Specific Intervention Strategies

IX SPECIFIC INTERVENTION STRATEGIES

A. Protocols #

01 Depression – Helplessness is the major characteristic of depression. Other symptoms may include: sadness, lack of interest, lack of energy, exertion, withdrawal, hopelessness, appetite change: gain or loss of weight, feelings of worthlessness, suicidal ideation, poor concentration, and sleep disturbance. Depression is a natural state in response to loss or defeat. From an evolutionary perspective, depression allows the person to shut down until the dire conditions improve. Everyone is prone to the characteristics of depression since the mind and body are operating exactly as they were designed to do in facing what appear to be insurmountable obstacles. Most people muddle through as best they can. Because depression is usually self-limiting, it will likely lift after a while. However, some people, perhaps because of thoughts, attitudes, and beliefs of pessimism, may extend normal depression by mental processes that maintain the state. Such people lack the resilience to ‘bounce’ back from defeat since they expected to be defeated in the first place. Depression then becomes a trait, from which some of the population garners certain secondary benefits of sympathy and caring from others, which helps to reinforce and maintain the status quo. For these people, giving up the symptoms is particularly difficult, since there is not only a diminished capacity for corrective action, there is a reward for not acting.

02 School Refusal – Specifically, school refusal behavior is identified in children aged five [05] to seventeen [17] years of age who: are completely absent from school, and/or, attend but then leave school during the course of the day, and/or, go to school following intense behavior problems [e.g., tantrums, refusal to move] in the morning, and/or, display unusual distress during school days that leads to pleas for future nonattendance that are directed to parents or others. School refusal behaviors are thus seen as a spectrum that includes children who always miss school as well as those who rarely miss school but attend under substantial duress. Substantial school refusal behavior is defined as those cases lasting at least two weeks. Acute school refusal behavior refers to cases lasting two weeks to one calendar year, having been a problem for a majority of that time. Chronic school refusal behavior refers to cases lasting more than one calendar year. This protocol is really four protocols to address four maintaining variables:

to avoid objects or situations,
to escape aversive social and/or evaluative situations,
for attention, and
to pursue tangible reinforcement

03 Insomnia – This protocol includes changing both the thoughts and the sleep culture of the child/family. Because the parents control the sleep culture of the family and may, in fact, supply many of the thought distortions about sleep, it is important, particularly for the younger child that both the child and the family be committed to the goal of improving sleep.

04 OCD – OCD is an anxiety disorder. It occurs when an unnatural fear occurs about somewhat normal events. We have all experienced a questioning of ourselves – i.e., did I turn off the lights? Most of us would ruminate on this for a short period of time, and then shrug it off and accept the risk that we didn’t turn them off, but probably did. The reason we are able to shrug off the concern is that we assume that even if we did not turn off the lights, everything will be all right. But what if the supposition that the lights are still on brings on the thought that the house will burn down. What if our belief is that a tragedy could occur? Perhaps we would want to go back to the house and check to see if we had, in fact, turned the lights out. We have all gone back and checked before and some of us, even then, continue to be concerned, to have anxiety that we cannot quite put our finger on. So we might check again.

05 ADHD – Most medical professionals, clinicians, and educators refer to the American Psychiatric Association’s description of ADHD, which includes the discerning characteristics: inattention, hyperactivity and impulsivity. These primary characteristics show significant fluctuation across various settings and caregivers. This factor gives indication that even children with very limited attention and high levels of hyperactivity can learn to control the deficiency in inhibiting behavior in response to situational demands.

06 Suicide – While suicide is a leading cause of death, there is no evidence that screening the general population for suicide risk is effective in reducing suicide rates. Even when a risk factor or suicidal intent is detected, there is weak evidence that interventions effectively reduce suicide rates. The assumption that must be made from this evidence that our traditional methods of addressing the issue of suicide are in some way flawed. With this construct in mind, this protocol is oriented toward the use of two innovations: 1) the use of prevention, rather than identification, as the focus of intervention, and 2) the focus on cognitive technology as the basis for intervention.

07 Conduct Disorder – Cognitive factors play an important and well- documented role in the primary characteristic of antisocial behaviors in conduct disorders. Both social and antisocial behaviors are learned behaviors, and therefore the etiology and maintenance of the learning need to be identified and addressed. Antisocial children often exhibit a cognitive response bias in which they interpret ambiguous interpersonal stimuli as being hostile. This cognitive bias may result in and justify aggressive responses to the misperceived hostile stimulus. In addition, such children may also be deficient in problem solving skills, particularly in generating multiple and/or prosocial alternative solutions that results in rigidity of aggressive responses.

08 Self-Affirmation – One of the main factors differentiating humans from other animals is the awareness of self: the ability to form an identity and then attach a value to it. In other words, you have the capacity to define who you are and then decide if you like that identity or not. A positive and realistic self-appraisal is essential for psychological survival. When you reject parts of yourself, you greatly damage the psychological structures that literally keep you alive.

09 Cognitive Restructuring – A person who has severe and persistent problems in living because of stable but maladaptive schema, probably will need an extensive protocol which includes Cognitive Process Correction and Imagery. This protocol outlines some of the specifics in designing individualized protocols for children who have developed in invalidating and psychotraumatizing environments.

