1.

FREUDS THEORY OF PSYCHOLOGICAL FUNCTIONING:

Five (5) of Freuds fundamental assumptions and/or principles on which he based his
theory of psychological functioning are:
Determinism is the principle that holds that psychological events are related to one
another and to an individuals past. These events are not random, haphazard, or
accidental, but are connected to thoughts and feelings that are causally related. The
relation between past events and current mental processes may be completely
unconscious.
For example, psychological maturity can only be gained by the capacity to need
others, to demonstrate love, and the desire to please and become like others. Gaining this
psychological maturity depends upon events related to ones childhood. Traumatic
experiences in childhood or poor interpersonal relations can unconsciously damage the
individual as to lead to severe forms of pathology known as narcissistic disorders
(instinctual drives centered mainly on the self), borderline states, and psychoses. (Arlow,
2000).
The Topographical Principle refers to the layering of the contents of the mind
according to how each layer is accessible to an individuals conscious mind or awareness.
For example, the conscious, preconscious, and unconscious are topographic concepts.
Consciousness results from perceptions of outside stimuli along with internal
psychological functioning. The preconscious consists of the contents of the mind, which
become accessible once attention is drawn to them. Finally, the unconscious comprises

that part of the mind that holds instinctual wishes, which Freud interpreted to be sexual in
nature. (Arlow, 2000).
The Structural Principle was Freuds belief in a structural organization of the mind.
In other words, the mind is organized according to how the structural groups of the mind
participate in conflict.
For example, Freud named these subdivisions or structural groups of the mind the ego,
the id, and the superego. The ego is that structure of the mind that is the mediator
between ones internal and external forces. The ego fulfills drives, yet with proper regard
for conscience and the realities of the world. The id controls the instinctual pressures on
the mind, such as sexual and aggressive impulses. The superego is that portion of the
structure that has been split-off (Arlow, 2000, p.25) from the ego, and consists of early
childhood moral training dealing with important childhood identifications and ideals.
(Arlow, 2000).
The Dynamic Principle refers to the interplay of the forces of the mind that consist of
sexual and aggressive impulses. These forces may be acting in unison or against one
another, however, they eventually find compromise in the form of expression.
For Example, the sexual impulse or the libidinal theory is driven by the unconscious.
The libido drive is that which seeks gratification, and ultimately, survival of the species.
The aggressive impulse or Thanatos is a counterbalance to the libidinal theory. Thanatos
is what Freud believed was a biological instinct toward death and destruction. In recent
years, however, this theory has nearly disappeared as a psychoanalytic concept. (Arlow,
2000).

The Genetic Principle recognizes how the past influences current mental activity, and
how those past influences shape current thoughts, behaviors, and feelings. The Genetic
principle theorizes that we never get over our childhood. This principle is based on
empirical findings and is intertwined with the fact that the human infant has a long period
of biological dependence. During this biological dependence, experiences and events in
childhood ultimately influence and shape personality structures later in life.
There are three (3) phases of development that are examples of the Genetic Principle:
the oral phase, the anal phase, and the phallic phase. The oral phase extends from birth to
approximately eighteen (18) months and centers around oral gratification, such as feeding
which in turn produces a satiated state. This induces sleep and freedom from tension.
The greatest danger in this phase is that the mother will not be available. It has been
observed that if there is frustration during the oral phase, individuals may turn out to be
pessimists and may have unconscious wishes and dreams later in life of chopping,
devouring, and then swallowing. (Arlow, 2000).
The anal phase occurs between the ages of eighteen (18) months and three (3) years
and concerns libidinal gratification. During this phase, the child is very interested in
bodily functions, and the excretions these functions produce. During this phase the
greatest danger is losing the mothers love. During potty training, should a child feel
ashamed of his or her interest in feces and the like, this may result in low self-esteem.
Further, later in life the child may display obsessive-compulsive behavior, such as having
to be meticulously clean, extremely punctual, and overly cautious with his or her
possessions. (Arlow, 2000).

The phallic stage occurs after the third year of life, when the libidinal gratification
shifts to the genitals, and the principal object of interest is the penis for both boys and
girls. Further, this is the phase that many girls realize the pleasurable stimulation
achieved by the clitoris and vagina. This is the phase in which children want to love and
possess those who give them pleasure; they become curious about the differences
between the sexes and how life begins. The principal danger in this phase is the childs
fear of castration. This is the phase in which hostile wishes or fantasies may develop
using the penis as a weapon of aggression, which gives rise to a fear of retaliation
directed at the penis. (Arlow, 2000).

2. CONCEPTS RELATED TO ADLERIAN PSYCHOTHERAPY:

For Adler, the family constellation is the primary social environment. Every child
competes for a position, or significant place, within the family constellation. The childs
birth order, sex, physical capabilities, etcetera, play a large part in where the childs place
will be within this constellation. Adlerians put emphasis on the family constellation in
terms of psychological position, and believe the relationships and positions within the
constellation can only be fully understood when the family climate and total
configuration of the conditions in the family are understood.
Adlerians believe that discouragement is the genesis of neurosis. Individuals may
discourage finding a solution, or being successful, through avoidance of a particular task.
For example, Students, fearful of failing examinations, will refrain from studying. In
the event they do fail, they merely have to hold that they were lazy or neglectful, but not
stupid. (Mosak, 2000, p. 67).
Life-style refers to the convictions one develops early in life to help deal with life
experiences. Further, life-style is the way a person perceives himself or herself in
relation to the way they perceive life. In this respect, a life-style is neither right nor
wrong and usually remains constant throughout ones life unless one has a change of
conviction that would warrant a change in life-style. Life-style is non-conscious and
comprises cognitive rather than behavioral organization. The patient in therapy brings

with them their life-style, and according to what that life-style is, expects the same
response from the therapist as others give him or her.
Superiority is another Adlerian concept. If one feels inferior or that the world is a
hostile place, they may strive for superiority. It is one of the central strivings of human
beings, and one may attempt to achieve superiority through .... over compensation,
wearing a mask, withdrawal, attempting only safe tasks where the outcome promises to
be successful, and other devices for protecting self-esteem. (Mosak, 2000, p. 56).
When a psychotic individual strives for superiority, his or her goal is beyond what any
human could attain. In his struggle, the psychotic loses interest in himself and others and
all common sense becomes useless.
A neurotic symptom is displayed when an individual knows what they should do or
feel, but just cant, or more likely, wont, in order to protect their self-esteem. Adler
found these types of individuals were quite capable of certain behaviors and feelings,
however, they would come up with excuses such as being sick, or incapable, etcetera, to
avoid certain behaviors, all mainly due to their fear of failure. Adlerians believe that
discouragement, as discussed above, is the genesis of such neurotic symptoms.
The psychological position is that which a child takes within the family, or family
constellation (as discussed above), rather than position based on birth order or any other
physical factor. The psychological position within the family, or family constellation (as
discussed above), is emphasized by Adlerians as it is believed the relationships and
positions within the family can only be fully understood when the psychology of the
family climate and total configuration of the conditions in the family are understood.

