DVD Transcipt
The following pages include verbatim transcripts of twelve role-plays that demonstrate
the twelve theories in sections I, II, III, and IV of the book. Each transcript is preceded by
a short description of the theory. These descriptions, the role-plays, as well as a
discussion that follows each role play (not included here) can be found on the
accompanying DVD that your instructor may show in class. As you read these
transcripts, reflect back on the chapter with which it is associated and consider if the
manner in which the therapist worked was the way you had imagined it to be after having
read the chapter.
Section I: Psychodynamic Approaches
Freudian Psychoanalysis
Jung’s Analytical Psychology
Individual Psychology (Adlerian Therapy)
Section II: Existential-Humanistic Approaches
Existential Therapy
Gestalt Therapy
Person-Centered Counseling
Section III: Cognitive-Behavioral Approaches
Behavior Therapy
Rational Emotive Behavior Therapy
Cognitive Therapy
Reality Therapy
Section IV: Post-modern Approaches
Narrative Therapy
Solution-Focused Behavior Therapy
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Freudian Psychoanalysis
Psychoanalysis proposes that our personality develops through a complex interaction
between the expression of our instincts and our early childhood environment where the
child encounters and internalizes shame and guilt. It is an in-depth therapy that assumes
much of our behavior is unconsciously driven and that there is value in bringing
unconscious motivations to awareness.
In this approach, the therapist is experienced as a parent figure, and therapy ideally
evolves as a more positive parenting process. This process occurs over a long period of
time as the client builds what is called a “transference” relationship with the analyst. This
transference relationships mimics early family relationships and offers rich material for
the client to examine. The transference relationship allows the client to acknowledge
forbidden and repressed thoughts and feelings in a safe environment and to integrate
these into conscious awareness. The alternative is that the latent unconscious content
remains destructive to the client’s sense of well-being and personal relationships,
manifesting in such symptoms as anxiety, depression, conflicts, or addictions. The
interpretation of dreams and free association became two of Freud’s primary therapeutic
techniques for accessing repressed material from the past.
Let’s take a look at how Dr. Paula Justice uses dream analysis in her work with Jeannie,
as she examines some repressed feelings regarding the death of her father.
Dr. Justice: Hi. Good to see you again. Last session I know you said you had a
significant dream that we didn’t have time to really process. I was wondering if you’d
like to start with that today.
Jeannie: I really would because it still is with me, and it feels like a really big dream. It
starts off in a sense of…I’ve been invited to this wedding, and I’m aware that I’m talking
to…I think it’s the grandfather. And, well when I say grandfather he’s my age, so it’s not
white beard or…and I’m aware that…there’s such a masculine feeling talking to him.
I’m aware that his son is also present, and the grandson. The wedding’s about the
daughter. But I’m looking at him – I mean, talking with the grandfather, and…there are
just…all three men, but the grandfather he’s so masculine. I’m aware that he’s
handsome, that he – that all of the men in the family are, that there’s a sense of strength,
you know? I’m just very attracted to the whole family in this way.
Dr. Justice: So there’s these three generations of sort of strong, masculine, handsome
men.
Jeannie: Yes.
Dr. Justice: And this is the wedding of the daughter.
Jeannie: Right. Right. And what seems to be so special about this is that the daughter
gets to have the wedding exactly the way she wants to. And in fact it’s almost as if
she’s…and I don’t want to say spoiled because I don’t think that she’s spoiled, but she
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has all this incredible attention by all the men in the family. And she is told that she can
have it exactly the way she wants. And it’s an extraordinary request that she’s asked for.
Dr. Justice: Hmm. Now, these three men; do they remind you of anyone?
Jeannie: Hmm. Now that you’re saying that I, I know that when I see them in my mind’s
eye they remind me somewhat of my brothers – my brothers are very handsome.
Dr. Justice: Mhmm.
Jeannie: And the…so there’s this sense of the father, the grandfather…I’m aware, I
mean, he looks kind of like my brothers as well. So, there’s that sense of the handsome,
strong male.
Dr. Justice: So you’re the…sister, in a way, to these handsome men.
Jeannie: Yes. Yes.
Dr. Justice: And in the dream the sister is marrying. And you said she has a very special
request – what was that request?
Jeannie: She wants to jump from an airplane, on a stallion, into the ocean, in her wedding
dress.
Dr. Justice: Whew. And what kind of airplane is this?
Jeannie: Well, it’s kind of like a cargo, I guess you would call it, a cargo plane, because
the back end opens up and it’s like there’s a ramp. I see her, in my mind’s eye again, I
can see her in her wedding dress on this beautiful stallion. The ramp goes down, and she
leaps into the ocean, and the horse’s hoof catches on the ramp.
Dr. Justice: Hmm. So there’s sort of a stumble as she come out of the…
Dr. Justice and Jeannie Together: Out of the plane.
Dr. Justice: Ok. And this leaping out of a plane over water – does this remind you of
anything?
Jeannie: Well, the part that really grabs me the most was, one: that she gets to ‘have it
her way’ so to speak…the ocean, well I’ve loved the water. That the father has allowed
her to do this, has given her this as a gift so she can have this wedding…
Dr. Justice: And what about your own father?
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Jeannie: You know, just when I was…Yeah. How strange, you know? I just
remembered that my father, who…again, I’m going back and forth in my head about
several different things as a daughter. And he was a pilot.
Dr. Justice: Hmm. I remember you saying he died when you were very young.
Jeannie: I was wondering if you had remembered that I had told you that. I was four, and
he was flying in the Air Force, and he was lost, actually, over the Gulf of Mexico. His
ejection seat went off, and…
Dr. Justice: So he sort of jumped out of a plane.
Jeannie: What you’re making me think about is the connection with this good-looking
grandfather too, and the whole masculine piece of it that I feel like I missed in my life.
And as you know, my husband…had a terrible accident recently. And I’m aware that I
didn’t have my father to walk me down the aisle. I’m aware that I have always wanted to
be a Daughter. I’m aware that I love the sense of my husband, who was for the first time
in my life, I think, a very strong masculine force. And I have felt protected by him. And
now he’s wounded.
Dr. Justice: Mhmm.
Jeannie: And you know, that idea of that horse stumbling…the ramp reminds me of how
my husband is now paralyzed. And he has to…the only way he can get around is with a
van that has a ramp on it. And so he’s now broken, or wounded.
Dr. Justice: So the dream really brings up that longing for the strong masculine, for the
father that you lost so early in life, the masculine strength that you had in your husband
but, in a way that’s been a little lost with his disability, his accident.
Jeannie: You know, and that’s why I think the dream impacted me so much, because of
that sense of longing, and sorrow that comes up, wells up in me. And I hadn’t made that
connection with my loss of my dad. And you know, it’s so funny even to say the word
‘dad.’ I speak of him as a father because I didn’t call him ‘dad.’ I don’t remember that,
or ‘daddy.’ So when I think of a strong masculine, and I had it for a while: the courage.
He was a jet pilot, and here’s my husband a motorcyclist, a spelunker – all the loves of
the physical. And that’s, I think, what I do connect with the masculine: being strong, and
adventurous, and courageous.
Dr. Justice: And in the dream, you sort of leap, as the daughter figure, you leap – she
leaps – from the plane into the water, which is where your father was lost, in reality.
Over the water. So you’re almost, it’s almost a wish to join him.
Jeannie: You know, there is… I think, part of that longing, now that you bring that up,
it’s probably what I would call…I feel like sort of a questioning of being here, when I’ve
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suffered so much loss, to join him is what you’re saying? There’s probably some kind of
longing for me to join with him? Wow. Ok, that makes sense.
Dr. Justice: And that would be sort of magic, to be able to join with that strong
masculine: have your father back, have your husband whole again.
Jeannie: If only. If only.
Dr. Justice: And that wish, of course, doesn’t mean that you’re spoiled.
Jeannie: Well thank you for that one. You know I think that there is a piece of it, if I
could have it my way, if I could have the masculine protect me, to give me, to support
me, you know, if I had a father…what would that have been like for me?
Dr. Justice: And knowing that, knowing that you have those feelings that this dream has
surfaced for you, how does that sort of inform your waking life today?
Jeannie: You know, in telling you, and you asking me some of these questions, I’m really
aware of a sense of – I’ve started breathing better…I think it brings some sort of comfort
knowing that there’s a connection this way, you know, that I can make that connection,
that I know that I long for that. So thank you.
Dr. Justice: Well thank you for sharing that.
Jeannie: I feel much better. Thank you.
Dr. Justice: Good.
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Jung’s Analytical Psychology
In Jungian analysis there is an assumption that the individual achieves well-being through
the exploration of what Carl Jung called the personal unconscious and the collective
unconscious. The personal unconscious contains repressed material from childhood and
is symbolized by Jung’s archetype of the Shadow self, which represents all parts of the
psyche unacceptable to self and others. Jung believed that the most important task of
early adulthood is to bring the contents of the Shadow self to awareness and integrate it
into the conscious personality. The Shadow manifests as the opposite of Jung’s concept
of the Persona, or our public mask.
In contrast, the collective unconscious is a universal and transpersonal component of the
psyche that contains all human experience and potential. Once the Shadow has been
embraced, the client can continue in the process of what Jung called Individuation, a
gradual incorporation of universal archetypal patterns into everyday experience. These
archetypes provide blueprints for creative development and manifest in our dreams, art,
religious symbols, and myths. Two of the most significant archetypes are the anima,
which represents the feminine within all males, and the animus, which represents the
masculine within all females.
Jung believed that the unconscious could be accessed through the imagination as
manifested in dreams, free association, images and symbols, as well as what Jung called
Active Imagination. Exploring these symbols and images are a means of understanding
the past, relieving psychological symptoms, and finding guidance in creating a full and
more meaningful life.
In this role-play, watch how Dr. Paula Justice works with Carin as they explore dream
images to help the client acknowledge and embrace her Shadow self and how it might be
integrated into her public self in waking life.
Dr. Justice: Well welcome back, it’s good to see you.
Carin: Good to see you too.
Dr. Justice: And the last time we were together, you said you had an interesting dream
that you thought was important to what we were talking about. Can you sort of describe
that at this point?
Carin: Yes. Well, I was in a shower room, and I remember being surrounded by
extremely obsese women—like 3 or 4 or 500 pounds. And I remember walking though
it, and we all were naked, we had no clothes on, but I remember being so proud that I was
the only thin one there. But all these women…I just was disgusted by them. I couldn’t
believe that they were in this shower room with me.
Dr. Justice: And so how did you feel when you woke up from this dream?
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Carin: Well I did feel pretty disgusted at how someone could let themselves get like that.
I just am turned off by it, that lack of self-control. I felt proud also, in my dream, because
I was so different from the rest of them and I had a certain amount of self-control and I
was doing good. So proud and disgusted.
Dr. Justice: Ok. And do you have any sense of…we had talked about day’s residue, how
this might relate to your waking life.
Carin: Yes. Well, I’m doing these pageants: I’m doing Miss Virginia Beach and Miss
Portsmouth Seawall. And especially for Miss Portsmouth Seawall right now I’m really
dieting. And I’ve lost about five pounds in the past two weeks, and that’s a lot for me; I
don’t usually fluctuate like that.
Dr. Justice: Mhmm.
Carin: And so I’m not allowing myself to eat everything I would like to, so I think that
that is definitely being perceived in my dream as my daily residue, is people that can eat.
And I almost like them, but I’m still proud of myself, so it’s that tearing emotionally.
Dr. Justice: Ok. So being very conscious about your own eating and your own weight
because of the pageants may have prompted this dream.
Carin: Oh yes. Because we have to be in a swimsuit in front of everyone.
Dr. Justice: Right. And we had talked about how dreams sometimes present a balance or
a compensation for what’s going on in our waking life. And so here we have these
women overeating, whereas you’re having to be so conscious of not eating.
Carin: Yeah.
Dr. Justice: And I encouraged you to perhaps do some journaling with the dream. Were
you able to do any of that?
Carin: Yeah, I actually brought it with me. I did a dream dialogue instead of the journal,
where I actually talked to one of the women, and we had a conversation. And she said
“Why are you so disgusted by me?” And I told her “your lack of self-control and what
you’re doing to your body, it just disgusts me.” And I said “I never want to be like you.”
So we had a pretty rough conversation.
Dr. Justice: Mhmm. Did you feel toward her differently in going through the
conversation?
Carin: Sort of towards the end, she kind of encouraged me to, you know “It’s ok to
overeat every once in a while, you can be indulgent once a week or whenever,” and I sort
of encouraged her to, you know “Maybe we can go work out.” So we both tried to help
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each other out at the end. So that was good. It was a very rough beginning but we kind
of came to amends at the end, to a degree.
Dr. Justice: Mhmm. So you felt a little closer to her.
Carin: Yeah.
Dr. Justice: I remember in one of our earlier sessions talking about how there are some
weight issues in your family and how you had some weight concerns as a younger
person.
