Avolition, as a symptom of various forms of psychopathology, is the decrease in the ability to initiate and persist in self-directed purposeful activities. Such activities that appear to be neglected usually include routine activities, including hobbies, going to work or school, and most notably, engaging in social activities. A person experiencing avolition may stay at home for long periods of time, rather than seeking out work or peer relations.
Psychopathology
People with avolition often want to complete certain tasks but lack the ability to initiate behaviours necessary to complete them. Avolition is most commonly seen as a symptom of some other disorder, but might be considered a primary clinical disturbance of itself (or as a coexisting second disorder) related to disorders of diminished motivation. In 2006, avolition was identified as a negative symptom of schizophrenia by the National Institute of Mental Health (NIMH), and has been observed in patients with bipolar disorder as well as resulting from trauma.
Avolition is sometimes mistaken for other, similar symptoms also affecting motivation, such as abulia, anhedonia and asociality, or strong general disinterest. For example, abulia is also a restriction in motivation and initiation, but characterised by an inability to set goals or make decisions and considered a disorder of diminished motivation. In order to provide effective treatment, the underlying cause of avolition (if any) has to be identified and it is important to properly differentiate it from other symptoms, even though they might reflect similar aspects of mental illness.
Social and Clinical Implications
Implications from avolition often result in social deficits. Not being able to initiate and perform purposeful activities can have many implications for a person with avolition. By disrupting interactions with both familiar and unfamiliar people, it jeopardizes the patient’s social relations. When part of a severe mental illness, avolition has been reported, in first person accounts, to lead to physical and mental inability to both initiate and maintain relationships, as well as work, eat, drink or even sleep.
Clinically, it may be difficult to engage an individual experiencing avolition in active participation of psychotherapy. Patients are also faced with the stresses of coping with and accepting a mental illness and the stigma that often accompanies such a diagnosis and its symptoms. Regarding schizophrenia, the American Psychiatric Association reported in 2013 that there currently are “no treatments with proven efficacy for primary negative symptoms” (such as avolition). Together with schizophrenia’s chronic nature, such facts added to the outlook of never getting well, might further implicate feelings of hopelessness and similar in patients as well as their friends and family.
Treatment
Antipsychotics are less effective in the treatment of negative symptoms of schizophrenia such as avolition than for positive symptoms. Low dose amisulpride has shown to be more effective than placebo for treating the negative symptoms of schizophrenia, which includes avolition. It works by blocking pre-synaptic dopamine receptors, causing a release of dopamine into the synapse.
Compared with social skills training (SST), cognitive behavioural therapy (CBT) shows more promise in treating the negative symptoms of schizophrenia, including avolition.
According to a 2015 article, aripiprazole may be useful for treatment of apathy syndrome (avolition). However, its role and efficacy in treatment of apathy requires further investigation in clinical trials. A comparison to amisulpride published in 2022, found that aripiprazole was effective in treating negative symptoms, while amisulpride was not.
According to a 2020 study, mitragynine contained in kratom may have the ability to reduce avolition.
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A social relation is the fundamental unit of analysis within the social sciences, and describes any voluntary or involuntary interpersonal relationship between two or more individuals within and/or between groups. The group can be a language or kinship group, a social institution or organisation, an economic class, a nation, or gender. Social relations are derived from human behavioural ecology, and, as an aggregate, form a coherent social structure whose constituent parts are best understood relative to each other and to the social ecosystem as a whole.
Brief History
Early inquiries into the nature of social relations featured in the work of sociologists such as Max Weber in his theory of social action, where social relationships composed of both positive (affiliative) and negative (agonistic) interactions represented opposing effects. Categorising social interactions enables observational and other social research, such as Gemeinschaft and Gesellschaft (lit. ‘community and society’), collective consciousness, etc.
Ancient works which include manuals of good practice in social relations include the text of Pseudo-Phocylides, 175–227, Josephus’ polemical work Against Apion, 198–210, and the deutero-canonical Jewish Book of Sirach or Ecclesiasticus, 7:18–36.
More recent research on social behaviour has demonstrated that newborn infants tend to instinctually gravitate towards prosocial behaviour. As obligate social apes, humans are born highly altricial, and require an extended period of post-natal development for cultural transmission of social organisation, language, and moral frameworks. In linguistic and anthropological frameworks, this is reflected in a culture’s kinship terminology, with the default mother-child relation emerging as part of the embryological process.
Forms of Relation and Interaction
According to Piotr Sztompka, forms of relation and interaction in sociology and anthropology may be described as follows: first and most basic are animal-like behaviours, i.e. various physical movements of the body. Then there are actions—movements with a meaning and purpose. Then there are social behaviours, or social actions, which address (directly or indirectly) other people, which solicit a response from another agent.
Next are social contacts, a pair of social actions, which form the beginning of social interactions. Symbols define social relationships. Without symbols, our social life would be no more sophisticated than that of animals. For example, without symbols people would have no aunts or uncles, employers or teachers-or even brothers and sisters. In sum, symbolic integrations analyse how social life depends on the ways people define themselves and others. They study face-to-face interaction, examining how people make sense out of life, how they determine their relationships.
Physical Movement
Meaning
Directed Towards Others
Await Response
Unique/Rare Interaction
Interactions
Accidental, Not Planned, But Repeated Interaction
Regular
Interactions Described by Law, Custom, or Tradition
A Scheme of Social Interactions
Behaviour
Yes
Action
Yes
Maybe
Social Behaviour
Yes
No
Yes
Social Action
Yes
Yes
Yes
No
Social Contact
Yes
Yes
Yes
Yes
Yes
Social Interaction
Yes
Yes
Yes
Yes
Yes
Yes
Repeated Interaction
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Regular Interaction
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Regulated Interaction
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Social Relation
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
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Social isolation is a state of complete or near-complete lack of contact between an individual and society. It differs from loneliness, which reflects temporary and involuntary lack of contact with other humans in the world. Social isolation can be an issue for individuals of any age, though symptoms may differ by age group.
Social isolation has similar characteristics in both temporary instances and for those with a historical lifelong isolation cycle. All types of social isolation can include staying home for lengthy periods of time, having no communication with family, acquaintances or friends, and/or wilfully avoiding any contact with other humans when those opportunities do arise.
Effects
True social isolation over years and decades can be a chronic condition affecting all aspects of a person’s existence. Social isolation can lead to feelings of loneliness, fear of others, or negative self-esteem. Lack of consistent human contact can also cause conflict with (peripheral) friends. The socially isolated person may occasionally talk to or cause problems with family members.
In the case of mood-related isolation, the individual may isolate during a depressive episode only to ‘surface’ when their mood improves. The individual may attempt to justify their reclusive or isolating behaviour as enjoyable or comfortable. There can be an inner realisation on the part of the individual that there is something wrong with their isolating responses which can lead to heightened anxiety. Relationships can be a struggle, as the individual may reconnect with others during a healthier mood only to return to an isolated state during a subsequent low or depressed mood.
Perceived Social Isolation in Humans
Research indicates that perceived social isolation (PSI) is a risk factor for and may contribute to “poorer overall cognitive performance and poorer executive functioning, faster cognitive decline, more negative and depressive cognition, heightened sensitivity to social threats, and a self-protective confirmatory bias in social cognition.” PSI also contributes to accelerating the ageing process: Wilson et al. (2007) reported that, after controlling for social network size and frequency of social activity, perceived social isolation is predictive of cognitive decline and risk for Alzheimer’s disease. Moreover, the social interactions of individuals who feel socially isolated are more negative and less subjectively satisfying. This contributes to a vicious cycle in which the person becomes more and more isolated.
Neuroimaging Studies
In the first resting state fMRI functional connectivity (FC) study on PSI, PSI was found to be associated with increased resting-state FC between several nodes of the cingulo-opercular network, a neural network associated with tonic alertness. PSI was also associated with reduced resting-state FC between the cingulo-opercular network and the right superior frontal gyrus, suggesting diminished executive control. Cacioppo and colleagues (2009) found that lonely individuals express weaker activation of the ventral striatum in response to pleasant pictures of people than of objects, suggesting decreased reward to social stimuli. Lonely individuals also expressed greater activation of the visual cortex in response to unpleasant depictions of people (i.e. negative facial expressions) than of objects; non-lonely individuals show greater activation of the right and left temporoparietal junction (TPJ), a region implicated in theory of mind. The authors interpreted the findings to represent that lonely individuals pay greater attention to negative social stimuli, but non-lonely individuals, to a greater degree than lonely individuals, insert themselves into the perspective of others. Moreover, Kanai et al. (2012) reported that loneliness negatively correlated with gray matter density in the left posterior temporal sulcus, an area involved in biological motion perception, mentalising, and social perception.
Overall, several neuroimaging studies in humans on perceived social isolation have emphasized implications of the visual cortex and right-hemispheric stress-related circuits underlying difference between lonely and non-lonely individuals. One population-genetics study marked a 50× increase in the neuroimaging research on perceived social isolation. The investigators tested for signatures of loneliness in grey matter morphology, intrinsic functional coupling, and fibre tract microstructure. The loneliness-linked neurobiological profiles converged on a collection of brain regions known as the default mode network. This higher associative network shows more consistent loneliness associations in grey matter volume than other cortical brain networks. Lonely individuals display stronger functional communication in the default network, and greater microstructural integrity of its fornix pathway. The findings fit with the possibility that the up-regulation of these neural circuits supports mentalising, reminiscence and imagination to fill the social void.
Social Isolation in Rodents
Experimental manipulations of social isolation in rats and mice (e.g. isolated rearing) are a common means of elucidating the effects of isolation on social animals in general. Researchers have proposed isolated rearing of rats as an etiologically valid model of human mental illness. Indeed, chronic social isolation in rats has been found to lead to depression-, anxiety-, and psychosis-like behaviours as well signs of autonomic, neuroendocrine, and metabolic dysregulation. For example, a systematic review found that social isolation in rats is associated with increased expression of BDNF in the hippocampus, which is associated with increased anxiety-like symptoms. In another example, a study found that social isolation in rats is associated with increased brain-derived neurotrophic factor (BDNF) expression in the prefrontal cortex. This results in the dysregulation of neural activity which is associated with anxiety, depression, and social dysfunction.
The effects of experimental manipulations of isolation in nonhuman social species has been shown to resemble the effects of perceived isolation in humans, and include: increased tonic sympathetic tone and hypothalamic-pituitary-adrenal (HPA) activation and decreased inflammatory control, immunity, sleep salubrity, and expression of genes regulating glucocorticoid responses. However, the biological, neurological, and genetic mechanisms underlying these symptoms are poorly understood.
Neurobiology
Social isolation contributes to abnormal hippocampal development via specific alterations to microtubule stability and decreased MAP-2 expression. Social isolation contributes to decreased expression of the synaptic protein synaptophysin and decreased dendritic length and dendritic spine density of pyramidal cells. The underlying molecular mechanism of these structural neuronal alterations are microtubule stabilisations, which impair the remodelling and extension of axons and dendrites.
