Shankar, G-PSY-7500- 40 Option I Part I Identifying Information

"Clean and Sober" is the story of a drug addict existing with the false impression of triumph and the way of his progressively built up awareness that lifes goings are not as they should be and he requires professional help. Michael Keaton plays as Daryl Poynter and he is a Philadelphia real estate agent and also addicted to cocaine (Substance abuse and dependence DSM IV). The substance use, abuse, dependence and recovery process depicted in the movie closely corresponds to that of real world drug rehabilitation centers, including the feelings and rebellion. Daryl Poynter is a single caucacian man in his thirties with means.

History of Presenting Problem

He holds a lucrative spot in a commercial real estate firm and is successful with the habit of cocaine dependence (Cocaine use and addiction)}. He sustains his cocaine use even with embezzlement. Cocaine use slowly infiltrates all his activities including his psych as well. His boss finds out the embezzlement $92,000 and Daryls reply is he borrowed" for investment even though he has lost most of it (Denial). In another situation, Daryl discovers that the woman in his bed is in a drug-coma.

Reason for Referral

Shankar, G-PSY-7500- 40 Option I He is informed by police officer not to leave town. Daryl while anxious about the events, finds out a drug rehabilitation center At this point Daryl chooses it as a temporary hideout (Avoidant behavior) . From the start Daryl is unwilling to cooperate and follow the

centers policies. He is not an addict like the rest and he is in the rehabilitation center only to escape from problems of embezzlement and hide from police. He is there to buy some time. He continues his drug seeking behavior in the drug rehabilitation center and even approaches his mother with unreasonable demands to maintain his cocaine addiction (Substance Craving). He gets kicked out by his counselor for various violations (Willful disregard for others-antisocial behavior). He slowly realizes he needs some people. It is common in many states drug addicts

are given an option to go for recovery programs of go to jail. Based on that, the ultimate punishment can be Daryl's is being ejected from the house.

Shankar, G-PSY-7500- 40 Option I Part II

Model I- Brief Psychodynamic Therapy and Cocaine Addiction

Background

Several different approaches to brief psychodynamic psychotherapy have evolved from psychoanalytic theory and have been clinically applied to a wide range of psychological disorders. A growing body of research supports the efficacy of these approaches (Messer and Warren, 1995). Strengths of brief psychodynamic therapies may include they have the best chance to be effective when they are integrated into a relatively comprehensive substance abuse treatment program that includes drug-focused interventions such as regular urinalysis, drug counseling are perhaps more helpful after abstinence is well established and in the movie these three are emphasized as well. . It is also important that the psychodynamic therapist know about the pharmacology of abused drugs, the subculture of substance abuse, and 12-Step programs. The theory supporting psychodynamic therapy originated in and is informed by psychoanalytic theory. Many psychodynamic therapists work with substance-abusing clients, in conjunction with traditional drug and alcohol treatment programs or as the sole therapist for clients with coexisting disorders, using forms of brief psychodynamic therapy.

Introduction to Brief Psychodynamic Therapy

Shankar, G-PSY-7500- 40 Option I In brief therapy, the central focus is developed during the initial evaluation process, occurring during the first session or two. This focus must be agreed on by the client and therapist. The central focus singles out the most important issues and thus creates a structure and identifies a goal for the treatment. In brief therapy, the therapist is expected to be fairly active in keeping the session focused on the main issue. The number of sessions varies from one approach to another, but brief psychodynamic therapy is typically considered to be no more than 25 sessions (Bauer and Kobos, 1987). The length of therapy is usually related to the expectations of the therapy goals. Most therapists are flexible in terms of the number of sessions they recommend for clinical practice. Main weakness of the therapy is often the number of sessions depends on a clients characteristics, goals, and the issues deemed core by the therapist and there is no standardized approach. Considering in the movie the program is said to be couple of weeks, the real therapy between Daryl and the therapist ideally should start after detoxification.

