Thursday, November 1, 2007

Multimodal Therapy - Chapter 11

My Lecture Notes.
Current Psychotherapies.
Multimodal Therapy.
Author: Arnold Lazarus.

Instructor: Jeff Garrett Ph.D.


Twenty Things You Need to Know About Multimodal Therapy
1. Multimodal therapy was developed by Arnold Lazarus.
2. The underlying principle of multimodal therapy is the necessity of individually tailored treatments.
3. A therapist's ability to use different treatment modalities without subscribing to their theoretical bases is called technical eclecticism.
4. The primary question a multimodal therapist asks is "Who or what is best for this particular individual?"
5. Deliberately tuning into a client's preferred modality initially is known as bridging.
6. Examining the firing order of a client's different modalities is termed tracking.
7. A structural profile in multimodal therapy is obtained by having patients complete likert scale ratings across BASIC I.D..
8. Lazarus describes thoughts outside of self awareness as nonconscious.
9. A structural profile in multimodal therapy is obtained by having patients complete likert scale ratings across BASIC I.D.
10. The principle of reciprocal determinism implies that thoughts mediate between stimuli and behavior.
11. Processes used to defend the individual against painful emotions would be termed by Lazarus as defensive reactions.
12. A multimodal therapist is best viewed as a trainer.
13. The nonjudgmental demeanor of a therapist is most readily linked with which BASIC I.D. area of affect.
14. Pre to post structural profiles are likely to change the most for depression.
15. In multimodal therapy, transference and countertransference issues are only addressed if problem arises.
16. Multimodal therapy is generally focused on being Psychoeducational and uses techniques which are eclectic.
17. Arnold Lazarus refers to the BASIC ID. These initials stand for Behaviors, affective responses, sensory reactions, images, cognitions, interpersonal relationships, and drugs and biology.
18. Lazarus is credited with coining the terms Behavior Therapy and Behavior Therapist.
19. Lazarus reports treatment relapse rates of less than 5%.
20. Multimodal therapy views all the modalities as crucial and believes they exist in a state of reciprocal transaction.

Basic Concepts.

Approach is largely psychoeducational and eclectic in nature.
Techniques used are theoretically consistent.
Based on social learning, general systems and group and communications theories.
Focuses on seven discrete but interactive modalities.
All modalities are crucial and exist in a state of reciprocal transaction/flux.
Successful treatment occurs when all modalities are addressed.
Multimodal Life History Inventory (Lazarus & Lazarus, 1991) administered to assess client in each modality.

BASIC I.D.

1. Behaviors.
2. Affective responses.
3. Sensory reactions.
4. Images.
5. Cognitions.
6. Interpersonal relationships.
7. Drugs and other biological interventions.

General Orientation is “Bespoke Therapy”.
Who or what is best for this particular individual?
· Bridging is the therapeutic procedure of tuning into the client’s preferred modality before branching towards other modalities.
· Tracking refers to a careful examination of the firing order of the different modalities.

Distinctive Features of Multimodal Therapy.
· Specific and comprehensive attention given to the entire BASIC ID.
· Use of second-order BASIC ID assessments.
· Use of modality profiles.
· Use of structural profiles.
· Deliberate bridging procedures.
· Tracking the modality firing order.

Comparing Multimodal Therapy to Other Systems.

The Multimodal therapist is not concerned with theoretical orientation, but rather asks: What works, for whom, and under what particular circumstances?
Multimodal therapy shares more in common with other approaches than differences.
All approaches advocate respect of the client.
Conflict resolution necessary for success.
Multimodal therapy integrates eclectic approaches in a theoretically thoughtful manner.
Approach draws significantly on cognitive and behavioral approaches because of their coping emphasis.

The Multimodal Position.
“The aim of MMT is to come up with the best methods for each client rather than force all clients to fit the same therapy. … Three depressed clients might be given very different treatments. … The only goal is helping clients make desired changes as rapidly as possible.” Zilbergeld.


History.

Hippocrates discussed human personality as mulitilayered.
Galen and Dubois also had multimodal views of humans.
MMT overlaps with the theory of functionalism offered by William James.
Arnold Lazarus earned his Ph.D. in clinical psychology from the University of Witwatersrand, Johannesburg, South Africa.
Worked 6 years in private practice and then emigrated to the U.S..
Taught at Standford University, Temple University Medical School, Yale University, and Rutgers University.
In 1958 Lazarus introduced the terms behavior therapy and behavioral therapist.
In 1965 Lazarus writes a paper on multimodal approach to alcoholism.
Over time Lazarus becomes a stronger proponent of a broad based approach and advocated against “narrow-band behavior therapy”.
At Rutgers Lazarus is a Distinguished Professor of Psychology (since 1972) and teaches in the Graduate School of Applied and Professional Psychology.

Current Status.


Formal training in MMT is offered at Rutgers and there are several MMT Institutes in the U.S. and one in London.
MMT approach is being studied internationally.
Numerous publications are available on the topic.

Multimodal Therapy View of Personality.

Humans are the product of genetic endowment, their environment and social learning.
Humans respond to their perceptions rather than to reality.
Perceptions are based on what is attended to.
New experiences create change.
Each individual reacts to the demands of the environment based on their individualized personal response pattern.
Psychopathology occurs when there is inflexible response patterns or response patterns that become conditioned in a maladaptive order.
At the physiological level the concept of thresholds is critical.
Individuals favor certain modalities over others.
An individual’s preferred modalities can be mapped into structural profiles on a 35-item. Structural Profile Inventory (SPI).
Multimodal Life History Inventory developed in Lazarus & Lazarus (1991) is a 15 page inventory administered to assess clients in each modality as the questionnaire assess antecedents, current problems and maintaining factors.

Multimodal Psychotherapy.
Addresses issues by intentionally introducing functional associations.
Modeling and vicarious learning are used to alter the firing order of modalities.

Examples of Treatment Techniques across BASIC ID.

Behaviors.
· Extinction.
· Counter-conditioning.
· Positive reinforcement.
· Negative reinforcement.
· Punishment.

Affective responses.
· Abreaction.
· Owning and accepting feelings.

Sensory reactions.
· Tension release.
· Sensory pleasuring.

Images.
· Creating coping images.

Cognitions.
· Cognitive restructuring.
· Awareness.

Interpersonal relationships.
· Modeling.
· Dispersing unhealthy collusions.
· Paradoxical maneuvers.
· Nonjudgmental acceptance.

Drugs and other biological interventions.
· Medications.
· ECT.


Application of MMT.

Treatment and prevention.
Classroom.
Childcare agencies.
Parent training.
Institutional settings.
Community disasters.

1 comment:

Michele and John said...

Great explanation of this theory. In my practice, I frequently use a multimodal approach and feel that it is more able to be adapted to client needs.