Research by Cole and colleagues showed that perceived social isolation is associated with gene expression – specifically, the under-expression of genes bearing anti-inflammatory glucocorticoid response elements and over-expression of genes bearing response elements for pro-inflammatory NF-κB/Rel transcription factors. This finding is paralleled by decreased lymphocyte sensitivity to physiological regulation by the HPA axis in lonely individuals. This, together with evidence of increased activity of the HPA axis, suggests the development of glucocorticoid resistance in chronically lonely individuals.
Social isolation can be a precipitating factor for suicidal behaviour. A large body of literature suggests that individuals who experience isolation in their lives are more vulnerable to suicide than those who have strong social ties with others. A study found social isolation to be among the most common risk factors identified by Australian men who attempt suicide. Professor Ian Hickie of the University of Sydney said that social isolation was perhaps the most important factor contributing to male suicide attempts. Hickie said there was a wealth of evidence that men had more restricted social networks than women, and that these networks were heavily work-based.
A lack of social relationships negatively impacts the development of the brain’s structure. In extreme cases of social isolation, studies of young mice and monkeys have shown how the brain is strongly affected by a lack of social behaviour and relationships.
In Social Animal Species in General
In a hypothesis proposed by Cacioppo and colleagues, the isolation of a member of a social species has detrimental biological effects. In a 2009 review, Cacioppo and Hawkley noted that the health, life, and genetic legacy of members of social species are threatened when they find themselves on the social perimeter. For instance, social isolation decreases lifespan in the fruit fly; promotes obesity and type 2 diabetes in mice; exacerbates infarct size and oedema and decreases post-stroke survival rate following experimentally induced stroke in mice; promotes activation of the sympatho-adrenomedullary response to an acute immobilisation or cold stressor in rats; delays the effects of exercise on adult neurogenesis in rats; decreases open field activity, increases basal cortisol concentrations, and decreases lymphocyte proliferation to mitogens in pigs; increases the 24-hour urinary catecholamine levels and evidence of oxidative stress in the aortic arch of rabbits; and decreases the expression of genes regulating glucocorticoid response in the frontal cortex.
Social isolation in the common starling, a highly social, flocking species of bird, has also been shown to stress the isolated birds.
Background
Social isolation is both a potential cause and a symptom of emotional or psychological challenges. As a cause, the perceived inability to interact with the world and others can create an escalating pattern of these challenges. As a symptom, periods of isolation can be chronic or episodic, depending upon any cyclical changes in mood, especially in the case of clinical depression.
Every day aspects of this type of deep-rooted social isolation can mean:
Staying home for an indefinite period of time due to lack of access to social situations rather than a desire to be alone;
Both not contacting, and not being contacted by, any acquaintances, even peripherally; for example, never being called by anybody on the telephone and never having anyone visit one’s residence; and
A lack of meaningful, extended relationships, and especially close intimacy (both emotional and physical).
Contributing Factors
The following risk factors contribute to reasons why individuals distance themselves from society.
Ageing – Once a person reaches an age where problems such as cognitive impairments and disabilities arise, they are unable to go out and socialise.
Health and disabilities – People may be embarrassed by their disabilities or health problems, such that they have a tendency to isolate themselves to avoid social interaction out of fear that they would be judged or stigmatised. Sometimes, rather than embarrassment, the disability itself and a person’s lack of a support network can be the cause of social isolation.
Autism – autistic and allistic (non-autistic) people communicate very differently, leading to a mutual friction when they try talking to each other. As autistic people are in a steep minority, often unable to find peers who communicate the same way they do, they are often ostracised by the majority, who mistake their direct, semantic communication style for them being purposefully arrogant, brash, and obtuse.
Hearing loss – hearing loss can cause communication impairment, which can lead to social isolation particularly in older adults.
The loss of a loved one can contribute to social isolation. Studies have shown that widows who keep in contact with friends or relatives have better psychological health. A study conducted by Jung-Hwa Ha and Berit Ingersoll-Dayton concluded that widows who had a lot of social contact and interactions lead to fewer depressive symptoms. During a time of loss social isolation is not beneficial to an individual’s mental health.
Living alone – A 2015 study by the National Centre for Family & Marriage Research found 13% of adults in the United States were living alone, up from 12% in 1990. The rate of living alone for people under 45 has not changed, but the rate for Americans aged 45 – 65 has increased over the past 25 years. People over the age of 65 are living alone less often.
Isolation may be imposed by an abusive spouse.
Rural isolation – In rural areas, factors such as living far apart from one another, rural flight, a negligible amount of public spaces and entertainment, and lack of access to mental health-related resources all contribute to isolation. Limited access to broadband internet and cellular activity also make it harder for those experiencing isolation to connect online or reach people.
Unemployment – This can begin if someone is fired, dismissed, or released from a job or workplace, or leaves one of their own accords. If the person struggles or is unable to find a new job for a long period of time (i.e. months or years) the sense of isolation can become exacerbated, especially in men.
Independent home worker – The tasks implied in this kind of job generally doesn’t imply social interaction in the physical level, nor going outside. Interactions and payments can be made by digital media so the person remains isolated from society.
Retirement – or other source of fixed income, makes it unnecessary for the person to search for a job, this situation is similar to unemployment but with better living on one hand but without the need to go outside on the other hand.
Transportation problems – If the person does not have transportation to attend gatherings or to simply get out of the house, they have no choice but to stay home all day, which can lead to those feelings of depression.
Societal adversity – Desire to avoid the discomfort, dangers, and responsibilities arising from being among people. This can happen if other people are sometimes, or often, rude, hostile, critical or judgemental, crude, or otherwise unpleasant. The person would just prefer to be alone to avoid the hassles and hardships of dealing with people. Being a part of an outgroup and social categorisation can also play a part in creating adverse circumstances that the individual may attempt to avoid depending on the policies and attitudes of the society.
Substance abuse can be both cause and/or effect of isolation, often coinciding with mood-related disorders, especially among those living alone.
Economic inequality – Poorer children have fewer school-class friends and are more often isolated. Adults on welfare, such as the Ontario Disability Support Programme prioritise their monthly entitlement towards rent and low-cost meals, leaving opportunities to socialise at restaurants and movie theatres out of the question.
Self-esteem – A person with a low self-esteem or lack of self love can contribute to that person’s isolation. Having a low self-esteem can cause one to overthink and stress themselves out when being around people, and can ultimately eliminate that feeling by isolating themselves. Removing this feeling can lead to an unfortunate social life in the future and can also harm potential relationships with others. According to Northeastern University, having a low self-esteem can hold us back from reaching out to making plans with other people. It can make a person feel like they’re a burden to them, therefore once again isolating themselves from going out. This can also lead a person into thinking that they are not worthy of making friends and deserve any love; and also feeling like they do not deserve to have a happy life.
Lockdowns, such as those imposed in 2020 and 2021 in an attempt to prevent the spread of SARS-CoV-2.
Social isolation can begin early in life. During this time of development, a person may become more preoccupied with feelings and thoughts of their individuality that are not easy to share with other individuals. This can result from feelings of shame, guilt, or alienation during childhood experiences. Social isolation can also coincide with developmental disabilities. Individuals with learning impairments may have trouble with social interaction. The difficulties experienced academically can greatly impact the individual’s esteem and sense of self-worth. An example would be the need to repeat a year of school. During the early childhood developmental years, the need to fit in and be accepted is paramount. Having a learning deficit can in turn lead to feelings of isolation, that they are somehow ‘different’ from others.
Whether new technologies such as the Internet and mobile phones exacerbate social isolation (of any origin) is a debated topic among sociologists, with studies showing both positive correlation of social connections with use of social media as well as mood disorders coinciding with problematic use.
Isolation among the Elderly
Social isolation impacts approximately 24% of older adults in the United States, approximately 9 million people. The elderly have a unique set of isolating dynamics that often perpetuate one another and can drive the individual into deeper isolation. Increasing frailty, possible declines in overall health, absent or uninvolved relatives or children, economic struggles can all add to the feeling of isolation. Among the elderly, childlessness can be a cause for social isolation. Whether their child is deceased or they did not have children at all, the loneliness that comes from not having a child can cause social isolation. Retirement, the abrupt end of daily work relationships, the death of close friends or spouses can also contribute to social isolation.
In the United States, Canada, and United Kingdom, a significant sector of the elderly who are in their 80s and 90s are brought to nursing homes if they show severe signs of social isolation. Other societies such as many in Southern Europe, Eastern Europe, East Asia, and also the Caribbean and South America, do not normally share the tendency towards admission to nursing homes, preferring instead to have children and extended-family of elderly parents take care of those elderly parents until their deaths.] On the other hand, a report from Statistics Norway in 2016 stated that more than 30% of seniors over the age of 66 have two or fewer people to rely on should personal problems arise. Even still, nearly half of all members of senior communities are at high risk for social isolation, this is especially prevalent with seniors of a lower education and within the lower economic class and compounded with diminished availability of socialising options to these lower class individuals. There has also been an observed increase in physical gait among members of these communities.
Social isolation among older adults has been linked to an increase in disease morbidity, a higher risk of dementia, and a decrease in physical mobility along with an increase in general health concerns. Evidence of increased cognitive decline has been link to an increase in social isolation in depressed elderly women. At the same time, increasing social connectedness has been linked to health improvements among older adults.
The use of video communication/video calls has been suggested as a potential intervention to improve social isolation in seniors. However, its effectiveness is not known.
Isolation and Health and Mortality
Social isolation and loneliness in older adults is associated with an increased risk for poor mental and physical health and increased mortality. There is an increased risk for early mortality in individuals experiencing social isolation compared to those who are not socially isolated. Studies have found social isolation is associated with increased risk in physical health conditions including high blood pressure, high cholesterol, elevated stress hormones, and weakened immune systems. Research also suggests that social isolation and mortality in the elderly share a common link to chronic inflammation with some differences between men and women. Social isolation has also been found to be associated with poor mental health including increased risk for depression, cognitive decline, anxiety, and substance use. Social isolation in elderly individuals is also associated with an increased risk for dementia. However, not all studies found social isolation associated with the risk of poor health outcome.
Isolation among Children and Teens
Middle school is a time when youth tend to be sensitive to social challenges and their self-esteem can be fragile. During this vulnerable time in development, supporting students’ sense of belonging at school is of critical importance. Existing research finds that adolescents’ development of a sense of belonging is an important factor in adolescence for creating social and emotional well-being and academic success. Studies have found that friendship-related loneliness is more explanatory for depressive symptoms among adolescents than parent-related loneliness. One possible explanation is that friends are the preferred source of social support during adolescence.
Scientists have long known that loneliness in adults can predispose depressive symptoms later in life. Lately, scientists have also seen that lonely children are more susceptible to depressive symptoms in youth. In one study, researchers conclude that prevention of loneliness in childhood may be a protective factor against depression in adulthood. Socially isolated children tend to have lower subsequent educational attainment, be part of a less advantaged social class in adulthood, and are more likely to be psychologically distressed in adulthood. By receiving social assistance, studies show that children can cope more easily with high levels of stress. It is also shown that social support is strongly associated with feelings of mastery and the ability to deal with stressful situations, as well as strongly associated with increased quality of life.
