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Therapist's Guide to Clinical Intervention - Sigmund Freud

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140 2. Assessing Special Circumstances<br />

B. Behavior<br />

1. Stress reaction<br />

a. Avoidance (identify full range for developing hierarchy)<br />

b. Cries for help (decreased functionality)<br />

c. Isolation<br />

d. Self-defeating behaviors<br />

C. Thoughts<br />

1. Subjective experience<br />

2. Irrational thinking<br />

3. Dis<strong>to</strong>rtions of reality<br />

4. Negative self-talk<br />

5. Fear of losing control<br />

D. Feelings<br />

1. Helpless<br />

2. Overwhelmed<br />

3. Fearful<br />

4. Vulnerable<br />

2. Maintaining fac<strong>to</strong>rs (interfere with progress)<br />

A. Avoidance<br />

B. Cognitive fac<strong>to</strong>rs, thoughts of dangerousness of phobic stimulus<br />

1. Doubting the value of treatment<br />

2. Doubting one's ability <strong>to</strong> follow through on treatment<br />

decisions<br />

C. Presence of generalized (heightened) anxiety<br />

1. Associated depression (dysthymia)<br />

D. Possible underlying fear associated with overcoming the phobia<br />

1. Secondary gain<br />

2. Security associated with what is known eliminated, thereby<br />

increasing distress<br />

3. Would other problems develop?<br />

3. Existing coping skills<br />

A. Methods of coping previously employed (may be helpful in<br />

treatment)<br />

B. Use of substances (alcohol/tranquilizers)<br />

C. What has been tried in an effort <strong>to</strong> overcome phobia?<br />

4. Resources<br />

A. Hobbies<br />

B. Sources of pleasure<br />

C. Sources of success<br />

D. Helpful and caring family and friends<br />

E. Community resources<br />

F. Personal characteristics (persistent, sense of humor, intelligence, etc.)<br />

5. Suitability for treatment<br />

A. Most cases improve with treatment<br />

B. Potential for noncompliant fac<strong>to</strong>rs<br />

1. Severe depression<br />

2. Substance dependence<br />

3. Personality disturbance<br />

> Requires prior treatment intervention

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