This chapter aims to help clinicians learn stabilization interventions for use in the Preparation Phase of eye movement desensitization and reprocessing (EMDR) treatment. Using these interventions will aid clients in developing readiness for processing trauma, learning how to manage symptoms of dissociation, dealing with affect regulation, and developing the necessary internal cohesion and resources to utilize the EMDR trauma-processing phase. Earlier negative experiences stored dysfunctionally increase vulnerability to anxiety disorders, depression, and other diagnoses. When assessing a client with a complex trauma history, clinicians need to view current symptoms of post-traumatic stress disorder (PTSD) or depression as reflections of the earlier traumas. The chapter outlines the strategies dealing with dissociative symptoms, ego state work, and internal stability that help clinicians to develop an individualized treatment plan to successfully guide the client through the EMDR phases of treatment.
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- Go to chapter: Stabilization Phase of Trauma Treatment: Introducing and Accessing the Ego State System
This chapter describes the current trends toward greater gender equality in couple relationships, what keeps old patterns of gendered power alive, and why equality is so important for successful relationships. Relationship vignettes like the ones just described are common. Sharing family and outside work more equitably is only part of the gender-equality story. Gender ideologies are replicated in the way men and women communicate with each other and influence the kind of emotional and relational symptoms men and women present in therapy. Stereotypic gender patterns and power differences between partners work against the shared worlds and egalitarian ideals that women and men increasingly seek. The concept of relationship equality rests on the ideology of equality articulated in philosophical, legal, psychological, and social standards present today in American and world cultures. The four dimensions of the relationship equality model are relative status, attention to the other, accommodation patterns, and well-being.
This book provides the foundations and training that social workers need to master cognitive behavior therapy (CBT). CBT is based on several principles namely cognitions affect behavior and emotion; certain experiences can evoke cognitions, explanation, and attributions about that situation; cognitions may be made aware, monitored, and altered; desired emotional and behavioral change can be achieved through cognitive change. CBT employs a number of distinct and unique therapeutic strategies in its practice. As the human services increasingly develop robust evidence regarding the effectiveness of various psychosocial treatments for various clinical disorders and life problems, it becomes increasingly incumbent upon individual practitioners to become proficient in, and to provide, as first choice treatments, these various forms of evidence-based practice. It is also increasingly evident that CBT and practice represents a strongly supported approach to social work education and practice. The book covers the most common disorders encountered when working with adults, children, families, and couples including: anxiety disorders, depression, personality disorder, sexual and physical abuse, substance misuse, grief and bereavement, and eating disorders. Clinical social workers have an opportunity to position themselves at the forefront of historic, philosophical change in 21st-century medicine. While studies using the most advanced medical technology show the impact of emotional suffering on physical disease, other studies using the same technology are demonstrating CBT’s effectiveness in relieving not just emotional suffering but physical suffering among medically ill patients.
- Go to chapter: Overview of the Problem-Solving Therapy Process, Introductory Sessions, and the Case of “Megan”
This chapter presents the therapy manual detailing the specific treatment guidelines encompassing problem-solving therapy (PST). It is important during the initial sessions with a new client to develop a positive therapeutic relationship. Upon obtaining a brief version of the client’s story, it becomes important early in treatment to provide an overview of PST that includes a rationale for why it is relevant to, and potentially effective for, this individual. Problem solving can be thought of as a set of skills or tools that people use to handle, cope with, or resolve difficult situations encountered in daily living. Research has demonstrated that social problem solving is comprised of two major components. The first is called problem orientation. The second major component is one’s problem-solving style. The chapter also presents the case of a 27-year-old woman suffering from multiple concerns, including anxiety, depression, fears of “going crazy”, and prior alcohol abuse.
When Charles, a 46-year-old divorced male with an extensive psychiatric history of depression, substance abuse, and disordered eating resulting in a suicide attempt, erratic employment, and two failed marriages, began treatment with a clinical social worker trained in dialectical behavior therapy (DBT), he was an angry, dysphoric individual beginning yet another cycle of destructive behavior. This chapter provides the reader with an overview of the standard DBT model as developed by Linehan. Dialectical behavior therapy, which engages vulnerable individuals early in its treatment cycle by acknowledging suffering and the intensity of the biosocial forces to be overcome and then attending to resulting symptoms, appears to be the model most congruent with and responsive to the cumulative scientific and theoretical research indicating the need for the development of self-regulatory abilities prior to discussions of traumatic material or deeply held schema.