Further, Adlerians do not recognize a causal relationship between family position and
sibling traits.
Another Adlerian concept looks at the issue of counseling vs. psychotherapy. There is
fine line between counseling and psychotherapy, however, the main difference between
the two (2) is that the aim of psychotherapy is to change ones life-style, and the goal of
counseling is to change behavior within the existing life-style.
Social interest appears to be a group of feelings or behaviors, that some believe are
innate, however, Adlerians do not see it as such. Adlerians believe that social interest is
not genetic.
An individual seeking treatment from an Adlerian Psychotherapist utilizing the above
concepts is an individual who:
a. may have been raised in a dysfunctional family;
b. may be experiencing feelings of insecurity;
c. may have trouble socializing with others;
d. may have a deep fear of failure; and
e. may be interested in changing, or if not changing, learning to cope with his or her
life-style.

3. PROGRESSION THROUGH THE FOUR (4) STAGES OF ANALYTIC

THERAPY AND EXAMPLES OF MAJOR CONCEPTS:
The four (4) stages of analytic psychotherapy are confession, elucidation, education,
and transformation. Confession, the first stage of Analytic psychotherapy, consists of a
patient recounting their personal history. The patient shares both conscious and
unconscious thoughts with the therapist, who listens to the patient in an empathetic, nonjudgmental manner. In this process, the human psyche is accessed. There are two (2)
elements to the human psyche: the conscious and the unconscious, however the
conscious is accessed much more freely in this stage of psychotherapy. In connection
with the recantation of the patient of their personal history to the therapist, the conscious
part of the psyche allows the patient to expand on his or her reality and perceptions that
are consciously drawn upon. Although the patient may also recount unconscious
thoughts, the unconscious part of the psyche is much less accessible at this stage of
therapy.
The unconscious and the conscious (the human psyche) are both part of the collective
unconscious. The collective unconscious appears to cross racial, cultural, and ethnic
boundaries, as it appears all humans have similar dreams, fantasies, and myths in one
form or another, which rise out of this collective unconscious. This process of confession
also tends to bind the patient to the therapist through transference.

Elucidation is the second stage of therapy and draws attention to the transference that
exists due to the first stage of therapy, confession. This stage also draws attention to the
dreams and fantasies of the patient so a connection can be made between the infantile
origins of transference. The collective unconscious holds dreams and fantasies, and also
expresses itself through archetypal images. An archetype can be described as human
energy that mirrors itself to almost every human experience. For example the archetype
anima is the feminine image that is that part of a man that is feminine; and the archetype
animus is masculine image that is that part of a woman that is masculine. At this stage
the personal unconscious is accessed, which contains experiences we may not remember
or have denied, such as repressed memories, as well as the collective unconscious as
understood through archetypal images. The goal of this stage is to give the patient insight
on both an intellectual and emotional level.
The third stage of Analytic therapy is called education. This stage is concerned with
the ego and persona tasks. The ego, one part of an archetype called the Self, develops
in childhood and is the center of consciousness and works as a mediator for the
unconscious and real world experiences. As the ego is part of the Self, it is also part of
the personal unconscious.
The persona is the image we portray when we are out in society. The persona shields
the ego by regulating the way an individual behaves when out in society. Because the
persona is in effect much of the time, an individual may believe they have actually
become that persona. During this stage insight is now converted into responsible action
through which the patient develops an active, healthy role in life and can balance the ego
and persona as an adapted social being.

Finally, the fourth stage is transformation. Although many individuals complete their
therapy at the third stage of Analytic therapy, some find transformation necessary if they
are still bonded to the therapist through transference. Usually these patients are in the
second half of their lives and feel compelled to go further with therapy. The patient feels
a desire for greater self-knowledge, or as Jung called it, self-actualization. This leads to
individuation, which includes a self-acceptance of ones positive as well as negative
personality traits. In this stage, what is happening to the patient, the therapist must now
also experience. In this way, the therapist will not look unfavorably upon the patient, and
is forced to deal with challenges in his or her own life that may have been evaded.
At the end of these four (4) stages, the goal of Analytic therapy is self-awareness,
individuation, a sense of responsibility and an awareness of the human condition. With
this comes a sense of finality, however each stage has no fixed duration.

4. EXPLANATION OF THE THERAPEUTIC TRIAD:

The therapeutic triad consists of empathy, unconditional positive regard, and
congruence. Empathy in client-centered therapy exists when the therapist attempts to not
only understand the patient, but to feel what the patient feels. Empathy can only be
attained through intense, continuous attention to the feelings of others, excluding all other
types of attention. The therapist and patient then develop a deeper relationship based on
mutual respect and understanding.
Unconditional positive regard is sometimes also called warmth, acceptance, nonpossessive caring, and prizing. Unconditional positive regard involves the therapist
allowing the patient to become the feeling he or she is experiencing. When the therapist
totally values the patient throughout this process, the therapy is likely to move in a
forward, progressive manner.
Congruence completes the therapeutic triad of client-centered therapy. This phase of
therapy involves the therapist sharing his or her thoughts and feelings with the client. In
so doing, the therapist cannot deny feelings being experienced within the therapeutic
relationship. This tends to strengthen the relationship between the client and the therapist
because the therapist is honestly displaying an expression of himself or herself without
covering up his or her true feelings.

