MODULE 13 EVIDENCED BASED PRACTICES
Title 450 Chapter 18
Standards and Criteria for Alcohol and Drug Treatment Programs
450:18-1-2. Definitions
"Evidence based practice" means programs or practices that are supported by research methodology and have produced
consistently positive patterns of results when replicated within the intent of the published guidance.
Top Five Evidence-Based Practices Rated Most Familiar
Cognitive Behavioral Therapy: 93.8%
Trauma-Focused Cognitive Behavioral Therapy: 65.3%
Reality Therapy: 61.7%
Rational Emotive Therapy: 56.7%
Medication Management: 52.6%
Top Five Evidence-Based Practice Rated Most Used
Cognitive Behavioral Therapy: 81.4%
Trauma-Focused Cognitive Behavioral Therapy: 35.8%
Medication Management: 31.6%
Integrated Treatment for Mental Health and Substance Use: 29.2%
Motivational Interviewing: 27.2%
http://www.ok.gov/odmhsas/documents/Evidence%20Based%20Practices%20Survey%20Overview.pdf
EVIDENCE BASED PRACTICES
MODALITIES & TECHNIQUES
BEHAVIORAL THERAPY / COGNITIVE BEHAVIORAL THERAPY / TRAUMA FOCUSED CARE
DEFINITION
Behavioral therapy, or behavioral modification, is a psychological technique based on the premise that specific,
observable, maladaptive, badly adjusted, or self-destructing behaviors can be modified by learning new, more
appropriate behaviors to replace them.
ORIGINS
Reward and punishment systems have been used throughout recorded history in an attempt to influence behavior,
from child rearing to the criminal justice system. Modern behavioral therapy began in the 1950s with the work of B.F.
Skinner and Joseph Wolpe. Wolpe treated his patients who suffered from phobias with a technique he developed
called systematic desensitization. Systematic desensitization involved gradually exposing a patient to an anxietyprovoking stimuli until the anxiety response was extinguished, or eliminated. Skinner introduced a behavioral technique
he called operant conditioning. Operant conditioning is based on the idea that an individual will choose his behavior
based on past experiences of consequences of that behavior. If a behavior was associated with positive
reinforcements or rewards in the past, the individual will choose it over behavior associated with punishments.
By the 1970s, behavior therapy enjoyed widespread popularity as a treatment approach. Over the past two decades,
the attention of behavioral therapists has focused increasingly on their clients' cognitive processes, and many
therapists have begun to use cognitive behavior therapy to change clients' unhealthy behavior by replacing negative or
self-defeating thought patterns with more positive ones.
BENEFITS
Behavioral therapy can be a useful treatment tool in an array of mental illnesses and symptoms of mental illness that
involve maladaptive behavior, such as sub-stance abuse, aggressive behavior, anger management, eating disorders,
phobias, and anxiety disorders. It is also used to treat organic disorders such as incontinence and insomnia by
changing the behaviors that might be contributing to these disorders.
Cognitive-behavioral therapy, an offshoot of behavioral therapy that focuses on changing maladaptive behaviors by
changing the faulty thinking patterns behind them, is a recommended treatment option for a number of mental
disorders, including affective (mood) disorders, personality disorders, social phobia, schizophrenia, obsessive
compulsive disorder (OCD), agoraphobia, post-traumatic stress disorder (PTSD), Alzheimer's disease, and attentiondeficit hyperactivity disorder (ADHD). It is also frequently used as a tool to deal with chronic pain for patients with
illnesses such as rheumatoid arthritis, back problems, and cancer.
Behavioral therapy techniques are sometimes combined with other psychological interventions such as medication.
Treatment depends on the individual patient and the severity of symptoms surrounding the behavioral problem.
DESCRIPTION
Behavioral therapy, or behavior modification, is based on the assumption that emotional problems, like any behavior,
are learned responses to the environment and can be unlearned. Unlike psychodynamic therapies, it does not focus on
uncovering or understanding the un-conscious motivations that may be
behind the maladaptive behavior. In other words, behavioral therapists don't try to find out why their patients behave
the way they do, they just teach them to change the behavior.
Initial treatment sessions are typically spent explaining the basic tenets of behavioral therapy to the patient and
establishing a positive working relationship between therapist and patient. Behavioral therapy is a collaborative, actionoriented therapy, and as such, it empowers patients by giving them an active role in the treatment process. It also
discourages overdependence on the therapist, a situation that may occur in other therapeutic relationships. Treatment
is typically administered in an out-patient setting in either a group or individual session. Treatment is relatively short
compared to other forms of psychotherapy, usually lasting no longer than 16 weeks or sessions.
There are a number of different techniques used in behavioral therapy to help patients change their behaviors. These
include:
 Behavioral homework assignments. The therapist often requests that the patient complete homework
assignments between therapy sessions. These may consist of real-life behavioral experiments where patients
are encouraged to try new responses to situations discussed in therapy sessions.
 Contingency contracting. In conjunction with the patient, the therapist outlines a written or verbal contract of
desired behaviors for the patient. The contract may have certain positive reinforcements (rewards) associated
with appropriate behaviors and negative reinforcements (punishments) associated with maladaptive behavior.
 Modeling. This is where the patient learns a new behavior through observation.
 Rehearsed behavior. The therapist and patient engage in role-playing exercises in which the therapist acts out
appropriate behaviors or responses to situations.
 Skills training techniques. The patient undergoes an education program to learn social, parenting, or other
relevant life skills.
 Conditioning. The therapist uses reinforcement to encourage a particular behavior. For example, a child with
ADHD may get a gold star every time he stays focused on tasks and accomplishes certain daily chores. The
gold star reinforces and increases the desired behavior by identifying it with something positive. Reinforcement
can also be used to extinguish unwanted behaviors by imposing negative consequences (this is also called
punishment and response).


Systematic desensitization. Patients are gradually exposed to a situation they fear, either in a role-playing
situation or in reality. The therapist will employ relaxation techniques to help them cope with their fear reaction
and eventually eliminate the anxiety altogether. For example, a patient in treatment for agoraphobia, a fear of
open or public places, will relax and then picture herself on the sidewalk outside of her house. In her next
session, she may relax herself and then imagine a visit to a crowded shopping mall. The imagery gets
progressively more intense until eventually, the therapist and patient approach the anxiety-producing situation
in real life by visiting a mall. By repeatedly pairing a desired response (relaxation) with a fear-producing
situation (open, public spaces), the patient gradually becomes desensitized to the old response of fear and
learns to react with feelings of relaxation.
Flooding. Flooding is an accelerated version of systematic desensitization, in which the patient is exposed
directly to the anxiety-provoking situation that he fears most (either through mental visualization or real life
contact) in an effort to extinguish the fear response.

Progressive relaxation. As the name implies, progressive relaxation involves complete relaxation of the muscle
groups of the body and calm and even breathing until the body is completely tension free. It is used by
behavioral therapists both as a relaxation exercise to relieve anxiety and stress, and as a method of preparing
the patient for systematic desensitization. Progressive relaxation is performed by first tensing and then relaxing
the muscles of the body, one group at a time. The therapist may suggest that the patient use one of many
available instructional relaxation tapes for practicing this technique at home.
Cognitive-behavioral therapy (CBT) integrates features of behavioral modification into the traditional cognitive restructuring
approach. In cognitive-behavioral therapy, the therapist works with the patient to identify the thoughts that are causing
distress, and employs behavioral therapy techniques to alter the resulting behavior. Patients may have certain fundamental
core beliefs, known as schemas, which are flawed and are having a negative impact on the patient's behavior and
functioning. For example, a patient suffering from depression may develop a social phobia because he is convinced he is
uninteresting and unlikable. A cognitive-behavioral therapist would test this assumption, or schema, by asking the patient to
name family and friends that care for him and enjoy his company. By showing the patient that others value him, the therapist
exposes the irrationality of the patient's assumption. He also provides a new model of thought for the patient to change his
previous behavior pattern (i.e., I am an interesting and likeable person, therefore I should not have any problem making new
social acquaintances). Additional behavioral techniques such as conditioning (the use of positive and/or negative
reinforcements to encourage desired behavior) and systematic desensitization (gradual exposure to anxiety-producing
situations in order to extinguish the fear response) may then be used to gradually reintroduce the patient to social situations.
Additional treatment techniques that may be employed with cognitive-behavioral therapy include:
 Cognitive rehearsal. The patient imagines a difficult situation, and the therapist guides him through the stepby-step process of facing and successfully dealing with it. The patient then works on practicing, or rehearsing,
these steps mentally. Ideally, when the situation arises in real life, the patient will draw on the rehearsed
behavior to address it.
 Journal therapy. Patients are asked to keep a detailed diary recounting their thoughts, feelings, and actions
when specific situations arise. The journal helps to make the patient aware of his or her maladaptive thoughts
and to show their consequences on behavior. In later stages of therapy, it may serve to demonstrate and
reinforce positive behavior.
 Validity testing. Patients are asked to test the validity of the automatic thoughts and schemas they encounter.
The therapist may ask the patient to defend or produce evidence that a schema is true. If the patient is unable
to meet the challenge, the faulty nature of that schema is exposed.
 Biofeedback. Biofeedback is a patient-guided treatment that is also associated with behavioral therapy.
Biofeedback teaches an individual to control muscle tension, pain, body temperature, brain waves, and other
bodily functions and processes through relaxation, visualization, and other techniques. In some cases, positive
reinforcements are used to reward patients who generate the correct biofeedback response during treatment.
The name biofeedback refers to the biological signals that are fed back to the patient in order for the patient to
develop techniques of controlling them.
PREPARATIONS
Patients may seek therapy independently, or be referred for treatment by a primary physician, psychologist,
psychiatrist, or other healthcare professional. Because the patient and therapist work closely together to achieve
specific therapeutic objectives, it is important that their working relationship be comfortable and that their treatment
goals are compatible. Prior to beginning treatment, the patient and therapist should meet for a consultation session, or
mutual interview. The consultation gives the therapist the opportunity to make an initial assessment (a detailed
behavioral analysis of the particular incidents which lead up to and ensue after a specific unwanted behavior) of the
patient and recommend a course of treatment and goals for therapy. It also gives the patient an opportunity to find out
important details about the therapist's approach to treatment, professional credentials, and any other relevant issues
important to them.
In some managed-care clinical settings, an intake interview or evaluation is required before a patient begins therapy.
The intake interview is used to evaluate the patient and assign him or her to a therapist. It may be conducted by a
psychiatric nurse, counselor, or social worker.
PRECAUTIONS
Behavioral therapy may not be suitable for some patients. Those who don't have a specific behavioral issue they wish
to address and whose goals for therapy are to gain insight into the past may be better served by psychodynamic
therapy. Patients must also be willing to take a very active role in the treatment process.
Behavioral therapy may also be inappropriate for cognitively-impaired individuals (e.g., patients with organic brain
disease or a traumatic brain injury) depending on their level of functioning.
Because of the brief nature of behavioral therapy, relapse has been reported in some patient populations. However,
follow-up sessions can frequently put patients back on track to recovery.
RESEARCH & GENERAL ACCEPTANCE
The use of behavioral modification techniques to treat an array of mental health problems have been extensively
described and studied in medical literature. There may be some debate among mental health professionals as to
whether behavioral therapy should be considered a first line treatment for some mental illnesses, and to what degree
other treatments such as medication should be employed as an adjunct, or complementary, therapy. However, the
general consensus seems to be that behavioral therapy techniques can be a powerful treatment tool for helping
patients change undesirable behaviors.
TRAINING & CERTIFICATION
Behavioral therapists are typically psychologists (Ph.D., Psy.D., Ed.D., or M.A. degree), clinical social workers
(M.S.W., D.S.W., or L.S.W. degree), counselors (M.A. or M.S. degree), or psychiatrists (M.D. with specialization in
psychiatry). Other healthcare providers may suggest brief behavioral interventions, but more extensive treatment
should be left to individuals who are trained in behavioral therapy techniques.
BOOKS
Mills, John. Control: A History of Behavioral Psychology. New York: New York University Press, 1998.
PERIODICALS
Gelder, M."The Future of Behavior Therapy." Journal of Psychotherapy Practice. 6, no. 4 (Fall 1997):285-93.
ORGANIZATIONS
The National Association of Cognitive-Behavioral Therapists. P.O. Box 2195, Weirton, WV 26062. (800) 853–1135.
Paula Ford-Martin
COGNITIVE-BEHAVIORAL THERAPY... is a form of psychotherapy that emphasizes the important role of thinking in
how we feel and what we do.