Demographics
Research has shown that men and boys are more likely to experience social isolation in their lives.
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Solution-focused brief therapy (SFBT) is a goal-directed collaborative approach to psychotherapeutic change that is conducted through direct observation of clients’ responses to a series of precisely constructed questions. Based upon social constructivist thinking and Wittgensteinian philosophy, SFBT focuses on addressing what clients want to achieve without exploring the history and provenance of problem(s). SF therapy sessions typically focus on the present and future, focusing on the past only to the degree necessary for communicating empathy and accurate understanding of the client’s concerns.
SFBT is a future-oriented and goal-oriented interviewing technique that helps clients “build solutions.” Elliot Connie defines solution building as “a collaborative language process between the client(s) and the therapist that develops a detailed description of the client(s)’ preferred future/goals and identifies exceptions and past successes”. By doing so, SFBT focuses on clients’ strengths and resilience.
Background
The solution-focused brief therapy approach grew from the work of American social workers Steve de Shazer, Insoo Kim Berg, and their team at the Milwaukee Brief Family Therapy Centre (BFTC) in Milwaukee, Wisconsin. A private training and therapy institute, BFTC was started by dissatisfied former staff members from a Milwaukee agency who were interested in exploring brief therapy approaches then being developed at the Mental Research Institute (MRI) in Palo Alto, California. The initial group included married partners, Steve de Shazer and Insoo Berg, and Jim Derks, Elam Nunnally, Judith Tietyen, Don Norman, Marilyn La Court and Eve Lipchik. Their students included John Walter, Jane Peller, Michele Weiner-Davis and Yvonne Dolan. Steve de Shazer and Berg, primary developers of the approach, co-authored an update of SFBT in 2007, shortly before their deaths. SFBT evolved from the Brief Therapy that was practiced at MRI.
The solution-focused approach was developed inductively rather than deductively; Berg, de Shazer and their team spent thousands of hours carefully observing live and recorded therapy sessions. Any behaviours or words on the part of the therapist that reliably led to positive therapeutic change on the part of the clients were painstakingly noted and incorporated into the SFBT approach. In most traditional psychotherapeutic approaches starting with Freud, practitioners assumed that it was necessary to make an extensive analysis of the history and cause of their clients’ problems before attempting to develop any sort of solution. Solution-focused therapists see the therapeutic change process radically differently and informed by the observations of de Shazer, which recognise that although “causes of problems may be extremely complex, their solutions do not necessarily need to be”.
SFBT might be best defined by what it does not do because SFBT presents an innovative and radically different approach from traditional psychotherapy. Traditional psychotherapy looks at how problems happen, manifest, and resolve. The problem-solving approach is influenced by the medical model, where the symptoms are assessed to diagnose and treat the malady. Outside of SFBT, the almost universal belief is that the clinician must define and understand the problem to help. To do this, the practitioner must develop some information about the nature of problems that they will help resolve and ask questions about the client’s symptoms. The more common problem-solving approach includes a description of the problem, an assessment of the problem, and plan and execute interventions to resolve or mitigate the impact of the problem. This is followed by an evaluation determining the success of the intervention and follow-up if necessary.
SFBT posits that a therapist can help clients resolve their problems without identifying the details or source problem and completely avoids exploring the details and context of the problem. SFBT believes that an assessment of the problem is entirely unnecessary. Focusing on the problem actually may serve to shift the client away from the solution. This is because SFBT fundamentally believes that the nature of the solution can be completely different from the problem. So instead, SFBT focuses on building solutions by conceptualising a preferred future with clients. SFBT is all about finding alternatives to the problem, not identifying and eliminating the problem.
SFBT is strengths-based and supports clients’ self-determination. Using the client’s language, SFBT uses the client’s perspective and fosters cooperation. The focus on the strengths and resources of clients is a factor in why some social workers choose SFBT.
SFBT is designed to help people change their lives in the fastest way possible. By finding and amplifying exceptions, change is efficient and effective. Treatment usually lasts less than six sessions, and it can work in about two sessions. Its brevity and its flexibility have made SFBT the choice of intervention for many health care settings. Interventions in a medical setting many times need to be brief. Agencies also choose SFBT because its efficiency translates into monetary savings.
Brief History
Solution-focused brief therapy is one of a family of approaches, known as systems therapies, that have been developed over the past 50 years or so, first in the US, and eventually evolving around the world, including Europe. The title SFBT, and the specific steps involved in its practice, are attributed to husband and wife Steve de Shazer and Insoo Kim Berg, two American social workers, and their team at the Brief Family Therapy Centre (BFTC) in Milwaukee, US. Core members of this team were Jim Derks, Elam Nunnally, Marilyn LaCourt, and Eve Lipchik as well as students Pat Bielke, Dave Pakenham, John Walter, Jane Peller, Elam Nunnally, Alex Molnar, and Michele Weiner-Davis. Wallace Gingerich and Gale Miller joined a few years later as research assistants.
In the 1970s, de Shazer, Berg and colleagues conducted Brief Family Therapy at Family Service of Milwaukee, a community agency, and installed one-way mirrors to observe sessions with clients to study which activities were most beneficial for the clients. The group of therapists used to meet in the couple’s home, where a therapist saw clients pro bono in the living room while the others observed, after which they would discuss their thoughts together in a bedroom. In 1978, when the administration disallowed the one-way mirrors, de Shazer and Berg put together a team of practitioners and students and founded the Brief Family Therapy Centre in Milwaukee, Wisconsin, to continue their work. The result was the eventual development of SFBT. BFTC served as a research centre to study, develop, and test techniques of psychotherapy to find those that are most efficient and effective with clients. Besides mental health professionals, the team included educators, sociologists, linguists, engineers and philosophers. Steve de Shazer, the director of BFTC, referred to this group as a “therapeutic think tank”. Over time people began to request training, so BFTC became a research and training centre.
SFBT has its roots in brief family therapy, a type of family therapy practiced at the Mental Research Institute (MRI). In the 1970s, de Shazer, the primary creator of SFBT, studied the work done at MRI and founded BFTC to serve as “the MRI of the Midwest”. John Weakland at MRI influenced him to develop simple techniques in brief goal-focused therapy, and at MRI he was introduced to the work of Milton Erickson which ultimately had a significant influence on the development of SFBT.
In 1982 there was the watershed moment where the founders of SFBT, Berg, de Shazer, and their team transformed their brief therapy practice to become solution-focused. A family came to be treated at the Milwaukee Brief Family Therapy. During the assessment, the family provided a list of 27 problems. The team was at a loss as to what to suggest the family try to do differently. They suggested that the family come back with a list of things they want to continue to happen. The effectiveness of this spontaneous intervention led to the understanding that the solution is not necessarily related to the problem. This was the beginning of solution-focused brief therapy.
SFBT practice began to be popularized starting in the late 1980s and experienced tremendous growth in its first 15–20 years. Their work in the early 1980s built on that of a number of other innovators, among them Milton Erickson and the group at the MRI – Gregory Bateson, Donald deAvila Jackson, Paul Watzlawick, John Weakland, Virginia Satir, Jay Haley, Richard Fisch, Janet Beavin Bavelas and others. SFBT gained tremendous popularity in the UK in the late 1990s and the 2000s. At that time, it also spread worldwide to be a leading brief therapy, with many agencies adopting SFBT as their only modality. It is now one of the most popular psychotherapeutic modalities globally.
SFBT Practice
In SFBT, practitioners employ conversational skills to facilitate a discussion focused on solutions, as opposed to dwelling on problems. The questions themselves serve as the intervention, directing clients toward a mindset that fosters positive change and reduces negative emotions. These questions help clients reinterpret their experiences, enabling them to recognise potential for change where they might not have seen it before.
The primary tools of the solution-focused approach are questions and compliments. SFBT therapists refrain from making interpretations and rarely confront clients. Instead, they concentrate on identifying clients’ goals and developing a detailed description of life when the goal is reached, and the problem is either resolved or managed satisfactorily. To devise effective solutions, they examine clients’ life experiences for “exceptions,” or moments when some aspect of their goal was already happening to some extent.
SFBT therapists believe personal change is constant. By helping clients identify positive directions for change and focusing on changes they wish to continue, SFBT therapists assist clients in constructing a concrete vision of a preferred future.
One way to understand SFBT is through the acronym MECSTAT, which stands for Miracle questions, Exception questions, Coping questions, Scaling questions, Time-out, Accolades, and Task. SFBT questions prompt clients to discuss their preferred future and describe what would be different when the problem is solved or managed. The “miracle question” is one such tool, asking clients to imagine that their problem was miraculously solved without their knowledge and to identify the first clues that would indicate the problem is resolved.
Therapists also ask questions that focus on previous solutions or “exceptions” to the problem. In SFBT, exceptions are times when the problem is less severe or better managed. Identifying exceptions helps build solutions by highlighting what is working in clients’ lives. By discovering and amplifying minor exceptions to the problem, therapists encourage clients to do more of what already works.
When seeking exceptions, the practitioner does not attempt to convince the client of their significance. Instead, the therapist adopts a genuinely curious stance and asks the client to explain the exception’s importance. Therapists must maintain a not-knowing stance, which can be challenging for emerging SFBT practitioners.
SFBT practitioners use tools such as starting sessions with the question “What’s been better since we last talked?” to help clients identify exceptions. Scaling questions are another tool, using a scale to measure clients’ progress toward their goals. Clients are asked to provide details about times when the problem was less severe or absent and to identify behaviours that work for them.
SFBT sessions are highly structured, following a specific format and employing formulated interviewing techniques. However, adhering to the underlying philosophy of SFBT is considered more important than strictly following the techniques. Central to SFBT is the belief that clients are the experts in their lives and possess the knowledge necessary to achieve their goals. Therapists are considered experts in asking questions that evoke the change process.
In authentic SFBT practice, resistance is rarely encountered. Maintaining a curious and not-knowing stance is vital for effective SFBT. Despite its apparent simplicity, SFBT is difficult to master. It requires disciplined practice, which can be challenging for many practitioners. As a result, some may only use components of SFBT instead of adhering to pure SFBT, often due to the difficulty in transitioning from a problem-focused stance. Conversely, new SFBT trainees may struggle with being overly optimistic and not genuinely validating clients’ pain. This may be because concentrating on newly learned SFBT skills and techniques takes focus away from being present with the client.
Authentic SFBT practice demands that therapists remain highly attuned to clients’ verbal and non-verbal communication, adapting their questions to better understand and engage with the client’s perspective. By doing so, SFBT practitioners can effectively facilitate client movement toward their goals and preferred futures.
Evidence-Based Status
In the early days of the model, critics often said that SFBT does not have enough research. In 2000 a review of SFBT research just showed preliminary evidence of the efficacy of SFBT. However, in 2010 the SFBT research grew to a level where the evidence was promising, and today several meta-analyses show SFBT to be effective with internalising issues. SFBT has a robust, broad, and growing evidence base and is recommended for use when deemed a good fit for the client and their problem.