Psychodynamic Psychotherapy for Substance Abuse

Supportive-expressive (SE) psychotherapy is one brief psychodynamic approach that has been adapted for use with people with substance abuse disorders. It has been modified for use for cocaine use disorders (Mark and Faude, 1995; Mark and Luborsky, 1992). There have been many studies of the use of SE therapy for substance abuse disorders, resulting in a significant body of empirical data on its effectiveness in treating these problems

Shankar, G-PSY-7500- 40 Option I Mark and Faude asserted that although their therapeutic approach was devised specifically for cocaine-dependent clients, these people often have multiple dependencies, and this approach can be used to treat a variety of substance abuse disorders. Mark and Faude theorized that substances of abuse substitute a "chemical reaction" in place of experiences and that these chemically induced experiences can block the impact of other external events. The person with a substance abuse disorder will therefore have a "tremendously impoverished and impaired capacity to experience," and traditional psychotherapy might have to be augmented with techniques that focus on increasing a client's ability to experience (Mark and Faude, 1995).

Effective SE therapy depends on appropriate use of what is termed the core conflictual relationship theme (CCRT), a concept first introduced by Lester Luborsky. According to Luborsky, a CCRT is at the center of a person's problems. The CCRT develops from early childhood experiences, but the client is unaware of it and how it developed. The CCRT develops out of a core response from others (RO), which represents a person's predominant expectations or experiences of others' internal and external reactions to herself, and a core response of the self (RS), which refers to a more or less coherent combination of somatic experiences, affects, actions, cognitive style, self-esteem, and self-representations.

Most people with substance abuse disorders and in case of Daryl, have particularly negative expectations of others' attitudes toward them (that is, the RO) as we have seen his

Shankar, G-PSY-7500- 40 Option I response to the policies of the facility and response to his friend, although it remains unclear which came first--this response or the substance abuse disorder and it is unclear from the movie. Either way, the two become mutually reinforcing. Following are examples of statements that reflect the core RO of a person with a substance abuse disorder like Daryl:

"Everybody hates me."

"No one understands how I feel."

For many people with substance abuse disorders, alcohol or drug use is a way of selfmedicating against feelings of low self-worth and low self-esteem that reflect the client's RS. A negative RO reinforces a negative RS and can lead to the deceptive and manipulative behavior that is sometimes observed in this population. The client's RS is based on the individual's somatic experiences, actions, and perceived needs. Following are examples of statements that could reflect a client's core RS:

"If I didn't use drugs, I would lose my mind."

"I'm not a very nice or honest person."

A third component of CCRT is a person's wish; it reflects what the client yearns for, wishes for, or desires. The client's "wish" is largely based on individual personality style. Those with substance abuse disorders often have a wish to continue using the substance without having

Shankar, G-PSY-7500- 40 Option I to endure the consequences. Put another way, they would like to be accepted (or loved or appreciated) as they are, without having to give up the pleasure they get from their use (Levenson et al., 1997). Many people who have substance abuse disorders have much invested in denying that they really have a problem as in the case of Daryl till the end, in disclaiming their role in the behavior that has brought them into treatment.

Once therapy has been initiated, the therapist and client can work together to put the client's goals into the CCRT framework and explore the meaning, function, and consequence of her substance abuse, looking in particular at how the RO and RS have contributed to the problem. The CCRT framework also can be used to identify potential obstacles in the recovery process as the therapist and client explore the client's anticipated responses from others and from herself and discuss how these perceptions will change when she stops abusing substances. The CCRT concept also can help clients deal with relapse, which is regarded by virtually all experts in the field as an integral and natural part of recovery. Relapse offers the client and the SE therapist the opportunity to examine how the RO and RS can serve as triggers and to devise strategies to avoid these triggers in the future. Finally, SE therapy is conducive to client participation in a self-help group such as Narcotics Anonymous in case of Daryl.

Clients Most Suitable for Psychodynamic Therapy

Shankar, G-PSY-7500- 40 Option I Brief psychodynamic therapy is more appropriate for some types of clients with substance abuse disorders than others. For some, psychodynamic therapy is best undertaken when they are well along in recovery and receptive to a higher level of self-knowledge like Daryl after he started developing caring for Charlie and reasonably became somewhat responsible. Although there is some disagreement in the details, this type of brief therapy is generally thought more suitable for the following types of clients:

Those who have coexisting psychopathology with their substance abuse disorder

Those who do not need or who have completed inpatient hospitalization or detoxification (Daryl?)

