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14 Νοε 2013 (πριν από 3 χρόνια και 8 μήνες)

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1


DVD Transcipt

The following pages include

verbatim transcripts of twelve role
-
plays that demonstrate
the twelve theories in sections I, II, III, and IV of the book.
Each transcript is preceded by
a short description of the theory. These descriptions, the
role
-
plays, as well as a
discussion that follows each role p
lay (not included here) can

be found on the
accompanying DVD th
at your instructor may show
in class. As you read these
transcripts,
reflect back on the chapter with which

it is
associated
and cons
ider if the
manner in which the therapist worked was the way you had imagined it to be after having
read the chapter.



Section I
: Psychodynamic Approaches






Page


Freudian Psychoanalysis


Jung’s Analytical Psychology


Individual Psychology (Adlerian T
herapy)


Section II: Existential
-
Humanistic Approaches


Existential Therapy


Gestalt Therapy


Person
-
Centered Counseling


Section III: Cognitive
-
Behavioral Approaches


Behavior Therapy


Rational Emotive Behavior Therapy


Cognitive Therapy


Reality Therapy


Section IV: Post
-
modern Approaches


Narrative Therapy


Solution
-
Focused Behavior Therapy


















2


Freudian
Psychoanalysis

Psychoanalysis proposes that our personality develops through a complex interaction
between the expression of our instincts and our early childhood environment where the
child encounters and internalizes shame and guilt. It is an in
-
depth therapy that assu
mes
much of our behavior is unconsciously driven and that there is value in bringing
unconscious motivations to awareness.


In this approach, the therapist is experienced as a parent figure, and therapy ideally
evolves as a more positive parenting process
. This process occurs over a long period of
time as the client builds what is called a “transference” relationship with the analyst. This
transference relationships mimics early family relationships and offers rich material for
the client to examine. The t
ransference relationship allows the client to acknowledge
forbidden and repressed thoughts and feelings in a safe environment and to integrate
these into conscious awareness. The alternative is that the latent unconscious content
remains destructive to the

client’s sense of well
-
being and personal relationships,
manifesting in such symptoms as anxiety, depression, conflicts, or addictions. The
interpretation of dreams and free association became two of Freud’s primary therapeutic
techniques for accessing re
pressed material from the past.



Let’s take a look at how Dr. Paula Justice uses dream analysis in her work with Jeannie,
as she examines some repressed feelings regarding the death of her father.


Dr. Justice:

Hi. Good to see you again. Last se
ssion I

know you said you had a
significant dream that we didn’t have time to really process. I was wondering if you’d
like to start with that today.


Jeannie:

I really would because it still is with me, and it feels like a really big dream. It

starts off in a

sense of…I’ve been invited to this wedding, and I’m aware that I’m talking
to…I think it’s the grandfather. And, well when I say grandfather he’s my age, so it’s not
white beard or…and I’m aware that…there’s such a masculine feeling talking to him.
I’m
aware that his son is also present, and the grandson. The wedding’s about the
daughter. But I’m looking at him


I mean, talking with the grandfather, and…there are
just…all three men, but the grandfather he’s so masculine. I’m aware that he’s
handsome,

that he


that all of the men in the family are, that there’s a sense of strength,
you know? I’m just very attracted to the whole family in this way.


Dr. Justice:

So there’s these three generations of sort of strong, masculine, handsome
men.


Jeannie:

Y
es.


Dr. Justice:

And this is the wedding of the daughter.


Jeannie:

Right. Right. And what seems to be so special about this is that the daughter
gets to have the wedding exactly the way she wants to. And in fact it’s almost as if
she’s…and I don’t wan
t to say spoiled because I don’t think that she’s spoiled, but she
3


has all this incredible attention by all the men in the family. And she is told that she can
have it exactly the way she wants. And it’s an extraordinary request that she’s asked for.


Dr
. Justice:

Hmm.

Now, these three men; do they remind you of anyone?


Jeannie:

Hmm.
Now that you’re saying that I, I know that when I see them in my mind’s
eye they remind me somewhat of my brothers


my brothers are very handsome.


Dr. Justice:

Mhmm.


Jean
nie:

And the…so there’s this sense of the father, the grandfather…I’m aware, I
mean, he looks kind of like my brothers as well. So, there’s that sense of the handsome,
strong male.


Dr. Justice:

So you’re the…sister, in a way, to these handsome men.


Jean
nie:

Yes. Yes.


Dr. Justice:

And in the dream the sister is marrying. And
you said she has a very special
request


what was that request?


Jeannie:

She wants to jump from an airplane, on a stallion,

into the ocean, in her wedding
dress.


Dr. Justice:

Wh
ew. And what kind of airplane is this?


Jeannie:

Well, it’s kind of like a cargo, I guess you would call it, a cargo plane, because
the back end opens up and it’s like there’s a ramp. I see her, in my mind’s eye again, I
can see her in her wedding dress
on this beautiful stallion. The ramp goes down, and she
leaps into the ocean, and the horse’s hoof catches on the ramp.


Dr. Justice:

Hmm.
So there’s sort of a stumble as she come out of the…


Dr. Justice and Jeannie
Together:

Out of the plane.


Dr. Justi
ce:

Ok. And this leaping out of a plane over
water


does this remind you of
anything?


Jeannie:

Well, the part that really grabs me the most was, one: that she gets to ‘have it
her way’ so to speak…the ocean, well I’ve loved the water. That the father h
as allowed
her to do this, has given her this as a gift so she can have this wedding…


Dr. Justice:

And what about your own father?


4


Jeannie:

You know, just when I was…Yeah. How strange, you know? I just
remembered that my father, who…again, I’m going
back and forth in my head about
several different things as a daughter. And he was a pilot.


Dr. Justice:

Hmm. I remember you saying he died when you were very young.


Jeannie:

I was wondering if you had remembered that I had told you that. I was four,
and
he was flying in the Air Force, and he was lost, actually, over the Gulf of Mexico. His
ejection seat went off, and…


Dr. Justice:

So he sort of jumped out of a plane.


Jeannie:

What you’re making me think about is the connection with this good
-
lookin
g
grandfather too, and the whole masculine piece of it that I feel like I missed in my life.
And as you know, my husband…had a terrible accident recently. And I’m aware that I
didn’t have my father to walk me down the aisle. I’m aware that I have always

wanted to
be a Daughter. I’m aware that I love the sense of my husband, who was for the first time
in my life, I think, a very strong masculine force. And I have felt protected by him. And
now he’s wounded.


Dr. Justice:

Mhmm.


Jeannie:

And you know, t
hat idea of that horse stumbling…the ramp reminds me of how
my husband is now paralyzed. And he has to…the only way he can get around is with a
van that has a ramp on it. And so he’s now broken, or wounded.


Dr. Justice:

So the dream really brings up
that longing for the strong masculine, for the
father that you lost so early in life, the masculine strength that you had in your husband
but, in a way that’s been a little lost with his disability, his accident.


Jeannie:

You know, and that’s why I think
the dream impacted me so much, because of
that sense of longing, and sorrow that comes up, wells up in me. And I hadn’t made that
connection with my loss of my dad. And you know, it’s so funny even to say the word
‘dad.’ I speak of him as a father becau
se I didn’t call him ‘dad.’ I don’t remember that,
or ‘daddy.’ So when I think of a strong masculine, and I had it for a while: the courage.
He was a jet pilot, and here’s my husband a motorcyclist, a spelunker


all the loves of
the physical. And that
’s, I think, what I do connect with the masculine: being strong, and
adventurous, and courageous.


Dr. Justice:

And in the dream, you sort of leap, as the daughter figure, you leap


she
leaps


from the plane into the water, which is where your father was

lost, in reality.
Over the water. So you’re almost, it’s almost a wish to join him.


Jeannie:

You know, there is…

I think, part of that longing, now that you bring that up,
it’s probably what I would call…I feel like sort of a questioning of being here,

when I’ve
5


suffered so much loss, to join him is what you’re saying? There’s probably some kind of
longing for me to join with him? Wow. Ok, that makes sense.


Dr. Justice:

And that would be sort of magic, to be able to join with that strong
masculine:
have your father back, have your husband whole again.


Jeannie:

If only. If only.


Dr. Justice:

And that wish, of course, doesn’t mean that you’re spoiled.


