(You can learn more of the martial arts history of Sigung Chavez by clicking here.)
I consider myself a cognitive-behaviorist, yet, as with many of my colleagues, I do not rely solely on cognitive-behavioral techniques when I work with clients. This belief is grounded in the fact that I have had the good fortune to be enrolled in an institute, which encourages and allows you to virtually design your own path. As with any APA accredited psychology program, the standards we were held to were high. The breadth and depth of knowledge we were exposed to and expected to acquire, gave us the education to embrace the science of psychology in order to become a scholar-practitioner. Subsequently, we were encouraged to transcend the norm and pardon the cliché, think outside the box. So to call myself a strict cognitive-behaviorist, would truly be a misnomer. Yet, this continues to beg the question: Exactly what is my theoretical foundation and contemporary context of my perspective?
My first experience as a new graduate student with regard to my theoretical orientation, came about in a manner which could have been disastrous. I was at a local coffee shop in my town, which is situated close to the university. It was not unusual to see professors there. One psychology professor, who I had known since my undergraduate days, asked me how my PhD program was going and, specifically, if I had settled on a theoretical orientation. I responded by saying I was very intrigued by cognitive-behavioral therapy, because it seem to be a natural transition for me. I was quite surprised by the affective shift I saw take place before me. At first he appeared startled, followed by a loss for words. This was atypical for this person. He then became mildly angry and said, “Don’t you know they don’t deal with people feelings?” Of course, at this point I am sure I displayed an affective shift of my own. I regained my composure and laughed it off; unfortunately, he was not laughing with me. I am quite sure this experience is not unique, but it did send a powerful message to this new graduate student. Sectarianism can even confuse the insightful.
In retrospect, I realized that was probably the best lesson I could have learned. Initially, I was vigilant in searching for any weaknesses I might have in my theoretical orientation. I quickly came to the realization that each theory had something to offer. What was especially rewarding with respect to the encounter with my professor, occurred when I came to understand that cognitive theory which originated with Beck’s attempt to empirically validate psychodynamically driven formulas of depression (Alford & Beck, 1997). Without discussing the specifics of the outcome, what came out of Beck’s need to test theories was a removal of the fear to question what is established, to be prepared to discard what does not work, and embrace the results when it is in the best interest of the patient and the science of psychology.
I was first introduced to the field of psychology via the martial arts. My instructor, from whom I earned my black belt in 1972, had a master’s degree in psychology. As I reflect back on my days as a beginning student of the martial arts and my instructor’s approach to teaching and motivating, I realized he was not your typical coach or sifu (teacher). Granted, he was not a clinician, his interests, in retrospect, seemed to be more oriented towards experimental and research psychology, yet he seemed to have a functional knowledge of instructing this group of kids to master sequencing, recall, improvisation, control, balance, and self-discipline. The martial arts, in those days, were not very popular, and often the kids who would join the martial arts club seemed to be the school “misfits.” I do speak for myself in this case.
As with many of the sports organizations in schools, to “make the team” you either had the ability or you did not. Representing the school seemed to be the most important focus to many coaches. It made no difference to my instructor whether you were a star athlete or lacked natural ability. I believe because of his use of appropriate reward/reinforcement and other components of learning theory, he was able to train us successfully, where others would merely “cut” us from the team rather than take the time or utilize good judgment and allow us to grow. He offered us the opportunity to go beyond our cognitive distortions and automatic thoughts, such as “I can’t do it”; “Everyone else always makes the team”; or, “I’ll never be an athlete.” Of course, he never used the terms “cognitive distortions” or “automatic thoughts”, nor did he verbalize his intervention strategy in psychological terms. As a result of his teaching/interventions a great number of us were able to go further than we ever thought possible. We also were learning, in some cases vicariously, important physical, mental, and emotional aspects of human nature. I will discuss these aspects in more detail later.
In addition and in relation to my theoretical perspective, the martial arts style I studied, Kajukembo has much to do with my openness to accept other forms and orientations. I believe that the beauty and effectiveness of this style is inherent in its original conceptualization. The founder collaborated with four other martial arts professors. All had mastered their respective self-defense art forms. It was the first multiculturally based system of self-defense. The goals were clear: Use what works; Do not hold onto what does not; and It must function in a street self-defense situation.