Cognitive-behavioral therapy does not exist as a distinct therapeutic technique. The term "cognitive-behavioral
therapy (CBT)" is a very general term for a classification of therapies with similarities. There are several approaches to
cognitive-behavioral therapy, including Rational Emotive Behavior Therapy, Rational Behavior Therapy, Rational Living
Therapy, Cognitive Therapy, and Dialectic Behavior Therapy.
However, most cognitive-behavioral therapies have the following characteristics:
1. CBT is based on the Cognitive Model of Emotional Response.
Cognitive-behavioral therapy is based on the idea that our thoughts cause our feelings and
behaviors, not external things, like people, situations, and events. The benefit of this fact is that we
can change the way we think to feel / act better even if the situation does not change.
2. CBT is Briefer and Time-Limited.
Cognitive-behavioral therapy is considered among the most rapid in terms of results obtained. The
average number of sessions clients receive (across all types of problems and approaches to CBT) is
only 16. Other forms of therapy, like psychoanalysis, can take years. What enables CBT to be
briefer is its highly instructive nature and the fact that it makes use of homework assignments. CBT
is time-limited in that we help clients understand at the very beginning of the therapy process that
there will be a point when the formal therapy will end. The ending of the formal therapy is a
decision made by the therapist and client. Therefore, CBT is not an open-ended, never-ending
process.
3. A sound therapeutic relationship is necessary for effective therapy, but not the focus.
Some forms of therapy assume that the main reason people get better in therapy is because of the
positive relationship between the therapist and client. Cognitive-behavioral therapists believe it is
important to have a good, trusting relationship, but that is not enough. CBT therapists believe that
the clients change because they learn how to think differently and they act on that learning.
Therefore, CBT therapists focus on teaching rational self-counseling skills.
4. CBT is a collaborative effort between the therapist and the client.
Cognitive-behavioral therapists seek to learn what their clients want out of life (their goals) and then
help their clients achieve those goals. The therapist's role is to listen, teach, and encourage, while
the client's roles is to express concerns, learn, and implement that learning.
5. CBT is based on aspects of stoic philosophy.
Not all approaches to CBT emphasize stoicism. Rational Emotive Behavior Therapy, Rational
Behavior Therapy, and Rational Living Therapy emphasize aspects of stoicism. Beck's Cognitive
Therapy is not based on stoicism.
Cognitive-behavioral therapy does not tell people how they should feel. However, most people
seeking therapy do not want to feel they way they have been feeling. The approaches that emphasize
stoicism teach the benefits of feeling, at worst, calm when confronted with undesirable situations.
They also emphasize the fact that we have our undesirable situations whether we are upset about
them or not. If we are upset about our problems, we have two problems -- the problem, and our
upset about it. Most people want to have the fewest number of problems possible. So when we
learn how to more calmly accept a personal problem, not only do we feel better, but we usually put
ourselves in a better position to make use of our intelligence, knowledge, energy, and resources to
resolve the problem.
6. CBT uses the Socratic Method.
Cognitive-behavioral therapists want to gain a very good understanding of their clients' concerns.
That's why they often ask questions. They also encourage their clients to ask questions of
themselves, like, "How do I really know that those people are laughing at me?" "Could they be
laughing about something else?"
7. CBT is structured and directive.
Cognitive-behavioral therapists have a specific agenda for each session. Specific techniques /
concepts are taught during each session. CBT focuses on the client's goals. We do not tell our
clients what their goals "should" be, or what they "should" tolerate. We are directive in the sense
that we show our clients how to think and behave in ways to obtain what they want. Therefore, CBT
therapists do not tell their clients what to do -- rather, they teach their clients how to do.
8. CBT is based on an educational model.
CBT is based on the scientifically supported assumption that most emotional and behavioral
reactions are learned. Therefore, the goal of therapy is to help clients unlearn their unwanted
reactions and to learn a new way of reacting.
Therefore, CBT has nothing to do with "just talking". People can "just talk" with anyone.
The educational emphasis of CBT has an additional benefit -- it leads to long term results. When
people understand how and why they are doing well, they know what to do to continue doing well.
9. CBT theory and techniques rely on the Inductive Method.
A central aspect of Rational thinking is that it is based on fact. Often, we upset ourselves about
things when, in fact, the situation isn't like we think it is. If we knew that, we would not waste our
time upsetting ourselves.
Therefore, the inductive method encourages us to look at our thoughts as being hypotheses or
guesses that can be questioned and tested. If we find that our hypotheses are incorrect (because we
have new information), then we can change our thinking to be in line with how the situation really is.
110. Homework is a central feature of CBT.
If when you attempted to learn your multiplication tables you spent only one hour per week
studying them, you might still be wondering what 5 X 5 equals. You very likely spent a great deal
of time at home studying your multiplication tables, maybe with flashcards.
The same is the case with psychotherapy. Goal achievement (if obtained) could take a very long
time if all a person were only to think about the techniques and topics taught was for one hour per
week. That's why CBT therapists assign reading assignments and encourage their clients to
practice the techniques learned.
CITATIONS: Author Info: Paula Ford-Martin, The Gale Group Inc., Gale, Detroit, Gale Encyclopedia of
Alternative Medicine, 2005
http://www.healthline.com/galecontent/behavioral-therapy
TRAUMA FOCUSED CARE
Trauma Focused Cognitive Behavioral Therapy is a short-term treatment typically provided in 12 to 18 sessions of
60 to 90 minutes or longer, depending on treatment needs. The intervention is typically provided in outpatient mental
health facilities, but it has been used in hospital, group home, school, community, and in-home settings.
The treatment involves individual sessions with the patient/child or caregiver/parent separately and joint sessions with
the patient and caregiver together. Each individual session is designed to build the therapeutic relationship while
providing education, skills, and a safe environment in which to address and process traumatic memories. Joint
caregiver and/or patient sessions are designed to help caregivers and/or patients practice and use the skills they
learned, while also fostering more effective caregiver and/or patient, or parent-child communication about the abuse
and related issues.
Goals
Generally, the goals of TF-CBT are to:
 Reduce the patient's negative emotional and behavioral responses to the trauma
 Correct maladaptive or unhelpful beliefs and attributions related to the abusive experience (e.g., a belief that
the patient or child is responsible for the abuse)
 Provide support and skills to help non-offending caregivers and/or parents cope effectively with their own
emotional distress
 Provide non-offending caregivers and/or parents with skills to respond optimally to and support the patient or
child
Protocol Components
Components of the TF-CBT protocol can be summarized by the word “PRACTICE”:
 P - Psychoeducation and Parenting skills—Discussion and education about child abuse in general and the
typical emotional and behavioral reactions to sexual abuse. Training for parents in child behavior management
strategies and effective communication.
 R - Relaxation techniques—Teaching relaxation methods, such as focused breathing, progressive muscle
relaxation, and thought stopping.
 A - Affective expression and regulation—Helping the child and parent manage their emotional reactions to
reminders of the abuse, improve their ability to express emotions, and participate in self-soothing activities.
 C - Cognitive coping and processing—Exploration and correction of inaccurate attributions about the cause
of, responsibility for, and results of the abusive experience(s).
 T - Trauma narrative—Gradual exposure exercises, including verbal, written, or symbolic recounting of
abusive events.
 I - In vivo exposure—Gradual exposure to nonthreatening trauma reminders in the child's environment (for
example, basement, darkness, school), so the child learns to control his or her own emotional reactions.
 C - Conjoint parent/child sessions—Family work to enhance communication and create opportunities for
therapeutic discussion regarding the abuse.
 E - Enhancing personal safety and future growth—Education and training on personal safety skills,
interpersonal relationships, and healthy sexuality; encouragement in the use of new skills in managing future
stressors and trauma reminders.
Integrates Several Established Treatment Approaches
TF-CBT combines elements drawn from:
 Cognitive therapy, which aims to change behavior by addressing a person's thoughts or perceptions,
particularly those thinking patterns that create distorted views
 Behavioral therapy, which focuses on modifying habitual responses (e.g., anger, fear) to identified situations
or stimuli
 Family therapy, which examines patterns of interactions among family members to identify and alleviate
problems
TF-CBT uses well-established cognitive-behavioral therapy and stress management procedures originally developed
for the treatment of fear, anxiety, and depression in adults (Wolpe, 1969; Beck, 1976). These procedures have been
used with adult rape victims with symptoms of PTSD (Foa, Rothbaum, Riggs, & Murdock, 1991) and have been
applied to children with problems with excessive fear and anxiety (Beidel & Turner, 1998). The TF-CBT protocol has
adapted and refined these procedures to target the specific difficulties exhibited by children who are experiencing
PTSD symptoms in response to sexual abuse or other childhood traumas. In addition, well-established parenting
approaches (e.g., Patterson, 2005; Forehand & Kotchick, 2002) also are incorporated into treatment to guide parents in
addressing their children's behavioral difficulties.
Successful in Various Environments and Appropriate for Multiple Traumas
TF-CBT has been implemented successfully in urban, suburban, and rural environments and has demonstrated
success with Caucasian, African-American, and Hispanic children from all socioeconomic environments. It has been
adapted for Latino and hearing-impaired populations. In addition, recent research findings suggest that TF-CBT may
be preferable to less directive treatment approaches for children who have a history of multiple traumas (e.g., sexual
abuse, exposure to domestic violence, physical abuse, as well as other traumas) and those with high levels of
depression prior to treatment (Deblinger, Mannarino, Cohen, & Steer, in press). The model also has been tested with
children who are experiencing traumatic grief after the death of a loved one (Cohen, Mannarino, & Knudsen, 2004;
Cohen, Mannarino, & Staron, in press).
Adapted from: http://www.childwelfare.gov/pubs/trauma/
Trauma-Focused-Cognitive Behavioral Therapy (TF-CBT) is a treatment provided to patients experiencing
symptoms of Post-Traumatic Stress Disorder after a traumatic event. It is a combination of cognitive behavioral therapy
and trauma-sensitive interventions developed to improve the emotional and social well being of patients with significant
behavioral or emotional problems related to traumatic life events. It is made up of individualized sessions to teach ways
of managing distressing thoughts and feelings, increasing communication, and improving coping skills.
INTEGRATED TREATMENT
Integrated Treatment involves coordinating services for mental health issues and substance abuse in the same setting.
Healthcare professionals acknowledge the differences between mental disorders and addiction and give equal
consideration to both. The team of addiction specialists providing treatment creates a customized program to
simultaneously provide solutions for both the abuse and underlying mental disorders, with sensitivity to an individual’s
personal history, cultural background, living arrangements, social network and vocation.
This comprehensive, consistent approach eliminates the need for outside consultation or contradictory interventions.
Treatment is administered in stages at an individual’s own pace and influenced by the severity of both conditions. By
addressing the dual diagnosis, progress made in one area also may positively influence the other disorder.
http://www.burningtree.com/programs/dual-diagnosis/integrated-treatment/
How does Integrated Treatment work?
Integrated services
Mental health and substance abuse treatment are integrated to meet the needs of people with co-occurring disorders.
Cross-trained practitioners
Integrated treatment specialists are trained to treat both substance use disorders and serious mental illnesses.
Stage-wise treatment
Integrated treatment specialists match services to the consumer’s stage of recovery.
Motivational interventions
Motivational interventions are used to help consumers identify and pursue personal recovery goals.
Cognitive-behavioral approach
A cognitive-behavioral approach is used to help consumers identify and change their thoughts, feelings, and behaviors
related to their co-occurring disorders.
Multiple formats
Services are available in individual, group, self-help, and family formats.
Integrated medication services
Medication services are integrated with other services.
MEDICATION MANAGEMENT
Medication Management
The prescribing and monitoring of medications for the management of symptoms related to mental health,
developmental disability, or substance abuse disorders by: (A) an allopathic or osteopathic physician with a current
license and board certification in psychiatry or board eligible in the state in which services are provided; and/or (B)
practitioners with a license to practice in Dual Diagnosis – Psychiatric Disorders and Addiction Psychiatric medication
abuse, though part of an alarming overall trend of prescription drug abuse in the U.S., has remained fairly constant in
recent years National Survey on Drug Use and Health (NSDUH). However, people who suffer from depression, anxiety
or other mental illnesses may also turn to drugs or alcohol to ease emotional and physical pain. This cyclical
relationship is referred to as dual diagnosis, a psychiatric disorder coupled with addiction.
Those who suffer from dual diagnosis look for drugs and alcohol to self-medicate symptoms related to psychiatric
issues. The resulting chemical imbalance in the brain worsens and symptoms become exacerbated. More drugs and
alcohol are needed in order alleviate psychiatric symptoms. Over time, tolerance to the drugs and alcohol builds within
the body.
