Category: Clinical Exercises

1. Tracking EMDR Results

After each EMDR session the individual should notice and list the impacts of their work. The results of EMDR are immediate. Here are some of the most commonly noticed changes from a successful EMDR session.

1. A decrease in anxiety and an increased feeling of relaxation.
2. A sudden decease in presenting symptoms of anxiety, depression and PTSD.
3. An increase in positive beliefs about self and a decrease in negative self thoughts.
4. An increase in the belief that the future will be good.
5. An awareness that the targeted memory is no longer thought about or bothersome.
6. A decrease in negative body sensations that occur during times of stress.
7. A decrease in negative emotions that had been triggered by reminders of traumatic memory.
8. An increased ability to problem solve in relationships.
9. An increase in the ability to be objective about self, others, the future and the past.
10. A feeling that a weight or heaviness has been lifted.
11. An increase in quality sleep.

2. Imago Listening Exercise

Imago Communication is a technique developed for marital therapy with the primary goal of developing relational intimacy. Proper Imago Communication will allow for the speaker to relate current relational conflicts to childhood experiences and emotions.

Mirroring –Mirroring is simply a repeat of what was heard by the speaker.

         So you are saying…Is there more…let me make sure I have it all…

Validation –Validation is a statement that the speaker’s perspective is reasonable. Validation is not necessarily agreeing with the speaker, however.

        That makes sense because…Can you help me understand?

Empathy – Empathy is the act of putting oneself in the position of the speaker and imagining how it would feel to experience their position.

       I can imagine you feel…

3. Finding your Imago – Complete the sections A-E then refer to the sentence below.

1. List the bad qualities of your mother and father.
2. List the good qualities of your mother and father
3. Complete the sentence – “What I wanted and needed most as a child was…”
4. List good memories of your childhood and how you responded emotionally.
5. List the disappointments of your childhood and how you responded behaviorally.

Complete the sentence below using the corresponding answers from the statements above. This sentence will give you a description of what you look for in a partner.

I am trying to find a person who is (A) to always be (B) so I can get (C) and feel (D). I stop myself from getting this sometimes by (E).

4. Cognitive Exercise

The goal of the cognitive exercise is to better understand negative thoughts and change related patterns and behaviors.

The exercise is divided into four parts. The exercise should be written.

1. Identify a situation that causes an emotional change such as feeling anxious or depressed.
2. List the negative self belief that accompanies the change in mood. Use the sentence “I am _______” and fill in the blank. Examples are “I am bad”, “I am worthless”, “I am not good enough”. Also write the negative emotion and body sensations that are felt from the negative emotion.
3. List the Cognitive Rebuttal – In other words what is the self perception you want to believe. It is usually the opposite of the negative belief. Again use the frame sentence “I am_________”. Examples may be “I am good”, “I am important” or “I am ok”. After this is listed then write as evidenced by… and fill in. Such as “I am good as evidenced by my daily respect and concern for my coworkers”.
4. Reread the positive Cognitive Rebuttal and the rational evidence for this description and then list the appropriate behavioral reaction. Follow through with the behavior.

5. Journal Exercise

The purpose of the journal exercise is to experience, track and increase awareness of emotions. This exercise helps to decrease symptoms and increases assertive communication. Journal writing should be done daily and can include any emotion from the day good or bad. Journal writing should follow very specific language. First, start with –

I feel________  because _______. For example “I feel angry because you forgot about me.”

After using this exercise for 3-4 weeks, change it to a more detailed version. Think about a specific situation and follow the suggestions below.

1. I think…..
2. I feel…
3. I want…

For example “I think you are more concerned about your own schedule. I feel hurt by your inconsiderate behavior and I want you to include me in your planning.”

By Jeff Dwarshuis LMSW ACSW 

Much of what a person feels is caused by what is said to themselves. Day after day, people at home and the workplace experience many situations and their perception and related self talk about these situations greatly influence outlook, mood and even health. Unfortunately, much of this self talk can be negative, irrational and incorrect. Negative self talk is automatic and starts in patterns developed during youth. As an adult, this negative talk leads to worry, perfectionism, low self esteem and panic. Socially or in the workplace it creates low mood and anger. Negative and irrational thoughts are called “distortions” and the way to end this irrational process is through what Cognitive Psychologists call – Thought Stopping, Substitution and Reframing.

Thought Stopping

Thought Stopping is the processes of recognizing, interrupting and ending a negative thought. Read the examples below to help identify any thought distortions you may have.

1. “I fell behind on the company expectation. I am such a loser.”

2. “I should have done a better presentation. I will never make it to management.”

3. “This equipment doesn’t work well. It is going to be an awful week.”

4. “Although my department has been successful, it doesn’t matter. We will always be behind.”

5. “My team hates me. Every time I do something wrong they give me the evil eye and wish I would quit.”

Keep in mind that thought distortions are not behaviors but are thoughts. Some people have a great deal of distorted thinking while others have little. In any case, they are automatic by nature and consistent across time. When recognizing a negative thought, write it down and then watch for patterns. People tend to think in patterns. Then, each time you catch yourself, either sit in silence not letting it happen or create a negative association like slapping a rubber band on your wrist. 

