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Positive Psychology focuses on the strengths and virtues that enable individuals and communities to cope and thrive, especially in times of stress and upheaval. Using this approach, clinicians help clients become more resilient and hopeful and find meaning and joy in their lives.
Cinema Therapy is an innovative therapeutic modality that uses clients' experiences with popular movies for the therapeutic process. It is an approach that lends itself well to be integrated into positive psychotherapy.
Our new online course is designed to help clinicians attend to the pressing issues of our time: Positive Psychology and the Movies: Transformational Effects of Movies through Positive Cinema Therapy.
Positive Cinema Therapy offers a powerful tool to help clients recognize latent resources that can be very effective in coping with the current crises.
- Films that are effective in this approach can be dark and intense, as they drive home important issues of the struggle of human suffering, and the painful acceptance of reality.
- Many movies follow the pattern of the mythological Hero's Journey. Despite initial resistance, the hero has to fight and overcome challenges and experiences an inner transformation in the process.
- Films and Positive Psychology can help us change our priorities by defining what is important, necessary, essential, and sustaining in contrast to what is unnecessary, frivolous or lacking in essential quality.
- By bringing our focus toward our virtues and strengths, we learn to appreciate what we have, and what can never be taken away from us and our clients, even during challenging times.
Positive Cinema Therapy uses movies that are entertaining and deeply engaging as therapeutic resources. For instance:
- Films like Places in the Heart or Where the Heart Is can help clients evaluate priorities, struggle with anxiety, and find and develop needed courage.
- Creativity and perspective are also important to prevail over challenges. They are demonstrated in Billy Elliott, The Piano, and Dead Poets Society.
- Persistence can be learned by watching A Beautiful Mind, I Am Sam, Lorenzo's Oil, or Seabiscuit.
- Hope is conveyed through such movies as It's a Wonderful Life, The Other Sister, or The Shawshank Redemption.
- Blessing and opportunity in crisis as well as the value of deep human connection are presented in movies like Kolya or In America.
The course, Positive Psychology & The Movies: Transformational Effects of Movies through Positive Cinema Therapy teaches how to develop clinical interventions by using films effectively in combination with positive psychotherapy. This course will:
- Review Positive Psychology, Positive Psychotherapy, and Positive Cinema Therapy.
- Define criteria for choosing movies.
- Select appropriate positive psychotherapy exercises and films.
- Explain Positive Cinema Therapy techniques
- Provide extensive resources
A basic course on Cinema Therapy for 4 CE credits.
Movie Lover Package of five courses for 25 CE credits. (Please note: this package does not include the new Positive Psychology & The Movies course.)
Clinical Update, December 2008
Power in Psychotherapy & Counseling
How powerful are we as therapists?
What is power in therapy?
What are the different faces of power?
Who has the power?
Understanding the role of power is essential for our understanding of the political, economic, communal, familial and clinical realms. I am pleased to announce a new, challenging and exciting online course, Power in Therapy. I have enthusiastically worked on the text for this course for several years and, as far as I know, it is the first and most comprehensive course on the topic.
About the new course, Power in Therapy:
- Earns 6 CEUs
- Fulfills the Law and Ethics requirements for California and other states
- For more details, see the course syllabus.
From the first day in graduate school in psychology, we psychotherapists-in-training have been instructed to pay great attention to the "inherent power differential" in psychotherapy. We were taught to be aware of the imbalance of power between therapists and clients, and repeatedly told to never abuse or exploit our vulnerable and dependent clients. When it comes to the psychotherapist-client relationship, the view of power as an attribute possessed exclusively by the psychotherapist has been unchallenged. In our professional newsletters, advice columns on ethics and risk management present a similar unified message about therapists' unilateral power and clients' inherent vulnerability.
Therapists and counselors generally ignore the issue of power and we rarely discuss it among ourselves or with our clients. On the other hand, ethicists, attorneys, and risk-management experts write and discuss it incessantly. All in all, even though power is extremely important and equally complex, it is rarely discussed in a comprehensive and non-simplistic way.
Many psychotherapy or counseling clients are, indeed, very vulnerable. They may be distressed, young, impaired, traumatized, anxious, and/or depressed. However, there are also clients who are high functioning and successful. For instance, many of today's clients (i.e., "consumers") seek therapy to enhance the quality of their lives. They want to improve their relationships or find meaning for their lives. They are neither depressed nor traumatized nor vulnerable.
Types of Power
- Legitimate Power: Designated-legal power
- Expert-Knowledge Power: Knowledge is power
- Professionalism Power: Influence-aura of power
- Positional or Role Power: Professional role
- Imbalance of Knowledge Power: Knowledge of others
- Coercive Power: Forcing one against one's will
- Reward Power: The power to reward or to withhold reward
- Referent Power: The power of admiration
- Manipulative Power: Devious-controlling power
Forms of Power
- Power Over
- Power-With
- Power-Within
The Power in Therapy online course will invite and challenge you to:
- Rethink the power differential assumption in psychotherapy
- Re-evaluate the myth of therapists' omnipotence and patients' fragility
- Examine the idea: "once a client, always a client"
- Examine our doubt as to whether clients, who are CEOs, power attorneys, or . . . therapists, are also always powerless and vulnerable
- Identify different types and forms of power in therapy
- Discuss the complexities of power in therapy
- Review the moral, professional, and ethical implications of the different views and forms of power
You can review the breadth and depth of the course by going to the course syllabus. The online course, Power in Therapy, is offered for 6 CE credits and fulfills the Law & Ethics Requirement for California and other states.
Clinical Update, November 2008
Therapy in Times of Financial Crisis and Despair
I hope you enjoyed your Thanksgiving holiday.
As therapists, many of us have clients who are faced with the grave prospect losing their jobs, homes, or life savings. Many of us, along with millions of people in the US and around the world, are concerned and frightened by the growing economic crisis. In fact, the crisis people are faced with may be much more than economic: many may experience a crisis of faith in our way of living and understanding of our world.
Therapists talk with greater ease about abuse, depression, anxiety or even death and sex than about matters related to money. However, this is NOT the time to avoid the subject of financial health. Avoiding discussions about financial concerns with many of our clients would amount to ignoring the elephant in the room. Such avoidance can be confusing to clients. Worse yet, it is "crazy making" not to address issues that are both emotionally charged and perceived as critical to a client's own survival.
The fact that we, as therapists, may be facing financial crises ourselves and be fearful about our own financial futures, can make it even more difficult to openly face and discuss the issue with our clients.
Following are some thoughts, comments, and suggestions for how to interact with clients regarding the current economic crisis.
General Points:
- Do not avoid the subjects of fear, panic or despair around financial issues if your clients bring it up or if you suspect it is on their minds.