10 Cognitive Process Correction – This protocol is concerned with the basic core of cognitive change and identifies a five step process:

Awareness – Help the child become aware of his/her automatic thoughts
Attendance – devise strategies such as the use of journals and homework assignment to ensure that the child attends to his/her automatic thoughts
Analysis – teach the child a formal and public process for analyzing his/her automatic thoughts
Alternatives – teach the child way to find new and different meanings in an experience and to weigh the consequences of these new meaning and to select one that is balanced and rational
Adaptation – teach the child the methods of habituation

11 Culture Restructuring/School-wide Prevention – The skills, protocols, techniques and procedures that are used in Cognitive Behavior Management can be used proactively to promote balanced and rational thinking and prevent problems in living. This protocol discusses the use of cognitive behavior management as a universal prevention procedure.

12 Social Competence – Expectancies and appraisals of social outcomes interact in complex ways with one another and with social behavior. Expectancies may operate to constrain the social cues that the person processes, as well as the evaluation s/he places them. This, in turn, has an important impact upon the social behavior emitted in the situation. Appraisals of behavioral outcomes can in turn so constrain attention and behavior as to set up or confirm expectancies in current or future social situations.

13 The Cognitive Path [Addiction] – The purpose of this protocol is to promote success by identifying and dealing with the biological, psychological and social factors that pertain to addiction and its resolution. The protocol is provided as a basis for addressing any addictive behavior and is not targeting a specific addiction. Addiction in this case is primarily concerned with the components of addictiveness such as immediate gratification, habituation, creative construction of reality, state learned bias, the ‘Imp of the Perverse’ and reactance, and the typical responses to these components. Addiction is such a potent and deceptive foe that intellectual appreciation is not sufficient. The procedural knowledge required to intentionally guide the client’s actions when face to face with potent stressors and temptations cannot be acquired by understanding alone. Each person must develop this competence through skill acquisition, personal experience and guided practice.

14 Reactive Attachment – As a relatively new diagnosis, Reactive Attachment Disorder (RAD), also known as Attachment Disorder (AD) is often misunderstood, and relatively unknown. Expertise is lacking and normal behavior interventions can very easily add to the symptoms if following instinctive patterns. Lack of a conscience in the child appears to be caused by their lacking trust in anyone. They become so dependent upon themselves, that they ignore the needs of others to the point that they will steal, damage, and destroy anything that they believe hinders their control. In short, they do not trust any caregiver or person in authority. At the core of Reactive Attachment Disorder is trauma caused by significant and substantial experiences of neglect, abuse, or prolonged and unresolved pain in the first two years to three years of life. These experiences are particularly disturbing since they are ‘visceral feelings’ which disrupt the normal attachment process so that the child’s capacity to form a secure attachment with a caregiver is distorted or absent. The child lacks trust, safety, and security.

15 Choice & Reality – William Glasser’s Choice Theory, supports reality therapy, and directly challenges the belief in the medical model of psychological problems. He contends that when we are unable to figure out how to satisfy one or more of the five basic needs built into our genetic structure that are the source of all human motivation, we sometimes choose to behave in ways that are currently labeled mental illness. These needs, are: survival, love and belonging, power, freedom and fun. What is common to these ineffective and unsatisfying choices, no matter what they may be, is unhappiness. Choice theory explains that, not only do we choose all our unhappy behaviors, but every behavior we choose is made up of four components, one of which is how we feel as we behave. When we choose a behavior that satisfies our needs, immediately or eventually, we feel good. When we choose a behavior that fails to satisfy our needs, sooner or later, we feel bad.

16 Procrastination – In many ways, procrastination seems to be the Rubik’s Cube of psychological problems since the difficulty depends on how you look at it. Procrastination comes from the Latin ‘pro’, meaning “forward, forth, or in favor of”, and ‘crastinus’, meaning “of tomorrow”. However, to go beyond this notion of delay is to encounter considerable disagreement. Not everyone believes it means the same thing. In an attempt to make some sense of this complexity, we can define three elements of procrastination and then examine each separately.

17 Executive Dysfunction – Parents and teachers are often baffled when students, including those who are intellectually gifted, teeter on the brink of school failure. Recently researchers may have solved part of this challenging puzzle by identifying deficits in critical cognitive skills. Known as executive functions, the lack of these skills may interfere with a student’s ability to achieve academic and even social competence. Practically speaking, executive function deficits may cause problems for students in several important areas: starting and finishing work, remembering homework, memorizing facts, writing essays or reports, working math problems, being on time, controlling emotions, completing long-term projects, and planning for the future. This protocol, is about ‘hope and rational optimism ’ regarding executive functioning and it is important to understand the Theory Of Structural Cognitive Modifiability. It involves the capacity of the individual to be modified by learning and the ability to use whatever modification has occurred for future adjustments.

B. Individual Technique #

01 Perceiving Reflex Thoughts – This is the first step in Cognitive Process Correction, which is essentially the process used by Aaron Beck in Cognitive Therapy and Albert Ellis in Rational Emotive Therapy. This first step concentrates on awareness of automatic thoughts and attendance to them through the use of Thought Journals. This technique is never used without a follow up of the next or next two techniques.

