Vignette 2

Alice was a bit overweight, had periodic eating binges. She’d sneak to the McDonald’s drive –through and order cheeseburgers and milkshakes. Afterward, she’d hate herself for it. She had tried for years to control her eating binges but with little success.

After an eating binge, I asked her to notice any thoughts that occurred to her, whether or not they seemed related to the eating binge. Her thoughts ran to her husband. She said he was self-centered and controlling and disregarded her needs. She said he treated her as a trophy to display, not as a human being with feelings of her own. Her additional associations were that her husband was happy when she was thin because she was a better trophy, that she felt deprived and unloved, and that she felt dependent on her husband and trapped. My patient’s eating binge was embedded in complex web of associations and meanings. As it turned out, her behaviour served simultaneously to punish her husband, to compensate for her emotional deprivation (because she associated food with love), to reassure herself that she was not under his control, to help suppress fantasies about leaving him (because being overweight would make her less desirable to other men), and to punish herself for her vengeful thoughts (because she hated being overweight).

Task 12. One of the ways of implementing systematic desensitization is progressive relaxation. Narrate the procedure of progressive muscle relaxation in the name of a client in the past tense. The verbs which may be helpful are provided. One sentence is done for you.

The psychologist asked/invited me to make myself in a comfortable position.

I. Patients make themselves in a comfortable position.	To ask/to invite
II. Light or soft music/pleasant visual cues are provided.	To suggest
III. A brief explanation about the progressive muscle relaxation (patients relax major muscle group in a fixed order, beginning with the small muscle group of the feet towards head)	To give/to offer, to explain
IV. Clients tense each muscle group for approximately 10 seconds.	To instruct
V. Clients feel the tension of the muscle and uncomfortable sensations in the body parts.	To warn
VI. Clients relax each muscle	To offer
VII. Clients feel the difference between both the situations.	To ask

Task 13. Another way of implementing systematic desensitization is hierarchy construction.

A. Narrate the example of hierarchy construction in the name of a client. Use the following patterns:

The psychologist suggested that I should…/The psychologist suggested doing…

The psychologist made me do…

The psychologist asked me to do…

An example of a hierarchy of events associated with a fear of elevators:

A. Discuss riding an elevator with the therapist.

B. Look at the picture of an elevator.

C. Walk into the elevator.

D. Push the button for the elevator.

E. Walk into the elevator with a trusted person, disembark before the door closes.

F. Walk into the elevator with a trusted person; allow the door to close; then open the door and walk out.

G. Rise the elevator one floor with a trusted person, then walk down the stairts.

H. Ride the elevator one floor with a trusted person and ride the elevator back.

I. Ride the elevator alone.

B. Build another example of hierarchy construction for another type of phobia.

Task 14. Provide feedback to what your client is saying to become an active listener. Use the following patterns:

Encouraging	Can you tell me more about…
Clarifying	What I am hearing is…; Sounds like you are saying that… What do you mean when you say…? Is this what you mean? Are you saying …? What does that look like?
Restating	I thought I heard you say… We may need to check this out further
Reflecting	You seem quite passionate about the idea…
Summarizing	These seem to be the key ideas you have expressed… What I hear you saying is… Is it about…? Let me make sure that I understand you…
Validating	I think I understand why you are so confused.

Client 1. My parents are always away and no one seems to care about me.

Client 2. My children are very busy so I am going to be a heavy burden to them.

Client 3. I have tried all possible means to overcome the addiction so there’s no other way than giving up.

Client 4. I don’t have any friends. I know so few people. I try not to care. People just aren’t dependable, everyone is out for himself/herself.

Client 5. The test results will be ready tomorrow. I am afraid I can’t face it if something goes wrong again.

Client 6. If my brother had done it, my dad wouldn’t have asked a question. It’s always been like that.

Client 7. My maths teacher is always trying to find fault with me no matter how hard I try to be diligent and obedient.

Client 8. I am the most experienced worker but I was fired after all those years. I have no idea what to do.

Client 9. I find my present job boring. I think I will quit it.

Client 10. If my parents are divorced I will have to stay with one of them and I am afraid it is their interests only what will count.

Task 15. One of the most effective humanistic techniques is asking open-ended questions which help the client to find their own solution. Remember, that open-ended questions typically begin with words such as "Why" and "How", or phrases such as "Tell me about...".

A. Translate each of the following “yes-no” questions into an “open-ended” one. Some examples are provided for you.

E. g. How does that make you feel?" or "What do you think you need to do to resolve the situation?"

1. (A doctor to a patient…) “Have you been taking your medication?

Your open-ended version:

2. (On talking with a person who looks disappointed…) “So you didn’t like that, huh?”

Your open-ended version:

3. (A psychotherapist to a client…) “Don’t you think it would be better if you receive the drug therapy first?

Your open-ended version:

4. (A psychotherapist to a client…) “Do you know how to cope with this problem?”

Your open-ended version:

5. (A psychotherapist to a client…) “Is it OK with you if we discuss the feelings you had at that time?)

Your open-ended version:

6. (A psychotherapist to a client…) “Did you have a good relationship with your parents”

Your open-ended version:

7. (A psychotherapist to a client…) “Did you like your pervious counselor?”

Your open-ended version:

8. (A psychotherapist to a client…) “Do you care about your health?””

Your open-ended version:

Key: 4. 5. What do you think about discussing the feelings…; 6. Tell me about your relationship with you parents.