Carin: Yeah. When I was younger, I know I was extremely overweight, and I remember
in 5th Grade my parents having to sit me down and say “You need to lose 20 pounds
or…you might develop type 2 diabetes, and this and that…” I also have two uncles who
are extremely obese. One of them is applying for gastric bypass surgery right now and
the other one is a workaholic and just doesn’t care. But his wife is so concerned. So I
feel like…I think I’m especially disgusted by these women because it runs in my family,
and I’m afraid that it could be a little too easy for me to get like that because of the
genetic traits that I carry.
Dr. Justice: Mhmm. And I remember you saying that it wasn’t until you had that
conversation with your parents you became—
Carin: —Self-conscious.
Dr. Justice: Yeah.
Carin: We used to do weigh-ins in PE, in front of everyone. And I remember that was a
little weird because I weighed more than all the other kids. But I really didn’t care until
my parents told me that there was something wrong with it. And then I remember it was
like a snap; I said “Oh, this isn’t right.” And so from then…I remember in 6th Grade I
went on my first diet, and I lost about 40-50 pounds that year.
Dr. Justice: Wow.
Carin: And from then on it’s just been sort of an obsession of mine. My sister has it as
well, we’re both eating-obsessed.
Dr. Justice: So in this dream perhaps you’re seeing sort of a shadow part of yourself, you
remember that we talked about the shadow part, the part that just lets herself go.
Carin: Yeah, it’s the part that I’m scared of too, the shadow part that I don’t want to be
seen. I don’t want to show people that I have a lack of self-control. I know when people
show a lack of self-control around me I just get very angry, and I know you said that’s a
part of your shadow self, things that you get very angry about.
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Dr. Justice: Mhmm.
Carin: I get very angry at very overweight people because I know it’s unhealthy and I
know that they could die—my grandpa died of a heart attack, which was related to
smoking as well, but also his extra fat and stuff like that. His heart wasn’t strong enough.
So it’s a serious fear of mine.
Dr. Justice: Yeah. So you have these family health issues, you have your parents’
concern, you have the beauty pageants—
Carin: —And also the career.
Dr. Justice: Oh.
Carin: Because I want to go into television somehow. Hopefully on camera; my dream is
be on camera on TV somehow as my career. And to do that I have to be very thin
because TV adds weight to you. And I’m to the point right now where I feel like I’ve got
all my studies in line, I’ve got all this in line, I’ve got everything else except for the
weight under control. That’s my mindset. So if I gain weight then it’s like I’m selfsabotaging my career. So it’s extra pressure for me.
Dr. Justice: One of the things that we work on with the shadow is finding a way to
embrace it so it isn’t so frightening or so threatening. You have a lot of reasons to be
fearful of these overweight women in the dream, but is there anything about them that
may be positive?
Carin: Yeah. We just saw this movie—it had Queen Latifah in it…I don’t remember
what it was called. She learned that she was going to die in a few months, and so she
lived her life, and she’s a thicker woman, and she was portrayed as so beautiful and just
so wonderful, and she had so much to give. Actually, Hollywood is sort of steering away
a little bit from the anorexic models; in Fashion Week they just fired several models
because you could see their bones. So…society’s becoming a little bit more encouraging,
and I can really see especially in heavier women, you can see their inner beauty a little bit
more, I think. Like in the movie with Gwyneth Paltrow—I don’t know if you’ve seen
it—I don’t really remember the name, but she was able to date this boy because he was
hypnotized to only see her inner beauty.
Dr. Justice: Is that “Shallow Hal?”
Carin: “Shallow Hal,” yes. So that was cool to see, how much inner beauty they have
inside of everyone.
Dr. Justice: Mhmm. And I remember you saying once that sometimes you associate very
thin women with coldness and distance.
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Carin: Very stoic, yeah. Heavier women…I think of them as more loving and caring.
For some reason I have that in my head. I think it’s because of some literature courses
I’ve taken; we describe motherly women, loving women, as heavier and skinnier women
as meaner. I don’t know.
Dr. Justice: So even though the overweight women are threatening in terms of your
career and possibly your health issues, there’s something about them that’s softer, more
loving, more motherly.
Carin:Yeah, uh huh.
Dr. Justice: And how might you want that in your life and in your future?
Carin: Well I do know that I need to calm down on the eating obsession, so it is a part of
me that…I would love to not care about what I eat so much. So that’s a positive thing in
the dream, these women really don’t care what they eat. I’d love to be like that. So that’s
an emotional mindset that I’m going to try to get to. And also they’re just so loving and I
want that as well. I want to be able to be like that instead of being so rigid about
everything I have to do. So there’re lots of positive things.
Dr. Justice: And I know you said that you felt like your boyfriend accepts you just the
way you are.
Carin: Yeah, my boyfriend. Matt, he always—I know that I’ve gained maybe 10 pounds,
during Christmas time especially, and then had another pageant so I lost 20, but he has
always been there. Every day he says “you’re so beautiful, you’re so wonderful, you’re
amazing.” So that’s so encouraging to me because I used to think “if I don’t lose weight
then I’ll never get a boyfriend.” And now that I’m getting older “I’ll never get a
husband, never keep a husband if I can’t stay thin.” So his unconditional love has been
so encouraging to me for my body image, to just know that I can be loved no matter what
I look like.
Dr. Justice: So he doesn’t have any problem embracing that part of you.
Carin: Not at all, no. He likes it. He does like this to my arm, saying “I love this jiggle!”
He likes it.
Dr. Justice: And you’re comfortable with him, whatever size he is.
Carin: I’m very comfortable, yeah. He actually hurt his back and so he gained a little bit
of weight. And he was very self-conscious about that, but I think he’s beautiful all the
time so it’s cool for me to see that as well: me not caring if he gains five pounds, and him
not caring if I gain 10. He loves me for more than just what I look like.
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Dr. Justice: So in becoming aware of the dream and dialoguing with the characters and
looking at it a bit, you’re kind of moving a little closer, maybe, to accepting some of the
things that these women represent in yourself and in your future.
Carin: Yeah. Not completely, but a little bit.
Dr. Justice: Baby steps.
Carin: Yeah. Baby steps…so good.
Dr. Justice: Well thank you very much for bringing that in.
Carin: Well thank you for having me.
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Individual Psychology (Adlerian Therapy)
Alfred Adler posited that we all develop styles of life that seek to compensate for innate
feelings of inferiority. He believed that we attempt to overcome such feelings as we strive
for a sense of superiority, defined as a desire to achieve emotional health and
completeness. He also felt that emotional well-being could be gauged by an individual’s
degree of social interest, or sense of connectedness to others and to a worldwide
community.
Adler stated that we are often victims of faulty assumptions or inaccurate perceptions of
the past that drive the kinds of choices we make. These choices are often based on our
family constellation, birth order, and childhood memories.
Although considered a psychodynamic theory by most because of its focus on
understanding the dynamic forces that shape one’s psyche, Adler’s theory has also been
described as one of the first to apply humanistic and systemic concepts. This is because
Adler believed that people can change, create the future, make meaning in life, be goaldirected, and not necessarily be shackled by past events.
Adler saw therapy as occurring through a series of stages that included establishing a
collaborative relationship, analyzing the client’s problems, sharing insights, helping the
client reorient himself or herself to new ways of living, and reinforcing and evaluating
the change process.
During the therapeutic process the therapist will often show empathy, conduct a lifestyle
assessment, examine early recollections and dreams, communicate respect and
confidence, focus on strengths and encourage clients, help clients combat faulty
assumptions, and focus on goals.
Let’s see how Dr. Sylinda Gilchrist uses some of the above techniques to help “Shannon”
examine her lifestyle as it relates to her family constellation.
Dr. Gilchrist: Hi Shannon, what brings you to counseling?
Shannon: Well I’ve really just recently been feeling really overwhelmed, and stressed
about…I feel like I have so many obligations in my life that pull me in different
directions that I’m not able to give my all to each of those areas.
Dr. Gilchrist: So how long have you been feeling that way?
Shannon: Actually I said recently, but when I think about it probably as long as I can
remember.
Dr. Gilchrist: Ok. Since you were a child?
Shannon: Yeah.
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Dr. Gilchrist: Can you tell me a little bit about your childhood?
Shannon: Sure. I grew up with my mom and my younger brother; he’s four years
younger than I am. My parents divorced when I was 8, so for the longest time it was just
my mom, my brother, and me. We kind of bounced around a lot, she worked two jobs to
support the two of us as a single mom.
Dr. Gilchrist: So you’ve been feeling overwhelmed for a long time now.
Shannon: Yeah, and actually I’d probably say even before I was 8, before they got
divorced, because my dad is an alcoholic, so even when they were together it was just
chaotic. And I always wanted to protect my brother and help my mom.
Dr. Gilchrist: Help your mom how so?
Shannon: Around the house, and helping out with my younger brother-taking care of
him. I really…didn’t have a childhood, I guess, because I did a lot of adult things.
Dr. Gilchrist: Adult things like?
Shannon: Doing the dishes, cooking dinners, staying in to watch my brother while my
friends are outside at the park and stuff. So lots of things I guess.
Dr. Gilchrist: So it sounds like you had a lot of responsibility for taking care of your
younger brother.
Shannon: Uh huh.
Dr. Gilchrist: What did you do for you?
Shannon: Me? That’s an interesting question…I guess for me, I got straight A’s.
Dr. Gilchrist: That’s an accomplishment.
Shannon: Yeah, but I really stressed myself out doing that.
Dr. Gilchrist: How did you stress yourself out?
Shannon: Just…feeling like I have to make straight A’s, and not even or only in school. I
do that at work-I have to be the best employee. I do that at home, I do that with my
friends, my roommates, and even in relationships, romantic relationships.
Dr. Gilchrist: So it seems like you strive to be perfect in school and in other areas. You
might even be striving to be the best client.
Shannon: Yeah, I guess.
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Dr. Gilchrist: It sounds like you have this need to be perfect. Is that stressful?
Shannon: It is, it is. I feel very disappointed if I don’t do my best. I beat myself up over
that. So it’s really stressful.
Dr. Gilchrist: Who places that expectation on you?
Shannon: I guess I do, but in order to make people proud of me.
Dr. Gilchrist: Ok. Can you tell me your earliest recollection of maybe not being perfect?
Shannon: Yes, and actually when you said that it came to me immediately. In seventh
grade I got my first B and I was extremely upset. And I cried the whole way home
because it was an awful feeling, just awful.
Dr. Gilchrist: Ok. And so you said that it made you feel really awful.
Shannon: Mhmm. It just…I felt…I had made straight A’s up until that point and that
first B, I was so disappointed like I had just let myself down completely from what I
expected of myself.
Dr. Gilchrist: Since childhood you’ve always been striving to be perfect. How is that
working for you?
Shannon: It’s really really stressful. Sometimes it even makes me sick, like physically
sick. I will stress myself out to the point where I have a stomach ache or a really bad
headache that I can’t get rid of. So I guess it’s really not working.
Dr. Gilchrist: And it seems like this stress, this need to be perfect is really causing some
physical symptoms as well as adding to your stress level.
Shannon: Yeah. And then when I get sick it takes away time that I need to be using for
studying or work…it creates a cycle and…
Dr. Gilchrist: Adds more stress.
Shannon: Yeah.
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Existential Therapy
Existential therapy is loosely based on existentialism, such as the writings of Jean Paul
Sartre and Martin Buber. However, its application as a therapy is actually much more
optimistic than the writings of many existentialist authors. Existential therapists believe
in the importance of discussing the philosophy of existential therapy and view therapy as
a shared journey that examines meaningfulness in life. Thus, it is not unusual for
existential therapists to share their knowledge about living (and dying) and to even
periodically self-disclose as they attempt to develop an authentic relationship with their
clients. Because existential therapy is based on the sharing of a philosophy, it does not
offer specific techniques for doing therapy. However, some argue that “sharing a
philosophy” is a technique in itself. Some of the underlying assumptions of this
philosophy include the following:
1. The ability to self-reflect and be self-aware. Although individuals often choose a
life of denial, they are capable of self-reflection and self-awareness.
2. Feelings as a message of our being in the world. Anxiety, guilt, depression and
other feelings are a statement about the choices we make and should be examined
in this context, not as an indication of pathology.
3. Choice: We are capable of making positive choices for ourselves and for all of
humanity. Not choosing is a choice and can lead to what some have called an
“existential death or existential vacuum.”
4. Responsibility. We have a responsibility to make choices that will positively
affect ourselves and others. Otherwise, we all will live in chaos.
5. Meaning through our relationships with others. We are constantly redefining
ourselves through our relationships. Therapy is a journey through which the
therapist and the client are equal partners in their search for meaning.
6. The importance of authenticity. It is critical that we are real with others.
Otherwise we live a life of lies and deceit—a life filled with denial of one’s true
feelings and inner thoughts.
7. A never-ending search for completeness and wholeness. As we become more
authentic and more aware, healthy choices become more obvious and easier to
make. However, due to the complexities of life, we will be faced with choices,
sometimes difficult ones, until we die.
Let’s see how Dr. Ed Neukrug applies this philosophy with his client, Betty, in their
shared existential journey.