02 Altering Limited Thinking Patterns – This is the second step in the Cognitive Process Correction Protocol. It teaches about cognitive errors and how to use them in the process of change.

03 Changing Distressing Thoughts – This is a third or alternate step in the Cognitive Process Correction Protocol. It deals with analysis of the evidence to support or refute the cognitive errors.

04 Relaxation – This is a technique that is valuable for all people. One cannot be sad, angry or anxious and relaxed at the same time. Thus, by learning how to relax in controlled situations and then learning to use cues to relax in stress situations can have a major impact on the client’s ability to carry out other cognitive skills.

05 Worry Control – Worry is a natural response to anticipated future problems. However, pervasive worry is not just a mental process, the client enters a cyclical pattern that involves thought, somatic and behavioral consequences. To control worry, the client will need to approach it on all of these levels.

06 Thought Stopping – Thought stopping involves concentrating on an unwanted thought for a short time then suddenly stopping it and emptying your mind. This is a simple technique for helping this process.

07 Flooding – Flooding is a simple technique in which the client intentionally imagines a feared situation or entertains an obsessive train of thought for a long time, at thigh intensity and without avoiding or neutralizing the images, until they finally grow bored and the images lose their power to upset.

08 Coping with Panic – When a panic attack strikes, there’s an overwhelming feeling of terror that you could die or completely lose control. Your body reacts with a host of stress symptoms that may include a racing heart, shortness of breath, a flushed feeling, weakness, dizziness, and feeling faint, as well as feelings of detachment, ‘spaciness’, and unreality. For many people struggling with panic disorder, the feelings of unreality and depersonalization are the most frightening of all because they interpret them as harbingers of insanity. Fortunately, in recent years there have been important breakthroughs in addressing panic disorder. The result is a clinical program that includes four main components:

Education about the nature of panic – what causes it and how it can be controlled
Breath control training – a process to simultaneously relax your diaphragm and slow down your breath rate
Cognitive Process Correction to help you reinterpret frightening physical symptoms while learning to control catastrophic thinking, and,
Interoceptive desensitization – a technique that exposes you to your most feared physical sensations in a safe, controlled way, while teaching you how to cope.

09 Coping Imagery – Coping imagery is a blend of stress inoculation and covert modeling. It combines the best features of both to enhance performance in problematic situations while simultaneously lowering anxiety. The client begins by identifying the detailed sequence of events that make up a problem situation – everything s/he does from beginning to end in the situation. Then note which elements of the sequence are the most anxiety evoking. Finally, the client rehearses performing the entire sequence while using specific relaxation techniques and coping thoughts to lower anxiety at crucial junctures in the sequence.

10 Stress Inoculation – Systematic desensitization teaches a client to master anxiety. Systematic desensitization is a simple process: first you relax, then you imagine a stressful scene until it produces anxiety. The scene is immediately erased and the process repeated until the scene no longer evokes any anxiety. Because each new scene is only slightly more anxiety evoking than the one before, the client progresses in gradual increments all the way to the most frightening items in the hierarchy.

11 Coping In Vivo – Full recovery from any phobia depends on successfully exposing the client in real life to core elements of their fear. If the client has developed a hierarchy of feared situations and visualized scenes from that hierarchy while relaxing the body and using helpful coping thoughts, s/he may now continue work on his/her phobia through in vivo exposure to the actual scenes and situations. To handle the inevitable anxiety that will come up during exposure, the child will need a coping script to help respond effectively to anxious arousal. The child will need to develop specific self-instructions to:

help physically relax,
remind themselves of the action plan should they encounter problems during exposure,
cope with anxious arousal and fight-or-flight symptoms,
cope with catastrophic thoughts,
accept anxious feelings as temporary and learn to float past them and, finally,
distract themselves, if necessary, from frightening thoughts.

12 Getting Mobilized – Feeling immobilized is not only a symptom of depression – it is a cause. The less you do, the more depressed you feel; and the more depressed you feel, the less you do. It’s a negative spiral that maintains withdrawal and prolongs depression. The solution is to push the child to higher levels of activity – even though s/he doesn’t feel like it. Aaron Beck (Beck et al. 1979), Arthur Freeman (Freeman et al. 1990), Christine Padesky (Greenberger and Padesky 1995), and others have shown that a technique called activity scheduling can re-energize the child and offer significant help in overcoming depression. The initial steps of the technique involve monitoring and recording daily activities and rating them for levels of pleasure and mastery. The later steps encourage the child to schedule in advance increasing numbers of pleasurable and mastery activities.

13 Problem Management – In 1971, Thomas D’Zurilla and Marvin Goldfried devised a five-step problem-solving strategy for generating novel solutions to any kind of problem. They defined a problem as ‘failure to find an effective response’. For example, the fact that a person can’t find one of his shoes in the morning is not in itself a problem. It becomes a problem only if he neglects to look under the bed where the shoe is most likely to be found. If he looks in the sink, the medicine cabinet, and the garbage disposal, he is beginning to create a problem – his response is not effective in finding the missing shoe and, therefore, the situation becomes ‘problematic’.

