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  #1  
Unread February 16th, 2005, 10:03 AM
James Pretzer James Pretzer is offline
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Default Multimodal Therapy case study available on-line

A new on-line journal, "Pragmatic Case Studies in Psychotherapy" is a free, online, peer-reviewed, multi-theoretical journal that "focuses on systematically and thickly described case studies". The first edition features a case study by Arnold Lazarus.

The journal and Lazarus' case study can be found at http://pcsp.libraries.rutgers.edu/

The Case of "Ben": A Flexible, Holistic Application of Multimodal Therapy

Arnold A Lazarus, Independent practice, The Lazarus Institute, Rutgers University


Abstract
"Ben," a white, male executive who was 50 years old at the beginning of therapy, presented with anxiety, depressive mood, anger, and relationship and career problems. The case, involving therapy in a private practice setting, illustrates some of the diverse individual client needs, life complexities, and accompanying twists and turns that can emerge in treatment. While grounded in a cognitive-behavioral framework, the "Multimodal Therapy" model employed in Ben's case is designed to be responsive to such challenges by drawing procedures from other traditions, when necessary, within the framework of a "technical eclecticism." In addition, the case illustrates attempts within the multimodal model to balance science versus artistry, and planned structure vs. creativity and flexibility.


Citation
Lazarus, A. A. (2005). The Case of "Ben": A Flexible, Holistic Application of Multimodal Therapy. Pragmatic Case Studies in Psychotherapy [Online], Vol. 1(1), Article 1. Available: http://hdl.rutgers.edu/1782.1/pcsp1.1.46

Note: This forum would be a very appropriate place for questions and discussion about the case study.
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  #2  
Unread May 2nd, 2005, 09:50 AM
JustBen JustBen is offline
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Default Re: Multimodal Therapy case study available on-line

The PCSP is a fantastic idea, and I hope it doesn't go the way of Prevention and Treatment. I'm a little concerned that we're still only seeing a single case study on the site, but I can't seem to find a publishing schedule so it's hard to know whether that's really a bad sign or not.

When I first started reading about the various approaches to therapy, I was searching mainly for differences -- in other words, what makes these approaches distinct? The more I read, however, the more obvious the similarities became. It's remarkable how many popular approaches recognize the same facets of human existence. The primary difference is in which of these facets can/should serve as "access points" for intervention.

For example, I don't think a Reality Therapist would quibble too much with Lazarus's "BASIC I.D." schema as a way of conceptualizing the client -- but he or she would insist that Action (or "Behavior" in BASIC I.D. terms) is the primary (only?) access point for change. A CBT therapist would expand that to include an access point for cognition as well as behavior. A Gestalt therapist would probably declare emotion (or "affect" in Multimodal terms) as the primary access point.

What seems to set Multimodal Therapy apart is the idea that all of these aspects (behavior, affect, sensory experience, interpersonal, cognition, imagery and biological) can be access points. In execution, however, the real differences between Multimodal and Cognitive therapy seem fairly minimal - at least after the initial assessment is completed. Is it possible that differences in terminology make these two theories seems more different than they actually are?

For example, isn't it fair to say that a Cognitive therapist's conception of "cognition" would also include what Lazarus calls "imagery"? (Perhaps more importantly, is it clinically useful to seperate the two into distinct categories?) Is "interpersonal" truly an independent "mode", or is it just a superset of behavior (talking with others, embracing them, etc.) and the cognition associated with that behavior?

Another aspect of multimodal that seemingly seperates it from CBT is the enthusiastic embrace of "technical eclecticism". In reality, however, the disciplines from which Multimodal therapists seem to draw are mostly cognitive and behavioral. As for the occasional Gestalt and Rogerian technique, that seems to be pretty common among Cognitive therapists as well.

At the risk of making this post ridiculously long, another idea that strikes me is the "relationship flexibility" of the Multimodal therapist -- an attempt is made to determine what kind of therapist the client wants (i.e. very warm and "soft", or "all business", etc.) and to adjust the clinical style appropriately. A couple questions: does CT have an "official" clinical style? Does anyone out there adjust their clinical style radically from client to client, and does this present any problems for them?
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  #3  
Unread May 9th, 2005, 09:49 PM
James Pretzer James Pretzer is offline
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Default CT's "Official" Clinical Style

You asked "does CT have an 'official' clinical style?"

I guess it does. If you take a look at items 14-18 of the version of the "Competency Checklist for Cognitive Therapists" in Appendix A of Cognitive Therapy of Depression, you'll see what could be argued to be the "official" stance on the therapeutic relationship in CT. It emphasizes genuineness, warmth, accurate empathy, professionalism, and rapport. Of course, many other approaches to psychotherapy emphasize the same aspects of the therapeutic relationship.

Another aspect of the "official" clinical style which is more specific to CT is what Beck calls "collaborative empiricism." Therapist and client/patient work together toward mutually agreed-upon goals, working together to collect the observations needed to test dysfunctional cognitions and come up with more adaptive alternatives, to find more effective ways to cope with problem situations, and to find adaptive ways to deal with problematic emotions.

Of course we adjust our therapeutic stance in response to the needs and preferences of the client but we don't abandon genuineness, warmth, empathe, professionalism, rapport, or collaborative empiricism in the process.

For other perspecitves on this issue, see my summary of Jesse Wright and Denise Davis' article on this topic (in the archives at http://www.behavior.net/forums/cogni...96/msg121.html) and Ellis's thoughts on the characteristics of effective therapists (in the archives at http://www.behavior.net/forums/cogni...96/msg128.html).
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  #4  
Unread May 28th, 2005, 11:55 AM
Gisela Betina Gisela Betina is offline
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Wink Re: Multimodal Therapy case study available on-line

I am a new therapist in this country.
I am a Psychoanalisist Psychologist from South America, and now I just needed to complete two courses in order to become a Marriage and Family Therapist. I am eager to continue educating my self and I want to know what are the main theorethical approaches used in California. Another question is what is the general opinion in regards to Psychoanalisis? Is it accepted or it lacks of prestige?
Thank you for any comment!
Gisela C.
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  #5  
Unread May 31st, 2005, 08:58 AM
JustBen JustBen is offline
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Default Re: Multimodal Therapy case study available on-line

Gisela, I'm not sure what this message has to do with the topic of the thread, but here goes: I can't speak specifically to California, but in the U.S. as a whole, the cognitive-behavioral approach seems to dominate. I can't offer any statistics, but my experience tells me that there are more CBT-oriented therapists/counselors than any other approach, there is more being researched and written about in CBT than any other approach, and CBT generally has greater acceptance among HMO's and insurance companies than any other approach. (Someone can jump in and correct me if I'm off base here.)

As far as psychoanalysis goes, I'm not sure I know how to answer that question. I think it lacks prestige among many practicing psychotherapists due to its lack of research support and the non-scientific nature of many of its claims, but the public as a whole still views it favorably thanks to its frequent portrayal in movies, television shows, and books.
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