Substitution

After recognizing and stopping the negative thought, create a replacement. This is called substitution. Replace the negative thought with a more realistic and positive description of the situation. This is also called “the rebuttal”. Substitution statements may sound like this –

1. “I fell behind on the company expectation but I have learned a great deal and did better then last month.”
2. “My presentation was acceptable. I got my point across and many people are better because of it.”
3. “The equipment does not work well. This is a perfect opportunity to talk to the salesman and negotiate some changes.”
4. “My department is successful and will continue to grow and be the best.”
5. “My team likes me most of the time. This is a good fit.”

Reframing

Thought stopping and substitution can change how we think, feel and respond. Reframing is an exercise in changing how you think and what you do related to a situational interpretation. It is an active process in considering the positive. Reframing is used well with the automatic thoughts that begin with the words “always” and “never”

These are three steps in Reframing and changing the interpretation of events.

1. Identify several situations that typically produce uncomfortable or distressing feelings.

2. List your automatic thoughts and feelings in each situation.

3. List a more useful way to perceive each situation which offers choices and potential for growth.

Thought Stopping, Substitution and Reframing is a process. Begin by creating a plan. Use a notebook to list negative thoughts, substitutions and reframes. Set aside specific times to address these. After a good beginning effort of 3-6 weeks, the process will become more automatic.

  

By Jeff Dwarshuis LMSW  ACSW                                                                                                     

The Use of Self to Increase Communication

The quality of communication within a relationship can be increased by the listener’s behavior. Generally this involves the alteration of things in the relational context that already exist but may be unclear, normalized, taken for granted or ignored. The three listening techniques for increasing quality communication are – The Art of Being Quiet, Boundaries and Self Disclosure.

A. The Art of Being Quiet – Both listeners and presenters maintain an unspoken time limit on the accepted length of silence between the exchange of language between each person. Altering the length of silence when responding to a presenter will increase the level of the listener’s attention to what is being said. The alteration of silence is taken from the discipline of Ericksonian Hypnotherapy. It is based on the recognition that communication is rhythmic and altering the timing sequence disrupts the unconscious timing pattern. Disrupting unconscious patterns creates an internal crisis and leaves the conscious mind working to make sense of the change. The result is a heightened level of attention to what is happening. Consider following these suggestions.

                      Wait longer before responding to a speaker. This causes the speaker to turn inward and have a heightened recognition of their thoughts and feelings.

                     Respond more quickly than expected after hearing a speaker. This creates a state of listener confusion which initiates an internal crisis response and a heightened attention state. This response causes an increase in attention to what is being said to them.        

B. Boundaries – Boundaries are the spoken and unspoken rules, roles and limitations relevant to a relationship and its context. Boundaries involve issues of time, authority, submission, involvement, distance and resources. Boundary management is a universal human challenge which was shaped by instinctual responses to the joys and disappointments of childhood attachment.  The quality of communication is greatly increased when boundaries are clear and verbalized. Boundaries are determined usually by the person in authority. When boundaries are clear, it allows for safety, freedom and self development. Here are examples of clear boundaries.

                         Job descriptions and work roles are clearly understood and well managed.

                      When a listener is clear and consistent regarding how long he or she can listen, what topics can be heard and how much he or she is willing to do.

                    When someone is willing to say “no” to tasks that are too big, inappropriate or out of line with expectations or personal decisions.

                   When a manager listens to an employee or colleague in the same location each time they talk.

 

C. Self Disclosure – Self disclosure is sharing information about one’s self that is personal. When a listener self discloses he or she is giving an unspoken suggestion that the speaker self disclose as well. Consider using these ideas:

                       Think about what you would like for the speaker to say that would move the discussion in a direction you would like. Based on this topic, pick something from your life that is personal and share it. The speaker will hear this and most likely respond with a personal example on the same topic. (If you want someone to talk about their mother than start by talking about your own mother.)

                         Self disclosure allows the listener to control the discussion by setting the parameters of what is acceptable. In other words, the level and detail of personal disclosure is determined by the listener.

                        The listener should be sure to only share as much as he or she can manage emotionally.                                                                                                 

By Jeff Dwarshuis LMSW ACSW 

What is Active Listening? 

Active listening is a communication technique that requires a listener in a relationship to use specific language to show an understanding of a speaker’s expression. The language, which consists of suggested phrases combined with the listener’s response, is designed to create psychological safety for the speaker. This structured process is highlights the importance of the speaker’s words and meaning and leaves no room for advice giving. Active listening is a developed skill which can be learned by most anyone to improve understanding and relational closeness between two people. Active Listening has four main parts; they are paraphrasing, clarifying, giving feedback and listening with your body. 

A. Paraphrasing – Paraphrasing is the first step in the active listening process. After hearing what the speaker initially says, the listener provides what is called a mirroring statement. A mirroring statement is a set of words that are nearly identical to the words said by the speaker and are preceded by one of the phrases below.  The use of these phrases followed by a mirroring statement creates a paraphrase and an atmosphere that is centered on the speaker. Following this structure keeps the attention off of the listener by eliminating the possibility of advice giving, question asking or interpretation. With this combination of a heightened focus on the speaker and the diminished importance of the listener’s thoughts, a sense of communicative predictability allows the speaker to feel emotionally safe. Generally when people feel safe they will express more. Consider using one of the phrases below to start the mirroring statement.