From my point of view, The Therapeutic Triad works for several reasons. First, I
believe empathy plays a major role in the success of Client-Centered therapy. Each and
every one of us want to be understood, therefore speaking to an empathetic person, in this
case the therapist, allows one to feel as though one is not alone in his or her emotional
state and that someone else can relate to such feelings. As stated above, the patient and
the therapist develop a deep relationship, as the empathy of the therapist allows mutual
respect and understanding.
Second, the warm acceptance of the unconditional positive regard given to the patient,
as the patient becomes what he or she is feeling, adds a sense of security to the whole
process. This feeling of value the patient receives from the therapist appears to aid
progression of the therapeutic process.
Finally, during congruence, when the therapist shares his or her thoughts with the
patient about what he or she is feeling, the patient may have further understanding of the
therapist and a deep respect may grow out of such an experience. This clearly would
have a tendency to strengthen the relationship between the patient and the therapist.
Although, as stated above, I believe Client-Centered therapy works on many levels, I
also believe it has its limitations. As each stage of therapy----empathy, unconditional
positive regard, and congruence----takes place, a client who is in therapy due to low selfesteem, has dependency issues, or is quite needy, may become too attached to therapist in
this process. This may be harmful, rather than productive, as the client may be unable to
make decisions or function in a healthy manner without consulting the therapist first.
Therefore, it is my opinion that Client-Centered therapy is generally for the

psychologically healthy person that may be dealing with certain short-term experiences
or situations in his or her life that may be hard to get through without seeking therapy.

5. BASIC PROCESSES AND MECHANISMS OF RATIONAL EMOTIVE

BEHAVIOR THERAPY:
Rational Emotive Behavior Therapy (hereinafter referred to as REBT) holds that,
. when a highly charged emotional consequence (C) follows a significant activating
event (A), event A may seem to, but actually does not, cause C. Instead, emotional
consequences are largely created by B---the individuals belief system. (Ellis, 2000, p.
168). Therefore, A x B = C, the disturbing consequence. For example, (A): I looked fat
today and (B): Im so embarrassed and disgusted, the result may be (C): feelings of
depression, worthlessness, disgust, and anxiety. To overcome such thinking, the therapist
focuses the patient on B and how such irrational thinking creates the bad feelings
experienced in C. By putting focus on these irrational thoughts, the patient can work on
ridding him or herself of such self-defeating thoughts.
To aid in changing dysfunctional behavior REBT uses a variety of concepts such as
cognitive and behavior modification methods. Homework assignments, bibliotherapy,
audiovisual aids, role-playing, assertion training, suggestion, support, humor, and
desensitization are just some of the activities used during therapy. Unconditional

acceptance of self and of others, taking into consideration human fallibility, is

encouraged.
There are two (2) basic forms of REBT, general and preferential. General REBT
teaches rational, healthy behaviors, and preferential REBT emphasizes a philosophic
change through disputing irrational thoughts, and promotes skeptical, rational thinking.
Through this thinking comes the insight that disturbing consequences that have occurred
in the past keep occurring because belief systems and irrational thoughts keep them
current. To change this mindset takes hard work and practice, however, it is well worth
it, as it will enforce rational and skeptical thinking.
REBT is perfect for short term brief therapy, and can be taught in fewer than ten (10)
sessions. With this, there is a sufficient understanding of the A-B-C method, as described
above, and an understanding of the patients emotional issues. In turn a change in
attitudes that create disturbances is achieved. Since REBT methods are discipline
oriented, therapy is usually more effective in shorter periods with fewer sessions. If a
patient is severely disturbed, this brief therapy may not be appropriate for him or her.
However, for one who is not too generally disturbed, with the help of REBT, they may
have reached the end of therapy within just a few sessions.
To help speed the therapeutic process, a REBT therapist will record the entire session.
This is so the patient may listen to the session at home or in his or her car so that he or
she may gain more insight regarding the session, or hear things he or she may have
missed. Further, the patient is provided with a Self-Help Form which the client uses
when he or she encounters issues or problems outside the therapy session.

REBT has also been successfully applied to marriage and family counseling.
Marriage partners, or love partners are usually seen together, and air their complaints to
each other during therapy. The therapist directs them that although their complaints
regarding each other may be justified, their overly upset reactions are not. REBT
principles are then applied to their relationship and they are taught how to compromise,
communicate, and minimize their incompatibilities.
It is not uncommon in REBT for the whole family to be seen during a session,
however, at times the children may be seen in separate sessions apart from the parents of
the family. Both parents and children are taught how to accept and learn tolerance for
one another as well as oneself.
In sum, the theory of REBT is that humans create their own emotional consequences,
and can convince themselves to believe foolish, irrational, thoughts as well as be taught
to rid themselves of such a harmful mindset, and learn to think in a healthy, rational,
skeptical manner.

6. CORE CONCEPTS OF BEHAVIORAL THERAPY:

Classical Conditioning is a core concepte of behavioral therapy. Traditional thinking
defined classical conditioning as a situation in which a previously neutral stimulus is
paired with a terrifying or frightening event (called the unconditional stimulus, or UC),
it can become a conditioned stimulus (CS) that elicits a conditioned response (CR) such
as anxiety. (Wilson, 2000, p. 214). Currently, it is believed that exposure to a traumatic
even does not lead to anxiety unless a correlation or contingent relationship is formed
between the traumatic event and the situation in which it is experienced.
For example, the patient may have had a parent die on a major holiday, such as
Christmas. Therefore, every year when Christmas comes around, he or she experiences
severe anxiety. Therefore, the therapist assists the patient in breaking this cycle by
introducing the patient in a clinical setting, to a positive stimulus that correlates with
Christmas.
Operant conditioning is based on the idea that positive and negative reinforcement
strengthens behavior. When there is an increase in the frequency of a response, followed

by a favorable event, positive reinforcement has been achieved. Negative reinforcement

refers to an increase in a certain behavior as a result of avoiding an adverse event that
was expected to occur.
A clinical example of operant conditioning is a token economy in a classroom. A
teacher rates students on their behavior and performance, both socially and academically.
At the end of the school day, students who have received good ratings could exchange
those good ratings for small gifts. Such a system may produce better behavior in students
and improve academic performance.
Extinction refers to a removal of a response, which amounts to inappropriate attention,
and therefore a change in behavior.
For example, a patient may have a severe phobia of snakes. Therefore, therapy may
entail repeated exposure to the source of anxiety, snakes in this case, in a clinical setting.
This repeated exposure is likely to lead to desensitization of snakes and in turn the phobic
response leading to anxiety becomes extinct.
Discrimination learning uses stimulus control in shaping behavior. This occurs when
behavior is rewarded or punished in one situation but not another.
A clinical example of discrimination learning can be seen in treatment of obsessive
compulsive behavior, such as constantly checking that household appliances are turned
off---not once, or twice, but repeatedly in succession at least five (5) or six (6) times.
Through assessment it is determined what is causing such behavior, and then, with the
patients knowledge and consent, the patient is then exposed to what may trigger this
behavior. This is exposure is systematic, and may increase the patients anxiety at first,