Dr. Neukrug: Well Betty, I want to thank you for coming in today and agreeing to share
some of your thoughts and concerns with me and um, wanna just kind of open it up and
start wherever you liked:
Betty: Well uh, I just recently retired from the police department and I’m moving into a
profession now, (into) counseling where I understand that I will need to have some type
of closeness, a relationship with my clients, but I really don’t have any, that much
experience in that regard because of my work and um, like the only uh, substantial
relationship I’ve had was with my mother.
15
Dr. Neukrug: It’s fascinating I find the contrast between being a police officer and a
counselor really interesting. Especially when you talk about the fact that it sounds like
you want some intimacy in your life, but you haven’t really had that except for with your
mother, so there is a stark contrast there between, again between being a police officer
and being a counselor. It sounds like you want to move into that direction of having more
intimacy in your life in general.
Betty: Yes um, I just… I just find it, I find it hard to talk about um, I umm
Dr. Neukrug: Which parts to talk about?
Betty: Uh, the intimacy part and I don’t understand how to work it, how to work it out
because there’s certain aspects of myself that just didn’t uh, acknowledge, I ignored. I’d
say the emotional part of myself was not honored. And now that I’m stepping out of a
role in which I had a script, you know, I had the uniform, I knew what I had to do there
was no question about what I had to do each day it was like a mantra, it was like
something I did everyday and now, it’s… I have to be, I have to come out of myself.
Dr. Neukrug: It almost sounds robot-like. Um, that you kind of, lived a role you even
said it you wore a uniform. And you put a certain image out to the world an image which
was maybe not the real you, as you saw yourself inside and now you’re really searching
for who that inner being is.
Betty: Right… More so uh… also, um, working in an environment that has been
historically racist and sexist uh... you tend to want to be invisible. Oh I mean to say “you
tend to be”… I tend to want to be invisible and not… and not be in front, so open about
who I was. It was like I just following the role, being like the “good girl” and my
womanhood was not honored it was a minor thing and it was not just something, not just
talking about the people, I’m talking about with myself and how it’s coming out that’s
who I am.
Dr. Neukrug: OK, so you found that, in that environment being a police officer, am I
correct in hearing that you personally experienced racism and sexism…
Betty: Yes...
Dr. Neukrug: … and that was very difficult for you and you kind of hid, is that accurate?
Betty: Yes, yes... um the way I dealt with that was to… to feel like I had to achieve in
order to be accepted, it was conditional. Um, I don’t know what else to say about that. It
was... it was uh, hard lessons. I learned a lot I also had to look at… look at how I, my
role in all of it…
Dr. Neukrug: You made some difficult choices I think as a police officer, in terms of how
you were going to live your life because of the sexism and racism and the nature of being
16
a police officer. The choices were maybe they weren’t even that conscious, but it sounds
like the choices where to kind of hide your real self.
Betty: Well it wasn’t like… well it was true it wasn’t conscious, uh I had to come to this
point reading, books and looking at other people to realize how much of myself was
unconscious of… what I was really doing was detrimental to me as a person… and
emotionally. So now that I have to work with people in that area, I need to, uh I need to
know myself and how to be in the world authentically.
Dr. Neukrug: Well I’m certainly impressed that this is, that you’ve switched roles like
that and that this is your new goal for yourself um and I’m really interested in how you
were able to raise your consciousness around your lack of awareness of self and your lack
of intimacy and how you were playing roles. How did you do that?
Betty: Well, I’d say it happened two different ways. One way was books I uh, there was
a book I found called, “Black Feminist Thought” that really opened my eyes a lot and
also when my mother was sick, I realized I was working and I realized that the role of
caring and the heart is so much more important to me in this life than… then the, I don’t
know what other way to put it, but a masculine way of being… being out there and then
the role of caretaking when my mother was sick was very important. I had to really like,
really open up to that and that takes a lot of courage to uh… do that…
Dr. Neukrug: Yes it does and I hear how courageous you were. And I think I’m also
hearing these kind of two parts of yourself being opened up at the same time and that was
that feeling part of yourself through your mother’s illness and also kind of the intellectual
part of yourself through this book that you read and other books that you’ve read. The
both of those kind of raised your consciousness about the importance for you that you
found more authenticity in your life.
Betty: Mmm-hmm, that was because, uh when you watch someone suffer which is hard,
I mean with the police work, uh there was uh, it was more of a…
Dr. Neukrug: …Detached suffering?
Betty: …Detached pseudo kind of presence I guess and you knew that you had to bind
yourself emotionally to get through it. It’s not a bad thing because, sometimes you need
to do that … uh you just don’t know what to do with it. And when my mother was
sick… Then I had to really look at those feelings and try to integrate then and that was
really hard… a lot of anger and all that.
Dr. Neukrug: So again, your mother’s illness really made you look at yourself in some
deeper ways.
Betty: Right, right. I had to make decisions to balance work and was at the hospital with
her a lot so I had to balance work and be there or make the decision to leave work and be
there, you know, leave so I had to uh, it was… it was like I don’t know if this makes any
17
sense, but it was like dealing with my mother and father. Like the police department, to
me, was like my surrogate father where you were like, not exactly I would say, a
balanced view of a father, but you had to be there, you had to stay strong, you had to do
your job along with my mom it was… it was different, I had to be open and receptive and
feeling, like you said get in touch with feeling parts.
Dr. Neukrug: Yeah, I think that I can really understand what you’re saying. I had a kind
of similar experience with my mom who was ill a few years ago and passed away and I
was like I was living two lives in some ways. Is that kind of the experience that you had?
Betty: Yeah, exactly… living two lives…yeah.
Dr. Neukrug: And I guess the um, in a way, and I hope you understand how I mean this,
the gift that your mom gave you, in her illness, was to help you see a deeper part of
yourself.
Betty: Alright, yeah… absolutely… because I did have to, um, walk through that and
see… I, I mean I really had to just be there and connect with a deeper part of myself
which wasn’t very easy or pretty. Life was very messy, yeah… yeah.
Dr. Neukrug: So now you’ve chosen a field which is, and maybe this was more of a
conscious choice, you’ve chosen a field which deals mostly with authenticity and
realness and now you wanna move on with your life in a new way. In a way where you
have more realness in relationships, more intimacy, um, perhaps realness in your
counseling relationships, perhaps more realness in your friendship and love relationships
and now you can consciously begin to make choices about bringing yourself to this new
place. Does that make any sense to you?
Betty: Yeah , I um, I have to… well I need to, let’s see… I would say… honor my
emotional life, which I have not done. It’s, uh, usually a sign of weakness in my uh, my
way of being in the world before…
Dr. Neukrug: That was you before and now we have a new you and I’ve got to say, I
really respect this new you. As you are honoring yourself, honoring your emotional self
and beginning to listen to it more effectively, more frequently.
Betty: Yeah, more frequently… thank you.
Dr. Neukrug: Well it sounds like it’s been a kind of, hard road for you in recent years, but
it, I’m also hearing that you’re making some really good choices for your self as you’re
moving forward in your life. And again, I really respect that.
Betty: Thank you. Seems like I have to work really, really hard to be uh, anything more
than ordinary … so I’ll just uh, just keep working as long as I don’t lose myself in my
work, that’s a fear too… (laughs)
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Dr. Neukrug: You want to remain real…
Betty: Right, right, right, right! Yeah…
Dr. Neukrug: I guess I’m thinking a lot of times we think that, um, life is gonna be easy,
but um… as you’re showing us, it usually isn’t. There are so many things in life that, that
give us difficult, hard times and messages to ourselves about who we are and where
we’re going and I think you’re really hearing some of the messages you’re getting about
yourself.
Betty: Can you give me something to uh, take with me?… (laughs)
Dr. Neukrug: I guess what I’m hearing… that’s a great question! I guess what I’m
hearing is that you’ve bee giving your self something and if I can give you anything
that’s what I want to give you and that is to continue to give yourself that sense of inner
awareness that you’ve begun to give to yourself. Thank you for sharing today.
Betty: Thanks…
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Gestalt Therapy
Originated by Fritz Perls, Gestalt Therapy has as its core belief the notion that reality is
often clouded over by unfinished business and it is therefore necessary to urge clients to
experience the “now.” Believing that awareness equals reality and that individuals tend to
avoid unfinished business, Gestalt therapists are active and directive as they push their
clients to understand how they use external supports to disguise their past hurts and pains.
Examples of some common external supports include the use of nonverbal behavior, such
as a client who taps his foot at the mention of an anxiety producing subject;
intellectualizing, such as a client who spews facts and figures to avoid feelings; and
blaming, such as a client who states that her depression is due to how her husband and
children treat her. In stark contrast to many psychodynamic approaches which slowly
attempt to help clients understand their defenses, Gestalt therapists push clients to deepen
their experiences and be freed from their defenses. A few of the many techniques Gestalt
therapists have developed to accomplish this include:
1. Awareness Exercises, such as when the therapist asks the client to close his or her eyes
and experience all prevalent feelings, thoughts, and senses to quickly get in touch with
one’s defenses.
2. Playing the projection and Using “I” Statements are used to discourage projecting
onto others and things. For instance, the statement: “I hate her, she doesn’t love me,”
becomes, “I hate myself; I’ve never learned how to love myself.”
3. Exaggeration Techniques are used when the therapist wants the client to get in touch
with the underlying meaning of a word, phrase, or nonverbal behavior. A client who
slouches is asked to slouch more and state what he or she is feeling. Suddenly the client
states: “I feel as though the world is on my shoulders.”
4. The Empty Chair Technique is used to help a person dialogue with a part of self or
another person in order to uncover underlying issues and feelings.
5. Turning Questions into Statements About Self are used because gestalt therapists
believe all questions are really statements about underlying feelings, issues, and values.
For instance, “Why don’t people care more about others?” may become: “I feel that
people don’t care about me.”
Let’s see how Dr. Ed Neukrug works with “Jill” to help her get in touch with some of her
unfinished business surrounding the death of her mother.
Dr. Neukrug: Well Jill, I really appreciate you being here today and I know that you had
some feelings and thoughts about some issues with your mom that you wanted to talk
about. So I’d love to hear what that’s all about.
Jill: Okay, I’m having a lot of difficulty dealing with the recent loss of my mom. My
mom died a few months ago and before she died, there was about a year and a half that I
didn’t have any contact with her. And I’m having a lot of trouble dealing with that. I
20
was close with my mom for my entire life, but for the year and a half prior to her death,
she didn’t have any contact with me. And fortunately I was able to see her the week
before she died, but it still didn’t heal any of the pain that I felt for the year and a half that
she didn’t have contact with me. So I’m hoping that um, you’ll be able to help me… get
through some of the, um, emotion that I’m feeling, um, help me resolve some of that pain
by talking about it and coming to terms with it.
Dr. Neukrug: Even as you’re talking I can see just in your face that the feelings are really
near the surface and that there’s really a lot of pain there for you.
Jill: Right… a lot of pain. Um, basically, like I said, my mom and I were close for my
entire life, uh she had trouble with relationships with my siblings and I was the one that
always stuck up for my mom. An um, about two years ago, she was diagnosed with a
terminal disease and I decided to have a family reunion at… in the Outer Banks. And I
invited my entire family, for the family reunion, and she did something very hurtful to
one of my siblings. And I didn’t stand up for my mom, and as a result of that she decided
to cut all communication with me and didn’t attend the family reunion. I, um, actually
hired a photographer, to take a family picture of everyone so that we would have that
remembrance of her knowing that she only had a couple of years to live. My mom didn’t
attend the family reunion; everybody else was there, so now I have this picture of the
whole family minus my mom. I’m having a lot of trouble, (voice breaking up); looking
at the picture knowing that I wasted a year and half of my life not having her in my life
and now it’s too late to make amends.
Dr. Neukrug: Okay… so it feels like you had this potential time to be with her and then
she cut off communication with you and so you’re really missing having that closure with
her.
Jill: Right… knowing it’s too late… to do anything.
Dr. Neukrug: Okay… so what I’m thinking is that maybe you need to have a
conversation with her and talk with her about how you’re feeling. And that’s something
we can do here, with this chair as if she was here. What do you think about… about that?
Jill: Pretend she’s here?
Dr. Neukrug: Mm-hmm (affirmative)
Jill: I can try… I can try that.
Dr. Neukrug: Maybe you can talk to her, to you mom. What do you usually call her?
Jill: I have (a) nickname, well we all have a nickname, we call her “Muz.” It sounds
funny I know, but that’s her nickname, Muz.
21
Dr. Neukrug: Okay… does that bring up some emotions when you say the name? Can
you say that a few times? Muz… Hi Muz.
Jill: Hi Muz… sigh…
Dr. Neukrug: Okay… you go, you can just… you can go with that feeling to say Hi
Muz…
Jill: Hi Muz… hi Muz…
Dr. Neukrug: And if you can put words to some of the feelings that you’re having…
Jill: nods…
Dr. Neukrug: I know how much you miss her if you can put words to… and talk to her
and tell her.
Jill: Hi Muz. Hi Muz. First I love you, miss you terribly and I miss the past year and a
half. (sobs)
Dr. Neukrug: Can you tell… can you say to her, “I feel I’ve been cheated out of that past
year and a half?”
