Theory Counseling Psychotherapy: The SAGE Encyclopedia of

The SAGE Encyclopedia of
Theory in
Counseling and
Psychotherapy
Edited by
Edward S. Neukrug
Old Dominion University
(c) 2015 Sage Publications, Inc. All Rights Reserved.

J
pastor father. As a result, he was at first unable to
JACKSON, DONALD look at the contents of the dream but eventually
came to interpret it as God pouring scorn on the
See Palo Alto Group Church and his father’s beliefs. This interpretation
freed Jung to explore his own religious path,
culminating in his later work Answer to Job, in
which he wrote about the dark or shadow side of
JUNG, CARL GUSTAV the Godhead.
In 1903, Jung married the heiress Emma
Analytical psychology is the creation of the Swiss Rauschenbach, her wealth ensuring that he was
psychiatrist and analytical psychologist Carl able to live the rest of his life in comfort, free from
Gustav Jung (1875–1961). He was born at Kesswil financial concerns. The marriage produced five
by Lake Constance in Switzerland, the fourth-born children, four daughters and a son. In the course
but first surviving child of his parents, he remained of his long married life, Jung had extramarital
an only child up to the age of 9 years, with the relationships, most notably with Sabine Spielrein
arrival of a sister, Trudi. He was a solitary child, and Toni Wolff. His relationship with the former
finding solace in dreams and daydreams, which set generated a great deal of prurient as well as seri-
the stage for his interest in an inner life. His father, ous interest, resulting in several books, a play, and
Paul Jung, was a country parson of the Basel three films. From the point of view of his work as
Reformed Church, and his mother, Emilie a psychoanalyst, the most important outcome of
Preiswerk, had recurring bouts of mental illness this liaison was his later work The Psychology of
that required hospital treatment. the Transference (1946). In writing that work, he
Each important event in Jung’s life was presaged was finally able to explore the erotic feelings that
by a significant dream, starting with one at the age had existed decades before between himself and
of 4 years that he remembered for the rest of his Spielrein, his first psychoanalytic patient. His
life. Another dream, at the age of 12, possibly the long-lasting affair with Wolff, a former patient,
most significant of all, may be summarized as led to their close personal and professional
follows. He found himself in the gloomy courtyard collaboration for 40 years and a triangular
of the gymnasium at Basel, Switzerland, and saw relationship between the two of them and his
before him the cathedral, above which sat God on wife, Emma.
His throne. This scene of harmony and beauty was Jung trained as a psychiatrist and worked in
shattered by God dropping a turd on the cathedral. that capacity at the Burghölzli Hospital in Zürich,
At the time of this dream, Jung was a devout Switzerland, from 1900 to 1909. It was in the
Christian following the religious teachings of his course of his work there that he first encountered
591

592 Jung, Carl Gustav
Spielrein, when she was admitted as an inpatient in collective unconscious is inherited, not developed, by
1904 with a diagnosis of psychotic hysteria. Jung individuals and is universal and impersonal. It is the
was a gifted psychiatrist and spent a great deal of realm of the archetypes. Allied to these is Jung’s
time talking with patients in the hope of discovering concept of the Self, sometimes thought of as the
the origin of their illness. He also conducted God-image, which transcends and defines the psychic
extensive research using word association tests to realm.
further his experimental work on complexes. Jung’s writings on typology, in particular the
Complexes may be defined as autonomous concepts of introversion and extraversion combined
subpersonalities that lie below the level of with the four ways of functioning—thinking,
consciousness and, when activated, intrude on the feeling, intuition, and sensation—shed light on the
conscious mind in a disturbing and harmful way. different personality types to be found in people.
One well-known example is that of a mother Among his other concepts, anima and animus
complex. This area of Jung’s work was so important represent the feminine and masculine principles,
to Jung that he considered calling his approach respectively; persona describes the mask or front
complex psychology. that is presented to the world; dreams perform a
Jung’s most significant professional collabora- compensatory function to the conscious personality;
tion was with the pioneer of psychoanalysis, and synchronicity stands for meaningful
Sigmund Freud (1856–1939). Jung first applied coincidence, an acausal connecting principle that
psychoanalytical ideas in his work as a psychiatrist synchronizes inner and outer events.
in 1904, with Freud starting a correspondence In 1913, Jung began a confrontation with the
between them in 1906. This led to their first unconscious that lasted until 1930. His fantasies
meeting in Vienna in 1907. The coming together of and paintings from that time were transcribed by
the two was based on mutual advantage, with him into the Red Book, which was published in
Jung deriving a theory to underlie his work on 2009 and can be thought of as Jung’s individuating
complexes and Freud finding in Jung’s research a process or spiritual autobiography. On the back
method that could provide proof for his own ideas. cover of the Red Book is a statement made by Jung
Jung became Freud’s heir apparent and was appointed in 1957, which ends by saying that the numinous
president of the International Psychoanalytic beginning, which contained everything, was then.
Association at the second psychoanalytic conference The numinous is a key concept in Jung’s approach
at Nuremberg, Germany, in 1910. Three years later, and may be defined as a fleeting experience of a
the Freud–Jung relationship collapsed into mutual religious or spiritual nature that is awesome and
diagnosis, and a split between them in 1913 has had mysterious.
repercussions for their followers in the psychoanalyti- His discovery of alchemy in 1928 led him away
cal world since that time. from his work on the Red Book; his researches
As a foreword to setting out some of the main into alchemy last continued for the rest of his life.
concepts of Jung’s metapsychology, it should be noted The dialectics of the alchemical process, that of
that he viewed psychology as the discipline that could union and separation, result in the symbolic higher
resolve the major debates in philosophy, sociology, marriage of opposites. Symbolism is able to unite
biology, anthropology, comparative religion, and the opposites of spirit and matter in a single image.
other fields. This view was an encyclopedic vision of A central goal of Jungian psychoanalysis is the
psychology as the discipline to unite the circle of coming into being of the capacity for symbolization,
science. His two signature concepts—(1) collective combined with the potential for patient and
unconscious and (2) archetypes—exemplify this analyst to be mutually transformed by the
vision, representing as they do innate universal psychological alchemical process.
structures in the mind or ancient thought forms Jung travelled extensively in the course of his
common to humanity. Archetypes are patterns of life to other parts of Europe, including England.
instinctual behavior that erupt into consciousness in He also ventured farther afield to the United
symbolic form and underlie the quest for individuation, States, his first voyage there being with Freud and
which is defined as becoming wholly and indivisibly fellow psychoanalyst Sandor Ferenczi in 1909. In
oneself, distinct from others. According to Jung, the the course of his travels, Jung also visited some

Jungian Group Psychotherapy 593
parts of Africa and India, particularly after he depth, therapy that seeks to foster the wholeness
retired in 1946. Visiting tribal cultures was and unique personal characteristics of the patient
important for Jung, as he sought to understand the in a psychotherapy group. Jungian approaches to
common symbols that were present in all cultures. group psychotherapy integrate the analytical
In 1955, his wife passed away, at which point he psychology of Carl Gustav Jung (1875–1961), a
became increasingly reclusive. He died in 1961 in Swiss psychiatrist and one of the seminal
Zurich, Switzerland. psychotherapists and thinkers of the 20th century.
In 1995, the International Association for Jung’s analytical psychology suggests that each
Analytical Psychology was formed, which serves as individual’s unconscious contains the drive for a
the professional body for Jungian psychoanalysts unique expression of the person’s life; thus,
worldwide. The work started by Jung continues in analytical psychology seeks to bring the individual
training institutes, developing groups, and/or in contact with his or her own unconscious
analytical psychology clubs in every continent. Jung’s purpose in life and to encourage its expression.
corpus of written work has largely been disseminated Because of his emphasis on the unique individual
through the 20 volumes of C. G. Jung: The Collected potential and wholeness of each patient, Jung
Works, the Freud/Jung Letters, the 2 volumes of the himself was not enthusiastic about the potential
C. G. Jung Letters, and an autobiographical work, for group psychotherapy. Nonetheless, some
Memories, Dreams, Reflections. Jungian analysts today offer psychotherapy groups
in which the group is treated as a means for
Ann Casement furthering individual growth, and they believe
See also Analytical Psychology; Classical Psychoanalytic
that the unique qualities of a group offer an
Approaches: Overview; Freud, Sigmund; Freudian opportunity to facilitate the individuation of each
Psychoanalysis client.
Further Readings Historical Context

Casement, A. (2001). Carl Gustav Jung. Thousand Oaks, Jung was an early disciple of Sigmund Freud
CA: Sage. (1856–1939), and the two had a close collaborative
Jung, C. G. (1953). Psychology and alchemy (Vol. 12). relationship from 1902 to 1913. Freud was hopeful
London, England: Routledge & Kegan Paul. that Jung would become the “crown prince” of the
Jung, C. G. (1954). The practice of psychotherapy psychoanalytical movement, but Jung viewed the
(Vol. 16). London, England: Routledge & Kegan Paul. dynamic unconscious more broadly than did
Jung, C. G. (1959). The archetypes and the collective Freud. Jung disagreed with Freud’s insistence that
unconscious (Vol. 9). London, England: Routledge & the unconscious contained predominately or
Kegan Paul.
exclusively aggressive and sexual drives; this
Jung, C. G. (1961). Memories, dreams, reflections.
disagreement led to a rupture between the two
London, England: Random House.
theorists. Jung went on to develop his own theory,
Jung, C. G. (1966). Two essays on analytical psychology
called analytical psychology to distinguish it from
(Vol. 7). London, England: Routledge & Kegan Paul.
Freud’s psychoanalysis. Beginning in the 1920s,
Jung, C. G. (1971). Psychological types (Vol. 6). London,
England: Routledge & Kegan Paul.
Jung published prolifically and wrote on a series of
Shamdasani, S. (2003). Jung and the making of modern groundbreaking studies that described the positive
psychology: The dream of a science. Cambridge, potential of the unconscious, outlined personality
England: Cambridge University Press. typology, and explored the common or “collective”
unconscious of humanity. Jung’s ideas became
popular with many in the “human potential”
movement in the 1960s and 1970s and remain an
JUNGIAN GROUP PSYCHOTHERAPY important, though frequently unacknowledged,
influence in psychology to this day. Over the years,
A Jungian (or analytical) approach to group Jungian analysis of the individual has thrived and
psychotherapy is a unique psychodynamic, or become a vital therapeutic modality. Although

594 Jungian Group Psychotherapy
Jung did not favor group psychotherapy, a small Jung’s View of the Dynamic Unconscious
number of Jungian analysts and Jungian-oriented
Jung believed that the dynamic unconscious
therapists have sought to integrate his ideas into
contained sexual and aggressive drives as well as
psychotherapy groups. In contrast to Jung, Jungian
positive drives, which combine to express the
group analysts believe, perhaps paradoxically, that
unique way of being for each person. Inherent in
a psychotherapy group offers a unique setting for
the unconscious, Jung believed, was a desire to
supporting individual patients as they seek to
affiliate in groups, a need for creative expression,
express their unique way of being.
the impulse to make meaning of human experience,
and an undefined additional unconscious potential.
Theoretical Underpinnings A Jungian group therapist would use the differing
perspectives of a group to explore a variety of
As a major variation of psychodynamic, or depth,
ways of understanding unconscious material.
psychotherapy, Jungian analytical psychology
follows the psychodynamic assumption that the
motivations of individual patients, and of the Individuation
group, will often be outside of their conscious At the center of Jung’s theory is the idea of
awareness. Jung developed his theories in the individuation, which is the unconscious need and
shadow of the 19th-century European philosophical desire of every human being to live a unique life
emphasis on materialistic science and objective, that is in accord with his or her deepest and truest
observable phenomena. Jung’s personal, scientific, nature. However, an individual’s true nature is
and clinical work convinced him that the old often hidden from his or her self, and the individual
scientific model was reductive and failed to account must challenge himself or herself to find it. In a
for more intuitive ways of knowing and psychotherapy group, individual members can
experiencing wholeness and individuality in life. support each other in finding and expressing their
As a result, he sought to develop a theory that strivings for individuation.
could explain not only the aggression and sexuality
that he observed in his patients but also their
strivings for unique personal wholeness, their The Ego–Self Axis
attempts to make sense of their experiences through The ego–self axis is an interaction between the
symbols and artistic endeavor, and the broad individual’s center of consciousness (the ego) and
human need for connection, meaning, and creative the individual’s most positive and inspiring
expression. In more recent years, some therapists unconscious (the self). If the ego is in a healthy
have taken Jung’s original concepts and used them alignment with the self, an individual will
within the group setting. These Jungian group experience support, inspiration, and growth
therapists believe that the nature of the group through contact with his or her personal
offers the individual the opportunity to examine unconscious. An individual ego that is too critical
how his or her self is perceived by others in the of, or shut off from, the self will result in alienation
group and gives the individual an opportunity to and despair. An individual ego that is uncritically
experiment with new, unexamined aspects of self overwhelmed by unconscious material can result
within a safe environment. in inflation, a naive spirituality, or foolish idealism.
A group setting provides an opportunity for
Major Concepts individuals to experiment with greater openness to
the self or improved functioning of the ego, as
Although Jung’s works takes up many volumes, six appropriate.
of the more important concepts for Jungian group
therapy are discussed in this section, including
The Problem of the Opposites
Jung’s view of the dynamic unconscious, individu-
ation, the ego–self-axis, the problem of the oppo- Jung maintained that every psychological
sites, an alchemical approach to transference, and phenomenon also brought with it an opposing
archetypes and the collective unconscious. energy. For instance, Jung suggested that each

person had an animus and an anima—or a masculine Techniques

and a feminine side, respectively. He stated that
Jung was averse to prescribing particular techniques
when an individual identified too strongly with
for conducting analytical psychology. Rather, he
either pole of an opposite, he or she became
believed that the analyst must be open to influences
“polarized.” He stated that psychological maturity
from the patient and respond authentically and to
involved being able to recognize and integrate
all aspects of the patient’s personality toward the
psychological phenomena that are diametrically
goal of helping the individual become whole.
opposed—the opposites of one’s personality. Group
Nonetheless, it is possible to infer some technical
members can help each other see their polar
guidelines based on Jung’s key principles.
opposites, and members can also experiment with
opposing parts of self within the group setting. In
addition, members in a psychotherapy group will A Broad Perspective on the Unconscious
frequently become polarized into opposing Jungian analysts leading groups seek to recognize
positions; the multiplicity of perspectives in the the broad potential of their patients’ unconscious
group is a helpful way to reduce this tension. and to integrate interpretations about sexual and
aggressive drives with interpretations about a
An Alchemical Approach to Transference patient’s other potential unconscious motivations.
The group therapist thus seeks to foster curiosity
Jung used medieval alchemy, or the notion that and exploration about the unconscious dynamics
a base metal could be transformed into a precious observed in a group. The therapist in a group
metal (e.g., iron into gold), as a metaphor for the invites other members to participate in “amplifying”
process of analytical psychology. He emphasized a possible unconscious motivation. To amplify in a
that both the patient and the analyst were mutually group suggests that many members would offer
transformed through contact with each other. In a perspectives on the unconscious motivations that
psychotherapy group, members allow themselves they observe in a group. In keeping with Jung’s
to soften ego boundaries and experience empathy orientation, the group therapist tries to avoid
deeply with one another and with the therapist, reductive interpretations but encourages a curious
thus transforming themselves and one another. In attitude that is open to multiple possibilities.
a Jungian perspective, it is also inevitable and
desirable that the group therapist will also
experience change and growth. Fostering Individuation
Jungian analysts are constantly looking for
Archetypes and the Collective Unconscious ways to encourage individuation in their clients,
that is, encouraging each member to increasingly
Analytical psychotherapy seeks awareness of embrace all aspects of self and become more fully
the power of archetypes, which are patterns of who he or she is. Jung encouraged patients to learn
psychological organization observed throughout about these aspects of self in individual therapy. In
time and across cultures. Archetypes reveal a a group, individual members are encouraged by
common human, or collective, unconscious that both the therapist and the other members to
manifests itself as similar drives, patterns, and uncover the opposite and lost parts of self and to
needs expressed universally in human culture. For express their visions of what their lives could be by
instance, all cultures seem to have similar stories discussing their hopes, dreams, and visions for
that symbolically reflect the “mother” or the “wise their lives. This process of mutual encouragement
person” or the “warrior.” Jungian psychotherapy and goal setting in the group aids individuals with
groups give group members permission to access their individuation processes.
their archetypes and to understand how they
become uniquely expressed in each member. By
Encouraging a Healthy Ego–Self Axis
expressing the range of this material, the group can
experience the power of the archetype to enhance To encourage a healthy ego–self axis, the group
dignity and meaning in individual members. analyst looks at the individual’s relationship

596 Jungian Group Psychotherapy
to his or her unconscious and seeks to increase members of the group. In a Jungian psychotherapy
access to the unconscious for those whose self- group, the deep empathy that develops among
knowledge is restricted. The analyst also encour- members softens ego boundaries, and members
ages critical thinking in patients who become help transform one another as they pursue their
overwhelmed by their unconscious content. The individual life journeys. The Jungian group
therapist introduces the group members to the therapist is also open to being deeply influenced by
concept of “the self,” which helps members see individual members and by the entire group.
positive and healing potential in the unconscious. Although the therapist may be circumspect in
As individual members explore their contact with disclosing the nature of this influence to group
the self, other members in the group become members, he or she will use that experience to
more open to their own self, and the group inform interventions with the group.
explores the effects of contact with this aspect of
consciousness. If a group member seems to have
Amplification of Archetypes
an overly harsh ego perspective toward his or her
and the Collective Unconscious
own self, other group members can share their
perspectives and encourage greater openness. If, A Jungian analyst working with dream or
on the other hand, an individual member’s sense other unconscious material in a group seeks to
of connection with the self is so powerful that his amplify the patient’s material through an open-
or her ego functioning deteriorates, the group can ended exploration of the themes that emerge in a
be a very effective means of helping to ground the group. Such amplification helps the patient
member in everyday reality. become more aware of hidden aspects of self—or
opposites that the person is fearful of facing. In
Avoiding Polarization addition, as a result of the amplification, the
patient may become aware of the similarities that
To encourage patients in a group to appreciate his or her unconscious material has to common
their wholeness and complexity, analysts help a cultural themes, myths, and narratives expressed
patient hold a “both/and” attitude toward by other group members. This awareness can help
seemingly irreconcilable positions. The analyst foster a sense of connectedness and appreciation
encourages group members to avoid becoming of others.
polarized and tries to have them accept all aspects
of their selves. In addition, sometimes group
members will become locked in positions toward Therapeutic Process
one another—as if their position alone holds the Although the principles of analytical psychotherapy
truth. A Jungian group therapist encourages all can be applied in group or workshop settings that
group members to help each other see multiple are as brief as a few hours or a weekend, Jungian
perspectives. Jungian group psychotherapy analytical psychotherapy in groups more typically
encourages personal growth in each member by requires a long-term commitment from both
challenging his or her fixed and rigid viewpoints patients and therapists. Regardless of the length of
and requiring each member to experiment with the the therapy, a Jungian group therapist consistently
multiple competing perspectives. attends to the strivings for individuation that he or
she observes in each patient. Analysis is concluded
An Alchemical Approach to Transference when the analyst, most group members, and the
individual group member all believe that the
An analyst who approaches clients with alchemy member has been able to confidently express more
in mind will be aware of the mutual nature of the of his or her unconscious potential, has come to
transference, and he or she may be more inclined terms with his or her complex nature, and has
to self-disclosure as a result. The exchange of developed a vital connection with his or her own
influence can result in the analyst’s vulnerable and unconscious.
related attitude toward the patient. The group
therapist also encourages this attitude between the Justin Hecht

See also Classical Psychoanalytic Approaches: Overview; Jung, C. G. (1946). The psychology of the transference. In
Ego Psychology; Existential-Humanistic Therapies: Collected works (Vol. 16, p. 233) Princeton, NJ:
Overview; Freudian Psychoanalysis Princeton University Press.
Jung, C. G. (1952). Symbols of transformation. In
Collected works (Vol. 5, pp. 121–444). Princeton, NJ:
Further Readings Princeton University Press.
Jung, C. G. (1957). The transcendent function. In
Edinger, E. (1972). Ego and archetype. Boston, MA:
Collected works (Vol. 8, p. 69). Princeton, NJ:
Shambala.
Princeton University Press.
Hecht, J. B. (2011). Becoming who we are in groups: One
Jung, C. G. (1964). Man and his symbols. New York, NY:
Jungian’s approach to group psychotherapy. GROUP,
Bantam Doubleday Dell.
35(2), 151–165.
Jung, C. G. (1943). Individuation. In Collected works
(Vol. 7, p. 173). Princeton, NJ: Princeton University
Press.
Jung, C. G. (1943). Individuation: The mana-personality. JUNGIAN THERAPY
In Collected works (Vol. 7, p. 238). Princeton, NJ:
Princeton University Press. See Analytical Psychology

K
child, assembled the chassis of an old car to have
KELLY, GEORGE transport to attend school. When the car proved
unreliable, he, at age 13, left home to continue his
George Kelly (1905–1967) developed personal education, living with family in Wichita, Kansas.
construct theory (PCT), a theoretical approach to In the period between his graduation from Park
personality theory and therapeutic intervention. College, Missouri, in 1926, majoring in mathemat-
PCT is a pragmatic approach, emphasizing the ics and physics, and the completion of his Ph.D. in
usefulness of beliefs, feelings, and actions rather psychology in 1931 at the University of Iowa, he
than their veracity. A distinguishing feature is undertook courses in sociology and labor relations
emphasis on sense making involving discrimina- and subsequently completed a teaching qualifica-
tions, whereby some things are seen as similar to tion in education at the University of Edinburgh as
and different from certain other things, with both an exchange student. While studying, he held a
similarity and difference essential for understand- variety of part-time jobs in the increasingly difficult
ing people’s functioning. The originality and economic conditions of the Great Depression,
breadth of his perspective drew on varied life including teaching speech, drama, and public
experiences and extensive practice and evaluation speaking, and working as an aeronautical engineer
of therapeutic intervention. for an aircraft manufacturing company. He
In a 1969 essay titled The Autobiography of a completed his Ph.D. in 9 months, with a thesis on
Theory, Kelly gives an account of the develop- reading and speech disabilities. Two days after his
ment of his theoretical ideas, which includes a graduation, he married Gladys Thompson.
broad-ranging theory not only about the pro- In 1931, the Kellys left for Hays, Kansas, where
cesses of therapy but also concerning the function- Kelly would occupy a psychology teaching post at
ing of people more generally. He detailed key Fort Hays Kansas State College. Although
events that led to his insights, not because he interested in physiological psychology, the
regarded these insights as shaped by those situa- circumstances he saw around him—great poverty,
tions but because these were events that he had deprivation, and, as drought turned the area into a
necessarily made sense of. But it was he, Kelly, dust bowl, starvation—could not be ignored. This
who was the active agent in this process, rather led to much experimentation as Kelly sought to
than being passively molded by his environment. mobilize whatever skills he could to improve the
Kelly was an only child, born in 1905 near lot of those in need. Kelly had begun to recognize
Perth, Kansas. His parents were farmers. The area that what seemed true of himself, particularly his
was isolated and sparsely populated, and his for- active nature, was also true of others. Those
mal schooling was intermittent. Self-reliance and enduring these limiting, devastating circumstances
invention were essential, and Kelly, a determined were not merely passive victims; there remained
599

600 Kelly, George
available choices and possibilities that they could actions and therapy. He explored how the roles we
implement to improve their lives. Helping people commit ourselves to and the actions that underlie
access those alternatives was the key to therapeutic such commitments can, in and of themselves, lead to
intervention. change. He and his students evaluated a type of role
When a 12-year-old child with school-related therapy in which the client experiments with living
issues was referred to the psychology department an alternate role temporarily. This technique, fixed-
at Fort Hays Kansas State College, Kelly set the role therapy, produced positive results. For fixed-
child’s evaluation as a class exercise. This proved role therapy clients, the alternate role was not so
an effective learning tool and resulted in a positive much the authentic way to continue life as an invita-
outcome for those involved, including the child. tion to explore and evaluate different ways of living.
Consequently, in 1932, Kelly set up a psychological Kelly initiated many therapeutic practices that
clinic that offered free diagnostic, therapeutic, and are now widely accepted. Such practices include a
assessment services, staffed by himself and trained detailed procedures manual for clinic workers, with
students. This service subsequently expanded, with an extensive list of ethical practices; evaluation of
the establishment of traveling and satellite branch therapy effectiveness, which included postinterven-
clinics, a model for subsequent community mental tion follow-ups; and methods for initial assessment
health centers. and subsequent evaluation, including the sorting of
The establishment and running of the clinic was self-descriptive terms, predating the Q-sort, and the
a steep learning curve, given Kelly’s limited training rating of self and others on bipolar dimensions (e.g.,
in clinical psychology and the absence of similar intelligent/stupid, lovable/unappealing), predating
models for such a service. Applying diagnostic semantic differential methodology.
labels proved pointless because of isolation from During World War II, Kelly and his family
support services to which patients could be referred. moved to Washington, where Kelly worked in the
Returning to psychoanalysis, which he had U.S. Navy’s Aviation division. After the war, in
previously rejected, Kelly was impressed by 1946, Kelly became the clinical psychology director
Sigmund Freud’s clinical understanding. The at Ohio State University. He aimed to reorganize
interpretations Kelly offered clients often brought the department and place it at the forefront of
them profound relief. But Kelly was wary of clinical training. In preparation for publishing his
dogmatism and certainties and became discomfited theoretical insights, Kelly met weekly with
by his “insights.” He cautiously experimented with postgraduates, reading sections of his writings for
increasingly preposterous interpretations, offered discussion and criticism. The first formal
to clients in the same way as his former “real” presentation of his theory occurred in 1951, when
ones—and they frequently worked. He realized he presented a paper titled “The Psychology of
that what clients needed was not necessarily a Personal Constructs,” which eventually became
“correct” interpretation of their situation but the title of his book, published in 1955.
novel ways of looking at it. Clients were taken in a The world, Kelly argued, is not given to us
different direction and given a framework that prepackaged in interpretable parcels. We,
prepared them for the events ahead. throughout our development, make discriminations
Because of staffing and other resourcing issues, about the world we experience, though we may
the clinic was forced to wait-list clients, and Kelly not be able to verbalize them. We start to see
suggested that, in the meantime, those future patterns, with some things similar to or different
clients might be helpful to another distressed from other things. Initially, these discriminations
person. Often though, when those who had adopted are fairly primitive. For example, young children
his suggestion were removed from the wait list and may regard all small four-legged animals as
offered therapy, they thought therapy was now “doggies.” But children continue to notice further
unnecessary; their altruistic actions had given them differences: Doggies bark, but kitties purr. Others
a new perspective. The problem had not necessarily help them make further useful distinctions, such as
gone away, but it had become manageable. between those animals that might bite and those
Such insights and Kelly’s interest in drama that will not. Kelly termed these contrasts
formed links to another approach to understanding “personal constructs.” These differentiations are

Kernberg, Otto 601
bipolar dimensions, each pole central to the throughout the world. He was the first American
meaning of the other; thus, for example, we have psychologist to present in the Soviet Union. His
no understanding of north except in relation to approach was adopted by a group of British-based
south, or hot except in contrast to cold. While no psychologists led by Don Bannister. In 1965, he
person’s construing is identical with another’s, we received a distinguished appointment to the Riklis
may share degrees of similarity. Taking into account Chair of Behavioral Science at Brandeis University,
how other people make sense of things is an near Boston, but he died unexpectedly in 1967.
important basis for productive and respectful Subsequently, personal construct groups were
relationships between people, a moral dimension formed in North America, Europe, and Australasia,
integral to Kelly’s approach. with alternating biennial local and international
According to Kelly, the way construing is used, conferences. A PCT center was established, now
not just its content, is important for long-term attached to the University of Hertfordshire. The
satisfying living. As we behave in ways reflecting Journal of Constructivist Psychology and an
our construing system, we test its effectiveness, just e-journal, Personal Construct Theory and Practice,
as scientists do when conducting an experiment. promote the theory, research, and practice.
Scientists develop hypotheses (people’s constructs),
devise an experiment to test out the effectiveness of Beverly M. Walker
their assumptions (people’s behavior on the basis
See also Constructivist Therapy; Personal Construct
of their construing), and evaluate the outcome, Theory
either revising their hypotheses (construing) or
continuing on, depending on the experimental
(behavioral) outcome. Effective experimentation is Further Readings
as essential for well-functioning human beings as Butt, T. (2008). George Kelly. New York, NY: Palgrave
for competent scientists. Macmillan.
As to therapy, PCT is theoretically coherent, Fransella, F. (Ed.). (2003). International handbook of
with both an encompassing general personality personal construct psychology. Chichester, England:
theory as well as a therapeutically oriented Wiley.
perspective about fostering change. However, it is Fransella, F., Bell, R., & Bannister, D. (2004). A manual
also methodologically eclectic, in that many differ- for repertory grid technique. Chichester, London:
ent techniques, developed by various practitioners Wiley.
and from differing theoretical stances, can be useful Kelly, G. A. (1955). The psychology of personal
in interventions in a theoretically consistent inte- constructs. New York, NY: W. W. Norton.
gration. The processes whereby we change our Maher, B. (Ed.). (1969). Clinical psychology and
construing involve both loosening up our current personality: The selected papers of George Kelly.
construing to explore alternative perspectives and New York, NY: Krieger.
reconfiguring our prior perspective into a modified, Walker, B. M., & Winter, D. A. (2007). The elaboration of
tightened alternative. Loosening techniques include personal construct psychology. Annual Review of
free association and fixed-role therapy, whereas Psychology, 58, 453–477. doi:10.1146/annurev.
tightening includes techniques such as listing pri- psych.58.110405.085535
orities, as well as Kelly’s best-known methodology,
the repertory grid. Helping clients deal creatively Website
with new challenges in their lives by coordinating
loosening and tightening generates viable alterna- PCP-net: http://www.personal-construct.net/
tive options for problem solving, providing clients
with an approach that can be applied beyond their
current predicament.
The publication of Kelly’s theory in 1955 in his KERNBERG, OTTO
book The Psychology of Personal Constructs
generated much interest, both approving and Otto F. Kernberg (1928– ), best known for his
critical. Kelly was invited to present at meetings work in object relations and its relationship to

602 Kernberg, Otto
personality disorders, primarily borderline known as the internalization system. This

personality disorder and narcissism, was born on internalization system is complex and varies over
September 10, 1928, in Vienna, Austria. His family time, based on the changing nature of the
fled Nazi Germany in 1939 and emigrated to relationship between the mother and the child, as
Chile. His education in Chile included biology and the child and the mother each develops. Kernberg
psychology, with the intent of becoming a identified three systems that over time reflect the
psychiatrist. He graduated from the Universidad stages in childhood development.
de Chile medical school in 1953. He first came to Kernberg’s first system stage was labeled
the United States in 1959 to study with Jerome introjection. In this stage, the child experiences
Frank at Johns Hopkins Hospital and emigrated in primitive emotions in relationship to the primary
1961 to join the C. F. Menninger Memorial caregiver without a real understanding of who is
Hospital, where he was director of Psychotherapy the primary caregiver. The child at this stage is
Research at the Menninger Foundation. During unable to identify the source of these feelings or
that time, he worked as supervising and training the significance associated with them. The
analyst at the Topeka Institute for Psychoanalysis. experience at this stage is assumed wholly by the
In 1973, he moved to New York, where he was child and identified as either negative or positive in
director of General Clinical Service at the New its completeness.
York State Psychiatry Institute. In 1974, he was The second system stage was labeled
appointed professor of Clinical Psychiatry at identification. In this stage, the child is able to set
Columbia University, where he was training and aside highly emotional responses to a point where
supervising analyst. In 1976 to 1995, he was previously unattributable responses are replaced
appointed at Cornell University as professor and by identification and awareness of the self–object
director of the Institute for Personality Disorders relationship. The child is able to identify self and
for New York Hospital. Most notably, from 1997 identify the other, with both of these roles
to 2001, he was president of the International complementing each other. At this stage, the child
Psychoanalytic Association. He is a distinguished also learns to adapt emotive responses previously
life fellow of the American Psychiatric Association. unmodulated in the introjection stage. The child is
Kernberg saw the relationship between deficits able to identify himself or herself as an interactant
in object relations and the emergence of in relationship to the separate object.
psychopathology. He developed a framework for Integration of ego occurs in the third and most
organizing personality disorders that included a highly developed stage in the system, ego identity.
structural design based on severity. Kernberg In this stage, various representations of self and
believed that object relations was a natural other are integrated into one sense of self. The
extension of psychoanalysis. He saw the mother– various representations and identifications are
child relationship as fundamental to understanding brought together into personality organization,
healthy psychological development. He proposed a and the self emerges as the essence in the individual
continuum of pathology that ranged from the and guides the way in which the individual sustains
chronically psychotic, through severe personality relationships. In this stage of development, the self
disorders, to neurotic functioning, to normal reflects all of the possible representations of
functioning. relationships with the object.
Kernberg contended that every mother–child Kernberg contributed to object relations theory
relationship consisted of three components: (1) an through his developmental model, explaining
image of self, (2) an image of other, and (3) an certain intrapsychic tasks that one must accomplish
affective disposition. The affective disposition is to develop healthy relationships. Failure to
mitigated by the child’s drive state when the successfully navigate these tasks can result in the
interaction with the mother occurs. If the child is risk of developing certain pathologies. Not
deprived as part of the interaction, he or she will accomplishing the first developmental stage,
be left feeling frustrated and lacking object introjection, where the infant clarifies the differ-
sustenance. The three-part configuration of self, ence between self and others, increases the risk of
other, and affectional disposition defines what is developing psychoses. Not accomplishing the

Kernberg, Otto 603
second developmental stage, identification, results the transference/countertransference; and the inte-
in increased risk of developing borderline gration of self representations that have been split
personality qualities. Individuals with borderline off. Of greatest concern is reduction of suicidal and
personality are unable to see relationships as self-destructive behaviors and addressing the ways
multifaceted and contextual but, rather, see them in which clients can subvert the treatment.
as all-good or all-bad, a condition Kernberg refers Kernberg’s model of narcissistic and borderline
to as identity diffusion. In the case of patients with personality was not without its critics. His model
narcissism, their development is typically more was inspired by Margaret Mahler’s work; however,
advanced than that of patients with borderline it was critiqued for not having significant detail.
personality disorder in that they have developed an Critics also argue that his ideas were foundationally
integrated self, although distorted by a sense of based on his work with adult clients and applied
grandeur. Kernberg postulates that those with deductively to infants. Heinz Kohut disagreed with
pathological narcissistic tendencies need to Kernberg on several ideas. Kernberg saw narcissistic
construct an inflated view of themselves to protect personality as a continuum with borderline
their sense of self. Their overtly expressed personality, whereas Kohut saw both disorders as
narcissism, which others around them experience, being distinctly different. They also differ in their
protects their unexpressed ideal self and prevents ideas on the development of the narcissistic
them from having feelings of failure and personality, with Kohut focusing on the libidinal
humiliation. drives and Kernberg focusing on aggression. And
To treat those with maladaptive object relations, finally, both Kernberg and Kohut differed on the
Kernberg developed transference-focused analytic process and whether transference is to be
psychotherapy (TFP). TFP is a form of intensive challenged (Kernberg) or allowed and encouraged
psychoanalytic therapy suitable for clients with (Kohut). Despite these differences, Kernberg is
borderline personality disorder, with the intent of regarded as one of the most influential theorists
integrating the split-off parts of self and the object who connected psychoanalysis with object relations
representations. It requires a minimum of three and also in the development and treatment of
45- or 50-minute sessions per week. The intent of personality disorders.
the therapy is to address unreconciled
representations of self and the significant object Marty Jencius
and to reduce the use of identity diffusion as a
See also Freudian Psychoanalysis; Interpersonal
defense mechanism. These relationships emerge as Psychoanalysis; Klein, Melanie; Mahler, Margaret;
a form of transference on the therapist. The Object Relations Theory; Relational Psychoanalysis;
therapist uses consistent interpretation and Sullivan, Harry Stack
reevaluation by the client to create a more integrated
self. The typical goals of TFP are better affective
control, better behavioral control, and more grati- Further Readings
fying relationships. To develop a better integrated
Clarkin, J. F., Yeomans, F. E., & Kernberg, O. F. (2005).
representation of self and object and to modify the
Psychotherapy for borderline personality: Focusing on
client’s defense mechanisms, the client’s internal
object relations (1st ed.). Arlington, VA: American
representations of previous relationships are chal- Psychiatric.
lenged and interpreted as part of the therapeutic Kernberg, O. F. (1975). Borderline conditions and
relationship. Clarification, confrontation, and pathological narcissism. New York, NY: J. Aronson.
interpretation are processed as the client transfers Kernberg, O. F. (1976). Object-relations theory and
his or her object experience onto the therapist. clinical psychoanalysis. New York, NY: J. Aronson.
TFP starts with the development of the treatment Kernberg, O. F. (1980). Internal world and external
contract. The treatment contract consists of general reality: Object relations theory applied. New York,
guidelines that apply to the client and the therapist. NY: J. Aronson.
The therapeutic process of TFP consists of a Kernberg, O. F. (1984). Severe personality disorders:
diagnostic description of the internal object relations; Psychotherapeutic strategies. New Haven, CT: Yale
elucidating the self and object relationship, including University Press.

604 Klein, Melanie
Kernberg, O. F. (1989). Psychodynamic psychotherapy of provided her young patients with a wealth of play
borderline patients. New York, NY: Basic Books. materials, including small figures, animals, cars,
Kernberg, O. F. (2012). The inseparable nature of love paper, pencils, water, and cups, but the
and aggression: Clinical and theoretical perspectives psychoanalytic play technique is most decidedly
(1st ed.). Washington, DC: American Psychiatric. not play therapy. Klein advocated making “deep”
Yeomans, F. E., Clarkin, J. F., & Kernberg, O. F. (2002). A interpretations of oedipal and pre-oedipal
primer on transference-focused psychotherapy for the phantasies, which she believed helped relieve
borderline patient. Northvale, NJ: J. Aronson. anxieties in the young child; as evidence, she cited
the release of inhibitions in play immediately
following such interpretations. Her work with
children led Klein to challenge some basic tenets of
KLEIN, MELANIE Freudian theory. She proposed that the young child
has an early superego and is capable of transference,
The British psychoanalyst Melanie Klein which Freud held was not possible until after the
(1882–1960), née Reizes, was born in Vienna, resolution of the Oedipus complex, leading to the
Austria, into a Jewish middle-class family. Klein formation of the superego at around age 6.
was a bright, ambitious child and did well in Klein’s new ideas were controversial in Berlin,
grammar school, but financial problems prevented so when Abraham died suddenly in 1926, she
the family from supporting her desire to train in welcomed an invitation from Ernest Jones, presi-
medicine; instead, circumstances forced her to dent of the British Psychoanalytical Society (BPS),
marry at the age of 21. Within a few years, she had to move to London, where many psychoanalysts
three children and moved to Budapest with her were eager to learn her play technique. Soon after
husband; however, a life of domesticity did not suit her arrival, the controversy over Klein’s approach
the independent and strong-willed Klein, and she prompted a debate with the Freuds in Vienna,
became depressed. Seeking treatment with the where Anna Freud was developing a different
Freudian analyst Sandor Ferenczi, Klein discovered method of child analysis. Anna Freud disagreed
a new and exciting intellectual pursuit in with Klein’s deep analysis of children and argued
psychoanalysis. Ferenczi encouraged her to train as that instead the analyst should seek to strengthen
an analyst and to venture into the as yet unexplored the child’s ego and serve as an external superego
field of child analysis. Klein began by analyzing her for the young child. Sigmund Freud also criticized
own children and went on to develop an innovative Klein’s challenges to his theory about the timing of
method of child analysis, called the psychoanalytic the Oedipus complex and the development of the
play technique, and a new school of thought in superego. Jones and several other key members of
psychoanalysis based on the earliest, infant–mother the BPS supported Klein in the debate, and the
relationship: object relations theory. dispute was left unresolved only to reemerge later
Klein became a psychoanalyst in 1919 and, when the Freuds moved to London at the beginning
soon after, divorced her husband and moved to of World War II.
Berlin, where she joined the Berlin Psychoanalytic Over the next decade, with the support of a
Society. The society’s president, Karl Abraham, loyal group of followers in the BPS, Klein developed
supported Klein’s work with children, and she a distinctly new approach to psychoanalysis known
soon developed the psychoanalytic play technique. as object relations theory, which challenged not
Klein’s play technique treats children’s play as only Freud’s account of child development but also
equivalent to the free associations of an adult on his view of the adult psyche and his method of
the couch: Play is seen as symbolizing unconscious analyzing adults. Klein’s most controversial idea
phantasies (Klein preferred this British spelling to was her claim about the existence of aggressive
emphasize the unconscious nature of the phantasies, phantasies derived from the workings of the death
in contrast to conscious fantasies, or daydreams). instinct in the infant psyche. Even though the
Thus, play activities are the material on which death instinct is a classical Freudian concept,
interpretations are based. To gain as much access Klein’s vision of the infant’s mind as a cauldron of
as possible to unconscious phantasies, Klein destructive phantasies was seen as going too far.

Klein, Melanie 605
Her most important and influential contribution development, the ego eventually works through
was the idea that the infant has a primary object the depressive position and develops a mature
relationship with the mother. In Freud’s view, the internal object world.
infant feels love for the mother only because she This account of infant development led Klein to
satisfies his or her basic physiological needs. In view adult personality in a new light. Depression
contrast, Klein argued that the infant is predisposed in adults is caused by a failure to work through the
from birth to seek a relationship with a caregiver depressive position, whereas schizoid and psy-
independent of other needs; thus, the relationship chotic states represent a reemergence of the
to a love object is primary. In Klein’s view, this paranoid-schizoid position, with its primitive
relationship is represented within the psyche by a defenses producing symptoms of paranoia and
complex world of mental representations, or distortions of reality. This object-relational view of
“internal objects.” This inner world of mental the adult in a paranoid-schizoid state made it
objects populates the ego and the superego, and possible to conduct analysis with more seriously ill
the dynamic relationships among them determine patients, such as schizophrenics, who had
the mental health of the individual. Klein’s previously been considered unreachable.
fundamental idea of personality being made up of Klein’s object-relational view of adult personal-
mental objects in relationship with one another ity together with her experiences conducting deep
has inspired various psychoanalytical schools of analysis with children also led to innovations in
object relations theory, including the approaches of her analytic technique with adults. Whereas
Donald Winnicott and Otto Kernberg. Freudian technique aims to reconstruct past
Kleinian object relations theory proposes the relationships by interpreting free associations,
existence of two fundamental phases in the child’s Kleinian technique focuses on immediately
development: (1) the paranoid-schizoid position interpreting the transference to reach the patient’s
and (2) the depressive position. In the current inner world of objects. Klein also
paranoid-schizoid position, the infant’s mind is advocated making deep oedipal and pre-oedipal
dominated by primitive defense mechanisms that interpretations from the start and paying close
split the object into part objects and into good and attention to the countertransference as a way of
bad. Hate for the bad objects and greed and envy understanding the patient’s primitive defenses,
of the good objects inspire phantasies of attacking such as projective identification. Changes in the
and destroying the mother’s body. Klein empha- transference relationship are taken to indicate
sized psychotic defenses such as denial, splitting, changes in the internal world of the patient. Thus,
and projection, and identified a new mechanism: the mutative factor is analysis of the transference,
projective identification. This defense has now not insight into the unconscious and past relation-
developed a variety of definitions within various ships, as suggested by classical psychoanalysis.
approaches, but in Klein’s original conception it Klein’s challenges to Freudian psychoanalysis
refers to the projection of parts of the self into the and ventures into working with psychotic patients
object and identification of the object with those prompted a second debate with Anna Freud,
parts. The paranoid-schizoid position is followed known as the Controversial Discussions, following
by the depressive position as the child begins to the Freuds’ arrival in London in 1938. Anna Freud
grasp the concept of whole objects and his or her quickly became an influential member of the BPS
psyche becomes dominated by feelings of and, with the support of her followers from Vienna
unconscious guilt for having attacked his or her and a handful of British analysts, argued that
love object in phantasy. This guilt leads the child to Klein’s ideas were not sufficiently Freudian and
attempt to repair the objects through acts of were incompatible with classical psychoanalysis.
reparation toward the mother. Early in develop- Klein was also criticized for working with psychotic
ment, the organization of the ego oscillates between patients without a medical qualification. The
these two states: Successful reparations will allow controversy went on for several years and was
the depressive position to predominate, while eventually resolved in 1944 when the two sides
unsuccessful ones will bring the paranoid-schizoid agreed to disagree and set up separate training
position to the fore. In the course of normal programs for their groups. The BPS still offers

606 Klein, Melanie
separate training for Freudians and Kleinians, but See also Attachment Group Therapy; Classical
there is also a strong group of Independents who Psychoanalysis; Freud, Sigmund; Freudian Psychoanalysis;
bridge the gap. Kernberg, Otto; Neo-Freudian Psychoanalysis; Object
Kleinian object relations theory is currently Relations Theory; Winnicott, Donald
practiced by a large Kleinian group in London and
is also popular among South American psychoana-
lysts, especially in Argentina, but it has been largely Further Readings
rejected by American psychoanalysts, who are Grosskurth, P. (1986). Melanie Klein: Her world and her
mostly ego psychologists and who reject the notion work. New York, NY: Knopf.
of the death instinct. Kernberg is among the few Hinshelwood, R. D. (1989). A dictionary of Kleinian
American analysts who have been influenced by thought. London, England: Free Association Books.
various aspects of Kleinian theory beyond the King, P., & Steiner, R. (Eds.). (1991). The Freud-Klein
basic concept of object relations. However, Klein’s controversies: 1941–45. London, England:
ideas have had a much larger influence on academic Routledge.
developmental psychology through the work of Klein, M. (1975). The collected writings of Melanie Klein
the psychoanalyst John Bowlby, who trained with (4 vols.). London, England: Free Press.
Klein and was inspired by object relations theory Mitchell, J. (Ed.). (1986). The selected Melanie Klein.
to develop his famous theory of infant attachment. New York, NY: Free Press.
Segal, H. (1979). Klein. London, England: Karnac
Gail Donaldson Books.

L
the United Kingdom as World War II was ending.
LACANIAN GROUP THERAPY He was interested in witnessing the new develop-
ments in treating war neurosis by the use of group
Lacanian group therapy is an approach to group treatment. After his visit, he wrote his article
analysis that differs from other group approaches “British Psychiatry and the War,” in which he
in the way the group narrative is understood. The expressed his respect for the work of these two
French psychoanalyst Jacques Lacan’s well-known pioneers in applying psychoanalysis to group work
statements “The unconscious is the discourse of in a military hospital. He took some of Bion’s ideas
the Other” and “The unconscious is structured like and made them part of his own developments in
a language” become the guiding orientation that what are called “the cartel” and “the pass” in
informs the group therapist in the analytic process Lacanian psychoanalysis.
of Lacanian group therapy.
Sigmund Freud, unlike Lacan, was not able to Theoretical Underpinnings
make use of Ferdinand de Saussure’s structural
linguistics, nor did he benefit from the anthropo- For Lacan, the unconscious is intimately tied to
logical findings of Claude Lévi-Strauss. However, both the structure of language and the impossibil-
Lacan, drawing from both Saussure and Lévi- ity of language to grasp all of our reality. Lacan’s
Strauss, demonstrated the importance Freud had concept of the unconscious is anchored in Freud’s
placed on careful interpretation of a patient’s own theory of the unconscious, but it is comple-
speech (e.g., the cases of the “rat man” and “Dora”) mented and expanded by his application of the
as the means by which one may decipher the structural linguistics (and the derived linguistic
unconscious. In doing so, Lacan was able to vali- signifiers) of Saussure (1857–1913) and the anthro-
date many of Freud’s insights and ultimately devel- pology of Lévi-Strauss (1908–2009).
oped his own expanded theory of the unconscious. Lacan transferred elements from Saussure and
Lévi-Strauss to expand and modify Freud’s id, ego,
and superego into what he called the three basic
Historical Context
registers of human experience: (1) the symbolic,
Lacan (1901–1981) is considered by many as the (2) the imaginary, and (3) the real. The symbolic,
most influential psychoanalyst since Freud (1856– also called the (big) Other, refers to the realm of
1939). Lacan’s work influenced psychoanalysis in language, or more specifically the way a person’s
Europe, South America, the Middle East, Australia, mental structure is organized by the particular
and, increasingly, the United States. linguistic signifiers of his or her language. The
Lacan was deeply impressed by the work of fel- imaginary reflects the realm of meanings associ-
low psychoanalysts Wilfred Bion (1897–1979) and ated with those linguistic signifiers. This equates
John Rickman (1891–1951). He spent 5 weeks in to Freud’s concept of ego, the initial form of
607

608 Lacanian Group Therapy
identity. It is also called the (little) other, the look- therapist is actually negating the importance of
alike and/or rival. The imaginary constitutes every- what the patient is referring to. This realization
day reality. The real remains outside the realm of may begin to bring the patient’s discourse into
the symbolic and the imaginary. In moments of what Lacan calls full speech, as opposed to empty
trauma, individuals encounter the real. During speech. In full speech, both conscious and uncon-
trauma, individuals try to grasp experience through scious elements are present, whereas in empty
the symbolic and the imaginary; however, the speech, the patient is using avoidance or negation,
impossibility encountered in language prevents or another kind of defense.
them from fully expressing the experience. This is
why Lacan also refers to the real as the impossible.
Jouissance
If, for instance, we are suddenly struck by an
earthquake and experience loss and destruction, In Lacanian psychoanalysis, jouissance stands
we have an experience that is hard to put into for the French term for “enjoyment” and is based
words. The same thing happens with the traumatic on Freud’s elaborations in “Beyond the Pleasure
experiences that patients bring into a group inso- Principle.” It is assumed that individuals can only
far as they defy accurate expression. experience a certain amount of pleasure but some-
times compulsively attempt to push beyond those
limits. Such a compulsion produces a mixture of
Major Concepts suffering and enjoyment. Jouissance is crucial to
Basic concepts that guide the work of the Lacanian the proper diagnosis of neurosis, perversion, and
group therapist include desire, speech, jouissance, psychosis. As such, the three realms, or “registers”—
and the dialogue in and of the group. the symbolic, the imaginary, and the real—operate
in different ways in relation to these conditions.
Through their symptoms, patients express their
Desire
relation to both the signifiers that have organized
When the human infant is introduced to lan- their psyche and the ways of enjoyment present in
guage, there is a gain and there is a loss. The gain is the unconscious through fantasies. For instance, a
the social connection with others through language, person may often cry when in fact he or she is
the symbolic. However, in moving from the world angry, or may act angry when he or she is afraid.
of nature to the universe of culture, the new being Sometimes the patient may revise his or her
is not the same. A basic lack is introduced, what assumptions after simply being questioned in an
Lacan calls a “lack of being.” It is this lack that emphatic way by the therapist. Jouissance is par-
constitutes desire. Desire moves us in search of oth- ticularly relevant in determining a person’s rela-
ers. Following Freud, Lacan asserts that an object tionship to the real.
that has been lost becomes an object of desire.
The Dialogue in the Group
Speech
The dialogue in the group is the discourse in the
Speech is the particular way in which each group as it evolves naturally. It is what appears as
group and each individual is affected by the sym- reality on a conscious level; therefore, it is the
bolic (language). Lacan wanted to restore the “the imaginary element of the group discussion, also
talking cure” to its place of distinction in psycho- called the signified in linguistic terms. It establishes
analysis. In group therapy, Lacan’s emphasis on the transference among members of the group,
full speech versus empty speech is central to the called horizontal transference.
interventions of the therapist.
In a group session, if a patient says, for example,
The Dialogue of the Group
“That does not matter to me,” the therapist may
simply repeat the sentence back to the patient. In The dialogue of the group refers to the repressed
hearing that from the therapist, the patient may unconscious processes behind the common narra-
become surprised and may begin to realize that the tive of the group: the motives, identifications,

Lacanian Group Therapy 609
fantasies, and desires of group members as they are Interpretation

stimulated in the group encounter. Through this
Interpretation is the optimal technique used by
dialogue, the therapist examines the horizontal
the therapist to confirm an insight that the group
transference among members as well as the trans-
members are close to realizing. Interpretation is
ference to the therapist, who is placed in the posi-
also a way the therapist may disrupt the status
tion of the Other. Transference toward the thera-
quo of jouissance by pointing out contradictions,
pist is called vertical transference.
omissions, and denials. In this latter use of inter-
pretation, the therapist creatively deconstructs the
Techniques patient’s narrative in an attempt to mobilize
the group and group members’ desire for the
In contrast to other theories that operate on a
revelation of the truth hidden by the symptom.
model of intersubjectivity, Lacanian theory places
the therapist in an asymmetrical position vis-à-vis
the group members and the group as a whole. The Therapeutic Process
group members are considered to be the subjects in
question, whereas the therapist is in the position of The Lacanian approach to group therapy attempts
the object. This guides the therapist’s interventions, to put the group and its members in touch with the
whether they are directed to an individual group three registers (the imaginary, the symbolic, and
member or to the group as a whole. the real) at different levels of depth depending
on the configuration of each group. The techniques
in the group therapy are geared to differential
Scansion and Punctuation
treatment depending on the diagnosis of each
We use scansion in poetry to determine the patient. There may be effects, events, situations,
rhythm of a line. We use punctuation to signal a and moments in the group that defy the work with
break or the end of a sentence. In group therapy, signifiers and meaning, such as when group mem-
these techniques are directly related to group bers confront trauma, finding it impossible to
members’ use of speech and the dimension of express themselves with language. At these junc-
time. In individual therapy sessions, the therapist tures, the work that has taken place with the two
may use scansion to vary the length of a session basic dialogues (in and of the group) makes it pos-
to uncover or emphasize certain meanings and/or sible for group members to access the aspect of
interpretations. In group therapy sessions, scan- human experience that defies language. For
sion is related to the therapist’s attention to the instance, in a group session, a young woman
dialogue of the group. For example, a therapist arrives in the group after being assaulted in the
may intervene to move a group member and/or street. She can barely speak and is shaking.
the entire group to full speech by repeating a Gradually, through the help of group members, she
word or a phrase that the group member or beings to speak and explain what has just hap-
members may use inadvertently without special pened to her. In the process, she is transforming an
meaning. experience of the real, of what could not be repre-
sented, into a narrative that begins to transform
Mediation the real through the symbolic and the imaginary.
Trauma affects the experience of space and time
Through mediation, the therapist may clarify, for the patient. The dialogues in and of the group
ask questions, express doubts, and even feign con- bring these dimensions back into the narrative and
fusion in response to the members’ use of lan- have a healing effect for patients.
guage. The therapist mediates the effects of the
members of the group on one another. The focus is Macario Giraldo
on the imaginary, or signified, meanings and on the
preconscious and conscious reality. Mediation pre- See also Freud, Sigmund; Freudian Psychoanalysis; Group
pares the group members for their common task of Analysis; Group Counseling and Psychotherapy
learning from one another. Theories: Overview; Lacanian Psychoanalysis

610 Lacanian Psychoanalysis
Further Readings published in 1966. During the last decades of his

Dor, J. (1997). Introduction to the reading of Lacan: The
career, Lacan focused on using mathematical for-
unconscious structured like a language (J. Feher malism to develop his approach.
Gurewich, Ed., in collaboration with S. Fairfield).
Northvale, NJ: Jason Aronson. Theoretical Underpinnings
Giraldo, M. (2012). The dialogues in and of the group:
Lacanian perspectives on the psychoanalytic group. The best known of Lacan’s early contributions to
London, England: Karnac Books. psychoanalytical theory was his account of the
Lacan, J. (1947). British psychiatry and the war. “mirror stage.” As the founding moment of both
Psychoanalytical Notebooks of the London Circle, 4, the imaginary order and the ego, it describes ego
9–34. formation as a process of recognition and identifi-
cation with one’s image as reflected in a mirror.
The mirror models the ego as a complete “whole”
that reflects the idealized prescriptions for identity
circulating in an individual’s familial and cultural
LACANIAN PSYCHOANALYSIS contexts; the ego thus becomes ensnared within a
circuit of identification and competition with an
Lacanian psychoanalysis is a form of psychoana- idealized self-image. Because Lacan’s first presenta-
lytic theory and practice derived from Jacques tions of the mirror stage drew on psychological
Lacan’s reformalization of Freudian concepts. observations, it has often been misinterpreted as a
Drawing from philosophy, structural linguistics developmental stage.
and anthropology, logic, and mathematics, Lacan Lacan’s use of philosophy (e.g., Hegel, Sartre)
(1901–1981) developed key Freudian insights rel- and structuralism to inform his rereading of Freud
evant both to the centrality of speech and language is seen in his emphasis on the role of desire in
in analysis and to construction of a theoretically human relations. His distinctions among need,
derived diagnostic framework. demand, and desire hinge on assumptions concern-
ing individuals’ physical interdependence (e.g.,
during infancy) and the fact that human “being” is
Historical Context
inseparable from its articulation in language.
Lacan’s early training was at the Faculté de méde- Lacan’s use of the term need approximates Freud’s
cine de Paris, where he treated a number of use of the term instinct and represents a more or
patients suffering from automatism. This work less strictly biological concept (e.g., hunger).
coincided with his developing interest in surrealist “Demand” is required by our reliance on others to
and psychoanalytical approaches to unconscious get our needs met (e.g., the infant’s dependence on
processes. He became involved in the nascent a caretaker for food, hygiene, and shelter requires
French psychoanalytical movement, entering anal- that it convey to the caretaker something of its
ysis with Rudolph Lowenstein in 1932. Lacan was needs) and is conditioned by the fact that our
among the diverse audience of French intelligentsia requests ultimately must be expressed in the lan-
at Alexandre Kojève’s lectures on Georg Hegel. His guage of our social environment. Hence, “demand”
first formal psychoanalytical paper—on the “mir- is addressed to an “other” via the language of the
ror stage”—was presented at the 14th Congress of “Other.” While an other’s response to a demand
the International Psychoanalytic Association in may temporarily satisfy a need, it is inevitably
1936. In “The Function and Field of Speech and inadequate to satisfy the demands for recognition
Language in Psychoanalysis” (1953), Lacan out- and love that, over time, become symbolically
lined elements of his psychoanalytical “linguistic intertwined with the expression of our needs. In
turn.” He conducted a series of public seminars the gap that opens up between need satisfaction
that supported important developments in and the impossibility of exacting from the other an
late-20th-century French philosophy; he also indisputable proof of love, “desire” emerges as a
formed three psychoanalytical schools between residue of insatiability, a force or tension that, once
1953 and 1980. Écrits, a selection of essays, was activated, incessantly seeks its own renewal.

Lacanian Psychoanalysis 611
Lacan claimed that Freud had realized the role Hence, the analyst adopts an intentionally igno-
of language in psychoanalytical inquiry but lacked rant stance toward the ordinary meanings of the
the theoretical tools necessary to develop its most analysand’s speech. This stance allows the analyst
radical implications. For example, Freud’s account to hear and speak from the place of an uncon-
of oedipalization (“castration”) was understood scious knowledge produced by signifying events
by Lacan to address the subject’s forced choice (e.g., a slip of the tongue) that disrupt the analy-
between accepting and rejecting the paternal “sig- sand’s significations by exceeding what he or she
nifier.” This signifier is the father’s “No!”—which “meant” to say. Unconscious knowledge produces
interrupts the imaginary bond of the mother–child its effects less by revealing the what and why
duality and represents the signifier that “founds” behind the analysand’s symptom and more by illu-
the symbolic ordering of social life according to minating how his or her symptom functions to
preexisting categories and modes of being. What is maintain a particular relation to the Other’s desire.
essential about this “primordial” signifier is its
intrinsic independence from that which it is sup-
Jouissance and Fantasy
posed to represent. Psychosis, for example, emerges
from a refusal of castration; the intensity of “imag- While jouissance is sometimes translated as
inary” meanings and experiences is difficult for the “enjoyment,” the latter’s temperate connotations
individual to separate from, since the (paternal) fail to convey its paradoxical admixture of plea-
signifier that would have introduced a mediating sure and pain, intoxication and uncanniness. Lacan
third term has been foreclosed. Through Lacan’s suggests that the subject must “pay” for the right
structuralist lens, castration represents an alien- to represent himself in language by sacrificing “a
ation of being in language that the subject accepts pound of flesh” (castration)—a renunciation of
in exchange for a place from which to speak and jouissance, which the subject then locates in the
be represented in socially constructed reality. Other. In Lacanian parlance, castration is a sym-
bolic function manifested concretely in familial
and societal imposition of prescriptive norms,
Major Concepts rules, and prohibitions. The limits set by castration
In Lacanian group therapy, a number of concepts simultaneously drain jouissance from the body and
underlie the approach, including the notion that imply that the body could enjoy fully, could experi-
the unconscious is structured like a language; jou- ence a “complete” jouissance, only if such prohibi-
issance and fantasy; the imaginary, the symbolic, tions were not imposed. Fantasy is the subject’s
and the real; and object a. response to his or her perceived lack of jouissance,
the jouissance he or she imagines the Other to
enjoy. Lacan suggests that the structure of a given
Unconscious Structured Like a Language
subject’s fantasy reflects his or her solution to the
Lacan’s account of the unconscious begins with problem posed by this forfeiting of jouissance to
Freud’s own preoccupation with manifestations of and for the Other (i.e., it is a response, an answer
the unconscious that are linguistic in form: slips of to the question of what the Other wants of the
the tongue, jokes, and dreams. The Freudian subject).
unconscious speaks, thus, through the “discourse
of the Other”—a language that is addressed to,
The Imaginary, the Symbolic, and the Real
insinuates itself within, affects, and exceeds us.
Lacan took signifiers (the formal, combinatory ele- Lacan presents the imaginary, the symbolic, and
ments of speech) rather than signs (meanings) as the real as interrelated “orders” that cover the field
the basic elements of language. In analysis, signifi- of psychoanalytical phenomena. The imaginary is
ers take on particular importance, as Lacan asserts characterized by its structure of dual relations,
that the unconscious can only be discerned through particularly between the ego and its idealized oth-
attention to the “letter” of the analysand’s speech ers but also between words and their significations.
(signifiers in their literal, “opaque” material aspect) The imaginary’s functioning is demonstrated in the
rather than its ostensible meanings (significations). mirror stage. Imaginary relations are founded in

612 Lacanian Psychoanalysis
the dual relation of the ego with its narcissistic to capital letter A, the Other (Autre in French),
counterpart, the prototype of which is identifica- denoting an irreducible otherness. Rather than
tion with the projection of one’s bodily form in a being an object (person, thing, or activity) toward
mirror. The mirror reflection suggests a subjective which a preexisting desire is “drawn” (e.g., we
autonomy and synthesis that presage the seductive might experience ourselves as “drawn” to a person
power of the image to compel the ongoing dramas we find desirable or to an activity we feel actualizes
of recognition and identification that constitute an important aspect of our being), object a func-
the ego’s domain. Lacan characterized the ego’s tions as the cause or impetus of our desire. Lacan
formation as a moment of profound alienation, associated object a—an object of neither satisfac-
and imaginary relations as dominated by rivalry tion (need) nor demand—with a surplus jouissance,
and aggression. produced in excess of the “exchange value” of com-
Lacan affords the symbolic a privileged role in modified desires. Hence, rather than representing
analysis. Lacan understood language to be an desire for some “thing,” say a particular trait or
autonomous system that functions in large part bodily attribute, object a stands in for a pure “desir-
outside our awareness. He uses the notion of the ousness” or “will to desire” of the other. Lacan links
symbolic’s ordering of the social field through kin- object a to the gaze and the voice (e.g., to certain
ship structures to illustrate our dependency on the ways of being looked at or spoken to).
signifier: To be recognized as a subject—in the
familial, social, juridical, national, and cultural
senses—means to accept and speak from one’s Techniques
place in a predetermined structure of kinship and
Interpretation
to participate in the legal transactions, ritualized
behaviors, and speech acts necessary to reproduce Lacanian interpretation problematizes notions
this structure over time. The analyst addresses his of meaning and focuses on the register of desire.
or her interventions to the unconscious subject The aim is to stimulate the analysand’s curiosity
that speaks through but eludes representation in and engage the unconscious in active production of
the symbolic; the analyst’s aim is to engage the new meanings and connections through interpreta-
subject in getting its signifiers “un-stuck” and, tions that are polyvalent. As analysis progresses,
thus, to revitalize desire by keeping the fluidity of the analyst may present more direct and construc-
signifying repetition alive. tive interpretations in an attempt to symbolize
The order designated as the real changes across affects or elements of the analysand’s experience
Lacan’s teachings. In his earlier seminars, the real that seem to have escaped prior symbolization.
is “impossible” because it cannot be imagined or
symbolized. The real’s impossibility is also a func-
tion of its mute “fullness,” a chaos or void that Punctuation
Lacan sometimes associated with undifferentiated, Punctuation serves to intervene in the analy-
“indifferent” materiality. Lacan became preoccu- sand’s flow of speech and disrupt his or her con-
pied with topology in his later work, and his sciously intended signification. Just as the insertion
account of the symptom shifts accordingly, moving of written punctuation reconfigures the meaning
from an emphasis on how the subject avoids con- of a sentence or text, an analyst’s punctuation
frontation with the Other’s lack to an emphasis on opens up the analysand’s discourse to enigmatic
how the jouissance of the symptom functions to and unintended meanings by hinting that the
knot the symbolic, imaginary, and real together in analysand is saying more than the analysand
a manner particular to a given analysand. thinks he or she is. Punctuation can take a number
of concrete forms, from a repetition of what the
analysand has said but with a different rhythm,
Object a
emphasis, or tone to a moment of silence, an
Lacan uses the small letter a to denote the other interruption, or a quizzical facial expression; the
(autre in French)—a person in reality that I perceive analyst may also punctuate by ending the session
to be more or less like myself—in contradistinction precipitously.

Lazarus, Arnold 613
Scansion See also Classical Psychoanalytic Approaches: Overview;

Lacanian Group Therapy
Scansion, or the variable session length, is a
form of punctuation that operates across, rather
than within, sessions. The analyst may punctuate a Further Readings
session by ending it at a particularly significant Barnard, S., & Fink, B. (Eds.). (2002). Reading seminar
moment, perhaps just after an analysand has made XX: Lacan’s major work on love, knowledge, and
a slip or has recounted an unsettling dream. feminine sexuality. Albany: State University of New
Alternatively, the analyst may interrupt the session York Press.
soon after it has begun and in the middle of, say, an Dor, J. (1998). Introduction to the reading of Lacan: The
analysand’s recounting of the past week’s events; unconscious structured like a language (J. Gurewich,
the analyst may also extend a session to sustain the Ed., with S. Fairfield). New York, NY: Other Press.
effects of the emergence of unconscious meanings Fink, B. (1997). A clinical introduction to Lacanian
and/or to nourish the development of an associa- psychoanalysis: Theory and technique. Cambridge,
tive chain. The aim is to accentuate the uncanny MA: Harvard University Press.
affects associated with the emergence of uncon- Lacan, J. (2007). Écrits: The first complete edition in
scious material and to stop the analysand from English (B. Fink, Ed.). New York, NY: W. W. Norton.
“time managing” his or her sessions to avoid, con- Nasio, J.-D. (1998). Five lessons of the psychoanalytic
tain, or control manifestations of the unconscious. theory of Jacques Lacan (D. Pettigrew & F. Raffoul,
Trans.; SUNY Series in Psychoanalysis and Culture,
H. Sussman, Ed.). Albany: State University of
Therapeutic Process New York Press.
Lacanian analysis does not have a predetermined
length, but many analyses continue for several
years or more. In the early stages of analysis, the
analyst listens beyond the analysand’s stock narra- LAING, R. D.
tives of what he or she is suffering from—first,
because such narratives typically represent a coop- See Phenomenological Therapy
tation of the subject’s desire by familial and cul-
tural norms and, second, because they impede
mobilization of the analytic unconscious. The ana-
lyst makes a preliminary diagnosis of the analy-
sand’s position vis-à-vis the Other, based on Lacan’s
LAZARUS, ARNOLD
diagnostic distinctions between neurosis (based on
repression and subdivided into obsession, hysteria, Arnold A. Lazarus (1932–2013), “Arnie” to those
and phobia), perversion (based on disavowal), and who knew him well, was an acclaimed clinical psy-
psychosis (based on foreclosure). Diagnosis sup- chologist and distinguished professor emeritus in
ports the analyst’s knowing how to situate himself the Graduate School of Applied and Professional
or herself in relation to the analysand’s subjectivity, Psychology at Rutgers University in New Jersey.
as well as indicating which forms of intervention to Born in Johannesburg, South Africa, Lazarus was
privilege and which to avoid. Lacanians typically the youngest, by many years, of four children born
refrain from interpretations in the early stages of to a middle-class South African family. Partly as a
analysis, relying instead on punctuation and scan- reaction to being mercilessly bullied by his second
sion. Manifestations of transference allow the eldest sister’s husband, Lazarus began competitive
analyst to understand the analysand’s fantasied bodybuilding, boxing, and a lifelong interest in
relation to the Other’s desire. The end of analysis is nutrition and health. As his muscles and boxing
indicated less by a resolution of the symptom skills grew, so too did his intellectual curiosity,
(Lacan rejects the notion of cure) than by a recon- and he began publishing articles and editorials on
figuration of the subject’s relation to the symptom. health and fitness in local newspapers and
magazines. Lazarus’s formal academic pursuits
Suzanne Barnard began at the University of the Witwatersrand in

614 Lazarus, Arnold
Johannesburg, South Africa, where he earned his pandering to the psychoanalysts. Lazarus was
Ph.D. in clinical psychology in 1960. In 1957, undeterred, however, and when his 1971 book
Lazarus married Daphne Ann Kessel and had two Behavior Therapy and Beyond was published (argu-
children with her, Linda Sue and Clifford Neil, in ably the first book on what subsequently came to
1959 and 1961, respectively. be called cognitive-behavioral therapy), the staunch
Immediately upon receiving his Ph.D., Lazarus behaviorists went from anger to rage over his insis-
started his career as a private practitioner. In 1963, tence that cognitive processes needed to be included.
he accepted an invitation to be a visiting assistant Professor H. J. Eysenck, who was the editor-in-chief
professor at Stanford University in California for a of the journal Behavior Research and Therapy,
year. He, along with his wife and two children, expelled Lazarus from the editorial board.
then returned to Johannesburg as a lecturer at the Wolpe, who had been Lazarus’s mentor and had
University of the Witwatersrand Medical School chaired his doctoral dissertation in South Africa,
and as a private practitioner. In 1966, Lazarus felt betrayed and became enraged. Lazarus argued
immigrated to the United States with his family to that Wolpe’s orientation was too narrow and
serve as director of the Behavior Therapy Institute fueled the flames of Wolpe’s ire by publishing sev-
in Sausalito, California, where, in collaboration eral papers on “broad-spectrum behavior therapy.”
with some of his former graduate students from Matters became worse when in 1976 Lazarus pub-
Stanford, he built one of the nation’s first behav- lished his book Multimodal Behavior Therapy, for
ioral health care practices. In subsequent years, he which Cyril Franks, the founder of the Association
taught at Temple University Medical School in for Advancement of Behavior Therapy (now the
Pennsylvania (1967–1970) and at Yale University Association for Behavioral and Cognitive
in Connecticut, where he also served as director of Therapies), wrote in the foreword, “To my way of
clinical training (1970–1972) before joining the thinking, this book represents a sampling of the
faculty as a distinguished professor at Rutgers best that modern developments in broad-spectrum
University in 1972, where he taught at the Graduate behavior therapy have to offer, a culmination of
School of Applied and Professional Psychology years of thinking” (p. ix). Lazarus subsequently
until he retired from formal academia in 1999. dropped the word behavior from multimodal
Despite turning his attention to academic and behavior therapy, saying that it made no sense to
scholarly matters, Lazarus’s feisty, fighter’s spirit selectively emphasize the behavioral modality, and
did not falter, and soon after entering clinical prac- changed the name of his approach to multimodal
tice, he began to “duke it out” with the status quo therapy, which is arguably one of the most com-
and the prevailing norms of Freudian psychoana- prehensive approaches to psychological therapy
lytic and other psychodynamic theories and thera- ever conceived. In general, Lazarus’s pioneering
pies. Consequently, he began working with the work on behavior therapy became cognitive-
psychiatrist Joseph Wolpe on what Lazarus termed behavioral therapy, which he broadened and
behavior therapy and, in fact, coined the term, refined to multimodal therapy.
along with behavior therapist, in the professional In addition to his emphasis on technical eclecti-
literature in 1958. cism, a hallmark of Lazarus’s clinical work was the
Lazarus found that focusing solely on behav- origination of his BASIC I.D. formulation, which is
ioral techniques was too limiting, which led him to the foundation of multimodal therapy. Lazarus
incorporate cognitive factors into his method. stressed that most of our experiences comprise
When he began publishing his assertions on the moving, feeling, sensing, imagining, thinking, relat-
value of technical eclecticism (i.e., using empiri- ing to one another, and physiological processes. In
cally supported methods without adherence to the other words, he concluded that human life and
method’s theoretical foundation), and especially conduct are products of ongoing behaviors, affec-
his views on the need to broaden the base of behav- tive processes, sensations, images, cognitions, inter-
ior therapy by including cognitive processes, personal relationships, and biological functions.
he encountered resistance from several of his The first letters of each of these modalities yield
behavioral colleagues. They accused him of trying BASIC IB, but by referring to the biological modal-
to bring “mentalism” back into the field and of ity as “drugs/biology” (because psychiatrically one

Lazarus, Arnold 615
of the most common biological interventions is the times but that knowing when to cross certain
use of psychotropic drugs), Lazarus arrived at the boundaries can enhance clinical effectiveness.
acronym BASIC ID. It is crucial to remember that As a reflection of his influential work in the field
the “D” not only stands for drugs and all other of clinical psychology, Lazarus received numerous
somatic interventions, it also includes the full spec- professional honors and awards, including but not
trum of health habits, such as nutrition, hygiene, limited to two lifetime achievement awards (from
exercise, sleep, and substance use. In 1981, to fully the Association for Behavioral and Cognitive
differentiate the “ID” of BASIC ID from any Therapies and from the California Psychological
Freudian connotation of the word, and to further Association), the Distinguished Service Award
demarcate it from the “I” of “imagery,” Lazarus from the American Board of Professional
changed his multimodal acronym to BASIC I.D. Psychology, the Distinguished Psychologist Award
BASIC I.D. is intended not only to serve as a from the American Psychological Association’s
comprehensive template for problem identification Division 29 (Psychotherapy), and the very first
and clinical decision making but also to account Cummings PSYCHE Award. Also, he was inducted,
for the full range of human phenomenology— as a charter member, into the National Academies
everything from anger, disappointment, disgust, of Practice as a Distinguished Practitioner in
greed, fear, grief, awe, contempt, anxiety, depres- Psychology.
sion, and boredom, to love, hope, faith, ecstasy, With 18 books and more than 350 scientific
optimism, and joy. An important supposition is and professional publications to his credit, coupled
that all seven components interact with each other. with his unequaled eloquence, humor, charm, and
Applying this theory clinically requires the thera- visionary genius, Lazarus was a highly sought after
pist not to neglect or ignore any of the modalities. speaker who gave numerous presentations nation-
If, for example, a person is suffering from a generally and abroad.
alized anxiety disorder, a comprehensive treatment Lazarus influenced students, colleagues, and cli-
protocol will focus on the affective modality and ents through his innovative and broad-minded
also provide a functional assessment of the recip- approach to the complexities of psychological inter-
rocal impact on the other six modalities. Moreover, vention. Clinical practice for Lazarus was a vehicle
Lazarus pointed out that it is also essential to rec- not just to help people but also to educate the next
ognize and include factors that fall outside the generation of therapists and to generate new ideas
BASIC I.D., such as sociocultural, political, and for both improved applications and research. His
other macro-environmental events. son, Clifford N. Lazarus, and daughter-in-law,
What’s more, his fighter’s passion never left him, Donna Astor-Lazarus, now run The Lazarus
and among his final efforts was a serious challenge Institute (founded in 2003), where Arnold Lazarus
of rigid, therapeutic boundaries, which Lazarus held a free, clinical supervision group until the last
believed hamper therapists’ clinical effectiveness. week of his life.
To be sure, Lazarus had strong opinions and some
controversial writings on the issue of therapy Clifford N. Lazarus
boundaries, as highlighted in his 2002 book Dual
See also Behavior Therapy; Cognitive-Behavioral Therapy;
Relationships and Psychotherapy. In particular, he Eclecticism; Multimodal Therapy; Therapeutic Touch
argued that therapists need to be more tolerant of
dual, nonsexual, nonexploitative relationships for
the benefit of the client. Lazarus was open to inter- Further Readings
actions with his active clients outside the therapy Lazarus, A. A. (1958). New methods in psychotherapy: A
sessions and shared that he had meals with them case study. South African Medical Journal, 32, 660–664.
and attended important events, such as weddings Lazarus, A. A. (1971). Behavior therapy and beyond.
of clients, and on rare occasions even invited cli- New York, NY: Springer.
ents to his home. Nevertheless, he cautioned that Lazarus, A. A. (1976). Multimodal behavior therapy.
therapists must remain careful not to misuse their New York, NY: Springer.
power. Lazarus also acknowledged that this Lazarus, A. A. (1981). The practice of multimodal
approach is not appropriate for all clients at all therapy. New York, NY: Mc-Graw Hill. (Updated

616 Linehan, Marsha
paperback edition, 1989, Johns Hopkins University and a Cajun French mother, her faith has been a
Press) central force throughout her life. A pivotal moment
Lazarus, A. A., & Zur, O. (2002). Dual relationships and occurred at age 20 when she experienced praying,
psychotherapy. New York, NY: Springer. feeling loved, and saying, “I love myself”—
something not experienced before. She says that as
a result of this experience she never again suffered
the way she had done in her adolescence. Her pro-
LINEHAN, MARSHA found experience of self-acceptance and connec-
tion offered her new hope for how to help those
Marsha M. Linehan (1943– ), the developer of suffering from mental illness, and her experience as
dialectical behavior therapy (DBT), was born in a patient contributed to her unwavering stance
Tulsa, Oklahoma, on May 5, 1943. Linehan’s pas- that mental health treatments must be based on
sion for science, spirituality, and helping others empirical evidence, not theoretical formulations.
was key to the development of DBT. Since the Linehan received her Ph.D. in social psychology
publication in 1993 of the manual on which it is in 1971 from Loyola University of Chicago. She
based, DBT has been widely adopted as a treat- chose this area of study specifically due to her
ment for borderline personality disorder and interest in applying scientific methods to alleviate
suicidal behaviors. Over time, Linehan and her human suffering. She subsequently pursued clinical
colleagues in several parts of the world have inves- training but often faced roadblocks due to not hav-
tigated the use of DBT to treat other disordered ing a traditional degree in clinical psychology.
behaviors, such as substance use, eating disorders, Through her tenacity and willingness to do what-
and depression. More recently, DBT skills are ever it took, including working in a clerical posi-
being studied for their effect in enhancing quality tion, Linehan began work at Suicide Prevention &
of life in families, schools, and organizations. DBT Crisis Service, Inc., Buffalo, New York, in 1971.
is a cognitive-behavioral therapy that uses princi- She insisted that the administration there send her
ples of acceptance and change to increase func- their most desperate suicidal patients and distin-
tional behavior and decrease maladaptive behavior. guished herself by ensuring that no patients killed
It developed as a result of Linehan’s attempt to themselves. Following her unconventional training
apply what many would consider two opposing experience, the crisis center recognized her work at
approaches—problem solving and acceptance—to the level of a postdoctoral clinical intern in psy-
the problems of suicidal persons experiencing chology, even though she did not have the required
despair and a sense of not belonging. Her aca- training for such an internship.
demic background led her to approach these prob- In 1972, Linehan began a postdoctoral fellow-
lems from the perspective of a behavior therapist, ship in behavior modification at the State University
and key personal experiences resulted in her of New York at Stony Brook, studying with Gerald
attempts to create conditions where persons would Davison and Marvin Goldfreid, two pioneers in
experience connectedness, love, and freedom. The the clinical application of behavior modification.
treatment is based on the foundations of behav- She became an assistant professor at Catholic
ioral science, contemplative/mindfulness practice, University of America in 1973, with interests in
and dialectical philosophy. behavior therapy and assertiveness training.
Linehan made headlines in 2011 when the New Linehan sought a means of fostering the condi-
York Times ran an article on its front page cover- tions for suicidal persons to experience connected-
ing an address she gave at the Institute of Living in ness, freedom, and joy. Her own path to this was
Hartford, Connecticut. During her address, rooted in the contemplative traditions of
Linehan described her 26-month experience as a Catholicism, and she was particularly influenced
patient at the hospital, beginning in 1961 at the by the spiritual direction of Gerald May and
age of 17. Although she described her treatment Tilden Edwards. However, she was keenly aware
providers as caring, she also noted that the treat- that the language used in one religious tradition
ment she received only made things worse. Having may cause problems for those of other traditions,
been raised Roman Catholic, with an Irish father as well as for those who do not espouse a religious

Linehan, Marsha 617
or spiritual tradition. Furthermore, she was the problems they faced. She also observed the
attempting to bring these practices into the field of reinforcement of dysfunctional patient behaviors
psychology and was faced with how to reconcile and punishment of necessary therapist behaviors.
them with its scientific values. She searched for a Moreover, it was observed that therapists could
means to define the practices that would foster easily become hopeless and judgmental about
patients’ experiencing connection and belonging patients. To address these problems, Linehan devel-
and that would not rely on language and concep- oped a set of skills that balance teaching accep-
tual formulations that might easily be rejected. tance of persons and things as they are with
Linehan decided that Zen most easily provided specific strategies for solving problems, getting
a means of operationally defining practices in a interpersonal needs met, and regulating emotions.
way that didn’t rely on religious or spiritual con- She also outlined a hierarchical set of treatment
cepts. She spent 6 months at Shasta Abbey in targets to provide clarity about how to approach
California and studied with Fr. Willigis Jäger, a treatment and developed the DBT consultation
Zen master (Roshi) and Catholic Benedictine team. The DBT consultation team helps therapists
monk in Germany, and with Fr. Patrick Hawk, a provide treatment skillfully, attends to how contin-
Zen master and Catholic Redemptorist priest in gencies operate in treatment, and helps motivate
Tucson, Arizona. Fr. Hawk Roshi studied with therapists.
Robert Aitken Roshi, the founder of the Diamond With the 1993 publication of Cognitive
lineage of Zen and one of the first to teach Zen Behavioral Treatment for Borderline Personality
practice in Western culture. Fr. Hawk Roshi named Disorder, which summarized Linehan’s research
her as a Zen Roshi shortly before his death in and outlined DBT, the demand for training in DBT
2012, and Fr. Jaeger Roshi named her a Roshi in grew. What followed were efforts at replicating
the Sanbo-Kyodan School shortly thereafter. research on the treatment and identifying effective
Despite this, she is careful to point out that she means of dissemination. She founded an annual
does not describe herself as Buddhist. DBT Strategic Planning Meeting at the University
Linehan joined the faculty of the Department of of Washington to coordinate the efforts of those
Psychology at the University of Washington in conducting research on DBT at multiple sites
1977. In 1980, she founded the Behavioral around the world. In addition, she and her gradu-
Research & Therapy Clinics there, which served as ate students founded the Linehan Training Group,
the laboratory where she began developing DBT in the precursor to the current Linehan Institute, to
earnest through research funded primarily by the meet the demands for treatment dissemination. She
National Institute of Mental Health and the also has an interest in the use of technology as a
National Institute of Drug Abuse. Her first federally means of increasing access to treatment and
funded randomized controlled trial of treatment for founded Behavioral Tech Research, Inc., a com-
suicidal persons began in 1981, and randomized pany involved in the research and development of
controlled trials and other clinical studies have con- online and computer-assisted treatment and train-
tinued to this day. She identified and developed the ing tools.
strategies of the treatment through meticulous Linehan is the recipient of numerous honors,
observation of her treatment sessions, which were has served in several leading positions in key pro-
then coded by her research assistants. It was at this fessional organizations, and has been featured in
time that the treatment came to be known as dialec- the popular media, including National Public
tical behavior therapy, a name taken from a col- Radio, Newsweek, O Magazine, and the The New
league’s description of how Linehan’s efforts to York Times. In 2009, the American Association of
balance the change-oriented strategies of behavior Suicidology created the Marsha M. Linehan Award
therapy and the acceptance-oriented practice of for Outstanding Research in the Treatment of
mindfulness while “walking the middle path” Suicidal Behavior in her honor, and in 2011, Time
sounded much like dialectical philosophy. listed DBT as one of the 100 Most Important New
Linehan’s training in behavior therapy led her to Discoveries.
observe that therapists and patients were both eas-
ily overwhelmed by the magnitude and quantity of Anthony P. DuBose

618 Logotherapy and Existential Analysis
See also Behavior Therapy; Cognitive-Behavioral Frankl construes the human being in three
Therapy; Dialectical Behavior Therapy; Evidence- dimensions: (1) body (soma), (2) mind (psyche),
Based Psychotherapy; Mindfulness Techniques and (3) spirit (noös). He calls this his “dimensional
ontology.” Frankl emphasizes the physiological/
Further Readings biological, emotional/intellectual, and spiritual/
social dimensions of selfhood. Key and core themes
Carey, B. (2011, June 23). Expert on mental illness reveals are meaning, emptiness, death, anxiety, finitude,
her own fight. The New York Times. Retrieved from boredom, freedom, and resilience (the “defiant
http://www.nytimes.com/2011/06/23/health/23lives
power of the human spirit”).
.html?pagewanted=1
According to Frankl, meaning may be found in
Hayes, S. C., Follette, V. M., & Linehan, M. M. (Eds.).
three main ways: (1) creatively, by encountering
(2004). Mindfulness and acceptance: Expanding the
meaning in all that we make or give to the world;
cognitive behavioral tradition. New York, NY:
Guilford Press.
(2) experientially, through all our experiences and
Linehan, M. M. (1993). Cognitive behavioral treatment of
encounters; and (3) attitudinally, by encountering
borderline personality disorder. New York, NY: our unavoidable suffering. Everything can be taken
Guilford Press. from us, yet there still remains the freedom to
Linehan, M. M. (1993). Skills training manual for treating choose our inner attitude to our conditions, which
borderline personality disorder. New York, NY: Frankl calls the “last of human freedoms.”
Guilford Press. Logotherapy is any meaning-centered intervention
leading to attitudinal and, thus, behavioral change.
It helps us deal with “blows of fate,” which at
times assail us and challenge how we come to
LOGOTHERAPY AND EXISTENTIAL define ourselves.
Having experienced the horror of the Holocaust
ANALYSIS firsthand, Frankl is mindful of what he calls the
“tragic triad” of human existence—(1) suffering,
Logotherapy and existential analysis, conceived by (2) guilt, and (3) death—but Frankl, always seek-
the Viennese neurologist and psychiatrist Viktor ing the full picture of the sometimes sad human
Frankl (1905–1997), is an internationally acknowl- scene, urges us to pay equal, if not more, attention
edged and empirically based, meaning-oriented to the “triumphant triad” of (1) healing, (2) mean-
school of therapy and counseling. Existential ing, and (3) forgiveness. Frankl advances his case
analysis is the philosophical and scientific under- for a “tragic optimism,” one that does justice to
pinnings and assumptions of this particular both dimensions of human reality. It is this under-
treatment modality; logotherapy is its clinical standing of reality that contributed to the critical
application. So it is both an analysis (explicating acclaim for his best-selling book Man’s Search for
existence as it unfolds) and a therapy (offering Meaning (1946), which, in 1991, was voted by the
concrete tools and techniques to deal with various Library of Congress as one of the 10 most influen-
disorders and conditions). The central tenet of tial books ever written. In this book and others,
Franklian psychology and philosophy is that “one Frankl urges us to understand that the quest for
is in order when one’s life is oriented to meaning”; meaning is personal and universal and that when
in contrast, disorder occurs when the disparate the “will to meaning” is frustrated or thwarted,
parts of the personality are out of harmony and existential frustration results, which may culmi-
out of sync with one another. If illnesses arise from nate in a neurosis.
nature, their cure comes from the “spirit” or
“noetic core” of a person. The spirit, which can
Historical Context
never be sick, refers to the uniquely human dimen-
sion of the person and, thus, to meaning, con- Logotherapy is often referred to as the third
science, love, humor, the transcendental categories Viennese school of psychotherapy, following the
of being (the true, the good, and the beautiful), and psychotherapy schools of Sigmund Freud (1856–
metaphysics, to give some examples. 1939) and Alfred Adler (1870–1937), both of

Logotherapy and Existential Analysis 619
whom were mentors and teachers of Frankl. similar life conditions to determine which internal
Freud’s psychoanalytic school, the first Viennese resources were being activated. In other words, his
school of psychotherapy, stressed pleasure as being proposal was to investigate not just what makes
a predominant force in the life of a subject; people sick but also what keeps them healthy and
Adlerian individual psychology, the second thriving. These studies led Frankl to the belief that
Viennese school of psychotherapy, emphasized the people are not entirely conditioned and determined
striving for superiority or success. In contrast, but can decide to distance themselves from their
Frankl’s logotherapy insists that how one finds inner and outer conditions and exert freedom of
meaning and purpose was paramount in a life that will—that is, their capacity for self-determination.
struggles to be human. To differentiate his own Frankl held that many if not all of the earlier
therapy from the earlier Viennese schools of depth psychological models tended toward a reductionist
psychology, Frankl coined the term height psychol- psychologism and pathologism, which attempted
ogy. Believing that Freud and Adler placed too to explain deeply and psychologically healthy
much emphasis on early-life experiences and con- human and existential concerns, such as the quest
ditions and how defense mechanisms determine for meaning, freedom, and authenticity, not as
behavior, Frankl attempted to balance their nar- expressions of human maturity but as mere com-
row and determinist approach to humans by pensations for psychological defects and frustrated
asserting that the past pushes us but the future “lower” needs. Logotherapy, however, holds that
pulls us. According to Frankl’s approach, the logos the search for meaning and purpose is a natural
(“spirit” or “meaning”) draws us. and important process that cannot be wholly
Historically, Frankl was exposed to existential- reduced to defensive processes, and that it reflects
ism and phenomenology and was much influenced intrinsic developmental concerns and addresses
by Max Scheler’s philosophical anthropology. All existential issues by specifying psychological pro-
the while, Frankl was intent on seeing the logos cesses that support or derail healthy psychological
(meaning) in the pathos (suffering). In this sense, development, maturity, and self-integration.
logotherapy is more than a school of psychological Logotherapy encourages and helps patients to
thought—it is a practical philosophy of life, one mobilize their remaining resources, which, even
that it is hoped will lead a person from existential during precarious times in a person’s life, can exert
floundering to ethical flourishing. In fact, the sub- a protective and curative influence. According to
title of Frankl’s first book, The Doctor and the logotherapy, awareness of individual meaning and
Soul, is “From Psychotherapy to Logotherapy.” purpose is the most potent resource and, in turn,
Indeed one of logotherapy’s explicitly stated aims also the most effective in activating other psycho-
is to purge both psychology and psychotherapy of spiritual resources.
their psychologism. Logotherapy and existential Logotherapy stood out for a long time as one of
analysis represents an integral nonreductionism. It the very few meaning- and growth-oriented alter-
is holism at its best. natives to the dominant approaches to psychother-
apy, which were largely deficit based. Only in recent
decades have new approaches that have also moved
Theoretical Underpinnings
away from this deficit approach emerged (e.g.,
According to Frankl, when one focuses on the positive psychology, solution-focused therapy).
determinants of human experience, as did Freud Logotherapy, thus, defines the awareness of
and Adler, people’s ability to consciously decide one’s capacity to choose and the search for mean-
how they react or respond to adverse life condi- ing as basic psychological needs that are essential
tions is systematically underestimated and under- for growth, integrity, and well-being. Conversely,
mined. Accordingly, he considered many of the alienation, indolence, and psychopathology result
“old psychologies” to be disproportionately con- from conditions that thwart these central aspects
cerned with deficits and limitations. Frankl, thereof human psychology: When people view them-
fore, began to study not only the life histories of selves as mere victims of outer and inner circum-
the mentally ill but also those of individuals who stances, or feel that their lives no longer have
had remained mentally healthy under the same or purpose, they despair and begin to feel hopeless,

lack fulfillment, and lose interest in life. According only to look beyond oneself but also to reach out
to Frankl, such inner emptiness and ennui consti- and respond to the meaning offered by each life
tutes a frustration of the will to meaning; that is, a situation and to actualize the meaning potential of
sense of despair and hopelessness means that one the moment. To be receptive to such offers of
has lost touch with one’s ability to change and find meaning and to be able to decipher them, it is often
meaning. Thus, the fundamental pillars on which necessary to look beyond one’s own immediate
logotherapy rests—its postulates—are the freedom current needs, urges, and drives and to view one-
of the will (we are free to choose and change self as an active participant and contributor to life.
despite restrictions), the will to meaning (human- A medical doctor who consciously decides to delay
kind’s main motivation), and the meaning of life immediate pleasures (e.g., going out with friends)
(to be detected and discovered in everyday experi- and instead remains a little longer in the hospital
ences and epiphanies). to talk with a confused or anxious patient, or an
Logotherapy’s call is to wholeness, which emergency physician who on his day off makes the
includes the unification of psychic and somatic decision to volunteer during a catastrophe in an
components of the human personality. Wholeness adjacent town exemplifies this ability to forgo
consists in this unification and in the synthesis of personal pleasure for the sake of others. Self-
the spirit (noetic core). This procedure or process transcendence enables individuals to develop
of unification and synthesis complements and interest and to become engaged not in their own
completes the process that is involved in making existences but in the existences of others.
conscious the unconscious.
Intentionality and Meaning
Major Concepts In brief, logotherapy holds that fulfillment in
In applied logotherapy, freedom and meaning are life is not the result of being preoccupied with
referred to as two basic human abilities: the ability the question of whether we feel good but of ask-
to self-distance and the ability to self-transcend. ing what we are good for. A number of research
studies imply that when individuals move from
an egocentric viewpoint (e.g., What does life
Self-Distancing owe me? When I do this, will I be as happy? Will
Self-distancing refers to the human capacity to I get the acknowledgment I deserve?) to a self-
observe oneself and one’s own psychological transcendent viewpoint (e.g., What do I owe
actions, thought tendencies, and affective reactions. life? When I do this, will it be good for the sake
Hence, the overly anxious person who is able to say of the project itself? How can I make sure that
to himself or herself, “I feel this anxiety, but who my choices and behavior will have a positive
says that I cannot do what is necessary and mean- impact on what I am about to do?), they not
ingful with this anxiety, rather than not doing it and only show heightened frustration tolerance but
feeling anxious anyway?” is on the road to recov- also experience a greater sense of purpose and
ery. This person has anxiety yet can still decide increased positive feelings. Accordingly, these
what to do with it, rather than letting the anxiety intentional acts that focus on fulfilling a self-
overcome him or her. In other words, this ability to transcendent viewpoint result in growth, integ-
self-distance enables an individual to “stop taking rity, well-being, and self-worth and are the
all that nonsense from oneself” and instead focus by-products or side effects of fulfilling a mission
on current meaningful offers from life. or purpose. So, for Frankl, life does not owe us
happiness; rather, it offers us meaning.
This principle also guides some treatment appli-
Self-Transcendence
cations in clinical logotherapy, especially in milder
The concept of self-transcendence is closely cases where often only a correction of one’s out-
related to self-distancing, but whereas the latter look in life may be sufficient to trigger one’s psy-
primarily deals with gaining relative independence chological healing processes. Thus, for example, a
from inner and outer obstacles to live a fulfilled logotherapist may encourage a person suffering
life, self-transcendence represents the capacity not from moderate to low self-esteem to not only

Logotherapy and Existential Analysis 621
uncover the unconscious causes of the low self- Paradoxical Intention

esteem in the unchangeable past (in his or her
Paradoxical intention, developed by Frankl in
childhood, learning history, genetic makeup, etc.)
1938, is a relatively simple technique whereby
but also discover the many opportunities to con-
patients consciously and intentionally disrupt the
tribute something worthwhile and meaningful in
vicious circle of anticipatory anxiety and anxiety-
the present (i.e., to bring forth reasons for an ame-
related and obsessive-compulsive symptoms by
liorated engagement with life through more worth-
(a) acknowledging the nonvolitional nature of their
while experiences and encounters). Here, in the
overwhelming and irrational feelings, (b) trying to
present, the patient can proactively engage by
refuse to be blackmailed and threatened by these
applying both self-distancing and self-transcen-
anxious and irrational feelings, and (c) finally
dence. Instead of focusing on and being hindered
using humorous exaggeration as a means to break
by a current lack of self-trust and its putative
their spell. Using paradoxical attention and guided
causes, the individual may try to open up to his or
by the logotherapist, patients learn to overcome
her surroundings and seek to find, and fulfill, a
their obsessions or anxieties by self-distancing and
meaningful task. Once the patient can honestly say
humorous exaggeration, thus breaking the circle
to himself or herself, “I know what I am good for,”
of symptom amplification. In numerous studies,
the patient is on the road to recovering his or her
paradoxical intention has been shown to be a par-
nearly lost knowledge of the value and intrinsic
ticularly effective and fast-working therapeutic
worth of each person, including himself or herself.
technique; in fact, research in this area has demon-
As the example illustrates, logotherapy views
strated that self-distancing can reduce symptoms
self-transcendence as both a human (psychologi-
to a similar, and sometimes greater extent than, for
cal) and an existential resource: On the one hand,
example, psychopharmacotherapy for obsessive-
it refers to our ability to connect to something
compulsive disorder. This technique is often used
beyond ourselves; on the other hand, such a con-
to treat compulsive disorders, anxiety disorders,
nection is thought to be possible only because the
and vegetative syndromes.
meaningfulness does exist “out there,” if only as
potentials to be actualized. In other words, logo-
therapy is based on the idea that meaning is an Dereflection
objective reality, as opposed to a mere illusion aris-
ing within the perceptional apparatus of the Instinctive, automatic processes are impeded
observer. and hindered by exaggerated self-observation. By
To summarize, according to logotherapy, the same token, some mild and well-founded sen-
humans are called upon, on the grounds of their sations of anxiousness or sadness will be increased
freedom and responsibility, to bring forth the best and amplified by self-observation, making them
possible in themselves and in the world by perceiv- more noticeable and engendering even more intense
ing and realizing the meaning of the moment in observation (excessive self-scrutiny). Dereflection
each and every situation. These meaning poten- is the process of breaking this circle of neuroticisim
tials, although objective in nature, are linked to the by drawing the patient’s attention away from the
specific situation and person and are therefore symptom to a more naturally flowing process. This
continually changing. Thus, logotherapy does not technique is often used with sexual disorders,
declare or offer a general meaning of life. Rather, sleeplessness, and anxiety disorders.
suffering and acting persons are aided in achieving
the openness and flexibility that will enable them Socratic Dialogue
to shape their day-to-day lives in a more meaning-
ful manner. Socratic dialogue is a conversational method
frequently used by logotherapists. Specific ques-
tions are framed to raise into consciousness the
Techniques
possibility of finding, and the freedom to fulfill,
Three major techniques often used in logotherapy meaning in one’s life. In the philosophical setting,
are (1) paradoxical intention, (2) dereflection, and this technique of guiding by maieutic questioning
(3) Socratic dialogue. was introduced by the Greek philosopher

Socrates, who characterized it as a sort of draw on his or her inner resources, harnessing the
“spiritual midwifery.” defiant power of the human spirit through the per-
Certain attitudes and expectations may be son’s attitudinal change to both himself or herself
obstacles to meaning fulfillment. They can alienate and the world.
a person from the meaning potentialities in his or Ultimately, logotherapy leads to more responsi-
her life, thus accentuating neurotic disorders or ble freedom, to a heightened sense of purpose and
even producing them via repeated poor decision meaning, to fullness of life, to values, and to rea-
making. It is important to note that the logothera- sons for happiness. Logotherapy also leads to the
pist must refrain from imposing his or her own gates of ultimate meaning—it is left to each person
values or meaning perceptions. Rather, the logo- whether or not to enter.
therapist guides patients toward perceiving their
unrealistic and counterproductive attitudes and Alexander Batthyány and Stephen J. Costello
encourages patients to develop a new outlook that
may be a better basis for a fulfilled and full life. See also Existential-Humanistic Therapies; Frankl, Viktor
This technique is often used with the adjustment or
alteration of a wide range of attitudes that have Further Readings
been found to be deleterious to intentionality and
meaning making. Batthyany, A., & Guttmann, D. (2005). Empirical
research in logotherapy and meaning-oriented
psychotherapy. Phoenix, AZ: Zeig, Tucker & Theisen.
Therapeutic Process Costello, Stephen J. (2010). The ethics of happiness: An
existential analysis. Lima, OH: Wyndham Hall Press.
When working with patients, the logotherapist not
Frankl, V. E. (1955). The doctor and the soul. New York,
only attempts to arrive at a whole picture of the
NY: Alfred A. Knopf. (Original work published 1946)
patient’s presenting problems but also listens to
Frankl, V. E. (1959). Man’s search for meaning. Boston,
the patient’s personality strengths. Thus, the posi-
MA: Beacon Press. (Original work published 1946)
tive and problematic aspects both unfold in the
Frankl, V. E. (2009). The feeling of meaninglessness:
course of the existential analysis as the person’s A challenge to psychotherapy and philosophy
existence begins to be explicated and unrolls. The (A. Batthyány, Ed. [with an introduction]). Milwaukee,
logotherapist always attempts to orient the patient WI: Marquette University Press.
toward meaning—to see the logos in the pathos. Lukas, E., & Hirsch, B. Z. (2002). Logotherapy. In
The therapeutic process is at once an analysis and E. Smith (Ed.), Logotherapy reader (pp. 5–8).
a therapy. Then, techniques may be offered from a Vienna, Austria: Viktor Frankl Institute.
wide repertoire to help with anxiety or phobias or Schwartz, J. M. (1996). Systematic changes in cerebral
depression, but the essence of the existential glucose metabolic rate after successful behavior
encounter is the dialogue that ensues between the modification treatment of obsessive-compulsive
two persons present. Finally, the hope is that thus disorder. Archives of General Psychiatry, 53, 109–113.
motivated and heard, the patient will be able to doi:10.1001/archpsyc.1996.01830020023004

M
families with different pathologies. While at the
MADANES, CLOE Mental Research Institute, she also became inter-
ested in the work of Milton Erickson and in family
The family therapist and teacher Cloe Madanes therapy.
(1940– ), one of the founders of the strategic Returning to Argentina in 1968, she was one of
approach to family therapy, was born in Buenos a few in her country familiar with the latest devel-
Aires, Argentina, the oldest of three children. Her opments in family therapy. Although most of her
grandparents were Jewish immigrants from Russia experience was as a researcher, she suddenly found
and Poland. Her father was a lawyer, and her herself in demand as a supervisor and teacher of
mother was one of the first two women who were therapy. In 1971, she returned to the United States
admitted to law school at the University of La with her husband, an economist in the World
Plata, but she dropped out after 2 years when she Bank, and her two daughters. With the help of
married and became pregnant. Salvador Minuchin, she obtained a job at the
Madanes decided by the age of 12 years that she Philadelphia Child Guidance Clinic, training
would be a psychologist. To prepare for her future
Puerto Rican paraprofessionals in family therapy.
career, she read works by Sigmund Freud, Wilhelm
Soon she was also training psychiatric residents,
Stekel, Simone De Beauvoir, and Alfred Adler. She
psychology interns, and social work students. She
hid the books under her mattress because her
divorced her husband in 1972. The next 2 years,
father thought that they were inappropriate for a
she developed her skills as a supervisor and, later,
child. An outstanding student, Madanes graduated
from the American High School in Buenos Aires for several years, taught at the University of
with a merit scholarship to Radcliffe; however, her Maryland Hospital, Howard University, and the
parents refused to let her go, believing that a young Children’s Hospital of Washington, D.C. During
woman should not be so far away from her family. this time, she developed a professional relationship
Instead, she obtained a licenciada in psychology with Jay Haley, whom she married in 1975, and
from the University of Buenos Aires. In one of her together they founded the Family Therapy Institute
last classes, she learned about communication of Washington, D.C.
theory work being done by Gregory Bateson and For more than 20 years, Madanes has taught
the Palo Alto group at the Mental Research large-group workshops all over the world. In addi-
Institute in Palo Alto, California. In 1965, she tion, she has used the technique of observation to
decided to continue her studies at the Mental supervise clinicians and teach students: From
Research Institute, where she became Paul behind a one-way mirror, Madanes, along with her
Watzlawick’s research assistant and finished Don students, observes therapists; then, Madanes offers
Jackson’s research after Jackson died, comparing suggestions to guide them. With the publication of
623

624 Mahler, Margaret
her first two books, Strategic Family Therapy and President of the Republic of Uruguay. Madanes
Behind the One-Way Mirror, Madanes introduced has been featured in Newsweek, The Washington
play and pretending into family therapy. Because Post, and the Boston Globe. Her books have been
of her knowledge of play therapy with children, translated into more than 20 languages.
she developed playful strategies that included the Sal Minuchin best summarized Madanes’s con-
whole family. She also incorporated playful strate- tribution when he wrote the following for the back
gies into marital therapy. Some feminists were cover of Madanes’s 2006 book The Therapist as
offended by her playful, light-hearted approach to Humanist, Social Activist, and Systemic Thinker . . .
marital therapy. However, Madanes refused to see and Other Selected Papers:
women as oppressed victims, which at that time
was the ideology of many feminist therapists. Cloe Madanes has a unique voice among family
In the 1980s, with the increased awareness of therapists. She is the only one among us for
child sexual abuse, Madanes developed the Steps whom techniques like ordeals, tasks, unbalancing
for Repentance method for the rehabilitation of and pretending commingle with shame, injustice,
juvenile sex offenders. This method, inspired by repentance and reparation. She has worked with
Tibetan Buddhist ideas on compassion, is applica- the most difficult patients, perpetrators of vio-
ble to a wide range of antisocial behaviors, and lence and incest, and has come out with clear
Madanes considers it one of her most important sequential steps of intervention committed
contributions. In the 1990s, she published two wholly to the process of healing.
books on the subject, Sex, Love and Violence and
The Violence of Men; at the same time, she Since 2002, Madanes has worked with the
switched to a different subject and published The author and speaker Anthony Robbins to create the
Secret Meaning of Money. In 2006, she published Robbins-Madanes Training program in collabora-
a collection of her papers titled The Therapist as tion with her daughter and son-in-law, Magali and
Humanist, Social Activist, and Systemic Thinker . . . Mark Peysha, respectively. Her latest book,
and Other Selected Papers. Relationship Breakthrough, is the result of this
Madanes has presented her work at profes- collaboration.
sional conferences all over the world and has given
keynote addresses for the American Association of Cloe Madanes
Marriage and Family Therapy, the National
See also Strategic Family Therapy; Strategic Therapy
Association of Social Workers, the Erickson
Foundation, the California Psychological
Association, the American Counseling Association, Further Readings
and many other national and international organi- Madanes, C. (1990). Sex, love, and violence: Strategies for
zations. She has been Primary Faculty at the transformation. New York, NY: W. W. Norton.
Evolution of Psychotherapy Conference since Madanes, C. (1994). The violence of men. San Francisco,
1985. CA: Jossey-Bass.
Over the years, Madanes has received many Madanes, C. (2006). The therapist as humanist, social
awards for her contributions, including the 1996 activist and systemic thinker . . . and other selected
Egner Foundation Award for Distinguished papers. Phoenix, AZ: Zeig, Tucker & Theisen.
Contribution in the fields of psychology, anthro- Madanes, C. (2009). Relationship breakthrough.
pology, and philosophy from the University of New York, NY: Rodale.
Zurich, Switzerland, and the 2000 Award for
Distinguished Contribution to Psychology from
the California Psychological Association. In 2001,
she was awarded the degree of Doctor of Humane MAHLER, MARGARET
Letters, honoris causa, by the trustees of the
University of San Francisco. In 2013, the Cloe Born into a Jewish family in Sopron, Hungary,
Madanes Center Against Child Abuse opened in Margaret Mahler (1897–1985) is one of the
Montevideo, Uruguay, funded by the Office of the founding pioneers in psychoanalytical theory and

Mahler, Margaret 625
practice. She is most noted for her separation- self, a safe harbor in the presence of anxiety in all
individuation theory of child development, which its varying forms and intensities throughout life.
emphasizes identity formation as occurring within The cycle begins again within our ongoing and
the context of relationships. After immigrating to new relationships. Each iteration and developmen-
the United States in 1938, Mahler’s work as a child tal stage reflects and provokes identity formation,
psychiatrist informed her theory regarding the which in turn allows for a continual evolving of
interplay between our internal (psychological) our ability to engage in reciprocating relationships
development and our external social environment. and manage the anxieties associated with them.
This approach was considered scandalous within Mahler believed that our capacity to understand
her professional community, which tended to and live with a both-and rather than an either-or
minimize sociocultural and relational contributors response to this ebb and flow influences our level
to our sense of self. Her conceptual framework of health or distress as individuals and a society.
regarding the nature of attachment relating, spe- As children progress through their first and sub-
cifically our need for both closeness and distance, sequent iterations of connecting, separating, and
is imbedded in many theoretical constructs regard- reconnecting, Mahler offered a nuanced applica-
ing attachment, interpersonal relationships, family, tion of what a parent’s relational attunement may
and broader social system functioning. look like in any given moment within the child’s
In her separation-individuation theory of child current cycle. Each of Mahler’s six development
development, Mahler hypothesized that the pro- stages—(1) normal autism, (2) symbiosis, (3) dif-
cess of becoming—of separating (differentiating ferentiation, (4) practicing, (5) rapprochement, and
out from our perceptual and emotional fusion (6) object constancy—suggests thematic attach-
with others) and individuating (developing con- ment behaviors, varying along a continuum from a
crete autonomous skills and abilities)—occurred more hands-on to a hands-off approach. However,
through a lifelong process of connecting and sepa- the affective and cognitive stances remain the
rating. Like the ebb and flow of a tide, each same: one of openness and embrace of the child’s
person continually needs to relationally “move need or challenge. The child’s developmental level,
in,” experiencing self within the context of “we” current context, and personality inform the actual
(symbiosis). Likewise, we continually need dis- attachment-based response.
tance, to “move out” to reestablish connection to For example, in the earliest stages (Stage 1, nor-
self as an “I” as we synthesize the good, bad, and mal autism, to Stage 2, symbiosis) of the infant’s
indifferent of current relationships or explore new first and most foundational iteration, the child
roles, relationships, and challenges. needs a high level of reassuring and affirming con-
The cycle nears its conclusion as we feel the tug nection expressed physically and verbally in
to move back toward connection, but with skepti- between moments of needed breaks from affective
cism, fear, or resentment. This ambivalence is or physical engagement. The parents’ job is to wel-
anchored by our dual encounter with the exhilara- come the child’s dependency needs and varying
tion of self-mastery and autonomy (as well as the moods. A third-grade student revisiting these
comfort of disconnection in reaction to disappoint- stages after a tough day at school or a bad night-
ment) and the joy of love, of knowing others, and mare may need extra hugs or time together doing
of being known (as well as the despair of loneli- activities of special meaning. Meanwhile, adoles-
ness). The process of overcoming this ambivalence cents often experience new depths of symbiosis
occurs as we move back in, gradually making peace with a reciprocating peer. But they still need to
and honoring these competing drives and experi- frequently nestle in, though on their own terms;
ences, accepting that we need distance from and the attuned parent reads those moments and
connection with imperfect others, even as they need responds accordingly.
the same from our imperfect selves. As we relax As the toddler takes the first steps away from the
into and accept the strengths (the good) and limits parent or the adolescent prepares to move away
(the bad) of self and other, deeper levels of care and from home emotionally and physically, both are
trust are made possible. This informs the internal- entering the substages of separation-individuation
ized attachment schemas forming our core sense of (Stage 3, differentiation; Stage 4, practicing; Stage 5,

626 Mahler, Margaret
rapprochement; and Stage 6, object constancy). On a societal level, Mahler’s hunch regarding
Attachment behaviors begin to look different as the universal struggle between connection and
steps of autonomy are supported without parental autonomy, and the tendency to “split” (be cut
judgment or abandonment, and moments of recon- off from some element of human experience as a
nection are not forced or disparaged. Here, the defense) rather than to engage in whole-object
attentive parental stance is with arms open, allow- relating, can be observed within a culture as it
ing the child to venture away even while keeping a struggles with the concepts of community and
watchful eye: The toddler begins to crawl away individuality. This struggle is most evident in
from the lap of the parent, while the adolescent the macrosystem values shaping its political,
wants extended curfews and increased privacy. economic, military, education, and religious
Those same hands provide a welcoming embrace systems.
when the child returns with whatever affective need Mahler’s own life reflects her relational chal-
drives the refueling, whether excitement over new lenges, navigating between symbiosis and object
discoveries, anger at limitations, guilt or shame due constancy. Her childhood was dominated by a
to failure, or just longing for the embrace of a loved rejecting mother and a doting father, who appeared
one. The toddler’s return may have been precipi- to treat her as a substitute mate or the son he never
tated by a bump on the head or the need for reas- had. Despite her success as a physician in Europe
surance after the first of many power struggles to and the United States during an era of overt and
come. The adolescent may seek reconnection after persistent sexism, she also lived in fear for her life
a betrayal by a peer or an encounter with law due to her Jewish identity; her father died shortly
enforcement. Hence, attachment behaviors include after Germany’s invasion of Hungary (1944), and
relationally moving in and moving out in response her mother died a year later in an Auschwitz con-
to the developmental need and circumstance of the centration camp. Her adult relationships with
relational other. friends, colleagues, and students have been charac-
Mahler’s developmental model has practical terized as either overly connected or highly conflic-
applications beyond child development. Her cycle tual. She was both loved and disliked, both
of symbiosis to object constancy is easily applied to celebrated and feared.
numerous types of relationships, for example, adult It is easy to speculate that Mahler’s experience
intimacy, the embrace of a new belief system or of deep longing for embrace in the face of rejection
community, and mentor–mentee relationships, such inspired her professional work with children and
as the supervisor and supervisee. New relationships the birth of her developmental theory. Regardless,
with people, organizations, or ideas often include a her life and work invite us to observe in self and
honeymoon period in which we experience symbio- others the lifelong challenge to become a self
sis. The need to reconnect with previous interests within the context of a relationship and to see the
and relationships or to focus on other tasks of the humanity in that struggle as we continually navi-
day, or emerging awareness of the imperfections of gate our own needs for connection and separation.
the new person, place, or cause begins the separa-
tion-individuation process. We remain connected, Anna A. Berardi
in deeper or perhaps a more limited form, as we
See also Classical Psychoanalytic Approaches: Overview;
come to terms with the positive and negative Contemporary Psychodynamic-Based Therapies:
elements in the self, the other, and the relationship. Overview; Ego Psychology; Intersubjective-Systems
The challenges of connection and separation are Theory; Object Relations Theory; Relational
evident in systems theories such as David Olson’s Psychoanalysis; Self Psychology
cohesion construct within the circumplex model
and Murray Bowen’s differentiation concept within
general systems theory. Similar to Mahler’s concept Further Readings
of whole-object relating, Bowen maintains that our Brandell, J. R. (2010). Contemporary psychoanalytic
lifelong challenge is to move out from fusion, expe- perspectives on attachment. Psychoanalytic Social
rienced as either enmeshment or disengagement, Work, 17, 132–157. doi:10.1080/15228878.2010.
and into differentiation. 512265

Mahoney, Michael J. 627
Coates, S. (2012). John Bowlby and Margaret S. Mahler: his favored baseball and other aerobic sports and
Their lives and theories. In L. Aron & A. Harris (Eds.), likely contributed to a sense of uniqueness and
Relational psychoanalysis: Vol. 4. Expansion of theory isolation. Of diminutive stature and defiant tem-
(pp. 131–157). New York, NY: Routledge/Taylor & perament, he often found himself in altercations
Francis. with numerous schoolmates and academic admin-
Edward, J., Ruskin, N., & Turrini, P. (1992). Separation/ istrators. As a consequence of an adolescent
individuation: Theory and application (2nd ed.). New trauma, he dropped out of high school and began
York, NY: Routledge. traveling throughout North America, supporting
Greenberg, J. R., & Mitchell, S. A. (1983). Object
himself doing construction work and seeking
relations in psychoanalytic theory. Cambridge, MA:
inspiration to hopefully emerge as a fiction writer.
Harvard University Press.
However, at the age of 18, his respiratory condi-
Mahler, M. S., Pine, F., & Bergman, A. (1975). The
tion worsened, and physicians advised Mahoney to
psychological birth of the human infant. New York,
NY: Basic Books.
abandon manual labor and to consider relocating
Stepansky, P. E. (Ed.). (1988). The memoirs of Margaret S.
to a more arid climate where he might pursue an
Mahler. New York, NY: Free Press. education, or else face a premature demise. Heeding
the warning, Mahoney began attending Joliet
Junior College as a probationary student to com-
plete basic coursework, including a number of
MAHONEY, MICHAEL J. classes in philosophy, his main area of interest. He
also began working as a psychiatric aide at a local
Michael J. Mahoney (1946–2006) represented hospital, which was his first introduction to the
one of the most integrative theorists in counseling mental health profession. His roles in the hospital
and psychotherapy, reflecting a spirit of true criti- varied, and he often found himself coleading
cal inquiry that led to revisions of his thought groups as well as acting as a substitute recreational
throughout his career. Known for his gentle therapist, occupational therapist, and crisis
demeanor and pointed Irish wit, he was also a interventionist, using his philosophical under-
self-proclaimed iconoclast, which led to question- standing in a type of inchoate cognitive therapy
ing—and frequently heated debate—of many of that involved reasoning with patients about their
the accepted core assumptions and practices difficulties.
within psychology. A prolific author/editor of The harsh Illinois winters continued to be a
more than 250 scholarly articles and chapters and problem for his health, and a random coin toss
19 books, Mahoney contributed significantly to a decided that he would pursue his undergraduate
number of theoretical orientations, from his early degree at Arizona State University (ASU). On
work in classical behaviorism, to his key role in arriving, he was told he would need to decide on a
the cognitive revolution, to foundational articles major within a week, and burdened by indecision
in sport psychology, and culminating with his and anxiety, Mahoney elected to seek out a thera-
articulation of constructivism, a comprehensive pist for assistance with the decision. Randomly
developmental metatheory that describes human pulling a name from the Phoenix phone book, he
beings as actively complex, socially embedded, selected the renowned psychotherapist Milton H.
and developmentally dynamic self-organizing Erikson. He spent his life savings of $60 on the
systems. Human Change Processes: The Scientific consultation, during which Erikson compassion-
Foundations of Psychotherapy effectively intro- ately guided him toward a major in psychology.
duced constructivism to the psychological main- This chance encounter in his life path would be
stream, and Constructive Psychotherapy: A Practical one of many formative meetings in his career.
Guide provides a detailed description of its The psychology department at ASU in the late
clinical applications. 1960s was thoroughly rooted in orthodox behav-
Born in Streator, Illinois, to Irish parents, iorism, and Mahoney excelled as a brilliant and
Mahoney’s early life was marked by personal and disciplined student. His first academic paper,
academic difficulties. An early diagnosis of asthma assisted by his mentor Dave Rimm, was published
prevented the young Mahoney from engaging in when he was only 23 years of age. Rimm also

628 Mahoney, Michael J.
introduced him to basic relaxation techniques, respiratory limitations, Mahoney began publish-
which would continue to evolve as a central ing a number of articles related to elite athletic
element in Mahoney’s therapeutic approach. performance and the implementation of relax-
Mahoney obtained his doctorate from Stanford ation, visualization, and other cognitive-behavioral
University in 1972, finishing in just 4 years. skills. In 1980, he served as a resident psychologist
Despite his early academic success in the Skinnerian for the U.S. weightlifting team at the U.S. Olympic
tradition, Mahoney was sensitive to the limitations Training Center in Colorado Springs, Colorado.
of pure behavioral models, and it was Albert Mahoney was active as a weightlifter over the
Bandura’s Principles of Behavior Modification that course of his life, eventually becoming a national
opened him to the relevance of cognitive processes champion and also medaling internationally. His
in change, contrary to the behaviorist dismissal of interest in sport and athletic performance
mental events as an unknowable “black box.” He influenced much of his later thinking on embodi-
was soon exploring cognitive processes at length, ment and the importance of physical rituals in
culminating in his first book Cognition and influencing change.
Behavior Modification, in which he articulated the In 1985, Mahoney left Penn State for the University
evidence supporting meditational models of learn- of California, Santa Barbara. Here, he developed rela-
ing, arguing that cognition is a critical interceding tionships with two renowned existential-humanistic
factor between brute stimulus and response. This therapists, James F. T. Bugental and Viktor Frankl,
position was much to the irritation of B. F. Skinner whose work emphasized the centrality of a genuine,
himself, who openly criticized Mahoney for ven- empathic relationship in the psychotherapy process,
turing down the blind alley of mentalism, and as well as the construction of meaning and the intrac-
would be the beginning of an ongoing debate table presence of isolation, anxiety, and suffering in
between the two that would last until Skinner’s human life. These dialogues also led to Mahoney
death in 1990. Mahoney’s work of this period, incorporating a number of holistic interventions out-
along with that of Aaron T. Beck and David side the cognitive-behavioral mainstream, including
Meichenbaum, would serve as the foundational Gestalt approaches, creative dance, restrictive sensory
pillars for what would later become known as the stimulation, massage and other bodywork, and a
“cognitive revolution” in psychology. variety of meditation techniques from different
After graduation, Mahoney obtained an appoint- contemplative religious traditions.
ment at Pennsylvania State University (Penn State), In 1990, Mahoney took a position at the
where he also began a small private practice, even- University of North Texas, where he remained for
tually focusing on treating difficult clients who 15 years. In his book Human Change Processes,
were often described as “borderline” or “personal- he provided a systematic articulation of construc-
ity disordered.” Here, he also began pursuing ideas tivism, defined as a view of human beings that
related to change processes in a wide range of emphasizes their active participation in the cre-
fields, including studies of complexity, intersubjec- ation of meanings around which they organize
tive field theory, dynamic systems, chaos theory, their lives, along with integrating theoretical con-
autopoiesis, and other evolutionary sciences. He cepts and clinical techniques from a broad range
was particularly influenced by the work of Friederich of counseling approaches. The central themes in
Hayeck, William Bartley, Humberto Maturana, and Mahoney’s constructivism include (a) the inherent
Walter Weimer, which led him toward a more per- activity of the organism, (b) the directness of that
spectival, postmodern epistemology, highlighting activity toward self-organization, (c) the centrality
multiple modalities of knowing and the active of processes associated with “selfhood” or per-
nature of the mind in organizing experience. His sonal continuity in referencing and organizing
book Scientist as Subject: The Psychological experiences, (d) social embeddedness that is pre-
Imperative critically examined the epistemological dominant in humans and inseparable from our
presuppositions of scientific inquiry as well as the symbolic capacities, and (e) a view of develop-
politics of research and graduate training. ment that is dialectical and dynamic. From a tech-
Having taken up Olympic weightlifting in his nical standpoint, Mahoney eschewed the idea of a
early 20s as a method of conditioning given his precise, scripted approach to treatment in favor of

Maslow, Abraham 629
a diverse spectrum of behavioral, cognitive, psy- Mahoney, M. J. (2004). Scientist as subject: The
chodynamic, contemplative, and body-based psychological imperative. Clinton Corners, NY:
interventions applied at the individual pacing of Percheron Press. (Original work published 1976)
each client to explore and potentially modify the Mahoney, M. J. (2005). Suffering, philosophy, and
client’s own personal meanings and core ordering psychotherapy. Journal of Psychotherapy Integration,
processes. 15, 337–352. doi:10.1037/1053-0479.15.3.337
In 2005, Mahoney left Texas for Salve Regina Rimm, D. C., & Mahoney, M. J. (1969). The application
University in Rhode Island, where he taught until of reinforcement and participant modeling procedures
in the treatment of snake phobic behavior. Behavior
his death. His last work focused on existential
Research and Therapy, 7, 369–376. doi:10.1016/0005-
realities such as suffering, meaninglessness, and
7967(69)90066-7
death and their minimization in the psychological
sciences, along with highlighting the risks of manu-
alized approaches to treatment and rigid training
programs that he felt often stripped students of a
genuine sense of awe and critical self-reflection. In MASLOW, ABRAHAM
addition to his extensive psychological work,
Mahoney also released a book of poetry and com- One of the original leaders of the humanistic
pleted a quasi-biographical novel, which remains movement, Abraham Maslow (1908–1970) was
unpublished. Highly regarded as an exemplary born in Brooklyn, New York, as the oldest of
educator, he was selected by the American seven children. Maslow had a difficult childhood
Psychological Association in 1981 as a Master and stated throughout his life that he was lonely,
Lecturer and in 1988 as a G. Stanley Hall Lecturer. unhappy, and struggled with the difficult circum-
He is recognized as one of the leading figures in stances surrounding his first-generation Jewish
psychotherapy integration and constructivism and Russian immigrant parents. His eventual develop-
was a fellow of both the World Academy of Art ment of his hierarchy of needs and his research on
and Science and the American Association for the self-actualizing individuals may have come from
Advancement of Science. a personal understanding of how difficult sur-
roundings can affect an individual’s personal
E. Scott Warren growth.
Growing up in a working-class neighborhood,
See also Beck, Aaron T.; Behavior Therapies: Overview; he had many encounters with his parents that led
Behavior Therapy; Cognitive-Behavioral Therapies:
to negative childhood memories. Maslow recounted
Overview; Constructivist Therapy; Existential-
Humanistic Therapies: Overview; Frankl, Viktor;
stories of both his father and mother that had a
Meichenbaum, Donald profound effect on him throughout his childhood.
A particularly potent story he recalled about his
mother involved her smashing two kittens’ heads
Further Readings against the basement floor when he brought them
home from school one afternoon. This experience,
Mahoney, M. J. (1974). Cognition and behavior
modification. Cambridge, MA: Ballinger.
among others, left him with a distaste for both
Mahoney, M. J. (1991). Human change processes: The
parents based on the poor way they treated him as
scientific foundations of psychotherapy. New York, well as their personal worldviews, eventually lead-
NY: Basic Books. ing to an estrangement. While this estrangement
Mahoney, M. J. (2000). Behaviorism, cognitivism, and lasted for some time, he eventually reconciled with
constructivism: Reflections on persons and patterns in his father later in his life.
my intellectual development. In M. R. Goldfried (Ed.), As Maslow grew up, he began to develop a love
How therapists change: Personal and professional for learning and went to the City College of New
reflections (pp. 183–200). Washington, DC: American York after graduating high school in 1926. He
Psychological Association. immediately had difficulty with the transition and
Mahoney, M. J. (2003). Constructive psychotherapy: A eventually transferred to Cornell for one semester
practical guide. New York, NY: Guilford Press. the following year. Eventually returning to City

630 Maslow, Abraham
College of New York to study law, he later went to presented in his 1943 article “A Theory of Human
the University of Wisconsin and earned three Motivation” and later, in more detail, in his book
degrees in psychology. During this time, he married Motivation and Personality, this theory, based on
his great love, Bertha Goodman, his first cousin. the ideas of developmental psychology, suggests
While at the University of Wisconsin, Maslow that individuals have inner systems of motivation
studied primates and behaviorism related to sexual- that drive human behavior.
ity under his mentor and advisor Harry Harlow. According to Maslow, there are five motiva-
Graduating with his doctorate in psychology in tional needs: (1) physiological, (2) safety,
1934, he was hired as a postdoctoral fellow at (3) belonging and love, (4) esteem, and (5) self-
Columbia University, working under E. L. Thorndike. actualization. The system works hierarchically:
During his time at Columbia, Thorndike gave Lower needs must be addressed before higher
Maslow an intelligence exam in which he was said needs become influential. The lowest level is physi-
to have scored at the genius level. Maslow contin- ological, in which the individual must ensure the
ued his research on sexuality, but with a focus on basic elements necessary for survival, including air,
female sexuality. water, food, sex, and sleep. Once these basic needs
In 1937, he began a long career as a faculty are completed, the individual transitions to work-
member at Brooklyn College. During his tenure at ing on safety needs, the focus of which is geared
Brooklyn College, he was profoundly affected by toward personal security and stability. The third
the work of many researchers in the psychological level is the need for belonging and love. Having
movement, including the Gestalt psychologist Max established basic survival and security, the indi-
Wertheimer and the anthropologist Ruth Benedict. vidual can focus on his or her social and intimate
While at Brooklyn College, he collaborated with relationships with others. Successful relationships
these researchers and mentors and began his with others set up the individual for tackling the
research on self-actualization. esteem needs. These are attained through positive
As Maslow continued his research, he struggled feelings of self-worth and through the praise and
with what he saw as major gaps in the popular respect received from others. The final stage of
psychological theories of the time. Maslow came Maslow’s hierarchy of needs is self-actualization.
to the conclusion that psychoanalysis was too This highest stage of human behavior is one in
focused on a negative view of human nature that which the individual can make full use of his or her
emphasized psychopathology instead of under- talent and ability. Maslow’s system is typically
standing the exceptional or normal person. taught as a pyramid, with physiological needs
Furthermore, he felt that behaviorism missed the forming its base while self-actualization is at the
deeper and more important aspects of an individ- upper tip.
ual, focusing instead on superficial factors. As he One aspect that Maslow was particularly
continued to delve into new research, he found focused on was the self-actualization stage.
that what was missing was an overall theory on Compelled by what he called metamotivation—
positive mental health. What did a person need to that is, a special gift of being able to maximize
feel fulfilled? one’s own potential—he researched what led cer-
Following this line of research, Maslow began tain individuals to reach the level of self-actualiza-
to shift his thinking to a more humanistic view of tion that many do not. One element that he saw
human nature. Splitting from those in the psycho- over and over again was that these individuals
analytical and behaviorism fields, Maslow began were not focused on any one goal but, instead,
to develop the concept that once an individual has looked within themselves. Maslow believed that
his basic needs met, he or she will begin to seek less than 1% of humans were self-actualized, but
more intrinsically motivated goals and continue he noted certain characteristics that were common
searching for fulfillment. These ideas became the in the self-actualized population. For example,
bases of some of Maslow’s most important work someone who is self-actualized has a clear percep-
in his career. tion of reality, dedication, acceptance of others,
Maslow is perhaps most well-known for his and peak experiences. These qualities were just a
theory known as the hierarchy of needs. Originally few of the qualifications of a self-actualizer, and

Maslow’s Hierarchy of Needs 631
Maslow included individuals like Albert Einstein sense of self. This concept of human motivation
as part of this group. Maslow continued to work can then provide a map for understanding a per-
at Brooklyn College until 1951, when he moved to son’s current state, as well as determining what
Brandeis University in Massachusetts. He was else may be needed or desired for future growth.
elected president of the American Psychological Needs progress from the most basic and instinc-
Association in 1966 and retired from teaching in tual impulses to a sense of personal integration
1968. In 1970, at the age of 62, he died of a heart and even spiritual transcendence. This hierarchi-
attack while jogging. cal view of motivation takes a holistic and
Maslow’s work has been influential in many dif- dynamic approach to understanding human
ferent areas of counseling and psychological theory. nature in that it incorporates the body, the mind,
Various theoretical models were developed, and and social influences.
research on the hierarchy of need, self-actualization,
and intrinsic motivation is still being conducted.
Historical Context
For example, self-determination theory uses the
concept of intrinsic motivation and applies it to the Maslow first published his concept of human
three principles of (1) competence, (2) autonomy, motivation in 1943 to fill what he felt was a sig-
and (3) relatedness. Furthermore, the Personal nificant gap in the current theoretical approaches
Orientation Inventory, developed by Everett to psychology. Through his own clinical practice,
Shrostrom, was based on Maslow’s work on self- he discovered that although the conceptualizations
actualization. Today, Maslow’s hierarchy of needs of human nature of the leading theorists of the day
is often cited in the counseling field as well as in (Sigmund Freud, Carl Jung, Alfred Adler, etc.) all
popular culture, making an impact throughout the had value, the efficacy of each approach varied by
world. individual or condition. Maslow reasoned that the
one thing that seemed to be lacking in all of them
Heather D. Dahl was the idea that each person has an essence, or
higher self, and that achieving this higher sense of
See also Existential-Humanistic Therapies: Overview;
Maslow’s Hierarchy of Needs
self is among our instinctual needs. He also
believed that rather than reducing a person to
symptoms or analyzing the minutiae of a person’s
Further Readings life, individuals could be viewed holistically, or as
Hoffman, E. (1998). The right to be human: A biography a sum of many parts that could all be significant to
of Abraham Maslow (2nd ed.). New York, NY: understanding the problem. Maslow’s hierarchy
McGraw-Hill. and concept of motivation are thus made up of
Maslow, A. H. (1943). A theory of human motivation. levels that incorporate the body, mind, soul, and
Psychological Review, 50, 370–396. doi:10.1037/ social experience of an individual.
h0054346 Maslow did not intend his concepts to become
Maslow, A. H. (1954). Motivation and personality. a theory in their own right, and though his hierar-
New York, NY: HarperCollins. chy of needs and constructs of motivation have
Maslow, A. H. (1962). Toward a psychology of being. contributed greatly to clinical practice and human-
New York, NY: Van Nostrand. istic models of counseling, they are still not viewed
Maslow, A. H. (1970). Religions, values, and peak as an integrated theory of counseling. However, his
experiences. New York, NY: Penguin Books. concepts have met his real intent, which was to
extend and expand an understanding of human
nature beyond the more psychoanalytical views of
his time.
MASLOW’S HIERARCHY OF NEEDS
Abraham Maslow’s hierarchy of needs identifies a
range of core needs and desires that can have a Maslow described his approach as holistic and
motivating effect on an individual’s behavior and dynamic, distinguishing it from what he felt were

632 Maslow’s Hierarchy of Needs
the more traditional reductionist and analytic without first fulfilling needs at the most basic level.
approaches within counseling and psychology. He Once these needs are satisfied, however, an indi-
saw the value in the available theoretical approaches vidual will tend to focus his or her attention on the
and did not intend to negate or challenge them, but next level of the hierarchy.
he did seek to develop concepts he felt were lack-
ing. A holistic approach to the individual was
Safety Needs
important to him because he saw that people have
many different driving forces apart from any one The next level within Maslow’s hierarchy of
determinant. Unconscious and instinctual impulses needs is that of safety and protection. Individuals
are important, as are relationships and a person’s who feel threatened in their environment or have an
own sense of self. His model, therefore, addresses overall sense of anxiety or instability may be domi-
human needs as containing physiological, social, nated by fear and motivated primarily toward seek-
and spiritual components. Similarly, he identified ing protection or comfort. A sense of safety and
his model as dynamic because it drew concepts stability may vary for different individuals, but the
from other theories to create an integrated frame- need for structure or relief from the threat becomes
work to understand motivation. His model primary for individuals who feel threatened. Safety
contains elements of biological drives, social can feel threatened by a wide range of influences,
connectedness, cognitions, behaviorism, positive such as war or violence, natural disasters, economic
psychology, and universality. uncertainty, or unemployment. Some individuals
Although he did not originally intend his ideas who experience heightened anxiety may likewise
to fall within a theoretical framework, his concepts remain in this level, as their sense of security is con-
of human nature and motivation best fit within stantly threatened by real or perceived fears. The
other humanistic approaches in that they stress the primary motivator in this level is to obtain a degree
importance of individuation, understanding a per- of structure and stability in order to offset feelings
son within his or her context, and viewing indi- of chaos or threats to personal safety.
viduals through a positive lens of growth and
motivation toward further development.
Belonging and Love
When an individual has the basic needs satisfied
Major Concepts and feels secure, he or she will most likely begin to
Maslow believed that individuals are motivated by desire connection with others. In this stage, the
their most pressing current needs and that these absence of significant others will be felt more
needs can change based on what the individual has strongly than in previous levels, when other desires
already achieved. As one level of needs is satisfied, outweighed the need for love and belonging. An
a person will begin to desire the next level, and this individual in this level will be more sensitive to
will motivate his or her thoughts and behaviors. feelings of loneliness and isolation and will seek
He identified five levels of needs: (1) basic, out relationships with others. Maslow believed
(2) safety, (3) belonging and love, (4) esteem, and that every person—provided that other lower
(5) self-actualization. order needs were met—craved intimacy and the
ability to both give and receive love. If the desires
for love and belonging are not met, an individual
Basic Needs will most likely remain within this level and be
Basic needs consist of the satisfaction of physi- unable to move toward fulfilling other higher
ological drives, such as the need to satisfy hunger. order needs.
If a person is starving or suffering from poor
health, nearly all of that person’s attention will be
Esteem Needs
devoted to resolving or satisfying these needs. The
person’s thoughts and actions will be dominated The next level of Maslow’s hierarchy involves
by the need for food, warmth, or shelter. an individual’s sense of self as well as how others
Consequently, it would be difficult for a person to value him or her. Maslow believed that every
truly care about satisfying other higher order needs person has a need for a stable, relatively high

Maslow’s Hierarchy of Needs 633
self-evaluation and likewise also has a need to feel counselor to work within the client’s reality and
respected and esteemed by others. If a person is select approaches that correspond to the more
able to satisfy these needs, then he or she will feel essential goals within the client’s level of need
confident and capable. However, individuals who fulfillment.
do not possess a high esteem of themselves and/or There are several additional considerations
are not valued by others for what they contribute Maslow provides regarding higher and lower
will likely become discouraged and will be unable order needs to assist in the application of his
to progress to the final level. model. For one, Maslow believed that the higher
order needs were evolutionary in that they distin-
guished human beings from other living things.
The Need for Self-Actualization
Basic needs such as food, water, shelter, and safety
Finally, Maslow theorized that even if all other are more instinctual, whereas self-actualization is a
needs are met, there exists within each individual distinctly human ambition. Likewise, human
an additional desire to strive to be the best he or beings have less of an urgent need for higher order
she can be and to be fully true to himself or herself. needs. A person may not be able to live long
A person can, for example, have met all basic without access to food and water, but he or she can
needs, feel a sense of security, have several close still sustain life in the absence of self-esteem or
relationships, and be highly competent and self-actualized identity.
esteemed by others, yet he or she may still feel Even though higher order needs are not neces-
unfulfilled. Maslow believed that the highest sary for survival, Maslow stated that individuals
human need is to fulfill one’s true purpose by who are able to satisfy these higher needs tend to
engaging in pursuits that utilize a person’s unique be healthier, less anxious, less prone to disease, and
talents and passions. Maslow made a distinction in able to live longer and more enriching lives than
later writings that this higher order need most individuals who satisfy only the most basic needs.
likely occurs in adulthood, as it is closely linked Related to treatment, individuals who are actively
with professional pursuits and other life roles. in pursuit of higher order needs also demonstrate
decreased psychopathology, which suggests that
working toward these needs is facilitative of men-
Techniques
tal health. Maslow also believed that individuals
Although Maslow’s hierarchy does not provide a pursuing higher order needs were more responsive
theoretical approach with corresponding tech- to psychotherapy than individuals who needed to
niques, it does provide a foundation for viewing satisfy lower order needs. Therefore, clients who
human nature, understanding blocks to personal are struggling to meet lower order needs would not
growth, and conceptualizing an ideal for psycho- benefit as much from insight-based therapies and
logical well-being. Counselors utilize the hierarchy would instead need to be connected to resources to
to position a client’s current dominant needs and resolve their more pressing concerns.
thus understand what might be needed to facilitate Despite the value of higher order needs for
change. A client who is having difficulty paying well-being, Maslow was careful to acknowledge
bills and purchasing enough food for her or his that it is difficult to obtain and sustain these needs.
family cannot, according to Maslow’s hierarchy, be The higher the need, the more difficult it can be to
expected to explore interpersonal skills or delve achieve. Individuals must have the time to build a
into issues of self-esteem. These other needs may foundation that can sustain each level, and their
indeed be important, but the client is primarily environment must be able to facilitate it. For
concerned with satisfying more basic needs and example, love and belonging typically require the
likely does not have much need for philosophical development of interpersonal skills, the invest-
discussions of identity. Similarly, a person who has ment of time and energy in the formation of rela-
been unemployed for 6 months and who is strug- tionships, and continued work to maintain them.
gling with self-confidence issues due to a frustrat- Self-esteem can be difficult to maintain in an envi-
ing job search is likely more concerned with ronment where jobs are scarce and individuals are
finding a job and less focused on becoming fully not able to work within their area of competency.
self-actualized. Maslow’s hierarchy thus allows the It is therefore important for counselors to develop

634 May, Rollo
an understanding of the client’s resources, both Rowan, J. (1998). Maslow amended. Journal of
personal and environmental, in order to determine Humanistic Psychology, 38, 81–92.
his or her position within the hierarchy as well as doi:10.1177/00221678980381008
the conditions needed for the client to move to Zalenski, R. J., & Raspa, R. (2006). Maslow’s hierarchy
higher levels. of needs: A framework for achieving human potential
in hospice. Journal of Palliative Medicine, 9,
1120–1127. doi:10.1089/jpm.2006.9.1120
Therapeutic Process
In the progression of therapy, the counselor first
determines which level the client is in and then
works to understand the various components MAY, ROLLO
influencing the current placement in the hierarchy.
Understanding the client’s desires can assist in Rollo Reece May (1909–1994), “father” of exis-
identifying the goals of therapy as well as facilitat- tential psychotherapy and a founder of the human-
ing motivation to work toward change. In addi- istic movement or third force in psychology, was
tion, the therapeutic relationship itself can provide one of the mid- to late 20th century’s leading and
some satisfaction of various needs within the hier- most influential psychologists. May was no
archy. A close therapeutic relationship can, for stranger to the inevitable existential crises and
example, provide a sense of love and belonging for anxiety to which, as he asserted, all human beings
a client who is struggling with a lack of connection are subject, and his psychology sprang partly from
with others. Acceptance and affirmation from the his own personal history and experience.
counselor can assist with self-esteem, as can the May was born in Ada, Ohio, in 1909. Named
awareness of progress made over time. Exploration by his mother after a fictional character from chil-
of the client’s desires and passions can help the dren’s books, May was the eldest son of six sib-
client gain awareness of what self-actualization lings. His older sister suffered from schizophrenia,
may look like for him or her. Thus, the hierarchy and with his father not home much, May felt
of needs can be useful both in structuring treat- responsible for taking care of her, his emotionally
ment as well as in understanding the role of the unstable mother, and his younger brothers. His
counselor in facilitating client progress toward parents’ tumultuous and acrimonious marriage
higher order needs. eventually ended in divorce, but not before the
painfully frightening, volatile, and unpredictable
Hannah B. Bayne family dysfunction piqued May’s loneliness,
resentment, insecurity, anxiety, codependency, and
See also Classical Psychoanalytic Approaches: Overview;
curiosity about psychology.
Maslow, Abraham; Person-Centered Counseling; Positive
Psychology; Psychosocial Development, Theory of
May’s transition to adulthood was stormy.
Banished from Michigan State University for pub-
lishing politically radical rhetoric, May was forced
Further Readings to transfer elsewhere. After graduating from
Koltko-Rivera, M. E. (2006). Rediscovering the later
Oberlin College in Ohio, May volunteered to
version of Maslow’s hierarchy of needs: Transcendence
spend 3 years in Saloniki, Greece, teaching English
and opportunities for theory, research, and unification. at Anatolia College. In his 1985 semiautobio-
Review of General Psychology, 10, 302–317. graphical book My Quest for Beauty, May writes
doi:10.1037/1089–2680.10.4.302 about how he felt terribly lonely and bored,
Maslow, A. H. (1943). A theory of human motivation. became unable to function, took to his bed for
Psychological Review, 50, 370–396. doi:10.1037/ weeks, and wandered around aimlessly in the
h0054346 freezing rain on nearby Mt. Hortiati. He knew he
Maslow, A. H. (1968). Toward a psychology of being desperately needed psychological support, but in
(2nd ed.). New York, NY: Van Nostrand Reinhold. 1931, there were few English-speaking psycho-
Maslow, A. H. (1970). Motivation and personality (2nd therapists in rural Greece. May attributes his
ed.). New York, NY: Harper & Row. recovery from this major depressive episode to his

May, Rollo 635
serendipitous rediscovery of beauty in a field of choose to confront fate or destiny, which, for May,
wild Greek poppies. includes those elements of life beyond our control.
May’s self-diagnosed “nervous breakdown” in Anxiously facing his own mortality, May became
Greece recalls Carl Jung’s devastating, prolonged fascinated with existential philosophy, devouring
yet immensely productive “confrontation with the the writings of Søren Kierkegaard and Friedrich
unconscious” during midlife, following his bitter Nietzsche in particular, writings that would pro-
rift with Sigmund Freud in 1913. Like Jung, May foundly inform his existential psychology and psy-
was severely shaken, depressed, and disoriented. chotherapy. Personal responsibility, integrity, choice,
He could no longer fend off his psychological courage, meaning, commitment, values, a sense of
demons. But for both, this unbidden “breakdown” purpose, and the conscious acceptance and asser-
or “constructive illness” set them on the path tion of one’s existential freedom and will, despite
toward a new, more authentic, creative, and mean- deterministic forces like sickness, death, family,
ingful life. What makes the concept of existential genes, culture, and circumstance, became central
crisis so essential to May’s psychology is its poten- themes in May’s existential psychology.
tiality to positively transform the personality by After recovering from his illness, May received
subverting self-defeating defense mechanisms, per- the first doctorate in clinical psychology granted by
ceptions, and patterns of behavior, forcing us to Columbia University in 1949. His dissertation,
fight for new life, open up to new experiences, and under the mentorship of the existential theologian
find and re-create ourselves anew. and philosopher Paul Tillich, whom May met while
As the direct result of his existential crisis in still a seminary student and later befriended, was
early adulthood, May relinquished his rigid, com- published in 1950 as The Meaning of Anxiety. This
pulsive, self-abnegating attitude toward life, comprehensive scholarly treatise stimulated the
decided to pursue his passion for art and beauty, psychological study of anxiety, boldly distinguish-
had his first love affair, attended seminars with ing between normal, ontological, or existential
Alfred Adler in Vienna, studied philosophy and anxiety and neurotic, psychotic, or pathological
theology, graduated from Union Theological anxiety and debunking the misconception of men-
Seminary in 1938, and authored by the age of tal health as defined by the absence of anxiety.
30 his first book The Art of Counseling (1939), Revised in 1977, May’s groundbreaking book
which innovatively blended depth psychology with remains relevant, providing a much-needed coun-
pastoral counseling. May served for 3 years as an terpoint to the pathologizing and suppressive treat-
ordained congregational minister in New Jersey ment of anxiety still predominant today. In this
but found the practical reality of this pastoral role sense, May, always the courageous rebel and trail-
frustrating in effectively counseling parishioners— blazer, anticipated and spoke out against the pit-
except at funerals, where the terrifying existential falls of too dogmatically applying the traditional
fact of mortality and raw emotional reactions to medical model to the treatment of psychological,
death could not be denied. spiritual, and existential angst, distress, or despair.
Feeling he could be of more help to people as a Demonstrating his lifelong cultural activism moti-
psychotherapist, May enrolled at Columbia vated by what Adler termed social interest, May
University in New York to study clinical psychol- also successfully fought against the powerful
ogy. However, in 1943, May experienced a second American Medical Association for the right of
existential crisis when he contracted tuberculosis, a nonphysicians to practice psychotherapy in the
then frequently fatal disease. His prognosis was dawning days of clinical psychology.
guarded at best. Confined to various sanatoria for As evidenced by his emphasis on existential
several years, May observed—as did his Viennese anxiety, death, and the problem of evil—with a few
contemporary, the psychiatrist Viktor Frankl, who exceptions, taboo topics for psychology and psy-
was confined in Nazi death camps during World chiatry—May never fully lost interest in theology,
War II—that one of the factors determining which seeing psychotherapy as a secular stand-in for reli-
individuals survived and which died was the willful gion and promoting the rapprochement of spiritu-
rather than passive attitude taken toward their exis- ality and psychology, which is increasingly popular
tential predicament. We are responsible for how we these days. After becoming a clinical psychologist,

636 May, Rollo
May pursued postgraduate psychoanalytical train- prescient given the suppressive, technique-driven,
ing at the William Alanson White Institute of symptom-focused, and pharmaceutical approach
Psychiatry, Psychoanalysis & Psychology in New taken by current therapies.
York under the tutelage of luminaries like Harry May touted the immense importance and healing
Stack Sullivan, Erich Fromm, and Fromm’s wife, power of existential presence, empathy, and the here-
Frieda Fromm-Reichman; May later became a and-now relationship in therapy over technical skills.
supervising and training analyst at the institute, a Although known as one of the pioneers of humanis-
position he held for many years. When interview- tic psychology, along with Abraham Maslow and
ing prospective candidates for analytic training, Carl Rogers, May’s existential approach to psycho-
May, the archetypal “wounded healer,” preferred therapy differed from most American humanistic
pupils who authentically struggled with their own psychologists in that he retained rather than rejected
neurotic tendencies to those pretentiously present- his psychodynamic perspective but modified and
ing some blandly well-adjusted persona. In 1958, deepened it with the philosophical tenets of phenom-
May coedited and contributed two seminal chap- enology and existentialism. Moreover, May took a
ters to Existence: A New Dimension in Psychiatry more European, tragic view of life than most of his
and Psychology, in which European existential more optimistic (sometimes naive) humanistic col-
analysis was introduced, explained, and exempli- leagues. Like Freud (the id) and Jung (the shadow),
fied. This well-received volume established May as May never minimized, sugarcoated, or denied the
the preeminent American exponent of existential darker, dangerous, shadowy, unconscious side of
therapy, which he felt more profoundly addresses humanity. His 1972 book Power and Innocence, a
the same “ultimate concerns” (to quote Tillich) as psychological analysis of the sources of violence in
religion: mortality, suffering, meaninglessness, our society, penned during the Vietnam War, seems
alienation, faith, responsibility, evil, and so on. tragically prophetic in light of today’s epidemic of
Rocked by yet a third existential crisis, a dif- school shootings, terrorism, and random mayhem.
ficult divorce from his first wife following three May’s theoretical orientation is best described as an
decades of marriage, May once more managed to “existential depth psychology,” in which the rich
channel his anguish, confusion, and anxiety cre- clinical wisdom of Freud, Jung, Adler (with whom he
atively into his writing, publishing in 1969 his studied), Otto Rank (whose lesser known contribu-
celebrated and erudite magnum opus, Love and tions May valued highly), Ludwig Binswanger,
Will, in which May muses about the meaning of Medard Boss, Eugène Minkowski, and Roland Kuhn
sex and love, will and intentionality, evil and is creatively combined with the sobering insights of
creativity and introduces his controversial, existential philosophers like Kierkegaard, Nietzsche,
revolutionary, paradoxical paradigm of the Karl Jaspers, Jean-Paul Sartre, Tillich, and others.
daimonic—the basic and indispensable under- However, unlike some existentialists, May did not
girding dynamic myth of May’s existential psy- succumb to continental nihilism, maintaining that
chology and therapy. In Love and Will, May man’s innate capacity for cruelty, evil, hatred, and
defines the daimonic as “any natural function destructiveness is counterbalanced by our potential-
that has the power to take over the whole person. ity for kindness, goodness, love, and creativity and
Sex and eros, anger and rage, and the craving for that life’s suffering, meaninglessness, and absurdity
power are examples” (p. 123). He contends that can be dealt with and made bearable by the creation
daimonic emotions like anger or rage, for instance, of meaning through myths, religion, art, eros, science,
are not necessarily negative but can be both and psychotherapy.
destructive (evil) and constructive depending on Relocating from Manhattan to San Francisco in
how we relate to them, emphasizing the futility 1974, May continued to practice, supervise, teach,
and dangers of chronically denying, avoiding, or and write, despite his slowly declining health, until
repressing rather than consciously acknowledg- his death from congestive heart failure in 1994. The
ing and confronting the daimonic. May’s stern Stanford University psychiatrist Irvin Yalom, per-
warning that the way mental health professionals haps the most prominent and popular spokesperson
deal with the daimonic (or avoid doing so, as is for existential therapy today, was one of May’s
often the case today) would be fateful for the patients, subsequently becoming a close friend and
future survival of psychotherapy has proven professional colleague. A recipient of the American

Meditation 637
Psychological Association’s Distinguished Career back as 1500 BCE (Hindu Vedic writings), 1 to
Award, May authored many books, including Man’s 200 BCE (Buddhist), 10 to 200 CE (Judaic),
Search for Himself (1953), Psychology and the 20 BCE (Christian), and 800 to 900 CE (Islamic).
Human Dilemma (1967), The Courage to Create While many religious and spiritual practices
(1975), Freedom and Destiny (1981), The Discovery (e.g., sacrifices, various superstitions and rituals,
of Being (1983), and The Cry for Myth (1991). belief in no longer recognized deities) have waxed
and waned over the years, meditation has been
Stephen A. Diamond practiced for a long time and has flourished.
Distinct from the scope of religious teachings, per-
See also Adler, Alfred; Existential Therapy; Existential-
Humanistic Therapies: Overview; Frankl, Viktor;
sonal experiences (compassion, deeper apprecia-
Freud, Sigmund; Jung, Carl Gustav; Maslow, tion for life, greater sense of inner balance,
Abraham; Freudian Psychoanalysis; Rogers, Carl; improved health and well-being) have been
Yalom, Irvin recorded, which serves to strengthen belief in the
utility of meditation.
Until recently, the benefits of meditation were
Further Readings regarded as anecdotal and unsubstantiated.
May, R. (1969). Love and will. New York, NY: However, beginning in the 1960s, research on
W. W. Norton. Transcendental Meditation began to closely inves-
May, R. (1972). Power and innocence: A search for the tigate how the body responds to meditative prac-
sources of violence. New York, NY: W. W. Norton. tice and opened up a greater understanding of its
May, R. (1975). The courage to create. New York, NY: physical and psychological benefits. Since then,
Bantam Books. there has been a proliferation of medical and scien-
May, R. (1977). The meaning of anxiety (Rev. ed.). New tific studies exploring how this ancient practice
York, NY: W. W. Norton. (Original work published affects the psychophysiological systems of the
1950) body.
May, R. (1986). The discovery of being: Writings in Today, there are numerous kinds of meditative
existential psychology. New York, NY: W. W. Norton. practices, including the following: (a) mantric
May, R. (1991). The cry for myth. New York, NY: (reciting of a specific word or phrase), (b) Vipassana/
W. W. Norton.
insight (focusing on the interconnection between
the mind and the body by way of purifying the
mind of the mental factors that cause distress
and pain), (c) Lectio Divina (reading, reflecting,
MEDITATION responding, and listening intended to promote
communion with God), (d) Centering Prayer (con-
Meditation is an intentional practice of calming cerned with the intention of developing and main-
one’s body and mind in a fashion that leads to an taining harmony with God’s presence and action
altered state of consciousness characterized by during prayer), and (e) Dhikr (an Islamic prayer in
expanded awareness, greater presence, and a more which the individual expresses, either silently or
integrated sense of self. Meditation is practiced for aloud, his or her remembrance of God).
religious, spiritual, and psychological or emotional
well-being. While the majority of meditation meth-
ods have their roots in religious and spiritual prac-
tices, modern medical and scientific research has led The basic purpose of meditation is to awaken in
to these techniques being incorporated into main- order to gain clarity as to the true nature of life as
stream medical and psychotherapeutic interventions. well as one’s own true nature. Many of us have
numerous layers of thoughts, feelings, memories,
and experiences that have served to shape and
Historical Context
define who we are. Over the years, our experiences
The practice of meditation has long been utilized tend to reinforce these layers of learnings, creating
in various spiritual or religious practices. Meditative a significant separation from our true selves. The
practices have been recorded in writings as far basic purpose of the psychotherapeutic process is

638 Meditation
to help uncover, discover, and recover that part of perspiration, pupillary dilation, urination, and
the client’s self (true nature) that has been repressed, sexual arousal). The autonomic nervous system is
split off, denied, silenced, and/or forgotten in order made up of two branches: (1) the sympathetic ner-
to help reintegrate the client with a more balanced vous system and (2) the parasympathetic nervous
and integrated experience of himself or herself and system. The sympathetic nervous system typically
his or her life. controls what is known as the fight, flight, or freeze
The purpose of integrating meditation practices response. The parasympathetic nervous system
with psychotherapy is to dampen the chronic over- controls what is referred to as the relaxation or
stimulation of the sympathetic nervous system and healing response.
elevate the functioning of the parasympathetic The fight, flight, or freeze response is triggered
nervous system, thus allowing the body’s own when there is a perceived threat (real or imagined)
healing mechanisms to facilitate a return to health and is designed to initiate our protective survival
and wellness. When the parasympathetic nervous mechanisms. When the threat is over, the parasym-
system is activated, it stimulates the vagus nerve, pathetic nervous system activates to heal the body
leading to a reduction in heart rate, blood pressure, from the effects of the fight, flight, or freeze
or both, as well as promoting the production of response and to restore a sense of calm. Research
acetylcholine. Interestingly, a cell repair and growth has shown that numerous emotional and physical
enzyme, ornithine decarboxylase, is not produced symptoms and conditions (e.g., irritable bowel
unless the parasympathetic nervous system is syndrome, anxiety, dermatological conditions,
activated, generally in deep sleep. hypertension, posttraumatic stress disorder, adre-
Integrating meditation into the psychotherapeu- nal fatigue, ulcers, panic attacks, insomnia, head-
tic experience also capitalizes on involving the aches) have their roots in the dysregulation of the
client more actively in his or her healing process, as autonomic nervous system. The practice of medita-
well as reinforcing the client’s innate psychobio- tion has been shown to positively affect autonomic
logical healing capacities. Both empower the client dysregulation, thus allowing clients to better heal
to take greater responsibility and limit reliance on from their symptomatic distress.
the therapist as the sole guide for healing.
It is important to clear up some common mis- Autonomic Dysregulation
conceptions regarding meditation. Meditation is
not medication. It does not make the client a bet- When the autonomic nervous system is func-
ter something (e.g., parent, lawyer, teacher). It tioning properly, the sympathetic nervous system
does make the client more something (e.g., and the parasympathetic nervous system perform
patient, spiritual, outgoing) or less something in consort to maintain autonomic nervous system
(shy, anxious, depressed). Similarly, meditation is equilibrium in the body. Under chronic stress, these
not practiced for a particular, specific outcome. two systems tend to fail to work in harmony, and
thus the autonomic nervous system becomes dys-
regulated toward sympathetic nervous system over-
Major Concepts activation. The sympathetic nervous system remains
The practice of meditation is directly related to the activated most of the time, and the parasympa-
functioning of the autonomic nervous system. thetic nervous system is prevented from turning on
Through meditation, balance can be restored to a and allowing the body to heal and repair. The body
dysregulated nervous system. then remains in a continual state of fight, flight, or
freeze. Many psychobiological processes begin to
degenerate, resulting in a variety of chronic health
Autonomic Nervous System
conditions and overall poor health.
In recent years, the practice of meditation has Meditation reduces autonomic dysregulation by
been shown to have great benefits with regard to dampening the overstimulation of the sympathetic
regulating the autonomic nervous system. The nervous system and facilitating the activation of
autonomic nervous system is the part of the periph- the parasympathetic nervous system. For this rea-
eral nervous system that controls visceral functions son, meditation has been taught to various popula-
(heart rate, digestion, respiratory rate, salivation, tions for different outcomes: (a) prison inmates, to

Meditation 639
help improve mood and behavior and to reduce Centering Prayer

recidivism; (b) individuals who have suffered
To employ the Centering Prayer technique, the
trauma, to help reduce anxiety and the accompa-
meditator chooses a sacred word as the symbol of
nying startle response; (c) those undergoing che-
his or her intention. The meditator introduces the
motherapy, to reduce anxiety and the side effects
sacred word to his or her awareness and remains
of the medications; (d) high school students, to
focused on the word. When thoughts or feelings
improve classroom behavior and academic perfor-
arise, the meditator returns gently to the sacred
mance; (e) children who are scheduled for surgery,
word. At the end of the prayer period, the medita-
to prepare them for the procedure; and (f) those
tor remains in silence with eyes closed for a couple
with depression and anxiety, to reduce problematic
of minutes.
symptoms.
Meditation has been shown to bring about not
only changes in brain structure and function, such Breath Meditation
as significant increases in left-sided anterior activa- Breath meditation refers to watching one’s
tion, a pattern previously associated with positive breathing. The CenterPoint Breathing technique
affect, but also improvement in immune function, discussed in the “Introduction” subsection of the
such as increases in antibody titers to influenza “Therapeutic Processes” section is often recom-
vaccine. In addition, studies have shown that spe- mended for breath meditation.
cific molecular changes occur throughout the body
as a result of meditation. For example, meditators
Walking Meditation
showed a range of genetic and molecular differ-
ences, including altered levels of gene-regulating Walking meditation brings the meditative expe-
machinery and reduced levels of pro-inflammatory rience into the meditator’s outward activity. The
genes, which in turn correlated with faster physical meditator spends a moment standing still. He or
recovery from a stressful situation, after periods of she takes some deep breaths and then begins walk-
meditation. ing at a relaxed, fairly slow but normal pace. As the
To date, empirical evidence has documented meditator walks, he or she pays attention to the
the beneficial qualities of meditation practices. sensations in his or her body and continues to do so
Such practices can be integrated into the psycho- throughout the duration of the walking experience.
therapeutic process, especially when it involves
helping individuals regulate their autonomic
Metta or Compassion Meditation
nervous system as well as their accompanying
emotions. This meditation cultivates compassion toward
oneself and others. The meditator sits quietly with
eyes closed and with relaxed breathing and then
Techniques recites the following phrases several times: “May I
There are many techniques of meditation. The five be happy. May I be well. May I be safe. May I be
listed in this section are those most frequently inte- peaceful and live with ease.”After pausing for sev-
grated into the psychotherapeutic experience. eral moments, the meditator then directs the medi-
tation toward others with the following phrases:
“May all beings be happy. May all beings be well.
Insight Meditation
May all beings be safe and live with ease.”
Insight meditation refers to being aware of sur-
rounding sounds and activities. In this technique,
Therapeutic Process
the meditator sits with his or her eyes closed and
with relaxed breathing. The meditator allows his When introducing meditation into the psycho-
or her mind to be fluid and to flow from one therapeutic process, therapists often use a three-
thought to the next; he or she does not focus on step process: (1) education, (2) an introduction to
any one thought, feeling, or sound and does not the process, and (3) integration. Throughout this
make judgments about what he or she is thinking, process, it is important to keep it as uncomplicated
feeling, or hearing. as possible.

640 Meditation
Education He or she also encourages the client to take time

every day to do this breathing meditation, articu-
Because many people equate meditation with a
lating to the client to start out slowly by meditating
specific religious practice, it is important for the
at a designated time every day for 2 to 3 minutes
therapist to address concerns the client may have
and increasing the length of time gradually. The
regarding this. The therapist can reassure the client
therapist can remind the client that what is impor-
by noting that recent medical and scientific discov-
tant initially is that the client takes the time to
eries have demonstrated that a meditation practice
meditate every day, not the length of time.
has important medical and psychological benefits
The client’s mind may wander during medita-
that relate to the client’s treatment and that the tech-
tion, so the therapist can reassure the client that
niques the therapist will teach the client will not
this is normal. In addition, the therapist can
interfere with the client’s religious practice and
remind the client to, simply and without judgment,
beliefs. In an easy and understandable fashion, the
pause at the end of each out breath when the client
therapist discusses the autonomic nervous system,
becomes distracted. Frustration and impatience are
parasympathetic nervous system, and sympathetic
part of the process, so the therapist can make the
nervous system interactions, and how each affects a
client aware of this and encourage the client to stay
person’s health, healing, and well-being. It is impor-
with it.
tant for the therapist to have a user-friendly infor-
mation sheet outlining the benefits of meditation for
the client’s condition, which the client can read and Integration
share with the important people in his or her life.
Each psychotherapeutic session begins with
5 minutes of meditation, including a word or
Introduction phrase for the client to focus on that will serve as
To introduce the client to meditation, the thera- a platform for the ensuing session. Other methods
pist instructs the client in an easy breathing tech- that can help integrate meditation into the thera-
nique that the client can practice at home, such as peutic process include the following: (a) discussing
CenterPoint Breathing. The steps a therapist with the client how a daily meditation practice can
observes to introduce the client to CenterPoint assist in moving the client’s healing in a positive
Breathing are as follows: and lasting direction, (b) giving the client a collec-
tion of healing sayings to use during meditation,
1. Have the client sit comfortably with eyes closed. and (c) encouraging the client to journal about his
or her meditation practice and any observations or
2. Invite the client to simply watch his or her
insights he or she has gained during the therapeutic
breathing.
process.
3. Have the client take a deep breath in through
the nose and exhale through the mouth.
Thomas B. Roberts
Encourage the client to exhale as completely as
See also Advanced Integrative Therapy; Breathwork in
is comfortable and then to breathe in and out Contemplative Therapy; Complementary and
easily. Alternative Approaches: Overview; Mindfulness
4. Repeat this sequence twice. Techniques; Prayer and Affirmations
5. Have the client return to simply watching his or

her breath, paying particular attention to the Further Readings
pause at the end of each exhaled breath. Have Aiken, G. (2006). The potential effect of mindfulness
the client rest comfortably in that pause until it meditation on the cultivation of empathy in
becomes time to gently inhale again, then exhale psychotherapy: A qualitative inquiry (Doctoral
and return to resting in the pause. dissertation). Saybrook Graduate School and Research
Center, San Francisco, CA.
The therapist allows the client several minutes Davidson, R. J., Kabat-Zinn, J., Schumacher, J.,
to experience this technique for himself or herself. Rosenkranz, M., Muller, D., Santorelli, S., . . .

Meichenbaum, Donald 641
Sheridan, J. F. (2003). Alterations in brain and immune dominant. Behavior therapy, which was becoming
function produced by mindfulness meditation. an increasingly dominant force in counseling and
Psychosomatic Medicine, 65, 564–570. therapy at that time, viewed a client’s thoughts and
doi:10.1097/01.PSY.0000077505.67574.E3 feelings within an operant and classical condition-
Deatherage, G. (1975). The clinical use of “mindfulness” ing framework, and thoughts were viewed as
meditation techniques in short-term psychotherapy. “coverants” (covert operants). The works of
Journal of Transpersonal Psychology, 7, 133–143. B. F. Skinner, Sidney Bijou, Donald Baer, Joseph
Kabat-Zinn, J. (2005). Bringing mindfulness to medicine: Wolpe, Hans Eysenck, Leonard Krasner, Leonard
An interview with Jon Kabat-Zinn, Ph.D. Interview by
Ullmann, and others were the major framework
Karolyn Gazella. Advances in Mind-Body Medicine,
for viewing psychotherapeutic interventions.
21(2), 22–27.
Illustrative of this behavioral influence was
Nhat Hanh, T. (1991). Peace is every step: The path of
Meichenbaum’s doctoral dissertation topic:
mindfulness in everyday life. New York, NY: Bantam
Books.
“Training Schizophrenics to Talk to Themselves: A
Roberts, T. (2009). The mindfulness workbook: A
Self-Instructional Training Procedure.” On gradua-
beginner’s guide to overcoming fear and embracing tion from the University of Illinois with a Ph.D. in
compassion. Oakland, CA: New Harbinger. clinical psychology, Meichenbaum took a job at a
new university in Ontario, Canada—the University
of Waterloo—where he remained for 40 years. The
next phase of his research was influenced by the
development of social learning theory, as advo-
MEICHENBAUM, DONALD cated by Albert Bandura and Richard Walters, as
well as the introduction of computer-based models
Donald Meichenbaum (1940– ) is known as one of of thoughts and feelings. Concepts like encoding,
the founders of cognitive-behavioral therapy and decoding, and appraisal processes; belief systems
in a survey of clinicians was voted “one of the ten and schemas; attribution biases; mental heuristics;
most influential psychotherapists of the 20th cen- and cognitive errors were coming to the fore. A
tury.” Born in the Bronx, New York, Meichenbaum “cognitive revolution” was taking place with the
attended New York City public schools and even- work of Daniel Kahneman and Amos Tversky,
tually attended the City College of New York Richard Lazarus, and Irving Janis. These concepts
(CCNY) from 1958 to 1962 for his undergraduate found their clinical counterpart in the pioneering
degree in psychology. work of Albert Ellis, Aaron Beck, Arnold Lazarus,
Meichenbaum tells the story of how he entered and Michael Mahoney. With this shifting zeitgeist
CCNY with the desire to become a chemical from a behavioral to a cognitive perspective,
engineer. On his arrival at CCNY, all incoming Meichenbaum and his graduate students con-
freshmen attended a meeting with the Dean of ducted a series of clinical studies extending the
Engineering, who told the incoming students to self-instructional training model to children and
look around the room, because in 4 years only adults who evidenced impulsivity, poor emotional
one in four would graduate as an engineer. and behavioral self-regulation, metacognitive defi-
Meichenbaum’s reaction was to immediately cits, and anger control problems. He also devel-
console his three friends and “inoculate” them oped Stress Inoculation Training, which included
against the stress of future failure. It turned out three phases: (1) educational, (2) skills acquisition,
that he was better at counseling than he was at and (3) application training. Stress Inoculation
engineering. Thus, his career toward becoming a Training was successfully applied to a host of
psychotherapist began. clients who evidenced aggressive behavior, pain
The next step in the journey of going from an control, and anxiety disorders. This research was
undergraduate in psychology at CCNY to becom- summarized in Meichenbaum’s seminal 1977 book
ing a noted clinical researcher was entry into the Cognitive-Behavior Modification: An Integrative
Clinical Psychology program at the University of Approach.
Illinois in Champaign. At that time (1962–1966), Soon thereafter followed several more books—
a behavioral perspective of psychotherapy was Stress Inoculation Training, Stress Reduction, Pain

642 Meichenbaum, Donald
and Behavior Medicine, Facilitating Treatment is presently research director of The Melissa
Adherence, and Nurturing Independent Learners. Institute for Violence Prevention and the Treatment
One of Meichenbaum’s contributions was to dem- of Victims of Violence in Miami, Florida.
onstrate that various forms of behavior therapy The initial form of counseling/psychotherapy
interventions could be made more effective and that Meichenbaum offered his fellow freshman
sustainable if they incorporated the client’s cogni- engineering students is still evident, but now it
tive and affective processes. He also developed occurs on a much larger scale. His contributions
innovative cognitive-behavioral interventions that have been recognized by the Clinical Division of
could be applied to a diverse group of clients. the American Psychological Association with a
Yet another conceptual and clinical change was Lifetime Achievement Award. He has received
about to take place in Meichenbaum’s journey. He other accolades from various psychological orga-
became more involved with clients who had experi- nizations. He has presented in all the 50 U.S. states,
enced traumatic and victimizing experiences, includ- in all the provinces in Canada, and internationally.
ing returning soldiers, victims of various forms of
abuse, and natural disasters survivors. He was Donald Meichenbaum
struck with the impressive and consistent findings See also Bandura, Albert; Beck, Aaron T.; Behavior
that no matter which traumatic event one studied, Therapies: Overview; Cognitive-Behavioral Therapies:
in most instances, 75% of individuals are affected Overview; Constructivist Therapies: Overview; Ellis,
but go on to evidence resilience and, in some Albert; Lazarus, Arnold; Mahoney, Michael J.; Pavlov,
instances, posttraumatic growth. In contrast, 25% Ivan; Skinner, B. F.
evidence posttraumatic stress disorder and related
psychiatric conditions and adjustment difficulties. Further Readings
This clinical observation led to work on what dis-
Meichenbaum, D. (1977). Cognitive behavior
tinguishes these two groups and the implications for
modification: An integrative approach. New York, NY:
ways to bolster resilience. His 2012 book Roadmap
Plenum Press.
to Resilience summarizes this work.
Meichenbaum, D. (1985). Stress inoculation training.
Meichenbaum became fascinated by the “sto-
New York, NY: Pergamon Press.
ries” that individuals tell others as well as them- Meichenbaum, D. (1994). Treating individuals with
selves that distinguish the 75% from the 25%. He PTSD. Clearwater, FL: Institute Press.
has now come to embrace a cognitive narrative Meichenbaum, D. (2002). Treating individuals with
perspective and views the psychotherapist’s task as anger-control problems and aggressive behaviors.
a way to help clients alter their “stories” and Clearwater, FL: Institute Press.
develop coping responses to accompany these Meichenbaum, D. (2012). Roadmap to resilience.
reauthoring, restorying, resilient-enhancing activi- Clearwater FL: Institute Press. Retrieved from www
ties. Meichenbaum now highlights the fact that .roadmaptoresilience.org
human beings are not only Homo sapiens, but they Meichenbaum, D., & Biemiller, A. (1998). Nurturing
are also “homo narrans,” or “storytellers,” and independent learners. Boston, MA: Brookline Books.
that the nature of the story that individuals tell Meichenbaum, D., & Jaremko, M. (1983). Stress
themselves is the basis of behavior change. reduction and prevention. New York, NY: Plenum
Thus, Meichenbaum’s journey has taken him Press.
from viewing cognitions and emotions as condi- Meichenbaum, D., & Turk, D. (1987). Treatment
tioned responses and as discriminative stimuli in nonadherence: A practitioner’s guidebook. New York,
an operant sense, to an information-processing NY: Plenum Press.
perspective, to a narrative perspective with fea- Turk, D., Meichenbaum, D., & Genest, M. (1983). Pain
tures of plots, characters, and themes. He has and behavior medicine. New York, NY: Guilford
blended these three elements into an integrative Press.
psychotherapeutic approach.
In 2006, Meichenbaum took early retirement
Website
from the University of Waterloo and, like many
folks living in Canada, moved to Florida, where he The Melissa Institute: www.melissainstitute.org

Mentalization-Based Treatment 643
Two well-controlled single-blind trials of outpa-

MENTALIZATION-BASED TREATMENT tient MBT have been conducted with adults with
BPD and self-harming adolescents. In both trials,
Mentalization-based treatment (MBT) is an MBT was superior to TAU in reducing self-harm,
evidence-based, manualized form of psychody- including suicidality, and depression.
namic psychotherapy. Mentalizing involves imagi-
natively observing and interpreting other people’s
and one’s own state of mind. The capacity to
mentalize is key to making sense of our own feel- Interpersonal understanding and communication
ings and to relating to other people, particularly is now understood as a major, evolutionarily pro-
those who are closest to us. The development of a tected human capacity. Impairments in theory of
child’s ability to mentalize is influenced by the mind (the ability to attribute mental states, e.g.,
quality of early relationships with caregivers; the thoughts, beliefs, and wishes to oneself and others
child’s acquisition of mentalizing skills can be and to understand that others’ mental states may
undermined by emotional neglect, abuse, or highly differ from one’s own) have long been associated
insensitive parenting. MBT seeks to improve a with pervasive developmental disorders such as
patient’s ability to mentalize when the patient is in autism, Asperger’s syndrome, and psychosis.
stressful interpersonal situations. Mentalization theory has enriched this under-
standing of the relationship between mental health
and our ability to understand both our own and
Historical Context
others’ behavior in terms of underlying mental
The mentalization-based approach to treatment states. In personality disorders, difficulties with
was developed in the context of working with mentalizing tend to occur when the attachment
patients with personality disorders and observing system (the behavioral system that serves to main-
their temporary but frequent failures of interper- tain or achieve closer proximity to the attachment
sonal understanding (mentalizing), which led to figure when the individual feels threatened, thereby
overwhelming affect and strong emotional dys- ensuring safety and security) is activated. Thus, at
regulation. In the 1990s, Anthony Bateman and times when an individual feels threatened and in
Peter Fonagy formulated MBT as a method for need of reassurance, the individual is particularly
working with patients with borderline personality likely to find it difficult to think about what is
disorder (BPD) in a partial hospital setting. MBT is going on both in the individual’s own mind and in
now applied to a variety of disorders in a range of others’ minds. This can cause significant distress
settings: Clinical reports suggest that it may be and difficulties in functioning, particularly when
helpful in work with a range of disorders, includ- it comes to dealing with close relationships or
ing eating disorders and antisocial personality challenging interpersonal experiences.
disorders, and with children.
In a randomized controlled trial of MBT for
Major Concepts
BPD in a partial hospital setting, significant posi-
tive changes in mood states and interpersonal The concepts central to MBT are mentalization,
functioning were associated with an 18-month attachment, and mentalizing failure. This section
treatment program. The benefits, relative to treat- briefly discusses each of these concepts.
ment as usual (TAU), were large (the number
needed to treat was around two) and increased
Mentalization
during the 18-month follow-up period. At the
8-year follow-up, the MBT group continued to Mentalization is the capacity to understand
show clinical and statistical superiority to the TAU other people’s and one’s own behavior in terms of
group on suicidality, diagnostic status, service use, mental states. The acquisition of this capacity is
use of medication, global functioning, and voca- influenced by the quality of early relationships
tional status, although their general social function with caregivers, including experience of trauma. It
remained impaired. is vulnerable to disruption under interpersonal

644 Mentalization-Based Treatment
stress. Individuals with BPD are particularly likely for their difficulties. The theory holds that any
to find it difficult to mentalize in the context of therapeutic approach that moves toward claiming
attachment relationships. However, the loss of to know how patients are is likely to be harmful.
mentalization is rarely total. Instead, the therapist adopts a “mentalizing
stance”—that is, a stance of inquisitiveness, curios-
ity, open-mindedness, and, perhaps ironically, not
Attachment
knowing—focusing on the mind of the patient as
The capacity to mentalize has been linked with the patient experiences himself or herself and others
attachment security in childhood. Parents who are at any given moment. The patient is helped to learn
securely attached, in part by virtue of their mental- more about how the patient thinks and feels about
izing capacity, mentalize in their interactions with himself or herself and others and how that might
their infants, enabling their infants to become trigger the patient’s reactions, and how difficulties
securely attached to them. Securely attached infants in understanding himself or herself and others lead
develop better mentalizing capacity in childhood. to impulsive actions (e.g., self-harm or violence).
Neglect and trauma in attachment relationships The therapist helps the patient recover the capacity
(which often feature in the histories of patients to mentalize when it is temporarily lost, including
with personality disorders) contribute to the disor- the breaks in mentalizing that inevitably occur
ganization of the attachment system and intergen- in the therapeutic relationship. When such failures
erational transmission of impaired mentalizing (on the part of both the patient and the therapist)
capacities. occur, the therapist must articulate what has hap-
pened to demonstrate that he or she is continually
reflecting on what goes on in his or her mind and
Mentalizing Failure
on what he or she does in relation to the patient.
Mentalization can be inhibited by intense emo-
tional arousal, which often occurs in the context of
attachment relationships. When this happens, indi- Therapeutic Process
viduals may fall back on primitive, prementalistic The therapist seeks to model an attitude that is
modes of thinking. These include psychic equiva- curious about mental states and respects their lack
lence (in which mental events are considered to of clarity (the mentalizing stance). The task is to
have the same status as physical reality), the pre- explore the different mental processes at work and
tend mode (when subjectivity becomes completely accept that diverse outlooks may be acceptable.
separated from reality), and teleological thinking This requires that therapists acknowledge moments
(the assumption that emotional difficulties can be when they themselves fail to mentalize, which are
solved by action, e.g., that anger can be resolved by treated as learning opportunities. Mentalizing in
destruction of property or violence). the therapeutic relationship has to be approached
sensitively to avoid overactivating the attachment
Techniques system, because if this occurs, it will reduce the
patient’s fragile capacity to mentalize even further.
Psychotherapy traditionally uses patients’ capacity
to consider their sense of their own mental state Peter Fonagy and Elizabeth Allison
alongside the psychotherapist’s perception of it.
Patients who struggle to understand behavior in See also Object Relations Theory
terms of mental states in the context of attachment
relationships are likely to struggle to benefit from
such approaches. The MBT therapist does not Further Readings
assume that the patient has such social cognitive Allen, J. G., & Fonagy, P. (2006). Handbook of mentalization-
capacities. Thus, the MBT therapist’s task is not to based treatment. Chichester, England: Wiley.
tell patients how they feel, what they think, or how Allen, J. G., Fonagy, P., & Bateman, A. W. (2008).
they should behave—or to explain to them Mentalizing in clinical practice. Arlington, VA:
the underlying conscious or unconscious reasons American Psychiatric.

Metaphors of Movement Therapy 645
Bateman, A. W., & Fonagy, P. (Eds.). (2012). Handbook Influenced by the work of Charles Faulkner, MoM
of mentalizing in mental health practice. Washington, is much more active in guiding the client to develop
DC: American Psychiatric. his or her metaphor and ultimately confront and
modify the behavior (or lack of it) that is revealed
in the metaphor.
METAPHORS OF MOVEMENT THERAPY

Metaphors of Movement (MoM) is an approach to Because metaphorical communication is highly
therapeutic change that focuses on the exploration organized and dense, a wealth of important infor-
of metaphors expressed in a client’s communica- mation can be extrapolated from even a very sim-
tion, much of which is out of the client’s usual ple metaphor. Metaphor is processed and expressed
awareness. The client is asked to explore and dis- primarily by the nondominant hemisphere of the
cover more about these metaphors. If the client does brain, which offers a unique window into nonver-
not spontaneously offer a metaphor for the prob- bal and mostly unconscious processes. MoM uti-
lem at hand, then the therapist will guide the client lizes inductive and deductive logic and inference to
toward finding a metaphor to describe the client’s expand, develop, and enrich the metaphoric expe-
situation by asking the client to think about what rience for the client. This makes the information
the problem is like. Sessions can be up to 3 hours in available to the dominant hemisphere, enabling a
duration, and the work is divided into three phases: change of the coping strategy employed to cope
(1) one-to-one work in therapist–client interaction, with the problematic situation.
(2) self-exploration following the session, and
(3) discussion and follow-up with the therapist.
MoM is particularly useful when applied to what Major Concepts
are termed stuck states and in helping people move The major concepts of MoM include the MoM
on from trauma. Whereas creating kinesthetic elaboration process, extrapolating from the meta-
change is the focus of most therapy, MoM focuses phor to enrich it further, and identifying and chal-
on changes in clients’ coping behaviors as expressed lenging boundary violations.
in their metaphors.
MoM Treatment Algorithm
Historical Context
The process of metaphor elicitation and develop-
The use of metaphor as a medium for teaching and ment has seven distinct phases: (1) elicitation of the
change in preliterate and literate cultures dates metaphorical representation, (2) simple exploration
back several thousand years, long before the para- of the metaphoric representation, (3) eliciting the
bles of the Bible. With the popularization of coping behavior represented in the metaphor,
Milton Erickson’s hypnotherapy and metaphorical (4) viewing the application of the coping behavior
storytelling as therapy that came with the develop- within the metaphor, (5) exploration of alternative
ment of neuro-linguistic programming (NLP) in coping behaviors, (6) application and exploration
the early 1980s, increased attention was given to of common idioms and phrases that match the
metaphor as a therapeutic medium. A logical next metaphoric situation, and (7) evaluation of the
step was to elicit a client’s own metaphor and then client’s ability to utilize the new coping strategy.
to work within that metaphor to discover appro-
priate changes. One such model is that of “Clean
Extrapolating From the Metaphor
Language” utilizing “Symbolic Modeling,” devel-
oped by James Lawley and Penny Tompkins. This Using everyday expressions and idioms that
is a method derived from David Grove’s work with fit the client’s metaphor, the therapist infers and
posttraumatic stress disorder, in which a client dis- demonstrates additional aspects of the client’s
covers his or her own metaphor for the problem, metaphorical experience. For instance, if a client
with minimal intervention by the therapist. says that he or she is “in the pit of despair,” the

646 Method of Levels
therapist may point out that the client is “in the the term that has been applied to the relationship
dark,” “trapped,” “very low,” “not going anywhere that can emerge in MoM sessions where clients are
in life,” and so on. free to experience a full range of emotions without
being constrained by the parameters of the rapport
with the therapist.
Boundary Violation
A boundary violation is a highly specific, pat-
terned, and predictable unconscious behavior in Therapeutic Process
which the client jumps from the metaphor into a MoM sessions are typically 2 to 3 hours long, to
different category of experience. For example, the explore the structure of most metaphors and to
client may say that his “past” is outside the meta- evoke a rich experience that the client can continue
phoric pit of despair, thus jumping from the cate- to process on his or her own after the session.
gory of metaphor into the category of personal MoM treatment can last a few sessions or continue
history. MoM assumes that a boundary violation over long periods of time depending on the client
is a naturally occurring behavior that serves to and the client’s situation.
distract, keeping the obvious solution to the prob-
lem outside of conscious awareness. This is coun- Andrew T. Austin
tered by insisting that the client stay within the
metaphoric experience and learn more about it. See also Erickson, Milton H.; Neuro-Linguistic
Programming
Techniques
Further Readings
A number of techniques have emerged from the
Faulkner, C. (2005). Metaphors of identity: Operating
MoM model, including the application of the cop-
metaphors and iconic change [Audio]. Lyons, CO:
ing behavior to the metaphor and the challenging
Genesis II.
of boundary violations. Lawley, J., & Tompkins, P. (2000). Metaphors in mind:
Transformation through symbolic modeling. London,
Application of the Current Coping England: Developing Company Press.
Behavior to the Metaphor
The practitioner challenges the problem meta-
phor by applying the coping behavior to the meta-
phor. For instance, for the client in the pit of METHOD OF LEVELS
despair who wants help to move forward, the
therapist may offer, “Let’s say we are walking The Method of Levels (MOL) is a transdiagnostic
down an imaginary road, and we come across a cognitive therapy that addresses the dilemmas,
poor fellow in a pit of despair. We could tell him, tensions, and conflicts underlying symptom
‘It’s all right, just move forward.’ Would that be patterns rather than focusing on the symptom
good advice?” Usually, the client can immediately patterns directly. With its unique theoretical
see that the poor fellow will just stumble into the framework, it has similarities with approaches
wall of the pit. Because the problem metaphor such as motivational interviewing and provides a
remains unchanged by the coping behavior, bridge between cognitive-behavioral therapy and
alternative behaviors can be explored. person-centered counseling. MOL optimistically
and respectfully provides the time and the focus
for people to generate their own solutions to the
Challenging Boundary Violations and Disrapport
difficulties they experience. It is very much an
Boundary violations were observed after the experiential therapy, in which a conversation is
original development of MoM, and it was noticed developed to first generate some of the distress
that challenging boundary violations produced the the person experiences outside of therapy and
most benefit, even if this led to a loss of rapport then to facilitate the processing of this distress in
between the client and the therapist. Disrapport is such a way that new perspectives and insights are

Method of Levels 647
developed and the person is able to find a more two control systems specify simultaneous but
contented and satisfying way to live. incompatible experiences. Wanting to experience
the progress of a stellar career and desiring the
warmth and intimacy of close family relationships
Historical Context
can, in some contexts, interfere with each other. As
The impetus for MOL began in the 1950s when more career progression is sought, family closeness
the perceptual control theorist William T. Powers diminishes. When efforts are made to restore
explored the effects of engaging in conversations familial closeness, the career may suffer. This is an
to become aware of background thoughts or meta- example of perceptual conflict. MOL has as its
cognitions. Timothy A. Carey learned of Powers’s primary purpose the resolution of perceptual con-
work and, between 2002 and 2007, with mentor- flict. In PCT, Powers proposes a learning mecha-
ing from Powers, developed MOL in the National nism that is so fundamental that it, itself, does not
Health Service in Scotland as a complete psycho- have to be learned. Reorganization involves ran-
logical therapy. He evaluated its impact and dom changes and error reduction. When the sys-
trained colleagues in its use. Warren Mansell, a tem experiences chronic, intrinsic error, random
clinical psychologist, researcher, and academic changes are generated. If a change reduces error,
from the University of Manchester, learned about then that change persists until error increases once
this approach and, along with his colleague Sara again. If the change does not reduce error, then
Tai, began conducting further research and teach- another random change occurs. Control, therefore,
ing perceptual control theory (PCT) and MOL to is the state of normal daily functioning; perceptual
their undergraduate and graduate students. conflict disrupts this process, and reorganization
restores it.
Techniques
PCT provides the theoretical underpinnings for
MOL. PCT is an explanation for the way in which Attitudes and principles are emphasized in MOL
the phenomenon of control functions in living over specific techniques. The primary resource for
things. The formal definition of control is quite an MOL therapist is to adopt an attitudinal stance
similar to the colloquial understanding of “making of nonassuming curiosity. At all times, the task is
things be right.” A single cell, if it is to survive, must to help the distressed person explore his or her
be able to act on its external environment to ensure distress in such a way that the distressed person
that its internal environment is maintained in its reorganizes the conflict satisfactorily. It is pro-
“right” state. For people to live contentedly, they posed that reorganization and awareness are
must have sufficient control to act on their environ- linked such that those experiences that are in
ments to experience them as they intend. Powers awareness indicate the control systems that will be
articulates a control system as the basic unit of reorganized. MOL, therefore, involves asking curi-
organization, and using this unit, he describes a ous questions about whatever it is the person
hierarchy of control systems that control increas- wants to speak about and then looking for clues as
ingly complex perceptions from intensities and to where the next most useful place might be to
sensations to programs and principles. direct the person’s attention. These clues come in
the form of “disruptions,” which are brief changes
in the person’s manner, behavior, or speech flow.
Major Concepts
The person might pause, look away, increase or
The major concepts in MOL are control, percep- decrease the volume of his or her voice, or speak
tual conflict, and reorganization. Control is a faster or slower. The person might grin slightly, or
dynamic, seamless process that is essential to life. the person’s eyes might mist with tears. All these
To live is to control. Control, then, provides a changes are indicators that the person may have
framework from which routine day-to-day func- become briefly aware of something that he or
tioning can be understood and also the way in she wasn’t thinking of before. The therapist, on
which this functioning can be disrupted. The main noticing these disruptions, directs the person’s
psychological way control is disrupted is when attention there.

648 Miller, Jean Baker
Therapeutic Process sequence of achievements, Jean Baker Miller

(1927–2006) may be remembered for the ways in
MOL is an iterative process of redirecting
which she related to the world. Her 1976 book
awareness to areas of experience that might, if
Toward a New Psychology of Women was the
reorganized, alter the nature of the conflict. There
foundation in which relational-cultural theory
are two main goals in MOL: (1) ask about the cur-
(RCT) was born and continues to be expanded
rent problem and (2) ask about disruptions. When
today. Her life work exemplified her belief that
an MOL therapist asks about a disruption, that
each life is shaped, transformed, and ultimately
becomes the new topic of conversation, and the
defined by relationships. Her lived experience is a
process of asking about the current topic and then
story of one growth-fostering relationship after
asking about disruptions begins again. Each MOL
another, each marking a milestone and creating the
session is regarded as a discreet, problem-solving
legacy of a woman whom many considered to be a
experience involving the redirecting of awareness
key relationship in their own lives.
to promote reorganization. In practice, systems are
Raised in poverty in the Bronx, New York,
developed so that people are able to book appoint-
Miller suffered several hardships from polio to the
ments at their own initiation to self-regulate the
Great Depression. In such difficult times, many
timing of their therapeutic process.
families saw the rise of hardworking women, the
Timothy A. Carey power of their nurturance, and, consequently, a
cultural push back against female empowerment.
See also Cognitive-Behavioral Therapy; Motivational As a child, Miller’s polio resulted in frequent visits
Interviewing; Person-Centered Counseling to the hospital, in which contact with two hard-
working nurses positively changed Miller’s view of
Further Readings working women. Because of the inspiration and
efforts from these two nurses and the tireless sup-
Carey, T. A. (2006). The method of levels: How to do port of her own mother, Miller began realizing the
psychotherapy without getting in the way. Hayward, power of supportive and fortifying relationships as
CA: Living Control Systems. a protection from trauma, illness, and hardship.
Carey, T. A. (2008). Hold that thought! Two steps to She also began to wonder about the cultural
effective counseling and psychotherapy with the paradox—the value of these strong women and the
method of levels. Chapel Hill, NC: Newview.
marginalization they experienced. This influenced
Mansell, W., Carey, T. A., & Tai, S. J. (2012). A
her later position that such growth-fostering rela-
transdiagnostic approach to CBT using method of
tionships are central to lifelong resilience and that
levels therapy: Distinctive features. London, England:
the positive experiences in these relationships
Routledge.
encouraged her to take risks and explore opportu-
nities that she may not have considered possible.
When she began to conceptualize these relation-
MILAN SCHOOL OF SYSTEMIC ships within her work, she defined them as being
characterized by at least “five good things”:
FAMILY THERAPY
1. A sense of zest or energy for each of the people
See Systemic Family Therapy in the relationship
2. A sense of empowerment inspiring action on

behalf of self and others
MILLER, JEAN BAKER 3. A growing or greater clarity or understanding of
self, the others in the relationships, and
There is irony in praising a woman who fostered a relationships in general
movement resistant to the glorification of individ-
4. A greater sense of worth for all those in the
ual achievement; yet there is ample reason for
relationship
acknowledgment of her value and contribution to
be shared. Rather than reducing her life to a 5. A growing desire for more connection.

Miller, Jean Baker 649
Her story is a story of relationship, opportunity, shaping her goal of depathologizing women’s
and the willingness to take risks. Miller earned behavior and directly addressing the forces that
admission to Hunter College High School in New devalued the role of women. Through involvement
York City, a school for girls with exceptional abili- with women’s committees and private practice,
ties. During that time, she experienced another Miller began to develop theories regarding wom-
growth-fostering relationship with a teacher who en’s psychological and developmental strengths.
encouraged her to apply to Sarah Lawrence College Rather than regarding women’s relational behav-
in Bronxville, New York—something she believed iors as strengths, society views them as behaviors
to be out of reach for a girl of her means. After that are simply expected of women. Miller recog-
graduating from Sarah Lawrence College with a nized this lack of respect for women’s strengths
B.A. in personal communications, an experience and began to give the world a rational view of
rich with exposure to women who served as women.
advisors, mentors, and examples to her, Miller con- Her 1976 book Toward a New Psychology of
tinued her education. With the support and encour- Women, in which she formally introduced RCT,
agement of her mentors, Miller received a full was yet another example of risk taking that
scholarship to Columbia University in New York stemmed from the encouragement of a growth-
City, earning a doctorate in psychiatry in 1952. fostering relationship (with writer Anne Bernays)
During her time at Columbia, she developed a and Miller’s willingness to face her own self-
powerful commitment to social justice and became limiting belief of not being capable of writing a
part of a student advocacy group focused on book. Rather than emphasize independence and
equity in health care and national health insurance. competition, Miller understood that growth-
An interesting twist occurred when the dean of the fostering relationships, such as so many she herself
medical school deemed participation in the student experienced, encouraged people to take risks and
advocacy group to be risky and insisted that Miller explore opportunities. Miller expanded this theory
drop out of the group or risk losing her scholar- through her work as a clinician and a scholar on
ship. Faced with the decision, Miller’s commitment both a therapeutic and a societal level. The theory
to social justice reigned, and she lost her scholar- reminds clinicians to work to build a better con-
ship. Despite this disillusioning experience, Miller nection with the client rather than attempt to inter-
once again rallied against injustice and completed pret or analyze what the client is saying. Because
her degree in 1952. A few years later, in 1955, she relationships are the central need in human life,
married Mike Miller, a sociologist and economist RCT posits that all problems develop through rela-
with whom she shared a passion for social justice. tional disconnection within cultural contexts.
His family’s economic hardships inspired his polit- Compared with traditional psychotherapy tech-
ical consciousness and work for social justice. niques, Miller believed that connecting with
Collectively, the couple worked to end the devalu- clients—and helping them foster more meaningful
ing of women and marginalized groups, believing connections in their lives—was far more useful.
that the dominant groups in society legitimized In 1986, Miller began to direct the Elizabeth
unequal relationships. The couple had two chil- Stone Center for Developmental Services and
dren while embarking on a shared mission to end Studies, a part of Wellesley College in Massachusetts
social injustice by creating a society that fostered that worked closely with Stone House, an alterna-
the growth of all people. Their relationship served tive to hospitals, serving people who would have
as an energizing force for both of them, but it also traditionally been sent to psychiatric wards. The
taught Miller about the overwhelming demands center was also the institutional home for Miller
and complicated choices women had to make if and fellow psychologists to initiate and expand
they wanted both a career and a family. She their collaborative theory-building group, focusing
described these as both forced choices and false on a new model for women’s psychology. The
choices that often devalued the relational work of group had a commitment to an evolving approach
women. in theory building. Before relinquishing responsi-
Miller was first introduced to The Feminine bilities as director of the center, Miller established
Mystique by Betty Friedman in the early 1960s, the Colloquium Series. Ideas about women’s psy-
sparking her interest in women’s psychology and chological experiences were regularly exchanged,

650 Miller, William R.
attracting audiences of up to 800 people and

resulting in the publication of several papers on MILLER, WILLIAM R.
theoretical issues. No longer being director of the
center, Miller was able to focus on education and William R. Miller (1947– ), along with Stephen
on formulating the RCT model. Rollnick, founded the counseling approach known
As part of the Stone Center, the Jean Baker Miller as motivational interviewing. Its development can
Training Institute was created to honor Miller and be traced to Miller’s work in 1975 to 1976 at a
to train people in the relational-cultural approach in summer internship in a Veterans Administration
psychotherapy. The institute continues its work hospital, where he worked with patients suffering
today by providing training and resources to clini- from alcoholism. Still interested in working with
cians, practitioners, scholars, activists, educators, addiction, after graduating with his Ph.D. in clini-
health care providers, business professionals, lead- cal psychology from the University of Oregon in
ers, and more. Miller died in 2006, but her vision of 1976, he accepted a faculty position at the
growing by supporting the growth of others contin- University of New Mexico. In 1982, Miller spent
ues to live on. Her message of hope inspires us to live 6 months on a sabbatical in Norway, where he
a life in connection. Many of the published biogra- worked with new psychologists, helping them
phies of Miller have been written by those who develop therapeutic skills with difficult clients.
shared in growth-fostering relationships with her Miller, who had been working from a modified
and seem to honor the work of Miller as a legacy of client-centered perspective, found his supervisees
connection. She has been consistently described as a to be engaged and interested in hearing more
woman whose life and work exemplified the power about his clinical approach. To clarify his own
of hope through relationships. thinking about his approach and to help the young
clinicians understand his clinical methods, Miller
Deborah C. Sturm began to piece together some of his guiding clinical
principles. He labeled his approach “motivational
See also Cross-Cultural Counseling Theory; Feminist interviewing” and distributed what he had put
Therapy; Relational-Cultural Theory
together to his group. Notably, he found that when
conducting an interview, he was helping the
Further Readings patients make their own argument for change. He
had no intention of publishing these notes, but in
Hartling, L. M. (2008). Jean Baker Miller: Living in response to a request from a friend, he developed
connection. Feminism & Psychology, 18, 326–335. an article manuscript, which was eventually
doi:10.1177/0959353508092085 published in the British journal Behavioural
Miller, J. B. (1976). Toward a new psychology of women. Psychotherapy. He acknowledges that he thought
Boston, MA: Beacon Press.
nothing more would come of it. Several years later,
National Library of Medicine. (n.d.). Changing the face
Steve Rollnick, a psychologist in Australia, read
of medicine: Dr. Jean Baker Miller. Retrieved from
the publication, and after some years, when Miller
http://www.nlm.nih.gov/changingthefaceofmedicine/
visited Australia, the two met to talk about some
physicians/biography_225.html
Pearce, J. (2006, August 17). Jean Baker Miller, 78,
of Miller’s ideas. Their discussion eventually led to
Psychiatrist, is dead. The New York Times. Retrieved
the publication of Motivational Interviewing:
from http://www.nytimes.com/2006/08/08/us/08miller Preparing People to Change in 1991.
.html?_r=0 The first edition outlined the basic tenets of
Walker, M., & Rosen, W. B. (2004). How connections motivational interviewing, emphasizing the role of
heal: Stories from relational cultural therapy. Wellesley, ambivalence in change and how to help clients
MA: Guilford Press. make a commitment to change. It also outlined the
Wellesley Centers for Women. (n.d.). Jean Baker active ingredients of effective counseling, which
Miller, M.D.: Noted feminist, psychoanalyst, social included feedback, responsibility, advice, menus,
activist 1927–2006. Retrieved from http://www empathic listening, and self-efficacy. These ingredi-
.wcwonline.org/Inactive-Researchers/jean-baker- ents combined with the five general principles of
miller-md motivational interviewing (expressing empathy,

Miller, William R. 651
developing discrepancy, avoiding argumentation, between where they are and where they want to
rolling with resistance, and supporting self- be), and the importance of change talk. In this edi-
efficacy), which constituted much of the early tion, Miller and Rollnick defined motivational
approach to motivational interviewing. Moti- interviewing as a client-centered, directive method
vational interviewing could be characterized at this for enhancing intrinsic motivation to change by
stage as a person-centered approach that empha- exploring and resolving ambivalence. Another
sized avoiding generating client resistance while important addition was the concept of the motiva-
helping clients explore the discrepancy between tional interviewing spirit, which included a belief
their values and their behaviors. in collaboration, evocation, and autonomy. It
The first edition of Motivational Interviewing seemed clear in the second edition that Miller and
was oriented toward providing a model that could Rollnick’s description of motivational interviewing
be used with addictive disorders. Given its focus was evolving from a prescriptive approach to a
on client ambivalence, working with client resis- more conceptual one. Reflecting this more general
tance, and developing a commitment to change in use of motivational interviewing in the second edi-
clients, it was a good fit for working with addicted tion, Miller and Rollnick moved away from chap-
clients. It also fit nicely with James Prochaska’s ters describing the types of specific motivational
emerging Transtheoretical Model of behavior interviewing interventions and focused more on
change and its emphasis on the different stages of motivational interviewing applications in a variety
motivation. Many of the motivational interviewing of settings. Last, they added a review of research
principles, such as developing discrepancy and on motivational interviewing, providing evidence
rolling with resistance, appealed to counselors that motivational interviewing had superior effects
working with addicted clients in the early stages of compared with no-treatment control groups.
change. Together, motivational interviewing and By the time the second edition of Motivational
the transtheoretical model provided an intuitively Interviewing was published, motivational inter-
appealing approach that was an alternative to the viewing was considered a cutting-edge approach to
more confrontational models for working with working with individuals who had addiction prob-
addicted clients. lems. Its popularity also spread to substance abuse
In 1993, Miller was one of the project directors prevention, with motivational interviewing being
for Project Match, a clinical study on addiction identified by the National Institute of Alcohol
treatment outcome, which at the time was the larg- Abuse and Alcoholism as a highly recommended,
est clinical trial ever conducted on therapeutic evidenced-based approach for dealing with college
outcomes. Motivational enhancement, a variation students having alcohol abuse problems.
of motivational interviewing, along with 12-step Motivational interviewing was also being used by
facilitation and cognitive-behavioral coping skills, counselors working with a variety of other health-
was one of the three approaches selected for the related problems and by counselors in correctional
research project. The research indicated that all settings. By 2002, in response to a growing need
three methods were effective in working with an for training in motivational interviewing, Miller
addicted population. The visibility of Project and his colleagues set up a program called
Match and the popularity of the manuals used for Motivational Interviewing Network of Trainers,
the three treatment methods exposed motivational which prepared more than 300 trainers.
interviewing to many counselors who had not been Motivational interviewing attracted an interna-
exposed to it before. tional audience, resulting in the first edition of
In 1992, the second edition of Motivational Motivational Interviewing being translated into
Interviewing was published. Although similar to Italian, German, Spanish, Portuguese, and Chinese.
the first edition, it focused less on addictive disor- During the years between the second edition of
ders and more on global behavior change. It also Motivational Interviewing and the publication of
placed more emphasis on having clients make the third edition in 2013, the influence of motiva-
changes and on rejecting the righting reflex (trying tional interviewing continued to grow. In that time,
to fix the problem for the client), developing dis- the number of trainers in the Motivational
crepancy (helping clients see their mismatch Interviewing Network of Trainers expanded from

652 Miller, William R.
300 in 2002 to more than 2,500 in 2013; 25,000 them respond to critics who have implied that the
articles cited motivational interviewing, including use of motivational interviewing approaches and
200 randomized clinical trials conducted on moti- strategies can be seen as manipulative. They
vational interviewing; and motivational interview- emphasize that it should be practiced in such a
ing was being taught in 45 languages. Of all the way that it “is done for and with someone, not on
counseling approaches to working with substance or to them” (Miller & Rollnick, 2013, p. 24).
use disorders, motivational interviewing has argu- For more than 30 years, Miller has strived to
ably the highest level of research support for its ensure that motivational interviewing has evolved
efficacy. The use of motivational interviewing has in response to outcome research and to counsel-
also expanded to working with other issues, ors’ experiences with this approach that began
including applications in public health, patient with a single modest article. His dedication to
compliance with medical treatment, and offender maintaining an open, scientific mind-set has con-
populations. In fact, motivational interviewing tributed to an evidence-based counseling style
appears to be applicable to any population or issue that has been widely accepted as an effective way
where reluctance to change might be a concern. It to work with the issue of substance abuse as well
could also be applicable to career counseling, as other health-related and mental health–related
school counseling, and a variety of mental health issues. The intuitive appeal of motivational inter-
issues in addition to substance use disorders. viewing, the positive tone of the method, and its
Results from the 200 randomized clinical trials effectiveness in evoking motivation in resistant
indicate that, as with research on many counseling populations make it likely that motivational
approaches, the outcome of motivational interview- interviewing will continue to make an important
ing studies was influenced by therapist characteris- contribution to the counseling profession for
tics more than the fidelity of the counselor to the years to come.
motivational interviewing approach. In addition,
Miller and Rollnick hypothesized that only a few Charles F. Gressard
motivational interviewing–inconsistent responses
(e.g., confrontive or directive statements that could See also Evidence-Based Psychotherapy; Palo Alto Group;
raise client defensiveness) may reduce the effect of Person-Centered Counseling; Rogers, Carl; Solution-
Focused Brief Therapy; Transtheoretical Model
using motivational interviewing, even when there
are many more motivational interviewing–consistent
responses. Last, they have found some strong indi- Further Readings
cators that the more a counselor can help a client
generate talk about making changes (change talk), Arkowitz, H., Westra, H. A., Miller, W. R., & Rollnick, S.
the more the client is likely to change. Although (2007). Motivational interviewing in the treatment of
psychological problems. New York, NY: Guilford
much has been learned, research on motivational
Press.
interviewing continues to be refined, and there is
Miller, W. R., & Rollnick, S. (2013). Motivational
still more to be discovered about this approach’s
interviewing: Helping people change (3rd ed.).
effectiveness.
New York, NY: Guilford Press.
In response to research that supported the role Miller, W. R., & Rose, G. S. (2009). Toward a theory of
of counselor characteristics in the effectiveness of motivational interviewing. American Psychologist,
motivational interviewing, Miller and Rollnick 64(6), 527–537. doi:10.1037/a0016830
placed even greater emphasis on the spirit of moti- Rollnick, S., Miller, W. R., & Butler, C. C. (2007).
vational interviewing in the third edition of Motivational interviewing in health care: Helping
Motivational Interviewing. Miller and Rollnick patients change behavior. New York, NY: Guilford
define the spirit of motivational interviewing as Press.
being the mind-set and the “heart-set” of the Rosengren, D. B. (2009). Building motivational
approach and identify four key elements: (1) part- interviewing skills: A practitioner workbook.
nership, (2) acceptance, (3) compassion, and New York, NY: Guilford Press.
(4) evocation. Identifying and emphasizing the Wagner, C. C., & Ingersoll, K. S. (2012). Motivational
spirit of motivational interviewing has also helped interviewing in groups. New York, NY: Guilford Press.

Mindfulness Techniques 653
commitment therapy, developed by Kelly Wilson,

MIND–BODY THERAPY Kirk Strosahl, and Steven Hayes. Mindfulness
techniques have been used to treat depression,
See Psychosocial Genomics anxiety, borderline personality disorder, eating
disorders, substance abuse, and posttraumatic stress
disorder. They have been used with children, adoles-
cents, adults, and the elderly; with individuals and
couples, and in group counseling.
MINDFULNESS TECHNIQUES
Mindfulness techniques include a variety of activi- Theoretical Underpinnings
ties designed to place counseling clients in full
Underlying the use of mindfulness and meditation in
contact with their experiencing. Mindfulness itself
the therapeutic context is the assumption that pain
has been described as a practice of offering one’s
is inevitable because every person will experience
full mental and sensory attention to what is
illness, loss, grief, and anxiety. However, those who
unfolding in the present moment both internally
make use of mindfulness techniques believe that the
(i.e., emotional, cognitive, and physical sensations)
source of such suffering arises from an inability to
as well as externally (i.e., relationally and in one’s
accept things as they are or reject what is unwanted.
physical environment). Additionally, this attention
Those who embrace mindfulness in their therapeutic
is placed within a basic attitude of nonjudgmental
work share the belief that suffering can be dimin-
acceptance and compassion for self and others.
ished by helping clients experience the world with
less judgment and greater acceptance. Mindfulness
activities in general, and meditation in particular, are
Historical Context
viewed as tools for building skill in accepting experi-
Mindfulness and mindfulness techniques, as they ences for what they are and reducing the tendency
are used in counseling practice today, were first to prize some experiences and to devalue others.
described by the Buddha more than 2,500 years The use of mindfulness techniques can be con-
ago. Although Sigmund Freud was unimpressed sidered to lie on a continuum from implicit to
with Buddhist psychology and meditation, later explicit. Implicit use of mindfulness techniques
psychoanalysts, such as Karen Horney, were describes the process by which the therapist uses
intrigued. For example, Horney communicated techniques to benefit the therapist’s own well-
regularly with Zen master D. T. Suzuki Roshi, and being and to enhance his or her own presence with
both Carl Jung (in 1949) and Eric Fromm, along clients. In contrast, explicit use of mindfulness
with Richard DeMartino (in 1960), coauthored describes a range of uses to address client difficul-
books with Roshi. However, it was Mark Epstein’s ties, from teaching clients to make use of mindful-
groundbreaking 1995 book Thoughts Without a ness techniques to implementing mindfulness and
Thinker: Psychotherapy From a Buddhist Perspective meditation within the therapeutic setting.
that initiated real interest in Buddhist psychology
among the more psychodynamically inclined practi-
tioners. In 1979, the biologist Jon Kabat-Zinn Major Concepts
developed a program for patients with chronic pain Underlying the practice of mindfulness are the foun-
and other difficult to treat medical conditions called dational qualities of awareness, present-moment
mindfulness-based stress reduction, which is now focus, and an accepting, nonjudgmental attitude, as
broadly used in hospitals and medical centers across well as the basic skills of noticing, labeling, leading
the United States and Europe. Mindfulness-based with curiosity, and offering compassion.
stress reduction later became the foundation for
mindfulness-based cognitive therapy, which in turn
Foundational Qualities
gave rise to a number of other mindfulness-based
therapies, such as dialectical behavioral therapy, Although mindfulness techniques are applied
developed by Marsha Linehan, and acceptance and broadly and used for a wide range of difficulties,

654 Mindfulness Techniques
all mindfulness techniques or activities have some approaching activities and people as if for the first
of the same foundational qualities: They feature time, leading with curiosity and avoiding judging
full awareness or attentiveness and a present- sensations, thoughts, emotions, or situations as
moment focus, and they offer a gentle and accept- positive or negative, rational or irrational. Instead,
ing (nonjudgmental) attitude that is applied to clients are asked to simply accept that the feeling,
whatever is noticed or to whatever that emerges. thought, or sensation has arisen, that it will change
The capacity to maintain focused attention on and then will eventually pass.
ever-shifting internal and external stimuli is known Finally, also in support of the nonjudgmental
as bare attention. attitude, mindfulness necessitates an attitude of
compassion directed at one’s self as well as toward
Basic Skills others. This aspect of mindfulness has been par-
ticularly key to the application of mindfulness in
The practice of mindfulness requires that the Western psychology to address low self-esteem,
practitioner gain four basic skills: (1) noticing, which is often seen in clients in the West.
(2) labeling, (3) leading with curiosity, and (4) offer-
ing compassion. To notice is to bring one’s attention
to what is unfolding within the mind and body. Techniques
These thoughts and sensations are observed both The application of mindfulness practice through
for how they are experienced and for how they mindfulness techniques can occur in a wide variety
change over time. Clients are invited to notice when of activities ranging from seated meditation, to
the mind has begun to wander, at which point the mindful eating, to walking and breathing. The fol-
client is asked to bring his or her thoughts back to lowing are some of the broadly used mindfulness
the present. Importantly, clients are asked to notice techniques.
and return their thoughts gently to a focal point
while avoiding being harsh with themselves.
Seated Meditation
Also important to all mindfulness techniques is
the practice of labeling thoughts and sensations as Seated meditation practices are similar in that
they arise from moment to moment. For example, the participant is seated, either on the floor or in a
while sitting, a client may notice a sensation of chair, in such a way that careful attention is given
discomfort in her knee, at which point she silently to both posture and awareness. The gaze is gener-
labels that sensation as “pain.” If the discomfort is ally focused about 5 feet in front of the participant,
followed by the intention to rub the knee, the forward and down, and should be gentle and not
intention is labeled “intending to rub my knee.” strained. The back is straight, and the chin is
Finally, the motions of lifting her arm, placing her tucked slightly, with the tongue resting lightly on
hand on her knee, and rubbing are all carefully the back of the front teeth. The jaw and shoulders
observed and labeled: “lifting my arm,” “placing are relaxed.
my hand,” and, finally, “rubbing my knee,” respec- Seated meditation may be placed in four primary
tively. Labeling can also be extended to outside categories: (1) concentration meditation, (2) guided
stimuli, such as “the phone ringing” or “a cricket meditation, (3) insight meditation, and (4) mindful-
chirping,” or to each step of everyday tasks, such as ness meditation. In concentration meditation, a
“placing toothpaste on the toothbrush.” The pur- word, sound, mantra, or physical object becomes
pose of labeling thoughts, feelings, sensations, and the focal point of attention. Practitioners often
movement is to remain in full contact with present- begin with these types of meditations to gain skill
moment experiencing while avoiding judgment of in focusing and maintaining attention. A guided
that experiencing. meditation, on the other hand, is one in which the
As an extension of a nonjudgmental attitude, meditator follows the live or recorded voice of
mindfulness techniques also foster a general dispo- another person, focusing on the imagery that is
sition of curiosity about what is happening in any described. This type of guided meditation fre-
given moment. Often referred to as beginner’s quently has a specific purpose in mind, such as
mind, clients are asked to engage mindfully by anxiety reduction, and can readily be done within

Mindfulness Techniques 655
group or individual counseling settings, or clients done while lying down, clients are directed to
can do guided meditations at home with record- focus concentration first on the top of the head
ings. Insight meditation is undertaken to glimpse and then move downward over the face, neck, and
into the nature of the mind itself. Finally, mindful- arms and eventually to the feet. Body scans can
ness meditation is one in which the client is encour- range from a few moments to 45 minutes and may
aged to notice the fullness of his or her experiences be self-guided or guided by a live or taped voice.
as he or she sits. All thoughts, feelings, and
sensations are noted, but none are given preference
Yoga
or judged negatively. As thoughts wander, the prac-
titioner gently notices and returns attention to The practice of yoga has also been used by a
present-moment experiencing. number of mindfulness-based and mindfulness-
influenced therapies. Yoga comprises a number of
physical postures. Clients are invited to give
Mindful Breathing focused attention to each posture and to the sensa-
Perhaps the most commonly used mindfulness tions and limitations within the body as each pos-
technique is the use of the breath as a focal point ture is executed. Clients’ movements are slow and
of mindfulness or meditation. In this technique, the careful, allowing the client to note shifts in their
client is asked to focus on the breath, though the capacity for stretching and holding postures over
directions for this attention may differ. For exam- time. Yoga is incorporated into mindfulness tech-
ple, clients may be asked to focus on the sensation niques to both enhance body awareness as well as
of the exhale only or on both the inhale and the encourage a nonjudgmental acceptance of the
exhale. body as it is.
Mindful Eating Walking Meditation

In this activity, clients are asked to examine Walking meditation is similar to a seated medi-
their food fully and deeply, first by looking care- tation except that the focus of the mind is shifted
fully at the color and texture of the food and then from the breath and passing thoughts and emotion
by noticing the aroma of the food and any nuances. to the sensations in the feet, legs, and ankles.
Clients are then asked to slowly place some of the Although there are a number of variations of walk-
food in their mouths, putting down their spoon or ing meditation, it begins by placing one’s hands
fork between bites. Clients are asked to feel the behind one’s back and setting one’s gaze forward
food in their mouths, notice the sensation of the and down. Walking meditations are generally done
texture, the temperature, and the flavors. Any at a slow and contemplative pace but can be done
nuances or changes in the food while chewing are at a more moderate or even fast pace to fit the
noted but not judged. Often clients are asked to needs of the client. Each step is taken with careful
consider the origins of the food, including the sun, attention to the sensations in the bottom of the foot
soil, and rain as well as the human beings who and the shift from the rear of the foot to the front.
helped nurture, cultivate, and prepare the food
before the participant began eating. Careful atten-
Therapeutic Process
tion is given to feelings of fullness as well as to any
urges to continue to eat even after feeling full. Many therapists are now teaching mindfulness
within individual or group therapy sessions. Time
in individual sessions may be set aside both at the
Body Scans
opening of the session and at the close of the ses-
Many authors note that it is possible to go sion to first bring presence to the session and finally
through an entire day without giving any thought to help clients carry over what was learned in the
or awareness to the physicality of the body; thus, session into day-to-day living. Group therapy may
body scans are designed to bring the participant in also begin or end with mindfulness techniques led
contact with the experience of the body. Frequently by the group leader.

656 Mindfulness-Based Cognitive Therapy
The essential therapeutic process of mindfulness depressive relapse. Since that time, it has been
techniques, whatever form they may take, is that adapted to meet the needs of those experiencing
the client first learns to be present, avoiding the anxiety, bipolar disorder, and some psychotic dis-
tendency to get lost in the past or to worry about orders. MBCT focuses on assisting clients in notic-
the future. The second step in the therapeutic pro- ing the transient nature of thoughts and feelings
cess is that clients are able to notice their thoughts and in being able to tolerate thoughts and feelings
and feelings with compassion while avoiding harsh as they arise.
self-judgments. Often this translates to less judg-
ment of others and of circumstances. Finally,
Historical Context
clients begin to develop greater flexibility in how
they respond to difficult situations because they Zindel Segal, Mark Williams, and John Teasdale
have developed skill in pausing and noticing adapted mindfulness-based stress reduction after
thoughts and feelings before acting on them. finding that it had success with depressed clients.
MBCT draws heavily from Buddhist principles of
Cherée F. Hammond mindfulness, as does mindfulness-based stress
reduction, and from Aaron Beck’s cognitive therapy
See also Acceptance and Commitment Group Therapy;
Acceptance and Commitment Therapy; Contemplative
and group therapy principles.
Psychotherapy; Dialectical Behavior Therapy;
Meditation; Mindfulness-Based Cognitive Therapy; Theoretical Underpinnings
Mindfulness-Based Stress Reduction
MBCT blends two primary theories: (1) cognitive
therapy and (2) mindfulness-based stress reduc-
Further Readings tion. Both mindfulness-based stress reduction and
Baer, R. (2011). Mindfulness-based treatment approaches: MBCT draw on the Buddhist philosophy of suffer-
Clinician’s guide to evidence base and applications. ing (dukkha). This notion stresses that suffering is
Boston, MA: Academic Press. a natural part of life but that the tendency to wish
Epstein, M. (1995). Thoughts without a thinker: for things to be different from how they are or
Psychotherapy from a Buddhist perspective. attempts to avoid inevitable difficulties amplify
New York, NY: Basic Books. suffering. Like cognitive therapy, MBCT attempts
Fromm, E., Suzuki, D. T., & De Martino, R. (1960). Zen to identify thoughts that result in disturbing feel-
Buddhism and psychoanalysis. New York, NY: ings and dysfunctional behaviors. However, unlike
Harper & Row. cognitive therapy, MBCT is not concerned with
Germer, C. K., Siegel, R. D., & Fulton, P. (2012). identifying distorted thoughts and then changing
Mindfulness and psychotherapy. New York, NY: those thoughts. Instead, MBCT focuses on assist-
Guilford Press. ing clients in noticing distressing thoughts and the
Linehan, M. (1993). Cognitive behavioral therapy for
transient nature of those thoughts and feelings
borderline personality disorder. New York, NY:
and, ultimately, being able to tolerate thoughts and
Guilford Press.
feelings as they arise.
Molino, A. (Ed.). (1998). The couch and the tree.
Counselors who make use of MBCT assert that
New York, NY: North Point Press.
sad feelings are a natural and inevitable part of
human life. However, for people who have expe-
rienced more than one major depressive episode,
MINDFULNESS-BASED COGNITIVE two primary processes are believed to contribute
to depression relapse. First, they have developed
THERAPY habits in which inevitable sad feelings are associ-
ated with depressive content. Second, they tend to
Adapted from Jon Kabat-Zinn’s mindfulness-based ruminate on that content with regret about the
stress reduction, mindfulness-based cognitive ther- past or worry about the future. Skills taught
apy (MBCT) was initially developed in the 1990s through MBCT are designed to help clients notice
to assist clients who were experiencing multiple and interrupt the process of evaluating thoughts,

Mindfulness-Based Cognitive Therapy 657
feelings, and experiences as “good” or “bad.” Techniques

Clients are then encouraged to notice how those
Many of the same mindfulness activities are
thoughts and feelings arise and pass away on
shared with mindfulness-based stress reduction,
their own.
including the raisin exercise, in which a raisin is
eaten slowly and mindfully, noting its color, tex-
Major Concepts ture, shape, aroma, and flavor. Body scans, yoga,
daily mindfulness activities, and a commitment to
Some concepts that are essential to MBCT include 45 minutes per day of formal meditation and
inviting the difficulties in, awareness of “autopi- 15 minutes per day of mindful activities of daily
lot,” kindness and self-compassion, and gathering living are all central to both MBCT and mindful-
the scattered mind. ness-based stress reduction. In addition, several
mindfulness techniques and activities have been
Inviting the Difficulties In developed specifically for MBCT, including the
3-minute breathing space activity, the pleasant
In MBCT, clients are encouraged to intention-
experiences calendar, the unpleasant experiences
ally call to mind their difficulties and to notice
calendar, and homework.
where in the body these difficulties are felt. As
temptations to ignore or push away these feelings
emerge, these temptations are noted and allowed Three-Minute Breathing Space
to pass. Clients are asked to be open and inviting The 3-minute breathing space activity is a three-
to whatever painful feelings begin to emerge while step mini-meditation used as a first mode of
maintaining an awareness of the breath. responding in challenging situations. In the first
step, participants are asked to bring awareness to
Awareness of Autopilot the current experience. The second step is to bring
the focus of attention onto the breath and its effect
Clients are taught to notice the ways in which on some aspect of the body. Finally, in Step 3, the
they respond automatically to events, thoughts, client is asked to expand attention to the body as
and feelings (“autopilot”) and how frequently they a whole while maintaining a sense of the breath.
act without awareness.
Pleasant Experiences Calendar

Kindness and Self-Compassion
The pleasant experiences calendar is an activity
Mindfulness is believed to include not only in which clients are asked to log at least one pleas-
moment-to-moment awareness but also the pres- ant event daily. The purpose is to draw attention to
ence of compassion that is offered to self and oth- pleasant events that might otherwise be missed and
ers. Consequently, clients are taught to engage in to help develop skill in noticing moment-to-
practices that cultivate self-compassion, and coun- moment experiencing.
selors are encouraged to create an environment of
compassion within the sessions.
Unpleasant Events Calendar
Like the pleasant experiences calendar, clients
Gathering the Scattered Mind
are asked to log daily events that are experienced
MBCT educates clients about the tendencies of as unpleasant, giving careful attention to thoughts,
the mind to try to figure out ways to reduce symp- feelings, and bodily sensations.
toms of anxiety or depression and how these ten-
dencies actually work to increase those symptoms,
Homework
often by triggering rumination and feelings of
aversion toward symptoms. Clients are taught to MBCT makes extensive use of homework,
anchor thoughts with focus on the breath while including a required 45 minutes per day of seated
allowing feelings to unfold as they are. meditation, 15 minutes per day of mindfulness

658 Mindfulness-Based Stress Reduction
activities, such as mindful dishwashing, and journ-

aling activities, such as the pleasant experiences MINDFULNESS-BASED STRESS
calendar. REDUCTION
Therapeutic Process Based in Buddhist philosophy, mindfulness-based
stress reduction (MBSR) is an 8-week structured
MBCT is a structured group program of eight, group program that was developed for medical
2-hour weekly sessions. Clients who seem to benefit patients with chronic pain, cancer, and other phys-
most from MBCT are those who have experienced ical difficulties to treat their physical health con-
three or more depressive relapses but are not cur- cerns. Since that time, MBSR has been used to treat
rently experiencing significant symptoms of depres- anxiety and depression as well as other mental
sion. The process begins with a preclass participant health symptoms and continues to be offered to
interview. In this initial interview, the counselor individuals with chronic pain and other physical
explores with the potential client the client’s hopes and mental health issues.
for the class and willingness to complete the assigned
homework. The counselor describes the process of
recurrent depression and how MBCT can help. Historical Context
The essential structure of each session is similar
MBSR arises out of Buddhist philosophy, particu-
in that sessions are opened with a mindfulness
larly the Buddhist practices of meditation and
activity and each session includes sitting medita-
mindfulness. Mindfulness is defined as the ongoing
tion, generally lengthening the sitting from one
cultivation of a nonjudgmental awareness and
session to the next. Each session also allows time
acceptance of the present moment. MBSR was
for clients to process their progress on homework
developed by Jon Kabat-Zinn, at the University of
assignments, including the challenges and successes
Massachusetts, in 1979 and became widely popu-
that were experienced.
larized by his book Full Catastrophe Living: Using
Cherée F. Hammond the Wisdom of Your Body and Mind to Face Stress,
Pain and Illness, written in 1990.
See also Cognitive-Behavioral Therapies: Overview;
Dialectical Behavior Therapy; Mindfulness Techniques;
Mindfulness-Based Stress Reduction Theoretical Underpinnings
Buddhist philosophy, and the Four Noble Truths in
Further Readings particular, provide the theoretical foundation for
MBSR. The first of these truths is that duhkha, or
Barnhofer, T., & Crane, C. (2009). Mindfulness-based
“suffering” (e.g., pain, illness, and aging), is inevi-
cognitive therapy for depression and suicidality. In F.
table. However, the second Noble Truth states that
Didonna & J. Kabat-Zinn (Eds.), Clinical handbook of
the true roots of human suffering arises from the
mindfulness (pp. 221–244). New York, NY: Springer.
wish that things be different from the way they are,
Fjorback, L. O., Arendt, M., Ornbol, E., Fink, P., &
Walach, H. (2011). Mindfulness-based stress reduction
from deep regret about how they have been, or
and mindfulness-based cognitive therapy: A systemic
from fear about the future, also described as desire
review of randomized controlled trials. Acta or craving. The third Noble Truth sheds light on
Psychiartrica Scandinavica, 124, 102–119. how people can reduce their suffering by accepting
doi:10.1111/j.1600-0447.2011.01704.x things as they are and by letting go of the need to
Segal, Z., Williams, M. G., & Teasdale, J. D. (2012). change things or to cling to things. The fourth
Mindfulness-based cognitive therapy for depression Noble Truth describes an ethical path of behavior
(2nd ed.). New York, NY: Guilford Press. that will help reduce suffering and bring liberation,
Williams, M., Teasdale, J., Segal, Z., & Kabat-Zinn, J. The Eightfold Path.
(2007). The mindful way through depression: Freeing Borrowing from the third Noble Truth, learning
yourself from chronic unhappiness. New York, NY: to accept things as they are with friendliness and
Guilford Press. curiosity rather than judgment and resistance,

Mindfulness-Based Stress Reduction 659
MBSR instructors teach participants to notice Techniques

what is unfolding within and around them and to
Some techniques often used in MBSR are the body
pause before responding. Through mindfulness
scan, practicing formal meditation, practicing
and meditation practice, participants reduce auto-
walking meditation, the raisin exercise, yoga, and
matic responding and become more flexible in dif-
homework.
ficult situations. In practice, this may include
approaching pain with curiosity by offering the
following questions: What is the feeling tone of Body Scan
this pain? Where is the pain most dense? As it radi- The body scan is an activity in which partici-
ates out, what is the periphery of this pain? Where pants focus on the sensations of the body, begin-
does it end? What is its texture? How does it ning at the top of the head and moving down to
change? the toes. The body scan is often practiced in a
reclined position but may be done while seated and
Major Concepts may be self-guided or guided by a live or recorded
voice.
Some of the major concepts of MBSR include the
breath as an ally, relationship with symptoms, and
mindfulness of daily life. Formal Meditation
Formal seated meditation is taught and prac-
The Breath as an Ally ticed within the weekly group sessions. Seated
meditation can be done in a chair, to accommodate
A central theme in MBSR is that through rigor- physical limitations, or on the floor on a medita-
ous practice of formal and informal mindfulness tion cushion. Meditations may be guided or have a
and meditation, the breath can be used as a focal focal point, such as the breath.
point and source of clarity and calm even in the
most difficult situations and with the most painful
of physical symptoms. Walking Meditation
Walking meditation is a practice of focused
Relationship With Symptoms attunement to the sensations of the feet, ankles,
and legs while walking. This practice can be
The MBSR program is less interested in prog- undertaken as a formal practice or while moving
ress or results, such as the reduction or elimina- from one activity of daily living to another and
tion of symptoms, and more interested in shifts in can be adjusted in pace to fit the needs of the
the relationship with those symptoms. The goal is participant.
for the client or patient to become less rejecting
toward the symptoms and more accepting of and
flexible with the arising and diminishing of The Raisin Exercise
symptoms. The raisin exercise is a signature MBSR activity
in which participants are asked to eat a raisin
Mindfulness of Daily Life mindfully, noticing its shape, texture, and aroma as
well as its flavor and texture in the mouth.
Participants are asked to bring present-moment
awareness to daily activities such as taking out
Yoga
the garbage, washing dishes, raking leaves, and
brushing one’s teeth. Careful present-moment Yoga is used to cultivate body awareness by
awareness is given to each aspect of the activity focusing attention on bodily sensations as the par-
while noting tendencies to prefer some experi- ticipant moves slowly and mindfully from one
ences over others. Participants are encouraged to posture to another. Careful attention is given to
return to the breath during everyday activities honoring physical limits. Clients are discouraged
and interactions. from striving to execute yoga poses that are more

660 Minuchin, Salvador
difficult than the client can safely or comfortably Kabat-Zinn, J. (1990). Full catastrophe living: Using the
execute. Striving to do poses that are unsafe or wisdom of your body and mind to face stress, pain
uncomfortable can happen when a client has not and illness. New York, NY: Dell.
fully accepted his or her level of physical fitness or Santorelli, S. (2000). Heal thyself: Lessons on mindfulness
flexibility or when he or she wishes them to be in medicine. Boston, MA: Harmony.
different from what they are. Stahl, R., & Goldstein, E. (2010). A mindfulness-based
stress reduction workbook. New York, NY:
New Harbinger.
Homework
All participants in the 8-week program are
required to commit to 45 minutes per day of
seated meditation. This meditation is sometimes MINUCHIN, SALVADOR
done to recordings made by the MBSR instructor
or may be done independently. Additionally, par- The life of Salvador Minuchin (1921– ) offers a
ticipants are asked to engage in a minimum of good example of the influence of family and social
15 minutes per day of mindful activity in their context in shaping individual identity—a central
day-to-day lives. tenet of his Structural Family Therapy model.
He was born in Argentina on October 13, 1921,
the first of three children, to a strict and fair father,
Therapeutic Process
who owned a small business, a protective mother,
This training program provides eight, 2.5- to who ran the household, and a large extended fam-
3-hour weekly sessions as well as an all-day inten- ily ensconced within a closely knit community of
sive retreat offered in Week 6. The session is gen- immigrant Russian Jews, which represented one
erally provided in a silent retreat format. quarter of the population of a small rural town.
Furthermore, extensive homework is required of Within this multilayered context, the young
all participants. Minuchin grew up as an Argentinean Jew, not only
Class sessions begin with education on mindful- embracing the Hispanic code of honor but also
ness and meditation, the rationale for the methods relying on his family and community for protec-
being used, advice on meditation at home, and tion from the anti-Semitic undertones of the host
opportunities for questions and answers. The culture—a complex experience that sensitized him
classes in Weeks 5 through 8 are experiential in to the workings of families and larger systems and
nature and offer opportunities for a wide range of to the need for interdependence, mutual loyalty,
meditation exercises and for participants to ask and social justice. He also experienced the impact
questions. The program is generally followed by a of socioeconomic changes on family life. When his
final interview, the purpose of which is to debrief father lost his business as a result of the Great
the client, to reinforce learning, and, occasionally, Depression and temporarily became an arriero,
to collect data for research purposes. herding horses across the plains, 9-year-old
Salvador contributed to the family’s subsistence by
Cherée F. Hammond
helping his mother sell produce. Later, when the
family business was rebuilt under the leadership of
Dialectical Behavior Therapy; Mindfulness Techniques; an uncle, the hierarchical arrangement of the
Mindfulness-Based Cognitive Therapy household shifted, as symbolized by the uncle
sitting at the head of the table during his visits.
Throughout the family’s financial ups and downs,
Further Readings Minuchin’s parents kept their commitment to the
Grossman, P., Niemann, L., Schmidt, S., & Walach, H. education of their children, and after finishing high
(2004). Mindfulness-based stress reduction and health school in 1940, their firstborn entered the school of
benefits a meta-analysis. Journal of Psychosomatic medicine. He was in his fourth year at the Universidad
Research, 57, 35–43. doi:10.1016/S0022- Nacional de Córdobawhen when a right-wing mili-
3999(03)00573-7 tary coup deposed the elected government and

Minuchin, Salvador 661
advanced over all aspects of the country’s life, includ- course of 8 years developed a theory of family func-
ing education. The universities, which for the previous tioning in underprivileged families and devised
quarter of the century had been run by an elected action-oriented techniques to help that population.
body including representatives of professors, students, Families of the Slums (1967) recounts the Wiltwyck
and alumni, were placed under the control of the experience and outlines the basic principles of what
state. An active participant in the student resistance, eventually became known as Structural Family
Minuchin spent 3 months in jail, his first encounter Therapy: Faulty family organization supports symp-
with institutionalized authority. Expelled from the tomatic behaviors, and the purpose of therapy is to
university and later readmitted, he graduated in 1946 disrupt dysfunctional family patterns and nurture
and prepared to practice as a pediatrician. However, healthier ones.
that same year, Juan Perón, a member of the military Minuchin’s reputation as a clinician grew, and in
junta, was elected president, and the political climate 1965, he was appointed director of the Philadelphia
once again became inhospitable to the young profes- Child Guidance Clinic, affiliated with the Children’s
sional. Meanwhile, events far away beckoned: The Hospital of Philadelphia and the University of
state of Israel was created and soon found itself at Pennsylvania. Despite the opposition of the local
war with its neighbors. In 1948, Minuchin left psychiatric establishment, Minuchin developed the
Argentina to join the Israeli army as a physician. clinic from a staff of fewer than a dozen into one of
After the war, Minuchin traveled to New York to the largest and most respected family therapy train-
train as a child psychiatrist. There he worked with ing centers in the world. Noting that the clinic’s
psychotic children at a hospital and in institutional clients were mostly African American or Latino
housing. He met and married Patricia Pittluck, a while the staff was primarily White, Minuchin
developmental psychologist, who in addition to recruited minority professionals, but even more
having her own academic career provided an significantly, he obtained a grant from the National
invaluable sounding board for her husband’s ideas. Institute of Mental Health to train paraprofessional
Back in Israel in 1951, Minuchin codirected five community leaders as therapists. Together with
residential institutions for disturbed children, most Braulio Montalvo and Jay Haley, whom he brought
of them Holocaust orphans and émigrés from Asia to Philadelphia, Minuchin created a training pro-
and the Middle East. The experience sharpened his gram based on live supervision of all sessions, a
understanding of cultural diversity and impressed method that helped the community workers trans-
on him the value of working therapeutically with form their spontaneous responses to clients into
groups rather than individuals. therapeutic interventions. The same inductive
Although the move to Israel was intended to be approach to training was utilized to shift the think-
permanent, within 3 years, the Minuchins, now new ing and practice of the clinic’s professionals from an
parents, returned to the United States. Attracted to individual to a family systems framework.
Harry Stack Sullivan’s interpersonal psychiatry, In 1975, 1 year after the publication of his book
Minuchin joined the William Alanson White Families and Family Therapy, Minuchin stepped
Institute to train as a psychoanalyst. But in 1957, he down as director and dedicated the next 8 years to
became the intake psychiatrist at the Wiltwyck teaching his model through the clinic’s Family
School for Boys, a residential school for troubled Therapy Training Center. The center’s in-house
youngsters, where he soon found out that long- training programs and Minuchin’s own national
term, interpretive techniques delivered in a pro- and international presentations attracted hundreds
tected environment did not help action-oriented of practitioners eager to learn “the steps of the
youths from the poor neighborhoods of New York dance,” captured by Minuchin and his disciple
City. With a small group of colleagues—Dick Charles Fishman in Family Therapy Techniques,
Auerswald, Charles King, Braulio Montalvo, and and by the early 1980s, Structural Family Therapy
Diana Rabinowitz—and a minimum of theory, was the most influential and widely practiced
Minuchin undertook to work with the young clients school of family therapy.
in the context of their families. The team installed a The clinic’s affiliation with the Children’s
one-way mirror, took turns learning from one Hospital of Philadelphia also made it possible
another how to interview families, and over the for Minuchin to study and treat the families of

662 Modern Analytic Group Therapy
children with asthma, diabetes, and anorexia. Another move, this time to Florida in 2004,
Research conducted at the hospital showed that slowed down but did not end Minuchin’s contribu-
maladaptive family patterns were partly to blame tions to the field of family therapy. He continued
for the course of the illness and that family therapy teaching and coauthored two more books: Assessing
helped the patients improve. Psychosomatic Families and Couples, with Michael Nichols and
Families, written with the pediatrician Lester Baker Wai-Yung Lee, and The Craft of Family Therapy,
and the researcher Bernice Rosman, discusses the with Michael Reiter and Charmaine Borda. In the
findings of this research and illustrates its thera- latter, published in 2013, Minuchin decries the cur-
peutic application with abundant clinical material. rent emphasis on theory in the training of family
After Minuchin left Philadelphia in 1983, he therapists and advocates for the inductive, experi-
spent 1 year consulting in England, and on his ential approach that he utilized in an informal
return to the United States, he founded his own cen- practicum for graduate students conducted at his
ter in New York, from where he continued teaching Florida home. His 92nd birthday found Salvador
and writing on families and family therapy. In Minuchin still invested in the future of family
Family Kaleidoscope, he analyzed the dynamics of therapy and faithful to the pedagogical principle,
violence and healing in clinical and legal cases, both first embraced more than 50 years ago at Wiltwyck,
contemporary and historical. Family Healing, coau- that the best learning comes from doing.
thored with Michael Nichols, blends vignettes from
Minuchin’s personal history with clinical cases to Jorge Colapinto
illustrate his understanding and treatment of families
See also Haley, Jay; Strategic Family Therapy; Structural
throughout various phases of family development. Family Therapy; Sullivan, Harry Stack
Institutionalizing Madness, with Joel Elizur, argues
for a family focus to counter the often dehumaniz-
ing nature of mental health service delivery. In Further Readings
Mastering Family Therapy, with his disciples Wai- Minuchin, P., Colapinto, J., & Minuchin, S. (1998).
Yung Lee and George Simon, Minuchin presents a Working with families of the poor. New York, NY:
model of supervision and training intent on expand- Guilford Press.
ing and diversifying therapists’ use of themselves as Minuchin, S. (1974). Families & family therapy.
instruments of change. Cambridge, MA: Harvard University Press.
The return to New York, where Minuchin’s Minuchin, S., & Fishman, H. C. (1981). Family therapy
career had started in institutional settings for mar- techniques. Cambridge, MA: Harvard University Press.
ginalized children, also renewed his commitment Minuchin, S., Montalvo, B., Guerney, B. G., Rosman,
to searching for ways to alleviate the plight of poor B. L., & Schumer, F. (1967). Families of the slums.
urban families caught in the net of well-intended New York, NY: Basic Books.
but unwittingly disempowering services. With the Minuchin, S., & Nichols, M. P. (1993). Family healing:
help of grants and a small group of collaborators, Tales of hope and renewal from family therapy.
Minuchin led multiyear projects to introduce New York, NY: Free Press.
family-friendly approaches in child welfare and Minuchin, S., Reiter, M., & Borda, C. (2013). The craft of
substance abuse programs. family therapy: Challenging certainties. New York,
In 1996, when Salvador Minuchin turned 75, he NY: Routledge.
and his wife, Patricia, left New York for Boston,
where their children and granddaughter lived.
There, through a contract with the Massachusetts
Department of Mental Health, Minuchin offered MODERN ANALYTIC GROUP THERAPY
live supervision and consultation to therapists who
provided home-based treatment to children and Modern psychoanalysis was developed by Hyman
their families. Both this work and the efforts at Spotnitz, M.D., and it is highly effective in the
system change pioneered earlier in New York are treatment of character problems that have their
featured in Working With Families of the Poor, origins in the early, preverbal period of human
which Minuchin coauthored with Patricia development. A distinguishing aspect of the modern
Minuchin and Jorge Colapinto. psychoanalysis method is the use of individual and

Modern Analytic Group Therapy 663
group treatment in combination. Typically, a the group member relates to the world around
patient participates in a weekly group as well as him or her. For example, if someone repeatedly
individual therapy. This makes for a powerful arrives late for group, the therapist may ask
therapeutic intervention because the report of about the lateness. If he or she replies from a
interpersonal issues in an individual can be brought reality perspective and says, “The train was late,”
to life in the group experience. the therapist may ask, “Was there an emotional
reason why you arrived late?” It is through this
process of investigation that the group members
Historical Context
begin to identify with one another, and their
Modern group analysis is an outgrowth of the pio- understanding of unconscious motivation deep-
neering work of Spotnitz, who developed the princi- ens. The leader encourages the development of a
ples of modern psychoanalysis in the 1950s. Spotnitz’s culture of curiosity and interest that slowly gets
work centered on creating a new psychotherapeutic established. The group members come to realize
method for the treatment of pre-oedipal disorders— that while the story of their lives outside the cir-
character problems like depression, which has its cle has meaning, the more important stories are
roots in the first days, weeks, and months of life, the ones unfolding in the room. The members
before children have language. Standard treatments engage in an ongoing study of each individual’s
at the time used language and interpretation to character in the service of helping participants
address events that shaped the character develop- achieve the goals they’ve identified for them-
ment of patients before they had language to describe selves. Attachments form, emotions can run high,
what affected them in their development. Unlike his and relationships in the group become increas-
classically trained analytic peers, who employed an ingly important. This allows one to experience
emotionally remote stance in relation to patients, issues in real time, unlike individual work, where
Spotnitz advocated the use of emotions induced in the patient reports on his or her difficulties.
the therapist as a guide for responding to patients. For most adults, there is some aspect of intimate
What was a unidirectional relationship became a life that is difficult to tolerate. Participants arrive in
cocreated experience with Spotnitz’s innovations. group with functional and dysfunctional methods
Spotnitz highlighted the power of group as a of relating that are learned in their formative years.
therapeutic method. Until then, group was seen as For example, patients often describe an unwilling-
a tool for socializing patients and, at best, a poor ness to deal with conflict and the feelings associ-
cousin to individual treatment. One of Spotnitz’s ated with such conflict, like frustration and anger.
students, Louis R. Ormont, expanded the theory By encouraging the expression of feeling and the
and practice of modern analytic group treatment building of relationships, and through analysis of
by placing emphasis on the group’s curative effect. resistances and transference, patients can begin to
Ormont emphasized the healing power of rela- understand how their early issues affect daily life.
tionships. In group, these relationships develop
member to member and member to leader.
Major Concepts
Based on some traditional psychoanalytical tech-
Therapeutic Underpinnings
niques as well as some modern contemporary psy-
The premise behind modern analytic group chodynamic approaches, the major concepts of
therapy is to encourage the group to establish a modern analytic group therapy include transference
safe environment in which the participants can and countertransference, search for understanding
take emotional chances. In this process, the and authenticity, self-feelings versus object feelings,
therapist wants to see how relationships get feelings versus states of mind, and resistance.
formed and maintained. As the group continues,
it is expected that some group members will
Transference and Countertransference
resist the group rules and group process. It is
through the analysis of resistance that the leader The emotional attitudes that a patient acquired
and the members get to know the struggles of early in life are directed at the therapist (the
each member, as resistance is a window into how transference) and may elicit a counterreaction

664 Modern Analytic Group Therapy
(countertransference) in the therapist. Transference resist treatment. This can occur in myriad ways,
is the key to understanding what the patient such as coming late to group, being hostile in
missed out on in his or her maturation and what group, withdrawing in group, or rejecting sugges-
is needed in the therapy for the patient to become tions by the therapist or the other group members.
a better integrated person. Countertransference One role of the therapist is to understand these
feelings can be used to craft therapeutic responses resistances and, in a timely fashion, explain them
that employ the therapist’s emotions in relation to the patient so that he or she can move beyond
to the patient’s needs. them and begin to work on underlying issues.
Search for Understanding and Authenticity Techniques

A well-functioning group engages all of the Some of the major techniques used by modern ana-
group members in the search for understanding lytic group therapists include being emotionally
and authenticity. The struggles and triumphs of life available, having the group offer emotional sup-
get lived openly through the group process, and port and helping the patient develop emotional
everyone benefits from the exposure. antibodies, joining, bridging, immediacy and inter-
personal availability, and interpreting transferences
Self-Feelings Versus Object Feelings and resistances.
Self-feelings—or feelings that begin with “I feel
. . . ”—include the following: frustration, sadness, Therapist Emotional Availability
anxiety, happiness, fear, shame, guilt, jealousy, The role of the therapist is to model emotional
hurt, envy, anger, and rage. Object feelings, or feel- availability so that all feelings are seen as welcome
ings directed toward another person, include love, and available to group members. The therapist
hate, affection, anger, and sexual excitement. does this by using listening skills, acceptance, and
empathy with the patients.
Feelings Versus States of Mind
Emotional Support and Emotional Antibodies
Whereas self-feelings and object feelings are all
considered “feelings,” states of mind include the fol- One goal of the group is to have members assist
lowing: disgusted, exhausted, identified, cautious, one another in learning how to manage their emo-
confused, suspicious, confident, mischievous, tions. Therapists can do this by offering support to
depressed, smug, overwhelmed, hopeful, surprised, the patients and by encouraging group members to
grateful, admiring, shocked, shy, bored, protective, offer support. For instance, in one group, Susan was
distraught, disappointed, and lost. For example, if attempting to develop a career as a choreographer,
someone says, “I feel disappointed in you,” he or she but she had little success at her auditions and so felt
is not actually talking about his or her feelings; that deeply rejected. The group members were devoted to
person is reporting a state of mind, usually with the seeing her succeed and supported and challenged her
intention of inducing guilt in and controlling the so that, in time, she became emotionally inoculated
other person. If the person says, “I’m hurt and fright- against the disorganizing effects of being turned
ened by what you said and angry with you for not down. Eventually, she developed emotional antibod-
considering me!” the communication is clear, and the ies that helped her contend with what was hampering
other person is in a better position to respond emo- her in attaining her goals, until one day, she got hired.
tionally. When someone says, “I’m frustrated,” he or
she is actually reporting on a condition; a more Joining
complete communication would be “I’m frustrated
(self-feeling) and angry with you (object feeling).” Modern analytic group therapy places an
emphasis on initially forming a therapeutic alli-
ance with patients, sometimes called joining.
Resistance
This is often done by allowing the patient to
When patients begin to get close to important, take the lead and to initially practice a high
yet painful, issues, they will often find ways to degree reflection of what the client is saying. The

Modern Analytic Group Therapy 665
goal is to be experienced as a nonintrusive entity and goals of the members so that they might be
entering the patient’s world. addressed in a new way, on an emotional level that
leads to personality integration. The method is not
Bridging so much about explanation as it is about explora-
tion. The group is devoted to helping members
Bridging is the process of connecting members achieve the goals they’ve identified for themselves
to one another. Relationships start to flow across (e.g., “I want to get married,” “I want to get a
the room as people make connections in a positive new job”).
and negative union. Everyone talks and contrib- As the group continues, resistances can be
utes, and no one gets overlooked. Patients have an explored, and patients can begin to examine their
opportunity to improve their relationship skills by fears about being a member of the group—a mem-
working horizontally, member to member, and ber who can freely express his or her feelings in
vertically, member to leader. healthy ways. Soon, transference issues are
explored. In this process, patients find aspects of
Immediacy and Interpersonal Availability their siblings, coworkers, parents, and supervisors
in the character of their fellow group members and
For group treatment to succeed, the members
the group leader. Through this process, they can
must be helped to live and communicate, in the
better understand why these people are able to
moment, with their feelings and to engage the
elicit such strong reactions in them. It then becomes
other person in a progressive communication
possible to experiment with new behaviors and
process.
new ways of communicating and relating.
As group continues, there is a unique opportu-
Interpreting Transferences and Resistance nity to help patients become better acquainted
For patients to move more deeply into an under- with the full spectrum of emotions and learn how
standing of their issues, the therapist needs to to best utilize feelings in relationship with other
interpret or explain a patient’s transferences and people. Here, the leader encourages immediacy
resistances to him or her. This must be done only and emotional availability on the part of the group
when the patient is able to hear such interpretations. members and offers emotional support to the
clients. Group then moves toward a new phase
where new ways of relating are attempted in the
Therapeutic Process
face of emotionally laden material. As a group
Prior to the beginning of the group, a screening member takes on these challenges and makes the
interview ensures that group members are appro- effort to stretch and flex in ways that were previ-
priate for the group. Generally, patients who are ously unknown, there is verbal recognition and
ready for group want to acquire a greater degree of reinforcement from the group.
emotional freedom and interpersonal availability, Over time, the voices of the group’s members
and they arrive in group curious about themselves begin to take up space in the mind of each member.
and their relationships. These voices, which are by and large nutritious,
Generally, a modern analytic group is of mixed replace the voices of negativity and doubt that
gender and meets once a week for 90 minutes. most patients arrive with. Sometimes called intro-
Prior to starting the group, a contract is estab- ject substitution, these newly incorporated voices
lished in which the group members commit to the contribute to the development of an insulation
following: arriving on time, eventually becoming barrier in each member. Harsh words, which once
active participants, maintaining confidentiality, might have elicited a reactive, disorganized
putting thoughts and feelings into words to avoid response, can now be considered and responded
acting out, working at understanding themselves to. In effect, the members develop an observing
and their relationships in the group, avoiding ego, which operates separately from the participat-
socializing outside the group with the other group ing ego, when confronted with emotionally charged
members, and paying the fee on time. experiences. From this position of engaged detach-
In the initial phase of treatment, the group pro- ment, the member can consider what he or she is
cess is dedicated to identifying the needs, wants, experiencing and formulate a response. Over time,

666 Morita Therapy
this ability develops into a very useful interper- hypochondriacal temperament or hypersensitivity
sonal skill that gets carried outside the group treat- to symptoms. Influenced by Zen Buddhism, though
ment room to enrich the member’s life at home, at not considered a religiously based therapy, and
work, and in the community at large. similar in philosophy to third-wave cognitive-
behavioral approaches (e.g., dialectical behavior
Elliot M. Zeisel therapy, mindfulness-based cognitive therapy, and
acceptance and commitment therapy), Morita
See also Cognitive-Behavioral Group Therapy; Emotion-
Focused Therapy; Object Relations Theory;
therapy employs psychoeducation, journaling, and
Psychodynamic Group Psychotherapy experiential learning in naturalized contexts to
promote coexistence with distressing thoughts and
feelings, and purpose-driven actions.
Further Readings
Furgeri, L. (Ed.). (2001). The technique of group Historical Context
treatment: The collected papers of Louis R.
Ormont, Ph.D. Madison, CT: Psychosocial Press. Morita therapy was developed in 1919 by Shoma
Grotjahn, M. (1977). The art and technique of analytic Morita, who served as the chairman of psychiatry
group therapy. New York, NY: Jason Aronson. at Jikei University School of Medicine, near
Ormont, L. (1992). The group therapy experience. Tokyo, Japan. Originally designed as a four-stage
New York, NY: St. Martin’s Press. treatment—(1) isolation and rest, (2) light activity
Rosenthal, L. (1987). Resolving resistances in group of daily-living occupational therapy, (3) strenuous
psychotherapy. Northvale, NJ: Jason Aronson. occupational therapy, and (4) complex activities
Spotnitz, H. (1976). Psychotherapy of pre-oedipal reintegrating patients into normalized occupa-
conditions. New York, NY: Jason Aronson. tional roles—Morita therapy was first practiced as
Zeisel, E. M. (2009). Affect education and the an inpatient residential intervention. It has since
development of the interpersonal ego in modern group evolved and is now frequently practiced in outpa-
analysis. International Journal of Group tient settings. Like other mindfulness-based
Psychotherapy, 59(3), 421–432. doi:10.1521/ approaches, Morita therapy was designed to
ijgp.2009.59.3.421 address a specific disorder but has expanded its
Zeisel, E. M. (2012). Meeting maturational needs in application to address a wide range of human
modern group analysis: A schema for personality suffering and performance.
integration and interpersonal effectiveness. In
J. L. Kleinberg (Ed.), The Wiley-Blackwell handbook
of group psychotherapy (pp. 217–229). Chichester, Theoretical Underpinnings
England: Wiley.
Morita proposed that human behavior is influ-
enced by two often opposing drives: (1) a drive to
live fully and (2) a drive for security. He suggested
that feelings of anxiety and discomfort were a
MORITA THERAPY natural result of living and should not be targeted
as pathological. In fact, according to Morita, the
Morita therapy was originally developed to treat attempt to avoid feelings of anxiety or discomfort
shinkeishitsu, an anxiety neurosis, closely corre- creates a contradictory mental attitude toward life.
sponding with the Diagnostic and Statistical The neurotic fixation on avoiding distressing
Manual of Mental Disorders (fourth edition, text thoughts and feelings has the paradoxical effect of
revision) diagnosis for anxiety disorders (mainly exacerbating suffering and disrupting purposeful
social phobia, panic, obsessive-compulsive disor- actions. The goal of Morita therapy is to help
der, and generalized anxiety disorder), depression, people achieve arugamama, acceptance of life as it
and personality disorders, especially Cluster C is, while fully engaging in purposeful activities.
personality disorders (anxiety- or fear-related dis- Purpose is defined as both actions required to meet
orders). The core of these problems was seen by the needs of a given situation (i.e., basic daily roles,
Shoma Morita as arising from what he termed a tasks, and contextual demands) and what holds

Morita Therapy 667
value (i.e., an individual’s life purpose). Morita self-centered and problem-focused attention
noted the role of misdirected attention in main- associated with greater suffering.
taining a fixation on trying to control or avoid
distressing thoughts and feelings. Morita therapy
Coexisting With Unpleasant Internal Experience
employs attention exercises in which patients prac-
tice maintaining a moment-to-moment focus dur- An important skill for patients to cultivate is the
ing simple tasks and are asked to notice the impact capacity to coexist with unpleasant thoughts and
of occupational engagement on directing attention. feelings.
For example, a therapist might encourage a patient
to sweep the floor while maintaining attention on Arugamama
the moment-to-moment sensory experience of
each motion of the broom rather than on judg- A primary goal of Morita therapy is to help
ments about the adequacy of sweeping. Experiential patients achieve acceptance of life as it is, with the
exercises used by contemporary practitioners are understanding that living fully naturally includes
often designed to bring patients into contact with distressing thoughts and feelings.
their direct experience of the world as opposed to
their thoughts or feelings about that experience. Mindfulness and Skillful Attention
“Emotional problems” are considered problems
Major Concepts of misdirected attention.
The major concepts of Morita therapy include the
naturalness of internal experience, a de-emphasis Purpose-Directed Action
of symptom control, the paradoxical effect of con-
Success in Morita therapy is measured by prog-
trol efforts on private experiences, the relationship
ress toward achieving one’s purpose rather than
of self-centered attention and suffering, the impor-
symptom reduction.
tance of coexisting with unpleasant internal expe-
riences, arugamama, mindfulness and skillful use
of attention, and purpose-directed actions. Techniques
Techniques include both traditional stage-specific
Naturalness of Internal Experience interventions and interventions emphasized by
Thoughts, feelings, and body sensations are contemporary practitioners (i.e., metaphor, experi-
regarded as natural and are not targeted as patho- ential exercises, mindfulness practice, and pur-
logical. pose-centered activities within a patient’s normal
environmental context).
De-Emphasis of Symptom Control
Isolation and Rest
Purposeful behavior is emphasized, and symp-
tom control or elimination is de-emphasized. Stage 1 of traditional Morita therapy is intended
to bring the patient into direct contact with the
suffering related to attempts to control and avoid
Paradoxical Effect of Control Efforts anxiety and to elicit boredom, the first expression
Efforts to control or manipulate thoughts, feel- of the drive to live fully.
ings, or body sensations are thought to exacerbate
distress and suffering.
Journaling
During isolation, Morita encouraged patients
Self-Centered Attention and Suffering
to do limited journaling about their internal expe-
Efforts to “work on” distressing thoughts rience, providing them feedback as a means of
and feelings are thought to result in increasingly education and guidance.

668 Motivational Interviewing
Psychoeducation Further Readings

A basic overview of the principles and philoso- Fujita, C. (1986). Morita therapy: A psychotherapeutic
phy of this approach, traditionally a part of the system for neurosis. New York, NY: Igaku-Shoin.
isolation and rest phase, now often occurs in the Nakamura, K., Kitanishi, K., & Maruyama, S. (2010).
initial phase of outpatient treatment. Guidelines for practicing outpatient Morita therapy
(I. Ishiyama, Trans.). Tokyo, Japan: Japanese Society of
Morita Therapy.
Metaphor Spates, R. C., Tateno, A., Nakamura, K., Seim, R. W., &
Metaphor is often preferred to illustrate con- Sheerin, C. M. (2011). The experiential therapy of
cepts rather than purely conceptual, rule-based Shoma Morita: A comparison to contemporary
learning. cognitive behavioral therapies. Annals of
Psychotherapy and Integrative Health, 14, 14–25.
Occupational Engagement and

Experiential Exercises
Learning by doing is emphasized, and patients
are encouraged to confirm concepts through their
MOTIVATIONAL INTERVIEWING
own experience, often in the context of day-to-day
Motivational interviewing is a client-centered,
tasks.
goal-driven counseling approach widely used with
a variety of mental health conditions. Described
Purposeful Activity more as a way of being than a specific set of tech-
Patients are encouraged to focus their efforts on niques and interventions, motivational interview-
meeting the needs of the situation and on value- ing was originally developed in the 1980s as a
centered actions. treatment for individuals with drinking problems.
It has since undergone several phases of develop-
ment, all aimed at providing therapeutic condi-
Mindfulness Practice tions that stimulate intrinsic motivation for change.
Morita therapists employ a variety of atten- Motivational interviewing has a core goal of
tional practice methods in addition to acceptance, increasing the client’s own desire or motivation for
and outward-directed intentional actions. change, which is facilitated by exploring the rea-
sons why clients are resistant to change. The theory
posits that most people teeter between a desire to
Therapeutic Process change problematic behavior and a desire to con-
Contemporary Morita therapy in an outpatient tinue those problematic behaviors. Clinicians then
setting often lasts between 8 and 15 sessions. The use client ambivalence as a tool for helping clients
early sessions involve gathering information from move toward making changes that are congruent
the patient about his or her situation, psychoedu- with their own values and goals.
cation, and providing a general overview of the
treatment. The subsequent sessions often include
graded involvement in a patient’s identified pur- Historical Context
pose (e.g., cleaning the house, exercise, or social In the 1980s, William R. Miller originally devel-
engagement). The therapist works with the patient oped motivational interviewing as a treatment for
to apply Morita principles in achieving their problem drinkers. Through Miller’s own work
identified purpose. with clients and interns, he realized that the tradi-
tional confrontation style of therapy was less effec-
James F. Hill
tive in sustaining client change. The traditional
See also Acceptance and Commitment Therapy; confrontational model of treatment typically
Dialectical Behavior Therapy; Mindfulness-Based involved having clients label themselves (e.g., “I
Cognitive Therapy am an addict”), confronting client denial, and also

Motivational Interviewing 669
a more directive counseling style that puts the cli- interviewing that is seen as a normal occurrence in
nician as the expert who establishes goals that the clients. By focusing on the ambivalence about a
client should then work to accomplish. In the decision and not the decision itself, the clinician
1980s, Miller trained a group of counseling interns allows the client to come to his or her own deci-
in person-centered counseling and in how to help sion as opposed to leading the client toward one
clients establish intrinsic motivation for change in extreme. This also helps empower clients to rely on
the treatment of problem drinkers. This training their own ability to make the right decisions in
unintentionally sparked the beginnings of motiva- their lives.
tional interviewing, leading to a clinical trial that A cornerstone of motivational interviewing is
found Miller’s treatment approach effective in eliciting the client’s intrinsic motivations for
treating addiction. change. The motivational interviewer will help the
Since the 1980s, more than 200 studies have client explore both sides of his or her ambivalence
explored the effectiveness of motivational inter- about change to have the client identify the pros
viewing with a wide range of client issues. It is and cons of changing. This process is undergirded
classified as an evidenced-based practice by the by a neutral stance on the interviewer’s part, in
National Registry of Evidence-Based Programs which the interviewer avoids leaning toward either
and Practices, demonstrating its effectiveness as side of the client’s ambivalence. As clients begin to
supported by research. The most important find- crystallize their decisions, the interviewer will
ings show that the style of the clinician, specifically reflect and emphasize statements that embody
his or her use of empathy, is one of the most change talk in clients. Change talk is any client
important predictors of client change. For Miller dialogue that centers on their commitment to
and his colleagues, this is rooted in Carl Rogers’s change. Motivational interviewers spend a large
necessary and sufficient conditions for change. In portion of treatment time in supporting and work-
1989, Miller began collaborating with Stephen ing to draw out client change talk. This aspect is
Rollnick, which led to several manuscripts aimed more akin to a cognitive-behavioral perspective in
at making motivational interviewing applicable that the client is encouraged to consider his or her
and usable in health care settings. life circumstances and begin to develop change
Today, motivational interviewing has been strategies.
shown to be effective in treating substance abuse
disorders and a host of psychological and physio-
logical issues. There are no specific time frames Major Concepts
within which motivational interviewing should be Motivational interviewing draws on the principles
used because this approach is influenced by clients’ of person-centered counseling, developed by Carl
readiness for change. However, it can be used as a Rogers, and elements of the stages of change
brief intervention in settings that have a limited model, developed by James Prochaska, Carlo
time frame for services. DiClemente, and John Norcross. Key concepts
include expressing empathy, avoiding confronta-
tion, responding to client ambivalence, creating
discrepancies, and bolstering client self-efficacy.
The phenomenological perspective of the client is
valued in motivational interviewing, as in most of
Expressing Empathy
the existential-humanistic approaches in counsel-
ing. By taking time to understand the worldview, Empathy is the capacity to express understand-
experiences, and perspectives of the client, the ing of the perspectives, feelings, and experiences of
motivational interviewer effectively engages the another person. In motivational interviewing,
client and establishes a therapeutic alliance. empathy is an active therapeutic tool that allows
Through that alliance, the interviewer creates a clients to honestly explore their ambivalence to
safe, supportive atmosphere in which the client’s change. Through expressing empathy, a safe, non-
ambivalence about change can be explored. judgmental relationship develops between the
Ambivalence is a key construct in motivational client and the clinician, allowing for clients to feel

670 Motivational Interviewing
accepted. This acceptance, facilitated by a strong and their future goals. The focus of creating
therapeutic bond, augments the process of deep discrepancies is on the client’s personal goals and
exploration of problematic issues and experiences. not the clinician’s. In working to help clients
perceive the discrepancy, it is important that the
clinician is not coercive and does not pressure the
Ambivalence
client. This supports an underlying theme in moti-
A key concept in motivational interviewing is vational interviewing, that the change has to come
the belief that people often struggle when it comes from within the client for it to be successful and
to decision making and, at times, people are stuck sustainable.
between two different choices in their lives (e.g.,
having the desire to stop smoking marijuana but
Supporting Self-Efficacy
not wanting to let go of the feelings of relaxation
when it is used). Instead of focusing on the reasons This approach believes that the potential for
why the client should stop using marijuana, a clini- growth and change lies within the client; the clini-
cian using this approach would focus on the cli- cian is not an expert on the best ways for a client
ent’s ambivalence about making the decision to to change. Self-efficacy is the client’s belief in his
stop using marijuana. As clients lean toward one or her own capabilities. By rolling with resistance,
decision, they are often pulled toward the opposite avoiding confrontation, and expressing empathy,
extreme, which is the dilemma of ambivalence. clinicians effectively communicate to clients that
Much of the clinician’s work using this approach is the power is in the client’s hands. Clinicians
to help clients fully explore their options. encourage clients to formulate a variety of options
for change versus providing the client with ways
to change. In addition, clinicians take a strengths-
Avoiding Confrontation
based approach to empower clients by focusing
The creed of collaboration, not confrontation, on previous successes and personal strengths
is pervasive in motivational interviewing because exhibited by the client.
change is more likely to occur in a relationship
that is collaborative and egalitarian. The clinician
does not presume to know what is best for Techniques
the client, nor does he or she directly challenge the Motivational interviewing relies on a collaborative
client, as confrontation creates defensiveness in counseling style as opposed to using a series of
clients, which increases resistance. In this approach, techniques. The most commonly used strategies
resistance occurs when there is a conflict between are open-ended questions, affirmation, reflection,
the client’s and the clinician’s interpretation of the and summaries, creating the acronym OARS for
problem or solution. In those situations, the clini- the ways in which clinicians can respond to clients’
cian is encouraged to “roll with the client’s resis- desire to change.
tance.” Instead of directly challenging the client,
the clinician focuses on having the client define his
Open-Ended Questioning
or her understanding of the problem and identify
steps toward a resolution. Power struggles are The use of open-ended questions such as “Can
continuously avoided while being careful not to you tell me more about that” or “What about that
communicate approval of certain problematic experience struck you the most?” gives the clini-
behaviors. cian a clear picture of the client’s subjective experi-
ence and helps establish rapport. In addition,
open-ended questioning positions the client as the
Creating Discrepancies
source of expertise and knowledge on his or her
An important activity in motivational inter- life. Finally, the use of open-ended questions invites
viewing is increasing clients’ motivation for a deeper level of thinking and introspection on the
change, which is facilitated when clients become client’s part, thereby initiating talk about the
aware of a disparity between their current situation change process.

Motivational Interviewing 671
Affirmation Summaries
An additional way to build rapport is by using Last, clinicians use this special type of reflection
statements that recognize client strengths, or affir- to review what the client has said. Summaries can
mations. When using affirmations, clinicians be used at the end of a session to recap overarching
should be genuine, and the affirmation needs to be themes, or they can be used to make connections
appropriate for the context. Clinicians can affirm between sessions to highlight progress or change
the client’s step toward change, personal strengths, talk. They can also be utilized as a bridge from one
and also good intentions. A specific technique topic to another. Summaries facilitate rapport
called reframing involves offering a positive inter- building by communicating that the clinician has
pretation of a negative client statement. For exam- been listening, and they also help ensure that the
ple, the client says, “I’m a total failure. Despite my clinician understands the client’s perspective.
efforts, I’ve never been able to stay sober for more
than 3 months.” The clinician offers a reframe, “I
can hear your disappointment at your previous Therapeutic Process
tries, but I also hear that you were able to sustain The therapeutic process in motivational interviewing
periods of sobriety in the past.” The clinician in involves four overlapping processes. The first process,
this example not only highlights the client’s previ- called engaging, centers on building the therapeutic
ous success at sobriety but also changes the client’s alliance and establishing rapport. In this phase, the
label of “failure” to “try.” By using reframing, the clinician avoids common barriers to rapport building
clinician is affirming the client’s capability to such as advice giving, agreeing, or communicating
change. approval. Instead, the focus is on reflective listening
and affirming. The second process, focusing, estab-
lishes a clear direction or goal for therapy. This is an
Reflection ongoing, collaborative process between the client and
Reflection, or reflective listening, is arguably one the clinician that will identify a set of intended out-
of the most critical components of motivational comes, which will guide the remainder of counseling.
interviewing. Reflection involves the use of careful Evoking, the third process, is perhaps the most active.
active listening followed by the expression of accu- With the goals in mind, the clinician works toward
rate empathy. It serves to strengthen rapport as well eliciting the client’s motivations for change. The goal of
as reinforce clients’ talk about change. Three types this stage is to have clients voice their own reasons for
of refection are highlighted that focus on the cli- wanting to change. In the last process, planning, clients
ents’ dialogue about change: (1) simple reflection, are ready to act on their previous change talk. This
(2) amplified reflection, and (3) double-sided reflec- phase involves the development of a change plan that
tion. Simple reflection repeats what a client has said maps out a path to beginning and sustaining desired
in a neutral manner (e.g., “You feel overwhelmed change. Clinicians are warned that ambivalence about
by the idea of discontinuing your marijuana use”). change can happen at any stage in motivational inter-
Amplified reflection repeats what the client has viewing. Empathy, affirmation, and reflective listening
said in a way that intensifies or amplifies the cli- can be utilized throughout all stages.
ent’s ambivalence, thereby focusing on the change
LaShauna M. Dean
talk (e.g., “Being overwhelmed makes you think
you cannot change”). The last type of reflection, See also Miller, William R.; Person-Centered Counseling;
double-sided reflection, recognizes what the client Solution-Focused Brief Therapy
has said and also highlights previous statements the
client has made about change (e.g., “You recognize
that it may not be easy to stop using marijuana, but Further Readings
you also realize it’s important for you to stop”). Hettema, J., Steele, J., & Miller, W. R. (2005).
Regardless of the type of reflection used, the focus Motivational interviewing. Annual Review of Clinical
of using reflection is expressing empathy and Psychology, 1, 91–111. doi:10.1146/annurev.
encouraging change talk. clinpsy.1.102803.143833

672 Multigenerational Family Therapy
Miller, W. R., & Moyers, T. B. (2007). Eight stages in to the family rather than the family’s thoughts,
learning motivational interviewing. Journal of feelings, and emotions.
Teaching in the Addictions, 5(1), 3–17. doi:10.1300/ Multigenerational family therapy was the first
J188v05n01_02 theory to coin terms now commonly understood
Miller, W. R., & Rollnick, S. (2009). Ten things that and referenced in family systems theories, such as
motivational interviewing is not. Behavioural and triangles, sibling position, and differentiation.
Cognitive Psychotherapy, 37(2), 129–140. Multigenerational family therapy is more theoreti-
doi:10.1017/S1352465809005128 cal than application oriented; therefore, there are
Miller, W. R., & Rollnick, S. (2013). Motivational
few techniques but numerous concepts and tenets.
interviewing: Helping people change (3rd ed.).
New York, NY: Guildford Press.
Olmstead, T., Caroll, K. M., Canning-Ball, M., & Historical Context
Martino, S. (2011). Cost and cost-effectiveness of
three strategies for training clinicians in motivational
Bowen received his medical degree from the
interviewing. Drug and Alcohol Dependence, 116,
University of Tennessee Medical School in 1937
195–202. doi:10.1016/j.drugalcdep.2010.12.015 and continued his training in New York until
Passmore, J. (2011). Motivational interviewing 1941, when he began to serve in the army during
techniques: Reflective listening. The Coaching World War II. He was slated to begin a fellowship
Psychologist, 7(1), 50–53. in surgery at the Mayo Clinic at the completion of
Rollnick, S., Butler, C. C., Kinnersley, P., Gregory, J., & his service, but as a result of his experience during
Mash, B. (2010). Competent novice motivational the war, he developed an interest in psychiatry. In
interviewing. British Medical Journal, 340(7758), 1946, he started psychiatric training at the
1242–1245. doi:10.1136/bmj.c1900 Menninger Clinic Foundation. During this time, he
started to see problems with his psychoanalytical
training. Psychoanalytical theory does not include
families in the counseling session and seeks to
MOVEMENT THERAPIES understand a person’s dysfunction through investi-
gation of the unconscious. Bowen, however, sought
to understand the individual as part of a system,
See Dance Movement Therapy; Yoga which often meant including the family in the
Movement Therapy counseling session. Bowen also explored individual
dysfunction through investigation of the immedi-
ate family as well as previous generations of the
family. Bowen, along with his colleague Michael
MULTIGENERATIONAL FAMILY THERAPY Kerr, viewed the symbiotic familial relationships as
a biological and evolutionary process developed
With his experience as a psychiatrist, Murray through adaption and necessity, like those seen in
Bowen developed multigenerational family ther- nature, thus applying Charles Darwin’s theory of
apy to explain an individual’s dysfunction or evolution and adaption to family systems. It was
pathology with consideration to the individual’s these observations that led Bowen and Kerr to
family. The importance of the family was virtually develop a natural systems theory that sought to
not considered or understood prior to the develop- explain human behavior and interactions, called
ment of Bowen’s theory; thus, Bowenian family family systems theory and later called Bowenian
systems theory is considered a first-generation theory or multigenerational therapy.
family therapy theory. This theory seeks to under- In 1954, Bowen relocated to Maryland to work
stand how a family’s functioning affects the fami- on a research project at the National Institute of
ly’s individual members. Multigenerational therapy Mental Health (NIMH). At NIMH, Bowen and his
has Bowenian theory as its foundation and seeks to colleagues continued to expand on his theory.
identify how the family’s current dysfunction is a During this project, Bowen observed schizophrenic
result of generational patterns. The multigenera- patients and their families. This work solidified
tional family therapist focuses on the facts related Bowen’s belief that families were undeniably

Multigenerational Family Therapy 673
connected and could even be viewed as emotional children to save money, or a parent may limit the
units. Oftentimes it was observed that a schizo- amount of television a child views to encourage the
phrenic patient and the patient’s mother seemed to child to be physically active. The feeling system
be a cohesive complementary unit as opposed to (not to be confused with the emotional system) is
two separate individuals. It was also noted that the bridge between the two systems; it allows an
family relationship had a certain cycle, like those individual to connect reason to action. This can be
often seen in nature (e.g., tides), as the family observed when an individual explains his or her
would fluctuate in emotional closeness. Just as frustration to a partner in a calm manner or when
Darwin established a physical relationship between a parent grounds a child for calling him or her a
humans and other animals, Bowen established an name. Bowen hypothesized that it was the emo-
emotional relationship between family members. tional system that dictated most human actions
and behavior because it is so ingrained in our
instinctual nature. This default to the emotional
system then influences the interactions within a
There are several key assumptions within this the- family system.
ory on what helps dictate human interactions. First, This theory also provides insight into why peo-
humans, although intelligent and high-functioning ple who typically respond logically and thought-
beings, can behave in a manner still dictated by fully can suddenly react illogically and ignorantly
their primal instincts. This is evidenced by an indi- in stressful situations. In Bowenian theory, each
vidual’s selection of sexual mates. These instinctual system is understood and utilized through counsel-
drives can be contradictory, because people have an ing, as the thinking system can provide the indi-
instinctual desire to be independent and self-reliant vidual with greater understanding of a problem,
while also having an instinctual desire to be con- the emotional system can provide clues to instinc-
nected to or part of a community. tual reactions, and the feeling system can provide
The second assumption of the theory is the insight into upsetting patterns or situations.
belief that disturbances within an individual can The foundation of Bowenian theory is the
actually be caused by disturbances within the indi- understanding that a system, whether it be family,
vidual’s system and that changes within a system business, or community, is a unified emotional
are caused by individuals within the system. This unit. Each family system has developed ways of
can be seen by a child’s misbehavior being a result interacting that over time have become patterns;
of violence taking place between his or her parents, these patterns are often continued through several
or by a parent’s decision to no longer drink alcohol generations of a family. These patterns of interact-
resulting in changes for each member within the ing within a family become the stabilized norm or
family system. This intricate connection between homeostasis of the family. This homeostasis wields
the system and the individual is deeply ingrained in a powerful force for the system’s individuals and
Bowenian theory. can lead to the repetition of patterns that can be
Bowen additionally explained that each indi- helpful or harmful to a family system. These pat-
vidual has three distinctly separate systems that terns can often even extend into systems outside
ultimately guide human behavior: (1) the emotional the family.
system, (2) the intellectual system, and (3) the feel-
ing system. Each of these systems plays a part in
Major Concepts
the individual’s behavior and interactions. Bowen
believed that the emotional system consists of the Multigenerational family therapy has eight core
instinctual reactions each individual has as a result concepts. These core concepts are interconnected
of the evolutionary process. Examples of this cornerstones of Bowenian theory and, when com-
include exploding in anger during an argument bined, can illuminate a family system’s interac-
with a family member or a child running away tions. Each of these core concepts provides insight
from home due to anger or frustration. The intel- into the individual’s adaptive responses, which are
lectual system consists of the individual’s ability to developed naturally as a way to decrease tension
reason. For example, a family may delay having and anxiety while increasing functionality.