SFBT has been examined in two meta-analyses and is supported as evidenced-based by numerous federal and state agencies and institutions, such as SAMHSA’s National Registry of Evidence-Based Programmes & Practices (NREPP). The conclusion of the two meta-analyses and the systematic reviews, and the overall conclusion of the most recent scholarly work on SFBT, is that solution-focused brief therapy is an effective approach to the treatment of psychological problems, with effect sizes similar to other evidenced-based approaches, such as CBT and IPT, but that these effects are found in fewer average sessions, and using an approach style that is more benign.
Applications
SFBT is very adaptable to many settings because it helps the clients create custom-made interventions for themselves, and the client is always considered to be the expert. Even the practitioner’s language is taken from the words the client uses to describe their life and preferred future. The result is that SFBT provides interventions that are perfectly matched with the clients’ way of understanding and acting. Techniques such as the miracle question can be adapted to make them more culturally relevant and come across in ways more empathetic and supportive based on the culture and needs of the population being served.
SFBT works well with children and families and can be applied to many family-related situations. It is effective with adolescents, pregnant and postpartum women, couples, and parents. SFBT was shown to be effective for families in the child welfare system, with case management in social welfare programmes, financial counselling, and with therapy groups.
SFBT has been applied to many settings, including education and business settings including coaching. and counselling. It is effective in schools and with college students. It was successfully used with populations in jails, inpatient addiction rehab centres, inpatient psychiatric facilities, and in a wide range of medical settings. It has been helpful with treating family members of patients with serious illnesses.
SFBT is effective with people in many countries and cultures, including people from Turkey, Chile, Iran, and China. A systematic review showed it to be effective with Latinos.
SFBT works in treating people who experienced trauma. It has been suggested to use with patients that are suicidal or in crisis, families coping with suicide, and patients with eating disorders substance use disorders, and obesity. It was also suggested as a promising intervention for individuals with a brain injury and was helpful with those with intellectual disabilities. It has even been documented to have been successfully used with a patient in a psychotic crisis.
SFBT is effective in treating clients with depression. It has been shown to be effective in helping increase self-esteem, hope, good behaviour, and social competence among adolescents and children. It has been suggested that SFBT’s ability to engender hope is what makes it effective for patients suffering from depression as the presence of hope is shown to have an inverse relationship with depression.
Workers with child protective services report in a qualitative study that SFBT training and supervision was helpful for them to work in a more cooperative and strength-based way and improved the overall mood and atmosphere of their encounters. There are models designed for child protection services that incorporate aspects of SFBT because SFBT alone is thought to be insufficient for child protective services because a more authoritative approach is necessary.
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Steve de Shazer (25 June 1940 to 11 September 2005) was a psychotherapist, author, and developer and pioneer of solution focused brief therapy. In 1978, he founded the Brief Family Therapy Centre (BFTC) in Milwaukee, Wisconsin with his wife Insoo Kim Berg.
De Shazer was originally trained as a classical musician and worked as a jazz saxophonist. He received a Bachelor in Fine Arts and an MSSW in Social Work from the University of Wisconsin–Milwaukee. He never studied at the Mental Research Institute in Palo Alto, California, even though some rumours have it he did. De Shazer wrote six books and was translated into 14 languages. He was a lifelong friend of John Weakland , whom he saw as his mentor.
De Shazer died in Vienna while traveling on a training and consulting tour in Europe. De Shazer has a nephew, Tony de Shazer whose wife is Marie Laure de Shazer, educator and author, and two great nieces Elodie and Amelie de Shazer.
Solution-Focused Heritage
Solution-Focused Brief Therapy
In 1978, de Shazer and Insoo Kim Berg co-founded the Brief Family Therapy Centre (BFTC) in Milwaukee. With this move, the couple are recognised as the primary developers of solution-focused brief therapy, which emerged from research they conducted at the BFTC in the 1980s, building upon studies conducted at the Mental Research Institute.
BFTC served as a research centre to study, develop, and test techniques of psychotherapy to find those that are most efficient and effective with clients. The team at BFTC was very diverse, with practitioners with various backgrounds, educations, and academic disciplines. Besides mental health professionals, the team included educators, sociologists, linguists, and even engineers and philosophers. Steve de Shazer, the director of BFTC, referred to this group as a “therapeutic think tank”. Over time people began to request training, so BFTC became a research and training centre.
Solution-Focused Applied Psychology (SoFAP)
Alongside the popular development of the practical application of solution-focused therapy, its theoretic foundation has been the topic of research in an academic context. The academic discipline of Solution-Focused Applied Psychology (SoFAP) uses the methodology offered by design science to investigate the epistemology that underlies the application of the solution-focused approach. In intuitive form, this approach was originally recognised in the practice of Dr. Milton H. Erickson and subsequently concretised by de Shazer and Berg, particularly in de Shazer’s book Patterns of Brief Family Therapy: An Ecosystemic Approach.
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Behaviour therapy or behavioural psychotherapy is a broad term referring to clinical psychotherapy that uses techniques derived from behaviourism and/or cognitive psychology. It looks at specific, learned behaviours and how the environment, or other people’s mental states, influences those behaviours, and consists of techniques based on behaviourism’s theory of learning: respondent or operant conditioning. Behaviourists who practice these techniques are either behaviour analysts or cognitive-behavioural therapists. They tend to look for treatment outcomes that are objectively measurable. Behaviour therapy does not involve one specific method, but it has a wide range of techniques that can be used to treat a person’s psychological problems.
Behavioural psychotherapy is sometimes juxtaposed with cognitive psychotherapy. While cognitive behavioural therapy integrates aspects of both approaches, such as cognitive restructuring, positive reinforcement, habituation (or desensitisation), counterconditioning, and modelling.
Applied behaviour analysis (ABA) is the application of behaviour analysis that focuses on functionally assessing how behaviour is influenced by the observable learning environment and how to change such behaviour through contingency management or exposure therapies, which are used throughout clinical behaviour analysis therapies or other interventions based on the same learning principles.
Cognitive-behavioural therapy views cognition and emotions as preceding overt behaviour and implements treatment plans in psychotherapy to lessen the issue by managing competing thoughts and emotions, often in conjunction with behavioural learning principles.
A 2013 Cochrane review comparing behaviour therapies to psychological therapies found them to be equally effective, although at the time the evidence base that evaluates the benefits and harms of behaviour therapies was weak.
Brief History
Precursors of certain fundamental aspects of behaviour therapy have been identified in various ancient philosophical traditions, particularly Stoicism. For example, Wolpe and Lazarus wrote,
While the modern behavior therapist deliberately applies principles of learning to this therapeutic operations, empirical behavior therapy is probably as old as civilization – if we consider civilization as having started when man first did things to further the well-being of other men. From the time that this became a feature of human life there must have been occasions when a man complained of his ills to another who advised or persuaded him of a course of action. In a broad sense, this could be called behavior therapy whenever the behavior itself was conceived as the therapeutic agent. Ancient writings contain innumerable behavioral prescriptions that accord with this broad conception of behavior therapy.
The first use of the term behaviour modification appears to have been by Edward Thorndike in 1911. His article Provisional Laws of Acquired Behaviour or Learning makes frequent use of the term “modifying behavior”. Through early research in the 1940s and the 1950s the term was used by Joseph Wolpe’s research group. The experimental tradition in clinical psychology used it to refer to psycho-therapeutic techniques derived from empirical research. It has since come to refer mainly to techniques for increasing adaptive behaviour through reinforcement and decreasing maladaptive behaviour through extinction or punishment (with emphasis on the former). Two related terms are behaviour therapy and applied behaviour analysis. Since techniques derived from behavioural psychology tend to be the most effective in altering behaviour, most practitioners consider behaviour modification along with behaviour therapy and applied behaviour analysis to be founded in behaviourism. While behaviour modification and applied behaviour analysis typically uses interventions based on the same behavioural principles, many behaviour modifiers who are not applied behaviour analysts tend to use packages of interventions and do not conduct functional assessments before intervening.
Possibly the first occurrence of the term “behavior therapy” was in a 1953 research project by B.F. Skinner, Ogden Lindsley, Nathan Azrin and Harry C. Solomon. The paper talked about operant conditioning and how it could be used to help improve the functioning of people who were diagnosed with chronic schizophrenia. Early pioneers in behaviour therapy include Joseph Wolpe and Hans Eysenck.
In general, behaviour therapy is seen as having three distinct points of origin: South Africa (Wolpe’s group), the United States (Skinner), and the United Kingdom (Rachman and Eysenck). Each had its own distinct approach to viewing behaviour problems. Eysenck in particular viewed behaviour problems as an interplay between personality characteristics, environment, and behaviour. Skinner’s group in the United States took more of an operant conditioning focus. The operant focus created a functional approach to assessment and interventions focused on contingency management such as the token economy and behavioural activation. Skinner’s student Ogden Lindsley is credited with forming a movement called precision teaching, which developed a particular type of graphing program called the standard celeration chart to monitor the progress of clients. Skinner became interested in the individualising of programs for improved learning in those with or without disabilities and worked with Fred S. Keller to develop programmed instruction. Programmed instruction had some clinical success in aphasia rehabilitation. Gerald Patterson used programme instruction to develop his parenting text for children with conduct problems. (see Parent management training.) With age, respondent conditioning appears to slow but operant conditioning remains relatively stable. While the concept had its share of advocates and critics in the west, its introduction in the Asian setting, particularly in India in the early 1970s and its grand success were testament to the famous Indian psychologist H. Narayan Murthy’s enduring commitment to the principles of behavioural therapy and biofeedback.
While many behaviour therapists remain staunchly committed to the basic operant and respondent paradigm, in the second half of the 20th century, many therapists coupled behaviour therapy with the cognitive therapy, of Aaron Beck, Albert Ellis, and Donald Meichenbaum to form cognitive behaviour therapy. In some areas the cognitive component had an additive effect (for example, evidence suggests that cognitive interventions improve the result of social phobia treatment.) but in other areas it did not enhance the treatment, which led to the pursuit of third generation behaviour therapies. Third generation behaviour therapy uses basic principles of operant and respondent psychology but couples them with functional analysis and a clinical formulation/case conceptualisation of verbal behaviour more inline with view of the behaviour analysts. Some research supports these therapies as being more effective in some cases than cognitive therapy, but overall the question is still in need of answers.
Theoretical Basis
The behavioural approach to therapy assumes that behaviour that is associated with psychological problems develops through the same processes of learning that affects the development of other behaviours. Therefore, behaviourists see personality problems in the way that personality was developed. They do not look at behaviour disorders as something a person has, but consider that it reflects how learning has influenced certain people to behave in a certain way in certain situations.
Behaviour therapy is based upon the principles of classical conditioning developed by Ivan Pavlov and operant conditioning developed by B.F. Skinner. Classical conditioning happens when a neutral stimulus comes right before another stimulus that triggers a reflexive response. The idea is that if the neutral stimulus and whatever other stimulus that triggers a response is paired together often enough that the neutral stimulus will produce the reflexive response. Operant conditioning has to do with rewards and punishments and how they can either increase or decrease certain behaviours.
