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

Children are exposed to distress, violence, and trauma even before they are born. In-utero and early childhood exposure can contribute to severe medical and psychological consequences. Children who have been exposed to such traumatic events often arrive at the psychotherapist’s office with emotional and behavioral symptoms suggestive of reactive attachment disorder (RAD), post-traumatic stress disorder (PTSD), and dissociation. This chapter reviews relevant theories of dissociation integrated with theories of development to provide a summary of how attachment impacts dissociation. With a developmentally grounded theory of dissociation, the chapter describes clinical interventions for treating the dissociative sequelae of attachment trauma in children. This theoretical framework offers a developmentally grounded and integrative framework for working with children with complex trauma and dissociation. Symptoms of dissociation are common with PTSD, but an extreme response to trauma can be dissociation and dissociative disorders.

This chapter presents advances in the understanding of adolescent brain development that can inform and improve social work practice with youth leaving foster care. Foster care populations have a high rate of mental health disorders, and the association of types of child maltreatment with elevated risk for such disorders is well known; discussion of specific mental health problems and their treatment can be found elsewhere. Conventional mental health approaches have often targeted the innervated cortical or limbic neural systems, rather than the innervating source of the dysregulation. Psychotherapy, whether psychodynamic or cognitive, acts on and has measurable effects on the brain, its functions, and metabolism in specific brain areas. The ethical response is a sharing of the dilemma, and of information about the neurobiology of the client’s struggle, to enable the client to make as informed a decision as possible. In addition, neuroimaging techniques themselves lead to other ethical dilemmas.

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

The importance of the functioning of mind and the limitations of medication has encouraged some clinicians to advance the use of psychotherapy. In the present period this is mostly in the form of cognitive behavioral therapy (CBT) for schizophrenia and psychosis, and this is strongly promoted in the British Psychological Society (BPS) publication “Understanding Psychosis and Schizophrenia: Why People Sometimes Hear Voices, Believe Things That Others Find Strange, or Appear Out of Touch With Reality, and What Can Help”. Although this document has not been received without criticism, it makes some very interesting reading for us as eye movement desensitization and reprocessing (EMDR) therapists and students of the Indicating Cognitions of Negative Networks (ICoNN) model. The meta-analyses that showed the most encouraging effect sizes were looking at two groups: treatment-resistant schizophrenia, and forms of psychotherapy that were highly specific and tailored according to case formulation, targeting delusions and auditory hallucinations.

The scripts included in this chapter exemplify how an Eye Movement Desensitization and Reprocessing (EMDR) therapist might talk with a client when the focus is on positive psychology and performance enhancement: reaching for a goal not yet realized, looking for a way to strengthen a positive quality. The scripts accompany a model that has been taught in a number of countries to therapists, coaches, and human resource advisors. The model combines elements of coaching and psychotherapy. Even if there were sufficient time, it would be inappropriate to do Standard EMDR processing with a large group where the practitioner could not monitor the experiences of individual participants. The performance model can also be applied with clients not yet ready to undergo EMDR desensitization because of ego fragility, emotional latency, or any other feature that suggests they cannot yet handle the affective intensity that accompanies EMDR processing.

The eye movement desensitization and reprocessing (EMDR) method represents a significant advance in psychotherapy. While most of the empirical research on EMDR demonstrates its efficacy as a treatment for posttraumatic stress disorder (PTSD), including relational traumas. Dysfunctional patterns of relating in the family of origin can imprint themselves on the relational template of adults, only to be reenacted in the contemporary couples relationship. Because EMDR can be effective at transforming these earlier relational traumas, adults can become less reactive, enjoy greater distress tolerance, and have a more resilient ego boundary. Thus, EMDR is an invaluable tool in couples therapy. A 5-step protocol is proposed that can guide therapists to develop an EMDR treatment plan within the context of couples therapy. This protocol can and should be applied to both partners in most cases, but of necessity, the therapist must choose one partner to begin with.