Those whose recovery is stable (Daryl?)

Those who do not have organic brain damage or other limitations due to their mental capacity

Psychodynamic Concepts Useful in Substance Abuse Treatment

The Therapeutic Alliance: The alliance that develops between therapist and client is a very important factor in successful therapeutic outcomes This is true regardless of the modality of therapy. The psychodynamic model has always viewed the therapist-client relationship as central and the vehicle through which change occurs. Of all the brief psychotherapies,

Shankar, G-PSY-7500- 40 Option I psychodynamic approaches place the most emphasis on the therapeutic relationship and provide the most explicit and comprehensive explanations of how to use this relationship effectively. Luborsky and colleagues are among those who have documented the profound effect that the therapist-client relationship has on the success of treatment

The psychodynamic model offers a systematic explanation of how the therapeutic relationship works and guidelines for how to use it for positive change and growth. In all psychodynamic therapies, the first goal is to establish a "therapeutic alliance" between therapist and client. In most cases, the development of a therapeutic alliance is partially a process of the passage of time. The more severe the client's disorder, the more time it will take. The capabilities of the therapist to be honest and empathic and of the client to be trusting are also factors. A therapeutic alliance requires intimate self-disclosure on the part of the client and an empathic and appropriate response on the part of the therapist. However, in brief psychodynamic therapy this alliance must be established as soon as possible and therapists conducting this sort of therapy must be able to establish a trusting relationship with their clients in a short time.

Insight: Psychodynamic approaches regard insight as a particular kind of self-realization or self-knowledge, especially regarding the connections of experiences and conflicts in the past with present perceptions and behavior and the recognition of feelings or motivations that have been repressed. Insight can come through a sudden flash of understanding or from gradual

Shankar, G-PSY-7500- 40 Option I acquisition of self-knowledge. Insight involves both thoughts and feelings. In treating substance abuse disorders, it is important to recognize that insight alone is often not sufficient to create change. Substances of abuse are powerful behavioral reinforces and the therapist needs to help the client counter the strong compulsive desire for them.

Defense Mechanisms And Resistance: All defense mechanisms have two characteristics in common: they deny, distort, or falsify reality, and they operate unconsciously like Daryl in this movie. Some defense mechanisms are adaptive and support the mature functioning of the individual, while others are maladaptive and hinder the individual's growth. Generally the defenses hamper the process of exploration in therapy, and for this reason they are often confronted in the more expressive models of analytic therapy In the treatment of substance abuse disorders, defenses are seen as a means of resisting change--changes that inevitably involve eliminating or at least reducing drug use. Mark and colleagues noted that two defenses frequently seen in those with substance abuse disorders are denial and grandiosity (Mark and Luborsky, 1992). Particularly with this group of clients, handling defenses can degenerate into an adversarial interaction, laden with accusations (we have seen in the movie); for example, when a therapist admonishes the client by saying, "You are in denial" (Mark and Luborsky, 1992). They recommend avoiding ineffective adversarial interactions around the client's use of defenses by using the following strategies:

Shankar, G-PSY-7500- 40 Option I Working with the client's perceptions of reality rather than arguing

Asking questions

Sidestepping rather than confronting defenses

Demonstrating the denial defense while interacting with the client to show her how it works

Transference: is the process of transferring prominent characteristics of unresolved conflicted relationships with significant others onto the therapist. The opening session in psychodynamic therapy usually involves the assessment of transference so that it may be incorporated into the treatment strategy. An initial goal of brief psychodynamic therapy is to foster transference by building the therapeutic relationship. Only then can the therapist help the client begin to understand her reasons for abusing substances and to consider alternative, more positive behavior. A longer term goal--necessitated by the brevity of the process--is to increase the client's motivation and participation in other modalities of treatment for substance abuse disorders.

