Assertive

Your Perfect Right

Your Perfect Right

Always wondered if you could use assertiveness and equality in your relationships and in your life? Here are some great information on how to be more assertive! Do you want to improve your career and the amount of money that you bring home? Do you want to break all the sales records in your office? Do you want to bring home more money? Do you feel as though you are just short of reaching all of your goals?

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Significance To Humans

Where they occur, jungle leeches are among the most self-assertive and omnipresent elements of a rainforest. Although it is unlikely that anyone would bleed to death from the dozens of leeches that find their way into socks or under shirts and trousers, many have been driven to distraction by their tenacity, the inability to escape their attentions, or the itchy welts that may arise from their bites. Occasionally featured in motion pictures (e.g., Apocalypse Now).

Psychiatric services and treatments

There has recently been a good deal of development in services. Assertive outreach teams have been developed in community mental health services these are concerned with patients who disengage with treatment, and they can be effective in reducing hospital admission and improving the lives of some of these severely affected ('revolving door') patients.

The Therapeutic Relationship

A 46 year-old woman suffered from social anxiety and agoraphobia. Initially, treatment (exposure in vivo) appeared to be going smoothly, but as the exercises progressed treatment halted. The patient started cancelling appointments and when she did show up she had not completed the assignments. In view of the initial smooth progress, the therapist hypothesized that the stagnation might have to do with fears associated with definitive improvement of the complaints. Inquiry revealed that the patient dreaded having to go back to work for her father, whom she described as an authoritarian man whom she felt unable to stand up to. As a result of this discussion, the functional analysis and treatment plan were revised and patient and therapist agreed to include assertiveness training as part of the treatment.

Synthetic Function of the

The essential issue of the integrative ego function discussed in the previous section was the regulation of energies to enable activity directed toward external goals. The central concern in the closely related synthetic ego function is that, given an accurate perception of reality, the realistically appreciated external goal can be approached in an active, unambiguous manner. A decisive, active approach to reality involves the person's capacity to implement steps to achieve specific goals. Such goals are not set or regulated by passive fantasies, but are approached instead in an assertive manner involving an array of necessary cognitive capacities, including planning, attention, concentration, consideration of detail, and the active, effective channeling of energy. Therefore, in discussing the synthetic ego function, the psychologist needs to be able to appreciate clearly the combined factors of tolerance for ambiguity within the context of reality testing and cognitive organization.

Communication Training

The main objective of communication training is to teach couples how to improve their communication. Partners receive training in skills that enable them to talk to one another more effectively. The following skills are instructed in a structured fashion active listening, expression of empathy, expression of emotion, and assertiveness. When the partners have adequately mastered these skills they can apply them when discussing their specific relationship issues. The therapist also applies the systematic problem-solving training as part of the course. Modelling, feedback, shaping and role playing are specific techniques used in communication training. Prior to formulating the treatment plan, the therapist will make a functional analysis of the relationship problems. A number of studies have demonstrated the efficacy of behavioural communication training among couples with relationship distress (Emmelkamp, 1988).

Models of case management

The two models of case management mentioned most often in the mental health literature are assertive community treatment (ACT) and intensive case management. Assertive community treatment ACT uses multidisciplinary teams, low client-to-staff ratios, an emphasis on assertive outreach, provision of in-vivo services (in the client's own setting), an Dixon, Lisa. Assertive Community Treatment Twenty-Five Years of Gold. Psychiatric Services 51, no. 6 (June 2000) 759-765. Schaedle, Richard, John H. McGrew, Gary R. Bond, and Irwin Epstein. A Comparison of Experts' Perspectives on Assertive Community Treatment and Intensive Case Management. Psychiatric Services 53, no. 2 (February 2002) 207-210. Ziguras, Stephen J. and Geoffrey W. Stuart. A Meta-Analysis of the Effectiveness of Mental Health Case Management Over 20 Years. Psychiatric Services 51, no. 11, (November 2000) 1410-1421.

