IV.

CLINICAL MANAGEMENT

A. THERAPEUTIC COMMUNICATIONS

In clinical psychology, interventions are actions performed

to bring about change in people. A wide range of intervention
strategies exist and they are directed towards various types of
issues. Most generally, it means any activities used to modify
behavior, emotional state, or feelings. Psychological interventions
have many different applications and the most common use is for
the treatment of mental disorders, most commonly
using psychotherapy and counseling. The ultimate goal behind
these interventions is not only to alleviate symptoms but also to
target the root cause of mental disorders.
Counseling, sometimes called “talk therapy,” is a
Psychotherapy is the conversation or series of conversations between a counselor and
treatment of behavior client. Counseling usually focuses on a specific problem and taking
the steps to address or solve it. Problems are discussed in the
disorders, mental illness,
present-tense, without too much attention on the role of past
or any other condition by experiences. Psychotherapy, like counseling, is based on a healing
utilizing insight, relationship between a health care provider and client.
persuasion, suggestion, Psychotherapy, or therapy for short, also takes place over a series
of meetings, though often it has a longer duration than counseling.
reassurance, and
Some people participate in therapy off and on over several years.
instruction so that clients Instead of narrowing in on individual problems, psychotherapy
may see themselves and considers overall patterns, chronic issues, and recurrent feelings.
their problems more This requires an openness to exploring the past and its impact on
realistically and have the the present. The aim of psychotherapy is to resolve the underlying
issues which fuel ongoing complaints. Psychotherapists help to
desire to cope effectively
resolve past experiences as part of laying the foundation for a
with them. satisfying future.

CLINICAL NOTE: Consider counseling if you have a single concern

that you would like to get some feedback on. Consider psychotherapy
if you noticed a pattern of problems or concerns that seems to keep
coming up.

1. Holistic Paradigm of Healing

In contrast to the biomedical model’s goal to cure with

symptom relief treatment, the goal in a holistic paradigm of
psychotherapy is healing. This is an important distinction, because
 2

curing is not always possible but healing is. Each component is

interdependent and interrelated, based on the premise that when
there is a change in one part of the system, the change
reverberates in all dimensions. For example, minor changes in
one’s emotions may potentiate a change in all other spheres as
well as in the person’s relationship with others and his or her
world. Conversely, a change in the context or relationships with
others may create changes in other dimensions (e.g., body, mind,
emotion, spirit) of the person. The goals of psychotherapy include
the reduction of symptoms, improvement of functioning, relapse
prevention, increased empowerment, and the specific
collaborative goals set with the client.
Within the biomedical model, symptoms are often thought
to be the cause of the patient’s problem and psychotropic
medications are prescribed to target specific symptoms in an
effort to eliminate or reduce the symptoms. For example,
prescribing a selective serotonin reuptake inhibitor (SSRI) to
increase serotonin levels is thought to treat the underlying cause
of the depressive disorder. However, whether this chemical
imbalance causes depression or coexists with some depressive
disorders is a matter of speculation. In contrast, in a holistic
model, symptoms are seen as a form of communication and are
useful for understanding the meaning of the dysregulation and
disharmony that is occurring for this person at a given time.
 3

2. Therapeutic and Non-Therapeutic Communication

Techniques

A number of techniques to assist the clinician in interacting

more therapeutically with clients are identified here as “technical
procedures” to be carried out and should serve to enhance
development of a therapeutic therapist–client relationship. Table
below includes a list of these techniques, a short explanation of
their usefulness, and examples of each:

THERAPEUTIC COMMUNICATIONS TECHNIQUES

Rationale Examples

Using Silence—Gives the client …………

the opportunity to collect and
organize thoughts, to think through
a point, or to consider introducing a
topic of greater concern than the
one being discussed.

Accepting—Conveys an attitude of “Yes, I understand what you said.”

reception and regard. Eye contact; nodding.

Giving Recognition— “Hello, Mr. G, I see you made your

Acknowledging and indicating assignment.”
awareness; better than
complimenting, which reflects the
therapist’s judgment.