- Remember that people worry about money regardless of how much money they have in savings or how many houses they own.
- Invite clients to express their financial concerns and respond with empathy and compassion.
- Acknowledge your own concerns and fears and, if appropriate, get personal or professional support to help you deal effectively with your own anxieties and despair.
- Many clients can benefit simply from sharing their deepest fears, sense of failure, etc. with an empathic ear.
- Help clients think about the issue in realistic terms by assisting them in differentiating between exaggerated anticipation of doom and more realistic possibilities.
- Money is one of the most potent metaphors of our culture. In fact money, sex, and time rank in the top three.
- Matters of money are often tied to security, self-esteem, identity, power and much more.
- Help clients to understand the power of metaphors and how they are at work, positively or negatively, in times of crisis.
- Do not hesitate to get into the nitty gritty details of your clients' situations.
- Some clients can benefit by making and sharing detailed budgets.
- Help your clients brainstorm about what they can change by cutting or reducing expenditures.
- Refer to financial advisers or accountants if necessary.
- Teach your clients stress management techniques, such as breathing, thought stopping, or taking a break from the tension by watching movies, exercising, or practicing prayer and meditation.
- Introduce them to helpful resources in the community.
- Explore with them their spiritual or religious beliefs to find help in coping with their situation.
- Inquire how the financial crisis may affect their marriages, intimate relationships, or relationships with children.
- Pay attention to suicidal ideation and note premature thoughts of divorce or separation.
- Share with clients your thoughts, feelings, or coping strategies, as clinically appropriate and at your comfort level.
Practice Management:
- It is time to be flexible with clients in regard to fees, frequency of sessions, or even taking a break from therapy. (See online course, Fees)
- Do not hesitate to bring up the issue of whether they can afford therapy or not. If you do not bring it up, they may simply drop out of therapy.
- Be responsive when clients suggest reducing the frequency of visits, seeing you at a reduced fee, or propose a bartering arrangement.
- When clients request a reduced fee, take the time for compassionate negotiation of a sliding scale, if appropriate.
- Some clients are too proud to pay a reduced fee and prefer to reduce frequency of sessions or to barter.
- Some clients may prefer to shift to a cheaper and less time consuming (including driving time) mode of psychotherapy, such as telehealth, where therapy is conducted by phone and/or e-mail. (See our online course on Telehealth.)
- Taking a break may be appropriate with some clients. Most clients do not like being pressured to stay in therapy and will drop therapy anyway. If they see you as caring and flexible, they are more likely to come back. (See online course on Termination.)
- Be cautious with allowing clients, who are already deep in debt, to defer payments.
- Some clients may propose a bartering arrangement. Be open, receptive and thoughtful. (See online course on Bartering.)
- Learn about and teach your clients about the philosophy of intermittent-long-term therapy, where clients come back to therapy at different times and junctions during their lives.
- When clients have suicidal ideation, attend to it appropriately and document your consideration, decision-making, and intervention.
Therapists' Self Care:
- If necessary, get personal or professional support to help you deal effectively with your own financial concerns.
- Practice what you preach and employ stress management techniques that are known to be effective. (See online course on Burnout.)
- Volunteer in ways that will assist the less fortunate. Sponsor food drives, book drives or toy drives. Increase your civic responsibility. Pay it forward.
- Talk to people who will focus on solutions and positive possibilities rather than those who exacerbate your fears and worries.
- If you are so inclined, focus on spiritual practice and community.
Crisis is an Opportunity:
- For many of us, and our clients, the financial, housing and job crises may trigger other emotional, existential, or spiritual experiences.
- When appropriate, work with your clients and yourself on the potential blessing of the crisis. These may vary:
- Deeper appreciation of intimate, loving and community connections.
- Developing better priorities by defining what is important, necessary, essential, and sustaining in contrast to what is unnecessary, frivolous or lacking in essential quality.
- Finding entertainment that costs nothing but brings people into closer relationship with each other. Examples would be playing board games, card games, taking hikes, etc.
- Get into the habit of sharing, borrowing, re-using, and creating rather than buying and contributing to pollution.
- Save for purchases rather than buying on credit.
- Question the consumerist mentality and identity.
- It can be empowering for both therapists and clients to see ourselves not only as innocent victims of greedy Wall Street brokers and deceitful loan officers, but rather as co-contributors to the crisis by the way we consume, live, or vote. In other words, seeing our part in entering a crisis can help us see our way out of it.
Clinical Update, November 2008
"Directive to Protect Mental Health Information": An Essential New Form for Psychotherapists and Counselors
Zur Institute is now offering a simple, short form, Directive to Protect Mental Health Information, developed to help clients secure the confidentiality of their mental health records AFTER clients' deaths.
This Directive is aimed at insuring that, in the event of a client's death, personal information shared in trust during psychotherapy sessions will NOT be revealed to any other person.
Consider the following clinical situations:
- An 88 year old client, who recently suffered two heart attacks and was facing an inevitable-deadly third one, did not want any of his descendants to see his clinical-psychotherapy records. He is a private and rather introverted man.
- A middle aged woman, who underwent therapy to work on issues associated with her multiple extramarital affairs, survived a recent car accident. When we resumed therapy she was concerned that, had she died, this hurtful information could have been open to her husband of 20 years and their children.
- A 25 year old female, who struggled with the shame of sexually compulsive behavior, entered therapy and was immediately concerned about who could see her records if she were to meet with an untimely death. She felt she could not enter treatment without first being assured that her records would be safe.
These cases illustrate the benefit of the new form, DIRECTIVE TO PROTECT MENTAL HEALTH INFORMATION. You may provide the form to new clients at the beginning of treatment when you discuss issues of confidentiality.
5 Ways to Receive the Directive to Protect Mental Health Information Form:
Clinical Update, October 2008
End of Life Issues: How We Live and How We Die
Recently, I have watched a few films exploring a common theme: The Bucket List, The Diving Bell and The Butterfly, and Ghost Town. Clearly, the common theme for these and many other contemporary movies is "how we live and how we die". Or, perhaps "how we view death and how we choose to die determines how we live".
Since I wrote the last Clinical Update on End of Life issues in August of 2007, not only has there been a proliferation of movies about the subject of death but there have been also changes in the business of selling coffins. Costco continues to sell "The Lady of Guadalupe Casket" for $924.99, but the price for "The Mother Casket" dropped from $1,299.99 to $924.99. This very probably reflects the effects of comparison-shopping, as bestpricecaskets.com offers a greater selection and some lower prices than does Costco. Most casket retailers offer rush orders for an extra fee but add the proviso, "Sorry, no returns." With confidence, they add the comforting promise, "Satisfaction is guaranteed", which obviously begs some questions.