Jeannie:

Well thank you for that one. You know I think that there is a piece of it, if I
could h
ave it my way, if I could have the masculine protect me, to give me, to support
me, you know, if I had a father…what would that have been like for me?


Dr. Justice:

And knowing that, knowing that you have those feelings that this dream has
surfaced for you
, how does that sort of inform your waking life today?


Jeannie:

You know, in telling you, and you asking me some of these questions, I’m really
aware of a sense of


I’ve started breathing better…I think it brings some sort of comfort
knowing that there’s

a connection this way, you know, that I can make that connection,
that I know that I long for that. So thank you.


Dr. Justice:

Well thank you for sharing that.


Jeannie:

I feel much better. Thank you.


Dr. Justice:

Good.




















6


Jung’s
Analytical Psychology

In Jungian analysis there is an assumption that the individual achieves well
-
being through
the exploration of what Carl Jung called the personal unconscious and the collective
unconscious. The personal unconscious contains repressed m
aterial from childhood and
is symbolized by Jung’s archetype of the Shadow self, which represents all parts of the
psyche unacceptable to self and others. Jung believed that the most important task of
early adulthood is to bring the contents of the Shadow
self to awareness and integrate it
into the conscious personality. The Shadow manifests as the opposite of Jung’s concept
of the Persona, or our public mask.


In contrast, the collective unconscious is a universal and transpersonal component of the
psyche

that contains all human experience and potential. Once the Shadow has been
embraced, the client can continue in the process of what Jung called
Individuation
, a
gradual incorporation of universal archetypal patterns into everyday experience. These
archetypes provide blueprints for creative development and manifest in our dreams, art,
religious symbols, and myths. Two of the most significant archetypes are the
anima
,
which

represent
s the feminine within all males, and
the
animus
,

which represents
the
masculine within all females.


Jung believed that the unconscious could be accessed through the imagination as
manifested in dreams, free association, images and sy
mbols, as well as what Jung called
Active Imagination. Exploring these symbols and images are a means of understanding
the past, relieving psychological symptoms, and finding guidance in creating a full and
more meaningful life.


In this role
-
play, watch how Dr. Paula Justice works with Carin as they explore dream
images to help the client acknowledge and embrace her Shadow self and how it might be
integrated into her public self in waking life.


Dr. Justice:

Well welcome back, it’
s good to see you.


Carin:

Good to see you too.


Dr. Justice:

And the last time we were together, you said you had an interesting dream
that you thought was important to what we were talking about. Can you sort of describe
that at this point?


Carin:

Yes
.

Well, I was in a shower room, and I remember being surrounded by
extremely obsese women

like 3 or 4 or 500 pounds. And I remember walking though
it, and we all were naked, we had no clothes on, but I remember being so proud that I was
the only thin one t
here. But all these women…I just was disgusted by them. I couldn’t
believe that they were in this shower room with me.


Dr. Justice:

And so how did you feel when you woke up from this dream?


7


Carin:

Well I did feel pretty disgusted at how someone could l
et themselves get like that.
I just am turned off by it, that lack of self
-
control. I felt proud also, in my dream, because
I was so different from the rest of them and I had a certain amount of self
-
control and I
was doing good.
So proud and disgusted.


Dr. Justice:

Ok.
And do you have any sense of…we had talked about day’s residue, how
this might relate to your waking life.


Carin:

Yes.
Well, I’m doing these pageants: I’m doing Miss Virginia Beach and Miss
Portsmouth Seawall. And especially for Miss Po
rtsmouth Seawall right now I’m really
dieting. And I’ve lost about five pounds in the past two weeks, and that’s a lot for me; I
don’t usually fluctuate like that.


Dr. Justice:

Mhmm.


Carin:

And so I’m not allowing myself to eat everything I would like t
o, so I think that
that is definitely being perceived in my dream as my daily residue, is people that can eat.
And I almost like them, but I’m still proud of myself, so it’s that tearing emotionally.


Dr. Justice:

Ok.
So being very conscious about your ow
n eating and your own weight
because of the pageants may have prompted this dream.


Carin:

Oh yes.
Because we have to be in a swimsuit in front of everyone.


Dr. Justice:

Right.
And we had talked about how dreams sometimes present a balance or
a compensation for what’s going on in our waking life. And so here we have these
women overeating, whereas you’re having to be so conscious of not eating.


Carin:

Yeah.


Dr. Justice:

And I
encouraged you to perhaps do some journaling with the dream. Were
you able to do any of that?


Carin:

Yeah, I actually brought it with me. I did a dream dialogue instead of the journal,
where I actually talked to one of the women, and we had a conversati
on. And she said
“Why are you so disgusted by me?” And I told her “your lack of self
-
control and what
you’re doing to your body, it just disgusts me.” And I said “I never want to be like you.”
So we had a pretty rough conversation.


Dr. Justice:

Mhmm.

Did you feel toward her differently in going through the
conversation?


Carin:

Sort of towards the end, she kind of encouraged me to, you know “It’s ok to
overeat every once in a while, you can be indulgent once a week or whenever,” and I sort
of encourage
d her to, you know “Maybe we can go work out.” So we both tried to help
8


each other out at the end. So that was good. It was a very rough beginning but we kind
of came to amends at the end, to a degree.


Dr. Justice:

Mhmm. So you felt a little closer to

her.


Carin:

Yeah.


Dr. Justice:

I remember in one of our earlier sessions talking about how there are some
weight issues in your family and how you had some weight concerns as a younger
person.


Carin:

Yeah. When I was younger, I know I was extremely
overweight, and I remember
in 5
th

Grade my parents having to sit me down and say “You need to lose 20 pounds
or…you might develop type 2 diabetes, and this and that…” I also have two uncles who
are extremely obese. One of them is applying for gastric byp
ass surgery right now and
the other one is a workaholic and just doesn’t care. But his wife is so concerned. So I
feel like…I think I’m especially disgusted by these women because it runs in my family,
and I’m afraid that it could be a little too easy fo
r me to get like that because of the
genetic traits that I carry.


Dr. Justice:

Mhmm.
And I remember you saying that it wasn’t until you had that
conversation with your parents you became



Carin:


Self
-
conscious.


Dr. Justice:

Yeah.


Carin:

We used to do
weigh
-
ins in PE, in front of everyone. And I remember that was a
little weird because I weighed more than all the other kids. But I really didn’t care until
my parents told me that there was something wrong with it. And then I remember it was
like a sna
p; I said “Oh, this isn’t right.” And so from then…I remember in 6
th

Grade I
went on my first diet, and I lost about 40
-
50 pounds that year.


Dr. Justice:

Wow.


Carin:

And from then on it’s just been sort of an obsession of mine. My sister has it as
well, we’re both eating
-
obsessed.


Dr. Justice:

So in this dream perhaps you’re seeing sort of a shadow part of yourself, you
remember that we talked about the shadow part, the part that just lets herself go.


Carin:

Yeah, it’s the part that I’m scared of
too, the shadow part that I don’t want to be
seen. I don’t want to show people that I have a lack of self
-
control. I know when people
show a lack of self
-
control around me I just get very angry, and I know you said that’s a
part of your shadow self, thin
gs that you get very angry about.


9


Dr. Justice:

Mhmm.


Carin:

I get very angry at very overweight people because I know it’s unhealthy and I
know that they could die

my grandpa died of a heart attack, which was related to
smoking as well, but also his extr
a fat and stuff like that. His heart wasn’t strong enough.
So it’s a serious fear of mine.


Dr. Justice:

Yeah. So you have these family health issues, you have your parents’
concern, you have the beauty pageants



Carin:


And also the career.


Dr. Justi
ce:

Oh.


Carin:

Because I want to go into television somehow. Hopefully on camera; my dream is
be on camera on TV somehow as my career. And to do that I have to be very thin
because TV adds weight to you. And I’m to the point right now where I feel like

I’ve got
all my studies in line, I’ve got all this in line, I’ve got everything else except for the
weight under control. That’s my mindset. So if I gain weight then it’s like I’m self
-
sabotaging my career. So it’s extra pressure for me.


Dr. Justice:

One of the things that we work on with the shadow is finding a way to
embrace it so it isn’t so frightening or so threatening. You have a lot of reasons to be
fearful of these overweight women in the dream, but is there anything about them that
may be pos
itive?