14 Testing Core Beliefs – Core beliefs are the foundation of the individual’s personality. They largely dictate what you can and cannot do (rules), and how you interpret events in your world (automatic thoughts). You can change negative core concepts. This technique identifies, tests and modifies these beliefs based on work by Aaron Beck and Arthur Freeman (1990), Donald Meichenbaurn (1988), Jeffrey Young (1990), and Matthew McKay and Patrick Fanning (1991).

15 Changing Core Beliefs with Visualization – Psychologically speaking, it is not true that you can’t change the past. Although you can’t alter what happened to you or what you did, you can use imagery to restructure memories so that they cause less pain and interfere less in present life.

16 Stress Inoculation for Anger – Stress inoculation training was extended to the management of anger by Raymond Novaco in 1975. Provocations don’t make you angry; hurtful, attacking statements don’t make you angry; stressful and overwhelming situations do not make you angry. What turns painful and stressful situations into anger are ‘trigger thoughts’.

17 Covert Modeling – One of the most important ways people learn to perform a new behavior is to observe and imitate someone else doing it successfully. Unfortunately, good models are not always readily available when you need them. In 1971 Joseph Cautela found that you can learn new behavior sequences by imagining people, including yourself, performing the desired behavior successfully. He called his technique covert modeling. Covert modeling enables a person to identify, refine, and practice in his/her mind the necessary steps for completing a desired behavior. Once you feel confident imagining yourself doing a particular activity, you can more effectively perform it in real life.

18 Covert Sensitization – Covert sensitization was developed and popularized by Joseph Cautela (1967) as an intervention for destructive habits. It is called “covert” because the basic treatment takes place inside the mind. The theory behind covert sensitization is that behaviors that have become strong habits are learned because they are consistently reinforced by a great deal of pleasure. One way to eliminate the habit is to begin associating the habitual behavior with some very unpleasant, imagined stimulus. As a result, the old habit no longer evokes images of enjoyment, but becomes associated with something noxious and repulsive. This association is formed by pairing the pleasurable images of the habit with painful images of nausea, physical injury, social ostracism, or other unpleasant experience. Covert sensitization can help the old habit lose most, if not all, of its appeal.

19 Anger Control – Anger management is a process of seeking alternative solutions. Once having created alternatives, the person must learn to weigh the consequences of each alternative to him/herself and to others. In the midst of the emotion such weighing is difficult since the bodily response has already prepared the person for action. However, it is a process that is likely to help calm them down.

20 Interpersonal Cognitive Problem Solving – Although very different from other popular methods of child management, the Interpersonal Cognitive Problem Solving [ICPS] approach developed by Myrna Shure continues the movement toward positive childrearing. As Shure states “In 1965 Haim Ginott sparked interest in positive parenting by suggesting in his book, Between Parent and Child, that instead of telling a child what not to do [“Don’t run!”], parent should emphasize the positive by telling them what to do [“Walk!”]. Then, in 1970, Thomas Gordon wrote the acclaimed book Parent Effectiveness Training [PET], which opened the door to the idea that active listening and using ‘I’ messages [“I feel angry when your room is messy”] instead of ‘you’ messages [“You are too messy”] are learned parenting skills.” These two landmark books paved the way for Shure’s book Raising a Thinking Child to take parents a step further. “ICPS moves from a primary focus on skills of the parent to focus on skills of the child as well. The thinking child does not have to be told how people feel or what to do; the thinking child can appreciate how people feel, decide what to do, and evaluate whether the idea is, or is not, a good one.”

21 Self-Verbalization Training – How do we take back control of our programming and control of our lives? The answer is Self Instruction. Self instructional procedures have been applied to a broad range of childhood disorders, but are seen as particularly effective with children with impulsive behaviors.

22 Six Step Reframing – Six Step Reframing is a process used in Neuro Linguistic Programming through which a problematic behavior is separated from the positive intention of the internal program or ‘part’ that is responsible for the behavior. New choices of behavior are established by having the ‘part’ responsible for the old behavior take responsibility for implementing other behaviors that satisfy the same positive intention but don’t have the problematic by-products. This somewhat mystical process is simply asking the client to articulate an unsayable answer. The client can only discover solutions that are already available within his/her mental architecture – thus, the client ‘creates’ responses which are usable.

23 Assertiveness Training – Assertiveness was originally described by Andrew Salter in the late 1940s as an innate personality trait. Wolpe (1958) and Lazarus (1966) redefined assertive behavior as “expressing personal rights and feelings”. They determined that assertiveness was situationally specific: most people can be assertive in some situations, and yet be ineffectual in others. Assertiveness training expands the number of situations in which a person can choose to be assertive.

24 Attribution Training – Changing personal attributions can occur either through individual self-examination or external manipulation. Internal self-examination can be focused either on the attributions or on the total cognitive set. External manipulation can occur either within the total culture or with a single significant individual. If a child states that s/he wants to hurt someone, the response ‘you are not that kind of person’ gives the child an internal reason not to behave inappropriately.

25 Testing Assumptions – The rules generated by core beliefs are testable, because implicit in each rule is a prediction of what will happen if the rule is broken. Each rule also creates a prediction about what will happen if you break the rule. These rules and their predictions create testable hypotheses by judiciously defining the rule and prediction and then breaking them and comparing the outcomes with the catastrophic prediction.