This chapter outlines the basic practice of rational emotive behavior therapy (REBT) and considers aspects of the therapeutic relationship between clients and therapists in REBT. It provides the major treatment techniques that are employed during REBT. REBT is an active-directive form of psychotherapy in that therapists are active in directing their clients to identify the philosophical source of their psychological problems and in showing them they can challenge and change their irrational musturbatory evaluations. REBT therapists tend to be appropriately humorous with most of their clients because they think that much emotional disturbance stems from the fact that clients take themselves and their problems. REBT therapists not only offer them “affective” empathy but also offer them philosophic empathy. Effective practitioners of REBT are usually comfortable with behavioral instruction and teaching and with providing the active prompting that clients often require if they are to follow through on homework assignments.

In this third category of presentations in the Indicating Cognitions of Negative Networks (ICoNN) model, the psychotic phenomena are evident, causing distress and a functional impairment. However, the psychological pathogen cannot be identified in the standard way and strong emotions cannot be tracked back across an affect bridge. The main phenomena that characterize this category of ICoNN cases are “heard voices” that can be spoken with. They act as a proxy for the dysfunctional memory network (DMN). Reprocessing is ultimately accomplished using an ego-state approach/voice dialogue approach with the facilitation of the dual attention stimulation/bilateral stimulation (DAS/BLS) elements of the eye movement desensitization and reprocessing (EMDR) therapy method. It is vitally important that the therapist work to develop the first three features of effective psychotherapy: an emotionally charged relationship, a therapeutic environment, and a rationale/myth that provides a plausible explanation for the symptoms.

This chapter discusses the type of group work using rational emotive behavior therapy (REBT) principles and practices. Several methods of psychotherapy, such as psychoanalysis, employ group therapy for expediency reasons. REBT distinctly uses an educational rather than a medical or psychodynamic model. REBT includes a number of role-playing and behavior modification methods that can be done during individual therapy sessions but that are more effective in group. Clients who are shy or who have interpersonal problems are particularly encouraged to join a group because it is often more therapeutic for them to work out their problems with their peers than to work on them only with an individual therapist. In cognitive-behavioral therapy in general and in group REBT in particular, the activity level of the therapist tends to be high. Group REBT and counseling especially have intrinsic disadvantages and limitations when compared to more individualized REBT proc.

This chapter examines both the history and benefits of teaching specific models in Marriage and Family Therapy (MFT) supervision and then focuses on an integrative, moderate common-factors approach. MFT as a profession originated in the late 1950s and 1960s with a series of rebellious pioneers who rejected the dominant individual-based behavior and psychoanalytic models of the time in favor of something new. Supervisors who intend to integrate common factors into the supervisory experience and education have several tasks, possibly the most important of which is to provide education to supervisees about the factors that truly are common to all psychotherapy modalities. The chapter describes the seven common factors: client factors, therapist factors, the therapeutic alliance, hope and expectancy, allegiance of the therapist, feedback, and interventions, such as behavioral, cognitive, affective that cut across all models.

Mindfulness is a contemplative practice involving focused attention, attentiveness to the present moment, and nonjudgmental awareness. It is a way of experiencing the world that can facilitate powerful life changes and open the door to greater well-being. Clinical interventions that use mindfulness offer a unique perspective that can help people improve clients’ lives. Mindful hypnotherapy (MH) is an intervention that intentionally uses hypnosis (hypnotic induction and suggestion) to integrate mindfulness for personal or therapeutic benefit. This chapter begins with a quote from Dr. Milton Erickson, one of the most important figures in contemporary psychotherapy and hypnosis: “Until you are willing to be confused about what you already know, what you know will never grow bigger, better, or more useful“. There is great potential for the integration of hypnosis and mindfulness; however, to achieve this, clinicians and individuals must be open and flexible in their understanding of both concepts.

Supervision in family therapy is an inherently complex enterprise. In any supervision of psychotherapy work, the supervisor must navigate the hierarchy of supervisor, therapist, and client; in family therapy, the client unit may include its own complex hierarchy as well. There are very different approaches to the supervision relationship. Ethical decision making in such a complex environment is understandably challenging for therapist and supervisor alike. Some evidence from other mental health professions suggests that supervisors may be hesitant to discuss issues of supervisees’ sexual attraction to clients in supervision, for fear of being accused of harassment or otherwise breaching ethical boundaries. Some supervisors are surprised to learn that confidentiality in supervision is very similar to confidentiality in therapy. There are a number of ways that ethical problems can arise in supervision, each requiring careful attention to be resolved in the best interests of all involved: client, therapist, supervisor, and setting.