Carin:

Yeah. We just saw this movie

it had Queen Latifah in it…I don’t remember
what it was called. She learned that she was going to die in a few months, and so she
lived her life, and she’s a thicker woman, and she was portrayed as so beautiful

and just
so wonderful, and she had so much to give. Actually, Hollywood is sort of steering away
a little bit from the anorexic models; in
Fashion Week

they just fired several models
because you could see their bones. So…society’s becoming a little bit
more encouraging,
and I can really see especially in heavier women, you can see their inner beauty a little bit
more, I think. Like in the movie with Gwyneth Paltrow

I don’t know if you’ve seen
it

I don’t really remember the name, but she was able to date

this boy because he was
hypnotized to only see her inner beauty.


Dr. Justice:

Is that “Shallow Hal?”


Carin:

“Shallow Hal,” yes. So that was cool to see, how much inner beauty they have
inside of everyone.


Dr. Justice:

Mhmm.
And I remember you saying
once that sometimes you associate very
thin women with coldness and distance.


10


Carin:

Very stoic, yeah. Heavier women…I think of them as more loving and caring.
For some reason I have that in my head. I think it’s because of some literature courses
I’ve

taken; we describe motherly women, loving women, as heavier and skinnier women
as meaner. I don’t know.


Dr. Justice:

So even though the overweight women are threatening in terms of your
career and possibly your health issues, there’s something about the
m that’s softer, more
loving, more motherly.


Carin:
Yeah, uh huh.


Dr. Justice:

And how might you want that in your life and in your future?


Carin:

Well I do know that I need to calm down on the eating obsession, so it is a part of
me that…I would love to not care about what I eat so much. So that’s a positive thing in
the dream, these women really don’t care what they eat. I’d love to be like that.

So that’s
an emotional mindset that I’m going to try to get to. And also they’re just so loving and I
want that as well. I want to be able to be like that instead of being so rigid about
everything I have to do. So there’re lots of positive things.


D
r. Justice:

And I know you said that you felt like your boyfriend accepts you just the
way you are.


Carin:

Yeah, my boyfriend. Matt, he always

I know that I’ve gained maybe 10 pounds,
during Christmas time especially, and then had another pageant so I lo
st 20, but he has
always been there. Every day he says “you’re so beautiful, you’re so wonderful, you’re
amazing.” So that’s so encouraging to me because I used to think “if I don’t lose weight
then I’ll never get a boyfriend.” And now that I’m getting
older “I’ll never get a
husband, never keep a husband if I can’t stay thin.” So his unconditional love has been
so encouraging to me for my body image, to just know that I can be loved no matter what
I look like.


Dr. Justice:

So he doesn’t have any probl
em embracing that part of you.


Carin:

Not at all, no. He likes it. He does like this to my arm, saying “I love this jiggle!”
He likes it.


Dr. Justice:

And you’re comfortable with him, whatever size he is.


Carin:

I’m very comfortable, yeah. He actual
ly hurt his back and so he gained a little bit
of weight. And he was very self
-
conscious about that, but I think he’s beautiful all the
time so it’s cool for me to see that as well: me not caring if he gains five pounds, and him
not caring if I gain 10.
He loves me for more than just what I look like.


11


Dr. Justice:

So in becoming aware of the dream and dialoguing with the characters and
looking at it a bit, you’re kind of moving a little closer, maybe, to accepting some of the
things that these women
represent in yourself and in your future.


Carin:

Yeah.
Not completely, but a little bit.


Dr. Justice:

Baby steps.


Carin:

Yeah.
Baby steps…so good.


Dr. Justice:

Well thank you very much for bringing that in.


Carin:

Well thank you for having me.


































12


Individual Psychology (Adlerian Therapy)

Alfred Adler posited that we all develop styles of life that seek to compensate for innate
feelings of inferiority. He believed that we attempt to overcome such feelings as we strive
for a sense of superiority, defined as a desire to achieve emotional heal
th and
completeness. He also felt that emotional well
-
being could be gauged by an individual’s
degree of social interest, or sense of connectedness to others and to a worldwide
community.


Adler stated that we are often victims of faulty assumptions or in
accurate perceptions of
the past that drive the kinds of choices we make. These choices are often based on our
family constellation, birth order, and childhood memories.



Although considered a psychodynamic theory by most because of its focus on
understan
ding the dynamic forces that shape one’s psyche, Adler’s theory has also been
described as one of the first to apply humanistic and systemic concepts.
This is because

Adler believed that people can change, create the future, make meaning in life, be goal
-
d
irected, and not necessarily be shackled by past events.


Adler saw therapy as occurring through a series of stages that included establishing a
collaborative relationship, analyzing the client’s problems, sharing insights, helping the
client reorient him
self or herself to new ways of living, and reinforcing and evaluating
the change process.


During the therapeutic process the therapist will often show empathy, conduct a lifestyle
assessment, examine early recollections and dreams, communicate respect and

confidence, focus on strengths and encourage clients, help clients combat faulty
assumptions, and focus on goals.


Let’s see how Dr.
Sylinda
Gilchrist uses some of the above techniques to help “Shannon”
examine her lifestyle as it relates to her family constellation.


Dr. Gilchrist:

Hi

Shannon
,

what brings you to counseling?


Shannon:

Well I’ve really just recently been feeling really overwhe
lmed, and stressed
about…I feel like I have so many obligations in my life that pull me in different
directions that I’m not able to give my all to each of those areas.


Dr. Gilchrist:

So how long have you been feeling that way?


Shannon:

Actually I said
recently, but when I think about it probably as long as I can
remember.


Dr. Gilchrist:

Ok. Since you were a child?


Shannon:

Yeah.


13


Dr. Gilchrist:

Can you tell me a little bit about your childhood?


Shannon:

Sure. I grew up with my mom and my younger br
other; he’s four years
younger than I am. My parents divorced when I was 8, so for the longest time it was just
my mom, my brother, and me. We kind of bounced around a lot, she worked two jobs to
support the two of us as a single mom.


Dr. Gilchrist:

So
you’ve been feeling overwhelmed for a long time now.


Shannon:

Yeah, and actually I’d probably say even before I was 8, before they got
divorced, because my dad is an alcoholic, so even when they were together it was just
chaotic. And I always wanted to p
rotect my brother and help my mom.


Dr. Gilchrist:

Help your mom how so?


Shannon:

Around the house, and helping out with my younger brother
-
taking care of
him. I really…didn’t have a childhood, I guess, because I did a lot of adult things.


Dr. Gilchrist
:

Adult things like?


Shannon:

Doing the dishes, cooking dinners, staying in to watch my brother while my
friends are outside at the park and stuff. So lots of things I guess.


Dr. Gilchrist:

So it sounds like you had a lot of responsibility for taking
care of your
younger brother.


Shannon:

Uh huh.


Dr. Gilchrist:

What did you do for you?


Shannon:

Me? That’s an interesting question…I guess for me, I got straight A’s.


Dr. Gilchrist:

That’s an accomplishment.


Shannon:

Yeah, but I really stressed mysel
f out doing that.


Dr. Gilchrist:

How did you stress yourself out?


Shannon:

Just…feeling like I have to make straight A’s, and not even or only in school. I
do that at work
-
I have to be the best employee. I do that at home, I do that with my
friends, my

roommates, and even in relationships, romantic relationships.


Dr. Gilchrist:

So it seems like you strive to be perfect in school and in other areas. You
might even be striving to be the best client.


Shannon:

Yeah, I guess.

14



Dr. Gilchrist:

It sounds lik
e you have this need to be perfect. Is that stressful?


Shannon:

It is, it is. I feel very disappointed if I don’t do my best. I beat myself up over
that. So it’s really stressful.


Dr. Gilchrist:

Who places that expectation on you?


Shannon:

I guess I
do, but in order to make people proud of me.


Dr. Gilchrist:

Ok. Can you tell me your earliest recollection of maybe not being perfect?


Shannon:

Yes, and actually when you said that it came to me immediately. In seventh
grade I got my first B and I was e
xtremely upset. And I cried the whole way home
because it was an awful feeling, just awful.


Dr. Gilchrist:

Ok. And so you said that it made you feel really awful.


Shannon:

Mhmm. It just…I felt…I had made straight A’s up until that point and that
first

B, I was so disappointed like I had just let myself down completely from what I
expected of myself.


Dr. Gilchrist:

Since childhood you’ve always been striving to be perfect. How is that
working for you?