Shankar, G-PSY-7500- 40 Option I Model II- Daryl: An Adlerian Analysis Alfred Adler once said: "If we want to understand a person we have to close our ears. We have only to look". Upon applying this statement to the portrayal of Daryl, it takes on an entirely different meaning. Although it is unknown whether it was an inherent or the result of his busy life-style, we have here with more intense examination, the disturbed individual. The superiority for which the maladjusted individual strives is the elevation of himself and the suppression of others, often hiding his own inferiority feelings to the extent that he himself cannot see it. Maladjustment consists of the more "selfish" striving for personal power and self-enhancement rather than for perfection. Instead of seeing the person as a victim to internal impulses as Freud suggested, Adler viewed the self, being pulled toward the external world, as central in his theory. He saw the most general cause of maladjustment as being the child's feelings of inferiority resulting from a combination of organ dysfunction, poor early environment, feelings of being hated, and dissatisfaction with early social relationships. However, where Freud may have searched for and identified certain agents as determining the individual's maladjustment, Adler thought that such factors were not causal, but influenced the individual's sense of self through the conclusions he draws from them. The basic dynamic force present in life is the individual's striving to be free of his inferiority feelings and feel that he is superior or a well-adjusted person. The Adlerian individual's movement through life is not a result of unseen forces or unconscious meddling to the extent that Freud's is, but the way that a person perceives his environment and reacts to it is of utmost importance. Daryl turned his striving inward on himself, eliminating the need to evaluate himself in relation to othersand focusing his life on the elevation of himself and his goals with the help of substance abuse and alcohol.

Shankar, G-PSY-7500- 40 Option I Adler believed that the basic, common inferiority feelings come from the dilemma of being a child in an adult world. The difficulty of remaining self-involved when needing to rely on social relationships creates the need for the child to see himself as embedded in a larger whole; he has to be a member of society and prepare himself to meet the problems encountered in social living. This need for Social Interest is innate, but it must be brought out in early relationships, especially from that with the mother, and it needs to be continued throughout life in the spheres of occupation, social relationships, and love. Whereas Freud had a tendency to compartmentalize the mother figure into an object to meet different needs throughout development, Adler viewed her as necessary to nourish the child's psychological needs to experience and understand basic fellowship and broaden them into a life-attitude toward others.The individual's basic ego drives (ego, not in Freud's sense of the battleground for warring drives and structures, but as the individual's holistic self) are directed towards society and the striving for power, dominance, and superiority within it, and it is the mother's role to model this Social Interest for the child. Adler saw Social Interest as the barometer of a child's normalcy and believed that all failures are so because they lack in it. In such a system, we would have to view, Daryl as a failure. His approaches to his occupation, friendships, and relationships indicate that he was unable to invest cooperatively in his social relationships and had to find the answers by himself. He turned to drugs as his replacements for the social investment that he was not able to make. Within Adler's system, this kind of striving for personal superiority would be maladjustment and put Daryl on the wrong path for a healthy future. The concept of the Fictionalism is that of an idea, including an unconscious notion, that has no counterpart in reality, yet serves the function of keeping an individual's life on a goal-

Shankar, G-PSY-7500- 40 Option I oriented path. These fictional structures are creations of the individual, fundamentally carried on in the unconscious, that assist in the formulation of a single life-goal toward the achievement of which one's life is directed. Adler believed that heredity, early experience, organ inferiority, and environment all contribute to the formation of this goal, but it is basically formed due to subjective unconscious causes, the point of which is to provide for a basic unity of personality, self-consistency in behavior, a basis for orientation in the world, and assist in compensating for the basic feelings of inferiority. The final goal that emerges from the individual will determine the path along which he will direct his life (mostly unconsciously) and what character traits that individual will manifest. It works to assure the individual that there is a goal toward which life is leading and create positive assurances in the present to help mitigate inferiority feelings. The system of the individual is holistic and goal-directed, and all behavior is striving toward the goal, regardless of how socially deviant it might seem; the subjective integrity of the individual is constantly being maintained. This self-ideal is mostly unknown and not understandable to the individual because it is formulated and exists for the most part in the unconscious. Adler's unconscious, however, is quite different from Freud's in that it really harbors no secret drives or repressed notions that the individual is unable to consciously deal with. The only true function of the unconscious is to contain the final goal toward which the person will spend his life striving; it is nothing other than that which the individual has been unable to formulate in clear concepts. For the most part, the healthy individual is almost completely unaware of his goal, but Adler thought that for the psychotic, the fictional goal could in part become conscious if this process is suited to achieve an enhancement of self-esteem.He thought that the goal of a paranoid schizophrenic is the loftiest of goals in that the individual is striving to be most like a god, and the height of the goal becomes