Establishing rapport, building therapeutic alliance, and establishing and maintaining healthy boundaries are all important therapeutic skills especially when working with victims of military sexual trauma (MST). Along with being caring psychotherapists, clinicians may be called upon to play a key part in third-party issues, such as legal issues including custody battles or in reporting on clients for MST Department of Veterans Affairs (VA) service-connected disability benefits. This chapter reviews psychotherapeutic issues that arise when treating those with MST, specifically, barriers to treatment, establishing trust and rapport, boundaries, third-party issues, and documentation. The issues that prevent MST survivors from seeking mental health treatment mirror problems that service members may have had in reporting it, including fear of blame and stigma. To protect clients and therapists alike, it is also important to be mindful of other common boundary testing by trauma clients.

Somatic experiencing (SE) has emerged from a long tradition of somatic education and body-oriented psychotherapy. When the body successfully implements the planned action sequence and adequately releases the remaining unused survival energy, the person regains equilibrium and does not encounter the physiological sequelae associated with trauma. The person then moves from acute arousal into a state of chronic arousal and generalized dysfunction in the central nervous system. SE draws upon the neurobiological study of the multidirectional interconnection between the body, brain, and mind. Posttraumatic stress disorder (PTSD) and the symptom clusters associated with the diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders illustrate the body’s “stuck energy”. Treating survivors of military sexual trauma (MST) introduces a unique set of circumstances. In the military, unit cohesion is synonymous with safety and survival.

This chapter provides a theoretical background for Medical Family Therapy (MedFT) as the systemic approach to integrated care as well as unique considerations for supervision in the integrated care settings where MedFTs typically practice. It consists case example to offers a frame and illustration for the application of this important approach. MedFTs master the elements of a traditional mental health intake to assess any psychopathology, history of past treatments, use of medications, family and social history, and relational dynamics that influence the exacerbation or maintenance of individual, relational, and/or health problems. In integrated care settings, a course of treatment typically unfolds episodically because the patients and their family members will have onsite access to return to psychotherapy when the need arises again. For most MedFTs, clinical care and supervision occur in an integrated health care setting.

Helping professions tend toward an ethic of self-sacrifice. Coming to terms with budgeting and financial management can be at best an afterthought and, at worst, anathema to the professional counselor. In the absence of independent wealth, failure to develop sound budgeting and financial management skills leads to stress, uncertainty, and, in the worst-case scenario, insolvency. From the perspective of fiscal management, distinguishing one’s work and becoming known among other professionals as a skilled and committed clinician is a key aspect of competition and collaboration. The degree to which clinicians are influenced by fiscal management in the orientation of their clinical practice varies, but can be an important consideration for beginning counselors as they establish a practice. Counselors often pursue therapeutic work because they find it intrinsically meaningful and personally and intellectually challenging. They do not consciously pursue the necessary skills to operate a financially sound psychotherapy practice while in training.

This chapter examines how to prepare patients for the reprocessing phases of the standard eye movement desensitization and reprocessing (EMDR) therapy procedure. The essential elements of the preparation phase covered in the chapter include providing patients the fundamental information needed for informed consent, and offering guidance and metaphors to orient patients to standard EMDR reprocessing procedures. The Preparation Phase in the EMDR approach to psychotherapy corresponds with the initial stabilization or ego-strengthening phase of treatment in the consensus model of treatment for trauma. An essential aspect of the preparation phase is patient education. Patients need to understand their diagnosis, symptoms, the impact of adverse and traumatic experiences, the stages of the treatment plan and what to expect during EMDR reprocessing. For those with histories of exposure to traumatic life experiences, normalizing the development of posttraumatic stress disorder (PTSD) is essential.

This chapter focuses on the common themes of meaning and the sacred that emerge in pastoral counseling practice. It elucidates explicit and implicit spiritual content that is commonly presented by clients. The chapter explores the explicit spiritual content commonly raised by clients within the Abrahamic traditions. It also explores implicit spiritual content, which is seemingly inherent to the human condition and often occupies the subtext of a client’s presentation. Grounding the exploration of explicit and implicit spiritual content in pastoral counseling is the belief that competent practice requires counselors to be spiritually and theologically flexible. Pastoral counselors employ a diversity of treatment modalities and are not limited to one model or school of psychotherapy. Responding to explicit and implicit spiritual content within mental health practice is a hallmark of pastoral counseling. Whether spiritual content is explicit or implicit, one primary goal of pastoral counseling is to facilitate spiritual growth.