however, by the end of treatment the negative reinforcement that was the source of the
patients compulsion is successfully coped with by the patient.
Social-cognitive learning occurs when one is aware of behavior and social rules
around them and the consequences associated with such behaviors. As such, one bases
their behavior on such observations. Many times ones anticipation about an outcome of
behavior or an event shapes behavior rather than the reality of a situation. Socialcognitive learning is also called vicarious learning, or modeling. This learning occurs
when an individual watches and learns from the behavior of others.
A clinical example of social-cognitive learning can be seen in the treatment of an
agoraphobic. The therapist assists the agoraphobic to make a self-attribution of any
behavioral change he or she has accomplished. Therefore, instead of the agoraphobic
leaving the house, functioning quite normally, and then attributing that successful outing
as luck, the therapist helps the patient learn to give themselves and credit for their
behavior, rather than just luck. In so doing, the agoraphobics confidence level changes
and social cognitive learning is achieved.

7. THE COGNITIVE THERAPEUTIC RELATIONSHIP AND FIVE (5)

TECHNIQUES/STRATEGIES USED BY COGNITIVE THERAPISTS:
In Cognitive therapy, the relationship between the patient and the therapist is
collaborative. In some cases the therapist takes the directive role, however, in most cases
the patient shares thoughts, beliefs, and images that occur in various situations, and the
behavior that goes along with them. Further, the patient is responsible for doing
homework between sessions and helping set the agenda for each session. Further, the
therapist guides the patient through their thoughts and beliefs and how those thoughts and
beliefs affect behavior. In turn, this assists the patient in cognitive change and learning
new coping skills.
In cognitive therapy the patients point of view is important, however, the therapist
must point out issues and problems and techniques to address them. Additionally, the
relationship between the therapist and the patient is an open one, allowing the patient to
freely give feedback to the therapist about the therapeutic sessions or the therapist, or

whatever they may wish to express. This allows the patient to take more responsibility
for therapeutic change.
The therapist utilizes both cognitive and behavioral therapy to allow the patient to
reach the goal of monitoring their negative thoughts. It is also used to help the patient
recognize the affects cognition has on behavior, and to understand thoughts that
automatically become distorted, and whether they are helpful or detrimental.
Additionally, the patient is assisted in understanding the reality behind the interpretations
of biased cognition, and to identify and change the beliefs that lead to distort their reality
and their experiences.
One (1) technique using cognitive therapy is the concept of automatic thoughts.
These thoughts are tested by using direct evidence that can be derived from past or
present situations, that are factually truthful, or by logical analysis. For example, if an
individual believes he or she is incapable of socializing with the opposite sex, he or she
may be encouraged to seek out several members of the opposite sex. This may lead to
the patient thinking in a more objective, non-distorted fashion, and in turn lead to
cognitive change.
Another technique used in cognitive therapy is redefining. Redefining leads the
patient to redefining the problem he or she is concerned about. For example, a patient
may think, Im uneducated and inept, so Ill never succeed in life or a decent career.
This problem may be redefined as, I need to go back to school, get an education, and
succeed in a field I am interested in. This redefines the issue in concrete rational terms,
so that the patient can address the behavior needed to redefine a problem.

A third technique utilized in cognitive therapy is decentering. Decentering is used

mainly in treating patients who believe everyone around them is focusing on them and
that they are the center of attention. After logically questioning why he or she would be
the center of everyones attention, the patient begins to question such irrational beliefs.
For example, an employee may be fearful of speaking at company meetings because he
or she believes everyone is watching like a hawk, and scrutinizing his or her every word
or movement. The therapist may instruct the employee, now the patient, to focus on
other individuals attending the meeting. In so doing, the patient begins to realize that
many individuals are not even paying attention to what he or she is saying, and allows the
patient to understand that his or her performance at the company meeting is not the only
concern others have, as they are preoccupied with concerns of their own.
Cognitive therapists also use behavioral techniques, such as exposure therapy. This
technique provides data on physiological responses, thoughts, images, and levels of
tension as reported by the anxious patient when they are confronted with certain
circumstances. For example, a student may believe that if they are called on to speak in
class, he or she will not succeed at the task for fear of stuttering out a response, or
possibly fainting. This is a distorted prediction by the student (the patient) of what may
occur in class, therefore he or she is given coping mechanisms by the therapist and shown
that his or her thoughts are irrational and such thoughts can be challenged in the future,
by therapy focusing on the patients idiosyncratic thoughts and particular needs.
Diversion is another behavioral technique used in cognitive therapy. Simply put,
diversionary techniques are used to get the patients thoughts away from negative
thinking and on to other activities. For example, if a patient is prone to strong emotions

and negative thinking, the therapist may recommend the patient join a gym and begin a
workout routine. In so doing, the patients thoughts are consumed with positive thoughts
and feelings, as he or she is now focus his or her thoughts on physical activity that is not
only providing positive thoughts, but doing something positive for his or her body.
A third behavioral technique is behavioral rehearsal and role-playing. This technique
is used to practice skills or techniques that the patient can later apply to real life
situations. For example, a patient may be shy and introverted and yearns to be assertive
in life. In therapy, the patient begins to rehearse, or role-play the assertive person he or
she would like to become. In so doing, the patient then applies these techniques in real
life and overcomes his or her shyness and becomes a more assertive individual.

8. YALOMS FOUR (4) CONCERNS AND HOW THEY ARE ADDRESSED IN

THERAPY:
The first concern of Yalom is death, as it is the ultimate concern of humankind. It is
an inevitable truth that is a frightening reality---death is a part of life. One is destined to
have to deal with this truth on a daily basis, whether consciously or not. Death anxiety
appears to exist in every manner of psychotherapy.
Therapists can assist patients in their awareness of death early in their life cycle, rather
than later when they are closer to death. Some therapists request that their patients write
his or her own epitaph or obituary, and imagine their own death or funeral, and still others
help patients confront their own mortality.
Existential therapists believe life cannot be lived, and death cannot be faced, without
some anxiety, therefore, only crippling levels of anxiety are sought to be alleviated. The
therapists role is to reduce anxiety about death to tolerable levels so the anxiety may be
used constructively.