As psychotherapists and health care providers, we are in a unique position to help the millions of generally well-to-do Baby Boomers, who are determined to die differently than their parents. Attitudes toward death and dying are drastically changing among this group, whose members tend to be determined to age with more awareness, consciousness. Their goal is not only to live long but to live well. There are many signs that Baby Boomers are also more willing to face death more directly and consciously.
To keep up with the field, we have revised and updated our online course on, End of Life Issues (9 CE Credits).
Complete Online Course Listing.
- In November of this year, 2008, Washington State will be voting on whether or not to legalize assisted suicide. California and Vermont are not far behind and will put this question on the ballot in the near future.
- By the year 2050, people over 85 are expected to make up 24% of older persons and 5% (numbering over 19 million) of the entire population in the United States. Currently, three-quarters of people who die yearly are older adults.
- Older adults want information about advanced directives, palliative and hospice care, and how to die comfortably at home.
- The fears that most older adults express are: 1) fear of pain, 2) fear of being alone at the moment of death, and 3) fear that health practitioners will ignore their last wishes.
- Curative care is disease-specific and restorative in principle. Palliative care is symptom-oriented and supportive in nature. Hospice care is an extension of palliative care and focuses on preparation at all levels (physical, social, emotional, spiritual and economic) for death.
- Euthanasia is a medical treatment in the Netherlands and Belgium and assisted suicide is a medical treatment in the Netherlands, Belgium and Oregon.
- In the United Kingdom, the British Medical Association's ethics committee in May 2006 recommended that doctors end the lives of some patients swiftly, humanely, and without guilt.
- Advanced planning for the dying can be a complex process. Having working knowledge of advanced directives, living wills, durable power of attorney for health care, and the protective medical decisions document is imperative for a clinician who spends time with dying clients. Beyond the legal matters, clinicians have to have clarity regarding their own ethical, moral, and spiritual biases.
Clinical Update, October 2008
Religious & Spiritual Issues in Therapy
Spirituality and religion are deeply important aspects of American culture, discussed well beyond the psychotherapy office. Many individuals are searching for spiritual meaning in their lives. Others seek to deepen and strengthen their current religious or spiritual foundation. Increasingly, clients turn to their therapists for help and guidance, yet many therapists lack the training and experience to deal with these issues.
Our latest online course, Spiritual and Religious Issues in Psychotherapy (4 CE Credits) provides a basis for therapists to prepare to counsel clients with these issues.
Introduction to Religious and Spiritual Issues in Therapy:
- Research has consistently demonstrated a small, but significantly positive, relationship between being religious or spiritual and better psychological health.
- Some spiritual or religious paths promote better psychological health, while others can create barriers to mental health.
- Skilled therapists can help clients identify the positive and negative factors associated with their religious beliefs.
- There are many different ways to integrate religious and spiritual issues into psychotherapy. Different interventions necessitate varying levels of training and supervision.
- Integrating religious and spiritual issues into therapy can create ethical dilemmas that do not typically arise in therapy.
- Religious and spiritual clients often enter therapy for reasons that are different than those of other clients. Some enter therapy to deepen their relationship with God, to become more compassionate, or to better cope with suffering caused by religion.
- Religion and spirituality often interact with cultural diversity. For example, many Eastern religions are practiced very differently in the West, as compared to their Eastern origins. Views of the self, the nature of the good life, and morality may be drastically different across different religious and cultural groups.
Dr. Hoffman, the author of this new course, is an editor/contributor to three books relevant to religious and spiritual issues in therapy: Spirituality and Pschological Health, The God Image Handbook for Spiritual Counseling and Psychotherapy, and Buddhist Approaches to Psychotherapy.
The Spiritual and Religious Issues in Psychotherapy course will teach you:
- Essential ethical issues therapists need to be aware of when dealing with religious and spiritual issues in psychotherapy.
- Various types of religious interventions, and their appropriateness for different clients.
- The varying levels of training necessary for different types of religious and spiritual interventions.
- The implications of religious diversity for psychotherapy.
- Various ways that religious clients may view the role of suffering and the good life.
Clinical Update, August 2008
I love these emails, or do I?
The Use of Emails in Psychotherapy and Counseling
I checked my emails the other day and saw that a client wanted to change his appointment for the following week. I swiftly responded affirmatively. Next I shot an email to a client asking her whether she could change her appointment next Monday from 10 AM to noon. Within seconds she responded with a one-word response, "Yes."
Don't you like these emails? I do! They are simple, quick and effective.
Long gone are the days when we played phone tag with clients. With email, we needn't start the phone conversation with "How are you?", opening ourselves to a long-winded response. We also avoid the time-wasters of getting busy phone lines, being put on hold, and dealing with overworked, low-paid, and sometimes irritated receptionists or operators. As therapists, many of us love the flexibility gained by receiving and sending emails from our computers, Blackberrys, or iPhones. With email, we can communicate during working and non-working hours, from the office, living room, beach, boat, or even from another country: in short, from whenever or wherever. Emails have saved us therapists time and energy so we can focus on what is important.
Then I woke up the other day to a short e-mail from a depressed client: "Doc, I cannot take it any longer!!!!!" I noticed it was sent at 2 AM. Now what am I to do? Send an email, call the patient back, call her listed emergency contact (not a good idea, as her contact happens to be her toxic friend), call the local crisis team or 911, or what? To read more, click "I Love these Emails, or Do I?".
The article is part of an updated Telehealth online course for 6 CEUs which fulfills the law and ethics requirement.
The article, "I Love these Emails, or Do I?", answers the following questions:
- Are emails between therapists and clients considered psychotherapy?
- If I give my email address to my clients, must I check my emails often?
- Does using email with clients mean you must be HIPAA Compliant?
- What about confidentiality and privacy of emails?
- Must emails be encrypted?
- What is an email signature and do I need one?
- If we email to clients, does it mean we are conducting tele-health or e-therapy?
- Are these emails part of the clinical records?
- Can these emails be subpoenaed just like any other chart notes?
- What are the guidelines to using email in therapy?
RELEVANT ONLINE COURSES FOR CONTINUING EDUCATION CREDITS:
Telehealth
Confidentiality
HIPAA Compliance
Record Keeping
Clinical Update, August 2008
Dialectical Behavior Therapy: Achieving a New Architecture in the Borderline Personality Structure
For decades, clinicians who have worked with clients diagnosed with Borderline Personality Disorder (BPD) felt helpless and overwhelmed. No matter what degree or credential clinicians held, or what clinical methods were employed, the diagnosis seemed to present a largely incurable and frustrating condition.
