Author: Beauty4TheSoul

Counseling, philosophy, Theology

Jay Adams, and the Dangers of Biblical Counseling

Almost fifty years ago, in 1970, Jay Adams wrote his controversial book, Competent to Counsel, insisting that Christians reclaim counseling from psychologists and psychiatrists and redistribute humanity’s problems into categories using labels that maintained a theological tone: sin, disobedience, and rebellion. The Biblical Counseling movement, ushered into Christian culture by Adams and his followers, declares that humanism (secular ideals and philosophy) establishes the foundation of professional counseling, creating blueprints for unstable soul repair.  For present day professional counselors this idea, aside from the obvious affront to psychology as a field of study, may seem dubious since the field of counseling is more complex than simply lumping all who counsel professionally into the field of psychology, or even psychiatry.  Regardless, Biblical Counselors see counseling belonging to a different authority altogether:  “Central to his [Adams] vision was the notion that human life is meant to be lived under benign authority—parental, pastoral, ecclesiastical, and, ultimately, immediate theocratic authority as articulated in the Bible—whose purposes were to transform human nature, not actualize it.” [1]  What is interesting here is that the line being drawn in the sand is over human nature—who gets to define it, have its say over it, and counsel in relation to it.  

Undoubtedly to the dismay of the American Psychological Association, modern day professional counselors are not required to study large quantities of psychology, nor are they mandated to specialize or equip themselves with a particular psychological model (i.e. Freudian Psycho-analysis).  Rather, modern day counselors study evidenced based practices for recognizing mental health disorders [2] (assessments) and evidenced based interventions (methods for treatment).  What is important to understand is there is a division in the secular world between professional counseling as underscored by the American Counseling Association and psychology as indicated by the American Psychological Association.  The American Counseling Association (ACA) describes the purpose of counseling in the following statement: “Counseling is a professional relationship that empowers diverse individuals, families, and groups to accomplish mental health, wellness, education, and career goals.  The American Counseling Association (ACA) is an educational, scientific, and professional organization whose members work in a variety of settings and service in multiple capacities.” [3]

The problem, aside from the various idealistic approaches to counseling—or, even defining the objective of counseling itself, is that at this very moment there are individuals who are suffering from mental health related issues (autism, bipolar disorder, trauma, PTSD, abuse (sexual, physical, emotional, and psychological, etc).  These individuals have grown up to believe that pastors, elders, and Sunday school teachers have been equipped with enough training to provide counseling on these matters.  Most mainline seminaries only provide one or two required classes in pastoral counseling.  Some pastors and teachers in the church have become certified in Biblical Counseling, but that is not particularly impressive.  One website I perused recently proudly offers a Biblical Counseling certificate to individuals who can part with $100 and attend 30 hours of training.  

On the contrary, a professional counselor who is licensed with the ACA is required to have a Masters Degree in counseling and included in the masters degree education a minimum of 700 hours of practicum and internship training is required. After an individual graduates with his or her masters degree in counseling an additional 3000 hours of supervision are required before one can be fully licensed. Built into a masters in counseling are classes that teach counselors about assessments, research studies, diagnosis, and evidence based practices and interventions.

The licensed counselor will not be surprised or overwhelmed by trauma because he or she will have had the training needed to meet you where you are.

However, what is even more shocking, is that the Biblical counselor will first, want to convert you or your son or daughter to Christianity prior to treatment—since treatment at its very start includes conversion. “Adams did not think that either peace of mind or socially acceptable behavior prescribed an adequate goal for the “cure of souls.” He asserted instead that the church should understand the vast majority of problems in living in terms of an explicitly moral model. Given this diagnostic framework, he established goals for the church’s counseling that employed the ingredients of the traditional Christian message. First, because “man’s greatest need is forgiveness,” the forgiving grace of Jesus Christ was essential to solving problems in living.” [4]

The Biblical counselor will set the agenda, drive the conversation, shaping it into whatever he or she thinks is best for the moment. The licensed counselor will avoid imposing his or her values onto the counseling session [5], having unconditional positive regard for the client (regardless of what he or she believes) and allow the client to bring up what he or she is struggling with and address it, in tandem with the client. The client and the professional licensed counselor work together on setting the goals, the client and the professional licensed counselor work together through the issues—and together they find hope and healing.

[1]  Powlison, David. The Biblical Counseling Movement. Greensboro, New Grow Press: 2010. p. 3. 

[2]  I am aware that there are many in the Christian community who do not believe that mental health disorders exist.  This warrants a separate post on the matter, but for now you may want to consider my post on the making of the DSM-V 

[3] https://www.counseling.org/about-us/about-aca/our-mission

[4]  Powlison, David. The Biblical Counseling Movement. Greensboro, New Grow Press: 2010. p. 2

[5]  Standard A.4.b of the ACA Code of Ethics 

Counseling

Regarding Some Misconceptions Regarding the DSM-5

Introduction

As a professional counselor in training, I have heard and seen some disconcerting assumptions asserted about the Diagnostic and Statistical Manual of Mental Disorders (5th Edition). I have encountered Christian professionals, both counselors and pastors, who argue with some contempt, that the DSM-5 does not offer “Christian” solutions to mental health issues. I use the term “mental health” lightly here, because I know that many pastors and Biblical Counselors reject the idea that there are “actual” mental health problems, preferring to use words like soul problems, human problems, sin problems, martial conflict, and so forth. In any case, this post is dedicated to the making of the DSM-5 and what the DSM-5 is designed to do.

Before I address the history, it is first necessary to recognize what the DSM-5 is designed to do. If a psychologist in Sweden, a licensed counselor in Germany, a medical doctor in Montana, and a psychiatrist in Canada were to sit in a room and discuss particular clients that all share the same symptoms they would use the DSM-5 as a point-of-reference, since the DSM-5 is internationally recognized as a reference and diagnostic tool. For example, a person diagnosed with Post-Traumatic-Stress Disorder from the DSM-5 will have either the same or very similar symptomatology of any other person (regardless of where they are in the world) as long as that other person has also been diagnosed with the DSM-5. They key point that I am trying to get at here, is that the DSM-5 is a diagnostic tool, listing certain sets of criteria that have to be met before someone can receive a particular diagnosis.

