The relationship between integrative and Islamic counselling

Integrative counselling is a valuable tool. However, it only considers the client within a social and natural framework. Islamic counselling on the other hand, utilizes the major tenets of integrative counselling, but adds to them an added dimension. This is the relationship between the client and his/her creator. In this paper I aim to draw out areas of commonality between integrative and Islamic counselling and highlight the main difference between these two therapeutic approaches.     

Cognitive-Behavioral Treatment of Panic Disorder: Confronting Situational Precipitants

Panic Disorder is a common, debilitating psychological problem which is often effectively treated through cognitive behavioral approaches. Cognitive-behavioral treatment incorporates education, relaxation training, cognitive therapy, behavioral exposure, and relapse prevention treatment strategies. A case illustration demonstrates how cognitive-behavioral treatment facilitated a client's ability to identify and confront situational precipitants to panic in a gradual and systematic manner. A therapeutic and collaborative relationship provided the foundation for treatment, while education helped the client to understand the vicious cycle between somatic symptoms, catastrophic thoughts, and anxiety. Passive relaxation training incorporated deep breathing, muscle relaxation, and positive imagery generated from the client's own experience. Cognitive restructuring involved identifying automatic thoughts related to panic, challenging dysfunctional beliefs associated with the client's depression and low self-esteem, and generating alternative ways of thinking. Behavioral exposure (e.g., imaginal exposure, behavioral rehearsal, in vivo techniques) helped the client gain a greater sense of mastery over panic attacks triggered by his fear of hypodermic needles. Over the course of treatment, the frequency and intensity of the client's panic attacks decreased. Furthermore, the client's sense of mastery over panic had beneficial effects on his mood and self-esteem. Treatment gains were maintained at one-year follow-up.     

Tools for Change

Abstract

This paper discusses the ways in which one may incorporate political action into a client's therapy process so the client may incorporate it into her/his life. A framework for defining this as ethical, therapeutic and necessary to the client is presented. A number of suggestions for helping clients and therapists to become more politically active, as well as vignettes demonstrating how this might work with clients in the therapy process are provided.     

Cognitive behaviour therapy approach to assessing dysfunctional thoughts

Research shows that the client who is emotionally distressed will have many negative or dysfunctional thoughts. Some of these thoughts are irrelevant or less important to the patient's problem. This means that some thoughts are more central to the client's problem than the others. Among these relevant central thoughts, one thought is hypothesed to be the most central to the client's problem. This is known as a critical thought and should be the most appropriate cognitive target for intervention. In addition, this paper suggests that the therapist/nurse should treat each of the expressed emotions relating to a negative event as a separate entity for assessment. Rationale and clinical strategies for the assessment, particularly on the identification of the critical thought, are discussed.     

Automatic classification of dysfunctional thoughts: a feasibility test.

The identification of dysfunctional thoughts is a central effort in cognitive therapy. This paper describes the first version of a computer module that classifies dysfunctional thoughts automatically. It is part of COGNO, a system we are developing to give automatic feedback on dysfunctional thoughts. The system uses rules that were developed from language markers identified in a sample of 149 dysfunctional thoughts. The system was tested with an independent set of 112 example thoughts. The system detects the majority of dysfunctional thoughts, but works reliably only for some thought categories. Automatic thought classification may be a first step toward developing natural dialogue systems in cognitive therapy.     

Automatic classification of dysfunctional thoughts: A feasibility test

The identification of dysfunctional thoughts is a central effort in cognitive therapy. This paper describes the first version of a computer module that classifies dysfunctional thoughts automatically. It is part of COGNO, a system we are developing to give automatic feedback on dysfunctional thoughts. The system uses rules that were developed from language markers identified in a sample of 149 dysfunctional thoughts. The system was tested with an independent set of 112 example thoughts. The system detects the majority of dysfunctional thoughts, but works reliably only for some thought categories. Automatic thought classification may be a first step toward developing natural dialogue systems in cognitive therapy.     