Differentiation of Self out stability by including a third member. This is

evidenced by a child being invited into an argu-
Differentiation of self is often acknowledged as
ment between his or her parents or an affair occur-
the most important or foundational concept in
ring outside a committed two-person relationship.
Bowen’s theory. Differentiation of self refers to the
This concept has become commonly known and
individual’s ability to remain autonomous while
acknowledged in family therapy. The addition of a
being part of a system. People who are highly dif-
third person allows the anxiety and focus to be
ferentiated are able to make decisions and act as
shared among three people as opposed to two; this
individuals, using their intellectual system to oper-
shift relieves some of the anxiety between the two
ate independently of their systemic relationships.
individuals. This can be seen as an adaptive
These individuals are likely to be self-aware and
response because it naturally occurs as a way to
possess the ability to regulate their own emotions.
relieve tension.
People with high levels of differentiation are able
to remain calm and respond thoughtfully when
people within the system become anxious or emo- Nuclear Family Emotional System
tionally agitated. These individuals are able to see This concept identifies four different mecha-
themselves as distinctly different and separate nisms that are used within a nuclear family:
from the system. (1) emotional distance, (2) marital conflict,
On the other end of the spectrum, people with (3) dysfunction in one spouse, and (4) transmission
low differentiation of self often make decisions of the problem to the child. Each of these mecha-
by using their emotional system. These individu- nisms is used throughout the relationship but espe-
als may lack an understanding of themselves and cially during times of stress to keep the family
effective coping skills, thus relying on others within its established level of functionality. A fam-
within the system to regulate their emotional ily may employ one or all of these mechanisms.
state. People with low differentiation are not Each mechanism often takes place within the
able to remain calm and often react emotionally parental relationship. It is believed that children
when others within the system become anxious often utilize the mechanisms their parents employed
or emotionally agitated. These individuals are within their nuclear family.
not able to understand where the system ends
and where the individual begins; the system and Emotional Distance
the individual are often fused together and thus
lack differentiation. Emotional distance occurs when an individual
Bowen identified an individual’s increased dif- within a relationship emotionally or physically
ferentiation of self as an important goal of therapy. distances himself or herself from the other indi-
He also believed that for counselors to be effective vidual, typically as result of deepened intimacy or
they must have high levels of differentiation from heightened stress. An example of this is when a
their own family. wife learns about another couple’s infidelity and
responds by distancing herself from her husband
to prevent similar pain of her own. This distance
Triangles can result in the formation of a triangle and addi-
Two-person relationships are common within tional distancing, such as if the wife’s husband
systems but are composed of constant shifts in begins an affair as a result of the wife’s emotional
intimacy, which ultimately result in instability distance.
within the relationship. When this two-person rela-
Martial Conflict
tionship becomes anxious or tenuous, the member
most uncomfortable with the anxiety will seek Marital conflict occurs when the partners within
relief by involving a third person. Bowen believed a relationship fluctuate between emotional close-
that the smallest stable relationship is a triangle ness and distance. Anxiety within the systems often
(three individuals), which often causes two-person results in anxiety within the relationship, thus
relationships to inadvertently or knowingly seek causing the martial relationship to shift. Martial

Multigenerational Family Therapy 675
conflict is best demonstrated when the partners hypothesizes that family interactions can be trans-
within the relationship blame one another for the mitted across generations. The patterns that often
anxiety or dysfunction. occur within a family can be repeated in the chil-
dren’s families and then transferred to their chil-
Dysfunction in One Spouse dren’s families, and so on. It has been noted that
Dysfunction in one spouse occurs within a this is often not noticed unless it is somewhat dys-
couple with little differentiation of self. One of the functional. This type of transmission is more likely
individuals in the relationship can be overly dys- to affect one sibling more than the others, just as in
functional, and the other individual responds the family projection process. Bowen also con-
overtly by taking control. As one member under- cluded that people often marry individuals with
performs, the other member overperforms. An similar levels of differentiation, which also leads to
example of this can be seen in a family where one continuation of the patterns across generations.
member is an alcoholic and thus another member
takes over the primary tasks in the family to keep Emotional Cutoff
the system functioning and keep attention off the
Emotional cutoff occurs in a family when an
alcoholic’s behavior.
individual within the system emotionally or physi-
cally separates himself or herself from the system.
Transmission of the Problem to the Child
This is often a result of low levels of differentiation
Transmission of the problem to the child occurs and can create the illusion of differentiation while
when the stress in the parental relationship results also leading to unhealthy relational patterns. An
in an increased focus on a child. This focus results example of this is when a son has an argument
in the projection of any systemic dysfunction onto with his father and as a result ceases all communi-
the child. In this case, the child’s misbehavior can cations and interactions with him, which would
become the focus of the parents’ concerns and likely alleviate some tension but does not resolve
efforts, and they may decide to seek counseling for the problem in a functional way.
the child’s problems instead of the family system as
a whole.
Sibling Position
This concept identifies the importance of a per-
Family Projection Process
son’s sibling position within the family and how
This concept addresses the unique relationship that position can assist or impede the person’s rela-
that can exist within a family when one child tionships in the future. This concept suggests that
becomes emotionally involved with one parent as a the sibling position of each partner might affect the
result of the parent’s level of differentiation and dynamic of the relationship. Partners who are both
stress. Typically, families with more stress and with the oldest child may experience some conflict due
parents with low levels of differentiation can pro- to the roles and expectations each of them experi-
duce this type of interaction. Parents simply project enced as the oldest child in their family of origin.
their own anxiety and stress onto one of their chil- Partners who were raised with different sibling
dren, which creates an alliance between that child positions, such as an oldest child in a relationship
and one of the parents. An example of this is when with a youngest child, may experience a more func-
a mother asks her son to sleep in the same bed with tional relationship due to previously established
her after she has separated from her partner. roles and functions in their family of origin.
Multigenerational Transmission Process Societal Emotional Process

The concept of multigenerational transmission This concept places importance on the influence
process has become a hallmark foundation of the environment can play on a family system, and
Bowen’s theory and is the reason why this theory is vice versa. Bowen believed that the society that a
often called multigenerational theory. This concept family was a part of could play a role in the family’s

level of differentiation and anxiety, while the level of this is when a therapist says, “You say you are
differentiation that occurs within families could also feeling closer and more connected, but you are sit-
affect the society around them. This concept ting across the room from one another.” This is
acknowledges that the family is guided by societal especially helpful to point out discrepancies
norms. For example, some cultures tend to have low between what the family says and how the family
levels of differentiation as a societal norm, and thus behaves. It is important not to state opinions or
low differentiation within this culture can be seen as interpretations during the session.
an adaptive response that allows the family to be
within the acceptable cultural and societal norms.
The Family Evaluation Interview
The therapist asks questions about the family’s
Techniques history, interactions, and behavior. This initial evalu-
Multigenerational family therapy is not a technique- ation is done with one, multiple, or all members of
driven theory; the majority of Bowen’s writings dis- the family. This type of fact-based questioning is used
cuss his theory and the major concepts that are throughout the therapeutic process to reveal family
foundational to the theory. There are some tech- interactions. Some questions that may be asked are
niques found in Bowen’s writings, but to practice “Who made the decision to come into counseling?”
family therapy the therapist must first understand the or “How do each of you handle stress?”
major concepts to help increase differentiation within
the family and reduce anxiety through increased “I-Statements”
awareness and the development of functional
patterns of interacting and communicating. To model emotional neutrality, which is the
result of a high level of differentiation, the thera-
pist uses “I-statements” such as “I notice that the
The Family Diagram mood in the room has changed.” The therapist also
The Family diagram (also called a genogram) is a encourages the family to use these “I-statements”
visual representation that documents the multigener- during their treatment. Emotional neutrality allows
ational family history; this diagram includes the rela- individuals to rely more on their thinking system
tional patterns and organizational structures found in than on their emotional system, which can result in
Bowen’s theory (e.g., triangles, emotional cutoffs, and families using more reason in interactions, thus
sibling positions). The genogram is developed during increasing functionality and differentiation. A fam-
family sessions to gather the family history, and it is ily member might be encouraged to say, “I feel hurt
used to inform the family and the therapist about the when you yell at me,” rather than stating, “You are
family’s patterns by calling attention to recurrences a terrible person who yells at everyone.”
through several generations.
Teaching the Family About Emotional Systems
Emotional Neutrality During the course of treatment multigenera-
The therapist is to remain emotionally neutral tional therapists teach the family about emotional
in the therapeutic process. Bowen believed that systems and how families contribute to dysfunc-
families with low levels of differentiation would tional patterns. This teaching is done subtly
unknowingly triangulate the therapist during the through modeling new approaches when the fam-
course of treatment, and the therapist must not ily is experiencing stress or anxiety, or more
allow his or her emotions to be involved in the directly through talking about observations when
treatment of the family. the family is calm.
Factual Statements Therapeutic Process

The therapist is also encouraged to make A multigenerational therapist does not attempt to
factual statements about the family. An example of make changes within the family but rather attempts

Multimodal Therapy 677
to evoke change by increasing awareness of family Kerr, M. E., & Bowen, M. (1988). Family evaluation.
processes among the family members. Furthermore, New York, NY: W. W. Norton.
change that is caused by a member outside the Papero, D. V. (1990). Bowen family systems theory.
family is not likely to be as impactful as change Boston, MA: Allyn & Bacon.
caused by a member within the system. The thera- Titelman, P. (Ed.). (1998). Clinical applications of Bowen
pist remains emotionally neutral, preventing any family systems theory. Binghamton, NY: Haworth
form of entanglement with the family. The thera- Press.
pist operates as an investigator by gathering infor- Toman, W. (1993). Family constellation: Its effects on
personality and social behavior (4th ed.). New York,
mation about the family. Through the use of family
NY: Springer.
diagrams and factual questioning, the therapist
Walsh, W. (1980). A primer of family therapy. Springfield,
starts to understand the family’s relational patterns.
IL: Charles C Thomas.
The therapist then determines how the family
members define their relationships, seeks clarifica-
tion for the roles, and teaches the family about
emotional systems and key patterns observed
within the family.
MULTIMODAL THERAPY
Through this process, the family ascertains the
events that led to relational changes or shifts in As a graduate student in the 1950s, Arnold Lazarus
the family. The identification of these events can broke away from his training in traditional psycho-
start a conversation about the family’s function- therapy. Despite favoring the nascent behavioral
ing and patterns. Through this process, the family movement, Lazarus soon realized that the narrow-
is made aware of its own interactions and pat- focused behavior therapy was too limited and
terns and may then seek to reduce anxiety by began developing cognitive-behavioral therapy,
making changes to the engrained patterns. broad-spectrum behavior therapy, and ultimately
Typically, the spousal members are recognized as multimodal therapy (MMT). Lazarus based MMT
the responsible members of the system, but this on his realization that seven transactional dimen-
therapy can be done with the entire family, one sions need to be addressed for therapy to be
member, or multiple members. optimally effective. Called the BASIC I.D., these
dimensions represent behavior, affect, sensation,
Amanda A. Brookshear imagery, cognition, interpersonal relationships, and
drugs/biological processes. Today, MMT is a com-
See also Bowen, Murray; Freudian Psychoanalysis; prehensive, biopsychosocial model of human func-
Strategic Family Therapy; Structural Family Therapy tioning as well as a paradigm of human personality
that is used around the world when working with
Further Readings a wide variety of clients.
Brown, F. H. (2006). Reweaving the family tapestry: A
multigenerational approach to families. New York, Historical Context
NY: W. W. Norton.
In the mid-1950s, when Lazarus was a graduate
Gilbert, R. M. (2004). The eight concepts of Bowen
theory: A new way of thinking about the individual
student in clinical psychology at the University of
and the group. Falls Church, VA: Leading Systems the Witwatersrand in Johannesburg, South Africa,
Press. he was drawn to a coterie of faculty members who
Guerin, P. J., Fogarty, T. F., Fay, L. F., Burden, S. L., & espoused conditioning therapy. They eschewed
Kautto, J. G. (1996). Working with relationship psychodynamic formulations in favor of a
triangles: The one-two-three of psychotherapy. New Pavlovian-based learning theory. The leader of this
York, NY: Guilford Press. group was a medical practitioner, Joseph Wolpe,
Hall, C. M. (1981). The Bowen family theory and its who developed systematic desensitization based on
uses. New York, NY: Jason Aronson. relaxation, assertiveness training, and aversive con-
Kerr, M. E. (1999). Murray Bowen, Bowen theory, and the ditioning, for clinical use. Lazarus was immediately
family movement. Family Systems Forum, 1(2), 5–7. enamored of this active approach, in contrast to

678 Multimodal Therapy
the psychoanalytical processes he had been taught. range of physiological and biological factors beyond
Wolpe became his mentor, chaired his doctoral dis- the use of substances, prescribed or otherwise. This
sertation, and supervised his assessment and treat- approach to assessment and therapy was termed
ment of several patients. In 1958, Lazarus coined multimodal therapy.
the terms behavior therapy and behavior therapist, While at Stanford University in 1963, Lazarus
which he felt were better than the conditioning was impressed by the work of Albert Bandura and
therapies, to separate their work from that of tra- often ascribed social and cognitive learning theory as
ditional psychotherapists. In 1966, he and Wolpe the theoretical framework on which MMT rests
coauthored a book, Behavior Therapy Techniques, because its tenets are open to verification or disproof.
a succinct account of this new approach. Instead of postulating putative unconscious forces,
Soon thereafter, Lazarus felt that Wolpe’s behav- social learning theory rests on testable factors (e.g.,
ioral model was too narrow and rigid and, at the modeling, observational learning, the acquisition of
very least, cognitive factors should be included, and expectancies, operant and respondent conditioning,
in 1971, he published what is arguably the first book and various self-regulatory mechanisms).
on cognitive-behavioral therapy, Behavior Therapy Nevertheless, irrespective of theoretical consider-
and Beyond. Lazarus drew a distinction between ations, a technically eclectic outlook is central and
“narrow-band behavior therapy” and “broad- pivotal to the MMT approach. Alternatively, theo-
spectrum behavior therapy.” When clinical follow- retical eclecticism, or attempts to integrate different
ups showed a higher relapse rate in patients who theories in the hope of producing a more robust
received narrow-band rather than broad-spectrum technique, is considered misguided. Therefore,
treatment, he developed a more detailed assessment while drawing on effective methods from any disci-
approach. Lazarus concluded that while many pline, the multimodal therapist does not embrace
systems tend to assess the usual “ABC” variables divergent theories but remains consistently within
(i.e., affect, behavior, and cognition), most of them social cognitive learning theory.
overlook or omit significant sensory, imagery, inter- To reiterate, MMT is predicated on the fact that
personal, and biological issues. As such, untreated human beings have BASIC I.D.s and thus calls the
excesses and deficits in these areas of human func- therapist’s attention to no less than these seven
tioning may leave clients vulnerable to backsliding. discrete but interactive modalities. Furthermore, in
In other words, therapeutic breadth is emphasized. addition to being a comprehensive biopsychosocial
He felt that it is necessary to provide a set of distinct assessment and treatment model, the BASIC I.D.
assessment procedures that facilitates treatment out- stands alone as a paradigm of human personality
come by shedding light on the interactive processes and functioning. With its emphasis on problem
that contribute to clients’ problems and by pinpoint- identification and, whenever possible, specifically
ing a selection of appropriate techniques and their tailored, empirically supported interventions,
best mode of implementation. MMT transcends standard psychiatric diagnoses
and nomenclature.
Lazarus hypothesized that most psychological Major Concepts
problems are multifaceted, multidetermined, and The primary concepts associated with MMT are
multilayered and that comprehensive therapy calls the already mentioned BASIC I.D., modality pro-
for a careful assessment of seven dimensions or files, the therapeutic relationship, and technical
“modalities” in which individuals operate: behav- eclecticism.
ior, affect, sensation, imagery, cognition, interper-
sonal relationships, and biological processes. Given
BASIC I.D.
that the most common biological intervention is the
use of psychotropic drugs, the first letters from the As previously discussed, the BASIC I.D. refers to
seven modalities can be combined to produce seven, reciprocally interactive dimensions of
the convenient acronym “BASIC I.D.”—although human psychology. In addition to serving as a
the “D” modality actually represents a complete comprehensive biopsychosocial assessment and

treatment template, the BASIC I.D. can stand alone profiles, and the Multimodal Life History
as a paradigm of human personality, functioning, Inventory (MLHI).
and phenomenology.
Bridging
Modality Profiles Simply put, bridging is a strategy whereby the
A modality profile is a list, or a matrix, of iden- therapist skillfully and in a nonconfrontational
tified problems across the BASIC I.D. and the best manner helps a client segue from one modality to
therapeutic interventions to address them. another. Employed by many experienced and
Whenever possible, MMT endeavors to use empir- effective therapists, bridging can readily be taught
ically supported and evidence-based treatments. to novices via the BASIC I.D. formulation. The
technique is best described through the use of an
example. Let’s say a therapist is interested in
The Therapeutic Relationship
assessing a client’s emotional response to an event.
While MMT looks to scientific evidence when The therapist might ask, “How did you feel when
available, it is far from a purely technique-driven your father yelled at you in front of your friends?”
approach. Indeed, for MMT, the therapeutic relation- Now suppose that instead of discussing his feel-
ship is the soil that enables the techniques to take ings, the client responds with a defensive and irrel-
root. Thus, a trusting and honest therapeutic evant intellectualization (e.g., “My dad had strange
connection—a good working alliance—is a corner- priorities, and even as a kid I used to question his
stone in the foundation of MMT. While the therapeutic judgment”). If additional probes into this client’s
relationship is regarded as the technique- enabling feelings yield only similar abstractions, it would
soil, MMT also recognizes that the therapeutic rela- likely be counterproductive to confront the client
tionship, per se, is usually insufficient to produce and point out that he is evading the question and
optimal outcomes. Indeed, an experienced multi- that he seems reluctant to face his true feelings.
modal therapist will often transition between degrees Instead, in situations of this kind, bridging is
of active-directive and supportive-nondirective inter- usually more effective.
vention, both within a given individual and across First, the therapist would deliberately attune to
clients in general. the client’s preferred modality, which in this case is
the cognitive domain. After a 5 to 10-minute dis-
course, the therapist would then endeavor to
Technical Eclecticism
branch off into other directions that seem more
Technical eclecticism is the practice of using a productive. For example, the therapist might say,
specific technique without necessarily agreeing “Tell me, while we have been discussing these mat-
with the theory that spawned it. In other words, ters, have you noticed any sensations anywhere in
techniques may work for reasons other than those your body?” This sudden switch from the cognitive
their originators believed and propounded. For modality to the sensory modality may then begin
example, a multimodal therapist might use the to elicit more pertinent information (given the
Gestalt empty chair technique for behavioral assumption that, in this instance, discussing sen-
rehearsal or assertiveness training rather than to sory accounts would likely be less threatening to
explore clients’ relationships with themselves. the client than discussing affective material).
What’s more, knowing precisely when and how to The client might respond to this question by
best use specific methods in a manner that is referring to some sensations of tension or bodily
uniquely suited to a given client is part of the discomfort—for instance, “My neck feels very
multimodal therapist’s artistry. tense”—at which point the therapist might ask
him to focus on the specific tension and discuss
any associated images and cognitions. The thera-
Techniques
pist might then venture to bridge into the affective
Common techniques used in MMT are bridging, domain by saying, “Beneath the sensations, can
tracking, second-order BASIC I.D., structural you find any strong feelings or emotions? Perhaps

680 Multimodal Therapy
they are there lurking in the background?” At this While tracking can be useful in uncovering
juncture, it would not be unusual for the client to fairly reliable patterns behind negative affective
give voice to his feelings. The client might say, “I reactions that clients find puzzling, it should not be
feel angry, and a little sad.” Thus, starting where assumed that these patterns are universal and that
the client is and then bridging into a different therapists can use the same treatment techniques,
modality often results in the client’s becoming will- in the same sequence, for all clients.
ing to traverse the more emotionally charged areas
he or she may have originally been avoiding.
Second Order BASIC I.D.
The initial BASIC I.D. is used to translate pre-
Tracking
senting complaints and vague, general, or diffuse
Tracking is a strategy that may be employed problems (e.g., “I feel depressed or anxious”) into
when clients are puzzled by affective reactions. For specific, discrete, and interactive difficulties, which
example, a client might say, “I don’t know why I can then be addressed with various techniques.
feel this way” or “I don’t know where these feel- Hence, the initial BASIC I.D. assessment, or modal-
ings are coming from.” The first step in tracking ity profile, provides a detailed, macroscopic picture
involves asking the client to recount the unpleasant of a client’s identified problems.
event or incident. In true multimodal form, the A second-order BASIC I.D. assessment takes an
client is then asked to consider what behaviors, item on the modality profile and “zooms in” to
affective responses, images, sensations, and cogni- examine it under a “higher magnification” by mak-
tions come to mind. As with bridging, this tech- ing a detailed inquiry into the associated behav-
nique is best described through the use of an iors, affective responses, sensory reactions, images,
example. Let’s say a therapist is working with a cognitions, interpersonal factors, and possible
client who reported having panic attacks “for no biological considerations associated with the prob-
apparent reason.” Working together, the therapist lem on the initial BASIC I.D. assessment. Second-
and the client were able to put together the order BASIC I.D. assessments are typically applied
following string of events. when therapy falters. When this occurs, a second-
The client had initially become aware that her order BASIC I.D. may help shed light on the situa-
heart was beating faster than usual (sensation). tion. This procedure can also help determine the
This brought to mind a memory of a time when she reasons behind factors such as noncompliance and
had passed out after drinking too much alcohol at poor progress.
a party (image).This memory still brought about a
strong sense of shame (affect). As such, the client
Structural Profiles
started believing that she would pass out again
(cognition), and as she dwelled on her sensations, Structural profiles are clients’ self-assessments
this cognition was intensified and culminated in her of their proclivities and their relative strengths and
panic attack. Thus, in this case, the client exhibited limitations across the BASIC I.D. Often using a
an S-I-A-C-S-C-A pattern (sensation–imagery– 7-point Likert-type scale, or any quantitative rat-
affect–cognition–sensation–cognition–affect). ing, clients rate themselves in terms of how behav-
Thereafter, the client was asked to note whether ioral, emotional, sensory, visual, thinking, social,
any subsequent anxiety or panic attacks followed a and physically/health oriented they are.
similar “firing order.” Subsequently, she confirmed This information is then used to determine inter-
that her two trigger points were usually in the sen- ventions of choice that are congruent with clients’
sory and imagery modalities. This alerted the thera- self-ratings of their preferred modalities. For exam-
pist to focus on sensory training techniques (e.g., ple, if one gives oneself a rating of 2 on imagery
diaphragmatic breathing and deep muscle relax- and a rating of 7 on cognition, it clues in the thera-
ation), followed immediately by imagery exercises pist that emphasizing visualization techniques
(e.g., the use of coping imagery and the selection might not be as useful as focusing on cognitive
of mental pictures that evoked profound feelings methods. Or if one’s structural profile indicates a
of calm). strong penchant for sensation and a low behavioral

inclination, sensory interventions might be initially (i.e., the impact that various behaviors have on the
prioritized over behavioral assignments. client’s affect, and vice versa).
To assess the client’s sensations, the therapist
might ask, “Are there any specific sensory com-
Multimodal Life History Inventory
plaints (e.g., tension, chronic pain, tremors)?” and
After conducting the initial interview, many “What positive sensations (e.g., visual, auditory,
multimodal therapists elect to have their clients tactile, olfactory, sensual, and/or gustatory) does
complete the MLHI. This 15-page questionnaire, the person report?” Or, staying with the notion
completed as a homework assignment, frequently that one must also assess the interactions among
facilitates treatment by providing a more com- modalities, the therapist might ask, “What feelings,
prehensive problem identification sequence to be thoughts, and behaviors are connected to these
derived than would typically be possible from the negative sensations?”
interview alone. The MLHI also generates a valu- To assess the client’s imagery, the clinician might
able perspective regarding a client’s style and ask, “What fantasies and images are predomi-
treatment expectations and is organized in a nant?” and “What is this client’s self-image?” The
manner that allows for easy determination of therapist might also assess for specific success or
specific excesses and deficits across a client’s failure images that the client holds and ask whether
BASIC I.D. Although clients with major psycho- the client experiences any negative or intrusive
logical problems may not comply, many outpa- images (e.g., flashbacks to unhappy or traumatic
tients who are reasonably motivated will find the experiences). As with the other modalities, the
exercise useful for speeding up routine history therapist might also assess how the client’s images
taking and readily providing the therapist with a are connected to ongoing cognitions, behaviors,
BASIC I.D. analysis. affective reactions, and so on.
To assess the client’s cognitions, the therapist
might ask, “Can we determine the client’s main
Therapeutic Process
attitudes, values, beliefs, and opinions?” and “Are
How does a therapist assess each of the BASIC I.D. there any definite dysfunctional beliefs or irratio-
modalities? In addition to, or in lieu of the MLHI, nal ideas?” Or the therapist might assess the
this is achieved through the use of a range of ques- client’s predominant “should statements” or try to
tions. For example, to assess the client’s behavior, detect any problematic automatic thoughts that
the therapist might ask, “What is this individual undermine his or her functioning.
doing that is getting in the way of his or her hap- To assess the client’s interpersonal functioning,
piness or personal fulfillment (self-defeating the therapist might ask, “Who are the significant
actions, maladaptive behaviors)?” or perhaps others in this client’s life?” or “What does this client
“What does the client need to increase and want, desire, expect, and receive from others, and
decrease?” or even “What should he or she stop what does he or she, in turn, give to and do for
doing and start doing?” them? The therapist might also ask, “What relation-
To assess the client’s affect, the clinician might ships give this particular client pleasure and pain?”
ask, “What emotions (affective reactions) are pre- Finally, to assess the client’s biological dimen-
dominant?” “Are we dealing with anger, anxiety, sion, the therapist might ask, “Is this client bio-
depression, or combinations thereof and, if so, to logically healthy and health conscious?” “Does he
what extent (e.g., irritation vs. rage, sadness vs. or she have any medical complaints or concerns?”
profound depression)?” The therapist might ask, “What relevant details pertain to diet, weight,
“What appears to generate these negative affects— sleep, exercise, alcohol, and drug use?” When there
certain cognitions, images, or interpersonal con- are any doubts, suspicions, or misgivings, the
flicts?” and “How does the person respond (behave) therapist refers the client to a medical practitioner.
when feeling a certain way?” In addition to assess- A client presenting for treatment may use one of
ing each modality separately, it is also important the seven modalities as his or her entry point, but
for the therapist to look for interactive processes it is more typical for people to enter into treatment
that occur between and among the modalities with problems in several modalities. The therapist

682 Multisystemic Therapy
initially engages the client by focusing on the Lazarus, A. A. (1989). The practice of multimodal
issues, modalities, and/or areas of concern that he therapy. Baltimore, MD: Johns Hopkins University
or she presents. Deflecting the emphasis too soon Press.
onto other matters that the therapist may deem Lazarus, A. A. (1992). Multimodal therapy: Technical
more important may make the client feel invali- eclecticism with minimal integration. In J. C. Norcross
dated. Once rapport has been established, how- & M. R. Goldfried (Eds.), Handbook of psychotherapy
ever, the therapist usually can easily shift to more integration (pp. 231–263). New York, NY: Basic
significant problems (i.e., bridging). Books.
Lazarus, A. A. (1993). Tailoring the therapeutic
The multimodal therapist will carefully note the
relationship or being an authentic chameleon.
specific modalities across the BASIC I.D. that are
Psychotherapy, 30, 404–407. doi:10.1037/0033-
being discussed, and which ones are omitted or
3204.30.3.404
glossed over. By thinking in BASIC I.D. terms, the
Lazarus, A. A. (1997). Brief but comprehensive psychotherapy:
therapist is apt to leave fewer important avenues The multimodal way. New York, NY: Springer.
unexplored. What’s more, given its all-inclusive Lazarus, A. A., Beutler, L. E., & Norcross, J. C. (1992).
and structured nature, even relatively novice ther- The future of technical eclecticism. Psychotherapy, 29,
apists can achieve a high degree of effectiveness by 11–20. doi:10.1037/0033-3204.29.1.11
using MMT. Lazarus, A. A., & Lazarus, C. N. (1991). Multimodal Life
Although MMT is an eclectic and flexible History Inventory. Champaign, IL: Research Press.
approach, in MMT the selection and development Lazarus, A. A., & Lazarus, C. N. (1998). Clinical
of specific techniques are not capricious. On the purposes of the Multimodal Life History Inventory. In
contrary, the position of MMT is that creative G. P. Koocher, J. C. Norcross, & S. S. Hill (Eds.),
eclecticism is warranted only when (a) manualized Psychologists’ desk reference (pp. 15–22). New York,
or empirically supported treatments do not exist NY: Oxford University Press.
for a particular disorder or (b) empirically sup- Lazarus, A. A., & Rego, S. A. (2013). What really matters:
ported treatments are not achieving the desired Learning from, not being limited by, empirically
results. Thus, when evidence-based treatments fail supported treatments. The Behavior Therapist, 16(3),
to be helpful, one may resort to less authenticated 67–69.
procedures or endeavor to develop new strategies. Lazarus, C. N. (1991). Conventional diagnostic
It must be emphasized, however, that a rag-tag nomenclature versus multimodal assessment.
combining of techniques without a sound rationale Psychological Reports, 68, 1363–1367. doi:10.2466/
will likely result only in syncretistic confusion. pr0.1991.68.3c.1363
Finally, although a modality profile may include
several identified problems, it is rarely necessary to
address each and every one in therapy. Because of
the reciprocal and interdependent nature of the MULTISYSTEMIC THERAPY
BASIC I.D. modalities, a positive ripple effect often
occurs. Thus, by resolving one or a few problem Multisystemic therapy(MST) is a structured treat-
areas, other problems that may not have been spe- ment that uses intensive, home-based family coun-
cifically worked on in treatment may also improve. seling as a method for treating youth with antisocial
behaviors. Rooted in social ecology theory, MST
Clifford N. Lazarus and Arnold A. Lazarus treats youth and their families in their natural envi-
ronments in the home, school, and community.
See also Behavioral Therapy; Cognitive-Behavioral Youth between the ages of 12 and 17 years at risk
Therapy; Eclecticism; Lazarus, Arnold of out-of-home placement, such as those involved in
the juvenile justice system or with child protective
services, are the focus of MST. MST utilizes nine
Further Readings guiding principles to develop specific assessment
Bandura, A. (1986). Social foundations of thought and and treatment formats. Interventions are developed
action: A social cognitive theory. Englewood Cliffs, jointly with the youth, family members, and school
NJ: Prentice Hall. or agency representatives. Clinicians generally

Multisystemic Therapy 683
provide treatment in the home; are on call 24 hours contributing factors, such as negative peers, and
a day, 7 days a week; and have a small caseload of designed to increase positive social (prosocial)
four to six clients for whom they provide multiple, behaviors and people within the youth’s ecology.
intensive family sessions within a week. Treatment Emphasis is placed on stopping cyclic reciprocal
lasts between 3 and 5 months. MST has been behavior, such as negative reinforcement occurring
widely studied by its developers and is evidence when parents stop assigning chores in response to
based. It is currently used in a majority of U.S. states youth violence.
and internationally.
Major Concepts
Historical Context MST is based on, and treatment must connect to,
Scott W. Henggeler began developing MST in the nine guiding principles. It should aim at (1) finding
mid-1970s in response to research on the ineffec- the fit; (2) being positive and strengths focused;
tiveness of out-of-home juvenile offender place- (3) increasing responsibility; (4) being present
ment. His research showed that placing youth in focused, action oriented, and well-defined; (5) tar-
facilities, such as residential treatment or juvenile geting sequences; (6) being developmentally appro-
detention centers, exacerbated antisocial behav- priate; (7) continuous effort; (8) evaluation and
iors, created deeper networks of delinquent youth, accountability; and (9) generalization.
and left unaddressed the problems in the youth’s
environment contributing to offending behaviors. Finding the Fit
He learned that many teens leaving these facilities
reengaged in antisocial behaviors, such as theft, Assessment focuses on finding the connections
truancy, drug use, and curfew violations, or learned (or fit) between antisocial behaviors and their envi-
new behaviors from peers. MST was developed to ronmental occurrence context.
address the evidence that multiple factors in the
individual, home, school, and community contrib- Positive and Strengths Focused
uted to juvenile delinquency and the failure of out-
Therapeutic involvement should emphasize pos-
of-home placement. At the Medical University of
itive elements and be strengths based.
South Carolina in the 1990s, Henggeler coformed
the Family Services Research Center to study evi-
dence-based treatment methods and created MST Increasing Responsibility
Services, a university-affiliated organization, to Interventions should increase family and indi-
manage the MST model. vidual responsibility.
Theoretical Underpinnings Present Focused, Action Oriented,

Based on social ecology theory, MST posits that and Well-Defined
adolescent behavior is influenced by the interaction Clearly defined interventions require specific
of multiple factors occurring in a youth’s life, fam- action by family members to succeed and are
ily, school, and community. Treatment for antiso- focused on the here-and-now.
cial behavior must address the factors influencing
each individual teen, focus within their natural
ecological settings, and involve all elements of the Targeting Sequences
systems affecting their life. Home- and community- Interventions target sequences that occur in
based treatment addresses the common barriers to multiple systems influencing antisocial behaviors.
treatment for delinquent youth, such as transporta-
tion. Detailed assessments, including all environ-
Developmentally Appropriate
mental factors contributing to delinquent behaviors,
form the basis of individualized treatment plans Interventions should match the developmental
aimed at eliminating antisocial behaviors and their level of youth.

684 Multitheoretical Psychotherapy
Continuous Effort officers, positive peers, etc.) by following the nine

guiding principles. Future sessions involve work-
Interventions require youth and their families
ing toward and adjusting treatment goals and
to put in regular effort toward completion of
interventions based on barriers to achieving them
treatment.
that arise from the youth and their family.
Clinicians meet weekly with their MST team and
Evaluation and Accountability supervisor to review cases and apply the model to
Clinicians are accountable for successful treat- problems, treatments, and barriers. Following
ment. Effectiveness is evaluated continuously. supervision, clinicians review treatment plans
with consultants, who ensure fidelity to the MST
model. Treatment ends when prosocial behaviors
Generalization within the home, school, and community have
Interventions are designed for parental mainte- replaced the identified problem behaviors and
nance following treatment and are generalizable to those behaviors are sustained for a period of 1 to
other family problems. 2 months.
Kevin C. Snow
Techniques
See also Cognitive-Behavioral Family Therapy; Ecological
MST interventions embrace many approaches, Counseling; Solution-Focused Brief Family Therapy;
including empathy, warmth, and cognitive-ehavioral Structural Family Therapy
techniques. Regular training, supervision, and con-
sultation ensure that treatments align with the nine
guiding principles. Several proprietary concepts are Further Readings
unique to MST and its treatment protocol, but Henggeler, S. W., Schoenwald, S. K., Borduin, C. M.,
finding the fit is the essential concept of the model. Rowland, M. D., & Cunningham, P. B. (2009).
Assessment begins the process of locating Multisystemic therapy for antisocial children and
the connection between problem behaviors and adolescents (2nd ed.). New York, NY: Guilford Press.
the environmental placement of those problems Swenson, C. C., Henggeler, S. W., Taylor, I. S., & Addison,
(the fit). Once the fit is defined for each identified O. W. (2005). Multisystemic therapy and
problem, treatment interventions are developed to neighborhood partnerships: Reducing adolescent
decrease antisocial behaviors and increase posi- violence and substance abuse. New York, NY:
tive social (or prosocial) behaviors. Throughout Guilford Press.
treatment, challenges to success, such as parental Wells, C., Adhyaru, J., Cannon, J., Lamond, M., &
failure to implement behavioral consequences, Baruch, G. (2010). Multisystemic therapy (MST) for
are addressed, and interventions are adjusted to youth offending, psychiatric disorder and substance
abuse: Case examples from a UK MST team. Child
overcome the barriers.
and Adolescent Mental Health, 15, 142–149.
doi:10.1111/j.1475-3588.2009.00555.x
Therapeutic Process
Clinicians, having small caseloads of four to six
families, are available on call 24 hours a day,
7 days a week. Services are delivered within the MULTITHEORETICAL PSYCHOTHERAPY
home, school, or community settings. Early ses-
sions involve detailed assessments of the multiple Multitheoretical psychotherapy (MTP) is an inte-
contributing factors within the youth’s environ- grative model encouraging therapists to combine
ment leading to antisocial behaviors. Specific interventions from more than one theoretical
treatment goals are developed in subsequent source, based on clients’ individual needs. MTP
sessions, utilizing a systems approach and incor- focuses on the interaction between three concur-
porating input from all involved parties (e.g., rent dimensions of functioning: thoughts, feel-
parents, extended family, teachers, probation ings, and actions. These dimensions are shaped

Multitheoretical Psychotherapy 685
byfour contextual dimensions: biology, interper- Theoretical Underpinnings

sonal patterns, social systems, and cultural con-
MTP describes key strategies from seven psycho-
texts. MTP describes key strategies from seven
therapy theories focusing on different dimensions
psychotherapy theories corresponding to these
of functioning. The relationship between the psy-
seven dimensions.
chotherapy theories and the focal dimensions is
illustrated in Table 1. MTP does not try to recon-
Historical Context cile the underlying differences between these theo-
ries but encourages psychotherapists to combine
MTP was developed by Jeff Harris and colleagues
strategies from more than one source.
between 2000 and 2008, while he was working at
The psychotherapy integration literature
the University of Hawaii at Manoa’s Counseling
describes four different routes to integration, and
and Student Development Center. It was designed
MTP combines features of technical eclecticism
as a practical method for training psychotherapists
and theoretical integration. Like other models of
to acquire a broad repertoire of intervention strat-
technical eclecticism, MTP describes intervention
egies and to plan for integrative treatment. MTP is
strategies that can be utilized from different theo-
considered a second-generation model of psycho-
ries based on the needs of individual clients. Like
therapy integration because it builds on principles
other models of theoretical integration, MTP
found in earlier models. MTP encourages multidi-
describes the relationship between distinct theories
mensional integration in a way similar to Arnold
and where each approach might be most useful.
Lazarus’s multimodal psychotherapy. A multitheo-
retical framework is proposed similar to the one
described in James O. Prochaska and Carlo C. Major Concepts
DiClemente’s transtheoretical model. Harris is
Five Principles for Psychotherapy Integration
now a professor at Texas Woman’s University,
where his research focuses on developing and test- MTP is based on five principles, suggesting that
ing MTP as a training and treatment method. A psychotherapy should be (1) intentional, (2) multi-
simple introduction to MTP, called “Key Strategies dimensional, (3) multitheoretical, (4) strategy based,
Training,” has been developed. MTP is being and (5) relational. Intentional integration involves
applied to the treatment of depression, trauma, acting with direction and purpose based on collab-
and addictions. orative dialogue with clients. Multidimensional
Table 1 A Multitheoretical Framework for Psychotherapy
Theories Focusing on Concurrent Dimensions of Functioning Focal Dimensions

Cognitive Thoughts
Behavioral Actions
Experiential-humanistic Feelings
Theories Focusing on Contextual Dimensions of Functioning Focal Dimensions

Biopsychosocial Biology
Psychodynamic-interpersonal Interpersonal patterns
Systemic-constructivist Social systems
Multicultural-feminist Cultural contexts
Source: Modified from J. E. Brooks-Harris, Integrative Multitheoretical Psychotherapy. Boston, MA: Houghton Mifflin (2008).

686 Multitheoretical Psychotherapy
integration involves recognizing the ways different Techniques

dimensions interact to cause distress. Multitheore-
To choose which theories to emphasize and which
tical integration advocates the use of different theo-
strategies to implement, MTP describes a five-step
ries based on the focal dimensions established for
process of integrative treatment planning:
each client (see Table 1). Strategy-based integration
involves using intervention strategies drawn from a 1. Watching for multidimensional focus markers
variety of theoretical sources. Relational integra- involves listening to clients for markers that
tion recognizes that psychotherapists can make indicate a useful focus for treatment.
intentional choices about the relationship styles
they cultivate with different clients. 2. Conducting a multidimensional survey allows
psychotherapists to explore clients’ thoughts,
actions, and feelings within the contexts of biology,
Multidimensional Adaptation interpersonal patterns, social systems, and culture.
MTP describes the purpose of psychotherapy 3. Establishing an interactive focus on two or three
as fostering adaptation. In this context, thoughts, dimensions results in agreement on a useful
actions, and feelings can be either adaptive or place to start the process of therapeutic
maladaptive. Functional thoughts are the intended exploration and change.
outcome of cognitive strategies. Effective actions
are the desired result of behavioral interventions. 4. Formulating a multitheoretical conceptualization
Adaptive feelings are the expected consequence of allows psychotherapists to use more than one
experiential strategies. MTP proposes that psy- theory to understand clients and to promote
chotherapy can help clients embrace thoughts, multidimensional change.
actions, and feelings that can help them adapt to 5. Choosing interventions from a catalog of key
biological, interpersonal, systemic, and cultural strategies encourages therapists to translate
contexts. theory into practice.
Key Strategies
Therapeutic Process
MTP describes a catalog of key strategies that
represents diverse options for intervention. Each of Throughout psychotherapy, MTP encourages
the seven theories listed in Table 1 has been detailed intentional choices based on collaborative dia-
with 12 to 16 key strategies. Key strategies are more logue with clients. MTP recognizes that different
complex than microskills—such as open questions relationship stances have been advocated by differ-
or summarization—and can be implemented at dif- ent theories, including collaborative empiricism,
ferent levels of complexity. The following are three social reinforcement, empathic attunement, health
examples of key strategies: promotion, participant-observation, social chore-
ography, and cultural consultation. Different rela-
COG-6: Forming and testing hypotheses about the tionship styles can be cultivated based on clients’
client’s beliefs and perceptions needs and preferences.
BHV-8: Prescribing specific actions or assigning Jeff E. Harris
homework that activates behavior or alters long-
standing patterns See also Eclecticism; Integrative Approaches: Overview;
Multimodal Therapy; Transtheoretical Model
EXP-7: Identifying, connecting, and integrating
different parts of self
Further Readings
MTP’s description of each key strategy includes Brooks-Harris, J. E. (2008). Integrative multitheoretical
a theoretical context, a strategy marker, sugges- psychotherapy. Boston, MA: Houghton Mifflin.
tions for use, an expected consequence, and a case Ivey, A. E., & Brooks-Harris, J. E. (2005). Integrative
example. psychotherapy with culturally diverse clients. In

Music Therapy 687
J. C. Norcross & M. R. Goldfried (Eds.), Handbook In 1983, the Certification Board for Music
of psychotherapy integration (2nd ed., pp. 321–339). Therapy was established to enhance the credibility
New York, NY: Oxford University Press. and competency of music therapists. Today, it main-
Harris, J. E., Kelley, L. J., Campbell, E. L., & Hammond, tains strong standards for education and training.
E. S. (2014). Key strategies training: An introduction to Currently, accredited music colleges and universities
multitheoretical psychotherapy. Journal of Psychotherapy offer degrees in music therapy at the undergraduate,
Integration, 24(2), 138–152. doi:10.1037/a0037056 master’s, and doctoral levels. Many schools offer
equivalency or certificate degrees in music therapy
for those who have a completed a degree in another
Websites
field. Although music therapy students receive
3D Recovery: www.3DRecovery.com traditional music training, allied health classes such
Multitheoretical Psychotherapy: www.multitheoretical.com as anatomy, physiology, and psychology are also
commonly required for degree completion.
MUSIC THERAPY Theoretical Underpinnings

Kenneth E. Bruscia’s theory defining music therapy
Music therapists use music experiences as a profes- posits the foundational and fundamental charac-
sional practice to engage and foster change and/or teristics of the roles of the therapist, the client, and
growth in clients. These music experiences allow cli- the music within music therapy. Although this
ents to view their health in an alternative and creative theory provides an overview of all areas of music
way. Music therapists practice within four main therapy, an integrative perspective is presented for
methods—improvisation, recreative, composition, music therapists who work within a psychother-
and receptive—which are the foundation of practice apy and counseling context. The theory also func-
and subsequently inform theory and research. tions as a learning tool for both music therapists
and non–music therapists alike in understanding
theory, research, and practice in music therapy.
Historical Context
There is a vast array of theories and philosophies
The belief that music affects health is at least as old that are foundational for music therapy practice,
as the writings of Aristotle and Plato. As a profes- particularly as it relates to psychotherapy. The vari-
sion, music therapy began shortly after World War ous theories and philosophies fall into five main
II. At the time, musicians were hired to play music categories, or a combination of these categories.
for hospitalized veterans. Physicians soon realized First, there are theories and philosophies in
the therapeutic value that performed music pro- music therapy that accommodate theories from
vided their patients. However, they also realized traditional psychotherapy. For example, a psycho-
that musicians may find it challenging performing dynamic music psychotherapy theory addresses
for severely physiologically and psychologically ill how one projects the unconscious onto music.
patients and so called for musicians to be “trained” Second are theories and philosophies that
to work with these clinical populations. accommodate a more specific psychotherapy
The psychologist E. Thayer Gaston was greatly approach. For example, Jungian archetypal theory
influential in creating the profession as it is viewed is helpful to explain how certain types of music
today. He developed a college curriculum to edu- relate to universal, deeply embedded human themes
cate and train music therapists at the University of (“the warrior,” “earth mother,” etc.).
Kansas in the 1940s. Shortly thereafter, similar The third category includes indigenous music
music therapy training programs were developed therapy theories and philosophies on the roles of
at colleges and universities across the country. In sound and sound relationships, and/or philosophical
1950, music therapy was officially recognized as a discussion on the nature of music. For example, what
profession. The current professional association is are the essential characteristics, if any, of music and
the American Music Therapy Association. music making that provide the foundation for growth

688 Music Therapy
and/or health? The theories in this category promote include processes in which the client listens to
the idea that music therapy theory does not need to music and, importantly, responds to the listening
accommodate or assimilate theories from other disci- experience. Although listening to music may be
plines such as psychotherapy or counseling. therapeutic by nature and many may enjoy listen-
Fourth, theories and philosophies that have a ing to music, this method focuses on the listening
phylogenetic basis propose that music and music within the therapeutic relationship and the subse-
making are a part of our biological makeup and, quent internal experiences that may emerge.
perhaps, even necessary for health. These theories
assert that it is important for clients not only to be
Music Therapy Is Method Based
exposed to music in their lives to grow and change
Rather Than Outcome Based
but also to interact with music experiences.
The fifth category includes theories that have “Method based” implies that there is a system-
been developed from specific models of music atic process in working with clients in achieving
therapy. There are several common models that are goals and objectives. The therapist has a knowledge
used (see the “Techniques” section). For example, base that meets the needs or health concerns of the
in music-centered music therapy, using improvisa- client. “Outcome based” implies that health may
tion with clients provides the means for clients to only be achieved by prescriptive music experiences.
understand self. Therefore, the client would be solely dependent on
Finally, there are those theories that do not fit the therapist for growth or change.
nicely into one of the categories listed above—for
example, music therapy theories that accommo-
Music Therapy Is Typically Experiential
date or assimilate theories on the metaphysics of
Instead of Verbal
music or the psychology of music.
In music therapy, there are aspects of the session
where traditional verbal techniques may be used,
Major Concepts
and some sessions may even have a high verbal
There are six major concepts in music therapy. component, while other sessions may be all music
Inherent in each of these concepts is the idea that experiences. Thus, depending on the circumstances
music functions as both a medium and a means— (e.g., client, session, etc.), music therapists may use
the music is the medium, and music experiences verbal techniques in preparing the client for a music
are the means. experience and/or clarifying the client’s feelings and
emotions during and after a music experience.
Music Therapy Has Four Main
Types of Experiences Music Therapy Is Creative
There are four main types of music experiences: Musical ability or talent is not a necessary com-
improvisation, recreative, composition, and recep- ponent for a client to receive music therapy. Music
tive (listening). Improvisation is spontaneous music therapists presume that musical products employed
making with musical instruments. The instruments within various music experiences are creative experi-
used may vary from traditional instruments, such ences and are valued as part of the process. Creativity
as piano, guitar, or percussion, to culture-specific in the music allows for the client to imagine, think,
instruments. Vocal improvisation is also widely or experience new ways of being. For example, a
used, with or without instruments. Recreative client who may have difficulty expressing emotions
methods include learning or performing music. In verbally may find that a music experience more
this method, musical development does not mean suitably describes his or her emotions.
that the client becomes “good” at making music but
that growth, change, or meaning is found in the act
Music Therapy Is Relationship Based
of making music. In composition methods, the
music therapist assists the client with writing songs, Whereas the focus of many therapeutic profes-
lyrics, or pieces of music. Receptive methods sions is on the therapist–client relationship only,

Music Therapy 689
music therapy also focuses on the relationships issues and problems, (b) exploring those issues and
within and through the music. Therefore, the fol- problems through the music experience, and then
lowing relationships may occur: (a) the client’s (c) discussing how the music experience relates to
relationship with the music, (b) the client’s relation- the client’s personal life.
ship with the therapist, (c) the therapist’s relation-
ship with the client, (d) the therapist’s relationship
Bonny Method of Guided Imagery and Music
with the client’s music, (e) the intrapersonal rela-
tionships the client has with the music and with the The Bonny method of guided imagery and
therapist, and (f) the intrapersonal relationships the music was developed by Helen Bonny while work-
therapist has with the music and the client. ing with Walter Pahnke at the Maryland Psychiatric
Research Center in the late 1960s and early 1970s.
During this time period, psychedelic drugs were
Music Therapy Is a Science, Art, and Humanity
used to induct clients into an altered state of con-
The use of music and music experiences is a sciousness, which was believed to lead to a deep
movement between science, art, and humanity. As level of exploration into the psyche. While drugged,
a science, music therapy has predictable and the patients imaged, which provided the psychia-
observable changes. As an art, the engagement in trists at the research center access to the clients’
the music experience provides meaning in and of consciousness. Bonny developed music programs
itself. As a humanity, music therapy situates the that could elicit the same altered state of con-
client, the therapist, and the music experiences in sciousness without the use of drugs. Although
the larger health context of the client’s community. other psychotherapy and counseling fields use
For example, the client’s “health” is related to the guided imagery and music, the Bonny method of
client’s community or culture’s “health”; that is, an guided imagery and music is a specific method that
individual’s health is dependent on the individual’s requires advanced training and education. This
culture. model is the only receptive model of music therapy.
Techniques Culture-Centered Music Therapy

This section discusses six of the most commonly As suggested by the music therapy scholar
practiced models of music therapy. Each has its Brynjulf Stige, the relatively new approach of
own theory, practice, and research traditions and, culture-centered music therapy is associated with
therefore, its own specific techniques. social science theories and has a progressive or
activist dimension in expanding the role of the
music therapist within the client’s culture or com-
Analytical Music Therapy
munity. One of the basic premises is that there is
Developed by the British music therapist Mary a communal aspect of making music with others
Priestly, analytical music therapy is a combination that goes beyond the boundaries of traditional
of traditional psychoanalytical theory and improvi- forms of psychotherapy and counseling. This
sational methods. The premise of analytical music technique involves incorporating each method
therapy is that emotional problems occur due to the of music therapy within the client’s culture or
repression of memories and are manifested in community.
destructive or relational patterns The main goal is
for the client to free or “let go of” these destructive
Music-Centered Music Therapy
patterns through the music experience. These nega-
tive emotions are then less likely to be avoided Music-centered music therapy, proposed by the
while being subconsciously expressed through the music therapist and researcher Ken Aigen, pro-
music. The music therapist is specifically trained in motes the idea that music is the means to reach
using improvisation and composition throughout clinical goals and objectives; there is no need for
the music therapy session. The technique involves verbal interpretation or discussion. This concept is
the client and the therapist (a) discussing current closely related to Nordoff-Robbins music therapy

690 Music Therapy
and the aesthetic philosophy of John Dewey. Client evaluation occur throughout the treatment as well
experience is of utmost importance; goals and as within specific sessions. For example, a music
objectives are both developed and treated purely therapist will use an assessment tool that provides
with music. There is then congruence between the the treatment goals and objectives, and near the end
client’s personal process and the client’s musical of treatment the client’s progress is evaluated. Also,
development. Typically, improvisation and compo- assessment, treatment, and evaluation may be com-
sitional techniques are used for music-centered pleted within a specific session. For example, the
music therapy. therapist assesses something in a specific music
experience, which leads to a specific treatment
objective, and the therapist evaluates that objective
Neurological Music Therapy
completely within one session. There is no typical
Developed by the music and neuroscience pro- music therapy process with regard to length of a
fessor Michael Thaut at Colorado State University, session and number of sessions. The length and
neurological music therapy is based in neuroscience style of a session are based on the client’s needs and
and the idea that music perception, and music, the music therapist’s training, education, and/or
influences changes in nonmusical behavior and orientation. The music therapist develops a rela-
brain functions. The fundamental premise is the tionship with the client through the music. This is
understanding of how the brain works with music not a social or entertainment-based relationship but
and without music and that music experiences have one based on the inherent meaning found through
a tremendous impact on brain function. For exam- and with the music.
ple, the technique may involve playing a musical
instrument to activate the auditory cortex, which Michael L. Zanders
then activates the motor circuits in improving brain
See also Behavior Therapies: Overview; Client-Centered
functioning in stroke patients. Counseling; Contemporary Psychodynamic-Based
Therapies: Overview; Creative Arts and Expressive
Nordoff-Robbins Music Therapy Therapies; Integrative Forgiveness Psychotherapy
Developed by the composer Paul Nordoff and

Further Readings
the special-needs educator Clive Robbins, Nordoff-
Robbins music therapy (NRMT) uses improvised Aigen, K. (2005). Music-centered music therapy. Gilsum,
and individually composed music to promote the NH: Barcelona.
internal development of the client. Some of the Bonny, H. (2002). Facilitating guided imagery and music
core concepts of NRMT are that humans (a) are (GIM) sessions. In L. Summer (Ed.), Music
inherently musical, (b) have a “music child” that consciousness: The evolution of guided imagery and
can be accessed through music, and (c) have a music (pp. 269–297). Gilsum, NH: Barcelona.
“conditioned child” that is incomplete, debilitated, Bruscia, K. E. (Ed.). (1991). Case studies in music therapy.
or assessed as “unhealthy.” Through the use of Gilsum, NH: Barcelona.
music improvisation, the client is able to create a Bruscia, K. E. (1998). Defining music therapy (2nd ed.).
new self called the “being child.” NRMT therapists Gilsum, NH: Barcelona.
Kenny, C. B. (Ed.). (1995). Listening, playing, creating:
are specifically trained to use improvisations and
Essays on the power of sound. Albany: State
compositions, with limited verbalizations, to work
University of New York Press.
with the client throughout the session. It is through
Priestly, M. (1994). Essays on analytical music therapy.
the music that the health objective is achieved.
Gilsum, NH: Barcelona.
Standley, J., Johnson, C. M., Robb, S. L., Brownell, M. D.,
Therapeutic Process & Kim, S. (2008). Behavioral approaches to music
therapy. In A. A. Darrow (Ed.), Introduction to
Music therapy is an interactive and reflexive approaches in music therapy (2nd ed., pp. 105–127).
process involving the music therapist, the client, Silver Spring, MD: American Music Therapy
and the music experiences. The process includes Association.
assessment, treatment, and evaluation with both Stige, B. (2002). Culture-centered music therapy. Gilsum,
groups and individuals. Assessment, treatment, and NH: Barcelona.

N
the emergence of narrative family therapy as social-
NARRATIVE FAMILY THERAPY constructivist thought was beginning to gain atten-
tion in the field of family therapy in the latter half of
Narrative family therapy, developed by Michael the 20th century. White’s early perspectives of post-
White and David Epston, is likely the most visible modern thought were informed by Gregory Bateson,
result of the convergence of postmodern thought and who in the 1970s was a member of the Palo Alto
the evolving counseling profession during the latter Group, an intellectual center for the study of family
part of the 20th century. This form of counseling therapy at the time that included Don Jackson and
adheres to the social-constructionist view of reality— Jay Haley as members. Bateson introduced White to
that is, that each person in a family system constructs the “interpretive method” as a way of examining
reality through the use of self-defined narratives in strategies of power and the way people make mean-
social exchanges with others. This theory maintains ing of the world around them. Bateson proposed
that language is not merely used to transmit one’s that individuals do not know reality directly but rely
reality but that language forms one’s reality as influ- on interpretations of their experiences as guided by
enced by the values of those in positions of power mental maps. A major tenet of Bateson’s was that
and privilege, which sway the formation of language. the formations of these maps are influenced by
These cultural influences in effect establish norms society and culture and are not reality but merely
that individuals internalize and compare themselves imperfect representations of reality.
against as they construct stories of their lives. White was further influenced by the work of the
Therefore, narrative family therapists do not view French historian-philosopher Michel Foucault,
problems as originating in one individual in the fam- who argued that knowledge is embedded in the
ily system but as the reflections of destructive, shifting cultural ages of history and accompanied
problem-saturated narratives resulting from the by related shifts in power. Foucault maintained
influence of larger, dominant cultural narratives that that shifts in knowledge and power are driven by
permeate each family member’s reality. Accordingly, those in dominant positions of power and form
narrative family therapists assist families in external- social discourses that individuals use to form their
izing problems, deconstructing self-limiting or reality. White’s interest in liberating people from
destructive stories, and creating and internalizing the effects of systematic oppression was also heav-
new stories that offer new possibilities and realities. ily influenced by his wife, Cheryl White, a feminist
and social activist, who founded the Dulwich
Center in Adelaide, Australia, in 1983, which
Historical Context
served as a testing ground of sorts for exploring
Michel White, a social worker from Australia, is new narrative practices and ideas with school and
widely credited with being the leading force behind native aboriginal communities.
691

692 Narrative Family Therapy
In the 1980s, White also became interested in outside the family system, the narrative family
the work of David Epston, a family therapist from therapist facilitates the family in working together
New Zealand at the Family Therapy Centre in toward fighting a common enemy. The stories
Auckland, who is widely regarded as the second families tell include many important thoughts,
most influential force in the formation of the nar- beliefs, and events that define them and are inter-
rative method. Epston’s interests included anthro- nalized. These thin descriptions are problem laden
pology and the role of storytelling, and he was and include labels or language imposed by people
known at the time for his work forming anti- or institutions of power. By deconstructing these
anorexia and antibulimia groups and his innova- self-limiting narratives and labels and examining
tive use of writing letters to clients and families to their effect on self-concept, the therapist promotes
extend the therapeutic effect of conversations. and supports the family in constructing thick
Epston was the first person to offer the idea of the descriptions that include multiple viewpoints,
narrative metaphor to White, and the two men move beyond mere labels, and open doors for
collaborated to define this new theory, which reauthoring alternate narratives that create new
countered the prevailing thought across existing realities for each family member and the family as
theories of family therapy that placed therapists in a whole.
the position of the “expert,” relying on models
based on analytic interpretation and definitions of
Major Concepts
normal family functioning, and locating dysfunc-
tion in individual family members. The two col- Narrative therapists believe in the concept of the
leagues wrote Narrative Means to Therapeutic narrative metaphor, which maintains the idea that
Ends in 1990, and in a series of international con- reality is formed and maintained by stories that
ferences attended by a wide variety of family are influenced by certain dominant narratives in
therapists that followed, the title of “narrative culture and are linked over time to make sense of
family therapy” was adopted for the theory behind one’s life. Therefore, the narrative therapist
White and Epston’s work. believes that the self-narratives that individuals
White died in 2008, and Epston continues as the and families share with others are not reflections
codirector of the Family Therapy Centre, but others of reality but actually form their reality. The
have furthered their groundbreaking work. Stephen major ideas that flow from this philosophy
Madigan, a Canadian who collaborated with include (a) the collaborative therapeutic relation-
White and Epston, is one of the most prominent ship, (b) the narrative perspective, (c) the influ-
and active narrative therapists in North America ence of dominant cultural narratives, and (d) thin
today. In 1992, he opened the Vancouver School for and thick descriptions.
Narrative Therapy and remains focused on clarify-
ing the effect that knowledge imparts on commu-
The Therapeutic Relationship
nity discourse that supports the marginalization
and oppression of the underprivileged. As a postmodern approach to therapy, narrative
therapy rejects viewing families as cybernetic sys-
tems to be reprogrammed by an expert therapist, as
modern theories maintain. Instead, narrative thera-
Narrative family therapists support a social- pists assume a not-knowing stance driven by a
constructivist view of reality and believe that the tradition of hermeneutic theory, which focuses on
narratives that people use to describe their lives interpretation of beliefs and assumptions in the
come from interactions with others as influenced construction of meaning and knowledge. Because
by dominant cultural narratives. Therapists using narrative therapists recognize the importance of
narrative therapy do not solve problems but adopt forming a collaborative relationship with families
a collaborative, respectful, curious, and nonexpert that is respectful and curious, conversations emerge
stance to help family members separate themselves in which sources of meaning are explored over
from problem-saturated and limiting narratives. time and new meanings are created that liberate the
By externalizing problems and positioning them family from the effects of existing dominant cultural

Narrative Family Therapy 693
themes. Narrative family therapists conduct ther- stories are consciously or unconsciously omitted,
apy with families as opposed to providing therapy and the stories include descriptions or labels
to families. imposed on the family by others with definitional
power. Descriptions incorporated into the family’s
history that include oppressive or self-limiting
The Narrative Perspective
truths are known as thin descriptions. Thin descrip-
A perspective represents both a way of viewing tions mask complexities of life and meaning-
and giving meaning to life and a way of living. The making processes and lead to thin conclusions that
narrative perspective not only a view of where disempower individuals. As oppressive and con-
problems are located and approaches for assisting trolling influences present in the family’s story are
people to find more meaningful stories but also identified and interpreted by the therapeutic part-
invites the therapist to address problematic social nership, client families begin making meaning of
discourses. The development of this perspective their own experiences and shed destructive cul-
was heavily influenced by Bateson’s work on the tural assumptions that bring problems into the
interpretive method, which acknowledges that we family’s reality. Alternatively, thick stories emerge
cannot know reality directly, but rather, our through the skillful use of questions by the narra-
knowledge of the world is carried in a series of tive family therapist. These descriptions are more
mental maps. It is the interpretation of events over elaborate than their thin counterparts and include
time that forms the stories that constitute our lives. subjective experiences, hopes, and dreams as well
as the family’s shared values and beliefs that are
free of the restrictions of dominant cultural narra-
Dominant Cultural Narratives
tives. By telling and retelling alternative stories, the
A family’s collective identity and reality, as family replaces problem-saturated narratives with
formed by the stories they tell, involve interpreta- multistoried lives as they become more aware of
tions of past experiences and internalization of the the alternatives and numerous possibilities that
meanings attached to them. These interpretations exist.
and meanings are influenced by larger cultural nar-
ratives that transmit messages of privilege and
Techniques
normality against which family members compare
their own experiences while selecting the language In contrast to many other theories, narrative fam-
that constructs the stories of their lives. Narrative ily therapy relies more on the therapist’s attitudes
therapy recognizes the power dominant cultural and perspectives than on a set formula of tech-
narratives exert, particularly when a family’s expe- niques. Much like person-centered and existential
riences fall outside the customary or preferred therapy, the therapist’s way of being and personal
ways of behaving in a certain culture. Toxic beliefs characteristics are paramount to establishing a
that form the basis of oppression based on race, climate that allows clients to view their life stories
class, gender, and so forth are also contained in from other perspectives. Narrative family therapy
cultural narratives and internalized by family does not establish a set of techniques but rather
members. Therefore, the narrative family therapist challenges the therapist to apply a set of specific
joins the family in externalizing and deconstruct- skills such as questioning, externalizing, and decon-
ing dominant cultural narratives that are problem- structing problem narratives; searching for unique
atic and self-restricting to free the family from the outcomes; assisting clients with reauthoring and
problem as they co-construct alternative stories. reinforcing their new stories; and writing letters.
Thin and Thick Descriptions Questioning

The problem-saturated stories that families Narrative therapists are said to be masters at
bring to therapy contain many important facts and asking questions and judiciously use questions
events necessary to understand the family’s plight. throughout the counseling process that access and
However, many items and pieces of the family’s surface new thoughts. Through respectful and

694 Narrative Family Therapy
attentive listening when openings present them- cultural values, beliefs, and truths that contributed
selves, the narrative therapist asks questions that to the formation of the problem narrative.
assist the family in externalizing the problem, Identifying unique outcomes provides the family
deconstructing its source and influence, identifying with proof of the power of external influences on
unique outcomes, or reauthoring their stories. their current narratives and proof that these
Using questions in this way supports the therapist’s narratives can be changed.
role as a respectful and curious collaborator and
adds thickness to family members’ narratives,
which highlights positive alternatives for the Reauthoring and Reinforcing
family’s future. As families separate from their problems, and
contradictions to dominant stories in the past are
illuminated and unique exceptions identified, the
Externalizing and Deconstructing
therapist is able to lead the family on an explora-
Externalization is an attitude promoted by the tion of the meaning of the unique outcomes and
therapist to frame the problem as the problem and how they may be incorporated into creating new
remove dysfunction or pathology labels from any narratives. Once again using questions, the thera-
individual in the family system. Because any num- pist and the family interpret the formation of rede-
ber of stories can be created to describe an event in scriptions and new meanings attached to the
the family system, the therapist engages in exter- unique outcomes of the past. By shifting to using
nalizing conversations to encourage family mem- questions that probe the unique possibilities asso-
bers to describe their relationship to the problem ciated with the exceptions of the past, the family is
and how it has affected many pertinent areas of able to move from past and present foci to allow
their lives. Externalizing in this way illuminates for the creation of narratives for the future as well.
alternative descriptions of current problems by One of the most effective ways of strengthening
each family member and opens him or her to the new, developing story is by creating a receptive
examining his or her relationship to the problem audience who serve as “witnesses.” The therapist
and the effects of internalizing it. As the stories are serves as an initial audience to witness the family’s
externalized, family members experience enough changing narrative, but the client family should be
separation from the problem so that the therapist encouraged to identify other audience members to
is able to next ask questions about taken- share it with. It is key that any audience be com-
for-granted realities and that lead to the problem- posed of supportive and optimistic people who can
saturated narratives. By deconstructing the sources offer validation to the family’s new reality.
and effects of externally imposed values, beliefs,
and truths that have been internalized, the thera-
pist assists family members in better understand- Documenting
ing how they were recruited into the problem Epston wrote letters to clients between sessions,
according to culturally transmitted norms of gen- and many narrative therapists continue this prac-
der, age, class, and so on, which are sustained in tice today. Letters serve a number of different pur-
the problem narratives. poses, including prolonging the therapeutic effect
of sessions, supporting families in maintaining
curiosity about change, keeping families connected
Searching for Unique Outcomes
to their emerging alternative stories, and stimulat-
Probing for unique outcomes adds thickness to ing family members to continued discourse for
thin descriptions of family narratives and opens meaning making that supports internalizing alter-
possibilities for including alternatives. Identifying native stories. Letters provide a great tool for
unique outcomes orients individual family mem- maintaining continuity of the narrative process
bers and the family as a whole to specific aspects because they can be read and reread over time.
of their past. It is through this exploration that the A narrative therapist may use summary letters to
therapist is able to illuminate contradictions and recap sessions and remind family members of
exceptions to the previously internalized dominant emerging stories, themes, and unique outcomes.

Narrative Therapy 695
Letters may also be written to invite and encourage Chang, J., Combs, G., Dolan, Y., Freedman, J., Mitchell, T., &
the participation of reluctant family members in Trepper, T. S. (2012). From Ericksonian roots to
the process, note duplications of roles in the family postmodern futures: Part I. Finding postmodernism.
to those wishing to change them, thank family Journal of Systemic Therapies, 31(4), 63–76. doi:10.1521/
members for their participation and inform them jsyt.2012.31.4.63
that they no longer need to play their role in the Chang, J., Combs, G., Dolan, Y., Freedman, J., Mitchell, T., &
alternative narrative, and, at the conclusion of Trepper, T. S. (2013). From Ericksonian roots to
therapy, predict continued success and encourage postmodern futures: Part II. Shaping the future. Journal of
Systemic Therapies, 32(2), 35–45. doi:10.1521/
the family to continue to search for new possibili-
jsyt.2013.32.2.35
ties. Whatever the narrative therapist’s form and
Epston, D. (2008). Saying hullo again: Remembering
purpose as a collaborator, the narrative therapist
Michael White. Journal of Systemic Therapies, 27(3),
maintains transparency by exposing his or her
1–15. doi:10.1521/jsyt.2008.27.3.1
thoughts to the family in letters and by providing Goldberg, H., & Goldberg, I. (2008). Family therapy: An
room for confirmation or challenge as the process overview (7th ed.). Belmont, CA: Thompson.
of co-construction progresses. Lewis, R. E. (2003). Brief theories. In D. Capuzzi &
D. R. Gross (Eds.), Theories of psychotherapy
Therapeutic Process (pp. 286–310). Upper Saddle River, NJ: Pearson.
Minuchin, S. (1998). Where is the family in narrative
Narrative family therapy is a nondirective, collab- family therapy? Journal of Marital and Family
orative, and relatively brief form of family therapy. Therapy, 24(4), 397–403.
Throughout the therapeutic process, therapists doi:10.1111/j.1752-0606.1998.tb01094.x
consistently and skillfully ask questions to pro- Schwartz, R. C. (1999). Narrative therapy expands and
mote the development of new narratives. This contracts family therapy’s horizons. Journal of Marital
allows client families to feel safe and respected and Family Therapy, 25(2), 263–267.
within the therapeutic relationship and be willing doi:10.1111/j.1752-0606.1999.tb01127.x
to share in examining internalized and self-limiting Shalay, N., & Brownlee, K. (2007). Narrative family therapy
truths transmitted from the dominant culture. with blended families. Journal of Family Psychotherapy,
Over time, family members and the family as a 18(2), 17–30. doi:10.1300/J085v18n02_02
whole become more aware of the effect that domi- White, M. (2007). Maps of narrative practice. New York,
nant cultural narratives have had in creating NY: W. W. Norton.
problem-saturated narratives, and they become White, M., & Epston, D. (1990). Narrative means to
empowered to reauthor their stories of the past, therapeutic ends. New York, NY: W. W. Norton.
present, and future. Once armed with new, prob-
lem-free stories, the therapist provides reinforce-
ment and support to the family through the use of
letters and by facilitating the recruitment of others NARRATIVE THERAPY
who can serve as audiences or witnesses to the
family’s new narratives. Narrative therapy (NT) is a strengths-based
approach to psychotherapy that uses collaboration
Herman R. Lukow II and Emilie Godwin
between the client or family and the therapist to
See also Constructivist Therapies: Overview;
help clients see themselves as empowered and capa-
Constructivist Therapy; Existential-Humanistic ble of living the way they want. In the face of crisis
Therapies: Overview; Palo Alto Group; White, or trauma, NT helps clients achieve a “This too will
Michael pass” attitude, while positioning the therapist as an
appreciative ally in the process. NT is useful with
individuals and is used extensively with families due
Further Readings
to its ability to separate clients from problems and
Beels, C. (2009). Some historical conditions of narrative unite families against problematic patterns. NT also
work. Family Process, 48(3), 363–378. lends itself well to joining with families because it
doi:10.1111/j.1545-5300.2009.01288.x stresses strengths and achievements over problems.

696 Narrative Therapy
Historical Context mind exceptions to a client’s or family’s stance of

no control. It assumes that many of our patterns of
In the 1980s, Michael White from Adelaine,
behavior are supported by self-fulfilling prophecies
Australia, and David Epston from Auckland, New
or false beliefs about ourselves that have been
Zealand, developed what has come to be known as
shaped by the world around us. Using these excep-
“narrative family therapy.” White passed away in
tions, new stories or narratives are created that
2008, but not before NT became widely accepted
better match the client’s sense of self.
as a standard option in family therapy. White
NT is strengths based. This means that the nar-
and Epston’s original book Narrative Means to
rative therapist will choose to focus on strengths
Therapeutic Ends was inspired and shaped by
over problems whenever possible. NT assumes that
Michael Foucault’s theory of power and knowl-
a client or family will rely on their strengths to
edge. Foucault’s work highlights how social power
overcome problems in their lives, making them an
forges the knowledge that people use to interpret
important part of the therapeutic process. Focusing
their lives. Using these ideas, NT challenges the
on strengths over problems also helps promote a
dominant knowledges that restrict clients from
more collaborative atmosphere where the narrative
progressing in their lives.
therapist can admire the client or family outside
More recently, NT has been influenced by the
of the problematic context. This greatly contributes
work of therapists such as Stephen Madigan, who
to the joining process and makes it easier to discuss
helped popularize techniques such as therapeutic
problems without judgment. According to some
letter-writing campaigns, and William Madsen,
research, therapists can actually learn more about
who developed collaborative family therapy. Of
problems by asking about strengths.
particular importance was the development of col-
NT is goal directed. Narrative therapists are less
laborative therapy by Madsen, a narrative approach
concerned with what caused a problem and more
outlined in his book Collaborative Therapy for
concerned about what changes will look like when
Multi-Stressed Families. This book has become a
the problem is no longer as much of a problem.
guide for many agencies supporting families due to
NT is also referred to as a future-focused approach
its straightforward and practical approach to
for this reason. Treatment plans are positively
working with systems and multistressed youth. It is
worded and stress how improvement will be
also commonly assigned as required reading for
noticed versus how problems will be resolved.
many family therapy programs and courses.
Finally, NT does not accept resistance as a useful
concept in therapy. That is not to say that narrative
therapists do not experience resistance; instead,
they interpret it as misunderstanding, rather than
NT refers to a range of social-constructionist and some of the other meanings that therapy sometimes
constructivist approaches to the process of thera- chooses to assign. If a narrative therapist is experi-
peutic change. Therefore, NT is based on the idea encing a client or family as resistant, he or she will
that problems are manufactured in social, cultural, respond by considering what is not being under-
and political contexts. Change occurs largely by stood about the client or family, always taking
exploring how language is used to create and special care to avoid overresponsibility for a client
maintain problems. Interpretation of one’s experi- or family in order to encourage empowerment,
ence is at the core of NT, which collapses these recognizing the relatively small role the narrative
experiences into narrative structures or stories that therapist plays in each client’s or family’s life.
provide a framework for understanding them. To
deepen understanding, problems have to be viewed
Major Concepts
from the context in which they are situated. This
includes exploring society as a whole and explor- Consistent with a social-constructionist or con-
ing the impact of various aspects of culture that structivist paradigm, some of the major concepts
help create and maintain the problem. include collaboration, dominant stories, social con-
To help clients shift their perspectives and text, thick and thin descriptions, alternative stories
change their behavior, NT points out and brings to and reauthoring, and community of support.

Collaboration Thin and Thick Descriptions

Collaboration is among the most important con- Thin description is how many clients in NT
cepts in NT because it helps promote a nonhierar- describe their dominant stories at the onset of
chical relationship between the family and the therapy. It allows little space for the complexities
psychotherapist. Madsen referred to the psycho- and contradictions of life. It also allows little space
therapist’s role in this relationship as an appreciative for people to articulate their own particular mean-
ally, or someone who appreciates the strengths and ings of their actions and the context within which
struggles of the family while striving to gain local they occurred. Often, thin descriptions of people’s
knowledge, which is information about the family’s actions are created by others with the power of
norms, values, and structure that helps elucidate the definition in particular circumstances (e.g., parent,
context where problems exist. The strengths-based teachers, health professionals). One goal of the
and future-focused nature of NT naturally facili- therapist is to help clients develop thick descrip-
tates a more collaborative relationship than tions of their stories, which are more complex nar-
problem-based approaches to psychotherapy, which ratives that deepen and broaden their story and
generally establish the psychotherapist as the expert help individuals view their stories in new ways.
in the relationship.
Alternative Stories and Reauthoring
Dominant Narratives or Stories When initially faced with seemingly overwhelm-
Dominant narratives or stories in NT are made ing thin conclusions and problem stories, narrative
up of events linked by a theme and occurring over therapists are interested in dialogues that promote
time and according to a plot. A story emerges as alternative stories. Alternative stories are examples
certain events are privileged and selected over of clients behaving outside of the problematic
other events as more important or true. As domi- context. This process has been referred to as reau-
nant stories take shape, they invite the teller to thoring in previous literature and is described
further select only certain information while other metaphorically as “shining a light on moments of
events become neglected, and thus, the same story competence.” Some of the techniques used to
is continually told. These self-fulfilling prophecies facilitate the reauthoring process are discussed in
become a template for how clients understand the following section.
themselves. For example, a client who considers
himself or herself as a “late person” may avoid Community of Support
engaging in behaviors to improve timeliness
A community of support is another important
because “I’m going to be late anyway.”
concept in NT. A community of support includes
anyone that a client or family chooses. It is impor-
Social Context tant because it speaks to the importance of a
client’s or family’s support outside of therapy, as
Social context is where dominant stories are well as the impact that a client’s or family’s social
created and maintained. The ways in which we context has on the creation and maintenance of the
understand our lives are influenced by the broader dominant story. Communities of support are called
stories of the culture in which we live. Some of on often in NT to assist with techniques such as
these stories will affect us positively and others letter-writing campaigns and to get a perspective
negatively. The meanings that clients give to events on clients outside of the problematic context.
in their lives do not occur in a vacuum. There is Letter-writing campaigns are described in more
always a context where the dominant stories in our detail in the next section, on techniques.
lives are formed. This context contributes to the
interpretations and meanings that we give to
events. Gender, class, race, culture, and sexual pref-
Techniques
erence are powerful contributors to the plot of the NT involves the use of a wide variety of techniques
stories by which we live. to help clients or families examine their lives

698 Narrative Therapy
within context and create alternative stories. another character in the client’s stories. For exam-
Psychotherapists select techniques based on their ple, a client might name anxiety “the Goblin” and
relationship with the family or client and on the talk with his psychotherapist about how he copes
ongoing assessment of their progress. Techniques when the Goblin comes into the classroom.
are generally implemented with fluidity rather than
in a directive or overly structured way. Some of the
Deconstructive Questions
more common techniques are joining, unique out-
comes or exceptions, externalization, deconstruc- Questions used to help narrative therapists, and
tive questions, reauthoring questions, preference their clients, to better understand the clients’ prob-
questions, reconnection interviews, therapeutic lems and dominant narratives are deconstructive
letter writing, letter-writing campaigns, and defini- questions. Deconstructive questions help narrative
tional ceremonies. therapists learn about a problem’s influence and
effects on clients and their community, cultural
and other supports, and tactics and strategies.
Joining
They can also help narrative therapists learn about
The term joining is used to describe the process clients’ preferences or opinions about a problem’s
involved with establishing a therapeutic relation- influence, effects, tactics, and supports. An exam-
ship in NT. Joining is how the therapist helps posi- ple of a deconstructive question might be “How
tion himself or herself as an appreciative ally in does anxiety keep making it difficult for you to get
clients’ lives. Some of the strategies used to join where you want to go?” or “When is anxiety most
with clients and families are strengths assessment, likely to show up in your life?”
listening, and collaboration.
Reauthoring Questions
Unique Outcomes or Exceptions
Reauthoring questions help build and support
As a client increasingly feels comfortable shar- alternative stories by examining life outside the
ing his or her problem-dominated stories, the problem. They also clarify client preferences and
therapist will try to identify themes that are at values, develop alternative stories in realms of
odds with the client’s story by asking the client if action and meaning, examine new possibilities
there were times when there were exceptions to the from alternative stories, and develop support for
story. In this manner, clients can begin to view their the enactment of new stories. An example of a
lives in new ways that do not include the problem reauthoring question might be “What do you think
narrative. Here, the therapist might be seen asking it means that you were able to make it to work on
the client questions like “Was there ever a time time every day this week?” or “What do you think
when you did not have this problem?” or “Were someone else would say about someone who was
there times when you effectively managed the able to do that?” or “What do you think your life
problem?” or “Can you tell me about a time when would look like if you didn’t have the problem?”
you were able to overcome your problem?”
Preference Questions
Externalization
Questions intended to help narrative therapists
In externalization, the therapist and the client and their clients better understand client prefer-
work collaboratively to find language to describe ences are preference questions. Preference ques-
and ways of thinking about problems as separate tions are often used with deconstructive questions
from one’s identity. Externalizing client problems when learning about cultural supports or tactics to
often involves referring to problems as entities in deal with a problem. They can also help evince cli-
and of themselves, which helps remove the sense ent preferences about a problem’s influence and
that the problem resides within the person. This also effects. An example of a preference question in NT
helps to de-pathologize the individual. Sometimes, might be “What would that be like?” or “What do
especially with children, this can involve imagining you think about that?”

Reconnection Interviews of a client’s stories to a carefully chosen group of

friends or significant others in the client’s life.
Reconnection interviews can help narrative
Witnesses are advised not to congratulate the client
therapists consider a client’s problem and/or the
but to dialogue with the client about how he or she
client’s reaction to the problem from the perspec-
has changed his or her understanding of the domi-
tive of a respected friend or family member. This
nant story. This helps solidify and reinforce the
allows for outside feedback from someone who
reauthoring of a client’s story.
can see the client or family outside of the problem-
atic context. When facilitating a reconnection
interview, a narrative therapist will ask a client to Therapeutic Process
find a person in his or her past who would recog-
Joining is the first step in NT. The ability of a nar-
nize and appreciate life outside the problematic
rative therapist to join with a client or family
story. Clients then provide details of the relation-
depends largely on how well he or she is able to
ship with that person, finding a specific event that
understand the context of the problem while
happened in the presence of him or her that high-
focusing on strengths and areas of competence.
lights an example of life then, outside the current
Many narrative therapists will spend the first ses-
problematic story. The narrative therapist will then
sion discussing only strengths as part of a strengths
link that story and its meaning to the present
assessment to help determine how the client will
and the future, attempting to bring that person’s
overcome constraints to their progressing. All nar-
presence more into the client’s current life.
rative therapists spend significant time early on
establishing a relationship that is collaborative and
Therapeutic Letter Writing free of judgment. Externalization often works well
Narrative therapists will sometimes write letters in achieving this outcome, which is vital to the
to their clients following a session to reflect more success of the approach.
deeply on the themes discussed or to express posi- Future-focused treatment planning generally
tive sentiments regarding a client’s strengths as follows the initial joining efforts. Achieving a
demonstrated in that session. Therapeutic letters future focus involves the narrative therapist
are generally relatively short in length and are encouraging the client or family to imagine what
intended to promote progress between therapy life would be like if the problem were not there.
appointments. If a client or a family is not able to do this, the
narrative therapist encourages them to remember
life before the problem was there or when the
Letter-Writing Campaigns problem was less intrusive. Using an image of life
One of the more risky narrative techniques, outside of the problematic context as a starting
letter-writing campaigns involve having clients point, the future-focused treatment plan sets
choose others in their community of support to short-term goals and considers how progress
write letters to them about them. For example, a might be noticed when it happens. Throughout
family might choose five people who know them and following this process, deconstructive and
outside the problematic story to write them letters. reauthoring questions are used to reinforce
Their lettered stories live outside the professional the story of the client or family outside of the
and cultural inscriptions that define the family’s problematic context.
suffering and are also stories that stand on the During therapy, sessions are used primarily as
belief that change is possible. They are used in NT an opportunity to check in on successes and revisit
to better examine and reinforce alternative or the collaborative therapy plan. During these times,
preferred stories. narrative therapists take great care to notice and
point out examples of the client or family acting
in accordance with their preferred stories. As cli-
Definitional Ceremonies
ents move toward an increased sense of mastery
Definitional ceremonies, sometimes called out- and competence in their lives, sessions are gener-
side witness groups, are the witnessing or a retelling ally lessened. Termination correlates with clients

700 Nature-Guided Therapy
reaching their stated goals and adopting a “This specific model in the broad field of ecotherapies
too will pass” attitude toward new problems in that explore and apply the ecopsychology research
their lives. about how contact with nature can have therapeu-
tic benefits. NGT has been used in the treatment of
Robert Rice mood disorders such as anxiety and depression,
substance abuse, relationship issues, and child and
See also Constructivist Therapies: Overview; Feminist
Therapy; Solution-Focused Brief Therapy; White,
adolescent therapy.
Michael
Historical Context
Further Readings NGT originated in the Australian prison system in
Anderson, H., & Goolishian, H. (1992). The client as the mid-1970s when the clinical psychologist
expert: A not knowing approach to therapy. In George W. Burns was researching targeted rein-
S. McNamee & K. J. Gergen (Eds.), Therapy as social forcers for behavior therapy programs. He observed
construction (pp. 25–39). Newbury Park, CA: Sage. that nature contexts were most commonly rated as
Duvall, J., & Beres, L. (2011). Innovations in narrative rewarding, relaxing, and enhancing. Researching
therapy: Connecting practice, training, and research. this observation—across multiple disciplines that
New York, NY: W. W. Norton. often did not find their way into the psychotherapy
Epston, D., & White, M. (1990). Narrative means to literature—he found considerable evidence show-
therapeutic ends. New York, NY: W. W. Norton. ing the therapeutic benefits of human–nature con-
Freedman, J., & Combs, G. (1996). Shifting paradigms: tact. Over the next couple of decades, he developed
From systems to stories. In J. Freedman & G. Combs and clinically trialed the Sensory Awareness
(Eds.), Narrative therapy: The social construction of
Inventory (SAI). In 1998, he published his findings
preferred realities (pp. 1–18). New York, NY:
and therapeutic applications in the book Nature-
W. W. Norton.
Guided Therapy.
Madigan, S. (2011). Narrative therapy. Washington, DC:
American Psychological Association.
Madigan, S., & Epston, D. (1995). From “spy-chiatric gaze” Theoretical Underpinnings
to communities of concern: From professional
monologue to dialogue. In S. Friedman (Ed.), The NGT is grounded in the theory that throughout
reflecting team in action: Collaborative practice in family our long evolutionary history, we have developed a
therapy (pp. 257–276). New York, NY: Guilford Press. “biological fit” with nature. This adaptation to our
Madsen, W. C. (2007). Collaborative therapy with multi- natural environment has been a crucial fact in our
stressed families. New York, NY: Guilford Press. physical, psychological, social, and spiritual well-
White, M. (2007). Maps of narrative practice. New York, being. In recent centuries—a very brief time in our
NY: W. W. Norton. evolutionary history—we have gone from nomadic
Wylie, M. S. (1994). Panning for gold. Family Therapy to agrarian to high-density, highly urbanized envi-
Networker, 18(6), 40–48. ronments, which has resulted in an increasing
Zimmerman, J., & Dickerson, V. (1996). If problems detachment from our historic and evolutionary
talked: Narrative therapy in action. New York, NY: connections with nature. Growing industrializa-
Guilford Press. tion, urbanization, and technology are claimed to
have outstripped our biological evolution, result-
ing in a negative effect on our personal well-being,
as seen in factors such as the escalating rates of
NATURE-GUIDED THERAPY depression in the urbanized, developed world.
Because we are now living in a world vastly differ-
Nature-guided therapy (NGT) takes a systemic ent from the environments in which we evolved,
approach to therapy, seeking to assist people not this mismatch is seen as a cause of much emotional
solely in terms of their individual psyches, relation- discontent and physical disease.
ships, family systems, or social and cultural milieu NGT seeks to help people reconnect with nature
but also in the person–nature connection. It is a in ways that will benefit their well-being by taking

Nature-Guided Therapy 701
the evidence-based findings and translating them provides both the therapist and the client with 60
into practical, beneficial therapeutic interventions. to 120 items that enhance the client’s sense of well-
being. Most of these items are usually nature based
and serve as the foundation on which to offer
Major Concepts
therapeutic activities and mindfulness exercises.
Four major concepts underpin the evidence that
human–nature contact can reduce levels of stress, Psychoeducation
lift feelings of depression, enhance experiences of
well-being, improve parasympathetic nervous sys- Psychoeducation informs the client about the
tem functioning, and facilitate optimal functioning: research, the client’s own personal experiences
from the SAI, and the values to be derived from the
1. In nature, people commonly escape the therapeutic exercises.
pressures and stressors of day-to-day life, such
as when gardening, walking through a park, or Nature-Guided Interventions
vacationing at the beach.
The SAI serves as a basis for offering nature-
2. In nature, there is a sense of being part of an guided interventions. For example, if a person lists
overall larger context, and this tends to alter the activity of walking with enjoying the sight of
people’s perspective on other issues. the ocean, the sound of breaking waves, the smell
3. Nature provides a rich variety of sensory of the salt air, and the feel of the sea breeze on his
stimulation that helps shift internal focus and or her skin, an intervention to help relaxation,
depressive ideation. improve mood, or shift unwanted cognitions may
be to take a daily walk along the beach.
4. Nature, in which we evolved, is conducive to
both psychological and physical feelings of
well-being. Nature-Guided Imagery Interventions
Where it is not possible, practical, or safe for a
Techniques person to engage in in vivo activities, it is possible
to introduce them to such experiences by guided
The threefold process on which NGT bases its imagery.
specific strategies and interventions for therapy is
as follows:
Nature-Guided Mindfulness
1. Assist a person to reconnect with his or her Nature-guided mindfulness—either in vivo or
positive sensory experiences of nature. imagery based—invites the client to select a pre-
ferred place in nature where the client can sit qui-
2. Help facilitate a mindful awareness of the
etly for 10 to 15 minutes, mindfully attending to
sensory connections with nature.
each sense modality—first being aware of his or her
3. Engage the person in individualized human–nature visual experiences of nature, followed by auditory,
connections to enhance his or her well-being. olfactory, taste, and tactile sensations.
These three steps are facilitated by the specific Couple and Family Therapy
techniques discussed in the following subsections.
In couple and family therapy, individuals com-
plete the SAI and then share their inventories with
Sensory Awareness Inventory
each other and engage in shared exercises to
Information is gathered about clients’ sensory increase well-being of the self, the other, and the
experiences that provide them with pleasure, com- relationship. The inventories are used to recall past
fort, and enjoyment. Listing 10 to 20 items under mutual nature-based pleasures, extend current and
headings for each of the five basic senses, plus one future mutual pleasure, and reinforce relationship
category for activities or things they enjoy doing, bonds.

702 Neo-Freudian Psychoanalysis
Therapeutic Process Horney and Fromm are also classified as “charac-

ter analysts.” A major thrust of their work centers
NGT tends to be a Brief Therapy without a pre-
on character types that emerge as a result of inter-
scribed number of sessions. Some people find that
action with an ill society. The neo-Freudian
in one or two sessions they have sufficient skills to
character analysts have contributed significantly
alter mood, cognitions, and behavior in more help-
more in the area of developmental theory and psy-
ful ways. With long-standing and intense issues, it
chopathology than in psychotherapy process.
may serve as an adjunct to other therapeutic inter-
Neo-Freudian ideas have often been described as a
ventions such as cognitive-behavioral therapy,
blend of psychotherapy, social science, and literary
Brief Therapy, solution-focused therapy, positive
movement.
psychotherapy, hypnotherapy, mindfulness, and
various counseling approaches. A follow-up ses-
sion is recommended to assess the client’s progress Historical Context
and offer recommendations for maintaining that
The heyday of neo-Freudian thinking was
progress.
between 1930 and 1950. At that time, neo-
George W. Burns Freudians were in dialogue and conflict with the
firmly entrenched psychoanalytic ego psycholo-
See also Ecological Counseling; Ecotherapy; EcoWellness gists, such as Anna Freud and David Rappaport.
Neo-Freudians were bringing a new and vital
interdisciplinary discussion to the analytic insti-
Further Readings
tutes. Also, during this period, there was a grow-
Burns, G. W. (1998). Nature-guided therapy: Brief ing interest in group and family therapies, which
integrative strategies for health and wellbeing. helped prepare for what was to become a major
Philadelphia, PA: Brunner-Mazel. conflict over the relative importance of intrapsy-
Burns, G. W. (2005). Naturally happy, naturally healthy: chic versus environmental factors in development
The role of the natural environment in well-being. In and psychopathology.
F. A. Huppert, N. Baylis, & B. Keverne (Eds.), The The wide and diverse interests of the neo-
science of well-being (pp. 405–431). Oxford, England: Freudian pioneers did not allow for the necessary
Oxford University Press. cohesion to establish a separate school of thought,
Burns, G. W. (2009). The path of happiness: Integrating
and traditional psychoanalytic institutes rejected
nature into therapy for couples and families. In
the socio-psychoanalytic attack on Freudian ortho-
L. Buzzell & C. Chalquist (Eds.), Ecotherapy: Healing
doxy. Horney and Fromm were politically astute
with nature in mind (pp. 92–103). San Francisco, CA:
and elected to bypass the traditional analytic insti-
Sierra Club Books.
tutes’ discussions of their new ideas. Instead, they
Burns, G. W. (Ed.). (2010). Happiness, healing,
enhancement: Your casebook collection for using
produced a large number of very accessible and
positive psychotherapy. Hoboken, NJ: Wiley. popular books for the lay public spelling out their
major arguments. This produced further animosity
in the classical analytic community. The tradition-
alists felt that the neo-Freudians were going over
their heads to the public. Classical analysts were
NEO-FREUDIAN PSYCHOANALYSIS also responding to the neo-Freudian interest in
issues beyond the consulting room (i.e., cultural
The term neo-Freudian psychoanalysis has been and economic issues). The pivotal event highlight-
loosely defined to include a wide variety of post- ing this conflict of approaches was the removal of
Freudian viewpoints and, at times, has included Horney from her training analyst position in the
the work of Alfred Adler, Carl Jung, Karen New York Psychoanalytic Society for essentially
Horney, Erich Fromm, and Harry Stack Sullivan. “undermining” Freudian theory and changing psy-
Horney and Fromm have emerged as the most choanalysis into a “social psychology.” Fortunately
prominent spokespersons for this sociocultural for psychoanalysis, Horney was undeterred and
offshoot of classical psychoanalytic theory. Both along with several colleagues formed a new

Neo-Freudian Psychoanalysis 703
institute to develop their ideas. In addition, she domesticity was encouraged and when women’s
was important to the founding of the Association professional options were very limited.
for the Advancement of Psychoanalysis. Horney stands out in her vigorous attack of
Freud’s early physiodynamic theories and espe-
cially his patricentric view of female development.
In a series of provocative articles, she attacked
The major conceptual shifts that characterize Freudian concepts such as penis envy and the sex-
Horney and Fromm and their theories is a repu- ual basis of neurosis, and in their place, she substi-
diation of the primacy of Freudian instinct theory, tuted concepts such as womb envy, dread of the
a move to a more life-span approach to develop- vagina, and the proposition that women rather
ment to replace psychosexual theory, and a rejec- than desiring a penis longed for the power denied
tion of the general pessimism attendant to by the masculine culture. She asserted the existence
Freudian psychic determinism. In its place, a field of a primary femininity and claimed that the wish
theory and cultural view of psychological devel- for motherhood was not derivative of failed
opment and illness is offered. Neo-Freudian masculinity, as Freud had suggested.
psychoanalysis is often referred to as socio- According to Horney, neurosis emerges from
psychoanalysis. Neurosis is seen as emerging from living in a neurotic culture and within a family
a neurotic culture, and as Fromm suggests, there system that is struggling with that culture. She
is a “pathology of normalcy.” In this concept, argued that the classical parent–child interaction
Fromm draws attention to the self-negating cannot be extracted from the cultural milieu.
accommodations required in the Western socio- Traditional analysts frequently critique Horney’s
economic context. emphasis on here-and-now neurotic solutions at
While this theory had considerable currency in the expense of their historical antecedents and
the mid-20th century, it has not survived as a dis- unconscious elements. It was, in fact, for this socio-
crete approach. The basic principles espoused by psychoanalytic here-and-now approach that
these psychoanalysts, however, have become inte- Horney was forced to leave the New York
grated into many of the contemporary approaches Psychoanalytic Society, after which she founded
to psychoanalytic treatment, especially those that her own institute.
rely on field theory and relational concepts. Coupled with this theoretical challenge, Horney
Horney’s invocation of the Self in terms of Real also repudiated instinct theory, which set the stage
and Ideal Self states set the stage for a more fully for her cultural theory of human development. This
elaborated set of theories found later in the work shift from biological determinism to object rela-
of Sullivan and Heinz Kohut. There is also a strong tions predicts the eventual emergence of contempo-
element of existential choice and self-actualization rary intersubjective theory steeped in postmodern
in their theories, which are seen more developed in sensibilities and quantum field theory.
the work of Carl Rogers and other humanistic
psychologists.
Erich Fromm
Fromm was a prominent and accessible writer
Karen Horney
on psychoanalytic issues who played a major role
The context for understanding the work of in establishing the importance of the social and
Horney is her revolt against Freud’s theory of economic setting as crucial in establishing the
female development. Much of what follows in this client’s internal world and personality orientation.
entry addresses Horney’s analysis of masculine Working from a Marxist perspective, he helped
civilization’s devaluation of women and women’s outline the importance of capitalism in the forma-
resultant internalization of this identity. While her tion of character structure. He endeavored to help
researches on the Feminine Type took place in the society move toward a democratic, humanistic
mid-20th century, many of her ideas still serve to socialism. For Fromm, modern society has failed
fuel the ongoing feminist path in psychoanalytic humans in their search for meaning and personal
theorizing. She was writing in a time when female fulfillment.

704 Neo-Freudian Psychoanalysis
Fromm was deeply immersed in an existentialist motivators of infant development. These concepts
paradigm for understanding the nature of the human predict the development of attachment research.
situation and the construction of personality. He
posited that one of humankind’s deepest needs is to Basic Anxiety
overcome a sense of aloneness and that a complete
lack of relatedness would lead to insanity. He was Basic anxiety emerges from the dysfunctional
particularly interested in the character formations family system and involves a lack of emotional
that led individuals to want to eschew their freedom containment, feelings of being small and helpless,
to become or be authentically themselves. Focusing and a generalized fear of the world.
on the confluence of people’s innate biological vul-
nerability and the fact that human evolution has Basic Hostility
separated humans from their instinctive oneness Basic hostility is a repressed reaction of rage to
with nature, Fromm says that humans are given a those hostile environments that have created the
freedom to choose between engaging the world in self-imposed restraints necessary for security and
love and productivity and seeking refuge in character the resultant basic anxiety. Basic hostility and basic
orientations that destroy freedom and integrity. anxiety are in a reciprocal relationship.
Fromm, like Horney, tended to publish his ideas
for the general public and avoided the rigidity of
“analytic institute” dialogue. This led to consider- The Ideal Self
able push back from traditional psychoanalytic The Ideal Self refers to the Self that people
theoreticians, who tended to view him as a wealthy aspire to achieve. However, because it is an ideal,
and rather Pollyannaish individual unwilling to it is impossible to achieve. Therefore, pursuit of
look at humankind’s darker nature. However, oth- the Ideal Self is at the expense of discovering the
ers have noted that this does not hold up in light of Real Self. Horney suggested that the Ideal Self
his many writings on human destructiveness and the refers to the Self that contemporary women aspire
necrophilius character. He fulfilled the role of gadfly to achieve. It is, however, patterned after the ideal
and provocateur to the rather conservative and woman seen in man’s eyes and is thus in line with
staid traditional analysts of the mid-20th century. patriarchal values.
Major Concepts The Real Self

Neo-Freudian psychoanalysts did not codify a The Real Self refers to a set of potentials at the
coherent set of principles to guide psychotherapy. core of the personality that is too often obscured
They did, however, provide a forceful challenge to by the neurotic solutions to our cultural illness and
traditional intrapsychic psychoanalysis in positing emerges from exercising our freedom to choose a
the influence of culture and object relations on the path consonant with our internal endowment.
emerging personality and resultant psychopathol-
ogy. Their approach is founded in a mix of psy- The Masculinity Complex
choanalytic principles and existential philosophy.
Emerging from this matrix are the concepts of This complex refers to the envy of men and the
personal freedom, choice, and the potential for wish to be a man, which is internalized in response
self-actualization through personal accountability. to the patriarchal culture. It is rooted in the
The following offer some of Horney’s and Fromm’s discrimination of women.
ideas that place them clearly in the neo-Freudian
camp. Neurotic Styles
These coping styles are strategies to manage
Karen Horney basic anxiety. Horney ultimately identified three
patterns: (1) moving toward people, (2) moving
Safety and Satisfaction
away from people, and (3) moving against people.
The drive for safety and satisfaction are seen These patterns act out helplessness and compliance,
to replace the pleasure principle as the primary isolation, and hostility, respectively.

Neo-Freudian Psychoanalysis 705
The Feminine Type The exploitative orientation also views everything of

value outside the Self; however, one has to work to
The feminine type is characterized by an over-
get it by whatever means. There are no expectations
valuation of love from a man, excessive competi-
that one will be given anything.
tiveness with other women, the adoption of a
compliant and dependent stance, sexualization The hoarding orientation is characterized by gaining
within the family environment, and the use of pro- security through hoarding and saving. There is little
jective identification (externalized living) to sur- productive thinking, and there is a pedantic orderli-
vive in the male-dominated culture. In addition, ness and cleanliness present.
Horney identifies the devaluation of behaviors that
The marketing orientation is based on selling oneself
detract from sexualized femininity.
as if one were a product. Human qualities are trans-
formed into assets and tools to bring a greater
Erich Fromm reward.
The Thrown Condition The productive orientation is characterized by relat-
The thrown condition is a term that denotes the edness in all realms of human experience, the use of
existential conditions of helplessness and vulnera- reason and love rooted in productiveness.
bility that mark the human condition, including
the perpetual defeat by death. To Have or To Be
This relates to Fromm’s conviction that the
Freedom receptive, exploitative, hoarding, and marketing
Freedom denotes Fromm’s belief that human orientations are about accumulation and having,
beings are free to create their lives in an authentic while the productive orientation is about being or
and loving manner but the forces of the thrown becoming a full human being.
condition make this a difficult choice.
Escapes From Freedom Therapeutic Process

There are three major routes humans use to The main contributions to psychotherapeutic tech-
attempt to escape the task of creating themselves nique based on the work of Horney center on two
authentically: fundamental shifts. First and foremost, she helped
usher in the shift away from a decidedly patricen-
1. Destructiveness, which aims at eliminating the tric classical theory to a more matricentric, dyadic,
object and is in direct relationship to the amount and mother–child object relations approach. This
of the expansiveness of life the Self curtailed. she did with the assistance of the other “mothers
of analysis,” Anna Freud, Helen Deutsch, and
2. Authoritarianism, which aims at fusing the Self
Melanie Klein. The feminine presence in psycho-
with somebody or something outside the Self,
analysis also helped move the focus of analytic
with the aim of symbiosis.
work away from oedipal to pre-oedipal issues.
3. Automaton conformity, which relates to While early-childhood experiences were impor-
nonthinking mimicry. tant, there was an equal focus on the here-and-
now struggle with neurotic coping styles.
Personality Orientations The emotional climate of the therapeutic contact
This typology refers to the basic personality ori- also moved from one solely devoted to unearthing
entations (character types) that Fromm identified pathology to one of mobilizing the constructive
that result from developing in our Western socio- forces of the personality. It was the goal of therapy
economic matrix. These include the following: to replace the Ideal Self with the Real Self.
Coupled with this is the underlying field theory
The receptive orientation, which sees everything of approach, which endorses the social matrix for
value outside the Self. There is a dependent stance emotional disorder. Horney’s approach helped
toward life. It is highly correlated with need and evolve the psychoanalytic listening perspective
entitlement to be loved. from a more distant and sterile analytic inquiry

706 Neurofeedback
into a more available and warm listening presence Horney, K. (1937). The neurotic personality of our time.
that exuded more elements of positive psychology New York, NY: Henry Holt.
and optimism. Horney’s emphasis on the failing Horney, K. (1967). Feminine psychology. New York, NY:
family system, and not just the mother’s mind, Henry Holt.
helped pave the way for a more systems approach McLaughlin, N. (1998). Why do schools of thought fail?
to therapeutic intervention. Neo-Freudianism as a case study in the sociology of
Horney and the other neo-Freudians adopted knowledge. Journal of the History of the Behavioral
many of the classical concepts related to the impor- Sciences, 34(2), 113–134. doi:10.1002/(SICI)1520-
6696(199821)34:2<113::AID-JHBS1>3.0.CO;2-T
tance of childhood relationships, the importance of
McLaughlin, N. (2000). Revisions from the margins:
the unconscious, and the importance of defense
Fromm’s contributions to psychoanalysis.
analysis. They supported the importance of techni-
International Forum of Psychoanalysis, 9, 241–247.
cal paradigms, including free association and dream
doi:10.1080/080370601300055679
analysis. The focus of interpretation, however, was Sayers, J. (1991). Mothers of psychoanalysis. New York,
not focused on oedipal dynamics (intrapsychic) but NY: Henry Holt.
on interpersonal and field (family) experience. Westcott, M. (1986). The feminist legacy of Karen
Foremost for Horney is her assessment of how the Horney. New Haven, CT: Yale University Press.
family had become a vehicle for the derailing of
young girls’ development through sexualization
and the devaluing of assertive capacities.
Perhaps one of the most important contribu-
tions emanating from Horney’s work is the high-
NEUROFEEDBACK
lighting of self-responsibility and the ability to
make choices to articulate a new vision for one’s Neurofeedback, or biofeedback for the brain, is a
life. Eschewing the psychology of victimization noninvasive method of brain wave neuromodula-
and emancipating the constructive forces of the ton and neurorehabilitation that is facilitated by
psyche are the fundamental underlying principles the use of a computer software interface and
of her work in psychoanalysis. In this work, she electroencephalogram (EEG). The definition of
helped establish the foundation for future neuromodulation is the alteration or changing of
approaches such as the existential-humanistic some aspect of neuronal functioning. Neurofeed-
approaches that emphasized responsibility and back treatment is often recommended for people
choice in the development of the Self. who have different types of brain dysregulation.
Neurofeedback involves measuring brain wave
Allen Bishop frequencies over time. With advances in neurosci-
ence and neurocounseling, and the introduction
See also Adler, Alfred; Adlerian Therapy; Analytical and understanding of neurofeedback as a counsel-
Psychology; Classical Psychoanalytic Approaches: ing intervention, helping professionals can utilize
Overview; Contemporary Psychodynamic-Based many efficacious neurofeedback treatments and/or
Therapies: Overview; Freud, Sigmund; Freudian
refer clients to certified neurotherapists. Neuro-
Psychoanalysis; Horney, Karen; Humanistic
feedback has the capability of assisting persons to
Psychoanalysis of Erich Fromm; Jung, Carl Gustav;
Jungian Group Psychotherapy; Klein, Melanie; Rogers, live in a more efficient and effective manner and
Carl; Sullivan, Harry Stack has significant potential in preparing future helping
professionals, research, and practice.
Further Readings
Historical Context
Fromm, E. (1941). Escape from freedom. New York, NY:
Henry Holt. From the beginning of time, humankind has tried
Fromm, E. (1955). The sane society. New York, NY: different methods of self-regulation. Praying, medi-
Henry Holt. tating, exercising, and using substances to alter
Fromm, E. (1973). The anatomy of human consciousness were often early methods to alter
destructiveness. New York, NY: Henry Holt. and regulate the mind and the body. As early as

Neurofeedback 707
1875, a British physician, Richard Canton, discov- is sleeping. Theta waves (5–8 Hz) are observed
ered that the brain had electrical impulses, or when persons are drowsy, daydreaming, or medi-
waves. Around 1924, Hans Berger, a German psy- tating. Alpha waves (9–13 Hz) are often seen when
chiatrist, created the first device to measure and persons are relaxed, idling, and not focusing on a
record the amplification of brain waves. This was task. Beta waves (13–18 Hz) are required to solve
the beginning of the electroencephalograph. Berger’s a problem or complete a task. Gamma waves
basic method of gathering brain wave electrical (35–45+ Hz) are often considered insight, consoli-
activity is still used today. Brain research continued dation, and higher level cognition waves. An easy
throughout the next few decades with promising pneumonic to assist in remembering the different
discoveries. In the early 1960s, researchers such as brain wave categories is Do Think About Brain
Joe Kamiya and Barry Sterman, working with Growth.
alpha states and low beta states, respectively, pub- There are many unique and different causes of
lished work that allowed neurofeedback to gain brain dysregulation. The most widely recognized
acceptance in the psychological realm. source is genetic inheritance. Early prenatal devel-
Sterman was hired by NASA (National opmental and birth complications may also cause
Aeronautics and Space Administration) to help dysregulation. The manner in which one eats may
astronauts who were having seizures because of cause dietary deficiencies. Environmental toxins
exposure to jet fuel. He began working with cats may also influence dysregulation. Other possible
and teaching them through a basic reward system causes of dysregulation include suppressive psy-
to control their resting brain waves. His research chosocial environments, head injuries, and alcohol
was not immediately available to the public for and/or drug abuse. Additional conditions such as
security reasons, but it became the underpinning seizures, strokes, and chronic ailments also influ-
for today’s neurofeedback protocol for attention- ence the brain’s efficiency. Even extended use of
deficit/hyperactivity disorder (ADHD) and seizure prescribed medications can alter brain efficiency.
work. Joel Lubar continued this work and began Finally, cognitive decline associated with aging
to replicate and expand the protocols for children and lack of exercise is an additional source of
with ADHD. Margaret Ayers began working with dysregulation.
neurofeedback and brain traumas, and Siegfried
and Sue Othmer used their physics background to
Major Concepts
develop new amplifiers and new training proto-
cols. Using neurofeedback, Eugene Peniston began To understand neurofeedback, one should have
working with veterans in the early 1990s and pub- basic knowledge of neuroplasticity, the efficacy
lished positive outcomes in addictions and trauma. guidelines, the goals of neurofeedback, and for
In the early 2000s, Leslie Sherlin began working whom the process seems to have worked best—
with athletes to develop peak performance. Since that is, knowledge of the evidence-based research.
that time, much research has been done on a
norm-based quantitative EEG and low-resolution
Neuroplasticity
brain electromagnetic tomography for diagnosis
and treatment. The majority of the research today Fifty years ago, researchers discovered that the
focuses on the validation of neurofeedback brains of mice and cats could be trained with oper-
protocols for specific symptom relief. ant and classical conditioning. Neuroscientists now
understand that the malleable, 3-pound human
brain has the capability to adapt and develop new
living neurons by engaging new tasks and chal-
To understand neurofeedback, a concise summari- lenges throughout life. This neuroplasticity can
zation of the major brain wave categories is needed. rearrange neuronal pathways by creating new neu-
Five brain waves are typically observed during rons, called the process of neurogenesis; this can
neurofeedback: (1) delta, (2) theta, (3) alpha, especially occur in the hippocampus. There is a
(4) beta, and (5) gamma. Delta waves are typically growing body of research demonstrating that the
0 to 4 Hertz (Hz) and are observed when someone brain can be taught to self-regulate and become

708 Neurofeedback
more efficient through neurofeedback. Many prac- Goals of Neurofeedback

titioners now believe that humans are capable of
Neurofeedback is a therapeutic intervention
intentionally controlling neural functioning when
that utilizes hardware and software capabilities in
trained properly.
which the client interacts with audio or video pro-
grams or games that can lead to changes in irregu-
Efficacy Guidelines lar brain wave patterns. Often, regional cerebral
blood flow is also observed along with the brain
Neurofeedback has been applied to many waves that are associated with physiological,
physiological and psychological problems. All behavioral, and psychological problems. It is
areas of neurofeedback’s efficacy have not been essential to understand that neurofeedback clients
thoroughly demonstrated, as the expense of dou- receive no electrical input. The outcome of neuro-
ble-blind controlled research studies is often feedback is to offer feedback of bandwidth activ-
restrictive. The Association for Applied ity relating to the client’s neuronal needs and
Psychophysiology and Biofeedback and the goals.
International Society for Neurofeedback and There are three main neurofeedback goals. The
Research, two professional organizations, devel- first is to normalize and reregulate brain function-
oped efficacy guidelines and levels. There are five ing, the second is to restore brain efficiency, and
levels of efficacy ratings. These efficacy levels are the third is to optimize daily brain performance.
essential to know, so that clinicians can advocate Often, just living life and making poor life choices
for neurofeedback with proper knowledge of causes brain dysregulation. This may create a
research outcomes. state of neurological overarousal, underarousal,
A rating of Level 1 suggests that a particular or instable arousal. Examples of overarousal
protocol is not empirically supported, except include anxiety, anger, obsessive-compulsive dis-
through anecdotal evidence or non-peer-reviewed order, insomnia, impulsiveness, and distractibility.
case studies. This rating does not mean that a par- Examples of underarousal include depression,
ticular neurofeedback treatment is not worthwhile, lack of concentration, and difficulty waking.
but it does let the practitioner know what research Illustrations of instability are less obvious but
has been accomplished. Level 2 has the rating of include migraine headaches, seizures, bipolar dis-
possibly efficacious by means of positive outcome orders, fibromyalgia, and posttraumatic stress
research but with no control group. Level 3 is disorder. In the instable arousal state, the body
probably efficacious, indicating that the protocol has a difficult time transitioning from one brain
has produced positive effects in more than one state to another.
clinical, observational wait list or within-subject or
between-subject study. Level 4 is an efficacious rat-
ing, indicating that the protocol has been shown to
Evidence-Based Research
be more effective than the outcomes for a no-
treatment or placebo control group and that at As noted previously, neurofeedback has been
least two studies have demonstrated the same particularly successful in the treatment of ADHD.
degree of efficacy. Level 5 is efficacious and spe- Other neurofeedback research studying veterans
cific, with outcomes that are statistically superior with posttraumatic stress disorder found only a
to those of a credible placebo in two or more 20% relapse of panic attacks. Several other neuro-
independent studies. feedback studies demonstrated a 70% reduction in
There are very few neurofeedback protocols epileptic seizures and discussed major improve-
that have achieved a Level 5 rating. However, in ments in depression after a 1-year follow-up. One
the area of ADHD, the research has been consis- landmark study discussed an increase of more than
tent and has shown the effects of neurofeedback 12 IQ (intelligence quotient) points in children
training to be profound and long lasting. This rat- with learning disabilities. Finally, several studies
ing and meta-analyses support the use of neuro- stated an 80% sobriety rate after a 4-year follow-
feedback as an evidenced-based treatment for up for alcoholics in a treatment program who also
children with ADHD. received neurofeedback training.

Neurofeedback 709
Techniques Teaching skin temperature control is another

method of helping clients understand how much
Some of the important techniques related to neuro-
control they have over their physiology.
feedback are establishing a baseline and brain
wave functioning assessment, determining treat-
ment protocol, and teaching heart rate variability.
Therapeutic Process
Establishing a Baseline and Brain Wave Individual treatment for neurofeedback sessions last
Functioning Assessment approximately 20 to 40 minutes. To gain the most
effective, overall treatment effect, neurofeedback
Neurofeedback reregulates neuronal activity clients usually require at least 20 sessions. To obtain
through the same principles of operant and classi- the maximum treatment effect, continuous, repeated
cal conditioning as do many other learning activi- sessions are required. Treatment plans are custom-
ties. The client’s current brain wave functioning is ized for each individual, and the number of sessions
first assessed by establishing a baseline. Often, this is based on the severity of symptoms and the
EEG assessment is conducted by measuring brain number of symptoms. The treatment can usually be
wave activity at five different locations on the completed in 20 to 40 sessions, and the cost of
scalp: (1) midline (CZ), (2) left occipital lobe site neurofeedback is slightly more than that of a regu-
(O1), (3) left prefrontal cortex (F3), (4) right pre- lar therapeutic hour. In some extreme cases, such as
frontal cortex (F4), and (5) above the midline (FZ). a diagnosis of autism, as many as 60 sessions may
This five-channel EEG or a more intensive and be required.
thorough, 19-channel EEG may be used for assess- Neurofeedback is a painless treatment with very
ment. Attaching noninvasive electrode sensors to few contraindications. A few clients have reported
the scalp with conductive paste and having the mild headaches. When side effects are shared with
client keep his or her eyes open or closed, read, the neurotherapist, brain wave thresholds can be
listen, and complete a mathematical problem, changed to eradicate the unwanted symptom. The
such as counting backward from 100 by sevens, most common consequence of a neurofeedback
measures several conditions and tasks. session is a tired brain, much like the tiredness
experienced after physical exercise.
Determining Treatment Protocol A major benefit of neurofeedback is that it can
be the treatment choice for a variety of physical
After the baseline data are analyzed, a neuro-
and psychological problems. A primary reason for
feedback treatment protocol is determined and
employing neurofeedback is to resolve the prob-
discussed with the client. The neurofeedback clini-
lems at the source, the brain. Neurofeedback relies
cian then reinforces and inhibits the required brain
on established principles of operant and classical
waves by setting desired thresholds. The client’s job
conditioning and learning, and the results can be
is to observe or listen to a computerized game,
objectively documented with brain wave charts,
video, or music on a computer monitor. The neuro-
statistics, and behavioral checklists. The results
feedback outcome is to eventually teach the client
tend to be long lasting unless another incident
to have the right brain wave for the right task at
occurs to dysregulate the brain, such as a major
the right time, allowing the brain’s response to
illness or organic brain trauma. Neurofeedback
become automatic and generalize to future tasks.
has assisted many clients to sometimes reduce or
even eliminate medications and certain symptoms.
Teaching Heart Rate Variability Another important neurofeedback benefit is that
Often, the biofeedback skill of heart rate vari- clients learn to rely on internal, not external, meth-
ability is taught to the client before the neurofeed- ods for staying healthy and living life effectively.
back training begins. Using a HeartMath software Lori A. Russell-Chapin
program is a simple and elegant method of assist-
ing clients to focus on their breathing, control the See also Biofeedback; Brain Change Therapy; Evidence-
variability of their heart rate, and begin to relax. Based Psychotherapy; Heart Rate Variability; HeartMath

710 Neuro-Linguistic Programming
Further Readings recalls a memory of love and connection as if view-

Chapin, T., & Russell-Chapin, L. (2014). Neurotherapy
ing it from a distance, so the client is unable to
and neurofeedback: Brain-based treatment for experience the special feelings he or she had with
psychological and behavioral problems. New York, that person and has only a feeling of emptiness.
NY: Routledge. The process for resolving a phobia is to learn how
Demos, J. N. (2005). Getting started with neurofeedback. to take a distant objective point of view, while the
New York, NY: W. W. Norton. process for resolving grief is to learn to reexperi-
Doidge, N. (2007). The brain that changes itself. New York, ence the loving memory by being inside it so that
NY: Penguin Books. the loving feelings can be experienced again. This
Myers, J., & Young, J. S. (2012). Brain wave biofeedback: example illustrates several key principles of NLP:
Benefits of integrating neurofeedback in counseling.
Journal of Counseling & Development, 90, 20–28. 1. The subjective structure of a problem indicates
doi:10.1111/j.1556-6676.2012.00003.x exactly what needs to be done to resolve it.
Othmer, S. (2007). Overview of neurofeedback
2. Every mental ability can be a valuable skill in
mechanisms: Setting the agenda for research.
Woodland Hills, CA: EEG Institute.
one context and the basis for a serious problem
Russell-Chapin, L., & Chapin, T. (2011). Neurofeedback: in another.
A third option when counseling and medication are 3. These process changes can be made without the
not sufficient. Alexandria, VA: American Counseling therapist knowing the content of the phobia or
Association. Retrieved from http://counselingoutfitters grief, so it is not necessary for the client to
.com/vistas/vistas11/Article_48.pdf discuss disturbing or embarrassing information.
Sherlin, L., Arns, M., Lubar, J., & Sokhadze, E. (2010).
A position paper on neurofeedback on the treatment 4. Because the client already has the ability to
of ADHD. Journal of Neurotherapy, 14, 66–78. remember in the two different ways, it is simply
doi:10.1080/10874201003773880 a matter of teaching him or her the application
Swingle, P. G. (2010). Biofeedback for the brain. New of the ability, making treatment very rapid, in
Brunswick, NJ: Rutgers University Press. many cases one session or less.
Yucha, C. B., & Montgomery, D. (2008). Evidence-based
practice in biofeedback and neurofeedback. Wheat
Ridge, CO: Association for Applied Psychophysiology Historical Context
and Biofeedback.
NLP was originally developed in the mid-1970s by
Richard Bandler and John Grinder, from studying
the verbal and nonverbal behavior of three excep-
tionally skilled and effective therapists: Virginia
NEURO-LINGUISTIC PROGRAMMING Satir (family therapy), Fritz Perls (Gestalt therapy),
and Milton Erickson (hypnotherapy). By examining
Neuro-linguistic programming (NLP) works these therapists’ behavior (and largely ignoring their
directly with the structure of the subjective experi- theoretical ideas about their work), they were able
ence that elicits a client’s problem response, in to extract specific linguistic and nonverbal behav-
contrast to exploring the historical events that cre- iors that these therapists used to elicit new and more
ated the structure. For instance, there are funda- useful behavioral responses in their clients. Building
mentally two ways to recall a memory (1) by being on this, Bandler and Grinder and their students pro-
inside it, as if the event were actually happening posed universal principles, which have been used to
again, or (2) by viewing the same event as an out- develop specific precise intervention protocols for
side observer, as if watching a distant movie of it, quickly resolving a number of common client prob-
which is often described as being “objective.” lems, including anger, anxiety, shame, regret, code-
A client with a phobia remembers an unpleasant pendence, trauma, posttraumatic stress disorder,
memory by being inside it and fully reexperiencing grief, phobias, habits, compulsions, and relationship
the feelings of terror and shock. But a client who is issues. Because NLP replaces a dysfunctional pro-
grieving a loss does exactly the opposite: He or she cess with a functional one, it can be used to teach

Neuro-Linguistic Programming 711
positive and generative skills such as motivation, traditional, verbal-based therapies. Some of these
making decisions, spelling, improving memory, and are primary versus secondary experience, process
developing a secure and stable identity. Therapy versus content, specifying the client’s outcome,
becomes simpler and faster because the therapist fundamental presuppositions, attention to nonver-
needs to learn only one process for addressing each bal communication, injunctive versus descriptive
kind of problem, such as the processes for treating language, scope of experience, categorization, and
phobia and grief illustrated above. While many joining and separating.
other therapies gather extensive historical and
developmental information about family interac-
Primary Versus Secondary Experience
tion patterns, attachment styles, and so on, NLP
only attends to these as they become evident in the Primary experiences are those that are repre-
context of the problem being addressed. sented in one or more of the five modalities. They
are the most powerful experiences in eliciting
responses, the basis of most problems, and an
individual’s most skilled and effective behaviors.
Every thought, memory, or future forecast— In contrast, words are secondary in importance
including the most abstract thinking—is experi- and always refer to groups or categories of expe-
enced as an internal representation in one or more rience. Words can be used to elicit primary experi-
of the five sensory modalities. Three of these ence, but they can also be used to keep an
modalities, visual (images), auditory (sounds or “intellectual” distance from experience and be a
words), and kinesthetic (movements, postures, barrier to change.
and tactile feelings), or some combination of
these, predominate in most problems. Although
Process Versus Content
smell and taste are seldom relevant, they are often
very important when present. Most therapies focus on changing the content of
Submodalities are the smaller process elements a problem. In contrast, most NLP interventions are
within each sense modality. For instance, the size, directed at changing the process, not the content.
closeness, color, movement, and location of an For instance, a client may be asked to change the
image are elements of the visual modality. Volume, tempo, melody, accent, loudness, or location of a
tempo, melody, tonality, and location are all troublesome critical or depressing voice. Although
elements of the auditory modality. Kinesthetic sub- the words remain unchanged, the client’s feeling
modalities include tactile sensations of movement, response often changes significantly because the
temperature, duration, intensity, hardness, extent, client’s feeling response is primarily to these non-
and so on. The submodalities of a troubling verbal aspects of the message, which are mostly
memory can be changed regardless of the content unconscious.
represented, and this kind of change is much easier,
faster, and more impactful than attempting to
Specifying the Client’s Outcome
change the content. For instance, an image of
chocolate cake that is close, large, three-dimensional, A client usually enters therapy with a poorly
and in color tends to elicit a strong feeling of desire. specified outcome that is usually stated as a
If the same image is far away, small, two- negative—the client wants something not to
dimensional, and grey, it will elicit much less intense happen—and usually it is extremely global, such
feeling. This intervention can be very useful in a as “I never want to feel bad.” A well-specified
variety of problems involving impulsivity, including outcome must be initiated and controlled by the
addictions and weight maintenance. client; specified in positive, sensory-based terms;
appropriately contextualized, with specific evi-
dence to know when it has been attained; and
Major Concepts
congruent with the client’s other goals, outcomes,
The major concepts in this approach to counseling and values if the change is to last without
describe a therapy that is very different from creating conflict.

712 Neuro-Linguistic Programming
Fundamental Presuppositions client can consciously understand it. NLP is more

often focused on injunctions and the spontaneous,
One fundamental presupposition is that every
unconscious changes that occur in response: “Do
individual always does the best he or she can at
this, and find out what happens,” “Make that
any moment in time given his or her perceptions,
image of abuse into a small transparent slide, then
knowledge, abilities, and limitations. This normal-
put it far behind you, and find out how that
izes even the most extreme and destructive behav-
changes your response to it.”
ior and focuses the therapist on changing the
client’s abilities and limitations so that more useful
and appropriate behaviors result. Scope of Experience
Another fundamental presupposition is that
every behavior has a positive intention. This sepa- Most problems can be described as some kind
ration of behavior from intention makes it easy to of “tunnel vision,” in which the scope of experi-
validate and agree with the intention and use this ence is so narrow that few alternatives are appar-
alliance as a basis for jointly exploring alternate ent. Expanding the scope of an experience to
new behaviors that could satisfy the intention include the larger context is commonly referred to
without the problematic consequences. This is as “seeing the big picture,” which creates a more
easier than trying to stop a problem behavior, balanced perspective in space—the problem seems
which is usually very difficult or even impossible, smaller and easier to solve when seen in relation to
because that would oppose the positive intention the larger context. This larger context also often
that drives the behavior. includes more information about alternative pos-
Another presupposition is that every behavior is sibilities for dealing with the problem. When a
appropriate in some contexts. This makes it possi- client’s problem is being “stuck” with a horrible
ble to validate the behavior in those contexts, still picture (often metaphorically described as
while exploring alternative behaviors in other con- being “frozen in time”), a process instruction to
texts where the behavior has problematic conse- turn that still picture into a movie and then to
quences. Additional presuppositions also serve to lengthen that movie so that it starts much earlier
guide and orient the therapist’s work in useful and ends much later increases the scope of time,
ways. providing a larger perspective.
However, a client who is confused and troubled
by “overwhelm” may discover that he or she has
Attention to Nonverbal Communication six different colorful movies, with loud sound,
Most therapies attend primarily to the verbal playing inside his or her head simultaneously, so
component of a client’s communication, hence the that it is impossible to attend to any one of them.
common term talk therapy. But because most A client who is overwhelmed needs to be taught
problems are not under the client’s conscious con- how to reduce the scope of his or her experience
trol, the nonverbal components—which are largely and focus on just one movie at a time, so that he
unconscious for most people—are much better or she can attend to it and process it.
indicators of the process of communication and
also of useful changes in that process. NLP includes Categorization
extensive and precise therapist training in attend-
ing to the client’s nonverbal behavior. The therapist People not only attend to a certain scope of expe-
is also trained to utilize the nonverbal components rience, but they also categorize it in some way, by
of his or her own communication—such as voice joining it with other experiences that are similar.
tone, tempo, postures, and gestures—to elicit more A change in categorization will result in a different
useful responses in the client. response, a reframing pattern often called “rede-
scription.” For instance, when someone categorizes
a problem as “insoluble,” it is reasonable to feel
Injunctive Versus Descriptive Language
hopeless and despairing. If the same experience is
Most therapies are focused on describing a recategorized as a “challenge,” it becomes some-
problem, or the history of a problem, so that the thing that may still be difficult but can be overcome

Neurological and Psychophysiological Therapies: Overview 713
with effort and skill. When a client thinks of an Therapeutic Process

event as a “failure,” it can be useful to ask the client
The first step is to elicit and specify the client’s
to recategorize it as useful feedback about his or her
outcome in positive, sensory-based terms, making
responses and behaviors and to use this information
sure that it is attainable and appropriately contex-
to learn how to be different in the future, in contrast
tualized and that the evidence for success is speci-
to futile dwelling on the unchangeable past.
fied, so that the results of testing after treatment
are unambiguous. The next step is to determine the
Joining and Separating structure of the client’s subjective experience of the
problem and to determine what kind of change is
All therapeutic change involves joining two or likely to be appropriate. Next is to select and
more scopes or categories into one experience or deliver an appropriate process to achieve the out-
separating two or more scopes or categories that come and finally to test the results in the client’s
are inappropriately joined. For instance, an iso- experience in appropriate contexts to confirm that
lated troublesome image of failure can be demoral- the treatment has been successful. Treatment for a
izing, particularly if it is very large and colorful. relatively simple and specific outcome such as
However, if it is seen together with four images of anxiety, overwhelm, or a phobia can take as little
success of the same size, it will elicit a more bal- as 30 or fewer minutes; a more general or more
anced and empowering response. A client who complex outcome or group of outcomes may
thinks of himself or herself as stupid can realize require a number of different interventions over
that many, or most, of the examples in the category several sessions.
“stupid” are actually examples of simple ignorance
or lack of knowledge, not stupidity. When all those Steve Andreas and Connirae Andreas
examples of ignorance are put into a separate cat-
egory, the category “stupid” becomes much smaller See also Erickson, Milton H.; Eye Movement Integration
and less disturbing, and easier to change. Therapy; Perls, Fritz; Satir, Virginia; Solution-Focused
Brief Therapy
Techniques
Further Readings
NLP is a comprehensive methodology including a
wide range of techniques. Some change inner Andreas, C., & Andreas, S. (1989). Heart of the mind.
thoughts, some change external behavior, and Boulder, CO: Real People Press.
some change feelings directly. Each method is pre- Andreas, S. (2006). Six blind elephants: Understanding
cise and used for a specific outcome. Each has a ourselves and each other (2 vols.). Boulder, CO: Real
clear structure and sequence, and each is explicit People Press.
about what the method accomplishes and how it Andreas, S., & Faulkner, C. (1994). NLP: The new
technology of achievement. New York, NY: William
does that.
Morrow.
One fundamental technique involves asking the
client to make a change in his or her representation
of the problem and to report how his or her experi-
ence changes as a result of this. For instance, a client
may be asked to add loud, inspiring background NEUROLOGICAL AND
music to the image of a troubling representation PSYCHOPHYSIOLOGICAL THERAPIES:
and then to report any spontaneous change in feel-
ing in response. The resulting change in feeling is OVERVIEW
typically instantaneous, providing immediate feed-
back on the effectiveness (or ineffectiveness) of the Neurological and psychophysiological counsel-
intervention. The therapist suggests changes that are ing theories have been described by some as the
likely to work, but the client is the ultimate author- “last frontier” or “missing link” for the future
ity, reporting whether or not the change actually development of the mental health professions.
makes a useful difference. The emergence of these new theories is grounded

714 Neurological and Psychophysiological Therapies: Overview
in recent advances in neuroscience that prove brain acted as the seat of intelligence, the controller
that the brain can change and grow, which chal- of the body’s biological functioning, and the pro-
lenges the long-held notion that the human brain vider of behavioral responses in relation to one’s
is unalterable. What has become clear in the past environment. Although this was later disproved, he
10 years or so is that the mechanics of the brain described the pineal gland as a linkage between the
drive mental processes and that actual change in functions of the mind and the body. Descartes’s
brain activity and structure can be directly attrib- association of the mind with psychological and
uted to psychological and physical processes. mental processes and the brain with physical and
Whereas neurological counseling focuses on link- biological processes bolstered a dualistic mind–
ing psychological events and brain responses, body dichotomy that many continue to debate
such as the changes in the brain caused by the today.
expression of empathy, psychophysiological At the beginning of the 19th century, the
counseling focuses on linking physical events and Scottish neurologist Charles Bell linked partial
brain responses, such as developing quicker facial paralysis to lesions on specific nerves (Bell’s
hand–eye reactions. To become competent in palsy), the English surgeon James Parkinson pub-
using these theories requires that a counselor be lished his essay on “shaking palsy” (Parkinson’s
knowledgeable about basic neuroscience, the disease), and Czech J. E. Purkinje was the first to
brain’s structure and functioning, its sensitivity describe the neurons in the brain (Purkinje cells).
to environmental factors, and the limitations of Later in the century, the French surgeon Paul Broca
assistive technology. Once adequately prepared, and the German physician and psychiatrist Carl
the counselor is able to identify neurological dis- Wernicke documented locales in the brain linked
connects and select from a wide array of thera- with specific functioning and discovered a separa-
pies and technologies to focus efforts on the tion of function between the left and right hemi-
appropriate regions of the client’s brain and to spheres. Broca identified the area on the left side of
educate the client on brain-based structural, the brain responsible for speech production, while
chemical, biological, and developmental hurdles. Wernicke discovered an area on the left side that
controls speech comprehension.
What many consider a hallmark in the develop-
Historical Context
ment of neuroscience is attributable to the
For thousands of years, generations of philoso- misfortune of a 25-year-old American railroad
phers and scientists have recognized the impor- construction foreman, Phineas P. Gage. While
tance of the brain and have tried to explain the working with explosives, an iron bar more than
link between the brain and the mind. Writings 3 feet in length and more than 1 inch in diameter
from as far back as 1700 BCE contain detailed was blown through Gage’s head, severely injuring
accounts of brain injuries and include the first or destroying the frontal lobes of his brain.
descriptions of the brain. Hundreds of years later, Although the specifics have been clouded by poor
in Ancient Greece, Hippocrates wrote of brain dis- documentation and the passage of time, there are
turbances as a means of explaining epilepsy and many reports that Gage experienced a profound
posited the brain as the seat of intelligence, as did personality change after this brain injury. Gage
Plato and other scholars of that day. Aristotle, will be forever known as one of the first cases that
however, suggested that the heart was the source of confirmed the frontal cortex’s involvement in per-
thought and emotion, with the brain functioning sonality, reigniting the mind–body dualism debate.
as a cooling mechanism for the blood that flowed The 20th century marked a significant period of
through the heart. growth in our understanding of the brain. In 1906,
In the 17th century, René Descartes, a French the Nobel Prize in Physiology was awarded to the
philosopher and physiologist, and Thomas Willis, Italian scientist Camillo Golgi and the Spanish sci-
an English doctor and founding member of the entist Santiago Ramon Cajal for their work in
Royal Society, became prominent figures in brain defining the cell structures of the brain. Although
research. Descartes maintained that the mind con- Golgi’s research maintained that the cells of the
trolled consciousness and self-awareness and the brain formed a continuous network and the nervous

system was a single entity, his work supported Barbara Brown, who conceptualized neurofeed-
Cajal’s findings of a contiguous network of sepa- back as linking the self-regulation of brain waves
rate brain and nerve cells that affect one another. to activating different circuits in the brain.
Around the same time, Sir Charles Scott Sherrington Simultaneously, Antoine Remond experimented
described the existence and functions of the syn- with voluntary control of brain waves, which led to
apse and identified the motor cortex region of the his discovery of a signature EEG pattern associated
brain. The first half of the 20th century also saw with what would later be classified as attention-
the first attempts at brain imaging. The American deficit disorder. The booklet The Alpha Average
surgeon Harvey Cushing, considered by many to be outlined his discoveries, and the disciplines of
the father of modern neurosurgery, became recog- biofeedback and neurofeedback were born.
nized as the first scientist to electrically stimulate By the 1970s, biofeedback researchers like Neal
the human sensory cortex and use X-rays to detect Miller and Leo DiCara provided evidence that vis-
tumors in the brain. ceral conditioning was possible, and Elmer and
A monumental achievement in neuroscience was Alyce Green established clinical protocols and inte-
the development by Jan Friedrich Tonnies of the grated skin temperature into biofeedback. The
first modern multichannel ink-writing electroen- American inventor Hershel Toomim, intrigued by
cephalogram (EEG) machine, which recorded the Remond’s earlier findings, developed the first stan-
minute electrical charges of neurons on the surface dardized, calibrated, and stand-alone biofeedback
of the cortex. The invention of the EEG opened a machine. Toomim’s machine combined measures of
new line of brain research, and in 1924, the electromyography (the electrical currents of mus-
German neurologist Hans Berger used this technol- cles), temperature, galvanic skin responses, and
ogy to first record the electrical activity of a human brain activity (EEG). Toomim’s wife, Marjorie, sub-
brain, his son’s, and identified alpha and beta sequently published a monumental study of gal-
rhythms. Associating alpha waves with relaxed vanic skin responses for clinical use, and in 1972,
states and beta rhythms with alertness, Berger saw Hershel added a computer to the mix to produce
the potential to use EEGs to improve diagnosis and the first programmable biofeedback system. The
measure therapeutic outcomes. A decade or so later, computer was also integrated with existing imaging
William Walter, a neurophysiologist who followed technologies, resulting in the creation of computer-
Berger’s work, improved the EEG machine and ized axial tomography scans and positron emission
identified delta waves, which he associated with tomography scans, which allowed for the explora-
deep sleep states, and theta waves, associated with tion of the brain without surgery. In 1977, Raymond
deep relaxation, drowsiness, and meditative states. Damadian created the first magnetic resonance
In the 1950s and 1960s, researchers became imaging (MRI) machine, and the examination of
interested in the chemistry of the brain and learned detailed, three-dimensional images of tissues, nearly
more about how medication might provide an as detailed as photographs, became possible. What
alternative to lobotomy or electroshock. In 1949, may be the most significant development in neuro-
lithium was discovered to be an effective treatment imaging was the creation of the functional MRI
for bipolar depression, followed by the Food and (fMRI) in the early 1990s. The fMRI revolutionized
Drug Administration’s approval of the chemical the field of neuroscience because surgeons could
chlorpromazine (Thorazine) for its calming and watch images while the brain was actually working.
antipsychotic properties. Other antidepressant, If the MRI provided snapshots of the brain, the
antianxiety, and antipsychotic drugs followed, with fMRI provided movies and allowed physicians and
names like Iproniazid, Valium, and Librium. At the researchers to observe patterns of blood flow to
same, Joe Kamiya maintained that low-frequency regions of the brain as patients performed mental
alpha brain waves could be reinforced through and physical tasks. As a result of the fMRI, there is
operant conditioning and that individuals could use now evidence that many aspects of psychotherapy,
feedback to alter alpha brain wave activity and such as expressing empathy or exercising insight,
produce a relaxed state. Meanwhile, the public was are biological interventions because these activities
becoming aware of biofeedback and neurofeedback stimulate specific neurological regions associated
due to the writings of the research psychologist with wellness.

Theoretical Underpinnings prenatal development; however, recent experimen-

tal work has demonstrated that more prescribed
The brain–body link is no longer mysterious, and
neurogenesis occurs in the adult brain and is essen-
it has been established that the brain can continue
tial for certain functions such as olfaction and
to grow and develop by exercising specific brain
memory. Neurogenesis in the hippocampus is
pathways through emotional and physical stimula-
believed to contribute to learning and memory.
tion. Whether a particular therapy uses technology,
Aging is associated with a decline in hippocampal
hypnosis, or touch, all these methods are based on
neurogenesis. Research has linked new neuronal
recent discoveries in neuroscience.
growth in the hippocampus to increased memory
capacity and clarity. There is also evidence that
Neuroplasticity indicates that hippocampal neurogenesis may be
Recent advances in structural and functional involved in the creation and maintenance of addic-
neuroimaging have disproven the belief that the tive behavior. The understanding that neurogenesis
adult human brain is an inflexible, hard-wired occurs in this brain region offers a promising new
organ. It is now understood that neuroplasticity is target for the development of mental health and
the fundamental process that enables lifelong cognitive interventions. What remains largely
learning, development, and environmental adapta- unknown is how therapeutic practices contribute to
tion. The underlying mechanism of neuroplasticity neurogenesis, and vice versa.
is experience-dependent reorganization of existing
neuronal structures and networks. Plasticity occurs Stress Reaction
through structural changes, such as synaptic gen-
eration or pruning, and functional changes, by Stress is defined as an emotional response to a
long-term synaptic potentiation or depression. stressful stimulus that produces predictable bio-
These synaptogenic and functional changes are logical and behavioral changes. As illustrated by
widespread, occurring throughout the cortical and Yerkes-Dodson Law, moderate degrees of stress
subcortical brain regions, and sometimes rapid, can be beneficial, producing enhanced perfor-
occurring in fewer than 3 hours. Neuroplasticity mance and drive. In contrast, elevated stress is
allows the brain to compensate for injury and deve- associated with numerous physical, emotional, and
lop new capabilities. These synaptic adaptations cognitive consequences. Stress is associated with
are profoundly influenced by experience. cognitive deficits in executive abilities housed in
Pioneers in the field of cognitive neuroscience the prefrontal cortex, such as judgment, planning,
are now examining the effectiveness of targeted and decision making. Physiologically, stress acti-
psychological exercises to promote brain plasticity vates the hypothalamic-pituitary-adrenal axis,
and alter neural circuitry, thereby fostering psycho- which results in the release of stress hormones,
logical well-being. Recent research has shown that glucosteroids, in the blood. Stress-induced
mindfulness therapy can increase gray matter con- glucosteroid production in turn inhibits neurogen-
centration in the hippocampus, cingulate cortex, esis. For example, in animal studies, chronic stress
temporal-parietal junction, and cerebellum—areas produced by electric shock reduces cell prolifera-
that are involved in learning, memory, emotional tion and neuronal differentiation and increases cell
regulation, and perspective taking. Other areas of mortality. In contrast, reward-based stressful expe-
investigation have targeted retraining the specific riences that produce elevated glucosteroid levels
neural circuits involved in anxiety and depression, are actually associated with increased neurogene-
and the results, thus far, are promising. sis. These findings suggest that in humans, positive
and rewarding experiences may buffer the brain
from the negative effects of elevated stress.
Neurogenesis
Unlike neuroplasticity, which involves the growth
Mirror Neurons
of new connections on existing neurons, neurogen-
esis is the process by which new neurons are In the mid-1990s, researchers at the University
produced. Neurogenesis occurs primarily during of Parma, led by Giacomo Rizzolatti, identified a

special type of brain cell, mirror neurons, that fired Autogenic Training
when monkeys executed an action sequence and
Autogenic training is a relaxation technique
when they observed or heard a similar action being
developed by the German psychiatrist Johannes H.
done by another monkey or a human participant.
Schultz that involves repeating a set of visualiza-
The mirror neuron system involves the premotor
tions that result in a state of relaxation. Clients
cortex, sensorimotor cortex, posterior parietal
conduct 15-minute sessions at multiple times dur-
lobe, superior temporal sulcus, and insula. It is
ing the day, usually in the morning, at lunch time,
now generally believed that humans have complex
and in the evening.
mirror neuron systems that allow us to carry out
actions and understand the actions and intentions
of others. The shared representation of motor Biofeedback
actions forms a foundational cornerstone of higher This technique can be used to reduce anxiety
order social processes. Mirror neurons are believed and prevent or treat migraine headaches, chronic
to be involved in response facilitation, mimicry, pain, incontinence, and high blood pressure. Small
simulation, imitation learning, understanding electrodes are attached to the skin at various points
actions, understanding intentions, empathy, theory of the body to capture breathing rate, blood pres-
of mind, and language. sure, skin temperature, sweating, or muscle activity.
The existence of mirror neurons has implica- The signals are sent to a display that translates the
tions for cognitive neuroscience, language, social signals into visual or audio representations, such as
psychology, and psychotherapy. For example, mir- images, sounds, or flashes of light. The therapist
ror neurons may explain aspects of social cognitive introduces relaxation exercises, and the client con-
theory first investigated by Albert Bandura. trols different body functions by controlling the
Bandura observed that we acquire knowledge and sound or the light display selected.
behavior by observational learning and imitation.
According to Christian Keysers at the University of
Groningen in the Netherlands, certain social emo- Brain Change Therapy
tions such as guilt, shame, pride, embarrassment, Brain Change Therapy (BCT) is grounded on
rejection, and disgust are based in the mirror neu- the concept of “self-directed neuroplasticity” and
ron system in the insula. Mirror neurons are recognizes neurological research that has demon-
hypothesized to play a central role in the experi- strated that people have the ability to turn brain
ence of empathy. Highly empathic individuals have circuits on and off in a way that changes their
been shown to have particularly active mirror psychophysiological states. BCT starts with the
neuron systems. It has also been hypothesized that assumption that repatterning of neural pathways
autism is associated with a breakdown in the mir- results in therapeutic change through practicing of
ror neuron system, thus impairing an individual’s focused attention. BCT integrates principles from
ability to understand the experiences of others. hypnosis, biofeedback, and cognitive therapy.
The implications for conducting psychotherapy
are profound.
Cerebral Electric Stimulation
This therapy provides support to the nervous
Short Descriptions of Neurological and
system for self-correcting electrical circulation
Psychophysiological Therapies
throughout the body. It results in promoting deep
There are a variety of neurological and psycho- relaxation and improved brain functioning, which
physiological approaches to counseling that foster may also result in improved speech and motor skills.
the release of various neurotransmitters and stimu-
late different regions and pathways in the brain.
Cognitive Enhancement Therapy
What all these approaches have in common is the
belief that the mind and the brain are inseparable Cognitive enhancement therapy is a manual-
and that counseling leads to positive changes in the ized approach that uses performance-based
brain. neurocognitive training exercises. Training assists

participants in overcoming a variety of neurocog- client is trained to relax physically and emotionally,
nitive impairments and issues related to cognitive reduce anxious thoughts and negative emotions,
style, social cognition, and social adjustment. and engage in deep breathing exercises.
Cognitive enhancement therapy typically encom-
passes more than a year of treatment and utilizes Hypnotherapy
both individual and group settings
Hypnotherapy is used for treating a wide range
of medical, dental, and psychological problems.
Developmental Counseling and Therapy:
A skilled practitioner interjects verbal communica-
Theory and Brain-Based Practice
tion while the client is in a hypnotic state to direct
Using Jean Piaget’s theory of cognitive develop- the client’s imagination in order to alter thoughts,
ment, this approach first determines a client’s feelings, and actions.
developmental level and then applies any of a
number of interventions that would be most effec- Integral Eye Movement Therapy
tive at that level. Being collaborative and cross-
culturally sensitive and appropriately matching Often used for clients who have had serious
developmental level and intervention strategy are trauma that developed from life events over which
critical if clients are to change. It is assumed that they had little control, this approach assumes that
accurately matching level and strategy will add emotional maps are formed through the memories
new neural connections and positively affect the of these events. The therapeutic process includes
client’s emotional/cognitive style. having clients focus on troubling events and
adjusting eye movements to determine any changes
in the client’s feeling state.
Eye Movement Desensitization
and Reprocessing
Neurofeedback
Eye Movement Desensitization and Reprocessing
therapy is a three-pronged protocol that addresses This therapy is a type of biofeedback targeted at
past memories, present disturbances, and future training the brain to operate more efficiently. Using
actions to alleviate the client’s distressing symp- electrodes as biofeedback does, neurofeedback
toms. Popularized in the treatment of posttrau- most commonly uses video or sound to provide
matic stress disorder, Eye Movement Desensitization real-time feedback to the client. Positive feedback
and Reprocessing is aimed at processing problem- is applied for desired brain activity and negative
atic distressing experiences to resolve them and feedback for undesirable brain activity. Neuro-
learning new lessons from the experiences that feedback guided by the use of a quantitative EEG
lead to healthier thoughts and behaviors. that provides computerized statistical analysis is
held to be the most accurate form of neurofeed-
back, most often used in clinical settings.
Eye Movement Integration Therapy
Based on brain research, this nonverbal therapy Neuro-Linguistic Programming
is often used to treat trauma and assumes that the
relationship between eye position and brain pro- Neuro-linguistic programming is an approach
cessing is critical in the treatment of individuals. that connects neurological processes (“neuro”), lan-
Therapeutic intervention includes asking the client guage (“linguistic”), and behavioral patterns learned
to recall a troubling memory and then asking the through experience (“programming”). Practitioners
client to move his or her eyes in a particular manner believe that these processes can be changed to achieve
in an attempt to determine which eye movements specific goals in a client’s life, including improved
decrease unpleasant feelings. communication and personal development.
Heart Rate Variability Neuroprocessing

This therapy is a form of biofeedback that This therapy recognizes that traumatic histories
focuses on self-regulation of heart rhythms. The may result in obstacles to one’s neuroprocessing,

Neuroprocessing 719
language, or executive functioning. Specific train- counseling. Journal of Counseling and Development,
ing profiles are entered into the system, and train- 90(1), 20–28. doi:10.1111/j.1556-6676.2012.00003.x
ing in the brain occurs as the client attempts to Roche, R. A. P., Commins, S., & Dockree, P. M. (2009).
modify his or her own brain activity to match the Cognitive neuroscience: Introduction and historical
profile. perspective. In R. A. P. Roche & S. Commins (Eds.),
Pioneering studies in cognitive neuroscience
(pp. 1–18). Maidenhead, England: McGraw-Hill.
Neuropsychoanalysis Snyder, P. J., Nussbaum, P. D., & Robins, D. L. (2006).
Clinical neuropsychology: A pocket handbook for
As the name implies, this therapy combines the
assessment. Washington, DC: American Psychological
lessons from neuroscience and psychoanalysis to
Association.
promote a better understanding of one’s mind
and brain. Unconscious functioning discovered
through the techniques of psychoanalysis is com-
bined with the underlying brain mechanisms that
control consciousness. NEUROPROCESSING
Herman R. Lukow II and Ana Mills
Neuroprocessing, also known as brain mapping, is
See also Autogenic Training; Biofeedback; Brain Change a therapeutic technique designed to assess cogni-
Therapy; Cerebral Electric Stimulation; Cognitive tive processing and its relationship to mental disor-
Enhancement Therapy; Eye Movement Desensitization ders. This therapy is related to biofeedback in that
and Reprocessing Therapy; Heart Rate Variability; it allows the client to better understand how to
Hypnotherapy; Neurofeedback; Neuro-Linguistic modify thoughts, feelings, and behaviors for opti-
Programming; Neuroprocessing; Neuropsychoanalysis mal brain functioning and mind—body wellness.
Much like biofeedback, neuroprocessing is used
both as an assessment tool and as an intervention
Further Readings
to address mental and physical disorders.
Bennett, E. D., & Smith, J. N. (2011). Neurology for The primary method utilized in neuroprocessing
smarties: Symptom recognition, referral, and support. is an assessment called a quantum electroencepha-
Retrieved from http://counselingoutfitters.com/vistas/ lograph (qEEG). This is an electroencephalograph
vistas11/Article_57.pdf (EEG) that displays brain wave data and uses
Charney, D. S., Nestler, E. J., Sklar, P., & Buxbaum, J. D. algorithms to depict the brain wave paths for a
(Eds.). (2013). Neurobiology of mental illness. more nuanced understanding of brain activity.
New York, NY: Oxford University Press. The quantum aspect depicts the neuroprocessing
Grawe, K. (2007). Neuropsychotherapy: How the through colorful topographic images to illustrate
neurosciences inform effective psychotherapy. the brain functions in a user-friendly and clinically
Mahwah, NJ: Lawrence Erlbaum.
useful way. The topographic images of cortical
Ivey, A. E., D’Andrea, M. J., & Ivey, M. B. (Eds.). (2012).
brain activity are detected from the electrodes
Neuroscience: The newest force in counseling and
placed in strategic positions on the client’s scalp.
psychotherapy. In Theories of counseling and
Once the client data are collected, they are often
psychotherapy: A multicultural perspective (7th ed.,
compared with normative databases to determine
pp. 49–86). Thousand Oaks, CA: Sage.
Ivey, A. E., & Zalaquett, C. P. (2011). Neuroscience and
whether any abnormalities are present.
counseling: Central issue for social justice leaders. Using neuroprocessing as an intervention appears
Journal for Social Action in Counseling and to exercise the brain’s ability to self-regulate. The
Psychology, 3, 103–116. brain typically conducts multiple levels of process-
Makinson, R. A., & Young, J. S. (2012). Cognitive ing at once, and if disorders are present, there is
behavioral therapy and the treatment of posttraumatic interference in its processing system. Disorders
stress disorder: Where counseling and neuroscience sometimes result in one area of the brain overcom-
meet. Journal of Counseling and Development, 90(2), pensating for another. Once that is discovered,
131–140. doi:10.1111/j.1556-6676.2012.00017.x treatment can be targeted to the appropriate area of
Myers, J. E., & Young, J. S. (2012). Brain wave the brain for correction and optimal functioning.
biofeedback: Benefits of integrating neurofeedback in With neuroprocessing, a qEEG pinpoints whether

720 Neuroprocessing
the brain remains in patterns of high or low arousal. past 50 years, data from EEG have shown particu-
Patterns of arousal are related to a variety of disor- lar brain wave activity to be correlated with some
ders, such as anxiety (high arousal) or depression psychiatric disorders, and with the development of
(low arousal). Neuroprocessing is often used to the qEEG, a more nuanced understanding of the
treat disorders of attention and focus such as relationship of brain waves to psychiatric disorders
attention-deficit/hyperactivity disorder (ADHD), has developed.
autism and learning disabilities, sensory processing Today, neuroprocessing is taught to both lay
disorders, and a variety of mental disorders. technicians and mental health professionals. There
are national certification programs as well as regu-
lation and continuing education requirements.
Historical Context
Some practitioners may work in medical settings,
Neuroprocessing is the product of modern techno- whereas others may practice in educational or pri-
logical developments and attempts to more accu- vate settings. Practitioners have used brain map-
rately diagnose mental disorders. Historically, ping to assess a variety of disorders. For example,
individuals sought to understand the mysteries of Helena Kerekhazi has used neuroprocessing for
the brain and its relationship to mental illness by more than 25 years in educational settings to assist
using fairly primitive techniques. For instance, in in better understanding learning disabilities, atten-
the 1800s, some practitioners engaged in phrenol- tion disorders, and sensory processing disorders as
ogy, the study of brain size and brain contour, well as to design individual education plans for
believing falsely that these were indicative of men- children with special needs.
tal health or pathology. Then, in the mid-1900s, Since the 1990s, the qEEG technique of neu-
some practitioners performed lobotomy—the roprocessing has been researched. It has been
removal of portions of the prefrontal cortex— used in studies assessing the neurological dam-
falsely assuming this therapy would remedy various age from cocaine abuse as well as studies exam-
forms of chronic mental illness, such as schizo- ining the possible neurobiological underpinnings
phrenia. Also during the mid-1900s, some practi- of obsessive-compulsive disorder. In other stud-
tioners treated mental disorders such as depression ies, the qEEG has been used to better understand
and schizophrenia with electroconvulsive therapy, the influence of antidepressants and various
in which the client’s brain is given electric shocks medications.
via electrodes attached to his or her head. Although Because neuroprocessing is a new approach,
these early attempts at electroconvulsive therapy the research base is still in its infancy, but clinical
were found to be harmful, in more recent years, and anecdotal reports seem to indicate the effec-
this approach has been significantly changed tiveness of neuroprocessing in treating anxiety,
and has been shown to have some positive out- chronic pain, migraines, autism (high-arousal
comes, especially with those who have long-term, right-brain training), head traumas, ADHD, and
intractable depression. other learning disabilities. Clinical reports indicate
During the 1970s, scientists began experiment- that it enhances the ability of the client to increase
ing with biofeedback of alpha and beta brain a sense of calm and control over his or her mind–
waves. For instance, an individual may hear body system. In addition, some recent studies
sounds or visualize colored lights depending on the indicate that neuroprocessing may be helpful
brain wave being produced. Through biofeedback, in differential diagnosis of mental disorders.
individuals can control the type of brain wave Understanding these more refined levels of dis-
being produced. Today, uncovering the mysteries crimination and subtypes, such as between
of the brain and its relationship to mental health unipolar and bipolar depression, may assist in
continues to drive clinical exploration and empiri- developing more accurate and customized treat-
cal research. In recent decades, modern and less ment procedures. Other research has used neuro-
invasive techniques, such as qEEG and single- processing to distinguish between ADHD and
photon emission computerized tomography anxiety disorders, which are sometimes misdiag-
(SPECT) brain imaging, have facilitated a more nosed due to overlapping symptoms. For example,
individualized and nuanced understanding of the some symptoms, such as psychomotor agitation,
influence of the brain in mental health. Over the overlap in ADHD and anxiety. qEEG readings

Neuroprocessing 721
discriminate between disorders that can appear to Quantitative EEG

be behaviorally similar. qEEG indicates that
qEEG is an assessment tool that converts tradi-
ADHD has excess theta activity and not enough
tional EEG data into colorful topographical
beta. An individual with an anxiety disorder is
images. Electrodes are placed on strategic positions
more likely to have a qEEG reading demonstrat-
on the client’s scalp to detect cortical activity. The
ing excess beta and not enough alpha. Correct
qEEG measures brain wave bands (e.g., alpha,
assessment of brain functions and alignment with
beta, gamma, and theta) to assess the level of brain
disorders allows for customized and more accu-
activity or arousal. For example, some studies have
rate treatments. Accurate diagnosis can decrease
found that people with an anxiety disorder have
the frustration and demoralization that may
little alpha activity and an abundance of beta
accompany the diagnostic process. Assessing brain
activity. qEEG assessments of adolescents or adults
activity in neuroprocessing adds an important
with ADHD display excess alpha activity and nor-
quantitative dimension to therapies that have been
mal levels of theta activity. However, individuals
clinically observed but may not have a large body
diagnosed with both ADHD and anxiety have very
of quantitative data behind them yet, such as
different brain wave patterns. Data derived from
thought field therapy, which is an energy therapy.
qEEG are compared with normative databases to
assist in diagnosing disorders.
Neuroprocessing draws from systems theories, Neuroplasticity
learning theory, and anatomical models. Systems Neuroplasticity refers to the human brain’s abil-
theories focus on the influence of one part of a ity to change over the life span. Historically, it was
system on another and also on the whole. believed that the brain developed during a critical
Neuroprocessing operates on the assumption that period in childhood, with little variation during
the brain is a system that can be positively influ- adolescence and adulthood. Current scientific
enced by making changes based on brain feedback. understanding is that the brain changes synaptic
The neurofeedback process allows clients to under- connections and neural pathways when behavior is
stand that they have some degree of control over changed. Based on this understanding, neuropro-
their mind–body system, and in some clinical cessing attempts to produce positive and effective
reports, brain patterns change in therapeutic direc- outcomes by engaging this adaptable function of
tions. The ability to participate in changing brain the brain (e.g., by changing thinking or other brain
wave patterns adds credence to the theory around processes such as awareness).
the neuroplasticity of the brain (i.e., the brain’s
ability to form new neural networks that lead to
more productive thought patterns and behaviors). Autonomic Activity
Regarding anatomical theory, cortical areas expand Autonomic activity describes the function of the
in areas targeted by the tasks in the neurofeedback autonomic nervous system, which includes the
programs. For example, a client with an anxiety sympathetic and parasympathetic nervous systems.
disorder is given the qEEG, performs neurofeed- When mental disorders are present, the autonomic
back tasks designed to decrease anxiety by decreas- nervous system typically produces dysfunctional
ing beta amplitudes and increasing alpha, and is autonomic responses, and techniques such as neu-
then measured again. The qEEG topographical rofeedback can engage the somatic nervous system
map indicates the changes in the expected cortical in changing dysfunctional autonomic responses to
areas. produce better brain wave activity and adaptive
physiological responses.
Major Concepts
Biofeedback Process in Neuroprocessing
A few concepts are important for the understand-
ing of neuroprocessing. They include qEEG, neuro- The primary objective of neuroprocessing is
plasticity, autonomic activity, and biofeedback to utilize a brain-focused biofeedback prog-
process in neuroprocessing. ram, generally referred to as neurofeedback.

722 Neuroprocessing
Neurofeedback includes attaching sensors to the Therapeutic Process

client’s scalp and asking the client to watch a
Neuroprocessing is used either as an adjunctive
visual display that is programmed to target spe-
assessment tool for diagnosis of disorders or as a
cific disorders. Other biofeedback interventions
precursor to a therapeutic process called neuro-
may include using biofeedback to measure
feedback. Initial qEEG assessment displays gen-
changes in the brain before and after meditation.
eral brain activity in terms of which areas “light
Neurotherapy uses EEG feedback in combina-
up” (are activated) when stimulated and specific
tion with cognitive-behavioral therapy to change
brain wave bands that are either aroused (domi-
awareness, thoughts, and behaviors to shift
nant) or underaroused (asleep). Clients present
brain waves from maladaptive states to more
with a specific mental diagnosis, and the qEEG
adaptive states.
assessment either confirms that the brain activity
is consistent with the diagnosis or indicates that
the diagnosis needs to be refined or corrected.
Techniques
Neurofeedback programs are utilized according
The primary technique used in neuroprocessing to the target brain wave bands that need to be
is a qEEG assessment of brain activity before and modified (e.g., increase of alpha or decrease in
after a neurofeedback procedure. In neurofeed- beta), and clients observe these programs while
back, sensors are applied on the scalp, and the their brain activity is monitored. There is some
client is asked to follow visual cues (something variation from clinic to clinic, but typically blocks
like a video program) that assess and direct brain of 20 sessions are recommended because chang-
activity toward adaptive brain wave bands or ing the brain’s neuroplasticity requires frequent
toward integrating parts of the brain that have and consistent attention until new brain patterns
not yet been engaged in productive activity. The are learned and integrated into experience. Clients
qEEG assessment is conducted during the video are interviewed in between sessions to ascertain
program, and the neuroprocessing professional symptom reduction. Initial data indicate that neu-
manipulates the program to shift the brain waves roprocessing is an effective therapy for refining
into the target areas. Other techniques may be the diagnosis, assessing the effects of medication
more passive, such as asking the client to become therapy, and reducing the symptoms of mental
more aware of his or her consciousness in disorders.
meditation.
The psychiatrist Daniel Amen has applied Christine Berger
SPECT imaging to study the brain and its rela-
See also Behavior Modification; Behavior Therapy;
tionship to mental and physical wellness with
Biofeedback; Brain Change Therapy; Cerebral Electric
similar goals as neuroprocessing. SPECT, consid-
Stimulation; Neurofeedback; Neurological and
ered nuclear medicine rather than neuroprocess- Psychophysiological Therapies: Overview
ing because radioactive isotopes are injected into
the client to identify unstable atoms producing
gamma energy, serves as a tracking system of the Further Readings
brain anatomy and processes. Amen’s method
Amen, D. (2009). Change your brain, change your life:
using SPECT has been applied in six clinics
The breakthrough program for conquering anxiety,
around the United States with reports of clinical depression, obsessiveness, anger and impulsiveness.
success. There is also an emerging body of empir- New York, NY: Random House.
ical research in this area, but it has not yet been Amen, D. (2013). Healing ADD revised edition: The
widely validated. Some of the initial findings breakthrough program that allows you to see and heal
from this approach are descriptions and data the seven types of ADD. New York, NY: Berkley
illustrating seven types of ADHD and multiple Trade.
types of other disorders, such as anxiety. This Collura, T. F. (2013). Technical foundations of
possible refined level of the brain or biological neurofeedback. London, England: Routledge.
aspect could play an important role in more accu- Larsen, S. (2012). The neurofeedback solution: How to
rately and efficiently treating clients with mental treat autism, ADHD, anxiety, brain injury, stroke,
disorders. PTSD and more. Rochester, VT: Healing Arts Press.

Neuropsychoanalysis 723
in neurology, especially the technology of brain

NEUROPSYCHOANALYSIS imaging. Neuropsychoanalysis attempts to better
understand the underlying neurological basis of
Neuropsychoanalysis is an approach to psychother- psychiatric disorders such as depression and schizo-
apy and research that attempts to bridge the gap phrenia. The insights into the interpersonal neuro-
between neuroscience and psychoanalysis. It strives biology of mental processes such as emotion and
to bring into accord neurological findings with reasoning take into account how the interaction
Sigmund Freud’s theory of psychoanalysis. Neuro- between the brain and the mind shapes psychological
psychoanalysis aims to integrate brain research by life. Neuropsychoanalysis is not without contro-
mapping subjective experience such as thoughts, feel- versy in trying to integrate two disparate fields—
ings, and motivation onto neural correlates, specific neurology and psychoanalysis—because of their
physiological states and functions of the brain. different philosophical assumptions.
Neuropsychoanalysis rests in the intersection of
philosophy, neuroscience, psychoanalysis, psychia-
try, and psychology and draws on an understand-
Major Concepts
ing of how neurological processes are turned into There are a number of concepts in neuropsycho-
psychological processes. Through the use of psy- analytical theory that guide in the investigation of
chodynamic principles, such as object relations neural correlates. Major psychoanalytical and neu-
and conflict theory, the process explores what “lies rological concepts include repression, unconscious,
beneath the surface” by exploring the client’s drives, libido, oedipal behaviors, and dreams—
unconscious conflicts that interfere with everyday each of which are discussed in turn in this section.
functioning. The influence of the unconscious is
applied to underlying brain and neurological pro- Repression
cesses, which contributes to symptoms such as
phobias, anxiety, depression, and compulsions. Repression represents what is unacceptable to the
conscious mind or the prefrontal cortex. As a result,
the unconscious mind excludes distressing impulses,
Historical Context desires, or fears in an attempt to ward off anxiety.
Mark Solms is credited with popularizing the term
neuropsychoanalysis through the introduction of Unconscious
the journal Neuropsychoanalysis in the late 1990s.
The unconscious refers to the level of human
However, its roots reach back to Freud’s theory of
consciousness where thoughts are automatic and
psychoanalysis, beginning in the 1890s. Trained as
not a part of our conscious awareness. Neuro-
a neurologist, Freud tried to find a treatment for
psychoanalysis is used to uncover unconscious
patients who suffered from neurosis and hysteria.
desires, impulses, and conflicts, which are then
This led him to eventually publish a book with
applied to underlying brain structures, such as the
Josef Breuer based on the treatment of a patient
limbic system.
dubbed Anna O. This book launched psychoanaly-
sis as a discipline, which was otherwise known as
the “talking cure.” Soon after this, Freud attempted Drives
to develop a neurological and physiological foun- Neuropsychoanalysis strives to integrate the
dation for his theories. This resulted in the 1895 soma (brain) and psyche (mind). Drives and
uncompleted monograph Project for a Scientific instinctual motivations arise from the evolution-
Psychology, which was left unpublished until after arily older part of the brain—the brainstem and,
his death. This unfinished strand of thought is specifically, the pons region of the brain.
where neuropsychoanalysis picks up.
Libido
Theoretical Underpinnings Libido is the driving force of all behavior and
Neuropsychoanalysis is a relatively new field, hav- embodies survival and sexual instincts that influence
ing emerged in the 1990s because of the advances psychosocial development. Factors in the formation

724 Neuropsychoanalysis
of attachment and trauma influence early brain Interpretation

development: namely, the limbic system, the prefron-
Interpretation is the process that a therapist uses
tal cortex, and the anterior cingulate cortex, which
to access a client’s unconscious conflicts that affect
play a role in an individual’s ability to progress
everyday functioning. Once the conflicts are brought
successfully through each stage.
to awareness, the therapist attributes meaning to
them. Interpreting dreams enables a client to uncover
Oedipal Behaviors latent and manifest content, which allows for the
further development of the right hemisphere of the
In the Oedipus/Electra complex, a child becomes
brain.
fixated on the opposite-sex parent and competes
with the same-sex parent for attention. This pro-
cess allows the child to loosen his or her ties from Transference/Countertransference
a parent as he or she strives for independence and
Another way in which unconscious content emer-
separateness. The process of moving toward indi-
ges is through the transference–countertransference
viduation is involved in the production and man-
relationship. Therapy focuses on understanding
agement of neurotransmitters, such as testosterone,
transference and countertransference from the per-
dopamine, and oxytocin, associated with affiliative
spective that memories from early attachment rela-
behaviors.
tionships are reactivated in therapy and draws on the
ways the client and the therapist regulate each
Dreams another through affective bodily expression.
Freud famously declared dreams to be the “royal
road to the unconscious.” By saying this, he high- Therapeutic Process
lighted the insightful primacy that dreams offer
Neuropsychoanalysis requires a considerable
about psychical life. Dreams have been found to
investment of time, energy, and money; therapy
have a cognitive problem-solving function associated
typically involves multiple sessions per week and
with brain reorganization.
may last for a number of weeks, months, or years.
The process typically begins with an evaluation or
Techniques consultation whereby the therapist evaluates the
suitability of the client for analysis. Throughout
The practice of neuropsychoanalysis uses neurosci-
therapy, the therapist draws on neuropsychoana-
ence as a foundation for the use of psychoanalyti-
lytical techniques to analyze and diagnose the
cal concepts such as free association, interpretation,
client’s dysregulating symptomatology. The thera-
and transference/countertransference. The tech-
peutic alliance is used to interpret the regulating
niques used by a neuropsychoanalyst are targeted
systems of both the client and the therapist,
toward rewiring the neuropathways of the client’s
allowing the brain to ultimately reorganize itself.
brain through a reworking of memories that allows
the client to gain new perspectives. Redefining neu- Leslie W. O’Ryan and Jacob W. Glazier
rotic beliefs and emotions makes room for new
neural pathways to form and promotes change in See also Ego Psychology; Freudian Psychoanalysis; Object
areas of the brain such as the prefrontal cortex. Relations Theory; Self Psychology
Free Association Further Readings

In free association, the client is encouraged to Kaplan-Solms, K., & Solms, M. (2002). Clinical studies in
communicate whatever comes into his or her mind neuro-psychoanalysis: Introduction to a depth
without censoring the thoughts in order to gain neuropsychology. New York, NY: Karnac Books.
insight into what he or she thinks and feels. This Northoff, G. (2011). Neuropsychoanalysis in practice:
allows the client to shift dominance from a left- to Brain, self, and objects. Oxford, England: Oxford
a right-hemispheric state, where he or she is able to University Press. doi:10.1093/med/9780199599691
recognize and express emotions. .001.0001

Non-Western Approaches 725
Schore, A. N. (2002). Advances in neuropsychoanalysis, they have unfamiliar names, they were and are
attachment theory, and trauma research: Implications also means to psychotherapeutic ends.
for self psychology. Psychoanalytic Inquiry, 22(3), Before Western theories, techniques, and
433–484. doi:10.1080/07351692209348996 approaches emerged, people across the planet had
found ways to achieve intrapersonal and interper-
sonal goals as well as to reach mental health and
wellness. Many non-Western approaches are
NON-WESTERN APPROACHES experiencing a transcultural awakening as our
predominately Western world of counseling and
Non-Western approaches to counseling and psy- psychotherapy are embracing these as comple-
chotherapy is a broad and nonspecific category mentary approaches with distinct benefits. While
that encompasses methods considered to have their readers may consider how the practice of medita-
origins outside Western developments in counsel- tion and the choreographed, internal energy work
ing and psychotherapy. “Non-Western” in this of taijiquan may hold promise as primary tools in
context usually refers to the people and cultures of modern counseling and psychotherapy, it is likely
India, China, Japan, and Korea, although in some that practitioners of these arts a millennium ago,
sources “non-Western” includes Africa, South who would have lacked our “mental health”
America, and the Pacific Islands. Some sources uti- vocabulary, experienced profound benefit through
lize the label “non-Western” to designate those their practice. Gifts from the past are being
approaches that are rooted in indigenous cultures rediscovered, and a renewal of interest in their
and often include spiritual and faith-based beliefs values is sparking modern applications as well as
and practices. empirical explorations.
Historical Context Theoretical Underpinnings

The origins of non-Western approaches to coun- Two concepts, worldview and epistemology,
seling and psychotherapy predate the West’s for- are imperative to understanding the significance
malization and professionalization of methods and importance of non-Western approaches to
that aim to help people with psychological need. counseling and psychotherapy.
Ancient artifacts from early civilizations reveal
methods of herbal medicine, bonesetting, and
Worldview
surgery; modernity has less evidence for how
early peoples supported, guided, and helped their Worldview is broadly defined as the way indi-
neighbors with psychological, emotional, and viduals experience their worlds as an outcome of
behavioral difficulties. It is naive if not unreason- how they live their lives. Worldview extends
able to believe that such needs did not exist beyond the mere vocabulary people use to explore
throughout our evolution or that remedies of and explain their beliefs about their world; it
some sort were nonexistent. However, it was in reflects the culture, ethos, mores, and social con-
the Western Hemisphere and in our more recent structions of people’s day-to-day lives. Worldview
past that the terms counseling and psychotherapy in the context of counseling and psychotherapy is
developed. Through our everyday vocabulary, a broad, culturally reflective lens through which
people in the West, as well as many in a growing individuals experience all aspects of life, with spe-
number of countries and nations, recognize these cific attention to how people view issues related to
terms. There is no doubt that counseling and mental health. Cultures, groups of people who
psychotherapy are invaluable tools that have share a common worldview, therefore form their
become well integrated into modern society. worldviews as well as perpetuate them. Non-
Interestingly, the meaning of counseling or psy- Western approaches to counseling and psycho-
chotherapy is overly broad and often imprecise. therapy are congruent with the worldviews from
The remainder of this entry describes approaches which they emerge.
with long and robust histories, each deeply It is critically important to consider how non-
embedded in non-Western cultures, and although Western approaches answer (or support) questions

726 Non-Western Approaches
such as the following: To what do we attribute developments. Traditional, indigenous, and folk
mental illness? Who cares for those individuals, practices are labels that often accompany non-
and how? Does science or tradition inform our Western approaches; however, there is abundant
understanding of how people help individuals with anecdotal support for the use of many non-Western
psychological difficulties? The answers to these approaches worldwide. Numerous non-Western
questions are as numerous as there are worldviews. approaches to counseling and psychotherapy have
Readers can best comprehend all approaches to withstood time and scrutiny; and although they are
counseling and psychotherapy, Western as well as perhaps less amenable to empirical validation,
non-Western, by first carefully and respectfully non-Western approaches have found favor in the
considering the worldview that informs each Western world. Epistemologically, as global access
approach. expands, the more people know about successful
approaches in counseling and psychotherapy, the
Epistemology stronger their armamentarium for treatment
becomes.
Epistemology is the study of knowledge. Simply
stated, it is the study of knowledge and justified
beliefs. To understand what theoretical differences Major Concepts
may exist between Western and non-Western The predominant concept underpinning the non-
approaches to counseling and psychotherapy, we Western approaches to counseling and psycho-
consider epistemology. Western epistemology often therapy covered here is self-regulation. Often
considers what is empirically proven to be supreme. adapted from religious, faith-based, or spiritual
Congruent with a worldview of valuing scientific traditions, such self-regulation aims at cultivating
inquiry, Western approaches to mental health are those qualities of humanity prized by and congru-
often held to the scrutiny of scientific rigor. In the ent with an individual’s aspirations and world-
West, validity and reliability are paramount con- view. The major concepts that are the goals of
cepts in developing reproducible methods of treat- these approaches include awareness, concentra-
ing individuals who are challenged by biological, tion, mental clarity, equanimity, “a healthy body
social, or psychological difficulties. Non-Western and healthy mind,” proactivity over reactivity, and,
approaches, emanating from significantly differing not the least, health preservation. Techniques to
worldviews and resources, prize methods and their achieve such personal and societal aspirations are
accompanying theories that have deep historical vast in number, worldwide, and have deep and rich
and cultural relevance. In many non-Western histories.
approaches, anecdotal evidence, the common
narrative of a culture, is the paramount test for
efficacy. Techniques
People establish their global fund of knowledge There exist a vast number of non-Western
by all practical tools and resources available to approaches in counseling and psychotherapy. In
them at that time. Consider a simple example: this section, five commonly encountered non-
With the advent of the microscope, the world of Western practices are briefly described. Their ori-
microbiology revealed itself. Before discovering gin, purpose, and practice or integration with
(knowing) that microorganisms could be respon- other approaches to mental health are highlighted.
sible for health as well as illness, explanations for
both were based on the best extant knowledge
Meditation
available to the people at that time. With develop-
ment, old theories are refuted, and new ones Meditation has a rich tradition in many of the
emerge. As time progresses, theories that have lim- world’s religious and faith traditions. In the context
ited utility or that have been soundly dismissed of counseling and psychotherapy, the practice of
disappear. However, when theories and methods meditation is often secularized—meaning that the
continue to have utility that is of practical benefit religious pursuits originally attached to the practice
to the people, they are retained despite the newer have been de-emphasized, leaving individuals who

learn to meditate to do so without interference of mindfulness training and practices to comple-

with their religious or spiritual beliefs. ment more contemporary Western-oriented thera-
Meditation is often divided into two broad peutic theories and methods (e.g., behavioral and
types: (1) awareness meditation and (2) concentra- cognitive therapies) offers measureable benefits to
tion meditation. Awareness meditation is a method clients and patients, including greater self-awareness
for practitioners to invite insights from any and all as well as enhanced cognitive, behavioral, and
possible sources. The phrases an open mind and an affective self-regulation. Literature across the allied
open heart often characterize this type of exercise. mental health professions is replete with references
In a sense, awareness meditation can be practiced to mindfulness and warrants continued exploration
as a means to attain mental health or to comple- and study.
ment other approaches in treatment. A goal of
awareness meditation is for the practitioner to Yoga
become more attuned to the world and to expand
or develop human potential. Concentration medi- Yoga is imbedded deeply in Hinduism. It is a
tation requires the practitioner to focus the mind cognitive-behavioral discipline, and like other non-
and all conscious awareness. The point of concen- Western approaches in counseling and psychother-
tration may be a word, a phrase, or an image apy, yogic practice in mental health has transformed
(cognitive concentration), or it may be a posture or from a religious discipline to a more secular, less
breathing pattern (body-regulating concentration). spiritual one. Yoga stems from many branches of
Both exercises are practiced over time diligently unique physical discipline, some with austere pos-
for the practitioner to attain whatever goal he or tural demands and some that are much more easily
she may aspire to. Meditation is often utilized in practiced by less physically able yoga aesthetes.
the reduction of anxiety and in coping favorably There is a wide range of yoga training available in
with stresses of daily living. It is also used quite the West. Like other principally physical or body-
extensively in the pursuit of relaxation. One popu- oriented practices, such as taijiquan, and additional
lar form of meditation is “mindfulness medita- types of meditation trainings, yoga is often included
tion,” with an overarching goal of enhancing as a complementary practice utilized by mental
meaning and equanimity in daily life. health clients and patients to enhance primary
treatment goals and objectives.
Yoga is characterized by physical postures
Mindfulness
(often referred to as poses), one’s breath and
Mindfulness describes the product of practicing awareness during these postures, the transition
a life with acute awareness. To be mindful describes between postures, and, in many schools and meth-
a level of attention that is attainable only through ods of training in yoga, mental imagery as well.
training and practice. Mindfulness is adapted from A primary focus of yoga is to increase mind–body
spiritual contexts such as Chan (Chinese) and Zen coherence. Training in yoga, therefore, is to enhance
(Japanese) Buddhism and Indian Buddhist and the capability and capacity for a healthy body and
Hindu origins. When encountered in the Western a healthy mind. One major element in the practice
world of counseling and psychotherapy, mindful- of yoga is breath. Breathing is fundamental
ness is often made secular; the aim is to make daily throughout all poses in yoga; a growing literature
living a more conscious and present endeavor for in the neurosciences as well as exercise physiology
clients, patients, and most certainly their clinicians reports the neurobiological effects that benefit
and therapists. yoga practitioners.
The techniques associated with mindfulness
training are often referred to as mindfulness prac-
Qigong
tice. Practice, as acclaimed in many non-Western
approaches, is a pursuit rather than a destination. Literally, “vital energy exercise,” qigong (or chi
Simply stated, mindfulness practice is a remedy gong) has a 1,000-year history in China.
to living mindlessly. Many Western counseling Throughout Chinese history and still at the base of
approaches value mindfulness. Often the addition Traditional Chinese Medicine, qi is the vital

728 Non-Western Approaches
essence of life. Qi is often translated as “breath” invisible. The practice is to heighten the practitio-
but is always understood to be the vital energy of ner’s sense of self-awareness, as knowing one’s self
life. Qigong is a broad category of physical and is a prerequisite to defending one’s self. Taijiquan
mental exercises that purport to sustain, increase, is characterized by slow and graceful movements
and heal, the vital energy that gives and sustains among upright and regal postures, which is often
life, which is found in all human (and nonhuman) called “stillness in motion.” As with meditation,
life. Qi, under the microscope of Western science is there are many different schools of taijiquan. Like
elusive and often characterized as the “human qigong, taijiquan is practiced as a health preserva-
spirit.” tion exercise. The movements are meticulously
Qigong, then, includes many ways to regulate guided by the practitioner’s intent, thereby linking
health and well-being as well as to treat illness. the mind and the body. Key instruction in taijiquan
Qigong exercises align on a continuum. Qigong highlights balance, posture, breath, and intent.
can be a very meditative practice. Breath control The prearranged movements of taijiquan string
and often complex accompanying mental imagery together to create complex forms called routines.
is qigong on the “stillness” side of the continuum. These routines are practiced repeatedly until the
On the other end is the physically demanding movements become a method of meditative
qigong, with martial arts–like vigor and routines. awareness.
Two examples: Zhan zhuang, “standing pole” Like qigong, taijiquan originates from a funda-
qigong, involves a practitioner standing perfectly mentally different worldview of mental health,
still in one of several postures. From this stillness that of Traditional Chinese Medicine. Taijiquan as
and regulated breath, the practitioner is able to an approach to counseling is most often a practice
balance vital energy, keep his or her energy robust to better integrate the mind and the body—to cul-
and vigorous in order to keep the mind and body tivate physical and mental health and well-being.
healthy. Ba Duan Jin qigong, “eight pieces of silk Not unlike yoga or qigong, taijiquan has been
qi exercises,” is more calisthenic, containing adopted in many settings as both physical and
intensely regulated stretches and movements. mental exercise. It, too, has an increasing reference
According to Traditional Chinese Medical the- in the allied mental health literature, often as a
ory, where qigong originated, where there is dys- complementary practice.
regulation or an imbalance of energy (qi) in the
body, there is mental and physical illness. The daily
Therapeutic Process
and often life-long practice of qigong is therefore
viewed by qigong practitioners as “life cultivating Non-Western approaches to counseling and psy-
and life preserving.” However, when illness occurs, chotherapy are not traditional talk therapies. In
qigong can be utilized as a treatment. In many these non-Western practices, the spoken narrative
contemporary hospitals across Asian countries, is often one of instruction, training, or teaching.
qigong is often prescribed as part of a patient’s Counselors or psychotherapists are masters or
treatment and rehabilitation. In the West, qigong is gurus or healers. These non-Western approaches
encountered in a variety of settings, including are practiced by the client or the patient often
increasingly in integrative medicine departments at alone or in groups (classes), usually without a
several large, research-oriented hospitals. counselor or a therapist present. The goal primar-
ily is to enhance self-awareness and to strengthen
physical and mental health. Like many Western
Taijquan
approaches, these practices promote self-discovery,
Taijiquan (tai chi chuan) literally translates self-insight, and integration of mind and body.
from Chinese as “the grand or ultimate fist.” They focus on cultivating well-being. Often, non-
Taijiquan is an “internal martial art,” one of the Western approaches are viewed solely as comple-
pantheon of Chinese martial arts practiced daily mentary to traditional Western counseling and
by an increasing number of people worldwide. psychotherapy, but this is not fully accurate. By
The martial art aspect of taijiquan often appears themselves, these practices have a robust history of

effectiveness in human prosperity, health, and Germer, C. K., & Siegel, R. D. (Eds.). (2012). Wisdom and
development. Numerous non-Western practices compassion in psychotherapy: Deepening mindfulness
have gained attention in the professional literature in clinical practice. New York, NY: Guilford Press.
over the past decade and appear to be significantly Lam, K. C., & Yu, Y. (2014). The Qigong workbook for
influencing Western approaches to counseling and anxiety: Powerful energy practices to rebalance your
psychotherapy. nervous system and free yourself from fear. Oakland,
CA: New Harbinger.
Kurt L. Kraus Pedersen, P. B., Draguns, J. G., Lonner, W. J., & Trimble,
J. E. (Eds.). (2007). Counseling across cultures (6th ed.).
See also Acupuncture and Acupressure; Body-Mind Thousand Oakes, CA: Sage.
Centering®; Hakomi Therapy; Meditation; Mindfulness- Rinpoche, P. (1992). The heart treasure of the enlightened
Based Stress Reduction; Morita Therapy; Reiki ones (commentary by D. K. Rinpoche). Boston, MA:
Shambhala.
Wallace, A. B., & Shapiro, S. L. (2006). Mental health
Further Readings
and well-being: Building bridges between Buddhism
Bankart, C. P. (1997). Talking cures: A history of Western and Western psychology. American Psychologist, 61,
and Eastern psychotherapies. Pacific Grove, CA: 690–701. doi:10.1037/0003-066x.61.7.690
Brooks/Cole. Wong, X. (Compiler-in-Chief). (2003). Life cultivation and
Bein, A. (2008). The Zen of helping: Spiritual principles rehabilitation of traditional Chinese medicine [In Chinese
for mindful and open-hearted practice. Hoboken, NJ: and English]. Shanghai, People’s Republic of China:
Wiley. Shanghai University of Traditional Chinese Medicine.

O
Psychoanalytic Institute. The result of these
OBJECT RELATIONS THEORY “Controversial Discussions” was the establishment
of two separate training tracks as well as a “Middle
Object relations theory is the legacy of a dynamic School” of nonaligned analysts that included
intellectual discourse among several psychoana- Donald Winnicott, John Bowlby, and Michael
lysts in Britain and Scotland, although the theory Balint. Probably the most important context for
was most influenced by the writings and clinical the emergence of object relations theory was that
work of Melanie Klein (1882–1960) and Ronald Klein centered her interest on the development and
Fairbairn (1889–1964). Both addressed this new treatment of her child patients. In contrast, Freud
paradigm while working independently and fewer had not had direct experience in this area, having
than 500 miles from each other. Their writing only supervised the parents of Little Hans in their
helped switch the psychoanalytical theory of moti- treatment of his phobia. Freud’s developmental
vation away from the basic drive reduction/plea- psychology was based on retrospective reconstruc-
sure principle perspective of Sigmund Freud tion from the analysis of his neurotic patients,
(1856–1939). In its place, these theorists saw the while Klein’s work was based on direct, hands-on
infant motivated by the need to be in relationship experience.
with another mind. Children are seen as building Meanwhile, Wilfred Bion (1897–1979) became a
up their internal world through the introjection of candidate at the British Institute after a distin-
a wide array of object representations and related guished career as a surgeon. He completed training
affects. These introjections (i.e., the internal analyses with John Rickman (1891–1951) and
mother) then serve as a template for the projective Klein, and his primary areas of interest were group
understanding of the child’s world. While Klein dynamics, theories of thinking, and psychotic pro-
held steadfastly to Freudian instinctual theory, cess. His concept of normal projective identifica-
Fairbairn veered away into a less biological or less tion, which is described later in this entry, represents
instinctual understanding of an individual’s moti- his most significant contribution to the field of
vation and focused on the environmental provision psychotherapy.
in terms of effective mothering. Fairbairn presents Out of the work of Klein and Bion came the
what could be considered a pure object relations Klein-Bion model. Two important variables in the
theory, eschewing Freud’s pleasure principle in development of this perspective came from observa-
favor of object seeking as the primary motivator. tions Klein made in the treatment of disturbed chil-
dren. She was struck by the intensity of both anxiety
and sadistic fantasy in the children’s play. In search-
Historical Context
ing classical Freudian theory for an explanation of
During the 1940s, the Kleinian approach com- this phenomenon, she concluded that Freud’s model
peted with Anna Freud’s ego psychological of the “death instinct” best explained the anxiety
approach for preeminence at the British and sadism. This became the cornerstone of her
731

732 Object Relations Theory
object relations theory. In her view, children are states) is the proper subject of psychotherapeutic
born with competing life and death instincts and the work. Current research in this paradigm includes
experience of birth and infantile helplessness acti- the study of prenatal mental life. Today, the con-
vates the death instinct first and foremost. She temporary Klein-Bion model of object relations
believed that it was only through ensuing sound has gained the most adherents, generated the most
parenting that the “life instinct” triumphs over the significant research and clinical advances, and is
death instinct. She was in agreement with Freud the focus of this entry.
that the projection of the death instinct in the world
took the form of aggression.
In addition to Klein and Fairbairn, a number of
psychoanalysts have helped develop various aspects The Klein-Bion model takes as its starting point
of today’s comprehensive object relations approach. the shift in the theory of motivation. In seeking a
These include Margaret Mahler (1897–1985) and relationship with another mind, the infant strug-
her theories of separation-individuation, John gles with the differential activation of loving and
Bowlby (1907–1990) and his followers on the sub- destructive instincts dependent on whether the
ject of attachment and loss, and Michael Balint parental environment is gratifying or frustrating,
(1896–1970) and his work on the “basic fault.” respectively. Instincts unfold in the context of
Donald Winnicott (1896–1971) has contributed object relations. Rather than view development in
to the objects relations discussion with his work on terms of psychosexual stages, as Freud does, Klein
early infant development and “good enough” views the infant progressing through two highly
mothering. One of his very useful conceptualiza- charged emotional positions in relation to internal
tions focused on defining the True and False Self and external objects. The first is the paranoid
states. This developmental concept refers to the schizoid position, which is characterized by anxi-
emergence of a False Self, which is designed to ety and sadistic conflict with the primary objects.
protect a core True Self, which has been trauma- Objects are alternately loved and hated. Defenses
tized by faulty parental responsiveness to the nor- of splitting and projective identification predomi-
mal and appropriate gestures of growth exhibited nate. With “good enough” parenting, the child is
in the first months and years of life. The False Self eventually ushered into the depressive position,
lives in compliance and projective identification characterized by whole object relations, concern
with the environment. It assumes the role of a for objects, guilt for having attacked the objects in
“caretaker” self, which takes over from the failing the paranoid schizoid position, and reparation as a
environment. The True Self emerges from the way to repair and revitalize the internal objects.
mother’s supportive and empathic engagement These emotional positions are part and parcel of
with the child’s unfolding instinctual life. developing an internal world that is animated by
Otto Kernberg (1928– ) has contributed a internal objects (i.e., internal mother or father).
comprehensive object relations approach that This internal world is achieved through the process
eschews the Kleinian emphasis on the death of internalization, or introjection.
instinct. According to Kernberg, self and object Underlying the above theory is the Kleinian
representations are constructed from the vicissi- assumption that anxiety and sadism are direct
tudes of aggressive and libidinal drives, and that expressions of the death instinct as it unfolds as
integration of positively and negatively valenced aggressive phantasy. These phantasies are stimu-
internal object representations leads to a more lated by inadequate and frustrating parental care.
robust ego. The parents, as primary objects, are the targets for
Object relations theory also signaled a move- this instinctual or phantasy projection. The child is
ment away from the patricentric and oedipal focus then faced with experiences of hating the parent
of Freudian psychoanalysis and substitutes a more (death instinct activation, related to frustration) and
matricentric mother–child paradigm. In general, loving the parent (life instinct activation, related to
object relations theory is considered a pre-oedipal gratification). According to Klein, the child splits
paradigm and assumes that the infant is father to these two states initially due to the terror of recog-
the child. This is another way of saying that early nizing that the good parent and the bad parent are
infant development (including perinatal mental one and the same.

Object Relations Theory 733
Major Concepts Depressive Position

A number of unique elements constitute the major Depressive position refers to the achievement of
concepts of object relations therapy from the whole object relations through the reduction of
Klein-Bion perspective and include alpha function, splitting and the replacement of projective identifi-
alpha elements, beta elements, death instinct, cation by repression. It is characterized by feelings
depressive position, envy, internal object, introjec- of guilt and concern and is the instigator of cre-
tion (internalization), normal projective identifica- ative reparation, which restores the conflicted
tion, object, paranoid schizoid position, projective internal world and is manifested in creative engage-
identification, reparation, splitting, and uncon- ment in the external world.
scious phantasy.
Envy
Alpha Function
Envy is a powerful and primitive derivative of
Alpha function refers to the ability of the thera- the death instinct. Envy is seen as an attack on the
pist or mother to make sense of the projected beta good object for “its goodness.” Envy represents a
elements and return them to the patient or child, “spoiling” attack on the vital connection to the
respectively, as useable alpha elements. This is cor- good object.
related to reverie and the capacity to use one’s
countertransference and life experience to make
Internal Object
sense of what the patient is projecting.
Internal object refers to the internal representa-
tion of an external object taken in through multiple
Alpha Elements
experiences, which is considered to be a concrete
Alpha elements are the products of alpha func- aspect of the ego.
tion, which in therapy can take the form of ver-
bal interventions. They allow the client to take in
Introjection
and hold on to mental experience that was for-
merly projected due to anxiety. The more alpha Introjection, or internalization, is the process
elements are accrued, the more the patient devel- through which external experiences are installed in
ops the capacity for his or her own alpha func- the inner world as psychological structures.
tion (to make sense of his or her own thoughts
and feelings).
Normal Projective Identification
Normal projective identification relates to the
Beta Elements
process of interpersonal communication and affect
Beta elements are those bits of indigestible men- induction rather than the simple evacuation associ-
tal experience that are expelled in normal projec- ated with defensive projective identification. Beta
tive identification (interpersonal communication). elements are transformed by alpha function into
alpha elements, which are then returned to the
Death Instinct child or the patient to serve as resources for dream-
ing, thinking, and feeling.
The death instinct was postulated by Freud to
be a silent instinctual drive toward the dissolution
of life and is identifiable as destructive aggression Object
when projected out in behavior. According to Object refers to a person (usually the primary
Klein, this concept helped her understand the sig- objects of childhood).
nificant aggression and sadism found in child play
therapy. Today, some analysts view this concept as
Paranoid Schizoid Position
related to the psyche’s capacity to destroy those
internal connections that cause overwhelming Paranoid schizoid position refers to the first
emotional experience. developmental position of infancy, characterized

734 Object Relations Theory
by conflict, anxiety, and the splitting of object and countertransference affective experience to both
self representations into good and bad. The defense inform himself or herself of the projected experi-
of projective identification is prominent in this ence of the patient and determine his or her
developmental period. empathic response.
Projective Identification Negative Transference

Projective identification refers to the expelling Negative transference refers to a prominent role
of an unwanted aspect of the self and its place- of sadism, destructiveness, and aggression that is
ment in an object with the intent of controlling expected to emerge in the transference relation-
that object. It is the prototype of an aggressive ship. No analysis is complete without engaging this
object relationship. core experience.
Reparation Play Technique

Reparation is the source of creative engagement Through a variety of play materials, the child’s
and action in the external world and represents the play is seen as an externalization of his or her
simultaneous action of repairing the internal world internal and unconscious processes.
compromised during the cruelty to the internal
objects of the paranoid schizoid position. Reverie
Reverie refers to the listening capacity most
Splitting
clearly aligned with negative capability. This con-
Splitting refers to the defense of separating good cept endorses approaching each hour with a
and bad object experiences in the service of internal patient as if it were the first, eschewing “memory
regulation and the avoidance of painful synthesis. and desire.”
Unconscious Phantasy Infant in the Child

Unconscious phantasy refers to the movement Infant in the child refers to the importance
of biological or instinctual experience into psycho- placed on the therapist’s ability to listen to the
logical experience. It is seen to undergird all mental patient’s experiences as expressing issues from
activity. Object relations unfold in the context. multiple levels, including adult, child, infant, and
even prenatal.
Techniques
Some techniques critical to the Kline-Bion model Therapeutic Process
are a here-and-now emphasis, metabolizing projec-
The Klein-Bion model of therapeutic process is
tive identifications, negative transference, play
based on Bion’s definition of normal projective
techniques, reverie, and infant in the child.
identification. Normal projective identification is
a sophisticated mode of interpersonal communi-
Here-and-Now Emphasis cation that involves the patient inducing affective
Here-and-now emphasis denotes the necessity experiences in the therapist as a mode of commu-
of working in the immediate setting and focusing nicating mental experience that the patient cannot
on anxiety. Working the transference relationship as yet put in words. Put another way, “I can’t tell
to a fever pitch allows the patient to produce all you what I am feeling, but I can certainly have you
the relevant historical detail. feel it.” When an indigestible mental experience
(beta element) is projected into the therapeutic
field, the experienced therapist accepts this experi-
Metabolizing Projective Identifications
ence into his or her subjective world, where it
Metabolizing projective identifications refers to stimulates the therapist’s corresponding states.
the therapist’s capacity to reflect on and utilize the The therapist is then able to reflect (reverie, alpha

O’Hanlon, Bill 735
function) and develop an intervention (alpha ele- Further Readings

ment), which is then given back to the patient. Bion, W. (1967). Second thoughts. London, England:
This alpha element is a digested and more easily Heinemann.
assimilated experience than the one that was Bleandonu, G. (2000). Wilfred Bion: His life and works
expelled. In a certain way, this is what may be 1897-1979. New York, NY: Other Press.
described as turning gristle (mental) into baby Casement, P. (1991). Learning from the patient. London,
food, which the patient’s mind can digest and then England: Guilford Press.
use to think, dream, and feel. Guntrip, H. (1977). Personality structure and human
The affective experiences that are created in the interaction. New York, NY: International Universities
therapist constitute, in the broadest sense, the thera- Press.
pist’s countertransference to the patient. These Hinshelwood, R. D. (1989). A dictionary of Kleinian
emotional reactions are the only emotional facts the thought. London, England: Free Association Books.
therapist has to work with in the session. Therapy Kernberg, O. (1976). Object relations theory and clinical
then is the ongoing process of interpersonal com- psychoanalysis. New York, NY: Jason Aronson.
munication whereby beta elements are digested and Segal, H. (1973). The work of Melanie Klein. London,
returned by the therapist in forms useable by the England: Karnac Books.
patient’s mind. The patient needs to have the thera- Spillius, E. (Ed.). (1994). Melanie Klein today:
pist’s mind to serve as an auxiliary mind in the Developments in theory and practice: Vol. 1. Mainly
process of not only development but also therapeu- theory. London, England: Routledge.
tic change. What is described here is an ongoing
process of projection and introjection and a focus
on countertransference listening capacities.
The Klein-Bion description of the transference O’HANLON, BILL
relationship builds on the early work of Freud. In
addition to the projection of internalized object William “Bill” O’Hanlon (1952– ) is a practicing
experiences, Klein adds the role of unconscious therapist, writer, motivational speaker, and consul-
phantasy. Transference represents the projection of tant widely known for his contributions to the
the entire internal world or the “total situation.” development of the solution-oriented counseling
Current phantasies (oral/hunger) are then amal- approach. A student of Milton Erickson and early
gamated with object representations (“I could eat collaborator with other practitioner-theorists such
you up!”). The listening perspective endorsed in as Steven De Shazer and Michele Weiner-Davis,
this approach is one of negative capability and O’Hanlon now refers to his model of counseling
reverie. The therapist attempts to forget all that he and psychotherapy as possibility therapy to allow
or she knows and understands in order to be room for clients to discuss problems alongside
receptive to what is new in the patient’s presenta- discussion of their strengths, competencies, and
tion. Memory and the desire to cure are seen to solutions.
interfere with this receptive capacity. Raised in the Chicago, Illinois, area, O’Hanlon
Regarding interpretation, this model endorses the grew up in a large Irish Catholic family. As one of
early and deep interpretation of unconscious mate- eight children, including two half brothers from his
rial. Where more classically trained therapists call for father’s first marriage, O’Hanlon experienced his
measured and well-timed interventions, the Kleinian family of origin as a village. He recalls his family
approach argues that the process of immediately and needing to remodel the attic into another shared
courageously engaging the major anxieties presented bedroom to accommodate his large blended family,
in treatment is relieving and contributes to the and sometimes their extended family and friends.
establishment of the therapeutic alliance. While O’Hanlon was himself shy, most of his
Allen Bishop siblings were outspoken. He grew accustomed to
multiple conversations at dinnertime and remem-
See also Classical Psychoanalytic Approaches: Overview; bers adopting the stance of an observer to his own
Ego Psychology; Freud, Sigmund; Freudian family’s dynamics from an early age. He credits his
Psychoanalysis; Kernberg, Otto; Klein, Melanie; family-of-origin experiences as formative to his
Neo-Freudian Psychoanalysis; Winnicott, Donald development as a family therapist. Believing that

736 O’Hanlon, Bill
people are sensitized by their life experiences, systems therapy in his third year of college that
O’Hanlon considers that his family of origin pre- would later serve as the basis of his therapeutic
disposed him to relationships, empathizing with orientation for the rest of his professional life. As a
others, and wanting to help in a nonjudgmental junior, he read Jay Haley’s book about Erickson
way. One important family dynamic revolved and became fascinated by systemic and strategic
around the practice of blaming. If things went therapy concepts. After spending time as a clinic-
wrong or undesirable things happened, members based counselor in Arizona, O’Hanlon sought out
of the family tended to blame, even when logically the opportunity to study with Erickson himself.
it did not make sense. When he began learning The charismatic and dynamic Erickson played a
about therapy and started to practice, he did not key role in encouraging O’Hanlon to become a
want to blame clients for their own problems. new kind of therapist. During this time, Erikson
Instead, he was moved to focus on listening, help- shared an influential story about his clinical work
ing, empathizing, and validating, partly to prevent with a client. Erikson approached the client with
what he felt happened to him in his family of origin kindness, focusing on inner resources, and what
from happening to his client. The goal of develop- abilities were present in the client rather than cor-
ing a helping approach that reduced or avoided the recting the client. Erikson sought out what was
need to blame led O’Hanlon to embrace the prin- working in the client’s life and gave it back to the
ciples of family systems therapy. He resonated with client. This optimistic approach and belief that this
the idea that the family environment is something client, as all people, had the resources to change
that is created together by the family members and had a profound effect on O’Hanlon’s desire to
so both positive and negative experiences are become a therapist and, more specifically, to
shared creations. This idea countered the tendency understand the type of therapist he wanted to be.
in families, including O’Hanlon’s own family, to In addition to the impact of Erickson, O’Hanlon
blame individuals for negative experiences. The was also profoundly influenced by Peter Berger
acknowledgment of the shared interaction and and Thomas Luckmann’s The Social Construction
creation of family dynamics seemed to O’Hanlon of Reality, first published in 1966. The framework
to be the answer to his dissatisfaction with other of social constructionism expanded O’Hanlon’s
concepts related to family environments. awareness of how reality is shaped, and in turn
As a young college student, O’Hanlon faced one shaped by, culture, language, gender, background,
of his greatest challenges. He found himself over- and other discourses or ways of knowing. He came
whelmed in a large university setting among out- to accept the view that diagnosis is not a neutral
sized classes, isolated from the contact and support act and that therapists always bring their own
of his family. His shyness intensified as he began to biases, values, and experiences into the therapy
spend much of his time alone. This was soon fol- relationship. As opposed to the phenomenology of
lowed by depression and, later, suicidal ideation. A strict constructivists, O’Hanlon also resonated
promise to a friend not to kill himself became the with the social-constructionist concept that indi-
turning point out of this crisis point in his life. This vidual and social interaction with reality brings
also deepened his fascination with understanding forth meaning. The active, ongoing, and dynamic
how people find meaning within themselves and co-construction of experience can be tapped into
with other people. O’Hanlon turned to psychology within a helping relationship to galvanize clients’
to gain the knowledge and understanding he competencies and sense of personal agency and
sought. What he found in psychology was the same ultimately devise novel solutions to what may
blaming, often in the form of pathologizing and seem like insurmountable problems.
objectifying people’s life experience, that he had Later, O’Hanlon worked with a client in crisis
developed a sensitivity to earlier in life. O’Hanlon whose primary therapist was unavailable. With the
quickly became dissatisfied with the apparent understanding that he would not be working with
acceptance within professional psychology of the this client for very long, O’Hanlon determined not
need to diagnose a client with a mental disorder to ask about the client’s problem but rather to ask
before therapeutic help could begin. It was his about what the primary therapist had done in the
exposure to Milton Erikson’s work in family previous sessions. Together, O’Hanlon and the client

Operant Conditioning 737
were able to recognize what was most helpful and make things worse but helps them move forward.
useful to the client. With O’Hanlon’s encourage- O’Hanlon recognizes that this may require the use
ment, the client agreed to repeat what had been of other theories. However, he feels that his loyalty
working well and left the session reinvigorated. to his clients is more important to him than his
O’Hanlon himself was also inspired by the experi- theory. Brief, solution-focused or solution-oriented
ence, and his self-examination of what he had done therapy is today considered to be an evidence-
differently led him to recall that the problem had based practice and counseling theory of choice for
not been discussed. This and other clinical experi- initial encounters with clients from different back-
ences helped solidify the importance of connecting grounds and for a wide variety of problems,
with clients’ strengths, often in brief therapy encoun- including depression, anxiety, and substance use
ters, and working with the possibilities inherent in disorders.
language to cocreate therapeutic change.
In 1981, O’Hanlon found his theoretical Jeffry Moe and Elsa Soto Leggett
approach to therapy changing to reflect the insights
See also de Shazer, Steve, and Insoo Kim Berg; Erickson,
and influences of the many experiences he had had Milton H.; Haley, Jay; Possibility Therapy; Solution-
by that point in his professional journey. He found Focused Brief Therapy
himself incorporating these realizations into work
with all or most clients, discussing the nature of
the problem less and asking about what is helpful Further Readings
for clients more. These were his first steps toward Berger, P. L., & Luckmann, T. (1991). The social
developing his theory of solution-oriented therapy. construction of reality: A treatise in the sociology of
Concurrently, Steve de Shazer, Insoo Kim Berg, and knowledge. London, England: Penguin Press.
others were developing solution-focused therapy. Haley, J., & Erickson, M. H. (1973). Uncommon therapy.
O’Hanlon saw that there were not only strong New York, NY: W. W. Norton.
similarities between solution-focused and solution- O’Hanlon, B., & Beadle, S. (1999). A guide to possibility
oriented models but also some notable differences. land. New York, NY: W. W. Norton.
Solution-oriented therapy was more person cen- O’Hanlon, S., & Bertolino, B. (2013). Evolving
tered, and it relied more on joining with clients and possibilities: Selected works of Bill O’Hanlon.
validating their concerns than solution-focused Philadelphia, PA: Routledge.
therapy, especially as conceived by de Shazer. This
included making more room for dialogue about Website
problems and validation of client efforts toward
and frustrations with change. Subsequently, Bill O’Hanlon: www.billohanlon.com
O’Hanlon identified the term possibility therapy as
more representative of his beliefs about profes-
sional helping.
O’Hanlon published his first book in 1987, OPERANT CONDITIONING
Shifting Contexts: The Generation of Effective
Psychotherapy, coauthored with James Wilk. He Adaptive behavior is anything an animal does that
has published 37 books, including Out of the Blue: aids its Darwinian fitness, that is, anything that
Six Non-Medication Ways to Relieve Depression, helps it to survive and reproduce. Adaptive behav-
published in 2014. Along with these publications, ior comes in two varieties, although the division is
O’Hanlon has numerous journal articles, book not sharp. Reflexes and many “instincts” are built
chapters, audio programs, video programs, com- in. For example, a child withdraws his or her hand
puter programs, and Internet courses to his credit. from the hot fire without instruction, but the same
Of all his works, Guide to Possibility Land can be child may have to learn not to touch a hot kettle.
seen as the one that provides the clearest insight The first behavior is the result of natural selection
into his thoughts about working with people. His during phylogeny, the evolution of the species. The
work seeks to help people relieve suffering in a second is the result of operant conditioning, volun-
way that respects them, does not harm them, or tary behavior modified by its (in this case, painful)

738 Operant Conditioning
consequences during ontogeny, the life of the indi- completes a fixed number of lever presses. A vari-
vidual. Operant conditioning is also the result of able-interval schedule delivers a reinforcer for the
selection, but selection by positive and negative first response after a time interval that varies from
consequences—reinforcers and punishers—during one reinforcer to another. Each reinforcement
ontogeny. Reinforcement selects from responses schedule generates its own distinctive pattern of
emitted by the organism in a conditioning situa- behavior.
tion. The varied responses that occur in a given Skinner invented a new technical language and
situation are termed the organism’s repertoire. philosophy of science. After World War II, he and
Operant conditioning is usually distinguished his students and followers proposed influential,
from classical, or Pavlovian, conditioning: In oper- and often controversial, applications for operant
ant conditioning, the organism learns that a behav- conditioning ranging from psychotherapy, to teach-
ior leads to a specific consequence; in classical ing, to the justice system, to the “design of cul-
conditioning, it learns that a stimulus leads to a tures.” Skinner’s emphasis on practical applications
specific outcome. Most learning situations involve led to effective, but sometimes labor-intensive,
both processes to some degree. treatment for a wide range of behavioral problems:
Behavior-analytic psychotherapy, or applied for example, token economies for psychiatric
behavior analysis (ABA), is the clinical application patients or behavioral treatments for autistic spec-
of the principles of operant conditioning. Its aim is trum disorders, an area where reinforcement sched-
to identify and eliminate consequences that main- ule–based methods have been especially successful.
tain undesirable behavior and implement conse- Today, the principles of operant conditioning are
quences that promote desired behavior. ABA has used in a wide range of behavior therapy approaches
been applied to psychotherapy for a wide variety and are often integrated by counselors and thera-
of mental health concerns but has been found to be pists into other theoretical orientations.
particularly useful when working with individuals
with autism, individuals with intellectual disabili-
ties, individuals with severe mental health disor-
ders, children on behavioral change, and certain The relation response → consequence in the pres-
forms of anxiety, as well as in providing parents ence of a certain discriminative stimulus is termed
with tools for parenting and in reinforcing new a 3-term contingency of reinforcement. For instance,
behaviors when providing other forms of therapy. mammals and birds readily learn to respond in a
desired manner when a green light is on but not
when a red is on—that is, they discriminate—after
Historical Context
sufficient training under a 3-term contingency.
E. L. Thorndike’s pioneer animal-learning experi- Operant conditioning is more complex than classi-
ments in the late 19th century led to his law of cal conditioning because it involves a minimum of
effect: Behavior immediately followed by some- three terms rather than just two—response, (dis-
thing the organism likes (positive reinforcement) criminative) stimulus, and consequence, rather
will tend to increase in frequency, and it will than just stimulus and consequence—as well as a
decrease in frequency if accompanied by some- feedback relation between the organism’s behavior
thing it does not like (punishment). But the study and its consequence.
of operant conditioning only took off with the Operant conditioning is an empirical phenom-
work of B. F. Skinner. In the early 1930s, he enon and as such is not tied to any particular
invented the “Skinner box,” an automated appara- theory. Nevertheless, much of operant condition-
tus for the study of operant conditioning in ani- ing research, notably among ABA practitioners, is
mals such as rats or pigeons. With its aid, he and still pursued within the framework of Skinner’s
his students discovered reinforcement schedules, radical behaviorism. Other approaches to operant
rules that deliver reinforcement depending on time conditioning—cognitive, computational, associa-
elapsed or the number of responses emitted in the tive, and theoretical—have come to prominence in
presence of a given stimulus, such as a light or a recent years, but their impact has been more at the
tone. A fixed-ratio (FR) schedule, for example, level of fundamental research on operant condi-
delivers a bit of food to a hungry animal after it tioning than on its clinical applications.

Skinner’s radical behaviorism rejects the kind of the subject. For instance, a pigeon will easily learn a
inferred-process theories widely used in the rest relation between pecking (a food-related behavior)
of psychology, restricting itself to the discovery of and food or between a sudden wing flap (a defensive
lawful relations between dependent (behavioral) behavior) and the termination of an electric shock.
and independent (environmental) variables. Learning is much harder if the consequences are
Skinner did not deny the existence of what he flipped—wing flap for food, and so on.
called “private” events but treated them as stimuli
and responses not fundamentally different from
Reinforcement, Punishment, and Choice
external stimuli and responses (“The skin does not
make a difference”). According to Skinner, the The effect of operant learning on behavior
same operant conditioning principles explain all depends on the motivational value of the conse-
behavior, whether overt or covert. If there are quence. The probability of a behavior will increase
internal variables, they belong to neuroscience, not (reinforcement) if the consequence is a reward
the science of behavior. This position has been (positive reinforcement) or the removal of an aver-
criticized as eccentric because ruling out all inter- sive event (negative reinforcement). It will decrease
nal variables would set behavioral psychology (punishment) if the consequence is the omission of
apart from the developed sciences, which all a reward (negative punishment) or the presenta-
depend on theories that involve inferred entities, tion of an aversive event (positive punishment).
such as gravity, atoms, and genes (genes and atoms Reinforcement and punishment affect the
were inferred long before they could actually be strength of the response, which is reflected in its
observed). Testable theoretical accounts for several rate (e.g., pecks per minute), its probability, or the
learning phenomena, such as habituation, interval proportion of time the organism devotes to it.
timing, choice, and reversal learning, have been According to a proposal by Richard Herrnstein,
proposed. All involve variables that cannot be response strength is proportional to its relative
directly measured. reinforcement rate (how much it is reinforced rela-
tive to other behavior emitted in that situation). In
a two-choice situation, it takes the form of the
Major Concepts
much studied matching law: The ratio of the rates
This section first examines conditions of learning, of the two responses matches their reinforcement
including contiguity, contingency, and biological rate ratio.
preparedness. Then it explores reinforcement, pun- J. A. Nevin has pointed to another dimension of
ishment, and choice; it concludes with a discussion responding, namely, its resistance to change (also
of stimulus control. termed behavioral momentum), that is to say, its
modifiability by extraneous variables such as free
The Conditions for Learning: Contiguity, reinforcers or changes in the reinforcement rate.
Contingency, and Biological Preparedness For instance, if reinforcement or punishment is
discontinued (extinction), the resistance to change
A subject will learn the relation between a of the behavior will determine how long it will take
behavior and a consequence (operant learning) if to get back to its baseline level. Resistance to
the following conditions are met: change is related to the rate of reinforcement, more
or less independently of the contingent relation
Contiguity: The consequence should follow the rein- between the reinforcer and the behavior, and to the
forced response closely in time. (Conditioning with consistency of reinforcement in the organism’s past.
delayed reinforcement is possible but slow and unre- Primary reinforcers and punishers are events
liable.) that have their effects without special training but
still require special circumstances for them to rein-
Contingency: The response must be a good predictor
force and punish behavior. According to behav-
of the consequence (free—response independent—
ioral regulation theory, for example, an organism
reinforcers impair conditioning).
has a preferred distribution of activities (bliss
Biological preparedness: The response and the con- point). Any manipulation that forces it away from
sequence must be linked in the natural repertoire of this bliss point is punishing (aversive), whereas any

manipulation that brings it closer is reinforcing. $100 now. But if given the choice between $100 in
For example, laboratory studies have shown that a 1 year and $105 in 1 year and 1 day, their prefer-
rat prefers to keep its rate of lever pressing low and ence would switch to the $105.
its rate of heroin intake high. This bliss point can
be reached if the animal has free access to heroin:
Stimulus Control
It can consume as much heroin and make as few
lever presses as it likes and still hit the spot. Stimuli correlated with reinforcement and pun-
Making heroin access contingent on lever pressing ishment can exercise stimulus control over an
forces the rat to compromise. If it does not increase operant response. An organism consistently rein-
its rate of lever pressing, it will consume much less forced in the presence of a single value on a unidi-
heroin than its preferred level. So it will increase its mensional stimulus such as wavelength (e.g., green
lever pressing until the marginal cost of an extra at 550 nanometers) will respond more slowly if
lever press is matched by the marginal benefit of shown other wavelengths. The resulting generaliza-
the extra bit of heroin. Deviations from the pre- tion gradient shows how response strength varies
ferred level of lever pressing are less aversive than with stimulus value. Gradients have a bell-shaped
deviations from the preferred level of heroin form usually centered on the stimulus value rein-
intake. In economist’s language, the demand for forced during training. A flat gradient indicates
heroin is inelastic while the demand for lever press- lack of stimulus control, whereas the subject
ing is elastic. Hence, increasing the rate of lever responding only at the value used in training indi-
pressing to increase the rate of heroin intake is cates perfect stimulus control. The shape of the
more satisfying (closer to the animal’s bliss point) gradient depends on the organism’s history and its
than is reducing the rate of heroin intake to keep sensory apparatus: The greater the exposure to the
the rate of lever pressing down. stimulus dimension (e.g., wavelength, frequency)
Another useful concept from economics is sub- and higher the rate of reinforcement in the pres-
stitutability. Heroin and methadone are perfect ence of a particular stimulus value, the sharper is
substitutes for each other. Hence, if methadone is the gradient. An early experiment showed that
made freely available, heroin will fail to reinforce pigeons reared in monochromatic light show flat
lever pressing: By substituting methadone for her- generalization gradients. The sharpest gradients
oin, the rat will be able to stay at its bliss point. Its are obtained through discrimination learning,
need for heroin will be fulfilled by substituting where behavior is reinforced in the presence of one
methadone for it, and it will not have to increase stimulus but not in the presence of another. The
its rate of lever pressing, hence keeping it to its closer two stimuli are to each other, the steeper the
preferred level. This kind of optimality analysis, gradient and the more likely its peak will be dis-
borrowing from economics, has revealed the com- placed away from the unreinforced stimulus value
mon properties of many operant conditioning (peak shift).
arrangements. There are two ways by which a stimulus can
Conditioned reinforcers and punishers acquire control behavior, which can be illustrated through
their reinforcing or punishing properties through the two potential outcomes of reinforcement
pairing with primary or previously acquired condi- devaluation procedure. In reinforcement devalua-
tioned reinforcers or punishers. The reinforcing or tion procedure, the value of a reinforcer is deval-
punishing value of a conditioned reinforcer or ued, for instance, by pairing it with something
punisher is a hyperbolic function of the delay of aversive (i.e., food with poison), after it has been
the primary reinforcer or punisher it signals used to reinforce a response in the presence of a
(hyperbolic discounting). This has interesting con- particular stimulus. After reinforcement devalua-
sequences: If given the choice between a large, tion, responding in the presence of the stimulus
delayed reward and a smaller, more immediate signaling the reinforcer will sometimes be sup-
one, organisms will usually prefer the latter if the pressed. If so, the response is said to be a goal-
overall delay of the rewards is small and the for- oriented behavior, and its controlling stimulus is a
mer if the overall delay of the rewards is large. For discriminative stimulus or an occasion setter, sig-
instance, if given the choice between $100 now naling that the response will be reinforced. If
and $105 tomorrow, most people will prefer the not suppressed, the response is said to be a habit

elicited by the stimulus through direct stimulus– analysis. The steps are then shaped sequentially.
response links. Factors affecting the sensitivity of a For backward chaining, the last step in the sequence
response to reinforcer devaluation procedures are is the first to be taught, then the next to last, and
the amount of training (behavior becomes less senso on, until the entire sequence is learned. In this
sitive to reinforcer devaluation after increased process, reinforcement is typically presented only
training) and the schedule of reinforcement (behav- after the completion of the final step in each trial.
ior is less sensitive to reinforcer devaluation in In this way, each additional step becomes the dis-
variable–interval schedules than in variable–ratio criminative stimulus for the remainder of the steps,
schedules). (See the following section on tech- which reliably result in reinforcement. This process
niques for a description of these schedules.) is effectively used in the operant acquisition of
behaviors where components are topographically
different from one another and need to occur in
Techniques sequence (e.g., putting on clothing). For some
Shaping skills, it is more effective to begin each training
trial at the first step in the process, called forward
Before a behavior can be reinforced, it must first chaining. This is more likely to be combined with
occur “for other reasons”; that is, it must be emitted total task presentation; that is, all substeps in the
spontaneously. Reinforcement is selection, but sequence are presented in each training trial, with
behavioral variation is the process through which it appropriate cues or assistance provided to success-
must work. Several factors that affect behavioral fully complete the entire chain each time. This is
variation have been identified, but a general theory is used for sequences of behaviors with distinct steps
still lacking. Reinforcement itself reduces variability, that would not reasonably lend themselves to
unless variability is itself the target of reinforcement. shaping or backward chaining (e.g., brushing one’s
Extinction increases variability, notably through a teeth).
phenomenon variously known as regression, resur-
gence, or spontaneous recovery, whereby suppressed
but previously reinforced behaviors return. Schedules of Reinforcement
Shaping is a technique used to train behavior Schedules of reinforcement are rules describing
that would have never been emitted spontaneously. the conditions under which a response will be rein-
It consists in reinforcing successive approxima- forced. The most commonly studied are interval
tions to the target behavior, while progressively schedules, whereby reinforcement depends on the
tightening the criterion for reinforcement as the time elapsed since the last reinforcement, and ratio
behavior gets closer to the target. Although effec- schedules, whereby reinforcement depends on the
tive in many clinical or animal-training settings— number of responses emitted since the last rein-
training dancing dogs or ping-pong-playing forcement (the ratio value). Chain schedules are a
pigeons—shaping is still an intuitive rather than a succession of schedules, each associated with a dif-
scientific process. The variables that promote ferent stimulus, where the reinforcer for schedule n
behavioral variability and the laws that determine − 1 is access to schedule n, until the last schedule
which behavior is a necessary antecedent to in the chain, which gives access to a primary rein-
another—the necessary learning sequences for forcer. For instance, a pigeon might have to peck a
shaping complex behaviors—are not well under- red key under an FR 15 schedule. The 15th peck
stood. Shaping is used to teach behaviors that, would turn the key from red to green, and pecking
while complex, are not easily broken down into on it would now be reinforced according to an FR
simpler parts (e.g., catching or throwing a ball). 30. The 30th peck would turn the key blue, and
pecking would now be reinforced according to an
FR 60. With FR 60 being the last schedule in the
Chaining
chain, the 60th peck would lead to food rather
Operant chaining is used to teach a sequence of than to another schedule. Tandem schedules are
behaviors that can be broken into a series of sim- like chained schedules, except that the transition
pler substeps or components. The process of from one schedule to the next is not signaled by a
designing these substeps is referred to as a task stimulus change. In multiple schedules, the subject

is successively exposed to several schedules, each therapy of insomnia relies on the assumption that
signaled by a different stimulus. In simple sched- insomnia is partly due to behavior other than
ules, only one response is explicitly reinforced, sleeping having been reinforced in the presence of
whereas in concurrent schedules, several responses stimuli present in the bedroom. The goal of the
(two levers, three pecking keys, etc.) are concur- therapy is to reestablish stimulus control of those
rently reinforced. If the reinforcer is access to stimuli over sleeping. Tinnitus retraining therapy
another schedule leading to primary reinforcement makes use of a phenomenon called fading, in
rather than to a primary reinforcer itself, it is a which a neutral stimulus is presented concurrently
concurrent chain schedule. with an already established discriminative stimu-
Schedules of reinforcement are used as research lus. The intensity of the discriminative stimulus is
tools for the study of choice and preference in the then progressively faded until it is no longer pre-
case of concurrent and concurrent chain schedules sented. This results in a transfer of its controlling
and for the study of temporal learning in the case properties over the neutral stimulus. In tinnitus
of fixed-interval schedules. Schedules are also a retraining therapy, patients are taught to ignore an
research topic in their own right, as different sched- external stimulus, whose intensity is progressively
ules induce different patterns of responding. For reduced, leading this response to transfer to the
instance, ratio schedules lead to much higher tinnitus, which the patients are now able to ignore.
response rates than do interval schedules, even For obvious ethical reasons, the use of punish-
when the reinforcement rates are the same. Variable ment remains controversial and is usually restricted
(random)–ratio and variable–interval schedules to extreme cases (e.g., to stop self-harming behav-
maintain a constant rate of responding over a wide ior such as head banging, which could severely
range. Animals pause after reinforcement in FR harm the patient if not rapidly stopped), especially
and fixed-interval schedules, with the duration of as other techniques relying on positive reinforce-
the pause roughly proportional to the ratio or ment, extinction, or stimulus control can be used
interval of the schedule. Variable-interval schedules to reduce the frequency of an undesirable behavior.
can sustain a very steady rate of responding despite These techniques are as efficient as punishment
low reinforcement rates. The effective application and pose none of the ethical problems or have the
of schedules of reinforcement is integral to effective problematic behavioral side effects (e.g., develop-
ABA in teaching and in maintaining desirable ment of anxiety and aggressive behavior) linked to
behaviors. aversive techniques. For instance, differential rein-
forcement of other behaviors and differential rein-
forcement of alternative behavior rely on positive
Therapeutic Process reinforcement of behavior incompatible with the
Today, many operant conditioning techniques are target behavior whose frequency the therapist is
used in therapy, including cognitive-behavioral trying to reduce. If the undesirable behavior is
approaches. Positive reinforcement is used most itself maintained by reinforcement (e.g., harmful
commonly. For instance, some patients can be behavior reinforced by the attention the patient
given tokens for exhibiting appropriate behavior. receives as a consequence of it), discontinuing
These tokens can be accumulated and exchanged those reinforcers will lead to a decrease in the fre-
later for other reinforcers. Use of charts or stickers quency of the reinforced behavior (extinction).
at home by parents involves the same behavior
J. Jozefowiez and J. E. R. Staddon
principles as more formal token systems. Verbal
attention and approval by a therapist or loved ones See also Applied Behavior Analysis; Behavior
also can function as reinforcers. Modification; Chess Therapy; Classical Conditioning
Stimulus control can also be used to profit. At a
very basic level, a maladaptive behavior under
stimulus control (e.g., overeating) can be reduced Further Readings
if the discriminative stimulus (e.g., caloric food) Domjan, M. E. (2009). The principles of learning and
for this behavior is withdrawn from the environ- behavior (6th ed.). Independence, KY: Wadsworth.
ment. More sophisticated uses of stimulus control Jozefowiez, J., & Staddon, J. E. R. (2008). Operant
are also possible. For instance, stimulus control behavior. In R. Menzel & G. Byrne (Eds.), Learning

Orgonomy 743
and memory: A comprehensive reference: Vol. 1. of significant others or circumstances in the hope
Learning theory and behavior (pp. 75–102). Oxford, of securing emotional needs and avoiding pain.
England: Elsevier. Orgonomists establish a contactful relationship
Lattal, K. A. (2012). The five pillars of the experimental with the patient and help define and change the
analysis of behavior. In G. J. Madden (Ed.), APA patient’s destructive defenses, simultaneously
handbook of behavior analysis: Vol. 1. Methods and working with the body to release biophysical hold-
principles (pp. 33–63). Washington, DC: American ing through deep massage and pressure and expres-
Psychological Association. sive exercises that allow the patient to have inner
Staddon, J. E. R. (1983). Adaptive behavior and learning.
sensate contact with self, increased breathing, and
Oxford, England: Oxford University Press. Second
release of emotion. Character restructuring and
edition, 2010, electronically available at http://
biophysical interventions help the patient gain
dukespace.lib.duke.edu/dspace/handle/10161/2878)
access to an authentic self, lower levels of stress
Staddon, J. E. R. (2014). The new behaviorism. Florence,
KY: Psychology Press.
and reactivity, and ameliorate trauma and symp-
Staddon, J. E. R., & Cerutti, D. T. (2003). Operant
toms such as posttraumatic stress disorder, depres-
conditioning. Annual Review of Psychology, 54, sion, anxiety, and psychogenic pain.
115–144. doi:10.1146/annurev.psych.54.101601
.145124
Historical Context
Reich developed orgonomy in the 1930s. Raised
in the Ukraine in a farm setting that stimulated his
interest in biology and natural science, he set up
ORGONOMY his first laboratory at the age of 8 years for col-
lecting butterflies and insects under the guidance
Developed in the early 20th century by Wilhelm of a private teacher. His interest in natural life
Reich (1897–1957), a physician, scientist, and psy- functions determined his later preoccupation
choanalyst, Reichian therapy, or orgonomy, is a with the biological foundations of humankind’s
systematic, psychodynamic, and somatic approach emotional life. As a physician, scientist, and psy-
that provides character and biophysical restruc- choanalyst, Reich early on became interested in
turing. Its engaged verbal therapy, paired with questions of psychic energy and drives, particu-
somatic interventions, contrasted the widely larly sexuality, which at that time was a taboo
accepted psychoanalytic approach of Reich’s men- subject. Reich’s interests led to discoveries of bio-
tor, Sigmund Freud (1856–1939). Orgonomy rec- energetic problems, including the biological basis
ognizes the functional identity of mind and body, of instincts, the nature of pleasure and tension, the
and Reich’s theories can be considered the founda- role of genitality, the function of the orgasm, and
tion of the somatic therapies that followed. Also the sources of neurotic anxiety. Reich left Europe
known as medical orgone therapy and orgonomic in 1939 for New York City and began publishing
therapy, Reichian therapy recognizes how armor- in English, training American physicians in his
ing against the free flow of life energy blocks therapeutic techniques and continuing his research.
authenticity and open expression and affects an In 1942, he purchased a large plot of land and
individual’s capacity to experience aliveness, farmhouse in Rangely, Maine, which became his
meaning, and fulfilling relationships. Orgonomists permanent laboratory and teaching center, called
believe that a loving sexual life is a vital aspect of Orgonon. There, he studied single-celled organ-
satisfying relationships. isms, human blood composition, and the origins
In Reichian therapy, the therapeutic focus is less of life and experimented with the basic energy he
on the story the patient relays and more on how found in all living things. He built what he called
the patient actually is and how he or she relates an orgone accumulator made up of organic and
and functions. Character defenses are established metal layers that attracted and contained atmo-
early on as the individual finds how best to survive spheric energy. Reich’s work was informed by his
when life events impinge on the developing authen- experimental study of the amoeba, which illus-
tic self. These adaptations create distorted ways of trated the principles of expansion, contraction,
being that conform to the perceived expectations and pulsation, so critical to his work with patients.

744 Orgonomy
He wrote prolifically on politics, sexuality, family Reich responded with a letter to the judge, which
practices, and society. stated that he would not appear in court as it would
The first phase of his career was in the psycho- allow a court of law to judge his scientific research
analytical movement, but his extensive clinical and validate a complaint not founded on scientific
work and research led to conflicts with Freud. research and science. The judge did not accept his
While Freud moved away from the concept of letter and escalated the injunction. One of Reich’s
libido as a biological sexual energy, Reich was con- students, without Reich’s permission, moved some
vinced otherwise. Reich believed that dammed-up accumulators and books from Maine to New York.
sexual energy was a factor in creating an imbal- The FDA then charged Reich with contempt of
ance in the body, leading to neurotic symptoms, court. Reich was convicted and sentenced to 2 years
and he argued that the function of the orgasm is to in federal prison. Reich appealed, but meanwhile
maintain an energetic equilibrium by discharging the government destroyed his orgone accumulators,
excess energy. Reich also discovered that in psychic and his literature was burned in Maine. In New
disturbances, this biological energy is bound up York in 1956, the FDA burned several tons of
not only in symptoms but, more important, in Reich’s publications, including major works such
characterological and muscular rigidities he defined as Character Analysis (with M. Higgins and
as armor. This theory set him apart from his col- C. Raphael, 1980) and The Function of the Orgasm
leagues, as it indicated that libido was a real (1973). With his appeals denied, he was taken to a
physical energy. Thus, Reich developed therapeutic federal penitentiary in Pennsylvania in 1957 and
techniques to eliminate patients’ character and soon after died of heart failure. Throughout his life,
biophysical armor to allow for the flow and dis- and continuing today, many of those who have
charge of bioenergy. studied his contributions realized the applicability
Reich was frustrated with analysts who relied of his visionary ideas to clinical modalities.
on the nonengaged blank screen approach that
centered on free association, interpretation, and
dream analysis. He often felt that approach was
chaotic and that the analysts’ use of interpretations Reich suggested that character structures are cre-
contributed to intellectualization and interventions ated early in life to protect against difficult feelings
that were not guided by the patient’s felt experi- and experiences that need to be avoided or forgot-
ence. Instead, Reich focused on topics of resistance, ten by the conscious mind. Core natural feelings of
latent negative transference, chaotic associations love, aggression, and anxiety can be inhibited due
used as avoidance, and defensive character traits to a variety of early conditions. When a person’s
that block contact with felt experience. natural impulses are thwarted and denied, the per-
Reich was an iconic and controversial figure son learns to redirect healthy needs and expres-
who was singled out during the McCarthy era of sions into distorted behaviors. Embedded in the
the 1950s and eventually imprisoned for contempt character style is the patient’s entire history and
of court. In 1947, an article by a freelance writer response pattern. Orgnonomy focuses on the
titled “The Strange Case of Wilhelm Reich” implied patient’s survival strategies and history right there
that Reich was a danger to the public. The author in the therapy room.
challenged the medical authorities to take action Character-analytic techniques are distinguished
against Reich through the Food and Drug by an active and dynamic approach. The orgono-
Administration. This resulted in a 10-year cam- mist sees the patient’s defensive structure and
paign by the FDA to discredit his work. The FDA engages it so that the patient can become conscious
focused on the orgone energy accumulator and the and self-aware of his or her characteristic stance
experiments Reich was doing with patients. In and the problems it creates. The patient can access
1954, the FDA filed a Complaint for Injunction the content and feelings underneath the defensive
against Reich in Maine. It declared that orgone facade. So, rather than follow the patient’s content
energy does not exist and asked the court to pro- or story line, the orgonomist makes observations on
hibit the shipment of accumulators in interstate how the patient is in the room and with the thera-
commerce and to ban Reich’s published literature. pist. This approach creates a lively, present-centered

Orgonomy 745
form of treatment that breaks through the patient’s within the body. Until the mind–body patterning is
habitual style. Through working from the outside realized and dismantled, patients’ access to rele-
in, the patient can unravel his or her own subjective vant material and its expression is stymied. Patients
experience—the cognitive, emotional, and historic do not have the capacity to develop to genitality, a
elements that contribute to the patient’s unique term used to define health whereby all earlier
character and biophysical condition. developmental blocks are eradicated, resulting in a
Reich felt that the analysts of his time focused healthy self-regulating core, defined identity, and
too much on positive feelings and shied away from sexual expression.
bringing out a patient’s negativity, resistance to Orgonomy includes a precise map of blockages,
therapy, and criticisms of the therapist. Orgonomists called segmental armoring, starting with the head
understand that patients and therapists hide behind and eyes (ocular) and moving down to the mouth,
pseudo-positive feelings that mask patients’ real neck, chest, abdomen, and pelvis. These areas of
negativity toward self and others. Therapists blockage are correlated with early developmental
should help patients express and tolerate their fixations and are worked through methodically
aggressive or anxious feelings, including those from top to bottom, so to speak. A diagnostic map
directed at their therapist. of character types plus the map of biophysical
Based in his growing biophysical knowledge armoring creates a systematic approach. Knowing
and experimentation, including his study of the the character type allows the orgonomist to utilize
function of the orgasm and the fact that the energy precise interventions.
is absorbed by organic material, Reich identified
specific energy in the body, which he called orgone
energy. Naming his therapy approach orgonomy, Major Concepts
Reich saw how the character armor is replicated in Reichian therapists embrace the concepts of char-
the patient’s physicality and that one’s character acter analysis, segmental body armoring, and the
style molds the body and results in blocked ener- treatment approach delineated in the previous sec-
getic movement. The body, in its entirety, reflects tion. The major concepts include a focus on char-
chronic character defenses, which affect the mus- acter, not symptoms; contact; resistance analysis;
cular, cardiovascular, autonomic nervous, hor- working with negativity; sexuality and energy
monal, and immune systems. Deep patterns of economy; and pulsation.
reactivity and developmental trauma are reflected
in the body. The autonomic nervous system, which
regulates fight, flight, or freeze responses, can cre- Focus on Character, Not Symptoms
ate chronic heightened reactivity patterns over a Orgonomists concentrate on a patient’s present-
lifetime, affecting the entirety of physical and men- ing character structure, not the patient’s symp-
tal functions. Orgonomy purports that the lack of toms, and readjust the character patterns that lead
the capacity to self-regulate is linked to deeply to the symptom picture. As character propensities
stored psychological or biophysical wounds and are understood, behaviors can change and symp-
ruptures in early infancy and beyond, affects the toms diminish.
development of the brain, and, in turn, has major
ramifications on a person’s ability to self-regulate.
Importance of Contact
Orgonomists help patients see that their atti-
tudes and historical restrictions affect the way Orgonomy stresses the importance of patient
energy moves, which can lead to constriction in all contact with the self and the therapist. Contact
systems within the body. In turn, biophysical con- means the capacity for present-centered energetic
tractions influence patients’ attitudes toward life. aliveness that enables connection to one’s thoughts,
Orgonomists understand that attitudes, cognitions, feelings, and sensations. Contact is encouraged as
feelings, sensations, and behaviors are a function the therapist helps the patient remove body armor
of the freedom, or lack thereof, of movement and break through deadening habits, which allows
(motility), energy circulation, and the capacity for greater movement of energy and increased experi-
natural pulsation: expansion and contraction ence of sensation.

746 Orgonomy
Resistance Analysis and Working With Negativity discussion of sexual issues is encouraged as well
as work on the biophysical segmental armoring to
Employing resistance analysis, Reich saw that
open all the upper segments first, leading to later
the main resistance to analysis was revealed not by
work on the pelvic segment. The therapist inter-
what the patient said or did but by the manner in
venes systematically, starting with the musculature
which the patient said or did it. The detached,
of the head, eyes, mouth, and neck and then
ultra-self-sufficient patient is resisting by the very
moving to the thoracic and abdominal regions
nature of the individual’s chronic detachment, as it
sequentially—opening those before releasing the
walls the person off from therapeutic exploration.
pelvic segment. Interventions include deep mas-
Orgonomists hold that the positive feelings a
sage or pressure on the musculature at specific
patient has for his or her therapist only go so far in
points, for example around the head, eyes, face,
helping the patient and can even reinforce the
and jaw. The therapist applies pressure to the
patient’s defensive structure. Thus, orgonomists
chest to increase breathing and massages the dia-
encourage dialogue about the inevitable resistance
phragm, belly, and back to release tension. Direct
to the therapist and the therapy and how that resis-
pressure on the musculature is accompanied by
tance may be manifesting. Patients may hide layers
patients’ expression of sound or emotions and
of feelings, including hatred, envy, resentment,
deeper access to felt experience. At this point, fur-
distain, contempt, and self-loathing, that need to
ther expression may be encouraged in the form of
be brought to the surface. Negativity or disagree-
kicking or pounding fists or other forms of physi-
able feelings about therapy that are hidden or
cal, vocal, or emotive expression. Each specific
expressed covertly are called latent resistance.
area of armor becomes more mobile, flexible, and
Resistance points are critical junctures in treat-
capable of expression. The patient learns to
ment, and once they are worked through, therapy
increase his or her capacity to relax.
can deepen.
As the armor is released from the top down,
more energy and sensation can flow into the pelvic
Sexuality and Energy Economy region and can be released. Issues emerging from
Orgonomists realize that a satisfactory sexual these various segments are understood and inte-
life is more than successful sexual mechanics and grated emotionally by the patient.
that it includes a capacity for real gratification in
the sexual act through surrendering physically and Pulsation
emotionally within a relationship. Calling this
capacity for love and gratification orgastic potency, Reich understood that all life forms pulsate; that
Reich suggests that this type of sexual openness is, they expand and contract. Organs, vessels, and
releases built-up energy with total convulsions fol- cells naturally pulsate, and humans emotionally
lowed by complete relaxation and a tender attitude expand with pleasurable, aggressive, or longing
toward one’s partner. feelings and contract with irritability, depression,
Orgone energy is built up in the organism by loss, and other disheartened feelings. Orgonomy
intake of food, fluid, and air as well as by being helps regulate pulsation and establishes a healthier
absorbed directly into the skin. It is discharged by bandwidth. The autonomic nervous system is a
activity, excretion, emotional expression, and con- pulsation between the sympathetic and parasym-
version into body heat. It is used up in growth as pathetic systems, and orgonomy stabilizes that bal-
well. In the usual course of events, more energy is ance. Life force pulsates, and individuals can learn
built up than discharged. To maintain a stable to feel part of that greater pulsation.
energy level, excess energy must be discharged at
more or less regular intervals. This, according to
Techniques
Reich, is the function of the orgasm accompanied
by orgastic convulsion. Orgonomic techniques are built on an evolving
Orgonomists embody a concept of good health therapeutic relationship with a clear frame and the
based on an energy metabolism of charge and consistency of weekly treatment. Present-centered
discharge, called sex or energy economy. Open character focus, contact, and appropriate tracking

Orgonomy 747
are the necessary variables for the verbal portion. attitudes, approaches, and behaviors in all aspects
The therapist also focuses on the patient’s physical- of a patient’s life and whether these ways of being
ity through breath work and direct interventions in and behaving are functional is discussed. This
the musculature to address the unique biophysical approach emphasizes process over content. The
tensions that cause problems for the patient. The orgonomist tracks and comments to the patient
following subsections describe some of these major and helps the patient investigate in the here-and-
techniques. now the ideas and feelings that surround a set of
behaviors obvious in the moment. The patient
begins to make contact without intellectualization
Therapeutic Relationship but, rather, with real affect and connection to his-
Establishing a trusting relationship between the torically relevant material. This brings awareness
therapist and the patient is critical, as the treat- as to why the patient acts the way he or she does
ment can be intensely emotional. This relationship and the real-life consequences of the patient’s
allows for confrontational and forthright interven- actions.
tions as well as the gentleness necessary to work
through trauma. The orgonomist seeks to under-
stand the patient and utilizes the best-suited Biophysical Techniques
approach for each character type. For some On a full-size bed, the patient, in comfortable,
patients, direct feedback is useful; for others, a loose-fitting clothes, lies down on his or her back
subtler, more nuanced approach is needed. and breathes with knees up and feet on the bed.
The patient inhales through the mouth and exhales
Here-and-Now Focus on Character
with an “ahh” sound, which allows the throat to
stay open and the voice to flow out. The therapist
Orgonomists utilize an interactively lively, pres- may give a special breathing pattern for the
ent-centered approach to dismantle a patient’s char- patient to follow, with the goal of allowing breath-
acter patterns. The character style of a patient is ing to become natural, spontaneous, and expanded
often obvious to a practiced orgonomist, so the over time.
orgonomist points out, confronts, and engages the The therapist will notice the quality of breath-
dominant aspects of the patient’s personality, such ing and work with the armoring pattern of the
as a tendency to dominate and control or to be con- patient. The segments include ocular, oral, cervical,
sistently obsequious and compliant. Then, the thoracic, abdominal, and pelvic. The therapist
patient can explore the function of his or her repeti- begins with the ocular and moves to the pelvis only
tive style. Defenses, such as intellectualization, ratio- after the first segments have been opened over
nalization, combativeness, withholding, focusing on time. The therapist may loosen various segments
the other, and contactless talking, are interrupted. with direct massage and pressure to help release
The patient learns, in the here-and-now, how he or muscular holding. There are particular interven-
she is and how he or she presents, and develops an tions for all these segments to help release block-
understanding of his or her defensive function. The age and muscular holding.
character style begins to change, and the content Expressive exercises help the patient release
deepens along with the biophysical work. emerging feelings. The patient may be helped to
cry more fully or to express anger, fear, rage, long-
ing, or grief. The patient may be asked to kick his
Contact and Tracking
or her legs, pound his or her fists, reach his or her
The orgonomist tracks a patient’s body lan- arms with longing, scream in fear with his or her
guage, way of speaking, eye contact (dullness, eyes wide open, or engage in other exercises that
brightness, movement, and expression), attitudes, help expressions to emerge. At the end of the ses-
and demeanor. Seeing what is noticeable in the sion, the patient lies quietly, often covered with a
patient’s character style, what stands out, and what blanket, allowing the parasympathetic relaxation
is obvious in the relationship with the therapist response to take over and integrate the events of
becomes the focus. How that style reflects specific the session.

748 Ortho-Bionomy
Therapeutic Process
ORTHO-BIONOMY
Reichian therapy is a mind–body approach that
can last many years. A goal is for the patient to feel
Ortho-Bionomy is a noninvasive approach for
safe within the therapeutic relationship. As the
pain and postural/structural imbalance due to
patient develops a more authentic self, freed of
injury, surgery, or chronic stress. Comfort and
dysfunctional character elements and biophysical
home exercises without forceful movements are
holdings, he or she becomes autonomous and
emphasized, although the technique was developed
responsible, has an improved sense of self-esteem,
by an osteopath. This is sometimes described as a
feels genuine, and can activate from a truer self-
“homeopathic” use of osteopathic principles to
experience. The healthy ability to self-regulate in
encourage self-healing.
all areas of life is established. Sexual functioning is
The patient’s body is always moved in the direc-
improved, and the individual has a greater capacity
tion of comfort, which encourages relaxation and
to be in fulfilling relationships.
trust in the process and the practitioner. This
Patricia R. Frisch facilitates rapid neuromuscular reeducation and
gait training, postural release, and home care–
See also Bioenergetic Analysis; Body-Oriented Therapies: based therapeutic routines.
Overview; Characteranalytical Vegetotherapy; Core
Energetics; Integrative Body Psychotherapy; Radix;
Reich, Wilhelm Historical Context
The British osteopath Arthur Lincoln Pauls read
Further Readings Lawrence Jones’s 1964 article “Spontaneous
Baker, E. (2000). The man in the trap. Princeton, NJ:
Release by Positioning” while still in osteopathic
American College of Orgonomy Press. college. He was intrigued by Jones’s observation
Baker, E. (2011). My eleven years with Wilhelm Reich. that if he placed a patient in a position that exag-
Princeton, NJ: American College of Orgonomy gerated his or her osteopathic lesion for 15 or 20
Press. minutes, the patient’s body would self-correct
Herskowitz, M. (1997). Emotional armoring: An without forceful manipulation.
introduction to psychiatric orgone therapy. Pauls was a martial artist, and his observations
Piscataway, NJ: Transaction Books. of fighting postures, yoga, tai chi, and even sleep
Placzek, B. (Ed.). (1981). A record of friendship, the positions had already prepared him for a posi-
correspondence of Wilhelm Reich and A. S. Neill. tional approach, as it had similarly affected Moshé
New York, NY: Farrar, Straus & Giroux. Feldenkrais in his development of the Feldenkrais
Reich, W. (1973). Ether, God and Devil. New York, Method. Pauls sought to decrease treatment times
NY: Farrar, Straus & Giroux. and discovered that by subtle movements and by
Reich, W. (1973). The function of the orgasm. New incorporating gentle compression toward a
York, NY: Farrar, Straus & Giroux. patient’s joint, spontaneous release could be
Reich, W. (1973). Selected writings: An introduction to achieved in just 30 seconds or fewer.
orgonomy. New York, NY: Farrar, Straus & Pauls soon found that these changes were con-
Giroux. sistent and easily taught to both patients and prac-
Reich, W., & Higgins, M. (Ed.). (1988). Passion of titioners. In 1976, he began teaching his system in
youth, Wilhelm Reich, an autobiography 1897- the United States and then Europe. Pauls tended to
1922. New York, NY: Farrar, Straus & Giroux.
approach his teachings as a philosophy and
Reich, W., & Higgins, M. (Ed.). (1994). Beyond
demanded the hyphen in Ortho-Bionomy as a
psychology letters and journals 1934-1939. New
reminder of the “vital gap” between the practitio-
York, NY: Farrar, Straus & Giroux.
ner and the patient.
Reich, W., & Higgins, M. (Ed.). (1999). American
odyssey, letters and journals 1940-1947. New York,
NY: Farrar, Straus & Giroux.
Reich, W., Higgins, M., & Raphael, C. (Eds.). (1980).
Character analysis. New York, NY: Farrar, Straus & Pauls taught Ortho-Bionomy as the “correct appli-
Giroux. cation of the natural laws of life” and said it “is

Ortho-Bionomy 749
really about understanding your whole life cycle. concept, to be “gentle and that less is more,” is
Naturally, we focus on the structure, because that critical in this process.
is the literal skeleton upon which our life is built. Most bodywork involves moving against the
When your structure works right, your circulation body’s resistance or through it to guide the body to
works better. You think better.” This is in keeping a new being, but in Ortho-Bionomy, resistance is
with the teachings of the founder of osteopathy, respected, and the positioning cues the patient’s
Dr. Andrew Taylor Still (1828–1917), who taught body to release. Through the proprioceptive
that the primary goal of manipulation is the response of the body, the patient can release the
improvement of circulation. unwanted habitual somatic patterns in the indi-
Ortho-Bionomy relies on the reflex action of vidual’s body, which releases the trauma and pain
proprioception, whereby movement decompresses physically and emotionally. This release liberates
tissue to active proprioceptors surrounding the better physical integration and an increase in range
joints. This fundamentally signals the nervous sys- of motion in the joint, which releases a greater
tem to reset the area, thus eliminating habitual range of possibility throughout all parts of the
patterns in the tissues that caused the pain and individual’s life.
other symptoms. If those symptoms are not allevi- Ortho-Bionomy can be beneficial for both
ated, they can negatively affect the individual’s patients and practitioners. Patients do not have to
mind, thoughts, emotions, and spirit. When the fear pain or pressure from the therapeutic process
somatic cause is dealt with, the systems integrate and are free to find comfort at their own speed.
with wide-ranging effect. Practitioners benefit by no longer having to fear
This comforting effect, initiated from within the injury to their own bodies from applying pressure
physical body structures, creates a balance of body, to help others. They do not have to be absorbed in
mind, and spirit, which enhances and is compatible fixing and correcting, which frees them to be more
with any healing system. The Society of Ortho- present for and supportive of their patients’ per-
Bionomy International reports that these techniques sonal healing process.
have been incorporated in varied health care settings,
such as sports medicine, HIV and AIDS clinics, and Techniques
outpatient chemotherapy clinics. Ortho-Bionomy
practitioners include dentists, medical doctors, chi- Ortho-Bionomy incorporates a wide range of
ropractors, osteopaths, nurses, lymphatic drainage static, active, and even energetic nontouching tech-
therapists, physical and occupational therapists, niques. However, the core of Ortho-Bionomy is
body workers of all kinds, psychotherapists, and identifying any areas of discomfort or dysfunction
social workers. in the body and moving the patient into positions
The neurological feedback about joint and soft of comfort that allow disruptive and unwanted
tissue position allows the muscle to release chronic patterns of somatic tension to be released and
response patterns and splinting along with the replaced by comfort and a feeling of well-being.
habitual pain signals back along the nerve path- This feeling of well-being may then spread from
ways. For example, in as little as one session, an the body into daily life, relationships, and emo-
ilium that is rotated posterior and has been chron- tional health.
ically held in position by the body may be released Ortho-Bionomy Phases 1 through 7 reflect
by rebalancing the tone around the joint, thus Pauls’s evolution of the philosophy and techniques
interrupting the pain signals of sciatica. In Ortho- of Ortho-Bionomy:
Bionomy, the positioning alone permits the release
of somatic tension, but it may require more than Phase 1: Observation of unconscious movement
one positioning to facilitate the release of all the while sleeping
different muscles around any given joint. Phase 2: Observation of conscious movement while
sitting in a chair or during other activities such as
martial arts or yoga
Major Concepts
Phase 3: Pauls’s observations of people’s ability to
Although the major concepts are touched on in the self-correct using strain/counterstrain techniques, as
“Theoretical Underpinnings” section, one other found in Jones’s work

750 Other Therapies: Overview
Phase 4: Weaving observation into a system by com- Chaitow, L. (2006). Muscle energy techniques with
bining gentle contact on tension points with com- DVD-ROM (3rd ed.). Philadelphia, PA: Churchill
fortable movement to initiate corrective reflexes; Livingston.
posture analysis and reeducation as needed for any Chaitow, L. (2007). Positional release techniques with
and all joints of the body DVD-ROM (advanced soft tissue techniques) (3rd
ed.). Philadelphia, PA: Churchill Livingston.
Phase 5: Introduction of new techniques that allow Kain, K. (1997). Ortho-bionomy: A practical manual.
greater expression of a person’s innate self (the prac- Berkeley, CA: North Atlantic Books.
titioner begins the movements, but the patient’s own Knittel, L. (2003). Inside-out bodywork. Yoga Journal.
reflexes continue through to relief) Retrieved from http://www.yogajournal.com/health/1004
Overmyer, L. (2008). Ortho-bionomy, osteopathic
Phase 6: Aura or electromagnetic field work, whereby
principles stimulate self-healing. Massage Magazine,
self-balancing is initiated by an interaction of the
July, 74–77.
practitioner’s and the patient’s body energy fields
Overmyer, L. (2009). Orthobionomy: A path to self-care.
Phase 7: Mental pattern projection to catalyze self- Philadelphia, PA: North Atlantic Books.
correction reflexes and to promote specific postural Pauls, A. (2002). The philosophy and history of ortho-
or other changes, integration, and well-being bionomy: “The evolvement of the original concept.”
British Columbia, Canada ALP.
Seidl, B. (1997). Advanced techniques in ortho-bionomy:
Therapeutic Process A unique approach to the integration of body, mind
and spirit. Unpublished manuscript.
The patient lies on a table with shoes off, wearing
loose-fitting, comfortable clothing. The practitio-
ner explores the areas of pain or dysfunction eluci-
dated by the patient and may gently touch those
areas to test for tenderness or ask the patient to
OTHER THERAPIES: OVERVIEW
demonstrate range of motion for later progress
evaluation. The other therapies entry includes a broad range of
The practitioner guides the patient through a theories and therapies that do not easily fit into
series of positions relevant to the areas of com- any of the major theoretical orientations or catego-
plaint and limited motion, which triggers proprio- ries listed in this encyclopedia. Each has a unique
ceptive neurological reflex responses that release history and theoretical underpinnings, and they,
the unwanted patterns causing the pain and other generally, do not relate to one another. The descrip-
problems. tions provided in this entry give insight into why
The practitioner usually gives the patient home- each of these therapies is distinctive in nature and
work in the form of instructing the patient in posi- is not included in other categories.
tions to use at home to reinforce and accelerate the
work done in session. The practitioner is then freed
to concentrate on encouraging the comfortable Short Descriptions of Other Therapies
evolution of the patient and to work more ener- Brief Therapy
getically with the patient during sessions.
Brief Therapy focuses on time-sensitive inter-
Christopher J. Rogers ventions that aim to quickly move the client out of
psychological distress by using strengths-based
See also Body-Oriented Therapies: Overview; methods and the therapeutic alliance.
Complementary and Alternative Approaches:
Overview; Feldenkrais Method; Hellerwork; Reich,
Wilhelm; Yoga Movement Therapy Chaos Theory
This theory suggests that a small change can
have an effect over time on a larger scale in a non-
Further Readings linear way. Therapists work with the disorder that
Anderson, D. (1994). Muscle pain relief in 60 seconds: occurs in clients’ lives as they move toward a new,
The fold and hold method. New York, NY: Wiley. organized transformative state for the clients.

Other Therapies: Overview 751
Common Factors in Therapy Metaphors of Movement Therapy

This approach focuses on the belief that various Metaphors of Movement therapy focuses on the
therapies share similar components related to treat- use of the metaphors that clients express, usually
ment outcome, which may be the ingredients most without awareness. Generally, clients spontane-
important to successful therapy. Some of these ele- ously provide their own metaphors, but some
ments include the client’s experience of the relation- therapists may suggest possible metaphors that
ship, the creation of hope and expectancy, structure relate to a client’s presenting problem, with the
and focus, and the qualities of the therapist. focus being on finding how the metaphor offers
coping behaviors for the client.
Cross-Cultural Counseling Theory
Pastoral Counseling
Cross-cultural counseling theory focuses on the
belief that counseling always involves a cross- Pastoral counseling focuses on the integration
cultural experience between the counselor and of counseling and theology in an effort to help
client. It highlights the notion that clients from individuals with their emotional, psychological,
traditionally oppressed minority groups have been and spiritual growth. Although there are various
particularly harmed when attending counseling types of pastoral counseling, ultimately, the task of
due to bias by counselors and the particularly pastoral counseling is to help clients find meaning
white and European/Western approach that per- in their spiritual lives so that it can help them in
meates most counseling theories. To ensure coun- their psychological world.
selor effectiveness, this approach highlights the
importance of the counselor having an awareness Provocative Therapy
of his or her own cultural and personal biases,
knowledge of other cultures, and cross-cultural This approach uses the frame of reference of the
skills to work effectively with clients from all biopsychosocial world of the client to identify new,
groups, but particularly nondominant groups. more helpful behaviors rather than previous, less
helpful behaviors that the client exhibited. Although
many of the techniques are existentially based,
Ecological Counseling
Provocative Therapy also uses mild confrontation
This approach focuses on the integration of to push the client toward change.
environmental and human factors and how they
can be used in the counseling session as the narra- Reevaluation Counseling
tive provides the story of the way the client lives
his or her life. This approach uses an interchangeable role
between the counselor and the clients in the sense
that it emphasizes a bidirectional counseling role,
Evidenced-Based Psychotherapy
with each participant being the “counselor” at dif-
Approaches that are labeled “evidenced-based ferent points in the process. The focus of this
psychotherapy” have demonstrated effectiveness approach is on equality in the therapeutic relation-
through peer-reviewed and controlled research. ship, with the goal being increased awareness of
Mental health practitioners are encouraged to use how socially generated stressors have caused dis-
those approaches that show the best efficacy for tress and of how discussion and emotional dis-
the client’s problems. charge can bring relief.
Feedback-Informed Treatment Relational-Cultural Theory

This transtheorectical approach facilitates This feminist approach focuses on healthy
greater communication between the client and the human development and identification of interper-
therapist by systematically soliciting feedback. sonal relationship struggles. It focuses on how
Information regarding the quality of the therapeu- unresolved issues in personal relationships as well
tic relationship and the clinical progress made are as issues within the larger social system (e.g., “isms”
used to inform and tailor service delivery. in society) can cause stress in clients and helps

752 Other Therapies: Overview
clients resolve their issues through sociopolitical discuss their relationships and by affirming the
awareness and healthy interpersonal connections. validity and importance of the clients’ intercon-
nected identities, beyond sexual orientation.
Self-Relations Psychotherapy
Self-relations psychotherapy focuses on how Status Dynamic Psychotherapy
one’s reality and sense of identity are constructed In addition to honoring traditional therapeutic
through what is called “frames” or “filters.” It sug- change processes, this approach takes therapy one
gests that the client’s reality becomes “locked” and step further by examining how clients’ statuses, or
that therapy provides an opportunity to creatively relational positions, influence their sense of self.
and consciously transform negative symptoms to a
positive, newly constructed reality.
Supportive Psychotherapy
Sexual Identity Therapy Supportive psychotherapy works by helping
clients reduce presenting symptoms through
This approach offers a model to mental health
increasing their sense of self-esteem and building
professionals on how they can work with clients
skills and by helping clients learn how to cope with
whose sexual identity is in conflict with their reli-
their symptoms rather than reconstructing person-
gious beliefs. It focuses on being nonjudgmental
ality. It is generally used for individuals who do not
and on helping clients accept their sexual orienta-
have the psychological resources to withstand
tion and how it might conflict with their religious
long, intensive psychodynamic therapy.
beliefs. Ultimately, some clients may choose to live
with their dissonance, others may choose not to Heather D. Dahl
act on their sexual orientation in an effort to be
true to their religious beliefs, and still others may See also Brief Therapy; Chaos Theory; Common Factors
change their religious affiliation to one that is in Therapy; Cross-Cultural Counseling Theory;
accepting of their sexual orientation. Ecological Counseling; Evidence-Based Psychotherapy;
Metaphors of Movement Therapy; Pastoral
Sexual Minority Affirmative Therapy Counseling; Provocative Therapy; Re-Evaluation
Counseling; Relational-Cultural Theory; Self-Relations
Sexual minority affirmative therapy focuses on Psychotherapy; Sexual Identity Therapy; Sexual
empowerment and support of sexual minority cli- Minority Affirmative Therapy; Status Dynamic
ents by creating a safe environment for clients to Psychotherapy; Supportive Psychotherapy

P
psychiatrist, soon joined Bateson’s research team.
PALO ALTO GROUP In January 1954, Bateson attended a lecture given
by Jackson, also a psychiatrist, on the subject of
The earliest reference to the “Palo Alto Group” family homeostasis, and soon Jackson joined the
dates from 1960 and refers to three overlapping team. Thus, the original Palo Alto Group began a
and interrelated teams of researchers that worked series of four research projects that over the next
together in Palo Alto, California, over a 60-year decade would usher in a radically contextual and
span beginning in 1952 and continuing to the pres- relationship-based alternative understanding of
ent day. Under the leadership of the renowned cul- human behavior.
tural anthropologist Gregory Bateson, the original The dominant focus in the behavioral science
team of researchers included John Weakland, Jay research at that time—and continuing today—was
Haley, William Fry, and Don D. Jackson. In 1958, biologically and psychologically oriented.
all original members of the Palo Alto team joined Explanation and treatment of emotional and
Jackson in founding the Mental Research Institute behavioral pathology were to be found in early-
(MRI), with Weakland, Haley, and Fry as research childhood trauma and genetically inherited traits.
associates, Bateson serving as a consultant, and In distinct contrast, the Bateson team intentionally
Jules Riskin, Virginia Satir, Richard Fisch, and Paul decided not to base their research on the search for
Watzlawick joining the team. The third team, pathology and instead to investigate processes of
referred to as the Palo Alto Group, began work in communication using cultural anthropology meth-
1965 with the founding of the MRI Brief Therapy odology and Harry Stack Sullivan’s interpersonal
Center by Fisch, Weakland, and Watzlawick, with theory of human behavior, introduced to the group
Jackson and Haley as consultants. by Jackson. The complementary fit of these orien-
The original Palo Alto Group began when tations provided the team of researchers a set of
Bateson secured a grant from the Rockefeller presuppositions and a conceptual frame to use as
Foundation to study the nature of paradoxes in guiding principles of investigation.
communication processes. Bateson asked According to Weakland, cultural anthropology
Weakland, a chemical engineer studying cultural methodology focuses inquiry on directly observ-
anthropology under the tutelage of the anthropol- able communication—while remaining aware that
ogists Ruth Benedict and Margaret Mead, to join important and observable messages may be very
the project. Based in the Anthropology Department subtle and hard to see. Concern is deliberately with
at Stanford University, Bateson and team had an the influential aspects of communication, of which
office at the Palo Alto Veteran’s Administration “information” is only one. Researchers keep in
(VA) Hospital. Haley, then a graduate student in mind that even the hardest “facts” and the clearest
mass communication at Stanford, and Fry, a messages are subject to differing interpretations.
753

754 Palo Alto Group
Attention is given to the nuances and complexity with juvenile delinquents and their parents,
involved in how people interact with one another, bringing film cameras and sound recorders into the
including contradiction, in communication situa- homes of families to observe them interact in their
tions—even when these can at first be character- natural environment, and even the study of a proc-
ized only roughly—rather than inappropriate tologist whose hobby was ventriloquism, among
atomization and oversimplification to fit the obser- many other inquiries.
vational or statistical tools already available. In While observing otters play in the San Francisco
cultural anthropology methodology, attention is Zoo, Bateson noticed two males suddenly go from
given to the whole system involved in any com- a posture of play to combat when in the midst of
municative interaction, including the researcher frolicking one otter bit down too hard on the ear
taking his or her own preconceptions and the of the other. The sudden change in the two otters’
effect of his or her presence in an interaction into behavior toward each other revealed that biting
account equally with the behavior of the people down too hard on the ear altered the meaning of
being observed. the exchange. Bateson had an epiphany that the
From the moment Jackson joined the Palo Alto playing animals had exchanged a metamessage, or
Group, he brought his understanding of Sullivan’s a message about a series of messages (a light bite
interpersonal theory of human behavior into the conveys play, and a hard bite means combat). With
project. Sullivan defined psychiatry as the study of this observation of a species responding to a mes-
processes that involve or go on between people in sage about a message, understanding of the com-
interpersonal relations in any and all circum- municative nature of behavioral exchanges took a
stances in which these relations exist. A person can quantum leap forward.
never be understood in isolation from the complex The focus of research shifted to making sense of
of interpersonal relations in which the person lives how behavior emerges from the contexts and rela-
and has his or her being. The feeling of anxiety is tionships of which it is a part. Asking questions
a central concept and is defined as a singularly such as “If behavior is a message, to whom is the
distressing experience that is a product of intense, message directed?” and “In what context would
denied rejection by significant others in important this behavior make sense?” opened the way for a
relationships—other people on whom the person radically alternative way of understanding that the
depends for his or her very survival. Prestige in the behavior of one person simultaneously shapes and
eyes of important others is vital. Anxiety is experi- is shaped by the behavior of others in the moment
enced whenever a person has acted in a way that is of interaction. With the team office being in the
not acceptable to his or her significant others (par- Palo Alto Veteran’s Administration Hospital, Haley
ticularly parents) and can be so debilitating that a suggested that patients offered a relevant object of
person will do just about anything to avoid or study. Meeting together with patients and family
reduce the experience. Jackson’s grasp of the impli- members allowed the team to observe how some
cations of Sullivan’s interpersonal theory was an forms of mental illness are induced from the nature
essential aspect of the Bateson team investigation of the relationship dynamics in a family in ways
of communication processes and can be seen as a similar to the way trance phenomena are induced
precursor to what Bateson, Jackson, Weakland, in hypnosis. Haley and Weakland were sent to
Haley, and Fry were later to refine into a commu- begin collaboration with the father of modern
nication/interactional approach to understanding medical hypnosis, Milton H. Erickson.
human behavior. Working with patients helped bring together the
The data investigated by the Palo Alto Group observations of Palo Alto Group members and
included a wide range of behavioral phenomena paved the way for making interpersonal sense of
occurring in natural settings, including observing behavior. The team began to comprehend the vital
animals in the San Francisco Zoo, analyzing the importance of complex but comprehensible con-
nature of the relationship between a professional texts of learning and contingencies of reinforce-
baseball player who had an emotional breakdown ment evident as emotionally disturbed people
and his parents, studying a psychologist who used defined the nature of their relationships with mem-
a one-way viewing screen to observe and work bers of their family. Combined with the concept of

Parent–Child Interaction Therapy 755
family homeostasis, the concept of the double bind and emulated approaches in use today. In turn,
emerged as a way of describing the sending of con- structural family therapy, developed by Salvador
flicting messages, as anxiety began to be under- Minuchin; Mara Selvini Palazzoli, Gianfranco
stood as having a protective quality, and as a way Cecchin, Luigi Boscolo, and Giuliana Prata’s Milan
of handling situations in such a way that tests the systemic family therapy; Steve deShazer and Insoo
reactions of others as safely as possible, with the Kim Berg’s solution-focused brief therapy; as well
least risk of negative personal and interpersonal as most narrative and postmodern models are in
consequences. direct lineage of the Palo Alto Group.
Other vital theoretical precepts emerged.
Bateson’s concepts of learning and deutro-learning Wendel A. Ray
(i.e., learning to expect certain kinds of contexts)
See also Brief Therapy; Couple and Family Hypnotic
began to reveal the profound ways in which people Therapy; Ecological Counseling; Erickson-Derived or
in intimate relationships influence one another. By -Influenced Theories: Overview; Multisystemic
placing the primary focus of attention on the Therapy; Multigenerational Family Therapy; Solution-
nature of interaction among significant family Focused Brief Family Therapy; Solution-Focused Brief
members and between the interviewer and the Therapy; Strategic Family Therapy; Strategic Therapy;
patient, these researchers pioneered understanding Structural Family Therapy; Systemic Family Therapy
of how the nature of contexts and relationships set
in motion reinforcement contingencies for learning
Further Readings
the expectations and experiences that shape, bring
forth, and perpetuate characteristic patterns of Bateson, G. (1972). Steps to an ecology of mind.
behavior. Symptoms were comprehended as unla- New York, NY: Ballantine Books.
beled metaphors of the untenable nature of family Bateson, G. (1979). Mind and nature: A necessary unity.
relationships, where explicitly clear statements are New York, NY: E. F. Dutton.
too dangerous. Messages, or more specifically Haley, J. (1973). Uncommon therapy. New York, NY:
what they imply, get lost in translation in ways so W. W. Norton.
subtle that they often escape the notice of even the Ray, W. (Ed.). (2005). Don D. Jackson—Essays from the
most awake and astute participant. dawn of an era: Selected Papers (Vol. 1). Phoenix,
AZ: Zeig, Tucker & Theisan.
By focusing on the patterns of interaction that
Sullivan, H. S. (1953). Conceptions of modern psychiatry.
connect the behavior of people, communication
New York, NY: W. W. Norton.
theory offered an altogether new and effective
Watzlawick, P., Beavin-Bavelas, J., & Jackson, D. (1967).
method of understanding behavior in context and
Pragmatics of human communication. New York, NY:
opened new alternatives for promoting construc- W. W. Norton.
tive change. By shifting the focus of attention away Weakland, J. H. (1967). Communication and behavior:
from what is purported to be going on inside An introduction. American Behavioral Scientist, 10(8),
people to what is going on between people in the 1–4.
interaction taking place in the present moment,
systemic family therapy was created.
Most, if not all, systemic and brief therapy mod-
els of practice trace their lineage directly to the PARENT–CHILD INTERACTION
contributions of Bateson’s team, the early research
and training in family and brief therapy at MRI, THERAPY
and the MRI Brief Therapy Center. In chronologi-
cal order, systemic approaches directly emergent Parent–child interaction therapy (PCIT) is a type
from the Palo Alto Group include Jackson’s con- of therapy used primarily with children between
joint family therapy, Satir’s variation of conjoint 2 and 7 years of age who have disruptive and
family therapy, Haley and Cloe Madanes’s strate- problem behaviors and their families. This thera-
gic family therapy approach, and the MRI brief peutic approach to strengthening parent–child
therapy articulated by Fisch, Weakland, and relationships combines behavior modification and
Watzlawick, which are among the most influential play therapy techniques. The child and parent are

756 Parent–Child Interaction Therapy
seen together in monitored play sessions where dual needs for nurturance and limits, thus promot-
the parent receives live, step-by-step coaching ing more behavioral and emotional regulation.
from therapists who are behind a two-way mirror.
Considered an evidence-based treatment, this
approach has demonstrated statistically and Major Concepts
clinically significant results in reducing children’s The central focus of PCIT is teaching parents the
maladaptive behaviors, improving appropriate skills to improve the parent–child relationship by
behaviors, reducing parent stress, and increasing changing negative parent–child interactional pat-
overall parental efficacy. It has a wide range of terns through parent skill training and coaching.
applications for improving behavior in children This therapy is divided into two stages: (1) the
who have been diagnosed with oppositional- relationship training stage, which aims at restruc-
defiant disorder, conduct disorder, and attention- turing the parent–child relationship through facili-
deficit/hyperactivity disorder and those exposed tating the development of a secure attachment
to abuse, trauma, and loss. relationship, and (2) the positive-discipline parent-
training stage, which emphasizes contingencies
that are consistent for child behavior.
Historical Context
PCIT was developed by Sheila Eyberg during the
mid-1970s as a clinical response to families expe- Child-Directed Approach
riencing difficult and stressful circumstances, Parents follow a play therapy format in which
whose parent–child interactions were marked by the primary aim is to develop a warm, loving, and
negative and emotionally hurtful interactions. The nurturing bond by providing differential attention.
efficacy of this therapeutic approach has been Parents are coached in the PRIDE relationship-
widely demonstrated in clinical populations by building skills: praise, reflection, imitation, descrip-
empowering parents with the skills to build nur- tion, and enthusiasm.
turing and secure relationships with their children.
Since its development, adaptations of the PCIT
Parent-Directed Approach
have been made for use in schools for a variety of
classroom settings that focus on teacher–student The parent is instructed and coached in a
interactions. positive-discipline program that entails the follow-
ing: limit setting, consistency, predictability, and
follow-through.
PCIT combines play therapy with the more dis-
crete and didactic approaches of behavioral ther- Techniques
apy. Broadly, the aim of behavioral therapy is to Relationship enhancement and child behavior
modify quantifiable behaviors that are learned management skills are taught to parents, and then
through interactions with the environment. The the parent is coached while playing with the child
therapist instructs parents in the use of rewards during relationship enhancement sessions. Parent–
and punishment to increase desirable child behav- child interaction data are recorded by the thera-
iors and reduce inappropriate ones. Play therapy pists and reviewed at the end of the session with
emphasizes the development and nurturing of a parents. Parents are given homework play assign-
therapeutic relationship that is child directed. ments to complete between sessions.
Parents are taught how to communicate accep-
tance of the child through responsive, warm reflec-
Assessments
tions of behavior and emotions during play. PCIT
is influenced by the research of the developmental Assessments are conducted before, during, and
psychologist Diana Baumrind associating parent- after therapy. A core battery of assessment proce-
ing styles with child outcomes. The aim of PCIT is dures can include a semistructured intake inter-
to create an environment that balances the child’s view, Child Rearing Inventory, Eyberg Child

Pastoral Counseling 757
Behavior Inventory, Therapy Attitude Inventory, the child-directed interaction sessions are 10
Dyadic Parent–Child Interaction Coding System, labeled praises, 10 reflections, and 10 behavioral
and Sutter-Eyberg Student Behavior Inventory. descriptions. Once mastery of the child-directed
interaction stage is achieved, parents progress to
the parent-directed interaction sessions, in which
Equipment
the parent is instructed and coached in positive-
It is optimal to have the following equipment: discipline techniques. Once mastery is achieved in
two-way mirror, toys, video camera, transmitter– the parent-directed interaction, the skills are grad-
receiver, toy clean-up box, and behavioral record- ually expanded for use outside the therapy room,
ing data sheet. Adaptations have been made for for generalization at home and in public spaces.
settings that lack two-way mirrors and recording
devices; walkie-talkies or having the therapist sit in Tami Sullivan
the room are acceptable modifications.
See also Attachment Theory and Attachment Therapies;
Behavior Therapies: Overview; Play Therapy
Teaching Sessions
The therapist meets with the parents in teaching Further Readings
sessions to present play and discipline skills. These Eyberg, S. M. (2005). Tailoring and adapting parent–child
skills are reinforced by therapist modeling and interaction therapy for new populations. Education
role-playing with parents. and Treatment of Children, 28, 197–201.
Eyberg, S. M., & Matarazzo, R. G. (1980). Training
Child-Directed Interaction Sessions parents as therapists: A comparison between
Play and discipline skills are first taught to the individual parent–child interaction training and parent
parent and then modeled and role-played with the group didactic training. Journal of Clinical Psychology,
therapist. Next, the therapist, who is behind a two- 36, 492–499. doi:10.1002/jclp.6120360218
Eyberg, S. M., & Robinson, E. (1982). Parent–child
way mirror, provides step-by-step coaching using a
interaction training: Effects on family functioning.
transmitter–receiver system while the parent and
Journal of Clinical Child Psychology, 11, 130–137.
child play together in the playroom. Spouses are
doi:10.1080/15374418209533076
encouraged to take turns playing with the child
Herschell, A., Calzada, E., Eyberg, S. M., & McNeil, C. B.
and observing. Parent–child interactions are
(2002). Parent–child interaction therapy: New
coached following a PRIDE sequence. directions in research. Cognitive and Behavioral
Practice, 9, 9–16. doi:10.1016/S1077-7229(02)80034-7
Parent-Directed Interaction Sessions
The aim of this phase of therapy is to teach par-
ents more effective means of disciplining their
child through the use of effective commands, PASTORAL COUNSELING
labeled praise, and redirection techniques.
Pastoral counseling is the integration of psychology
and theology to aid individuals in psychological,
Therapeutic Process
emotional, and spiritual growth. The identity of the
PCIT is a mastery-based rather than a time-limited pastoral counselor is what differentiates pastoral
approach; duration of therapy ranges from 12 to counseling from other forms of counseling. Pastoral
20 sessions. Discrete parenting skills taught in each counselors are representatives of various faith tra-
session are coded, charted, and reviewed with the ditions and communities. In pastoral counseling,
parents to provide immediate feedback. The pri- spiritual growth may take precedence at times over
mary therapeutic goals are to decrease problem psychological and emotional growth. The task of
behavior, increase parenting skills, decrease parent- pastoral counselors is to facilitate clients’ openness
ing stress, and ultimately improve the quality of to God’s kindness in their lives. In practice, the
the parent–child relationship. Mastery criteria for human effort of pastoral counselors is active along

758 Pastoral Counseling
with the kindness of God. The openness of clients Philosophy (Ph.D.), Doctor of Ministry (D.Min.),
to the pastoral counseling process can lead to and Doctor of Pastoral Counseling (D.P.C.). Yearly,
healthier psychological and spiritual functioning in pastoral counselors provide 3 million hours of treat-
their respective religious communities. ment in institution- and community-based settings.
Historical Context Theoretical Underpinnings

The origin of pastoral counseling can be traced to There are a variety of theoretical underpinnings that
nearly 2,000 years ago with the Judeo-Christian have affected the discipline and identity of pastoral
tradition. Prophets, priests, and wise people were counseling. Regarding theoretical underpinnings,
the representatives of religion who employed the there were four influential theologians who con-
ethic of care. Regarding Christianity, Jesus had structed the work of pastoral counseling in the
transformative conversations with individuals, 20th century: Seward Hiltner, Carroll Wise, Paul
which resulted in addressing human need and the Johnson, and Wayne Oates. Hiltner authored a pri-
relief of suffering (Mark 10:17–22; Matthew mary text for pastoral counseling that involved
15:21–28; Luke 19: 1–10). psychodynamic experience and Rogerian nondirec-
When exploring the origins of pastoral counsel- tive techniques. Influenced by Freudian psychoanal-
ing, there are two strands that developed together. ysis and Rogerian techniques, Wise asserted that the
One strand was Clinical Pastoral Education, which counseling relationship connects the meaning of the
concentrated on the training of seminary students Gospel to a client’s need. Johnson utilized Rogerian
in hospital settings. The other strand was more techniques and was influenced by the work of the
generalized and concentrated on the integration of neo-Freudian Harry Stack Sullivan. Conversely,
psychology, psychiatry, and the wisdom from Oates was not as influenced by Sigmund Freud and
spiritual traditions. The strand of Clinical Pastoral Carl Rogers. Oates viewed the pastoral counseling
Education began with Rev. Anton Boisen and relationship through a theological framework. The
Dr. Richard Cabot at Worchester State Hospital in pastoral counselor was a representative of Christ’s
Worchester, Massachusetts, in 1925. Cabot, a care for people in need. Three of the seminal theo-
medical ethicist, was an avid proponent for semi- rists of pastoral counseling were heavily influenced
nary students to be supervised for 1 year in psychi- by Freud and Rogers, whereas Oates was focused on
atric and general hospitals in working with patients. the theological implications of pastoral counseling.
Later, in 1967, the Association for Clinical Pastoral
Education was formed.
The second strand of pastoral counseling was a Major Concepts
clinical focus in the combination of psychiatry and The major concepts are the areas pastoral counsel-
religion in mainstream counseling. In 1937, ors integrate into their practice. Religion, pastoral
Norman Vincent Peale, a prominent minister, and theology, spirituality, and the integration of theol-
Smiley Blanton, a psychiatrist, formed the American ogy and counseling are all areas that influence the
Foundation of Religion and Psychiatry in New identity and practice of pastoral counselors.
York City. The American Foundation of Religion
and Psychiatry later became the Blanton-Peale
Institute, which provided psychotherapy in a reli- Religion
gious context. One hundred counselors from the Religion is a set of life-guiding principles in a
American Foundation of Religion and Psychiatry belief system that are practiced by a religious com-
founded the American Association of Pastoral munity in specific cultural contexts.
Counselors in 1963.
Today, there are more than 100 pastoral counsel-
Pastoral Theology
ing centers in the United States that are separate
from the church. Presently, Protestant and Catholic Pastoral theology is the discipline that influ-
universities offer degrees in pastoral counseling, ences and informs the pastoral counselor’s view of
including Master of Science (M.S.), Doctor of pastoral counseling.