The Big Five Model And The Fivefactor Model

The Extraversion domain contrasts a sort of gregarious sociability with a more reserved interpersonal style. Individuals who are high on Extraversion tend to be actively outgoing, assertive, and enthusiastic. The Extraversion domain scale is strongly correlated with vocational interest in enterprising occupations (Costa, McCrae, & Holland, 1984). Low scorers on Extraversion tend to be reserved, independent, and less exuberant. Individuals who are low on Extraversion are not necessarily introspective, reflective, or socially anxious they are simply independent in their interpersonal style, comfortable being by themselves. The facet scales measuring some of the characteristics of Extraversion cover the range through which this attribute can be expressed. They include Warmth, Gregariousness, Assertiveness, Activity, Excitement-Seeking, and Positive Emotions. The facet most associated with a potential for intimacy and close attachments is Warmth. Gregariousness taps a preference for...

Between the individual and the clinician

Are Hispanics does not necessarily mean that they share the same ethnicity (i.e., values, norms, and lifestyle). In this context, a Hispanic clinician, for example, who does not believe in the cultural values of machismo and marianismo would diagnosis a Hispanic female with Dependent Personality Disorder when, in fact, this woman is simply behaving according to norms expected in the Hispanic community. In the same case, a treatment plan with emphasis on social skills training (teaching a client what to do and say to develop self-assertive behaviors, for example) would be a bad tactic in the treatment of that Hispanic female because the clinician would be recommending an intervention which competes with the value that Hispanic places on respeto, machismo, and marianismo (Paniagua, 1998).

Minority and Immigrant Status as Antecedents of Distress

The status of Asian Americans as members of a visible racial minority group in the United States is likely to influence the content of their distress. In an analysis of Asian American-White American differences on various indices of personality patterns (many of which are traits associated with distress), Uba (1994) proposed that the documented ethnic differences can be interpreted on the basis of cultural value differences and the status of Asian Americans as minorities. For example, Uba speculated that the lower levels of assertiveness among Asian Americans compared to non-Asian counterparts may be due to Asian cultural ideals, such as respect for others, modesty, interpersonal harmony, and restraint of hostile and aggressive emotions (cultural basis), but the deferential behavior of Asian Americans may also reflect a strategy for surviving in a racist society or a learned helplessness arising from their experience as minorities.

Treatment Psychological Treatments

Psychological treatment of sexual arousal problems generally consists of sensate focus excercises and masturbation training, with the emphasis on becoming more self-focussed and assertive (38). A lack of meaningful treatment goals for women, the difficulty in obtaining adequate control groups, and a lack of clear treatment protocols, may explain the paucity of well-controlled randomized trials of psychological therapy (50).

Proxy Designation Clause

Ducting on the efficacy of advance directives, I find that even when the advance directive is in its proper place in the medical chart and is noticed, it still has little or no impact on clinical practice because physicians seldom acknowledge that the patient has the conditions designated (lines 4-7) to trigger the advance directive. The best hope for such patients is to have a strong, assertive proxy or agent acting on their behalf (L. L. Emanuel, et al., 1991 L. L. Emanuel & E.J. Emanuel, 1989 Heintz, 1997 High, 1993 Morrison et al., 1995).

Specific Multicultural Issues

As noted above, clinicians with lack of understanding of the significance of machismo and marianismo in the Hispanic culture might just be on the wrong track when suggesting therapeutic interventions from standard textbooks. For example, the general goal of social skill training interventions (e.g., Lang & Jakubowski, 1976) is to teach the client to be assertive in his or her expression of feelings, emotions, and behaviors. Hispanic women who believe in marianismo and machismo as culturally appropriate values in her community would probably drop out from therapy in those cases when they are told that they will be trained to be self-assertive and to negotiate safe-sex practices with the assistance of these interventions (Paniagua, 1998).