Using drugs and alcohol negates the effects of psychiatric medications. Psychiatric symptoms worsen with the
ingestion of drugs and/or alcohol. Individuals will increase their intake of psychiatric medications for mental health
symptoms which have been exacerbated by substance abuse. These individuals are under the false assumption that
more psychiatric medication will help decrease symptoms related to substance abuse. There are many risks involved
with increasing psychiatric medications along with increasing substance abuse. This vicious cycle continues until the
individual realizes that he or she needs addiction treatment.
Psychiatric Medication Addiction Treatment Programs
Not all mental health treatment programs can address addiction. Nor are all drug or alcohol treatment programs able to
handle a mental health disorder. A treatment facility that has a quality dual diagnosis program provides both addiction
and mental health treatment simultaneously. In a dual diagnosis program, the individual will focus on learning daily
living skills for managing mental health issues while learning healthier coping skills to eliminate substance abuse
patterns.
A comprehensive medical and clinical evaluation will be needed during the detox process followed by an individualized
treatment plan. Detox alone will not solve mental health issues nor address the addictive behavior.
A dual diagnosis treatment program supervised by physicians, nurses, and psychiatrists certified in addiction medicine
with an expertise in mental health disorders can provide patients with mental health workshops, life skills, addiction
education, medication management, relapse prevention, and aftercare plans necessary for a strong recovery.
http://www.recoveryconnection.org/addiction-psychiatric-medication-treatment/
NARRATIVE THERAPY
What is narrative therapy?
by Alice Morgan
We have included here, the introduction and first two chapters from Alice Morgan's influential and highly popular text,
'What is narrative therapy? An easy-to-read introduction'. This book is available from The Narrative Therapy Library
and Bookshop and we strongly recommend it to anyone who is trying to, or is wanting to apply narrative ideas in their
own work context.
Introduction
Hello! Welcome to this easy-to-read book which is designed as an introduction to some of the main themes of narrative
therapy. It includes simple and concise explanations of the thinking behind narrative practices as well as many
practical examples of therapeutic conversations. This book certainly doesn’t cover everything but hopefully it will serve
as a starting point for further explorations. To assist this, included at the end of most of the chapters are references for
further reading on various topics.
There are many different themes which make up what has come to be known as ‘narrative therapy’ and every therapist
engages with these ideas somewhat differently. When you hear someone refer to ‘narrative therapy’ they might be
referring to particular ways of understanding people’s identities. Alternatively, they might be referring to certain ways of
understanding problems and their effects on people’s lives. They might also be speaking about particular ways of
talking with people about their lives and problems they may be experiencing, or particular ways of understanding
therapeutic relationships and the ethics or politics of therapy.
Narrative therapy seeks to be a respectful, non-blaming approach to counseling and community work, which centers
people as the experts in their own lives. It views problems as separate from people and assumes people have many
skills, competencies, beliefs, values, commitments and abilities that will assist them to reduce the influence of
problems in their lives.
There are various principles which inform narrative ways of working, but in my opinion, two are particularly significant:
always maintaining a stance of curiosity, and always asking questions to which you genuinely do not know the
answers. I invite you to read this book with these two principles in mind. They inform the ideas, the stance, the tone,
the values, the commitments and the beliefs of narrative therapy.
Possibilities for conversations
I have written this book in sections, each chapter describing one aspect or theme of narrative ways of working. I have
done so in the hope that this makes each element easy to understand. Instead of approaching the ideas conveyed in
this book like a recipe, however, one that must be followed in a particular order, I’d invite you to instead approach them
as you would a smorgasbord – an array of delicacies to choose from! I hope this book simply outlines a range of
possibilities for narrative conversations.
When I meet with the people consulting me, I sometimes think of the possibilities for the directions of the conversation
as if they are roads on a journey. There are many cross-roads, intersections, paths and tracks to choose from. With
every step, a new and different cross road or intersection emerges – forwards, back, right, left, diagonal, in differing
degrees. With each step that I take with the person consulting me, we are opening more possible directions. We can
choose where to go and what to leave behind. We can always take a different path, retrace our steps, go back, repeat
a track, or stay on the same road for some time. At the beginning of the journey we are not sure where it will end, nor
what will be discovered.
The possibilities described in this book are like the roads, tracks and paths of the journey. Each question a narrative
therapist asks is a step in a journey. All the paths may be taken, some of the paths, or one can travel along one path
for a time before changing to another. There is no ‘right’ way to go – merely many possible directions to choose from.
Collaboration
Importantly, the person consulting the therapist plays a significant part in mapping the direction of the journey.
Narrative conversations are interactive and always in collaboration with the people consulting the therapist. The
therapist seeks to understand what is of interest to the people consulting them and how the journey is suiting their
preferences. You will often hear, for example, a narrative therapist asking:
 How is this conversation going for you?
 Should we keep talking about this or would you be more interested in …?
 Is this interesting to you? Is this what we should spend our time talking about?
 I was wondering if you would be more interested in me asking you some more about this or whether we should
focus on X, Y or Z? [X, Y, Z being other options]
In this way, narrative conversations are guided and directed by the interests of those who are consulting the therapist.
Summary
So, before we dive into this exploration of narrative ways of working, let’s quickly summarize what we have considered
so far:
 Narrative therapy seeks to be a respectful, non-blaming approach to counseling and community work, which
centers people as the experts in their own lives.
 It views problems as separate from people and assumes people have many skills, competencies, beliefs,
values, commitments and abilities that will assist them to change their relationship with problems in their lives.
 Curiosity and a willingness to ask questions to which we genuinely don’t know the answers are important
principles of this work.
 There are many possible directions that any conversation can take (there is no single correct direction).
 The person consulting the therapist plays a significant part in determining the directions that are taken.
It seems appropriate to begin any exploration of narrative therapy with a consideration of what is meant by the
‘narratives’ or ‘stories’ of our lives.
Chapter 1 Understanding and living our lives through stories
Narrative therapy is sometimes known as involving ‘re-authoring’ or ‘re-storying’ conversations. As these descriptions
suggest, stories are central to an understanding of narrative ways of working.
The word ‘story’ has different associations and understandings for different people. For narrative therapists, stories
consist of:
 events
 linked in sequence
 across time
 according to a plot
As humans, we are interpreting beings. We all have daily experiences of events that we seek to make meaningful. The
stories we have about our lives are created through linking certain events together in a particular sequence across a
time period, and finding a way of explaining or making sense of them. This meaning forms the plot of the story. We
give meanings to our experiences constantly as we live our lives. A narrative is like a thread that weaves the events
together, forming a story.
We all have many stories about our lives and relationships, occurring simultaneously. For example, we have stories
about ourselves, our abilities, our struggles, our competencies, our actions, our desires, our relationships, our work,
our interests, our conquests, our achievements, our failures. The way we have developed these stories is determined
by how we have linked certain events together in a sequence and by the meaning we have attributed to them.
An example: the story of my driving
I could have a story about myself as a ‘good driver’. This means I could string together a number of events that have
happened to me whilst driving my car. I could put these events together with others into a particular sequence and
interpret them as a demonstration of me being a good driver. I might think about, and select out for the telling of the
story, events such as stopping at the traffic lights, giving way to pedestrians, obeying the speed limits, incurring no
fines and keeping a safe distance behind other vehicles. To form this story about my ability as a driver, I am selecting
out certain events as important that fit with this particular plot. In doing so, these events are privileged over others.
As more and more events are selected and gathered into the dominant plot, the story gains richness and thickness. As
it gains thickness, other events of my driving competence are easily remembered and added to the story. Throughout
this process, the story thickens, becomes more dominant in my life and
it is increasingly easy for me to find more examples of events that fit with the meaning I have reached.
These events of driving competence that I am remembering and selecting out are elevated in their significance over
other events that do not fit with the plot of being a good driver. For instance, the times when I pulled out too quickly
from the curb or misjudged the distances when parking my car are not being privileged. They might be seen as
insignificant or maybe a fluke in the light of the dominant plot (a story of driving competence). In the retelling of stories,
there are always events that are not selected, based upon whether or not they fit with the dominant plots.
The diagram on the next page (this figure cannot be represented here on this webpage but is included in the book!)
demonstrates the idea of stories consisting of events linked in sequence across time according to plot. The X marks
are all the events that have occurred in my life as a driver. The events that fit with the story of ‘driving competence’ are
scattered amongst events that are outside of that story (e.g. a car accident that occurred 4 months ago). In order to
author a story of driving competence, certain events are selected out and privileged over other events. Once privileged,
they are linked with other events, and then still more events across time, to form a story about being a good driver. The
line on the diagram shows this linking of events to form the dominant story. As you can see there are other events (X)
that are outside of this dominant story that remain hidden or less significant in the light of the dominant plot.
In this example, perhaps why I can attend only to the good events, and have managed to construct a story of being a
competent driver, is due to the reflections of others. If my family members and friends have always described me as a
good driver, this would have made a significant difference. Stories are never produced in isolation from the broader
world. Perhaps, in this example, I was never subjected to diminishing remarks on the basis of my gender. Who knows?
The effects of dominant stories
The dominant story of my driving abilities will not only affect me in the present but will also have implications for my
future actions. For example, if I am asked to drive to a new suburb or drive a long distance at night, my decision and
plans will be influenced by the dominant story I have about my driving. I would probably be more inclined to consider
doing these things when influenced by the story I have about myself as being a good driver than if I had a story about
myself as being a dangerous or accident-prone driver. Therefore, the meanings I give to these events are not neutral in
their effects on my life – they will constitute and shape my life in the future. All stories are constitutive of life and shape
our lives.
Living many stories at once
Our lives are multistoried. There are many stories occurring at the same time and different stories can be told about the
same events. No single story can be free of ambiguity or contradiction and no single story can encapsulate or handle
all the contingencies of life.
If I had a car accident, or if someone in my life began to focus on every little mistake that I ever made while driving, or if
a new law was introduced that discriminated against people like me in some way, an alternative story about my driving
might begin to develop. Other events, other people’s interpretations of these events, and my own interpretations could
lead to an alternative story developing about my driving – a story of incompetence or carelessness. This alternative
story would have effects too. For a time I might live with differing stories about my driving depending upon the context
or the audience. Over time, depending on a variety of factors, the negative story about my
driving might gain in influence and even become the dominant story in my life in relation to my driving. Neither the story
of my driving ability nor the story of my driving failure would be free of ambiguity or contradiction.
Different types of stories
There are many different sorts of stories by which we live our lives and relationships – including stories about the past,
present and future. Stories can also belong to individuals and/or communities. There can be family stories and
relationship stories.
An individual may have a story about themselves as being successful and competent. Alternatively they may have a
story about themselves as being ‘a failure at trying new things’ or ‘a coward’ or as ‘lacking determination’. Families may
have stories about themselves as being ‘caring’ or ‘noisy’ or ‘risky’ or ‘dysfunctional’ or ‘close’. A community may have
a story about itself as ‘isolated’ or ‘politically active’ or ‘financially strong’. All these stories could be occurring at the
same time, and events, as they occur, will be interpreted according to the meaning (plot) that is dominant at that time.
In this way, the act of living requires that we are engaged in the mediation between the dominant stories and the
alternative stories of our lives. We are always negotiating and interpreting our experiences.
The broader social context of the stories by which we live our lives
The ways in which we understand our lives are influenced by the broader stories of the culture in which we live. Some
of the stories we have about our lives will have positive effects and some will have negative effects on life in the past,
present and future. Laura may describe herself as a skilled therapist. She has developed this story about herself from
her experiences and feedback from her work. All these experiences have contributed to shaping a story about herself
as a competent, caring and skilful therapist. When faced with the decision to apply for a new job in a field that is less
familiar to her, Laura is more likely to apply or think about applying under the influence of this positive self-narrative. I
suspect that she would experience the challenges in her work with some confidence and might talk about her work in
ways that describe it as enriching.
The meanings that we give to these events occurring in a sequence across time do not occur in a vacuum. There is
always a context in which the stories of our lives are formed. This context contributes to the interpretations and
meanings that we give to events. The context of gender, class, race, culture and sexual preference are powerful
contributors to the plot of the stories by which we live. Laura’s story of herself as a skilled therapist, for instance, would
have been influenced by the ideas of the culture in which she lives. This culture would have particular beliefs about
what constitutes ‘skills’ as a therapist and Laura’s story would be shaped by these beliefs.
Laura’s working-class background may have significantly contributed to the ways in which she finds it easy to make
connections with people who come to consult with her from a diversity of backgrounds. Her confidence in speaking out
in work situations may have much to do with her history within the feminist movement and also the fact that as she is a
white Australian professional, it is likely that people will listen to what she is saying.
In these sorts of ways, the beliefs, ideas and practices of the culture in which we live play a large part in the meanings
we make of our lives.