B. Respond to the client’s words using open-ended questions:

1. Client: I had already sought therapy before.

Psychotherapist:

2. Client: I was a neglected child.

Psychotherapist:

3. Client: I feel very lonely.

Psychotherapist:

4. Client: I was divorced the same year.

Psychotherapist:

5. Client: My 16-year old daughter is pregnant.

Psychotherapist:

6. Client: My previous therapist couldn’t find a way with me.

Psychotherapist:

7. Client: I feel guilty for what has happened.

Psychotherapist:

8. Client: I was overwhelmed with fear when they announced the diagnosis to me.

Psychotherapist:

9. Client: My husband hasn’t shown me any love lately.

Psychotherapist:

10. Client: All my friends seem to avoid my company.

Psychotherapist:

Task 16. Fill in the prepositions if necessary.

1. Free associations enable the person to become aware … conflicts that in some cases date … … early childhood. 2. Is your psychologist able to do anything … this problem? 3. Behaviourists try to substitute the learned response of ‘fear’ … the response of ‘relaxation’. 4. Cognitive-behavioural therapies aim … identifying and changing negative or maladaptive beliefs. 5. Relaxation techniques may help to cope … anxiety symptoms such as panic attack. 6. This approach enabled the therapist to deal … the immediate problems of the panic attacks and to probe more deeply … the reasons … these attacks. 7. The rationale … this type of therapy lies … the belief that individual problems are often exacerbated by relationship difficulties … the family. 8. A mental illness arises … … ‘frustration’ as a result of circumstances ‘blocking’ the individual’s progress … fulfilling their potential. 9. Group therapy resulted ... the resolution of psychological difficulties for him. 10. In family therapy each family member becomes aware … how the individual relates … the others and how this interaction contributes .. the family’s problems.

Key: 1. of, back to; 2. about; 3. for; 4. at; 5. with; 6. with, into, behind; 7. behind, in, within; 8. out of, towards; 9. in; 10. of, to, to.

Task 17. Translate the following sentences from Russian into English.

1. Основные методики психоанализа включают анализ сновидений, свободных ассоциаций и лечение гипнозом. 2. Какие методики помогают индивиду осознать наличие внутреннего конфликта? 3. Бихевиористы полагают, что человек, страдающий фобией, ассоциирует объект, вызывающий страх, с негативными последствиями. 4. Бихевиористы рассматривают человеческое поведение как ряд условных/ приобретенных рефлексов на внешние раздражители. 5. Бихевиористские методики недостаточно учитывают индивидуальные процессы мышления и рассуждения. 6. Эклектический подход включает сочетание методик всех основных психологических подходов к лечению. 7. Гуманистическое направление в консультативной работе основано на подходе, согласно которому для индивидов характерна естественная тенденция к самореализации. 8. Роль терапевта состоит в том, чтобы помочь человеку проанализировать/исследовать свои собственные мысли и эмоции. 9. Это лечение позволит ей найти лучшее решение этой проблемы. 10. Самораскрытие и самоанализ позволили ему решить психологические трудности.

Key. 1. The main psychoanalysis techniques include dream analysis, free association and hypnotherapy. 2. Which techniques help an individual to become aware of their internal conflict? 3. Behaviourists believe that the phobic person associates the feared object with negative consequences. 4. Behaviourists regard human behaviour as a series of learned responses to external stimuli. 5. Behavioural techniques pay little attention to the individual’s thinking or reasoning processes. 6. An eclectic approach involves combining techniques from each of the main psychological approaches to therapy. 7. Humanistic counselling is based on the approach according to which individuals possess a natural tendency towards self-fulfillment. 8. The therapist’s role is to help the individual to explore his or her own thoughts and emotions. 9. This therapy will enable her to arrive at the best solution to this problem. 10. Self-disclosure and self-examination enabled him to resolve his psychological difficulties.

Task 18. Use the chart to below to describe commonly used psychotherapies according to the pattern:

… is a method whose main goal is … . It uses the techniques of … . The major means of achieving its goals is … .

Therapy Method	Main Technique(s)	Main Goal	Means of Achieving Goal
Psychoanalysis	Free association, dream analysis, transference	Reduce anxiety and guilt from unconscious urges	Verbal processes
Humanistic Therapy	Active listening, acceptance, support	Fulfill one’s potential and improve self-concept	Verbal processes
Cognitive Therapy	Talking, listening, role-playing, and completion of assignments	Unite behaviours and thought	Revising thoughts
Behavior Therapy	Counterconditioning, operant conditioning, systemic desensitization	Change one’s unwanted or abnormal behaviours and acquire desirable behaviours	Behavioural training

Task 19. The following words and phrases are in the interview. Check the meaning and the pronunciation in your dictionary.

Boring; date; inapt; to figure out, to feel sick; failure; slob; disgusting; to flirt; to exchange; usher; to giggle; to bash; bizarre; in a full alert; to remind; anxious; awkward; to ignore; to represent.

Task 20. Listen to the text. Say which of these the client really complained of.

1. Sleeping problems.

2. Feeling awkward when he starts dating a woman.

3. Feeling sick when he starts dating a woman.

4. Failure to flirt with women.

5. Lack of self-confidence when dating a woman.

6. Seeing one and the same woman in his dreams.

7. Missing his mother and her garden.

Task 21. Listen to the text again and fill in the gaps with the missing words. Then identify the parts of the interview where different psychoanalytic techniques are employed: dream analysis, transference, free association.