Personality Characteristics

With some of the adjectives, you are not likely to experience much difficulty in answering these two questions. In one large study of college students from 30 countries across the world, the respondents consistently checked the following adjectives as descriptive of men adventurous, strong, dominant, assertive, task-oriented, aggressive, enterprising, and independent. Women, on the other hand, were consistently described as sensitive, gentle, dependent, emotional, sentimental, weak, submissive, and people-oriented (Williams & Best, 1990). Other studies have found girls and women to be more empathic and sensitive to other people (Eisenberg & Lennon, 1983). They are also viewed as more dependent, fearful, irritable, and demanding, but less self-confident than males. Males, on the other hand, are characterized as more active, exploratory, and impulsive than females (Feshbach & Weiner, 1991). In As discussed at length in Chapters 5 and 7 of this book, women are more...

Psychological Wellbeing And Quality Of Life

Decreased psychological well-being has been reported in hypopituitary adults despite replacement of all hormone deficiencies with the exception of GH (2). In studies comparing adults with long standing GH-deficiency with matched controls the patients reported lower openness, less assertiveness, less energy, greater emotional lability, more difficulties with sexual relationships and a greater sense of social isolation (2,3). Evi

Psychological Assessment As A Tool For Treatment Planning

Similarly, knowledge of the patient's weaknesses or deficits may also affect the type of treatment plan that is devised. Greene and Clopton (1999) provided numerous types of deficit-relevant information from the MMPI-2 content scales that have implications for treatment planning. For example, a clinically significant score (T > 64) on the Anger scale should lead one to consider the inclusion of training in assertiveness or anger control techniques as part of the patient's treatment. On the other hand, uneasiness in social situations, as suggested by a significantly elevated score on either the Low Self-Esteem or Social Discomfort scale, suggests that a supportive approach to the intervention would be beneficial, at least initially.

Phallic Assertion Conflict

A third developmental theme in the formation of early character and derivative interpersonal behavior is the phase of development that requires a person to become assertive in the pursuit of needs and goals. The focus on assertion presupposes a foundation based on the relatively successful resolution of dependency and control needs derived from earlier stages. Then, when there are disturbances in the phallic-assertion period, certain specific problematic character formations are likely to develop around the theme of assertion. For example, difficulties in meeting the demands of this phase can produce passivity as well as the limitation of becoming assertive only through anger. Various forms of passive and aggressive behavior, including passive-dependent approaches, are also consequences of difficulties correlated to this phallic stage of development. The key compromise in addressing the central developmental task of this stage namely the sense of entitlement to be assertive is the...

Gender issues in mental health

Traditional gender roles define masculinity as having power and being in control in emotional situations, in the workplace, and in sexual relationships. Acceptable male behaviors include competitiveness, independence, assertiveness, ambition, confidence, toughness, anger, and even violence (to varying degrees). Males are expected to avoid such characteristics associated with femininity as emotional expressiveness, vulnerability (weakness, helplessness, insecurity, worry), and intimacy (especially showing affection to other males). Traditional femininity is defined as being nurturing, supportive, and assigning high priority to one's relationships. Women are expected to be emotionally expressive, dependent, passive, cooperative, warm, and accepting of subordinate status in marriage and employment. Competitiveness, assertiveness, anger, and violence are viewed as unfeminine and are not generally tolerated as acceptable female behavior. Additional sources of stress common to women include...

Long TermCare Facilities

The negative perception that society, and older adults in particular, have of nursing homes is due in part to the desire of older adults to remain with their families in familiar surroundings rather than being placed in an unfamiliar environment to be tended by strangers and await death. Accounts of unsanitary and unsafe conditions and inadequate treatment of patients by nursing home staff during the 1970s and 1980s prompted a number of investigations of the entire nursing home industry. One result of these investigations and the attendant publicity was passage of the Nursing Home Reform Act of 1987, containing a set of regulations that apply to all nursing home facilities. This legislation resulted in the gradual phasing out of the distinction between nursing homes and intermediate care facilities, and, more importantly, to a greater respect for patients' rights. Nursing home patients are now more likely to be treated as individuals who merit respect and should be permitted and...