Pavlov, Ivan 759
Spirituality See also Analytical Psychology; Freud, Sigmund; Freudian

Psychoanalysis; Jung, Carl Gustav; Maslow, Abraham;
Spirituality involves the profoundest dimen- Neo-Freudian Psychoanalysis; Person-Centered
sions of human experience and transcends to the Counseling; Prayer and Affirmations; Rogers, Carl;
level of greater causes, meanings, and reality. Sullivan, Harry Stack
Theology and Counseling

Further Readings
Theology and religion are viewed as ways in
Hiltner, S. (1979). Preface to pastoral theology. Nashville,
which people seek to answer their ultimate ques- TN: Abingdon.
tions about life and death. Theology encompasses Townsend, L. (2009). Introduction to pastoral counseling.
the beliefs people hold concerning their origin, des- Nashville, TN: Abingdon.
tiny, and relationship to the world. Counseling is Wicks, R. J., & Parsons, R. D. (Eds.). (1993). Clinical
another way for people to answer ancient problems handbook of pastoral counseling (Vol. 2). Mahwah,
concerning the purpose and meaning of humanity. NJ: Paulist Press.
Techniques
It would be impossible to state specifically the
techniques that all pastoral counselors employ. The
PAVLOV, IVAN
techniques pastoral counselors utilize are as varied
as the techniques that mainstream counselors use. Due to his industrious studies on classical condi-
However, psychoanalytical and Rogerian tech- tioning, Ivan P. Pavlov (1849–1936) is considered
niques have influenced the field of pastoral coun- one of the most prominent researchers in psychol-
seling profoundly. ogy. He was born in Ryazan, Russia, a small village
where his father was the local priest. Although
initially interested in theology and considering fol-
Therapeutic Process lowing in his father’s footsteps, Pavlov was heavily
Pastoral counseling is based on the formation of a influenced by Charles Darwin’s On the Origin of
relationship between the counselor and the client Species, which contributed to his shift in vocation
that reflects the healing presence of God. Once the and dedication to the study of science instead of
relationship is formed, pastoral counselors discuss religion. Pavlov studied medicine at the University
the spiritual resources of clients as a basis for heal- of Saint Petersburg in Russia, where he received his
ing. These resources of healing could be scriptures, doctorate in medicine and then traveled to Germany
songs, religious practices, and/or prayers that aid to continue specializing in physiology. During his
the client in spiritual, psychological, or emotional early work, he focused on the study of the digestive
growth. Furthermore, pastoral counselors focus on system, which earned him the Nobel Prize in
goals in pathway thinking and agency thinking. Physiology or Medicine in 1904.
Pathway thinking is how clients map possible During Pavlov’s research on the physiology of
routes to different experiences. Agency thinking is gastric and salivary glands in dogs, he and his col-
a way in which clients can initiate new goals. The leagues noticed that secretion of saliva may be
termination of pastoral counseling includes focus- induced not only in response to food but also due
ing on how clients constructively change their to psychic causes, as the salivary glands would
spiritual, emotional, or psychological issues. When often activate at seemingly unnecessary times.
situations are impossible to change, clients can Pavlov concluded from his experiments that this
change their attitudes. A therapeutic process of psychic activity allowed organisms to differentially
pastoral counseling would include the following: respond to stimulation from the environment and
relationship, spiritual resources, planning for to adapt to it.
change, and maintenance of change. Pavlov demonstrated this in one of his many
experiments. When a stimulus such as food is
Matthew Wardell Bonner placed in the mouth of most mammals, salivation

760 Pavlov, Ivan
is a naturally occurring (or unconditioned) response Pavlov and colleagues assessed whether neurotic
to such stimulation. Additionally, if Pavlov’s dogs behavior could be induced and then treated. Dogs
had experienced presentations of the food stimulus were trained to discriminate between a circle asso-
preceded by another stimulus that initially did not ciated with food, which provoked a conditioned
produce salivation (e.g., the ring of a bell), this ini- excitatory salivary response, and an ellipse associ-
tially neutral stimulus came to elicit the salivation ated with the absence of food, which provoked the
response by itself. The neutral stimulus had become inhibition of such a response. The dogs easily
a conditioned stimulus. In other words, Pavlov learned this discrimination, as evidenced by
identified what is now called classical or Pavlovian the amount of salivary secretions evoked by the
conditioning, a learning mechanism that is at the respective stimuli. The response was higher to the
basis of many behaviors beyond gland secretions or circle relative to the ellipse. Of importance, train-
other reflexive actions, including emotional reac- ing of the discrimination was then manipulated to
tions and normal and abnormal behavior. Classical become increasingly more difficult by making the
conditioning is one of the principal theories used in ellipse more circular on successive trials. Eventually,
behavioral modification, which is applied in vari- the ellipse and the circle were hardly able to be dif-
ous clinical settings (e.g., exposure therapy). ferentiated by the dog, which was unable to
Moreover, Pavlovian conditioning is thought today respond appropriately to the task. The procedure
to be an adaptive tool that helps organisms regu- had apparently generated a direct conflict between
late themselves by recognizing the causal and pre- inhibitory and excitatory processes. Furthermore, a
dictive relationships between events. once peaceful dog became highly excitable, aggres-
Based on the path of his discoveries regarding sive, and showed erratic behavior as well as other
classical conditioning in glands and the ideas pro- emotional responses indicative of distress.
posed by the illustrious Russian physiologist Ivan Pavlov’s curiosity in psychopathology did not
Sechenov in Reflexes of the Brain, which posited stop at identifying a potential source of experimen-
that the entire behavior of humans may be tal neurosis but continued on with the intent to give
explained in physiological reflex terms, Pavlov treatment to neurotic dogs. Interestingly, similar
became interested in studying the function of the efforts to induce neurosis were replicated by one of
brain. Pavlov’s scientific vision made him think Pavlov’s students with children who were trained to
that the acquisition and extinction of conditioned master increasingly difficult levels of discrimination
responses was indicative of brain function, which between two sounds until they had difficulty dis-
resulted from the interaction between organisms criminating, at which point, they showed signs of
and the environment. Specifically, Pavlov’s studies distress. However, those particular experiments
led him to suspect that excitatory processes in the were found to be ineffective in reducing the subjects’
brain result in the acquisition of conditioned symptoms of the experimentally induced neurosis.
responses, whereas inhibitory processes are respon- Research conducted in Pavlov’s laboratory on
sible for the extinction of conditioned responses experimental neurosis is important not only based
(i.e., a phenomenon in which presenting a condi- on the merits of the specific results but also because
tioned stimulus by itself after a conditioned it illustrated a methodology through which psycho-
response was acquired results in the attenuation or pathological causes and treatment could be studied
elimination of such a response; e.g., Pavlov with a high degree of experimental control.
observed that after presenting the bell repeatedly Therapeutic approaches that followed Pavlov’s
without food, the dog no longer salivated). research focused on the experimental methods of
Interestingly, Pavlov thought that abnormal behav- classical conditioning rather than on the specific
ior, such as the ones he observed in neurotic and underlying neural mechanisms proposed by the
psychotic patients, was due to a conflict between physiologist. Pavlov’s studies on experimental neu-
these inhibitory and excitatory processes. rosis were the basis for the use of classical condition-
The initial evidence of the role of classical con- ing in psychotherapy (e.g., systematic sensitization).
ditioning in the development of abnormal behavior Pavlov was also a pioneer in linking physiology
came from Pavlov’s studies on experimental neuro- to individual differences that resulted in personal-
ses. Again using dogs as experimental subject, ity types. In 1924, during a flood that affected his

Perls, Fritz 761
laboratory, Pavlov noticed that some dogs were translational and clinical research based on the
frightened, others were excited, and some seemed principles of classical conditioning is still inform-
withdrawn while being rescued from the rising ing psychotherapeutic approaches, as in the case of
waters. These events, in addition to previous obser- exposure therapy. Through his life, Pavlov demon-
vations of dogs manifesting different personalities strated scientific brilliance and a great instinct for
regarding aggressiveness and friendliness, inspired research. Affected by pneumonia at the age of 86,
Pavlov to investigate individual differences. Pavlov Pavlov asked one of his colleagues to record every
developed rigorous research practices that led him detail of his passing, a last indication of his dedica-
to theorize about nervousness. He hypothesized tion to his rigorous and scientific approach to life.
that individual nervous systems differ in their
levels of excitation and inhibition. For him, the Gonzalo Miguez and Mario A. Laborda
baseline levels of excitation and inhibition are indi-
See also Behavior Therapies: Overview; Behavior
vidually determined by various physiological Therapy; Classical Conditioning; Exposure Therapy;
variables and therefore result in diverse types of Operant Conditioning; Skinner, B. F.; Systematic
personality. These ideas evolved into the theory Desensitization
of physiological bases of extraversion and intro-
version elaborated by Hans J. Eysenck and the
concept of arousability developed by Jeffry A. Gray. Further Readings
In Pavlov’s diverse research interests, from his Pavlov, I. (1927). Conditioned reflexes. Oxford, England:
research on the physiology of the digestive system Oxford University Press.
to his studies of classical conditioning, psychopa- Pavlov, I. (1928). A physiological study of the types of the
thology, and individual differences, we can find a nervous systems, i.e., of temperaments. In Lectures on
common pattern: All the studies were always con- conditioned reflexes: Twenty-five years of objective
ducted with a rigorous methodology, paying study of the higher nervous activity (behaviour) of
extreme attention to detail and empirical control. animals (pp. 370–378; P. Gantt & W. Horsley, Trans.).
This might be one of the greatest lessons researchers New York, NY: Liverwright. doi:10.1037/11081-034
in psychology learned from Pavlov’s work. Pavlov, I. (1928). Relation between excitation and
In addition to the Nobel Prize, Pavlov received inhibition and their delimitations: Experimental
much academic recognition for his industrious neuroses in dogs. In Lectures on conditioned reflexes:
research. He collaborated in the foundation of the Twenty-five years of objective study of the higher
Department of Physiology at the Institute of nervous activity (behaviour) of animals (pp. 339–349;
Experimental Medicine, St. Petersburg, Russia, P. Gantt & W. Horsley, Trans.). New York, NY:
where he used the facilities as the headquarters for Liverwright. doi:10.1037/11081-034
his research, mentored several doctoral students, Pavlov, I. (1994). Psychopathology and psychiatry.
and conducted much of his research. His most New Brunswick, NJ: Transaction.
important legacy is the discovery of classical con- Wolpe, J., & Plaud, J. J. (1997). Pavlov’s contribution to
behavior therapy: The obvious and the not so obvious.
ditioning, an important learning mechanism that
American Psychologist, 52, 966–972.
allows an organism to adapt to a changing envi-
doi:10.1037/0003–066X.52.9.966
ronment. The discovery that neurosis can be
experimentally induced, and the idea that classical
conditioning principles can be involved in its
acquisition and potentially in its treatment, set a
precedent for the future development of behavior PERLS, FRITZ
therapy in the 1950s. Even today, the knowledge
established by Pavlov has generated a productive Fritz Perls (1883–1970), codeveloper (with his wife,
line of research and theory regarding classical con- Linda Perls) of Gestalt therapy, was born to lower-
ditioning in the field of basic learning and behav- middle-class German Jewish parents in Berlin,
ioral psychology. Pavlov’s methods for studying Germany. He grew up before World War I and then
conditioned responses is still used to assess pro- lived through the chaos of the Weimar Republic—a
cessing of the brain in modern neuroscience, while time of great economic stress, hyperinflation, and

762 Perls, Fritz
the rise of Adolf Hitler and Nazism in the The intellectual and bohemian culture of
early 1930s. He served as a medical officer in the Frankfurt around 1926 was similar to that of Paris
German army during World War I, developing an in the next decade. Fritz Perls and, to a somewhat
abhorrence for war and causing his politics to drift lesser extent, Laura Perls were some of the connec-
decidedly to the left. tive tissue between what was, what was coming,
After completing medical school in 1920, Perls and what might be. They were trained by the gen-
was living and working in Berlin, immersed in his eration of psychoanalysts who were going beyond
friendship circle of artists, philosophers, poets, Sigmund Freud and integrating Freud’s work with
intellectuals, and, especially, members of the some of the swirl of voices being heard around
Bauhaus movement. He began his own psycho- them, adding their own idiosyncratic perspectives
analysis with Karen Horney, which was soon inter- to the evolving mix. In addition to his intellectual
rupted when Perls left Berlin in 1926 to work with pursuits, Fritz was also influenced by the famous
Kurt Goldstein in Frankfurt. When Perls moved to German theater director, Max Reinhardt, with
Frankfurt from Berlin, he continued his analysis whom he studied acting in Berlin.
with Clara Happel, a student of Horney, and it was In 1927, Perls left Frankfurt for Vienna to com-
around this time that he began training in psycho- plete his psychoanalytical studies, which he did in
analysis. Perls and Horney, however, maintained a 1928. He returned to Berlin and set up his practice
strong connection, with Horney being Perls’s men- as a Freudian psychoanalyst for the next several
tor, supervisor, colleague, and friend; years later, in years. Beyond his short analysis with Horney in
1946, Horney supported Fritz and Laura Perls’s Berlin, Perls, on Horney’s recommendation, had a
move to New York City. personally and professionally rewarding analysis
In Frankfurt, Perls worked as an assistant to with Wilhelm Reich, who heavily influenced him.
Kurt Goldstein, M.D., and the Gestalt psychologist In 1929, Fritz and Laura Perls married in Berlin
Adhemar Gelb, Ph.D., at the Frankfurt and had their first child, Renate, in 1931. Because of
Neuropsychiatric Institute, where Goldstein and their subversive political activities protesting the ris-
Gelb were treating World War I soldiers as orga- ing National Socialist dictatorship and because they
nized wholes (heavily influenced by Gestalt psy- were Jewish, the couple left Nazi Germany one night
chology), not just as body parts and pieces needing in 1934. They lived and tried to work in Holland,
fixing. While in Frankfurt, Perls met Lore Posner but without work permits and because of the poor
(aka, Laura Perls), a doctoral student at the economy and large number of refugees, they found
university working in Goldstein’s lab. it difficult to survive in Holland. Ernest Jones, the
The zeitgeist in Frankfurt in the 1920s was first English-speaking psychoanalyst and president
teeming with influences from existentialism, phe- of the International Psychoanalytic Association,
nomenology, wholism, Gestalt psychology, psycho- offered a position to Perls if he would emigrate to
analysis, linguistics, behaviorism, somatics, and South Africa and establish a psychoanalytical train-
Bauhaus design. Well-known philosophers, psy- ing institute there. Perls, it is said, without asking
chologists, and psychiatrists, such as Martin Buber, anything much about the arrangements (logistics,
Paul Tillich, Kurt Goldstein, Adhemar Gelb, and money, structure, contract, etc.) immediately agreed,
Max Werthheimer, were all living and working so the couple left for South Africa in 1935.
there. Laura Perls worked and studied with Buber Materially and professionally, Fritz and Laura
and Tillich as well as the phenomenologist Edmund Perls flourished in South Africa: having another
Husserl for her doctoral studies and contributed child (Steven), establishing a psychoanalytical
much to Fritz’s formulation of Gestalt therapy training institute, building a Bauhaus home, writ-
theory—although frequently not sufficiently cred- ing, and so forth. In 1936, Perls went to the
ited. Fritz was also influenced by Kurt Lewin (field Psychoanalytic Conference in Czechoslovakia and
theory), Kurt Koffka, Wolfgang Köhler, and Prime presented on “Oral Resistances.” His paper was
Minister Jan Smuts (who was also a philosopher) coldly received; Perls often told the story of being
in South Africa and by Harry Stack Sullivan, Erich queried and chided by an official of the International
Fromm, and Clara Thompson in the United States. Psychoanalytic Association as to whether he didn’t

Perls, Fritz 763
believe that all resistance was anal. Perls shot back With the publication of PHG, Perls was invited
that he didn’t know psychoanalysis was based on to present his work across the United States, stimu-
“belief”! Soon after, Fritz and Laura Perls’s certifi- lating the creation of Gestalt therapy institutes in
cation as training analysts in South Africa was Cleveland (with Erv Polster, Edwin, Sonia Nevis,
revoked by the association’s ruling that only peo- etc.) and later in Los Angeles (with Jim Simkin and
ple who had already been trainers in Europe could Bob Resnick) and San Francisco (with Abe
be trainers outside Europe. Perls was disheartened Levitsky), to name a few of the larger ones.
and angry as he wanted to become an important Perls left New York City in 1956 and bounced
innovator in the modernization of psychoanalysis. around for several years from Miami, to San
In South Africa, Perls was influenced by the Francisco, to Los Angeles, finally going on a
philosophical, holistic writings of Prime Minister round-the-world trip and ending up living at the
Jan Smuts. Anticipating Smuts’s retirement in 1948 Esalen Institute in Big Sur, California, where he
and the next ruling party to be the Nationalists, and Simkin established training in Gestalt therapy
who were to introduce apartheid, Perls emigrated for hundreds of therapists.
to New York City in 1946. He was sponsored by Perls’s disregard for professional boundaries cre-
Horney, who now lived there. Laura Perls and their ated a lot of confusion in discriminating between
two children followed in 1947. Gestalt therapy and Perls’s personality, resulting in a
In New York City, Perls found a group of bad reputation in some quarters for Gestalt therapy.
analysts at the William Alanson White Institute For instance, Perls’s sexual escapades with women,
who were most congruent with his views. This his sometimes outrageous behavior, and his unpre-
group, which primarily followed the teachings of dictable, strong reactions were often erroneously
Sullivan, was crucial to Perls’s theoretical develop- attributed to Gestalt therapy when they actually
ment. Sullivan, the innovator of interpersonal psy- reflected Perls’s complex and contradictory person-
choanalysis, confirmed Perls’s ideas about the ality. His deficits sometimes detracted from his
relationship of any organism, from an amoeba to genius, creativity, sweetness, and generosity. Gestalt
a person, to the field (organismic/environmental therapists, as other professional therapists, follow
field, or ecology) being crucial to the understand- the ethical codes of their professional organizations.
ing of that organism. During this period, Perls was Perls was a mischievous dialectician who would
both influenced by and had influence on the provoke the status quo by going to an extreme
William Alanson White Institute faculty. position. For example, in response to what he saw
While in New York, Perls met the philosopher, as the overly socialized, conforming, and intellec-
author, and social commentator Paul Goodman, tual zeitgeist of America in the 1950s, he would
who was in therapy with Laura Perls. Perls col- say things such as “The intellect is the whore of
laborated with Goodman and Ralph Hefferline (a intelligence” and “Lose your mind and come to
Columbia University psychology professor who your senses.” Unless one understood the context of
was also in therapy with Laura Perls) on rewriting these remarks—attempting to rebalance the issues
one of Fritz’s manuscripts that was published in of conformity or independent thinking and the
1951 as the seminal text Gestalt Therapy: overuse of the intellect at the expense of emotions
Excitement and Growth in the Human Personality and sensations—it could be easy to dismiss Perls as
(eventually known as PHG). Most people believe just a simplistic troublemaker.
that Hefferline organized the exercises section of Few psychotherapy theorists were influenced by
the book, while Perls and Goodman collaborated so many and in turn influenced so many others
on the theoretical section, with many ascribing themselves. Many of Perls’s cutting-edge ideas in
much of the theory to Goodman. Importantly, his early days have been integrated into most con-
many of the theoretical roots of Gestalt therapy in temporary psychotherapies.
PHG can be found in Perls’s earlier writings. Fritz Perls remained at Esalen until 1969 and then
and Laura Perls began training therapists in New moved to Lake Cowichan, Canada, to establish the
York in the late 1940s and officially established the first Gestalt community. Having traveled to
New York Institute for Gestalt Therapy in 1952. Chicago after an opera tour of Europe, he died

764 Personal Construct Theory
there on March 14, 1970, at the age of 78. Perhaps Historical Context
apocryphal, his last words to a postsurgery nurse
Kelly saw his theory very much as an alternative
who was trying to stop him from pulling tubes out
to its psychological bedfellows in the 1950s—
of his body were “Don’t you tell me what to do!”
behaviorism and psychoanalysis. He emphasized
Robert W. Resnick that from the point of view of his theory, a person
is not to be seen as a puppet manipulated by uncon-
See also Gestalt Therapy; Horney, Karen; Psychoanalysis; scious processes or a mere receiver of external
Reich, Wilhelm stimuli but that the solutions to a person’s prob-
lems lie in reconstruing—seeing himself or herself
and his or her circumstances in a different way,
Further Readings perhaps radically so. Kelly did not see any need for
Buber, M. (1958). I and thou. New York, NY: Scribner. theories of motivation that view people as being
Goldstein, K. (1939). The organism: A holistic approach kick-started into action, because, for Kelly, a person
to biology derived from pathological data in man. is in a perpetual state of motion from the time he
New York, NY: American Book. or she comes into being as a construing organism.
Horney, K. (1950). Neurosis and human growth. Kelly seems to have found Freudian ideas both
New York, NY: W. W. Norton. frustrating and helpful. While there are some
Perls, F. S., Hefferline, R. F., & Goodman, P. (1951). echoes of psychoanalytical theory in PCT, there are
Gestalt therapy: Excitement and growth in the human many fundamental differences, and PCT is not a
personality. New York, NY: Dell. psychodynamic (or, for that matter, a behaviorist
Perls, L. (1992). Living at the boundary. Gouldsboro, or cognitive) theory. The PCT approach is to see a
ME: Gestalt Journal Press. person and his or her problems from that particu-
Reich, W. (1933). Character analysis (M. Higgins & lar person’s point of view and use that understand-
C. M. Raphael, Eds.; V. R. Carfagno, Trans.; ing to help him or her reconstrue. That essential
3rd enlarged ed.). New York, NY: Farrar, Straus &
aspect of truly understanding a person in his or her
Giroux. (Original work published in Germany)
own unique terms through the individual’s system
Resnick, R. W. (1995). Interviewed by Malcolm Parlett—
of bipolar dimensions (e.g., good vs. evil; good
Gestalt therapy: Principles, prisms and perspectives
natured vs. hard to get on with), which Kelly called
editors note. British Gestalt Journal, 4(1), 3–13.
“personal constructs,” is the hallmark of PCT and
the basis of the many methodologies developed
from it.
Another significant influence on Kelly was psy-
PERSONAL CONSTRUCT THEORY chodrama, partly due to its focus on the varying
aspects or roles of a person. Indeed, Kelly said that
George Kelly’s personal construct theory (PCT) is the title for his magnum opus could have been
an early example of constructivist psychology, an Role Theory. There are many allusions in his the-
approach that takes the standpoint that people ory to the idea that people are playing out roles
construct their own “versions” of the world that they have constructed. The implications of
through their subjective psychological processes. that are extremely important in the context of a
This implies that an individual can construe the person who is trying to change from being who he
same event in different ways at different times and or she is to someone who might be quite different.
that different people may construe the same event If it is accepted that a person is playing a role and
in different ways. Kelly’s theory takes this view- that he or she has many different roles, it follows
point (“constructive alternativism”) but elaborates that it might be possible for a person to be able to
it far beyond a simple philosophical proposition. create a new role for himself or herself. As Kelly
While the major focus of application of PCT is says, a person does not have to be a “victim of
psychotherapy, it has been applied in a wide range their biography.”
of other contexts including education, manage- Kelly is probably unique in setting out PCT in
ment/organizational development, architecture, its entirety in a two-volume work, first published
and market research, to name but a few. as The Psychology of Personal Constructs in 1955.

Personal Construct Theory 765
Although there is a huge literature on PCT, very be safe to do so. The man then drives at 80 miles
few significant amendments or additions have per hour along a road with a 40-mile-per-hour
been made to Kelly’s original theory. speed limit. Her construing of this man has been
Kelly anticipated that at some stage in the invalidated because she now reconstrues him as a
future, his theory, like other types of theory, reckless person who drives too fast and she
would be replaced by another, more useful way changes her behavior by no longer accepting lifts
of understanding people. If the current produc- from him.
tion of literature is anything to go by, it would
seem that PCT is still considered useful and not
Major Concepts
yet in need of replacement.
In addition to its central feature, the bipolar con-
struct, PCT embraces a range of concepts, and
Theoretical Underpinnings some of the most important of these are considered
in this section.
Perhaps understandably for someone who studied
physics and thought of becoming an engineer,
Kelly sets out his theory in the form of a Person as Scientist
Fundamental Postulate elaborated with 11 corollar- All psychological approaches to understanding
ies, rather in the style of an engineering blueprint. human behavior have either an explicit or an
The corollaries describe the nature, formation, implicit model of the person; for example, some
change, and organization of personal constructs, as may view the person as a self-actualizer, whereas
well as how they are applied. Finally, in his others may view the person as an information pro-
Sociality Corollary, Kelly takes his theory into the cessor. However, from a PCT standpoint, people
realm of the interpersonal by saying that to the are seen as similar to scientists, in the sense of
extent that a person can construe the construing of using their “mini-theories” (their bipolar personal
another person, he or she can play a role in rela- constructs) to create personal hypotheses, which
tion to that other person. In his Fundamental they test by behaving, as in the previous example.
Postulate, Kelly states what, from a PCT point of
view, a person is in business for—namely, antici-
pating (predicting) what is going to happen in his Reflexivity
or her personal world and testing out those predic- PCT is reflexive in the sense that it applies as
tions by behaving. For Kelly, behavior is the exper- much to the person who is applying it to others as
iment that a person conducts to see whether the it does to those others. Indeed, Kelly described
hypotheses he or she forms, based on the applica- how PCT itself explained why he chose to create
tion of his or her personal constructs, are validated PCT rather than some other psychological theory.
or invalidated. These processes usually take place The PCT practitioner’s clients are seen as being
at a very low level of awareness. For instance, a engaged in exactly the same psychological pro-
young woman may have the bipolar distinction cesses as the professional—construing their world
sensible versus reckless in her idiosyncratic system and trying to make sense of it. In that sense, the
of personal constructs. For some people, reckless PCT practitioner is his or her own client and needs
may not be the opposite in meaning to sensible, to reflect on his or her own construing in a profes-
but for this young woman it is, and this construct sional relationship, as well as the construing of his
represents one of her “pathways of movement”— or her client.
people, including herself, who are not sensible are
construed as being reckless. Furthermore, the
Resistance to Change
meanings that this person attaches to the labels
sensible and reckless may be quite different from From a PCT point of view, people who are not
the meanings that others would ascribe to those doing what they or others want them to do are not
words. Now, suppose that someone whom this “resisting change” but behaving as they are because
person considers sensible offers her a lift in his car, it makes more sense to them to behave in that way
which she accepts because she predicts that it will rather than in some other way—even if their

766 Personal Construct Theory
current behavior is highly undesirable from their technique was invented by Kelly himself and is
own point of view or that of others. In her seminal unusual in that it contains both qualitative (the
work with those who stutter, Fay Fransella found personal constructs) and quantitative data. A rep-
that such people choose to be disfluent, not in the ertory grid is composed of columns and rows,
sense of their preferring to have such a debilitating forming a matrix of cells. The column headings
speech impediment but because it makes more in the grid are the things, or elements, construed
sense to them to stutter than to be fluent speakers. (e.g., people, situations, or aspects of the self). The
PCT has a range of “professional constructs,” rows contain bipolar personal constructs, which
each with its own special meaning (which is quite are usually elicited from the individual by asking
different from their usual meaning), to help the him or her to compare and contrast the elements.
PCT practitioner understand why a person is hav- After the grid has been designed, it is completed by
ing difficulty in changing. Examples of those pro- rating or rank-ordering each of the elements on
fessional constructs are anxiety, threat, hostility, each of the constructs. Numerous computer pro-
and guilt. Anxiety occurs when an event cannot be grams have been developed to analyze repertory
construed adequately because it is outside the grids, using methods such as principal components
“range of convenience” of a person’s constructs. analysis and cluster analysis. Kelly placed great
A person will feel threatened when his or her “core weight on a mathematical relationship between
constructs”—those constructs that relate to the constructs indicating a psychological relationship
person’s very identity—may imminently be among them. So if the ratings in the grid are simi-
changed. A person is being hostile when he or she lar for the constructs loyal versus disloyal and kind
“cooks the books”—that is, distorts evidence that versus cruel, then the hypothesis would be that the
suggests that he or she may not be the sort of per- person who completed the grid would expect
son he or she construes himself or herself to be. someone who is loyal also to be kind.
Kelly said that when a therapist observes hostility,
the therapist should look for guilt. He said that Self-Characterizations
because guilt is experienced when a person is “dis-
lodged” from his or her “core role,” that is, when Kelly’s self-characterization method is an early
the person believes that he or she has behaved in a example of a narrative technique. In its original
manner that is contrary to the way in which that form, a person is asked to write a character sketch
person thinks he or she should have behaved in of himself or herself in the third person, as if he or
some important respect. A person who finds him- she is a character in a play, from the point of view
self or herself in such a position may become hos- of a sympathetic observer. This technique, which
tile to stave off the feelings of guilt that might reflects Kelly’s notion that if you want to know
otherwise be experienced. what is wrong with someone you should ask them,
is simple but can be extremely effective.
Techniques
Therapeutic Process
Although a great many techniques have been
created by PCT therapists over the years, two of From a PCT perspective, people seeking therapy
the most well known are repertory grids and self- do so because they are “stuck” in the sense that
characterizations, which were invented by Kelly they are unable to reconstrue and move on without
himself. These two techniques are considered professional help. A cornerstone of the therapeutic
assessment techniques, whereas Kelly’s “Fixed Role process is the assumption, alluded to earlier, that
Therapy” is a therapeutic intervention (technique), people are as they are because it makes more sense
discussed in the “Therapeutic Process” section. to them, from the point of view of how they con-
strue the world, to be as they are rather than to
change to being someone different. Accordingly,
Repertory Grids
the therapeutic process has to involve understand-
The most well-known and most used technique ing the client’s idiosyncratic construing of the
in PCT is the repertory grid. The repertory grid world in terms of his or her personal constructs.

Person-Centered Counseling 767
A “diagnosis” can then be done by applying the Psychology, 58, 453–477. doi:10.1146/annurev
professional constructs referred to earlier in this .psych.58.110405.085535
chapter. The only major therapeutic intervention Winter, D. A. (1992). Personal construct psychology in
that Kelly himself described is Fixed Role Therapy, clinical practice: Theory, research and applications.
which exemplifies the approach of experimenta- London, England: Routledge.
tion that is used in PCT. Fixed Role Therapy
invites a person to try out a new role (applying
new personal constructs and existing constructs in
a different way) for size by undertaking behavioral PERSON-CENTERED COUNSELING
experiments both within the consulting room
(e.g., role-play) and in the outside world. Person-centered counseling is an existential-
Contemporary approaches to personal con- humanistic approach to counseling and psycho-
struct psychotherapy range from methods focused therapy that has influenced the manner in which
on the resolution of dilemmas, in which the most counselors and psychotherapists conduct
preferred pole of one construct (e.g., happy in a clinical work. Developed by Carl Rogers during the
construct happy vs. sad) is associated with the non- mid-20th century, this approach was originally
preferred pole of another (e.g., insensitive in a called client-centered counseling and stood in stark
construct sensitive vs. insensitive), to those more contrast to the then popular psychoanalytical
concerned with the therapeutic relationship, focus- approach of Sigmund Freud and the behavioral
ing on the therapist’s and the client’s construing of approach of B. F. Skinner. Using the word client
each other’s construing and the implications of this instead of patient, the approach was novel for its
for the client’s other significant relationships. PCT time, as it stressed the individual’s potential to
therapy has been applied with couples, families, understand his or her predicament and change if he
and groups as well as individuals across the life or she is placed in an environment that provided
span. psychological safety and facilitated self-under-
standing. Continuing to be popular today, this
Nick Reed and David A. Winter nondirective approach helps the client recognize
how he or she has been incongruent or nongenuine
See also Constructivist Therapy; Kelly, George; in his or her life—that is, how the client’s feelings,
Psychodrama
behaviors, and thoughts are out of sync. Such
incongruence occurs due to the client’s need to be
Further Readings loved by significant others and willingness to act in
accordance with how significant others want the
Bannister, D., & Fransella, F. (1986). Inquiring man client to act in order to gain such love. This results
(3rd ed.) London, England: Routledge.
in a denial of one’s own way of being and sense of
Caputi, P., Viney, L. L., Walker, B. M., & Crittenden, N.
self. Although incongruence generally starts early
(Eds.). (2012). Personal construct methodology.
in life as parents or other important people impose
Chichester, England: Wiley-Blackwell.
their wishes or conditions on the client, an indi-
Fransella, F. (Ed.). (2003). International handbook of
personal construct psychology. Chichester, England:
vidual’s nongenuineness can continue throughout
Wiley.
one’s lifetime as additional significant others place
Fransella, F., Bell, R. C., & Bannister, D. (2004). conditions on the individual. However, if a coun-
A manual for repertory grid technique. Chichester, selor shows acceptance and understanding, the cli-
England: Wiley. ent can break this pattern and begin to hear his or
Fransella, F., & Dalton, P. (2000). Personal construct her inner voice; that is, get in touch with his or her
counselling in action. London, England: Sage. true self. Person-centered counseling attempts to
Kelly, G. A. (1991). The psychology of personal facilitate this process through the use of three core
constructs (2 vols.). New York, NY: W. W. Norton. conditions: (1) genuineness, (2) unconditional posi-
(Original work published 1955) tive regard (UPR), and (3) empathic understanding.
Walker, B. M., & Winter, D. (2007). The elaboration of Seen as one of the early existential-humanistic
personal construct psychology. Annual Review of approaches, person-centered counseling and the

768 Person-Centered Counseling
core conditions of genuineness, UPR, and empathy important skills for any person to adopt if the
continue to have a profound impact on the manner person was to live a life based on realness, mutual
in which most counselors and psychotherapists understanding, acceptance, and caring for others.
conduct counseling and therapy. Thus, he changed the name of his approach to
person-centered counseling, stressing that one need
not be a client to reap the benefits of the person-
Historical Context
centered approach, as even friends and significant
Developed by Rogers in the 1940s, person- others could facilitate such understanding. Over the
centered counseling eventually became one of the years, Rogers would criticize other approaches that
most important approaches to counseling and psy- had a more directive approach and were based on
chotherapy. Rogers had been raised in a strict the counselor’s expert knowledge of a theory. During
Pentecostal Christian home, and although he the 1960s, Rogers’s nondirective approach became
entered the seminary at a young age, he eventually one of the most popular approaches of the time, and
rejected the dualistic thinking of his parents and of its popularity continued into the 21st century.
his religion and became interested in understand- Person-centered counseling was originally
ing the human condition from a humanistic per- viewed as a short-term approach when compared
spective. Put off by the psychoanalytical training in with the rather long-term approach of psychoana-
his doctoral psychology program at Columbia lytic therapy. Whereas psychoanalysts would meet
University, Rogers was influenced by individuals with their clients three, four, or five times a week
like Otto Rank, who had split from Freud and had for years, person-centered counselors tended to
moved toward a more existential-humanistic meet much less frequently and would continue
approach, as well as John Dewey, a humanistic only as long as the client wanted to continue.
educational philosopher and psychologist. Rogers During the late 1990s and the first part of the 21st
eventually embraced many of the existential- century, as brief approaches to counseling became
humanistic beliefs of the time, such as the belief increasingly popular, person-centered counseling
that people had a natural tendency to be good if began to be seen as a long-term approach. This is
placed in a loving environment that allowed them somewhat ironic given its history.
to actualize their true selves and a belief in the In recent years, research has continued to vali-
subjective nature of the person; that is, a belief that date the three core conditions that Rogers so
reality is a construction of the person’s percep- strongly advocated for. In fact, research by Bruce
tions. Soon, he began to develop an approach that Wampold, John Norcross, and others asserts that
was based on the three core conditions. these conditions seem to be an important ingredi-
Rogers’s early approach was called client- ent of the “common factors” in the therapeutic
centered therapy. This contrasted with the psycho- relationship—factors that appear to be essential in
analytical and behavioral approaches of the time, the development of positive client outcomes.
which were counselor centered. Such approaches Although, there continue to be a fair number of
assumed that the counselor was the expert and had person-centered counselors today, due to the popu-
the knowledge to help the client and that the coun- larity of the shorter term approaches, there are few
selor should direct or guide the client toward change person-centered purists. However, as a testament
as a function of this knowledge. On the other hand, to the staying power of the person-centered
Rogers believed that the counselor should provide approach, most counselors today continue to stress
the three core conditions in an effort to develop a the importance of the three core conditions when
therapeutic environment that would facilitate client working with clients.
self-understanding. Client awareness, and eventu-
ally client change, would be a product of this self-
understanding, and the role of the counselor was to
simply provide this safe and facilitative environment As adherents to an existential-humanistic approach
so that the client could unravel this new knowledge to counseling and psychotherapy, person-centered
of self on his or her own. counselors have a phenomenological perspective
As Rogers refined his approach, he came to of the person, which means that the counselor
believe that the skills needed for the counselor were accepts the reality of the client and assumes that

the client’s sense of the world is based on his or her the choices made by such a person are somewhat
unique understanding of reality. Person-centered based on this false sense. Thus, the choices made
counselors believe that individuals are born with will often continue the client’s nongenuine self.
an actualizing tendency, which drives the individu- After the client is in counseling or therapy, how-
als toward their full potential. However, this ever, he or she will begin to actualize self, or live
tendency can be thwarted when others place out the true self, and begin to make decisions
expectations on the individuals to act in a manner based on this newfound self. At this point, choices
incongruent to their actual self. Called conditions become increasingly congruent for the client; that
of worth, a person’s need to be regarded by others is, the client’s feelings about self, thoughts about
is so strong that rather than follow the actualizing self, and eventual actions match one another. In
tendency, the individual attenuates to these condi- fact, as the client gains increasing clarity of self, the
tions in an effort to gain love from significant choices become clearer, almost as if there is no
others. When conditions of worth result in behav- choice—that is, there is an obvious path for the
iors that are in contrast to the individual’s natural client to take.
way of being, the individual is said to be acting in
an incongruent or nongenuine manner; that is, the Major Concepts
individual’s feelings, thoughts, and behaviors are
not in sync with one another. Incongruence will Person-centered counselors are driven by the
yield defensiveness, distortions of situations, anxi- philosophy behind existential humanism, and most
ety, or a general sense that the individual is out of of their major ideas flow from that orientation.
sync with self. Some of these include actualizing tendency, need
Although conditions of worth can be placed on for positive regard, conditions of worth, nongenu-
a person at any point in a person’s life by any sig- ineness (incongruence), organismic valuing pro-
nificant other, they are often first experienced from cess, choice and self-determination, nondirective
an individual’s parents or guardians. When chil- counseling, necessary and sufficient conditions,
dren have such conditions placed on them, to and growth and change.
maintain the significant others’ love, they learn to
behave in a manner in which the parents or guard- Actualizing Tendency
ians want them to behave as opposed to how they
Person-centered counselors believe that indi-
want to behave. This incongruence between one’s
viduals are born with an actualizing tendency,
actions, feelings, and thoughts can continue into
which drives the individual toward behaviors that
adulthood as grown children continue to act as
are congruent with his or her sense of self. However,
they believe others would want them to behave in
this tendency can be thwarted by conditions of
contrast to who they actually are. In actuality, the
worth.
individual has lost touch with his or her true self
and is acting out a false sense of self. Person-
centered counselors suggest that this process, Need for Positive Regard
which usually happens outside of the person’s All individuals are born with a need to be
awareness, can be reversed if the client is placed in positively regarded by others. This need can be so
an environment that is conducive to unearthing the great that if a person perceives that a significant
conditions of worth and facilitative of the client other is willing to withdraw his or her positive
understanding his or her true self. Such an environ- regard if the individual does not act in a certain
ment, suggest person-centered counselors, involves manner, then the individual becomes willing to
the expression of the three core conditions within forgo his or her true self and act in a manner
the therapeutic setting. incongruent to that true self.
Person-centered counselors have an interesting
take on the concept of choice and free will. Because
Conditions of Worth
the client is seen as incongruent or nongenuine, he
or she will be out of touch with his or her true self. Conditions of worth are conditions or expecta-
Thus, reality for this individual is partially based tions placed on a person that are incongruent with
on the client’s false sense of self, and accordingly, how the person actually wants to behave. Such

770 Person-Centered Counseling
conditions can result in a person acting in a self-determination. By offering the three core condi-
manner reflective of a false self as his or her true tions, such an environment is created, and the client
self becomes repressed in an effort to please and be will naturally begin to hear himself or herself more
regarded by the significant other. clearly and begin the process of becoming more
congruent; that is, the client becomes more true to
Nongenuineness or Incongruence his or her real self.
Nongenuineness, or incongruence, is when an

Necessary and Sufficient Conditions
individual’s feelings, thoughts, and behaviors are
not in sync. In an effort to be regarded by a sig- In developing his approach to counseling,
nificant other, an individual will sometimes act in Rogers suggested that there were six conditions
ways that others want him or her to act instead of that were necessary for counseling to be effective
being real or true to the individual’s own self. This and they were alone sufficient for positive out-
usually occurs when an individual has conditions comes in counseling:
of worth placed on him or her that results in that
individual living out a false self. When a person 1. The client and the counselor meet and are in
lives a life that is nongenuine or incongruent, he or contact with each other.
she tends to become defensive, distort situations,
2. The client is incongruent and is struggling with
feel anxiety, or have a general sense that he or she
some issues.
is out of sync with self.
3. Within the context of the therapeutic
relationship, the counselor is congruent or
Organismic Valuing Process
genuine.
The organismic valuing process is the innate pro-
cess of moving toward those who value a person’s 4. The counselor shows unconditional positive
real self and offer positive regard and acceptance. regard to the client.
However, if conditions of worth are placed on an 5. The counselor is empathic with the client.
individual, the person may lose touch with his or her
organismic valuing process. Listening to one’s organ- 6. To some degree, the client recognizes that the
ismic valuing process will result in positive self- counselor is empathic and is showing
esteem and a positive self-image. Ignoring one’s unconditional positive regard to the client.
organism valuing process will result in incongruence.
Growth and Change
Choice and Self-Determination Person-centered counselors believe that growth
When a client is afforded an environment by the and change occur through the counselor’s ability to
counselor that offers the three core conditions, that exhibit the necessary and sufficient conditions of
client will begin to make choices that are in sync therapy. Typically, growth and change are experi-
with his or her true self and actualizing tendency. enced in a variety of ways by clients, including an
Person-centered counselors believe that clients can increased sense of trust in self, increased self-esteem,
and will make positive choices for their lives if the ability to make decisions more easily, a greater
afforded such an environment and that clients will awareness of self and of the selves of others, an
determine both the direction of counseling and the increased sense of psychological adjustment, a
direction of their lives when given the opportunity greater belief in one’s ability to make decisions and
to hear themselves clearly in counseling or therapy. the diminution of the need for others to make
decisions for a person, and greater acceptance of self.
Nondirective Counseling
Techniques
Person-centered counselors believe that it is
critical for the counselor to create an environment In contrast to many other theories, person-centered
that is conducive to client self-discovery and counseling has only three techniques: (1) the use of

empathy, (2) showing UCR, and (3) being genuine or destructive feeling is a whole person who is
or congruent in the therapeutic relationship. In loving and giving. It involves understanding that
fact, Rogers and others generally did not consider conditions of worth that have been placed on a
these attributes as techniques, instead suggesting person have, ultimately, been responsible for the
that they were qualities to be found in the coun- individual living an incongruent life, which has led
selor, qualities that all people might consider to distortions in reality, defensiveness, and destruc-
embracing if they were to live congruent, loving, tive ways of living. And it involves the belief that
and accepting lives. This section briefly describes by showing UPR the individual will become in
these three techniques or qualities. touch with his or her true self, which, by its very
nature, will be a more loving and caring person.
Empathy
Genuineness or Congruence
The cornerstone of person-centered counseling,
empathy is the ability to understand the feelings, Genuineness, sometimes called congruence, is
thoughts, and experiences of another person and when an individual’s feelings, thoughts, and actions
letting that person know that one has gained a are in sync. It indicates that what a person feels is
deep understanding of him or her. It involves put- reflected in his or her thoughts and that thoughts
ting oneself in the shoes of another person and and feelings match the kinds of behaviors exhib-
reflecting back this understanding to the person. ited. For the counselor, it means that his or her
Empathy can be shown in many ways, such as feelings, thoughts, and actions are congruent, or in
reflecting back the client’s content and feelings, sync, within the confines of the therapeutic rela-
through metaphor or analogy, by sensing the tionship. Although a counselor may be struggling
deeper feelings of the client and reflecting these with his or her own issues outside of the therapeu-
feelings, and more. However, empathy is not the tic relationship, within the relationship, he or she
same as sympathizing with the client, identifying is whole and genuine. It means that if the coun-
with the client, or interpreting the client’s experi- selor is having ongoing negative or positive feel-
ences. Over the years, a number of models have ings about the client, the counselor will be aware
been developed to help in the development and of those feelings and will consider sharing those
expression of empathic understanding. These mod- feelings if he or she believes that it will benefit the
els have often been used to teach counselors micro- therapeutic relationship. Rogers suggested that if a
counseling skills and break down the learning of counselor initially feels negatively toward a client,
skills into small component parts. One such model, he or she should wait a bit before sharing that feel-
the Carkhuff Scale, operationalized the original ing, as once a relationship is developed, the coun-
definition of empathy by Rogers and was quite selor can facilitate client understanding, see the
popular in the later part of the 20th century. client more clearly, and understand the client’s
Although used less frequently today, such models pain. It is only then that the counselor can compre-
still have an important place in the training of hend why the client acted the way he or she did.
counselors and others in empathy. Such understanding generally dissipates the nega-
tive feelings.
Unconditional Positive Regard
Therapeutic Process
Also called acceptance, UPR is accepting the
client unconditionally within the context of the Person-centered counseling is a nondirective
therapeutic relationship. It means that the coun- approach that can last from a few sessions to many
selor is able to hear the client fully and that the years. Throughout the therapeutic process, coun-
client has a sense that he or she can say anything selors consistently apply the three core conditions
to the counselor without being judged. Such UPR of empathy, UPR, and genuineness, sometimes
can only be achieved by a counselor if he or she called congruence. This allows the client to feel
believes that, ultimately, UPR will be healing for safe within the therapeutic relationship and to be
the client, even if the client says some outrageous increasingly willing to examine all parts of himself
things. It is the belief that underneath any negative or herself. Over time, clients become more aware

772 Phenomenological Therapy
of their true selves, are more in touch with their

feelings and thoughts, have higher self-esteem, PHENOMENOLOGICAL THERAPY
become increasingly autonomous, and are better
able to make decisions in their lives. Phenomenological therapy is a philosophical
therapy that is firmly based in dialogue. It proceeds
Edward S. Neukrug through careful description and aims to explore
people’s difficulties in living as experienced rather
See also Existential Group Psychotherapy; Existential
than by referring to psychodiagnostic categories or
Therapy; Existential-Humanistic Therapies: Overview;
Experiential Family Therapy; Gestalt Therapy;
other theoretical concepts. It seeks to achieve
Interpersonal Group Therapy; Process Groups; understanding by encouraging a person to set his
Rogers, Carl or her problems against the wider horizon of the
human condition. It avoids prescription, interpreta-
tion, and explanation and emphasizes description
Further Readings of purpose, meaning, values, conflicts, dilemmas,
Kirschenbaum, H. (2009). The life and work of Carl and paradoxes instead.
Rogers. Alexandria, VA: American Counseling
Association. Historical Context
Kirschenbaum, H., & Henderson, V. (Eds.). (1989). Carl
Rogers dialogues. Boston, MA: Houghton Mifflin. Phenomenological therapy is based on the method
Kirschenbaum, H., & Henderson, V. (Eds.). (1989). The of phenomenology, which originated with the
Carl Rogers reader. Boston, MA: Houghton Mifflin. philosopher Edmund Husserl’s work in the early
Kramer, R. (1995). The birth of client-centered therapy: part of the 20th century. Phenomenology, literally
Carl Rogers, Otto Rank, and “the beyond.” Journal of the science of appearances, is a method for sys-
Humanistic Psychology, 35(4), 54–110. tematic description of conscious awareness,
doi:10.1177/00221678950354005 which results in grasping what is essential about
Neukrug, E. S. (2011). Person-centered counseling. In something so that we can understand better what
Counseling theory and practice (pp. 214–244). it means. Such conscious awareness can help
Belmont, CA: Cengage. a person set aside his or her usual assumptions
Neukrug, E. S., Bayne, H., Dean-Nganga, L., & Pusateri, and bias.
C. (2012). Creative and novel approaches to empathy: Several psychiatrists saw the importance of this
A neo-Rogerian perspective. Journal of Mental Health new method for the human and social sciences.
Counseling, 35(1), 29–42. Both Karl Jaspers in Germany and Ludwig
Rogers, C. R. (1942). Counseling and psychotherapy: Binswanger in Switzerland started applying phe-
New concepts in practice. Boston, MA: Houghton nomenology to psychiatry to connect more closely
Mifflin.
with the way in which their patients were experi-
Rogers, C. R. (1951). Client-centered therapy: Its current
encing the world. Their efforts to apply phenome-
practice, implications and theory. Boston, MA:
nology to their work with their patients happened
Houghton Mifflin.
concurrently with the German philosopher Martin
Rogers, C. R. (1957). The necessary and sufficient conditions
of therapeutic personality change. Journal of Consulting
Heidegger’s application of phenomenology to the
Psychology, 21, 95–103. doi:10.1037/h0045357
philosophy of human existence. His book Being
Rogers, C. R. (1961). On becoming a person: A and Time showed that human existence may be
therapist’s view of psychotherapy. Boston, MA: better understood if one starts with an ontological
Houghton Mifflin. analysis, that is, by establishing what is essential
Rogers, C. R. (1980). A way of being. Boston, MA: to Being. He described the fundamental ways in
Houghton Mifflin. which human beings (Dasein) stand out in the
The top 10: The most influential therapists of the past world in relation to time. The Swiss psychiatrist
quarter-century. (2007, March/April). Psychotherapy Medard Boss worked with Heidegger for many
Networker. Retrieved from http://www years to apply this framework to psychotherapy
.psychotherapynetworker.org/ index.php/magazine/ and developed a particular form of therapy named
populartopics/219-the-top-10 Daseinsanalysis.

Phenomenological Therapy 773
Many other philosophers and psychotherapists Major Concepts

were inspired by phenomenological ideas and gener-
Phenomenological observation requires researchers
ated alternative forms of therapy. Jean-Paul Sartre
or therapists to clear their minds and to suspend
and Merleau Ponty in France, who with others like
their usual prejudice and assumptions so that
Simone de Beauvoir and Albert Camus developed
attention becomes more fully available and can be
existentialism, greatly influenced phenomenological
focused carefully as intentionality. Husserl showed
forms of therapy. In the United States, Fritz Perls’s
how to remove preconceptions and clear the mind
Gestalt psychotherapy and Carl Rogers’s person-
in order to observe the world and our conscious-
centered therapy were both influenced by the phe-
ness of it more diligently. These processes when
nomenological principle of attending to what is
applied to the practice of psychotherapy lead to a
actually happening to the person. Eugene Gendlin’s
number of concepts that become the cornerstones
focusing therapy is directly based in phenomeno-
of progress.
logical principles. In the United Kingdom, R. D.
Laing’s alternative psychiatry was also inspired by
these ideas, as was George Kelly’s personal construct Time Genetic Constitution
psychology. Laing’s phenomenological descriptions Phenomenology reminds and emphasizes the
of family interactions and schizophrenic experience importance of time. As human beings, we are born
are a good example of the method. and live for a period of time, and then we die. We
The European School of Existential- are never able to be all we are capable of being,
Phenomenological Therapy, sometimes known as and we are constantly changing. When people
the British School, is deeply rooted in phenomeno- begin to grasp that they affect the change in their
logical principles. This method has also engendered lives, their therapy starts in earnest. It will take a
numerous forms of phenomenological qualitative lot longer for most people to begin to take respon-
research, which have been applied to psychological sibility for all the life choices they make. Awareness
research with great success. of how they either engage or disengage from the
situations they are in will take even longer.
Theoretical Underpinnings Phenomenological therapy assumes the capacity of
all human beings to evolve by self reflection.
Phenomenology requires people to pay systematic
Agreement with this premise, or rather a discovery
attention to not only the way in which human
of its truth in practice, is essential to the success of
awareness shapes our own consciousness but also
the work.
the way in which we perceive objects that we direct
our consciousness toward. It also affects the pro-
cess of thinking and experiencing. It is a study of Transforming the Dynamic Self
human consciousness and its functional principle Most clients who come to therapy have lost
of intentionality. Scientists have long neglected the track of their ability to be many different things
mysterious process of consciousness because it is and have lost faith in their ability to deploy their
not open to objective study. They have preferred to talents in new ways and to make new connections
study the objects in the world, which can be objec- and meanings in the world. Phenomenological
tively studied, or the physical brain, which under- therapy assumes the importance of this capacity
pins the complex processes of the mind. Such study for connectivity and transformation and aims to
isolates and analyzes something that has become stimulate and inspire it.
objectified. In this process, essential connections
between the object and the environment, on the
Owned Living and Intersubjectivity
one hand, and the object and the subject, on the
other, are often lost sight of. Phenomenology on Husserl showed the importance of intersubjec-
the contrary brings object, process, and subject tivity, which is the dialogical connectedness
together in one intentional arc that unites all between people. Many people forget about this,
these elements, which is particularly relevant to deny it, distort it, or avoid it. Owned living is when
psychotherapy. a person is not just at the mercy of circumstances

774 Phenomenological Therapy
or other people’s dictates but is able to self reflect Techniques

and face his or her temporality and limitations.
Phenomenological therapy involves a dialogue
People have often translated owned living as
between the client and the therapist and seeks to
authentic living and disowned living as inauthentic
assist clients in seeking understanding of the
living, thus missing the deeper meaning of the need
human condition. Rather than using specific tech-
for clarity about the limits of life.
niques, the therapist is more concerned about the
therapeutic process and uses the following con-
Worldview cepts to guide his or her dialogue with the client.
Human beings create their lives in a world that
is multidimensional and where all layers of exis- Description
tence have to be taken into account and dealt with
This is the hallmark of phenomenological ther-
appropriately and ably. The four-world model,
apy. Clients are invited to observe and attend to
based on Heidegger’s idea of the fourfold, consid-
their own experience carefully before describing it
ers a person’s engagement in 16 areas of human
until it sounds accurate to them.
existence, arrived at by the four dimensions of life
(physical, social, personal, and spiritual) squared
against themselves. The fourfold world model can Bracketing
be used to perform a structural existential analysis Clients are encouraged to consider what they
of the position a person holds in the world and take for granted and to set aside their usual preju-
how that person deals with challenges on all dice to examine their experience anew. The thera-
dimensions. pist applies the same method to personal bias.
Affectivity Horizontalizing
A person’s engagement with the world and his The story that the client tells is examined for its
or her consciousness are filtered through the per- limits and horizons. Each person is centered in his
son’s affectivity, or emotional compass. A person or her own world and can only see as far as his or
moves toward and away from the world according her vision reaches. It is important to locate a per-
to the values he or she seeks out or avoids. The son’s experience within his or her situation and
emotional compass is a model that describes the context and not immediately expect the person to
entire spectrum of the sensory, emotional, mental, jump beyond this.
and intuitive qualities of awareness that show a
person how he or she feels about the various
aspects and events in the world. These feelings Equalizing
always refer to values and lead to action. They can The therapist initially aims to hold his or her
be articulated in language. attention evenly and to let every aspect of the cli-
ent’s story come to the fore without favoring any
Paradox
particular aspect. Eventually, how the client is
organizing his or her experience and what his or
Human living happens in a force field of contra- her blind spots and habits of emphasis are will
dictory influences. At each dimension of existence, become obvious.
human beings are faced with difficulties and
opposing ideas and realities. We have to deal with
Dialogue
life and death on the physical dimension, love and
hate on the social dimension, strength and weak- As a philosophical method, phenomenological
ness on the personal dimension, and meaning and therapy is centered on dialogue, where the client
absurdity on the spiritual dimension. The art of and the therapist debate the issues in mutuality
human living is to learn how to work with these and with the focus on understanding something by
paradoxes and contradictions. talking through the issues.

Phenomenological Therapy 775
Actualizing may use certain heuristic devices, such as the

four-world map or the emotional compass.
Phenomenology allows a person to become
aware of how he or she engages or disengages with
certain aspects of life. Actualizing and taking own- Verification
ership of one’s own experience creates a new All phenomenological methods highly value the
energy and enthusiasm of engagement. principle of verification, whereby one constantly
checks that one’s account of reality coincides with
Perspectives the experience of those who are actually impli-
cated in it. This means that the therapist will not
Everything in the world can be looked at from
impose meanings or observations but will check
different angles and has multiple facets.
them out for veracity with the client. Therapists
Phenomenological therapists enable their clients to
proceed slowly toward greater accuracy by invit-
explore those facets and adumbrations they had
ing correction from the client.
not considered before.
Directionality and Purpose Therapeutic Process
Human beings live in time and move forward The therapeutic process begins by the therapist
toward a certain destination and objective, even entering into the relationship with the client in a
when they are not aware of what this is or are manner that is respectful of the client’s way of
confused about it. Phenomenological therapy helps being. Phenomenological therapy requires the ther-
people retrieve their sense of direction and pur- apist to be fully engaged with the client and to be
pose. This immediately creates a greater sense of truly present, in a wholehearted manner. In reso-
connectivity and meaning. nating with the client’s worldview, the therapist
will be able to participate in it and thus understand
it from the inside.
Dialectical Enquiry Much of the therapy is based on dialogue. The
Human experience, like nature, is embedded in conversation is open and receptive. The objective is
a struggle between opposing forces. As humans, we a joint enquiry into what creates difficulty for the
evolve as we overcome the tensions and polarities client. In this conversation, the therapist is direct
by finding a way to synthesize and surpass them. and speaks as simply and truly as possible. The
Our values and purpose are what provide us with therapist is also directional rather than directive or
the forward thrust to transcend the problems and nondirective. This means that attention is paid to
follow a project. the direction of the client’s life, so that the client’s
important projects are elucidated and tracked.
All through the work, the therapist will use phe-
Hermeneutics nomenological methods to bracket assumptions
Interpretation in phenomenological therapy is that appear both in the client’s words and in the
hermeneutical. This means that the final interpre- therapist’s mind. Gradually, a picture emerges of
tation is the responsibility of the client rather than the client’s worldview, beliefs, and values and also
of the therapist. Meaning is not derived from a of the way in which he or she has stagnated or
theoretical model but from the experience of the become scared to move on.
client. There will be occasions when paradoxes or con-
tradictions are encountered. When this occurs, the
therapist uses dialectical methods to enable the
Heuristics
client to discover a purpose and meaning that can
Phenomenological therapy is a search for truth carry the client beyond the conflict by surpassing it
and an investigation or enquiry into what is actu- and making decisive new choices.
ally the case. The objective is always that of greater A joint search for truth and understanding will
understanding. As part of this enquiry, therapists guide the process. This is a philosophical enquiry

776 Play Therapy
where the client learns to ask the right questions to Laing, R. D. (1961). Self and others. New York, NY:
come up with informative answers. The client learns Routledge.
about the human ability to make sense of experi- Laing, R. D. (1967). The politics of experience.
ence and puzzles out new meanings in the world. New York, NY: Pantheon House.
The phenomenological therapeutic process Laing, R. D. (1970). The divided self. Harmondsworth,
includes lessons about the importance of engagement England: Penguin Books. (Original work
with life and its many challenges. Clients frequently published 1959)
get a sense of the productivity of their learning and Perls, F., Hefferline, R. F., & Goodman, P. (1951). Gestalt
therapy. New York, NY: Julian Press.
so stop fearing new and more challenging experi-
Rogers, C. (1951). Client-centered therapy. London,
ences, realizing that troubles and difficulties can be
England: Constable.
moments of breakthrough rather than breakdown.
Spinelli, E. (2005). The interpreted world: An
From a phenomenological perspective, getting better
introduction to phenomenological psychology
at intelligent engagement with living makes life more (2nd ed.). London, England: Sage.
meaningful and worthwhile.
Emmy van Deurzen
See also Daseinsanalysis; Existential Group PLAY THERAPY

Psychotherapy; Existential Therapy; Existential-
Humanistic Therapies: Overview; Focusing-Oriented
Therapy; Gestalt Therapy; Perls, Fritz; Person-
Play therapy is an approach to counseling children
Centered Counseling; Rogers, Carl in which trained counselors integrate play into
their therapeutic approach as a way to prevent or
resolve difficulties. Because many children do not
Further Readings have the cognitive development to participate in
Adams, M. (2013). Existential counselling in a nutshell. traditional talk therapy to verbalize and analyze
London, England: Sage. their problems, they can use play, art, music, games,
Cooper, M. (2003). Existential therapies. London, and other playful media to communicate in a way
England: Sage. that is meaningful to them. Play is considered the
van Deurzen, E. (2012). Existential counselling and language of children, and the toys are the words to
psychotherapy in practice (3rd rev. ed.). London, express their experiences. Play allows children the
England: Sage. space to distance themselves from troubling events
van Deurzen, E. (2010). Everyday mysteries: Handbook and project their thoughts and feelings onto the
of existential therapy. London, England: Routledge. toys. Children can re-create and reenact events in
van Deurzen, E., & Adams, M. (2011). Skills in ways that allow them to change the outcome and
existential counselling and psychotherapy. London, thus gain mastery of their thoughts and feelings.
England: Sage. Play therapy becomes the platform to address
Gendlin, E. T. (1978). Focusing. London, England: concerns and to work toward optimal growth and
Bantam Books. development. While play therapy was developed to
Heidegger, M. (1962). Being and time (J. Macquarrie &
work with children between the ages of 3 and
E. S. Robinson, Trans.). London, England: Harper &
11 years, many counselors integrate play into their
Row. (Original work published 1927)
work with adolescents, groups, and families.
Husserl, E. (1931). Ideas (W. R. Boyce Gibson, Trans.).
New York, NY: Macmillan. (Original work
published 1913) Historical Context
Husserl, E. (1960). Cartesian meditations: An
introduction to phenomenology (D. Cairns, Trans.) The development of play therapy parallels the pro-
The Hague, Netherlands: Nijhoff. (Original work gression of theoretical advances in the overall
published 1929) counseling field. In 1909, Sigmund Freud first
Husserl, E. (1977). Phenomenological psychology mentioned integrating play as a treatment modal-
(J. Scanlon, Trans.). The Hague, Netherlands: Nijhoff. ity in the work he conducted with Little Hans.
(Original work published 1925) While Freud did not work with the child directly,

Play Therapy 777
he asked Little Hans’s father for descriptions of the knowledge and expertise in play therapy. In
child’s play and then provided interpretations and addition to the International Journal of Play
suggestions for how the father could work with his Therapy, APT manages credentials for licensed
child to help gain mastery of the child’s fears. In mental health professionals who want to become a
1919, Hermine Hug-Hellmuth began to directly Registered Play Therapist or a Registered Play
incorporate play as a central component of psy- Therapist-Supervisor. As a way to further encour-
choanalysis in understanding the conflicts and age continued training and research, APT offers
personality structures of children. Anna Freud also designations for Approved Centers of Play Therapy
began to observe children’s play as a way to estab- Education and Approved Providers of Play Therapy
lish relationships with children, and in the late Continuing Education.
1930s, Melanie Klein began to use play with chil-
dren as a direct substitute for traditional talk as the
medium of expression in psychotherapy.
In 1938, David Levy developed what he termed While counselors who utilize play therapy may
Release Therapy, in which a child who has experi- adhere to a variety of theoretical orientations, their
enced a specific stressful situation would be given approach can be divided into two major catego-
play materials related to the situation and allowed ries: (1) nondirective and (2) directive play therapy.
free play time to act out various scenarios in order From a nondirective approach, children have the
to reenact the event and release the painful power to make all of the decisions about what
thoughts and emotions. In 1955, Gove Hambidge happens in the playroom. In contrast, counselors
built on Levy’s work and established an even more utilizing a directive approach structure activities
structured, direct approach in which he would and lead children in scenarios within the play-
establish rapport and then ask the child to repeat- room. While some counselors may strictly use one
edly play out the exact traumatic situation in order approach or the other, many use a combination of
to cope and gain mastery over the event. these approaches. Counselors may begin with a
In contrast, during the 1950s, Virginia Axline nondirective approach to build the therapeutic
modified Carl Rogers’s client-centered therapy into relationship and assess the presenting issues and
a nondirective, client-centered play therapy then move to more directed activities to address
approach. She believed that children will naturally concerns as they emerge.
move toward growth if counselors develop a warm
and accepting relationship where children can take
Nondirective Play Therapy
the lead in their play and counselors can reflect
their feelings in such a way that the children can In nondirective play therapy, counselors do not
gain insight into their own problems. In the 1960s, direct or manage the play but, instead, provide a
Bernard Guerney and Louise Guerney developed safe, genuine relationship where children can
Filial Therapy, in which counselors train parents in explore their own challenges and direct their own
the basic tenets of nondirective client-centered play process. Axline outlined eight basic principles of
therapy so that the parents can work directly with nondirective play therapy:
their children in special play sessions at home to
build the parent–child relationship. As theoretical 1. The therapist must build a warm, friendly,
approaches continued to expand in the next few genuine relationship with the child client that
decades, counselors incorporated play therapy with will facilitate a strong therapeutic rapport.
those orientations, including cognitive-behavioral
2. The therapist must be completely accepting of
play therapy, Gestalt play therapy, brief solution-
the child, without desiring the child to change in
focused play therapy, and eclectic prescriptive play
any way.
therapy.
In 1982, the Association for Play Therapy 3. The therapist must develop and maintain an
(APT) was established to further promote theoreti- environment of permissiveness so that the child
cal development, research, and clinical practice for can feel free to completely explore and express
individuals who want to gain more specialized his or her feelings.

778 Play Therapy
4. The therapist must pay constant attention to the Because play is a natural way for children to
child’s feelings and reflect them in a manner have fun, counselors who utilize play in therapy
that encourages the child to gain insight into can quickly build a nonthreatening therapeutic
and enhance his or her understanding of self. relationship and assist children in overcoming
resistance to therapy. Children are allowed to
5. The therapist must always be respectful of the
communicate in their own way and allow the
child’s capacity for solving his or her own
toys to speak for them. Through the use of role
problems if given the opportunity and resources
play, they can express strong emotions and gain
necessary. The child must be solely responsible
mastery over difficult experiences by trying out
for his or her own decisions and must be able to
alternative solutions and visualizing new possi-
freely choose whether and when to make
bilities. They can build competence by trying out
changes.
new behaviors in the playroom and creatively
6. The therapist must not take the lead in therapy. thinking about how to solve problems in new
This responsibility and privilege belongs to the constructive ways. Additionally, counselors dem-
child. The therapist always follows the lead of onstrate a caring, supportive relationship, which
the child. can help children build stronger attachments and
positive social relationships in their lives outside
7. The therapist must never attempt to hasten the
the playroom. Like many other alternative
course of therapy. Play therapy is a slow and
approaches that do not predominantly rely on
gradual process that depends on the child’s
clients talking about their issues, play therapy is
pace, not the therapist’s.
an effective, creative way to engage clients to
8. The therapist must only set limits that are work through difficulties and focus on optimal
essential for anchoring therapy to reality and to growth for the future.
return to the child responsibility for his or her
role in the therapeutic process.
Techniques
Directive Play Therapy Counselors are guided by their theoretical

orientation and can utilize a variety of techniques
In directive play therapy, counselors lead the in their approach to play therapy. While these
play sessions by tailoring activities to the needs of skills may appear very similar to the techniques
the individual child. Specific toys are selected for a utilized in traditional talk therapy, the approach
child to work out a particular problem or to reex- may differ when working with children in play
perience a particular situation. Repetition becomes sessions. The basic techniques include tracking,
important so that children can gradually play out restating content, restating feelings, returning
the experiences until the experiences become less responsibility, and limit setting.
overpowering, the thoughts attached can be
restructured, and the emotions can be released.
Tracking
The most fundamental skill in play therapy is
Major Concepts
tracking. Because play is the child’s language,
Counselors who utilize play therapy often promote tracking allows the counselor a way to describe
the therapeutic powers of play. Researchers have the behavior in a literal, noninterpretative way.
demonstrated the efficacy of play therapy with a Particularly in beginning play sessions, counselors
wide range of presenting problems, including utilize tracking to build the relationship with the
depression, anxiety, concentration, phobias, aggres- child. Just as sportscasters give a play-by-play of
sion, abuse, grief, divorce, terminal illness, and a game, counselors let children know that they
severe trauma. The therapeutic factors are the ben- are paying attention by concretely describing
efits that children can obtain within the context of what the children are doing or what the play
play therapy beyond the overarching presenting objects are doing while the children create their
issue. play scenes.

Play Therapy 779
Restating Content during their play, they do let children know what
specific behaviors are not permitted in the play ses-
Similar to paraphrasing with adult clients,
sion. Counselors may differ in their approach to
counselors restate what children verbalize in their
setting limits in the playroom, but they do agree
play. The purpose of restating content is to demon-
that limits are needed to protect clients from hurt-
strate genuine interest in what the children are
ing themselves, the counselor, and the materials in
saying. Counselors try to match the content of the
the room. Counselors also limit children from tak-
message in an age-appropriate way so that the
ing toys out of the playroom, leaving without per-
children understand that they have been heard and
mission before the time is up for the session, or
have the opportunity to gain insight into their ver-
staying after the end of the session. Other limits
balizations as needed.
may be set based on the theoretical orientation and
personality of the counselor. For instance, nondi-
Reflecting Feelings rective counselors keep limits to a minimum to
Developmentally, children may have very lim- encourage clients to have autonomy and permis-
ited “feeling-word” vocabularies and may not be siveness in the playroom, while directive counsel-
able to clearly articulate how they are feeling ors tend to structure the sessions in a way that lets
about particular situations. Counselors reflect children know what toys they will use and what
what children are expressing verbally and nonver- they are expected to do in session.
bally in play sessions as a way to help children
understand the variety of feelings they may be Therapeutic Process
experiencing and also to help expand their feeling-
word vocabulary. Children are given permission An essential component of the therapeutic process
to express themselves in a variety of ways in the is the personality of the counselor. Effective play
playroom, so counselors reflect those emotions in counselors have been described as having the fol-
such a way that children can feel validated and lowing characteristics: appreciation and respect for
understood. children, a sense of humor, self-confidence and self-
reliance, openness and honesty, willingness to use
play as a vehicle for communication, flexibility and
Returning Responsibility the ability to handle ambiguity, and the ability to
Adults often do for children things that children set limits and maintain personal boundaries.
should and could be doing for themselves. To pro- Counselors must also be able to set up a welcom-
mote independence and self-efficacy, counselors ing space that mirrors a sense of comfort,
empower children to make their own choices and happiness, and safety.
to complete their own tasks in play sessions. When The toys that go into the playroom are also
children ask for help on a task that they can clearly carefully chosen to enhance the therapeutic pro-
address on their own, counselors simply reiterate cess. Counselors purposely select toys that allow
that they can handle the situation and encourage children to explore real-life experiences, test limits,
them to make the decision for themselves. and express a range of feelings. The toys generally
Sometimes counselors may not be absolutely sure fall into one of the following categories: family
that clients can manage on their own, so they start toys, scary toys, aggressive toys, expressive toys,
by reflecting the content and feelings being and fantasy toys. Family toys are used to explore
expressed and watch for a response to know if relationships and can include items such as a doll-
they need to collaborate on the task in order to house, baby dolls, play kitchen, and puppets. Scary
build responsibility within the child without fully toys can include sharks, insects, dinosaurs, and
taking over for the child. scary puppets to allow children to deal with fears
and phobias. Aggressive toys are used to symboli-
cally express anger and control and can include
Limit Setting
weapons, soldiers, shields, and handcuffs.
While counselors do not typically set limits on Expressive toys include items such as art materials,
what children can verbalize or symbolically express modeling compounds, and pipe cleaners to allow

780 Poetry Therapy
for creativity. Fantasy toys include dress-up clothes, Kottman, T. (2010). Play therapy: Basics and beyond
masks, and medical kits to allow for pretend and (2nd ed.). Alexandria, VA: American Counseling
role-play opportunities. The purpose is not to fill a Association.
room with a bunch of random toys but, instead, to Landreth, G. (2012). Play therapy: The art of the
carefully select items that will promote free expres- relationship (3rd ed.). New York, NY: Routledge.
sion and creativity. O’Connor, K. (2000). The play therapy primer (2nd ed.).
Another key component of the therapeutic pro- Hoboken, NJ: Wiley.
cess is the involvement of the parents or guardians Schaefer, C. (Ed.). (2011). Foundations of play therapy.
Hoboken, NJ: Wiley.
of the child. They may bring the child into therapy
with the hope that the counselor will immediately
fix whatever the presenting issue may be. They
may also have concerns about the perception that
the counselor is just playing with their children POETRY THERAPY
instead of doing traditional talk therapy. A coun-
selor skilled in play therapy is able to explain the Poetry therapy and bibliotherapy are terms used
value of play therapy and partner with the parents synonymously to describe an intentional process in
or guardians to set realistic goals for what they which language, story, and symbol act as catalysts
want to see happen as a result of the process. for psychological health and well-being. Poetry
Counselors begin by completing a comprehen- therapy is an interactive process with three essen-
sive assessment of the situation, which may include tial components: (1) the literature, (2) the trained
personal observations in a variety of settings, facilitator, and (3) the client. A trained facilitator
reports from family members and teachers, or for- selects a poem or other form of written or spoken
mal diagnostic assessments. While the techniques media to serve as a catalyst and evoke feeling
that are utilized vary according to the counselor’s responses for discussion. Literature is either
theoretical orientation, the counselor explores imported (brought in from elsewhere) or exported
what themes continue to reappear, what feelings (brought out of the client through writing). The
are being expressed, and what the next steps need interactive process helps the individual develop on
to be as the child plays and interacts in sessions. the emotional, cognitive, and social levels. A poetry
The counselor continues to work with the child in therapist works with individuals, families, and
a nondirective or directive way until the therapeu- groups.
tic goals have been reached and the child’s attitude Poetry therapy has a broad range of applica-
and behaviors have improved from the initial tions with people of all ages and is used for health,
functioning. maintenance, and marginal populations. It has
been successful with those suffering from addic-
Kathleen Levingston tion; those with learning disabilities; families with
problems; the frail elderly; survivors of violence,
See also Adventure-Based Therapy; Art Therapy; Creative
abuse, and incest; the homeless; and veterans.
Arts and Expressive Therapies: Overview; Dance
Movement Therapy; Drama Therapy; Integrative
Approaches: Overview; Music Therapy; Narrative Historical Context
Therapy; Parent–Child Interaction Therapy
Poetry therapy has been documented as far back as
the fourth millennium BCE in Egypt, where heal-
Further Readings ing words were written on papyrus and then dis-
Association for Play Therapy. (2013). About play therapy. solved in a solution so that the words could be
Retrieved from http://www.a4pt.org/?page=AboutAPT physically ingested by a sufferer and take effect
Axline, V. (1969). Play therapy. New York, NY: Ballantine quickly. In ancient Rome, a Roman physician
Books. named Soranus prescribed tragedy for his manic
Kaduson, H., & Schaefer, C. (Eds.). (1997). 101 favorite patients and comedy for those who were depressed.
play therapy techniques. New York, NY: Jason Centuries later, in 1751, Pennsylvania Hospital
Aronson. employed complementary treatments for mentally

Poetry Therapy 781
ill patients, including reading, writing, and publi- the release of emotion. The concept of catharsis,
cation of their writings. By World War I, the term conceived of by Greek philosopher Aristotle,
bibliotherapy was adopted by librarians who saw involved controlling, directing, and releasing emo-
the value of selecting and using books helpful to tions. In the early 19th century, the poet William
patients. Early pioneers included the psychiatrist Wordsworth referenced such cathartic relief in the
Karl Menninger, the writer Robert Schauffler, the poem Intimations of Immortality.
psychoanalyst Smiley Blanton, and the pharmacist
and lawyer Eli Greifer, who volunteered in many Major Concepts
hospitals to prove that “poem therapy” was effec-
tive. By the 1960s, poetry therapy had begun to Several different poetry therapist practitioners
flourish in the hands of professionals in various have contributed their own theories. The major
disciplines, including rehabilitation, education, concepts include, but are not limited to, the follow-
library science, recreation, and the creative arts. ing: interactive biblio/poetry therapy, Receptive/
Jack J. Leedy, Ann White, and Gil Schloss formed Expressive/Symbolic model, journal therapy, and
the Association for Poetry Therapy in 1969. Leedy, transformative writing.
a psychiatrist, edited the first volume by practitio-
ners, called Poetry Therapy. Interactive Biblio/Poetry Therapy
Today, the National Association for Poetry
Interactive biblio/poetry therapy, devised by Sister
Therapy is still in existence as a membership orga-
Arleen Hynes and Mary Hynes-Berry, refers to a
nization. The credentialing body is a separate orga-
group process in which four different phases occur:
nization, the National Federation for Biblio/Poetry
(1) Recognition (Identification), (2) Examination
Therapy.
(attention to details with the assistance of guided
questions), (3) Juxtaposition (many different
Theoretical Underpinnings thoughts are expressed and compared to stretch the
mind), and (4) Application (participants explore
The power of literature is derived largely from
how the material is relevant to their own lives).
imagery or seeing with the mind’s eye. Research
has shown that imagery is linked with learning,
relaxation techniques, life meaning, and life enjoy- Receptive/Expressive/Symbolic Model
ment. Imagery is the language of dreams and the Nicholas Mazza’s Receptive/Expressive/
unconscious and, as such, serves as a catalyst for Symbolic model makes the distinction between
bringing unconscious material into conscious prescriptive poetry, where the facilitator selects the
awareness. literature, and the expressive/creative mode, in
Dramatic plays, videos, and short stories may be which people write for self-expression. The ritual
chosen to help people gain control over their life of forming a writing circle to work on one’s inner
situation; the viewer or reader identifies with the life and the use of story and symbols validate a feel-
characters and seeks solutions that are unique and ing or event as significant. Rituals give stability in
universal. Symbolic representation and imagery times of change. Examples of rituals are writing
are poetic qualities that can be found not only in letters and burning the letters to dispel unfinished
poetry but also in fiction, myths, fairy tales, and business, writing holiday cards, and eulogy writing.
dramatic plays.
When participants externalize feelings through
Journal Therapy
writing, the literature is a black-and-white testa-
ment to feelings and thoughts previously without Katherine Adams is an advocate for writing
form. The externalization allows individuals to down thoughts and feelings to sort through prob-
view their feelings from a different perspective and lems and come to a deeper understanding of one-
often leads to insight. self and issues in one’s life. Through reading one’s
The poetic elements play a central role in own words, the writer is able to perceive experi-
heightening the emotional impact of literature ences more clearly, reflect, problem solve, and
with the potential for catharsis—cleansing through experience relief of tension.

782 Poetry Therapy
Transformative Writing letters, memoirs, and interviews may be used to

integrate a person’s life experience into a meaning-
Sherry Reiter suggests 10 principles of transfor-
ful whole.
mative writing that act as catalysts for change:
mastery, ritual, safety, freedom, venting (contain-
ment and release), the magic of the poetic, bearing Therapeutic Process
witness, creativity, integration, and theory of self
A typical poetry therapy session consists of three
and relativity (self in the world).
steps: (1) warm-up, (2) body, and (3) closure.
Techniques Warm-Up
Techniques include, but are not limited to, the fol- The poetry therapist creates a gentle, nonthreat-
lowing: expressive writing, prescriptive reading, ening atmosphere in which clients feel safe and are
journal therapy, performance poetry, and life review. able to share feelings openly and honestly. The
group agrees to respect any confidential issues that
Expressive Writing are brought up. A warm-up consisting of a word
game, word associations, a song, or other verbal
Expressive writing employs different genres that
introduction is used to “break the ice” so that
lend themselves to specific needs. For example,
everyone feels comfortable.
preschool and older children benefit from collab-
orative storytelling. Junior high school kids read,
write, and react enthusiastically to soap opera Body
scenarios. Teens are especially responsive to song In the body of the session, the facilitator sug-
lyrics and may choose to write their own. gests a creative writing theme or uses writing that
has already been published to help participants
Prescriptive Reading explore feelings, thoughts, ideas, and personal
issues. The developmental level, cultural makeup,
Prescriptive reading is the technique of reading literacy level, circumstance, and emotional fragility
articles, short stories, novels, and poems specifi- of the participants are assessed prior to making a
cally chosen to reflect the conflicts or concerns of literary selection.
the specific reader. A poem may also be memorized
to increase ego strength and regulate emotions.
Discussion follows the reading. Closure
At the end of the session, the facilitator will help
Journal Therapy provide closure. Factors for the facilitator to consider
include the length of the session, the degree of self-
Journal therapy is a way to discover what has disclosure and group unity, and the degree of tension
been learned over time through reflecting on per- encountered during the workshop. Closure provides
sonal experiences. a time for “winding down” and “tying up loose ends.”
Poetry therapy may be used in short-term ther-
Performance Poetry apy, as in the case of grieving the loss of a pet, or
for working on developmental issues, such as
Performance poetry is a technique that is popu- midlife transition. Poetry therapy may also be used
lar with teens and adults, in which performance, in long-term therapy, as in the case of working on
voice, and individualistic expression are applauded deep-seated psychological problems or maladap-
by an audience. tive behavior patterns.
Life Review and Reminiscence Sherry Reiter
Life review and reminiscence have been partic- See also Activity-Based Group Psychotherapy;
ularly effective in helping older persons. Albums, Bibliotherapy; Common Factors in Therapy; Creative

Positive Psychology 783
Arts and Expressive Therapies: Overview; Guided like clinical psychologists or licensed professional
Imagery Therapy; Narrative Therapy; Writing Therapy counselors. Both licensed therapists and profes-
sional/executive/personal/life coaches may admin-
ister well-being interventions. Coaches are advised
Further Readings
to have clients evaluated by a mental health coun-
Adams, K. (Ed.). (2013). Expressive writing: Foundations selor or therapist and/or a family physician before
of practice. Lanham, MD: Rowman & Littlefield. coaching in order to screen clients for mental or
Hynes, A. M., & Hynes-Berry, M. (2012). Biblio/poetry physical disorders that may be causing or worsen-
therapy—the interactive process: A handbook. ing their life problems. Clients who lack motiva-
St. Cloud, MN: North Star Press. tion to improve their work or relationships may be
Mazza, N. (2004). Poetry therapy: Theory and practice. taking a medication or may have a physical disor-
London, England: Routledge. der like diabetes that is making them tired or amo-
Reiter, S. (2009). Writing away the demons: Stories of tivational. In this situation, clients need the help of
creative coping through transformative writing. a physician before embarking on professional
St. Cloud, MN: North Star Press.
coaching or psychotherapy.
Historical Context
POSITIVE PSYCHOLOGY Positive psychology or well-being is a subdiscipline
of psychology that was created in 1998. It is also
Positive psychology or well-being, an integrative an interdisciplinary field of study created at the
approach to therapy, can be defined as the science same time and studied by researchers in many
of the study and promotion of happiness, meaning, other disciplines such as medicine, economics, and
and strengths. The study of happiness includes sociology. Well-being is the preferred term here
basic research on who is happy and why. This because it is interdisciplinary and, therefore,
research centers on individuals and entire coun- encompasses any and all academic disciplines
tries as researchers identify the happiest countries studying the topic of happiness.
in the world. Positive psychologists argue that we Both the interdisciplinary discipline and the sub-
should assess “gross happiness level” along with discipline of psychology known as positive psychol-
gross national product or wealth to see whether a ogy or well-being were created in 1998 by Marty
country is truly successful. Seligman as part of his tenure as president of the
The promotion of happiness refers to positive American Psychological Association. Seligman
psychology interventions or treatments designed to thought that the discipline of psychology had been
help people build happier and more meaningful hijacked by the field of abnormal psychology from
lives. These interventions are called psychotherapy the end of World War II in 1945 to 1998 in so far
treatments if applied to clients with a serious and as it focused primarily on what was wrong with
diagnosable mental disorder or psychological dis- people instead of focusing on what was right—that
turbance. Well-being treatments are often added to is, human strengths and happiness. The aftermath
existing treatments like cognitive-behavioral ther- of the war, including the return of the veterans,
apy to make the treatment stronger or to prevent many of whom were psychologically distressed,
relapse once the treatment is over. This application had brought a new focus on and government fund-
has been pioneered in the field by Giovanni Fava ing for the treatment of mental disorders. For
and Michael B. Frisch. example, the newly created National Institute of
Positive psychology interventions are called Mental Health and the Department of Veterans
coaching interventions (and not therapy or treat- Affairs health care system almost single-handedly
ments) if applied to clients who want to be happier encouraged and funded the profession of clinical
or more successful in life but who do not have a psychology for many decades after the war. President
serious and diagnosable mental disorder or psy- Kennedy’s 1963 initiative to establish community
chological disturbance. Treatment clients are best mental health centers, primarily outpatient counsel-
treated by licensed mental health professionals, ing clinics, in cities and towns throughout the

784 Positive Psychology
United States further encouraged a focus on Finally, a few researcher-practitioners, such as

understanding and curing mental disturbance Giovanni Fava, Michael B. Frisch, and Michael
and disability, a new frontier for medical and Fordyce, developed and tested happiness training
psychological science at the time. interventions prior to 1998.
In 1998, Seligman dubbed the new field positive
psychology, a term used earlier by Abraham
Maslow, the humanistic psychology pioneer who
studied genius, happiness, and “self-actualization” The greatest human strength and the desired out-
in an informal way. In sharp contrast to humanis- come or end point in all positive psychology inter-
tic psychology, Seligman insisted that all claims, ventions is what Sonja Lyubomirsky calls “chronic”
theories, tests, and interventions in positive psy- or stable happiness. Happiness consists of three
chology be subjected to rigorous testing, using the elements: (1) high positive affect, (2) low negative
latest procedures and conventions of social and affect, and (3) satisfaction with life or content-
natural science. Only those findings subject to ment. You are considered happy to the extent that
empirical test would find their way into the annals you feel generally satisfied and content with your
of positive psychology, a view that prevails to this life. In addition, positive affective or emotional
day due to Seligman’s indefatigable efforts to build experience should greatly predominate over the
a discipline from the ground up. While some ideas daily experience of negative affects or feelings like
came from humanistic psychologists, the applied depression, anger, or anxiety (although even the
or interventionist arm of the field quickly morphed very happy will be upset when goal striving is
into a methodological and practical “sister” to blocked or thwarted).
cognitive-behavioral therapy (with basic research To say that positive psychology or well-being is
under the umbrella of social and personality psy- a science means that it conforms to the standards
chology). Interventions are called skills training of science followed by other subfields of psychol-
and consist of specific thoughts and behaviors that ogy like neuroscience or social psychology. It
are highly reminiscent of cognitive-behavioral means that any claim, theory, or intervention must
therapy. In contrast, the theories are quite diverse be tested using the latest standards of science. For
and are usually an integrative mix of two or more example, according to Seligman, evidence-based
models or schools of psychotherapy. research support or empirical validation is essen-
Philosophical treatments of happiness and the tial for a well-being or positive psychology theory,
good life stretch back in time to at least the 4th intervention, or assessment to be judged viable
century BCE with the ancient Greeks, including the and worthy of widespread application. Indeed,
Epicureans, Stoics, Plato, and Aristotle. Psychology this emphasis and even insistence on empirical
research on happiness, meaning in life, and human validation distinguishes positive psychology or
strength or virtue predates the emergence of posi- well-being from earlier humanistic approaches to
tive psychology as a field, including a seminal human happiness, meaning, and strengths, mak-
review article on subjective well-being written by ing this an integrative approach to therapy. More
Ed Diener in 1984. This article summarized and specifically, Seligman has insisted on randomized
synthesized psychological work to date and moved controlled trials and replication to establish the
the field forward for the next 30 years with specific effectiveness of well-being interventions, includ-
terminology and a clear research agenda. Beginning ing his own positive psychotherapy. To be consid-
in the late 1950s and early 1960s, sociologists, ered evidence based or empirically validated, an
many identified with the Social Indicators intervention must be found superior to a control
Movement, such as Alex Michalos, began to study group in two randomized controlled trials with
the quality of life, well-being, and happiness of at least one trial conducted in an independent
communities and countries as a whole. In the late laboratory—that is, outside the laboratory of ori-
1950s, gerontologists and medical researchers gin (e.g., the author’s lab); this standard holds
began to study the quality of life, happiness, and true for both clinical and coaching interventions
well-being of medical patients and older people. and treatments.

Major Concepts of-life therapy or its companion assessment, the

Quality of Life Inventory. That is, the targets for
Positive psychology textbooks such as Positive
intervention or assessment will consist of only
Psychology: The Science of Happiness and
those areas in the Sweet 16 deemed important to
Flourishing by William Compton and Edward
a particular client.
Hoffman cite four comprehensive theories of well-
being: (1) Seligman’s well-being theory, (2) Frisch’s
quality-of-life therapy, (3) Edward Deci and Deci and Ryan’s Self-Determination Theory
Richard Ryan’s self-determination theory, and In contrast to Frisch’s goals and wishes, Deci
(4) Carol Ryff’s psychological well-being theory. and Ryan’s self-determination theory asserts that
human happiness requires the fulfillment of three
Seligman’s Well-Being or PERMA Theory basic needs:
Seligman’s well-being or PERMA (positive
1. Autonomy, or a sense of freedom to choose
emotion, encouragement, relationships, meaning,
one’s behavior, as in pursuing intrinsic
and achievement) theory posits five constituent
motivations or goals
parts to human well-being. Well-being includes
more than happiness and positive emotion (or the 2. Competence, or a feeling of mastery and self-
p in PERMA). It also includes engagement with the efficacy in controlling one’s internal and
world or frequent high-flow activities; relationships external environment
in which one feels cared for and supported by oth-
3. Relatedness, or a sense of closeness to other
ers; meaning, altruism, or prosocial behavior—that
people and feeling cared for by others
is, involvement in activities and causes beyond indi-
vidual, selfish concerns, which benefit others or Other needs can also be important and
society as a whole; and achievement in some area may vary in their happiness-boosting properties
or areas. depending on an individual’s psychology.
Frisch’s Quality-of-Life Therapy

Ryff’s Psychological Well-Being Theory
Frisch’s quality-of-life therapy is one that
focuses on the pursuit of goals and wishes within Ryff’s psychological well-being theory is a
a set of 16 outlined avenues for achieving happi- theory that identifies six key aspects necessary to
ness. Frisch argues that after temperament, 50% achieving happiness. A sense of well-being—“self-
to 80% of happiness depends on the successful realization”—as well as the ability to function
pursuit of our most cherished needs, goals, and effectively in the world include the following:
wishes, described as the “Sweet 16” areas of life
1. Self-acceptance, or liking oneself, in spite of any
said to make for human happiness in cultures
failings or frailties
around the world. These areas are specifically
defined to allow for easily targeted interventions 2. Positive relations with others
but can be summarized as goals and values that
3. Autonomy, or the ability to direct, determine,
may or may not include the following: spiritual
and regulate the self in the service of goals
life; self-esteem; regard; health; relationships with
that are personally and freely chosen, which
friends; relationships with lovers, partners, or
also includes the ability to resist outside
spouses; relationships with children; relationships
pressure to do the bidding of others when this
with relatives; work and retirement; play or recre-
is contrary to one’s personal or intrinsic
ation; helping; altruism or prosocial activities;
motivation
learning; creativity; money or standard of living;
and surroundings (i.e., home, neighborhood, and 4. Environmental mastery, or the ability to find,
community). Only areas of life that are valued as choose, and create environments that fit our
important to the client are considered in quality- unique abilities and goals

786 Positive Psychology
5. Purpose in life, or the fashioning of personal and at all possible times—at home, with family
goals that give one’s life a sense of direction, and friends, in hobbies, at work, and in retire-
meaning, and purpose ment—in order to maximize our happiness and
life satisfaction. While affect is often neutral or
6. Personal growth, or the realization of one’s
absent during flow activities, it is decidedly
personal potential in a lifelong process of
positive after such activities.
learning and growth
Techniques Apply Strengths to Goals and Flow
Four well-being interventions have been found to In this technique, counselors ask clients to
be useful to clinicians and coaches: (1) assess the identify big and little things that they are good at
positive, (2) maximize the time in flow, (3) apply and that people like about them. Next, the coun-
strengths to the goals and flow, and (4) the Five selor urges clients to take pride in these strengths,
Paths to Happiness. Each is described in the talents, and (positive) traits and to use them to
following subsections. achieve their goals, such as when clients use their
excellent conversational skills to make new
friends or to ask for help with a favorite hobby.
Assess the Positive Strengths and talents can also be clues to what
Evidence-based well-being assessments are con- activities are flow activities for clients; clients’
ducted before, during, and after therapy to assess time spent on flow activities should be maximized
an entire new realm of human functioning ignored each day.
in the past, including positive affect, life satisfac-
tion or contentment, and clients’ strengths. This Five Paths to Happiness
testing is seen as an alternative to or supplement of
traditional psychological assessments of negative The Five Paths to Happiness, or CASIO, tech-
affect or feelings, negative symptoms, and mental nique supports clients in solving their problems
disorders. Figure 1 displays the results of positive and boosting their satisfaction with any area of life,
mental health testing using the evidence-based such as love, work, or play, by applying one of
Quality of Life Inventory. five strategies or paths, represented by the CASIO
The Quality of Life Inventory assesses overall acronym (circumstances, attitude, standards,
satisfaction with life and meaning and explains it in important, and other). Thus, the counselor may tell
terms of a satisfaction profile similar to a Minnesota clients to boost happiness in an area like work by
Multiphasic Personality Inventory-2 profile of (a) changing their circumstances or situation by
negative mental health. Because clients’ overall asking themselves, “What do I want?” and “How
contentment is made up of the sum of satisfactions can I get it?” or “How can I change my behavior or
in specific profile areas of life, interventions are the situation to make it better?”; (b) changing their
“prescribed” for areas of unhappiness (as well as attitude by getting all the facts, finding a better way
for other positive personal goals). Boosting satis- to look at the problem, and seeing themselves sur-
faction in these areas of unfulfillment will, there- vive and thrive eventually, even if the worst hap-
fore, increase overall happiness and quality of life. pens; (c) setting more realistic but challenging goals
and standards for being satisfied in the area of
concern; (d) emphasizing what is most important
Maximize Time in Flow
and controllable in the area; and (e) boosting satis-
A flow is an activity that requires our total faction in other areas of life that they care about
attention; we are not distracted by other worries even though they are not areas of concern.
or concerns. A flow is an activity with a definite
challenge that requires us to use our maximum
Therapeutic Process
skill, as in reading a book written at or just
slightly above our reading level. As much as pos- The therapeutic process will differ from one client
sible, we want to find out our flow activities and to the next, depending on whether the case is a
carry out these flow activities in all spheres of life coaching or therapy case. In therapy cases, positive

(Raw Score: 1.2)

Overall Quality of Life
T Score: 39
(%ile Score: 16) VERY LOW LOW AVERAGE HIGH
0 37 43 58 77
Weighted Satisfaction Profile

DISSATISFACTION SATISFACTION
–6 –4 –3 –2 –1 0 1 2 3 4 6
Health Health
Self-Esteem Self-Esteem
Goals-&-Values Goals-&-Values
Money Money
Work Work
Play Play
Learning Learning
Creativity Creativity
Helping Helping
Love Love
Friends Friends
Children Children
Relatives Relatives
Home Home
Neighborhood Neighborhood
Community Community
–6 –4 –3 –2 –1 0 1 2 3 4 6
Figure 1 Quality of Life Inventory Profile at Start of Therapy or Coaching

Source: Excerpt from Client Online Profile Report. Copyright 1994, 2014 by Michael B. Frisch and Pearson Assessments.
All rights reserved.
psychology assessments or interventions are of termination to prevent relapse. In contrast,

typically added to the usual therapy regimen used coaching cases consist of positive psychology
by a clinician for a specific Diagnostic and assessments or interventions alone.
Statistical Manual of Mental Disorders (fifth edi-
Michael B. Frisch
tion) disorder like depression, anxiety, or bulimia.
For example, a well-being assessment may be See also Beck, Aaron T.; Existential-Humanistic
added to a traditional assessment to develop posi- Therapies: Overview; Maslow, Abraham; Maslow’s
tive goals for clients, something Aaron T. Beck Hierarchy of Needs; Possibility Therapy; Seligman,
describes as essential for lasting change in psycho- Martin; Solution-Focused Brief Therapy; Wellness
therapy. Interventions may also be included as part Therapy

788 Possibility Therapy
Further Readings and therapy. It stands on two principles:

Compton, W. C., & Hoffman, E. (2013). Positive
(1) acknowledgment and (2) possibility.
psychology: The science of happiness and flourishing The premise of Possibility Therapy is that peo-
(2nd ed.). Belmont, CA: Wadsworth, Cengage ple get stuck at some point in their lives in one or
Learning. more areas: cognitively, emotionally, perceptually,
Diener, E., & Biswas-Diener, R. (2008). The science of neurologically, physiologically, behaviorally, or
optimal happiness. Boston, MA: Blackwell. relationally. Those stuck places create suffering for
Fredrickson, B. (2013). Love 2.0: Finding happiness and the person and others around them. Thus, the goal
health in moments of connection. New York, NY: of Possibility Therapy is to get people unstuck as
Hudson Street Press/Penguin. quickly as possible and to relieve their suffering. It
Frisch, M. B. (2013). Evidence-based well-being/ is light on theory and heavy on method.
positive psychology assessment and intervention
with quality of life therapy and coaching and the
Quality of Life Inventory (QOLI). Social Indicators
Historical Context
Research, 114, 193–227. doi:1007/s11205-012- Although the approach was developed in the
0140-7 1990s, many of its ideas are rooted in theories
Frisch, M. B., Clark, M. P., Rouse, S. V., Rudd, M. D., that came before it. For instance, its focus on
Paweleck, J., & Greenstone, A. (2005). Predictive and acknowledgment is derived from a strong empha-
treatment validity of life satisfaction and the Quality sis on validation and acceptance of clients, similar
of Life Inventory. Assessment, 12(1), 66–78. to unconditional positive regard found in person-
doi:10.1177/1073191104268006 centered counseling. From social construction-
Kashdan, T. B., & Ciarrochi, J. (2013). Mindfulness,
ism, it derives a sense of skepticism of fixed
acceptance, and positive psychology: The seven
states, traits, diagnoses, and experiences. The use
foundations of well-being. Oakland, CA:
of storytelling, the nonconscious change methods,
New Harbinger.
and its future orientation are derived from the
Layous, K., Chancellor, J., & Lyubomirsky, S. (2014).
Positive activities as protective factors against mental
work of the psychiatrist Milton H. Erickson. Its
health conditions. Journal of Abnormal Psychology,
emphasis on finding and expending strengths,
123, 3–12. doi:10.1037/a0034709 previous solutions, exceptions, and abilities is
Lyubomirsky, S. (2013). The myths of happiness. from solution-oriented counseling and therapy
New York, NY: Penguin Press HC. approaches. Finally, its emphasis on client exper-
Rashid, T., & Seligman, M. (2014). Positive tise and collaboration derives from collaborative,
psychotherapy. In R. J. Corsini & D. Wedding (Eds.), strengths-based approaches to change.
Current psychotherapies (10th ed., pp. 461–498).
Belmont, CA: Brooks/Cole, Cengage Learning.
Rodrigue, J. R., Mandelbrot, D. A., & Pavlakis, M.
(2011). A psychological intervention to improve Possibility Therapy does not orient to pathology
quality of life and reduce psychological distress in (what is wrong with, damaged, or deficient in the
adults awaiting kidney transplantation. Nephrology client) or to diagnoses to guide treatment. Influenced
Dialysis Transplantation, 26(2), 709–715. by social constructionism, Possibility Therapy
doi:10.1093/ndt/gfq382 operates under the assumption that emphasizing
Seligman, M. E. P. (2011). Flourish. New York, NY: people’s abilities and hopes elicits a better environ-
Free Press. ment for change than does highlighting and
focusing on people’s failings and flaws.
The approach is also not a normative one.
Except for some broad ethical stances, such as not
POSSIBILITY THERAPY supporting physically harming oneself or others
and not supporting criminal acts, the approach
Possibility Therapy, originated by the psychothera- does not have a model of what is normal, healthy,
pist Bill O’Hanlon in the 1990s, is a present- to or the right way to live or be. Instead, the model
future-oriented approach to change in counseling serves the client by taking seriously what the client

Possibility Therapy 789
says he or she is suffering from and wants to Collaboration

change, without searching for some underlying
Possibility Therapy puts equal weight on client
meaning or theoretical construct to explain the
and therapist expertise. Thus, the therapist is not
client’s experience or behavior.
seen as an aloof expert or the person who “holds
the answer” to the client’s problems. Instead, an
Major Concepts equal relationship is built where the therapist
invites the client to work with him or her. Questions
Seven basic premises drive Possibility Therapy: that a therapist can use to invite collaboration
include the following:
1. People are influenced by their sense of what is
possible for their future. What are you concerned or worried about?
2. People are influenced by their past, thoughts, What would you like to have happen here?
genetics, environments, and feelings, but their
What has been working so far?
actions and the course of their lives are not
necessarily determined by any of these factors. What has been frustrating or difficult in the situation
up to now?
3. People are more likely to cooperate when they
and their feelings and points of view, as well as How have you dealt with that frustration or difficulty
their abilities and strengths, are validated and at your best moments?
respected.
If you could do one small thing that might make a
4. Counselors and therapists can never know the difference, what would that be?
truth about people because they are always
How will you know that things are heading in a
influencing what aspects of that truth get
good or better direction?
spoken and heard.
How will you know when the situation is resolved?
5. No one knows for certain what causes Or at least better enough?
behavioral, psychological, emotional, or
relational problems (although there is no Is there anything you would like me to understand
shortage of people who will claim to know). that you are not sure I have so far?
6. What therapists do in therapy either works or Is this conversation helpful or going in the right
doesn’t. If it doesn’t work, it is best to first try direction?
something different rather than deciding that
the person, couple, or family is unmotivated, If the therapist has a concern or an ethical issue, he
resistant, or unable to change. or she could say, “Here’s what I am concerned
about . . .”
7. There are many pathways to change. No one
technique, method, or philosophy works for
everyone, although, again, there is no shortage Dissolving Impossibility Talk
of people who will profess to know the one It is important for therapists to both acknowl-
right and effective way to help people change. edge and validate clients without closing down the
possibilities of change for them. Too much empha-
sis on change and possibility can give clients the
Techniques
message that the therapist does not understand or
There are many change methods used in Possibility care about their suffering or dilemmas. Too much
Therapy, because it borrows from whatever works emphasis on acknowledgment can give clients the
in other approaches, being nondogmatic as to message that they cannot change or might encour-
theory and method. The following are a few of the age wallowing in the pain and hopelessness. The
more frequently used methods (except when they following methods are designed to combine both
don’t serve to help or validate clients). acknowledgment and invitations to change and

790 Possibility Therapy
possibility. These methods are designed to be motivated away from or want to avoid. Then,
respectful, to deeply empathize with clients’ suffer- the therapist experientially connects clients to
ing, and to evoke possibilities; however, if they are their motivations to bring about change in the
used disrespectfully or superficially, they start to problem situation.
become formulaic.
4. Orient to preferred future and goals: Here, the
therapist finds out what clients want out of
Method 1: Spinning problems into the past. Use
therapy or the minimal change they hope for.
the past tense when people speak about current
Then, the therapist connects clients to hope and
problems or limitations.
futures with possibilities.
Method 2: Modifying generalizations. Respond
5. Elicit solution patterns in the areas of viewing
to generalized statements by restating them with
(point of view, meaning, attribution), doing
slight changes in the quantifiers and qualifiers
(action, interaction, and language), and context:
(e.g., “usually,” instead of “always”).
In this step, the therapist explores exceptions to
Method 3: Spinning reality/truth claims into percep- the problem. He or she explores positive coping
tions. Limitations are often less in reality than in methods and times and tries to find any context
peoples’ perceptions. Reflect limitation statements in which the problem would not occur. In
by inserting perception phrases into them. addition, the therapist finds out where attention
is focused in nonproblem moments or times and
Often Used Techniques identifies any alternate stories or ideas that are
different from typical or problematic stories or
In addition to being collaborative and dissolv- ideas.
ing impossibility talk, the Possibility Therapist
often uses other techniques such as storytelling, 6. Introduce or notice and encourage small
self-disclosure, solution-oriented evocation changes: In this last step, the therapist identifies
questions, hypnosis, and task assignments. anything anyone involved in the problem
situation is willing or able to do to make a
small change in the viewing, doing, or context.
Therapeutic Process Usually, this will involve some rigidly repetitious
The six primary steps in Possibility Therapy are as aspect of the problem situation. It might involve
follows: deliberately taking some action that is part of
the solution patterns evoked or identified.
1. Create an atmosphere of change and possibility:
Here the therapist uses possibility language, Typically, if a therapist uses these steps, he or
assumes change can happen, and does not she will notice relatively quickly that the client
assume that the client is irrevocably damaged or begins to shift from talking about problems, revis-
pathological. iting the past, and complaining about suffering to
talking about the present and the future and the
2. Acknowledge pain, suffering, problems, possibilities for change.
explanations, feelings, and points of view while
keeping possibilities for change open: In this Bill O’Hanlon
step, the therapist validates the client’s current
reality without assuming that things will stay See also Ericksonian Therapy; Person-Centered
Counseling; Solution-Focused Brief Therapy
the same. He or she also listens without trying
to make things more positive than they seem to
the client. Further Readings
3. Connect with or evoke motivation: In this step, O’Hanlon, B. (2003). A guide to inclusive therapy.
the therapist reflects about the people involved New York, NY: W. W. Norton.
in the problem situation and considers what O’Hanlon, B. (2006). Change 101. New York, NY:
they are motivated for and what they are W. W. Norton.

Postural Integration 791
O’Hanlon, B., & Beadle, S. (1998). A guide to possibility More recently, a number of members of the
land. New York, NY: W. W. Norton. International Council of PsychoCorporal (Bodymind)
O’Hanlon, B., & Bertolino, B. (1998). Invitation to Integration Trainers, who were both PI trainers and
possibility-land: A teaching seminar with Bill psychotherapists, developed Psychotherapeutic
O’Hanlon. Philadelphia, PA: Brunner/Mazel. Postural Integration, which places PI within a more
O’Hanlon, S., & Bertolino, B. (1999). Evolving explicit psychotherapy framework.
possibilities: B. O’Hanlon’s selected papers.
Philadelphia, PA: Brunner/Mazel.
Based on neo-Reichian approaches to psycho-
therapy and personal development, one of the
POSTURAL INTEGRATION foundational principles of PI is that the patterns
of muscular tension that form an individual’s
Postural Integration (PI) is a process-oriented habitual posture not only reflect repressed emo-
somatic therapy that employs manipulative body- tions but also are the mechanism through which
work integrated with a variety of other techniques, emotions are repressed. PI works with an inte-
derived principally from Gestalt therapy, bioener- grated approach of hands-on bodywork (in the
getics, and Reichian psychotherapy, to facilitate form of targeted deep tissue massage) while
the client’s process of holistic change. It is not simultaneously encouraging cognitive awareness
directly presented as a psychotherapy but rather as (mindfulness) and emotional expression and
a mode of self-experienced exploration in which release.
the practitioner supports and facilitates the client’s The therapeutic relationship is arguably more
process of change. Thus, PI does not attempt to critical in PI than in most other therapies. The issue
diagnose or pathologize (except to the extent that of the client’s trust in the therapist regarding emo-
character structures are recognized); the desired tional safety extends not only to the psychological
outcome is the client’s own sense of positive but also to the physical. Bodywork in PI is usually
change, greater self-integrity, and an enhanced performed with the client at least partially and per-
capacity to feel and express. haps fully unclothed. The client is in the therapist’s
hands literally as well as metaphorically, with all the
Historical Context vulnerability that this implies. The practitioner
therefore needs exceptional skill in setting and hold-
PI was developed in the 1970s by Jack Painter, ing appropriate boundaries and in communicating
former professor of philosophy at the University of nonjudgmental acceptance.
Miami. In the 1960s, with the burgeoning human
potential movement, he experienced various forms
of therapy in his own process of personal develop- Major Concepts
ment, including Rolfing, Characteranalytical PI grew out of humanistic psychology and the
Vegetotherapy, Reichian psychotherapy, and human potential movement. Practitioners of this
Gestalt therapy, as well as many other practices therapy tend to be person centered and with a
from Asian cultures, such as acupuncture, Zen, commitment to self-direction, authenticity, and
and yoga. Aware of both the benefits and the self-actualization.
limitations of the therapies he had personally
undertaken, he became interested in developing a
Bodymind
coherent method that integrated the most effective
aspects of these approaches. He began developing Bodymind is a term from humanistic psychol-
his own style of “deep, wholistic bodywork,” ogy that proposes an alternative to Cartesian
which ultimately he refined as PI; he founded the mind–body dualism. Bodymind refers to a unified
International Centre for Release and Integration system in which mind, body, and spirit are dynam-
and began promoting and training others in this ically interrelated and changes in one area
new approach. propagate throughout the whole system.

792 Postural Integration
Body Armor altering the pattern, often assisted by work on the

musculature of the rib cage and diaphragm.
Body armor may be thought of as chronic
muscular tension that is the physical manifestation
of psychological repression. By hardening and Contact
desensitizing areas of the body, unwanted feelings
PI operates at the contact boundary (a term
may be controlled or excluded from conscious
from Gestalt therapy): the place where the client
awareness—for example, deep pelvic tension to
and the practitioner literally touch and also bring
both minimize and avoid awareness of sexual
awareness to the subjective experience of that
excitation.
touch (physical, emotional, and psychological
reactions). In this, the practitioner may act as both
Character Structures a focus and a catalyst for the client; the nature of
the practitioner’s contact in an armored body area
In a development of Wilhelm Reich’s and other
(e.g., persistent, nurturing, or provocative) encour-
psychoanalytical theories of character, Alexander
ages the client to shift from the simple perception
Lowen’s bioenergetics proposed a character typol-
of sensation to a deeper awareness.
ogy in which psychological character types are
associated with certain patterns of body armor.
A character structure is thus an organized system Therapeutic Process
of psychological and physical defenses whose aim
is the security and survival of the individual. Sessions may be between 1 and 2 hours in length.
The basic format of a session is an initial body
reading in which both the client and the practitio-
Techniques ner focus on the patterns of muscular holding
PI works with the bodymind. The primary aim of currently present; this may be followed by bioener-
the practitioner is to soften and release body getic movement exercises aimed at both increasing
armor, both as an end in itself and to assist the cli- client awareness and preparing the body for touch,
ent to connect with the emotional dimension of the and breathwork; next comes the hands-on work of
armor and, in a more psychotherapeutic mode, deep tissue massage, during which there may be a
become aware of its psychological origin. PI works Gestalt dialogue, in which a client has a conversa-
on many levels at the same time: physical, cognition with a part of self or with imagined others to
tive, emotional, energetic, and relational. address unfinished business. This leads to an emo-
tional release. Last, there is a final body reading to
help the client notice the change that has occurred.
Deep Tissue Massage Both the client and the practitioner are very active
Slow and deep tissue massage is used to soften and engaged in a creative shared dialogue about
and release body armor, working especially on the what is felt, sensed, and thought.
myofascial structures. The sessions are cumulative and progressive,
producing a controlled softening of body armor,
which allows the client to restructure the
Gestalt Therapy bodymind into a more effective way of being.
PI emphasizes the importance of good contact, There is a formal sequence of 10 sessions, start-
here-and-now awareness, emotional expression, ing at the extremities (hands and feet) and working
and dialogue between conflicting emotions. toward the core, covering the entire body, and end-
ing with a final whole-body “tuning.” In practice,
most clients will need certain steps to be repeated,
Reichian Breathwork
as later stages addressing deeper layers of the mus-
The practitioner will draw attention to the cli- culature can only be undertaken if the superficial
ent’s style of breathing: any patterns of overbreath- layers have softened sufficiently to allow access.
ing or underbreathing and the degrees of chest and The number of sessions also depends greatly on the
belly breathing. The client will be invited to try client’s self-awareness and ability to engage with

Prayer and Affirmations 793
the process, as well as the establishment of a often seen as lying beyond the scope of the
therapeutic relationship that contains a very high counseling professional. However, with research
level of trust. and U.S. census trend data revealing that a majority
of individuals (between 70% and 95%) view faith
Richard Lawton as an integral part of their identity and thus as an
important resource in recovery and well-being, it
See also Bioenergetic Analysis; Gestalt Therapy; Rolfing
has become evident that faith-related counseling
skills, such as the use of prayer and affirmations,
Further Readings are important to the counseling relationship.
Erken, R., & Schlage, B. (Eds.). (2012). Transformation of
the self with bodymind integration: Postural Theoretical Underpinnings
integration—energetic integration—psychotherapeutic
postural integration. Berlin, Germany: Holzinger. Prayer and affirmations involve diverse belief
Lowen, A. (1958). The language of the body. New York, systems and practices of individuals. These prac-
NY: Macmillan. tices may or may not include a deity, and there may
Painter, J. W. (1986). Deep bodywork and personal be rules or guidelines for the practice. Even within
development: Harmonizing our bodies, emotions and religious traditions, there can be great differences
thoughts. Mill Valley, CA: Bodymind Books. among individuals in how they choose to pray or
Painter, J. W. (1987). Technical manual of deep wholistic affirm their beliefs.
bodywork: Postural integration. Mill Valley, CA: Even though prayer and affirmations are varied,
Bodymind Books. they have been associated with many positive out-
Reich, W. (1972). Character analysis (3rd ed.; comes, such as recovery from addiction, enhanced
F. R. Carfagno, Trans.). New York, NY: Macmillan. pain management, stress reduction, and optimism.
(Original work published 1933) Recovery programs for addiction often utilize a
12-step model that stresses releasing control to
one’s higher power, whether a religious figure or
another symbol of strength that exists outside of
PRAYER AND AFFIRMATIONS the individual. Releasing full control of one’s cir-
cumstances can have the effect of instilling hope
Prayer and affirmations can be spiritual and/or and reducing guilt and negative self-talk. Prayer
religious in nature and are often associated with that has a foundation in a religious or faith tradi-
successful coping, recovery, and optimism. As tion can also provide clients with a sense that they
counselors learn to integrate the client’s faith prac- are not isolated in their struggle and that their
tices more fully within their counseling interven- higher power has a greater purpose for their lives.
tions, prayer and affirmations to a higher power Affirmations can also serve as meditative remind-
have emerged as techniques that can be highly ers of a client’s belief system, allowing the client to
effective if incorporated appropriately. step back and gain a broader perspective on his or
her circumstances.
Historical Context
Counseling theory has been neutral toward Major Concepts
religion over the years. For instance, Sigmund The following sections briefly describe prayer
Freud (1856–1939) suggested that religion hides and affirmations and then offer some ethical
the reality of life, and the cognitive therapist Albert considerations as to when one might use them.
Ellis (1913–2007) suggested that religion often
was the source of the development of dogmatic
Prayer
thinking. Because a number of major theorists
viewed religion in this negative context, counseling The act of prayer involves the intent to commu-
has traditionally held a predominately secular ori- nicate with, petition, and/or establish a meaningful
entation, with spiritual and religious concerns relationship with a higher power. It can be done

794 Prayer and Affirmations
privately or with others, spoken aloud or through universal experience, nor should they implement
silent meditation. There are various types of prayer, prayer in session without first understanding the
including the following: client’s beliefs. In some cases, prayer or affirmations
may be unwise to pursue with a client, particularly
Adoration: Worship and celebration of the higher if the client is a member of a cult, if the client
power associates his or her faith with condemnation or
Confession: Asking for forgiveness of transgressions
fear, or if there is significant psychopathology.
Additionally, counselors should be aware of their
Thanksgiving: Acknowledgment of positive events, own motives for including prayer or affirmations
circumstances, and blessings and extension of grati- in counseling. These techniques should only be
tude to the higher power used if they are consistent with the client’s belief
Supplication: Asking the higher power to intervene
system and should not be integrated based on the
in one’s life
counselor’s own agenda or faith tradition.
Reception: Clearing the mind and listening to gain

insight from a higher power—similar to meditation
Techniques
Prayer and affirmations can be included in
Obligatory: Specific words to pray or designated
counseling in a variety of ways. Counselors can
times of the day when prayer should occur
pray on their own asking for guidance before a ses-
Some research suggests that prayers of thanks- sion. Clients who view prayer as a personal
giving, reception, and adoration have positive resource can also be encouraged to utilize prayer
effects on well-being and optimism, whereas outside the counseling session. Occasionally, it may
prayers of confession and supplication may have be appropriate to pray within a session, though it is
less positive effects. recommended that the counselor take the following
steps when incorporating prayer into the session:
Affirmations 1. Assess the client’s belief in the importance of

Affirmations are statements that acknowledge prayer and what the client expects from prayer.
aspects of a higher power. Affirmations can be 2. Consider the potential impact of prayer on the
used in meditative practice as a focusing thought counseling relationship, including power
or as a form of worship and reflection on the differentials that may occur if the client begins
nature of one’s relationship with a higher power. to see the counselor as a spiritual authority.
Examples of affirmations include statements such
as “I am fearfully and wonderfully made,” “God 3. If prayer is included, use it to focus on the
has a plan for me,” or “The universe flows in me counseling process and client goals. Prayers can
and through me.” These affirmations can be reas- highlight client progress, summarize session
suring and can reframe negative or self-defeating content, or request guidance from a higher
thoughts. power to enhance the counseling relationship
and/or the client’s well-being.
Ethical Considerations 4. Encourage the client to lead in-session prayers,

and carefully explore client motivations if he or
Although incorporating prayer and affirmations
she wants the counselor to lead the prayer.
in counseling can be beneficial, there are also ethi-
Counselors can explain that there are many
cal considerations to take into account. To practice
differences in how to pray and that prayer is a
ethically, counselors are advised to assess the
personal act of reflection. Thus, the client
importance of faith as a factor in the client’s life, as
should be seen as the expert on how to pray for
well as the extent to which the client would want
his or her concerns.
to have it included in counseling. Attention should
be given to the client’s beliefs about prayer and/or 5. After the praying, help the client process the
affirmations, including how the client prays. experience and reflect on any feelings or insights
Counselors should not assume that prayer is a elicited from the prayer.

Primal Integration 795
Therapeutic Process from birth, as it attempts to have clients work

through early memories. The intended outcome is
Prayer and affirmations can be positive interven-
for clients to become warmer, more “human,” less
tions to incorporate a client’s faith or belief system
defensive, and more in touch with their real,
in counseling, but it is important for counselors to
authentic selves than they were before entering
acknowledge and control for ethical consider-
therapy.
ations and impacts on the counseling relationship.
Clients may begin to view the counselor as having
a direct link to the higher power, which may lead Historical Context
to dependency on the counselor or unrealistic
Primal integration as a separate approach was cre-
expectations of the change process. Counselors
ated by the staff of the Center for the Whole
who successfully integrate prayer and affirmations
Person in 1962 and later adopted and expanded by
into their practice conduct careful assessment
Frank Lake and William Emerson using ideas from
and research prior to implementing prayer or
Stanislav Grof. Grof’s research, which extended
affirmations in the counseling setting.
over 50 years, examined the nature of memory
Hannah B. Bayne during four stages of birth. Lake, on the other
hand, suggested that there were four levels of
See also Meditation; Mindfulness-Based Stress Reduction; trauma during birth. Lake and Grof eventually
Pastoral Counseling developed a 16-cell matrix derived from the four
stages and the four levels and found many com-
mon syndromes related to the 16 cells.
Further Readings William Swartley, a Canadian psychologist,
Frame, M. W. (2003). Integrating religion and spirituality brought primal integration to Britain in 1978 and
into counseling: A comprehensive approach. Belmont, ran a successful course in London until his death
CA: Brooks/Cole. 2 years later. His work was taken up by Juliana
Juhnke, G. A., Watts, R. E., Guerra, N. S., & Hsieh, P. Brown and Richard Mowbray and still continues
(2009). Using prayer as an intervention with clients today. The International Primal Association has its
who are substance abusing and addicted and who headquarters in the United States and produces
self-identify personal faith in God and prayer as conferences and newsletters that focus on primal
recovery resources. Journal of Addictions & Offender therapy and primal integration.
Counseling, 30, 16–23.
doi:10.1002/j.2161-1874.2009.tb00053.x
Weld, C., & Erikson, K. (2007). The ethics of prayer in Theoretical Underpinnings
counseling. Counseling and Values, 51, 125–138. Primal integration draws on a number of theoreti-
doi:10.1002/j.2161-007X.2007.tb00070.x
cal assumptions. For instance, it draws from Carl
Whittington, B. L., & Scher, S. J. (2010). Prayer and
Jung’s belief that there are mental functions, which
subjective well-being: An examination of six different
include sensing, feeling, thinking, and intuition,
types of prayer. International Journal for the
and it develops methods of working with individu-
Psychology of Religion, 20, 59–68.
als based on each of these functions. In addition,
doi:10.1080/10508610903146316
primal integration draws from the work of Grof,
who suggested that there are four basic perinatal
matrices (BPMs) reflecting the four stages of birth.
Memories from birth, suggested Grof, affect an
PRIMAL INTEGRATION individual as he or she grows into adulthood.
Finally, from Lake, a British doctor who did
Originating from a critique of Arthur Janov’s work research on individuals who were given LSD, came
on primal therapy, primal integration embraces an examination of trauma, including the trauma of
many of Janov’s concepts, including the emphasis birth. His lengthy case histories established the
on deep feelings and early experiences. A depth four levels of trauma.
therapy, primal integration focuses mostly on Grof and Lake corresponded and worked out a
trauma, including perinatal trauma and trauma 16-cell matrix derived from the four stages and the

796 Primal Integration
four levels. They found that many common syn- ceremonies and the like may be experienced. BPM
dromes can be traced to at least one of these 4 is the emergence from the womb, including the
16 cells. Case studies by Grof and Lake seem to cutting of the umbilical cord, and may be experi-
validate their initial research. enced as a triumph or a disaster. Although doubt
has been cast on the accuracy of these memories, it
is important to realize that to go back this far can
Major Concepts only be done through reliving, not through ordi-
Primal integration is focused on Jung’s mental nary recall.
functions, Grof’s stages of birth, and Lake’s work
on levels of trauma and early memories. Levels of Trauma
Lake’s work on trauma suggests that there are
Jung’s Mental Functions four levels, from no trauma to intense trauma, and
Jung suggested that there are four mental that trauma can occur at any point in one’s life,
functions, and primal integration addresses each of including in the womb. Memories from such early
the client’s functions. In addressing the “sensing trauma are embedded in one’s psyche and body
function,” primal integration focuses on the body and affect the person in unconscious ways. The
and early trauma to the body. One outgrowth is four levels are the following:
the use of bodywork, such as when a client hits
soft objects with a bat, has a whole-body catharsis, Level 1: This level is pain free and need satisfying
and rolls on the floor on mats. To address the “feel- and is considered the ideal state.
ing function,” primal integration focuses on the Level 2: This is when the trauma is bearable, and
here-and-now and the relationship between the even perhaps strengthening, because it evokes effec-
client and the therapist, drawing from humanistic tive and mostly nonneurotic defenses.
theories such as person-centered counseling,
Gestalt therapy, psychodrama, and focusing. With Level 3: During this level, the individual tries to
regard to the “thinking function,” primal integra- oppose the pain. However, because the pain is so
tion has a more psychodynamic focus and draws strong, the individual represses it, or if the person is
on concepts such as transference, countertransfer- an infant, the young child splits off and dissociates
ence, attachment, defenses, internal objects, from the pain.
projective identification, and insight. And for the Level 4: Also called transmarginal stress, this level
“intuitive function,” there is a focus on fantasy, refers to trauma that is so powerful and/or so early
meditation, and enactments, and an interest in that the person cuts himself or herself off from it
previous lives and the subtle body. completely and may even turn against the self, want-
ing to die. Some research suggests that many child
Basic Perinatal Matrices accidents are in fact unconscious attempts at suicide,
based on this fourth level of trauma.
Grof suggested that there are four stages of
birth, or BPMs, each with its own unique contribu-
Memory
tion. BPM 1 is undisturbed life in the womb; this
is usually peaceful, sometimes even ecstatic as an Any approach to therapy that includes the
experience, but it can also be negative, depending trauma of birth has to explain why such memories
on the experiences and moods of the mother. BPM are possible when many suggest that memory can-
2 is the stage where there is immense pressure, but not be retrieved prior to 3 or 4 years of age. Primal
the cervix has not yet opened; this, if prolonged or integration deals with this by suggesting that there
problematic, can be the origin of claustrophobia are four memories: (1) intellectual or cognitive,
and other panicky reactions. BPM 3 is the journey (2) emotional, (3) bodily, and (4) subtle or soul.
down the birth canal; if this is prolonged or Intellectual or cognitive memory is located mostly
obstructed, powerful emotions may be evoked, in the cerebral cortex, and most research focuses
and fantasies of death, terror, explosions, evil on this type of memory. Emotional memory is

Primal Therapy 797
found mainly in the limbic system and takes the See also Analytical Psychology; Body-Oriented Therapies:
form of images rather than words. It is best Overview; Gestalt Therapy; Jung, Carl Gustav;
accessed by reexperiencing the events concerned. It Orgonomy; Person-Centered Counseling;
often resides in our muscles, as Wilhem Reich and Psychodrama; Reich, Wilhelm
other body therapists have discovered. Bodily
memory is held all over the body and can only be Further Readings
uncovered by reexperiencing or reliving it. Graham
Brown, J., & Mowbray, R. (1994). Primal integration.
Farrant calls it cellular memory, and much of the
In D. Jones (Ed.), Innovative therapy: A handbook
primal work in psychotherapy focuses on this level
(pp. 13–27). Buckingham, England: Open University
of memory. Subtle or soul memory is held in the
Press.
body, not in the brain, and it holds memories of Chamberlain, D. (1984). Consciousness at birth: A review
previous lives and of lives lived at other levels of of the empirical evidence. San Diego, CA:
the transpersonal realm. Chamberlain Communications.
Chamberlain, D. (1998). The mind of your newborn
baby. Berkeley, CA: North Atlantic Books.
Techniques
Emerson, W. (1984). Infant and child birth re-facilitation.
Primal integration involves access to a wide range Guildford, England: Institute for Holistic Education.
of techniques. From the sensing function, it draws Fedor-Freybergh, P. G., & Vogel, M. L. V. (1988). Prenatal
on bodywork, reenactments of birth, holotropic and perinatal psychology and medicine: Encounter
breathing, and cathartic expression. From the feel- with the unborn: A comprehensive survey of research
ing function, it draws on existential confrontation, and practice. Nashville, TN: Parthenon.
chairwork, focusing, and psychodramatic enact- Grof, S. (1975). Realms of the human unconscious.
ments. From the thinking function, it employs New York, NY: Viking Press.
insight, exploration of the family of origin, and Lake, F. (1980). Constricted confusion. Oxford, England:
early attachment patterns. And from the intuitive Clinical Theology Association.
function, it draws on guided fantasy, exploration of Rothschild, B. (2000). The body remembers: The
previous lives, and respect for visions, mythology, psychophysiology of trauma and trauma treatment.
New York, NY: W. W. Norton.
and dreams. Thus, primal integration can draw on
Verny, T. (1982). The secret life of the unborn child.
a wide array of techniques as it attempts to help a
London, England: Sphere.
person heal himself or herself of past trauma.
Woolger, R. (1988). Other lives, other selves: A Jungian
psychotherapist discovers past lives. New York, NY:
Therapeutic Process Bantam Books.
Common with other therapies in the humanistic

realm, primal integration focuses on helping the cli-
ent reveal his or her real self and become more
authentic. It assumes that once a person deals with
PRIMAL THERAPY
his or her trauma, his or her true self will emerge, and
the person can become increasingly self-actualized. Primal Theory asserts that unmet needs and unre-
After a person begins primal integration therapy, he solved repressed traumatic incidents from birth,
or she will quickly confront his or her trauma when infancy, and childhood remain in the subconscious
the therapist uses one or more of the many tech- mind and are compounded with subsequent unre-
niques at his or her disposal. These techniques tend solved traumas, layer on layer throughout life,
to lead to a good deal of cathartic work. This may causing physical and emotional pain and repeated
then result in a complete “rebirth,” where every- patterns of dysfunctional behavior. Primal therapy
thing changes. Eventually, the client will become provides a method by which these repressed trau-
warmer, more “human,” less defensive, and more in mas are brought to consciousness, reexperienced
touch with his or her real, authentic self. fully in the present, and transformed into mere
remembered past history that no longer causes
John Rowan suffering.

798 Primal Therapy
Historical Context including rebirthing, regression, and scream

therapy. None were connected to Janov, nor were
Primal therapy is a psychotherapeutic approach to
they related to Primal Theory in theory or method.
healing introduced by the American psychologist
Arthur Janov in the late 1960s. Janov graduated
from the University of California, Los Angeles, and
Claremont Graduate School. He worked at the
Veteran’s Administration Hospital and the Los When the brain becomes overwhelmed with
Angeles Children’s Hospital and was a practicing injurious data (extreme physical or emotional
Freudian psychoanalyst before developing primal pain), it blocks, redirects, and stores the data in the
therapy. subconscious mind. These traumas are individually
According to Janov, during a psychoanalytical called primal scenes and collectively called primal
session, a patient spoke of a disturbing theatrical pain. The beginning of primal pain is often rooted
performance he had seen in which an actor skipped in the birth imprint, the “imprint” made by trauma
around the stage crying and screaming “Mama,” during the birth process. Births that are considered
vomited into a bag, and then invited the audience to normal and nondetrimental by medical and societal
do the same. Acting on intuition, Janov encouraged standards are, in reality, often traumatic. The birth
his patient to call out for his mother in the same experience has an amplified impact because the
manner. The patient started hesitantly but then sud- nervous system of an infant before, during, and
denly began to contort and wail like an infant, cry- shortly after birth is extremely vulnerable and
ing out, “Mama, Mama!” This experience ended highly impressionable. Traumatic birth events are
with a piercing scream. Afterward, the patient said, exceptionally defining because the stakes are so
“I made it! I don’t know what, but I can feel.” high, swaying between life and death. The birth
Intrigued, Janov later suggested to a second patient imprint, embedded deep in the brain and nervous
that he call out for his mother. That patient had a system, is compacted and partially hidden by later
similar experience, reporting that his “whole life developments in the cortex and life experience, but
seemed to have suddenly fallen into place.” Janov it is always the preeminent influence, laying the
named these experiences “primals” and has since foundation, either positive or negative, for the rest
devoted his life to developing primal therapy. He of an individual’s life. It predisposes the develop-
has authored several books, conducts extensive ment of specific defense mechanisms for survival in
research, and trains therapists in his method. an individual’s environment and determines how he
The Primal Scream, published in 1970, was or she will respond to the world. The effects mani-
Janov’s first book. It became a bestseller through- fest both psychologically and physically. If an infant
out the United States and across the Western world has a gentle birth and thereafter remains with his or
following translation into many languages. His her mother and family in a loving environment, the
ideas were new, unique, and resonated with young child’s imprint will be that of feeling loved.
adults who were trying to free themselves from Birth trauma can be greatly mitigated by
what they believed was a cultural emphasis on nurturing parents and supportive extended family
superficial appearances, hypocritical social behav- members. If children are allowed to express their
ior, and suppressed emotions. The book title natural and organic needs and the needs are met,
became a pop culture phrase, and Janov became a they are likely to grow into happy, content, and
media personality after a number of celebrities healthy adults. For example, when an infant asks
(notably Dyan Cannon, James Earl Jones, John for attention by crying and is picked up immedi-
Lennon, Yoko Ono, and Roger Williams) were ately by its caregiver and then fed and cuddled in
vocal about their experiences in primal therapy. close mutual gentle embrace with eyes meeting, it
John Lennon’s album Plastic Ono Band contains stops crying because its needs are met and it bonds
many songs he wrote during and after his experi- with the caregiver. Too often, however, infants are
ence with primal therapy. separated from their mothers shortly after birth,
Several therapies inspired by Primal Theory they are fed on schedules, and parents are taught
sprang up and enjoyed some brief popularity, that if they pick up infants immediately after they

Primal Therapy 799
begin to cry, they are “spoiling” them. Such treat- profound transformations some describe after
ment, though “normal,” is not natural. In fact, having experienced a near-death experience.
Primal Theory asserts the opposite: True “spoiling”
is giving what is not needed (usually material
Major Concepts
things) while giving very little of what is needed
(nurturing and time). There can be no excess of The major concepts in primal therapy include
healthy attention and nurturing. primal pain and the birth imprint, as discussed in
As parents become overwhelmed with increas- the previous section, as well as causes to symp-
ing responsibilities, children are sometimes treated toms, and feeling, which are discussed in this
as burdens rather than blessings. Even the most section. To conclude this section, an example of a
well-meaning parents may ignore, shame, or primal experience is presented.
actively punish children for needing to be held
close, for needing their full attention, or for want- Causes to Symptoms
ing to be more active than the parent has the time
or inclination for. Parents may also unconsciously According to Primal Theory, primal therapy
use their children to act out their unmet needs, works from causes to symptoms rather than from
driven by their own birth imprints. Children are symptoms to causes, going much deeper and
forced to conform their behavior to parental needs resulting in a more thorough healing than possible
rather than to their own developmental needs. with other approaches. Primal therapy emphasizes
When children reach adolescence, they are that when excessive trauma is experienced in
inclined to look elsewhere for warmth and accep- utero, during a difficult birth, or in infancy, it can
tance, choosing equally deprived friends, with reach life-threatening intensity. For the infant to
whom they engage in destructive behaviors such as survive, memories of such traumas are repressed,
indiscriminate drug use, alcohol, and sexual encoun- but they leave a profound and lasting birth imprint.
ters. These behaviors often continue into adulthood The birth imprint, compounded by further child-
and are defended as “just having fun.” In reality, hood trauma, causes primal pain. During a primal
“act-outs” (unconscious or semiconscious symbolic therapy session, when a patient experiences a full
“primal,” or complete “feeling,” the repressed
re-creations of unresolved traumas or repressed
memory (a primal scene) emerges to consciousness
primal scenes) are desperate attempts to intimately
and is experienced safely with full expression of
relate to others and to reduce emotional suffering.
any and all associated emotions, such as anger,
They are driven by deep pain, not by conscious
fear, terror, loss, and the need that could not be
choice. Acting-out can lead to temporary feelings of
expressed at the time of the original trauma.
relief, but because it does not allow one to make
real connections with the causative trauma, there is
no resolution, and the suffering continues. Feeling
When real needs are not met, the “Real Self” is The act of “feeling” (primaling) is reacting con-
also denied. The Real Self still exists and is always sciously and fully to a formerly repressed trau-
pushing to have its needs met, no matter how matic memory (i.e., a primal scene) and connecting
daunting the task. It will even settle for harmful it to the present dysfunctional behavior, thereby
attention (e.g., anger or rage) because any attention resolving the original pain. It allows the body to
is better than none at all. Hence, parents are often respond naturally to a repressed memory that has
perplexed when children “never learn” and always emerged to consciousness. Healing takes place
seem to “demand” attention by being “bad.” during and after a full primal, and the acting-out
Primaling allows the individual to experience the connected to the healed trauma ceases.
“finite pain” of repressed scenes that caused years
of suffering and, finally, satisfy the original unmet
A Primal Experience
needs. The effects of having a completed primal
compare with having chronic physical wounds One patient was shocked during a primal to
cleaned, sutured, and healed, and are often like the suddenly feel the sharp cutting sensations of his

800 Primal Therapy
infant circumcision. For several weeks before, he they inevitably “trigger” (act as catalysts for)
had found that vocalizing the words “Mama, memories of much earlier or deeper unresolved
help!” or just “Mama!” transported him to memo- traumas. Therapists listen for emotional signs
ries of desperately crying out for his mother as a (e.g., anger, tears, nervous laughter) that may
baby. Until this session, he had no idea what the denote feelings “on the rise.” Therapists “follow”
emergency was. His cries of “Mama” at one point patients as they reexperience each scene, support-
suddenly stopped, and he felt the need to kick his ing and encouraging them to express the emotions
legs upward, as if to ward something off. This they could not express originally. Intervening only
kicking motion immediately provoked excruciat- if they digress from the current focus of feeling,
ing sensations of cutting around the shaft of his therapists keep patients “on track,” ensuring full
penis. After the session, the physical pain of the expression of experiences in the present while
memory subsided, but there was no immediate encouraging access to older memories and feelings
emotional resolution. In subsequent days and as they arise naturally. When patients talk “about”
weeks, however, without any conscious effort, he incidents, they are encouraged to speak directly to
experienced a flood of vivid recollections of long- the person or persons involved, as this brings the
forgotten sensations of embarrassment, shame, scenes into greater vividness, resulting in complete
and shyness associated with sex, dating, and mar- resolution.
riage. These painful memories emerged after his
circumcision primal because they had always been
Therapeutic Process
linked unconsciously to that preverbal trauma.
After a few months, a change gradually took place, Primal therapy typically begins with a 3-week-long
and he was able to have intercourse without expe- “intensive” period (although some independent
riencing the anxiety associated with intimacy that primal therapists require an intensive period of
had bothered him since puberty. only 1 or 2 weeks), during which the patient meets
After a completed primal, as the body realigns with a therapist daily for open-ended sessions (no
and balances, there is a conscious realization that time limit). The patient otherwise isolates himself
the suffering previously related to that primal or herself in a motel room, abstaining from dis-
scene is entirely gone. Spontaneous cascading tractions such as reading, television, or phone
memories are released from multiple phases of calls. After the intensive period, the patient has
one’s life over days and sometimes even weeks—all open-ended sessions once or twice weekly and
related to that primal scene—that play a powerful attends group sessions to begin interaction with
role in creating an awesome effect of understand- other patients. As patients make progress, they
ing without thinking. There is profound clarity and attend groups and learn to “buddy” (have primal
integration of a vital aspect of life that was sessions with other patients), eventually eliminat-
formerly unknown or distorted. The torment ing the need for a therapist unless crises arise.
resulting from that particular primal scene is now Patients may also participate later in therapist-led
integrated and resolved, and life feels infinitely primal retreats.
more valuable than before. The intensive phase and early sessions with a
knowledgeable therapist are critical to learn how
to address primal scenes effectively, to express the
Techniques
feelings associated with repressed memories com-
A patient’s temperature and pulse may be taken pletely, and to effect permanent changes. As
before and after a session to compare pre- and patients learn how to recognize triggers that indi-
postprimal vital signs. Sessions are conducted in cate emerging primal scenes, instead of ignoring or
rooms with soft lighting. Patients lie on a mat. acting out, they proactively choose to “feel” the
Therapists sit beside them as patients state what is original pain.
currently on their minds, such as intrusive disqui- Formal primal therapy typically lasts about a
eting thoughts, uncomfortable bodily sensations, year, although if patients have strong personal sup-
or inexplicable sadness in their present life. As port systems—spouses, close friends, secure jobs,
these present-day incidents are fully addressed, and so on—formal therapy length may be reduced.

Process Groups 801
Because sexuality is an element of everyone’s Janov, A. (2000). The biology of love. Amherst, NY:
core being, many enter primal therapy with sex- Prometheus Books.
ual concerns. Changes occur naturally and organ- Janov, A. (2011). Life before birth: The hidden script that
ically as the feeling process connects traumas of rules our lives. Chicago, IL: NTI Upstream.
the past with present-day suffering, resulting in Reese, R. (1988). Healing fits: The cure of an epileptic.
patients becoming healthier overall. There is no Los Angeles, CA: Big Sky Press.
active “reparative” endeavor to alter orientation
or inclination. As the Real Self emerges, individ-
ual sexuality falls clearly and comfortably into
place. PROCESS GROUPS
Primaling creates a change in attitude and
behavior that heals beyond intellectual insight. As The process group is an experiential approach to
one learns to recognize the memories emerging learning about group dynamics. In process groups,
from the subconscious mind, it becomes second usually 8 to 15 individuals sit in a circle and talk
nature to confront and reexperience unresolved with one another, most often with the assistance of
traumas. Resolution takes place, individuals a leader or a consultant. In addition to learning
become healthier, and the journey continues about group dynamics, often process group
throughout life. participants develop an understanding of their
Over time, many therapists have expanded interpersonal patterns, communication styles,
treatment approaches to include practical skills. and characteristics of personal and professional
These skills, simultaneous with the primal process, development. Currently, many clinical training
include making changes in diet and exercise and programs use process groups to teach group psy-
attending parenting or couple sessions. Patients chotherapy to trainees and to offer support and
are encouraged to become actively responsible personal growth opportunities. Similarly, modern
to themselves and others. This can create a organizations and businesses use process group
more immediately rewarding quality of life and models to help employees better understand group
provide triggers for critical memories, which often dynamics and gain insight into their management
accelerate therapeutic changes. and leadership styles. Industrial and organizational
psychology uses process consultations, developed
Frances Rinaldo by Edgar Schein to understand organizational
dynamics that may be affecting productivity,
See also Primal Integration
morale, communication, and structural issues.
Further Readings
Historical Context
Alexander, T. S. (1996). Facing the wolf: Inside the
In the late 19th century, the German psychologists
process of deep feeling therapy. New York, NY:
Wilhelm Wundt and Émile Durkheim sought to
Dutton.
understand human behavior through the analysis
Howes, R. (2010, February). In therapy. Psychology
Today. Retrieved from http://www.psychologytoday
of the collective rather than the individual. In
.com/blog/in-therapy/201002/cool-intervention-
1943, the German Gestalt psychologist Kurt Lewin
3-primal-therapy coined the term group dynamics to reflect the flow
Janov, A. (1970). The primal scream. New York, NY: and variety of behaviors group members experi-
Putnam. ence while working together. Interest in group
Janov, A. (1972). The primal revolution: Toward a real dynamics accelerated following the atrocities of
world. New York, NY: Simon & Schuster. World War II, as scientists and social theorists
Janov, A. (1983). Imprints: The lifelong effects of the sought to understand how humans could act
birth experience. New York, NY: Perigee Books. with profound cruelty and obedience, on the one
Janov, A. (1996). Why you get sick, how you get well: hand, and incredible self-sacrifice, bravery, and altru-
The healing power of feelings, West Hollywood, CA: ism, on the other. After emigrating from Germany,
Dove Books. Lewin helped set up the Research Center for

802 Process Groups
Group Dynamics at the Massachusetts Institute of experiences enhance and deepen the participants’
Technology and the National Training Laboratories understanding of such dynamics in a much fuller
in Bethel, Maine, to study group dynamics through way than just academic study of similar principles.
observation of unstructured and semistructured
groups. Simultaneously, in England, Wilfred Bion,
Major Concepts
Sigmund Foulkes, and others developed a thera-
peutic community at the Northfield Hospital and Process groups have developed a set of unique
assisted at the Tavistock clinic, where they began approaches to maximize learning from the experi-
holding unstructured group gatherings for the ence. These include set structural elements, a non-
study of group dynamics. Bion’s classic book pathology focus, here-and-now interactions, and
Experiences in Group, published in 1961, emerged having the leader and the members repeatedly
from his Tavistock experience. This text outlined examine and discuss the emerging group processes.
what were in his view the common stances, or
basic assumptions, exhibited in group interaction:
Structural Elements
(a) dependency (looking for the one person, usu-
ally the leader, to provide answers and solve prob- Structural elements refer to the setting, and the
lems), (b) pairing (having two members dominate boundaries, guidelines, and agreements the par-
the group activities), and (c) fight-or-flight (in fight ticipants follow. Process groups have firmly set
mode, the group is marked by aggressiveness and time boundaries as to when each session begins
hostility, and in flight mode, the group avoids the and ends, and participants are expected to attend
work or tasks of the group). he entire process. The leader will often give an
These experiences and experiments set the stage instruction to the group to examine and discuss
for process groups to be used in a variety of set- the unfolding processes of the group. Often all
tings. Through the 1960s and 1970s, experiments members are encouraged to share their experience
in process groups expanded and were widely avail- of the emerging group process, and sometimes the
able in varied forms, including leaderless groups, directive of sharing the talking time between
marathon groups that lasted for days, T-groups members is included. Confidentiality is requested,
(training groups), encounter groups, and human and members are encouraged not to share what
relations groups (which attracted those curious to happens in the group with others in any manner
learn about themselves in relation to others). that would identify other members. The research
Since the 1980s, process groups have become into process groups shows that these groups
increasingly refined for more specific purposes. generally move through certain stages of develop-
Currently, process groups are regularly used to ment, such as Tuckman’s model of forming,
help train clinicians to understand and personally storming, norming, performing, and adjoining,
experience the less apparent dynamics of group and commonly, the group consultant will comment
processes. Process groups have also continued in on the stage of development. Generally, time is
the public sector as established organizations set aside at the end of the group experience for
encourage private individuals to attend process the leader and the members to talk about the
group trainings both to learn more about group group dynamics that occur and to bring cognitive
dynamics and to foster personal growth and learning to the experience.
increased self-awareness.
Nonpathology Focus
The leader focuses on members’ strengths, rela-
Process groups are conducted from the viewpoint tional tendencies, and reactions to the group
that experience is the best teacher. Process group dynamics and avoids using an individual pathol-
participants encounter group dynamic phenom- ogy framework for understanding members.
ena such as the stages of group development, the Likewise, members are also encouraged not to use
formation of cohesion, subgrouping or scapegoat- diagnostic language about themselves or other
ing dynamics, and termination processes. These members as the primary focus is on the group

Process Groups 803
dynamics and personal growth and not on treating current thoughts and feelings. The leader and
the emotional challenges of the members. members reflect on the process and comment on
what is occurring. Common themes explored
include feelings of intimacy or distance, inclusion
Here-and-Now Interactions
or exclusion, being excited and engaged or bored
Process group members are encouraged to and withdrawn, and the projections toward the
share the experiences in the moment, without leader’s competence and care. Often subgroups or
explanations about their own personal history. factions (e.g., demographic variables such as gen-
If a member is feeling happy or frustrated with der balance) are discussed and explored to see their
what is happening in the process, the member is impact on the group’s behavior. The group will
encouraged to share his or her personal experience explore what has happened or has not occurred in
without adding the story of his or her childhood the group to create the myriad thoughts, feelings,
or other outside-the-group information. behaviors, and dynamics. Commonly, during this
process, members may hear feedback about their
communication style, their role in the group, and
Techniques
how they affect others through the process. Process
Process group consultants’ comments are almost group members often report on the experiences
always directed toward the group dynamics and being helpful in areas of personal growth, such as
not toward individual members. Leaders may gaining insight into their relational tendencies and
draw on their training in group theory, social more awareness and confidence in social and
psychology, and/or organizational consulting to group settings. The process group remains
interpret the group dynamics. These interpreta- a unique and focused method of experiential
tions may be descriptive as the leader will discuss learning about group dynamics and oneself.
group stage development or subgroup dynamics as
they appear to be occurring in the group. Other Francis J. Kaklauskas and Elizabeth A. Olson
leaders will use more symbolic or metaphoric
See also Experiential Psychotherapy; Group Counseling
interpretations as they engage the members in
and Psychotherapy Theories: Overview; Tavistock
exploring the unconscious dynamics occurring in Group Training Approach; Training Groups; Yalom,
the group. Examples of leader interventions may Irving
include statements such as “This group seems to
like to focus on problems more than on solutions”
or “The members in this group aren’t sure if they Further Readings
want to be enemies or friends.”
Bion, W. (1961). Experiences in groups. London,
England: Tavistock.
Therapeutic Process Freud, S. (1959). Group psychology and the analysis of
the ego (J. Strachey, Trans.). New York, NY:
The length or the number of meetings of process
W. W. Norton. (Original work published 1922)
groups can vary depending on the setting. Many
Kaklauskas, F. J., & Olson, E. A. (2008). Large group
times, process groups are conducted at conferences
process: Grounding Buddhist and psychological theory
or special events and can last between 12 and in experience. In F. J. Kaklauskas, S. Nimanheminda,
20 hours over the course of 2 or 3 consecutive L. Hoffman, & M. S. Jack (Eds.), Brilliant sanity:
days; many urban areas offer process group expe- Buddhist approaches to psychotherapy (pp. 133–160).
riences that are scheduled once a week for about Colorado Springs, CO: University of the Rockies
90 minutes and last between 3 and 12 months. Press.
One important goal concerning length is for the Le Bon, G. (1920). The crowd: A study of the popular
group to have time to traverse and reflect on the mind. London, England: Ernest Benn. (Original work
stages of group development. published 1895)
The members work to stay in the present Lieberman, M. A., Yalom, I. D., & Miles, M. B. (1973).
moment or the here-and-now of the unfolding Encounter groups: First facts. New York, NY: Basic
group process as they notice and speak of their Books.

804 Process-Oriented Psychology
Nitsun, M. (1996). The anti-group: Destructive forces in relationship life and can even be associated with
the group and their creative potential. London, synchronicities in the client’s world. He termed this
England: Routledge. phenomena dreambody. Mindell used this concep-
Rogers, C. R. (1970). Carl Rogers on encounter groups. tual framework as the basis for facilitating conflict
New York, NY: HarperCollins. and diversity issues in large groups, which he
Schein, E. H. (1998). Process consultation revisited: termed Worldwork.
Building the helping relationship. Boston, MA: In the late 1990s, Mindell incorporated his
Addison Wesley Longman. knowledge of quantum physics into his theory, espe-
Swillel, H. I., Land, E. A., & Halperin, D. A. (1993).
cially quantum wave function, which mathematically
Process groups for training psychiatric residents. In
formulates the patterned behavior of matter. He
A. Alonso & H. L. Swiller (Eds.), Group therapy in
hypothesized that, much like quantum wave func-
clinical practice (pp. 237–254). Washington, DC:
tion, our subtle or sentient experiences form patterns.
American Psychiatric Press.
Tuckman, B. W., & Jensen, M. (1977). Stages of small
group development. Group & Organizational Studies, Theoretical Underpinnings
2, 419–427. doi:10.1177/105960117700200404
Yalom, I., & Leszcz, M. (2005). The theory and practice Mindell’s work was informed by a cross section of
of group psychotherapy (5th ed.). New York, NY: philosophies and paradigms including Jungian and
Basic Books. Gestalt psychologies, indigenous beliefs, Taoism,
sociology, and physics to facilitate the process of
engagement with the disowned or “other/not me”
in the client’s experience. The philosophy underly-
PROCESS THERAPY ing Processwork is that individuals, or groups,
have a preference in how they identify themselves,
See Human Validation Process Model but this sense of self is often challenged by issues
of difference that appear within themselves, their
relationships, or their communities.
Processwork holds many of the humanistic and
PROCESS-ORIENTED PSYCHOLOGY transpersonal values, embracing a deep value and
belief in the person and his or her ability for self
Process-oriented psychology, also known as awareness and reflection. Processwork adds spe-
Processwork, was developed by Arnold Mindell as cific facilitation skills beyond these paradigms to
a teleological, therapeutic paradigm for developing effect client and community change.
awareness and change through the deeper meaning
within human experience. The teleological per- Major Concepts
spective views events as having meaning and pur-
pose, and individuals and communities as having The underlying major concept of Processwork is
an innate tendency to evolve their own deeper that a person’s awareness is the basis for facilitating
sense of self and connection toward a point of personal and social change. Understanding the three
resolution. This paradigm currently has applica- levels of awareness, dreambody, and deep democ-
tions for a wide range of psychotherapies and racy helps us understand this overarching belief.
body–mind therapies, working with people in
coma states, organizational development, conflict Levels of Awareness
resolution, and multicultural community building.
There are three levels of awareness within each
person: (1) consensus reality, (2) dreaming level,
Historical Context and (3) essence level.
In the late 1970s, Mindell, then a Jungian analyst,
Consensus Reality
noticed that the dynamics of a client’s dreams can
parallel the client’s somatic and emotional experi- Consensus reality is the everyday reality that is
ences and have repeated themes in his or her shared and agreed on by most people—the “what

Process-Oriented Psychology 805
is” reality of our world—which then provides a principles of deep democracy support awareness
shared pattern of experience and belief that become and interaction with diverse or conflicting feelings,
promoted collectively as a preferred way of being. points of view, and experiences to develop a deeper
understanding and incorporation of diverse ways
Dreaming Level of being within society.
Dreaming represents a phenomenon unique to
an individual and not only refers to night dreaming Techniques
but also represents an individual’s personal mean-
ing attributed to his or her inner world as with A person’s sense of self or identity evolves from the
persistent images from dreams or reoccurring body relationship between aspects that support his or her
symptoms. Externally, the dreaming level represents identity in the world and those that have elements
the people or roles missing that are meaningful and of difference that can polarize, disturb, or challenge
important in the client’s lives, such as a client’s com- them. To facilitate this process, the therapist
ment “If only someone would see how hard I try.” employs primary and secondary process and edges,
signals, channels, and amplification and unfolding.
Essence Level
The essence level represents a unified sense of Primary and Secondary Process and Edges
self within the context of space and time. In this The more familiar identity is called the primary
nondualistic or nonpolarized level of conscious- identity, and the less familiar and potentially
ness, people have an experience of “sentience,” a emerging identity is called the secondary identity.
transpersonal awareness that is a subtle yet mean- Primary process is the supporting of this primary
ingful experience. This can further be described as identity with qualities and aspects that a person
the “seed” or prethought stage of a tendency will use to define his or her sense of self within the
before awareness and action. world. Secondary processes are attributes and
capacities that are disowned or marginalized by
Dreambody the person in an attempt to reduce his or her inter-
action with these aspects and limit any threat to
Human awareness gives a meaningful context the individual’s primary identity. Often there is
to sensations and experiences. This context can be reluctance or inability to understand and integrate
elaborated as the client’s awareness focuses on the this new experience as though a psychic boundary
experience. For example, when a client says, “My separates the primary from the secondary pro-
headache feels like someone is pressing in on my cesses. This boundary is called the “edge,” repre-
temples,” this initial statement allows the therapist senting the edge of the person’s current identity. At
to respond, “Show me how that someone creates the edge reside beliefs, values, and judgments,
that pressure in you.” Dreambody alludes to attri- which reinforce the primary identity and hinder
butes of human experience less identified by a the fluid transition into unknown experiences.
person and unique in his or her own psychological
perception and construct of awareness.
Signals
Deep Democracy Signals are information that a person becomes

aware of, such as body movements and gestures,
Processwork has a basic premise that useful and images, sounds, feelings, or bodily sensations that
meaningful solutions occur when there is a genuine he or she can describe. In therapy, signals that
interaction between diverse roles. Deep democracy persist or repeat are significant.
extends this premise in working with large groups,
where diversity issues and conflicts inhibit social
Channels
sensitivity and community cohesiveness. In groups,
marginalization occurs when mainstream or Processwork describes six channels of aware-
majority viewpoints repress differing, minority ness that provide the medium for information, or
viewpoints. Similar to individual therapy, the signals, and defines process as the ongoing flow of

806 Prolonged Exposure Therapy
signals through various perceptual channels. See also Cognitive Analytic Therapy; Experiential
Channels are the ways in which we experience Psychotherapy; Transpersonal Psychology: Overview
ourselves, others, and the world around us. The
channels are the visual channel, auditory channel, Further Readings
proprioceptive or feeling channel (referring to
inner-body feeling experiences), kinesthetic or Mindell, A. (1982). Dreambody: The body’s role in
movement channel, relationship channel (where revealing the self. Portland, OR: Sigo Press.
we experience the process occurring in relation- Mindell, A. (1992). Riding the horse backwards: Process
work in theory and practice. London, England:
ship), and world channel (happenings in the world
Penguin-Arkana.
around us). People’s experience of themselves and
Mindell, A. (1995). Sitting in the fire: Large group
their world can change based on potential new
transformation using conflict and diversity. Portland,
information in different channels. Initially, the
OR: Lao Tse Press.
therapist notices which channel the client’s pri- Mindell, A. (2000). Quantum mind: The edge between
mary identity is expressed in and seeks the client’s physics and psychology. Portland, OR: Lao Tse Press.
potential awareness in other channels. Hence, pro- Mindell, A. (2013). Dancing with the ancient one.
cess becomes the ongoing flow of signals through Portland, OR: Deep Democracy Exchange.
various perceptual channels.
Amplification and Unfolding

PROCESSWORK
Amplification is asking the client to focus
attention on some aspect of his or her experience
and report to the therapist what the client notices
See Process-Oriented Psychology
as his or her attention remains with the experience.
Clients are helped to identify with less conscious
sensations and experiences first through amplifica-
tion of aspects that are more secondary for the
PROLONGED EXPOSURE THERAPY
client. The client can then follow through with
embodying and supporting the tendencies of this Prolonged exposure therapy is an approach to
sensation. This process is termed unfolding. treatment that focuses on reducing symptoms
related to posttraumatic stress disorder (PTSD) and
related disorders. Based on cognitive-behavioral
Therapeutic Process therapy, this approach uses psychoeducation,
breathing retraining, imaginal exposure, in vivo
Processwork skills are used to enhance individuals’
exposure, and talk therapy to decrease a wide
and groups’ sensitivity, knowledge, and capacities
range of symptoms that may result from a trau-
by engaging with perceived challenging or disturb-
matic situation. Therapy is generally 90 minutes
ing elements in themselves or in others to realign
long and usually takes between 8 and 15 sessions.
their sense of self and identity. The therapeutic
This approach to PTSD has been shown to be effi-
process initially involves the therapist gleaning the
cacious when working with a wide range of clients
nature of the primary/secondary dichotomy within
who have experienced trauma related to rape,
the client’s experience. The facilitation of the cli-
military combat, car accidents, disasters, abuse,
ent’s more secondary experiences across various
and more. It has been successfully used by the
channels allows for potential new awareness to
U.S. Department of Veterans Affairs with military
develop. This awareness when developed further
personnel and by clinicians in general.
allows clients to develop a new sense of self incor-
porating elements once secondary to them but
important in that the sensitivity, knowledge, and Historical Context
skills are useful for them in some aspects of their
lives. Prolonged exposure therapy was developed during
the mid-1980s by Edna B. Foa, director of the
Alan Richardson Center for the Treatment and Study of Anxiety at

Prolonged Exposure Therapy 807
the University of Pennsylvania. Since then, Breathing Retraining

prolonged exposure therapy has been researched
Breathing retraining is a process used to reduce
in multiple studies and shown to be effective when
physiological arousal by teaching new, slow,
treating those with PTSD and related disorders.
rhythmic breathing techniques to clients.
With returning soldiers from the wars in Iraq and
Afghanistan experiencing high rates of PTSD, this
approach has become particularly important, Fear Structures
receiving an Exemplary Substance Abuse Fear structures are brain structures that are
Prevention Program Award from the U.S. formed in an effort to protect the individual from
Department of Health and Human Services a recurrence of an event by creating images of the
Substance Abuse and Mental Health Services event so that when the individual confronts similar
Administration in 2001. In recent years, the situations, the individual knows to avoid them.
approach has been expanded for use with related
disorders with a wide variety of clients.
Imaginal Exposure
Imaginal exposure describes the purposeful
reliving of an event through memory.
A cognitive-behavioral approach, prolonged
exposure therapy suggests that fear structures in Posttraumatic Stress Disorder
one’s memory are developed and continue fol-
lowing a traumatic event. Such structures are Often the result of a trauma, PTSD is a psycho-
formed in an effort to protect the individual from logical response that occurs as a result of the original
a recurrence of the event by creating images of event and includes symptoms such as severe anxiety,
the event so that when the individual confronts depression, guilt, anger, nightmares, dissociation,
similar situations, he or she knows to avoid body shaking, and physiological reexperiencing of
them. However, when new situations are faced, the event even though the event is not recurring.
the original response sometimes becomes gener-
alized to the new situation, even if the new event Subjective Unit of Distress Scale
is not potentially harmful. Thus, the individual’s
The SUDS is a device for measuring an individ-
fear structures may continue to be triggered by a
ual’s physiological or psychological distress. The
series of similar stimuli, and the individual is not
scale ranges from 0 to 100, with 0 representing no
able to successfully reduce his or her physiologi-
distress and 100 representing extreme distress.
cal distress that results from the stimuli. Some of
the responses that a person might have to the
fear structures include a feeling of panic, a Techniques
pounding heart rate, a shaking body, disassocia-
With prolonged exposure therapy, techniques are
tion, and other symptoms often associated with
intimately related to the stages of therapy. In the
panic and severe anxiety. Classical conditioning
order they are conducted, they include gathering
suggests that if exposure to potentially fear-
information, psychoeducation, breathing retrain-
inducing situations becomes continually paired
ing, in vivo exposure, and imaginal exposure.
with a calm mood, the fear-inducing situations
will eventually be habituated to or experienced
calmly by the client. Gathering Information
Gathering information is the process whereby
Major Concepts therapists inquire about the clients’ original trauma
and subsequent situations that cause distress.
A number of concepts related to cognitive-
behavioral theory are used in this approach. Major
Psychoeducation
concepts include breathing retraining, fear struc-
tures, imaginal exposure, PTSD, and the Subjective Psychoeducation describes the process of edu-
Unit of Distress Scale (SUDS). cating clients about the theory behind prolonged

808 Provocative Therapy
exposure therapy and the goals of prolonged See also Behavior Therapies: Overview; Classical
exposure therapy. Conditioning; Exposure and Response Prevention;
Systematic Desensitization
Breathing Retraining
Further Readings
Through breathing retraining, therapists teach
clients how to reduce physiological arousal through Foe, E. B., Hembree, E. A., & Rothbaum, B. O. (2007).
implementing slow, rhythmic breathing techniques. Prolonged exposure therapy for PTSD: Emotional
processing of traumatic experiences therapist guide.
New York, NY: Oxford University Press.
In Vivo Exposure Nacasch, N., Foa, E. B., Huppert, J. D., Tzur, D., Fostick,
In vivo exposure refers to having clients develop L., Dinstein, Y., . . . Zohar, J. (2010). Prolonged
a hierarchy of distress based on their sense of how exposure therapy for combat- and terror-related
they would feel if they were to place themselves in PTSD: A randomized control comparison with
a situation related to the trauma that would cause treatment as usual. Journal of Clinical Psychiatry, 72,
1174–1180. doi:10.4088/JCP.09m05682blu
them distress. In a systemic manner, clients can
Peterson, A. L., Foaa, E. B., & Riggs, D. S. (2011).
slowly place themselves in such situations and use
Prolonged exposure therapy. In B. A. Moore &
their breathing to maintain a sense of calm. The
W. E. Penk (Eds.), Treating PTSD in military personnel
SUDS scale may be used to monitor the client’s
(pp. 42–58). New York, NY: Guilford Press.
amount of distress.
Imaginal Exposure
Imaginal exposure is the ongoing revisiting of
PROVOCATIVE THERAPY
the original traumatic memory so that clients
eventually habituate to the event and no longer Provocative Therapy is named from the Latin
feel extreme distress from memories of the event. provocare, meaning to “call forth from,” and is
Clients are asked to recall the event in extreme effective in its ability to call forth new and useful
detail. Clients can use their breathing to maintain behaviors from clients who have previously exhib-
a sense of calm, and the SUDS scale may be used ited negative behaviors and beliefs. Provocative
to monitor the amount of distress they are Therapy works with clients within their biopsy-
experiencing. chosocial world to assist them to develop more
effective behaviors and strategies. Originally devel-
oped in 1963 by Frank Farrelly while working
Therapeutic Process with chronic schizophrenics, the techniques used in
Prolonged exposure therapy typically last between Provocative Therapy, such as sensory-rich lan-
8 and 15 sessions. Early sessions involve gathering guage, are applicable to the full range of client
information from the client about his or her situa- issues, groups, and family work.
tion, psychoeducation, a general overview of the
treatment, building a therapeutic alliance, and Historical Context
teaching breathing retraining. The next sessions
involve developing the hierarchy for in vivo expo- Trained as a master’s level social worker in 1956,
sure, which can be followed up with homework so Farrelly worked with the psychologist Carl Rogers
that the client can practice such exposure. This is for many years at Mendota Mental Health Institute
followed by a number of sessions that focus on in Madison, Wisconsin, and was a therapist on
imaginal exposure. Therapists conclude with a Rogers’s research project with chronic schizophren-
final session that examines the progress made in ics. Farrelly took part in therapy listening sessions,
therapy. where client interviews were taped and presented for
discussion in weekly meetings with colleagues.
Edward S. Neukrug In 1963, he began to develop Provocative Therapy.

Provocative Therapy 809
He found that by confronting his own feelings in 5. Clients need to recognize that the choices they
response to a client and by using countertransference make affect society and to take responsibility
as a tool in which he would express his own thoughts for their behaviors. As Farrelly would say,
about the client’s experience, he could build trust “Some people need boundaries taking out, and
effectively and rapidly. The level of honesty, self some people need boundaries putting in.”
awareness, and flexibility required of the provoca-
6. People are treated as they are subjectively
tive therapist in an interview may be quite challeng-
perceived.
ing for an aspiring provocative therapist to achieve,
and supervision is required during this process. 7. Therapists have the responsibility to have clients
Provocative Therapy was eventually used in hear feedback and to have the clients act on this
individual therapy, group therapy, and family ther- feedback by taking responsibility for their
apy and within the therapeutic community work at actions and developing their own solutions to
Mendota. Farrelly subsequently became a clinical their problems.
professor in the School of Social Work at the
University of Wisconsin and an assistant clinical 8. People have more ability than is generally
professor in the Department of Psychiatry at the assumed and can develop new coping strategies
University of Wisconsin. In the 1970s, he was one of and useful behaviors.
the individuals whom Richard Bandler and John 9. All experiences, including those in adulthood,
Grinder modeled when they were developing neuro- are important for the change process, and
linguistic programming. Farrelly also worked in growth can occur at any point in a person’s life.
private practice and gave seminars and lectures
around the world until his death in 2013. Provocative 10. Clients’ behavior with their therapist is a good
Therapy continues today, and provocative tech- approximation of their habitual behavior.
niques have also been subsequently incorporated by 11. Nonverbal communication is significant; it’s not
his students into Provocative Coaching, as well as what is said but how it is said.
into Nick Kemp’s Provocative Change Works.
12. People can be understood.
Provocative Therapy shares with many of the Major Concepts
existential-humanistic theories the assumption that Most of the major concepts are incorporated in the
people can change at any point in their lives and 12 assumptions listed in the “Theoretical
that the choices people make affect others and soci- Underpinnings” section and the techniques dis-
ety. Additionally, it embraces postmodern beliefs cussed in the following section. In general, the
that drive the theory, including the following: Provocative Therapy approach tends to focus on
demonstrating acceptance of a client nonverbally
1. Growth occurs in response to challenge. If a and producing change in the client with appropriate
challenge is not overwhelming, a “fight” rather provocation and humor.
than “flight” response is stimulated, and people
develop coping strategies and new and useful
behaviors. As Farrelly would say, “When the Techniques
pain begins, the learning starts.” Although many techniques from person-centered
2. People can make a major change in their lives, counseling and other humanistic and postmodern
and maintain this new behavior, regardless of therapies can be used, techniques specific to
the duration or degree of the problem state. Provocative Therapy include talking as if talking
to an old friend, use of sensory-rich language, use
3. Change doesn’t have to take a long time.
of nonverbal communication to demonstrate
4. If individuals receive useful feedback, then they acceptance, use of humor, playing devil’s advocate,
can make changes themselves. and being in charge.

810 Psychedelic Therapy
Talking As If Talking to an Old Friend 3. Assisting clients in clarifying their self-image

and in the development of adaptive behaviors
Provocative therapists talk to each client as if
they are talking to an old friend, with a twinkle in 4. Consolidation and integration of new behaviors
the eye and affection in the heart, putting aside
their professional dignity on behalf of the client. In Nick Kemp
addition, therapists use the language of the client,
in the present, and avoid professional jargon.
Person-Centered Counseling; Solution-Focused Brief
Therapy
Use of Sensory-Rich Language and Nonverbal
Demonstration of Acceptance
Further Readings
By using sensory-rich, varied language, with
metaphors and storytelling, and verbal and nonver- Brandsma, J., & Farrelly, F. (1974). Provocative therapy.
bal responses, therapists get the attention of clients Fort Collins, CO: Shields.
Freud, S. (1928). Humour. International Journal of
and convey their reactions effectively to, and on
Psychoanalysis, 9, 1–6.
behalf of, the clients, demonstrating nonverbally
Rogers, C. R. (1951). Client centered therapy. Boston,
their acceptance of the client. This enables the
MA: Houghton-Mifflin.
client to confront issues rather than avoid them.
Use of Humor Websites

Association for Provocative Therapy:
Humor, exaggeration, and mimicking are used
www.provocativetherapy.eu
to lampoon the problem, not the client. Humor is
Provocative Change Works:
a key tool to assist the client to make insights
www.provocativechangeworks.com
and increase the client’s understanding in an
Provocative Therapy: www.provocativetherapy.com
acceptable, nonoverwhelming fashion.
Playing Devil’s Advocate

The therapist plays devil’s advocate on behalf of PSYCHEDELIC THERAPY
the client’s problem, thus provoking the client to
“do the work” and take responsibility for himself Psychedelic therapy relies on hallucinogens or
or herself. entheogenic drugs to augment therapy. During the
1950s, before many of these drugs were criminal-
Being in Charge ized, psychedelic therapy showed promise as an
effective augmentation of psychotherapy.
The therapist uses all these devices to remain in Reactions to the drugs varied widely and ranged
control of the interaction with the client, responding from fearful to joyful, enlightening to depressing,
to what comes back from the client rather than let- and spiritual to personal. Therapists’ interpreta-
ting the client control the interview and avoid change. tions of these responses also varied significantly,
making it difficult to standardize this approach.
Therapeutic Process
Provocative Therapy has four stages; the duration Historical Context
of therapy is 20 to 25 sessions on average, but it
The origins of psychedelic therapy can be traced
can range from 2 through 200 sessions. The stages
back to the introduction of lysergic acid diethylam-
are as follows:
ide (LSD) in 1943, when Albert Hofmann, a phar-
macologist at Sandoz Pharmaceutical laboratories
1. Assisting clients to confront their issues
in Switzerland, identified its powerful psychological
2. Having clients acknowledge that change is properties. His discovery attracted scientific curios-
required by themselves ity and resulted in thousands of studies with the

Psychedelic Therapy 811
drug over the next decade. The psychiatrist Humphry and are often used in shamanic rituals and also in
Osmond coined the term psychedelic in 1957, dur- psychedelic therapy. Some entheogens are peyote,
ing his investigations in Canada with the psychia- psilocybin mushrooms, and cannabis.
trist Abram Hoffer; they subsequently introduced
the concept of psychedelic therapy.
Psychedelic therapy boasted extraordinary Theoretical Underpinnings
results, with success rates between 50% and 90% After reviewing the extant literature on mescaline,
for its use among alcoholics. Contemporary addic- Osmond found that the investigators recognized
tions researchers, however, were skeptical of the similarities between psychosis and chemically
research design and the selection criteria used for induced hallucinations. Arriving in Saskatchewan,
subjects. One such concern stemmed from the fact Canada, in 1951, he began exploring these ideas
that the subjects had vastly different reactions, and through self-experimentation with the newly avail-
it was unclear whether their response had more to able drug LSD. Working closely with the psychiatrist
do with individual differences, the setting, or the Hoffer, he compared LSD reactions with descrip-
drug itself. Attempts to isolate the effects of the tions of psychosis by schizophrenic patients and
drug, though, had damaging results for the sub- also with reports of delirium tremens from alcoholic
jects, with the majority having negative and even patients, which had some similarities to psychosis.
terrifying experiences. Based on their findings, the researchers concluded
In 1962, Timothy Leary, a psychologist at that the drug was a psychotomimetic, a chemical
Harvard, drew controversy when he was fired for that mimicked or modeled psychosis. This led them
engaging in psychedelic research of questionable to theorize that they may have discovered a way to
scientific value. Over the next few years, his name help alcoholics experience a psychosis similar to
became synonymous with the recreational (ab)use delirium tremens. They went on to suggest that if
of LSD and psychedelic drugs, and he forged a con- alcoholics were given LSD before their problem
nection between psychedelics and the countercul- drinking became too severe, it might help them gen-
ture. Researchers using psychedelics struggled to erate the psychological willpower necessary to seek
retain their credibility during this period. By 1967, help at an earlier point in their disease process.
despite the clinical optimism, the Food and Drug
Administration in the United States made psyche-
delics illegal, as did many nations around the world. Techniques
New substances and novel approaches have led Psychedelic therapy relied chiefly on an empathic
to a resurgence in psychedelic science. Research therapist–patient relationship, attention to the set
continues to examine the use of psychedelics in and setting, and conventional follow-up treatments.
palliative care, addictions therapy, and psycho- Osmond recommended that staff have a psychedelic
therapy. The neuroscientists Franz Vollenweider, in experience before working with individuals who had
Switzerland, and Marc Geyer, in the United States, experienced psychosis or patients about to take LSD.
are exploring the use of psychedelics in the
growing field of neuroscience.
Empathy
Major Concepts Recreating psychotic symptoms in a patient

frequently meant stimulating feelings of paranoia.
Three important concepts for understanding psyche- Thus, reassurances from an empathic helper
delic therapy are psychedelic, hallucinogens, and assisted in minimizing the negative consequences
entheogens. The term psychedelic was coined by of these reactions. Some therapists preferred to
Osmond in 1957 by combining psyche with the create a stronger connection with the patient by
Greek term delos, meaning “to bring to light.” taking a dose of LSD at the same time.
“Psychedelic” denotes a mind-manifesting experience.
Hallucinogens are chemicals, including mescaline and
Set and Setting
LSD, that produce changes in visual perception, mood,
and thought. Entheogens are spiritually inducing A carefully constructed, comfortable, nonthreat-
substances, or those that reveal the “God within,” ening environment was critical to therapy, and

812 Psychodrama
some therapists also insisted on adjusting the orchestra, like his family, was attempting to work
lighting, adding specific music, and incorporating together while he, the out-of-tune piccolo, dis-
artwork as soothing and distracting influences to rupted that cadence. This allowed him to see that
guide a patient into a positive experience. his family was not to blame for his problems and
that he must take ownership of his behavior.
Techniques Based on the Therapist’s Erika Dyck
Theoretical Orientation
See also Complementary and Alternative Approaches:
Psychedelic therapy was routinely followed up Overview; Existential Therapy; Freudian
with regular psychotherapy; however, the Psychoanalysis; Meditation; Phenomenological
approaches to psychotherapy differed significantly Therapy; Prayer and Affirmations
and depended on the orientation of the therapist.
Typically, the patient brought personal items,
including photographs or letters, which often Further Readings
became the subject of discussions. For example, a Dyck, E. (2008). Psychedelic psychiatry: LSD from clinic
family photograph could focus a conversation to campus. Baltimore, MD: Johns Hopkins University
about broken relationships or feelings of guilt Press.
toward children. Hoffer, A., & Osmond, H. (1967). The hallucinogens.
New York, NY: Academic Press.
Dosage Langlitz, N. (2013). Neuropsychedelia: The revival of
hallucinogen research since the decade of the brain.
Patients often did not return for repeat doses of Berkeley: University of California Press.
LSD; thus, one intense session was used to set the Strassman, R. (2001). DMT the spirit molecule: A
stage for subsequent therapeutic interactions. doctor’s revolutionary research into the biology of
Many patients agreed that its intensity was suffi- near-death and mystical experiences. Rochester, VT:
cient to cultivate the willpower to want to stop Park Street Press.
drinking, to generate perspective on a pattern of
dysfunctional behavior, or to inspire one to accept
a power greater than oneself. The overwhelming
result was a humbling experience and one that PSYCHOANALYSIS
therapists argued prepared patients for success in
conventional psychotherapy.
See Freudian Psychoanalysis
Therapeutic Process
Psychedelic therapy sessions typically involved an
intense 6- to 8-hour session with a helper present, PSYCHODRAMA
followed by a night’s sleep under observation and
a brief period of reflection the following morning. Psychodrama is a therapy modality that arose in
After a single psychedelic session, patients contin- parallel to the classical psychoanalysis of Sigmund
ued with conventional psychotherapy for several Freud. It is sometimes used as an adjunct to the
months or years. talk therapies frequently used in modern counsel-
Reactions were highly personal. For instance, ing and is designed to access the client’s emotional
one man treated for alcoholism explained that he and psychological content that is otherwise beyond
found himself gripped in a hallucination that had verbal description. Developed by the psychiatrist
turned him into a piccolo. He believed that he was Jacob Levy Moreno (1889–1974), psychodrama is
part of a beautiful orchestra but that he was out of used to help the client (called a protagonist) obtain
tune, which disrupted the otherwise harmonious catharsis by revisiting a source of distress through
symphony. By the end of his session, he explored reenactment. Reenactment (role-play, action, enact-
this insight as a metaphor explaining that the ment, tableau) is the literal development of a scene

Psychodrama 813
with multiple actors, dialogue that is loosely inherently faulted, which Moreno believed was
scripted, and in vivo exposure. The goal of the inaccurate. Rather than developing his work in
reenactment is, with the support of those partici- response to that of Freud or of other theorists,
pating in the psychodrama, to facilitate recogni- Moreno claimed that his theories derived from a
tion of how a past interaction influences current combination of knowledge dating to Ancient Greece
distress and to help the client overcome the effects and his own observations of human behavior.
of the event on his or her current ability to cre-
atively respond to life stressors. Psychodrama may
be likened to family counseling in that it is its own
specialty, with its own history and literature, yet its Psychodramatists argue that a unique aspect of
influence is inextricably woven into the way con- psychodrama is its rejection of the notion that
temporary counseling is provided. As such, the humans are motivated by basic needs or drives.
early psychodramatists, such as Moreno, argued Moreno posited that we develop roles as a result of
that psychodrama is a form of individual therapy the influences of both biology and social interac-
because the tableaus being reenacted are focused tion. He termed the space between biology and
on the experience of a single person. More modern social feedback spontaneity or s-factor and
interpretations point to the experience of others in described spontaneity as the flexibility with which
the sharing phase as an experience that is thera- one adapts to a novel situation or develops a new
peutic to those other than the protagonist, while adaptation for a familiar situation. Therefore,
also acknowledging that psychodrama may be human development is presented as a continuous
used as part of an overarching therapy plan. process of tapping into one’s creativity to make
meaning out of the situation or circumstances one
is presented. Furthermore, though there are certain
Historical Context
biological reflexes with which we are born (e.g.,
Psychodrama was developed by Moreno following sucking), some creative learning between a child
his service as a physician during World War I. and caregivers is required for the child to success-
Accounts of how Moreno came to develop psycho- fully meet his or her needs. In the case of a baby
drama vary. Moreno himself argued that the gen- using a bottle, there is the biological need to feed,
esis of psychodrama dates to his own experience the reflex to suck, and the context that the care-
with childhood imaginative play, while others note giver provides to create an environment of safety
the likelihood that life experiences such as obser- for the child to appropriately latch onto. The iden-
vations of combatant and civilian groups during tity one develops is the aggregate of learned roles.
World War I shaped his theory’s emphasis on the The social connection between individuals, for
individual in the context of the group. instance, the child and the caregiver, is intangible
Moreno grew up and lived in Vienna, Austria, but perceptible. This connection is termed tele and
and was a contemporary of many of the early is operationalized through Moreno’s work on soci-
figures of psychotherapy (i.e., Freud, Alfred Adler, ometry. Sociometry, the aspect of Moreno’s work
Viktor Frankl, and Carl Jung). As with most coun- that emphasized the relationships between indi-
seling theorists, Moreno’s work is likely a reflection viduals and communities at large, underlies the
of the context in which he was raised. While in way in which psychodrama is understood to work.
Vienna, Moreno trained as a psychiatrist and is Drawing from the tele, the curative factor is seen as
known to have met Freud. However, he was not how the protagonist connects with the other per-
a part of Freud’s psychoanalytical community sons facilitating the psychodrama so that he or she
and held significant disdain for psychoanalysis, may revisit and rescript a distress-inducing event.
believing that it was myopically focused on the
individual. Among his other criticisms of Freudian
Major Concepts
psychoanalysis were Freud’s avoidance of religion,
a central organizing principle for many people, Psychodrama is grounded in the principle that
which Moreno thought critical to human immediacy allows the client to approach psycho-
development; and a bias toward seeing humans as logical wounds otherwise hidden by the roles the

814 Psychodrama
client has accepted. Psychodrama relies on certain Role

roles being played out in the enactment to facilitate
Roles are the labels that one puts on others, as
client catharsis.
well as self, based on perceived characteristics.
Roles can be developed based on a trial-and-error
Protagonist process where the role is adopted and then others
The protagonist refers to the client, who is the respond, through observations of other members
principal actor in the psychodrama. of society, or through otherwise ingrained
rules about what characterizes a particular role
(i.e., the belief that one’s role as a man is char-
Director acterized by not crying). The adoption of roles
The director is the counselor who is facilitating comes before one develops an identity, as the
the psychodrama. The director may either instruct self is understood as the integration of multiple
the protagonist and the auxiliaries as to which roles.
roles should be adopted and how they should
be reenacted or co-construct the reenactment with Spontaneity
the protagonist. The director is responsible for
ensuring continued momentum in the role-plays. Spontaneity underpins the way in which cathar-
sis is achieved in psychodrama. The protagonist
(the client) is charged with tapping into his or her
Auxiliaries own spontaneity to identify how distress-inducing
Auxiliaries are the other participants in the psy- circumstances were previously approached. He or
chodrama. Those who assume the role of an auxil- she may be charged with developing a new way of
iary may be other professionals who typically approaching the same distress-inducing situation.
work with the director in facilitating psychodra- Moreno posited that the use of spontaneity allows
mas. In situations where the auxiliaries are not clients to access content otherwise hidden by the
other professionals, they may be other members of defenses that precluded their description in talk
a therapy group. When other group members are therapy.
auxiliaries, the protagonist is asked to intention-
ally choose group members who seem to best fit Techniques
specific roles (e.g., one’s mother or father).
Psychodrama is characterized by a series of
role-plays that are most likely to facilitate the
Audience
protagonist’s catharsis. Although role-plays may
The audience refers to those who are present to be considered the technique associated with
witness the enactment but are not participating in psychodrama, specific processes and modifica-
the action. Audience members may be called on to tions to the role-plays serve as the tools used by
share their personal experiences of the action on psychodramatists.
the conclusion of the role-play.
Data Collection and Preparation
Stage to Develop Role-Play
The physical space in which the action takes Before the participating psychodrama group is
place is called the stage. While it is not necessary to convened, the protagonist and the director meet to
have a full variety of props or a formal theater discuss background information. The director may
stage, setting boundaries for where the audience then either co-construct the role-play that will be
will be, what the context of the enactment is, enacted or, based on his or her assessment, identify
and the freedom of movement of the protagonist, how to conduct the warm-up activities, set up the
director, and auxiliaries are considerations in stage, and identify which prompts to provide the
psychodrama. protagonist and the auxiliaries.

Psychodrama 815
Warm-Up Doubling
This is the first stage of the psychodrama and is An auxiliary may be tasked with serving as a
used to ensure that those who will be participating companion to the protagonist in the enactment.
in the role-play are psychologically and emotionally This “double” helps convey nonverbally or ver-
ready. In the warm-up stage, those acting reflect on bally the feelings the protagonist has and helps
their own emotional and psychological state, address bring to awareness underlying emotions, which
anxieties about assuming a different role, and max- may then influence the direction the rest of the
imize their ability to be spontaneous in the role-play. role-play takes. The nonverbal double may also
This is akin to introducing an intervention to clients foster a sense of courage in the client (i.e., simply
before simply asking them to execute it. help the client to not feel alone as the distressing
event is approached). A verbal double, sometimes
called a spontaneous double, may identify the
Action or Enactment
underlying emotions in the role-play and provide
The second stage of psychodrama, the action or suggestions to the protagonist or speak as the
enactment stage, is when the protagonist and the protagonist.
auxiliaries enact the situation identified as distress
inducing. The action phase may include more than
Mirroring
a single role-play and may include a rescripting of
events. Because the auxiliaries were not present at Mirroring is when an auxiliary assumes the role
the original event that the protagonist is reenact- of the protagonist so that the protagonist sees how
ing, they rely on their own interpretation of their others view his or her actions. The protagonist
roles. What is said in the action stage may require may then reevaluate his or her behaviors and state-
some direction and repetition to appropriately ments during the distress-inducing event. In a situ-
facilitate the client’s new experience of the initially ation where the role-play presents a new way of
distressing event. approaching the event, the protagonist also is
afforded the opportunity to consider whether or
Sharing
not the new way is something that works for him
or her.
Following the action stage, those who observed
(audience) or participated (protagonist and auxil-
iaries) are invited to share their personal reactions Therapeutic Process
to what took place. Those who acted as an auxil-
The psychodrama process includes the stages
iary may suggest what they believe their character
(phases) of warm-up, action or enactment, and
experienced or may share their own personal expe-
sharing. The way psychodrama is used in prac-
rience from being an actor in that role. Analysis of
tice varies. Although a client may seek out coun-
what the protagonist did or said in the role played
seling with the express intent of engaging in
is discouraged. The director may, however, create
psychodrama, it may be more likely that the cli-
an opportunity for the audience and the auxiliaries
ent will be exposed to psychodrama as part of
to gently challenge the understanding that the
another type of therapy group. Regardless of the
protagonist has shared of the events.
venue, the director may develop the role-plays
with varying degrees of input from the protago-
Role Reversal nist but should be mindful of how pushing a
protagonist beyond the protagonist’s level of
Role reversal is a technique whereby the protag-
readiness without the protagonist’s prior input
onist is asked to assume the role of another person
could be retraumatizing.
in the tableau. This may allow the protagonist to
develop a different perspective on the events that led Daniel M. Paredes
to distress by garnering a different understanding
of the motivations of those involved. See also Drama Therapy; Emotion-Focused Therapy

816 Psychodynamic Family Therapy
Further Readings with real events and people only as those events
Blatner, A. (2000). Foundations of psychodrama: History,
influenced a client’s unconscious internal conflicts.
theory, and practice (4th ed.). New York, NY: Springer. Today, however, proponents of psychodynamic
Dayton, T. (1994). The drama within: Psychodrama and family therapy tend to view individual conflicts
experiential therapy. Deerfield Beach, FL: Health and relational patterns as interlocking systems that
Communications. must be addressed within the treatment process.
Haworth, P. (1998). The historical background of Like their Freudian predecessors, psychodynamic
psychodrama. In M. Karp, P. Holmes, & K. B. Tauvon family therapists acknowledge that repression of
(Eds.), The handbook of psychodrama (pp. 15–28). early problematic experiences inhibits individuals
London, England: Routledge. from relating freely to the outside world. However,
Karp, M. (1998). An introduction to psychodrama. In unlike their predecessors, psychodynamic family
M. Karp, P. Holmes, & K. B. Tauvon (Eds.), The therapists aim to discover and address the repressed
handbook of psychodrama (pp. 3–14). London, but unfinished problems affecting a family as well
England: Routledge. as its individual members. Shedding the cold,
Konipik, D. A., & Cheung, M. (2013). Psychodrama as a “blank screen” approach of the classical psycho-
social work modality. Social Work, 58, 9–20. analyst, today’s psychodynamic family therapists
doi:10.1093/sw/sws054 work to create a warm and secure therapeutic or
Lipman, L. (2003). The triadic system: Sociometry, “holding” environment, in which family members
psychodrama, and group psychotherapy. In can feel safe to work through their repressed
J. Gerhsoni (Ed.), Psychodrama in the 21st century: issues. Key Freudian psychoanalytical techniques
Clinical and education applications (pp. 3–14). are applied in psychodynamic family therapy,
New York, NY: Springer.
along with more contemporary techniques aimed
Marineau, R. F. (2007). The birth and development of
at helping families understand and change
sociometry: The work and legacy of Jacob Moreno
unwanted interaction patterns. From a psychody-
(1889–1974). Social Psychology Quarterly, 70,
namic family therapy perspective, it is the
322–325.
Moreno, J. L. (1964). Psychodrama (Vol. 1, 3rd ed.).
therapist’s interpretation of family members’ early
Beacon, NY: Beacon House.
conflictual relationships that makes them con-
Wilkins, P. (Ed.). (1999). Setting the stage: The scious through language and, thus, accessible in
instruments and techniques of psychodrama. therapy, as a tool for individual and family change.
In Creative therapies in practice: Psychodrama
(pp. 20–39). London, England: Sage. Historical Context
Beginning in World War II and throughout the
1940s, Freudian psychoanalytical theory became
dominant in American psychological practice as a
PSYCHODYNAMIC FAMILY THERAPY number of psychoanalytically trained theorists and
clinicians traveled to the United States from Europe
Psychodynamic family therapy is an approach to to escape Nazi persecution. The classical Freudian
family therapy that integrates classical Freudian approach to mental health treatment sought to cor-
psychoanalytical theory’s interest in the uncon- rect the damage of childhood conflicts resulting
scious aspects of individual personality develop- from destructive interactions in one’s family of
ment and function with an interest in the social origin, and Freud believed that treatment was most
context, and especially the family context, in effective if conducted with individuals apart from
which individual and relational dysfunction devel- the harmful influences of their family members. In
ops. Most of the pioneers of psychodynamic fam- the 1950s, some psychoanalysts began to move
ily therapy were physicians trained in Freudian away from the Freudian focus on the individual
psychoanalysis who, with the birth of the systems toward viewing select family relationships as the
paradigm in the 1960s and 1970s, came to view unit of psychodynamic treatment. Among these
Freud’s individually focused psychoanalytical ideas were the American psychiatrists Nathan Ackerman,
as antiquated and inadequate. In therapy, the Ivan Böszörményi-Nagy, and Harry Stack Sullivan.
Freudian psychoanalyst addressed relationships Ackerman, who is sometimes regarded as the

Psychodynamic Family Therapy 817
“grandfather of family therapy,” adopted the view may, as adults, demand acceptance excessively
that individual symptoms were units of interper- and inappropriately from others in defense of an
sonal behavior displayed in the context of shared uncertain and negotiable self-image.
family conflict. Böszörményi-Nagy’s contextual From a traditional Freudian perspective, indi-
approach to psychiatric treatment emphasized the vidual personality development occurs through
importance of family loyalties and ethical obliga- each person’s unique pattern of gratifying and
tions to the mental health of individual family repressing his or her instinctive drives. From an
members. Sullivan emphasized the importance of interpersonal or family psychodynamic perspective,
peer relationships in personal and social develop- it is the unconscious storing, or introjection, of
ment, stressing that the seeds for later disturbance unique early relational experiences or so-called
were sown in early dealings with others. This object relationships that is at the core of personal-
emerging “interpersonal” view in psychiatry was ity development. It is peoples’ inner world of
formalized in the 1960s with the development of a internalized object relationships that forms the
psychodynamic family therapy training program at blueprint for how they will come to regard them-
the Washington School of Psychiatry in Washington, selves and relate to others in later life. This is due
D.C. In the 1970s, the program recruited the psy- to the fact that very young children do not view
chiatrists David Scharff and Jill Savage (now their parents as individuals but, rather, as a part of
Scharff), whose object relations view of family themselves or, in Kohut’s terms, as self objects. As a
treatment centered on addressing parents’ destruc- result, the good or bad qualities they attach to their
tive projections of past relational conflicts from early object relationships with significant others
their families of origin onto their current family become the bases for their self-assessments of
relationships with spouses and children. By the “good me” or “bad me,” which then become a part
mid-1980s, the Washington School of Psychiatry of their responses to future interpersonal situations.
had become (and remains) a leading center for psy- Psychodynamic family counselors hold that
chodynamic family therapy in the United States, marital partners often choose and relate to each
and during the 1990s, the Scharffs went on to form other in unconscious ways that are intended to
the International Institute for Object Relations resolve the negative self-assessments stemming
Therapy in Chevy Chase, Maryland, where they from their early family-of-origin relationships. As
actively continue to promote their object relations a defense against the anxiety caused by these
approach as the primary bridge between psycho- assessments, the partners unconsciously external-
analytic and family therapies. ize, or project, unwanted perceptions of themselves
onto each other and their children and then
Theoretical Underpinnings respond, or identify, in family relationships based
on a partner’s or child’s resemblance to the pro-
At the core of all psychodynamic treatments is the jected perceptions. From a psychodynamic family
discovery and interpretation of unconscious psy- counseling point of view, family problems occur
chological impulses, or drives, and the defenses whenever family member relationships are based
against them. Whereas proponents of Freudian on these projective identifications rather than on
psychoanalytical theory contend that these instinc- the reality of how members truly behave. Resolution
tive drives are sexual and aggressive in nature, of family problems lies in family members gaining
psychodynamic family therapists view the drives as insight into and, thus, freedom from burdensome
being toward attachment to constant and attentive projections so that their relationships can develop
other people. Drawing on Heinz Kohut’s Self honestly and in the present.
Psychology theory, psychodynamic family thera-
pists acknowledge a direct relationship between a
Major Concepts
child’s success in satisfying his or her drive for a
safe and secure relationship with a parent or pri- In their work with families, psychodynamic family
mary caregiver and the child’s success in making therapists draw on concepts from both classical
and sustaining relationships later in life. Those (Freudian) and interpersonal psychoanalytical the-
children who grow up feeling insufficiently ories. Those concepts include, but are not limited
attended to and nurtured by primary caregivers to, psychological drives, intrapsychic conflicts,

defense mechanisms, Self Psychology, object subconsciously to shape their adult social relation-
relationships, the holding environment, splitting, ships and interactions. A primary goal of the psy-
and projective identification. chodynamic family therapist is to help clients gain
insight into how these introjected object relation-
ships from the past may be at the source of
Psychological Drives
problems in their current relationships.
Psychological drives are instinctual needs that
have the power to direct individual behavior.
The Holding Environment
Whereas Freudian psychoanalysts were interested in
clients’ sexual and aggressive drives, psychodynamic A holding environment refers to the safe and
family therapists are more interested in clients’ nurturing environment that children need from
drives toward secure attachments to other people. their parents or caregivers for healthy psychologi-
cal development to occur. It also refers to the com-
parable environment that the therapist seeks to
Intrapsychic Conflicts
create for the client in order to promote optimal
Intrapsychic conflicts refer to unconscious men- growth and healing.
tal struggles that result when one’s impulses and
drives are incongruent with or unmet by existing Splitting
realities. Psychodynamic family therapists seek to
discover how such conflicts that occurred in early Splitting refers to a defense mechanism used ini-
relationships may be preventing clients from tially by very young children to cope with the
relating effectively in the present. anxiety of negative experiences with their parent or
caregiver. Unable to reconcile the negative experi-
ence with their need and desire for a caring parent,
Defense Mechanisms they form two distinct internal images of the parent
Defense mechanisms are unconscious psycho- and acknowledge only the good image while mini-
logical strategies that people apply to protect mizing or repressing the bad image. As children
themselves from the overwhelming anxiety created grow older, most of them are able to integrate the
by intrapsychic conflicts. Projective identification two conflicting images and accept others as having
and splitting are two defense mechanisms that are both good and bad qualities; but if the conflict is
of particular interest to psychodynamic family not resolved, then their view of others (and them-
therapists. selves) as either all good or all bad will impair their
ability to develop satisfying adult relationships.
Self Psychology
Projective Identification
Self Psychology is Kohut’s version of psycho-
analysis, which emphasizes the importance of Projective identification is an unconscious men-
parental modeling and nurturance to the healthy tal process in which relating individuals defend
psychological development of children. It supports against anxiety by projecting unwanted, or split-
the interpersonal view of psychodynamic family off, aspects of themselves onto each other and then
therapy by describing the means by which an indi- relating to each other on the basis of those projec-
vidual’s sense of self-esteem is a product of the tions rather than on each other’s actual behavior.
quality of his or her relationship with parents or For psychodynamic family therapists, the projective
primary caregivers. identification process is seen as a primary source of
relational difficulty to be addressed in therapy.
Object Relationships
Techniques
Object relationships refer to images, or introj-
ects, of subjective experiences in early relationships Despite the differences between traditional (indi-
with caregivers that children carry into adulthood vidual) and interpersonal (family) psychoanalyti-
as objects in their subconscious and that they use cal theories, the two share five common techniques

Psychodynamic Family Therapy 819
aimed at clients’ insight into the unconscious and emotions (countertransference) in response to
processes that are affecting themselves and their it. However, in contrast to the classical psychoana-
relationships with others. Those techniques are lytical model, psychodynamic family therapists
listening, analysis of resistance, analytical neutral- also look for ways in which the resistance of indi-
ity, transference, and interpretation. In addition, vidual family members speaks to the unconscious
psychodynamic family therapists are likely to relational processes affecting the cohesiveness and
assume more active influence on the therapeutic interaction patterns of the entire family.
process than their more traditional psychoana-
lytical counterparts through the application of Transference
techniques such as expanding the field of
participation, working in the here-and-now, and Transference refers to the client’s projection of
addressing complementarity. feelings, attitudes, and desires onto the therapist. It
is used in psychodynamic family therapy to under-
stand what the dominant emotions are within a
Listening
family and toward whom in the present or past
For psychodynamic family therapists, listening those emotions are directed. Through the transfer-
is the most important technique that can be ence process, family members form a bond with
applied in the therapeutic process because it is only the family therapist and act toward the therapist as
through effective listening that the therapist can though he or she is the actual person toward
achieve accurate insight into a family’s complex whom the emotions are directed. By releasing pent-
array of conscious and unconscious dynamics. up emotions, gaining new insights, and learning
Effective listening involves resisting the temptation new ways to interact within the transference pro-
to be drawn in to reassure, advise, or confront cess, family members are able to work through
families in favor of sustained but silent immersion their unfinished business of the past and more
in their experience. Methods for achieving this objectively face the issues in their present lives.
include a therapist maintaining balanced attention
to what clients are saying without directing notice
Analytical Neutrality
to any one thing in particular; avoiding the prac-
tice of note taking in session, as it requires selective In contrast to some models of family therapy in
attention to what has been said; and maintaining which the therapist works to become an active part
emotional control so as not to be inadvertently of the family system, psychodynamic family thera-
attentive to a particular topic as a result of its strik- pists tend to adopt a more neutral stance of
ing an emotional chord. Because desired family involved impartiality so that they can be attentive
outcomes are seen as a by-product of insight and to what is happening to themselves within the
understanding, the psychodynamic family thera- therapeutic process (i.e., countertransference) as
pist characteristically suspends direct effort to well as what is taking place within the family.
promote outcomes in favor of establishing, through Although careful to create a warm and safe thera-
effective listening, a climate for deep analytical peutic, or holding, environment, they remain out-
exploration. side the family system in order to be an impartial
target, or object of transference, onto whom vari-
Analysis of Resistance ous family members can project and work through
their unfinished problems of the past.
Psychodynamic family therapists do not differ
from classical psychoanalysts in their belief that
Interpretation
points of client resistance to the unfolding of
therapy hold the clue to understanding important Interpretation has been referred to as the work-
intrapsychic conflicts that may be at the source of horse in psychodynamic family therapy. It refers to
the resistance. As a result, they attempt in therapy the family therapist sharing his or her acquired
to analyze and understand the resistance by identi- understanding of a family’s problematic and often
fying and processing the observed resistance with unconscious processes to help the family members
the clients and by examining their own thoughts resolve their problems through greater conscious

insight into those processes. Psychodynamic family that marital partners often take on roles that are
therapists are careful to provide interpretations regulated by early relational experiences rather
only after acquiring deep understanding of the than by the adaptational needs of their current
family and in such a way that family members are relationship. When this occurs, their relationship is
able to modify the new understanding as needed to subject to a failure of complementarity, whereby
align it with their shared experience. Interpretation there is an imbalance between the partners in the
is intended to help families understand the prob- level of satisfaction received from their individual
lems they are facing and also to convey that the roles. By examining the complementarity of current
family therapist is working hard to understand and family roles, a psychodynamic family therapist can
assist them. discover important clues about relationships in the
past that may be keeping the family from adapting
successfully to its present relational context.
Working in the Here-and-Now
In a sharp departure from the focus of classical
psychoanalysts on analyzing past relationships, Therapeutic Process
psychodynamic family therapists often find con- The primary goal of psychodynamic family
siderable therapeutic power in analyzing relational therapy is to free family members from the uncon-
interactions that occur spontaneously within the scious restrictions imposed by early relationships.
therapy session itself. Interactions, such as an To achieve this goal, the family therapist first
angry look, an interruption, a hurtful comment, or establishes a warm and safe holding environment
loss of temper, that occur in the therapy session are in which family members feel free to interact with
shared and, thus, felt by everyone. Psychodynamic one another for the sake of growth and healing.
family therapists may call attention to such inter- Next, the family members are encouraged to share
actions when they occur, viewing them to be a their early relational experiences with caregivers so
powerful medium for family-wide engagement in that the family therapist can assess and interpret
the transference and interpretation processes. for them the intrusive internalized conflicts and
projective identifications that may be negatively
affecting their current interactions. Once the intru-
Expanding the Field of Participation
sions are identified, the therapist then helps the
Psychodynamic family therapists often work to family members to resolve or work through them
engage all family members in the therapy session. and learn to interact with one another on the basis
When a recurring issue between two family mem- of current realities rather than past object relation-
bers is raised, it is not uncommon for the therapist ships. Successful treatment is measured more by the
to ask other family members to offer their thoughts family’s increased insight and self-understanding
and feelings about the issue and about the family than by immediate relief of symptoms.
members who repeatedly engage in it. For psycho-
dynamic family therapists, the purpose of expand- Rip McAdams
ing family member participation is twofold. First, it
See also Ackerman Relational Approach; Adlerian
supports the establishment of an inclusive holding
Therapy; Attachment Theory and Attachment
environment wherein all family members can feel
Therapies; Contextual Therapy; Freudian
free to interact and express themselves. Second, it Psychoanalysis; Interpersonal Psychoanalysis; Object
leads to more useful interpretations by illuminating Relations Theory; Self Psychology
the context in which family interactions occur and
other family members emotionally respond to them.
Further Readings
Ackerman, N. W. (1966). Treating the troubled family.
Examining Complementarity
New York, NY: Basic Books.
Complementarity refers to the degree of har- Bowlby, J. (1988). A secure base: Parent/child attachment
mony that exists among the roles of various family and healthy human development. New York, NY:
members. Psychodynamic family therapists assume Basic Books.

Psychodynamic Group Psychotherapy 821
Böszörményi-Nagy, I. (1987). Foundations of contextual and these concepts, in the context of group pro-
therapy: Collected papers of Ivan Böszörményi-Nagy. cess, are critical to psychodynamic group therapy.
New York, NY: Brunner Mazel.
Burnham, J. C. (Ed.). (2012). After Freud left: A century
of psychoanalysis in America. Chicago, IL: University
Historical Context
of Chicago Press. For all practical purposes, group therapy came into
Gerson, M. J. (2010). The imbedded self: An integrative being as a viable therapeutic modality during and
psychodynamic and systemic perspective on couples just after World War II. The necessity of treating
and family therapy. New York, NY: Routledge. large numbers of soldiers and civilians requiring
Kohut, H. (1977). The restoration of the self. New York, psychological care during those war years led to
NY: International Universities Press. seeing them together in groups. As military doc-
Scharff, D. E., & Scharff, J. S. (1987). Object relations tors, nurses, and medics began to work with their
family therapy. Northvale, NJ: Jason Aronson.
patients in groups, they began to notice that
Spillius, E., & O’Shaughnessy, E. (2011). Projective
groups had a powerful and unanticipated effective-
identification: The fate of a concept. New York, NY:
ness as a treatment modality. Meeting in groups
Routledge.
made treatment more potent, and thus, group
St. Clair, M. (2004). Object relations and self-psychology:
An introduction (4th ed.). Belmont, CA: Thompson-
therapy came to be.
Brooks/Cole.
This time period was also the heyday of psycho-
Zimmer, J., & Shapiro, R. (1976). Projective identification analytic therapy. However, most centers of psycho-
as a mode of perception of behavior in families of analytical training did not view this new group
adolescents. International Journal of Psychoanalysis, therapy as a particularly useful modality. Analysts
5, 523–530. practiced one-on-one therapy, typically with
patients lying down and facing away. They
depended on the fantasies, projections, and trans-
ferences of their patients to make inferences about
PSYCHODYNAMIC GROUP what was going on in their client’s unconscious
and to reconstruct the etiology of their client’s per-
PSYCHOTHERAPY sonality and psychopathology. Many psychoana-
lysts felt that the multiperson setting of group
Although Sigmund Freud (1856–1939) never therapy would interfere with those curative fac-
applied his principles to group therapy, he did have tors. In particular, they believed that the presence
a regular group that met in his apartment begin- of many people would preclude the effective use of
ning in 1902. The Wednesday Psychological Society transference and free association for the individual
included psychoanalysis luminaries such as Karl members.
Abraham (1877–1925), Alfred Adler (1870–1937), For the early group therapists, it soon became
Sandor Ferenczi (1873–1933), Carl Jung apparent that psychodynamic principles would
(1875–1961), and Otto Rank (1884–1939), who work effectively in group settings. They found that
kept notes and collected the dues. Founded to dis- transference was alive and well in groups, though
cuss psychoanalytical theory, over time, it became in a somewhat different form. The transferences in
so highly personal and contentious that in 1908 groups, at least initially, are horizontal rather than
Freud disbanded the group and re-formed it under vertical; that is, members project their expectations
a new name that he hoped would keep it more and fears onto their fellow group members, or
academic in focus: The Vienna Psychoanalytic even onto the group as a whole, more powerfully
Society. Today, psychodynamic group psychother- than onto the leader. When members experience
apy is grounded in Freud’s psychoanalytical theory, distorted views of the therapist (vertical transfer-
and most modern theories of psychological treat- ence), the group often gains by comparing the dif-
ment owe some debt to Freud’s pioneering insights. fering views of the leader held by various members.
For instance, his concepts of the unconscious, free Analysts in that era also believed that free asso-
association, transference, and countertransference ciation, the “divining rod” that takes patients to the
are now woven into the fabric of Western society, deepest recesses of the unconscious, would not

822 Psychodynamic Group Psychotherapy
work in a group setting. It turned out that in groups, therapists with “solutions,” not problems. In other
“free association” became “group process” and the words, the problems that are presented are the
associations of the whole group became data that result of the patient’s attempts at adaptation as he
helped illuminate the deeper processes of the group or she unconsciously tries to resolve past conflicts.
and the individual members. Just as analysts assume However, such adaptation either no longer works
that all content is related, group therapists listen or becomes too much of a burden for a person to
for how topics that arise are connected. In fact, carry. The dynamic assumption is that whatever
while it may appear that topics occur randomly in atypical behavior the counselor or therapist sees
group meetings, psychodynamic theory suggests can be understood and altered if the problem it is
that topics are almost always related. attempting to solve can be unlocked. These dynamic
Also at this time in history, the foundations of assumptions can be worked at individually or in a
Freud’s theory were undergoing revision. For group format; however, the group process offers a
Freud, psychopathology was an internal, solitary rich and somewhat different focus from individual
struggle between the innate, biological instincts of therapy as patients can gain a better understanding
individuals and the dictates of society. The goal of of the unconscious, projection, resistance, and
maturation was healthy independence. Freud’s fol- transference by viewing other patients’ experience
lowers, however, began to formulate the funda- in the group and by gaining feedback from the
mental thrust of personality as relational. The goal group leader and from group members.
of maturation was no longer the ability to be inde-
pendent but, instead, the ability to be in healthy
Major Concepts
relationships. This began early with Freud’s daugh-
ter Anna (1895–1982), who is typically credited An overall goal of psychodynamic group therapy is
with founding object relations theory by suggest- to help individuals become aware of their basic,
ing that the goal of instincts is not self-preservation unexamined assumptions about life—that is, mak-
or procreation but rather to be in relationship. ing the unconscious conscious. To do this, a num-
Adler suggested that inner conflict was not the ber of traditional psychoanalytical processes are
driving force of personality; rather, it was the indi- integrated within a group format. Thus, many of
vidual’s innate desire to relate to and build a sense the major concepts of psychodynamic group ther-
of community with others. Jung moved away from apy are basic to all types of psychodynamic work
Freud’s highly individualized theories by proposing and are highlighted in this section.
the collective unconscious, which assumed that all
people share a similar heritage to which they can Unconscious Processes
relate. At around the same time, Rank viewed this
issue from the opposite side—separation anxiety. The most radical of Freud’s hypotheses, and the
For Rank, personality is forged in response to a one on which all others rest, is the suggestion that
dread of separation, which he traced to leaving there is an out-of-awareness world of perceptions,
the womb. As psychodynamic theory became rela- memories, and affects that influences how persons
tionally based, group therapy became an obvious perceive and react to their world. Psychopathology
psychodynamic treatment modality. occurs when people react to current stimuli or
Although today’s psychodynamic groups are still relationships as if they were reacting to those
based on many traditional psychoanalytical con- archaic, unconscious assumptions. In group ther-
cepts, such as the unconscious, transference, and apy, unconscious assumptions are continually pres-
projection, they are also heavily influenced by the ent and are immediately available for observation
interpersonal modifications of classic psychoana- as fellow group members confirm or contest the
lytical theory. Modern groups emphasize corrective assumptions on which others operate.
relational experience as a primary healing factor.
Transference
Transference is the distorting of current
Psychodynamic group therapy is based on the relationships on the basis of much earlier relation-
conviction that patients come to counselors and ships. As such, understanding this process in a

Psychodynamic Group Psychotherapy 823
patient becomes a primary means of inferring the Epigenetic Development

patient’s earlier, formative relationships. In fact, it
Psychodynamic theory assumes that personality
has been suggested that transference explains why
is formed developmentally, with each subsequent
we can never really know another person as we are
stage depending on the prior stage. Inadequately
always transposing earlier relationships onto those
mastered early stages of development will adversely
we are close to. In groups, transference is often
influence all succeeding stages. It is assumed that
more evident, because a panel of trusted peers is
problems in early developmental stages can be
available to assess the perceptions of individuals.
repaired by healthy interpersonal interactions
later in life. In mature groups, members come to
Resistance understand the critical developmental times in the
Patients resist change, and the examination of lives of other group members and can help them
resistance is another window into the unconscious. understand how particular times in their history
Typically, resistance is misunderstood as resistance have influenced their views of themselves and the
to growth, or even therapy itself. In fact, resistance world.
occurs when patients anticipate pain or discomfort
(rejection, overwhelming affect, etc.). Careful exam- Group Process
ination of resistance provides data about what
Where psychoanalysts followed free association
patients “expect” will be painful and thus indicates
as a guide to unconscious material, group thera-
that a patient is close to understanding an important
pists follow group process. Just as analysts believed
part of self. In groups, the resistance that individuals
that free association was anything but “free,”
exhibit is much more transparent because the other
group therapists assume that whatever topics arise
group members come to expect and name it.
in group are in some way linked to what had gone
before and that by trying to understand those
Determinism links, important information about unconscious
material might be detected.
Psychodynamic theory assumes that all human
behavior is lawfully connected, and thus, all
behavior is predictable if we could understand Techniques
how past events affect current-day living.
Philosophically, determinism posits that whatever Interpretation
happens is determined by prior factors and that no Psychodynamic therapists make interpretations.
other result is possible. Therapeutically, this leads They try to discover the unconscious narratives
to the conviction that the behavior therapists that explain the dysfunctional behavior of patients.
observe in their patients and themselves is deter- Interpretations need not be correct to be helpful,
mined by the past. In therapy groups, members can because just making them implies that there is an
observe different styles of relating and can associ- explanation for otherwise irrational behavior. In
ate those styles to history. For example, the adult group therapy, interpretations often follow obser-
who was beaten as a child is likely to view vation of the interpersonal styles demonstrated in
personal intimacy as potentially dangerous. group interactions.
Adaptive Behavior Free Association

All human behavior, however atypical or odd, is To the degree that patients can set aside logic
adaptive, which means that the behavior arose as a and simply report what comes to mind, they can
response to perceived danger or to gain interper- gain clues into some of the deepest workings of
sonal nurturance, and thus makes sense within this their unconscious. In groups, how one relates to
context. In group therapy, other members become others is a kind of free association as the mem-
aware of traditional defenses that individual members transfer their earlier relationship patterns
bers demonstrate, and they can flag and name onto the other group members in a “free”-form
them when they occur. manner.

824 Psychodynamic Group Psychotherapy
Analysis of Defenses their problems or by demonstrating them through

their actions in the group. The role of the thera-
Patients develop defenses to protect themselves
pist is to provide a safe environment where mem-
from anticipated danger or pain. These defenses
bers can share and reveal their characteristic
can range from denial, to anxiety, to depression, to
interpersonal style. In this setting, members will
psychosis, and so on. A careful analysis of defenses
come to understand their characteristic assump-
can help understand the danger or pain under-
tions about themselves and how they typically
neath the defenses and the origins of the defenses—
interact in interpersonal relationships. Through
why they were created. In therapy groups, these
feedback from the group leader and from group
defenses, especially those that defend against inti-
members, they will have a chance to gain knowl-
macy and interpersonal vulnerability, are especially
edge about their defenses, their resistances, their
evident and can be acknowledged, interpreted,
transferences, and their unconscious and slowly
and, in time, understood by patients.
begin to know why they respond to others in the
manner that they do. Then, they can decide to
Appreciation of Countertransference correct distortions in current relationships that
are the result of unconscious conflicts from past
Modern psychodynamic practitioners under- relationships. Some have called this process a
stand that they are not “experts” analyzing patients. “corrective emotional experience.”
They are involved in a relationship with their
patients, and as part of those relationships, they are J. Scott Rutan
“invited” to have certain feelings. Practitioners can
feel very differently with different patients as they See also Cognitive-Behavioral Group Therapy; Existential
enter each patient’s interpersonal field. This is per- Group Psychotherapy; Gestalt Group Therapy;
haps the richest source of data practitioners have Interpersonal Group Therapy; Psychoeducational
about their patients. And this is to be distinguished Groups; Tavistock Group Training Approach
from classic countertransference, in which the
therapist’s past precludes accurately understanding
patients. Sitting in a therapy group provides a rich Further Readings
opportunity for a therapist to assess his or her Alonso, A., & Swiller, H. I. (1993). Introduction: The case
countertransference because it can be measured for group therapy. In A. Alonso & H. I. Swiller (Eds.),
against the feelings of group members. For Group therapy in clinical practice (pp. xxii–xxiii).
example, if the therapist finds himself or herself Washington, DC: American Psychiatric Press.
feeling angry at a particular patient, it is often dif- Billow, R. M. (2003). Relational group psychotherapy:
ficult to determine if this is countertransference or From basic assumptions to passion. London, England:
an accurate response to the interpersonal field of Jessica Kingsley.
the patient. In group therapy, the therapist can Gans, J. S., & Alonso, A. (1998). Difficult patients: Their
observe the reactions of other group members and construction in group therapy. International Journal of
can see if they share the same reaction. Group Psychotherapy, 48, 311–338.
Greene, L. R. (2012). Group therapist as social scientist,
with special reference to the psychodynamically
Therapeutic Process oriented therapist. American Psychologist, 67,
477–489. doi:10.1037/a0029147
Psychodynamic groups typically do not begin Kauff, P. F. (1997). Transference and regression in and
with an agenda or topic, but there is an expecta- beyond analytic group psychotherapy: Revisiting some
tion that members will be as honest as possible in timeless thoughts. International Journal of Group
sharing feelings, reactions, and memories. As the Psychotherapy, 47, 201–210.
group begins, one patient will bravely decide to Malcolm, J. (1981). Psychoanalysis: The impossible
share intimate parts of himself or herself. This profession. New York, NY: Vintage Books.
sharing will stimulate the associations and con- Nitsun, M. (1996). The anti-group: Destructive forces in
tributions of others. Soon, other group members the group and their creative potential. London,
will reveal parts of themselves by talking about England: Routledge.

Psychoeducational Groups 825
Ormont, L. R. (1967). Group resistance and the facilitation tasks, and group stage development.
therapeutic contract. International Journal of Group The structure and direction for psychoeducational
Psychotherapy, 18, 147–154. groups are different because of the following rea-
Rutan, J. S. (1992). Psychodynamic group psychotherapy. sons: (a) leaders do not usually engage in pregroup
International Journal of Group Psychotherapy, 42(1), screening or have the option to select or reject
19–35. doi:10.1016/B978-012564745-8/50016-9 group members; (b) the leader predetermines the
Rutan, J. S., Stone, W. N., & Shay, J. J. (2007). goals and objectives and preplans the focus,
Psychodynamic group psychotherapy (4th ed.). emphasis, and activities; and (c) the group is gener-
ally closed, not accepting new members after the
Shay, J. J. (2011). Projective identification simplified:
group begins. Time for psychoeducational groups
Recruiting your shadow. International Journal of
differs in that the groups generally have a specific
Group Psychotherapy, 61, 239–261. doi:10.1521/
duration, such as a predetermined number of ses-
ijgp.2011.61.2.238
Stone, W. N. (2005). Group-as-a-whole: A self
sions over a scheduled period of time, which is
psychological perspective. Group, 29, 239–255.
communicated to members prior to the group’s
Yalom, I. D., & Leszcz, M. (2005). The theory and beginning. A short duration can mean that there is
practice of group psychotherapy (5th ed.). New York, insufficient time to allow many group processes
NY: Basic Books. and therapeutic factors to unfold.
Leader facilitation tasks for psychoeducational
groups can differ because there is more emphasis
on dissemination of information and exploration
PSYCHOEDUCATIONAL GROUPS of family-of-origin factors is discouraged, as is
deepening the experience or intensifying emotions.
Psychoeducational groups—also referenced in the These groups may not be of sufficient length to
literature as structured, guidance, and themed complete all of the group stages: beginning, con-
groups—are groups that are usually organized and flict/transition, working, and termination. Group
presented for members who have a commonly held leaders have to be emotionally prepared to not
condition, issue, illness, or disorder and that fea- have the group experience the productive or work-
ture a balance of cognitive material and emotional ing stage, as the process to reach this stage may not
expression. Many cognitive-behavioral therapy have time to be developed.
groups could also be characterized as psychoedu- There are numerous similarities with other
cational. Psychoeducational groups are generally types of groups, including clinical groups. The
time limited, with the duration of the group speci- group leader’s preparation and facilitation skills,
fied in advance, where once the group is formed, and fundamental group factors are critical compo-
no new members are added, the format is struc- nents for all types of groups and may be more so
tured, the leaders are active and directive, and for psychoeducational groups because of time
there are predetermined goals and objectives. The constraints. Leader preparation includes instruc-
major purposes for this modality are to present tion and supervised practice in group leadership,
information that members can use to cope more understanding of the leader’s personal issues and
effectively with the issue, condition, illness, or dis- unfinished business that can produce potential
order that brought them to the group; to learn new countertransference, and a knowledge base for the
skills; to provide opportunities for emotional issues and conditions that will be addressed in the
expression; and to experience personal growth and group. Leader facilitation skills consist of observa-
development. Psychoeducational groups are an tion and use of group dynamics, a focus on group
essential part of other treatment modalities such as process, managing problem or difficult member
Linenhan’s Dialectical Behavior Therapy and behaviors, enforcing group rules, and identification
McFarlane’s multifamily groups for the treatment and repair of empathic failures. Psychoeducational
of severe psychiatric disorders. group leaders also have to be aware of fundamen-
Psychoeducational groups differ from many tal group factors, which include the effect of
clinical or psychotherapy groups in several ways, culture and diversity on group members, ethics and
such as in structure and direction, time, leader ethical decision making, the importance of group

826 Psychoeducational Groups
therapeutic factors and how to foster their behavior, social influences on groups, and the
emergence, and creation of the therapeutic alliance. importance and impact of group leaders’ training
and facilitation. The principles of experiential
learning are key components for psychoeduca-
Historical Context
tional groups because much of their emphasis is on
Although Joseph Pratt used psychoeducational learning.
groups as the starting point for applying the group Although research and applications attention
modality to treatment in the early 1900s, the was given primarily to psychotherapy groups, the
actual designation or term psychoeducational outcomes proved applicable to psychoeducational
groups did not emerge until late in the century, groups as well. Among the contributions that link
around 1990. Pratt was a physician who decided to psychoeducational groups are those from
to treat tuberculosis patients with a structured Wilfred Bion, the work done through the Tavistock
educational and psychological group approach in Institute, Harry Stack Sullivan, Heinz Kohut and
which both information dissemination and estab- Carl Rogers, and Albert Ellis and Aaron Beck. Bion
lishing relationships between group members were contributed the group-as-a-whole perspective and
emphasized. He also became interested in psychol- the basic assumptions of dependence, fight-
ogy and began to apply many psychology princi- or-flight, and pairing; focused on the task of the
ples to his group work. Many recognize his work group; and instituted group-as-a-whole interven-
as the beginning of group therapy. tions, such as group process commentary, where
Pratt began groups with medically ill patients, the leader comments on his or her observations of
and this practice continues even today, with psy- the group as a whole. Tavistock groups emphasized
choeducational groups conducted for a variety of the importance of the leader’s management
medical illnesses, such as diabetes, cancer, vascular of boundaries with regard to both time and
and cardiac diseases, and AIDS. These groups also space. Sullivan proposed the importance of the
have a significant emotional component in treat- interpersonal approach; both Kohut and Rogers
ment and healing. Other areas in which psycho- emphasized the importance of empathy; and Ellis
educational groups are being increasingly used and Beck drew attention to the importance of emo-
include emotional disturbances such as anorexia tional reactions. Other concepts that grew out of
and schizophrenia; skills development such as research and theory for psychotherapy groups that
communication and relationship building; care- also apply to psychoeducational groups include the
giver support for those caring for people with therapeutic contract, linking or bridging, the critical
cancer and Alzheimer’s disease; court-ordered and importance of the therapeutic alliance, curative or
incarcerated felons, such as perpetrators of inti- therapeutic factors, stages of group development,
mate partner violence; training groups for mental how important messages are contained in group
health professionals; personal growth and devel- process, and how the group’s progress can be
opment; life transitions such as career, aging, and facilitated with group process commentary.
divorce; and prevention and wellness.
Since the early 1930s, much of the psychother-
apy field’s attention, research, and emphasis moved
to exploring group processes, leadership, and tech- Theories that provide the framework for psycho-
niques as applied to group psychotherapy, although educational groups include the learning theories:
many of the groups described and studied could be behavioral, cognitive, constructivist, and connective
classified as psychoeducational groups. theories; social-interpersonal theories, such as per-
Another prominent contributor to psychoedu- son-centered and interpersonal theories; and cre-
cational group development was Kurt Lewin, who ative/expressive theories and therapies. Behavioral
created the structure for training groups and expe- research provides evidence for those theories about
riential learning principles, which led to the devel- how people learn, the role of memory, and how
opment of the National Training Laboratory. transfer occurs. Cognitive theories demonstrate the
Lewin’s other contributions include the use of field importance of conceptualization, clear objectives,
theory, understanding how environment influences reasoning, and problem solving. Constructivist

theories include the subjective experiencing of cannot be overstated, as these are the factors for
individuals in making meaning and the importance optimal positive group functioning to establish
of engagement, participation, and social and cul- trust, safety, and a constructive and positive group
tural factors. Connective contributions include the climate and to encourage participation. The struc-
intersection of prior learning and experiencing, tural and science leader tasks are planning, orga-
perceptions, and the use of technology. nizing, directing, evaluating, structuring sessions,
Social-interpersonal theories address relation- and matching the group members’ needs to the
ship building and communication that can enhance material. Teaching and group process skills help
relationships and help them become meaningful balance the cognitive and affective needs and
and enduring. Learning socialization skills is also expectations for the group. Presenting cognitive
an important component using social-interpersonal material can be accomplished in various ways,
theories. The role of creative/expressive techniques such as through lectures, discussions, the media,
is a significant contributor to these groups, and the readings, and the Internet. Affective tasks include
theories that underlie their uses provide an under- the skills of facilitating members’ self-disclosure
standing of how they can enhance the learning of and interactions among members and with the
group members. group leader, giving and receiving feedback,
encouraging emotional expression, and modeling
how to manage conflict constructively and to man-
Major Concepts age and contain intense feelings. The range of tech-
The major concepts associated with psychoeduca- niques that can be used is vast, and group leaders
tional groups are the components for leaders, the need to understand how to select techniques that
principles of experiential learning, an emphasis on are compatible with the needs of the group and of
cognitive learning, social interactions and communi- individual members, to not rely solely on tech-
cation with others, and here-and-now experiencing. niques and activities, and to have the facility to
demonstrate how these are enhancements to mem-
bers’ self-understanding, growth, development,
Components for Leaders
and healing.
Psychoeducational groups are best if organized
around the blended components of the leaders’
Principles of Experiential Learning
knowledge, level of self-development, attention to
the structural and science factors for the group, The principles of experiential learning are a
teaching and group process skills, and selection of major component for psychoeducational groups.
techniques and strategies. It is helpful when group The three principles are (1) a social and supportive
leaders know the fundamentals about groups, such environment that promotes intrapersonal and
as group stage development and expected member interpersonal learning, (2) that learning is enhanced
behaviors, observation and use of group dynamics, with active participation, and (3) that behavioral
the importance of fostering the emergence of change is fostered by the group’s interactions and
group therapeutic factors, specific information feedback and by members’ appreciation of one
about the central focus of the particular group, another. Experiential learning includes participa-
and the principles of instruction. The leader’s level tion, discussion of group process, as well as group
of self-development is critical for developing the activities. Participation is critical, as research seems
therapeutic alliance, as it is the leader’s essential to support that the level of involvement can deter-
self that conveys warmth, caring, genuineness, tol- mine personal gains both cognitive and affective.
erance, and respect. This self-development is also A discussion of the group’s process can produce
important for cultural and diversity sensitivity, personal learning and understanding for group
constructive use of objective countertransference, members. It seems to be helpful for members to
modeling how to manage and contain personal discuss what took place in the group session, such
emotions, increasing the capacity to be empathic, as the level of participation, the group-level resis-
and the ability to make process commentary. The tance, empathic failures and their repair, and other
importance of the structural and science factors process topics. Group activities offer directed and

828 Psychoeducational Groups
guided opportunities for members to discover suppressed or denied, when members lack the
unrealized or overlooked inner resources, encour- words, or when they have a need to express feel-
age self-disclosure, increase socialization by ings and to then provide time and space where
encouraging member interactions, assist in reduc- group members can feel safe to express these feel-
ing resistance and defensiveness, teach new ways ings. Opportunities for expressing feelings are also
to understand self and others as well as new provided through the use of exercises and other
behaviors, and promote the emergence of many activities that facilitate members’ expressions of
group therapeutic or curative factors. feelings.
An Emphasis on Learning Members’ Interactions

A critical component for psychoeducational Psychoeducational groups can be major oppor-
groups is cognitive learning. Therefore, there needs tunities for social interactions, for teaching relating
to be an emphasis on learning, and it is the leader’s and communication skills, and for members to
responsibility to know the principles of learning learn how to give and receive feedback. The inter-
and retention of material and to implement these actions among members can address the curative
when planning the teaching and learning strategies factors of universality, existential factors by reduc-
to maximize them. This component requires that ing isolation and alienation, catharsis with expres-
the leader attend to the quality and accuracy of the sion of feelings and the interpersonal learning
material disseminated, select the best modality to feedback loop described by Irving Yalom, the
present the material, schedule the sessions to installation of realistic hope, and opportunities for
provide opportunities for members to learn and altruistic actions.
practice new skills, and identify other resources
that can provide the needed information.
Here-and-Now Interactions
Psychoeducational groups offer group members
Expression of Feelings
encouragement to be in the moment with their
The other critical component is the affective thoughts and feelings, to create new ideas and
piece, and although it may appear that the focus or thoughts, and to be able to verbalize these and
topic for the group is very cognitive, the leader is receive immediate feedback and support. They can
likely to find that the affective piece is more impor- learn the value of empathic responding for oneself
tant for some group members. While having a bal- and for others, strategies for managing intense and
ance of cognitive and affective components is very difficult feelings, and how to give and receive con-
important, it is essential that the leader maintain structive feedback.
space and time for expression of feelings, as these
can be the most important part for some members
Techniques
because the group may be the only place where
they can openly express some feelings, especially Techniques are drawn from various theoretical
negative feelings. It is essential that the leader assist perspectives and can be categorized as dissemina-
members in their expression, but it is also essential tion of information, experiential learning, and
that the leader not let the members’ feelings process enhancement. A defining characteristic of
become too overwhelming or too intense for indi- psychoeducational groups is the dissemination of
vidual members or the group as a whole to handle. information, which is the cognitive component and
Feelings can be triggered during discussions when one of Yalom’s therapeutic or curative factors. This
members bring important and urgent matters to is also a part of the group’s structure and direc-
group sessions. Comments or other members’ sto- tions, which are primarily the group leader’s
ries, and even lectures in some instances, can also responsibility to plan, develop, and present. Group
be triggers that cause intense feelings to emerge. leaders take into account the abilities and needs of
Leaders have to remain alert to indirect expres- the target audience, select important and helpful
sions of feelings, when feelings are being information for that audience, and select the mode

for presenting. Dissemination of information can also helpful for group members to discuss and
be accomplished through a variety of ways: expert collaborate on setting the group’s rules and to
speakers, the media, print materials, Internet understand the expectation for group participation
sources, and mini-lectures that provide a modest as a member. The therapeutic process also involves
amount of information at a session. efforts to provide some symptom relief, such as a
Experiential learning uses the principles devel- reduction in anxiety; to establish a realistic hope
oped by Lewin to foster active participation and for growth, coping, and healing; and to promote
provide a personal connection to learning for each universality among group members. These tasks
group member as part of the affective component. can be accomplished with the focus on informa-
Activities and techniques include rehearsal, role- tion, identifying member inner resources that will
play, skills practice, and creative/expressive activi- allow members to participate in their own growth
ties such as art, writing, music, drama, stories, such and healing, and facilitating the development of
as fairy tales, poetry, and the like. The creative/ coping skills that fit each individual member and
expressive activities are used as stimuli but not his or her circumstances.
interpreted by the leader, as would be done by A general template for sessions begins with an
trained professionals in those techniques. opening that sets the time boundary for the group
Process enhancement refers to the leader to begin. This may be a ritual opening, such as a
techniques and strategies that encourage self- short meditation period, identification of current
exploration and self-disclosure and provide for feelings brought into the group, or a short exercise
emotional expression and member-to-member in the first couple of sessions. The opening pro-
interactions in the here-and-now. Leader strate- vides a transition to the here-and-now for group
gies include emotional presence, the identifica- members and focuses their attention. The leader
tion of empathic failures and their repair, a focus then provides a session focus and objectives, sub-
on feelings, and the provision of adequate struc- ject to members’ approval and the absence of
ture and direction. It can also be helpful for something urgent and important a member may
the group leader to openly speak the process need to address or unfinished business from the
commentary when needed. previous session. The planned procedure then
includes information about a predetermined topic
related to the mission and purpose of that particu-
Therapeutic Process
lar group, identification of members’ emotional
The therapeutic process of psychoeducation groups connections to that topic, a short discussion, and,
is similar to that of other types of counseling and when appropriate and when time permits, an activ-
psychotherapy groups in that the initial tasks are ity that encourages disclosure, self-exploration,
the same. Those tasks are to establish a therapeutic and enhancement of the material for that session.
alliance, provide structure and direction, establish The session can close with a summary of what
safety and trust, reduce ambiguity and uncertainty, transpired, a review of the process for the session,
facilitate interactions among group members, and or a transition period of silence or meditation.
encourage emotional expression. Although the Leaders are encouraged to establish a consistent
leader may have a predetermined focus and empha- procedure for ending sessions.
sis that has set the major goals and objectives for Group closing or termination is an opportunity
the group, it is essential that the leader engage to consolidate and make visible members’ prog-
members in collaborative goal setting, whereby the ress, reinforce the use of members’ personal inner
members’ individual goals are combined with the strengths and competencies, provide encourage-
purpose and emphasis of the group to develop ment and support for continued growth and heal-
group goals and objectives that incorporate both. ing, reflect on and appreciate the altruistic acts of
Along with the collaborative goal setting, the fellow group members and the leader, complete
leader addresses ethical issues and concerns, such unfinished business among group members, and
as the need and limits of confidentiality, reporting provide group members with an opportunity to
and documentation requirements, and other learn more satisfactory ways to end an experience
expectations of the leader and the members. It is and relationships. There are many activities that

830 Psychosocial Development, Theory of
can be used to provide closure, with the emphasis psychosocial development shifts the focus to how
on the extent to which the members’ and group relationships and social needs shape behavior.
goals were accomplished, the major cognitive and
affective learning gained, what was personally
Historical Context
helpful for each group member, feelings about
the group and its members, and feelings being In the late 1800s and early 1900s, the psychoana-
experienced about the group’s ending. lytical movement, championed by Freud, domi-
nated the mental health profession by explaining
Nina W. Brown how instincts and childhood sexuality affect psy-
chological development. Erikson was trained in
See also Behavior Therapies: Overview; Cognitive-
Behavioral Therapies: Overview; Creative Arts and
psychoanalysis and was personally analyzed by
Expressive Therapies: Overview; Existential- Anna Freud, Sigmund Freud’s daughter. Although
Humanistic Therapies: Overview trained as an analyst, Erikson eventually came to
believe that social and cultural factors played a
bigger role in development than Freud had sug-
Further Readings gested. Eventually, Erickson’s ideas developed into
Brown, N. (2011). Psychoeducational groups. New York, a theory of development and were highlighted in
NY: Routledge. his 1950 book Childhood and Society and his
Johnson, D., & Johnson, F. (2013). Joining together 1968 book Identity: Youth and Crisis. In contrast
(11th ed.). Upper Saddle River, NJ: Pearson. to Freud’s theory, which focused on childhood
McFarlane, W. (2002). Multifamily groups in the development, Erikson’s eight stages of psychoso-
treatment of severe psychiatric disorders. New York, cial development emphasized lifelong development
NY: Guilford Press. and stressed social influences in contrast to Freud’s
focus on instincts and childhood sexuality.
Erikson’s personal history is compelling, given
his influence on the study of psychosocial develop-
PSYCHOSOCIAL DEVELOPMENT, ment and identity. His mother, a Danish Jew, was
initially married to a Jewish man, Waldemar
THEORY OF Salomonsen. However, when Erikson was born,
Salomonsen had been absent for a number of
Psychosocial theories emphasize the role of rela- months, and because of Erikson’s blue eyes and
tionships as they relate to psychological and per- blond hair, some believed he was the child of an
sonality development. Erik Erikson’s theory of affair. Eventually, his mother married another
psychosocial development is the most widely Jewish man, Theodor Homberbger, who officially
known and applied psychosocial theory, but other adopted Erikson, giving him the name Erik
notable figures include Arthur Chickering and Homberger. The fact that Homberger was not his
Linda Reisser, James Marcia, Otto Rank, and biological father was kept from Erikson for a num-
Karen Horney. Erickson’s theory is not usually ber of years. As a child with light features, he was
applied as a therapeutic approach; however, the often teased at school. These early-childhood fac-
general concepts are frequently used by behavioral tors likely influenced his later ideas about the
health professionals to understand the nature of importance of psychosocial factors in identity
client problems and their possible origins or under- development, for which he is most famous. As a
lying issues. This theory is often classified as neo- young adult, he lacked a formal college education
Freudian because of Erikson’s involvement in the and was a free-spirited aspiring artist. Through a
psychoanalytical movement and because it shares friend, he became associated with the psychoana-
some similarities with Sigmund Freud’s psychoanalytical movement and received a certificate from
lytical theory in terms of how individuals progress the Vienna Psychoanalytic Society. In 1930, he
through the early stages of psychological develop- married Joan Serson Erikson, a Canadian dance
ment. However, rather than a focus on how instructor, and during the early 1930s, they moved
instincts drive and shape behavior, the theory of to the United States, where he eventually taught at

Psychosocial Development, Theory of 831
Harvard and Yale and worked as a clinician. While psychoanalytical ideology. However, his focus on
in the United States, he took on his wife’s name relationships and culture demonstrate elements of
and became Erik H. Erikson, representing the third systems, humanistic, and multicultural perspec-
name change in his life, a notable event for the tives. Because of the fundamental similarities
person who is associated with the concept of iden- between Erickson’s theory of psychosocial develop-
tity crisis. He died in 1994 and, along with Jean ment and Freud’s psychoanalytical theory, it has
Piaget, is considered to be one of the two most been named a contemporary psychodynamic or
prominent figures in developmental psychology. neo-Freudian approach, although the latter term is
Although Erikson is the primary historical often debated. The similarities begin with the stage
figure in psychosocial theory, others also made model of psychological development. Both theories
significant contributions. Karen Horney also influ- believe that age-related developmental tasks or
enced psychoanalytical theory by including more crises related to not fulfilling those tasks guide per-
psychosocial elements. In the 1930s through the sonality development. Therefore, in both theories,
1950s, she postulated that social power was a early-life experiences affect development over the
more important factor in neurosis than was biol- life span. Success in one task promotes the likeli-
ogy, the focus of Freud’s theory, and she integrated hood of success in the next task, while problems
more social and cultural themes into the frame- during one stage can lead to long-term impedi-
work. Alfred Adler, during this time frame, also ments to psychological development. Freud’s tasks
highlighted social themes, such as the importance related more with physical needs, whereas Erikson
of birth order and one’s position in one’s family, as focused on social needs. For example, the first stage
major elements of psychological development. for Freud’s model is the oral stage, where infants
Several researchers have explored in greater receive physical gratification through feeding and
detail Erikson’s ideas on identity development. In other oral behaviors. The first stage in Erikson’s
the 1960s and later, James Marcia studied the model is trust versus mistrust, where infants learn
identity development of teenagers and young to view the world as a safe or unsafe place.
adults and developed four types of identity statuses Psychosocial theory also has post-Freudian
based on exploration and commitment levels. influences connected to attachment theory. John
These are outlined in the “Major Concepts” sec- Bowlby and Mary Ainsworth, key figures in
tion of this entry. Arthur Chickering wrote attachment theory, highlighted the role of emo-
Education and Identity in 1969 and revised the tional bonds with caretakers as a key component
book later in 1993 with Linda Reisser. They of psychological development. Many researchers
expanded Erikson’s theory by focusing on the now believe that early bonding experiences affect
stages of identity development while focusing adult relationships and that attachment styles can
mainly on traditional college students. have lifelong implications.
Psychosocial theory of development has been
influential throughout the history of the various
mental health professions. The core ideas are Major Concepts
taught in undergraduate and graduate courses in Although Chickering and Reisser, Marcia, and oth-
psychology and related professions. In addition, ers have all developed psychosocial theories that
Erikson’s theory has substantially directed mental have been applied to counseling relationships,
health professions by highlighting the importance Erikson’s approach is considered the most widely
of relationships and cultural influences. used. Therefore, this section briefly describes
Erikson’s eight stages of development.
Trust Versus Mistrust
Many researchers struggle with classifying psycho-
social theory of development from a philosophical The first psychosocial stage in Erikson’s model is
and theoretical perspective. Erikson’s theory from birth to approximately18 months of age. This
of psychosocial development, the most widely is a time when a child is building the virtues of hope
applied psychosocial model, is deeply rooted in and faith. The individual needs to find a healthy

832 Psychosocial Development, Theory of
balance between stability (trust) and a healthy from the irresponsibility and powerlessness of
degree of apprehension with others (mistrust). childhood into the responsibility and power of
adulthood. This stage is where the individual begins
Autonomy Versus Shame and Doubt to learn to live within the rules of society, along with
understanding “who” the individual is within that
The second stage in Erikson’s theory of develop- society. When adolescents appropriately explore a
ment revolves around willfulness and determination. variety of roles and activities, they strengthen their
A child 18 months to 3 years of age needs to inde- sense of self. If they fail to explore these possible
pendently explore his or her world but with some identities, then they develop a sense of role confu-
healthy boundaries set by caretakers. Autonomy is sion, which represents a weak sense of identity.
developed when caretakers allow children to explore
and make choices with fewer restrictions. If caretak-
Intimacy Versus Isolation
ers overly restrain children, then the children experi-
ence a lack of self-reliance and a sense of doubt that In this stage of Erikson’s model, people around
could impede future development. the approximate ages of 20 to 40 years are focused
on close and intimate relationships with others
Initiative Versus Guilt within society while maintaining a healthy balance
of not losing themselves within the relationships or
Play is a key factor in this third stage of isolating themselves from relationships.
Erikson’s model for 3- to 6-year-olds. A child is
striving to create courage and purpose as part of
Generativity Versus Stagnation
his or her ego. A healthy proportion needs to occur
between learning new things (initiative) as well as This stage in Erikson’s model revolves around
taking on responsibility and moral judgment. raising children and giving back to society. Between
Children should be encouraged to act on fantasy the approximate ages of 20 and 60 years, individuals
and imagination. They learn new skills and a sense involve themselves not only with other individuals,
of purposefulness through these experiences. particularly children, but also with organizations.
However, a healthy balance must be achieved. If Many individuals in this stage seek a healthy balance
children focus on their objectives without a sense centered on caring for oneself (self-absorption) as
of guilt toward others, then according to Erikson, well as for others (generativity). Stagnation occurs
they become maladaptive and ruthless. when individuals become too self-absorbed.
Industry Versus Inferiority Integrity Versus Despair

Within this stage of Erikson’s model, 6- to This stage in Erikson’s model begins around
12-year-olds are influenced by more than just care- the period of retirement, usually around the age of
takers and family, as this is the time when school 60 years. This is a time in one’s life when an
becomes a key factor, with teachers and peers play- individual reflects on the past with satisfaction
ing a larger part in children’s lives. In this stage, (integrity) or regret (despair), which in turn affects
social skills are a focus for the individual to form one’s present outlook on life.
competence. As children develop skills and compe-
tencies, their sense of industry and confidence Therapeutic Process
increases. A sense of inferiority occurs when these
new challenges are not mastered successfully, and Psychosocial theory provides a structure for under-
children begin to lack confidence. A healthy bal- standing the psychological development of clients
ance between a sense of competence along with a and the underlying causes of their psychological
realization of limitations is needed. problems. Many mental health professionals are
aware of this theory and use it as a lens from which
to understand client stagnation and as a barometer
Identity Versus Role Confusion
to monitor client growth. As a distinct model, it does
Within this stage, a rite of passage is beneficial not offer a system for treating clients, although the
for adolescents (12- to 20-year-olds) to progress principles of the model apply well to the therapeutic

Psychosocial Genomics 833
process. Counselors may use this model to reframe psychotherapy. The holistic arts of mind–body heal-
common client issues within a developmental con- ing from ancient times to the current era of personal
text. For instance, a teenager who is fighting with genomics are embraced within this new evidence-
her parents may not be labeled as dysfunctional but based theory of counseling and psychotherapy.
instead may be considered to be exploring identity
development. Or a 45-year-old client who is feeling
Historical Context
anxious may be wrestling with a lack of being suc-
cessful in his life (i.e., in the generativity vs. stagna- The psychosocial genomics of mind–body healing
tion stage). He may need more time for volunteering was conceived in the 1960s by Ernest Rossi during
or spending time with his family. his 2-year U.S. Public Health Post-Doctoral
Although the psychosocial theory of develop- Fellowship in Clinical Psychology studying psycho-
ment model does not provide techniques for coun- somatic medicine with the physician Franz Alexander.
seling, it may utilize any treatment objective that Psychosomatic medicine studies the impact of psy-
promotes the successful completion of Erickson’s chosocial and behavioral factors on physical health
eight stages of development. Psychosocial theory, and life quality standards. At the time, Alexander was
thus, can be extremely valuable for case conceptu- a leading Freudian analyst teaching in the psychiatry
alization and for developing insight with clients. department at Mount Sinai Hospital in Los Angeles,
California. Rossi initially summarized his observa-
Trey Fitch and Jennifer Marshall tions of Alexander’s work with two publications in
The Journal of Humanistic Psychology, where he
Ego Psychology; Freudian Psychoanalysis
introduced the four-stage creative cycle as the essen-
tial dynamic of counseling and psychotherapy.
Stage 1 of the four-stage creative cycle is get-
Further Readings ting interested in working on a problem. Stage 2
Berk, L. E. (2013). Development through the lifespan (6th is the typically difficult experience of incubation,
ed.). New York, NY: Pearson. struggle, emotions, and conflict. This second stage
Chickering, A. W., & Reisser, L. (1993). Education and is when many people experience symptoms of
identity. San Francisco, CA: Jossey-Bass. stress, anxiety, or depression that lead them to
Erikson, E. H. (1950). Childhood and society. New York, consult a psychotherapist. Stage 3 is the creative
NY: W. W. Norton. moment of getting a flash of insight often
Erikson, E. H. (1958). Young man Luther. New York, described as an “aha!” experience. Stage 4 is the
NY: W. W. Norton. application of this insight for problem resolution
Erikson, E. H. (1968). Identity: Youth and crisis. in the real world. The four-stage creative cycle of
New York, NY: W. W. Norton. inner experience is an approach for counseling
Marcia, J. E. (1966). Development and validation of and psychotherapy, whereby the basic problem is
ego-identity status. Journal of Personality and Social to bring together a mass of data (one’s personal
Psychology, 3, 551–558. doi:10.1037/h0023281 experiences) so that new insights (aha! experi-
Santrock, J. (2013). Lifespan development (14th ed.). ences) can generate a better integration of cogni-
New York, NY: McGraw-Hill. tion, consciousness, and personality. This new
integration of human psychology with biology
based on current neuroscience includes gene
expression research on social variables, the relax-
PSYCHOSOCIAL GENOMICS ation response, therapeutic hypnosis, meditation,
the therapeutic placebo, and yoga.
Psychosocial genomics explores how an individual’s People frequently feel an immediate sense of
positive encounters with art, beauty, and truth as well relief and purpose about exploring their natural
as stress and trauma can modulate gene expression, creative cycle when they can understand how
brain plasticity, and the creation of new conscious- their feelings of depression, tension, anxiety, and
ness. Psychosocial and cultural genomics is the sci- confusion, in Stage 2, are the natural symptoms
ence of how transformational states of mind, body, of a profound widening of consciousness, or
and spirit can be facilitated during counseling and self-awareness, that takes place because of new

834 Psychosocial Genomics
academic and social experiences. Instead of and joyful life experiences, could activate DNA in
focusing on the typically negative reactions of the new science of epigenetics, which integrates
despair and inadequacy about emotional prob- mind, nature, and nurture. Epigenetics is the study
lems, during Stage 2 of the creative cycle, people of how gene expression changes due to signals from
are helped to reinterpret and reframe their symp- the environment. Important life experiences can
toms as positive life possibilities, which in turn can turn on epigenomic patterns of activity-dependent
facilitate the natural growth of their consciousness. gene expression to make the proteins, hormones,
In the 1970s, Rossi continued his postdoctoral neurotransmitters, and growth factors needed to
studies with Milton H. Erickson, who was the generate the growth of new neural networks in the
founding editor of The American Journal of Clinical brain. This became the central insight of psychoso-
Hypnosis and the innovator of a new naturalistic cial genomics as a new evidence-based theory,
school of therapeutic hypnosis. A distinguishing research, and practice of counseling, meditation, and
feature of Erickson’s therapeutic sessions was that psychotherapy. In 2012, a major breakthrough for
they usually lasted 90 to 120 minutes, about dou- the theoretical and experimental underpinning of
ble the 50-minute session of conventional counsel- psychosocial genomics was implied in the simulta-
ing and psychotherapy. Rossi hypothesized that neous publication of 30 leading papers by the
Erickson’s long therapeutic sessions shared many Encyclopedia of DNA Elements (the ENCODE
features of the human biological cycle known as Project) in major scientific journals such as Nature,
Basic Rest-Activity Cycle (also called ultradian Science Genome Research, and Genome Biology.
rhythms). Like cycles of breathing, blood circula- Figure 1 illustrates how the psychosocial genomics
tion, bowel activity, and appetite, ultradian rhythms of mind–body therapy can be conceptualized as an
were correlated with optimal performance, stress integration of the four-stage creative cycle with
reduction, and healing in normal everyday life. mind–body rhythms on all levels from mind to gene.
To explore the natural psychobiological sources The top circle of Figure 1 represents classical
of Erickson’s mind–body therapy, Rossi coedited psychological research with the addition of the
two volumes of international research on ultradian more recent emphasis on consciousness studies of
rhythms with David Lloyd, a professor in the art, beauty, truth, and creativity in current neuro-
School of Pure and Applied Biology at the University science. Key research at this top level explores
of Wales. Charles Darwin wrote in his classical how focused attention, positive expectations, and
volume on The Origin of Species that while we see the novelty–numinosum–neurogenesis effect (fas-
evidence of how evolution progresses over millions cinating, mysterious, and tremendous experi-
of years, the work of evolution actually proceeds ences) tend to evoke the four-stage creative cycle
on a daily and hourly basis. Psychosocial genomics during important life opportunities and crises.
facilitates the natural daily and hourly evolution-
ary work of optimizing adaptive gene expression. Major Concepts
Theoretical Underpinnings While the psychosocial genomics of counseling

and psychotherapy has its theoretical and experi-
During the 1980s and 1990s, neuroscientists made mental underpinning firmly rooted in the sciences
many startling discoveries documenting how mind– of math, physics, biology, and genomics, its exis-
gene communication, cognition (thinking), and con- tential or humanistic aspect is most commonly
sciousness are created on the molecular–genomic expressed in the dramas, literature, and psychology
(biological–genetic) level in daily life. They learned of the arts and humanities.
how novelty, activity, and life experiences could turn
on gene expression, stem cell healing, and brain
Integrating the Twin Cultures of the
plasticity, which documents how normal daily life
Sciences and the Humanities
experience rewires the circuitry of the human brain.
Suddenly, there was a new understanding of how The educational opportunities as well as social
psychological stress and trauma, as well as insightful disruptions of the twin but seemingly opposite

Psychosocial Genomics 835
Art, Beauty & Truth

• Attention
• Expectancy
• Novelty/Numinosum
• Enrichment
Neuroplasticity 1 Bioinformatics
• Synaptogenesis • Activity
• Neurogenesis Mind • Sensory
• Memory • Perceptual
• Learning Crisis/Opps • Motor
4 2
Brain & Body Mirror Neurons
Insight/Apps Intuition
3
mRNA Translation
eRNA Transcription
• Proteins Genomics • ~2 Million Micro RNAs
• Neurotransmitters
• Gene Modulation
• Hormones Adapt/Heal • Cellular Messengers
• Cytokines
Gene Expression
• DNase Sites ~ 3 Million
• Promoters
• Transcription/Translation
Figure 1 The Core Four-Stage Cycle of Psychosocial Genomics

Source: E. Rossi, R. Erickson-Klein, & K. Rossi (Eds.), Collected Works of Milton H. Erickson, M.D. on Therapeutic Hypnosis,
Psychotherapy and Rehabilitation (16 vols.). Phoenix, AZ: Milton H. Erickson Foundation Press (2008–2014).
Note: (1) Experiences of mind are transformed into (2) eRNA molecules in mirror neurons of the brain that turn on
(3) genomics—patterns of gene expression that facilitate adaption and healing by (4) optimizing brain plasticity to create
new insights for resolving human problems.
perspectives of the sciences and the humanities were facilitating adaptive or healing gene expression and
well documented by C. P. Snow in his 1959 classic brain plasticity within the daily and hourly work of
book The Two Cultures and the Scientific Revolution. creating new consciousness and personal identity
Psychosocial genomics is the art and science of during important life turning points.