26 The Calm Technique – This technique is about mental control. The notion that people have preferences about their own thoughts, emotions and motives, and that there are things that they can do to influence these states is the basis for change. Mental control occurs when people suppress a thought, concentrate on a sensation, inhibit an emotion, maintain a mood, stir up a desire, squelch a craving, or otherwise influence their own mental states (Wegner, 1989; Wegner & Schneider, 1989).

27 Motivation & Goal Setting – The purpose of this technique is to assist a child with problems in living in obtaining absolute clarity on what s/he wants in every area of his/her life. If s/he is interested in improving the quality of day-to-day experiences, then s/he must define a richer, fuller, more satisfying life. S/he must face what s/he wants. This technique is designed to be a tool to determine and clarify all of the child’s personal desires, wants, and dreams; becoming aware of what they are, assessing them and making them real by acting on them.

28 Traumatic Incident Reduction – The PTSD experience is characterized by the fact that the survivor is living in the past instead of the present. The key cognitions contained in the memory of any traumatic incident that later cause trouble when they are re-stimulated are those specific conclusions, decisions, and intentions the individual generated during the incident itself in order to cope emotionally with the painful urgency of the moment. In such a circumstance, not only would certain pre- existing beliefs govern one’s reaction to a traumatic event, but also the traumatic event itself would give rise to the formulation of new, potentially errant cognitions. Viewed in this light, PTSD is very much a cognitive-emotive disorder and not nearly as Pavlovian as it at first appears to be. Accordingly, an effective cognitive-emotive approach is called for in its remediation, one in which the errant cognitions generated under the duress of the trauma are located and corrected.

29 Fast Phobia – Variously called ‘Fast Phobia Cure’, ‘Rewind Technique’, and ‘Double Dis-association method’. The technique was developed by Richard Bandler and John Grinder, the developers of Neurolinguistic Programming. Highly recommended and effective with any anxiety disorder.

30 Anchoring – Anchors developed as a product of Pavlov’s concept of stimulus response. Anchors define the triggers for states and behavior. You can learn how to establish triggers for selected responses that are desired both in yourself and others. In clinical practice, both the theoretical underpinnings and practice directions need to be considered and utilized to their fullest. The connection of cognitive approaches to learning experiences allows anchoring to be used in multiple situations. The use of an anchor can be ‘instantaneous’. However reinforcement through repetition is usually necessary. Intensity may allow an effective anchor to be placed once. This fact should raise clinical questions about what is being anchored in highly emotion charged situations.

31 Cross Mapping Submodalities – NeuroLinguistic Programming, starts with the premise that all subjective experience is ultimately reducible to what is called ‘sensory data’ plus language. When a person says ‘I think’, ‘I know’, ‘I remember’, or ‘I believe’, s/he is talking about experiencing certain images, sounds, words (often in a specific tone or voice), and feelings. Frequently these images, sounds, sentences, etc. are below the threshold of consciousness but can be brought into awareness by asking very careful questions. The separation of subjective experience into the basis modalities — visual, auditory, and kinesthetic (feelings) — is basic. More recent developments also emphasize the ‘submodalities’: sensory qualities such as brightness, size, distance, color, loudness, pitch, heaviness, temperature, etc. Thinking is tied closely to physiology. People’s thought processes change their physiological state. Changing submodalities therefore changes the physiology and create a new meaning.

32 Pathological Critic – The pathological critic is a term coined by psychologist Eugene Sagan to describe the negative inner voice that attacks and judges you. Everyone has a critical inner voice. But those people with negative self-appraisal tend to have a more vicious and vocal pathological critic. The Critic has many weapons. Among the most effective are the values and rules of living that you grew up with. The Critic has a way of turning your ‘shoulds’ against you. The Critic compares the way you are with the way you ought to be and judges you inadequate or wrong.

33 Shoulds – The tyranny of ‘shoulds’ is based on the distortion, the cognitive error, the absolute nature of belief, the unbending sense of right and wrong. The operative words in that statements are absolute and unbending, and this is what makes certain ‘shoulds’ psychological unfit. You can tell whether your beliefs, rules and ‘shoulds’ are fit or not, by applying the following criteria.

34 Reframing – We can understand frames as being our conceptual or cognitive views of particular situations. For instance, do we perceive a story we hear from a client to be a tale of problems or of solutions? Our choices of frames help us to hear certain aspects of the client’s talk, while not helping us to hear other parts of the conversation. In general communication theory there is a basic axiom that a signal only has meaning in terms of the frame or context in which it appears. The sound of a squeaky shoe on a busy sidewalk has little meaning; the same sound outside your window when you are alone in bed means something different altogether. We can change the meaning of an experience by changing either the context or the content.

35 The Mirror Model – Pay close attention to the very first thing a client says. Even before they think they’ve started. After all, the client is demonstrating their pattern to you as they walk through the door – they can’t help it. And pay particularly close attention to their answer to the first question. Real change happens at an emotional and deep- structural, not a rational and intellectual, level – its a uniquely personal, internal experience. If you agree with an ‘experiential philosophy’ (ref. 3), then your role is to keep pace with your clients as they track their own experience of already knowing what is good. [‘Good’ in the sense of useful and valuable uniquely for them]. The aim of open questioning is to reflect, expand and shift a person’s internal process without interpretation or suggestion from the questioner.