Jill: I fell cheated out of the past year and a half. … Sigh... I feel cheated out of the
family reunion. I feel cheated out of the experiences our entire family could have had.
Dr. Neukrug: Can you tell your mother how angry you are at her?
Jill: I’m not good at it… expressing anger.
Dr. Neukrug: Can you try that?
Jill: I’m really not good at expressing anger.
Dr. Neukrug: Okay
Jill: I’m hurt.
Dr. Neukrug: Okay… tell her about the hurt…
Jill: You know? I feel hurt. I feel hurt that I was the only child that always stuck up for
you. When everybody else turned their back on you I was the only one that stuck up for
you!
Dr. Neukrug: Can you say, “I stuck up for you and then you turned your back on me?”
22
Jill: I stuck up for you and you were the one that turned your back on me! (sobs) And I
don’t think I deserve that.
Dr. Neukrug: And tell her how much you miss her.
Jill: I miss you and I wish I could take back the past two years… (sobbing) I really do. I
would give anything to take ‘em back… it’s so petty now. It’s so petty now; I wish I
could take it back. But, I’m grateful, I’m grateful that I got to say goodbye to you.
Because that’s the only thing that I can look back on now and be grateful about because I
truly don’t think I could… I truly don’t think I could deal with any of this now if I didn’t
have the opportunity to say goodbye to you.
Dr. Neukrug: So you did have that opportunity?
Jill: Yes
Dr. Neukrug: So a lot of the feelings that you have is not around your closure, saying
goodbye, it’s more around the feelings you have, having missed that year and a half with
her.
Jill: Right, right. Exactly.
Dr. Neukrug: Okay… and do you ever think about what she’d say back to you if she was
here?
Jill: Well, my step-father told me a few months ago, he actually came to visit me, and he
said, “Jill I just want you to now that your mom loved you very much.” You know, and
that meant a lot to me so I truly think that she was just, you know, stubborn and I don’t
think she meat to hurt me. I think she was just stubborn and had difficulty, you know,
making that first move. You know?
Dr. Neukrug: I kind of hear how much you loved her…
Jill: Oh, very much.
Dr. Neukrug: And maybe you can tell her one last time how much you loved her and how
much you regret not having had that time with her.
Jill: Muz, I love you. I do regret wasting the past year and a half of your life. I’m glad
we had all those other years and I’m lad we had all those other photographs. And I’m
glad that I have Joe, my step-dad. And I promise that I will not waste any years with
him.
Dr. Neukrug: And I… I sense and feel the loss that you feel from not having that year
and a half and I think that’s gonna be, um, an ongoing issue for you. But I hope that you
can continue to have conversations with your mom. Maybe though a chair, though
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journaling, um in other ways so that you can help to resolve some of those feelings that
you have.
Jill: Thank you, very helpful.
Dr. Neukrug: Well, I look forward to hearing how you do with that.
Jill: Thank you.
24
Person-Centered Counseling
The heart of person-centered counseling rests on three critical personality characteristics
that Carl Rogers, the founder of this therapy and philosophy of living, believed were
critical: congruence, unconditional positive regard, and empathy.
People who are congruent are real, genuine, or transparent with others. Their feelings,
thoughts, and behaviors are “in sync.” However, it is important to note that therapists
who are congruent do not necessarily express moment-to-moment feelings with clients as
sometimes such feelings can rapidly change and often deepen over time. However, it is
important for the therapist to express feelings toward his or her client, even negative
ones, if such feelings are persistent. Otherwise the relationship would be marred by
falseness or incongruity.
Unconditional positive regard is the ability to provide the client with a sense of
acceptance, regardless of what feelings or experiences are expressed by the client. Such
acceptance allows the client to feel safe within the relationship and to delve deeper into
him- or herself. Person-centered counselors believe that individuals are born with a need
to be loved, and when significant others, such as parents, do not provide unconditional
positive regard, children end up living as they believe others would want them to be, as
opposed to being who they really are.
The last quality, empathic understanding, has been one of the most widely used tools of
the counseling relationship, regardless of theoretical orientation, and has been shown to
be a critical factor in positive therapeutic outcomes. Empathy can be demonstrated in
many ways, including accurately reflecting the client’s meaning and affect; using a
metaphor, analogy, or visual image; or simply nodding one’s head or gently touching the
client during the client’s deepest moments of pain. A therapist who shows empathy is
“with” the client; “hears” the client; understands the client fully, and is able to
communicate such understanding to the client.
Let’s join Dr. Ed Neukrug as he tries to embody the characteristics of congruence,
unconditional positive regard, and empathy with Jose, who is discussing some concerns
he has about his mother and younger brother.
Dr. Neukrug: Hi Jose. Thanks for coming in today. I know you had some things you
wanted to talk about, so where would you like to start?
Jose: Well actually, I’m very concerned about my brother back home in Puerto Rico.
Dr. Neukrug: Ok.
Jose: I think that environment, which I grew up in, isn’t the best for him. So one of my
plans is to actually go back to school for a Ph.D., and move to Florida; be able to bring
him with me, and also my mom. So I’m kind of concerned about…if he gets in any
trouble—more than he already is.
25
Dr. Neukrug: So you’re concerned about your brother obviously, and somewhat your
mom also.
Jose: Correct.
Dr. Neukrug: And you’re hoping to move to Florida as quickly as possible.
Jose: Right.
Dr. Neukrug: So you can help them out.
Jose: Right. My mom has done a lot for all the family, for so many years. I think it is
time for her to relax, and I think if my plans go as I have them worked out I’ll be able to
provide that for her.
Dr. Neukrug: So you want to give back to your mom.
Jose: Of course.
Dr. Neukrug: She’s given to you so much.
Jose: Correct. I want to be here for her, you know? And back in Puerto Rico I think it’s
getting more difficult all the time.
Dr. Neukrug: So it sounds like things are getting worse there.
Jose: Yes.
Dr. Neukrug: And I guess I’m hearing, in some ways the urgency that you’re feeling.
Jose: Correct; that’s one of my main concerns. The urgency of getting them out. And
for me to be able to accomplish what I want to do in the time that I want to.
Dr. Neukrug: Ok. So the urgency of both helping your brother and your mother and
getting to Florida—it seems like if you got to Florida that would be easier to do from
there.
Jose: Correct. Yes, basically…Florida here in the U.S. is the most similar environment
to Puerto Rico.
Dr. Neukrug: Right.
Jose: Not just that. I went recently to a 25th high school reunion, and I found out that a
lot of my high school mates live in Florida. So I actually, even though I’ve never been in
Florida, know more friends and family that live there than people that I know here in
Norfolk. And I’ve been here for six years.
26
Dr. Neukrug: So in a sense you feel more connected to people in Florida even though
you’ve never lived there.
Jose: Yeah.
Dr. Neukrug: And it feels also more like an environment that feels more similar to where
you grew up.
Jose: Correct. This time it was kind of…when I went back to Puerto Rico it was kind of
shocking, because for the first time I realized that I won’t be back, it’s not really an
option at this time because of the financial situation back in Puerto Rico. So it was a hard
reality to accept.
Dr. Neukrug: Ok. So it kind of hit you when you went back this last time that you
weren’t going to move back there.
Jose: Correct.
Dr. Neukrug: And I guess up until that point in time you were thinking that that might be
something you would do.
Jose: Correct. That is home, that’s home.
Dr. Neukrug: Ok.
Jose: So realizing that going back home is not a real option is really challenging.
Dr. Neukrug: I would guess that taking that feeling of home out of your life must be hard.
Jose: Correct. And the little that I have achieved to this point…I don’t think it’s
complete without the opportunity to help my mom, to get my mom out of there and my
little brother.
Dr. Neukrug: So you’re not going to feel complete unless you move to Florida and help
your mom and your brother, who’s been having some issues.
Jose: Correct. Yeah, especially with things getting worse every time. And actually,
today is going to be the burial for a friend of mine—a very good friend of mine. We
grew up together, and once again it’s just the environment around there, it’s so so bad.
So bad that they don’t really get to see out of it.
Dr. Neukrug: So you’re going to a funeral of a friend of yours.
Jose: I won’t be able to, but today is his funeral back in my home town.
27
Dr. Neukrug: Ok.
Jose: Yeah. My mom called me and she told me about this. So that reminds me of the
real sense of urgency to actually do what I want to do and get them out of there as soon as
I can.
Dr. Neukrug: So somehow the death of this friend of your is making it more present for
you, more urgent for you to do something to help your mom and your brother.
Jose: Correct. Yes, it’s really…it worries me. And I talk to my mom every Sunday, and
I ask “how’s my mother doing?” He’s still running around. And I try to help him, I
don’t think anybody else will. He’s been living with my mom for several years and he’s
just stuck. He’s just living there, he’s not making any progress. So he’s kind of at the
mercy of what is around him.
Dr. Neukrug: And you’re feeling like it’s a life or death situation for him.
Jose: It may come to that. It’s likely with his…last time…he’s younger than I am, and
when he stands next to me he looks older. He’s really making it worse.
Dr. Neukrug: So his lifestyle is really draining the life out of him, and again I hear your
love for them, and I hear your concern about them, and I hear the urgency again of you
feeling like you need to do something.
Jose: Correct, yes. I have to do something. I’m older, and we grew up with a single
family home. So we owe everything to our mom. And she’s doing the best she can but
she still worries a lot about him. So he’s wearing her out, even at this stage.
Dr. Neukrug: And being the older you feel some responsibility for both taking care of
your younger brother and taking care of your mom.
Jose: Correct. And he’s a really hard worker. I know that if I’m able to get him out of
there and moved here, he will adapt and he won’t have that choice of working next to a
bar…there’s a bar every ten feet, you know? So…
Dr. Neukrug: I think one of the things I’m hearing also is the tug, maybe the internal tug
of your feelings, between the things that you need to finish up here and also your need to
take care of them.
Jose: Right.
Dr. Neukrug: And move to Florida. And that must be a real struggle for you.
Jose: It is. I feel that in order for me to be able to be more effective in helping them I
must…it’s not something that I really want to do: go for the Ph.D. But I think if I’m able
28
to accomplish that I would be more well-positioned to help them out. But that would
take me a few years. So that’s my concern, how to balance that.
Dr. Neukrug: And do both of those things.
Jose: Correct.
Dr. Neukrug: So if you get the Ph.D. you’re in a better position to help them, but on the
other hand if you get the Ph.D. you’re waiting, and you don’t want to wait too long.
Jose: Right, right.
Dr. Neukrug: Well it sounds like…what I’m hearing is your concern for your family,
your desire and wanting help your family and you want to do it in the best way possible.
You have a lot of important choices to make for yourself, and they’re pretty difficult
choices because people’s lives are at stake.
Jose: Right. Correct, yes. Basically it’s weighing those decisions. I’m hoping that I’m
making the right ones. So yes, every day…that’s my decision: am I doing the right thing.
Dr. Neukrug: I guess, I’m sitting here thinking “boy, I wish I could make those decisions
for you and tell you which one is the right one to make.” But at the same time I’m
thinking only you have that inner sense of what’s going to be right for you and your
family.
Jose: I really think I’m the one who should arrive to that decision. I think I’m in a
position where I can…not just balance the decisions but also know the details of the
situation. And I grew up there, so I know how it is there.
Dr. Neukrug: At the same time, I hope that maybe I can be helpful to you in helping you
look at some of the feelings you have inside that will help direct you to the right decision
for you. So maybe that’s something we can do here and talk about.
Jose: Ok. Certainly, talking about how I feel about it, and having feedback or a sense of
direction; whether or not I’m going the right way, would be very helpful.
Dr. Neukrug: Well thank you so much for sharing with me today.
29
Behavior Therapy
Developed during the first half of the twentieth century, behavior therapy is based on
three types of paradigms: operant conditioning, classical conditioning, and modeling.
Originally viewed as a scientific, reductionistic, and mostly sterile approach to
counseling, today’s behavior therapist realizes the importance of having a strong
therapeutic relationship. For instance, it is now usual for the modern-day behaviorist to
use empathy and develop a collaborative working relationship with the client. This allows
the therapist to build trust and correctly identify targeted behaviors the client would like
to change. After behaviors are identified, goals can be established and techniques chosen.
Today’s behavior therapists usually have a wide-range of techniques to choose from, with
some of the more popular ones being:
Modeling, such as when clients observe behaviors, usually in the clinical setting, and later
practice the behaviors in the office and on their own. Assertiveness training has been
particularly used in this fashion.
Operant conditioning techniques, such as positively reinforcing targeted behaviors and
extinguishing unwanted behaviors (e.g., use of sticker charts for children)
Relaxation exercises, such as learning how to progressively relax oneself in an effort to
reduce anxiety or other unwanted feelings.
Systematic desensitization, which is often used with anxiety disorders, is the deliberate
pairing of collaboratively chosen hierarchical aspects of the feared object with learned
relaxation techniques, thus slowly reducing the fear response.
Flooding and implosion techniques both involve the exposure to intensive amounts of
fearful stimuli, with the assumption being that prolonged exposure will extinguish the
fear response.