Although the concept of freedom is not normally associated with anxiety, it is the
second concern of Yalom. With freedom comes responsibility, with responsibility comes
choices, and with choices comes varying levels of anxiety. Individuals react differently
to responsibility that comes with freedom. Some accept responsibility willingly, others
displace it on to others, some deny responsibility, and there are those that shirk
responsibility by claiming irrational thinking and/or a temporary lapse in thinking.
Another aspect of freedom is willing, which represents the passage from responsibility
to action. Willing consists of wishing, and then making a decision about that wish.
Many individuals who have trouble with spontaneity experience difficulty in wishing, as
wishing is close to feeling, and because these individuals have trouble acting
spontaneously, they are unable to feel and in turn wish.
The existential therapist addresses freedom by focusing on the patients responsibility
for his or her own anxiety. When the patient is aware of this, there becomes a motivation
to change. The therapist uses various methods to accomplish such a goal, such as
interrupting the patient when the patient appears to be displacing responsibility and
reminding the patient of their responsibility for their self-created situation.
Therapists also encourage patients to wish, by shouting at them and asking them what
they want, or question why they dont seem to wish for anything. Some types of mental
blocks that the therapist tries to slowly dissolve can hinder wishing. This takes time and
perseverance, however, can be successful once the therapist discovers the source and
nature of the blocks and the feelings behind them.
Some patients fail to wish because they are unable to discriminate between wishes and
have a tendency to act impulsively when it comes to fulfilling their wishes. The therapist

aids these patients in discriminating between which wishes are productive and which
wishes must be relinquished.
The therapist also aid in decision making with the patient. Ultimately, though, the
therapist helps the patients recognize that they themselves must make decisions on their
own, and own ones decisions along with ones feelings. For many patients the decision
making process is blocked by obstacles and it is the therapists job to move these
obstacles. Decisions are constant and unavoidable, therefore the therapist must make the
patient understand this and enlighten them to the fact they are making decisions all the
time and may be unaware of it. In this way, the patient becomes an active participant in
decision-making and his or her feeling of power is reinforced.
Existential isolation is the third ultimate concern of Yalom. Every one of us enters
this world alone, and will exit from it alone upon death. Death is the strongest reminder
of isolation. Many individuals experience panic and anxiety when they are alone. This
emanates from a dissolution of ego boundaries, as these individuals come to believe they
do not exist unless they are in the presence of others or being responded to or thought
about by another.
Fusion is another method individuals use to overcome isolation. The fuse with
another individual such as a love interest, or a group, cause or project. Some individuals
use sexual compulsivity to overcome isolation, however, this is temporary and can be
destructive. The sexual relationship is just a caricature of a true relationship as sexually
compulsive individuals dont really know their partners, but only know those parts of
their partner that deal with seduction and the sex act.

Therapy assists a patient in dealing with isolation by making them understand

isolation will always exist, however forming interpersonal relationships may aid in a
reduction of isolation, and/or isolated feelings. The therapist must assist each patient in
dealing with periods of isolation, with a support system geared toward that patient. Some
therapists encourage patients to isolate themselves for periods of time, and record the
thoughts and feelings they are experiencing during this self-inflicted isolation.
The fourth and final ultimate concern of Yalom is meaninglessness. It appears that
human beings strive for meaning in life and existence. A sense of meaning in life is
important for an individuals hierarchy of values, as values not only tell us why we live
but how to live.
In order to deal with the subject of meaninglessness, a therapist must increase
sensitivity to it, and must attune to the overall focus and direction of the patients life.
The major solution, however, to meaninglessness is engagement. Engagement deals
with the patterns in ones life, such as the need to find a partner, home, career, etcetera.
The patients desire to engage is ever present, however it is the therapists job to remove
the obstacles that may be blocking the patient from engaging.

9. EXISTENTIAL CONCEPTS OF GUILT, ANXIETY, AND BEING IN THE

WORLD:
For the existential therapist, guilt can be both normal and neurotic. Normal guilt
arises when an individual behaves in a manner that opposes his ethical beliefs. Neurotic
guilt arises out of thinking about unethical behavior that is fantasized.
Further, individuals can experience guilty feelings toward themselves when they feel
they have not lived up to their potential. The origins of neurosis and psychosis can come
from a patients own blocking of such potential, all due to guilt.
Existential therapists believe anxiety arises from a human need for survival,
preservation, and assertion of the self. It displays itself when an individual is confronted
with a threat to his or her existence. The main goal of the existential therapist is to assist
patients when confronting anxiety that arises in day-to-day life.
Normal anxiety is that anxiety that is appropriate to the situation. It is not repressed as
we are able to come to terms with it, and it can be used creatively. On the other hand,
Neurotic anxiety is not appropriate to the situation, is usually repressed, and is

destructive, rather than constructive, as it tends to hinder creativity. Being mentally

healthy is being able to live without neurotic anxiety and tolerate the unavoidable
existential anxiety of living.
The existential concept of being-in-the-world theorizes the therapist must understand
the world in which the patient exists and participates. The patients whole world,
however, cannot be understood just by the environment in which they exist.
Existential therapists believe there are three (3) modes of the world: Umwelt, which
means world around or the environment around us; Mitwelt, meaning with-world,
the world of those around us; and, Eigenwelt, which means own- world, and refers to
the relationship to ones self.
Umwelt is the world around us and includes biological needs, drives, and instincts,
and encompasses our cycle of life and our biological determinism. It is in essence natural
law, which existential therapists hold is as real as ever.
Eigenwelt is that part of the world that is ours. It is our perspective on the world
regarding how we function and relate to our world. It is our self-awareness of our world.
Being-in-the-world requires all three (3) modes to work in unison. For example, we
may not be able to understand certain things in Umwelt, or the world around us, without
an adequate understanding of Miltwelt, the world we share with others, and of course,
Eigenwelt, our own world.

10. EXAMPLE OF AN INDIVIDUAL SEEKING THERAPY FROM A REALITY

THERAPIST AND A TREATMENT STRATEGY FOR THEM:
Per Dr. Caroll Ryans email of October 20, 2003, this question may be skipped.