I believe the aforementioned mentoring and exposure contributed to laying the groundwork for me to construct my theoretical orientation as a future psychologist. Seeing a need to apply my martial arts abilities outside of the competitive arena, I became a volunteer self-defense instructor for the Albuquerque Rape Crisis Center and the Shelter for Victims of Domestic Violence. I approached the staff at both agencies as a person with much to teach them about defending themselves in a sexual assault or domestic violence situation, but soon realized that I would start out as the student and not as the teacher. In addition, while I assumed I was teaching my new students how to defend themselves on a physical level, I was inadvertently empowering my students with skills I did not fully understand at the time. It was not until I started to learn psychology, in general, and the structural components of Cognitive-Behavioral therapy, in particular, that I realized I was offering more than just physical self-defense. One of my primary goals as a self-defense instructor was to offer the clients the ability and opportunity to take themselves out of the victim role and empower them to change their thinking about defending themselves or developing the courage to leave a dysfunctional relationship.
As a result, as I began to study the theories which make up cognitive psychology, and with the idea of “victim” as my focus and initial challenge, I was attracted to the concept of “schema” (Beck, Rush, Shaw, & Emery 1979). Beck, et al. describe schema as a cluster of stable cognitive patterns. Young and Klosko (1993) add that they are “deeply entrenched beliefs about ourselves and the world, learned early in life” (p. 6). More specifically, and to use a more contemporary version of the term, Elliott and Lassen (1998) posit the concept of self-schema. They define self-schemas as “…abundant information about your characteristics, strengths, weaknesses, behavior, and preferences, and about the way you relate to others” (p. 8). Schemas can be adaptive or maladaptive. The maladaptive schema, Vulnerable, I believe, closely describes a victim schema. Elliott and Lassen use descriptors such as agitation, tension, fear, and allude to thoughts of criminal perpetration, and feeling small and weak.
Therefore, with these various “red flags” raised by my students, I would often approach them, because of my limited knowledge at the time, via a physical intervention. For example, if a student presented in a fearful/anxious state or experienced panic, the first technique we would discuss and learn were breathing methods, since physical symptoms, such as shortness of breath, are prevalent in many such cases (Carlson, 1995) along with increased heart rate (Masters, Burish, Hollon, & Rimm, 1991). I would notice that many times, proper breathing techniques when mastered, would decrease negative emotional content. This became evident in the affective shift I saw taking place with the student; this along with verbal feedback. The outcome resulted in the student’s ability to think in a more constructive manner and allow the cognitive-behavioral technique of cognitive restructuring to begin to take place (Edwards, 1989). Once this restructuring started occurring, I would notice an increase in the person’s ability to learn and articulate more directly and clearly what their needs were in relation to defending themselves and/or thoughts of leaving a potentially destructive situation. The ultimate goal was to teach the person how to generalize this information to the environment where the abuse was occurring.
Examples, such as the aforementioned one compelled me to investigate more comprehensively the emotional aspects of my clients. Originally, this was not the focus of my teaching. My involvement with survivors of sexual assault and domestic violence redirected my focus. It was around this time that I was hired to assist in the development of a therapeutic program for adolescents in a psychiatric facility. It was because of my martial arts involvement with the Rape Crisis Center and Shelter for Victims of Domestic Violence that the clinical director wanted me to play a key role in program development. It was especially fortuitous for me that the clinical director’s theoretical orientation was cognitive-behavioral, and he was also enthusiastic about integrating martial arts as therapeutic intervention.
It was through this involvement that I started to solidify my approach. My earlier work centered around issues usually resulting from assault and abuse of the mental, physical, and emotional type. Entering the world of psychiatric patients brought about many changes and learning experiences, thus further refining my theoretical orientation. Along with cognitive-behaviorists, I had the opportunity to work alongside therapists and to be influenced by practioners of many different orientations. I observed and participated in psycho-drama (Masters, Burish, Hollon, & Rimm, 1991), experiential therapy (Greenberg, Safran, & Rice), music therapy (Yeou-Cheng, Nagler, Lee, & Cabrera, 2001), addiction therapy (Ellis, 2001), and group psychotherapy (Yalom, 1975). I also had the opportunity to observe and, when appropriate, participate in folk healing rituals conducted by local tribal healers and curanderas (spiritual healers) (Koss-Chioino & Vargas, 1999; Sue & Sue, 2003).
Despite my inclination to instruct individuals in the art of self-defense in violent situations, another facet of human behavior caught my attention and became an integral part of my theoretical foundation. I felt compelled to investigate and better understand, in depth, the basis of anger and violent aggression. Through my years of training in the martial arts, I have had the opportunity to train and observe fighters. It became obvious from the beginning that the more angry a person became during a confrontation, the less able he/she was to physically and cognitively function effectively to gain control over the opponent. Physical performance has been known to suffer as a result of violent arousal (Cox, 1990). To put this in cognitive terms, when a person reacts in an excessively emotional manner, it is quite common for cognitive dysfunction to manifest itself (Beck, Rush, Shaw, & Emery, 1979) and I believe directly affects motor performance.