36 Eye Movement Desensitization Processing – Eye movement desensitization and reprocessing is a controversial technique reported to relieve traumatic memories, phobias, and a wide variety of psychological problems. EMDR is thought to be an advanced stage of the REM processing. As the brain via the eye-movement processes troubling images and feelings, resolution of the issue can be achieved. At the same time, there is argument that the rapid eye movement is not the remedial factor at all, since it is possible to achieve many of these same results with other means, e.g., audio in alternating ears. While some researchers want to give the credit for the positive outcomes to the Cognitive Behavior Management processes that accompany the EMDR intervention, it is not clear that it matters where the positive resource lies, only that it works.

37 Metaphor Counseling through Clean Language – A breakthrough discovery made by counseling psychologist David Grove was of an untapped level of symbolic meaning that is already underlying problems and symptoms. Information about the past can be held in the body, not only as feelings (e.g. pain, tension) but also as metaphors. (For example, “a pain in the stomach like a sharp knife”.) By skilful questioning, a number of metaphors or symbols relating to the problem may be uncovered which were not previously available to the conscious mind. These metaphors or symbols contain the seeds of memory and of change, but they need to be ‘brought alive’ by the counselor’s skills before they can be used for change. Each person has a unique metaphor system, comprised of various objects or symbols which, in the language of the unconscious mind, are located in or around the body space (e.g. a yoke around the neck).

38 Dialectical Behavior Counseling – The format of this counseling endeavor is well thought out and has merit particularly for adolescents who have survived invalidating environments and psychotraumatization. While the percentage of adolescents who meet these characteristics may not be large, they are generally the most difficult to serve and are resistant to most service offerings. It is from that standpoint that we encourage the use of this material for the very difficult to serve adolescent. DBC is organized by Functions and Modes and by Stages and Targets. The first goal is to ensure the client stays alive, so that the second goal (staying in service), results in meeting the third goal (building a better quality of life), partly through the acquisition of new behaviors (skills).

39 Schema Focused Brief Counseling – This technique is designed to address and modify these deeper patterns or themes, also known as ‘schemata’. The schemata that are targeted are enduring and self- defeating patterns that typically begin early in life. These patterns consist of negative/ dysfunctional thoughts, feelings and behaviors, have been repeated and elaborated upon, and pose obstacles for accomplishing one’s goals and getting one’s needs met.

40 Calm Action – Calm action is predicated on mindfulness – the ability to take in what is happening both inside and outside of yourself without attachment and response. Mindfulness is a detachment from the emotional cues that cause us to act in ways that ultimately prove to be harmful or disruptive. There are four [04] skills leading up to the ability to obtain what you want without internal or external turmoil: relaxing, objectifying, imaging, affirming yourself and your power to act and obtaining the results imagined.

41 Solutions Focused Brief Counseling – Solution-Focused Brief Counseling (SFBC) is a short-term goal-focused therapeutic approach that helps clients change by constructing solutions rather than dwelling on problems. Elements of the desired solution are often already present in the client’s life, and become the basis for ongoing change. The ability to articulate what the changes will be like is often more important than understanding what led to the problem.

42 Psychological First Aid – This technique is based on the concept of crisis and the premise that this concept is an essential building block in any structured understanding of growth and development. Far too often people think of crises as the unusual, mostly negative events that bring disruption to ‘normal’ life. The implication is that an ideal world would be one without crises. Crisis theory, however, takes a very different perspective. Major life transitions – similar in their components, varying only in degree and intensity – are the stuff of which life is made. Very few people avoid crisis altogether. Adult life, whether neurotic or normal, healthy or ill, optimistic or pessimistic in outlook, is a function of how we have weathered earlier crises, whether changing schools, surviving the divorce of parents, dealing with a life-threatening illness, or surviving the loss of a first love.

43 Possible Selves – This technique examines the shape and development of the possible selves of adolescents 13 to 16 years of age. More than any other time in life, adolescence is the stage of possibility and of the promises as well as the worries that attend this possibility. It is the time when one creates the self that “I could become”. Possible selves are conceptualized as the elements of the self-concept that represent the individual’s goals, motives, fears, and anxieties. They give precise self-relevant form, meaning, and direction to these dynamics. They are conceived of as the self- relevant, internal structures that embody and give rise to generalized feelings of self-efficacy, competence or control. Furthermore, possible selves contribute to the sense of importance, commitment, or centrality accorded to certain aspects of the self. Possible selves refer only to that subset of goals, outcomes, or expectancies that are personalized or individualized and given self- relevant form or meaning.

44 Sleep Techniques – Lack of sleep and inappropriate behavior may very well be interactive variables. This booklet is oriented toward providing parents with specific techniques that can be used to help there children get the proper rest. It differs from the Insomnia protocol in the prescriptive nature of the techniques. Two patterns 1) waking at night and 2) sleeping at the wrong times are targeted. In either pattern, we can have a child who either manifests disruptive behavior or not. Obviously, if the child is having a tantrum every time s/he wakes up that is a different problem than if s/he wakes up but lies quietly in bed.