Summary
As I have tried to explain, narrative therapists think in terms of stories – dominant stories and alternative stories;
dominant plots and alternative plots; events being linked together over time that have implications for past, present and
future actions; stories that are powerfully shaping of lives. Narrative therapists are interested in joining with people to
explore the stories they have about their lives and relationships, their effects, their meanings and the context in which
they have been formed and authored.
Chapter 2 Stories in the therapeutic context
Let us think about some of the stories that are brought into the context of therapy. Most commonly, when people
decide to consult a therapist it is because they are experiencing a difficulty or problem in their lives. When meeting with
a therapist, they will often begin by telling the therapist about many events in the life of the problem for which they are
seeking help. Commonly they will also explain the meanings they have given to these events.
The Craxton family sought my assistance when one of the members of the family, Sean, was caught stealing. As I
heard about the problem of stealing, Sean’s parents explained:
We are really worried about Sean because he is stealing and we have tried to stop him but he just won’t. He’s always
been a problem child from the time he was little. He didn’t get much attention when he was a small boy because Anne
[his mother] was ill. Since then he always gets in trouble at school. He didn’t toilet train himself and is always starting
fights with his brothers. Now he’s stealing to get people to notice him.
Within this story, Sean’s stealing was interpreted as meaning he was ‘attention seeking’. This particular meaning (or
dominant plot) occurred through a gathering together of many other events in
the past that fitted with this interpretation. As Sean more and more came to be seen according to this story, more and
more events which supported the story of ‘attention seeking’ began to be selected out, and the story was told and retold. As more events were added to this plot, the story of Sean as an ‘attention seeker’ became stronger.
To tell this particular story, certain events from the present and past were selected out and explained to fit with the
meanings that his parents had arrived at. In doing so, certain events were selected and privileged to be told, as they
were interpreted to fit with the plot of ‘attention seeking’. Therefore, other events (that didn’t fit with Sean as seeking
attention) remained untold and unrecognized. The exceptions to this story of ‘attention seeking’ or times that might not
fit with the ‘attention seeking’ story became less visible. So too, the broader cultural understandings of Sean’s actions
become obscured – including the fact that stealing is a common act by young men of Sean’s class background in his
neighborhood. All the complexities and contradictions of Sean’s life had been simplified into the understanding that
Sean was an ‘attention seeker’.
Thin description
Early in their meetings with people, therapists often hear stories, like the one above, about the problem and the
meanings that have been reached about them. These meanings, reached in the face of adversity, often consist of what
narrative therapists call ‘thin description’.
Thin description allows little space for the complexities and contradictions of life. It allows little space for people to
articulate their own particular meanings of their actions and the context within which they
occurred. For example, in the story above, the description of Sean’s behavior as ‘attention seeking’ was a thin
description. It was generated by others (as is often the case with thin descriptions) and left little room for movement.
This thin description of Sean’s actions (attention seeking) obscures many other possible meanings. For all we know,
the last thing Sean wanted may have been for his stealing to be given attention! Perhaps these actions had more to do
with making a stand for belonging with peers, with acquiring something for his sister, with standing up to the bullying of
others, or with establishing himself as a leader in a neighborhood where leadership for a young man means leading
break and enters (robberies). A thin description of ‘attention seeking’ has the potential to leave Sean isolated and
disconnected from his parents and his peers, whereas alternative descriptions may open other possibilities.
Often, thin descriptions of people’s actions/identities are created by others – those with the power of definition in
particular circumstances (e.g. parents and teachers in the lives of children, health professionals in the lives of those
who consult them). But sometimes people come to understand their own actions through thin descriptions. In whatever
context thin descriptions are created, they often have significant consequences.
Thin conclusions and their effects
Thin description often leads to thin conclusions about people’s identities, and these have many negative effects. For
example, as Sean’s actions were thinly described as ‘attention seeking’, he quickly became seen as ‘an attention
seeker’. This thin conclusion about Sean as a person was having negative effects, not only in relation to Sean’s
experience of himself, but also on the relationships between Sean and his parents.
Thin conclusions are often expressed as a truth about the person who is struggling with the problem and their identity.
The person with the problem may be understood to be ‘bad’, ‘hopeless’, or ‘a troublemaker’. These thin conclusions,
drawn from problem-saturated stories, disempower people as they are regularly based in terms of weaknesses,
disabilities, dysfunctions or inadequacies. I can recall many of these thin conclusions that people who have consulted
me have been invited into: ‘It’s because I’m a bad person’ or ‘We are a dysfunctional family’.
Sometimes these thin conclusions obscure broader relations of power. For example, if a woman has come to see
herself as ‘worthless’ and ‘deserving of punishment’ after years of being subjected to abuse, these thin conclusions
make invisible the injustice she has experienced. They hide the tactics of power and control to which she has been
subjected, as well as her significant acts of resistance.
Once thin conclusions take hold, it becomes very easy for people to engage in gathering evidence to support these
dominant problem-saturated stories. The influence of these problematic stories can then become bigger and bigger. In the
process, any times when the person has escaped the effects of the problem, any times when they have not been ‘bad’,
‘hopeless’ or ‘a trouble maker’ become less visible. As the problem story gets bigger and bigger it becomes more powerful
and will affect future events. Thin conclusions often lead to more thin conclusions as people’s skills, knowledge, abilities and
competencies become hidden by the problem story.
Alternative stories
Narrative therapists, when initially faced with seemingly overwhelming thin conclusions and problem stories, are interested
in conversations that seek out alternative stories – not just any alternative stories,
but stories that are identified by the person seeking counseling as stories by which they would like to live their lives. The
therapist is interested to seek out, and create in conversations, stories of identity that will assist people to break from the
influence of the problems they are facing.
Just as various thin descriptions and conclusions can support and sustain problems, alternative stories can reduce the
influence of problems and create new possibilities for living.
For Sean, for example, an exploration of the alternative stories of his life might create space for change. These would
not be stories of being an attention seeker or a problem child. Instead, they might consist of stories of determination
throughout his history, or stories of how he overcame troubles in earlier times in his life, or ways in which he gives
attention as well as seeks it. All of these might be alternative stories of Sean’s life. Or, alternative stories might be
found in other realms entirely – realms of imaginary friends, histories of connectedness with his mother or father, or
within special knowledge that Sean might possess through his relationship with his beloved pet dog Rusty. In any of
these territories of life, through therapeutic conversations, alternative stories might be unearthed that could assist in
addressing the problems Sean is currently struggling with. The ways in which therapists and those who consult with
them can co-author alternative stories will be described in following chapters.
With these ideas about stories informing their work, the key question for narrative therapists becomes: how can we
assist people to break from thin conclusions and to re-author new and preferred stories for their lives and
relationships?
As Jill Freedman and Gene Combs describe:
Narrative therapists are interested in working with people to bring forth and thicken stories that do not support or
sustain problems. As people begin to inhabit and live out the alternative stories, the results are beyond solving
problems. Within the new stories, people live out new self images, new possibilities for relationships and new futures.
(1996, p.16)
Towards rich and thick description
To be freed from the influence of problematic stories, it is not enough to simply re-author an alternative story. Narrative
therapists are interested in finding ways in which these alternative stories can be ‘richly described’. The opposite of a
‘thin conclusion’ is understood by narrative therapists to be a ‘rich description’ of lives and relationships.
Many different things can contribute to alternative stories being ‘richly described’ – not least of which being that they
are generated by the person whose life is being talked about. Rich description involves the articulation in fine detail of
the story-lines of a person’s life. If you imagine reading a novel, sometimes a story is richly described – the motives of
the characters, their histories, and own understandings are finely articulated. The stories of the characters’ lives are
interwoven with the stories of other people and events. Similarly, narrative therapists are interested in finding ways for
the alternative stories of people’s lives to be richly described and interwoven with the stories of others.
The ways in which alternative stories are co-authored, how they are told and to whom, are all relevant considerations
for narrative therapists. In the following pages, ways to co-author conversations that engage people in the ‘rich
description’ of their lives and relationships will be more fully explored.
Further reading
Freedman, J. & Combs, G. 1996: ‘Shifting paradigms: From systems to stories.’ In Freedman, J. & Combs, G.,
Narrative Therapy: The social construction of preferred realities, chapter 1. New York: Norton.
Epston, D. & White, M. 1990: ‘Story, knowledge, power.’ In Epston, D. & White, M., Narrative Means to Therapeutic
Ends, chapter 1. New York: Norton.
White, M. 1997: ‘The culture of professional disciplines.’ In White, M., Narratives of Therapists’ Lives, chapter 1.
Adelaide: Dulwich Centre Publications.
Copyright © 2000 by Dulwich Centre Publications
to list of books from Dulwich Centre Publications
to list of articles on this web page
Dulwich Centre Home Page CITATION: http://www.dulwichcentre.com.au/alicearticle.html
FAMILY SYSTEMS THERAPY
JEAN B. BLACKBURN, M.S.N., R.N., C.S.
REGISTERED NURSE
MASTER OF SCIENCE IN NURSING
CERTIFIED, PSYCHIATRIC-MENTAL HEALTH CLINICAL SPECIALIST
SYMPTOMS CAN OCCUR IN ONE OR MORE OF THE FOLLOWING AREAS:
MARRIAGE--conflict, unfaithfulness, abuse
HEALTH--poor physical or emotional health
PARENT-CHILD RELATIONSHIPS--disobedience, abuse, communications
SUBSTANCE ABUSE--alcohol and other drugs
SCHOOL PROBLEMS--poor grades --poor relationships with peers and teachers
COMMUNITY RELATIONS--delinquent behavior, legal problems --difficulties with neighbors
WORK--malingering, absenteeism, tardiness --conflict with supervisors or coworkers
FAMILY
The human family is the biological unit designated by nature to sustain the human being. Family units vary in size and
structure. In a family each person learns to relate to others, to cope with and solve the problems of living. These
abilities are learned in the context of family relationships.
A deeply rooted, automatic and instinctual emotional system governs life processes. The emotional system influences
how individuals function in relationships. Consequently, the emotional system often dictates the quality and success
of an individual's life.
When life experiences are threatening, a frequent response is anxiety. With high anxiety, problem solving is more
automatically driven by the emotional system. All family members are susceptible to anxiety and can be vulnerable to
emotional difficulties.
METHODOLOGY
Family Systems Therapy is a method of psychotherapy based on the Murray Bowen Theory of Natural Systems. It
has applicability in a wide range of problems. Any family member who seeks help will aid the entire family.
The aim of Family Systems Therapy is for family members to understand and accept their individual responsibility in
the emotional functioning of the family unit. By learning to recognize the emotional relationship patterns and how
anxiety is handled in the family, individual family members can manage themselves in more functional ways.
Relationships change and symptoms decrease as family members improve their emotional functioning.
CONSULTATION AND EDUCATION
Consultation and education services are available. The concepts and methods developed in the Family Systems
framework are applicable in industrial and other organizational settings. When managerial and administrative
personnel understand how emotional systems function, employees become more effective. When all employees
function effectively, productivity increases. The organizational goals are advanced. Courses based on Family
Systems Theory are appropriate for executives, managers and supervisors, as well as employees.
SUMMARY
A METHOD FOR DEALING WITH:
 Marriage relations difficulties
 Parent/child problems
 Family crisis
 Associated problems
handicapped adult or child
divorce and child custody
serious illness or death
single parenthood
school problems
separation
 Consultation and education programs
CITATION: JEAN B. BLACKBURNM.S.N., R.N., C.S.,
Psychiatric-Mental Health Clinical Specialist
Licensed by States of Tennessee and Georgia
Certified by American Nurses Association
Postgraduate Training Theory and Psychotherapy, Georgetown Family Center, Washington, D.C.
Master of Science in Nursing, Vanderbilt University, Nashville, Tennessee
Bachelor of Science in Nursing, Florida State University, Tallahassee, Florida
http://www.familysystemstherapy.com/index.shtml
RATIONAL EMOTIVE THERAPY
Copied with permission from CounsellingResource.com
"Rational emotive behavior therapy focuses on uncovering irrational beliefs which may lead to unhealthy negative
emotions and replacing them with more productive rational alternatives.