Emotion Attached Dependent Types Dependent Personality

In the test protocol, projective stories may be characterized by excessive dependency features, magical solutions to problems that avoid active application of any personal resources in an assertive or realistic manner, and reliance on others for implementation of activities leading to accomplishment of goals. Figure drawings may be characterized by childlike representations. Although the inkblots may generate an average number of responses, they may frequently lack an appreciable focus on significant detail. Rather, percepts will center on simple, whole, and easily formed conventional responses. The frequency of animal contents may be high and regressive circles may appear in graphic material consistent with the individual's immature approach.

Behaviour Therapy Rationale

Behaviour therapy concentrates on the present and sets specific, clearly defined treatment goals within a time-limited and structured intervention. Given the emphasis on engaging patients in rewarding behaviours and reducing punishing behaviours, one of the initial tasks is collaboratively identifying the impact of behaviour on depressive symptoms. Specific interventions are then scheduled to elucidate patterns of reinforcement, for example through monitoring daily activities and rating the associated mastery and pleasure. Tasks are then assigned to gradually increase mastery and pleasure and decrease negatively reinforcing patterns. Progress may be made through imaginal or in vivo exposure to problematic situations with the ultimate aim of identifying and implementing behavioural techniques for managing identified difficulties. Specific areas of difficulty are addressed through appropriate skills training, for example assertiveness or social skill training.

Background and history

The more recent trend has been development of community mental health centres, plus crisis teams, and assertive outreach teams, with the aim of reducing inpatient admissions further still. In the context of managerial reorganization of the NHS as a whole, profound organizational changes to psychiatric services have been introduced. Debate continues as to which model is best, and what future policy should be.

Personalityassessment In The Future

Psychological assessment has typically been tied to the medical model, in which health is defined as the absence of pathology rather than as an aggregate of positive psychological traits that differentiate the psychologically healthy person from others (e.g., Adler, 1958 Erikson, 1963 Maslow, 1954 May, Angel, & Ellenberger, 1958 Rogers, 1961). Seligman and Csikszentmihalyi (2000) have suggested using the term positive psychology instead. Such variables as playfulness, the ability to self-soothe and to be soothed by others, psychological-mindedness, flexibility, and the ability to establish intimacy and to express tenderness in relationships are important variables to consider. Seligman has discussed the concept of optimism, and several of the variables discussed by the Big Five theorists, such as openness to experience (McCrae, 1996), surgency, and agreeableness (Goldberg, 1992) describe positive aspects of personality functioning. The surgency factor includes such concepts as...

The Structure of Cognitive Therapy Behavioural Techniques Cognitive Techniques and Homework

Table Disfunctional Thoughts Record

The first class of therapeutic approaches focus on the client's behaviour. The rationale is that for some people behaviour monitoring, behavioural activation and behavioural change can lead to substantive gains. For example, people with more severe depression often become withdrawn and inactive, which can feed into and exacerbate depression. They withdraw and then label themselves as 'ineffectual', fuelling the depression. By focussing on this relationship and gradually increasing the person's sense of daily structure and participation in masterful and pleasurable activities the person can take the first steps in combating depression (Beck et al., 1979). Other behavioural strategies include scheduling pleasurable activities, breaking down large tasks (such as finding employment) into more manageable graded tasks (buying a newspaper with job advertisements, preparing a resume ), teaching relaxation skills, desensitising a person regarding feared situations, role playing and...