Offering Self—Making oneself “I’ll stay with you awhile.”

available on an unconditional basis,
“I’m interested in you.”
increasing client’s feelings of self-
worth.

Giving Broad Openings—Allows “What would you like to talk about

the client to take the initiative in today?”
introducing the topic; emphasizes
“Tell me what you are thinking.”
the importance of the client’s role
in the interaction.

Offering General Leads—Offers “Yes, I see.” “Go on.”

the client encouragement to
“And after that.”
continue.

Placing the event in time or
sequence—Clarifies the
relationship of events in time so
that the therapist and client can
view them in perspective.
Making Observations—
Verbalizing what is observed or
perceived. This encourages the
client to recognize specific
behaviors and compare perceptions
with the therapist.
Encouraging description of
perceptions—Asking the client to
verbalize what is being perceived;
often used with clients experiencing
hallucinations.
Encouraging Comparison—
Asking the client to compare
similarities and differences in ideas,
experiences, or interpersonal
relationships. This helps the client
recognize life experiences that tend
to recur as well as those aspects of
life that are changeable.
Restating—The main idea of what
the client has said is repeated; lets
the client know whether or not an
expressed statement has been
understood and gives him or her
the chance to continue, or to clarify
if necessary.
Reflecting—Questions and feelings
are referred back to the client so
that they may be recognized and
accepted, and so that the client
may recognize that his or her point
of view has value—a good
4
“What seemed to lead up to...?”
“Was this before or after...?”
“When did this happen...?”
“You seem tense.”
“I notice you are pacing a lot.”
“You seem uncomfortable when
you...”
“Tell me what is happening now.”
“Are you hearing the voices again?”
“What do the voices seem to be
saying?”
“Was this something like...?”
“How does this compare with the
time when...?”
“What was your response the last
time this situation occurred?”
Cl: “I can’t study. My mind keeps
wandering.”
Th: “You have difficulty
concentrating.”
Cl: “I can’t take that new job.
What if I can’t do it?”
Th: “You’re afraid you will fail in
this new position.
Cl: “What do you think I should do
about my wife’s drinking problem?”
Th: “What do youthink you should
do?”
 5

technique to use when the client Cl: “My sister won’t help a bit
asks the therapist for advice. toward my mother’s care. I have to
do it all!”

Th: “You feel angry when she

doesn’t help.

Focusing—Taking notice of a “This point seems worth looking at

single idea or even a single word; more closely. Perhaps you and I
works especially well with a client can discuss it together.”
who is moving rapidly from one
thought to another. This technique
is not therapeutic, however, with
the client who is very anxious.
Focusing should not be pursued
until the anxiety level has subsided.

Exploring—Delving further into a “Please explain that situation in

subject, idea, experience, or more detail.”
relationship; especially helpful with
“Tell me more about that particular
clients who tend to remain on a
situation.”
superficial level of communication.
However, if the client chooses not
to disclose further information, the
therapist should refrain from
pushing or probing in an area that
obviously creates discomfort.

Seeking clarification and “I’m not sure that I understand.

validation—Striving to explain that Would you please explain?”
which is vague or incomprehensible
“Tell me if my understanding
and searching for mutual
agrees with yours.”
understanding. Clarifying the
meaning of what has been said “Do I understand correctly that you
facilitates and increases said…?”
understanding for both client and
therapist.

Presenting Reality—When the “I understand that the voices seem

client has a misperception of the
environment, the therapist defines
reality or indicates his or her
perception of the situation for the
client.
real to you, but I do not hear any
voices.”
“There is no one else in the room
but you and me.”

Voicing Doubt—Expressing “I find that hard to believe.”

uncertainty as to the reality of the
 6

client’s perceptions; often used “That seems rather doubtful to

with clients experiencing delusional
thinking.
me.” “
I understand that you believe this
to be true, but I see this situation
differently than you.”