Following Dr. Marsha Linehan's development of Dialectical Behavior Therapy (DBT), many clinicians breathed a collective sigh of relief. Finally, an effective approach to the treatment of this complex Personality Disorder was in hand.
Our newest online course: Dialectical Behavior Therapy (DBT):Treatment for Borderline Personality Disorder (BPD) for 2 CEUs
Dialectical Behavior Therapy is based on Marsha Linehan's Bio-Social theory of Borderline Personality Disorder. Linehan proposed that BPD resulted from the exposure of the emotionally vulnerable individual to an "invalidating environment". Like many trauma survivors, emotionally vulnerable individuals eventually become so biochemically hypersensitive that they produce exaggerated responses to relatively low levels of stress and are unable to return to baseline as quickly as those who are not so emotionally vulnerable. Because those in their primary environments do not validate their experiences, these individuals fail to develop trust in their emotional and physical experience, their decisions, and even about their own intuition. As a result, they do not develop confidence in themselves, nor do they develop coping skills and strategies. They must then seek the aid and assistance of others in order to manage their daily lives.
DBT outlines specific strategies to facilitate the empowerment and eventual independence of the client.
There are four modes of treatment for DBT:
- Individual therapy
- Group skills training
- Group skills training is used to enhance core mindfulness skills, interpersonal effectiveness skills, emotion modulation skills, and distress tolerance skills.
- Telephone contact
- Therapist consultation
Linehan outlines specific stages of treatment and strategies to be used as well as goals to be met within each stage of treatment. Issues or "targets" are prioritized in each stage of therapy and are addressed this way in the treatment setting.
- The Pre-Treatment Stage focuses on assessment, commitment and orientation to therapy.
- The First Stage of treatment focuses on limiting, resolving and avoiding crisis situations. The therapy also addresses suicidal behaviors, therapy interfering behaviors and behaviors that interfere with the quality of life. Techniques for better managing these behaviors are identified during this first stage of treatment.
- The Second Stage addresses issues associated with Post-Traumatic Stress.
- The Third Stage focuses on the development of self-esteem and the identification of individual treatment goals.
The core strategies in DBT are "validation" and "problem solving".
Circumstantial and/or emotional obstacles may inhibit effective problem-solving, even when the individual has learned the required skills. In those instances, additional strategies for management may be required. These may include:
- Contingency management
- Cognitive therapy
- Exposure based therapies
- Pharmacotherapy
The spontaneous provision of telephonic support between sessions is a unique feature of DBT.
Courses related to this topic:
Dialectical Behavioral Therapy for Borderline Personality Disorder for 2 CEUs.
Borderline Personality Disorder for 5 CEUs.
Clinical Update, August 2008
Transporting Confidential Clinical Records on Laptops: A Heads Up for Psychotherapists & Counselors
A more extensive article on the topic is available at Laptop Theft and Confidentiality. Feel free to share this important link with your colleagues or to post it on your favorite listserv, chatroom, or blog.
Increasing numbers of therapists are traveling with their laptops to conferences, vacations, and between homes and offices. Some estimates suggest that a laptop is stolen every minute and most of them are never recovered. Laptops are stolen from cars, offices, and homes and are mistakenly left behind in cabs, coffee houses, hotel rooms, and restrooms. Stolen laptop computers that contain clients' private and confidential information often result in serious breaches of confidentiality.
In one of the few enforcements ever by HIPAA, Health and Human Services, a Seattle home health company, has been recently forced to pay a $100,000 settlement because laptops and disks containing individuals' health records were taken from company employees' cars. The agreement seems to signal that HIPAA is finally taking a tougher stance toward violations, and they may have started to shift from the education approach they have taken so far to an enforcement mode. While laptops are here to stay and theft and breaches of confidentiality cannot be always avoided, there are protective measures that psychotherapists, counselors, and administrators should seriously consider.
A more in-depth study of this topic is offered in the updated Confidentiality Online Course for 6 CE credits, which fulfills the ethics requirement in most states and also includes Office Policies and other forms.
How to Handle Laptops and Laptop Theft (a partial list):
- The use of laptop computers must be addressed in the informed consent process, and potential drawbacks or risks involved must be discussed along with all precautions taken to preserve and protect each counseling client's confidentiality.
- Therapists may inform clients of electronic storage of clinical records via their Office Policies or, when appropriate, in person. (See also Clinical Forms.)
- If you keep electronic clinical records, it means that you are a "Covered Entity" under HIPAA and must be HIPAA compliant. Becoming HIPAA compliant is not difficult. (HIPAA online course for CE credits.)
- Make sure that your laptop has a security password, virus protection, and a firewall.
- Backup, Backup, and Backup. Keep backup disks off-site.
- As required by HIPAA, document your office policies regarding laptop security.
- Treat the laptop like cash in your wallet and never leave it unattended.
- Comply with HIPAA law and monitor others carefully when you let them access your computer or laptop.
- Therapists who use billing programs might want to contact the software company to see if they have any helpful hints regarding security for their product.
- When deleting confidential records from your laptop, you must use special software to wipe the hard drive clean. Unless you are highly technical, get a techie to help you.
- Strictly follow all security procedures each and every day. It just takes one minute away from your laptop, putting it down unattended for 30 seconds, not backing up data just one time, failing to use password protection one time, or letting virus protection software lapse one day to violate clients' trust and your responsibilities to protect and preserve clients' privacy in every reasonably available way.
- Therapists should assess whether or not a stolen laptop only contains confidential clinical information or also includes billing information, which may provide data (social security numbers, for instance) that can be used to steal the identity of any and all patients.
- Extreme, super-diligent and rarely used methods for protecting your laptop may be worthy of consideration (but are not mandatory):
- Encryption, though often recommended, is rarely, if ever, used by psychotherapists and staff in private practice or small clinic settings.
- Physically securing a laptop with a locking cable whenever you are not personally carrying it.
- Visual locks and restraints to secure your laptop and to act as a deterrent.
- Anti-theft software that can track and locate your laptop through the IP address once the stolen laptop is used to access the Internet.
- Invisible ultraviolet markings.
- Installing a system on your laptop that enables you to remotely self-destruct documents.
After a Laptop is Stolen & Patients' Confidential Information may be Compromised (partial list):
- Notify any clients who may be affected with such breach of confidentiality, unless there are reasons (i.e., client is suicidal or in crisis) not to do so.
- Assess whether the lost computer may also contain personal information that can readily lead to identity theft.
- File a report with police and with other agencies and institutions if, and as, required.
- If appropriate, notify other people (non-clients) who may be significantly affected with such a breach.
- Consult with your state or national ethics committee or your malpractice insurer.
- Consult with your billing software vendor, if you have one.