11. EXAMPLE OF AN INDIVIDUAL SEEKING TREATMENT FROM

ARNOLD LAZARUS AND HIS OR HER TREATMENT USING SEVEN (7)
MODALITIES OF BASIC I.D.:
An individual seeking therapy from Arnold Lazarus is seeking a comprehensive
psychotherapeutic approach called Multimodal therapy. It was developed by Lazarus, a
clinical psychologist, assessing each are of a persons BASIC I.D., which is broken down
as follows: B = Behavior; A = Affect; S = Sensation; I = Imagery; C = Cognition;

= Interpersonal relationships; and D = Drugs/Biology. Multimodal therapy has been

characterized as mostly behavioral, and appears to be effective in treatment of depression,
stress, tension, mild sexual disorders, and phobias, just to name a few. Multimodal
therapy can also be used to treat individuals with physical pain, such as tension headache
and/or muscle spasms by using techniques such as behavioral changes, cognitive shifts,
and attention place on other aspects of physical functioning. Patients who display bizarre
behaviors, or experience delusions or other signs of psychosis, are not good candidates
for multimodal therapy and are referred to doctors of psychiatry or psychiatric facilities.

The average patient will attend weekly sessions for about one (1) year. The therapy
encompasses specification of goals and problems and of treatment techniques to achieve
these goals and solve the problems, as well as a systematic measurement of the success of
these techniques.
An example of an individual who is a good candidate for multimodal therapy is one
who is suffering from depression. This individual may be in the habit of imagining life as
gloomy and foreseeing a dismal, dark future, thus causing himself or herself to be in a
depressive state.
This patients first session includes questions regarding the patients current
complaints, and what the patient wishes to derive from therapy. The therapist further
questions the patient regarding what led the patient to this current state, and who or what
is maintaining it. During the time the patient is airing their current complaints, the
therapist carefully pays attention to which modality of the BASIC I.D. The patient and
the therapist will then select strategies to deal with these complaints, and these
complaints are then dissected into the BASIC I.D. modality. For this hypothetical
patient, his or her modality profile is drawn up for the second interview.
This patients behavior was assessed as: Excessive overeating; lack of physical
exercise in comparison to calories eaten. Therapeutic techniques that can be used to deal
with this behavior encompass extinction, and other types of conditioning techniques.
This patients affect was assessed as: Bitter, anger, resentment, which may have been
expressed, but not effectively; fear (of being alone, and of failure). Techniques used in
therapy to address the patents affect include abreaction, plus owning and accepting
feelings.

The sensation modality for this patient was assessed as: Tension headaches; shallow
breathing; stomach upset. Therapeutic techniques used for these sensations are tension
release and sensory pleasuring mechanisms.
Imagery for this patient includes: Gloom and doom; death; failure; loss of control. To
address these issues entail a change in self-image and coping images.
Cognition for this patient was assessed as: Excessive romantic fantasies; overly selfconscious; worried about others judgment of him or her. Techniques to tackle these
issues include cognition restructuring and awareness.
This patients interpersonal modality was found to include: Cries when frustrated;
uses aggressiveness in place of rational thinking; becomes quiet and introverted when
challenged. Therapeutic techniques for this modality can include modeling, dispersing of
unhealthy collusions, paradoxical maneuvers, and nonjudgmental acceptance.
Drugs/Biologicals modality for this patient is assessed as: May need anti-depressants
in the short term; regular exercise may assist as stress reliever. Techniques used in
treating these issues include learning and/or lesions: learning falls into the BASIC I.
modality and lesions fall into the D modality.
A treatment plan for this hypothetical patient will include biofeedback and relaxation
techniques, along with an exercise routine. Further, this patient will be given homework
so he or she can utilize some of these techniques at home. These therapeutic techniques
will assist the patient to reduce tension and stress. This will not only alleviate some of
the physical ailments the patient has displayed, but also will aid in his or her thinking
process.

Additionally, imagery exercises will be implemented. The patient will be asked to

close his or her eyes and relax. The patient is then asked to picture in his or her minds
eye an incident that occurred in their life that may have been particularly disturbing to
them. The patient is told to focus on other images that may emerge during this session.
The patients can then imagine themselves beyond this disturbing incident, years into the
future, remaining free of harmful experiences. This time projection is to be practiced by
the patient at least twice a day for five (5) to ten (10) minutes at a time. This technique
allows the patient to imagine a future free of doom and gloom, and alleviates fear of what
the future may hold, so the patient can be more outgoing.
During treatment, the patient is also encouraged to use positive self-statements. Such
statements for this patient may include, I am a great person just the way I am. Its not
important what others think of me, but what I think of myself. These positive selfstatements should be practiced along with the time projection imagery. This technique
will aid in changing the patients thought processes to perceive them in a positive,
optimistic light.
After several months of treatment, the desired outcome is that the patients BASIC
I.D. will be as follows:
Behavior: The patient has stopped overeating.
Affect: The patient has become more aware of his or her feelings, and accepts them.
Sensation: The patients tension headaches and other signs of anxiety have been
reduced or subsided altogether.
Imagery: The patient is able to see him or herself in a positive light and feels capable
of accomplishing specific goals.

Cognition: The patient has reduced fantasizing, and is less concerned about how he or
she is judged by others.
Interpersonal: The patient has replaced rational thinking in place of frustration and
aggressiveness, when challenged.
Drugs/Biological: The patient is taking anti-depressants and regularly exercises. Both
have succeeded in alleviating much of the patients depression and stress.
In sum, at the conclusion of therapy, the patient is practicing his or her exercises
diligently, thereby eliminating any setbacks. In so doing the goal of therapy will be
accomplished: the patient will be aware of their behavior, habits, and feelings, thereby
having the ability to correct any disturbances in his or her life through various techniques
learned in therapy. Therefore, the therapy sessions would continue until the patient has
come to complete awareness. Of course, the length of treatment and the exact techniques
used will vary on a case-by-case basis, so an exact length of therapy and exact treatment
cannot be determined until a few therapeutic sessions have taken place.

12: A HYPOTHETICAL FAMILY OF FIVE (5) SEEKING TREATMENT:

My hypothetical family of five (5) includes:
Father: Age 41; self-starter; entrepreneur; educated; over achiever; controlling;
expects children in the family, especially the males, to follow in his footsteps.
Mother: Age 38; homemaker; subservient; unassuming; makes few decisions;
pampers the children.
Son 1: Age 17; first born; average looking; average academically; soft spoken; not
athletically inclined; wants to please everyone; a mamas boy; father sees him as weak
and a disappointment.
Son 2: Age 15; handsome; academic achiever; athletic; outgoing; father praises his
achievements, and lives his youth vicariously through Son 2.
Daughter: Age 12; considered baby of the family by all in the family, especially
father and mother, therefore she easily manipulates them and is spoiled by them; she can
do no wrong in the eyes of father and mother; father is overprotective of her, as she is his

pride and joy.