Shankar, G-PSY-7500- 40 Option I so great that common sense becomes useless to the person in solving his everyday difficulties. The paranoid strives to be the center of attention (and oftentimes actually believes he is), and eventually loses all interest not only in other people, but in his own reason and understanding. Though it is impossible for anyone to determine exactly what Daryls fictional goal consisted of from the movie, there is no doubt that because of the fact that he turned out to be serious drug addict, his pathology resembles something like what Adler described. Adler's theory can even account for Daryl's drug abuse in that he stated that alcohol or drug addictions result from an individual's being confronted with insoluble goals Daryl's drug addiction then, it would seem, was a result of his own construction and maintenance when viewed in Adlerian terms For Daryl from an early point on, the way that he presented himself, his Style of Life, was indicative of his internal and external struggles. Daryl as he was presented in the movie with little regard for anyone besides the more threatening people in his life. Those people who tried to reach out to him were usually met with extreme resistance like he handled the counselor, his mother and his friend, and this selfishness eventually resulted his mental break, something that was as painfully obvious to to Daryl. Inferiority Feeling (IF)

Adler Adler: "The feeling of inferiority rules the mental life and can be clearly recognized in the sense of incompleteness and unfulfillment, and in the uninterrupted struggle both of individuals and humanity

Practical Application Daryl and his approaches to his occupation, friendships, and relationships indicate that he was unable to invest cooperatively in his social relationships and had to find the answers by himself. He turned to drugs as his replacements for the social investment that he was not able to make. Within Adler's system, this kind of striving for personal superiority would be maladjustment and put

Shankar, G-PSY-7500- 40 Option I Daryl on the wrong path for a healthy future. Therapist must identify the client's specific IF and guide the client

Striving for Significance Adler Striving for the illusion of significance in order to overcome the IF rather than striving for genuine significance. The desire for significance, achievement, accomplishment.

Practical Application Therapist is a "co-thinker" and works with the client to find genuine significance. Daryl turned his striving inward on himself, eliminating the need to evaluate himself in relation to others and focusing his life on the elevation of himself and his goals with the help of substance abuse and alcohol and therapist can focus on his achievements minus drugs

Feeling of Community Adler The addict's feeling of community is very narrow. Interconnectedness with all of life has three components: 1. Cognitive - to know it 2. Affective - to feel it 3. Behavioral - to do it Practical Application Therapeutic goal is to extend the feeling of community to everyone. Daryl as he was presented in the movie with little regard for anyone besides the more threatening people in his life. Those people who tried to reach out to him were usually met with extreme resistance like he handled the counselor, his mother and his friend. But movie also shows Daryl could change, his readiness for writing the moral inventory is big step towards introspection (even as a last resort) and his genuine concern for Charlie is another one. It can be extended to his friends, parents and community

Shankar, G-PSY-7500- 40 Option I Style of Life Adler Substance abusers are often self-indulgent, avoid responsibility. Themes of escape distance from reality, wanting an easy way....

Practical Application Therapeutic goal is to develop self-discipline, acceptance of responsibility. Daryl is able to talk honestly about life with an attractive woman in the center, Charlie. . Daryl started

One central theme is reflected in every psychological expression, in the way the individual approaches/avoids the t tasks of life. Involves all or nothing thinking, rather than the flexible problem solving of a healthy person.

staying straight, not because he has been cured, but because he has found someone else to control - he takes the responsibility for keeping Charlie straight and it is a good beginning and therapist can start working from there.

Private Logic Adler Involves an antithetical scheme of rigidly classify self, others, and experiences. It is related to a child's need for security. Feeling of entitlement. "I deserve everything I want because I had a terrible childhood, my mother died, my father was an alcoholic, my sister was the favorite," etc.

Practical Application Therapeutic goal is to develop feelings of obligation to others. Daryls way of breaking the policies and using the phone of councilor, breaking into office building at odd hours and asking his mother and prodding her to take second mortgage to cater his problems of addiction and embezzlement are the issues therapist should work with.