This brings me to a philosophical connection between the martial arts and cognitive-behavioral psychology. I stated earlier that my martial arts instructor had a background in psychology; there is great significance to this with respect to my interest in becoming a future psychologist. It is important to keep in mind the Western basis of modern psychology and its Eurocentric roots; however, the underlying component/connection that I believe has had a greater influence on my theoretical orientation is the Eastern concept of balance illustrated by the yin and yang. In describing the yin and yang, Chan (1969) quoted Confucius by stating “Ch’ien and k’un are indeed the gate of Change! Ch’ien is yang and k’un is yin. When yin and yang are united in their character, the weak and the strong attain their substance” (p. 248-249). Mann (1972) adds that the components of which the yin and yang are comprised, must not be seen as absolute, but as relative. He also states that these complementary opposites are the very foundation of life in China, and everything from medicine and art to writing and philosophy are guided by it. Chinese acupuncturists have embraced the concept of yin and yang in their discipline when treating psychological illnesses. There is not sufficient space in this paper to present an in-depth description of the acupuncture approach, but the idea is to find a balance within the internal organs to bring about psychological change.
The concept of yin and yang/balance has allowed me to effectively bridge the gap within and between the two disciplines (therapy and martial arts) in a number of ways. I must mention that I utilize the combination of Eastern and Western approaches in a way that is acceptable to my clients and their families. For example, I do not require that my clients “snatch a stone from my hand” before they can successfully leave therapy. Putting the concept of balance in Western terms, in my experience, has allowed a number of my clients and their family members to grasp various psychological concepts with more understanding.
Support for this idea has been effectively illustrated in Elliott and Lassen’s book Why Can’t I Get What I Want? (1998). The authors, while referring to the cognitive-behavioral concept of adaptive versus maladaptive schemas, which I mentioned earlier in this section, utilize the Eastern concept that “The more opposite two phenomenon appear, the more they become the same” (p. 26.). To the linear (Western) thinker, this might appear to be a Confucian distracter, completely missing the point. An illustration I have seen manifest many times with adolescents, which supports the concept of opposites, has to do with order, rules, and freedom. I can offer many instances where highly oppositional adolescents, when first introduced to the program rules, argued and fought over having to comply, since autonomy is an important concern with many in this age group (Levesque, Zuehlke, Stanek, & Ryan, 2004; Regoli & Hewitt, 1997). In many cases, the family system was guided by faulty parenting techniques (Connor, 2002). Albeit anecdotal information, I have spoken with many teens who have successfully completed treatment in the program I was involved with and I started hearing a recurring theme in their feedback. Many reported that, once they understood the rules and followed them, they no longer felt oppressed by them. All too often they came from an environment that was chaotic or “out of balance”. There was no order, or, in some cases there was inappropriate, oppressive order. Once they could see that the rules were established to keep them safe, they understood the difference, and this appeared to give them a sense of balance in their lives.
To further illustrate the concept of balance, I will discuss it across three domains: physical, emotional, and cognitive. The most common connection, especially to the layperson, is the concept of physical balance. Interrupting an opponent’s physical balance during a physical confrontation is a very effective method of defense. I teach this to my martial arts students early in their training. Outside of that area, if we lose our balance just walking down the street, we do what we can to regain it, i.e. grab for a handrail, put our arms in front of us, or brace for the fall. At that split moment, nothing else matters to us. Losing one’s balance can be a result of a medical condition, not paying attention, instigated by someone else, substance use, or age, for instance. This is an especially critical issue for senior citizens (Kallin, Jensen, Olsson, Nyberg, & Gustafson, 2004).