 Underlying Theory of Rational Emotive Behavior Therapy
 Therapeutic Approach of Rational Emotive Behavior Therapy
 Criticisms of Rational Emotive Behavior Therapy
 Best Fit With Clients
Underlying Theory of Rational Emotive Behavior Therapy
Rational emotive behavior therapy ('REBT') views human beings as 'responsibly hedonistic' in the sense that they
strive to remain alive and to achieve some degree of happiness. However, it also holds that humans are prone to
adopting irrational beliefs and behaviors which stand in the way of their achieving their goals and purposes. Often,
these irrational attitudes or philosophies take the form of extreme or dogmatic 'musts', 'shoulds', or 'oughts'; they
contrast with rational and flexible desires, wishes, preferences and wants. The presence of extreme philosophies can
make all the difference between healthy negative emotions (such as sadness or remorse or concern) and unhealthy
negative emotions (such as depression or guilt or anxiety). For example, one person's philosophy after experiencing
a loss might take the form: "It is unfortunate that this loss has occurred, although there is no actual reason why it
should not have occurred. It is sad that it has happened, but it is not awful, and I can continue to function." Another's
might take the form: "This absolutely should not have happened, and it is horrific that it did. These circumstances are
now intolerable, and I cannot continue to function." The first person's response is apt to lead to sadness, while the
second person may be well on their way to depression. Most importantly of all, REBT maintains that individuals have
it within their power to change their beliefs and philosophies profoundly, and thereby to change radically their state of
psychological health.
REBT employs the 'ABC framework' -- depicted in the figure below -- to clarify the relationship between activating
events (A); our beliefs about them (B); and the cognitive, emotional or behavioral consequences of our beliefs (C).
The ABC model is also used in some renditions of cognitive therapy or cognitive behavioral therapy, where it is also
applied to clarify the role of mental activities or predispositions in mediating between experiences and emotional
responses.
The figure below shows how the framework distinguishes between the effects of rational beliefs about negative
events, which give rise to healthy negative emotions, and the effects of irrational beliefs about negative events, which
lead to unhealthy negative emotions.
In addition to the ABC framework, REBT also employs three primary insights:
1. While external events are of undoubted influence, psychological disturbance is largely a matter of personal choice
in the sense that individuals consciously or unconsciously select both rational beliefs and irrational beliefs at (B)
when negative events occur at (A)
2. Past history and present life conditions strongly affect the person, but they do not, in and of themselves, disturb
the person; rather, it is the individual's responses which disturb them, and it is again a matter of individual choice
whether to maintain the philosophies at (B) which cause disturbance.
3. Modifying the philosophies at (B) requires persistence and hard work, but it can be done.
Therapeutic Approach of Rational Emotive Behavior Therapy
The main purpose of REBT is to help clients to replace absolutist philosophies, full of 'musts' and 'shoulds', with more
flexible ones; part of this includes learning to accept that all human beings (including themselves) are fallible and learning
to increase their tolerance for frustration while aiming to achieve their goals. Although emphasizing the same 'core
conditions' as person-centered counseling -- namely, empathy, unconditional positive regard, and counselor genuineness - in the counseling relationship, REBT views these conditions as neither necessary nor sufficient for therapeutic change to
occur.
The basic process of change which REBT attempts to foster begins with the client acknowledging the existence of a
problem and identifying any 'meta-disturbances' about that problem (i.e., problems about the problem, such as feeling
guilty about being depressed). The client then identifies the underlying irrational belief which caused the original problem
and comes to understand both why it is irrational and why a rational alternative would be preferable. The client challenges
their irrational belief and employs a variety of cognitive, behavioral, emotive and imagery techniques to strengthen their
conviction in a rational alternative. (For example, rational emotive imagery, or REI, helps clients practice changing
unhealthy negative emotions into healthy ones at (C) while imagining the negative event at (A), as a way of changing their
underlying philosophy at (B); this is designed to help clients move from an intellectual insight about which of their beliefs
are rational and which irrational to a stronger 'gut' instinct about the same.) They identify impediments to progress and
overcome them, and they work continuously to consolidate their gains and to prevent relapse.
To further this process, REBT advocates 'selective eclecticism', which means that REBT counselors are encouraged to
make use of techniques from other approaches, while still working specifically
within the theoretical framework of REBT. In other words, REBT maintains theoretical coherence while pragmatically
employing techniques that work.
Throughout, the counselor may take a very directive role, actively disputing the client's irrational beliefs, agreeing
homework assignments which help the client to overcome their irrational beliefs, and in general 'pushing' the client to
challenge themselves and to accept the discomfort which may accompany the change process.
Criticisms of Rational Emotive Behavior Therapy
As one leading proponent of REBT has indicated, REBT is easy to practice poorly, and it is from this that one immediate
criticism suggests itself from the perspective of someone who takes a philosophical approach to life anyway: inelegant
REBT could be profoundly irritating! The kind of conceptual disputing favored by REBT could easily meander off track into
minutiae relatively far removed from the client's central concern, and the mental gymnastics required to keep client and
therapist on the same track could easily eat up time better spent on more productive activities. The counselor’s and client's
estimations of relative importance could diverge rather profoundly, particularly if the client's outlook really does embody
significant irrationalities. Having said all that, each of the preceding sentences includes the qualifier 'could', and with a
great deal of skill, each pitfall undoubtedly could be avoided.
Perhaps more importantly, it would appear that the need to match therapeutic approach with client preference is even
more pressing with REBT than with many others. In other words, it seems very important to adopt the REBT approach only
with clients who truly are suitable, as it otherwise risks being strongly counter-productive. On this point, however, it is
crucial to realize that some clients specifically do appreciate exactly this kind of approach, and counselors who are unable
or unwilling to provide the disputation required are probably not right for those clients.
Best Fit With Clients
REBT is much less empirically supported than some other approaches: the requisite studies simply have not been
completed yet, and the relevant data points for determining the best match with clients are therefore thin on the ground.
However, one may envision clients responding particularly well who are both willing and able to conceptualize their
problems within the ABC framework, and who are committed to active participation in the process of identifying and
changing irrational beliefs (including performing homework assignments in support of the latter). Clients will also need to
be able to work collaboratively with a counselor who will challenge and dispute with them directly, and a scientific and at
least somewhat logical outlook would seem a pre-requisite. REBT would be less suitable for clients who do not meet one
or more of the above. And as hinted above in the section on Criticisms, one might also speculate that clients who are
already highly skilled in philosophical engagement could find the approach less useful. (Perhaps REBT-style self help
could be of more benefit for such clients?)
Note that REBT is closely related to cognitive therapy and is viewed by many as a subset of it."
http://www.counsellingresource.com/types/rational-emotive/Copyright 2003-2004
CITATIONS - http://suicideandmentalhealthassociationinternational.org/ret.html
SOLUTION FOCUSED THERAPY
Solution-Focused Brief Therapy (SFBT), also called Solution-Focused Therapy, Solution-Building Practice therapy
was developed by Steve de Shazer (1940-2005), and Insoo Kim Berg (1934-2007) and their colleagues beginning in
the late 1970’s in Milwaukee, Wisconsin. As the name suggests, SFBT is future-focused, goal-directed, and focuses
on solutions, rather than on the problems that brought clients to seek therapy.
The entire solution-focused approach was developed inductively in an inner city outpatient mental health service
setting in which clients were accepted without previous screening. The developers of SFBT spent hundreds of hours
observing therapy sessions over the course several years, carefully noting the therapists’ questions, behaviors, and
emotions that occurred during the session and how the various activities of the therapists affected the clients and the
therapeutic outcome of the sessions. Questions and activities related to clients’ report of progress were preserved
and incorporated into the SFBT approach.
Since that early development, SFBT has not only become one of the leading schools of brief therapy, it has become a
major influence in such diverse fields as business, social policy, education, and criminal justice services, child
welfare, domestic violence offenders treatment. Described as a practical, goal-driven model, a hallmark of SFBT is its
emphasis on clear, concise, realistic goal negotiations. The SFBT approach assumes that all clients have some
knowledge of what would make their life better, even though they may need some (at times, considerable) help
describing the details of their better life and that everyone who seeks help already possesses at least the minimal
skills necessary to create solutions.
Key Concepts and Tool
All therapy is a form of specialized conversations. With SFBT, the conversation is directed toward developing and
achieving the client’s vision of solutions. The following techniques and questions help clarify those solutions and the
means of achieving them.
Looking for previous solutions
SF therapists have learned that most people have previously solved many, many problems and probably have some
ideas of how to solve the current problem. To help clients see these potential solutions they may ask, “Are there
times when this has been less of a problem?" or "What did you (or others) do that was helpful?”
Looking for exceptions
Even when a client does not have a previous solution that can be repeated, most have recent examples of exceptions
to their problem. These are times when a problem could occur, but does not. The difference between a previous
solution and an exception is small, but significant. A previous solution is something that the family has tried on their
own that has worked, but later discontinued. An exception is something that happens instead of the problem, often
spontaneously and without conscious intention. SF therapists may help clients identify these exceptions by asking,
“What is different about the times when this is less of a problem?”
Present and future-focused questions vs. past-oriented focus
The questions asked by SF therapists are usually focused on the present or on the future. This reflects the basic
belief that problems are best solved by focusing on what is already working, and how a client would like their life to
be, rather than focusing on the past and the origin of problems. For example, they may ask, “What will you be doing
in the next week that would indicate to you that you are continuing to make progress?”
Compliments
Compliments are another essential part of solution focused brief therapy. Validating what clients are already doing
well, and acknowledging how difficult their problems are encourages the client to change while giving the message
that the therapist has been listening (i.e., understands) and cares.
Compliments in therapy sessions can help to punctuate what the client is doing that is working. In SF therapy,
compliments are often conveyed in the form of appreciatively toned questions of “How did you do that?” that invite the
client to self-compliment by virtue of answering the question.
Inviting the clients to do more of what is working.
Once SF therapists have created a positive frame via compliments and then discovered some previous solutions and
exceptions to the problem, they gently invite the client to do more of what has previously worked, or to try changes
they have brought up which they would like to try – frequently called “an experiment."
Miracle Question (MQ)
This unusual sounding tool is a powerful in generating the first small steps of 'solution states' by helping clients to
describe small, realistic, and doable steps they can take as soon as the next day. The miracle question developed
out of desperation with a suicidal woman with an alcoholic husband and four “wild” children who gave her nothing but
grief. She was desperate for a solution, but that she might need a 'miracle' to get her life in order. Since the
development of this technique, the MQ has been tested numerous times in many different cultures. The most recent
version is as follows:
T: I am going to ask you a rather strange question . . . that requires some imagination on your part . . .
do you have good imagination?
C: I think so, I will try my best.
T: Good. The strange question is this; After we talk, you go home (go back to work), and you still
have lots of work to do yet for the rest of today (list usual tasks here). And it is time to go to bed . . . and
everybody in your household are sound asleep and the house is very quiet . . . and in the middle of the night,
there is a miracle and the problem that brought you to talk to me about is all solved . But because this happens
when you are sleeping, you have no idea that there was a miracle and the problems is solved . . . so when you
are slowly coming out of your sound sleep . . what would be the first small sign that will make you wonder . .
.there must’ve been a miracle . . the problem is all gone! How would you discover this?
C: I suppose I will feel like getting up and facing the day, instead of wanting to cover my head under
the blanket and just hide there.
T: Suppose you do, get up and face the day, what would be the small thing you would do that you
didn’t do this morning?
C: I suppose I will say good morning to my kids in a cheerful voice, instead of screaming at them
like I do now.
T: What would your children do in response to your cheerful “good morning?”
C: They will be surprised at first to hear me talk to them in a cheerful voice, and then they will calm
down, be relaxed. God, it’s been a long time that happened.
T: So, what would you do then that you did not do this morning?
C: I will crack a joke and put them in a better mood.
These small steps become the building block of an entirely different kind of day as clients may begin to implement
some of the behavioral changes they just envisioned. This is the longest question
asked in SFBT and it has a hypnotic quality to it. Most clients visibly change in their demeanor and some even break
out in smiles as they describe their solutions. The next step is to identify the most recent times when the client has
had small pieces of miracles (called exceptions) and get them to repeat these forgotten experiences.
Scaling Questions: Scaling questions (SQ) can be used when there is not enough time to use the MQ and it is also
useful in helping clients to assess their own situations, track their own progress, or evaluate how others might rate
them on a scale of 0 to 10. It is used in many ways, including with children and clients who are not verbal or who
have impaired verbal skills. One can ask about clients' motivation, hopefulness, depression, confidence, and
progress they made, or a host of other topics that can be used to track their performance and what might be the next
small steps.
The couple in the following example sought help to decide whether their marriage can survive or they should get
divorced. They reported they have fought for 10 years of their 20 years of marriage and they could not fight anymore.
T: Since you two know your marriage better than anybody does, suppose I ask you this way. On a
number of 1 to 10, where 10 stands for you have every confidence that this marriage will make it
and 1 stands for the opposite, that we might just as well walk away right now and it’s not going to
work. What number would you give your marriage? (After a pause, the husband speaks first.)
H: I would give it a 7. (the wife flinches as she hears this)
T: (To the wife) What about you? What number would you give it?
W: (she thinks about it a long time) I would say I am at 1.1.
T: (Surprised) So, what makes it a 1.1?
W: I guess it’s because we are both here tonight.
