Strength-based practice is a social work practice theory that emphasizes people's self-determination and strengths. It is a philosophy and a way of viewing clients as resourceful and resilient in the face of adversity. It is client-led, with a focus on future outcomes and strengths that people bring to a problem or crisis. When applied beyond the field of social work, strength-based practice is also referred to as the "strength-based approach".
EMDR (Eye Movement Desensitization and Reprocessing) is a psychotherapy that enables people to heal from the symptoms and emotional distress that are the result of disturbing life experiences. Repeated studies show that by using EMDR therapy people can experience the benefits of psychotherapy that once took years to make a difference. It is widely assumed that severe emotional pain requires a long time to heal. EMDR therapy shows that the mind can in fact heal from psychological trauma much as the body recovers from physical trauma. When you cut your hand, your body works to close the wound. If a foreign object or repeated injury irritates the wound, it festers and causes pain. Once the block is removed, healing resumes. EMDR therapy demonstrates that a similar sequence of events occurs with mental processes. The brain’s information processing system naturally moves toward mental health. If the system is blocked or imbalanced by the impact of a disturbing event, the emotional wound festers and can cause intense suffering. Once the block is removed, healing resumes. Using the detailed protocols and procedures learned in EMDR therapy training sessions, clinicians help clients activate their natural healing processes.
More than 30 positive controlled outcome studies have been done on EMDR therapy. Some of the studies show that 84%-90% of single-trauma victims no longer have post-traumatic stress disorder after only three 90-minute sessions. Another study, funded by the HMO Kaiser Permanente, found that 100% of the single-trauma victims and 77% of multiple trauma victims no longer were diagnosed with PTSD after only six 50-minute sessions. In another study, 77% of combat veterans were free of PTSD in 12 sessions. There has been so much research on EMDR therapy that it is now recognized as an effective form of treatment for trauma and other disturbing experiences by organizations such as the American Psychiatric Association, the World Health Organization and the Department of Defense. Given the worldwide recognition as an effective treatment of trauma, you can easily see how EMDR therapy would be effective in treating the “everyday” memories that are the reason people have low self-esteem, feelings of powerlessness, and all the myriad problems that bring them in for therapy. Over 100,000 clinicians throughout the world use the therapy. Millions of people have been treated successfully over the past 25 years.
EMDR therapy is an eight-phase treatment. Eye movements (or other bilateral stimulation) are used during one part of the session. After the clinician has determined which memory to target first, he asks the client to hold different aspects of that event or thought in mind and to use his eyes to track the therapist’s hand as it moves back and forth across the client’s field of vision. As this happens, for reasons believed by a Harvard researcher to be connected with the biological mechanisms involved in Rapid Eye Movement (REM) sleep, internal associations arise and the clients begin to process the memory and disturbing feelings. In successful EMDR therapy, the meaning of painful events is transformed on an emotional level. For instance, a rape victim shifts from feeling horror and self-disgust to holding the firm belief that, “I survived it and I am strong.” Unlike talk therapy, the insights clients gain in EMDR therapy result not so much from clinician interpretation, but from the client’s own accelerated intellectual and emotional processes. The net effect is that clients conclude EMDR therapy feeling empowered by the very experiences that once debased them. Their wounds have not just closed, they have transformed. As a natural outcome of the EMDR therapeutic process, the clients’ thoughts, feelings and behavior are all robust indicators of emotional health and resolution—all without speaking in detail or doing homework used in other therapies.
EMDR therapy combines different elements to maximize treatment effects. A full description of the theory, sequence of treatment, and research on protocols and active mechanisms can be found in F. Shapiro (2001) Eye movement desensitization and reprocessing: Basic principles, protocols and procedures (2nd edition) New York: Guilford Press.
EMDR therapy involves attention to three time periods: the past, present, and future. Focus is given to past disturbing memories and related events. Also, it is given to current situations that cause distress, and to developing the skills and attitudes needed for positive future actions. With EMDR therapy, these items are addressed using an eight-phase treatment approach.
Phase 1: The first phase is a history-taking session(s). The therapist assesses the client’s readiness and develops a treatment plan. Client and therapist identify possible targets for EMDR processing. These include distressing memories and current situations that cause emotional distress. Other targets may include related incidents in the past. Emphasis is placed on the development of specific skills and behaviors that will be needed by the client in future situations.
Initial EMDR processing may be directed to childhood events rather than to adult onset stressors or the identified critical incident if the client had a problematic childhood. Clients generally gain insight on their situations, the emotional distress resolves and they start to change their behaviors. The length of treatment depends upon the number of traumas and the age of PTSD onset. Generally, those with single event adult onset trauma can be successfully treated in under 5 hours. Multiple trauma victims may require a longer treatment time.