Theoretical Formulations

The standard therapies for GAD, evaluated in clinical trials from 1980 to 2000, have been broadly based on the procedures and principles of cognitive therapy as applied to the appraisal of threat (Beck, Emery & Greenberg, 1985) and behaviour therapy as applied to reducing muscle tension through relaxation training (Bernstein & Borkovec, 1973 Ost, 1987). These approaches will be familiar to therapists with a basic training in cognitive behaviour therapy (CBT). The primary emphasis is on a process of self-regulation in which the sufferer learns to understand and then interrupt his or her particular cycle of anxiety triggers, bodily responses and worries with coping strategies based on either reducing arousal and muscle tension or changing the beliefs, and appraisal processes that underlie worrisome thinking. Clinical and research evidence suggests that confidence in either approach can bring about significant reductions in the severity of GAD but confidence in both is probably...

How Therapeutic Challenges Are Conceptualized And Managed

Behavioral and cognitive-behavioral therapists are generally accustomed to being able to establish a fairly straightforward therapeutic relationship at the outset of therapy and then proceeding without much attention to the interpersonal aspects of therapy. However, this is generally not the case when working with clients who have personality disorders because the dysfunctional interpersonal behaviors that the clients manifest in relationships outside therapy are likely to emerge within the therapist-client relationship as well. For example, if an individual believes, I don't count and anticipates that others will not take him or her seriously, this is likely to have much the same impact in therapy as it has in daily life. The individual may well react strongly to perceived slights by the therapist and may have difficulty being appropriately assertive in therapy.

What Constitutes Capacity to Consent to Sexual Relationships

To engage in sexual intercourse for a material object, such as cigarettes, they need to know how else these might be obtained). Realistically, to make a voluntary choice, many people would also need assertiveness training, so that they did not simply submit to sexual activity because of compliance.

Collecting Assessment Information

As a further challenge in formulating assessment goals, specific and psychologically phrased referral questions may still lack clarity as a consequence of addressing complex and multidetermined patterns of behavior. In employment evaluations, for example, a referring person may want to know which of three individuals is likely to perform best in a position of leadership or executive responsibility. To address this type of question effectively, assessors must first be able to identify psychological characteristics that are likely to make a difference in the particular circumstances, as by proceeding, in this example, in the belief that being energetic, decisive, assertive, self-confident, and reasonably unflappable contribute to showing effective and responsible leadership.

Personalityguided Context

To make unbalanced or deficient polarities the primary aim of therapy is a new focus and a goal only modestly tested. In contrast, the clinical domains in which problems are expressed lend themselves to a wide variety of therapeutic techniques, the efficacy of which must continue to be gauged by ongoing experience and future systematic research. Nevertheless, our repertoire here is a rich one. For example, there are numerous cognitive-behavior techniques (Bandura, 1969 Craighead et al., 1994 Goldfried & Davison, 1976), such as assertiveness training, that may fruitfully be employed to establish a greater sense of self-autonomy or an active rather than a passive stance with regard to life. Similarly, pharmaceuticals are notably efficacious in reducing the intensity of pain (anxiety, depression) when the pleasure-pain polarity is in marked imbalance.

Health Care System

For these homeless people with severe mental illness, the delivery of appropriate health care is challenging but essential to improving their health and housing status. The Assertive Community Treatment (ACT) model attempts to address this problem through a team of psychiatrists, nurses, and social workers who follow a small caseload of homeless mentally ill clients, seeking them out in the community to provide high-intensity mental health treatment and case management. Studies have found that mentally ill homeless people receiving ACT spend fewer days hospitalized as a psychiatric inpatient and have somewhat greater improvement in symptoms than those receiving usual care (Lehman, et al., 1997). However, ACT is labor-intensive and costly, and its availability is often quite limited.

Bias and Base Rates

Information provides some useful guidelines for a two-step process in taking account of background and situational differences among respondents. The interpretive phase of assessment provides the first step, which consists of arriving at descriptive statements that identify a respondent's psychological characteristics as they exist independently of his or her cultural context and circumstances. Having superior intelligence, being orderly and compulsive, experiencing memory loss, being emotionally reserved, having an assertive and competitive bent, and being prone to acute anxiety in unfamiliar surroundings are examples of characteristics that define the nature of the individual. As revealed by assessment data, such characteristics will be present in people regardless of where they live, from whence they come, and in what they are involved. The utilization phase of the assessment process provides the second step, which involves being sufficiently sensitive to respondents' cultural and...