Clinical Update, July 2008
The Emergence of Personal and Professional Coaching: An Alternative Career Path for Therapists
In the last several years, personal and professional coaching has emerged as a recognized career. It has created new options for people who seek help with life transitions and who want to find a guide to partner with in designing their desired future. While coaching has grown to incorporate a variety of specialized applications, the case can be made that, at its foundation, coaching involves a whole-person, client-centered approach. All coaching is life coaching, whether it be executive, leadership, or personal coaching.
Our online course, Coaching is offered for 4 CE Credits.
What is Coaching?
Coaching is collaborating with clients in a thought-provoking and creative process that inspires them to maximize their personal and professional potential. Professional coaches provide an ongoing partnership designed to help clients produce fulfilling results in their personal and professional lives. Coaches help people improve their performance and enhance the quality of their lives. (International Coach Federation)
Why Therapists Can Make Great Professional Coaches
Dr. Patrick Williams, MCC, Founder and CEO of Institute for Life Coach Training, and author of the online course articulates the following:
Successful coaches come from a myriad of professional backgrounds. Business and professional consultants, human resources managers, organizational consultants, entrepreneurs, and marketing specialists are a few of the careers that coaches might have had before adding coaching to their résumés. In this course, we will discuss why trained and experienced helping professionals would find the coaching relationship a perfect addition to their practice. Below is a highlighted list of why therapists are uniquely qualified to make the transition into life coaching.
- Skillful listening: Deep and empathic listening is at the heart of the therapeutic relationship, and helping professionals have had much professional experience honing their listening skills.
- Listening to the "unsaid": In addition to listening, therapists are trained to hear what is not being said and to detect nuances of expression, voice, and energy that either confirm or contradict the client's verbal and nonverbal cues.
- Gift of reframing: The skill of putting a positive or less innocuous spin on a statement or belief expressed by a client is critical to effective life coaching. Turning problems into learning opportunities is one way to use reframing as a coaching skill.
- Ability to suspend judgment: Helping professionals have heard it all! They can listen to "truth telling" from their clients and not be shocked. Most of the time, what clients need to be truthful about is not earth shattering, except to them. Having a place to "release" frustration or anxiety and express their deepest desires or fears, as in the coaching relationship, is very freeing.
- Experience with confidentiality and ethics: Professional therapists already respect confidentiality and have strong ethical guidelines. In fact, the boundaries and professional guidelines in therapy are so strong that coaches will actually find that coaching clients, who generally are not emotionally fragile, allows them to be looser with their own boundaries around privacy and confidentiality.
- Ability to seek solutions and think of possibilities: Trained and experienced therapists are typically good solution seekers and possibility thinkers, and their professional training and experience has undoubtedly enhanced these skills.
- Knowledge of paradigms: Therapists, who have embraced humanistic and client-centered paradigms, including the recent advances in solution-focused therapy and positive psychology, will adapt quickly to problem solving as a coach.
- Assessments: Coaching typically begins with a personal interview (either face-to-face or by teleconference call) to assess the individual's current opportunities and challenges, define the scope of the relationship, identify priorities for action, and establish specific desired outcomes. Therapists are very comfortable with this initial process. And there are specific personality assessments that fit the coaching paradigm well.
- Sessions conducted in person or over the phone: Subsequent coaching sessions may be conducted in person or over the telephone. Having these options expands therapists' opportunities to work with clients who are out of state or out of the immediate area.
- Fieldwork: Therapists are familiar with issuing 'homework' to their clients. Coaching clients are accustomed to receiving fieldwork, to completing specific actions that support the achievement of one's personally prioritized goals.
- Length of relationship: The duration of the coaching relationship varies depending on the individual's personal needs and preferences. Together, the coach and client can come up with a mutually comfortable time to end the coaching relationship or not. The coaching relationship is one that is co-created between the client and coach. Therapists may find this a welcome change in their practices.
- Familiar with administering assessments: Depending upon the needs and circumstances of the individual, there are varieties of assessments available to support coaches.
- Comprehensive knowledge of the behavioral sciences: A variety of concepts, models and principles drawn from the behavioral sciences, management literature, spiritual traditions, and/or the arts and humanities may be incorporated into the coaching conversation in order to increase the individual's self-awareness and awareness of others, foster shifts in perspective, promote fresh insights, provide new frameworks for looking at opportunities and challenges, and energize and inspire the individual's forward actions.
View the course description and syllabus for our online course, Coaching which is offered for 4 CE Credits.
Clinical Update, July 2008
PASTORAL COUNSELING:
On Psychology and Spirituality
In a world besieged by daily crises, many people turn to their local faith communities for nourishment and guidance. Indeed, research has found that the majority of Americans prefer a mental health professional who integrates spiritual values into the counseling process. Pastoral counseling provides a helping relationship between a religiously-affiliated counselor and an individual, couple, or family seeking assistance to cope with life.
Our new online course (4 CE Credits): Pastoral Counseling: The Intersection of Psychology and Spirituality.
The Zur Institute offers over 90 Online Courses by Subject.
Pastoral Counseling 101:
- An underlying premise of pastoral counseling is that a counselee's spiritual life may be a valuable resource for healing wounds, resolving conflicts, and creating meaning and values.
- Types of pastoral counseling include brief situational support, short-term counseling, and long-term pastoral psychotherapy.
- Brief situational pastoral counseling consists of one to three sessions aimed at strengthening counselees in life situations that have temporarily thrown them off course.
- Short-term pastoral counseling usually requires four to nine sessions in order to move through the therapeutic cycle of problem analysis, experimentation with coping strategies, and consolidation of gains.
- Long-term pastoral psychotherapy generally requires ten sessions to one year. While some exposure to clinical pastoral training is recommended for all pastoral counselors, long-term pastoral psychotherapy, in particular, requires formal academic and supervisory training in the field of counseling.
- Pastoral counseling often takes the form of a specialized ministry within a church, parish, or synagogue, where pastors or professional counselors offer counseling under the auspices of pastoral care.
- Pastoral counseling can also function as an outreach ministry through a local hospital, homeless shelter, or independent counseling center; or it may serve persons through the chaplaincy in a prison, military base, or college campus.
- Psychologist William James was one of the first American thinkers to envision the integration of behavioral science and religious faith. His book, Varieties of Religious Experience (1902), placed this topic on the agenda for exploration in churches, universities, and seminaries.
- Insights from therapeutic psychology have historically influenced and enriched pastoral counseling. Carl Jung, for example, viewed faith in God as a crucial resource for mental health.
This new introductory course on pastoral counseling was developed by Dan Montgomery, Ph.D., author of, among other books, Compass Psychotheology: Where Psychology and Theology Really Meet.