Phase 2: During the second phase of treatment, the therapist ensures that the client has several different ways of handling emotional distress. The therapist may teach the client a variety of imagery and stress reduction techniques the client can use during and between sessions. A goal of EMDR therapy is to produce rapid and effective change while the client maintains equilibrium during and between sessions.
Phases 3-6: In phases three to six, a target is identified and processed using EMDR therapy procedures. These involve the client identifying three things:
1. The vivid visual image related to the memory
2. A negative belief about self
3. Related emotions and body sensations.
In addition, the client identifies a positive belief. The therapist helps the client rate the positive belief as well as the intensity of the negative emotions. After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously engaging in EMDR processing using sets of bilateral stimulation. These sets may include eye movements, taps, or tones. The type and length of these sets is different for each client. At this point, the EMDR client is instructed to just notice whatever spontaneously happens.
After each set of stimulation, the clinician instructs the client to let his/her mind go blank and to notice whatever thought, feeling, image, memory, or sensation comes to mind. Depending upon the client’s report, the clinician will choose the next focus of attention. These repeated sets with directed focused attention occur numerous times throughout the session. If the client becomes distressed or has difficulty in progressing, the therapist follows established procedures to help the client get back on track.
When the client reports no distress related to the targeted memory, (s)he is asked to think of the preferred positive belief that was identified at the beginning of the session. At this time, the client may adjust the positive belief if necessary, and then focus on it during the next set of distressing events.
Phase 7: In phase seven, closure, the therapist asks the client to keep a log during the week. The log should document any related material that may arise. It serves to remind the client of the self-calming activities that were mastered in phase two.
Phase 8: The next session begins with phase eight. Phase eight consists of examining the progress made thus far. The EMDR treatment processes all related historical events, current incidents that elicit distress, and future events that will require different responses.
Cognitive Behavioral Therapy
Your therapist will encourage you to talk about your thoughts and feelings and what's troubling you. Don't worry if you find it hard to open up about your feelings. Your therapist can help you gain more confidence and comfort.
CBT generally focuses on specific problems, using a goal-oriented approach. As you go through the therapy process, your therapist may ask you to do "homework" — activities, reading or practices that build on what you learn during your regular therapy sessions — and encourage you to apply what you're learning in your daily life.
Your therapist's approach will depend on your particular situation and preferences. Your therapist may combine CBT with another therapeutic approach — for example, interpersonal therapy, which focuses on your relationships with other people.
Steps in CBT
CBT typically includes these steps:
· Identify troubling situations or conditions in your life. These may include such issues as a medical condition, divorce, grief, anger or symptoms of a mental illness. You and your therapist may spend some time deciding what problems and goals you want to focus on.
· Become aware of your thoughts, emotions and beliefs about these problems. Once you've identified the problems to work on, your therapist will encourage you to share your thoughts about them. This may include observing what you tell yourself about an experience (self-talk), your interpretation of the meaning of a situation, and your beliefs about yourself, other people and events. Your therapist may suggest that you keep a journal of your thoughts.
· Identify negative or inaccurate thinking. To help you recognize patterns of thinking and behavior that may be contributing to your problem, your therapist may ask you to pay attention to your physical, emotional and behavioral responses in different situations.
· Reshape negative or inaccurate thinking. Your therapist will likely encourage you to ask yourself whether your view of a situation is based on fact or on an inaccurate perception of what's going on. This step can be difficult. You may have long-standing ways of thinking about your life and yourself. With practice, helpful thinking and behavior patterns will become a habit and won't take as much effort.
Length of therapy:
CBT is generally considered short-term therapy — about 10 to 20 sessions. You and your therapist can discuss how many sessions may be right for you. Factors to consider include:
· Type of disorder or situation
· Severity of your symptoms
· How long you've had your symptoms or have been dealing with your situation
· How quickly you make progress
· How much stress you're experiencing
· How much support you receive from family members and other people
Except in very specific circumstances, conversations with your therapist are confidential. However, a therapist may break confidentiality if there is an immediate threat to safety or when required by state or federal law to report concerns to authorities. These situations include:
· Threatening to immediately or soon (imminently) harm yourself or take your own life
· Threatening to imminently harm or take the life of another person
· Abusing a child or a vulnerable adult (someone over age 18 who is hospitalized or made vulnerable by a disability)
· Being unable to safely care for yourself
Mindfulness-based cognitive therapy (MBCT) is a psychological therapy psychological therapy designed to aid in preventing the relapse of depression, specifically in individuals with major depressive disorder (MDD). Its intent to address MDD specifically distinguishes MBCT from other mindfulness-based therapies such as mindfulness-based stress reduction which is applicable to a broad range of disorders, and mindfulness-based relapse prevention which is used to treat addiction.