Cooperation/Social Interest Adler

Practical Application

Shankar, G-PSY-7500- 40 Option I Social interest is the capacity for generating cooperation, connection in ever widening circles. Contribution. Social interest is a multi-level concept: Affective - feel a deep belonging and empathy for others. Feeling at home on the earth. Cognitive - necessary interdependence with others. The welfare of any one individual depends on the welfare of everyone. Behavioral - thoughts and feelings translated into actions aimed at self-development and cooperative movement toward others. Therapeutic goal is to develop unlimited, unconditional cooperation/social interest. For Daryl from an early point on, the way that he presented himself, his Style of Life, was indicative of his internal and external struggles. Daryl as he was presented in the movie with little regard for anyone besides the more threatening people in his life. Those people who tried to reach out to him were usually met with extreme resistance like he handled the counselor, his mother and his friend. However at the end as he stated caring for Charlie, it is definite path towards social interest despite its narrow outlook and in my view therapist can make a beginning in improving his social interest and the need of self development and individuals dependence on others and the beauty of social interest

Shankar, G-PSY-7500- 40 Option I Model III - Daryl -A Cocaine Addict : Integrative Model with CBT One of the integrative models is Matrix Model of treating cocaine dependents on out-patient basis.Usually patients are treated on outpatient basis for about 16 weeks and can be intensive. It combines cognitive behavioral therapy techniques, 12 week psychoeducation to the patient and the family in a group therapy approach and sessions may be anywhere from 3 to 10 in 12 weeks. Participation in 12-step program requires positive reinforcement and behavioral change. This approach works like a source of positive emotional and social support. This program to be successful treatment compliance is a must (Rawson, Obert& McCann, 1995). Another important aspect of this integrative model is weekly drug testing and it is an important component of the matrix program. The Matrix Model is involved in an integrated treatment experience for cocaine users through the approach of cognitive behavioral therapy. With its special emphasis on motivational interviewing style, and supplemented with contingency management CBT is the very crucial component of Matrix model dealing with cocaine abuse. Cognitive behavioral therapy can be very useful in the treatment of substance use disorders in combination with pharmacotherapy. Outcome can be evaluated by the drug free urine analysis and reduction of cocaine craving. This process requires accurate information on the drug use status of patients as they regress through treatment. The most verifiable method of monitoring clients for substance use throughout the treatment is through the use of urine analysis on weekly basis. Substance use and dependence disorders are believed to be learned behaviors that are attained through practice. If a substance offers certain preferred outcomes (e.g., good

Shankar, G-PSY-7500- 40 Option I feelings, reduced stress etc.) on frequent events , it may become the favorite way of accomplishing those results, mainly in the deficiency of other means of meeting those chosen outcomes. From this standpoint, the major assignment of treatment are,(1) to recognize the specific desires substances are being used to meet and (2) expand the skills that supply different ways of meeting those needs. "Cognitive-behavioral" methodology comprises cognitions, thoughts, behaviors and emotions with the features that are measured to trigger or sustain behavior. The cognitive-behavioral model includes the two major types of learning that have been recognized in behavior workshop: learning by connection and learning by outcome. In learning by connection ( classical conditioning), stimuli that are formerly neutral can become activated for substance use, or for longing, as a result of recurring connections between those stimuli and substance use. Longing could be external to the individual, such as objects in ones environment, settings and locations, or certain , or they may be internal events like thoughts, emotions, or physiological changes. Connections among various occurrences and substance use can build up if they repeatedly occur in close sequential closeness to each other. These connections are steadily toughen through the path of repeated. Cognitive-behavioral model of substance use and addictive behavior has been explained in which substance use behaviors are considered to be learned behaviors that are attained through the manner of classical and/or operant conditioning. In this story, Daryl develops into focus to longings that can be stimulated by stimuli that were previously neutral but have now become probable sparks. In the learning by outcome model (operant conditioning), substance use behaviors are fortified by the outcome that results their use. If after using a Daryl more comfortable in social