And,
Self-Management Techniques, which are used when one wants to help clients learn
various behavioral techniques and have them practice on their own.
In the following role-play, Dr. Suzan Thompson works with “Rayneer,” who is struggling
with a panic disorder resulting from a recent car accident. Dr. Thompson will assist Ivy in
applying relaxation techniques to her anxiety about driving.
Dr. Thompson: Hi Rayneer, welcome back.
Rayneer: Hi Suzan, how are you?
Dr. Thompson: I’m doing okay. So, how has the practicing been going with the
relaxation techniques that we talked about last time?
30
Rayneer: Well, it was kind of hard at first. I just kept having my heart palpitations and
the sweating, and then I put little hearts up around the house and every time I saw a heart,
it helped me remember to do the breathing that you taught me.
Dr. Thompson: What a great idea! Sort of that association
Rayneer: Well, I really need it, cause if I didn’t see something outside of me, I just kept
getting involved in the feeling.
Dr. Thompson: And so that reminded you to bring up that relaxation that we talked about.
Rayneer: Mmhmm
Dr. Thompson: Okay, so well one of the things that we’re going to do today is to talk
about the different components of what’s happened for you. And use the relaxation along
with sort of a hierarchy of events or situations that you might face. And eventually what
we’ll do is have you practice the relaxation along with each of the different pieces of it.
Does that make sense?
Rayneer: It does. Um, that will be good because it’s been really hard just getting in the
passenger side of the car, and somebody else has had to drive me.
Dr. Thompson: Yea, I was wondering about that.
Rayneer: And just getting in the car, it makes me very nervous and I start to sweat and
tremble and feel a little shortness of breath and I’m real concerned that I won’t be able to
go back to work cause I drive for everything and if I’m not driving then I can’t make do
for my family.
Dr. Thompson: Mmhm, so we really kinda have some short term immediate things that
you want to focus on, getting in the car even. And then maybe some longer term, that
would be getting you back to work, is that…?
Rayneer: Yes
Dr. Thompson: Okay, um you said that you had some of the anxiety come up when you
were even getting into the passenger side coming here.
Rayneer: Yes, I felt a little like I was choking and I just had this loss of control that if I
was in the car again, something else would happen. And when this accident happened, I
didn’t have any passengers. And I keep thinking if it happened again, and what if there
were passengers or someone else was injured?
Dr. Thompson: Right.
Rayneer: So it’s very scary.
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Dr. Thompson: Yeah, it sounds like it was. Well, if we have to kind of break things
down, because you’re telling me now of what’s going on now. And if we had to break
things down into smaller pieces, let’s look at what those pieces might be.
Rayneer: Okay
Dr. Thompson: And I’m going to write some things down so that we can kind of keep
things straight
Rayneer: Sure
Dr. Thompson: So um one of the things that you’re having a hard time with is that even
getting into the passenger side. But maybe we could back up from there.
Rayneer: Okay
Dr. Thompson: So, what, as you think about even getting into a car, what happens to your
anxiety?
Rayneer: Um, it goes up. It’s…I’d say just thinking about getting in the car, it goes up to,
on a scale of one to ten, it goes to like a five. And maybe, a four, it’s like it gets to a five
when I get ready to get in the car. But I start the heart palpitations and I’m sweating and I
start to tremble a little bit and I just have that fear that I’m going to lose control or
something’s going to happen.
Dr. Thompson: Yeah, so even just thinking about.
Rayneer: Mmhmm
Dr. Thompson: I’m glad that you went ahead and put that scale to it. We talked about that
last time as an application here. So thinking about getting into the car is about a four or
five.
Rayneer: Well, I think probably, it’s….I just get so…to me, it’s not just thinking about,
it’s getting into the car. So I guess thinking about it is a three but actually getting into a
car is probably a five.
Dr. Thompson: Okay, and is that getting into the passenger side or the drivers side?
Rayneer: Well, I’m getting into the passenger’s side, I’ve been too afraid to get into the
drivers side. So the passenger’s side is definitely a five and the driver’s side is higher.
Dr. Thompson: Okay, so where would you rate getting into the drivers side?
Rayneer: Um..it’s definitely at least a seven.
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Dr. Thompson: Okay, and I’m wondering if there’s something in between there. Getting
into the driver’s side, or what’s surrounding that?
Rayneer: Um, well you know, opening the door
Dr. Thompson: Okay
Rayneer: And once I got into the driver’s side and then usually I kinda put my hands on
the wheel, and then I’ll start the car after I check the mirrors and put on my seatbelt and
stuff.
Dr. Thompson: Okay, alright so you’re doing a great job of starting to break things down.
That’s exactly where we’re headed with this. Um, okay so just so I have it straight. It’s
thinking about getting into the car even before you go anywhere, even before you leave
the house, is about a three so that brings up some of the anxiety.
Rayneer: Yes
Dr. Thompson: And then getting into the passengers side is a little higher, opening the
door to the driver’s side is a little bit higher than that, but not as high as say, getting into
the driver’s side.
Rayneer: Right
Dr. Thompson: Okay, and then putting your hands on the wheel, kind of brings it up a
little bit more. And then starting the car um, is a little bit more too.
Rayneer: Yes, it feels like it would be. I haven’t tried it yet because I’ve been too anxious
about it.
Dr. Thompson: And that makes sense. Okay, so starting the car and then if we take it one
step further, what would be another step from there?
Rayneer: Um, I guess, um, maybe driving the car, like a short distance, or maybe in the
driveway or something.
Dr. Thompson: Yeah, a really short distance, so in the driveway. Um, and then what
would be a next step from there that we could aim for?
Rayneer: I guess going around the block.
Dr. Thompson: Okay, and if you had to think…even thinking about that right now.
Rayneer: That feels like it’s a nine.
Dr. Thompson: Okay
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Rayneer: I start sweating all over again just thinking about driving, going around the
block because I know there will be other cars out there, and that really is scary for me.
Dr. Thompson: And I see that in your face, okay. So then, we have sort of a hierarchy of
different pieces of getting back to driving that we can then apply the relaxation
techniques. Okay? So let’s just do one right now, just for practice and see how that goes,
alright? That first one that you have on the list is just thinking about getting into a
vehicle.
Rayneer: Okay
Dr. Thompson: So right now as you’re thinking about getting into the vehicle. I see that
you’re kind of shaking. Remember the relaxation, talk me through the relaxation that
you’re aware of.
Rayneer: Taking a breath, and holding it for the count of five and breathing out again.
Dr. Thompson: So, you’re gonna do that, good, just independently, just be in that relaxed
place…great. And now as you’re in that relaxed place, think about, just think about
leaving your house and getting into a vehicle, the passenger’s side. And go back to that
relaxed, take a deep breath, and go back to that relaxed place.
Rayneer: (breathing)
Dr. Thompson: and how is that?
Rayneer: Well, you know thinking about getting in the car is kind of scary but I know I
can put a heart in the car so I know to breathe when I see them, cause I have them in the
house.
Dr. Thompson: Okay, great idea. So yeah, even right now as you think about getting into
the car, where would that heart be?
Rayneer: I would, right now need to put it on the door.
Dr. Thompson: Right on the door.
Rayneer: Or on the window.
Dr. Thompson: I almost thought of putting it, slap a big huge heart on the car, but it’s
your image so…
Rayneer: Well I’d feel better with a little one…just a little one.
Dr. Thompson: Okay, so let’s go back to the deep breath, get to a relaxed place…and as
you’re in that relaxed place, think about just going out to your car, that heart is right on
your car right where you put it. Go, keep relaxing, that’s it.
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Rayneer: I feel more like I have to do it than I’m relaxed about it.
Dr. Thompson: What do you mean?
Rayneer: Well, if I can’t drive again then I won’t be able to work again.
Dr. Thompson: We’re just gonna take it a little bit at a time. So right now, just it’s that
one piece, thinking about going out there. The rest of it will fade away for right now.
Rayneer: Neat trick…Okay, that does feel a little better.
Dr. Thompson: Okay, before when we first started talking about that, you rated it as a
three, where is it right now?
Rayneer: It’s probably a 2.5
Dr. Thompson: So, we brought it down a little bit. What I’m going to ask you to do then
is to keep practicing because the more you practice it, just like you did at home, the more
you practice with the relaxation and the heart you were able to get to that place. It’s the
same thing with each one of these so we’re going to take it a little bit at a time and we’ll
build from there, okay?
Rayneer: Thank you, I appreciate your help.
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Rational Emotive Behavior Therapy
REBT is an action- and results-oriented psychotherapy which teaches clients how to
identify self-defeating thoughts, beliefs and actions and replace them with more effective,
life-enhancing ones. One of the first of the modern cognitive behavior therapies, REBT
was developed in 1955 by Albert Ellis, Ph.D.
Using a technique called “uncovering the ABCs of personality formation,” REBT
therapists state that it is not the (A) Activating event that causes emotional Consequences
(C), but (B) the Belief (B) about the event. For instance, faced with the loss of a
relationship, one client’s belief system might lead to suicidal depression, while another
client’s belief system might leave him or her feeling fine about the breakup.
One role of the REBT therapist is to create (D) a Disputing intervention (D) for (B) the
Belief that is irrational. This will (E) Effect a new, and better, (F) Feeling. REBT
practitioners teach their clients to (1) analyze episodes of emotional and behavioral
disturbance with the ABC model; (2) discriminate between irrational and rational beliefs;
(3) distinguish healthy negative emotions from unhealthy emotions and (4) utilize a
variety of means for modifying the irrational beliefs that support their emotional and
behavior problems.
In working with clients, the REBT therapist uses a number of cognitive, behavioral, and
emotive techniques, including.
1.
2.
3.
4.
Actively disputing irrational beliefs throughout the day.
Bibliotherapy.
Role-Playing new ways of living
Practicing what might be for the client new, unconventional ways of living in the
world (e.g., an introvert acting extroverted at a party)
5. Imagery exercises, where the client imagines how he or she would like to be.
6. Practicing new behaviors through traditional behavioral techniques (e.g.,
conditioning, modeling, assertiveness training)
In the following role-play, watch how Dr. Korrie Allen uses the ABC of Rational
Emotive Behavior Therapy to assist Rebekah with her feelings about a recent break-up
with her girlfriend.
Dr. Allen: Good morning Rebecca, what brings you here?
Rebekah: Um, I’m just feeling depressed and upset, and just a little worthless.
Dr. Allen: is there anything that’s going on that’s different in your life right now?
Rebekah: Um, my girlfriend and I are having some problems. Um, she’s been talking about
breaking up and um, actually I think that she’s gonna break up with me.
36
Dr. Allen: so that must be really difficult to think about. Um, what are some of the thoughts that
are going through your head when you think of the possibility of you guys breaking up?
Rebekah: All kinds of things like, I need a girlfriend, I really miss here. I mean, just even now
we’re having a lot of problems and ya know, I just miss things being the way it used to be. I want
to have a family one day, we’ve just made all kinds of plans and it’s not going to happen.
Dr. Allen: And what if you were to break up?
Rebekah: Well, I mean I guess I think about the fact that I mean, we’ve been together for 3 years.
I’m 25, I’ve already invested 3 years into this relationship. Um, we talked about the future and
having kids. I need a girlfriend, I need a girlfriend to have all those things that I planned on
having, that we had planned on having.
Dr. Allen: I hear you saying that you need a girlfriend in order to have certain things in your life
in place. When I think of a need, I think of things that you absolutely must have. For example, if
you didn’t have food, what would happen?
Rebekah: I would die
Dr. Allen: And what if you didn’t have water?
Rebekah: I would eventually die.
Dr. Allen: And even along a little bit of a different line, have you ever been….I know you’re in
graduate school, I’m sure you have lots of tests. Have you ever been studying, go to get in your
car and your car doesn’t start?
Rebekah: Yea
Dr. Allen: And how did you feel at that point?
Rebekah: Um, really mad. Just really upset.
Dr. Allen: Do you recall what was going through your mind at that time?
Rebekah: Just that I was really upset. Um, I needed my car to start so I could get to school.
Dr. Allen: Mmhmm, and were you able to problem solve and come up with a solution that you’re
thinking “I need my car to start”, “I have to have it to start?”
Rebekah: Um, no.
Dr. Allen: You just kind of froze?
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Rebekah: yea, well I guess I would just be so upset that my car wasn’t starting that I probably
wouldn’t be able to think about anything else.
Dr. Allen: Mmhmm, do you think it was the fact that your car wasn’t starting that caused you to
feel upset?
Rebekah: Yes
Dr. Allen: Ok, well in REBT, what we have are called the ABC’s. And A is the activating event,
which in that situation would be the car not starting, and the B is the belief and C is the
consequence. And do you think that it was the fact that the car didn’t start? Or what you were
telling yourself about the car not starting? That was causing you to feel upset
Rebekah: Um, I guess it would be what I was telling myself.
Dr. Allen: And that was?
Rebekah: that I needed to have the car to start to get to school.