Verbalizing the Implied—Putting Cl: “It’s a waste of time to be

into words what the client has only
implied or said indirectly; it can
also be used with the client who is
mute or is otherwise experiencing
impaired verbal communication.
This clarifies that which is implicit
rather than explicit.
here. I can’t talk to you or anyone.”
Th: “Are you feeling that no one
understands?”
Cl: (Mute)
Th: “It must have been very
difficult for you when your husband
died in the fire.”

Attempting to translate words “Cl: “I’m way out in the ocean.”

into feelings—When feelings are Th: “You must be feeling very
expressed indirectly, the therapist lonely now.”
tries to “desymbolize” what has
been said and to find clues to the
underlying true feelings.

Formulating a plan of action— “What could you do to let your

When a client has a plan in mind anger out harmlessly?”
for dealing with what is considered
to be a stressful situation, it may “Next time this comes up, what
might you do to handle it more
serve to prevent anger or anxiety
appropriately.”
from escalating to an
unmanageable level.

Several approaches are considered to be barriers to open

communication between the therapist and client. The table below,
identified a number of these techniques. Therapists should
recognize and eliminate the use of these patterns in their
relationships with clients. Avoiding these communication barriers
maximizes the effectiveness of communication and enhances the
therapist–client relationship.
 7

NON-THERAPEUTIC COMMUNICATIONS TECHNIQUES

Rationale Examples

Giving Reassurance—Indicates to “I wouldn’t worry about that if I

the client that there is no cause for were you”
anxiety, thereby devaluing the
client’s feelings; may discourage “Everything will be all right.”

the client from further expression Better to say:“We will work on

of feelings if he or she believes that together.”
they will only be downplayed or
ridiculed.

Rejecting—Refusing to consider or “Let’s not discuss...”

showing contempt for the client’s
“I don’t want to hear about...”
ideas or behavior. This may cause
the client to discontinue interaction Better to say: “Let’s look at that
with the therapist for fear of further a little closer.”
rejection.

Giving approval or disapproval “That’s good. I’m glad that you...”

—Sanctioning or denouncing the
“That’s bad. I’d rather you
client’s ideas or behavior; implies
wouldn’t...”
that the therapist has the right to
pass judgment on whether the Better to say: “Let’s talk about
client’s ideas or behaviors are how your behavior invoked anger in
“good” or “bad,” and that the client the others.”
is expected to please the therapist.
The therapist’s acceptance of the
client is then seen as conditional
depending on the client’s behavior..

Agreeing/Disagreeing— “That’s right. I agree.”

Indicating accord with or opposition
“That’s wrong. I disagree.”
to the client’s ideas or opinions;
implies that the therapist has the “I don’t believe that.”
right to pass judgment on whether
the client’s ideas or opinions are Better to say: “Let’s discuss what
“right” or “wrong.” Agreement you feel is unfair about the new
prevents the client from later community rules.”
modifying his or her point of view
without admitting error.
Disagreement implies inaccuracy,
provoking the need for

defensiveness on the part of the
client.
Giving Advice—Telling the client
what to do or how to behave
implies that the therapist knows
what is best, and that the client is
incapable of any self-direction. It
nurtures the client in the
dependent role by discouraging
independent thinking.
Probing—Persistent questioning of
the client; pushing for answers to
issues the client does not wish to
discuss. This causes the client to
feel used and valued only for what
is shared with the therapist and
places the client on the rdefensive.
Defending—Attempting to protect
someone or something from verbal
attack. To defend what the client
has criticized is to imply that he or
she has no right to express ideas,
opinions, or feelings. Defending
does not change the client’s
feelings and may cause the client
to think the therapist is taking sides
against the client.
Requesting an Explanation—
Asking the client to provide the
reasons for thoughts, feelings,
behavior, and events. Asking “why”
a client did something or feels a
certain way can be very
intimidating, and implies that the
client must defend his or her
behavior or feelings.
8
“I think you should...”
“Why don’t you...”
Better to say:“What do you think
you should do?”
“Tell me how your mother abused
you when you were a child.”
“Tell me how you feel toward your
mother now that she is dead.”
“Now tell me about...”
Better technique: The therapist
should be aware of the client’s
response and discontinue the
interaction at the first sign of
discomfort.
“No one here would lie to you.”
“You have a very capable
physician. I’m sure he only has
your best interests in mind.”
Better to say: “I will try to
answer your questions and clarify
some issues regarding your
treatment.
“Why do you think that?”
“Why do you feel this way?”
“Why did you do that?”
Better to say: “Describe what you
were feeling just before that
happened