This Pastoral Counseling (PC) course will teach you to:
- Identify the history and types of pastoral counseling (PC)
- Explain the main issues involved in PC
- Summarize practical psychological techniques pertinent to PC
- Navigate the complexity of integrating a faith tradition with therapeutic psychology
- Discuss the basics of Compass Therapy
- Summarize ethical issues pertinent to pastoral counseling
New online course (4 CE Credits): Pastoral Counseling: The Intersection of Psychology and Spirituality
Clinical Update, May 2008
OCD: Obsessive-Compulsive Disorder
Our latest online course (6 CE Credits): Obsessive-Compulsive Disorder (OCD).
- Obsessive-Compulsive Disorder (OCD) occurs when an individual experiences obsessions and compulsions for more than an hour each day and, most importantly, that these experiences interfere with his or her life.
- Obsessions are intrusive, irrational thoughts, unwanted ideas or impulses that repeatedly well up in a person's mind.
- Compulsions are repetitive rituals such as handwashing, counting, checking, hoarding, or arranging.
- About 18% of American adults have anxiety disorders.
- The National Institute of Mental Health estimates that more than 2% of the US population, or nearly one out of every 40 people, will suffer from OCD at some point in their lives.
- The disorder is two to three times more common than schizophrenia and bipolar disorder.
- OCD affects 1% to 3% of children and adolescents.
- Heredity appears to be a strong factor in the development of OCD. If you have OCD, there is a 25% chance that one of your immediate family members will have it.
- Sufferers experience "pathological doubt" because they are unable to distinguish between what is possible, what is probable, and what is unlikely to happen.
- Generally, OCD symptoms are not relieved by psychoanalysis or other forms of "talk therapy". However, there is strong evidence that behavior and cognitive-behavioral therapies can be effective alone or in combination with medication.
- Compared to other conditions, OCD is generally treatable.
- About two in every 100 adolescents experience OCD.
- An estimated 700,000 to 1.4 million people in the United States are believed to have compulsive hoarding syndrome.
- A reasonable estimate is that 20% to 30% of individuals diagnosed with OCD have hoarding symptoms.
- People who hoard also have higher rates of personality disorders, social phobias, and pathological grooming behaviors such as skin picking.
- Psychoanalysts classify hoarding as reflective of anal eroticism.
- According to the Academy of Cognitive Therapy, diminished symptoms of OCD are reported by 75% of those who complete exposure and response prevention treatment.
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Clinical Update, June 2008
Menopause in the New Millenium
As Baby Boomers enter midlife, millions of women (more than ever in human evolution) are facing menopause. An unprecedented number of women are making the transition through "the change", creating a massive impact on the healthcare and integrative medical systems, as well as increasing the use of numerous alternative treatments. With so many women entering this phase of their lives, it is imperative that clinical personnel be aware of the parameters, symptoms and solutions of this physical, psychological and emotional passage.
Our latest online course (6 CE Credits): Menopause in the New Millennium.
Recent studies show:
- In 1900, the average life expectancy for an American woman was 48 years. Today, most women experience menopause between ages 45-55.
- Some symptoms that are commonly considered menopausal may actually be related to aging in general.
- Contrary to the myth that postmenopausal women are sexless, studies show that about 50% experience no change in sexual appetite and pleasure, over 30% experience an increase, and less than 20% experience a decline.
- In the US, almost half of all postmenopausal women studied report having used hormone replacement therapy (HRT). Most often, HRT is taken in pill form.
- Although most women started using HRT around the time of menopause, 25% started taking it five or more years after menopause.
- Among women who were at least 10 years postmenopause, 14% had taken HRT pills for at least 10 years.
- Compared to women with natural menopause, those with surgically-induced menopause were much more likely to have used HRT and also more likely to be currently using it.
- There was no difference in HRT use among age groups for women with natural menopause.
- Non-Hispanic white women were more likely to use HRT than either non-Hispanic black or Mexican American women.
- Women with more than a high school education, or whose household income was above the poverty level, were more likely to use HRT than women with less education or lower family income.
- There are no substantial differences between HRT users and nonusers in terms of risky health behaviors and self-reported health issues.
- Diabetes was twice as prevalent among nonusers and past HRT users than among current users.
- Approximately 45% of women 40-60 years of age reported receiving counseling from a physician about the pros and cons associated with using HRT after menopause.
- Women with higher levels of education were more likely to receive counseling than women with less education, regardless of race or ethnicity.
- Women who had received recent preventive health services, such as mammograms, pap smears and general examinations, were much more likely to have received HRT counseling than those who had not.
- Of all ambulatory medical care visits by women 40 years of age and over, 7.5% used an HRT prescription.
- Obstetric/gynecology visits were 1.9 times more likely to result in an HRT prescription than visits to primary care physicians.
- On average, women develop heart disease approximately 10 years later than men, but the largest increase in coronary mortality coincides with menopause.
- Osteoporosis affects an estimated one in six women and one in sixteen men over the age of 50.
- Women can lose up to 20 percent of their bone mass in the five to seven years following menopause.
- Aerobic, weight-bearing and resistance exercise improves bone mineral density (BMD) in postmenopausal women, whether or not they use hormone therapy.
- Perimenopausal and postmenopausal women differ hormonally and experientially. Therapies tested on one population should not necessarily be extrapolated to the other.
New online course (6 CE Credits): Menopause in the New Millennium.
The new Menopause course will:
- Educate clinicians about Perimenopause, Menopause and Postmenopause
- Describe the symptoms associated with each of these phases
- Identify conventional and integrative medical interventions
- Review the debate about Hormone Replacement Therapy
Clinical Update, May 2008
DSM:
Diagnosing for Status and Money
A Critical Look at the DSM and the economic forces that shape it.
In principal, mental health diagnoses can be helpful to clinicians and researchers in their formulation of treatment, research and communication with other professionals. Unfortunately, the DSM has been shaped by economic and political influences rather than by scientific and medical ones. The DSM assigns diagnoses in a biased manner, resulting in more harm than good to our patients, their families and society at large while delivering huge profits to pharmaceutical companies. Women, children, minorities, lower income and older people are the groups most likely to be negatively affected by the biases presented in the DSM.
A newly published article: DSM: Diagnosing for Status and Money
Online Course for 4 CE Credits: DSM: Diagnosing for Money and Power
DSM Recap:
- The DSM has been called the billing bible of psychiatry and has become one of the most influential texts in the field of mental health.
- The DSM is a powerful tool of social control: its criteria are used to judge who is normal or abnormal, sane or insane or who should remain free or be hospitalized against their will.
- Most texts and graduate and postgraduate courses present the DSM as an objective, scientific document. It is neither.