Dr. Allen: Mmhm, and in that situation what do you think you might have been able to say that
would have caused you to feel a little less upset, and would have enabled you to problem solve
and come up with an alternative solution quicker?
Rebekah: I guess if I wasn’t so focused on you know, my piece of crap car, I could think about
“Ok my car won’t start, now what am I going to do?” I guess I need to call a friend, or just
figured out another way to get to school.
Dr. Allen: Right, you’d really like it to start but you’re okay. You didn’t die because it didn’t
start
Rebekah: Right
Dr. Allen: And you’re able to get through the problem okay, right? So in that situation, you can
see that it’s actually the belief that’s causing you to feel upset, not the fact that the car didn’t
start, the activating event. Does that make sense?
Rebekah: Yea, I see what you’re saying…yeah
Dr. Allen: And this, to me sounds a little similar to some of the things that are going through
your head about your girlfriend. If you’re saying to yourself “I need to have a girlfriend, I must
have a girlfriend in order to be happy. I’m 25, I need to have a family, that’s what everybody’s
doing that’s my age”, how are you feeling at that point?
Rebekah: Depressed, I mean that’s how I’m feeling now.
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Dr. Allen: Right, and so how do you think you would feel if you were to say something along the
lines of: “I’d prefer to have a girlfriend, I’d like to have a girlfriend, but if I don’t its okay.” How
do you think you would feel at that point?
Rebkah: I would still be upset, but I guess it would change my focus.
Dr. Allen: Do you think you would be as anxious around your girlfriend?
Rebekah: Probably not.
Dr. Allen: Right, and so if you had to explain to me the difference between a want and a need,
what would you, how would you describe that?
Rebekah: Um, I guess like you said you know, if you’re talking about food and water, I mean it
is something that you have to have or you’re gonna die. And a want is something that you would
like to have, would be nice if you had.
Dr. Allen: And even if we go back to the car example, if you said to yourself: “I’d really like to
have a car, I want to have a car, it’s important to be on time”. How do you think you would feel
at that point?
Rebekah: Upset, but I would still…I would feel better about making other arrangements, and not
being so focused on being angry.
Dr. Allen: Right, so what this models shows is when anybody, it doesn’t matter if you’re black,
white, rich, poor, male or female; whenever you turn a preference or a desire or a want into an
absolute must, you’re going to feel miserable. Do you see how that applies to you?
Rebekah: Yeah, I guess I never really thought about it that way.
Dr. Allen: Mmhm, and today we’ve talked really only about one need that you brought up. The
need to really have a relationship and be with your girlfriend, but can you give me a different
way to think about that that might help you feel a little less depressed?
Rebekah: Well, I guess I’m gonna still be upset but if we do break up and I don’t have her, I’m
not gonna die. Even though it may feel that way, I’m not going to. I guess it’s a want, I would
like to have, I would like for us to stay together, I would like to have her as a girlfriend.
Dr. Allen: Yeah, and when you’re with her and you’re thinking I would like to be with her, I
enjoy being with her, how do you feel?
Rebekah: Good.
Dr. Allen: Good, but when you’re with her and you’re thinking “I really hope she doesn’t break
up with me, I really need this relationship, its important that we stay together.” How do you feel
at that point?
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Rebekah: Bad, I mean, depressed I guess. A lot of pressure.
Dr. Allen: Yeah, and how do you act around her?
Rebekah: Strange (laughing)
Dr. Allen: Yeah, then she’s kinda going “okay”. Yeah. Um, so in like I’m sure you’ve
experienced many hassles and when you have, for example a test, a lot of times you don’t want
to study for the test but you do. So when you take things like your wants and your desires to have
a girlfriend and turn that into an absolute must, a need, it makes you feel depressed, it leads to a
dysfunctional emotion. However, when you change that to more “I would like to be with my
girlfriend, it’s important that we’re together and I enjoy spending time with her” you feel better,
and you act differently around her. So one of the things that I really hope you’re able to see now
is that it’s that belief about having the girlfriend that’s causing you to feel depressed than the
activating event, the thought of her breaking up with you. Does that make sense?
Rebekah: Yeah. I’ve just never thought about things in that way before.
Dr. Allen: Right, well that’s great. I’m glad that you’re starting to make that connection cause
that’s really the fundamental idea behind REBT, that it’s the belief that’s causing us to feel
unhappy. So what I’d like you to do over this week is a little bit of homework. In REBT we
always give homework. I want you to practice the process we’ve gone over. I’d like you to just
jot down whenever you feel panicked or anxious or depressed during the week. And then once
you put that down, think about what was the activating event, what was the event that kind of
started that? And then what was the belief that you have that caused you to feel anxious,
depressed, or self-hatred. Does that make sense?
Rebekah: Yeah.
Dr. Allen: Can you give me an example from what we’ve talked about today.
Rebekah: When I’m studying for a test and I get really really anxious and I just start thinking
about, “I have to make an A, I have to study, I can’t be in graduate school, I can’t do bad.”
Dr. Allen: And so in that situation, the A is…the activating event would be…
Rebekah: Studying, I have to study
Dr. Allen: Right, and the belief is, the irrational thought is “I have to do well”
Rebekah: I have to make an A
Dr. Allen: Right, and that would cause you to feel anxious. Okay, so what could you maybe
think a little differently that would cause you to feel less anxious? Because some anxiety is
gonna be there, but what could cause you to feel a little less anxious?
40
Rebekah: That I studied and, you know, just to calm myself down “Okay, I studied for the test,
I’m
gonna do well, I know the material, if I don’t make an A I’m not gonna get kicked out of the
school.”
Dr. Allen: That’s great, and so what I want you to do this week is focus on those situations when
they come up and really write down, what was the A, what’s the activating event, the belief,
focus on that belief. And whether it’s rational or irrational, I want you to really focus on either
one. And try to catch those irrational ones so you can start to really work on those and then
whatever emotions they made lead to. So do you think you would be able to do that over the next
week? Jot down those situations?
Rebekah: Yeah
Dr. Allen: And then we can go over them next week and really start to identify some of the
irrational beliefs that may be causing you to feel depressed and anxious.
Rebekah: Okay.
Dr. Allen: Do you feel good about that?
Rebekah: Yeah.
Dr. Allen: Okay, well then I look forward to seeing you next week.
Rebekah: Okay, thank you.
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Cognitive Therapy
Cognitive therapists believe in changing clients’ inaccurate perceptions of themselves and
their environments by uncovering faulty beliefs that are causing personal and
interpersonal problems. Coming from the behavioral tradition, cognitive therapists
believe thoughts can be considered behaviors which can be modified. Such modification
occurs through the “disputation” of thoughts and by experimenting with new behaviors.
Many cognitive therapists believe that problems in living are caused by cognitive
schemas or “floor plans” that influence how people make sense of the world. Once these
cognitive schemas have been identified, the therapist helps the client uncover the
moment-to-moment automatic thoughts that fuel the continuation of the schema. The
counselor then helps the client discover the cognitive errors in those automatic thoughts.
Examples of just a few of these include: all or nothing thinking, such as believing that life
is either great or horrible; overgeneralization, such as believing that one must be fearful
of flying because planes have crashed; and personalization, or seeing oneself as the cause
of negative events such as believing that one was the reason for his or her parents’
divorce.
Today, most cognitive therapists believe in establishing a therapeutic alliance through
careful listening and by collaborating with the client as they help him or her understand
the cognitive therapy process. Cognitive therapists use questions to probe the client’s way
of thinking. Eventually, therapists help the client acquire more adaptive thoughts and
assist the client in devising a plan that includes practicing new behaviors that will
reinforce new thoughts. Cognitive therapists believe clients can make dramatic changes
in how they think and act; however, they tend to focus on coping, not curing the client.
Changing embedded ways of thinking and behaving does not occur easily.
Let’s see how Dr. Garrett McAuliffe helps Karen identify cognitive distortions as she
works on issues related to how fear of loss has led her to avoid commitments in her life.
Dr. McAuliffe: Karen, hi again.
Karen: Hi
Dr. McAuliffe: We met once before and we talked about your fear of loss, and how it
connects to your fear of commitment at this time in your life. I asked you to monitor
some thoughts you might have had around specific incidents in your relationship and
write down those thoughts when you felt a sense of dread about the current relationship
with John, your partner. What have you noticed this week?
Karen: Um, I did try to think about my thoughts and one example I was remembering as I
was driving over here was when John made reference to the fact that I don’t clean out the
refrigerator, that I don’t you know, worry about that as something that I need to do. And
um, I remember thinking, um the feelings that came up were like “See, I’m not good at
everything. I don’t do the refrigerator, you know, things like that he’s not gonna like, it’s
42
gonna negatively affect the relationship.” And I mean it just led from one thing to another
um, and that feeling came back you know that the relationship will somehow end. It just
kinda all builds together.
Dr. McAuliffe: How likely is that to be true?
K: Well, based on just the refrigerator incident, probably not very likely. Um, and I know
that, but somehow those little things just build up and you know that fear feeling comes
up when they happen.
Dr. McAuliffe: So you generalize from before.
Karen: Yes, yes.
Dr. McAuliffe: You’ve lost a father when you were very young, and a little brother when
you were quite young, and you talked last week about a stepfather when you were an
adolescent and then your older brother in your life. And so those are genuine losses that
have happened to you. But what’s different about this relationship?
Karen: That’s where I get confused because I know that this relationship is different. But
the feelings of loss that come up, just remind me that I don’t want to have to experience
that again. So I know it’s different, um, but I don’t want to experience loss again.
Dr. McAuliffe: You’re afraid of feeling that pain again. You’re saying to yourself on
some deep level, “Everytime I get close, I’ll experience loss. Every time there’s a
problem things will end.” Is it true that every time there’s a problem you will experience
loss?
Karen: Well, not every time. I mean, you know he could die, but not every time, no.
Dr. McAuliffe: Right, relationships do end, but not every time that there’s a minor
problem. You are generalizing and that’s one word that you can use, overgeneralizing
from the past and another word that maybe you can remember is catastrophizing from
those situations as if they’re the same as the current one. Do you see how you’re doing
this?
Karen: Yes, yes. Um, cause every time there’s that little problem I get that pain so, yeah.
Dr. McAuliffe: So that pain’s a cue for you and then you start worrying. The pain comes
from deeply embedded, now maladaptive thoughts, that really maybe were effective at
the time but aren’t anymore. There’s a word for that called a cognitive schema, or a
cognitive floorplan. That you’re operating from as if it’s true now what was true then.
You’re saying to yourself, “If there’s any problem then a relationship is going to end.”
Karen: Yes.
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Dr. McAuliffe: It’s so embedded that you don’t catch the thoughts in the present, as if
they’re different now, but you still can come back to them.
Karen: Wow
Dr. McAuliffe: With new more adaptive thoughts, not maladaptive thoughts, but not
generalizing like you’re doing or catastrophizing. What type of thoughts do you think that
you can have now?
Karen: Well, um, I guess when that feeling comes up I know that I can say, you know
that this relationship is different and that we can talk about things. And I know that
John’s not gonna leave me, I feel very confident about that. Like I said, other than if he
dies. Um, and he’s willing to work with me so I know I can…I have to just say those
things.
Dr. McAuliffe: Good, then let’s work on what I’ll call a homework assignment. Is that
okay with you?
Karen: Yes, I will work on it
Dr. McAuliffe: What situation with John might bring up these thoughts?
Karen: Um, it will probably be some complaint about the dog.
Dr. McAuliffe: Mmhm, and what will you say to him? To yourself.
Karen: I will try to remember and say, you know, “We can talk about this. He’s not going
to leave, and just because we have a disagreement over the dog doesn’t mean that it’s
going to lead to a loss.”
Dr. McAuliffe: Great! You’re reminding yourself not to catastrophize; that this
relationship is different from all of those other experiences in the past. And one thing I
think it’s important to remember is how long did it take to develop this fear of loss, this
floorplan.
Karen: Well, my dad died when I was three so, my whole lifetime.
Dr. McAuliffe: So it’s gonna take some hard work to combat these embedded, we’ll call
them, thoughts, your cognitive floorplan. It’s gonna have to slowly change.
Karen: Right, I see. I’m really gonna have to work on this.
Dr. McAuliffe: I have a suggestion. I’d like you to write down every incident that brings
up those thoughts and then how you’ve combated each incident with the new thoughts
44
that we’ve talked about today. Is that something you think you can do?
Karen: Yes. Yes, I can do that
Dr. McAuliffe: Great, I look forward to seeing how you do it.
Karen: Thank you. It’s gonna take a lot of work.
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Reality Therapy and Choice Theory
Reality therapy postulates that there are five inborn needs: love and belonging, power,
freedom, fun, and survival, and proposes that every behavior we exhibit is an attempt to
have these needs met. However, Reality theory also suggests that we sometimes develop
dysfunctional behaviors to meet our needs and those behaviors become the basis for how
we perceive reality. Reality therapy states that we continue to exhibit these behaviors in
order to obtain what clients would consider to be their “quality” world. Throughout the
counseling process, reality therapists believe that clients can be shown how they create
their reality through the behaviors they choose; thus the term choice theory. For instance,
a CEO who has spent much of his or her life striving for power at work may become
depressed because he or she has developed a repertoire of behaviors to meet the need for
power but has neglected his or her need for love and belonging.
