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284 PART IV: Applied Researcharticles “because” she could not remember themwell enough. She often felt that she could notunderstand what was being said in a conversationand that this was due to her low intelligence.She attempted to hide her lack of comprehensionby adopting a passive role in these interactionsand was fearful lest she be discoveredby being asked for more of a response. She didnot trust her own opinions and, indeed, sometimesdoubted whether she had any. She feltdependent on others to provide opinions for herto adopt.Administering a Wechsler Adult IntelligenceScale (WAIS), I found her to have a verbal IQof about 120, hardly a subnormal score. Herdigit span indicated that at least her short-termmemory was not deficient. The test confirmedwhat I had already surmised from talking withher: that there was nothing wrong with her levelof intelligence or her memory. After discussingthis conclusion, I suggested that we investigatein greater detail what kinds of things she wouldbe able to do if she felt that her memory, intelligence,and level of self-confidence were sufficientlyhigh. In this way, we were able to agreeupon a list of behavioral goals, which includedsuch tasks as stating an opinion, asking for clarification,admitting ignorance of certain facts, etc.During therapy sessions, I guided Susan throughovert and covert rehearsals of anxiety-arousingsituations . . . structured homework assignmentswhich constituted successive approximations ofher behavioral goals, and had her keep records ofher progress. In addition, we discussed negativestatements which she was making to herself andwhich were not warranted by the available data(e.g., “I’m stupid”). I suggested that whenevershe noticed herself making a statement of thissort, she counter it by intentionally saying moreappropriate, positive statements to herself (e.g.,“I’m not stupid—there is no logical reason to thinkthat I am”).During the fifth session of therapy, Susan reportedthe successful completion of a presumablydifficult homework assignment. Not onlyhad she found it easy to accomplish, but, shereported, it had not aroused any anxiety, evenon the first trial. . . . It was at this point that thenature of the therapeutic relationship was altered.During future sessions, Susan rated her progressduring the week, determined what the next stepshould be, and devised her own homework assignments.My role became that of a supervisorof a student therapist, reinforcing her successesand drawing attention to factors which she mightbe over looking.After the ninth therapy session, direct treatmentwas discontinued. During the followingmonth, I contacted Susan twice by phone. Shereported feeling confident in her ability to achieveher goals. In particular, she reported feeling a newsense of control over her life. My own impressionsare that she had successfully adopted a behavioralproblem-solving method of assessment andhad become fairly adept at devising strategies foraccomplishing her goals.Follow-upFive months after termination of treatment, I contactedSusan and requested information on herprogress. She reported that she talked more thanshe used to in social situations, was feeling morecomfortable doing things on her own (i.e., withouther husband), and that, in general, she no longerfelt that she was stupid. She summarized by saying:“I feel that I’m a whole step or level abovewhere I was.”I also asked her which, if any, of the techniqueswe had used in therapy she was continuing to useon her own. . . . Finally, she reported that on atleast three separate occasions during the 5-monthperiod following termination of treatment, she hadtold another person: “I don’t understand that—will you explain it to me?” This was a responsewhich she had previously felt she was not capableof making, as it might expose her “stupidity” tothe other person.Three months after the follow-up interview, Ireceived an unsolicited letter from Susan (I hadmoved out of state during that time), in which shereminded me that “one of [her] imaginary exerciseswas walking into a folk dancing class andfeeling comfortable; well, it finally worked.”**Source: Kirsch, I. (1978). Teaching clients to be their owntherapists: A case study illustration. Psychotherapy: Theory,Research, and Practice, 15, 302–305. (Reprinted by permission.)