Coping Questions
This question is a powerful reminder that all clients engage in many useful things even in times of overwhelming
difficulties. Even in the midst of despair, many clients do manage to get out of bed, get dressed, feed their children,
and do many other things that require major effort. Coping questions such as “How have you managed to carry
on?” or “How have you managed to prevent things from becoming worse?” open up a different way of looking at
client’s resiliency and determination.
Consultation Break and Invitation to Add Further Information
Solution focused therapists traditionally take a brief consultation break during the 2nd half of each therapy session
during which the therapist reflects carefully on what has occurred in the session. Some time prior to the break, the
client is asked “Is there anything that I did not ask that you think it would be important for me to know?” During the
break, the therapist or the therapist and a team reflect carefully on all that has occurred in the session. Following that,
the client is complimented and usually offered a therapeutic message based on the client’s stated goal. Usually this
takes the form of an invitation for the client to observe and experiment with behaviors that result in positive
movement in the direction of the client’s identified goal.
Research Findings
Even though it is an inductively developed model, from its earliest beginnings there has been consistent interest in
assessing SFBT’s effectiveness. Given the clinical philosophy behind the SFBT approach, it is not surprising that
the initial research efforts relied primarily on client self reports. Since then, an increasing number of studies have
been generated, many with randomized
comparison groups, such as that of Lindforss and Magnusson who studied the effects of SFBT on the prison
recidivism in Hageby Prison in Stockholm, Sweden. Their randomized study compared those clients who received
average of five SFBT sessions and those who received their usual available services. Clients were followed at 12 and
16 months after discharge from prison. The SFBT group consistently did better than the control group.
A number of researchers have reviewed studies conducted in a variety of settings and geographical locations, with a
range of clients. Based on the reviews of these outcome studies, Gingerich and Eisengrat concluded that the studies
offered preliminary support that the SFBT approach could be beneficial to clients. However, more microanalysis
research into the co-construction process in solution-focused conversation is needed to develop additional
understanding of how clients change through participating in these conversations.
Yvonne Dolan, M.A. (Psychology), Executive Director, Institute for Solution-focused Brief Therapy, Hammond, IN 46323.
Suggested Readings and References
Berg, I.K. & Dolan, Y. (2001). Tales of solution: A collection of hope inspiring stories. New York: W.W. Norton.
Berg, I. K., & de Shazer, S. (1993). Making numbers talk: Language in therapy. In S. Friedman (Ed.), The new
language of change: Constructive collaboration in psychotherapy. New York: Guilford.
De Jong, P., & Berg, I.K.(2007). Interviewing for solutions (3rd Edition). Brooks/Cole: Pacific Grove.
De Shazer, S. (1984). The death of resistance. Family Process, 23, 79-93.
De Shazer, S. & Dolan, Y. with Korman, H , Trepper, T. S., McCollom, E., Berg, I. K. (2007). More Than Miracles: The
State of the Art of Solution-focused Brief Therapy. Binghamtom, N.Y: Haworth Press.
Gingerich, W., & Eisengrat, S. (2000). Solution-focused brief therapy: A review of the outcome research. Family
Process, 39, 477-498.
Lindforss, L. & Magnusson, D. (1997). Solution-focused therapy in prison. Contemporary Family Therapy: An
International Journal, 19, 89-1-3.
McGee, D., Del Vinto, A., & Bavelas, J. (2005). An interactional model of questions as therapeutic interventions.
Journal of Marital and Family Therapy, 31, 371-384.
CITATION - http://www.solutionfocused.net/solutionfocusedtherapy.html
REALITY THERAPY
Reality Therapy was developed by Willam Glasser MD. Reality Therapy is a counseling method which focuses on the
future. Its fundamental idea is that no matter what has happened in the past, our future is ours and success is based
on the behaviors we choose. Dr. Glasser began teaching Reality Therapy in 1965 and founded the Institute for
Reality Therapy in 1967. In 1996, it was renamed and is now the William Glasser Institute.
Reality therapy is based on choice theory and continues to evolve. It has become a technique widely studied and
embraced by people throughout the world. The principles of reality therapy extend to many different areas. It is
embraced by professionals, including counselors, educators, psychologists, psychiatrists, social workers, parents and
others.
Since unsatisfactory or non-existent connections with people we need are the source of almost all human problems,
the goal of Reality Therapy is to help people reconnect. This reconnection almost always starts with the
counselor/teacher first connecting with the individual, and then using this connection as a model for how the
disconnected person can begin to connect with the people he or she needs.
There are two major components to Reality Therapy...


create a trusting environment
employing techniques for helping a person discover what they really want
Creating such a relationship involves a number of considerations and practices....
Focus on the present and avoid discussing the past because all human problems are caused by unsatisfying
present relationships.
Avoid discussing symptoms and complaints as much as possible since these are the ways that counselees
choose to deal with unsatisfying relationships.
Understand the concept of total behavior, which means focus on what counselees can do directly-act and think.
Spend less time on what they cannot do directly; that is, change their feelings and physiology. Feelings and
physiology can be changed, but only if there is a change in the acting and thinking.
Avoid criticizing, blaming and/or complaining and help counselees to do the same. By doing this, they learn to
avoid these extremely harmful external control behaviors that destroy relationships.
Remain non-judgmental and non-coercive, but encourage people to judge all they are doing by the Choice
Theory axiom: Is what I am doing getting me closer to the people I need? If the choice of behaviors is not getting
people closer, then the counselor works to help them find new behaviors that lead to a better connection.
Teach counselees that legitimate or not, excuses stand directly in the way of their making needed connections.
Focus on specifics. Find out as soon as possible who counselees are disconnected from and work to help them
choose reconnecting behaviors. If they are completely disconnected, focus on helping them find a new
connection.
Help them make specific, workable plans to reconnect with the people they need, and then follow through on
what was planned by helping them evaluate their progress. Based on their experience, counselors may suggest
plans, but should not give the message that there is only one plan. A plan is always open to
revision or rejection by the counselee.
Be patient and supportive but keep focusing on the source of the problem, disconnectedness. Counselees who
have been disconnected for a long time will find it difficult to reconnect. They are often so involved in the
symptom they are choosing that they have lost sight of the fact that they need to reconnect. Help them to
understand, through teaching them Choice Theory and encouraging them to read the book, Choice Theory: A
New Psychology of Personal Freedom, that whatever their complaint, reconnecting is the best possible solution
to their problem.
As Reality Therapy has at its foundation Choice Theory, such an understanding is essential for the success of
applying Reality Therapy.
Choice Theory® states that all we do is behave, that almost all behavior is chosen, and that we are driven by our
genes to satisfy five basic needs: survival, love and belonging, power, freedom and fun. In practice, the most
important need is love and belonging, as closeness and connectedness with the people we care about is a requisite
for satisfying all of the needs. Choice Theory (and the Seven Caring Habits) is offered to replace external control
psychology (and the Seven Deadly Habits), the present psychology of almost all the people in the world.
Unfortunately, this forcing, punishing psychology is destructive to relationships. When used in a relationship, it will
always destroy the ability of one or both to find satisfaction in that relationship, and will result in people becoming
disconnected from those with whom they want to be connected. Disconnectedness is the source of almost all human
problems, such as what is called mental illness, drug addiction, violence, crime, school failure, spousal and child
abuse, to mention a few.
Students of Reality Therapy find the structures it gives their counseling to be clear, efficient and straightforward.
Reality Therapy emphasizes the client's responsibility and self-empowerment. A positive change in behavior is often
realized in clients of Reality Therapy.
CITATION: http://www.journalofrealitytherapy.com/realitytherapy.htm
BEHAVIORAL THERAPY
As the name implies, this approach focuses on behavior-changing unwanted behaviors through rewards,
reinforcements, and desensitization. Desensitization, or Exposure Therapy, is a process of confronting something
that arouses anxiety, discomfort, or fear and overcoming the unwanted responses. Behavioral therapy often involves
the cooperation of others, especially family and close friends, to reinforce a desired behavior.
RECAP
Biomedical Treatment:
Medication alone, or in combination with psychotherapy, has proven to be an effective treatment for a number of
emotional, behavioral, and mental disorders. The kind of medication a psychiatrist prescribes varies with the disorder
and the individual being treated.
Cognitive Therapy:
This method aims to identify and correct distorted thinking patterns that can lead to feelings and behaviors that may
be troublesome, self-defeating, or even self-destructive. The goal is to replace such thinking with a more balanced
view that, in turn, leads to more fulfilling and productive behavior.
Cognitive/Behavioral Therapy:
A combination of cognitive and behavioral therapies, this approach helps people change negative thought patterns,
beliefs, and behaviors so they can manage symptoms and enjoy more productive, less stressful lives.
Couples Counseling and Family Therapy:
These two similar approaches to therapy involve discussions and problem-solving sessions facilitated by a therapistsometimes with the couple or entire family group, sometimes with individuals. Such therapy can help couples and
family members improve their understanding of, and the way they respond to, one another. This type of therapy can
resolve patterns of behavior that might lead to more severe mental illness. Family therapy can help educate the
individuals about the nature of mental disorders and teach them skills to cope better with the effects of having a
family member with a mental illness-such as how to deal with feelings of anger or guilt.
Electroconvulsive Therapy:
Also known as ECT, this highly controversial technique uses low voltage electrical stimulation of the brain to treat
some forms of major depression, acute mania, and some forms of schizophrenia. This potentially life-saving
technique is considered only when other therapies have failed, when a person is seriously medically ill and/or unable
to take medication, or when a person is very likely to commit suicide. Substantial improvements in the equipment,
dosing guidelines, and anesthesia have significantly reduced the possibility of side effects.
Group Therapy:
This form of therapy involves groups of usually 4 to 12 people who have similar problems and who meet regularly
with a therapist. The therapist uses the emotional interactions of the group's members to help them get relief from
distress and possibly modify their behavior.
Interpersonal Psychotherapy:
Through one-on-one conversations, this approach focuses on the patient's current life and relationships within the
family, social, and work environments. The goal is to identify and resolve problems with insight, as well as build on
strengths.
Light Therapy:
Seasonal affective disorder (SAD) is a form of depression that appears related to fluctuations in the exposure to
natural light. It usually strikes during autumn and often continues through the winter when natural light is reduced.
Researchers have found that people who have SAD can be helped with the symptoms of their illness if they spend
blocks of time bathed in light from a special full-spectrum light source, called a "light box."
Play Therapy:
Geared toward young children, this technique uses a variety of activities-such as painting, puppets, and dioramas-to
establish communication with the therapist and resolve problems. Play allows the child to express emotions and
problems that would be too difficult to discuss with another person.
Psychoanalysis:
This approach focuses on past conflicts as the underpinnings to current emotional and behavioral problems. In this
long-term and intensive therapy, an individual meets with a psychoanalyst three to five times a week, using "free
association" to explore unconscious motivations and earlier, unproductive patterns of resolving issues.
Psychodynamic Psychotherapy:
Based on the principles of psychoanalysis, this therapy is less intense, tends to occur once or twice a week, and
spans a shorter time. It is based on the premise that human behavior is determined by one's past experiences,
genetic factors, and current situation. This approach recognizes the significant influence that emotions and
unconscious motivation can have on human behavior.
CITATION: http://counsellingresource.com/types/traditional.html
PSYCHOANALYTIC THERAPY
Psychoanalytic psychotherapy usually requires two to four, but no fewer than two sessions per week, in order both to
explore transference developments and to follow the changing reality of the patient’s daily life. It is not possible to
carry out these tasks with patients with severe psychopathology on a schedule of weekly sessions: on a once-weekly
session, the time would either be utilized completely by updating the therapist of developments in the patient’s life,
thus precluding transference analysis, or else, systematic transference analysis under these circumstances may
foster the splitting off of important developments (and acting out) in the patient’s external life situation. Psychoanalytic
psychotherapy should be carried out in ‘face-to-face’ sessions that permit highlighting the communication of the
patient’s non-verbal behavior—a predominant mode of communication in severe personality disorders—and facilitate
the therapist’s simultaneous attention to (a) the patient’s communication of subjective experience by means of free
association, (b) the communication by means of non-verbal behavior, (c) the therapist’s counter transference
analysis. As in psychoanalysis, the combined analysis by the analyst of the information coming from these three
sources permits the establishment of a ‘selected fact’ (Bion, 1968, 1970), signaling the main thrust of interpretation.