Contingency management programs are a direct product of research from operant conditioning.
Current Forms
Behavioural therapy based on operant and respondent principles has considerable evidence base to support its usage. This approach remains a vital area of clinical psychology and is often termed clinical behaviour analysis. Behavioural psychotherapy has become increasingly contextual in recent years. Behavioural psychotherapy has developed greater interest in recent years in personality disorders as well as a greater focus on acceptance and complex case conceptualisations.
Functional Analytic Psychotherapy
One current form of behavioural psychotherapy is functional analytic psychotherapy. Functional analytic psychotherapy is a longer duration behaviour therapy. Functional analytic therapy focuses on in-session use of reinforcement and is primarily a relationally-based therapy. As with most of the behavioural psychotherapies, functional analytic psychotherapy is contextual in its origins and nature. and draws heavily on radical behaviourism and functional contextualism.
Functional analytic psychotherapy holds to a process model of research, which makes it unique compared to traditional behaviour therapy and cognitive behavioural therapy.
Functional analytic psychotherapy has a strong research support. Recent functional analytic psychotherapy research efforts are focusing on management of aggressive inpatients.
Assessment
Behaviour therapists complete a functional analysis or a functional assessment that looks at four important areas: stimulus, organism, response and consequences. The stimulus is the condition or environmental trigger that causes behaviour. An organism involves the internal responses of a person, like physiological responses, emotions and cognition. A response is the behaviour that a person exhibits and the consequences are the result of the behaviour. These four things are incorporated into an assessment done by the behaviour therapist.
Most behaviour therapists use objective assessment methods like structured interviews, objective psychological tests or different behavioural rating forms. These types of assessments are used so that the behaviour therapist can determine exactly what a client’s problem may be and establish a baseline for any maladaptive responses that the client may have. By having this baseline, as therapy continues this same measure can be used to check a client’s progress, which can help determine if the therapy is working. Behaviour therapists do not typically ask the why questions but tend to be more focused on the how, when, where and what questions. Tests such as the Rorschach inkblot test or personality tests like the MMPI (Minnesota Multiphasic Personality Inventory) are not commonly used for behavioural assessment because they are based on personality trait theory assuming that a person’s answer to these methods can predict behaviour. Behaviour assessment is more focused on the observations of a person’s behaviour in their natural environment.
Behavioural assessment specifically attempts to find out what the environmental and self-imposed variables are. These variables are the things that are allowing a person to maintain their maladaptive feelings, thoughts and behaviours. In a behavioural assessment “person variables” are also considered. These “person variables” come from a person’s social learning history and they affect the way in which the environment affects that person’s behaviour. An example of a person variable would be behavioural competence. Behavioural competence looks at whether a person has the appropriate skills and behaviours that are necessary when performing a specific response to a certain situation or stimuli.
When making a behavioural assessment the behaviour therapist wants to answer two questions: (1) what are the different factors (environmental or psychological) that are maintaining the maladaptive behaviour and (2) what type of behaviour therapy or technique that can help the individual improve most effectively. The first question involves looking at all aspects of a person, which can be summed up by the acronym BASIC ID. This acronym stands for behaviour, affective responses, sensory reactions, imagery, cognitive processes, interpersonal relationships and drug use.
Clinical Applications
Behaviour therapy based its core interventions on functional analysis. Just a few of the many problems that behaviour therapy have functionally analysed include intimacy in couples relationships, forgiveness in couples, chronic pain, stress-related behaviour problems of being an adult child of a person with an alcohol use disorder, anorexia, chronic distress, substance abuse, depression, anxiety, insomnia and obesity.
Functional analysis has even been applied to problems that therapists commonly encounter like client resistance, partially engaged clients and involuntary clients. Applications to these problems have left clinicians with considerable tools for enhancing therapeutic effectiveness. One way to enhance therapeutic effectiveness is to use positive reinforcement or operant conditioning. Although behaviour therapy is based on the general learning model, it can be applied in a lot of different treatment packages that can be specifically developed to deal with problematic behaviours. Some of the more well known types of treatments are: Relaxation training, systematic desensitization, virtual reality exposure, exposure and response prevention techniques, social skills training, modelling, behavioural rehearsal and homework, and aversion therapy and punishment.
Relaxation training involves clients learning to lower arousal to reduce their stress by tensing and releasing certain muscle groups throughout their body. Systematic desensitisation is a treatment in which the client slowly substitutes a new learned response for a maladaptive response by moving up a hierarchy of situations involving fear. Systematic desensitization is based in part on counter conditioning. Counter conditioning is learning new ways to change one response for another and in the case of desensitisation it is substituting that maladaptive behaviour for a more relaxing behaviour. Exposure and response prevention techniques (also known as flooding and response prevention) is the general technique in which a therapist exposes an individual to anxiety-provoking stimuli while keeping them from having any avoidance responses.
Virtual reality therapy provides realistic, computer-based simulations of troublesome situations. The modelling process involves a person being subjected to watching other individuals who demonstrate behaviour that is considered adaptive and that should be adopted by the client. This exposure involves not only the cues of the “model person” as well as the situations of a certain behaviour that way the relationship can be seen between the appropriateness of a certain behaviour and situation in which that behaviour occurs is demonstrated. With the behavioural rehearsal and homework treatment a client gets a desired behaviour during a therapy session and then they practice and record that behaviour between their sessions. Aversion therapy and punishment is a technique in which an aversive (painful or unpleasant) stimulus is used to decrease unwanted behaviours from occurring. It is concerned with two procedures: 1) the procedures are used to decrease the likelihood of the frequency of a certain behaviour and 2) procedures that will reduce the attractiveness of certain behaviours and the stimuli that elicit them. The punishment side of aversion therapy is when an aversive stimulus is presented at the same time that a negative stimulus and then they are stopped at the same time when a positive stimulus or response is presented. Examples of the type of negative stimulus or punishment that can be used is shock therapy treatments, aversive drug treatments as well as response cost contingent punishment which involves taking away a reward.
Applied behaviour analysis is using behavioural methods to modify certain behaviours that are seen as being important socially or personally. There are four main characteristics of applied behaviour analysis. First behaviour analysis is focused mainly on overt behaviours in an applied setting. Treatments are developed as a way to alter the relationship between those overt behaviours and their consequences.
Another characteristic of applied behaviour analysis is how it (behaviour analysis) goes about evaluating treatment effects. The individual subject is where the focus of study is on, the investigation is centred on the one individual being treated. A third characteristic is that it focuses on what the environment does to cause significant behaviour changes. Finally the last characteristic of applied behaviour analysis is the use of those techniques that stem from operant and classical conditioning such as providing reinforcement, punishment, stimulus control and any other learning principles that may apply.
Social skills training teaches clients skills to access reinforcers and lessen life punishment. Operant conditioning procedures in meta-analysis had the largest effect size for training social skills, followed by modelling, coaching, and social cognitive techniques in that order. Social skills training has some empirical support particularly for schizophrenia. However, with schizophrenia, behavioural programs have generally lost favour.
Some other techniques that have been used in behaviour therapy are contingency contracting, response costs, token economies, biofeedback, and using shaping and grading task assignments.
Shaping and graded task assignments are used when behaviour that needs to be learned is complex. The complex behaviours that need to be learned are broken down into simpler steps where the person can achieve small things gradually building up to the more complex behaviour. Each step approximates the eventual goal and helps the person to expand their activities in a gradual way. This behaviour is used when a person feels that something in their lives can not be changed and life’s tasks appear to be overwhelming.
Another technique of behaviour therapy involves holding a client or patient accountable of their behaviours in an effort to change them. This is called a contingency contract, which is a formal written contract between two or more people that defines the specific expected behaviours that you wish to change and the rewards and punishments that go along with that behaviour. In order for a contingency contract to be official it needs to have five elements. First it must state what each person will get if they successfully complete the desired behaviour. Secondly those people involved have to monitor the behaviours. Third, if the desired behaviour is not being performed in the way that was agreed upon in the contract the punishments that were defined in the contract must be done. Fourth if the persons involved are complying with the contract they must receive bonuses. The last element involves documenting the compliance and noncompliance while using this treatment in order to give the persons involved consistent feedback about the target behaviour and the provision of reinforcers.
Token economies is a behaviour therapy technique where clients are reinforced with tokens that are considered a type of currency that can be used to purchase desired rewards, like being able to watch television or getting a snack that they want when they perform designated behaviours. Token economies are mainly used in institutional and therapeutic settings. In order for a token economy to be effective there must be consistency in administering the program by the entire staff. Procedures must be clearly defined so that there is no confusion among the clients. Instead of looking for ways to punish the patients or to deny them of rewards, the staff has to reinforce the positive behaviours so that the clients will increase the occurrence of the desired behaviour. Over time the tokens need to be replaced with less tangible rewards such as compliments so that the client will be prepared when they leave the institution and won’t expect to get something every time they perform a desired behaviour.
Closely related to token economies is a technique called response costs. This technique can either be used with or without token economies. Response costs is the punishment side of token economies where there is a loss of a reward or privilege after someone performs an undesirable behaviour. Like token economies this technique is used mainly in institutional and therapeutic settings.
Considerable policy implications have been inspired by behavioural views of various forms of psychopathology. One form of behaviour therapy, habit reversal training, has been found to be highly effective for treating tics.
In Rehabilitation
Currently, there is a greater call for behavioural psychologists to be involved in rehabilitation efforts.
Treatment of Mental Disorders
Two large studies done by the Faculty of Health Sciences at Simon Fraser University indicate that both behaviour therapy and cognitive-behavioural therapy (CBT) are equally effective for OCD. CBT is typically considered the “first-line” treatment for OCD. CBT has also been shown to perform slightly better at treating co-occurring depression.
Considerable policy implications have been inspired by behavioural views of various forms of psychopathology. One form of behaviour therapy (habit reversal training) has been found to be highly effective for treating tics.
There has been a development towards combining techniques to treat psychiatric disorders. Cognitive interventions are used to enhance the effects of more established behavioural interventions based on operant and classical conditioning. An increased effort has also been placed to address the interpersonal context of behaviour.
Behaviour therapy can be applied to a number of mental disorders and in many cases is more effective for specific disorders as compared to others. Behaviour therapy techniques can be used to deal with any phobias that a person may have. Desensitisation has also been successfully applied to other issues such as dealing with anger, if a person has trouble sleeping and certain speech disorders. Desensitisation does not occur over night, there is a process of treatment. Desensitisation is done on a hierarchy and happens over a number of sessions. The hierarchy goes from situations that make a person less anxious or nervous up to things that are considered to be extreme for the patient.
Modelling has been used in dealing with fears and phobias. Fears are thought to develop through observational learning, and so positive modelling, when a person’s behaviour is imitated, can used to counter these effects. In a systematic review of 1,677 papers, positive modelling was found to lower fear levels. Modelling has been used in the treatment of fear of snakes as well as a fear of water.
Aversive therapy techniques have been used to treat sexual deviations, as well as alcohol use disorder.