Preparation

Preparation for assertiveness training varies from person to person. For some participants, no preparation is needed before practicing the techniques for others, however, individual counseling or therapy may help prepare the individual for assertiveness training. For participants who may be more shy and feel uncomfortable saying no or speaking up for themselves, a brief course of individual therapy will help to prepare them psychologically and emotionally to use assertive techniques.

Aftercare

Aftercare can involve ongoing supportive therapy, again based on the individual's level of comfort in using the assertive techniques. For those who are comfortable using the techniques on their own, a supportive social network or occasional participation in a support group will be enough to help maintain the new behavioral patterns. The ultimate goal is for each participant to self- Assertive Confidently self-assured able to Role-playing A technique used in assertiveness training and other forms of therapy in which participants act out roles relevant to real-life situations in order to change their attitudes and behaviors. monitor effectively his or her use of assertive techniques on an ongoing basis.

Normal results

An enhanced sense of well-being and more positive self-esteem are typical results from assertiveness training. Many participants report that they feel better about themselves and more capable of handling the stresses of daily life. In addition, people who have participated in assertiveness training have a better sense of boundaries, and are able to set appropriate and healthy limits with others. Being able to set appropriate limits (such as saying no) helps people to avoid feeling victimized by others. A healthy sense of self-determination and respect for others is the ultimate outcome of assertiveness training. Such a balance helps each person work better with others, and make appropriate decisions for themselves.

Terminal Drop

The fact that cognitive abilities may show a general decline with aging is seen in the phenomenon known as the terminal drop. Research on this phenomenon, which is signaled not only by decrements in IQ, memory, and cognitive organization, but also in reaction time, assertiveness, and other sensorimotor abilities and personality characteristics during the last few months of life, was prompted by the observations made by a nurse in a home for the aged. She claimed that she was able to predict which patients were going to die soon, because they just seem to act differently (Lieberman, 1965, p. 181). Research studies initiated in response to the nurse's observations found that patients who died within an year after psychological assessments showed declines on various measures of cognitive and sensorimotor abilities and adaptation to the environment (Granick & Patterson, 1972 Lieberman & Coplan, 1969 Reimanis & Green, 1971 Riegel & Riegel, 1972).

Conservative Mode

The conservative mode is also one in which the environment acts as the source of criminal activity, but here changes to the internal state of the offender are sought. This operational style might give rise to crimes that are motivated by a desire for a sense of power or control. Individuals who commit burglary and or theft to fund a drug habit can also be seen to be operating in this mode, as can creators of computer viruses who derive no financial benefit from their crimes. Within other crimes it is also possible to find examples of criminals who derive psychological, as well as instrumental, gain from their illegal activities. Crime prevention measures directed at these forms of activity will need to recognise the psychological benefits perceived by the offender, and should seek to modify the target so as to deny these benefits. Alternatively, crime prevention measures operating at the individual level must attempt to reduce the perception of crime as a legitimate means to obtain...

Suicide

Regardless of age, depression is the most common factor in suicide (Carson & Butcher, 1992). However, it is not the only factor. Despite the fact that depression is significantly more prevalent among females than males, the suicide rate is substantially lower for females than males-whiteor black. Contributing to the higher rate for males is the fact that males who attempt suicide employ more lethal methods, such as firearms. Another factor contributing to the sex difference in suicide rate is that the more assertive, achievement-oriented, middle-aged man has greater difficulty than the more passive, nurturant, middle-aged woman adapting to role changes in later life. Women also tend to have more extensive social supports, which can act as a buffer against despair. Many older men, especially the less affluent, are unable to attain satisfaction in their new roles while retaining the macho myth that they can only maintain their dignity or manliness by keeping quiet about their...