                       So you are saying…In other words…If I understand you correctly…What I hearing you saying is that…Let me get this straight…

                     After paraphrasing is complete the speaker should have the sense that they were heard and are understood. The listener, however, does not have to agree with what was said.

B. Clarifying – After giving feedback, the listener should clarify to the speaker what they heard. This is done by asking questions about the presented topic and making sure there are no misunderstandings. Since the listener is actively seeking understanding, clarifying should make the speaker feel important and that their concerns have value. The listener also should be sure to have a goal of understanding the meaning of what the person said rather than being preoccupied with the factual information the person provides. Too much attention to facts will cause the speaker to feel interrogated.

                     To establish language that leads to clarification ask the “who, what, when, where” questions to make sure the speaker is understood.

C. Feedback – After paraphrasing and clarifying the listener should give feedback. Feedback is a supportive yet honest expression of the listener’s opinion regarding the topic. Feedback should be given at the same time as the discussion because the speaker is then more likely to hear the feedback. Feedback gives the speaker an understanding of the impact of their language and it can provide a fresh point of view.  

                        Feedback should be honest but supportive. For example to say “I think you may have made a mistake” rather than “You blew it!”  

D. Listening With Your Body – Listening with your body is an unspoken gesture that is done while listening to someone. These gestures make it easier for the speaker to talk. This can be done in many ways. For example,

                      Maintain eye contact, move closer or lean forward, nod as positive reinforcement, smile or frown in sympathy, keep posture open, remove distraction and remove objects between self and presenter. 

Active listening is a developed skill. Begin by practicing each part separately and memorizing the suggested phrases before listening. Active listening can be used with family, employees, colleagues and friends. You will discover that this tool increases understanding and closeness in relationships. 

By Jeff Dwarshuis LMSW ACSW

Neuro–linguistic Programming (NLP) is a branch of psychotherapy that is based on the idea that people experience the world through their senses and translate sensory information into both conscious and unconscious thought processes. These thought processes activate the neurological system that affects physiology, emotions and behavior. The linguistic aspect in NLP refers to the idea that language helps us to capture, conceptualize and communicate our experiences. Programming has to do with the idea that we have patterned internal processes that help us learn, act and get results.

Cause and Effect

How we make personal decisions and act behaviorally has a great deal to do with our perception of personal control. We all maintain the assumption that every effect has an underlying cause. Because of internal dialogue and past history, individuals can be programmed to unrealistically view themselves as victims of their circumstances. In NLP the concept of “cause and effect” attempts to create a method of understanding one’s thoughts to recognize if they are thinking as if they are in or out of control of their circumstances. In NLP terms people are said to be “at cause” or “at effect” as follows:

At Cause – When an individual has the thoughts and behavior that reflect the idea of “I am not making excuses.” or “I am in control of my destiny.” or “What lessons do I need to learn from this situation.”

At Effect – When an individual has the thoughts and behavior that reflect the idea of “I am out of control”. The “at effect” person blames others, makes excuses and passively watches his or her experiences pass through time.

Where are you at right now in your perception of cause and effect both at work and in the family? Understanding one’s own patterns can impact mood, productivity and attitude.

Tuning Into Language

NLP maintains that our internal world of conscious and unconscious thinking is reflected in our words and body language. Someone’s perception of their own level of control over their circumstances is reflected in their language. Notice the differences in the examples below –

“At Effect” language –

1. “He made me do it.”
2. “I have to stay late and work because my manager makes me feel guilty.”

“At Cause” language –

1. “I don’t want to talk now. I am giving myself time to respond.”
2. “I took time off last week and I have enough energy to complete the project.”

Notice the differences. The “at effect” responses represent an unconscious thought of not being in control. The “at cause” responses represent an attitude of self responsibility and taking control of one’s circumstances.

Examining Internal Dialogue

Individuals live in a private world of internal dialogue and have the capacity for what is called the “What if reasoning processes” or the ability to mentally rehearse different scenarios. People have the tendency to repeat the same thought patterns and if this is with the internal dialogue of being “at effect’ self management will take a great deal of unnecessary energy and will limit productivity and natural capacity.

To change this, first recognize internal dialogue that reflects an “at effect” perspective. Then interrupt this unconscious process by adjusting physical sensations through deep breathing or meditation and alter negative thought process by writing affirmations of positive self beliefs. Then list the “at effect” statement and then respond to it with an “at cause” statement.

For example “My colleagues are in my way” would be replaced by “I can create space to work freely when I want.” Another example might be “My boss’s suggestions make me stressed.” This would be replaced by “I have been chosen for this job and I am the best qualified to understand suggestions.”

Interrupting the negative patterns though recognition, altering thoughts and body sensations allows one to change negative unconscious patterns and instead think more creatively about one’s own abilities and accomplishments.