Reality therapists often use the WDEP model to describe the counseling process. “W”
represents asking the client what he or she “Wants” in an effort to create a quality world
or success identity. D stands for “Doing” and is the point where the counselor asks the
client what choices and behaviors he or she is currently making to obtain a quality world.
E stands for helping clients Evaluate what they have been doing to meet their needs and
to identify new behaviors that would more effective in obtaining a quality life or success
identity. P stands for developing a Plan for change. The therapeutic process involves
creating a trusting environment, working collaboratively with the client as equal partners,
and being committed to the client as they explore the change process.
In the following role-play we will see Dr. Sylinda Gilchrist work with “Mercer,” a 55year old male who has been struggling with Post Traumatic Stress Syndrome. Let’s see
how Dr. Gilchrist uses the strategies just described.
Dr. Gilchrist: Hi Todd. What brings you here today?
Todd: Well I’ve been feeling pretty stressed lately, maybe a little down. I just noticed I’m
pretty much not the same as I used to be. Just, um feel a little overwhelmed at times, I’m
not really motivated and that’s pretty much it. I retired probably about two years ago and
I just don’t have the same kind of go that I did before.
Dr. Gilchrist: So you’re feeling kind of down because you retired?
Todd: Um, I don’t think its so much because I retired, I don’t know, I think I just don’t
feel motivated, you know it might be because I’m not as focused as I was in the military.
I always had something to do, I knew where I stood, you know I had responsibility,
people depended on me and those things have changed, that might have something to do
with it. I don’t know.
Dr. Gilchrist: Okay, so you’re feeling a little down because you retired recently from the
military and you had more responsibilities and your life has kind of transitioned or
changed.
46
Todd: Yeah, that’s pretty much it. I mean, it might also be because I’m real focused on
being a single parent right now, and school and you know, I noticed that if I’m not doing
that then I’m really not doing anything else. Like when I was in the military I had friends,
I had a big support group and you know, I always had something going on, and it’s just
not that way anymore.
Dr. Gilchrist: So it sounds like since you’ve retired you lost a lot of your friends and that
support system that you had, while you were in the military it’s now gone.
Todd: Yes ma’am, I think that would have a lot to do with it. I’m pretty much a cave
dweller now, I don’t much get out or anything like that so uh, you know I don’t
have…you know I had a good support group when I was in the military because I was
always working but since I got out they’re all transient so you know I really don’t talk to
or see anybody that I used to work with. So it’s just pretty much me and my eleven year
old.
Dr. Gilchrist: Okay, so what would make you happy or feel connected again?
Todd: I don’t know, I guess um, getting out and getting involved with other people,
talking to them maybe. You know I just, I just really don’t know how to do that. I’m not
sure how to go out. I know when my son was playing soccer I didn’t feel as sad as I do
now. And I guess because I was talking to the adults on the sidelines while he was out
there playing, and I had a pretty good group of friends then. He hasn’t played the last
season, and we sort of drifted apart you know with me doing school and stuff like that.
Dr. Gilchrist: So it sounds like you felt better when you were involved in activities
around adults or activities that involved your son that allowed you to communicate with
other adults.
Todd: Yeah, I mean that was a benefit of going to those soccer games, I mean it doesn’t
really have to be with my son. I mean that was always great, but I mean, you know just
the adult interaction would be, you know, probably better than nothing. Yeah, I’m not
really talking to anybody.
Dr. Gilchrist: So it sounds like what you would like to have is more interactions with
adults and develop more support mechanisms or support from other adults that you had
when you were in the military.
Todd: Yeah, that sounds like that would benefit me. I think this all started occurring to
me when I threw out my back and I realized that I don’t have the option to be off, or to
have a sick day, you know I’m a full time parent now you know I have to go to school I
can’t miss classes or exams. And you know it occurred to me, I don’t have anybody to
call, to step in.
Dr. Gilchrist: Okay, so what would you want? What would make you happy? What
would support look like? Outside of the military.
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Todd: Probably just some kind of camaraderie but I’m real apprehensive about being
obligated. I don’t want to be in a position…I think that’s what holds me back. I don’t
want to be in a position that I have to do anything. I want to be able to you know, cancel
out if I’m going to meet people on Thursday night if something comes up because I end
up feeling really guilty if I don’t meet my obligations and I just don’t want to be pulled
into anything. You know, in the military I had to do what everybody else said. I guess
maybe I’m shying away from that. I guess I want the best of both worlds you know, be in
a group but not be stuck with it all the time.
Dr. Gilchrist: So you want some interaction or interaction with adults but you don’t want
the required obligation.
Todd: Right, cause for a time there I was getting involved with the church and they were
calling like twice a week, and it would stress me out cause I felt obligated and I just don’t
want to take any time away from school or my son and that is most important.
Dr. Gilchrist: Okay, so we’re going to look for maybe activities or maybe something that
will allow you to interact with other adults and increase your social circle but no time
restraint, no time obligation.
Todd: Yeah, that would be the ultimate cause like I said, I end up just severing ties if it
becomes too overwhelming and I don’t want to have that stress again. So I’d like to have
some kind of adult interaction where I don’t feel required to attend.
Dr. Gilchrist: So what are you doing to get that adult interaction?
Todd: Well I’m busy in school right now, and you know my son has a lot of school
projects.
Dr. Gilchrist: Mmhmm, outside of school?
Todd: Well, I guess if I’m outside of school I’m pretty much focused on my son and
doing stuff with him right now.
Dr. Gilchrist: You kind of mentioned before that you were a “cave dweller”. What does
that mean?
Todd: I guess I, you know I really don’t go out unless I have to go somewhere. You know
to the store or to school or anything like that, and I guess I’m either inside unless I go to
the gym or something I don’t really go out.
Dr. Gilchrist: So you’re kind of choosing to stay in your cave.
Todd: Well it’s not a choice. I don’t have anything else to do, I’m not making that choice,
there’s just nothing else out there.
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Dr. Gilchrist: Okay, but staying in the cave is that giving you what you want with
increasing your friends?
Todd: No, I guess not. I guess I’m really not creating opportunities to meet people.
Dr. Gilchrist: So we really have to possibly look at other ways to develop more of a
support circle for you.
Todd: Yeah, that would be good as long as, like I said, you know I guess I’m paranoid
about getting pulled into something and being stuck. I just don’t….I have to go to school
three nights a week, I just don’t wanna have the other four nights of the week…
Dr. Gilchrist: Obligated to something.
Todd: Yeah
Dr. Gilchrist: Okay so what are some ways you think you could go and meet people, or
some activities you can try, some groups, military groups, single parent activities, church
groups. Are there some activities out there or places you can investigate?
Todd: I guess I could probably do a web search for local kinds of things. I know you
could probably just type in “Virginia Beach activities” or something. Yeah, I could
probably find all kinds of stuff, I could look into that.
Dr. Gilchrist: Okay
Todd: I mean, even, there might even be some single parent type groups or something
like that, I don’t know, I never thought of that before.
Dr. Gilchrist: Okay, so you can go on the internet and search for some activities in this
area. Would it have to be an activity involving your son?
Todd: No, no. I mean we do things together but you know with adults, it doesn’t have to
involve him.
Dr. Gilchrist: Okay, so one plan of something we can do, we can actually go on and you
can search the internet and look for activities or clubs that you may be interested in that
would help you increase your social circle, introduce you to other people. Are there other
things that you could possibly do?
Todd: Well, there is this recreation center that my son and I used to go to in the summer
and I remember there’s all kinds of flyers and pamphlets and all kinds of stuff there with
activities. Yeah, I never thought of that before, I’ve seen them, you know they’re
everywhere. And there’s a lot of interesting activities that I didn’t consider before. There
might be an avenue to take, that’s a great idea.
49
Dr. Gilchrist: And so now we have two activities that we can do to kinda increase your
social circle. We can actually search the internet, as well as go to the community center
and see what flyers and activities are availabe in your area.
Todd: Yes ma’am, yes ma’am that sounds like a great idea.
Dr. Gilchrist: Okay, and so hopefully we can move you out and actually allow you to be
happy and content again.
Todd: Haha, not live in the cave anymore.
Dr. Gilchrist: Not live in the cave anymore.
Todd: Yes ma’am. That sounds good
Dr. Gilchrist: Well, thank you for coming in.
Todd: Thank you for your time, I appreciate your help.
Dr. Gilchrist: You’re welcome.
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Narrative Therapy
Narrative therapy is an insight oriented therapy that seeks to understand how the client
comes to make sense of his or her world. This process occurs through the therapist’s
attempts to gain clarity about the client through the stories the client tells about his or her
life. In understanding the client’s life stories, the therapist is open-minded, shows a
respectful curiosity, and may ask many questions. Ultimately, the therapist will
externalize the client’s problem by giving it a name, thus helping the client view the
“problem as the problem” as opposed to the client being the problem. Then the breadth,
depth, and scope of the externalized problem are explored. The goal of therapy is to
deconstruct the problem story and reconstruct a new, healthy story through reframing the
problem, finding exceptions to the problem, helping the client see multiple alternative
stories, empowering the client, and building on successes.
In the role-play you are about to see Dr. Milliken is meeting with “Shane,” a 40-year-old
male who is struggling with depression. During the first session the therapist used
empathy and open-ended questions to explore the depth, breadth, and scope of the
problem story. In the session you are about to see, the problem story will be
deconstructed and a healthy reconstructed story will begin to be developed. Other parallel
stories will begin to be explored. Also, please notice that in this role-play, Dr. Tammi
Milliken will be called “Tammi,” as the power dynamics are de-emphasized in narrative
therapy.
Tammi: Hi Shane welcome back. Glad you were able to make it in today. I thought we’d
start out today just kind of summarizing where we ended up last week after our first
session and you had mentioned feeling down, feeling like there was a cloud hanging over
you, um feeling, just a sense of darkness and that that darkness contributed to you lacking
confidence, not feeling as thought you are connecting as well with people as you would
like. And um, it seems like the term “darkness” really captures the essence of what
you’re experiencing. How do you feel about calling what you’re experiencing
“darkness?”
Shane: It’s a pretty good assessment. I guess that a pretty good, uh word to use, uh yeah
definitely.
Tammi: Alright, well, um let’s take a little bit of a different angle with that though, I’m
interested to hear about a time in your life when you didn’t feel like darkness had quite
the hold on you that it does today.
Shane: Um…guess if I had to think back, it might be right around high school I guess. I
felt more on my “game” in high school it seemed like nothing could get me down, I was
pretty successful in that time of my life, so imagine that would be the best time I could
think of.
Tammi: Okay… what exactly was it about high school that kept darkness away? How
did you defy darkness’s prescriptions at that point?
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Shane: Um, well I mean, I ran, I was an athlete in high school; I ran track and um, had a
lot of success there. Um, I um, was good in academics; I mean out of six hundred-someodd people I graduated twenty-fifth…
Tammi: Wow!
Shane: …in my class so that was pretty good. Um … I guess that would pretty much
uh…
Tammi: Okay so really working out gave you a sense of accomplishment and certainly
being so talented academically helped you to feel a great deal of success and those two
things were your tools, essentially, to battle darkness and to fight darkness away.
Shane: Yeah, um… I guess back then I didn’t feel as cloudy, it was easier to talk to
people, I was uh… as if no noise was in my head and uh, there clouding up my
thoughts… things came to me a lot easier than they do now.
Tammi: Okay, okay and so when darkness wasn’t present, it seemed as though you were
able to have more clarity to be able to, uh feel more present, you were able to lift that veil
and to experience life in a more positive, lighter way, in many ways.
Shane: Yeah, it’s not like it’s there all the time, like um, there is some days where it’s not
there, the darkness is not there it’s a little more lighter. But, I would say more often than
not it is there… definitely.
Tammi: Okay so when it is present, then it’s difficult to focus you have a difficult time
connecting, but when it’s not you’re able really to focus in and be present, um your game
is on, I think you even mentioned that earlier. So even today you are saying though that
the darkness isn’t present constantly, that you do have the strength to push it away. What
would life be like if darkness took a permanent vacation?
Shane: Oh I’d be great! That would be fantastic. It’d be a lot more light in my life as
opposed to that darkness.
Tammi: Mm-hmm (affirmative)
Shane: Things would be a lot easier to get accomplished.
Tammi: Okay… so in the past, working out and feeling successful were the two of the
ways that you really fought off darkness and that even today you still do have the strength
to battle it at times. What could you do now to help you fight off darkness even more so?
Shane: Well, I’ve heard… well I’ve assumed medication would be something I could try.
Um... maybe working out, I could try that since it was big a part of my life, you know, all
through my life, it’s not now. So I’m thinking of some differences between then and
now, so… I guess those two things… probably the best things.
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Tammi: How do you see medication and working out actually fighting off that darkness?