MBCT uses traditional cognitive behavioral therapy (CBT) methods and adds in newer psychological strategies such as mindfulness and mindfulness meditation. Cognitive methods can include educating the participant about depression. Mindfulness and mindfulness meditation, focus on becoming aware of all incoming thoughts and feelings and accepting them, but not attaching or reacting to them. This process is known as "Decentering" and aids in disengaging from self-criticism, rumination, and dysphoric mood that can arise when reacting to negative thinking patterns.
Like CBT, MBCT functions on the theory that when individuals who have historically had depression become distressed, they return to automatic cognitive processes that can trigger a depressive episode. The goal of MBCT is to interrupt these automatic processes and teach the participants to focus less on reacting to incoming stimuli, and instead accepting and observing them without judgment. This mindfulness practice allows the participant to notice when automatic processes are occurring and to alter their reaction to be more of a reflection. It is theorized that this aspect of MBCT is responsible for the observed clinical outcomes.
Beyond its use in reducing depressive acuity, research additionally supports the effectiveness of mindfulness meditation upon reducing cravings for substances that people are addicted to. Addiction is known to involve the weakening of the prefrontal cortex that ordinarily allows for delaying of immediate gratification for longer term benefits by the limbic and paralimbic brain regions. Mindfulness meditation of smokers over a two-week period totaling five hours of meditation decreased smoking by about 60% and reduced their cravings, even for those smokers in the experiment who had no prior intentions to quit. Neuroimaging of those who practice mindfulness meditation has been shown to increase activity in the prefrontal cortex, a sign of greater self-control.
Hypnosis, also referred to as hypnotherapy or hypnotic suggestion, is a trance-like state in which you have heightened focus and concentration. Hypnosis is usually done with the help of a therapist using verbal repetition and mental images. When you're under hypnosis, you usually feel calm and relaxed, and are more open to suggestions.
Hypnosis can be used to help you gain control over undesired behaviors or to help you cope better with anxiety or pain. It's important to know that although you're more open to suggestion during hypnosis, you don't lose control over your behavior.
Hypnotherapy can be an effective method for coping with stress and anxiety. In particular, hypnosis can reduce stress and anxiety before a medical procedure, such as a breast biopsy.
Hypnosis has been studied for other conditions, including:
· Pain control. Hypnosis may be beneficial for pain associated with cancer, irritable bowel syndrome, fibromyalgia, temporomandibular joint problems, dental procedures and headaches.
· Hot flashes. Hypnosis may relieve symptoms of hot flashes associated with menopause.
· Behavior change. Hypnosis has been used with some success in the treatment of insomnia, bed-wetting, smoking, obesity and phobias.
· Fatigue. Hypnosis has been used to treat fatigue associated with radiotherapy in people with breast cancer.
How Mediation Works
· Gather Information and Identify Issues. As a first step, we gather information about your situation and identify decisions you have already made and issues that remain. I can help to make you aware of the topics that need to be addressed.
· Discuss Issues. We then discuss the open issues, working to identify and understand each of your needs and interests. Having a better understanding of each party’s needs clears the way to creative solutions.
· Identify and Evaluate Options. With a full understanding of everyone’s interests, we brainstorm options and then evaluate to see which best meet your needs.
· Make Decisions. Once we have explored all of the possible options, you are then in a position to make decisions that are the best solutions for your situation.
· Formalize Agreement. We draft a legal and binding agreement to reflect the decisions you have made.
Benefits of Mediation
· Control. The parties decide for themselves what is best for their situation, allowing them to craft solutions that are tailored to their unique situation.
· Privacy. The parties meet with the mediator in a private, comfortable setting that encourages a collaborative, non-adversarial experience.
· Collaboration. Because the approach is collaborative rather than adversarial, mediation allows for a result that satisfies both parties’ needs without pitting one against the other.
· Timing. Mediation proceeds according to the schedule that the parties choose rather than waiting for scheduling on court calendars.
· Savings. Mediation is much less expensive than litigation. The savings result from direct communication and voluntary disclosure, without depositions, court conferences, motions or other procedural steps.
· Communication. In addition to resolving the issues being faced, mediation can create a new dynamic that improves future interactions.
· Satisfaction. Because mediation encourages each party to fully express their views and allows the parties to control the outcome of their dispute, people are most often satisfied with the process and results of a mediated settlement.