Exposure and prevention procedure techniques can be used to treat people who have anxiety problems as well as any fears or phobias. These procedures have also been used to help people dealing with any anger issues as well as pathological grievers (people who have distressing thoughts about a deceased person).
Virtual reality therapy deals with fear of heights, fear of flying, and a variety of other anxiety disorders. VRT has also been applied to help people with substance abuse problems reduce their responsiveness to certain cues that trigger their need to use drugs.
Shaping and graded task assignments has been used in dealing with suicide and depressed or inhibited individuals. This is used when a patient feel hopeless and they have no way of changing their lives. This hopelessness involves how the person reacts and responds to someone else and certain situations and their perceived powerlessness to change that situation that adds to the hopelessness. For a person with suicidal ideation, it is important to start with small steps. Because that person may perceive everything as being a big step, the smaller you start the easier it will be for the person to master each step. This technique has also been applied to people dealing with agoraphobia, or fear of being in public places or doing something embarrassing.
Contingency contracting has been used to effectively deal with behaviour problems in delinquents and when dealing with on task behaviours in students.
Token economies are used in controlled environments and are found mostly in psychiatric hospitals. They can be used to help patients with different mental illnesses but it does not focus on the treatment of the mental illness but instead on the behavioural aspects of a patient. The response cost technique has been used to successfully address a variety of behaviours such as smoking, overeating, stuttering, and psychotic talk.
Treatment Outcomes
Systematic desensitisation has been shown to successfully treat phobias about heights, driving, insects as well as any anxiety that a person may have. Anxiety can include social anxiety, anxiety about public speaking as well as test anxiety. It has been shown that the use of systematic desensitisation is an effective technique that can be applied to a number of problems that a person may have.
When using modelling procedures this technique is often compared to another behavioural therapy technique. When compared to desensitisation, the modelling technique does appear to be less effective. However it is clear that the greater the interaction between the patient and the subject he is modelling the greater the effectiveness of the treatment.
While undergoing exposure therapy, a person typically needs five sessions to assess the treatment’s effectiveness. After five sessions, exposure treatment has been shown to provide benefit to the patient. However, it is still recommended treatment continue beyond the initial five sessions.
Virtual reality therapy (VRT) has shown to be effective for a fear of heights. It has also been shown to help with the treatment of a variety of anxiety disorders. Due to the costs associated with VRT in 2007, therapists were still awaiting results of controlled trials investigating VRT, to assess which applications demonstrate the best results.
For those with suicidal ideation, treatment depends on how severe the person’s depression and sense of hopelessness is. If these things are severe, the person’s response to completing small steps will not be of importance to them, because they do not consider the success an accomplishment. Generally, in those without severe depression or fear, this technique has been successful, as completion of simpler activities builds their confidences and allows them to progress to more complex situations.
Contingency contracts have been seen to be effective in changing any undesired behaviours of individuals. It has been seen to be effective in treating behaviour problems in delinquents regardless of the specific characteristics of the contract.
Token economies have been shown to be effective when treating patients in psychiatric wards who had chronic schizophrenia. The results showed that the contingent tokens were controlling the behaviour of the patients.
Response costs has been shown to work in suppressing a variety of behaviours such as smoking, overeating or stuttering with a diverse group of clinical populations ranging from sociopaths to school children. These behaviours that have been suppressed using this technique often do not recover when the punishment contingency is withdrawn. Also undesirable side effects that are usually seen with punishment are not typically found when using the response cost technique.
“Third Generation”
Since the 1980s, a series of new behavioural therapies have been developed. These have been later labelled by Steven C. Hayes as “the third-generation” of behavioural therapy. Under this classification, the first generation of behavioural therapy is that independently developed in the 1950s by Joseph Wolpe, Ogden Lindsley and Hans Eysenck, while the second generation is the cognitive therapy developed by Aaron Beck in the 1970s.
Other authors object to the term “third generation” or “third wave” and incorporate many of the “third wave” therapeutic techniques under the general umbrella term of modern cognitive behavioural therapies.
This “third wave” of behavioural therapy has sometimes been called clinical behaviour analysis because it has been claimed that it represents a movement away from cognitivism and back toward radical behaviourism and other forms of behaviourism, in particular functional analysis and behavioural models of verbal behaviour. This area includes acceptance and commitment therapy (ACT), cognitive behavioural analysis system of psychotherapy (CBASP) (McCullough, 2000), behavioural activation (BA), dialectical behaviour therapy, functional analytic psychotherapy (FAP), integrative behavioural couples therapy, metacognitive therapy and metacognitive training. These approaches are squarely within the applied behaviour analysis tradition of behaviour therapy.
Acceptance and Commitment Therapy (ACT) may be the most well-researched of all the third-generation behaviour therapy models. It is based on relational frame theory. As of March 2022, there are over 900 randomised trials of Acceptance and Commitment Therapy and 60 mediational studies of the ACT literature. ACT has been included in over 275 meta-analyses and systematic reviews. As the result of multiple randomised trials of ACT by the World Health Organisation (WHO) now distribute ACT-based self-help for “anyone who experiences stress, wherever they live, and whatever their circumstances.” As of March 2022, a number of different organizations have stated that Acceptance and Commitment Therapy is empirically supported in certain areas or as a whole according to their standards. These include: American Psychological Association, Society of Clinical Psychology (Div. 12), The WHO, The United Kingdom National Institute for Health and Care Excellence (NICE), Australian Psychological Society, Netherlands Institute of Psychologists: Sections of Neuropsychology and Rehabilitation, Sweden Association of Physiotherapists, SAMHSA’s National Registry of Evidence-based Programs and Practices, California Evidence-Based Clearinghouse for Child Welfare, and the US Veterans Affairs/Department of Defence.
Functional analytic psychotherapy is based on a functional analysis of the therapeutic relationship. It places a greater emphasis on the therapeutic context and returns to the use of in-session reinforcement. In general, 40 years of research supports the idea that in-session reinforcement of behaviour can lead to behavioural change.
Behavioural activation emerged from a component analysis of cognitive behaviour therapy. This research found no additive effect for the cognitive component. Behavioural activation is based on a matching model of reinforcement. A recent review of the research, supports the notion that the use of behavioural activation is clinically important for the treatment of depression.
Integrative behavioural couples therapy developed from dissatisfaction with traditional behavioural couples therapy. Integrative behavioural couples therapy looks to Skinner (1966) for the difference between contingency-shaped and rule-governed behaviour. It couples this analysis with a thorough functional assessment of the couple’s relationship. Recent efforts have used radical behavioural concepts to interpret a number of clinical phenomena including forgiveness.
A review study published in 2008, concluded that at the time, third-generation behavioural psychotherapies did not meet the criteria for empirically supported treatments.
Organisations
Many organisations exist for behaviour therapists around the world. In the United States, the American Psychological Association’s Division 25 is the division for behaviour analysis. The Association for Contextual Behavioural Science is another professional organisation. ACBS is home to many clinicians with specific interest in third generation behaviour therapy. Doctoral-level behaviour analysts who are psychologists belong to American Psychological Association’s Division 25 – behaviour analysis. APA offers a diploma in behavioural psychology.
The Association for Behavioural and Cognitive Therapies (formerly the Association for the Advancement of Behaviour Therapy) is for those with a more cognitive orientation. The ABCT also has an interest group in behaviour analysis, which focuses on clinical behaviour analysis. In addition, the Association for Behavioural and Cognitive Therapies has a special interest group on addictions.
Characteristics
By nature, behavioural therapies are empirical (data-driven), contextual (focused on the environment and context), functional (interested in the effect or consequence a behaviour ultimately has), probabilistic (viewing behaviour as statistically predictable), monistic (rejecting mind–body dualism and treating the person as a unit), and relational (analysing bidirectional interactions).
Behavioural therapy develops, adds and provides behavioural intervention strategies and programs for clients, and training to people who care to facilitate successful lives in various communities.
Training
Recent efforts in behavioural psychotherapy have focused on the supervision process. A key point of behavioural models of supervision is that the supervisory process parallels the behavioural psychotherapy provided.
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Asociality refers to the lack of motivation to engage in social interaction, or a preference for solitary activities. Asociality may be associated with avolition, but it can, moreover, be a manifestation of limited opportunities for social relationships. Developmental psychologists use the synonyms non-social, unsocial, and social uninterest. Asociality is distinct from, but not mutually exclusive to, anti-social behaviour. A degree of asociality is routinely observed in introverts, while extreme asociality is observed in people with a variety of clinical conditions.
Asociality is not necessarily perceived as a totally negative trait by society, since asociality has been used as a way to express dissent from prevailing ideas. It is seen as a desirable trait in several mystical and monastic traditions, notably in Hinduism, Jainism, Roman Catholicism, Eastern Orthodoxy, Buddhism and Sufism.
Introversion
Introversion is “the state of or tendency toward being wholly or predominantly concerned with and interested in one’s own mental life.” Introverted persons are considered the opposite of extraverts, who seem to thrive in social settings rather than being alone. An introvert may present as an individual preferring being alone or interacting with smaller groups over interaction with larger groups, writing over speaking, having fewer but more fulfilling friendships, and needing time for reflection. While not a measurable personality trait, some popular writers have characterised introverts as people whose energy tends to expand through reflection and dwindle during interaction.
In matters of the brain, researchers have found differences in anatomy between introverted and extraverted persons. Introverted people are found to experience a higher flow of blood to the frontal lobe than extraverts, which is the part of the brain that contributes to problem-solving, memory, and pre-emptive thought.
Social Anhedonia
Social anhedonia is found in both typical and extreme cases of asociality or personality disorders that feature social withdrawal. Social anhedonia is distinct from introversion and is frequently accompanied with alexithymia.
Many cases of social anhedonia are marked by extreme social withdrawal and the complete avoidance of social interaction. One research article studying the individual differences in social anhedonia discusses the negative aspects of this form of extreme or aberrant asociality. Some individuals with social anhedonia are at higher risk of developing schizophrenia and may have mental functioning that becomes poorer than the average
In Human Evolution and Anthropology
Scientific research suggests that asocial traits in human behaviour, personality, and cognition may have several useful evolutionary benefits. Traits of introversion and aloofness can protect an individual from impulsive and dangerous social situations because of reduced impulsivity and reward. Frequent voluntary seclusion stimulates creativity and can give the individual time to think, work, reflect, and see useful patterns more easily.
Research indicates the social and analytical functions of the brain function in a mutually exclusive way. With this in mind, researchers posit that people who devoted less time or interest to socialisation used the analytical part of the brain more frequently and thereby were often responsible for devising hunting strategies, creating tools, and spotting useful patterns in the environment in general for both their own safety and the safety of the group.
Imitation and social learning have been confirmed to be potentially limiting and maladaptive in animal and human populations. When social learning overrides personal experience (asocial learning), negative effects can be observed such as the inability to seek or pick the most efficient way to accomplish a task and a resulting inflexibility to changing environments. Individuals who are less receptible, motivated, and interested in sociability are likely less affected by or sensible to socially imitated information and faster to notice and react to changes in the environment, essentially holding onto their own observations in a rigid manner and, consequently, not imitating a maladaptive behaviour through social learning. These behaviours, including deficits in imitative behaviour, have been observed in individuals with autism spectrum disorders and introverts, and are correlated with the personality traits of neuroticism and disagreeableness.