Indicating the existence of an
external source of power—
Attributing the source of thoughts,
feelings, and behavior to others or
to outside influences. This
encourages the client to project
blame for his or her thoughts or
behaviors on others rather than
accepting the responsibility
personally.
Belittling feelings expressed—
When the therapist misjudges the
degree of the client’s discomfort, a
lack of empathy and understanding
may be conveyed. The therapist
may tell the client to “perk up” or
“snap out of it.” This causes the
client to feel insignificant or
unimportant. When one is
experiencing discomfort, it is no
relief to hear that others are or
have been in similar situations.
Making stereotyped
comments—Cliches and trite
expressions are meaningless in a
therapist–client relationship. When
the therapist makes empty
conversation, it encourages a like
response from the client.
Using denial—When the therapist
denies that a problem exists, he or
she blocks discussion with the
client and avoids helping the client
identify and explore areas of
difficulty.
Interpreting—With this technique
the therapist seeks to make
conscious that which is
9
“What makes you say that?”
“What made you do that?”
“What made you so angry last
night?”
Better to say: “You became angry
when your brother insulted your
wife.
Cl: “I have nothing to live for. I
wish I were dead.”
Th: “Everybody gets down in the
dumps at times. I feel that way
myself sometimes.”
Better to say: “You must be very
upset. Tell me what you are feeling
right now.
“I’m fine, and how are you?”
“Hang in there. It’s for your own
good.”
“Keep your chin up.”
Better to say: “The therapy must
be difficult for you at times. How do
you feel about your progress at this
point.
Cl: “I’m nothing.”
Th: “Of course you’re something.
Everybody is somebody.”
Better to say: “You’re feeling like
no one cares about you right now.
“What you really mean is...”
“Unconsciously you’re saying...”
Better technique: Clinicians must
leave interpretation of the client’s
 10

unconscious, to tell the client the behavior to registered psychologist.

meaning of his experience.
Some practitioner has not been
prepared to perform this technique,
and in attempting to do so, may
endanger other roles with the
client.

Introducing an unrelated “Cl: “I don’t have anything to live

topic—Changing the subject
causes the therapist to take over
the direction of the discussion. This
may occur in order to get to
something that the therapist wants
to discuss with the client or to get
away from a topic that he or she
would prefer not to discuss.
for.”
Th: “Did you have visitors this
weekend?”
Better technique: The therapist
must remain open and free to hear
the client, to take in all that is
being conveyed, both verbally and
nonverbally.

3. Supportive Relationships

The supportive relationship is a relationship which

attempts to make the client feel as comfortable and appreciated
as possible. This goal can be pursued through therapeutic
behaviors that are general and applicable to all clients, as well as
therapeutic behaviors that are designed specifically for the
particular client. Behaviors that encourage the formation of a
supportive relationship in a specific client have to take into
account the individual's personality style is also of great help in
deciding what kind of behaviors will be seen by the client as
supportive. Since this type of supportive treatment goes along
with the basic personality style, the therapist should also be
concerned with two factors while delivering treatment.

a. That the therapist delivers only as much support as is

needed and no more since delivering more would be perhaps
promoting further exaggeration of the personality style. For
example, in treating a client with a dependent personality
style, a therapist may want to support the client by playing
a dominant role. The therapist may authoritatively offer
advice, telling the client what to do in situations where the
client feels lost or indecisive.