History of the DSM-5

The history of the DSM-5 began in 1999, which was initiated by the American Psychological Association (APA). The APA wanted a significant amount of collaboration on this project, so they recruited professionals from many different fields: internationally recognized clinicians, scientific researchers, and professional organizations. “Through this wide scale collaboration, the DSM-5 development process has involved not only psychiatrists, but also experts with backgrounds in psychology, social work, psychiatric nursing, pediatrics, and neurology” (APA, 2013).

A task force was created that included over 160 mental health and medical professionals who were leaders in their fields. From these 160 professionals, 13 work groups were created which comprised over 90 academic and mental institutions around the world. More specifically, within the 160 professionals collaborating on this project: “Nearly 100 are psychiatrists, 47 are psychologists, two are pediatric neurologists and three are statisticians/epidemiologists. In addition, also included are a pediatrician, speech and hearing specialist, social worker, psychiatric nurse and consumer and family representative” (APA, 2013).

In addition to the 160 mental health and professionals who were collaborating on this project, an additional 300 advisors came along side the project to help inform specific areas requiring additional expertise.

The American Psychological Association partnered with the World Health Organization as well as the World Psychiatric Association to help with the organization of the DSM-5. “From 2004-2008, APA, WHO and the National Institutes of Health supported 13 additional conferences involving nearly 400 participants from 39 countries, including 16 developing nations. The work resulted in 10 monographs, hundreds of published articles regarding the current state of knowledge and recommendations for additional research in many fields” (APA, 2013).

Committees also helped in the process, such as the APA Board of Trustees, which overviewed the content for the DSM-5 along with A Scientific Review Committee and A Clinical and Public Health Committee.

Additionally, public feedback was also requested, which brought in about 11,000 comments which impacted changes. Lastly, thousands of additional clinicians and professionals volunteered their time to over up their expertise, contributing to the making of the DSM-5.

Final Remarks

It is important to understand that the DSM-5 is not a “Christian” document. It’s purpose is to function as a diagnostic tool. It is it true that the DSM-5 does not offer Christian advice for how to address mental health issues, however the DSM-5 does not offer any advice on how to treat or medicate mental health issues. It is not designed to do that.

Reference

American Psychological Association (2013). The People Behind the DSM-5. PP 1-2. Click here for page location.

Counseling, Techniques

A Goodbye Letter to Sugar

Sugar, 

When I think about your soon to be absence in my life, I wonder: Will life ever be so sweet again?  I shall cherish the memory of your whispered promises of comfort and pleasure. Who knew you would be such a loyal companion, always waiting for me to passively entertain your presence.  Your enchantments linger and I so frequently look for you, able to find your presence wherever I go, you call out to me, and I wait for your permission to be self-indulgent.  You are effective, consistent, and offer yourself freely to me without constraints.  You bring excitement, and allure, you help me through the darkest of times and I can always count on you to deliver some new form of yourself for me to experiment.  You are an adventure with unending and unexplored jungles of exotic varieties.  

For the next 6 weeks we will part ways, in part, because not mentioned in your chocolate glazed promises are the consequences of your presence in my life: the headaches, mood swings, the sugar highs and of course the resulting lows, the weight gain and the frequent need to find ways to incorporate you into my life.  You are a little controlling, a little too demanding, and at times a bit too intrusive in my life.  It’s time to rethink this relationship, to disentangle this web of deceit, and to make new friends.  

Since every year the average American consumes at least 50 pounds of sugar a year, I doubt you will miss me, but for now, I will miss you and maybe one day I’ll be free of my dependency on you.  You are not god, but a chemical, but I often treat you as the former while dismissing the latter.  

philosophy

Cicero on the Recklessness of Assertion

For we Academicians are not men [or women] whose minds wander in uncertainty and never know what principles to adopt.  For what sort of mental habit, or rather what sort of life would that be which should dispense with all rules for reasoning or even for living? Not so with us; but, as other schools maintain that some things are certain, others uncertain, we, differing with them, say that some things are probable, others improbable.

What, then, is to hinder me from accepting what seems to me to be probable, while rejecting what seems improbable, and from shunning the presumption of dogmatism, while keeping clear of that recklessness of assertion which is as far as possible removed from true wisdom?

– Cicero, On Duties. Book II, Section 8.  *brackets added

Reflecting on our politically charged atmosphere, I found this quote to be comforting.  I realize that may seem like an odd thing to say since the quote is rather philosophical in nature.  However, if one replaces the term “Academicians” with student, manager, sales associate, or whatever one prefers to use, the potential for identifying with Cicero grows, particularly when the desire is to share what one is thinking, learning, and discovering with others.  In my experience, the exhausting nature of our present political environment is that the dogmatic assertion comes in the form of heat.  A fire fueling tyrannous outrage, burning logic and reason, destroying their ability to sift through and filter out the dogmatic assertions which are frequently declared without any thought to their etymology or philosophical underpinnings.  For me, this quote is a reminder to think and ask myself:  How have I arrived to the things I believe?  Can I provide evidence for what I believe? Do I also merely contribute to the problem of merely asserting without providing a reasonable argument for the beliefs and values I hold?  What does it look like for me to pursue true wisdom?

 

Counseling, Techniques, Trauma

On The Efficacy of EMDR in Treating Children with PTSD

The Diagnostic and Statistical Manual of Mental Disorders (2013), indicates for those aged six and older, a diagnosis with post-traumatic stress disorder (PTSD) symptoms include but are not limited to the following: dissociation (i.e. flashbacks), nightmares, recurring, involuntary and distressing memory recollection. Additionally, the DSM-V (2013) indicates that a PTSD diagnosis is accompanied with negative thinking and mood alterations with regard to the traumatic event. Persistent avoidance of triggers associated with the traumatic situation is also common and one of the necessary requirements to receive a diagnosis of PTSD.

“Many youth (possibly up to 50%) who have experienced sexual and physical abuse may display PTSD” (Kearney et al, p. 410, 2012). Research indicates there is difficulty regarding clinicians’ ability to identify and diagnose PSTD in children (Racco, 2014). Consequently, there is confusion concerning comorbidity of symptomatology, which leads to difficulty in identifying the best intervention. Rubin (2007) indicates it is difficult to estimate the outcome of treatment for PTSD with short-term interventions such as Eye Movement Desensitization and Reprocessing (EMDR) which is due to the number of comorbid symptoms of PTSD (i.e. anxiety, depression, substance abuse, and personality disorders).