Shankar, G-PSY-7500- 40 Option I circumstances, or elevated, for example, then the use of the substance is likely to be continuous due to this positive reinforcement. CBT Application Model for Daryl- Few Examples Downward Arrow & Striving for Significance CBT Daryl is helped to uncover underlying assumptions in logic and sequence through careful questioning by the therapist, "Comparing : Striving for the illusion of significance over others in order to overcome the IF rather than striving for genuine significance. The desire for significance, achievement, accomplishment. Feeling of Community & Labeling of Distortions CBT Practical Application Practical Application Daryl turned his striving inward on himself, eliminating the need to evaluate himself in relation to others and focusing his life on the elevation of himself and his goals with the help of substance abuse and alcohol and therapist can focus on his achievements minus drugs

Shankar, G-PSY-7500- 40 Option I Daryl is helped to identify automatic thoughts that are "dysfunctional or irrational." Daryls feeling towards others is very superficial. Interconnectedness with all of life have three components: 1. Cognitive - to know it 2. Affective - to feel it 3. Behavioral - to do it Therapeutic goal is to extend the feeling of community to everyone. Daryl as he was presented in the movie with little regard for anyone besides the more threatening people in his life. Those people who tried to reach out to him were usually met with extreme resistance like he handled the counselor, his mother and his friend. But movie also shows Daryl could change, his readiness for writing the moral inventory is big step towards introspection (even as a last resort) and his genuine concern for Charlie is another one. It can be extended to his friends, parents and community Ostrich technique CBT Substance abusers are often self-indulgent, avoid responsibility. Themes of escape distance from reality, wanting an easy way.... Practical Application Therapeutic goal is to develop self-discipline, acceptance of responsibility. Daryl is able to talk honestly about life with an attractive woman in the center, Charlie. . Daryl started One central theme is reflected in every psychological expression, in the way the staying straight, not because he has been cured, but because he has found someone else

Shankar, G-PSY-7500- 40 Option I individual approaches/avoids the t tasks of life. Involves all or nothing thinking, rather than the flexible problem solving of a healthy person. to control - he takes the responsibility for keeping Charlie straight and it is a good beginning and therapist can start working from there.

Automatic Thought Records and Cognitive Rehearsal CBT The automatic thought record (ATR) is a key component of CBT. The ATR is used as homework after introducing the process within the therapy session. The individual completes the columns identifying a troubling situation, resulting emotion, and thoughts associated with both. The therapist and Daryl work on clarification and development of "rational" responses in order to debate or challenge the original reaction. Prior to making a behavioral change, it is sometimes less threatening to "practice" the new behavior through visualization and Practical Application Daryl seems to have fluctuating thoughts .Therapeutic goal is to develop feelings of responsibility and obligation to others. Daryls way of breaking the policies and using the phone of councilor, breaking into office building at odd hours and asking his mother and prodding her to take second mortgage to cater his problems of addiction and embezzlement are the issues therapist should work with based on his automatic thoughts, documenting the thoughts and working with therapist. REBT approach with Daryl can be very effective

Shankar, G-PSY-7500- 40 Option I discussion. For example, this would include practicing assertiveness in a mirror or "talking through" a confrontation out loud prior to actually following through with the conversation.

Social Skills Training CBT It is important for the therapist to review and instruct on behaviors that will improve the potential for successful social interactions. Affective - feel a deep belonging and empathy for others. Feeling at home on the earth. Cognitive - necessary interdependence with others. The welfare of any one individual depends on the welfare of everyone. Behavioral - thoughts and feelings translated into actions aimed at self-development and cooperative movement toward others. Practical Application Therapeutic goal is to develop unlimited, unconditional cooperation/social interest. For Daryl from an early point on, the way that he presented himself, his Style of Life, was indicative of his internal and external struggles. Daryl as he was presented in the movie with little regard for anyone besides the more threatening people in his life. Those people who tried to reach out to him were usually met with extreme resistance like he handled the counselor, his mother and his friend. However at the end as he stated caring for Charlie, it is

Shankar, G-PSY-7500- 40 Option I definite path towards social interest despite its narrow outlook and in my view therapist can make a beginning in improving his social interest and the need of self-development and individuals dependence on others and the beauty of social interest

Shankar, G-PSY-7500- 40 Option I References

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