836 Psychosocial Genomics
Important Life Turning Points movie. Individuals are encouraged to self reflect on
their dreams relative to their identity and
Integrating the scientific and the existential or
consciousness.
humanistic perspectives in counseling and psycho-
therapy during important life turning points is a
challenge. Many personal problems involving anx- Facilitating Optimal Cycles of Circadian and
iety, fatigue, stress, and feelings of inadequacy can Ultradian Healing in Everyday Life
be traced to being stuck in Stage 2 of the creative
Learning how to recognize and facilitate opti-
process. The same can be said of many social
mal cycles of circadian and ultradian creativity and
issues, such as crime, prejudice, terrorism, and war,
healing in everyday life is a basic therapeutic tech-
as well as business downturns and economic
nique of psychosocial genomics. Ultradian rhythms
depressions on local, national, or international
are the fundamental epigenomic regulators of
levels. Psychosocial genomics makes the broad
mind–gene communication that turn on activity-
claim that all these personal, cultural, social, and
dependent gene expression, brain plasticity, and
business issues are examples of being stuck in
the creation of new consciousness. Most people do
Stage 2 of the four-stage creative cycle.
not recognize that they have choices in the expres-
sion of their natural, four-stage Basic Rest-Activity
Techniques Cycle, which occurs about 12 times a day. Every
Psychosocial genomics’ focus on the four-stage 90 to 120 minutes, individuals experience choice
creative process for resolving human problems is points where, with proper training, they can alter
evident in its therapeutic techniques. These include this cycle. Every 90- to 120-minute therapy session
a review of the creative aspects of a person’s dreams of psychosocial genomics is a life lesson on how to
and early-morning thoughts, the process of self convert the ultradian stress syndrome into the
reflection in dreams, and facilitating optimal cycles ultradian healing response.
of circadian and ultradian healing in everyday life.
Therapeutic Process
Dreams and Early Morning Thoughts
A psychosocial genomic overview of how mind,
People are encouraged to linger in bed on awak- brain, and body cocreate each other daily and hourly
ening for about 20 to 30 minutes, recalling and is illustrated with the Creative Psychosocial Genomic
recording their dreams and early morning thoughts. Experience (CPGHE), also known as Mind-Body
The first hour or two after awakening are usually Healing Experience. The CPGHE is a 20- to
the clearest of the day. This is the period when one 30-minute therapeutic protocol used to activate
can learn how to become aware of the new con- mind–body healing and problem solving via gene
sciousness. This is the ideal time for receiving and expression and brain plasticity. While the formal
realizing the novelty–numinosum–neurogenesis administration of the freely available CPGHE can be
effect, which is when interesting, strange, or unusual an impressive introduction to the healing experiences
cognitions, emotions, and/or images of dreams of psychosocial genomics, there are infinite varia-
can become seeds for creating new consciousness tions that can be developed to fit the needs of most
and identity. individuals and situations in counseling and psycho-
therapy. To document the efficacy of the CPGHE
Self Reflection in Dreams and its variations is the most important clinical and
research challenge facing psychosocial genomics
People’s dreams frequently function as a self- today. There are many new technologies being devel-
reflective apparatus that mirrors their internal oped currently to assess therapeutic mind–body
world. Typically, dreams are of two types: (1) com- transformations that could be adapted to document
mon experiential dreams, in which the dreamer the evidence-based psychosocial genomic healing
simply recalls experiencing a vivid here-and-now before, during, and after each session.
drama, and (2) observer dreams, wherein dreamers
observe themselves in dream dramas as if in a Ernest Lawrence Rossi and Kathryn Lane Rossi

Psychosynthesis 837
See also Complementary and Alternative Approaches: to psychoanalysis, psychosynthesis posits that a
Overview; Creative Arts and Expressive Therapies: client is more than reactions to past conditioning
Overview; Cyclical Psychodynamics; Erickson, Milton, and childhood development and has a discrete,
H.; Maslow, Abraham; May, Rollo; Positive realizable core self, contact with which enables
Psychology; Psychosocial Development, Theory of
him or her to be self-directive, have a sense of pur-
pose, and have an active impulse toward service.
Further Readings Finding this core self within enables a client to
reach the heights as well as depths of the psyche;
Lloyd, D., & Rossi, E. (Eds.). (1992). Ultradian rhythms
contact a deeper Transpersonal Self, which is uni-
in life processes: A fundamental inquiry into
chronobiology and psychobiology. New York, NY:
versal to all life; and realize all experiences as part
Springer-Verlag.
of a larger, collective expression of an inner spiri-
Lloyd, D., & Rossi, E. (Eds.). (2008). Ultradian rhythms tual nature. A psychosynthesis psychotherapist
from molecule to mind: A new vision of life. facilitates conditions in which a client may become
New York, NY: Springer. more centered on this core self, develop the ability
Rossi, E. (2000). Dreams, consciousness, spirit (3rd ed.). to control previously divisive elements of his or her
Phoenix, AZ: Zeig, Tucker & Theisan. behavior, restructure the personality around this
Rossi, E. (2002). The psychobiology of gene expression: new core self, and realize the essential goodness in
Neuroscience and neurogenesis in hypnosis and the all life. The development of will and imagination is
healing arts. New York, NY: W. W. Norton. an essential component in the practice of psycho-
Rossi, E. (2007). The breakout heuristic: The new synthesis, as is engaging in a nondenominational
neuroscience of mirror neurons, consciousness and and personally relevant spiritual practice. While
creativity in human relationships (Vol. 1; Selected it is primarily used in psychotherapy, psychosyn-
papers of Ernest Lawrence Rossi). Phoenix, AZ: thesis is also applied in education, social work,
Milton H. Erickson Foundation Press. medicine, business, parenting, and all human
Rossi, E. (2012). Creating consciousness: How therapists interactions and endeavors. Some of its techniques,
can facilitate wonder, wisdom, truth and beauty particularly subpersonality work, have influenced
(Vol. 2; Selected papers of Ernest Lawrence Rossi). and been incorporated into various other therapeutic
Phoenix, AZ: Milton H. Erickson Foundation Press. models.
Rossi, E., Erickson-Klein, R., & Rossi, K. (Eds.).
(2008–2014). Collected works of Milton H. Erickson,
M.D. on therapeutic hypnosis, psychotherapy and Historical Context
rehabilitation (Vols. 1–16). Phoenix, AZ: Milton H. Roberto Assagioli, an Italian doctor who trained in
Erickson Foundation Press. psychoanalysis, began developing psychosynthesis
Rossi, E., & Rossi, K. (2013). Creating new consciousness in the early 20th century, devoting his life to
in everyday life: The psychosocial genomics of self uncovering human potential and exploring the
creation. Seattle, WA: Amazon Digital Services.
various methods that have been discovered to
(A Video eBook available at Amazon.com)
achieve this. Strongly influenced by concepts and
techniques from both Eastern and Western mystery
traditions and, later on, the humanistic approaches
of Carl Rogers and Abraham Maslow, Assagioli
PSYCHOSYNTHESIS created an approach to psychotherapy that is
essentially person centered, with an emphasis on
Psychosynthesis is a humanistic and transpersonal empathy and genuineness but with a directive, edu-
approach to psychotherapy and counseling. While cational aspect concerning the actualization of a
it has a set of core principles, psychosynthesis is an client’s potential. Since Assagioli’s death in 1974,
open approach that continues to be developed by psychosynthesis continues to be developed and
practitioners as new understanding of the human applied in both counseling and psychotherapy.
psyche and effective methods of psychotherapeutic While this development was encouraged by
intervention are discovered. While the early stages Assagioli, especially with regard to incorporating
of psychosynthesis psychotherapy have similarities discoveries from modern research, for instance in

838 Psychosynthesis
neurobiology, psychosynthesis has a unique and to the Freudian subconscious, includes repressed
congruent theoretical center. complexes, long-forgotten memories, drives,
instincts, and physical functions over which a
client (ordinarily) has no conscious control. In
therapy, the focus is primarily on the repressed
At the core of psychosynthesis theory is the “egg material, often presented by a client as phobias,
diagram,” a map of the psyche, which underpins obsessions, and compulsive urges. The middle
all its major concepts and practices (see Figure 1). unconscious contains material readily accessible
Analyzing the psyche through an understanding of to a client, including the thoughts and feelings of
its various component parts enables the psycho- everyday life and present or recent experiences;
therapist and the client to work together to put the of primary concern in psychotherapy is that
parts back together into a more effective whole, a which a client, for one reason or another, is
synthesis of the previously unintegrated parts. choosing not to bring into awareness. The higher
A core self is developed from where a client can unconscious is where a client experiences the
more effectively direct his or her life. The aim is deepest sense of an aspiration toward meaning,
not to reach a goal but to engage with the process inspiration, and creativity, and it is the major area
of life in the spirit of inquiry. of exploration at later stages of psychotherapy
The egg diagram includes four distinct but concerned with actualizing a client’s potential.
interconnected levels—(1) lower unconscious, The collective unconscious is common to every-
(2) middle unconscious, (3) higher unconscious, one, and there is a constant, active interchange
and (4) collective unconscious—the difference between us and other sentient beings, whether
between them being developmental rather than we are aware of it or not.
hierarchical. The lower unconscious, corresponding Each client has a personal self, his or her “I,” an
unchangeable center that experiences the client’s
different states of consciousness, including all
6 thoughts, emotions, and sensations, but in itself is
none of these. Generally, the personal self is not
7 experienced in a clearly defined way, and a major
part of psychosynthesis psychotherapy is prepar-
ing the ground for and helping an individual
3
contact this “I” and make it a living, experienced
reality in his or her consciousness.
5 Awareness of the personal self is a primary
goal of psychosynthesis as this helps a client
4 effectively direct his or her personality. The per-
2 sonal self is a reflection or spark of the spiritual
or Transpersonal Self, which is universal and
unaffected by an individual’s conscious experi-
1 ence. Becoming more centered on the personal
self may lead a client to clearer contact with and
7 7 understanding of the Transpersonal Self, not
through transcendent experiences but directly
Figure 1 Psychosynthesis Egg Diagram, Formulated by through the personality and its interactions with
Roberto Assagioli the outer world.
Source: Psychosynthesis Online/Graeme Wilson/Wikimedia
Commons.
Note: This diagram depicts various aspects of consciousness Major Concepts
as described in psychosynthesis: (1) the lower unconscious;
Each human is a fundamentally healthy organism
(2) the middle unconscious; (3) the higher unconscious; (4) the
field of consciousness; (5) the conscious Self, or “I”; (6) the in which there is a temporary complaint or break-
higher Self, or Transpersponal Self; and (7) the collective down. Pain, crisis, failure, and all other client-
unconscious. presenting issues are framed as opportunities for

Psychosynthesis 839
growth and essential parts of the client’s life Valuing life requires a self-commitment to act in
purpose. Holding psychotherapy within a transper- cooperative and responsible ways.
sonal context reframes and confers meaning to
a client’s issues and engenders creativity and Importance of Grounding
inspiration.
Spiritual and transpersonal energies need
grounding both for the psychological health of the
The Balancing and Synthesis of Opposites client and for the treasure such experiences can
We live in a world of polarities in our inner bring to our world.
world no less so than in the outer, so our world
experience is based on duality and we are divided Techniques
within. Psychosynthesis stresses the importance
of each part of the psyche, or subpersonality, Psychosynthesis is open to development, and each
being made whole in itself before it can be truly psychotherapist may include techniques from a
synthesized with other parts. variety of influences and sources, but there are core
techniques that give psychosynthesis its distinctive
flavor and direction. Each client has a personal
Two Dimensions of Growth self, reachable through the development of the
Everyone has a personality and a self, so a will, which when contacted helps organize, and
psychotherapist holds an inclusive bifocal vision, ultimately synthesize, all the various parts of the
seeing each client as both personality and self, client’s personality.
thereby working toward healing (wholeness) both
in the everyday world and in relation to the client’s Analytical Inquiry
innermost, creative nature.
Through active dialogue and exchange, a
psychotherapist evokes an understanding of the
Self-Identification and Disidentification workings of the client’s psyche, increasing aware-
Through conscious disidentification from the ness and discrimination. Tendencies traced back
contents of the personality and identification with to early development and childhood are explored,
the self, a client is enabled to direct and harmonize always within an understanding that even
his or her subpersonalities. apparently negative life issues offer the client a
creative opportunity for change. Where appro-
priate, a client might be invited to keep a
The Will
psychological workbook to facilitate this aspect
Activation of a client’s will increases the client’s of the work.
capacity to make choices that enrich rather
than limit life and that offer the potential for Subpersonality Work
psychospiritual freedom.
Each personality is composed of lots of different
parts, called subpersonalities, all having their own
Spiritual Emergence and Repression
needs and desires. Each subpersonality, even those
of the Sublime
with conflicting thoughts and feelings, has a part
The emergence of previously suppressed or to play in a client’s life. Identifying and exploring
repressed spiritual material is usually accompanied subpersonalities bring more clarity about their
by crisis, offering an opportunity for change and conflicting needs and enable a client, through
growth. meeting these needs, to reduce conflict between
opposing subpersonalities.
Essential Interconnectedness
Disidentification and Self-Identification
Humans are interconnected and interdependent
beings, each individual being part of a larger A basic underlying principle in all psychosyn-
whole with local, social, and global responsibility. thesis psychotherapy is that we are controlled by

840 Psychosynthesis
everything with which our self becomes identified transmuted or resolved, and build a positive image
and, conversely, we can gain control and have of a desired state and a sense of a deeper purpose.
choice over everything from which we disidentify
ourselves. Disidentification involves the client step- Meditation and Inner Silence
ping back consciously from limiting identities,
attitudes, and outdated roles and beliefs to gain Meditation, including reflective, receptive, and
greater perspective and choice. A useful analogy creative forms, may be introduced, along with
compares subpersonalities to the members of an techniques for the evocation of serenity and the
orchestra; the personal self is the conductor of the creation of inner and interpersonal silence.
orchestra, and the Transpersonal Self is the source Meditation may enhance mental and emotional
of the music. development, a clearer sense of identity, and
transpersonal exploration.
Purpose and the Creative Will
Although not necessarily directly applied with a Therapeutic Process
client, the therapist is aware of the six stages in the The aim in psychosynthesis psychotherapy is for a
act of will: (1) investigation, (2) deliberation, client to become more aware of his or her true self,
(3) decision, (4) affirmation, (5) planning, and to become increasingly autonomous while building
(6) execution. Various exercises might be intro- a sense of interconnectedness with all other living
duced for developing a client’s capacity to make beings, to connect more deeply to a sense of inner
healthy, deliberate choices and to connect with a purpose and meaning in his or her life, and to be
sense of life purpose and motivation. A relationship better able to make more effective life choices.
with the will is encouraged not through struggle or While it is rarely linear in practice, psychosynthesis
“power over” but in a fluid and easy manner. psychotherapy has distinct stages. Analytical
inquiry, which helps the client gain knowledge of
Imagery and Visualization his or her personality and its behavior patterns, is
followed by focusing on ways to control and inte-
Imagery and visualization are used to explore a
grate the various parts of the personality, primarily
client’s unconscious, inner processes and to stimu-
through disidentification and the creation of a
late personal, interpersonal, and transpersonal
strong center or “I.” Once a strong connection
growth. Imagery, whether guided, spontaneously
with this “I” is made, the next step is the recon-
arising, or from dreams, may help a client draw
struction of the personality around this center.
out and understand aspects of his or her uncon-
These stages can last from a few sessions to many
scious and express inner wisdom in a stimulating
years. For many people, personal psychosynthesis
way, connect to inner processes, and work with
is enough, as it helps them become more harmoni-
underdeveloped parts of the psyche.
ous individuals, well adjusted within themselves
and within the communities or groups to which
Acceptance and Change they belong. However worthy an achievement this
In accepting pleasure, without a craving for it may be, for some clients, it is not enough, and they
and attachment to it, and in accepting pain, when touch on a need inside to develop spiritually as
unavoidable, without fearing it and rebelling well. Transpersonal psychosynthesis explores the
against it, a client can learn from both pleasure spiritual regions, areas beyond our ordinary aware-
and pain and can create the space in life for change ness where we find the source of intuition and a
or not, as appropriate. sense of value and meaning in life.
Will Parfitt
The Ideal Model
See also Existential Therapy; Integrative Body
The psychotherapist helps the client create a Psychotherapy; Mindfulness Techniques; Person-
vision or sense of the client’s potential, often with Centered Counseling; Transpersonal Psychology:
regard to problems that can be envisioned as Overview

Pulsing 841
Further Readings style of bodywork that included greater emphasis

Assagioli, R. (1974). The act of will. London, England:
on the skeletal system and on whole-body experi-
Wildwood House. ence, set within a framework of somatic psychol-
Assagioli, R. (1975). Psychosynthesis: A collection of ogy, likely derived from Postural Integration.
basic writings. London, England: Turnstone Books. Turchin visited the United Kingdom in 1978 and
Ferrucci, P. (1982). What we may be: The visions and gave a demonstration of Pulsing at the Open
techniques of psychosynthesis. Wellingborough, Centre (one of the longest established centers for
England: Turnstone Press. bodymind development in the United Kingdom).
Firman, J., & Gila, A. (2002). Psychosynthesis: A Some of the participants persuaded him to return
psychology of the spirit. New York: State University of the following year to train them. Subsequently, the
New York Press. Open Centre became the main center for Pulsing
Parfitt, W. (2006). Psychosynthesis: The elements and development and training worldwide.
beyond. Glastonbury, England: PS Avalon.
Whitmore, D. (1991). Psychosynthesis counseling in
action. London, England: Sage.
Pulsing draws extensively on somatic education
systems. These are primarily physical therapies,
ones chiefly concerned with the remediation of
PULSING pain and discomfort in movement caused by mal-
adaptive physical habits developed as a result of
Pulsing, also known as Pulsing Rhythmic injury, poor posture, or emotional stress; they seek
Bodywork, is a form of somatic therapy that to mitigate pain by reeducating the muscles into a
employs rhythmic and rocking manipulation of the more natural and healthy state. However, the theo-
body as the primary means of encouraging emo- retical basis of Pulsing extends this view in its
tional release and the dissolution of body armor acceptance of the Reichian theory of body armor
(i.e., chronic muscular tension that reflects (see next section). It combines hands-on bodywork
repressed emotions). It is a significant development (in the form of rhythmic manipulation of the
of the Trager approach of somatic education musculoskeletal system) with conventional verbal
within a conceptual framework that embraces the psychotherapeutic techniques to encourage mind-
Reichian theory of body armor. It works indirectly fulness, emotional expression and release, and the
with body armor to avoid the trauma that can dissolution of armor.
often accompany the de-armoring process. Pulsing
is presented as a form of somatic self-experiencing Major Concepts
and does not take a diagnostic approach that
focuses on specific treatments for symptoms; how- Three major concepts of pulsing are bodymind,
ever, some practitioners offer an approach that body armor, and mindfulness.
works more explicitly with the client’s ongoing
therapeutic process. Bodymind
Bodymind is a term from humanistic psychol-
Historical Context ogy that proposes an alternative to Cartesian
mind–body dualism. Bodymind refers to a unified
Pulsing was developed in the late 1970s by Curtis system in which the mind, body, and spirit are
Turchin, a doctor of chiropractic in California, dynamically interrelated and changes in one area
trained in both the Trager approach (a physical propagate throughout the whole system.
therapy) and Postural Integration (a somatic psy-
chotherapy). He appreciated Trager for its nurtur-
Body Armor
ing, respectful, and supportive approach to the
client and came to the view that this style of work Body armor may be thought of as patterns of
would be highly suited to assisting the release of chronic muscular tension that not only reflect
body armor. He developed his own Trager-inspired repressed emotions but also are the mechanism

842 Pulsing
through which emotions are repressed. By hardening lifting–dropping, rotating, and swinging. The
and desensitizing areas of the body, unwanted application of force in this way opens up a com-
feelings may be controlled or excluded from con- pressed skeletal system, separating the bones and so
scious awareness (e.g., deep pelvic tension to both encouraging the muscles to conform to the changed
minimize and avoid awareness of sexual excitation). skeletal pattern. There is also extensive work on the
neck, which is viewed as the pathway connecting the
Mindfulness mind and the body.
This traditional Buddhist practice was adopted

Breathwork
by Gestalt therapy and by somatic psychologies
and is now becoming a mainstream approach. It Particular attention is given to working the
can be thought of as maintaining a watchful and intercostal muscles and freeing the ribcage using a
nonjudgmental awareness of self: the presence and compression–release technique. This aims to
movement in and out of consciousness of thoughts encourage fuller and deeper breathing and to
(including imagery and fantasy), emotions, sensa- promote emotional expression and release.
tions, and states. It may also include comprehen-
sion of how these are related or triggered by Contact
external or internal stimuli.
Pulsing operates at the contact boundary
(a term from Gestalt therapy)—the place where
Techniques the client and the practitioner literally touch—and
Pulsing promotes safe regression of the bodymind. also bring awareness to the subjective experience
The primary aim of the practitioner is to help the of that touch (physical, emotional, and psycho-
client reconnect with pleasure to his or her innate logical reactions). The practitioner’s use of
movement potential and the freedom and vibrancy manipulation of the body combined with verbal
of both mind and body that is the inherent state of interventions encourages the client to shift from
the bodymind prior to any armoring that has simple perception of sensation to a deeper awareness
occurred. Some of the more important techniques and expression of repressed emotions.
include rocking, musculoskeletal manipulation,
breathwork, and contact. Therapeutic Process
A session normally requires one full hour of hands-
Rocking on work. It is performed with the client on a mas-
The principal feature of Pulsing is that the prac- sage couch that is wider and more deeply padded
titioner maintains a rhythmic rocking of the cli- than standard couches. The practitioner begins by
ent’s body throughout the session. The speed and working on the head and neck, followed by the
intensity may be varied at times, but there is limbs, and then the torso. The usual practice is to
always a return to a baseline rhythm that is close first work the front of the body and then the back.
to a normal fetal heart rate of 120 to 160 beats per At the end, the client is asked to give a brief feed-
minute. It is hypothesized that the rocking recalls back on what has been experienced; this may be at
the gentle sway experienced by the fetus in the greater length with process-oriented work.
womb or the infant in a cradle. Rocking is also a Pulsing takes a pleasurable and playfully pro-
universal method of self-soothing, while rhythmic vocative approach to de-armoring. It may be per-
movement features in many spiritual practices. The formed in various tones (e.g., nurturing, playful,
soothing and entrancing rhythm allows for safe or cathartic), and indeed, these are often all pres-
regression into a supported and nurturing space. ent within a single session. Within the overall
framework of nurturing and supportive rocking,
there is likely to be a flow of peaks and troughs,
Musculoskeletal Manipulation
a wave of physical and emotional movement that
While there is some massage of soft tissue, the may range from cathartic expression to profound
primary focus is on the skeletal system. The limbs are tranquility. The rocking creates a safe space, while
subjected to various manipulations: pushing–pulling, the gentle rhythm has an almost hypnotic effect

Pulsing 843
that perhaps lulls body armor, thus allowing See also Bioenergetic Analysis; Gestalt Therapy; Postural
repressed emotions to surface. Integration
The experiencing of pleasure in movement dur-
ing a session is a key part of the process. Clients
Further Readings
tend to report feeling deeply relaxed and energized
by a session. This in itself has a positive impact on Gladstone, G. (n.d.). Pulsing—touch with rhythmic
the client’s sense of well-being; more significantly, movement. Retrieved from http://www.pulsing.org.uk/
it provides an immediate felt benefit to set against articles/gg001.html
the more nebulous (and often unconscious) bene- Lawton, R. (2010). Pulsing—get rhythm! Retrieved from
fits of defensive armoring. There are perhaps few http://www.pulsing.org.uk/articles/rl002.html
other therapies where the potential outcome of the Turchin, C. (1979). Pulsing. Energy & Character: The
process may be so immediately experienced by the Journal of Biosynthesis, 10(2), 67–69.
client. Turchin, C. (1979). Trager body work. Energy &
Character: The Journal of Biosynthesis, 10(1),
Richard Lawton 54–55.

R
which leads to the liberation and channeling of
RADIX the life force.
Kelley founded The Radix Institute in the early
Radix is a body-centered holistic therapy that 1970s to develop and extend Reich’s fundamental
works with the body, mind, and emotions to teachings. Early in his career, Kelley specialized in
achieve healing and to develop clients’ capacity to vision experiments through his study of the Bates
fully engage with life. Radix means “root” or “point method of vision improvement, which uses simple
of origin.” In the context of Radix therapy, the term eye exercises to relax the eyes to achieve better
refers to the fundamental energy or life force that vision rather than correcting vision with glasses or
moves, pulsates, and finds form within each indi- surgery. His research into the relationship between
vidual. Radix therapists (through talking, move- vision and emotion gave him a special appreciation
ment, breath, touch, vision, and sound) work with for the importance of working with what Reich
a client’s life force to achieve healing and growth called the “ocular segment,” concluding that pulsa-
and to help clients realize their full potential. tion of the life force in the eyes is essential for
integration of one’s emotional experience. Kelley
also introduced the concept of using Reichian prin-
Historical Context
ciples in group work. Current Radix practitioners
Radix is based on principles derived from the continue to develop applications of Kelley’s
work of Wilhelm Reich (1897–1957), a psycho- approach to many therapy and personal-growth
analyst whose scientific investigation into the issues while continuing his emphasis on well-being,
human life force was called orgonomy. After vitality, and the power of the educational model.
studying Reich’s work and attending several of his Many other Radix Institute trainers have influ-
seminars, Charles Kelley (1922–2005), an experienced the direction and development of Radix
mental psychologist, developed Radix as a form of theory and practice. For example, Renan Suhl, a
personal growth work. At the time, Kelley was the Radix Institute trainer, responded in the 1980s to
director of Applied Vision Research and an assis- the wider cultural and social recognition of trauma
tant professor in psychology at North Carolina and its effects on people. Suhl concluded that not
State University. He later became editor of the first all human beings develop armor that needs to be
Reichian-oriented journal, The Creative Process, “broken down,” as in the classic Reichian model,
after Reich’s death. Reich conceived of his work as that many people have insufficient armor to ade-
going “beyond psychology” deep into the realm of quately function in the world and, in fact, need
the biophysical. Kelley, too, distanced himself different ways to build it. With this perception
from the concept of therapy and conceived of his came a shift in Radix work from the model of
project as “Education in Feeling and Purpose,” energetic catharsis to that of restoring the inward
845

846 Radix
and outward flow of the energetic pulsation. With attached primary importance to practitioners
contributions from other practitioners, Radix con- doing their personal work, so that they can toler-
tinues to evolve to include biophysical approaches ate, accept, and respect their clients’ depth and
to trauma and biophysical ways of working with track them in their inner voyage. Practitioners
attachment issues and other presenting client sometimes follow clients to places of considerable
problems. intensity and energy, emphasizing the need for
practitioners to learn tolerance for these forces in
Theoretical Underpinnings their own lives. Therefore, tolerance, acceptance,
and respect for personal experiences are corner-
Radix is rooted in the Reichian perception of mus- stones of Radix therapy. Other theoretical con-
cular tension interrupting the life force flowing in cepts important to Radix include energetic charge
the body. Sometimes this is chronically blocked or and discharge, a focus on the breath as the most
trapped in the core and sometimes in the periphery. easily used pulsation, the understanding that
When trapped in the core, the muscle tension hin- chronic blocking (whether due to suppression,
ders the smooth flow of life force into the eyes, repression, or directed purposeful activity) leads to
arms, or legs, making it difficult for individuals to muscular armor, and an understanding of the
see realistically, to reach out with their arms to embodiment of character, which is rooted in the
grasp, to hold or love, or to “stand on their own.” energetic flow or blockages to the flow.
For some individuals, the life force is habitually
trapped in the periphery, meaning that the indi-
vidual is in contact with the world but lacks con- Techniques
nection with the self. In both these extreme cases, There are several unique techniques used in Radix,
the goal of Radix is for the individual to find bal- including contact, observation, breath, movement
ance, developing a deep self-awareness and an easy and sound, and touch.
movement and engagement in the world.
Pulsation, a primary concept in this approach,
becomes the heart of the therapeutic or educa- Contact
tional enterprise. In this context, pulsation is The basic Radix premise is that healing takes
defined as a rhythmic expansion and contraction place in relationship, and contact between the
of life energy (that which underlies and gives rise practitioner and the client is the starting point.
to feeling and movement). Radix practitioners Contact with a client in the present means meeting
observe and actively work with the many subtle the client where the client is emotionally and ener-
ways in which pulsation is interrupted in a client, getically so that the client feels fully heard, seen,
working to balance the two strokes of that pulsa- and understood, thereby establishing a base from
tion. When pulsation is in balance, clients can sur- which the work can deepen. The practitioner
render to deep contact with their inner world (i.e., observes and registers the quality and nature of the
emotions, dreams, vision, and spirit) on the life contact—the degree of being present in the eyes, a
energy instroke (contraction) and can express their tension and pulling away in the body, or perhaps
inner world actively on the life energy outstroke an emotional quality to the voice that is incongru-
(expansion). Practitioners work to bring attention ent with the spoken words.
and consciousness to a client’s own experience.
A practitioner’s focus on the clients’ experience
Observation
might involve ocular work (which involves attend-
ing to the self and self-perception), helping the cli- The Radix practitioner both observes and feels
ents center or ground themselves, helping them the client’s energy and observes the client’s skin
find boundaries they previously lacked, or helping tone, muscular tension, and posture and the quality
the clients to learn emotional containment. and nature of the client’s breathing, sometimes
Regardless of the particular direction of the drawing the client’s attention to areas that the prac-
work, the relationship and contact between the cli- titioner feels are tense and sometimes simply asking
ent and the practitioner is paramount. Kelley the client where he or she is experiencing tension.

Radix 847
The process of observing together helps establish Therapeutic Process

an atmosphere of learning and self-acceptance.
Clients come to Radix work for a variety of
reasons, from specific problems to a general desire
Breath for personal growth. It is useful for a practitioner
to understand a client’s specific goals in doing the
While there are many types of pulsation in the
work. Each session begins with the practitioner
body, Radix works with the pulsation of the breath
hearing from the client about what is going on for
because it is both voluntary and involuntary and is
the client in terms of concerns, emotions, and body/
integrally involved in blocking or expressing every
energetic processes. The practitioner listens,
emotion. In fact, breathing patterns are indicative
observes, and evaluates the client in terms of the
of one’s basic character or armoring. A full breath
client’s process and the need to work toward ener-
involves an active, flexible back, chest, diaphragm,
getic integration and wholeness. The practitioner
and abdominal muscles. To restore fuller breath-
may then use any of a wide variety of techniques to
ing, a practitioner may work with a constricted
redistribute the client’s energy with particular con-
breath pattern by verbally encouraging a different
cepts in mind. For example, a practitioner may ask
pattern, having the client move in such a way as to
a client who is experiencing anxiety to run in place,
change the breath, or, perhaps, pressing on the
shake his or her arms, and make sounds in order to
client’s chest to facilitate a different breathing pat-
deepen the breath and siphon off excess energy;
tern. At root, the process results in restoring natu-
then the practitioner may ask the client to stand
ral breathing rather than in the client learning how
with legs bent and upper body curled forward to
to breathe.
help ground and center the client. Once the client’s
energy is redistributed, the practitioner facilitates
Movement and Sound self-awareness in the client and contact between the
Once it has been determined what expression client and the practitioner to be sure that the client
may be blocked or, conversely, needs to be con- is fully present in the here-and-now. Verbally pro-
tained, movement and sound are essential tools to cessing the client’s experience during the session
help redistribute a client’s energy toward full pulsa- often helps the client integrate his or her experience
tion, contact, better grounding, centering, boundar- and accept it as representative of who he or she is.
ies, and containment. Changing the breathing Melissa Lindsay, Narelle McKenzie,
pattern, shutting and opening the eyes, running the and Jim Ross
legs into a mat, standing, curling over, hitting or
squeezing a pillow, pushing or leaning against a See also Bioenergetic Analysis; Orgonomy; Reich, Wilhelm
wall or the practitioner are all movements designed
to move energy into various parts of the body and
help expression become more full and congruent Further Readings
throughout the whole person. Encouraging sound Glenn, L., & Müller-Schwefe, R. (Eds.). (1999). The
(humming, yelling, singing, and emotional vocaliza- Radix reader: A neo-Reichian approach to human
tion) also facilitates full expression and congruence. growth. Conway, AR: Heron Press.
Kelley, C. (2004). Life force: The creative process in man
Touch and in nature. Victoria, British Columbia, Canada:
Trafford.
In Radix work, touch may be used to bring McKenzie, N., & Showell, J. (1998). Living fully: An
awareness and energy to a particular part of the introduction to Radix body-centred personal growth
body, for physical or emotional support, for con- work. Adelaide, South Australia, Australia:
tainment, to loosen muscles, or to support a sense Centreprint.
of contact between the client and the practitioner.
Touch is always done with the client’s permission
Website
and with a clear intention on the practitioner’s
part. Radix Institute: www.radix.org

848 Rational Emotive Behavior Therapy
philosophers, psychologists, essayists, novelists,

RATIONAL EMOTIVE BEHAVIOR poets, and other writers—some of the more influ-
THERAPY ential writers included Socrates, Epicurus, Epictetus,
Marcus Aurelius, Seneca, Confucius, Lao Tzu,
Rational emotive behavior therapy (REBT) is the Gautama Buddha, Ralph Waldo Emerson, John
vigorous pioneering cognitive approach that her- Dewey, George Santayana, Bertrand Russell,
alded in the cognitive revolution that began in the Ludwig Wittgenstein, Benedict de Spinoza,
mid-20th century in the fields of psychotherapy, Immanuel Kant, David Hume, Henry David
psychology, and counseling. It was created and Thoreau, Alfred Korzybski, Sigmund Freud, John
developed by Albert Ellis (1913–2007), who Watson, Karen Horney, and Alfred Adler. The cop-
wrote more than 85 published books and more ing actions and attitudes he came up with to
than 2,000 published articles about REBT, begin- successfully overcome his occasional childhood
ning in the early 1950s and throughout his life- feelings of depression about parental neglect, anxi-
time. REBT is unique in its strong emphasis on the ety, and extreme shyness in his teen years and his
benefits of experiencing and practicing uncondi- tendencies of impatience and low frustration toler-
tional acceptance and in the precision and vigor it ance are incorporated into the REBT approach.
encourages people to employ in their disputation From 1952 to early 1955, he was one of the most
of unhealthy irrational beliefs. It is an active- active-directive psychoanalytically oriented psy-
directive, humanistic approach and is infused with chotherapists in the field, and his clients were expe-
compassion. It is effective as a brief therapy riencing better and more lasting results in shorter
approach as well as for long-term therapy and periods of time than they had done when partici-
group therapy and as a tool many members of the pating in more traditional modes of psychoanaly-
general public can learn to apply as a self-help sis. By 1955, the basic theory and principles of
technique through reading books or articles and/ REBT had been formulated, and in 1956, Ellis gave
or attending lectures, workshops, and seminars on his first major presentation about it to psycholo-
the approach. Ellis intended REBT to be utilized gists at the American Psychological Annual
and learned by both academic and practitioner Convention held in Chicago. He was booed and
communities as well as by their clients and by jeered and called superficial and simplistic by many
members of the general public, and to that end, of his colleagues and peers at that time who favored
many of his publications were written in a style the psychoanalytical approach, yet he persisted in
easily understandable and acceptable to individu- continuing to research and write about REBT, uti-
als in each of those groups. His work continues to lizing it and teaching it, and by the 1960s, and in
influence and help the lives of countless people in the years following, it was embraced and utilized
empowering and transforming ways. by many practitioners in his field. A number of
cognitive approaches and theories, including cogni-
tive therapy, cognitive-behavioral therapy, reality/
Historical Context
choice therapy, dialectical behavior therapy, accep-
REBT was born from a combination of Ellis’s tance and commitment theory, positive psychology,
innovative genius and capacity for problem solv- and others, which came after the works by Ellis on
ing; his desire to help others suffer less emotional REBT were published and presented, include some
misery; the methods he developed for helping him- or many of REBT’s principles. Known in its early
self endure and overcome adversities, which he years as rational therapy, it deliberately emphasized
faced from childhood onward; his research and rational versus irrational components of thinking
reading; and his abandonment of the psychoana- and showed that rational therapy contrasted greatly
lytical approach he had been trained in and prac- with most existing therapies at that time, which
ticed in his early years as a therapist. He believed Ellis found to include little on cognitive aspects.
that psychoanalysis helped some people feel better REBT emphasizes the importance and benefits
but that it did not help them to get sufficiently of working on one’s cognitions and emotions and
better and stay better by taking responsibility for behaviors. In so doing, it is a most holistic thera-
their own emotions. His main influences were peutic modality. In 1961, Ellis changed the name of

Rational Emotive Behavior Therapy 849
his approach to rational emotive therapy, and in individuals; however, it asserts that with awareness
1993, he added the B—calling it rational emotive and motivation to change, people can choose to
behavior therapy (REBT), a title that still remains. work at changing any unhealthy thinking/emotion/
Since its early years, REBT has expanded and has behavior tendencies and habits into life-enhancing
been refined, backed by research on it specifically ones. REBT reminds us that with awareness comes
and by much of the abundant cognitive-behavioral choice. It asserts that the maintenance of therapeu-
therapy research, which also supports its premises. tic gains requires ongoing effort, work, and prac-
Surveys in the United States in the 1980s named tice. It reminds us that relapse may take place for
Ellis as the most cited writer in the field since 1957 some people, and that if it does, they can choose to
and found him to be the second most influential accept it as a common occurrence rather than cata-
psychotherapist of his time. (Carl Rogers was strophize about it, and it then encourages them to
found to be the first, and Sigmund Freud was return to healthier ways. REBT incorporates
named as the third most influential one.) A Canadian relapse prevention techniques. It is a pragmatic,
study at that time found Ellis to be the most influ- compassionate, realistic, and optimistic approach,
ential therapist, followed by Rogers and then Aaron encouraging self-awareness and the identification
Beck. In his later years, Ellis was writing books and of one’s philosophical beliefs. It encourages people
articles and presenting lectures, workshops, semi- to have the willingness to assess the accuracy of
nars, and professional trainings with his wife, part- such beliefs and to change any that are not essen-
ner, and collaborator, Debbie Joffe Ellis, on the tially ethical and based on fact and logic. REBT
various aspects of REBT, and he included seminars vigorously reminds people that they can choose to
and writings on more “spiritual” topics such as use their minds in healthy ways by thinking ratio-
REBT and Buddhism. He entrusted Joffe Ellis to nally in order to create healthy emotions and
continue his work after his passing, which she does behaviors and, in so doing, enjoy life more. It
throughout the United States and around the globe. reminds us that life inevitably contains loss and
In 2004, Ellis was named a “Counseling Legend” at suffering but by learning to think in healthy ways,
the annual American Counseling Association con- one minimizes the suffering and maximizes the joy.
ference, and Joffe Ellis was given the same recogni- REBT also encourages individuals to have social
tion at the same conference in 2014. interest and to demonstrate care for others and to
be helpful whenever possible, both to other human
beings and to the environment around them. REBT
encourages its therapists to have empathy and
Some basic premises infuse the REBT approach compassion toward their clients and the clients’
and are the underpinnings of its theory. For predicaments, challenges, and difficulties, with the
instance, REBT acknowledges that each human is primary goal being to help a client learn the tools
fallible, capable of making mistakes, and failing at to help himself or herself. It discourages unhealthy
desired goals; however, the worth of the human dependence of a client on the therapist, which in no
being is not defined according to competencies, way minimizes the therapist’s willingness to
successes, talents, or any other qualities of charac- embrace his or her role of counselor, educator, and
ter or behavior. REBT asserts that each human has encourager enthusiastically and for as long as is
worth simply because he or she is alive. Some gen- healthily appropriate in the therapeutic relation-
eral semantic principles are incorporated into ship. REBT also recommends that therapists do
REBT. For example, REBT encourages people to their best to practice its principles so that they too
constructively evaluate their actions as good or live better lives and, in doing so, serve as healthy
bad, mistaken or advantageous, failures or victo- models for their clients and others and display
ries, beneficial or destructive, but it reminds them solid authenticity in practicing what they preach.
not to judge their essential worth based on their
actions. REBT encourages people to guard against
Major Concepts
overgeneralizing. REBT acknowledges the influ-
ences of both biology and environment in contrib- Some of the major concepts of REBT include the
uting to the thinking patterns and behaviors of idea that we create and control our emotional and

behavioral destinies, irrational thinking, rational others, and life (unconditionally accepting); and it
thinking, unhealthy versus healthy negative emo- has high frustration tolerance.
tions in response to adverse circumstances, uncon-
ditional acceptance, the A B C D E method in
Unhealthy Versus Healthy Negative Emotions
response to disturbing emotions, and work and
in Response to Adverse Circumstances
practice.
In understanding unhealthy and healthy nega-
tive emotions, it is important to first be clear that
Creating and Controlling Our Emotional
when it comes to emotions, negative does not
and Behavioral Destinies
mean “bad” but, rather, less pleasant than positive
It is not outer circumstances that create our emotions such as joy, happiness, and contentment.
emotions and lead to our actions but what we tell The main unhealthy negative emotions that are
ourselves about them. We create and control our created from irrational thinking include anxiety,
emotional and behavioral destinies by the way we depression, rage, guilt, shame, and jealousy,
think. When we think in healthy and rational whereas the main healthy negative emotions
ways, we create healthy and appropriate emotions; include concern, sadness, grief, annoyance, and
when we think in unhealthy irrational ways, we frustration. The unhealthy emotions can debilitate
create unhealthy and often debilitating emotions. and lead to destructive behavior; the healthy ones
REBT clearly defines the features of rational and are appropriate responses to disappointments, to
irrational thinking; it distinguishes between the not getting what we want, and to getting what we
healthy negative emotions that we may create in don’t want.
response to adverse circumstances by thinking in A misconception some people hold about REBT
rational ways and the unhealthy emotions that we is that it is about not feeling painful emotions. This
create by thinking in irrational ways. is far from the truth. REBT encourages people to
live a full life, which includes the rich tapestry of
both pleasing and nonpleasing events and emo-
Irrational Thinking
tions. To minimize inevitable and excessive suffer-
REBT describes the main features of irrational ing in response to loss and disappointment, REBT
thinking as having the tendency to demand teaches us the difference between creating unneces-
(shoulds, musts, oughts) that things be the way we sary debilitating emotions and creating, allowing,
want them to be; it exaggerates, awfulizes, and and accepting nondebilitating ones.
catastrophizes; it damns the person, others, and life
itself when things don’t go the way we think they
Unconditional Acceptance
“should” go; and it has abysmally low frustration
tolerance. The three main irrational core beliefs— REBT’s principles and practices assert that one
from which countless others stem—are as follows: can maintain emotional stability and well-being by
ongoing effort to acquire and experience uncondi-
1. I must always be approved of and liked/loved tional acceptance in three forms:
by everyone.
1. Unconditional self acceptance: One accepts
2. You should always treat me well and act the
oneself totally—including any mistakes or
way I think you should.
failures. One attempts to learn from mistakes or
3. Life should always be fair and just. failures and to not repeat them, but one does
not damn oneself for having made them:
separating the actions from the inherent worth
Rational Thinking
of oneself for simply being alive and human.
Rational thinking prefers, as opposed to Even if one performs bad actions, unconditional
demands, that things go the way we want them to self acceptance reminds the person that he or
go; it keeps things in perspective; it is based on she is not totally bad, though his or her actions
empirical facts and reality; it is nondamning of self, may have been undesirable.

Rational Emotive Behavior Therapy 851
2. Unconditional other acceptance: One refuses to the headings of cognitive, emotive, and behavioral
totally damn the other person even if his or her techniques—though certainly there is overlapping
actions may be damnable—remembering that the of some. Some of the main techniques within the
other person is a fallible human prone to error three categories are discussed in this section.
as each one of us is; and while still appropriately
responding to any bad actions from the other Cognitive Techniques
person, REBT reminds us to maintain an attitude
of “hating the bad action but not hating the
The A B C D E Method for Emotional
and Behavioral Disturbance
person’s essential being.” REBT recommends
striving to feel compassion for wrongdoers. As noted earlier, this is one of the more impor-
tant ways of combating emotional and behavioral
3. Unconditional life acceptance: One sees
disturbance and is focused on changing irrational
circumstances in life that may appear wrong,
thinking in the following ways:
cruel, unethical, and immoral—and one may do
what one can to change them if possible—but at A (Activating Event): Identifying the activating event
the same time, one accepts that just because or adversity that appeared to lead to the response
some things in life are unfair and unjust, it does
not mean that all of life is bad, cruel, and B (Beliefs): Identifying the irrational beliefs follow-
unjust. One refuses to conclude that all of life is ing “A”
hopeless and terrible, even when some things C (Consequence): Recognizing the emotional conse-
are indeed very bad, and maintains hope and quence and any possible behavioral consequences
realistic optimism.
D (Disputing): Disputing each irrational belief as
vigorously and thoroughly as possible: realistically,
The A B C D E Method in Response
logically, and pragmatically, typically asking ques-
to Disturbing Emotions
tions such as “Where is the evidence for this belief?”
This method clarifies the connection between the “Does it logically follow from my preferences?”
activating event and its consequences by identifying “Where is it getting me to hold this belief—is it help-
the beliefs involved and provides the means for ing me or hurting me?”
replacing irrational beliefs with rational ones
E (Effective New Philosophies): Replacing irrational
through healthy disputation, which results in the
beliefs with healthy and realistic beliefs. As a result,
emergence of effective new beliefs, emotions, and
the emotions and behaviors, if any, are likely to
behaviors. The boldness, precision, and vigor that
become more healthy and life enhancing.
REBT encourages individuals to apply when disput-
ing their irrational beliefs is one of the aspects that It is helpful for a client to apply this method in
sets REBT apart from other cognitive approaches. writing, and the more often the client does so, the
REBT invites individuals to dispute those beliefs sooner it can be effectively done in the client’s head
realistically, logically, and pragmatically. without the written form.
Work and Practice Assessing the Cost–Benefit Ratio of the Beliefs

and Behaviors That Are Being Examined
REBT reminds us that ongoing work and prac-
tice are required for lasting beneficial changes that For example, a client whose goal it is to end an
lead to people not only “feeling” better but also addiction to smoking would make a list of the
“getting and staying” better! advantages and real disadvantages of the harmful
addiction and review and strongly think about the
disadvantages several times each day. Another
Techniques
example would be of a client who had been avoid-
The techniques offered in REBT that help clients ing or procrastinating about doing something that
create and maintain healthy ways of thinking, feel- would enhance his or her life, writing a list of the
ing, and behaving can be broadly divided under advantages and disadvantages of continuing to do

so, and then reviewing and strongly reminding client can stand it, does not “need” the approval of
himself or herself many times daily of the advan- others, and chooses to unconditionally accept him-
tages of taking action. self or herself.
Secondary Symptoms Coping Statements

This technique seeks to identify any secondary This technique includes using coping statements
symptoms (e.g., anxiety about anxiety, depression strongly and vigorously (e.g., “I can stand what
about depression) and then attend to reducing or I don’t like—I just don’t like it!”).
eliminating them before attending to the primary
emotional disturbance. Use of Humor
The use of humor can provide a healthy per-
Distraction Methods
spective and prevent the client from taking
Palliative and short-term distraction methods things too seriously. To this end, Ellis wrote hun-
are better than inaction. Healthy ones may dreds of “Rational Humorous Songs,” which
include doing exercise, yoga, and meditation. were often sung by attendees at his workshops
They may calm the mind and emotions but do and lectures.
not root out and eliminate the underlying irratio-
nal beliefs that created the disturbing emotions in Behavioral Techniques
the first place.
In Vivo Desensitization
Modeling This technique includes exposing oneself gradu-
This includes thinking about people who model ally to that which one is afraid of: doing uncom-
and demonstrate the healthy outcomes that the fortably what one wants to feel comfortable about
client hopes to achieve. (e.g., for people with extreme shyness, saying hello
to someone in a coffee shop each day until the fear
Reading, Watching, and Listening is reduced and then eliminated over time).
This technique involves reading, watching, and
Reinforcements: Positive and Negative
listening to healthy and beneficial material about
REBT—healthy philosophies and/or other This technique can be helpful in encouraging
inspiring and educational works. the client to stick to his or her goals.
Skills Training
Emotive Techniques
Learning new skills can support the attainment
Rational Emotive Imagery
of the client’s goals (e.g., taking a course in asser-
This technique includes visualizing the worst tiveness training for people suffering from social
case scenario of the issue the client is working on anxiety).
and evoking the troubling emotion and then prac-
ticing reducing or eliminating the emotion through Relapse Prevention
changing the client’s thinking. This technique includes taking preventive steps
that help maintain the client’s forward-moving
Shame-Attacking Exercises
path toward healthy change.
These exercises involve the client’s performing a
nondangerous activity that attracts attention, such
Therapeutic Process
as an activity that the client considers shameful or
embarrassing (e.g., wearing unusual clothing, call- Usually, one of the first steps in the initial REBT
ing out subway stops while traveling on the sub- session is clarifying the client’s issues and the
way), while reminding himself or herself that even therapeutic goals. The effective REBT therapist
if others find the client ridiculous or strange, the listens well, as much as possible modeling REBT

Rational Living Therapy 853
principles such as unconditional acceptance, Ellis, A., & Ellis, D. J. (2011). Rational emotive behavior
empathy, and compassion. At the same time, the therapy. Washington, DC: American Psychological
therapist remains alert and communicates in a Association.
direct fashion, particularly when identifying self- Ellis, D. J. (2014). Rational Emotive Behavior Therapy
defeating beliefs and behaviors that the client pres- (DVD—Series 1: Systems of Psychotherapy).
ents. The therapist teaches the principles of REBT Washington, DC: American Psychological Association.
to the client over time, providing or recommending Korzybski, A. (1990). Science and sanity. Concord, CA:
relevant reading material if appropriate and giving International Society for General Semantics. (Original
work published 1933)
homework chosen from the variety of cognitive,
Padesky, C. A., & Beck, A. T. (2003). Science and
emotive, and behavioral techniques. Humor can be
philosophy: Comparison of cognitive therapy and
used to provide healthy perspective. The therapist
rational emotive behavior therapy. Journal of
is flexible, creative, willing to add additional and
Cognitive Therapy, 17, 211–229. doi:10.1891/
new goals for the client as the sessions progress, jcop.17.3.211.52536
and encouraging, and acknowledges positive Smith, D. (1982). Trends in counseling and
changes while being patient and tolerant of any psychotherapy. American Psychologist, 37, 802–809.
client backsliding. The therapist may at times self- doi:10.1037/0003-066X.37.7.802
disclose—but only for the benefit of the client’s Warner, R. E. (1991). A survey of theoretical orientations
gaining a clearer understanding and perspective. of Canadian clinical psychologists. Canadian
The REBT approach is greatly life enhancing, and Psychology, 32, 525–528. doi:10.1037/h0079025
when therapists incorporate it into their ways of
life, blocks or challenges experienced during ses-
sions (and in nonwork circumstances) can be more
effectively handled. RATIONAL LIVING THERAPY
Debbie Joffe Ellis
Rational Living Therapy (RLT) is a form of cogni-
See also Adler, Alfred; Beck, Aaron T.; Classical tive-behavioral therapy (CBT) influenced by neuro-
Psychoanalytic Approaches: Overview; Cognitive- linguistic programming and general semantics.
Behavioral Therapies: Overview; Cognitive-Behavioral This approach is derived from rational emotive
Therapy; Ellis, Albert; Existential-Humanistic behavior therapy (REBT), rational behavior ther-
Therapies: Overview apy (RBT), and cognitive therapy (CT). In the
same tradition as REBT and many other forms of
Further Readings CBT, RLT is considered a comprehensive, short-
term, goal-oriented approach aimed at helping
Ellis, A. (1958). Rational psychotherapy. Journal of
people “get better” through systematic processes
General Psychology, 59, 35–49. doi:10.1080/0022130
that address core issues and lead to long-lasting
9.1958.9710170
change. RLT does not support “quick fixes” to
Ellis, A. (1962). Reason and emotion in psychotherapy.
Secaucus, NJ: Citadel.
simply “feel better” in the present moment. RLT
Ellis, A. (2003). Similarities and differences between
emphasizes the work of the therapist while under-
rational emotive behavior therapy and cognitive scoring the value of the client’s rational self-coun-
therapy. Journal of Cognitive Therapy, 17, 225–240. seling skills. It is used to treat a variety of issues,
doi:10.1891/jcop.17.3.225.52535 including anxiety, depression, relationship prob-
Ellis, A. (2005). Discussion of Christine A. Padesky and lems, substance abuse, and traumatic events.
Aaron T. Beck, “Science and philosophy: Comparison
of cognitive therapy and rational emotive behavior Historical Context
therapy.” Journal of Cognitive Therapy, 19, 181–185.
doi:10.1891/jcop.19.2.181.66789 RLT was developed in the 1990s by Aldo R. Pucci,
Ellis, A. (2005). The myth of self esteem. Amherst, NY: president of the National Association of Cognitive
Prometheus Books. Behavioral Therapists. Pucci received training in
Ellis, A. (with Ellis, D. J.). (2010). All out! An cognitive-behavioral therapy from Maxie C.
autobiography. Amherst, NY: Prometheus Books. Maultsby, the founder of RBT. RLT grew from

854 Rational Living Therapy
Pucci’s modifications to Maultsby’s approach. RLT evolved to include its own unique set of
has continued to evolve since its inception. Recently, philosophical tenets and concepts. The ABCs of
RLT has been adapted for work with relationships emotions, the four As, irrational labeling, reflexive
and couples counseling. RLT incorporates research thoughts, and the rational thinking score are
findings from various areas of psychology, includ- among the major concepts of RLT.
ing learning theory, cognitive development, and
brain functioning. However, in an age where the ABCs of Emotions
implementation of evidence-based practices is
emphasized, empirical evidence of the effectiveness The ABCs of emotions highlight the intermedi-
of RLT is not available. ate role cognition plays in determining emotional
responses to events or conditions. The A stands for
awareness. The B stands for what we believe or
Theoretical Underpinnings think about that which we are aware of. Such
As a cognitive-behavioral approach, RLT maintains thoughts can be positive, neutral, or negative. The
characteristics similar to most cognitive-behavioral C stands for the emotional consequence experi-
therapies. Specifically, RLT closely aligns with the enced as a result of what we believe or think about
philosophies of REBT, RBT, and CT. RLT incorpo- a given situation. This concept has evolved into a
rates the cognitive model of emotional response and commonly used technique by the same name.
emphasizes aspects of stoicism, suggesting that irra-
tional thinking leads people to emote and behave in Four As
irrational ways. This approach suggests that the RLT refutes the notion of self-esteem and con-
“shoulds” and “musts” people think are the root of siders the concept irrational. It suggests that the
emotional and behavioral problems and ultimately concept of self-esteem equates to a rating system
prevent happiness. RLT posits that people engage in based on the evaluation of a person as a whole.
self-counseling every day, although they rarely This approach views the totality of an individual
acknowledge these intentional and sometimes as too complex to be understood by one global
unconscious processes. In addition to the traditional term. However, the four As offer a rational alterna-
theoretical underpinnings of cognitive-behavioral tive to self-esteem and replace this general and
therapy, RLT relies on concepts rooted in neuro- problematic concept. The term four As stands for
linguistic programming, brain development, and accurate assessment of attributes and abilities. This
general semantics. For example, RLT emphasizes concept encourages factual assessments of charac-
the subconscious mind and the importance of self- teristics and qualities as they relate to identified
talk in ways similar to neuro-linguistic program- goals. Assessing attributes, rather than the whole
ming. Additionally, RLT focuses attention on the person, promotes an objective nonjudgmental per-
ways in which the left and right hemispheres of the spective that offers a direction for goal attainment.
brain communicate. Comparable to general seman- The four As serve to combat common mental mis-
tics, RLT also values the use of the scientific method takes including overgeneralizing, underestimating
to solve daily problems and address dysfunction. abilities, discounting coping skills, and overempha-
This approach suggests that goal setting and the sizing failures.
development of rational, behavior-targeted, positive
statements are critical aspects to behavior change.
Rational living therapists aim to dispute irrational Irrational Labeling
beliefs in a variety of ways and teach clients rational Irrational labeling occurs when an individual is
self-counseling skills. described using a single attribute or characteristic
(i.e., mean, bad). RLT considers these labels irratio-
nal because they fail to completely describe indi-
Major Concepts
viduals. Rational living therapists believe that
This approach is influenced by a number of cogni- people are far too complex for labeling in this man-
tive-behavioral therapies. However, RLT has ner. Therefore, irrational labeling is discouraged,

Rational Living Therapy 855
and the subsequent hopelessness that clients often stemming from irrational behaviors. Employing
experience from labeling is thwarted. Rational liv- negative imagery can bring awareness of such
ing therapists refrain from using absolute terms thoughts and can be used to encourage clients to
such as oppositional, depressed, or dependent to avoid them.
describe clients. As a result, this approach disagrees
with the use of diagnostic labeling often used by Rational Action Planner
mental health professionals.
The rational action planner is a technique that
comprises several commonly used RLT techniques
Reflexive Thoughts
(i.e., ABCs of emotions, camera check, rational
Reflexive thoughts are automatic, unconscious questions). This single procedure reinforces the
thoughts that can be either rational or irrational. RLT philosophy and assists the client in developing
Problems arise when reflexive thoughts are irratio- a goal-oriented action plan.
nal. RLT emphasizes the importance of developing
rational reflexive thoughts in lieu of irrational Rational Questions
ones.
Rational questions is a technique used to help
clients challenge their irrational thoughts. An
Rational Thinking Score example of a rational question is “Is my thinking
The Rational Thinking Questionnaire is a based on fact?” This technique disproves the valid-
51-item measure of rational thinking. A Rational ity of irrational thoughts and encourages rational
Thinking Score is derived from this measure. The thinking.
score indicates the degree of rationality maintained
by an individual. Rational Hypnotherapy
RLT posits that hypnosis, whether intentional
Techniques or unintentional, can be used to influence thoughts
A variety of techniques are available in RLT, and processes (i.e., promote rational thoughts). Many
the ones most readily used offer structure and rational living therapists are trained in hypnother-
serve to empower the client. These techniques apy. Rational hypnotherapy is often utilized when
include the camera check, positive/negative imag- addressing cases of posttraumatic stress disorder.
ery, the rational action planner, rational questions,
and rational hypnotherapy. Therapeutic Process
RLT is a structured, goal-oriented, active-directive
Camera Check form of treatment, similar to other cognitive-
The camera check, a technique borrowed from behavioral therapies. Treatment is short-term, last-
RBT, is used in RLT to dispute irrational thoughts. ing as few as 8 to 10 weeks, with sessions typically
This technique asks the simple question “What 45 to 60 minutes in length. During the initial ses-
would the camera reveal if a photo of the situation sions, an assessment is conducted, offering insight
were taken?” This technique helps the client view into the client’s negative patterns of irrational
situations in an objective, realistic way. thinking and behaving. The assessment provides
direction for a targeted treatment in upcoming ses-
sions. Once problematic areas are identified, a
Positive/Negative Imagery
variety of strategies and techniques are utilized to
Positive/negative imagery is a visualization tech- challenge and replace irrational thoughts. In some
nique useful in establishing patterns of rational instances, rational hypnotherapy may be employed
behavior. Positive imagery promotes rational to facilitate cognitive and behavioral change. With
behavior by emphasizing positive outcomes. emphasis on the role that rational self-counseling
Negative imagery highlights the negative results skills play in treatment, homework assignments

856 Reality Therapy
are frequently recommended in RLT. The goal of had more control over their actions than they at
RLT is to equip clients with the tools and skills first believed.
needed to be happy, to reach their goals, and to live Subsequently, Glasser added a theory of brain
rationally. functioning, called control system theory or con-
trol theory, as the basis for the delivery system,
Jeffrey M. Warren reality therapy. Because of the central place of
human choice in counseling and psychotherapy,
Cognitive-Behavioral Therapy; Hypnotherapy; Neuro-
Glasser changed the name of the theoretical basis
Linguistic Programming; Rational Emotive Behavior for reality therapy from control theory to choice
Therapy theory. He further added a five-needs schema (dis-
cussed later) as the origin or motivational drive
behind human behavior, redefined as a unit com-
Further Readings posed of actions, cognition, emotions, and physiol-
Pucci, A. R. (2006). The client’s guide to cognitive- ogy. Therefore, strictly speaking, choice theory is
behavioral therapy: How to live a healthy, happy life separate from reality therapy in that it is the under-
. . . no matter what! Bloomington, IN: iUniverse. lying justification for the practice of reality ther-
Pucci, A. R. (2010). Feel the way you want to feel . . . no apy. Glasser has pointed out that choice theory is
matter what! Bloomington, IN: iUniverse. like a train track and reality therapy is the train.
Pucci, A. R. (2011). About rational living therapy. They are interdependent components. However,
Retrieved from http://www.rational-living-therapy.org/ the phrase reality therapy is most often used to
AboutRLT.htm include both the theoretical basis and the process,
Pucci, A. R. (2013). Rational living therapy relationship the train and the track.
therapy. Retrieved from http://freecbthandouts.com/ Because of the emphasis on choosing behavior,
cbt-articles/rational-living-therapy-relationship- especially choosing actions, the reality therapist
therapy/ believes that clients can make effective choices to
satisfy their inner motivations, employing skills
derived from the WDEP system of reality therapy,
which involves helping clients define their wants,
REALITY THERAPY examine their behavior (i.e., what they are doing),
conduct self-evaluations, and make efficacious
Reality therapy is an internal control system used plans for improvement. These interventions are
by counselors and psychotherapists throughout built on empathy, positive regard, and genuineness.
the world. It is a theory and a method expressed in
language understandable to both professionals and
Historical Context
laymen and used by individuals in a wide range of
settings. In 1946, Glasser attained a bachelor’s degree in
Developed by William Glasser in the 1950s and engineering from Case Western Reserve in
1960s on the foundational principle that human Cleveland, Ohio. Preferring to work more directly
behavior originates from within the person and is with people, he entered medical school and became
the result of current internal motivations, reality a psychiatrist working in a mental hospital and a
therapy is neither a response to external stimuli correctional institution in Los Angeles, California.
nor an attempt to resolve early-childhood con- During his psychiatric internship, Glasser devel-
flicts. Glasser and his teacher G. L. Harrington, oped his method to the point of insisting that
while working in a mental health hospital, reacted patients discuss only their current behavior and
against both their training and current psychiatric taught them that, whatever their condition, they
practice. They attributed little value to what they have choices. During this evolution, he hesitantly
believed was the never-ending search for insight shared this attitude with his supervisor,
and unconscious motivations. Rather, they held G. L. Harrington. Rather than rejecting Glasser’s
their clients responsible for their behavior and approach, Harrington reached across the desk,
taught them that though they did not feel com- extended his hand, and spoke the oft-quoted
pletely in charge of their lives, they nevertheless response, “Join the club.” Together they began a

Reality Therapy 857
reality-based program for the patients in one of the relationships. When human relationships are more
psychiatric wards. After 3 years, approximately satisfying, happiness and a sense of hope result,
50% of the patients were released from the hospi- stress is lessened, and a more fulfilling life is possi-
tal, with only a 3% rate of return. ble. The third human need or motivator is the even
In 1965, Glasser published his watershed work more general and often misunderstood need for
Reality Therapy. Subsequently, he was asked to power. Power, in choice theory, equates not with
lecture on his book throughout North America. domination but with achieving a sense of inner
For a short time, he labeled his system “reality control. It includes gaining a sense of achievement,
psychiatry.” But the psychiatric profession charac- a feeling of self-pride, self-worth or self-esteem, and
terized by the psychodynamic approach rejected even a passion for living an industrious life. It can
Glasser’s principles. Several counselors, social include a sense of victory as in a sporting event. But
workers, psychologists, and educators, however, it is not limited to a zero-sum game in which there
responded favorably and requested further train- are winners and losers. The fourth need, freedom,
ing. As a result, Glasser renamed the system “real- means making decisions. Human beings are born
ity therapy” and founded the Institute for Reality with a need to choose. In implementing choice
Therapy, now known as William Glasser theory (i.e., practicing reality therapy), the coun-
International, with training programs conducted selor assists clients to make satisfying choices and
throughout the world. Because of the widespread to realize that they possess the ability and the pos-
acceptance of reality therapy by educators, Glasser sibility of making more choices than previously
and his institute developed systemic applications considered. The fifth need or human motivator is
to schools called Schools Without Failure, later fun. The philosopher Aristotle described a human
renamed the Glasser Quality School. The core of being as a risible creature. Humans can laugh.
the application of reality therapy to education con- Effective users of reality therapy assist clients to see
sists in creating a school atmosphere in which humor in their environment and to choose activi-
students can satisfy their five needs and are given ties that bring them enjoyment.
as many choices as are reasonably possible. The Clearly, the needs overlap with one another. A
school personnel learn to communicate with stu- person chooses to perform an activity with a
dents and parents by using reality therapy inter- friend. They gain a sense of accomplishment from
ventions. The proven outcome of the program the activity and enhance their relationship. In mak-
includes enhanced learning and fewer behavioral ing such choices, they often feel free of the stressors
problems. previously endured. Although the needs lead to
Robert Wubbolding has extended reality ther- specific behaviors, they themselves are general,
apy interventions or procedures and formulated a universal, and multicultural. All people possess the
pedagogical tool, the WDEP system, for helping needs and develop specific wants related to each
counselors and therapists learn and apply choice need—a process that lies at the basis of behavioral
theory and reality therapy. choices. The collection of wants or desires related
to each need is unique for each person. The reality
therapist helps clients clarify specific wants so that
satisfying them becomes possible. The first goal of
Underlying the practice of reality therapy is a the- the practitioner is to become part of this inner
ory of human personality: choice theory. This sys- world of client wants and to be seen as someone
tem explains human motivation. Human beings are who demonstrates helpful qualities such as empa-
seen as genetically instructed to satisfy five general thy, positive regard, authenticity, and competence.
motivators or needs. The need for survival causes Human behavior results from efforts to satisfy
people to generate behaviors that ensure self-pres- the inner world of wants. The four components of
ervation and the survival of the human species. The behavior are analogous to the wheels of an auto-
second need, and often the focus of counseling and mobile, with the driver exerting more direct control
therapy, is the need for belonging. Adherents to the over the front wheels, action and cognition, and
principles of reality therapy encourage a discussion less direct control over the back wheels, emotions
of human relationships because they see that at the and physiology. Consequently, psychotherapy
basis of many disturbances are dysfunctional focuses primarily on the most controllable elements

858 Reality Therapy
of behavior: actions and thinking, especially actions. Major Concepts

This principle illustrates that choice theory, and its
Because of its emphasis on choice, some textbook
implementation, reality therapy, is an internal con-
authors place reality therapy among the existential
trol system in that human behavior generates from
systems. Others see reality therapy as a cognitive
within the person and is treated as a choice. An
system because of the emphasis on helping clients
important caveat is that choice is predicated on
evaluate their behavior and because of the princi-
actions, not on emotions or physiology. Emotions,
ple that feelings or emotions are not the cause of
and to some extent physiology, play the role of
dysfunction but are rather behaviors generated to
lights on the dashboard of the car. When they light
satisfy the five-needs system. Both of these view-
up, they suggest to the driver that action is needed.
points serve as a basis for the major concepts of
The unity of action, cognition, emotion, and physi-
reality therapy, such as the distinction between
ology is called total behavior.
choice theory and its delivery system, reality ther-
Human behavior is also purposeful and goal
apy; the central role of wants and needs satisfac-
directed. Its purpose is to influence the world or to
tion, especially human relationships in choice
control it so that the agent of behavior gains the
theory and reality therapy; behavior as purposeful
perception of satisfying one or more need and
and as a choice; self-evaluation as a necessary
wants related to the need. The chosen behaviors
prerequisite for change; and the therapeutic alli-
can be effective or ineffective, helpful or unhelpful,
ance or counseling environment, including toxic
productive or counterproductive. Many clients
and tonic behaviors.
seek the help of therapists because they have made
ineffective choices for the purpose of satisfying
their needs. Some people desiring pleasure and Distinction Between Reality Therapy
seeking freedom from stress turn to drugs or alco- and Choice Theory
hol to gain the perception of fulfilling the need for From a strictly definitional viewpoint, choice
fun, freedom, and even belonging and power. If theory is distinct from reality therapy. Choice the-
continually used to an excessive degree, choices ory, with its needs system of human motivation, its
become not only ineffective but also harmful. fourfold definition of behavior, and its delineation
In summary, the theory was originally known as of behavior as purposeful, constitutes a theory of
control theory or control system theory, in which human personality. Reality therapy, on the other
the human mind is seen as functioning in a way hand, consists in operationalizing and delivering
similar to a control system. For example, a thermo- the theory to clients. However, most frequently the
stat wants the room temperature at 72 degrees. term reality therapy includes both choice theory
When it perceives that it is not achieving its pur- and the practice of reality therapy.
pose, it sends a signal to the heating or cooling unit
to generate more effective behaviors to raise or
Central Role of Wants and Needs Satisfaction
lower the room temperature. The human mind
operates in a way analogous to a control system, Human behaviors spring from specific wants
but in a much more complex manner. As people unique to individuals and related to their five-
grow and mature, they are able to insert into their needs system, especially the need for belonging.
quality world wants that are helpful and altruistic Regardless of the presenting issue, the practitioner
or harmful and even antisocial. They can also of reality therapy helps clients examine their cur-
choose behaviors that are helpful and humane or rent human relationships. Even though past expe-
dysfunctional and destructive. Additionally, the riences have created the clients’ current situation,
human mind does not function in isolation. It only repeated discussion of personal history is less
develops as a result of interaction with other important than examining current human rela-
human beings, a principle scientifically demon- tionships and improving them. When clients
strated in attachment theory and recent studies satisfy their need for belonging as currently expe-
centering on the neuroplasticity of the brain. rienced, their dysfunction and their unhappiness
Hence, the reality therapist focuses on human rela- decrease. Their lives improve, and their happiness
tionships in most counseling and therapy sessions. increases.

Reality Therapy 859
Behavior as Purposeful and as a Choice The Art of Asking Questions

Similar to Adlerian principles, behavior is goal Reality therapists ask many questions of clients.
centered. Its purpose is to affect the world so that The reason is that clients possess strengths and
the person gains a perception of needs and wants answers that they are often unaware of. The work
satisfaction. Human beings have little direct con- of the therapist is to elicit information and work-
trol over physiology and emotions and more con- able strategies to address clients’ wants and needs.
trol over cognition and actions, with actions the
most easily controlled and changed. When choices Using Metaphors
are made to change actions, alterations in thinking,
feelings, and even physiology can occur. Analogies, figures of speech, and a multitude of
metaphors help clients externalize their problems,
see humor that was previously hidden, and grapple
Self-Evaluation as a Necessary
more effectively with effective plans.
Prerequisite for Change
Helping clients evaluate the effectiveness of Discussing Nonproblem Areas
their freely chosen actions, the attainability of their
wants, and their perceived degree of control (i.e., When clients discuss their successes, their
their locus of control) constitutes the cornerstone healthy relationships, and their wants and needs
in the process of reality therapy. Therefore, a pre- currently satisfied, they learn that they have a
eminent goal of the reality therapist is to facilitate problem. They are not the problem.
a skill by which clients learn to self-evaluate.
Direct Teaching of Choice Theory
The Therapeutic Alliance and Reality Therapy
As with many systems of psychotherapy, the Part of using reality therapy is well-timed
effective use of reality therapy is built on a therapeu- instruction about the needs system, the quality
tic alliance. When clients place the therapist in their world, the behavior as chosen, and the WDEP sys-
quality worlds, they see an authentic, ethical, and tem of reality therapy. The skilled reality therapist
competent helper. Clients learning from a therapist teaches when the appropriate time presents itself.
who models a healthy relationship characterized by
empathy, positive regard, and honesty are likely to Therapeutic Process
personalize these qualities and to implement them in
their own relationships. A skillful reality therapist The goal of the reality therapy therapeutic process
assists clients in specific ways to enhance their is to help clients gain more effective control of
interpersonal relationships by avoiding the toxic their lives. Control in the context of reality therapy
behaviors of arguing, blaming, and criticizing and to does not refer to the regulation of other people’s
realize that they can control only their own behavior. behavior. Another way of describing the goal is
that therapy is directed toward helping clients sat-
isfy their five needs effectively and efficiently with-
Techniques
out infringing on the rights of others. The acronym
Choice theory is an open system in that it allows WDEP summarizes specific therapeutic interven-
for the use of many techniques, such as disputing tions utilized by the reality therapist. Each letter
irrational thinking, paradoxical techniques, and represents a cluster of skills that practitioners use
the incorporation of the Ericksonian principle stat- in a wide variety of settings: clinics, schools, child
ing that often the solution seems to have nothing care, health care, corrections, addictions, parent-
to do with the presenting issue. And yet there are ing, and so on. W represents the exploration of
techniques that are most typical of reality therapy: clients’ quality worlds—more specifically, what
the art of asking questions, using metaphors, dis- they want. This process includes identifying their
cussing nonproblem areas, and direct teaching of hopes, their dreams, their intense desires, and their
choice theory and reality therapy. whimsical wishes. It often involves helping clients

860 Rebirthing
clarify unclear pictures of what they want. It can See also Adlerian Therapy; Cognitive-Behavioral
also include a discussion of conflicting wants and Therapy; Existential-Humanistic Therapies: Overview;
what they want from their parents, their spouse, Rational Emotive Behavior Therapy; Solution-Focused
their children, their job, the community, family Therapy
members, friends, religion or spirituality, social
agencies, and any person or group that impinges Further Readings
on their lives. Special focus is given to what they
Glasser, W. (1965). Reality therapy. New York, NY:
want from themselves or their level of commitment
Harper & Row.
and how much energy they will exert to fulfill their
Glasser, W. (1998). Choice theory. New York, NY:
wants. W also refers to asking clients about their
HarperCollins.
perceived locus of control. The therapist assists Glasser, W. (2003). Warning: Psychiatry can be
clients to describe whether they see themselves in hazardous to your mental health. New York, NY:
control of their lives or victimized by their per- HarperCollins.
sonal history, society, or current circumstances. Glasser, W. (2011). Take charge of your life. Bloomington,
D represents interventions focusing on doing or IN: iUniverse.
on total behavior, especially clients’ actions. The Roy, J. (2014). William Glasser: Champion of choice.
therapist asks clients specific questions relating to Phoenix, AZ: Zeig, Tucker & Theisen.
current choices, with emphasis on their relation- Siegel, D. (2012). Pocket guide to interpersonal
ships with other people. D also stands for an neurobiology. New York, NY: W. W. Norton.
exploration of clients’ self-talk as derived from Wubbolding, R. (1988). Using reality therapy. New York,
choice theory. People who feel that they are at the NY: Harper & Row.
mercy of their external world tell themselves, Wubbolding, R. (1991). Understanding reality therapy.
“I can’t” or “They won’t let me.” The antisocial New York, NY: HarperCollins.
person engages in self-talk such as “No one can tell Wubbolding, R. (2000). Reality therapy for the
me what to do.” When the most prominent compo- 21st century. Philadelphia, PA: Brunner Routledge.
nent of behavior is emotion, the reality therapist Wubbolding, R. (2011). Reality therapy: Theories of
listens carefully and relates the feeling to the more psychotherapy series. Washington, DC: American
controllable component of behavior: actions. Psychological Association.
E stands for self-evaluation, the core of reality Wubbolding, R., & Brickell, J. (1999). Counselling
therapy. Conducting a searching and fearless self- with reality therapy. Milton Keynes, England:
evaluation is the royal road to behavioral change. Speechmark.
Wubbolding, R., & Brickell, J. (2001). A set of directions
Reality therapists ask clients not only to describe
for putting and keeping yourself together.
the W and the D but also to make a judgment
Minneapolis, MN: Educational Media Corporation.
about them. The following interventions are char-
acteristic of E: “Is what you’re doing helping or
hurting you?” “Is it really true that you have no
control in your life?” “If you make no effort to
alter your actions, will anything change for the bet-
REBIRTHING
ter?” “Is what you want realistically attainable?”
P represents planning. When clients formulate Rebirthing is a controversial approach to working
plans, they benefit by addressing not only specific with individuals who have attachment issues, such
issues but also the side effects that often occur. as those that may be found in children who have
Deriving a sense of hope and confidence, they real- been adopted. In this approach, the practitioner
ize that they need not remain powerless. They have works to help the client go through age regression
more control than at first perceived. The plan to re-create the experience of being born. It is
should be simple, attainable, measurable, immedi- related to holding approaches and loosely related
ate, and controlled by the planner, that is, not to attachment-based therapies, although most
dependent on others. attachment-based therapies do not have the nega-
tive consequences that have been shown in this
Robert E. Wubbolding approach.

Rebirthing 861
Historical Context rebirthing, it may be used as a preliminary

intervention. Holding may be applied as a sched-
Rebirthing emerged in the mid-20th century as an
uled event, occurring at prescribed intervals through-
approach to mitigate attachment difficulties. The
out the day. An early, and subsequently discredited,
approach was aimed to help those with attachment
version of holding therapy is attributed to Robert
challenges bond with their parents (biological, foster,
Zaslow, who created what he called the Z-process.
or adoptive). In theory, once a rebirthing was accom-
plished, a reparenting phase may be warranted to
further enhance the attachment process. In the early Regression Theory
years of the 21st century, rebirthing came under Regression theory, as it relates to rebirthing,
increased scrutiny, in part due to the death of a suggests that it is possible for individuals to experi-
10-year-old girl who underwent the rebirthing pro- ence age regression aimed at ameliorating the lack
cess as a result of her reported challenges in attach- of achievement of various developmental mile-
ing to her adoptive mother. The girl was wrapped in stones. Other objectives of regression therapy may
a sheet while lying in the fetal position. Four adults include the retrieval of unconscious material or
subsequently pressed on her with pillows to re-create memories that have been repressed.
the birthing process. Despite the girl’s cries for help
and her statements that she was unable to breathe,
the session continued for more than an hour. She Attachment
was unconscious and unresponsive when the sheet A lack of healthy parent–child attachment is a
was removed and was pronounced dead a day later. major concept associated with the use of rebirthing
Rebirthing has faced ethical and legal challenges and techniques. The disruption of the attachment pro-
has been outlawed in some jurisdictions. cess is thought to give rise to a host of behavioral
and relational problems in the child, thus requiring
Theoretical Underpinnings intervention.
Rebirthing is viewed as an outgrowth of regres-
sion-based theories, catharsis, holding therapies, Rage Reduction Theory
and rage reduction models. It has been linked to Rage reduction sessions may last for multiple
psychoanalysis, attachment theory, the Z-process, hours and call for the practitioner to come into
Ericksonian theory, as well as a host of other theo- physical contact with the client through holding
ries. One of its aims is to interrupt defense mecha- techniques. Confrontational, often demeaning
nisms that block the pathway to healthy parent– statements by the therapist may be repeated
child attachment. It is predicated on the notion that throughout the session in an effort to have the
the application of compression can re-create the child give up manipulative and defensive behav-
birthing process so that the child is able to bond iors. The intent is to help the client reach a state of
normally with the parent as the two make eye con- catharsis so that the rage is released and the child
tact as the child emerges from the simulated womb. can be re-parented.
Major Concepts
Techniques
Rebirthing is associated with myriad concepts that
vary by practitioner. The major concepts associated In an effort to re-create the birthing process,
with the approach include holding theory, regres- practitioners may employ a variety of techniques.
sion theory, attachment, and rage reduction theory. Preliminary training in breathwork may precede
the formal rebirthing process. The main technique
applied in this approach is compression therapy,
Holding Theory
which is intended to trigger a rebirthing experience
Holding theory exists in many forms, based on to such a degree that the client becomes amenable
the notion that holding is essential to the establish- to bonding with the parent. Confrontation of
ment of healthy attachment. In the context of the client’s statements that are expressed during

862 Rebirthing-Breathwork
the process is another aspect of the approach. The requests to go to the bathroom are viewed by
sessions last for multiple hours, and more than one practitioners as attempts at manipulation and are
session may be prescribed by the practitioner. thus ignored. The goal is for the child to cry and
struggle to push out of the makeshift womb with
the ultimate goal of making eye contact with and
Breathwork
subsequently attaching to the parent.
As alluded to in its name, breathwork consists The role of the practitioner in this process is
of the use of regulated breathing as a means to often to serve as the coach to the client, the parent,
address various psychological states. Breathwork and other participants. Sessions are often held in
may call for the slowing of breath or breathing in the office of the practitioner, although the sessions
prescribed patterns. The general purpose of breath- could be conducted in the home of the parent. The
work may be to achieve enhanced psychological sessions often last for several hours and as such can
awareness or to help reduce one’s sense of stress. be enormously physically taxing to all involved,
As a corollary to rebirthing, some practitioners especially the client. During the rebirthing process,
have asserted that breathwork can allow one to the weight of several adults may be pressing down
recapture and deal with repressed traumatic emo- on the client, who may be completely encapsulated
tions, such as those that have led to obstacles in in blankets and pillows, creating a great risk to the
bonding with parents. client’s physical as well as emotional health. It is
important to note that rebirthing has been out-
Compression Theory lawed in multiple jurisdictions. Its lack of empirical
validity has contributed to its discredited status.
In the quest to re-create the birthing process,
early theorists devised compression techniques that Peggy L. Mayfield
called for the swaddling of the client. In addition,
this approach often uses pillows or cushions that See also Cautious, Dangerous, and/or Illegal Practices:
are placed on the child’s body with pressure Overview; Classical Psychoanalytic Approaches:
Overview
applied by the practitioners. Theorists hypothe-
sized that the application of pressure to the child
via the swaddling and pillows would trigger psy- Further Readings
chological regression to the extent that the child
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F.,
could reexperience the birth process. Spitz, A. M., Edwards, V., . . . Marks, J. S. (1998).
Relationship of childhood abuse and household
Confrontation dysfunction to many of the leading causes of death in
adults. The Adverse Childhood Experiences (ACE) Study.
Clients typically cry and call for help during the American Journal of Preventive Medicine, 14, 245–258.
rebirthing process. Often the child will request a Freeman, J. C., Epston, D., & Lobovits, D. (1997). Playful
drink or will request to be allowed to use the bath- approaches to serious problems: Narrative therapy
room. These types of requests are viewed by prac- with children and their families. New York, NY:
titioners as manipulative behaviors and are met W. W. Norton.
with confrontation from the practitioners. Perry, B. D. (2009). Maltreated children: Experience, brain
development and the next generation. New York, NY:
W. W. Norton.
Therapeutic Process
Rebirthing calls for the client to be wrapped, some-
times while in the fetal position, in some type of
cloth (i.e., a blanket or sheet) in an effort to REBIRTHING-BREATHWORK
re-create the womb. The individual’s head may or
may not be exposed. Practitioners then use pillows, Rebirthing-Breathwork, also known as Rebirthing,
or similar objects, to press against the client to Connected Breathing, Intuitive Energy Breathing,
replicate the birthing process. Cries for help or among other names, is a therapeutic process whose

Rebirthing-Breathwork 863
practice primarily involves a circular breathing The psychotherapeutic community began taking an
technique and spontaneous form of regression interest in Rebirthing-Breathwork after observing
therapy. Founded in the 1970s by Leonard Orr, its effectiveness in healing patients of the negative
some of the practices resemble those of ancient effects of their past.
yoga methods, though the founder was unaware of
this until after he had developed his original theo-
The First Rebirthing Method
ries. It is founded partly on the belief that the act
of being born is an inherently traumatic event, In 1962, while relaxing in the bath for an
leaving a deep psychological imprint that most extended period of time, Orr had a spontaneous
people are unable to recall but that nonetheless regression that left him weak and unable to move
affects their behavior and breathing ability, and from the tub. He later realized that he had
that birth trauma has a natural tendency to reach regressed into an infancy memory and an experi-
the conscious mind when one is relaxed and feels ence of helplessness. This regressed state lasted
safe. Rebirthing in this usage is not to be confused 3 hours. Orr continued spending extended time in
with other practices bearing the same name, such his tub relaxing through feelings of urgency. Each
as the controversial techniques used to re-create time he relaxed through these urgency barriers,
the birth experience for children showing signs of Orr recovered early infancy, birth, and prenatal
detachment. memories as far back as conception.
Orr found many people who were interested in
accessing their own early memories, asking him for
Historical Context
guidance and support. Orr began by sitting beside the
Rebirthing-Breathwork has been called “an tub supporting them through several urgency barri-
American form of Pranayama Yoga” by Haidakhan ers. Eventually, he purchased a large house in the
Babaji, an Indian saint who identified himself to Haight-Ashbury district of San Francisco, California,
Orr as the Shiva Mahavatar Babaji, known to and invited volunteers to move in and help develop
many through Paramahansa Yogananda’s his Rebirthing method. This was the beginning of
Autobiography of a Yogi. Pranayama is a form of Theta House, which launched the Rebirthing move-
yoga concerned with the ancient study of the ment into a worldwide phenomenon.
breath and the methods of breathing practiced by
yogis, wherein the effects of such breathing can be
The Second Rebirthing Method
felt in the form of healing energy throughout the
entire body. Orr decided to move the sessions from the bath-
Born in 1938 in Walton, New York, Orr was tub to a hot tub. With the participant floating and
raised in a nonreligious home. He became an evan- breathing through a snorkel, Orr, in the tub beside
gelical Christian at 18 years of age, but he became the participant, instructed the participant to con-
disenchanted with the institution of the church and tinue breathing until he or she was overwhelmed
began to study the scripture of many ancient tradi- with memory and had to come out to integrate the
tions, looking for answers his Christian education experience. Eventually, Orr noticed that this con-
stirred within him. As part of his spiritual quest, tinuous unbroken rhythm triggered a powerful
from 1962 to 1974, he studied the human con- effect on the participant’s overall breathing pat-
sciousness and experimented with breathing exer- tern. At a certain point, the breathing would
cises, deep relaxation, and bathtub meditation and become spontaneous, and a powerful circular
began to spontaneously reexperience memories rhythm would emerge. Ultimately, this realization
going as far back as the time of his birth. When oth- led to experimenting with the breath alone, with-
ers, following Orr’s techniques, similarly described out the water.
birth memories, the term Rebirthing came into
common use to describe this modality. Orr has
The Third Method: Rebirthing-Breathwork
stated that between 1988 and 1993, he used
Rebirthing-Breathwork to heal himself of eight ter- Orr began to facilitate sessions with partici-
minal diseases, as well as his senility experience. pants lying comfortably on the floor or a mattress

864 Rebirthing-Breathwork
and guiding their breathing into a connected attendants. Under the best of circumstances, this
circular rhythm. This method proved to be highly process is challenging. Common medical practices
effective in reproducing the same results Orr had have denaturalized this process and introduced
noticed in the tub, and Rebirthing-Breathwork was trauma-inducing practices, including spanking a
born. With continued refinement, this technique newborn (the traditional explanation has been that
has evolved into the gentle yet powerful Rebirthing- this clears the infant’s air passages), cutting the
Breathwork methods employed successfully by umbilical cord immediately after birth, removing
thousands of Rebirthing-Breathwork instructors the child from the mother soon after birth, isolation
throughout the world today. in an incubator, and so on. These practices were
probably designed to hasten the child’s acclimation
to the world, but they leave behind damage that the
person does not remember in later life.
According to the principles of Rebirthing-
Breathwork, disease and misery are caused by unre- Misuse of the Human Mind: Personal
solved trauma, misuse of the human mind, poor Law and Specific Negatives
diet and lifestyle, inadequate rest or solitude, and
ignorance of basic cleansing practices. This results Personal law refers to the most abstract negative
in emotional suppression, inhibited breathing, phys- thought that individuals have about themselves.
ical contraction, chronic stress, and accumulated The term law is used because the individual
waste, causing many common diseases. The therapy enforces it to the point where deviation from it
seeks to address illness simultaneously from physi- seems impossible. Individuals will interpret their
cal, mental, and spiritual perspectives through the life experiences in accordance with their personal
study of metaphysical principles and spiritual puri- law and use this as evidence for their false beliefs.
fication practices, including conscious energy Specific negatives are negative thoughts that align
breathing, which accomplishes this automatically. with and support one’s most fundamental beliefs.
By studying these causes of disease, misery, and Any given person’s personal law and specific nega-
death, it becomes possible to bring unconscious tives run his or her life until he or she identifies
thoughts, beliefs, and behaviors into awareness; to them, disproves them through reason, and replaces
resolve unhealed trauma; and to make changes that them by building a construct of life-enhancing
may ultimately bring healing. Living a conscious life thoughts through recognition of one’s natural
on the path of unlimited personal mastery is the innocence, true nature, and unique gifts.
ultimate goal of Rebirthing-Breathwork.
Parental Disapproval Syndrome
Major Concepts Much adulthood trauma is related to childhood

feelings of betrayal from one’s parents. Among the
Rebirthing-Breathwork identifies a number of com- earliest dynamics between children and their par-
mon factors contributing to physical, mental, and ents is that by which parents withhold affection to
spiritual illness, including birth trauma, misuse of discipline the child. This can lead to unhealthy life-
the human mind, parental disapproval syndrome, long behavioral patterns in which the child associ-
unconscious death urge, school and religious ates love with pain and trauma and thus seeks out
trauma, senility, and emotional energy pollution. unhealthy and dangerous relationships and situa-
tions. Without some form of therapy, it is very dif-
Birth Trauma ficult to overcome parental disapproval syndrome.
According to Orr’s principles, birth, at its core, is
Unconscious Death Urge
a natural event. The ability for a successful, healthy
birth is innate to all species. By design, the infant The unconscious death urge is a thought struc-
passes through the birth canal, moving from the ture consisting of any and all antilife thoughts. At
womb to the world; takes its first breath; and is the root of the unconscious death urge is the belief
suckled, cared for, and comforted by its mother and that life is inherently lethal, that existence is unsafe,

Rebirthing-Breathwork 865
that humans are separated from the source of their Emotional energy pollution can be removed
being, and that the only way out is death. Ancestral from the energy body with spiritual purification
and cultural beliefs and attitudes are the primary practices. Basic spiritual purification practices are
source from which we learn these beliefs. Rebirthing- fasting, good diet, exercise (earth), conscious
Breathwork seeks to identify and redirect one’s energy breathing (air), bathing twice per day
thinking in a life-enhancing direction. Rebirthing (water), and sitting by an open flame (fire). These
practitioners recommend sitting before an open fire basic spiritual purification practices can clean the
to silence the mind and counteract the urge. mind faster than the mind can clean the mind.
School and Religious Trauma Therapeutic Techniques

For some, unpleasant experiences in early Two main therapeutic techniques are used in
schooling can stifle creativity and a sense of nur- Rebirthing-Breathwork: (1) conscious energy
turing, as well as exposing children to “emotional breathing and (2) affirmation and emotional
energy pollution.” Such trauma may include response technique.
negative reinforcement as a means of exercising
discipline. Some individuals raised under a harsh
religious doctrine may grow up with a sense of Conscious Energy Breathing
shame and false beliefs about themselves and their In practice, Rebirthing sessions center on con-
self-worth. scious energy breathing, whose purpose is to liber-
ate the breathing mechanism, develop the ability to
Senility breathe energy as well as air, and allow divine
Practitioners of Rebirthing-Breathwork use the energy to move throughout the body. The breath-
term senility to describe a general surrender to ing practiced in the sessions is circular and con-
disease. Unhealed trauma, infancy memories, along nected, with relatively full and fast, yet unforced,
with accumulated emotional energy pollution will inhales and relaxed exhales. The goal is to awaken
eventually surface as misery, disease, and degenera- a pattern of breathing that more closely resembles
tion. Senility is seen as “the final exam.” When the that of an infant; adults tend to breathe discon-
individual is successful with addressing his or her nected breaths with palpable muscle tension and
sources of misery and suffering, the result is lon- restrictions. Insufficient breathing is a common
gevity. When unsuccessful, the result is increasing problem for most people. Particularly in moments
stiffness, contraction, and death. of stress, people frequently hold their breath or
restrict their inhale without realizing it. Breathwork
is effective in working through this conditioning
Emotional Energy Pollution
and the resulting energy blockages that can be
Just as Earth has an atmosphere, individual caused by subventilation. In a given session, 1 to 2
beings, too, have an atmosphere. The individual’s hours will be devoted to conscious energy breath-
atmosphere is its energy body, which permeates ing; the exact length is determined by the actual
and extends beyond the physical body. The mind duration of an energy cycle. A completed energy
and emotions are also contained within the energy cycle can be recognized by feelings of deep relax-
body. Thoughts (or mental constructs) and emo- ation and presence. This type of breathwork is not
tions are palpable not only to an individual but to be confused with hyperventilation, which is ten-
also to other individuals, even in the absence of sion based and involuntary.
direct communication. The information contained In practice, the individual will become aware of
in energy bodies is transferable. In fact, there is a “concentrations of energy” in the form of negative
continuous exchange between all life forms within thoughts, suppressed feelings, and sensation in their
the environment. When individuals are creating physical body. “Breathing into” this area and relax-
thoughts and generating emotions from conditioning on the exhale can lead to effective relief for the
ing, they are creating and generating emotional individual. With practice, this experience can become
energy pollution. increasingly more comfortable and enjoyable.

866 Recovered Memory Therapy
By breathing in this fashion, clients frequently and obtain a sense of safety through this process,
report feelings of bliss, a release of anger, and a especially through the “breath release: This occurs
general sense of well-being. Because the Rebirthing when the breathing mechanism releases the tension
sessions re-create infant respiratory patterns, created at birth.”
patients can experience long-forgotten memories
from early childhood, as well as birth and prenatal Virginia Peace Arnold
memories.
See also Body-Mind Centering®; Energy Psychology;
Focusing-Oriented Therapy; Mindfulness Techniques;
Affirmation and Emotional Response Technique Prayer and Affirmations
Repetition of high-quality ideas will often cause
contrasting ideas and their associated feelings to Further Readings
surface, where they can be experienced and evalu- Churchill, P. (2007). Eternal breath: A biography of
ated along with the impact these thoughts have in Leonard Orr, founder of rebirthing breathwork.
our lives. Practitioners of Rebirthing-Breathwork Victoria, British Columbia, Canada: Trafford.
utilize written or spoken affirmations for this pur- Orr, L. D. (1995). Breath awareness. Staunton, VA:
pose. Through reason and repetition, one can use Inspiration University.
this information to negate these negative beliefs Orr, L. D. (1995). The new rebirthing book. Staunton,
and build a high-quality thought structure to VA: Inspiration University.
replace the outdated information and improve the Van Laere, F., & Orr, L. D. (2011). Manual for rebirthers.
quality of clients’ lives considerably. Someone who Madrid, Spain: Vision Libros.
gravitates toward abusive relationships, for exam-
ple, may be acting from a core belief that he or she
is unworthy, so the client’s treatment will include
statements affirming his or her worthiness of love RECOVERED MEMORY THERAPY
and respect and acceptance of relationships
embodying these qualities. Recovered memory therapy refers to several differ-
ent techniques based on the premise that memories
Therapeutic Process of brutal, terrifying childhood events can be com-
pletely hidden from consciousness but still cause
Rebirthing-Breathwork can usually be taught in 10 significant emotional problems. The assumption is
to 20 sessions, each session lasting 1½ to 2 hours. that the traumatic events were so horrible that the
The first session involves developing a rapport client developed amnesia through a process of
with the client while gathering background infor- repression or dissociation and therefore must be
mation, including what brings the client to this helped to uncover these buried memories in order
process and past experience in the area of self- to heal from the trauma. Recovered memory ther-
improvement. This is followed by breathing exer- apy is highly controversial, and there is strong
cises, preparation for the first breathwork session, evidence that recovered memory techniques can
and the breathwork session itself. produce false memories. The theories and tech-
Subsequent sessions involve introducing meta- niques are not scientifically supported and are not
physical principles, exercises for revealing personal generally accepted in the scientific community.
law and specific negatives, unraveling the uncon-
scious death urge, and developing individual affir-
Historical Context
mation statements. Each of the subsequent sessions
concludes with a breathwork session. Recovered memory therapy began surfacing in the
The primary goal of the breathwork sessions is late 1980s in connection with claims of childhood
to teach the client to guide his or her breath into a sexual abuse. Therapists specializing in this effort
circular rhythm, merge the inhale with the exhale, maintain that many incest survivors do not remem-
breathe energy as well as air, maintain this for at ber their abuse but their abuse results in emotional
least 1 hour or the completion of an energy cycle, and physical problems. They claim that clients

Recovered Memory Therapy 867
must be helped to retrieve their memories in order and psychogenic amnesia, posttraumatic stress
to recover from the trauma. Some recovered disorder, multiple personality disorder, body
memories include bizarre ritual satanic abuse. memories, and flashbacks and dreams.
From the beginning, recovered memory therapy
was controversial, with critics maintaining that there Repression
was no support for the theories the therapy was
based on and that clients were in danger of develop- Repression is a mechanism by which the person
ing false memories of terrible things that never is unable to remember or be cognitively aware of
happened. In the 1990s, there were several highly disturbing feelings, thoughts, or experiences. It is
publicized malpractice lawsuits by clients who, differentiated from ordinary forgetting. Despite
when they realized that their memories of incest and the fact that repression is a basic assumption of
ritual abuse were false, successfully sued their thera- Freudian personality theory, in this context, it is
pists. The result of these malpractice lawsuits, along not empirically supported. Traditional analytically
with licensing board revocations, is that recovered oriented therapists, who may use the concept of
memory therapy has virtually disappeared. repression, are concerned with the client’s percep-
tions of reality rather than the historical accuracy
of the material uncovered in therapy. Also, there is
nothing in the repression literature supporting the
Recovered memory experts believe that survivors belief that it is common for repeated episodes of
have repressed memories as a protective mecha- sexual abuse to be completely repressed for years,
nism that keeps memories out of consciousness. only to be remembered years later.
However, the trauma is believed to exert itself
unconsciously through emotional and behavioral Dissociation and Psychogenic Amnesia
problems, which are manifested through body
memories, flashbacks, nightmares, or dissociation. Dissociation is defined as an alteration in the
If the abuse was frequent and prolonged, it is normally integrative functions of identity, memory,
believed that alternate personalities may form to and consciousness. Because the person’s thoughts,
protect the person during the abuse, which can feelings, or actions are altered, some information
result in the development of multiple personality may not be integrated with other information and
disorder. therefore is not accessible to memory. A dissoci-
Recovered memory therapists believe that large ated memory is seen as distinctly different from
numbers of people have suffered childhood sexual one that is simply forgotten.
abuse but repressed their memories. They believe Dissociation is seen as a protective response to
that the repressed abuse results in a variety of psy- traumatic childhood sexual abuse in which the
chological problems that individuals may deny as child dissociates the abuse experiences so that they
the abuse is buried in the unconscious. Typical are not available to memory. Because the child is in
symptoms include dreams of being pursued, sleep an altered state of consciousness, there is limited
disturbances, eating disorders, substance abuse, access to these memories during the ordinary state.
compulsive sexuality, sexual dysfunction, chronic Retrieval of the memories is therefore accom-
anxiety attacks, depression, difficulty with rela- plished in adulthood through an altered state of
tionships, distrust of others, guilt, impaired self- consciousness, such as hypnosis or age regression.
esteem, self-destructive behaviors, and personality Psychogenic amnesia is the dissociation mecha-
disorders. Retrieval of the repressed memories is nism postulated to explain the lack of memory for
believed to be necessary for healing and recovery. childhood abuse. The essential feature of psycho-
genic amnesia is a sudden inability to recall impor-
tant personal information. However, there are no
Major Concepts
empirical data supporting a concept of psycho-
Therapists support the assumption of repressed genic amnesia for a category of events stretching
memories by referring to one or more psychologi- across several years at different times and under
cal concepts, including repression, dissociation different circumstances in differing environments.

868 Recovered Memory Therapy
Persons with psychogenic amnesia have multiple personality disorder itself is controversial
undergone severe life stresses, such as violent physical and appears to be heavily dependent on cultural
abuse, torture, confinement in concentration camps, influences for both its emergence and its diagnosis.
or combat. However, most people experiencing Skeptics believe that people learn to enact the role
trauma do not develop amnesia for the trauma. Case of the multiple-personality client and that thera-
studies on the reactions of people to documented pists play an important part in the generation and
severe trauma indicate that they show many symp- maintenance of this role enactment.
toms, but total amnesia for the event is not common.
Children below 3 or 4 years of age are unlikely Body Memories
to remember a trauma because of their age, but
this is not psychogenic amnesia, dissociation, or The assumption underlying the body memories
repression. Such forgetting is due to the phenome- concept is that, although there are no conscious
non of infantile or childhood amnesia. Adults and memories, the body remembers and the client has
older children rarely remember events that happen physical symptoms that correspond to the child-
prior to ages 3 to 4 years. This inability to recall hood abuse. The person is said to retrieve colors,
events from an early age is a function of the nor- hear sounds, experience odors, and taste sensa-
mal process of growth and development. tions, and the person’s body may react in pain or
develop stigmata reminiscent of the abuse. The
theory is that body memories are emotional, kines-
Posttraumatic Stress Disorder
thetic, or chemical recordings stored at the cellular
Posttraumatic stress disorder (PTSD) is diag- level and can be retrieved. There is no scientific
nosed when a client develops characteristic symp- evidence supporting these assumptions.
toms after experiencing a distressing and traumatic
event that is outside the range of usual human Flashbacks and Dreams
experience. The event is experienced with intense
fear, terror, and helplessness. The symptoms involve Recovered memory therapists believe that flash-
reexperiencing the traumatic event, avoidance of backs confirm the reality of the abuse since the
stimuli associated with the event, numbing of gen- flashback is interpreted as the reliving of an actual
eral responsiveness, and increased arousal. traumatic experience. However, flashbacks cannot
Although the criteria for PTSD mention numbing be assumed to represent a memory of an actual life
and efforts to avoid thoughts or feelings, along event. Instead, they are the development from the
with psychogenic amnesia for an important aspect experience of a “worst fear” scenario. They are
of the event, there is no mention of total amnesia likely to reflect the client’s fears of the terrible
for the entire event. Also, to diagnose PTSD, there things assumed to have happened to the client and
must be a known stressful event. The diagnosis can be generated out of the focus in therapy.
cannot be given on the basis of the symptoms Recovered memory “experts” sometimes view
alone without verification of the event. dreams as reflecting actual events. They believe that
the boundary between the conscious and the uncon-
scious mind is more permeable while dreaming.
Multiple Personality Disorder
However, as with flashbacks, dreams cannot be
Multiple personality disorder (now called dis- assumed to reflect actual events. Rather, the content
sociative identity disorder) may be diagnosed, of the dream reflects what the person has been
especially when the alleged abuse is violent and thinking. If clients are reading a survivor’s book or
sadistic. Multiple personality disorder is the exis- attending a survivors’ group and trying to remem-
tence within the person of two or more distinct ber forgotten abuse, it is likely to affect their dreams.
personalities or personality states. A “protector”
personality is said to emerge and take over for the
Techniques
individual, who therefore escapes psychologically
from the abuse. However, support for this theory is Recovered memory therapists use a variety of
based only on clinical case reports. In addition, techniques to help clients recover memories, in

Recovered Memory Therapy 869
addition to simply asking them about it. The memory movement, asserts that the lack of
techniques include hypnosis, age regression, Amytal memories of abuse does not mean that clients
interviews, ideomotor signaling with the uncon- have not been abused—if their life shows the
scious, guided imagery, interpreting flashbacks and symptoms, then they were abused. Other books
dreams, reading books, attending survivors’ include Secret Survivors by E. Sue Blume and
groups, bodywork, journaling, and art therapy. Repressed Memories: A Journal to Recovery
There is no empirical support for the assumption From Sexual Abuse by Renee Fredrickson. These
that these techniques result in reliable information books accept the reality of recovered memories
about real events. not only of repressed abuse but also of ritual
satanic abuse.
Hypnosis, Age Regression,
and Amytal Interviews Survivors’ Groups
The use of hypnosis or sodium Amytal (“truth Individuals are often referred to survivors’
serum”) for memory retrieval raises serious prob- groups, which are considered to be a powerful
lems about the accuracy of the memories elicited. stimulus for recovering previously forgotten mem-
People are more suggestible under both and are ories. Because the task of therapy is to recover the
likely to experience the retrieved memories as hidden memories, group members are encouraged
vivid, detailed, and real even when they are false. and reinforced as they report new memories.
When used for age regression, clients who are
told that this is a valid technique can come to Bodywork
believe that they can even recall complex past-life
identities. This type of therapy includes massage therapy
as well as adaptations designed to unlock memo-
ries of repressed abuse. The premise is that as cer-
Ideomotor Questioning and Guided Imagery tain places on the body are touched or certain
Ideomotor questioning, a variant of hypnother- movements are made, memories are released that
apy, is intended to be a way of getting information talk therapy cannot touch.
from the unconscious. While in a trance, clients are
told to relax while their unconscious does the Journaling and Art Therapy
work, and then, they are asked questions, which
are answered by finger signals. In guided imagery, Journal writing is believed to be a way of
clients are told to relax, take deep breaths, picture accessing the unconscious. After getting a flash-
a scene, and then relate as many details as possible. back or body memory, clients are told to write
The therapist asks questions to guide the images. quickly in their journal without censoring what is
written. The client may use free association or just
tell a story. In art therapy, clients allow their hand
Interpreting Flashbacks and Dreams to paint or draw whatever picture it wants to with-
Clients are asked to discuss their flashbacks and out trying to control the outcome with the con-
dreams as a way of uncovering or clarifying scious mind.
repressed memories. When interpreting dreams,
the symbolism of the dream is explored, and cli- Therapeutic Process
ents are helped to actively look for clues about
their abuse history in the dream. With this type of therapy, there is no time limit, and
recovered memory therapy can continue for long
periods. Often, clients are encouraged to confront
Reading Books
their parents or break off ties with their family.
Clients are often asked to read The Courage to They may be hospitalized or referred to survivors’
Heal by Ellen Bass and Laura Davis. This book, groups. Therapists use the various techniques, dis-
which has been called the bible of the recovered cussed in the previous section, throughout sessions

870 Re-evaluation Counseling
for the duration of treatment in an attempt to because of its emphasis on the egalitarian and
uncover and heal the trauma of the repressed bidirectional relationship between the counselor and
memory. the client. Simply stated, the roles of the counselor
and the client are interchangeable, with each person
Hollida Wakefield functioning in both roles; the underlying premise is
that people can learn to help one another. Thus,
See also Bibliotherapy; Body-Oriented Therapies:
Overview; Hypnotherapy; Other Therapies: Overview
basic counseling skills such as active listening and
reflection of feeling are important points of empha-
sis for the person acting in the counselor role. From
Further Readings an RC perspective, negative behaviors are consid-
Goldstein, E., & Farmer, K. (1992). Confabulations. Boca ered socially generated stressors that can be elimi-
Raton, FL: Sirs Books. nated through the process of discharge. The idea of
Loftus, E., & Ketcham, K. (1994). The myth of repressed discharge is akin to the client-centered concept of
memory: False memories and allegations of sexual conditions of worth as well as the psychoanalytical
abuse. New York, NY: St. Martin’s Press. idea of repression and is the central goal of RC.
Lynn, S. J., Lock, T., Loftus, E., Krackow, E., & Lilienfeld,
S. O. (2003). The remembrance of things past:
Problematic memory recovery techniques in Historical Context
psychotherapy. In S. O. Lilienfeld, S. J. Lynn, & The origins of RC can be traced to the 1950s.
J. M. Lohr (Eds.), Science and pseudoscience in clinical While Harvey Jackins is considered the father of
psychology (pp. 205–239). New York, NY: Guilford the RC movement, the approach itself is thought to
Press. be an offshoot of L. Ron Hubbard’s Dianetics
McNally, R. J. (2005). Debunking myths about trauma Institute, which later evolved into the Scientology
and memory. Canadian Journal of Psychiatry, 50, movement. Thus, many of the central tenets of the
817–822.
RC approach (e.g., discharge) are similar to
McNally, R. J., & Geraerts, E. (2009). A new solution to
Dianetics principles developed earlier by Hubbard.
the recovered memory debate. Perspectives in
Jackins developed RC based on his clinical
Psychological Science, 4, 126–134.
experience watching clients emote (e.g., laugh, cry,
doi:10.1111/j.1745-6924.2009.01112.x
shake) and progress from, at times, nonfunctioning
Ofshe, R., & Watters, E. (1994). Making monsters:
False memories, psychotherapy, and sexual hysteria.
to fully functioning states. Based on these experi-
New York, NY: Scribner. ences, Jackins and colleagues began experimenting
Piper, A., Lillevik, L., & Kritzer, R. (2008). What’s wrong with techniques that actively promoted emotional
with believing in repression? A review for legal expression among their clients in sessions. In con-
professionals. Psychology, Public Policy, and Law, 14, trast to other counseling approaches, the RC
223–242. doi:10.1037/a0014090 model evolved from hours of clinical observation
Spanos, N. P. (1996). Multiple identities and false rather than new or current theories of human
memories: A sociocognitive perspective. Washington, behavior. In 1958, Jackins began offering “Personal
DC: American Psychological Association. Re-Evaluation Counseling” classes, in which he
Wakefield, H., & Underwager, R. (1994). Return of the and his colleagues taught people to co-counsel.
furies: An investigation into recovered memory Originally developed in Seattle, the RC move-
therapy. Chicago, IL: Open Court. ment soon spread nationally, with proponents in
California and then the East Coast, and eventually
internationally (classes started being offered in
England). Today, the co-counseling movement can
RE-EVALUATION COUNSELING be found in approximately 93 countries worldwide.
In response to the rapid growth and interest, the
Re-evaluation Counseling (RC) is a growth and leaders of the RC movement developed procedures
awareness process that focuses on repressive forces for ensuring competency in the understanding of the
in clients’ lives that have created unresolved dis- theory and practice of the approach. Along these
tress. RC is often referred to as co-counseling lines, an RC certification process was developed,

Re-evaluation Counseling 871
along with a basic structure for organizing RC perspiring, yawning, laughing, or talking. However,
classes and ensuring minimum levels of competence in many cases, this emotive process is interrupted
and adherence. (often because of the uncomfortable feeling that
After Jackins’s death in 1999, his son, Tim may be generated by the discharge behavior itself)
Jackins, became the leader and International and may result in the discharge behavior being
Reference Person for the RC approach. Tim Jackins equated with the original trauma. More specifi-
continues to promote the work of his father and cally, rather than viewing the release or discharge
has expanded in other areas as well. of emotion related to the trauma as a positive
Harvey Jackins is responsible for most of the event, it is often perceived as a symptom of the
literature written on the approach and was an problem behavior, to be interrupted or shut down.
active contributor to the primary RC journal, In response to this, the RC technique of discharge
Present Time, which reports on new theoretical allows the expression of feeling and helps the indi-
and clinical developments. While it is not uncom- vidual move beyond the pain.
mon for proponents of particular theories to According to proponents of RC, everyone has
espouse, and sometimes exaggerate, the benefits of the capacity to facilitate the discharge process
a given approach, Jackins claimed, “Re-evaluation through training in basic counseling techniques.
counseling can be confidently viewed as the very The person in the counselor role listens, engages
leading edge of the tendency toward order and the other person in the counseling process, and
meaning in the universe” (as cited in Tourish & encourages honest emotional discharge and expres-
Wohlforth, 2000, p. 96). Yet there is a lack of sion. The role of the client is to talk, discharge, and
empirical evidence concerning the use of RC; the re-evaluate the painful situation. Thus, given the
approach has been modified and refined based on basic structure of the process, the roles of the
the clinical experiences of the RC leaders rather counselor and the client can be used interchange-
than scientific data. ably, thereby removing the potential for power
Interestingly, Jackins did not approve the term imbalances, which can sometimes be problematic
co-counseling, which became the name of an off- in more traditional counseling approaches.
shoot of RC developed in the 1960, Co-Counseling Kauffman and New’s 2004 book Co-Counselling
International (CCI). While there is an overlap lists eight fundamental principles of RC:
between these two schools of therapy, the primary
differences include less emphasis on the “no social- 1. The basis of human distress is interference with
izing” guideline in CCI, less consideration on intelligence by hurtful experiences in very
social oppression as a source of distressful patterns specific ways.
in CCI, and differences in leadership structures.
2. There is an assumption that humans are
inherently wholesome, intelligent, zestful, loving,
Theoretical Underpinnings and good and believe that everyone has the
capacity to flourish beyond what has been
RC theory provides a model of what human beings
observed.
can be like in their interactions with others and
their environment. According to Katie Kauffman 3. The only source of dysfunction in a human
and Caroline New, who have written extensively being is an experience of hurt (physical or
on RC, individuals are born with inherent intelli- emotional).
gence, zest, and kindness, but these qualities
4. The full range of the discharge process is of
become compromised as a result of accumulated
central importance.
distressing experiences (e.g., fear, hurt, loss, pain,
anger, embarrassment) that begin early in life and 5. There is a distinct human difference between the
are continuously reinforced through social oppres- person and his or her distress.
sion. RC posits that people have an inherent desire
6. The peer relationship is critical in RC.
to rid themselves of negative events or behavior
through a natural emotional discharge process of 7. The wider social context is an important
behaviors such as nonrepetitive crying, shaking, contributor to distress and hurt.

872 Re-evaluation Counseling
8. It is helpful to be part of a group that shares its Chronic Patterns

collective resources of attention and increasing
Chronic patterns are distressful patterns that
skill.
continuously occur, regardless of setting or envi-
ronmental cues; they are often considered person-
While the ultimate goal of RC is the discharge ality traits.
of distress, society continuously imposes institu-
tionalized classism, sexism, and racism on a daily
basis. Thus, as part of the reemergence process, Co-Counselng
clients are encouraged to be socially active and Co-counseling occurs when individuals take
apply the techniques and skills learned in RC on a turns in the client and counselor roles, each assist-
more widespread and global level to help others. ing the other in recovering from distressing events.
Major Concepts RC Community

A number of major concepts help us understand RC Community refers to the Re-evaluation
the process of RC, including discharge, re-evalua- Counseling community, which began in the 1970s
tion, directions, distress recordings, intermittent as a network of RC therapists who focused on
patterns, chronic patterns, co-counseling, RC com- their own recovery and on assisting others in doing
munity, fundamentals class, and support groups. the same. The members agree to adhere to the
Guidelines for the Re-evaluation Counseling
Discharge Communities.
Discharge is the process of removing distress

patterns through outward physical manifestations Fundamentals Class
of the distressing event (e.g., crying, trembling, Fundamentals class describes the basic RC class
laughter, and/or talk). that typically meets once a week for instruction in
simple communication skills and the co-counseling
Re-evaluation process. Students or clients view instructor dem-
onstrations of the RC approach and informal co-
The process of re-evaluation occurs after dis- counseling sessions between class members on a
charge and involves re-evaluation of the material weekly basis. During this introductory level, the
released through discharge, which would not have emphasis is on respect, active listening, and
been otherwise accessible. support.
Directions Support Groups

Directions refers to a way of contradicting a Support groups are ongoing classes available to
distressing pattern by maintaining a position or fundamentals class graduates that focus on a vari-
perspective contrary to the distressing recording. ety of themes (e.g., discrimination, women’s
oppression, work-related stress, and inequities).
Distress Recordings
Distress recordings (i.e., distress patterns) Techniques
describe the characteristics of a painful event
(e.g., sights, smells, sounds) and feelings that are With proper application of the discharge
mentally recorded. technique, RC proponents believe that any dis-
tressing pattern can be eliminated, although with
more serious and complicated issues (e.g., the sud-
Intermittent patterns
den death of a loved one, sadness, anger, fear), it
Intermittent patterns are upsetting patterns that may require discharge in a more sequential man-
only occur under certain circumstances. ner, with the most distressing emotions addressed

Re-evaluation Counseling 873
prior to dealing with the less distressing feelings. as well as confidence in a client’s ability to change.
Some of the techniques typically used in this pro- From an RC vantage, it is critical that the coun-
cess are creating a warm and supportive environ- selor is able to separate the person from the pat-
ment through the use of touch, facial expressions, tern of behavior; the clearer this distinction, the
active listening, and the choice of appropriate greater the discharge for the client. That said, in
words in communicating with the client; focusing general, clients tend to identify themselves with
attention on reality; allowing for recognition of their distressing patterns, and thus, the counselor
feelings rather than suppressing them; trying to must be able to gently challenge clients’ distress-
build a close and supportive relationship; offering ing patterns. As with humanistic approaches, in
specific acknowledgment and appreciation of the RC, the client is believed to be the expert on his or
client’s distress; taking a leadership role in empow- her own life, and the counselor’s role is to present
ering clients; maintaining a position that is con- and create an environment conducive to
trary to the distressing pattern; and telling life discharge.
stories. In addition, the person acting in the role of There is recognition in RC of the courage
the counselor may also want to convey a sense of required to enroll in RC, which often requires the
empathy and reflexively listen to the client to dem- individual to step out of his or her comfort zone.
onstrate his or her understanding of the presenting Along these lines, it can also require a big shift in
issues or concerns. how individuals typically handle distress, which
may be to internalize the hurt rather than speak
Therapeutic Process of it. Thus, in general, the typical RC process
involves two people getting together for the pur-
The principal activity in RC is one-to-one sessions pose of helping each other discharge existing
between members, with each taking turns in the hurts or pain, some of which may be long-stand-
client and counselor roles. The process works best ing. Each participant takes turns in the roles of
when each participant adheres to the following both counselor and client. As noted above, the
recommendations: counselor’s role is to actively listen, acknowledge
and clarify, and promote the open and authentic
1. No socializing outside the RC relationship emotion. The client’s job is to openly express
2. Keeping the process confidential existing feelings and emotions. The counselor, in
turn, then becomes the client, and the roles are
3. No substance abuse by either participant reversed.
Because RC relies on the relationship between Keith Klostermann

peers, the two participants are considered
See also Other Therapies: Overview; Person-Centered
equal regardless of the experience level of either Counseling
participant.
According to Kauffman and New, nearly every-
thing the counselor does is aimed at assisting cli- Further Readings
ents to “cross the bridge” to discharge—to the Bronstein, P. (1986). Re-evaluation Counseling: A self-help
crying, shaking, perspiring with cold and warm model for recovery from emotional distress. Women
sweat, raging, laughing, and interested nonrepeti- & Therapy, 5(1), 41–54. doi:10.1300/J015V05N01_08
tive talking and yawning that release tension Jackins, H. (1997). The list. Seattle, WA: Rational Island
from recent upsets and stored-up hurts—and give Publishing.
back to the client his or her clear thinking. Thus, Kauffman, K., & New, C. (2004). Co-counselling:
in contrast to other counseling approaches, there The theory and practice of Re-evaluation Counseling.
is no advice giving, interpreting behaviors, or goal New York, NY: Brunner-Routledge.
setting; the sole objective is removing stored Study Group on Psychotherapy Cults. (1992). A
distress. documentary history of the career of Harvey Jackins
Jackins believed that effective RC counselors and Re-evaluation Counselling. Brussels, Belgium:
displayed approval, delight, and respect for clients Study Group.

874 Reich, Wilhelm
Tourish, M., & Irving, P. (1996). Group influence and the 1919, and Reich became part of the Vienna
psychology of cultism within Re-evaluation Counseling: Psychoanalytic Society at the age of 23 years.
A critique. Cultural Studies Journal, 13(2), 171–192. Like Freud, Reich was a prolific writer. He
doi:10.1080/09515079508258695 published numerous important essays in the field
Tourish, D., & Wohlforth, T. (2000). On the edge: following the case study method favored by Freud.
Political cults right and left. Armonk, NY: M. E. Reich’s early therapeutic technique was classical
Sharpe. psychoanalysis. Patients would lie on a couch, and
Reich would listen to their free associations and
dreams and make interpretations that addressed
the patients’ childhood experiences, the impor-
REGRESSION THERAPY tance of infantile sexuality, the oedipal complex,
the patients’ various defense mechanisms, and the
See Primal Therapy importance of the unconscious and repressed
memories that manifest themselves in the patients’
symptoms.
At the same time that Reich endorsed Freud’s
REICH, WILHELM techniques, he also began to modify them, as early
as in 1922 in the article “Two Narcissistic Types.”
An early disciple of Sigmund Freud, Wilhelm Reich This article plants the seeds that Reich would later
(1897–1957) was a major, but controversial, figure develop into his theory of character analysis.
in the Vienna Psychoanalytic Society. Having Character-analytic technique, which Reich culti-
advanced character analysis theories and sexual vated throughout the 1920s and published as a
theories, Reich applied these theories to politics book in 1934, moves away from analysis of indi-
and society. Later in his career, Reich developed a vidual symptoms to an analysis of the entire per-
therapy for harnessing one’s cosmic energy as a son’s character. This shift from symptom to person
treatment for mental and physical ailments, a had important implications for therapeutic tech-
therapy that was attacked by the medical and sci- niques. First, Reich focused on the patient’s entire
entific establishment. Reich was born on a farm in presentation during a therapy session. He paid
Bakovina, now part of the Ukraine. His early life close attention to speech patterns, inflections, pos-
was marred by tragedy. Reich’s mother died of an ture, gait, seating arrangement, and all manner of
apparent suicide when Reich was only 13 years of nonverbal communication. This shift away from
age. His father died only 4 years later of tubercu- the purely “talking cure” took serious account of
losis, an illness that Reich later contracted and the body. Accordingly, Reich’s approach was more
survived. The family was Jewish but spoke High holistic than Freud’s was. In fact, for Reich, a
German and did not actively practice the faith. patient actually developed what Reich called char-
Nonetheless, the Nazis’ persecution of Jews in the acter armor as the patient’s physical resistance to
1930s and 1940s was one of the many psycho- treatment. A second innovation was the necessary
logical and personal struggles Reich endured. shift toward the present. In focusing on the patient
Reich served on the front line in the Austrian in the here-and-now of the therapy session, Reich
army during World War I, but the experience of stressed the patient’s present behavior rather than
war demoralized him. In particular, Reich grew past memories. Third, the therapist became more
disenchanted with the military’s patriarchal struc- active than the classical psychoanalyst did. Reich
ture and value system. This dislike for hypermas- faced and often touched his patients in what he
culine structures provided part of Reich’s strong considered a therapeutic fashion. He wanted to
political arguments in the early 1930s. After the release the tension or anxiety trapped in knotted
war, Reich enrolled in law at the University of muscles. Finally, Reich had a slightly different
Vienna, but soon, he turned to medicine and, like approach to transference. Rather than focus on the
Freud, graduated as a medical doctor. At the uni- patient’s affection for the therapist, Reich stressed
versity, Reich became quickly drawn to Freud’s the value of negative transference or hatred of the
pioneering psychoanalytical work. The two met in therapist. Reich strongly felt that this negative

Reich, Wilhelm 875
transference had to be confronted by the therapist against or reject such conditions to the extent that
for any progress to be made. such a rejection is possible. In his book, he found
Reich identified a group of maladaptive character the answer by linking society to the psyche. This
types: neurotic, hysterical, compulsive, phallic-nar- linkage of therapy to social policy represented a
cissistic, and masochistic. Maladaptive character pioneering innovation of Reich’s work. Prior to
was contrasted with the very happy and emotion- this innovation, traditional psychoanalysis was
ally healthy genital character. Emotionally healthy largely intrapsychic, focusing on the individual
for Reich meant physically or sexually healthy indi- mind, but Reich focused on the relationship
viduals. Even more than Freud, Reich made the between the mind and the society. Reich found the
libido theory fundamental to treatment and health. family to be a factory for reproducing the social
He called his libido theory orgastic potency, a term ideology of the dominant class, but he went further
used to measure a person’s sexual health. Only an by showing how that ideology shaped individual
orgastically potent individual could live life as a thought and behavior, thus bringing oppression
genital character. Reich articulated his evolving and repression together.
sexual theories in The Function of Orgasm While Freud did not approve of Reich’s earlier
published in 1927. political activity, he did support Reich’s efforts at
For Reich, individuals needed to experience bringing mental health services to the working
powerful full-body orgasms to maintain a bal- class and the poor. Reich formed a movement that
anced life. Orgasms put a person in open contact he called The Sex-Pol movement to bring sex edu-
with the flow of energy that unresolved anxiety cation to the urban poor and rural areas, which he
would bind to the body’s armor in unhealthy ways. treated through mobile van clinics. Ultimately,
This position was not necessarily contrary to though Reich later firmly rejected the Communist
Freud’s ideas, but Reich’s underlying philosophy of Party, his affiliation with the party contributed to
libido radically departed from Freud’s conceptual- his ouster from the psychoanalytical community.
ization. Around 1919, Freud posited the death Ahead of his time, Reich’s progressive views antic-
drive in his book Beyond the Pleasure Principle. ipated later social realities such as women’s right
Reich never accepted Freud’s theory, and as early to choose, equal rights for women, simple divorce
as 1923, he made his disagreement with Freud laws, and contraceptives for teenagers.
evident. Reich did not believe in man’s inherent The Mass Psychology of Fascism and Character
aggressiveness but felt that aggression could be Analysis represented two important contributions
successfully overcome through character analysis to the history of psychology and counseling, but
and fully established orgastic potency. Reich argued they also ended Reich’s work in the psychoanalyti-
for the relationship between sexual repression and cal tradition. Around 1935, Reich turned toward a
aggression in a pioneering book The Mass concept he called vegetotherapy and, later, orgone
Psychology of Fascism. In this book, Reich ana- therapy. This change in direction moved Reich
lyzed the psychodynamics of the totalitarian per- beyond therapy into a quasi-scientific realm of
sonality, which predated Theodor Adorno’s related natural experimentation in harnessing a cosmic
social psychoanalytical work in The Authoritarian energy he called orgone. Reich believed that this
Personality by more than 15 years. orgone energy, a blue-green glow, could be
The Mass Psychology of Fascism both brought observed, measured, and employed in treatment
a phase of Reich’s analytic work to a culmination for both psychological and medical illnesses,
and simultaneously got him evicted from the including cancer. The psychoanalytical community
Communist Party, of which he had been a member abandoned Reich, but his charisma and drive
since 1928, and largely ended his political activity. attracted a new group of followers in Scandinavia;
The Mass Psychology of Fascism also brought a Forrest Hills, New York (after he fled the Nazis);
psychoanalytical perspective to politics and soci- and eventually in Raingley, Maine. Orogone
ety. Reich often wondered why poor people did therapy, a bioenergetic model, used technology,
not steal more often than they did. He wondered including his infamous orgone accumulator. This
why so many people living in oppressed conditions box—big enough to accommodate a large male—
of poverty and disenfranchisement did not revolt attempted to layer organic and metallic material to

876 Reiki
attract orgone energy into the box. The patient Reich, W. (1980). Genitality in the theory and therapy of
would absorb this positive orgone energy, which neurosis: Vol. 2. Early writings (P. Schmitz, Trans.).
Reich believed restored the patient to a state of New York, NY: Farrar, Straus & Giroux. (Original
well-being. Although orgone therapy appealed to work published 1927)
some well-known artists like William Burroughs Seelow, D. (2005). Radical modernism and sexuality:
and J. D. Salinger, as well as the public, the scien- Freud/Reich/D. H. Lawrence & beyond. New York,
tific community rejected Reich’s orgone therapy. NY: Palgrave Macmillan.
Ultimately, a Food and Drug Administration inves- Sharaf, M. (1994). Fury on earth: A biography of Wilhelm
Reich. New York, NY: Da Capo.
tigation of the orgone accumulator led to injunc-
tions against the equipment and, in the end, to
Reich’s arrest and imprisonment for 2 years at
Lewisburg Federal Penitentiary, where he died of
heart failure. Preceding his death, the government REICHIAN THERAPY
sanctioned an unprecedented public book burning
of his work. See Orgonomy
Despite the controversy that surrounds both
the science and the politics of Reich’s later work,
a number of influential therapists followed and
used his postanalytic therapeutic techniques. For REIKI
example, Elsworth Baker founded the American
College of Orgonomy to promote orgone ther- Reiki is a symbol-based, channeled-energy
apy, Alexander Lowen developed bioenergetic technique that finds its roots in traditional Japanese
analysis (a mind–body treatment modality), and healing. It can be used in conjunction with many
Fritz Perl’s Gestalt therapy owes its foundation other psychological therapy techniques. Reiki tech-
to Reich’s work. In fact, the biopsychosocial niques are based on the concept that the body is a
model that guides much of current counseling is nonlinear, dynamic, chemical-electrical system
a logical result of Reich’s contribution to the where changes in the oscillatory rate in the waves
mental health field. His work also has analogies of the extra low-frequency magnetic field allow the
to alternative medical practices and Eastern release of overcharged energy in areas where imag-
treatments such as Reiki, frequently used by ery and trauma may be stored in muscle memory.
clinicians today. There is also research evidence that Reiki produces
relaxation effects within the client’s parasympa-
David Seelow thetic nervous system. Reiki practitioners work
with clients in an energy or healing session and
See also Bioenergetic Analysis; Biopsychosocial Model;
Characteranalytical Vegetotherapy; Freud, Sigmund;
may engage in limited dialogue with the client
Freudian Psychoanalysis; Gestalt Therapy; Orgonomy; before and after the session to help the client spon-
Perls, Fritz; Reiki; Rolfing taneously speak about presenting issues or areas of
psychological “stuckness.” The technique can be
hands-off or hands-on, depending on practitioner
Further Readings license and client preference.
Corrington, R. S. (2003). Wilhelm Reich: Psychoanalyst
and radical naturalist. New York, NY: Farrar, Straus Historical Context
& Giroux.
Reich, W. (1970). The mass psychology of Fascism The development of Reiki is credited to Mikao
(V. P. Carafagno, Trans.). New York, NY: Farrar, Usui (1865–1926) in the early 1900s in Japan.
Straus & Giroux. (Original work published 1933) Reiki is based on mystic experiences Usui had
Reich, W. (1972). Character analysis (M. Higgins & while on a retreat at the Tendai Buddhist monas-
C. M. Raphael, Eds.; M. D. Vincent & P. Carfagno, tery, located on Mount Kurama in Kyoto, Japan.
Trans.; 3rd enlarged ed.). New York, NY: Farrar, Traditional stories state that Usui had been medi-
Straus & Giroux. (Original work published 1934) tating and fasting for 21 days at the monastery. On

Reiki 877
the final day, he went to the top of the mountain, Currently, there are more than 126 variations of
where, while meditating, he saw a series of sym- Reiki practiced in the United States. Key differ-
bols in the air in front of him and gained wisdom ences among these Western versions are the steps
and insight on how the symbols should be used. taken to achieve attunement and the specific sym-
He then experienced three miracles. First, he was bols used in the attunement process. Traditional
filled with energy in spite of his fasting, and Reiki also displays differences both in the attun-
although he cut his toe while walking back, he put ement process and in the number of symbols used.
his hands on the injury, and it healed in seconds. The Reiki attunement process usually consists
Second, he stopped at an inn on his way down the of the Reiki symbols being drawn several times
mountain and ate a full meal without difficulty. over the top of the head, hands, and forehead.
Third, a young girl with an abscessed tooth was at Then, the practitioner doing the attunement thinks
the inn. He put his hands on her face, and the about the symbols and blows a puff of air along
problem cleared. the midline of the body. Most Reiki is taught in
Following this experience, Usui founded a clinic stages. Historically, a student-practitioner is
and began teaching his new techniques. He is said engaged in 10,000 hours of practice between
to have taught approximately 2,000 students, with attunements and in hundreds of sessions in clinic
20 to 21 “master’s”-level students. Several students settings, under supervision, prior to being allowed
then founded their own systems: For example, to move to the next level. In contrast, today, indi-
Toshishiro Eguchi formed the Tenohira Ryoji viduals may be attuned to Levels 1 and 2 in a single
Kenkyo Kai system, and Kaji Tomita established weekend and attuned the following weekend to the
the Tomita Teate Ryoho system. Usui was the master teacher level.
founder and first president of the still active Usui Today, there are several hundred different energy-
Reiki Ryoho Gakkai association. The symbols that based techniques practiced in the United States. In
Usui saw in his visions, which are used in Reiki, are addition to Reiki, other types of energy techniques
similar to those displayed in the monastery at include laying-of-hands healing in a religious or
Mount Kurama. These symbols have traditional nonreligious setting; qigong, meridian-based or
meanings of peace, love, power, and consistency. meridian stimulation systems; other symbol-based
The symbols are drawn in the air over the student or channeled-attuned energy systems; totem and
practitioner during Reiki attunement (training) shamanic healing; element systems; kinesthetic sys-
and over the client during Reiki healing sessions, tems; color systems; and sound systems.
where they support the movement of the Reiki
energy wave into the client’s body.
Usui taught Chujiro Hayashi, who also founded
his own lineage, Hayashi Reiki Ryoho Kenkyu kai. As previously discussed, Reiki is based on the
He was not among those students whom Usui theory that channeled energy transferred from an
made a master teacher. Hayashi taught Hawayo attuned practitioner to a client can effect changes
Takata, who brought the Reiki lineage to the West. in the client’s energy fields, which in turn can help
Takata studied with Hayashi from 1936 to 1938 in the client psychologically. Although the mecha-
Japan, and later Hayashi visited Takata in Hawaii nisms of action involved in how Reiki works on
and worked with her for a short time. Takata the body and psyche are not completely under-
trained 22 master students in the last 10 years of stood, there are recent studies that point to the
her life. The attunement process is a ceremony underlying mechanisms. These studies support that
believed to allow the Reiki symbols to be embed- Reiki produces oscillations of the amplitude in the
ded in the practitioner’s body and lived experience. body’s extra low-frequency magnetic wave and
There are different levels of attunement and differ- oscillations in the strength of the body’s radio fre-
ent symbols used in the process. Masters who are quency waves, as well as changes in the microcap-
fully attuned are then allowed to attune and train illary dilation in practitioners’ hands. Practitioners
other practitioners. Most of the Usui Reiki lineages believe that as they place their hands over or on a
practiced in the United States today come from the client, the channeled energy moves through their
22 master practitioners whom Takata trained. hands to the client and causes changes in the

878 Reiki
strength and oscillation of the client’s magnetic one section of the city and represented an acknowl-
and radio waves, which in turn disrupt areas of edged “profession.” This city section was called
“stuckness” and allow healing to take place. In the enclave of beggars. Usui founded one clinic
addition, there is evidence that a level of brainwave within the enclave and practiced Reiki on its
entrainment takes place between the practitioner members for free. He observed that many would
and the client, supporting a “relaxation effect.” heal and start to move forward with their life but
then would fail and return to the beggar commu-
Major Concepts nity. He determined that the individuals who
failed lacked gratitude for the change and improve-
In addition to the transfer of channeled energy ment in their situation. As a result of this observa-
from the practitioner to the client, there are several tion, Usui added gratitude as a Reiki precept.
other concepts important to Reiki: precepts; the use Within the practitioner community, it is said,
of listening, empathy, and presence; and gratitude. “Gratitude is the most similar energy to enlighten-
ment.” Usui defined an enlightened person as one
Precepts of Reiki who is not swayed from his or her state of calm
compassion by life’s experiences and who has suf-
The precepts of Reiki were developed by Usui ficient clarity in his or her life and physical body
and are written on his memorial, which is located so that energy moves through the physical form
at the Saihoji temple in the Suginami district of so freely that the person’s body produces light,
Tokyo. They are as follows: meaning tit glows physically.
Do not worry today.
Do not get angry today. Techniques
Be kind to yourself and others today. Reiki consists of three basic techniques. In the first
technique, the practitioner uses his or her hands to
Work hard today. draw one or more Reiki symbols one or more
Be grateful today. times over the client’s problem area or a related
area. The second technique involves the practitio-
These precepts are to be practiced daily by the ner placing his or her hands on or just above the
practitioner and shared with the client as a method client’s body in specific positions, leaving them
of living with both greater grace and more peace. there for a period of time in a standard or specified
pattern to allow the “movement” of the Reiki
waves into the client. In some versions of Reiki, the
Listening, Empathy, and Presence time limit of hand placement is specified; in others,
During a Reiki session, the practitioner’s focus hand placement change is based on practitioner
is on the client. Listening is a key skill of the prac- perception. The third technique consists of the
titioner, and it is done with empathy and without practitioner using both of the first two techniques
judgment both before and after the energy session. at the same time.
Although a typical Reiki session may include the Practitioners commonly describe three types of
practitioner asking the client questions, it does not sensations: (1) the sensation of their hands heating
involve the kind of therapeutic dialogue found in a or cooling, (2) the energy current wiggling or puls-
psychological or psychiatric therapy session. ing, and (3) the current being pulled through the
Practitioners provide compassionate, gentle sup- hands. Laboratory studies found that the wiggling
port throughout treatment. and pulsing sensation aligns with changes in the
rate of oscillation of the extra low-frequency mag-
netic field of the practitioner’s hands and the sen-
Gratitude
sation of the energy current being pulled through
In Japan in the early 1900s, beggars, or home- the hands corresponds to practitioners’ producing
less members of society, were housed together in direct current from their hands.

Relational Group Psychotherapy 879
Therapeutic Process Connor, M., Jacobs, L., & Schwartz, G. (2005, April).
Demographics of energy healing training programs.
Reiki is not a substitute for psychological Paper presented at the Research Symposium
treatment but is a support process used to facilitate Conference Proceedings of the Second QiGong
dialogue, trauma release, and client relaxation. It Summit and Whole Person Healing Conference,
can be used in conjunction with many other thera- Washington, DC.
peutic techniques and interventions, based on Connor, M., Tau, G., & Schwartz, G. (2005, June).
practitioner skill and preference or client prefer- Methodological challenges in the evaluation
ence, to support a compassionate and healing cli- of energy medicine practitioners. Paper presented
ent space. When using Reiki in conjunction with a at the Research Symposium Conference
psychological session, the practitioner should Proceedings of the International Society for the
describe the technique and obtain consent from Study of Subtle Energies and Energy Medicine,
the client. When Reiki is added to a standard Boulder, CO.
therapy session, the wiggling of the electrodermal Fung, P. C. (2009). Probing the mystery of Chinese
skin current can change the way trauma, which is medicine meridian channels with special emphasis on
stored as muscle memory, is released. The effect the connective tissue interstitial fluid system,
enables the client to speak about difficult issues mechanotransduction, cells durotaxis and mast cell
with greater ease and comfort. Furthermore, the degranulation. BioMed Central, 4(10).
inclusion of Reiki in traditional therapeutic treat- doi:10.1186/1749-8546-4-10
ment may produce a change in the regulation of Miles, P. (2006). Reiki: A comprehensive guide.
the parasympathetic part of the nervous system, New York, NY: Penguin.
Miles, P., & True, G. (2002). Reiki: Review of a biofield
often as a relaxation response. If this change
therapy history, theory, practice, and research.
occurs, the therapeutic process may move more
Alternative Therapies in Health and Medicine, 8(3),
quickly, as the client becomes more open to
88–95.
sharing sensitive issues.
National Center for Complementary and Alternative
Melinda H. Connor Medicine. (2010, May 4). Reiki: An introduction
(NCCAM gackgrounder). Washington, DC:
See also Bioenergetic Analysis; Core Energetics; Government Printing Office.
Emotional Freedom Technique; Energy Psychology; Paul, N. L. (2006). Reiki for dummies. Indianapolis, IN:
Feldenkrais Method; Healing Touch; Mindfulness Wiley.
Techniques; Therapeutic Touch Rand, W. L. (n.d.). Usui Memorial. Retrieved from http://
www.reiki.org/reikinews/memorial.html
Rand, W. L., & Gaia, L. S. (n.d.). Discovering the roots of
Further Readings Reiki. Retrieved from http://www.reiki.org/reikinews/
Ahn, A. C., Park, M., Shaw, J. R., McManus, C. A., rootsreiki.html
Kaptchuk, T. J., & Langevin, H. M. (2010). Electrical Vennells, D. F. (1999). Beginner’s guide to Reiki:
impedance of acupuncture meridians: The relevance of Mastering the healing touch. New York, NY: Barnes
subcutaneous collagenous bands. PLoS One, 5(7), & Noble Books.
e11907. doi:10.1371/journal.pone.0011907
Baginski, B. J., & Sharamon, S. (1988). Reiki: Universal
life energy. Mendocino, CA: Life Rhythm.
Becker, R. O., & Selden, G. (1985). The body electric:
RELATIONAL GROUP PSYCHOTHERAPY
Electromagnetism and the foundation of life.
New York, NY: William Morrow. Relational group psychotherapy refers to a form
Connor, M., Creath, K., & Schwartz, G. (2004, of therapy in which group members, individually
November). Oscillation of amplitude as measured by and collectively, advance via a meaning-making
an extra low frequency magnetic field meter as a process from experience, through expression, to
physical measure of intentionality. Paper presented at cocreated understanding. Relational group psy-
the Conference Proceedings of the World Qi Gong chotherapy is based on relational theory and
Congress, San Francisco, CA. assumes that the defining characteristics of group

880 Relational Group Psychotherapy
life are mutually generated by unconscious as well and projective identification (first described by
as conscious participation by all group members, Klein) that influence how humans hear and think
including the therapist. about others’ or a group’s communication, how we
convey our experiences, and how this communica-
Historical Context tive interplay affects the participants and the cur-
rent state of relationships among the participants.
Relational theory builds on multiple psychotherapy Bion’s conceptualization of thinking—the pro-
constructs—particularly neo-Freudian, Kleinian, cess of establishing a mental relationship with a
Winnicottean, interpersonal, intersubjective, and personality (including one’s own) and that personal-
self theory—as well as on recent empirical literature ity’s emotional experience—defines mentalization, a
on early infancy and parent–child attachment. The concept that has become a topic of scholarly interest
common denominator is an emphasis on relation- in the 21st century. Bion propounded how a human
ships, internal and external, and their dynamic, need—the need to think and reach emotional
life-supporting qualities rather than on intrapsychic truth—conflicts with a desire to avoid the mental
or “one-person” metapsychological entities like pain (e.g., feelings of persecution and depression)
drives, defenses, ego structure, or an archeological that accompanies and is a consequence of emotional
unconscious. thinking.
In an effort to replace the classical model of the
“blank screen” analyst and the “regressed” patient
or group, relational theorists reconceived thera- Major Concepts
peutic relationships in terms of co-constructed or Among the main concepts associated with rela-
mutually inspired interactions. From this perspec- tional group psychotherapy are truth, the basic
tive, the unconscious as well as interpersonal rela- conflict, bonding, perspectivism, enactment, pri-
tionships are considered to be socially constructed mary emotions and passion, and the centrality of
and linked to dynamics of power, status, gender, the group therapist. This section discusses each of
race, age, and cultural norms. Explorations of the these concepts in turn.
past—retrospections—are useful in understanding
the present and in releasing the individual and the Truth
group from old allegiances, allowing for change
and increased growth. Truth develops as a process, occurring in rela-
tionship to self and others, of seeking and develop-
ing emotional awareness. We make truth by
grounding and transforming experience through
Relational psychotherapy does not represent a single various evolving emotional and intellectual per-
theory or a consistent metapsychology but references spectives. Psychotherapeutic treatment focuses
philosophical, social-constructivist, communication, on developing the ability to search for and the
and systems theories. The important intellectual for- capacity to suffer—and enjoy—the creative use of
bearers include Georg Wilhelm Friedrich Hegel truth in interpersonal relationships. In relational
(1770–1831), Friedrich Nietzsche (1844–1900), psychotherapy groups, truths—both conscious
Martin Heidegger (1889–1976), Sigmund Freud and nonconscious—are discovered, integrated,
(1856–1939), Sandor Ferenzci (1873–1933), Harry and reconfigured in group members’ psyches and
Stack Sullivan (1892–1949), Donald Winnicott interpersonal relationships and in the structure
(1896–1971), Ronald Fairbairn (1889–1964), Heinz and process of the group itself.
Kohut (1913–1981), Melanie Klein (1882–1960), Important too are the methods by which truth is
and Heinrich Racker (1910–1961). reached and the uses to which it is put. The thera-
The approach described herein is inspired by W. pist must monitor the process for certain truths,
R. Bion’s object relations theory of thinking, modi- and certain modes of truth seeking may be experi-
fied and extended to relational and group relational enced as destructive to the self or others, and so not
therapy. Bion (1897–1979) drew attention to the beneficial. Even when factual, truth may be chal-
preverbal mechanisms of introjection, projection, lenged as misleading, irrelevant, or inappropriate,

as a means of buffering against genuine mental the field of inquiry and is limited by his or her own
interaction. subjective perceptions. Other members form valid
and significant insights regarding the group, includ-
ing its therapist. A group progresses through the
The Basic Conflict
process of understanding and learning as different
Individuals seek psychotherapeutic treatment perspectives are revealed and examined.
because of a need to learn about themselves and
others. Emotional truth often hurts, but so too
Enactment
does its absence. Such truth, although necessary
for growth and change and often welcomed, can Relational theorists assert that individuals do
bring to the fore intense ambivalences, imperma- much of their thinking unconsciously and inter-
nence, uncertainty, and the necessity for change. subjectively, responding to various and often subtle
A basic conflict exists within the self and within aspects of narrative and interaction. Frequently, we
a group and its members: a conflict between want- learn only retrospectively about what has been
ing to tolerate, develop, and integrate thoughts and going on, when what has been out of awareness
feelings, on the one hand, and wishing to evade an emerges into our consciousness. By that time,
often painful, truth-seeking process, on the other. words and actions have produced enactments,
Emotional thinking and evasion are part of the behavioral scenarios with unacknowledged sym-
psychological dimensions of all group members’ bolic meaning. A group provides its members with
consciousness and unconsciousness and of a opportunities to experience enactments and make
group’s structure, culture, and process. meaning of enactments, with the benefit of insight,
hindsight, and mutual feedback.
Bonding
Primary Emotions and Passion
Verbal communication advancing truth seeking
depends on establishing preverbal contact and Our experiences derive significance from how
safety, which is based on genuine caring and inter- we feel about them. At the most fundamental level,
est. As a mode of interpersonal behavior, bonding primary emotions, or “instincts”—specifically, to
establishes a feeling of empathic connection. The love, to hate, and to know—determine feelings.
affective experience involves a feeling of mutual Loving (as in attachment or bonding), hating (as in
communication, in which individuals feel satisfac- expressing frustration or aggression), and coming
torily recognized, cared for, and understood. to know (exercising curiosity) connect us to, as
Group cohesion develops from combinations of well as disconnect us from, others. However, pri-
member-to-member, member-to-subgroup, mem- mary emotions do not operate in pure form.
ber-to-entire group, and member-to-therapist Defense mechanisms often disguise, minimize,
bonds. While the dynamics of member–therapist exaggerate, or displace feelings, and they are diffi-
bonding may be subtle and unacknowledged, they cult to regulate in situations of anxiety and conflict.
influence the bonding of other relationships and Passion has a special meaning as it applies to
the ongoing group process. group process. It refers to the mental activity and
mode of connection that can occur in a group when
group members remain open to the often discom-
Perspectivism
forting expressions of love, hate, and curiosity. When
Emotional truths are not necessarily logical and the group sustains passion, the members progress
consistent, and they emerge on many psychic levels from merely intellectual to emotional understanding
and from different perspectives. A group’s consen- of their relationships, attitudes, and values.
sus concerning what is said, what is meant, and its
significance may be negotiated as well as inter-
Centrality of the Group Therapist
preted, and it is subject to revision.
The relational therapist recognizes that, like Individually and collectively, group members
other members, he or she remains situated within not only form unconscious transferences but also

882 Relational Group Psychotherapy
realistically assess the therapist. The therapist’s individual and group defenses. He or she fosters
personality and character, and his or her profes- integration by establishing boundaries and moni-
sional, theoretical, and technical allegiances, influ- toring interpersonal behavior to provide an ongo-
ence what occurs and does not occur during group ing sense of safety. But to discover that which
therapy. Indeed, whether speaking or remaining members fear to feel, think about, and reveal, the
silent, the therapist implicitly “shapes” the work- therapist also promotes disintegration, a breaking
ing group culture. He or she determines how group down of conventional emotional attitudes and
relationships and experiences are to be regarded group routines.
and the emotional depth to which exchanges may
be understood. Group members’ view of their The Therapeutic Self
therapist—the degree of admiration and respect—
may trump the therapeutic impact of the thera- The relational therapist tends to be more active
pist’s ideas. and interactive than therapists who use traditional
analytic approaches. Freer from the classical ideals
of neutrality, anonymity, and objectivity, the rela-
Techniques tional therapist may share thoughts and feelings,
Relational psychotherapy treatment aims to facili- offer opinions, and openly attempt to shape the
tate truth seeking and authentic interpersonal direction of the group process. He or she may not
interactions. This section describes certain opera- necessarily wait for group tensions or themes to
tional strategies and techniques that relational resolve through the members’ activity. To invite the
therapists may use to promote change and growth members to relate more openly, the therapist may
in individuals and in the group itself: combined make it “all about me,” nondefensively provoking
individual–group psychotherapy, integration–dis- discussion regarding his or her interpersonal
integration, use of the therapeutic self, nuclear functioning and leadership qualities.
ideas, and four modes of therapeutic interaction.
Nuclear Ideas
Combined Individual–Group Psychotherapy By offering himself or herself as an emotional,
Combined individual–group psychotherapy is thinking, and self-reflecting subject, and treating oth-
in keeping with relational theory, because it sup- ers similarly, the relational therapist sets up a culture
ports a multiperson rather than one-person psy- and process in which the group comes to listen for
chology model. In this treatment approach, the and develop nuclear ideas. These core psychological
group members contribute ideas and insights, concepts emerge from the network of communica-
much like the therapist does. Honoring the contri- tions and interactions. They may develop from any-
butions of group members reduces the therapist’s thing that captures interest: a premise, a theme,
perceived authority and power and fosters a demo- common tension, enactment, or insight. In sustaining
cratic atmosphere of mutual respect and apprecia- focus on a nuclear idea, the therapist encourages
tion. exploration of its connections to the group process
and the psyches of individual members.
Integration–Disintegration
Therapeutic Interaction
The relational therapist attempts to assess and
respond to the truth needs of the various individu- Leadership involves more than an application of
als and the group. The primary task is twofold: learned theory, tactics, and techniques. It demands
pursuing emotions that are meaningful but painful, self-knowledge and the capacity to use subjective
while at the same time modifying emotional expe- experience to connect to others. Different dimen-
riences that are present but are felt as too painful sions of the therapist’s self are called forth to
to become meaningful. To foster authentic com- cement bonding to the group and its members,
munication and reduce falsity, the therapist works build trust, and allow troubled relationships to
to modify the impact of social anxiety and evolve and resolve.

Diplomacy involves the therapist’s strategic use Refusal manifests itself as willful nonparticipa-
and sharing of leadership power in establishing tion in the interactions and activities of group
and maintaining relationships. Integrity emerges therapy. Such refusal can vary in persistence, inten-
from the therapist’s moral and ethical principles sity, and legitimacy. To move group relationships
and how they are utilized to establish ground rules (psychic and interpersonal) forward and expand
as well as negotiate conflicting principles and the boundaries of what can be thought and talked
beliefs. Sincerity conveys genuine feeling and con- about, the therapist encourages thinking about
scious intention, which are essential dimensions of refusal yet also conveys respect for the reasons
bonding. In functioning with authenticity, the behind it. Interest in truth remains basic, and
therapist communicates with conviction, while members think about ongoing and past group
acknowledging that his or her interventions are experience when resisting, rebelling against, or even
subjective opinions and up for discussion and refusing certain emotional links to understanding it.
challenge.
Richard M. Billow
Therapeutic Process See also Group Analysis; Intersubjective Group

Psychotherapy; Intersubjective-Systems Theory;
Group process may be conceptualized as a series of Mentalization-Based Treatment; Relational
intrapsychic and interpersonal moves and counter- Psychoanalysis
moves to express, redirect, modify, or block the
search for truth. The 3 Rs—resistance, rebellion,
and refusal—represent three strategies individuals Further Readings
and groups utilize to tolerate, regulate, and negoti- Billow, R. M. (2003). Relational group psychotherapy:
ate the various iterations of emotional truth. From basic assumptions to passion. Philadelphia, PA:
Resistance specifically refers to the creative Jessica Kingsley.
unconscious, which generates and communicates Billow, R. M. (2010). Resistance, rebellion and refusal in
its own “take” on experience. The group’s dis- groups: The 3 Rs. London, England: Karnac Books.
course and behaviors communicate underlying Billow, R. M. (2014). Relational group psychotherapy:
symbolic meaning, which the therapist may bring Developing nuclear ideas. London, England: Karnac
to the members’ attention. The therapeutic process Books.
focuses on exploration and interpretation, the Gayle, R. (2009). Co-creating meaningful structures
sharing of thinking, and mutual discovery. within long-term psychotherapy group culture.
Rebellion typically arises from therapist– International Journal of Group Psychotherapy, 59,
member conflicts regarding the group’s immediate 311–333. doi:10.1521/ijgp.2009.59.3.311
Ivey, G. (2008). Enactment controversies: A critical review
or long-term focus, values, and methods. What is
of current debates. International Journal of
said to represent truth and when and how empath-
Psychoanalysis, 89, 19–38.
ically it is said may create controversy and opposi-
doi:10.1111/j.1745-8315.2007.00003.x
tion. When group members cannot resolve or
Schermer, V., & Rice, C. (2012). Towards an integrative
choose to live with dissent, rebellion can take vari- intersubjective and relational group psychotherapy. In
ous action pathways that the therapist attends to J. L. Kleinberg (Ed.), The Wiley-Blackwell handbook
and may attempt to resolve: defiance, secession/ of group psychotherapy (pp. 59–88). Chichester,
exile, anarchy, or revolution. Defiance represents a England: Wiley.
type of conspicuous pressure exerted against an Schwartz, H. (2012). Intersubjectivity and dialecticism.
ongoing process. In secession/exile, group mem- International Journal of Psychoanalysis, 93, 401–425.
bers’ reciprocal allegiances and attachments are doi:10.1111/j.1745-8315.2011.00543.x
threatened or ruptured. Anarchy refers to “anti- Stolorow, R. D. (1997). Principles of dynamic systems,
group” or high-crisis interludes that threaten to intersubjectivity, and the obsolete distinction between
impel destructive behavior. In revolution, rebel- one-person and two-person psychologies.
lious premises and solutions aim to bring the group Psychoanalytic Dialogues, 7, 859–868.
to a new phase, which may be positive or negative. doi:10.1080/10481889709539224

884 Relational Psychoanalysis
self-consciousness in patients seeking psychological

RELATIONAL PSYCHOANALYSIS treatment.
Postmodernism, along with the influences of
Relational psychoanalysis, a significant approach parent–infant research, neurobiology, cognitive psy-
among contemporary psychoanalytical schools, chology, and trauma research after the Vietnam War,
emerged as a critique of more traditional or classi- contributed to the psychoanalytical focus of indi-
cal psychoanalysis. Relational psychoanalysis viduality. Individuality began to be seen as a direct
developed beyond the predominately intrapsychic result of social context rather than of intrapsychic
model of classical analysis into an approach that structures. Later, the influence of queer theory and
included both interpersonal and intersubjective postcolonialist critique affected the relational-
dimensions of human experience. Instead of a sin- psychoanalytical understanding of how sex, gender,
gle theoretical model, relational psychoanalysis race, class, transsexuality, alternative family struc-
became an umbrella covering a diverse range of ture, and immigration influence the intersubjective
perspectives based on a common set of core con- dimensions between the analyst and the patient.
cepts and clinical strategies. The relational tradi- The relational movement found an institutional
tion emerged in post-Freudian thought and was home in 1988 within the New York University
first recognized as a movement by Jay Greenberg Postdoctoral Program in Psychotherapy and
and Stephen Mitchell. It has subsequently been Psychoanalysis. In 1990, Mitchell initiated the
developed by analysts worldwide. Relational Perspectives book series, later partnering
with Lewis Aron in this effort. Additionally, Mitchell
developed the first psychoanalytical journal dedi-
Historical Context
cated to a multiplicity of voices, called Psychoanalytic
Relational psychoanalysis emerged in the United Dialogues: A Journal of Relational Perspectives.
States in the 1970s and 1980s as ego psychology’s Since Mitchell’s death in 2000, Aron has edited the
prominence declined and the British object rela- Relational Perspectives series with Adrienne Harris;
tions and Self Psychology theories gained traction as of 2014, 64 books, including 5 volumes of influ-
in American psychological circles. In 1983, ential articles written by major contributors of the
Greenberg and Mitchell coauthored the seminal movement, have been released.
book Object Relations in Psychoanalytic Theory Relational thought continues to develop at the
and coined the term relational. This term synthe- annual meeting of the Division of Psychoanalysis
sized interpersonal psychoanalysis, with its empha- (i.e., Division 39) of the American Psychological
sis on the exploration of observable “external” Association and the International Association for
interpersonal relations, and British object relations Relational Psychoanalysis and Psychotherapy. The
theory, with its focus on the importance of inter- Stephen A. Mitchell Center of Relational Studies
nalized object relations and the phenomenological opened in 2007 in New York City to provide con-
map of the internal world. In addition to bridging tinued education about the theory and clinical
the object relations and interpersonal traditions, practice of relational psychoanalysis.
relational theory incorporated elements of Self
Psychology, existential psychotherapy, attachment
theory, and more contemporary developments in
Freudian theory, particularly those of Hans The relational movement emerged across a wide
Loewald. range of theoretical schools and traditions, each of
Relational theory was strongly influenced by which was distinguishing itself from the Freudian
feminism, an emphasis that may reflect the increas- classical tradition, which had taken the individual
ingly strong presence of women in the relational- mind as a basic unit. While Sigmund Freud himself
analytic field, and the realm of psychology in a had argued that all individual psychology was
broader sense. Strongly influenced by the French group psychology, his fundamental framework
philosopher Michel Foucault’s critical theory and was of the individual mind energized by the forces
critique of ideology, the relationalists encouraged a of drive and seeking tension reduction. Relational
simultaneously interpersonal and sociocultural psychoanalysis developed from a large group of

Relational Psychoanalysis 885
contributors who continued to build on Greenberg Jessica Benjamin contributed another important
and Mitchell’s ideas as a scaffold to expand the theory of intersubjectivity distinct from Stolorow’s
theory and clinical applications. Mitchell devel- version. Benjamin, building on her sociological
oped the framework of the relational matrix to background in the Frankfurt school and feminist
hold the dialectical tension between the self, the studies, proposed an intersubjective recognition
other, and the interaction between these two poles. theory that views the capacity for mutual recogni-
Fairbairnian object relations highlighted the per- tion and intersubjectiveness between mother and
sonification of the internal object and the internal baby as a critical part of development. Benjamin
experience of the other; Heinz Kohut and Donald viewed intersubjectivity as a developmental trajec-
Winnicott’s self psychologies emphasized the self tory in which children begin with more primary
and its feeling of realness, aliveness, authenticity, forms and develop more sophisticated forms of
coherence, and continuity. Harry Stack Sullivan’s mutual recognition of the other as separate sub-
interpersonalism and John Bowlby’s attachment jects. In contrast, Stolorow defined intersubjectiv-
perspective highlighted the observed interaction ity in such a way that all relationships between
between these two poles. people are intersubjective because there is always
Mitchell was also influenced by the work of bidirectional influence. With the emergence of the
Merton Gill and his colleague, Irwin Hoffman. Gill relational tradition, there was a shift away from
was a classical analyst in the United States who the emphasis on verbal interpretation to a new
challenged the ego psychological understanding of focus on the verbal and nonverbal, insight and
transference as a distortion, misperception, and experience, and interpretation and relationship.
misattribution. In contrast, Gill emphasized trans- Peter Fonagy and Mary Target conceptualized
ference as the interaction of the patient and the mentalization as the ability to make and use men-
analyst in a mutually influencing relationship. Gill tal representations of their own and other people’s
rejected the idea that the analyst had a superior emotional states. Conceptualizing mentalization as
view of the patient’s intrapsychic reality and a disturbance of attachment and a key goal of
instead stressed the exploration of the plausibility treatment is consistent with the main thrust of
of the patient’s construal of the analyst. relational psychoanalysis, and the concept has
Robert Stolorow introduced the concept of been utilized by many relational authors.
intersubjectivity to American psychoanalysis,
stressing the bidirectional influence of two subjec-
tivities. Rejecting Cartesianism, Stolorow and his Major Concepts
colleagues critiqued the myth of the isolated mind. Relational psychoanalysis is fueled by many shared
Stolorow’s intersubjective systems theory proposed concepts, including multiplicity, dissociation,
that minds exist within interpersonal and intersub- enactment, and the analytical third.
jective relationships and develop in relational con-
texts. This framework also grew from the nonlin-
Multiplicity
ear dynamic systems theory, which was influential
in providing a metaphor for psychoanalysts to The relational focus on multiple selves, or mul-
conceptualize the process of developmental change tiple self states, is a way of highlighting that people,
within complex systems that did not unfold within their selves, or their characters are variable from
a predetermined, linear pattern. Instead, the one context to another. The classical intrapsychic
dynamic-systems framework began to understand focus, with its delineation of ego integration and
that change is nonlinear, spontaneous, and discon- ego identity, has tended to privilege psychic struc-
tinuous. The analyst began to tolerate uncertainty, ture as the essential factor in the development of
find meaning in the fragmented communication personality. By talking about multiple self states,
between the analyst and the patient, and under- relational analysts like Jody Davies, Donnel Stern,
stand how the cocreation of the analyst and the and Philip Bromberg made the point that psychic
patient would emerge from the ordinary attentions structure (i.e., the self) varies based on interper-
of life and create a new moment of meeting in the sonal context. The theorization of multiple self
different dyadic states. states derives from both the American interpersonal

886 Relational Psychoanalysis
tradition, with its theory of dissociation and Analytic Third

personifications, and from British and American
The analytic “third” is a psychoanalytical
object relations theory, with its examination of
concept that refers to an emergent phenomenon or
internal selves and objects, as well as from Kohut’s
analytic field that steps outside binary oppositions
self-psychological description of vertical splits in
and polarized thinking. There are many concep-
the self.
tions of the “third” among theorists in various
schools of psychoanalysis. Benjamin and Aron
Dissociation emphasized a variety of thirds, each of which tran-
Sullivan proposed that self states are derived scends or deconstructs a binary, such as inner and
from the internalization of recurring patterns of outer worlds, (e.g., doer/done to or sadist/masoch-
interactions in our early significant relationships ist). For other theorists, such as Thomas Ogden,
with others. These relationships shaped distinctive the third is an extension of the notion of intersub-
patterns where one is minimizing or avoiding jectivity. It reflects the idea that it takes two people
threats of anxiety activated by these relationships. for one person to be able to think or feel. The third
Sullivan understood anxiety in a child as derived requires surrender from the patient and the ana-
through the empathic linkage with the parent. The lyst, allowing each to stay connected to the other’s
child discovers that some behaviors are met with mind while also accepting the other’s separateness.
parental approval, which enhances the child’s secu- For some theorists, the third refers to the uncon-
rity, whereas other interactions generate anxiety or scious psychological field that constitutes the
disapproval from the parent. The child then devel- ground of intersubjectivity.
ops a “good” and a “bad” me, which find their
way into the subjective experience of being who
Techniques
the child is. The individual then grows to develop
a selective inattention that allows the individual to Relational psychoanalysis and psychotherapy
make a dissociation from certain unaccepted emphasize that therapeutic change takes place
aspects of himself or herself that trigger anxiety. within a two-person intersubjective relationship
Enactment becomes the “interpersonalization” of constituted by the mutual influence of two sepa-
the dissociation, where the patient externalizes the rate subjects. The belief is that analysts inevitably
part of the self that is hard to realize and attaches influence the field through their own participation
it to the analyst. and that the analyst and the patient are always
regulating each other in both unconscious and
conscious ways. Like all forms of psychoanalysis,
Enactment
the relational approach utilizes an exploration of
Enactment is the process in which an analyst the relationship patterns between the analyst and
becomes an unconscious participant in the rela- the patient, the patient’s current patterns inside
tional matrix of the patient. The analyst is affec- and outside the therapy room, and the patient’s
tively engaged and becomes, with the patient, history. These repetitive relational patterns reflect
active in acting out patterns from the patient’s the analyst’s and the patient’s distinct personal
past, often related to past traumas. Enactments stories, conflicts, and ways of relating to the world.
allow for the patient and the analyst to dramatize The use of judicious self-disclosure has been
and engage a variety of “old” self and object rela- encouraged by some writers within the relational
tions patterns while gradually introducing “new” tradition, and some willingness to share subjective
self and object configurations. Enactment may be experience has become associated with the rela-
valuable in and of itself in that it dramatizes and tional approach, in contrast to the “blank-slate”
plays with core relational configurations, espe- stance propagated in a one-person psychology
cially disruption and repair; in addition, it may be model. Many relational analysts value thoughtful
therapeutically useful in that understanding and and selective disclosure as a way of engaging the
resolution lead to insight and behavioral and expe- patient and stimulating an exploration of the rela-
riential change. tionship. Relational analysts have been able to

Relational-Cultural Theory 887
understand their personal associations, feelings, Mitchell, S. A. (1997). Influence and autonomy in
and reactions as a critical part of their empathizing psychoanalysis. Hillsdale, NJ: Analytic Press.
with a patient. Still other relational analysts, such Mitchell, S. A., & Aron, L. (1999). Relational
as Joyce Slochower, have emphasized the analyst’s psychoanalysis: The emergence of a tradition.
“holding” function, a bracketing of subjectivity Hillsdale, NJ: Analytic Press.
that protects the patient’s vulnerable self states.
Therapeutic Process RELATIONAL-CULTURAL THEORY

The relational perspective approaches psychotherapy
with the belief that analysts inevitably influence the Relational-cultural theory (RCT), and the type of
phenomenon they are observing through their own psychotherapy approach that it engenders, differs
participation in the relational field. The analyst and from other postmodern and feminist approaches in
the patient are continuously influencing each other in its emphasis on the need for healthy interpersonal
conscious and unconscious ways. The ongoing pro- connections as a basic requirement for healthy
cess of therapy allows for mutual influences to human development. RCT is a type of postmodern
develop into relational patterns, or enactments. The feminist therapy that places prominence on both
repetitive nature of these enactments reflects the indi- personal relationships and relationships within
vidual’s personal history, conflicts, and ways of relat- larger social systems. RCT holds that most prob-
ing to both the analyst and the patient. Therapeutic lems that bring people into counseling are due to
relationship allows for the analyst and the patient to fractured interpersonal relationships and/or pres-
identify shared unconscious patterns and create and sures from those who have power over the client
develop new patterns. within social systems. Problems of racism, sexism,
classism, and other types of sociopolitical oppres-
Lewis Aron and Melissa Kate McIntosh sion are the common underlying causes of every-
day problems for many clients.
See also Ego Psychology; Interpersonal Psychoanalysis;
Intersubjective-Systems Theory; Object Relations
Theory; Self Psychology; Unifying Nonlinear Historical Context
Dynamical Biopsychosocial Systems Approach
RCT grew out of the pioneering work of Jean
Baker Miller. Miller was a psychiatrist who lived
Further Readings and worked in the northeastern United States dur-
ing the mid-20th century. The traditional roles of
Aron, L. (1996). A meeting of minds. Hillsdale, NJ: men and women were rapidly changing, as were
Analytic Press.
ideas about race and social class. In 1976, Miller’s
Aron, L., & Harris, A. (2012). Relational psychoanalysis
landmark book Towards a New Psychology of
IV: Expansion of theory. New York, NY: Routledge.
Women was published. The book outlined her
Aron, L., & Lechich, M. L. (2012). Relational
thoughts about the shortcomings of other common
psychoanalysis. In G. O. Gabbard, B. E. Litowitz, &
P. Williams (Eds.), Textbook of psychoanalysis (2nd ed.,
approaches to psychotherapy and human develop-
pp. 211–224). Washington, DC: American Psychiatric.
ment that emphasized independence and separate-
Benjamin, J. (2004). Beyond doer and done to: An ness as goals healthy adults should strive to
intersubjective view of thirdness. Psychoanalytic achieve. Most of these models saw women’s desire
Quarterly, 73(1), 5–46. doi:10.1002/j.2167-4086 for connection with others as a weakness. Because
.2004.tb00151.x of their need for relationships, women were often
Greenberg, J., & Mitchell, S. A. (1983). Object relations painted as the less intelligent, less capable sex in
in psychoanalytic theory. Cambridge, MA: Harvard any setting apart from homemaking. Instead,
University Press. Miller argued, all people naturally seek affinity
Maroda, K. (1998). Seduction, surrender, and and connection with others and are stronger and
transformation: Emotional engagement in the analytic healthier when they have growth-fostering
process. New York, NY: Psychology Press. relationships.

888 Relational-Cultural Theory
Miller’s model of psychotherapy also stressed the In 1981, Miller became the director of the Stone
importance of mutually growth-fostering relation- Center at Wellesley College. The Stone Center was
ships. In these relationships, both people in the pair the campus counseling center for the college. While
are able to grow and receive care and empathy from working there, Miller continued to refine her the-
their partner. At the time, women struggled to achieve ory, encouraged others to write about and add to
mutual growth within their marriages, which were it, and taught courses on relational psychology at
still predicated on a model of the man being dominant several nearby colleges and universities. Miller
in most matters while the woman was subordinate died in 2006, but her work continues at the Stone
and was expected to serve the needs of the man. Center, which now also houses the Jean Baker
Same-sex romantic partnerships were highly stigma- Miller Training Institute. The institute conducts
tized and generally not accepted in society. The notion training on RCT for therapists several times a year,
that both partners should engage in empathic care curates articles about the approach, and works to
and understanding of each other was considered spread the practice of RCT.
radical in the 1970s. Miller also wrote that men ben-
efit from growth-oriented relationships and, in fact,
need nurturing empathic exchanges to be emotionally
healthy. This was also a radical departure from the RCT is built on the concept that healthy human
common belief that men are strong and independent social and emotional development leads not only
and do not need to express emotions. to separateness but also to healthy connections
Miller and her theory received a great deal of with other people. Radiating out from this central
negative attention from many psychiatrists and psy- concept are ideas about how people attempt to
chologists, most of whom practiced from a Freudian connect one another, what can go wrong with
perspective. Freudian psychiatrists and psycholo- these connections, and how they might be repaired.
gists believed that the basis for clients’ problems lay Within the past decade, neuroscientists have bol-
in early experiences that were held in the subcon- stered the credibility of these ideas with discoveries
scious. Dream analysis, hypnosis, free association, about the form and function of the human brain
and similar methods of uncovering and analyzing and how it is hardwired to connect with others.
clients’ repressed memories were the generally Absence of connection, especially during the early
accepted techniques in therapy at the time. Miller’s years of a child’s development, can cause damage
notion that clients’ problems were available to their to most of the major functions of the brain.
conscious minds and revolved around their primary Repair to damaged brains is possible, and new
relationships seemed foreign in comparison. research suggests that talk therapy can repair some
Miller also faced sexual discrimination on of the damage done during abusive and neglectful
many occasions, and her work was often shunned early experiences. Therapists who use RCT harness
by male colleagues who refused to accept the idea the self-healing power of the human brain when
that a woman could make meaningful contribu- they work with clients. Scientific validation of ear-
tions to science. However, her ideas became more lier ideas about the healing power of connection
popular and accepted as women gained more bolsters RCT claims that healing is done within
ground during the women’s rights movements in relationships with others, not in isolation. The pri-
the 1970s and onward. By the mid-1980s, Miller mary underpinning of the theory is that all humans
was the center of a group of women psychiatrists, need and crave healthy, growth-fostering relation-
psychologists, and similar professionals who met ships and will do whatever is required to create
weekly to discuss their ideas about relational the- and maintain relationships with others. When
ory. Dubbed the “Monday Night Group,” they relationships fail, are painful, or do not meet the
met at Miller’s home to discuss ideas about needs of the people involved, psychopathology or
women in society, therapy, theory, and life. Many emotional distress may result. RCT theorists see
ideas now found in books and peer-reviewed arti- most depression, anxiety, addictions, traumatic
cles grew out of these Monday night conversa- stress, and other types of psychological problems
tions, attended by authors such as Judith Jordan, as unsuccessful attempts at connection. Over time,
Irene Stiver, Maureen Walker, Laura Hartling, and repeated broken relationships may cause clients to
Janet Surrey. retreat into isolation, develop various types of

Relational-Cultural Theory 889
anxiety, or turn to addictive drugs or behaviors in Condemned Isolation

order to counter the pain they feel.
When people give up reaching out to others for
People recover from psychological distress
meaningful relationships, they are said to experi-
when they are able to examine their past rela-
ence condemned isolation. They retreat into them-
tional problems, learn to have self-empathy and
selves and do not attempt to connect with others.
empathy for others, and expand their capacities
This is often seen as depression and is a cause of
for future healthy, growth-fostering relationships.
addiction.
It is important to note that relationships refer
both to interpersonal relationships and relation-
ships to the broader culture. Clients may suffer Relational Templates
from disconnection in their close personal rela- People develop a set of expectations for the
tionships and may also suffer from cultural behavior of others through their lived experiences.
oppression in the form of sexism, racism, hetero- These cognitive sets, or schemas, develop into rela-
sexism, ageism, or other related problems. tional templates, which drive a person’s expecta-
Therefore, clients are encouraged to examine both tions about future relationships. These may vary
close personal relationships and the powerful cul- by the type of relationship (e.g., romantic, profes-
tural disconnections that may be present in their sional, etc.) and the type of person (e.g., man, older
lives as part of the healing process. person, etc.).
Major Concepts Central Relational Paradox

Mutual Empathy People crave and need relationships. This
The therapist’s empathic comments and body remains true even when a person has experienced
language help the client see how his or her experi- painful or negative relationships. Often, the more
ences and stories can affect others emotionally. bad experiences a person has had in relationships,
the more he or she feels a need to connect with
others.
Self-Empathy
Clients are encouraged to feel empathy for Techniques
themselves prior to trying to feel empathy for oth-
ers. Clients are often unable to discuss their own RCT does not have a set of specific techniques.
feelings accurately and are assisted in identifying However, the ability to communicate mutual
them and allowing the feelings to be experienced empathy with a client is essential to the success of
as worthy and important. therapy. Beyond the use of mutual empathy, RCT
therapists often use expressive arts and cognitive
techniques to assist clients in examining their rela-
Five Good Things
tional templates, relationships, strategies of discon-
The five good things are the elements Miller nection, and capacity for self-empathy. RCT may
identified as being present in mutually growth- be used with clients across the life span, including
enhancing relationships. They are groups, couples, families, and individual children,
adolescents, and adults.
1. zest, a feeling of a greater sense of vitality and
energy;
Therapeutic Process
2. an ability to take action in mutually growth-
RCT does not have a specific, dogmatic process by
producing relationships and in the world;
which all therapeutic encounters must unfold. It
3. an accurate picture of oneself and the other follows the general progression of most current
person(s) (also known as clarity); therapies in stages of assessment, working, and
termination. All of these typical stages are con-
4. a greater sense of self worth; and
ducted with a deep, radical respect for the client
5. an increased desire for more connections. and his or her coping methods.

890 Relationship Enhancement Therapy
During assessment, the therapist will seek infor- Miller, J. B., & Stiver, I. (1997). The healing connection.
mation about the types and qualities of the clients’ Boston, MA: Beacon Press.
past and current relationships. General informa- Robb, C. (2006). This changes everything: The relational
tion about any addictive behaviors, thoughts of revolution in psychology. New York, NY: Picador.
self-harm or harm to others, and coping skills is Walker, M., & Rosen, W. (Eds.). (2004). How connections
also recorded. In the early phase of therapy, RCT heal: Stories from relational-cultural therapy.
therapists try to learn as much as they can about New York, NY: Guilford Press.
how the client connects and disconnects with oth-
ers. The client’s “strategies of disconnection” are
crucial to finding the source of distress and the
source of healing. RELATIONSHIP ENHANCEMENT
Once the therapist has an understanding of the
client and his or her context and concerns and the
THERAPY
client begins to feel safe within the context of
the therapeutic relationship, the therapist begins to Relationship Enhancement® is an educationally
help the client explore more deeply fraught areas. based skills-training approach to human problems
Relational templates are explored, along with how that emphasizes helping people in significant rela-
these past experiences influence current behavior. tionships learn and apply skills to help them act as
The client is encouraged to experience self-empa- change agents for each other and enhance their
thy as well as empathy for others. The therapist relationships. Relationship Enhancement programs
maintains an open, curious, and supportive stance. are effective with individuals, couples, families,
Advice giving and judgment are not allowed. groups, and any important relationship. The key
As the client comes to understand his or her pat- ingredient is helping clients learn skills that enhance
terns of disconnection and relational templates, the psychological and emotional satisfactions from
and to value his or her own emotional life, the such close relationships and thereby improve the
counselor remains supportive and empathic. The well-being of the individual and the group (couple
therapist may use expressive arts strategies to help or family). The goal is to modify behavior through
the client elicit and process relational memories the learning and generalization of specific interper-
and emotions. Sometimes, psychoeducation may sonal skills. When people do this in the context of
be used to help the client understand what a their primary and significant relationships, the
healthy relationship is and how healthy relation- changes are more satisfying and long lasting. The
ships differ from toxic ones. The goal of therapy is problem’s solution is not ignored; rather, the client is
for the client to increase his or her capacity for taught to solve problems as part of the therapy. The
healthy, growth-fostering relationships. intent is less to help people change than to help them
learn to create a secure emotional context in which
Mary Catherine Tucker constructive change is more likely to occur. Once
this context is established, clients become more
See also Feminist Therapy; Miller, Jean Baker autonomous and differentiated and, ultimately,
more intimate with significant people in their lives.
Further Readings Having learned these skills, and trusting that they
can solve their own problems, clients are in a better
American Psychological Association. (2008). Relational position to deal with life’s crises on their own.
cultural therapy [DVD, APA Systems of Psychotherapy
Video Series].Washington, DC: Author.
Jordan, J. V. (2009). Relational-cultural therapy. Historical Context
Washington, DC: American Psychological Association.
Jordan, J. V., Walker, M., & Hartling, L. (Eds.). (2004). When Bernard G. Guerney Jr. created Relationship
The complexity of connection. New York, NY: Enhancement in the 1960s, he was concerned
Guilford Press. about the efficacy of the prevailing practices used
Miller, J. B. (1976). Toward a new psychology of women. to treat children and their parents. Rather than
Boston, MA: Beacon Press. viewing emotional and behavioral problems as

Relationship Enhancement Therapy 891
reactions to intrapsychic issues resulting from Relationship Enhancement therapy skills

unconscious and unresolved emotional conflicts, emphasize the following: empathic understanding
he assumed that the majority of cases were the and the acknowledgment of this understanding,
result of lack of skill in and knowledge about emo- ownership of oneself (emotional regulation), and
tional functioning and interpersonal interactions emotional attunement, attachment, and intimacy.
(relationships). He believed that by helping clients In Relationship Enhancement Couple Education
learn to improve their emotional and relationship (Mastering the Mysteries of Love form of
skills in their primary and significant relationships, Relationship Enhancement), Guerney and col-
and through internalizing these skills with practice leagues have developed nine Relationship
and attention to their principles, they would be Enhancement skills that are taught: expressive,
able to resolve intrapersonal and interpersonal empathic, problem discussion, problem solution,
conflicts, improve coping, and be responsible for partner facilitation, self-change, other-change, gen-
their own problems. Relationship Enhancement eralization, and maintenance. Couples and fami-
was one of the first models to use family members lies learn these skills with one another; practice
as change agents with one another in a structured, and apply them at home, at work, and in their
systematic, and time-designated way. communities; and generalize and maintain these
Relationship Enhancement began as a program skills with others who are significant to them. This
called Filial Therapy, in which parents worked thera- helps them improve the quality and satisfaction in
peutically as change agents with their own children. their lives. In recent years, Barry G. Ginsberg has
Here, parents learned how to conduct child-centered emphasized the importance of emotion as an orga-
play therapy sessions at home with their own chil- nizing principle and emotional engagement/attach-
dren. Guerney believed that therapeutic change ment as the underlying principle in all nine skills.
would be more probable and long lasting if parents
served as their children’s therapists. It was believed
that this process would allow children to experience
improved self-concept, emotional regulation, and a Guerney formulated Relationship Enhancement
more attuned attachment relationship with their therapy as an integrative, systematic, and time-
parents. Parents would not only learn to improve designated approach. The key values of Relationship
their parenting skills but also become more empathic Enhancement therapies emphasize the importance
and attuned to their children’s development. These of relationships and that accessing an understand-
skills changed how parents responded to their chil- ing of our deepest emotions is transformative to
dren, increased children’s self-concept and emotional ourselves and our relationships. It further suggests
lives, and ultimately improved family life. that people develop “interpersonal reflexes” that
The development of Filial Therapy, originally are shaped by early relationships, which in turn
Child Parent Relationship Enhancement Family shapes the same kind of response in others:
Therapy, began at a time when there were signifi- Positive responses trigger positive responses and
cant concerns about the ability to provide psycho- negative responses trigger negative responses. This
logical services to growing populations. As a result, reciprocal process is out of one’s awareness or
there was growing pressure to develop self-growth consciousness, is derived from family histories, is
and prevention activities by employing paraprofes- integrated into the habits of present and new rela-
sionals and other nonprofessionals. tionships, and explains why people become stuck
With a National Institute of Mental Health in habitual patterns. Key to the change process is
research grant, Guerney began to explore applying the ability of individuals in relationships to show
the principles of Filial Therapy to other subsystems deep empathy and other relationship skills that
and populations and to educational/prevention foster understanding and love in relationships.
programs, including Relationship Enhancement Deep empathy
programs such as Couple Relationship Enhancement,
Parent-Adolescent Relationship Development, • helps individuals understand the motivations,
Mastering the Mysteries of Love, and Relationship values, and feelings of others, particularly those
Enhancement Family-of-Origin Consultation. significant in their lives;

892 Relationship Enhancement Therapy
• allows for openness and honesty, which are • Interpersonal theory is central to this integrative
necessary to this understanding of oneself and approach, stressing the importance of relation-
others; ships and reciprocal cycles of interaction.
• can occur only in an accepting and nonjudgmen- • The importance of environment and context in
tal atmosphere; shaping behavior comes from developmental
• allows for individuals to understand the underly- systems theory.
ing feelings and motivations of others; • The influence of early emotional and relational
• helps individuals become more congruent in their development in the formation of personality, the
lives—that is, allows their feelings, behaviors, capacity to develop emotional bonds in relation-
and thoughts to be in sync; ships and develop secure bonds, comes from
• is best if it occurs in an “empathic relationship,” attachment theory.
where people can be open with their deepest • All this emerges in the family emotional system,
emotion with little defensiveness or blame; which influences individuals (family systems
• promotes security, lessens anxiety, and builds theory).
confidence in oneself and the relationship;
• promotes a sense of well-being and happiness; Techniques
• enables partners to become more intimate,
In Filial Therapy, parents are taught child-centered
collaborative, and problem solvers;
play therapy skills. These skills allow for children
• lessens power inequities between partners;
to initiate and be self-directed in a nonjudgmental,
• allows individuals to become more flexible and
accepting, and empathic context. Parents learn to
better able to adapt and cope with change; and
be empathic, nonjudgmental, and accepting of
• helps people emphasize what’s right and not
their children; learn to set effective limits and con-
what’s wrong.
sequences; and learn how to conduct play therapy
sessions at home with their own children and gen-
When these skills are learned and practiced in
eralize the principles and skills learned in their play
one’s significant and important relationships, they
sessions with their children in their everyday lives.
can be internalized and integrated in one’s life and
This can be done as an individual family therapy
relationships, resulting in a more satisfying life
or in multifamily groups.
experience.
In Relationship Enhancement, Couple and
In developing Relationship Enhancement ther-
Family Therapies, instead of play therapy, couples
apy, Guerney drew on the pertinent aspects of the
and families learn relationship skills derived from
major theories to develop this integrative approach,
the same principles and methods as those of Filial
including the following:
Therapy such as the following:
• The concepts of the unconscious, defense mecha- Speaking/owning (an expressive skill; taking owner-
nisms, and the value of catharsis were drawn ship): Learning to recognize and acknowledge, with
from psychoanalytical theory. acceptance and nonjudgment, one’s underlying feel-
• Client-centered (now person centered) therapy ing motivations for one’s behavior in the present—
emphasizes the importance of empathy, uncondi- essentially empathy for oneself
tional positive regard including acceptance and
nonjudgment, self-understanding, congruence, Listening/empathic responding (a receptive skill):
and self-determination. Learning to suspend judgment and, with acceptance,
• Operant conditioning and reinforcement from understand fully the underlying primary emotional
learning theory are important for this educa- motivation for the expressions and actions of others,
tional approach. and acknowledge this understanding to others, par-
• Social learning theory contributed modeling, ticularly in one’s primary and significant relation-
self-regulation, self-determination and personal ships—essentially empathy for others
behavior, positive reinforcement, shaping, and Discussion/emotional engagement (an attachment
the importance of practice to effect change. skill; relationship): Learning to give emotional

Relationship Enhancement Therapy 893
acknowledgment to the meaning and importance of Therapy in Relationship Enhancement is defined

the other person’s feelings in the relationship—an by this skill-learning process and its practice, help-
intimacy skill that incorporates speaking and listening clients internalize the skills and incorporate
ing skills and increased collaboration in this empathic them in their everyday lives with one another.
context. Relationship Enhancement emphasizes the
importance of emotion as the transformative agent
Then, they practice the skills with one another in change, particularly in the development of
during the scheduled practice sessions at home and attachment security in primary relationships.
record these practice sessions, which are then used A secure context is necessary to enable individuals
for supervision and reinforcement of the skills in and families to improve their functioning.
office sessions with the therapist. Structuring for success (a positive connotation) is
Clients are taught and reinforced in how to gen- an essential principle to enable families to continue
eralize these skills in their everyday lives (general- the scheduled weekly half-hour home practice.
ization skill) and maintain them over time (main- Clients record and/or self-report these home prac-
tenance skill). tices for supervision. Once the clients are engaged
in home practice, they are seen less often and office
sessions emphasize review of their home practice
Therapeutic Process and their efforts to generalize and maintain the
Relationship Enhancement programs are educa- skills in their everyday lives. The emphasis in these
tion/skill learning based and highly structured, and sessions is less on problem solving per se and more
the training is detailed and systematic and typically on applying appropriate principles and methods to
time designated. Relationship Enhancement pro- each situation. An important principle is for indi-
grams proceed in a systematic way. Therapy typi- viduals and families to look for the underlying
cally progresses in phases. positive (e.g., “You’re important to me.”).
Barry G. Ginsberg
Tutorial phase: It is a more intensive process and
comparable with a traditional therapeutic role. See also Behavior Therapy; Cognitive-Behavioral
Therapists create a safe, secure, and trusting thera- Therapies: Overview; Couples, Family, and Relational
peutic context to model and directly supervise cli- Models: Overview; Emotion-Focused Therapy;
ents in skill practice with one another and help them Existential-Humanistic Therapies: Overview; Person-
learn how to conduct skill practice sessions at home. Centered Counseling; Psychoeducational Group;
Rogers, Carl; Sullivan, Harry Stack
Coaching phase: It is a less intensive process with
less frequent meetings with the therapist. This is a
generalization phase. Clients conduct structured and Further Readings
taped home practice sessions at designated times Ginsberg, B. G. (1997). Relationship enhancement family
each week and bring samples (tapes) of their home therapy. New York, NY: Wiley.
practice and generalization activities to the sessions Guerney, B. G., Jr. (1982). Relationship enhancement. In
with the therapist. The therapist reinforces the home E. K. Marshall & P. D. Kurtz (Eds.), Interpersonal
skill practice and helps maintain the stability and helping skills (pp. 482–518). San Francisco, CA:
security of the relationship system to help maintain Jossey-Bass.
practice over time. Guerney, B. G., Jr. (1984). Relationship enhancement
therapy and training. In D. Larson (Ed.), Teaching
Consultant phase: It refers to the trusting relation- psychological skills: Models for giving psychology
ship between the therapist and clients, which away (pp. 171–206). Monterey, CA: Brooks/Cole.
becomes a resource for continued stability and secu- Guerney, B. G., Jr. (1977). Relationship enhancement. San
rity of the individuals and the relationship. This Francisco, CA: Jossey-Bass.
phase allows for booster sessions and refresher pro- Guerney, L. (1976). Filial therapy program. In D. H.
grams and attention to other subsystems and prob- Olson (Ed.), Treating relationships (pp. 67–92). Lake
lems of the family. Mills, IL: Graphic.

894 Response-Based Practice
Guerney, L., & Ryan, V. (2013). Group filial therapy. The developers initially used the term
Philadelphia, PA: Jessica Kingsley. interactional and discursive model to highlight the
VanFleet, R. (2013). Filial therapy (3rd ed.). Sarasota, FL: importance of language and social interaction.
Professional Resource Press. Then, to emphasize the conceptual distinction
between “the language of effects” and “the lan-
guage of responses,” they coined the terms
response-based therapy and, later, response-based
REPARATIVE THERAPY practice to denote applications of the approach in
different settings.
See Sexual Orientation Change Efforts
Response-based practice integrates and departs
RESPONSE-BASED PRACTICE from earlier contextual models (e.g., brief, sys-
temic, fifth province, feminist, narrative, solution
Response-based practice (which subsumes focused, and discursive) in its focus on the manner
response-based therapy) is a specialized model in which individuals respond to adversity, resist
for working with individuals and groups experi- violence, and work to retain their dignity.
encing adversity, including violence and injustice. Responses to adversity often reveal capacities that
It is a conceptual framework for research, critical can be brought to bear in addressing a wide range
analysis, and policy and consists of methods that of presenting concerns and developing preferred
are readily adapted across settings (e.g., in child futures.
protection, group therapy, victim assistance, ref- Philosophically, this orientation aligns with a
uges and transition houses, policing, family law, contextual and critical realist perspective. It stems
trauma treatment, prevention education, commu- in part from close analysis of human interaction in
nity development, and individual and group everyday and extreme circumstances and draws on
therapy with victims and offenders and their methods developed in microanalysis, critical dis-
children). course analysis, conversation analysis, discursive
The main tenets of the approach are supported psychology, culture studies, microsociology, and
by clinical, social science, and biological science narrative analysis. Response-based practice
research. Response-based practice grew from direct acknowledges preexisting competencies evident in
service with individuals and families in diverse everyday living and in the most adverse circum-
social, cultural, and geographical locations and stances. The “problem” resides not in the minds or
continues to evolve in collaboration with a wide brains of isolated individuals but in the mistreat-
range of professionals and activists. ment and humiliation of those individuals in the
context of violence and injustice and through
negative social responses.
Historical Context
Allan Wade, Linda Coates, and Nick Todd devel-
Major Concepts
oped response-based practice in the early 1990s as
a model of therapy with victims and perpetrators Response-based practice integrates several key
of violence and their families. The initial group tenets:
and newer colleagues (Shelly Bonnah, Ann Maje-
Raider, Cathy Richardson, Gillian-Weaver 1. Humans are agentive, in and outside of social
Dunlop, Cindy Ogden, Robin Routledge, Brenda interaction.
Adams, Barb McInerney, Vikki Reynolds, and
2. Dignity is central to individual and collective
Renee-Claude Carrier) worked with diverse
well-being.
and marginalized groups. Indigenous families and
communities, in particular, helped to shape the 3. Individuals respond to adversity and resist
approach from the outset. violence.

Response-Based Practice 895
4. Violence is, with rare exceptions, deliberate. responses to those social responses. Response-based
practice builds safety, defers to individuals’ con-
5. Violence is unilateral (i.e., not mutual) and
cerns and aspirations, contests blaming and attribu-
consists of actions by one person (or group)
tions of pathology, and formulates individuals
against the will and well-being of another.
instead as agentive and capable responders.
6. Language can be used in restrictive or This is achieved grammatically with questions
liberating ways, to (a) conceal or reveal and formulations that position individuals (i.e.,
violence, (b) obscure or reveal offender victims, perpetrators, children) as subjects who
responsibility, (c) conceal or elucidate responses respond extemporaneously and deliberately in
and resistance, and (d) blame or contest the social interaction. Language is used judiciously
blaming of victims. to develop accurate descriptions and contest mis-
representations in which violence is portrayed as
7. Humans are understood better as responding mutual rather than unilateral, individuals who
agents than as affected objects. experience violence are portrayed as passive and
8. The social and material context is central to
affected objects, and individuals who use
human experience and must be taken into
violence are portrayed as lacking control and
account.
deliberation.
Individuals who face adversity often encounter Therapeutic Process

negative social responses from social networks and
Therapy is largely a process of providing a posi-
authorities. Their experience is sometimes misrep-
tive, socially just response to the person and his or
resented in ways that fundamentally change, or
her loved ones. The immediate goal is to uphold
distort, the events in question. Positive social
dignity (which encompasses safety) and to estab-
responses, based on accurate analysis and descrip-
lish a context in which necessary information can
tions, are “therapeutic” in the sense that they
be exchanged in a way that furthers positive
uphold the dignity of the person, clarify responsi-
change.. The conversation is jargon-free, equitable,
bility, and provide social redress.
and respectful. While the therapist exerts influence
The same orientation applies to individuals who
through the content of questions and other actions,
perpetrate violence, who generally are more capa-
every effort is made to position the client as com-
ble and concerned with their responsibility than is
petent and as capable of discerning both good
generally presumed. Close analysis of the strategies
process and best outcome.
used to commit violence shows that, with rare
exceptions, individuals who commit violence Allan Wade
already possess the skill and awareness to desist
violence prior to therapeutic intervention. Therapy See also Collaborative Therapy; Exposure Therapy;
consists in part of elucidating and honoring the Feminist Family Therapy; Feminist Therapy;
capacities evident in victim responses and resis- Interpersonal Theory; Narrative Therapy; Solution-
tance and, in a complementary way, identifying the Focused Brief Therapy; Systemic Family Therapy
preexisting capacity of offenders to choose more
respectful courses of action. Further Readings
Coates, L., & Wade, A. (2007). Language and violence:
Techniques Analysis of four discursive operations. Journal of
Family Violence, 22, 511–522. doi:10.1007/s10896-
Therapists use a number of techniques to clarify 007-9082-2
context and interactional details, develop accurate Todd, N., & Wade, A. (2003). Coming to terms with
descriptions of violent actions (and other adversi- violence and resistance: From a language of effects to
ties), explore the forms and “situational logic” of a language of responses. In T. Strong & D. Pare (Eds.),
responses and resistance to those actions, review Furthering talk: Advances in the discursive therapies
the social responses, and discuss individuals’ (pp. 145–161). New York, NY: Kluwer Academic.

896 Rogers, Carl
Wade, A. (1997). Small acts of living: Everyday resistance worker with children and families and as director
to violence and other forms of oppression. of his department and then agency, he straddled
Contemporary Family Therapy, 19, 23–39. the fields of social work and psychology, arranging
doi:10.1023/A:1026154215299 for institutional and foster home placement, rec-
Wade, A. (2007). Hope, despair, resistance: Response- ommending changes in school programs, doing
based therapy with victims of violence. In C. Flaskas, family counseling, and providing individual ther-
I. McCarthy, & J. Sheehan (Eds.), Hope and despair in apy for children and parents. Eclectic in his prac-
narrative and family therapy: Adversity, forgiveness tice, his main focus was on “what works”—what
and reconciliation (pp. 63–74). Hove, England:
approaches helped children to successfully adjust
Brunner-Routledge.
to life’s challenges. One therapeutic approach that
particularly impressed and influenced him was the
relationship therapy developed at the Philadelphia
School of Social Work by students of Otto Rank.
ROGERS, CARL At the end of his time in Rochester, his first major
book, Clinical Treatment of the Problem Child,
Carl Rogers (1902–1987) was one of the leading summarized his learning about environmental and
psychologists and psychotherapists of the 20th clinical treatment and led to a job offer at Ohio
century. He developed the client-centered or per- State University.
son-centered approach to counseling and psycho- As professor of clinical psychology at Ohio
therapy and was a pioneer and leader in the State University, in what might have been the first
humanistic psychology movement of the later part university clinical practicum for psychologists in
of the century. He also was the first person to the country, rather than just summarize others’
record and publish complete cases of psychother- approaches, he began to articulate his own views
apy and, at the time, did more scientific research on effective therapeutic treatment of children and
on a therapeutic approach than had ever been adults. Rogers’s initial “nondirective” counseling
done. and psychotherapy was but one of what he called
Growing up in a mid-Western American family, the “newer therapies” of the time. These
Rogers first learned the scientific method as a boy, approaches were a counterpoint to the widely
conducting agricultural experiments on the family applied directive methods in college counseling
farm. He intended to be a modern farmer, but and the medical model of psychiatry with its
influenced by his religiously conservative family expert diagnoses and treatment. In contrast,
and a 6-month trip during college to Japan, the Rogers’s nondirective therapy placed a great deal
Philippines, and China, where he attended a World of faith in the client’s ability to know what hurts
Youth Christian Federation conference, he decided and to direct the conversation in therapy. The
instead to become a minister. When he moved with therapist’s role was not to offer advice, sugges-
his new wife, Helen, to New York City in the tions, interpretations, or probing questions but to
1920s to attend Union Theological Seminary, rely exclusively on “acceptance” and “reflection
growing religious doubts and a fascination with of feelings,” which would allow clients to achieve
psychology led him to transfer to Teachers College, their own insights, leading to their own positive
Columbia University, where he earned a Ph.D. in actions.
clinical psychology. In his dissertation and clinical Rogers’s 1941 book Counseling and Psycho-
work, he learned to balance the testing and mea- therapy: Newer Concepts in Practice described the
surement, and the psychodynamic approaches that nondirective approach, provided numerous clinical
were a part of his training, coming to deeply value examples, popularized the word client as the recipi-
both the individual’s subjective experience in ther- ent of counseling, and included the first complete
apy and the objective investigation of the process psychotherapy case ever published. It became an
of psychotherapy. instant best seller. It appealed widely to psycholo-
He put both of these approaches into practice gists, social workers, counselors, ministers, health
for the next 12 years, working in the child guid- care professionals, and others and thus helped
ance field in Rochester, New York. As a clinical spread counseling and psychotherapy to many

Rogers, Carl 897
different fields. His being elected president of Rogers became to humanistic psychology. A widely
the American Academy of Psychotherapists, the publicized debate and 6-hour dialogue between
American Association of Applied Psychology, and Rogers and Skinner added to Rogers’s stature as
the American Psychology Association evidenced the leading spokesperson for humanistic psychol-
Rogers’s growing influence. ogy, as did the dialogues he had with Martin
The recording and transcribing of actual sessions Buber, Paul Tillich, Reinhold Niebuhr, Gregory
revolutionized both training and research in coun- Bateson, Rollo May, and other leading intellectuals
seling and psychotherapy and led Rogers to move to and theologians of the 20th century.
the University of Chicago (1945–1957), where he Following his tenure in Chicago, Rogers spent
developed one of the major centers in the world for another 6 years at the University of Wisconsin
training and research in the field. There, his before leaving academia in 1963. Rather than rest
nondirective approach gradually evolved into the on his laurels, he spent the next quarter-century
“client-centered” approach to counseling and psy- applying what he came to call the “person-centered
chotherapy. Rogers argued and demonstrated approach” to an ever-widening circle of applications
through personal example and extensive research in other fields. In Freedom to Learn, with examples
that certain conditions were both “necessary and and case studies, he showed how teachers could
sufficient” for psychotherapeutic change in clients. adapt the three core conditions of (1) empathy
Among these were the three “core conditions” of (understanding), (2) unconditional positive regard
therapist empathy, unconditional positive regard, (trust), and (3) congruence (genuineness) to become
and congruence. Empathy was the deep and sensi- “facilitators of learning,” unleashing students’
tive understanding of the client’s thoughts, feelings, intrinsic motivation, productivity, and creativity. In
and meanings, which was primarily achieved through Becoming Partners: Marriage and Its Alternatives,
the kind of active listening that Rogers came to again through examples and case studies, he
embody through widely distributed audio and video explored how realness and open communication
recordings. Unconditional positive regard was the could help couples enrich their relationships,
therapist’s complete acceptance of the client as he or whether traditional or unconventional. In Man and
she is, without judgment or imposing “conditions of the Science of Man, including transcript excerpts
worth” on the client. Congruence was the therapists’ from a conference Rogers and colleagues held on
genuineness and authenticity in the relationship— the topic, he applied the principles of humanistic
coming across as a real and caring person rather psychology to the study of the behavioral sciences.
than playing a professional role. Rogers argued that One of the major applications of the person-
when these conditions in the therapeutic relation- centered approach that Rogers helped develop and
ship were present and clients perceived them, then disseminate was the intensive small-group experi-
therapeutic progress was inevitable. ence known as the “encounter group.” In these
For the voluminous research that Rogers and groups, facilitated by a leader embodying the core
his associates did to demonstrate these proposi- conditions of empathy, positive regard, and con-
tions, he received the first of the American gruence, participants learn to lower their facades
Psychological Association’s Distinguished Scientific and defenses and communicate more deeply and
Contribution Awards. In the 1960s and 1970s, authentically with others. Rogers conducted scores
Rogers was also active, along with Gordon Allport, of encounter groups with diverse populations,
Abraham Maslow, and others, in developing and from business executives to educators. He and his
popularizing what Maslow called the “third force” colleagues then went on to produce similar results
in psychology, after psychoanalysis and behavior- in person-centered communities with much larger
ism. “Humanistic psychology” emphasized human numbers of participants. Although the process was
potential and wellness instead of illness, honored more volatile in the larger groups, with more emo-
the phenomenological or inner world of the client, tion, conflict, and leadership struggles, the benefits
and focused holistically on the biological, psycho- of the egalitarian person-centered approach were
logical, social, and spiritual dimensions of human consistently reaffirmed.
experience. As Sigmund Freud was to psychoanal- The person-centered approach has sometimes
ysis and B. F. Skinner was to behaviorism, Carl been criticized as individualistic; less relevant to

898 Rolfing
non-Western, collectivist cultures; and neutral to, Rogers, C. R. (1969). Freedom to learn: A view of what
or even dismissive of, the client’s social and political education might become. Columbus, OH: Charles
context. These critics are usually unfamiliar with Merrill. (New editions in 1983 and 1994)
the past 20 years of Rogers’s career, in which, not Rogers, C. R. (1977). Carl Rogers on personal power.
content with personal growth as an outcome of New York, NY: Delacorte.
encounter groups or person-centered communities, Rogers, C. R. (1980). A way of being. Boston, MA:
Rogers worked extensively with non-Western audi- Houghton Mifflin.
ences in traditional societies and applied the per- Rogers, C. R., & Dymond, R. (1954). Psychotherapy and
personality change. Chicago, IL: University of Chicago.
son-centered approach to cross-cultural communi-
cation, intergroup conflict resolution, and even
international peacekeeping. He and his team went
around the world conducting successful small and
large groups, for example, with Catholics and ROLFING
Protestants from strife-torn Northern Ireland,
blacks and whites in South Africa under apartheid, Rolfing, also known as Rolfing Structural
and the protagonists in the Central American war Integration, is a complementary treatment using
between the Contras and Sandinistas. For this physical manipulation to treat physical and
work, he was nominated for the Nobel Peace Prize psychological concerns. Rolfing is a unique, sys-
a month before his death. Arguably, no other the- tematic method of bodywork that releases blocked
ory of counseling and psychotherapy has been or congested tissue areas in the body. It is designed
applied so explicitly in the community and the to bring the client’s body into a nimble and
wider world. well-balanced relationship within itself and gravity.
Rogers’s theory and practice have also been
criticized as naive, superficial, and unworkable
Historical Context
with populations with serious mental health diag-
noses. Apart from Rogers and colleagues’ own Rolfing, developed in the 1930s and named after
research to the contrary, ironically the latest gen- the biochemist Ida Rolf (1896–1979), was origi-
eration of process and outcome research on a wide nally called Postural Release and then became
variety of therapy approaches appears to be vali- known as Structural Integration. Based on ideas
dating much of Rogers’s theory regarding the cen- from biochemistry, Yoga, osteopathy, bodywork,
trality of the therapeutic relationship to successful and other related postural training and movement
counseling and psychotherapy. therapies, Rolfing focuses on hands-on manipula-
tion of a client’s fasciae, which are fibrous connec-
Howard Kirschenbaum tive tissues that encapsulate muscles, blood vessels,
and nerves. Manipulating the soft tissues, Rolf
See also Emotion-Focused Therapy; Existential-
Humanistic Therapies: Overview; Focusing-Oriented
theorized, improves alignment (symmetry) of the
Therapy; Freud, Sigmund; Maslow, Abraham; Person- body, resulting in multiple physical and psycho-
Centered Counseling; Skinner, B. F. logical benefits. Although outcome research is
limited on Rolfing, this treatment is a popular
alternative therapy for an assortment of health
Further Readings concerns.
Kirschenbaum, H. (2009). The life and work of Carl Because Rolf had extensive experience in bio-
Rogers. Alexandria, VA: American Counseling chemistry and physics, she researched the myofas-
Association. (UK edition: PCCS Books, 2007) cial system, and her resulting theory has been
Kirschenbaum, H., & Henderson, V. (Eds.). (1989). The considered as the connector therapy between chi-
Carl Rogers reader. Boston, MA: Houghton Mifflin. ropractics and massage. Her theory allows for
Rogers, C. R. (1951). Client-centered therapy: Its current emotional release to occur with physical release.
practice, implications and theory. Boston, MA: Although Rolfing is seen as a somewhat painful
Houghton Mifflin. process, it has evolved to a more gentle manipulation
Rogers, C. R. (1961). On becoming a person. Boston, with much less pain. It became somewhat popular
MA: Houghton Mifflin. during the 1970s and has recently seen a resurgence.

Rolfing 899
Today, the Rolf Institute of Structural Integration Major Concepts

is the only accreditation and credentialing body.
Even though the application of Rolfing begins with
There are two paths to credentialing. Individuals
the three main principles, it helps clients learn
can become certified through the institute by com-
about themselves physically and emotionally. The
pleting a 12- to 18-month training program,
Rolfer uses these principles to assist clients to
although those who have experience in bodywork
increase the efficiency of muscle use.
can go through an accelerated program. A Rolfing
practitioner, or Rolfer, must receive 18 days of
training from 3 to 7 years to qualify to become an Principle 1: Human Beings Are Physically out of
Advanced Rolfer. Advanced Rolfers learn how to Alignment With the Earth’s Gravity
work outside the usual 10-session format. The human fasciae help make up the human
form through the support of muscle groups and
Theoretical Underpinnings are the organ of form. The fasciae are connective
tissues that encapsulate muscles, blood vessels,
Rolf researched the impact of earth’s gravity on the and nerves. Fasciae separate and organize groups
human body. She theorized that people hold their of muscles. They help these muscles, if required
bodies in abnormal ways due to injury, emotional by body physiology, to touch and to move with
stress, and gravity. Furthermore, Rolf believed that minimal friction. Rolfers in training learn to
a human might face potential injuries, which, visualize physical blocks that must be aligned as
although small, can affect the body throughout the symmetrically as possible. To envision proper
life span. For example, if a person falls while riding alignment, Rolf describes a vertical line that
a bicycle, small injuries may occur. These injuries, aligns the ear, shoulder, hip, knee, and ankle. The
such as a strain, sprain, or tear that occurs in a Rolfer manipulates the client’s fasciae to be sym-
muscle or joint, may not be visible except for metrical, which may lead to a defined center of
minor swelling or inflammation. Although the balance.
injury may not be visible, the injured bicyclist may
compensate for the pain by limping and may con-
tinue to limp as a part of functioning with constant Principle 2: Humans Have Improved Function
pain. When Aligned With Gravitational Fields
In addition to physical traumas, Rolf theorized Gravity is the force to be coped with physiolog-
that a person might also carry emotional and ically. Minimal changes in the environment may
psychological trauma physically, resulting in psy- change how the body interacts with gravity. Over
chosomatic or psychogenic problems. Anecdotal time, the body adjusts to anatomical defects and
evidence suggests that treating fibromyalgia balance issues. Gravity causes the spine to com-
(though not always psychosomatic) patients using press and shrink as a person ages, which is appar-
Rolfing assists in management of pain and eases ent in elderly people. Rolfing is used to realign the
physical and psychological symptoms. body from the ground up, like balancing blocks
Referred to as the Rolfing Cycle, the therapy one on top of the other. The body’s center of grav-
requires 10 one-hour sessions, which are based on ity is rebuilt, starting with the feet. Successfully
three principles: coping with gravity may ensure better posture,
according to this principle.
1. Human beings are physically out of alignment
with the earth’s gravity.
Principle 3: The Human Body Has Plasticity,
2. Humans have improved function when aligned Through Soft Tissues, Which May Be Aligned
with gravitational fields. With Gravity
3. The human body has a sort of plasticity, through All muscles are wrapped in fasciae, which hold
soft tissues, which may be aligned with gravity. the muscles together and help muscles, muscles
The tightening of the soft tissues due to human systems, and body organs rub against each other
adaptation to gravity, pain, and stress negatively without causing trauma. Human fasciae are pli-
affects the human musculoskeletal system. able, similar to the elasticity of plastic, but as with

900 Rolfing
plastic, they may stiffen over time. The tightening Session 3: Hips and Shoulders
of the soft tissues due to human adaptation to
With more pliability of the soft tissues from the
gravity, pain, and stress negatively affects the
hips to the shoulders, the client experiences
human musculoskeletal system. By applying energy
smoother muscle movements between the hips and
and touch, the soft tissues may be released (to
neck. The Rolfer manipulates the front part of the
become pliable), which promotes anatomical and
hips, stomach, and chest aligning the thorax. This
physiological alignment. The plasticity of the fascia
session incorporates breathing, balance, and
is theorized to be pliable at any age, which makes
the release of stiffened soft tissues.
Rolfing a treatment for clients of most ages.
Rolfing can be practiced on most clients to
improve posture, increase range of movement, and Core
enhance quality of life. Session 4: Balancing the Hips and Legs
These muscle groups associated with the hips
Techniques and legs are the largest in the body and carry the
most body weight. These muscle groups are the core
The goal of the Rolfing Cycle is to make the of balance and are dependent on the symmetry and
client’s physiological structure symmetrical. alignment of the feet, ankles, and knees. Manipulation
Rolfing first loosens the superficial fascia before of the hips and legs improves range of motion and
working deeper areas. Improving support in the balance and gives an overall healthy feeling.
feet and legs before working the higher structures
helps clients benefit from freer movement in daily Session 5: Abdominal Wall
activities. Rolfing helps a client to feel more effi-
cient and to be more organized and more coordi- This session aims to balance the soft tissues
nated, with better posture. Rolfing requires a client spanning the front part of the pelvis and lower
to complete 10 one-hour sessions to gain the most back by increasing pliability from left to right and
benefit. The first 3 sessions are referred to as from the surface to deeper within. As the deeper
“sleeve” sessions, the 4th through 7th sessions are pelvic and abdominal restrictions are freed, the
called “core” sessions, and the 8th through 10th shifts in the fascia increase and lead to a supportive
sessions are “integration.” and balanced horizontal position.
Session 6: Heel to Midback

Sleeve
The deep muscles of the back and hips are
Session 1: Building Rapport and
lengthened, which complements the change that
Efficient Breathing
was achieved in the front of the body in Session 5.
The Rolfer aims to increase the pliability of the The Rolfer starts with the legs, and works on the
soft tissues on the front of the body around the calves, hamstrings, and pelvis, and up both sides of
ribs, which may allow for better movement, releas- the spine, which establishes more freedom of
ing the diaphragm to work more efficiently. Better movement and resilience in the spine.
breathing allows more oxygen for muscles, which
produces better overall movement. The Rolfer Session 7: Head and Neck
manipulates the front of the hips, thighs, and rib
As the Rolfer works with the neck, cranium,
cage area, as well as the front and sides of the
and face, the rhythms of cranial movement become
shoulders.
balanced.
Session 2: Body Support
Integration
The Rolfer aims to soften the tissues of
Session 8: Hands, Wrists, Elbows, and Arms
the lower leg to more efficiently carry the weight
of the body. Working from the bottom and moving Manipulation increases biomechanical flow
up helps the client’s feet, ankles, and knees support between the upper extremities and the spine.
the body more efficiently, resisting gravity. The Rolfer focuses on the upper body parts, and

Rubenfeld Synergy 901
incorporates the body parts with the rib cage, See also Body-Oriented Therapies: Overview; Core
shoulders, arms, and neck and head. Energetics; Integrative Body Psychotherapy; Postural
Integration; Yoga Movement Therapy
Session 9: Lower Extremities Through
Hips and Pelvis
Further Readings
This session increases biomechanical flow
Anisman, H. (2014). An introduction to stress and health.
between the lower extremities and the spine. It is
Thousand Oaks, CA: Sage.
often during a lower-body session that the Rolfer
Anson, B. (1998). Rolfing: Stories of personal
integrates the legs with higher structures in the empowerment. Berkeley, CA: North America Books.
body. This session creates better lower-body Brecklinghaus, H. G. (2002). Rolfing structural
integration and support for the upper body. integration. What it achieves, how it works and whom
it helps. Freiburg im Breisgau, Germany: Lebenshaus
Session 10: Biomechanical Flow Through Verlag.
Extremities, Shoulder, and Pelvic Girdles to Spine
Joshi, V. (2005). Stress: From burnout to balance.
In this session, the Rolfer increases the overall Thousand Oaks, CA: Sage.
uniformity of muscle tone. Session 10 is custom- Karrasch, N. (2009). Meet your body: A Rolfer’s guide to
ized to each client’s body needs and is the final release bodymindcore trauma. Philadelphia, PA:
integration of the 10 sessions. The Rolfer involves Jessica Kingsley.
the whole body in this session. Karrasch, N. (2012). Freeing emotions and energy
through myofacial release. Philadelphia, PA: Jessica
Kingsley.
Therapeutic Process
Rolf, I. P. (1990). Rolfing and physical reality. Rochester,
When a Rolfer meets with a client seeking therapy VT: Healing Arts Press.
for bodily pain and discomfort, the Rolfer first
asks questions about possible injury and then aims
at organizing and ordering the body. The Rolfer
uses the body’s theoretical, ideal disposition to ROLLNICK, STEVE
physically organize a client’s supporting structures.
The client commits to participating in a series of See Miller, William R.
10 hour-long sessions, which are based on the
three principles previously mentioned. Clients have
reported feeling an emotional release following
sessions, leading to a more content psychological RUBENFELD SYNERGY
state. When the client feels content, he or she may
be more amenable to counseling; also, when the
client does not feel emotional pain, he or she can Rubenfeld Synergy, or the Rubenfeld Synergy
work better on problems relating to psychological Method (RSM), is an alternative therapy that con-
issues such as depression and anxiety. sists of a combination of talk and touch. The word
A counselor could integrate Rolfing into the synergy refers to the increased effectiveness of an
therapeutic process by partnering with a Rolfer to intervention when it is combined with an addi-
increase the physical reactions a person may have tional intervention. RSM is based on the premise
to a psychological stimulus. Through connecting of a holistic mind, body, and spirit connection and
to the physical manifestations of psychological the premise that emotions can unconsciously be
issues, a client may be better able to identify when stored as energies in the physical body. For exam-
his or her mind affects physical health, resulting in ple, situational or emotional life stressors may
better management of overall well-being. show up later as aches and pains, fatigue, or a
Additionally, a counselor could refer a client to a general apathy or disconnection. The method
Rolfer when physical pain is blocking the counsel- blends simple movement and body awareness
ing process. interventions with Gestalt therapy techniques,
which include experiential or here-and-now coun-
Charles Crews and Janet Froeschle seling interventions that are used to explore

902 Rubenfeld Synergy
feelings and thoughts. RSM supports the idea that requirements and supervised internships) to ensure
an awareness of stress in the body, combined with quality control of the method. There is also an
targeted gentle touch, compassionate listening, and ethical code titled the Standards of Practice and
the talking through of emotions, is a healing and Ethical Principles for Certified Rubenfeld
restorative process that can reduce both physical Synergists, which emphasizes the consensual
and emotional pain. RSM was created by Ilana boundaries of talk and touch interventions and the
Rubenfeld in the United States in the late 1970s importance of collaboration between the synergist
and has grown to include a full training program and the client.
that has graduated over 400 Certified Rubenfeld
Synergists in the United States, Canada, Great
Historical Context
Britain, Australia, and Bermuda.
RSM is appropriate for clients of all ages who Ilana Rubenfeld was born in Tel Aviv, Israel, and
are able to effectively verbalize emotions and has resided there before immigrating to New York at
been used to treat a variety of physical and mental the age of 5 years. Her parents, Bluma and
health concerns. In a typical session, the client Leopold, were both of Russian Jewish descent and
remains fully clothed and is asked to lie on a fled their home country during the Russian
padded table or sit in a comfortable chair. The Revolution. Rubenfeld’s father was a classically
synergist begins by introducing gentle touch to the trained pianist who instilled a love for music and
client’s body. The client is an active participant in art in his daughter, who took up the viola at a
the therapy, and the synergist always follows the young age. Later, Rubenfeld attended both the
lead of the client. As the client becomes aware of Manhattan School of Music and Julliard, where
bodily sensations such as pain or tightness, the cli- she studied to become a conductor. Long hours of
ent verbally describes these feelings to the syner- both playing and conducting led to significant
gist. RSM assumes that the body stores memories back problems and muscle spasms, but Rubenfeld
and messages that may not be realized without found limited relief from medical interventions.
touch, and the method is designed to increase She then turned to the F. M. Alexander technique
awareness between the body, mind, and spirit by (explained in detail in the following section) to
sharing messages aloud with the synergist. The correct her posture and reduce her chronic pain.
synergist will touch pained areas, make careful When touched by the therapist, Rubenfeld experi-
movements of the body, and verbally offer reflec- enced a deep emotional reaction. She wanted to
tions and support. Sessions generally last between talk about the feelings and memories that arose
45 and 50 minutes, but the frequency and duration with the physical therapist, but the therapist was
of treatment vary for each client. unable to assist her in a talk therapy process.
Research on RSM is sparse, and there is no Rubenfeld next visited a talk therapist, only to find
direct evidence-based support for the effectiveness that she longed for the comforting touch that had
of this treatment modality. However, when com- evoked her emotions in the first place. In the
pared with traditional talk therapy and other types 1970s, no combination of talk and touch existed,
of bodywork alone, a combination of talk and so Rubenfeld created RSM to address the need for
touch therapies (as in RSM) has been shown to a more holistic integration of therapies.
have longer lasting impacts on physical pain reduc-
tion than any single intervention. Emotional ben-
efits may include the relief of stress, improved
self-esteem, and reduced anxiety and depression. In RSM was born from a pairing of the F. M.
addition, testimonials from clients who have par- Alexander technique of movement and sensory
ticipated in RSM have been quite favorable, espe- awareness with Gestalt therapy techniques from
cially from those who were disappointed by more Fritz and Laura Perls’s counseling theory, to
traditional counseling, bodywork, or medical address Rubenfeld’s desire for a mind–body–spirit
interventions. The Rubenfeld Synergy Training connection in healing practices. Later, the
Institute provides a rigorous training program Feldenkrais method was added to blend nervous
(including more than 4 years of educational system training and motor skills exercises.

Rubenfeld Synergy 903
The Alexander technique was created by body aches, the mind will not rest. One must
Frederick Matthias Alexander (1869–1955), a integrate and treat the whole person to resolve
Shakespearean actor who frequently lost his voice mental and physical issues. Therefore, a combina-
with no apparent medical cause. He developed a tion of treatment modalities, such as talk and
somatic method to improve body movements and touch, is more effective than any one method alone.
mental functioning, which was found to improve
breathing and reduce back pain. The technique
Touch Therapy
corrects muscular and skeletal strain by reteaching
individuals to perform physical tasks with a more Touch is a nonverbal form of communication
appropriate posture. Teachers of the Alexander that can find emotional messages in the body that
technique often demonstrate it with hands-on are unconscious to the mind. Touch therapy has
coaching, which is what first helped Rubenfeld to been utilized for centuries and has been shown to
identify her own body sensations and to react emo- be effective in treating many mental and physical
tionally. health issues. Trained Rubenfeld synergists can feel
Gestalt therapy techniques, popularized by Fritz the quality of the client’s energy by using “listening
and Laura Perls in the 1950s and 1960s, are based hands” and identify physical areas of concern to
in existential and experiential theory. Gestalt ther- the client. Each individual’s body tells a unique
apy focuses heavily on the present, here-and-now story that can be brought to awareness through
experience and the relationship between the coun- touch.
selor and the client to create awareness of psycho-
logical roadblocks that may inhibit a desired state
Present-Focused Change
of being. Rubenfeld became a student of Fritz and
Laura Perls in the early 1970s and found that this Change can only occur in the present moment,
method of therapy added a psychotherapeutic so RSM sessions utilize present-focused talk and
structure to the emotional processing component experiential therapy. Negative memories of the
of the theory that later became RSM. past can be managed by reliving the experience in
Finally, the Feldenkrais Method was developed the present through both the mind and the body.
by Moshé Feldenkrais (1904–1984). Often used by Simultaneous feeling and processing is essential
performers and athletes, this method combines to the effectiveness of this method. The client
Awareness Through Movement exercises, to holds the responsibility to create change in his or
increase the individual’s range of motion through her life through self-healing and self-regulation,
exploring the relationship between body posture and the synergist is there to support and encour-
and structure, with Functional Integration, which age this change.
promotes kinesthetic communication through gen-
tle touching and physical manipulation of the
Techniques
affected areas by a trained therapist. When
Rubenfeld met and trained under Feldenkrais, A combination of techniques are used in RSM,
gentle touch and a listening hand became signifi- including forming a collaborative relationship,
cant tenets of RSM. gentle touch, reflection of feeling and content,
here-and-now techniques, and appropriate use of
humor.
Major Concepts
RSM has several major concepts relevant to the
Forming a Collaborative Relationship
method, including holistic health, touch therapy,
and present-focused change. RSM requires a respectful, consensual, and col-
laborative relationship in which the client is both
active and directive. The client is responsible for
Holistic Health
communicating sensations to the synergist and
The mind, body, spirit, and emotions are con- identifying areas of pain, tension, or stress. RSM
nected and inseparable. For example, when the acknowledges that every individual is unique and

904 Rubenfeld Synergy
different clients will prefer different styles of touch, Therapeutic Process

verbal interaction, and movement. The synergist
The therapeutic process of RSM is unique for every
follows the client’s lead and openly provides feed-
client. However, early sessions focus on building a
back as needed.
therapeutic alliance and collaborative relationship.
Clients are educated about RSM, holistic health,
Gentle Touch touch therapy, and present-centered change prior to
Touching in RSM begins sparingly and slowly the first therapeutic session with touch. The next
to give the client time to process feelings and sessions focus on processing emotions and sensa-
memories about prior touch. Using the “Butterfly tions that are found in the body through the use of
Touch” theory, very light touching is recommended gentle touching, here-and-now techniques, an
to initially begin a sensory awakening in the hands appropriate use of humor, reexperiencing and
or feet. Increased contact, body movement, and restorying of memories, and imagining a future
massage follow only as the client feels comfortable. without pain or tension. The goal of each session is
Then, the synergist communicates the intention of to bring about a sense of complete relaxation and a
the touch and perceived sensations. connection of mind, body, spirit, and emotion.
Between sessions, the synergist may encourage the
client to practice some of the touching and cogni-
Reflection of Feeling and Content tive techniques. As the client’s insight increases
Repeating the direct words or phrases that a cli- regarding his or her emotions and body sensations,
ent says, sometimes with a change in inflection or the client becomes better prepared to make life
emphasis, or interpreting and restating the mean- changes. Outcomes may include reduced anxiety
ing or feeling derived from the client’s words is and depression, increased self-esteem, a sense of
another integral technique of RSM. By using active empowerment, an uplifted spirit, and increased life
listening and accurate reflection, the synergist cre- satisfaction. Due to the highly individualized nature
ates an environment in which the client feels of RSM, there is no specified length of treatment or
respected and appreciated. recommended number of sessions to achieve prog-
ress or satisfaction from the method.
Here-and-Now Techniques Katherine A. Heimsch
Derived from Gestalt therapy, many different
See also Alexander Technique; Feldenkrais Method;
here-and-now techniques are introduced for the Gestalt Therapy
client to process emotions and bodily sensations.
These may include cognitive, behavioral, or physi-
cal interventions to induce relaxation. Further Readings
Medina, L. L., & Montgomery, M. J. (2012). Touch
Humor therapy combined with talk therapy: The Rubenfeld
Synergy Method®. Body, Movement and Dance in
While messages and memories of pain and Psychotherapy: An International Journal for Theory,
stress can be stored in the body, so can those of Research and Practice, 7, 71–79. doi:10.1080/174329
happiness and love. The appropriate use of 79.2011.622788
humor—not sarcasm—is a tool to find and iden- Rubenfeld, I. (2001). The listening hand: Self-healing
tify feelings of pleasure and induce laughter. through The Rubenfeld Synergy Method of talk and
Balancing difficult emotions with positive ones touch. New York, NY: Bantam.
can interrupt self-destructive habits of storing Rubenfeld Synergy. (2013). Befriend your body:
anger and tension to make way for new coping Transform your life. Retrieved from http://www
mechanisms. .rubenfeldsynergy.com/

S
Mental Research Institute in Palo Alto. Others at
SATIR, VIRGINIA the institute at the time included Gregory Bateson,
Jay Haley, Robert Spitzer, and Paul Watzlavick,
Virginia Satir (1916–1988), one of the pioneers of who were working on a communication theory
family therapy, developed a systemic and positively involving schizophrenia. As she worked with
directional model that has been identified by Bateson and Jackson, she simplified their commu-
names such as communication theory of couples nication concepts into two different levels of
and family therapy, the human validation process congruent and incongruent communication. For
model, and transformational systemic therapy. example, when verbal and nonverbal communica-
Satir has been identified among practitioners in tions were in harmony, she considered them con-
counseling, social work, and psychology as one of gruent. If not, she considered the communications
the most influential figures in psychotherapy over incongruent. She identified four universal patterns
the past 25 years. of incongruent communication: (1) placating,
Satir was born Virginia Pagenkopf on a farm in (2) blaming, (3) computing (superreasonable), and
Neillsville, Wisconsin, on June 26, 1916. At the age (4) distracting (irrelevant).
of 20, she began her professional career as a class- Satir’s identification of congruent and incongru-
room teacher. As a teacher, she was curious and ent communication formed the first stage of her
touched by the many difficulties the children were theoretical perspective. Many therapists still refer
bringing to school beyond their learning focus. She to Satir’s incongruent communication pattern as
felt that there must be ways to understand and her main contribution to family therapy. After her
deal with the many problems these children faced. work at MRI, Satir moved to Esalen, a human
As a result, she decided to go into social work, and potential center in Big Sur, California, where she
in 1941, she started her Master of Social Work became the director of training. While there, she
degree at the University of Chicago. was encouraged and supported by Carl Rogers and
In 1951, she married Norman Satir and became Abraham Maslow to include the family as part of
known as Virginia Satir. Her early professional the counseling process and to shift full blame away
clinical practice was at the Chicago Home for Girls from parents as the cause of their children’s mental
and at the Institute for Juvenile Research in illness. She moved away from problem-focused
Chicago. During the late 1950s, she worked with therapy to a more resource-focused practice. Her
the psychiatrist Harold Visotsky to develop her process at that time became known as the human
first family therapy training program at the Illinois validation process model. This model was viewed
State Psychiatric Institute of Chicago. and practiced as a positive belief system of valida-
In 1959, she moved to California and joined tion, with less focus on resolving the negative
Don Jackson and Jules Riskin to establish the impacts of the past and the present.
905

906 Satir, Virginia
Satir then focused her work on emphasizing growth, rather than on pathologizing or problem
change and growth. She used the metaphor of an solving. Satir’s model is also change focused, with
iceberg to demonstrate the different components in particular attention paid to transformational
an individual that could either hinder change or change. Questions asked throughout the therapy
provide areas for therapeutic growth. According to session are change related and give the client an
Satir, change needed to include behavior, feelings, opportunity to explore uncharted waters inside the
perceptions (often called cognition), expectations, client’s own intrapsychic system.
and yearnings. Change therapy thus involved Finally, as previously mentioned, the congru-
changing many internal and interactive blocks that ence of the therapist is essential for clients to access
kept people from becoming more congruent. their own spiritual Life Energy. When therapists
The next component of Satir’s approach devel- are congruent, clients experience them as caring,
oped out of her own personal appreciation of accepting, hopeful, interested, genuine, authentic,
spirituality, cultivated at an early age as she and actively engaged. In addition, therapists’ use of
observed the life force of nature while growing up their own creative Life Energy in the form of meta-
on a dairy farm in Wisconsin. This element, called phor, humor, self-disclosure, sculpting, and many
transformational change, has, at its base, a deeply other creative interventions also comes from the
spiritual core. Satir believed that all people can connection they have to their own spiritual Self
access, experience, and live from this spiritual Life when in a congruent state. This connection to Life
Energy and that doing so can be helpful to psycho- Energy also allows the therapist to access his or her
logical well-being. intuitive wisdom, which opens the door to many
The five essential elements for this transforma- positive possibilities.
tional change consist of therapy that is experien- In addition to these principles of transforma-
tial, systematic, positively directional, change tional change, Satir also identified four universal
focused, and includes the self of the therapist. metagoals as the basic underpinnings of her sys-
Counseling should be experiential in that the client tem. The first involves raising self-esteem to influ-
must experience the impact of a past event in the ence how a person experiences and judges himself
present. It is only when clients are experiencing or herself in the present. When a person has a high
both the negative energy of the impact and the sense of self-esteem, he or she is experiencing him-
positive energy of their Life Force in the now that self or herself positively through his or her spiritual
an energetic shift can take place. Life Energy, or Self. Second, clients are encouraged
Therapy must also be systematic in that it must to become choice makers. One’s choices are in the
work within the intrapsychic and interactive sys- direction of health, happiness, peace, and love, and
tems in which the client experiences his or her life. one feels empowered to choose wisely. Many cli-
The intrapsychic system includes the emotions, ents feel that they have no choice or are stuck in a
perceptions, expectations, yearnings, and spiritual dichotomous choice. Satir believed that there is
energy of the individual, all of which interact with always at least a third choice more in harmony
one another in a systemic manner. The interactive with Life Energy.
systems include the relationships, both past and Third, Satir believed that a goal of counseling is
present, that the person has experienced in his or for clients to become responsible. When one is liv-
her life and that are internalized. A change in one ing from the level of Self, one is conscious of one’s
affects the other. Transformational change is an internal experiences and is responsible for all feel-
energetic shift in the intrapsychic system, which ings, perceptions, expectations, and yearnings as
then changes the interactive systems. well as one’s behavior. Satir believed that our inter-
In the Satir model, counseling is positively direc- nal experiences belong to us and that we have
tional in that the therapist actively engages with the choice over them. When we become responsible
client to help reframe perceptions, generate possi- for our internal world, we experience the vastness
bilities, hear the positive message of universal of our Being and become responsible for our own
yearnings, and connect the client to his or her posi- growth toward becoming more fully human.
tive Life Energy. The focus is on health and possi- Finally, congruence is a deeply embedded con-
bilities, on appreciating resources and anticipating cept and goal of the Satir model. Congruence as a

Schema Therapy 907
metagoal implies that people can grow to be in The Satir approach to counseling continues to
harmony with their own Life Energy and to experi- develop, even after her untimely death in 1988, led
ence the peace, joy, love, and connection that exist by some of her close students and colleagues.
there. When one is more congruent, one is free
from negative experiences of the past as one is now John Banmen
living in the present at the level of being. Other
See also Human Validation Process Model; Systemic
ways of describing congruence might include being Family Therapy
integrated, real, genuine, or authentic; one is able
to accept and honor oneself, to accept and honor
the experience of others, and to accept and honor Further Readings
the context in which one is situated. There is an Banmen, J. (2006). Applications of the Satir growth
expectation in the Satir model that therapists have model. Wendell, NC: Virginia Satir Network.
attained a fairly high level of congruence in their Banmen, J. (2008). Satir transformational systemic
lives and can be congruent while working with therapy. Palo Alto, CA: Science and Behavior Books.
their clients. Satir, V. (1964). Conjoint family therapy (1st ed.). Palo
Although she stressed these core principles, Satir Alto, CA: Science and Behavior Books.
played down the focus on specific techniques. She Satir, V. (1967). Conjoint family therapy (Rev. ed.). Palo
was focused on activating and encouraging inter- Alto, CA: Science and Behavior Books.
nal growth and harmony to then connect with Satir, V. (1983). Conjoint family therapy (3rd Rev. expanded
others at the level of congruence. Her use of sculpt- ed.). Palo Alto, CA: Science and Behavior Books.
ing individuals in their incongruent communica- Satir, V. (1988). New peoplemaking. Palo Alto, CA:
tion stance and its relationship with others became Science and Behavior Books.
a helpful technique to let surface what was really Satir, V., & Baldwin, M. (1982). Satir step by step. Palo
happening with the clients. She suggested that the Alto, CA: Science and Behavior Books.
personal iceberg could be used to help clients Satir, V., Banmen, J., Gerber, J., & Gomori, M. (1991).
become personally aware and that the counseling The Satir model: Family therapy and beyond. Palo
relationship could bring hope and genuine accep- Alto, CA: Science and Behavior Books.
tance. She thus advocated a therapy consisting of Simon, R. (2007, March/April). Ten most influential
the following recommendations for therapists: therapists: The most influential therapists of the past
quarter century. Psychotherapy Networker, 68, 24–37.
1. Prepare yourself: be congruent, be in harmony

with your own life energy.
2. Make full, energetic contact with the client. SCHEMA THERAPY
3. Bring hope, love, caring, curiosity, acceptance,
and patience to each session. Schema therapy is an integration of several differ-
ent theories that were combined to treat chronic
4. Explore early on the hopes (positively psychological disorders such as depression, anxi-
directional) of the clients in coming to therapy. ety, eating disorders, as well as more severe person-
5. Explore how the problem was actually not the ality disorders. Healing of maladaptive schema, or
problem and how to meet yearning better. pervasive dysfunctional cognitive themes, is the
ultimate goal of schema therapy. For the client, the
6. Set some positively directional goals to work on. schema includes a set of memories, emotions,
bodily sensations, and cognitions; the healing
7. Work on changes at the feelings, perceptions,
involves techniques that target all of these areas
and expectations levels and more directly at the
and start with the initial schema assessment inven-
yearning level to help the individual and the
tory. This approach utilizes several theoretical
family system achieve a sense of harmony and
approaches to address dysfunctional patterns of
peace within, between, and among the members.
memories, emotions, cognitions (e.g., schemas),
8. Anchor changes in as many ways as possible. and behaviors that developed during childhood.

908 Schema Therapy
Historical Context degree. Young and colleagues have categorized

these schemas into different types as well as five
Developed by Jeffrey Young and colleagues in the
domains.
1990s, schema therapy was a response to a defi-
ciency in treating severe mental health disorders
formerly categorized under Axis I in the Diagnostic Domains of Treatment
and Statistical Manual, fourth edition, text revi- According to Young, these schemas can be bro-
sion. The concept of schema has been seen through- ken down into 18 different types, divided into five
out history, particularly by the stoic logician domains.
Chrysippus (ca 279–206), Kantian philosophy, and
cognitive developmental psychology. Within the Domain 1: Disconnection and Rejection
field of psychology, Jean Piaget’s childhood devel-
opmental theory is most closely identified with Clients in this category are unable to create
schema. Also, Aaron Beck utilized the concept of secure and satisfying attachments to others due to
schema in his cognitive therapy; however, the idea unstable, abusive, emotionally cold, and rejecting
was broader. Psychology and psychotherapy family relationships. The themes are abandon-
thought that schema was an organizing principle ment/instability, mistrust/abuse, emotional depri-
by which individuals made sense of their own life vation, defectiveness/shame, and social isolation/
experience. It was not until Young and colleagues alienation.
began thinking deeper, and writing about schema,
that it became a formalized modality of treatment. Domain 2: Impaired Autonomy and Performance
Clients in this category typically experience diffi-
culties separating from parental figures. The follow-
ing are the themes under this category: dependence/
The premise of schema therapy is that all human incompetence, vulnerability to harm or illness,
beings develop schemas (e.g., patterns of thinking) enmeshment/undeveloped self, and failure.
that originate from the person’s developmental life
experiences from childhood. Some of these frames Domain 3: Impaired Limits
of thinking can be healthy, while others can be
Clients in Domain 3 experience difficulties with
maladaptive and, hence, damaging. The theoretical
boundaries. Characteristics are as follows: diffi-
underpinning of schema originates from the cogni-
culty with keeping appointments, cooperating with
tive-behavioral, attachment, Gestalt, object rela-
others, and/or setting long-term goals. The themes
tions, constructivist, and psychoanalytical schools
are entitlement/grandiosity and insufficient self-
of thought.
control/self-discipline.
Major Concepts Domain 4: Other-Directedness
A major concept that drives schema therapy is that Clients in Domain 4 will meet the needs of oth-
these schemas may be maladaptive, and they are ers to the point of harm to self. In addition, the
categorized into five categories. However, a proper person with this schema often lacks awareness of
definition of schema should be articulated before his or her own anger. The intent behind other-
discussing the maladaptive categories. directedness behavior is to gain the approval of
others, maintain emotional connection, and/or
avoid retaliation. The following are the themes:
Schemas subjugation, self-sacrifice, and approval seeking/
Schemas are pervasive themes that develop in recognition seeking.
childhood and are related to one’s perception of
Domain 5: Overvigilance and Inhibition
self and others. They also comprise memories,
emotions, cognitions, and body sensations regard- Clients in this category suppress spontaneous
ing oneself as developed during childhood and/or feelings and impulses. They also attempt to meet
adolescence that are dysfunctional to a significant rigorous rules in their own performance at the

Schema Therapy 909
expense of happiness. Themes include self-expres- behavioral instructions to assist with countering
sion, relaxation, close relationships, and/or good the maladaptive schema
health. In addition, clients under this domain are
6. Filing out Schema Diary forms—when a schema
characterized by pessimism and worry. They often
is triggered, the client fills out the form to work
feel that their lives could fall apart if they are not
through the problem to arrive at a healthy
vigilant and careful at all times.
solution; clients identify the trigger events,
emotions, thoughts, behaviors, schemas, healthy
Techniques views, realistic concerns, overreactions, and
healthy behaviors being implemented
Replacing existing unhealthy schemas with healthy
ones is a crucial element of schema therapy. In
contrast to other theories, schema therapy has sev- Experiential Strategies
eral foundational theoretical underpinnings from Experiential techniques establish two goals for
therapeutic models such as attachment theory, the client: (1) to trigger the emotions or connection
developmental theory, family systems, neurobiol- to the early maladaptive schemas and (2) to repar-
ogy, and cognitive-behavioral, Gestalt, object rela- ent the client in order to heal these emotions and
tions, constructivist, and psychoanalytical theories. partially meet the client’s unmet childhood needs.
Cognitive strategies, along with experiential ones; With experiential techniques, clients can transition
behavioral pattern breaking; and the therapeutic from knowing the intellectual components of their
relationship itself are considered the foundation of therapy work to believing in them much deeper in
technique within schema therapy. their emotional core. Specific techniques such as
imagery and dialogues, relaxation techniques, and
Cognitive Strategies bodywork can assist clients in making the cogni-
tive-emotional connections. The rationale for
Cognitive strategies assist the client in articulat-
imagery work is threefold: (1) to identify those
ing a healthy voice to counter the schema, thus
schemas that are most central for the client, (2) to
strengthening the client’s healthy adult mode. Self-
enable clients to experience schemas on the affec-
awareness of the schemas is the first step often
tive level, and (3) to help clients link emotionally
achieved through the schema inventory. Therapists
the origins of their schemas in childhood and
assist the client in building a logical case against
adolescence with problems in their current lives.
the target schemas. Cognitive strategies assist cli-
ents to evaluate externally the veracity of the sche-
mas. The therapist validates the clients’ use of Therapeutic Process
schemas and coping styles as understandable given
their life history. Concurrently, the therapist Schema therapy is an integrated approach that can
reminds clients that these maladaptive ways of liv- last from a few sessions to many years. The thera-
ing assisted in their survival then but are no longer peutic relationship is the foundational component
healthy. of schema therapy necessary for client change.
Specific cognitive techniques include the following: Exploring the maladaptive schema inventory and
reflecting on the results is the next vital step within
the therapeutic process. There are two additional
1. Testing the reality of a schema
components of the therapeutic process within
2. Reframing the evidence supporting a schema schema therapy: (1) the therapist stance of
empathic confrontation and (2) the use of limited
3. Evaluating the advantages and disadvantages of
reparenting. The final stage of schema therapy
the client’s coping styles
focuses on continuing to explore the causes of the
4. Conducting dialogues between the “schema maladaptive schemas and implementation of
side” and the “healthy side” healthy adult cognitive-behavioral aspects while
working with the therapist toward interpersonal
5. Constructing schema flash cards, which consist success.
of client acknowledgment of the current feeling,
identification of the schema, reality testing, and Jason K. Neill and Candace M. McLain Tait

910 Self Psychology
See also Beck, Aaron T.; Cognitive-Behavioral Therapy; conflict and Self Pathology. Kohut characterized
Constructivist Therapy; Freudian Psychoanalysis; Gestalt this as the difference between the “guilty man”
Therapy; Object Relations Theory; Schema Therapy (conflict) and the “tragic man” (deficits). In addi-
tion, the paradigm informed a gradual shift in
Further Readings psychoanalytical technique from a stance that here-
tofore had embraced Freudian prescriptions of
Young, J. E. (2002). Schema-focused therapy for
abstinence and anonymity to a model that endorsed
personality disorders. In G. Simos (Ed.), Cognitive
behaviour therapy (pp. 201–222). New York, NY:
provision and the gratification of substantive devel-
Routledge.
opmental needs. This paradigm shift set the stage
Young, J. E., Arntz, A., Atkinson, T., Lobbestael, J., for the current emergence of relational and inter-
Weishaar, M. E., Van Vreeswijk, M., & Klokman, J. subjective approaches to psychoanalytic psycho-
(2007). The Schema Mode Inventory. New York, NY: therapy. Kohut introduced the concepts of the Self
Schema Therapy Institute. and the Self Object as foundational constructs for
Young, J. E., & Brown, G. (1994). Young Schema- his psychology. The Self is viewed as a reflection of
Questionnaire. In J. E. Young (Ed.), Cognitive therapy the content of the experiences of the mind but not
for personality disorders: A schema-focused approach as an agency or structure of the mind (id, ego, and
(Rev. ed., pp. 63–76). Sarasota, FL: Professional superego). The Self Object is an object that is expe-
Resource Press. rienced as part of the Self and represents a merger
Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). state. For Kohut, the Self represents the psyche’s
Schema therapy: A practitioner’s guide. New York, attempt to gain an internal coherence around
NY: Guilford Press. which relationships with the world and objects can
be organized. The Self is the product of the inter-
play with the Self Objects of childhood.
SCREAM THERAPY Historical Context

See Primal Therapy Kohut was a prominent figure in the American
Psychoanalytic Association and the Chicago
Institute of Psychoanalysis. His training defined
him as an ego psychologist, which was the pre-
SELF PSYCHOLOGY dominant American perspective in the 1940s and
1950s. His early interests included studies of the
Self Psychology represents a major paradigm shift effect of music on the psychic organization and
in psychoanalytical theorizing. Heinz Kohut, an structures. During the 1950s, Kohut began to feel
Austrian psychiatrist, came to Chicago in the 1940s some dissatisfaction with his psychoanalytical
and quickly embraced the ego psychological efforts. Many of his clients seemed to be unable to
approach dominating analytic thinking at that progress or would return for treatment after an
time. During the 1960s and 1970s, he and a small initial termination. Coupled with these experiences
group of associates at the Chicago Psychoanalytic were personal countertransference experiences
Institute worked in a study group to expand his during many treatments where he felt unappreci-
research on narcissistic conditions into a full- ated, taken for granted, and not respected as a
fledged psychology of the Self. This new approach separate individual. Unlike other therapists who
represented a challenge to the classical drive and might blame the client for these feelings, he asked
defense perspectives offered by Sigmund Freud and important questions about the efficacy of the cur-
the object relations theorists. It represented a sub- rent mode of psychoanalytical treatment. He won-
stantive shift from conflict psychology to one of dered whether it was the treatment that was not
deficit psychology. In highlighting how many cli- working, rather than the resistance of the client
ents suffer less from intrapsychic conflicts and more leading to unsatisfactory outcomes. These ques-
from the lack of necessary psychological structures, tions led Kohut to begin a series of studies on the
Kohut opened new doors to understanding both topic of empathy, which he eventually defined as

Self Psychology 911
an affect-neutral data-gathering tool and a form of While Kohut did not explicate a formal devel-
vicarious introspection. These studies led Kohut to opmental model, it has been extracted from his
eventually define the boundaries of psychoanalyti- writings. Kohut postulated that the infant is born
cal treatment as those experiences that were avail- in a state of primary narcissism and with a virtual
able to empathic resonance. self, which can be defined as a set of psychological
Additionally, Kohut had an increasing interest in tissues that evolve into a Self with the proper envi-
narcissism. After reviewing Freud’s classic 1915 ronmental responses. The event of birth, however,
article on the topic and investigating the psychologi- rapidly destabilizes the sense of narcissistic plea-
cal mergers associated with narcissistic disturbance, sure and security as postnatal life now places
he began a project to revise our basic understanding extraordinary burdens on the infant’s nascent psy-
of narcissistic states. Eventually, he posited narcis- chological organization. The infant has become a
sism as not just a pathological condition but a life- predator of its own desires coupled with the ubiq-
long normal line of development, separate from the uitous infant helplessness. To stabilize in this envi-
object relations line. ronment, the infant through omnipotent fantasy
Kohut believed that people never completely lose creates psychological mergers with its caretakers.
Self Object needs for admiration, and idealized Objects are felt to be part of the Self and not sepa-
object and soothing. For Kohut, a successful lifelong rate. It is not that a separate mother is feeding the
experience with Self Objects left a legacy in several infant; rather, the infant is feeding itself. Kohut
important capacities, including empathy, creativity, identified this relationship as a Self Object rela-
the ability to tolerate human impermanence, humor, tionship wherein the Self and the object area unite.
and wisdom. He referred to these capacities as This process helps stabilize the infant’s anxieties
acquisitions of the ego subsequent to successful nar- about helplessness.
cissistic development. This understanding allowed Self Objects fulfill many functions for the grow-
him to recast narcissistic mergers as necessary psy- ing infant. The two primary functions are mirroring
chological experiences for the client’s psychological and soothing. Mirroring is the process of admiring
unfolding. He rescued narcissistic needs from the and appreciating in a phase-appropriate manner
exclusive domain of psychopathology. the infant’s growing grandiose and exhibitionistic
attempts to master its body and its world. The sec-
ond primary function is that of soothing. This is
where the parental Self Object serves as an ideal-
The self-psychological perspective is an extension ized object and helps calm the anxieties associated
of the evolution of psychoanalytical treatment with developmental derailments and experiences of
from an intrapsychic perspective to a field or rela- failure and helplessness. Kohut suggested that, in a
tional perspective. This approach evolved primar- normal developmental track, the parental environ-
ily out of Kohut’s extensive inquiry into the ment provides optimal frustrations that do not
phenomenon of empathy coupled with his research overwhelm the child’s growing psyche, while at the
into narcissistic states. Kohut redefined the con- same time spurring growth. This might be considered
cept of narcissism and established it as a lifelong analogous to Jean Piaget’s concept of disequilib-
line of development, separate from the develop- rium as a necessary condition for progressing
ment of object relations. In conjunction with this through the stages of cognitive development.
research, he introduced the concept of the Self to When the child finds the Self Object failing in its
identify the internal structure in the psychic appa- function (and stimulating a premature sense of
ratus, which is separate from the Freudian triad of separateness), this is experienced as an empathic
id, ego, and superego. failure. “Good enough” parenting and Self Object
To understand the self-psychological approach functioning will lead the parent to re-attune with
to treatment, it is necessary to explore the theo- the child in its distress. At this point, the child
retical ideas underlying Kohut’s revised develop- begins to experience the functions associated with
mental theory of narcissism. Kohut did not find mirroring and soothing as qualities that it can
that Freud’s discussion of narcissism captured the internalize through a process Kohut termed trans-
complexity of his clinical experience. muting internalization. It is through a series of

912 Self Psychology
these experiences of failure, re-attunement, and Optimal Frustration

transmuting internalization that the child begins to
Optimal frustration refers to the subtraumatic
construct its nuclear self. This self thus contains
experiences of empathic failure experienced by
the abilities formerly only found in the parental
both the child during development and the client
Self Object.
during the course of treatment. It is considered
optimal in that the intensity of anxiety experienced
Major Concepts does not lead to protracted fragmented states in
the nuclear self.
Major concepts of Self Psychology include empa-
thy, Self, Self Object, and optimal frustration.
Additional concepts include primary and second- Primary Narcissism
ary narcissism and transmuting internalization.
Primary narcissism refers to the libidinal body–
ego focus of the neonate prior to the establishment
Empathy of object relations. It is the energy that is given to
From a Self Psychology perspective, empathy is objects and creates object love in lieu of self-love.
viewed as an investigative tool. It is affect neutral Some primary narcissism remains in the psyche.
and represents the process of vicarious identifica-
tion. Psychoanalytical treatment is limited to those Secondary Narcissism
things that are subject to empathy. A therapist’s
empathic capacity is the result of the intersection Secondary narcissism refers to the reinvestment
of developmental experiences, training, and con- of object love energies into the narcissistically
tinuous self reflection. internalized objects (in the ego) that have been lost
or have provided massive disappointment to the
client.
Self
The Self is defined as a bipolar structure con- Transmuting Internalization
taining the capacities, talents, skills, and ambitions
of the individual, accrued and structured through Transmuting internalization refers to the pro-
successive experiences of transmuting internaliza- cess of internalization of the psychological func-
tion. This structure then directs the individual’s tions experienced in the Self Object at the moments
actions, attitudes, and engagement with the object of re-attunement subsequent to an optimal and
world. It leads to a feeling of agency and center of nontraumatic empathic failure. What is internal-
action in the world. The cohesive Self reflects the ized is a set of functions (appreciation of strengths
resilient functioning structure, whereas the frag- and limitations and soothing) rather than the
mented Self represents states of disintegration sub- “good mother or good father” seen in object rela-
sequent to narcissistic injury. tions theory.
Self Object Techniques

“Self Object” refers to a unique psychological Techniques of Self Psychology include Self Object
merger that allows the child or client to view transference, bipolar transference, provision, nar-
objects in his or her environment as actual parts of cissistic rage, and Self Pathology.
himself or herself. Narcissistic transferences are
generally viewed as Self Object transferences. The
Self Object Transference
mirroring Self Object provides phase-appropriate
admiration and encouragement of the exhibitionis- Self object transference refers to the narcissistic
tic grandiose self. The idealized parental imago self transference established with the therapist in which
object provides an idealized and soothing function. the therapist is needed to fulfill Self Object needs,
The alter-ego Self Object reflects the establishment including mirroring, idealizing, and soothing. These
of latency phase relationship, where one needs the are viewed as developmental transferences, which
sense of being like the therapist. require the therapist’s active provision, as opposed

Self Psychology 913
to conflict transference, which deals with projec- permanent self fragmentation that is not amenable
tions and distortions from archaic object relations. to analytic treatment due to the client’s inability to
establish stable Self Object relations sufficient for
Bipolar Transference
structure building. Borderline disorders are also
included in the primary category and are viewed as
Bipolar transference refers to the oscillation encapsulated psychotic states with the same core
between Self Object and conflict-based transfer- of a fragmented self held together by rigid defenses.
ences in the therapy hour. When the Self Object This would also not be viewed as an analyzable
transference is interrupted by an empathic failure, condition. Narcissistic personality disorders are
the client organizes his or her experience around also primary and represent significant yet not per-
past conflicts and defenses. The therapist must rec- manent damage to the self. Self Object transfer-
ognize this and help the client both to engage these ences can develop in clients, and structure building
states of mind and to reestablish the Self Object can be the reconstruction of a coherent nuclear
transference. Self Object transferences are seen as self. The narcissistic behavioral disorder presents a
structure building, whereas conflict transferences unique problem in that the addictions and perver-
lead to structure modification. sions characteristic of these conditions keep the
requisite psychic pain at bay and prevent the full
Provision efficacy of psychoanalytical intervention. In these
situations, the addictions and perversions are inter-
In contrast to classical conflict-based theories dicted, which in turn cause the client to feel an
that prescribe an attitude of deprivation and frus- interiority of pain. In effect, the narcissistic behav-
tration of infantile needs, the Self Psychology ioral disorder is converted into a narcissistic
approach endorses a stance based in provision. personality disorder and is thus amenable to treat-
Acting on the belief that the classical approach of ment. Other forms of self disorders include the
withholding is a variation of retraumatization, Self empty self, which is characterized by a lack of
psychologists endorse a more flexible frame and vitality and mood disturbance; the overburdened
the provision of narcissistic supplies, including self, which is characterized by a lack of self-
mirroring and soothing, which were absent in the soothing capacity; and the overstimulated self,
client’s developmental years. which is characterized by hypomanic behaviors in
response to environmental failure.
Narcissistic Rage
Narcissistic rage refers to the sudden violent Therapeutic Process
rage experienced by clients who have significant
narcissistic vulnerability. It denotes a rapid internal The Self Psychology therapeutic approach can be
decompensation of the individual’s self state, and best captured in the phrase failure and repair. The
while seemingly an exaggeration of the identified job of the therapist is to listen empathically to the
empathic break, it must be approached with client’s material, recognizing that multiple levels of
humility and understanding as to the depth of communication are possible. These levels deter-
trauma being experienced. The therapist does not mine whether one is dealing with Self Object trans-
try to talk the client out of this fragile state but ferences (e.g., mirroring, idealized parental imago,
views it as an opportunity to re-attune in very and alter ego) or the conflict-based transferences
powerful ways. It can be distinguished from other identified by Freud, Melanie Klein, and others. The
forms of rage by its appeal to rationality, persis- concept of bipolar transference helps point out the
tence over time, and matrix in retaliation and ongoing oscillation between these transference
righting a wrong. constellations. The imperfection of the therapist is
sufficient to ensure periodic empathic failures. If
these failures are optimal, the therapist is able to
Self Pathology
reestablish an empathic connection with the client,
Self psychologists have identified a variety of setting up the conditions for the transmuting inter-
self disorders. Primary self disorders include psy- nalization of mirroring and soothing functions by
chosis, which is conceptualized as a protracted and the client. It is in the transmuting internalization of

914 Self-Help Groups
these functions that the client begins to build up a consist of peers who share similar mental, emo-
cohesive nuclear self. tional, or physical challenges or who are interested
If the empathic failures are experienced as in a focal issue such as education or parenting.
“traumatic” by the client, the client may experi- Most self-help groups are voluntary, nonprofit
ence a narcissistic rage. The therapist is cautioned associations open to anyone with similar needs or
to not confront or defend himself or herself at this interests, although sometimes, these groups may be
point but to explore what he or she has done to run by a mental health professional. Although the
“injure” the client. This empathic acknowledgment structure tends to be informal, the group under-
and curiosity help heal the breach and reestablish takes defined tasks. Group participation typically
the self object transference. is free of charge or low in cost.
Allen Bishop
Historical Context
See also Ego Psychology; Freud, Sigmund; Klein, Melanie;
Object Relations Theory
Formal support groups may appear to be a mod-
ern phenomenon, but they are actually an offshoot
of historical fraternal organizations such as
Further Readings Freemasonry, the origins of which date to the end
of the 14th century. Historically, people joined
Goldberg, A. (1984). Advances in self psychology.
together to enhance their chances for survival by
New York, NY: International Universities Press.
sharing their social and economic resources; how-
Kohut, H. (1959). Introspection, empathy and
psychoanalysis: An examination of the relationship
ever, contemporary groups are more likely to orga-
between mode of observation and theory. Journal of
nize around a theme or problem. Alcoholics
the American Psychoanalytic Association, 7, 459–483. Anonymous, one of the first contemporary self-
doi:10.1177/000306515900700304 help groups, was founded in 1935 by two alcohol-
Kohut, H. (1966). Forms and transformations of ics—a New York broker and an Ohio physician. At
narcissism. Journal of the American Psychoanalytic the time, the medical profession was perceived as
Association, 14, 243–272. doi:10.1177/ struggling to provide a cure to those battling alco-
000306516601400201 holism.
Kohut, H. (1971). The analysis of the self. New York, The importance of self-help groups was not
NY: International Universities Press. commonly recognized until well after World War
Kohut, H. (1972). Thoughts on narcissism and narcissistic II. During the 1960s and 1970s, self-help groups
rage. Psychoanalytic Study of the Child, 27, 360–400. began to spread in the United States. Alcoholics
Kohut, H. (1977). The restoration of the self. New York, Anonymous groups flourished worldwide, and the
NY: International Universities Press. self-help movement was growing in North America,
Kohut, H. (1984). How does analysis cure. Chicago, IL: empowering men and women to take charge of
University of Chicago Press. their lives. The self-help industry was taking shape.
Lessem, P. (2005). Self psychology: An introduction. Although the mental health professions struggled
Lanham, MD: Jason Aronson. with the legitimacy of self-help groups well into
St. Clair, M. (2003). Object relations and self psychology: the latter part of the 20th century, today, self-help
An introduction. Belmont, CA: Cengage Learning. groups are acknowledged by mental health profes-
Wolf, E. (1988). Treating the self: Elements of clinical self sionals, often used as an adjunct to therapy, and
psychology. New York, NY: Guilford Press.
sometimes run by counselors and therapists to
assist persons who have a focused and ongoing
problem with which they struggle. Today, books,
DVDs, audio tapes, life coaches, seminars, personal
SELF-HELP GROUPS trainers, mentors, and motivational speakers offer
self-help services; the self-help industry is worth as
Self-help groups, sometimes known as mutual-help much as $10 billion annually.
or support groups, are groups of people who pro- A few of the many examples of self-help groups
vide mutual support for one another. The members are groups for addictions, AIDS, Alzheimer’s disease,

Self-Help Groups 915
anxiety, breastfeeding, brain trauma, cancer, diabe- world. For instance, observing how someone has
tes, domestic violence, eating disorders, families of overcome his or her sexual addiction by listening
addicts, fibromyalgia, grief, infertility, miscarriage, to that person’s story and describing the behaviors
depression, Parkinson’s disease, postpartum depres- he or she used can be a model for an individual
sion, abuse survivors, stroke, and suicide prevention. who has just joined the group.
Some well-known self-help groups are Alcoholics Finally, although some people tend to distin-
Anonymous, Narcotics Anonymous, Al-Anon, and guish support groups and self-help groups, herein
Sex Addicts Anonymous. they are discussed as the same because they have a
common heritage and because their structure is
more similar than different. Whereas support
groups are more likely facilitated by a professional
Research on self-help groups suggests that there is counselor, self-help groups are more likely run by
no one particular theoretical viewpoint, although a peer paraprofessional.
many self-help groups have a cognitive, behavioral,
or social learning conceptual framework.
From a cognitive perspective, it is believed that Major Concepts
how we think determines our feelings and behav- Seven concepts that tend to be critical for self-help
iors. If people can change their interpretation and groups are providing support, imparting informa-
understanding, they can explore new thinking. tion, promoting stress reduction, providing an
Thus, the experience of being in a self-help group atmosphere of safety, offering a sense of belonging,
may help people reframe how they think and how communicating experiential knowledge, and teach-
they redefine their reality. For instance, a person ing coping methods. The concepts are explained in
who has struggled with self-esteem issues due to a the following subsections.
mental illness may make self-statements like “I am
worthless.” Self-help groups will often encourage
individuals to change their self-statements to posi- Providing Support
tive ones (“I am struggling with a mental illness, but The primary purpose of a self-help group is to
I am a good person”). Learning new self-statements share support. This is most often mentioned by
from others in a group can change a person’s out- members who are asked what their group does for
look and behaviors. them. Support appears to be the essential element
From a behavioral point of view, behavior is that defines a group’s success.
perceived as learning process; therefore, what has
been learned can be unlearned. Behavioral theory
focuses on observable behaviors and assumes that Imparting Information
people behave as they do because of repeated rein- Self-help and support groups provide an oppor-
forcement contingencies and punishments. In a tunity for group members to share information.
self-help group, group members can learn new Such groups depend on peer members exchanging
behaviors through discussions and bibliotherapy, information or on professionals providing infor-
try out new behaviors, and be reinforced for their mation. Information exchanges take place in for-
successes within the group. For instance, a person mal meetings and during informal gatherings
who has struggled with alcoholism can learn new before or after meetings.
strategies for stopping drinking, such as calling
one’s sponsor, seeking help from friends, and/or
Promoting Stress Reduction
attending meetings.
From a social learning perspective, it is sug- Taking part in a self-help group can promote
gested that people can learn new information and stress reduction because being a member of a
behaviors by observing other people (i.e., model- group of people who can relate to similar stressors
ing). Observing how others overcome adversity creates a sense of community and a feeling that one
can be a powerful motivator for individuals and is not alone in this world. This can reduce a per-
can offer group members new ways of living in the son’s feeling of tension and stress.

916 Self-Help Groups
Providing an Atmosphere of Safety Open-Ended Questions

Self-help groups provide a fundamentally safe An open question such as “Can you tell me
environment for group members, who describe this more about that” can keep the group conversation
sense of safety as unconditional acceptance by group moving and assist in probing deeper into the topics
members. Most people rely on families and close and feelings raised by group members.
friends for this sense of security, but sometimes seek-
ing safety outside one’s primary circle is beneficial. Active Listening
Offering a Sense of Belonging Active listening involves engaging and respond-

ing to the person who is sharing. This can be
Joining any group is a demonstration of affilia- demonstrated by expressed words or nonverbal
tion. As social beings, people like to feel that they actions that involve a clear sign that one is listen-
belong to a group. Self-help and support groups ing (e.g., nodding the head in agreement, making
offer opportunities for gaining a sense of belong- eye contact, and responding with good listening
ing, which can decrease the feeling of social isola- skills).
tion and create a community.
Reflecting
Communicating Experiential Knowledge
Reflecting encourages expanding on the topic,
Experiential knowledge is a person’s unique
adding an acknowledgment, or exploring feelings
lived experience conveyed by personal stories of
or unstated thoughts.
learning to cope and using the group’s support to
help manage one’s struggles. The process of com-
municating one’s experience in self-help and sup- Being Curious and Showing Interest
port groups helps facilitate personal growth. Curiosity and interest can help prompt further
disclosure and help a group member feel accepted.
Teaching Coping Methods
How one copes effectively with issues is a pro- Reframing
cess that involves learning new strategies to approach
one’s struggles. Group members seek to develop The skill of reframing offers an alternative
healthier methods for coping with their situations. way of looking at a situation, typically one that
The group setting provides an opportunity for is more constructive and positive. An alcoholic
members to learn and develop their life skills. who has had a “slip” might be told, “Okay, you
started drinking that one time, but that slip has
taught you some new triggers that you can avoid
Techniques in the future.”
A number of techniques are basic to building rap-
port and support in a group and to offering an envi- Being Open to Process
ronment of unconditional acceptance. These include
listening, open-ended questions, active listening, Being open to process involves listening, refram-
reflecting, being curious and showing interest, ing, and expanding what the person says. Attending
reframing, being open to process, and unconditional behaviors involve eye contact, posture, and verbal
acceptance. Although these skills are sometimes and nonverbal cues.
taught by a professional who may be running a
group, more often, they are learned as a by-product Unconditional Acceptance
of the group process.
This involves accepting others with their flaws
and problems. Although one may not like every-
Listening
thing a person does, one can understand how the
Being able to hear the feelings of others and the person has come to behave the way he or she does
content of what they are saying is crucial to the due to the problem that brought the person to the
basic skills needed in a self-help group. self-help group.

Self-Relations Psychotherapy 917
Therapeutic Process Psychotherapy Theories: Overview; Psychoeducational

Groups; Yalom, Irvin
Meeting formats for self-help groups are typically
loosely structured with a casual atmosphere. The
following activities are common to many group Further Readings
meetings and can be used as a guide for designing
Gartner, A., & Riessman, F. (1980). Help: A working guide
a self-help group. to self-help groups. New York, NY: New Viewpoints/
Vision Books.
Announcements Kurtz, L. F. (1997). Self-help and support groups.
Thousand Oaks, CA: Sage.
Any information about community or national Nichols, K., & Jenkinson, J. (2006). Leading a support
activities is shared with the self-help group. group: A practical guide. New York, NY: Open
University Press.
Leftover Feelings Powell, T., & Perron, B. E. (2010). Self-help groups and
mental health/substance use agencies: The benefits of
Any feelings (appreciation, resentments, fears, organizational exchange. Substance Use and Misuse,
etc.) or realizations from the previous meeting are 43, 315–329. doi:10.3109/10826080903443594
expressed to clear away old feelings and enable Remine, D., Rice, R. M., & Ross, J. (1984). Self-help
everyone to be present. groups and human services agencies: How they work
together. Fayetteville, NC: Family Services America.
Schopler, J. H., & Galinsky, M. J. (1996). Support groups:
Formal Opening of Meeting
Current perspectives on theory and practice.
At the agreed-on time, the meeting is called to New York, NY: Routledge.
order by the facilitator. Stang, I., & Mittelmark, M. B. (2008). Learning as an
empowerment process in breast cancer self-help
groups. Journal of Clinical Nursing, 18, 2049–2057.
Checking In
doi:10.1111/j.1365-2702.2008.02320.x
Members express how they are feeling (excited, Yalom, I. (1995). The theory and practice of group
anxious, sad, etc.) and whether they wish to use psychotherapy. New York, NY: Basic Books.
time in the meeting. It is essential that each mem-
ber checks in with the other group members.
Website
Alcoholics Anonymous: www.aa.org
Activities or Discussion
At each meeting, the peer counselor has two
tasks. The first is to facilitate a self-help group
activity or discussion. The second is to keep time
to ensure that all members who wish to speak have
SELF-RELATIONS PSYCHOTHERAPY
time to do so.
Self-relations psychotherapy has been developed
by the American psychologist Stephen Gilligan
Wrapping Up over the past 30 years. It emphasizes how reality
The last 5 to 10 minutes are used for closing and identity are constructed and how enduring
the meeting. This includes a summary, express- problems represent an unconscious “locking” of
ing appreciation, and expressing concerns. a consciousness frame, so that the same negative
Refreshments are typically served at a break or reality is repeatedly constructed. More impor-
after the meeting, which are optimal times for tant, it describes how these negative frames may
informal conversations. be “unlocked” and reorganized to allow new,
positive realities to emerge. This entry over-
Agatha Parks-Savage views the self-relations approach, describing its
historical influences and theoretical underpin-
See also Cognitive-Behavioral Group Therapy; Existential nings as well as some of its core concepts and
Group Psychotherapy; Group Counseling and techniques.

918 Self-Relations Psychotherapy
Historical Context the social/conscious world. Thus, “intimacy” could

be represented and experienced in many different
Self-relations psychotherapy was especially influ-
ways, some negative and some positive, depending
enced by the work of the American psychiatrist/
on the specific filters through which it passes.
hypnotherapist Milton Erickson (1901–1980).
The filters that translate a general pattern into a
Erickson emphasized how each person is unique
specific experience or behavior may be held with
and how each person’s behavioral/experiential pat-
either creative flow or neuromuscular lock. When
tern could be positively utilized for therapeutic
held with creative flow, a person is more fluid,
purposes. For example, Erickson counseled a
flexible, and mindful, so that the resulting experi-
woman who believed that the large gap in her
ence tends to be positive. For example, a person
front teeth made her ugly and unlovable by telling
holding “intimacy” filters with creative flow will
her to learn to squirt water through her teeth and
be more attuned and sensitive and more able to
then playfully use the squirting to flirt with a
adjust understandings and behaviors to find the
young man to whom she was attracted. A second
best fit between the person and the environment.
historical influence is humanistic psychology,
When held with neuromuscular lock, a filter
which emphasized each person’s orientation
becomes a closed and rigid frame held without
toward positive growth. A third influence is con-
positive human presence, thereby creating a nega-
structivism, which emphasizes how reality is con-
tive experience and behavior. In other words, a
structed through various psychological “lens” or
person in neuromuscular lock is incapable of cre-
“filters.” Taken together, these influences form the
ative expression in that given area. Thus, a person
base for seeing each person as actively involved in
who suffers a painful intimacy experience may
the reality the person experiences and capable of
become neuromuscularly locked around that event,
changing those realities in positive directions.
such that further intimacy experiences will follow
the same general pattern. The goal of self-relations
psychotherapy, then, is to identify these locked,
Theoretical Underpinnings negative areas of a person’s life and help that per-
In emphasizing how reality is constructed through son develop a new relationship of creative flow in
filters or frames, self-relations psychotherapy iden- such areas, so that new, more positive experiences
tifies three general types of filters: (1) field based— and behaviors may unfold.
for example, culture, family, social context, and
personal history; (2) somatic—for example, a per-
son’s posture, emotional state, body image, and Major Concepts
breathing patterns significantly influence the per- Self-relations therapy emphasizes how a person’s
son’s experiential reality; and (3) cognitive—for reality is created through his or her filters and that
example, belief systems, goals, thinking patterns, experience may be problematic or positive depend-
and ways of making meaning are filters that sig- ing on whether the filters are held rigidly with
nificantly influence experience. Taken together, neuromuscular lock or flexibly with creative flow.
these patterns create a network or matrix that The differences between these two relational styles
translates the flow of consciousness into specific are elaborated further in this section.
concrete realities.
In this model, the reality construction moves
How Neuromuscular Lock Becomes a Habit
through two levels: (1) the creative unconscious
and (2) the social/conscious world. In the creative The neuromuscular lock that underlies problem-
unconscious, experience is organized as general atic experience is a form of conditioned stress.
(archetypal) patterns around core human experi- Self-relations therapy talks about the “4 Fs” of neu-
ences, such as “intimacy,” “maintaining boundar- romuscular lock as its most general forms: (1) fight
ies,” and “sexuality.” The archetypal patterns are (anger, aggression, resentment), (2) flight (fear, avoid-
abstract and general, so that information or energy ance, anxiety), (3) freeze (high tension, “paralysis by
patterns only become specific as they pass through analysis,” dissociation), and (4) fold (depression,
a person’s filters to become the actual experience in apathy, low energy). Each of these general states

Self-Relations Psychotherapy 919
constitutes a rigid physiological and psychological make the statement “What I most want to create in
frame that creates a negative learning state. These my life is . . . ,” noticing the word or phrase that
negative states may become automatically condi- comes up each time the statement is made. After
tioned, so that they become reactivated each time a four or five rounds, the therapist asks the client to
person steps into a similar situation. This repetitive select the goal that seems the most resonant. The
negative cycle can culminate in chronic symptoms client is further asked to identify and share a visual
such as anxiety, depression, and dissociation. image representing the client having achieved the
A crucial idea is that as long as one attempts to desired goal—for example, enjoying a positive per-
resolve a problem while in one of these negative sonal relationship or having achieved a profes-
states, the unintended result is usually re-creating sional goal.
the problem. For example, trying to get rid of
anxiety while in an anxious state usually re-creates Mindbody Centering
the anxiety in some way. Thus, self-relations psy-
To develop this second positive connection, the
chotherapy emphasizes first helping clients into a
client is helped to develop a felt sense of well-being
positive (symptom-free) state and then working to
and presence. This might be done by mindbody
change the negative patterns of the symptom while
methods such as breathing, slowing down, attuning
still remaining in the positive state.
to the heart and stomach areas, and remembering
positive experiences. The goal is to help a person
The Primary Importance of a develop a somatic presence that is relaxed,
Creative Flow State grounded, open, attuned, and absorbed.
With its core emphasis on how a person’s state
strongly influences his or her consequent reality, Positive Resources
the self-relations therapist tracks two levels of con- To establish this third positive connection, a
versation: (1) the content of the work (e.g., goal, person is helped to attune to those presences in his
problem, and strategies for change) and (2) the or her life that can be called on to support the jour-
contextual state in which the work is explored ney of change. Examples include friends, family
(i.e., whether a person is in a state of neuromuscu- members, spiritual beings, historical or ancestral
lar lock or creative flow). A central part of self- persons, places in nature, and pets. Such connec-
relations work is thus devoted to how to help a tions are used to increase relevant dimensions of
client develop and maintain a positive state so that the person’s positive state, such as courage, sup-
significant positive changes may be developed. port, guidance, and self-love.
Techniques Self-Scaling Techniques

To develop a sustainable positive state, self-relations Because each positive connection can vary in its
psychotherapy uses a core method called the three intensity level, self-scaling techniques are used to
positive connections. These connections can be opti- have clients subjectively rate (e.g., on a 1–10 scale)
mized through self-scaling methods and used to how much connection they feel to a given param-
transform negative states. eter and also to help them increase the level. The
general idea is that a low rating on a scale—for
The Three Positive Connections example, “2” on the “connection to positive goal”
scale—means a person is not ready to orient
Positive Intention or Goal Setting
toward a challenge (e.g., changing a negative
The first connection is developing a positive belief, transforming a negative feeling). Such thera-
intention or goal. This is a simple but often chal- peutic efforts are initiated only when self-ratings
lenging step, as attention in a problem state is usu- indicate that the positive connections are suffi-
ally focused on negative goals (“I just want to get ciently developed; even then, periodic checking
rid of this”) or no goals at all. One simple tech- (and close nonverbal observation) is used to ensure
nique is to have the client slowly and repetitively that a person remains in the positive state. Again,

920 Seligman, Martin
the general idea is that when action is taken while working in a creative state of disciplined flow—that
in a positive state, positive outcomes are likely, but is, open to the flow of energy or information
when attempted in a negative state, negative out- (images, felt sense, awareness) but grounded in the
comes are likely. creative discipline of a positive state (e.g., the three
positive connections of intention, centering, and
Transforming Negative Symptoms resources). Thus, it is not a mechanical or rigid pro-
to Positive Resources cess but one in which spontaneous developments
often occur. Within the safety and positive nature of
One final technique of note involves transform- a creative flow state, each unfolding moment is
ing negative symptoms to positive resources. To positively welcomed and creatively utilized.
reiterate, each experience (including symptoms)
has two levels: (1) a primary general energy or Stephen Gilligan
information pattern with many possible forms and
values and (2) the psychological relationship to it, See also Ego State Therapy; Erickson-Derived or
-Influenced Theories: Overview; Focusing-Oriented
which translates it into a specific form and value.
Therapy; HeartMath; Mindfulness Techniques;
Thus, a symptom is a core archetypal experience Somatic Experiencing
that is held with the neuromuscular lock of nega-
tive human presence. To transform it into a
resource, a centered state is developed that allows Further Readings
a person to release negative holding of the experi-
Gendlen, E. (1978). Focusing. New York, NY: Bantam
ence; then a positive connection is developed, Books.
thereby allowing a new, more positive form of the Gilligan, S. G. (1983). Effects of emotional intensity on
core experience to be created. learning (Unpublished doctoral dissertation). Stanford
Consider, for example, a man who has sought University, Stanford, CA.
the help of a therapist for anxiety. The self-relations Gilligan, S. G. (1987). Therapeutic trances: The
therapist helps him center (e.g., by remembering cooperation principle in Ericksonian hypnotherapy.
how he felt when fishing), develop a positive inten- New York, NY: Brunner/Mazel.
tion (e.g., “I want to feel open-hearted and relaxed Gilligan, S. G. (1997). The courage to love: Principles and
with my family”), and connect with resources (e.g., practices of self-relations psychotherapy. New York,
his 6-year-old son, a kindly grandfather). When the NY: Norton Professional Books.
therapist asks him to sense what would interfere Gilligan, S. G., & Dilts, R. (2009). The hero’s journey: A
with his positive goal realization, he says, “anxi- voyage of self-discovery. Carmarthen, England: Crown
ety.” With guidance, he senses the anxiety as a felt House.
sense in his heart and notes that it feels like himself Rossi, E. L. (Ed.). (1980). The collected papers of Milton
at 6 years of age. While maintaining his positive Erickson on hypnosis: Vol. 1. The nature of hypnosis
connections, the therapist guides him to feel a lim- and suggestion. New York, NY: Irvington.
bic resonance (“felt sense” or “energetic connec- Rossi, E. L. (Ed.). (1980). The collected papers of Milton
tion”) with the younger (fearful) presence and to Erickson on hypnosis: Vol. 4. Innovative
use positive conversation (as if he were talking to psychotherapy. New York, NY: Irvington.
his own son) to transform the negative state into a
gentle positive energy that he can sense and use as
an integral resource. Further work helps him inte-
grate this into daily practice. SELIGMAN, MARTIN
Commonly known as the father of modern positive
Therapeutic Process
psychology, Martin Seligman (1942– ) was born in
Self-relations psychotherapy sees therapy as a cre- Albany, New York. Events during his adolescent
ative conversation in which both the therapist and years at times caused him to experience a sense of
the client become centered and open to new pos- helplessness, rejection, and loneliness. After gradu-
sibilities. Both are observers and participants, ating from the Albany Academy for Boys, he went

Seligman, Martin 921
on to earn a B.A. degree from Princeton University way to the notion of learned optimism (the counter
in 1964 and a Ph.D. in psychology from the to his earlier recognition of learned helplessness)
University of Pennsylvania in 1967. Seligman’s and the emergence of positive psychology.
work is heavily influenced by the humanistic theo- Positive psychology is grounded in the present
rists Carl Rogers and Abraham Maslow. His focus and the future. Seligman urges us to move beyond
on optimism encourages us to examine strengths psychology’s traditional stance of viewing childhood
and character rather than illness and pathology events and circumstances as the chief determinants
alone. Ultimately, the focus on positive experiences, of life direction. He details important experiences
traits, and institutions aims to prevent mental ill- such as a sense of well-being and satisfaction, hope
ness and improve the quality of life. and optimism, and happiness. While debate about
After spending time at Cornell University as an these ideas can be traced back to the early philoso-
assistant professor, Seligman returned to the phers as well as various psychological theorists, it
University of Pennsylvania to teach psychology. was Seligman who brought research attention on
For several decades, his research was grounded in them to the forefront of psychology. His develop-
abnormal psychology. Specifically, he focused on ment of positive psychology may be viewed as a
the role of failure and helplessness in animals and response to the illness/medical model of the
humans. These early studies shed light on the role Diagnostic and Statistical Manual of Mental
of learning relative to our experiences. He con- Disorders. Seligman argues that such a diagnostic
cluded that when people lose control over environ- perspective is ineffective in terms of prevention.
mental events, they tend to give up and do not Instead of looking for problems, he set out to
attempt to reclaim that control. This led to the explore the factors associated with wellness. Positive
notion of learned helplessness, a staple concept in psychology seeks to understand and acknowledge
modern psychology. This is the idea that we may those things that make life worth living. His ideas
learn to behave helplessly even in the face of may be viewed as not in opposition to traditional
opportunities to help ourselves. Learned helpless- psychology but, rather, as a broadened or balanced
ness is an associated feature of many psychological perspective of the human condition.
issues, and Seligman’s efforts had an especially This focus on optimism led Seligman and his col-
important impact on our understanding and treat- leagues to conduct research on cultures spanning the
ment of conditions such as depression. globe. Their work produced a set of common virtues
Following decades of research on pessimism by that include wisdom, courage, humanity, justice,
his team, Seligman rather haphazardly experienced temperance, and transcendence. These virtues are
an event that shifted his focus. He recounts an significant because they contribute to fulfillment.
interaction with his then 5-year-old daughter. These qualities tend to be valued and learnable,
While working in his garden, he yelled at her dur- prompt positive response, and facilitate the better-
ing a moment of interruption. She responded by ment of others. Seligman also points out that our
reminding him that she had made a decision to character can be strengthened by adverse experi-
stop whining, explained how difficult this was, and ences, such as traumatic events. His recognition of
concluded that if she could do that then he should these conditions encourages self-determination.
be able to stop being a grouch. This exchange had He is careful to acknowledge that there is a differ-
a profound impact on the way he viewed his work ence between the talents we are born with and the
as well as the role of psychology. Since World Word strengths we can choose to focus on. This choice
II, the focus of psychology had been on treating provides us with the opportunity for pride and
mental illness. For Seligman, the perspective of his accomplishment, ultimately saying something about
child pointed to the need to nurture strengths who we are. By choosing which strengths to pursue,
rather than correct issues. He surmised that condi- we are able to attain genuine satisfaction and happi-
tions where there is an absence of illness are worth ness. Seligman urges that this choice is more impor-
examining. This idea would lead him to focus on tant than constantly striving to correct weaknesses.
the positive qualities of human experience. He In a nutshell, his goal is to understand the fulfilling
wanted to know about identifying and nurturing aspects of human behavior and what contributes to
our strongest qualities. His subsequent work gave optimal functioning.

922 Seligman, Martin
Over the years, Seligman’s thinking on positive active agent in this process, moving even further
psychology has evolved, and he has continued to away from the orientation of traditional therapy.
develop his approach. He argued in Learned Seligman cautions that adherence to a disease
Optimism (1991) that optimism can improve the model hinders our ability to nurture strength.
quality of our lives. This hinges on reinterpreting Seligman was appointed president of the
our behavior and developing a positive internal American Psychological Association in 1998.
dialogue. Learned optimism has been shown to During his inauguration address, he announced his
have a positive impact on the prevention of depres- agenda for expanding psychology from a singular
sion and anxiety. In Authentic Happiness (2002), focus on pathology. Since that speech, positive psy-
he asserted that happiness is something that can be chology has enjoyed continuous growth and wide-
cultivated by naturally utilizing the strengths we spread popularity. This area of psychology now
already possess. Over time, the consistent use of has a broad research base, associated organizations
these strengths develops into positive character and conferences, and university courses and pro-
traits. He touched on many factors, including grams around the world. While some disagreement
money, marriage, relationships, gender, religion, persists whether positive psychology should stand
health, and even climate. Seligman concluded that as its own movement, the work of Seligman has
these traditional factors only account for a small enhanced our understanding of positive emotions
portion of our happiness and came to view the and character traits. It encourages the enterprise of
cultivation of character as the most important fac- psychology to encompass more than victimhood
tor. More recently, Seligman has expanded his and remediation. His body of work, which includes
focus on happiness to include overall well-being. In more than 200 scholarly articles, best selling
Flourish (2011), he characterizes the goal of well- books, and numerous professional honors, com-
being as increasing positive emotion, engagement, fortably establishes him as one of the most influen-
meaning, relationships, and achievement. It is tial psychologists of the 20th century. Seligman is
important to note that positive psychology is not currently the director of the Positive Psychology
simply the pursuit of what makes us happy. Center and the Zellerbach Family Professor of
Happiness is only one of the concerns. Nor should Psychology at the University of Pennsylvania.
it be viewed as positive thinking. He recognized Recent initiatives include applying positive
that optimism is not always appropriate. Negative psychology principles to soldier fitness, therapy,
or realistic thinking may be a more suitable neuroscience, health, and education. His work con-
response depending on the situation. Thus, his tinues to focus on the development and promotion
work developed into a systematic and scientific of wellness principles and the fostering of positive
effort to examine those strengths/weaknesses and virtues.
virtues that allow us to thrive as individuals. His
position is that our state of mind is our responsibil- Everett W. Painter
ity and the aforementioned virtues serve as a buffer
against mental illness. Maslow, Abraham; Person-Centered Counseling;
Seligman’s work has important implications for Positive Psychology; Rogers, Carl
practicing mental health clinicians. He reminds us
of the importance of attending to a client’s strengths.
The focus moves away from simply reducing Further Readings
symptoms toward promoting the identification of Seligman, M. (1975). Helplessness: On depression,
traits that protect against the development of issues development, and death. San Francisco, CA:
and strengthen resiliency. Seligman outlines several W. H. Freeman.
of the strengths built in therapy, such as courage, Seligman, M. (1991). Learned optimism: How to change
insight, honesty, perspective, purpose, realism, and your mind and your life. New York, NY: Knopf.
optimism. Such an orientation on building positive Seligman, M. (2002). Authentic happiness: Using the new
emotions and meaning helps the client flourish positive psychology to realize your potential for lasting
rather than simply survive. The client becomes an fulfillment. New York, NY: Free Press.