This chapter provides an overview of the medication issues and concerns mental health practitioners will encounter. The philosophy of the authors is simple: collaborative teamwork between physicians, prescribers, nurses, other health care providers, and mental health practitioners such as social workers is necessary for ethical and competent practice. Social workers make up the majority of mental health professionals in the United States. The chapter offers both historical and current perspectives on the importance of the knowledge of medications used in competent professional practice. From a social work perspective, it encourages an interdisciplinary team approach that takes into account the client's environment; thus, special attention is given to empowering clients to become active participants in the treatment process. The approach also recognizes the social worker as an important member of the health care delivery team. Psychopharmacology, medication as a primary treatment modality, and psychotherapeutic approaches are discussed.

Contemporary psychotherapy addresses behavioral issues of an older adult by focusing on the degree to which an older adult is able to cope positively with the environmental stressors converging on him or her. An environmental geropsychologist focuses on the environment component of Lewin’s equation and develops interventions to change older adults’ interpersonal and intrapersonal experiences with psychosocial stressors with interventions aimed at the environment. The theory of affordances states that the perceptions that older adults have of their physical environments have functional significance for older adults, and shape older adults’ behaviors. The tri-dimensional intervention model states that there is a comprehensive interaction among the cognitive, conative, and affective components in an older adult’s environment. All three components are the targets for intervention by an environmental geropsychologist. The conative component is the aspect of the brain that acts on one’s thoughts and feelings.

This chapter presents the conceptual framework for understanding eye movement desensitization and reprocessing (EMDR) therapy. It begins with a review of selected aspects of four models of psychotherapy that historically most directly support understanding the evolution of EMDR therapy. The early history and evolution of EMDR therapy in turn have been strongly associated with the search to understand and treat the relationship between trauma and dissociation. Classical behavior therapy views posttraumatic stress disorder (PTSD) through the lens of conditioning in which a powerful conditioned association is formed between specific cues were present at the time of adverse or traumatic experiences and the intense state of alarm evoked by the experience. In EMDR therapy, various strategies can be employed to support the goals of stabilization and symptom reduction. Some stabilization strategies commonly used in EMDR therapy were developed in other traditions such as progressive relaxation, self-hypnosis, biofeedback, and meditation.

This chapter examines sources of difficulty clinicians newly trained in eye movement desensitization and reprocessing (EMDR) therapy face in developing and following a treatment plan. It considers a series of essential elements of case conceptualization including degree of structural dissociation and attachment classification; standardized tools and clinical strategies for history taking including EMDR-specific forms and the use of bridge techniques; issues surrounding recovered memories and the plasticity of memory; and a brief introduction to the history of and concepts in attachment theory including the impact of attachment organization in phases of psychotherapy; tools and clinical strategies for assessing adult attachment classification. The chapter examines a research supported, symptom informed model for target sequencing in EMDR therapy and close with a sample treatment plan based on a prototype case of a rape survivor. It reviews three standardized tools to assist in gathering information about patients’ histories, presenting complaints, and treatment goals.

Psychologists work with micro-level and macro-level orientations. Clinical psychologists with a micro-level orientation focus on individuals, families, and small groups when performing psychotherapy. Community psychologists have a macro-level orientation. The aging population presents many opportunities for psychologists, both those engaged in scholarship and those working clinically with older adults, and for community psychologists addressing issues relating to social structures and organized communities of older adults, economic issues such as poverty and access to medical services, and issues relating to senior housing. Contemporary theory indicates that it is equally important for psychologists working with older adults to focus on the positive aspects of aging when addressing the psychopathological problems older adults are experiencing. Erikson’s stage theory originally had seven stages: basic trust versus basic mistrust; autonomy versus shame and doubt; initiative versus guilt; industry versus inferiority; identity versus role confusion; intimacy versus isolation; and generativity versus stagnation.