In family therapy, the familys structure and processes are scrutinized. The former,
structure, involves how the family is arranged, organized, and maintains itself; the latter,
processes, is the way the family changes, evolves, and adapts over time. The family is
also seen as a cybernetic system that includes a flow of information and communication
patterns that exist within the family. Additionally, there exists within each family unit
organized subsystems, which may be determined by generation, gender, or family
function. Three (3) of these subsystems are key subsystems: spousal, the interaction
between the parents or mom and dad; parental, the interaction between child and
parent; and sibling, the interaction between siblings. Any dysfunction in any of these
subsystems is bound to reverberate throughout the family and cause disharmony and
instability. There are also invisible lines called boundaries within each family unit that
separate a subsystem, or individual within the family from outside surroundings.
There are a variety of concepts within family therapy. One of them is family rules
which deals with rules that are learned within the family unit, such as what behavior is
expected or permitted, and vice versa. Family therapists focus on repetitive behaviors
within the family, called the redundancy principle, because this principle reveals the
familys range of options for dealing with each other.
The concept of family rules can be applied to the hypothetical family of five (5)
described above. It is apparent from this family that Father makes all or most of the rules
within the family unit. Since Mother is so subservient, she eagerly follows his lead.
Because of Fathers overbearing manner, both Son 1 and Son 2 also follow Fathers rules
as best they can. Although Daughter may follow Fathers rules as well, unbeknownst to

Father, she also makes some rules of her own. She does this through her manipulation of
Father and Mother, who basically give her whatever she pleases. She may also
manipulate Son 1 and Son 2, as they see her as the baby of the family.
Family paradigms is another concept within family therapy. Families develop
paradigms about the world in one (1) of three (3) ways: Consensus-sensitive families
are composed of enmeshed members who see the world as chaotic and confusing so that
they must maintain agreement in all matters in order to protect themselves from danger.
Interpersonal-distance-sensitive families are made up of disengaged members who strive
for autonomy from one another, believing that closeness represents a display of
weakness. Environmentally sensitive families typically operate as open systems and are
apt to be most problem-free. They see the world as knowable and orderly, with each
member expected to contribute. (Goldenberg & Goldenberg, 2000, p. 387).
The paradigm that the hypothetical family seems to have adopted is the interpersonaldistance-sensitive family. Father strives to be autonomous and clearly believes any
display of sensitivity or closeness is a sign of weakness. Although Mother appears weak
and subservient, by not making any decisions for the family she keeps her own autonomy.
Father views Son 1 as weak because he appears to want some type of approval from the
family, and is unsuccessful in getting it no matter what he does. Son 2 receives Fathers
praises, however, not for the type of person he is, but for his academic and athletic
achievements. Daughter appears to strive for autonomy when it is beneficial to her, and
strives for affection in the same way.
Another concept is pseudomutuality and pseudohostility. Pseudomutuality is the
unreal way a family expresses both positive and negative emotion to one another. The

family dreads separateness as a threat and focuses only on togetherness, thereby

forsaking any healthy balance between the two. In this way a family does not have to
deal with conflict, as the perceived togetherness prevents them from experiencing deeper
emotions and intimacy with one another.
There is definitely an unhealthy atmosphere in our hypothetical family. Although this
family does not appear to focus on togetherness, in their own way, they actually do, even
though it may only be a perception and not a reality. Father is constantly chiding his
children, especially Son 1 and Son 2, to be over achievers and excel in all they do. Father
perceives this as relating to his sons, which in turn, he believes creates closeness with
them. Mother pampers the children and obeys Fathers every word. This is her concept
of togetherness. By striving to please all, Son 1 feels as though he is keeping a close
connection to everyone in the family; and by actually pleasing all, Son 2 has found his
idea of togetherness. Additionally, by being babied by the rest of the family, Daughter
perceives her spoiled, manipulative nature as keeping the family close knit.
Pseudohostility is the constant bickering and arguing within the family, which is a
superficial tactic for avoiding deeper, more genuine emotion and feeling. The turmoil is a
way of keeping a connection between one another without becoming deeply affectionate
or overly hostile with one another. Both pseudomutuality and pseudohostility represent a
distorted way of communicating and creates irrational thinking about the familial
relationship.
In our hypothetical family, any hostility that exists is not between Father and Mother,
because Mother hangs on Fathers every word (although Mother may have repressed
hostility that is not being expressed); and not between Mother and the children, because

in Mothers eyes her children can do no wrong. Therefore, the conflict that exists in this
family is primarily between Father and the children. For example, Father perceives Son 1
as weak and disappointing, and expresses his feelings to Son 1 every chance he gets.
Father is proud of Son 2, however, by constantly praising Son 2s achievements, Father
has put undue pressure on Son 2, which has led to pent up hostility within Son 2. Father
and Daughters relationship is also laced with hostility and conflict, as Daughter feels
smothered by Fathers overprotection of her. Although, she is able to manipulate him and
Mother, Fathers overbearing nature leads to a feeling of anger and resentment in
Daughter.
Mystification is another concept in family therapy. Mystification is when a parent
distorts a childs reality, thereby obscuring or distorting any conflict that may be
happening within the family. This does not deter conflict, but instead clouds the meaning
of the conflict and occurs when a family member upsets the status quo by expressing
their feelings. In essence, mystification contradicts an individuals reality, and in extreme
cases may lead to an individual questioning their own grip on reality.
In our hypothetical family, Father is reliving his youth vicariously through Son 2.
Although Son 2 may not wish to continue playing a particular sport, or choosing a
particular course of academic study, Fathers praises and encouragement allow Son 2 to
believe that what Father wants for him, is what Son 2 really and truly wants; even though
this may not be so. The other family members all appear to go along with this
mystification process.
Another concept in family therapy is scapegoating. Scapegoating occurs when one (1)
member of the family is blamed for any dysfunctions that happen within the family unit.