Shannon:

It’s really really

stressful. Sometimes it even makes me sick, like physically
sick. I will stress myself out to the point where I have a stomach ache or a really bad
headache that I can’t get rid of. So I guess it’s really not working.


Dr. Gilchrist:

And it seems like
this stress, this need to be perfect is really causing some
physical symptoms as well as adding to your stress level.


Shannon:

Yeah. And then when I get sick it takes away time that I need to be using for
studying or work…it creates a cycle and…


Dr. Gil
christ:

Adds more stress.


Shannon:

Yeah.









15


Existential Therapy

Existential therapy is loosely based on existentialism, such as the writings of Jean Paul
Sartre and Martin Buber. However, its application as a therapy is actually much more
optimistic
than the writings of many existentialist authors. Existential therapists believe
in the importance of discussing the philosophy of existential therapy and view therapy as
a shared journey that examines meaningfulness in life. Thus, it is not unusual for
ex
istential therapists to share their knowledge about living (and dying) and to even
periodically self
-
disclose as they attempt to develop an authentic relationship with their
clients. Because existential therapy is based on the sharing of a philosophy, it d
oes not
offer specific techniques for doing therapy. However, some argue that “sharing a
philosophy” is a technique in itself. Some of the underlying assumptions of this
philosophy include the following:


1.

The ability to self
-
reflect and be self
-
aware
.

Alth
ough individuals often choose a
life of denial, they are capable of self
-
reflection and self
-
awareness.

2.

Feelings as a message of our being in the world.

Anxiety, guilt, depression and
other feelings are a statement about the choice
s we make

and should be e
xamined
in this context, not as an indication of pathology.

3.

Choice
: We are capable of making positive choices for ourselves and for

all of
humanity.
Not choosing is a choice and can lead to what some have called an
“existential death or existential vacuum.


4.

Responsibility
.
We have a responsibility to make choices that will positively
affect ourselves and others. Otherwise, we all will live in chaos.

5.

Meaning through our relationships with others
. We are constantly redefining
ourselves through our relationshi
ps. Therapy is a journey through which the
therapist and the client are equal partners in their search for meaning.

6.

The importance of authenticity
.

It is critical that we are real with others.
Otherwise we live a life of lies and deceit

a life filled with

denial of one’s true
feelings and inner thoughts.

7.

A never
-
ending search for completeness and wholeness.

As we become more
authentic and more aware, healthy choices become more obvious and easier to
make. However, due to the complexities of life, we will b
e faced with choices,
sometimes difficult ones, until we die.


Let’s see how Dr. Ed Neukrug applies this philosophy with his client, Betty, in their
shared existential journey.


Dr. Neukrug:

Well Betty, I want to thank you for coming in today and agreeing
to share
some of your thoughts and concerns with me and um, wanna just kind of open it up and
start wherever you liked:


Betty:

Well uh, I just recently retired from the police department and I’m moving into a
profession now, (into) counseling where I unde
rstand that I will need to have some type
of closeness, a relationship with my clients, but I really don’t have any, that much
experience in that regard because of my work and um, like the only uh, substantial
relationship I’ve had was with my mother.

16



Dr.

Neukrug:


It’s fascinating I find the contrast between being a police officer and a
counselor really interesting. Especially when you talk about the fact that it sounds like
you want some intimacy in your life, but you haven’t really had that except for w
ith your
mother, so there is a stark contrast there between, again between being a police officer
and being a counselor. It sounds like you want to move into that direction of having more
intimacy in your life in general.


Betty:

Yes um, I just… I just fin
d it, I find it hard to talk about um, I umm


Dr. Neukrug:

Which parts to talk about?


Betty:

Uh, the intimacy part and I don’t understand how to work it, how to work it out
because there’s certain aspects of myself that just didn’t uh, acknowledge, I igno
red. I’d
say the emotional part of myself was not honored. And now that I’m stepping out of a
role in which I had a script, you know, I had the uniform, I knew what I had to do there
was no question about what I had to do each day it was like a mantra, i
t was like
something I did everyday and now, it’s… I have to be, I have to come out of myself.


Dr. Neukrug:

It almost sounds robot
-
like. Um, that you kind of, lived a role you even
said it you wore a uniform. And you put a certain image out to the world

an image which
was maybe not the real you, as you saw yourself inside and now you’re really searching
for who that inner being is.


Betty:

Right… More so uh… also, um, working in an environment that has been
historically racist and sexist uh... you tend t
o want to be invisible. Oh I mean to say “you
tend to be”… I tend to want to be invisible and not… and not be in front, so open about
who I was. It was like I just following the role, being like the “good girl” and my
womanhood was not honored it was a m
inor thing and it was not just something, not just
talking about the people, I’m talking about with myself and how it’s coming out that’s
who I am.


Dr. Neukrug:

OK, so you found that, in that environment being a police officer, am I
correct in hearing tha
t you personally experienced racism and sexism…


Betty:

Yes...


Dr. Neukrug:

… and that was very difficult for you and you kind of hid, is that accurate?


Betty:

Yes, yes... um the way I dealt with that was to… to feel like I had to achieve in
order to be
accepted, it was conditional. Um, I don’t know what else to say about that. It
was... it was uh, hard lessons. I learned a lot I also had to look at… look at how I, my
role in all of it…


Dr. Neukrug:

You made some difficult choices I think as a police
officer, in terms of how
you were going to live your life because of the sexism and racism and the nature of being
17


a police officer. The choices were maybe they weren’t even that conscious, but it sounds
like the choices where to kind of hide your real se
lf.


Betty:

Well it wasn’t like… well it was true it wasn’t conscious, uh I had to come to this
point reading, books and looking at other people to realize how much of myself was
unconscious of… what I was really doing was detrimental to me as a person… an
d
emotionally. So now that I have to work with people in that area, I need to, uh I need to
know myself and how to be in the world authentically.


Dr. Neukrug:

Well I’m certainly impressed that this is, that you’ve switched roles like
that and that this

is your new goal for yourself um and I’m really interested in how you
were able to raise your consciousness around your lack of awareness of self and your lack
of intimacy and how you were playing roles. How did you do that?


Betty:

Well, I’d say it happ
ened two different ways. One way was books I uh, there was
a book I found called, “Black Feminist Thought” that really opened my eyes a lot and
also when my mother was sick, I realized I was working and I realized that the role of
caring and the heart is
so much more important to me in this life than… then the, I don’t
know what other way to put it, but a masculine way of being… being out there and then
the role of caretaking when my mother was sick was very important. I had to really like,
really open up

to that and that takes a lot of courage to uh… do that…


Dr. Neukrug:

Yes it does and I hear how courageous you were. And I think I’m also
hearing these kind of two parts of yourself being opened up at the same time and that was
that feeling part of you
rself through your mother’s illness and also kind of the intellectual
part of yourself through this book that you read and other books that you’ve read. The
both of those kind of raised your consciousness about the importance for you that you
found more a
uthenticity in your life.


Betty:

Mmm
-
hmm, that was because, uh when you watch someone suffer which is hard,
I mean with the police work, uh there was uh, it was more of a…


Dr. Neukrug:

…Detached suffering?


Betty:

…Detached pseudo kind of presence I gu
ess and you knew that you had to bind
yourself emotionally to get through it. It’s not a bad thing because, sometimes you need
to do that … uh you just don’t know what to do with it. And when my mother was
sick… Then I had to really look at those feeling
s and try to integrate then and that was
really hard… a lot of anger and all that.


Dr. Neukrug:

So again, your mother’s illness really made you look at yourself in some
deeper ways.


Betty:

Right, right. I had to make decisions to balance work and was at the hospital with
her a lot so I had to balance work and be there or make the decision to leave work and be
there, you know, leave so I had to uh, it was… it was like I don’t know if this ma
kes any
18


sense, but it was like dealing with my mother and father. Like the police department, to
me, was like my surrogate father where you were like, not exactly I would say, a
balanced view of a father, but you had to be there, you had to stay strong, y
ou had to do
your job along with my mom it was… it was different, I had to be open and receptive and
feeling, like you said get in touch with feeling parts.


Dr. Neukrug:

Yeah, I think that I can really understand what you’re saying. I had a kind
of simil
ar experience with my mom who was ill a few years ago and passed away and I
was like I was living two lives in some ways. Is that kind of the experience that you had?