This chapter presents the author’s view that for multicultural counseling approaches to be successful; there must be a strong consideration for race, ethnicity, and biracial/ethnic identity; attributes of age, gender, gender fluidity, disability, social, economic, educational, rural, urban, and geographic identity and other ethnographic variables that define individuals and groups by nationality, ethnicity, languages, and spiritual and religious identity. In addition, there has to be awareness that many cultures do not endorse counseling and psychotherapy approaches. The chapter talks about core constructs in multicultural counseling and offers guidelines on how to apply such approaches with indigenous cultural groups that reach beyond the U.S. borders. This is necessary because professional counseling associations have organized volunteers and provided disaster mental health relief opportunities for counselors who want to serve on disaster sites internationally. The chapter also discusses mental health practitioners culturally competent skills that help translate theoretical models into multicultural counseling.

If one purpose of psychotherapy is to treat all mental disorders including sexual problems, then the provider needs a definition of sexual health. Besides being a vague concept, sexual health is also complex, as it is more than the idea that sex is a fun activity that should be enjoyed by all. What sexual health entails, but is so little spoken openly about, are attitudes, behaviors, and beliefs that foster increased feelings of self-esteem, the ability to explore erotic dimensions of human experience, and facilitation of adult attachment. It also includes that the individual has the physical means for sexual enjoyment, though what that means may vary by person and across the life span. Though sexual health may be portrayed as a basic human right, it is not necessarily an innate human state. This chapter examines some common factors that undermine sexual health.

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.

Children come to psychotherapy for a variety of stressful or traumatic situations that are unique to children. This chapter is designed to help the clinician conceptualize these child-specific situations through all eight phases of Eye Movement Desensitization and Reprocessing (EMDR) therapy. It addresses how to use EMDR therapy with child/teen-specific situations. There are many issues infants, toddlers, children, and adolescents face when their parents divorce. Once the child learns resourcing and containment skills, the therapist can then have the child focus on any anticipatory anxiety about testifying. EMDR therapy works well with infants, toddlers, children, and adolescents in dealing with their sense of loss, safety, power, and control in a divorce situation. An EMDR therapy child/adolescent therapist is encouraged to use and weave together other clinical modalities and techniques within the eight phases of treatment to treat the many common issues that children/teens bring to psychotherapy.

This chapter covers several key areas critical to improving the outcome of psychotherapy. Readers are offered ways to increase the fit (i.e., how well a model aligns with a particular client) and effect (i.e., the outcome) of the treatment. It explores how to match and select strategies to help clients reach their goals and achieve successful outcomes. This process is a form of “mapping”. The chapter also discusses classes of intervention (COI). COI include specific methods such as selected and used by therapists to promote affective, cognitive, and behavioral/interactional change. Each class or domain will be described in brief to orient readers toward categories of intervention based on information gathered during client interactions and described over the first five chapters of this book. The chapter provides case example of how a client’s background can serve as an influence with a life circumstance.

The eighth phase of the Eye Movement Desensitization Reprocessing (EMDR) therapy is the Reevaluation Phase. Reevaluation refers to the therapist’s evaluation of processing a specific target, whether incomplete or complete, and progress on the client’s treatment plan, as well as the overall course of treatment. Reevaluation first occurs at the beginning of each session of psychotherapy when the therapist is assessing what’s happening in the client’s life. Reevaluation then occurs after the Assessment Phase is completed for the first time and treatment has moved to Desensitization. During the Desensitization Phase, the therapist has the client return to reevaluate the original target memory when the memory appears to be resolved. There are three components to reevaluation. One is to assess the specific target during trauma reprocessing. A second is to review changes in the clinical landscape between sessions. And finally, reevaluation is to assess treatment progress.

This chapter examines eye movement desensitization and reprocessing (EMDR) therapy as a powerful healing mechanism in the treatment of addiction and provides insights on future directions. Francine Shapiro’s early writing about integrating EMDR into the treatment of addictive disorders offers sound guidance for introducing EMDR therapy to someone seeking recovery from chemical dependency or other compulsive behaviors often described under the umbrella of addiction. The culturally sensitive EMDR therapist may not impose their biases about the utility of any one model of recovery on their clients; rather, the therapist may facilitate an experience where the client can discover which path can best serve him or her. EMDR therapy, by design, can address several issues: the spiritual, the lifestyle, the cognitive, the somatic, and the historical facets of addiction. EMDR is usually referred as the “missing piece” in addiction treatment care.

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.