- The DSM is primarily driven by the psychopharmacological industry, which reaps huge profits from each new diagnosis that can be treated with medication.
- The frame of the DSM is distorted by a primarily intra-psychic-individual focus and tends to ignore contextual factors. It does not address what cannot be solved with a pill. It does not appropriately address patients who, in fact, are wrestling with social problems, such as sexism, racism, or homophobia, or existential anxieties regarding loneliness or death. Unfortunately, using the DSM, the dis-ease of such patients will be redefined as medically treatable maladies.
- The DSM perpetuates the myth that the medical-mechanistic model can simply be applied to psychology.
- Some clinicians have used the DSM categories as a form of "name calling". Accordingly, the DSM gives some therapists an illusory feeling of power and superiority driven by the "power to name".
- DSM-based research has repeatedly been shown to be of questionable validity and is, in fact, very unreliable.
- Since its inception in 1952, the DSM has consistently viewed pathology as residing within the individual. Subsequent revisions in 1980 and 1987 have evolved toward a more firmly biological perspective.
- In response to insurance companies' need for increasing specificity in diagnoses and the psychopharmacology industry's need for new markets, the number of available diagnostic labels rose from 297 in 1994 to 374 in 2000. The upcoming DSM V is likely to include hundreds more "new" (and profitable) mental disorders.
- DSM is big business, not only for its publisher, the American Psychiatric Association, but even more so for the psychopharmacological industry, which profits from prescriptions written for the ever-increasing numbers of DSM disorders.
DSM pathologizes many normal and healthy behaviors:
- Shyness: You are mentally ill if you are very introverted or extremely shy.
- Grief: God forbid if you intensely grieve the loss of a beloved one for more than six months.
- Depression: You must be mentally ill if you respond to real life issues or injustices with deep sadness and intense despair. (For more, see our online course: Depression.)
- Anxiety: You must be mentally ill if your reaction to the existential reality of mortality or loneliness involves profound or debilitating anxiety. (For more, see our online course: Anxiety.)
- Lack of Sexual Interest: Lack of sexual interest is often not a mental disorder. Many women may have good reasons to avoid sex that may stem from domestic abuse, overwork or other reasons. Kaschak and Tiefer (2001) discussed Female Sexual Dysfunction (FSD) as "a textbook case of disease mongering by the pharmaceutical industry..." or what they call the "medicalization industry." (For more, see our online course:
Feminist Sex Therapy.)
- Spirited Children: DSM casts a very broad net around the ADHD diagnosis, and often includes millions of spirited, strong-willed, and highly gifted and creative children. It results in huge profits for medicating psychiatrists and pharmaceutical companies. (For more, see our online course: ADHD: Myths or Facts.)
Online Course for 4 CE Credits: DSM: Diagnosing for Money and Power
Clinical Update, May 2008
Borderline Personality Disorder:
How Therapists Can Successfully Treat One of the Most Difficult, Fascinating, Volatile, Dreaded and Potentially Rewarding Populations
Our new online course on Borderline Personality Disorder is offered for 5 CE Credits.
No other mental disorder has stirred and evoked more fascination, volatility, trepidation and dread in therapists as borderline personality disorder (BPD). We have all heard statements like the following:
"Never have more than one or two Borderlines in your practice at a time."
"You are one Borderline away from losing your license."
"I have one Borderline too many in my practice."
"If you take on a BPD client, you will be swamped with late night phone calls and an all-consuming, volatile therapeutic relationship."
The Risks:
Litigation Risk: BPD clients are more likely than other clients to file complaints and initiate legal actions against their therapists.
Emotional Toll: Working with BPD can be emotionally taxing and exhausting. Learn about the nature of the disorder and carefully manage your counter-transference. Do not act impulsively. Do seek support and consultation as necessary.
The Hope:
Contrary to the prevailing myths that BPD is incurable, new perspectives and new (and old) therapies have proven surprisingly effective. With the aid of this online course, it is our hope that BPD will no longer be the disorder that therapists dread. The course will discuss how BPD is eminently treatable and show how working with BPD clients can be highly rewarding.
Strategies for Risk Management:
- Developing a deep understanding of the nature of BPD and treatment options.
- Comprehend the actions and reactions that are often evoked.
- Implement clearly articulated treatment plans.
- Set clear, appropriate and compassionate (not punitive) boundaries.
- Carefully manage your counter-transference, do not act impulsively.
- Terminate thoughtfully.
- Document, document, and . . . document.
- Consult, consult, and . . . consult.
RECAP: Borderline Personality Disorder
- The DSM captures only part of the symptoms of BPD. Research shows that most therapists use other tell-tail signs as diagnostic tools.
- Instead of diagnosing and understanding BPD from DSM symptom checklists, it may be more accurate, and provide a richer clinical picture, to think in terms of four symptom clusters: affect, cognition, impulsivity, and interpersonal relationships.
- BPD has diverse etiologies, including biological and psychosocial. Understanding your client's specific etiology will help you make effective treatment choices.
- The belief that BPD is an intractable part of personality may not be true. Many BPD clients mysteriously shed their BPD symptoms. They sometimes do so without treatment.
- There are several different highly effective treatments for BPD. Many treatments are new, but some are traditional.
- There is a tangled web between Axis I mood disorders and Axis II personality disorders. Understanding your client's specific web will help you make better treatment decisions.
- Although no medications specifically address BPD, some medications may occasionally play a valuable role in treatment.
- Neuro-imaging studies suggest how and why BPD develops.
- Observational studies of mothers and babies may provide insight as to how BPD is transmitted from mother to baby.
- Dialectical behavior therapy, interpersonal psychotherapy, transference-focused (psychodynamic) therapy, emotionally supportive therapy, and mentalization-focused therapies have all proven effective with BPD. However, they each address different dimensions of the disorder.
- Therapists are particularly prone to strong counter-transference with BPD clients, which presents a legal peril. Understanding the dynamics and taking precautions may help insulate you from legal problems.
- Many treatment failures with BPD clients may be due more to therapists' hesitations and defenses than to the "intractability" of BPD.
This Course Will Help Therapists to:
- Identify the symptoms and accurately diagnose BPD.
- Understand the diverse etiologies of BPD.
- Identify effective therapies.
- Learn the principles of several effective therapies.
- Understand the limitations of DSM taxonomy in regard to BPD.
- Learn the appropriate use of medications for BPD.
- Learn the common ethical and legal pitfalls in treating BPD.
- Practice ethical risk-management with BPD.
- Access resources for therapists, clients and families.