Sensorimotor Psychotherapy 923
Seligman, M. (2011). Flourish: A visionary new developed the Hakomi body-centered method of
understanding of happiness and well-being. New York, psychotherapy, and built sensorimotor psycho-
NY: Simon & Schuster. therapy in part on this base.
Seligman, M., & Csikszentmihalyi, M. (2000). Positive
psychology: An introduction. American Psychologist,
55, 5–14. doi:10.1037/0003-066X.55.1.5 Theoretical Underpinnings
Seligman, M., & Pawelski, J. O. (2003). Positive Sensorimotor psychotherapy is based on research
psychology: FAQs. Psychological Inquiry, 14, 159–163. and clinical practice from diverse disciplines. The
Sheldon, K. M., & King, L. (Eds.). (2001). Positive practice combines somatic psychotherapy, devel-
psychology [Special issue]. American Psychologist, opmental psychodynamic theory, and cognitive-
56(3), 216–263. behavioral approaches. It also incorporates
research from attachment theory, studies of disso-
ciation, and neuroscience. As a foundation, senso-
rimotor psychotherapy employs techniques from
SENSORIMOTOR PSYCHOTHERAPY the Hakomi method and the writings of the
early-20th-century French analyst Pierre Janet.
Sensorimotor psychotherapy is an experiential Janet theorized that traumatic experience lives in
approach to trauma treatment that explicitly brings the body and is residual from the helplessness and
the client’s embodied awareness into the counsel- terror that occurred at the time. Janet believed that
ing session. Utilizing the client’s mindful processing traumatized individuals suffer from movement
of traumatic relational or physical experience, it incompletion, which Janet defined as defensive
includes awareness of body sensations, spontane- actions they were unable to take at the time of the
ous movement impulses, and habitual movement trauma. Sensorimotor psychotherapy explicitly
patterns as foci of attention. Sensorimotor psycho- focuses on the manifestations of trauma, starting
therapy may be used as the principal method of with awareness of body sensation, movement pat-
treatment or in combination with other theoretical terns, and impulses. Bringing these from the
approaches. Because trauma deeply affects the unconscious to conscious awareness provides a
body, sensorimotor psychotherapy offers access to source of healing through the integration of the
unconscious or implicit traumatic material. Bodily mind and the body.
awareness serves as a portal through which the
unconscious can move into consciousness, offering Major Concepts
access via language and new movement patterns;
the potential transformation of the client’s under- Sensorimotor concepts are drawn primarily from
standing of trauma, its attendant affective dysregu- somatic psychology, especially Kurtz’s Hakomi
lation, and imbedded beliefs; and ultimately a body-centered psychotherapy as applied to trauma
more unified body and mind. treatment. These include action tendencies, core
organizers, experiments, indicators, mindfulness,
the organization of experience, tracking, and the
Historical Context window of tolerance.
Pat Ogden developed sensorimotor psychotherapy
during the 1980s. Its techniques and interventions Action Tendencies
were created to work with the effects of trauma, Action tendencies are a readiness for a behavior,
including posttraumatic stress disorder and diag- latently present until a specific internal or external
noses related to complex trauma. Sensorimotor stimulus activates it.
psychotherapy offers treatment for developmental
or attachment trauma, trauma resulting from Core Organizers
events such as accidents and natural disasters, and
complex traumatic stress disorders. For several Core organizers are emotions, beliefs, five-sense
years, Ogden was an associate of Ron Kurtz, who perception, movement impulses, gestures, posture,

924 Sensorimotor Psychotherapy
habitual movement patterns, and inner body sensa- Phase-Oriented Treatment

tions (vertigo, feeling empty, frozen, etc.).
Phase-oriented treatment refers to the steps in
sensorimotor trauma treatment and includes
Experiments (a) stabilization, (b) memory and emotion work,
and (c) integration work. Stabilization includes
Experiments are counselor-suggested physical
enhancement of client resources, slowing the pace
or verbal actions that challenge client beliefs or
of the session, guiding the client’s “in the present
habits of behavior.
moment” awareness, and management of nervous
system arousal. Memory and emotion work focuses
Indicators on dual awareness of body and mind responses to
traumatic memories and related beliefs, with atten-
Indicators are client responses arising from
tion to a sense of mastery over previously over-
counselor-suggested experiments. Indicators are
whelming experience. Integration is the practicing,
revealed in client statements such as “I want to
in and out of session, of emerging new belief, rela-
hide,” “I don’t feel safe,” or “My throat feels
tional, and nervous system arousal patterns.
tight.”
Mindful Awareness of Bodily Experience

Mindfulness
Mindful awareness of bodily experience is a
Mindfulness is client awareness of and ability to client practice. The client remains in the present
report on core organizers without judgment as moment during session, observing emerging core
these occur in the present moment. organizers.
Organization of Experience Client Self-Regulation of Bodily Arousal

The organization of experience is habits or Client self-regulation of bodily arousal is a
unconscious internal organization and beliefs treatment goal for the resolution of dysregulated
influenced by attachment history, developmentally responses to overwhelming physical sensations,
derived beliefs, and/or traumatic experience. emotions, and distorted beliefs. The counselor
teaches clients to notice and track the early signs of
Tracking dysregulation as well as the somatic means for
calming the nervous system.
Tracking refers to the counselor’s detailed notic-
ing of momentary changes in the client’s nonverbal
behavior. Processing Memories
The sensorimotor approach assumes that
Window of Tolerance memories are encoded explicitly (the story) and
implicitly (sensations, images, movement pat-
The window of tolerance refers to the optimal terns, posture, vague feelings). Clients are encour-
zone for sensorimotor processing. The nervous aged to “drop the story” and to mindfully attend
system is neither hyperaroused nor hypoaroused. to core organizers.
Techniques Movement Impulses and Incomplete Actions

Several techniques are associated with sensorimo- Sensorimotor psychotherapy includes a focus
tor psychotherapy: phase-oriented treatment, on completing actions that were impossible at the
mindful awareness of bodily experience, mindful time of trauma due to immobilization. Actions that
awareness of bodily arousal, processing memo- “wanted to happen,” such as striking out, escaping
ries, and movement impulses and incomplete the situation, or defending oneself, continue to live
actions. in the body.

Sexual Identity Therapy 925
Therapeutic Process
SEXUAL IDENTITY THERAPY
Sensorimotor psychotherapy is guided by the
Hakomi concept of assisted self-study. Establishing
Sexual identity therapy (SIT) is a framework
a nonjudgmental, present-moment climate is
designed to assist mental health professionals in
important throughout. Pacing is slow. The client
their work of helping people resolve dissonance
intermittently drops the remembered traumatic
between religious beliefs and sexual orientation.
story and focuses on present bodily awareness.
This approach helps therapists assist clients to
When indicators of repetitive patterns, sensations,
clarify core beliefs and values about sexuality and
or beliefs emerge, the counselor may suggest an
their religious beliefs and to develop strategies to
experiment, such as amplifying an observed move-
pursue congruence between their beliefs and their
ment impulse or noticing bodily sensation when
sexual identity. The framework for SIT is presented
the client’s emergent belief is repeated to the
in four phases: (1) assessment, (2) advanced
counselor. During the session, the counselor
informed consent, (3) psychotherapy, and (4) sex-
monitors and seeks feedback regarding the cli-
ual identity synthesis.
ent’s window of tolerance. Is the client becoming
agitated (hyperaroused) or disconnected
(hypoaroused)? If so, the counselor asks the client
to return to mindful awareness of body sensation. Historical Context
Goals of counseling include nonjudgmental self- The framework was first conceptualized in 2005
observation, increased client self-regulation, and by Warren Throckmorton and Mark Yarhouse.
assisting the client to place traumatic memory in Throckmorton recommended the framework for
the past. It brings unconscious material, seques- therapists who sought to help clients who believe
tered in the body, into awareness, where it can be that their religious beliefs contradict their sexual
integrated into a client’s autobiography and self- orientation. For some clients, living a life whose
understanding. behaviors are in line with their religious beliefs
despite their sexual orientation might be an objec-
Catherine B. Jenni
tive; for others, acceptance of sexual orientation
may be the goal.
See also Body-Oriented Therapies: Overview;
During the latter part of the 20th century and
Developmental Counseling and Therapy: Theory and
Brain-Based Practice; Hakomi Therapy; Mindfulness early part of the 21st century, the American
Techniques; Rolfing; Somatic Experiencing Counseling Association, American Psychiatric
Association, American Psychological Association
(APA), and National Association of Social Workers
Further Readings developed policy statements that strongly discour-
aged the use of Sexual Orientation Change Efforts
Fisher, J., & Ogden, P. (2009). Sensorimotor
(SOCE) because research suggested that it may be
psychotherapy. In C. Courtois & J. Ford (Eds.),
harmful to clients. In 2005, Throckmorton sug-
Treating complex traumatic stress disorders: An
gested that the creation of neutral guidelines for
evidence-based guide (pp. 312–328). New York, NY:
Guilford Press.
therapists would best serve those clients struggling
Janet, P. (1925). Principles of psychotherapy. London, with conflicts related to their religious beliefs and
England: Allen & Unwin. sexual orientation. Throckmorton and Yarhouse
Kurtz, R. (1990). Body-centered psychotherapy: The collaborated to create the SIT framework, which
Hakomi Method. Mendocino, CA: Life Rhythm. placed clients in charge of setting the direction of
Ogden, P., & Fisher, J. (2014). Sensorimotor therapy while at the same time recognizing that
psychotherapy: Interventions for trauma and SOCE was rarely successful. In fact, the APA Task
attachment. New York, NY: W. W. Norton. Force on Appropriate Therapeutic Responses to
Ogden, P., Minton, K., & Pain, C. (2006). Trauma and Sexual Orientation found that change efforts
the body: A sensorimotor approach to psychotherapy. involve risk and that insufficient evidence existed
New York, NY: W. W. Norton. to support the use of SOCE.

926 Sexual Identity Therapy
The SIT approach is founded in the person- Theoretical Underpinnings

centered tradition in that clients are encouraged to
Sexual identity therapists view sexual orientation
clarify their values and beliefs related to their
as one element of a person’s identity and religious
religious affiliation and sexual orientation with
beliefs as another important variable, both of
minimal direction from therapists. For this reason,
which are important for establishing personal
some clients will affirm their identity as lesbian,
identity. Sexual identity therapists recognize that
gay, bisexual, transgender, intersex, or question-
some clients who hold traditional religious views
ing, while others will affirm a nonaffirming
have a sexual orientation that is in conflict with
religious tradition despite their sexual orientation
their religious beliefs. For instance, some who
and decide to live a life that is behaviorally consis-
experience same-sex attraction do not identify as
tent with those religious beliefs. Therapists are
gay because they do not engage in same-sex sexu-
encouraged to leave their ideological loyalties
ality. Others who have a same-sex attraction along
out of the counseling office and assist clients
with religious beliefs that conflict with same-sex
to achieve a resolution that is most satisfactory
relationships decide to abandon their religious
to them.
beliefs.
In 2006, the SIT framework was published on
The APA also recognizes a distinction between
a website dedicated to the approach and then
organismic congruence and telic congruence. Some
presented at the 2007 APA convention in San
religious traditions promote telic congruence,
Francisco, California. The framework has under-
which is defined as living consistently with one’s
gone subsequent revisions to incorporate ongo-
religious beliefs. Sexual minority–affirming
ing research regarding sexual orientation. The
approaches to lesbian, gay, bisexual, transgender,
approach was considered and then rejected by
intersex, or questioning clients often promote
the National Association for the Research and
organismic congruence, which can be described as
Therapy of Homosexuality, the only organiza-
living consistently with one’s experience, in this
tion that advocates for reparative therapy. The
case, with one’s natural sexual attractions. In SIT,
SIT framework has received criticism from sex-
the decision whether to seek telic or organismic
ual orientation change therapists due to the neu-
congruence, or some combination of the two, is
tral stance of SIT advocates. Criticism has also
left with the clients.
come from some sexual minority–affirming ther-
apists, as they believe that it does not go far
enough in affirming an individual’s sexual orien- Major Concepts
tation. In 2008, Throckmorton and three pre-
senters were slated to present the SIT format The framework for SIT is presented in four steps:
before the American Psychiatric Association. (1) assessment, (2) advanced informed consent,
However, this presentation was cancelled due to (3) psychotherapy, and (4) sexual identity synthe-
pressure from those who believed that this sis. At any point during the therapy, a previous step
approach was oppressive to individuals strug- may be revisited for further investigation or to
gling with their sexual orientation. In 2009, the explore a new direction in the therapy.
SIT framework was cited favorably by the APA’s
Task Force report on therapeutic approaches to
Assessment
sexual orientation.
SIT may be used with therapists of many differ- Clients who present with sexual identity con-
ent theoretical persuasions. There is no prescribed cerns receive a standard mental health assessment.
number of sessions, and not all clients experience Then, the reasons why the clients requested ther-
all four phases, which are subsumed under the apy are explored with attention to what they hope
heading of SIT. SIT is best considered a therapeutic to accomplish. This assessment covers sexual his-
stance of respect for religion and sexual orienta- tory, current sexuality, religious beliefs and affilia-
tion variables along with a dedication to provide tions, and beliefs regarding sexuality. At times, this
clients with the most up-to-date information pos- assessment process leads naturally into a process
sible regarding sexual orientation. of belief and values clarification. For other clients,

Sexual Identity Therapy 927
values clarification comes during the psychother- of their sexual orientation, values, and beliefs.
apy phase. Because therapists using SIT do not Many clients find it helpful to attend support
prescribe a particular value or behavioral course of groups and manage their lives in ways that affirm
action, the assessment process is an individual one. their new identity.
Advanced Informed Consent Techniques

Therapists inform clients about current infor- Because SIT is compatible with many theoretical
mation regarding sexual orientation. Therapists approaches to counseling, there are not many spe-
using SIT inform clients that the major mental cific techniques. Therapists must be skilled in basic
health associations consider same-sex sexual orien- mental health interviewing and assessment as well
tation as normal ways of bonding with individuals. as in distinguishing mental and emotional disor-
Sexual identity therapists also indicate that change ders and conditions that can exacerbate sexual
of sexual attractions or orientation is not consid- identity confusion and dissonance. Because SIT
ered a part of empirical practice due to the durabil- places emphasis on treating any existing mental
ity of sexual orientation. Therapists may inform and emotional conditions simultaneously with or
clients that their religious beliefs will be respected prior to addressing the dissonance of having a
and that some people do live in alignment with sexual identity that is in conflict with one’s reli-
their religious views, even if this means living celi- gious beliefs, therapists should be skilled in treat-
bately. In addition, clients are informed that their ing such conditions.
sexual orientation will be respected and that some More specifically, therapists should have exper-
individuals decide to abandon or change their reli- tise in human sexuality and in religion and should
gious affiliation to be more in line with their sexual be proficient in the use of techniques that help
orientation. clients clarify their religious beliefs and values and
in helping clients understand their sexual orienta-
Psychotherapy tion. In-depth knowledge of sexual orientation
research and of the impact of religious beliefs on
SIT provides a framework for existing tech- one’s sexual orientation is critical to assist clients
niques rather than a specific method of psycho- in providing advanced informed consent. Finally,
therapy. Many therapeutic models can be used to therapists have to be adept at accepting, honoring,
facilitate congruence and resolution of sexual and understanding a person’s sexual orientation
identity dissonance. The goal of counseling is to and religious beliefs. It is only through being able
help clients live comfortably with their sexual ori- to hold these conflicting orientations, beliefs, and
entation and their religious beliefs. Therapists con- values simultaneously that a client can make an
tinually assess for the effects of interventions and informed decision about his or her life course and
are prepared to offer counseling that is effective to direction.
treat the mental health disorders or conditions that
sometimes accompany sexual identity distress or
the distress of being in a religion that denies one’s Therapeutic Process
sexual orientation. At times, referral may be indi- SIT may require only two or three sessions or may
cated if a therapist does not feel competent to last several years. Some clients prefer to attend
assist a client. several sessions with long breaks between epi-
sodes. Some clients will change their views on
Sexual Identity Synthesis religious and value issues, which may renew dis-
sonance throughout the life span. Sexual identity
As a consequence of the prior three phases, therapists demonstrate flexibility in adjusting the
many clients arrive at a plan to integrate their reli- process of counseling to the needs and pace of
gious beliefs and sexual orientation. Therapists may clients.
assist by helping clients facilitate actions and com-
mitments congruent with their new understanding Warren Throckmorton

928 Sexual Minority Affirmative Therapy
See also Person-Centered Counseling; Sexual Minority an independent system of psychotherapy but a
Affirmative Therapy; Sexual Orientation Change therapeutic perspective that challenges the notion
Efforts that same-sex attractions or atypical gender identi-
ties are inherently pathological and in need of
Further Readings change or alteration. This therapeutic lens views
societal stigma and internalized sexual prejudice as
American Psychological Association. (2009). Report of major pathways for the circumstances that bring
the task force on appropriate therapeutic response to
many sexual minority individuals to therapy. An
sexual orientation. Washington, DC: Author.
affirmative perspective is profoundly validating of
Tan, E. S. N., & Yarhouse, M. A. (2010). Facilitating
these clients and their relationships and does not
congruence between religious beliefs and sexual
privilege heterosexuality over sexual minority ori-
identity with mindfulness. Psychotherapy, 47(4),
500–511. doi:10.1037/a0022081
entations and identities. Affirmative therapy goes
Throckmorton, W. (2012). In praise of round pegs.
beyond the creation of a neutral therapeutic cli-
Edification, 3, 27–28. mate, or one that merely “accepts” same-sex
Throckmorton, W., & Yarhouse, M. A. (2006). Sexual attracted individuals. Rather, it creates a safe space
identity therapy: Practice guidelines for managing for clients to examine and affirm all intercon-
sexual identity conflicts (Unpublished paper). Retrieved nected identities, including their racial, cultural,
from http://sitframework.com/wp-content/uploads/ gender, ethnic, religious, and sexual identities. This
2009/07/sexualidentitytherapyframeworkfinal.pdf congruence, or coming together, can be life enhanc-
Yarhouse, M. A. (2001). Sexual identity development: The ing for individuals who rarely have been allowed
influence of valuative frameworks on identity synthesis. to examine the various aspects of themselves free
Psychotherapy, 38(3), 331–341. doi:10.1037/0033- of judgment and censure.
3204.38.3.331
Yarhouse, M. A. (2008). Narrative sexual identity
therapy. American Journal of Family Therapy, 36,
Historical Context
196–210. doi:10.1080/01926180701236498 The term homosexual was first used in the 1870s
Yarhouse, M. A., & Tan, E. S. N. (2004). Sexual identity in Germany to describe a distinct category of peo-
synthesis: Attributions, meaning-making, and the ple who were erotically attracted to their own sex.
search for congruence. Lanham, MD: University Press Prior to this, in Western society, these individuals
of America. were considered heterosexuals who were behaving
Yarhouse, M. A., Tan, E. S. N., & Pawlowski, L. M. immorally, were violating religious law and/or civil
(2005). Sexual identity development and synthesis law (which often reflected the values of the domi-
among LGB-identified and LGB dis-identified persons.
nant religion), or were inherently ill and in need of
Journal of Psychology and Theology, 33(1), 3–16.
a cure by the medical community.
Prior to the 1960s, most psychotherapeutic
writing about homosexuality was based on the
SEXUAL MINORITY AFFIRMATIVE assumption that homosexuality was a pathological
condition to be cured, much like any other disease.
THERAPY Some saw this assumption as more humane than
persecuting and prosecuting sexual minorities, as
Sexual minority affirmative therapy provides a many governments tended to do, or condemning
frame of reference for working with sexual minor- them to eternal damnation, as the tenets of various
ity clients, including lesbian, gay, bisexual, and religions proclaimed. Since that time, in the United
transgender; gender variant; asexual (who experi- States and in other Western nations, mental health
ence no sexual attraction); cisgender (who identify professionals have worked to avoid identifying
as the gender assigned at birth); intersex (whose same-sex attraction and atypical gender identity as
reproductive anatomy does not fit the typical defi- pathological and to reduce the stigma associated
nitions of male or female); and other emerging with these identities. Although the concept of an
categories or self-definitions, such as GSM (i.e., affirmative therapy for sexual minorities may have
gender and sexual minority). This approach is not been used informally, the psychologist Alan Malyon

Sexual Minority Affirmative Therapy 929
first used the term gay affirmative therapy in the For example, many sexual minority individuals
early 1980s. have difficulty reconciling their sexual orientation
Despite recent societal shifts with regard to the or gender identity with the values of a religion that
acceptance of sexual minority citizens and ongoing condemns same-sex behaviors and restricts believ-
advocacy for their rights in areas such as housing, ers to celibacy or to heterosexual marriage. This
medical care, military service, employment, and struggle can be particularly devastating for indi-
election to public office, heterosexism is prevalent viduals who are deeply bonded to their faith and
in the United States as a major socializing factor. who experience a profound sense of marginaliza-
For example, sexual minority children are pres- tion or exclusion from their families or from their
sured to live out traditional gender roles, and most religion. Clinicians utilizing a sexual minority
religious groups support only traditional mar- affirmative therapy approach take this experience
riages and families. Those who are “different,” of rejection seriously, reflect the intensity of clients’
such as gender-atypical children, may be targeted pain, and assist clients in their grief.
or bullied and may feel powerless to fight back. In
addition, the family and friends of sexual minority
Major Concepts
individuals often fail to recognize or understand
the extent of the trauma of these socializing fac- As noted previously, sexual minority affirmative
tors. Such traumatization can, of course, affect a therapy provides a frame of reference for clinicians
person’s sense of self and, therefore, can be an working with sexual minority clients. For this rea-
important focus of therapy. son, the major concepts of this perspective focus
on clinicians’ attitudes toward same-sex-attracted
and gender-variant clients and their understanding
of the issues that such clients face in their relation-
Because of the stigma and other socializing factors ships and in society. To direct ethical psychological
directed toward sexual minorities, an understand- practice with sexual minority clients, the American
ing of such bias is critical to providing ethical and Psychological Association (APA), the largest pro-
effective therapy. To offer competent and bias-free fessional psychological association in the United
mental health service, clinicians must be aware of States, has created committees and/or task forces
the emotional and logistical burdens faced by sex- to develop practice guidelines. In 2011, the APA
ual minorities of all ages, ethnicities, and circum- issued Guidelines for Psychological Practice With
stances. Clinicians with an affirmative perspective Lesbian, Gay, and Bisexual Clients, and as of
appreciate the profound effects of heterosexism on 2013, another task force is working on developing
mental health that clients bring to therapy, such as Guidelines for Psychological Practice With
social withdrawal, passivity, anxiety, suspicion, Transgender and Gender Non-Conforming Clients.
insecurity, depression, substance use, and suicidal- The Guidelines for Psychological Practice With
ity, which frequently are the consequences of living Lesbian, Gay, and Bisexual Clients has incorporated
in a stigmatizing societal environment. many of the major concepts of sexual minority
Today, with knowledge gained from a large affirmative therapy into its 21 specific guidelines,
body of research, professional mental health asso- arranged into six topic areas: (1) Attitudes Toward
ciations do not view sexual minorities as deficient, Homosexuality and Bisexuality, (2) Relationships
ill, or in need of a cure but as healthy human and Families, (3) Issues of Diversity, (4) Economic
beings who, like all individuals, struggle with and Workplace Issues, (5) Education and Train-
problems of living. However, due to continued ing, and (6) Research. For example, Guideline 1
societal devaluation, some clients bring to counsel- addresses the issue of stigmatization, noting that
ing the negative mental health effects of societal clinicians should strive to understand the effects of
stigma. A clinician’s mirroring, or reflection of the stigma, and Guideline 2 affirms that sexual orien-
fundamental goodness and wholeness of these tations, specifically lesbian, gay, and bisexual ori-
individuals, is vital to counteract the individuals’ entations, are not mental illnesses. Other principles
sense of shame and failure, which can be perpetu- of the guidelines include the notions that efforts to
ated by others and by institutions. change sexual orientation are neither effective nor

930 Sexual Minority Affirmative Therapy
safe, that bisexual individuals have unique experi- sexual minorities may experience from continually
ences, that the relationships and families of sexual facing the biases imposed by society. Reframing
minorities deserve respect, and that racial and eth- and challenging pessimistic cognitions could also
nic sexual minorities face multiple challenges. be helpful, as well as using a form of narrative
Readers are encouraged to read the complete therapy to shift the harmful conversations clients
guidelines, available on the APA’s website, for fur- have learned to tell themselves about their worth
ther understanding and information regarding the and of their place in society. These negative stories
application of these guidelines. can be transformed into narratives of resilience,
competence, and growth. Adlerian theorists focus
on early recollections and internalized feelings of
Techniques
inferiority. Bringing these memories and emotions
Although sexual minority affirmative psychother- to awareness, subjecting them to examination, and
apy is the first therapeutic movement to acknowl- incorporating them into a client’s life can neutral-
edge the harm done to sexual minority individuals ize the self-defeating effects they have had. Finally,
by heterosexist socialization, there are no tech- expressive techniques such as role-play, move-
niques that are specific to counseling sexual minor- ment, art therapy, and psychodrama can help
ity individuals. The clinical work with these clients clients develop feelings of power and resourceful-
employs established techniques from an affirming ness, which they may have found difficult to
perspective. mobilize.
However, an increasing volume of literature
related to the adaption of existing techniques
Therapeutic Process
to the unique issues of these clients exists.
Modifications to existing techniques, though, must Sexual minority clients often enter therapy with
take into consideration the marginalized world in apprehension. After a lifetime of often feeling
which some sexual minority clients reside and the unheard and misrepresented, many may be reluc-
unique conditions of their lives. For example, some tant to confide in a clinician until that individual
clients may live in quite stigmatizing and even dan- has earned their trust. In addition, many sexual
gerous situations; others may not be experiencing minority clients fear even exploring the secret that
such dire circumstances, but their past may include they have kept most hidden—even to themselves.
considerable stigmatization and distress. Such stig- Given this, therapy frequently is a careful and slow
matization and distress, regardless of the extent, is process, with the mirroring and affirmation by the
incorporated into affirmative therapy. clinician being extremely important for client
The empathy and deep listening used in person- exploration and growth. Clinicians, thus, strive to
centered therapy is an example of a therapeutic understand the degree to which heterosexism has
perspective that is considered essential when work- affected the context of clients’ lives and to convey
ing with distraught sexual minority clients. to those who are in their care that much of the
Unconditional positive regard, a core concept of distress they are experiencing is a result of living in
person-centered therapy, is valuable in counteract- a stigmatizing society and not a result of their own
ing an individual’s negative or nonexistent views of brokenness.
self. Object relations theorists suggest the tech- Clinicians also carefully examine their own
niques of mirroring, or reflecting of the genuine biases regarding same-sex sexual behaviors and
person, and the creating of a safe, or holding, envi- atypical gender identities so that their own counter-
ronment for clients. Affirmative therapists can use transferences do not impede empathic attunement
these object relations techniques to safely contain, with clients. While striving toward true impartial-
or hold, the pain and wounds of sexual minority ity, clinicians additionally may consider their own
clients, which can then facilitate the emergence of position regarding heterosexuality in terms of mar-
hope. riage, childbearing, adoption, family structures,
Some clinicians have proposed using cognitive religion, and morality—that is, whether they are
therapy for addressing the depression and anxiety encouraging clients toward a specific outcome,

Sexual Orientation Change Efforts 931
such as opposite-sex attraction, a denial or repres- Ritter, K. Y., & Terndrup, A. I. (2002). Handbook of
sion of the clients’ feelings toward their own sex, affirmative psychotherapy with lesbians and gay men.
and being comfortable with the gender of their New York, NY: Guilford Press.
birth, a particular religion, or therapeutic conver-
sion. With empathy and support, sexual minority Website
clients can navigate their issues and difficulties and
can face challenges with increasing courage. An American Psychological Association: www.apa.org
indication of therapeutic success is when sexual
minority clients are no longer burdened with feel-
ings of shame and self-deprecation but can live SEXUAL ORIENTATION
their lives overcoming the same challenges that
every human faces. CHANGE EFFORTS
Kathleen Y. Ritter Sexual orientation change efforts (SOCE) refers to
the dangerous and unethical forms of treatment
See also Contemporary Psychodynamic-Based Therapies:
aimed at changing one’s sexual orientation or
Overview; Contextual Therapy; Cross-Cultural
Counseling Theory; Narrative Therapy; Object behavior. SOCE has been called by many names,
Relations Theory; Person-Centered Counseling; including, but not limited to, conversion and repar-
Rogers, Carl; Winnicott, Donald ative therapy. The goal of this form of treatment is
to assist persons in suppressing their sexual orien-
tation so as to be more socially congruent with the
Further Readings mainstream heterosexual culture; often, this is
American Psychological Association. (2009). Report of done for religious purposes. The paradigm in
the APA task force on appropriate therapeutic which SOCE has been conceived pathologizes vari-
responses to sexual orientation. Retrieved from www ous sexual identities and behaviors while advanc-
.apa.org/pi/lgbt/resources/therapeutic-response.pdf ing the idea that lesbian, gay, and bisexual (LGB)
American Psychological Association. (2012). Guidelines persons are damaged and in need of repair. As such,
for psychological practice with lesbian, gay, and no major mental health association has endorsed
bisexual clients. American Psychologist, 67(1), 10–42. SOCE, and many have drafted resolutions or posi-
doi:10.1037/a0024659 tion statements cautioning against its use.
American Psychological Association. (2012). Guidelines
for psychological practice with lesbian, gay, and
bisexual clients. Retrieved from http://www.apa Historical Context
.org/pi/lgbt/resources/guidelines.aspx
Prior to the 19th century, same-sex desire and
Bieschke, K. J., Perez, R. M., & DeBord, K. A. (Eds.).
sexual activity were viewed in a religious context,
(2007). Handbook of counseling and psychotherapy
grounded in the Judeo-Christian tradition, as
with lesbian, gay, bisexual, and transgender clients
unnatural and as a sin. Legally, same-sex behavior
(2nd ed.).Washington, DC: American Psychological
was criminalized, first in 16th-century England
Association.
Bigner, J. J., & Wetchler, J. L. (Eds.). (2012). Handbook of
and later in other parts of the world. This was
LGBT-affirmative couple and family therapy. challenged and changed in Napoleonic France in
New York, NY: Routledge. the late 18th century, with laws instead focusing
Gonsiorek, J. C. (Ed.). (1982). Homosexuality and on public sexual acts and sexual acts with minors.
psychotherapy: A practitioner’s handbook of Men arrested under public sex laws were forced to
affirmative models. New York, NY: Haworth Press. undergo medical examinations to see if anal sex
Malyon, A. K. (1982). Psychotherapeutic implications of had occurred, which marked the start of a medical
internalized homophobia in gay men. In J. C. interest in human sexual behavior. In 1857, Auguste
Gonsiorek (Ed.), Homosexuality and psychotherapy: Ambroise Tardieu published a study of men
A practitioner’s handbook of affirmative models arrested under these laws, advancing a theory of
(pp. 59–69). New York, NY: Haworth Press. sexual development that suggested that these men

932 Sexual Orientation Change Efforts
had psychological and behavioral traits that were the Diagnostic and Statistical Manual of Mental
forms of insanity. Disorders, second edition (DSM-II). However,
Following this report, medical professionals opposition among some psychiatrists about the
began to view same-sex desire as a pathological, removal of homosexuality from the DSM led to a
innate illness in need of change. This notion chal- compromise in the DSM-II, published in 1968,
lenged the established norm at the time, which with the new diagnosis of Sexual Orientation
viewed same-sex desire as a choice and as inher- Disturbance, which was based on a person’s con-
ently sinful (against the wishes of God) and unlaw- flict with his or her sexual orientation. This diagno-
ful. As such, this new medical, yet pathological, sis was replaced with Ego-Dystonic Homosexuality
view of same-sex behavior was seen as progressive in the DSM-III, published in 1980. Both diagnoses
and liberatory because viewing it as an illness have been removed from later editions of the DSM.
shifted the discourse away from viewing same-sex Because empirical research has not supported
attractions as being an active, sinful choice. Writers the effectiveness of SOCE, the American Association
at the time argued that since same-sex attractions of Marriage and Family Therapists (AAMFT),
were innate, such persons should come under psy- American Psychiatric Association, American
chiatric care rather than legal prosecution. Psychological Association, and National
The paradigm that suggested that homosexual- Association of Social Workers have all adopted
ity was innate and pathological continued until the policy statements that caution their professions
early 20th century, when Sigmund Freud, accord- about treatment efforts centered on changing sex-
ing to Kenneth Lewes, a psychoanalytical scholar, ual orientation. In 1999, the American Counseling
suggested that homosexuality was the natural out- Association (ACA) Governing Council adopted a
come of a developmental process in some persons. statement opposing reparative therapy. The 2014
Freud suggested that this developmental process ACA Code of Ethics has an ethical principle that
was deeply embedded in the person and thus states the need for professionals to use evidence-
extremely difficult, if not impossible, to change. In based practices in their work; position statements
fact, Freud described an unsuccessful attempt he of the AAMFT also follow this principle. ACA
made to change a woman’s same-sex desire after (2014) also has a second ethical principle that asks
her parents mandated her to go to treatment. counselors not to utilize techniques, modalities, or
Freud concluded his report by stating how unlikely theories where substantial evidence demonstrates
SOCE was to succeed, based on the findings of his that such use can cause harm, regardless of
case. Other mental health professionals who fol- whether a client requests this form of treatment.
lowed Freud, however, continued to follow the
previous paradigm that viewed same-sex desire as
Techniques
innate, pathological, and in need of change.
One of those professionals who challenged Historical medical interventions for changing sex-
Freud’s notions in the years that followed was ual orientation have included cold sitz baths, cas-
Sandor Rado, who is credited with developing the tration, sterilization, and lobotomy. Psychiatric
next model of SOCE. In “A Critical Examination treatments have included hypnosis, electroshock
of the Concept of Bisexuality,” Rando (1940) chal- therapy, and psychoanalysis. As previously noted,
lenged Freud’s suggestions regarding sexual desire, because such forms of treatment are not consid-
conceptualizing same-sex desire as a phobic flight ered ethically sound or empirically effective, nearly
from heterosexual sexual activity following par- all mental health professional organizations have
ents’ prohibitions against childhood sexuality. This cautioned practitioners away from SOCE, and
theory served as the foundation for later reparative many have statements about the need to conduct
therapy models as well as the rationale for classify- empirically supported treatment.
ing homosexuality as a mental illness.
The civil rights movement, political advocacy,
Therapeutic Process
and psychological research conducted by scholars
such as Alfred Kinsey and Evelyn Hooker during Because SOCE has not been shown to be effective,
the 1950s and 1960s provided support for the and nearly all major mental health organizations
potential declassification of homosexuality from have statements condemning or cautioning against

Shapiro, Francine 933
the use of this form of treatment, a discussion of

the therapeutic process is unwarranted. However, SHAPIRO, FRANCINE
because SOCE is potentially harmful for clients,
this section briefly addresses the potential side Francine Shapiro (1948– ), the creator of Eye
effects of this form of treatment. Side effects for Movement Desensitization and Reprocessing
individuals undergoing SOCE may include low (EMDR) therapy, was born in Brooklyn, New York.
self-esteem, self-harm, and suicide. Systemically, A major motivating factor in Shapiro’s develop-
the use of this form of treatment reinforces the ment was the death of her 9-year-old sister when
inappropriate pathologization of LGB persons and Shapiro was 17 years of age. It caused a ripple effect
furthers the marginalization, discrimination, and throughout the rest of her life, especially when
mistreatment of these persons. Shapiro later conceptualized it as a stress-related
condition. This loss became one of the major incen-
Kristopher M. Goodrich and Sarah Meng tives for her investigations into psychoneuroimmu-
See also Sexual Identity Therapy; Sexual Minority
nology, which later evolved into the development of
Affirmative Therapy EMDR therapy. Through the advent of EMDR
therapy, the field was introduced to a new under-
standing of psychopathology and rapid healing
Further Readings called the Adaptive Information Processing (AIP)
American Counseling Association. (2014). ACA code of model.
ethics. Retrieved from http://www.counseling.org/ Shapiro’s early interest was English literature,
Resources/aca-code-of-ethics.pdf and she earned her B.A. and M.A. at Brooklyn
American Psychological Association. (2009). Report of the College in this field. After teaching high school, she
APA task force on appropriate therapeutic responses to entered a Ph.D. program in Literature at New York
sexual orientation. Retrieved from http://www.apa.org/ University. Concurrently, she became interested in
pi/lgbt/resources/therapeutic-response.pdf behavior therapy after reading the works of
Drecher, J. (2002). I’m your handyman: A history of Andrew Salter and Joseph Wolpe. What fascinated
reparative therapies. Journal of Gay & Lesbian her was that a focused, predictable, cause-and-
Psychotherapy, 5(3), 5–24. doi:10.1300/ effect approach to human psychology seemed
J236v05n03_02 compatible with concepts regarding literary char-
Group for the Advancement of Psychiatry. (2012). The acter and plot development. Current research on
history of psychiatry and homosexuality. Retrieved the correlation of reading literature with a robust
from http://www.aglp.org/gap/1_history/ theory of mind and concomitant development of
Hooker, E. (1956). A preliminary analysis of group empathy also indicates that this was excellent
behavior of homosexuals. Journal of Psychology, 42, preparation for her later work in psychology.
217–225. doi:10.1080/00223980.1956.9713035
Shapiro was 30 years old and an “ABD” (“all
Hooker, E. (1957). The adjustment of the male overt
but dissertation”) in English Literature when she
homosexual. Journal of Projective Techniques, 21,
was diagnosed with cancer. She confronted the
18–31. doi:10.1080/08853126.1957.10380742
disease with scholarly dedication and acuity. She
Kinsey, A. C., Pomeroy, W. B., & Martin, C. E. (1948).
Sexual behavior in the human male. Philadelphia, PA:
studied the new field of psychoneuroimmunology
W. B. Sanders.
to learn about the connection between disease and
Kinsey, A. C., Pomeroy, W. B., Martin, C. E., & Gebhard, stress. After her cancer was “cured,” she recog-
P. H. (1953). Sexual behavior in the human female. nized that while the research appeared to have
Philadelphia, PA: W. B. Sanders. merit, there was little known about how people
Lewes, K. (1988). The psychoanalytic theory of male could apply this knowledge to their own lives. She
homosexuality. New York, NY: Simon & Schuster. took this as a challenge to find what methods were
Morgan, K. S., & Nerison, R. M. (1993). Homosexuality available and which of them worked, and ulti-
and psychopolitics: An historical overview. mately to make them available to the general
Psychotherapy: Theory, Research, Practice, Training, public. Over the next decade, she attended cutting-
30(1), 133–140. doi:10.1037/0033-3204.30.1.133 edge trainings and workshops and created interdis-
Smiley, K. A., & Chaney, M. P. (2010). Reparative ciplinary conferences on the subject. She also
therapy. ALGBTIC News, XXXV(2), 6–8. enrolled in the Clinical Psychology Ph.D. program

934 Shapiro, Francine
at the Professional School for Psychological Studies cases—that when she changed the procedures
in San Diego, California, to find out more formally according to the AIP model, there was a simultane-
what was already known. The analytic tools she ous desensitization and cognitive restructuring of
acquired at New York University to evaluate and memories and personal attributions, all of which
understand the deep motives and behavior of char- appeared to be by-products of the adaptive pro-
acters in literature as they unfolded helped her, as cessing of the disturbing memories. This change in
a psychologist, to develop the ability to observe name was the result of a paradigm shift that took
and understand human behavior and character. EMDR therapy beyond its original purpose as a
In 1987, Shapiro took a walk in the park and treatment for posttraumatic stress disorder (PTSD)
discovered a relationship between her eye move- toward becoming an expanded methodology and
ments and cognitive processes. She noticed that new approach to psychotherapy.
when a distressing thought arose, her eyes sponta- Shapiro believes that EMDR therapy and the
neously started moving rapidly back and forth AIP model offer the field a redefinition of pathol-
diagonally. When she brought up the thought ogy and healing. According to this model, the
again, the negative emotion had decreased. She primary cause of many clinical complaints is the
then deliberately moved her eyes while concentrat- presence of unprocessed memories of adverse life
ing on disturbing thoughts, finding again that they experiences. Subsequent research has supported
disappeared and lost their emotional “charge.” this tenet by demonstrating the association of these
This observation became the subject of her doc- experiences with both mental and physical dys-
toral dissertation. During the next 6 months, function. By using EMDR therapy procedures to
Shapiro worked with approximately 70 people to stimulate the intrinsic information-processing sys-
create a protocol that could be standardized and tem, memories are transformed into useful learn-
used to decrease anxiety, which she called Eye ing experiences that result in integration, increased
Movement Desensitization. For her doctoral resilience, new insight, and a redefinition of the
research, she conducted a randomized controlled self. For other psychotherapies, the etiology of
study that was published in 1989 in the Journal of pathology and the change agents are viewed differ-
Traumatic Stress Studies, titled “Efficacy of the Eye ently, such as when a belief, emotion, or behavior
Movement Desensitization Procedure in the is seen as the cause of problems and is specifically
Treatment of Traumatic Memories.” She taught the manipulated to achieve therapeutic effects. In con-
procedure to Joseph Wolpe, one of the fathers of trast, the AIP model views them as the symptoms
behavior therapy, who described the procedure as of clinical problems and guides the use of EMDR
a “breakthrough” and invited her to write a subse- therapy to identify and reprocess the underlying
quent article, which was published in the Journal memories causing the dysfunction. For example,
of Behavior Therapy and Experimental Psychiatry. EMDR can eliminate phantom limb pain because
During that time, she was invited to join the fac- in many cases it is actually an indicator of a physi-
ulty of the Mental Research Institute in Palo Alto, ologically stored unprocessed memory of a trau-
California, where she subsequently became a matic injury. In sum, a basic AIP conceptualization
senior research fellow. is that unprocessed memories are the root of the
Shifting away from a behavioral formulation, diverse symptoms that make up most diagnoses.
Shapiro broadened her scope by including the pro- Shapiro has been a strong advocate for research,
cessing of cognition and emotion rather than sim- routinely encouraging clinicians to use standard-
ply the reduction of arousal, fear, and anxiety. ized measures, document outcomes, and share
Influenced by Peter J. Lang’s work on memory their findings to guide applications and establish
networks, she had begun thinking in terms of best practices. However, many of the early studies
information processing instead of simply desensiti- of EMDR therapy were component analyses that
zation. She developed a new theory of pathology treated only one memory in multiply traumatized
and healing, which eventually became the AIP veterans, or used undiagnosed populations or
model. As Shapiro explained in her 1995 text, Eye untrained clinicians. Not until 1995, when the first
Movement Desensitization became Eye Movement randomized study with appropriate clients who
Desensitization and Reprocessing therapy after she were given the correct amount of treatment was
realized—from the evaluation of hundreds of published in the Journal of Consulting and Clinical

Skinner, B. F. 935
Psychology, was her original study replicated. In See also Behavior Therapy; Eye Movement
1995, Shapiro published her first edition of Eye Desensitization and Reprocessing Therapy; Integrative
Movement Desensitization and Reprocessing: Psychotherapy; Strategic Family Therapy; Strategic
Basic Principles, Protocols, and Procedures. She Therapy
felt that there were a sufficient number of com-
pleted studies awaiting publication to demonstrate Further Readings
EMDR therapy as a valid treatment for PTSD. She
Luber, M., & Shapiro, F. (2009). Interview with Francine
supported an independent group of clinicians to
Shapiro: Historical overview, present issues, and future
monitor standards and trainings that became the
directions of EMDR. Journal of EMDR Practice and
EMDR International Association.
Research, 3, 217–231. doi:10.1891/1933-3196.3.4.217
In the same week that Shapiro’s Eye Movement Shapiro, F. (1989). Efficacy of the eye movement
Desensitization and Reprocessing: Basic Principles, desensitization procedure in the treatment of traumatic
Protocols, and Procedures was published, the memories. Journal of Traumatic Stress, 2, 199–223.
bombing of the Alfred P. Murrah Federal Building doi:10.1002/jts.2490020207
in Oklahoma City, Oklahoma, occurred. She Shapiro, F. (2001). Eye movement desensitization and
responded to a call for assistance for the local reprocessing: Basic principles, protocols and
therapeutic community by offering free EMDR procedures (2nd ed.). New York, NY: Guilford Press.
training and survivor assistance. This marked the Shapiro, F. (2007). EMDR, adaptive information
start of the EMDR Humanitarian Assistance processing, and case conceptualization. Journal of
Programs (HAP), a nonprofit organization that has EMDR Practice and Research, 1, 68–87.
since expanded its mandate to treat people in need doi:10.1891/1933-3196.1.2.68
worldwide. Shapiro believes that through HAP Shapiro, F. (2013). Getting past your past: Take control
clinicians can forge bonds that transcend their eth- of your life with self-help techniques from EMDR
nicities, countries, and ideologies. These are the therapy. New York, NY: Rodale Books.
bonds that can assist in healing the trauma and Shapiro, F. (2014). The role of eye movement
pain that usually would lead to unending cycles of desensitization and reprocessing therapy in medicine:
violence and suffering. Humanitarian assistance Addressing the psychological and physical symptoms
programs have now become an integral part of the stemming from adverse life experiences. Permanente
national and regional EMDR therapy organiza- Journal, 18, 71–77. doi:10.7812/TPP/13-098
tions throughout the United States, Latin America,
Europe, Asia, and Africa. Website
Shapiro is the executive director of the EMDR
EMDR Humanitarian Assistance Programs: http://www
Institute and the founder and president emeritus
.emdrhap.org
of HAP. Among other awards, she is a recipient of
the American Psychological Association Division
56 Award for Outstanding Contributions to
Practice in Trauma Psychology, the Distinguished
Scientific Achievement in Psychology Award pre- SKINNER, B. F.
sented by the California Psychological Association,
and the International Sigmund Freud Award for The modern psychological theorist Burrhus
Psychotherapy presented by the City of Vienna Frederic Skinner (1904–1990), known to col-
in conjunction with the World Council of leagues and the public as B. F. Skinner, was the
Psychotherapy. EMDR therapy is now recognized originator of operant conditioning, a way of shap-
worldwide as an empirically validated treatment ing the behavior of white rats and pigeons through
of trauma. In 2013, the World Health Organization “schedules of reinforcement.” The organism (rat or
practice guidelines stated that EMDR therapy pigeon) was contained in the “operant chamber,”
was one of only two psychotherapy approaches known as the “Skinner Box,” and given the oppor-
recommended for the treatment of PTSD across tunity to press a lever, the operation or operant,
the life span. which delivered a food pellet. The schedule of food
delivery that determined the rate of lever pressing
Marilyn Luber was measured by a “cumulative recorder.” This

936 Skinner, B. F.
device marked the frequency of lever pressing and Skinner defended his doctoral dissertation, “The
became the basis for the science of behavioral Concept of the Reflex,” in 1931, arguing that the
analysis in the 1930s. Skinner believed that posi- mental reflex was always simply behavior and
tive reinforcement could also shape human behav- referring to the synapse as a philosophical concept.
ior and fashion a better way of living. The prestigious Harvard Junior Fellowship allowed
Skinner spent his boyhood in the small railroad him to expand his work on behavioral science into
town of Susquehanna, Pennsylvania, about 30 miles his first book, The Behavior of Organisms, which
south of the New York state line. His father, was published in 1938. By then, he had married
William, was a lawyer for the Erie Railroad, who Yvonne Blue and had become the father of the first
had political aspirations that never materialized. of two girls, Julie and Deborah. In 1936, he
His mother, Grace, was a more important parental accepted his first academic position at the University
influence on young Skinner, continually reminding of Minnesota. While at the University of Minnesota,
him to be careful of what people would think— Skinner became involved in “Project Pigeon,” a
hence, making the young man acutely aware of his project that involved positively reinforcing pigeons
own behavior and the behavior of others. to guide missiles or bombs in an effort to help the
While growing up in Susquehanna, Skinner had United States win World War II. After achieving
the freedom to roam the countryside and devise tremendous accuracy, he unsuccessfully tried to
toys such as roller skate scooters, seesaws, sleds, convince the National Defense Research Committee
and a cannon that shot potatoes over neighbors’ that pigeon guidance was more accurate than the
houses. He excelled in the local small high school, gyroscope system that had been developed during
where he was introduced to Darwinian evolution World War I. Nonetheless, Project Pigeon aug-
and the theory of natural selection, which he mented Skinner’s conviction that a science of
enthusiastically endorsed. Skinner enjoyed reading, behavior could be of value in human affairs—even
especially adventure stories in which the characters if indirectly.
invented devices or contraptions that altered their The transfer of reinforcement conditioning into
environments—Jules Verne’s Mysterious Island the human social world marked a momentous shift
and Daniel Defoe’s Robinson Crusoe have been in Skinner’s focus. It eventually brought him into
reported to be his favorites. He even fashioned his contention with writers (e.g., Robert Wood Krutch
own boyhood Skinner box, a small enclosed space and Ayn Rand) and psychologists, who believed
where he could read and dream. that Skinnerian behavioral engineering of humans
After leaving Susquehanna, Skinner became an threatened traditional American beliefs about free-
undergraduate at Hamilton College in Clinton, dom and individual choice. Yet Skinner shared
New York. Suffering a lonely and miserable fresh- broad humanist values with these individuals.
man year, he was befriended by a chemistry profes- Whatever their essential disagreements, they all
sor whose home was a mecca for intellectuals such wanted to help people live better lives. They were
as Ezra Pound and Robert Frost. Frost read one of all altruistic.
Skinner’s short stories and encouraged him to be a In 1944, Skinner began work on another inven-
writer. After graduating in 1926, he returned to tion—the “Baby Tender” or “Aircrib”—the first
live with his parents, who had moved to Scranton, that directly involved humans rather than pigeons.
Pennsylvania, and tried to write the great American Indeed, the Baby Tender became the infant home
novel. He discovered that he had nothing to say, for his second daughter, Deborah, for the first
moved to Greenwich Village for a brief time, gave 2 years of her life. Skinner had noted that pigeons
up writing, and enrolled as a graduate student in could be handheld and restrained but still be free
psychology at Harvard. Almost immediately, he to peck keys. He recalled that his first daughter,
was drawn to the physiologist and Harvard profes- Julie, had been restrained by diapers and night-
sor William Crozier, who believed that real science gowns and that she slept on a thick mattress
involved controlling experimental variables and zipped into a flannel blanket—a virtual prisoner in
avoided all metaphysical assumptions. These con- her own garb. But the Baby Tender allowed
cepts became the theoretical basis for Skinner’s Deborah, clad in only a diaper, to have her own
behavioral science. enclosed space with a large window and a stretch

Skinner, B. F. 937
canvas bottom that could be removed and cleaned unsuccessfully, to defend his position. He remained
in seconds. The crib was equipped with thermo- unmoved by critics. In 1954, he visited a private
statically filtered air that prevented her skin from school in Cambridge that his daughter Deborah
becoming contaminated with urine and sweat. Her attended. Observing that the teacher gave an
mother could remove her from the Baby Tender for assignment and then checked on the students to see
play or feeding at any time. Otherwise, she was how they were proceeding, Skinner noticed that
comfortable and safe in her special crib. He sent an some students finished quickly and were bored,
article, “Baby Care Can Be Modernized,” to Ladies whereas others were struggling to even get started.
Home Journal, which published it as “Baby in a In an effort to devise a better way of teaching,
Box” in October 1945. It brought Skinner national Skinner developed a simple teaching machine in
attention with two diverging reactions. Some criti- which a plastic slider covered the correct answer
cized the device for restricting mother and child until the student wrote the correct answer and then
contact; others saw the crib as a progressive inven- moved to the next questions. The questions were
tion freeing both the baby and the mother. sequenced with small gradations of difficulty so
At the end of World War II, Skinner left the that most students had little problem with moving
University of Minnesota for Indiana University, ahead in little steps. Getting the correct answer
where he chaired the psychology department from was the reinforcement that elicited movement of
1946 to 1947. He returned to his alma mater, the slider to the next question. Although
Harvard, as full professor in 1948, where he International Business Machines and several other
remained until his death in 1990. He remained large companies contracted Skinner to build a
fully involved in intellectual endeavors, publishing teaching machine, all rejected this slider model. In
seven books and 30 articles. In 1971, his contro- 1968, Skinner wrote The Technology of Teaching;
versial book Beyond Freedom in Dignity appeared however, it was not widely read among the general
and created a firestorm of criticism. Skinner public. Later, Skinner agreed that the computer
argued that only societies shaped by behavioral could do a far better job with programmed instruc-
engineering could allow humanity to survive in a tion than his simple slider machine.
world increasingly fixated on individual freedom At the end of his life, suffering from leukemia,
while looming catastrophes such as overpopula- Skinner believed that human beings had passed the
tion, nuclear war, and ecological destruction grew point of no return. Humanity had failed to imple-
ever nearer. As in his 1948 novel Walden Two, ment a science that could ensure they had a future.
which created a fictional behaviorally engineered He often noted that many psychologists under-
community, this best seller maintained that con- stood that the brain originated mental life. But he
cepts such as freedom, consciousness, and God argued that the brain was part of the body, and
were simply entrenched myths that blinded human- once you focus on the body, you should be focused
kind from understanding that only a behavioral on behavior and seek to change it.
science could save the human species. But some
psychologists, such as Carl Rogers, who had Daniel Bjork
debated Skinner earlier in 1956, asked if scientists
See also Behavior Therapies: Overview; Behavior
were to control the future of humankind, who Therapy; Cognitive-Behavioral Therapies: Overview;
would control the scientists? The linguist Noam Cognitive-Behavioral Therapy; Ellis, Albert; Rational
Chomsky, who reviewed Beyond Freedom and Emotive Behavior Therapy; Rogers, Carl
Dignity for the New York Review of Books,
insisted that a genuine scientist would not dismiss
the experimental study of self-consciousness and Further Readings
mental states. Skinner, B. F. (1938). The behavior of organisms.
In September 1971, Skinner appeared on the New York, NY: Appleton-Century-Crofts.
cover of Time with the clearly negative caption Skinner, B. F. (1948). Walden two. New York, NY:
“We Can’t Afford Freedom.” He also appeared on Macmillan.
a number of television talk shows, such as William Skinner, B. F. (1953). Science and human behavior.
Buckley’s Firing Line, where he tried, mostly New York, NY: Macmillan.

938 Social Cognitive Theory
Skinner, B. F. (1958). Verbal behavior. New York, NY: under the title of social learning theory. Social
Appleton-Century-Crofts. learning theory represented a wide range of view-
Skinner, B. F. (1968). The technology of teaching. points, and it became increasingly apparent to
New York, NY: Appleton-Century-Crofts. Bandura that his approach, which for some time
Skinner, B. F. (1971). Beyond freedom and dignity. had included psychosocial phenomena and self-
New York, NY: Knopf. regulatory processes that extended beyond learn-
ing principles, was not adequately covered by the
descriptive label of social learning theory. He
replaced the ill-fitting social learning theory label
SOCIAL COGNITIVE THEORY that had previously designated his work with the
more general label of social cognitive theory. In the
Social cognitive theory is a comprehensive theory preface to his 1986 book, Bandura acknowledges
of human agency that examines the interlinkages the importance of both the social and cognitive
between persons, behaviors, and environments. aspects of human behavior, affect, and motivation.
From this perspective, human behavior is viewed One of his first collaborations was at Stanford
as the result of the interplay between intrapsychic University with Richard Walters, which led to two
factors within individuals and the broad range of major books—Adolescent Aggression (1959) and
social environments that impinge on them: (a) those Social Learning and Personality Development
environments that are imposed on them, (b) those (1963). In the latter book, Bandura and Walters
they select, and (c) those they create. This theory presented a comprehensive account of social learn-
was systematically articulated by Albert Bandura ing theory that addressed the development and
in his 1986 book Social Foundations of Thought modification of human behavior—moving from a
and Action: A Social Cognitive Theory. Social cog- behavioristic approach to a more cognitively based
nitive theory has been applied in a variety of areas, theory that took account of the social context in
including clinical, counseling, and educational set- which behavior was performed. Even in the 1960s,
tings; family processes; aggressive behavior; gender the cognitive emphasis in Bandura’s approach was
development; and morality—in fact, in almost evident in his classic Bobo doll studies on children’s
every area of human conduct. In its application in emulation of aggressive models and in his 1963
therapeutic and counseling contexts, in keeping book with Walters, Social Learning and Personality
with the conceptualization of human functioning Development. In his view of observational learn-
within the triadic model of reciprocal determinism, ing, for example, more attention was given to cog-
interventions are directed at personal, environmen- nitive processes than was typical in most social
tal, and behavioral factors. From this perspective, learning theory approaches. He continued to
an intervention focusing on altering aggressive develop the role of cognitive processes in human
behavior in schools, for example, would involve development and change; these processes were not
teachers and counselors to modify emotional states disembodied from the experience of the individual
and correct faulty beliefs about aggressive behav- but were embedded within the ongoing experiences
ior (personal factors), improve interpersonal skills of the individual. This approach paved the way for
and ways of handling interpersonal conflict (behav- his placing human agency at the cornerstone of
ioral factors), and modify classroom and school social cognitive theory. People were not only influ-
structures that contribute to aggressive behavior enced by their environments, but they also selected
(environmental factors). and created them as they did their own destiny.
Bandura introduced the term self-efficacy into the
literature in 1977 in his publication “Self-Efficacy:
Historical Context
Toward a Unifying Theory of Behavioral Change”
Although social cognitive theory only dates to and further expounded self-directedness in human
1986, with the publication of Bandura’s book functioning and the self-regulatory processes gov-
Social Foundations of Thought and Action: A erning human behavior in his 1997 book Self-
Social Cognitive Theory, it had been in the making Efficacy: The Exercise of Control.
for many decades. Prior to this publication, Bandura’s early work bore the seeds for the later
Bandura’s writings and research had been captured development of social cognitive theory, in which

Social Cognitive Theory 939
human functioning is conceived within the triadic There is no fixed manner in which these three
model of reciprocal determinism, involving the sources of influence are expected to interact with
interplay of personal, behavioral, and environmen- one another. Although the interaction among the
tal factors. This, more cognitive approach to three sources of influence is bidirectional, the influ-
understanding human behavior also gave rise to ence is not necessarily equal among sources, nor is
the role of the self in guiding the course of human it fixed. The way these variables interact with one
development, adaptation, and change. The impor- another may vary in different contexts and at differ-
tance of self reflection, self-regulatory processes, ent phases in development. For example, in family
and self-organizing individuals who were not only contexts where rigid rules are enforced, there is little
reactive to their environmental circumstances but leeway for personal factors to exert a strong influ-
also proactively shaped their life course within ence on individual behavior. Similarly, at the societal
sociocultural constraints was emphasized. In a level, where there are authoritarian rules in place
departure from traditional behavioristic approaches and many sociocultural constraints, there is little
to human functioning, Bandura acknowledged, room for developing personalized life trajectories. In
along with his predecessor William James, the role contrast, in more egalitarian families and societies,
of introspection and human thought in under- where less rigid lifestyles are prescribed, individuals
standing human behavior. Social cognitive theory are better able to personalize and direct their own
also differs from biological theories that emphasize life course. Therefore, the manner in which these
the role of evolutionary forces. Instead, biological three sources influence the course of development
factors are viewed as interacting determinants of depends on the activities involved, the situation, and
human behavior within the model of reciprocal sociostructural constraints and opportunities. It is
determinism, not its sole determinants. And, as apparent that this model extends the conception of
Bandura and Bussey noted in their 1999 article human development and functioning beyond any
“Social Cognitive Theory of Gender Development simplistic shaping by the environment. People are
and Differentiation,” environmental innovations active contributors to their own development. Even
and technological change create selection pressures in the most oppressive of circumstances, individuals
for evolutionary change as much as evolved bio- are able to exert some influence over their life
logical attributes dictate social behavior; both fac- course. The environment is not a monolithic struc-
tors influence each other bidirectionally. ture imposed on people that demands conformity.
Rather, people are able to select alternate environ-
ments and even create their own environments.
People who are shunned by some sections of society
In the social cognitive theory approach, greater do not wait until similar others appear in their
attention is directed toward cognition than in the immediate environment. Instead, they seek out oth-
earlier, more behavioristic approaches of social ers who share similarities with themselves, and
learning theory. While behavior change is at the some may even embark on changing societal views.
cornerstone of any therapeutic intervention from Although this approach recognizes individual and
this perspective, achieving behavioral modification sociostructrual constraints in human adaptation
requires not only behavior change but also cognitive and change, it also recognizes the agentic capabili-
change, along with a consideration of the social ties of individuals to direct and shape their life tra-
context in which the behavior occurs. As already jectories. From the perspective of this integrated
stated, this approach views the development, main- theory, environmental influences operate through
tenance, and modification of human functioning the self-system mechanisms to influence behavior.
within the triadic model of reciprocal causation. It The manner in which environmental influences are
is postulated that personal factors, environmental synthesized determines future action, rather than
factors, and behavior influence one another bidirec- environments acting in some unspecified omnipo-
tionally. The personal factors comprise cognitive, tent manner. Agentic control is largely exercised
affective, and biological events; the environmental through the self-system mechanisms.
factors refer to a range of social influences that Observational learning plays a central part in
people encounter in their daily lives; and behavior human development and change. Individuals can
encompasses the broad range of activity patterns. acquire new skills and change old habits through

observing others, without having to undergo trial- of influence to affect behavioral outcomes. These
and-error learning or receive response conse- modes of influence and the major psychological
quences for their performances. By observing processes of social cognitive theory are described in
others and observing the outcomes associated with the following subsections.
different performances, people learn those activi-
ties that are valued by others and that lead to Modes of Influence
rewarding outcomes and those that do not. In this
way, individuals select suitable models consistent Modeling
with their goals and the outcomes they hope to Modeling is a major mode for the acquisition of
achieve. The self system is further evident in peo- information and for behavior change. Bandura’s
ple’s self-regulatory capabilities. Internal standards research on modeling has been crucial in delineat-
are developed from a wide source of environmen- ing the psychological processes associated with
tal influences and serve as a gauge against which to learning from observing models. Consistent with
self-evaluate the anticipated behavioral enactment. the cognitive emphasis of this theory, Bandura
People act in ways that bring anticipated self- specified attentional, retentional, production, and
satisfaction and shy away from those activities that motivational processes that are involved in deter-
bring self-disapproval. In this way, people are mining what is learned from observing models and
motivated to behave in ways that are congruent what aspects of those performances are repro-
with their internal standards. This self-directness is duced. His early research shunned the idea that
central to social cognitive theory. In keeping with modeling is mere mimicry. People are selective in
this approach is the self-conception of self-efficacy what they learn from models and in what they
beliefs, in which an individual’s behavior is moti- decide to emulate. In a therapeutic context particu-
vated not only by societal and personal acceptance larly, similarity between the model and the observer
but also by whether one believes in one’s own is one factor that leads to heightened observational
capabilities to behave in a certain way independent learning and also reproduction of the modeled
of the actual skill levels attained. Perceived behavior. Modeling can be used to teach new skills,
self-efficacy refers to a person’s belief in his or her such as social skills, or to reduce anxiety-related
ability to effectively perform a specified activity or disorders, such as phobias.
to think in a particular way.
Enactive Experience
Major Concepts Enactive experience involves abstracting the
The focus on human agency in this theory means evaluative outcomes resulting from one’s actions.
that self-regulatory processes are pivotal in under- Evaluative outcomes for performing different
pinning human behavior. These self-regulatory behaviors provide a rich source of information
processes, while individually derived, are informed about the social sanctioning of different types of
by the social environment. Different individuals conduct. Not only do different behaviors lead to
who experience the same environment may develop different outcomes, but different people respond to
different judgmental aspects of the self-regulatory the same behavior differently, with these outcomes
processes depending on their experiences and how often varying in different contexts. People extract,
these experiences are synthesized. People are not weigh, and integrate this diverse information to
simply conduits of their environmental experiences; form their own expectations regarding the out-
they are active participants in shaping and selecting comes of different types of conduct.
their experiences, which contribute to the range of
Direct Tuition
variability in human functioning. The actual pro-
cesses, however, remain invariant across individu- Direct tuition is an instructional method for pro-
als. The modes of influence that lead to acquiring viding information about ways to behave in differ-
new skills and behavior can also be used to modify ent situations. It is a method for informing people
behavior. From this theoretical viewpoint, it is about the diverse forms of behavior and their suit-
possible to identify modes of influence as well as ability in different contexts. Tutoring can also be
the psychological processes that enable those modes used to generalize the informativeness of specific

Social Cognitive Theory 941
modeled behavior and behavior outcomes for enact- competencies, and resilient self-beliefs that will
ment in other contexts. It is most effective when it is enable them to effectively exert control over
based on shared values and weakened when what is their life course. The different classes of determi-
being taught is contradicted by what is modeled. nants and mediating mechanisms, which have
already been discussed, come into play in vary-
Regulators of Conduct ing ways in the therapeutic context, depending
on the problem being addressed.
Social Outcome Expectations Knowledge structures are scripts and self-sche-
From the three modes of influence described mata for behavioral enactment and rules of action
above, individuals develop their social outcome that enable the development of complex behavioral
beliefs. These beliefs are not simply transmitted in competencies. These structures and competencies
a wholesale manner but are constructed from these are acquired, adapted, and changed through obser-
three modes of influence. According to social cog- vational learning, direct tuition, and enactive expe-
nitive theory, these social outcome expectations rience, as discussed previously. Apart from address-
influence behavior through their informational ing the acquisition and modification of knowledge
and motivational functions. People are motivated structures and competencies in the therapeutic
to perform those behaviors for which they antici- context, it is necessary to address the role of regu-
pate receiving social approval and to shun those lators and motivators of human functioning, which
behaviors for which they anticipate receiving are an integral part of social cognitive theory.
social disapproval. These multilevel factors operate mainly through
forethought. The ability to anticipate potential out-
Self-Outcome Expectations comes for pursuing a particular course of action is
another way in which behavior is regulated and
Over the course of development, once personal modified. The anticipated outcome expectancies
standards for conduct are developed, self-sanctions include external outcome expectancies, vicarious
are increasingly used to regulate conduct. The stan- outcomes, and self-evaluative reactions. It is the
dards provide the guidance, and self-sanctions pro- interplay of these different types of outcome expec-
vide the motivation to behave in accord with the tancies that influences human functioning.
standards. Anticipation of self-censure for violating Apart from therapeutic remediation to build
the standards aligns conduct with standards, whereas skills and competencies, weak self-efficacy beliefs
behaving in ways consistent with the standards contribute to poor performances. There are four
brings self-satisfaction and a sense of self-worth. major sources that inform self-efficacy beliefs, and
these can be used to strengthen them: (1) enactive
Self-Efficacy Beliefs
mastery, (2) vicarious experience, (3) verbal persua-
Perceived self-efficacy refers to personal beliefs sion, and (4) physiological and affective states. The
about performing specific actions in particular first mode of influence, involving enactive mastery,
contexts as well as exercising control over thought provides the most authentic evidence of a person’s
processes, motivation, affect, and physiological capabilities as this requires successful performance
states. These self-beliefs are linked to specific of the behavior to be mastered. The more individu-
domains of functioning and are not global, trait- als are successful in their performances, the greater
like assessments of capabilities. the boost in confidence about their capabilities.
However, in situations where skills need to be
acquired or anxieties overcome, guided mastery is
Techniques
required for individuals to develop the required
The techniques that are used in treatment derive skills or to overcome self-debilitating thoughts, as
directly from the theoretical constructs of social in the case of phobic behavior. Enabling conditions
cognitive theory. The major aim of therapeutic that utilize mastery aids, joint performance of
intervention from the social cognitive theory intimidating activities with a therapist, and break-
perspective is not simply to remedy a particular ing down intimidating tasks into manageable units
problem but to enable people to surmount of easily mastered steps help teach skills and boost
future challenges by enhancing their knowledge, confidence. Modeling can also be used to increase

competencies and people’s beliefs in their compe- own thoughts and behavior and over the events in
tencies to carry out the modeled activities. Vicarious their lives, is necessary. Self-efficacy is the process
experience, which involves seeing people who are that underpins the effectiveness of any form of treat-
similar to oneself master new skills or overcome ment. From the social cognitive theory perspective,
fears, gives observers the belief that they too can a range of treatments can be used. Intervention is
perform successfully, thereby raising their self-effi- not confined to individual or group interventions
cacy beliefs. Verbal persuasion, although not as but can occur at the societal level. Modeling diverse
influential as enactive mastery in strengthening behaviors through television drama series with vary-
self-efficacy beliefs, can also be used to boost self- ing levels of acceptance can change group behavior
efficacy beliefs. When others convey confidence in and thought patterns on a large scale. At the indi-
a person’s abilities rather than doubt, self-efficacy vidual level, therapeutic programs can be tailored to
beliefs can be strengthened, particularly when the individual needs, with the major goal being that of
persuasory information is realistic. By helping to equipping the person with sociocognitive skills to
allay self-doubts, people are able to strive more to deal effectively with future events that may arise.
develop new skills. Persuasory efficacy information
can be provided in the form of evaluative feedback Kay Bussey
when a skill is being acquired. The manner in
See also Bandura, Albert; Cognitive-Behavioral Group
which the information is framed is crucial for its Therapy; Cognitive-Behavioral Therapies: Overview;
influence on self-efficacy beliefs and self-directed Mindfulness-Based Cognitive Therapy; Motivational
change, particularly when advocating health- Interviewing
promoting behavior. The final source for creating
and altering self-efficacy beliefs is physiological
arousal and affective states. Somatic indicators and Further Readings
mood are often used to inform self-efficacy beliefs Bandura, A. (1977). Self-efficacy: Toward a unifying
in various domains, including behavioral accom- theory of behavioral change. Psychological Review,
plishments, health functioning, and coping with 84, 191–215. doi:10.1037/0033-295X.84.2.191
stress. When people focus on their physiological Bandura, A. (1986). Social foundations of thought and
stress reactions, less attention is directed to their action: A social cognitive theory. Englewood Cliffs,
performance. In addition, interpretation of these NJ: Prentice Hall.
somatic indicators can influence self-efficacy Bandura, A. (1997). Self-efficacy: The exercise of control.
beliefs. For example, the more that anxiety during New York, NY: Freeman.
a mathematical task is ascribed to lack of ability Bandura, A., Ross, D., & Ross, S. A. (1961). Transmission
rather than to task difficulty, the more debilitating of aggression through imitation of aggressive models.
the effect on performance through weakening self- Journal of Abnormal & Social Psychology, 63,
efficacy beliefs and creating self-doubts. 575–582. doi:10.1037/h0045925
Bandura, A., Ross, D., & Ross, S. A. (1963). Imitation of
film-mediated aggressive models. Journal of Abnormal
Therapeutic Process & Social Psychology, 66, 3–11. doi:10.1037/h0048687
Bandura, A., & Walters. R. H. (1959). Adolescent aggression.
There is no set time or number of sessions required
New York, NY: Ronald Press.
for the therapeutic process using social cognitive
Bandura, A., & Walters, R. H. (1963). Social learning
theory principles. There can be as few as two or and personality development. New York, NY: Holt,
three sessions and as many as a number of sessions Rinehart, & Winston.
lasting over several months. The aim of therapeutic Bussey, K. (2011). The influence of gender on students’ self-
intervention based on social cognitive theory is to regulated learning and performance. In B. J. Zimmerman
develop competence and self-belief in one’s compe- & D. H. Schunk (Eds.), Handbook of self-regulation of
tence to perform the newly acquired behavior. learning and performance (pp. 426–441). New York,
Acquisition of new behavioral repertoires and NY: Routledge.
thought patterns is not sufficient for termination of Bussey, K., & Bandura, A. (1999). Social cognitive theory
the therapeutic process. In addition, the develop- of gender development and differentiation. Psychology
ment of the ability for self-regulative change, where Review, 106, 676–713. doi:10.1037/0033-295X.106
individuals are able to exercise control over their .4.676

Solution-Focused Brief Family Therapy 943
innate strengths and previous successes.

SOLUTION-FOCUSED BRIEF Accordingly, it is not necessary to understand the
FAMILY THERAPY origins of the problem, how the problem devel-
oped, the nuances of what it looks like, or even
Solution-focused brief family therapy (SFBFT) is a how the problem is maintained in order to fix it. In
brief, future-oriented, goal-directed, and pragmatic fact, SFBFT believes that focusing on the problem
approach to family therapy and family systems will tend to maintain the problem and intention-
work. This therapy is focused on identifying and ally maintains a future-oriented approach that
punctuating families’ strengths to develop solu- seeks to avoid problem-focused talk. These foun-
tions to client-identified concerns. Treatment is dational beliefs keep the therapy present and
typically short-term, and SFBFT has a growing future oriented with the goal of cocreating solu-
evidence base demonstrating its efficacy with a tions to the “problem” as the family identifies it.
wide array of demographics and symptomatology. These solutions, no matter how small, build
momentum toward a realistic future that the fam-
ily has defined as a better life.
Historical Context
SFBFT was developed by Steve de Shazer, Insoo Major Concepts
Kim Berg, and their colleagues at the Brief Family
A number of core solution-focused tenets are the
Therapy Center in Milwaukee, Wisconsin, during
foundation of the SFBFT approach. The major
the 1980s through watching hundreds of tapes,
concepts include the following: if it isn’t broke,
identifying what was working, and doing more of it.
don’t fix it; if something is working, do more of it;
Both de Shazer and Berg had been trained at the
if it’s not working, do something different; small
Mental Research Institute (MRI) in Palo Alto,
steps can lead to large changes; the solution is not
California, and were greatly influenced by the
directly related to the problem; the language to
MRI’s pragmatic and brief way of conducting
describe a solution is different from the language
therapy. What emerged was a therapy that focuses
to describe a problem; no problem happens all the
not on problems but on solutions and that has a
time, there are always exceptions; and the future is
strengths-based orientation, a present and a future
both created and negotiable.
focus, and a collaborative discovering of what is
currently working and what can work in the future.
From its inception, SFBFT was applied to families at If It Isn’t Broke, Don’t Fix It
an inner-city outpatient mental health center. Today,
This refers to the fact that SFBFT focuses only
SFBFT is widely used in couples and family work.
on addressing what the family identifies as the
problem. In this way, sessions are kept brief and
Theoretical Underpinnings don’t detour into a morass of past or problem-
oriented talk.
SFBFT falls under the social-constructivist metathe-
ory as it believes that language used by the client
and within the client’s social milieu is responsible If Something Is Working, Do More of It
for the construction of the client’s reality. SFBFT The counselor’s job is to focus on and punctu-
does not operate from a traditional theoretical ate the family’s strengths. This tenet reminds coun-
conceptualization that endeavors to explain how selors to believe in the inherent capabilities of a
systems and subsystems interact within families to family and to allow the family to define and decide
maintain problem behaviors; instead, SFBFT is what is working and what will work in the future.
rooted in the belief that families are healthy and
competent, know what is best for them, and have
If It’s Not Working, Do Something Different
within them the resources to make the changes
they need to make. As a result, SFBFT believes that This tenet reinforces that SFBFT does not blame
the goal of therapy is not to solve or eradicate the family when things do not go well. When inter-
problem behaviors but to capitalize on the family’s ventions do not work or when family patterns

944 Solution-Focused Brief Family Therapy
persist that do not lead to change, the counselor used: Instead of deficits, the family talks about
does not explore why. Rather than engaging the strengths; instead of a problem, there are solutions;
family around the problem or dysfunction, the instead of remaining mired in conflict, there are
counselor maintains the focus on what did work memories of successes.
and continues to cocreate solutions that may work
in the future. No Problem Happens All the Time,
There Are Always Exceptions
Small Steps Can Lead to Large Changes According to SFBFT, problems can change and
The focus in SFBFT is always on making small never happen all the time. This tenet focuses the
changes that move the family in the right direction. counselor on finding exceptions to problems no
This tenet reflects the belief that the counselors are matter how immutable they seem, leading to coun-
not the authority on what needs to happen and, as selors actively listening for, punctuating, and
a result, do not push for larger scale change; rather, encouraging the finding of exceptions to problems.
they help the family harness its strengths to make
small changes that the family identifies as useful. The Future Is Both Created and Negotiable
SFBFT believes that small changes will lead to
additional changes that naturally build momentum This tenet reflects the underlying philosophy
toward larger changes. that people are not locked in a set of behaviors but
are participants in constructing their reality. In this
way, the world is a hopeful place where clients are
The Solution Is Not Directly capable of actively changing their lives. This tenet
Related to the Problem focuses treatment on working toward a realistic
This tenet exemplifies SFBFT’s true departure future that the family defines as a better life.
from most therapies’ logic models. Typically, thera-
pies start with an examination of the problem to
Techniques
understand how it was created or maintained.
Once that is understood, the counselor can work In SFBFT, several core techniques are utilized to
to do something differently that will stop the facilitate client movement toward strength-focused
mechanisms that maintain it. SFBFT counselors and solution-oriented interactions. The major
don’t believe that understanding the problem or its techniques are miracle questions, scaling, and lis-
history is helpful in solving it. Furthermore, they tening for, finding, and punctuating solutions and
don’t believe that the path to change has to have exceptions.
anything to do with the problem. The path to
change is rooted solely in helping the family move Miracle Questions
forward by enacting solutions that capitalize on its
inherent strengths. In this way, the family begins to The miracle question is a technique that gets
change, and its ability to be healthy in any direc- families to begin to think in terms of solutions. The
tion is enhanced. counselor asks the members of the family to imag-
ine that a miracle has happened and the problem
that led them to the counselor’s office has disap-
The Language to Describe a Solution Is Different
peared overnight. The counselor then asks them to
From the Language to Describe a Problem
identify one thing that they notice that is different
The language of problem-focused talk tends to now that this miracle has occurred. By having fam-
be deficit oriented, rooted in the past, and immuta- ily members describe one small thing that is differ-
ble. The language of solutions tends to be the oppo- ent after the miracle has occurred, the counselor is
site; it tends to be positive, to be future oriented, getting them to begin to talk in the language of
and to imply that change is possible. The very core solutions and set manageable, solution-focused
of this approach involves reframing the family’s goals. This technique can be applied to the entire
problem by continually changing the language family, and the counselor then elicits collaboration

Solution-Focused Brief Family Therapy 945
or consensus on goals the family would like to Therapeutic Process

work toward. If the miracle question is addressed
As the name implies, SFBFT is brief and typically
to a family member individually, it can be used to
works with whoever attends the session. Counselors
help all members of the family begin to notice and
begin with a positive, solution-oriented stance that
support the individual in attaining these manage-
seeks to collaboratively determine both the pace
able goals.
and the content of the session. From the beginning,
SFBFT counselors seek to shift the focus of the
Scaling conversation from problem-focused talk to solu-
Scaling is utilized as both an assessment of tion-focused talk by asking for and intentionally
progress in the session and an intervention itself. In listening for statements about previous or current
practice, it involves asking the family members to solutions or exceptions to the problem. As strengths
scale from 1 to 10 (where 10 indicates that every- and previous solutions are developed, the session
thing is perfect and 1 is the worst it can possibly moves to the current problem as the family defines
be) where they are at the moment and where they it, occasionally using scaling techniques to identify
would like to be. That number then serves as the the family’s view of the severity of the problem.
assessment of how the family is doing. As an inter- From there, the counselor seeks to develop a mea-
vention, the counselor helps the family members surable goal of what needs to happen for the fam-
develop their answer and then asks them what ily to feel that it is making progress. After the goal
would be different if they were one number higher. is established, the session is focused on cocreating
In this way, the counselor facilitates solution- with the family solutions that are practical and
oriented talk and gently pushes the family toward reasonable for the members to implement.
thinking about goals. The counselor can also use Throughout this process, the counselor resists
the technique over multiple sessions and compare engaging the family system in accounts of what is
the family’s change across sessions. If the family’s not working and is actively engaged in finding
numbers increase, the counselor will ask, “How solutions and exceptions to the problem behaviors.
did you do that?” and build on the success. If the This parallels other family systems’ focus on not
family’s numbers do not change, the counselor will becoming enmeshed in dysfunctional family pat-
ask, “How did you manage to keep your score the terns and continually focuses treatment on work-
same?” And if the numbers decrease, the counselor ing toward small successes that allow clients to
can ask, “How did you manage to not have the improve their lives.
number fall even further?” In each instance, the John Dewell
counselor is attempting to have the family mem-
bers discuss in detail what they are doing right and See also Brief Therapy; de Shazer, Steve, and Insoo Kim
where their strengths lie. Berg; Solution-Focused Brief Therapy; Strategic Family
Therapy; Structural Family Therapy; Systemic Family
Listening For, Finding, and Punctuating Therapy
Solutions and Exceptions
This is a consistent part of the counselor’s work Further Readings
in SFBFT. The counselor is actively shaping and de Castro, S., & Guterman, J. T. (2008). Solution-focused
directing the session by listening for signs of previ- therapy for families coping with suicide. Journal of
ous solutions, finding exceptions to problems, and Marital & Family Therapy, 34(1), 93–106. doi:10
emphasizing them with enthusiasm and support. In .1111/j.1752-0606.2008.00055.x
this way, treatment is always moving away from Conoley, C. W., Graham, J. M., Neu, T., Craig, M. C.,
problem-oriented talk and working toward devel- O’Pry, A., Cardin, S. A., . . . Parker, R. I. (2003).
oping strengths, focusing on how they can be Solution-focused family therapy with three aggressive
applied to the present and future, and building and oppositional acting children: An N = 1 empirical
practical solutions to collaboratively identified study. Family Process, 42, 361–374. doi:10.1111/
problems. j.1545-5300.2003.00361.x

946 Solution-Focused Brief Therapy
Lee, M. Y. (1997). A study of solution-focused brief family unwelcome challenge to mainstream thinking and
therapy: Outcomes and issues. American Journal of practice, SFBT since its development has been
Family Therapy, 25, 3–17. doi:10.1080/ incorporated into a new psychotherapeutic main-
01926189708251050 stream that has become more collaborative and
Lipchik, E., Derks, J., Lacourt, M., & Nunnaly, E. (2012). more interested in brief interventions.
The evolution of solution-focused brief therapy. In
C. Franklin, T. Trepper, W. J. Gingerich, & E. E.
McCollum (Eds.), Solution-focused brief therapy: A Historical Context
handbook of evidenced-based practice (pp. 3–19).
At the point when de Shazer and colleagues set up
New York, NY: Oxford University Press.
the BFTC, their interest, following that of the Palo
Paylo, M. J. (2005). Helping families search for solutions:
Alto Group, lay in problem patterns and how to
Working with adolescents. Family Journal, 13(4),
interrupt them. The Palo Alto Group had devel-
456–458. doi:10.1177/1066480705278687
Trepper, T. S. (2012). Solution-focused brief therapy with
oped the idea that problems are maintained by the
families. Asia Pacific Journal of Counseling and
repeated application of the wrong solution, and
Psychotherapy, 3(2), 137–148. doi:10.1080/21507686. central to their approach was the idea that therapy
2012.718285 needs to be directed toward creating the conditions
under which clients do something different; any-
thing different they proposed would disrupt the
established problem pattern and create the possi-
bility of a new pattern being established. However,
SOLUTION-FOCUSED BRIEF THERAPY as the BFTC team were focusing on problem pat-
terns, they became aware of something that funda-
Solution-focused brief therapy (SFBT) is a post- mentally shifted their approach and that can be
modern constructivist approach to psychotherapy seen as foundational in the development of what
closely associated in its origins with the early came to be termed solution-focused brief ther-
development of family therapy. Steve de Shazer apy—namely, that there are exceptions within
and Insoo Kim Berg, the two most significant fig- every problem pattern. They noticed that clients
ures in the approach, met in the mid-1970s at the spontaneously and almost invariably refer to times
Mental Research Institute in Palo Alto, California, when the problem could have happened and did
where their mentor John Weakland and his col- not, times when the problem happened but with
leagues, the Palo Alto Group, were founding their less intensity or with shorter duration—in other
problem resolution brief therapy. Leaving Palo words, times when things were better. Rather than
Alto in 1978, de Shazer and Berg set up the Brief writing these episodes off as chance events and
Family Therapy Center (BFTC) in Milwaukee, thus essentially insignificant, the BFTC team came
Wisconsin, where, with a group of talented col- to see them as significant, as moments when the
laborators, they developed an approach that was client already has a small part of a solution pat-
to prove both challenging and increasingly influen- tern. This transformed the way BFTC framed the
tial. Currently, the influence of the solution-focused interaction between the client and the therapist.
approach is found beyond psychotherapy in the Therapy was no longer focused on having the cli-
fields of education, mental health, social work, ent do something different; rather, it began to focus
coaching, leadership, and organizational develop- on encouraging clients to do more of what they
ment, utilized by many practitioners who would were already doing that was working. The influ-
not describe themselves as psychotherapists. ence of Milton Erickson is evident in the early ver-
Central to the development of the approach were sion of SFBT, for example, in the therapist’s lack of
de Shazer’s commitment to minimalism, the paring interest in an explanation of why the problem is
away of all that appears to be unnecessary in the occurring or in the client’s psychological history.
change process, and Berg’s emphasis on the cen- Neither the Ericksonian nor the SFBT approach
tralizing of the client, an emphasis often expressed has a framework for developing diagnoses or for
in terms of the aspiration to leave no footprints in hypothesizing about client problems. Additionally,
the client’s life. Initially regarded by many as an both approaches share an interest in projecting the

Solution-Focused Brief Therapy 947
client into an imagined future using what Erickson approach espouses no particular theory of the per-
described as the crystal ball technique and SFBT son, of human development, or of relationships.
came to refer to as the miracle question. Both SFBT is not normative and does not claim to have
approaches are also interested in the construction any idea of how people should live their lives. It
of therapeutic tasks. has no theory of problem beyond the most mini-
Along with other innovations, the founders of mal idea, inherited from the Palo Alto Group, that
SFBT brought a new way of thinking about the people get stuck in their lives doing things that do
nature of therapy. The metaphor of therapy as con- not work for them and fail to notice what it is that
versation increasingly took center stage in the they are doing that works, and indeed might work
solution-focused literature. de Shazer reminded his better if they were to do more of it. The approach
readers that there are no wet beds in therapy, just has no formally delineated theory of change
descriptions of wet beds, and the therapist’s task is beyond the idea that as people describe their lives
thus reframed, namely, to construct with the client differently, this is associated with lived changes.
a different sort of narrative, one that can be While social constructionism and Wittgenstinian
described as progressive rather than regressive. The thinking are referred to in the key SFBT texts, both
central therapeutic preoccupation is to invite the theories largely represent a post hoc attempt to
client to describe life differently, a description explain why the approach works rather than an
based in solution talk rather than problem talk. integral part of the model that has shaped the
The key themes of solution talk involve focusing development of the practice.
on the client’s preferred future rather than the
failed past, focusing on the client’s resources rather
than the client’s deficits, focusing on progress Major Concepts
rather than “stuckness,” and focusing on whatever Solution-focused brief therapy, as its name implies,
the client is doing that is useful rather than the is an outcome-focused approach. The therapist
opposite. The task of the therapist is defined as chooses to assume that every client is motivated
inviting clients into a different conversation, help- and that clients are experts on their own lives,
ing clients shift from talking themselves into prob- knowing both what they want from therapy and,
lems to talking themselves out of them. With this in response to the therapist’s questions, the best
new way of thinking about therapy, a different way to achieve what they want.
conceptual framework was introduced by de
Shazer as the underpinning of his approach.
An Outcome-Focused Therapy
Erickson became less influential in the later devel-
opment of SFBT; his place was taken by social Most therapeutic approaches require some
constructionism, with de Shazer referring increas- knowledge of the nature of the problem presented
ingly to Jacques Derrida, Michel Foucault, and, in to proceed, but in this respect, SFBT differs. To
particular, Ludwig Wittgenstein. Wittgenstein’s determine the direction of the therapy, what is
later philosophical writings, in particular his writ- required is that clients specify what they want,
ings about language games, served de Shazer well their best hopes from the therapy. Merely telling
as a way of conceptualizing the change process. the therapist the nature of the difficulty cannot
Within this new perspective, solutions are viewed serve to determine what it is that the client wants
as interactionally constructed realities, emerging as instead, because knowing what will not be hap-
the client and the therapist coconstruct new mean- pening tells one little about what will. The task for
ings in their talking together. the therapist and the client is to construct together
the preferred future, the life that will flow from the
client’s best hopes being realized. SFBT is focused
on the construction with the client of the desired
de Shazer stated that there is no theory in the SFBT outcome rather than deconstruction of the prob-
approach. Instead, he asserted that SFBT is merely lematic present: It is an outcome-focused approach.
a description of a way of talking with clients that Every question that the therapist asks must be con-
is associated with clients making changes. The nected to the client’s best hopes; if the question

948 Solution-Focused Brief Therapy
fails this test of legitimacy, it will be regarded as cooperate leaves the therapist with the onus of
intrusive and impositional. Some clients require finding a way of working with and fitting with the
the therapist to hear something of their distress client’s response.
prior to moving with the therapist into solution
talk; when so required, a solution-focused brief
Clients Are the Experts on Their Own Lives
therapist will hear, acknowledge, and validate the
client’s distress without asking questions about it, SFBT proposes that only clients can know what
which might serve to detain the client in problem they want from therapy and only clients can
elaboration. describe the lives that they want. Furthermore, the
approach assumes that clients will have their own
best ways of building their preferred futures, even
Questions as Invitations if at the outset of therapy that is not clear to them.
At the heart of SFBT lies a structured set of The approach seeks in this way to centralize the
questions that the therapist deploys flexibly, in a client, restricting the role of the therapist to the
way that fits sufficiently with the client’s responses asking of useful questions and to the creation of
such that they make sense to the client and also the conditions within which it will be possible for
serve to move the conversation in the direction of the client to work. The therapist’s expertise in
solution talk. In asking these questions, the thera- SFBT is largely conversational, centered on a
pist is not trying to make sense of the client’s situ- capacity to engage clients in this specific conversa-
ation or, indeed, to make sense of the client. The tional process. When therapists feel that they have
therapist attends to the client’s responses to build been unable to help a client find a way forward,
the platform for the next question, each question they may be tempted to make suggestions; how-
building on the client’s previous answer. Questions ever, this usually involves their stepping away from
are conceived as invitations to clients to describe truly solution-focused work.
their lives in a particular way, rather than as tools
to seek deeper information about their lives.
Theoretically, a client who remains silent while Techniques
answering the questions privately might derive as SFBT is a highly disciplined conversational process
much benefit from the process as a client who using a range of specific questions that serve to
answers out loud (although silent responses make shift clients’ attention and to engage the client in
it impossible for the therapist to craft the next solution talk. The shift of attention is enhanced
question in a way that is delicately attuned to the and amplified by the therapist’s use of selective
client’s last answer). summarization, by end-of-session suggestions, as
well as by the therapist’s focused listening.
Every Client Is Motivated
Listening With a Constructive Ear
Solution-focused brief therapists assume that
every client wants something as a consequence of Eve Lipchik, one of the original members of the
meeting with a therapist. The question facing BFTC team, coined the phrase listening with a
therapists is to discover what it is that their clients constructive ear. She proposed that there is a dif-
want and to put this at the center of the work. The ference between hearing and listening. In SFBT, the
more therapists stay connected to what clients therapist hears whatever the client requires to be
want, the more clients will appear motivated. In a heard but focuses his or her attention and listening
similar way, de Shazer announced early in his work specifically on those things that fit in with the like-
the death of resistance, and consequently, SFBT lihood of progress on the client’s part, namely,
has no concept of client-based resistance. Every strengths, competences, resources, and capacities.
client, de Shazer argued, shows a unique way of This process is continuous and foundational and
attempting to cooperate, and the therapist’s job is serves to construct an appreciative context for the
to cooperate with that way. Framing the client’s conversation, which in turn is associated with
response, whatever it might be, as an attempt to enhanced flexibility on the client’s part.

Solution-Focused Brief Therapy 949
Questions the preferred future are happening and times when

the problem is less dominating of clients’ lives.
The core of solution-focused practice resides in
Having established such moments, the solution-
questions and the capacity of the therapist to invite
focused therapist invites clients to consider what
the client into detailed descriptions that will typi-
they have done to bring such moments about
cally take the client beyond the previously thought
(strategy questions) and what they might have
and previously articulated material. This process
drawn on to do so (identity questions). Clients are
requires a capacity on the therapist’s part to slow
invited to discover themselves in their successes.
down clients’ responses with simple requests for
In addition, solution-focused therapists ask
more detail: for example, “What else and how else
progress-oriented questions that invite clients to
might you know and who else might notice . . . ?”
notice any possible progress made. Pretreatment
Solution-focused questions can be subdivided into
change questions serve to draw clients’ attention to
three major groupings: (1) future-oriented ques-
differences already occurring prior to arriving for
tions, (2) present- and past-oriented questions, and
their first meeting. Other progress questions, such
(3) progress-oriented questions.
as scale questions, are used to make clients’ prog-
Future-oriented questions enable the therapist
ress toward their preferred futures more visible,
to establish a contract for the work, to find out
and each follow-up meeting will start with the
what the client wants, and then to support the cli-
question “What has been better since we last
ent in describing how life will be different when
spoke?” This question shapes the direction of cli-
the contract is achieved. Asking about clients’ best
ents’ attention and will often have been preceded
hopes from the work together represents the start-
by an invitation to the clients between sessions to
ing point for most solution-focused conversations,
pay attention to anything that is moving in their
and once established, enquiring of clients how they
preferred direction.
will know that their best hopes are happening
allows for the detailing of that picture. The miracle
question is just one such future-focused question, Solution-Focused Summary and Suggestion
typically framed as follows:
Typically, solution-focused sessions end with the
Imagine you go home from here, do what you therapist summarizing what the client has said that
have to do for the rest of the day, and at some fits with the idea that change is expectable. This
point you go to bed and go to sleep. And while summary might include strengths and capacities
you are asleep a miracle happens, and as a result that the client has noticed and named during the
of the miracle, your best hopes from coming here meeting, whatever the client is doing that is useful,
all happen, just that since you are asleep you signs of hope, instances, and exceptions. The thera-
can’t know that the miracle has happened. When pist may then offer the client a minimally interven-
you wake up tomorrow how will you know? tive noticing suggestion, inviting the client to pay
What will be different that will tell you that a careful attention to signs of progress and what it is
miracle has happened? that the client is doing that is associated with this
progress.
The question is intended to support the develop-
ment of a detailed picture of the client’s preferred
Therapeutic Process
future. Asking questions from the perspectives of
those most closely associated with clients and how SFBT is not a time-limited process. de Shazer
those people will respond differently when progress defined the word brief in the approach’s title as
is occurring facilitates the development of detail meaning “as long as it takes and not one session
and creates an interactional richness in the descrip- more.” Clients are involved in determining the
tion, embedding the preferred future into the net- gaps between sessions, which typically tend to be
work of relationships at the heart of the client’s life. longer than is characteristic of other therapies,
With present- and past-oriented questions, the such that a four-session therapy might take place
solution-focused therapist is interested in instances over a period of 8 weeks or more. Presently, there
and exceptions, times when even small elements of is no evidence of problem presentations for which

950 Somatic Experiencing
SFBT is significantly less effective, and there are de Shazer, S., Dolan, Y., Korman, H., Trepper, T.,
therefore no exclusion criteria and no need for a McCollum. E., & Berg, I. K. (2007). More than
therapeutic assessment prior to commencement. As miracles: The state of the art of solution-focused brief
clients determine the contract—that is, what they therapy. New York, NY: Haworth Press.
want from the work—so clients also determine
when they are ready to finish, with a typical atten-
dance of between three and four sessions.
Solution-focused client descriptions are tenta- SOMATIC EXPERIENCING
tive and provisional—today’s picturing of how
tomorrow might look when clients’ lives are mov- Somatic Experiencing® theory is premised on the
ing in the direction of the preferred future. There is idea that trauma affects the brain, mind, and body.
no attempt by the therapist to get people to change, However, the body is often neglected in the psy-
no action planning, just a supportive and persistent chotherapy of trauma. Somatic Experiencing
process of inquiry that seeks to engage clients’ teaches that trauma is not caused by the event itself
attention on where they might want to go and but, rather, develops by the failure of the body,
what they are already doing that is useful. The cli- mind, spirit, and nervous system to process extreme
ent’s pathway toward change is unpredictable, and adverse events. Many approaches to treating
neither the client nor the therapist can know what trauma aim to correct faulty cognitions and/or
steps the client will take until they are taken. access and express emotional content. In contrast,
the approach presented here engages the “Living
Evan George, Chris Iveson, and Harvey Ratner Body,” through contacting primal sensations that
support core autonomic self-regulation and coher-
See also Constructivist Therapies: Overview; de Shazer,
Steve, and Insoo Kim Berg; Narrative Therapy; Palo
ence. Work at this level allows the body to speak
Alto Group; Solution-Focused Brief Family Therapy; its mind. In doing this, the processing moves
Strategic Family Therapy upward from these core sensations toward feelings
or emotions and cognitions. This way, both the
Further Readings
mind and the body are given an equal place in an
integrative and holistic treatment of trauma.
Franklin, C., Trepper, T. S., Gingerich, W. J., &
McCollum, E. E. (Eds.). (2012). Solution-focused brief
therapy: A handbook of evidence-based practice. Historical Context
New York, NY: Oxford University Press. In the early 1970s, Somatic Experiencing was
Iveson, C., George, E., & Ratner, H. (2012). Brief coaching: developed by Peter A. Levine, a biophysicist and
A solution focused approach. London, England: stress researcher, who received his doctorate in
Routledge.
medical biophysics from the University of
Ratner, H., George, E., & Iveson, C. (2012). Solution
California, Berkeley, in 1977 and then in psychol-
focused brief therapy: 100 key points and techniques.
ogy from the International University in 1979.
London, England: Routledge.
Levine’s clinical work began in the late 1960s with
de Shazer, S. (1984). The death of resistance. Family
Process, 23, 11–17. doi:10.1111/j.1545-5300.1984
a private practice focusing on mind–body aware-
de Shazer, S. (1985). Keys to solution in brief therapy.
ness and stress reduction. He refined his techniques
New York, NY: W. W. Norton. to specifically engage humans’ innate capacity to
de Shazer, S. (1988). Clues: Investigating solutions in brief rebound from exposure to life threats and in
therapy. New York, NY: W. W. Norton. response to overwhelming events. As an ardent
de Shazer, S. (1994). Words were originally magic. student of naturalistic animal behavior (ethology),
New York, NY: W. W. Norton. he recognized that animals in the wild exhibited an
de Shazer, S., Berg, I. K., Lipchik, E., Nunnally, E., apparent immunity to becoming traumatized.
Molnar, A., Gingerich, W., & Weiner-Davis, M. (1986). Combining this understanding with his studies of
Brief therapy: focused solution development. Family comparative neurophysiology, Levine realized that,
Process, 25, 207–221. doi:10.1111/j.1545-5300.1986 as part of the animal kingdom, humans utilize the
.00207.x same parts of the brain to mediate survival instincts

Somatic Experiencing 951
and behaviors. He reasoned that the human ani- Major Concepts

mal should exhibit the same capacity to rebound
Somatic Experiencing facilitates the completion of
from threatening encounters. Through mind–body
self-protective motor responses and the release of
awareness, Somatic Experiencing evolved to help
thwarted survival energy bound in the body, thus
people tap into the same innate resilience. Somatic
addressing the root cause of trauma symptoms.
Experiencing is taught worldwide and has been
This is done by gently guiding clients to develop
shown to be effective in mental health, medicine,
increasing tolerance for difficult bodily sensations
physical and occupational therapies, bodywork,
and suppressed emotions.
addiction treatment, education, as well as commu-
It is critical to resolve the biological shock reac-
nity leadership.
tions and then, secondarily, process related emo-
tions, perceptions, and cognitions. This entails
Theoretical Underpinnings bringing the client out of immobility and into the
active, empowered defensive responses that were
Somatic Experiencing offers a framework to assess
lacking at the time of the traumatic experience.
where a person is “stuck” in the fight, flight, freeze,
Another key concept in Somatic Experiencing is to
or collapse responses to threats and provides clini-
not retraumatize the client by exposing the client’s
cal tools to resolve these fixated psychophysiologi-
experience too rapidly or too intensely. To do this,
cal triggers.
the therapist must accurately track the client’s inner
When acutely threatened, we mobilize vast
experience. Levine developed SIBAM to chart this
energies to protect and defend ourselves. Our
“bottom-up” process, working from the body to
muscles contract to fight or flee. However, if our
emotions and cognitions. SIBAM is an acronym for
actions are ineffective, we freeze or collapse. This
sensation (internal-interoceptive), image, behavior
“last-ditch” innate defense of shutdown, when
(both voluntary and involuntary), affect (feelings
observed in animals, is called tonic immobility and
and emotions), and meaning (including old or trau-
is meant to be a temporary state of paralysis. A
matic beliefs and new perceptions). These five ele-
wild animal exhibiting this acute physiological
ments are the channels of experience that occur
shock reaction will either be eaten or, if spared,
during a session. Therapists first work with sensa-
resume life as before its brush with death.
tion and image, then move into behavior and
Humans, in contrast to other animals, frequently
affect, which then provides new meaning for the
remain stuck and do not fully reengage in life after
client. Being able to track the client’s channel
experiencing overwhelming threat. Through ratio-
allows the therapist to use the appropriate lan-
nalizations, judgments, shame, enculturation, and
guage. For example, to respond to the traumatic
fear of our body sensations, we are able to disrupt
belief “I am a bad person,” an appropriate response
our innate capacity to self-regulate, essentially
might be “Oh, so you have the thought that you are
“recycling” disabling terror and helplessness.
a bad person,” that is, normalizing that this is an
Traumatized individuals exhibit a propensity for
(potentially neutral) observation and then reflect-
freezing in situations where a nontraumatized indi-
ing, “Where in your body do you notice that?”
vidual might only sense danger or even feel some
Somatic Experiencing catalyzes corrective
excitement. Instead of being a last-ditch reaction to
bodily experiences that contradict those of fear
inescapable threat, paralysis becomes a “default”
and helplessness while resetting the nervous sys-
response to a wide variety of situations in which
tem, restoring inner balance, enhancing resilience
one’s feelings are highly aroused. For example, the
to stress, and increasing people’s vitality, equanim-
arousal of sex may turn unexpectedly from excite-
ity, and capacity to actively engage in life.
ment to frigidity, revulsion, or avoidance.
If the nervous system does not reset after an
overwhelming experience, then cardiovascular,
Techniques
digestive, respiration, immune, and sleep system
functions become disturbed. Unresolved physio- When working with traumatic reactions, such as
logical distress can also lead to an array of cogni- states of intense fear, Somatic Experiencing pro-
tive, emotional, and behavioral symptoms. vides therapists with nine essential building blocks.

952 Somatic Experiencing
In therapy sessions, these steps are intertwined and immobility response is the key both to avoiding the
dependent on one another and may be accessed prolonged debilitating effects of trauma and to heal-
repeatedly and in any order, although Steps 1 ing even entrenched symptoms.
through 3 must always be present.
Step 7: Resolve Hyperarousal States
Step 1: Establish an Environment
This step aims to resolve hyperarousal states by
of Relative Safety
gently guiding the “discharge” and redistribution
The therapist must help create an atmosphere of the vast survival energy mobilized for life-
that conveys refuge, hope, and possibility. For trau- preserving action. This is often experienced as
matized individuals, this can be a delicate task. waves of gentle involuntary shaking and trembling,
followed by changes from tight, shallow breathing
Step 2: Support Initial Exploration to deep, spontaneous, and relaxed breathing.
and Acceptance of Sensation
Traumatized individuals try to escape their Step 8: Engage Self-Regulation
internal sensations. However, without these primal In this step, self-regulation is engaged to restore
sensations, instincts, and feelings, they are unable “dynamic equilibrium” and relaxed alertness.
to orient to the here-and-now. Therapists must be
able to help their clients self-soothe and befriend
their bodily sensations. Step 9: Orient to the Here-and-Now
In this final step, the therapist helps the client ori-
Step 3: Establish “Pendulation” and ent to the here-and-now, contact the environment,
Containment: The Innate Power of Rhythm and reestablish the capacity for social engagement.
While trauma is about being frozen or stuck,

pendulation is the constant shift between pleasant Therapeutic Process
and unpleasant felt experience. No matter how The following vignette illustrates how Somatic
horrible one is feeling, those feelings can and will Experiencing can be applied in practice, in this case
change. This helps the client to “contain” strong to help treat a survivor of the terrorist attacks on
feelings and sensations so that they can be experi- the World Trade Center on September 11, 2001:
enced without causing further dissociation.
Sharon was working on the 80th floor of the
Step 4: Implement Titration north tower of the World Trade Center the morn-
Titration is about carefully touching into the ing of 9/11. After witnessing the walls in her
smallest “drop” of survival-based arousal, and it office moving 20 feet in her direction, Sharon
helps prevent retraumatization. mobilized immediately, springing to her feet and
readying to flee for her life. However, she was
slowly and methodically led down 80 floors via
Step 5: Replace Passive With Active Responses stairwells filled with the suffocating, acrid smell
This technique provides a corrective experience of burning jet fuel and debris. After she finally
by supplanting the passive responses of collapse reached the mezzanine 80 minutes later, the south
and helplessness with active, empowered, and tower suddenly collapsed. The shock waves lifted
defensive responses. Sharon into the air, throwing her violently on top
of a crushed bloody body. An off-duty police
detective discovered her and helped her find her
Step 6: Uncouple Fear From Immobility
way out of the wreckage and away from the site,
This technique separates the conditioned associa- through absolutely thick, pitch blackness.
tion of fear and helplessness from the (normally In the weeks following her survival, a dense
time limited but now maladaptive) biological immo- yellow fog enveloped her in a deadening numb-
bility response. The “physiological” ability to go ness. Sharon felt indifferent by day; merely going
into, and then come out of, the innate (hardwired) through the motions of living, with little passion.

Status Dynamic Psychotherapy 953
Her great passion for classical music, no longer “felt sense,” she becomes aware of an overall feel-
diverted her; she could no longer stand listening ing of agitation in her legs and arms and tight
to it. While she was numb most of the time, at “lumps” in her gut and throat. In suspending the
night she was awakened by her own screaming compulsion for understanding, she experiences a
and sobbing. For the first time in her life, this sudden burst of energy, which she describes as
once highly motivated executive could not imag- “coming from deep inside my belly; it’s red, bright
ine a future for herself; terror had become the red, like a fire.” Her experience then shifts into
organizing principle of her life. (what she recognizes as) a strong urge to run,
Seeking the help of a therapist, Sharon tells the concentrated in her legs and arms. She feels this as
therapist about the horrors of the event, blandly, a release of energy and exhilaration.
as though it had happened to someone else. The When she eventually reached the mezzanine,
therapist notices a slight, expansive gesture made the south tower collapsed, and she was thrown
by Sharon’s arms and hands. To the therapist, violently into the air. Finally, there was the stark
Sharon’s body is telling another story, a story that horror of finding herself lying semiconscious on
is hidden from her mind. Perplexed at first, Sharon a dead body. With the new resources she has
describes the gesture as though she is “holding gained, Sharon is now able to process the emo-
something.” Unexpectedly, a fleeting image of the tional reality of this horror.
Hudson River appears in her mind’s eye. Sharon no longer feels trapped in the anguish
Sharon becomes agitated as she tells her thera- of the event; it has begun to recede into the past,
pist how she is haunted by the smoldering smoke where it belongs. It is now possible for Sharon to
plumes. They evoke the horribly acrid smells travel on the subway to hear her favorite music
from that day; she feels a burning in her nostrils. at Lincoln Center. Life is beginning again.
Rather than letting her go on “reliving” the trau-
matic intrusion, the therapist firmly contains and Peter A. Levine
coaxes her to also continue focusing on the sen-
See also Mindfulness-Based Stress Reduction
sations of her arm movements. A spontaneous
image emerges in Sharon’s mind, one of boats
moving on the river. They convey to her a com- Further Readings
forting sense of timelessness, movement, and Levine, P. A. (1996). Waking the tiger, healing trauma.
flow. “You can destroy the buildings but you Berkeley, CA: North Atlantic Books.
can’t drain the Hudson,” she pronounces softly. Levine, P. A. (2010). In an unspoken voice: How the body
Then, rather than going on with the horrifying releases trauma and restores goodness. Berkeley, CA:
details of the event, she describes (and feels) how North Atlantic Books.
beautiful it had been when she had set out for Van der Kolk, B. (2014). The body keeps the score: Brain,
work on that “perfect autumn morning.” She mind, body in the healing of trauma. New York, NY:
becomes aware of a sense of relief. As she looks Viking Adult.
quizzically at her hands, first one then the other,
both she and her therapist breathe a sigh of relief. Website
Sharon can now begin to stand back and “sim-
ply” observe these difficult, uncomfortable, phys- Somatic Experiencing Trauma Institute: www
ical sensations and images without becoming .traumahealing.com/
overwhelmed by them.
When the first plane hit the building, only 10
stories above her office, the explosion sent a
shock wave of terror through her body. Sharon STATUS DYNAMIC PSYCHOTHERAPY
needed to inhibit the primal urge to run and
walked in an orderly line down the stairs along Psychotherapists’ primary time-honored paths to
with dozens of other terrified individuals; this was change have been through modifying their clients’
the case, even though her body was “adrenaline behaviors, cognitions, insights into unconscious
charged” to run at full throttle. In following her factors, and patterns of interaction with significant
“body story,” islands of safety begin to form in others. Status dynamic psychotherapy (SDP) pres-
Sharon’s stormy trauma sea. As she attends to this ents a further—and complementary—therapeutic

954 Status Dynamic Psychotherapy
option: that of bringing about changes in clients’ recognizing and occupying positions of enhanced
statuses, which, as employed in SDP, means rela- power and eligibility from which they can act to
tional position or place. bring about desired changes. Such “reposition-
ing” of clients is different from (while being
complementary to) historically preferred strate-
Historical Context
gies such as modifying clients’ cognitions and
Status dynamics is the creation of Peter Ossorio behavioral competencies.
(1926–2007), professor of psychology at the
University of Colorado. It represents the clinical
applications of his much larger system, descriptive Major Concepts
psychology, which was originally formulated in the Key major concepts of SDP include status, behav-
late 1960s and developed continually since that ior potential, status assignment, and world, all of
time. An extremely broad range framework, which are articulated elsewhere in this entry.
descriptive psychology has been applied to psycho-
therapeutic practice and to a wide array of clinical
problems, including posttraumatic stress disorder, Techniques
depression, and eating disorders. Nonclinically, it
Repositioning Victims as Perpetrators
has been applied to diverse enterprises such as
organizational functioning, human spirituality, and Psychotherapy clients often hold victim formu-
artificial intelligence programs for NASA. lations of their problems. That is, they conceive
their position in relation to their problems in such
a way that the problem’s source, and thus resolu-
tion, is seen as lying outside their personal control.
SDP is concerned with clients’ statuses as crucial This problem source may be seen as something
determinants of the range of behaviors in which personal (e.g., a mental disorder) or something
they are able to participate. All individuals occupy environmental (e.g., the unchangeable character of
a variety of positions in relation to everything in a significant other). In either case, it is seen as
their world, and these are their statuses. In psycho- something that is not subject to the client’s per-
therapy, statuses that frequently come into play sonal control, and the client’s perceived status is
include clients’ actual and perceived positions in thus that of a helpless victim.
relation to (a) themselves (e.g., imposer of degrad- SDP presents a general strategy for repositioning
ing labels on themselves such as “worthless”), clients in the grip of such victim formulations. This
(b) significant others (e.g., victimized by some strategy includes, first of all, assessing to determine
other), (c) their presenting concern (e.g., helpless if in fact these clients occupy heretofore unrecog-
victim of a mental disorder), or (d) society (e.g., nized positions of power and control vis-à-vis their
stigmatized as “mentally ill”). problems. If such positions are discovered, the
From a clinical perspective, the crucial point of strategy then involves reframing their problems
focusing on clients’ statuses is that the occupation into perpetrator formulations—redescriptions that
of certain relational positions restricts clients’ abil- articulate their positions of power—and presenting
ity to act—their behavior potential—while the these to clients. Finally, the strategy entails assisting
occupation of others expands this potential. From clients in approaching their problems from this
one position, they are unable to exercise power or new and different position of enhanced power and
control over their problems and/or deem them- control.
selves ineligible to act in needed ways. From For example, a young bulimic woman, Laura,
another position, these barriers do not exist, and initially experienced herself as the helpless victim
they are able to exercise such power. of inexplicable compulsions to binge. On assess-
In SDP, therapists use this fact about statuses, ment, it became clear that she occupied a different,
and the behavior potential inherent in them, to far more powerful position, that of a harsh, restric-
benefit their clients. The primary goal is to bring tive, pleasure-denying regulator of herself, whose
about positive change through empowering self-imposed regimen was resulting in the self-
status assignments—essentially, assisting clients in rebellious behavior of binge eating. Therapeutic

StoryPlay Therapy 955
efforts in Laura’s case subsequently focused pri- Website

marily not on her eating behavior but on getting Index of SDP Papers: www.sdp.org/sdp/papers/
her to attack her problem from this high power
position of harsh self-regulator and from this
position working to modify her modes of self-
management. Successful achievement of this objec-
tive resulted not only in her adoption of more
STORYPLAY THERAPY
benign and effective ways of regulating herself but
also in the cessation of her bingeing and purging. StoryPlay® therapy is an Ericksonian, resiliency-
based, indirective model of play therapy that inter-
weaves cultural diversity, metaphor, natural healing
Other Features of SDP abilities, and creativity to effect transformational
SDP embodies many further features that, due change, healing, and problem solving for children,
to space limitations, cannot be covered here. These adolescents, families, and communities who have
include (a) a different approach to the therapeutic experienced trauma, grief, disaster, adversity, or
relationship wherein nine different statuses are loss. Because play is the language of children and
assigned to clients on an a priori basis; (b) a new creativity is the language of play, the StoryPlay
formulation of the self-concept, as well as interven- model unites these pivotal elements to form a tap-
tions designed to circumvent its notorious resis- estry of unique methods for moving past the limita-
tance to change in the face of disconfirming facts; tions of diagnostic labeling to access and reawaken
(c) a unique approach to therapeutic storytelling; the resilient child within.
and (d) a large set of therapeutic policies—that is,
general guidelines or choice principles for the
effective conduct of psychotherapy. Historical Context
In response to Hurricane Iniki, a catastrophic nat-
Therapeutic Process ural disaster that devastated the island of Kaua’i,
Hawaii, on September 11, 1992, Joyce Mills devel-
In SDP, the therapeutic process is threefold. It con- oped a community-based program to meet the
sists, first of all, in assessing the client’s world, needs of the children, youth, and families on the
conceived here as coming to an understanding, west side of the island. Along with local elders and
both empathic and objective, of this world and of community residents, natural healing activities
the client’s perceived status/position within it. were implemented on a weekly basis. The founda-
Second, it involves figuring out why and in what tion of these activities was stories. These stories
respects the client’s current status has rendered this provided cultural appreciation and, at the same
world problematic for him or her. Third, it involves time, activated a process of healing for those who
helping the client reconstruct his or her world in participated. For example, children were told a
such a way, focusing heavily on status change, that resiliency-focused cultural story and then were
it can be rendered no longer problematic. given art materials to use to create a symbolic rep-
resentation of the story. They were never told to
Raymond Bergner
talk about the hurricane, yet, while they were
See also Brief Therapy; Cognitive-Behavioral Therapy; together, they talked and supported one another in
Solution-Focused Brief Family Therapy; Solution- ways that were not directed. The premise was to
Focused Brief Therapy reconnect them with their inner strengths so that
they could discover new possibilities for healing
from the trauma. This was the basis of what even-
Further Readings tually became known as StoryPlay.
Bergner, R. (2007). Status dynamics: Creating new paths Today, aspects of StoryPlay have been used in a
to therapeutic change. Ann Arbor, MI: Burns-Park. variety of settings and modalities, including indi-
Ossorio, P. (1997). Essays on clinical topics: The collected vidual, group, hospital, classroom, sand tray, music,
works of Peter G. Ossorio (Vol. 2). Ann Arbor, MI: and art therapies. Centered on activating the resil-
Descriptive Psychology Press. iency pathway within each client, the approaches

956 StoryPlay Therapy
implemented in StoryPlay are designed to trans- artistic metaphors, breathing and relaxation exer-
form posttraumatic stress disorder into posttrau- cises, sensory synchronicity, wellness and balance,
matic stress healing. These approaches are indirect and therapeutic rituals and ceremonies.
and differ greatly from the dominant debriefing
models often used after a trauma or disaster. No Therapeutic Metaphors
one is asked to relive a traumatic event in any way.
Instead, clients are provided with natural healing Real-life, made-up, and myth stories are created
activities that use creativity, metaphor, and cultural and utilized to open new pathways for healing and
wisdom to facilitate reconnection to inner strengths problem solving.
and resources.
Story Crafts
Theoretical Underpinnings These are a series of natural healing activities
The difference between StoryPlay and other mod- that expand therapeutic stories and metaphors
els of play therapy is the recognition, develop- into artistic expression.
ment, and utilization of indirect suggestions to
facilitate positive unconscious associative patterns Artistic Metaphors
for transformational change. This is a direct appli-
These specific drawing strategies are used to
cation of Milton Erickson’s use of indirect sugges-
assist in pain and fear management, to facilitate
tions that spoke to the client’s unconscious mind
transformational healing from trauma, and to
rather than seeking conscious awareness.
improve problem-solving skills.
Interspersing indirect suggestions when a child is
playing allows the child to continue to be absorbed
in the play activity while, at the same time, receiv- Breathing and Relaxation Exercises
ing the suggestions developed in accordance with
The Magic Happy Breath, Mini-mind Vacation,
what the child needs to heal or reach his or her
and Heartsong Mediation are some of the exer-
full potential.
cises designed to reduce stress, help with self-
The following provides an example: A child is
disregulation issues, and assist with issues related
playing in the sand tray with miniature horses he
to attention-deficit/hyperactivity disorder.
has taken from the box of horses. In a directive
model, the therapist might say, “We can also build
a coral for the horses in which they can sleep.” In a Sensory Synchronicity
nondirective model, the therapist might say, “You With sensory synchronicity, particular
are playing with the horses.” In the indirective approaches are utilized to help the therapist iden-
StoryPlay model, the therapist might say, “I wonder tify a child’s sensory system that is a strength and
how many things those horses will discover as they a sensory system that may be blocked because the
are playing in the sand.” Rather than telling the child experienced traumatic events, learning chal-
child what to do with the horses or repeating back lenges, or a physical illness.
to the child what the therapist observes, the
StoryPlay therapist intersperses the indirect sugges-
tion “how many things those horses will discover” Wellness and Balance
while the child is playing. The suggestion is meant Wellness and balance refers to an exercise that
to activate the possibilities of new discoveries facilitates the need for recognition of self-care in
within the child and implies that there will be new four areas of functioning: mental, emotional,
discoveries. physical, and spiritual.
Techniques Therapeutic Rituals and Ceremonies

The interventions include the development and Based on respect for a client’s multicultural
utilization of therapeutic metaphors, story crafts, values and principles, rituals and ceremonies are

Strategic Family Therapy 957
cocreated with clients to meet their individual

needs. STRATEGIC FAMILY THERAPY
Developed by Jay Haley and later by Cloe
Therapeutic Process Madanes, strategic family therapy is an out-
Rather than focusing on reliving the problem or growth of the work of the psychiatrist Milton
trauma, StoryPlay utilizes the inner resources, gifts, Erickson. A primary feature of this therapy is that
and strengths of each child, adolescent, family, and the responsibility is on the therapist to plan a
community to help them heal from and overcome strategy for solving the client’s presenting prob-
adversity. Each session is designed to meet the indi- lems or symptomatic behavior. In this process, the
vidual needs of the client. The recognition and therapist sets clear goals, which always include
utilization of inner resources and strengths is the solving the presenting problem. The emphasis is
centering focus of each session. The sessions are not on a method to be applied to all cases but on
from 60 to 90 minutes in accordance with the cli- designing a strategy for each specific problem.
ent’s need. The length of treatment varies as well. Because the therapy focuses on the social context
There is a closure session, which includes the of human dilemmas, the therapist’s task is to
cocreation and use of therapeutic ritual and cere- design an intervention in the client’s social situa-
mony in accord with cultural and spiritual beliefs. tion. Therapy is planned in steps to achieve the
goals, and every problem is defined as involving
Joyce C. Mills at least two or three people. Interventions usually
take the form of directives about something that
See also Erickson-Derived or -Influenced Theories:
family members are to do, inside and outside the
Overview; Ericksonian Therapy; Hypnotherapy;
Nature-Guided Therapy; Neuro-Linguistic
therapy session, with the focus being on how
Programming; Play Therapy; Positive Psychology; people communicate with one another, the use of
Possibility Therapy; Self-Relations Psychotherapy metaphors and analogies, and the hierarchical
organization of the family.
Further Readings
Hines, P., Mills, J. C., Bonner, R., Sutton, C. E., & Castellano, Historical Context
C. (2007). Healing and recovery after trauma: A disaster During the 1950s, Gregory Bateson, Jay Haley,
response program in first responders. In A. J. Sargent Don Jackson, and John Weakland attempted to
(Ed.), Systemic responses to disasters: Stories of the describe the problems or symptomatic behavior
aftermath of hurricane Katrina (AFTA Monograph that people exhibited in terms of their relation-
Series) (pp. 61–66). Washington, DC: American Family ships with others. During this project, Bateson
Therapy Academy.
proposed that communication between human
Malchiodi, C., & Crenshaw, D. A. (Eds.). (2014). Creative
beings can be described in terms of levels (e.g.,
arts and play therapy for attachment problems.
message content and nonverbal message) and that
these levels can conflict in paradoxical ways. For
Mills, J. C. (1999). Reconnecting to the magic of life.
instance, a person can say, “I love you” and look
Phoenix, AZ: Imaginal Press.
Mills, J. C., & Crowley, R. J. (2014). Therapeutic
askance at the person to whom he or she is direct-
metaphors for children and the child within. New ing the message. Or as Epimendies, the Greek
York, NY: Routledge. philosopher, suggested, an ancient Greek could
Oaklander, V. (2007). Hidden treasure. London, England: say, “I am lying” and yet be telling the truth if,
Karnac Books. indeed, he was lying (meaning, he is not lying).
Short, D., Erickson, B. A., & Erickson-Klein, R. (2005). Here, we see the complexity of human communi-
Hope and resiliency: Understanding the cation. The investigation of how messages “frame”
psychotherapeutic strategies of Milton H. Erickson. other messages in conflicting ways was a focus of
Norwalk, CT: Crown House. the project undertaken by Bateson and his col-
Siegel, D. J. (1999). The developing mind. New York, NY: leagues. The term double bind was coined to
Guilford Press. describe dual messages that conflict paradoxically.

958 Strategic Family Therapy
By 1962, when the project ended, they had made With this organizational view, it is possible to
the shift from describing symptoms as individual see the conflicting levels of messages in context—
phenomena to describing them as communicative the conflicting hierarchies in the organizations
behavior between people. For instance, a mother where people communicate. A mother who asks
might say to her child, “I want you to spontane- her child to obey her spontaneously can be in an
ously do as I say” (one cannot be spontaneous and organization where (a) she is in charge of the child
do what another says). Placed in this double bind, by the fact of being a parent, but (b) the child is
the child may then respond with disturbing behav- also in charge of her because of the power of dis-
ior to this contradictory communication. Up to turbing behavior or because of the power given by
this point, the mother’s conflicting communication coalitions with family members of high status.
would have been explained by references to her Therefore, the mother must give directives because
nature or to her need to respond to a child who of the nature of her position, but she can only
was communicating in disturbing ways. What was express helplessly the wish that the child might do
lacking was a way to conceptualize the larger as she says.
social context to which family members were Today, strategic family therapy is commonly
adapting. used by many family therapists and taught in most
Through the 1960s and the 1970s, for the first family therapy training programs. However, obtain-
time, family structures—such as cross-generation ing the skills necessary to be able to understand the
coalitions when a spouse joins a child against the complexity of human communication, perceive
other spouse—began to be delineated. In the dysfunctional hierarchies, give appropriate direc-
1970s, Haley described pathological systems in tives, and work effectively with families is not easily
terms of malfunctioning hierarchies, for example, come by and may take years of training to refine.
one where a mother and a child are in an overly
intense relationship and the father is peripheral. As
strategic family therapy developed in the 1970s, Theoretical Underpinnings
interventions usually took the form of directives Strategic family therapy views the individual within
designed to change the ways in which people relate the broader context of the family system and
to one another. Paradoxical directives, which send examines how symptoms are a function of com-
multiple messages to the clients and subtly chal- munication among people, the structure of the
lenge the clients to change, were developed. For family, and the organizational hierarchy in the
example, after telling the family that he or she family structure.
wants to help them change, a therapist might sug-
gest that there might be negative consequences to
changing, challenging the family to prove the Major Concepts
therapist wrong by changing. Some of the major concepts of strategic family
In the 1980s, Madanes suggested that the social therapy that drive the theory are analogies and
organizations of people who present to therapy metaphors, the concept of self-determination, an
with problems or with symptomatic behavior have interactional view, directives, the family as a self-
a dual hierarchy that requires conflicting levels of help group, and the stages of emotional and spiri-
communication. She developed strategies to change tual development.
such organizational structures so that symptom-
atic behavior is no longer appropriate and adap-
Analogies and Metaphors
tive. Just as Bateson proposed that there is a
human dilemma when dual levels of messages are A behavior is analogical to another behavior
incongruent, Madanes proposed that in a social when there is a resemblance between them in some
organization such as a family, dual hierarchies can particular way, even though they may be otherwise
be incongruent. In fact, she suggested that dual unlike. A behavior is metaphorical for another
levels of messages will be incongruent if the orga- behavior when it symbolizes or is used in place of
nization has incongruent hierarchies. another behavior. Symptomatic behavior has been

considered analogical and metaphorical in certain The Family as a Self-Help Group

specific ways:
In its origins, family therapy was thought to be
a “cure” for the whole family that was considered
1. A symptom may be a report on an internal to be “sick” or “pathological.” Rather than view-
state and also a metaphor for another internal ing the family as sick or healthy, strategic family
state. For example, a person’s headache may be therapy views the family as the ultimate self-help
expressing more than one kind of pain. group. No one can help or interfere as much with
2. A symptom may be a report on an internal the well-being of a person as those who have ongo-
state and also an analogy and a metaphor for ing relationships—who have a history, a present,
another person’s symptoms or internal states. and a future together.
For example, a boy who refuses to go to
school may be expressing his own fears and
Emotional and Spiritual Development
also his mother’s fears. The boy’s fear is
analogical to the mother’s fear (in that fears There are four stages of emotional and spiritual
are similar) and also metaphorical (in that the development:
boy’s fear symbolizes or represents the
mother’s fear). 1. The need for certainty and security by having
power and control over one’s own life and over
significant others
Self-Determination
2. The wish to be loved, appreciated, and cared for
Central to the strategic family approach is the
belief that a person is capable of making a plan for 3. The desire to give love to others, to protect and
his or her own future and that each person is care for the people one loves
responsible for who she or he is. No matter what
4. The need to repent for mistakes, wrongdoings,
the circumstances, there is always a choice to be
and harm caused to others and to forgive others
made. The individual is not predetermined by
for harm caused to oneself
chemistry, the family, or the social context.
These needs are hierarchical in that the first
An Interactional View need we develop as children is the need for cer-
tainty and security. Then, we develop the wish to
The most efficient way of changing a person is
be loved, followed later by the desire to love and
to change the social context of the person—the
protect others, and finally by the need to repent
ongoing relationships with significant others.
and to forgive. The therapist moves the individ-
These significant others are usually the family, but
ual client and his or her family through these
sometimes, the most important interactions are
stages, which are essential for a meaningful, sat-
with friends, at school, or at the workplace, so the
isfying life.
therapist also intervenes in those relationships.
Directives Techniques
The most frequent intervention is the directive. There are many ramifications to the idea that con-
People are asked to do certain things in therapy flicting levels of communication reflect conflicting
and, between sessions, outside of the therapy hierarchies within an organization. A major issue
room. Directives can be straightforward or indi- for the therapist is the opportunity that arises for
rect, metaphorical or paradoxical. Most directives new forms of therapeutic intervention. Although
involve introducing a minor change in a small seg- nearly 100 techniques exist, what follows is a
ment of behavior, with the expectation that a small description of some of the most successful of these
change can have larger consequences. strategies.

960 Strategic Family Therapy
Correcting the Hierarchy who try to overcome their own problems in

order to help the child.
Haley developed a variety of strategies for reor-
In the strategy of pretending, developed by
ganizing a malfunctioning hierarchy. One way is to
Madanes, the therapist encourages the child to
shift from the presenting system to a different
pretend to have the presenting problem and
problematic one before reorganizing the family
encourages the parents to pretend to help the child.
into a more functional hierarchy. For example, if a
In this way, the child no longer needs to actually
mother and a child are in an overly intense rela-
have the problem to protect the parents; pretend-
tionship and the father is peripheral, the first stage
ing to have it is enough to become the focus of
can be one where the father takes total control of
concern for the parents. But the parents’ concern
the child and the mother is excluded. This is a
will also be a pretense, and the situation will have
problematic system, and from it, one can move to
changed to a game—to make-believe and play.
a healthier one. Another way of doing this might
The strategy of pretending can also be used with
be to ask the father to do a minor thing with the
adults. For example, a depressed man can be asked
child that the mother would not approve of. In this
to pretend to be depressed (at a time when he is
case, it will be difficult for the mother to take
actually not depressed) and to do it in such a way
charge of what the father and the child do because
that his wife will not be able to tell whether he’s
it is something she does not want. Another way of
really depressed or not. This will change the way
correcting the hierarchy is to encourage the par-
the wife typically responds to her husband’s
ents to agree on rules and on consequences for the
depression, and he, in turn, will have to change.
child if the rules are disobeyed.
Life Stages Interactional Metaphors

Haley described the life cycle of the family in Building on the concepts of analogies and meta-
stages: courtship, early marriage, dealing with phors, Madanes proposed that not only can an
young children, children leaving home, retirement, individual’s messages be assigned meaning in the
and old age. Serious problems or symptoms can context of other messages but also the interaction
arise in any of these life stages. For instance, dur- between people is analogical and can be assigned
ing the leaving home stage, serious symptoms may meaning in a context of other interactions. That is,
develop that hinder the young person from leav- a sequence of interactions usually has a second ref-
ing home. Consciously or unconsciously, the erent different from the sequence explicitly expressed.
young person may worry about what will happen The interaction between two people in a family
to the parents if he or she leaves (e.g., the possibil- can be an analogy and a metaphor, replacing the
ity of divorce). Haley developed strategies to hold interaction of another dyad in the family. For
the parents together so that the young person can example, a mother may be upset and worried, and
leave without fear (i.e., without fear that the par- her husband may try to reassure and comfort her.
ents’ relationship will deteriorate and result in If a child develops a recurrent pain, the mother
divorce). may become preoccupied with reassuring and
comforting the child in the same way that the
father was previously reassuring and comforting
Pretending
her. The mother’s involvement with the child in a
Presenting problems or symptomatic behavior helpful way will preclude her involvement with
in an individual can be the result of an incongru- the husband in a helpless way, at least during
ity in the hierarchical organization of the family. the time in which the mother is involved with the
For example, when a child has problems or child. The interaction between the mother and the
symptomatic behavior, he or she becomes the child replaces the interaction between the wife and
focus of attention for the parents, and so the the husband. If the child’s recurring pain disap-
child takes on a superior position, distracting pears, the mother will go back to being helpless.
the parents from other concerns. Often, the child, Thus, if the child abandons the recurring pain, the
wittingly or unwittingly, protects the parents, therapist will intervene so that the mother can be

helpful and competent most of the time, instead of Steps for Repentance
being helpless. Madanes developed a series of
Madanes developed a successful method for the
strategies to increase mothers’ self-confidence and
rehabilitation of the sexual criminal and the victim
competence.
of incest. The method varies depending on whether
or not the victim is part of the family. The follow-
Prescribing the Pretending of the ing is a summary of the steps when the victim is a
Function of the Symptom younger relative of the offender and is present in
the sessions.
This is a strategy where family members per- First, the therapist gathers the family and asks
form, in a playful way, actions that represent what each family member what he or she knows about
the therapist believes to be the function of the pre- the sexual crime, pointing out that the offender’s
senting problem. These actions are a condensed, actions were solely his responsibility and that nei-
abbreviated, somewhat symbolic, and somewhat ther the victim nor anyone else is to blame. Then
humorous version of the family drama. The roles the therapist asks the parents and the offender why
of family members are reversed. For example, if a what the offender did was wrong. After everyone
daughter is depressed, the mother is asked to pre- has spoken, the therapist explains that the sexual
tend to be depressed, and the daughter is asked to crime caused a spiritual pain in the victim (because
help the mother; if a son has fears, the father may sexuality and spirituality are related in human
be asked to pretend to be afraid, and the son may beings, a sexual attack can be considered an attack
be asked to protect his father. In this case, the on the spirit of the person).
therapist might conceptualize the function of the Then, the therapist acknowledges the spiritual
presenting problem as a child covertly helping pain of the offender for having inflicted this pain
the parent through the problem. In the playful on another human being and the pain of every
prescription, the parent overtly asks for help, and family member because of the hurt inflicted on
the child overtly helps the parent. The result is that the child. The offender is asked to get on the floor
the child no longer resorts to helping the parent in on his knees in front of the victim and express his
covert, problematic ways. The parent’s request for sorrow and repentance for what he did. The fam-
help and the child’s helpfulness are now overt in a ily and the therapist judge whether the offender
playful, humorous way. is sincere. If anyone says that the offender is
hypocritical, then the offender must repeat the
repentance until everyone agrees that the offender
Prescribing a Reversal in the Family Hierarchy
is sincere. The next step involves the therapist
This strategy, developed by Madanes, consists asking the whole family to kneel in front of the
of putting the children in charge of one aspect of victim and for each to express his or her sorrow
their parents’ lives—their happiness. The children for not having protected the victim and prevented
are asked to give suggestions to the parents as to the abuse.
how they could be happier and to organize special In subsequent sessions, the adults discuss future
events for the parents, such as a dinner or a party. consequences should the offender commit another
As the children give love to their parents (by actu- sexual crime, and agree on a punishment. They
ally giving them directives or by taking care of also agree on what acts of reparation toward the
them), the parents not only become more respon- victim will be required from the offender. The
sible and caring toward the children, but they also therapist enlists from the extended family a pro-
often resolve many of their own problems. Children tector who will be tasked with making sure that
are often surprisingly wise in their advice, and the victim is not hurt again. The therapist dis-
with the therapist’s encouragement, they can be cusses sexuality with the offender, encouraging
very helpful. The strategy is especially useful when repression and establishing certain steps for the
parents are rejecting or incompetent, because little offender to follow should an inappropriate sexual
or nothing is expected from them and all demon- impulse arise.
strations of love and concern are solicited from the With the victim, the therapist encourages the
children. perspective that the victimization, although

962 Strategic Therapy
traumatic, will not be the major event in the Madanes, C. (1990). Sex, love and violence: Strategies for
child’s life. This establishes that the offender, transformation. New York, NY: W. W. Norton.
not the victim, should carry the shame. Madanes, C. (1994). The secret meaning of money.
In a sense, these steps are a set of operational San Francisco, CA: Jossey-Bass.
instructions for transforming bad relationships Madanes, C. (1995). The violence of men. San Francisco,
into good ones. They have been used successfully CA: Jossey-Bass.
with many different kinds of family violence. Also, Madanes, C. (2006). The therapist as humanist, social
in a sense, these steps are a ritual by which a family activist and systemic thinker . . . and other selected
or a group can self-critique and change its own papers. Phoenix, AZ: Zeig, Tucker & Theisen.
routine behavioral sequences as its members coop-
erate to heal an afflicted individual member.
STRATEGIC THERAPY
Therapeutic Process
Because strategic family therapy encompasses Strategic therapy is an approach that stems from
many different strategies, there is no one specific Milton Erickson’s family therapy and includes
therapeutic process. However, the general guide- diverse approaches, all of which have certain char-
lines are to begin by interviewing everyone involved acteristics in common. Strategic therapy differs
with the presenting problem or symptomatic from strategic family therapy in that the focus is on
behavior. Once the therapist has gathered informa- the individual instead of a couple or family, while
tion, he or she formulates a strategy and plans one still being aware of the social system the individual
or more directives that are given to the family to be is a part of.
followed in and out of the therapy sessions. If this
strategy does not solve the problem, the therapist
Historical Context
expands the unit, inviting extended family and/or
other significant others to participate. A new strat- During the first half of the 20th century, under the
egy and new directives are formulated based on the influence of psychoanalysis, Rogerian therapy, and
new information and new resources that these oth- psychodynamic therapies, the focus of therapy was
ers bring to the therapy. Because strategic family on intrapsychic issues, and the client mostly deter-
therapy is not an orthodoxy that proposes one mined the course of therapy. Within this context,
method to be used always in the same way, it bor- therapists either interpreted client concerns within
rows from other schools of therapy any techniques a preset therapeutic model or used empathy and
that are helpful in solving the presenting problem acceptance to try and understand the client’s situa-
and improving people’s lives. tion, believing that clients could find their own
solutions to their concerns. These insight-oriented
Cloe Madanes models used the same approach with every client,
regardless of the client’s presenting problem.
See also Erickson, Milton H.; Erickson-Derived or
Strategic therapy was developed as a reaction to
-Influenced Theories: Overview; Haley, Jay; Madanes,
Cloe; Strategic Therapy the passivity of these approaches, as it emphasized
that the therapist needed to take a more active,
directive, and influential role with clients and sug-
Further Readings gested that the role could change dramatically as a
Haley, J. (1976). Problem-solving therapy: New strategies function of the presenting problem. The major
for effective family therapy. San Francisco, CA: proponent of this new approach was Jay Haley,
Jossey-Bass. who based many of his ideas on the innovative
Madanes, C. (1981). Strategic family therapy. work of Milton Erickson. Clarifying and explain-
San Francisco, CA: Jossey-Bass. ing Erickson’s approach, integrating communica-
Madanes, C. (1984). Behind the one-way mirror: tion theory and system ideas from Gregory Bateson
Advances in the practice of strategic therapy. and the Palo Alto Group, and introducing many
San Francisco, CA: Jossey-Bass. new therapeutic strategies, Haley came up with a

Strategic Therapy 963
new, dynamic approach to conducting therapy, there are coalitions across generations (i.e., when a
which he called strategic therapy. Others who were parent sides with a child against the other parent)
influential in the approach include John Weakland, or where those lower in the hierarchy (e.g., chil-
Richard Fisch, and Paul Watzlawick from the dren) have undue power over those higher in the
Mental Research Institute in Palo Alto, California; hierarchy (e.g., parents).
the “Milan Group”; and Giorgio Nardone.
Since its early beginnings, strategic therapy has
grown and is an approach taught in many gradu- Major Concepts
ate programs in counseling, social work, and psy- Two main concepts associated with strategic ther-
chology as well as in training centers. Today, the apy are (1) defining the problem and (2) analogies
literature describes well over 100 strategies that and metaphors.
are associated with strategic therapy.
Defining the Problem
A problem is defined as a type of behavior that
Some guiding concepts of strategic therapy are is part of a sequence of acts between several peo-
derived from cybernetics, which is the study of how ple. Symptoms such as depression or phobias are
information-processing systems (families, schools, thought of as contracts between people and there-
corporations, etc.) are self-correcting, controlled by fore as adaptive to relationships. The therapist is
feedback loops. Systems are seen as maintaining a included in such relationships, because he or she
homeostasis, which reflects their usual state of defines the problem. The strategic therapy approach
functioning. This state can be dysfunctional or emphasizes a distinction between (a) identifying a
healthy. For instance, one family may have a ver- problem presented in therapy and (b) creating a
bally abusive spouse, and each time that individual problem by applying a diagnosis or by character-
becomes outraged, the other spouse withdraws and izing a person in a certain way. Psychiatric and
the children leave the home to play with their psychological diagnostic criteria are seldom used
friends (to “escape”). If the spouse who withdraws in strategic therapy, and the first task of the thera-
attempts to become more assertive, the verbally pist is to define a presenting problem in such a way
abusive spouse becomes more abusive, thus ensur- that it can be solved. To label a client as “bipolar”
ing that the system maintains its homeostasis, or or “clinically depressed” is to participate in the
the usual way of functioning. Within this context, creation of the problem that the therapy must
problems are viewed as interactions between peo- solve. Sometimes the label creates a problem, so
ple where any deviation from the norm (the norm that the solution is made more difficult. For exam-
may be dysfunctional or healthy) may result in a ple, “depression” is more difficult to resolve than
negative feedback loop that will return the system “laziness”; “clinical depression” is not easy to
to its previous state. cure, but “difficulty in holding a job” is more ame-
Positive feedback loops, on the other hand, occur nable to change.
when the system develops new ways of interaction
among its members, and change is thus brought
Analogies and Metaphors
about. In the example above, a new way of interact-
ing might be for the abused spouse to call his or her The strategic approach emphasizes the analogi-
mother-in-law (as soon as the verbal abuse starts) cal in the way it conceptualizes a problem. It is
to tell her how much he or she loves her. Change in assumed that a problem or a symptom is the way
one part of the system effects change in other parts in which one person communicates with another.
of the system and may lead to changes in other For example, in the case of a depressed man who
areas of life. Within systems, it is important to does not work, it would be assumed that this is the
consider the hierarchy, as an individual is more dis- way the man and his wife (and/or his mother,
turbed in direct proportion to the number of mal- father, children, etc.) communicate about some
functioning hierarchies in which the individual is specific issues, such as whether the husband should
embedded. A malfunctioning hierarchy is one where do what his wife or his mother wishes. That is,

964 Strategic Therapy
when the man says, “I’m depressed,” he is analogi- someone with panic attacks, is to say, “I would like
cally, or metaphorically, expressing a problem. He you to deliberately have a panic attack right now
is also solving it because, for example, it is not his here in my office” or “I would like you to have a
fault that he won’t work—it is his “depression.” panic attack every morning as soon as you get up.”
This solution, however, is usually unsatisfactory The paradox lies in the fact that the client wants
for everyone involved. the therapist to help him or her get rid of the panic
Often, the focus of therapy is on changing attacks and, in that context, the therapist is
analogies and metaphors, for example, by telling requesting the panic attack. A symptom is, by defi-
stories that resemble the client’s problem and also nition, involuntary, so if the client can have the
contain a solution to the problem. A client can be symptom deliberately, then it is not a symptom.
asked to say he has a particular problem or symp- This approach is based on the idea that some
tom—a stomach ache, for example—when in fact people who present for therapy are resistant to the
he has not, so that the verbal statement serves the help offered; the therapist expects the client to be
same metaphorical purpose as the original prob- defiant and thus not be willing to deliberately pro-
lem he presented with, but without the pain. Some duce the symptom, thus proving to the client that
people are able to say, “You give me a pain” and he or she has control over the symptom.
not have the pain, while others must develop a Paradox first entered therapy as a therapeutic
pain as a way of making a statement about their strategy when Viktor Frankl (in the early 1950s)
situation. developed it to show clients that they had control
over their symptoms. However, it was Gregory
Bateson and colleagues (in the late 1950s) who
Techniques
systematically formulated paradox for use in
Common interventions employed in strategic ther- solving presenting problems in therapy. They
apy include directives, rituals, ordeals, and the showed that paradox is a basic constituent of
stages of emotional and spiritual development. mental problems and can be used effectively in
their resolution.
Directives Most directives are planned to improve rela-
tionships, involve people who have been previ-
Interventions usually take the form of directives ously disengaged, promote agreement and good
about something that the client will do during the feeling, increase positive interchanges, provide
session and/or outside the session. These directives information, and help people organize in more
are designed to change the ways in which the client functional ways. Based on the notion that a small
relates to others and to the therapist. Directives are change can have larger consequences, most direc-
also used to gather information by observing the tives are aimed at relatively few or relatively small
way the client responds to instructions. changes in behavior.
The strategic therapy approach assumes that all
therapy is directive and that a therapist cannot
Rituals
avoid being directive, because even the issues he or
she chooses to comment on and his or her tone of A special kind of directive is the ritual. Here, the
voice are directive. In this therapy, directives are therapist recommends a ceremony consisting of a
deliberately planned, and they are the main thera- series of actions performed according to a pre-
peutic technique. scribed order. Rituals are useful in marking the
Directives may be straightforward or paradoxi- transition from one stage of life to another or to
cal, direct or indirect, and simple or complex. An indicate a transition in a relationship. The intensity
example of a straightforward directive is to say to of the ritual should be commensurate with the
a man, “I would like you to be especially nice to severity of the problem presented to therapy. For
your wife this week.” An indirect way of saying minor problems, a birthday party or a trip to visit
this is “I don’t want you to be so nice to your wife relatives may be appropriate. A serious transition
this week that she might have a heart attack.” An may require a more complex ritual, for example, a
example of a paradoxical directive, let’s say to ceremony of renewal of marital vows.

Strategic Therapy 965
Ordeals is, the stages take the form of a spiral as the person
moves from one stage to the other to have a bal-
The ordeal is a strategy devised by Erickson to
anced life.
make it more difficult for a person to have a symp-
tom than not to have it. A man with insomnia, for
example, may be told that if he does not fall asleep
Therapeutic Process
by a certain time, he has to get up and scrub the
floors. The ordeal should be more unpleasant than From the first meeting, the therapist focuses on the
the symptom but beneficial to the person with the following:
symptom.
Ordeals are particularly appropriate for prob- • What is the client’s relationship with himself or
lems of self-inflicted violence (e.g., bulimia), for herself
obsessions, and for compulsions because these • What is happening with the client’s relationships
often occur with people who are methodical, moti- with others
vated, and hardworking. They compulsively per- • What is happening with the client’s relationship
form an action that they do not like or want to do. with the social environment—the values and
So at the request of the therapist, they can perform norms of the social context within which the
another action that they also do not like and do client lives
not want to do. The secret of using this strategy • How the problem presented manifests within
successfully is to motivate the person to apply the those relationship patterns
ordeal. • How the patient has tried so far to solve the
problem
• How the problem situation can be changed as
Stages of Emotional and Spiritual Development quickly as possible
Cloe Madanes described four stages of emo-
tional and spiritual development. At the lower Before designing a strategy, the therapist needs
level is the first stage, where the person is con- to be able to answer the following questions:
cerned with controlling and dominating his or
her environment, including the relationships the • How does the client define the problem?
individual is in. A somewhat higher level is the • How does the problem manifest itself?
second stage, where the person is concerned with • In whose company does the problem appear,
being loved. Yet higher is the third stage, where worsen, or not appear?
the person wants to give his or her love to others. • Where does the problem usually appear or not
At the fourth stage, the person needs to repent appear? In what situations?
for whatever harm he or she has caused others • How often does the problem appear, and how
and to forgive whatever harm was done to him serious is it?
or her. • What has been done and is currently being done
When a therapist determines that a client is at (by the client alone or by others) to resolve the
Level 1—wanting to dominate and control—he or problem?
she moves the person to the next level—wanting to • Whom or what does the problem benefit?
be loved. If the client is stuck in wanting to be • Who could be hurt by the disappearance of the
loved (Level 2), the therapist moves him or her to problem?
wanting to give love (Level 3). If the client is overly
focused on loving, the therapist moves the client to Once this information is obtained, the therapist
the stage of admitting and repenting for the harm designs a strategy that usually consists of sugges-
the client has caused and forgiving the harm tions or directives about what the client will do. In
caused to the client (Level 4). If the client is stuck subsequent sessions, the client reports on the
in repentance and forgiveness, the client has to be results of the strategy, and then the strategy is
moved once again to the first stage of focusing on continued, or a new strategy is designed. Regular
controlling his or her environment, and so on. That follow-ups after termination are recommended.

966 Structural Family Therapy
Because in strategic therapy a specific therapeu- approaches that did not seem to help that popula-
tic plan is designed for each problem, there are no tion, Minuchin turned his attention to the young-
contraindications in terms of client selection and sters’ families. He noted that parenting and other
suitability. The approach has been used with cli- interpersonal contacts were erratic and inconsis-
ents of all ages and all socioeconomic classes and tent and that the families tended to be isolated
with all kinds of presenting problems. This is a from their community, while other families living
pragmatic approach that allows the therapist to in the same poor neighborhoods but not having
borrow from other models of therapy any tech- delinquent children were better organized and con-
niques that may be useful in solving a presenting nected with others. Minuchin and his collabora-
problem. tors then set out to coach the youngsters’ families
into more structured ways of interacting.
Cloe Madanes Acknowledging the concrete, action-oriented style
of the families, Minuchin introduced nontradi-
See also Erickson, Milton H.; Erickson-Derived or
-Influenced Theories: Overview; Haley, Jay; Madanes,
tional, “more doing than talking” techniques.
Cloe; Palo Alto Group; Strategic Family Therapy Families of the Slums, published in 1967, provides
a thorough account of the experience.
In 1965, Minuchin left Wiltwyck to lead the
Further Readings Philadelphia Child Guidance Clinic, bringing with
Bateson, G. (1972). Steps to an ecology of mind. him two of his collaborators, the clinician Braulio
New York, NY: Ballantine Books. Montalvo and the researcher Bernice Rosman.
Haley, J. (1973). Uncommon therapy. New York, NY: They were joined by Jay Haley, whose thinking
W. W. Norton. influenced and was influenced by Minuchin’s.
Haley, J. (1976). Problem-solving therapy. San Francisco, Serving a heterogeneous urban population, the
CA: Jossey-Bass. clinic made Minuchin’s approach available to a
Haley, J. (1984). Ordeal therapy. San Francisco, CA: wider spectrum of families and problems and
Jossey-Bass. helped expand and precise it. By the early 1970s, it
Madanes, C. (1990). Sex, love and violence. New York, began to be known as “structural family therapy”;
NY: W. W. Norton. its tenets were formulated and illustrated with
abundant clinical material in the classic Families
and Family Therapy, published in 1974.
The clinic’s association with a children’s hospi-
STRUCTURAL FAMILY THERAPY tal opened up an opportunity to apply the model
to the treatment of psychosomatic conditions like
Structural family therapy is a systemic model of asthma, diabetes, and anorexia. Unlike the disor-
therapy developed by Salvador Minuchin in the ganized families of Wiltwyck, families with
1960s and 1970s. One of the most influential in psychosomatic children tended to be too rigidly
the field of family therapy, its distinctive features organized and in need of more flexibility. The
are the decisive role attributed to the family both action techniques developed at Wiltwyck to facili-
in accounting for the behavioral problems of its tate communication with “nonverbal” clients were
members and in working toward their resolution, now helpful in dealing with clients who talked too
and the responsibility placed on the therapist as a much. Minuchin and his collaborators Rosman
catalyst of change. and Lester Baker also demonstrated experimen-
tally the impact of family interactions on individ-
ual physiology and presented their clinical and
Historical Context
research findings in Psychosomatic Families,
In the early 1960s, Minuchin was the intake psy- published in 1978.
chiatrist at the Wiltwyck School for Boys, a resi- In the mid-1970s, as interest in the structural
dential facility in Upstate New York for juvenile approach was growing, Minuchin stepped down
delinquents from the inner city. Looking for an as director and created the clinic’s Family Therapy
alternative to traditional psychotherapeutic Training Center. The concepts and techniques

Structural Family Therapy 967
taught at the center to hundreds of practitioners accommodate to one other. Once the complemen-
became the subject matter of Family Therapy tary roles of mother, father, and child are set,
Techniques, written by Minuchin in collaboration deviations from the “script” tend to be countered
with his student and eventual colleague Charles by corrective movements. But homeostasis does
Fishman and published in 1981. Two years later, not fully describe the family’s process.
Minuchin moved to New York and founded the Counterdeviation moves notwithstanding, the
Family Studies Institute, dedicated to the training family constantly evolves toward increasing com-
of family therapists and the application of struc- plexity, adapting to changing internal and external
tural principles in programs that affect the lives of demands: Children are born and grow; parents
low-income families. A product of that effort was age; there may be illnesses, financial hardship, and
Working With Families of the Poor, which changes of homes, jobs, or schools. A well-
Minuchin coauthored with his wife, Patricia, and functioning family is not defined by the absence of
Jorge Colapinto. Following Minuchin’s retirement stress or conflict but by how effectively it handles
in 1993, the Family Studies Institute was renamed them. An “ineffective” mother may bring into play
the Minuchin Center for the Family. the assertiveness that she demonstrates in other
relationships; a “rough” father may allow his ten-
der side to show through the apparent gruffness.
By contrast, a family becomes dysfunctional when
Structural family therapy conceptualizes individual it maintains a relational structure that no longer
behavior as a function of the individual’s family works. Giving in to a child’s tantrums may not be
context. A boy’s violent outbursts, for instance, are a problem when the child is 2 years of age and the
seen as his participation in a larger picture that family functions as a more or less self-contained
may include a protective mother and an authori- unit, but it may become one if it continues when
tarian father. “I try to set limits,” says the mother, the child reaches school age.
“but then my son throws a temper tantrum, and if The process of mutual accommodation that
I don’t give in, his father will get involved and generates the family’s transactional structure also
things will get worse.” The mother’s giving in pre- underlies the development of individual identity.
empts her husband’s roughness, which in turn may As the child interacts with parents, siblings, and
be a response to what he sees as the mother’s spoil- others, some traits (e.g., shyness) are selected,
ing of their son. Completing the picture, the dis- while others (e.g., assertiveness) are discouraged.
agreement between the parents provides a fertile Because the child participates in different transac-
ground for the son’s tantrums. Complementarity tions, the resulting identity is multifaceted: A girl
designates this correspondence or “fit” between may be domineering in her interactions with her
the behaviors of family members. An assertive younger brother and submissive in relationship to
mother and an obedient child fit each other. So do her father.
the parents who work as a team, and the parent The concept of an evolving, multifaceted iden-
and the teenager who negotiate issues of responsi- tity has significant implications for assessment and
bility or autonomy. These are all examples of func- treatment. The structural family therapist assumes
tional complementarity. Complementarity can also that clients are functioning with just a fraction of
be dysfunctional: a disobedient child and her inef- their potential and that traits that may not be
fective mother, a couple where one pursues and the apparent at first sight, such as the capacity to nur-
other withdraws, and a rebellious teenager and a ture or to exercise responsible leadership, may be
rigidly authoritarian parent. or have been active in other contexts. Thus, the
To account for the formation of complementary same family that displays dysfunctional interac-
patterns, structural therapists resort to the physio- tions holds—in the form of hidden or underuti-
logical concept of homeostasis, the tendency of an lized strengths—the keys to better functioning. In
organism to maintain a quasi equilibrium. Giving therapy, it is not necessary for a mother to work
in before “things get worse” keeps internal tension through the historical origins of her low self-
within acceptable levels. Homeostatic patterns esteem before she can become a competent parent.
develop over time as family members constantly For example, if the father does not interfere in her

relationship with her son, she can actualize her Subsystems

latent competency. At a deeper philosophical
Subsystems are groups of family members
level, the structural therapist’s interventions are
defined by gender, generation, common interests,
rooted in the belief that individual differentiation
or functions. For instance, a husband and wife
is not achieved through retrenchment into oneself
form the spouse subsystem, whose function is to
but through participation in multiple relation-
provide mutual support. They are also part of the
ships. The goal is not the self-sufficiency of the
parental subsystem, organized around issues of
rugged individual but the mutual reliance on the
nurturance, guidance, and discipline. Within the
network.
sibling subsystem, children learn to make friends,
handle conflict, and provide and receive support.
Major Concepts
A number of major concepts that originated with Boundaries
structural family therapy are now used by most Boundaries define subsystems. A boundary can
family therapists. Here, we take a look at just a few be depicted as an encircling line around two or
of them: family structure, subsystems, boundaries, more family members that shields them from the
and hierarchies. rest, allowing for self-regulation. Boundaries pro-
tect the spouses from the intrusion of in-laws, chil-
Family Structure dren, and others, and the sibling subsystem from
excessive parental interference. Like the membrane
Family structure is the set of rules, often unspo-
of a cell, good boundaries are defined well enough
ken but observable, that dictate the “who, how,
to let the members of a subsystem negotiate their
and when” of interactions—for instance, that a
relationship autonomously, but they are also flexi-
mother will give in to her son who is throwing a
ble enough to allow for participation in other sub-
tantrum before the father takes punitive action.
systems. When boundaries are too weak between
The structure can be pictured as a map where
two or more family members, the latter are said to
women are represented by circles and men by
be overinvolved; the behavior of one member
squares, each positioned higher or lower in the
immediately affects the others. There is a height-
diagram depending on their relative power within
ened sense of belonging and mutual worrying,
the family and interconnected by single, double,
protection, and loyalty demands; one member’s
broken, or wavy lines to denote the quality of their
attempts to change elicit resistance from the others.
relationships. The family map in Figure 1 depicts a
On the other hand, when boundaries are too rigid,
very close relationship between mother and son, a
there is excessive distance among the members, a
more distant one between father and son, a con-
lack of mutual support and protection, scarce com-
flictive relationship between father and mother,
munication, and excessive tolerance of deviant
and a hierarchical arrangement where the mother
behavior—a situation described as disengagement.
holds more power.
Overinvolvement and disengagement may describe
the whole family structure or different relation-
ships within the family; for instance, there may be
overinvolvement between mother and son and
MOTHER disengagement between the father and both of
them. This triangular pattern, common in families
FATHER with a symptomatic child, may allow for detour-
ing: The parents avoid dealing with their own con-
flicts by focusing their shared concern on the child.
Hierarchy
SON
Hierarchy refers to the different degrees of
decision-making power held by the various mem-
Figure 1 A Structural Map bers. In general, parents should be in charge of

Structural Family Therapy 969
their children—not as dictators but as providers of patterns developed over time (“How did it come to
guidance and protection. However, while some happen that the father is the disciplinarian and the
form of hierarchical arrangement is necessary, mother the softy?”).
families can function with a variety of arrange-
ments. For instance, a grandmother or an older
child may function in a parental capacity, provided Reframing
there is a clear delineation of responsibilities. Reframing is the process of zooming in or out
Hierarchical patterns that are clear and flexible on a problem situation to obtain a different per-
tend to work well; too rigid or too erratic patterns spective on the problem. While the quest for an
are problematic—in one case, the children’s auton- alternative perspective is common to most thera-
omy is impaired; in the other, they experience a pists, structural therapists emphasize particularly
lack of guidance and protection. In a flattened the reframing of “individual” problems as rela-
hierarchy, parents and children hold the same tional ones. If a girl who has been labeled as hyper-
amount of power, as when a mother and her teen- active is displaying her symptoms by running
age daughter argue like sisters. In a reversed hier- around the room while her mother begs her to sit
archy, the children hold more power, as when the down, the therapist may ask the mother, “Is that
teenager controls the parent by acting out. In a how the two of you spend your time together?”—
cross-generational coalition, two members on dif- thus locating the problem in the interaction instead
ferent levels of the hierarchy join forces against a of in the girl. If the father then succeeds in quieting
third one; for instance, a father supports his son in the girl, the therapist may note that she is more or
disobeying the mother, or a grandmother and her less hyperactive depending on whom she is inter-
grandchild “gang up” against the child’s parent. acting with. Other reframings typically utilized by
structural therapists aim at shifting the meaning of
behaviors from negative to positive (“You wouldn’t
Techniques be so angry at each other if you did not care so
Some of the main techniques utilized by structural much for each other”) or, conversely, from positive
family therapists, such as tracking and reframing, to negative (“Your father is helpful, but if he does
are applied in one way or another by therapists of everything for you, you will always remain incom-
all persuasions. However, structural therapists are petent”).
specific in what they track (i.e., the family’s struc-
ture) and how they reframe (i.e., by locating the
Enactment
problem in the family interactions rather than the
individual). A third primary technique, enactment, Reframing sets the stage for the most powerful
is a trademark of structural family therapy. restructuring technique, enactment. Having identi-
fied the problem as a relational one, the structural
therapist directs the family members to interact
Tracking
differently than what they usually do: “Discuss this
Tracking is used to get a picture of the family with your wife, and don’t let your daughter dis-
structure. For instance, to assess affiliations, com- tract you” or “Don’t check with your mother when
plementary patterns, power distribution, and styles you are talking to your father.” The purpose of an
of conflict resolution, the therapist first observes enactment is to have the family members experi-
the interactions between the family members, pay- ence one another in novel ways; in the examples
ing attention to the process rather than the verbal given, the therapist pursues that goal by drawing a
content: who takes the initiative, who interrupts, boundary around two family members, shielding
who completes phrases, supports, or criticizes. them from the intrusion of a third one, so that they
Additional information is gathered by asking fam- can address their differences.
ily members to interact in specific ways (“Can you Because of the natural tendency of the family
move closer to your daughter and discuss this issue to regress to its established ways, enactments need
with her?”), inquiring about events at home to be sustained by the therapist. Consistent with
(“How was it decided that your son would not go the premise that change comes from actualizing
to school last Wednesday?”), and exploring how skills that have been deselected in the course of the

family’s development but are available to the fam- development. Structural therapists are proactive
ily in latent form, structural therapists prefer to and encouraging, and they challenge families to
take a decentralized position, resisting the pull to take a different look at their problems and to
“cure” individuals, teach communicational skills, change how they interact. This requires a strong
or arbitrate differences; instead, therapists encour- connection with the family members, the ability to
age the family members to interact with one understand their problems in context, and a will-
another, and they intervene selectively as needed ingness to direct them toward better ways to relate
to keep the interaction going and direct it toward to one another.
a new desired outcome. Through joining, the therapist gains the accep-
For instance, the therapist may intervene to tance of the family, as a temporary member with
enforce the boundaries of an enactment when they permission to influence the system from within.
are infringed. If a father moves to overimpose his Joining calls for respecting the family’s existing
authority when the mother is trying to assert her structure (e.g., by addressing the parents before the
own (“Do what your mother says”), the therapist children); validating all members’ perspectives and
may block him (“Let your wife do it”). Structural expressions of concern, sadness, anger, fear, and
therapists also interject their comments on the even rejection of therapy; and suspending judg-
enactment, not by making long interpretations but ment, interpretations, or diagnoses. But it must
by briefly punctuating stumbling blocks (“She also communicate that therapy can make a differ-
gave you that look again, and you dropped the ence, by introducing some measure of challenge to
issue”) and successes (“Great, now that you got the family’s presentation (“You say that you have
the children to play on their own, we can resume had it with your son, but your face says you are
our conversation”). very concerned for him”).
To push the family beyond their “comfort zone,” Joining begets an initial assessment of the fam-
the therapist may need to elevate the temperature ily—as the therapist experiences how the family
of the session. This can take a mild form, like does and does not work; who is close to whom;
extending the duration of an enactment (“You which members are in conflict; what are the sub-
need to keep talking until you reach an agree- systems, the affiliations, and the triangles; and how
ment”), or, if the family’s patterns are particularly their transactions relate to the problems at hand.
rigid, a more intense one, like the technique of The therapist is also alert to indications of strengths
unbalancing, where the therapist supports one that the family may not be aware of, or value
family member—typically the less powerful—more enough, and organizes all the information into a
than the others. preliminary map of the family structure and the
An enactment, no matter how intense, does not possible roads to change, which will continue to be
beget durable change by itself. It does shake the redrawn through the process of treatment.
family out of their homeostatic arrangement and Consistent with structural theory, therapy
shows that change is possible and what it might aims at restructuring the family system, which,
look like; but consolidating the change—thickening depending on the case, may mean decreasing or
the boundary around the parental subsystem, mak- increasing the levels of involvement among indi-
ing more room for an adolescent’s autonomy, shift- viduals and subsystems, and/or realigning hierar-
ing to a different way of negotiating power and chies. The goal is not just to extricate individuals
control—requires more work. New ways of relat- from unhealthy family binds but also to make
ing must be experienced repeatedly, with each suc- those binds healthier, allowing for both belong-
cessful enactment expanding the family’s relational ing and differentiation. When the structural
repertoire, until a qualitatively different and health- therapist encourages more distance between a
ier transactional structure emerges and holds. mother and a child, it is not to isolate either one
but to make room for them to participate in
other subsystems—child–father, wife–husband,
Therapeutic Process
and child–siblings—where they can actualize
The purpose of structural family therapy is to free alternative aspects of their selves.
the family from the constraining patterns that it
has constructed over time, so that it can resume its Jorge Colapinto

Sullivan, Harry Stack 971
See also Haley, Jay; Madanes, Cloe; Minuchin, Salvador; This may have contributed to the significance that
Strategic Family Therapy; Strategic Therapy; Systemic Sullivan would place on same-sex friends, or
Family Therapy “chums” in his term, in his theory of interpersonal
relationship, which he developed later in his life.
Further Readings On a scholarship to attend Cornell University,
Sullivan as a college freshman in 1909 seemed to
Colapinto, J. (1988). Teaching the structural way. In be an intellectually promising, if socially awkward,
H. Liddle, D. Breunlin, & R. Schwartz (Eds.),
young man. Soon, however, Sullivan found himself
Handbook of family therapy training and supervision
involved in difficulties that contributed to his men-
(pp. 17–37). New York, NY: Guilford Press.
tal instability, which resulted in his suspension
Colapinto, J. (1991). Structural family therapy. In
from the school. The nature of the trouble is
A. Gurman & D. Kniskern (Eds.), Handbook of family
therapy (Vol. 2, pp. 417–443). New York, NY:
unclear, but it was serious enough for him to
Brunner/Mazel.
decide not to go back to Cornell. Two years later,
Lappin, J. (1988). Family therapy: A structural approach. he began pursuing a degree in a medical school in
In R. Dorfman (Ed.), Paradigms of clinical social work Chicago, associated with Valparaiso University,
(pp. 220–252). New York, NY: Brunner/Mazel. Indiana. After stints as an industrial physician and
Minuchin, P., Colapinto, J., & Minuchin, S. (2007). a surgeon in the U.S. Army, Sullivan went as a liai-
Working with families of the poor. New York, NY: son officer to St. Elizabeth Hospital in Washington,
Guilford Press. D.C., in 1921, and then, the following year, to
Minuchin, S. (1972). Structural family therapy. In Sheppard and Enoch Pratt Hospital (also referred
G. Caplan (Ed.), American handbook of psychiatry to as Sheppard-Pratt) in Towson, Maryland, where
(Vol. 2, pp. 178–192). New York, NY: Basic Books. he became familiar with mentally ill patients for
Minuchin, S. (1974). Families and family therapy. the first time in his medical career.
Cambridge, MA: Harvard University Press. It was at Sheppard-Pratt that Sullivan’s talent as
Minuchin, S., & Fishman, H. C. (1981). Family therapy a psychiatrist blossomed. In particular, his ability
techniques. Cambridge, MA: Harvard University Press. to talk with young, male, schizophrenic patients in
Minuchin, S., Montalvo, B., Guerney, B. G., Rosman, B. L., & sharply insightful, often therapeutically effective,
Schumer, F. (1967). Families of the slums. New York, NY: ways quickly made him a renowned figure in the
Basic Books. psychiatry of the time, which struggled to under-
Minuchin, S., Reiter, M., & Borda, C. (2013). The craft of stand the debilitating illness. The hospital physi-
family therapy: Challenging certainties. New York, cians used a psychoanalytically oriented talk
NY: Routledge. therapy, but it was not clear at first if the method
Minuchin, S., Rosman, B. L., & Baker, L. (1978).
would be useful for the treatment of severely dis-
Psychosomatic families: Anorexia nervosa in context.
turbed schizophrenic patients. Sullivan showed
Cambridge, MA: Harvard University Press.
that it could be, as the success rate in his ward
appeared extremely high. This was a striking
accomplishment, especially given the general
understanding of the time that psychoanalysis
SULLIVAN, HARRY STACK was effective for neurosis but not necessarily for
psychosis.
Harry Stack Sullivan (1892–1949), the founder of An often overlooked aspect of his clinical work
the interpersonal theory of mental illness, was at Sheppard-Pratt was that many of his patients
born in Norwich, Upstate New York, the son of were homosexual men. A closeted homosexual
the only Catholic, Irish American family in the vil- man himself, and by 1928 living with his lover
lage. Although the modest farm that his family James Inscoe, who would become his lifelong part-
owned in this rural, economically struggling com- ner, Sullivan was committed to eradicating
munity may not have been the best environment homophobia, which he believed could cause men-
for an introverted, alert, and bookish boy, Sullivan tal disturbances including schizophrenia. Lacking
had several supportive figures in his youthful a critical mass of like-minded people to push for-
years, including a teenage boy with whom he ward this progressive view publically or politically,
established an unusually close emotional bond. Sullivan concentrated his efforts on reducing the

972 Sullivan, Harry Stack
internalized homophobia and self-hatred among served as his intellectual outlets. Pushing his under-
his patients in a protected, clinical environment. standing of mental illness in social milieus further,
He was critical of traditional or religious teaching Sullivan asserted that an individual personality is
about sexuality as well. The prohibition of mastur- “illusory” because it cannot be isolated from inter-
bation, premarital sex, and interracial sexual rela- actions with others. This view was closely related
tions became the target of his critique of “outdated” to his clinical experience, as he believed that as an
morality, which he considered responsible for observer, a doctor always participated in what
considerable damage to a person’s self-esteem. happened in an interpersonal encounter with a
Although he followed in Sigmund Freud’s steps in patient. Thus, what a doctor observed was not a
many ways as one of America’s neo-Freudians, fixed personality of a patient but a patient in the
Sullivan’s evolving theory marked a clear depar- process of relating to the doctor. To comprehend a
ture from classical psychoanalysis. He understood patient, then, a doctor must become a “participant-
illnesses in social, interpersonal interactions rather observer,” who collects the data not only of the
than in purely psychological dynamisms. dynamisms of the ongoing doctor–patient interac-
So it was that Sullivan in the 1930s became tions but also of the “life history” of both the
increasingly convinced that not only mental disor- patient and the doctor that shapes the current
ders but also the sociocultural and interpersonal therapeutic relationship. In the life history of a
conflicts that cause them needed to be addressed patient, Sullivan sought to find elements of healthy
by psychiatrists. Thus, he embarked on several development, such as a positive relationship with a
intellectual and institutional initiatives that were to chum in preadolescence. Equally important, he
change psychiatric education and research in a tried to find as possible causes of illness a range of
way that promoted prevention and a better social interpersonal failures and embarrassments at all
acceptance of the mentally ill. He worked with stages of personality development.
luminous intellectuals of the era such as Edward The last decade of Sullivan’s work, from 1939
Sapir, Harold Lasswell, Ruth F. Benedict, and to his death in 1949, was devoted to the making of
Margaret Mead, expanding the horizon of inter- the psychiatric screening system for the U.S. Army
disciplinary collaborations between psychiatry and and to establishing international mental health
the social sciences. Sullivan wanted psychiatry to programs for the World Health Organization, the
be a science, and his way of accomplishing this World Federation for Mental Hygiene, and
goal was to expand the discipline outward. During UNESCO. However, these efforts were plagued
the 1930s, Sullivan also undertook private practice with serious limitations. Originally modeled on his
in New York City, with the hope that treating neu- participant observation and life history methods,
rosis would help prevent more serious conditions the mass screening of prospective soldiers became
such as schizophrenia. He continued to pursue his a hasty, often dysfunctional, and ultimately unreli-
goal of debunking internalized homophobia among able diagnostic procedure. There is little doubt that
his patients and students, although some of his Sullivan’s intention was to protect psychologically
practices involving sexual intimacy with patients fragile military recruits from possible mental
and students crossed ethical boundaries and breakdowns in the army environment. But the
shocked many colleagues. screening system fell harshly on the rejected indi-
Sullivan was not a prolific or eloquent writer, viduals, including homosexual persons who were
but his interpersonal theory reached maturity and denied the right to serve the nation because of their
fame in the late 1930s and early 1940s. Although “homosexual proclivity” or “psychopathic person-
most of his monographs were published posthu- ality.” And yet, his work for national mobilization
mously, his insights into mental illness as a result in World War II elevated Sullivan’s reputation,
of conflicted interpersonal relationships became leading him to serve as one of the major architects
well-known through his articles, lectures, and of postwar liberal mental health policies, such as
seminars. His interdisciplinary journal Psychiatry, the International Congress on Mental Health and
along with the institutions that he either estab- the UNESCO Tensions Project. Both of these pro-
lished (The Washington School of Psychiatry) or grams aimed to study and prevent the interper-
was affiliated with (Chestnut Lodge Hospital), sonal and international tensions that cause wars.

Supportive Psychotherapy 973
By the end of the 1940s, Sullivan was an enig-

matic figure whom many of his students and SUPPORT GROUPS
colleagues found mysterious and not easily
approachable. Nonetheless, Sullivan’s interper- See Self-Help Groups
sonal theory became one of the major components
of psychoanalytical treatment and theory of men-
tal illness after World War II, when psychoanalysis
reached its golden age in the United States. To be SUPPORTIVE PSYCHOTHERAPY
sure, the influence of psychoanalysis on psychiatry
declined after biological and neuroscientific Supportive psychotherapy is a dyadic approach
approaches to mental disorders became main- aimed at improving symptoms, self-esteem, psy-
stream. But Sullivan’s interpersonal approach to chological function, and adaptive skills. With its
mental illness continues to be a vital component roots in the psychodynamic approach, the purpose
of the clinical practice of many psychologists, psy- of supportive psychotherapy is to help clients cope
chotherapists, and counselors today. He was an with psychological symptoms rather than make
important pioneer in midcentury interdisciplinary personality adjustments. Supportive psychother-
collaboration. Also, he is remembered as a practi- apy is traditionally used for clients who do not
tioner of extraordinary talent and a theorist who have the cognitive or psychological abilities to
passionately and fearlessly pursued disciplinary endure intensive psychodynamic approaches to
border crossing in the history of American psy- psychotherapy. However, supportive psychother-
chiatry and social sciences. apy is not restricted to use with impaired individu-
als and can be utilized to address a range of client
Naoko Wake concerns. Relatively healthy individuals can also
benefit from supportive psychotherapy in dealing
See also Classical Psychoanalytic Approaches: Overview; with short-term problems, such as relationship
Contemporary Psychodynamic-Based Therapies: concerns.
Overview; Freud, Sigmund; Freudian Psychoanalysis;
Horney, Karen; Interpersonal Theory; Neo-Freudian
Psychoanalysis Historical Context
In the early 20th century, psychoanalysis was the
Further Readings primary approach in psychological treatment. By
the 1950s, some psychoanalysts, such as Kurt
Bérubé, A. (1990). Coming out under fire: The history of Eissler, saw a need for an approach to therapy with
gay men and women in World War Two. New York, more limited objectives than those of psychoanaly-
NY: Free Press.
sis—to treat clients with cognitive or psychological
Evans, F. B., III. (1996). Harry Stack Sullivan: Interpersonal
impairments (e.g., addiction, eating disorder) that
theory and psychotherapy. New York, NY: Routledge.
made traditional psychoanalysis more difficult.
Hale, N., Jr. (1995). The rise and crisis of psychoanalysis
Supportive psychotherapy was developed by indi-
in the United States: Freud and the Americans,
1917–1985. New York, NY: Oxford University Press.
viduals such as Eissler, Jerome Frank, and Herbert
Perry, H. S. (1982). Psychiatrist of America: The life of
Schlesinger to address this need. Since its establish-
Harry Stack Sullivan. Cambridge, MA: Belknap Press. ment in the 1960s, supportive psychotherapy has
Sullivan, H. S. (1953). Conceptions of modern psychiatry. evolved and also taken on elements of cognitive-
New York, NY: W. W. Norton. behavioral therapy, interpersonal therapy, and
Sullivan, H. S. (1954). The psychiatric interview. New York, other influences. Despite supportive psychothera-
NY: W. W. Norton. py’s long tenure in the helping professions, teach-
Sullivan, H. S. (1964). The fusion of psychiatry and social ing and training in supportive psychotherapy have
sciences. New York, NY: W. W. Norton. been limited. The Accreditation Council on
Wake, N. (2011). Private practices: Harry Stack Sullivan, Graduate Medical Education’s Residency Review
the science of homosexuality, and American liberalism. Committee for Psychiatry is now mandating com-
New Brunswick, NJ: Rutgers University Press. petency for graduates in supportive psychotherapy.

974 Supportive Psychotherapy
Theoretical Underpinnings past and present conflicts. The supportive psycho-

therapist works to prevent anxiety from increasing
Supportive psychotherapy was initially derived
during the sessions.
from the psychodynamic approach, but has grown
to include aspects of cognitive-behavioral and
interpersonal therapy approaches as well. Conversational Style
Originally intended as a less intensive form of psy- Supportive psychotherapy seeks to have an
choanalysis, supportive psychotherapy focuses on informal interaction between the client and the
the individual’s issues at hand, such as issues of therapist rather than the therapist teaching a les-
self-esteem, interpersonal functioning, and coping son or interrogating the client. Unlike traditional
strategies. While past issues and past behavior are psychoanalysis, exploration of mental content is
discussed in supportive psychotherapy, more atten- not a focus in supportive psychotherapy, and
tion is paid to present conflicts and the present therapy unfolds more like a conversation than in a
behavior of the client. structured therapeutic format.
Major Concepts Techniques

Supportive psychotherapy uses concepts related to Techniques for supportive psychotherapy are
psychodynamic theory, in addition to those from aimed at lifting the client up in an effort to improve
cognitive-behavioral and interpersonal therapy his or her self-esteem, psychological function, and
approaches including conscious and unconscious, adaptive ability. Techniques include praise, refram-
therapeutic alliance, self-esteem, anxiety, and con- ing, normalizing, advice and teaching, rehearsal,
versational style. paraphrasing, and confrontation.
Conscious and Unconscious Praise

Conscious issues for the client are often A therapist genuinely praising the client for suc-
discussed, but therapists utilizing supportive psy- cesses, achievements, or positive changes can have
chotherapy do not seek to uncover unconscious a profound effect on the client’s self-esteem and
conflicts within the client. Defense mechanisms, encourage healthy psychological function and
like rationalization or denial, are not explored adaptation.
unless they have become maladaptive to the client
and his or her relationships.
Reframing
Therapeutic Alliance Reframing occurs when the therapist shares a

different and more positive perception of a client’s
Supportive psychotherapy seeks to create a safe statements or beliefs. A constructive reframing of a
environment for the client by creating an alliance client’s narrative can be effective in helping the cli-
between the client and the therapist that is positive ent see his or her situation from another perspective.
and caring, and promotes change in sessions.
Normalizing
Self-Esteem
By using normalizing, therapists show clients
Therapists utilizing supportive psychotherapy that their feelings, thoughts, and behaviors are not
seek to improve clients’ self-esteem by conveying uncommon and are often experienced by others.
acceptance, approval, interest, respect, and admi-
ration toward the clients during sessions.
Advice and Teaching
Therapists using supportive psychotherapy will
Anxiety
often take opportunities to share their advice with
Supportive psychotherapy works to alleviate clients in dealing with certain issues. Additionally,
conscious anxieties in clients by not focusing on teaching a client a new skill or coping technique is

Symbolic Experiential Family Therapy 975
used often in supportive psychotherapy. Advice has reached his or her goals or when the client
and teaching can be used together to reinforce decides to discontinue therapy. Therapy may
desired behavioral changes. resume in the future at the client’s discretion.
Brett K. Gleason
Rehearsal
Rehearsal entails the therapist considering in See also Behavior Therapy; Classical Psychoanalytic
advance what difficulties the client may encounter in Approaches: Overview; Cognitive-Behavioral
Therapy; Freudian Psychoanalysis; Interpersonal
the obtainment of a goal and then structuring strate-
Psychoanalysis
gies to overcome them with the client in session.
Further Readings
Paraphrasing
Dewald, P. A. (1994). Principles of supportive
Paraphrasing involves the therapist reporting
psychotherapy. American Journal of Psychotherapy,
back to the client what the client said in an effort
48(4), 505–518.
to convey understanding of what the client just
Werman, D. S. (1984). Principles of supportive
explained. psychotherapy. New York, NY: Brunner/Mazel.
Winston, A., Rosenthal, R. N., & Pinsker, H. (2004).
Confrontation Introduction to supportive psychotherapy. Arlington,
VA: American Psychiatric.
Confrontation involves the therapist bringing
the client’s attention to a feeling, thought, or
behavior that was expressed, perhaps without real-
ization, and challenging the client to address it or
pointing out discrepancies or inconsistencies in the SYMBOLIC EXPERIENTIAL
feeling, thought, or behavior. FAMILY THERAPY
Symbolic experiential family therapy (SEFT)
Therapeutic Process
emerged from the clinical experience of Carl
Supportive psychotherapy is limited to meeting the Whitaker and continues to develop in the clinical
goals and needs of the client. A client with many experience of experiential practitioners. A magical
needs may be involved in supportive psychother- therapeutic spirit—constituted by a blend of imagi-
apy for several months or even years. Supportive nation, wisdom, attention, and empathy—residing
psychotherapy should not go beyond the comple- in an individuated practitioner is the energetic core
tion of client goals to address personality changes of experiential family therapy. In therapeutic inter-
or explore the past deeply. Brief forms of support- views, the practitioner creates a climate invigorated
ive psychotherapy exist for crisis intervention. by the systemic dialectics of individuation and
Brief supportive psychotherapy typically lasts five belonging, creativity and adaptation. Even though
to eight sessions and is used for clients with limita- veiled by endless discord and suppression, the ener-
tions of time or money. getic core of the human spirit yearns for an ideal, is
The beginning sessions of supportive psycho- creative, and is thus implicitly noncompliant. The
therapy focus on the formation of the therapeutic SEFT practitioner looks for fragments of health in
alliance. The therapist seeks to understand the the family’s living patterns and helps families dis-
presenting issues of the client and to form clinical cover the possibility of becoming a healing com-
goals. Middle sessions have the therapist focusing munity with the assertive competence to deal with
on the continuation of the therapeutic alliance, as their problems. Additionally, therapy encourages
well as using psychoeducational and skill-building individual family members to gain access to more
interventions to help the client with the accom- of themselves through experience and to increase
plishment of his or her goals. Termination in sup- adequacy, as individuals and as a group. The best
portive psychotherapy does not have an official access to experience comes with therapeutic play
process. Termination takes place once the client and expansion of symbolic awareness. The therapy

976 Symbolic Experiential Family Therapy
process is suspended in the medium of language practitioners. He read widely but valued original
used both to describe experience and to create thinking, resisted adaptation, and was constantly
experience. developing novel ideas. His thinking was influ-
enced by Otto Rank, an unconventional analyst
with an experiential bent; Susanne K. Langer, who
Historical Context
paid careful attention to the symbolic understruc-
SEFT evolved from Whitaker’s seminal work with ture of experience; and Gregory Bateson, a critical
his Atlanta colleagues in experiential psychother- thinker with an interest in primary process and
apy, as his attention moved from working with the interpersonal components of schizophrenia.
individuals to therapy with families as multigen- Overall, the conceptual formulations of SEFT are
erational systems. Whitaker had no training in an open-ended theoretical collection including
psychoanalytical dynamics. His ideas about psy- fragments from systems theory, existential philos-
chotherapy came from play therapy with young ophy, Bateson, dialectical ideas, psychoanalytical
children and doing co-therapy with patients with theory, Donald Winnicott, theology, literary the-
schizophrenia before the introduction of antipsy- ory, Zen, hypnotherapy, play therapy, and more.
chotic medicines. He paid specific attention to the Experiential therapy attends to an energetic
psychotherapeutic process. Working with those healing, symbolic process. It pays attention to the
with schizophrenia and with children can have an pain and emotional hunger at the root of patients’
impact on how language is used in therapeutic emotional troubles and encourages patients to be
practice; as a result, Whitaker in his therapy ses- noncompliant and creative in the interest of
sions used language that was artful, poetic, and not expanding health. In SEFT, patients’ psychopathol-
inhibited by theory. ogy is seen as a symptom of patients’ frustrated
In 1965, he left his private practice in Atlanta to yearning for intimacy and for enlivening family
become professor of psychiatry at the University of relationships. That is, mental and behavioral disor-
Wisconsin Medical Center. There he worked exclu- ders are assumed to arise out of a failed effort to
sively with couples and families. He routinely make things better.
included grandparents and other members of his
patients’ social networks. He worked with the
range of emotional and psychological disorders, Major Concepts
including what are thought of as major mental A number of concepts drive the process of SEFT
disorders. His interviewing style has been described and include having an understanding of the change
as engaging, mysterious, perplexing, interesting, process, knowing the role of the practitioner,
and sometimes upsetting. His therapeutic inter- depathologizing identified patients (family mem-
viewing pattern implicitly criticized and raised bers), identifying culturally invisible pathology,
questions about conventional cultural patterns, in keeping an eye toward family morale, maintaining
the way an artist’s work implicitly interrogates a the personhood of the practitioner, acknowledging
culture. the importance of families playing, using everyday
During his years in Wisconsin, August Napier, language, considering three generations of pat-
Ph.D., and David Keith, M.D., beginning as learn- terns, giving the emotional process priority,
ers, became coauthors, copractitioners, and col- expanding the relation system, using co-therapy
leagues, cultivating the growth of experiential and consultation, and learning from experience.
family therapy in their careers.
The Change Process
The family practitioner, regardless of his or her
Whitaker consistently characterized experiential discipline, is viewed as a change agent, both nur-
therapy as “atheoretical.” He insisted that his turing and challenging, one who catalyzes meta-
methods were grounded in clinical experience. morphosis in thinking and behavior patterns in
In his view, theory interferes with clinical respon- families. The artful work of the practitioner is to
siveness and erodes the crucial creative spirit of locate the yearning, the concealed energy for

growth in the family story. To do this, the practi- patient provides a counterbalance to culturally
tioner takes action and uses language in novel, invisible pathology in the family and is dedicated
playfully destabilizing ways. The process of ther- to undermining the family’s apathy about invisible
apy is to recycle the family’s experiential debris— pathology.
such as defiance, depression, or bipolarity—and Some culturally invisible symptoms are the fol-
process it into yearning, desire, and a deepening lowing: (a) loss of or dead imagination, (b) inability
sense of individuation and belonging. Language is to laugh, (c) irony deficiency, and (d) fundamental-
used in ways that challenge the possibility of fixed ism, political or religious. Another formulation
meanings. In this clinical framework, everything involves “abnormally normal” families, who can
considered psychopathological is related to talk at length about the identified patient, while
impasses in interpersonal relationships past and everything else is normal. Their sense of normality
present, until proven otherwise. Genetics and neu- is unrealistic, symptomatic of their inability to
rophysiologic explanations may be part of the metacommunicate about relational experience (i.e.,
problem but never the whole story. Nurturing, to make remarks about interpersonal communica-
experience, and symbolic reality are fundamental tion, such as “You sound like you are afraid of
components in the evolution of these complex her”). They give only brief descriptions to the prac-
problems. titioner’s queries; thus, the first interview typically
last only 20 minutes. They resist putting experience
into words; thus, there is no capacity for talking
Role of the Practitioner
about emotional pain.
The metaphorical model for the experiential
practitioner is the foster mother who provides a
Family Morale
blend of structure and nurturing in a time-limited
relationship. And, of course, the foster mother is a Health is rooted in the group spirit of the family.
role played by practitioners, who in their heads are When the family morale improves, the security of
a generation older than the oldest family member all members is likely to increase. The increased
in the session. security enables family members to reflect on what
they may be contributing to the problem. That is,
each family member is able to use the relationship
Depathologizing
with the practitioner to become a patient. This
In SEFT, the person identified as troubled by the way, they can question themselves and expand
family is considered the healthiest member of the their consciousness of what goes on in their family
family, defeated in his or her attempt to restore and in their lives. The patient, then, becomes some-
vigor to relationships. Symptoms are suppressed or one who is learning or has learned to use a rela-
failed efforts at repair. Individual psychopathology tionship with another to question himself or herself
represents a thwarted attempt to fix the family. For and bring about change in his or her living.
instance, a child’s depression may be seen as a
result of failing to relieve the mother’s chronic dis-
Personhood of the Practitioner
tress about the father’s distance. Defiance begins as
a collapse of fealty (trust in leadership). The child The dynamics of therapy are in the personhood
or adolescent loses faith in the parents’ capacity to of the practitioner in relation to the process
be nurturing leaders. Initially, the defiant behavior dynamics of the family. This is a critical therapeu-
insists that the parents be more alive. tic, experientially open precept, requiring reflec-
tion. As incongruous as it sounds, the practitioner
may be the most important patient. The practitio-
Culturally Invisible Pathology
ner develops a therapeutic consciousness founded
Culturally invisible pathology is behavior prac- in impeccable constancy to a structured pattern of
titioners overlook because it matches conventional practice, which guides decision making and enables
cultural values. Culturally invisible pathology is him or her to make use of fantasy, free association,
toxic to the core of family morale. The identified and body responses to a family in the clinic. The

978 Symbolic Experiential Family Therapy
structure provides a safe ground for creative thera- Priority to Emotional Process
peutic action. As with improvisational music,
The practitioner gives priority to emotional pro-
where the quality of a music performance resides
cess over cognitive processes. This therapy process
in the tension between structure and improvisation
attends to and is energized by the chaos and crisis
(the musician begins in a musical structure, which
at the core of modern living, where conventional
he or she leaves when improvising, but knows how
linear logic may create unintentional distortions.
to return to the structure), the effectiveness of
Clinically based learning and conceptual develop-
SEFT is found in the interplay between structure
ment are implicit in family therapy.
and creativity
Expanding the Relational System

Play Therapy as a Paradigm
When therapy is not working, it is common for
All experiential psychotherapy is play. If a fam- the practitioner to add people to either side of the
ily do not know how to play, it is the practitioner’s therapeutic relationship. Colleagues, grandparents,
job to teach them. Play is purposeless and always ex-spouses, probation officers, pastors, teachers,
carries the risk of meaning nothing. The primary and former practitioners may be added as consul-
reality of therapy is metaphorical and ironic. The tants. They come in for one interview to help the
capacity for play with language is a part of health; practitioner help the family who is stuck. In this
when it is possible to play with language, it is pos- process, it is critical to understand that consultants
sible to play with life and its meanings. are treated differently than patients.
Use of Everyday Language Cultural Influences of Modern Psychiatry

The practitioner uses the language of personal Modern biological psychiatry, with its emphasis
experience, everyday language, which abounds on individual diagnosis and the use of medication,
with ambiguity and inference, as opposed to the is based on hypotheses about behavior and psycho-
more specific language of a particular profession pathology that almost insist that practitioners not
or an applied theory. This style creates an atmo- be “distracted” by the whole family. Conventional
sphere of informality, invites participation, and modern psychiatry uses a syntax that has affected
makes personhood more accessible on both sides the way practitioners use language to talk about
of the therapeutic relationship. In this process of human pain and has shaped the ways clinical prac-
acting at an apparently less sophisticated level, titioners of all disciplines think about emotional
distinctions are usefully clouded—mind/body, distress. Additionally, psychiatry’s focus on pathol-
smart/dumb, doctor/patient, innocent/guilty, sick/ ogy as opposed to an implicit yearning to grow
healthy, personal/impersonal—and standard per- de-emphasizes the possibility of change and inter-
ceptions are obscured in ways that confuse but feres with enhancing family vitality and strengths.
stimulate, and open up the possibility of change or In contrast, experiential therapeutic principles are
adjustment. Metaphorical and ironic use of lan- founded in a clinical syntax for including the fam-
guage is an invitation to interaction and reflection. ily in a way that destabilizes living and thinking
patterns and opens up the possibility for relational
Three-Generational Patterning and intrapsychic change.
Family living is organized by out-of-conscious-

Co-Therapy and Consultation
ness multigenerational patterns. The practitioner’s
initial history interview of the family includes The use of co-therapy, especially with more
questions about the families in which the adults difficult families, is part of this therapeutic
grew up. Unconsciously, families prepare for the method. Usually, two practitioners join together
future by looking backward to where they came in a professional partnership to provide ongoing
from, expecting the past to be replayed in the treatment. Co-therapy is therapeutically effective
future. It is common practice to have the grandpar- and cost-effective; more happens in fewer ses-
ents come in for a consultation interview. sions. Consultation is a variant of co-therapy.

The practitioner may first see the family alone interviews the children about the parents, remem-
and then invite a colleague in for a consultation bers that the problems are in the family and tries
interview with the family. The consultant may not to get caught up in the family anxiety, trans-
also periodically attend continuing treatment ses- forms history from being factual to being symbolic,
sions. The processes of co-therapy teaming and and considers termination as a process, not the end.
consultation can be helpful and therapeutically
enriching. Another co-therapy variant is the
Including the Whole Family
consultation group, a therapy group for the pro-
fessional self of the practitioner. A group of col- The first interview can happen only once, and
leagues meet regularly to talk about impasses in the more family members present for that session,
treatment cases. Groups of this sort can vitalize the more productive the interview will be. An
practitioners and make their work more enjoy- interpersonal mind-set is induced by asking ques-
able and growth producing. tions about relationships. Father is asked, “Can
you tell me what your family is like? How does the
Learning From Experience
family work?” To the 13-year-old son, the practi-
tioner might say, “How do Mom and Dad relate
This is vital to the development of good practi- with each other?” Three generations are consid-
tioners. Adequate experiential family therapy ered in the assessment. The parents are pressured
depends on the ability of the practitioner to learn to describe the families from which they came and
from one’s own experience and the capacity to what the parents were like when they were their
dialogue with colleagues about those experiences. children’s age.
Techniques Conducting a Family History

There are few specific techniques. Instead, the A history of the family is taken during the first
practitioner keeps in mind the overall process of interview with the entire family present. The his-
therapy that he or she brings to the session. Thus, tory is focused on the family as a whole and its
the practitioner keeps in mind his or her person- patterns, not just the person with symptoms. The
hood during the session, depathologizes the patient, process is implicitly therapeutic for the family.
uses everyday language, considers three genera- They often see themselves as they have never seen
tions of patterns, has an eye toward culturally themselves before. In the process of taking the his-
invisible pathology, remembers that the emotional tory, the practitioner is not passive but comments,
process is a priority and that all families need to paraphrases, and infers. Language is used to induce
know how to play, and expands the relational sys- experience in the interest of producing change in
tem to significant others when needed. how the family thinks and behaves. For families,
There is a countercultural spirit in experiential the history can induce a shift from linear content
family therapy. The practitioner learns to be a to a narrative-transcending process. The practitio-
practitioner by doing therapy and by talking with ner develops a mind-set including historical events
colleagues about their work. Practitioners are along with associations and images that are stored
encouraged to value their experience and develop in his or her mind.
their own ideas. Being a professional psychothera-
pist is a disciplined art enhanced by practice. The
Pushing for Open Conversation
practitioner practices not in the service of self-gain
but in service of some obscure but vital spirit. It is important that the identified patient hears
other family members talk explicitly about their
concerns. The practitioner asks that each family
Therapeutic Process
member speak directly to him or her so that the
During therapy, there are a number of processes other family members overhear but are not required
that one would expect to occur. For instance, the to respond or allowed to comment. Children’s fan-
practitioner includes the whole family, conducts tasies and nightmares are typically far worse than
a family history, pushes for open conversation, any reality they hear or see in a therapy hour.

980 Systematic Desensitization
Interviewing Children About the Parents There is almost never a termination “process”;
rather, the practitioner and the family members
The practitioner talks to the children about the
figure out a way to go on living while enduring the
parents in the third person, mirroring the talk with
mystery of not knowing (just because there are
the parents about the children: “What does Dad do
questions does not mean that there are answers). In
when Mom is crying?” “What do you do when
general, therapeutic possibilities are much greater
Mom and Dad are having a fight?” “How do you
in family therapy than in other therapies; change
kids know when Dad or Mom is angry?” “When
happens more quickly and is more enduring.
you worry about your family, what do you worry
about the most?” David V. Keith
Remembering That the Problems See also Existential Therapy; Experiential Psychotherapy;
Phenomenological Therapy; Whitaker, Carl
Belong to the Family
SEFT practitioners remember that the problems
belong to the family, not to the practitioners. When Further Readings
practitioners become overinvolved with the fami- Connell, G., Mitten, T., & Bumberry, W. (1999).
ly’s real world, they lose their capacity to function Reshaping family relationships: The symbolic therapy
effectively in their therapeutically vital symbolic of Carl Whitaker. Philadelphia, PA: Brunner/Mazel.
role. It is the practitioner’s job to raise family Keith, D. (2014). Process, practice, and magic: Continuing
anxiety so that they have to mobilize dormant or the experiential approach of Carl Whitaker. Phoenix,
deactivated resources to deal with the struggles AZ: Zeig, Tucker & Thiessen.
they confront. Keith, D., Connell, G., & Connell, L. (2001). Defiance in
the family: Finding hope in therapy. Philadelphia, PA:
Brunner-Routledge.
Transforming the Family Interview
Keith, D., & Whitaker, C. (1981). Play therapy: A
The practitioner keeps a “poet’s mind” attuned paradigm for work with families. Journal of Marital
in listening to family stories. All major, intractable and Family Therapy, 7, 243–254.
“psychiatric” problems have components rooted in doi:10.1111/j.1752–0606.1981.tb01376.x
the symbolic experience of the family. The etymol- Napier, A., & Whitaker, C. (1978). The family crucible.
ogy of symbolic means “thrown together.” In the New York, NY: Harper & Row.
symbolic history, things, people, events, and con- Neil, J., & Kniskern, D. (1982). From psyche to system:
cepts are “thrown together”: What happened plus The evolving therapy of Carl Whitaker. New York,
what else happened and when plus what it meant NY: Guilford Press.
Whitaker, C. (1989). Midnight musings of a family therapist
characterize the layers of significance.
(M. Ryan, Ed.). New York, NY: W. W. Norton.
Whitaker, C., & Bumberry, W. (1988). Dancing with the
Considering Termination As a Process, family: A symbolic-experiential approach. New York,
Not the End NY: Brunner Mazel.
At the end of each interview, the practitioner
asks the family if they want to come back.
Continuation of therapy depends on the family
initiative, not on the practitioner’s perception of SYSTEMATIC DESENSITIZATION
their needs. The family are pushed to decide about
coming back, based on whether they are getting Systematic desensitization is a behavioral tech-
anything out of the therapy. nique that effectively reduces symptoms in specific
Experiential family therapy is often uninten- phobias and other anxiety disorders. It was devel-
tionally brief, from 8 to 12 sessions. Anxiety oped by Joseph Wolpe and is based on two animal
decreases, and although the problems may remain, models of treatment, Pavlovian countercondition-
they are less intense, and the family are prepared to ing and reciprocal inhibition, to overcome dysfunc-
go on with their lives as a healing community. tional fearful behavior. Systematic desensitization

Systematic Desensitization 981
proceeds in three basics steps: First, the therapist chamber in the absence of shocks. Unfortunately,
teaches the client a relaxation technique; then, the this approach did not have much of a therapeutic
client and the therapist elaborate a fear hierarchy effect on the cats. However, Wolpe observed that
(ranking events that are anxiety eliciting for the after the cats were fed in the presence of the fear-
client); and finally, the client is confronted by the evoking stimuli, these stimuli no longer evoked
situations of the hierarchy in ascending order of fear responses. Specifically, Wolpe began feeding
anxiety while he or she engages in relaxation tech- the animals in situations that resembled the origi-
niques. Exposure to the anxiety-eliciting situations nal context in which the fear was acquired. As the
is traditionally implemented by imagining these fear responses were reduced, he moved to situa-
situations, although in vivo exposure is also used. tions that were increasingly more similar to the
Systematic desensitization is widely known as a situations in which the traumatic situation origi-
successful and empirically supported therapy that nated (initially, it was impossible to feed the cats
has been traditionally used to treat major anxiety in this context given that the anxiety was too
disorders as well as test anxiety, sexual dysfunc- strong). After this procedure, the cats were no
tions, and other behavioral problems. longer afraid of the context, but they still exhib-
ited fear to the auditory cue; thus, Wolpe fed the
animals at a certain distance from the auditory
Historical Context
cue and continued feeding the cats closer and
In the 1950s, Wolpe defined a psychotherapeutic closer to the sound source, like he had done with
method to treat anxiety based on the animal the experimental chamber. Eventually, the cats
learning literature, which he named systematic stopped being anxious in the presence of the audi-
desensitization. As a psychiatrist formed in psy- tory cue. Wolpe concluded that the anxiety
chodynamic theories, Wolpe was unsatisfied with response was incompatible with the eating
the outcome of psychoanalytical treatment. His response; he called this relearning produced by
contact with James G. Taylor and Leo Reyna, who incompatible responses reciprocal inhibition.
were followers of Clark L. Hull and Kenneth Wolpe suggested that the reciprocal inhibition
Spence, respectively, exposed him to the experi- principle could be applied to the treatment of anx-
mental foundations of learning principles. His ious clients. He evaluated diverse responses that
interest consequently changed to the area of clas- could interfere with anxiety (e.g., sexual responses,
sical conditioning and psychopathology. During assertive responses, pleasant emotional excitement,
this period, Wolpe came to know about Ivan and nonaversive shocks) and found that deep mus-
Pavlov’s neurotic dogs, J. H. Masserman’s neurotic cular relaxation was the most efficient response to
cats, and Mary C. Jones’s and John B. Watson’s accomplish the task. Before Wolpe, Edmund
treatment for fear in kids based on the pairings of Jacobson had treated neurotic clients by extensive
a fearful stimulus or event with food (i.e., an appe- training in muscle relaxation. Jacobson’s relax-
titive stimulus). ation was prescribed to be performed at all times,
During 1947 and 1948, in his office at the however; in Wolpe’s systematic desensitization
Witswatersrand University Medical School in procedure, relaxation was contingent with the
Johannesburg, South Africa, Wolpe built experi- anxious response, so relaxation and anxiety would
mental chambers to study neurotic behavior and inhibit reciprocally. Furthermore, the systematic
its treatment in cats. His subjects received mild component ensured that the relaxation response is
electric shocks in an experimental chamber imme- always stronger than the anxious responses and,
diately after an auditory cue was presented. The consequently, it is the relaxation response that
animals responded to the shocks with responses overcomes the anxiety and not the other way
indicative of fear, such as crouching, trembling, around. This occurs because in this technique the
and howling, and these responses were soon anxiety response is induced by presenting anxiety-
evoked by the auditory cue as well as by exposure eliciting situations ranked in ascending order.
to the chamber. Wolpe then tried to extinguish Despite the researched efficacy of systematic
this Pavlovian association by confronting his sub- desensitization, it has been controversial whether
jects with the auditory cue and the experimental reciprocal inhibition is the mechanism behind the

982 Systematic Desensitization
behavioral change. In 1968, Gerald Davison pro- Several revisions of Wolpe’s traditional systematic
posed that the learning principle underlying sys- desensitization technique opened the possibility that
tematic desensitization was counterconditioning, a other theoretical mechanisms, different from recip-
process first described by Pavlov. Presumably, both rocal inhibition, may play a role in the behavioral
counterconditioning and reciprocal inhibition (and change produced by this technique. Davison postu-
maybe even other principles) partially contribute lated that systematic desensitization might operate
to the reduction of anxious responses to fearful through counterconditioning, a phenomenon first
stimuli. Even when the original operational descrip- described by Pavlov. In counterconditioning, a cue
tion of systematic desensitization provided by that predicts an aversive consequence is paired with
Wolpe was modified and improved, several studies an appetitive outcome. As a result of this procedure,
continued to prove the effectiveness of the tech- organisms form a new association between the cue
nique in treating anxious clients. However, in and the appetitive outcome that will interfere with
recent decades, the use of systematic desensitiza- the old aversive association when the stimulus is
tion has decreased, and psychotherapists favor the presented in the future. In the case of systematic
use of modern exposure techniques (e.g., exposure desensitization, the anxiety-eliciting event plays the
therapy, flooding). Although studies regarding the role of the cue, and the anxiety response plays the
effectiveness of systematic desensitization report role of the aversive consequence. When the tech-
more evidence than other empirically validated nique is applied, a new learning is formed. The event
treatments for anxiety, scientific research on the is the same, but it is now followed by an appetitive
topic has declined since the 1970s. instead of an aversive consequence, so the event now
has a new meaning. Although reciprocal inhibition
and counterconditioning are quite similar processes,
they differ in that reciprocal inhibition assumes that
Systematic desensitization assumes that the etiol- the habit of the anxious response is reduced due to
ogy and treatment of clients with anxiety is based competition of outputs (relaxation interferes with
on learning principles. Clients with anxiety disor- anxiety) whereas counterconditioning assumes that
ders have developed a fearful emotional reaction the association between the cue and the appetitive
to nonharmful stimuli and situations (i.e., an irra- outcome (learned through systematic desensitiza-
tional fear). This is explained by the establishment tion) interferes with the expression of the association
of a Pavlovian association between an initially between the event and anxiety. Presumably, the two
nonharmful stimulus and a threatening and anxi- processes partially contribute to the behavioral
ety-eliciting situation. change expressed in the reduction of anxiety due to
Wolpe proposed the principle of reciprocal inhi- what was once an anxiety-eliciting stimulus.
bition as the theoretical mechanism underlying Furthermore, some researchers state that reciprocal
systematic desensitization. Reciprocal inhibition inhibition may be responsible for the short-term
occurs when two incompatible responses are effects of systematic desensitization whereas coun-
prompted simultaneously. In other words, two terconditioning may explain the long-term efficacy
incompatible psychological states, such as anxiety of this therapeutic technique.
and relaxation, cannot occur at the same time in
an organism. At a physiological level, reciprocal
inhibition is based on the notion that the sympa- Major Concepts
thetic activation of the nervous system, which As mentioned, systemic desensitization as a treat-
operates in reaction to stress to facilitate fight or ment for dysfunctional fearful behavior is grounded
flight responses, is diminished by the parasympa- in two animal models of treatment: reciprocal
thetic activation induced by relaxation techniques. inhibition and counterconditioning.
In reciprocal inhibition, it is important to evoke
the incompatible response (relaxation) in the pres-
Reciprocal Inhibition
ence of the undesirable response (anxiety). Due to
the interference created by the relaxation response, Reciprocal inhibition is a process in which a
anxious clients no longer experience fearful reac- habit is not performed in the presence of its elicit-
tions to previously anxiety-eliciting stimuli. ing stimulus given that an incompatible response,

Systematic Desensitization 983
also associated with the stimulus, interferes with discriminate between the two states. Alternative
its expression. For example, in the case of a specific responses incompatible with anxiety are also used.
phobia to dogs, a dog is the anxiety-eliciting stimu- For example, emotional excitement, sexual arousal,
lus, and getting anxious in the presence of a dog is meditation, imagining positive outcomes, breath-
the habit. According to the reciprocal inhibition ing exercises, and nonaversive (distracting or
principle, if anxiety is interfered in the presence of interfering) electric shocks are often used to elicit
the dog, then the probabilities of getting anxious alternative anxiety-incompatible responses.
the next time the client is confronted with a dog
will decrease.
Elaboration of a Fear Hierarchy
The therapist and the client identify situations
Counterconditioning
that make the client anxious. These situations are
Counterconditioning refers to basic phenomena related to the phobic object in specific phobias
based on classical conditioning. A conditioned (e.g., viewing a spider for those with arachnopho-
response is reduced when the conditioned stimulus bia). The standard is to create lists of approxi-
that elicits it is repeatedly paired with a second mately 10 events or items to work on in the
unconditioned stimulus that evokes a response following sessions. The list begins with the event
opposite to the one elicited by the unconditioned inducing the least anxiety and ends with the event
stimulus with which the conditioned stimulus was that induces the most anxiety.
initially associated. As a result, a new, classically
conditioned association is formed. In the case of
Systematic Exposure to Fear-Inducing
conditioned fear, which is assumed to be involved
Events While the Client Is Relaxed
in the etiology of phobias and other anxiety disor-
ders, a fear-inducing conditioned stimulus stops This is the actual desensitization procedure. It
eliciting fear after being repeatedly paired with an begins by helping the client to completely relax,
appetitive unconditioned stimulus (i.e., a pleasant and then the lowest anxiety-inducing event in the
outcome). hierarchy is presented. In the original systematic
desensitization, the events are presented to the
imagination. However, in vivo presentation of the
Techniques events can be used for clients who are not dis-
With systematic desensitization, techniques are turbed by imagining the situations of the hierarchy.
closely related to the three steps of the therapy. In Presentation of the items to the imagination lasts a
the first step, the therapist teaches the client a few seconds and is repeated until the client is no
relaxation method or an alternative incompatible longer disturbed by the event. Then, the procedure
response. The second step consists of the elabora- is repeated with the next anxiety-inducing event in
tion of a fear hierarchy. The third step consists of the hierarchy.
systematic exposure to the situations considered in
the fear hierarchy while the client is relaxed.
Therapeutic Process
Between three and six initial sessions are used to
Training in Relaxation or Alternative
collect information about the client and to train
Incompatible Response
the client in the deep muscle relaxation technique,
Traditional systematic desensitization uses the which occupies the beginning of the sessions and
technique of deep muscle relaxation. The therapist extends for approximately 15 minutes. The
guides the client to tense and relax specific mus- remaining time in the sessions is used to construct
cles, starting from the muscles of the hands, fol- delimited anxiety-eliciting situations, which then
lowed by those of the arms, head, shoulders, then are listed in order depending on the level of anxi-
the muscles of the middle body, and finally the ety they induce in the client. After the initial ses-
muscles of the lower body. The idea is for the cli- sions, the actual desensitization begins. Anxiety
ent to tense a small group of muscles for a few responses elicited by the events of the hierarchy
seconds and then relax them, allowing the client to are systematically confronted with relaxation until

984 Systemic Constellations
these situations no longer induce anxiety. The Historical Context

gains achieved during systematic desensitization
Bert Hellinger (1925– ) developed systemic con-
are typically maintained in the long-term.
stellation therapy. Hellinger was a German Catholic
Mario A. Laborda and Gonzalo Miguez who was recruited by the Hitler Youth during
Nazi-era Germany. When he declined to join, he
See also Behavior Therapy; Classical Conditioning; was considered an enemy and faced persecution.
Exposure and Response Prevention; Exposure To escape this persecution, he joined the German
Therapy; Operant Conditioning; Pavlov, Ivan; regular army. While serving in combat during
Prolonged Exposure Therapy; Skinner, B. F. World War II, he was captured and imprisoned in
an Allied prisoner-of-war camp in Belgium. After
escaping from imprisonment, he returned to
Further Readings Germany, where he entered a Catholic religious
Head, L. S., & Gross, A. M. (2008). Systematic order. He became a priest and practiced for
desensitization. In W. T. O’Donohue & J. E. Fisher 20 years. Part of that time was spent in South
(Eds.), Cognitive behavior therapy: Applying Africa, where he was a missionary to the Zulu. In
empirically supported techniques in your practice the late 1960s, he left the priesthood, married, and
(2nd ed., pp. 542–549). Hoboken, NJ: Wiley. started studying psychoanalysis. By the time
Rachman, S. (1967). Systematic desensitization. Psychological Hellinger was 60 years old, he had spent 15 years
Bulletin, 67, 93–103. doi:10.1037/h0024212 studying psychoanalytical theory, primal therapy,
Wolpe, J. (1952). Experimental neuroses as learned transactional analysis, psychodrama, Gestalt ther-
behavior. British Journal of Psychology, 43, 243–268. apy child psychology, and hypnotherapy. Hellinger
doi:10.1111/j.2044–8295.1952.tb00347.x combined his work as a private practice clinician
Wolpe, J. (1954). Reciprocal inhibition as the main basis utilizing eclectic existential therapy, his extensive
of psychotherapeutic effects. Archives of Neurology therapeutic training, and his experiences as a mis-
and Psychiatry, 72, 205–226. doi:10.1001/archneurpsyc sionary with the Zulu to form the theoretical basis
.1954.02330020073007 of systemic constellations therapy.
Wolpe, J. (1958). Psychotherapy by reciprocal inhibition.
Stanford, CA: Stanford University Press.
Wolpe J. (1968). Psychotherapy by reciprocal inhibition. Theoretical Underpinnings
Conditional Reflex, 3, 234–240. doi:10.1007/BF03000093
Wolpe, J., & Plaud, J. J. (1997). Pavlov’s contribution to Systemic constellations therapy, done within a
behavior therapy: The obvious and the not so obvious. group format, has three primary theoretical ori-
American Psychologist, 52, 966–972. doi:10.1037 gins: (1) phenomenology, (2) Zulu ancestor rever-
/0003 ence, and (3) family systems therapy. Developing a
representational constellation that highlights the
systemic problems, is an essential component of
the approach.
SYSTEMIC CONSTELLATIONS
Phenomenology
Systemic constellations is an intervention that aims Hellinger’s perception of phenomenology con-
to identify or release prereflective, transgenera- sisted of individuals resisting their need for scien-
tional patterns that are rooted in family, commu- tific inquiry to grasp the unknown and allow their
nity, and organizational systems. The intervention attention to focus on self and the understanding of
integrates existential phenomenology, family sys- consciousness from the individual’s first-person
tems therapy, and the ancestor respect of South perspective.
African Zulu culture. This process addresses the
unhealthy, destructive, or ineffective dynamics
Zulu Ancestor Reverence
within systems. Anecdotal and case study data sug-
gest that participants experience a heightened In their traditional culture, the Zulu live and act
awareness of embedded patterns of behavior that in a religious world in which their ancestors are
plays itself out within the system. the central focal point. Ancestors are regarded as

Systemic Constellations 985
positive, beneficial, and creative presences within member of the system is repeating or compensat-
the Zulu culture. Failure to show ancestors proper ing for prior sufferings. The approach works to
respect invites adversity, whereas proper respect suggest new healing resolutions within the created
ensures benefit. Systemic constellations supports a and symbolic constellations in a session.
similar position toward intergenerational system
dynamics and looks at the organization or family
as a whole. Soul
The soul is the source of drives and impulses
Family Systems Therapy that are deeply rooted. Individuals cannot recall
their origins, and their purpose cannot be reached
Hellinger’s approach recognizes the transgener- by the conscious mind.
ational connectedness concept from the family
therapy approach of Böszörményi-Nagy and
Virginia Satir. Böszörményi-Nagy and Satir both Conscience
believed that generational issues get played out Conscience is that which serves to join individu-
unconsciously in current family members. als to a specific person or group, or separate them.
Its purpose is to join individuals to their family or
Major Concepts other system.
Some of the major concepts of systemic constella-
tions are (a) the three principles, (b) constellations, Belonging, Balance, and Hierarchy
(c) soul, (d) conscience, and (e) belonging, balance, Belonging controls membership in the system.
and hierarchy. Balance maintains equilibrium between giving and
taking in relationships. A tiered order (hierarchy)
Three Principles positions the members of the system in relation to
one another. Violations and disruptions to these
Hellinger’s major concepts are best explored
themes can cause illnesses, accidents, estrange-
through several principles and themes. He identi-
ments, dysfunction, and deviant behavior.
fied the therapeutic intervention and the funda-
mental structures as three principles, which he
named the orders of love: (1) parents give and Techniques
children receive, (2) every member of the system
has an equal and unequivocal right to belong, and In a session, individuals present a closely focused
(3) each system has an unconscious group con- and pressing personal, professional, or organiza-
science that regulates guilt and innocence as a tional issue and select members from the group to
means to protect the survival of the group. They stand in as the representatives of members of the
include soul; conscience; belonging, balance, and problem system. With help from the facilitator, the
hierarchy; and existence. These themes have no individuals then place these members in a symbolic
religious connotations or scientific references as model of the system. Once placed, the representa-
used in Hellinger’s approach. tives do not speak, act, or move. This placement
becomes the constellation. The silence and stillness
of a session allows the individuals and the repre-
Constellation
sentatives to tune into the unconscious collective
A constellation is a spatial arrangement of indi- will of the system. The individuals are able to per-
viduals from a family, community, or organization ceive a prereflective, systemic connection between
that reflects both the current conscious experience past family ancestral patterns and the current
of the persons in the constellation as well as the problem. The process is brought to a close when
unconscious patterns that have been passed down the individuals gain insight and the facilitator
from previous generations. Systemic constellations removes himself or herself from the scenario. The
create new understanding about generational heri- individuals then visualize an image of healing. In
tage, and through the process of systemic constel- the last step, the facilitator suggests one or two
lations therapy, often what is realized is that a healing sentences to be said in the session.

986 Systemic Family Therapy
Therapeutic Process systems theories, this theory sees the family, not the
individual, as the symptomatic client and ulti-
The process normally occurs once with 10 to 30
mately allows the family to understand the com-
participants who serve as representatives, but it
plex interactions and relationships of its members.
may occur over two or more sessions when used in
Systemic family therapists seek to understand how
business or other organizational settings. There are
the family has come to organize itself by using
active participants and observing participants.
unspoken and subtle family dynamics and pro-
Individuals are not diagnosed, and facilitators may
cesses, with the goal of helping the family find new
or may not have a medical or counseling back-
ways to organize itself relationally and emotion-
ground. This process can be seen as intense and is
ally so that the family members no longer produce
best for people who wish to experience individual
symptoms.
growth or are looking to resolve a temporary dis-
turbance in their life or group. Individuals barely
speak during a session. For many individual cli-
ents, systemic constellations therapy is used in
Historical Context
addition to conventional therapy. As a group of psychoanalytical psychiatrists in
the late 1960s, Luigi Boscolo, Gianfranco Cecchin,
Tracy L. Jackson Mara Selvini Palazzoli, and Giuliana Prata began
working with couples and families in therapy ses-
See also Böszörményi-Nagy, Ivan; Existential Therapy;
Family Constellation Therapy; Human Validation
sions. In contrast to the individual focus of most
Process Model; Multigenerational Family Therapy; psychoanalysts of the time, the group started to
Psychodrama; Satir, Virginia discuss their ideas and thoughts regarding their
experiences working with these couples and
families.
Further Readings In 1971, the group opened the Milan Center for
Cohen, D. (2006). Family constellations: An innovative the Study of the Family, where they treated couples
systemic phenomenological group process from and families and deepened their understanding of
Germany. Family Journal, 14(3), 226–233. doi:10.1177/ family communication and relational patterns.
1066480706287279 Gregory Bateson’s research on communication
Crawford, J. (2013). Sister of the heart and mind: Healing theory, circular systems, and cybernetics was criti-
and teaching with family system constellations. Women cal to the group and became foundational in their
& Therapy, (1–2), 100–109. doi:10.1080/02703149 work with families. The group also incorporated
.2012.720554 ideas from Murray Bowen’s multigenerational
Talarczyk, M. (2011). Family constellation method of Bert family systems, Jay Haley’s strategic model, and
Hellinger in the context of the code of ethics for Salvador Minuchin’s structural theory.
psychotherapists. Archives of Psychiatry and The term Milan Approach was coined by Lynn
Psychotherapy, 13(3), 65–74. Hoffmann, another family therapist, to identify the
Weinhold, J., Hunger, C., Bornhäuser, A., Link, L., Rochon, original contributions of Boscolo and Cecchin
J., Wild, B., & Schweitzer, J. (2013). Family constellation
after they parted from Palazzoli and Prata at the
seminars improve psychological functioning in a general
end of the 1970s. The years between the late 1970s
population sample: Results of a randomized controlled
and early 2000s are considered the “roaring years”
trial. Journal of Counseling Psychology, 60(4), 601–609.
of the Milan Approach. During this time, Boscolo
doi:10.1037/a0033539
and Cecchin founded their school, the Milan
School of family therapy, which facilitated the
expansion of the Milan Approach and solidified its
significance. The school’s founders and theorists
SYSTEMIC FAMILY THERAPY were continually seeking and processing new
information to expand their theoretical founda-
Systemic family therapy, practiced and developed tions and understanding of the family and family
by the Milan School of family therapy, is also therapy. In particular, they were influenced by a
known as the Milan Approach. Like most family number of their students who were working in

Systemic Family Therapy 987
various settings, as well as by their own travels implement a collaborative therapeutic process in
throughout the world, which enriched their per- which the therapist is not the expert.
spective and theoretical work.
Major Concepts
Theoretical Underpinnings Some of the major concepts important to the Milan
Approach are using a systemic approach with cli-
The theoretical roots of the Milan Approach can
ents, understanding the importance of observer
be traced to the development of communication
cybernetics, mapping families, using storytelling
theory by Bateson and his colleagues in Palo Alto,
and narratives, taking a social-constructivist per-
California (sometimes called “the Bateson
spective, and honoring different theoretical
Project”). This approach looked at the complex
approaches.
ways people communicate in systems and was one
of the first approaches that viewed the develop-
ment of psychological and psychiatric symptoms Systemic Approach
from a communication and systematic perspec- The Milan Approach views individuals, couples,
tive. This project developed and expanded on and families systemically. Human systems—such
concepts regarding general systems theory and as families, groups, and organizations—respond to
cybernetics. Circular causality and triadic interac- established recurring patterns. Change is believed
tions became foundational to the Milan School’s to occur from within the system, and the priority is
understanding of family interactions. These con- to identify problems in the system and implement
cepts assert that individuals within a family are therapeutic strategies that cause disruptions to the
interconnected (A causes changes in B, which in established patterns and interactions. Change then
turn causes changes in C, which eventually causes occurs as the system develops new paths toward
changes in A). growth and transformation.
In its initial theoretical development, the Bateson
Project focused on how people communicate in
relationships and create “relational patterns.” Observer Cybernetics
These relational patterns can be observed and Observer cybernetics, also called second-order
understood within family systems. Bateson hypoth- cybernetics, supposes that the family affects the
esized that these patterns could be modified with therapist just as the family is affected by the thera-
appropriate methods of communication. These pist. Thus, it is believed that there can never be true
methods include techniques by which a therapist therapeutic objectivity because the therapist is
interviews and converses with each member of the affected by the family system. Given this, however,
family while in the presence of the family system. the therapist can still affect the system, and in fact,
During the session, the therapist could consult just his or her presence within the system should
with colleagues, observing the session through a change the system in some manner. Therefore,
one-way mirror. Sessions would typically end with therapists must be flexible and attempt to under-
a final intervention, such as a poignant comment, stand how their ideas, emotions, and reactions
a reframing, or a prescription. play a dramatic role in the unfolding nature of the
This original treatment modality was strongly family dynamics.
strategic, which means that therapy was focused
on helping solve the presenting problem in the sys-
Maps
tem. This approach was not particularly concerned
about the past or mentalistic concepts like the The family comes into therapy with an estab-
unconscious or insight. However, over the years, lished “map,” which is reflective of the unique
the theory has become increasingly postmodern manner in which the family interacts. This map
and has moved toward inviting couples and fami- reflects the family homeostasis, which describes
lies to discuss their life circumstances, especially the manner in which family members are likely to
relative to their relational patterns. Since the very respond in different situations. Families with dys-
beginning, the Milan Approach has strived to function are treated by modifying their map.

988 Systemic Family Therapy
Storytelling and Narrative Therapy working with clients. Thus, the Milan School tries
to foster professional and scientific relations with
Bateson, whose thoughts deeply influenced the
colleagues from all over the world and acknowl-
Milan Approach, stated that our minds work by
edges that different fields and perspectives can be
stories. Therefore, it is not surprising that aspects of
a source of learning for all professionals and schol-
narrative therapy, a therapy that examines individ-
ars in this field. At the same time, this cooperation
uals and family stories, have come to play a major
helps to better appreciate the common grounds
role in the development of the Milan Approach.
underlying the different schools and approaches.
The founders of systemic family therapy had talents
that contributed to this narrative aspect. For
instance, Boscolo was a talented storyteller who Techniques
used stories as a key therapeutic resource for estab-
lishing rapport with clients. Cecchin reinterpreted As a social-constructionist methodology that seeks
the stories told by individuals and families using to understand client narratives, the Milan Approach
principles that are similar to those of the Italian to working with families takes a respectful, inquis-
theatre tradition commedia dell’arte. This type of itive, curiously questioning, nonpathological
theatre originated in Italy in the 16th century and approach with families as it uses circular question-
comprises improvised stories that are sometimes ing, specific techniques to conclude the interview,
surprising or even bizarre; however, these stories positive connotations, and creativity.
can trigger processes of change. These talents have
proved to be integral in the theoretical development Circular Questioning
of the Milan Approach: Understanding a family’s
The core of the Milan techniques resides in cir-
stories from the multiple perspectives of the family
cular questioning, which consists of asking family
members has become a critical tool in mapping the
members different kinds of questions to best
family and understanding the family system.
understand the family’s and its members’ narra-
tives and unique perspectives on their lives. There
Social Constructionism are several types of circular questioning: hypo-
thetical, triadic, future oriented, and rank oriented.
The current Milan Approach is strongly influ-
enced by social constructionism, or the belief that Hypothetical Questions
society and the individual construct truth and
meaning. This foundation is especially important Hypothetical (what if . . .) questions allow fam-
with regard to therapeutic conversations in that the ily members to develop new ideas about how they
therapist values the client’s stories, views the client can live in the world: for instance, What if your
as the expert about his or her life, and respects the family were able to be loving to one another—
client’s values and beliefs. In addition, because truth what do you think that would look like? This type
is viewed as subjective, pathology and diagnosis are of question allows the members of the family to
downplayed, as they are seen as the product of an both look at the current ways it communicates and
external reality often based on oppressive social begin to imagine new ways of communicating. The
mores. The therapist seeks to make the therapeutic responses to these questions are representations,
process nonpathological by depicting the problem often highly metaphorical, of the relationships tak-
and the recovery as part of a wider process of ing place within the family. They help the therapist
change and transformation, involving not only rela- to remain active and in touch with the family, give
tionships and family issues but also cultural issues the family hope for the future, and help the family
and transformations in the client’s life environment. members see that they can abandon and replace
old maps with new ones that are more in line with
healthy functioning.
Honoring Different Theoretical Approaches
Triadic Questions
Although the Milan Approach takes a relaxed
critical stance against strict adherence to a theory, Triadic questions provide insight into family
it does recognize the important role that theory interactions and allow each member of the family
can play in the development of novel ways of to understand the role the other members plays

Systemic Family Therapy 989
during significant interactions. For instance, the really wants to discuss its feelings). These interven-
question “When Mom criticizes your brother, what tions are determined by the therapist and help
does Dad do?” helps the therapist and the family establish the family’s last impression before leaving
see the intricate dynamic that occurs between the session.
Mom, Dad, child, and brother at a significant com-
munication point. Positive Connotations
Future-Oriented Questions The Milan Approach seeks to depathologize
clients, so the therapist will try to reframe negative
Future-oriented questions allow the family to
concepts into positive concepts. For example, if a
discuss expectations and concerns about the future.
client describes herself using these words, “I am
They can be helpful in understanding how family
cranky, this is who I am!” then through a series of
members react to potential changes in the family,
questions formulated according to a circular epis-
and the responses can be useful in assessing if
temology, the therapist will offer an alternative
progress has been made and in identifying goals.
view in which the presumed personality traits will
For instance, the question “How do you figure
take on a more positive meaning. As a result, as the
Mom and Dad will get by when you leave home?”
therapist asks this series of questions, the client
can give the therapist and the family an inkling
realizes that her crankiness is really worry about
into to how Mom and Dad are getting along now
ensuring the positive health of her family. Thus, the
(statements about how people will do in the future
original description, which was perceived to be the
are often reflections of how they are doing in the
only possible and unchangeable way of perceiving
present) and can be helpful in identifying what
the individual, is complemented with other possi-
issues to work on in therapy.
ble, plausible descriptions for the client, thus gener-
ating an experience of more freedom for the client.
Rank-Oriented Questions
This is likely to facilitate a positive change not only
Rank-oriented questions (Who in this family is for the individual but also for the whole family
the unhappiest when Jack plays hooky?) allow the system.
family to identify how the problems that one
member is experiencing can affect other members
Creativity and Respect
of the system. In addition, they tend to help the
family understand who is in a position of power, Cecchin, one of the theory’s founders, encour-
the major personality traits of individual family aged the use of creativity with families and in the
members, and the gender and cultural placement therapeutic relationship. He also advocated the
of family members. For instance, the question sacred role often played by the therapist and that
“Who is in charge of this family?” tells the thera- the therapist approach the family with the utmost
pist who holds power in the family and if the respect and reverence.
power is held by gender roles. Follow-up ques-
tions like “How does that person keep his or her
Therapeutic Process
power?” can reveal interesting dynamics in the
family. All Milan therapy starts with one (or two) initial
consultation sessions, in which therapists assess
whether they can be helpful, develop treatments
Concluding Intervention
plans, and negotiate the goals of the therapy with
Each session is concluded with an important the family.
intervention, such as a prescription, which is a sug- The ideal setting for family therapy is a room
gestion of what the family should do; a ritual, with seats arranged in a circle and the therapist
which is something unique to the family that the sitting together with the family. In another room,
family can do on an ongoing basis (e.g., saying a there are other therapists observing the session via
prayer, having a family discussion, etc.); or a a one-way mirror or video. Before closing the ses-
reframing, which refers to describing a trait of the sion, the therapist leaves the room to talk with the
family in a new, more positive way (e.g., a family group of observing therapists, at which point the
that argues a lot can be described as a family that therapist receives input regarding the family and

990 Systems-Centered Group Therapy
possible therapeutic interventions or techniques, Further Readings

especially for the closing intervention. The thera- Boscolo, L., Cecchin G. F., Hoffmann, L., & Penn, P.
pist then rejoins the family to close the session, (1987). Milan systemic family therapy. New York, NY:
often utilizing input from the group. Basic Books.
Throughout the treatment, the group of thera- Boscolo, L., & Bertrando, P. (1993). I tempi del tempo:
pists behind the mirror gradually becomes an Una nuova prospettiva per la consulenza e la terapia
important protagonist of the therapeutic process. sistemica [The times of time: A new perspective in
This group is likely to influence the clients’ percep- systemic therapy and consultation]. Torino, Italy:
tions also. The Milan Approach advocates for time Boringhieri. (English translation published by
to lapse (about 1 month) between sessions, enough W. W. Norton, New York)
time for the effects or results of the previous ses- Boscolo, L., & Bertrando, P. (1996). Systemic therapy
sion to have occurred. This perspective is unique in with individuals. London, England: Karnac Books.
family systems theories. Cecchin, G. F. (1987). Hypothesizing, circularity and
According to Bateson’s approach, on which sys- neutrality revisited: An invitation to curiosity. Family
temic family therapy is based, the therapeutic pro- Process, 26, 405–413.
cess is focused on communication in context and Cecchin, G. F., & Apolloni, T. (2003). Idee perfette:
on the concept that pathology can make sense Hybris delle prigioni della mente [Perfect ideas:
when considered as part of broader processes. All Hybrid prisons of the mind]. Milan, Italy: Franco
therapeutic techniques or interventions take place Angeli.
in a positive environment because people do not Cecchin, G. F., Lane, G., & Ray, W. A. (1992).
easily change when they are blamed or criticized. Irreverence. A strategy for therapist’s survival. London,
England: Karnac Books.
Each participant in the session has the same dig-
Cecchin, G. F., Lane, G., & Ray, W. A. (1997). The
nity and rights regardless of his or her label,
cybernetics of prejudices in the practice of
pathology, or rank within the system. Dignity is
psychotherapy. London, England: Karnac Books.
also important when issues related to diversity of
cultures arise in the therapeutic process. Throughout
treatment, the family’s narratives are discussed,
because the past, present, and future narratives can
provide powerful connections and implications. SYSTEMS-CENTERED GROUP
The Milan Approach focuses on emotions and
considers them to be a pathway to participation THERAPY
and a trigger to change.
In the Milan Approach, the best way to con- Developed by Yvonne Agazarian in the 1990s,
clude therapy is based on a shared perception, systems-centered therapy and training (SCT) for
both by the therapist and by the family, that a groups is a comprehensive systems approach
positive process of change has been set in motion. where each of the methods and techniques was
When these conditions occur and interfere as little developed by first operationally defining the spe-
as possible with the family members’ autonomous cific theoretical constructs and then applying each
ways of changing, the therapist proposes to termi- construct in practice. The core method in SCT for
nate the therapeutic relationship. groups is functional subgrouping, notable for low-
ering acting out of scapegoating and enabling
Enrico Cazzaniga and Massimo Schinco groups to explore and integrate differences or con-
flicts in the here-and-now. SCT also emphasizes
See also Ackerman Relational Approach;
influencing group norms quickly, because once
Böszörményi-Nagy, Ivan; Bowen, Murray;
Couples, Family, and Relational Models:
norms are set, they influence what is and is not
Overview; Haley, Jay; Minuchin, Salvador; possible. SCT leaders work actively in the early
Multigenerational Family Therapy; Palo Alto phases of a group to influence norms that support
Group; Satir, Virginia; Solution-Focused Brief group development (e.g., functional subgrouping,
Family Therapy; Strategic Therapy; White, eye contact, centering, starting and stopping on
Michael time). Furthermore, SCT leaders discourage

Systems-Centered Group Therapy 991
importing social norms such as explaining and norms are established, they govern the people in
vagueness or ambiguity. the group, including the therapist.
Agazarian’s work assumes that human beings
have difficulty with differences. Because SCT intro-
Historical Context
duced a different approach for group therapists,
In the 1980s, Agazarian worked as part of the especially in its active leadership to influence group
American Group Psychotherapy Association’s norms, it is not surprising that Agazarian’s SCT
General Systems Committee to apply general sys- methods have taken time to gain acceptance.
tems theory to group therapy. When this commit- Today, more than 20 years after SCT was intro-
tee disbanded, Agazarian continued this work, duced as a coherent approach, SCT’s functional
ultimately developing her theory of living human subgrouping has become well-known and widely
systems, which has been applied to systems of all used in the group therapy field. The entirety of the
sizes: person, couple, family, therapy group, work theory and method is as yet less widely understood.
team, and even a whole organization. In contrast
to models that are person centered or leader cen-
tered, Agazarian developed a systems-centered
approach that lowers the human tendency toward Agazarian has defined a theory of living human
self-centeredness and personalizing. systems as a hierarchy of isomorphic systems that
A number of theorists’ work influenced are energy organizing, goal directed, and system
Agazarian: Ludwig von Bertalanffy’s definition of correcting. In brief, hierarchy is defined as a set of
isomorphy, James Miller’s equation of energy with three systems, where one system always exists in
information, Claude Shannon’s theory of commu- the context of the system above it and is the con-
nication, Kurt Lewin’s force field model of driving text for the system below it (picture concentric
and restraining forces on the path to a goal, circles). Thus, living humans systems are always
Warren Bennis and Herbert Shepard’s phases of nested in a context and cannot be fully understood
group development, and Habib Davanloo’s work when seen in isolation. Applying this to a therapy
in actively weakening defenses. group, the hierarchy of systems is the group-as-a-
Also, Agazarian and Anita Simon’s sequential whole (the largest circle of the three concentric
analysis of verbal interaction (SAVI) significantly circles), the member (the middle circle), and the
contributed to SCT. In developing SAVI, they person (the smallest circle). The person system sup-
applied Shannon’s theory of communication to plies the energy for the whole hierarchy. Members
verbal communication, creating a system for cod- organize their energy toward the goal of the group.
ing communication behaviors as approaching or Whenever there is a conflict, members cluster
avoiding the goal of communication. Using SAVI together to explore similarities using functional
to code both individual and group communication subgrouping. The norms of the group-as-a-whole
patterns revealed that the group pattern governs develop and transform as differences are inte-
individual patterns. In one study, Agazarian coded grated, thus supporting development and transfor-
an entire session of an ongoing therapy group; it mation at all levels of the system hierarchy.
showed a group pattern of flight. Looking at the Isomorphy is defined as similarity in structure
sequence of patterns in the group, every time an and function for the systems in a hierarchy. Structure
individual’s communication shifted out of flight to is defined as boundaries, which open to energy or
a work pattern, the next speaker reintroduced information. Boundaries close to noise in commu-
flight so that the group pattern remained in flight. nication (defined as ambiguity, contradiction, or
Most dramatically, at one point the group had redundancy) and to differences that are experi-
three communications in sequence in a work pat- enced as too different. SCT leaders monitor and
tern and the therapist then responded in a way influence boundary permeability at all system levels
that took the communication pattern back to (e.g., teaching group members to interact with less
flight. This recognition contributed to SCT’s noise when they contribute). Groups function
emphasis on establishing norms for valid commu- to survive, develop, and transform from simpler
nication as quickly as possible, because once to more complex systems through the process of

discriminating and integrating differences. SCT’s they are ambiguous or to get to the bottom line
method of functional subgrouping puts this con- when they are redundant.
struct into practice, where members learn to join By defining function, SCT posits that the central
first on similarities, with differences being explored mechanism of change is the process of discriminat-
in a different subgroup with others who have a ing and integrating differences. This is put into prac-
similar difference. tice with functional subgrouping, a core SCT method.
In defining a goal-directed strategy, SCT presupposes
that weakening the restraining forces opposing the
Major Concepts
goal is an easier and more sustainable change strat-
Although SCT has a developing body of research, egy than trying to increase the driving forces. For
it is foremost a theory-driven approach, and its example, in the flight phase, SCT introduces a skill
guiding concepts have come from operationally that weakens the restraining force of negative predic-
defining each theoretical construct, which then tions and future speculations (e.g., “This group will
links to methods and techniques. not work out for me”). This then frees the group to
From defining hierarchy, SCT assumes that reality-test (a driving force) in the present (How is
one’s context has as much if not more to do with the group working for you right now?”).
how one functions than one’s personal dynamics.
For example, when we are in our family context,
we behave and relate in one way and when we are Techniques
in our work context, in another way. Thus, SCT Each of the techniques below was developed by
shapes the norms of the group context by influenc- applying SCT theory and its constructs, and they
ing the variables of structure, function, energy, goal link to the concepts discussed in the previous sec-
orientation, and system hierarchy. SCT also asserts tion. For example, Agazarian’s definition of func-
that learning to see one’s system context supports tion guided her work in developing both the
change. Just as a group always exists in a context method of functional subgrouping and the tech-
(e.g., a group exists within a counseling center and niques that implement subgrouping to enable
its norms), group members always exist in the con- groups to integrate differences rather than scape-
text of the therapy group, its norms, and the phase goating them.
of group development. For example, in the flight
phase, members commonly feel anxious. Sarah
Functional Subgrouping
was very anxious in her first group, worried that
something was wrong with her and thinking she Right from the start of the group, SCT leaders
did not belong in the group. As soon as she heard introduce functional subgrouping by asking par-
the leader say it was normal to be anxious in a new ticipants to say whatever they want and then end
group and others talked of being anxious too, she by saying “Anyone else?” The next speaker’s job is
saw that how she felt was a product of the context. to build on the first with his or her own version
Putting this idea into practice enables groups to and then say “Anyone else?” This pattern contin-
weaken the human pull to personalizing, or taking ues until someone brings in a difference and the
one’s self as the only context. Seeing the larger group signals readiness for a different subgroup to
context of one’s experience lowers the distress and explore.
anguish, which increase when we take things just Functional subgrouping builds a group climate
personally, and helps us shift from self-centered to for integrating differences rather than the common
systems-centered thinking. human responses of trying to convert, reject,
By defining boundaries, SCT works with the attack, or otherwise scapegoat differences.
awareness that how a group communicates is more Responses to differences may be subtle, like a redi-
important than what is said. SCT leaders actively rection, as when Dick describes excitement and
influence the communication norms (the “how”) Jane responds, “I’m a little excited, but I am more
by lowering noise in communication. This leaves anxious.” Or they can be more overt, as when Dick
the group free to choose “what” to explore. For says, “Jane, I don’t know why you are anxious.
example, members are asked to be specific when This group is perfectly harmless. You shouldn’t feel

that way. Just relax, and you’ll feel more excited.” For example, in a new group, those who are
Introducing functional subgrouping whenever anxious explore with others who are also anxious;
there is a difference or conflict interrupts incipient and in turn, those who are excited explore excite-
or overt scapegoating communications and instead ment together. An illustration of this depicts both
asks those who are feeling similarly to explore the theory and the practice of functional subgroup-
together. ing (see Figure 1).
1A. 1B.
Anxious
Excited
Time 1: Group comes together Time 2: A difference emerges–represented here by

round and square
1C. 1D.
Time 3: In turn, each subgroup explores and Time 4: Discovering similarities across difference
discovers differences within its similarity
1E.
Time 5: Integration in the group-as-a-whole and

greater complexity
Figure 1 Illustration of Functional Subgrouping in a New Group

Sources: S. P. Gantt, Functional Subgrouping and the Systems-Centered Approach to Group Therapy, in J. Kleinberg (Ed.), The
Wiley-Blackwell Handbook of Group Psychotherapy, pp. 116–117. Oxford, England: Wiley (2011). Copyright 2010 by Susan P.
Gantt. Reprinted with permission of the author; “Developing the Systems-Centered Functional Subgrouping Questionnaire-2,”
by R. M. O’Neill, S. P. Gantt, G. M. Burlingame, J. Mogle, J. Johnson, & R. Silver, 2013. Group Dynamics: Theory, Research,
and Practice, 17(4), pp. 252–269. doi:10.1037/a0034925

Members were asked what it was like to begin Fork in the Road of Choice
as a new group (Figure 1A). Some voiced anxiety
The fork-in-the-road technique is first intro-
and others excitement. The group then formed
duced early in a group as the fork between
two subgroups (Figure 1B), the “anxious” sub-
“explaining” (redundantly going over what one
group depicted here by circles and the “excited”
already knows, which introduces noise and closes
subgroup by squares. Each subgroup in turn
boundaries) versus “exploring” and opening to the
explored its experience. Exploring in the context
unknown. Group members are asked to choose
of one’s similar subgroup creates the security
whether to explore the wish to explain their expe-
needed for neurobiological change as participants
rience or to explore their experience. For example,
find others who are like them in that moment.
Dick reports, “I am angry because Tom was late.”
Then, while relating to similarities, boundaries
Dick is asked to choose whether to explore his
open, and they discover small differences (Figure
experience of anger or explore the part of him that
1C). Some anxious subgroup members reported
wants to explain why he is angry. Similarly, the
feeling calmer (Figure 1C, the solid figures) and
“yes, but” social communication pattern is
others curious (the dots), and still others noticed
reframed as a fork in the road and then modified
both apprehension and excitement (the stripes).
by introducing functional subgrouping and asking
The excited subgroup then explored together
members to choose which subgroup to explore, the
(squares in Figure 1B and C), joining on similari-
“yes” or the “but.” This allows the group to
ties and discovering small differences within these
weaken contradictions, which are another source
similarities (Figure 1C), including calmness, curi-
of noise in group communication.
osity, and apprehension.
Integration occurred as both subgroups discov-
Lowering Personalizing and
ered their similarities across what were initially
Learning Contextualizing
two different subgroups (Figures 1D and E), find-
ing curiosity, excitement, and apprehension in SCT groups learn to discriminate between per-
common. The group had developed greater com- sonalizing, when members perceive something as
plexity (Figure 1E) and more resources. Group being just about themselves, versus contextualiz-
members learned to explore together: legitimizing ing, or learning to see the bigger picture. For
anxiety, excitement, apprehension, and curiosity example, if Tom takes it “just personally” that oth-
and lowering the group’s anxiety, an important ers do not like it when he is late for group, he will
step in a new group’s flight subphase. have one feeling (irritation at the group or turning
SCT groups use functional subgrouping when- his irritation back on himself and feeling badly). If,
ever there is a conflict or difference that cannot instead, he sees it from the point of view of his
easily be integrated or resolved. Sometimes this is member role, where he recognizes the impact on
a conflict within the group itself and requires the the group when anyone is late, then he will have
group to integrate the differences by exploring another perspective and different feelings (curios-
each viewpoint, rather than one subgroup trying to ity about the impact and empathy for himself and
convince the other. In a group further along in its the group). Or if he sees himself as part of a
development, conflict may first surface inside one subgroup of late members, he is likely to be less
member. In one group, Dawn talked about hating defensive and more curious about what the late
her partner but being afraid of feeling so angry. A subgroup is expressing for the whole group. When
“but” always signals two subgroups. SCT leaders he can see the “late” subgroup as containing one
monitor for “but,” which signals a difference or side of a group conflict or issue and the “on time”
conflict, and then ask the group to divide into the subgroup comprising the other side, then he is free
two sides of the conflict to explore each side, one to support the group’s exploring the two sides of
at a time, using subgrouping. The group then dis- its conflict.
covers who resonates with which side of Dawn’s Weakening personalizing also supports personal
conflict, resulting in one subgroup exploring the development. Personal development is at the heart
experience of hating their partner and another of every group member’s goal. SCT sees the path-
subgroup exploring their fears about their feelings. way to development as taking membership both in

the group, to support the group’s goals, and in related to symptoms of anxiety, tension, or low
oneself as a person, to support one’s personal energy are also weakened in this subphase.
goals. Learning to shift from a self-centered to a In the transition subphase between flight and
systems-centered focus lowers personalizing and fight, SCT weakens the defenses against the retalia-
enables membership development, which then tory impulse (boomeranging back on the self in
develops the person’s capacity to take a member depression or hostile outrage against others),
role in other life contexts. which is aroused whenever a difference is too dif-
ferent or one feels hurt. When the retaliatory
impulse is explored rather than enacted, it deepens
Weakening Defenses (or Restraining Forces)
the connection to one’s life force.
in the Context of the Phase of the Group’s
The group then moves to the role subphase,
Development
exploring and weakening habitual roles and role-
There is extensive group literature on phases of locks enacted in the group (e.g., one up/one down,
development. Uniquely, Agazarian has conceptual- dominant/submissive). As these roles are weak-
ized each phase of development as a system defined ened, group cohesion increases, and the group
according to its system properties: its goal orienta- explores its hatred of the leader (equivalent to the
tion, driving and restraining forces, boundary per- negative transference), a key step in learning to
meability, and discriminations or integrations. take one’s own authority.
SCT identifies three phases of group develop- The group then shifts into the intimacy phase,
ment: (1) the authority phase and its subphases where the goal is exploring the issues in separation
(flight, transition between flight and fight, fight and individuation. Exploring the origin of the roles
and interpersonal role-locks between members that imprison members in their relationships, both
[e.g., one up paired with one down, and vice in the group and in their lives, modifies the early
versa], and the crisis of hatred with the leader), (2) roles that maintain insecure attachment patterns.
the intimacy phase, and (3) the work phase. SCT Having undone the split inherent in the authority
leaders then work with the group to weaken the phase of blaming others and one’s past, the work
restraining forces to development according to the in this phase orients to revisiting the past in a way
group’s phase. Clinically, restraining forces are that enables reworking of early attachment pat-
called defenses. Members are introduced to spe- terns and developing a new coherent narrative.
cific skills that enable them to weaken their own In the work phase, the goal is to use what one
defenses relevant to the phase of development. knows in context, weakening the tendency to per-
Weakening the defenses linked to the group’s phase sonalize one’s experience or to legislate rules at
enables SCT leaders to work in attunement with the expense of common sense. Here, the group
the group and makes it less likely that the leader focuses on the ongoing work of learning to use
will ask the group to do work it cannot yet do. The comprehensive and apprehensive knowledge in
authority phase work is to weaken externalizing here-and-now work together. Also, the group
and blaming others, especially those in authority, revisits earlier phase dynamics whenever they
in order to be freer to take one’s own authority. reoccur, thus enabling the group to work through
Toward this goal in the flight subphase, SCT its phase dynamics at increasingly deeper levels of
weakens social communication by working with a experience.
here-and-now task, rather than social introduc-
tions, which lead to stereotyped hierarchies based
Therapeutic Process
on outside roles. Once functional subgrouping is
established, each group starts with a brief period of The heart of the therapeutic process in an SCT
centering, connecting to the ground, one’s breath- group is discriminating and integrating differences
ing and one’s own center. This supports shifting in the service of surviving, developing from simpler
out of habitual roles and into here-and-now mem- to more complex, and transforming at all system
bership with access to one’s centered knowing. levels. This is accomplished through developing
SCT also modifies the communication defenses to group norms that support functional subgrouping,
build a valid communication system. Defenses learning to shift from person to member, and

learning skills that weaken the defenses in sequence Agazarian, Y. M., & Gantt, S. P. (2000). Autobiography
in each phase of group development. These proof a theory: Developing a theory of living human
cesses simultaneously modify the symptoms that systems and its systems-centered practice. London,
bring people to therapy and lead to increased com- England: Jessica Kingsley.
mon sense and emotional intelligence. Agazarian, Y. M., & Gantt, S. P. (2005). The systems
perspective. In S. Wheelan (Ed.), Handbook of group
Susan P. Gantt research and practice (pp. 187–200). Thousand Oaks,
CA: Sage.
See also Attachment Group Therapy; Group Analysis; Gantt, S. P. (2011). Functional subgrouping and the
Group Counseling and Psychotherapy Theories: systems-centered approach to group therapy. In
Overview; Psychodynamic Group Psychotherapy; J. Kleinberg (Ed.), The Wiley-Blackwell handbook
Tavistock Group Training Approach of group psychotherapy (pp. 113–138). Oxford,
England: Wiley.
Gantt, S. P., & Agazarian, Y. M. (2010). Developing the
Further Readings
group mind through functional subgrouping: Linking
Agazarian, Y. M. (1997). Systems-centered therapy for systems-centered training (SCT) and interpersonal
groups. New York, NY: Guilford Press. neurobiology. International Journal of Group
Agazarian, Y. M. (2001). A systems-centered approach to Psychotherapy, 60(4), 515–544. doi:10.1521/ijgp.2010
inpatient group psychotherapy. Philadelphia, PA: .60.4.515
Jessica Kingsley. O’Neill, R. M., Gantt, S. P., Burlingame, G. M., Mogle, J.,
Agazarian, Y. M. (2012). Systems-centered group Johnson, J., & Silver, R. (2013). Developing the systems-
psychotherapy: A theory of living human systems and centered functional subgrouping questionnaire-2. Group
its systems-centered practice. GROUP: The Journal of Dynamics: Theory, Research, and Practice, 17(4),
the Eastern Group Psychotherapy Society, 36(1), 252–269. doi:10.1037/a0034925
19–36. Simon, A., & Agazarian, Y. M. (2000). The system for
Agazarian, Y. M. (2012). Systems-centered group analyzing verbal interaction. In A. Beck & C. Lewis
psychotherapy: Putting theory into practice. (Eds.), The process of group psychotherapy: Systems
International Journal of Group Psychotherapy, 62(2), for analyzing change (pp. 357–380). Washington, DC:
171–195. doi:10.1521/ijgp.2012.62.2.171 American Psychological Association.

T
England. This approach grew from his work with
TAVISTOCK GROUP returning military personnel who suffered from psy-
TRAINING APPROACH chiatric disorders (termed shell shock then and post-
traumatic stress disorder currently). Bion introduced
Central to the Tavistock Group Training Approach the concept of container–contained, for how mem-
is the concept of the group behaving as a collective bers project onto the group as an entity, not just as a
system whose major task is to survive. Groups collection of individuals, and for the group to study
come into being when individuals become aware its own process as the container of those projections.
of their common relationship and work toward a This method also incorporated his ideas about com-
common task, either in response to external or munity, self-determination, and the importance of
internal needs or as a group-based conscious providing structure for therapeutic services.
choice. The Tavistock approach assumes that the Bion was influenced by the psychoanalytical
group becomes the focus, rather than the individu- work of Melanie Klein, who had introduced the
als, and places attention on the collective identity notion of projective identification (the uncon-
created by the group members. scious process of sending feelings and others
The Tavistock Group Training Approach makes unconsciously catching them) as part of a larger
use of psychoanalytical concepts, especially projec- body of work in child and developmental analytic
tion, resistance, the unconscious being reflected in theory. Bion continued in this vein through the
behavior, and an analysis of relationships in the 1950s; in 1957, the Tavistock Institute and the
here-and-now. The interventions generally move University of Leicester sponsored the first group
between conscious work mode and unconscious relations conference.
resistance that is observed in the group process, A. K. Rice, a member of the Tavistock Centre
and these differences are highlighted by the consul- for Applied Social Research, helped move the focus
tant, or group leader. This consultant intervention from the roles assumed at work to group leader-
is intended to make the unconscious conscious so ship dynamics and issues of authority relationships
that it can be examined and understood. in groups. He was also instrumental in introducing
the concept that much could be learned from
studying the conference and/or group itself. Rice
sponsored the first group relations conference in
Historical Context
the United States in 1965, and his A. K. Rice
The Tavistock approach was developed in the late Institute continues to provide conferences and
1940s, after World War II, by Wilfred Bion at the training in the Tavistock approach.
Centre for Applied Social Research, located in the The Tavistock approach uses a different lan-
Tavistock Institute of Human Relations in London, guage than is usually found in group therapy. For
997

998 Tavistock Group Training Approach
example, Tavistock group work settings are referred behaving and relating. Lewin believed that this
to as conferences, workshops, or educational kind of setting can open new pathways of under-
events instead of therapy, and the group leader is standing of the self and of others, can provide an
called a consultant. opportunity for constructive feedback to be given
and received, and can allow self-perceptions to be
changed or to become more open to change. In
addition, in this type of setting, different learning
Many of the concepts used in the Tavistock styles can be accommodated; learners can choose
approach are derived from traditional psychoana- to focus on what they consider to be personally
lytical theories and include things such as the important; the physical, cognitive, emotional, cre-
importance of the leader remaining aloof so that ative, and inspirational aspects of the person can
group members can project onto him or her and all be tapped into; and difficult material can be
understanding how resistances play a role in pro- more easily accepted.
tecting group members from accessing unconscious
interpersonal and intrapersonal issues. The
Major Concepts
Tavistock approach proscribes that the group
leader remain aloof and remote from the group, There are four major concepts that distinguish the
provide interpretations of the group’s behavior, Tavistock approach: (1) a focus on the group as a
and act as a screen for group members’ projections. whole, (2) basic assumptions, (3) the leader as a
Making the unconscious conscious is a psychoana- consultant, and (4) the conference design and
lytical concept that is seen in the projections of the issues.
unconscious needs, wishes, fantasies, and desires
onto the group leader, who is purposefully emo-
Group as a Whole
tionally unavailable to the group members. The
group leader observes these processes in the group The concept of the group as a whole focuses on
as a whole and summarizes these as comments to the group and its major task of survival. The
the group. This allows for unconscious material to group’s life is derived from the collection of mem-
become visible to the group members and for bers’ fantasies and projections; these can be best
members to move toward conscious exploration. understood from observation of their behavior in
Also, in Tavistock groups, resistance is expected the group, which reflects their personal histories
but is not always recognized by the group mem- and needs as well as those of the group. The group
bers. The leader observes the group, attends to is always talking and reflecting on itself, even when
what the group as a whole is resisting, comments, it appears that individual issues and concerns are
and thus allows the resistance to be more visible the focus; these individual issues and concerns can
for group members’ exploration. be best understood and can best produce personal
One of the methods used in Tavistock groups is awareness and understanding for the particular
derived from the work of Klein, who used direct group member when the group’s process is ana-
confrontation as an intervention. This can be seen lyzed and understood. Thus, a major task for the
in the comments by the group leader, who reflects leader is to observe, understand, and make visible
back to the group as a whole what the group can- the group’s process as it progresses.
not see for itself and what individual group mem-
bers may be resisting.
Basic Assumptions
A major theoretical perspective of the Tavistock
approach was provided by Kurt Lewin, who was a Bion conceptualized three basic assumptions—
proponent of experiential group learning. He (1) dependency, (2) fight or flight, and (3) pair-
found that the social and supportive environment ing—and later, Pierre Turquet added the basic
provided by the group offers a sense of safety and assumption of oneness. These basic assumptions
trust among the group members, which promotes are the motivations for what the group does to
intrapersonal and interpersonal learning and survive and are based on the projections of the
encourages experimentation with new ways of group as a whole.

Tavistock Group Training Approach 999
Dependency refers to the desire for safety, The issue of authority is one that is not usually
whether from another group member or from the examined in a group but is an important hidden
leader. The group longs for the all-knowing and force in all groups. This approach has the group
all-powerful rescuer or leader to guide it in accom- examining how authority is determined in the
plishing its task and acts in a way that indicates group and by whom, and how this affects role
that the group members cannot do it for them- relationships. It assumes that group members por-
selves. Group members can become profoundly tray roles that the group needs (e.g., gatekeeper,
disappointed and hostile when the leader fails to nurturer) but that these roles are not preassigned.
meet this need. Fight-or-flight refers to the group’s Responsibility flows from the discussion on
proclivity to engage in either aggressive behaviors, authority and refers to the implications of accept-
such as verbal or physical aggression and scape- ing a particular role in the group. This can produce
goating, or passive behaviors, such as avoidance information on the relationships established in the
and withdrawal, to minimize the task or the failure group and may have ramifications at a personal
to accomplish it. Pairing refers to the bonding level for members’ experiences in life outside the
between two group members to provide mutual group.
support. These two group members exhibit warmth Boundaries are both physical and psychological,
and affection toward each other, which effectively and the Tavistock approach puts a great deal of
excludes other group members. Oneness, as pro- emphasis on the various types of boundaries:
posed by Turquet, refers to the group’s desire to (a) input boundary, (b) task boundary, (c) role
survive by joining with an inspirational leader who boundary, and (d) time boundary. The input
provides well-being and wholeness, or meaning boundary is the process of application to and
and purpose that seem to be greater than oneself. acceptance of the task. The task boundary is the
specific task assigned to the conference within its
limitations, which are always clearly defined. The
Leader Tasks
role boundary demands that consultants (group
In contrast to other types of groups, in Tavistock leaders) stay “in role” throughout the life of the
groups, the leader serves as a consultant and only conference, including during any informal gather-
reports to the group as a whole, not to individuals. ings that may occur. Consultants do not socialize
This can be very discordant for some group mem- with group members during the conference. The
bers who usually expect a leader to be responsive final boundary is the time boundary: It is essential
to individual group members; when this does not that the conference begin and end at the specified
happen, the resulting feelings can be disappoint- times and that the schedule is always followed.
ment, hostility, or other primitive interpersonal
responses. The leader maintains the role of consul-
Techniques
tant on the group’s process regardless of what the
members feel and express, which allows the leader The organization of the conference, described in
to make visible the group’s projections and the like the next section, provides a significant structural
and promotes their examination for these. component of the method. The schedule and
movement between groups are designed to provide
opportunities for accomplishing the learning task,
Conferences
allowing group members to increase awareness of
As opposed to most other kinds of groups, this their conscious and unconscious wishes and needs
approach does not refer to psychotherapy but and grow in their understanding of their relation-
rather terms the group meetings as conferences ships in the many groups they inhabit in their
with a unique design and issues. The conference worlds. Within this context, techniques draw from
design is presented in the “Therapeutic Process” the experiential group work by Lewin, who pro-
section; the concepts presented here are the issues posed that active participation in and examination
for the groups: (a) authority, (b) responsibility, of a group’s process produce and increase learning
(c) boundaries, (d) projection, and (e) large-group for individual members. The consultant’s role of
phenomena. making comments on the group’s process in the

1000 Therapeutic Touch
here-and-now uses the techniques of direct con- unresolved conference issues and the relevance of
frontation of resistance, projections, reactions to the conference to their home situations.
authority, and dependency. In this regard, the
group (and its individual members) can be made Joshua Gross
aware of what they are doing and not doing, with
See also Group Analysis; Intersubjective Group
the goal of facilitating group and individual learn- Psychotherapy; Intersubjective-Systems Theory; Object
ing as well as enhancing task accomplishment. Relations Theory; Self Psychology
Therapeutic Process Further Readings

Although used widely in businesses and organiza- Bion, W. R. (2010). Experiences in groups (7th ed.).
tions, the process of the Tavistock approach is also New York, NY: Routledge.
compatible with group therapy. The structural Harrison, T. (2000). Bion, Rickman, Foulkes and the
components of the conference provide much of the Northfield experiments: Advancing on a different
therapeutic process: a conference opening, small front. London, England: Jessica Kingsley.
groups, a large group, an intergroup event, appli- Lewin, K. (1951). Field theory in social science.
cation groups, and the conclusion with a confer- New York, NY: Harper.
ence discussion. The schedule usually moves among Mackenzie, K. R. (1992). Classics in group psychotherapy.
the various components, with specific time periods New York, NY: Guilford Press.
allotted for each, whether the conference is a one- Melanie Klein Trust. (2013). Furthering the
day or a multiple-day conference. The staff pro- psychoanalytic theory and technique of Melanie Klein.
vides the conference opening with statements of Retrieved from http://www.melanie-klein-trust.org.uk
intent and design for the conference events. Segal, H. (1975). Introduction to the work of Melanie
Participants are assigned or can choose their Klein. London, England: Hogarth Press.
Turquet, P. (1974). Leadership: The individual and the
small groups and are charged with examining their
group. In G. S. Gibbard, J. J. Hartman, & R. D. Mann
group’s behavior in the here-and-now. Most of the
(Eds.), Analysis of groups (pp. 338–357). San
time, a consultant is assigned to work with each
Francisco, CA: Jossey-Bass.
group, but there are conferences where the consul-
tant may move among groups or where consul-
tants meet as a group, where members observe Website
them. Some conference designs promote the inter- A. K. Rice Institute for the Study of Social Systems: www
change of members’ ideas among groups, with .akriceinstitute.org
physical movement among the groups.
The large group consists of all conference mem-
bers, with two to four consultants provided for the
group. The task of the large group is to study its THERAPEUTIC TOUCH
behavior in situations that cannot be face-to-face
or that are problematic. Therapeutic touch is an approach to treatment
The intergroup event can function in two ways: that focuses on reducing symptoms that afflict the
(1) the members form small groups whose task is body and mind. Based on a philosophy that
to study the relationships among groups, and a humans are energy-based people who need social
consultant is assigned to the small groups, or interaction, this approach uses a combination of
(2) staff groups are formed, their meetings are in energy work, massage, and narrative therapies to
public, and participants observe the staff groups’ decrease a wide range of symptoms that may be
functioning. associated with a variety of disorders. Often con-
The conference discussion provides participants sidered a supportive therapy, therapeutic touch can
the opportunity to discuss the conference, with little be incorporated into any therapeutic session cou-
expectation of providing each individual member pled with other counseling modalities. However,
with a sense of closure or personal achievements therapeutic touch may be used on its own in a
gained. The therapeutic process is centered on session that can last from 30 to 90 minutes. This
work designed to understand and make sense of approach has shown positive correlations in

Therapeutic Touch 1001
decreasing symptoms when working with a wide this approach suggests that individuals will begin
range of clients who have experienced trauma, to disconnect from society as a whole as well as
dementia, anxiety, autism, anxiety, or substance from themselves, increasing the opportunity for
abuse. Therapeutic touch has become incorporated symptoms to continue to affect their everyday life.
into modalities such as play therapy to assist in the
treatment of young children who have autism or
Major Concepts
attachment disorders and is encouraged as a sup-
portive method to cognitive-behavioral therapies A number of concepts are used in this approach.
when treating dementia. Major concepts include centering, assessing, inter-
vention, balancing, and closure.
Historical Context
Centering
Therapeutic touch was developed during the early
1970s by Dolores Krieger, a professor at New York Centering is the process of bringing the body,
University, along with her close colleague Dora mind, and soul to a quiet focused state in the here-
Kunz, who identified herself as a natural healer. and-now through the use of breath, imagery, and
Since then, therapeutic touch has been researched meditation.
in multiple studies and has been shown to have
strong correlations when treating a variety of dis- Assessing
orders and symptoms. Therapeutic touch has
Assessing is the process of paying attention to
proven difficult to study in some respects because
sensory cues from the client and establishing what
it is often coupled with other modalities and incor-
type of therapeutic touch should be used.
porates several approaches, such as energy work,
massage, and talk, to engage all aspects of the cli-
ent. However, qualitative research has supported Intervention
the use of therapeutic touch as individuals con- Intervention is the actual use of therapeutic
tinue to report the reduction of symptoms due to touch either by the counselor or by the client to
the physical interactions of touch. While it is create change.
believed that aspects of therapeutic touch have
existed long before the 1970s in relation to spiri-
tual beliefs, it was not until Krieger and Kunz Balancing
began to develop research on therapeutic touch Balancing is the directive action of moving the
that it was established as a supportive treatment therapeutic touch to areas that need help to rees-
approach. tablish order in the system through the use of
energy work.
A transpersonal approach, therapeutic touch sug- Closure
gests that a personal connection between the coun- Closure is the use of professional and informed
selor and the patient affects all aspects of the judgment to determine when the session has ended
neurological structure of the patient, promoting and how many therapeutic touch sessions might be
health and regeneration through a body–mind–soul needed for further treatment.
connection. The foundation of our needs as humans
suggests that we should not be isolated and that we
Techniques
have a natural need for interaction with others.
Therapeutic touch identifies the need of individuals With therapeutic touch, techniques are directly
to feel safe and secure with those in their surround- related to the comfort level of the counselor and
ings, through the physical interaction of someone the client. Some techniques require no touching
being close by, laying a hand on the shoulder, or from the counselor and can focus more on the cli-
stimulating the senses through more interactive ent’s use of touch in a narrative approach to com-
therapeutic massage. If isolation were to continue, municating with the counselor.

1002 Training Groups
Focus on the Here-and-Now Further Readings

With here-and-now techniques, the client is Doherty, D., Wright, S., Aveyard, B., & Sykes, M. (2006).
asked to touch certain parts of his or her body Therapeutic touch and dementia care: An ongoing
to help heighten the client’s awareness of the journey. Nursing Older People, 18(11), 27–30.
body-felt sensations when experiencing different Eyckmans, S. (2009). Handle with care: Touch as a
symptoms. therapeutic tool. Gestalt Journal of Australia &
New Zealand, 6(1), 40–53.
Ferraresi, M., Clari, R., Moro, I., Banino, E., Boero, E.,
Sense of Safety Crosio, A., . . . Piccoli, B. G. (2013). Reiki and related
therapies in the dialysis ward: An evidence-based and
Sense of safety describes the process of the
ethical discussion to debate if these complementary
counselor using therapeutic touch as a way to
and alternative medicines are welcomed or banned.
ensure that the client is in a safe place when
BMC Nephrology, 14, 129. doi:10.1186/1471-2369-
addressing difficult situations such as trauma, by
14-129
touching in a protective way. Examples of this may
Hagemaster, J. (2000). Use of therapeutic touch in
include placing a hand on the client’s shoulder or treatment of drug addictions. Holistic Nursing
hand. Practice, 14(3), 14–20. doi.org/10.1097/00004650-
200004000-00005
Energy Transference
The energy transference technique describes the
process whereby the hands of the counselor are
randomly moved above the patient’s body. This is
TRAINING GROUPS
done while the counselor and client use vivid imag-
Training groups (T-groups) are emotionally inten-
ery of healing energy flowing from the counselor
sive small-group experiences where members learn
to the client. Based on the comfort level of the
to approach relationships with increased openness
counselor and the client, the choice can be made to
and flexibility. The group process is the primary
physically touch the client or not.
vehicle for learning as the discussion content gen-
erates valuable data for group members to critique
Therapeutic Process and analyze. Throughout the process, members
become more aware of the complex social dynam-
Therapeutic touch can last anywhere from 10 to ics that underlie human relationships and develop
90 minutes depending on the counselor and the a broader range of interpersonal skills that gener-
client’s collaborative decision. Early sessions alize beyond the group setting. On completion of a
involve building a relationship between the client T-group, participants often report increased aware-
and the counselor and establishing the comfort ness, increased empathy for others, better commu-
level for using touch in therapy. The following ses- nication skills, and more satisfying interpersonal
sion will involve developing the flow of energy relationships. Former members are also more
during the touch and incorporating imagery allow- likely to view personal growth as a valuable
ing the client to visualize healing energy flowing endeavor, use humor to resolve conflicts, and
from the counselor to the client. Future sessions generally regard the group as an important life
may include encouraging the client to use thera- experience.
peutic touch on his or her own as a way to address
symptoms as they arise.
Historical Context
Eric D. Jett
Although various researchers deserve credit for
®
See also Body-Mind Centering ; Body-Oriented Therapies: laying the initial framework, Kurt Lewin is often
Overview; Complementary and Alternative cited as the father of modern T-groups. In 1946,
Approaches: Overview; Integrative Body the executive director of the Connecticut Interracial
Psychotherapy; Reiki Commission approached Lewin and his colleagues

Training Groups 1003
to teach educators, social work professionals, and outcomes. Although modern reformulations of
business leaders how to apply new communication classical encounter groups continue to operate, the
skills in an effort to de-escalate rising interracial contemporary status of T-groups reflects only a
tensions. After the initial workshop, the experience shadow of its former impact.
encouraged Lewin to create the National Training During the 1960s, a public debate emerged
Laboratory for Group Development (the name regarding the potentially harmful effects of
was eventually changed to the NTL Institute of T-groups. Although research concluded that
Applied Behavioral Sciences). The creation of the T-group experiences provided an effective format
NTL ushered in a new era that focused on group for promoting self reflection and reevaluation of
process in counseling and organizations. one’s values, research also found that some mem-
The popularity of T-group training grew as bers were initially disturbed by the emotional
regional laboratories began to emerge across qualities that are deliberately heightened during
the country (e.g., Western Training Laboratory, the group process. Participants commonly reported
the Pacific Northwest Training Laboratory, the feelings of anxiety and discomfort as members
Intermountain for Group Development, and begin to receive feedback from their peers. Although
Boston University Summer Laboratory). By the this anxiety lessened as the group progressed, psy-
mid-1950s, the NTL tailored T-group experiences chologically vulnerable participants sometimes
to help executives and religious leaders increase experienced this process as overwhelming, intoler-
their sensitivity to the experiences of others. As the able, and distressing. As a result, recommendations
appeal of T-groups increased, it became difficult to arose that urged group leaders to obtain adequate
oversee the expanding number of international training before leading a T-group, employ careful
consultants. Popular growth centers such as the selection procedures, develop a crisis intervention
Esalen Institute and organizations like Synanon, a plan, and educate group members about the
drug rehabilitation program, also entered the mar- nature, purpose, potential risks, and expected ben-
ket and began introducing a menu of similar inten- efits of the group.
sive small-group experiences. Each growth center Although they are less prominent today,
could be distinguished by its unique leadership T-groups are often used in mental health training
style, commitment to scientific inquiry, and theo- programs and business and industry where the aim
retical approach toward structuring the group is to increase empathy, increase communication
experience. skills, understand and tolerate individual differ-
The rapidly increasing popularity of growth ences, and be able to communicate and solicit
centers and emotionally charged media accounts feedback from others more effectively.
of harmful experiences began to have an impact on
public confidence. T-groups became threatened by
their own success as the allure of free expression
attracted participants who held countercultural During the T-group, participants learn to construct
values or antiwar sentiments, and those who were a social microcosm where members are encour-
more suited for psychotherapy rather than for aged to learn new interpersonal skills in a safe and
interpersonal confrontation. The culture within the trusting atmosphere. Although many theories have
NTL also began changing due to financial con- been proposed to explain how T-groups promote
cerns shifting the emphasis away from rigorous interpersonal learning, group leaders have tradi-
small-group research toward the rejection of schol- tionally relied on field theory and group dynamics
arly inquiry. During the late 1970s, interest in to structure the group experience. Lewin hypothe-
T-groups waned when concerns expressed by men- sized that people are born into social groups gov-
tal health professionals and members of the aca- erned by unique customs, norms, laws, and values.
demic community began to challenge the empirical This complex system of rules channels our behav-
foundation and safety of T-group experiences. ior into a narrow range of routine responses and
Citations in academic journals began to dwindle, inhibits opportunities for interpersonal creativity
and corporate leaders began to doubt the practical or growth. Because the group exerts a powerful
benefits of T-group experiences in organizational influence on encouraging or stifling member

1004 Training Groups
behavior, the leader must help shape the group they have played in their lives, which is why some
experience and facilitate a constructive dialogue. refer to T-groups as a microcosm of society.
Without guidance from the leader, individual Understanding these roles helps group members
members may be prevented from exploring new comprehend how issues of race, gender, socioeco-
methods of interacting with others. nomic status, age, disability, and other “isms” of
Over time, the sociological theory espoused by society are critical factors in all group dynamics.
Lewin and his colleagues began to fade as a new
generation of NTL consultants began using Leadership Style
Rogerian and psychoanalytical principles to inform
the group experience. Today, educators sometimes The facilitator’s leadership style may influence
use T-groups as an experiential learning method to the group’s success. For example, an authoritative,
help students become familiar with the complexi- insincere, and abstruse leader may amplify feelings
ties of group leadership. For this setting, educators of anxiety to a level that prompts destructive mem-
may also integrate elements from David Kolb’s ber behaviors. Furthermore, because members
experiential learning model to design reflective often draw cues from the facilitator’s behavior,
writing assignments and classroom exercises leaders must carefully consider the frequency and
around the T-group experience to promote deeper depth of their involvement. Leaders must avoid
learning and personal growth. unintentional cues that derail the natural course of
the conversation. Leaders must also monitor over-
active members who may share inappropriately or
Major Concepts antagonize others. Such members may become the
A few of the important concepts of T-groups are subject of criticism, disdain, or scapegoating.
boundaries and group rules, roles and power
dynamics, leadership style, group structure and Group Structure and Group Commitment
group commitment, learning and communication,
and unfreezing. During early sessions, members often expect the
group to progress without much personal invest-
ment. This view changes quickly when leaders
Boundaries and Group Rules deliberately remove structure to create an unset-
The group leader is responsible for outlining tling and ambiguous atmosphere. The absence of
learning objectives, protecting members from structure also generates uncertainty around mem-
potential harm, maintaining boundaries, identify- ber roles, acceptable boundaries, power dynamics,
ing the risks and benefits of participation, and and goals. The lack of structure removes predict-
orienting new members to the group process. ability and forces members to question who they
During the initial meeting, participants are told are and who they wish to be. Members quickly
how long the group will meet, the total number of learn that the group’s success is driven largely by
sessions, whether members can socialize outside their mutual cooperation. Members must decide
the group, and what behaviors are not permissible how much to invest in the group process. This
(e.g., physical acting out is not allowed). To protect experience may provoke feelings of anxiety as each
members from potential harm, leaders develop person evaluates the potential danger in this unfa-
crisis intervention procedures, use careful selection miliar environment and decide how much to share
methods to identify vulnerable candidates, and and how much to withhold. Participation may
possess adequate training to safely implement leave members feeling depleted but still inspired to
effective interventions. continue.
Roles and Power Dynamics Learning and Communication

One of the most important focuses of T-groups Learning occurs when members experiment
is helping individuals see how each member tends with new roles and interpersonal skills. The group
to play out certain roles within the group. In experience encourages members to communicate
T-groups, members will usually play out roles that with one another in ways that are rarely attempted

Training Groups 1005
during a typical social interaction. Over time, indi- safe environment, and help members organize their
vidual participants realize that the group’s success experience in the group have the lowest dropout
isn’t guaranteed but is negotiated with the other rates and facilitate stable improvements in self-
members. Communication improves as members esteem, mental health, and positive views toward
become more skilled at giving and receiving feed- others.
back. Once members become more proficient in
communication, new opportunities for collabora- Feedback
tion are created because defenses are lowered and
group members become more open and receptive Learning to give and receive feedback is a pow-
to feedback. As members feel more comfortable erful technique that helps members modify and
taking risks and experimenting with new behav- adopt new behaviors. Lewin believed that modern
iors, the motivation and desire for personal growth social norms prevent individuals from experienc-
are heightened. ing how others truly perceive them. Lewin held
that learning occurs as members receive feedback,
in a safe, supportive, and structured environment,
Unfreezing
about how their behavior affects others. Through
Unfreezing occurs when group members recog- open discussion and critical analysis, T-group
nize that their usual ways of responding—their members learn how to translate feedback into
“go-to” thoughts and actions—are no longer effec- more constructive thoughts and behaviors.
tive. This experience destabilizes long-held patterns
of behavior and forces the individual to generate Observant Participation
alternative ways of responding. The group helps
members break free from these old habits and Observant participation is a challenging tech-
replace rigidly held beliefs with more constructive nique where members are taught to actively par-
values. ticipate in the group process while simultaneously
stepping outside of their emotional experience and
objectively dissecting the complex dynamics that
Techniques underlie group member interactions. Learning
T-groups are designed to capitalize on topics occurs when members actively experiment with
generated by participants. Because the primary new behaviors and evaluate the impact these
intention is to critically deconstruct and analyze behaviors have on the group process.
discussion content, group leaders often employ
techniques such as feedback, observant participa- Cognitive Aids
tion, and cognitive aids to help members make
meaning from their experience. However, to build Some T-group leaders use psychoeducational
initial trust, listening and empathy are often mini-lectures to help members organize their
needed. Slowly, as the group develops, members experience in the group. For example, a leader
gain increased learning about their style of relat- may use the Johari Window, an exercise to help
ing, begin to “unfreeze” and develop new ways of individuals understand parts of their hidden selves,
acting with one another, and communicate more to help participants conceptualize how feedback
effectively. from the group can be used to build insight and
self-awareness.
Listening and Empathy
Therapeutic Process
Early in the group process, leaders use empathy
to build cohesion and trust among participants. T-groups can last for one long session or for many
Together, the group constructs a safe, supportive, sessions over a number of months. Whatever the
and democratic environment that reinforces coop- length, it is important that enough time is given for
eration and views conflict as an opportunity for members to begin to understand some of the roles
members to learn more about one another. Caring they play and to become clearer on some of the
leaders who communicate competence, ensure a dynamics that occur in all groups.