Betty:

Yeah, exactly… living two lives…yeah.


Dr. Neukrug:

And I guess the um, in a way
, and I hope you understand how I mean this,
the gift that your mom gave you, in her illness, was to help you see a deeper part of
yourself.


Betty:

Alright, yeah… absolutely… because I did have to, um, walk through that and
see… I, I mean I really had t
o just be there and connect with a deeper part of myself
which wasn’t very easy or pretty. Life was very messy, yeah… yeah.


Dr. Neukrug:

So now you’ve chosen a field which is, and maybe this was more of a
conscious choice, you’ve chosen a field which dea
ls mostly with authenticity and
realness and now you wanna move on with your life in a new way. In a way where you
have more realness in relationships, more intimacy, um, perhaps realness in your
counseling relationships, perhaps more realness in your fri
endship and love relationships
and now you can consciously begin to make choices about bringing yourself to this new
place. Does that make any sense to you?


Betty:

Yeah , I um, I have to… well I need to, let’s see… I would say… honor my
emotional life,
which I have not done. It’s, uh, usually a sign of weakness in my uh, my
way of being in the world before…


Dr. Neukrug:

That was you before and now we have a new you and I’ve got to say, I
really respect this new you. As you are honoring yourself, honor
ing your emotional self
and beginning to listen to it more effectively, more frequently.


Betty:

Yeah, more frequently… thank you.


Dr. Neukrug:

Well it sounds like it’s been a kind of, hard road for you in recent years, but
it, I’m also hearing that you’r
e making some really good choices for your self as you’re
moving forward in your life. And again, I really respect that.


Betty:

Thank you. Seems like I have to work really, really hard to be uh, anything more
than ordinary … so I’ll just uh, just keep w
orking as long as I don’t lose myself in my
work, that’s a fear too… (laughs)


19


Dr. Neukrug:

You want to remain real…


Betty:

Right, right, right, right! Yeah…


Dr. Neukrug:

I guess I’m thinking a lot of times we think that, um, life is gonna be easy,
bu
t um… as you’re showing us, it usually isn’t. There are so many things in life that, that
give us difficult, hard times and messages to ourselves about who we are and where
we’re going and I think you’re really hearing some of the messages you’re getting
about
yourself.


Betty:

Can you give me something to uh, take with me?… (laughs)


Dr. Neukrug:

I guess what I’m hearing… that’s a great question! I guess what I’m
hearing is that you’ve bee giving your self something and if I can give you anything
that’s what I want to give you and that is to continue to give yourself that sense of inner
awareness that you’ve begun to give to yourself. Thank you for sharing today.


Betty:

Thanks…





























20


Gestalt Therapy

Originated by Fritz Perls
, Gestalt Therapy has as its core belief the notion that reality is
often clouded over by unfinished business and it is therefore necessary to urge clients to
experience the “now.” Believing that awareness equals reality and that individuals tend to
avoid
unfinished business, Gestalt therapists are active and directive as they push their
clients to understand how they use external supports to disguise their past hurts and pains.
Examples of some common external supports include the use of nonverbal behavior
, such
as a client who taps his foot at the mention of an anxiety producing subject;
intellectualizing, such as a client who spews facts and figures to avoid feelings; and
blaming, such as a client who states that her depression is due to how her husband a
nd
children treat her. In stark contrast to many psychodynamic approaches which slowly
attempt to help clients understand their defenses, Gestalt therapists push clients to deepen
their experiences and be freed from their defenses. A few of the many techni
ques Gestalt
therapists have developed to accomplish this include:


1.
Awareness Exercises,
such as when the therapist asks

the client to close his or her eyes
and experience all prevalent feelings, thoughts, and senses to quickly get in touch with
one’s d
efenses.


2.
Playing the projection and Using “I”

Statements
are used to discourage projecting
onto others and things. For instance, the statement: “I hate her, she doesn’t love me,”
becomes, “I hate myself; I’ve never learned how to love myself.”


3.
Exag
geration Techniques
are used

when the therapist
wants the client to get in touch
with the underlying meaning of a word, phrase, or nonverbal behavior. A client who
slouches is asked to slouch more and state what he or she is feeling. Suddenly the client
st
ates: “I feel as though the world is on my shoulders.”


4. The
Empty Chair
Technique

is used to help a person dialogue with a part of self or
another person in order to uncover underlying issues and feelings.


5.
Turning Questions into Statements About Se
lf
are used because gestalt therapists
believe all questions are really statements about underlying feelings, issues, and values.

For instance, “Why don’t people care more about others?” may become: “I feel that
people don’t care about me.”


Let’s see how

Dr. Ed Neukrug works with “Jill” to help her get in touch with some of her
unfinished business surrounding the death of her mother.


Dr. Neukrug:

Well Jill, I really appreciate you being here today and I know that you had
some feelings and thoughts about
some issues with your mom that you wanted to talk
about. So I’d love to hear what that’s all about.


Ji
ll:

Okay, I’m having a lot of difficulty dealing with the recent loss of my mom. My
mom died a few months ago and before she died, there was about a ye
ar and a half that I
didn’t have any contact with her. And I’m having a lot of trouble dealing with that. I
21


was close with my mom for my entire life, but for the year and a half prior to her death,
she didn’t have any contact with me. And fortunately I
was able to see her the week
before she died, but it still didn’t heal any of the pain that I felt for the year and a half that
she didn’t have contact with me. So I’m hoping that um, you’ll be able to help me… get
through some of the, um, emotion that I’
m feeling, um, help me resolve some of that pain
by talking about it and coming to terms with it.


Dr. Neukrug:

Even as you’re talking I can see just in your face that the feelings are really
near the surface and that there’s really a lot of pain there f
or you.


Jill:

Right… a lot of pain. Um, basically, like I said, my mom and I were close for my
entire life, uh she had trouble with relationships with my siblings and I was the one that
always stuck up for my mom. An um, about two years ago, she was dia
gnosed with a
terminal disease and I decided to have a family reunion at… in the Outer Banks. And I
invited my entire family, for the family reunion, and she did something very hurtful to
one of my siblings. And I didn’t stand up for my mom, and as a res
ult of that she decided
to cut all communication with me and didn’t attend the family reunion. I, um, actually
hired a photographer, to take a family picture of everyone so that we would have that
remembrance of her knowing that she only had a couple of y
ears to live. My mom didn’t
attend the family reunion; everybody else was there, so now I have this picture of the
whole family minus my mom. I’m having a lot of trouble, (voice breaking up); looking
at the picture knowing that I wasted a year and half o
f my life not having her in my life
and now it’s too late to make amends.


Dr. Neukrug:

Okay… so it feels like you had this potential time to be with her and then
she cut off communication with you and so you’re really missing having that closure with
her.


Jill:

Right… knowing it’s too late… to do anything.


Dr. Neukrug:

Okay… so what I’m thinking is that maybe you need to have a
conversation with her and talk with her about how you’re feeling. And that’s something
we can do here, with this chair as if sh
e was here. What do you think about… about that?


Jill:

Pretend she’s here?


Dr. Neukrug:

Mm
-
hmm (affirmative)


Jill:

I can try… I can try that.


Dr. Neukrug:

Maybe you can talk to her, to you mom. What do you usually call her?


Jill:

I have (a) nickname, well we all have a nickname, we call her “Muz.” It sounds
funny I know, but that’s her nickname, Muz.


22


Dr. Neukrug:

Okay… does that bring up some emotions when you say the name? Can
you say that a few times? Muz… Hi Muz.


Jill:

Hi M
uz… sigh…


Dr. Neukrug:

Okay… you go, you can just… you can go with that feeling to say Hi
Muz…


Jill:

Hi Muz… hi Muz…


Dr. Neukrug:

And if you can put words to some of the feelings that you’re having…


Jill:

nods…


Dr. Neukrug:

I know how much you miss
her if you can put words to… and talk to her
and tell her.


Jill:

Hi Muz. Hi Muz. First I love you, miss you terribly and I miss the past year and a
half. (sobs)


Dr. Neukrug:

Can you tell… can you say to her, “I feel I’ve been cheated out of that past
year and a half?”


Jill:

I fell cheated out of the past year and a half. … Sigh... I feel cheated out of the
family reunion. I feel cheated out of the experiences our entire family could have had.