The portion of the brain that is deeply affected by PTSD is the prefrontal cortex. The individual diagnosed with PTSD may experience a series of debilitating physiological responses as a result of the prefrontal cortex being affected by a traumatic experience. Physiology of that portion of the brain that is affected includes but is not limited to fight or flight, inhibition, planning and anticipation (Blankenship, 2017). The Bilateral eye movement is one of several methodologies of EMDR.  Verbalization and cognitive reframing appear to be the key methodological aspects in EMDR, however, cathartic healing, where painful experiences lose their ability to provoke traumatic memories, resulting in intense emotional responses is EMDR’s primary function in trauma healing (Smith, 2004). This suggests the methodology of EMDR has flexibly as an intervention to meet the needs of those who do not meet the formal criteria of PTSD. The tension in the research thus far indicates EMDR is being tested on both those who have received a diagnosis of PTSD and on those whose trauma is enough to indicate PTSD but not quite specific enough for an actual PTSD diagnosis. This review seeks to answer the question: What is the efficacy of EMDR in treating children and adolescents with PTSD?

EMDR Methodology and Protocol

According to Hensel (2008) EMDR methodology includes using bilateral movement of the therapist’s fingers in the air. The client is asked to watch the fingers move back and forth while also concentrating on the memory of the worse part of their traumatic experience. Then the therapist asks the client what he or she noticed the most. Whatever came about from the first set of eye movements is now the material for the new focus of the second set of eye movements. This routine continues until the client is able to report that the distressing memory no longer has power and is able to report a healthy perspective concerning the memory.

One of the interesting features of EMDR is how quickly it begins to help a person who has had a traumatic experience. Adding to this neurological mystery, EMDR works with little to no talking on behalf of the therapist or the client, which does not necessitate cognitive reframing to occur in order for EMDR to work (Smith, 2004).

EMDR was developed by Francine Shapiro (Greber et al, 2012) and includes the bilateral eye movement methodology for an intentional eight phase approach to treatment. Research indicates that these eight stages are able to be manipulated depending on the age and setting of the client. For example, in a study conducted by Jarero, Artigas, Uribe, & García (2016) the eight phase protocol for EMDR was utilized in group therapy. EMDR has a group therapy adaptation: Integrative Group Therapy Protocol (EMDR-IGTP) which allows the eight phases of individual EMDR to be applied in a group setting. A case study from the group therapy concluded that a cancer patient, Eva, diagnosed with severe PTSD, EMDR-IGTP demonstrated its effectiveness in reducing her symptoms from minimum to none.

It should be noted that the majority of the research literature uses the term “bilateral” to refer to the kind of eye movement stimulation that occurs in EMDR. However, Shapiro (2018) uses the phrase “bilateral dual attention stimulation” (p. 2). For the sake of clarity the author of this article will use the phrase, “bilateral” in reference to the eye movement portion of the EMDR protocol.

A review of the literature indicates a diagnosis of PTSD frequently accompanies comorbid symptoms and diagnoses.

EMDR and Comorbidity of PTSD Symptoms

While in tandem, a child who has PTSD symptoms but does not meet the criteria for a PTSD diagnosis, there remains the option to undergo EMDR therapy for trauma related symptoms. However, according to Fleming (2012), regardless of differences in symptomatology both children and adults may be diagnosed with PTSD (an anxiety disorder) after a traumatic experience. Some researchers utilize two categories of PTSD: Simple and Complex. Simple PTSD would refer to a singular traumatic experience whereas complex PTSD would refer to a repeated traumatic experience (Blankenship, 2017).

Comorbidity, once explored in relation to other mental health disorders, helps clarify the role in which EMDR might play in mental health wellness. The DSM-V (2013) indicates those with a PTSD diagnosis are 80% more likely to have another mental health disorder such as depressive, anxiety, bipolar; in the case of males they are more likely to have conduct disorder and substance use disorder. However, Shapiro (2018) reports that children can exhibit symptoms similar to adults who suffer from complex trauma. These symptoms include but are not limited to lying, stealing, aggressive behavior, and defiance.

In a mixed methods case study, Grey (2011) utilized the Beck Depression Inventory-II (BDI-II) for pre, mid, and post treatment of EMDR for a female participant in her thirties, who was employed, married, and of Euro-American descent. She was diagnosed with major depression disorder and panic disorder with agoraphobia. However, the diagnostic criteria was not met for PTSD. Similarly, children can have trauma related symptoms that do not meet the criteria for a PTSD diagnosis (Fleming, 2012). However, in the study conducted by Grey (2011) after twelve EMDR sessions this study indicates the possible efficacy of EMDR in decreasing emotional symptoms in an expedient way. This case study exemplifies a review of the research that indicates, for persons (children and adults) struggling with comorbid depression and anxiety, EMDR may be helpful.

Though children and adults may experience trauma differently, symptomatology does not appear significantly different between the two populations. Because the research literature for EMDR as an intervention in children is being utilized, the following section will explore trauma and PTSD in children.

EMDR Interventions in Trauma and PTSD in Children

Brief therapy, such as EMDR, is recognized as an empirically supported intervention by the International Society for Traumatic Stress Studies (Rubin, 2007). For children, EMDR protocol can be adjusted, as in a study conducted by Hensel (2009). An age modified EMDR therapy for children was used and the study concluded EMDR was effective in treating PTSD symptoms in children. Shapiro (2018) claims children who have encountered trauma in relation to assault or natural disasters are healed from their symptoms as a result of going through EMDR.

Two particular studies have been included in this review because they are examples of evidence based research demonstrate the efficacy of EMDR in the treatment of PTSD in Children. Regarding trauma, a mixed-methods study was created by Turunen, Haravuori, Pihlajamäki, Marttunen & Punamäki (2014). They conducted a study of survivors of a school shooting where survivors were given the opportunity to participate in therapeutic sessions. Of the original sample (N=389, n=236) responded to surveys aimed at gathering the therapy experiences of participants regarding the perceived efficacy of the treatments they received. More professional therapy was given to students with severe trauma, which included regular psychotherapy meetings. Twenty percent of these regular meetings included EMDR therapy. Feedback from the students, analyzed in this study, demonstrates that the students felt the availability of psychosocial therapy was helpful.