Borderline Personality Disorder Online Course-5 CE Credits
Clinical Update, April 2008
Innovations in Infertility:
Nuts & Bolts of Fertility Medicine for the Curious Clinician
After two years, and more than a hundred thousand dollars spent,
I sat in the fertility specialist's office
and stared blankly at him as he informed me,
"Regretfully, it's not possible for you to have a baby!"
"What?" I thought again to myself.
"But women are designed to have babies."
Twenty years later, I can only smile at how wrong he was
as I listen to my five (!) children play gleefully in the other room.
Dr. Debeixidon, Author of Infertility Course
Unlike the Baby Boomers before them, much of the following generation has placed greater focus on developing careers than creating a family. Many decided to delay families while getting their careers in order, only to discover that when it was finally the right time to have children, it was no longer biologically easy or feasible.
Infertility is now rampant amongst 30-45 year olds, affecting about 25% of reproductive-aged couples, leaving many with heartache and guilt. In a desperate effort to turn back their biological clocks, couples are spending hundreds of thousands of dollars for technical procedures and costly medications. While there is certainly merit to all that is available through modern medicine, a growing number of couples are looking to a more comprehensive approach to infertility treatment, one that actively combines tools from Western and Eastern Medicine.
Our latest Online Course on Infertility Innovations is offered for 5 CE Credits.
Our CE Accreditations include APA, BBS-CA, NBCC, NAADAC and CA-BRN.
View our Online Course Offerings by Course Title.
Infertility - 101:
- It is estimated that more than 6.1 million people were diagnosed with some form of infertility in the US.
- Research suggests that 9% of those of reproductive age suffer from infertility.
- Nearly three quarters of a million women lose their pregnancies each year to ectopic and molar pregnancies, miscarriage, and stillbirth.
- The decrease in female fecundity beginning after the age of 30 and exaggerated after 40, is a well-documented finding.
- The incidence of miscarriage increases with maternal age.
- Women who conceive late in life generally have a late menopause as well.
- As most clinicians have experienced, while we can address and explore the loss of a pregnancy with a couple, nothing seems to deter them from the desire to succeed with a live birth. Having techniques that are designed to provide more than just loss management or bereavement counseling provides more of what these couples are seeking.
- Approximately 1% of the live births in the US are due to Assisted Reproductive Technologies (ART) procedures.
- Success rates for pregnancy by ART range between 20% and 30%.
- The first "test tube baby" was born less than 30 years ago.
- The research suggests that implantation and "take-home baby" rates are significantly higher with electro-acupuncture than without.
- Acupuncture can increase blood flow to the reproductive organs, which dramatically improves a woman's response to the hormonal therapy.
- Infertility can result from building up emotional baggage- when you stuff the contents of your emotional life into virtual suitcases inside, and fail to empty them out at an appropriate time.
- Use of individual and couples psychotherapy to increase awareness of process and to explore emotional and psychological issues has been proven to increase chances of conception.
- Research conducted through Harvard Medical Center indicates that use of mindfulness techniques can significantly, positively, impact fertility.
The Infertility Online Course will:
- Deepen clinicians' understanding of infertility
- Summarize the current and latest advances in infertility treatments
- Broaden clinicians' knowledge of fertility medicine
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Clinical Update, March 2008
From King David to Katharine Hepburn to Bill Clinton to Eliot Spitzer:
Infidelity, Affairs, Monogamy and Their Clinical Implications
From King David in Jerusalem to Kathryn Hepburn in LA, Prince Charles in England, Bill Clinton in DC and Eliot Spitzer in NY, infidelity has been a consistent part of "his-story." Infidelity is much more common than we like to believe. It is also no longer primarily the province of men, as women, statistically, are catching up fast. Equal opportunity, indeed.
The world has long been titillated by the extramarital transgressions of the high and mighty, from emperors, queens and presidents, to evangelists and movie stars, as well as our co-workers, friends and families. The theme has threaded itself throughout history, art, literature and, certainly, through politics and Hollywood. Moving this trend into high gear is none other than the Internet, where couples meet and mingle frequently, anonymously and sometimes perfidiously.
The online course Infidelity and Affairs: Myth, Realities and Effective Therapies for 5 CE credits, examines the issues and complexities of infidelity.
Myths and Facts about Infidelity
Myth: Infidelity is rare in the animal kingdom.
Fact: Only 3% of the 4,000 species of mammals are genetically pre-programmed for monogamy. Humans, doves and swans are not among the faithful 3%: however, the flatworm is.
Myth: An affair inevitably destroys the marriage.
Fact: Many marriages survive affairs and even emerge stronger.
Myth: Infidelity is not normal.
Fact: Men's infidelity has been recorded in almost all societies, and in quite a few cultures it is the prevailing norm.
Myth: Western culture supports fidelity.
Fact: Western culture gives lip service to fidelity, but actually supports infidelity through its obsession with sexuality in the media and role modeling by celebrities.
Myth: People's attitudes toward infidelity are consistent with their behavior.
Fact: A striking paradox is that while 90% disapprove of extramarital relationships, about a third to a half of couples and partners are, in fact, engaged in such relationships.
Myth: Men initiate almost all affairs.
Fact: Unlike in the past when women could lose everything, including their lives, infidelity has become an equal opportunity venture in the West. Women are catching up rapidly as they are less dependent on men for physical and financial support.
Myth: An affair always means there are serious problems in the marriage.
Fact: Some who engage in affairs report high marital satisfaction. Others report that the affair has actually spiced up their marriage.
Myth: Disclosure of the affair to the betrayed spouse is essential to healing the marriage.
Fact: Therapists must conduct a careful risk-benefit analysis before encouraging or insisting that clients disclose their affairs. Some affairs are best kept secret. Some disclosures, especially by women, can increase the likelihood of domestic violence and homicide.
Myth: Full disclosure of all the details of the affair to the betrayed spouse is essential to regaining trust.
Fact: This moralistic-puritanical view of affairs can be very destructive. Giving the partner X-rated details of the affair can be haunting, traumatizing and can fuel obsessions. When appropriate, sharing very general information is often sufficient.
Myth: Extramarital affairs are never consensual.
Fact: Open marriages used to be popular in the 1970s and are still around today. Many couples have an implicit or explicit consensus regarding extramarital relationships.
Myth: Couples therapy is the best approach to dealing with an infidelity crisis.
Fact: No one approach is best. Therapists must take into consideration the type of affair, personalities, culture, etc. when constructing a treatment plan.
Learn how to assess, counsel and intervene in cases of infidelity with the Infidelity Online Course. This course includes a printable informational brochure to provide to clients as an adjunct to therapy.
Guidelines that are provided above are meant to be aspirational and general, as they may not apply to certain situations, clients and settings. For more details go to zurinstitute.com/privacy.html .
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