Dr. Neukrug:

Can you tell your mother how angry you ar
e at her?


Jill:

I’m not good at it… expressing anger.


Dr. Neukrug:

Can you try that?


Jill:

I’m really not good at expressing anger.


Dr. Neukrug:

Okay


Jill:

I’m hurt.


Dr. Neukrug:

Okay… tell her about the hurt…


Jill:

You know? I feel hurt. I feel h
urt that I was the only child that always stuck up for
you. When everybody else turned their back on you I was the only one that stuck up for
you!


Dr. Neukrug:

C
an you say, “I stuck up for you and then you turned your back on me?”


23


Jill:

I stuck up for

you and you were the one that turned your back on me! (sobs) And I
don’t think I deserve that.


Dr. Neukrug:

And tell her how much you miss her.


Jill:

I miss you and I wish I could take back the past two years… (sobbing) I really do. I
would give
anything to take ‘em back… it’s so petty now. It’s so petty now; I wish I
could take it back. But, I’m grateful, I’m grateful that I got to say goodbye to you.
Because that’s the only thing that I can look back on now and be grateful about because I
tru
ly don’t think I could… I truly don’t think I could deal with any of this now if I didn’t
have the opportunity to say goodbye to you.


Dr. Neukrug:

So you did have that opportunity?


Jill:

Yes


Dr. Neukrug:

So a lot of the feelings that you have is not
around your closure, saying
goodbye, it’s more around the feelings you have, having missed that year and a half with
her.


Jill:

Right, right. Exactly.


Dr. Neukrug:

Okay… and do you ever think about what she’d say back to you if she was
here?


Jill:

Well
, my step
-
father told me a few months ago, he actually came to visit me, and he
said, “Jill I just want you to now that your mom loved you very much.” You know, and
that meant a lot to me so I truly think that she was just, you know, stubborn and I don’t
think she meat to hurt me. I think she was just stubborn and had difficulty, you know,
making that first move. You know?


Dr. Neukrug:

I kind of hear how much you loved her…


Jill:

Oh, very much.


Dr. Neukrug:

And maybe you can tell her one last time how

much you loved her and how
much you regret not having had that time with her.


Jill:

Muz, I love you. I do regret wasting the past year and a half of your life. I’m glad
we had all those other years and I’m lad we had all those other photographs. And I
’m
glad that I have Joe, my step
-
dad. And I promise that I will not waste any years with
him.


Dr. Neukrug:

And I… I sense and feel the loss that you feel from not having that year
and a half and I think that’s gonna be, um, an ongoing issue for you. Bu
t I hope that you
can continue to have conversations with your mom. Maybe though a chair, though
24


journaling, um in other ways so that you can help to resolve some of those feelings that
you have.


Jill:

Thank you, very helpful.


Dr. Neukrug:


Well, I look

forward to hearing how you do with that.


Jill:

Thank you.







































25


Person
-
Centered Counseling

The heart of person
-
centered counseling rests on three critical personality characteristics
that Carl Rogers, the founder of this
therapy and philosophy of living, believed were
critical: congruence, unconditional positive regard, and empathy.


People who are congruent are real, genuine, or transparent with others. Their feelings,
thoughts, and behaviors are “in sync.” However, it is

important to note that therapists
who are congruent do not necessarily express moment
-
to
-
moment feelings with clients as
sometimes such feelings can rapidly change and often deepen over time. However, it is
important for the therapist to express feelings
toward his or her client, even negative
ones, if such feelings are persistent. Otherwise the relationship would be marred by
falseness or incongruity.


Unconditional positive regard is the ability to provide the client with a sense of
acceptance, regardles
s of what feelings or experiences are expressed by the client. Such
acceptance allows the client to feel safe within the relationship and to delve deeper into
him
-

or herself. Person
-
centered counselors believe that individuals are born with a need
to be l
oved, and when significant others, such as parents, do not provide unconditional
positive regard, children end up living as they believe others would want them to be, as
opposed to being who they really are.


The last quality, empathic understanding, has
been one of the most widely used tools of
the counseling relationship, regardless of theoretical orientation, and has been shown to
be a critical factor in positive therapeutic outcomes. Empathy can be demonstrated in
many ways, including accurately reflec
ting the client’s meaning and affect; using a
metaphor, analogy, or visual image; or simply nodding one’s head or gently touching the
client during the client’s deepest moments of pain. A therapist who shows empathy is
“with” the client; “hears” the client
; understands the client fully, and is able to
communicate such understanding to the client.


Let’s join Dr. Ed Neukrug as he tries to embody the characteristics of congruence,
unconditional positive regard, and empathy with Jose, who is discussing some co
ncerns
he has about his mother and younger brother.


Dr. Neukrug:

Hi Jose
. Thanks for coming in today. I know you had some things you
wanted to talk about, so where would you like to start?


Jose:

Well actually, I’m very concerned about my brother back
home in Puerto Rico.


Dr. Neukrug:

Ok.


Jose:

I think that environment, which I grew up in, isn’t the best for him. So one of my
plans is to actually go back to school for a Ph.D., and move to Florida; be able to bring
him with me, and also my mom. So
I’m kind of concerned about…if he gets in any
trouble

more than he already is.


26


Dr. Neukrug:

So you’re concerned about your brother obviously, and somewhat your
mom also.


Jose:

Correct.


Dr. Neukrug:

A
nd you’re hoping to move to Florida as quickly as
possible.


Jose:

Right.


Dr. Neukrug:

So you can help them out.


Jose:

Right. My mom has done a lot for all the family, for so many years. I think it is
time for her to relax, and I think if my plans go as I have them worked out I’ll be able to
provide t
hat for her.


Dr. Neukrug:

So you want to give back to your mom.


Jose:

Of course.


Dr. Neukrug:

She’s given to you so much.


Jose:

Correct. I want to be here for her, you know? And back in Puerto Rico I think it’s
getting more difficult all the time.


D
r. Neukrug:

So it sounds like things are getting worse there.


Jose:

Yes.


Dr. Neukrug:

And I guess I’m hearing, in some ways the urgency that you’re feeling.


Jose:

Correct; that’s one of my main concerns. The urgency of getting them out.

And
for me to be able to accomplish what I want to do in the time that I want to.


Dr. Neukrug:

Ok. So the urgency of both helping your brother and your mother and
getting to Florida

it seems like if you got to Florida that would be easier to do from
th
ere.


Jose:

Correct. Yes, basically…Florida here in the U.S. is the most similar environment
to Puerto Rico.


Dr. Neukrug:

Right.


Jose:

Not just that. I went recently to a 25
th

high school reunion, and I found out that a
lot of my high school mates live

in Florida. So I actually, even though I’ve never been in
Florida, know more friends and family that live there than people that I know here in
Norfolk. And I’ve been here for six years.

27



Dr. Neukrug:

So in a sense you feel more connected to people in F
lorida even though
you’ve never lived there.


Jose:

Yeah.


Dr. Neukrug:

And it feels also more like an environment that feels more similar to where
you grew up.


Jose:

Correct. This time it was kind of…when I went back to Puerto Rico it was kind of
shocki
ng, because for the first time I realized that I won’t be back, it’s not really an
option at this time because of the financial situation back in Puerto Rico. So it was a hard
reality to accept.


Dr. Neukrug:

O
k. So it kind of hit you when you went back
this last time that you
weren’t going to move back there.


Jose:

C
orrect.


Dr. Neukrug:

And I guess up until that point in time you were thinking that that might be
something you would do.


Jose:

Correct. That is home, that’s home.


Dr. Neukrug:

Ok.


Jose:

So realizing that going back home is not a real option is really challenging.


Dr. Neukrug:

I would guess that taking that feeling of home out of your life must be hard.


Jose:

Correct. And the little that I have achieved to this point…I don’t think

it’s
complete without the opportunity to help my mom, to get my mom out of there and my
little brother.


Dr. Neukrug:

So you’re not going to feel complete unless you move to Florida and help
your mom and your brother, who’s been having some issues.


Jose:

Correct. Yeah, especially with things getting worse every time. And actually,
today is going to be the burial for a friend of mine

a very good friend of mine. We
grew up together, and once again it’s just the environment around there, it’s so so bad.
So bad that they don’t really get to see out of it.


Dr. Neukrug:

So you’re going to a funeral of a friend of yours.