b. That the therapist does not inappropriately go along with

the individual’s personality bends, or foster behaviors that
will get the individual into trouble.
 11

CHARACTERISTICS OF THERAPEUTIC INTERVENTIONS

THOUGHT TO BE SUPPORTIVE TO DIFFERENT
PERSONALITY STYLES

Personality Styles Guidelines for Supportive

Therapeutic Relationships
Schizoid Accept the client’s inability and
disinterest in interpersonal relationships.
Allow him to be superficial and
somewhat distant and aloof. Be ready to
take a more active role in keeping the
discussion going but also be comfortable
with silences or discussions that are
somewhat extraneous to treatment.
Avoidant Make an effort to reassure the client that
she will not be rejected and be sure to
have a positive regard for her. Be
sensitive to the strength of relationship
that the client is comfortable with and do
not attempt to get closer. Be aware of
your own anxiety and try to be as
relaxed as possible during the sessions.
Try not to cancel appointments or give
other indications of lack of interest.
Dependent Play a dominant role—be willing to tell
the client what to do and to give him
some assurance that he will be taken
care of.
Histrionic Give the client as much opportunity as
possible to be the center of attention.
Accept whatever dramatics the client
has, laugh at her jokes, be sure to let her
know often things that you like about
her.
Narcissistic Accept the premise that the client is a
superior human being. Treat him with
respect and do not humiliate him in any
way. Allow the client, as much as
possible, to control the relationship.
Antisocial Accept the view of the world as a race.
Try to look at the practical and material
aspects of life. Try to emphasize the
races that the client has won rather those
she has lost.
Compulsive Allow the client to organize the sessions
as much as possible. Discuss
developments with him so that nothing
 12

comes as a surprise, and so that he can

predict the future of the relationship. Be
prepared, well organized and punctual
for the sessions. Accept the premise that
if one does the right thing, one will
come out ahead.
Passive-Aggressive You can tell the client what the limits
are but do not tell her what to do within
those limits, allowing her as much as
leeway as possible. Try to avoid having
the client depend on you for anything
that she can do herself. Be sure that the
therapy contract is clear to the client and
that you live up to your agreement.
 13

READINGS # 8

The Importance of the Relationship in Therapy

How a strong therapeutic alliance can lead to real change

By Lisa Firestorm Ph.D. in Compassion Matters, December 22, 2016

As a therapist, my role in a person’s life is a unique one. I meet strangers who come to me for help, support, and to take on what I believe is the most
important venture anyone can, to truly know and understand themselves. The trust I am awarded each time a person tells me his or her story is
something that has never ceased to humble and inspire me in my 30-plus years of clinical practice. When I see someone start to break free from
some of the limitations imposed on them by their own past or the pain of their early relationships and experiences, to find their way, uncover
their goals, and start to reveal who they really are, it is genuinely the most rewarding part of therapy. I consider each of the people I’ve spoken to
brave and am grateful to play any role in their journey toward becoming the only thing any of us can hope to be… our real selves. For those reasons
and more, I care deeply about the relationship I establish with the people who come to see me in therapy.

Over the years, research has confirmed what so many therapists have known intuitively, that the therapeutic relationship itself is essential to the
success a patient experiences. Some studies have even called it the most important common factor to successful outcomes. When a task force put
together by APA’s Society of Clinical Psychology set out to identify empirically supported treatments, they found that the “therapy relationship makes
substantial and consistent contributions to psychotherapy outcome independent of the specific type of treatment,” and that “the therapy relationship
accounts for why clients improve (or fail to improve) at least as much as the particular treatment method.”

Dr. John Norcross, who headed up the task force, defined the therapeutic alliance as referring to “the quality and strength of the collaborative
relationship between client and therapist, typically measured as agreement on the therapeutic goals, consensus on treatment t asks, and a
relationship bond.” Along with empathy and genuineness, this alliance represents an integral part of the therapeutic relationship. Research shows,
time and time again, that this alliance plays an extremely important role in the change process.