C. Assessment Techniques #

01 FCBA – Most educators and clinicians are familiar with a functional behavior assessment process which attempts to verify the function of each component of the stimulus, response of operant behavior. This techniques adds two features: first, the cognitive factor [stimulus, thought:emotion, response] thus considering both the internal and external context of the behavior, and second, the inter-relatedness of the child to his/her community of interest [or personal support network]. These features make the technique extremely powerful.

02 Sociometry – The single most important variable for the prediction of future problems in living is the child’s relations with peers. This technique provides several procedures that can be used to determine the peer relations of a child.

03 Meta Model – Clinicians come to know and understand their clients primarily through language, and since language is also one of the primary ways all humans represent or model their experiences, the focus of this material is on the assessment of language. The technique was created by Richard Bandler and John Grinder using Choamsky’s theory of transformational grammar, which was developed to explicitly describe patterning in human language systems. People have consistent intuitions about the structure of their language and its transformational grammar as formal representations of those intuitions. Since we use language as a representational system, our linguistic representations are subject to the three universal errors of human modeling: Generalization, Deletion and Distortion.

04 Plan of Change – The goal of assessment is not to create a diagnostic label, but rather to provide a profile of functioning that will yield concrete guidelines for selection of intervention strategies. The translation of the profile of functioning into a sequential and targeted plan of correction that meets the preferred preferences of the client is the intent of this technique.

05 Community Assessment/Support Team – This Techniques is built upon three conceptual structures:

that interactions between people create thoughts in the other
person which may be helpful and/or harmful;
that this interrelatedness extends to all of the people who
regularly populate an individual’s ecosystem; and
that these regularly participants need to take responsibility for
the whole, not simply draw attention to a part.

To suggest that a disruption in the community is caused by an individual takes responsibility away from all other participants. This is an enhancement of the FCBA process.

06 Repertory Grid Technique – The Repertory Grid Technique is an extraordinarily versatile tool. While we have chosen to list it as an assessment tool because of our own desire to make assessments of children more goal oriented than ‘need’ oriented, it could easily have been listed as a management tool or a practitioner tool. It is emphasized throughout that the technique is a conversation – however, it is a structured conversation, which may be documented or not. As a documented conversation, it can be used to identify and cognitively map a client for counseling. As an undocumented conversation, it can be used in situ by the counselor to explore with the client his/her thoughts, beliefs and values about a given domain of interest

D. Teacher [Classroom] Techniques #

01 Assertive Discipline – Assertive discipline is a systematic behavior management procedure designed by Lee Canter to put elementary and
secondary classroom teachers in charge of their classes. Combining tenets from assertion training and behavior modification, Canter (1979) believes that he has identified four discipline competencies that all teachers need to master to handle problem behaviors successfully. The
competencies include:

identifying appropriate behaviors that form the basis for
classroom rules,
systematically setting limits for inappropriate behavior,
consistently reinforcing appropriate behavior, and
working cooperatively with parents and principals.

In this cookbook approach to discipline the steps for acquiring these competencies are detailed, even to the extent of specifying the number
of rules and the number of negative consequences.

02 Attribution Training – The strongest lesson from Attribution Theory seems to be its simplicity. You might have been struck by that fact as you read about the experiments. To achieve obvious and apparently enduring effects, all the sources had to do was make a few well-timed and appropriate statements. There was no great deception or elaboration machinations. There are two key steps to effective use of Attribution. First, it must be applied in a situation where people are thinking about why things are happening. Second, the explanation must be an internal attribution.

03 Cognitive Modeling – Cognitive modeling is one of the techniques based on cognitive behavior management, which involves the manipulation of
antecedents (before response of the student) and consequences (after response of the student) to change both overt (external) and covert (internal [cognitive]) behavior. Cognitive modeling incorporates modeling plus some form of verbal rehearsal such as verbal mediation, self-instruction, or problem-solving procedures. Students are active participants in the program and imitate as the model uses various types of verbal mediation. The students then rehearse the behaviors aloud, in a whisper, and silently. Cognitive modeling is often used to develop self-control in students.

04 Individual Behavioral Learning – The goal and activities of the Individual Behavior Learning Packets are focused on a proactive instructional approach to behavior management as proposed by Colvin, Kameenui and Sugai. This focus conceptualizes the management of social behavior problems in much the same way as the management of instructional problems. Most often, educators approach social behavior problems differently than instructional problems. For example, when a student makes an error in academic subjects (e.g., decoding, math computation, concept application), a correction procedure is implemented and the student is provided with more practice and review. If the errors become persistent or chronic, teachers diagnose the problem (i.e., identify the misrule), rearrange the presentation, and provide more practice and review. Clearly, such a proactive emphasis enhances the student’s opportunities to make the correct academic response.