Sex therapy is often distinguished from other types of psychotherapy as being specialized strictly in the treatment of sexual dysfunction, ensuring that cisgender, heterosexual people’s genitals work so that they can experience penis-vagina intercourse. This is unfortunate, because sex therapy covers a broad spectrum of human experiences, both in and out of the bedroom. Our sexuality can touch almost any aspect of life across the life span, with minor or profound effects. Our self-esteem, our relationships with others, our perception of life as being joyful or bleak can all depend on how we feel about our sexuality and our attitude about sexual pleasure. Providers who include treatment of sexual problems must also be adept at many different theoretical approaches. Bronfenbrenner’s ecosystemic approach and its application to sexuality is also being used more frequently in conceptualizing sexual development and interactions between and among systems in varied populations.

The final chapter’s focus is squarely on increasing the benefit of psychotherapy by improving clinician effectiveness. It is meant to be concise, and a starting point for those committed to achieving clinical excellence. The chapter considers ways for therapists to determine their baseline rates of effectiveness, obtain feedback, and engage in deliberate practice to improve their performance. It also includes examples of activities and exercises that therapists can use to develop domain-specific knowledge and evolve over the course of their careers. The chapter offers ideas for simulating real-world learning in psychotherapy. It provides an overview of the basics of the cycle of excellence (COE) framework with the hope that therapists will explore it in greater detail through a growing body of available literature and resources. The chapter presents a closing discussion whose purpose is to consider moving the conversation forward to the future to elevate the usefulness of supervision.

The value of efficiency is quite important in practically all psychotherapy, but is often neglected. Feeling better has a great advantage, but it is limited in many respects. In Rational Emotive Behavior Therapy (REBT), an existential view of depth-centeredness in psychotherapy has various advantages over less depth-centered views. Pervasiveness in psychotherapy may be defined as a therapist helping his or her clients to deal with many of their problems, and in a sense their whole lives, rather than with a few presenting symptoms. Extensiveness in psychotherapy means that clients can be helped not only to minimize their disturbing negative feelings for example, anxietizing, depressing, and raging but also to maximize their potential for happy living that is, to be more productive, creative, and enjoying. Efficiency in therapy, particularly with resisting clients, therefore consists of convincing them thoroughly that they’d better go for a more elegant, rather than a less elegant, change.

The basic theory of Rational Emotive Behavior Therapy (REBT) says that its practitioners never dispute or argue with clients’ strong preferences, desires, and goals all of which are considered “rational” in REBT. REBT practitioners accept all clients with their many varieties of cultural, religious, political, and other standards; and they only question how rigidly clients adhere to their cultural goals and how they sometimes sabotage themselves by their absolutism and rigidity. Culture seems to have a biological as well as a social learning basis. REBT helps people who do not strictly follow the rules of their original culture to feel healthily sorry and regretful about flouting these rules instead of feeling as many of them do when they first come to therapy unhealthily guilty, depressed, and self-downing. Psychotherapy in general and REBT in particular promote unconditional self-acceptance (USA) and unconditional other-acceptance (UOA).

Practically all clients resist changing to some considerable degree, resistant clients, and present more difficulty. Our therapeutic goals, especially if we use Rational Emotive Behavior Therapy (REBT) or Cognitive Behavior Therapy (CBT), may be to first get at our clients’ Irrational Beliefs and thereby get to their dysfunctional feelings and behaviors. The author explores some of the ways in which therapist can use REBT to help resistant clients change the Adversities of their lives. Some techniques for helping clients overcome their resisting actually work, and sometimes quickly, but have their own limitations and disadvantages. Even reputable and good techniques of psychotherapy, as the author pointed out in a paper on the limitations and disadvantages of behavior therapy in 1983, can distinctly distract people from using still better techniques and therefore can be relatively harmful.

Solution-focused therapy (SFT) is a future-focused, postmodern approach to psychotherapy that is based on how the therapist and client co-construct language in order to shift the conversation from a focus on problems to a focus on solutions. In SFT, it is not essential to know the source of the problem in order to help the client create a solution. The assumption in SFT is that a small change will produce larger change. Therefore, the goal is to solve the problem by making small changes. SFT takes a distinctly postmodern approach, focusing on developing a preferred future. While the preferred future is the focus, there are opportunities, once the preferred future is defined, to explore past experiences in the form of exception gathering. Seeking exceptions with family members once the preferred future is defined empowers individuals to notice the strength within themselves and their family members.