1006 Transactional Analysis
After building cohesion through listening, empa- Psychologist, 31(3), 247–255. doi:10.1037/0003-
thy, and ongoing discussion with an emphasis on 066X.31.3.247
building trust, T-groups will slowly move to an Highhouse, S. (2002). A history of the T-group and its
increased lack of structure as members are given a early applications in management development. Group
free rein to discuss topics and leaders consistently Dynamics: Theory, Research, and Practice, 6(4),
do not provide “answers” for members’ questions. 277–290. doi:10.1037/1089-2699.6.4.277
After building group cohesion, T-groups move Kolb. D. A., & Fry, R. (1975). Toward an applied theory
into a three-step format: unfreezing, moving, and of experiential learning. In C. Cooper (Ed.), Theories
of group process (pp. 33–57). London, England: Wiley.
refreezing. Under this model, unfreezing occurs
Lieberman, M. A., Yalom, I., & Miles, M. (1973).
when members learn that their habitual patterns of
Encounter groups: First facts. New York, NY: Basic
responding to others are no longer effective. From
Books.
a practical standpoint, this sense of disequilibrium
Rogers, C. R. (1970). Encounter groups. New York, NY:
is created by the lack of structure or session Harper & Row.
agenda. The effect is further heightened when the
leader declines to direct the process and informs
participants that the group is responsible for
achieving growth or change. This short introduc-
tion is often followed by a long silence as members
TRANSACTIONAL ANALYSIS
struggle to adapt to this unfamiliar experience.
Moving occurs when members learn to reevaluate Transactional analysis is a theory of personality
how they perceive themselves and their behavior designed for, and adapted to, the purpose of group
and select new, more adaptive responses. This pro- psychotherapy, which is, as Eric Berne, its creator,
cess begins as group members adjust to the puts it, “to cure patients.” Therefore, given that
unstructured format and learn to use here-and- Berne believed that the patient has to participate
now conflicts to explore their behavior and exper- fully in the curative process, the theory needed to
iment with new and more effective methods. The be understandable and accessible as well as credi-
final refreezing stage occurs when members resolve ble and verifiable.
to adopt and integrate the lessons learned into As a theory of personality, transactional analy-
their personal and professional interactions, have sis holds that individuals relate to reality, and
developed more effective communication skills, transact with one another, via three distinct, visi-
and have more empathy for others. ble, easily identifiable manifestations of the ego,
called ego states: (1) the Parent, (2) the Adult, and
Sean B. Hall (3) the Child. In their interpersonal relationships,
people engage in observable interactional patterns
See also Group Counseling and Psychotherapy Theories: between ego states, some of which, called games,
Overview; Rogers, Carl; Tavistock Group Training are repetitive, maladaptive transactional sequences
Approach; Yalom, Irvin that reaffirm a person’s script, or life plan.
The therapeutic process of transactional analy-
Further Readings sis assumes that the maladaptive transactions of
games, usually between the Parent and Child ego
Back, K. W. (1972). Beyond words: The story of states, are at the root of emotional and mental
sensitivity training and the encounter movement. disturbance and the inability to live a full life.
New York, NY: Russell Sage Foundation. Therefore, the goal of transactional analysis is to
Bradford, L. P., Gibb, J. R., & Benne, K. D. (1967).
disable the games and chart a return to emotional
T-group theory and laboratory method: Innovation in
and mental health.
re-education. New York, NY: Wiley.
Faith, M. S., Wong, F. Y., & Carpenter, K. M. (1995).
Group sensitivity training: Update, meta-analysis, and
Historical Context
recommendations. Journal of Counseling Psychology,
42, 390–399. doi:10.1037/0022-0167.42.3.390 Transactional analysis was a pointed response to the
Hartley, D., Roback, H. B., & Arbramowitz, S. I. (1976). hegemony of the psychoanalytical methods of the
Deterioration effects in encounter groups. American mid-20th century. Berne, who had been in

Transactional Analysis 1007
psychoanalytical training, which he did not com- Major Concepts

plete, reported finding it difficult to visualize con-
The major concepts associated with transactional
cepts of psychoanalysis, such as the id and the
analysis include ego states, transactions, strokes,
superego. He objected to what he saw as a do-
games, and scripts.
nothing therapeutic methodology based on the
imaginative writings of Sigmund Freud and his
followers. Instead of analyzing dreams and free Ego States
associations as a way of understanding human beha- Transactions take place among unique ego
vior, Berne proposed analyzing the interactions— states—the Parent, the Adult, and the Child—which
transactions—between people toward the same end. are visible, observable, and quantifiable aspects of
Berne developed transactional analysis in the early the ego. The ego states, as proffered by Berne, are not
1950s over a period of about 5 years, beginning a mere rephrasing of the ego, superego, and id but a
with the division of the ego into ego states and fol- parsing of the ego into three distinct, specific mani-
lowing in quick order with his ideas about transac- festations. Each state has its own feelings, experi-
tions, games, and scripts. ences, function, and consistent patterns of behavior;
Berne departed from psychoanalysis in several each has a locus in the brain; each is a vital compo-
ways. He insisted that a psychotherapist had to nent of a healthy ego and person; and each has spe-
concentrate on achieving a cure, a notion that was cific survival value. When one of the three ego states
considered scandalous at a time when practitioners dominates a personality to the exclusion of the other
were loath to even commit to therapeutic improve- two, the person’s capacities are diminished.
ment, let alone a cure. Berne’s stipulation that any
person who cures a patient is a real doctor opened
The Child
the door to the practice of psychotherapy by any-
one competent to do so, regardless of professional When a person is in the Child ego state, he or she
degrees. Another of Berne’s departures was his thinks, feels, sees, hears, and acts like the child he
emphasis on group treatment, which he believed or she once was. The Child has all emotions—for
was as effective, if not more effective, than one-to- example, fear, love, anger, joy, sadness, and shame—
one therapy. and is seen as the source of creativity, recreation,
Transactional analysis was particularly popular and procreation. In its undesirable form, the Child
during the 1960s and 1970s. Today, it has a large can dominate a person’s life, as in the cases of per-
worldwide following, can be taught relatively sons whose confused, depressed, crazy, or addicted
quickly, and has been shown to be effective with a Child drives them to self-destruction.
wide variety of clients.
The Parent
Theoretical Underpinnings The Parent is a collection of prejudged, preju-
diced codes for living. The Parent decides, without
Berne did not draw on other writers’ theories,
reasoning, how to react to situations, what is good
except for Freud, whose concepts he initially
or bad, and how people should live. It is useful
applied occasionally—concepts such as transfer-
when there is no information available to the Adult
ence, repetition compulsion, and sphincter distur-
or no time for the Adult to think. The Parent
bance. He was a self-taught existentialist, and his
judges for or against and can be controlling or sup-
existential preoccupations were embedded in his
portive. When the Parent is critical, it is called the
theory, in which scripts and games have a profound,
Critical Parent. When it is supportive, it is called
lifelong existential component that interferes
the Nurturing Parent. In its undesirable form, the
with personal autonomy and its constituents—
Parent dominates a person’s life and does not allow
spontaneity, awareness, and intimacy. Throughout
the Child and the Adult to express themselves.
his writings, he was concerned with the question of
how people structure the time between birth and
The Adult
death, whether by “waiting for rigor mortis” or for
“Santa Claus,” or smelling the roses and striving When in the Adult ego state, a person functions
for autonomy. as a human computer. The Adult operates on the

1008 Transactional Analysis
data it collects and stores and uses those data to Communication can continue smoothly between
make decisions according to a logic-based pro- two people as long as transactions are complemen-
gram. When in the Adult ego state, a person uses tary. Crossed transactions disrupt communication
logical thinking to solve problems, making sure and are often, but not always, the first transaction
that Child or Parent emotions do not contaminate in a game.
the process. The Parent or the Child ego state can Ulterior or duplex transactions (Figure 1C)
contaminate the Adult’s decision process, causing occur when people appear to be in one ego state
the Adult to come to erroneous conclusions. When (usually the Adult) but are actually in another.
a contamination comes from the Parent, it is called Ulterior transactions are especially interesting
a prejudice. A Child contamination is called a delu- because they are deceptive and are the basis of
sion. In its undesirable form, the Adult excludes games. They have a social (overt) and a psychologi-
the Child and the Parent, resulting in a soulless, cal (covert) level. The outcome of an interaction can
robotic personality. be predicted on the basis of the covert (rather than
overt) content of the transactions within it.
Transactions
Strokes
A transaction consists of a stimulus (S) and
a response (R). A complementary transaction Strokes are personal-recognition transactions
involves one of the ego states in each person and can be positive or negative depending on how
(Figure 1A). In a crossed transaction (Figure 1B), they are experienced. Positive strokes are essential
the transactional response is addressed to an ego to a person’s physical and psychological health,
state different from the one that initiated the trans- but when not available, the person will accept
actional stimulus. negative strokes in the same way that people have
been known to drink foul water when pure water
is not available.
The exchange of positive strokes is one of the
most important activities that people engage in
Parent P P P their daily lives. However, people are bound by the
rules of a stroke economy, imposed by the Critical
S Parent, which severely restricts positive stroking.
Adult A A S A This produces a stroke scarcity and hunger in
R
R people, which in turn causes them to resort to
games, which produce mostly negative strokes.
Child C C C
A. Complementary Transaction B. Crossed Transaction Games
Stimulus (S): How much is 3 x 5? S: How much is 3 x 5?
Response (R): 15. R: I hate math!
A game is a recurring series of covert transac-
tions with a beginning, middle, and end and a
P P payoff. The payoff is a hidden advantage that
motivates the players to participate. Every game
SS pays off at three different levels:
Social
A RS A
1. The biological payoff is strokes. Even though
SP
games end badly, all the players get a
Psychological
C RP C considerable number of strokes—mostly
negative—from playing them. This is a basic
C. Duplex or Ulterior Transaction
Ssocial: Let’s work late, Miss Smith. function of games—to provide the strokes
Spsychological: Let’s have a drink, Sally. needed for physical—biological—and
Rsocial: Yes, let’s do that.
Spsychological: Oh, Bill! I thought psychological survival.
you’d never ask....
2. The social payoff is time structuring. People are
Figure 1 Transactions able to fill time with an exciting activity.

Transactional Analysis 1009
3. The existential payoff of a game confirms the form of an internalized, negative narrative about
existential position of each player’s script, himself or herself.
thereby advancing each of their scripts. The script decision is a prediction that life will
unfold in a specific way—for example, short,
Some games are two-handed, while others can unhealthy, depressed, angry, failed, active, or pas-
involve more than two players. Everyone involved sive. When the conclusion is that life will be bad or
is participating in the service of their own script. self-damaging, this is seen as a life script. Script
Games are played with a number of roles. There decisions are made, at times consciously, to go
are three major roles: (1) the Rescuer, (2) the along with parental injunctions. The young person
Persecutor, and (3) the Victim. These three dra- trades autonomy for parental protection to avoid
matic roles can be placed in a triangle (Drama punishment and criticism. Decisions can be revoked
Triangle), illustrating the principle that people will and redecided so that life can be lived in a more
switch from role to role within the games they play script-free, autonomous, and realistic manner.
(Figure 2). In a game of addiction, for instance, the Scripts can be banal or tragic. Tragic scripts are
therapist may start as the Rescuer of a disinter- highly dramatic, such as drug addiction, suicide, or,
ested, uncooperative drug addict and eventually sometimes, mental illness. Banal, or garden-variety,
become the addict’s Victim when the addict dem- scripts are less dramatic but more common: the
onstrates the therapist’s incompetence to cure him. melodramas of everyday life. They often occur in
The therapist may then switch to Persecutor when large subgroups of people, as when men and
the therapist declares the addict psychopathic and women are affected by sexist scripting, when racial
kicks the addict out of treatment. Next, the addict groups adopt racist scripting, or when teenagers or
switches from Victim to Persecutor when he old people are influenced by ageist scripting.
accuses the therapist of racism, and so on. This
demonstrates how in the game of addiction, as in
all games, every participant is playing some role Techniques
and how these roles switch between participants. The transactional analyst’s techniques are as fol-
The therapist’s task is to stay out of the dramatic lows: (a) making clear, goal-oriented therapeutic
games and script and avoid any of the roles, main- contracts, (b) making an effective analysis of peo-
taining a “no drama” course of action. ple’s transactions, (c) convincingly giving people
permission to change, (d) protecting them from
Scripts their fears of change, and, finally, (e) trusting in
and working with nature’s healing hand, the uni-
Transactional analysts believe that most people versal life force and tendency toward healing.
are born basically “okay” and end up in difficulty With these techniques, it is possible for almost
only because their parents (or other grown-ups anyone to improve his or her life and become
and influential young peers) have exposed them to more loving and productive as well as autonomous
harsh conditions and powerful injunctions and and free.
attributions. Such conditions cause the young per-
son to abandon his or her original “okay” position
and replace it with a self-damaging position in the Therapeutic Process
As a theory of psychotherapy, transactional analy-
sis requires the establishment of a treatment con-
tract. The contract is an agreement negotiated
RESCUER PERSECUTOR
between the therapist and the client in which the
client’s complaint (the issue for which the client is
seeking treatment) is specified by the client and
accepted for treatment by the therapist, and in
which the conditions defining the cure are made
VICTIM clear. After establishing the treatment contract, the
therapeutic process involves a careful Adult dis-
Figure 2 The Drama Triangle cussion and analysis of the client’s transactional

1010 Transpersonal Psychology: Overview
patterns, as illustrated by his or her interactions in Steiner, C. (2009). The heart of the matter: Love,
group or in the real world. As appropriate, the information and transactional analysis. Pleasanton,
therapist explains ego states and game and script CA: TA Press.
theory with the aid of diagrams. Steward, I., & Joines, V. (1987). TA today. Chapel Hill,
Not all of a client’s complaints can be attributed NC: Lifespace.
to games that are played, but the possible connec-
tion between a person’s complaint and his or her
transactional patterns is explored. The necessity of
stopping the game transactions between the client, TRANSFORMATIONAL SYSTEMIC
the therapist, and all others, in group and out, is THEORY
highlighted, and methods are explained. Berne
emphasized Adult control as a way of arresting
game playing. Robert and Mary Goulding empha-
See Human Validation Process Model
sized redeciding the script as the most therapeutic
process. Claude Steiner postulated that the person
needs to learn how to acquire positive strokes
directly instead of by playing games. TRANSPERSONAL PSYCHOLOGY:
Because the vast majority of people are born OVERVIEW
“okay,” it stands to reason that, with competent
help, they can return to their original “okay” posi- Transpersonal means “beyond the personal.”
tion. The capacity to be “okay” is waiting in every Transpersonal psychology is the study of experi-
person, ready to be released from the inhibitions of ences that transcend the usual personal limits of
the script. The therapist’s task involves permission space, time, and identity, such as intuitive, psi
(to give up game behavior and get strokes directly), (including precognition, telepathy, psychokinesis),
protection (from the fear of making the changes), and mystical (encounter with a nonordinary, seem-
and potency (to support the client in his or her ingly higher reality) experiences; the states of con-
changes). All people have the capacity, with the aid sciousness and levels of development associated
of nature’s healing hand (the inborn tendency to with such experiences; and applications of the
heal), to improve their lives by modifying the way resulting knowledge in various areas including
in which they behave transactionally. psychotherapy, education, and business. Although
Claude M. Steiner some authors have used the term transpersonal
synonymously with spiritual—pertaining to the
See also Analytical Psychology; Ego State Therapy; Freud, sacred or divine—transpersonal psychology
Sigmund; Freudian Psychoanalysis; Gestalt Therapy; includes but is not limited to phenomena catego-
Jung, Carl Gustav; Perls, Fritz rized as spiritual. Similarly, although religion is the
social institution pertaining to spirituality, transper-
sonal psychology includes attention to religious
Further Readings phenomena but is not inherently affiliated with
any religious perspective. Because the transper-
Berne, E. (1961). Transactional analysis in psychotherapy.
sonal perspective on human nature, experience,
New York, NY: Grove Press.
and development is unique in comparison with
Berne, E. (1964). Games people play. New York, NY:
Grove Press.
body- and egoic-based approaches to the promo-
Berne, E. (1966). Principles of group treatment. tion of human well-being, addressing it is essential
New York, NY: Grove Press. for a comprehensive treatment of theories of coun-
Goulding, R., & Goulding, M. (1978). The power is in seling and psychotherapy.
the patient: A TA/Gestalt approach to psychotherapy.
San Francisco, CA: Transactional Publications.
Historical Context
Karpman, S. (1968). Script drama analysis. Transactional
Analysis Bulletin, 7(26), 39–43. The earliest appearance of the term transpersonal
Steiner, C. (1974). Scripts people live. New York, NY: in the professional literature appears to have been
Grove Press. in a 1905 lecture by the U.S. psychologist William

Transpersonal Psychology: Overview 1011
James. Subsequently, the Swiss psychiatrist Carl Humanistic Psychology

Jung Gustav used the term in 1942, and the U.S.
Also as an outgrowth of humanistic psychology,
psychologist Gardner Murphy used it in 1949.
transpersonal psychology tends to retain and also
By the mid-1960s, in reaction to the prevailing
extend humanistic assumptions about people.
psychoanalytical and behavioral perspectives, the
These assumptions include the belief that people
humanistic psychology movement had taken root,
are fundamentally motivated to fulfill their positive
emphasizing human wellness and potential. Yet
potential—to realize or actualize their innate poten-
several prominent proponents of humanism
tial to lead meaningful, authentic lives. Whereas
believed that even that innovative shift in perspec-
humanists tend to limit their focus in this regard to
tive did not go far enough to include the full range
the material domain of the physical and relational
of human experience and developmental potential.
world, transpersonalists extend the focus to include
In the late 1960s, three of these proponents—the
potentials beyond “mere” self-actualization. Many
Czech American psychiatrist Stanislav Grof,
transpersonalists theorize not only a lower uncon-
the American psychologist Abraham Maslow, and
scious based in biological processes but also a
the Austrian existential psychiatrist Viktor Frankl—
higher unconscious involving transcendent motives
proposed that the new field be called transpersonal.
such as empathy, compassion, connectedness, and
Their and others’ establishment of transpersonal
creative inspiration. Likewise, they theorize not
psychology was accompanied by the founding of
only a self that functions in the everyday world but
an organization, the Transpersonal Institute (which
also a Self, a transcendent entity of which the self
later became the Association for Transpersonal
is but a dim reflection. Unlike the self, the Self is
Psychology), and the scholarly, peer-reviewed
not limited by space or time; thus, Self-actualization
Journal of Transpersonal Psychology.
includes experiences and levels of development
The 1970s saw the founding of several transper-
beyond meaningful, authentic functioning in the
sonally oriented organizations, educational institu-
world to include the intuitive, the paranormal, and
tions, and both popular and scholarly publications
the mystical. These latter experiences and develop-
that continue today. Advances in various fields
ments have the potential to further deepen a
including anthropology, technology, and physics,
person’s subjective experience of existence and
as well as ongoing research into transpersonal phe-
functioning in the world.
nomena, have contributed to a continuous broad-
Like their humanistic forebearers, transperson-
ening and deepening of transpersonal psychology.
alists tend to be nondeterministic, believing that
heredity and environment influence but do not
Theoretical Underpinnings ultimately determine a person—that people retain
some capacity to choose even in the face of hered-
Although transpersonal counselors and psycho- itary and environmental factors. Also like human-
therapists are a broad group of practitioners who ists, transpersonalists tend to be nonreductionist,
use a variety of techniques when working with believing that phenomena cannot be fully explained
clients, to some degree they are represented by by deconstructing them into their components—
several theoretical and philosophical positions. that the whole is greater than the sum of its parts.
On a related note, transpersonalists tend to adhere
to a nonmaterialist philosophy. Materialism is the
Phenomenology
belief that everything, including consciousness,
As an outgrowth of humanistic psychology that derives from physical matter. One manifestation of
addresses the individual’s experience in the world this belief is the idea that when a person’s brain
over more objective and observable aspects, dies, one’s consciousness dies. Transpersonalists
transpersonal psychologists extend the focus to tend to believe, as expressed by theorists such as
individuals’ experiences that transcend the mate- William James, that consciousness is essentially
rial world. These include the aforementioned independent of the brain: Rather than producing
intuitive, paranormal, and mystical experiences, consciousness, the brain is actually a filter and
whereby the processes and content of the experi- limiter of an essentially broader consciousness that
ences transcend purely worldly phenomena and people often experience in extreme states such as
the laws that characterize them. deep meditation and close brushes with death.

1012 Transpersonal Psychology: Overview
Finally, transpersonalists value the philosophy of rushes of energy up the spine, extreme heat gener-
science—the scientific method—but not scientism, ated in the body, and a variety of changes in con-
the belief that the only source of valid knowledge sciousness, emotions, and eating and sleeping
is in the study of phenomena that can be measured. patterns. Although these symptoms can be dis-
Thus, transpersonalists value the process of science rupting to a person’s life, people who have
as one vital, but not the only, source of knowledge; managed the awakening well—often with guid-
according to them, people have experiences of ance from others who are knowledgeable about
realities beyond measurable material reality that kundalini—eventually manifest spiritual develop-
they find meaningful and that seem to enhance ment that they consider to be worth the challenges
their well-being and development. of the awakening.
Developmental Psychology Cross-Cultural Psychology

Developmental psychology is the study of how Cross-cultural psychology is the study of both
organisms—particularly humans—change over the the unique aspects of and the commonalities and
life span, with a particular focus on an innate ten- universalities between the world’s cultures. From
dency to change in the direction of sequentially its inception, transpersonal psychologists focused
increasing knowledge and ability. Transpersonalists on transpersonally oriented practices and beliefs
tend to embrace a developmental perspective. of the world’s Western and Eastern cultures. These
Whereas traditional human developmental psychol- practices and beliefs included shamanism of
ogists limit their focus to personal development— indigenous peoples around the world, Eastern
psychosexual, moral, psychosocial, cognitive, and so meditative practices, reincarnation beliefs, various
on—transpersonalists tend to also acknowledge cultures’ mythological stories and symbols, and
levels of development beyond the “merely” personal. the perennial philosophy—the seemingly common
Ken Wilber, for example, though having disaf- core of all the world’s great spiritual traditions.
filiated himself from the field of transpersonal Transpersonal therapists have adopted and
psychology because of its eclectic nature, which adapted aspects of these phenomena in conceptu-
did not align entirely with his views, nevertheless alizing and working with clients. For example,
offered a conceptualization of developmental they employ meditation not only to promote
stages beyond the personal that reflect many personal well-being but also to facilitate transper-
transpersonalists’ theoretical perspective. These sonal development.
stages are characterized by paranormal experi-
ences, experiences of communication with nonma-
Parapsychology
terial entities such as deceased people and other
nonphysical entities, mystical experiences of com- Traditional parapsychology has consisted pri-
munion with a nonmaterial deity, experiences of marily of the study of phenomena such as extra-
the source behind all material and nonmaterial sensory perception—perception that seems not to
manifestations, and the culminating experience of involve the normal processes of sensing or of
unity consciousness, whereby all manifestations rationally deducing, such as telepathy (knowing
and the source of those manifestations are experi- another person’s thoughts and/or feelings), pre-
enced as “not-two”—meaning not two separate cognition (knowing a future event), clairvoyance
phenomena. (knowing distant objects or scenes), and extrap-
As with prepersonal and personal stages of hysical abilities such as psychokineses (moving
development, suprapersonal stages are character- objects without contacting them physically).
ized by increasingly greater knowledge and Transpersonal psychology also includes the study
ability—as well as by unique challenges. Among of other transpersonal phenomena, including syn-
the better known of these challenges is kundalini chronicity (meaningful coincidences that seem to
awakening, described by Gopi Krishna, in which imply a deeper meaning in the universe), near-
spiritual practice such as meditation can result death experiences (subjectively real experiences of
suddenly in psychophysical experiences such as altered consciousness that occur during close

Transpersonal Psychology: Overview 1013
brushes with death), after-death communication symbolic reliving of physical birth to a variety of
and mediumship (experiences of communicating transpersonal phenomena, such as past-life mem-
with a deceased person), nearing-death awareness ories and mystical experience.
(terminal illness and deathbed experiences of
after-death communication and glimpses into
Integral Psychotherapy
subjectively real alternate realities), experiences
associated with the use of psychedelics, and past- This approach is based on Wilber’s integral
life memories and reincarnation. To promote theory, whereby people are supported in their
psychological healing and development, many inherent capacity to develop from the prepersonal
transpersonal therapists use the results of such functioning that characterizes early childhood; to
research to guide them in responding most thera- the personal functioning in the material world that
peutically to clients who disclose such experi- characterizes most people in late childhood, ado-
ences, and some transpersonal therapists use lescence, and adulthood; to possibly suprapersonal
techniques to facilitate these experiences, as in functioning, characterized by experiences of tran-
practices of past-life therapy and facilitated after- scendence of the material world.
death communication.
Carl Jung
Short Descriptions of Transpersonal Jung tried to understand and make sense out of
Therapists and Therapies psychic phenomena and developed the concept of
Analytical Psychology the collective unconscious, which suggested that all
human beings have universal archetypes that are
Analytical psychology is an approach to psy- the road map to what makes us human. Many of
chotherapy developed by Jung in which people are his ideas are used in transpersonal psychology.
conceptualized as having a conscious self, having a
personal unconscious, and sharing a collective
unconscious—the collective experience of human- Abraham Maslow
ity innate in each person’s psyche that, Jung Abraham Maslow (1908–1970) is a founder of
believed, accounted for the cross-cultural univer- humanistic psychology whose studies of high-
sality of spiritual experiences. functioning people led him to theorize an inher-
ently transcendent, spiritual aspect of human
nature, thus rendering him a founder also of
Holotropic Breathwork
transpersonal psychology.
Holotropic Breathwork is a technique, devel-
oped by Stanislav Grof and Christina Grof, in
Maslow’s Hierarchy of Needs
which participants use a special breathing tech-
nique along with an evocative setting to experi- Maslow’s hierarchy of needs is a theory of
ence states of consciousness to enhance both human motivation whereby people have an inher-
personal and transpersonal integration and devel- ent desire to meet a sequence of needs, beginning
opment. Typically, the breather begins by lying with basic biological needs, proceeding to a need
down in a reduced-light room filled with evoca- for personal integration, and sometimes advancing
tive music and begins the breathing technique. to a need for transcendent spirituality.
Meanwhile, a sitter sits by the breather’s side to
attend to any needs the breather might experi-
Psychosynthesis
ence. The technique is intended to alter the per-
son’s state of consciousness such that material Developed originally by the Italian psychiatrist
from the breather’s unconscious mind emerges Roberto Assagioli, this approach is based on a
into awareness. Over the course of the process, theory of the human psyche that includes both a
which usually lasts a couple of hours, breathers lower and a higher unconscious and both a per-
have reported experiences ranging from actual or sonal self and a transpersonal Self. It addresses

1014 Transthoeretical Model
people’s potential to integrate and develop in both across leading theories of counseling and psycho-
the personal domain, for effective and authentic therapy, hence the name transtheoretical. Using
functioning in the everyday world, and the evidence-based algorithms, counseling can be
transpersonal domain, including experiences of tailored to the needs of each individual with typi-
“higher” realities beyond the everyday world. cally just three sessions from 20 to 45 minutes in
length.
Janice Miner Holden
See also Analytical Psychology; Holotropic Breathwork;

Integral Psychotherapy; Jung, Carl Gustav; Maslow,
Historical Context
Abraham; Maslow’s Hierarchy of Needs; Psychedelic TTM was developed in the late 1970s by James O.
Therapy; Psychosynthesis Prochaska, director of the Cancer Prevention
Research Center at the University of Rhode Island,
Further Readings and Carlo C. DiClemente, currently professor of
clinical psychology at the University of Maryland,
Assagioli, R. (2007). Transpersonal development: The Baltimore County. At the time, the therapy field
dimension beyond psychosynthesis. Forres, Scotland: was fragmenting into more than 300 therapies,
Smiling Wisdom.
and there was a need for integration. Since then,
Assagioli, R. (2012). Psychosynthesis: A collection of
TTM has been researched in multiple studies and
basic writings. Amherst, MA: Synthesis Center.
has been shown to be effective in treating addic-
(Original work published 1965)
tive, affective, energy balance, aggressive, and
Cardena, E., Lynn, S. J., & Krippner, S. (Eds.). (2000).
Varieties of anomalous experience: Examining the
adherence behaviors. The TTM developers have
scientific evidence (pp. 151–182). Washington, DC:
received multiple awards for their interventions,
American Psychological Association. including the Innovators Award for Addiction
Friedman, H. L., & Hartelius, G. (Eds.). (2013). The from the Robert Wood Johnson Foundation and a
Wiley-Blackwell handbook of transpersonal Medal of Honor for Clinical Research from the
psychology. West Sussex, England: Wiley. American Cancer Society. Since its development,
Krishna, G. (1970). Kundalini: The evolutionary energy in TTM has been applied to a broad range of popula-
man. Boston, MA: Shambhala. tions and problems.
Maslow, A. H. (1971). The farther reaches of human
nature. New York, NY: Viking Press.
Scotton, B. W., Chinen, A. B., & Battista, J. R. (Eds.). Theoretical Underpinnings
(1996). Textbook of transpersonal psychiatry and
As an integrative therapy approach, TTM system-
psychology. New York, NY: Basic Books.
atically matches principles and processes of
Walsh, R. (1999). Essential spirituality: The 7 central
change to particular stages of change, to help cli-
practices to awaken heart and mind. New York, NY:
ents progress from one stage to the next. Research
Wiley.
Wilber, K. (1999). Integral psychology: Consciousness,
has shown that across 48 mental and physical
spirit, psychology, therapy. In K. Wilber (Ed.), The health–related behaviors the pros of changing
collected works of Ken Wilber (Vol. 4, pp. 423–718). increase from precontemplation to contemplation
Boston, MA: Shambhala. and the cons decrease from contemplation to
action. This decision-making process—weighing
the pros and cons of changing—typically is not
very conscious, empirical, or rational, and treat-
ment using the TTM model helps clients to be
TRANSTHOERETICAL MODEL more intentional and effective with their decision
making. The skill that is emphasized most is
The Transtheoretical Model (TTM) construes increasing competence in how to change or prog-
behavior change as a process that unfolds over ress at each stage of change by applying different
time and involves progress through a series of theoretical principles at different stages. The
stages. At each stage of change, TTM applies dif- dimension of TTM that underpins such integra-
ferent processes and principles of change from tion is the stages of change.

Transthoeretical Model 1015
Major Concepts overcome their problems. Action involves the most

overt behavioral changes and requires consider-
The core concepts of TTM are represented in the six
able commitment of time and effort. The action
stages of change—(1) precontemplation, (2) con-
stage lasts about 6 months, but many people
templation, (3) preparation, (4) action, (5) mainte-
believe the worst will be over in a few weeks or
nance, and (6) termination—which provide the
months. If they ease up on their efforts too soon,
major integrative dimension for the theory. These
they are likely to relapse quickly. Individuals are
stages illustrate how clients can move from unwill-
encouraged to think of action as the behavioral
ingness to change to elimination of the problem,
equivalent of life-saving surgery, where they would
with several stages in between.
have recovery as a top priority and would let oth-
ers know that they are not going to be at their best
Precontemplation and will need more support.
Precontemplation is the stage at which there is
no intention to change behavior in the foreseeable Maintenance
future. Many individuals in this stage are unaware
Maintenance is the stage in which people work
or underaware of their problems. Families, friends,
to prevent relapse and consolidate the gains attained
or employers, however, are often well aware that
during action. This stage extends from 6 months to
the precontemplators have problems. When pre-
about 5 years. The number one cause of relapse
contemplators present for psychotherapy, they
over the long-term is distress: periods of anxiety,
often do so because of pressure from others. They
depression, anger, and stress. People need to be pre-
can be very sensitive to pressures from a counselor
pared to cope with distress in healthy ways rather
to take immediate action, and they make up a high
than regress to their problem patterns.
percentage of patients who drop out of treatment
prematurely.
Termination
Contemplation Termination is the stage in which individuals
have total confidence that they will not return to
Contemplation is the stage in which people are
their problem behavior (self-efficacy) and have
aware that a problem exists and are seriously
zero temptation. These are demanding criteria, and
thinking about overcoming it but have not yet
for many people, change may mean remaining in
made a commitment to take action. They tend to
the maintenance stage for their lifetime.
weigh the pros and cons of changing as essentially
equal, which produces profound doubt and ambiv-
alence. People can remain stuck in the contempla- Techniques
tion stage for long periods. On discrete measures,
individuals who state that they are intending to The techniques of TTM include the following:
change their behavior in the next 6 months are (a) assess the stage of change, (b) design individual-
classified as contemplators. ized treatment, (c) assess the four effects, (d) inte-
grate across systems of psychotherapy, (e) prescribe
“relationships of choice” and “treatments of
Preparation choice,” (f) avoid mismatching stages and pro-
Preparation is the stage in which individuals are cesses, and (g) think complementarily.
intending to take action in the next month. They
assess the pros of changing as outweighing the Assess the Stage of Change
cons. Their number one concern is that when they
act they may fail. The first step in treatment is to assess the stage
of a client’s readiness to take action and to tailor
interventions accordingly. Therapists first inform
Action
clients that whichever stage of change they are in,
Action is the stage in which individuals modify the therapist can help them. This message allows
their behavior, experiences, and/or environment to clients to be open about their stage. Giving a brief

1016 Transthoeretical Model
description of each stage can help clients to quickly Effort Effects

understand the concept of stages of change, and
Individuals who make better efforts at each
the majority of clients are quite accurate in assess-
stage are more successful; thus, therapists need to
ing their current stage.
help clients do the right things (processes) at the
right time (stages).
Design Individualized Treatment
Therapists frequently design excellent action- Integrate Across Systems of Psychotherapy
oriented treatment and self-help programs, but Thirty years of research in behavioral medicine,
clients do not follow through on them because self-change, and psychotherapy converge in TTM
they are not in the action stage. Thus, it is critical and show that different processes of change are
that therapists understand the stage the client is in differentially effective in certain stages of change.
and develop treatments specific to that stage. In general, change processes traditionally associ-
Therapists approaching clients only with action- ated with the experiential, cognitive, and psycho-
oriented therapies are likely to underserve or mis- analytical perspectives are most useful during the
serve the majority of their potential clients. earlier precontemplation and contemplation stages.
Change processes traditionally associated with the
Assess the Four Effects existential and behavioral traditions, by contrast,
There are four effects assessed at the start of are most useful during the action and maintenance
treatment that have been found to be the best pre- stages. In TTM, particular change processes will be
dictors of long-term success and can be used to optimally applied by therapists at each stage of
help clients set smarter goals for progress. change for their clients. In other words, therapists
will select additional therapeutic techniques from
across different systems of psychotherapy that best
Stage Effects
match the stage of change of the client.
The first effect is the stage effect, which finds
that people who are in the preparation stage prior
Prescribe “Relationships of Choice”
to treatment are more successful than those in the
and “Treatments of Choice”
contemplation stage, who are more successful than
those in the precontemplation stage. Therefore, a Psychotherapists seek to tailor their interper-
goal to progress one stage can double the chance sonal stance to different clients. Paralleling the
of success and a goal of progressing a second stage notion of “treatments of choice” (matching treat-
can triple the chances of effective action being ments to stage), therapists must have “relation-
taken in the next few months. In this manner, cli- ships of choice,” in which they match interpersonal
ents can be more hopeful of having higher self- stances to stage. With precontemplators, the thera-
efficacy and achieving success in the future as pist’s role is like that of a nurturing parent joining
compared with taking immediate action that may with a resistant youngster who is both drawn to
not be successful. and repelled by the prospects of becoming more
independent. With contemplators, the therapist’s
Treatment Effects role is akin to that of a Socratic teacher who
encourages clients to develop their own insights
Individuals receiving treatment are more success-
into and ideas about their condition. With clients
ful than those who do not. Engaging patients in
who are in the preparation stage, the stance is lik-
therapy by matching their treatment to their stage
ened to that of an experienced coach who has been
can decrease dropping out and increase success.
through many crucial matches and can provide a
fine game plan or can review a client’s own action
Severity Effects
plan. With clients who are progressing into the
Individuals with less severe problems are more action and maintenance stages, the psychothera-
successful in achieving change. Helping clients take pist becomes a consultant who is available to pro-
small steps to reduce severity early in treatment vide expert advice and support when action is not
can predict greater long-term success. progressing as smoothly as expected.

Transthoeretical Model 1017
Avoid Mismatching Stages and Processes interactive online programs. Clients are encour-
aged to return to brief TTM therapy if they once
It is critical that the process of therapy match
again find themselves stuck in a stage.
the stage of therapy. For instance, action-oriented
Change is not a linear progression through the
therapies may be quite effective with individuals
stages; rather, most clients move through the stages
who are in the preparation or action stages. These
of change in a spiral pattern. People typically prog-
same programs may be ineffective or detrimental,
ress from contemplation, to preparation, to action,
however, with individuals in the precontemplation
to maintenance, but most individuals will relapse.
or contemplation stages. There are two frequent
During relapse, individuals regress to an earlier
mismatches. First, some therapists rely primarily
stage. Some relapsers feel like failures—
on change processes most indicated for the con-
embarrassed, ashamed, and guilty. These individu-
templation stage—consciousness-raising, self-
als become demoralized and resist thinking about
reevaluation—while the client is moving into the
behavior change. As a result, they may return to
action stage. They try to modify behaviors by mak-
the precontemplation stage and can remain there
ing the client more aware, a common criticism of
for various periods of time. Based on research,
classical psychoanalysis—that insight alone does
approximately 15% of relapsers regressed to the
not necessarily bring about behavior change.
precontemplation stage. However, most—roughly
Second, other therapists rely primarily on change
85%—move back to the contemplation stage and
processes most indicated for the action stage—
eventually into the preparation and action stages.
contingency management, stimulus control, coun-
Therapists usually let clients know that the only
terconditioning—without the requisite awareness,
major mistake they can make is to give up on their
decision making, and readiness to be achieved in
ability to change. A therapist thus tells clients that
the contemplation and preparation stages. They
the therapist will not give up on them and will be
try to modify behavior without creating aware-
there if the clients need help to recycle through the
ness, a common criticism of radical behaviorism—
stages.
that overt action without insight is likely to lead to
temporary change. James O. Prochaska
Think Complementarily See also Advanced Integrative Therapy; Behavior

Therapy; Common Factors in Therapy; Evidence-
Competing systems of psychotherapy are often Based Psychotherapy; Integrative Approaches:
viewed as promulgating rival processes of change. Overview; Motivational Interviewing
However, ostensibly contradictory processes can
become complementary when embedded in the
stages of change. Research has consistently docu- Further Readings
mented that ordinary people in their natural envi-
Blissmer, B., Prochaska, J. O., Velicer, W. F., Redding, C. A.,
ronments and psychotherapists in their consultation
Rossi, J. S., Greene, G. W, . . . Robbins, M. (2010).
rooms can be remarkably effective in synthesizing
Common factors predicting long-term changes in
powerful change processes across the stages of
multiple health behaviors. Journal of Health Psychology,
change, like decision making in the early stages and
15, 205–214. doi:10.1177/1359105309345555
contingency management in later stages.
Hall, K. L., & Rossi, J. S. (2008). Meta-analytic
examination of the strong and weak principles across
Therapeutic Process 48 health behaviors. Preventive Medicine, 46,
266–274. doi:10.1016/j.ypmed.2007.11.006
The therapeutic process involves progress through Norcross, J. C. (Ed.). (2011). Psychotherapy relationships
the stages of change, with different processes and that work (2nd ed.). New York, NY: Oxford
principles of change being applied at different University Press.
stages. Therapy can start the change process by Norcross, J. C., Krebs, P. M., & Prochaska, J. O. (2011).
helping individuals who are stuck in a particular Stages of change. Journal of Clinical Psychology, 67,
stage. Individuals can then be free to progress on 143–154. doi:10.1002/jclp.20758
their own with the use of stage-matched self-help Prochaska, J. O., DiClemente, C. C., & Norcross, J. C.
books and manuals and individualized and (1992). In search of how people change: Applications

1018 Trauma-Focused Cognitive-Behavioral Therapy
to addictive behaviors. American Psychologist, 47, of the child or adolescent by using a variety of
1102–1114. doi:10.1037//0003–066X.47.9.1102 techniques in a structured format.
Prochaska, J. O., & Norcross, J. C. (2013). Systems of
psychotherapy: A transtheoretical analysis (8th ed.).
Pacific Grove, CA: Brooks/Cole. Major Concepts
Prochaska, J. O., Norcross, J. C., & DiClemente, C. C. Major concepts in TF-CBT include a variety of
(1995). Changing for good. New York, NY: Avon. CBT tenets including acting-out behaviors, mood
Rosen, C. S. (2000). Is the sequencing of change processes disorders, maladaptive beliefs, and PTSD.
by stage consistent across health problems? A meta-
analysis. Health Psychology, 19, 593–604.
doi:10.1037/0278–6133.19.6.593 Acting-Out Behaviors
When a child or adolescent is exposed to a trau-
matic event, an unhealthy coping skill of behav-
ioral or emotional acting out occurs.
TRAUMA-FOCUSED COGNITIVE-
BEHAVIORAL THERAPY Mood Disorders
Mood disorders is a category of disorders that
Trauma-focused cognitive-behavioral therapy (TF-
involves a disturbance and marked difference in a
CBT) is a treatment approach focusing on reducing
person’s emotions and mood.
symptoms related to posttraumatic stress disorder
(PTSD) in children and adolescents. Used by thera-
pists when treating children and adolescents between Maladaptive Beliefs
the ages of 3 and 18 years who have symptoms of Maladaptive beliefs is the extreme altering of
depression, anxiety, or PTSD, it is typically a 12- to beliefs to include guilt, anger, powerlessness, and
16-session treatment approach that uses parents or fear in an effort to adapt to traumatic events.
guardians as a component of treatment. TF-CBT has
been shown to significantly reduce traumatic symp-
toms in children and adolescents. Posttraumatic Stress Disorder
PTSD is a disorder that occurs as a result of a
Historical Context traumatic event or stressor and can include intru-
sion symptoms, avoidance, negative changes in
TF-CBT was first developed in the late 1980s by cognitions and/or moods, and changes in arousal
Judy Cohen, Esther Deblinger, and Anthony and reactivity.
Mannarino as a treatment exclusively for children
and adolescents. TF-CBT is recommended for use
with children and adolescents between the ages of Techniques
3 and 18 years who have been exposed to a trau- In TF-CBT, techniques are used throughout the 12-
matic event or sexual abuse. Currently, TF-CBT is to 16-session model in a structured manner accord-
an evidence-based practice frequently used by a ing to the TF-CBT manual. Techniques are listed in
variety of clinicians. the format of the acronym PRACTICE and include
psychoeducation, parent management skills, relax-
Theoretical Underpinnings ation, affective modulation, coping skills, trauma
narrative, in vivo desensitization, conjoint parent–
TF-CBT is an adapted treatment model using child/adolescent sessions, and enhancement of safety.
cognitive-behavioral therapy, family therapy, and
psychodynamic, empowerment, and attachment
Psychoeducation
approaches in a manualized treatment format.
When a traumatic event occurs, the client devel- In this component of treatment, in conjunction
ops behavioral and/or emotional problems with their parents or guardians, the child or ado-
related to the event, and the emphasis of treat- lescent is educated on typical emotional and
ment is on addressing the biopsychosocial needs behavioral reactions to a traumatic event.

Trauma-Focused Cognitive-Behavioral Therapy 1019
Parent Management Skills Conjoint Parent–Child/Adolescent Sessions

This is a psychoeducational component that is In these joint sessions, the therapist uses tech-
focused on helping parents deal with their reac- niques to enhance communication strategies between
tion, management, and coping with regard to their parents and children during discussion of the trauma.
child’s or adolescent’s reaction to a traumatic
event. In addition, it teaches TF-CBT goals and
theory. Enhancement of Safety
Enhancement of safety refers to the psychoeduca-
Relaxation tional aspect of sessions in which the therapist works
with the client on topics such as interpersonal rela-
Through relaxation techniques, therapists tionships, safety, and working with future stressors.
train the child or adolescent in visual imagery,
how to refocus breathing, and progressive muscle
relaxation. Therapeutic Process
During the 12 to 16 sessions of TF-CBT, the thera-
Affective Modulation pist works with the client and his or her parents or
guardian using the PRACTICE model. Throughout
Along with the parents, the therapist helps the
the sessions, the therapist works with the child or
client manage emotional reactions and aids in the
adolescent to correct maladaptive beliefs and reduce
identification of emotions.
negative emotional and behavioral responses to the
traumatic experiences. At the same time, the thera-
Cognitive Coping Skills pists offer psychoeducation to the parents or guard-
Cognitive coping skills refer to a therapeutic ians so that they can cope with their own emotional
technique whereby the client is encouraged to reactions and respond appropriately to the child or
connect thoughts, feelings, and behaviors to the adolescent.
traumatic event after the client has read his or Heather D. Dahl
her trauma narrative in session. The therapist
may suggest reading through the trauma narra- See also Cognitive Processing Therapy; Cognitive-
tive and then discussing with the client whether Behavioral Therapy; Eye Movement Desensitization and
or not a specific thought that was expressed Reprocessing Therapy; Prolonged Exposure Therapy
in the narrative was accurate or helpful to
treatment.
Further Readings
Trauma Narrative Cohen, J. A., Deblinger, E., Mannarino, A. P., & Steer, R. A.
(2004). A multisite, randomized controlled trial for
The trauma narrative is when the client is asked children with sexual abuse-related PTSD symptoms.
to provide, by writing, drawing, or discussing, a Journal of the American Academy of Child &
detailed statement of the traumatic event and how Adolescent Psychiatry, 43, 393–402.
it has changed the client’s worldview. doi:10.1097/00004583-200404000-00005
Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2006).
In Vivo Desensitization Treating trauma and traumatic grief in children &
adolescents. New York, NY: Guilford Press.
The child or adolescent is reminded of certain Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2012).
traumatic experiences, and the therapist works Trauma-focused CBT for children and adolescents:
with him or her to control the emotional reac- Treatment applications. New York, NY: Guilford Press.
tion by gradually exposing the child or adoles- Deblinger, E., & Heflin, A. H. (1996). Treating sexually
cent to specific triggers related to his or her abused children and their nonoffending parents: A
trauma. cognitive behavioral approach. Thousand Oaks, CA: Sage.

U
psychotherapy, which Henriques argues consists of
UNIFIED THEORY three major components. The first is the quality of
the therapeutic relationship, which refers to the
Developed by Gregg Henriques, the unified theory extent to which the client experiences the therapist
offers a way to theoretically unify the major as competent, ethical, and kind, and results in
approaches to the field of psychotherapy (e.g., therapeutic flow, that is, the sense that there is a
modern psychodynamic, humanistic, and cognitive- useful, meaningful exchange during the work. The
behavioral) into a coherent whole. It achieves this second major component of psychotherapy is the
synthesis by applying a set of ideas that, Henriques formulation or conceptualization, which refers to
argues, defines the science of human psychology the shared narrative of the nature of a client’s
and integrates it to the art and practice of psycho- problems and the goals of the therapy. This
therapy. Central to this approach to psychotherapy involves the therapist understanding the client’s
is adaptive living—that is, when an individual valued states of being and the nature of the dis-
maximizes valued states of being, given his or her tress, and an analysis of the systems of adaptation
capacities, needs, and situation. Related to adaptive in the current and historical context. The final
living, much of personality can be described in component refers to the interventions and tasks
terms of systems of character adaptation, which are that are designed to foster achieving the goals,
the unique and specific ways in which individuals which should be assessed and used to determine
adjust and respond to situations in their lives. the future course of action.
According to Henriques’s unified theory, there
are five systems of character adaptation: (1) the
Historical Context
habit system, (2) the experiential system, (3) the
relationship system, (4) the defensive system, and As psychotherapy began to gain significant trac-
(5) the justification system. The major systems of tion in the 1950s and 1960s, it was initially
psychotherapy correspond with these systems of dominated by “single”-school approaches, such as
adaptation. Specifically, the behavioral tradition psychoanalytic, behavioral, or humanistic. Each
corresponds to the habit system, the experiential school held different views of human nature, had
and emotion-focused traditions correspond to the different philosophies of science, were grounded
experiential system, the psychodynamic tradition in the science of psychology in different and often
corresponds to the relational and defensive sys- contradictory ways, and were largely based on
tems, and the justification system corresponds to what the respective theorists felt were the most
the cognitive and existential traditions. effective ways to achieve change. Students were
The five systems of character adaptation set educated in the context of each school, and the
the stage for organizing the unified approach to general consensus was that each approach was a
1021

1022 Unified Theory
separate, distinct paradigm and that practitioners Behavioral Investment Theory

must adopt only one approach.
BIT is the joint point between Life and Mind
Over the past 25 years, interest in and accep-
and provides the framework for understanding
tance of eclectic and integrative approaches to
mental behavior. BIT merges B. F. Skinner’s con-
psychotherapy have grown such that currently
cept of behavioral selection with cognitive neuro-
most mental health practitioners describe their ori-
science. The basic idea of BIT is that the nervous
entation as eclectic or integrative. The unified the-
system has evolved as a value system that com-
ory was born out of the psychotherapy integration
putes increasingly complex and flexible behaviors.
movement but represents a new phase of unification
BIT consists of six fundamental principles that are
instead of integration. Henriques developed the
generally well-known in animal behavioral science
unified theory to offer researchers, theorists, and
but are often not effectively communicated to psy-
practitioners a way to coherently assimilate and
chologists: (1) energy economics, (2) evolution,
integrate previously disparate lines of thought into
(3) behavioral genetics, (4) computational control,
a comprehensive, holistic picture of the discipline
(5) learning, and (6) development. With regard to
and its relation to other fields, thus setting the
the five systems of character adaptation, BIT
stage for a general, unified approach to psycho-
explicitly grounds the habit system in that it incor-
therapy.
porates the foundational structure of the nervous
system and how it habituates and sensitizes to new
Theoretical Underpinnings stimuli. It also provides a foundational framework
for understanding the experiential system, which is
There are several key theoretical ideas that are organized by positive and negative emotional
combined in unified theory, which also form the states that orient an individual to approach bene-
basis of the major concepts used by therapists. fits and avoid costs.
These theoretical concepts include the tree of
knowledge (ToK) system, behavioral investment
theory (BIT), the influence matrix (IM), and the The Influence Matrix
justification hypothesis (JH).
The IM is an extension of BIT to human social
motivational and emotional processes. The IM
The ToK System
maps the architecture underlying the way humans
Historically, there has been no overarching process social information, develop social goals,
metatheory of psychology that considers evolution- and are guided by emotions in navigating the social
ary perspectives and links among various dimen- environment. It corresponds to the relationship
sions of nature. To fill this gap, the unified theory system of character adaptation. The first founda-
offers the ToK system, which depicts the evolution tional assumption of the IM is that humans are
of complexity as consisting of four dimensions motivated toward the experience of relational
(Matter, Life, Mind, and Culture), which corre- value, which is the extent to which they feel known
spond to the behavior of four classes of objects and valued by others. From an evolutionary per-
(material objects, organisms, animals, and humans), spective, relational value is key because it is an
and four classes of science (physical, biological, evolved indicator of social influence; thus, it serves
psychological, and social). Each dimension on the as a barometer of the degree to which others will
ToK system is linked at a “joint point.” For exam- act in accordance with an individual’s interests.
ple, the modern evolutionary synthesis, the merger Relational value as a signal of social influence
of Darwin’s natural selection with genetics, is the reflects a basic, primary need and desire. It is, of
Matter-to-Life joint point. If this is valid, it suggests course, not the only foundational motivation
that there should be a joint point between Life and humans have, but it is theorized to be a central one.
Mind and between Mind and Culture. Indeed, two The second key aspect of the IM is that there
of the other three pieces of the unified theory, BIT are three conceptually distinct dimensions under-
(Life to Mind) and the JH (Mind to Culture), fill in lying the computation of high social influence in
these gaps and are bridged by the IM. adults: (1) power (dominance–submission),

Unified Theory 1023
(2) love (affiliation–hostility), and (3) freedom about what is morally right and wrong and make
(autonomy–dependence). According to the IM, claims about how individuals should organize
higher levels of relational value and social influ- their personal and public lives accordingly.
ence are associated with higher levels of power and The JH, in combination with BIT, gives rise to a
affiliation and a healthy balance between auton- tripartite model of human consciousness: (1) the
omy and dependency. In contrast, lower levels of experiential self, (2) the private self-consciousness
social influence are associated with hostile and system, and (3) the public self. The experiential self
submissive orientations and relative extremes of refers to the sentient aspects of consciousness,
independence or dependence. The IM is central to which include raw sensations (e.g., seeing the color
understanding the unified theory because motives brown), perceptions that relate to goals and gener-
for social influence play a crucial role in how ate emotions (e.g., seeing a bear), and images and
humans construct reasons for their behavior, simulated actions (e.g., planning to escape). The
which is the focus of the fourth and final piece of other two domains of human consciousness repre-
the unified theory. sent the two separable domains of justification:
(1) the private and (2) the public. The private self
is the center of self-reflective awareness in adults
The Justification Hypothesis
and is made up of the internal dialogue that
The JH is the Mind-to-Culture joint point on weaves a narrative of what is happening and why.
the ToK system, and it corresponds to the defensive It is a second-order awareness system, one that is
and justification character adaptation systems. The influenced by, translates, and feeds back to the
JH provides a framework for understanding the experiential system. The public self is a mixture of
nature of human self-consciousness and the evolu- how individuals want to be seen and how they
tion of human culture. The JH interprets both imagine they are seen by others (although both
human self-consciousness and culture as justifica- may be quite different from how an individual’s
tion systems. Justification systems refer to the image is actually received by others).
ways in which humans use language to legitimize The relationship between the domains of con-
their thoughts, beliefs, and actions and make sense sciousness is regulated by two filters: (1) the
of their own reality. Freudian filter and (2) the Rogerian filter. The
The JH consists of three postulates. The first is Freudian filter exists between the experiential self
that the evolution of language created a new and and the private self and refers to the process by
unique adaptive problem for our hominid ances- which unjustifiable or painful images and impulses
tors, namely, the problem of social justification, are sometimes filtered out and/or reinterpreted to
which refers to the fact that humans became the be consistent with the individual’s conscious justi-
first animal species in evolutionary history that fication system. It is called the Freudian filter
had to justify why they did what they did. Because because the dynamic relationship between self-
humans have always been social creatures, there is conscious thoughts and subconscious feelings is a
reason to believe that social justification was an central focus in both classical psychoanalysis and
essential problem in our ancestral past. The second modern psychodynamic theory. The filtering that
postulate of the JH is the claim that the human takes place between the private and the public
self-consciousness system functions as a justifica- selves is called the Rogerian filter because, in rela-
tion system that filters out problematic images and tionship to early psychoanalytic thinking, Carl
feelings and constructs narratives for why an indi- Rogers shifted the focus to conscious experiences
vidual does what he or she does that take into and here-and-now interpersonal processes. He also
account the individual’s social context and relative emphasized that the root of much psychopathol-
degree of social influence. The third postulate is ogy was found in how others can stunt the devel-
that the JH provides the basic framework for opment of an individual’s real or true self. According
understanding and analyzing cultures. On a cul- to Rogers, individuals, fearing the judgment of
tural level, justification systems provide the rules others, filter out their true desires and put on a
and patterns for acceptable behaviors. Such cul- mask—a social self—often to appease (and some-
tural justification systems offer beliefs and values times to deceive) others.

1024 Unified Theory
Major Concepts Therapeutic Process

The major concepts of the unified theory are inti- The unified theory views the therapeutic process as
mately linked to the theoretical underpinnings a developmental process whereby individuals enter
described above. These concepts are best under- therapy with a vague understanding that they want
stood within the context of the theory and include things to be different but are often not sure what
the ToK system, BIT, the IM, and the JH, which they need to do or how to go about changing.
have been already defined. Therapy thus fosters individuals moving from con-
templating what and how they might change into
more active change, which if successful results in
Techniques attempting to maintain those changes. Therapy is
The unified theory does not come with a pre- not expected to be a clear linear process. Unified
scribed set of techniques or procedures; rather, it theory emphasizes the three key process variables
emphasizes the establishment of a strong healing of awareness, acceptance, and active change; the
relationship between the therapist and the client work of therapy can be understood as moving
within psychotherapy. This process may have toward valued states of being via (1) becoming
many unique elements, depending on the situation, aware (i.e., of one’s capacities, conflicts, needs, his-
the presenting problem, the policy and social con- tory, and situation), (2) accepting elements of being
text, and the personalities of the individuals that cannot be controlled, and (3) actively learning
involved. The art of psychotherapy is found in new skills and ways of behaving that foster change.
recognizing these idiographic factors and in creat-
Gregg R. Henriques
ing a relationship with good therapeutic flow.
The unified theory offers therapists, clients, and See also Assimilative Psychotherapy Integration;
researchers a road map to developing effective Common Factors in Therapy; Integral Psychotherapy;
interventions that incorporate personality, psycho- Transtheoretical Model; Unified Therapy
pathology, relationship processes, and other con-
textual variables like biological, developmental,
Further Readings
and cultural dimensions. This map is called the
unified approach to conceptualizing and is depicted Henriques, G. R. (2003). The tree of knowledge system
in Figure 1. and the theoretical unification of psychology. Review
Sociocultural Context
Macro,
Meso,
{
Micro
Language based beliefs and values; Public to Private Filtering;
Justification System
Attributions; Identity and Self Concept; Existential Meaning Making
Defensive System { Defense Mechanisms; Dissonance Reduction; Filtering

between Experiential and Justification Systems
{ Current and
Learning &
Future
{
Developmental Context
Early Attachments; Power, Love, Dependency and Freedom;
Relational System Agentic or Communal Orientations; Internal Working Models Environmental
Distal Proximal
Stressors and
{ Perceptual, Motivational and Affective Experiences (P-M=>E);

Affordances
Experiential System Layering of emotions; Overregulated or Underregulated; Images
Physiology
Habit System { Daily routines; Subconscious action patterns; Associative

Conditioning; Patterns of eating, sleeping, exercise, substance use
Genetic
Biological Context
Figure 1 The Unified Approach to Conceptualizing

Source: © Gregg Henriques.

Unified Therapy 1025
of General Psychology, 7, 150–182. doi:10.1037/1089- are often problematic because mental processes are
2680.7.2.150 often not observable. According to the unified
Henriques, G. R. (2004). Psychology defined. Journal of therapy model, each theory is multifactorial, so all
Clinical Psychology, 60, 1207–1221. doi:10.1002/ schools have some ideas that are valid while also
jclp.20061 containing incomplete or inaccurate ideas.
Henriques, G. R. (2005). Toward a useful mass movement. In response to this complexity, the psychiatrist
Journal of Clinical Psychology, 61, 121–139. doi:10.1002 David Allen developed unified therapy in the early
/jclp.20094 1980s in an attempt to provide a more powerful,
Henriques, G. R. (2007). Integrating treatments for
overarching model (metamodel) and treatment
suicidal patients into an effective package. Pragmatic
that integrate conflicting ideas from all of the
Case Studies in Psychotherapy, 3, 50–60. doi:http://
major schools, including social psychology, for
dx.doi.org/10.14713/pcsp.v3i2.900
both individual psychology and behavior change.
Henriques, G. R. (2008). The problem of psychology and
the integration of human knowledge: Contrasting
Allen is a member of the Society for the Exploration
Wilson’s consilience with the tree of knowledge system.
of Psychotherapy Integration (SEPI), which was
Theory and Psychology, 18, 731–755. doi:10.1177 formed in the early 1980s by like-minded practi-
/0959354308097255 tioners from different schools looking for common
Henriques, G. R. (2011). A new unified theory of ground. However, the founders of SEPI did not
psychology. New York, NY: Springer. want to create a metamodel for fear that this
Henriques, G. R. (2013). Evolving from methodological would become just one more school, but Allen and
to conceptual unification. Review of General others disagreed.
Psychology, 17, 168–173. doi:10.1037/a0032929 Psychotherapy schools that focus on group pro-
Henriques, G. R., & Cobb, H. C. (2004). Introduction to the cesses, such as family systems theory, were under-
special issues on the unified theory. Journal of Clinical represented within SEPI, and Allen wished to
Psychology, 60, 1203–1205. doi:10.1002/jclp.20060 address social-psychological issues as well as indi-
Henriques, G. R., & Sternberg, R. J. (2004). Unified vidual psychology. After leaving private practice,
professional psychology: Implications for combined- Allen continued to develop and research the uni-
integrated doctoral training programs. Journal of Clinical fied therapy model at the University of Tennessee
Psychology, 60, 1051–1063. doi:10.1002/jclp.20034 College of Medicine.
Henriques, G. R., & Stout, J. (2012). A unified approach
to conceptualizing people in psychotherapy. Journal of
Unified Psychotherapy and Clinical Science, 1, 37–60. Theoretical Underpinnings
Unified therapy theory proposes that the psycho-
logical problems it targets are caused by psycho-
logical conflicts that are created, triggered, and
UNIFIED THERAPY reinforced, at unpredictable times, by repetitive
interactions with members of the patient’s family
Unified therapy is a model for individual psycho- of origin that are characterized by conflict, misbe-
therapy for personality disorders, repetitive havior, abuse, and/or neglect. Dysfunctional inter-
self-destructive behavior patterns, and chronic actions, in turn, result from obsolete rules that
depression and anxiety. It combines ideas from define family roles and behavior within a sociocul-
most major psychotherapy schools. In particular, tural context.
it attempts to alter patients’ repetitive dysfunc- The treatment is derived from Murray Bowen’s
tional family-of-origin interactions that trigger therapy. He believed that the behaviors of family-
and perpetuate problematic behavior. of-origin members are the most powerful influ-
ences on individual behavior and that interactions
within this group must change if patients are to
Historical Context
make significant changes in their own behavior.
Human psychology is so complicated that there Unified therapy uncovers and explains to the
are hundreds of competing schools of thought patient the nature and causes of problematic family
about psychological processes and behavior interactions that create the patient’s own problem-
change. Empirical studies of psychological theories atic behavior.

1026 Unified Therapy
The following paragraphs detail the theoretical irrational thoughts. To play this role effectively,
ideas, borrowed from multiple psychological individuals must believe that they really are the
schools of thought, used in unified therapy, which character being played (Allen calls this the actor’s
also form the basis of major concepts within this paradox). However, their real selves never disap-
psychotherapeutic approach. pear. This leads role behavior to become more
According to unified therapy, dysfunctional compulsive and rigid (a phenomenon known as
family rules develop due to cultural evolution: reaction formation), played habitually and with-
Rules that define the roles and obligations of vari- out thought.
ous individuals in the family within a cultural When family members are not ambivalent
group change over time. Such changes force upon about their own roles, they support one another by
groups a continuous need for restructuring. mirroring or validating one anothers’ thoughts and
Women, for example, were suddenly able to enter behaviors. Mirroring helps people feel “at home”
the workforce when family survival required two in the world. Without it, they experience terror and
incomes. Some families remain stuck with old, panic (i.e., existential groundlessness). However,
obsolete rules (known as cultural lag). In general, when a family member’s self-actualizing tendencies
culture has evolved in ways that require more flex- lead to a significant threat to family homeostasis,
ible and individualized, less rule-driven behavior family members refuse to mirror such behavior.
by individuals. It allows people to follow their own They begin to undermine or invalidate that family
idiosyncratic desires (i.e., self-actualization). member.
Self-actualization is somewhat enticing for One major threat to homeostasis is parental
everyone. However, cultural lag may create a role function ambivalence: Older family members
battle within individuals between idiosyncratic experience the siren song of individualism and
desires and the need to follow the old, predict- therefore appear to need help from other family
able rules (often termed family homeostasis). members to maintain their old but now obsolete
Ambivalence about the old rules may cause fam- roles. The others are induced to find ways to pro-
ily members to give off double messages to one vide this help (also called role function support or
another about what behavior they expect from enabling).
the others, and individuals must then devise ways To provide this support, family members develop
to respond to these conflicting signals. This often a role of their own. They may act out the parents’
leads to self-destructive behavior in the individu- repressed urges or act to balance a parent’s guilt
als involved. and anger. Such roles are also played ambivalently
To understand how and why this happens, uni- and at great cost to the individual, creating a situ-
fied therapy employs dialectical thinking to explain ation in which the younger family members also
how people react to one another under these cir- give off mixed messages. All the family members
cumstances. Dialectics posits that individuals then experience discomfort because their attempts
within a system interact continuously and simulta- to support one another seem to be rejected. Self-
neously influence and change one another. sacrifice actually backfires and harms the others
Individuals form schemata (i.e., mental images of (Allen calls this the altruistic paradox) by prevent-
self, others, and relationships), which are continuing resolution of their internal conflicts. Mutual
ously updated throughout their lifetime. When discomfort drives family members away from one
family members give off mixed messages about another, which is often called distancing.
what they expect, the others must guess what they When individuals playing a role marry, they will
really expect and need. pick someone who helps them play it. They need
When people sacrifice self-actualization such support because of their ambivalence. They
because their families seem to require it, they may like to give up the role, but if they did, they
may develop a false self or persona—a role that would suffer two negative consequences: (1) a cri-
is played to maintain family equilibrium. To play sis for the family of origin and (2) an existential
it, they must often deny or denigrate their natural crisis for themselves. Simultaneously, they will
inclinations (a concept known as mortification), provide support for any such role their spouses are
accomplished through defense mechanisms and playing (also called mutual role function support

Unified Therapy 1027
or the marital quid pro quo). Each spouse knows Wilhelm Friedrich Hegel; separation-individuation,
what behavior the other seems to expect, but not intrapsychic conflict, and reaction formation from
why. Asking about it usually leads to denial, so psychoanalysis; cultural evolution from Erich
they instead make a guess, which is usually at least Fromm; persona from Carl Jung; mirroring from
partially inaccurate, such as “He needs to abuse me Heinz Kohut; groundlessness from existentialism;
so he can have an outlet for his repressed hostility family homeostasis and marital quid pro quo from
toward his mother.” family systems theory; metacommunication and the
All such problems in both marital couples and game without end from Paul Watzlawick; invalida-
family of origin can be solved if family members tion from Marsha Linehan; differentiation of self
calmly discuss the reasons for their roles and the from Bowen; mental schemas from Jean Piaget;
ambivalence such roles create. Such communica- mortification through irrational thoughts from
tion is termed metacommunication—that is, the Albert Ellis and Aaron T. Beck; the altruistic para-
honest discussion by family members of how they dox from Ayn Rand; kin selection from evolution-
are interpreting one another’s behavior. They will ary biology; and postindividuation depression from
then understand and validate one another for James Masterson.
devising alternative strategies for solving the origi-
nal threat to homeostasis.
However, such conversations are rarely held in Techniques
dysfunctional families for two reasons. First, a pro- There are several key techniques, detailed in the
tection racket, or unspoken family conspiracy to following subsections, that are used by unified
protect members from hurt, develops because therapists, and they include undermining transfer-
metacommunication often seems to threaten the ence, the Adlerian question, usage of genograms,
mental stability of the other family members. Also, role-playing, general instructions for metacommu-
if an attempt at metacommunication sounds like a nication, and termination techniques.
criticism, the others usually react with defensive-
ness, denial, and invalidation of the metacommu-
nicator. Undermining Transference
Second, if changes are made, a game without Patients tend to act out their false selves with the
end develops. Individuals tend to be suspicious therapist (termed transference), thereby interfering
when others suddenly ask for major changes. New with the process of therapy. Transference is under-
behaviors are therefore performed in ways that mined when the therapist assumes that the patient
invite criticism. If criticism is forthcoming, the has a good reason for apparently dysfunctional
individuals who requested the change seem to be behavior and is empathic with the patient’s need to
insincere, so their request for change is ignored. engage in it, rather than invalidating it. Unified
Unified therapy is designed to help the patient therapy has developed several strategies that coun-
push forward with metacommunication so that ter the patient’s attempts to engage the therapist in
family members may learn to validate more indi- nonproductive transference battles. The therapist
viduated behavior from one another and to address also avoids lecturing or the use of interpretations
threats to family homeostasis. Once a person’s true that paint the patient as immature or stupid.
self is no longer invalidated by his or her family,
old roles become obsolete, and the person becomes
The Adlerian Question
free to give up the old roles.
The Adlerian question—“What would be the
downside of (solving whatever problem the patient
Major Concepts
has), or who might be affected negatively?”—is
The major concepts of unified therapy theory are all used to uncover the negative consequences that
borrowed and modified from other schools of would ensue within a patient’s family if the patient
thought and have been explained in context within were to give up a dysfunctional role. The therapist
the “Theoretical Underpinnings” section. Specifically, then gets blow-by-blow descriptions of repetitive
the major concepts include dialectics from Georg problematic family-of-origin interactions and

1028 Unified Therapy
connects them to worsening of the patient’s symp- Therapeutic Process

toms or problems.
Unified therapy is a long-term therapy, often last-
ing 1 to 3 years. Sessions are for 45 minutes and
Developing a Genogram are held once every 2 weeks. The therapist follows
The reasons for troublesome parental behaviors a specific series of steps:
are discovered and explained by the patient through
the generation of a genogram with the help of the 1. Employing transference-reducing techniques and
unified therapist. Genograms are maps that explore empathy to gain the patient’s trust and obtain
the historical forces and individual experiences of accurate information.
family members over at least three generations. 2. Framing the patient’s chief complaint and
This allows patients to learn to be more empathic current difficulties as responses to family-of-
with them without condoning their misbehavior. origin issues.
This in turn allows patients to better learn and
3. Gathering detailed information and identifying
employ skills that prevent formidable, defensive,
interpersonal relationship patterns that trigger
angry, or withdrawing responses from other family
the patient’s self-destructive behavior.
members when they attempt to metacommunicate.
4. Gathering information about the patient’s
genogram to understand troublesome parental
Role-Playing
behavior patterns.
Role-playing is used in treatment for shaping
5. Developing and sharing with the patient a
strategies for the patient to use to metacommuni-
hypothesis about both the patient’s current role
cate with family members. First, the patient plays
in the family and why the family seems to
the target to show the therapist what the patient is
require this role.
up against, and the therapist tries out different
strategies to see what may work. The patient and 6. Designing a metacommunicative strategy using
the therapist then trade places: The patient prac- role-playing.
tices agreed-on strategies, with the therapist con- 7. Encouraging the patient to implement the
fronting the patient with worst-case scenarios strategy and then obtaining feedback about its
consistent with the target’s prior behavior. effectiveness.
8. Following this strategy in the same manner to
General Instructions for Metacommunication help the patient confront each major issue with
For metacommunication to be effective, the each important family member.
patient must be alone with each primary caretaker 9. Discussing termination issues.
to try out the practiced strategy; a time and place
for this is set in session. The patient is given David Allen
instructions by the therapist on how to retreat if
the conversation does not go well. The patient is See also Beck, Aaron; Bowen, Murray; Ellis, Albert;
Integrative Approaches: Overview; Interpersonal
told to bring back a detailed description of each
Theory; Linehan, Marsha; Schema Therapy; Unified
conversation for further strategy planning.
Theory
Termination Techniques Further Readings

The therapist describes the sense of groundless- Allen, D. M. (1988). A family systems approach to
ness that usually comes when someone starts to individual psychotherapy. Northvale, NJ: Jason
give up a role that had previously guided his or her Aronson. (Originally titled Unifying individual and
life so that the patient is prepared for it. The family therapies)
patient is encouraged to experiment with different Allen, D. M. (1991). Deciphering motivation in
lifestyle changes. The therapist describes the game psychotherapy. New York, NY: Plenum Press.
without end and what to do about relapses into Allen, D. M. (1993). Unified therapy. In G. Stricker &
old family interactions. J. Gold (Eds.), Comprehensive handbook of

Unifying Nonlinear Dynamical Biopsychosocial Systems Approach 1029
psychotherapy integration (pp. 125–137). New York, achieved prominence in the mid-20th century,
NY: Plenum Press. when Ludwig von Bertalanffy articulated his gen-
Allen, D. M. (2003). Psychotherapy with borderline eral systems theory, applied chiefly to biology, in
patients: An integrated approach. Mahwah, NJ: an attempt to understand the universal principles
Lawrence Erlbaum. by which complex systems operate. Since then,
Allen, D. M., Abramson, H., Whitson, S., Al-Taher, M., systems theory, often characterized as a metathe-
Morgan, S., Veneracion-Yumul, A., . . . Mason, M. ory given its usage across theories and disciplines,
(2005). Perceptions of contradictory communication has fostered the development of various approaches
from parental figures by adults with borderline
to systemic thinking, including cybernetics, chaos
personality disorder: A preliminary study.
theory, nonlinear dynamical theory, and complex
Comprehensive Psychiatry, 46(5), 340–352.
adaptive systems. These various approaches have
doi:10.1016/j.comppsych.2005.01.003
been applied effectively throughout the physical,
Allen, D. M., & Whitson, S. (2004). Avoiding patient
distortions in psychotherapy with patients with
life, and social sciences. Systems theory has also
borderline personality disorder. Journal of
been instrumental in the development of therapy
Contemporary Psychotherapy, 34(3), 211–229. approaches such as family therapy.
doi:10.1023/b:JOCP.0000036631.41400.57 In the 1970s, George Engel developed the bio-
psychosocial model as a comprehensive alternative
to the standard medical model for treating indi-
viduals with mental and physical health problems.
UNIFYING NONLINEAR DYNAMICAL In this model, Engel combined multilevel biologi-
cal, psychological, and sociocultural influences and
BIOPSYCHOSOCIAL SYSTEMS created a unified view of the complexity of human
APPROACH personality. The interpersonal tradition, rooted in
Harry Stack Sullivan’s interpersonal theory of psy-
The unifying nonlinear dynamical biopsychosocial chiatry, stresses the importance of covert and overt
systems (NDBPSS) approach provides a multipara- processes in relation to self (agency) and others
digm framework to guide therapeutic intervention. (communion). The interpersonal tradition views
NDBPSS emphasizes a holistic perspective on agency and communion as essential features of
understanding human functioning and experience human development, personality, mental health,
by encompassing many major domain systems that psychopathology, and psychotherapy.
interdependently constitute and influence life span Another model influencing NDBPSS is psycho-
development, personality, psychological health, therapy integration, which dates from the 1930s but
and psychopathology. NDBPSS psychotherapy emerged in the 1980s as a fully developed move-
merges multiple influences, such as systems theory, ment with a profound impact on the field of psy-
the biopsychosocial model, the interpersonal tradi- chotherapy. Psychotherapy integration identifies
tion, and psychotherapy integration. NDBPSS also and incorporates into the treatment process key
draws on scientific interest in understanding the common therapeutic factors that operate across
interrelationships among clusters of domains mak- approaches and integrates principles, concepts, and
ing up human structures and processes, evidence- techniques from various independent theories to
based practice in psychology, and solution-focused create an effective, comprehensive, and versatile
strengths-based perspectives. NDBPSS synthesizes approach to psychotherapy. The development of the
these diverse influences to promote individualized integration movement has provided key ontological
treatment (based on a client’s personality, identified and epistemological foundations for NDBPSS by
problems, strengths, and psychotherapy needs) of a promoting plurality in the field of psychotherapy.
wide spectrum of disordered biopsychosocial states. NDBPSS psychotherapy is also built on psycho-
logical approaches that incorporate a holistic
understanding of the interrelationships of human
Historical Context
structures, processes, and functioning, rather than
NDBPSS is rooted in several theoretical models, on the reductive views of health prevalent in the
each with their own historical context. One such traditional medical model. Allan Schore’s interdis-
foundational model is systems theory, which first ciplinary work linking findings from the study of

1030 Unifying Nonlinear Dynamical Biopsychosocial Systems Approach
neuroscience, human development, interpersonal other problematic symptoms. In NDBPSS, thera-

attachment, affect regulation, and the self pro- pists aim to help the client initiate or resume effec-
vides an illustration from clinical science, and tive movement toward agentic and communal
John Cacioppo and colleagues’ approach to under- goals, which infuse a person’s life with greater
standing complex behavior and the mind through meaning, purpose, and positive affective states.
investigating interconnections among the biologi- Improvement is achieved when the client becomes
cal, cognitive, and social domains provides a “unstuck” from maladaptive self-regulatory pro-
basic-science illustration. In addition to reflecting cesses, ameliorates negative affective states and
the holistic approaches to understanding, NDBPSS symptoms, and develops healthier covert and overt
incorporates the importance evidence-based prac- self-regulatory processes.
tice in psychology places on flexibly tailoring
treatment to the specific client at hand. An integral
component of individually tailored treatment Major Concepts
involves taking into account the client’s strengths,
Major concepts in NDBPSS include holism, the bio-
a major focus of both positive psychology and
psychosocial model, dynamical systems, nonlinear-
solution-focused strengths-based psychotherapy.
ity, teleology, agency and communion, regulatory
processes, strengths and resources, and dialectical
thinking.
While the range of goals and desired states that
Holism
humans are motivated to strive for is large, the
NDBPSS approach proposes that throughout the Holism means that a complex system is com-
human life cycle, a person’s most essential motiva- posed of a variety of heterogeneous elements or
tions are those focused on the goals of agency and parts (e.g., subsystems) that, through self-organiz-
communion. Agency centers on developing and ing interdependencies, are bound together and func-
maintaining a positively experienced, differenti- tion as a totality or unified whole in the pursuit of
ated and integrated, coherent, and effective sense the totality’s aims.
of self, while communion focuses on developing
and maintaining satisfying relationships with oth-
Biopsychosocial Model
ers. Affective states are barometers of a person’s
relative success in attaining these goals. When The biopsychosocial model provides a holistic
effectively pursuing and attaining goals connected conception of the human being through defining
to agency and communion, affective states are the multiple, hierarchically organized domains and
positive (e.g., pleasure, happiness, well-being). As subsystems that interdependently constitute an indi-
part of maintaining these positive “steady states,” vidual. These domains include the biological domain
an individual must engage in effective regulation (genetic, anatomical, physiological, and biochemi-
of both self and his or her social environment. cal subsystems), the psychological domain (cogni-
However, strong internal or external disruptions in tive, affective, and motivational subsystems), and
biological, psychological, and/or social processes the sociocultural domain (speech, the behavioral
can lead to disturbances in a person’s biopsycho- subsystem, and an individual’s sociocultural envi-
social stability. If an individual does not adequately ronment comprising layers such as dyadic, family,
regulate such disturbances and their related desta- community, religious, cultural, or political subsys-
bilizing effects on his or her life, then the individ- tems). The biopsychosocial model also incorporates
ual may stop effective pursuit of his or her agentic the phenomenological domain—underscoring that
and communal goals and develop negative affec- human biopsychosociality is a lived experience
tive states, such as sadness, anger, or anxiety. filled with purpose, values, and meaning.
A continuation of or increase in regulatory diffi-
culties can maintain or amplify the disturbances in
Dynamical Systems
a person’s biopsychosocial system, further dimin-
ish his or her capacity to effectively pursue life Dynamical systems refers to the concept that
goals, and in turn lead to increased distress and complex living organisms change over time due

to interactions among the organism’s multiple regulatory processes. Negative affective states indi-
subsystems. cate the perception of discrepancies between a
valued agentic and/or communal goal state and
Nonlinearity
one’s actual circumstances, indicating that regula-
tory processes have gone awry.
The concept of nonlinearity permits a detailed
picture of the interactions among biological, psy-
Strengths and Resources
chological, and sociocultural subsystems by empha-
sizing these subsystems’ reciprocal effects, feedback Strengths and resources involve a person’s
loops, networks, and cycles. Nonlinearity recognizes assets, skills, and zones of health in the biological,
that there can be a disproportionate relationship psychological, and/or sociocultural levels of an
between the amount of input from a subsystem and individual’s biopsychosocial system.
the magnitude of its effects on other subsystems.
Dialectical Thinking
Teleology A dialectic implies bipolarity, meaning two ele-
Teleology states that all complex living systems ments that are in direct opposition or contradiction
actively strive toward achieving goals, attaining to each other. These bipolar opposites create a uni-
desired states, and realizing valued ends, all of fied, holistic system through their dynamic inter-
which reflect purposefulness and intentionality on play with each other. Therefore, in dialectical think-
the part of the systems. ing, a person can understand a particular process
or phenomenon by going back and forth between
the opposing sides of the bipolarity and recognizing
Agency and Communion
that each side is an integral part of the whole and
Agency involves striving to develop a positively therefore each contributes important knowledge
experienced individual self that is coherent, differ- about the process or phenomenon. Important
entiated and integrated, and effective. Communion NDBPSS dialectics include health–pathology,
focuses on achieving satisfying interpersonal rela- reductionism–holism, analysis–synthesis, linearity–
tionships. While many factors make these concepts nonlinearity, stability–change, agency–communion,
unique for each person, agency and communion idiographic–nomothetic, and insight–action.
are the two aspects of human life that provide pur-
pose for all humans.
Techniques
Regulatory Processes The NDBPSS approach is highly eclectic in the

techniques used to facilitate initiation or resump-
To succeed in attaining agentic and communal tion of movement toward meaningful agentic and
goals, an individual must have capacities to self- communal goals. These techniques include blend-
regulate and to regulate his or her social environ- ing insight- and action-oriented approaches tai-
ment. Regulatory processes include gauging one’s lored to overcome biopsychosocial disruptions in
current status relative to a desired agentic or com- and obstacles to clients’ goal pursuits and to facili-
munal state, communicating to the self informa- tate proactive forward movement. Essential to the
tion about discrepancies that may exist between therapeutic process of NDBPSS, therapists foster
the current and the desired state, and instituting effective interplay between negative and positive
corrective actions to the extent that deviations are regulatory feedback loops and “work the loops”
occurring. In the human biopsychosocial system, with clients.
feedback operates as one of these principal regula-
tory mechanisms, with affective states serving as a
Technical Eclecticism
primary source of feedback about the extent of
success in attaining one’s aims. Positive affective The NDBPSS approach draws on strategies and
states indicate effective navigation toward or techniques from many major paradigms of therapy
attainment of a desired agentic and/or communal (e.g., psychoanalytic-psychodynamic, cognitive-
state and connote that one is engaging in effective behavioral, humanistic-experiential, biomedical,

1032 Unifying Nonlinear Dynamical Biopsychosocial Systems Approach
systemic, multicultural, hermeneutic-constructivist, reduce or diminish) interconnected biopsychoso-

and solution-focused strengths-based). This mul- cial subsystem processes that inhibit or otherwise
tiparadigmatic treatment methodology reflects the derail movement toward a desired goal. Positive
view that techniques are distinctly systematic ways feedback loops amplify (i.e., augment or intensify)
of bringing about therapeutic effects. To promote interrelated multisubsystem processes that foster
growth and change, disconnecting effective tech- effective goal-directed movement. Techniques can
niques from their specific theoretical models per- be differentiated in terms of whether their primary
mits a therapist to choose the technique that works aim is to dampen particular maladaptive processes
best for a particular biopsychosocial domain and (e.g., exposure to reduce social anxiety) or amplify
subsystem of a client. healthy processes (e.g., an experiential technique
to help the client contact and more deeply experi-
ence the personal strength of courage). Fostering
Insight and Action
effective pursuit of agentic and communal goals
Insight-oriented techniques (e.g., interpretation, requires the therapist to move between techniques
the use of metaphor, the two-chair technique, and for facilitating the development of negative feed-
affective focusing) help clients sharpen their self- back loops (reducing unhealthy processes) and
awareness and facilitate their understanding of techniques for promoting positive feedback loops
desired, elusive, or disrupted agentic or communal (increasing healthy processes).
goals. Techniques designed to foster clients’ insight
also assist them to identify and understand specific
Working the Loop
biopsychosocial obstacles (e.g., faulty beliefs,
health problems, psychological defenses, or dys- Working the loop refers to using constructive
functional interpersonal patterns) impeding the change that occurs in one subsystem to actively
attainment of desired goals. In addition, techniques promote change in other subsystems in the same
that advance insight help clients recognize healthy domain and/or in other domain subsystems. For
self-regulatory processes (e.g., sleep hygiene, con- example, the therapist and the client examine how
structive self-talk, managing affective states, antici- the client can actively harness a given change (e.g.,
pating the consequences of actions, and proactive feeling empowered by regular physical exercise
coping) that facilitate their effective pursuit of undertaken to cope with depression) in ways that
agentic and communal goals. Action-oriented tech- can positively affect other biopsychosocial pro-
niques explicitly promote the enactment of health- cesses (e.g., improving feelings of self-efficacy,
ier self-regulatory processes. Covert action-oriented undertaking an avoided task necessary to achieving
techniques are exemplified by cognitive restructur- a specific agentic goal, or attempting more asser-
ing, teaching mindfulness and distress tolerance tive communication). The client is also encouraged
skills, progressive muscular relaxation, compas- to examine within sessions and to observe between
sionate mind training, and problem solving. sessions how a selected change (e.g., diminishing
Illustrations of overt action-oriented techniques anxiousness and increasing calmness) may be
include clients following medication regimens, affecting processes in other subsystems (e.g., physi-
taking action to change their environments, putting ological state, decision making, level of motivation,
their values and strengths into action, or engaging effectiveness of actions, interpersonal behavior). In
in spiritual or religious practices. Therapists use turn, these specific constructive changes identified
insight- and action-oriented techniques in comple- as occurring in other biological, psychological,
mentary ways to advance clients’ therapeutic and/or social subsystems are underscored and,
progress. depending on client progress, may themselves
become targets of amplifying techniques.
Developing Negative and Positive
Regulatory Feedback Loops Therapeutic Process
Effective self-regulatory processes involve the NDBPSS psychotherapy can be used in a brief
interplay between negative and positive feedback therapy format or as a framework for long-term
loops. Negative feedback loops dampen (i.e., treatment when clients chronically fail to achieve

agentic or communal goals, when they persistently Anchin, J. C. (2003). Cybernetic systems, existential
experience connected pain, and/or when maladap- phenomenology, and solution-focused narrative:
tive processes perpetuate in their lives. A positive Therapeutic transformation of negative affective
therapeutic alliance is essential to the therapy pro- states through integratively oriented brief
cess as it provides a secure base for the collabora- psychotherapy. Journal of Psychotherapy
tive treatment process, which from the start of Integration, 13, 334–442. doi:10.1037/1053-0479.13
therapy highlights how the client’s pain indicates a .3-4.334
blockage or failure to achieve agentic or commu- Anchin, J. C. (2006). A hermeneutically informed
approach to psychotherapy integration. In
nal goals. The client and the therapist solidify the
G. Stricker & J. Gold (Eds.), A casebook of
client’s desired agentic and/or communal goals and
psychotherapy integration (pp. 261–280).
use the dialectical interplay between analysis and
Washington, DC: American Psychological
synthesis to identify and develop insight about the
Association.
maladaptive self-regulatory processes the client has Anchin, J. C. (2008). Pursuing a unifying paradigm for
been using to cope with life disturbances and the psychotherapy: Tasks, dialectical considerations,
connected negative symptoms. Once insight is and biopsychosocial systems metatheory. Journal of
gained into these maladaptive client behaviors, the Psychotherapy Integration, 18, 310–349.
therapist helps the client become “unstuck” doi:10.1037/a0013557
through specific insight- and action-oriented Cacioppo, J. T., & Decety, J. (2011). Social
techniques tailored to help the client decrease the neuroscience: Challenges and opportunities in the
maladaptive behaviors and increase healthy self- study of complex behavior. Annals of the New York
regulatory processes. The therapist also helps the Academy of Sciences, 1224, 162–173. doi:10.1111/
client to proactively develop effective achievement j.1749-6632.2010.05858.x
of agentic and/or communal goals so that the client Kiesler, D. J. (1999). Beyond the disease model of
can experience purpose, meaning, and positive mental disorders. Westport, CT: Praeger.
affective states in his or her life. Luyten, P., & Blatt, S. J. (2013). Interpersonal
relatedness and self-definition in normal and
Jack C. Anchin disrupted personality development: Retrospect and
prospect. American Psychologist, 68, 172–183.
See also Biopsychosocial Model; Eclecticism; Existential- doi:10.1037/a0032243
Humanistic Therapies: Overview; Integral Magnavita, J. J., & Anchin, J. C. (2014). Unifying
Psychotherapy; Integrative Approaches: Overview; psychotherapy: Principles, methods, and evidence
Interpersonal Psychotherapy; Relational from clinical science. New York, NY: Springer.
Psychoanalysis; Solution-Focused Brief Therapy; Marquis, A. (2009). An integral taxonomy of
Unified Theory; Unified Therapy therapeutic interventions. Journal of Integral
Theory and Practice, 4, 13–42.
Melchert, T. P. (2011). Foundations of professional
Further Readings
psychology: The end of theoretical orientations and
American Psychological Association Presidential Task the emergence of the biopsychosocial approach.
Force on Evidence-Based Practice. (2006). Evidence- London, England: Elsevier.
based practice in psychology. American Psychologist, Schore, A. N. (2012). The science of the art of
61, 271–285. doi:10.1037/0003-066X.61.4.271 psychotherapy. New York, NY: W. W. Norton.

V
them questions about their goals, purposes,
VALUES CLARIFICATION choices, and action patterns, they began to reflect
on their choices and decisions, and their “value-
Values clarification is an integrative approach to needs behaviors” started changing toward the
counseling that includes significant humanistic- more “value-driven behaviors” of enthusiasm,
existential, cognitive, and behavioral components. consistency, a more thoughtful balance between
It is designed to help clients set goals, establish conformity and nonconformity, and better deci-
priorities, make decisions, and take action in their sion making.
lives to achieve their values. It is not a therapeutic Raths’s students Sidney Simon and Merrill
approach, per se, designed to assist clients with Harmin further developed the approach with addi-
mental health issues, but a counseling and develop- tional methods (called “strategies”), a fuller theory,
mental approach aimed at helping individuals and a name—values clarification. Their book
achieve greater life satisfaction. Nevertheless, the Values and Teaching and a subsequent values
methods and process of values clarification can be clarification handbook in the 1970s became edu-
used by mental health practitioners to enhance cational bestsellers, with teachers, youth group
their practice, especially when helping clients set leaders, and counselors of many types being the
goals, make decisions, and develop plans as part of primary users of the approach. In the 1980s, values
their recovery. clarification became embroiled in controversies
Values clarification can be used in a wide vari- over value education, moral education, and char-
ety of counseling and educational settings, includ- acter education in schools and faded from popu-
ing school, career, couple and family, pastoral, larity. Meanwhile, many of its methods had become
rehabilitation, gerontological, and financial. It can standard practices in the repertoires of individual
be used in individual counseling, group counseling, and group counselors in many fields, who often
psychoeducational groups, and organizational used values clarification without knowing it by
consulting. name or understanding its theory or nuances of
practice.
Historical Context
Values clarification was first developed by the edu-
cator Louis Raths in the 1950s. He noticed that The basic hypothesis of values clarification, as it
many youth exhibited the behaviors of apathy, developed over the years, is that individuals will be
flightiness, overconforming, overdissenting, and more likely to make decisions and live lives that
poor decision making. However, when he asked are personally satisfying and socially constructive
1035

1036 Values Clarification
if they engage in a “valuing process” consisting of a boastful or arrogant pride or hubris, or a favor-
seven subprocesses: able comparison of oneself with others, but rather
a feeling of prizing, cherishing, and valuing one’s
Prizing choices and various facets of one’s life.
1. Prizing and cherishing
2. Affirming and communicating Affirmation
Choosing Sometimes called “public affirmation,” this is a

willingness to share with others one’s value indica-
3. Choosing from alternatives tors (beliefs, feelings, actions, and values) in appro-
4. Choosing after considering consequences priate circumstances. It is the opposite of hiding
5. Choosing freely one’s choices or behavior out of shame. This valu-
Acting ing process both is clarifying for the individual and
helps bring about one’s values in the world.
6. Acting
7. Acting consistently, with a pattern
Choosing From Alternatives
All the methods of values clarification are Considering alternative views, ideas, possibilities,
designed to assist clients in utilizing one or more of and solutions increases the likelihood that one’s
these processes as applied to “value-rich” areas of choices will have value for one. On the other hand,
their lives, such as work, relationships, money, choosing the first idea or the only idea presented is
family, religion, leisure time, sex, health, and aging. less likely to yield a long-term satisfying result.
Consistent application of these processes will turn
“value indicators” (feelings, preferences, beliefs,
Considering Consequences, Pros and Cons
opinions, habits, and goals) into full-blown “val-
ues,” that is, when one’s thoughts, feelings, and The premise is that it’s better to look before one
actions are fully integrated in the areas of one’s life. leaps. Values clarification works best when one
Using the valuing process does not guarantee good considers a wide range of consequences (e.g., per-
decisions; it simply increases the likelihood of and sonal, social, physical, financial, and spiritual—
provides opportunities for reevaluation and cor- one’s whole value system), when one considers the
recting mistakes. pros and cons of any belief, choice, or action not
This is an essentially optimistic, humanistic only for oneself but also for others (family, rela-
theory that trusts the human capacity to develop in tionships, society, and the world), and when one
increasingly healthy directions when surrounded considers long-term consequences as well as short-
by positive conditions for growth. term ones.
Major Concepts Choosing Freely

In addition to the concepts of value-rich areas, Values clarification encourages the process of
value indicators, values, and valuing processes, helping individuals better understand the personal
which have been mentioned above, other major and social influences on their choices, examine the
concepts in values clarification include (a) proud pressures that may be influencing them, and then
and prizing; (b) affirmation; (c) choosing from make a choice that feels like their own, that they
alternatives; (d) considering consequences, pros can take responsibility for.
and cons; (e) choosing freely; (f) acting consis-
tently, in a pattern; (g) sharing, not imposing; and Acting Consistently, in a Pattern
(h) the right to pass.
Patterns can represent thoughtfully chosen
behaviors or unaware habits. Hence, clarifying
Proud and Prizing
questions and strategies ask clients to examine what
Values clarification encourages individuals to their actions and patterns are—if they are habits
take pride in their choices and actions. This is not or choices; if they are freely chosen; if they truly

Values Clarification 1037
represent their beliefs, priorities, and values; and if One or more good, clarifying questions can be
they are consistent with other behaviors and values. very helpful to a client’s clarifying process. There
are hundreds of variations on clarifying questions,
Sharing, Not Imposing and values clarification counselors become adept
at asking appropriate, relevant, and well-timed
Counselors using values clarification learn to questions.
ask open-ended, unbiased questions that do not
imply correct or better answers. They learn to react
to clients and group members with acceptance, Clarifying Strategies
respect, and encouragement to continue using the Values clarification helped popularize many
valuing process and not with verbal or nonverbal counseling exercises and activities that have
approval or disapproval, however subtle. They become staples of counseling and other helping
learn the appropriate times and ways to model the professions. These “strategies” help clients and
valuing process by sharing some of their own group members explore value-rich areas by com-
responses and alternatives, without imposing them bining one or more clarifying questions with a
on clients or group members. structured format for responding. Individuals can
think about their responses, write or draw, respond
The Right to Pass verbally, or a combination of these. Of the hundred
or more values clarification strategies that have
Clients and group members always have the
been developed, the following are some examples
right to pass, to not participate in an activity or
that can be used with myriad topics.
respond to a question. This is extremely important
to create the atmosphere of safety and respect in
Voting: In a group setting, participants raise their
which values clarification flourishes.
hands, put their thumbs down, or fold their arms
to pass in response to propositions the counselor
Techniques suggests.
There are three major types of values clarification Ranking: Clients rearrange several choices the coun-
techniques relevant to counseling—(1) clarifying selor presents in order of their preference.
questions, (2) clarifying strategies, and (3) the
clarifying interview—with an infinite number of Continuum: Clients place themselves on the line
examples and variations possible within them. somewhere between the extreme end points the
counselor has identified.
Clarifying Question Values circle: Each group member has a chance to

respond to a clarifying question.
The foundational technique of values clarifica-
tion is the clarifying question. A clarifying question Inventory: Clients are asked to make a list of
invites clients or group members to engage in one alternatives relevant to the values issue at hand
of the seven value-clarifying processes, as the (e.g., 15 things you love or like to do as a couple;
following examples show: 10 behaviors that might improve your health) and
then code their lists for further clarification (e.g.,
1. Prizing: How strongly do you feel about that? put a $ sign if it costs money; put a P if it requires
planning).
2. Affirming: Do you talk to others about this?
Public interview: One group member responds to a
3. Alternatives: Would you consider doing ____? series of clarifying questions.
4. Consequences: Does that feel like you’re taking Unfinished sentences: Clients complete sentence
a big risk? stems about the values issue being considered.
5. Choosing freely: Do you feel pressured about this? “I learned . . . ” statements: Unfinished sentences
(“I learned that I . . . ”; “I was surprised that I . . . ”)
6. Acting: What would your first step be?
invite clients to reflect on what they learned from an
7. Pattern: Do you think you’ll repeat this choice? experience, exercise, or discussion.

1038 Values Clarification
Either/or forced choice: Clients choose between two values issue. These may be questions and activities
opposite alternatives, in a group setting, possibly the counselor thinks up spontaneously in the
going to opposite sides of the room. course of the counseling or group session, or they
may be questions and strategies the counselor
Strongly agree/strongly disagree: Clients respond on
came prepared to use with the client or group.
a 4- or 5-point scale as to how much they agree or
disagree with a number of statements or viewpoints 3. Encourage the seven valuing processes: The
on the topic at hand. questions and activities help the client and group
members utilize one or more of the seven values
Self-contract: Clients write a contract about what
processes of prizing, choosing, and acting as they
they will do by what date—and sign the contract if
engage with the value-rich issue.
they choose to commit.
4. Maintain safety, respect, and nonimposition
Clarifying Interview of values: Within the structure of the questions
and strategies and through words and nonverbal
In individual counseling, the clarifying interview communication, the counselor establishes and
uses values-clarifying questions and strategies in a maintains an atmosphere of safety, self-respect,
sequential fashion to help clients sort out the value respect for others, and nonimposition of the coun-
dilemmas and life choices they are working on. selor’s or others’ values. In this way, clients and
The general sequence of the clarifying interview is group members can truly explore the issues and
as follows, although counselors and clients move choices, make their own decisions, and develop
back and forth among the steps as the need arises. their own values.
• Clarifying the dilemma Thus, the values clarification counselor is a

• Acknowledging feelings facilitator of the individual’s growth and devel-
• Setting goals and priorities opment, relying on the client’s motivation and
• Generating alternatives trusting his or her capacity for responsible self-
• Considering consequences, pros and cons direction. In this respect, values clarification
• Making a free choice or decision shares common elements with person-centered
• Formulating the next steps counseling, existential therapy, Adlerian Indivi-
• Committing or resolving to act dual Psychology, reality therapy based on choice
theory, solution-focused brief therapy, acceptance
Therapeutic Process and commitment therapy, motivational inter-
viewing, appreciative inquiry, and positive psy-
Because values clarification focuses more on iden- chology. Many of these latter approaches utilize
tifying values and developmental issues, and is not values clarification methods.
specifically designed to assist clients with mental
health issues, it is more appropriate to examine its Howard Kirschenbaum
“counseling process” rather than its therapeutic
process. With values clarification, whatever the See also Acceptance and Commitment Therapy;
counseling setting or topic, the process consists of Cognitive-Behavioral Therapies: Overview;
Motivational Interviewing; Positive Psychology; Group
four sequential or concurrent steps:
Counseling and Psychotherapy Theories: Overview
1. Identify a values issue to explore: Presumably

this is done by the client, although in some man- Further Readings
dated or psychoeducational group settings the
topic may be set in advance or introduced by the Figler, H. (1979). A career workbook for liberal arts
students (2nd ed.). Cranston, RI: Carroll.
counselor or facilitator.
Glaser, B., & Kirschenbaum, H. (1980). Using values
2. Use clarifying questions and strategies: The clarification in counseling settings. Personnel and
counselor uses one or more values-clarifying ques- Guidance Journal, 58(9), 569–574. doi:10.1002/
tions or strategies to explore and work on the j.2164-4918.1980.tb00452.x

Voice Dialogue 1039
Kirschenbaum, H. (1977). Advanced value clarification. that currently support and utilize the Voice Dialogue
La Jolla, CA: University Associates. method in their practice. As of August 2012, the
Kirschenbaum, H. (2013). Values clarification in Stones have stopped training groups, but they still
counseling and psychotherapy: Practical strategies for teach private lessons on Voice Dialogue at their
individual and group settings. New York, NY: Oxford California home. The Stones do not support the
University Press. certification of Voice Dialogue, so there are no certi-
Kirschenbaum, H., & Simon, S. B. (Eds.). (1973). fied facilitators or trainers of the method, and it is
Readings in values clarification. Minneapolis, MN: not taught in any formal educational setting.
Winston Press.
Larson, R., & Larson, D. (1976). Values and faith:
Value-clarifying exercises for family and church
groups. Minneapolis, MN: Winston Press.
Rokeach, M. (1973). The nature of human values Although Voice Dialogue has been likened to several
(2nd ed.). New York, NY: Free Press. other psychotherapeutic theories and techniques,
Simon, S., Howe, L., & Kirschenbaum, H. (1979). Values such as psychodrama, transactional analysis, psy-
clarification: A handbook of practical strategies for chosynthesis, and Gestalt therapy, the originators of
teachers and students. Hadley, MA: Values Press. Voice Dialogue report that they were not influenced
(First edition 1972, Hart Publishing) by any of these approaches (some of which were
Simon, S., Howe, L., & Kirschenbaum, H. (1995). popularized at a later date). Instead, Hal Stone bor-
Values clarification: Your action-directed workbook. rowed concepts from his training as a Jungian and
New York, NY: Warner Books.
Sidra Stone drew on her experience as a behaviorist
Values in Action Institute. (2012). Values in Action
when they created the method.
Signature Strengths Test (based on Seligman’s concept
The Psychology of Selves theory purports that
of authentic happiness). Retrieved from www
humans are naturally born with a unique psychic
.authentichappiness.org.
fingerprint of personality traits and roles, but
social learning and training from the family of ori-
gin and the environment force one to identify with
some selves (primary) and to repress others (dis-
VOICE DIALOGUE owned). Primary selves are neither good nor bad
but serve as roles for survival in an environment
Voice Dialogue is a counseling method based on that might otherwise threaten one’s physical, emo-
the Psychology of Selves, which theorizes that the tional, and psychological well-being. Primary
psyche is divided into many subpersonalities, ener- selves may include, for example, a main protector-
gies, or selves. When using Voice Dialogue, the controller (who makes the rules for one’s behavior
therapist initially provides psychoeducation about and serves as a general caretaker), a pleaser (who
the psyche and subpersonalities, creates an atmo- wants to be liked and is pleasant to others), a
sphere for the development of awareness of the pusher (who provides drive and motivation to
subpersonalities, and ultimately allows the client complete tasks), or a perfectionist (who insists that
to embrace disowned aspects of self that the client everything be done flawlessly). Disowned selves
had previously rejected. are the undeveloped, vulnerable, opposites of the
primary selves that remain buried in the subcon-
scious, such as the rebel, the inner critic, or the
Historical Context
clown. For example, if the primary self is ambi-
The Voice Dialogue method and the Psychology of tious, the disowned self might be lazy. The
Selves theory were introduced in 1972 by the Psychology of Selves teaches that there are multiple
American psychoanalysts and authors, Hal (1927– ) selves that are interchangeable instantaneously, but
and Sidra (1937– ) Stone. The creators personally only one self can be present at any given moment.
taught and spread the Voice Dialogue method Therefore, complications and stressors arise when
through individual and group trainings, books, and a person responds from one self (e.g., anger) when
their personal website. There are approximately 146 the situation may have called for another self’s
therapists and agencies in more than 16 countries characteristics (e.g., sadness).

1040 Voice Dialogue
Major Concepts Guided Imagery

Voice Dialogue has two major concepts relevant to Guided imagery is a creative process of imag-
the method: (1) humans are composed of many ining any and every situation from the safety of
selves and (2) there are multiple levels of con- a neutral, relaxed environment. With the Voice
sciousness. Dialogue method, guided imagery can be used to
identify with a self that may feel vulnerable or
at risk.
Humans Are Composed of Many Selves
Humans are born with the potential for a wide
array of selves or subpersonalities. Each person Role-Play
develops a unique pattern of primary selves to An essential part of Voice Dialogue is the client’s
physically, emotionally, and psychologically adjust ability to role-play his or her multiple selves with
to life and protect the person in his or her environ- thoughts, feelings, and even physical movement.
ment. Paradoxically, this process also represses For example, the therapist may encourage the cli-
essential selves that are needed to fully experience ent to “be” his or her perceived weakness. The
and respond to the world. For example, if one dis- client will physically move to a new location or
owns the self that experiences sadness, then the body position and speak as only this self, referring
individual will not be able to react appropriately to in the third person to his or her whole self (“Kelly
sad moments and situations. This tends to cause does not recognize how scared I feel when asked to
personal and relational distress. speak in public”). Often, this unique self will have
a different perspective on the client’s life situation,
Multiple Levels of Consciousness and even present with a different voice tone, range
of feelings, set of memories, physical or bodily sen-
Disowned selves are not lost forever but are sations, and age of development or creation.
stored in the subconscious or unconscious mind.
Voice Dialogue techniques are aimed at discover-
ing the disowned selves by accessing altered states Therapeutic Process
of consciousness.
The Voice Dialogue method introduces a system of
conscious intrapersonal communication among the
Techniques client’s various selves, so that all subpersonalities,
A combination of techniques is used in Voice energies, and selves can be consciously honored,
Dialogue, including psyche mapping, dreamwork, developed, and efficiently utilized. The therapist
guided imagery, and role-play. initially provides psychoeducation about the psyche
and subpersonalities and then assists the client to
develop an aware ego, which allows the client to
Psyche Mapping separate from the identified selves and embrace the
Psyche mapping is a process of discovering one’s disowned selves that the client had rejected in the
unique patterns of subpersonalities, energies, or course of growing up. This process, while opening
selves. The client identifies which selves are pri- one to intense vulnerability, is typically viewed as a
mary and which are disowned, and strives to deter- liberation from conditioned roles. Next, Voice
mine the characteristics of his or her own psychic Dialogue therapists assist the client in constellating
fingerprint, or the child within. an inner teacher through an exploration of the cli-
ent’s dreams, which are thought to be organized,
purposive, and representative of the unconscious.
Dreamwork
Dream analysis is considered to be an unpeeling of
Voice Dialogue explains that dreams serve as a personality, during which one may uncover dis-
natural inner teacher that advises one about the owned selves or realize imbalances in one’s life.
personality. Dreams are a window to the uncon- These issues are processed in therapy sessions
scious mind and shed light on the selves that may through talk therapy, a specialized method of role-
be unbalanced. play, and the use of immediacy. It is the final goal

Voice Dialogue 1041
of Voice Dialogue for the client to achieve personal time following the session to recenter before
clarification of transpersonal energies, which returning to their daily routine.
addresses issues such as why one’s selves have been
either primary or disowned, how one can commu- Katherine A. Heimsch
nicate with selves that need recognition, and how
See also Guided Imagery Therapy; Psychodrama;
one can choose to utilize different selves to manage Psychosynthesis; Transactional Analysis
life’s decisions and stressors.
Voice Dialogue has been applied to many dif-
ferent psychological and physical issues. Therapy Further Readings
that uses the Voice Dialogue method is completely Hoffman, D. (Ed.). (2012). The voice dialogue anthology:
individualized in terms of the length of treatment, Explorations of the psychology of selves and the
as it is highly personal in nature. Each session aware ego process. Albion, CA: Delos.
lasts at least 1.5 hours in duration, to allow time Stone, H., & Stone, S. L. (1989). Embracing our selves:
to identify an issue, for a self to emerge, and then The voice dialogue manual. Novato, CA: Nataraj.
to verbally process the experience. Videotaping
sessions of the Voice Dialogue method is not
Website
unusual, so that clients can review moments dur-
ing therapy where another self was dominant. It is Voice Dialogue International: https://delos-inc.com/index
also recommended that clients take additional .htm

W
way to approach healing would be to teach people
WELLNESS COUNSELING ways of living so that they would not become sick;
hence, the wellness movement was initiated.
Wellness counseling is a tradition that emphasizes Wellness has been variously defined as a holistic
optimum functioning in all areas. The emphasis in concept that incorporates all aspects of human
the wellness counseling process has been variously behavior, including body, mind, and spirit, and
defined as preventive and developmental. The differs in significant ways from what we have
focus is on the dual facets of awareness and deci- come to know as health, a more or less neutral
sion making toward a goal of optimum health and point on a continuum from illness at one end to
well-being in which body, mind, and spirit are high-level wellness at the other. The World Health
integrated. Thus, wellness counseling is the process Organization as early as 1946 defined health as
of helping an individual become aware of the “physical, mental, and social well-being, not merely
personal meaning of wellness; become conscious the absence of disease” and later provided a
of how his or her thoughts, feelings, and behaviors definition of optimal health as “a state of complete
mitigate for or against wellness; and engage physical, mental, and social well-being and not
in decision making on a continuous basis that merely the absence of disease or infirmity.”
contributes to optimum human functioning. Although the history of wellness spans more
Wellness is a complex construct composed of than 2,000 years, the history of wellness in coun-
multiple interacting components that work sepa- seling spans only the past century. The earliest
rately and together to create or inhibit movement forms of counseling—career and rehabilitation—
toward greater wellness. Change in any one area incorporated elements of what has come to be
may mitigate for or against holistic well-being due more widely known as wellness counseling.
to the holistic nature of human functioning. Although the terminology differed, the basic
concepts have remained unchanged: What began
as “developmental counseling” has always included
Historical Context
a concern for growth in social, personal, voca-
The historical roots of wellness may be traced to tional, and other areas. Helping persons with
the Ancient Greek god of healing, Aesculapias, disabilities has always included an orientation
whose two daughters defined opposing ways of toward optimum functioning within any personal
approaching illness and health. One daughter, or individual limitations. Within the past quarter
Panacea, believed that healing meant approaching century, wellness has emerged into the mainstream
people to treat existing illness, thus launching the of counseling, a movement made possible in part
paradigm still followed in modern medicine. because of the development of counseling-based
Hygeia, the other daughter, believed that the best wellness models and the identification of methods
1043

1044 Wellness Counseling
for infusing wellness counseling within the broader In the Wheel of Wellness model, spirituality is
contexts of the profession. Importantly, wellness depicted as the center of the wheel and its most
has been defined as the singular philosophy and important characteristic, establishing the centrality
approach that defines counseling in relation to of meaning and purpose in life. Surrounding the
other mental health disciplines. While wellness center is a series of 12 spokes in the life task of
counseling and mental health disciplines have self-direction: (1) sense of worth; (2) sense of control;
much in common—theories, techniques, assess- (3) realistic beliefs; (4) emotional responsiveness and
ments, interventions, and client characteristics— management; (5) intellectual stimulation, problem
what defines wellness counseling as unique is its solving, and creativity; (6) sense of humor;
philosophy of empowerment, focus on strengths- (7) exercise; (8) nutrition; (9) self-care; (10) stress
based assessment and intervention, and goal of management; (11) gender identity; and (12) cultural
optimum functioning across the life span. identity. These spokes help regulate or direct the self
Today, wellness counseling is practiced with as one responds to the Adlerian life tasks of work
persons of all ages, cultures, and life circumstances, and leisure, friendship, love, and spirit.
though the dynamics of interventions may differ The evolution of wellness counseling was facili-
based on client characteristics such as age; culture; tated by the development of an empirical or evidence-
social, financial, and personal resources; and dis- based model, the indivisible self (IS), or IS-Wel
ability, to name only a few. Indeed, in the context model of wellness, also developed by Myers
of holistic functioning, the specific applications of and Sweeney. This model was developed through
wellness counseling are understandably diverse structural equation modeling of a large database
and require creativity on the part of the counselor gathered over more than a decade. The outcome of
in helping each person develop self-understanding exploratory and confirmatory factor analyses
and motivation toward lifestyles marked by greater resulted in a clearly defined structural model in
health, quality of life, and longevity. which the self is the central and indivisible core of
wellness, represented by a single, higher order factor
called Wellness. Surrounding this core are five second-
order factors: (1) Creative Self, (2) Coping Self,
Counseling-based wellness models originated in the (3) Social Self, (4) Essential Self, and (5) Physical
early 1990s through studies of cross-disciplinary Self. One result of the factor analysis was that the
research in an effort to identify correlates of circumplex structure hypothesized in the theoretical
health, quality of life, and longevity. Although wheel model was not supported. In that model,
most research is equivocal in nature, in that there spirituality was hypothesized to be the central and
is almost always a counterpoint to a given finding, most important aspect of wellness. Here instead, all
an examination of characteristics that correlate factors emerged as distinct third-order factors,
with health and wellness revealed multiple factors though the relationships among the factors were
that met the criterion of enhancing quality and simplified in that each contributed to a central factor
length of life. The contribution of the earliest of total wellness. In the IS-WEL model, the original
counseling-based wellness model, the theoretical 17 factors were confirmed as unique third-order
Wheel of Wellness developed by Jane E. Myers factors and are grouped within the five second-order
and Thomas J. Sweeney, presented a schema that factors of the self. Contextual variables are also
defined the hypothetical relationship among an important part of this model and include local,
the diverse factors of body, mind, and spirit. institutional, global, and chronometrical variables.
Using Adlerian Individual Psychology as an The model continues to evolve through research on
organizing system, the wheel provided a graphical the factors, individually and collectively, and through
representation of relationships among 12, and cross-disciplinary and cross-cultural studies that both
later 17, components of wellness. The interactive examine wellness and provide definitions of wellness
nature of the factors was emphasized, as well as in cultural contexts. For example, recent studies in
the interaction of the individual in an ecological Hong Kong have resulted in a conclusion that a
context that included both local and global forces different definition of spirituality in Eastern cultures
that affect holistic well-being. is needed, one that incorporates concepts from

Wellness Counseling 1045
Confuscianism and Buddhism. Parallel developments The Coping Self

in the United States include the emergence of a new
The Coping Self is a combination of elements
construct, ecoWellness, which defines the singular
that regulate our responses to life events and pro-
importance of relationships with the natural environ-
vide a means for transcending their negative
ment as integral to well-being, and technoWellness,
effects. This factor includes four components or
a concept that promotes our understanding of
third-order factors: (1) Realistic Beliefs, (2) Stress
how technology, a constantly changing feature of our
Management, (3) Self-Worth, and (4) Leisure.
lives, mitigates for or against individual well-being.
Irrational beliefs are the source of many frustra-
tions and disappointments with life; relinquishing
Major Concepts our irrational need to be perfect is one way to help
reduce or cope with stress. Likewise, self-worth
The main components of the IS-Wel model are the can be enhanced through effective coping with
singular higher order factor of Wellness and five life’s challenges. Finally, leisure is essential to
second-order factors of the self: (1) Creative Self, wellness and continual development. Learning to
(2) Coping Self, (3) Social Self, (4) Essential Self, become totally absorbed in an activity where time
and (5) Physical Self. stands still helps one both cope with and transcend
life’s other requirements. Leisure opens pathways
Wellness: The Higher Order Factor to growth in the creative and spiritual dimensions,
thus establishing a strong link between the various
Adler’s emphasis on holism is the foundation for selves, or second order factors.
understanding the IS-Wel model. His thesis that
humans are more than the sum of their parts and
cannot be divided provided the essential philo- The Social Self
sophical foundation for explaining the structural The Social Self includes the two third order
model, particularly the higher order Wellness factor. factors: (1) Friendship and (2) Love and is thus
All components of wellness are highly interrelated. defined in terms of connections with others in
Not only does change in any one area contribute to friendships and intimate relationships, including
or cause changes in other areas, but also each family ties. Friendship and love exist on a
aspect of wellness, though distinct, has a strong continuum and, as a consequence, are not clearly
relationship with the other wellness factors. distinguishable in practice. What is clear is that
friendships and intimate relationships enhance the
The Creative Self quality and length of one’s life. Isolation, alien-
ation, and separation from others are generally
Adler referred to the Creative Self as the combi- associated with a variety of poor health conditions
nation of attributes that each individual forms to and greater susceptibility to premature death, while
make a unique place among others in our social social support remains in multiple studies as the
interactions. Five third-order factors make up the strongest identified predictor of positive mental
creative self: (1) Thinking, (2) Emotions, (3) Control, health over the life span. The mainstay of this
(4) Positive Humor, and (5) Work. Both research and support is the family, with healthier families
clinical experience have revealed that what we think providing the most positive sources of individual
affects our emotions as well as our body. Similarly, wellness. Of course, healthy families can be either
emotional experiences influence our cognitive biological families or families of choice, particularly
responses to subsequent experiences perceived as for adults.
similar. Positive expectations result from a perceived
sense of control and influence our emotions, our
The Essential Self
behavior, and anticipated outcomes. In addition,
positive humor has a pervasive influence on physical The Essential Self comprises four third order
as well as mental functioning, and work is an essen- factors: (1) Spirituality, (2) Self-Care, (3) Gender
tial element in human experience that can enhance Identity, and (4) Cultural Identity. Spirituality,
or exacerbate one’s capacity to live life fully. which incorporates one’s existential sense of

1046 Wellness Counseling
meaning, purpose, and hopefulness toward life, on enhancing virtually any area of wellness will
has positive benefits for longevity and quality of improve holistic wellness. Wellness counseling
life and was viewed by Alfred Adler as central to proceeds through four clearly defined phases.
holism and wellness. Both gender and cultural
identity are filters through which life experiences Phase 1: Introduction of the Wellness Model
are seen, and they affect how others are experi-
enced in response to oneself. Both affect essential It is helpful to clients when counselors define
meaning-making processes in relation to life, self, wellness and allow clients time to reflect on the
and others. Self-care includes proactive efforts to personal meaning of wellness. Then, the Wheel of
live long and live well, while carelessness, avoid- Wellness or IS-Wel model can be presented and the
ance of health-promoting habits, and general importance of a wellness lifestyle discussed.
disregard of one’s well-being are potentially signs Although the wheel is theoretical, many clients
of despair, hopelessness, and alienation from life’s readily identify with the centrality of spirituality in
opportunities, reflected in loss of a sense of mean- this model. The interaction of the components of
ing and purpose in life. the model can be described by explaining how
change in any one area can contribute to or create
changes in other areas and that these changes can
The Physical Self
be for better or worse. Clients need to realize that
The Physical Self refers to the biological and wellness is a choice and that each choice made
physiological processes that constitute the physical toward wellness empowers them toward greater
aspects of our development and functioning, happiness and life satisfaction.
including the two third order factors of (1) Exercise The wellness models represent a cross section of
and (2) Nutrition. The physical components behaviors that have an effect over the course of the
of wellness are often overemphasized to the exclu- life span; thus, attention to each component has
sion of other components of holistic well-being; consequences that multiply over time. For those
however, the evidence is compelling with regard to who make choices toward wellness, the cumulative
the importance of exercise and nutrition for posi- effect over the life span is improved quality of life
tive well-being over the life span. Not surprisingly, and longevity.
“survivors,” those individuals who live longest,
place a priority on both good nutrition and Phase 2: Assessment of the
exercise. Components of Wellness
The purpose of assessment is to provide a basis
Techniques for developing a personal wellness plan. Assessment
Because wellness counseling can be applied through may be accomplished through an interview supple-
a wide variety of theoretical approaches, there are mented by scaling questions. For example, after
no specific techniques that are typically used. discussing the meaning of social wellness, a coun-
However, there is a process that can be followed to selor might ask a client to rate her or his social
ensure that the client’s wellness is attended to. This wellness on a scale of 1 to 10. Formal assessment
process is highlighted under the following section, with an instrument such as the Five Factor Wellness
“Therapeutic Process.” Inventory (5F-Wel) may provide information about
current levels of functioning in specific areas of
wellness. It is up to clients to examine their scores
Therapeutic Process
and determine which areas, if any, they would like
Wellness counseling requires a strong basis in to change.
assessment, either formal or informal, with atten- Whether assessment is informal or formal,
tion to strengths and the use of strengths to clients should be encouraged to reflect on their
enhance other wellness areas. The basic tenet of scores, determine how representative the scores are
interaction among the components of wellness of their total wellness (i.e., how well the scores
provides much flexibility to the clinician, as a focus reflect their perceptions of their total wellness),

Wellness Counseling 1047
and then reflect on the pattern of their high and positive change in these dimensions. Other areas,
low scores. Some discussion on the balance between such as emotional awareness, coping, and realistic
various aspects of wellness and the desirability of beliefs, may benefit from traditional counseling
balance is helpful. interventions to facilitate change.
Clients may be encouraged to select one or
more of their low scores as areas for which they Jane E. Myers
can develop a personal wellness plan. Alternately,
See also Adlerian Therapy; Adventure-Based Therapy;
they may choose an area in which they received a Complementary and Alternative Approaches: Overview;
high score yet one in which they would like to Creative Arts and Expressive Therapies: Overview;
enhance their personal wellness. In all cases, it is EcoWellness; Foundational Therapies: Overview
important to build on assets found within the
profile by emphasizing attributes that can help
strengthen those areas found less satisfactory by Further Readings
the client. Hattie, J. A., Myers, J. E., & Sweeney, T. J. (2004).
A factor structure of wellness: Theory, assessment,
analysis, and practice. Journal of Counseling &
Phase 3: Intentional Interventions to Enhance
Development, 82, 354–364.
Wellness—Developing a Personal Wellness Plan
doi:10.1002/j.1556-6678.2004.tb00321.x
Once wellness in each dimension has been Lawson, G., & Myers, J. E. (2011). Wellness, professional
assessed, clients may be asked to choose one or quality of life, and career sustaining behaviors: What
more areas of wellness that they would like to keeps us well? Journal of Counseling & Development,
change and improve. Once the client identifies 89, 163–171. doi:10.1002/j.1556-6678.2011.tb00074.x
those dimensions, a personal wellness plan can be Lewis, T. F., & Myers, J. E. (2010). Wellness factors as
developed. The plan should be based on personal predictors of alcohol use among undergraduates:
strengths and limitations related to the wellness Implications for prevention and intervention. Journal
area targeted for change and should emphasize of College Counseling, 13(2), 111–125.
behaviors that will result in change. The inclusion doi:10.1002/j.2161-1882.2010.tb00053.x
of specific objectives for change, methods to be Myers, J. E., & Sweeney, T. J. (2005). The Five Factor
used to effect change, and resources that will be Wellness Inventory. Palo Alto, CA: Mindgarden.
Myers, J. E., & Sweeney, T. J. (2005). The indivisible self:
employed to help the client change can be noted.
An evidence-based model of wellness. Journal of
The development of a timeline for change, rewards
Individual Psychology, 61(3), 269–279.
or reinforcements, and a public commitment from
Myers, J. E., & Sweeney, T. J. (Eds.). (2005). Wellness in
the client will maximize the potential success of
counseling: Theory, research, and practice. Alexandria,
the plan.
VA: American Counseling Association.
Myers, J. E., & Sweeney, T. J. (2008). Wellness counseling:
Phase 4: Evaluation and Follow-Up The evidence base for practice. Journal of Counseling &
Development, 86, 482–493. doi:10.1002/
A discussion of evaluation procedures and
j.1556-6678.2008.tb00536.x
timelines is an important part of any behavioral Myers, J. E., Willse, J. T., & Villalba, J. A. (2011).
plan. The client should be encouraged to commit Promoting self-esteem in adolescents: The influence of
to an ongoing plan for regular and systematic wellness factors. Journal of Counseling & Development,
evaluation, with identified markers that signify 89, 28–36. doi:10.1002/j.1556-6678.2011.tb00058.x
progress in making change (e.g., short- and long- Reese, R., & Myers, J. E. (2012). Ecowellness: The
range goals). Many clients are able to develop and missing factor in holistic wellness models. Journal of
implement their own wellness plans, while others Counseling & Development, 90, 400–406.
prefer a more focused, step-by-step process involv- doi:10.1002/j.1556-6676.2012.00050.x
ing discussion with a professional. Some areas of Wester, K. L., Trepal, H. C., & Myers, J. E. (2009).
wellness are popular in the media today, such as Wellness of counselor educators: An initial look. Journal
nutrition and exercise, and little outside interven- of Humanistic Counseling, Education & Development,
tion may be required to help a client experience 48(1), 91. doi:10.1002/j.2161-1939.2009.tb00070.x

1048 Whitaker, Carl
World Health Organization. (1958). Constitution of the Thomas Malone, he wrote Roots of Psychotherapy,
World Health Organization. Retrieved from http:// founded in the notion that psychotherapy is a
www.who.int/governance/eb/who_constitution_en.pdf biological process. The book included a detailed
description of the therapeutic process and a
pattern of therapy beyond interpretation. “Beyond
interpretation” implies that interpretative comments
WHITAKER, CARL and questions are not intended to be conclusive
but rather to generate creative action and reflection—
Carl Whitaker (1912–1995) was a psychiatrist and between family members or between a family
psychotherapist who worked on determining what member and the therapist. The therapeutic effects
psychotherapy is and approached this question in emanate from the process of the present experi-
much the same way an artist explores painting ence, based on the idea that the energy for change
by painting. He called his therapeutic approach or growth comes from experience and insight
experiential. His therapeutic explorations led him follows experience.
to family therapy, and symbolic experiential family Whitaker was best known in the realm of family
therapy emerged, founded not on a specific theo- therapy, where he was characterized as a founder,
retical formulation but on clinical experience. His a pioneer, a perpetual innovator, and an appealing
artful style was modeled on parallel play. maverick. His therapeutic pattern was unique for
The large dairy farm on the St. Lawrence River its honesty and spontaneity founded in play. He
near Messina, New York, where Whitaker grew up was a role model not only for how to survive
was part of his identity and provided roots for how personally and professionally but also for how to
he characterized himself. He began a residency in do so with vigor and creativity.
obstetrics and gynecology, but after working in a During the 1960s and 1970s, family therapy
psychiatric hospital, he became fascinated with had the characteristics of an innovative movement,
people who had been diagnosed with schizophrenia with many creative practitioners involved in this
and decided to enter psychiatry. Later, when he was emerging domain. Whitaker had great ability for
widely known, he would say, “The weird thing is acknowledging the undercurrents of chaos and
I never had any training. I learned how to be a crisis in modern life and for incorporating them
psychiatrist from patients” (C. Whitaker, personal into his therapeutic work. He perceived deeper
communication, 1972). From his therapeutic humanness and beauty in the wide, sometimes
experiences working with children and patients stormy, nonlogical ocean of family experience. His
with schizophrenia, he developed ideas about creative therapeutic ideas were considered novel,
experiential relating, play with language, valuing stimulating, and imagination reviving.
metaphorical reality, and adding doses of ironic Whitaker’s approach to the practice of psycho-
humor. His career (1938–1993) was organized therapy implicitly questioned the codes, roles, and
around exploring the profound nature of psycho- principles of conventional therapeutic methods.
therapy through clinical work: What is a patient? He held the view that all psychopathology is
What does it mean to be a therapist? What are grounded in interpersonal experience until proven
therapeutic experiences, and where do they occur? otherwise and that healing comes from interper-
In 1946, he became the first chairman of sonal experience. Thus, according to Whitaker,
psychiatry at Emory University in Atlanta, Georgia, psychopathology arises out of an effort to heal or
and developed a novel education program involving push growth. For example, a depressed mother is
group therapy for medical students facilitated by attempting to heal her family.
faculty members, with the idea that a person learns While theories provide direction and protection
to be a healer from being a patient. Later, the for therapists, Whitaker believed that they inter-
therapeutic groups moved on to seeing patients as fered with the “aliveness” he valued. His theory
a group. Initially, his psychotherapeutic pattern, thus emerged in fragments from dialogue with
developed in steady dialogue with the circle of close colleagues and with patients, dialogue in which
colleagues who made up the psychiatry faculty, truth was either new or not at all. Whitaker’s
was called experiential therapy. In 1953, with theory is dialectic and condensed into ironic,

Whitaker, Carl 1049
koan-like aphorisms. Such aphorisms, although meant using ambiguous words to destabilize rigid
never fully definable, stimulate reflection and living patterns and to increase possibility where
reveal possibilities. none existed. Play therapy became his model for
“The only you I know is me” is an example of family therapy. Most of the play was with
an aphorism: This comment on the limitations of language and relational formulations: for example,
being an “I” in relation to other “I’s” attempts to “We are all schizophrenic.” To the husband
coach in the dynamic art of integrity. In the year complaining that his wife is too controlling, he
after his death, many who talked and wrote about would say, “How did you trick her into taking
Whitaker said that they had come to know them- charge?” He used language more like an artist than
selves better from knowing him. How can I get to like a social scientist. Artists are transgressors:
know myself better from knowing someone else? They challenge the rules for seeing, disrupt
This question is at the heart of the process of standardized ways of thinking, and create new
Whitaker’s experiential therapy. possibilities. In that sense, Whitaker was an artist,
In Whitaker’s way of thinking, attention to the a clinically responsible artist.
self of the therapist is vital to effective therapy Salvadore Minuchin and Whitaker were mutu-
because, as noted in another of his reflection- ally appreciative dynamic teachers, conceptualizers,
inducing ideas, the dynamics of therapy emerges and practitioners. Minuchin once said that he was
from the personhood of the therapist. Therapists fascinated with what Whitaker did as a therapist
learn first to pay attention to psychosomatic (body but that the problem with his symbolic experien-
and mind) responses that occur during interviews. tial style is that it “couldn’t be taught.” Then, a
Then, they learn how to make use of these nonra- month or so later, Whitaker articulated a new
tional responses in therapeutic work. Although aphorism, which became a mantra: “What’s worth
logic and reason are games invented by humans in knowing can’t be taught. It must be learned.”
the interest of understanding, we come to believe With this in mind, it is possible to understand
that logic and reason are a part of nature. that while Whitaker’s influence was wide not many
Whitaker’s primary reality in therapeutic work learned to do what he did. He encouraged practi-
was ironic and metaphorical—that is, nonrational. tioners to value their own ideas and creativity.
Whitaker always characterized himself as com- While his methods are inviting, they tend to be
monplace: a farmer, a garage mechanic, a folk destabilizing or perturbing to both families and
singer. All of these persons become skilled at their therapists and therefore may be difficult to assimi-
work by doing it, by cultivating the capability for late. His pattern of working was not based on
figuring things out founded on inner intelligence as well-formulated theory but on clinical experience
opposed to outside authority. He never made plus an amalgam of psychoanalyses, Zen, fairy
himself a model for how to do it right. He used tales, existential philosophy, theology, theater of
himself as a model for how to struggle with life, the absurd, and more.
how to invest in staying alive.
He was a therapeutic troubadour, a folk singer David V. Keith
whose lyrics were down-to-earth. He might say to
See also Experiential Psychotherapy; Minuchin, Salvador;
a patient, “Your problem is you aren’t crazy Symbolic Experiential Family Therapy
enough” or “Do you think your dad might be
jealous of the fun you have with your mom?” His
language/music was deceptively simple on the sur- Further Readings
face, but the chord structure was complex, subtle, Betz, B., & Whitehorn, J. (1975). Effective psychotherapy
and rhizomal (growing, linking) underneath. with the schizophrenic patient. New York, NY: Jason
One of the qualities many relished in Whitaker Aronson.
was his unusual capacity to work and be playful Keith, D. (2014). Continuing the experiential approach of
with chaotic families and people who were deeply Carl Whitaker: Process, practice, and magic. Phoenix,
distressed. He used the ambiguous words crazy or AZ: Zeig, Tucker & Thiessen.
craziness to mean alive, creative, distressed, loving, Napier, A., & Whitaker, C. (1978). The family crucible.
and/or lonely. Part of play therapy with language New York, NY: Harper & Row.

1050 White, Michael
Neil, J., & Kniskern, D. (1982). From psyche to system: cultural norms, discourse, and dominant beliefs of
The evolving therapy of Carl Whitaker. New York, what constituted normalized personhood. The
NY: Guilford Press. therapeutic practice of viewing the problem in this
Whitaker, C. (1989). Midnight musings of a family context was called externalizing the problem.
therapist (M. Ryan, Ed.). New York, NY: W. W. Norton. White’s therapeutic practice of externalizing
Whitaker, C., & Bumberry, W. (1988). Dancing with the problems set out to separate the client from the
family: A symbolic-experiential approach. New York, problem and/or the restraints that maintained the
NY: Brunner Mazel. dominant discourse (of problematic stories) about
Whitaker, C., & Malone, T. (1993). The roots of
the problem. In White’s therapeutic world, the
psychotherapy. New York, NY: Blakiston. (Original
problem was given a name and located outside the
work published 1953)
client or relationship that had been objectified,
identified, and specified.
White perceived that persons and their relation-
ships and the troubles they encountered were
WHITE, MICHAEL “productions” of modern culture—as persons
acted to reproduce the dominant ideas of what
Michael White (1949–2008) was a psychothera- they perceived the “proper” worker, parent, son or
pist and the founder of narrative therapy. At the daughter, or roles in an intimate relationship to be.
heart of White’s practice of narrative therapy was He felt that these cultural productions (and the
an unswerving commitment to not individualize or identity stories told and internalized) were “thin”
locate the origins of problems inside the client’s conclusions as to the client’s identity and who the
body. This radical therapeutic departure from the client might become. White worked to rescue
central tenets of 150 years of psychological, psy- people’s unaccounted-for stories, abilities, and/or
chiatric, and scientific understandings of mental knowledge that allowed them to survive traumatic
health affords narrative therapy a unique position problems. He also explored their response to
within psychology’s therapeutic landscape. trauma through researching qualities that allowed
Much has been written about the “magic,” them to act outside of the problem and resist the
“difference,” and “mystique” of White’s practice problem’s definition of them (i.e., as a less than
of narrative therapy. What made his narrative worthy person). White’s work was viewed as a
therapy practice different from what had preceded therapy that acted to more fully appreciate the
him was his decision to embrace the enormous often undertold stories of a client’s life. He also
body of scholarship directed toward uncovering viewed problems as being shaped within a context
the ideological, political, and ethical biases under- of structural inequalities and believed that a
lying the authority for psychological knowledge person’s position within the social hierarchy—such
and rewriting how problems originate in client as class, gender, sexual orientation, money,
lives and relationships. privilege, and race—had a direct influence on
White’s philosophical turn away from psycho- problem making.
logical theory, along with his deft ability to White felt that therapy was a political act. For
translate the “high” disciplines of poststructural the theoretical positions that guided his political
theory into a helpful day-to-day practice of and narrative practice, he turned to the disciplines
therapy, jettisoned him onto the world stage and and understandings of postmodern anthropology
toward international notoriety. Many have gone and the poststructural French philosophical works
so far as to categorize narrative therapy as the of Michel Foucault and Jacques Derrida. He also
field’s first postpsychological therapy. utilized feminist, queer, and postcolonial theories
White’s work was committed to not locating the to explain the foundations of his therapy practice.
source of any mental health problem solely inside They found that the prevailing ways of describing
the client’s body. His practice followed a simple clients were culture-based constructs shaped by
belief that “the person was the person, and the larger institutional knowledges like religion,
problem was the problem” and that the person and media, psychiatry, education, law, science, and
his or her related “problems” were mediated by government. They also realized that the majority

White, Michael 1051
of our psychological practice ideas were not developed into the international journal and a
truths but taken-for-granted ideas produced book that became a central text for narrative
through the institutions’ knowledge and power therapy.
practices and consequently reproduced by the From the beginning, a central poststructural
citizenry. For example, White began to question tenet of narrative therapy was the idea that we, as
how a large majority of therapists were locating persons, are multistoried. Simply stated, narrative
what was being newly called attention-deficit/ therapists took up the position that within the
hyperactivity disorder directly inside young persons’ context of therapy there could be numerous
bodies, thereby leaving any contextual factors interpretations about persons and problems. And
(e.g., increasing class size, ongoing financial cuts the interpretations of persons and problems that
to education, lack of exercise) outside of the diag- therapists bring forth are mediated through the
nosis or of the story being told. White perceived prevailing ideas held by our culture regarding the
the hard-and-fast ideas being inscribed on the specifics of who and what these persons and
young person’s bodies and identities as historical, problems are and what they represent (e.g., normal/
having been negotiated throughout many different abnormal, good/bad, worthy/unworthy). For
cultural arenas. Despite the questions narrative example, White brought to our attention that, in
therapy raised regarding the structuralist or relation to incest, the dominant knowledges that
individualist foundations of modern psychology influence women in the construction of their
and their noncontextualized treatment and identities are embedded within patriarchal ideol-
understanding of issues such as attention-deficit/ ogy and helped along through popular forms
hyperactivity disorder, the therapy field continued of psychiatry that diagnose and classify. White
to view White as one of the most important and viewed these ideologies as the traditional
highly skilled therapists of his generation. linguistic and epistemological contexts in which
In the early 1970s, White began his studies as an incest has traditionally been located, written
engineering draftsman. Becoming disenchanted, he about, and treated.
drifted into social work and completed his B.S.W. In formulating his ideas about trauma and
(the highest level of education he achieved). White incest and conversing with numerous clients who
then sought out training in family therapy, where had experienced incest and its traumatic effects,
his early influences included systems theory, com- White relied on his therapeutic concepts of exter-
munication theory, and second-order cybernetics, nalizing problem stories (separating the person’s
with individuals such as Gregory Bateson at the identity from the problem as well as from the
Mental Research Institute in Palo Alto, California. actions of the person who perpetrated the problem
White first worked in mental health services, in trauma) and of re-authoring (revising the stories
both a psychiatric hospital and a child guidance that people internalized about themselves). White
clinic. He began practicing family therapy while also developed his idea of double listening, which
employed at a children’s hospital, working with is listening to the accounts of what happened as
the families of young people who were inpatients well as how the person responded to what hap-
in the psychiatric ward. During his 6 years at the pened. For instance, in addition to hearing the
hospital, the development of narrative ideas story of trauma, the narrative therapist will engage
emerged. He then moved from the public hospital in “double listening” to an individual’s expression
system to private practice, and in 1983, he founded of his or her trauma by recognizing the degree to
the Dulwich Centre in Adelaide, Australia. During which the individual is protesting the trauma
this time, he also established the Australian Family through expressions of depression, cutting oneself,
Therapy Journal. In December 1983, he and his risky behavior, and so on. White believed that a
wife, Cheryl White, began the International Journal person’s expressions in response to the trauma
of Narrative Therapy and Community Work. The could be considered a direct reflection of the
journal’s publication began as a newssheet to degree to which the person feels violated and that
advertise a speaking event, but then, it grew from they are also a mechanism of demonstrating the
including short summaries of free talks given at individual’s ethical beliefs about the act of being
Dulwich Centre into a newsletter, and eventually, it violated in general.

1052 Winnicott, Donald
From White’s narrative therapy perspective, the White, M. (1988). The externalizing of the problem and
professional stories we tell about persons and the re-authoring of lives and relationships. In M.
problems are viewed not as factual or natural but White (Ed.), Selected papers (pp. 5–28). Adelaide, AU:
as constructs shaped by larger institutional knowl- Dulwich Centre.
edges like religion, media, psychiatry, science, and White, M. (1988). Selected papers. Adelaide, AU: Dulwich
government. For example, our thoughts on how Centre.
we interact with the identities of a transgendered
person, a corporate business person, a gang
member, or a young person diagnosed with atten-
tion deficit disorder are viewed as being under the WILDERNESS THERAPY
influence of socially constructed, agreed-on points
of view and assembled through societal ideas See Adventure-Based Therapy
about who we believe these people “really” are.
Narrative therapy argues that there can be (and
always are) multiple stories about persons and
problems. Keeping this in mind, narrative therapy WINNICOTT, DONALD
critiques all forms of the Diagnostic and Statistical
Manual of Mental Disorders’ diagnostic technology, Donald Winnicott (1896–1971), the British pediatri-
assessment tools, or any attempt by a professional cian and psychoanalyst, was a key figure in the devel-
therapist to reduce a person’s identity to a solitary, opment of object relations theory, one of the most
unified pathological definition. influential of the contemporary psychodynamic-
Through publishing White’s early works, as well based therapies. Object relations theory modified
as the works of the co-originator of these ideas, classical Freudian theory by shifting the locus of
David Epston, the Dulwich Centre Publications in personality development from the unfolding of bio-
Adelaide, Australia, introduced the reader to a logical instincts to the quality of one’s early relation-
plethora of fresh ideas on therapeutic letter writing, ships. As an object relations theorist, Winnicott
rites of passage, unique outcomes, relative-influence sought to explain how, through early interactions
questions, therapeutic documents, externalizing with caregivers, an infant comes to develop and
conversations, alternative or subordinate story lines, experience a sense of self separate from the world
and a wide variety of curiosities and inquiries—all around it. For Winnicott, it was the quality of one’s
designed and communicated through narrative relationships that determined the measure of one’s
questions and letter writing and originating from a health and maturity.
new form of therapeutic grammar. In continuity with his theory, one could seek the
Numerous narrative therapy teaching, confer- sources of Winnicott’s ideas in his own develop-
ence, training, and practice centers have developed mental history. Born in Plymouth, England,
in the five continents. Narrative therapy’s novel Winnicott was the third of three children born to a
critique of dominant psychological theory and wealthy merchant family involved in both civic
practice has recruited thousands of interested and religious activities. His family life provided
therapists worldwide. Winnicott with a certain economic and social sta-
bility. However, he described his father as caring
Stephen Madigan but busy and noted that his mother suffered from
depression. This meant that Winnicott’s early care-
See also Constructivist Therapies: Overview; Narrative
givers included not only his mother and father but
Therapy; Narrative Family Therapy
also his older sisters and a nanny. Growing up in
this environment generated a desire in Winnicott
Further Readings to understand the influence of such early relation-
Epston, D. (1988). Collected papers. Adelaide, AU: ships on the formation of personality.
Dulwich Centre. Winnicott credited his early home life with pro-
Madigan, S. (2011). Narrative therapy: Theory and practice. viding him a basic sense of hopefulness about life
New York, NY: American Psychological Association Press. and its possibilities. He further credited his early

Winnicott, Donald 1053
life with bequeathing to him the freedom to think environment” for healthy development to take
for himself. This freedom of thought was rein- place. For Winnicott, “holding” is a metaphor that
forced both by a home life deeply influenced by the refers to the totality of the mother’s care. When a
nonconformist tradition in religion and by an mother (figure) “holds” her child (or a therapist
education that highlighted the English valuing of “holds” a client’s emotional experience and
freedom (e.g., Wordsworth, Keats, Locke, the expression), the child (or client) is able to experi-
Magna Carta). Valuing the freedom to find one’s ence continuity in the expression of the self that
own voice not only became a defining quality of can endure the temporary disruptions of its
Winnicott’s character, but it would become a hall- psychic environment. Conversely, if the infant’s
mark of his psychological theory as well (i.e., his (or client’s) experience is not adequately held,
focus on the development of the true self vs. the ruptures in the development of the self occur.
false self). A related concept is Winnicott’s notion of the
Winnicott’s interest in how one’s early relation- “good enough mother.” What he seeks to capture
ships shape personality influenced his pursuit of in this term is the importance of a consistent yet
pediatrics as his vocation. Over the course of his not “perfect” interaction between the caregiver
career, Winnicott observed more than 60,000 cases and the emerging infant self if the infant is to come
of mothers and infants interacting. These close to grips with and function well in the external
observations, coupled with the ability to follow environment. If an infant had a caregiver that was
these children for several years, provided him first- always perfectly attuned to meeting the infant’s
hand data on how early interactions influenced every need, such a caregiver would ill prepare the
personality development. His desire to understand infant for the real world, in which needs are some-
more of the psychological dynamics at work in times frustrated; what one actually needs to
these interactions, as well as a desire to understand become a healthy, functional adult, according to
more about his own development, fueled a further Winnicott, is a “good enough mother.” Thus, the
interest in psychoanalysis. When compared with good enough mother (and the good enough thera-
his own close observations of mother–infant inter- pist) provides a safe, reliable environment that is
actions, Winnicott found psychoanalysis to be adequately attuned to the child’s (and client’s)
both helpful as well as restrictive in explaining emotional needs.
what he saw happening in these exchanges. His Another central concept from Winnicott is the
focus on the importance of these interactions met “transitional object” (and its correlates, transi-
with resistance from the two main camps in British tional phenomena and transitional space). In
psychoanalysis at that time. Those who followed observing how infants learn to tolerate the anxiety
Melanie Klein thought that Winnicott neglected attendant on the mother’s inevitable absences,
the power of the infant’s inner psychic life in shap- Winnicott noted that there is a kind of psychic
ing personality, whereas those who followed Anna middle ground (a transitional space) between the
Freud (daughter of Sigmund Freud) thought that external reality represented by the mother (and her
Winnicott downplayed the impact of biological absence) and the child’s inner reality (which can
drives. True to his valuing of independent thought, give rise to terrifying fantasies about such absences).
Winnicott was unable to align with either of these Winnicott observed that the infant makes use of
groups and began to develop a theory that was this intermediate space between inner and outer
faithful to his own experience as both a pediatri- reality by imbuing certain objects with special
cian and a psychoanalyst. He and several others character, motivation, and substance. These special
eventually established the “independent” tradition objects help the child transition between the times
in British object relations theory. of the mother’s presence and absence; the teddy
Winnicott’s way of expressing his insights has bear and the security blanket are well-known
given the field of psychoanalysis (and all of ther- illustrations of such objects. Whether one knows
apy to some extent) a rich language for describing this term for them or not, most people are well
some of the key processes in human development. aware of the child’s use of such objects. Winnicott
Concepts particularly associated with Winnicott has provided us a clear understanding of how such
include the need of a nurturing, reliable “holding objects function in the child’s emerging psychic life

1054 Writing Therapy
and their continued endurance into adulthood, well with research on the “common factors” in
where they are connected with the ability to play therapeutic change, which consistently identifies
and be creative. the therapeutic relationship as a leading factor.
One can see Winnicott’s legacy in therapy in the
idea that therapy is to be a safe, reliable place for Stephen Parker
exploration of the self. To the extent that current
therapy seeks to provide a safe, reliable place Classical Psychoanalytic Approaches: Overview;
where clients can express and explore their deepest Contemporary Psychodynamic-Based Therapies:
fears, pains, confusions, and desires, it functions as Overview; Freud, Sigmund; Freudian Psychoanalysis;
what Winnicott called a holding environment. The Interpersonal Psychoanalysis; Klein, Melanie; Object
client comes to experience the therapeutic alliance Relations Theory; Relational Psychoanalysis
as a place where these deep, and often frightening,
emotions can be “held” or contained so that they
Further Readings
will not overwhelm or destroy the person if
expressed. The concept of transitional objects also Abram, J. (2007). The language of Winnicott:
has applications to therapy. For Winnicott, the A dictionary of Winnicott’s use of words (2nd ed.).
therapeutic encounter is a transitional space in London, England: Karnac Books.
which the client can experiment (or “play”) with Parker, S. E. (2012). Winnicott and religion. Lanham,
new ways of being and relating. Similarly, the MD: Jason Aronson.
therapist might function as a transitional object Phillips, A. (1988). Winnicott. Cambridge, MA: Harvard
that helps the client tolerate the anxiety attendant University Press.
on transitions from these older ways of being and Tuber, S. (2008). Attachment, play, and authenticity:
relating to newer ones. A Winnicott primer. Lanham, MD: Jason Aronson.
Further Winnicottian concepts that resonate Winnicott, D. W. (1965). Maturational processes and the
facilitating environment. Madison, CT: International
with other therapeutic approaches are his notion
Universities Press.
that therapy is to provide a space for the emer-
Winnicott, D. W. (1971). Playing and reality. London,
gence of authentic living (i.e., the true self vs. the
England: Routledge.
false self) and his concept that the ability to “play”
and be creative is a measure of health. With regard
to the latter, one might note that Winnicott has
added to Freud’s definition of health and maturity
as the ability to love and work a reminder that WRITING THERAPY
play is also a measure of health and maturity.
Winnicott is the most cited psychoanalytical Writing therapy, also called therapeutic writing,
theorist after Freud. He and the other object involves the expression of one’s thoughts and feel-
relations theorists were at the forefront of ings through the act of writing. Writing therapy is
demonstrating the importance of early relation- flexible and can be performed individually, in
ships and how these are reenacted in therapy. groups, and via distance counseling. It is adaptable
Winnicott reminds us that therapy is first and to many theoretical orientations, including psycho-
foremost a relationship and that therapeutic dynamic, cognitive-behavioral, solution-focused,
change is governed in large measure by the quality and narrative theories. Writing therapy interven-
of the therapeutic relationship. Most of those tions are often in the form of assignments in which
who practice contemporary psychoanalytic or the therapist prompts the clients to compose a letter
psychodynamic-oriented therapy work from some or e-mail, journal entry, short story, poem or haiku,
sort of interpersonal or relational perspective. or other forms of the written word. This approach
Object relations theory also influenced John involves reflection, self-disclosure, creativity, and
Bowlby’s work on early attachments, which influ- expressiveness. Writing therapy can be used to
enced the contemporary clinical work of many address a variety of emotional concerns. Some
others. Finally, one can note that Winnicott’s focus mental health issues in which writing therapy has
on the quality of one’s relationships comports been frequently employed are grief and loss, trauma,

Writing Therapy 1055
substance abuse, disordered eating, depression, and In recent decades, writing therapy has been most
anxiety. Therapeutic writing is most often assigned frequently associated with cognitive-behavioral and
as an adjunct to traditional, face-to-face counseling solution-focused theories. Structured writing assign-
and psychotherapy, and it has demonstrated ments are often given to the client to complete as a
benefits in both physical and emotional health. supplement to counseling sessions, as “homework”
between sessions, and/or to keep track of one’s
thoughts and feelings. An example might be
Historical Context
composing journal/diary entries or writing a letter
The practice of writing as a therapeutic interven- to a deceased relative. Therapeutic writing can also
tion dates to the 1950s, and possibly even earlier. be linked to both rational emotive behavior therapy
Free writing was the first technique to be system- and Adlerian therapy, in which a client examines his
atically studied by Fred McKinney in the 1950s for or her own belief system in an effort to reflect and
its utility in addressing personal adjustment issues. explore irrational thoughts and increase insight.
Four of McKinney’s graduate students also exam- Additionally, writing therapy is congruent with the
ined variations of his original writing protocol in narrative theoretical approach, as therapists can
separate studies. Around the same time when help clients address life experiences and personal
McKinney began studying free writing, Albert Ellis perspectives in an attempt to “restory” aspects of
discussed the practice of journal or diary writing their life in a more positive and beneficial way by
by his clients between sessions to process life facilitating therapeutic writing assignments. Given
events in an unstructured manner. In the following its versatility, therapeutic writing can be adapted
decades, writing assignments became more struc- and utilized as a technique in a variety of ways by
tured and formal, as researchers studied writing therapists from a range of theoretical orientations.
therapy’s effectiveness in reducing emotional and
physical distress (e.g., Maultsby examined the
Major Concepts
helpfulness of written homework assignments for
his psychotherapy patients in the 1970s). In the Writing therapy is a form of expressive therapy in
1970s, a physician named James Pennebaker which a client uses the written word to communi-
began examining expressive writing as a therapeu- cate his or her thoughts and feelings, borrowing
tic tool and developed a writing paradigm, the from a range of familiar writing forms, such as
Pennebaker Writing Paradigm, which he and many journaling (diary writing), poetry writing, or free
others have utilized in research studies to deter- writing. Expressive therapies involve creativity, self-
mine whether writing interventions are associated disclosure, and reflection, which make therapeutic
with positive health and emotional benefits. Over writing a flexible tool on a broad spectrum from
the past 40 years, therapeutic writing has grown in informal and unstructured expressions to formal
popularity in the United States and Europe due to and highly structured assignments. As writing ther-
its convenience, adaptability, and effectiveness. apy can be linked to a variety of counseling theories,
Writing therapy is utilized by professionals in vari- the implementation of writing assignments such as
ous disciplines for a broad range of issues, and format and interpretation may vary depending on
through distance counseling, it has transcended the theoretical orientation of the therapist. The
into the digital age of mental health services. underlying assumption in writing therapy is that a
client’s distress can be relieved by written expression
and disclosure, regardless of the form (e.g., journal,
poem, or short story). Additional concepts and
Writing therapy developed as an expressive practice techniques are discussed in the following section.
to address the underlying emotional needs, interper-
sonal concerns, and events that negatively affected
Techniques
the client. Also referred to as free writing or expres-
sive writing, writing therapy initially evolved from There are a variety of methods for assigning
a psychoanalytical framework and was assigned therapeutic writing in counseling. Depending on
with little structure and prompting by therapists. the objective, the therapist might offer very little

1056 Writing Therapy
direction to the client, suggesting an unstructured such as how often to write and on what subject, or
assignment. Examples of unstructured writing the therapist may suggest less structured writing.
therapy include free writing and expressive or The client may bring his or her writing to the fol-
creative writing, such as poetry and stories. lowing session or e-mail the assignment, depending
Alternatively, the therapist may offer very specific on the nature of the counseling relationship
directions to the client. For example, the client may (i.e., distance or in-person). Then, the therapist
be instructed to write daily in a journal or diary might offer feedback to the client, or the writing
describing his or her mood and situational factors. may serve as a facilitative starting point for further
Other structured assignments include letter writing in-session discussion. Writing therapy can also serve
and the Pennebaker Writing Paradigm, which as a supplement to traditional psychotherapy,
assigns the client to write about his or her thoughts depending on the nature of the client’s concerns as
and feelings for 15 to 30 minutes each day for 3 to well as the style and approach of the therapist or
5 consecutive days. This paradigm includes a stan- mental health professional. Therapeutic writing is an
dard prompt and is the most frequently used ongoing process, and its facilitation can be adapted
assignment in research studies about writing to meet the needs of individual clients or groups.
therapy. Therapeutic writing therapy can occur
asynchronously (i.e., at different times) or in vivo Gina B. Polychronopoulos
(e.g., during group sessions), can be handwritten
See also Creative Arts and Expressive Therapies:
or typed, and can be practiced face-to-face or via Overview; Narrative Therapy; Poetry Therapy
distance counseling.
Further Readings
Therapeutic Process
Cooper, P. (2012). Can the use of writing lower
Because it is highly flexible, writing therapy can be rumination of negative thoughts in depressed adults?
tailored to meet clients’ and therapists’ needs. International Journal of Therapy and Rehabilitation,
Writing is often used as an adjunct to traditional, 19(1), 43–52.
face-to-face psychotherapy; however, it may also L’Abate, L. (1991). The use of writing in psychotherapy.
be used as an alternative to in-person sessions or American Journal of Psychotherapy, 45(1), 87–98.
via distance counseling. Typically, the therapist Pennebaker, J. W. (1997). Writing about emotional
suggests a writing assignment, which the client experiences as a therapeutic process. Psychological
completes outside the counseling session at his or Science, 8(3), 162–166. doi:10.1111/j.1467-9280
her own pace. There may be specific instructions, .1997.tb00403.x

Y
interest in group therapy and by his search for an
YALOM, IRVIN empirically based approach to determining the
efficacy of the various schools of therapy.
Irvin David Yalom (1931– ), a psychiatrist, textbook After Johns Hopkins, Yalom served in the
author, and novelist, was born on June 13, 1931, armed forces in Hawaii from 1960 to 1962. He
to Russian immigrant parents in Washington, then joined the department of psychiatry at the
D.C. He grew up in a small apartment above his Stanford University School of Medicine, where
parents’ grocery store, located at that time in the in 1977 he became a fellow in the Stanford
segregated African American section of inner-city Center for Advanced Study in the Behavioral
Washington. His neighborhood was perilous, and Sciences. In 1994, he became professor emeritus
as a child, Yalom sought refuge from life on the at Stanford University School of Medicine, a
streets by turning to the inspiration, wisdom, and position he continues to hold today.
alternate world offered by literature. Twice a Academically, Yalom has received several
week, he biked to the library to stock up on honors and awards. In 2002, the American
books, where he once spent a year reading through Psychiatric Association awarded Yalom the Oscar
a biography bookcase from A (John Adams) to Pfister Award for contributions to religion and
Z (Zoroaster). During this time, he developed the psychiatry. He received a Fellowship Award from
notion that writing a novel is the finest thing a the Rockefeller Foundation in Bellagio, Italy,
person can do. in 1988.
Due to the culturally limited professional choices Yalom’s fascination with psychiatry stems from
for children of immigrants during this time period, a curiosity and interest in the story that will unfold
Yalom decided to pursue a career in medicine. with each patient. His central belief in approaching
After completing his undergraduate studies at this work is that therapy must be individually
George Washington University, he entered medical tailored to each patient depending on the person’s
training at Boston University School of Medicine, unique story, bringing an existential approach in
having already decided to study psychiatry. After close proximity with Adlerian Individual
receiving is doctor of medicine degree, he trained Psychology. This philosophy is in contrast to the
as an intern at Mount Sinai Hospital in New York symptom-based, de-individualizing, diagnostic and
and then in psychiatry at the Phipps Clinic at Johns protocol-driven therapeutic culture currently
Hopkins Hospital in Baltimore, Maryland. While popular in the United States. His work suggests
studying at Johns Hopkins, Yalom worked closely that a generic approach to therapy is not applicable
with Jerome Frank, who taught there for many to all patients or to all problems encountered in
years. Yalom was highly influenced by Frank’s psychiatry, and for that matter in medicine.
1057

1058 Yalom, Irvin
Yalom has written several important psychiatric Club Gold Medal Award for the best novel in
textbooks. In 1970, he wrote The Theory and 1992, and it was chosen by the mayor of Vienna,
Practice of Group Psychotherapy, which continues Austria, as Book of the Year for distribution to the
to be the standard textbook in the field and has general public in 2009. Lying on the Couch uses
been widely used for training therapists from many the lives of three psychotherapists to explore
different backgrounds. It is now in its fifth edition themes of transference, countertransference, and
and has been translated into 12 languages. It is self-disclosure in the therapeutic setting. The
based on empirical evidence but utilizes storytell- Schopenhauer Cure discusses the technique of
ing in the form of human vignettes throughout the group psychotherapy. One group member’s char-
text, which creates accessibility and enhances its acter is modeled on Arthur Schopenhauer, a misan-
effectiveness as a teaching tool. thrope who ended up being altered by the power
In 1980, Yalom wrote a second textbook, of the group experience. The novel fluctuates
Existential Psychotherapy, which also became a between the stories of the patients’ lives in the
standard in the field. In 1983, he completed group and Schopenhauer’s biography and teach-
Inpatient Group Psychotherapy, which discusses ings. Yalom’s latest novel, The Spinoza Problem,
how to lead groups in an inpatient psychiatric explores the themes of humanistic enlightenment
ward. From the publication of Inpatient Group and fascistic thought and practices.
Psychotherapy to the present day, Yalom’s writing His novels have had great commercial success
has turned toward more creative efforts, though he and noteworthy financial success for psychiatric
has never abandoned his focus on teaching and on writings. Many have been best sellers among a
themes surrounding psychotherapy. general audience and have been translated into
In 1974, Yalom wrote Every Day Gets a Little more than 15 languages.
Closer, which was the product of a collaboration Each of these works melds aspects of clinical
with one of his patients who was also a writer. practice, philosophy, and narrative together, dem-
Based on Yalom’s and the patient’s summaries of onstrating Yalom’s skill as a clinician, writer, and
their therapeutic sessions, the book shows how the teacher. Both his textbooks and his creative works
relationship between the psychiatrist and the provide a rare glimpse into the inner workings of
patient develops. This was the first of Yalom’s the minds of the patient and the therapist. The
work to expose the inner life and musings of the insight into how clinical problems are thought
therapist, an enterprise that was previously nonex- through and the frustrations and successes associ-
istent in the psychiatry field and one that he has ated with the process creates a powerful teaching
continued in his later nonfiction and fiction works. tool. Yalom’s courage in exposing his own likes
Yalom has utilized creative narrative as a tool to and dislikes within these works is unprecedented
elucidate the more personal and deeper layers of in psychiatric literature. He not only unveils the
psychotherapy and psychiatry, thus creating a new inner workings of psychotherapy through his
creative literary genre, the teaching novel. Beginning writing, but he also questions technical interventions
in 1974, when he wrote A Twice Told Therapy, and encourages using the therapeutic relationship
which presents a fictionalized case history, he has itself as an emotional compass.
continued to write fiction that shows the inner More recently, Yalom has turned to brief
workings of the complex enterprise that is now presentations of useful maneuvers in therapy with
called psychotherapy. In 1989, he produced Love’s books such as Momma and the Meaning of Life:
Executioner, a collection of fictionalized cases. He Tales of Psychotherapy (2000) and The Gift of
has written four novels that focus on themes in Therapy: An Open Letter to a New Generation of
psychotherapy: When Nietzsche Wept (1993), Therapists and Their Patients (2009). Both of these
Lying on the Couch (1997), The Schopenhauer collections contain many gems of practical advice,
Cure (2005), and The Spinoza Problem (2012). which help even the most accomplished therapists
When Nietzsche Wept tells a fictional story of to more finely hone their craft.
how psychotherapy was invented and presents the Yalom’s dual identity as a doctor and a writer
foundations of both depth analytic technique and has enhanced his skill in both fields. He approaches
existential therapy. It won the Commonwealth his work with patients much like how he presents

Yoga Movement Therapy 1059
his fictional creative characters—with a focus on Historical Context

the individual narrative and on the complexities
Yoga is an ancient science of health for the
that make each person uniquely human.
physical body and balance for the mind and emo-
Hans Steiner and Rebecca Hall tions. Yoga has rich philosophical origins, which
include detailed theories of human development,
See also Adlerian Therapy; Existential Therapy; the spiritual journey, suffering, and enlightenment.
Existential-Humanistic Therapies: Overview; Group Ultimately, yoga is described as the union between
Counseling and Psychotherapy Theories: Overview the individual self and the universal Self, or that of
divinity. It is by this union that humans can reach
Further Readings their full potential.
Yoga has been traced back more than 5,000 years
Steiner, H. (1996). Treating adolescents. San Francisco,
to the ancient Indus and Sarasvati regions, which are
CA: Jossey-Bass.
in Pakistan and India today. Early spiritual and
Steiner, H. (2011). Handbook of developmental
philosophical texts, the Vedas and the Upanishads,
psychiatry. Singapore: World Scientific.
Steiner, H. (2012). Laudatio for Irvin David Yalom, MD.
provided the introductory beliefs of the yogic tradi-
Z. f. Individualpsychol, 37, 293–304. doi:10.13109/
tion. Over thousands of years, yoga has emerged as
zind.2012.37.3.293 an integration of spiritual practices with origins in
Yalom, I. D. (1970). The theory and practice of group many religions, such as Hinduism, Buddhism, and
psychotherapy. New York, NY: Basic Books. Jainism. Later in the 2nd century BCE, Patanjali, a
Yalom, I. D. (1980). Existential psychotherapy. New York, sage and yogi, developed the Yoga Sutras, which
NY: Basic Books. became the foundational model of Yoga philosophy
Yalom, I. D. (1983). Inpatient group psychotherapy. and practice. In the late 1800s, several yoga gurus
New York, NY: Basic Books. transformed yoga to include a more substantial
physical practice that more holistically unites the
body, the mind and emotions, and the spirit.
YOGA MOVEMENT THERAPY Fast forward to the 21st century in the West,
where the general understanding of yoga has been
reduced to the physical postures, called asanas,
Movement therapy can be considered a high-level
which are either used for the purposes of stretching
term to identify a group of therapies that assume
and relaxing or are so complex that they require
mind–body unity and that emphasize physical
extreme flexibility and strength. While the physical
awareness and movement as a therapeutic factor.
postures are integral and contribute to a flexible
At the core of their beliefs is the notion that our
body and calm mind, hatha yoga is a comprehensive
emotional and cognitive experiences are connected
philosophy and practice that leads a person toward
to our physical bodies; therefore, interventions to
greater overall well-being and enlightenment.
heal thoughts, emotions, and behavior must inte-
The empirical support for hatha yoga as a
grate movement and awareness of the body. The
therapeutic intervention for mental and physical
increase of research in the fields of psychology and
disorders has increased in recent years. Studies
neuroscience has well documented that the pro-
have shown indisputable benefits of yoga in the
cesses of the mind and the body are inseparable.
treatment of disorders such as depression, anxiety,
This discovery prompted the increase in empirical
attention deficit disorder, insomnia, and eating
research on movement therapies. Included in the
disorders.
category of movement therapies, but not limited to
it, are yoga, dance therapy, and qigong. This entry
focuses on yoga as a movement therapy, with par-
ticular emphasis on hatha yoga, which has deep
roots in Yoga philosophy. It is difficult to carve out Movement therapy is driven by a number of Yoga
the implications of therapeutic movement within concepts, including kleshas, koshas, and eight
hatha yoga, so it is highlighted in the context of the limbs. The following subsections offer brief
overarching purpose and process of hatha yoga. descriptions of these concepts.

1060 Yoga Movement Therapy
Kleshas the kleshas at each of the koshas, or aspects of the

person. The eight limbs are described in the
The sage and yogi Patanjali created the Yoga
“Techniques” section, with emphasis on the fourth
Sutras, which is a text containing 196 adages that
limb, asana, which is the aspect of hatha yoga that
describe Yoga philosophy and practice. He
focuses on therapeutic movement.
describes the goals of yoga as (a) knowledge of the
self and (b) cessation of mental fluctuations.
Knowledge of the self can be defined as attaining Major Concepts
unification of mind, body, and spirit; achieving
The principles of hatha yoga complement the
self-awareness; and ceasing mental fluctuations. In
ultimate goals of therapy, which are often self-
yoga, mental fluctuations refer to the dysfunc-
awareness, self-acceptance, and self-efficacy. While
tional ways we think, emote, and behave. When a
hatha yoga is a holistic approach to wellness, the
person is lacking self-knowledge and awareness,
application of yoga as a movement therapy alone
the mental fluctuations transform to kleshas, or
can propel a person toward wellness and healing.
mental afflictions, which are the unconscious pat-
The essential concept of movement is that the
terns of the mind. The kleshas lead to dis-ease,
mind and the body are inseparable and what
separation, and suffering. Much of this separation
affects one will affect the other. Symptoms of
occurs at the unconscious level and has been
mental disorders not only affect the functions of
created by a history of conditioned responses,
the mind and the emotions but also manifest
behaviors, and emotions at the level of the person’s
themselves in parts of the body such as the muscles
experiences, family, society, and culture. Yoga
and the fascia and negatively affect the functions
provides a way out of this suffering and toward a
of systems of the body such as the nervous, endo-
different understanding of self and universe.
crine, and immune systems. At the foundation of
movement therapies is the notion that conscious,
Koshas
mindful, intentional movements paired with breath
Yoga philosophy postulates that there are five practices will bring balance to the body and offer
layers or facets of human beings: (1) physical, an entryway into the mind and the emotions.
(2) energetic, (3) psychoemotional, (4) wisdom, and
(5) bliss. These levels form the road map for the
Techniques
journey of self-discovery. Unity occurs when all
five levels are in complete integration and balance, The following techniques are the eight limbs
while dis-ease emerges as the result of separation at developed by Patanjali in the Yoga Sutras. When
any of the five levels. Separation at any of the koshas these techniques are practiced, the person will
is as a result of the kleshas, which are the mental become balanced at each kosha layer, with the goal
fluctuations of the mind previously discussed. of minimizing and extinguishing the kleshas. These
techniques are the practical applications that
Eight Limbs emerged from Yoga philosophy. The eight limbs
are briefly described, with special consideration to
Hatha yoga is a recipe for mental peace and the third limb, asana, or therapeutic movement.
freedom from the conditioned responses resulting
from difficult life experiences. The practices of liv-
ing well in relation to self and others, exercising Yama
the body, and controlling the breath are some of The five yamas are ways of ethical living in the
the steps on this path. After those practices are context of one’s relationship with the world.
mastered, more concentrative and meditative
activities round out a collection of yoga practices
Niyama
that heal the person holistically. Patanjali describes
this process as an eight-limbed, nonlinear pathway The five niyamas are personal practices and are
that guides a person toward well-being and enlight- focused on the ways in which people engage in
enment. The practice of the eight limbs reconciles self-care.

Yoga Movement Therapy 1061
Asana or Therapeutic Movement especially asanas, is a trusting, flexible, and non-

judgmental relationship between the professional
Asanas are the physical postures practiced in
and the client. After an assessment of the client’s
hatha yoga. The physical postures have many effects
physical and psychological state, the professional
on the body, especially regulating systems that are
will determine the most appropriate hatha yoga
affected negatively by the stress response. The
techniques and poses and then teach them to the
benefits of practicing the physical movements, or
client with the goal of practicing independently.
asanas, in hatha yoga are numerous. They include,
Daily practice renders the most benefit; however,
but are not limited to, the following: (a) improving
practice at least three to four times a week aids
immune system functioning, (b) improving breath-
in reduction of symptoms and greater overall
ing patterns, (c) increasing circulation, (d) relaxing
well-being.
and improving the functions of the nervous system,
This briefly describes the process of working
(e) changing neurotransmitter levels, (f) lowering
with an experienced yoga professional. In the
the levels of the stress hormone cortisol, (g) improv-
West, hatha yoga is often practiced in large groups,
ing bowel functioning, (h) improving psychological
with minimal individual attention. While this
health, and (i) relieving pain.
still has mental and physical benefits, for healing
a specific physical and/or psychological disorder, it
Pranayama is wise to consult a trained professional and work
Pranayama consists of simplistic to advanced individually or in small groups with classes
breath practices. that are specifically geared toward healing that
disorder.
Pratyahara Jana Whiddon
Pratyahara is the advanced practice of sensory See also Body-Mind Centering®; Concentrative
withdrawal to prepare for meditation. Movement Therapy; Dance Movement Therapy;
Feldenkrais Method; Integrative Body Psychotherapy
Dharana
Dharana is the practice of concentrative focus. Further Readings
Emerson, D., & Hopper, E. (2011). Overcoming trauma
Dhyana through yoga. Berkeley, CA: North Atlantic Books.
Forbes, B. (2011). Yoga for emotional balance. Boston,
Dhyana is the practice of extending the duration
MA: Shambhala.
of focus, as in meditation.
NurrieStearns, M., & NurrieStearns, R. (2010). Yoga for
anxiety: Meditations and practices for calming the
Samadhi body and mind. Oakland, CA: New Harbinger.
Patel, N. K., Newstead, A. H., & Ferrer, R. L. (2012).
Samadhi is when one’s object of internal focus
The effects of yoga on physical functioning and health
receives one’s full, complete, and undivided attention. related quality of life in older adults: A systematic
review and meta-analysis. Journal of Alternative and
Therapeutic Process Complementary Medicine, 18, 902–917. doi:10.1089/
acm.2011.0473
The integration of yoga techniques in professional Stoller, C. C., Greuel, J. H., Cimini, L. S., Fowler, M. S., &
settings, such as with a mental health counselor or Koomar, J. A. (2012). Effects of sensory-enhanced
physician, is in the early stages of development. yoga on symptoms of combat stress in deployed
Many professionals in the fields of psychology, military personnel. American Journal of
counseling, and medicine are becoming educated Occupational Therapy, 66(1), 59–68. doi:10.5014/
and trained to implement yoga techniques into ajot.2012.001230
traditional treatment protocols. At the core of Weintraub, A. (2012). Yoga skills for therapists.
the implementation of hatha yoga techniques, New York, NY: W. W. Norton.

1062 Yoga Movement Therapy
West, J., Otte, C., Geher, K., Johnson, J., & Mohr, D. C. Whiddon, J., & Bazini, A. (2011). The effects of
(2004). Effects of hatha yoga and African dance on hatha yoga in the treatment of depression.
perceived stress, affect, and salivary cortisol. Annals of Journal of Alternative Medicine Research, 3,
Behavioral Medicine, 28(2), 114–118. doi:10.1207/ 219–227. doi:10.1163/1234-5678_beh_
s15324796abm2802_6 com_000354

Z
psychology. He has taught for more than 50 years,
ZIMBARDO, PHILIP GEORGE retiring from Stanford in 2003. Additionally, he
has been a professor at Palo Alto University, the
Philip George Zimbardo (1933– ) is a social Pacific Graduate School of Psychology, the Naval
psychologist who, through a series on public Postgraduate School (in Monterey, California),
television, numerous publications, and ground- Yale University, New York University, and
breaking research—including the historic Stanford Columbia University. He served as president for
Prison Experiment—has become an international both the American Psychological Association and
spokesperson for the field of psychology. the Western Psychological Association. Through
Zimbardo was born on March 23, 1933, in his widely distributed public television video series,
New York City. His parents, George Zimbardo, an Discovering Psychology, and the teaching videos
electrician, and Margaret Bisicchia, immigrated that he produced, Zimbardo has introduced
from Cammarata, Italy, a village about 40 miles psychology to high school students, college
from Palermo, Sicily, and raised their four children students, and the public at large. It may be argued
in the ghetto of the South Bronx during the 1930s that Zimbardo has introduced psychology to
and 1940s. Zimbardo remembers having good more individuals in the world than anybody else
friends as a child but took notice of how the working in the field of psychology.
environment would negatively influence their Zimbardo has authored more than 300 profes-
behaviors. This recollection would later influence sional publications and 50 books, including a
his future work in the field of psychology. psychology textbook, Psychology and Life (now in
Zimbardo graduated from high school in its 19th edition), which is the longest running
1950 and received a B.A. in 1954 from Brooklyn published introductory psychology textbook. He is
College, where he majored in sociology/ an acclaimed expert on shyness and the abuse of
anthropology and psychology. Although he had power. His research interests have spanned trauma,
received a C in Introduction to Psychology, he cult behavior, politics, torture, terror, and evil, the
went on to earn an M.A. in 1955 and a Ph.D. in latter of which he has written about in The Lucifer
1959 from Yale University, both in psychology. Effect: Understanding How Good People Turn
While he was at Yale University, he had a strong Evil, a New York Times bestseller.
relationship with his advisor, Neal E. Miller, with In August 1971, Zimbardo conducted the
whom he coauthored a journal article published in Stanford Prison Experiment, a research experiment
the Journal of Child Psychology and Psychiatry, a that simulated a prison environment, with student
leading journal at the time. participants assuming the roles of prisoners and
In 1968, Zimbardo took a position at Stanford prison guards. The aim of the experiment, accord-
University, where he is now professor emeritus of ing to the Stanford Prison Experiment website, was
1063

1064 Zimbardo, Philip George
to “understand the development of norms and the having met all the American Psychological
effects of roles, labels, and social expectations in a Association ethical guidelines, Zimbardo reported
simulated prison environment.” Twenty-four male that this oversight contributed to a dual relation-
college students were selected and randomly ship that put the participants at risk, noting that
assigned to participate in the projected 2-week future researchers should not make a similar
study; however, the study was ended after only mistake. Zimbardo’s Stanford Prison Experiment
6 days because of ethical considerations. After continues to garner interest in the psychological
passing psychological wellness testing, half of the community. In 2005, a documentary DVD of the
student participants were assigned to act as study was released and has been used in training
“guards,” and the other half were assigned to act prison guards working in Iraq after the 2003–2004
as “prisoners.” They were paid $15 per day. human rights violations of prisoners at Abu Ghraib
Zimbardo initially instructed the guards to main- by the U.S. military.
tain law and order without using physical violence, Zimbardo has received many awards, including
noting that they would have total power in the the Vaclav Havel Foundation Prize, presented for
situation and the student prisoners would not have achievements in science. When he received this
any say. Subsequently, the student prisoners were award, he met with Havel and the president of
brought to the prison basement blindfolded to Iraq, Jalal Talabani. They discussed the conditions
confuse them about their whereabouts. Thereafter, of Iraqi prisons. Many individuals had come to
they were actually stripped and deloused, and the believe that the abuses at Abu Ghraib were real-life
degradation process began (i.e., the guards, because examples of the results from Zimbardo’s Stanford
of their position of power, made fun of the Prison Experiment. Zimbardo agreed with this and
prisoners). Over the course of the 6 days, the thereafter began to focus his work on heroism,
guards became oppressive, and the prisoners did testifying as an expert witness in the court martial
not support one another. One guard even consid- of Staff Sgt. Ivan “Chip” Frederick. Frederick had
ered leaving the project but did not. Half of the been the highest ranking officer implicated in the
prisoners left the project due to reported emotional Abu Ghraib scandal. Zimbardo argued for a lesser
or cognitive concerns. Unlike the guards, they were sentence; despite his testimony, a maximum 8-year
not allowed to leave on a daily basis. The study sentence was imposed on Frederick for abusing the
showed how power corrupts and how victims of Iraqi detainees. Zimbardo argued during the case
abuse do not stand up for themselves or other that the Stanford experiment had demonstrated
victims. Whereas the student guards had become that few people can withstand the situational
cruel and sadistic toward the prisoners (including pressures of a prison situation.
use of prohibited physical abuse), the prisoners Today, Zimbardo directs the Heroic Imagination
had become hopeless and depressed. Project, an organization that he founded to inspire
The study furthered the debate about the ethics heroism among ordinary people to become agents
of using human subjects, just as Stanley Milgram’s of social change. He also oversees the Zimbardo
study on the abuse of authority had done a decade Educational Foundation, which provides academic
earlier. Interestingly, like Zimbardo, Milgram had scholarships to students in his native ancestral
attended James Monroe High School in the Bronx homeland. His most recent book, coauthored with
and was interested in the power of social situations John Boyd, The Time Paradox, focuses on how
to overwhelm individuals. Zimbardo examined individuals develop orientations of time that
how individuals respond to being oppressed, manage the flow of past, present, and future
whether they would accept or act against it. His experiences into mental categories. He is particu-
study, like Milgram’s, brought about changes to larly interested in how the effects of unbalanced
ethical guidelines, thus introducing better safe- mental categories are either over- or underutilized
guards to protect human participants in psycho- according to the situation.
logical research. For example, Zimbardo had
taken the role of prison superintendent, a role that Jack D. Simons
he would later say he shouldn’t have assumed,
while also serving as primary investigator. Despite See also Seligman, Martin

Zimbardo, Philip George 1065
Further Readings Zimbardo, P. (2007). The Lucifer effect: Understanding

how good people turn evil. New York, NY: Random
Gerrig, R., & Zimbardo, P. G. (2010). Psychology and life
House.
(19th ed.). Boston, MA: Allyn & Bacon.
Zimbardo, P. G., & Boyd, J. N. (2008). The time
Zimbardo, P. G. (1972). The Stanford prison experiment:
paradox. New York, NY: Simon & Schuster.
A simulation study of the psychology of imprisonment.
Stanford, CA: Philip G. Zimbardo. Retrieved from
http://www.prisonexp.org/
Website
Zimbardo, P. G. (1991). Shyness: What it is, what to do about it.
Reading, MA: Perseus Press. (Original work published 1977) Stanford Prison Experiment: www.prisonexp.org/

Appendix A: Chronology
Select Moments in the History of 1911: Carl Jung becomes president of the
Counseling and Psychotherapy International Psychoanalytic Association.
1913: Carl Jung and Sigmund Freud part ways as

1870s: Jean-Martin Charcot begins research on
Jung develops his theory of analytical psychology.
conversion disorder and hysteria in France and
His ideas around the psychological types that
eventually treats it with hypnosis.
define a person’s usual way of functioning; a per-
sonal unconscious, which houses all repressed
1885: Sigmund Freud goes to Paris to study with
materials; and a collective unconscious, which
Jean-Martin Charcot.
houses archetypes that are models for human
experience become a new model for understanding
1893–1896: Sigmund Freud and Josef Breuer
human behavior.
document case studies and begin to identify the
importance of free association, catharsis, and abre- 1913: Jacob Moreno develops psychodrama,
action. These early influences eventually lead to which some consider the beginning of group
understanding about neuroses, the unconscious, psychotherapy.
defense mechanisms, transference and counter-
transference, and dream analysis. 1920s: Karen Horney begins to develop her ideas
on psychotherapy and is one of the original neo-
Late 1800s–early 1900s: Sigmund Freud coalesces Freudians, along with Eric Fromm, who stresses
his ideas into the first comprehensive theory of the influence of culture and object relations on the
psychoanalysis. He focuses on the conscious and development of personality. Her ideas are also con-
the unconscious, the structure of personality (id, sidered foundational to feminist psychology.
ego, and superego), and the psychosexual stages of
development (oral, anal, phallic, latency, and geni- 1920s: John B. Watson applies the principles of
tal) as some of his key concepts. classical conditioning to humans, such as his well-
known study of “Baby Albert,” whom he condi-
1906: Based on his experiments with hungry dogs tions to be fearful of a white rat by pairing the
being conditioned to salivate to a bell when the striking of a steel bar (a loud noise) with the hold-
bell is paired with food, Ivan Pavlov explains the ing of the rat. The fear created becomes general-
principles of classical conditioning. Classical con- ized to other objects.
ditioning later becomes the basis of some major
behavioral approaches to counseling, such as sys- 1926: Otto Rank gives a lecture on “The Genesis
tematic desensitization. of Object Relations,” which opposes some of
Sigmund Freud’s ideas and is the birth of object
1910–1912: Alfred Adler becomes president of the relations theory.
Vienna Psychoanalytic Society but later resigns
from it and establishes the Society for Individual 1930s: Viktor Frankl begins to develop his ideas
Psychology, which espouses his ideas about psy- on logotherapy, a form of existential therapy,
chotherapy. which some call the “third wave of Viennese
1067

1068 Appendix A: Chronology
psychology” (after Freudian analysis and 1943: Abraham Maslow’s article “A Theory of
Individual Psychology). His ideas concerning Human Motivation” is published. This article, and
how individuals find meaning and make choices his 1954 book Motivation and Personality, helps
in their lives become foundational to many usher in the humanistic psychology movement,
existential-humanistic therapies. which stresses the nature of the person in the
counseling relationship and the ability of the indi-
1933: Wilhem Reich publishes Character Analysis, vidual to change. Maslow’s hierarchy of needs,
which is the basis for his ideas on body armor and which becomes one of the first developmental
Orgone therapy. This approach to therapy becomes models of understanding change, focuses on how
foundational to many of the body-oriented lower order needs (e.g., hunger, shelter) must be
approaches of counseling and psychotherapy. addressed before higher order needs (e.g., love and
belonging, self-esteem, self-actualization) can be
1938: B. F. Skinner publishes the Behavior of examined.
Organisms, which is based on his studies of oper-
ant conditioning, such as the place of negative and 1947: The Tavistock Institute of Human Relations
positive reinforcement in the shaping of behavior. is established to study organizational development
This book, and his continued research and scholar- and action research.
ship, becomes the foundation for many types of
behavior therapy. 1948: Milton H. Erickson establishes a private
practice that uses a variety of uncommon methods
Late 1930s–1940s: The neo-Freudians become
when working with individuals. Considered one of
increasingly popular as individuals like Harry
the “master therapists” of all time, his use of hyp-
Stack Sullivan stress that in addition to intrapsy-
nosis, homework assignments, and any ethical
chic issues, interpersonal interactions and social
technique to actively help clients change in a brief
context should also be considered important fac-
amount of time was to influence a wide range of
tors in understanding the person.
therapists, particularly those involved with strate-
gic therapy.
1940s: Kurt Lewin studies and writes about group
dynamics and experiential group counseling. This
eventually leads to the establishment of the Mid- to Late 1900s: Rollo May becomes one of
National Training Laboratories in Bethel, Maine, the key figures in American existential therapy and
which studies group dynamics. writes a series of well-known books on issues such
as anxiety, love, and being that become classics in
1941: Eric Fromm publishes Escape From Freedom, the field and influence the development of other
which marks the beginning of his ideas on human- theories.
istic psychoanalysis, which are known for their
political and social focus. 1950s: The Palo Alto Group is formed and includes,
over the years, a wide range of individuals from a
1942: Carl Rogers publishes Counseling and variety of disciplines that study communication in
Psychotherapy, which addresses the beginning of systems, how context affects behavior, the struc-
his nondirective, client-centered approach to coun- ture of systems, and brief approaches to therapy.
seling, originally called client-centered counseling Some of its original members are Gregory Bateson,
and later called person-centered counseling. William Fry, Jay Haley, Don D. Jackson, and John
Weakland. Some of their work is inspired by
1942: Fritz Perls publishes Ego, Hunger, and Milton H. Erickson.
Aggression, which challenges many of Sigmund
Freud’s ideas and is the beginning of his existen- 1950s: Albert Ellis develops rational therapy,
tial-humanistic approach that eventually becomes which eventually becomes rational emotive behav-
known as Gestalt therapy. His ideas regarding ior therapy, one of the first therapies to focus on
unfinished business and how unsatisfied needs cognitions in the treatment of mental disorders
direct behavior become important in many types and problematic behaviors. His ABC theory
of existential-humanistic approaches. (A = activating event, B = belief about the event,

Appendix A: Chronology 1069
C = consequences of the belief about the event) 1958: Joseph Wolpe writes Psychotherapy by
becomes a popular method of conceptualizing Reciprocal Inhibition. This text becomes the basis
problematic behaviors for cognitive therapists. of his ideas on systematic desensitization, which is
used to help individuals conquer phobias and
1950s: Salvadore Minuchin develops structural anxiety.
family therapy. This approach departs from the
intrapsychic approach of psychodynamic therapy 1960s: Aaron Beck develops cognitive therapy.
and examines the structure of families, including Like Albert Ellis, he focuses on cognitions as the
boundaries in families, how individuals communi- source of emotional problems, but his theory
cate in families, subsystems, contextual issues, and examines the place of automatic thoughts and cog-
stress in families. nitive schemas in the development of problems and
maladjusted feelings.
1950s and Later: Melanie Klein challenges some of
the basic tenets of Sigmund Freud’s psychoanalytic 1960s: Albert Bandura’s research leads to the dis-
approach and is considered one of the founders of covery of social cognitive theory (modeling, social
the object relations school of therapy. In particular, learning), which examines how important behav-
she believes that the infant has a primary relation- iors are imitated and reproduced by others.
ship with the mother that is separate from the idea Modeling is widely used in many approaches to
that the mother satisfies the infant’s physiological counseling, particularly those that have a cogni-
needs, as Freud had proposed. Others, such as tive-behavioral focus.
Margaret Mahler, Otto Kernberg, and Donald
Winnicott, also contribute to the object relations 1962: The Esalen Institute is founded at Big Sur,
approach. California, and sponsors workshops and confer-
ences on humanistic psychology by world-
renowned researchers and therapists.
1954: Nathan Ackerman proposes that families
should be seen as a whole unit and states that if one
1963: Erik Erikson writes Childhood and Society,
family member has a problem, the whole family
which stresses psychosocial factors in the develop-
has a problem. This approach is in stark contrast to
ment of the individual over the life span.
the individualistic approach of the psychoanalysts
and other individually oriented counselors and 1963: Jay Haley’s book Strategies of Psychotherapy
therapists. is published. He and Cloe Madanes drastically
change the way many individuals do counseling
1954: Murray Bowen obtains a grant from the and therapy as they focus on strategies that will
National Institute of Mental Health to study indi- lead to change for individuals, couples, and fami-
viduals with schizophrenia and their families. His lies rather than focusing on the past or trying to
research eventually leads to ideas about the impor- unearth underlying issues that are assumed to cre-
tance of differentiation of self within families, how ate problems.
triangles within families handle stress, and the
nuclear family emotional system that explains 1964: Virginia Satir publishes Conjoint Family
family patterns. Therapy, and her ideas about communication in
families and her positive and humanistic approach
1955: George Kelly’s book The Psychology of to working with families become widely known
Personal Constructs becomes the forerunner of and practiced.
what are later known as constructivist and post-
modern therapies and examines how individuals 1965: The Mental Research Institute’s Brief
construct meaning throughout their lives. Therapy Center is founded by John Weakland,
Richard Fisch, and Paul Watzlawick, with Don D.
1958: Jules Riskin, Virginia Satir, Richard Fisch, Jackson and Jay Haley as consultants. This insti-
and Paul Watzlawick join the original Palo Alto tute looks at how problems can be addressed in
Group to form the Mental Research Institute, brief and novel ways. It is the foundation of a
which examines interactions in systems. number of therapies, including strategic therapy,

1070 Appendix A: Chronology
solution-focused therapy, and other forms of brief listed as a mental disorder since the first edition of
treatment. the Diagnostic and Statistical Manual in 1952.
Other prominent mental health associations soon
1967: William Glasser establishes the Institute for concur.
Reality Therapy and Educator Training Center to
develop his ideas on reality therapy and, later, 1976: Jean Baker Miller writes Toward a
choice theory. His ideas about how we develop Psychology of Women, which describes relational-
pictures in our quality world based on our need— cultural theory and focuses on the importance of
strength profile (survival, love and belonging, connections with clients—especially women. She
power, freedom, and fun) are picked up by coun- eventually directs the Elizabeth Stone Center at
selors and others and often used as a model for Wellesley College, where she works with others on
running institutions (e.g., schools). developing a new model of working with women.
1969: John Bowlby publishes Attachment and 1976: Stanislav Grof establishes the International
Loss, which becomes the basis for ideas on attach- Transpersonal Association and explores ideas
ment theory. about spirituality and identity beyond the self or
psyche, including peak experiences, mysticism, and
1970: Irvin Yalom publishes The Theory and altered states.
Practice of Group Psychotherapy. This book
becomes the standard text for understanding the 1977: Donald Meichenbaum writes Cognitive
issues and practice of group counseling and helps Behavior Therapy Modification: An Integrative
place group counseling on an equal footing with Approach and becomes well-known for develop-
other forms of counseling and psychotherapy. ing innovative cognitive-behavioral techniques in
this therapeutic approach. In the 21st century, he
1970: Carl Rogers writes On Encounter Groups, increasingly takes on a cognitive narrative/con-
which describes the experiential group process and structivist perspective.
is based on his experience running such groups
over the years. 1976: Arnold Lazarus breaks from the more tradi-
tional cognitive-behavioral therapists and publishes
1971: Phillip Zimbardo conducts the Stanford Multimodal Behavior Therapy, which examines
Prison Experiment, which examines abuse of broad aspects of a person’s functioning, which he
power and how perceived roles affect how people calls the BASIC I.D. (behaviors, affective processes,
act. Later, he becomes increasingly interested in the sensations, images, cognitions, interpersonal rela-
power of positive psychology. tionships, and drugs/biology).
1973: Ivan Böszörményi-Nagy writes Invisible 1978: Carl Whitaker and August Napier write The
Loyalties, which stresses the importance of rela- Family Crucible, which stresses the importance of
tional ethics in family counseling. experiential activities and spontaneity when work-
ing with couples and families. Their approach
1975: Otto Kernberg’s developmental object rela- increasingly moves couple and family counseling
tions theory examines how the successful master- away from the removed position of the therapist
ing of unconscious tasks at various developmental prevalent in the psychodynamic approach to work-
levels is critical to the developmental of a healthy ing with individuals.
ego. Unhealthy development leads to identity dif-
fusion and individuals who see the world as all 1980s: Michael White and David Epston develop
good or all bad. narrative therapy, which is based on the philoso-
phies of social constructionism and postmodern-
1975: The American Psychological Association ism. These philosophies state that reality is socially
states that homosexuality is not a mental disorder, constructed through language and that the narra-
which the American Psychiatric Association had tives or stories we create represent our current

Appendix A: Chronology 1071
understanding of our lives. This nonpathological, working with clients that focuses on helping to
humble approach to therapy is used to help “reau- enhance the intrinsic motivation of clients to
thor” individuals’ lives. change.
1987: Francine Shapiro develops Eye Movement 1992: Cross-cultural counseling competencies are
Desensitization and Reprocessing Therapy, which simultaneously published by the Journal of
becomes one of the many approaches to the treat- Counseling and Development and the Journal of
ment of trauma, focusing on the use of rapid eye the Association for Multicultural Counseling and
movements, or some other rhythmic stimulation, Development, two journals of the American
while simultaneously remembering a traumatic Counseling Association. Eventually endorsed by
event. This pairing of rhythmic stimulation with the American Counseling Association and the
memory seems to de-potentiate neural pathways American Psychological Association, these compe-
and helps clients become calm. tencies will be critical to the training of mental
health professionals relative to working with cli-
1990s: Insoo Kim Berg and Steve de Shazer popu- ents from nondominant groups.
larize solution-focused therapy. Based on some of
the same philosophies as narrative therapy (social 1993: Marsha Linehan popularizes dialectical
constructionism and postmodernism), this non- behavior therapy, which balances teaching clients
pathological, future-oriented approach focuses on how to accept their lives with offering problem-
solutions, not problems. Its brief approach to work- solving strategies and skills to help clients regulate
ing with clients fits in nicely with the emerging their emotions.
managed-care organizations, which look to cut
costs of services, and with practitioners who need to 1998: The National Center for Complementary
work briefly with clients (e.g., school counselors). and Alternative Medicine is established to promote
research on complementary and alternative medi-
1990s: Bill O’Hanlon offers his take on solution- cine.
focused therapy by developing solution-oriented
therapy and, later, Possibility Therapy, which 2004: Steven Hayes and others popularize accep-
focuses more on validating client issues and joining tance and commitment therapy, which examines
with them as they dialogue about their problems. how behaviors and cognitions are related to an
intricate web of relationship associations. Realizing
1990s: Michael Mahoney popularizes constructiv- the complexity of symptoms, they encourage
ist therapy, which emphasizes how individuals acceptance of symptoms as one method in helping
actively create their reality and meaning by orga- one reduce or eliminate symptoms.
nizing their experiences within their social world.
2007: The American Psychological Association
1991: With the publication of Learned Optimism, adopts the Guidelines for Psychological Practice
Martin Seligman becomes one of the leaders usher- With Girls and Women, which offers 11 guidelines
ing in the positive psychology movement, with its that become a focus for feminist therapy.
focus on improving lives through positive internal
dialogue. Recent years: Research on how the brain and
behaviors are intimately related is increasingly
1991: With the publication of Motivational being conducted, resulting in the development of
Interviewing: Preparing People to Change, William new theories related to neurophysiology and men-
Miller and Steve Rollnick provide a new model for tal health.

Appendix B: Resource Guide—
Journals and Professional Associations
Journals Annals of the New York Academy of Sciences*

The following is an exhaustive list of journals in Annual Review Clinical Psychology*
the social sciences. To some degree, all of these Annual Review of Psychology*
journals publish conceptual or research articles Applied Psychophysical and Biofeedback*
related to the use of techniques and theories of Archives of General Psychiatry*
counseling and psychotherapy. A large portion of
them have been cited in the encyclopedia (indicated Archives of Neurology & Psychiatry*
with an asterisk following their names). Archives of Psychiatry and Psychotherapy
Art Psychotherapy
Asia Pacific Journal of Counseling and
Accident, Analysis and Prevention*
Psychotherapy*
Acta Psychiartr Scandinavica*
Assessment*
Adolescence*
Attachment & Human Development*
Adolescent Aggression*
Australian and New Zealand Journal of Family
Adoption and Fostering* Therapy*
Advances in Mind-Body Medicine* Australian Journal of Clinical Hypnotherapy and
Advances in Psychiatric Treatment* Hypnosis*
Alcoholism Treatment Quarterly The Behavior Analyst*
Alternative and Complementary Therapies The Behavior Analyst Today*
Alternative Therapies in Health and Medicine* Behavior Research and Therapy*
American Behavioral Scientist The Behavior Therapist*
American Journal of Clinical Hypnosis* Behavior Therapy*
American Journal of Dance Therapy Behavioral and Brain Sciences*
American Journal of Family Therapy* Behavioral Science*
American Journal of Occupational Therapy* Behavioral Scientist*
American Journal of Orthopsychiatry* Behaviour Research and Therapy*
American Journal of Preventive Medicine* Behavioural and Cognitive Psychotherapy*
The American Journal of Psychiatry* Bioenergetic Analysis*
American Journal of Psychotherapy* Biofeedback*
American Psychologist* BioMed Central*
Annals of Behavioral Medicine* BMC Nephrology*
Annals of Psychotherapy & Integrative Health* BMC Psychiatry*
1073

1074 Appendix B: Resource Guide—Journals and Professional Associations
Body, Movement and Dance in Psychotherapy* Counseling Psychology Quarterly*

BRAT Series in Clinical Psychology Counseling Today
British Gestalt Journal* Counselor*
The British Journal of Play Therapy* Counselor Education and Supervision*
British Journal of Psychiatry* Dissociation*
British Journal of Psychology Drug and Alcohol Dependence*
British Journal of Psychotherapy* Early Child Development and Care*
British Medical Journal* Edification*
Bulletin of the Menninger Clinic Education & Treatment of Children*
Cahiers Critiques de Therapie Familiale et de Energy & Character: The Journal of Biosynthesis
Pratiques de Reseaux Energy Psychology: Theory, Research, and
Canadian Journal of Music Therapy Treatment*
Canadian Journal of Psychiatry* European Journal of Oral Sciences*
Canadian Psychology* European Journal of Psychotherapy and
Chantiers d’Art-therapie Counseling*
Child & Family Behavior Therapy European Psychologist*
Child and Adolescent Mental Health* European Review of Applied Psychology*
Child Development* Families, Systems, & Health
Child Psychiatry & Human Development* Familles et Therapie
Circulation* The Family Journal: Counseling and Therapy for
Clinical Child & Family Psychology Review* Couples and Families*
The Clinical Psychologist* Family Process*
Clinical Psychology & Psychotherapy* Family Relations*
Clinical Psychology Review* Family Systems Forum
Clinical Psychology: Science and Practice* Family Therapy
Clinical Social Work Journal* Family Therapy Magazine
CNS Drugs* The Family Therapy Networker*
The Coaching Psychologist* Feminism & Psychology*
Cognitive and Behavioral Practice* Frontiers in Physiology*
Cognitive Behaviour Therapy Gestalt Journal*
Cognitive Therapy and Research* Gestalt Journal of Australia & New Zealand*
Comprehensive Psychiatry* Gestalt Review*
Conditional Reflex GROUP
Constructivism in the Human Sciences* Group and Organizational Studies*
Contemporary Family Therapy* Group Dynamics: Theory, Research, and
Contemporary Hypnosis & Integrative Therapy Practice*
Context (Canterbury) Group Psychotherapy
Counseling and Values* GTK Rivista di Psicoterapia Istituto di Gestalt
Counseling News—The Voice of Counseling Therapy
Training* Guidance and Counseling*
The Counseling Psychologist* Health Psychology

Appendix B: Resource Guide—Journals and Professional Associations 1075
Holistic Nursing Practice* Journal of Alternative Medicine Research*

Identity: An International Journal of Theory and Journal of Applied Behavior Analysis*
Research* Journal of Basic and Applied Science*
Integral Review* Journal of Behavioral Therapy and Experimental
Integrative Therapie Psychiatry*
International Association for Regression Research The Journal of Biosynthesis*
and Therapies. Newsletter Journal of Brief, Strategic & Systemic Therapies
The International Journal for the Psychology of Journal of Brief Therapy*
Religion*
Journal of Child Sexual Abuse*
International Journal of Behavioral and
Journal of Clinical Child Psychology*
Consultation Therapy
Journal of Clinical Nursing*
International Journal of Behavioral Medicine
Journal of Clinical Psychiatry*
International Journal of Choice Theory and
Reality Therapy* Journal of Clinical Psychology*
International Journal of Clinical and Journal of Cognitive Psychotherapy*
Experimental Hypnosis* Journal of Cognitive Therapy*
International Journal of Cognitive Therapy Journal of College Counseling*
International Journal of Comparative Journal of Constructivist Psychology*
Psychology* Journal of Consulting and Clinical Psychology*
International Journal of Family Studies* Journal of Consulting Psychology*
International Journal of Group Psychotherapy* Journal of Contemporary Psychotherapy*
International Journal of Healing and Caring* Journal of Contextual Behavioral Science*
International Journal of Narrative Therapy and Journal of Counseling and Development*
Community Work
Journal of Counseling Psychology*
International Journal of Play Therapy
Journal of Couple & Relationship Therapy
International Journal of Psychoanalysis*
Journal of Creativity in Mental Health*
International Journal of Psychology and
Journal of Divorce & Remarriage*
Psychological Therapy
Journal of EMDR Practice and Research*
International Journal of Reality Therapy
Journal of Experiential Education*
International Journal of Therapy and
Rehabilitation* Journal of Family Psychotherapy*
Jiritsu Kunren KenkyuNihon Jiritsu Kunren Journal of Family Therapy*
Gakkai Journal of Family Violence*
The Journal for the Study of Human Interaction Journal of Feminist Family Therapy
and Family Therapy Journal of Gay & Lesbian Psychotherapy*
Journal for the Theory of Social Behaviour* The Journal of General Psychology*
Journal of Abnormal and Social Psychology* Journal of Health Psychology*
Journal of Abnormal Psychology* Journal of Holistic Nursing
Journal of Addiction & Therapy Journal of Humanistic Counseling, Education &
Journal of Addictions & Offender Counseling* Development*
Journal of Aggression, Maltreatment & Trauma* Journal of Humanistic Education and
Journal of Alternative and Complementary Development*
Medicine* Journal of Humanistic Psychology*

Journal of Imago Relationship Therapy Journal of Trauma and Dissociation*

Journal of Individual Psychology* Journal of Traumatic Stress*
Journal of Instructional Psychology* Journal of Traumatic Stress Disorders &
Journal of Integral Theory and Practice* Treatment*
Journal of Marital and Family Therapy* Journal of Unified Psychotherapy and Clinical
Science*
Journal of Mental Health Counseling*
Journal of Multicultural Counseling and Kodo Ryoho Kenkyu
Development* Kunst und Therapie
Journal of Nervous and Mental Disease* Kunst, Gestaltung und Therapie
Journal of Neuroscience* Les Cahiers de Gestalt-Therapie
Journal of Neurotherapy* Massage and Bodywork*
Journal of Palliative Medicine* Medical Hypotheses*
Journal of Personality and Social Psychology* Mental Health Occupational TherapyMusic
Journal of Poetry Therapy Therapy Now
Journal of Projective Techniques* Music Therapy Perspectives
The Journal of Psychological Therapies in Nature*
Primary Care Nephrology Dialysis Transplantation*
Journal of Psychology* Neuropsychopharmacology*
Journal of Psychology & Theology* The New Zealand Journal of Music Therapy
Journal of Psychosomatic Research* Nihon Kodo Ryoho Gakkai Nyuzu Reta
Journal of Psychotherapy Integration* Nippon Geijutsu Ryoho GakkaishiNippon
Journal of Rational-Emotive & Cognitive- Geijutsu Ryoho Gakkai
Behavior Therapy Nursing Older People*
Journal of Reality Therapy* Pacific Health Dialog*
Journal of Regression Therapy Paradigms in Theory Construction*
Journal of Sandplay Therapy Patient Education and Counseling*
Journal of Sex & Marital Therapy The Permanente Journal*
Journal of Sleep Disorders & Therapy The Personnel and Guidance Journal*
Journal of Social Action in Counseling and Personzentrierte Beratung und Therapie
Psychology* Perspectives in Psychological Science*
The Journal of Spirituality in Mental Health* Phytomedicine*
Journal of Sports Therapy Phytotherapy Research*
Journal of Systemic Therapies* Pilgrimage
Journal of Teaching in the Addictions* Play Therapy
Journal of the American Academy of Child and PLoS One*
Adolescent Psychiatry*
Practical Pain Management*
Journal of the American Psychoanalytic
Association* Pragmatic Case Studies in Psychotherapy*
The Journal of the Eastern Group Psychotherapy Preventive Medicine*
Society* Professional Psychology: Research and Practice*
Journal of the History of the Behavioral Sciences Psychiatric Clinical*
Journal of Transpersonal Psychology* Psychiatry*

Psychoanalytic Dialogues* Somatics Magazine—Journal of the Mind/Body

Psychoanalytic Inquiry* Arts and Sciences
The Psychoanalytic Quarterly* South African Medical Journal*
Psychoanalytic Social Work Spring Journal
The Psychoanalytic Study of the Child* Substance Use & Misuse
Psychoanalytical Notebooks of the London Theory & Psychology*
Circle Therapie KreativTherapy Today
Psychodrama* Tijdschrift voor Kreatieve Therapie
Psychological Bulletin* Traumatology*
Psychological Inquiry* Trials*
Psychological Reports* Turkish Psychological Counseling and Guidance
Psychological Review* Journal*
Psychological Science* Voice of Counseling Training, The
Psychology and Psychotherapy: Theory, Women & Therapy*
Research, and Practice* Zeitschrift fuer Individualpsychol
Zeitschrift fuer Systemische Therapie und
Psychology in the Schools*
Beratung
The Psychology of Gender*
Psychology, Public Policy, and Law*
Psychophysiology* Professional Associations
Psychosomatic Medicine* The following select associations and foundations
Psychosozial are related, in some manner, to the use of one or
more of the theories found in this encyclopedia.
Psychotherapy*
What follows is a very brief description of the
Psychotherapy and Psychosomatic* association and its web address. If you are inter-
Psychotherapy Bulletin* ested in learning more about the association and
Psychotherapy Networker* its relationship to one or more of the theories in
the encyclopedia, please visit its website.
Psychotherapy Research*
Psychotherapy: Theory, Research, and Practice*
American Academy of Neurology
PsycSCAN: Behavior Analysis and Therapy
(Online) Description: For the diagnosis, treatment, and
Quarterly Journal of Experimental practice of neurological diseases
Psychology* Web address: www.aan.com/
Research on Social Work Practices
Research Quarterly for Exercise and Sport* American Art Therapy Association
Review of General Psychology* Description: Promotes the healing of art and
School Psychology International* creative therapies
Science* Web address: www.arttherapy.org/
Selbstpsychologie Brandes und Apsel Verlag
Sexual and Relationship Therapy American Association of Pastoral Counselors
Social Indicators Research* Description: Promotes information about pastoral
Social Psychology Quarterly* counseling
Social Work Web address: www.aapc.org/

American Counseling Association Association for Behavioral and

Cognitive Therapies
Description: Focuses on the growth and awareness
of all aspects of the counseling profession Description: Focuses on the application of cogni-
Web address: www.counseling.org tive, behavioral, and evidence-based practices
Web address: www.abct.org/home/
American Group Psychotherapy Association
Association for Contextual Behavioral Science
Description: Provides theory, research, and educa-
tion in group work Description: For anyone interested in acceptance
Web address: www.agpa.org/ and commitment therapy, relational frame theory,
or contextual behavioral science
Web address: http://contextualscience.org/
American Psychiatric Association
Description: Assists its member physicians in the Association for Humanistic Psychology
promotion of the human treatment of individuals
with mental disorders Description: Promotes the philosophy of humanis-
tic counseling and psychology
Web address: www.psychiatry.org
Web address: http://afhc.camp9.org/page-
1242938
American Psychoanalytic Association
Description: Promotes education, practice, Association for Marriage and Family Therapy
research, and advocacy in psychoanalytic work
Description: Provides theory, research, and educa-
Web address: www.apsa.org tion in couples and family counseling
Web address: www.aamft.org
American Psychological Association
Description: Advances a wide range of psycho- Association for Multicultural
logical knowledge through its many divisions and Counseling and Development
work
Description: Promotes understanding of others in
Web address: www.apa.org the counseling relationship
Web address: www.multiculturalcounseling.org/
American Psychological Society
Description: Promotes a wide range of scientific Association for Natural Psychology
psychology in research, teaching, and working Description: Focuses on mental health improve-
with individuals ment through multiple, natural methods, without
Web address: www.psychologicalscience.org/ the use of drugs
Web address: www.winmentalhealth.com/
American Society of Clinical Hypnosis
Description: Founded by Milton Erickson to Association for Play Therapy
support clinicians who practice clinical hypnosis Description: Promotes the use of play with clients
Web address: www.asch.net/ Web address: www.a4pt.org/
Association for Behavior Analysis International Association for Specialists in Group Work
Description: Focuses on the development of behav- Description: Provides theory, research, and educa-
ior analysis through practice, research, and teaching tion in group work
Web address: www.abainternational.org/ Web address: www.asgw.org/

Association for the Advancement Clinical Neuropsychology (Division 40 of the

of Gestalt Therapy American Psychological Association)
Description: Fosters the enhancement, research, Description: Focuses on the relationship between
and practice of Gestalt therapy brain and behavior
Web address: www.aagt.org Web address: www.div40.org/
Association for the Study of Dreams Cognitive Neuroscience Society

Description: Examines dreams from an eclectic Description: Examines the relationship between
and integrative perspective mind, brain, and behavior and their relationship to
Web address: www.asdreams.org/ mental disorders
Web address: www.cogneurosociety.org/
Association for Transpersonal Psychology
Description: Examines alternative and peak expe- Cognitive Science Society
riences and promotes eco-spiritual transformation. Description: Brings together the fields of artificial
Web Address: www.atpweb.org/ intelligence, linguistics, anthropology, psychology,
neuroscience, philosophy, and education to under-
Behavior Analysis (Division 25 of the stand the human mind
American Psychological Association) Web address: http://cognitivesciencesociety.org/
Description: Focuses on all aspects of behavior,
including experimental, applied, and conceptual European Association of Body Psychotherapy
Web address: www.apadivisions.org/division-25/ Description: Supports, advocates, and promotes
index.aspx a wide range of body psychotherapies and
techniques
B. F. Skinner Foundation Web address: www.eabp.org/
Description: Informs professionals and the public
about the science of behavior International Association for
Web address: www.bfskinner.org/ Individual Psychology
Description: Provides a forum for discussion and
British Association of Play Therapists application of individual psychology (Adlerian
Description: Regulates the practice of play therapy Therapy)
in Great Britain Web address: www.iaipwebsite.org/
Web address: www.bapt.info/
International Association for
Canadian Mental Health Association Marriage and Family Counselors
Description: Promotes advocacy, education, Description: Provides theory, research, and educa-
research, and service for individuals with mental tion in couple and family counseling
health problems in Canada Web address: www.iamfconline.org/
Web address: www.cmha.ca/
International Association for
Canadian Psychological Association Mental Health Online
Description: Promotes a wide range of psychologi- Description: Promotes mental health through
cal knowledge for its members and for the public technology
Web address: www.cpa.ca/ Web address: http://ismho.org/

International Forum for Milton H. Erickson Foundation

Psychoanalytic Education
Description: Promotes the clinical work of Milton
Description: Open to any person interested in the H. Erickson
study of psychoanalysis Web address: http://erickson-foundation.org/
Web address: www.ifpe.org/
National Academy of Neuropsychology
International Neurological Association
Description: Explores the evaluation and treat-
Description: A multidisciplinary organization that ment of brain disorders
examines the brain–behavior relationship Web address: www.nanonline.org/
Web address: www.the-ins.org/
The National Association of
International Psychoanalytic Association Cognitive-Behavioral Therapy
Description: Founded by Sigmund Freud to pro- Description: Supports, advocates, and teaches
mote the ideas and concepts of psychoanalysis cognitive-behavioral principles
Web address: www.ipa.org.uk/ Web address: www.nacbt.org/
International Society for Gestalt National Association of Complementary

Theory and Its Applications and Alternative Medicines
Description: Promotes Gestalt theory and practice Description: Provides a wide range of information
through research for practitioners and the public on complementary
Web address: www.gestalttheory.net/cms/ and alternative medicine
Web address: www.nacams.org/
International Society for the Study of
Trauma and Dissociation National Association of Social Workers
Description: Promotes clinically effective treat- Description: Enhances the growth and develop-
ment for trauma and dissociation disorders ment of social workers and the individuals with
Web address: www.isst-d.org/ whom they work
Web address: www.naswdc.org/
The International Transactional
Analysis Association North American School of Adlerian Psychology
Description: Dedicated to advancing the theory Description: Promotes the ideas of Adlerian
and methods of transactional analysis psychology and encourages research on its
Web address: www.itaaworld.org/ efficacy
Web address: www.alfredadler.org/
Jung Society
Pavlovian Society
Description: Promotes the basic theoretical phi-
losophy proposed by Carl Jung and his theory, Description: Promotes the science of behavior and
Jungian (analytical) therapy encourages understanding of how it affects the
Web address: www.jung.org (See related sites also whole organism
by search for “Jung Society or Foundation”) Web address: http://campus.albion.edu/pavlovian/

Sandplay Therapists of America orientation, clinical practice, and diverse methods of

inquiry
Description: Focuses on the use of play therapy,
sandplay, art and sandtray therapy Web address: www.sepiweb.org
Web address: www.sandplay.org/
United States Association of
Society for Clinical and Experimental Hypnosis Body Psychotherapy
Description: Dedicated to the scientific understand- Description: Supports healing of the body/mind
ing, education, and practice of clinical hypnosis for through somatic and body techniques
all mental health professionals who practice it Web address: http://usabp.org/
Web address: www.sceh.us/
United States of America Transactional
Society for the Exploration of Analysis Association
Psychotherapy Integration Description: Dedicated to advancing the theory
Description: Promotes the exploration and develop- and methods of transactional analysis
ment of psychotherapies that integrate theoretical Web address: www.usataa.org/

Appendix C: Bibliography
About 80% of this bibliography reflects a compilation of the various further readings from the
encyclopedia. The rest includes iconic and important citations from a variety of sources.
Abram, J. (2007). The language of Winnicott: A writings (H. L. Ansbacher & R. R. Ansbacher, Eds.).
dictionary of Winnicott’s use of words (2nd ed.). New York, NY: Harper Torchbooks.
London, England: Karnac Books. Adler, A. (1958). What life should mean to you. New York,
Abramowitz, J. S. (1996). Variants of exposure and NY: Capricorn. (Original work published 1931)
response prevention in the treatment of obsessive- Adler, A. (1963). The practice and theory of individual
compulsive disorder: A meta-analysis. Behavior psychology (P. Radin, Trans.). Patterson, NJ:
Therapy, 27, 583–600. doi:10.1016/S0005- Littlefield, Adams. (Original work published 1925)
7894(96)80045-1 Adler, A. (1963). The problem child: The life style of the
Abramowitz, J. S., Deacon, B. J., & Whiteside, S. P. H. difficult child as analyzed in specific cases. New York,
(2011). Exposure therapy for anxiety: Principles and NY: Capricorn. (Original work published 1930)
practice. New York, NY: Guilford Press. Adler, A. (1964). Advantages and disadvantages of the
Abrams, M., & Abrams, L. (2005). A brief biography of inferiority feeling. In H. L. Ansbacher & R. R.
Dr. Albert Ellis. Retrieved from http://www.rebt.ws/ Ansbacher (Eds.), Superiority and social interest: A
albertellisbiography.html collection of later writings (pp. 50–58). Evanston,
Ackerman, N. (1950). Anti-Semitism and emotional IL: Northwestern University Press. (Original work
disorder. New York, NY: Harper. published 1933)
Ackerman, N. (1958). The psychodynamics of family life. Adler, A. (1964). Religion and individual psychology. In
New York, NY: Basic Books. H. L. Ansbacher & R. R. Adler (Eds.), The structure of
Ackerman, N. (1966). Treating the troubled family. neurosis (pp. 83–95). Evanston, IL: Northwestern
New York, NY: Basic Books. University Press. (Original work published 1932)
Adams, K. (Ed.). (2013). Expressive writing: Adler, A. (1964). Religion and individual psychology. In
Foundations of practice. Lanham, MD: Rowman & H. L. Ansbacher & R. R. Ansbacher (Eds.), Superiority
Littlefield. and social interest: A collection of later writings
Adams, M. (2013). Existential counselling in a nutshell. (pp. 271–310). Evanston, IL: Northwestern University
London, England: Sage. Press. (Original work published 1933)
Addams, J. (1910). Twenty years at Hull House. New York, Adler, A. (1964). Typology of meeting life problems. In
NY: Macmillan. H. L. Ansbacher & R. R. Ansbacher (Eds.), Superiority
Addis, M. E., & Martell, C. R. (2004). Overcoming and social interest: A collection of later writings
depression one step at a time: The new behavioral (pp. 66–70). Evanston, IL: Northwestern University
treatment to getting your life back. Oakland, CA: Press. (Original work published 1935)
New Harbinger. Adler, A. (1966). The psychology of power. Journal of
Adler, A. (1927). Understanding human nature. New York, Individual Psychology, 22, 166–172. (Original work
NY: Greenberg. published 1928)
Adler, A. (1929). The science of living. New York, NY: Adler, A. (1979). Superiority and social interest (3rd ed.;
Greenberg. H. L. Ansbacher & R. R. Ansbacher, Eds.). New York,
Adler, A. (1937). Mass psychology. International Journal NY: W. W. Norton.
of Individual Psychology, 3, 111–120. Adler, A. (1992). What life could mean to you (P. Radin,
Adler, A. (1956). The individual psychology of Alfred Trans.). Oxford, England: Oneworld. (Original work
Adler: A systematic presentation in selections from his published 1931)
1083

1084 Appendix C: Bibliography
Adler, A. (2002). The neurotic character: Fundamentals of Aigen, K. (2005). Music-centered music therapy. Gilsum,
a comparative individual psychology and NH: Barcelona.
psychotherapy (The Collected Clinical Works of Alfred Aiken, G. (2006). The potential effect of mindfulness
Adler, Vol. 1; H. T. Stein, Ed., C. Koen, Trans.). meditation on the cultivation of empathy in
Bellingham, WA: Alfred Adler Institute of psychotherapy: A qualitative inquiry (Doctoral
Northwestern Washington. (Original work published dissertation). Saybrook Graduate School and Research
1912) Center, San Francisco, CA.
Adler, A. (2002). Physician as educator. In H. T. Stein Ainsworth, M. D. (1989). Attachments beyond infancy.
(Ed.), The collected clinical works of Alfred Adler American Psychologist, 44, 709–716.
(Vol. 2, pp. 32–38; G. L. Liebenau, Trans.). doi:10.1037/0003-066X.44.4.709
Bellingham, WA: Alfred Adler Institute of Ainsworth, M. D., Blehar, M. C., Waters, E., & Wall, S.
Northwestern Washington. (Original work published (1978). Patterns of attachment: A psychological study
1904) of the strange situation. Oxford, England: Lawrence
Adler, A. (2002). A study of organ inferiority and its Erlbaum.
psychical compensation: A contribution to clinical Albert, L. (2003). Cooperative discipline: A teacher’s
medicine. In H. T. Stein (Ed.), The collected clinical handbook. Circle Pines, MN: American Guidance
works of Alfred Adler (Vol. 2, pp. 115–222; G. L. Service.
Liebenau, Trans.). Bellingham, WA: Alfred Adler Alberti, R., & Alberti, M. (2008). Your perfect right (9th
Institute of Northwestern Washington. (Original work ed.). New York, NY: Impact.
published 1907) Alberto, P., & Troutman, A. C. (2006). Applied behavior
Adler, G. (Ed.). (1973). C. G. Jung letters: 1906–1950 analysis for teachers (7th ed.). Upper Saddle River, NJ:
(Vol. 1). Princeton, NJ: Princeton University Press. Merrill Prentice Hall.
Adler, U. C., Krüger, S., Teut, M., Lüdtke, R., Bartsch, I., de Alcantara, P. (1999). The Alexander technique: A skill
Schützler, L., . . . Witt+, C. M. (2011). Homeopathy for life. Marlborough, England: Crowood Press.
for depression—DEP-HOM: Study protocol for a Alexander, F. (1950). Analysis of the therapeutic factors in
randomized, partially double-blind, placebo controlled, psychoanalytic treatment. Psychoanalytic Quarterly,
four armed study. Trials, 12(1), 43–49. 19, 482–500. doi:10.1002/j.2167-4086.2007.
doi:10.1186/1745-6215-12-43 tb00293.x
Agazarian, Y. M. (1997). Systems-centered therapy for Alexander, F. (1956). Psychoanalysis and psychotherapy:
groups. New York, NY: Guilford Press. Developments in theory, technique, and training.
Agazarian, Y. M. (2001). A systems-centered approach to New York, NY: W. W. Norton.
inpatient group psychotherapy. Philadelphia, PA: Alexander, F. M. (1985). The use of the self. London,
Jessica Kingsley. England: Orion. (Original work published 1932)
Agazarian, Y. M. (2012). Systems-centered group Alexander, F. M. (2004). Constructive conscious control of
psychotherapy: A theory of living human systems and the individual. London, England: Mouritz. (Original
its systems-centered practice. GROUP: Journal of the work published 1923)
Eastern Group Psychotherapy Society, 36(1), 19–36. Alexander, J. (2001). Mind body spirit. London, England:
Agazarian, Y. M. (2012). Systems-centered group Carlton Books.
psychotherapy: Putting theory into practice. Alexander, T. S. (1996). Facing the wolf: Inside the process
International Journal of Group Psychotherapy, 62(2), of deep feeling therapy. New York, NY: Dutton.
171–195. doi:10.1521/ijgp.2012.62.2.171 Allen, D. M. (1988). A family systems approach to
Agazarian, Y. M., & Gantt, S. P. (2000). Autobiography individual psychotherapy. Northvale, NJ: Jason
of a theory: Developing a theory of living human Aronson. (Originally titled, Unifying individual and
systems and its systems-centered practice. London, family therapies)
England: Jessica Kingsley. Allen, D. M. (1991). Deciphering motivation in
Agazarian, Y. M., & Gantt, S. P. (2005). The systems psychotherapy. New York, NY: Plenum Press.
perspective. In S. Wheelan (Ed.), Handbook of group Allen, D. M. (1993). Unified therapy. In G. Stricker &
research and practice (pp. 187–200). Thousand Oaks, J. Gold (Eds.), Comprehensive handbook of
CA: Sage. psychotherapy integration (pp. 125–137). New York,
Ahrens, J., & Rexford, L. (2002). Cognitive processing NY: Plenum Press.
therapy for incarcerated adolescents PTSD. Journal of Allen, D. M. (2003). Psychotherapy with borderline
Aggression, Maltreatment & Trauma, 6, 201–216. patients: An integrated approach. Mahwah, NJ:
doi:10.1300/J146v06n01_10 Lawrence Erlbaum.

Appendix C: Bibliography 1085
Allen, D. M., Abramson, H., Whitson, S., Al-Taher, M., American Psychological Association. (n.d.). Evidence-
Morgan, S., Veneracion-Yumul, A., . . . Mason, M. based practice in psychology. Retrieved from http://
(2005). Perceptions of contradictory communication www.apa.org/practice/resources/evidence/
from parental figures by adults with borderline American Psychological Association Presidential Task
personality disorder: A preliminary study. Force on Evidence-Based Practice. (2006). Evidence-
Comprehensive Psychiatry, 46(5), 340–352. based practice in psychology. American Psychologist,
doi:10.1016/j.comppsych.2005.01.003 61, 271–285. doi:10.1037/0003-066X.61.4.271
Allen, D. M., & Whitson, S. (2004). Avoiding patient American Psychological Association Systems of
distortions in psychotherapy with patients with Psychotherapy Video Series. (2008). Relational
borderline personality disorder. Journal of cultural therapy [DVD]. Washington, DC: Author.
Contemporary Psychotherapy, 34(3), 211–229. Amini, R. L., & Woolley, S. R. (2011). First-session
doi:10.1023/b:JOCP.0000036631.41400.57 competency: The brief strategic therapy scale-1.
Allen, J. G., & Fonagy, P. (2006). Handbook of Journal of Marital & Family Therapy, 37(2),
mentalization-based treatment. Chichester, England: 209–222. doi:10.1111/j.1752-0606.2010.00201.x
Wiley. Anchin, J. C. (2003). Cybernetic systems, existential
Allen, J. G., Fonagy, P., & Bateman, A. W. (2008). phenomenology, and solution-focused narrative:
Mentalizing in clinical practice. Arlington, VA: Therapeutic transformation of negative affective
American Psychiatric Publishing. states through integratively oriented brief
Allen, W., & Brickman, M. (1973). Sleeper [Original film psychotherapy. Journal of Psychotherapy Integration,
script]. Culver City, CA: Rollins & Joffe Productions. 13, 334–442. doi:10.1037/1053-0479.13.3-4.334
Alonso, A., & Swiller, H. I. (1993). Introduction: The case Anchin, J. C. (2006). A hermeneutically informed
for group therapy. In A. Alonso & H. I. Swiller (Eds.), approach to psychotherapy integration. In G. Stricker
Group therapy in clinical practice (pp. xxii–xxiii). & J. Gold (Eds.), A casebook of psychotherapy
Washington, DC: American Psychiatric Press. integration (pp. 261–280). Washington, DC:
Amen, D. (2009). Change your brain, change your life: American Psychological Association.
The breakthrough program for conquering anxiety, Anchin, J. C. (2008). Pursuing a unifying paradigm for
depression, obsessiveness, anger and impulsiveness. psychotherapy: Tasks, dialectical considerations, and
New York, NY: Random House. biopsychosocial systems metatheory. Journal of
Amen, D. (2013). Healing ADD revised edition: The Psychotherapy Integration, 18, 310–349.
breakthrough program that allows you to see and heal doi:10.1037/a0013557
the seven types of ADD. New York, NY: Berkley. Anchin, J. C., & Magnavita, J. J. (2006). The nature of
American Counseling Association. (2014). ACA code of unified clinical science: Implications for
ethics. Retrieved from http://www.counseling.org/ psychotherapeutic theory, practice, training, and
Resources/aca-code-of-ethics.pdf research. Psychotherapy Bulletin, 41(2), 26–36.
American Psychological Association. (2002). Criteria for Andersen, T. (1987). The reflecting team: Dialogue and
evaluating treatment guidelines. American meta-dialogue in clinical work. Family Process, 26,
Psychologist, 57, 1052–1059. doi:10.1037//0003- 415–428. doi:10.1111/j.1545-5300.1987.00415.x
066X.57.12.1052 Anderson, D. (1994). Muscle pain relief in 60 seconds:
American Psychological Association. (2007). Guidelines The fold and hold method. New York, NY: Wiley.
for psychological practice with girls and women. Anderson, H. (1997). Conversation, language and
Washington, DC: Author. possibilities: A postmodern approach to therapy.
American Psychological Association. (2009). Report of the New York, NY: Basic Books.
APA Task Force on appropriate therapeutic responses Anderson, H., & Gehart, D. (Eds.). (2007).
to sexual orientation. Retrieved from http://www.apa Collaborative therapy: Relationships and
.org/pi/lgbt/resources/therapeutic-response.pdf conversations that make a difference. New York, NY:
American Psychological Association. (2012). Guidelines Taylor & Francis.
for psychological practice with lesbian, gay, and Anderson, H., & Goolishian, H. (1988). Human systems
bisexual clients. American Psychologist, 67(1), 10–42. as linguistic systems: Preliminary and evolving ideas
doi:10.1037/a0024659 about the implications for clinical theory. Family
American Psychological Association. (2012). Guidelines Process, 27(4), 371–393.
for psychological practice with lesbian, gay, and doi:10.1111/j.1545-5300.1988.00371.x
bisexual clients. Retrieved from http://www.apa.org/pi/ Anderson, H., & Goolishian, H. (1992). The client is
lgbt/resources/guidelines.aspx the expert: A not-knowing approach to therapy.

In S. McNamee & K. J. Gergen (Eds.), Therapy as social psychological problems. New York, NY: Guilford
construction (pp. 25–39). Newbury Park, CA: Sage. Press.
Anderson, J. G., & Taylor, A. G. (2011). Effects of healing Armour, R. (1953, February 16). A child’s private logic.
touch in clinical practice: A systematic review of Time Magazine, 63.
randomized clinical trials. Journal of Holistic Nursing, Aron, L. (1996). A meeting of minds. Hillsdale, NJ:
29(3), 221–228. doi:10.1177/0898010110393353 Analytic Press.
Andreas, C., & Andreas S. (1989). Heart of the mind. Aron, L., & Harris, A. (2012). Relational psychoanalysis
Boulder, CO: Real People Press. IV: Expansion of theory. New York, NY: Routledge.
Andreas, S. (1990). Eye movement integration booklet. Aron, L., & Lechich, M. L. (2012). Relational
Boulder, CO: Real People Press. psychoanalysis. In G. O. Gabbard, B. E. Litowitz, &
Andreas, S. (1993). Demonstration with a Vietnam P. Williams (Eds.), Textbook of psychoanalysis (2nd ed.,
veteran with PTSD [Video demonstration]. Boulder, pp. 211–224). Washington, DC: American Psychiatric
CO: Real People Press. Publishing.
Andreas, S. (1993). Eye movement integration with a Arredondo-Dowd, P. M., & Gonsalves, J. (1980).
Vietnam veteran [Video demonstration]. Boulder, CO: Preparing culturally effective counselors. Personnel
Real People Press. (Free excerpt on YouTube; search and Guidance Journal, 58(10), 657–661.
for Steve Andreas, EMI) doi:10.1002/j.2164-4918.1980.tb00351.x
Andreas, S. (2006). Six blind elephants: Understanding Assagioli, R. (1974). The act of will. London, England:
ourselves and each other (Vols. 1 and 2). Boulder, CO: Wildwood House.
Real People Press. Assagioli, R. (1975). Psychosynthesis: A collection of
Andreas, S., & Faulkner, C. (1994). NLP: The new basic writings. London, England: Turnstone Books.
technology of achievement. New York, NY: William Assagioli, R. (2007). Transpersonal development: The
Morrow. dimension beyond psychosynthesis. Forres, Scotland:
Anisman, H. (2014). An introduction to stress and health. Smiling Wisdom.
Washington, DC: Sage. Assagioli, R. (2012). Psychosynthesis: A collection of
Ansbacher, H. L. (1962). Was Adler a disciple of Freud? A basic writings. Amherst, MA: Synthesis Center.
reply. Journal of Individual Psychology, 18, 126–135. (Original work published 1965)
Ansbacher, H. L. (1964). The increasing recognition of Association for Multicultural Counseling and
Adler. In H. L. Ansbacher & R. R. Ansbacher (Eds.), Development. (n.d.). Cross cultural competencies.
Superiority and social interest: A collection of later Retrieved from http://www.counseling.org/docs/
writings (pp. 3–19). Evanston, IL: Northwestern competencies/cross-cultural_competencies_and_
University Press. objectives.pdf?sfvrsn=3
Ansbacher, H. L., & Ansbacher, R. R. (Eds.). (1956). The Association for Play Therapy. (2013). About play therapy.
individual psychology of Alfred Adler: A systematic Retrieved from http://www.a4pt.org/?page=AboutAPT
presentation in selections from his writings. New York, Atwood, G. E. (2012). The abyss of madness. New York,
NY: Basic Books. NY: Routledge.
Anson, B. (1998). Rolfing: Stories of personal Atwood, G. E., & Stolorow, R. D. (2014). Structures of
empowerment. Berkeley, CA: North America Books. subjectivity (2nd ed.). New York, NY: Routledge.
Antony, M. M., & Roemer, L. (2011). Behavior therapy. Aviv, R. (2005, August 19). The interpretation of reams:
Washington, DC: American Psychological Association. Talking with Albert Ellis, world-renowned anti-Freud
APA Task Force on Appropriate Therapeutic Responses therapist. The Village Voice. Retrieved from http://www
to Sexual Orientation. (2009). Report of the Task .villagevoice.com/people/0534,interview,67068,24.html
Force on appropriate therapeutic response to sexual Axline, V. (1969). Play therapy. New York, NY:
orientation. Washington, DC: Author. Ballantine Books.
Arkowitz, H., & Miller, W. R. (2008). Learning, applying, Axthelm, P. (1978, December 4). The emperor Jones.
and extending motivational interviewing. In H. Newsweek, pp. 54–60.
Arkowitz, H. A. Westra, W. R. Miller, & S. Rollnick Ayllon, T., & Azrin, N. H. (1965). The measurement and
(Eds.), Motivational interviewing in the treatment of reinforcement of behavior of psychotics. Journal of
psychological problems (pp. 1–25). New York, NY: Experimental Analysis of Behavior, 8, 357–383.
Guilford Press. Ayllon, T., & Azrin, N. H. (1968). The token economy: A
Arkowitz, H., Westra, H. A., Miller, W. R., & Rollnick, S. motivational system for therapy and rehabilitation.
(2007). Motivational interviewing in the treatment of New York, NY: Appleton-Century-Crofts.

Aziz, R. (1990). C.G. Jung’s psychology of religion and Bandura, A., Ross, D., & Ross, S. A. (1961). Transmission
synchronicity. Albany: State University of New York of aggression through imitation of aggressive models.
Press. Journal of Abnormal and Social Psychology, 63, 575–
Bach, P. A., & Moran, D. J. (2008). ACT in practice: Case 582. doi:10.1037/h0045925
conceptualization in acceptance and commitment Bandura, A., Ross, D., & Ross, S. A. (1963). Imitation of
therapy. Oakland, CA: New Harbinger. film-mediated aggressive models. Journal of Abnormal
Back, K. W. (1972). Beyond words: The story of and Social Psychology, 66, 3–11. doi:10.1037/
sensitivity training and the encounter movement. New h0048687
York, NY: Russell Sage Foundation. Bandura, A., & Walters, R. H. (1959). Adolescent
Baer, R. (2011). Mindfulness-based treatment approaches: aggression. New York, NY: Ronald Press.
Clinician’s guide to evidence base and applications. Bandura, A., & Walters, R. H. (1963). Social learning and
Boston, MA: Academic Press. personality development. New York, NY: Holt,
Baginski, B. J., & Sharamon, S. (1988). Reiki: Universal Rinehart, & Winston.
life energy. Mendocino, CA: Life Rhythm. Bankart, C. P. (1997). Talking cures: A history of Western
Baim, C., Burmeister, J., & Maciel, M. (Eds.). (2007). & Eastern psychotherapies. Pacific Grove, CA:
Psychodrama: Advances in theory and practice. Brooks/Cole.
Advancing theory in therapy. New York, NY: Banmen, J. (2002). The Satir model: Yesterday and today.
Routledge/Taylor & Francis Group. Contemporary Family Therapy, 24(1), 7–22.
Bainbridge Cohen, B. (2012). Sensing, feeling, and action: doi:10.1023/A:1014365304082
The experiential anatomy of body-mind centering. Banmen, J. (2006). Applications of the Satir Growth
Northampton, MA: Contact Quarterly Books. Model. Wendell, NC: Virginia Satir Network.
Baker, E. (2000). The man in the trap. Princeton, NJ: The Banmen, J. (2008). Satir transformational systemic
American College of Orgonomy Press. therapy. Palo Alto, CA: Science and Behavior Books.
Baker, E. (2011). My eleven years with Wilhelm Reich. Bannister, D., & Fransella, F. (1986). Inquiring man (3rd
Princeton, NJ: American College of Orgonomy Press. ed.). London, England: Routledge.
Balsam, K. F., Martell, C. R., & Safren, S. A. (2006). Barker, P. (2007). Basic family therapy (5th ed.). Ames,
Affirmative cognitive-behavioral therapy with lesbian, IO: Blackwell Science.
gay, and bisexual people. In P. A. Hays & G. W. Barlow, D. H., & Hersen, M. (1984). Single case
Iwamasa (Eds.), Culturally responsive cognitive- experimental designs. New York, NY: Pergamon.
behavioral therapy: Assessment, practice, and Barnard, S., & Fink, B. (Eds.). (2002). Reading Seminar
supervision (pp. 223–244). Washington, DC: American XX: Lacan’s major work on love, knowledge, and
Psychological Association. feminine sexuality. Albany: State University of
Bamberg, M. (2011). Who am I? Narration and its New York Press.
contribution to self and identity. Theory & Psychology, Barnhofer, T., & Crane, C. (2009). Mindfulness-based
21(3), 3–24. doi:10.1177/0959354309355852 cognitive therapy for depression and suicidality. In
Bandura, A. (1969). Principles of behavioral modification. F. Didonna & J. Kabat-Zinn (Eds.), Clinical handbook
New York, NY: Holt, Rinehart, & Winston. of mindfulness (pp. 221–244). New York, NY: Springer.
Bandura, A. (1973). Aggression: A social learning analysis. Barratt, B. (1984). Psychic reality and psychoanalytic
Englewood Cliffs, NJ: Prentice Hall. knowing. Hillsdale, NJ: Analytic Press.
Bandura, A. (1977). Self-efficacy: Toward a unifying Barrett, D. (Ed.). (2010). Hypnosis and hypnotherapy:
theory of behavioral change. Psychological Review, 84, Neuroscience, personality, and cultural factors
191–215. doi:10.1037/0033-295X.84.2.191 (Vols. 1 & 2). Santa Barbara, CA: Praeger.
Bandura, A. (1977). Social learning theory. Englewood Baruth, L. G., & Huber, C. H. (1984). An introduction to
Cliffs, NJ: Prentice Hall. marital theory and therapy. Pacific Grove, CA: Brooks/
Bandura, A. (1986). Social foundations of thought and Cole.
action: A social cognitive theory. Englewood, NJ: Bateman, A. W., & Fonagy, P. (Eds.). (2012). Handbook
Prentice Hall. of mentalizing in mental health practice. Washington,
Bandura, A. (1997). Self-efficacy: The exercise of control. DC: American Psychiatric Publishing.
New York, NY: W. H. Freeman. Bateson, G. (1972). Steps to an ecology of mind. New
Bandura, A. (2006). Toward a psychology of human York, NY: Ballantine Books.
agency. Perspectives on Psychological Science, 1, Bateson, G. (1979). Mind and nature: A necessary unity.
164–180. doi:10.1111/j.1745-6916.2006.00011.x New York, NY: E. F. Dutton.

Bateson, G., Jackson, D. D., Haley, J., & Weakland, J. Beck, A. T. (1976). Cognitive therapy and the emotional
(1956). Toward a theory of schizophrenia. Behavioral disorders. New York, NY: New American Library.
Science, 1, 251–264. doi:10.1002/bs.3830010402 Beck, A. T. (1979). Cognitive therapy and the emotional
Batten, S. V. (2011). Essentials of acceptance and disorders. New York, NY: Plume.
commitment therapy. London, England: Sage. Beck, A. T. (1991). Cognitive therapy: A 30-year
Batthyany, A. (Ed.). (2009). The feeling of retrospective. American Psychologist, 46, 368–375.
meaninglessness: A challenge to psychotherapy and doi:10.1037//0003-066X.46.4.368
philosophy. Milwaukee, WI: Marquette University Beck, A. T. (1999). Prisoners of hate: The cognitive basis
Press. of anger, hostility, and violence. New York, NY:
Batthyany, A. (2009). Viktor E. Frankl & the development HarperCollins.
of logotherapy and existential analysis. In V. Frankl Beck, A. T. (2002). Prisoners of hate. Behaviour Research
(Ed.), The feeling of meaninglessness: A challenge to and Therapy, 40(3), 209–216. doi:10.1016/S0005-
psychotherapy and philosophy (pp. 7–41). Milwaukee, 7967(01)00103-6
WI: Marquette University Press. Beck, A. T. (2005). The current state of cognitive therapy.
Batthyany, A., & Guttmann, D. (2005). Empirical Archives of General Psychiatry, 62, 953–959.
research in logotherapy and meaning-oriented doi:10.1001/archpsyc.62.9.953
psychotherapy. Phoenix, AZ: Zeig, Tucker & Theisen. Beck, A. T., Freeman, A., Davis, D., & Associates. (2004).
Battino, R. (2002). Meaning: A play based on the life of Cognitive therapy of personality disorders (2nd ed.).
Viktor E. Frankl. Carmarthen, England: Crown New York, NY: Guilford Press.
House. Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979).
Battino, R. (2006). Expectation: The very brief therapy Cognitive therapy of depression. New York, NY:
book. Norwalk, CT: Crown House. Guilford Press.
Baucom, D. H., & Epstein, N. (2013). Cognitive- Beck, A. T., Steer, R. A., & Brown, G. K. (2003). BDI-II
behavioral marital therapy. New York, NY: Routledge. manual. San Antonio, TX: Psychological Corporation.
Baum, S., Guze, V., Hall, D., Madden, A., Panvini, R., Beck, J. (1995). Cognitive therapy: Basics and beyond.
Rhoads, E., . . .Tuccillo, E. (2011). Modern New York, NY: Guilford Press.
bioenergetics: An integrative approach to Beck, J. (2005). Cognitive therapy for challenging
psychotherapy. New York: The New York Society for problems. New York, NY: Guilford Press.
Bioenergetic Analysis. Beck, J. (2007). The Beck diet solution: Train your brain
Baumgarten, E., & Roffers, T. (2003). Implementing and to think like a thin person. Birmingham, AL: Oxmoor
expanding on Carkhuff’s training technology. Journal House.
of Counseling and Development, 81(3), 285–291. Beck, J. S. (2010). Cognitive behavior therapy: Basics and
doi:10.1002/j.1556-6678.2003.tb00255.x beyond (2nd ed.). New York, NY: Guilford Press.
Bayne, H., Neukrug, E., Hays, D., & Britton, B. (2013). A The Beck Institute. (2008). Dr. Aaron T. Beck’s biography.
comprehensive model for optimizing empathy in Retrieved from http://www.beckinstitute.org/aaron-
person-centered care. Patient Education and beck/
Counseling. doi:10.1016/j.pec.2013.05.016 The Beck Institute. (2008). Dr. Judith S. Becks biography.
Beaulieu, D. (2003). Eye movement integration therapy. Retrieved from http://www.beckinstitute.org/aaron-
Williston, VT: Crown House. beck/
Beaulieu, D. (2006). Impact techniques for therapists. Becker, R. O., & Selden, G. (1985). The body electric:
New York, NY: Routledge. Electromagnetism and the foundation of life. New York,
Beck, A. T. (1964). Thinking and depression: II. Theory and NY: William Morrow.
therapy. Archives of General Psychiatry, 10, 561–571. Becvar, D., & Becvar, R. (2006). Family therapy: A
doi:10.1001/archpsyc.1964.01720240015003 systemic integration (6th ed.). New York, NY: Pearson
Beck, A. T. (1967). Cognitive therapy and the emotional Education.
disorders. New York, NY: International Universities Beels, C. (2009). Some historical conditions of narrative
Press. work. Family Process, 48(3), 363–378.
Beck, A. T. (1967). Depression: Clinical, experimental, doi:10.1111/j.1545-5300.2009.01288.x
and theoretical aspects. New York, NY: Harper & Begley, S. (2007). Train your mind, change your brain:
Row. (Republished as Depression: Causes and How a new science reveals our extraordinary potential
treatment. Philadelphia: University of Pennsylvania to transform ourselves. New York, NY: Ballantine
Press, 1972) Books.

Behr, H., & Hearst, L. (2005). Group-analytic Berg, I. K., & Dolan, Y. M. (2001). Tales of solutions: A
psychotherapy: A meeting of minds. London, England: collection of hope-inspiring stories. New York, NY:
Whurr. W. W. Norton.
Bein, A. (2008). The Zen of helping: Spiritual principles Berg, I. K., & Gallagher, D. (1991). Solution-focused
for mindful and open-hearted practice. Hoboken, NJ: brief treatment with adolescent substance abusers.
Wiley. In T. C. Todd & M. D. Selekman (Eds.), Family
Bell, I. R., Lewis, D. A., II, Lewis, S. E., Brooks, A. J., therapy approaches with adolescent substance
Schwartz, G. E., & Baldwin, C. M. (2004). Strength abusers (pp. 93–111). Needham Heights, MA: Allyn
of vital force in classical homeopathy: Bio-psycho- & Bacon.
social-spiritual correlates within a complex systems Berg, I. K., & Miller, S. D. (1992). Working with the
context. Journal of Alternative & Complementary problem drinker: A solution-focused approach.
Medicine, 10(1), 123–131. doi:10.1089/10755530432 New York, NY: W. W. Norton.
2849048 Berg, I. K., & Reuss, N. H. (1998). Solutions step by step:
Bell, L. (2005). Psychoanalytic theories of gender. In A. H. A substance abuse treatment manual. New York, NY:
Eagly, A. E. Beall, & R. J. Sternberg (Eds.), The W. W. Norton.
psychology of gender (2nd ed., 145–168). New York, Berg, I. K., & Steiner, T. (2003). Children’s solution work.
NY: Guilford Press. New York, NY: W. W. Norton.
Bellak, L., Hurvich, M., & Gediman, H. (1973). Ego Berg, I. K., & Szabo, P. (2005). Brief coaching for lasting
functions in schizophrenics, neurotics and normals. solutions. New York, NY: W. W. Norton.
New York, NY: Wiley. Berger, P. L., & Luckmann, T. (1991). The social
Benjamin, J. (1988). The bonds of love: Psychoanalysis, construction of reality: A treatise in the sociology of
feminisms, and the problem of domination. New York, knowledge. London, England: Penguin.
NY: Pantheon Books. Bergner, R. (2007). Status dynamics: Creating new paths
Benjamin, L. S. (1996). Interpersonal diagnosis and to therapeutic change. Ann Arbor, MI: Burns-Park.
treatment of personality disorder (2nd ed.). New York, Berk, L. E. (2013). Development through the lifespan
NY: Guilford Press. (6th ed.). New York, NY: Pearson.
Bennet, E. A. (1961). C. G. Jung. London, England: Barrie Berlin, L. J., & Cassidy, J. (1999). Relations among
& Rockliff. relationship: Contributions from attachment theory
Bennet, E. A. (1967). What Jung really said. New York, and research. In J. Cassidy & P. R. Shaver (Eds.),
NY: Schocken. Handbook of attachment theory (pp. 688–712).
Bennett, E. D., & Smith, J. N. (2011). Neurology for New York, NY: Guilford Press.
smarties: Symptom recognition, referral, and support. Berne, E. (1961). Transactional analysis in psychotherapy:
Retrieved from http://counselingoutfitters.com/vistas/ A systematic individual and social psychiatry.
vistas11/Article_57.pdf New York, NY: Grove Press.
Bennett-Levy, J., Butler, G., Fennell, M., Hackmann, A., Berne, E. (1964). Games people play. New York, NY:
Mueller, M., & Westbrook, D. (Eds.). (2004). Oxford Grove Press.
guide to behavioural experiments in cognitive therapy. Berne, E. (1966). Principles of group treatment. New York,
Oxford, England: Oxford University Press. NY: Grove Press.
Benson, H., & Klipper, M. (1975). The relaxation von Bertalanffy, L. (1934). Modern theories of
response. New York, NY: HarperCollins. development: An introduction to theoretical biology.
Berg, I. K. (1994). Family-based services: A solution- London, England: Oxford University Press.
focused approach. New York, NY: W. W. Norton. von Bertalanffy, L. (1968). General systems theory.
Berg, I. K. (1995). Solution-focused brief therapy with New York, NY: Braziller.
substance abusers. In A. Washton (Ed.), Psychotherapy Bertolino, B., & Miller, S. D. (Eds.). (2012). The ICCE
and substance abuse: A practitioner’s handbook treatment and training manuals (6 vols.). Chicago, IL:
(pp. 223–242). New York, NY: Guilford Press. ICCE Press.
Berg, I. K. (n.d.). For students only. Retrieved from http:// Bertolino, B., & O’Hanlon, B. (2002). Collaborative,
www.sfbta.org/bftc/Steve&Insoo_PDFs/ competency-based counseling and therapy. Needham
ForStudentsOnly.pdf Heights, MA: Allyn & Bacon.
Berg, I. K. (n.d.). Insoo Kim Berg Vita. Retrieved from Bérubé, A. (1990). Coming out under fire: The history of
http://educationandcounseling.sdstate.edu/ gay men and women in World War Two. New York,
CHRDtribute.aspx NY: The Free Press.

Berzergianov, R. (2011). Character education with chess. comparative psychotherapy process literature. Clinical
Seattle, WA: Amazon Digital Services. Psychology Review, 22, 671–706. doi:10.1016/S0272-
Besley, A. C. T., & Edwards, R. G. (2005). Editorial: 7358(01)00117-9
Poststructuralism and the impact of the work of Blampied, N. M., & Kahan, E. (1992). Acceptability of
Michel Foucault in counselling and guidance. British alternative punishments: A community survey.
Journal of Guidance & Counselling, 33(3), 277–281. Behavior Modification, 16, 400–413.
doi:10.1080/03069880500179244 doi:10.1177/01454455920163006
Beutler, L. E., Malik, M., Alimohamed, S., Harwood, T. M., Blatner, A. (2000). Foundations of psychodrama: History,
Talebi, H., Noble, S., & Wong, E. (2004). Therapist theory, and practice (4th ed.). New York, NY:
variables. In M. J. Lambert (Ed.), Bergin and Garfield’s Springer.
handbook of psychotherapy and behavior change Bleandonu, G. (2000). Wilfred Bion: His life and works
(5th ed., pp. 227–306). New York, NY: Wiley. 1897-1979. New York, NY: Other Press.
Bhat, N. (2008, March 27). Problems are treated from the Blissmer, B., Prochaska, J. O., Velicer, W. F., Redding, C.
outside in. San Diego Union Tribune. Retrieved from A., Rossi, J. S., Greene, G. W., . . . & Robbins, M.
http://www.signonsandiego.com/uniontrib/20080327/ (2010). Common factors predicting long-term changes
news_1c27therapy.html in multiple health behaviors. Journal of Health
Bidwell, D. R. (2007). Miraculous knowing: Epistemology Psychology, 15, 205–214.
and solution-focused therapy. In T. S. Nelson & F. N. doi:10.1177/1359105309345555
Thomas (Eds.), Handbook of solution-focused brief Blocher, D. H. (2000). The evolution of counseling
therapy: Clinical applications (pp. 65–87). New York, psychology. New York, NY: Springer.
NY: Haworth Press. Block, D., & Simon, R. (1982). The strength of family
Bieschke, K. J., Perez, R. M., & DeBord, K. A. (Eds.). therapy: Selected papers of Nathan W. Ackerman.
(2007). Handbook of counseling and psychotherapy New York, NY: Brunner Mazel.
with lesbian, gay, bisexual, and transgender clients Bloom, B. L. (1992). Planned short-term psychotherapy:
(2nd ed.). Washington, DC: American Psychological A clinical handbook. Boston, MA: Allyn & Bacon.
Association. Blume, T. W. (2010). Counseling for identity
Bigner, J. J., & Wetchler, J. L. (Eds.). (2012). Handbook of renegotiation. Identity: An International Journal of
LGBT-affirmative couple and family therapy. New York, Theory and Research, 10, 92–105.
NY: Routledge. doi:10.1080/15283481003711700
Billow, R. M. (2003). Relational group psychotherapy: Blumenthal, R. (2006, December 24). Hotel log hints at
From basic assumptions to passion. Philadelphia, PA: illicit desire that Dr. Freud didn’t repress. New York
Jessica Kingsley. Times. Retrieved from http://www.nytimes
Billow, R. M. (2010). Resistance, rebellion and refusal in .com/2006/12/24/world/europe/24freud.html
groups: The 3 Rs. London, England: Karnac Books. Bohart, A. C., Elliott, R., Greenberg, L. S., & Watson, J. C.
Billow, R. M. (2014). Relational group psychotherapy: (2002). Empathy. In J. C. Norcross (Ed.), Psychotherapy
Developing nuclear ideas. London, England: Karnac relationships that work: Therapist contributions and
Books. responsiveness to patients (pp. 89–108). New York,
Binswanger, L. (1963). Being-in-the-world: Selected NY: Oxford University Press.
papers of Ludwig Binswanger. New York, NY: Basic Bonny, H. (2002). Facilitating guided imagery and music
Books. (GIM) sessions. In L. Summer (Ed.), Music
Bion, W. (1961). Experiences in groups. London, England: consciousness: The evolution of guided imagery and
Tavistock. music (pp. 269–297). Gilsum, NH: Barcelona.
Bion, W. (1967). Second thoughts. London, England: Boscolo, L., & Bertrando, P. (1993). I tempi del tempo:
Heinemann. Una nuova prospettiva per la consulenza e la terapia
Bion, W. R. (2010). Experiences in groups (7th ed.). sistematica [The Times of Time: A new perspective in
New York, NY: Routledge. systemic therapy and consultation] (B. Torino, Trans.).
Bitter, J. R. (2009). Theory and practice of family therapy New York, NY: W. W. Norton.
and counseling. Belmont, CA: Brooks-Cole. Boscolo, L., & Bertrando, P. (1996). Systemic therapy
Bjork, D. W. (1997). B. F. Skinner: A life. Washington, with individuals. London, England: Karnac Books.
DC: American Psychological Association. Boscolo, L., Cecchin, G., Hoffman, L., & Penn, P. (1987).
Black, S. (2004). A way of life: Core energetics. Lincoln, Milan systemic family therapy: Conversations in
NE: iUniverse. theory and practice. New York, NY: Basic Books.
Blagys, M., & Hilsenroth, M. (2002). Distinctive activities Bosnak, R. (1988). A little course in dreams. Boston, MA:
of cognitive-behavioral therapy: A review of the Shambhala.

Boss, M. (1979). Existential foundations of medicine and Brammer, L. M., & MacDonald, G. (2003). The helping
psychology. New York, NY: Jason Aronson. relationship: Process and skills (8th ed.). Boston, MA:
Bosser, A. (2008). Relieve stiffness and feel younger again Allyn & Bacon.
with undulation. Issaquah, WA: Vital Self. Brandell, J. R. (2010). Contemporary psychoanalytic
Boszormenyi-Nagy, I. (1973). Invisible loyalties: perspectives on attachment. Psychoanalytic Social
Reciprocity in intergenerational family therapy. Work, 17, 132–157. doi:10.1080/15228878.2010.512
New York, NY: Harper & Row. 265
Boszormenyi-Nagy, I. (1987). Foundations of contextual Brandsma, J., & Farrelly, F. (1974). Provocative therapy.
therapy: Collected papers of Ivan Boszormenyi-Nagy. Fort Collins, CO: Shields.
New York, NY: Brunner Mazel. Brecklinghaus, H. G. (2002). Rolfing structural
Boszormenyi-Nagy, I., & Framo, J. (Eds.). (1985). integration: What it achieves, how it works and whom
Intensive family therapy. Theoretical and practical it helps. Freiburg im Breisgau, Germany: Lebenshaus
aspects. New York, NY: Brunner/Mazel. (Original Verlag.
work published 1965) Breger, L. (2000). Freud: Darkness in the midst of vision.
Boszormenyi-Nagy, I., & Krasner, B. (1986). Between give New York, NY: Wiley.
and take. A clinical guide to contextual therapy. Breggin, P. (1991). Toxic psychiatry. New York, NY:
New York, NY: Brunner/Mazel. St. Martin’s Press.
Boszormenyi-Nagy, I., & Spark, G. (1984). Invisible Brenkman, J. (2004). Freud the modernist. In M. S.
loyalties. New York, NY: Brunner/Mazel. (Original Micale (Ed.), The mind of modernism: Medicine,
work published 1973) psychology, and the cultural arts in Europe and
Bottome, P. (1957). Alfred Adler: A portrait from life. America, 1880–1940 (pp. 172–196). Stanford, CA:
New York, NY: The Vanguard Press. Stanford University Press.
Boudewyns, P. A., & Shipley, R. H. (1983). Flooding and Brenner, C. (1973). Elementary text in psychoanalysis.
implosive therapy: Direct therapeutic exposure in New York, NY: International Universities Press.
clinical practice. New York, NY: Plenum Press. Bretherton, I. (2010). Fathers in attachment theory and
Bouton, M. E. (2006). Learning and behavior: A research: A review. Early Child Development and
contemporary synthesis. Sunderland, MA: Sinauer. Care, 180(1/2), 9–23.
Bouton, M. E., Winterbauer, N. E., & Vurbic, D. (2012). doi:10.1080/03004430903414661
Context and extinction: Mechanisms of relapse in Breuer, J., & Freud, S. (1895). Studies on hysteria (2nd
drug self-administration. In M. Haselgrove & L. Standard ed., pp. 3–19). London, England: Hogarth
Hogarth (Eds.), Clinical applications of learning theory Press. (Original work published 1953)
(pp. 103–133). East Sussex, England: Psychology Press. Brewin, C. R. (1989). Cognitive change processes in
Bowen, M. (1976). Theory in the practice of psychotherapy. Psychological Review, 96, 379–394.
psychotherapy. In P. J. Guerin (Ed.), Family therapy: doi:10.1037//0033-295X.96.3.379
Theory and practice (pp. 42–90). New York, NY: Brickell, J. (2007, February). Reality therapy: Helping
Gardner Press. people take more effective control of their lives.
Bowen, M. (1978). Family therapy in clinical practice. Counseling at Work, 6–9.
New York, NY: Jason Aronson. Bridges, S. K. (2015). Coherence therapy: The roots of
Bowen, M., & Kerr, M. (1988). Family evaluation. problems and the transformation of old solutions. In
New York, NY: W. W. Norton. H. E. A. Tinsley, S. H. Lease, & N. S. G. Wiersma
Bowlby, J. (1988). A secure base: Parent/child attachment (Eds.), Contemporary theory and practice of
and healthy human development. New York, NY: counseling and psychotherapy (pp. XX–XX).
Basic Books. Thousand Oaks, CA: Sage.
Bowlby, J. (2005). The making and breaking of affectional Bridle, S., & Edelstein, A. (2000, Spring/Summer). Was ist
bonds. New York, NY: Routledge. “das Ich”? EnlightNext Magazine, 17, 126–129,
Boyesen, G., & Boyesen, M. L. (1974). Psycho-peristalsis: 176–177.
The abdominal discharge of nervous tension. Energy Bringhurst, D. L., Watson, C. S., Miller, S. D., & Duncan,
& Character: The Journal of Biosynthesis, 5(1), 5–16. B. L. (2006). The reliability and validity of the
Bradford, L. P., Gibb, J. R., & Benne, K. D. (1967). outcome rating scale: A replication study of a brief
T-Group theory and laboratory method: Innovation in clinical measure. Journal of Brief Therapy, 5(1), 23–29.
re-education. New York, NY: Wiley. Bronfenbrenner, U. (1977). Toward an experimental
Bradshaw, J. (1990). Homecoming: Reclaiming and ecology of human development. American
championing your inner child. Deerfield Beach, FL: Psychologist, 32, 515–531. doi:10.1037/0003-066X.
Health Communications. 32.7.513

Bronstein, P. (1986). Re-evaluation counseling: A self-help Quarterly, 30, 15–24. doi:10.1111/j.1471-6402.2006

model for recovery from emotional distress. Women .00258.x
& Therapy, 5(1), 41–54. doi:10.1300/J015V05N01_08 Brown, L. S., & Bryan, T. C. (2007). Feminist therapy
Brook, A. (2000). Contact improvisation and body-mind with people who self-inflict violence. Journal of
centering: A manual for teaching and learning Clinical Psychology: In Session, 63(11), 1121–1133.
movement. Boulder, CO: Smart Body Books. doi:10.1002/jclp.20419
Brook, A. (2001). From conception to crawling: Brown, M. Z. (2006). Linehan’s theory of suicidal
Foundations for developmental movement. Boulder, behavior: Theory, research, and dialectical behavior
CO: Smart Body Books. therapy. In T. T. Ellis (Ed.), Cognition and suicide:
Brook, A. (2014). Birth’s hidden legacy: How surprising Theory, research, and therapy (pp. 91–117).
beliefs from infancy limit adult and child behavior Washington, DC: American Psychological Association.
(Vol. 1). Boulder, CO: Smart Body Books. Brown, N. (2011). Psychoeducational groups. New York,
Brook, A. (2014). Birth’s hidden legacy: Treat earliest NY: Routledge.
origins of shock and attachment trauma in adults, Brown, N. W. (2013). Creative activities for group
children, and infants (Vol. 2). Boulder, CO: Smart therapy. New York, NY: Routledge.
Body Books. Brown, R. (1999). Imago relationship therapy: An
Brooks, G. R., & Good, G. E. (2005). The new handbook introduction to theory and practice. New York, NY:
of psychotherapy and counseling with men: A Wiley.
comprehensive guide to settings, problems, and Brownell, P. (2010). Gestalt therapy: A guide to
treatment approaches (Revised & abridged ed.). contemporary practice. New York, NY: Springer.
San Francisco, CA: Jossey-Bass. Bruscia, K. E. (Ed.). (1991). Case studies in music therapy.
Brooks-Harris, J. E. (2008). Integrative multitheoretical Gilsum, NH: Barcelona.
psychotherapy. Boston, MA: Houghton Mifflin. Bruscia, K. E. (1998). Defining music therapy (2nd ed.).
Broverman, I. K., Broverman, D. M., Clarkson, F., Gilsum, NH: Barcelona.
Rosenkrantz, P., & Vogel, S. (1970). Sex role Buber, M. (1958). I and thou (2nd ed.). New York, NY:
stereotyping and clinical judgments of mental health. Scribner.
Journal of Consulting and Clinical Psychology, 45, Buber, M. (1971). I and thou (Ich und Du). New York,
250–256. doi:10.1037/h0028797 NY: Scribner.
Brown, C. (1993). Feminist contracting: Power and Buchanan, P. A. (2012). The Feldenkrais Method® of
empowerment in therapy. In C. Brown & K. Jasper somatic education. In A. Bhattacharya (Ed.), A
(Eds.), Consuming passions: Feminist approaches to compendium of essays on alternative therapy
weight preoccupation and eating disorders (pp. 176– (pp. 147–172). Retrieved from http://www.intechopen
194). Toronto, Ontario, Canada: Second Story Press. .com/articles/show/title/the-feldenkrais-method-of-
Brown, C. (2007). Situating knowledge and power in the somatic-education
therapeutic alliance. In C. Brown & T. Augusta-Scott Buchanan, P. A., & Ulrich, B. (2001). The Feldenkrais
(Eds.), Narrative therapy: Making meaning, making Method®: A dynamic approach to changing motor
lives (pp. 3–22). Thousand Oaks, CA: Sage. behavior. Research Quarterly for Exercise and Sport,
Brown, C. G., Weber, S., & Ali, S. (2008). Women’s body 72, 315–323. doi:10.1080/02701367.2001.10608968
talk: A feminist narrative approach. Journal of Buchheimer, A. (1959). From group to “Gemeinschaft.” In
Systemic Therapies, 27(2), 92–104. doi:10.1521/ K. A. Adler & D. Deutsch (Eds.), Essays in individual
jsyt.2008.27.2.92 psychology: Contemporary applications of Alfred
Brown, F. H. (2006). Reweaving the family tapestry: A Adler’s theories (pp. 242–246). New York, NY: Grove
multigenerational approach to families. New York, Press.
NY: W. W. Norton. Buck, J. N. (1948). The H-T-P technique: A qualitative
Brown, J., & Mowbray, R. (1994). Primal integration. In and quantitative scoring manual. Journal of Clinical
D. Jones (Ed.), Innovative therapy: A handbook Psychology, 4, 317–396. doi:10.1002/1097-
(pp. 13–27). Buckingham, England: Open University Press. 4679(194810)4:4<317::AID-JCLP2270040402>3
Brown, L. (2010). Feminist therapy. Washington, DC: .0.CO;2-6
American Psychological Association. Buckley, T. R., & Franklin-Jackson, C. F. (2005). Diagnosis in
Brown, L. S. (2006). Still subversive after all these years: racial-cultural practice. In R. T. Carter (Ed.), Handbook
The relevance of feminist therapy in the age of of racial-cultural psychology and counseling: Theory and
evidence-based practice. Psychology of Women research (Vol. 2, pp. 286–296). Hoboken, NJ: Wiley.

Bugental, J. F. T. (1976). The search for existential Butt, T. (2008). George Kelly. New York, NY: Palgrave
identity: Patient-therapist dialogues in humanistic Macmillan.
psychotherapy. San Francisco, CA: Jossey-Bass. Bütz, M. R., Chamberlain, L. L., & McCown, W. G.
Bugental, J. F. T. (1978). Psychotherapy and process: The (1997). Strange attractors: Chaos, complexity, and the
fundamentals of an existential-humanistic approach. art of family therapy. New York, NY: Wiley.
New York, NY: Random House. Buzzell, L., & Chalquist, C. (Eds.). (2009). Ecotherapy:
Burger, W., & Youkeles, M. (2008). Human services in Healing with nature in mind. San Francisco, CA:
contemporary America (7th ed.). Belmont, CA: Sierra Club Books.
Brooks/Cole. Cabaniss, D. L., Cherry, S., Douglas, C. J., & Schwartz, A. R.
Burlingame, G. M., Fuhriman, A., & Johnson, J. E. (2011). Psychodynamic psychotherapy: A clinical
(2002). Cohesion in group psychotherapy. In manual. Hoboken, NJ: Wiley-Blackwell.
J. Norcross (Ed.), A guide to psychotherapy Cacioppo, J. T., & Decety, J. (2011). Social neuroscience:
relationships that work (pp. 71–88). New York, NY: Challenges and opportunities in the study of complex
Oxford University Press. behavior. Annals of the New York Academy of
Burlingame, G. M., Strauss, B., Joyce, A., MacNair- Sciences, 1224, 162–173.
Semands, R., MacKenzie, R., Ogrodniczuk, J., & doi:10.1111/j.1749-6632.2010.05858.x
Taylor, S. (2005). American Group Psychotherapy Cade, B. (2005). Obituary: Steve de Shazer: 1940–2005.
Association’s CORE battery—Revised. New York, Retrieved from http://www.ebta.nu/page28/page32/
NY: American Group Psychotherapy Association. page32.html
Burnham, J. C. (Ed.). (2012). After Freud left: A century Cade, B. (2007). Springs, streams, and tributaries: A
of psychoanalysis in America. Chicago, IL: University history of the brief, solution-focused approach. In T. S.
of Chicago Press. Nelson & F. N. Thomas (Eds.), Handbook of solution-
Burns, G. W. (1998). Nature-guided therapy: Brief focused brief therapy: Clinical applications (pp.
integrative strategies for health and wellbeing. 25–64). New York, NY: Haworth Press.
Philadelphia, PA: Brunner-Mazel. Caffaro, J. V. (2013). Sibling abuse trauma: Assessment
Burns, G. W. (2005). Naturally happy, naturally healthy: and intervention with children, families, and adults
The role of the natural environment in well-being. In (2nd ed.). New York, NY: Routledge.
F. A. Huppert, N. Baylis, & B. Keverne (Eds.), The Caffaro, J. V., & Conn-Caffaro, A. (2003). Sibling
science of well-being (pp. 405–431). Oxford, England: dynamics and group psychotherapy. International
Oxford University Press. Journal of Group Psychotherapy, 53(2), 135–154.
Burns, G. W. (2009). The path of happiness: Integrating doi:10.1521/ijgp.53.2.135.42818
nature into therapy for couples and families. In Cain, D. J. (2002). Defining characteristics, history, and
L. Buzzell & C. Chalquist (Eds.), Ecotherapy: Healing evolution of humanistic psychotherapies. In D. J. Cain
with nature in mind (pp. 92–103). San Francisco, CA: (Ed.), Humanistic psychotherapies: Handbook of
Sierra Club Books. research and practice (pp. 3–54). Washington, DC:
Burns, G. W. (Ed.). (2010). Happiness, healing, American Psychological Association.
enhancement: Your casebook collection for using Campbell, A., & Hemsley, S. (2009). Outcome rating
positive psychotherapy. Hoboken, NJ: Wiley. scale and session rating scale in psychological practice:
Bussey, K. (2011). The influence of gender on students’ Clinical utility of ultra-brief measures. Clinical
self-regulated learning and performance. In B. J. Psychologist, 13, 1–9.
Zimmerman & D. H. Schunk (Eds.), Handbook of doi:10.1080/13284200802676391
self-regulation of learning and performance (pp. 426– Campbell, J. (Ed.). (1971). The portable Jung. New York,
441). New York, NY: Routledge. NY: Penguin.
Bussey, K., & Bandura, A. (1999). Social cognitive theory Caputi, P., Viney, L. L., Walker, B. M., & Crittenden, N.
of gender development and differentiation. Psychology (Eds.). (2012). Personal construct methodology.
Review, 106, 676–713. doi:10.1037/0033- Chichester, England: Wiley-Blackwell.
295X.106.4.676 Cardena, E., Lynn, S. J., & Krippner, S. (Eds.). (2000).
Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. Varieties of anomalous experience: Examining the
T. (2006). The empirical status of cognitive-behavioral scientific evidence (pp. 151–182). Washington, DC:
therapy: A review of meta-analyses. Clinical American Psychological Association.
Psychology Review, 26(1), 17–31. doi:10.1016/j. Carey, B. (2006, January 31). Judge orders psychologist
cpr.2005.07.003 reinstated to institute. New York Times. Retrieved

from http://www.nytimes.com/2006/01/31/nyregion/ component yoga breath program for Vietnam veteran

31ellis.html?ex=1180756800&en=4f0c1198ea0d7b91& post traumatic stress disorder: Randomized controlled
ei=5070 trial. Journal of Traumatic Stress Disorders &
Carey, B. (2011, June 23). Expert on mental illness reveals Treatment, 2(3), 1–10. doi:10.4172/2324-8947
her own fight. New York Times. Retrieved from http:// .1000108
www.nytimes.com/2011/06/23/health/23lives Casement, A. (2001). Carl Gustav Jung. Thousand Oaks,
.html?pagewanted=all CA: Sage.
Carey, T. A. (2006). The method of levels: How to do Casement, P. (1991). Learning from the patient. London,
psychotherapy without getting in the way. Hayward, England: Guilford Press.
CA: Living Control Systems Publishing. Casswell, G., Golding, K. S., Grant, E., Hudson, J., &
Carey, T. A. (2008). Hold that thought! Two steps to Tower, P. (2014). Dyadic developmental practice
effective counseling and psychotherapy with the (DDP): A framework for therapeutic intervention and
method of levels. Chapel Hill, NC: New View. parenting. Child and Family Clinical Psychology
Carhart-Harris, R., Mayberg, H. S., Malizia, A. L., & Review, 2.
Nutt, D. (2008). Mourning and melancholia revisited: Castonguay, L. G., Newman, M. G., Borkovec, T. D.,
Correspondences between principles of Freudian Grosse Holtforth, M., & Maramba, G. G. (2005).
metapsychology and empirical findings in Cognitive-behavioral assimilative integration. In
neuropsychiatry. Annals of General Psychiatry, 7, 9. J. C. Norcross & M. R. Goldfried (Eds.), Handbook
doi:10.1186/1744-859X-7-9 of psychotherapy integration (2nd ed., pp. 241–260).
Caring, M., Cook, C., Feinsten, G., Fodor, I., Friedman, New York, NY: Oxford University Press.
Z., Gerstman, A., . . . Wolfert, R. (1999). Adding de Castro, S., & Guterman, J. T. (2008). Solution-focused
women’s voices: Feminism and Gestalt therapy. Gestalt therapy for families coping with suicide. Journal of
Review, 3(3). Retrieved from http://www.gisc.org/ Marital & Family Therapy, 34(1), 93–106.
gestaltreview/v3.php doi:10.1111/j.1752-0606.2008.00055.x
Carkhuff, R. (1969). Helping and human relations (Vol. Ceballos, P. L., & Bratton, S. C. (2010). Empowering
2). New York, NY: Holt, Rinehart & Winston. Latino families: Effects of a culturally responsive
Carkhuff, R. (2000). The art of helping in the twenty-first intervention for low-income immigrant Latino parents
century (8th ed.). Amherst, MA: Human Resource on children’s behaviors and parental stress. Psychology
Development Press. in the Schools, 47(8), 761–775. doi:10.1002/
Carkhuff, R. R., & Berenson, B. G. (1977). Beyond pits.20502
counseling and therapy (8th ed.). New York, NY: Holt, Cecchin, G. F. (1987). Hypothesizing, circularity and
Rinehart & Winston. neutrality revisited: An invitation to curiosity. Family
Carlson, J., Watts, R. E., & Maniacci, M. (2006). Process, 26, 405–413.
Adlerian therapy: Theory and practice. Washington, doi:10.1111/j.1545-5300.1987.00405.x
DC: American Psychological Association. Cecchin, G. F., & Apolloni, T. (2003). Idee Perfette:
Carlson, J. C. (2002). Strategic family therapy. In Hybris delle prigioni della mente [Perfect ideas:
J. Carlson & D. Kjos (Eds.), Theories and strategies of Hybris prisons of the mind]. Milan, Italy: Franco
family therapy (pp. 80–97). Boston, MA: Allyn & Angeli.
Bacon. Cecchin, G. F., Lane, G., & Ray, W. A. (1992).
Carlson, T. D., & Erickson, M. J. (2000). Re-authoring Irreverence. A strategy for therapist’s survival. London,
spiritual narratives: God in persons’ relational identity England: Karnac Books.
stories. Journal of Systemic Therapies, 19(2), 65–83. Cecchin, G. F., Lane, G., & Ray, W. A. (1997). The
Carr, A. (2004). Thematic review of family therapy cybernetics of prejudices in the practice of
journals in 2003. Journal of Family Therapy, 26(4), psychotherapy. London, England: Karnac Books.
430–445. doi:10.1111/j.1467-6427.2004.00292.x Chace, M., Sandel, S. L., Chaiklin, S., & Lohn, A. (1993).
Carr, A. (2005). Thematic review of family therapy Foundations of dance/movement therapy: The life and
journals in 2004. Journal of Family Therapy, 27(4), work of Marian Chace. Columbia, MD: Marian Chace
399–421. doi:10.1111/j.1467-6427.2005.0330.x Memorial Fund of the American Dance Therapy
Carson, R. C. (1969). Interaction concepts of personality. Association.
Chicago, IL: Aldine. Chaitow, L. (2006). Muscle energy techniques with DVD-
Carter, J., Gerbarg, P. L., Ware, R. S., D’Ambrosio, C., ROM (3rd ed.). Philadelphia, PA: Churchill
Anand, L., . . . Katzman, M. A. (2013). Multi- Livingston.