Psychoanalytic psychotherapy thus does not dilute the ‘gold’ of psychoanalysis with the ‘copper’ of support, but
maintains an essentially psychoanalytic technique geared to analyze unconscious conflicts activated in the
transference within a modified framework, spelled out and explicitly agreed to by the patient in advance. The attention
to developments in the patient’s external life represents a modified focus from the standard psychoanalytic approach,
in contrast to the ‘goallessness’ of each psychoanalytic hour within an ego-psychological framework, or the ‘absence
of memory and desire’ (Bion, 1967) within a Kleinian framework. Concern regarding the patient’s external life in
psychoanalytic psychotherapy also extends to the maintenance of alertness to the relationship between transference
developments and the long-range treatment goals, that is, attention to the extent to which the treatment itself, as a
sheltered haven, may acquire secondary gain functions as a protection against external reality in the case of patients
with severe psychopathology (Kernberg et al., 1989).
SUPPORTIVE THERAPY
Supportive psychotherapy, originally conceived of as the treatment of choice for patients with severe personality
disorders, may now be considered the alternative treatment for those patients with severe personality disorders who
are unable to participate in psychoanalytic psychotherapy. The Menninger Foundation Psychotherapy Research
Project showed that patients with the least severe psychoneurotic disturbances tend to respond very positively to all
three modalities derived from psychoanalytic theory, although best to standard psychoanalysis (Kernberg et al.,
1972). Supportive psychotherapy based on psychoanalytic theory may also be defined along the lines of the three
major techniques mentioned. Regarding interpretation, supportive psychotherapy utilizes the preliminary steps of
interpretive technique, that is, clarification and confrontation, but does not use interpretation per se. In contrast, it
utilizes cognitive and emotional support, that is, statements of the therapist that tend to reinforce adaptive
compromises between impulse and defense by means of the provision of cognitive information (such as persuasion
and advice) and by means of emotional support (including suggestion, reassurance, encouragement and praise). In
addition, supportive psychotherapy utilizes direct environmental intervention, by the therapist, relatives, or other
mental health personnel engaged in auxiliary therapeutic functions (Rockland, 1989).
NEURO-FEEDBACK/BIOFEEDBACK
Learning to control muscle tension and "involuntary" body functioning, such as heart rate and skin temperature, can
be a path to mastering one's fears. It is used in combination with, or as an alternative to, medication to treat disorders
such as anxiety, panic, and phobias. For example, a person can learn to "retrain" his or her breathing habits in
stressful situations to induce relaxation and decrease hyperventilation. Some preliminary research indicates it may
offer an additional tool for treating schizophrenia and depression.
CITATION: http://counsellingresource.com/types/alternative.html
GUIDED IMAGERY OR VISUALIZATION
This process involves going into a state of deep relaxation and creating a mental image of recovery and wellness.
Physicians, nurses, and mental health providers occasionally use this approach to treat alcohol and drug addictions,
depression, panic disorders, phobias, and stress.
CITATION: http://counsellingresource.com/types/alternative.html
DIALECTICAL BEHAVIOR THERAPY
Dialectical behavior therapy (DBT) is a type of cognitive behavioral therapy. Its main goal is to teach the patient skills
to cope with stress, regulate emotions and improve relationships with others.
DBT is derived from a philosophical process called dialectics. Dialectics is based upon the concept that everything is
composed of opposites and that change occurs when one opposing force is stronger than the other, or in more
academic terms: thesis, antithesis and synthesis.
The Three Fundamentals of Dialectical Behavior Therapy
1. Cognitive Behavioral Therapy
Learning new behaviors -- which can be anything a person thinks, feels or does -- is a crucial part of DBT. There are
four main strategies that are used to change behavior: skills training, exposure therapy, cognitive therapy, and
contingency management.
 Skills Training - Attending skills groups, doing homework assignments and role playing new ways of
interacting with people.
 Exposure Therapy - Exposing oneself to feelings, thoughts or situations which were previously feared and
avoided.
 Cognitive Therapy - Recognizing and reassessing patterns of negative thoughts and replacing them with
positive thoughts that more closely reflect reality.
 Contingency Management - Identifying how maladaptive behavior is rewarded and how adaptive behavior is
punished and using this knowledge to modify behavior in a positive way.
2. Validation
For patients with borderline personality disorder, the process of cognitive behavioral therapy can cause a great deal
of distress. The push for change feels to them as if it invalidates the emotional pain they are feeling. Linehan and her
team found that by offering validation along with the push for change, patients were more likely to cooperate and less
likely to suffer distress at the idea of change. The therapist validates that the person's actions "make sense" within
the context of his personal experiences without necessarily agreeing that they are the best approach to solving the
problem.
3. Dialectics
Dialectics makes three basic assumptions: (1) all things are interconnected (2) change is constant and inevitable and
(3) opposites can be integrated to form a closer approximation of the truth. In DBT, the patient and therapist are
working to resolve the seeming contradiction between self-acceptance and change in order to bring about positive
changes in the patient.
What Is Dialectical Behavior Therapy Used For?
DBT is designed for use by people who have urges to harm themselves, such as those who self-injure or who have
suicidal thoughts and feelings. It was originally intended for people with borderline personality disorder, but has since been
adapted for other conditions where the patient exhibits self-destructive behavior, such as eating disorders and substance
abuse.
CITATION: http://www.ask.com/bar?q=types+of+psychotherapy+&page=1&qsrc=2417&ab=7&u=http%
3A%2F%2Fdepression.about.com%2Fod%2Fpsychotherapy%2Fa%2Ftypes.htm
CLIENT-CENTERED THERAPY
Client-centered therapy, which is also known as person-centered, non-directive, or Rogerian therapy, is an approach to
counseling and psychotherapy that places much of the responsibility for the treatment process on the client, with the
therapist taking a nondirective role.
In client-centered therapy, the client determines the general direction of therapy, while the therapist seeks to increase the
client's insight and self-understanding through informal clarifying questions.
Process
Carl Rogers (The developer of Client-centered Therapy) believed that the most important factor in successful therapy was
not the therapist's skill or training, but rather his or her attitude. Three interrelated attitudes on the part of the therapist are
central to the success of client-centered therapy: congruence; unconditional positive regard; and empathy. Congruence
refers to the therapist's openness and genuineness—the willingness to relate to clients without hiding behind a
professional facade. Therapists who function in this way have all their feelings available to them in therapy sessions and
may share significant emotional reactions with their clients. Congruence does not mean, however, that therapists disclose
their own personal problems to clients in therapy sessions or shift the focus of therapy to themselves in any other way.
Unconditional positive regard means that the therapist accepts the client totally for who he or she is without evaluating or
censoring, and without disapproving of particular feelings, actions, or characteristics. The therapist communicates this
attitude to the client by a willingness to listen without interrupting, judging, or giving advice. This attitude of positive regard
creates a nonthreatening context in which the client feels free to explore and share painful, hostile, defensive, or abnormal
feelings without worrying about personal rejection by the therapist.
The third necessary component of a therapist's attitude is empathy ("accurate empathetic understanding"). The therapist
tries to appreciate the client's situation from the client's point of view, showing an emotional understanding of and
sensitivity to the client's feelings throughout the therapy session. In other systems of therapy, empathy with the client
would be considered a preliminary step to enabling the therapeutic work to proceed; but in client-centered therapy, it
actually constitutes a major portion of the therapeutic work itself. A primary way of conveying this empathy is by active
listening that shows careful and perceptive attention to what the client is saying. In addition to standard techniques, such
as eye contact, that are common to any good listener, client-centered therapists employ a special method called reflection,
which consists of paraphrasing and/or summarizing what a client has just said. This technique shows that the therapist is
listening carefully and accurately, and gives clients an added opportunity to examine their own thoughts and feelings as
they hear them repeated by another person. Generally, clients respond by elaborating further on the thoughts they have
just expressed.
According to Rogers, when these three attitudes (congruence, unconditional positive regard, and empathy) are conveyed
by a therapist, clients can freely express themselves without having to worry about what the therapist thinks of them. The
therapist does not attempt to change the client's thinking in any way. Even negative expressions are validated as legitimate
experiences. Because of this nondirective approach, clients can explore the issues that are most important to them—not
those considered important by the therapist. Based on the principle of self-actualization, this undirected, uncensored selfexploration allows clients to eventually recognize alternative ways of thinking that will promote personal growth. The
therapist merely facilitates self-actualization by providing a climate in which clients can freely engage in focused, in-depth
self-exploration.
CITATION: http://www.ask.com/bar?q=clientcentered+THERAPY&page=1&qsrc=2417&ab=2&u=http%
3A%2F%2Fwww.minddisorders.com%2FOb-Ps%2FPerson-centered-therapy.html
GESTALT THERAPY
Gestalt therapy is a humanistic therapy technique that focuses on gaining an awareness of emotions and behaviors
in the present rather than in the past. The therapist does not interpret experiences for the patient. Instead, the
therapist and patient work together to help the patient understand him/herself. This type of therapy focuses on
experiencing the present situation rather than talking about what occurred in the past. Patients are encouraged to
become aware of immediate needs, meet them, and let them recede into the background. The well-adjusted person
is seen as someone who has a constant flow of needs and is able to satisfy those needs.
Ideally, the patient identifies current sensations and emotions, particularly ones that are painful or disruptive. Patients
are confronted with their unconscious feelings and needs, and are assisted to accept and assert those repressed
parts of themselves.
The most powerful techniques involve role-playing. For example, the patient talks to an empty chair as they imagine
that a person associated with an unresolved issue is sitting in the chair. As the patient talks to the "person" in the
chair, the patient imagines that the person responds to the expressed feelings. Although this technique may sound
artificial and might make some people feel self-conscious, it can be a powerful way to approach buried feelings and
gain new insight into them.
Sometimes patients use battacca bats, padded sticks that can be used to hit chairs or sofas. Using a
battacca bat can help a patient safely express anger. A patient may also experience a Gestalt therapy marathon,
where the participants and one or more facilitators have nonstop group therapy over a weekend. The effects of the
intense emotion and the lack of sleep can eliminate many psychological defenses and allow significant progress to be
made in a short time. This is true only if the patient has adequate psychological strength for a marathon and is
carefully monitored by the therapist.
ART THERAPY
Drawing, painting, and sculpting help many people to reconcile inner conflicts, release deeply repressed emotions,
and foster self-awareness, as well as personal growth. Some mental health providers use art therapy as both a
diagnostic tool and as a way to help treat disorders such as depression, abuse-related trauma, and schizophrenia.
You may be able to find a therapist in your area who has received special training and certification in art therapy.
CITATION: http://counsellingresource.com/types/alternative.html
PSYCHO-EDUCATIONAL THERAPY
A treatment intended to teach people about their problem, how to treat it, and how to recognize signs of relapse so
that they can get necessary treatment before their difficulty worsens or recurs. Family psycho-education includes
teaching coping strategies and problem-solving skills to families, friends, and/or caregivers to help them deal more
effectively with the individual.
INSIGHT ORIENTED THERAPY
Insight Oriented Therapy helps the individual understand how patterns that are repeated in adult life actually have a
genesis in their formative years. Many people question why they are inclined to enter unhealthy relationships and
situations with the expectation of a different outcome. Cycles of repetition are a hallmark feature in people who have
problems with drugs/alcohol. In a nonjudgmental environment our therapists guide individuals in a variety of forums—
individual, group, art, and equine—in a process of illumination of the causes of these old patterns, essentially making
what was unconscious conscious. By helping individuals become aware of these underpinnings they have more
freedom to make healthier choices for themselves.
GUIDED INTERACTION THERAPY
GIT facilitates development of personal insight and immediate feedback through guided interaction with significant
others and/or the clinician.
Interaction Guidance (McDonough, 1992, Beebe, 2000) was created specifically to work with infants and mothers for
assessment and parenting skills instruction in interactive sessions. The treatment approach focuses on the infantcaregiver relationship rather than either the infant or the caregiver. Mother-child interactions in play are observed and
videotaped. The therapist reviews select scenes from the video with the child's mother and focuses on her parenting
strengths. Mothers are guided in learning to interact in attunement with the child's emotions and behavior. Research
evidences the effectiveness of this treatment method in treating infants with growth failure, pediatric disorders sleeping, feeding, elimination, excessive crying, and substance exposed and genetic disorders (McDonough &
Boukydis, 1993, 1995).
Guided Interaction with children and parents in play therapy integrates the methods and techniques of Developmental
Play Therapy (Brody, 1993), Experiential Play Therapy (Norton & Norton, 1997), and Child-Centered Play Therapy
(Axline, 1969, Landreth, 1991). With play interactions as the focus of intervention, the therapist forms therapeutic
relationships, engages parents and caregivers directly in therapeutic play sessions, provides didactic parenting
instruction, reinforces interactions of nurturing and protective parenting, and transitions the play therapy process to the
parents.