This chapter explores many kinds of resistance to psychotherapy and to self-help therapy and describes how one, as a therapist, can effectively deal with them. Obviously, however, it will favor Rational Emotive Behavior Therapy (REBT) that started in 1955 and that has developed into Cognitive Behavior Therapy (CBT) in the 1960s and 1970s. Therefore, for REBT and CBT to be effective, one had better convince clients of the importance of their beliefs and show them that it is quite possible to change them and thereby improve their disturbing Consequences (C’s). The chapter emphases on a number of cognitive, emotive, and behavioral techniques, and is therefore similar to what Arnold Lazarus calls multimodal therapy. REBT, more than the other Cognitive Behavior Therapies, particularly differentiates healthy negative feelings, such as concern, sorrow, regret, frustration, and annoyance from unhealthy or destructive feelings, such as panic, depression, and rage.

This chapter considers more methods of contradicting and actively working against Irrational Beliefs that people can use with some of their most difficult clients. Resistant clients frequently view self-change as too arduous and painful because it requires so much persistent effort and practice. Rational Emotive Behavior Therapy (REBT) and Cognitive Behavior Therapy (CBT) therefore try to help them to reframe the process of self-change as more of an adventure and challenge than a hardship. Many resistant clients lose their sense of humor when they neuroticize themselves. A major goal of REBT and CBT, therefore, is to have clients solidly achieve a basic philosophy of effort. Its practitioners assume that resistors often indulge in low frustration tolerance (LFT). Quick and active disputing of clients’ Irrational Beliefs may save people’s considerable time and effort, and demonstrate to clients that helpful techniques of psychotherapy can be done in a short period of time.

In the field of family therapy, there is a need for working with families struggling with medical problems. The collaboration of both medicine and psychology in addressing the particular familial and individual issues that occur in dealing with illness have led to the medical family therapy (MedFT) model. MedFT represents a meta framework that encompasses overarching principles within which any mode of psychotherapy can be practiced. What sets MedFT apart from other family therapy theories is the routine collaboration with medical professionals as well as seeing illness as part of the systems. Collaboration is a primary aspect; medical family therapists need to have an understanding of the medical system to embrace a multidisciplinary team approach with physicians and other healthcare providers. The hope is that the MedFT therapist will aid the family, along with the medical staff, traverse illness and journey united together in coping with the effects of illness.

This chapter serves as an introduction to theories of counseling and psychotherapy. Theories of counseling and psychotherapy are foundational to the practice of mental health professions. Professional counseling or psychotherapy is the process whereby a trained professional uses his or her knowledge of biology, psychology, personality, relationships, and social systems to change behaviors and to solve client problems. Counselors are highly educated professionals who are directed by ethical codes to help people in need. Psychotherapists, no matter what their professional affiliations, are bound by the ethical principles of beneficence and non-maleficence. Mental health is not just the absence of mental disorder. The American Psychiatric Association published its highly used Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM- 5), which provides a listing of mental disorders and the criteria used to diagnose them. It is a typology of mental disorder-mental illnesses viewed as within the person.

This chapter introduces an approach that is unique to counseling theory, based on its focus on solutions rather than problems. It gives an example of a model that is based on social constructivism philosophy. Solution-Focused Brief Therapy (SFBT) represents a significant break with the underlying philosophy at the core of traditional psychologically oriented psychotherapy approaches. It also represents a unique philosophy that extends beyond that of classic social systems theory, which is at the base of the classic family therapy approaches. The goal of SFBT is the replacement of symptomatic or problem behaviors with functional and wanted healthy behaviors. SFBT can be accomplished as an individual psychotherapy, as couple counseling, or as family therapy. Research is beginning to show that SFBT has great potential and is a viable, efficient, and effective approach to treating mental health issues.

The focus of this book is on theories for direct (or clinical, micro) social work practice. It focuses on theories for practice with individuals, although the relevance of these theories for practice with couples, families, and groups is also considered. Beyond simply offering a survey of clinical theories in this book, the authors promote what they call a generalist-eclectic approach for the use of theory in direct practice.