This has the effect of removing focus from the true conflict within the family, which
could harm the family unit. By selecting a scapegoat, other family members can avoid
dealing with one another or examining what is really taking place in the family. Many
times a child who is labeled a scapegoat will actively participate in the familys
scapegoating process, which may lead to chronic behavioral disturbance. The family
retains a vested interest in choosing one (1) member as a scapegoat; therefore until major
changes occur in the family, the scapegoating will not cease. If the scapegoating
continues, the targeted family member will continue to carry the pathology for the family.
Son 1 appears to be the scapegoat in our hypothetical family. Even though he tries to
please everyone, he fails at doing so. Father perceives him as weak, and the rest of the
family probably adopts this perception as well. Son 1 is seen as the only member of the
family that does not fit in, and his constant failure is probably partially due to his active
participation in the familys scapegoating process. Therefore, Son 1 will continue to
carry the familys dysfunction and pathology until a change takes place within the family
unit.

13. A THEORETICAL MODEL THAT IS WELL SUITED TO MY

PERSONALITY:
I would describe my personality as outgoing at times, yet introspective on many
occasions. Further, my personality can become quiet and demur if an individual or a
situation intimidates me, however, if I feel attacked or slighted, I can become
confrontational (verbally, not physically), which is surprising to those around me. There
some obsessive aspects to my personality, and I sometimes experience mild depression.
Further, due to my education and experiences, I am quite cynical and analyze both sides
of every situation before I make a decision. I am concerned with the way I am perceived
by others, and want to look presentable at all times. Therefore, I can be self-conscious at
times, and also experience irrational thinking, but have noticed a decrease in both as I
have matured.
As for my style, I like to infuse humor into conversations and situations.

I love

watching horror movies and detest most chick flicks or romantic type movies. I enjoy
very hard, aggressive music, and only listen to certain select softer music occasionally.

Although I do not attend church, I have strong beliefs that are entrenched within the
Christian faith. I believe that there are consequences, both good and bad, for our actions,
and these consequences not only affect us in this life as karma or what comes around
goes around, but also in an afterlife.
Because my personality, style, and beliefs are such that they are, I believe the type of
psychotherapy that is best suited to me is Rational Emotive Behavior Therapy
(hereinafter referred to as REBT). Because I can be introspective, obsessive, and
depressed at times, I believe the A x B = C can be applied to my personality. The
introspection (A) may lead to some type of obsessive irrational thinking (B), which then
turns in to feelings of depression (C). Because REBT teaches such rational, skeptical
thinking, which is already part of my personality, it would be much easier for me to adapt
to this thought process fully, in a short period of time.
Further, because my style is infused with humor, I am able to look at my patterns of
thought with openness and a sense of humor. Therefore, I would be willing to attempt the
therapeutic concepts utilized in REBT. For example, assertion training, humor,
homework assignments and other techniques all seem plausible and therapeutic to me.
And, due to time constraints, such as work, family, and school, REBTS success with
patients using brief therapy would suit me quite well.
Neither does REBT conflict with my belief system, as it teaches compromise,
communication, and tolerance for others, which are cornerstones of not only the Christian
faith, but other religions as well.
The methods used in REBT are straightforward logical solutions to problems that are
created by ones own thinking processes. Therefore, as demonstrated above, REBT

appears to be a perfect fit for my personality, style, and belief system. I believe after
reading the chapter on REBT and answering the essay question regarding REBT, I have
already gained a deeper insight into my thought processes and have begun to weed out
irrational thoughts from rational thoughts. If I begin to think irrationally, I am able to
stop and analyze the irrational thought, and replace it with a rational, logical thought. In
so doing, I have experienced a more positive outlook in every aspect of my life and feel
as though I am in control of my thoughts and feelings, rather than my thoughts and
feelings being in control of me.
14. CHALLENGES FACED BY THERAPISTS TODAY AND HOW THEY
MIGHT MEET SUCH CHALLENGES:
A dual relationship occurs when the therapist and patient have some type of
interaction outside the therapeutic relationship. There are those in practice that believe
dual relationships are harmless and unavoidable, and those that believe dual relationships
should be consciously avoided at all costs. The most reasonable way of approaching this
issue seems to be somewhere in the middle of these two (2) extremes. If unavoidable
dual relationships are encountered, the therapist can meet this challenge by
acknowledging the relationship exists and then can be processed. Both the patient and
therapist need to acknowledge their special relationship and the uniqueness of any
encounters that may occur.
Although patient and therapist confidentiality exists, every therapist has a duty to
warn potential victims, or the appropriate agency, should the therapist become aware of
the fact that their patient may be a danger to others. Further, if the patient is perpetrating
acts such as child abuse, most states mandate the therapist report such behavior.

It is clear that patient confidentiality is held in extreme regard by, however, the
therapist can avoid breaking legal, ethical, and moral issues by following state mandated
laws regarding a duty to warn. Therefore, when the therapist has a patient in which a
duty to warn applies, the therapist is putting the welfare of the public and potential
victims ahead of the patients, as it should be in this unique situation.
Confidentiality is another challenge faced by therapists. The communication between
a patient and therapist is privileged communication and is to be kept confidential (with
certain exceptions, such as the duty to warn discussed above). Therefore, even
superficial communication between patient and therapist, such as a telephone call, is to
remain confidential. Only the client may waive this privilege of confidentiality, which is
an extension of the right to privacy as defined by the Fifth Amendment to the
Constitution.
The therapist can meet the challenges that go along with this issue by holding the
confidentiality issue between he or she and the patient as sacred, unless the patient
decides that confidentiality can be waived. Of course, as previously discussed, the
therapist should not think twice about breaking this confidentiality when a duty to warn
warrants so. These situations include a dangerous patient and/or a patient who is
committing child abuse.
Another challenge to therapists is the issue of Informed Consent. A client has a right
to be informed about all matters in therapy that affect them. This includes the likelihood
of success, any harm that may occur, confidentiality limits, any side effects they may
experience, the likely duration of the therapy, and the cost of the treatment. The therapist

must also inform the patient of alternatives to therapy, such as medication or treatment by
a medical doctor, and the availability of such treatment to them.
The therapist can adhere to informed consent requirements by having the patient sign
a therapeutic contract prior to starting therapy. This contract should inform the patient of
their rights, explain privileged communication and when such confidentially can be
broken, etcetera. This contract can be useful by allowing the patient to feel like an active
participant in their treatment plan.

References
Corsini, R.J., & Wedding, D. (2000). Current Psychotherapies. Belmont, CA:
Wadsworth/Thomas Learning.