The benefits of this behaviour for the individual and their kin caused it to be preserved in part of the human population. The usefulness for acute senses, novel discoveries, and critical analytical thought may have culminated in the preservation of the suspected genetic factors of autism and introversion itself due to their increased cognitive, sensorial, and analytical awareness.
In Psychopathology
Schizophrenia
In schizophrenia, asociality is one of the main five “negative symptoms”, with the others being avolition, anhedonia, reduced affect, and alogia. Due to a lack of desire to form relationships, social withdrawal is common in people with schizophrenia. People with schizophrenia may experience social deficits or dysfunction as a result of the disorder, leading to asocial behaviour. Frequent or ongoing delusions and hallucinations can deteriorate relationships and other social ties, isolating individuals with schizophrenia from reality and in some cases leading to homelessness. Even when treated with medication for the disorder, they may be unable to engage in social behaviours. These behaviours include things like maintaining conversations, accurately perceiving emotions in others, or functioning in crowded settings. There has been extensive research on the effective use of social skills training (SST) for the treatment of schizophrenia, in outpatient clinics as well as inpatient units. SST can be used to help patients with schizophrenia make better eye contact with other people, increase assertiveness, and improve their general conversational skills.
Personality Disorders
Avoidant Personality Disorder
Asociality is common amongst people with avoidant personality disorder (AvPD). They experience discomfort and feel inhibited in social situations, being overwhelmed by feelings of inadequacy. Such people remain consistently fearful of social rejection, choosing to avoid social engagements as they do not want to give people the opportunity to reject (or possibly, accept) them. Though they inherently crave a sense of belonging, their fear of criticism and rejection leads people with AvPD to actively avoid occasions that require social interaction, leading to extremely asocial tendencies; as a result, these individuals often have difficulty cultivating and preserving close relationships.
People with AvPD may also display social phobia, the difference being that social phobia is the fear of social circumstances whereas AvPD is better described as an aversion to intimacy in relationships.
Schizoid Personality Disorder
Schizoid personality disorder (SzPD) is characterised by a lack of interest in social relationships, a tendency towards a solitary lifestyle, secretiveness, emotional coldness, and apathy. Affected individuals may simultaneously demonstrate a rich and elaborate but exclusively internal fantasy world.
It is not the same as schizophrenia, although they share such similar characteristics as detachment and blunted affect. There is, moreover, increased prevalence of the disorder in families with schizophrenia.
Schizotypal Personality Disorder
Schizotypal personality disorder is characterized by a need for social isolation, anxiety in social situations, odd behaviour and thinking, and often unconventional beliefs. People with this disorder feel extreme discomfort with maintaining close relationships with people, and therefore they often do not. People who have this disorder may display peculiar manners of talking and dressing and often have difficulty in forming relationships. In some cases, they may react oddly in conversations, not respond, or talk to themselves.
Autism
Autistic people may display profoundly asocial tendencies, due to differences in how autistic and allistic (non-autistic) people communicate. These different communication styles can cause mutual friction between the two neurotypes, known as the double empathy problem. Autistic people tend to express emotions differently and less intensely than allistic people, and often do not pick up on allistic social cues or linguistic pragmatics (including eye contact, facial expressions, tone of voice, body language, and implicatures) used to convey emotions and hints.
Connecting with others is important to overall health. An increased difficulty in accurately reading social cues by others can affect this desire for people with autism. The risk of adverse social experiences is high for those with autism, and so they may prefer to be avoidant in social situations rather than experience anxiety over social performance. Social deficits in people with autism is directly correlated with the increased prevalence of social anxiety in this community. As they are in a steep minority, there is risk of not having access to like-minded peers in their community, which can lead them to withdrawal and social isolation.
Mood Disorders
Depression
Asociality can be observed in individuals with major depressive disorder or dysthymia, as individuals lose interest in everyday activities and hobbies they used to enjoy, this may include social activities, resulting in social withdrawal and withdrawal tendencies.
SST can be adapted to the treatment of depression with a focus on assertiveness training. Depressed patients often benefit from learning to set limits with others, to obtain satisfaction for their own needs, and to feel more self-confident in social interactions. Research suggests that patients who are depressed because they tend to withdraw from others can benefit from SST by learning to increase positive social interactions with others instead of withdrawing from social interactions.
Social Anxiety Disorder
Asocial behaviour is observed in people with social anxiety disorder (SAD), who experience perpetual and irrational fears of humiliating themselves in social situations. They often have panic attacks and severe anxiety as a result, which can occasionally lead to agoraphobia. The disorder is common in children and young adults, diagnosed on average between the ages of 8 and 15. If left untreated, people with SAD exhibit asocial behaviour into adulthood, avoiding social interactions and career choices that require interpersonal skills. SST can help people with social phobia or shyness to improve their communication and social skills so that they will be able to mingle with others or go to job interviews with greater ease and self-confidence.
Traumatic Brain Injury
Traumatic brain injuries (TBI) can also lead to asociality and social withdrawal.
Management
Treatments
Social Skills Training
Social skills training (SST) is an effective technique aimed towards anyone with “difficulty relating to others,” a common symptom of shyness, marital and family conflicts, or developmental disabilities; as well as of many mental and neurological disorders including adjustment disorders, anxiety disorders, attention-deficit/hyperactivity disorder, social phobia, alcohol dependence, depression, bipolar disorder, schizophrenia, avoidant personality disorder, paranoid personality disorder, obsessive-compulsive disorder, and schizotypal personality disorder.
Fortunately for people who display difficulty relating to others, social skills can be learned, as they are not simply inherent to an individual’s personality or disposition. Therefore, there is hope for anyone who wishes to improve their social skills, including those with psychosocial or neurological disorders. Nonetheless, it is important to note that asociality may still be considered neither a character flaw nor an inherently negative trait.
SST includes improving eye contact, speech duration, frequency of requests, and the use of gestures, as well as decreasing automatic compliance to the requests of others. SST has been shown to improve levels of assertiveness (positive and negative) in both men and women.
Additionally, SST can focus on receiving skills (e.g. accurately perceiving problem situations), processing skills (e.g. considering several response alternatives), and sending skills (delivering appropriate verbal and non-verbal responses).
Metacognitive Interpersonal Therapy
Metacognitive interpersonal therapy is a method of treating and improving the social skills of people with personality disorders that are associated with asociality. Through metacognitive interpersonal therapy, clinicians seek to improve their patients’ metacognition, meaning the ability to recognise and read the mental states of themselves. The therapy differs from SST in that the patient is trained to identify their own thoughts and feelings as a means of recognising similar emotions in others. Metacognitive interpersonal therapy has been shown to improve interpersonal and decision-making skills by encouraging awareness of suppressed inner states, which enables patients to better relate to other people in social environments.
The therapy is often used to treat patients with two or more co-occurring personality disorders, commonly including obsessive-compulsive and avoidant behaviours.
Coping Mechanisms
In order to cope with asocial behaviour, many individuals, especially those with avoidant personality disorder, develop an inner world of fantasy and imagination to entertain themselves when feeling rejected by peers. Asocial people may frequently imagine themselves in situations where they are accepted by others or have succeeded at an activity. Additionally, they may have fantasies relating to memories of early childhood and close family members.
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Parataxic distortion is a psychiatric term first used by Harry S. Sullivan to describe the inclination to skew perceptions of others based on fantasy. The “distortion” is a faulty perception of others, based not on actual experience with the other individual, but on a projected fantasy personality attributed to the individual. For example, when one falls in love, an image of another person as the “perfect match” or “soul mate” can be created when in reality, the other person may not live up to these expectations or embody the imagined traits at all.
The fantasy personality is created in part from past experiences and from expectations as to how the person “should be”, and is formulated in response to emotional stress. This stress can originate from the formation of a new relationship, or from cognitive dissonance required to maintain an existing relationship. Parataxic distortion serves as an immature cognitive defence mechanism against this psychological stress and is similar to transference.
Parataxic distortion is difficult to avoid because of the nature of human learning and interaction. Stereotyping of individuals based on social cues and the classification of people into groups is a commonplace cognitive function of the human mind. Such pigeonholing allows for a person to gain a quick, though possibly inaccurate, assessment of an interaction. The cognitive processes employed, however, can have a distorting effect on the clear understanding of individuals. In essence, one can lose the ability to “hear the other” through one’s own projected beliefs of what the other person is saying.
Etymology
From the Greek παράταξις, “placement side by side”
Para – A Greek prefix which came to designate objects or activities auxiliary to or derivative of that denoted by the base word ( parody; paronomasia, paranoia) and hence abnormal or defective.
Taxic – indicating movement towards or away from a specified stimulus.
In this sense, Parataxic distortion, is a shift in perception away from reality.
Interpersonal Relationships and Emotions
Distorting one’s perception of others can often interfere with interpersonal relationships. In many cases, however, it may be beneficial to do so. Humans are constantly and subconsciously stereotyping. According to Paul Martin Lester, “our brains naturally classify what we see, we can’t help but notice the differences in physical attributes between one person and another”. Parataxic distortion runs parallel to stereotyping while it remains in the subconscious. As we make quick judgements, we are drawing from previous experiences stored in our memory.
Parataxic distortion can be a beneficial defence mechanism for the individual, allowing the individual to maintain relationships with others with whom he or she would otherwise be unable to interact or allowing the individual to endure difficult periods in relationships. A self-imposed blindness to certain personality traits can keep a relationship healthy, or it can also prove destructive. For instance, parataxic distortion can keep one in denial of the abusive nature of a spouse.
Attachment Theory
Parataxic distortion can begin in the early stages of development in infants. A mother’s nurturing personality and emotional warmth might be projected onto a lover later in life. This could initially generate stronger feelings for the woman than are warranted by her behaviour and character alone. This example of attachment theory correlates with Parataxic Distortion.
Attachment theory would have it that the fantasy selves projected onto others in parataxic distortion are informed by our long-term attachment patterns. Not only are these imagined traits the resultant of our earliest bonds and unresolved emotional issues from past relationships, but they are recreated in these fantasy selves for the purpose of recreating that past attachment in the present.
Negative Effects
Dealing with current situations or people that relate to a past event, or remind someone of a person from the past, can have negative effects on a human from an emotional standpoint. If the person from the past was a negative figure or the past event had a negative influence on a person, the person may create a self-sense of identity for the new individual they met. The negative emotional response happens when the individual realises that they have been creating a fake identity for the new individual.
Parataxic distortion is most effective in the realm of interpersonal communication. Parataxic distortion is typically used to avoid coping with past events. For example, if a child is mistreated by his or her father, the child may not only attach the fear and anger towards the father but will also relate this fear and anger to other men that look, talk or act like the father. The human mind keeps track of situations that we have encountered in the past to help us deal with future situations. The unconscious memory, without our knowing, helps us understand and deal with situations in the present that we have dealt with in the past. Parataxic distortion and our unconscious mind make us act the same way in current situations as we did in the past, even without realising it.