Menopause

Along with a drop in testosterone in approximately half of all meno-pausal women, the aforementioned changes presumably contribute to a decline in the sex drive reported by 30 or so women after menopause (Sheehy, 1993). Perhaps an even more important factor in the reduced sexual activity of widows, however, are social mores that view sex as something that older women should not be interested in. Despite the decline in sexual activity for most older women, the increased independence and assertiveness experienced by many postmenopausal women are often accompanied by a renewed interest in sex.

Controlled drug use

Many users do not wish to give up drugs, and the treatment aim is therefore 'harm reduction'. Advice includes instruction on safer injection techniques, giving out clean needles to reduce needle sharing, and encouraging change from injected to oral drugs. Some teams adopt an 'assertive outreach' approach to drug users who lack the initiative to seek regular help for themselves.

Directed Questions

The key problem with directed questions is one of selectivity. A witness may be asked about the injuries to the child's left leg, but not to the right. The witness may have important evidence to give about the child's right leg, but not be given a question to answer about it. The witness may assume, reasonably it is suggested, that the lawyer will, to continue the example, move from the left to the right leg in due course. The lawyer is in charge of which questions are asked and in which order. So the witness may not be asked for information which might, on an impartial reading of the case, be critical. Without that information only part of the picture will have been presented to the jury. Of course the witness may be assertive enough to insist on giving that evidence, although the lawyer may object. Witnesses are often told, directly and indirectly, to answer the question, and only the question. The lawyer for the other side may provide the witness with an opportunity for the whole...

Casting Doubt

Few witnesses will be sufficiently assertive, prepared and competent to make such a response. Indeed, if the lawyer suspected that the witness was that competent then he or she will avoid asking such a question. The lawyer will have 'sized up' the witness in advance. And the witness, who does answer with such an assertive response, is liable to be accused of having been coached. While telling a witness what to say in a particular case, with reference to particular evidence, is objectionable, general training to be a skilful witness is not.

Behaviour Therapy

Argyle et al. (1974) found that these patients benefited from both social skills training and psychodynamic therapy Stravynski et al. (1994) compared social skills training conducted in the clinic with training in the clinic plus in vivo and found both equally effective, although dropout rates were much higher when in vivo work was included. Alden (1989) Cappe & Alden (1986) and Marzillier et al. (1976) evaluated social skills training, exposure and systematic desensitisation and found that patients with APD made modest gains with all three relative to a waiting-list control. Alden & Capreol (1993) concluded from a trial of 76 patients with APD that individuals presenting as angry and distrustful benefited more from exposure therapy while those whose primary problem was lack of assertiveness responded better to social skills training. Results suggest that patients with APD are likely to demonstrate only modest improvements in social...

Counselling

The authors include a list of the 92 papers included in their meta-analysis of counselling. A quick review of these references shows that the studies in the meta-analysis included the following counselling techniques anger management, assertiveness training, social skills training, exposure treatment for obsessive compulsive disorder, desensitisation, relaxation training, cognitive therapy, group cognitive behaviour therapy, shaping, reinforcement of non-depressed behaviours and implosion. Hence, the possibility that the apparent effectiveness of counselling was due largely to the inclusion of traditional behaviour therapy cannot be excluded. At this time we must conclude that there are very limited data to support the use of counselling with people with intellectual disabilities.

Support groups

Socialization, interpersonal relationships, and social support that can be gained through the group may not be available elsewhere, and as such, it can be a very positive experience for the participant. In a group situation, a participant can learn how to express feelings in a healthy and positive way, practice assertive communication, receive feedback about appropriate and inappropriate content for conversation, receive feedback about nonverbal communication, learn new ways to ask for help from others, be able to help others, learn how to form friendships, and learn new coping skills and behaviors.