In a mixed methods case study, Aranda, Ronquillo & Calvillo (2015) used EMDR as an intervention for an eighteen year old woman, named Sophia, who was single and of Mexican origin. She had been diagnosed with PTSD due to childhood sexual abuse. Neuropsychological and physiological measures were triangulated against psychological inventories providing data to measure improvement. Using biofeedback, this study indicates that Sophia’s decreased heart rate between the baseline at the start and end of the EMDR treatment yields evidence for the treatment’s effectiveness. EMDR treatment resulted in significant improvement of Sophia’s scores on the Paced Auditory Serial Addition Test (PASAT). The PASAT measures working memory and improvement in attention. Additionally, a one year follow-up conversational session with Sophia revealed she had stabilized and no longer demonstrated PTSD symptoms. It should be noted that researchers were unable to gather third-party confirmation of Sophia’s change of behavior.

Due to the complex nature of PTSD symptomatology and the variety of EMDR approaches to trauma, there is a need to review research methodology in order to ascertain the various approaches to applying evidenced based practices to using EMDR in therapy.

Strengths and Weaknesses of Research Methodologies

A review of the research literature indicates some tension regarding methodical testing as well as the usefulness of particular aspects of EMDR methodology. Yet, withstanding this tension, the efficacy reports of EMDR as an intervention for PTSD in children and adolescents remain positive. However, a weakness in research literature reported in a review by Greyber (2012) demonstrates a lack of evidence from random control trials that indicate EMDR is an effective intervention for children who have experienced trauma. Additionally, the review indicates small sample sizes and the use of control groups, which he states does not allow for the placebo affect. Yet, Blankenship (2017) indicates in his literature review that EMDR is an integrative therapy with over twenty random control trials demonstrating its efficacy in treating trauma. Though there is a five year interval between these reviews, the enigmatic quality of results despite methodical approach provides evidence for EMDR as a treatment for trauma related symptoms.

A strength in the research literature indicates an increase in quantitative studies since 2012 regarding the efficacy of EMDR in the treatment of children. For example, a meta-analysis by Brown, et al., (2017) reviewed thirty-six research studies including 3,541 children and youth participants with regards to efficacious treatments for PTSD. This study concludes that EMDR is one of several interventions that has shown to be effective in treating children after a mass traumatic event. However, it should be noted the quality of these studies was not assessed independently.

Research also indicates that case studies have much to offer regarding the efficacy of EMDR treating PTSD. The strengths of the method in the literature often involves mixed methods models in which the participant is tested and also has a follow-up conversations regarding his or her improvement. In Grey (2011) a mixed methods, single case study approach was conducted with a participant (in her thirties) who took 12 EMDR sessions condensed into one month and then was assessed by the Beck Depressive Inventory-II (BDI-II) and Beck Anxiety Inventory (BAI). Though generating objective data, the single case study design, is weakened by it’s lack of universality of results. However, the profit of the mixed methods single case design is supported by the literature—consistent results for effective treatment of EMDR for PTSD symptomatology. In addition to the quantitative data that has been reported, more mixed methods and single case studies with children and adolescents would help the body of efficacious evidence in support of using EMDR to treat PTSD in youth.

A limitation recognized in the research literature indicates a further need for training in EMDR as wells as a lack of knowledge about its efficacy. A study conducted by Edmond, Lawrence, and Schrag (2016) investigated the perceptions and use of EMDR therapy in rape crises centers. Their study indicated that there remains a great deal of uncertainty among counseling staff at Rape Crises Centers regarding EMDR as a treatment for sexual trauma. Additionally, they discovered in their study many of those using EMDR at rape crises centers are doing so without basic training in EMDR. A pattern has been recognized in the research literature that indicates few studies identify the amount and type of EMDR training received on behalf of those doing research regarding the efficacy or effectiveness of EMDR in treating PTSD in children.

Ethical and Culturally Relevant Issues

When deciding on treatment options for a client with a PTSD diagnosis, a primary concern is using an intervention that is evidence based. By consensus in the counseling community, when treating trauma survivors, a PTSD diagnosis is alleviated when the trauma survivor is to work through the traumatic event. EMDR therapy and trauma-focused cognitive-behavioral therapy (CBT) are both recognized as the primary two effective treatments that have empirical support for treating PTSD (Shapiro, 2018).

Research indicates that EMDR is effective in treating PTSD symptoms in children to such a degree that they either have minimum symptoms or are asymptomatic (Fleming, 2012).

Shapiro (2018) indicates that EMDR is a treatment that is effective throughout the lifespan and has successfully been used as intervention with a child as young as age two. Additionally, nine random control trials indicate positive effects for treating trauma related symptomatology in children with EMDR. However, research also indicates criticism towards aspects of EMDR’s bilateral eye-movement, saying the benefits of EMDR are due to it functioning as a kind of exposure therapy (Rubin, 2003). Yet, Maxfield, Lake, & Hyer, (2004) clarify by reporting that subjective distress experienced by participants at the end of EMDR sessions was much lower than that of an exposure therapy session. Ethically, this is important, as the level of emotional distress that may be experienced by a client in therapy needs to be communicated to the client prior to an EMDR intervention.

Shapiro (2018) indicates after a comprehensive client history is taken (Phase 1), then EMDR may be considered as a possible intervention and the client would be prepared for the targeting of memories that may bring emotional disturbance (Phase 2). Ethically, this process first considers the client’s needs, then informs the client regarding how EMDR may affect the client. As a result, veracity, nonmaleficence, beneficence, and autonomy, values of the ACA Code of Ethics (2014) are being upheld.

Concerning multiculturalism and EMDR, therapeutic interventions, particularly with children, therapists may consult the Cultural Formulation Interview (CFI) in the DSM-V (2013) for reference in reviewing applicable questions for their particular client population. In study conducted by ter Heide, June, Mooren, Knipscheer, & Kleber, (2014) on using EMDR for refugees, the authors state that the efficacy of EMDR has been found in participants from non-Western cultural environments. In particular they note that language barriers may be lessoned because speech is not always necessary in EMDR protocol and that EMDR does not have homework assignments.