Developmental Play Therapy is based on attachment theory (Bowlby, 1988) and draws from the theoretical models of
Theraplay (Jernberg, 1979, DeLauriers, 1962)) and Touch Therapy (Field, 2003) in child-parent therapy. The
theoretical premise is that children who experience rich sensory experiences, nurturing physical affection and caring
touch in the child-parent relationship will develop a core sense of self and move toward healthy physical and socialemotional development (Brody, 1993). Developmental play provides children with critical developmental experiences
essential in child-parent attachment. Research evidences the efficacy of the use of caring touch and safe and
respectful physical affection with children.
Experiential Play Therapy extends the principles of the theoretical models of Relationship Play Therapy (Moustakas,
1959) and Child-Centered Play Therapy (Axline, 1969, Landreth, 1991). Experiential play therapy is reaching children
through interactive play and relating to children with depth on an experiential level. Entering a child's play and
interacting on an experiential level allows for immediate access to the child's emotional pain and facilitates movement
into earlier stages of development. Playing with the child defines and strengthens the therapeutic relationship. The
living relationship between the child and the therapist is the key and essential dimension in the child's therapeutic
process (Moustakas, 1959).
There are four phases in guided interaction with children and parents in play therapy. These include integrating parents
and caregivers in play sessions, guiding parents and caregivers in play sessions, consulting with parents and
caregivers, and transitioning interactive play and the play therapy process to the parents and caregivers.
Citation & Further Information and Techniques - http://playtherapyseminars.com/Articles.aspx
Parent-Child Interaction Therapy (PCIT) is an empirically-supported treatment [utilizing Guided Interaction Therapy]
for conduct-disordered young children that places emphasis on improving the quality of the parent-child relationship
and changing parent-child interaction patterns. In PCIT, parents are taught specific skills to establish a nurturing and
secure relationship with their child while increasing their child’s prosocial behavior and decreasing negative behavior.
This treatment focuses on two basic interactions: Child Directed Interaction (CDI) is similar to play therapy in that
parents engage their child in a play situation with the goal of strengthening the parent-child relationship; Parent
Directed Interaction (PDI) resembles clinical behavior therapy in that parents learn to use specific behavior
management techniques as they play with their child.~Excerpt from: http://pcit.phhp.ufl.edu
MOTIVATIONAL INTERVIEWING
Motivational interviewing is a collaborative, person--centered form of guiding to elicit and strengthen motivation for
change. It is an empathic, supportive counseling style that supports the conditions for change. Practitioners are careful
to avoid arguments and confrontation, which tend to increase a person's defensiveness and resistance.
Motivational interviewing is a proven and effective way to:
 Engage individuals with co-occurring disorders
 Develop therapeutic relationships
 Determine individualized goals
Motivational interviewing is used for the treatment of many conditions. Specific strategies have been successfully
applied to working with individuals with co-occurring disorders include:
 Assessing the person's perception of the problem
 Exploring the person's understanding of his or her condition
 Examining the person's desire for continued treatment
 Ensuring a person's attendance at initial sessions
 Expanding the person's perceptions for the possibilities of successful change
Research shows that motivational interviewing techniques, including counseling, assessment, multiple sessions, and
brief interventions, are associated with greater participation in treatment and positive treatment outcomes.
Creating Conditions for Change
Practitioners who use motivational interviewing project acceptance rather than censure, which helps free the person to
change. Empowering people is an important part improving motivation for change.
Motivational interviewing helps practitioners connect with an individual's intrinsic motivation to change by exploring and
resolving ambivalence. It also regards ambivalence to change as normal, expected behavior.
Motivation for change is created when a person recognizes discrepancies between their behavior and their personal
goals. The intent of motivational interviewing is to explore the discrepancies with the goal of reducing ambivalence and
identifying the individual's goals and priorities. In other words, motivational interviewing helps the person recognize the
difference between where they are and where they hope to be.
This approach accepts a person's level of motivation-whatever it is-as the starting point for change.
When to use motivational interviewing techniques
Motivational interviewing may be helpful at many stages of treatment. It is particularly helpful early in treatment or for
individuals who are experiencing problems but do not recognize the severity of their condition. It may be used during
the assessment process to determine the individuals' goals and functional level.
Motivational Interviewing and the Stages of Change
People go through a series of stages when they change health behavior. The stages are cognitive and behavioral. In
the early phases, people tend to focus on thinking about change-whether change is something they need to consider.
In later stages, people are actively doing things to change or maintaining the changes that they have been able to
make.
The Stages of Change Model has five phases:
 Pre-contemplation: Avoidance. That is, not seeing a problem behavior or not considering change.
 Contemplation: Acknowledging that there is a problem but struggling with ambivalence. Weighing pros and
cons and the benefits and barriers to change.
 Preparation/Determination: Taking steps and getting ready to change.
 Action/Willpower: Making the change and living the new behaviors, which is an all-consuming activity.
 Maintenance: Maintaining the behavior change that is now integrated into the person's life.
The Stages of Change Model describes five stages of readiness and provides a framework for understanding the
change process. By identifying where a person is in the change cycle, interventions can be tailored to the individual's
"readiness" to progress in the recovery process. Interventions that do not match the person's readiness are less likely
to succeed and more likely to damage rapport, create resistance, and impede change. Anything that moves a person
through the stages toward a positive outcome should be regarded as a success.
Motivation is multidimensional
Motivation is multidimensional and not easily assessed. In addition to readiness to change, practitioners should also
consider the key factors of "importance" and "self-efficacy." Importance is determined by what value a person places
on making the change. Self-efficacy is the belief or confidence in one's ability to achieve change.
When individuals think that change is beyond their capabilities, they may not try. People who are high on importance
but low on confidence need encouragement that change is possible. They also need specific ideas about how to do it.
This approach promotes engagement and allows greater self-efficiency and identifies the person's greatest needs and
goals.
Motivational Interviewing Skills and Techniques
Motivational Interviewing is an empathic, gentle, and skillful style of counseling that helps practitioners have productive
conversations with individuals with co-occurring and other disorders. Essential characteristics of motivational
interviewing include:
 Expressing empathy through reflective listening.
 Noting discrepancies between current and desired behavior.
 Avoiding argumentation and rolling with resistance.
 Encourage the consumer's belief that he or she has the ability to change.
 Communicating respect for and acceptance of people and their feelings.
 Establishing a nonjudgmental, collaborative relationship.
 Being a supportive and knowledgeable consultant.
 Complimenting rather than denigrating.
 Listening rather than telling.
 Gently persuading, with the understanding that change is up to the person.
 Providing support throughout the process of recovery.
This approach is different from pressuring a person through threats of negative health consequences, shame, or guilt.
The core communications skills of motivational interviewing -asking, informing, listening- are well suited to helping
people talk about, commit to, and undertake health behavior change. Empathy, hope, and respect provide the
foundation for what is possible in recovery from co-occurring disorders.
It is a crucial, collaborative conversation and joint decision-making process between the practitioner and person
receiving treatment. Ultimately, only the individual can make behavior and lifestyle changes to improve his or her
health. Motivational interviewing techniques include:

Asking open-ended questions

Using affirmations

Forming reflective statements

Providing a summaries
These core techniques are referred to as OARS .
Ask open-ended questions
Below are some examples of how you can ask open-ended questions.
 Invite individuals with co-occurring disorders to tell their story in their own words without leading them in a
specific direction.
 Elicit what is important to the individual.
 Establish rapport, gather information, and increase understanding.
 Demonstrate genuine interest and respect.
 Help the person go deeper and provoke thought. The practitioner's goal is to encourage thinking that envisions
a different future.
 Affirm a person's autonomy and self-direction.
 Provide opportunity to hear oneself speak.
 Asking sounds like:
 "How are things going?"
 "What is most important to you right now?"
 "Hmm... Interesting... Tell me more..."
 "How did you manage that in the past?"
 "How would you like things to be different?"
 "What will you lose/gain if you give up XXX?"
 "What do you want to do next?"
 "How can I help you with that?"
Use Affirmations
Providers can empower individuals by using language that affirms their strengths. Examples of Affirmations include:
 "I'm really glad you brought that up."
 "I think what you are doing is really difficult. I'm really proud to be working with you on this."
 "So many people avoid seeking help. It says a lot about you that you are willing to take this step."
 "What have you noticed about yourself in the past few months since you started coming here?" This question
is designed to prompt the consumer to self-affirm.
Form Reflective Statements
Practitioners can show individuals that they are listening and understand issues from their perspective by using
reflective statements. The use of reflective statements also allow individuals to hear their own words and resolve
ambivalence. Depending on the individual's stage of change, practitioners may use different types of reflective
statement.
Provide Summaries
Summaries can be used for multiple purposes. For example, summaries can be used to:
 Highlight important aspects of the discussion
 Shift the direction of conversations that become "stuck"
 Highlight both sides of an individual's ambivalence about change
 Communicate interest and understanding of an individual's perspective
INTEGRATED TREATMENT
Effective treatments exist for people with co-occurring disorders. Integrated Treatment for Co-occurring Disorders is an
evidence-based approach to care, which recognizes that individuals go through different stages on their way to
recovery. Treatment tailored to this process is called stage-wise treatment, and it is a key component of integrated
treatment programs.
Stage-Wise Treatment: A Key Component in an Evidence-based Approach to Treating Co-occurring Disorders
For people with mental and substance use disorders, access to effective treatment can be the difference between a
stable recovery and a prolonged struggle. Unfortunately, many individuals with co-occurring disorders receive
fragmented or incomplete treatment. Some people receive no treatment at all.
Stage-wise treatment can help people achieve recovery
Stage-wise treatment guides individuals with co-occurring disorders through four stages of treatment:
 Engagement
 Persuasion
 Active treatment
 Relapse prevention
Integrated treatment specialists—practitioners trained to treat both substance use disorders and mental illness—work
closely with individuals as they move through the stages. After establishing a trusting relationship with an individual,
the integrated treatment specialist assesses the individual's stage and collaborates with him or her to tailor practical
and intensive treatments.
Treating co-occurring disorders in this stage-wise fashion can help people achieve recovery. However, change is not
an easy process. Some individuals with co-occurring disorders move through treatment stages one-by-one, while
others go back and forth between stages before achieving stable remission from substance use.
Stage-wise treatment is designed to accommodate these differences. Integrated treatment specialists are prepared to
adjust treatment on a continual basis. This flexibility helps individuals achieve their goals, wherever they are in the
process.
Practitioners and individuals work together through the stages of treatment
Stage-wise treatment provides individuals with services specific to each stage of treatment. In the opening stage,
integrated treatment specialists strive to establish a trusting relationship with the individuals they treat. Practitioners call
this relationship a working alliance. By the final stage, both parties are working well together to achieve treatment goals
and maintain abstinence.
The process begins in the engagement stage, before individuals are ready for treatment. In fact, sometimes people
with co-occurring disorders do not believe they have a problem. In response, integrated treatment specialists seek to
engage individuals in the treatment process. In this stage, practitioners:
 Reach out and listen to people
 Work to understand how they see their situation
 Help them with immediate needs
 Assess their co-occurring disorder
These tasks can be challenging, as engagement often begins in the context of a crisis.
In the persuasion stage, the individual and the integrated treatment specialist form a trusting relationship and start
working together. The practitioner interviews and helps the individual think about substance use, mental illness, and life
goals. The practitioner also continues to assess the individual, sometimes meeting with family and friends.
The third stage is active treatment, when individuals see their substance use as a problem and start making positive
changes, such as stopping use, making new friends, or joining a self-help group. The integrated treatment specialist
offers support and help with important social skills.
Individuals are in the fourth stage, relapse prevention, when they have been abstinent for six months or more. Here
the individual and the practitioner work together to create a relapse prevention plan. They also build on positive
behaviors and relationships going forward.
Stage-wise treatment is not a failure if a person relapses—even a person who achieves a long period of sobriety.
Relapses are a natural part of behavior change. Practitioners are trained to work with individuals and continue
treatment if they relapse.
Evidence-based practices are at the core of stage-wise treatment
From the earliest moments of the treatment process through sustained periods of remission, integrated treatment specialists
use numerous evidence-based tools and practices that can help make treatment a success. Treatment includes:
 Integrated screening and assessment techniques
 Treatment planning strategies
 Motivational interviewing
 Cognitive behavioral therapy
 Peer support

Stage-wise treatment helps people build meaningful lives
Most people with co-occurring disorders want to recover and pursue meaningful goals. For many individuals, stagewise treatment provides a path to recovery—a process that can drastically improve the quality of their lives.
Sources:
http://www.samhsa.gov/co-occurring/topics/training/motivational.aspx
http://www.samhsa.gov/co-occurring/topics/training/change.aspx
http://www.samhsa.gov/co-occurring/topics/training/skills.aspx
http://www.samhsa.gov/co-occurring/topics/training/stage-wise-treatment.aspx