Defence Mechanism
As a defence mechanism, parataxic distortion protects one from the emotional consequences of a past event. A person may not remember a certain event, or be acting on it consciously, but will act a certain way to protect themselves from an outcome with the use of parataxic distortion. This behaviour is a pathological attempt to cope with reality by using unreality.
Parataxic distortion is a commonly used psychological defence mechanism. It is not an illness or a disease, but a part of everyday, normal human psychology that can become maladaptive in certain situations. The cognitive abilities used to generate internal models of others are useful in interaction. As we can never truly internalise the full reality of another, we must interact with a shorthand version of them. It is only when we believe that the shorthand version is their reality that this ability can become maladaptive. One may also attempt to coerce or force another to ‘fit the mould’ and act more according to expectations, more like the idealised version they dream the other as being. This is also pathological.
However, all humans engage in parataxic distortion to one extent or another, in one realm or another. It may be to manage emotions within their family, to facilitate communication between them and their spouse, or to imagine a relationship between them and their nation-state.
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Supervision is used in counselling, psychotherapy, and other mental health disciplines as well as many other professions engaged in working with people. Supervision may be applied as well to practitioners in somatic disciplines for their preparatory work for patients as well as collateral with patients. Supervision is a replacement instead of formal retrospective inspection, delivering evidence about the skills of the supervised practitioners.
It consists of the practitioner meeting regularly with another professional, not necessarily more senior, but normally with training in the skills of supervision, to discuss casework and other professional issues in a structured way. This is often known as clinical or counselling supervision (consultation differs in being optional advice from someone without a supervisor’s formal authority). The purpose is to assist the practitioner to learn from his or her experience and progress in expertise, as well as to ensure good service to the client or patient. Learning shall be applied to planning work as well as to diagnostic work and therapeutic work.
Milne (2007) defined clinical supervision as: “The formal provision, by approved supervisors, of a relationship-based education and training that is work-focused and which manages, supports, develops and evaluates the work of colleague/s”. The main methods that supervisors use are corrective feedback on the supervisee’s performance, teaching, and collaborative goal-setting. It therefore differs from related activities, such as mentoring and coaching, by incorporating an evaluative component. Supervision’s objectives are “normative” (e.g. quality control), “restorative” (e.g. encourage emotional processing) and “formative” (e.g. maintaining and facilitating supervisees’ competence, capability and general effectiveness).
Some practitioners (e.g. art, music and drama therapists, chaplains, psychologists, and mental health occupational therapists) have used this practice for many years. In other disciplines the practice may be a new concept. For NHS nurses, the use of clinical supervision is expected as part of good practice. In a randomly controlled trial in Australia, White and Winstanley looked at the relationships between supervision, quality of nursing care and patient outcomes, and found that supervision had sustainable beneficial effects for supervisors and supervisees. Waskett believes that maintaining the practice of clinical supervision always requires managerial and systemic backing, and has examined the practicalities of introducing and embedding clinical supervision into large organisations such as NHS Trusts (2009, 2010). Clinical supervision has some overlap with managerial activities, mentorship, and preceptorship, though all of these end or become less direct as staff develop into senior and autonomous roles.
Key issues around clinical supervision in healthcare raised have included time and financial investment. It has however been suggested that quality improvement gained, reduced sick leave and burnout, and improved recruitment and retention make the process worthwhile.
United Kingdom
Clinical supervision is used in many disciplines in the British National Health Service (NHS). Registered allied health professionals such as occupational therapists, physiotherapists, dieticians, speech and language therapists and art, music and drama therapists are now expected to have regular clinical supervision. C. Waskett (2006) has written on the application of solution focused supervision skills to either counselling or clinical supervision work. Practising members of the British Association for Counselling and Psychotherapy are bound to have supervision for at least 1.5 hours a month. Students and trainees must have it at a rate of one hour for every eight hours of client contact.
The concept is also well used in psychology, social work, the probation service and at other workplaces.
Models or Approaches
There are many different ways of developing supervision skills which can be helpful to the clinician or practitioner in their work. Specific models or approaches to both counselling supervision and clinical supervision come from different historical strands of thinking and beliefs about relationships between people. A few examples are given below.
Peter Hawkins (1985) developed an integrative process model which is used internationally in a variety of helping professions. His “Seven Eyed model of Supervision” was further developed by Peter Hawkins along with Robin Shohet, Judy Ryde and Joan Wilmot in “Supervision in the Helping Professions” (1989, 2000 and 2006 and 2012) and with Nick Smith in “Coaching, Mentoring and organisational Consultancy: Supervision and Development” (2006 and 2013]) and is taught on the courses of the Centre for Supervision and Team Development as well as many other supervision training courses.
S. Page and V. Wosket describe a cyclical structure.
F. Inskipp and B. Proctor (1993, 1995) developed an approach based on the normative, formative and restorative elements of the relationship between supervisor and supervisee. The Brief Therapy practice teaches a solution focused approach based on the work of Steve de Shazer and Insoo Kim Berg which uses the concepts of respectful curiosity, the preferred future, recognition of strengths and resources, and the use of scaling to assist the practitioner to progress. Waskett has described teaching solution-focused supervision skills to a variety of professionals.
Evidence-based CBT supervision is a distinctive and recent model that is based on cognitive-behaviour therapy (CBT), enhanced by relevant theories (e.g. experiential learning theory), expert consensus statements, and on applied research findings (Milne & Reiser, 2017). It is therefore an example of evidence-based practice, applied to supervision. CBT supervision meets the general definition of clinical supervision above (Milne, 2007), adding some distinctive features that reflect CBT as a therapy. This includes a high degree of session structure and direction (e.g. detailed agenda-setting), but within a fundamentally collaborative relationship. Also, there is a primary emphasis on cognitive case conceptualisation, mainly through the use of case discussion, intended to develop diagrammatic CBT formulations. But discussion should properly be combined with other CBT techniques, including Socratic questioning, guided discovery, educational role-play, behavioural rehearsal, and corrective feedback. Another distinctive aspect is a focus on evidence-based principles and methods, including the use of reliable instruments for feedback and evaluation, in relation to both therapy and supervision. Perhaps the single most defining characteristic of evidence-based CBT supervision is the active and routine commitment to research methods and findings: where other approaches refer to theory and clinical/supervisory experience for guidance, evidence-based CBT supervision appeals ultimately to ‘the data’. Examples of the use of relevant theories, expert consensus statements and research, together with six formally-developed supervision guidelines (illustrated through video clips), can be found in Milne & Reiser (2017).
Counselling or clinical supervisors will be experienced in their discipline and normally then have further training in any of the above-mentioned approaches, or others.
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Emotional competence and emotional capital refer to the essential set of personal and social skills to recognise, interpret, and respond constructively to emotions in oneself and others. The term implies an ease around others and determines one’s ability to effectively and successfully lead and express.
Definition
Emotional competence refers to an important set of personal and social skills for identifying, interpreting, and constructively responding to emotions in oneself and others. The term implies ease in getting along with others and determines one’s ability to lead and express effectively and successfully. Psychologists define emotional competence as the ability to monitor one’s own and others’ feelings and emotions and to use this information to guide one’s thinking and actions.
Description
Emotional competence is another term for emotional intelligence. It describes a person’s ability to express their emotions completely freely, and it comes from emotional intelligence, the ability to recognise emotions. Individual’s emotional competence is considered to be an important predictor of their ability to adapt to their environment, and it refers primarily to their ability to identification, understanding, expression, regulation, and use their own and other’s emotions. Emotional competence is often referred to in social contexts, and is considered a capability of recognising their own emotions, as well as those of others and expressing them in socially acceptable ways. Competence is the level of skill at which a person interacts constructively with others. This personal emotional capacity is based on a person’s perception of their emotions and how they affect others, as well as the ability to maintain control and adaptation of emotions.
Brief History
In 1999, Carolyn Saarni wrote a book named The Development of Emotional Competence. Saarni believed that emotional abilities are not innate, but are cultivated and developed through children’s interactions with others, especially family members and peers. Saarni defined emotional capacity as the functional ability of humans to achieve goals after experiencing an emotion-eliciting encounter. She defined emotion as a component of self-efficacy, and she described the use of emotions as a set of skills that lead to the development of emotional capacity.
Examples
Understand others: To be aware of other people’s feelings and perspectives
Develop others: Be aware of the development needs of others and enhance their capabilities
Service orientation: Anticipate, recognise and meet customer needs
Leverage diversity: Nurture opportunities through different types of people
Intelligence Quotient and Emotional Quotient
Intelligence quotient (IQ): Is a measure of person’s reasoning ability, introduced by the German psychologist Louis William Stern as a qualitative method of assessing individual differences.
Emotional quotient (EQ): Is a measure of self-emotional control ability, introduced in American psychologist Peter Salovey in 1991. The emotional quotient is commonly referred to in the field of psychology as emotional intelligence(also known as emotional competence or emotional skills). IQ reflects a person’s cognitive and observational abilities and how quickly they can use reasoning to solve problems. EQ, on the other hand, is an index of a person’s ability to manage their own emotions and to manage the emotions of others.
Daniel Goleman’s Model
In Daniel Goleman’s Emotional Intelligence, he introduced components of EQ:
Self-awareness: precise awareness of self emotions
Self-regulation: controlled emotional expression
Motivation: emotional self-motivation
Empathy: adept at modulating the emotional responses of others and helping them to express their emotions
Social skills: excellent communication skills
Personal Competence
Self-Awareness – Know one’s internal states, preferences, resources and intuitions. The competencies in this category include:
Emotional Awareness – Recognize one’s emotions and their effects
Accurate Self-Assessment – Know one’s strengths and limits
Self-Confidence – A strong sense of one’s self-worth and abilities
Self-Regulation – Manage one’s internal states, impulses and resources.
Social Competence:
Empathy – Awareness of others’ feelings, needs and concerns. The competencies in this category include:
Understand Others – Sense others’ feelings and perspectives
Develop Others – Sense others’ development needs and bolstering their abilities
Service Orientation – Anticipate, recognise and meet customers’ needs
Leverage Diversity – Cultivate opportunities through different kinds of people
Political Awareness – Read a group’s emotional currents and power relationships
Emotional intelligence
Emotional Intelligence and the Four-Branch Model
Psychologists see emotional competence as a continuum, ranging from lower levels of emotional competence to perform mental functions to complex emotional competence for personal self-control and management. The higher levels of emotional competence, on the other hand, comprise four branches:
Perceive emotions in oneself and others accurately
Use emotions to facilitate thinking
Understand emotions, emotional language, and the signals conveyed by emotions
Manage emotions so as to attain specific goals
Each branch describes a set of skills that make up overall emotional intelligence, ranging from low to high complexity. For example, perceiving emotions usually begins with the ability to perceive basic emotions from faces and vocal tones, and may progress to the accurate perception of emotional blends and the capture and understanding of facial micro-expressions.
Assertiveness
Building up emotional competence is one way of learning to handle manipulative or passive-aggressive behaviour in which the manipulator exploits the feelings of another to try to get what they want.
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