In his new book, Overcoming the Destructive Inner Voice: True Stories of Therapy and Transformation, my father, Dr. Robert Firestone, invites an
audience into the therapy process, where they can witness how the formation of this relationship can deeply impact the evolution of an individual.
One of the things I most admire about my father’s approach to therapy is his ability to see the possibility of a person without their defenses. With an
almost x-ray like vision, he can almost immediately appreciate the unique essence of a person, separate from the influence of a painful past or the
ongoing abuse of a cruel inner critic. The short stories he tells in his book eloquently and colorfully illustrate exactly how the relationship between
patient and therapist can help people change. In his foreword to the book, my father wrote of psychotherapy that “nowhere in life is a person listened
to, felt, empathized with, and experienced with such concentrated sharing and emphasis on every aspect of personal communication.”

A good therapist has a deep interest in their client as an individual and will see and relate to them in ways that are sensitively tailored to the person’s
specific needs. There is no one proven method of therapy – no one-size-fits-all approach to treatment, because no one person is like the other. In
order to be available to a patient and establish a solid relationship built on trust and understanding, the therapist has to be equally attuned to the
patient and their own state of being. As my father put it, “Above all the therapist must remain an authentic human being with genuine feelings.”

When you consider how many of our problems come from early issues in our relationships, it makes sense that much of our heali ng would occur
within a relationship. An attuned therapist can offer a person, not just a new way of looking at themselves but at relationships in general. Attachment
research tells us that the biggest predictor of our attachment patterns in our relationships is the one we experienced growing up. The attachment
strategy we form in our earliest years can shape the reactions we have and the reactions we create in others throughout our lives. The best way to
form healthier, more secure attachments is to make sense and feel the full pain of our story – to create what Dr. Daniel Siegel often refers to as a
“coherent narrative.” This process of self-understanding is one of the great gifts of the therapeutic process. The genuine curiosity a therapist has in
their patient creates a safe space for the client to explore their own story and start to make sense of it.

When the therapist reacts to someone in a different manner than they’re used to or would expect, with attunement and reflection, the person can form
a new model for attachment. The formation of a secure attachment to the therapist has been shown to be significantly associated with greater
reductions in client distress. By experiencing a secure attachment with the therapist, the person can feel safe to start to r esolve some of their
old traumas and evolve their model of relating. This is why the establishment of trust in the relationship is so crucial to the success of the outcome of
therapy.

It is on this groundwork of trust that a person feels safest to reveal their real selves. As they peel back the layers of their defenses, they can star t to
recognize their unique wants and needs, what they wish to change or who they hope to become. As my father put it, “There is a need to be sensitive
to clients’ real feelings, qualities, and priorities, and to distinguish them from the negative overlay on their personalities that prevents them from
reaching their full potential for living.” This is the principle I aim to live by both in my practice and in myself, because I know that only by knowing
ourselves can we be fully available and of service to others.
 14

B. COUNSELING AND PSYCHOTHERAPIES

Clinical psychology students can begin to acquire a

counseling style tailored to their own personality by familiarizing
themselves with the major approaches to therapeutic practice.
Approaches to counseling and psychotherapy will present the
basic concepts of each approach and discussing features such as
the therapeutic process (including goals), the client–therapist
relationship, and specific procedures used in the practice of
counseling. The information will help clinicians develop a balanced
view of the major ideas of various theorists, therapists, and the
practical techniques commonly employed by counselors who
adhere to the various approaches.

Psychotherapy is a process of engagement between two

persons, both of whom are bound to change through the
therapeutic venture. At its best, this is a collaborative process that
involves both the therapist and the client in co-constructing
solutions to concerns. Therapists are not in business to change
clients, to give them quick advice, or to solve their problems for
them. Instead, counselors facilitate healing through a process of
genuine dialogue with their clients. The kind of person a therapist
is remains the most critical factor affecting the client and
promoting change. If practitioners possess wide knowledge, both
theoretical and practical, yet lack human qualities of compassion,
 15

caring, good faith, honesty, presence, realness, and sensitivity,

they are more like technicians. And those who function exclusively
as technicians do not make a significant difference in the lives of
their clients. It seems essential that counselors explore their own
values, attitudes, and beliefs in depth and that they work to
increase their own awareness.