Future Research

A review of the literature indicates an increase in random control trials from 2012 to 2018 for the efficacy of EMDR in treating children with PTSD, however a few gaps in the literature are as follows: (1) Fidelity to EMDR protocol is at times neglected or altered to fit a study’s research design. Further research is needed to identify the value of each phase of the EMDR protocol. Present research indicates using correct EMDR protocols leads to better treatment outcomes (Hensel, 2009). (2) Qualitative research is needed for exploring post-treatment analysis as well as participants’ feelings experiences regarding EMDR as a treatment. Additionally, questions that explore how the client felt at each of the eight phases of the EMDR intervention would provide insight as to where clients might need further clarification and insight from their therapist. (3) There is also a need for more longitudinal studies to measure the efficacy of EMDR on PTSD over greater periods of time. (4) Organizations offer differing criteria for training in EMDR, which results in non-standard approaches and techniques. Research is needed to explore the efficacy of different EMDR training programs in teaching therapists how to efficaciously treat PTSD in their clients. Additionally, there are both online and physical location programs for training. A correlational study would serve to provide greater detail on which of the two educational formats has efficacious results. (5) Further research is needed to explore complex PTSD in children and the efficacy of EMDR in treating prolonged trauma. (6) Some skepticism remains regarding the use of bilateral eye stimulation in EMDR methodology and protocol (Greyber, 2012). Further research is needed to identify why the bilateral eye stimulation is efficacious in EMDR and how it works as an efficacious tool for desensitization of traumatic experiences.

References

American Counseling Association. (2014). ACA code of ethics. Retrieved from https://www.counseling.org/resources/aca-code-of-ethics.pdf

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, D. C.: American Psychiatric Publishing.

Aranda, B. D. E., Ronquillo, N. M., & Calvillo, M. E. N. (2015). Neuropsychological and physiological outcomes pre- and post-EMDR therapy for a woman with PTSD: A case study. Journal of EMDR Practice and Research, 9(4), 174-187. http://dx.doi.org/10.1891/1933-3196.9.4.174

Blankenship, D. M. (2017). Five efficacious treatments for posttraumatic stress disorder: An empirical review. Journal of Mental Health Counseling, 39(4), 275-288. https://doi.org/10.17744/mehc.39.4.01

Brown, R. C., Witt, A., Fegert, J. M., Keller, F., Rassenhofer, M., & Plener, P. L. (2017). Psychosocial interventions for children and adolescents after man-made and natural disasters: A meta-analysis and systematic review. Psychological Medicine, 47(11), 1893-1905. https://doi.org/10.1017/S0033291717000496

Edmond, T., Lawrence, K. A., & Schrag, R. V. (2016). Perceptions and use of EMDR therapy in rape crisis centers. Journal of EMDR Practice and Research, 10(1), 23-32. https://doi.org/10.1891/1933-3196.10.1.23

Fleming, J. (2012). The effectiveness of eye movement desensitization and reprocessing in the treatment of traumatized children and youth. Journal of EMDR Practice and Research, 6(1), 16-26. Retrieved from http://proxy112.nclive.org/login?url=https://search.proquest.com/docview/922392629?accountid=12544

Greyber, L. R., Dulmus, C. N., & Cristalli, M. E. (2012). Eye movement desensitization reprocessing, posttraumatic stress disorder, and trauma: A review of randomized controlled trials with children and adolescents. Child & Adolescent Social Work Journal, 29(5), 409-425. http://dx.doi.org/10.1007/s10560-012-0266-0

Grey, E. (2011). A pilot study of concentrated EMDR: A brief report. Journal of EMDR Practice and Research, 5(1), 14-24. Retrieved from http://proxy112.nclive.org/login?url=https://search.proquest.com/docview/858829446?accountid=12544

ter Heide, F., Jackie June, Mooren, T. T. M., Knipscheer, J. W., & Kleber, R. J. (2014). EMDR with traumatized refugees: From experience-based to evidence-based practice. Journal of EMDR Practice and Research, 8(3), 147-156. Retrieved from http://proxy112.nclive.org/login?url=https://search.proquest.com/docview/1559070317?accountid=12544

Hensel, T. (2009). An intervention study. Journal of EMDR Practice and Research, 3(1), 2-9. http://proxy112.nclive.org/login?url=https://search.proquest.com/docview/222692641?accountid=12544

Jarero, I., Artigas, L., Uribe, S., García, L. E., Cavazos, M. A., & Givaudan, M. (2015). Pilot research study on the provision of the eye movement desensitization and reprocessing integrative group treatment protocol with female cancer patients. Journal of EMDR Practice and Research, 9(2), 98-105. http://dx.doi.org/10.1891/1933-3196.10.3.199

Maxfield, L., Lake, K., & Hyer, L. (2004). Some Answers to Unanswered Questions about the Empirical Support for EMDR in the Treatment of PTSD. Traumatology, 10(2), 73-89. doi:http://dx.doi.org/10.1177/153476560401000202

Kearney, C. A., Wechsler, A., Kaur, H., & Lemos-miller, A. (2010). Posttraumatic stress disorder in maltreated youth: A review of contemporary research and thought. Clinical Child and Family Psychology Review, 13(1), 46-76. http://dx.doi.org/10.1007/s10567-009-0061-4

Racco, A., & Vis, J. (2015). Evidence based trauma treatment for children and youth. Child & Adolescent Social Work Journal, 32(2), 121-129. http://dx.doi.org/10.1007/s10560-014-0347-3

Rubin, A., & Parrish, D. (2007). Challenges to the future of evidence-based practice in social work education. Journal of Social Work Education, 43(3), 405-428. Retrieved from https://search.proquest.com/docview/209794776?accountid=12544

Rubin, A. (2003). Unanswered questions about the empirical support for EMDR in the treatment of PTSD: A review of research. Traumatology, 9(1), 4-30. http://dx.doi.org.proxy112.nclive.org/10.1177/153476560300900102

Shapiro, F. (2018) Eye Movement Desensitization and Reprocessing Therapy: Basic Principles, Protocols, and Procedures. Third Edition. New York: Guilford.

Smith, J. (2004). Reexamining psychotherapeutic action through the lens of trauma. Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry, 32(4), 613-31. Retrieved from http://proxy112.nclive.org/login?url=https://search.proquest.com/docview/198142358?accountid=12544

Turunen, T., Haravuori, H., Pihlajamäki, J.,J., Marttunen, M., & Punamäki, R. (2014). Framework of the outreach after a school shooting and the students perceptions of the provided support. European Journal of Psychotraumatology, 5. http://dx.doi.org/10.3402/ejpt.v5.23079

Beauty, Theology

St. Augustine’s Literary Praxis and The Beautiful

*This is not a “counseling” related paper, rather a reflective theological paper written when I was in seminary.

St. Augustine’s Literary Praxis and The Beautiful
In what ways does Augustine’s view of beauty influence his understanding of God in relation to the Christian life in his Confessions?