Jose:

I won’t be able to, but today is his funeral back in my home town.


28


Dr. Neukrug:

Ok.


Jose:

Yeah. My mom called me and she told me
about this. So that reminds me of the
real sense of urgency to actually do what I want to do and get them out of there as soon as
I can.


Dr. Neukrug:

So somehow the death of this friend of your is making it more present for
you, more urgent for you to do

something to help your mom and your brother.


Jose:

Correct. Yes, it’s really…it worries me. And I talk to my mom every Sunday, and
I ask “how’s my mother doing?” He’s still running around. And I try to help him, I
don’t think anybody else will. He’s

been living with my mom for several years and he’s
just stuck. He’s just living there, he’s not making any progress. So he’s kind of at the
mercy of what is around him.


Dr. Neukrug:

And you’re feeling like it’s a life or death situation for him.


Jose:

It may come to that. It’s likely with his…last time…he’s younger than I am, and
when he stands next to me he looks older. He’s really making it worse.


Dr. Neukrug:

So his lifestyle is really draining the life out of him, and again I hear your
love for
them, and I hear your concern about them, and I hear the urgency again of you
feeling like you need to do something.


Jose:

Correct, yes. I have to do something. I’m older, and we grew up with a single
family home. So we owe everything to our mom. And
she’s doing the best she can but
she still worries a lot about him. So he’s wearing her out, even at this stage.


Dr. Neukrug:

And being the older you feel some responsibility for both taking care of
your younger brother and taking care of your mom.


Jose
:

Correct. And he’s a really hard worker. I know that if I’m able to get him out of
there and moved here, he will adapt and he won’t have that choice of working next to a
bar…there’s a bar every ten feet, you know? So…


Dr. Neukrug:

I

think one of the t
hings I’m hearing also is the tug, maybe the internal tug
of your feelings, between the things that you need to finish up here and also your need to
take care of them.


Jose:

Right.


Dr. Neukrug:

And move to Florida. And that must be a real struggle for y
ou.


Jose:

It is. I feel that in order for me to be able to be more effective in helping them I
must…it’s not something that I really want to do: go for the Ph.D. But I think if I’m able
29


to accomplish that I would be more well
-
positioned to help them out
. But that would
take me a few years. So that’s my concern, how to balance that.


Dr. Neukrug:

And do both of those things.


Jose:

Correct.


Dr. Neukrug:

So if you get the Ph.D. you’re in a better position to help them, but on the
other hand if you get t
he Ph.D. you’re waiting, and you don’t want to wait too long.


Jose:

Right, right.


Dr. Neukrug:

W
ell it sounds like…what I’m hearing is your concern for your family,
your desire and wanting help your family and you want to do it in the best way possible.

You have a lot of important choices to make for yourself, and they’re pretty difficult
choices because people’s lives are at stake.


Jose:

Right. Correct, yes. Basically it’s weighing those decisions. I’m hoping that I’m
making the right ones. So yes,

every day…that’s my decision: am I doing the right thing.


Dr. Neukrug:

I guess, I’m sitting here thinking “boy, I wish I could make those decisions
for you and tell you which one is the right one to make.” But at the same time I’m
thinking only you have

that inner sense of what’s going to be right for you and your
family.


Jose:

I really think I’m the one who should arrive to that decision. I think I’m in a
position where I can…not just balance the decisions but also know the details of the
situation.
And I grew up there, so I know how it is there.


Dr. Neukrug:

At the same time, I hope that maybe I can be helpful to you in helping you
look at some of the feelings you have inside that will help direct you to the right decision
for you. So maybe that’s
something we can do here and talk about.


Jose:

Ok. Certainly, talking about how I feel about it, and having feedback or a sense of
direction; whether or not I’m going the right way, would be very helpful.


Dr. Neukrug:

Well thank you so much for sharing
with me today.










30


Be
havior Therapy

Developed during the first half of the twentieth century, behavior therapy is based on
three types of paradigms: operant conditioning, classical conditioning, and modeling.
Originally viewed as a scientific,
reductionistic, and mostly sterile approach to
counseling, today’s behavior therapist realizes the importance of having a strong
therapeutic relationship. For instance, it is now usual for the modern
-
day behaviorist to
use empathy and develop a collaborati
ve working relationship with the client. This allows
the therapist to build trust and correctly identify targeted behaviors the client would like
to change. After behaviors are identified, goals can be established and techniques chosen.
Today’s behavior th
erapists usually have a wide
-
range of techniques to choose from, with
some of the more popular ones being:


Modeling
, such as when clients observe behaviors, usually in the clinical setting, and later
practice the behaviors in the office and on their own.
Assertiveness training has been
particularly used in this fashion.


Operant conditioning techniques
, such as positively reinforcing targeted behaviors and
extinguishing unwanted behaviors (e.g., use of sticker charts for children)


Relaxation exercises
, s
uch as

learning how to progressively relax oneself in an effort to
reduce anxiety or other unwanted feelings.


Systematic desensitization
, which is often used with anxiety disorders, is the deliberate
pairing of collaboratively chosen hierarchical aspects
of the feared object with learned
relaxation techniques, thus slowly reducing the fear response.



Flooding and implosion techniques

both involve the

exposure to intensive amounts of
fearful stimuli, with the assumption being that prolonged exposure will
extinguish the
fear response.


And,


Self
-
Management Techniques
, which are used when one wants to help clients learn
various behavioral techniques and have them practice on their own.


In the following role
-
play, Dr. Suzan Thompson works with “Rayneer,”
who is struggling
with a panic disorder resulting from a recent car accident.

Dr. Thompson will assist Ivy in
applying relaxation techniques to her anxiety about driving.


Dr. Thompson:

Hi Rayneer, welcome back.


Rayneer:

Hi Suzan, how are you?


Dr. Thomps
on:

I’m doing okay. So, how has the practicing been going with the
relaxation techniques that we talked about last time?


31


Rayneer:

Well, it was kind of hard at first. I just kept having my heart palpitations and
the sweating, and then I put little hearts u
p around the house and every time I saw a heart,
it helped me remember to do the breathing that you taught me.


Dr. Thompson:

What a great idea! Sort of that association


Rayneer:

Well, I really need it, cause if I didn’t see something outside of me, I jus
t kept
getting involved in the feeling.


Dr. Thompson:

And so that reminded you to bring up that relaxation that we talked about.


Rayneer:

Mmhmm


Dr. Thompson:

Okay, so well one of the things that we’re going to do today is to talk
about the different co
mponents of what’s happened for you. And use the relaxation along
with sort of a hierarchy of events or situations that you might face. And eventually what
we’ll do is have you practice the relaxation along with each of the different pieces of it.
Does tha
t make sense?


Rayneer:

It does. Um, that will be good because it’s been really hard just getting in the
passenger side of the car, and somebody else has had to drive me.


Dr. Thompson:

Yea, I was wondering about that.


Rayneer:

And just getting in the car, it makes me very nervous and I start to sweat and
tremble and feel a little shortness of breath and I’m real concerned that I won’t be able to
go back to work cause I drive for everything and if I’m not driving then I can’t ma
ke do
for my family.


Dr. Thompson:

Mmhm, so we really kinda have some short term immediate things that
you want to focus on, getting in the car even. And then maybe some longer term, that
would be getting you back to work, is that…?


Rayneer:

Yes


Dr. Tho
mpson:

Okay, um you said that you had some of the anxiety come up when you
were even getting into the passenger side coming here.


Rayneer:

Yes, I felt a little like I was choking and I just had this loss of control that if I
was in the car again, somethin
g else would happen. And when this accident happened, I
didn’t have any passengers. And I keep thinking if it happened again, and what if there
were passengers or someone else was injured?


Dr. Thompson:

Right.


Rayneer:

So it’s very scary.

32


Dr. Thompson:

Y
eah, it sounds like it was. Well, if we have to kind of break things
down, because you’re telling me now of what’s going on now. And if we had to break
things down into smaller pieces, let’s look at what those pieces might be.


Rayneer:

Okay


Dr. Thompson:

And I’m going to write some things down so that we can kind of keep
things straight


Rayneer:

Sure


Dr. Thompson:

So um one of the things that you’re having a hard time with is that even
getting into the passenger side. But maybe we could back up from the
re.


Rayneer:

Okay


Dr. Thompson:

So, what, as you think about even getting into a car, what happens to your
anxiety?