This chapter discusses the treatment of comorbid chronic depression and personality disorders. It then discusses recent treatment advances in the cognitive behavior field relevant to this population. Recently, research has been done comparing schema therapy to Otto Kernberg’s latest model. Because of severe emotional distress, patient often experience suicidal and/or parasuicidal behaviors. The chapter explores the benefits of mode work with these particular difficulties while maintaining a therapeutic approach of connection and compassion; this alliance is crucial for the approach to be effective. It focuses on the five most common modes for those with chronic depression and personality disorders namely the abandoned/abused mode, the detached protector mode, the angry mode, the punitive mode and the healthy adult mode. The interventions described in schema mode therapy have cognitive, experiential, and behavioral components. Identification of the mode the patient is in when suicidal is essential when managing a crisis.
In this chapter, the author begins with his career in the helping professions as a sex, marital, and family counselor in the early 1940s. In the early 1950s the author became increasingly disillusioned with both the theoretical validity and the clinical effectiveness of psychoanalytic treatment and began to see more clearly that human disturbance had profound ideological roots. The author develops a therapeutic approach based upon a perspective of human disturbance that stressed philosophic determinants and deemphasized psychoanalytic psychodynamics. The author applied this approach to a number of therapeutic modalities, including couples therapy. Couple disturbance arises when one or both partners become emotionally disturbed about the dissatisfactions. Rational emotive behavior couples therapy (REBCT) theory holds that couple disturbance can develop and be perpetuated in a number of different ways. Partners give themselves an emotional problem about die problem of dissatisfaction.
This chapter aims to introduce the different symptoms characteristic of a psychotic episode. The five major categories of symptoms are positive symptoms, negative symptoms, disorganized symptoms, affective symptoms, and cognitive symptoms. Two associated symptom categories associated are abnormal motor behavior and level of insight. Some more frequently occurring themes of delusions include persecutory delusions, erotomanic delusions, grandiose delusions, and somatic delusions. Hallucinations are the perceptual experiences that occur in the absence of an external stimulus. Negative symptoms represent things that have been taken away from an individual’s previous functioning, and reflect absences from the typical experience of most people. Avolition refers to a decrease in self-initiated activities and low motivation. Young adults experiencing psychosis may also experience symptoms of depression. Mania refers to a period of time in which an individual experiences expansive or elevated mood, or irritability, and excessive energy.
Anger, depression, and anxiety that cause distress are sometimes hard for clients to manage and gain control over. Deconstructing the problem to find out why such reactions are occurring does not lead to solutions; rather, it provides more reasons to suggest that a normal life is impossible. This chapter shows how identifying the effects of such descriptions slow down the progress of the person’s triumph over the problem. There is a special moment in a therapy session when a therapist suggests that the client “stand up for himself against the anger”. With clients who come to therapy and present with diagnoses, it is very important to remain respectful of their attempts to understand why they are experiencing distress. Externalizing a problem or diagnosis allows clients to separate themselves from the dominant stories that have shaped their lives and relationships.
This chapter suggests that Irrational Beliefs (IB’s) play a major role in the creation of human disturbance, and that people make themselves disturbed mainly by escalating their goals, desires, and preferences into absolutistic musts and demands. Rational Emotive Behavior Therapy (REBT) hypothesizes that Irrational Beliefs rarely exist by themselves, but are preceded by or associated with rational ones. One can use modeling techniques with resistant clients by showing them that no matter how difficult they find it to reduce their disturbed feelings, as well as to reduce their anxiety and depression about these feelings. They can also read and learn about other very disturbed people who have used REBT, Cognitive Behavior Therapy (CBT), and other therapy methods to considerably help themselves. Encouraging clients to do an effective cost-benefit analysis of their various forms of resistance seems to be mainly a cognitive method of therapy.