Chaitow, L. (2007). Positional release techniques with & Family Therapy, 38(1), 241–264.
DVD-ROM (3rd ed.) (Advanced Soft Tissue doi:10.1111/j.1752-0606.2011.00246.x
Techniques). Philadelphia, PA: Churchill Chesler, P. (1972). Women and madness. New York, NY:
Livingston. Doubleday.
Chamberlain, D. (1984). Consciousness at birth: A review Cheung, G., & Chan, C. (2002). The Satir model and
of the empirical evidence. San Diego, CA: cultural sensitivity: A Hong Kong reflection.
Chamberlain Communications. Contemporary Family Therapy, 24(1), 199–215.
Chamberlain, D. (1998). The mind of your newborn doi:10.1023/A:1014338025464
baby. Berkeley, CA: North Atlantic Books. Cheung, M. (2006). Therapeutic games and guided
Chamberlain, S. (2003). A tale of narrative therapy. imagery: Tools for mental health and school
Retrieved from http://therapy.massey.ac.nz/175772/ professionals working with children, adolescents, and
narrative/mod1web/3hour1.html their families. Chicago, IL: Lyceum Books.
Chambless, D. L., Baker, M. J., Baucom, D. H., Beutler, L. Chiari, G., & Nuzzo, M. L. (1996). Psychological
E., Calhoun, K. S., Crits-Cristoph, P., . . . Woody, S. R. constructivisms: A metatheoretical differentiation.
(1998). Update on empirically validated therapies, II. Journal of Constructivist Psychology, 9, 163–184.
The Clinical Psychologist, 51(1), 3–16. doi:10.1080/10720539608404663
Chambless, D. L., & Ollendick, T. H. (2001). Empirically Chiari, G., & Nuzzo, M. L. (2010). Constructivist
supported psychological interventions: Controversies psychotherapy: A narrative hermeneutic approach.
and evidence. Annual Review of Psychology, 52, Hove, England: Routledge.
685–716. doi:10.1146/annurev.psych.52.1.685 Chickering, A. W., & Reisser, L. (1993). Education and
Chandler, C. (2005). Animal assisted therapy in identity. San Francisco, CA: Jossey-Bass.
counseling. New York, NY: Routledge. Chodorow, N. J. (1978). The reproduction of mothering:
Chandler, C., Bodenhamer-Davis, E., Holden, J. M., Psychoanalysis and the sociology of gender. Berkeley:
Evenson, T., & Bratoon, S. (2001). Enhancing personal University of California Press.
wellness in counselor trainees using biofeedback: An Church, D. (2013). The EFT manual (3rd ed.). Santa
exploratory study. Applied Psychophysiology and Rosa, CA: Energy Psychology Press.
Biofeedback, 26(1), 1–7. Churchill, P. (2007). Eternal breath: A biography of
Chang, J., Combs, G., Dolan, Y., Freedman, J., Mitchell, Leonard Orr, founder of rebirthing breathwork.
T., & Trepper, T. S. (2012). From Ericksonian roots to Victoria, British Columbia, Canada: Trafford.
postmodern futures. Part I: Finding postmodernism. Ciarrochi, J., & Bailey, A. (2008). A CBT-practitioner’s
Journal of Systemic Therapies, 31(4), 63–76. guide to ACT: How to bridge the gap between
doi:10.1521/jsyt.2012.31.4.63 cognitive behavioral therapy and acceptance and
Chang, J., Combs, G., Dolan, Y., Freedman, J., Mitchell, commitment therapy. Oakland, CA: New Harbinger.
T., & Trepper, T. S. (2013). From Ericksonian roots to Clark, A. J. (2002). Early recollections: Theory and
postmodern futures. Part II: Shaping the future. practice in counseling and psychotherapy. New York,
Journal of Systemic Therapies, 32(2), 35–45. NY: Brunner-Routledge.
doi:10.1521/jsyt.2013.32.2.35 Clark, D. A., & Beck, A. T. (2010). Cognitive therapy of
Chapin, T., & Russell-Chapin, L. (2014). Neurotherapy anxiety disorders: Science and practice. New York,
and neurofeedback: Brain-based treatment for NY: Guilford Press.
psychological and behavioral problems. New York, Clark, D. A., Beck, A. T., & Alford, B. A. (1999). Scientific
NY: Routledge. foundations of cognitive theory and therapy of
Chard, K. M. (2005). An evaluation of cognitive depression. New York, NY: Wiley.
processing therapy for the treatment of child sexual Clarke, J. J. (1992). In search of Jung. London, England:
abuse. Journal of Child Sexual Abuse, 15, 87–103. Routledge.
doi:10.1037/0022-006X.73.5.965 Clarke, S., Kinston, J., Wilson, K. G., Bolderston, H., &
Charney, D. S., Nestler, E. J., Sklar, P., & Buxbaum, J. D. Reminton, B. (2012). Acceptance and commitment
(Eds.). (2013). Neurobiology of mental illness. New therapy for a heterogeneous group of treatment-
York, NY: Oxford University Press. resistant clients: A treatment development study.
Chenail, R. J., St. George, S., Wulff, D., Duffy, M., Scott, Cognitive and Behavioral Practice, 19, 560–572.
K. W., & Tomm, K. (2012). Clients’ relational doi:10.1016/j.cbpra.2012.03.001
conceptions of co-joint couple and family therapy Clarke, S., Thomas, P., & James, K. (2013). Cognitive
quality: A grounded formal theory. Journal of Marital analytic therapy for personality disorder: Randomized

controlled trial. British Journal of Psychiatry, 203, Handbook of family therapy training and supervision
129–134. doi:10.1192/bjp.bp.112.108670 (pp. 17–37). New York, NY: Guilford Press.
Clarkin, J. F., Yeomans, F. E., & Kernberg, O. F. (2005). Colapinto, J. (1991). Structural family therapy. In
Psychotherapy for borderline personality: Focusing on A. Gurman & D. Kniskern (Eds.), Handbook of family
object relations (1st ed.). Arlington, VA: American therapy (Vol. 2, pp. 417–443). New York, NY:
Psychiatric Publishing. Brunner/Mazel.
Clarkson, P. (2004). Gestalt counseling in action (3rd Colins, K. A. (2002). An examination of feminist
ed.). Thousand Oaks, CA: Sage. psychotherapy in North America during the 1980s.
Clinebell, H. (1996). Ecotherapy: Healing ourselves, Guidance and Counseling, 17, 105–112.
healing the earth. Minneapolis, MN: Fortress Press. Collins, S., & Arthur, N. (2010). Culture-infused
Clinton, A. (2002). Seemorg matrix work: The counseling: A model for developing multicultural
transpersonal psychotherapy. In F. P. Gallo (Ed.), competence. Counseling Psychology Quarterly, 23(2),
Energy psychology in psychotherapy: A comprehensive 217–233. doi:10.1080/09515071003798212
sourcebook (pp. 93–115). New York, NY: W. W. Collura, T. F. (2013). Technical foundations of
Norton. neurofeedback. London, England: Routledge.
Clinton, A. (2006). Seemorg matrix work: A new Compton, W. C., & Hoffman, E. (2013). Positive
transpersonal psychotherapy. Journal of Transpersonal psychology: The science of happiness and flourishing
Psychology, 38(1), 95–116. (2nd ed.). Belmont, CA: Wadsworth, Cengage Learning.
Cloud, J. (2006, February 5). The third wave of therapy. Condrau, G. (1998). Martin Heidegger’s impact on
Time Magazine. Retrieved from http://www.time.com/ psychotherapy. New York, NY: Mosaic.
time/magazine/article/0,9171,1156613,00.html Connell, G., Mitten, T., & Bumberry, W. (1999).
Coates, L., & Wade, A. (2007). Language and violence: Reshaping family relationships: The symbolic therapy
Analysis of four discursive operations. Journal of of Carl Whitaker. Philadelphia, PA: Brunner/Mazel.
Family Violence, 22, 511–522. doi:10.1007/s10896- Connor, M., Creath, K., & Schwartz, G. (2004).
007-9082-2 Oscillation of amplitude as measured by an extra low
Coates, S. (2012). John Bowlby and Margaret S. Mahler: frequency magnetic field meter as a physical measure
Their lives and theories. In L. Aron & A. Harris (Eds.), of intentionality. Conference Proceedings of World Qi
Relational psychoanalysis: Expansion of theory (Vol. 4, Gong Congress, San Francisco, CA.
pp. 131–157). New York, NY: Routledge/Taylor & Connor, M., Jacobs, L., & Schwartz, G. (2005).
Francis Group. Demographics of energy healing training programs.
Cockburn, G. (2013). “Seeing what is so simply present”: Research Symposium Conference Proceedings, Second
Learning to be a bioenergetic therapist. Bioenergetic QiGong Summit and Whole Person Healing
Analysis, 23, 75–100. Conference, Washington, DC.
Cohen, D. B. (2006). “Family constellations”: An Connor, M., Tau, G., & Schwartz, G. (2005).
innovative systemic phenomenological group process Methodological challenges in the evaluation of energy
from Germany. The Family Journal, 14(3), 226–233. medicine practitioners. Research Symposium
doi:10.1177/1066480706287279 Conference Proceedings of International Society for
Cohen, J. A., Deblinger, E., Mannarino, A. P., & Steer, R. A. the Study of Subtle Energies and Energy Medicine,
(2004). A multisite, randomized controlled trial for Boulder, CO.
children with sexual abuse-related PTSD symptoms. Conoley, C. W., Graham, J. M., Neu, T., Craig, M. C.,
Journal of the American Academy of Child and O’Pry, A., Cardin, S. A., . . . Parker R. I. (2003).
Adolescent Psychiatry, 43, 393–402. Solution-focused family therapy with three aggressive
doi:10.1097/00004583-200404000-00005 and oppositional acting children: An N = 1 empirical
Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2006). study. Family Process, 42, 361–374.
Treating trauma and traumatic grief in children & doi:10.1111/j.1545-5300.2003.00361.x
adolescents. New York, NY: Guilford Press. Conyne, R. K., & Cook, E. P. (Eds.). (2004). Ecological
Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2012). counseling: An innovative approach to conceptualizing
Trauma-focused CBT for children and adolescents: person-environment interaction. Alexandria, VA:
Treatment applications. New York, NY: Guilford American Counseling Association.
Press. Cook, E. P. (2012). Understanding people in context: The
Colapinto, J. (1988). Teaching the structural way. In ecological perspective in counseling. Alexandria, VA:
H. Liddle, D. Breunlin, & R. Schwartz (Eds.), American Counseling Association.

Cooper, J. O., Heron, T. E., & Heward, W. L. (2007). Criswell, E. (1995). Biofeedback and somatics. Novato,
Applied behavior analysis (2nd ed.). Upper Saddle CA: Freeperson Press.
River, NJ: Pearson. Dalal, F. (2002). Race, colour and the processes of
Cooper, M. (2003). Existential therapies. London, racialization: New perspectives from group analysis,
England: Sage. psychoanalysis and sociology. London, England:
Cooper, P. (2012). Can the use of writing lower rumination Routledge.
of negative thoughts in depressed adults? International Danielian, J., & Gianotti, P. (2012). Listening with
Journal of Therapy and Rehabilitation, 19(1), 43–52. purpose: Entry points into shame and narcissistic
Corbin, H. (1972). Mundus imaginalis or the imaginary vulnerability. New York, NY: Jason Aronson.
and the imaginal. Spring Journal, 1–19. Retrieved Danto, E. A. (2005). Freud’s free clinics: Psychoanalysis
from https://www.scribd.com/doc/21749897/ and social justice, 1918–1938. New York, NY:
MUNDUS-IMAGINALIS Columbia University Press.
Corcoran, J., & Pillai, V. (2007). A review of the Dattilio, F. M. (2001). Cognitive-behavior family therapy:
research on solution-focused therapy. British Journal Contemporary myths and misconceptions.
of Social Work [Electronic Version]. Retrieved from Contemporary Family Therapy, 23(1), 3–18.
http://bjsw.oxfordjournals.org/cgi/reprint/bcm098v1? doi:10.1023/A:1007807214545
maxtoshow=&HITS=10&hits=10 RESULTFORMAT Dattilio, F. M. (2009). Cognitive-behavioral therapy with
=&fulltext=corcoran&searchid=1&FIRSTINDEX=0 couples and families: A comprehensive guide for
&resourcetype=HWCIT clinicians. New York, NY: Guilford Press.
Corey, G. (2013). The art of integrative counseling (3rd Davidson, R. J., Kabat-Zinn, J., Schumacher, J.,
ed.). Belmont, CA: Brooks/Cole, Cengage Learning. Rosenkranz, M., Muller, D., Santorelli, S., . . .
Corey, G. (2013). Theory and practice of counseling and Sheridan, J. F. (2003). Alterations in brain and immune
psychotherapy. Belmont, CA: Cengage. function produced by mindfulness meditation.
Cornell, A. W. (2013). Focusing in clinical practice: The Psychosomatic Medicine, 65, 564–570.
essence of change. New York, NY: W. W. Norton. doi:10.1097/01.PSY.0000077505.67574.E3
Corrington, R. S. (2003). Wilhelm Reich: Psychoanalyst Davies, B., & Harré, R. (1990). Positioning: The
and radical naturalist. New York, NY: Farrar, Straus discursive production of selves. Journal for the Theory
& Giroux. of Social Behaviour, 20, 43–63.
Costello, S. J. (2010). The ethics of happiness: An doi:10.1111/j.1468-5914.1990.tb00174.x
existential analysis. Lima, OH: Wyndham Hall Press. Davis, W., Gfeller, K., & Thaut, M. (Eds.). (2008). An
Cowen, V. (2011). Therapeutic massage and bodywork introduction to music therapy: Theory and practice
for autism spectrum disorders: A guide for parents and (3rd ed.). Silver Spring, MD: American Music Therapy
caregivers. London, England: Singing Dragon (An Association.
imprint of Jessica Kingsley Publishing). Dayton, T. (1994). The drama within: Psychodrama and
Coyne, R. (2010). The Oxford handbook of group experiential therapy. Deerfield Beach, FL: Health
counseling. New York, NY: Oxford University Press. Communications.
Crane, R. (2009). Mindfulness-based cognitive therapy. De Jong, P., & Berg, I. K. (2002). Interviewing for
New York, NY: Routledge. solutions (2nd ed.). Pacific Grove, CA: Brooks/Cole.
Craske, M. G. (2010). Cognitive-behavioral therapy. Deatherage, G. (1975). The clinical use of “mindfulness”
Washington, DC: American Psychological Association. meditation techniques in short-term psychotherapy.
Crawford, J. (2013). Sisters of the heart and mind: Journal of Transpersonal Psychology, 7, 133–143.
Healing and teaching with family system Deblinger, E., & Heflin, A. H. (1996). Treating sexually
constellations. Women & Therapy, 36(1–2), 100–109. abused children and their nonoffending parents: A
doi:10.1080/02703149.2012.720554 cognitive behavioral approach. Newbury Park, CA:
Crawford, S. (1986). Holding therapy. Adoption & Sage.
Fostering, 10, 43–46. Deming, W. E. (1986). Out of the crisis. Cambridge: MIT
doi:10.1177/030857598601000411 Center for Advanced Engineering Study.
Crethar, H., Rivera, E. T., & Nash, S. (2008). In search of Demos, J. N. (2005). Getting started with neurofeedback.
common threads: Linking multicultural, feminist, and New York, NY: W. W. Norton.
social justice counseling paradigms. Journal of Dermer, S., Olund, D., & Sori, C. F. (2006). Engaging
Counseling & Development, 86, 269–278. children in family therapy: Creating approaches to
doi:10.1002/j.1556-6678.2008.tb00509.x integrating theory and research in clinical practice

(C. F. Sori, Ed.). New York, NY: Routledge / Taylor & approach (3rd ed.). Upper Saddle River, NJ: Merrill/
Francis Group. Prentice Hall.
van Deurzen, E. (2002). Existential counseling and Dobbs, M. (2005, January 19). Harvard chief’s comments
psychotherapy in practice (2nd ed.). London, England: on women assailed: Academics critical of remarks
Sage. about lack of gender equality. Washington Post, A02.
van Deurzen, E., & Kenward, R. (2005). Dictionary of Doering, S., Ohlmeier, M., de Jongh, A., Hofmann, A., &
existential psychotherapy and counseling. London, Bisping, V. (2013). Efficacy of a trauma-focused
England: Sage. treatment approach for dental phobia: A randomized
van Deurzen, E. (2010). Everyday mysteries: Handbook clinical trial. European Journal of Oral Sciences, 121,
of existential therapy. London, England: Routledge. 584–593. doi:10.1111/eos.12090
van Deurzen, E. (2012). Existential counselling and Doherty, D., Wright, S., Aveyard, B., & Sykes, M. (2006).
psychotherapy in practice (3rd rev. ed.). London, Therapeutic touch and dementia care: An ongoing
England: Sage. journey. Nursing Older People, 18(11), 27–30.
van Deurzen, E., & Adams, M. (2011). Skills in Doidge, N. (2007). The brain that changes itself. New
existential counselling and psychotherapy. London, York, NY: Penguin Books.
England: Sage. Dolan, Y. (2006). Steve de Shazer: In memoriam. Journal
van Deurzen, E., & Kenward, R. (2005). Dictionary of of Marital and Family Therapy, 32(1), 1–2.
existential psychotherapy and counseling. London, doi:10.1111/j.1752-0606.2006.tb01583.x
England: Sage. Dolan, Y. (2007). Tribute to Insoo Kim Berg. Journal of
Deutsch, D. (1958). Didactic group discussions with Marital and Family Therapy, 33(2), 129–131.
mothers in a child guidance setting: A theoretical Retrieved from http://www.sfbta.org/insookimberg
statement. Group Psychotherapy, XI(1), 52–56. .doi:10.1111/j.1752-0606.2007.00011.x
Dewald, P. A. (1994). Principles of supportive Domjan, M. E. (2009). The principles of learning and
psychotherapy. American Journal of Psychotherapy, behavior (6th ed.). Independence, KY: Wadsworth.
48(4), 505–518. Dor, J. (1997). Introduction to the reading of Lacan: The
Dimeff, L., & Linehan, M. M. (2001). Dialectical unconscious structured like a language (J. Feher
behavior therapy in a nutshell. The California Gurewich, Ed., with S. Fairfield). Northvale, NJ: Jason
Psychologist, 34, 10–13. Aronson.
Dimidjian, S., Barrera, M., Jr., Martell, C., Muñoz, R. F., Dor, J. (1998). Introduction to the reading of Lacan: The
& Lewinsohn, P. M. (2011). The origins and current unconscious structured like a language (J. Gurewich,
status of behavioral activation treatments for Ed., with S. Fairfield). New York, NY: Other Press.
depression. Annual Review of Clinical Psychology, 7, Dossey, L. (1999). Reinventing medicine: Beyond mind-
1–38. doi:10.1146/annurev-clinpsy-032210-104535 body to a new era of healing. San Francisco, CA:
Dimidjian, S., Hollon, S. D., Dobson, K. S., Schmaling, K. HarperSanFrancisco.
B., Kohlenberg, R. J., Addis, M., . . . Jacobson, N. S. Drecher, J. (2002). I’m your handyman: A history of
(2006). Randomized trial of behavioral activation, reparative therapies. Journal of Gay & Lesbian
cognitive therapy, and antidepressant medication in Psychotherapy, 5(3), 5–24. doi:10.1300/
the acute treatment of adults with major depression. J236v05n03_02
Journal of Consulting and Clinical Psychology, 74(4), Drewey, W., & Winslade, J. (1997). The theoretical story
658–670. doi:10.1037/0022-006X.74.4.658 of narrative therapy. In G. Monk, J. Winslade,
Dimidjian, S., Martell, C. R., Herman-Dunn, R., & K. Crocket, & D. Epston (Eds.), Narrative therapy in
Hubley, S. (2014). Behavioral activation for practice: The archaeology of hope (pp. 32–52).
depression. In D. H. Barlow (Ed.), Clinical handbook San Francisco, CA: Jossey-Bass.
of psychological disorders: A step-by-step treatment Dry, A. M. (1961). The psychology of Jung: A critical
manual (5th ed., pp. 353–393). New York, NY: interpretation. New York, NY: Wiley.
Guilford Press. Dryden, W., & DiGiuseppe, R. (1990). A primer on
Dinkmeyer, D., & Dreikurs, R. (1963). Encouraging rational-emotive therapy. Champaign, IL: Research
children to learn: The encouragement process. Press.
Englewood Cliffs, NJ: Prentice Hall. Dryden, W., & Neenan, M. (2003). The REBT therapist’s
Dinkmeyer, D., & Eckstein, D. (1996). Leadership by pocket companion. New York. NY: Albert Ellis
encouragement. Delray Beach, FL: Saint Lucie Press. Institute.
Dinkmeyer, D., Jr., & Sperry, L. (2000). Counseling and Du Plessis, G. P. (2012). Integrated recovery therapy:
psychotherapy: An integrated, individual psychology Toward an integrally informed individual

psychotherapy for addicted populations. Journal of Edinger, E. F. (1992). Ego and archetype. Boston, MA:
Integral Theory and Practice, 7(1), 124–148. Shambhala.
Ducommun-Nagy, C. (2002). Contextual therapy. Edris, A. E. (2007). Pharmaceutical and therapeutic
In F. Kaslow, R. Massey, & S. Massey (Eds.), potentials of essential oils and their individual volatile
Comprehensive handbook of psychotherapy: constituents: A review. Phytotherapy Research, 21,
Interpersonal/humanistic/existential (Vol. 3, 308–323. doi:10.1002/ptr.2072
pp. 463–488). New York, NY: Wiley. Edward, J., Ruskin, N., & Turrini, P. (1992). Separation/
Duncan, B. L., Miller, S. D., Reynolds, L., Sparks, J., individuation: Theory and application (2nd ed.).
Claud, D., Brown, J., & Johnson, L. D. (2003). The New York, NY: Routledge.
Session Rating Scale: Psychometric properties of a Efran, J. S., Lukens, M. D., & Lukens, R. J. (1990).
“working” alliance scale. Journal of Brief Therapy, Language, structure, and change: Frameworks of
3(1), 3–12. meaning in psychotherapy. New York, NY:
Duncan, B. L., Miller, S. D., Wampold, B. E., & Hubble, W. W. Norton.
M. A. (Eds.). (2010). The heart and soul of change: Efron, D., & Bradley, B. (2007). Emotionally focused
Delivering what works in therapy (2nd ed.). therapy and emotionally focused family therapy: A
Washington, DC: American Psychological Association. challenge/opportunity for systemic and post-systemic
Dunham, S., Dermer, S., & Carlson, J. (2011). Poisonous therapists. Journal of Systemic Therapies, 26(4), 1–4.
parenting: Toxic relationships between parents and doi:10.1521/jsyt.2007.26.4.1
their adult children. New York, NY: Routledge. Egan, G. (2002). The skilled helper: A problem
Duvall, J., & Beres, L. (2011). Innovations in narrative management and opportunity-development approach
therapy: Connecting practice, training, and research. to helping (7th ed.). Belmont, CA: Brooks/Cole.
New York, NY: W. W. Norton. Eiden, B. (1999). The history of body psychotherapy: An
Dworkin, M. (2005). EMDR and the relational overview. Counseling News—The Voice of Counseling
imperative: The therapeutic relationship in EMDR Training, 12, 15–21.
treatment. New York, NY: Routledge. Eifert, G. H., & Forsyth, J. P. (2005). Acceptance and
Dyck, E. (2008). Psychedelic psychiatry: LSD from clinic commitment therapy for anxiety disorders. Oakland,
to campus. Baltimore, MD: Johns Hopkins University CA: New Harbinger.
Press. Ekstrom, S. R. (1988). Jung’s typology and DSM-III
Easwaran, E. (2007). The Dhammapada (introduced and personality disorders: A comparison of two systems of
translated by E. Easwaran). Tomales, CA: Nilgiri Press. classification. Journal of Analytical Psychology, 33(4),
Ecker, B., & Hulley, L. (1996). Depth oriented brief 329–344. doi:10.1111/j.1465-5922.1988.00329.x
therapy. San Francisco, CA: Jossey-Bass. Ellenberger, H. L. (1970). The discovery of the
Ecker, B., & Hulley, L. (2011). Coherence therapy practice unconscious. New York, NY: Basic Books.
manual and training guide. Oakland, CA: Coherence Elliott, R., Greenberg, L. S., & Lietaer, G. (2004). Research
Psychology Institute. Retrieved from http://www on experiential psychotherapies. In M. J. Lambert (Ed.),
.coherencetherapy.org/resources/manual.htm Bergin and Garfield’s handbook of psychotherapy and
Ecker, B., Ticic, R., & Hulley, L. (2012). Unlocking the behavior change (5th ed., pp. 493–539). New York,
emotional brain: Eliminating symptoms at their roots NY: Wiley.
using memory reconsolidation. New York, NY: Ellis, A. (1948). A critique of the theoretical contributions
Routledge. of non-directive therapy. Journal of Clinical
Ecker, B., Ticic, R., & Hulley, L. (2013). Unlocking the Psychology, 4, 248–255. doi:10.1002/1097-
emotional brain: Is memory reconsolidation the key to 4679(194807)4:3%3C248::AID-
transformation? Psychotherapy Networker, 37, 18–25, JCLP2270040308%3E3.0.CO;2-8
46–47. Ellis, A. (1950). An introduction to the principles of
Eckstein, D., & Kern, R. (2002). Psychological scientific psychoanalysis. Genetic Psychology
fingerprints: Lifestyle assessments and interventions. Monographs, 41, 147–212. doi:10.1016/B978-1-4832-
Dubuque, IA: Kendall/Hunt. 3162-4.50009-5
Eden, D. (2008). Energy medicine (Rev. ed.). New York, Ellis, A. (1951). Neurosis and human growth.
NY: Tarcher/Penguin. Psychological Bulletin, 48(6), 542–544. doi:10.1037/
Eden, D., & Feinstein, D. (2008). Energy medicine: h0049944
Balancing your body’s energies for optimal health, joy, Ellis, A. (1956). An operational reformulation of some
and vitality (Updated and expanded ed.). New York, basic principles of psychoanalysis. Psychoanalytic
NY: Penguin Group. Review, 43, 163–180.

Ellis, A. (1957). How to live with a neurotic. New York, therapy.” Journal of Cognitive Therapy, 19, 181–185.
NY: Crown. doi:10.1891/jcop.19.2.181.66789
Ellis, A. (1957). Outcome of employing three techniques Ellis, A. (2005). The myth of self esteem. Amherst, NY:
of psychotherapy. Journal of Clinical Psychology, 13, Prometheus Books.
344–350. doi:10.1002/1097-4679(195710)13:4% Ellis, A. (n.d.). REBT by Albert Ellis, Ph.D.: 12 irrational
3C344::AID-JCLP2270130407%3E3.0.CO;2-9 ideas that cause and sustain neurosis. Retrieved from
Ellis, A. (1958). Rational psychotherapy. Journal of http://www.rebt.ws/REBT%20explained.htm
General Psychology, 59, 35–49. doi:10.1080/0022130 Ellis, A. (with Ellis, D. J.). (2010). All out! An
9.1958.9710170 autobiography. Amherst, NY: Prometheus Books.
Ellis, A. (1958). Sex without guilt. New York, NY: Lyle Ellis, A., & Ellis, D. J. (2011). Rational emotive behavior
Stuart. therapy. Washington, DC: American Psychological
Ellis, A. (1962). Reason and emotion in psychotherapy. Association.
Secaucus, NJ: Lyle Stuart. Ellis, A., & Harper, R. A. (1975). A new guide to rational
Ellis, A. (1989). Comments on my critics. In M. E. living. North Hollywood, CA: Wilshire.
Bernard & R. DiGiuseppe (Eds.), Inside rational- Ellis, A., & MacLaren, C. (2005). Rational emotive
emotive therapy: A critical appraisal of the theory and behavior therapy: A therapist’s guide (2nd ed.).
therapy of Albert Ellis (pp. 199–235). New York, NY: Atascadero, CA: Impact.
Academic Press. Ellis, D. J. (2014). Rational emotive behavior therapy
Ellis, A. (1994). The essence of rational emotive behavior (DVD—Series 1: Systems of Psychotherapy).
therapy [Brochure]. New York, NY: The Albert Ellis Washington, DC: American Psychological
Institute. Association.
Ellis, A. (1996). Better, deeper, and more enduring brief Ellman, S. (1991). Freud’s technique papers. Northvale,
therapy: The rational emotive behavior therapy NJ: Jason Aronson.
approach. New York, NY: Bruner/Mazel. EMDR Institute. (2005). The efficacy of EMDR.
Ellis, A. (1996). A social constructionist position for Retrieved from http://www.emdr.com/general-
mental health counseling: A reply to Jeffrey T. information/efficacy.html
Guterman. Journal of Mental Health Counseling, 18, Emerson, D., & Hopper, E. (2011). Overcoming trauma
16–28. through Yoga. Berkeley, CA: North Atlantic Books.
Ellis, A. (1998). How rational emotive behavior therapy Emerson, W. (1984). Infant and child birth re-facilitation.
belongs in the constructivist camp. In M. F. Hoyt Guildford, England: University of Surrey Press.
(Ed.), The handbook of constructive therapies: Emmerson, G. (2007). Ego state therapy. Bethel, CT:
Innovative approaches from leading practitioners Crown House.
(pp. 83–99). San Francisco, CA: Jossey-Bass. Engel, G. L. (1977). The need for a new medical model: A
Ellis, A. (2001). Overcoming destructive beliefs, challenge for biomedicine. Science, 196, 129–136.
feelings, and behaviors: New directions for rational doi:10.1126/science.847460
emotive behavior therapy. Amherst, NY: Engel, G. L. (1980). The clinical application of the
Prometheus Books. biopsychosocial model. The American Journal of
Ellis, A. (2003). Similarities and differences between Psychiatry, 137, 535–544. doi:10.1093/jmp/6.2.101
rational emotive behavior therapy and cognitive Engel, G. L. (1996). From biomedical to biopsychosocial:
therapy. Journal of Cognitive Therapy, 17, 225–240. Being scientific in the human domain. Families,
doi:10.1891/jcop.17.3.225.52535 Systems, and Health, 14, 425–433. doi:10.1037/
Ellis, A. (2004). Rational emotive behavior therapy: It h0089973
works for me, it can work for you. Amherst, NY: Enns, C. Z. (1993). Twenty years of feminist counseling
Prometheus Books. and therapy: From naming biases to implementing
Ellis, A. (2004). The road to tolerance: The philosophy of multifaceted practice. The Counseling Psychologist,
rational emotive behavior therapy. Amherst, NY: 21(1), 3–87. doi:10.1177/0011000093211001
Prometheus Books. Enns, C. Z. (2001). Some reflections on imagery and
Ellis, A. (2004). Why I (really) became a therapist. Journal psychotherapy implications. Journal of Counseling
of Rational-Emotive Cognitive Behavior Therapy, Psychology, 48, 136–139. doi:10.1037//0022-
22(2), 73–77. doi:10.1002/jclp.20166 0167.48.2.136
Ellis, A. (2005). Discussion of Christine A. Padesky and Enns, C. Z., & Williams, E. N. (Eds.). (2013). The
Aaron T. Beck, “Science and philosophy: Comparison Oxford handbook of feminist multicultural counseling
of cognitive therapy and rational emotive behavior psychology. New York, NY: Oxford University Press.

Enright, J. B. (1970). An introduction to Gestalt Erikson, E. H. (1982). The life cycle completed. New York,
techniques. In J. Fagan & I. L. Shepherd (Eds.), Gestalt NY: W. W. Norton.
therapy now (pp. 107–124). New York, NY: Harper & Erken, R., & Schlage, B. (Eds.). (2012). Transformation of
Row. the self with bodymind integration: Postural
Epstein, M. (1995). Thoughts without a thinker: integration—energetic integration—psychotherapeutic
Psychotherapy from a Buddhist perspective. New York, postural integration. Berlin, Germany: Holzinger.
NY: Basic Books. Escorbar, M., & Miller, R. R. (2004). A review of the
Epstein, N. B., & Baucom, D. H. (2002). Enhanced empirical laws of basic learning in Pavlovian
cognitive-behavioral therapy for couples: A contextual conditioning. International Journal of Comparative
approach. Washington, DC: American Psychological Psychology, 17, 279–303.
Association. Evans, F. B., III (1996). Harry Stack Sullivan:
Epston, D. (1988). Collected papers. Adelaide, South Interpersonal theory and psychotherapy. New York,
Australia, Australia: Dulwich Centre. NY: Routledge.
Epston, D. (2008). Saying hullo again: Remembering Evans, K. M., Kincade, E. A., Marbley, A. F., & Seem, S. R.
Michael White. Journal of Systemic Therapies, 27(3), (2005). Feminism and feminist therapy: Lessons from
1–15. doi:10.1521/jsyt.2008.27.3.1 the past and hopes for the future. Journal of Counseling
Epston, D. (2008). Saying hullo again: Remembering & Development, 83, 269–277. doi:10.1002/
Michael White. Journal of Systemic Therapies, 27(3), j.1556-6678.2005.tb00342.x
1–15. Evans, K. M., Kincade, E. A., & Seem, S. R. (2011).
Epston, D., & White, M. (1990). Narrative means to Introduction to feminist therapy: Strategies for social
therapeutic ends. New York, NY: W. W. Norton. and individual change. Thousand Oaks, CA: Sage.
Epston, D., & White, M. (1992). Experience, Eyberg, S. M. (2005). Tailoring and adapting parent-child
contradiction, narrative, and imagination: Selected interaction therapy for new populations. Education
papers of David Epston and Michael White, 1989– and Treatment of Children, 28, 197–201.
1991. Adelaide, South Australia, Australia: Dulwich Eyberg, S. M., & Robinson, E. (1982). Parent-child
Centre. interaction training: Effects on family functioning.
Erickson, M. H. (1980). Collected papers (Vols. 1–4; E. L. Journal of Clinical Child Psychology, 11, 130–137.
Rossi, Ed.). New York, NY: Irvington. doi:10.1080/15374418209533076
Erickson, M. H. (2009). Further clinical techniques of Eyckmans, S. (2009). Handle with care: Touch as a
hypnosis: Utilization techniques. American Journal of therapeutic tool. Gestalt Journal of Australia &
Clinical Hypnosis, 51, 341–362. doi:10.1080/0002915 New Zealand, 6(1), 40–53.
7.1959.10401792 Eysenck, H. J. (1952). The effects of psychotherapy: An
Erickson, M. H., & Rossi, E. L. (1979). Hypnotherapy: evaluation. Journal of Consulting Psychology, 16,
An exploratory casebook. New York, NY: Irvington. 319–324. doi:10.1037/h0063633
Erickson, M. H., & Rossi, E. L. (1981). Experiencing Fabry, J. B. (1980). The pursuit of meaning (Rev. ed.).
hypnosis. New York, NY: Irvington. New York, NY: Harper & Row.
Erickson, M. H., & Rossi, E. L. (2009). The February Fadul, J., & Canlas, R. (2009). Chess therapy. Raleigh,
man: Evolving consciousness and identity in NC: Lulu Press.
hypnotherapy. New York, NY: Routledge. Fairbairn, W. R. D. (2001). Psychoanalytic studies of the
Erickson, M. H., Rossi, E. L., & Rossi, S. I. (1976). personality. New York, NY: Taylor & Francis.
Hypnotic realities. New York, NY: Irvington. (Original work published 1952)
Erikson, E. H. (1950). Childhood and society. New York, Fairfield, M. (2004). Gestalt groups revisited: A
NY: W. W. Norton. phenomenological approach. Gestalt Review, 8,
Erikson, E. H. (1958). Young man Luther. New York, 336–357.
NY: W. W. Norton. Faith, M. S., Wong, F. Y., & Carpenter, K. M. (1995).
Erikson, E. H. (1959). Identity and the life cycle. New York, Group sensitivity training: Update, meta-analysis, and
NY: International Universities Press. recommendations. Journal of Counseling Psychology,
Erikson, E. H. (1963). Childhood and society (2nd ed.). 42, 390–399. doi:10.1037/0022-0167.42.3.390
New York, NY: W. W. Norton. Fall, K., Holden, J. M., & Marquis, A. (2010).
Erikson, E. H. (1968). Identity: Youth and crisis. Constructivist approaches. In K. Fall, J. M. Holden, &
New York, NY: W. W. Norton. A. Marquis (Eds.), Theoretical models of counseling
Erikson, E. H. (1980). Identity and the life cycle. and psychotherapy (2nd ed., pp. 347–286). New York,
New York, NY: W. W. Norton. NY: Routledge.

Fall, K., Holden, J. M., & Marquis, A. (2010). Theoretical Feldenkrais, M. (2010). Embodied wisdom: The collected
models of counseling and psychotherapy (2nd ed.). papers of Moshe Feldenkrais. San Diego, CA: Somatic
New York, NY: Routledge. Resources.
Family therapy. (n.d.). Therapist profiles: Michael White. Felder, R., & Weiss, A. (1992). Experiential
Retrieved from http://www.abacon.com/famtherapy/ psychotherapy: A symphony of selves. Lanham, MD:
white.html University Press of America.
Fanon, F. (2008). Black skin, white masks (1st ed.). Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F.,
New York, NY: Grove Press. (Original work published Spitz, A. M., Edwards, V., . . . Marks, J. S. (1998).
1952) Relationship of childhood abuse and household
Faulkner, C. (2005). Metaphors of identity: Operating dysfunction to many of the leading causes of death in
metaphors and iconic change [Audio]. Lyons, CO: adults: The Adverse Childhood Experiences (ACE)
Genesis II Publishing. study. American Journal of Preventive Medicine, 14,
Fava, G. A. (2009, June 19). Well-being therapy. 245–258.
Workshop presented at the First World Congress on Felixson, H. (Producer), & Marton, E. (Director). (2002).
Positive Psychology, Philadelphia, PA. My name from Sabina Spielrein [Motion picture].
Fava, G. A., & Ruini, C. (2003). Development and Stockholm, Sweden: Folkets Bio.
characteristics of a well-being enhancing Feminist Therapy Institute. (1999). Feminist therapy code
psychotherapeutic strategy: Well-being therapy. Journal of ethics (Rev. ed.). Retrieved from http://www
of Behavior Therapy and Experimental Psychiatry, 34, .chrysaliscounseling.org/Feminist_Therapy.html
45–63. doi:10.1016/S0005-7916(03)00019-3 Fenell, D. L., & Weinhold, B. K. (2003). Counseling
Fava, G. A., & Sonino, N. (2008). The biopsychosocial families: An introduction to marriage and family
model thirty years later. Psychotherapy and therapy (3rd ed.). Denver, CO: Love.
Psychosomatics, 77, 1–2. doi:10.1159/000110052 Ferguson, K. E. (2003). Relaxation. In W. O’Donohue,
Feder, B. (2008). Gestalt group therapy: A practical guide. U. J. Fisher, & S. C. Hayes (Eds.), Cognitive behavior
Metairie, LA: Gestalt Institute Press. therapy: Applying empirically supported techniques in
Fedor-Freybergh, P. G., & Vogel, M. L. V. (1988). Prenatal your practice (pp. 330–340). Hoboken, NJ: Wiley.
and perinatal psychology and medicine: Encounter Fernando, D. M. (2007). Existential theory and solution-
with the unborn: A comprehensive survey of research focused strategies: Integration and application. Journal
and practice. Nashville, TN: Parthenon. of Mental Health Counseling, 29(3), 226–241.
Fehr, S. S. (2003). Introduction to group therapy: A Fernbacher, S., & Plummer, D. (2005). Cultural influences
practical guide (2nd ed.). Binghampton, NY: Haworth and considerations in Gestalt therapy. In A. L. Woldt &
Press. S. M. Toman (Eds.), Gestalt therapy: History, theory,
Feinstein, D. (2012). Acupoint stimulation in treating and practice (pp. 117–132). Thousand Oaks, CA: Sage.
psychological disorders: Evidence of efficacy. Review Ferraresi, M., Clari, R., Moro, I., Banino, E., Boero, E.,
of General Psychology, 16, 364–380. doi:10.1037/ Crosio, A., . . . Piccoli, B. G. (2013). Reiki and related
a0028602 therapies in the dialysis ward: An evidence-based and
Feinstein, D. (2012). What does energy have to do with ethical discussion to debate if these complementary
energy psychology? Energy Psychology: Theory, and alternative medicines are welcomed or banned.
Research, and Treatment, 4(2), 59–80. doi:10.9769/ BMC Nephrology, 14, 129. doi:10.1186/1471-2369-
EPJ.2012.4.2.DF 14-129
Feinstein, D., Eden, D., & Craig, G. (2005). The promise Ferri, G., & Cimini, G. (2012). Psicopatologia e
of energy psychology: Revolutionary tools for Carattere, L’Analisi Reichiana: la psicoanalisi nel
dramatic personal change. New York, NY: Tarcher/ corpo ed il corpo in psicoanalisi [Psychopathology and
Penguin. character, Reichian analysis: Psychoanalysis in the
Feldenkrais, M. (1972). Awareness through movement: body and the body in psychoanalysis]. Italia, Rome:
Health exercises for personal growth. New York, NY: Alpes Editore.
Harper & Row. Ferrucci, P. (1982). What we may be: The visions and
Feldenkrais, M. (1985). The potent self: A guide to techniques of psychosynthesis. Wellingborough,
spontaneity. San Francisco, CA: Harper. England: Turnstone Press.
Feldenkrais, M. (1996). Body and mature behavior: A Fiebert, M. S. (1997). In and out of Freud’s shadow: A
study of anxiety, sex, gravitation and learning. chronology of Adler’s relationship with Freud.
Madison, CT: International Universities Press. Individual psychology, 53(3), 241–269.

Figler, H. (1979). A career workbook for liberal arts Foa, E. B., Hembree, E. A., & Rothbaum, B. O. (2007).
students (2nd ed.). Cranston, RI: Carroll. Prolonged exposure therapy for PTSD: Emotional
Fine, A. (Ed.). (2006). Handbook on animal-assisted processing of traumatic experiences therapist guide.
therapy: Theoretical foundations and guidelines for New York, NY: Oxford University Press.
practice (2nd ed.). San Diego, CA: Academic Press. Foa, E. B., Huppert, J. D., & Cahill, S. P. (2006).
Fink, B. (1997). A clinical introduction to Lacanian Emotional processing theory: An update. In B. O.
psychoanalysis: Theory and technique. Cambridge, Rothbaum (Ed.), Pathological anxiety: Emotional
MA: Harvard University Press. processing in etiology and treatment (pp. 3–24).
Firman, J., & Gila, A. (2002). Psychosynthesis: A psychology New York, NY: Guilford Press.
of the spirit. New York: State University of New York Foa, E. B., Yadin, E., & Lichner, T. K. (2012). Exposure
Press. and response (ritual) prevention for obsessive-
Fisch, R., Ray, W. A., & Schlanger, K. (Eds.). (2010). Focused compulsive disorder: Therapist guide (2nd ed.).
problem resolution: Selected papers of the MRI Brief New York, NY: Oxford University Press.
Therapy Center. Phoenix, AZ: Zeig, Tucker & Theisen. Follette, W. C., & Bonow, J. T. (2009). The challenge of
Fisher, J., & Ogden, P. (2009). Sensorimotor understanding process in clinical behavior analysis:
psychotherapy. In C. Courtois & J. Ford (Eds.), The case of functional analytic psychotherapy.
Treating complex traumatic stress disorders: An The Behavior Analyst, 32, 135–148.
evidence-based guide (pp. 312–328). New York, NY: Fonagy, P. (2000). The outcome of psychoanalysis:
Guilford Press. The hope for a future. The Psychologist, 13(12),
Fiske, H. (2007). Solution-focused training: The medium 620–623.
and the message. In T. S. Nelson & F. N. Thomas Fonagy, P. (Ed.). (2002). An open door review of outcome
(Eds.), Handbook of solution-focused brief therapy: studies in psychoanalysis (2nd rev. ed.). London,
Clinical applications (pp. 317–342). New York, NY: England: International Psychoanalytic Association.
Haworth Press. Forbes, B. (2011). Yoga for emotional balance. Boston,
Fitzgerald, L. F., & Nutt, R. (1986). The Division 17 MA: Shambhala.
principles concerning the counseling/psychotherapy of Forgash, C., & Copeley, M. (2007). Healing the heart of
women: Rationale and implementation. The Counseling trauma with EMDR and ego state therapy. New York,
Psychologist, 14, 180–216. doi:10.1177/001100008 NY: Springer.
6141019 Forman, M. (2010). A guide to integral psychotherapy:
Fjorback, L. O., Arendt, M., Ornbol, E., Fink, P., & Complexity, integration, and spirituality in practice.
Walach, H. (2011). Mindfulness-based stress reduction Albany: State University of New York Press.
and mindfulness-based cognitive therapy: A systemic Fosha, D. (2000). The transforming power of affect: A
review of randomized controlled trials. Acta Psychiartr model for accelerated change. New York, NY: Basic
Scandinavica, 124, 102–119. doi:10.1111/j.1600 Books.
-0447.2011.01704.x Fosha, D., Paivio, S. C., Gleiser, K., & Ford, J. (2009).
Flaws, B., & Lake, J. M. (2001). Chinese medical Experiential and emotion-focused therapy. In C.
psychiatry: A texbook and clinical manual. Boulder, Courtois & J. D. Ford (Eds.), Complex traumatic
CO: Blue Poppy Press. stress disorders: An evidence-based clinician’s guide
Flax, J. (1990). Thinking fragments: Psychoanalysis, (pp. 286–311). New York, NY: Guilford Press.
feminism, and postmodernism in the contemporary Fosha, D., Siegel, D. J., & Solomon, M. F. (Eds.). (2009).
West. Berkeley: University of California Press. The healing power of emotion: Affective neuroscience,
Fleming, J., & Strong, S. (1945). Observations on the development & clinical practice. New York, NY: W. W.
use of chess in the therapy of an adolescent boy. Norton.
The Psychoanalytic Quarterly, 14, 562. Fosha, D., & Yeung, D. (2006). AEDP exemplifies the
Flora, C. (2009, January/February). The pursuit of seamless integration of emotional transformation and
happiness. Psychology Today, 42(1), 60–69. dyadic relatedness at work. In G. Stricker & J. Gold
Flores, P. J. (2010). Group psychotherapy and neuro- (Eds.), A casebook of integrative psychotherapy
plasticity. International Journal of Group Psychotherapy, (pp. 165–184). Washington, DC: APA Press.
60, 546–571. doi:10.1521/ijgp.2010.60.4.546 Foster, S., & Gurman, A. S. (1985). Family therapies. In
Foa, E. B. (1996). The efficacy of behavioral therapy with S. J. Lynn & J. P. Garske (Eds.), Contemporary
obsessive-compulsives. The Clinical Psychologist, psychotherapies: Models and methods (pp. 377–418).
49(2), 19–22. Columbus, OH: Merrill.

Fotopolu, A., Pfaff, D., & Conway, M. (Eds.). (2012). Frankl, V. E. (2004). On the theory and therapy of mental
From the couch to the lab: Psychoanalysis, disorders: An introduction to logotherapy and
neuroscience and cognitive psychology in dialogue. existential analysis (J. M. DuBois, Trans.). London,
Oxford, England: Oxford University Press. England: Brunner-Routledge.
Foulkes, S. H. (1986). Group-analytic psychotherapy: Frankl, V. E. (2004). Yearly report, October 1942–
Method and principles. London, England: Karnac October 1943. In E. Makarova, S. Makarov, &
Books. (Original work published 1975) V. Kuperman (Eds.), University over the abyss: The
Foundation for Inner Peace. (1975). A course in miracles. story behind 520 lectures and 2,430 lectures in KZ
Mill Valley, CA: Author. Theresienstadt 1942–1944 (pp. 249–252).
Fox, E. B., & Kozak, M. J. (1997). Beyond the efficacy Jerusalem, Israel: Verba. (Original work written in
ceiling? Cognitive behavior therapy in search of 1942–1943)
theory. Behavior Therapy, 28, 601–611. Frankl, V. E. (2007). Man’s search for meaning: An
Frager, R., & Fadiman, J. (2005). Personality and introduction to logotherapy (With a new foreword by
personal growth (6th ed.). New York, NY: Pearson. Harold S. Kushner and a new biographical afterword
Frame, M. W. (2003). Integrating religion and spirituality by William J. Winslade). Boston, MA: Beacon Press.
into counseling: A comprehensive approach. Belmont, Frankl, V. E. (2009). The feeling of meaninglessness: A
CA: Brooks/Cole. challenge to psychotherapy and philosophy (Edited
Frank, J. D., & Frank, J. B. (1991). Persuasion and and with an Introduction by A. Batthyany).
healing: A comparative study of psychotherapy. Milwaukee, WI: Marquette University Press.
Baltimore, MD: Johns Hopkins University Press. Franklin, C., Trepper, T. S., Gingerich, W. J., &
Frankel, R. M., Quill, T. E., & McDaniel, S. H. (Eds.). McCollum, E. E. (Eds.). (2012). Solution-focused brief
(2003). The biopsychosocial approach: Past, present, therapy: A handbook of evidence-based practice. New
future. Rochester, NY: University of Rochester Press. York, NY: Oxford.
Frankl, V. E. (1984). Man’s search for meaning. New Fransella, F. (Ed.). (2003). International handbook of
York, NY: Washington Square Press. personal construct psychology. Chichester, England:
Frankl, V. E. (1955). The doctor and the soul. New York, Wiley.
NY: Alfred A. Knopf. (Original work published 1946) Fransella, F., Bell, R. C., & Bannister, D. (2004). A
Frankl, V. E. (1959). Man’s search for meaning. Boston, manual for repertory grid technique. Chichester,
MA: Beacon Press. (Original work published 1946) England: Wiley.
Frankl, V. E. (1968). Psychotherapy and existentialism. Fransella, F., & Dalton, P. (2000). Personal construct
New York, NY: Simon & Schuster. counselling in action. London, England: Sage.
Frankl, V. E. (1972). Viktor Frankl archive: Audio and von Franz, M. L. (1975). C. G. Jung: His myth in our
videotapes: The will to meaning. Retrieved from time. New York, NY: Putnam.
http://logotherapy.univie.ac.at/e/audioE.html Fraser, G. A. (1991). The dissociative table technique: A
Frankl, V. E. (1975). The unconscious God: strategy for working with ego states in dissociative
Psychotherapy and theology. New York, NY: Simon & disorders and ego-state therapy. Dissociation, 4(1),
Schuster. 205–213. doi:10.1300/J229v04n04_02
Frankl, V. E. (1984). Viktor Frankl archive: Audio and Fraser, L. (2005, Summer). Therapy with transgender
videotapes: On reductionism. Retrieved from http:// people across lifespan. APA Division 44 Newsletter,
logotherapy.univie.ac.at/e/audioE.html 21(3), 14–18.
Frankl, V. E. (1988). The will to meaning: Foundations Fraser, M. W., Galinsky, M. J., Smokowski, P. R., Day, S. H.,
and applications of logotherapy. New York, NY: Terzian, M. A., Rose, R. A., & Guo, S. (2005). Social
New American Library. information-processing skills training to promote social
Frankl, V. E. (1997). Viktor Frankl—Recollections: An competence and prevent aggressive behavior in the
autobiography (J. Fabry & J. Fabry, Trans.). New York, third grades. Journal of Consulting and Clinical
NY: Insight Books. Psychology, 76, 1045–1055. doi:10.1037/0022-
Frankl, V. E. (2000). Man’s search for ultimate meaning. 006X.73.6.1045
New York, NY: Perseus Book. Frederick, R. (2009). Living like you mean it: Use the
Frankl, V. E. (2000). Recollections: An autobiography. wisdom and power of your emotions to get the life
Cambridge, MA: Perseus Book. you really want. San Francisco, CA: Jossey-Bass.
Frankl, V. E. (2004). The doctor and the soul: From Frederickson, J. (1999). Psychodynamic psychotherapy:
psychotherapy to logotherapy. London, England: Learning to listen from multiple perspectives. New York,
Souvenir. (Original work published 1946) NY: Routledge.

Fredrickson, B. (2001). The role of positive emotions in Freud, S. (1961). Beyond the pleasure principle
positive psychology: The broaden-and-build theory of (J. Strachey, Trans.). New York, NY: W. W. Norton.
positive emotions. American Psychologist, 56, (Original work published 1920)
218–226. doi:10.1037/0003-066X.56.3.218 Freud, S. (1961). The ego and the id (J. Strachey, Trans.).
Fredrickson, B. (2009, June 19). Positivity: The path to New York, NY: W. W. Norton. (Original work
flourishing. Workshop presented at the First World published 1927)
Congress on Positive Psychology, Philadelphia, PA. Freud, S. (1961). The future of an illusion (J. Strachey,
Fredrickson, B. (2013). Love 2.0: Finding happiness and Trans.). New York, NY: W. W. Norton. (Original work
health in moments of connection. New York, NY: published 1927)
Hudson Street Press/Penguin. Freud, S. (1961). Some psychical consequences of the
Fredrickson, B., & Losada, M. F. (2005). Positive affect anatomical distinction between the sexes (Standard
and the complex dynamics of human flourishing. ed., 19, pp. 241–258). London, England: Hogarth
American Psychologist, 60, 678–686. Press. (Original work published 1925)
doi:10.1037/0003-066X.60.7.678 Freud, S. (1964). Femininity. In New introductory lectures
Freedman, J., & Combs, G. (1996). Narrative therapy: on psycho-analysis (pp. 139–166). New York, NY:
The social construction of preferred realities. W. W. Norton. (Original work published 1932)
New York, NY: W. W. Norton. Freud, S. (1965). The origin and development of
Freedman, J., & Combs, G. (1996). Shifting paradigms: psychoanalysis. Chicago, IL: Henry Regnery. (Original
From systems to stories. In J. Freedman & G. Combs work published 1910)
(Eds.), Narrative therapy: The social construction of Freud, S. (1973). Introductory lectures on psychoanalysis
preferred realities (pp. 1–18). New York, NY: (J. Strachey, Trans.). New York, NY: Pelican Books.
W. W. Norton. (Original work published 1917)
Freeman, E., & Power, M. (Eds.). (2007). Handbook of Freud, S. (1976). The interpretation of dreams
evidence-based psychotherapies: A guide of research (J. Strachey, Trans.). New York, NY: Penguin Books.
and practice. West Sussex, England: Wiley. (Original work published 1899)
Freeman, G. A. (2007, March 28). In search of death. Freud, S. (1976). Jokes and their relation to the
Rolling Stone Magazine. Retrieved from http://www unconscious (J. Strachey, Trans.). New York, NY:
.rollingstone.com/news/story/5939950/bug_chasers Penguin Books. (Original work published 1905)
Freeman, J. C., Epston, D., & Lobovits, D. (1997). Playful Freud, S. (1976). Three essays on the theory of sexuality
approaches to serious problems: Narrative therapy (J. Strachey, Trans.). New York, NY: Basic Books.
with children and their families. New York, NY: (Original work published 1905)
W. W. Norton. Freud, S. (1989). The psychopathology of everyday life
Freeman, M. L. (1999). Gender matters in the Satir (J. Strachey, Trans.). New York, NY: W. W. Norton.
growth model. American Journal of Family Therapy, (Original work published 1901)
27(4), 345–363. doi:10.1080/019261899261907 Freud, S. (2005). Civilization and its discontents
Freud, A. (1966). The ego and the mechanisms of defense. (J. Strachey, Trans.). New York, NY: W. W. Norton.
New York, NY: International Universities Press. (Original work published 1930)
(Original work published 1936) Freud, S., & Breuer, J. (1974). 3 studies in hysteria
Freud, S. (1928). Humour. International Journal of (J. Strachey, Trans.). New York, NY: Penguin Books.
Psychoanalysis, 9, 1–6. (Original work published 1895)
Freud, S. (1950). Totem and taboo: Some points of Freud, S., & Strachey, J. (1970). An outline of psycho-
agreement between the mental lives of savages and analysis. New York, NY: W. W. Norton.
neurotics (J. Strachey, Trans.). New York, NY: Friedberg, R. D. (2006). A cognitive-behavioral approach
W. W. Norton. (Original work published 1913) to family therapy. Journal of Contemporary
Freud, S. (1952). On dreams. New York, NY: Psychotherapy, 36(4), 159–165. doi:10.1007/s10879-
W. W. Norton. 006-9020-2
Freud, S. (1953). “The first dream,” fragment of an Friedman, H. L., & Hartelius, G. (Eds.). (2013). The
analysis of a case of hysteria. In J. Strachey & Wiley-Blackwell handbook of transpersonal
A. Freud (Eds.), Complete works of Freud (Vol. 7). psychology. West Sussex, England: Wiley.
(Original work published 1905) Friedman, M. (1989). Martin Buber and Ivan
Freud, S. (1959). Group psychology and the analysis of Boszormenyi-Nagy: The role of dialogue in contextual
the ego (J. Strachey, Trans.). New York, NY: therapy. Psychotherapy, 26, 402–409. doi:10.1037/
W. W. Norton. (Original work published 1922) h0085452

Friedman, P. (1980). Integrative psychotherapy. In Fritchey, P. (2005). Practical herbalism: Ordinary plants
R. Herink (Ed.), The psychotherapy handbook with extraordinary powers. Warsaw, IN: Whitman.
(pp. 308–313). New York, NY: New American Library. Frojan-Parga, M. X., Calero-Elvira, A., & Montano-
Friedman, P. (1981). Integrative family therapy. Family Fidalgo, M. (2009). Analysis of the therapist’s verbal
Therapy, 8(3), 171–178. behavior during cognitive restructuring debates: A case
Friedman, P. (1982). Assessment tools and procedures in study. Psychotherapy Research, 19(1), 30–41.
integrative psychotherapy. In A. Gurman (Ed.), doi:10.1080/10503300802326046
Questions and answers in the practice of family Fromm, E. (1941). Escape from freedom. New York, NY:
therapy (pp. 46–49). New York, NY: Guilford Press. Avon.
Friedman, P. (1982). The multiple roles of the integrative Fromm, E. (1947). Man for himself: An inquiry into the
marital psychotherapist. Family Therapy, 9(2), psychology of ethics. New York, NY: Holt, Rhinehart &
109–118. Winston.
Friedman, P. (1989). Creating well-being: The healing Fromm, E. (1955). The sane society. New York, NY:
path to love, peace, self-esteem, and happiness. Henry Holt.
Saratoga, CA: R&E. Fromm, E. (1956). The art of loving. New York, NY:
Friedman, P. (1992). Friedman well-being scale and Harper.
professional manual. Plymouth Meeting, PA: Fromm, E. (1973). The anatomy of human
Foundation for Well-Being. destructiveness. New York, NY: Henry Holt.
Friedman, P. (2002). Integrative energy and spiritual Fromm, E. (1976). To have or to be. New York, NY:
therapy. In F. Gallo (Ed.), Energy psychology in Harper & Row.
psychotherapy: A comprehensive sourcebook Fromm, E. (1994). The art of listening. New York, NY:
(pp. 198–215). New York, NY: W. W. Norton. Open Road.
Friedman, P. (2006). Pressure point therapy. In P. Fromm, E., Suzuki, D. T., & De Martino, R. (1960).
Mountrose & J. Mountrose (Eds.), The heart & soul Zen Buddhism and psychoanalysis. New York, NY:
of EFT and beyond (pp. 260–268). Sacramento, CA: Harper & Rowe.
Holistic Communications. Fruzzetti, A. R., & Fruzzetti, A. E. (2003). Dialectics in
Friedman, P. (2010). The forgiveness solution: The whole cognitive and behavior therapy. In W. O’Donohue,
body Rx for finding true happiness, abundant love, U. J. Fisher, & S. C. Hayes (Eds.), Cognitive behavior
and inner peace. San Francisco, CA: Conari Press. therapy: Applying empirically supported techniques
Friedman, P. (2014). EFT, change, forgiveness and the in your practice (pp. 121–128). Hoboken, NJ:
positive pressure point techniques. In D. Church & Wiley.
S. Marohn (Eds.), The clinical EFT handbook (Vol. 2, Fujita, C. (1986). Morita therapy: A psychotherapeutic
chap. 57). Fulton, CA: Energy Psychology Press. system for neurosis. New York, NY: Igaku-Shoin
Friedman, P., & Toussaint, L. (2006). Changes in Medical.
forgiveness, gratitude, stress, and well-being during Fukuyama, M. A. (1990). Taking a universal approach to
psychotherapy: An integrative, evidence-based multicultural counseling. Counselor Education and
approach. International Journal of Healing and Supervision, 30(1), 6–17.
Caring, 6(2), 11–28. doi:10.1002/j.1556-6978.1990.tb01174.x
Friman, P. C., & Finney, J. W. (2003). Time in (and time Funderburk, J. R., & Fukuyama, M. A. (2002). Feminism,
out). In W. O’Donohue, U. J. Fisher, & S. C. Hayes multiculturalism, and spirituality. Women & Therapy,
(Eds.), Cognitive behavior therapy: Applying 24(3), 1–18. doi:10.1300/J015v24n03_01
empirically supported techniques in your practice Fung, P. C. (2009). Probing the mystery of Chinese
(pp. 429–435). Hoboken, NJ: Wiley. medicine meridian channels with special emphasis on
Frisch, M. B. (2013). Evidence-based well-being/positive the connective tissue interstitial fluid system,
psychology assessment and intervention with quality mechanotransduction, cells durotaxis and mast cell
of life therapy and coaching and the Quality of Life degranulation. BioMed Central, 4, 10.
Inventory (QOLI). Social Indicators Research, 114, doi:10.1186/1749-8546-4-10
193–227. doi:10.1007/s11205-012-0140-7 Funk, R. (Ed.). (2009). The clinical Erich Fromm:
Frisch, M. B., Clark, M. P., Rouse, S. V., Rudd, M. D., Personal accounts and papers on therapeutic
Paweleck, J., & Greenstone, A. (2005). Predictive and technique. Amsterdam, Netherlands: Rudopi.
treatment validity of life satisfaction and the Quality Furgeri, L. (Ed.). The technique of group treatment
of Life Inventory. Assessment, 12(1), 66–78. (The collected papers of Louis R. Ormont, Ph.D.).
doi:10.1177/1073191104268006 Madison, CT: Psychosocial Press.

Furrow, J., & Palmer, G. (2007). EFFT and blended herbal medicine, food cures and Qi Gong. London,
families: Building bonds from the inside out. Journal England: Carlton Books.
of Systemic Therapies, 26(4), 44–58. doi:10.1521/ Garcia-Toro, M., & Aguirre, I. (2007). Biopsychosocial
jsyt.2007.26.4.44 model in depression revisited. Medical Hypotheses, 68,
Furtmuller, C. (1964). Alfred Adler: A biographical essay. 683–691. doi:10.1016/j.mehy.2006.02.049
In H. L. Ansbacher & R. R. Ansbacher (Eds.), Gardner, S., & Stevens, G. (1992). Red Vienna and the
Superiority and social interest: A collection of later golden age of psychology: 1918–1938. New York, NY:
writings (pp. 311–393). Evanston, IL: Northwestern Praeger.
University Press. Gartner, A., & Riessman, F. (1980). Help: A working
Gabbard, G. O. (1995). Are all psychotherapies equally guide to self-help groups. New York, NY: New
effective? The Menninger Letter, 3(1), 1–2. Viewpoints/Vision Books.
Gabbard, G. O., Gunderson, J. G., & Fonagy, P. (2002). Gass, M. A., Gillis, H. L., & Russell, K. C. (2012).
The place of psychoanalytic treatments within Adventure therapy: Theory, research, and practice.
psychiatry. Archives of General Psychiatry, 59(6), New York, NY: Routledge.
505–510. doi:10.1001/archpsyc.59.6.501 Gay, P. (1988). Freud: A life for our time. New York, NY:
Gaffney, S. (2006). Gestalt with groups: A cross-cultural W. W. Norton.
perspective. Gestalt Review, 10(3), 205–219. Gay, P. (1995). The Freud reader. New York, NY:
Galatzer-Levy, R. M., Bachrach, H., Skolnikoff, A., & W. W. Norton.
Waldron, S. (2000). Does psychoanalysis work? Gayle, R. (2009). Co-creating meaningful structures
New Haven, CT: Yale University Press. within long-term psychotherapy group culture.
Gallagher, D. (2007). Solution-focused brief therapy in International Journal of Group Psychotherapy, 59,
faith-based communities. In T. S. Nelson & F. N. 311–333. doi:10.1521/ijgp.2009.59.3.311
Thomas (Eds.), Handbook of solution-focused brief Gaynor, S. T., & Lawrence, P. (2002). Complementing
therapy: Clinical applications (pp. 225–248). New CBT for depressed adolescents with learning through
York, NY: Haworth Press. in vivo experience (LIVE): Conceptual analysis,
Gallese, V., Eagle, M. E., & Migone, P. (2007). Intentional treatment description, and feasibility study.
attunement: Mirror neurons and the neural Behavioural & Cognitive Psychotherapy, 30, 79–101.
underpinnings of interpersonal relations. Journal of doi:10.1017/S135246580200108X
the American Psychoanalytic Association, 55, Gazda, G. M., Balzer, F. J., Childers, W. C., Nealy, A.,
131–176. doi:10.1177/00030651070550010601 Phelps, R., & Walters, R. P. (2006). Human relations
Gallo, F. P. (2004). Energy psychology: Explorations at development: A manual for educators (7th ed.).
the interface of energy, cognition, behavior, and health Boston, MA: Allyn & Bacon.
(2nd ed.). Boca Raton, FL: CRC Press. Geary, B. B., & Zeig, J. K. (Eds.). (2002). The handbook
Gans, J. S., & Alonso, A. (1998). Difficult patients: Their of Ericksonian psychotherapy. Phoenix, AZ: The
construction in group therapy. International Journal of Milton H. Erickson Foundation Press.
Group Psychotherapy, 48, 311–338. Gelb, M. J. (2004). Body learning: An introduction to the
Gantt, S. P. (1984). A view of psychotherapy: An integration Alexander technique. London, England: Aurum Press.
of experiential psychotherapy and existential- Gelso, C. J., & Carter, J. A. (1994). Components of the
phenomenological philosophy (Unpublished doctoral psychotherapy relationship: Their interaction and
dissertation). Georgia State University, Atlanta, GA. unfolding during treatment. Journal of Counseling
Gantt, S. P. (2011). Functional subgrouping and the Psychology, 41(3), 296–306. doi:10.1037/0022-
systems-centered approach to group therapy. In 0167.41.3.296
J. Kleinberg (Ed.), The Wiley-Blackwell handbook Gelso, C. J., & Woodhouse, S. (2003). Toward a positive
of group psychotherapy (pp. 113–138). Oxford, psychotherapy: Focus on human strength. In B. W.
England: Wiley. Walsh (Ed.), Counseling psychology and optimal
Gantt, S. P., & Agazarian, Y. M. (2010). Developing the human functioning (pp. 171–197). Mahwah, NJ:
group mind through functional subgrouping: Linking Lawrence Erlbaum.
systems-centered training (SCT) and interpersonal Gendlin, E. T. (1964). A theory of personality change. In
neurobiology. International Journal of Group P. Worchel & D. Byrne (Eds.), Personality change
Psychotherapy, 60(4), 515–544. doi:10.1521/ (pp. 100–148). New York, NY: Wiley. Retrieved from
ijgp.2010.60.4.515 http://www.focusing.org/gendlin/docs/gol_2145.html
Gao, D. (Ed.). (2013). Traditional Chinese medicine: The Gendlin, E. T. (1978). Focusing. London, England:
complete guide to acupressure, acupuncture, Chinese Bantam Books.

Gendlin, E. T. (1984). The client’s client: The edge of Gilhooley, D. (2002). Misrepresentation and misreading
awareness. In R. L. Levant & J. M. Shlien (Eds.), in the case of Anna O. Modern Psychoanalysis, 27(1),
Client-centered therapy and the person-centered 75–100.
approach: New directions in theory, research and Gilligan, S. G. (1983). Effects of emotional intensity on
practice (pp. 76–107). New York, NY: Praeger. learning (Unpublished doctoral dissertation). Stanford
Gendlin, E. T. (1996). Focusing-oriented psychotherapy. University, Stanford, CA.
New York, NY: Guilford Press. Gilligan, S. G. (1987). Therapeutic trances: The
George, E., Iveson, C., & Ratner, H. (1999). Problem to cooperation principle in Ericksonian hypnotherapy.
solution: Brief therapy with individuals and families. New York, NY: Brunner/Mazel.
London, England: Brief Therapy Press. Gilligan, S. G. (1997). The courage to love: Principles and
Gergen, K. J. (1985). The social constructionist movement practices of self-relations psychotherapy. New York,
in modern psychology. American Psychologist, 40, NY: W. W. Norton.
266–275. doi:10.1037//0003-066X.40.3.266 Gilligan, S. G., & Dilts, R. (2009). The hero’s journey: A
Gergen, K. J. (1999). An invitation to social construction. voyage of self-discovery. Carmarthen, Wales: Crown
Thousand Oaks, CA: Sage. House.
Gergen, K. J. (2008). Therapeutic challenges of multi- Gingerich, W. (2006). Obituary: Steve de Shazer. Research
being. Journal of Family Therapy, 30, 335–350. on Social Work Practice, 16, 549–550.
doi:10.1111/j.1467-6427.2008.00447.x doi:10.1177/1049731506289129
Gergen, K. J., & Gergen, M. M. (2008). Social Gingerich, W. J., & Eisengart, S. (2000). Solution-focused
construction and psychological inquiry. In J. A. brief therapy: A review of the outcome research.
Holstein & J. F. Gubrium (Eds.), Handbook of Family Process, 39, 477–498.
constructionist research (pp. 171–188). New York, doi:10.1111/j.1545-5300.2000.39408.x
NY: Guilford Press. Ginsberg, B. G. (1997). Relationship enhancement family
Gergen, K. M. (2009). An invitation to social therapy. New York, NY: Wiley.
construction (2nd ed.). Thousand Oaks, CA: Sage. Ginsburg, C. (2010). The intelligence of moving bodies: A
Germer, C. K., & Siegel, R. D. (Eds.). (2012). Wisdom somatic view of life and its consequences. Santa Fe,
and compassion in psychotherapy: Deepening NM: AWAREing Press.
mindfulness in clinical practice. New York, NY: Giraldo, M. (2012). The dialogues in and of the group:
Guilford Press. Lacanian perspectives on the psychoanalytic group.
Germer, C. K., Siegel, R. D., & Fulton, P. (2012). London, England: Karnac Books.
Mindfulness and psychotherapy. New York, NY: Gladding, S. T. (2007). Family therapy: History, theory,
Guilford Press. and practice (4th ed.). Upper Saddle River, NJ: Merrill.
Gerrig, R., & Zimbardo, P. G. (2010). Psychology and life Gladding, S. T. (2011). Family therapy: History, theory,
(19th ed.). Boston, MA: Allyn & Bacon. and practice (5th ed.). Boston, MA: Pearson
Gerson, M. J. (2010). The imbedded self: An integrative Education.
psychodynamic and systemic perspective on couples Gladstein, G. (1983). Understanding empathy: Integrating
and family therapy. New York, NY: Routledge. counseling, developmental, and social psychology
Ghezzi, P. M., Wilson, G. R., Tarbox, R. S. F., & perspectives. Journal of Counseling Psychology, 30,
MacAleese, K. R. (2003). Token economy. In 467–482. doi:10.1037//0022-0167.30.4.467
W. O’Donohue, U. J. Fisher, & S. C. Hayes (Eds.), Gladstone, G. (n.d.). Pulsing-touch with rhythmic
Cognitive behavior therapy: Applying empirically movement. Retrieved from http://www.pulsing.org.uk/
supported techniques in your practice (pp. 346–341). articles/gg001.html
Hoboken, NJ: Wiley. Glaser, B., & Kirschenbaum, H. (1980). Using values
Gifford, E. V., & Shoenberger, D. (2003). Rapid smoking. clarification in counseling settings. Personnel and
In W. O’Donohue, U. J. Fisher, & S. C. Hayes (Eds.), Guidance Journal, 58(9), 569–574.
Cognitive behavior therapy: Applying empirically doi:10.1002/j.2164-4918.1980.tb00452.x
supported techniques in your practice (pp. 314–320). Glasser, W. (1960). Mental health or mental illness:
Hoboken, NJ: Wiley. Psychiatry for practical action. New York, NY: Harper &
Gilbert, R. M. (1992). Extraordinary relationships. Row.
Minneapolis, MN: Chronimed. Glasser, W. (1965). Reality therapy: A new approach to
Gilbert, R. M. (2004). The eight concepts of Bowen theory: psychiatry. New York, NY: Harper & Row.
A new way of thinking about the individual and the Glasser, W. (1969). Schools without failure. New York,
group. Falls Church, VA: Leading Systems Press. NY: Harper & Row.

Glasser, W. (1972). The identity society. New York, NY: Goldberg, A. (1984). Advances in self psychology.
Harper & Row. New York, NY: International Universities.
Glasser, W. (1976). Positive addiction. New York, NY: Goldenberg, H., & Goldenberg, I. (2008). Family therapy:
Harper & Row. An overview (7th ed.). Belmont, CA: Thompson.
Glasser, W. (1981). Stations of the mind. New York, NY: Goldenberg, H., & Goldenberg, I. (2013). Family
Harper & Row. therapy: An overview (8th ed.). Belmont, CA:
Glasser, W. (1984). Control theory. New York, NY: Brooks/Cole.
Harper & Row. Goldenberg, N. R. (1990). A feminist critique of Jung. In
Glasser, W. (1986). Control theory in the classroom. R. Moore & D. J. Meckel (Eds.), Jung and Christianity
New York, NY: Harper & Row. in dialogue: Faith, feminism, and hermeneutics
Glasser, W. (1989). Control theory in the practice of (pp. 104–111). Mahwah, NJ: Paulist Press.
reality therapy: Case studies. New York, NY: Harper Goldenthal, P. (1996). Doing contextual therapy: An
& Row. integrated model for working with individuals, couples
Glasser, W. (1998). Choice theory. New York, NY: and families. New York, NY: W. W. Norton.
HarperCollins. Goldfried, M. R., & Davison, G. C. (1994). Clinical
Glasser, W. (2001). Counseling with choice theory: The behavior therapy. New York, NY: Wiley.
new reality therapy. New York, NY: HarperCollins. Goldner, V., Penn, P., Sheinberg, M., & Walker, G. (1990).
Glasser, W. (2003). Warning: Psychiatry can be hazardous Love and violence: Gender paradoxes in volatile
to your mental health. New York, NY: HarperCollins. attachments. Family Process, 29, 343–364.
Glasser, W. (2006). Every student can succeed. doi:10.1111/j.1545-5300.1990.00343.x
Chatsworth, CA: William Glasser. Goldstein, E., & Farmer, K. (1992). Confabulations. Boca
Glasser, W. (2011). Take charge of your life. Bloomington, Raton, FL: Sirs Books.
IN: iUniverse. Goldstein, E. G. (1984). Ego psychology and social work
Glasser, W. (n.d.). Development of the ideas. Retrieved practice. New York, NY: Free Press.
from http://www.wglasser.com/images/glasser_forms/ Goldstein, K. (1939). The organism: A holistic approach
develop_ideas.pdf to biology derived from pathological data in man.
Glasser, W., & Glasser, C. (1999). The language of choice New York, NY: American Book.
theory. New York, NY: Harper Perrenial. Goleman, D. (2013). Focus: The hidden driver of
Glasser, W., & Glasser, C. (2000). Getting together and excellence. New York, NY: Bloomsbury.
staying together. New York, NY: HarperCollins. Goncalves, O. F., & Machado, P. P. (1999). Cognitive
Glasser, W., & Glasser, C. (2007). Eights lessons for a narrative psychotherapy: Research foundations.
happier marriage. New York, NY: HarperCollins. Journal of Clinical Psychology, 55(10), 1179–1191.
Glasersfeld, E. von. (1995). Radical constructivism: A doi:10.1002/(SICI)1097-4679(199910)55:10<
way of knowing and learning. London, England: 1179::AID-JCLP2>3.0.CO;2-L
Falmer Press. Gondor, E. I. (1959). Art and play therapy. In K. A. Adler
Gleason, B. (2001). Mortal spirit: A theory of spiritual- & D. Deutsch (Eds.), Essays in individual psychology:
somatic evolution. Lincoln, NE: Writers Club Press. Contemporary applications of Alfred Adler’s theories
Gleick, J. (2008). Chaos: Making a new science. (pp. 206–215). New York, NY: Grove Press. (Original
New York, NY: Penguin Books. work published 1954)
Glenn, L., & Müller-Schwefe, R. (Eds.). (1999). The Gonsiorek, J. C. (Ed.). (1982). Homosexuality and
Radix reader: A neo-Reichian approach to human psychotherapy: A practitioner’s handbook of
growth. Conway, AR: Heron Press. affirmative models. New York, NY: Haworth Press.
Glickauf-Hughes, C., & Wells, M. (2007). Object Good, G. E., Gilbert, L. A., & Scher, M. (1990). Gender
relations psychotherapy: An individualized and aware therapy: A synthesis of feminist therapy and
interactive approach to diagnosis and treatment. knowledge about gender. Journal of Counseling &
Lanham, MD: Rowman & Littlefield. Development, 68(4), 376–380.
Gold, J., & Stricker, G. (Eds.). (2006). Case studies in doi:10.1002/j.1556-6676.1990.tb02514.x
psychotherapy integration. Washington, DC: APA Books. Goodman, P. (1960). Growing up absurd: Problems of
Gold, J., & Stricker, G. (2006). Introduction: An overview youth in the organized system. New York, NY:
of psychotherapy integration. In G. Stricker & J. Gold Random House.
(Eds.), A casebook of psychotherapy integration Gordon, D., & Meyers-Anderson, M. (1981). Phoenix:
(pp. 3–16). Washington, DC: American Psychological Therapeutic patterns of Milton H. Erickson.
Association. Cupertino, CA: Meta.

Gottdiener, W. H. (2013). Assimilative dynamic addiction Grof, S. (2012). Healing our deepest wounds: The
psychotherapy. Journal of Psychotherapy Integration, holotropic paradigm shift. Newcastle, WA: Stream of
23, 39–48. doi:10.1037/a0030271 Experience Productions.
Gottman, J. M. (1994). What predicts divorce? The Grof, S., & Bennett, H. Z. (1992). The holotropic mind:
relationship between marital processes and marital The three levels of human consciousness and how they
outcomes. Hillsdale, NJ: Lawrence Erlbaum. shape our lives. San Francisco, CA:
Gottman, J. M. (1999). The marriage clinic: A HarperSanFrancisco.
scientifically based marital therapy. New York, NY: Grof, S., & Grof, C. (2010). Holotropic breathwork: A
W. W. Norton. new approach to self-exploration and therapy. Albany:
Gottman, J. M., & Gottman, J. S. (2008). Gottman State University of New York.
method couple therapy. In A. S. Gurman (Ed.), Clinical Gross, S. (2000). Racism in the shadow of Jung. In
handbook of couple therapy (pp. 138–166). New E. Christopher & H. M. Solomon (Eds.), Jungian
York, NY: Guilford Press. thought in the modern world (pp. 71–86). New York,
Goulding, R., & Goulding, M. (1978). The power is in NY: Free Association Books.
the patient: A TA/Gestalt approach to psychotherapy. Grosskurth, P. (1986). Melanie Klein: Her world and her
San Francisco, CA: TA Press. work. New York, NY: Knopf.
Graham, P., & Reynolds, S. (Eds.). (2013). Cognitive Grossmann, K., Grossmann, K. E., Kindler, H., &
behaviour therapy for children and families. Zimmermann, P. (2008). A wider view of attachment
Cambridge, England: Cambridge University Press. and exploration: The influence of mothers and fathers
doi:10.1017/CBO9780511543845 on the development of psychological security from
Grand, D. (1999). Defining and redefining EMDR. infancy to young adulthood. In J. Cassidy & P. Shaver
New York, NY: Biolateral Books. (Eds.), Handbook of attachment: Theory, research, and
Grand, D. (2001). Emotional healing at warp speed: The clinical applications (2nd ed., pp. 857–879).
power of EMDR. New York, NY: Harmony Books. New York, NY: Guilford Press.
Grand, D. (2013). Brainspotting: The revolutionary new Grossman, P., Niemann, L., Schmidt, S., & Walach, H.
therapy for rapid and effective change. Lewisville, CO: (2004). Mindfulness-based stress reduction and health
Sounds True. benefits a meta-analysis. Journal of Psychosomatic
Grawe, K. (2007). Neuropsychotherapy: How the Research, 57, 35–43. doi:10.1016/S0022-
neurosciences inform effective psychotherapy. 3999(03)00573-7
Mahwah, NJ: Lawrence Erlbaum. Grossmark, R. (2007). The edge of chaos: Enactment,
Green, A. (2003, October). The human condition ageless, disruption, and emergence in group psychotherapy.
guiltless. The New Yorker. Retrieved from http://www Psychoanalytic Dialogues, 17, 479–499.
.newyorker.com/magazine/2003/10/13/ageless-guiltless doi:10.1080/10481880701487193
Green, E. (1969). Feedback technique for deep relaxation. Grotjahn, M. (1977). The art and technique of analytic
Psychophysiology, 6(3), 371–377. group therapy. New York, NY: Jason Aronson.
doi:10.1111/j.1469-8986.1969.tb02915.x Group for the Advancement of Psychiatry. (2012). The
Greenberg, J. R., & Mitchell, S. A. (1983). Object history of psychiatry and homosexuality. Retrieved
relations in psychoanalytic theory. Cambridge, MA: from http://www.aglp.org/gap/1_history/
Harvard University Press. Guastello, S. J., Koopmans, M., & Pincus, D. (Eds.).
Greenberg, L. S., & Dompierre, L. M. (1981). Specific (2011). Chaos and complexity in psychology: The
effects of Gestalt two-chair dialogue on intrapsychic theory of nonlinear dynamical systems. New York,
conflict in counseling. Journal of Counseling Psychology, NY: Cambridge University Press.
28(4), 288–294. doi:10.1037//0022-0167.28.4.288 Guerin, P. J. (1976). Family therapy: The first twenty-five
Greenberg, L. S., Rice, L. N., & Elliott, R. (1993). years. In P. J. Guerin (Ed.), Family therapy: Theory
Facilitating emotional change: The moment by and practice (pp. 2–23). New York, NY: Gardner
moment process. New York, NY: Guilford Press. Press.
Greene, L. R. (2012). Group therapist as social scientist, Guerin, P. J., Fogarty, T. F., Fay, L. F., Burden, S. L., &
with special reference to the psychodynamically Kautto, J. G. (1996). Working with relationship
oriented therapist. American Psychologist, 67, triangles: The one-two-three of psychotherapy. New
477–489. doi:10.1037/a0029147 York, NY: Guilford Press.
Grof, S. (1975). Realms of the human unconscious. Guerin, P. J., & Guerin, K. (2002). Bowenian family
New York, NY: Viking. therapy. In J. Carlson & D. Kjos (Eds.), Theories and

strategies of family therapy (pp. 126–157). Boston, Haber, R. (2002). Virginia Satir: An integrated,
MA: Allyn & Bacon. humanistic approach. Contemporary Family Therapy,
Guerney, B. G., Jr. (1977). Relationship enhancement. San 24(1), 23–34. doi:10.1023/A:1014317420921
Francisco, CA: Jossey-Bass. Haddock, S. A., Zimmerman, T. S., & MacPhee, D.
Guerney, B. G., Jr. (1982). Relationship enhancement. In (2000). The power equity guide: Attending to gender
E. K. Marshall & P. D. Kurtz (Eds.), Interpersonal in family therapy. Journal of Marital & Family
helping skills (pp. 482–518). San Francisco, CA: Therapy, 26(2), 153–170.
Jossey-Bass. doi:10.1111/j.1752-0606.2000.tb00286.x
Guerney, B. G., Jr. (1984). Relationship enhancement Hagemaster, J. (2000). Use of therapeutic touch in
therapy and training. In D. Larson (Ed.), Teaching treatment of drug addictions. Holistic Nursing
psychological skills: Models for giving psychology Practice, 14(3), 14–20. doi:10.1097/00004650-
away (pp. 171–206). Monterey, CA: Brooks/Cole. 200004000-00005
Guerney, L. (1976). Filial therapy program. In D. H. Halasz, G. (2004). Interview: In conversation with Dr.
Olson (Ed.), Treating relationships (pp. 67–92). Lake Albert Ellis. Australasian Psychiatry, 12(4), 325–333.
Mills, IA: Graphic. Hale, N., Jr. (1995). The rise and crisis of psychoanalysis
Guerney, L., & Ryan, V. (2013). Group filial therapy. in the United States: Freud and the Americans,
Philadelphia, PA, Jessica Kingsley. 1917-1985. New York, NY: Oxford University Press.
Guidano, V. F. (1987). Complexity of the self: A Haley, J. (1959). The family of the schizophrenic: A
developmental approach to psychopathology and model system. Journal of Nervous and Mental Disease,
therapy. New York, NY: Guilford Press. 129(4), 357–374. doi:10.1097/00005053-195910000-
Guidano, V. F. (1995). Constructivist psychotherapy: A 00003
theoretical framework. In M. J. Mahoney (Ed.), Haley, J. (1963). Strategies of psychotherapy. New York,
Cognitive and constructive psychotherapies: Theory, NY: Grune & Stratton.
research, and practice (pp. 89–102). New York, NY: Haley, J. (1973). Uncommon therapy: The psychiatric
Springer. techniques of Milton H. Erickson, M.D. New York,
Guleyupoglu, B., Schestatsky, P., Edwards, D., Fregni, F., & NY: W. W. Norton.
Bikson, M. (2013). Classification of methods in Haley, J. (1974). Problem solving therapy. San Francisco,
transcranial Electric Stimulation (tES) and evolving CA: Jossey-Bass.
strategy from historical approaches to contemporary Haley, J. (1976). Problem-solving therapy: New strategies
innovations. Journal of Neuroscience, 219, 297–311. for effective family therapy. San Francisco, CA: Jossey-
doi:10.1016/j.jneumeth.2013.07.016 Bass.
Guntrip, H. (1964). Personality structure and human Haley, J. (1980). Leaving home: The therapy of disturbed
interaction. New York, NY: International Universities young people. New York, NY: McMillian.
Press. Haley, J. (1984). Ordeal therapy. San Francisco, CA:
Guntrip, H. (1969). Schizoid phenomena, object relations, Jossey-Bass.
and the self. New York, NY: International Universities Haley, J. (Ed.). (1985). Conversations with Milton H.
Press. Erickson, MD: Changing individuals (Vol. 1).
Guntrip, H. (1977). Personality structure and human New York, NY: W. W. Norton.
interaction. New York, NY: International Universities Haley, J. (Ed.). (1985). Conversations with Milton H.
Press. Erickson, MD: Changing couples (Vol. 2). Harrisburg,
Guterman, J. T. (1994). A social constructionist position PA: Triangle Press.
for mental health counseling. Journal of Mental Haley, J. (1986). The power tactics of Jesus Christ and
Health Counseling, 16, 226–244. other essays (2nd ed.). Rockville, MD: Triangle.
Guterman, J. T. (1996). Reconstructing social Haley, J. (1987). Problem-solving therapy. San Francisco,
constructionism: A response to Albert Ellis. Journal of CA: Jossey-Bass.
Mental Health Counseling, 18, 29–40. Haley, J. (1993). Jay Haley on Milton H. Erickson.
Guterman, J. T. (2006). Solution-focused counseling. New York, NY: Brunner Mazel.
Alexandria, VA: American Counseling Association. Haley, J. (1993). Uncommon therapy: The psychiatric
Haaga, D. A., & Davison, G. C. (1989). Outcome studies techniques of Milton Erickson. New York, NY:
of rational-emotive therapy. In M. E. Bernard & W. W. Norton.
R. DiGiuseppe (Eds.), Inside rational-emotive therapy Haley, J. (1996). Learning and teaching therapy.
(pp. 155–195). San Diego, CA: Academic Press. New York, NY: Guilford Press.

Haley, J. (2009). Jay Haley: The family therapist. Harris, R. (2006). Embracing your demons: An overview
Retrieved from http://www.jay-haley-on-therapy.com/ of acceptance and commitment therapy. Psychotherapy
html/family_therapy.html in Australia, 12(4), 2–8.
Haley, J., & Hoffman, L. (Eds.). (1967). Techniques of Harris, R. (2008). The happiness trap: How to stop
family therapy. New York, NY: Basic Books. struggling and start living. Boston, MA: Trumpeter
Haley, J., & Richeport-Haley, M. (2007). Directive family Books.
therapy. Binghamton, NY: Haworth Press. Harrison, T. (2000). Bion, Rickman, Foulkes and the
Hall, C. M. (1981). The Bowen family theory and its Northfield experiments: Advancing on a different
uses. New York, NY: Jason Aronson. front. London, England: Jessica Kingsley.
Hall, C. S., & Nordby, V. J. (1999). A primer of Jungian Hart, B. (1995). Re-authoring the stories we work by:
psychology. New York, NY: Meridian. (Original work Situating the narrative approach in the presence of the
published 1973) family of therapists. Australian & New Zealand
Hall, E., Hall, C., Stradling, P., & Young, D. (2006). Journal of Family Therapy, 16(4), 181–189. doi:10.1002/j
Guided imagery: Creative interventions in counseling .1467-8438.1995.tb01058.x
and psychotherapy. London, England: Sage. Hart, J., Corriere, R., & Binder, J. (1975). Going sane: An
Hall, K. L., & Rossi, J. S. (2008). Meta-analytic introduction to feeling therapy. New York, NY: Jason
examination of the strong and weak principles across Aronson.
48 health behaviors. Preventive Medicine, 46, Hartley, D., Roback, H. B., & Arbramowitz, S. I. (1976).
266–274. doi:10.1016/j.ypmed.2007.11.006 Deterioration effects in encounter groups. American
Hammer, L. I. (1990). Dragon rises, red bird flies: Psychologist, 31(3), 247–255. doi:10.1037/0003-
Psychology & Chinese medicine. New York, NY: 066X.31.3.247
Station Hill Press. Hartling, L. M. (2008). Jean Baker Miller: Living in
Hannah, B. (2000). The inner journey: Lectures and connection. Feminism & Psychology, 18, 326–335.
essays on Jungian psychology. Toronto, Ontario, doi:10.1177/0959353508092085
Canada: Inner City Books. Harvey, A. G., Watkins, E. R., Mansell, W., & Shafran, R.
Hansen, J. C., Rossberg, R. H., & Cramer, S. H. (1994). (2004). Cognitive behavioural processes across
Counseling: Theory and process (5th ed.). Boston, psychological disorders: A transdiagnostic approach to
MA: Allyn & Bacon. research and treatment. Oxford, England: Oxford
Hare-Mustin, R. T. (1978). A feminist approach to family University Press.
therapy. Family Process, 17(2), 181–194. Hasbach, P. (2012). Ecotherapy. In P. Kahn & P. Hasbach
doi:10.1007/978-1-4684-4754-5_20 (Eds.), Ecopsychology: Science, totems, and the
Hargrave, T. D. (1994). Families and forgiveness: Healing technological species (pp. 115–139). Cambridge: MIT
wounds in the intergenerational family. New York, Press.
NY: Brunner/Mazel. Hattie, J. A., Myers, J. E., & Sweeney, T. J. (2004). A
Hargrave, T. D., & Pfitzer, F. (2003). The new contextual factor structure of wellness: Theory, assessment,
therapy: Guiding the power of give and take. New analysis, and practice. Journal of Counseling &
York, NY: Routledge. Development, 82, 354–364. doi:10.1002/
Harmon, S. C., Lambert, M. J., Smart, D. M., Hawkins, j.1556-6678.2004.tb00321.x
E., Nielsen, S. L., Slade, K., & Lutz, W. (2007). Havel, V. (1990). Disturbing the peace: A conversation
Enhancing outcome for potential treatment failures: with Karel Hvizdala (P. Wilson, Trans.). New York,
Therapist-client feedback and clinical support tools. NY: Alfred A. Knopf.
Psychotherapy Research, 17(4), 379–392. Havens, R. A. (2005). The wisdom of Milton H Erickson:
doi:10.1080/10503300600702331 The complete volume. Wilshire, England: Crown
Harned, M. S., Banawan, S. F., & Lynch, T. R. (2006). House.
Dialectical behavior therapy: An emotion-focused Haworth, P. (1998). The historical background of
treatment for borderline personality disorder. Journal psychodrama. In M. Karp, P. Holmes, & K. Bradshaw
of Contemporary Psychotherapy, 36, 67–75. Tauvon (Eds.), The handbook of psychodrama
doi:10.1007/s10879-006-9009-x (pp. 15–28). London, England: Routledge.
Harris, J. E., Kelley, L. J., Campbell, E. L., & Hammond, Hayes, R. A. (2005). Introduction to evidenced-based
E. S. (2014). Key strategies training: An introduction practice. In C. E. Stout & R. A. Hayes (Eds.), The
to multitheoretical psychotherapy. Journal of evidence-based practice: Methods, models, and tools
Psychotherapy Integration, 24(2), 138–152. for mental health professionals (pp. 1–9). Hoboken,
doi:10.1037/a0037056 NJ: Wiley.

Hayes, S. C. (2004). Acceptance and commitment therapy, Hays, P. A. (2006). Introduction: Developing culturally
relational frame theory, and the third wave of responsive cognitive-behavioral therapies. In P. A.
behavioral and cognitive therapies. Behavior Therapy, Hays & G. Y. Iwamasa (Eds.), Culturally responsive
35, 639–665. doi:10.1016/s0005-7894(04)80013-3 cognitive-behavioral therapy: Assessment, practice, and
Hayes, S. C., Barnes-Holmes, D., & Wilson, K. G. (2012). supervision (pp. 3–21). Washington, DC: American
Contextual behavioral science: Creating a science Psychological Association.
more adequate to the challenge of the human Hays, P. A., & Iwamasa, G. W. (Eds.). (2006). Culturally
condition. Journal of Contextual Behavioral Science, responsive cognitive-behavioral therapy: Assessment,
1, 1–16. doi:10.1016/j.jcbs.2012.09.004 practice, and supervision. Washington, DC: American
Hayes, S. C., Follette, V. M., & Linehan, M. M. (Eds.). Psychological Association.
(2004). Mindfulness and acceptance: Expanding the Head, L. S., & Gross, A. M. (2008). Systematic
cognitive behavioral tradition. New York, NY: desensitization. In W. T. O’Donohue & J. E. Fisher
Guilford Press. (Eds.), Cognitive behavior therapy: Applying
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & empirically supported techniques in your practice
Lillis, J. (2006). Acceptance and commitment therapy: (2nd ed., pp. 542–549). Hoboken, NJ: Wiley.
Model, processes and outcomes. Behavior Research Heather, N. (2007). Alcohol problems. In C. Freeman &
and Therapy, 44, 1–45. doi:10.1016/j. M. Power (Eds.), Handbook of evidence-based
brat.2005.06.006 psychotherapies: A guide for research and practice
Hayes, S. C., & Pankey, J. (2003). Acceptance. In (pp. 251–268). West Sussex, England: Wiley.
W. O’Donohue, U. J. Fisher, & S. C. Hayes (Eds.), Hecht, J. B. (2011). Becoming who we are in groups: One
Cognitive behavior therapy: Applying empirically Jungian’s approach to group psychotherapy. GROUP,
supported techniques in your practice (pp. 4–9). 35(2), 151–165.
Hoboken, NJ: Wiley. Hecker, L. L., & Wetchler, J. L. (2003). An introduction
Hayes, S. C., & Smith, S. X. (2005). Get out of your to marriage and family therapy. New York, NY:
mind and into your life: The new acceptance and Routledge Mental Health/Taylor & Francis.
commitment therapy. Oakland, CA: New Harbinger. Heidegger, M. (1962). Being and time (J. Macquarrie &
Hayes, S. C., & Strosahl, K. D. (Eds.). (2004). A practical E. S. Robinson, Trans.). London, England: Harper &
guide to acceptance and commitment therapy. New Row. (Original work published 1927)
York, NY: Springer. Heins, T., & Ritchie, K. (1988). Beating sneaky poo:
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Ideas for faecal soiling. Retrieved from http://www
Acceptance and commitment therapy: An experiential .dulwichcentre.com.au/beating-sneaky-poo-1.pdf
approach to behavior change. New York, NY: Helfaer, P. (2011). Foundations of bioenergetic analysis.
Guilford Press. In V. Heinrich-Clauer (Ed.), Handbook of bioenergetic
Hayes, S. C., Strosahl, K., & Wilson, K. (2003). analysis (pp. 21–34). Giessen, Germany: Psychosocial-
Acceptance and commitment therapy: An experiential Verlag.
approach to behavior change. New York, NY: Heller, J., & Hanson, J. (2005). Hellerwork client’s
Guilford Press. handbook. Los Alamitos, CA: Hellerwork
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). International. Retrieved from http://www.hellerwork
Acceptance and commitment therapy: The process and .com/files/6313/9173/5260/heller.handbook.pdf
practice of mindful change (2nd ed.). New York, NY: Heller, J., & Henkin, W. (2004). Bodywise: An
Guilford Press. introduction to Hellerwork for regaining flexibility
Hayes, S. C., & Wilson, K. G. (1994). Acceptance and and well being. Berkeley, CA: North Atlantic Books.
commitment therapy: Altering the verbal support for Hellinger, B. (2003). Peace begins in the soul: Family
experiential avoidance. The Behavior Analyst, 17, constellations in the service of reconciliation (C.
289–303. Beaumont, Trans.). Heidelberg, Germany: Carl-Auer-
Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., Systeme Verlag.
& Strosahl, K. (1996). Experiential avoidance and Hendrix, H. (1990). Getting the love you want: A guide
behavioral disorders: A functional dimensional for couples. New York, NY: Harper & Row.
approach to diagnosis and treatment. Journal of Hendrix, H., & Hunt, H. (1997). Giving the love that
Consulting and Clinical Psychology, 64, 1152–1168. heals: A guide for parents. New York, NY: Harper &
doi:10.1037/0022-006X.64.6.1152 Row.
Hayman, R. (2001). A life of Jung. New York, NY: Henggeler, S. W., Schoenwald, S. K., Borduin, C. M.,
W. W. Norton. Rowland, M. D., & Cunningham, P. B. (2009).

Multisystemic therapy for antisocial children and Psychology, 1, 91–111. doi:10.1146/annurev.clinpsy.

adolescents (2nd ed.). New York, NY: Guilford Press. 1.102803.143833
Henriques, G. (2008). The problem of psychology and the Hibbs, B. J. (2009). Try to see it my way: Being fair in
integration of human knowledge: Contrasting Wilson’s love and marriage. New York, NY: Avery.
consilience with the tree of knowledge system. Theory Highhouse, S. (2002). A history of the T-group and its
& Psychology, 18, 731–755. early applications in management development. Group
doi:10.1177/0959354308097255 Dynamics: Theory, Research, and Practice, 6(4),
Henriques, G. (2013). Evolving from methodological to 277–290. doi:10.1037/1089-2699.6.4.277
conceptual unification. Review of General Psychology, Hilgard, E. R. (1965). Hypnotic susceptibility. New York,
17, 168–173. doi:10.1037/a0032929 NY: Harcourt Brace & World.
Henriques, G. R. (2003). The tree of knowledge system Hill, J., Fonagy, P., Safier, E., & Sargent, J. (2003). The
and the theoretical unification of psychology. Review ecology of attachment in the family. Family Process,
of General Psychology, 7, 150–182. doi:10.1037/1089- 42, 205–221. doi:10.1111/j.1545-5300.2003.42202.x
2680.7.2.150 Hill, M., Glaser, K., & Harden, J. (1998). A feminist
Henriques, G. R. (2004). Psychology defined. Journal of model for ethical decision making. Women & Therapy,
Clinical Psychology, 60, 1207–1221. doi:10.1002/ 21, 101–121. doi:10.1300/J015v21n03_10
jclp.20061 Hill, M., & Jeong, J. Y. (2008). Putting it all together:
Henriques, G. R. (2005). Toward a useful mass Theory. In M. Ballou, M. Hill, & C. West (Eds.),
movement. Journal of Clinical Psychology, 61,121– Feminist therapy: Theory and practice (pp. 135–151).
139. doi:10.1002/jclp.20094 New York, NY: Springer.
Henriques, G. R. (2007). Integrating treatments into an Hillman, J. (1975). Re-visioning psychology. New York,
effective package. Pragmatic Case Studies in NY: Harper & Row.
Psychotherapy, 3, 50–60. doi:10.14713/pcsp.v3i2.900 Hillman, J. (1983). Archetypal psychology: A brief
Henriques, G. R. (2011). A new unified theory of account. Dallas, TX. Spring.
psychology. New York, NY: Springer. Hiltner, S. (1979). Preface to pastoral theology. Nashville,
Henriques, G. R., & Stout, J. (2012). A unified approach TN: Abingdon.
to conceptualizing people in psychotherapy. Journal of Hines, P., Mills, J. C., Bonner, R., Sutton, C. E., &
Unified Psychotherapy and Clinical Science, 1, 37–60. Castellano, C. (2007). Healing and recovery after
Hepple, J. (2012). Cognitive-analytic therapy in a group. trauma: A disaster response program in first
Reflections on a dialogic approach. British Journal of responders. In A. J. Sargent (Ed.), AFTA Monograph
Psychotherapy, 28(4), 474–495. Series: Systemic responses to disasters: Stories of the
doi:10.1111/j.1752-0118.2012.01312.x aftermath of hurricane Katrina (pp. 61–66).
Heppner, P. P., Kivlighan, D. M., & Wampold, B. E. Washington, DC: American Family Therapy Academy.
(1999). Research design in counseling (2nd ed.). Hines, P. M., Petro, N. G., McGoldrick, M., Almeida, R.,
Belmont, CA: Wadsworth. & Weltman, S. (2005). Culture and the family life
Hermans, H. J. M., & Dimaggio, G. (Eds.). (2004). The cycle. In B. Carter & M. McGoldrick (Eds.), The
dialogical self in psychotherapy. Hove, England: expanded family life cycle: Individual, family, and
Brunner-Routledge. social perspectives (3rd ed., pp. 69–87). Boston, MA:
Herschell, A., Calzada, E., Eyberg, S. M., & McNeil, C. B. Allyn & Bacon.
(2002). Parent-child interaction therapy: New Hinshelwood, R. D. (1989). A dictionary of Kleinian
directions in research. Cognitive and Behavioral thought. London, England: Free Association Books.
Practice, 9, 9–16. doi:10.1016/S1077-7229(02) Hinton, D., Warnke, B., & Wubbolding, R. (2011).
80034-7 Choosing success in the classroom by building student
Hersen, M., & Sledge, W. H. (2002). Beck, A. T. In relationships. International Journal of Choice Theory
M. Hersen & W. H. Sledge (Eds.), Encyclopedia of and Reality Therapy, 31(1), 90–96.
psychotherapy (Vol. 1, p. 177). Boston, MA: Academic Hinz, L. D. (2009). Expressive therapies continuum: A
Press. framework for using art in therapy. New York, NY:
Herskowitz, M. (1997). Emotional armoring: An Routledge/Taylor & Francis.
introduction to psychiatric orgone therapy. Hirai, M., & Clum, G. A. (2006). A meta-analytic study
Piscataway: NJ: Transaction, Rutgers-State University. of self-help interventions for anxiety disorders.
Hettema, J., Steele, J., & Miller, W. R. (2005). Behavior Therapy, 37(2), 99–111. doi:10.1016/j.
Motivational interviewing. Annual Review Clinical beth.2005.05.002

Ho, M. K., Rasheed, J. M., & Rasheed, M. N. (2004). Hooker, E. (1957). The adjustment of the male overt
Family therapy and ethnic minorities (2nd ed.). homosexual. Journal of Projective Techniques, 21,
Thousand Oaks, CA: Sage. 18–31. doi:10.1080/08853126.1957.10380742
Hoekstra, R., & Tsai, M. (2010). FAP for interpersonal Hopcke, R. H. (1989). A guided tour of the collected
process groups. In: J. W. Kanter, M. Tsai, & R. H. works of C. G. Jung. Boston, MA: Shambhala.
Kohlenberg (Eds.), The practice of functional analytic Hopper, E. (2003). Traumatic experience in the
psychotherapy (pp. 247–260). New York, NY: Springer. unconscious life of groups: The fourth basic
Hoffer, A., & Osmond, H. (1967). The hallucinogens. assumption: Incohesion: Aggregation/massification or
New York, NY: Academic Press. (ba) I:A/M. London, England: Jessica Kingsley.
Hoffler, A. (2001). Jung’s analysis of Sabina Spielrein and Hopper, E. (Ed.). (2012). Trauma and organizations.
his use of Freud’s free association method. Journal of London, England: Karnac Books.
Analytical Psychology, 46, 117–128. Hopper, E., & Weinberg, H. (Eds.). (2011). The social
doi:10.1111/1465-5922.00218 unconscious in persons, groups, and societies: Volume
Hoffman, D. (Ed.). (2012). The voice dialogue anthology: 1. Mainly theory. London, England: Karnac Books.
Explorations of the psychology of selves and the Horney, K. (1932). The dread of women. International
aware ego process. Albion, CA: Delos. Journal of Psycho-Analysis, 13, 348–360.
Hoffman, E. (1994). The drive for self: Alfred Adler and Horney, K. (1937). The neurotic personality of our time.
the founding of individual psychology. New York, NY: New York, NY: W. W. Norton.
Addison-Wesley. Horney, K. (1939). New ways in psychoanalysis. New
Hoffman, E. (1998). The right to be human: A biography York, NY: W. W. Norton.
of Abraham Maslow (2nd ed.). New York, NY: Horney, K. (1945). Our inner conflicts: A constructive
McGraw-Hill. theory of neurosis. New York, NY: W. W. Norton.
Hoffman, E. (Ed.). (2003). The wisdom of Carl Jung. Horney, K. (1950). Neurosis and human growth: The
New York, NY: Kensington. struggle toward self-realization. New York, NY:
Hoffman, L. (2011). Exchanging voices: A collaborative W. W. Norton.
approach to family therapy. London, England: Karnac Horney, K. (1967). Feminine psychology. New York, NY:
Books. Henry Holt.
Hofmann, S. G., Asmundson, G. J., & Beck, A. T. (2013). Horowitz, L., & Strack, S. (2011). Handbook of
The science of cognitive therapy. Behavior Therapy, interpersonal psychology. Hoboken, NJ: Wiley.
44, 199–212. doi:10.1016/j.beth.2009.01.007 Horowitz, L. M., Alden, L. E., Wiggins, J. S., & Pincus, A. L.
Holland, J. G., & Skinner, B. F. (1961). The analysis of (2000). The Inventory of Interpersonal Problems (IIP-32).
behavior: A program for self-instruction. New York, San Antonio, TX: Psychcorp.
NY: McGraw-Hill. Horvarth, A. O., & Bedi, R. P. (2002). The alliance. In
Hollon, S. D., & Beck, A. T. (2003). Cognitive and J. C. Norcross (Ed.), Psychotherapy relationships that
cognitive-behavioral therapies. In M. J. Lambert (Ed.), work: Therapist contributions and responsiveness to
Bergin and Garfield’s handbook of psychotherapy and patients (pp. 37–61). New York, NY: Oxford
behavior change (5th ed., pp. 447–492). New York, University Press.
NY: Wiley. House, A. S. (2006). Increasing the usability of cognitive
Holmes, J. (2001). The search for the secure base: processing therapy for survivors of child sexual abuse.
Attachment theory and psychotherapy. New York, NY: Journal of Child Sexual Abuse, 15, 87–103.
Routledge. doi:10.1300/J070v15n01_05
Homans, P. (1990). C. G. Jung: Christian or post- Hover-Kramer, D. (2002). Healing touch: A guidebook
Christian psychologist? In R. Moore & D. J. Meckel for practitioners (2nd ed.). Albany, NY: Delmar.
(Eds.), Jung and Christianity in dialogue: Faith, Howard, K. I., Kopta, S. M., Krause, M. S., & Orlinsky,
feminism, and hermeneutics (pp. 21–37). Mahwah, D. E. (1986). The dose-effect relationship in
NJ: Paulist Press. psychotherapy. American Psychologist, 41, 159–164.
Honeyman, A. (1990). Perceptual changes in addicts as a doi:10.1037//0003-066X.41.2.159
consequence of reality therapy based on group Howes, R. (2010, February). In therapy. Psychology Today.
treatment. Journal of Reality Therapy, 9(2), 53–59. Retrieved from http://www.psychologytoday.com/blog/
Hooker, E. (1956). A preliminary analysis of group in-therapy/201002/cool-intervention-3-primal-therapy
behavior of homosexuals. Journal of Psychology, 42, Hoyt, M. F. (1994). Introduction: Competency-based
217–225. doi:10.1080/00223980.1956.9713035 future-oriented therapy. In M. F. Hoyt (Ed.),

Constructive therapies (pp. 1–10). New York, NY: Hyde, J. S., Lindberg, S. M., Linn, M. C., Ellis, A. B., &
Guilford Press. Williams, C. C. (2008). Gender similarities
Hoyt, M. F. (1996). Solution building and language characterize math performance. Science, 321,
games: A conversation with Steve de Shazer. In 494–495. doi:10.1126/science.1160364
M. F. Hoyt (Ed.), Constructive therapies (Vol. 2, Hynes, A. M., & Hynes-Berry, M. (1986). Bibliotherapy—
pp. 60–86). New York, NY: Guilford Press. the interactive process: A handbook. Boulder, CO:
Hoyt, M. F. (2000). Some stories are better than others: Westview Press.
Doing what works in brief therapy and managed care. Hynes, A. M., & Hynes-Berry, M. (2012). Biblio/poetry
Philadelphia, PA: Brunner/Mazel. therapy—the interactive process: A handbook. St.
Hoyt, M. F. (2009). Brief psychotherapies: Principles and Cloud, MN: North Star Press.
practices. Phoenix, AZ: Zeig, Tucker & Theisen. Ibrahim, F. A. (1999). Transcultural counseling:
Hoyt, M. F., & Talmon, M. (Eds.). (2014). Capturing the Existential worldview theory and cultural identity.
moment: Single-session therapy and walk-in services. In. J. McFadden (Ed.), Transcultural counseling
Bethel, CT: Crown House. (2nd ed., pp. 3–22). Alexandria, VA: American
Hubble, M. A., Duncan, B. L., & Miller, S. D. (Eds.). Counseling Association.
(1999). The heart and soul of change: What works in Ibrahim, F. A. (2003). Existential worldview counseling
therapy. Washington, DC: APA Press. theory: Inception to applications. In F. D. Harper &
Hughes, D. (2004). An attachment-based treatment of J. McFadden (Eds.), Cultural and counseling: New
maltreated children and young people. Attachment & approaches (pp. 196–208). Boston, MA: Allyn &
Human Development, 6, 263–278. doi:10.1080/14616 Bacon.
730412331281539 The Icarus Project. (2006). Icarus project: Mission
Hughes, D. (2006). Building the bonds of attachment statement. Retrieved from http://theicarusproject.net/
(2nd ed.). Northvale, NJ: Jason Aronson. about-us/icarus-project-mission-statement
Hughes, D. (2007). Attachment-focused family therapy. The Icarus Project. (2008). Icarus project: Welcome
New York, NY: W. W. Norton. to Icarus. Retrieved from http://theicarusproject
Hughes, D. (2009). Attachment-focused parenting. .net/
New York, NY: W. W. Norton. Illsley-Clarke, J., & Dawson, C. (1998). Growing up
Hughes, D. (2009). The communication of emotions and again: Parenting ourselves, parenting our children
the growth of autonomy and intimacy within family (2nd ed.). Center City, MN: Hazelden Information
therapy. In D. Fosha, D. J. Siegel, & M. Solomon Education.
(Eds.), The healing power of emotion: Affective Ingersoll, R. E., & Marquis, A. (2014). Understanding
neuroscience, development, and clinical practice psychopathology: An integral perspective on etiology
(pp. 280–303). New York, NY: W. W. Norton. and treatment. Columbus, OH: Pearson Merrill
Hughes, D. (2011). Attachment-focused family therapy Prentice Hall.
workbook. New York, NY: W. W. Norton. Ingersoll, R. E., & O’Neill, B. (2005). Gestalt therapy
Hull, G. H., & Mather, J. (2006). Understanding and spirituality. In A. L. Woldt & S. M. Toman (Eds.),
generalist practice with families. Belmont, CA: Gestalt therapy: History, theory, and practice
Brooks/Cole. (pp. 133–150). Thousand Oaks, CA: Sage.
Hurley, D. (2004, May 4). From therapy’s Lenny Bruce: Ingersoll, R. E., & Rak, C. F. (2006).
Get over it! Stop whining! New York Times: Health Psychopharmacology for helping professionals: An
Section. Retrieved from http://www.nytimes integral exploration. Toronto, Ontario, Canada:
.com/2004/05/04/health/psychology/04PROF.html?pag Thomson Brooks/Cole.
ewanted=2&ei=5070&en=7f9ae346ae424997 Ingersoll, R. E., & Sink, C. (Eds.). (2007). Integral theory
&ex=1180670400 in counseling [Special issue]. Counseling and Values,
Husserl, E. (1931). Ideas (W. R. Boyce Gibson, Trans.), 53(3), 162–234.
New York, NY: Macmillan. (Original work published Ingersoll, R. E., & Zeitler, D. A. (2010). Integral
1913) psychotherapy: Inside out/outside in. Albany: State
Husserl, E. (1960). Cartesian meditations: An University of New York.
introduction to phenomenology (D. Cairns, Trans.). Irigaray, L. (1985). Speculum of the other woman
The Hague, Netherlands: Nijhoff. (Original work (G. C. Gill, Trans.). Ithaca, NY: Cornell University
published 1929) Press. (Original work published 1974)
Husserl, E. (1977). Phenomenological psychology (J. Iveson, C., George, E., & Ratner, H. (2012). Brief
Scanlon, Trans.). The Hague, Netherlands: Nijhoff. coaching: A solution-focused approach. London,
(Original work published 1925) England: Routledge.

Ivey, A. (2000). Developmental therapy: Theory into Jacobs, E., & Schimmel, C. (2013). Impact therapy: The
practice. North Amherst, MA: Microtraining courage to counsel. Star City, WV: Impact Therapy
Associates. (Original work published 1986) Associates.
Ivey, A., & Ivey, M. (1998). Reframing DSM-IV: Positive Jacobson, E. (1938). Progressive relaxation. Chicago, IL:
strategies from developmental counseling and therapy. University of Chicago Press.
Journal of Counseling & Development, 76, 334–350. Jacobson, N. S., & Christenson, A. (1996). Integrative
Ivey, A., Ivey, M., Myers, J., & Sweeney, T. (2005). couple therapy. New York, NY: W. W. Norton.
Developmental counseling and therapy: Promoting Jaffé, A. (1964). Symbolism in the visual arts. In C. G.
wellness over the lifespan. North Amherst, MA: Jung, & M. L. von Franz (Eds.), Man and his symbols
Lahaska. (pp. 230–271). Garden City, NY: Doubleday.
Ivey, A. E., & Brooks-Harris, J. E. (2005). Integrative Jaffé, A. (1971). From the life and work of C. G. Jung.
psychotherapy with culturally diverse clients. In J. C. New York, NY: Harper & Row.
Norcross & M. R. Goldfried (Eds.), Handbook of Jain, S., & Mills, P. J. (2010). Biofield therapies: Helpful
psychotherapy integration (2nd ed., pp. 321–339). or full of hype? A best evidence synthesis.
New York, NY: Oxford University Press. International Journal of Behavioral Medicine, 17(1),
Ivey, A. E., D’Andrea, M. J., & Ivey, M. B. (2012). 1–16. doi:10.1007/s12529-009-9062-4
Neuroscience: The newest force in counseling and Janet, P. (1925). Principles of psychotherapy. London,
psychotherapy. In Theories of counseling and England: Allen & Unwin.
psychotherapy: A multicultural perspective (7th ed., Janov, A. (1970). The primal scream. New York, NY:
pp. 49–86). Thousand Oaks, CA: Sage. Putnam.
Ivey, A. E., D’Andrea, M., Ivey, M. B., & Simek-Morgan, Janov, A. (1972). The primal revolution: Toward a real
L. (2007). Theories of counseling and psychotherapy: world. New York, NY: Simon & Schuster.
A multicultural perspective (6th ed.). Boston, MA: Janov, A. (1983). Imprints: The lifelong effects of the
Allyn & Bacon. birth experience. New York, NY: Perigee Books.
Ivey, A. E., & Ivey, M. (2003). Intentional interviewing Janov, A. (1996). Why you get sick, how you get well:
and counseling: Facilitating client development in a The healing power of feelings. West Hollywood, CA:
multicultural society (5th ed.). Pacific Grove, CA: Dove Books.
Brooks/Cole. Janov, A. (2000). The biology of love. Amherst, NY:
Ivey, A. E., & Zalaquett, C. P. (2011). Neuroscience and Prometheus Books.
counseling: Central issue for social justice leaders. Janov, A. (2011). Life before birth: The hidden script that
Journal for Social Action in Counseling and rules our lives. Chicago, IL: NTI Upstream.
Psychology, 3, 103–116. Japanese Society of Morita Therapy. (2010). Guidelines
Ivey, G. (2008). Enactment controversies: A critical review for practicing outpatient Morita Therapy (English ed.).
of current debates. International Journal of Tokyo, Japan: Author.
Psychoanalysis, 89, 19–38. Jarrett, L. S. (1998). Nourishing destiny. Stockbridge,
doi:10.1111/j.1745-8315.2007.00003.x MA: Spirit Path Press.
Iwamasa, G. W. (1996). Introduction to the special series: Jennings, S. (1997). Drama therapy with families, groups,
Ethnic and cultural diversity in cognitive and and individuals: Waiting in the wings. London,
behavioral practice. Cognitive and Behavioral Practice, England: Kingsley.
3, 209–213. doi:10.1016/s1077-7229(96)80014-9 Johanson, G. (2009). Psychotherapy, science, and spirit:
Iwamasa, G. Y., Hsia, C., & Hinton, D. (2006). Nonlinear systems, Hakomi therapy, and the Tao.
Cognitive-behavioral therapy with Asian Americans. Journal of Spirituality in Mental Health, 11(3),
In P. A. Hays & G. Y. Iwamasa (Eds.), Culturally 172–212. doi:10.1080/19349630903081093
responsive cognitive-behavioral therapy: Assessment, Johanson, G., & Kurtz, R. (1991). Grace unfolding:
practice, and supervision (pp. 117–140). Washington, Psychotherapy in the spirit of the Tao-Te Ching.
DC: American Psychological Association. New York, NY: Bell Tower.
Jack, S. J., & Ronan, K. R. (2008). Bibliotherapy: Practice Johnson, D. R., & Enumah, R. (2009). Current
and research. School Psychology International, 29, approaches to drama therapy. Springfield, IL: Charles
161–182. doi:10.1177/0143034308090058 C Thomas.
Jackins, H. (1997). The list. Seattle, WA: Rational Island. Johnson, S. (1994). Character styles. New York, NY:
Jackson, D. (2005). The question of family homeostasis. W. W. Norton.
In W. Ray (Ed.), Don D. Jackson: Essays from the Johnson, S. (2007). A new era for couple therapy: Theory,
Dawn of an Era (pp. 99–110). Phoenix, AZ: Zeig, research, and practice in concert. Journal of Systemic
Tucker & Theisan. Therapies, 26(4), 5–16. doi:10.1521/jsyt.2007.26.4.5

Johnson, W. R., & Smith, E. W. L. (1997). Gestalt Jung, C. G. (1943). Individuation: The mana-personality.
empty-chair dialogue versus systematic desensitization In The collected works of C. G. Jung (Vol. 7, p. 238)
in the treatment of phobia. Gestalt Review, 1(2), Princeton, NJ: Princeton University Press.
150–162. Jung, C. G. (1946). The psychology of the transference. In
Jones, F. P. (1997). Freedom to change. London, England: The collected works of C. G. Jung (Vol. 16, p. 233).
Mouritz. Princeton, NJ: Princeton University Press.
Jones, P. (2007). Drama as therapy: Vol. 1. Theory, Jung, C. G. (1952). Symbols of transformation in
practice, and research. New York, NY: Routledge. collected works (Vol. 5). Princeton, NJ: Princeton
Jones, S. L. (1988). A religious critique of behavior University Press.
therapy. In W. R. Miller & J. E. Martin (Eds.), Jung, C. G. (1953). Psychology and alchemy (Vol. 12).
Behavior therapy and religion: Integrating spiritual London, England: Routledge & Kegan Paul.
and behavioral approaches to change (pp. 139–170). Jung, C. G. (1954). The collected works of C. G. Jung:
Newbury Park, CA: Sage. The development of personality (R. F. C. Hull, Trans.).
Jordan, J. V. (2009). Relational-cultural therapy. London, England: Pantheon.
Washington, DC: American Psychological Association. Jung, C. G. (1954). The practice of psychotherapy (Vol.
Jordan, J. V., Walker, M., & Hartling, L. (Eds.). (2004). 16). London, England: Routledge & Kegan Paul.
The complexity of connection. New York, NY: Jung, C. G. (1957). The transcendent function. In
Guilford Press. Collected works (Vol. 8, p. 69). Princeton, NJ:
Joshi, V. (2005). Stress: From burnout to balance. Princeton University Press.
Washington, DC: Response Books. Jung, C. G. (1959). The archetypes and the collective
Jozefowiez, J., & Staddon, J. E. R. (2008). Operant unconscious (Vol. 9). London, England: Routledge &
behavior. In R. Menzel & G. Byrne (Eds.), Learning Kegan Paul.
and memory: A comprehensive reference: Vol. 1. Jung, C. G. (1961). Memories, dreams, reflections.
Randolf Menzel: Learning theory and behavior London, England: Random House.
(pp. 75–102). Oxford, England: Elsevier. Jung, C. G. (1964). Approaching the unconscious. In
Juedes, J., & Barton, W. (2002). Fringe psychology of the C. G. Jung & M. L. von Franz (Eds.), Man and his
1960s in breakthrough/momentus training. Retrieved symbols (pp. 18–103). Garden City, NY: Doubleday.
from http://www.empirenet.com/~messiah7/brk_ Jung, C. G. (1964). Man and his symbols. New York, NY:
fringepsych.htm Bantam Doubleday Dell.
Juhnke, G. A., Watts, R. E., Guerra, N. S., & Hsieh, P. Jung, C. G. (1964). Psychological types (H. G. Baynes,
(2009). Using prayer as an intervention with clients Trans.). London, England: Pantheon. (Original work
who are substance abusing and addicted and who self- published 1921)
identify personal faith in God and prayer as recovery Jung, C. G. (1966). The collected works of C. G. Jung:
resources. Journal of Addictions & Offender The practice of psychotherapy (Vol. 16; R. F. C. Hull,
Counseling, 30, 16–23. Trans.). Princeton, NJ: Princeton University Press.
doi:10.1002/j.2161-1874.2009.tb00053.x Jung, C. G. (1966). The collected works of C. G. Jung:
Jung, C. G. (1907). The psychology of dementia praecox The spirit in man, art, and literature (Vol. 15; R. F. C.
(2nd ed.). In The psychogenesis of mental disease, Hull, Trans.). Princeton, NJ: Princeton University
collected works (Vol. 3). New York, NY: Nervous and Press.
Mental Disease. (Original work published 1936; this is Jung, C. G. (1966). Two essays on analytical psychology
the disease now known as schizophrenia.) (Vol. 7). London, England: Routledge & Kegan Paul.
Jung, C. G. (1916). Psychology of the unconscious: A Jung, C. G. (1968). The collected works of C. G. Jung:
study of the transformations and symbolisms of the The archetypes and the collective unconscious (Vol. 9,
libido, a contribution to the history of the evolution of Pt. 1; R. F. C. Hull, Trans.). Princeton, NJ: Princeton
thought (B. Moses, Trans.). Princeton, NJ: Princeton University Press.
University Press. Jung, C. G. (1968). The collected works of C. G. Jung:
Jung, C. G. (1936). The collected works of C. G. Jung: Psychology and alchemy (Vol. 12; R. F. C. Hull,
The archetypes and the collective unconscious (Vol. 9; Trans.). Princeton, NJ: Princeton University Press.
R. F. C. Hull, Trans.). London, England: Pantheon. Jung, C. G. (1969). The collected works of C. G. Jung: The
Jung, C. G. (1943). Individuation. In The collected works structure and dynamics of the psyche (Vol. 8; R. F. C.
of C. G. Jung (Vol. 7, p. 173). Princeton, NJ: Princeton Hull, Trans.). Princeton, NJ: Princeton University
University Press. Press.

Jung, C. G. (1969). Studies in word-association: Kaiser, C. (1995). An interview with Kurt Adler on his
Experiments in the diagnosis of psychopathological 90th birthday. Retrieved from http://www.adlerian.us/
conditions carried out at the psychiatric clinic of the kurt-90.htm
University of Zurich under the direction of C. G. Jung. Kakar, S. (1991). The analyst and the mystic. Chicago, IL:
New York, NY: Russell & Russell. (Original work The University of Chicago Press.
published 1918) Kaklauskas, F. J., Nimanheminda, S., Hoffman, L., &
Jung, C. G. (1971). Psychological types (Vol. 6). London, Jack, M. S. (2008). Brilliant sanity: Buddhist
England: Routledge & Kegan Paul. approaches to psychotherapy. Colorado Springs, CO:
Jung, C. G. (1976). The collected works of C. G. Jung: University of the Rockies Press.
The symbolic life: Miscellaneous writings (Vol. 18; Kaklauskas, F. J., & Olson, E. A. (2008). Large group
R. F. C. Hull, Trans.). Princeton, NJ: Princeton process: Grounding Buddhist and psychological theory
University Press. in experience. In F. J. Kaklauskas, S. Nimanheminda,
Jung, C. G. (1977). The practice of psychotherapy. In The L. Hoffman, & M. S. Jack (Eds.), Brilliant sanity:
collected works of C. G. Jung (Vol. 16, R. F. C. Hull, Buddhist approaches to psychotherapy (pp. 133–160).
Trans.). Princeton, NJ: Princeton University Press. Colorado Springs, CO: University of the Rockies Press.
Jung, C. G. (1977). Two essays on analytical psychology. Kaplan, M. (1978). Uses of the group in gestalt therapy
In The collected works of C. G. Jung (Vol. 7). groups. Psychotherapy: Theory, Research, & Practice,
Princeton, NJ: Princeton University Press. 15, 80–89. doi:10.1037/h0085845
Jung, C. G. (1989). Memories, dreams, reflections. Kaplan, R., & Kaplan, S. (1989). The experience of
New York, NY: Vintage Books. nature: A psychological perspective. Cambridge,
Jung, C. G., & Campbell, J. (Eds.). (1971). The portable England: Cambridge University Press.
Jung (R. F. C. Hull, Trans.). New York, NY: Penguin Kaplan-Solms, K., & Solms, M. (2002). Clinical studies in
Books. (Original work published 1928) neuro-psychoanalysis: Introduction to a depth
Jung, C. G., & von Franz, M. L. (Eds.). (1964). Man and neuropsychology. New York, NY: Karnac Books.
his symbols. Garden City. NY: Doubleday. Karon, B. P., & VandenBos, G. R. (1994). Psychotherapy
Kabat-Zinn, J. (1990). Full catastrophe living: Using the for schizophrenia: The treatment of choice. Lanham,
wisdom of your body and mind to face stress, pain MD: Rowman & Littlefield.
and illness. New York, NY: Dell. Karp, M. (1998). An introduction to psychodrama.
Kabat-Zinn, J. (2005). Bringing mindfulness to medicine: In M. Karp, P. Holmes, & K. B. Tauvon (Eds.),
An interview with Jon Kabat-Zinn, Ph.D. Interview by The handbook of psychodrama (pp. 3–14). London,
Karolyn Gazella. Advances in Mind-Body Medicine, England: Routledge.
21(2), 22–27. Karpman, S. (1968). Script drama analysis. Transactional
Kabat-Zinn, J. (2013). Full catastrophe living: Using the Analysis Bulletin, 7(26), 39–43.
wisdom of your body and mind to face stress, pain, Karrasch, N. (2009). Meet your body: A Rolfer’s guide to
and illness (Rev. ed.). New York, NY: Bantam Books. release bodymindcore trauma. Philadelphia, PA: Jessica
Kaduson, H., & Schaefer, C. (Eds.). (1997). 101 favorite Kingsley.
play therapy techniques. New York, NY: Jason Karrasch, N. (2012). Freeing emotions and energy
Aronson. through myofacial release. Philadelphia, PA: Jessica
Kaetz, D. (2007). Making connections: Hasidic roots and Kingsley.
resonance in the teachings of Moshe Feldenkrais. Karuna Institute. (2013). Core process psychotherapy.
Metchosin, British Columbia, Canada: River Centre. Retrieved from http://www.karuna-institute.co.uk
Kagin, S. L., & Lusebrink, V. B. (1978). The expressive Kashdan, T. B., & Ciarrochi, J. (2013). Mindfulness,
therapies continuum. Art Psychotherapy, 5(4), acceptance, and positive psychology: The seven
171–180. foundations of well-being. Oakland, CA: New
Kahn, J. S. (2011). Feminist therapy for men: Challenging Harbinger.
assumptions and moving forward. Women & Therapy, Kasman, G. S., Cram, J. R., & Wolf, S. L. (1998). Clinical
34, 59–76. doi:10.1080/02703149.2011.532458 applications in surface electromyography: Chronic
Kahn, M. (1991). Between therapist and client: The new musculoskeletal pain. Gaitherburg, MD: Aspin.
relationship (Rev. ed.). New York, NY: Holt Kauff, P. F. (1997). Transference and regression in and
Paperbacks. beyond analytic group psychotherapy: Revisiting some
Kain, K. (1997). Ortho-bionomy: A practical manual. timeless thoughts. International Journal of Group
Berkeley, CA: North Atlantic Books. Psychotherapy, 47, 201–210.

Kauffman, K., & New, C. (2004). Co-counselling: Kennard, D., Roberts, J., & Winter, D. A. (Eds.). (1993).
The theory and practice of re-evaluation counseling. A work book of group-analytic interventions. London,
New York, NY: Brunner-Routledge. England: Routledge.
Kaufman, M. T. (2007, July 25). Albert Ellis, 93, Kenny, C. B. (Ed.). (1995). Listening, playing, creating:
influential psychotherapist, dies. New York Times. Essays on the power of sound. Albany: State
Retrieved from http://www.nytimes.com/2007/07/25/ University of New York Press.
nyregion/25ellis.html?ei=5088&en=fafd65d9cfba7311 Kepner, E. (1994). Gestalt group process. In B. Feder &
&ex=1343016000&partner=rssnyt&pagewanted=all R. Ronall (Eds.), Beyond the hot seat: Gestalt
Kazdin, A. E. (1978). History of behavior modification. approaches to group (pp. 1–10). New York, NY:
Baltimore, MD: University Park Press. Bruner/Mazel.
Kazdin, A. E. (2013). Behavior modification in applied Kernberg, O. F. (1975). Borderline conditions and
settings. Long Grove, IL: Waveland Press. pathological narcissism. New York, NY: Jason
Keegan, L. (2001). Healing with complementary and Aronson.
alternative therapies. Albany, NY: Delmar Thomson Kernberg, O. F. (1976). Object relations theory and
Learning. clinical psychoanalysis. New York, NY: Jason
Keeney, B. P. (1983). Aesthetics of change. New York, Aronson.
NY: Guilford Press. Kernberg, O. F. (1980). Internal world and external
Keeney, B. P. (1991). Improvisational therapy: A practical reality: Object relations theory applied. New York,
guide for creative clinical strategies. New York, NY: NY: Jason Aronson.
Guilford Press. Kernberg, O. F. (1984). Severe personality disorders:
Keeney, H., & Keeney, B. (2012). Circular therapeutics: Psychotherapeutic strategies. New Haven, CT: Yale
Giving therapy a healing heart. Phoenix, AZ: Zeig, University Press.
Tucker & Theisen. Kernberg, O. F. (1989). Psychodynamic psychotherapy of
Keeney, H., & Keeney, B. (2013). Creative therapeutic borderline patients. New York, NY: Basic Books.
technique: Skills for the art of bringing forth change. Kernberg, O. F. (2006). The pressing need to increase
Phoenix, AZ: Zeig, Tucker & Theisen. research in and on psychoanalysis. International
Keith, D. (in press). Process, practice, and magic: Journal of Psychoanalysis, 87, 919–926.
Continuing the experiential approach of Carl doi:10.1516/46N7-ULAM-DQKR-VGRT
Whitaker. Phoenix, AZ: Zeig, Tucker & Thiessen. Kernberg, O. F. (2012). The inseparable nature of love
Keith, D., Connell, G., & Connell, L. (2001). Defiance in and aggression: Clinical and theoretical perspectives
the family: Finding hope in therapy. Philadelphia, PA: (1st ed.). Washington, DC: American Psychiatric.
Brunner-Routledge. Kerr, M. E. (1999). Murray Bowen, Bowen theory, and the
Keith, D., & Whitaker, C. (1981). Play therapy: A family movement. Family Systems Forum, 1(2), 5–7.
paradigm for work with families. Journal of Marital Kerr, M. E., & Bowen, M. (1988). Family evaluation.
& Family Therapy, 7, 243–254. New York, NY: W. W. Norton.
doi:10.1111/j.1752-0606.1981.tb01376.x Kessler, R. C., Soukup, J., Davis, R. B., Foster, D. F.,
Keleman, S. (1985). Emotional anatomy. Berkley, CA: Wilkey, S. A., Van Rompay, M. I., & Eisenberg, E. M.
Center Press. (2001). The use of complementary and alternative
Kelley, C. (2004). Life force: The creative process in man therapies to treat anxiety and depression in the United
and in nature. Victoria, British Columbia, Canada: States. American Journal of Psychiatry, 158(2), 289–
Trafford. 294. doi:10.1176/appi.ajp.158.2.289
Kelly, G. A. (1955). The psychology of personal Kiesler, D. J. (1996). Contemporary interpersonal theory
constructs. New York, NY: W. W. Norton. and research: Personality, psychopathology, and
Kelly, G. A. (1991). The psychology of personal psychotherapy. New York, NY: Wiley.
constructs (2 vols.). New York, NY: W. W. Norton. Kiesler, D. J. (1999). Beyond the disease model of mental
(Original work published 1955) disorders. Westport, CT: Praeger.
Kelly, S. (2006). Cognitive-behavioral therapy with Kim, J. S. (2008). Examining the effectiveness of solution-
African Americans. In P. A. Hays & G. W. Iwamasa focused brief therapy: A meta-analysis. Research on
(Eds.), Culturally responsive cognitive-behavioral Social Work Practice, 18, 107–116.
therapy: Assessment, practice, and supervision (pp. doi:10.1177/1049731507307807
97–116). Washington, DC: American Psychological King, P., & Steiner, R. (Eds.). (1991). The Freud-Klein
Association. controversies: 1941-45. London, England: Routledge.

Kinsey, A. C., Pomeroy, W. B., & Martin, C. E. (1948). Klein, M. (1975). The collected writings of Melanie Klein
Sexual behavior in the human male. Philadelphia, PA: (4 vols.). London, England: Free Press.
W. B. Sanders. Klein, M. (1975). Psychoanalytic theory: An exploration
Kinsey, A. C., Pomeroy, W. B., Martin, C. E., & Gebhard, of essentials. New York, NY: International Universities
P. H. (1953). Sexual behavior in the human female. Press.
Philadelphia, PA: W. B. Sanders. Klerman, G., Weissman, M., Rounseville, B., & Chevron,
Kirchner, M. (2000). Overview of Gestalt Therapy E. (1984). Interpersonal psychotherapy of depression.
Theory. Gestalt e-Journal, 4(3). New York, NY: Basic Books.
Kirsch, D. L. (2002). The science behind cranial Klever, P. (2004). The multigenerational transmission of
electrotherapy stimulation (2nd ed.). Edmonton, nuclear family processes and symptoms. The American
Alberta, Canada: Medical Scope. Journal of Family Therapy, 32, 337–351. doi:10.1080/
Kirsch, D. L., & Gilula, M. F. (2007). CES in the 01926180490454962
treatment of anxiety disorders: A review and meta- Kline, W. B. (2003). Interactive group counseling and
analysis of cranial electrotherapy stimulation (CES) in therapy. Upper Saddle River, NJ: Merrill Prentice
the treatment of anxiety disorders. Practical Pain Hall.
Management, 7(4), 33–41. Klingberg, H. (2001). When life calls out to us: The love
Kirschenbaum, H. (1977). Advanced value clarification. and lifework of Viktor and Elly Frankl. New York,
La Jolla, CA: University Associates. NY: Doubleday.
Kirschenbaum, H. (1979). On becoming Carl Rogers. Knill, P., Levine, E., & Levine, S. (2004). Principles and
New York, NY: Delacorte Press. practice of expressive arts therapies: Toward a
Kirschenbaum, H. (2009). The life and work of Carl therapeutic aesthetics. Philadelphia, PA: Jessica
Rogers. Alexandria, VA: American Counseling Kingsley.
Association. Knittel, L. (2003). Inside-out bodywork. Yoga Journal.
Kirschenbaum, H. (2013). Values clarification in Retrieved from http://www.yogajournal.com/
counseling and psychotherapy: Practical strategies for health/1004
individual and group settings. New York, NY: Oxford Koerner, K. (2012). Doing dialectical behavior therapy: A
University Press. practical guide. New York, NY: Guilford Press.
Kirschenbaum, H., & Henderson, V. (Eds.). (1989). Carl Koerner, K., & Linehan, M. M. (2002). Dialectical
Rogers dialogues. Boston, MA: Houghton Mifflin. behavior therapy for borderline personality disorder.
Kirschenbaum, H., & Henderson, V. (Eds.). (1989). The In S. Hofmann & M. Tompson (Eds.), Treating
Carl Rogers reader. Boston, MA: Houghton Mifflin. chronic and severe mental disorders: A handbook of
Kirschenbaum, H., & Henderson, V. (1989). Introduction. empirically supported interventions (pp. 317–342).
In H. Kirschenbaum & V. Henderson (Eds.), The Carl New York, NY: Guilford Press.
Rogers reader (pp. xi–xvi). Boston, MA: Houghton Kohlenberg, R. J., & Tsai, M. (1987). Functional analytic
Mifflin. psychotherapy. In N. Jacobson (Ed.), Psychotherapists
Kirschenbaum, H., & Henderson, V. (1989). A more in clinical practice: Cognitive and behavioral
human world. In H. Kirschenbaum & V. Henderson perspectives (pp. 388–443). New York, NY: Guilford
(Eds.), The Carl Rogers reader (pp. 434–435). Boston, Press.
MA: Houghton Mifflin. Kohlenberg, R. J., & Tsai, M. (1991). Functional analytic
Kirschenbaum, H., & Henderson, V. (1989). A philosophy psychotherapy: Creating intense and curative
of persons. In H. Kirschenbaum & V. Henderson therapeutic relationships. New York, NY: Plenum
(Eds.), The Carl Rogers reader (pp. 398–401). Boston, Press.
MA: Houghton Mifflin. Kohut, H. (1959). Introspection, empathy and
Kirschenbaum, H., & Simon, S. B. (Eds.). (1973). psychoanalysis. Journal of the American
Readings in values clarification. Minneapolis, MN: Psychoanalytic Association, 7, 459–483.
Winston Press. doi:10.1177/000306515900700304
Kivlighan, D. M., Jr., & Kivlighan, D. M., III. (2014). Kohut, H. (1966). Forms and transformations of
Therapeutic factors: Current theory and research. In narcissism. Journal of the American Psychoanalytic
J. L. DeLucia-Waack, D. A. Gerrity, C. R. Kalodner, & Association, 14, 243–272.
M. T. Riva (Eds.), Handbook of group counseling and doi:10.1177/000306516601400201
psychotherapy (2nd ed., pp. 22–36). Thousand Oaks, Kohut, H. (1971). The analysis of the self. New York,
CA: Sage. NY: International Universities Press.

Kohut, H. (1972). Thoughts on narcissism and narcissistic Ashburn, VA: National Recreation and Park
rage. The Psychoanalytic Study of the Child, 27, 360– Association. Retrieved from www.nrpa.org/
400. uploadedFiles/nrpa.org/Publications_and_Research/
Kohut, H. (1977). The restoration of the self. New York, Research/Papers/MingKuo-Summary.PDF
NY: International Universities Press. Kurtz, L. F. (1997). Self-help and support groups.
Kohut, H. (1984). How does analysis cure? Chicago, IL: Thousand Oaks, CA: Sage.
University of Chicago Press. Kurtz, M. W., & Mueser, K. T. (2008). A meta-analysis of
Kolb, D. A., & Fry, R. (1975). Toward an applied theory controlled research on social skills training for
of experiential learning. In C. Cooper (Ed.), Theories schizophrenia. Journal of Consulting and Clinical
of group process (pp. 33–58). London, England: Wiley. Psychology, 76, 491–504. doi:10.1037/0022-
Koltko-Rivera, M. E. (2006). Rediscovering the later 006X.76.3.491
version of Maslow’s hierarchy of needs: Transcendence Kurtz, R. (1990). Body-centered psychotherapy: The
and opportunities for theory, research, and unification. Hakomi method. Mendicino, CA: LifeRhythm.
Review of General Psychology, 10, 302–317. L’Abate, L. (1991). The use of writing in psychotherapy.
doi:10.1037/1089-2680.10.4.302 American Journal of Psychotherapy, 45(1), 87–98.
Konipik, D. A., & Cheung, M. (2013). Psychodrama as a Laborda, M. A., McConnell, B. L., & Miller, R. R.
social work modality. Social Work, 58, 9–20. (2011). Behavioral techniques to reduce relapse after
doi:10.1093/sw/sws054 exposure therapy: Applications of studies of
Korzybski, A. (1990). Science and sanity. Concord, CA: experimental extinction. In T. R. Schachtman &
International Society for General Semantics. (Original S. Reilly (Eds.), Associative learning and conditioning
work published 1933) theory: Human and non-human applications (pp.
Kottman, T. (1995). Partners in play: An Adlerian 79–103). Oxford, England: Oxford University Press.
approach to play therapy. Alexandria, VA: American Lacan, J. (1947). British psychiatry and the war.
Counseling Association. Psychoanalytical Notebooks of the London Circle, 4,
Kottman, T. (2010). Play therapy: Basics and beyond (2nd 9–34.
ed.). Alexandria, VA: American Counseling Lacan, J. (2007). Écrits: The first complete edition in
Association. English (B. Fink, Ed.). New York, NY: W. W. Norton.
Kramer, R. (1995). The birth of client-centered therapy: Laing, R. D. (1961). Self and others. New York, NY:
Carl Rogers, Otto Rank, and “the beyond.” Journal of Routledge.
Humanistic Psychology, 35(4), 54–110. Laing, R. D. (1967). The politics of experience. New
doi:10.1177/00221678950354005 York, NY: Pantheon House.
Krampen, G. (1999). Long-term evaluation of the Laing, R. D. (1970). The divided self. Harmondsworth,
effectiveness of additional autogenic training in the England: Penguin. (Original work published 1959)
psychotherapy of depressive disorders. European Lake, F. (1980). Constricted confusion. Oxford, England:
Psychologist, 4(1), 11–18. doi:10.1027//1016- Clinical Theology Association.
9040.4.1.11 Lake, J. (2007). Textbook of integrative mental health
Krapp, K. (Ed.). (2005). Beck, Aaron Temkin. care. New York, NY: Thieme Medical.
Psychologists and their theories for students (Vol. 1, Lam, K. C., & Yu, Y. (2014). The qigong workbook for
pp. 67–91). Detroit, MI: Gale Cengage. anxiety: Powerful energy practices to rebalance your
Krisch, D., & Nichols, F. (2013). Cranial electrotherapy nervous system and free yourself from fear. Oakland,
stimulation for treatment of anxiety, depression, and CA: New Harbinger.
insomnia. Psychiatric Clinical, 36, 169–176. Lamagna, J. (2011). Of the self, by the self, and for the
doi:10.1016/j.psc.2013.01.006 self: An intra-relational perspective on intra-psychic
Krishna, G. (1970). Kundalini: The evolutionary energy in attunement and psychological change. Journal of
man. Boston, MA: Shambhala. Psychotherapy Integration, 21(3), 280–307.
Krishnamurti, J. (1969). Freedom from the known (M. doi:10.1037/a0025493
Lutyens, Ed.). New York, NY: Harper & Row. Lambert, M. J., & Bergin, A. E. (1994). The effectiveness
Kristeva, J. (1987). In the beginning was love: of psychotherapy. In A. E. Bergin & S. L. Garfield
Psychoanalysis and faith. New York, NY: Columbia (Eds.), Handbook of psychotherapy and behavior
University Press. change (4th ed., pp. 143–198). New York, NY: Wiley.
Kuo, F. E. (2010). Parks and other green environments: Lambert, M. J., & Ogles, B. (2004). The efficacy and
Essential components of a healthy human habitat. effectiveness of psychotherapy. In M. J. Lambert (Ed.),

Bergin and Garfield’s handbook of psychotherapy and principles (pp. 33–63). Washington, DC: American
behavior change (5th ed., pp. 139–193). New York, Psychological Association.
NY: Wiley. Lawley, J., & Tompkins, P. (2000). Metaphors in mind:
Lambert, M. J., & Miller, M. J. (2001). Helping Transformation through symbolic modeling: Highgate.
prospective patients avoid harmful psychotherapies. London, England: The Developing Company Press.
Journal of Contemporary Psychology, 46, 386–388. Lawrence, G. (2000). Forward. In E. Christopher &
doi:10.1037/002457 H. M. Solomon (Eds.), Jungian thought in the modern
Landgarten, H. B. (1981). Clinical art therapy: A world (pp. xii–xviii). New York, NY: Free Association
comprehensive guide. New York, NY: Brunner/Mazel. Books.
Landreth, G. (2002). Play therapy: The art of relationship. Lawson, G., & Myers, J. E. (2011). Wellness, professional
New York, NY: Taylor & Francis. quality of life, and career sustaining behaviors: What
Landreth, G. (2012). Play therapy: The art of the keeps us well? Journal of Counseling & Development,
relationship (3rd ed.). New York, NY: Routledge. 89, 163–171. doi:10.1002/j.1556-6678.2011.tb00074.x
Längle, A., & Sykes, B. (2006). Viktor Frankl—advocate Lawton, R. (2010). Pulsing: Get rhythm! Retrieved from
for humanity: On his 100th birthday. Journal of http://www.pulsing.org.uk/articles/rl002.html
Humanistic Psychology, 46(1), 36–47. Layng, T. V. J. (2009). The search for an effective clinical
doi:10.1177/0022167805281150 behavior analysis: The nonlinear thinking of Israel
Langlitz, N. (2013). Neuropsychedelia: The revival of Goldiamond. The Behavior Analyst, 32, 163–184.
hallucinogen research since the decade of the brain. Layous, K., Chancellor, J., & Lyubomirsky, S. (2014).
Berkeley: University of California Press. Positive activities as protective factors against mental
Lanius, U., Paulsen, S. L., & Corrigan, F. (2014). The health conditions. Journal of Abnormal Psychology,
neurobiology and treatment of traumatic dissociation: 123, 3–12. doi:10.1037/a0034709
Toward an embodied self. New York, NY: Springer. Lazarus, A. A. (1958). New methods in psychotherapy: A
Lankton, S., & Lankton, C. (2008). The answer within: A case study. South African Medical Journal, 32, 660–664.
clinical framework of Ericksonian hypnotherapy. Bethel, Lazarus, A. A. (1971). Behavior therapy and beyond.
CT: Crown House. (Original work published 1983) New York, NY: Springer.
Lankton, S. R., Lankton, C. H., & Erickson, M. H. Lazarus, A. A. (1976). Multimodal behavior therapy.
(1986). Enchantment and intervention in family New York, NY: Springer.
therapy: Training in Ericksonian approaches. Lazarus, A. A. (1981). The practice of multimodal
Trowbridge, England: Crown House. therapy. New York, NY: McGraw-Hill. (Updated ed.,
Laplanche, J., & Pointalis, J. B. (1973). The language of 1989, Johns Hopkins University Press.)
psychoanalysis. London, England: Karnac Books. Lazarus, A. A. (1986). Multimodal therapy. In U. C.
Lappin, J. (1988). Family therapy: A structural approach. Norcross (Ed.), Handbook of eclectic psychotherapy
In R. Dorfman (Ed.), Paradigms of clinical social work (pp. 65–93). New York, NY: Brunner/Mazel.
(pp. 220–252). New York, NY: Brunner/Mazel. Lazarus, A. A. (1989). The practice of multimodal therapy.
Larre, C., Rochat de la Vallee, S. J., Rochat de la Vallee, Baltimore, MD: Johns Hopkins University Press.
E., & Stang, S. (1995). Rooted in spirit: The heart of Lazarus, A. A. (1992). Multimodal therapy: Technical
Chinese medicine, a sinological interpretation of eclecticism with minimal integration. In J. C. Norcross
chapter eight of Huangdi Neijing Lingshu (S. Strang, & M. R. Goldfried (Eds.), Handbook of
Trans.) New York, NY: Sttion Hill Press. psychotherapy integration (pp. 231–263). New York,
Larsen, S. (2012). The neurofeedback solution: How to NY: Basic Books.
treat autism, ADHD, anxiety, brain injury, stroke, Lazarus, A. A. (1993). Tailoring the therapeutic
PTSD and more. Rochester, VT: Healing Arts Press. relationship or being an authentic chameleon.
Larson, R., & Larson, D. (1976). Values and faith: Value- Psychotherapy, 30, 404–407. doi:10.1037/0033-
clarifying exercises for family and church groups. 3204.30.3.404
Minneapolis, MN: Winston Press. Lazarus, A. A. (1995). Different types of eclecticism and
Latner, J. (1992). The theory of Gestalt therapy. In E. C. integration: Let’s be aware of the dangers. Journal of
Nevis (Ed.), Gestalt therapy: Perspectives and Psychotherapy Integration, 5(1), 27–39.
applications (pp. 13–56). New York, NY: Gardner Press. Lazarus, A. A. (1996). The utility and futility of
Lattal, K. A. (2012). The five pillars of the experimental combining treatments in psychotherapy. Clinical
analysis of behavior. In G. J. Madden (Ed.), APA Psychology: Science and Practice, 3(1), 59–68.
handbook of behavior analysis: Vol. 1. Methods and doi:10.1111/j.1468-2850.1996.tb00058.x

Lazarus, A. A. (1997). Brief but comprehensive Le Bon, G. (1920). The crowd: A study of the popular
psychotherapy: The multimodal way. New York, NY: mind. London, England: Ernest Benn. (Original work
Springer. published 1895)
Lazarus, A. A. (1997). Brief, focused, solution-oriented, Lee, B. K. (2002). Congruence in Satir’s model: Its
and yet comprehensive? In J. K. Zeig (Ed.), The spiritual and religious significance. Contemporary
evolution of psychotherapy: The third conference Family Therapy, 24(1), 57–78.
(pp. 83–89). New York, NY: Brunner/Mazel. doi:10.1023/A:1014321621829
Lazarus, A. A. (2002). The multimodal assessment Lee, C. C. (1994). Pioneers of multicultural counseling: A
therapy approach. In F. Kaslow (Ed.), Comprehensive conversation with Clemmont E. Vontress. Journal of
handbook of psychotherapy (Vol. 4, pp. 241–254). Multicultural Counseling and Development, 22(2),
New York, NY: Wiley. 66–78. doi:10.1002/j.2161-1912.1994.tb00245.x
Lazarus, A. A. (2008). Multimodal therapy. In R. J. Lee, C. W., & Cuijpers, P. (2013). A meta-analysis of the
Corsini & D. Wedding (Eds.), Current psychotherapies contribution of eye movements in processing
(8th ed., pp. 368–401). Belmont, CA: Brooks/Cole. emotional memories. Journal of Behavioral Therapy
Lazarus, A. A., & Beutler, L. E. (1993). On technical and Experimental Psychiatry, 22, 231–239.
eclecticism. Journal of Counseling & Development, doi:10.1016/j.jbtep.2012.11.001
71(4), 381–385. doi:10.1002/j.1556-6676.1993. Lee, M. Y. (1997). A study of solution-focused brief
tb02652.x family therapy: Outcomes and issues. American
Lazarus, A. A., Beutler, L. E., & Norcross, J. C. (1992). Journal of Family Therapy, 25, 3–17.
The future of technical eclecticism. Psychotherapy, 29, doi:10.1080/01926189708251050
11–20. doi:10.1037/0033-3204.29.1.11 Lehrer, P. M., Vaschillo, E., & Vaschillo, B. (2000).
Lazarus, A. A., & Lazarus, C. N. (1991). Multimodal Life Resonant frequency biofeedback training to increase
History Inventory. Champaign, IL: Research Press. cardiac variability: Rationale and manual for training.
Lazarus, A. A., & Lazarus, C. N. (1998). Clinical Applied Psychophysiology and Biofeedback, 25(3),
purposes of the Multimodal Life History Inventory. In 177–191.
G. P. Koocher, J. C. Norcross, & S. S. Hill (Eds.), Lehrer, P. M., Woolfolk, R. L., & Sime, W. E. (Eds.).
Psychologists’ desk reference (pp. 15–22). New York, (2007). Principles and practice of stress management
NY: Oxford University Press. (3rd ed.). New York, NY: Guilford Press.
Lazarus, A. A., & Messer, S. B. (1991). Does chaos Leiby, J. (1978). A history of social welfare and social
prevail? An exchange on technical eclecticism and work in the United States. New York, NY: Columbia
assimilative integration. Journal of Psychotherapy University Press.
Integration, 1, 143–158. Leichsenring, F. (2005). Are psychodynamic and
Lazarus, A. A., & Rego, S. A. (2013). What really matters: psychoanalytic therapies effective? A review of
Learning from, not being limited by, empirically empirical data. International Journal of Psychoanalysis,
supported treatments. The Behavior Therapist, 16(3), 36(3), 841–868. doi:10.1516/rfee-lkpn-b7tf-kpdu
67–69. Leman, K. (1998). The birth order book: Why you are the
Lazarus, A. A., & Zur, O. (2002). Dual relationships and way you are. Grand Rapids, MI: Revell.
psychotherapy. New York, NY: Springer. Lennon, B. (2000). From “reality therapy” to “reality
Lazarus, C. N. (1991). Conventional diagnostic therapy in action.” The International Journal of
nomenclature versus multimodal assessment. Reality Therapy, 20(1), 41–46.
Psychological Reports, 68, 1363–1367. doi:10.2466/ Lessem, P. (2005). Self psychology: An introduction.
pr0.1991.68.3c.1363 Lanham, MD: Jason Aronson.
Leah, M. M., & Sullivan, A. (2001). The intersection of Leszcz, M., & Goodwin, P. (1998). The rationale and
race, class, and gender on diagnosis. In D. B. Pope- foundations of group psychotherapy for women with
Davis & H. K. Coleman (Eds.), The intersection of metastatic breast cancer. International Journal of
race, class, and gender in multicultural counseling Group Psychotherapy, 48, 245–273.
(pp. 353–384). Thousand Oaks, CA: Sage. Leszcz, M., & Spiegel, D. (2009). Group psychotherapy
Leahy, R. L. (2003). Cognitive therapy techniques: A and the terminally ill. In H. M. Chochinov &
practitioner’s guide. New York, NY: Guilford Press. W. Breitbart (Eds.), Handbook of psychiatry in
Leary, T. F. (1957). Interpersonal diagnosis of personality. palliative medicine (pp. 490–503). Oxford, England:
New York, NY: Ronald. Oxford University Press.

Lethem, J. (2003). Using solution-focused therapy with T. Nexworski (Eds.), Clinical implications of attachment
women. In B. O’Connell & S. Palmer (Eds.), (pp. 327–351). Hillsdale, NJ: Lawrence Erlbaum.
Handbook of solution-focused therapy (pp. 118–128). Lieberman, M. A., Yalom, I., & Miles, M. (1973).
Thousand Oaks, CA: Sage. Encounter groups: First facts. New York, NY: Basic
Leuzinger-Bohleber, M., & Target, M. (2002). Books.
Introductory remarks. In M. Leuzinger-Bohleber & M. Lilienfeld, S. O. (2007). Psychological treatments that
Target (Eds.), Outcomes of psychoanalytic treatment: cause harm. Perspectives on Psychological Science, 2,
Perspectives for therapists and researchers (pp. 1–15). 53–70. doi:10.1111/j.1745-6916.2007.00029.x
New York, NY: Brunner-Routledge. Lilienfeld, S. O., Fowler, K. A., Lohr, J. M., & Lynn, S. J.
Levine, P. A. (1996). Waking the tiger, healing trauma. (2005). Pseudoscience, nonscience, and nonsense in
Berkeley, CA: North Atlantic Books. clinical psychology: Dangers and remedies. In R. H.
Levine, P. A. (2010). In an unspoken voice: How the body Wright & N. A. Cummings (Eds.), Destructive trends
releases trauma and restores goodness. Berkeley, CA: in mental health: The well-intentioned path to harm
North Atlantic Books. (pp. 187–218). New York, NY: Routledge.
Levis, D. J., & Krantweiss, A. R. (2003). Working with Linden, W. (1990). Autogenic training: A clinical guide.
implosive (flooding) therapy: A dynamic cognitive- New York, NY: Guilford Press.
behavioral exposure psychotherapy treatment Linehan, M. M. (1987). Dialectical behavior therapy for
approach. In W. O’Donohue, U. J. Fisher, & S. C. borderline personality disorder: Theory and method.
Hayes (Eds.), Cognitive behavior therapy: Applying Bulletin of the Menninger Clinic, 51, 261–276.
empirically supported techniques in your practice Linehan, M. M. (1993). Cognitive-behavioral treatment
(pp. 463–470). Hoboken, NJ: Wiley. of borderline personality disorder. New York, NY:
Levitzky, A., & Perls, F. S. (1970). The rules and games of Guilford Press.
Gestalt therapy. In J. Fagan & I. L. Shepherd (Eds.), Linehan, M. M. (1993). Skills training manual for treating
Gestalt therapy now (pp. 140–149). New York, NY: borderline personality disorder. New York, NY:
Harper & Row. Guilford Press.
Lewes, K. (1988). The psychoanalytic theory of male Linehan, M. M. (1997). Validation and psychotherapy. In
homosexuality. New York, NY: Simon & Schuster. A. Bohart & L. Greenberg (Eds.), Empathy reconsidered:
Lewin, J. L. N. (1998). Dance therapy notebook. New directions in psychotherapy (pp. 353–392).
Columbia, MD: Marian Chace Memorial Fund of the Washington, DC: American Psychological Association.
American Dance Therapy Association. Lionells, M., Fiscalini, J., Mann, C. H., & Stern, D. B.
Lewin, K. (1951). Field theory in social science. New (1995). Handbook of interpersonal psychoanalysis.
York, NY: Harper. Hillsdale, NJ: The Analytic Press.
Lewis, R. E. (2003). Brief theories. In D. Capuzzi, & Lipchik, E., Derks, J., Lacourt, M., & Nunnaly, E. (2012).
D. R. Gross (Eds.), Theories of psychotherapy The evolution of solution-focused brief therapy. In
(pp. 286–310). Upper Saddle River, NJ: Pearson. C. Franklin, T. Trepper, W. J. Gingerich, & E. E.
Lewis, T. F., & Myers, J. E. (2010). Wellness factors as McCollum (Eds.), Solution-focused brief therapy: A
predictors of alcohol use among undergraduates: handbook of evidenced-based practice (pp. 3–19).
Implications for prevention and intervention. Journal New York, NY: Oxford University Press.
of College Counseling, 13(2), 111–125. Lipke, H. (2000). EMDR and psychotherapy integration:
doi:10.1002/j.2161-1882.2010.tb00053.x Theoretical and clinical suggestions with focus on
Li, S. T., Jenkins, S., & Sundsmo, A. (2007). Impact of traumatic stress. New York, NY: CRC Press.
race and ethnicity on the expression, assessment, Lipman, L. (2003). The triadic system: Sociometry,
and diagnosis of psychopathology. In M. Hersen, psychodrama, and group psychotherapy. In
S. M. Turner, & D. C. Beidel (Eds.), Adult J. Gerhsoni (Ed.), Psychodrama in the 21st century:
psychopathology and diagnosis (pp. 101–121). Clinical and education applications (pp. 3–14).
Hoboken, NJ: Wiley. New York, NY: Springer.
Library of Congress. (2001). Freud: Conflict and culture Lipton, B., & Fosha, D. (2011). Attachment as a
(Section 3: From the individual to society). Retrieved transformative process in AEDP: Operationalizing the
from http://www.loc.gov/exhibits/freud/freud03.html intersection of attachment theory and affective
Lieberman, A. F., & Pawl, J. H. (1988). Clinical neuroscience. Journal of Psychotherapy Integration,
applications of attachment theory. In J. Belsky & 21(3), 253–279. doi:10.1037/a0025421

Little, S. G. (2003). Classroom management. In directions of EMDR. Journal of EMDR Practice and
W. O’Donohue, U. J. Fisher, & S. C. Hayes (Eds.), Research, 3, 217–231. doi:10.1891/1933-
Cognitive behavior therapy: Applying empirically 3196.3.4.217
supported techniques in your practice (pp. 64–70). Luborsky, L., Crits-Christoph, P., Mintz, J., & Auerbach,
Hoboken, NJ: Wiley. A. (1988). Who will benefit from psychotherapy?
Litwack, L. (2007). Research review: Dissertations on Predicting therapeutic outcomes. New York, NY: Basic
reality therapy and choice theory—1970–2007. Books.
International Journal of Reality Therapy, 27(1), 14–16. Luepnitz, D. (2002). Schopenhauer’s porcupines: Intimacy
Lloyd, D., & Rossi, E. (Eds.). (1992). Ultradian rhythms and its dilemmas. New York, NY: Basic Books.
in life processes: A fundamental inquiry into Lukas, E., & Hirsch, B. Z. (2002). Logotherapy. In
chronobiology and psychobiology. New York, NY: F. W. Kaslow, R. F. Massey, & S. D. Massey (Eds.),
Springer-Verlag. Comprehensive handbook of psychotherapy:
Lloyd, D., & Rossi, E. (Eds.). (2008). Ultradian rhythms Interpersonal/humanistic/existential (Vol. 3,
from molecule to mind: A new vision of life. pp. 333–356). New York, NY: Wiley.
New York, NY: Springer. Luoma, J. B., Hayes, S. C., & Walser, R. D. (2007).
Loftus, E., & Ketcham, K. (1994). The myth of repressed Learning ACT: An acceptance and commitment
memory: False memories and allegations of sexual therapy skills-training manual for therapists. Oakland,
abuse. New York, NY: St. Martin’s Press. CA: New Harbinger.
Loizzo, J. (2000). Mediation and psychotherapy: Stress, Luquet, W. (2007). Short-term couples therapy: The
allostasis and enriched learning. In P. Muskin (Ed.), Imago model in action (2nd ed.). New York, NY:
Complementary and alternative medicine and Routledge.
psychiatry (pp. 147–198). Washington, DC: American Luyten, P., & Blatt, S. J. (2013). Interpersonal relatedness
Psychiatric Press. and self-definition in normal and disrupted personality
Lojk, L. (1986). My experiences using reality therapy. development: Retrospect and prospect. American
Journal of Reality Therapy, 5(2), 28–35. Psychologist, 68, 172–183. doi:10.1037/a0032243
Long, S., Hollander, M., & Kazaoka, K. (1988). Six group Lynch, T. R., Chapman, A. L., Rosenthal, M. Z., Kuo, J. R., &
therapies: Behavior therapy group. New York, NY: Linehan, M. M. (2006). Mechanisms of change in
Plenum Press. dialectical behavior therapy: Theoretical and empirical
Loriedo, C. (2008). Systemic trances. Using hypnosis in observations. Journal of Clinical Psychology, 64, 459–480.
family therapy. The American Association for doi:10.1002/jclp.20243
Marriage and Family Therapy, Family Therapy Lynn, S. J., Lock, T., Loftus, E., Krackow, E., & Lilienfeld,
Magazine, 7(4), 27–30. Retrieved from http://www S. O. (2003). The remembrance of things past:
.familytherapyresources.net/cgi-shl/twserver. Problematic memory recovery techniques in
exe?run:FTRUPD_2:TradeWinds_KEY=142 psychotherapy. In S. O. Lilienfeld, S. J. Lynn, &
Loriedo, C., & Torti, M. C. (2010). Systemic hypnosis J. M. Lohr (Eds.), Science and pseudoscience in clinical
with depressed individuals and their families. psychology (pp. 205–239). New York, NY: Guilford
International Journal of Clinical and Experimental Press.
Hypnosis, Special issue: Hypnosis and Treating Lynn, S. J., Rue, J. W., & Kirsch, I. (Eds.). (2010).
Depression, 58(2), 222–246. Handbook of clinical hypnosis (2nd ed.). Washington,
doi:10.1080/00207140903523277 DC: American Psychological Association.
Louv, R. (2012). The nature principle: Human restoration Lyubomirsky, S. (2013). The myths of happiness.
and the end of nature-deficit disorder. Chapel Hill, New York, NY: Penguin Press HC.
NC: Algonquin Books. Ma, S. H., & Teasdale, J. D. (2004). Mindfulness-based
Lowen, A. (1958). The language of the body. New York, cognitive therapy for depression: Replication and
NY: Macmillan. exploration of differential relapse prevention effects.
Lowen, A. (1975). Bioenergetics. New York, NY: Journal of Consulting and Clinical Psychology, 72,
Coward, McCann, & Geoghegan. 31–40. doi:10.1037/0022-006X.72.1.31
Lowen, A. (1994). Bioenergetics. New York, NY: Penguin. MacDonald, A. J. (1994). Brief therapy in adult
Lowenstein, L. F. (2010). Attachment theory and parental psychiatry. Journal of Family Therapy, 16, 415–426.
alienation. Journal of Divorce & Remarriage, 51(3), doi:10.1111/1467-6427.00048
157–168. doi:10.1080/10502551003597808 Machtiger, H. G. (1982). Countertransference/
Luber, M., & Shapiro, F. (2009). Interview with Francine transference. In M. Stein (Ed.), Jungian analysis
Shapiro: Historical overview, present issues, and future (pp. 86–110). La Salle, IL: Open Court.

Maciocia, G. (2009). The psyche in Chinese medicine. help seeking: Implications for practice and training.
Edinburgh, Scotland: Churchill Livingstone. Professional Psychology: Research and Practice, 34(2),
MacIsaac, S. (1974). Freud and original sin. New York, 123–131. doi:10.1037/0735-7028.34.2.123
NY: Paulist Press. Maher, B. (Ed.). (1969). Clinical psychology and
Mackenzie, K. R. (1992). Classics in group personality: The selected papers of George Kelly.
psychotherapy. New York, NY: Guilford Press. New York, NY: Krieger.
Mackinnon, R., Michels, R., & Buckley, P. (2006). The Mahler, M. S. (1952). On child psychosis and
psychiatric interview in clinical practice (2nd ed.) schizophrenia: Autistic and symbiotic infantile
Washington, DC: American Psychiatric Publishing. psychosis. In R. S. Eissler, A. Freud, H. Hartmann, &
MacLeod, R., Elliott, R., & Rodgers, B. (2012). Process- E. Kris (Eds.), The psychoanalytic study of the child
experiential/emotion-focused therapy for social (Vol. 7, pp. 286–305). New York, NY: International
anxiety: A hermeneutic single case efficacy design. Universities Press.
Psychotherapy Research, 22, 67–81. doi:10.1080/1050 Mahler, M. S. (1968). On human symbiosis and the
3307.2011.626805 vicissitudes of individuation (Vol. I: Infantile psychosis).
Madanes, C. (1981). Strategic family therapy. San New York, NY: International Universities Press.
Francisco, CA: Jossey-Bass. Mahler, M. S., Pine, F., & Bergman, A. (1975). The
Madanes, C. (1984). Behind the one-way mirror: psychological birth of the human infant. New York,
Advances in the practice of strategic therapy. San NY: Basic Books.
Francisco, CA: Jossey-Bass. Mahler, M. S., Pine, F., & Bergman, A. (2000). The
Madanes, C. (1990). Sex, love, and violence: Strategies for psychological birth of the human infant: Symbiosis
transformation. New York, NY: W. W. Norton. and individuation. New York, NY: Basic Books.
Madanes, C. (1994). The secret meaning of money. (Original work published 1975)
San Francisco, CA: Jossey-Bass. Mahoney, M. J. (1974). Cognition and behavior
Madanes, C. (1995). The violence of men. San Francisco, modification. Cambridge, MA: Ballinger.
CA: Jossey-Bass. Mahoney, M. J. (1991). Human change processes: The
Madanes, C. (2006). The therapist as humanist, social scientific foundations of psychotherapy. New York,
activist and systemic thinker . . . and other selected NY: Basic Books.
papers. Phoenix, AZ: Zeig, Tucker & Theisen. Mahoney, M. J. (Ed.). (1995). Cognitive and constructive
Madanes, C. (2009). Relationship breakthrough. New psychotherapies: Theory, research, and practice.
York, NY: Rodale. New York, NY: Springer.
Madigan, S. (2011). Narrative therapy. Washington, DC: Mahoney, M. J. (1995). Theoretical developments in the
American Psychological Association. cognitive and constructive psychotherapies. In M. J.
Madigan, S. (2011). Narrative therapy: Theory and practice. Mahoney (Ed.), Cognitive and constructive
New York, NY: American Psychological Association psychotherapies: Theory, research, and practice (pp.
Press. 3–19). New York, NY: Springer.
Madigan, S., & Epston, D. (1995). From “spy-chiatric gaze” Mahoney, M. J. (2000). Behaviorism, cognitivism, and
to communities of concern: From professional constructivism: Reflections on persons and patterns in
monologue to dialogue. In S. Friedman (Ed.), The my intellectual development. In M. R. Goldfried (Ed.),
reflecting team in action: Collaborative practice in family How therapists change: Personal and professional
therapy (pp. 257–276). New York, NY: Guilford Press. reflections (pp. 183–200). Washington, DC: American
Madison, G. (Ed.). (2014). Theory and practice of Psychological Association.
focusing oriented psychotherapy. London, England: Mahoney, M. J. (2003). Constructive psychotherapy: A
Jessica Kingsley. practical guide. New York, NY: Guilford Press.
Madsen, W. C. (2007). Collaborative therapy with multi- Mahoney, M. J. (2004). Scientist as subject: The
stressed families. New York, NY: Guilford Press. psychological imperative. Clinton Corners, NY:
Magnavita, J. J., & Anchin, J. C. (2014). Unifying Percheron Press. (Original work published 1976)
psychotherapy: Principles, methods, and evidence from Mahoney, M. J. (2005). Suffering, philosophy, and
clinical science. New York, NY: Springer. psychotherapy. Journal of Psychotherapy Integration,
Mahalik, J. R. (1990). Systematic eclectic models. The 15, 337–352. doi:10.1037/1053-0479.15.3.337
Counseling Psychologist, 18(4), 655–679. Mahoney, M. J., & Marquis, A. (2002). Integral
doi:10.1177/0011000090184007 constructivism and dynamic systems in psychotherapy
Mahalik, J. R., Good, G. E., & Englar-Carlson, M. processes. Psychoanalytic Inquiry, 22(5), 794–813.
(2003). Masculinity scripts, presenting concerns, and doi:10.1080/07351692209349018

Mahoney, M. J., Miller, H. M., & Arciero, G. (1995). Marcotte, C., & Bilodeau, S. (2007). Reality therapy and
Constructive metatheory and the nature of mental choice theory in group homes project: A research
representation. In M. J. Mahoney (Ed.), Cognitive and report. International Journal of Choice Theory, 2(1),
constructive psychotherapies: Theory, research, and 16–18.
practice (pp. 195–208). New York, NY: Springer. Marcus, S., Marquis, P., & Sakai, C. (1997). Controlled
Maines, R. P. (2001). The technology of orgasm. study of treatment of PTSD using EMDR in an HMO
Baltimore, MD: The Johns Hopkins University Press. setting. Psychotherapy, 34, 307–315. doi:10.1037/
Makari, G. (2008). Revolution in mind. New York, NY: h0087791
HarperCollins. Marineau, R. F. (2007). The birth and development of
Makinson, R. A., & Young, J. S. (2012). Cognitive sociometry: The work and legacy of Jacob Moreno
behavioral therapy and the treatment of posttraumatic (1889-1974). Social Psychology Quarterly, 70, 322–
stress disorder: Where counseling and neuroscience 325. doi:10.1177/019027250707000402
meet. Journal of Counseling & Development, 90(2), Marlan, S. (Ed.). (2008). Archetypal psychologies.
131–140. doi:10.1111/j.1556-6676.2012.00017.x New Orleans, LA: Spring Journal Books.
Malchiodi, C. A. (1998). The art therapy sourcebook. Los Marmarosh, C. L., Markin, R. D., & Spiegel, E. B. (2013).
Angeles, CA: Lowell House. Attachment in group psychotherapy. Washington, DC:
Malchiodi, C., & Crenshaw, D. A. (Eds.). (2014). Creative American Psychological Association.
arts and play therapy for attachment problems. New Maroda, K. (1998). Seduction, surrender, and
York, NY: Guilford Press. transformation: Emotional engagement in the analytic
Malcolm, J. (1981). Psychoanalysis: The impossible process. New York, NY: Psychology Press.
profession. New York, NY: Vintage Books. Maroda, K. J. (2010). Psychodynamic techniques:
Malone, K., Malone, T., Kuckleburg, R., Cox, R., Barnett, Working with emotion in the therapeutic relationship.
J., & Barstow, D. (1982). Experiential psychotherapy. New York, NY: Guilford Press.
Pilgrimage, 10(1), 1–63. Marquis, A. (2008). The integral intake: A guide to
Malyon, A. K. (1982). Psychotherapeutic implications of comprehensive idiographic assessment in integral
internalized homophobia in gay men. In J. C. psychotherapy. New York, NY: Routledge.
Gonsiorek (Ed.), Homosexuality and psychotherapy: A Marquis, A. (2008). Michael J. Mahoney: A constructive
practitioner’s handbook of affirmative models (pp. heart and the heart of constructivism. Constructivism
59–69). New York, NY: Haworth Press. in the Human Sciences, 12(1), 119–141.
Mamtani, R., & Cimino, A. (2002). A primer of Marquis, A. (2009). An integral taxonomy of therapeutic
complementary and alternative medicine and its interventions. Journal of Integral Theory and Practice,
relevance in the treatment of mental health problems. 4(2), 13–42.
Psychiatric Quarterly, 73(4), 367–381. Marquis, A. (2013). Methodological considerations of
Manaster, G. J., Painter, G., Deutsch, D., & Overholt, B. J. studying a unified approach to psychotherapy: Integral
(Eds.). (1977). Alfred Adler: As we remember him. methodological pluralism. Journal of Unified
Chicago, IL: North American Society of Adlerian Psychotherapy and Clinical Science, 2(1), 45–73.
Psychology. Marquis, A., Warren, E. S., & Arnkoff, D. B. (2009).
Manning, J. (2007). The use of meridian-based therapy Michael J. Mahoney: A Retrospective. Journal of
for anxiety and phobias. Australian Journal of Clinical Psychotherapy Integration, 19, 402–418. doi:10.1037/
Hypnotherapy & Hypnosis, 28(2), 45–50. a0017971
Mansell, W., Carey, T. A., & Tai, S. J. (2012). A Marquis, A., & Wilber, K. (2008). Unification beyond
transdiagnostic approach to CBT using method of eclecticism and integration: Integral psychotherapy.
levels therapy: Distinctive features. London, England: Journal of Psychotherapy Integration, 18(3), 350–358.
Routledge. doi:10.1037/a0013560
Manzoni, G., Pagnini, F., Castelnuovo, G., & Molinari, E. Martell, C. R., Dimidjian, S., & Herman-Dunn, R.
(2008). Relaxation training for anxiety: A ten-years (2010). Behavioral activation for depression: A
systematic review with meta-analysis. BMC Psychiatry, clinician’s guide. New York, NY: Guilford Press.
8(41), 1–12. doi:10.1186/1471-244X-8-41 Maslow, A. H. (1943). A theory of human motivation.
Maratos, J. (Ed.). (2014). Group analysis for the 21st Psychological Review, 50, 370–396. doi:10.1037/
century: A book of foundational readings. London, h0054346
England: Karnac Books. Maslow, A. H. (1954). Motivation and personality.
Marcia, J. E. (1966). Development and validation of ego- New York, NY: HarperCollins.
identity status. Journal of Personality and Social Maslow, A. H. (1962). Toward a psychology of being.
Psychology, 3, 551–558. doi:10.1037/h0023281 New York, NY: Van Nostrand.

Maslow, A. H. (1962). Was Adler a disciple of Freud: A McCraty, R., Atkinson, M., & Tomasino, D. (2001).
note. Journal of Individual Psychology, 18, 125. Science of the heart: Exploring the role of the heart in
Maslow, A. H. (1968). Toward a psychology of being human performance. Boulder Creek, CA: Institute of
(2nd ed.). New York, NY: Van Nostrand Reinhold. HeartMath, HeartMath Research Center.
Maslow, A. H. (1970). Motivation and personality McCraty, R., Atkinson, M., Tomasino, D., & Bradley, R. T.
(2nd ed.). New York, NY: Harper & Row. (2009). The coherent heart: Heart-brain interactions,
Maslow, A. H. (1970). Religions, values, and peak psychophysiological coherence, and the emergence of
experiences. New York, NY: Penguin. system-wide order. Integral Review, 5(2), 10–115.
Maslow, A. H. (1971). The farther reaches of human McCraty, R., & Childre, D. (2010). Coherence:
nature. New York, NY: Viking Press. Bridging personal, social and global health.
Masson, J. M. (Ed.). (1985). The complete letters of Alternative Therapies in Health and Medicine,
Sigmund Freud to Wilhelm Fliess: 1887–1904 16(4), 10–24.
(J. M. Masson, Trans.). Cambridge, MA: Belknap McCraty, R., & Tomasino, D. (2006). Emotional stress,
Press of Harvard University Press. positive emotions, and psychophysiological coherence.
Masson, J. M. (2003). The assault on truth: Freud’s In B. B. Arnetz & R. Ekman (Eds.), Stress in health
suppression of the seduction theory. New York, NY: and disease (pp. 342–365). Weinheim, Germany:
Ballantine Books. Wiley-VCH.
Matson, J. L. (Ed.). (2012). Functional assessment for McCready, K. F. (2002). Creating an empathic
challenging behavior. New York, NY: Springer. environment at the San Joaquin Psychotherapy Center.
Maultsby, M. C., & Ellis, A. (1974). Techniques for using In P. Breggin, G. Breggin, & F. Bemak (Eds.),
rational-emotive imagery. New York, NY: Institute for Dimensions of empathic therapy (pp. 67–78). New
Rational-Emotive Therapy. York, NY: Springer.
May, R. (1967). Psychology and the human dilemma. McCullough, J. P. (2000). Treatment for chronic
New York, NY: W. W. Norton. depression: Cognitive behavioral analysis system of
May, R. (1969). Existential psychology. New York, NY: psychotherapy. New York, NY: Guilford Press.
Random House. McCurdy, A. (1982). Establishing and maintaining the
May, R. (1969). Love and will. New York, NY: analytical structure. In M. Stein (Ed.), Jungian analysis
W. W. Norton. (pp. 47–67). La Salle, IL: Open Court.
May, R. (1972). Power and innocence: A search for the McFarlane, W. (2002). Multifamily groups in the
sources of violence. New York, NY: W. W. Norton. treatment of severe psychiatric disorders. New York,
May, R. (1975). The courage to create. New York, NY: NY: Guilford Press.
Bantam Books. McGoldrick, M. (2005). History, genograms, and the
May, R. (1977). The meaning of anxiety (Rev. ed.). New family life cycle: Freud in context. In B. Carter &
York, NY: W. W. Norton. (Original work published 1950) M. McGoldrick (Eds.), The expanded family life cycle:
May, R. (1980). Psychology and the human dilemma. Individual, family, and social perspectives (3rd ed.,
New York, NY: W. W. Norton. pp. 47–68). Boston, MA: Allyn & Bacon.
May, R. (1986). The discovery of being: Writings in McGoldrick, M., Giordano, J., & Garcia-Preto, N.
existential psychology. New York, NY: W. W. Norton. (2005). Ethnicity and family therapy (3rd ed.).
(Original work published 1946) New York, NY: Guilford Press.
May, R. (1991). The cry for myth. New York, NY: McKenzie, N., & Showell, J. (1998). Living fully: An
W. W. Norton. introduction to Radix body-centred personal growth
May, R., Angel, E., & Ellenberg, H. F. (Eds.). (1958). work. Adelaide, South Australia, Australia:
Existence: A new dimension in psychiatry and Centreprint.
psychology. New York, NY: Basic Books. McLaughlin, L. E. (2006). The pros and cons of viewing
Mazza, N. (2003). Poetry therapy: Theory and practice. formal diagnosis from a social constructionist
New York, NY: Brunner-Routledge. perspective. Journal of Humanistic Counseling,
Mazza, N. (2004). Poetry therapy: Theory and practice. Education and Development, 45(2), 165–173.
London, England: Routledge. doi:10.1002/j.2161-1939.2006.tb00015.x
McClung, C., & Hoglund, R. (2013). A Glasser quality McLaughlin, N. (2000). Revisions from the margins:
school leads to choosing excellence. International Journal Fromm’s contributions to psychoanalysis.
of Choice Theory and Reality Therapy, 32(2), 54–64. International Forum of Psychoanalysis, 9, 241–247.
McCormick, E. (2012). Change for the better: Self help doi:10.1080/080370601300055679
through practical psychotherapy (4th ed.). Thousand McLynn, F. (1996). Carl Gustav Jung. New York, NY:
Oaks, CA: Sage. St. Martin’s Press.

McMillan, J. H., & Schumacher, S. (2006). Research in Melanie Klein Trust. (2013). Furthering the
education: Evidence-based inquiry (6th ed.). Boston, psychoanalytic theory and technique of Melanie Klein.
MA: Allyn & Bacon. Retrieved from http://www.melanie-klein-trust.org.uk
McNally, R. J. (2005). Debunking myths about trauma Melchert, T. P. (2011). Foundations of professional
and memory. Canadian Journal of Psychiatry, 50, psychology: The end of theoretical orientations and
817–822. the emergence of the biopsychosocial approach.
McNally, R. J., & Geraerts, E. (2009). A new solution to London, England: Elsevier.
the recovered memory debate. Perspectives in Messer, S. B. (1992). A critical examination of belief
Psychological Science, 4, 126–134. structures in integrative and eclectic psychotherapy. In
doi:10.1111/j.1745-6924.2009.01112.x J. C. Norcross & M. R. Goldfried (Eds.), Handbook
McNamee, S., & Gergen, K. J. (Eds.). (1992). Therapy as of psychotherapy integration (pp. 130–165). New
social construction. London, England: Sage. York, NY: Basic Books.
McNiff, S. (2004). Art heals: How creativity cures the Messer, S. B. (Ed.). (2001). Introduction to the special
soul. Boston, MA: Shambhala. issue on assimilative integration. Journal of
McWilliams, N. (1999). Psychoanalytic case formulation. Psychotherapy Integration, 11, 1–54. doi:10.1023/A
New York, NY: Guilford Press. :1026619423048
McWilliams, N. (2004). Psychoanalytic psychotherapy: A Meyer, V. (1966). Modification of expectations in cases
practitioner’s guide. New York, NY: Guilford Press. with obsessional rituals. Behaviour Research and
McWilliams, N. (2011). Psychoanalytic diagnosis: Therapy, 4, 273–280. doi:10.1016/0005-7967(66)
Understanding personality structure in the clinical 90023-4
process. New York, NY: Guilford Press. Meyeroff, R. (1999). Comparative effectiveness of HT
Medina, L. L., & Montgomery, M. J. (2012). Touch with aggressive children. Child Psychiatry & Human
therapy combined with talk therapy: The Rubenfeld Development, 29, 303–313.
Synergy Method®. Body, Movement and Dance in doi:10.1023/A:1021349116429
Psychotherapy: An International Journal for Theory, Mikulincer, M., & Shaver, R. (2007). Attachment in
Research and Practice, 7, 71–79. doi:10.1080/174329 adulthood: Structure, dynamics, and change.
79.2011.622788 New York, NY: Guilford Press.
Meichenbaum, D. (1977). Cognitive behavior Miles, P. (2006). Reiki: A comprehensive guide.
modification: An integrative approach. New York, NY: New York, NY: Penguin.
Plenum Press. Miles, P., & True, G. (2002). Reiki: Review of a biofield
Meichenbaum, D. (1985). Stress inoculation training. therapy history, theory, practice, and research.
New York, NY: Pergaman Press. Alternative Therapies in Health and Medicine, 8(3),
Meichenbaum, D. (1994). Treating individuals with 88–95.
PTSD. Clearwater, FL: Institute Press. Miller, A. L., Rathus, J., & Linehan, M. (2007).
Meichenbaum, D. (2002). Treating individuals with Dialectical behavior therapy with suicidal adolescents.
anger-control problems and aggressive behaviors. New York, NY: Guilford Press.
Clearwater, FL: Institute Press. Miller, J. B. (1976). Toward a new psychology of women.
Meichenbaum, D. (2012). Roadmap to resilience. Boston, MA: Beacon Press.
Clearwater, FL: Institute Press. Retrieved from www Miller, J. B., & Stiver, I. (1997). The healing connection.
.roadmaptoresilience.org Boston, MA: Beacon Press.
Meichenbaum, D., & Biemiller, A. (1998). Nurturing Miller, J. H., & Page, S. E. (2007). Complex adaptive
independent learners. Boston, MA: Brookline Books. systems: An introduction to computational models of
Meichenbaum, D., & Jaremko, M. (1983). Stress social life. Princeton, NJ: Princeton University Press.
reduction and prevention. New York, NY: Plenum Miller, L. (2008). Foucauldian constructionism. In J. A.
Press. Holstein & J. F. Gubrium (Eds.), Handbook of
Meichenbaum, D., & Turk, D. (1987). Treatment constructionist research (pp. 251–274). New York,
nonadherence: A practitioner’s guidebook. New York, NY: Guilford Press.
NY: Plenum Press. Miller, M. V. (1996). Elegiac reflections on Isadore From.
Meissner, W. W. (2001). Psychic reality in the The Gestalt Journal, 19(1), 45–56.
psychoanalytic process. Journal of the American Miller, S. D., Duncan, B. L., Brown, J., Sparks, J., &
Psychoanalytic Association, 49, 855–890. doi:10.1177 Claud, D. (2003). The outcome rating scale: A
/00030651010490031601 preliminary study of the reliability, validity, and

feasibility of a brief visual analog measure. Journal of Minuchin, P., Colapinto, J., & Minuchin, S. (2007).
Brief Therapy, 2(2), 91–100. Working with families of the poor. New York, NY:
Miller, S. D., Hubble, M. A., & Duncan, B. L. (1997). Guilford Press.
Escape from Babel: Toward a unifying language for Minuchin, S. (1972). Structural family therapy. In
psychotherapy practice. New York, NY: W. W. Norton. G. Caplan (Ed.), American handbook of psychiatry
Miller, W. R. (1983). Motivational interviewing with (Vol. 2, pp. 178–192). New York, NY: Basic Books.
problem drinkers. Behavioural Psychotherapy, 11, Minuchin, S. (1974). Families & family therapy.
147–172. doi:10.1017/s0141347300006583 Cambridge, MA: Harvard University Press.
Miller, W. R. (1999). Enhancing motivation for change in Minuchin, S. (1981). Family therapy techniques.
substance abuse treatment. Rockville, MD: U. S. Cambridge, MA: Harvard University Press.
Department of Health and Human Services. Minuchin, S. (1998). Where is the family in narrative
Miller, W. R., & Martin, J. E. (1988). (Eds.). Behavior family therapy? Journal of Marital & Family Therapy,
therapy and religion: Integrating spiritual and 24(4), 397–403. doi:10.1111/j.1752-0606.1998.
behavioral approaches to change. Newbury Park, CA: tb01094.x
Sage. Minuchin, S., & Fishman, H. C. (1981). Family therapy
Miller, W. R., & Moyers, T. B. (2007). Eight stages in techniques. Cambridge, MA: Harvard University Press.
learning motivational interviewing. Journal of Minuchin, S., Montalvo, B., Guerney, B. G., Rosman, B. L., &
Teaching in the Addictions, 5(1), 3–17. doi:10.1300/ Schumer, F. (1967). Families of the slums. New York, NY:
J188v05n01_02 Basic Books.
Miller, W. R., & Rollnick, S. (2002). Motivational Minuchin, S., & Nichols, M. P. (1993). Family healing:
interviewing: Preparing people for change (2nd ed.). Tales of hope and renewal from family therapy.
New York, NY: Guilford Press. New York, NY: Free Press.
Miller, W. R., & Rollnick, S. (2009). Ten things that Minuchin, S., Reiter, M., & Borda, C. (2013). The craft of
motivational interviewing is not. Behavioural and family therapy: Challenging certainties. New York,
Cognitive Psychotherapy, 37(2), 129–140. NY: Routledge.
doi:10.1017/S1352465809005128 Minuchin, S., Rosman, B. L., & Baker, L. (1978).
Miller, W. R., & Rollnick, S. (2013). Motivational Psychosomatic families: Anorexia nervosa in context.
interviewing: Helping people change (3rd ed.). Cambridge, MA: Harvard University Press.
New York, NY: Guilford Press. Missildine, W. (1963). Your inner child of the past.
Miller, W. R., & Rose, G. S. (2009). Toward a theory of New York, NY: Simon & Schuster.
motivational interviewing. American Psychologist, Mitchell, J. (Ed.). (1986). The selected Melanie Klein.
64(6), 527–537. doi:10.1037/a0016830 New York, NY: Free Press.
Mills, J. C. (1999). Reconnecting to the magic of life. Mitchell, J. T., & Everly, G. S. (2000). Critical incident
Phoenix, AZ: Imaginal Press. stress management and critical incident debriefings:
Mills, J. C., & Crowley, R. J. (2014). Therapeutic Evolutions, effects and outcomes. New York, NY:
metaphors for children and the child within. Cambridge University Press.
New York, NY: Routledge. Mitchell, J. T., & Everly, G. S. (2001). The basic critical
Miltenberger, R. G. (2012). Behavior modification: incident stress management course: Basic group crisis
Principles and procedures. Belmont, CA: Thompson intervention (3rd ed.). Ellicott City, MD: International
Wadsworth. Critical Incident Stress Foundation.
Mindell, A. (1982). Dreambody: The body’s role in Mitchell, J. T., & Everly, G. S. (2001). Critical incident
revealing the self. Portland, OR: Sigo Press. stress debriefing: An operations manual for CISD,
Mindell, A. (1995). Sitting in the fire: Large group defusing and other group crisis intervention services
transformation using conflict and diversity. Portland, (3rd ed.). Ellicott City, MD: Chevron.
OR: Lao Tse Press. Mitchell, S. A. (1988). Relational concepts in psychoanalysis.
Mindell, A. (2000). Quantum mind: The edge between Cambridge, MA: Harvard University Press.
physics and psychology. Portland, OR: Lao Tse Press. Mitchell, S. A. (1993). Hope and dread in psychoanalysis.
Mindell, A. (2013). Dancing with the ancient one. New York, NY: Basic Books.
Portland, OR: Deep Democracy Exchange. Mitchell, S. A. (1997). Influence and autonomy in
Mindell, A., & Mindell, A. (1992). Riding the horse psychoanalysis. Hillsdale, NJ: Analytic Press.
backwards: Process work in theory and practice. Mitchell, S. A. (2002). Can love last? The fate of romance
London, England: Penguin-Arkana. over time. New York, NY: W. W. Norton.

Mitchell, S. A., & Lewis, A. (1999). Relational Mullan, H. (1992). “Existential” therapists and their
psychoanalysis: The emergence of a tradition. group therapy practices. International Journal of
Hillsdale, NJ: Analytic Press. Group Psychotherapy, 42, 453–468.
Moen, P., Elder, G. H., Jr., & Luscher, K. (Eds.). (1995). Muller-Leonhardt, A., Mitchell, S. G., Vogt, J., &
Examining lives in context: Perspectives on the Schumann, T. (2014). Critical incident stress
ecology of human development. Washington, DC: management (CISM) in complex systems: Cultural
American Psychological Association. adaptation and safety impacts in healthcare. Accident;
Molino, A. (Ed.). (1998). The couch and the tree. New Analysis & Prevention, 68, 172–188. doi:10.1016/j.
York, NY: North Point Press. aap.2013.12.018
Mollon, P. (2008). Psychoanalytic energy psychotherapy. Murphy, J. J. (2008). Solution-focused counseling in
London, England: Karnac Books. schools (2nd ed.). Alexandria, VA: American
Monson, C. M., Schnurr, P. P., Resick, P. A., Friedman, M. J., Counseling Association.
Young-Xu, Y., & Stevens, S. P. (2006). Cognitive Myerhoff, B. (1982). Life history among the elderly:
processing therapy for veterans with military-related Performance, visibility, and re-membering. In J. Rub
posttraumatic stress disorder. Journal of Consulting & (Ed.), A crack in the mirror: Reflexive perspectives in
Clinical Psychology, 74, 898–907. doi:10.1037/0022- anthropology (pp. 99–120). Philadelphia: University of
006X.74.5.898 Pennsylvania Press.
Moon, B. L., Huestis, R., & Reece, J. (1994). Introduction Myerhoff, B. (1986). “Life not death in Venice”: Its
to art therapy: Faith in the product. Springfield, IL: second life. In V. W. Turner & E. M. Bruner (Eds.),
Charles C Thomas. The anthropology of experience (pp. 261–286).
Moon, C. (2010). A history of materials and media in art Chicago: University of Illinois Press.
therapy. In C. Moon (Ed.), Materials and media in art Myerhoff, B. (2007). Stories as equipment for living: Last
therapy: Critical understandings of diverse artistic talks and tales of Barbara Myerhoff (Rev. ed.). Ann
vocabularies (pp. 3–47). New York, NY: Routledge/ Arbor: University of Michigan Press.
Taylor & Francis. Myers, J. E., & Sweeney, T. J. (2004). The indivisible self:
Moore, B., & Fine, B. (1990). Psychoanalytic terms and An evidence-based model of wellness. Journal of
concepts. New Haven, CT: Yale University Press. Individual Psychology, 61(3), 269–278.
Moreno, F. J. (2001). Teaching life skills through chess: A Myers, J. E., & Sweeney, T. J. (2005). Counselors for
guide to educators and counselors. Baltimore, MD: wellness: Theory, research, and practice. Alexandria,
American Literary Press. VA: American Counseling Association.
Moreno, J. L. (1946). Psychodrama. New York, NY: Myers, J. E., & Sweeney, T. J. (2005). The Five Factor
Beacon House. Wellness Inventory. Palo Alto, CA: Mindgarden.
Morgan, A. (2000). What is narrative therapy? An easy- Myers, J. E., & Sweeney, T. J. (2005). The indivisible self:
to-read introduction. Adelaide, South Australia, An evidence-based model of wellness. Journal of
Australia: Dulwich Centre. Individual Psychology, 61(3), 269–279.
Morgan, K. S., & Nerison, R. M. (1993). Myers, J. E., & Sweeney, T. J. (Eds.). (2005). Wellness in
Homosexuality and psychopolitics: An historical counseling: Theory, research, and practice. Alexandria,
overview. Psychotherapy: Theory, Research, Practice, VA: American Counseling Association.
Training, 30(1), 133–140. doi:10.1037/0033- Myers, J. E., & Sweeney, T. J. (2008). Wellness counseling:
3204.30.1.133 The evidence based for practice. Journal of Counseling
Mosak, H. H., & Dipietro, R. (2006). Early recollections: & Development, 86, 482–493. doi:10.1002/j
Interpretive method and application. New York, NY: .1556-6678.2008.tb00536.x
Routledge. Myers, J. E., Willse, J. T., & Villalba, J. A. (2011).
Mosak, H. H., & Maniacci, M. (1999). A primer of Promoting self-esteem in adolescents: The influence
Adlerian psychology. Philadelphia, PA: Accelerated of wellness factors. Journal of Counseling &
Development/Taylor & Francis. Development, 89, 28–36. doi:10.1002/j.1556-6678
Mosak, H. H., & Maniacci, M. P. (1999). A primer of .2011.tb00058.x
Adlerian psychology: The analytic-behavioral-cognitive Miller, G. W., Ethridge, P., & Morgan, K. T. (2011).
psychology of Alfred Adler. Philadelphia, PA: Brunner/ Exploring body-mind centering®: An anthology of
Mazel. experience and method. Berkeley, CA: North Atlantic
Moss, D., McGrady, A., Davies, T. C., & Wickramasekera, Books.
I. (2003). Handbook of mind-body medicine for Nacasch, N., Foa, E. B., Huppert, J. D., Tzur, D., Fostick, L.,
primary care. Thousand Oaks, CA: Sage. Dinstein, Y., . . . Zohar, J. (2010). Prolonged exposure

therapy for combat- and terror-related PTSD: A diagnosis and therapy. New York, NY: Teachers
randomized control comparison with treatment as College Press.
usual. Journal of Clinical Psychiatry, 72, 1174–1180. Naumburg, M. (1966). Dynamically oriented art therapy:
doi:10.4088/JCP.09m05682blu Its principles and practice. New York, NY: Grune &
Napier, A., & Whitaker, C. (1972). A conversation about Stratton.
co-therapy. In A. Ferber, M. Mendelsohn, & A. Napier Navarro, F. (1989). La Somatopsicodinámica
(Eds.), The book of family therapy (pp. 480–506). [Somatopsychodynamics]. Valencia, Spain:
New York, NY: Jason Aronson. Publicaciones Orgón.
Napier, A., & Whitaker, C. (1978). The family crucible. Navarro, F. (1989). La vegetoterapia caracteroanalítica
New York, NY: Harper & Row. [Characteranalytical vegetotherapy]. Revista
Napier, G. (2002). Experiential family therapy. In Somathotherapies et Somatologie Strasbourg.
J. Carlson & D. Kjos (Eds.), Theories and strategies of Retrieved from http://www.esternet.org/
family therapy (pp. 296–316). Boston, MA: Allyn & vegetoterapiacaracteroanalitica/index_eng.htm
Bacon. Navarro, F. (1991). Caratterologia postreichiana [Post-
Nash, M. R., & Barnier, A. J. (Eds.). (2008). The Oxford Reichian characterology]. Palermo, Italy: Nuova Ipsa
handbook of hypnosis: Theory, research and practice. Editore.
New York, NY: Oxford University Press. Nay, W. R. (1979). Multimethod clinical assessment.
Nasio, J.-D. (1998). Five lessons of the psychoanalytic New York, NY: Gardner Press.
theory of Jacques Lacan (SUNY Series in Neil, J., & Kniskern, D. (1982). From psyche to system:
Psychoanalysis and Culture; D. Pettigrew & F. Raffoul, The evolving therapy of Carl Whitaker. New York,
Trans., H. Sussman, Ed.). Albany: State University of NY: Guilford Press.
New York. Neimeyer, R. A. (1995). An appraisal of constructivist
Nathan, O., & Norden, H. (1960). Einstein on peace. psychotherapies. In M. J. Mahoney (Ed.), Cognitive
New York, NY: Simon & Schuster. and constructive psychotherapies: Theory, research,
Nathan, P. E., Gorman, J. M., & Salkind, N. J. (1999). and practice (pp. 163–194). New York, NY: Springer.
Treatment of mental disorders: A guide to what Neimeyer, R. A. (2009). Constructivist psychotherapy.
works. New York, NY: Oxford University Press. Hove, England: Routledge.
National Center for Complementary and Alternative Neimeyer, R. A. (2009). Constructivist psychotherapy:
Medicine. (2007). What is CAM? Retrieved from Distinctive features. London, England: Routledge.
http://nccam.nih.gov/news/camstats/2007/camsurvey_ Neimeyer, R. A., & Mahoney, M. J. (1995).
fs1.htm Constructivism in psychotherapy. Washington, DC:
National Center for Complementary and Alternative American Psychological Association.
Medicine. (2009). About NCCAM. Retrieved from Neimeyer, R. A., & Mahoney, M. J. (Eds.). (1996).
http://nccam.nih.gov/about/ Constructivism in psychotherapy. Washington, DC:
National Center for Complementary and Alternative American Psychological Association.
Medicine. (2010, May 4). Reiki: An introduction Neimeyer, R. A., & Mahoney, M. J. (Eds.). (1999).
(NCCAM Backgrounder). Washington, DC: US Constructivism in psychotherapy. Washington, DC:
Government Printing Office. American Psychological Association.
National Library of Medicine. (n.d.). Changing the face Nelson, M. L., Gizara, S., Hope, A. C., Phelps, R.,
of medicine: Dr. Jean Baker Miller. Retrieved from Steward, R., & Weitzman, L. (2006). A feminist
http://www.nlm.nih.gov/changingthefaceofmedicine/ multicultural perspective on supervision. Journal of
physicians/biography_225.html Multicultural Counseling & Development, 34, 105–
Natterson, J. M., & Friedman, R. J. (1995). A primer of 115. doi:10.1002/j.2161-1912.2006.tb00031.x
clinical inter-subjectivity. Northvale, NJ: Aronson Nelson-Becker, H. B. (2004). Spiritual, religious,
Press. nonspiritual, and nonreligious narratives in
Naugle, A. E., & Maher, S. (2003). Modeling and marginalized older adults: A typology of coping styles.
behavioral rehearsal. In W. O’Donohue, U. J. Fisher, & Journal of Religion, Spirituality, & Aging, 17(1/2),
S. C. Hayes (Eds.), Cognitive behavior therapy: 21–38. doi:10.1300/J496v17n01_02
Applying empirically supported techniques in your Neudeck, P., & Wittchen, H.-U. (Eds.). (2012). Exposure
practice (pp. 238–246). Hoboken, NJ: Wiley. therapy: Rethinking the model—refining the method.
Naumburg, M. (1950). An introduction to art therapy: New York, NY: Springer.
Studies of the “free” art expression of behavior Neukrug, E. (2007). The world of the counselor. Belmont,
problem children and adolescents as means of CA: Brooks/Cole.

Neukrug, E. (2011). Counseling theory and practice. Norcross, J. C. (Ed.). (2011). Psychotherapy relationships
Belmont, CA: Cengage. that work: Evidence-based responsiveness (2nd ed.).
Neukrug, E., Bayne, H., Dean-Nganga, L., & Pusateri, C. New York, NY: Oxford University Press.
(2012). Creative and novel approaches to empathy: A Norcross, J. C., & Beutler, L. E. (2014). Integrative
neo-Rogerian perspective. Journal of Mental Health psychotherapies. In D. Wedding & R. J. Corsini
Counseling, 35(1), 29–42. (Eds.), Current psychotherapies (10th ed., pp.
Newland, L. A., & Coyl, D. D. (2010). Fathers’ role as 499–532). Belmont, CA: Brooks/Cole, Cengage
attachment figures: An interview with Sir Richard Learning.
Bowlby. Early Child Development and Care, 180(1/2), Norcross, J. C., Beutler, L. E., & Levant, R. (2006).
25–32. doi:10.1080/03004430903414679 Evidenced-based practices in mental health: Dialogue
Newman, B. M., & Newman, P. R. (2003). Development on the fundamental questions. Washington, DC:
through life: A psychosocial approach. Belmont, CA: American Psychological Association.
Wadsworth. Norcross, J. C., Bike, H., & Evans, K. L. (2009). The
Nhat Hanh, T. (1991). Peace is every step: The path of therapist’s therapist: A replication and extension 20
mindfulness in everyday life. New York, NY: Bantam years later. Psychotherapy Theory, Research, Practice,
Books. Training, 46(1), 32–41. doi:10.1037/a0015140
Ni, M. (1995). The yellow emperor’s classic of medicine: Norcross, J. C., & Goldfried, M. R. (Eds.). (2005).
A new translation of the NeiJing SuWen. Boston, MA: Handbook of psychotherapy integration (2nd ed.).
Shambhala. New York, NY: Oxford University Press.
Nicholi, A. M. (2002). The question of God: C.S. Lewis Norcross, J. C., Krebs, P. M., & Prochaska, J. O. (2011).
and Sigmund Freud debate God, love, sex, and the Stages of change. Journal of Clinical Psychology, 67,
meaning of life. New York, NY: Free Press. 143–154. doi:10.1002/jclp.20758
Nichols, K., & Jenkinson, J. (2006). Leading a support Norcross, J. C., & Lambert, M. J. (2011). Evidence-based
group: A practical guide. New York, NY: Open therapy relationships. In J. C. Norcross (Ed.),
University Press. Psychotherapy relationships that work: Evidence-
Nichols, M. P. (2012). Family therapy concepts and based responsiveness (2nd ed., pp. 3–21). New York,
methods (10th ed.). Boston, MA: Pearson Education. NY: Oxford University Press.
Nichols, M. P., & Schwartz, R. C. (2009). The essentials Norcross, J. C., & Wampold, B. E. (2011). Evidence-
of family therapy (4th ed.). Boston, MA: Allyn & based therapy relationships: Research conclusions and
Bacon. clinical practices. In J. C. Norcross (Ed.),
Nickerson, E. T., & O’Laughlin, K. (Eds.). (1982). Psychotherapy relationships that work: Evidence-
Helping through action: Action-oriented therapies. based responsiveness (2nd ed., pp. 423–430).
Amherst, MA: Human Resource Development Press. New York, NY: Oxford University Press.
Nielsen, S. L., Johnson, W. B., & Ellis, A. (2001). Norcross, J. C., & Wampold, B. E. (2011). What works
Counseling and psychotherapy with religious persons: for whom: Tailoring psychotherapy to the person.
A rational emotive behavior therapy approach. Journal of Clinical Psychology, 67(2), 127–132.
Mahwah, NJ: Lawrence Erlbaum. doi:10.1002/jclp.20764
Nitsun, M. (1996). The anti-group: Destructive forces in Northoff, G. (2011). Neuropsychoanalysis in practice:
the group and their creative potential. London, Brain, self, and objects. Oxford, England: Oxford
England: Routledge. University Press.
Nitsun, M. (2006). The group as an object of desire: Nunneley, P. (2000). The biodynamic philosophy and
Exploring sexuality in group therapy. London, treatment of psychosomatic conditions (Vols. 1 & 2).
England: Routledge. Bern, Switzerland: Peter Lang.
NNDB. (2007). Sigmund Freud. Retrieved from http:// NurrieStearns, M., & NurrieStearns, R. (2010). Yoga for
www.nndb.com/people/736/000029649/ anxiety: Medications and practices for calming the
Noetic Sciences. (2009). About IONS: History. Retrieved body and mind. Oakland, CA: New Harbinger.
from http://www.noetic.org/about/history.cfm Nye, R. D. (1992). The legacy of B. F. Skinner: Concepts
Norcross, J. C. (2001). Purposes, processes, and products and perspectives, controversies and misunderstandings.
of the task force on empirically supported therapy Pacific Grove, CA: Brooks/Cole.
relationships. Psychotherapy: Theory, Research, Nye, R. D. (2000). Three psychologies: Perspectives from
Practice, Training, 38, 345–356. doi:10.1037/0033- Freud, Skinner, and Rogers (6th ed.). Belmont, CA:
3204.38.4.345 Brooks/Cole.

Oaklander, V. (2007). Hidden treasure. London, England: O’Hanlon, B., & Bertolino, B. (1998). Invitation to
Karnac Books. possibility-land: A teaching seminar with Bill
Oberst, U. E., & Stewart, A. E. (2003). Adlerian O’Hanlon. Philadelphia, PA: Brunner/Mazel.
psychotherapy: An advanced approach to individual O’Hanlon, B., & Weiner-Davis, M. (2003). In search of
psychology. London, England: Brunner-Routledge. solutions: A new direction in psychotherapy (Rev. ed.).
O’Callaghan, D., & Chandler, C. (2011). An exploratory New York, NY: W. W. Norton.
study of animal assisted interventions utilized by O’Hanlon, S., & Bertolino, B. (1999). Evolving
mental health professionals. Journal of Creativity in possibilities: B. O’Hanlon’s selected papers.
Mental Health, 6(2), 90–104. doi:10.1080/15401383. Philadelphia, PA: Brunner/Mazel.
2011.579862 O’Hanlon, S., & Bertolino, B. (2013). Evolving
O’Connell, B. (2003). Introduction to the solution- possibilities: Selected works of Bill O’Hanlon.
focused approach. In B. O’Connell & S. Palmer (Eds.), Philadelphia, PA: Routledge.
Handbook of solution-focused therapy (pp. 1–11). Oken, B. S., Storzbach, D. M., & Kaye, J. A. (1998).
Thousand Oaks, CA: Sage. The efficacy of ginkgo biloba on cognitive function
O’Connell, B. (2005). Solution-focused therapy (2nd ed.). in Alzheimer disease. Archives of Neurology, 55,
Thousand Oaks, CA: Sage. 1409–1415.
O’Connor, K. (2000). The play therapy primer (2nd ed.). O’Leary, E. (2006). The need for integration. In E.
Hoboken, NJ: Wiley. O’Leary & M. Murphy (Eds.), New approaches to
O’Connor, M. J., Frankel, F., Paley, B., Schonfeld, A. M., integration in psychotherapy (pp. 3–12). New York,
Carpenter, E., Laugeson, E. A., & Marquardt, R. NY: Routledge.
(2006). A controlled social skills training for children O’Leary, E., & Murphy, M. (2006). New approaches to
with fetal alcohol spectrum disorders. Journal of integration in psychotherapy. New York, NY:
Consulting and Clinical Psychology, 74, 639–648. Routledge.
doi:10.1037/0022-006X.74.4.639 Olmstead, T., Caroll, K. M., Canning-Ball, M., &
O’Donohue, W., Fisher, U. J., & Hayes, S. C. (Eds.). Martino, S. (2011). Cost and cost-effectiveness of
(2003). Cognitive behavior therapy: Applying three strategies for training clinicians in motivational
empirically supported techniques in your practice. interviewing. Drug and Alcohol Dependence, 116,
Hoboken, NJ: Wiley. 195–202. doi:10.1016/j.drugalcdep.2010.12.015
O’Donohue, W., & Krasner, L. (1995). Theories of O’Neill, R. M., Gantt, S. P., Burlingame, G. M., Mogle, J.,
behavior therapy. Washington, DC: American Johnson, J., & Silver, R. (2013). Developing the
Psychological Association Press. systems-centered functional subgrouping
O’Donohue, W., & Lilienfeld, S. O. (2013). Case studies questionnaire-2. Group Dynamics: Theory, Research,
in clinical psychological science. New York, NY: and Practice, 17(4), 252–269. doi:10.1037/a0034925
Oxford University Press. Orange, D. M., Atwood, G. E., & Stolorow, R. D. (1997).
O’Donohue, W. T., & Fisher, J. E. (Eds.). (2009). Cognitive Working intersubjectively: Contextualism in
behavior therapy: Applying empirically supported psychoanalytic practice. Hillsdale, NJ: Analytic Press.
techniques in your practice. Hoboken, NJ: Wiley. Oren, E., & Solomon, R. (2012). EMDR therapy: An
Ofshe, R., & Watters, E. (1994). Making monsters: False overview of its development and mechanisms of
memories, psychotherapy, and sexual hysteria. action. European Review of Applied Psychology, 62,
New York, NY: Scribner. 197–203. doi:10.1016/j.erap.2012.08.005
Ogden, P., & Fisher, J. (2014). Sensorimotor Organista, K. C. (2006). Cognitive-behavioral therapy
psychotherapy: Interventions for trauma and with Latinos and Latinas. In P. A. Hays & G. W.
attachment. New York, NY: W. W. Norton. Iwamasa (Eds.), Culturally responsive cognitive-
Ogden, P., Minton, K., & Pain, C. (2006). Trauma and behavioral therapy: Assessment, practice, and
the body: A sensorimotor approach to psychotherapy. supervision (pp. 73–96). Washington, DC: American
New York, NY: W. W. Norton. Psychological Association.
O’Hanlon, B. (2003). A guide to inclusive therapy. Orlinsky, D. E., Rønnestad, M. H., & Willutzki, U.
New York, NY: W. W. Norton. (2004). Fifty years of psychotherapy process-outcome
O’Hanlon, B. (2006). Change 101. New York, NY: research: Continuity and change. In M. J. Lambert
W. W. Norton. (Ed.), Bergin and Garfield’s handbook of
O’Hanlon, B., & Beadle, S. (1999). A guide to possibility psychotherapy and behavior change (5th ed., pp. 307–
land. New York, NY: W. W. Norton. 389). New York, NY: Wiley.

Ormont, L. (1992). The group therapy experience. Palazzoli, S. M., Boscolo, L., Cecchin, G., & Prata, G.
New York, NY: St. Martin’s Press. (1978). Paradox and counterparadox. New York, NY:
Ormont, L. R. (1967). Group resistance and the Jason Aronson.
therapeutic contract. International Journal of Group Panksepp, J. (1998). Affective neuroscience: The
Psychotherapy, 18, 147–154. foundations of human and animal emotions. London,
Orr, L. D. (1995). Breath awareness. Staunton, VA: England: Oxford University Press.
Inspiration University. Papadopoulos, R. (1992). Commentary. In
Orr, L. D. (1995). The new rebirthing book. Staunton, R. Papadopoulos (Ed.), Carl Gustav Jung: Critical
VA: Inspiration University. assessments (Vol. 2, pp. 97–103). New York, NY:
Ortner, N. (2013). The tapping solution. Carlsbad, CA: Routledge.
Hay House. Papero, D. V. (1990). Bowen family systems theory.
Oschamn, J. L. (2000). Energy medicine: The scientific Boston, MA: Allyn & Bacon.
basis. Churchill Livingstone, England: Churchill Papp, P. (1983). The process of change. New York, NY:
Livingstone. Guilford Press.
Oschman, J. L. (2003). Energy medicine in therapeutics Papp, P., & Imber-Black, E. (1996). Family themes:
and human performance. Edinburgh, Scotland: Transmission and transformation. Family Process, 35,
Butterworth-Heinemann. 5–20. doi:10.1111/j.1545-5300.1996.00005.x
Ossorio, P. (1997). Essays on clinical topics: The collected Paradis, C. M., Cukor, D., & Friedman, S. (2006).
works of Peter G. Ossorio (Vol. 2). Ann Arbor, MI: Cognitive-behavioral therapy with Orthodox Jews. In
Descriptive Psychology Press. P. A. Hays & G. W. Iwamasa (Eds.), Culturally
Othmer, S. (2007). Overview of neurofeedback responsive cognitive-behavioral therapy: Assessment,
mechanisms: Setting the agenda for research. practice, and supervision (pp. 161–176). Washington,
Woodland Hills, CA: The EEG Institute. DC: American Psychological Association.
Overmyer, L. (2008, July). Ortho-bionomy, osteopathic Pardeck, J. T. (1998). Using books in clinical social work
principles stimulate self-healing. Massage Magazine, practice: A guide to bibliotherapy. New York, NY:
74–77. Hawthorne Press.
Overmyer, L. (2009). Orthobionomy: A path to self-care. Parfitt, W. (2006). Psychosynthesis: The elements and
Philadelphia, PA: North Atlantic Books. beyond. Glastonbury, England: PS Avalon.
Owen, D. W. (2010). Spontaneous and guided imagery in Paris, B. J. (1994). Karen Horney: A psychoanalyst’s
counseling: Putting fantasy to work. Turkish search for self-understanding. New Haven, CT: Yale
Psychological Counseling and Guidance Journal, 4, University.
71–80. Park, J. (2008). Existential guilt: Deeper than the pangs
Padesky, C. A. (1994). Schema change processes in of conscience. Retrieved from http://www.tc.umn
cognitive therapy. Clinical Psychology & .edu/~parkx032/CY-GUILT.html
Psychotherapy, 1, 267–278. doi:10.1002/ Park, J. L. (2006). Our existential predicament:
cpp.5640010502 Loneliness, depression, anxiety, and death.
Padesky, C. A., & Beck, A. T. (2003). Science and Minneapolis, MN: Existential Books.
philosophy: Comparison of cognitive therapy and Park, S. (2008). More words. Retrieved from http://
rational emotive behavior therapy. Journal of narrativepractices.com.au/michael-white/michael-
Cognitive Psychotherapy: An International Quarterly, white-memorial-sue-park-and-paul-white
17(3), 211–225. doi:10.1891/jcop.17.3.211.52536 Parker, R. (in press). Change from the inside: Focusing
Painter, J. W. (1986). Deep bodywork and personal oriented therapy with an adolescent sex offender. In
development: Harmonizing our bodies, emotions and V. Follette, J. Briere, J. Hopper, D. Rozelle, & D. Rome
thoughts. Mill Valley, CA: Bodymind Books. (Eds.), Contemplative methods in trauma treatment:
Painter, J. W. (1987). Technical manual of deep wholistic Integrating mindfulness and other approaches. New
bodywork: Postural integration. Mill Valley, CA: York, NY: Guilford Press.
Bodymind Books. Parker, S. E. (2012). Winnicott and religion. Lanham,
Paivio, S. C., & Greenberg, S. (1995). Resolving MD: Jason Aronson.
“unfinished business”: Efficacy of experiential therapy Pascal, E. (1992). Jung to live by. New York, NY: Warner
using empty-chair dialogue. Journal of Consulting and Books.
Clinical Psychology, 63(3), 419–425. Passaro, P., Moon, M., Wiest, D., & Wong, E. (2004). A
doi:10.1037//0022-006X.63.3.419 model for school psychology practice: Addressing the

needs of students with emotional and behavioral Payne, M. (2006). Narrative therapy. Thousand Oaks,
challenges through the use of an in-school support CA: Sage.
room and reality therapy. Adolescence, 39, 503–517. Pearce, J. (2006, August 17). Jean Baker Miller, 78,
Passmore, J. (2011). Motivational interviewing Psychiatrist, is dead. The New York Times. Retrieved
techniques: Reflective listening. The Coaching from http://www.nytimes.com/2006/08/08/us/08miller
Psychologist, 7(1), 50–53. .html?_r=0
Passons, W. (1972). Gestalt therapy interventions for Pearce, J. (2008, April 28). Michael White dies: Used stories
group counseling. Personnel and Guidance Journal, 51, as therapy. The New York Times. Retrieved from http://
183–189. doi:10.1002/j.2164-4918.1972.tb04944.x www.nytimes.com/2008/04/28/us/28white.html
Patel, N. K., Newstead, A. H., & Ferrer, R. L. (2012). The Pedersen, P. B., Draguns, J. G., Lonner, W. J., & Trimble,
effects of Yoga on physical functioning and health J. E. (Eds.). (2007). Counseling across cultures (6th
related quality of life in older adults: A systematic ed.). Thousand Oakes, CA: Sage.
review and meta-analysis. Journal of Alternative & Pehrsson, D.-E., & McMillen, P. (2010). A national
Complementary Medicine, 18, 902–917. doi:10.1089/ survey of bibliotherapy preparation and practices for
acm.2011.0473 professional counselors. Journal of Creativity in
Pattakos, A. (2004). The prisoners of our thoughts: Mental Health, 5, 412–425. doi:10.1080/15401383.20
Viktor Frankl’s principles at work. San Francisco, CA: 10.527807
Berret-Kohler. Pendergrast, M. (1995). Victims of memory: Incest
Patterson, C. H. (1996). Multicultural counseling: From accusations and shattered lives. Hinesburg, VT: Upper
diversity to universality. Journal of Counseling & Access.
Development, 74(3), 227–231. Pennebaker, J. W. (1997). Writing about emotional
doi:10.1002/j.1556-6676.1996.tb01856.x experiences as a therapeutic process. Psychological
Paul, N. L. (2006). Reiki for dummies. Indianapolis, IN: Science, 8(3), 162–166. doi:10.1111/j.1467-9280.1997
Wiley. .tb00403.x
Pauls, A. (1980). The philosophy of ortho-bionomy: The Peper, E., Tylova, H., Gibney, K. H., Harvey, R. A., &
evolvement of the original concept. Unpublished Combatalade, D. (2009). Biofeedback mastery: An
article. experiential teaching and self-training manual. Wheat
Paulsen, S. L. (2009). Looking through the eyes of trauma Ridge, CO: Association for Applied Psychophysiology
and dissociation: An illustrated guide for EMDR and Biofeedback.
therapists and clients. Charleston, SC: Booksurge. Perls, F. (1947). Ego, hunger, and aggression: A revision
Pavlov, I. (1927). Conditioned reflexes. Oxford, England: of Freud’s theory and method. London, England:
Oxford University Press. G. Allen & Unwin. (Original work published 1942)
Pavlov, I. (1928). A physiological study of the types of the Perls, F. (1969). Gestalt therapy verbatim. Moab, UT:
nervous sytems, i.e., of temperaments. In I. Pavlov Real People Press.
(Ed.), Lectures on conditioned reflexes: Twenty-five Perls, F. (1969). In and out the garbage pail. Lafayette,
years of objective study of the higher nervous activity CA: Real People Press.
(behaviour) of animals (pp. 370–378; P. Gantt & Perls, F. (1970). Four lectures. In J. Fagan & I. L.
W. Horsley, Trans.). New York, NY: Liverwright. Shepherd (Eds.), Gestalt therapy now (pp. 14–46).
Pavlov, I. (1928). Relation between excitation and New York, NY: Harper & Row.
inhibition and their delimitations; experimental Perls, F. (1973). The Gestalt approach and eyewitness to
neuroses in dogs. In I. Pavlov (Ed.), Lectures on therapy. Palo Alto, CA: Science and Behavior Books.
conditioned reflexes: Twenty-five years of objective Perls, F. (1978). Finding self through Gestalt therapy.
study of the higher nervous activity (behaviour) of Gestalt Journal, 1(1), 54–73.
animals (pp. 339–349; P. Gantt & W. Horsley, Trans.). Perls, F., Hefferline, R. F., & Goodman, P. (1951). Gestalt
New York, NY: Liverwright. therapy. New York, NY: Julian Press.
Pavlov, I. (1994). Psychopathology and psychiatry. Perls, F. S. (1947). Ego hunger and aggression: The beginning
New Brunswick, NJ: Transaction Books. of gestalt therapy. New York, NY: Random House.
Paylo, M. J. (2005). Helping families search for solutions: Perls, F. S. (1969). Gestalt therapy verbatim. Lafayette,
Working with adolescents. Family Journal, 13(4), CA: Real People Press.
456–458. doi:10.1177/1066480705278687 Perls, F. S., Hefferline, R. F., & Goodman, P. (1951).
Payne, H. (1992). Dance movement therapy: Theory and Gestalt therapy: Excitement and growth in the human
practice. New York, NY: Routledge. personality. New York, NY: Dell.

Perls, L. (1992). Living at the boundary. Gouldsboro, Pines, M. (1998). Circular reflections: Selected papers on
ME: The Gestalt Journal Press. group analysis and psychoanalysis. London, England:
Perry, B. D. (2009). Maltreated children: Experience, brain Jessica Kinglsley.
development and the next generation. New York, NY: Pinsof, E. M. (1995). Integrative problem-centered
W. W. Norton. therapy. New York, NY: Basic books.
Perry, H. S. (1982). Psychiatrist of America: The life of Piper, A., Lillevik, L., & Kritzer, R. (2008). What’s wrong
Harry Stack Sullivan. Cambridge, MA: Belknap Press. with believing in repression? A review for legal
Perry, N., & Perry, E. (2006). Aromatherapy in the professionals. Psychology, Public Policy, and Law, 14,
management of psychiatric disorders: Clinical and 223–242. doi:10.1037/a0014090
neuropharmacological perspectives. CNS Drugs, 20, Pistole, M. C., & Arricale, F. (2003). Understanding
257–280. doi:10.2165/00023210-200620040-00001 attachment: Beliefs about conflict. Journal of
Perry, W. G. (1968). Forms of intellectual and ethical Counseling & Development, 81, 318–328.
development in the college years: A scheme. New doi:10.1002/j.1556-6678.2003.tb00259.x
York, NY: Holt, Rinehart, & Winston. Placzek, B. (Ed.). (1981). A record of friendship, the
Peterson, A. L., Foaa, E. B., & Riggs, D. S. (2011). correspondence of Wilhelm Reich and A.S. Neill.
Prolonged exposure therapy. In B. A. Moore & W. E. New York, NY: Farrar, Straus & Giroux.
Penk (Eds.), Treating PTSD in military personnel (pp. Poleshuck, E. L., Gamble, S. A., Cort, N., Hoffman-King,
42–58). New York, NY: Guilford Press. D., Cerrito, B., Rosario-McCabe, L. A., & Giles, D. E.
Peterson, C. (2006). A primer in positive psychology. (2010). Interpersonal psychotherapy for co-occurring
New York, NY: Oxford University Press. depression and chronic pain. Professional Psychology:
Phillips, A. (1988). Winnicott. Cambridge, MA: Harvard Research and Practice, 41, 312–318. doi:10.1037/
University Press. a0019924
Phillips, A. (2014). Becoming Freud. New Haven, CT: Yale. Poling, A., & Gaynor, S. T. (2003). Stimulus control. In
Phillips, M., & Frederick, C. (1995). Healing the divided W. O’Donohue, U. J. Fisher, & S. C. Hayes (Eds.),
self: Clinical and Ericksonian hypnotherapy for post- Cognitive behavior therapy: Applying empirically
traumatic and dissociative conditions. New York, NY: supported techniques in your practice (pp. 396–401).
W. W. Norton. Hoboken, NJ: Wiley.
Philpot, C. L., Brooks, G. R., Lusterman, D., & Nutt, R. Polster, E., & Polster, M. (1973). Gestalt therapy integrated:
L. (1997). Bridging separate gender worlds. Contours of theory and practice. New York, NY:
Washington, DC: American Psychological Association. Vintage Books/Random House.
Piedmont, R., & Friedman, P. (2011). Spirituality, Polster, E., & Polster, M. (1999). From the radical center:
religiosity and quality of life. In K. Land, A. Michalos, The heart of Gestalt therapy. Cleveland, OH: The
& M. J. Sirgy (Eds.), Handbook of social indicators Gestalt Institute of Cleveland Press.
and quality of life research (pp. 313–330). New York, Porter, N. (2010). Feminist and multicultural
NY: Springer. underpinnings to supervision: An overview. Women
Piercy, F. P., Sprenkle, D. H., & Wetchler, J. L. (1996). & Therapy, 33, 1–6. doi:10.1080/0270314090
Family therapy sourcebook (2nd ed.). New York, NY: 3404622
Guilford Press. Powell, T., & Perron, B. E. (2010). Self-help groups and
Pierrakos, J. (1987). Core energetics: Developing the mental health/substance use agencies: The benefits of
capacity to love and heal. Mendocino, CA: organizational exchange. Substance Use & Misuse,
LifeRythmn. 43, 315–329. doi:10.3109/10826080903443594
Pierrakos, J. (2001). Eros, love & sexuality. Mendocino, Power, M. J., & Dalgleish, T. (1997). Cognition and
CA: LifeRhythm. emotion: From order to disorder. Hove, England:
Pies, R. W. (1994). Clinical manual of psychiatric Psychology Press.
diagnosis and treatment: A biopsychosocial approach. Powers, W. T. (1973). Behavior: The control of
Washington, DC: American Psychiatric Press. perception. Chicago, IL: Aldine.
Pignotti, M., & Mercer, J. (2007). Holding therapy and Prenn, N. (2011). Mind the gap: AEDP interventions
dyadic developmental psychotherapy are not translating attachment theory into clinical practice.
supported and acceptable social work interventions: A Journal of Psychotherapy Integration, 21(3), 308–329.
systematic research synthesis revisited. Research on doi:10.1037/a0025491
Social Work Practices, 17, 513–519. Priestly, M. (1994). Essays on analytical music therapy.
doi:10.1177/1049731506297046 Gilsum, NH: Barcelona.

Prilleltensky, I., & Prilleltensky, O. (2006). Promoting Rank, O. (1996). A psychology of difference: The American
well-being: Linking personal, organizational, and lectures. Princeton, NJ: Princeton University Press.
community change. Hoboken, NJ: Wiley. Rankin, H., Hodgson, R., & Stockwell, T. (1983). Cue
Prochaska, J. O., DiClemente, C. C., & Norcross, J. C. exposure and response prevention with alcoholics: A
(1992). In search of how people change: Applications controlled trial. Behaviour Research and Therapy, 21,
to addictive behaviors. American Psychologist, 47, 435–446. doi:10.1016/0005-7967(83)90013-X
1102–1114. doi:10.1037//0003-066X.47.9.1102 Rapaport, D. (1958). The theory of ego autonomy: A
Prochaska, J. O., & Norcross, J. C. (2013). Systems of generalization. Bulletin of the Menninger Clinic, 22,
psychotherapy: A transtheoretical analysis (8th ed.). 13–35.
Pacific Grove, CA: Brooks/Cole. Rashid, T., & Seligman, M. (2014). Positive
Prochaska, J. O., & Norcross, J. C. (2014). Systems of psychotherapy. In R. J. Corsini & D. Wedding (Eds.),
psychotherapy: A transtheoretical analysis. Stamford, Current psychotherapies (10th ed., pp. 466, 461–498).
CT: Cengage Learning. Belmont, CA: Brooks/Cole, Cengage Learning.
Prochaska, J. O., Norcross, J. C., & DiClemente, C. C. Raskin, J. D. (2002). Constructivism in psychology:
(1995). Changing for good. New York, NY: Avon. Personal construct psychology, radical constructivism,
Pucci, A. R. (2006). The client’s guide to cognitive- and social constructionism. In J. D. Raskin & S. K.
behavioral therapy: How to live a healthy, happy life . . . Bridges (Eds.), Studies in meaning: Exploring
no matter what! Bloomington, IN: iUniverse. constructivist psychology (pp. 1–25). New York, NY:
Pucci, A. R. (2010). Feel the way you want to feel . . . no Pace University Press.
matter what! Bloomington, IN: iUniverse. Raskin, J. D., & Bridges, S. K. (Eds.). (2008). Studies in
Pucci, A. R. (2011). About rational living therapy. meaning 3: Constructivist psychotherapy in the real
Retrieved from http://www.rational-living-therapy.org/ world. New York, NY: Pace University Press.
AboutRLT.htm Raskin, J. D., Bridges, S. K., & Kahn, J. S. (Eds.). (2014).
Pucci, A. R. (2013). Rational living therapy relationship Studies in meaning 5: Perturbing the status quo in
therapy. Retrieved from http://freecbthandouts.com/ constructivist psychology. New York, NY: Pace
cbt-articles/rational-living-therapy-relationship-therapy/ University Press.
Quenk, N. (2000). Essentials of Myers-Briggs Type Rasolkhani-Kalhorn, T., & Harper, M. L. (2006). EMDR
Indicator assessment. New York, NY: Wiley. and low frequency stimulation of the brain.
Quinn, S. (1987). A mind of her own: The life of Karen Traumatology, 12(1), 9–24.
Horney. New York, NY: Summit. doi:10.1177/153476560601200102
Quirk, G. J., & Mueller, D. (2008). Neural mechanisms of Ratner, H., George, E., & Iveson, C. (2012). Solution
extinction learning and retrieval. focused brief therapy: 100 key points and techniques.
Neuropsychopharmacology, 33, 56–72. doi:10.1038/ New York, NY: Routledge.
sj.npp.1301555 Ray, W. (Ed.). (2005). Don D. Jackson: Essays from the
Rachman, S. (1967). Systematic desensitization. dawn of an era—selected papers (Vol. 1). Phoenix, AZ:
Psychological Bulletin, 67, 93–103. doi:10.1037/ Zeig, Tucker & Theisan.
h0024212 Ray, W. (2009). (Ed.). Don D. Jackson: Interactional
Radtke, L., Sapp, M., & Farrell, W. C. (1997). Reality theory in clinical practice—selected papers (Vol. 2).
therapy: A meta-analysis. Journal of Reality Therapy, Phoenix, AZ: Zeig, Tucker & Theisan.
17(1), 4–9. Ray, W., & Nardone, G. (2009). (Eds.). Insight may cause
Raheim, S., White, C., Denborough, D., Waldegrave, C., blindness and other essays: Selected papers of Paul
Tamasese, K., Tuhaka, F., . . . Carey, M. (n.d.). An Watzlawick. Phoenix, AZ: Zeig, Tucker & Theisan.
invitation to narrative practitioners to address privilege Reese, R. (1988). Healing fits: The cure of an epileptic.
and dominance. Retrieved from http://www Los Angeles, CA: Big Sky Press.
.narrativetherapylibrary.com/free-downloads/ Reese, R. F. (2013). EcoWellness: Construction and
an-invitation-to-narrative-practitioners-to-address- validation of the Reese EcoWellness Inventory.
issues-of-privilege-and-dominance.html Dissertation Abstracts International. Retrieved from
Rand, W. L. (n.d.). Usui memorial. Retrieved from http:// http://libres.uncg.edu/ir/uncg/listing.aspx?id=10079
www.reiki.org/reikinews/memorial.html Reese, R. F., & Myers, J. E. (2012). EcoWellness: The
Rand, W. L., & Gaia, L. S. (n.d.). Discovering the roots of missing factor in holistic wellness models. Journal of
Reiki. Retrieved from http://www.reiki.org/reikinews/ Counseling & Development, 90(4), 400–406.
rootsreiki.html doi:10.1002/j.1556-6676.2012.00050.x

Rehm, L. P., & Adams, J. H. (2003). Self-management. Resnick, R. W. (1984). Gestalt therapy east and west:
In W. O’Donohue, U. J. Fisher, & S. C. Hayes (Eds.), Bi-coastal dialogue, debate or debacle? Gestalt
Cognitive behavior therapy: Applying empirically Journal, 7(1), 13–32.
supported techniques in your practice (pp. 354–360). Resnick, R. W. (1995). Interviewed by Malcolm Parlett—
Hoboken, NJ: Wiley. Gestalt therapy: Principles, prisms and perspectives.
Reich, W. (1970). The mass psychology of Fascism (V. R. British Gestalt Journal, 4(1), 3–13.
Carafagno, Trans.). New York, NY: Farrar, Straus & Resnick, R. W. (1997). The “recursive loop” of shame: An
Giroux. (Original work published 1933) alternate gestalt therapy viewpoint. Gestalt Review,
Reich, W. (1972). Character analysis (3rd ed.; V. R. 1(3), 256–269.
Carfagno, Trans.). New York, NY: Macmillan. Reverse engineering organized stalking. (2013, February).
(Original work published 1933) Attack therapy. Retrieved from www.redecomposition
Reich, W. (1973). Ether, god and devil. New York, NY: .wordpress.com/2013/02/01/attack-therapy/
Farrar, Straus & Giroux. Richard, D. C. S., & Lauterbach, D. L. (Eds.). (2007).
Reich, W. (1973). The function of the orgasm. New York, Handbook of exposure therapies. Burlington, MA:
NY: Farrar, Straus & Giroux. Academic Press.
Reich, W. (1973). Selected writings: An introduction to Ridgway, I. R., & Sharpley, C. F. (1990). Empathic
orgonomy. New York, NY: Farrar, Straus & Giroux. interactional sequences and counselor trainee
Reich, W. (1980). Genitality in the theory and therapy of effectiveness. Counseling Psychology Quarterly, 3(3),
neurosis: Early writings (Vol. 2; P. Schmitz, Trans.). 257–265. doi:10.1080/09515079008254256
New York, NY: Farrar, Straus & Giroux. (Original Rimm, D. C., & Mahoney, M. J. (1969). The application
work published 1927) of reinforcement and participant modeling procedures
Reich, W. (2007). The function of the orgasm. New York, in the treatment of snake phobic behavior. Behavior
NY: Farrar, Straus & Giroux. (Original work Research and Therapy, 7, 369–376. doi:10.1016/0005-
published 1927) 7967(69)90066-7
Reich, W., & Higgins, M. (Ed.). (1988). Passion of youth, Rinpoche, D. K. (1992). The heart treasure of the
Wilhelm Reich, an autobiography 1897-1922. enlightened ones. Boston, MA: Shambhala.
New York, NY: Farrar, Straus & Giroux. Riskind, J. H. (2005). Cognitive mechanisms in
Reich, W., & Higgins, M. (Ed.). (1994). Beyond generalized anxiety disorder: A second generation of
psychology letters and journals 1934-1939. New York, theoretical perspectives. Cognitive Therapy and
NY: Farrar, Straus & Giroux. Research, 29, 1–5. doi:10.1007/s10608-005-1644-0
Reich, W., & Higgins, M. (Ed.). (1999). American Riso, L. P., du Toit, P. L., Stein, D. J., & Young, J. E.
odyssey, letters and journals 1940-1947. New York, (2007). Cognitive schemas and core beliefs in
NY: Farrar, Straus & Giroux. psychological problems: A scientist-practitioner guide.
Reich, W., Higgins, M., & Raphael, C. (Eds.). (1980). Washington, DC: American Psychological Association.
Character analysis. New York, NY: Farrar, Straus & Ritter, K. Y., & Terndrup, A. I. (2002). Handbook of
Giroux. affirmative psychotherapy with lesbians and gay men.
Reiter, S. (2009). Writing away the demons: Stories of New York, NY: Guilford Press.
creative coping through transformative writing. St. Ritterman, M. (1983). Using hypnosis in family therapy.
Cloud, MN: North Star Press. San Francisco, CA: Jossey-Bass.
Remine, D., Rice, R. M., & Ross, J. (1984). Self-help Rivière, J. (1929). Womanliness as a masquerade.
groups and human services agencies: How they International Journal of Psychoanalysis, 9, 303–313.
work together. Fayetteville, NC: Family Services Rizvi, S. L., Welch, S., & Dimidjian, S. (2009). Mindfulness
America. and borderline personality disorder. In D. Fabrizio
Rescorla, R. A. (1988). Pavlovian conditioning: It’s not (Ed.), Clinical handbook of mindfulness (pp. 245–257).
what you think it is. American Psychologist, 43, New York, NY: Springer Science + Business Media.
151–160. doi:10.1037/0003-066X.43.3.151 Robb, C. (2006). This changes everything: The relational
Resick, P., & Schnicke, M. K. (1992). Cognitive processing revolution in psychology. New York, NY: Picador.
therapy for sexual assault victims. Journal of Robbins, L. B. (n.d.). The art of promoting choice: A
counseling and clinical psychology, 5, 148–156. doi:10 counseling workbook. Oakland, TN: Author.
.1037//0022-006X.60.5.748 Roberts, T. (2009). The mindfulness workbook: A
Resnick, R. F., & Estrup, E. A. (2000). Supervision: A beginner’s guide to overcoming fear and embracing
collaborative endeavor. Gestalt Review, 4(2), 121–127. compassion. Oakland, CA: New Harbinger.

Robertson, R. (1992). Beginner’s guide to Jungian B. Stevens (Eds.), Person to person: The problem of
psychology. Berwick, ME: Nicholas Hays. being human (pp. 181–192). Moab, UT: Real People
Robins, C. J., Schmidt, H., & Linehan, M. M. (2004). Press.
Dialectical behavior therapy: Synthesizing radical Rogers, C. R. (1994). Freedom to learn: A view of what
acceptance with skillful means. In S. Hayes, V. Follette, education might become. Columbus, OH: Charles
& M. Linehan (Eds.), Mindfulness and acceptance: Merrill. (Original published 1969)
Expanding the cognitive-behavioural tradition (pp. Rogers, C. R. (1970). Carl Rogers on encounter groups.
30–44). New York, NY: Guilford Press. New York, NY: Harper & Row.
Robinson-Wood, T. L. (2009). Advocacy and social Rogers, C. R. (1970). Encounter groups. New York, NY:
justice. In T. L. Robinson-Wood (Ed.), The Harper & Row.
convergence of race, ethnicity, and gender: Multiple Rogers, C. R. (1972). Becoming partners: Marriage and
identities in counseling (3rd ed., pp. 284–294). Upper its alternatives. New York, NY: Delacorte Press.
Saddle River, NJ: Merrill. Rogers, C. R. (1977). Carl Rogers on personal power.
Roche, R. A. P., Commins, S., & Dockree, P. M. (2009). New York, NY: Delacorte Press.
Cognitive neuroscience: Introduction and historical Rogers, C. R. (1980). A way of being. Boston, MA:
perspective. In R. A. P. Roche & S. Commins (Eds.), Houghton Mifflin.
Pioneering studies in cognitive neuroscience (pp. Rogers, C. R. (1986). Reflection of feelings. Person-
1–18). Maidenhead, England: McGraw-Hill. Centered Review, 1(4), 375–377.
Rodrigue, J. R., Mandelbrot, D. A., & Pavlakis, M. Rogers, C. R., & Dymond, R. (1954). Psychotherapy and
(2011). A psychological intervention to improve personality change. Chicago, IL: University of
quality of life and reduce psychological distress in Chicago.
adults awaiting kidney transplantation. Nephrology Rogers, C. R., Gendlin, E. T., Kiesler, D. J., & Truax, C. B.
Dialysis Transplantation, 26(2), 709–715. (1967). The therapeutic relationship and its impact: A
doi:10.1093/ndt/gfq382 study of psychotherapy with schizophrenics. Madison:
Rogers, C. R. (1931). Measuring personality adjustment University of Wisconsin Press.
in children nine to thirteen years of age. New York, Rokeach, M. (1973). The nature of human values (2nd
NY: Teachers College. ed.). New York, NY: Free Press.
Rogers, C. R. (1939). The clinical treatment of the Rolf, I. P. (1990). Rolfing and physical reality. Rochester,
problem child. Boston, MA: Houghton Mifflin. VT: Healing Arts Press.
Rogers, C. R. (1942). Counseling and psychotherapy: New Rollnick, S., Butler, C. C., Kinnersley, P., Gregory, J., &
concepts in practice. Boston, MA: Houghton Mifflin. Mash, B. (2010). Competent novice motivational
Rogers, C. R. (1951). Client-centered therapy: Its current interviewing. British Medical Journal, 340(7758),
practice, implications and theory. Boston, MA: 1242–1245. doi:10.1136/bmj.c1900
Houghton Mifflin. Rollnick, S., & Miller, W. R. (1995). What is motivational
Rogers, C. R. (1957). The necessary and sufficient interviewing? Behavioural and Cognitive
conditions of therapeutic personality change. Journal Psychotherapy, 23, 325–334. doi:10.1017/
of Consulting Psychology, 21, 95–103. doi:10.1037/ S135246580001643X
h0045357 Rollnick, S., Miller, W. R., & Butler, C. C. (2007).
Rogers, C. R. (1957). A note on the “nature of man.” Motivational interviewing in health care: Helping
Journal of Counseling Psychology, 4(3), 199–203. patients change behavior. New York, NY: Guilford
doi:10.1037/h0048308 Press.
Rogers, C. R. (1959). A theory of therapy, personality and Rosaldo, R. (1993). Culture and truth: The remaking of
interpersonal relationships as developed in the client- social analysis. Boston, MA: Beacon Press.
centered framework. In S. Koch (Ed.), Psychology: A Rosen, C. S. (2000). Is the sequencing of change processes
study of science: Vol. 3. Formulations of the person by stage consistent across health problems? A meta-
and the social context (pp. 184–256). New York, NY: analysis. Health Psychology, 19, 593–604.
McGraw-Hill. doi:10.1037/0278-6133.19.6.593
Rogers, C. R. (1961). On becoming a person: A Rosen, S. (Ed.). (2010). My voice will go with you: The
therapist’s view of psychotherapy. Boston, MA: teaching tales of Milton H. Erickson. New York, NY:
Houghton Mifflin. W. W. Norton.
Rogers, C. R. (1967). Some learnings from a study of Rosenberg, J. (1973). Total orgasm. New York, NY:
psychotherapy with schizophrenics. In C. R. Rogers & Random House.

Rosenberg, J., & Kitaen-Morse, B. (1996). The intimate Rowa, K., Antony, M. M., & Swinson, R. P. (2007).
couple. Atlanta, GA: Turner. Exposure and response prevention. In M. M. Antony,
Rosenberg, J., Rand, M., & Asay, D. (1985). Body, self C. Purdon, & L. J. Summerfeldt (Eds.), Psychological
and soul. Atlanta, GA: Humanics. treatment of obsessive-compulsive disorder:
Rosengren, D. B. (2009). Building motivational Fundamentals and beyond (pp. 79–109). Washington,
interviewing skills: A practitioner workbook. DC: American Psychological Association.
New York, NY: Guilford Press. Rowan, J. (1998). Maslow amended. Journal of
Rosenthal, L. (1987). Resolving resistances in group Humanistic Psychology, 38, 81–92. doi:10
psychotherapy. Northvale, NJ: Jason Aronson. .1177/00221678980381008
Rossi, E. (2000). Dreams, consciousness, spirit (3rd ed.). Rowland, S. (2002). Jung: A feminist revision. Malden,
Phoenix, AZ: Zeig, Tucker & Theisen. MA: Blackwell.
Rossi, E. (2002). The psychobiology of gene expression: Roy, D. M. (2003). Body-centered counseling and
Neuroscience and neurogenesis in hypnosis and the psychotherapy. In D. Capuzzi & D. R. Gross (Eds.),
healing arts. New York, NY: W. W. Norton. Counseling and psychotherapy: Theories and
Rossi, E. (2007). The breakout heuristic: The new interventions (3rd ed., pp. 387–414). Upper Saddle
neuroscience of mirror neurons, consciousness and River, NJ: Merrill Prentice Hall.
creativity in human relationships (Vol. 1, selected Roy, D. M. (2007). Body-centered counseling and
papers of Ernest Lawrence Rossi). Phoenix, AZ: psychotherapy. In D. Capuzzi & D. R. Gross (Eds.),
Milton H. Erickson Foundation Press. Counseling and psychotherapy: Theories and
Rossi, E. (2012). Creating consciousness: How therapists interventions (4th ed., pp. 360–389). Upper Saddle
can facilitate wonder, wisdom, truth and beauty (Vol. River, NJ: Pearson, Merrill Prentice Hall.
2, selected papers of Ernest Lawrence Rossi). Phoenix, Roy, J. (2014). William Glasser: Champion of choice.
AZ: Milton H. Erickson Foundation Press. Phoenix, AZ: Zeig, Tucker & Theisen.
Rossi, E., & Rossi, K. (2013). Creating new consciousness Rubenfeld, I. (2001). The listening hand: Self-healing
in everyday life: The psychosocial genomics of self through the Rubenfeld synergy method of talk and
creation. Seattle, WA: Amazon Digital Services. (A touch. New York, NY: Bantam Books.
Video eBook available at Amazon.com) Rubenfeld Synergy. (2013). Befriend your body:
Rossi, E. L. (Ed.). (1980). The collected papers of Milton Transform your life. Retrieved from http://www
Erickson on Hypnosis: Vol. 1. The nature of hypnosis .rubenfeldsynergy.com/
and suggestion. New York, NY: Irvington. Rubin, J. A. (2010). Introduction to art therapy: Sources
Rossi, E. L. (Ed.). (1980). The collected papers of Milton & resources (Rev. ed.). New York, NY: Routledge/
Erickson on Hypnosis: Vol. 4. Innovative Taylor & Francis.
psychotherapy. New York, NY: Irvington. Rudes, J., & Guterman, J. T. (2007). The value of social
Rossi, E. L., Erickson-Klein, R., & Rossi, K. (Eds.). constructionism for the counseling profession: A reply
(2008–2014). Collected works of Milton H. Erickson, to Hansen. Journal of Counseling & Development, 85,
M.D. on therapeutic hypnosis, psychotherapy and 387–392. doi:10.1002/j.1556-6678.2007.tb00606.x
rehabilitation (Vols. 1–16). Phoenix, AZ: Milton H. Rudmin, F. (1991). Seventeen early peace psychologists.
Erickson Foundation Press. Journal of Humanistic Psychology, 31(2), 12–43.
Rossi, E. L., Erickson-Klein, R., & Rossi, K. (2010). The doi:10.1177/0022167891312003
collected works of Milton H. Erickson, M.D. (Vols. Ruini, C., & Fava, G. A. (2009). Well-being therapy for
1–10). Phoenix, AZ: Milton H. Erickson Foundation generalized anxiety disorder. Journal of Clinical
Press. Psychology, 65, 510–519. doi:10.1002/jclp.20592
Roszak, T. (1992). The voice of the earth: An exploration Russell, E., & Fosha, D. (2008). Transformational affects
of ecopsychology. Grand Rapids, MI: Phanes Press. and core state in AEDP: The emergence and
Roszak, T., Gnomes, M., & Kanner, A. (Eds.). (1995). consolidation of joy, hope, gratitude and confidence in
Ecopsychology: Restoring the earth, healing the mind. the (solid goodness of the) self. Journal of
San Francisco, CA: Sierra Club Books. Psychotherapy Integration, 18(2), 167–190.
Roth, A., & Fonagy, P. (2005). What works for whom? A doi:10.1037/1053-0479.18.2.167
critical review of psychotherapy research (2nd ed.). Russell, S., & Carey, M. (2004). Narrative therapy:
New York, NY: Guilford Press. Responding to your questions. Adelaide, South
Rothschild, B. (2000). The body remembers: The Australia, Australia: Dulwich Centre.
psychophysiology of trauma and trauma treatment. Russell-Chapin, L., & Chapin, T. (2011). Neurofeedback:
New York, NY: W. W. Norton. A third option when counseling and medication are

not sufficient. Vistas Online. Retrieved from http:// mechanisms keeping women in abusive relationships. In
www.counseling.org/resources/library/vistas/2011-v- C. Arcidiacono, I. Testoni, & A. Groterath (Eds.),
online/Article_48.pdf Daphne and the centaurs: Overcoming gender based
Rutan, J. S. (1992). Psychodynamic group psychotherapy. violence (pp. 93–103). Leverkusen, Germany: Budrich
International Journal of Group Psychotherapy, 42(1), International.
19–35. doi:10.1016/B978-012564745-8/50016-9 Santorelli, S. (2000). Heal thyself: Lessons on mindfulness
Rutan, J. S., Stone, W. N., & Shay, J. J. (2007). in medicine. Boston, MA: Harmony.
Psychodynamic group psychotherapy (4th ed.). Santrock, J. (2013). Lifespan development (14th ed.).
New York, NY: Guilford Press. New York, NY: McGraw-Hill.
Rybak, C., Russell-Chapin, L., & Moser, M. (2000). Satir, V. (1972). Family systems and approaches to
Jung and theories of gender development. Journal of family therapy. In G. D. Erickson & T. P. Hogan
Humanistic Counseling, Education and Development, (Eds.), Family therapy: An introduction to
38(3), 152–161. doi:10.1002/j.2164-490X.2000. theory and technique (2nd ed., pp. 211–225). Pacific
tb00075.x Grove, CA: Brooks/Cole. (Original work published
Ryff, C. D. (1989). Happiness is everything, or is it? 1967)
Explorations on the meaning of psychological well- Satir, V. (1972). Peoplemaking. Palo Alto, CA: Science and
being. Journal of Personality and Social Psychology, 6, Behavior Books.
1069–1081. doi:10.1037/0022-3514.57.6.1069 Satir, V. (1983). Conjoint family therapy. Palo Alto, CA:
Ryle, A. (1997). Cognitive analytic therapy and borderline Science and Behavior Books. (Original work
personality disorder: The model and the method. published 1964)
Chichester, England: Wiley. Satir, V. (1988). New peoplemaking. Palo Alto, CA:
Ryle, A., Kellett, S., Hepple, J., & Simmonds, R. (2014). Science and Behavior Books.
Cognitive analytic therapy (CAT) at thirty. Advances Satir, V., & Baldwin, M. (1982). Satir step by step.
in Psychiatric Treatment, 20, 258–268. doi:10.1192/ Palo Alto, CA: Science and Behavior Books.
apt.bp.113.011817 Satir, V., Banmen, J., Gerber, J., & Gomori, M. (1991).
Ryle, A., & Kerr, I. B. (2002). Introducing cognitive The Satir model: Family therapy and beyond. Palo
analytic therapy: Principles and practice. Chichester, Alto, CA: Science and Behavior Books.
England: Wiley. Satir, V. M., & Bitter, J. R. (1991). Human validation
Sadigh, M., & Montero, R. (2001). Autogenic training: A process model. In A. M. Horne & J. L. Passmore
mind-body approach to the treatment of fibromyalgia (Eds.), Family counseling and therapy (2nd ed.,
and chronic pain syndrome. New York, NY: pp. 13–45). Itasca, IL: Peacock.
Hawthorne Medical Press. Sautter, R. A., & LeBlanc, L. A. (2006). Empirical
Safran, J. (2009, March). President’s column. IARRP applications of Skinner’s analysis of verbal behaviors
eNEWS, 8(1). Retrieved from http://www.iarpp.net/ with humans. The Analysis of Verbal Behavior, 22,
resources/enews/enews16.pdf 35–48.
Safran, J., & Messer, S. B. (1997). Psychotherapy Sayers, J. (1991). Mothers of psychoanalysis. New York,
integration: A postmodern critique. Clinical NY: Henry Holt.
Psychology: Science and Practice, 4, 140–152. Scaer, R. (2005). The trauma spectrum: Hidden wounds
doi:10.1111/j.1468-2850.1997.tb00106.x and human resiliency. New York, NY: W. W. Norton.
Safran, J. D., & Muran, J. C. (2000). Negotiating the Schaefer, C. (Ed.). (2011). Foundations of play therapy.
therapeutic alliance: A relational treatment guide. Hoboken, NJ: Wiley.
New York, NY: Guilford Press. Schanks, D. R. (2007). Associationism and cognition:
Saiger, G. M. (1996). Some thoughts on the existential Human contingency at 25. Quarterly Journal of
lens in group psychotherapy. Group, 20, 113–130. Experimental Psychology, 60, 291–309. doi:10
doi:10.1007/BF02109140 .1080/17470210601000581
Saint-Arnault, D. M., Molloy, M., & O’Halloran, S. Scharff, D. E., & Scharff, J. S. (1987). Object relations
(2012). The use of psychodrama in biodynamic family therapy. Northvale, NJ: Jason Aronson.
psychotherapy: Case examples from a domestic Schein, E. H. (1998). Process consultation revisited:
violence healing workshop. International Journal of Building the helping relationship. Boston, MA:
Family Studies, 17, 111–118. Addison Wesley Longman.
Saint-Arnault, D. M., Molloy, M., O’Halloran, S., & Bell, G. Schermer, V., & Rice, C. (2012). Towards an integrative
(2013). “You made your bed, now you can lie in it”: The intersubjective and relational group psychotherapy. In
biodynamic understanding of healing the social J. L. Kleinberg (Ed.), The Wiley-Blackwell handbook

of group psychotherapy (pp. 59–88). Chichester, Schur, M. (1972). Freud: Living and dying. New York,
England: Wiley. NY: International Universities Press.
Schmidt, S. J. (2004). Developmental needs meeting Schwartz, H. (2012). Intersubjectivity and dialecticism.
strategy: A new treatment approach applied to International Journal of Psychoanalysis, 93, 401–425.
dissociative identity disorder. Journal of Trauma & doi:10.1111/j.1745-8315.2011.00543.x
Dissociation, 5(4), 55–78. doi:10.1300/J229v05n04_04 Schwartz, J. M. (1996). Systematic changes in cerebral
Schmidt, S. J. (2009). The developmental needs meeting glucose metabolic rate after successful behavior
strategy: An ego state therapy for healing adults with modification treatment of obsessive-compulsive
childhood trauma and attachment wounds. San disorder. Archives of General Psychiatry, 53, 109–113.
Antonio, TX: The DNMS Institute. doi:10.1001/archpsyc.1996.01830020023004
Schmidt, S. J., & Hernandez, A. (2007). The Schwartz, M. S., & Andrasik, F. (Eds.). (2005).
developmental needs meeting strategy: Eight case Biofeedback: A practitioner’s guide (3rd ed.).
studies. Traumatology, 13, 27–48. New York, NY: Guilford Press.
doi:10.1177/1534765607299913 Schwartz, R. C. (1995). Internal family systems therapy.
Schmitz, B. (1995). Eine Meta-analyse der Wirksamkeit New York, NY: Guilford Press.
von Gestalttherapie [A meta-analysis of the Schwartz, R. C. (1999). Narrative therapy expands and
effectiveness of Gestalt therapy]. Zeitschrift für contracts family therapy’s horizons. Journal of Marital
Klinische Psychologie, Psychopathologie und & Family Therapy, 25(2), 263–267.
Psychotherapie, 123(2), 324–356. doi:10.1111/j.1752-0606.1999.tb01127.x
Schneider, K. J., & Krug, O. T. (2010). Existential therapy. Schwartz, R. C. (2009). An introduction to internal
Washington, DC: American Psychological Association. family systems therapy. Oak Park, IL: Trailheads.
Schoenberg, P. (2000). The impact of Gestalt group Schwartz, R. C. (2013). Moving from acceptance toward
therapy on persons with borderline personality transformation wither internal family systems therapy
disorder (group therapy). Dissertation Abstracts (IFS). Journal of Clinical Psychology, 69, 805–816.
International: Section A. Humanities and Social doi:10.1002/jclp.22016
Sciences, 60(7-A), 2389. Schwebel, A. I., & Fine, M. A. (1992). Cognitive-behavioral
Schoenewolf, G. (2008). A psychoanalyst’s perspective: family therapy. Journal of Family Psychotherapy, 3(1),
AIDS and the death wish. National Association for 73–91. doi:10.1300/j085V03N01_04
Research and Therapy of Homosexuality. Retrieved Scott, J. (2005). Electra after Freud: Myth and culture.
from http://www.narth.com/docs/deathwish.html Ithaca, NY: Cornell University Press.
Schopler, J. H., & Galinsky, M. J. (1996). Support groups: Scotton, B. W., Chinen, A. B., & Battista, J. R. (Eds.).
Current perspectives on theory and practice. (1996). Textbook of transpersonal psychiatry and
New York, NY: Routledge. psychology. New York, NY: Basic Books.
Schore, A. N. (2002). Advances in neuropsychoanalysis, Scully, M. (1995, April). Viktor Frankl at ninety: An
attachment theory, and trauma research: Implications interview by Matthew Scully. Journal of Religion,
for self psychology. Psychoanalytic Inquiry, 22(3), Culture, and Public Life, 52, 39–43.
433–484. doi:10.1080/07351692209348996 Seelow, D. (2005). Radical modernism and sexuality:
Schore, A. N. (2012). The science of the art of Freud/Reich/D.H. Lawrence & Beyond. New York,
psychotherapy. New York, NY: W. W. Norton. NY: Palgrave Macmillan.
Schreiber-Willnow, K. (2000). The body and self Segal, H. (1973). The work of Melanie Klein. London,
experience grid in clinical Concentrative Movement England: Karnac Books.
Therapy (CMT). In J. W. Scheer (Ed.), The person in Segal, H. (1975). Introduction to the work of Melanie
society: Challenges to a constructivist theory (pp. 317– Klein. London, England: Hogarth Press.
327). Gießen, Germany: Psychosozial. Segal, H. (1979). Klein. London, England: Karnac Books.
Schreiber-Willnow, K., & Seidler, K.-P. (2013). Therapy Segal, H. (1991). Dream phantasy and art. London,
goals and treatment results in body psychotherapy: England: Routledge.
Experience with the concentrative movement therapy Segal, L. (1996). IV. Freud and feminism: A century
evaluation form. Body, Movement and Dance in of contradiction. Journal of the American
Psychotherapy, 8, 254–269. doi:10.1080/17432979.20 Psychoanalytic Association, 6, 290–297.
13.834847 doi:10.1177/0959353596062019
Schultz, R. L., & Feitis, R. (1996). The endless web: Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002).
Fascial anatomy and physical reality. Berkeley, CA: Mindfulness-based cognitive therapy for depression.
North Atlantic Books. New York, NY: Guilford Press.

Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2012). Serrano, X. (2011). Profundizando en el diván reichiano:
Mindfulness-based cognitive therapy for depression La Vegetoterapia en la psicoterapia caracteroanalítica
(2nd ed.). New York, NY: Guilford Press. [More deeply on the Reichian couch: Vegetotherapy in
Seidl, B. (1997). Advanced techniques in ortho-bionomy: character-analytical psychotherapy]. Madrid, Spain:
A unique approach to the integration of body, mind Biblioteca Nueva.
and spirit. Unpublished manuscript. Sexton, T. (1993). A review of the counseling outcome
Seidler, K.-P., & Schreiber-Willnow, K. (2004). research. In G. R. Walz & J. C. Bleuer (Eds.),
Concentrative movement therapy as body-oriented Counselor efficacy: Assessing and using counseling
psychotherapy for inpatients with different body outcomes research (pp. 79–120; Report No. ISBN-1-
experience. Psychotherapy Research, 14, 378–367. 56109-056-5). Ann Arbor, MI: ERIC Clearinghouse
doi:10.1093/ptr/kph031. on Counseling and Personnel Services (ERIC
Selesnick, S. T. (1966). Alfred Adler: The psychology of Document Reproduction Service No. ED362 821).
the inferiority complex. In F. Alexander, S. Eisenstein, Sexton, T. L. (1999). Evidence-based counseling:
& M. Grotjahn (Eds.), Psychoanalytic pioneers (pp. Implications for counseling practice, preparation, and
78–86). New York, NY: Basic Books. professionalism (Report No. ED435948). Greensboro,
Seligman, L. W., & Reichenberg, L. W. (2014). Theories NC: ERIC Clearinghouse on Counseling and Student
of counseling and psychotherapy. Upper Saddle River, Services (ERIC Document Reproduction Service No.
NJ: Pearson. ED99CO0014).
Seligman, M. (1975). Helplessness: On depression, Sexton, T. L., & Whiston, S. C. (1991). A review of the
development, and death. San Francisco, CA: W. H. empirical basis for counseling: Implications for
Freeman. practice and training. Counselor Education and
Seligman, M. (1991). Learned optimism: How to change Supervision, 30, 330–354.
your mind and your life. New York, NY: Knopf. doi:10.1002/j.1556-6978.1991.tb01215.x
Seligman, M. (2002). Authentic happiness: Using the new Shadish, W. R., & Baldwin, S. A. (2003). Meta-analysis of
positive psychology to realize your potential for lasting MFT interventions. Journal of Marital & Family
fulfillment. New York, NY: Free Press. Therapy, 29(4), 547–570.
Seligman, M. (2011). Flourish: A visionary new doi:10.1111/j.1752-0606.2003.tb01694.x
understanding of happiness and well-being. New York, Shalay, N., & Brownlee, K. (2007). Narrative family
NY: Simon & Schuster. therapy with blended families. Journal of Family
Seligman, M. E. P. (1975). Helplessness: On depression, Psychotherapy, 18(2), 17–30. doi:10.1300/
development, and death. San Francisco, CA: W. H. J085v18n02_02
Freeman. Shallcross, L. (2013, April). Building a more complete
Seligman, M. E. P. (1990). Learned optimism. New York, client picture. Counseling Today, 55(10), 30–39.
NY: Knopf. Shamdasani, S. (2003). Jung and the making of modern
Seligman, M. E. P. (2009, June 18). Positive education. psychology: The dream of a science. Cambridge,
Lecture presented at the First World Congress on England: Cambridge University Press.
Positive Psychology, Philadelphia, PA. Shannon, S. (2002). Handbook of complementary and
Seligman, M. E. P., & Csikszentmihalyi, M. (Eds.). (2000). alternative therapies in mental health. San Diego, CA:
Positive psychology [Special issue]. American Academic Press.
Psychologist, 55(1). Shapiro, F. (1989). Efficacy of the eye movement
Seligman, M. E. P., & Csikszentmihalyi, M. (2000). desensitization procedure in the treatment of traumatic
Positive psychology: An introduction. American memories. Journal of Traumatic Stress, 2, 199–223.
Psychologist, 55, 5–14. doi:10.1037/0003- doi:10.1002/jts.2490020207
066X.55.1.5 Shapiro, F. (2001). Eye movement desensitization and
Seligman, M. E. P., & Maier, S. F. (1967). Failure to reprocessing: Basic principles, protocols and
escape traumatic shock. Journal of Experimental procedures (2nd ed.). New York, NY: Guilford Press.
Psychology, 74, 1–9. doi:10.1037/h0024514 Shapiro, F. (2002). (Ed.). EMDR as an integrative
Seligman, M. E. P., & Pawelski, J. O. (2003). Positive psychotherapy approach: Experts of diverse
psychology: FAQs. Psychological Inquiry, 14, 159–163. orientations explore the paradigm prism. Washington,
Semmler, P. L., & Williams, C. B. (2000). Narrative DC: American Psychological Association.
therapy: A storied context of multicultural counseling. Shapiro, F. (2002). EMDR treatment: Overview and
Journal of Multicultural Counseling and Development, integration. In F. Shapiro (Ed.), EMDR as an
28, 51–62. doi:10.1002/j.2161-1912.2000.tb00227.x integrative psychotherapy approach: Experts of diverse

orientations explore the paradigm prism (pp. 27–56). de Shazer, S. (1994). Words were originally magic.
Washington, DC: American Psychological Association. New York, NY: W. W. Norton.
Shapiro, F. (2007). EMDR, adaptive information de Shazer, S., Berg, I. K., Lipchik, E., Nunnally, E.,
processing, and case conceptualization. Journal of Molnar, A., Gingerich, W., & Weiner-Davis, M. (1986).
EMDR Practice and Research, 1, 68–87. Brief therapy: Focused solution development. Family
doi:10.1891/1933-3196.1.2.68 Process, 25, 207–221.
Shapiro, F. (2013). Getting past your past: Take control doi:10.1111/j.1545-5300.1986.00207.x
of your life with self-help techniques from EMDR de Shazer, S., & Dolan, Y. V. (2007). More than miracles:
therapy. New York, NY: Rodale Books. The state of the art of solution-focused therapy.
Shapiro, F. (2014). The role of eye movement Binghamton, NY: Haworth Press.
desensitization and reprocessing therapy in medicine: de Shazer, S., Dolan, Y. V., Korman, H., Trepper, T.,
Addressing the psychological and physical symptoms McCollum, E., & Berg, I. K. (2007). More than
stemming from adverse life experiences. The Permanente miracles: The state of the art of solution-focused brief
Journal, 18, 71–77. doi:10.7812/TPP/13-098 therapy. New York, NY: Haworth Press.
Shapiro, F., & Forrest, M. S. (1997). EMDR: The de Shazer, S., & Isebaert, L. (2003). The Bruges model: A
breakthrough “eye movement” therapy for overcoming solution-focused approach to problem drinking.
anxiety, stress, and trauma. New York, NY: Perseus Journal of Family Psychotherapy, 14(4), 43–52.
Books. doi:10.1300/J085v14n04_04
Shapiro, F., & Laliotis, D. (2011). EMDR and the Shedler, J. (2006). That was then, this is now: An
adaptive information processing model: Integrative introduction to contemporary psychodynamic therapy.
treatment and case conceptualization. Clinical Social Retrieved from http://www.jonathanshedler.com/PDFs/
Work Journal, 39, 91–200. doi:10.1007/s10615-010- Shedler%20(2006)%20That%20was%20then,%20
0300-7 this%20is%20now%20R9.pdf
Shapiro, J. P., Friedberg, R. D., & Bardenstein, K. K. Shedler, J. (2010). The efficacy of psychodynamic
(2006). Child and adolescent therapy: Science and art. psychotherapy. American Psychologist, 65(2), 98–109.
Hoboken, NJ: Wiley. doi:10.1037/a0018378
Shapiro, R. (Ed.). (2005). EMDR solutions: Pathways to Shedler, J. (2010). Getting to know me. Scientific
healing. New York, NY: W. W. Norton. American, 21, 52–57. doi:10.1038/
Shapiro, R. (Ed.). (2009). EMDR solutions II: For scientificamericanmind1110-52
depression, eating disorders, performance, and more. Sheinberg, M., & Fraenkel, P. (2001). The relational
New York, NY: W. W. Norton. trauma of incest: A family-based approach to
Sharaf, M. (1994). Fury on Earth: A biography of treatment. New York, NY: Guilford Press.
Wilhelm Reich. New York, NY: Da Capo. Sheldon, K. M., & King, L. (Eds.). (2001). Positive
Sharf, R. S. (2012). Theories of psychotherapy and psychology [Special issue]. American Psychologist,
counseling. Belmont, CA: Brooks/Cole. 56(3), 216–263.
Sharpe, M. (Ed.). (1995). The third eye: Supervision of Shepard, M. (1975). Fritz. New York, NY: Saturday
analytic groups. London, England: Routledge. Review Press.
Shay, J. J. (2011). Projective identification simplified: Sherlin, L., Arns, M., Lubar, J., & Sokhadze, E. (2010). A
Recruiting your shadow. International Journal of position paper on neurofeedback on the treatment of
Group Psychotherapy, 61, 239–261. doi:10.1521/ ADHD. Journal of Neurotherapy, 14, 66–78.
ijgp.2011.61.2.238 doi:10.1080/10874201003773880
de Shazer, S. (1982). Patterns of brief family therapy. Sherman, R. (1999). Family therapy: The art of integration.
New York, NY: Guilford Press. In R. E. Watts (Ed.), Intervention and strategies in
de Shazer, S. (1984). The death of resistance. Family counseling and psychotherapy (pp. 101–134).
Process, 23, 11–17. Philadelphia, PA: Taylor & Francis.
doi:10.1111/j.1545-5300.1984.00011.x Shinozaki, M., Kanazawa, M., Kano, M., Endo, Y.,
de Shazer, S. (1985). Keys to solution in brief therapy. Nakaya, N., Hongo, M., & Fukudo, S. (2010). Effect
New York, NY: W. W. Norton. of autogenic training on general improvement in
de Shazer, S. (1988). Clues: Investigating solutions in brief patients with irritable bowel syndrome: A
therapy. New York, NY: W. W. Norton. randomized controlled trial. Applied Psychophysical
de Shazer, S. (1991). Putting difference to work. New York, Biofeedback, 35, 189–198. doi:10.1007/s10484-009-
NY: W. W. Norton. 9125-y

Shor, R. E., & Orne, E. C. (1962). The Harvard Group Skinner, B. F. (1953). Science and human behavior.
Scale of hypnotic suggestibility. Palo Alto, CA: New York, NY: Free Press.
Consulting Psychologists Press. Skinner, B. F. (1958). Verbal behavior. New York, NY:
Short, D., Erickson, B. A., & Erickson-Klein, R. (2005). Appleton-Century-Crofts.
Hope and resiliency: Understanding the Skinner, B. F. (1960). Pigeons in a pelican. American
psychotherapeutic strategies of Milton H. Erickson. Psychologist, 15, 28–37. doi:10.1037/h0045345
Norwalk, CT: Crown House. Skinner, B. F. (1968). The technology of teaching.
Siegel, D. (2012). Pocket guide to interpersonal New York, NY: Appleton-Century-Crofts.
neurobiology. New York, NY: W. W. Norton. Skinner, B. F. (1969). Contingencies of reinforcement:
Siegel, D. J. (1999). The developing mind. New York, NY: A theoretical analysis. New York, NY: Appleton-
Guilford Press. Century-Crof.
Sills, F. (2008). Being and becoming: Psychodynamics, Skinner, B. F. (1971). Beyond freedom and dignity.
Buddhism, and the origins of selfhood. Berkeley, CA: New York, NY: Knopf.
North Atlantic Books. Skinner, B. F. (1974). About behaviorism. New York, NY:
Sills, M., & Lown, J. (2008). The field of subliminal mind Knopf.
and the nature of being. European Journal of Skinner, B. F. (1976). Particulars of my life: Part one of an
Psychotherapy & Counselling, 10, 71–80. autobiography. New York, NY: Knopf.
doi:10.1080/13642530701869318 Skinner, B. F. (1978). Reflections on behaviorism and
Silverman, D. (2005). What works in psychotherapy and society. Englewood Cliffs, NJ: Prentice Hall.
how do we know? What evidence-based practice has Skinner, B. F. (1979). The shaping of a behaviorist: Part
to offer. Psychoanalytic Psychology, 22(2), 306–312. two of an autobiography. New York, NY: Knopf.
doi:10.1037/0736-9735.22.2.306 Skinner, B. F. (1983). A matter of consequences: Part three
Silverman, M. S., McCarthy, M., & McGovern, T. (1992). of an autobiography. New York, NY: Knopf.
A review of outcome studies of rational-emotive Skynner, A. C. R. (1976). Systems of marital and family
therapy from 1982–1989. Journal of Rational-Emotive psychotherapy. New York, NY: Brunner/Mazel.
& Cognitive-Behavior Therapy, 10(3), 86–111. Skynner, A. C. R. (1981). An open-systems, group-analytic
doi:10.1007/BF01061071 approach to family therapy. In A. S. Gurman &
Simon, A., & Agazarian, Y. M. (2000). The system for D. P. Kniskern (Eds.), Handbook of family therapy
analyzing verbal interaction. In A. Beck & C. Lewis (pp. 39–84). New York, NY: Brunner/Mazel.
(Eds.), The process of group psychotherapy: Systems Smiley, K. A., & Chaney, M. P. (2010). Reparative
for analyzing change (pp. 357–380). Washington, DC: therapy. ALGBTIC News, pp. 6–8. Retrieved
American Psychological Association. from http://nebula.wsimg.com/e1b513de6f1d34
Simon, R. (2007, March/April). Ten most influential a132b4ef6111a12369?AccessKeyId=1
therapists: The most influential therapists of the past AE1E812BE407E8BE618&disposition=0&
quarter century. Psychotherapy Networker. Retrieved alloworigin=1
from http://www.psychotherapynetworker.org/ Smith, D. (1982). Trends in counseling and
component/content/article/81-2007-marchapril/898- psychotherapy. American Psychologist, 37, 802–809.
ten-most-influential-therapists doi:10.1037/0003-066X.37.7.802
Simon, S., Howe, L., & Kirschenbaum, H. (1979). Values Smith, T. W. (1989). Assessment in rational-emotive
clarification: A handbook of practical strategies for therapy: Empirical access to the ABCD model. In
teachers and students. Hadley, MA: Values Press. M. E. Bernard & R. DiGiuseppe (Eds.), Inside
Simon, S., Howe, L., & Kirschenbaum, H. (1995). Values rational-emotive therapy: A critical appraisal of the
clarification: Your action-directed workbook. theory and therapy of Albert Ellis (pp. 135–152).
New York, NY: Warner Books. New York, NY: Academic Press.
Singer, E. (1965). Key concepts in psychotherapy. Smith, T. W., & Nicassio, P. M. (1995). Psychological
New York, NY: Basic Books. practice: Clinical application of the biopsychosocial
Singer, J. (1994). Boundaries of the soul. New York, NY: model. In P. Nicassio & T. Smith (Eds.), Managing
Anchor Books. chronic illness: A biopsychosocial perspective (pp.
Skinner, B. F. (1938). The behavior of organisms. 1–31). Washington, DC: American Psychological
New York, NY: Appleton-Century-Crofts. Association.
Skinner, B. F. (1948). Walden two. New York, NY: Smuts, J. C. (1926). Holism and evolution. New York,
Macmillan. NY: Macmillan.