Rayneer:

Um, it goes up. It’s…I’d say just thinking about getting in the car, it goes up to,
on a scale of one to ten, it goes to like a
five. And maybe, a four, it’s like it gets to a five
when I get ready to get in the car. But I start the heart palpitations and I’m sweating and I
start to tremble a little bit and I just have that fear that I’m going to lose control or
something’s going t
o happen.


Dr. Thompson:

Yeah, so even just thinking about.


Rayneer:

Mmhmm


Dr. Thompson:

I’m glad that you went ahead and put that scale to it. We talked about that
last time as an application here. So thinking about getting into the car is about a four or
five.


Rayneer:

Well, I think probably, it’s….I just get so…to me, it’s not just thinki
ng about,
it’s getting into the car. So I guess thinking about it is a three but actually getting into a
car is probably a five.


Dr. Thompson:

Okay, and is that getting into the passenger side or the drivers side?


Rayneer:

Well, I’m getting into the pass
enger’s side, I’ve been too afraid to get into the
drivers side. So the passenger’s side is definitely a five and the driver’s side is higher.


Dr. Thompson:

Okay, so where would you rate getting into the drivers side?


Rayneer:

Um..it’s definitely at leas
t a seven.


33


Dr. Thompson:

Okay, and I’m wondering if there’s something in between there. Getting
into the driver’s side, or what’s surrounding that?


Rayneer:

Um, well you know, opening the door


Dr. Thompson:

Okay


Rayneer:

And once I got into the driver’s side and then usually I kinda put my hands on
the wheel, and then I’ll start the car after I check the mirrors and put on my seatbelt and
stuff.


Dr. Thompson:

Okay, alright so you’re doing a great job of starting to break

things down.
That’s exactly where we’re headed with this. Um, okay so just so I have it straight. It’s
thinking about getting into the car even before you go anywhere, even before you leave
the house, is about a three so that brings up some of the anxiety
.


Rayneer:

Yes


Dr. Thompson:

And then getting into the passengers side is a little higher, opening the
door to the driver’s side is a little bit higher than that, but not as high as say, getting into
the driver’s side.


Rayneer:

Right


Dr. Thompson:

Okay
, and then putting your hands on the wheel, kind of brings it up a
little bit more. And then starting the car um, is a little bit more too.


Rayneer:

Yes, it feels like it would be. I haven’t tried it yet because I’ve been too anxious
about it.


Dr.
Thompson:

And that makes sense. Okay, so starting the car and then if we take it one
step further, what would be another step from there?


Rayneer:

Um, I guess, um, maybe driving the car, like a short distance, or maybe in the
driveway or something.


Dr. T
hompson:

Yeah, a really short distance, so in the driveway. Um, and then what
would be a next step from there that we could aim for?


Rayneer:

I guess going around the block.


Dr. Thompson:

Okay, and if you had to think…even thinking about that right now.


Rayneer:

That feels like it’s a nine.


Dr. Thompson:

Okay

34


Rayneer:

I start sweating all over again just thinking about driving, going around the
block because I know there will be other cars out there, and that really is scary for me.

Dr. Thompson:

And I
see that in your face, okay. So then, we have sort of a hierarchy of
different pieces of getting back to driving that we can then apply the relaxation
techniques. Okay? So let’s just do one right now, just for practice and see how that goes,
alright? That
first one that you have on the list is just thinking about getting into a
vehicle.


Rayneer:

Okay


Dr. Thompson:

So right now as you’re thinking about getting into the vehicle. I see that
you’re kind of shaking. Remember the relaxation, talk me through th
e relaxation that
you’re aware of.


Rayneer:

Taking a breath, and holding it for the count of five and breathing out again.


Dr. Thompson:

So, you’re gonna do that, good, just independently, just be in that relaxed
place…great. And now as you’re in that r
elaxed place, think about, just think about
leaving your house and getting into a vehicle, the passenger’s side. And go back to that
relaxed, take a deep breath, and go back to that relaxed place.


Rayneer:

(breathing)


Dr. Thompson:

and how is that?


Rayneer:

Well, you know thinking about getting in the car is kind of scary but I know I
can put a heart in the car so I know to breathe when I see them, cause I have them in the
house.


Dr. Thompson:

Okay, great idea. So yeah, even right now as you think a
bout getting into
the car, where would that heart be?


Rayneer:

I would, right now need to put it on the door.


Dr. Thompson:

Right on the door.


Rayneer:

Or on the window.


Dr. Thompson:

I almost thought of putting it, slap a big huge heart on the car, but it’s
your image so…


Rayneer:

Well I’d feel better with a little one…just a little one.


Dr. Thompson:

Okay, so let’s go back to the deep breath, get to a relaxed place…and as
you’re in

that relaxed place, think about just going out to your car, that heart is right on
your car right where you put it. Go, keep relaxing, that’s it.

35



Rayneer:

I feel more like I have to do it than I’m relaxed about it.

Dr. Thompson:

What do you mean?


Rayn
eer:

Well, if I can’t drive again then I won’t be able to work again.


Dr. Thompson:

We’re just gonna take it a little bit at a time. So right now, just it’s that
one piece, thinking about going out there. The rest of it will fade away for right now.


Ray
neer:

Neat trick…Okay, that does feel a little better.


Dr. Thompson:

Okay, before when we first started talking about that, you rated it as a
three, where is it right now?


Rayneer:

It’s probably a 2.5


Dr. Thompson:

So, we brought it down a little bit. W
hat I’m going to ask you to do then
is to keep practicing because the more you practice it, just like you did at home, the more
you practice with the relaxation and the heart you were able to get to that place. It’s the
same thing with each one of these so

we’re going to take it a little bit at a time and we’ll
build from there, okay?


Rayneer:

Thank you, I appreciate your help.
























36


R
ational Emotive Behavior Therapy

REBT is an action
-

and results
-
oriented psychot
herapy which teaches
clients how to
identify

self
-
defeating thoughts, beliefs and actions and replace them with more effecti
ve,
life
-
enhancing ones. O
ne of the first of the modern cognitive behavior therapies
, REBT

was developed in 1955 by Albert Ellis, Ph.D.


Using a technique called “uncovering the
ABCs of personality formation,”
REBT
therapists state that it is not the (A)
Activating

event that causes emotional
Consequences

(C), but (B) the
Belief

(B) about the event. For instance, faced with the loss of a
relationship, one client’s belief system might lead to suicidal depression, while another
client’s belief system might leave him or her feeling fine about the breakup.


One role of the REBT ther
apist is to create (D) a
Disputing

intervention (D) for (B) the
Belief that is irrational. This will (E) Effect a new, and better, (F) Feeling. REBT
practitioners teach their clients to (1) analyze episodes of emotional and behavioral
disturbance with the
ABC model; (2) discriminate between irrational and rational beliefs;
(3) distinguish health
y

negative emotions from unhealthy emotions and (4) utilize a
variety of means for modifying the irrational beliefs that support their emotional and
behavior problem
s.


In working with clients, the REBT therapist uses a number of cognitive, behavioral, and
emotive techniques, including.


1.

Actively disputing irrational beliefs throughout the day.

2.

Bibliotherapy.

3.

Role
-
Playing new ways of living

4.

Practicing what might be

for the client new, unconventional ways of living in the
world (e.g., an introvert acting extroverted at a party)

5.

Imagery exercises, where the client imagines how he or she would like to be.

6.

Practicing new behaviors through traditional behavioral techniqu
es (e.g.,
conditioning, modeling, assertiveness training)


In the following role
-
play, watch how Dr. Korrie Allen uses the ABC of R
ational
Emotive Behavior Therapy to assist Rebekah with her feelings about a recent break
-
up
with her girlfriend.


Dr. Allen:

Good morning Rebecca, what brings you here?


Rebekah:

Um, I’m just feeling depressed and upset, and just a little worthless.


Dr. Allen:

is there anything that’s going on that’s different in your life right now?


Rebekah:

Um, my girlfriend and I are havin
g some problems. Um, she’s been talking about
breaking up and um, actually I think that she’s gonna break up with me.


37


Dr. Allen:

so that must be really difficult to think about. Um, what are some of the thoughts that
are going through your head when you t
hink of the possibility of you guys breaking up?


Rebekah:

All kinds of things like, I need a girlfriend, I really miss here. I mean, just even now