THE CASE OF GEORGE

Clinicians will learn a great deal by seeing a theory in action,

preferably in a single case, demonstrating one or two techniques
from each of the theories. This case history of the hypothetical
client (George) helpful in understanding how various techniques
are applied to the same person. George’s case, which describes
his life and struggles, is presented here to give students significant
background material to draw from as you study the applications
of the theories. Each of the 11 theory includes a discussion of how
a therapist with the orientation under discussion is likely to
proceed with George. A summary of the intake interview with
George, his autobiography, and some key themes in his life are
presented to provide a context for making sense of the way
therapists with various theoretical orientations might work with
George.

SETTING: A community mental health agency where both

individual and group counseling are available. George comes to
counseling because of his drinking. He was convicted of driving
under the influence of alcohol, and the judge determined that
he needed professional help. George recognizes that he does
have problems, but he is not convinced that he is addicted to
alcohol. George arrives for an intake interview and provides the
counselor with this information:
 16

INTAKE INTERVIEW KEY THEMES

At the present time I work in construction. I A number of themes appear to represent
like building houses, but probably won’t stay in core struggles in George’s life. Here are some of
construction for the rest of my life. When it comes to the statements we can assume that he may make
my personal life, I’ve always had difficulty in getting at various points in his therapy and themes that
along with people. I could be called a “loner.” I like will be addressed from the theoretical
people in my life, but I don’t seem to know how to perspectives:
stay close to people. It probably has a lot to do with
why I drink. I’m not very good at making friends or
getting close to people. Probably the reason I
sometimes drink a bit too much is because I’m so
scared when it comes to socializing. Even though I
hate to admit it, when I drink, things are not quite so
overwhelming. When I look at others, they seem to  Although I’d like to have people in my life, I
know the right things to say. Next to them I feel just don’t seem to know how to go about
dumb. I’m afraid that people don’t find me very making friends or getting close to people.
interesting. I’d like to turn my life around, but I just
don’t know where to begin. That’s why I went back
to school. I’m a part-time college student majoring in
psychology. I want to better myself. In one of my
classes, Psychology of Personal Adjustment, we
talked about ourselves and how people change. We
also had to write an autobiographical paper. The  I’d like to turn my life around, but I have no
autobiography reads: sense of direction.
Where am I currently in my life? At 35 I feel
that I’ve wasted most of my life. I should be finished
with college and into a career by now, but instead I’m
only a junior. I can’t afford to really commit myself to
pursuing college full time because I need to work to  I want to make a difference.
support myself. Even though construction work is
hard, I like the satisfaction I get when I look at what I
have done.
I want to get into a profession where I could
work with people. Someday, I’m hoping to get a  I am afraid of failure.
master’s degree in counseling or in social work and
eventually work as a counselor with kids who are in
trouble. I know I was helped by someone who cared
about me, and I would like to do the same for
someone else.
I have few friends and feel scared around  I know when I feel alone, scared, and
most people. I feel good with kids. But I wonder if I’m overwhelmed, I drink heavily to feel better.
smart enough to get through all the classes I’ll need
to become a counselor. One of my problems is that I
frequently get drunk. This happens when I feel alone
and when I’m scared of the intensity of my feelings.
At first drinking seemed to help, but later on I felt
awful. I have abused drugs in the past also.  I am afraid of women.
I feel overwhelmed and intimidated when I’m
around attractive women. I feel cold, sweaty, and
terribly nervous. I think they may be judging me and
see me as not much of a man. I’m afraid I just don’t
measure up to being a real man. When I am sexually
intimate with a woman, I am anxious and  Sometimes at night I feel a terrible anxiety
preoccupied with what she is thinking about me. and feel as if I’m dying.
I feel anxiety much of the time. I often feel as
if I’m dying inside. I think about committing suicide,
and I wonder who would care. I can see my family
coming to my funeral feeling sorry for me. I feel
guilty that I haven’t worked up to my potential, that  I often feel guilty that I’ve wasted my life,
I’ve been a failure, that I’ve wasted much of my time, that I’ve failed, and that I’ve let people
and that I let people down a lot. I get down on myself down. At times like this, I get depressed
and wallow in guilt and feel very depressed. At times
like this I feel hopeless and that I’d be better off dead.
For all these reasons, I find it difficult to get close to
anyone.
There are a few bright spots. I did put a lot of
my shady past behind me, and did get into college. I
like this determination in me—I want to change. I’m
tired of feeling the way I do. I know that nobody is
going to change my life for me. It’s up to me to get
what I want. Even though I feel scared at times, I like
that I’m willing to take risks. What was my past like?
A major turning point for me was the confidence my
supervisor had in me at the youth
 17