Working With the Suicidal Client Who Also Abuses Substances

Substance use disorders and suicidal thoughts and behaviors commonly co-occur in adolescent and adult psychiatric populations and are often functionally interrelated. Although the evidence base for treatment of this population is sparse, integrated cognitive behavioral treatment (CBT) protocols, or those that rely heavily on CBT techniques, hold promise. In this paper, we provide an overview of the evidence-based literature for interventions that target suicidal behavior and substance use disorders with adults and adolescents. We then discuss the manner in which these behaviors may be functionally interrelated and offer a conceptual framework (S-O-R-C) to guide case conceptualization and treatment planning for clients with co-occurring suicidality and substance use disorders. Next, we provide a case example of a client with suicidal behavior and an alcohol use disorder and demonstrate how to apply an integrated CBT treatment protocol to this case. This case example is followed by a more general discussion about the potential advantages of integrated CBT protocols for suicidality and substance use disorders, guidelines for prioritizing treatment targets and skill selection for each individual client, and other important treatment considerations. We conclude with recommendations for future research in this area.     

Inhibiting the mentalizing capacities

This paper describes a phobic patient who inhibited her capacity to mentalize defensively in situations when emotionally overwhelmed. When provoked by anxiety, she used the ‘silencing-method’, not reflecting on her internal world or her relationships. In order to avoid painful thinking, she stopped mentalizing and used practical or physical activities as a psychic retreat from an unpleasant reality. In psychoanalysis, she developed a growing tolerance to conceiving her own mental states However, even after several years of analysis, inhibiting her mentalizing capacities remained her defensive strategy. This paper suggests that phobia could be understood as an intolerance of conceiving mental states, preventing integration of psychic trauma. Improvement of the mentalizing capacities through psychoanalysis makes phobic symptoms fade.     

Behind the Mirror: Reflective Listening and its Tain in the Work of Carl Rogers

Although Rogerian reflective listening is considered a fundamental therapeutic practice, it is widely misunderstood. This article endeavors to dispel myths about Rogers’ reflective approach through detailed readings of his work, while also opening up a central problematic in Rogers’ thinking. Rogers struggled repeatedly with the dilemma of how the therapist can faithfully reflect the client's experience while avoiding insincerity. The metaphor of a mirror and its tain, or back surface, is used to guide a close analysis of how Rogers grappled with the tension between the therapist's reflective listening process and his or her inner experience while reflecting. It is shown that each of Rogers’ revisions of his conceptualization of reflective listening constitutes a dialectical shift that opens a different approach to the problem of the tain, eventually concluding in an interactional formulation of reflection as the provision of tentative therapist understandings designed to be amended in response to client feedback.     

Psychotherapy without the self–a Buddhist perspective,by Mark Epstein

This article seeks to explore how John Rolland's Family Systems Illness Model can be utilized by counselling psychologists working with individuals or families experiencing medical problems. Based on systemic theory the model provides a psychosocial typology of illness and examines how the demands of an illness over time can provide a number of hurdles to be overcome by the client and his/her family. Specific examples and techniques are described to illustrate how the application of the model can be used to guide the interventions employed in a counselling session. the model applies a biopsychosocial approach to health care, and the applicability of this within a British NHS healthcare setting is discussed with the conclusion that such an approach may be in its infancy in this country. Limitations and ideas for expansion of the model from chronic physical illness into spheres of mental health are discussed.     

The Use of Empirically Supported Strategies for Building a Therapeutic Relationship With an Adolescent With Oppositional-Defiant Disorder

Manualized evidence-based treatments, particularly behavioral and cognitive-behavioral interventions, have been found efficacious for the treatment of adolescents with oppositional-defiant disorder (ODD). However, despite research that underscores the importance of the therapeutic relationship for the success of treatment, manuals do not adequately address how a therapist should engage an adolescent and his/her family in treatment. This paper demonstrates how to utilize findings from the empirical literature on youth and parent engagement when delivering evidence-based treatment to an adolescent diagnosed with ODD. Examples of strategies for engaging adolescents and parents in treatment are provided.     

Tuning into the psychotic wavelength: Psychoanalytic supervision for mental health professionals

In this paper, material is presented from supervision groups run for mental health professionals in different mental health settings. I will argue that a psychoanalytic framework, which puts the transference and countertransference at the centre of clinical practice, offers an important model for thinking about psychosis and psychotic means of communication. When staff are able to ‘tune in’ to their patients' communications it can help to change a patient's monologue about his/her delusional world into a meaningful dialogue about their emotional world.     