When talking about beauty we can easily fall prey to discussing beauty abstractly rather than making the spiritual heart-felt connections between beauty and God that Augustine frequently makes in his Confessions. The polarity Augustine seamlessly intertwines between reflecting on his past and confessing his sins of unbelief while at the same time commenting on what he believes, post-conversion, illustrates for the reader a heart deeply moved by God’s love.

When Augustine began his Confessions, ten years had passed since Augustine’s conversion to Christianity in the year of 386 A.D., which allowed for him to write a reflection on his past and at the same time process his thoughts and questions in regards to Christianity. One such example of this is at the beginning of book 1. Augustine is quick to inform his readers what his spiritual questions are:

You stir us so that praising you may bring us joy, because you have made us and drawn us to yourself, and our heart is unquiet until it rests in you. Grant me to know and understand, Lord, which comes first: to call upon you or to praise you? To know you or to call upon you? [1]

For modern day Christians whose language for speaking about their relationship with God includes intimate words and consider this way of speaking a reflection of their “personal relationship” with God, Augustine’s Confessions may be surprisingly refreshing. Augustine writes beautifully and even poetically at times, to such a degree that one wonders if Augustine considered his writing of the Confessions as an act of worship in of itself. I submit that the ability to confess sin while at the same time acknowledging the character and supremacy of who God is as well as why He deserves to be praised is an act of worship. This kind of worship is modeled by Augustine for the reader and as a result reflects particular theological underpinnings in the way Augustine approaches God and thinks about Him. The question I want to explore further in this paper is: in what ways does Augustine’s view of beauty influence his understanding of God in relation to the Christian life in his Confessions?

Augustine’s sincerity in his Confessions affords him the ability to express questions to God in such a way that his transparency gives the reader room to consider why and how he thought as he did and if we also think or feel as he did. Consequently, we are in a way, invited to participate in Augustine’s journey, which makes the answerability of the above question all the more important for us as Christians. We have an opportunity to learn from Augustine’s past and personal struggles. It might challenge us to ask of ourselves if we have been complicit with a secular way of thinking about beauty in relation to God. We might also learn from the kind of intimacy Augustine has with God which demonstrates that our confidence may rest in the free gift of salvation from the God who lovingly pursues his children. Augustine phrases it this way, “You, my God, you it was who dealt so with me; for our steps are directed by the Lord, and our way is of his choosing. What other provision is there for our salvation, but your hand that remakes what you have made?” [2]

Until Augustine’s conversion—which we are privileged to read about nearly halfway through his Confessions—Augustine develops three themes that he consistently wrestles with, which in turn causes the reader to ask the following questions. Firstly, Augustine is unsure of what the nature of a human being is. Is man good or evil? Can man save himself by living in a particular way? Secondly, Augustine’s sensual experience with creation and beauty manifests within him desires to experience as much as possible (i.e. carnal pleasure). What is the nature of creation? In what ways is man similar to or distinct from creation? Why are there things that are beautiful and does that beauty mean anything? Thirdly, Augustine is unsure of what to do with the idea of God. Through Neoplatontism he would be able to philosophically construct a being called God, yet whether that God is personal or Creator is something that he would not reach clarification on until he reads Scripture. This in turn causes the reader to ask: in what ways does God reveal himself in Scripture? In creation? In beauty? In man? These three themes fit into a larger struggle to which I will refer to as Augustine’s internal-external dilemma. Roy W. Battenhouse, editor of A Companion to the study of St. Augustine, offers the following explanation:

The philosophical path that Augustine himself wishes to follow is clearly modeled upon the Neoplatonic ascent from the multiplicities of the material world to particular instances of rationality, thence to a contemplation of Reason itself, and — beyond all — to a vision of the Source of all. […] When properly understood, however, the life of reason permeates all the arts of man. […] In one of its efforts to ascend from particular instances of beauty to the Beauty which they symbolize, reason begets poetry. [3]

Augustine wants desperately for the world to make sense rationally, something that proves to be difficult as he works through the doctrines of Manichaeism, which claims that the material world is evil. However, pre-conversion Augustine is curious by what he sees; he delights in the beauty found in the material world, not realizing that carnal pleasure from these things were corrupting his thinking about God (see Book IV, chapters 15 and 24). It’s as if Augustine’s internal-external dilemma creates a kind of friction in his thinking about beauty. On the one hand beauty seems to point to something beyond itself. On the other, he is not able to fully grasp what beauty is. Consider Augustine’s reflection below:

[…] In Love with beautiful things below me, I was plunging unto the depths. To my friends I would say, “Do we love anything save what is beautiful? And what is beautiful, then? Indeed, what is beauty? What is it that entices and attracts us in the things we love? Surely if beauty and loveliness of form were not present in them, they could not possibly appeal to us.” [4]

In Book 5, Augustine parallels Romans 1 when he chides secular philosophers for distorting truth and worshiping creation rather than the Creator. I submit that Augustine’s theology of beauty begins to overshadow his introspective-reflection and eventually comes full circle as he thinks through his conversion. Commenting on Augustine’s earlier works Carol Harrison in her book, Beauty and Revelation In The Thought of Saint Augustine, makes the following observation:

The implications of these ideas on Augustine’s aesthetics cannot be overestimated: since beauty (forma/formosus) is thus inseparable from existence given by and orientated towards God, the whole of the Christian revelation—in God’s formation of Creation, His image or form in man, His forming and ordering of history and an aspect of beauty which is at once immanent within the temporal, mutable realm, but which yet belongs to and originates in transcendent Divine Beauty. […] The synonymity of existence, goodness, and beauty which Augustine’s idea of forma implies is obviously, in part, anti-Manichean. [5]

Divine beauty would haunt Augustine as he wrestled with man’s relationship to creation and in turn man’s relationship with God. As he reflects on his past, Augustine makes reference to a few books he wrote entitled The Beautiful and the Harmonious, dedicated to a man from an orator in Rome, named Hierius. Augustine’ desire to win the approval of Hierius was in part his motivation for writing these books, however Augustine also provides another reason, “But I continued to enjoy turning over in my mind the question of the beautiful and the harmonious about which I had written to him; I considered it with a contemplative eye and admired it, although no one shared my appreciation.” [6] As he continues his reflection he comments, “I did not yet see that the whole vast question hinged on your artistry, almighty God, who alone work wonders.” [7] Lastly in the same stream of thought he concludes:

I was about twenty-six or twenty-seven when I wrote those volumes. The materialistic images on which I was speculating set up a din in the ears of my heart, ears which were straining to catch your inner melody, O gentle Truth. I was thinking about the beautiful and the harmonious, and longing to stand and hear you, that my joy might be perfect at the sound of the Bridegroom’s voice, but I could not, because I was carried off outside myself by the clamor of my errors, and I fell low, dragged down by the weight of my pride. No joy and gladness from you reached my ears, nor did my bones exult, for they had not yet been humbled. [8]

There is something about the grandiose nature of creation that lends to thinking about it in ways that are greater than ourselves. In the above quotes Augustine readily admits that he was thinking about beauty incorrectly, not attributing to the God who created it and as a result trading joy in the Lord for the weight of pride. I submit that Augustine does not fault creation for his lack of inward resolution, rather he brings with himself a particular way of approaching creation, which hinders his ability to perceive God as Creator. After conversion Augustine would reconstruct how man should see beauty in relation to God. Carol Harrison phrases it this way, “Man’s attitude to Creation, Augustine observes, should therefore be dictated by the order he finds there; since it is divine ordained, it will lead him who follows it to God, its Creator and orderer.” [9]

Treating beauty as if it were a kind of road map to God or like a mirror that reflects God in some is not entirely unique to Augustine. It would be somewhat of an injustice to not mention that Augustine has read Plotinus, who claims that symmetry and harmony of material forms are a reflection, as Harrison points out in her chapter on Augustine’s earlier writings. [10] For Augustine this reflection is deeply personal and not just purely an abstraction. The significance of creation and God as Creator, lies in what He communicates in and through his creation. In book 5.1.1 Augustine claims that creation never tires of praising God. [11] Later, in book 10.6.8, Augustine says, “I love you, Lord, with no doubtful mind but with absolute certainty. You pierced my heart with your Word, and I fell in love with you. But the sky and the earth too, and everything in them —all these things around me are telling that I should love you […].” [12]

There are two things we gain from Augustine’s view of beauty in creation so far. Firstly, beauty has a divine purpose, as it is divinely created. That purpose is to direct our gaze to God, the Creator and worship Him, not the creation itself. Additionally, creation celebrates the glory of God, by praising God intrinsically. Secondly, human beings were not created to worship the creation. We see this in book 5, as Augustine continues to chide the philosophers for they way they approach the creation:

This in turn leads them into an extreme of blind perversity, where they will even ascribe to you what is theirs, blaming you, who are Truth, for their own lies, and changing the glory of the incorruptible God into the likeness of corruptible humans, or birds or four-footed beasts or crawling things. They distort truth into a lie, and they worship and serve the creature instead of the creator. [13]

Augustine is evidently leaning on Romans 1:21, where Paul, in the prior two verses states, “For what can be known about God is plain to them, because God has shown it to them. For his invisible attributes, namely, his eternal power and divine nature, have been clearly perceived, ever since the creation of the world, in the things that have been made. So they are without excuse” (Romans 1:19-20, ESV). There is no doubt from what has been covered so far that Augustine desires to communicate the dangers of looking at the world through a lens that does not account for a Creator. Augustine’s own testimony reaches into his internal-external dilemma, prior to conversion, and exposes his own blindness by recognizing that Truth itself had to replace his faulty thinking by rescuing him out of a self-made worldview. At the risk of being reductionistic, I submit that for all Augustine’s philosophical training and Manichean influences, his overall struggle was between worshiping the creation rather than the Creator.

As I near the end of this paper, I want to focus on what it looks like for Augustine to worship the Creator through the beauty of Creation. Augustine makes two profound statements regarding his conversion, which is contextualized around his need of strength and enjoyment of God. The first quote comes from book 7, at a point where Augustine is looking at creation. He makes the following statement:

And then my mind attained to That Which Is, in the flash of one tremulous glance. Then indeed did I perceive your invisible reality through created things, but to keep my gaze there was beyond my strength. I was forced back through weakness and returned to my familiar surroundings, bearing with me only a loving memory, one that yearned for something of which I had caught the fragrance, but could not yet feast upon. [14]

Seeing God through creation created “a loving memory” that he longed to find again, if only he had the strength to rest in that state. The second quote shortly thereafter follows the one above. Augustine says, “Accordingly I looked for a way to gain the strength I needed to enjoy you, but I did not find it until I embraced the mediator between God and humankind, the man Christ Jesus, who also is God, supreme over all things and blessed for ever.” [15] Notice that Augustine says he looked for “strength” in order that he might “enjoy” God.

When we link the “loving memory” of perceiving God through creation to his finding “strength” in Jesus Christ—his savior—to enjoying God we are given a glimpse into what it means for Augustine to look through creation, to its Creator and ultimately to his Redeemer. Keep in mind that we humans are a part of God’s creation and once redeemed there all kinds of new possibilities at hand when it comes to participating in creation, and in a sense, demonstrating through our actions who God is to others. Explaining Augustine’s response to beauty in creation, Carol Harrison makes the following comment:

It is in the praise, awe, jubilation, and love of the Psalmist that Augustine finds a suitable response to the beauty of Creation. The psalmist, he comments, thereby becomes the voice of a mute Creation praising its Creator, and this through the month of a fallen man, who is in turn brought to acknowledge his Creator. He expresses these ideas succinctly in Confessions, ‘Let your works praise You that we may love you, and let us love You that Your works may praise You.’ [16]

Augustine’s play on words near the end of the quote reveals something about Augustine’s inner change. The internal-external dilemma that he consistently reveals to us as he struggles with his identity before God no longer cultivates a barrier in relation to the purposes of creation. In this way, creation cannot be properly understood apart from God, nor beauty, nor our purpose for existing. Augustine came out of a kind of narcissistic pride, where he reveled in carnal pleasure and deeply struggled with how to discern what was truth. In was not until he was saved by Truth itself that his eyes were opened and freed from the pains of living for himself.

Augustine knew he needed to covert when he read the following passage, “Let us walk properly as in the daytime, not in orgies and drunkenness, not in sexual immorality and sensuality, not in quarreling and jealousy. But put on the Lord Jesus Christ, and make no provision for the flesh, to gratify its desires” (Romans 13:13-14, ESV). He was in a garden wrestling with questions and doubt, but when he read this verse it struck him at the core of his heart. The translator, Maria Boulding, in the Kindle Edition of the Confessions, makes the following statement, “Since Book VII the central issue for Augustine has been acceptance of Christ; this now crystallizes into the “putting on” of Christ in baptism, sacramentally symbolized by the clothing in the new robe.” [17] I submit that this revelation from Scripture functioned as the keystone for an entirely new modus operandi for Augustine. By “putting on” Christ, Augustine was able to understand his need for salvation what it meant to live in a way that reflected this redeemed life. He would never encounter beauty the same way, as if looking through a window he will be able to see the Creator as the one that creates and sustains life.