INTAKE INTERVIEW KEY THEMES

going to change my life for me. It’s up to me to get
what I want. Even though I feel scared at times, I like
that I’m willing to take risks. What was my past like?
A major turning point for me was the
confidence my supervisor had in me at the youth
camp where I worked the past few summers. He  I like it that I have determination and that I
helped me get my job, and he also encouraged me to
go to college. He said he saw a lot of potential in me really want to change.
for being able to work well with young people. That
was hard for me to believe, but his faith inspired me
to begin to believe in myself. Another turning point
was my marriage and divorce. This marriage didn’t
last long. It made me wonder about what kind of man
I was! Joyce was a strong and dominant woman who
kept repeating how worthless I was and how she did
not want to be around me. We had sex only a few  I’ve never really felt loved or wanted by my
times, and most of the time I was not very good at it. parents.
That was hard to take. It made me afraid to get close
to a woman. My parents should have divorced. They
fought most of the time. My mother (Angie)
constantly criticized my father (Frank Sr). I saw him
as weak and passive. He would never stand up to
her. There were four of us kids. My parents
compared me unfavorably with my older sister
(Judy) and older brother (Frank Jr.). They were
“perfect” children, successful honor students. My  I’d like to get rid of my self-destructive
younger brother (Karl) and I fought a lot. They tendencies and learn to trust people more.
spoiled him. It was all very hard for me.
In high school I started using drugs. I was
thrown into a youth rehabilitation facility for stealing.
Later I was expelled from regular school for fighting,
and I landed in a continuation high school, where I
went to school in the mornings and had afternoons
for on-the-job training. I got into auto mechanics,  I put myself down a lot, but I’d like to feel
was fairly successful, and even managed to keep better about myself
myself employed for 3 years as a mechanic.
I can still remember my father asking me:
“Why can’t you be like your sister and brother? Why
can’t you do anything right?” And my mother treated
me much the way she treated my father. She would
say: “Why do you do so many things to hurt me?
Why can’t you grow up and be a man? Things are so
much better around here when you’re gone.” I recall
crying myself to sleep many nights, feeling terribly
alone. There was no talk of religion in my house, nor
was there any talk of sex. In fact, I find it hard to
imagine my folks ever having sex.
Where would I like to be 5 years from now?
What kind of person do I want to become? Most of
all, I would like to start feeling better about myself. I
would like to be able to stop drinking altogether and
still feel good. I want to like myself much more than
I do now. I hope I can learn to love at least a few other
people, most of all, a woman. I want to lose my fear
of women. I would like to feel equal with others and
not always have to feel apologetic for my existence.
I want to let go of my anxiety and guilt. I want to
become a good counselor for kids. I’m not certain
how I’ll change or even what all the changes are I
hope for. I do know that I want to be free of my self-
destructive tendencies and learn how to trust people
more. Perhaps when I begin to like myself more, I’ll
be able to trust that others will find something about
me to like.