05 Reality Training – Reality training is a technique for dealing with affective behavior by teaching students actively to change their overt behaviors. Through teacher-directed questioning, students learn how to describe and evaluate their own behavior and how to develop a plan for changing that behavior into a more responsible and socially acceptable one. Through class meetings, students are given opportunities to express their concerns about the class, their home, and other areas, as teachers listen. Discipline and a warm student-teacher relationship are
necessary components to supplement questioning and class meeting procedures. Subjective interpretations of feelings and thoughts are ignored, and the students are led to face the ‘reality’ of their behavioral responses.

06 Self-Management – Self-management strategies involve teaching students how to manage their own behaviors. Students actively participate in the selection of the target behavior for improvement and the behavioral goals, in the antecedent and consequent events, and in the recording and evaluation of the behavioral changes. External or teacher control is minimal.

07 Systematic Desensitization – Systematic desensitization is a procedure by which new behaviors are learned in response to stimuli that previously elicited other behaviors. Information giving, relaxation training, establishment of hierarchies, and counter-conditioning procedures are included in the strategy. Recently, rational or balanced self-talk and active participation have been added as components of systematic desensitization procedures. Although the procedure was developed and used primarily in clinical settings, it has proved helpful in reducing test anxiety and curing school phobia.

08 Time Out – Time out is a type of strategy that involves the withdrawal of all reinforcement for a specified period of time. Either the student may be removed from the setting or the reinforcer may be withdrawn from the student. The removal or withdrawal takes place after the student has displayed the inappropriate behavior. Time out procedures vary from a mild form, in which social attention is withdrawn, to a severe form, in which the student is isolated in a padded room.

09 Token System – A token system is a management procedure that is often used in classrooms for students with emotional and social problems. In a token system an object or ‘token’ is given to the student as an immediate reward for certain behavioral responses. The tokens have no value of their own but are exchanged for backup rewards such as tangible products, activities, and/or privileges.

10 Social Skill Training – Social skills training is a direct approach to improving a student’s interpersonal relationships. Goals associated with general affective growth, such as the enhancement of self-concept or the development of a personal set of values, are not a primary focus in social skills training. Instead, friendship skills such as greeting, asking for and returning information, inviting participation in activities, and leave taking, are the focus of social skills training programs. Other programs target social maintenance skills (such as giving positive attention, helping, or cooperation, or conflict resolution skills (such as non-aggressive, compromising, or persuasive behaviors) as the goals of social skill training. Any behaviors believed to contribute to successful interpersonal functioning in school settings may be the focus of a social skills training program.

E. Group Techniques

01 Anger Control – Developed by Jim and Mary Anne Tanner, this seven-part program covers anger cues, triggers, anger producing thoughts, time outs, boosters & reducers and anger styles.

02 Interdependence – The elements of co-dependence are seen in many relationships, including when parents, teachers and clinicians try to make decisions for or take responsibility for the actions of the children they manage. Through the group process, a co-dependent’s interactional problems are triggered; at the same time, peer validation, feedback, modeling of new behaviors, and healing can occur.

03 Learning Resilience – The overall goals of this training are twofold: 1) to address the current episode of major depression so that the client is no longer experiencing significant depressive systems, and 2) to teach the client skills that will help prevent relapse of the depression in the future. The goals should be circumscribed – that is, clients who have a myriad of problems apart from their depression may continue to experience those peripheral problems. The goals within the context of the group are specifically related to resilience and depression. To meet the dual goals of addressing current depression and preventing future depressions, it will be necessary to cover three topics. Within each topic area, specific goals are addressed in turn. The first area is cognition. The goal here is to teach clients to identify and to change negative, dysfunctional cognitions that precipitate and maintain depression to more positive, health-enhancing cognitions. The second area involves activities. The goal in this area is to increase the number of pleasant activities in which the client participates. The final area involves improving interpersonal relationships. The goal is individualized for each client, and may include expanding friendship networks, improving relationships with others, becoming more assertive, or learning to value friendship.

04 Standing Up For Me – Assertiveness training has been employed with a variety of populations, including grade school children and adolescents. The assertiveness training model described here emphasizes the building of assertiveness skills, using model presentation, rehearsal, positive feedback, prompting, covert modeling, and homework assignments. Basic assumptions regarding one’s assertive rights are made explicit, traditional assumptions and fears that inhibit assertive behavior are challenged, and the pros and cons of assertive and nonassertive behavior are explored. Assertiveness training is most useful for people who can take the responsibility to identify social situations in which they have difficulty communicating assertively and who lack certain assertiveness skills, or are not comfortable in certain situations using the assertiveness skills they do possess.

05 Taking Charge of Myself – The anger control group model described here employs all three major anger control interventions: cognitive rehabilitation, relaxation coping skills, and social skills training. The social skills component is based on a technique called response choice rehearsal that trains clients to use up to six adaptive responses when struggling with an anger-provoking situation. A successful anger control group depends on appropriate selection. Pre-group interviews should be conducted. Ask questions about the duration and quality of relationships that would help you identify personality disorders. Narcissistic or borderline personality disorders are rarely helped by cognitive and behavioral anger control measures. And they are often disruptive and time-consuming to group members. Ask questions to determine if the client enjoys his or her anger, nurture it, relies on it, or is otherwise invested in maintaining an anger stance. Clients who experience their anger as rewarding and useful tend to have less success in anger control groups