapist asks the child/teen to scan his or her body using the script. A set of bilateral stimulations (BLS) is done, if any sensation is reported. The discomfort is reprocessed fully until it subsides, if a discomfort is reported. Then the body scan is done again to see if there are still any negative sensations. BLS is done to strengthen the positive feeling, if a positive or comfortable sensation is reported. The Body Scan Phase often occurs during the session immediately following the Installation Phase, when the client has achieved a Validity of Cognition (
VoC) of 7. Typically a session would not begin with Body Scan Phase unless the previous session ended at the conclusion of the Installation Phase.
For decades, televisions have been referred to as “boob tubes”. The “tube” side of the slang term referred to the huge cathode-ray tubes that powered the viewing screen in the Stone Age of television. This basic belief persists, that time spent on entertainment media, particularly visual media is associated with reduced intelligence or academic performance. On the other hand, some investigators are examining whether newer forms of media can be used to promote learning. This chapter examines these concerns and beliefs and elucidates to what degree consuming entertainment media influences our academic achievement. Children who had watched fast-paced cartoon had reduced executive functioning compared to an educational show, or to perform a controlled drawing task. The American Academy of Pediatrics (AAP) has released a host of policy statements on media issues. These have ranged from media violence to “Facebook Depression”, the belief that time spent on social media causes depression.
The management of brain tumors involves a multidisciplinary approach and is challenging in terms of morbidity and mortality. Tumors originating from glial cells are called “gliomas” and, on the basis of the type of glial cell involved, are further divided into subtypes such as astrocytomas, oligodendrogliomas, schwannomas, ependymomas and meningiomas. Brain tumors may be slowly growing tumors, with a long insidious course, and may be found as incidental findings on autopsy. In children with brain tumors, there can be extreme variability in time from onset of symptoms to diagnoses of brain tumor, as migraines or gastrointestinal illness are much more common. Limited intracranial space due to fusion of bones and compression of neurological structures and pathways play an important role in the manifestation of brain tumors. Clinical presentation depends on the pathogenesis rather than types of brain tumors. Pituitary tumors require specialized serum evaluations to assess the hypothalamic-pituitary hormone axis.