I have presented evidence to show that Augustine had three primary areas of struggle: man, creation, and God. Throughout his Confessions, Augustine intertwines these thematically, each with their own sets of concerns and frustrations, hindered by a stubborn heart fueled by lusts and carnal desires. Augustine was in love with creation and created things, he looked for hope in Manichaeism, solidarity in the company of philosophy, and joy in his own intellectual endeavors. Yet, he was not at peace until he surrendered himself to Christ. It was only then that he could delight in the Lord and discover the pleasure of God’s presence echoed by creation and manifested in Scripture.

Augustine’s Confessions offer to us a glimpse into a man who has been radically changed, renewed, and re-directed. His love of Christ permeates his writing and is a tribute to the personal and loving God we worship. We learn from Augustine that beauty should inspire us to worship the Lord and recognize it as something God created to echo his glory on earth. This means we have no room for complacency. We are missing something that is deep, true, and wonderful if we fail to see that the Creator of the universe has made us in his image, yet sinful, but also saved, having “put on” Christ. This means the Redeemer and the light of truth is able to shine through us to others and then back to himself, making us walking and talking beacons of God’s love and mercy. Because of Christ, we have the opportunity to participate in God’s creation in such a way that when we obey Christ, worship Christ, and delight in Christ we demonstrate the beauty of Christ to the world. Living in this way is an act of worship.

Endnotes

  1. Saint Augustine, The Confessions (New York: Vintage, 1998), 3.
  2. Ibid, 84.
  3. Roy W. Battenhouse, Companion to the Study of St. Augustine (Cambridge: Baker Book House, 1979), 105.
  4. Saint Augustine, The Confessions (New York: Vintage, 1998), 67.
  5. Carol Harrison, Beauty and Revelation in the Thought of Saint Augustine (Oxford: Oxford University Press, USA, 1992), 39. There appears to be a typo in the quote. The continuity of the text seems to flow better once the word “yet” is removed.
  6. Saint Augustine, The Confessions (New York: Vintage, 1998), 69. And the previous paragraph.
  7. Ibid, 69.
  8. Ibid, 71.
  9. Carol Harrison, Beauty and Revelation in the Thought of Saint Augustine (Oxford: Oxford University Press, USA, 1992), 23.
  10. Ibid. 5.
  11. Saint Augustine, The Confessions (New York: Vintage, 1998), 75.
  12. Ibid. 201.
  13. Ibid. 78-79.
  14. Ibid. 139.
  15. Ibid. 139.
  16. Carol Harrison, Beauty and Revelation in the Thought of Saint Augustine (Oxford: Oxford University Press, USA, 1992), 132.
  17. St. Augustine (2007-04-01). The Confessions (1st Edition; Study Edition) (Kindle Locations 4789-4790). New City Press. Kindle Edition

Bibliography

Augustine, Saint The Confessions. New York: Vintage, 1998.

Battenhouse, Roy W. Companion to the Study of St. Augustine. Cambridge: Baker Book House, 1979.

Harrison, Carol. Beauty and Revelation in the Thought of Saint Augustine. Oxford: Oxford University Press, USA, 1992.

St. Augustine (2007-04-01). The Confessions (1st Edition; Study Edition) (Kindle Location 20). New City Press. Kindle Edition.

Counseling, Techniques

40 Techniques Every Counselor Should Know, A Book Review

This is a Review of the book: 40 Techniques Every Counselor Should Know by Bradley T. Erford (2015).

What I appreciate about this book is its simplistic layout, clarity, and practical descriptions of each of the techniques listed in the book.  For a full list of the techniques covered in the book see the end of this post.  The techniques are grouped together according to their theoretical origins and each theoretical origin has a description of its primary founders and the contextual framework for it’s psychological perspective.

Each of the techniques listed has a section devoted to the origins of that technique, how to implement the technique, an example of the technique (usually in a mock-dialogue format), which is then followed by a section devoted to the usefulness and evaluation of the technique.

In terms of resourcefulness, the book provides a fantastic overview of counseling techniques that would help any counselor be aware of the kinds of techniques counselors may be engaging in.  Whether or not one agrees with the psychological model that provides the contextual framework for a particular technique, it would be helpful to understand the historical and theoretical framework for the techniques counselors use in order that clients who may have experienced some of these techniques with a counselor in the past, feel understood by their present counselor.

The following is the table of contents for this book:

Section 1: Techniques Based on Solution-Focused Brief Counseling

  • Scaling
  • Exceptions
  • Problem-Free Talk
  • Miracle Question
  • Flagging the Minefield

Section 2: Techniques Based on Adlerian or Psychodynamic Approaches

  • I-Messages
  • Acting As If
  • Spitting in the Soup
  • Mutual Storytelling
  • Paradoxical Intention

Section 3: Techniques Based on Gestalt and Psychodrama

  • Empty Chair
  • Body Movement and Exaggeration
  • Role Reversal

Section 4: Techniques Based on Mindfulness Approaches

  • Visual/Guided Imagery
  • Deep Breathing
  • Progressive Muscle Relaxation Training (PMRT)

Section 5: Techniques Based on Humanistic-Phenomenological Approaches

  • Self-Disclosure
  • Confrontation
  • Motivational Interviewing
  • Strength Bombardment

Section 6: Techniques Based on Cognitive-Behavioral Approaches

  • Self-Talk
  • Reframing
  • Thought Stopping
  • Cognitive Restructuring
  • Rational-Emotive Behavior Therapy (REBT): The ABCDEF Model and Rational-Emotive Imagery
  • Bibliotherapy
  • Journaling
  • Systematic Desensitization
  • Stress Inoculation Training

Section 7: Techniques Based on Social Learning Approaches Using Positive Reinforcement

  • Premack Principle
  • Behavior Chart
  • Token Economy
  • Behavior Contract

Section 9: Techniques Based on Behavioral Approaches Using Punishment

  • Extinction
  • Time Out
  • Response Cost
  • Overcorrection