Shane: Well, I guess medication, from what I’ve heard, it kinds brings you at different
levels, so a normal person is here (raised hand) then when you medicate, you’re normally
down here (lowered hand) and it kinda brings you up to here (meets lowered hand with
raised hand) sometimes I mean, that’s what I’ve heard. So I guess that would help me
out, um, to maybe work on some things and I guess working out from a physiological
point, I guess it just pump more oxygen to your brain and kind up wake you up a little bit
there.
Tammi: Okay… so what I’ve been hearing you say is that you’ve been really dominated
by darkness for a while. Darkness keeping you from fully participating and enjoying life
and now I’m hearing you taking a new direction and essentially looking at ways that you
can control darkness. Looking at potentially using medicine as a way to fight off
darkness, using working out as a way to give you strength and to bring light into your
life.
Shane: Yeah… yeah no doubt.
Tammi: Okay, well, I would like to definitely see if we could potentially make up a plan
for perhaps giving you some referrals to individuals who could help you to explore the
possibility of using medicine. I’d also like for us, in our time together, to come up with a
real concrete workout plan so that you can start using that as a tool to fight off darkness.
Where do you think that these changes might lead to?
Shane: Well, I mean, I guess to steal what you’re talking about, to bring more light in my
life and kinda push that darkness away, maybe lift a veil, fog, I’ve been walking around
with. And maybe just be able to enjoy my life a little bit more than I have been.
Tammi: Wow! That would be real impressive to be able to do that. Well then, it sounds
like we should definitely come up with that plan, but before we do that, I also heard
another perspective that you were mentioning, that when you were in high school, you
felt a real strong sense of accomplishment, that a lot of the activities that you were
engaging in resulted in rewards and recognition and you know, as adults we don’t get a
lot of recognition in life. You know, we work really hard and there just aren’t very often,
people giving us rewards or pats on the back and that seemed to be a tool for you to fight
off that darkness. I’m wondering if this might be another, kind of story, that we could
take a look at and even think about ways in which you might be able to find reward in
your life today.
Shane: Yeah, that’s pretty interesting, I mean, you don’t get rewards for doing stuff in
life do ya? I mean like, it’s not like people hand you good grades for doing certain things
and you’re not gettin’ trophies for things you do in life. I guess you gotta find it within
so, yeah, that’s interesting, I never thought about that.
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Tammi: Okay… well lets’ pick up more on that in our next session, and for now come up
with that plan for working out and for looking at some potential outlets for finding that
medication.
Shane: Great!
Tammi: Okay, great! Thank you!
Shane: Awesome!
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Solution-Focused “Brief” Therapy
Solution-focused therapy focuses on the present and the future in an attempt to find new
and more effective ways of being in the world. In contrast to most treatment modalities,
solution-focused therapy states that understanding the client’s problem is not necessary.
In fact, solution-focused practitioners believe that a prolonged problem focus can be
detrimental, as the problem is mired in power struggles and conjures up negative feelings.
As clients and therapists co-construct solutions, therapists are guided by a number of
principles that include:
1. A belief that clients already have the strengths and resources necessary for
change.
2. Establishing a collaborative and egalitarian relationship with an emphasis on
client empowerment.
3. Assuming an affirming and supportive stance, and projecting confidence and
optimism about what the client can achieve.
4. A curious, respectful and appreciative “ambassador perspective” toward the
client’s cultural context.
5. Acceptance of the client’s perception of their situation with a focus on the client’s
preferred outcomes.
6. Looking for opportunities to invite clients to focus on solutions.
7. The belief that if it works, do more of it. If it doesn’t work, do something
different.
8. An emphasis on small, specific, and achievable goals and the belief that small
change can be the path to larger change.
9. Finding exceptions to problem behavior and amplifying positive changes that are
already occurring in the client’s life.
10. The principle of parsimony: keep it simple, use the minimum amount of
intervention needed, and conclude therapy as soon as possible. Treat every
session as if it may be the last.
Let’s see how Dr. Tim Grothaus applies some of these principles as he works with Ms.
LaTonya Riddick on finding balance in her life and integrating a relationship into her
busy world. Also, please notice that in this role-play, Dr. Tim Grothaus will be called
called “Tim,” as the power dynamics are de-emphasized in solution-focused therapy.
Tim: So LaTonya, it sounds like we’re all set. No more questions about the paperwork or
what the kind of process we have here or confidentiality. I did have another question for
you before we formally stared if that’s okay. Um, and that is remember when you were
on the phone and made the appointment, you were asked to observe if you noticed any
positive changes between the time you made the appointment and the time you came in,
in the area of your concerns did you see any, what we call pre-treatment change that
changed in a positive direction prior to coming in here?
Latonya: Actually no, everything’s pretty much the same.
55
Tim: Okay, okay… Now that we are in here today I was wondering if you could share
with me what your best hope would be for today? What would be some signs that things
are beginning to get a little better?
Latonya: Well actually I’m really looking for balance in my life. I’m divorced, I’m the
mother of two, I’m a student and I’m working full time so I trying to find another way to
put a dating relationship into the mix… trying to have some balance with dating.
Tim: Okay, so you’re already juggling an impressive amount of activity and priorities:
children, work, school… I was wondering if you could tell me what are some qualities or
skills, what are some things you’re already doing to help you achieve the successful
balance you have now? How does that… can you describe how that balance works now?
What are you doing that makes that work?
Latonya: Well for the things that are already in place, work is essential, school I’m
passionate about and the kids, I just love spending time with. But there’s a lot of things
that I don’t do. I don’t do a lot of things just for myself; most of time is spent with my
girls or at school or with work.
Tim: Okay, so to make the balance you have now, be reasonably successful, if that’s
accurate to say, use time management skills, it sounds like, if that’s accurate, um some
discipline and self-sacrifice, and you prioritize and make sure that you spend the time in
the areas that are of value to you. Would that be an accurate summary?
Latonya: Yes.
Tim: Have you been able to do that anytime in the past…With a dating relationship? To
find that balance with a dating relationship added?
Latonya: Actually no. I meet people all the time. As a matter of fact I met someone on
my way here and he actually asked if we could meet later for what he called a “cookie”
and uh he’s Jamaican, he had this cute little Jamaican accent and I immediately felt
overwhelmed. And I remembered I didn’t have a sitter and felt relieved.
Tim: Okay so you had a situation where um, the possibility of a dating relationship came
up and you had some, sounds like some strong unpleasant feelings about feeling
overwhelmed, perhaps in lieu of that balance that you’re trying to create. I’m wondering,
looking at times where the balance has been working for you, if there’s anything that
you’ve added recently, that’s now a part of your balance, but wasn’t there a little while
back, where you had a previous balance of all the important things you were keeping
going. Anything that you’ve added recently that’s now part of the balance that’s
working?
Latonya: Well, yes I just recently entered a graduate program and I’ve been able to add
that into our already busy lives, but that’s a little different, I can kind of manipulate my
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schedules so that I’m got gone from the house too many nights a week or I spent a lot of
time trying to make sure that doesn’t affect my schedule with the girls.
Tim: Okay… so to me, that’s still impressive even though there’s some differences that
you identified that you had, would it be accurate to say, a busy, but successful balance
previously for something you decided you wanted and that is to work toward the graduate
degree that you’re presently pursuing and you were able to make the new balance,
transition to the new balance. What are some things you did that helped the balance
remain acceptable to you, while working in something new that’s a fairly big
commitment, something new that’s important. What are some skills that you use, what
are some things you did to make that new balance work?
Latonya: Well I think that, for that, mostly it’s just the time management I was able to
control my scheduling a little bit more. It seems like with the dating relationship, I don’t
have that control, because it’s another person’s schedule that’s also involved.
Tim: Okay… certainly with you being able to pick your classes to some degree, I mean
you don’t have control over, perhaps, I’m guessing, when they’re offered, unless it’s an
independent study or unless you know something that most student’s don’t, I’m guessing
that you can’t control when the projects are due or how big they are, so within…but to
some degree, there’s some control you have. And then the other pieces that you don’t
have control over, you make work through your time management skills so it’s a
combination of elements you can control and then managing those that are not quite in
your control… would that be accurate?
Latonya: Exactly.
Tim: Okay… Well I’m gonna ask something now that’s referred to as a “miracle
question” and that’s common in folks who do solution-focused work. And it asks you to
envision a future using your imagination a bit. Would you mind of I ask you that?
Latonya: No, not at all.
Tim: Okay… Let’s pretend that after you leave here and you go through the rest of your
day successfully, and you go to sleep tonight, have a restful night, and you wake up in the
morning and lo and behold, the problem’s gone. The solution you wish for is actually in
place. I’m gonna ask you to pretend as if there was a camera following you before this
wasn’t working, a camera only that you can see, and now tomorrow morning there’s a
camera that follows you for a while and pictures this new balance that is exactly what you
want. If you look, if we were to bring in and look at the two tapes, what would we see,
what would jump out at us as different in the second tape that we wouldn’t see in the
first? Tell me about this new balance, can you describe it?
Latonya: Well, I think picturing that, I would be in a successful relationship and still have
all of the other elements of my life working just fine. And that’s part of the problem, I
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can picture the end result, I would like the successful relationship, but it’s just getting
there that I have the hard time with.
Tim: Okay… well what I hear you saying now is that there’s hope that there is a future
where this established relationship is working. We’ll look at successfully co-creating a
solution where you get to that point the preliminary stages work out well. So when
somebody with a cute accent asks for a cookie, perhaps it can get to that last stage, would
that be fair to say?
Latonya: Mm-hmm (affirmative).
Tim: I’d like to ask you to use numbers for a second on a scale. And if ten would be that
image you just described, where it’s already working, where things are in balance and the
relationship’s established and one would be a place where it’s abysmal and there is
nothing working at all. Where would you rate yourself in terms of adding that dating
piece now in between one and ten?
Latonya: I would have to say that I’m a one.
Tim: Okay. Could you describe why where you are now, you’d see as a one?
Latonya: Because I don’t see any signs of success. I don’t think that I’m dating
successfully at all.
Tim: Okay… okay. So you’re at a one now, plenty of room to grow! Um, what, looking
at the next step, not necessarily biting off the next big piece, but we talk about small
changes leading to bigger changes down the road. What would a two look like? If you
picture yourself successfully at a two, what’s involved with a two? Could you describe a
two for me?
Latonya: I think that a two would be just having someone that I could go out with every
now and then. Someone that I would talk to maybe a couple of times a week and maybe
once a week or every other week, just go out very casually.
Tim: Okay… so it sounds like a key point for you to go from one to two would be the
pacing of the new relationship that it wouldn’t be too demanding on your already busy,
successful balance you already have. So the pacing of that relationship would be
acceptable to you. Okay… do you have any non-dating relationships that are of some
importance to you where that pacing is acceptable? Where you have that kind of pacing
that fits in with your balance?
Latonya: Yes, actually I do. I have friendships, friends that are platonic, people, even
some that I’ve dated in the past that now we’re just friends and so, yes, we do to lunch
maybe once or twice a month and we do talk on the phone maybe once or twice a week.
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Tim: Okay, so having that pacing in other relationships outside of family, work and
school, you have success with that already. What would it take for a dating relationship
to have the pacing that you successfully have with other relationships? What might be
involved there? How might that look?
Latonya: Well, I think I need to be dating someone who is busy also; someone who also
had a full life.
Tim: And if that person had a full life, how would that be helpful to you in achieving the
pacing you would like, that is acceptable and not overwhelming?
Latonya: Well I think that we would be able to maybe balance our schedules so I
wouldn’t have the guilt or feel the pressure of needing to be available as much.
Tim: Okay…okay. Well if I could kind of summarize where we are now, and see if
you’re in agreement with what I’m seeing so far. Maybe we can look at what we want
our next step would be, if.. have… you’re busy, sounds like a successful person in terms
of balancing many important pieces in your life, work and children, family and school
that you picked up and added recently. You’ve recently experienced a successful
transition to a new balance you want to add something new like, as you added graduate
school, although there is some differences, perhaps some of the skills would be similar in
terms of achieving a new balance, you can use some of the same skills perhaps. And you
wanna look at a relationship that has a pacing, if that term’s ok, that isn’t overwhelming.
And you have examples of relationships that are important that have that kind of
successful pacing or agreeable pacing that works within your balance. So what I hear is
that, while certainly this is a dilemma, and there’s work to be done to get you to the two
and beyond, some of the pieces that you want to have in place being be able to transition
to a new balance. Having successfully experienced relationships that have a good pacing,
an idea of where you might find a gentleman that would be able to um, have that similar
pacing, somebody with a busy and full life. Here’s what I see already in place that we
can draw from this strengths, as I summarize in that fashion, how does that sound to you
and how do you feel about that?
Latonya: Well, actually it makes me feel hopeful.
Tim: Okay, because…
Latonya: Just being able to look at it from that aspect, just knowing that maybe I do
already have the skills in place and thinking of ways that I can actually employ what I
already have.
Tim: So perhaps, that can be our next step in our time together; is looking at how to use
all the skills that you already mention, having all the strengths, all the experience that
worked for you to be successful and use those to help you move from a one to a two and
perhaps beyond if you wish. How’s that sound?
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Latonya: That sounds wonderful.
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