Including the word generalist in the name of the approach might seem odd because one of the generally accepted hallmarks of generalist social work practice is that it spans direct and indirect (or macro) practice methods, whereas this approach focuses only on direct practice. By using the word generalist to describe the approach to direct practice, the authors emphasize their belief that specialization in direct practice must be firmly grounded in the generalist perspective of social work practice; that the values, principles, generic processes, and holistic perspective that are integral to generalist social work practice are a necessary foundation for direct practice specialization. Although this might be taken for granted by some, this sometimes gets lost in the rush for specialization.

One reason it is important to ensure that direct practice is grounded explicitly within the generalist perspective is because most theories that clinical social workers use have been developed outside of the profession, and aspects of such theories may not fit well with some social work principles. When this is the case, modifications to these aspects of theories are necessary. For example, theories that place the worker in the role of expert should be used in a more egalitarian, collaborative manner, and theories that have a specific and narrow conception of human problems should be broadened to include consideration of a wide range of factors (e.g., environmental and sociocultural factors need to be considered along with biological, intrapsychic, and interpersonal factors).

A second reason for embedding direct practice within the generalist perspective is that the latter can function to broaden the mandate and role of direct practitioners beyond narrow clinical confines. For instance, it is important that the focus of clinical social work should include helping clients to meet basic needs by providing them with or linking them to resources and services, and engaging in social advocacy for clients—and the generalist perspective reminds us of the importance of such helping strategies. In addition, social work students who are entering their concentration or specialization year will have the generalist grounding and application of the direct practice theories will be reinforced by this knowledge.

This chapter provides an overview of our generalist-eclectic approach to direct practice. The major elements of the generalist social work perspective central to our generalist-eclectic approach to direct practice are reviewed. Then, an overview of the distinctive aspects of our generalist-eclectic approach is provided Finally, in some detail eclecticism, primarily with regard to the trend toward it over the last 35 years is discussed. The latter discussion includes (a) an overview of eclecticism that documents historical resistance to eclecticism, the fact of and reasons for the trend toward the eclectic use of theory and technique, and continuing resistance to eclecticism (particularly in the form of the empirically supported treatment [EST] movement); (b) a review of the four major approaches to eclecticism in the literature and some of the specific eclectic models within each of the approaches; and (c) a delineation of our approach to eclecticism.

In 1980, the battered women advocates attempted to take control of what loosely was called “the battered woman’s movement” away from the professionals. However, some of those women who already have been identified with a mental disorder that is exacerbated by the abuse or those who develop battered woman syndrome and posttraumatic stress disorder from the abuse itself may need some psychotherapy to help them heal and move on with their lives. The link between sex trafficking and domestic violence has also become much better known within the last 10 years. The history of society’s newest interest in the eradication of violence against women and children demonstrates both the intricacies of the problem and the difficulties in dealing with it. Although shelters do provide safety for only a small number of women and children, their presence in a community sends a message about zero tolerance for such abuse.

This chapter introduces Narrative Therapy (NT) as a theory that aligns with the social constructivism paradigm of counseling and psychotherapy. It provides some historical context for the development of the theory and biographical sketches of Michael White and David Epston. A primary influence to NT was the work of Gregory Bateson and his illustration of the unique way in which humans make sense of the world. NT focuses on the stories individuals tell about the events in their lives. A story or narrative is a mental account or chronicle of a person’s experiences or life events. In NT, therapeutic conversation is seen as an artful science where client stories are laid out, examined, challenged, and expanded on interactively and collaboratively. Narrative therapists take a decentralized but influential position in therapy. The narrative therapist takes great care to create an environment of collaboration, respect, and acceptance.

This chapter provides a biographical sketch of Virginia Satir, the founder of conjoint family therapy. It describes Satir’s basic ideas about relationships and their importance to mental health. The chapter presents an overview of techniques and methods of conjoint family therapy and outlines the basic premises of a theory that crossed over into a more purely relational way of viewing counseling and psychotherapy. Conjoint Family Therapy is a process of facilitating effective communication in a relational context. The therapist acts as an official observer of family interaction and as a teacher of clear communication. Satir’s treatment program is one of adhering to several basic principles. First, it is assumed that positive changes result through the interpersonal process of therapy, which is a conclusion, primarily based on her humanistic attitude that people have honorable motives and that everyone is healable.