Snyder, P. J., Nussbaum, P. D., & Robins, D. L. (2006). Spinelli, E. (2005). The interpreted world: An
Clinical neuropsychology: A pocket handbook for introduction to phenomenological psychology (2nd
assessment. Washington, DC: American Psychological ed.). London, England: Sage.
Association. Spinelli, E. (2007). Practicing existential psychotherapy:
Sonstegard, M. A., & Bitter, J. R. (2004). Adlerian group The relational world. Thousand Oaks, CA: Sage.
counseling and therapy: Step by step. New York, NY: Spotnitz, H. (1976). Psychotherapy of pre-oedipal
Brunner/Routledge. conditions. New York, NY: Jason Aronson.
Southwell, C. (1988). The Gerda Boyesen method: Spruill, D. A., & Benshoff, J. M. (2000). Developing a
Biodynamic therapy. In J. Rowan & W. Dryden (Eds.), personal theory of counseling: A theory building
Innovative therapy in Britain (pp. 179–201). London, model for counselor trainees. Counselor Education
England: Open University Press. and Supervision, 40, 70–80.
Spanos, N. P. (1996). Multiple identities and false St. Clair, M. (2003). Object relations and self psychology:
memories: A sociocognitive perspective. Washington, An introduction. Belmont, CA: Brooks/Cole, Cengage
DC: American Psychological Association. Learning.
Sparks, A. C., & Smith, B. (2008). Narrative St. Clair, M. (2004). Object relations and self-psychology:
constructionist inquiry. In J. A. Holstein & J. F. An introduction (4th ed.). Belmont, CA: Thompson-
Gubrium (Eds.), Handbook of constructionist research Brooks/Cole.
(pp. 295–314). New York, NY: Guilford Press. St. Martin, S. (2011). Symptoms, stories, and the evolving
Spates, R. C., Tateno, A., Nakamura, K., Seim, R. W., & child. Guadalajara, Mexico: Ediciones de La Noche.
Sheerin, C. M. (2011). The experiential therapy of St. Martin, S. (2012). Symptoms, stories, and the evolving
Shoma Morita: A comparison to contemporary child: Using art therapy and biofeedback with
cognitive behavioral therapies. Annals of children, Part I. Somatics Magazine-Journal of the
Psychotherapy & Integrative Health, 14, 14–25. Mind/Body Arts and Sciences, 16(4), 50–51.
Sperry, L. (2006). Biopsychosocial aspects of some St. Martin, S. (2013). Alcanzando Ninos en las Fronteras
common chronic illnesses. In L. Sperry (Ed.), [Reaching children along the U.S./Mexico Border]: A
Psychological treatment of chronic illness: The program for disadvantaged children. Biofeedback,
biopsychosocial therapy approach (pp. 41–64). 41(2), 66–70. doi:10.5298/1081-5937-41.2.01
Washington, DC: American Psychological Association. St. Martin, S. (2013). Symptoms, stories, and the evolving
Sperry, L. (2006). Biopsychosocial therapy: Assessment child: Using art therapy and biofeedback with
and case conceptualization. In L. Sperry (Ed.), children, Part II. Somatics Magazine-Journal of the
Psychological treatment of chronic illness: The Mind/Body Arts and Sciences, 17(1), 36–40.
biopsychosocial therapy approach (pp. 115–139). Staddon, J. E. R. (2010). Adaptive behavior and learning
Washington, DC: American Psychological Association. (2nd ed.). Oxford, England: Oxford University Press.
Sperry, L. (2006). Cognitive behavior therapy of DSM- Retrieved from http://dukespace.lib.duke.edu/dspace/
IV-TR personality disorders (2nd ed.). New York, NY: handle/10161/2878)
Taylor & Francis. Staddon, J. E. R. (2014). The new behaviorism. Florence,
Sperry, L. (2014). Cognitive behavior therapy of DSM-5 KY: Psychology Press.
personality disorders (3rd ed.). New York, NY: Staddon, J. E. R., & Cerutti, D. T. (2003). Operant
Routledge. conditioning. Annual Review of Psychology, 54, 115–
Spiegel, H., & Spiegel, D. (1978). A manual for the 144. doi:10.1146/annurev.psych.54.101601.145124
hypnotic induction profile. New York, NY: Soni Stahl, R., & Goldstein, E. (2010). A mindfulness-based
Medica. stress reduction workbook. New York, NY: New
Spiegel, R. (2004, June 2). Cognitive behavior therapy’s Harbinger.
controversial founder: All things considered Standley, J., Johnson, C. M., Robb, S. L., Brownell, M. D., &
[Transcript]. Washington, DC: National Public Radio Kim, S. (2008). Behavioral approaches to music therapy.
(NPR). In A. A. Darrow (Ed.), Introduction to approaches in
Spillius, E. (1994). Melanie Klein today: Mainly theory music therapy (2nd ed., pp. 105–127). Silver Spring, MD:
(Vol. 1). London, England: Routledge. American Music Therapy Association.
Spinella, M. (2001). The psychopharmacology of herbal Stang, I., & Mittelmark, M. B. (2008). Learning as an
medicine: Plant drugs that alter mind, brain, and empowerment process in breast cancer self-help
behavior. Boston: Massachusetts Institute of groups. Journal of Clinical Nursing, 18, 2049–2057.
Technology. doi:10.1111/j.1365-2702.2008.02320.x

Starr, A. (1973). Sociometry of the family. In H. H. Stickgold, R. (2002). EMDR: A putative neurobiological
Mosak (Ed.), Alfred Adler: His influence on mechanism of action. Journal of Clinical Psychology,
psychology today (pp. 95–105). Park Ridge, NJ: 58, 61–75. doi:10.1002/jclp.1129
Noyes Press. Stige, B. (2002). Culture-centered music therapy. Gilsum,
Staunton, T. (Ed.). (2002). Body psychotherapy: NH: Barcelona.
Advancing theory in therapy. New York, NY: Taylor Stoller, C. C., Greuel, J. H., Cimini, L. S., Fowler, M. S., &
& Francis. Koomar, J. A. (2012). Effects of sensory-enhanced yoga
Stein, D. J., Solms, M., & van Honk, J. (2006, August). on symptoms of combat stress in deployed military
The cognitive-affective neuroscience of the personnel. American Journal of Occupational Therapy,
unconscious. CNS Spectrums, 11(8), 580–583. 66(1), 59–68. doi:10.5014/ajot.2012.001230
Stein, H. T. (1999). Classical Adlerian quotes: Feeling of Stolorow, R. D. (1997). Principles of dynamic systems,
inferiority. Retrieved from http://www.adlerian.us/ intersubjectivity, and the obsolete distinction between
qu-infer.htm one-person and two-person psychologies.
Stein, H. T. (2007). Adler’s legacy: Past, present, and Psychoanalytic Dialogues, 7, 859–868.
future. Retrieved from http://pws.cablespeed doi:10.1080/10481889709539224
.com/~htstein/adlers-legacy.htm Stolorow, R. D. (2007). Trauma and human existence:
Stein, H. T., & Edwards, M. E. (1998). Alfred Adler: Autobiographical, psychoanalytic, and philosophical
Classical theory and practice. In P. Marcus & reflections. New York, NY: Analytic Press.
A. Rosenberg (Eds.), Psychoanalytic versions of the Stolorow, R. D. (2011). World, affectivity, trauma:
human condition: Philosophies of life and their impact Heidegger and post-Cartesian psychoanalysis.
on practice (pp. 64–93). New York, NY: New York New York, NY: Routledge.
University Press. Stolorow, R. D., & Atwood, G. E. (1992). Contexts of
Stein, M. (1982). The aims and goal of Jungian analysis. being: The intersubjective foundations of psychological
In M. Stein (Ed.), Jungian analysis (pp. 27–46). La life. Hillsdale, NJ: Analytic Press.
Salle, IL: Open Court. Stolorow, R. D., Atwood, G. E., & Brandchaft, B. (Eds.).
Steinem, G. (1994). Moving beyond words. New York, (1994). The intersubjective perspective. Northvale, NJ:
NY: Simon & Schuster. Jason Aronson.
Steiner, C. (1974). Scripts people live. New York, NY: Stolorow, R. D., Atwood, G. E., & Orange, D. M. (2002).
Grove Press. Worlds of experience: Interweaving philosophical and
Steiner, C. (1990). Scripts people live: Transactional clinical dimensions in psychoanalysis. New York, NY:
analysis of life scripts. New York, NY: Grove Basic Books.
Press. Stolorow, R. D., Brandchaft, B., & Atwood, G. E. (1987).
Steiner, C. (2009). The heart of the matter: Love, Psychoanalytic treatment: An intersubjective approach.
information and transactional analysis. Pleasanton, Hillsdale, NJ: Analytic Press.
CA: TA Press. Stolze, H. (1983). Concentrative movement therapy. The
Steiner, H. (1996). Treating adolescents. San Francisco, Charlotte Selver Foundation Bulletin: The work after
CA: Jossey-Bass. Elsa Gindler, 11, 9–15.
Steiner, H. (2011). Handbook of developmental Stone, H., & Stone, S. L. (1989). Embracing our selves:
psychiatry. Singapore: World Scientific. The voice dialogue manual. Novato, CA: New World
Steiner, H. (2012). Laudatio for Irvin David Yalom, MD. Library.
Zeitschr. f. Individualpsychol, 37, 293–304. Stone, W. N. (2005). Group-as-a-whole: A self
Stepansky, P. E. (Ed.). (1988). The memoirs of Margaret S. psychological perspective. Group, 29, 239–255.
Mahler. New York, NY: Free Press. Storr, A. (1973). C. G. Jung. New York, NY: Viking
Stern, D. B., Mann, C. H., Kantor, S., & Schlesinger, G. Press.
(1995). Pioneers of interpersonal psychoanalysis. Stout, C. E., & Hayes, R. A. (Eds.). (2005). The
Hillsdale, NJ: Analytic Press. evidenced-based practice: Methods, models, and
Stetter, F., & Kupper, S. (2002). Autogenic training: A tools for mental health professionals. Hoboken, NJ:
meta-analysis of clinical outcome studies. Applied Wiley.
Psychophysiology and Biofeedback, 27(1), 45–98. Strassman, R. (2001). DMT the spirit molecule: A
doi:10.1023/A:1014576505223 doctor’s revolutionary research into the biology of
Steward, I., & Joines, V. (1987). TA today. Chapel Hill, near-death and mystical experiences. Rochester, VT:
NC: Lifespace. Park Street Press.

Street, R. F. (1931). A Gestalt completion test: A study of Swack, J. A. (2009). Elimination of post traumatic stress
a cross-section of intellect. New York, NY: Columbia disorder (PTSD) and other psychiatric symptoms in a
University. disabled Vietnam veteran with traumatic brain injuries
Stricker, G. (2010). Psychotherapy integration. (TBI) in just six sessions using Healing from the Body
Washington, DC: American Psychological Association. Level UpTM methodology: An energy psychology
Stricker, G. (2013). The process of assimilative approach. International Journal of Healing and Caring
psychodynamic integration. Psychotherapy, 50, 404– Online, 9(3). Retrieved from http://www
407. doi:10.1037/a0032719 .wholistichealingresearch.com/user_files/documents/
Stricker, G., & Gold, J. (2005). Assimilative ijhc/articles/Swack-9-3.pdf
psychodynamic psychotherapy. In J. C. Norcross & Swack, J. A. (2012). Elimination of PTSD and psychiatric
M. R. Goldfried (Eds.), Handbook of psychotherapy symptoms in one to six sessions in two civilian women
integration (2nd ed., pp. 221–240). New York, NY: and one female Iraq war veteran using Healing from
Oxford University Press. the Body Level Up (HBLU) methodology: An energy
Stricker, G., & Gold, J. (Eds.). (2006). A casebook of psychology approach. International Journal of Healing
psychotherapy integration. Washington, DC: American and Caring Online, 12(3). Retrieved from http://www
Psychological Association. .wholistichealingresearch.com/123swack.html
Stricker, G., & Gold, J. (Eds.). (2013). Comprehensive Sweeney, T. (1998). Adlerian counseling: A practitioner’s
handbook of psychotherapy integration. New York, approach (4th ed.). Philadelphia, PA: Accelerated
NY: Springer. Development.
Stuart, S., & Robertson, M. (2003). Interpersonal Sweeney, T. (2009). Adlerian counseling and
psychotherapy: A clinician’s guide. New York, NY: psychotherapy: A practitioner’s approach (5th ed.).
Arnold. New York, NY: Routledge.
Study Group on Psychotherapy Cults. (1992). A Swenson, C. C., Henggeler, S. W., Taylor, I. S., & Addison,
documentary history of the career of Harvey Jackins O. W. (2005). Multisystemic therapy and
and re-evaluation counselling. Brussels, Belgium: Study neighborhood partnerships: Reducing adolescent
Group. violence and substance abuse. New York, NY:
Sue, D. W. (1982). Position paper: Cross-cultural Guilford Press.
counseling competencies. The Counseling Psychologist, Swillel, H. I., Land, E. A., & Halperin, D. A. (1993).
10(2), 45–52. doi:10.1177/0011000082102008 Process groups for training psychiatric residents. In
Sue, D. W. (2001). Multidimensional facets of cultural A. Alonso & H. I. Swillel (Eds.), Group psychotherapy
competence. The Counseling Psychologist, 29(6), in clinical practice (pp. 533–547). Washington, DC:
790–821. doi:10.1177/0011000001296002 American Psychiatric Press.
Sue, D. W., Arredondo, P., & McDavis, R. J. (1992). Swingle, P. G. (2010). Biofeedback for the brain. New
Multicultural counseling competencies and standards: Brunswick, NJ: Rutgers University Press.
A call to the profession. Journal of Counseling & Szasz, T. (1961). The myth of mental illness. New York,
Development, 70, 477–486. NY: Paul B. Hoeber.
doi:10.1002/j.1556-6676.1992.tb01642.x Szasz, T. (1974). The myth of mental illness. New York,
Sullivan, H. S. (1953). Conceptions of modern psychiatry. NY: Harper & Row.
New York, NY: W. W. Norton. Talarczyk, M. (2011). Family constellation method of
Sullivan, H. S. (1953). The interpersonal theory of Bert Hellinger in the context of the code of ethics for
psychiatry. New York, NY: W. W. Norton. psychotherapists. Archives of Psychiatry &
Sullivan, H. S. (1954). The psychiatric interview. Psychotherapy, 13(3), 65–74.
New York, NY: W. W. Norton. Tan, E. S. N., & Yarhouse, M. A. (2010). Facilitating
Sullivan, H. S. (1964). The fusion of psychiatry and social congruence between religious beliefs and sexual
sciences. New York, NY: W. W. Norton. identity with mindfulness. Psychotherapy, 47(4), 500–
Sulloway, F. (1979). Biologist of the mind. New York, 511. doi:10.1037/a0022081
NY: Basic Books. Teyber, E. (2001). Interpersonal process in psychotherapy:
Sulloway, F. (1979). Freud, biologist of the mind. A relational approach. Belmont, CA: Brooks/Cole.
New York, NY: Basic Books. Teyber, E., & McClure, F. (2011). Interpersonal process in
Swack, J. A. (2002). Healing from the Body Level Up. In therapy: An integrative model. Belmont, CA: Brooks/
F. P. Gallo (Ed.), Energy psychology in psychotherapy: Cole, Cengage Learning.
A comprehensive source book (pp. 59–76). New York, Thomas, F. N., & Nelson, T. S. (2007). Assumptions and
NY: W. W. Norton. practices within the solution-focused brief therapy

tradition. In T. S. Nelson & F. N. Thomas (Eds.), Townsend, L. (2009). Introduction to pastoral counseling.
Handbook of solution-focused brief therapy: Clinical Nashville, TN: Abingdon.
applications (pp. 3–24). New York, NY: Haworth Tracey, T. J. G. (2002). Stages of counseling and therapy:
Press. An examination of complementarity and the working
Thompson, C. (1943). “Penis envy” in women. Psychiatry, alliance (pp. 265–297). In Tryon, G. S. (Ed.),
6, 123–125. Counseling based on process research: Applying what
Thompson, M., & Thompson, L. (2003). The biofeedback we know. Needham Heights, MA: Allyn & Bacon.
book: An introduction to basic concepts in applied Trask, B. S., & Hamon, R. R. (Eds.). (2007). Cultural
psychophysiology. Wheat Ridge, CO: Association for diversity and families: Expanding perspectives.
Applied Psychophysiology and Biofeedback. Thousand Oaks, CA: Sage.
Thompson, M. J., & Cotlove, C. (2005). The therapeutic Treatment4addiction.com. (2011). Treating addiction
process: A clinical introduction to psychodynamic through attack therapy. Retrieved from www
psychotherapy. Washington, DC: Jason Aronson. .treatment4addiction.com/treatment/types/attack-
Throckmorton, W. (2012). In praise of round pegs. therapy
Edification, 3, 27–28. Trepper, T. S. (2012). Solution-focused brief therapy with
Throckmorton, W., & Yarhouse, M. A. (2006). Sexual families. Asia Pacific Journal of Counseling and
identity therapy: Practice guidelines for managing Psychotherapy, 3(2), 137–148. doi:10.1080/21507686.
sexual identity conflicts. Unpublished paper. Retrieved 2012.718285
from http://sitframework.com/wp-content/ Truax, C. B., & Mitchell, K. M. (1971). Research on
uploads/2009/07/sexualidentitytherapyframeworkfinal certain therapist interpersonal skills in relation to
.pdf process and outcome. In A. E. Bergin & S. L. Garfield
Titelman, P. (Ed.). (1998). Clinical applications of Bowen (Eds.), Handbook of psychotherapy and behavior
family systems theory. Binghamton, NY: Haworth change: An empirical analysis (3rd ed., pp. 299–344).
Press. New York, NY: Wiley.
Todd, J., & Bohart, A. C. (2003). Foundations of clinical Trungpa, C., & Goleman, D. (2005). The sanity we are
and counseling psychology (3rd ed.). Long Grove, IL: born with: A Buddhist approach to psychology.
Waveland Press. Boston, MA: Shambala.
Todd, N., & Wade, A. (2003). Coming to terms with Tsai, M., Kohlenberg, R. J., Kanter, J. W., Holman, G. I.,
violence and resistance: From a language of effects to & Loudon, M. P. (2012). Functional analytic
a language of responses. In T. Strong & D. Pare (Eds.), psychotherapy: Distinctive features. Hove, England:
Furthering talk: Advances in the discursive therapies Routledge.
(pp. 145–161). New York, NY: Kluwer. Tsai, M., Kohlenberg, R. J., Kanter, J. W., Kohlenberg, B.,
Toman, W. (1993). Family constellation: Its effects on Follette, W., & Callaghan, G. (Eds.). (2009). A guide
personality and social behavior (4th ed.). New York, to functional analytic psychotherapy: Awareness,
NY: Springer. courage, love and behaviorism in the therapeutic
Tomm, K. (1998). A question of perspectives. Journal of relationship. New York, NY: Springer.
Marital & Family Therapy, 24(4), 409–413. Tuber, S. (2008). Attachment, play, and authenticity: A
doi:10.1111/j.1752-0606.1998.tb01096.x Winnicott primer. Lanham, MD: Jason Aronson.
Torneke, N. (2010). Learning RFT: An introduction to Tuccillo, E. (2013). Somatopsychic unconscious processes
relational frame theory and its clinical application. and their involvement in chronic relational trauma.
Oakland, CA: New Harbinger. Bioenergetic Analysis, 23, 17–62.
Totora, S. (2006). The dancing dialogue. Baltimore, MD: Tuckman, B. W., & Jensen, M. (1977). Stages of small
Paul H. Brooks. group development. Group and Organizational
Totton, N. (2002). Foreign bodies: Recovering the history Studies, 2, 419–427.
of body psychotherapy. In T. Staunton (Eds.), Body doi:10.1177/105960117700200404
psychotherapy (pp. 7–26). New York, NY: Taylor & Tunnell, G. (2011). An attachment perspective on the first
Francis. interview. In C. Silverstein (Ed.), The initial
Totton, N. (2003). Body psychotherapy: An introduction. psychotherapy interview: A gay man seeks treatment
Philadelphia, PA: Open University Press. (pp. 137–156). New York, NY: Elsevier Insight Books.
Tourish, M., & Irving, P. (1996). Group influence and the (Recipient of 2011 Distinguished Book Award from
psychology of cultism within re-evaluation counseling: American Psychological Association, Division 44)
A critique. Cultural Studies Journal, 13(2), 171–192. Turchin, C. (1979). Pulsing. Energy & Character: The
doi:10.1080/09515079508258695 Journal of Biosynthesis, 10(2), 67–69.

Turchin, C. (1979). Trager body work. Energy & Van Nuys, D. (2007). An interview with William Glasser,
Character: The Journal of Biosynthesis, 10(1), 54–55. MD and Carleen Glasser on happier marriages.
Turk, D., Meichenbaum, D., & Genest, M. (1983). Pain Retrieved from http://www.mentalhelp.net/poc/view_
and behavior medicine. New York, NY: Guilford doc.php?type=weblog&id=283&wlid=9&cn=289
Press. Vandenberghe, L. (2009). A functional analytic approach
Turner, L. H., & West, R. (2006). Perspectives on family to group therapy. The Behavior Analyst Today, 10,
communication (3rd ed.). Boston, MA: McGraw-Hill. 71–82.
Turquet, P. (1974). Leadership: The individual and the Vandenberghe, L., Ferro, C. L. B., & Cruz, A. C. F.
group. In G. S. Gibbard, J. J. Hartman, & R. D. Mann (2003). FAP-enhanced group therapy for chronic pain.
(Eds.), Analysis of groups (pp. 338–357). San The Behavior Analyst Today, 4, 369–375.
Francisco, CA: Jossey-Bass. Vanderbilt, S. (2004, June/July). Hellerwork: Structural
Ulanov, A. B. (1982). Transference/countertransference: A integration for mind, body and spirit. Massage &
Jungian perspective. In M. Stein (Ed.), Jungian analysis Bodywork. Retrieved from http://www
(pp. 68–85). La Salle, IL: Open Court. .massageandbodywork.com/Articles/JuneJuly2004/
United Kingdom Association for Solution Focused Practice. hellerwork.html
(2006). Riding the underground railroad: Insoo Kim VanFleet, R. (2013). Filial therapy (3rd ed.). Sarasota, FL:
Berg talks about the origins and future of the solution Professional Resource Press.
focused approach. Solution News, 2(3), 3–6. VanFleet, R., & Faa-Thompson, T. (2010). A case for
Unutzer, M. P. H., Klap, R., Sturm, R., Young, A. S., using animal-assisted play therapy. British Journal of
Marmon, T., Shatkin, J., & Well, K. B. (2000). Mental Play Therapy, 10, 4–18.
disorders and the use of alternative medicine: Results Veltheim, E. (2001). Who am I? The seeker’s guide to
from a national survey. American Journal of nowhere paperback. Sarasota, FL: PaRama LLC.
Psychiatry, 157, 1851–1857. Veltheim, J. (2013). The science and philosophy of
Ursano, R. J., Sonnenberg, S. M., & Lazar, S. G. (2004). BodyTalk: Healthcare designed by your body.
Concise guide to psychodynamic psychotherapy: Sarasota, FL: PaRama LLC.
Principles and techniques of brief, intermittent, and Vennells, D. F. (1999). Beginner’s guide to Reiki:
long-term psychodynamic psychotherapy (3rd ed.). Mastering the healing touch. New York, NY: Barnes
Washington, DC: American Psychiatric. & Noble.
Utay, J., & Miller, M. (2006). Guided imagery as an Vera, E. M., & Speight, S. L. (2003). Multicultural
effective therapeutic technique: A brief review of its competence, social justice, and counseling psychology:
history and efficacy research. Journal of Instructional Expanding our roles. The Counseling Psychologist,
Psychology, 33, 40–43. 31(3), 253–272. doi:10.1177/0011000003031003001
Values in Action Institute. (2012). Values in action Verny, T. (1982). The secret life of the unborn child.
signature strengths test (based on Seligman’s concept London, England: Sphere.
of authentic happiness). Retrieved from www Viktor Frankl Institute. (2005). Life and work. Retrieved
.authentichappiness.org from http://logotherapy.univie.ac.at/e/lifeandwork.html
Van der Kolk, B. (2014). The body keeps the score: Brain, Viktor Frankl Institute. (n.d.). The institute. Retrieved
mind, body in the healing of trauma. NY, New York: from http://www.viktorfrankl.org/e/institutE.html
Viking Adult. Vineyard, M. (2007). How you stand, how you move,
Van der Kolk, B. A. (1996). The body keeps the score: how you live. Cambridge, MA: Da Capo Press.
Approaches to the psychobiology of posttraumatic Vocisano, C., Klein, D. N., Arnow, B., Rivera, C., Blalock,
stress disorder. In B. A. van der Kolk, A. C. McFarlane, J. A., Rothbaum, B., . . . Thase, M. E. (2004).
& L. Weisaeth (Eds.), Traumatic stress: The effects of Therapist variables that predict symptom change in
overwhelming experience on mind, body, and society psychotherapy with chronically depressed outpatients.
(pp. 214–241). New York, NY: Guilford Press. Psychotherapy: Theory, Research, Practice, Training,
Van der Kolk, B. A., McFarlane, A. C., & Wisaeth, L. 41, 255–265. doi:10.1037/0033-3204.41.3.255
(1996). Traumatic stress: The effects of overwhelming Vontress, C. E. (2009). A conceptual approach to
experience on mind, body and society. New York, NY: counseling across cultures. In C. C. Lee, D. A. Burnhill,
Guilford Press. A. L. Butler, C. P. Hipolito-Delgado, M. Humphrey, O.
Van Laere, F., & Orr, L. D. (2011). Manual for rebirthers. Munoz, & H. Shin (Eds.), Elements of culture in
Madrid, Spain: Vision Libros. counseling (pp. 57–76). Columbus, OH: Pearson.

Wachtel, E. F., & Wachtel, P. L. (1986). Family dynamics Wallerstein, J. S., & Blakeslee, S. (2004). Second chances:
in individual psychotherapy. New York, NY: Guilford Men, women, and children a decade after divorce
Press. (Rev. ed.). New York, NY: Houghton Mifflin.
Wachtel, P. L. (2008). Relational theory and the practice Wallerstein, R. S. (2001). The growth and transformation
of psychotherapy. New York, NY: Guilford Press. of American ego psychology. Journal of the American
Wachtel, P. L. (2011). Inside the session: What really Psychoanalytic Association, 50, 135–169. doi:10.1177
happens in psychotherapy? Washington, DC: American /00030651020500011401
Psychological Association. Wallin, D. J. (2007). Attachment in psychotherapy.
Wachtel, P. L. (2011). Therapeutic communication: New York, NY: Guilford Press.
Knowing what to say when (2nd ed.). New York, NY: Walsh, F. (2006). Strengthening family resilience.
Guilford Press. New York, NY: Guilford Press.
Wacker, D. P., Harding, J., Berg, W., Cooper-Brown, L. J., & Walsh, F. (Ed.). (2011). Normal family processes:
Barretto, A. (2003). Punishment. In W. O’Donohue, Growing diversity and complexity. New York, NY:
U. J. Fisher, & S. C. Hayes (Eds.), Cognitive behavior Guilford Press.
therapy: Applying empirically supported techniques in Walsh, R. (1999). Essential spirituality: The 7 central
your practice (pp. 308–320). Hoboken, NJ: Wiley. practices to awaken heart and mind. New York, NY:
Wade, A. (1997). Small acts of living: Everyday resistance Wiley.
to violence and other forms of oppression. Walsh, R. A., & McElwain, B. (2002). Existential
Contemporary Family Therapy, 19, 23–39. psychotherapies. In D. J. Cain (Ed.), Humanistic
doi:10.1023/A:1026154215299 psychotherapies: Handbook of research and practice
Wade, A. (2007). Despair, resistance, hope: Response- (pp. 253–278). Washington, DC: American
based therapy with victims of violence. In C. Flaskas, Psychological Association.
I. McCarthy, & J. Sheehan (Eds.), Hope and despair in Walsh, W. (1980). A primer of family therapy. Springfield,
narrative and family therapy: Adversity, forgiveness IL: Charles C Thomas.
and reconciliation (pp. 63–74). New York, NY: Walsh, W. B., Craik, K. H., & Price, R. H. (Eds.). (2000).
Routledge. Person-environment psychology: New directions and
Wadeson, H. (2010). Art psychotherapy (2nd ed.). perspectives. Mahwah, NJ: Lawrence Erlbaum.
Hoboken, NJ: Wiley. Walsh, W. M., & McGraw, J. A. (2002). Essentials of
Wagner, C. C., & Ingersoll, K. S. (2012). Motivational family therapy: A structured summary of nine
interviewing in groups. New York, NY: Guilford approaches (2nd ed.). Denver, CO: Love
Press. Publishing.
Wake, N. (2011). Private practices: Harry Stack Sullivan, Wampold, B. E. (2001). The great psychotherapy debate:
the science of homosexuality, and American liberalism. Models, methods, and findings. Mahwah, NJ:
New Brunswick, NJ: Rutgers University Press. Lawrence Erlbaum.
Wakefield, H., & Underwager, R. (1994). Return of the Wampold, B. E. (2010). The basics of psychotherapy: An
furies: An investigation into recovered memory introduction to theory and practice. Washington, DC:
therapy. Chicago, IL: Open Court. American Psychological Association.
Walker, B. M., & Winter, D. (2007). The elaboration of Warner, R. E. (1991). A survey of theoretical orientations
personal construct psychology. Annual Review of of Canadian clinical psychologists. Canadian
Psychology, 58, 453–477. doi:10.1146/annurev. Psychology, 32, 525–528. doi:10.1037/h0079025
psych.58.110405.085535 Waters, E., & Cummings, E. (2000). A secure base from
Walker, M., & Rosen, W. B. (2004). How connections which to explore close relationships. Child
heal: Stories from relational cultural therapy. Wellesley, Development, 71(1), 164–172. doi:10.1111/1467-
MA: Guilford Press. 8624.00130
Wallace, A. B., & Shapiro, S. L. (2006). Mental health Watkins, C. E., & Guarnaccia, C. A. (1999). The scientific
and well-being: Building bridges between Buddhism study of Adlerian theory. In R. E. Watts (Ed.),
and Western psychology. American Psychologist, 61, Intervention and strategies in counseling and
690–701. doi:10.1037/0003-066x.61.7.690 psychotherapy (pp. 207–230). Philadelphia, PA: Taylor
Wallerstein, J. S., & Blakeslee, S. (1989). Second chances: & Francis.
Men, women, and children a decade after divorce. Watkins, J. G., & Watkins, H. H. (1997). Ego oriented:
New York, NY: Ticknor & Fields. Theory and therapy. New York, NY: W. W. Norton.

Watson, G., Batchelor, S., & Claxton, G. (Eds.). (2000). Watzlawick, P., Weakland, J. H., & Fisch, R. (1974).
The psychology of awakening: Buddhism, science, and Change: Principles of problem formation and problem
our day-to-day lives. York Beach, ME: Samuel Wiser. resolution. New York, NY: W. W. Norton.
Watson, J. B. (1925). Behaviorism. Chicago, IL: University Weakland, J. H. (1967). Communication and behavior:
of Chicago Press. An introduction. American Behavioral Scientist, 10(8),
Watson, J. C. (1999). Rational emotive behavior therapy: 1–4.
Origins, constructs, and applications (Report No. Weakland, J. H., & Ray, W. (1995). Propagations: Thirty
CG029710; ERIC Document Reproduction Service years of influence from the mental research institute
No. ED436712) [Electronic version]. Retrieved from (MRI). New York, NY: Haworth Press.
http://eric.ed.gov/?id=ED436712 Wegela, K. (2010). The courage to be present: Buddhism,
Watson, J. C., Goldman, R. N., & Greenberg, L. S. psychotherapy, and the awakening of natural wisdom.
(2007). Case studies in emotion-focused treatment of Boston, MA: Shambala.
depression: A comparison of good and poor outcome. Wegela, K., & Richio, D. (2010). What really helps: Using
Washington, DC: American Psychological Association. mindfulness and compassionate presence to help,
Watts, R. E. (1999). The vision of Adler. In R. E. Watts support and encourage others. Boston, MA: Shambala.
(Ed.), Intervention and strategies in counseling and Weil, A. (1995). Spontaneous healing: How to discover
psychotherapy (pp. 1–13). Philadelphia, PA: Taylor & and enhance your body’s natural ability to maintain
Francis. and heal itself. New York, NY: Knopf.
Watts, R. E. (2000). Biblically based Christian spiritual Weinberg, D. (2008). The philosophical foundations of
and Adlerian psychotherapy. Journal of Individual constructionist research. In J. A. Holstein & J. F.
Psychology, 56(3), 316–328. Gubrium (Eds.), Handbook of constructionist research
Watts, R. E. (Ed.). (2003). Adlerian, cognitive, and (pp. 13–40). New York, NY: Guilford Press.
constructivist psychotherapies: An integrative dialogue. Weinberg, H. (2014). The paradox of Internet groups:
New York, NY: Springer. Alone in the presence of virtual others. London,
Watts, R. E. (2003). Reflecting “as if”: An integrative England: Karnac Books.
process in couples counseling. The Family Journal: Weinhold, J., Hunger, C., Bornhäuser, A., Link, L.,
Counseling and Therapy for Couples and Families, 11, Rochon, J., Wild, B., & Schweitzer, J. (2013). Family
73–75. doi:10.1177/1066480702238817 constellation seminars improve psychological
Watts, R. E., & Carlson, J. (Eds.). (1999). Interventions functioning in a general population sample: Results of
and strategies in counseling and psychotherapy. a randomized controlled trial. Journal of Counseling
New York, NY: Routledge. Psychology, 60(4), 601–609. doi:10.1037/a0033539
Watts, R. E., & Critelli, J. (1997). Roots of contemporary Weininger, O. (1992). Melanie Klein, from theory to
cognitive theories and the individual psychology of reality. New York, NY: Karnac Books.
Alfred Adler: A review. Journal of Cognitive Weintraub, A. (2012). Yoga skills for therapists.
Psychotherapy, 11, 147–156. New York, NY: W. W. Norton.
Watts, R. E., & Holden, J. M. (1994). Why continue to Weishaar, M. E. (1993). Aaron T. Beck. London, England:
use “fictional finalism?” Individual Psychology, 50, Sage.
161–163. Weiss, H., Johanson, G., & Monda, L. (Eds.). (2015).
Watts, R. E., & Pietrzak, D. (2000). Adlerian Hakomi: Mindfulness-centered, somatic
“encouragement” and the therapeutic process of psychotherapy. New York, NY: W. W. Norton.
solution-focused brief therapy. Journal of Counseling Weissman, M. M., Markowitz, J. C., & Klerman, G. L.
& Development, 78, 442–447. (2000). Comprehensive guide to interpersonal
doi:10.1002/j.1556-6676.2000.tb01927.x psychotherapy. New York, NY: Basic Books.
Watts, R. E., & Shulman, B. H. (2003). Integrating Weisstein, N. (1968). Kinder, kuche, kirche as scientific
Adlerian and constructive therapies: An Adlerian law: Psychology constructs the female. Boston, MA:
perspective. In R. E. Watts (Ed.), Adlerian, cognitive, New England Free Press.
and constructivist therapies: An integrative dialogue Weitzenhoffer, A. M., & Hilgard, E. (1962). Stanford
(pp. 9–38). New York, NY: Spring. Scale of hypnotic suggestibility: Form C. Palo Alto,
Watzlawick, P., Beavin-Bavelas, J., & Jackson, D. (1967). CA: Consulting Psychologists Press.
Pragmatics of human communication. New York, NY: Wellesley Centers for Women. (n.d.). Jean Baker Miller,
W. W. Norton. M.D.: Noted feminist, psychoanalyst, social activist

1927-2006. Retrieved from http://www.wcwonline White, K. P. (2009). What psychologists should know
.org/Inactive-Researchers/jean-baker-miller-md about homeopathy, nutrition, and botanical medicine.
Wells, C., Adhyaru, J., Cannon, J., Lamond, M., & Professional Psychology: Research & Practice, 40(6),
Baruch, G. (2010). Multisystemic therapy (MST) for 633–640. doi:10.1037/a0016051
youth offending, psychiatric disorder and substance White, M. (1988). The externalizing of the problem and
abuse: Case examples from a UK MST team. Child the re-authoring of lives and relationships. In Selected
and Adolescent Mental Health, 15, 142–149. papers (pp. 5–28). Adelaide, South Australia,
doi:10.1111/j.1475-3588.2009.00555.x Australia: Dulwich Centre.
Weltmer, A. A. (1900). Suggestion simplified. Nevada, White, M. (1988). Selected papers. Adelaide, South
MO: American School of Magnetic Healing. Australia, Australia: Dulwich Centre.
Werman, D. S. (1984). Principles of supportive White, M. (1991). Deconstruction and therapy. Dulwich
psychotherapy. New York, NY: Brunner/Mazel. Centre Newsletter, 3, 21–40. Adelaide, South
West, J., Otte, C., Geher, K., Johnson, J., & Mohr, D. C. Australia, Australia: Dulwich Centre.
(2004). Effects of hatha yoga and African dance on White, M. (1993). Narrative therapy using a reflective
perceived stress, affect, and salivary cortisol. Annals of team [Video]. Alexandria, VA: American Counseling
Behavioral Medicine, 28(2), 114–118. doi:10.1207/ Association.
s15324796abm2802_6 White, M. (1995). Re-authoring lives: Interviews and
Westcott, M. (1986). The feminist legacy of Karen essays. Adelaide, South Australia, Australia: Dulwich
Horney. New Haven, CT: Yale University. Centre.
Westen, D. (1998). The scientific legacy of Sigmund White, M. (1997). Narratives of therapists’ lives.
Freud: Toward a psychodynamically informed Adelaide, South Australia, Australia: Dulwich Centre.
psychological science. Psychological Bulletin, 124(3), White, M. (2000). Reflections on narrative practice:
333–371. doi:10.1037/0033-2909.124.3.333 Essays and interviews. Adelaide, South Australia,
Wester, K. L., Trepal, H. C., & Myers, J. E. (2009). Australia: Dulwich Centre.
Wellness of counselor educators: An initial look. White, M. (2002). Addressing personal failure.
Journal of Humanistic Counseling, Education & International Journal of Narrative Therapy and
Development, 48(1), 91. Community Work, 3, 33–76.
doi:10.1002/j.2161-1939.2009.tb00070.x White, M. (2007). Maps of narrative practice. New York,
Wheelan, S. (2005). The handbook of group research and NY: W. W. Norton.
practice. Thousand Oaks, CA: Sage. White, M. (2008, May 6). Curriculum vitae (Sent via
Whiddon, J., & Bazini, A. (2011). The effects of hatha e-mail by Jane Hales, assistant to Cheryl White).
yoga in the treatment of depression. Journal of Adelaide, South Australia, Australia: Dulwich Centre.
Alternative Medicine Research, 3, 219–227. White, M., & Epston, D. (1990). Narrative means to
Whitaker, C. (1976). The hindrance of theory in clinical therapeutic ends. New York, NY: W. W. Norton.
work. In P. J. Guerin (Ed.), Family therapy (pp. 154– White, M., Epston, D., & Andrews, J. (1994). The best of
164). New York, NY: Gardner Press. friends: A live interview with Michael White [Video].
Whitaker, C. (1989). Midnight musings of a family Los Angeles, CA: Master’s Works Video Productions.
therapist (M. Ryan, Ed.). New York, NY: W. W. White, M. B., & Tyson-Rawson, K. J. (1995). Assessing
Norton. the dynamics of gender in couples and families: The
Whitaker, C., & Bumberry, W. (1988). Dancing with the gendergram. Family Relations, 44, 253–260.
family: A symbolic-experiential approach. New York, doi:10.2307/585523
NY: Brunner Mazel. White, R. (1963). Ego and reality in psychoanalytic
Whitaker, C., & Malone, T. (1981). The roots of theory: A proposal regarding ego energies. New York,
psychotherapy. New York, NY: Brunner/Mazel. NY: International Universities Press.
(Original work published 1953) White, R. W. (1963). Motivation reconsidered: The
Whitaker, C., & Malone, T. (1993). The roots of concept of competence. In E. J. Shoben & F. L. Ruch
psychotherapy. New York, NY: Blakiston. (Original (Eds.), Perspectives in psychology (pp. 33–59).
work published 1953) Glenview, IL: Scott, Foresman.
Whitaker, R. (2012). Anatomy of an epidemic: Magic White, W., & Miller, W. (2007). The use of confrontation
bullets, psychiatric drugs, and the rise of mental illness in addiction treatment: History, science and time for
in America. New York, NY: Broadway Paperbacks. change. Counselor, 8(4), 12–30.

Whitmont, E. C. (1969). The symbolic quest. Princeton, yourself from chronic unhappiness. New York, NY:
NJ: Princeton University Press. Guilford Press.
Whitmore, D. (1991). Psychosynthesis counseling in Wilson, D. S., Hayes, S. C., Biglan, A., & Embry, D. D.
action. London, England: Sage. (2014). Evolving the future: Toward a science of
Whittington, B. L., & Scher, S. J. (2010). Prayer and intentional change. Behavioral and Brain Sciences,
subjective well-being: An examination of six different 37(4), 395–416. doi:10.1017/S0140525X13001593
types of prayer. The International Journal for the Wilson, E. O. (1984). Biophilia. Cambridge, MA:
Psychology of Religion, 20, 59–68. Harvard University Press.
doi:10.1080/10508610903146316 Wilson, G. T. (2010). Behavior therapy. In R. Corsini &
Wicks, R. J., & Parsons, R. D. (Eds.). (1993). Clinical D. Wedding (Eds.), Current psychotherapies (9th ed.,
handbook of pastoral counseling (Vol. 2). Mahwah, pp. 235–273). Belmont, CA: Brooks/Cole.
NJ: Paulist Press. Wilson, K. G. (1997). Science and treatment development:
Wiener, D. J., & Oxford, L. K. (Eds.). (2003). Action Lessons from the history of behavior therapy.
therapy with families and groups: Using creative arts Behavior Therapy, 28, 547–558. doi:10.1016/S0005-
improvisation in clinical practice. Washington, DC: 7894(97)80011-1
American Psychological Association. Wilson, S., Becker, L. A., & Tinker, R. H. (1997).
Wiggins, J. S. (1991). Agency and communion as Fifteen-month follow-up of eye movement
conceptual coordinates for the measurement and desensitization and reprocessing (EMDR) treatment
understanding of interpersonal behavior. In of post-traumatic stress disorder and psychological
D. Cicchetti & W. M. Grove (Eds.), Essays in honor of trauma. Journal of Consulting and Clinical
Paul E. Meehl (pp. 89–113). Minneapolis: University Psychology, 65, 1047–1056. doi:10.1037/0022-
of Minnesota Press. 006X.65.6.1047
Wilber, K. (1999). Integral psychology: Consciousness, Wingard, B. (2001). Telling our stories in ways that make
spirit, psychology, therapy. In K. Wilber (Ed.), The us stronger. Retrieved from http://www
collected works of Ken Wilber (Vol. 4, pp. 423–718). .narrativetherapylibrary.com/telling-our-stories-in-
Boston, MA: Shambhala. ways-that-make-us-stronger-1.html
Wilber, K. (2000). Integral psychology: Consciousness, Winnicott, D. W. (1958). Through paediatrics to
spirit, psychology, therapy. Boston, MA: Shambhala. psychoanalysis. London, England: Hogarth.
Wilkins, P. (1999). Setting the stage: The instruments and Winnicott, D. W. (1965). Maturational processes and the
techniques of psychodrama. In Creative therapies in facilitating environment. Madison, CT: International
practice: Psychodrama (pp. 20–39). London, England: Universities Press.
Sage. Winnicott, D. W. (1971). Playing and reality. London,
The William Glasser Institute. (2009). Choice theory: The England: Routledge.
ten axioms of choice theory. Retrieved from http:// Winslade, J., Crocket, K., & Monk, G. (1997). The
www.wglasser.com/the-glasser-approach/choice-theory therapeutic relationship. In G. Monk, J. Winslade,
The William Glasser Institute. (2009). International K. Crocket, & D. Epston (Eds.), Narrative therapy in
locations. Retrieved from http://www.wglasser practice: The archaeology of hope (pp. 53–81). San
.officewebsiteonline.com/who-we-are/international- Francisco, CA: Jossey-Bass.
locations Winslade, J., & Geroski, A. (2008). A social
The William Glasser Institute. (2009). Reality therapy. constructionist view of development. In K. Kraus
Retrieved from http://www.wglasser (Ed.), Lenses: Applying lifespan development theories
.officewebsiteonline.com/the-glasser-approach/reality- in counseling (pp. 88–113). New York, NY: Lahaska
therapy Press.
The William Glasser Institute. (2009). The William Winston, A., Rosenthal, R. N., & Pinsker, H. (2004).
Glasser Institute: Home of choice theory. Retrieved Introduction to supportive psychotherapy. Arlington,
from http://www.wglasser.com/ VA: American Psychiatric Publishing.
Williams, E. N., & Barber, J. S. (2004). Power and Winter, D. A. (1992). Personal construct psychology in
responsibility in therapy: Integrating feminism and clinical practice: Theory, research and applications.
multiculturalism. Journal of Multicultural Counseling London, England: Routledge.
& Development, 32, 390–401. Winter, D. A. (2007). Constructivist and humanistic
Williams, M., Teasdale, J., Segal, Z., & Kabat-Zinn, J. therapies. In E. Freeman & M. Power (Eds.),
(2007). The mindful way through depression: Freeing Handbook of evidence-based psychotherapies: A guide

of research and practice (pp. 123–140). West Sussex, Wood, B. L. (2012). Chapter 9: Biopsychosocial. In
England: Wiley. L’Abate, L. (Ed.), Paradigms in theory
Winter, D. A., & Viney, L. L. (Eds.). (2005). Personal construction (pp. 169–186). doi:10.1007/978-1-
construct psychotherapy: Advances in theory, practice 4614-0914-4_9
and research. London, England: Whurr. Wood, M. (2004). The practice of traditional Western
Wittgenstein, L. (1963). Philosophical investigations herbalism, basic doctrine, energetics and classification.
(G. E. M. Anxcombe, Trans.). New York, NY: Berkeley, CA: North Atlantic Books.
Macmillan. Wood, M. (2005). Vitalism: The history of herbalism,
Woelk, H., & Schläfke, S. (2010). A multi-center, double- homeopathy and flower essences. Berkeley, CA: North
blind, randomised study of the Lavender oil Atlantic Books.
preparation Silexan in comparison to Lorazepam for Woolger, R. (1988). Other lives, other selves: A Jungian
generalized anxiety disorder. Phytomedicine, 17, psychotherapist discovers past lives. New York, NY:
94–99. doi:10.1016/j.phymed.2009.10.006 Bantam Books.
Wolf, E. (1988). Treating the self: Elements of clinical self World Health Organization. (1958). Constitution of
psychology. New York, NY: Guilford Press. the World Health Organization. Retrieved from
Wolfert, R. (2000). The spiritual dimensions of Gestalt http://whqlibdoc.who.int/publications/a38153_
therapy. Gestalt, 4(3). annexes.pdf
Wolfgang, C. H. (2001). Solving discipline and classroom World Health Organization. (2013). Guidelines for the
management problems: Methods and models for management of conditions that are specifically related
today’s teachers (5th ed.). New York, NY: Wiley. to stress. Geneva, Switzerland: Author.
Wollheim, R. (1991). Freud. London, England: Fontana Wright, F. (2004). Being seen, moved, disrupted, and
Modern Masters. reconfigured: Group leadership from a relational
Wolpe, J. (1954). Reciprocal inhibition as the main basis perspective. International Journal of Group
of psychotherapeutic effects. Archives of Neurology & Psychotherapy, 54, 235–251. doi:10.1521/ijgp.54.2.235
Psychiatry, 72, 205–226. doi:10.1001/ .40388
archneurpsyc.1954.02330020073007 Wright, J. (2008). Transcript of Jeremiah Wright’s April
Wolpe, J. (1958). Psychotherapy by reciprocal inhibition. 26th, 2008 speech to NAACP. Retrieved from http://
Stanford, CA: Stanford University Press. edition.cnn.com/2008/POLITICS/04/28/wright.
Wolpe, J. (1968). Psychotherapy by reciprocal inhibition. transcript/index.html
Conditional Reflex, 3, 234–240. doi:10.1007/ Wubbolding, R. (1988). Using reality therapy. New York,
BF03000093 NY: Harper & Row.
Wolpe, J. (1990). The practice of behavior therapy (4th Wubbolding, R. (1991). Understanding reality therapy.
ed.). New York, NY: Pergamon Press. New York, NY: HarperCollins.
Wolpe, J. (1997). Thirty years of behavior therapy. Wubbolding, R. (1996). Professional issues: The use of
Behavior Therapy, 28, 633–635. doi:10.1016/S0005- questions in reality therapy. Journal of Reality
7894(97)80023-8 Therapy, 16(1), 122–127.
Wolpe, J., & Lazarus, A. A. (1966). Behavior therapy Wubbolding, R. (2000). Reality therapy for the 21st
techniques: A guide to the treatment of neuroses. century. Philadelphia, PA: Brunner Routledge.
New York, NY: Pergamon Press. Wubbolding, R. (2008). Cycle of managing, supervising,
Wolpe, J., & Plaud, J. J. (1997). Pavlov’s contribution to counseling and coaching [Chart] (16th rev. ed.).
behavior therapy: The obvious and the not so obvious. Cincinnati, OH: Center for Reality Therapy.
American Psychologist, 52, 966–972. Wubbolding, R. (2010). Reality therapy: Monograph
doi:10.1037/0003-066X.52.9.966 psychotherapy series. Washington, DC: American
Wolpe, J., & Turkat, I. D. (1985). Behavioral formulation Psychological Association.
of clinical cases. In J. I. D. Turkat (Ed.), Behavioral Wubbolding, R. (2011). Reality therapy: Theories of
case formulation (pp. 5–35). New York, NY: Plenum psychotherapy series. Washington, DC: American
Press. Psychological Association.
Wong, X. (Compiler-in-Chief). (2003). Life cultivation Wubbolding, R., & Brickell, J. (1998). Qualities of the
and rehabilitation of traditional Chinese medicine (In reality therapist. International Journal of Reality
Chinese and English). Shanghai, People’s Republic of Therapy, 17(2), 47–49.
China: Shanghai University of Traditional Chinese Wubbolding, R., & Brickell, J. (1999). Counselling with
Medicine. reality therapy. Milton Keynes, England: Speechmark.

Wubbolding, R., & Brickell, J. (2001). A set of directions Yim, V. W., Ng, A. K., Tsang, H. W., & Leung, A. Y. (2009).
for putting and keeping yourself together. A review on the effects of aromatherapy for patients
Minneapolis, MN: Educational Media Corporation. with depressive symptoms. Journal of Alternative and
Wubbolding, R., Brickell, J., Imhof, L., Kim, R., Lojk, L., Complementary Medicine, 15, 187–195. doi:10.1089/
& Al-Rashidi, B. (2004). Reality therapy: A global acm.2008.0333
perspective. International Journal for the Advancement Yontef, G. (1990). Gestalt therapy in groups. In
of Counselling, 26(3), 219–228. I. Kutash & A. Woolf (Eds.), Group psychotherapists
doi:10.1023/B:ADCO.0000035526.02422.0d hand book (pp. 191–210). New York, NY: Columbia
Wubbolding, R. E., Basheer, A., Brickell, J., Kakitani, M., University Press.
Kim, R. I., Lennon, B., . . . Tham, E. (1998). Yonteff, G. M. (1976). Theory of Gestalt therapy. In
Multicultural awareness: Implications for reality C. Hatcher & P. Himelstein (Eds.), The handbook of
therapy and choice theory. International Journal of Gestalt therapy (pp. 213–221). New York, NY: Jason
Reality Therapy, 17(2), 4–6. Aronson.
Wuthrich, V. M., & Rapee, R. M. (2013). Randomised Young, J. E. (2002). Schema-focused therapy for
controlled trial of group cognitive behavioural therapy personality disorders. In G. Simos (Ed.), Cognitive
for comorbid anxiety and depression in older adults. behaviour therapy (pp. 201–222). New York, NY:
Behaviour Research and Therapy, 51, 779–786. Routledge.
doi:10.1016/j.brat.2013.09.002 Young, J. E., Arntz, A., Atkinson, T., Lobbestael, J.,
Wylie, M. S. (1994). Panning for gold. The Family Weishaar, M. E., Van Vreeswijk, M., & Klokman, J.
Therapy Networker, 18(6), 40–48. (2007). The Schema Mode Inventory. New York,
Xue, C. C., & Li, C. G. (2003). Principles in designing NY: Schema Therapy Institute.
traditional medicine education programs. Pacific Young, J. E., & Brown, G. (1994). Young schema-
Health Dialog, 10(2), 99–105. questionnaire (2nd ed.). In J. E. Young (Ed.),
Yalom, I. D. (1970). The theory and practice of group Cognitive therapy for personality disorders: A
psychotherapy. New York, NY: Basic Books. schema-focused approach (Rev. ed., pp. 63–76).
Yalom, I. D. (1980). Existential psychotherapy. New York, Sarasota, FL: Professional Resource Press.
NY: Basic Books. Young, J. E., Klosko, J., & Weishaar, M. (2003). Schema
Yalom, I. D. (1983). Inpatient group psychotherapy. therapy: A practitioner’s guide. New York, NY:
New York, NY: Basic Books. Guilford Press.
Yalom, I. D. (with Leszcz, M.). (2005). The theory and Young-Eisendrath, P., & Dawson, T. (2007). The
practice of group psychotherapy (5th ed.). New York, Cambridge companion to Jung. Cambridge, MA:
NY: Basic Books. Cambridge University Press.
Yankura, J., & Dryden, W. (1990). Doing RET: Albert Yucha, C. B., & Montgomery, D. (2008). Evidence-
Ellis in action. New York, NY: Springer. based practice in biofeedback and neurofeedback.
Yarhouse, M. A. (2001). Sexual identity development: The Wheat Ridge, CO: Association for Applied
influence of valuative frameworks on identity Psychophysiology and Biofeedback.
synthesis. Psychotherapy, 38(3), 331–341. Yurdakul, L., Holttum, S., & Bowden, A. (2009).
doi:10.1037/0033-3204.38.3.331 Perceived changes associated with autogenic
Yarhouse, M. A. (2008). Narrative sexual identity training for anxiety: A grounded theory study.
therapy. American Journal of Family Therapy, 36, Psychology and Psychotherapy: Theory, Research,
196–210. doi:10.1080/01926180701236498 & Practice, 82, 403–419. doi:10.1348/147608309
Yarhouse, M. A., & Tan, E. S. N. (2004). Sexual identity X444749
synthesis: Attributions, meaning-making, and the Zalaquett, C. P., Chatters, S. J., & Ivey, A. E. (2013).
search for congruence. Lanham, MD: University Press Psychotherapy integration: Using a diversity-sensitive
of America. developmental model in the initial interview. Journal
Yarhouse, M. A., Tan, E. S. N., & Pawlowski, L. M. of Contemporary Psychotherapy, 43, 53–62.
(2005). Sexual identity development and synthesis doi:10.1007/s10879-012-9224-6
among LGB-identified and LGB dis-identified persons. Zalaquett, C. P., Fuerth, K. M., Stein, C., Ivey, A. E., &
Journal of Psychology & Theology, 33(1), 3–16. Ivey, M. B. (2008). Reframing the DSM-IV-TR from
Yeomans, F. E., Clarkin, J. F., & Kernberg, O. F. (2002). A a multicultural/social justice perspective. Journal of
primer on transference-focused psychotherapy for the Counseling & Development, 86, 364–371.
borderline patient. Northvale, NJ: Jason Aronson. doi:10.1002/j.1556-6678.2008.tb00521.x

Zalenski, R. J., & Raspa, R. (2006). Maslow’s hierarchy Zucker, T. L., Samuelson, K. W., Muench, F., Greenberg,
of needs: A framework for achieving human potential M. A., & Gevirtz, R. N. (2009). The effects of
in hospice. Journal of Palliative Medicine, 9, 1120– respiratory sinus arrhythmia biofeedback on heart rate
1127. doi:10.1089/jpm.2006.9.1120 variability and posttraumatic stress disorder
Zeig, J. K. (1985). Experiencing Erickson: An symptoms: A pilot study. Applied Psychophysiology
introduction to the man and his work. New York, NY: and Biofeedback, 34, 135–143. doi:10.1007/s10484-
Brunner/Mazel. 009-9085-2
Zeig, J. K. (Ed.). (1985). Teaching seminar with Milton H.
Erickson. New York, NY: Routledge.
Websites
Zeig, J. K. (2014). Teaching seminar with Milton H.
Erickson. New York, NY: Taylor & Francis. (Original A. K. Rice Institute for the Study of Social Systems: www
work published 1980) .akriceinstitute.org
Zeig, J. K., & Gilligan, S. G. (Eds.). (1990). Brief therapy: Alcoholics Anonymous: www.aa.org
Myths, methods, and metaphors. New York, NY: American Psychological Association: www.apa.org
Brunner/Mazel. American Society for the Alexander Technique (AmSAT):
Zeig, J. K., & Munion, W. M. (1999). Milton H. www.amsatonline.org
Erickson. Thousand Oaks, CA: Sage. Association for Comprehensive Energy Psychology: www
Zeisel, E. M. (2009). Affect education and the .energypsych.org
development of the interpersonal ego in modern group Association for Contextual Behavioral Science (ACBS):
analysis. International Journal of Group www.contextualscience.org
Psychotherapy, 59(3), 421–432. Association for Provocative Therapy: www
doi:10.1002/9781119950882.ch11 .provocativetherapy.eu
Zeisel, E. M. (2012). Meeting maturational needs in The Association for the Advancement of Gestalt Therapy:
modern group analysis: A schema for personality www.aagt.org
integration and interpersonal effectiveness. In J. L. The Beck Diet Solution: www.beckdietsolution.com/
Kleinberg (Ed.), The Wiley-Blackwell handbook of Bill O’Hanlon: www.billohanlon.com
group psychotherapy (pp. 217–229). West Sussex, Bowen Center for the Study of the Family: www
England: Wiley. .thebowencenter.org
Zimbardo, P. (2007). The Lucifer effect: Understanding BRIEF (formerly the Brief Therapy Practice): www.brief
how good people turn evil. New York, NY: Random .org.uk/
House. EMDR Humanitarian Assistance Programs: www
Zimbardo, P. G. (1972). The Stanford prison experiment: .emdrhap.org
A simulation study of the psychology of imprisonment. European Brief Therapy Association: www.ebta.nu
Retrieved from http://www.prisonexp.org/ The Focusing Institute: The Gendlin Online Library:
Zimbardo, P. G. (1991). Shyness: What it is, what to do www.focusing.org/gendlin/
about it. Reading, MA: Perseus Press. (Original work Index of SDP Papers: www.sdp.org/sdp/papers/
published 1977) The Gestalt Directory: www.gestalt.org
Zimbardo, P. G., & Boyd, J. N. (2008). The time The Gestalt Therapy Network: www.gestalttherapy.net
paradox. New York, NY: Free Press, Simon & International Critical Incident Stress Foundation: www
Schuster. .icisf.org
Zimmer, J., & Shapiro, R. (1976). Projective identification International Federation of Daseinsanalysis: www.i-f-da.org
as a mode of perception of behavior in families of International Gestalt Journal: www.international-gestalt-
adolescents. International Journal of Psychoanalysis, journal.org
5, 523–530. Manchester Gestalt Center for Psychotherapy and
Zimmerman, J., & Dickerson, V. (1996). If problems Counselling: www.123webpages.co.uk
talked: Narrative therapy in action. New York, NY: The Melissa Institute: www.melissainstitute.org
Guilford Press. Mental Research Institute: www.mri.org
Zoellner, L. A., Abramowitz, J. S., & Moore, S. A. (2003). The Milton H. Erickson Foundation: www.erickson
Flooding. In W. O’Donohue, U. J. Fisher, & S. C. foundation.org
Hayes (Eds.), Cognitive behavior therapy: Applying Multitheoretical Psychotherapy: www.multitheoretical.com
empirically supported techniques in your practice Neuropsychoanalysis: www.karnacbooks.com/
(pp. 160–166). Hoboken, NJ: Wiley. JournalNeuroPsycho.asp

PCP-net: www.personal-construct.net/ Society of Teachers of the Alexander Technique (STAT):

Positive Psychology Center: www.ppc.sas.upenn.edu/ www.stat.org.uk
Provocative Change Works: www.provocativechange Somatic Experiencing Trauma Institute: www
works.com .traumahealing.com/
Provocative Therapy: www.provocativetherapy.com Stanford Prison Experiment: www.prisonexp.org/
Radix Institute: www.radix.org Unified Psychotherapy Project: www
Society of Clinical Psychology, American Psychological .unifiedpsychotherapyproject.org
Association, Division 12, Research-Supported Psychological Voice Dialogue International: https://delos-inc.com/index
Treatments: www.psychologicaltreatments.org .htm

Index
Entry titles and their page numbers are in bold. Page numbers preceded by 1: are in volume 1, and page
numbers preceded by 2: are in volume 2.
A. K. Rice Institute, 2:997 Accreditation Council for Graduate Medical Education,

ABC (affect, behavior, cognition) variables, 2:678 1:89, 2:973
ABC (awareness, believe, emotional consequences), of Acculturation, 1:262
emotions, 2:854 Ackerman, Nathan, 1:10–12, 1:247, 1:248, 1:250,
ABCDE (Approach for Changing Disturbing Emotions) 1:488, 2:816–817. See also Ackerman relational
approach, 1:334, 2:851 approach
Abdominal breathing, 1:198 Ackerman Institute for the Family, 1:12–13,
About Illness (Paracelsus), 1:351 1:16–17, 1:264
Abraham, Karl, 2:604, 2:821 Ackerman relational approach, 1:12–17
Accelerated experiential dynamic psychotherapy, 1:1–5 historical context, 1:12–13
affective neuroscience, 1:2 major concepts, 1:14–15
attachment theory and developmental research, 1:2 overview, 1:250
emotion theory, 1:2 techniques, 1:15–16
historical context, 1:1 theoretical underpinnings, 1:13–14
major concepts, 1:2–3 therapeutic process, 1:16–17
overview, 1:232 “Acting as if” technique, 1:34
techniques, 1:3 Actings, 1:159
theoretical underpinnings, 1:1–2 Action, transtheoretical model and, 2:1015
therapeutic process, 1:3–4 Active agency, 1:280
transformational studies, 1:2 Active expressive techniques, 1:240
Acceptance and commitment group therapy, 1:5–7 Active imagination, 1:47
acceptance, defined, 1:6 Activity and mood monitoring, 1:104
historical context, 1:5 Activity structuring and scheduling, 1:104
major concepts and techniques, 1:6 Activity-based group psychotherapy, 1:17–20
theoretical underpinnings, 1:5–6 historical context, 1:17
therapeutic process, 1:6–7 major concepts, 1:18–19
Acceptance and commitment therapy, 1:7–10 overview, 1:474
applied behavior analysis and, 1:51 techniques, 1:19–20
historical context, 1:7 theoretical underpinnings, 1:17–18
major concepts, 1:8–9 therapeutic process, 1:20
overview, 1:96, 1:191, 1:473 Actualizing, phenomenological therapy, 2:775
techniques, 1:9 Actualizing tendency, 2:769
theoretical underpinnings, 1:7–8 Acupuncture and acupressure, 1:20–24
therapeutic process, 1:9–10 acupoints, 1:336
unconditioned acceptance, 2:850–851, 2:916 historical context, 1:20–21
Accommodation, 1:179 integrative forgiveness psychotherapy, 1:560
“Accomplices,” 1:265–266 major concepts, 1:21–23
Accreditation Commission for Acupuncture and Oriental overview, 1:210
Medicine, 1:21 techniques, 1:23–24
1161

1162 Index
theoretical underpinnings, 1:21 Advanced Techniques of Hypnosis and Therapy: Selected

therapeutic process, 1:24 Papers of Milton H. Erickson, M.D. (Erickson), 1:350
as Traditional Chinese Medicine technique, 1:20 Adventure-based therapy, 1:37–39
Adams, Brenda, 2:894 adventure-based counseling model, 1:38
Adams, Katherine, 2:781 historical context, 1:37–38
Adaptive behavior, 2:823 major concepts, 1:38
Addiction, drama therapy for, 1:303 overview, 1:254
ADHD, neurofeedback for, 2:708 techniques, 1:38–39
Adler, Alfred, 1:24–27 theoretical underpinnings, 1:38
Adlerian therapy, 1:30–31 therapeutic process, 1:39
biographical information, 1:24–27 Aerztiliche Seelsorge (The Doctor and the Soul) (Frankl),
classical psychoanalytic approaches and, 1:169, 1:170 1:433
cognitive-behavioral therapies and, 1:189–190 Aesthetics of Change (Keeney), 1:536
constructivist therapies and, 1:217 Affective-reflective dialogue, 1:78
ego psychology and, 1:320, 1:331 Affectivity, 1:588–589, 2:774
existential-humanistic therapies and, 1:375 Affirmation, 2:671, 2:866
Frankl and, 1:432 Agazarian, Yvonne, 2:990–991, 2:992, 2:995
Fromm and, 1:519 Age regression, 2:869
group counseling and psychotherapy theories, Agency, 1:201, 1:280, 1:581, 2:1031
1:473, 1:475 Aggregates, 1:468
inner child therapy and, 1:538 Aigen, Ken, 2:689
logotherapy and, 2:618–619 Ainsworth, Mary, 1:67, 1:70, 1:71, 1:338, 2:831
May and, 2:635, 2:636 Aitken, Robert, 2:617
psychodynamic group psychotherapy and, Albert Ellis Institute, 1:335
2:821, 2:822 Alcanzando Ninos en Las Fronteras, 1:175–176
psychosocial development and, 2:831 Alden, Lynn, 1:420
wellness counseling, 2:1045–1046 Alexander, Franz, 1:64, 2:833
See also Adlerian group therapy; Adlerian therapy Alexander, Frederick Matthias, 1:39–40,
Adlerian group therapy, 1:27–30 2:902, 2:903
historical context, 1:27 Alexander technique, 1:39–43
major concepts, 1:27–29 Alexander and, 1:39–40, 2:902, 2:903
techniques, 1:29 historical context, 1:40
theoretical underpinnings, 1:27 major concepts, 1:41–42
therapeutic process, 1:29–30 overview, 1:127, 1:211
Adlerian therapy, 1:30–35 techniques, 1:42
cognitive behavioral therapies and, 1:190, 1:191 theoretical underpinnings, 1:40–41
contextual therapy and, 1:235 therapeutic process, 1:42–43
historical context, 1:30–31 use of the self, 1:39–40
major concepts, 1:31–32 Alienation, 1:520
overview, 1:170, 1:331, 1:429 Allegiance, 1:207
techniques, 1:32–34 Allen, David, 2:1025, 2:1026
theoretical underpinnings, 1:31 Allers, Rudolf, 1:432
unified therapy, 2:1027 Alliant International University, 1:488
Administration on Aging, Department of Health and Allport, Gordon, 2:897
Human Services, 1:270 Ally, Ted, 1:51
Adolescent Aggression (Bandura, Walters), 2:938 Aloneness, undoing of, 1:2
Adorno, Theodor, 2:875 Alpha Average, The (Remond), 2:715
Advanced integrative therapy, 1:35–37 Alpha function/alpha elements, 2:733
historical context, 1:36 Alternative treatment modality, 1:303
major concepts, 1:36 Ambivalence, 2:670
overview, 1:211 Amen, Daniel, 2:722
techniques, 1:36–37 American Association for Marriage and Family Therapy
theoretical underpinnings, 1:36 (AAMFT), 1:248, 2:932
therapeutic process, 1:37 American Association for Nude Recreation, 1:334

Index 1163
American Association of Pastoral Counselors, 2:758 American Society of Clinical Hypnosis, 1:349
American Association of Suicidology, 2:617 Amplification, 1:47, 2:806
American Board of Professional Psychology, 2:615 Amytal interviews, 2:869
American Cancer Society, 2:1014 Analytic characteristic (applied behavior analysis), 1:53
American College of Orgonomy, 2:876 Analytic third, 2:886
American Counseling Association (ACA), 1:259–260, Analytical music therapy, 2:689
1:335, 1:464, 2:849, 2:925, 2:932 Analytical psychology, 1:43–48
American Dance Therapy Association (ADTA), historical context, 1:43–44
1:269–270 major concepts, 1:45–46
American Foundation of Religion and Psychiatry overview, 1:171, 1:331, 1:429, 2:1013
(Blanton-Peale Institute), 2:758 techniques, 1:47
American Group Psychotherapy Association (AGPA), theoretical underpinnings, 1:44–45
1:419, 1:468, 2:991 therapeutic process, 1:47–48
American Journal of Clinical Hypnosis, 1:349, 2:834 Anapanasati, 1:142–143
American Journal of Dance Therapy, 1:270 Anatomy of Destructiveness, The (Fromm), 1:170
American Medical Association, 1:169, 1:502, 2:635 Anchin, Jack, 1:549
American Music Therapy Association, 2:687 Anderson, Harlene, 1:203, 1:222
American Orthopsychiatric Association, 1:11 Andreas, Connirae, 1:394, 1:540
American Personnel and Guidance Association Andreas, Steve, 1:394, 1:540
(American Counseling Association), 1:259–260 Angel, Ernst, 1:370
American Psychiatric Association, 2:602, 2:925, 2:926, Anima/animus, 1:45
2:932, 2:1057. See also individual references to Animal assisted therapy, 1:48–50
Diagnostic and Statistical Manual of Mental certified therapy animals (CTA), 1:48, 1:49
Disorders historical context, 1:48
American Psychoanalytic Association major concepts, 1:49
cross-cultural counseling theory and, 1:260 overview, 1:255
on training, 1:169 techniques, 1:49–50
American Psychological Association (APA) theoretical underpinnings, 1:48–49
Accelerated Experiential Dynamic Psychotherapy and, 1:5 therapeutic process, 1:50
Annual Convention of, 2:848 “Anna O.” (Breuer’s patient), 1:168, 2:723
Bandura and, 1:87 Anxiety, Horney on, 2:704
Beck and, 1:87, 1:89 Anxious-avoidant attachment, 1:73
classical conditioning, 1:166 Anxious-resistant (ambivalent) attachment, 1:73
classical psychoanalytic approaches, 1:169 Applied behavior analysis, 1:50–55, 1:96
couples, family, and relational models, 1:248 historical context, 1:50–52
cross-cultural counseling theory, 1:260 major concepts, 1:52–54
Division of Clinical Psychology, 1:362–363 techniques, 1:54
Ellis and, 1:334 theoretical underpinnings, 1:52
on evidence-based practice, 1:550 therapeutic process, 1:54–55
evidence-based psychotherapy, 1:362–363 Applied characteristic (applied behavior analysis), 1:53
feedback-informed treatment, 1:401 AQAL (all-quadrants, all-levels), 1:544, 1:545
focusing-oriented therapy, 1:423 Archetypal psychotherapy, 1:55–57
gender aware therapy, 1:449 archetypal, defined, 1:55
Glasser and, 1:464 historical context, 1:55
Lazarus and, 2:615 major concepts, 1:55
Maslow and, 2:631 overview, 1:232
relational psychoanalysis and, 2:884 techniques, 1:57
Rogers and, 2:897 theoretical underpinnings, 1:55–56
Seligman and, 2:783, 2:922 Archetypes, 1:45–46, 2:592, 2:595, 2:596
sexual identity therapy and, 2:925, 2:926 Aristotle, 1:301, 2:714, 2:781, 2:857
sexual minority affirmative therapy and, 2:929, 2:930 Armoring, 1:111, 1:239
sexual orientation change efforts, 2:932 Aromatherapy, 1:57–59
Shapiro and, 2:935 historical context, 1:57–58
Zimbardo and, 2:1063 major concepts, 1:58

1164 Index
overview, 1:211 Association for Applied Psychophysiology and

techniques, 1:58 Biofeedback, 1:116, 2:708
theoretical underpinnings, 1:58 Association for Behavioral and Cognitive Therapies,
therapeutic process, 1:58 1:89, 2:615
Aron, Lewis, 2:884, 2:886 Association for Clinical Pastoral Education, 2:758
Art of Counseling, The (May), 2:635 Association for Comprehensive Energy
Art of Loving, The (Fromm), 1:170 Psychology, 1:345
Art therapy, 1:59–63 Association for Contextual Behavioral Science, 1:7
cognitive enhancement therapy, 1:177, 1:178 Association for Non-White Concerns (ANWC),
Expressive Therapies Continuum (ETC) and, 1:60–61, 1:259–260
1:60 (fig.) Association for Play Therapy (APT), 2:777
historical context, 1:59 Association for Poetry Therapy, 2:781
major concepts, 1:61 Association for Specialists in Group Work, 1:420
overview, 1:255 Association for the Advancement of Behavior Therapy
recovered memory therapy, 2:869 (Association for Behavioral and Cognitive
techniques, 1:61–62 Therapies), 1:89
theoretical underpinnings, 1:59–61, 1:60 (fig.) Association for the Advancement of Psychoanalysis,
therapeutic processes, 1:62–63 2:703
Artistic imagery, 1:479 Association for Transpersonal Psychology, 2:1011
Arugamama, 2:667 Association of Contextual Behavioral Science, 1:5
Asanas, 2:1061 Association of Multicultural Counseling and
Asclepiades, 1:351 Development (AMCD), 1:259–260
Assagioli, Roberto, 2:837–838, 2:1013 Associative channels, 1:391–392
Assertiveness training, 1:100 Aston, Judith, 1:499
Assessing Families and Couples (Minuchin, Nichols, Astor-Lazarus, Donna, 2:615
Lee), 2:662 Attachment group therapy, 1:67–70
Assessment historical context, 1:67
activity-based group psychotherapy, 1:18 major concepts, 1:68–69
behavior modification, 1:91 overview, 1:476
cognitive-behavioral family therapy, 1:184 techniques, 1:69
cognitive-behavioral group therapy, 1:186 theoretical underpinnings, 1:67–68
dance movement therapy, 1:271–272 therapeutic process, 1:69–70
developmental counseling and therapy, 1:286 Attachment theory and attachment therapies, 1:70–75
in drama therapy, 1:302–303 animal assisted therapy, 1:49
EcoWellness, 1:318–319 attachment cycle and holding therapy, 1:505, 1:506
feminist therapy, 1:417–418 attachment group therapy, 1:67–70
integrative family therapy, 1:556 attachment injuries, 1:74
integrative forgiveness psychotherapy, 1:559, 1:560 attachment-focused family therapy, 1:75–79
parent-child interaction therapy, 2:756–757 cyclical psychodynamics, 1:265
positive psychology, 2:786 emotion-focused family therapy, 1:338–339
See also Focused brief group therapy feminist psychoanalytic therapy, 1:413
Assignment and review of homework, 1:104 historical context, 1:71
Assimilation, 1:179, 1:262 interpersonal psychoanalysis, 1:576
Assimilative integration, 1:308 major concepts, 1:72–73
Assimilative psychotherapy integration, 1:63–66 mentalization-based treatment, 2:644
historical context, 1:63–64 overview, 1:232
major concepts, 1:65 rebirthing, 2:861
overview, 1:549 techniques, 1:73–74
techniques, 1:65–66 theoretical underpinnings, 1:71–72
theoretical underpinnings, 1:64–65 therapeutic process, 1:74–75
therapeutic process, 1:66 Attachment-focused family therapy, 1:75–79
Associated Psychological Health Services, 1:563 historical context, 1:75–76
Association for Advancement of Behavior major concepts, 1:76–77
Therapy, 2:614 overview, 1:250

Index 1165
techniques, 1:77–78 Baker, Elsworth, 2:876

theoretical underpinnings, 1:76 Baker, Lester, 2:662, 2:966
therapeutic process, 1:78 Bakhtin, Mikhail, 1:173, 1:203
Attack therapy, 1:79–81 Balance, acupuncture and, 1:22
historical context, 1:79 Balance, family constellation therapy and, 1:400
major concepts, 1:80 Balint, Michael, 2:731, 2:732
overview, 1:149 Bandler, Richard, 1:225, 2:710, 2:809
techniques, 1:80 Bandoroff, Scott, 1:38
theoretical underpinnings, 1:79–80 Bandura, Albert, 1:85–87
Attractor, 1:156 behavior therapies, overiew, 1:94, 1:95, 1:97
Attunement, 1:493 biographical information, 1:85–87
Atwood, George E., 1:586, 1:587 foundational therapies and, 1:427
Auerswald, Dick, 2:661 Lazarus and, 2:678
Australian Family Therapy Journal, 2:1051 Mahoney and, 2:628, 2:641
Austrian Medical Society for Psychotherapy, 1:433 social cognitive theory and, 2:717, 2:938–942
Austrian Socialist High School Students’ Association, Bannister, Don, 2:601
1:432 Barker, Anthony, 1:153
Authentic existence, 1:372–373 Barnes-Jewish Hospital Siteman Cancer Center, 1:160
Authentic Happiness (Seligman), 2:922 Bartlett, Fredric, 1:222
Authentic Movement, 1:269, 1:271 Bartley, William, 2:628
Authoritarian Personality, The (Adorno), 2:875 Base of activities, activity-based group psychotherapy,
Autobiography of a Theory, The (Kelly), 2:599–601 1:18–19
Autobiography of a Yogi (Yogananda), 2:863 Basic anxiety, 2:704
Autogenic training, 1:81–83 Basic conflict, 2:881
biofeedback, 1:118 Basic Fault, 1:553
cognitive enhancement therapy, 1:177 BASIC I.D., 2:614–615, 2:678–679, 2:680
historical context, 1:81 Basic needs, Maslow on, 2:632
major concepts, 1:82 Bass, Ellen, 2:869
overview, 1:211, 2:717 Bateman, Anthony, 2:643
techniques, 1:82 Bateson, Gregory
theoretical underpinnings, 1:81 Ackerman compared to, 1:11
therapeutic process, 1:82–83 Couple and Family Hypnotic Therapy, 1:243, 1:244,
Automatic adaptive anticipatory reactions, 1:165 1:247, 1:248, 1:250
Automatic thoughts, cognitive-behavioral family deShazer and Berg, 1:276
therapy, 1:182 dialectical behavior therapy, 1:297–298
Autonomic activity, 2:721 Erickson and, 1:350
Autonomic dysregulation, 2:638–639 Hakomi therapy, 1:483, 1:487
Autonomic nervous system (ANS), 1:116–117, Haley and, 1:488
1:495, 2:638 interaction focused therapy and, 1:565, 2:623
“Autopilot,” 2:657 Keeney and, 1:536
Autopoiesis, 1:222 narrative family therapy and, 2:691, 2:693
Aversion therapy, 1:95 strategic family therapy and, 2:957, 2:958
Avicenna (Ibn Sina), 1:351 strategic therapy and, 2:962–963, 2:964
Avoidance, 1:103–104 symbolic experiential family therapy and, 2:976
Awareness, 1:459, 2:804–805 systemic family therapy and, 2:986, 2:987, 2:990
Axline, Virginia, 2:777–778 White and, 2:1051
Ayers, Margaret, 2:707 See also Palo Alto Group
Azrin, Nathan, 1:555 Baucom, Donald, 1:181
Baumrind, Diana, 2:756
Babaji, Haidakhan, 2:863 Bavelas, Janet, 1:277
“Baby Care Can Be Modernized” (Skinner), 2:937 Beaulieu, Danie, 1:394, 1:533
“Baby in a Box” (Skinner), 2:937 Beck, Aaron T., 1:87–90
Baer, Donald, 1:51, 1:53 behavioral activation and, 1:102, 1:103
Bainbridge Cohen, Bonnie, 1:124–125 biographical information, 1:87–90

1166 Index
cognitive-behavioral family therapy and, 1:181 Behavior Therapy Techniques (Lazarus, Wolpe), 2:678
cognitive-behavioral group therapy and, 1:185–186 Behavioral activation, 1:102–105
cognitive-behavioral therapies, overview, historical context, 1:102–103
1:189–190, 1:194 major concepts, 1:103–104
cognitive-behavioral therapy and, 1:194 overview, 1:96, 1:101
foundational therapies and, 1:427 techniques, 1:104
group counseling and psychotherapy theories, theoretical underpinnings, 1:103
overview, 1:473–474 therapeutic process, 1:104
Mahoney and, 2:628 Behavioral analysis, 1:104
Meichenbaum and, 2:641 Behavioral (chain) analysis, dialectical behavior therapy
mindfulness-based cognitive therapy and, 2:656 and, 1:294
positive psychology and, 2:787 Behavioral chains (BC), 1:92
psychoeducational groups and, 2:826 Behavioral characteristic (applied behavior
rational emotive behavior therapy and, 2:849 analysis), 1:53
schemas and, 2:908 Behavioral context, 1:103
unified therapy and, 2:1027 Behavioral group therapy, 1:105–108
Becoming Partners: Marriage and Its Alternatives historical perspective, 1:105
(Rogers), 2:897 overview, 1:473
Behavior techniques, 1:106–108
defined, 1:103 theoretical underpinnings, 1:105–106
ecological counseling and, 1:311–313 Behavioral Interventions, 1:51
identity renegotiation counseling, 1:530 Behavioral investment theory (BIT), 2:1022–1024
Behavior analysis. See Applied behavior analysis Behavioral parent training, 1:183
Behavior Analysis in Practice, 1:51 Behavioral Research & Therapy Clinics, 2:617
Behavior Analyst Certification Board, 1:51–52 Behavioral skills training (BST), 1:93
Behavior modification, 1:90–93 Behavioral Tech Research, Inc., 2:617
attack therapy, 1:80 Behaviorism, 1:90
historical context, 1:90 Behavioural Psychotherapy, 2:650
major concepts, 1:90–92 Behind the One-Way Mirror (Madanes), 2:623–624
overview, 1:96 Behr, Harold, 1:467
techniques, 1:92–93 Being and Time (Heidegger), 1:273, 2:772
theoretical underpinnings, 1:90 “Being present,” 1:6, 1:8
therapeutic process, 1:93 “Being public,” 1:204–205
Behavior of Organisms, The (Skinner), 2:936 “Being-in-the-world,” 1:274, 1:371–372
Behavior Research and Therapy, 1:51, 2:614 Bell, Charles, 2:714
Behavior the Control of Perception (Powers), 1:463 Belonging, family constellation therapy and, 1:400
Behavior therapies: overview, 1:93–98 Belonging, Maslow on, 2:632
behavior therapy, defined, 1:93 Benedict, Ruth, 1:511, 2:630, 2:753
historical context, 1:93–94 Benign neurosis, 1:520
short descriptions of, 1:96–97 (See also individual Benjamin, Jessica, 1:413, 1:584, 2:885, 2:886
discussions of behavior therapies) Bennis, Warren, 2:991
theoretical context, 1:94–96 Bentham, Jeremy, 1:221–222
Behavior therapy, 1:98–102 Berg, Insoo Kim. See De Shazer, Steve and Insoo Kim Berg
cognitive-behavioral family therapy, 1:184 Berger, Hans, 2:707, 2:715
cognitive-behavioral therapies and, 1:189–190 Berger, Peter, 1:221–222, 2:736
historical context, 1:98 Bergson, Henri, 1:25–26, 1:157
Lazarus and, 2:678 Berkeley, George, 1:221
major concepts, 1:99–101 Berlin Institute, 1:519
overview, 1:96, 1:430 Berlin Psychoanalytic Institute, 1:110, 1:511
rational emotive behavior therapy, 2:848–853 Berlin Psychoanalytic Society (BPS), 2:604, 2:605–606
theoretical underpinnings, 1:98–99 Bernays, Anne, 2:649
therapeutic process, 1:101–102 Bernays, Martha, 1:434
Behavior Therapy and Beyond (Lazarus), 2:614, 2:678 Berne, Eric, 1:332–333, 1:399, 1:533, 1:538,
Behavior Therapy Institute, 2:614 2:1006–1007

Index 1167
Bernheim, Hippolyte, 1:440, 1:525 theoretical underpinnings, 1:120–121

Beta elements, 2:733 unifying nonlinear dynamical biopsychosocial systems
Beutler, Larry, 1:64, 1:307 approach, 2:1030
Beyond Freedom in Dignity (Skinner), 2:937 Bipilor transference, 2:913
Beyond the Pleasure Principle (Freud), 1:329, Bisicchia, Margaret, 2:1063
2:608, 2:875 Blagys, Matthew, 1:230–231
Bezergianov, Roumen, 1:161 Blanchardand, Edward, 1:86–87
Bibliotherapy, 1:108–110 Blanton, Smiley, 2:758, 2:781
historical context, 1:108 Blanton-Peale Institute, 2:758
major concepts, 1:108–109 Block, Donald, 1:12
overview, 1:255 Blocking, 1:164
poetry therapy, 2:780–783 Blue, Yvonne, 2:936
recovered memory therapy, 2:869 Blume, E. Sue, 2:869
techniques, 1:109 Blume, Thomas W., 1:529
theoretical underpinnings, 1:108 Bobo doll, 1:85, 2:938
therapeautic process, 1:109 Body armor, 2:792, 2:841–842
Bifurcation, 1:156 Body dialogue, concentrative movement therapy and,
Bijou, Sidney, 1:51 1:215–216
Bilateral (brain) stimulation, 1:139 Body image, 1:215
Binswanger, Ludwig, 1:273, 1:370, 2:636, 2:772 Body memories, 2:868
Biodynamic psychology, 1:110–112 Body scans, 2:655, 2:659
historical context, 1:110 Body Self and Soul (Rosenberg, Rand), 1:552
major concepts, 1:111–112 Body-centered therapy, 1:336, 1:460, 1:484
overview, 1:127 Body/energy reading, 1:240
theoretical underpinnings, 1:110–111 Bodymind, 2:791, 2:841
Bioenergetic analysis, 1:113–115 Body-Mind Centering®, 1:124–126
historical context, 1:113 historical context, 1:125
major concepts, 1:113–114 major concepts, 1:125
overview, 1:127 overview, 1:127
techniques, 1:114–115 techniques, 1:125–126
therapeutic process, 1:114–115 theoretical underpinnings, 1:125
Biofeedback, 1:115–119 Body-oriented therapies: overview, 1:126–129
BodyTalk and, 1:130 body symptoms and, 1:126–127
cognitive enhancement therapy, 1:177–178 historical context, 1:127
feedback, defined, 1:115–116 short descriptions of, 1:127–129
heart rate variability, 1:496 theoretical underpinnings, 1:127
historical context, 1:116 BodyTalk, 1:129–131
major concepts, 1:116–118 historical context, 1:129–130
neuroprocessing, 2:721–722 major concepts, 1:130–131
techniques, 1:118 theoretical underpinnings, 1:130
theoretical underpinnings, 1:116 therapeutic process, 1:131
therapeutic process, 1:119 Bodywork, 2:869
Biofeedback Certification International Alliance, 1:116 Bogardus, Emory S., 1:259
Biofeedback Research Society (Association for Applied Boisen, Rev. Anton, 2:758
Psychophysiology and Biofeedback), 1:116 Bonding, 2:881
Biofield therapies, 1:492 Bonnah, Shelly, 2:894
Bion, Wilfred R., 1:169, 1:468, 1:477, 1:584, 2:607, Bonny, Helen, 2:689
2:731, 2:802, 2:826, 2:880, 2:997, 2:998 Bonny method, of guided imagery and music, 2:689
Biophilia hypothesis, 1:48–49 Bonow, Jordan, 1:51
Biopsychosocial model, 1:119–124 “Book ending,” 1:421
historical context, 1:120 Borda, Charmaine, 2:662
major concepts, 1:121–122 Borderline personality behavior, 1:294
overview, 1:549 Boscolo, Luigi, 1:298, 2:755, 2:986, 2:988

1168 Index
Boss, Medard, 1:273–274, 1:370, 2:636, 2:772 deep breathing, 1:118

Böszörményi-Nagy, Ivan, 1:131–133, 1:234, 1:235, heart-focused, 1:498
1:236, 2:816–817, 2:985 holotropic breathwork, 1:507–509
Bottle-feeding, holding therapy and, 1:506 integrative body psychotherapy, 1:553
Boundaries, 1:250, 2:968, 2:1005 meditation introduction and, 2:639
Boundary-determined media, 1:61 mindful breathing, 2:655
Bowen, Murray, 1:133–137 mindfulness-based stress reduction, 2:659
Ackerman and, 1:11 pranayama, 2:1061
biographical information, 1:133–136 prolonged exposure therapy, 2:807, 2:808
family psychotherapy, 1:134–136, 1:135 (fig.) pulsing, 2:842
Mahler and, 2:626 Radix, 2:847
multigenerational family therapy, 2:672–674, rebirthing-breathwork, 2:862–866
2:675–676 Reichian breathwork, 2:792
systemic family therapy and, 2:986 three-minute breathing space, 2:657
transgenerational family therapy, 1:248 See also Breathwork in contemplative psychotherapy;
unified therapy and, 2:1025, 2:1027 Holotropic breathwork; Mindfulness techniques;
Bowen Center for the Study of the Family, 1:134 Rebirthing-breathwork
Bowenian therapy. See Multigenerational family therapy Breathwork in contemplative psychotherapy, 1:142–144
Bowlby, John historical context, 1:142
attachment group therapy, 1:67 major concepts, 1:143
attachment theory and attachment therapies, 1:70, overview, 1:211
1:71, 1:76 theoretical underpinnings, 1:142–143
contemporary psychodynamic-based therapies, 1:230 therapeutic process, 1:144
emotion-focused therapy, 1:338, 1:341 Breuer, Josef, 1:168, 1:352, 1:434, 1:525, 2:723
group counseling and psychotherapy theories, Brickell, John, 1:464
overview, 1:476 Bridging, 2:665, 2:679–680
Klein and, 2:606 Brief Family Therapy Center (BFTC), 1:144, 1:145,
object relations theory and, 2:731, 2:732 1:147, 1:276, 2:943, 2:946
relational psychoanalysis and, 2:885 Brief solution-based group therapy. See Focused brief
theory of psychosocial development and, 2:831 group therapy
writing therapy and, 2:1054 Brief therapy, 1:144–148
Boyd, John, 2:1064 historical context, 1:145
Boyesen, Gerda, 1:110 major concepts, 1:146
Bracketing, 2:774 overview, 2:750
Bradshaw, John, 1:538 techniques, 1:146–147
Braid, James, 1:352, 1:525 theoretical underpinnings, 1:145–146
Brain Change Therapy, 1:137–140 therapeutic process, 1:147
historical context, 1:137 Brief Therapy Center, 1:145, 1:298
major concepts, 1:138 Brief Therapy Conference, 1:464
overview, 1:355, 2:717 British Association for Counselling & Psychotherapy,
techniques, 1:138–139 1:241
theoretical underpinnings, 1:137–138 “British Psychiatry and the War” (Lacan), 2:607
therapeutic process, 1:140 British Psychoanalytic Institute, 2:731
Brainspotting, 1:140–142 British Psychoanalytical Society, 1:67
historical context, 1:140 Broca, Paul, 2:714
major concepts, 1:141 Broch, Eva, 1:238
overview, 1:211 Bromberg, Philip, 2:885
theoretical underpinnings, 1:141 Bronfenbrenner, Urie, 1:311, 1:312
therapeutic process, 1:141–142 Brooklyn College, 2:630
Brandchaft, Bernard, 1:587 Brown, Barbara, 2:715
Breathing techniques Brown, Juliana, 2:795
abdominal breathing, 1:198 Bruke, Ernst, 1:434
breath meditation, 2:639 Bruner, Jerome, 1:222
Core Energetics, 1:240 Bruscia, Kenneth E., 2:687

Index 1169
Buber, Martin, 1:132, 1:235, 1:369, 1:370, 1:457, Centre for Applied Social Research, 2:997
1:458, 2:762 Centre for Reality Therapy, 1:464
Buddhism Cerebral electric stimulation, 1:151–155
breathwork in contemplative psychotherapy, 1:143 historical context, 1:151–152
contemplative psychotherapy and, 1:226–229 major concepts, 1:152–153
Core Process Psychotherapy, 1:240–242 overview, 2:717
mindfulness-based stress reduction, 2:658–659 techniques, 1:153–154
Bugental, James F.T., 1:370, 2:628 theoretical underpinnings, 1:152
Burgholzi Mental Hospital, 1:43 therapeutic process, 1:154
Burlingham, Dorothy, 1:67 Certification Board for Music Therapy, 2:687
Burns, George W., 2:700 Certified therapy animals (CTA), 1:48, 1:49
Burroughs, William, 2:876 Chace, Marian, 1:269, 1:270–271
Bussey, K., 2:939 Chaining, 2:741
Buzzell, Linda, 1:314 Chakras, 1:209
Byng-Hall, John, 1:338 Chalquist, Craig, 1:314
Change: Principles of Problem Formation and
C. G. Jung Institute, 1:55 Problem Resolution (Watzlawick, Weakland,
Cabot, Richard, 2:758 Fisch), 1:145
Cacioppo, John, 2:1030 Changing-point-of-view drawing, for art therapy, 1:62
Cajal, Santiago Ramon, 2:714–715 Channels, 2:805–806
Calendar, pleasant/unpleasant events, 2:657 Chaos theory, 1:155–157
California Psychological Association, 2:615, 2:935 historical context, 1:155
Callahan, Roger, 1:344–345 major concepts, 1:155–156
Camera check, 2:855 overview, 2:750
Canlas, Reynaldo, 1:162 techniques, 1:156
Cannon, Walter, 1:496–497 theoretical underpinnings, 1:155
Canon of Medicine, The (Avicenna), 1:351 therapeutic process, 1:156
Canton, Richard, 2:706–707 Character, 1:459, 1:483–484, 1:553–554
Caplan, Gerald, 1:257 Character Analysis (Reich), 1:159, 2:744, 2:875
Carey, Timothy A., 2:647 Character armor, 2:874
Carl Rogers on Encounter Groups (Rogers), 1:571 Character structure, 1:239, 2:744–745, 2:747, 2:792
Carrier, Renee-Claude, 2:894 Characteranalytical vegetotherapy, 1:157–160
“Carrying forward,” 1:424 historical context, 1:157–158
Carter, Betty, 1:407 major concepts, 1:159
Case conceptualization, 1:442–443 overview, 1:127–128
CASIO (circumstances, attitude, standards, important, theoretical underpinnings, 1:158–159
other), 2:786 therapeutic process, 1:159–160
Castonguay, Louis, 1:66 Charcot, Jean-Martin, 1:352, 1:354, 1:434, 1:440, 1:525
“Catching oneself,” 1:34 Chard, Kathleen, 1:179
Cautious, dangerous, and/or illegal practices: overview, Charge/discharge, 1:239
1:149–151 Chess therapy, 1:160–163
historical context, 1:149–150 historical context, 1:161
short descriptions, 1:150–151 (See also individual major concepts, 1:161–162
names of therapies) overview, 1:255
theoretical underpinnings, 1:150 techniques, 1:162
Cecchin, Gianfranco, 1:298, 2:755, 2:986, 2:988, 2:989 theoretical underpinnings, 1:161
Center for Family Studies, 1:298 therapeutic process, 1:162
Center for Self Leadership, 1:568 Chestnut Lodge Hospital, 2:972
Center for the Treatment and Study of Anxiety, Chicago Psychoanalytic Institute, 2:910
2:806–807 Chickering, Arthur, 2:831
Center for the Whole Person, 2:795 Child & Family Behavior Therapy, 1:51
Centering, 1:492 Childhood and Society (Erikson), 1:170, 2:830
Centering Prayer technique, 2:639 Children’s Hospital of Philadelphia, 2:661–662
Central relatedness, 1:520 Chodorow, Nancy, 1:413

1170 Index
Chogyam Trungpa, 1:142, 1:211, 1:226 interpersonal psychoanalysis, 1:576

Choice, self-determination and, 2:770 interpersonal psychotherapy, 1:578–579
Choice theory, 2:858 intersubjective stance of therapists, 1:77 (See also
Choice Theory (Glasser), 1:463 Attachment-focused family therapy)
Chomsky, Noam, 2:937 meditation, 2:640
Christ, 2:758 multimodal therapy, 2:679
Christensen, Andrew, 1:555 narrative family therapy, 2:692–693
Chronicity, 1:540–541 possibility therapy, 2:789–790
Chrysippus, 2:908 provocative therapy, 2:910
Circadian healing, 2:836 reality therapy, 2:859
Circular causality, 1:249, 1:565 relational group psychotherapy, 2:881–882
Circular questioning, 1:566 therapist tasks in FAGT, 1:443
Circumplex, 1:581–582, 1:582 (fig.) transference and countertransference,
City College of New York (CCNY), 2:641 1:231–232, 1:242
Clark University, 1:169 See also Transference
Classical conditioning, 1:163–167 Cline, Foster, 1:505
behavior modification and, 1:92 Clinebell, Howard, 1:314
historical context, 1:163 Clinical Treatment of the Problem Child
major concepts, 1:164–165 (Rogers), 2:896
overview, 1:95, 1:96, 1:98 Clinically relevant behaviors (CRBs), 1:446–447
techniques, 1:165–166 Clinton, Asha, 1:36, 1:211
theoretical underpinnings, 1:163–164 Clockwork Orange, A (Kubrick), 1:95
therapeutic process, 1:166–167 Cloe Madanes Center Against Child Abuse, 2:624
Classical psychoanalytic approaches: overview, Cluttered space, 1:228
1:167–171 Coates, Linda, 2:894
historical context, 1:167 Coburn, William J., 1:587
short descriptions, 1:170–171 (See also individual Co-counseling. See Re-evaluation counseling
names of therapies) Co-Counseling International (CCI), 2:871
theoretical context, 1:167–170 Co-Counselling (Kauffman, New), 2:871
Classification systems, for disorders, 1:89 Cocreation of meaning, 1:77
Clay manipulation, for art therapy, 1:62 Cognition, behavior therapy and, 1:100
Client factors, 1:207 Cognition and Behavior Modification (Mahoney),
Client-centered counseling. See Person-centered 2:628
counseling Cognitive analytic therapy, 1:172–175
Client-therapist relationship historical context, 1:172
biopsychosocial model, 1:122, 1:123 major concepts, 1:173–174
common factors in, 1:208 overview, 1:191, 1:549
counseling relationship, 1:232 techniques, 1:174–175
counselor self-awareness, feminist therapy, 1:417 theoretical underpinnings, 1:172–173
developmental constructivism, 1:281–282 therapeutic process, 1:175
developmental counseling and therapy, 1:284, 1:288 Cognitive and Behavioral Practice, 1:51
emotion-focused therapy, 1:343 Cognitive Behavioral Treatment for Borderline
energy psychology, 1:346–347 Personality Disorder, 2:617
experiential psychotherapy, 1:380–381 Cognitive blocks, 1:286
feedback-informed treatment, 1:402 Cognitive defusion, 1:6, 1:8
Focusing-Oriented Therapy, 1:425 Cognitive enhancement therapy, 1:175–179
gender aware therapy, 1:451 historical context, 1:175–176
Gestalt group therapy, 1:455 major concepts, 1:176–177
guided imagery therapy, 1:479 overview, 2:717–718
Hakomi therapy, 1:485–486 techniques, 1:177–178
impact therapy, 1:534–535 theoretical underpinnings, 1:176
integral psychotherapy, 1:545 therapeutic process, 1:178
integrative forgiveness psychotherapy, 1:559–560 Cognitive modification, dialectical behavior therapy and,
interaction focused therapy, 1:567 1:294–295

Index 1171
Cognitive processing therapy, 1:179–181 major concepts, 1:204–205

historical context, 1:179 overview, 1:219
techniques, 1:180 techniques, 1:205
theoretical underpinnings, 1:179–180 theoretical underpinnings, 1:203–204
therapeutic process, 1:180 therapeutic process, 1:205
Cognitive rehearsal, 1:197 Collaborative Therapy for Multi-Stressed Families
Cognitive restructuring, 1:182, 1:197, 1:506 (Madsen), 2:696
Cognitive schema, 1:182 Collective unconscious, 1:46, 2:592,
Cognitive-Behavior Modification: An Integrative 2:595, 2:596
Approach (Meichenbaum), 1:189, 2:641 College of Traditional Acupuncture, 1:21
Cognitive-behavioral family therapy, 1:181–185 Colloquium Series, 2:649–650
historical context, 1:181 Colorado State University—research done by Thaut at
major concepts, 1:182 this school, 2:690
overview, 1:250 Columbia University, 1:10–11, 2:630, 2:649
techniques, 1:182–184 Committed action, 1:6
therapeutic process, 1:184 Common factors in therapy, 1:205–208
Cognitive-behavioral group therapy, 1:185–188 eclecticism, 1:308
major concepts, 1:186–187 major concepts, 1:207–208
overview, 1:473–474 overview, 1:549, 2:751
theoretical underpinnings, 1:185–186 theoretical underpinnings, 1:206–207
therapeutic process, 1:187–188 therapeutic process, 1:208
Cognitive-behavioral therapies: overview, 1:188–194 Communication
generally, 1:430 chaos theory and, 1:156
historical context, 1:189–190 cognitive-behavioral family therapy, 1:183
short descriptions, 1:191–193 (See also individual human validation process model, 1:515
names of therapies) interpersonal psychotherapy, 1:578
theoretical context, 1:190–191 metacommunication, 2:1028
Cognitive-behavioral therapy, 1:194–199 Palo Alto Group and, 2:753–755
evidence-based psychotherapy, 1:364 psychodynamic family therapy, 2:819
historical context, 1:194–195 relational group psychotherapy, 2:881
Lazarus, 2:614–615 voice dialogue, 2:1039–1041
major concepts, 1:195–196 See also Language
overview, 1:95–96, 1:191 Communication theory of couples and family therapy.
techniques, 1:196–197 See Human validation process model
theoretical underpinnings, 1:195 Communication/validation family therapy. See Human
therapeutic process, 1:197–198 validation process model
Cognitive/emotional abstraction ladder, 1:285–286 Communist Party, 2:875
Cohen, Judy, 2:1018 Compassion meditation, 2:639
Coherence, 1:498 Compassionate hospitality, 1:227
Coherence therapy, 1:199–203 Complementary and alternative approaches: overview,
historical context, 1:199–200 1:208–214
major concepts, 1:200–202 complementary and alternative medicine (CAM),
overview, 1:219 defined, 1:209–210
techniques, 1:202 complementary and alternative medicine (CAM) with
theoretical underpinnings, 1:200 herbal medicine, 1:504
therapeutic process, 1:202 Eastern approaches to wellness, 1:209
Coherent autobiographical narratives, 1:76 historical context, 1:209
Cohesion, 1:570 interpersonal relationships, 1:582
Colapinto, Jorge, 2:662, 2:967 psychodynamic family therapy, 2:820
Collaboration, 2:696, 2:697, 2:789 short descriptions of, 1:210–213 (See also individual
Collaborative relationship, 1:242, 1:358, 1:573 names of therapies)
Collaborative therapy, 1:203–205 theoretical underpinnings, 1:210
historical context, 1:203 Western approaches to wellness, 1:209–210

1172 Index
Complexes, 1:46 Radix, 2:846, 2:847

Compression theory, 2:862 See also Gestalt therapy
Compromise formation, 1:438 Contemplation, 2:1015
Compton, William, 2:785 Contemplative psychotherapy, 1:225–229
Concentrative movement therapy, 1:214–216 historical context, 1:226
historical context, 1:214 major concepts, 1:226–228
major concepts, 1:215 overview, 1:211
overview, 1:128 theoretical underpinnings, 1:226
techniques, 1:215–216 therapeutic process, 1:228–229
theoretical underpinnings, 1:214 Contemporary psychodynamic-based therapies:
therapeutic process, 1:216 overview, 1:229–234
“Concept of the Reflex, The” (Skinner), 2:936 historical context, 1:229–230
Conceptually systematic characteristic (applied behavior short descriptions of, 1:232–234 (See also individual
analysis), 1:54 names of therapies)
Concretization, 1:589 theoretical underpinnings, 1:230–232
Condemned isolation, 2:889 Contextual therapy, 1:234–238
Condenser phenomenon, 1:469 Gestalt group therapy, 1:454
Conditioned response (CR), 1:163 historical context, 1:235
Conditioned stimulus (CS), 1:163 justice and trustworthiness for, 1:234–235
Condrau, Gion, 1:274 major concepts, 1:236–237
Conduct, regulators of, 2:941 overview, 1:207, 1:446, 1:549
Conductor metaphor, 1:468–469, 1:470 theoretical underpinnings, 1:235–236
Confrontation, 1:80, 2:670, 2:862 therapeutic process, 1:237–238
Conger, Carolyn, 1:499 Contextualism, 1:64–65, 1:133
Congruence, 2:771 Contingency, 1:103, 1:294–295
Conjoint sex therapy, 1:184 Contracting, in cognitive-behavioral family therapy, 1:183
Connecticut Interracial Commission, 2:1002–1003 Control Theory (Glasser), 1:463
Conscience, family constellation therapy Conversion therapy. See Sexual orientation change efforts
and, 1:400 Coping Self, 2:1045
Conscious energy breathing, 2:865–866 Corbin, Henry, 1:56
Consciousness, 1:46, 1:484, 1:525, 1:544 Core conditions, 1:207
Consciousness-raising, 1:409 Core Energetics, 1:238–240
Consensus reality, 2:804–805 historical context, 1:238
Constellation therapy. See Family constellation therapy; major concepts, 1:239
Systemic constellations overview, 1:128
Constructive Psychotherapy (Mahoney), 1:279, 1:281, techniques, 1:239–240
1:282, 2:627 theoretical underpinnings, 1:238–239
Constructivist therapies: overview, 1:216–221 Core issues, existential group psychotherapy and, 1:367
Erickson and, 1:353–354 Core ordering processes (COPs), 1:280–281
historical context, 1:216–217 Core organizing beliefs, 1:483
short descriptions of, 1:219–220 (See also individual Core Process Psychotherapy, 1:240–242
names of therapies) “Core” and “Process” of, 1:240–241
theoretical context, 1:217–219 historical context, 1:241
Constructivist therapy, 1:221–225 major concepts, 1:241–242
historical context, philosophical roots, 1:221–222 overview, 1:232
historical context, psychological application, 1:222 techniques, 1:242
major concepts, 1:223 theoretical underpinnings, 1:241
overview, 1:219, 1:431 Core self, 1:553, 1:554
techniques, 1:223–225 Coregulation of affect, 1:76–77
theoretical underpinnings, 1:222–223 Coué, Émile, 1:352
therapeutic process, 1:225 Council for Accreditation of Counseling and Related
Contact Educational Programs, 1:248
importance of, 2:745, 2:747, 2:792 Counseling and Psychotherapy: Newer Concepts in
pulsing, 2:842 Practice (Rogers), 2:896

Index 1173
Counterconditioning, 1:166, 1:387, 2:983 theoretical underpinnings, 1:260–261

Countertransference, 1:231–232, 1:242, 1:438, therapeutic process, 1:262–263
1:576–577, 2:824 Crothers, Samuel, 1:108
Couple and family hypnotic therapy, 1:243–246 Crozier, William, 2:936
historical context, 1:243 Cry for Myth, The (May), 2:636–637
major concepts, 1:244–245 Cultural anthropology methodology. See Palo Alto Group
overview, 1:250–251, 1:355 “Cultural Competence in the Social Work Profession”
techniques, 1:245–246 (NASW), 1:260
theoretical underpinnings, 1:243–244 Cultural issues. See Cross-cultural counseling theory
therapeutic process, 1:246 Curative factors, 1:570
Couple therapy, dialogue technique for, 1:532 Cushing, Harvey, 2:715
Couple therapy, nature-guided therapy for, 2:701 Cybernetics, 1:250. See also Improvisational therapy
Couples, family, and relational models: overview, Cyclical psychodynamics, 1:263–267
1:246–253 assimilative psychotherapy integration, 1:64
gender aware therapy and, 1:451 historical context, 1:264
historical context, 1:247–249 major concepts, 1:265–266
short descriptions of, 1:250–252 (See also individual overview, 1:232, 1:549
names of therapies) techniques, 1:266
theoretical underpinnings, 1:249–250 theoretical underpinnings, 1:265
Courage to Create, The (May), 2:636–637 therapeutic process, 1:266
Courage to Heal, The (Bass, Davis), 2:869
Course in Miracles, A (Foundation for Inner Peace), Dalal, Farhad, 1:468
1:557, 1:559 Damadian, Raymond, 2:715
Craft of Family Therapy, The (Minuchin, Reiter, Dance movement therapy, 1:269–273
Borda), 2:662 historical context, 1:269–270
Craig, Gary, 1:212, 1:336, 1:345 major concepts, 1:271–272
Cranial electrotherapy stimulation (CES), 1:152–153 overview, 1:255
Creative arts and expressive therapies: overview, techniques, 1:272
1:253–256 theoretical underpinnings, 1:270–271
historical context, 1:253 therapeutic process, 1:272–273
short descriptions of, 1:254–256 (See also individual D’Andrea, Michael, 1:261
names of therapies) Daniels, Judy, 1:261
theoretical underpinnings, 1:253–254 Darwin, Charles, 1:229, 2:672, 2:673, 2:759, 2:834
Creative Process, The, 2:845 Daseinsanalysis, 1:273–275
Creative Psychosocial Genomic Experience definitions, 1:273
(CPGHE), 2:836 existential therapy, 1:371
Creative Self, 2:1045 historical context, 1:273–274
“Critical Examination of the Concept of Bisexuality, A” major concepts, 1:274
(Rando), 2:932 overview, 1:377
Critical incident stress management, 1:256–259 phenomenological therapy, 2:772–773
historical context, 1:256–257 techniques, 1:274
major concepts, 1:257–258 theoretical underpinnings, 1:274
overview, 1:191–192 therapeutic process, 1:274–275
techniques, 1:258 Daseinsanalytic Institute for Psychotherapy and
theoretical underpinnings, 1:257 Psychosomatics, 1:274
therapeutic process, 1:258 Datillio, Frank, 1:181
Cross-Cultural Counseling Competencies (APA), 1:260 Davanloo, Habib, 2:991
Cross-cultural counseling theory, 1:259–263 Davies, Jody, 2:885
cultural sensitivity, 1:29 Davis, Laura, 2:869
culture-centered music therapy, 2:689 Davison, Gerald, 2:616, 2:982
historical context, 1:259–260 De Maré, Pat, 1:470
major concepts, 1:262 De Shazer, Steve and Insoo Kim Berg, 1:275–278
overview, 2:751 biographical information, 1:275–278
techniques, 1:262 brief therapy and, 1:145, 1:147

1174 Index
O’Hanlon and, 2:735, 2:737 overview, 1:550, 2:718

parent-child interaction therapy and, 2:755 techniques, 1:286–288
solution-focused brief therapy and, 2:943, 2:946, theoretical underpinnings, 1:284
2:947, 2:948, 2:949 therapeutic process, 1:288
Death Developmental needs meeting strategy, 1:288–292
death instinct, 2:731, 2:733 historical context, 1:289
existential group psychotherapy and, 1:367 major concepts, 1:289–290
existential therapy and, 1:372 overview, 1:332
unconscious death urge, 2:864–865 techniques, 1:290–291
Deblinger, Esther, 2:1018 theoretical underpinnings, 1:289
Debriefing, 1:422 therapeutic process, 1:291–292
Deci, Edward, 2:785 Developmental therapy, 1:222
Decision dialogue, Ackerman Relational Approach, 1:16 Developmental Therapy: Theory Into Practice
Deep breathing, 1:118 (Ivey), 1:284
Deep democracy, 2:805 Dewey, John, 1:40, 1:217, 1:221, 2:689–690, 2:768
Deep draining, 1:112 Dharana, 2:1061
Deep tissue massage, 2:792 Dhyana, 2:1061
Deep-state transformation, 1:139 Diagnostic and Statistical Manual of Mental Disorders,
Defenses Seligman and, 2:921
attack therapy, 1:80 Diagnostic and Statistical Manual of Mental Disorders,
ego psychology, 1:322 Winnicott and, 2:1052
ego-oriented therapies, overview, 1:331 Diagnostic and Statistical Manual of Mental Disorders
psychodynamic family therapy, 2:818 (DSM-II ), 2:932
psychodynamic group therapy, 2:824 Diagnostic and Statistical Manual of Mental Disorders
Defining value directions process, 1:6 (DSM-IV), 2:666, 2:908
Definitional ceremonies, 2:699 Diagnostic and Statistical Manual of Mental Disorders
Defoe, Daniel, 2:936 (DSM-V), 1:294, 2:787
Defusion, 1:6, 1:8, 1:257 Dialectical behavior therapy, 1:292–297
Dehumanizing, 1:56 historical context, 1:292–293
DeMartino, Richard, 2:653 major concepts, 1:294
Demoralization, 1:207 overview, 1:96, 1:192
Depressive position, 2:733 techniques, 1:294–296
Dereflection, 2:621 theoretical underpinnings, 1:293–294
Derrida, Jacques, 1:203, 2:947, 2:1050 therapeutic process, 1:296–297
Descartes, René, 1:210, 2:714 Dialectical enquiry, phenomenological therapy, 2:775
Desire, 2:608, 2:610 Dialectical thinking, 2:1031
Destablization, 1:359 Dialogic imagery, 1:478
“Destructive entitlement,” 1:133, 1:236–237 Dialogic self, 1:173
Destructiveness, 1:521–522 Dialogue, 1:235, 2:774, 2:839. See also Language
Determinism, 2:823 Dianetics Institute, 2:870
Deutsch, Helen, 2:705 DiCara, Leo, 2:715
Development, cyclical psychodynamics and, 1:265–266 DiClemente, Carlo C., 2:669, 2:685, 2:1014
Developmental constructivism, 1:278–283 Diener, Ed, 2:784
constructivism, defined, 1:278 Difference between people, Gestalt therapy and, 1:460
historical context, 1:278–279 Differential reinforcement of other behavior, 1:99
major concepts, 1:279–281 Differentiation, ego psychology and, 1:323
overview, 1:549 Differentiation of self, 1:135
techniques, 1:281–282 Diffuse physiological arousal (DPA), 1:466
theoretical underpinnings, 1:279 Dilthey, Wilhelm, 1:586
therapeutic process, 1:282–283 DiMaggio, Giancarlo, 1:224–225
Developmental counseling and therapy: theory and Direct tuition, 2:940–941
brain-based practice, 1:283–288 Directed thought, 1:42
historical context, 1:284 Directive play therapy, 2:778
key concepts, 1:284–286 Directive skills, integration of, 1:78

Index 1175
Directive techniques, 1:49–50 “Earning of constructive entitlement,” 1:133

Directive therapy, 1:297–301 Eastern Psychiatric Institute, 1:235
historical context, 1:297–298 Eating, mindful, 2:655
major concepts, 1:299 Ecker, Bruce, 1:199–200, 1:223
overview, 1:355 Eclecticism, 1:307–310
strategic therapy, 2:964 historical context, 1:307–308
techniques, 1:299–300 major concepts, 1:308–309
theoretical underpinnings, 1:298–299 overview, 1:550
therapeutic process, 1:300 technical eclecticism, 2:679
Discouragement, Adlerian therapy and, 1:32 techniques, 1:309
Discovering Psychology (television series), 2:1063 theoretical underpinnings, 1:308
Discovery of Being, The (May), 2:636–637 therapeutic process, 1:309–310
Disguised sanity model, 1:228 Ecological counseling, 1:310–314
Dissociation, 1:331, 1:520, 1:585, 2:867–868, 2:886 historical context, 1:311
Dissociative identity disorder, 2:868 major concepts, 1:311–313
Division of Clinical Psychology (APA), 1:362–363 overview, 2:751
Doctor and the Soul, The (Frankl), 1:433, 2:619 techniques, 1:313
Dollard, John, 1:63–64, 1:511, 1:547 theoretical underpinnings, 1:311
Domains of treatment, 2:908–909 therapeutic process, 1:313–314
Dose-response relationship, 1:402 Ecology, Gestalt therapy and, 1:460
Double bind technique, 1:360, 2:957 Ecotherapy, 1:314–316
Double diamond model, 1:38 historical context, 1:314–315
Doubling, 2:815 major concepts, 1:315
Drama therapy, 1:301–305 overview, 1:211
historical context, 1:301 techniques, 1:315–316
overview, 1:255 therapeutic process, 1:316
techniques, 1:304 Ecotherapy: Healing With Nature in Mind (Buzzell,
theoretical underpinnings, 1:301–302 Chalquist), 1:314
therapeutic process, 1:304–305 EcoWellness, 1:316–320
Drama triangle, 2:1009, 2:1009 (fig.) historical cotnext, 1:317
Drawing, for art therapy, 1:62 major concepts, 1:317–318
Dreambody, 2:805 overview, 1:255
Dreaming level, of awareness, 2:805 techniques, 1:318–319
Dreams theoretical underpinnings, 1:317
analytical psychology, 1:47 Écrits (Lacan), 2:610
dream analysis, 1:324, 1:438–439, 1:440, 1:523, Eden, Donna, 1:212
2:724, 2:836 “Edge,” 2:805
dreamwork, 2:1040 Education
recovered memory therapy, 2:868, 2:869 cognitive behavioral therapies and, 1:191
Dreikurs, Rudolf, 1:432 cognitive-behavioral family therapy, 1:183
Dreikurs, Rudolph, 1:27 EcoWellness, 1:319
Drexel University, 1:132 gender aware therapy, 1:452
Drives, 2:723 meditation and, 2:639
DSM-III, 2:932 psychoeducation, 1:239
Dual Relationships and Psychotherapy (Lazarus), 2:615 school and religious trauma, 2:865
Ducommun-Nagy, Catherine, 1:235, 1:236 See also Psychoeducation
Dulwich Centre, 2:691, 2:1051, 2:1052 Education and Identity (Chickering), 2:831
Duncan, Barry, 1:206, 1:308–309, 1:310 Edwards, Tilden, 2:616
Dunlop, Gillian-Weaver, 2:894 Effective characteristic (applied behavior analysis),
Durkheim, Emile, 2:801 1:54
Dynamic administration, 1:469 “Efficacy of the Eye Movement Desensitization
Dynamic dialectical life span development, 1:280 Procedure in the Treatment of Traumatic
Dynamical systems, 2:1030–1031 Memories” (Shapiro), 2:934

1176 Index
EFT Manual (Craig), 1:345 Ellis, Albert, 1:333–335

Egalitarian relationships, 1:409, 1:416, 1:417 Beck and, 1:89
“Egg diagram,” 2:838, 2:838 (fig.) biographical information, 1:333–335
Ego cognitive processing therapy, 1:181
analytical psychology, 1:44 cognitive-behavioral group therapy, 1:185–186
characteranalytical vegetotherapy, 1:158 cognitive-behavioral therapies, overview,
in contemplative psychotherapy, 1:189–190
1:226–227 cognitive-behavioral therapy, 1:194
defined, 1:329, 1:330 developmental counseling and therapy, 1:284
ecocentric perspective versus, 1:315 foundational therapies, overview, 1:427
ego states, 2:1007–1008 group counseling and psychotherapy theories,
ego-self axis, 2:594, 2:595–596 overview, 1:473–474
group analysis, 1:469 impact therapy and, 1:533
See also Ego psychology influence of, 2:848–849
“Ego and the Id, The” (Freud), 1:329 Meichenbaum and, 2:641
Ego and the Mechanisms of Defense, The (Freud), prayer/affirmation and, 2:793
1:169–170 psychoeducational groups and, 2:826
Ego psychology, 1:320–325 “Rational Humorous Songs,” 2:852
historical context, 1:320–321 unified therapy and, 2:1027
major concepts, 1:321–322 views on Adler, 1:26
overview, 1:171, 1:332 writing therapy and, 2:1055
techniques, 1:322–324 Embodied relational dynamics, 1:240
theoretical underpinnings, 1:321 EMDR. See Eye Movement Desensitization and
therapeutic process, 1:324–325 Reprocessing therapy
Ego state therapy, 1:325–328 EMDR Humanitarian Assistance Programs (HAP),
historical context, 1:325 1:390, 2:935
major concepts, 1:326 Emerson, William R., 1:241, 2:795
overview, 1:332, 1:355 Emic/etic approaches, 1:262
techniques, 1:326–328 Emory University, 1:379, 2:1048
theoretical underpinnings, 1:325–326 Emotion impulse training, 1:162
therapeutic process, 1:328 Emotional agency, 1:554, 1:573
Ego-oriented therapies: overview, 1:328–333 Emotional blocks, 1:286
historical context, 1:329–330 Emotional cutoff, 1:136, 2:675
short descriptions of, 1:331–333 (See also individual Emotional disengagement/withdrawal, 1:465
names of therapies) Emotional energy pollution, 2:865
theoretical context, 1:330–331 Emotional freedom techniques, 1:335–337
Eguchi, Toshishiro, 2:877 historical context, 1:335–336
Eigenwelt, 1:370–371 major concepts, 1:336
“Eight limbs,” 2:1061 overview, 1:211–212
Einstein, Albert, 1:36, 2:630–631 techniques, 1:336–337
Einthoven, Willem, 1:495 theoretical underpinnings, 1:336
Eissler, Kurt, 2:973 therapeutic process, 1:337
Electroconvulsive therapy, 1:152 Emotional impact, 1:360
Electrodermal response (EDR), 1:117 Emotional neutrality, 2:676
Electroencephalograph (EEG), 2:719, 2:720 Emotional regulation, attachment versus, 1:68
Electrosleep, 1:151, 1:152 Emotional response technique, 2:866
11th Book of Healing (Avicenna), 1:351 Emotional support, of group therapy, 2:664
Elizabeth Stone Center for Developmental Services and Emotion-focused family therapy, 1:337–341
Studies, 2:649–650 historical context, 1:337–338
Elizur, Joel, 2:662 major concepts, 1:338–339
Ellenberger, Henri, 1:370 overview, 1:251, 1:550
Ellias, Norbert, 1:467 techniques, 1:339–340
Elliotson, John, 1:351 theoretical underpinnings, 1:338
Elliott, Robert, 1:222 therapeutic cycles, 1:340

Index 1177
Emotion-focused therapy, 1:341–344 Erickson, Milton H., 1:348–350

ABC (awareness, believe, emotional consequences) of adventure-based therapy, 1:38
emotions, 2:854 attachment-focused family therapy, 1:76
historical context, 1:341 biographical information, 1:348–350
major concepts, 1:342 brief therapy, 1:144, 1:145, 1:146
overview, 1:232–233, 1:377 constructivist therapies, overview, 1:219–220
strategic therapy, 2:965 couple and family hypnotic therapy, 1:243
techniques, 1:343–344 deShazer and Berg, 1:276
theoretical underpinnings, 1:341–342 directive therapy, 1:297–298, 1:299
therapeutic process, 1:344 Erickson-derived or -influenced theories, overview,
Emotions, unhealthy versus healthy, 2:850 1:350–356
Empathy Ericksonian therapy, 1:356–362
focused brief group therapy, 1:421 foundational therapies, overview, 1:427–429, 1:431
focusing-oriented therapy, 1:425 Haley and, 1:488
Freudian psychoanalysis, 1:440 impact therapy, 1:533
Imago relationship therapy, 1:532 inner child therapy, 1:538
motivational interviewing, 2:669–670 Mahoney and, 2:627
overview, 1:287–288 metaphors of movement therapy, 2:645
person-centered counseling, 2:771 neuro-linguistic programming and, 2:710
psychedelic therapy, 2:811 O’Hanlon and, 2:735, 2:736
Reiki, 2:878 Palo Alto Group and, 2:754
relational-cultural theory, 2:889 possibility therapy and, 2:788
self psychology, 2:912 psychosocial genomics, 2:834, 2:835 (fig.)
training groups, 2:1005 psychosocial genomics and, 2:834
Empowerment self-relations psychotherapy and, 2:918
developing, 1:139 solution-focused brief therapy and, 2:946–947
feminist therapy, 1:416 StoryPlay therapy and, 2:956, 2:957
Empty-chair work, 1:343, 1:455 strategic family therapy and, 2:962–963
Emunah, Renée, 1:302 strategic therapy and, 2:965
Enactive experience, 2:940 theory of psychosocial development and, 2:830
Enactment, 1:585, 2:881, 2:886, 2:969–970 Erickson-derived or -influenced theories: overview,
Enchiridion, The (Epictetus), 1:189 1:350–356
Encouragement, Adlerian therapy and, 1:33 historical context, 1:351–353
Encyclopedia of DNA Elements (ENCODE Project), 2:834 short descriptions of, 1:354–356 (See also individual
Endgaining, 1:41 names of therapies)
Energy psychology, 1:344–348 theoretical underpinnings, 1:353–354
historical context, 1:344–345 Ericksonian therapy, 1:356–362
overview, 1:212 historical context, 1:356–357
techniques, 1:346–347 major concepts, 1:358–359
theoretical underpinnings, 1:345–346 overview, 1:219–220, 1:355, 1:431
therapeutic process, 1:347–348 techniques, 1:359–361
Engagement, 1:207 theoretical underpinnings, 1:357–358
Engel, George, 1:119–121, 1:549, 2:1029 therapeutic process, 1:361
Enoch Pratt Hospital, 2:971 Erikson, Erik, 1:170, 1:233, 1:271, 1:303, 1:320–321,
Envy, 2:733 1:332, 1:538, 2:830–833. See also Psychosocial
Epictetus, 1:189, 1:221 development, theory of
Epigenetic development, 2:823 Esalen Institute, 1:453, 1:514, 1:552, 2:763,
Epimendies, 2:957 2:905, 2:1003
Epistemology, 2:726 Esdaile, James, 1:351–352
Epstein, Mark, 2:653 Essence level, of awareness, 2:805
Epstein, Norman, 1:181 Essential Self, 2:1045–1046
Epstein, Raissa Timofeyewna, 1:25, 1:26 Esteem, Maslow on, 2:632–633
Epston, David, 1:223, 2:691, 2:692, 2:696, 2:1052 Ethics, of prayer and affirmation, 2:794
Equalizing, 2:774 Ethnic identity, 1:262

1178 Index
Europäischer Arbeitskreis für Konzentrative Experiential family therapy. See Symbolic experiential
Bewegungstherapie, 1:214 family therapy
European Association for Body Psychotherapy, 1:158 Experiential learning, 2:827–828
European Association for Psychotherapy, 1:158, Experiential learning cycle, 1:38
1:463–464 Experiential psychotherapy, 1:379–382
European Association for Reality Therapy, 1:464 historical context, 1:379–380
European Association of CMT (EAKBT), 1:214 major concepts, 1:380–381
European Brief Therapy Association, 1:277 overview, 1:377
European Group Analytic Training Institutions techniques, 1:381
Network, 1:467 theoretical underpinnings, 1:380
European School of Existential-Phenomenological therapeutic process, 1:381–382
Therapy (“British School”), 2:773 Experimental extinction, 1:387
Evergreen Clinic, 1:505 Exposure and response prevention, 1:382–385
Every Day Gets a Little Closer (Yalom), 2:1058 cognitive-behavioral therapy, 1:198
Evidence-based psychotherapy, 1:362–365 historical context, 1:382–383
historical context, 1:362–363 major concepts, 1:383–384
major concepts, 1:363–364 overview, 1:96–97
overview, 1:550, 2:751 therapeutic process, 1:384–385
techniques, 1:364 Exposure therapy, 1:385–388
theoretical underpinnings, 1:363 classical conditioning and, 1:166
therapeutic process, 1:364 dialectical behavior therapy and, 1:294–295
Evolution of Psychotherapy Conference, 2:624 historical context, 1:385–386
Exchange, 1:228 major concepts, 1:387
Excitor, 1:165 overview, 1:97, 1:101
Existence: A New Dimension in Psychiatry and prolonged exposure therapy, 2:806–808
Psychology (May, Angel, Ellenberger), 1:370, 2:636 techniques, 1:387–388
Existential anxiety/guilt, 1:372 theoretical underpinnings, 1:386–387
Existential group psychotherapy, 1:365–368 therapeutic process, 1:388
historical context, 1:365 Expression of feelings, 2:828
major concepts, 1:366 Expressive Therapies Continuum (ETC), 1:60–61,
overview, 1:474–475 1:60 (fig.)
techniques, 1:366–367 Externalization, 2:694, 2:698, 2:734
theoretical underpinnings, 1:365–366 Extinction, 1:99
therapeutic process, 1:367–368 Extraversion, 1:46
Existential phenomenology, 1:399 Eyberg, Sheila, 2:756
Existential philosophy, defined, 1:376 Eye contact, holding theory and, 1:506
Existential Psychotherapy (Yalom), 1:370, 2:1058 Eye fixation, 1:141
Existential suffering, neurotic versus, 1:227 Eye Movement Desensitization and Reprocessing: Basic
Existential therapy, 1:368–373 Principles, Protocols, and Procedures (Shapiro), 2:935
historical context, 1:369–370 Eye Movement Desensitization and Reprocessing
major concepts, 1:371–373 therapy, 1:388–394
overview, 1:377, 1:430 brainspotting and, 1:140, 1:141
techniques, 1:373 historical context, 1:389–390
theoretical underpinnings, 1:370–371 major concepts, 1:391–392
therapeutic process, 1:373 overview, 1:550, 2:718
See also Gestalt group therapy; Gestalt therapy Shapiro and, 1:389–390, 1:540, 2:933–935
Existential-humanistic therapies: overview, 1:373–379 techniques, 1:392–393
historical context, 1:374–376 theoretical underpinnings, 1:390–391
short descriptions of, 1:377–378 (See also individual therapeutic process, 1:393
names of therapies) Eye movement integration therapy, 1:394–397
Exoneration, 1:237 major concepts, 1:395–396
Experience retrieval, 1:526 theoretical underpinnings, 1:394–395
Experiences in Group (Bion), 2:802 Eysenck, Hans J., 1:94, 2:614, 2:761

Index 1179
Faces in a Cloud (Atwood, Stolorow), 1:586 family therapy; Narrative family therapy;
Facilitating Treatment Adherence (Meichenbaum), Psychodynamic family therapy; Solution-focused
2:641–642 brief family therapy; Strategic family therapy;
Faculté de médecine de Paris, 2:610 Structural family therapy; Symbolic experiential
Fadul, Jose, 1:162 family therapy; Systemic family therapy; Unified
Fairbairn, Ronald, 1:169, 1:172, 1:241, 2:731, therapy
2:732, 2:880 Family Therapy Centre, 2:692
“Falling apart,” 1:56 Family Therapy Institute, 1:298, 1:488, 2:623
Families and Family Therapy (Minuchin), 2:661, 2:966 Family Therapy Techniques (Minuchin, Fishman),
Families of the Slums (Minuchin), 2:661, 2:966 2:662, 2:967
Family. See Attachment-focused family therapy; Family Therapy Training Center, 2:661, 2:966
Emotion-focused family therapy Farrant, Graham, 2:797
“Family as a Social and Emotional Unit, The” Farrelly, Frank, 2:808–809
(Ackerman), 1:11 Faulkner, Charles, 2:645
Family constellation therapy, 1:399–401 Fault sensory appreciation, 1:42
historical context, 1:399 Fava, Giovanni, 2:783
major concepts, 1:400 Fear, reducing. See Systematic desensitization
overview, 1:251 Federn, Paul, 1:325, 1:329
techniques, 1:400 Feedback, 2:1005, 2:1032
theoretical underpinnings, 1:399–400 Feedback loops, 1:422
therapeutic process, 1:401 Feedback-informed treatment, 1:401–403
Family diagram, 2:676 historical context, 1:401–402
Family Dynamics in Individual Psychotherapy major concepts, 1:402–403
(Wachtel), 1:264 overview, 2:751
Family Healing (Minuchin, Nichols), 2:662 techniques, 1:403
Family Institute (Ackerman Institute for the Family), theoretical underpinnings, 1:402
1:12, 1:248, 1:264 therapeutic process, 1:403
Family interactions, contextual therapy and, 1:235 “Feet to the fire,” 1:422–423
Family Journal, The, 1:248 Feinstein, David, 1:212
Family Kaleidoscope (Minuchin), 2:662 Feldenkrais, Moshé, 1:40, 1:404, 2:748, 2:903
Family Mental Health Clinic of Jewish and Family Feldenkrais Method, 1:403–407
Services, 1:12 Alexander technique and, 1:40
“Family of the Schizophrenic: A Model System, The” Guild Certified Feldenkrais Teachers,
(Haley), 1:298, 1:488 1:403–404
Family Process, 1:12, 1:407, 1:488 historical context, 1:404
Family projection process, 1:136 major concepts, 1:404–406
Family schema Ortho-Bionomy, 2:748
cognitive-behavioral family therapy, 1:182 overview, 1:128
human validation process model, 1:516 Rubenfeld Synergy, 2:903
Family sculpture method techniques, 1:406
adventure-based therapy and, 1:39 theoretical underpinnings, 1:404
family constellation therapy and, 1:399 therapeutic process, 1:406
human validation process model, 1:516 “Felt sense,” 1:126, 1:424, 1:425
Family Services Research Center, 2:683 Feminine Mystique, The (Friedan), 2:649
Family Studies Institute (Minuchin Center for the Feminine type, 2:705
Family), 2:967 “Feminist Approach to Family Therapy, A”
Family Study Project, 1:134 (Hare-Mustin), 1:407
Family systems theory, 1:572–573 Feminist family therapy, 1:407–410
Family therapy. See Ackerman, Nathan; Cognitive- historical context, 1:407
behavioral family therapy; Couple and family major concepts, 1:408–409
hypnotic therapy; Couples, family, and relational overview, 1:251
models: overview; Family constellation therapy; techniques, 1:409–410
Feminist family therapy; Integrative family therapy; theoretical underpinnings, 1:407–408
Internal family systems model; Multigenerational therapeutic process, 1:410

1180 Index
Feminist psychoanalytic therapy, 1:410–414 Fonagy, Peter, 2:643, 2:885

historical context, 1:411 Forgiveness, 1:237, 1:557–569
major concepts, 1:412–413 Forgiveness Solution, The (Friedman), 1:560–561
overview, 1:233 Fork-in-the-road technique, 2:994
techniques, 1:413 Formalism in Ethics and Non-Formal Ethics of Values
theoretical underpinnings, 1:411–412 (Scheler), 1:432
therapeutic process, 1:414 Forman, Mark, 1:541
Feminist therapy, 1:414–419 Formulation, BodyTalk, 1:131
historical context, 1:414–415 Fort Hays Kansas State College, 2:599–600
major concepts, 1:416 Fosha, Diana, 1:1, 1:282
overview, 1:220, 1:431 Foucault, Michel, 2:691, 2:696, 2:884, 2:947, 2:1050
techniques, 1:416–417 Foulkes, Sigmund H., 1:467, 1:468, 1:469, 2:802
theoretical underpinnings, 1:415–416 Foundation for Inner Peace, 1:557
therapeutic process, 1:417–418 Foundational therapies: overview, 1:426–432
Ferenczi, Sandor, 1:63, 1:158, 1:168–169, 2:604, historical context, 1:426–428
2:821, 2:880 short descriptions of, 1:429–431
Ferri, Genovino, 1:158 theoretical underpinnings, 1:428–429
Ferster, Charles, 1:102, 1:103 “Four As,” 2:854
Figure-ground perception, 1:454, 1:458 “Four givens,” 1:372
Filial Therapy, 2:891, 2:892 “Four horsemen of the apocalypse,” 1:465
Finger painting, for art therapy, 1:62 “Four Noble Truths,” 1:227
First-order change, 1:299 “Four primary emotions” drawing, for art therapy, 1:62
Fisch, Richard, 1:145, 1:276, 1:565, 2:753, 2:755. See Fractals, 1:155–156
also Palo Alto Group Frames, 1:439
Fishman, Charles, 2:661, 2:967 Frank, Jerome, 1:173, 1:206, 1:207, 1:547,
“Five good things,” 2:648, 2:889 2:602, 2:1057
Five Paths to Happiness, 2:786 Frankfurt Institute for Social Research (“Frankfurt
Five-Element Acupuncture system, 1:21, 1:23 school”), 1:519
Fixed Role Therapy, 1:224 Frankfurt Neuropsychiatric Institute, 2:762
Flashbacks, 2:868, 2:869 Frankfurt Psychoanalytic Institute, 1:519
Fleming, Joan, 1:161, 1:162 Frankl, Viktor, 1:432–434
Flexibility, interpersonal, 1:420 biographical information, 1:432–434
Flexner Report, 1:502 existential group psychotherapy and, 1:365
Flooding, 1:198 existential therapy and, 1:370, 1:372
Flourish (Seligman), 2:922 existential-humanistic therapies and, 1:375
Floyd, Carleen, 1:463 logotherapy and existential analysis, 2:618–620, 2:621
Floyer, John, 1:494 Mahoney and, 2:628
Foa, Edna B., 2:806–807 May and, 2:635
Focused brief group therapy, 1:419–423 strategic therapy and, 2:964
historical context, 1:419–420 transpersonal psychology and, 2:1011
major concepts, 1:420–421 Franklin, Benjamin, 1:524
overview, 1:474 Franks, Cyril, 2:614
techniques, 1:421–423 Fransella, Fay, 2:766
theoretical underpinnings, 1:420 Frederick, Ivan “Chip,” 2:1064
therapeutic process, 1:423 Fredrickson, Renee, 2:869
Focusing technique, 1:343 Free association, 1:435, 1:439, 1:440, 2:724, 2:823
Focusing-Oriented Therapy, 1:423–426 Freedom
historical context, 1:423 Daseinsanalysis and, 1:274
major concepts, 1:424–425 existential therapy and, 1:372
overview, 1:377 Fromm on, 2:705
techniques, 1:425 humanistic psychoanalysis, 1:521
theoretical underpinnings, 1:424 Freedom and Destiny (May), 2:636–637
therapeutic process, 1:425–426 Freedom to Learn (Rogers), 2:897
Follette, William, 1:51 Freeman, Annis, 1:519

Index 1181
Freire, Paolo, 1:523 influence of, 2:849

French Royal Commission, 1:351 internal family systems model and, 1:567–568
Freud, Anna interpersonal integrative group therapy and, 1:572
attachment group therapy, 1:67 interpersonal psychoanalysis and, 1:575
classical psychoanalytic approaches, overview, intersubjective group psychotherapy and, 1:584
1:169–170 Jung and, 1:43–44
creative arts and expressive therapies, overview, 1:254 Kelly and, 2:600
dance movement therapy, 1:271 Klein and, 2:604
ego psychology, 1:321, 1:329 Lacanian group therapy and, 2:607, 2:608
Freudian psychoanalysis, 1:437 Lacanian psychoanalysis and, 2:610–611
Klein and, 2:604, 2:605 logotherapy and existential analysis, 2:618–619
neo-Freudian analysis and, 2:705 May and, 2:635, 2:636
object relations theory and, 2:731 mindfulness, 2:653
play therapy and, 2:777 neo-Freudian psychoanalysis, 2:703
psychodynamic group psychotherapy and, 2:822 neuropsychoanalysis, 2:723, 2:724
theory of psychosocial development and, 2:830, 2:831 object relations theory, 2:731, 2:732, 2:733
Winnicott and, 2:1053, 2:1054 orgonomy, 2:743, 2:744
Freud, Sigmund, 1:434–436 pastoral counseling and, 2:758
Adler and, 1:24, 1:25 Perls and, 2:762
assimilative psychotherapy integration and, 1:63, 1:65 person-centered counseling and, 2:767, 2:768
Beck and, 1:88 play therapy and, 2:776–777
bioenergetic analysis, 1:113, 1:115 prayer/affirmation and, 2:793
biographical information, 1:434–436 psychodrama and, 2:812, 2:813
body-oriented therapies, 1:127 psychodynamic family therapy and, 2:816
brief therapy, 1:145 psychodynamic group therapy and, 2:821, 2:822
chaos theory, 1:157 psychosocial development and, 2:830
classical psychoanalytic approaches, 1:167–169, Reich and, 2:874, 2:875
1:170, 1:171 relational group psychotherapy and, 2:880
cognitive enhancement therapy, 1:177 relational psychoanalysis and, 2:884
cognitive-behavioral therapies, 1:189 self psychology and, 2:910, 2:911
contemplative psychotherapy, 1:226 sexual orientation change efforts and, 2:932
contemporary psychodynamic-based therapies, Sullivan and, 2:972
1:229–230 transactional analysis and, 2:1007
core process psychotherapy, 1:241 Winnicott and, 2:1054
couples, family, and relational models, 1:247, 1:253 See also Freudian psychoanalysis
developmental counseling and therapy, 1:284 Freudian psychoanalysis, 1:436–441
ecological counseling, 1:311 contemporary psychodynamic-based therapies and,
ego psychology, 1:320, 1:321, 1:325, 1:328–330, 1:229–231
1:331, 1:332 historical context, 1:437
Ellis’ views on, 1:26 major concepts, 1:438–439
emotional freedom techniques, 1:335–336 overview, 1:171, 1:332, 1:430
Erickson and, 1:348, 1:352, 1:356 techniques, 1:439–440
existential therapy, 1:369 theoretical underpinnings, 1:437–438
experiential psychotherapy, 1:380 therapeutic process, 1:440–441
feminist psychoanalytic therapy, 1:411, 1:412 Friedan, Betty, 2:649
foundational therapies, 1:430, 1:432 Friedman, Philip H., 1:212, 1:557–559, 1:560–561
Fromm and, 1:519 Frisch, Michael B., 2:783, 2:785
Gestalt therapy, 1:456 Fromm, Erich
group analysis, 1:468 Ackerman and, 1:11
group counseling and psychotherapy theories, classical psychoanalytic approaches and, 1:170
overview, 1:473 contemplative psychotherapy and, 1:226
guided imagery therapy, 1:478 Gestalt therapy and, 1:457
Horney and, 1:511 Horney and, 1:511
hynotherapy, 1:525 humanistic psychoanalysis of, 1:378, 1:518–524

1182 Index
interpersonal psychoanalysis of, 1:574 overview, 1:220

May and, 2:636 techniques, 1:451–452
mindfulness and, 2:653 theoretical underpinnings, 1:449–450
neo-Freudian psychoanalysis, 2:702, 2:703–704, 2:705 therapeutic process, 1:451–452
Perls and, 2:762 Gender role analysis, 1:409, 1:417
unified therapy and, 2:1027 Gendlin, Eugene, 1:423, 1:424, 2:773
Fromm-Reichman, Frieda, 1:519, 1:574, 2:636 Generalization, 1:446
Frozen structures, 1:425 Genogram, 2:676, 2:1028
Fry, William, 1:298, 1:488, 1:565, 2:753, 2:754. See also Genome Biology, 2:834
Palo Alto Group Genuineness, 2:771
Full Catastrophe Living: Using the Wisdom of Your Georgetown Family Center (Bowen Center for the Study
Body and Mind to Face Stress, Pain and Illness of the Family), 1:134
(Kabat-Zinn), 2:658 Georgetown University Medical Center, 1:134
Fuller, Buckminster, 1:499 Gergen, Kenneth, 1:203, 1:218, 1:222
“Function and Field of Speech and Language in German Association of CMT, 1:214
Psychoanalysis, The” (Lacan), 2:610 Gestalt group therapy, 1:452–456
Function of the Orgasm, The (Reich), 1:158, historical context, 1:453
2:744, 2:875 major concepts, 1:454–456
Functional analysis, 1:90, 1:184 overview, 1:475
Functional analytic group therapy, 1:441–445 theoretical underpinnings, 1:453–454
historical context, 1:442 therapeutic process, 1:456
major concepts, 1:442–443 Gestalt Institute of Cleveland, 1:453
overview, 1:474 Gestalt therapy, 1:456–462
techniques, 1:443–444 Alexander technique, 1:40
theoretical underpinnings, 1:442 historical context, 1:457
Functional analytic psychotherapy, 1:445–448 overview, 1:332, 1:377, 1:430
applied behavior analysis and, 1:51 postural integration, 2:792
major concepts, 1:446–447 theoretical underpinnings, 1:457–458
overview, 1:97, 1:192 therapeutic process, 1:461
techniques, 1:447 Gestalt Therapy: Excitement and Growth in the Human
theoretical underpinnings, 1:445–446 Personality (PHG) (Perls, Hefferline, Goodman),
therapeutic process, 1:447 2:763
Functional behavior assessment (FBA), 1:50, 1:52, 1:100 Gestalt Therapy (Perls, Hefferline, Goodman), 1:457
Functional family therapy, 1:183 Getting the Love You Want (Hendrix, Hunt), 1:531
Functional magnetic resonance imaging (fMRI), 2:715 Geyer, Marc, 2:811
Future pace questions, 1:139 Gift of Therapy: An Open Letter to a New Generation of
Therapists and Their Patients, The (Yalom), 2:1058
Gadamer, Hans-Georg, 1:203, 1:586 Gilbert, Lucia A., 1:449
Gage, Phineas P., 2:714 Gill, Merton, 2:885
Galen, 1:494 Gilligan, Stephen, 2:917
Gallo, Fred, 1:345 Gindler, Elsa, 1:157, 1:214
Games, 2:1008–1009 Gingerich, Wallace, 1:276
Garcia, John, 1:95 Ginsberg, Barry G., 2:891
Garfield, Sol, 1:547 Glasser, William, 1:38, 1:462–464, 2:856–857
Gaston, E. Thayer, 2:687 “Go round,” 1:455
Gattefossé, Rene, 1:57 Goal-setting, in cognitive-behavioral group
Gaynor, Scott T., 1:442 therapy, 1:186
Gelb, Adhémar, 1:457, 2:762 “Going up a generation,” 1:15–16
Gemeinschaftsgefuhl, 1:26, 1:31, 1:32 Gold, Jerry, 1:65
Gender aware therapy, 1:449–452 Goldenthal, Peter, 1:235
historical context, 1:449 Goldfried, Marvin, 1:547, 1:555, 2:616
major concepts, 1:450–451 Goldstein, Kurt, 1:457, 1:467, 1:518–519, 2:762

Index 1183
Golgi, Camillo, 2:714–715 psychoeducational groups, 2:826–830

Gomes, Mary, 1:314 as social microcosm, 1:570
Gonçalves, Óscar, 1:284 techniques, 1:469–470
Good, Glenn E., 1:449 theoretical underpinnings, 1:467–468
Good-bye letters, 1:174 therapeutic process, 1:470–471
Goodman, Bertha, 2:630 Group Analysis: The International Journal of
Goodman, Paul, 1:457, 1:458, 2:763 Group-Analytic Psychotherapy, 1:467
Goolishian, Harold, 1:203, 1:222 Group Analytic Practice, 1:467
Gottdiener, William, 1:66 Group Analytic Society, 1:467
Gottman, John, 1:181, 1:465, 1:466 Group as an Object of Desire: Exploring Sexuality in
Gottman method couples therapy, 1:465–466 Group Therapy, The (Nitsun), 1:468
historical context, 1:465 Group counseling and psychotherapy theories: overview,
major concepts, 1:465–466 1:471–477
overview, 1:251 benchmarks and theorists, 1:472 (table)
theoretical underpinnings, 1:465 historical context, 1:472–473
therapeutic process, 1:466 short descriptions of, 1:473–477 (See also individual
Goulding, Mary, 2:1010 names of therapies)
Goulding, Robert, 2:1010 theoretical context, 1:473
Graded tast assignments, 1:198 Group-Analytic Psychotherapy (Hearst), 1:467
Gräff, Christine, 1:214 Grove, David, 1:540, 2:645
Grand, David, 1:140, 1:211 Growth model. See Human validation process model
Gratitude, 2:878 Guerney, Bernard G., Jr., 2:777, 2:890–891, 2:892
Gray, Jeffry A., 2:761 Guerney, Louise, 2:777
Great chain of being, 1:542 Guidano, Vittorio, 1:223, 1:224, 1:225
Green, Alyce, 2:715 Guide to Possibility Land (O’Hanlon), 2:737
Green, Elmer, 2:715 Guided facilitation, 1:470
Greenberg, Jay, 2:884, 2:885 Guided imagery, 2:869, 2:1040
Greenberg, Leslie, 1:222, 1:338, 1:341 Guided imagery, Bonny method of, 2:689
Greifer, Eli, 2:781 Guided imagery therapy, 1:477–481
Grief process cognitive-behavioral therapy, 1:197
inner child therapy, 1:539 historical context, 1:478
interpersonal psychotherapy, 1:579 major concepts, 1:478–479
Grinder, John, 1:225, 2:710, 2:809 overview, 1:192
Groddeck, Georg, 1:329 techniques, 1:479–480
Grof, Christina, 1:507, 1:509, 2:1013 theoretical underpinnings, 1:478
Grof, Stanislav, 1:241, 1:507, 2:795–796, 2:1011, therapeutic process, 1:480–481
2:1013 Guided journaling, adventure-based therapy
Grosser, Tilly, 1:433 and, 1:39
“Ground of Being,” 1:542 Guidelines for Providers of Psychological Services to Ethnic
Grounding, 1:239, 1:240, 1:492, 2:839 and Culturally Diverse Populations (APA), 1:260
Group analysis, 1:467–471 Guidelines for Psychological Practice With Lesbian,
chaos theory and, 1:156 Gay, and Bisexual Clients (APA), 2:929
cognitive-behavioral group therapy, 1:186 Guidelines for Psychological Practice With Transgender
group as a whole, 2:998 (See also Tavistock Group and Gender Non-Conforming Clients (APA), 2:929
Training Approach) Guntrip, Harry, 1:172
group as safe haven, 1:68 Guthrie, Edwin, 1:52
group dynamics, 1:468
historical context, 1:467 Habit, force of, 1:41
major concepts, 1:468–469 Habit reversal, 1:101
as organismic system, 1:454–455 (See also Gestalt Hahnemann, Samuel, 1:212, 1:502, 1:509–510
group therapy) Hahnemann University, 1:132
overview, 1:475 Hakomi therapy, 1:483–487
process groups, 2:801–804 characteristic techniques, 1:485–486
psychodynamic group psychotherapy, 2:823 historical context, 1:483

1184 Index
major concepts, 1:484–485 Healing Touch, 1:491–494

overview, 1:128 historical context, 1:491–492
theoretical underpinnings, 1:483–484 major concepts, 1:492–493
therapeutic process, 1:487 overview, 1:212
Haley, Jay, 1:487–489 techniques, 1:493
Ackerman and, 1:12 theoretical underpinnings, 1:492
biographical information, 1:487–489 therapeutic process, 1:494
brief therapy and, 1:145 Health Care Financing Administration of the
couples, family, and relational models, 1:248 Department of Health and Human Services, 1:270
de Shazer and, 1:276 Hearst, Liesel, 1:467
directive therapy and, 1:298, 1:299 Heart and Soul of Change: Delivering What Works in
Erickson and, 1:348, 1:350, 1:354 Therapy, The (Duncan, Miller, Wampold, Hubble),
interaction focused therapy and, 1:565 1:308–309
Madanes and, 2:623 Heart rate variability, 1:494–496
Minuchin and, 2:661 biofeedback, 1:117
narrative family therapy and, 2:691 historical context, 1:494–495
O’Hanlon and, 2:736 major concepts, 1:495
Palo Alto Group and, 2:753, 2:754, 2:755 neurofeedback, 2:709
strategic family therapy of, 2:957–962 overview, 2:718
strategic therapy of, 2:962–963 theoretical underpinnings, 1:495–496
structural family therapy and, 2:966 therapeutic process, 1:496
systemic family therapy and, 2:986 See also HeartMath
See also Palo Alto Group HeartMath, 1:496–499
Hall, Clark, 1:52 CAM, 1:212
Hambidge, Gove, 2:777 heart rate variability pattern, 1:497 (fig.)
Hamilton College, 2:936 historical context, 1:496–497
Hands-on listening, to client, 1:126 major concepts, 1:498
Hands-on techniques, 1:240 neurofeedback, 2:709
Happel, Clara, 2:762 overview, 1:212
Happiness, study of, 2:783 techniques, 1:498
Hare-Mustin, Rachel, 1:407 theoretical underpinnings, 1:497
Hargrave, Terry, 1:235 therapeutic process, 1:498–499
Harlow, Harry, 2:630 Hefferline, R. F., 1:457, 2:763
Harmin, Merrill, 2:1035 Hegel, Georg Wilhelm Friedrich, 1:293, 1:294, 2:610,
Harrington, G. L., 1:462, 2:856–857 2:880, 2:1027
Harris, Adrienne, 2:884 Heidegger, Martin, 1:221, 1:273, 1:274, 1:369,
Harris, Jeff, 2:685 1:370, 1:371, 1:399, 1:586–587, 2:772, 2:774,
Harvard Medical School, 1:345 2:880
Harvard University, 2:936 Heller, Joseph, 1:499, 1:500, 1:501
Having, being versus, 1:521 Hellerwork, 1:499–502
Hawk, Patrick, 2:617 historical context, 1:499–500
Hayashi, Chujiro, 2:877 major concepts, 1:501
Hayeck, Friederich, 2:628 overview, 1:212
Hayes, Steven, 1:5, 1:7, 1:51, 1:190, 2:653 techniques, 1:501
Healing From The Body Level Up, 1:489–491 theoretical underpinnings, 1:500–501
major concepts, 1:490 Hellerwork Institute, 1:500
overview, 1:212 Hellinger, Bert, 1:399, 2:984, 2:985
techniques, 1:490–491 Helm Stierlin group, 1:243
theoretical underpinnings, 1:489–490 Helmholtz, Hermann, 1:229
therapeutic process, 1:491 Hendrix, Harville, 1:531
“Healing Place of the Soul, The” (inscription, Henggeler, Scott W., 2:683
Thebes), 1:108 Henriques, Gregg, 2:1021, 2:1022
Healing setting, 1:207 Heraclitus, 1:278

Index 1185
Herbal medicine, 1:502–505 Holotropic breathwork, 1:507–509

major concepts, 1:503 major concepts, 1:508
overview, 1:212 overview, 1:128, 2:1013
techniques, 1:503–504 theoretical underpinnings, 1:507
theoretical underpinnings, 1:503 therapeutic process, 1:508–509
therapeutic process, 1:504 Homberbger, Theodor, 2:830
“Here-and-now” emphasis Homecoming: Reclaiming and Championing Your Inner
existential group psychotherapy, 1:366–367 Child (Bradshaw), 1:538
Gestalt group therapy, 1:454 Homeopathic medicine and counseling, 1:509–511
guided imagery therapy, 1:480 historical context, 1:509
interpersonal group therapy, 1:571 major concepts, 1:510
interpersonal integrative group therapy, 1:573 overview, 1:212
interpersonal psychoanalysis, 2:734 techniques, 1:510–511
orgonomy, 2:747 theoretical underpinnings, 1:510
process groups, 2:803 therapeutic process, 1:511
psychodynamic family therapy, 2:820 Homeostasis, 1:249–250, 1:420–421
psychoeducational groups, 2:828 Homework
Rubenfeld Synergy, 2:904 Ackerman Relational Approach, 1:16
Hermans, Hubert, 1:223, 1:224–225 behavioral activation, 1:104
Hermeneutics, phenomenological therapy, 2:775 cognitive behavioral therapies and, 1:191
Herophilos, 1:494 cognitive-behavioral family therapy, 1:183
Herrnstein, Richard, 2:739 cognitive-behavioral therapy, 1:198
Heschel, Abraham, 1:370 EcoWellness, 1:319
Heuristics, phenomenological therapy, 2:775 imago relationship therapy, 1:532
Hierarchical arrangement, 1:299, 2:968–969 integrative forgiveness psychotherapy, 1:559–560
Hierarchy, family constellation therapy mindfulness-based cognitive therapy, 2:657–658
and, 1:400 mindfulness-based stress reduction, 2:660
Hierarchy of needs, 1:289 Hooker, Evelyn, 2:932
Higgins, M., 2:744 Hopper, Earl, 1:467, 1:468
Hillman, James, 1:55–57, 1:232 Horizontal development, 1:286
Hilsenroth, Mark, 1:230–231 Horizontalizing, 2:774
Hiltner, Seward, 2:758 Horney, Karen, 1:511–513
Hippocrates, 1:351, 1:354, 1:509, 2:714 biographical information, 1:511–513
Hitler, Adolf, 1:436, 1:468, 2:761–762, 2:984 classical psychoanalytic approaches, overview, 1:170
Hoffer, Abram, 2:811 contemplative psychotherapy and, 1:226
Hoffman, Edward, 2:785 ego psychology and, 1:320
Hoffman, Irwin, 2:885 Freudian psychoanalysis and, 1:438
Hoffman, Louis, 1:370 Fromm and, 1:519
Hoffman, Lynn, 2:986 Gestalt therapy and, 1:457
Hofmann, Albert, 2:810–811 interpersonal psychoanalysis and, 1:574
Holding, 1:111 mindfulness and, 2:653
Holding environment, 2:818 neo-Freudian psychoanalysis, 2:702–706
Holding therapy, 1:505–507 Perls and, 2:762, 2:763
historical context, 1:505 psychosocial development and, 2:831
human validation process model, 1:517 Horowitz, Leonard, 1:420
major concepts, 1:505–506 Hostility, Horney on, 2:704
overview, 1:149, 1:233 “Hot seat,” 1:80
rebirthing, 2:861 How to Live With a Neurotic (Ellis), 1:334–335
techniques, 1:506 Howard, Kenneth, 1:401
theoretical underpinnings, 1:505 Huang Di, 1:20–21
therapeutic process, 1:506–507 Hubbard, L. Ron, 2:870
Holding Time (Welch), 1:505 Hubble, Mark, 1:206, 1:308–309, 1:310
Holism, 1:28–29, 1:241, 1:354, 1:510, 2:1030 Hug-Hellmuth, Hermine, 2:777

1186 Index
Hughes, Daniel, 1:75–76 Identity: Youth and Crisis (Erikson), 2:830

Hull, Clark L., 1:94, 1:348, 2:981 Identity renegotiation counseling, 1:529–531
Hulley, Laurel, 1:199–200, 1:223 historical context, 1:529
Human agency, 1:86 major concepts, 1:529–530
Human change processes, 1:279–280 overview, 1:220, 1:251
Human Change Processes (Mahoney), 1:279, 2:627, 2:628 techniques, 1:530
Human validation process model, 1:513–518 theoretical underpinnings, 1:529
historical context, 1:513–514 therapeutic process, 1:530–531
major concepts, 1:515–516 Ideomotor questioning, 2:869
overview, 1:251 IIP-32, 1:421–422
techniques, 1:516–517 Illinois State Psychiatric Institute of Chicago, 2:905
theoretical underpinnings, 1:514–515 Imagery. See Visualization
therapeutic process, 1:517–518 Imaginal exposure, 1:384, 1:388, 2:807, 2:808
Humanistic psychoanalysis of Erich Fromm, 1:518–524 Imaging technology, 2:715, 2:719–722
historical context, 1:519 Imagining, 1:56
major concepts, 1:520–522 Imago relationship therapy, 1:531–533
overview, 1:378 historical context, 1:531
techniques, 1:522–523 major concepts, 1:532
theoretical underpinnings, 1:519–520 overview, 1:251
therapeutic process, 1:523–524 techniques, 1:532
Humanistic psychology, defined, 1:377 theoretical underpinnings, 1:531–532
Humanistic-experiential model. See Human validation therapeutic process, 1:532–533
process model Imber-Black, Evan, 1:16
Hunt, Helen LaKelly, 1:531 Impact therapy, 1:533–535
Husserl, Edmund, 1:221, 1:274, 1:586–587, historical context, 1:533
2:762, 2:772 major concepts, 1:534
Huxley, Aldous, 1:40 overview, 1:192, 1:255, 1:355
Hynes, Arleen, 2:781 techniques, 1:534
Hynes-Berry, Mary, 2:781 theoretical underpinnings, 1:533–534
Hypnotherapy, 1:524–528 therapeutic process, 1:534–535
Ericksonian therapy, 1:360 Impact Therapy: The Courage to Counsel (Jacobs,
historical context, 1:524–525 Schimmel), 1:534
hypnotic induction, 1:244–245 “Implying,” 1:424
major concepts, 1:525–526 Improvisational therapy, 1:535–537
rational hypnotherapy, 2:855 major concepts, 1:536–537
recovered memory therapy, 2:869 overview, 1:255, 1:355
techniques, 1:526–527 techniques, 1:537
theoretical underpinnings, 1:525 theoretical underpinnings, 1:536
therapeutic process, 1:526–527 therapeutic process, 1:537
Hypothesis interpretation, 1:34 Improvisational Therapy: A Practical Guide for Creative
Clinical Strategies (Keeney), 1:535
“I” statements, 1:516, 2:676 In virtuo exposure, 1:388
IBP Central Institute, 1:552 In vivo exposure, 1:384, 1:388, 2:808
Ichazo, Oscar, 1:558 Incongruence, 2:770
Id, 1:329 Individual psychology. See Adlerian therapy
Identification Individual(s)
Kernberg and, 2:602–603 cyclical psychodynamics, 1:265
psychosocial development, 2:832 encountering the individual, 1:47
psychosynthesis, 2:839–840 Ericksonian therapy, 1:358
Identity feminist family therapy, 1:408–409
dissociative identity disorder, 2:868 internal family systems model, 1:569
integral eye movement therapy, 1:541 Individuals with Disabilities Education Act
process-oriented psychology, 2:805 (IDEA), 1:270

Index 1187
Individuation, 1:46, 2:594, 2:595, 2:625 developmental constructivism

Induction phenomena, 1:245, 1:526 and, 1:279
“Infant in the child,” 2:734 eclecticism, 1:307–308
Inferiority complex, 1:28, 1:31 ego state therapy, 1:328
Influence matrix (IM), 2:1022–1024 historical context, 1:547
Information, gathering, 2:807 integration-disintegration, 2:882
Information processing (EMDR), 1:391 integrative five-phase model, 1:302
Ingersoll, Elliott, 1:541 meditation and, 2:639
Inner child therapy, 1:537–539 multitheoretical psychotherapy, 2:685–686
historical context, 1:538 short descriptions of, 1:549–551 (See also individual
inner child metaphor, 1:506 names of therapies)
major concepts, 1:538 theoretical underpinnings, 1:547–549
overview, 1:332 Integrative body psychotherapy, 1:552–555
techniques, 1:539 historical context, 1:552
therapeutic process, 1:539 overview, 1:128
Inoculation, 1:422 techniquess, 1:554
Inpatient Group Psychotherapy (Yalom), 2:1058 theoretical underpinnings, 1:552–553
Inscoe, James, 2:971 therapeutic process, 1:554
Insight, 1:439, 1:459 Integrative family therapy, 1:555–557
Insight meditation, 2:639 historical context, 1:555
Institute for Child Development (University of major concepts, 1:556
Washington), 1:51 overview, 1:251
Institute for Contextual Growth, 1:132 techniques, 1:556
Institute for Family Studies, 1:248 theoretical underpinnings, 1:555–556
Institute for Reality Therapy, 1:462, 1:463 thereapeutic process, 1:557
Institute for the Study of Therapeutic Change, 1:401 Integrative forgiveness psychotherapy, 1:557–562
Institute of Experimental Medicine, 2:761 historical context, 1:557
Institute of Group Analysis, 1:467 major concepts, 1:559–560
Institute of Living, 2:616 metamodel of integrative psychotherapy, 1:557–558,
Institute of Medicine, 1:401 1:558 (fig.)
Institute of Social Medicine, 1:172 overview, 1:550
Institutionalizing Madness (Minuchi, Elizur), 2:662 techniques, 1:560–561
Integral eye movement therapy, 1:539–541 theoretical underpinnings, 1:557–559
major concepts, 1:540–541 Integrative milieu model, 1:562–564
techniques, 1:541 overview, 1:550
therapeutic process, 1:541 theoretical underpinnings, 1:563–564
Integral Life Practices (ILPs), 1:545 therapeutic process, 1:564
Integral psychotherapy, 1:541–546 Intensive Family Therapy (Böszörményi-Nagy), 1:132
Four Quadrants, 1:542–543, 1:543 (fig.) Intention, 1:492–493, 2:620–621, 2:685–686
historical context, 1:542 Interaction focused therapy, 1:564–567
major concepts, 1:543–545 historical context, 1:565
overview, 1:550, 2:1013 major concepts, 1:565–566
techniques, 1:545 overview, 1:355
theoretical underpinnings, 1:542–543 techniques, 1:566–567
therapeutic process, 1:545–546 theoretical underpinnings, 1:565
Integral Taxonomy of Therapeutic Interventions therapeutic process, 1:567
(ITTI), 1:545 Interactional and discursive model, 2:894
Integrative approaches: overview, 1:546–552 Interconnectedness, psychosynthesis
biodynamic psychology, 1:111 and, 2:839
dance movement therapy, 1:271 Interference patterns, 1:490

1188 Index
Internal family systems model, 1:567–569 major concepts, 1:573

major concepts, 1:568–569 techniques, 1:573–574
overview, 1:251, 1:332 theoretical underpinnings, 1:572–573
techniques, 1:569 therapeutic process, 1:574
theoretical underpinnings, 1:568 Interpersonal psychoanalysis, 1:574–577
therapeutic process, 1:569 historical context, 1:574–575
Internal object, 2:733 major concepts, 1:575–576
Internalization, 1:323 overview, 1:233
International Association for Relational Psychoanalysis techniques, 1:576–577
and Psychotherapy, 2:884 theoretical underpinnings, 1:575
International Association of Marriage and Family therapeutic process, 1:577
Counselors, 1:248 Interpersonal psychotherapy, 1:577–580
International Business Machines, 2:937 historical context, 1:578
International Center for Clinical Excellence (ICCE), major concepts, 1:578–579
1:401, 1:402 overview, 1:550–551
International Centre for Release and Integration, 2:791 techniques, 1:579
International Council of PsychoCorporal (Bodymind) theoretical underpinnings, 1:578
Integration Trainers, 2:791 therapeutic process, 1:579
International Family Therapy Association, 1:248 Interpersonal theory, 1:580–584
International Federation of Daseinsanalytic historical context, 1:580
Psychotherapy, 1:274 interpersonal behaviors model, 1:582 (fig.)
International Feldenkrais Federation, 1:404 major concepts, 1:581–582
International Institute for Object Relations techniques, 1:582–583
Therapy, 2:817 theoretical underpinnings, 1:580–581
International Journal of Eclectic Psychotherapy, therapeutic process, 1:583
1:547, 1:555 Interpersonal theory of mental illness, 2:971
International Journal of Individual Psychology, Interpersonal utilization, 1:526
1:26, 1:432 Interpretation, 1:439, 2:609, 2:724, 2:819–820, 2:823
International Journal of Narrative Therapy and Interpretation of Dreams, The (Freud), 1:168
Community Work, 2:1051 Intersubjective group psychotherapy, 1:584–586
International Journal of Play Therapy, 2:777 historical context, 1:584
International Journal of Sexology, 1:334 major concepts, 1:585
International Library of Group Analysis, overview, 1:475–476
The (Pines), 1:467 techniques, 1:585
International Library of Group Psychotherapy and theoretical underpinnings, 1:584–585
Group Process, The (Pines, Hopper), 1:467 therapeutic process, 1:585–586
International Primal Association, 2:795 Intersubjective stance, of therapist, 1:77
International Psychoanalytic Association, 1:157, 2:602, Intersubjective-systems theory, 1:586–590
2:610, 2:762–763 historical context, 1:586–587
International Society for Neurofeedback and major concepts, 1:587–589
Research, 2:708 overview, 1:233
International Society for Research on Aggression, 1:87 technique, 1:589
International Society for Traumatic Stress Studies, theoretical underpinnings, 1:587
1:389, 1:390 therapeutic process, 1:589
Interpersonal group therapy, 1:569–572 Intersubjectivity, 2:773–774
historical context, 1:570 Intervention
major concepts, 1:570–571 guided imagery therapy, 1:479–480
overview, 1:475 multisystemic therapy, 2:683–684
techniques, 1:571 nature-guided therapy, 2:701
theoretical underpinnings, 1:570 Intimate Couple, The (Morse, Rosenberg), 1:552
therapeutic process, 1:571 Introjection, 2:733
Interpersonal integrative group therapy, 1:572–574 Introversion, 1:46
historical context, 1:572 Invisible Loyalties (Böszörményi-Nagy), 1:131

Index 1189
Invisible loyalty, 1:237 Journal of Abnormal and Social Psychology,

Irrational labeling, 2:854–855 The, 1:348
Irrational thinking, 1:182, 1:186, 2:850 Journal of Abnormal Child Psychology, 1:51
Irwin, Eleanor, 1:301, 1:302 Journal of Applied Behavior Analysis, 1:51
Isebaert, Luc, 1:277 Journal of Behavior Therapy and Experimental
Israelitische Kultusgemeinde Vienna, 1:432–433 Psychiatry, 2:934
Iteration, 1:156 Journal of Child Psychology and Psychiatry, 2:1063
“I-Thou,” defined, 1:376, 1:458 Journal of Constructivist Psychology, The, 2:601
Itin, Christian, 1:38 Journal of Consulting and Clinical Psychology,
Ivey, Allen, 1:222, 1:284 2:934–935
Iwata, Brian, 1:52 Journal of Counseling and Clinical Psychology, 1:390
Journal of Counseling and Development, 1:260
Jackins, Harvey, 2:870–871, 2:873 Journal of Humanistic Psychology, The, 2:833
Jackins, Tim, 2:871 Journal of Individual Psychology, 1:26
Jackson, Don D. Journal of Integrative and Eclectic Psychotherapy, 1:547,
Ackerman and, 1:11, 1:12 1:555
couples, family, and relational models, 1:247–248 Journal of Marital and Family Therapy, 1:248
de Shazer and, 1:276 Journal of Psychotherapy Integration, 1:547
directive therapy and, 1:298 Journal of the Association for Multicultural Counseling
Haley and, 1:488 and Development, 1:260
interaction focused therapy and, 1:565, 1:567 Journal of Transpersonal Psychology, 2:1011
Madanes and, 2:623 Journal of Traumatic Stress, 1:389, 2:934
narrative family therapy and, 2:691 Journal of Unified Psychotherapy and Clinical
Palo Alto Group and, 2:753, 2:754, 2:755 Science, 1:547
Satir and, 2:905 Journaling
strategic family therapy and, 2:957 adventure-based therapy and, 1:39
See also Palo Alto Group cognitive-behavioral therapy, 1:197, 1:198
Jacobs, Ed, 1:533, 1:534 Morita therapy, 2:667
Jacobsen, Edward, 1:116 recovered memory therapy, 2:869
Jacobson, Edmund, 1:157, 2:981 See also Writing therapy
Jacobson, Neil, 1:102, 1:181, 1:555 Joy, Brugh, 1:499
Jäger, Willigis, 1:293, 2:617 Jung, Carl Gustav, 2:591–593
James, William, 1:95, 1:302, 1:353, 1:496, 2:939, analytical psychology and, 1:43–45, 1:171
2:1010–1011 biographical information, 2:591–593
Janet, Pierre, 1:325, 1:352, 1:525, 2:923 body-oriented therapies and, 1:127
Janis, Irving, 2:641 classical psychoanalytic approaches, overview, 1:169
Janov, Arthur, 2:795, 2:798 cognitive enhancement therapy and, 1:176
Jaspers, Karl, 2:772 contemplative psychotherapy and, 1:226
Jean Baker Miller Training Institute, 2:650, 2:888 ecotherapy and, 1:315
Jennings, Sue, 1:301 ego-oriented therapies and, 1:329, 1:331
Jesus, 2:758 Fromm and, 1:519, 1:523
Jet Propulsion Laboratory, 1:499 group counseling and psychotherapy theories,
Jing, 1:21, 1:22 overview, 1:473, 1:475
Joffe Ellis, Debbie, 2:849 guided imagery therapy and, 1:478
Johns Hopkins Hospital, 2:602, 2:1057 May and, 2:635, 2:636
Johnson, David Read, 1:301, 1:302 mindfulness and, 2:653
Johnson, Paul, 2:758 overview, 2:1013
Johnson, Sue, 1:338 primal integration and, 2:795, 2:796
Johnson, Susan, 1:74 psychodynamic group psychotherapy and, 2:821
Joining, 2:664–665, 2:698, 2:713 transpersonal psychology and, 2:1010–1011, 2:1013
Jones, Ernest, 2:604, 2:762 unified therapy and, 2:1027
Jones, Lawrence, 2:748 Jungian group psychotherapy, 2:593–597
Jones, Mary C., 1:386, 2:981 historical context, 2:593–594
Jouissance, 2:608, 2:611 major concepts, 2:594–595

1190 Index
overview, 1:475 object relations theory, 2:731–733, 2:735

techniques, 2:595–596 play therapy and, 2:777
theoretical underpinnings, 2:594 relational group psychotherapy and, 2:880
therapeutic process, 2:596 Tavistock Group Training Approach and,
Jungian therapy. See Analytical psychology 2:997, 2:998
Justification hypothesis (JH), 2:1022–1024 Winnicott and, 2:1053
Juxtaposition experience, 1:201–202 Klerman, Gerald, 1:578
Kleshas, 2:1060
Kabat-Zinn, Jon, 1:213, 1:226, 2:653, 2:656, 2:658 “Knowing,” 1:424
Kagu school, 1:226 Koffka, Kurt, 2:762
Kahneman, Daniel, 2:641 Kohlenberg, Robert J., 1:442, 1:445
Kaiser Foundation Research, 1:580 Köhler, Wolfgang, 2:762
Kamiya, Joe, 2:707, 2:715 Kohut, Heinz
Kanner, Allen, 1:314 classical psychoanalytic approaches and, 1:170, 1:171
Kano, Jigoro, 1:404 contemporary psychodynamic-based therapies
Kant, Immanuel, 1:25–26, 1:217, 1:221, 1:278 and, 1:230
Kardiner, Abram, 1:511 Kernberg and, 2:603
Karuna Institute, 1:241 neo-Freudian psychoanalysis and, 2:703
Kauffman, Katie, 2:871, 2:873 psychodynamic family therapy and, 2:817, 2:818
Keeney, Bradford, 1:535, 1:536 psychoeducational groups and, 2:826
Kegan, Robert, 1:280 relational group psychotherapy and, 2:880, 2:885–886
Keith, David, 2:976 relational psychoanalysis and, 2:885–886
Kelley, Charles, 2:845, 2:846 self psychology and, 1:234, 2:910–911
Kelly, George, 2:599–601 unified therapy and, 2:1027
biographical information, 2:599–601 Kojève, Alexandre, 2:610
cognitive analytic therapy and, 1:173 Kolb, David A., 1:18, 1:37, 1:38, 2:1004
constructivist therapies and, 1:217–220, Korzybski, Alfred, 1:217, 1:221
1:222–223, 1:225 Koshas, 2:1060
developmental constructivism and, 1:278–279 Krasner, Barbara, 1:235
personal construct theory of, 2:764–767 Krieger, Dolores, 1:213, 1:492, 2:1001
phenomenological therapy and, 2:773 Krishna, Gopi, 2:1012
Kemp, Nick, 2:809 Kubrick, Stanley, 1:95
Kennard, David, 1:469 Kuhn, Roland, 2:636
Kennedy, John F., 2:783–784 Kunz, Dora, 1:213, 2:1001
Kennedy, Rick, 1:161, 1:162 Kurtz, Ronald S., 1:483, 1:486, 2:923
Kerekhazi, Helena, 2:720
Kernberg, Otto, 1:170, 2:601–604, 2:605, 2:732 Lacan, Jacques, 1:233, 1:284, 2:607–608, 2:610–613
Kerr, Michael, 2:672 Lacanian group therapy, 2:607–610
Kershaw, Carol, 1:137 historical context, 2:607
Kessel, Daphne Ann, 2:614 major concepts, 2:608–609
Kestenberg, Judith, 1:271 overview, 1:476
Keysers, Christian, 2:717 techniques, 2:609
Kierkegaard, Søren, 1:369, 2:635 theoretical underpinnings, 2:607–608
Kindness, 1:242, 2:657 therapeutic process, 2:609
Kinesiology, 1:490 Lacanian psychoanalysis, 2:610–613
King, Charles, 2:661 historical context, 2:610–611
Kinsey, Alfred, 2:932 major concepts, 2:611–612
Klein, Melanie, 2:604–606 overview, 1:233
attachment group therapy and, 1:67 techniques, 2:612–613
classical psychoanalytic approaches, overview, 1:169 Laing, R. D. See Phenomenological therapy
expressive therapies and, 1:254 Lake, Frank, 1:241, 2:795–796
group counseling and, 1:477 Lambert, Michael, 1:206, 1:309, 1:401
intersubjective group psychotherapy and, 1:584 Landauer, Karl, 1:519
non-Freudian psychoanalysis and, 2:705 Landy, Richard, 1:301, 1:302, 1:303

Index 1191
Landy, Robert, 1:301 Levitsky, Abe, 2:763

Lane, Richard, 1:285 Levy, David, 2:777
Lang, Peter J., 2:934 Lewes, Kenneth, 2:932
Langer, Susanne K., 2:976 Lewin, Kurt
Language activity-based group psychotherapy and, 1:18
of the body, 1:157–160 ecological counseling and, 1:311
feedback-informed treatment, 1:400–401 Gestalt therapy and, 1:457–458
Gestalt group therapy, 1:455 interpersonal group therapy and, 1:570
internal family systems model, 1:569 Perls and, 2:762
Lacanian group therapy, 2:607–609 process groups and, 2:801–802
Lacanian psychoanalysis, 2:610–613 psychoeducational groups and, 2:826, 2:829
neuro-linguistic programming, 2:710–713 systems-centered group therapy and, 2:991
“other” and “Other,” 2:607–608, 2:610 Tavistock Group Training Approach and,
provocative therapy, 2:808–810 2:998, 2:999
religion and, 2:616–617 training groups and, 2:1002–1003,
symbolic experiential family therapy, 2:978 2:1004, 2:1005
Lao Tzu, 1:278 Lewinsohn, Peter, 1:102, 1:103
Lasswell, Harold, 1:511 Libido, 2:723–724
Law of effect, 2:738 Library of Congress, 1:433, 2:618
Law of Similars, 1:510 Liebeault, Ambroise-Auguste, 1:352, 1:525
Law of Similia (Hippocrates), 1:509 Lieberman, Morton, 1:570
Law of Simplex, 1:510 Life review/reminiscence, 2:782
Lawley, James, 2:645 Lifeline drawing, for art therapy, 1:62
Lawrence, P. Scott, 1:442 Lilienfeld, Scott O., 1:150
Lazarus, Arnold, 1:64, 1:97, 1:185, 1:308–309, 1:547, Lilly, John, 1:499
2:613–616, 2:641, 2:677–678, 2:685 Limits, setting, 2:779
Lazarus Institute, The, 2:615 Lindemann, Eric, 1:257
Leaders Linderberg, Elsa, 1:157
psycheducational groups, 2:827 Lindkvist, Marion, 1:301
role of, 1:69 Lindsley, Ogden, 1:53, 1:94
Learned Optimism (Seligman), 2:922 Linehan, Marsha, 1:190, 1:195, 1:292–293, 2:616–618,
Learning, conditions for, 1:164–165, 2:828 2:653, 2:1027
Learning theory, 1:98 Linehan Institute, 2:617
“Learning Through In Vivo Experience” (Gaynor, Linehan Training Group, 2:617
Lawrence), 1:442 Linking, 1:360–361
Leary, Timothy, 1:580, 2:811 Liotti, Giovanni, 1:223, 1:224, 1:225
Leaving Home (Haley), 1:487 Lipchik, Eve, 1:276, 2:948
Lee, Wai-Yung, 2:662 Listening, 2:819, 2:916, 2:948, 2:1005
Leedy, Jack J., 2:781 “Little Hans,” 2:731, 2:776–777
Legacy, 1:237 Lloyd, David, 2:834
Leherer, Paul, 1:496 Loewald, Hans, 2:884
Leiman, Mikael, 1:173 Logical connotation, 1:299
Leipzig University, 1:157 Logotherapy and existential analysis, 2:618–622
Lennon, John, 2:798 historical context, 2:618–619
Lesbian gay bisexual transgender (LGBT). See Sexual major concepts, 2:620–622
identity therapy; Sexual minority affirmative overview, 1:378
therapy; Sexual orientation change efforts theoretical underpinnings, 2:619–620
Leszcz, Molyn, 1:420 Lorenz, Edward, 1:155
Letter writing, 2:694–695, 2:699 Lorenze, Konrad, 1:71
Letter writing, integrative forgiveness Love, Maslow on, 2:632
psychotherapy, 1:560 Love and Will (May), 2:636
Levine, Peter A., 2:950 Love Lab, The, 1:465
Levinson, Boris, 1:48 Love’s Executioner (Yalom), 2:1058
Lévi-Strauss, Claude, 1:586–587, 2:607 Loving presence, 1:484

1192 Index
Lowen, Alexander, 1:113, 1:115, 1:127, 1:238, 1:507, Marx, Karl, 1:25–26, 1:157
2:792, 2:876 Maryland Psychiatric Research Center, 2:689
Lowenstein, Rudolph, 2:610 Masculinity complex, 2:704
LSD. See Psychedelic therapy Maslow, Abraham, 2:629–631
Lubar, Joel, 2:707 on developmental needs, 1:289
Lucifer Effect: Understanding How Good People Turn on dramatic play, 1:302
Evil, The (Zimbardo), 2:1063 Erickson and, 1:349
Luckmann, Thomas, 1:221–222, 2:736 holotropic breathwork and, 1:507
Ludwig, Carl, 1:495 Maslow’s hierarchy of needs, explained,
Luquet, Wade, 1:532–533 2:629–634
Luthe, Wolfgang, 1:81 May and, 2:636
Lying on the Couch (Yalom), 2:1058 overview, 2:1013
Lyotard, Jean François, 1:203 positive psychology and, 2:784
Lyubomirsky, Sonja, 2:784 psychosynthesis and, 2:837
Rogers and, 2:897
Maccoby, Michael, 1:519, 1:523, 1:524 Satir and, 2:905
Macy Foundation, 1:298 Seligman and, 2:921
Madanes, Cloe, 1:248, 1:298–299, 1:488, 2:623–624, transpersonal psychology and, 2:1011, 2:1013
2:755, 2:957, 2:958, 2:960–961, 2:965 Maslow’s hierarchy of needs, 2:631–634
Madigan, Stephen, 2:692, 2:696 historical context, 2:631
Madsen, William, 2:696, 2:697 major concepts, 2:632–633
Magnavita, Jeffrey, 1:549 overview, 1:378, 2:1013
Magnetic resonance imaging (MRI), 2:715 techniques, 2:633–634
Mahler, Margaret, 1:169, 1:230, 1:271, 2:603, theoretical underpinnings, 2:631–632
2:624–627, 2:732 therapeutic process, 2:634
Mahoney, Michael J., 1:224, 1:278, 1:279, 1:281, 1:282, Mass Psychology of Fascism, The (Reich), 2:875
1:283, 2:627–629, 2:627–629, 2:641 Massachusetts Department of Mental Health, 2:662
Main, Mary, 1:67 Massage, biodynamic, 1:112
Maintenance, transtheoretical model and, 2:1015 Masserman, J. H., 2:981
Maintenance (dynamic administration), 1:469 Masses, 1:468
Mair, Miller, 1:224–225 Masson, Jeffrey, 1:168
Maje-Raider, Ann, 2:894 Mastering Family Therapy (Minuchin, Lee,
Makinen, Judy, 1:74 Simon), 2:662
Maladaptive introjects, 1:290 Masterson, James, 2:1027
Malignant neurosis, 1:520 Materia Medica, 1:502
Malone, Thomas, 2:1048 Matrix, dynamic, 1:469
Malyon, Alan, 2:928–929 Maturana, Humberto, 1:218, 1:222, 1:223,
Man and the Science of Man (Rogers), 2:897 1:458, 2:628
Man for Himself (Fromm), 1:521 Maultsby, Maxie C., 1:194, 2:853–854, 2:1055
Mandala drawing, for art therapy, 1:62 May, Gerald, 2:616
Mann, James, 1:173 May, Rollo, 1:370, 2:634–637
Mannarino, Anthony, 2:1018 Mazza, Nicholas, 2:781
Manoa’s Counseling and Student Development McCready, Kevin, 1:562, 1:563
Center, 2:685 McCullough, James, 1:190
Man’s Search for Himself (May), 2:636–637 McFarlane, W., 2:825
Man’s Search for Meaning (Frankl), 1:433, 2:618 McInerney, Barb, 2:894
Man’s Search for Ultimate Meaning (Frankl), 1:433 McKinney, Fred, 2:1055
Mansell, Warren, 2:647 McWilliams, Nancy, 1:230–231
Mapping, 1:156 Mead, Margaret, 1:349–350, 1:511, 1:519, 2:753
Maratos, Jason, 1:467 Meaning
Marcel, Gabriel, 1:369 cocreation of, 1:77
Marcia, James, 2:831 logotherapy and exitential analysis, 2:620–621
Marquis, Andre, 1:541, 1:545 meaningless and existential therapy, 1:372
Marriage Consultation Center, 1:247 Meaning of Anxiety, The (May), 2:635

Index 1193
Media, for art therapy, 1:61 Method of Levels, 2:646–648

Mediation, 2:609 historical context, 2:647
Medical College of Virginia, Division of Family and major concepts, 2:647
Social Psychiatry, 1:134 overview, 1:192
Medical model, in therapy, 1:207 techniques, 2:647
Medicare facilities, 1:270 theoretical underpinnings, 2:647
Meditation, 2:637–641 Metta meditation, 2:639
historical context, 2:637 Mexican Institute of Psychoanalysis, 1:519
major concepts, 2:638–639 Meyer, Victor, 1:382
as non-Western approach, 2:726–727 Meynert, Theodor, 1:434
ongoing practice of, 1:228 (See also Contemplative Michael, Jack, 1:51
psychotherapy) Michalos, Alex, 2:784
overview, 1:212 Michigan State University, 2:634
psychosynthesis, 2:840 Microskills, 1:287
techniques, 2:639 Middlesex University of London, 1:241
theoretical underpinnings, 2:637–638 Milan school of systemic family therapy. See Systemic
therapeutic process, 2:639–640 family therapy
See also Mindfulness-based cognitive therapy; Miles, Pamela, 1:213
Mindfulness-based stress reduction Milgram, Stanley, 2:1064
Meichenbaum, Donald, 1:89, 1:181, 1:189, 1:194–195, Miller, James, 2:991
2:628, 2:641–642 Miller, Jean Baker, 1:271, 2:648–650, 2:887–888
Memory Miller, Neal E., 1:63–64, 1:547, 2:715, 2:1063
networks, 1:391 Miller, Scott, 1:206, 1:308–309, 1:310, 1:401
primal integration, 2:796–797 Miller, William R., 2:650–652, 2:668–669
reconsolidation, 1:201 Mills, Joyce, 2:955
Mendota Mental Health Institute, 2:808–809 Milton H. Erickson Foundation, 1:350, 1:464
Menninger, Karl, 2:781 Mind-body connection
Menninger Clinic Foundation, 2:672 awareness, 1:242
Menninger Foundation, 1:134 biofeedback and, 1:117
Mental functions, Jung on, 2:796 integrative body psychotherapy, 1:552–553
Mental Research Institute (MRI). See Palo Alto Group mind-body as indivisible unit, 1:41
Mentalization-based treatment, 2:643–645 Mind-Body Healing Experience, 2:836
attachment group therapy, 1:68 Mindell, Arnold, 2:804
historical context, 2:643 Mindfulness techniques, 2:653–656
major concepts, 2:643–644 breathwork, 1:143
mentalization, defined, 2:643–644 contemplative psychotherapy, 1:228
overview, 1:233 dialectical behavior therapy, 1:294
techniques, 2:644 Hakomi therapy, 1:484–487
therapeutic process, 2:644 major concepts, 2:653–654
Mentgen, Janet, 1:212, 1:492 Morita therapy, 2:667, 2:668
Meridians, 1:23, 1:336, 1:490–491 as non-Western approach, 2:727
Merleau-Ponty, Maurice, 1:221 overview, 1:213
Merton, P. A., 1:153 pulsing, 2:842
Mesmer, Franz Anton, 1:351, 1:524 techniques, 2:654–656
Messer, Stanley, 1:64, 1:65, 1:66 theoretical underpinnings, 2:653–654
Metaphor, 2:668, 2:958, 2:960, 2:963–964 Mindfulness-based cognitive therapy,
Metaphors of Movement therapy, 2:645–646 2:656–658
techniques, 2:646 techniques, 2:657–658
theoretical underpinnings, 2:645 theoretical underpinnings, 2:656–657
therapeutic process, 2:646 therapeutic process, 2:658

1194 Index
Mindfulness-based stress reduction, 2:658–660 theoretical underpinnings, 2:666–667

historical context, 1:658, 2:658 therapeutic process, 2:668
major concepts, 2:659 Morse, Beverly Kitaen, 1:552
overview, 1:192 Morton, H. B., 1:153
techniques, 2:659–660 Mothers, psychoanalysis and, 1:413
therapeutic process, 2:660 Motivation, activating, 1:139
“Mini-theories,” 2:765 Motivation and Personality (Maslow), 2:630
Minkowski, Eugène, 2:636 Motivational interviewing, 2:668–672
Minuchin, Patricia, 2:661, 2:662, 2:967 historical context, 2:668–669
Minuchin, Salvador, 2:660–662 major concepts, 2:669–670
Ackerman and, 1:12 overview, 1:192
biographical information, 2:660–2:662 techniques, 2:670–671
couple and family hypnotic therapy, theoretical underpinnings, 2:669
1:243, 1:248 Motivational Interviewing: Preparing People to Change
directive therapy and, 1:298 (Miller, Rollnick), 2:650–651
Haley and, 1:488 Motivational Interviewing Network of Trainers, 2:651–652
Madanes and, 2:623, 2:624 Mount Sinai Hospital, 2:833
Palo Alto Group and, 2:755 Movement
structural family therapy and, 2:966, 2:967 Alexander technique and, 1:39–43
systemic family therapy and, 2:986 Body-Mind Centering® and, 1:126
Whitaker and, 2:1049 body-oriented therapies, overview, 1:126–129 (See
Minuchin Center for the Family, 2:967 also individual names of body-oriented therapies)
Mirror neurons, 2:716–717 concentrative movement therapy, 1:214–216
Mirror stage, 2:610 Radix, 2:847
Mirror time, 1:281 therapies, overview, 1:355
Mirroring, 1:469, 2:815 See also Alexander technique; Feldenkrais Method
Mitchell, Jeffery, 1:256, 1:257 Movement therapies. See Dance movement therapy;
Mitchell, Stephen, 2:884 Yoga movement therapy
Mitwelt, 1:370–371 Mowbray, Richard, 2:795
Modality profiles, 2:679 MRI Brief Therapy Center, 2:753, 2:755
Modeling, 1:198, 1:207, 2:940 Muller, A., 1:157
Modern analytic group therapy, 2:662–666 Multidirectional partiality, 1:237
historical context, 2:663 Multigenerational family therapy, 2:672–677
overview, 1:476 major concepts, 2:673–676
techniques, 2:664–665 overview, 1:251
therapeutic process, 2:665–666 techniques, 2:676
therapeutic underpinnings, 2:663 theoretical underpinnings, 2:673
Molnar, Alex, 1:276 therapeutic process, 2:676–677
“Moments of meeting,” 1:585 Multigenerational transmission process, 1:136
Momma and the Meaning of Life: Tales of Multimodal Behavior Therapy (Lazarus), 2:614
Psychotherapy (Yalom), 2:1058 Multimodal therapy, 2:677–682
Montalvo, Braulio, 1:298, 1:488, 2:661, 2:966 assimilative psychotherapy integration, 1:64
More Than Miracles: The State of the Art of Solution- historical context, 2:677–678
Focused Brief Therapy (de Shazer), 1:277 major concepts, 2:678–679
Moreno, Fernando, 1:20, 1:161, 1:162, 1:302 overview, 1:97, 1:193, 1:551
Moreno, Jacob Levy, 1:301, 1:399, 1:453, 1:474, 1:570, techniques, 2:679–682
2:812–813, 2:814 theoretical underpinnings, 2:678
Morita, Shoma, 1:213, 2:666–668 Multiple impact therapy (MIT), 1:203
Morita therapy, 2:666–668 Multiple personality disorder, 2:868
historical context, 2:666 Multiple perspectives, Ackerman Relational Approach, 1:15
major concepts, 2:667 Multiple self states model (MSSM), 1:174
overview, 1:213 Multiplicity, self states and, 2:885–886
techniques, 2:667–668 Multiplicity of the mind, 1:568

Index 1195
Multisensory techniques. See Impact therapy identity renegotiation counseling, 1:530

Multisystemic therapy, 2:682–684 individual/family narratives, 1:78
historical context, 2:683 major concepts, 2:696–697
major concepts, 2:683–684 overview, 1:220, 1:431
overview, 1:251–252 techniques, 2:697–699
theoretical underpinnings, 2:683 therapeutic process, 2:699–700
therapeutic process, 2:684 White and, 1:223, 2:691, 2:696, 2:1050–1052
Multitheoretical psychotherapy, 2:684–687 NASA (National Aeronautics and Space Administration),
historical context, 2:685 2:707, 2:954
major concepts, 2:685–686 NASW Code of Ethics, 1:260
multitheoretical framework for psychotherapy, National Academies of Practice, 2:615
2:685 (table) National Association for Poetry Therapy, 2:781
overview, 1:551 National Association for the Research and Therapy of
techniques, 2:686 Homosexuality, 2:926
theoretical underpinnings, 2:685 National Association of Cognitive Behavioral
therapeutic process, 2:686 Therapists, 2:853
Murphy, Gardner, 2:1011 National Association of Social Workers (NASW),
Murray, Henry, 1:586 1:260, 2:925, 2:932
Muscle testing, 1:490 National Center for Complementary and Alternative
Musculoskeletal manipulation, 2:842 Medicine (NCCAM), 1:209, 1:270, 1:492
Music therapy, 2:687–690 National Certification Commission for Acupuncture and
historical context, 2:687 Oriental Medicine, 1:21
major concepts, 2:688–689 National Coalition of Creative Arts Therapies
music-centered music therapy, 2:689–690 Associations, 1:253
overview, 1:255 National Defense Research Committee, 2:936
techniques, 2:689–690 National Federation for Biblio/Poetry Therapy, 2:781
theoretical underpinnings, 2:687–688 National Health Service (NHS), 1:172, 2:647
Mutual inquiry, 1:204 National Institute of Alcohol Abuse and
My Quest for Beauty (May), 2:634 Alcoholism, 2:651
Myers, Jane E., 1:284, 1:317, 2:1044 National Institute of Drug Abuse, 2:617
Myofascial system, rolfing and, 2:898 National Institute of Mental Health (NIMH), 1:134,
Mysterious Island (Verne), 2:936 1:465, 2:617, 2:661, 2:672, 2:783, 2:891
National Institutes of Health (NIH), 1:209,
Nagy, Ivan, 1:131 1:270, 1:492
Napier, August, 2:976 National Registry of Evidence-Based Programs and
Narcissism, 1:520, 1:522, 2:912, 2:913 Practices, 2:669
Naropa institute, 1:226 National Training Laboratories, 2:801–802, 2:826
Narrative family therapy, 2:691–695 Natural flow EMDR, 1:140
historical context, 2:691–692 Natural healing tendency, 1:241–242
major concepts, 2:692–693 Nature. See Ecotherapy; EcoWellness
overview, 1:252 Nature, Science Genome Research, 2:834
techniques, 2:693–694 Nature-guided therapy, 2:700–702
therapeutic process, 2:694 major concepts, 2:701
Narrative Means to Therapeutic Ends (White, Epston), overview, 1:255, 1:355
2:692, 2:696 techniques, 2:701
Narrative therapy, 2:695–700 theoretical underpinnings, 2:700–701
chaos theory and, 1:156 therapeutic process, 2:702
coherent autobiographical narratives, 1:76 Nature-Guided Therapy (Burns), 2:700
constructivist therapy and storying, 1:223 Naumburg, Margaret, 1:59
emotion-focused therapy, 1:343–344 Navarro, Federico, 1:158, 1:159
historical context, 2:696 Needs, reality therapy and, 2:858
hypnotherapy and therapeutic metaphor, 1:527 Negentropy, 1:484

1196 Index
Neo-Freudian psychoanalysis, 2:702–706 New Library of Group, Analysis, The (Hopper), 1:467
historical context, 2:702–703 New Ways in Psychoanalysis (Horney), 1:511
major concepts, 2:704–705 New York Institute, 1:453
overview, 1:171 New York Institute for Gestalt Therapy, 2:763
theoretical underpinnings, 2:703–704 New York Psychoanalytic Society, 2:702, 2:703
Neurocoaching, 1:138 New York University, 2:884, 2:934
Neurofeedback, 2:706–710 Newton, Isaac, 1:155
cognitive enhancement therapy, 1:178 Nichols, Michael, 2:662
historical context, 2:706–707 Nietzsche, Friedrich, 1:25–26, 1:229, 1:369, 1:371,
major concepts, 2:707–708 1:586–587, 2:635, 2:880
overview, 1:117, 2:718 Nitsun, Morris, 1:468
techniques, 2:709 Nixon, Richard, 1:21
theoretical underpinnings, 2:707 Niyamas, 2:1060
Neurogenesis, 2:716 “Noble Truth,” 2:658–659
Neuro-linguistic programming, 2:710–713 Nonconscious experiences, 1:585
historical context, 2:710–711 Nondirective counseling, 2:770
major concepts, 2:711–713 Nondirective play therapy, 2:777–778
overview, 1:355, 2:718 Nondirective skills, integration of, 1:78
techniques, 2:713 Nondirective therapeutic facilitation, 1:49
theoretical underpinnings, 2:711 Nongenuineness, 2:770
Neurological and psychophysiological therapies: Nonlinear paradigm of change, 1:358, 2:1031
overview, 2:713–719 Nonthinking, 1:139
historical context, 2:714–715 Non-Western approaches, 2:725–729
short descriptions of, 2:717–719 (See also individual historical context, 2:725
names of therapies) major concepts, 2:726 (See also Meditation;
theoretical underpinnings, 2:716–717 Mindfulness techniques; Yoga movement therapy)
Neurological music therapy, 2:690 overview, 1:209, 1:213
Neuromuscular lock, 2:918–919 techniques, 2:726–728
Neuroplasticity, 2:707–708, 2:716 theoretical underpinnings, 2:725–726
Neuroprocessing, 2:719–722 therapeutic process, 2:728–729
historical context, 2:720–721 Norcross, John, 1:307, 2:669, 2:768
major concepts, 2:721–722 Nordoff, Paul, 2:690
overview, 2:718–719 Nordoff-Robbins music therapy, 2:690
techniques, 2:722 Normal projective identification, 2:733
theoretical underpinnings, 2:721 North American Drama Therapy Association
therapeutic process, 2:722 (NADTA), 1:301
Neuropsychiatric Institute, 1:457 North American Nursing Diagnosis Association, 1:492
Neuropsychoanalysis, 2:723–725 North American Society for Adlerian Psychology, 1:26
historical context, 2:723 North American Solution-Focused Brief Therapy
major concepts, 2:723–724 Association, 1:277
overview, 1:233, 2:719 Northfield Hospital, 2:802
techniques, 2:724 Northfield Military Hospital, 1:467
therapeutic process, 2:724 Note cards, use of, 1:422
Neuropsychoanalysis, 2:723 Not-knowing, 1:204
Neuro-repatterning/tuning, 1:139 NTL Institute of Applied Behavioral Sciences, 2:1003
Neurosis and Human Growth: The Struggle Toward Nuclear family emotional system, 1:136, 2:674–675
Self-Realization (Horney), 1:512 Nuclear ideas, 2:882
Neurotic Personality of Our Time, The (Horney), 1:511 Nunnally, Elam, 1:276
Neurotic styles, 2:704 Nurturing Independent Learners (Meichenbaum),
Neurotic suffering, existential versus, 1:227 2:641–642
Neutral reinforcement, 1:446 Nyingma school, 1:226
Neutral stimuls (NS), 1:163
Nevin, J. A., 2:739 Oates, Wayne, 2:758
New, Caroline, 2:871, 2:873 Object feelings, 2:664

Index 1197
Object Relations in Psychoanalytic Theory (Greenberg, Organizing principles, 1:587

Mitchell), 2:884 Organon of the Medical Art, The (Hahnemann), 1:509
Object relations theory, 2:731–735 Orgastic potency, 2:746
ego psychology, 1:322 Orgonomy, 2:743–748
historical context, 2:731–732 historical context, 2:743–744
major concepts, 2:733–734 major concepts, 2:745–746
object, defined, 2:733 overview, 1:128
object relationships, overview, 2:818 techniques, 2:746–747
overview, 1:171 theoretical underpinnings, 2:744–745
therapeutic process, 2:734–735 Orgonon, 2:743
Observant participation, 2:1005 Orienting, 1:104
Observation, Radix and, 2:846–847 Origin of Species, The (Darwin), 2:834
Observational learning, 1:100 Ormay, Tom, 1:468
Obsessive-compulsive disorder, 1:382, 1:383 Ormont, Louis R., 2:663
Occupational engagement, 2:668 Orr, Leonard, 1:213, 2:863–864
Oedipal behaviors, 2:724 Ortega y Gasset, Jose, 1:524
Office of Alternative Medicine, 1:492 Ortho-Bionomy, 2:748–750
Ogden, Cindy, 2:894 historical context, 2:748
Ogden, Pat, 2:923 major concepts, 2:749
Ogden, Thomas, 1:172, 2:886 overview, 1:128
O’Hanlon, Bill, 2:735–737, 2:788 techniques, 2:749–750
Ohio State University, 2:600, 2:896 theoretical underpinnings, 2:748–749
Older Americans Act reauthorization amendments therapeutic process, 2:750
(PL 102–375), 1:270 Osmond, Humphry, 2:811
Olson, David, 2:626 Ossorio, Peter, 2:954
“On the Meaning of Life” (Frankl), 1:432 Other therapies: overview, 2:750–752
On the Origin of Species (Darwin), 2:759 brief therapy, 2:750
“On the Psychology of Philosophical Thought” chaos theory, 2:750
(Frankl), 1:432 common factors in therapy, 2:751
Open Centre, 2:841 cross-cultural counseling theory, 2:751
Open facilitation, 1:469 ecological counseling, 2:751
Open-ended questioning, 2:670 evidence-based psychotherapy, 2:751
Operant behavior, 1:50–51 feedback-informed treatment, 2:751
Operant conditioning, 2:737–743 Metaphors of Movement therapy, 2:751
behavior modification, 1:91–92 pastoral counseling, 2:751
behavior therapies, 1:95, 1:97 provocative therapy, 2:751
behavior therapy, 1:98–99 reevaluation counseling, 2:751
cognitive-behavioral family therapy, 1:182 relational-cultural theorying, 2:751–752
differential reinforcement of other self-relations psychotherapy, 2:752
behavior, 1:99 sexual identity therapy, 2:752
historical context, 2:738 sexual minority affirmative therapy, 2:752
major concepts, 2:739–741 status dynamic psychotherapy, 2:752
techniques, 1:106, 2:741–742 supportive psychotherapy, 2:752
theoretical underpinnings, 2:738–739 “Other”/”Other,” 2:607–608, 2:610
therapeutic process, 2:742 Othmer, Siegfried, 2:707
Opposites, balancing of, 2:839 Othmer, Sue, 2:707
Opposites, problem of, 2:594–595 Our Inner Conflicts (Horney), 1:512
Oppression, identifying, 1:308 Out of the Blue: Six Non-Medication Ways to Relieve
“Oral Resistances” (Perls), 2:762 Depression (O’Hanlon), 2:737
Orange, Donna, 1:587 Outcome rating scale (ORS), 1:402
Ordeals, 2:965 Overaccommodation, 1:180
Organicism, pluralism versus, 1:65 Overt statements, 1:202
Organismic valuing process, 2:770 Owned living, 2:773–774

1198 Index
PACE (playfulness, acceptance, curiosity, empathy), 1:77 Pavlov, Ivan, 1:90, 1:93, 1:95, 1:163, 1:189, 1:385–386,
Pahnke, Walter, 2:689 2:759–761, 2:981, 2:982
Pain and Behavior Medicine (Meichenbaum), 2:641–642 Peak performance, biofeedback and, 1:117
Painter, Jack, 2:791 Peale, Norman Vincent, 2:758
Palazzoli, Mara Selvini, 1:298, 2:755, 2:986 Peniston, Eugene, 2:707
Palo Alto Group, 2:753–755 Pennebaker, James, 2:1055
brief therapy concept, 1:144 Pennebaker Writing Paradigm, 2:1056
couples, family, and relational models, 1:247–248 Pennsylvania Hospital, 2:780–781
Erickson and, 1:350 Perennial philosophy, 1:542
Haley and, 1:487, 1:488 Perinatal matrices, 2:796
history of, 2:753–755 Peripheral skin temperature training, 1:117
Madanes and, 2:623 Perls, Fritz, 2:761–764
narrative family therapy, 2:691 Alexander technique and, 1:40
Satir and, 2:905 biographical information, 2:761–764
Shapiro and, 2:934 body-oriented therapies and, 1:127
solution-focused brief family therapy, 2:943 ego-oriented therapies and, 1:330, 1:332
solution-focused brief therapy, 2:946, 2:947 existential-humanistic therapies and, 1:375
strategic therapy, 2:962–963 Gestalt group therapy, 1:453, 1:454, 1:456
systemic family therapy, 2:987 Gestalt therapy, 1:457, 1:458, 1:459, 1:460
Papp, Peggy, 1:12, 1:13, 1:16, 1:407 guided imagery therapy, 1:478
Paracelsus, 1:351 holotropic breathwork, 1:507
Parad, Howard, 1:257 impact therapy and, 1:533
Paradox, 1:299–300, 1:354, 2:621, neuro-linguistic programming and, 2:710
2:667, 2:753, 2:774 phenomenological therapy and, 2:773
Paradoxical intention, 1:147 Rubenfeld synergy and, 2:902, 2:903
Paranoid schizoid position, 2:733–734 See also Gestalt group therapy
Parapraxis, 1:439 Perls, Laura Posner, 1:330, 1:332, 1:453, 1:456, 1:457,
Parent-child interaction therapy, 2:755–757 1:458, 1:461, 2:761–763, 2:902–903
historical context, 2:756 Perls, Renate, 2:762
major concepts, 2:756 PERMA (positive emotion, encouragement, relationships,
overview, 1:97 meaning, achievement) theory, 2:785
techniques, 2:756–757 Perón, Juan, 2:661
theoretical underpinnings, 2:756 Perpetual problems, Gottman on, 1:466
therapeutic process, 2:757 Persona, 1:45, 1:46
Parenting Personal construct theory, 2:764–767
parental disapproval syndrome, 2:864 constructivist therapy, 1:222
parent-child relationships, 1:231 historical context, 2:764–765
parenting skills training, 1:340 Kelly and, 2:599–601
primal therapy, 2:797–801 major concepts, 2:765–766
relationship enhancement therapy, 2:891, 2:892 overview, 1:220
Parkinson, James, 2:714 techniques, 2:766
Participation-observation technique, 1:576 theoretical underpinnings, 2:765
Pastoral counseling, 2:757–759 therapeutic process, 2:766–767
historical context, 2:758 Personal Construct Theory and Practice, 2:601
major concepts, 2:758–759 “Personal is political,” 1:416
overview, 2:751 Personal law, 2:864
theoretical underpinnings, 2:758 Personal meaning organizations, 1:222
therapeutic process, 2:759 Personal strength inventory, 1:287
Patanjali, 2:1059, 2:1060 Personal unconscious, 1:46
Pathologizing, 1:56 Personality orientations, 2:705
Pathology of normalcy, 1:520 Person-centered counseling, 2:767–772
Pattern interruption, 1:361 historical context, 2:768
Patterson, Gerald, 1:181 major concepts, 2:769–770
Pauls, Arthur Lincoln, 2:748–749 overview, 1:378, 1:430–431

Index 1199
techniques, 2:770–771 Pluralism, organicism versus, 1:65

theoretical underpinnings, 2:768–769 Poet-oedipal development, 1:413
therapeutic process, 2:771–772 Poetry therapy, 2:780–783
Personifying, 1:56 historical context, 2:780–781
Perspectivism, 2:881 major concepts, 2:781–782
Persuasion and Healing (Frank), 1:547 overview, 1:256
Peysha, Magali, 2:624 therapeutic process, 2:782
Peysha, Mark, 2:624 See also Bibliotherapy
Phallocentric nature, of psychoanalytical theory, Poetry Therapy (Leedy), 2:781
1:412–413 Poincare, Henri, 1:155
Phenomenological stance, 1:28 Point formula rationale, 1:23
Phenomenological therapy, 2:772–776 Polarization, avoiding, 2:596
historical context, 2:772–773 Ponty, Merleau, 2:773
major concepts, 2:773–774 Positions, 1:222
overview, 1:378 Positive asset search, 1:287
techniques, 2:774–775 Positive connections, self-relations psychotherapy
theoretical underpinnings, 2:773 and, 2:919
therapeutic process, 2:775–776 Positive feedback loop, 1:299
Phenomenology, 1:376, 1:458, 1:522, 2:984 Positive pressure point techniques, integrative forgiveness
Philadelphia Child Guidance Clinic, 1:298, 1:488, 2:623, psychotherapy, 1:560
2:661, 2:966 Positive psychology, 2:783–788
Philadelphia School of Social Work, 2:896 historical context, 2:783–784
“Philosophy and Psychotherapy: On the Foundation of major concepts, 2:785–786
an Existential Analysis” (Frankl), 1:432 overview, 1:378, 1:551
Philosophy of As If (Vaihinger), 1:217 quality-of-life therapy, 2:785, 2:787 (fig.)
Physical contact, 1:215 techniques, 2:786
Physical Self, 2:1046 theoretical underpinnings, 2:784
Piaget, Jean therapeutic process, 2:786–788
cognitive enhancement therapy and, 1:176 Positive Psychology: The Science of Happiness and
constructivist therapies and, 1:217, 1:222 Flourishing (Compton, Hoffman), 2:785
developmental constructivism and, 1:278 Positive Psychology Center, 2:922
inner child therapy and, 1:538 Positive regard, need for, 2:769, 2:771
integrative approaches and, 1:548 Positive reinforcement, 1:198, 2:738, 2:739–740
intersubjective-systems theory and, 1:586–587 Positive/negative imagery, 2:855
neurological and psychophysiological therapies, 2:718 Possibility therapy, 2:788–791
psychosocial development and, 2:831 historical context, 2:788
schema therapy and, 2:908 major concepts, 2:789
self psychology and, 2:911 overview, 1:355
unified therapy and, 2:1027 techniques, 2:789–790
Pierrakos, John, 1:238 theoretical underpinnings, 2:788–789
Pincus, Aaron, 1:420 therapeutic process, 2:790
Pines, Malcolm, 1:467, 1:468 Postmodern constructivist approaches. See Constructivist
Planned short-term therapy, 1:144 therapies: overview
Plato, 1:351 Posttraumatic stress disorder
Play therapy, 2:776–780 cognitive processing therapy, 1:180
concentrative movement therapy and, 1:215 energy psychology, 1:345–346
historical context, 2:776–777 prolonged exposure therapy, 2:806–808
Madanes and, 2:624 recovered memory therapy, 2:868
major concepts, 2:778 trauma-focused cognitive-behavioral therapy,
overview, 1:255–256 2:1018–1019
symbolic experiential family therapy, 2:978 See also Trauma
techniques, 2:778–779 Postural integration, 2:791–793

1200 Index
overview, 1:128 Procedural sequence model (PSM), 1:173–174

techniques, 2:792 Process, Gestalt therapy and, 1:460
theoretical underpinnings, 2:791 Process groups, 2:801–804
therapeutic process, 2:792–793 historical context, 2:801–802
Potentization, 1:510 major concepts, 2:802–803
Power analysis, 1:409–410, 1:417 overview, 1:475
Power and Innocence (May), 2:636 techniques, 2:803
Powers, William T., 1:463, 2:647 theoretical underpinnings, 2:802
Pragmatism, 1:353 therapeutic process, 2:803
Pranayama, 1:142, 1:143, 2:1061 Process therapy. See Human validation process model
Prata, Giuliana, 1:298, 2:755, 2:986 Process-oriented psychology, 2:804–806
Pratt, Joseph, 1:472–473, 1:570, 2:826 historical context, 2:804
Pratyahara, 2:1061 major concepts, 2:804–805
Prayer and affirmations, 2:793–795 overview, 1:378
overview, 1:213 theoretical underpinnings, 2:804
techniques, 2:794 therapeutic process, 2:806
theoretical underpinnings, 2:793–794 Processwork. See Process-oriented psychology
therapeutic process, 2:795 Prochaska, James O., 1:555, 2:651, 2:669, 2:685,
Precontemplation, 2:1015 2:1014
Premack’s principle, 1:182 Procter, Harry, 1:224
Preparedness, 1:165, 2:1015 Progressive muscle relaxation, 1:118
Prescribing, 1:510 Project Adventure, 1:38
Prescriptive reading, 2:782 Project for a Scientific Psychology, The (Freud),
Present Time, 2:871 1:167, 2:723
Present-oriented focus, 1:28 Project Match, 2:651
Presupposition, 1:360 Projection process, family and, 2:675
Priestly, Mary, 2:689 Projective identification, 2:734, 2:817, 2:818
Prigogine, Ilya, 1:484 Prolonged exposure therapy, 1:97
Primal integration, 2:795–797 Prolonged exposure therapy, 2:806–808
historical context, 2:795 historical context, 2:806–807
overview, 1:128, 1:378 techniques, 2:807–808
theoretical underpinnings, 2:795–796 therapeutic process, 2:808
therapeutic process, 2:797 Protocol, BodyTalk, 1:131
Primal Scream, The (Janov), 2:798 Provision, 2:913
Primal therapy, 2:797–801 Provocative therapy, 2:808–810
historical context, 2:798 historical context, 2:808–809
overview, 1:128, 1:378 overview, 2:751
techniques, 2:800 techniques, 2:809–810
therapeutic process, 2:800–801 Psyche mapping, 2:1040
Primary adaptive emotions, 1:342 Psychedelic therapy, 2:810–812
Primary emotional responses, 1:339, 2:881 historical context, 2:810–811
Primary experience, secondary experience versus, 2:711 major concepts, 2:811
Primary identity, 2:805 overview, 1:149
Primary personality, 1:111 techniques, 2:811–812
Principles and systems theory, 1:483 theoretical underpinnings, 2:811
Principles of Behavior Modification (Bandura), 2:628 therapeutic process, 2:812
Problem Solving Therapy (Haley), 1:487 “Psychiatric Nurse as a Behavioral Engineer, The” (Ally,
Problem-solving skill building, 1:183, 1:358, Michael), 1:51
1:566, 2:963 Psychiatry, 2:972

Index 1201
Psychoanalysis. See Freudian psychoanalysis Psychology of Selves, 2:1039

Psychoanalysis and Behavior Therapy: Towards an Psychophysiology, 1:117
Integration (Wachtel), 1:64 Psychosexual development, Freud on, 1:438
Psychoanalytic Dialogues: A Journal of Relational Psychosocial development, theory of, 2:830–833
Perspectives, 2:884 historical context, 2:830–831
Psychoanalytic frame, 1:440 major concepts (stages of development), 2:831–832
Psychodrama, 2:812–816 overview, 1:233, 1:332
adventure-based therapy and, 1:39 theoretical underpinnings, 2:831
holding therapy, 1:506 Psychosocial genomics, 2:833–837
human validation process model, 1:516 four-stage cycle of, 2:835 (fig.)
overview, 1:256, 1:378, 1:474 major concepts, 2:834–836
techniques, 2:814–815 overview, 1:356
therapeutic process, 2:815 theoretical underpinnings, 2:834
Psychodynamic family therapy, 2:816–821 therapeutic process, 2:836
historical context, 2:816–817 Psychosomatic Families (Minuchin, Rosman, Baker),
major concepts, 2:817–818 2:662, 2:966
overview, 1:252 Psychosynthesis, 2:837–841
techniques, 2:818–820 historical context, 2:837–838
therapeutic process, 2:820 overview, 2:1013–1014
Psychodynamic group psychotherapy, 2:821–825 techniques, 2:839–840
historical context, 2:821–822 theoretical underpinnings, 2:838, 2:838 (fig.)
major concepts, 2:822–823 therapeutic process, 2:840
overview, 1:476 Psychotherapy, biodynamic, 1:112
techniques, 2:823–824 “Psychotherapy and Weltanschauun” (Frankl), 1:432
theoretical underpinnings, 2:822 Pucci, Aldo R., 2:853–854
therapeutic process, 2:824 Pulsing, 2:841–843
Psychodynamics of Family Life, The (Ackerman), 1:247 historical context, 2:841
Psychoeducation major concepts, 2:841–842
biofeedback, 1:118 overview, 1:128
core energetics, 1:239 pulsation, 2:746
EcoWellness, 1:319 techniques, 2:842
exposure and response prevention, 1:384, 1:387–388 theoretical underpinnings, 2:841
Morita therapy, 2:668 therapeutic process, 2:842–843
nature-guided therapy, 2:701 Punctuation, 2:609, 2:612
prolonged exposure therapy, 2:807–808 Punishment, 1:91, 2:738, 2:739–740
Psychoeducational groups, 2:825–830 “Puppet interview,” 1:302–303
historical context, 2:826 Purkinje, J. E., 2:714
major concepts, 2:827–828 Pushbutton technique, 1:34
overview, 1:474
techniques, 2:828–829 Qi, 1:21, 1:22, 1:23
theoretical underpinnings, 2:826–827 Qi Bo, 1:20–21
therapeutic process, 2:829–830 Qigong, 2:727–728
Psychogenic amnesia, 2:867–868 Quality-of-life therapy, 2:785, 2:787 (fig.)
Psychological well-being theory, 2:785–786 Quantum electroencephalograph (qEEG), 2:719–722
Psychologizing, 1:56 “Question, the,” 1:33–34
Psychology and Life (Zimbardo), 2:1063 “Question of Family Homeostasis, The”
Psychology and the Human Dilemma (May), 2:636–637 (Jackson), 1:488
Psychology for Neurologists (Freud), 1:436 Questions/questioning
Psychology of Personal Constructs, The (Kelly), 2:600, circular questioning, 1:566
2:601, 2:764 clarification (See Values clarification)

1202 Index
cognitive-behavioral therapy, 1:196–197 theoretical underpinnings, 2:854

future pace questions, 1:139 therapeutic process, 2:855–856
miracle questions, 2:944–945 Rational Thinking Questionnaire, 2:855
motivational interviewing, 1:192, 2:668–672 Rationale, 1:208
narrative family therapy, 2:693–694 Rayner, Rosalie, 1:163
narrative therapy, 2:698–699 RCFFC (rapport, contract, focus, funel,
open-ended questions, 2:916 close), 1:534
“puppet interview,” 1:302–303 Reaching Children at the U.S./Mexico Border,
rational questions, 2:855 1:175–176
reality therapy, 2:859 Reading. See Bibliotherapy
recovered memory therapy, 2:869 Reality therapy, 2:856–860
Socratic questioning, 1:180, 1:196–197, 2:621–622 Glasser and, 1:462, 2:857
solution-focused practice, 2:949 historical context, 2:856–857
Standard Cognitive-Developmental Interview, major concepts, 2:858–859
1:286–287 overview, 1:193, 1:430
systemic family therapy, 2:988–989 techniques, 2:859
“the question,” 1:33–34 theoretical underpinnings, 2:854–855, 2:857–858
therapeutic process, 2:859–860
Rabinowitz, Diana, 2:661 Reality Therapy: Theories of Psychotherapy
Racker, Heinrich, 2:880 (Wubbolding), 1:464
Radix, 2:845–847 Reality Therapy (Glasser), 1:462, 2:857
historical context, 2:845–846 Rebirthing, 2:860–862
techniques, 2:846–847 major concepts, 2:861
theoretical underpinnings, 2:846 overview, 1:150
therapeutic process, 2:847 techniques, 2:861–862
Radix Institute, 2:845 theoretical underpinnings, 2:861
Rado, Sandor, 2:932 Rebirthing-breathwork, 2:862–866
Rage reduction theory, 2:861 historical context, 2:863–864
Raisin exercise, 2:659 major concepts, 2:864–865
Raknes, Ola, 1:110, 1:157, 1:158, 1:159 overview, 1:213
Rand, Ayn, 2:1027 theoretical underpinnings, 2:864
Rand, Marjorie, 1:552 therapeutic techniques, 2:865–866
Rank, Otto, 1:369–370, 2:636, 2:768, 2:821, 2:822, Receptive/Expressive/Symbolic model, 2:781
2:896, 2:976 Reciprocal inhibition, 2:982–983
Raphael, C., 2:744 Reciprocal roles, 1:174
Rapid reacquisition, 1:166 Recovered memory therapy, 2:866–870
Rapid transcranial magnetic stimulation (rTMS), 1:153 historical context, 2:866–867
Rapport, 1:526 major concepts, 2:867–868
“Rat Man,” 1:435 overview, 1:150
Raths, Louis, 2:1035 techniques, 2:868–869
Rational emotive behavior therapy, 2:848–853 theoretical underpinnings, 2:867
historical context, 2:848–849 therapeutic process, 2:869–870
major concepts, 2:849–851 Recuperation, biodynamic psychology and, 1:111
overview, 1:193, 1:430 Red Book (Jung), 2:592
techniques, 2:851–852 Reddy, Vasu, 1:173
theoretical underpinnings, 2:849 Reese, Ryan F., 1:317
therapeutic process, 2:852–853 Re-evaluation counseling, 2:870–874
Rational living therapy, 2:853–856 historical context, 2:870–871
historical context, 2:853–854 major concepts, 2:872
major concepts, 2:854–855 overview, 2:751
rational action planner, 2:855 techniques, 2:872–873
rational hypnotherapy, 2:855 theoretical underpinnings, 2:871–872
rational questions, 2:855 therapeutic process, 2:873

Index 1203
Reflection, 1:19, 2:671, 2:779, 2:916 Relational psychoanalysis, 2:884–887

Reflexes of the Brain (Sechenov), 2:760 historical context, 2:884
Reflexicity, 2:765 major concepts, 2:885–886
Reflexive thoughts, 2:855 overview, 1:233–234
Reformulation, 1:174 techniques, 2:886–887
Reframing, 1:147, 1:300, 1:340, 1:361, 1:516, 1:526, theoretical underpinnings, 2:884–885
2:916, 2:969 therapeuic process, 2:887
Regression therapy, 2:861 Relational psychodynamic theory, 1:572
Regulatory processes, 2:1031 Relational-cultural theory, 2:887–890
Reich, Wilhelm, 2:874–876 historical context, 2:887–888
biodynamic psychology and, 1:110 major concepts, 2:889
bioenergetic analysis and, 1:113, 1:115 overview, 2:751–752
biographical information, 2:874–876 techniques, 2:889
body-oriented therapies and, 1:127–128 theoretical underpinnings, 2:888–889
characteranalytical vegetotherapy and, 1:157, 1:158, therapeutic process, 2:889–890
1:159–160 Relationship, Adlerian therapy and, 1:34–35
emotional freedom techniques, 1:336 Relationship Breakthrough (Madanes), 2:624
Frankl and, 1:432 Relationship cycles, 1:339
Gestalt therapy and, 1:457 Relationship enhancement therapy, 2:890–894
orgonomy and, 2:743–748 historical context, 2:890–891
Perls and, 2:762 overview, 1:252
postural integration and, 2:792 techniques, 2:892–893
primal integration and, 2:797 theoretical underpinnings, 2:891–892
Radix and, 2:845 therapeutic process, 2:893
Reichian therapy. See Orgonomy Relationship with symptoms, 2:659
Reik, Theodor, 1:519 Relaxation
Reiki, 2:876–879 holotropic breathwork, 1:508
historical context, 2:876–877 training, 1:100, 1:107
major concepts, 2:878 Religion
overview, 1:213 Linehan on, 2:616–618
techniques, 2:878–879 pastoral counseling, 2:757–759
theoretical underpinnings, 2:877–878 school and religious trauma, 2:865
therapeutic process, 2:879 See also Buddhism; Spirituality
Reinforcement, 1:91, 1:103, 1:445–446 Remond, Antoine, 2:715
Reinhardt, Max, 2:762 Renewal, 1:166
Reisser, Linda, 2:831 Reorientation, 1:359
Reiter, Michael, 2:662 Reparative therapy. See Sexual orientation change efforts
Reiter, Sherry, 2:782 Repertory grids, 2:766
Relational context of individual, Ackerman Relational Repressed Memories: A Journal to Recovery From
Approach, 1:14–15 Sexual Abuse (Fredrickson), 2:869
Relational ethics, 1:235 Repression, 1:439, 1:520, 2:723, 2:867
Relational expertise, 1:204 Rescorla, Robert, 1:163–164
Relational group psychotherapy, 2:879–883 Research Center for Group Dynamics at Massachusetts
historical context, 2:880 Institute of Technology, 2:801–802
major concepts, 2:880–882 Resick, Patricia, 1:179
overview, 1:476 Resistance, 1:439, 1:440, 2:664, 2:765–766, 2:819, 2:823
techniques, 2:882–883 Resistance analysis, 2:746
theoretical underpinnings, 2:880 Resnick, Bob, 2:763
therapeutic process, 2:883 Resocialization, 1:410
Relational meaning, Ackerman Relational Resonance, 1:469
Approach, 1:14 Resource spot, 1:141
Relational Perspectives (Aron, Harris), 2:884 RESPECTFUL model, 1:261, 1:262
Relational Perspectives Book Series Respiration rate, 1:117–118
(Mitchell), 2:884 Response cost, 1:92, 1:100–101

1204 Index
Response-based practice, 2:894–896 non-Freudian psychoanalysis and, 2:703

historical context, 2:894 pastoral counseling and, 2:758
major concepts, 2:894–895 person-centered counseling and, 2:767–768,
overview, 1:220 2:770, 2:771
techniques, 2:895 phenomenological therapy and, 2:773
theoretical underpinnings, 2:894 play therapy and, 2:777
therapeutic process, 2:895 provocative therapy and, 2:808
Restraining forces, 2:995 psychoeducational groups and, 2:826
Retrieval, 1:201 psychosynthesis and, 2:837
Reverie, 2:734 Satir and, 2:905
Revisioning Psychology (Hillman), 1:56 Seligman and, 2:921
Revivification, 1:527 Skinner and, 2:937
Revolving slate, 1:237 unified theory and, 2:1023
Reyna, Leo, 2:981 Rogers, Martha, 1:492
Reynolds, Vikki, 2:894 Role reversal, 2:815
Rice, A. K., 2:997 Role theory, 1:49, 1:302–303
Rice, Laura, 1:338 Role-playing, 1:324, 1:579, 2:1028, 2:1040
Richardson, Cathy, 2:894 Rolf, Ida, 1:499, 1:500, 2:898–899
Richeport-Haley, Madeline, 1:488 Rolf Institute, 1:499
Rickman, John, 2:607, 2:731 Rolf Institute of Structural Integration, 2:899
Rigazio-Digilio, Sandra, 1:284 Rolfing, 2:898–900
Rimm, Dave, 2:627 historical context, 2:898–899
Riskin, Jules, 1:298, 2:753, 2:905 major concepts, 2:899–900
Risley, Todd, 1:53 overview, 1:129
Ritter, Bruni, 1:86–87 Rolfing Cycle, 2:899–901
Ritterman, Michele, 1:243 techniques, 2:900–901
Rituals, 1:16, 1:300, 1:316, 2:964 theoretical underpinnings, 2:899
Rituals, compulsive, 1:382, 1:383 Rollnick, Steve, 2:650–651, 2:652, 2:669. See also
Rizzolatti, Giacomo, 2:716–717 Miller, William R.
Roadmap to Resilience (Meichenbaum), 2:642 Roots of Psychotherapy (Whitaker, Malone), 2:1048
Robbins, Anthony, 2:624 Ropes courses, adventure-based therapy and, 1:39
Robbins, Clive, 2:690 Rosenberg, Jack Lee, 1:552
Robert Wood Johnson Foundation, 2:1014 Rosenzweig, Saul, 1:206
Robinovitch, Louise, 1:151 Rosman, Bernice, 2:662, 2:966
Robinson Crusoe (Defoe), 2:936 Ross, Dorrie, 1:85
Rockefeller Foundation, 2:753 Ross, Sheila, 1:85
Rocking, 2:842 Rossi, Ernest, 2:833, 2:834
Rogers, Carl, 2:896–898 Roszak, Theodore, 1:314, 1:317
adventure-based learning and, 1:38 Rothschild Hospital, 1:432–433
Alexander technique and, 1:42 Routledge, Robin, 2:894
attachment-focused family therapy and, 1:76 Royal Society, 2:714
biographical information, 2:896–898 Rubenfeld, Ilana, 1:40, 2:902
common factors in therapy, 1:207 Rubenfeld synergy, 2:901–904
dialectical behavior therapy and, 1:295 Alexander technique, 1:40
drama therapy and, 1:302 historical context, 2:902
emotion-focused family therapy and, 1:338 major concepts, 2:903
emotion-focused therapy and, 1:341, 1:343 overview, 1:129
existential-humanistic therapies and, 1:375 synergy, defined, 2:901–902
focusing-oriented therapy and, 1:423 techniques, 2:903–904
Fromm and, 1:522 theoretical underpinnings, 2:902–903
influence of, 2:849 therapeutic process, 2:904
interpersonal group therapy and, 1:570, 1:571 Rubenfeld Synergy Training Institute, 2:902
May and, 2:636 Ruesh, Jurgen, 1:244
motivational interviewing and, 2:669 Rupture repair model, 1:174

Index 1205
Russell, Bertrand, 1:298 Schimmel, Christine, 1:533, 1:534

Rutgers University, 1:586 Schloss, Gil, 2:781
Ryan, Richard, 2:785 Schlössel, Maria Theresien, 1:432
Ryff, Carol, 2:785–786 Schmidt, Gunther, 1:243
Ryle, Anthony, 1:172–173 Schmidt, Shirley Jean, 1:289
Schneider, Kirk, 1:370
Sachs, Hans, 1:519 Schnicke, Monica, 1:179
Sacrifice, in chess therapy, 1:161–162 School for Body-Mind Centering®, 1:125
Safety needs, Maslow on, 2:632 Schopenhauer, Arthur, 1:229, 1:432, 2:1058
Safran, Jeremy, 1:338 Schopenhauer Cure, The (Yalom), 2:1058
Salinger, J. D., 2:876 Schore, Allan, 2:1029–1030
Salter, Andrew, 2:933 Schulz, Johannes Heinrich, 1:116, 1:211, 2:717
Samadhi, 2:1061 Schwartz, Richard C., 1:568
San Francisco Gestalt Institute, 1:552 Schwarz, Lisa, 1:140
San Francisco Zoo, 2:754 Schwarz, Oswald, 1:432
San Joaquin Psychotherapy Center, 1:563 Schwindt, Eleanore, 1:433
Sanbo-Kyodan School, 2:617 Scientist as Subject: The Psychological Imperative
Sandoz Pharmaceutical, 2:810 (Mahoney), 2:628
Sartre, Jean-Paul, 1:369, 1:586–587, 2:773 Scream therapy. See Primal therapy
Satir, Virginia, 2:905–907 Scripted imagery, 1:478–479
activity-based group psychotherapy, 1:17 Scripts, 2:1006, 2:1009
adventure-based therapy, 1:39 Sculpting, Ackerman Relational Approach, 1:16
biographical information, 2:905–907 Scuola Europea Di Orgonoterapia, 1:158
couples, family, and relational models, 1:248 Seated meditation, 2:654–655
directive therapy, 1:298 Sechenov, Ivan, 2:760
family-constellation therapy, 1:399 Secondary emotions, 1:339, 1:342
Hellerwork, 1:499 Secondary experience, primary experience versus, 2:711
human validation process model, 1:513–514, 1:515 Second-order BASIC I.D., 2:680
neuro-linguistic programming, 2:710 Second-order change, 1:147, 1:299
Palo Alto Group, 2:753, 2:755 Secret Meaning of Money, The (Madanes), 2:624
systemic constellations, 2:985 Secret Survivors (Blume), 2:869
Saussure, Ferdinand de, 2:607 Secure attachment, 1:72–73
Savage, Jill (Scharff), 2:817 Secure base exploration, 1:73
Scaffolding, 1:353–354 Seeding, 1:360
Scaling, 2:945 “Seeing through,” 1:56
Scansion, 2:609, 2:611 Seemorg Matrix Work, 1:36
Scharff, David, 2:817 Segal, Zindel, 1:190, 2:656
Schattner, Gertrud, 1:301 Self
Schauffler, Robert, 2:781 analytical psychology, 1:46
Schedule of reinforcement (SOR), 1:91, 2:741–742 constructivist therapy and, 1:224
Schein, Edgar, 2:801 as context, 1:6, 1:9
Scheler, Max, 1:432, 2:619 core, 1:553, 1:554
Schema therapy, 2:907–910 developmental constructivism, 1:280, 1:281
cognitive-behavioral therapy, 1:195–196 Developmental Needs Meeting Strategy, 1:289,
emotion-focused therapy, 1:342 1:290–291
historical context, 2:908 differentiation of self, 1:135, 2:674
major concepts, 2:908–909 Gestalt therapy, 1:461
overview, 1:193 higher self, lower self, and mask, 1:239
schema, defined, 2:908 Ideal Self, 2:704
symptom-requiring schema, 1:201 integral psychotherapy, 1:544–545
techniques, 2:909 internal family systems model, 1:568
theoretical underpinnings, 2:908 Mahler on, 2:625
therapeutic process, 2:909 Real Self, 2:704
Scher, Murray, 1:449 self system and, 1:576

1206 Index
therapeutic self, 2:882 Seligman, Martin, 2:784, 2:785, 2:920–923

therapist’s use of, 1:380–381 Selvini-Palazzoli, Mara, 1:248
true self, 1:143 Seminars in Hypnosis, 1:349
unconscious and conscious aspects, 1:330–331 Senility, 2:865
Self object transference, 2:912–913 Sensorimotor psychotherapy, 2:923–925
Self objects, 2:817 historical context, 2:923
Self organization, 1:156 major concepts, 2:923–924
Self psychology, 2:910–914 overview, 1:129
historical context, 2:910–911 techniques, 2:924
major concepts, 2:912 theoretical underpinnings, 2:923
overview, 1:171, 1:234, 2:818 therapeutic process, 2:925
techniques, 2:912–913 Sensory awareness inventory, 2:701
theoretical underpinnings, 2:911–912 Sentence completion, 1:202
therapeutic process, 2:913–914 Sentiment override, 1:465
Self-actualization, Maslow on, 2:633 Separation-individuation theory, 2:625
Self-as-process, 1:370 Sequential diagrammatic reformulation, 1:174
Self-characterization method, 2:766 Sequoia Psychotherapy Center, 1:563
Self-compassion, 2:657 Serrano-Hortelano, Xavier, 1:158
Self-determination, 2:770, 2:785 Sesame, 1:301
Self-distancing, 2:620 Session rating scale (SRS), 1:402–403
Self-efficacy, 1:86, 2:670, 2:941, 2:1015 Set/setting, 2:811–812
Self-Efficacy: The Exercise of Control (Bandura), 2:938 Sex, Love and Violence (Madanes), 2:624
“Self-Efficacy: Toward a Unifying Theory of Behavioral Sexism, gender aware therapy on, 1:449
Change” (Bandura), 2:938 Sex-Pol Movement, 2:875
Self-esteem, 1:516 Sexual abuse, Freud on, 1:435
Self-evaluation, 2:859 Sexual identity therapy, 2:925–928
Self-feelings, 2:664 historical context, 2:925–926
Self-help groups, 2:914–917 major concepts, 2:926–927
major concepts, 2:915–916 Sexual Orientation Change Efforts (SOCE) and, 2:925
overview, 1:477 techniques, 2:927
therapeutic process, 2:917 Sexual minority affirmative therapy, 2:928–931
Selfhood, 1:587–588 historical context, 2:928–929
Self-hypnosis, 1:527 major concepts, 2:929–930
Self-image, 1:405 overview, 2:752
Self-knowledge, 1:231 techniques, 2:930
Self-management programs, 1:107 theoretical underpinnings, 2:929
Self-medication, 1:511 therapeutic process, 2:930–931
Self-organizing change, 1:357 Sexual orientation change efforts, 2:931–933
Self-projection, 1:59 historical context, 2:931–932
Self-reaction, 1:86 overview, 1:149
Self-reflection, 1:15, 2:836 overview, 1:150
Self-regulation, 1:118, 1:454, 1:459, 1:498 sexual identity therapy and, 2:925
Self-relations psychotherapy, 2:917–920 techniques, 2:932
major concepts, 2:918–919 Shadow, 1:45, 1:46
overview, 1:356, 2:752 Shakespeare, William, 1:229
techniques, 2:919–920 Shannon, Claude, 2:991
theoretical underpinnings, 2:918 Shaping, 1:92, 2:741
therapeutic process, 2:920 Shapiro, Francine, 1:389–390, 1:540, 2:933–935
Self-scaling techniques, 2:919–920 Sharpe, Meg, 1:468, 1:470–471
Self-transcendence, 2:620 Shasta Abbey, 1:293, 2:617

Index 1207
Shedler, Jonathan, 1:230–231 Snow, C. P., 2:834–835

Sheinberg, Marcia, 1:12–13, 1:16 Social activism, 1:410
Shen, 1:21, 1:22 Social cognitive theory, 2:938–942
Shepard, Herbert, 2:991 animal assisted therapy, 1:49
Shepard, Paul, 1:314 Bandura and, 1:85–87, 1:94, 1:95, 1:97, 1:427, 2:628,
Sheppard-Pratt, 2:971 2:641, 2:678, 2:717
Sherlin, Leslie, 2:707 historical context, 2:938–939
Sherrington, Charles Scott, 1:40, 2:715 major concepts, 2:940–941
Shifting Contexts: The Generation of Effective overview, 1:97
Psychotherapy (O’Hanlon, Wilk), 2:737 techniques, 2:941–942
Shotter, John, 1:203 theoretical underpinnings, 2:939–940
Shrodes, Caroline, 1:108 therapeutic process, 2:942
Shrostrom, Everett, 2:631 “Social Cognitive Theory of Gender Development and
Shultz, Johannes Heinrich, 1:81, 1:157 Differentiation” (Bandura, Bussey), 2:939
S-I-A-C-S-C-A (sensation-imagery-affect-cognition- Social Construction of Reality, The (Berger,
sensation-cognition-affect) pattern, 2:680 Luckmann), 2:736
Sibling position, 2:675 Social context, 2:697
Signals, 2:805 Social feeling, 1:28
Sills, Franklyn, 1:241 Social Foundations of Thought and Action: A Social
Sills, Maura, 1:241 Cognitive Theory (Bandura), 2:938
Silver, Naomi, 1:462, 1:463 Social justice, 1:15
Simkin, Jim, 2:763 Social learning, 1:323–324
Simon, Anita, 2:991 Social Learning and Personality Development (Bandura,
Simon, George, 2:662 Walters), 2:938
Simon, Sidney, 2:1035 Social Learning Theory (Bandura), 1:85
Single-photon emission computerized tomography Social mediation, 1:49
(SPECT) brain imaging, 2:720, 2:722 Social Self, 2:1045
Six Realms, 1:227 Social skills training, 1:106–107
Skills training, dialectical behavior therapy and, Social Work Speaks: NASW Policy Statements, 1:260
1:294–295 Social-symbolic processes, 1:280
Skinner, B. F., 2:935–938 Societal emotional process, 1:136, 2:675–676
acceptance and commitment therapy and, 1:7 Society for Free Psychoanalytic Research (Society for
applied behavior analysis and, 1:50–51, 1:52 Individual Psychology), 1:26, 1:30–31
behavior modification and, 1:90, 1:185 Society for the Exploration of Psychotherapy Integration
behavior therapy and, 1:94, 1:103, 1:181 (SEPI), 1:307–308, 1:547, 1:555, 2:1025
behavioral investment theory and, 2:1022 Society for the Scientific Study of Sex, 1:334
biographical information, 2:935–938 Society of Behavioral Medicine, 1:87
cognitive-behavioral therapies and, 1:189 Society of Ortho-Bionomy International, 2:749
foundational therapies and, 1:427 Society of Teachers of the Alexander Technique, 1:43
Mahoney and, 2:628 Socrates, 2:621–622
operant conditioning theory of, 1:93, 1:95, 1:97, Socratic questioning, 1:180, 1:196–197, 2:621–622
1:182, 2:738–739 Sodium Amytal, 2:869
person-centered counseling and, 2:767 Softening, 1:73–74
Rogers and, 2:897 Solms, Mark, 2:723
Studies in Behavior Therapy (Skinner, Lindsley), 1:94 Solution-focused brief family therapy, 2:943–946
Skinner, Deborah, 2:936–937, 2:937 historical context, 2:943
Skinner, Grace, 2:936 major concepts, 2:943–944
Skinner, Julie, 2:936 overview, 1:252, 1:356, 1:431
Skinner, William, 2:936 techniques, 2:944–945
Slade, Peter, 1:301 theoretical underpinnings, 2:943
Slavson, S. R., 1:17, 1:474 therapeutic process, 2:945
Slochower, Joyce, 2:887 Solution-focused brief therapy, 2:946–950
SMART goals, 1:324 de Shazer and Berg, 1:145, 1:147, 1:275–278, 2:735,
Smuts, Jan, 2:762, 2:763 2:737, 2:755

1208 Index

overview, 1:220 Steiner, Claude, 1:538, 2:1010
techniques, 2:948–949 Stephen A. Mitchell Center of Relational Studies, 2:884
theoretical underpinnings, 2:947 Sterman, Barry, 2:707
therapeutic process, 2:949–950 Stern, Daniel, 1:76, 1:173
Somatic experiencing, 2:950–953 Stern, Donnel, 2:885
“being present,” 1:6, 1:8 Stige, Brynjulf, 2:689
“being-in-the-world,” 1:274, 1:371–372 Still, Andrew Taylor, 2:749
brainspotting and, 1:141 Stimulus control, 1:99, 2:740–741
cognitive enhancement therapy, 1:177, 1:178 Stokes, Trevor, 1:51
defined, 1:553 Stolorow, Daphne Socarides, 1:587
historical context, 2:950–951 Stolorow, Robert D., 1:586, 1:587, 2:885
major concepts, 2:951 Stolze, Helmuth, 1:214
overview, 1:129, 1:573 Stone, Abraham, 1:247
techniques, 2:951–952 Stone, Hal, 1:499–500, 2:1039
theoretical underpinnings, 2:951 Stone, Hannah, 1:247
therapeutic process, 2:952–953 Stone, Sidra, 1:499–500, 2:1039
See also “Here-and-now” emphasis Stone Center, 2:888
Soranus, 2:780 Stone House, 2:649–650
Soul, family constellation therapy and, 1:400 Stony Lodge Hospital, 1:11
“Soul making,” 1:56 Storying, 1:222
Sound StoryPlay therapy, 2:955–957
biodynamic psychology and, 1:110–112 historical context, 2:955–956
brainspotting and, 1:141 overview, 1:356
Space, to experience/reflect, 1:215 techniques, 2:956–957
Spark, Geraldine, 1:235 theoretical underpinnings, 2:956
Speech. See Language therapeutic process, 2:957
Spence, Donald, 1:222 Strachey, James, 1:330
Spence, Kenneth, 1:94, 2:981 “Strange Case of Wilhelm Reich, The,” 2:744
Sperry, Roger, 1:394 Strategic family therapy, 2:957–962
Spinoza Problem, The (Yalom), 2:1058 historical context, 2:957–958
Spirituality overview, 1:252
integral psychotherapy, 1:543–544 techniques, 2:959–962
pastoral counseling, 2:757–759 theoretical underpinnings, 2:958–959
prayer and affirmation, 2:793–795 therapeutic process, 2:962
psychosynthesis, 2:839 Strategic Family Therapy (Madanes), 2:623–624
strategic therapy, 2:965 Strategic therapy, 2:962–966
Spitz, Rene, 1:67 historical context, 2:962–963
Splitting, 2:734, 2:818 major concepts, 2:963–964
“Spontaneous Release by Positioning” (Jones), 2:748 overview, 1:356, 1:431
Spotnitz, Hyman, 2:662–663 techniques, 2:964–965
Spotniz, Hyman, 1:476 theoretical underpinnings, 2:963
“Squeezing the lemon,” 1:141 therapeutic process, 2:965–966
St. Elizabeth’s Hospital, 1:269, 2:971 Strategies of Psychotherapy (Haley), 1:487
St. Martin, Shari Shamsavari, 1:175 Stress Inoculation Training (Meichenbaum), 2:641–642
St. Thomas’ Hospital, 1:172 Stress management
Standard Cognitive-Developmental Interview, 1:286–287 acupuncture and acupressure for, 1:24
Stanford University, 1:85, 1:488, 2:614, 2:753, 2:938, neuroscience and, 1:286
2:1057, 2:1063–1064 Stress Reduction Clinic, 1:226
State University of New York at Stony Brook, 2:616 Stress Reduction (Meichenbaum), 2:641–642
Status dynamic psychotherapy, 2:953–955 Stricker, George, 1:65, 1:66, 1:308
historical context, 2:954 Striving for superiority, 1:28, 1:31, 1:32
major concepts, 2:954–955 Strokes, 2:1008

Index 1209
Strong, Samuel, 1:161, 1:162 relational psychoanalysis and, 2:885, 2:886

Strosahl, Kirk, 1:7, 2:653 Rollo and, 2:636
Structural elements, 2:802 Superego, 1:329
Structural family therapy, 2:966–971 Support groups. See Self-help groups
historical context, 2:966–967 Supportive psychotherapy, 2:973–975
major concepts, 2:968–969 historical context, 2:973
overview, 1:252 major concepts, 2:974
structural map, 2:968 (fig.) overview, 2:752
techniques, 2:969–970 techniques, 2:974–975
therapeutic process, 2:970 Surface electromyography (sEMG), 1:118
Structural profiles, 2:680 Survival mechanisms, 1:111
Structured intuition, 1:130 Survivors’ groups, 2:869
Strupp, Hans, 1:555 Sustaining, 1:323
Stuart, Richard, 1:181 Suzuki, D. T., 2:653
Stuck points, 1:180 Swack, Judith A., 1:212, 1:489
Studies in Behavior Therapy (Skinner, Lindsley), 1:94 Swartley, William, 2:795
Studies in Hysteria (Breuer), 1:437 Sweeney, Thomas J., 1:284, 2:1044
Style of life, 1:28, 1:31–32, 1:33 Symbolic experiential family therapy, 2:975–980
Subgroups, 2:992–993, 2:993 (fig.) historical context, 2:976
Subida, Angelo, 1:161, 1:162 major concepts, 2:976–979
Subjective emotional development, 1:587 overview, 1:252
Subjective experience, complexity of, 1:231 techniques, 2:979–980
Subjective Units of Distress Scale (SUDS), 1:141, 1:384, Symptom deprivation, 1:202
1:387, 2:807 Symptom prescription, 1:147, 1:299–300, 1:361
Subpersonalities, 2:839 Symptom-requiring schema, 1:201
Subsystems, 1:250, 2:968 Synanon, 1:79, 1:80
Sue, David, 1:261 Synanon drug and alcohol residential treatment
Sue, Derald, 1:259, 1:260, 1:261, 1:262 center, 2:1003
Suggestion, 1:359, 1:525, 1:527 Syncretistic confusion, 1:307
Suhl, Renan, 2:845 System coherence, 1:200–201
Suicide Systematic desensitization, 2:980–984
Beck on, 1:89 behavioral group therapy, 1:107
dialectical behavior therapy, 1:294 historical context, 2:981–982
Suicide Prevention & Crisis Service, Inc., 2:616 major concepts, 2:982–983
Sullivan, Harry Stack, 2:971–973 overview, 1:97
Ackerman and, 1:11 techniques, 2:983
biographical information, 2:971–973 theoretical underpinnings, 2:982
classical psychoanalytic approaches and, 1:170 therapeutic process, 2:983–984
Freudian psychoanalysis and, 1:171 Systematic positive reinforcement, 1:198
Fromm and, 1:519 Systemic constellations, 2:984–986
Gestalt therapy and, 1:457 constellation, defined, 2:985
interpersonal group therapy and, 1:570, 1:572 historical context, 2:984
interpersonal integrative group therapy overview, 1:252
and, 1:574 techniques, 2:985
interpersonal psychoanalysis and, 1:233, 1:234 theoretical underpinnings, 2:984–985
interpersonal theory of, 1:580, 1:581, 2:1029 therapeutic process, 2:986
Minuchin and, 2:661 Systemic family therapy, 2:986–990
neo-Freudian psychoanalysis and, 2:703 historical context, 2:986–987
Palo Alto Group and, 2:753, 2:754 major concepts, 2:988
pastoral counseling and, 2:758 overview, 1:156, 1:252
Perls and, 2:762, 2:763 techniques, 2:988–989
psychoeducational groups and, 2:826, 2:971–973 theoretical underpinnings, 2:987
relational group psychotherapy and, 2:880 therapeutic process, 2:989–990

1210 Index
Systems-centered group counseling, 2:990–996 Therapist as Humanist, Social Activist, and Systemic
historical context, 2:991 Thinker . . . and Other Selected Papers, The
major concepts, 2:992 (Madanes), 2:624
overview, 1:476–477 “Thin”/”thick” descriptions, 2:693, 2:697
subgroups, 2:992–993, 2:993 (fig.) Thompson, Clara, 1:11, 1:457, 1:574, 2:762
techniques, 2:992–995 Thompson, Gladys, 2:599
theoretical underpinnings, 2:991–992 Thomson, Samuel, 1:502
therapeutic process, 2:995–996 Thorndike, Edward L., 1:90, 1:93, 1:95, 1:185, 2:630,
2:738
Tai, Sara, 2:647 Thorne, Frederick, 1:547
Taijiquan (tai chi chuan), 2:728 Thought field therapy (TFT), 1:344–345
Takata, Hawayo, 2:877 Thoughts, identifying, 1:180
Take Charge of Your Life (Glassser), 1:463 Thoughts Without a Thinker: Psychotherapy From a
“Talking for/about,” 1:77–78 Buddhist Perspective (Epstein), 2:653
Tardieu, Auguste Ambroise, 2:931–932 Three Treasures, 1:22
Target, Mary, 2:885 “Three waves,” of behavior therapy, 1:190
Task complexity, for art therapy, 1:61 3-Step Transformation, 1:36–37
Tavistock Group Training Approach, 2:997–1000 Throckmorton, Warren, 2:925, 2:926
historical context, 2:997–998 Thrown condition, 2:705
major concepts, 2:998–999 “Tickling the defenses,” 1:12
overview, 1:477 Tillich, Paul, 1:370, 1:457, 2:635, 2:636, 2:762
process groups, 2:802 Time genetic constitution, 2:773
psychoeducational groups, 2:826 Time Paradox, The (Zimbardo, Boyd), 2:1064
techniques, 2:999–1000 Time-out, 1:92, 1:100–101
theoretical underpinnings, 2:998 Time-sensitive treatment, 1:144
therapeutic process, 2:1000 Tinbergen, Nikolaas, 1:40, 1:505
Taylor, James G., 2:981 Tissue armor, 1:111
Teaching and Learning Therapy (Haley), 1:487 Title IV grant, 1:270
Teasdale, John, 2:656 To Have or to Be? (Fromm), 1:170
Technical eclecticism, 2:679 Todd, Nick, 2:894
Technical integration, 1:308 Token economy, 1:92, 1:100
Techniques of Family Therapy (Haley, Hoffman), 1:487 Tolman, Edward, 1:52, 1:95
Technological characteristic (applied behavior Tomita, Kaji, 2:877
analysis), 1:53 Tomkins, Silvan, 1:586
Technology of Teaching, The (Skinner), 2:937 Tompkins, Penny, 2:645
Teleology, 2:1031 Tonnies, Jan Friedrich, 2:715
Tendai Buddhist monastery, 2:876–877 Toomim, Hershel, 2:715
Texas Woman’s University, 2:685 Total Orgasm (Rosenberg), 1:552
Thaut, Michael, 2:690 Toward a New Psychology of Women (Miller),
Theoretical integration, 1:63–64, 1:308 2:648, 2:649
Theory and Practice of Group Psychotherapy, The “Toward a Theory of Schizophrenia” (Bateson, Jackson,
(Yalom), 1:570, 2:1058 Haley, Weakland), 1:488
“Theory of Human Motivation, A.” (Maslow), 2:630 Towards a New Psychology of Women (Miller), 2:887
Theory of mind, 1:358 Tracking, 1:485, 2:680, 2:747, 2:778, 2:969
Therapeutic alliance. See Client-therapist relationship Traditional Chinese Medicine, 1:20–24, 1:22 (fig.)
Therapeutic double bind, 1:300 Training groups, 2:1002–1006
Therapeutic self, 2:882 historical context, 2:1002–1003
Therapeutic touch, 2:1000–1002 major concepts, 2:1004–1005
major concepts, 2:1001 theoretical underpinnings, 2:1003–1004
overview, 1:213 therapeutic process, 2:1005–1006
techniques, 2:1001–1002 “Training Schizophrenics to Talk to Themselves: A
theoretical underpinnings, 2:1001 Self-Instructional Training Procedure”
See also Rolfing; Rubenfeld synergy (Meichenbaum), 2:641

Index 1211
Trance phenomena, 1:526 critical incident stress management, 1:256–258

Transactional analysis, 2:1006–1010 ego state therapy, 1:327–328
drama triangle, 2:1009, 2:1009 (fig.) energy psychology, 1:345–346
historical context, 2:1006–1007 inner child therapy, 1:539
major concepts, 2:1007–1009 primal integration and level of, 2:796
overview, 1:332–333, 1:378 prolonged exposure therapy, 2:806–808
techniques, 2:1009 Somatic Experiencing, 2:950–953
theoretical underpinnings, 2:1007 Trauma Treatment Model, 1:289
therapeutic process, 2:1009–1010 See also Trauma-focused cognitive-behavioral
transactions, defined, 2:1008 therapy
Transcranial electric stimulation, 1:153 Trauma-focused cognitive-behavioral therapy,
Transference 2:1018–1019
contemporary psychodynamic-based therapies, historical context, 2:1018
1:231–232 overview, 1:193
core process psychotherapy, 1:242 techniques, 2:1018–1019
countertransference and, 1:231–232, 1:242, 1:438, theoretical underpinnings, 2:1018
1:576–577, 2:824 therapeutic process, 2:1019
defined, 1:588 Tree of knowledge (ToK) system, 2:1022–1024
Freudian psychoanalysis, 1:439, 1:440 Trevarthen, Colwyn, 1:76, 1:173
interpersonal psychoanalysis, 1:576–577 Triangle concept, 1:135
Jungian group psychotherapy, 2:595, 2:596 Triangles, 2:674
modern analytic group psychotherapy, 2:663–666 Trop, Jeffrey, 1:587
neuropsychoanalysis, 2:734 True, Fiona, 1:16
psychodynamic family therapy, 2:819 “Trust the group,” 1:470
psychodynamic group psychotherapy, 2:822–823 Truth, 1:274, 2:880–881
self psychology, 2:912–913 Tsai, Mavis, 1:442, 1:445
transference neurosis, 1:439 Tuckman, B. W., 2:802
transference-focused psychotherapy (TFP), 2:603 Tummo, 1:142
unified therapy, 2:1027 Turchin, Curtis, 2:841
Transformance, 1:1, 1:2 Turquet, Pierre, 2:998
Transformational change, 1:201–202, 2:773 Tvwersky, Amos, 2:641
Transformational systemic theory. See Human validation Twice Told Therapy, A. (Yalom), 2:1058
process model Two Cultures and the Scientific Revolution, The (Snow),
Transforming Power of Affect, The (Fosha), 1:1 2:834–835
Transmission process, multigenerational, 2:675 “Two Narcissistic Types” (Reich), 2:874
Transpersonal Institute (Association for Transpersonal Two-chair work, 1:343
Psychology), 2:1011
Transpersonal psychology: overview, 2:1010–1014 Ultradian healing, 2:836
historical overview, 2:1010–1011 Umwelt, 1:370–371
short descriptions of, 2:1013–1014 (See also individual Uncertainty, 1:205
names of therapies) Uncluttered space, 1:228
theoretical underpinnings, 2:1011–1013 Uncommon Therapy: The Psychiatric Techniques of
Transtheoretical model, 2:1014–1018 Milton H. Erickson, M.D. (Haley), 1:145, 1:350
historical context, 2:1014 Uncommon Therapy (Haley), 1:487
major concepts, 2:1015 Unconditioned response (UR), 1:163
overview, 1:551 Unconditioned responses, 1:92
techniques, 2:1015–1017 Unconditioned stimulus (UR), 1:163
theoretical underpinnings, 2:1014 Unconscious, 1:231, 1:484, 1:525, 1:588, 2:822, 2:823
therapeutic process, 2:1017 Unconscious God, The (Frankl), 1:433
Trauma Unconscious phantasy, 2:734
advanced integrative therapy, 1:36–37 UNESCO, 2:972
biopsychosocial model, 1:122 “Unfinished business,” 1:454
birth trauma, 2:864 Unfolding, 2:806
cognitive processing therapy, 1:180 Unfreezing, 2:1005

1212 Index
Unified theory, 2:1021–1025 U.S. Public Health, 2:833

historical context, 2:1021–1022 U.S. Supreme Court, 1:334
major concepts, 2:1024 Usui, Mikao, 1:213, 2:876–877, 2:878
techniques, 2:1024 Usui Reiki Ryoho Gakkai association, 2:877
theoretical underpinnings, 2:1022–1023 Utilization, 1:349, 1:359
therapeutic process, 2:1024
unified approach to conceptualizing, 2:1024 (fig.) Vaihinger, Hans, 1:25–26, 1:217, 1:221
Unified therapy, 2:1025–1029 Validation, 1:294, 1:343, 1:530
historical context, 2:1025 Validity testing, 1:197
overview, 1:551 Value and Teaching (Simon, Harmin), 2:1035
techniques, 2:1027–1028 Values clarification, 2:1035–1039
theoretical underpinnings, 2:1025–1027 Acceptance and Commitment Therapy, 1:9
therapeutic process, 2:1028 historical context, 2:1035
Unifying nonlinear dynamical biopsychosocial systems major concepts, 2:1036–1037
approach, 2:1029–1033 overview, 1:378
historical context, 2:1029–1030 techniques, 2:1037–1038
major concepts, 2:1030–1033 theoretical underpinnings, 2:1035–1036
overview, 1:551 therapeutic process, 2:1038
theoretical underpinnings, 2:1030 Vancouver School for Narrative Therapy, 2:692
United Kingdom Council for Psychotherapy, 1:241 Varela, Francisco, 1:222, 1:223, 1:458
United States International University, 1:433 Vedas, 2:1059
Universal human needs, 1:520 Vegetotherapy, 1:112
University of Chicago, 1:423, 2:897 Veltheim, Esther, 1:129
University of Hawaii, 2:685 Veltheim, John, 1:129
University of Hertfordshire, 2:601 Ventura School for Girls, 1:462
University of Illinois in Champaign, 2:641 Verification, phenomenological therapy, 2:775
University of Iowa, 1:94 Verne, Jules, 2:936
University of Kansas, 2:687 Vertical development, 1:286
University of La Plata, 2:623 Veterans Administration, 1:462, 2:650, 2:753, 2:754
University of Leicester, 2:997 Vico, Giambattista, 1:217, 1:221
University of Manchester, 2:647 Victim formulations, 2:954–955
University of Massachusetts, 2:658 Vienna General Hospital, 1:434
University of Minnesota, 2:936 Vienna Medical School, 1:434
University of Nevada, Reno, 1:7 Vienna Psychoanalytic Society, 1:24, 1:25, 1:30,
University of Parma, 2:716–717 2:821, 2:874
University of Pennsylvania, 1:89, 2:661, 2:922 Vienna Rathausplatz, 1:433
University of Southern California, 1:259 Viktor Frankl Institute, 1:433
University of Tennessee College of Medicine, 2:1025 Viktor Frankl—Recollections (Frankl), 1:433
University of Texas Medical Branch, 1:203 Violence of Men, The (Madanes), 2:624
University of the Witwatersrand, 2:677 Visotsky, Harold, 2:905
University of Washington, 1:51, 1:465, 2:617 Visualization
University of Wisconsin, 1:348, 2:976 autogenic training, 1:82
Unlocking the Emotional Brain (Ecker, Hulley), 1:200 biofeedback and, 1:118
Upanishads, 2:1059 psychosynthesis, 2:840
U.S. Army, 2:971, 2:972 See also Guided imagery therapy
U.S. Department of Education, 1:21 Vital force, 1:510
U.S. Department of Health and Human Services, Voice Dialogue, 2:1039–1041
1:270, 1:401 historical context, 2:1039
U.S. Department of Veterans Affairs, 1:179, major concepts, 2:1040
2:783, 2:806 overview, 1:333
U.S. Federal Civil Service, 1:270 techniques, 2:1040
U.S. Food and Drug Administration (FDA), 1:57, theoretical underpinnings, 2:1039
1:152–153, 1:502, 2:715, 2:744, 2:811, 2:876 therapeutic process, 2:1040–1041
U.S. Olympic Training Center, 2:628 Vollenweider, Franz, 2:811

Index 1213
Von Bertalanffy, Karl Ludwig, 1:121, 1:155, 1:249, White, Ann, 2:781
1:311, 2:991, 2:1029 White, Michael, 1:223, 2:691, 2:696, 2:1050–1052
Von Foerster, Heinz, 1:222 Whitehead, Alfred North, 1:298
Von Glasersfeld, Ernst, 1:217, 1:218, 1:222 Whitehouse, Mary, 1:269, 1:271
Von Goethe, Johann Wolfgang, 1:229 Whittingham, Martyn, 1:419
Vygotsky, Lev, 1:173, 1:203 WholeHealthCare, 1:130
Wiener, Norbert, 1:298–299
Waal, Nic, 1:157 Wiggins, Jerry, 1:420
Wachtel, Ellen, 1:264, 1:266 Wilber, Ken, 1:541, 1:542, 1:544, 1:545, 2:1012, 2:1013
Wachtel, Paul L., 1:64, 1:264, 1:547, 1:555 Wilderness therapy. See Adventure-based therapy
Wade, Allan, 2:894 Wilk, James, 2:737
Wade, Bill, 1:137 Will to Meaning, The (Frankl), 1:433
Wagner, Alan, 1:163–164 Will to power, 1:369
Walden Two (Skinner), 2:937 William Alanson White Institute, 1:11, 1:519,
Walking meditation, 2:639, 2:655, 2:659 2:636, 2:763
Walter, William, 2:715 William Glasser International, 1:462, 1:463,
Walters, Marianne, 1:407 1:464, 2:857
Walters, Richard, 1:85, 2:641, 2:938 Williams, Mark, 2:656
Wampold, Bruce, 1:206, 1:308–309, 1:310, 2:768 Willis, Thomas, 2:714
Wants, reality therapy and, 2:858 Wilson, E. O., 1:317
Washington School of Psychiatry, 2:817, 2:972 Wilson, Kelly, 1:7, 2:653
Watkins, Helen, 1:325–326, 1:327–328 Wiltwyck School for Boys, 2:661, 2:966
Watkins, John G., 1:325–326, 1:327–328 Winnicott, Donald, 2:1052–1054
Watson, Jean, 1:492 attachment group therapy and, 1:70
Watson, John B., 1:90, 1:105, 1:163, 1:333, biographical information, 2:1052–1054
1:386, 2:981 classical psychoanalytic approaches, overview,
Watzlawick, Paul, 1:145, 1:276, 1:298, 1:565, 2:623, 1:169, 1:215
2:753, 2:755, 2:1027 cognitive analytic therapy and, 1:172
WDEP (want, doing, self-evaluation, planning), contemporary psychodynamic-based therapies
2:859–860 and, 1:230
Weakland, John, 1:145, 1:276, 1:298, 1:350, 1:488, core process psychotherapy and, 1:241
1:565, 2:753, 2:754–755, 2:946, 2:957 dance movement therapy and, 1:271
Wednesday Psychological Society (Vienna Psychoanalytic on false self, 1:45
Society), 2:821 Klein and, 2:605
Wegela, Karen, 1:229 object relations theory and, 2:731, 2:732
Weimer, Walter, 2:628 relational group psychotherapy and, 2:880
Weiner, Norbert, 1:250 relational psychoanalysis and, 2:885
Weiner-Davis, Michele, 1:276, 2:735 symbolic experiential family therapy and, 2:976
Weissman, Myrna, 1:578 Wise, Carroll, 2:758
Welch, Martha, 1:505 Wish fulfillment, 1:435
Well-established treatments, defined, 1:362, 1:363–364 Witswatersrand University Medical School, 2:981
Wellness counseling, 2:1043–1048 Wittenberg, Wilhelm, 1:519
historical context, 2:1043–1044 Wittgenstein, Ludwig, 1:203, 1:277, 2:947
major concepts, 2:1045–1046 Wolf, Montrose, 1:51, 1:53
overview, 1:256 Wolpe, Joseph, 1:94, 1:181, 1:189, 1:386, 2:614,
techniques, 2:1046 2:677–678, 2:933, 2:934, 2:980, 2:981–982
theoretical underpinnings, 2:1044–1045 Women’s Project in Family Therapy, 1:407
therapeutic process, 2:1046–1047 Women’s roles, psychoanalysis and, 1:413. See also
Wernicke, Carl, 2:714 Feminist family therapy; Feminist psychoanalytic
Wertheimer, Max, 1:457, 2:630, 2:762 therapy; Feminist therapy
Western Psychological Association, 2:1063 Wong Tai, 1:351
When Nietzsche Wept (Yalom), 2:1058 Worchester State Hospital, 2:758
Whitaker, Carl, 1:248, 1:379, 1:380, 2:975, 2:976, Wordsworth, William, 2:781
2:1048–1050 “Working through,” 1:439, 1:577

1214 Index
Working up/down, 1:237 focused brief group therapy, 1:419, 1:420, 1:474
Working With Families of the Poor (Minuchin, interpersonal group therapy of, 1:570
Minuchin, Colapinto), 2:662, 2:967 May and, 2:636
World Council of Psychotherapy, 2:935 psychoeducational groups and, 2:828
World Federation for Mental Hygiene, 2:972 Yamas, 2:1060
World Health Organization, 2:935, 2:972, 2:1043 Yarhouse, Mark, 2:925
World Tapping Summit, 1:345 Yellow Emperor’s Classic of Internal Medicine, 1:20–21
World Trade Center, 2:952–953 Yin-yang balance, 1:21, 1:22, 1:22 (fig.)
World Youth Christian Federation, 2:896 Yoga movement therapy, 2:1059–1062
Worldview, 2:725–726, 2:774 historical context, 2:1059
Worsely, J. R., 1:21 major concepts, 2:1060
Worth, conditions of, 2:769–770 mindfulness techniques, 2:655
Wright State University, 1:419 mindfulness-based stress reduction, 2:659–660
Writing therapy, 2:1054–1056 as non-Western approach, 2:727
major concepts, 2:1055 pranayama, 1:142, 1:143
overview, 1:256 techniques, 2:1060–1061
techniques, 2:1055–1056 theoretical underpinnings, 2:1059–1060
See also Bibliotherapy; Journaling Yogananda, Paramahansa, 2:863
Wubbolding, Robert “Bob,” 1:464, 2:857 Young, Jeffrey, 1:189, 2:908
Wundt, Wilhelm, 1:175, 2:801
Wynn, Lyman, 1:11 Zalaquett, Carlos, 1:284
Zaslow, Robert, 1:505, 2:861
Yale University, 2:1063 Zimbardo, Philip George, 2:1063–1065
Yalom, Irvin, 2:1057–1059 Zimbardo Educational Foundation, 2:1064
biographical information, 2:1057–1059 Zinkin, Louis, 1:469
existential group psychotherapy, 1:365 Zone of firing, 1:111
existential therapy, 1:370, 1:372 Zulu, ancestor reverence by, 1:399, 1:400, 2:984–985

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The SAGE Encyclopedia of

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Further Readings Historical Context

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person had an animus and an anima—or a masculine Techniques

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personality disorders, primarily borderline known as the internalization system. This

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fantasies, and desires of group members as they are Interpretation

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Further Readings published in 1966. During the last decades of his

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Scansion See also Classical Psychoanalytic Approaches: Overview;

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uncover the unconscious causes of the low self- Paradoxical Intention

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help improve mood and behavior and to reduce Centering Prayer

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Education He or she also encourages the client to take time

5. Have the client return to simply watching his or

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