A CBT-based therapeutic alternative to working with complex client problems

This paper offers a therapeutic alternative to working with complex client problems, based on a cognitive behavioural therapy (CBT) approach, which is informed by a combination of schema-focussed cognitive behavioural therapy (McGinn and Young 1996; Young 1994; Padesky 1994; Pretzer and Fleming 1989), specialized cognitive behaviourally-focussed trauma therapy (Herbert 1996, 2001, 2002a, 2002b; Herbert and Wetmore 1999, 2001), eye movement desensitization and reprocessing techniques (EMDR – Shapiro 1995) and mindfulness techniques (Bennett-Goleman 2001; Teasdale et al. 1995; Kabat-Zinn 1994; Linehan 1993). This paper attempts to illustrate how such an approach might be applied to working with complex client problems, such as Tracey's, by addressing some of the therapeutic issues that have been highlighted in the original case study of Tracey by her therapist and introducing an alternative understanding of these.     

Divergent ethical perspectives on the duty-to-warn principle with HIV patients

This article presents the case of an HIV-positive client who reported having sexual relations with an unknowing partner. The issue raised is whether the therapist was required to warn the unknowing partner, similar to the Tarasoff mandate that is imposed on therapists. The case is analyzed from an ethical framework similar to that presented by Beauchamp and Childress (1994). Two opinions are presented, each leading to different conclusions about whether the therapist should inform the unknowing partner. It is concluded that although such analysis is valuable in aiding the therapist in his or her decision-making process, no clear professional standard for the management of the problem is evident.     

Response to Lazarus's " How Certain Boundaries and Ethics Diminish Therapeutic Effectiveness"

This article presents the case of an HIV-positive client who reported having sexual relations with an unknowing partner. The issue raised is whether the therapist was required to warn the unknowing partner, similar to the Tarasoff mandate that is imposed on therapists. The case is analyzed from an ethical framework similar to that presented by Beauchamp and Childress (1994). Two opinions are presented, each leading to different conclusions about whether the therapist should inform the unknowing partner. It is concluded that although such analysis is valuable in aiding the therapist in his or her decision-making process, no clear professional standard for the management of the problem is evident.     

Pastoral counseling with alcoholics and their families

The pastor is often in contact with the alcoholic and his or her family. Providing help to alcoholics and their families is a spiritual, humanistic, and therapeutic challenge. Recent developments have favored a family systems orientation to working with alcoholic families. This orientation acknowledges the family as contributor to maintaining alcoholic behavior and includes the family in treatment. Specific family systems concepts are discussed and how they relate to the dysfunctional unit which houses an alcoholic. Implications for pastors and specific role definitions are explored. Krebs' therapeutic model is expanded to: 1) evaluate, 2) support, 3) refer, and 4) support, as appropriate for the pastor working with alcoholics and their families.     

The ego according to Klein: return to Freud and beyond

This paper explores fundamental dimensions of Melanie Klein's concept of the ego through a detailed study of the writings of Klein and her early colleagues (Paula Heimann, Susan Isaacs and Joan Riviere). The study examines three central issues: (a) the basic theoretical framework for Klein's conceptualization of the ego, and specifically how her conceptualization builds on Freud's structural and dual instinct models; (b) the processes involved in the development of the ego and its capacities (including the development from id to ego and from ego to superego); and (c) the view of the ego as an object of phantasy. Through this examination, the study demonstrates that Klein's conceptualization of the ego is firmly grounded both in Freud's formulations about the ego and in his theoretical and metapsychological approach to thinking about the ego. This counters the prevalent view that Klein was only focused on clinical understandings, unconcerned with theory and fuzzy in her abstract thinking. More specifically, it counters the view that Klein did not really have a concept of the ego in any well-structured sense of the term (Britton, 2003; Hinshelwood, 1994; Segal, 2001). The study considers the sources of these misconceived views. Finally, it argues that discarding such views allows us to appreciate better the richness of Klein's thinking, her theoretical affinities to Freud, and the role of theory in the development and justification of psychoanalysis.     

Professional beliefs related to the practice of pediatric medicine and school psychology

This article proposes that pediatric medicine and school psychology are complementary fields. Five professional beliefs are reviewed: (a) the importance of classification, (b) a preference for evidence-based interventions, (c) an endorsement of advocacy in public policy, (d) the importance of working with the whole child including his/her parents, and (e) an assertion of team leadership. Each belief is discussed as a core value of pediatric medicine and considered for points of connection with school psychology. Some of these beliefs are widely shared by school psychologists, others are rejected because of historical and situational factors, and all warrant consideration in light of school psychology's continuing evolution.