The next two areas of balance, emotional and cognitive, I often combine when doing therapy, since one often impacts the other in both good and bad ways. For example, if we take the cognitive concept of “subjective reasoning” (Beck & Weishaar, 1989), which confuses feelings with facts, and believe a cognitive distortion (I will never get the job.) to be based in fact, and the feeling of “worthlessness” (I don’t deserve to get the job.) validates the distorted thought, we will constantly keep ourselves off balance. In other words, the more we validate distorted thinking, the more ingrained or inflexible it becomes and the less able we are to maintain emotional and cognitive equilibrium. A common, and unfortunately often deadly manifestation of this is the phenomenon of “road rage” (Vest, Cohen, & Tharp, 1997). For instance, a person changes lanes and forgets to use his or her turn signal. The person in back has to break quickly and becomes enraged. The person who was cut off believes that the person did not signal the lane change on purpose just to “anger him” (distorted thought). The enraged person now feels that he will never let anyone purposely take advantage of him (worthlessness), so he acts out violently. Vest, et al. reported that “aggressive driving” altercations have increased by 51% since 1990. Firearms have been used in 37% of the cases, other weapons 28%, and cars, 35 %. This is obviously a serious problem, but, according to the AAA, these percentages need to be re-evaluated, since this was the first study of its kind. I would like to add that it is not my belief that all of the above reported occurrences are a direct result of distorted thinking or inflexible schemas.
Another important and useful component of my earlier experience as an instructor of martial arts which I brought to the field of psychology was my ability to read my competitor’s/student's body language and affect. Gibbs and Wilson (2002) reported that “people's pervasive bodily actions provide the foundation for significant aspects of how people think and talk about their experiences” (p. 12). If one is reliant on "reading" a competitor for gaining points in a competition or knowing how to prevent a potential abuser from doing harm, this skill should be of the utmost importance for survival. I quickly learned that our emotions tap into our biological core in order to utilize the body as a transmitter (Damasio, 1999). While working with survivors, we would often discuss various situations and role-play different outcomes and techniques of defense. Depending on the level and type of abuse and trauma, I began to see generalized physical manifestations across genders (Halberstadt & Saitta, 1987) and cultures (Ekman, 1980). This also helped me to better understand the person’s level of cognitive receptivity and their potential ability to apply techniques in a future situation. I also came to a realization that my own body language had an effect on the people around me. Because of this experience, I understood the value of body language in psychiatric settings. Many of the patients were not in treatment voluntarily, unlike at the Rape Crisis Center and Shelter for Victims of Domestic Violence. Initially, patients experience great reluctance in discussing their issues until a solid rapport could be established. Many years of experience with body language proved invaluable in approaching my patients’ needs more effectively and appropriately and enhanced my contribution to the treatment process. In relation to rapport building, having scrutinized closely my own body language, I was aware of its impact on my clients, and the process allowed me to better integrate constructively into the overall process and build trust.
Furthermore, when I became a licensed therapist and began conducting individual, family, and group sessions, I was not accustomed to sitting down while participating in the session; I was used to a more instructional classroom setting role. Initially, I felt compelled to stand and move about the room, partially out of habit. Sitting offered me a different perspective and motivated me to verbally apply more directly my cognitive-behavioral techniques, as opposed to relying on my physical techniques and abilities to make my point or instigate an intervention.
In summary, my theoretical foundation was refined by various philosophies. I have focused on studying, embracing, discarding, and tailoring many of the myriad theoretical orientations that exist in psychology today and combined the many other interests and experiences I have had over the years. I believe entering the field during one’s middle age offers perspective and experience we do not have in our early twenties. Lessons learned through living may not always have empirical support and may pertain only to a select few; yet, the young person, like the painter, who adds colors to reveal their piece of art, as we get older, we become the sculptor, who reveals their masterpiece by removing that which is not needed.
2) How your perspective has changed and evolved, including how you have decided to incorporate and reject other perspectives, during your study of the wide array of psychological theory and research.
As I stated in Section I of this paper, I did not enter the program as a therapist, as many of my colleagues had, so I was not fully grounded in one particular theory as a working clinician. Over the course of my graduate studies, I often utilized a cognitive-behavioral orientation as my template, yet other aspects of the science of psychology intrigued me greatly, and I continue to find ways to incorporate them into my work.
One of these aspects, neuropsychology, captured my attention and altered my perspective on both my future theoretical orientation and how I work with and view my clients and their behaviors. Before entering graduate school, I read a book by Oliver Sachs titled The Man Who Mistook His Wife for his Hat (1985). This was my first introduction to the mysteries surrounding the uniqueness and function of the human brain and served to fuel my interest in the topic. During my second year in graduate school, one of our visiting professors highly recommended Antonio A. R. Luria’s book The Working Brain (1973) and Demasio’s book Descartes’ Error (1994).
Prior to that time, I had recently completed my graduate coursework in the “History and Systems of Psychology” and found the earlier research in the area of neuropsychology to be riddled with controversy. One of the more interesting yet quickly discredited approaches, was Franz Joseph Gall’s concept known as Phrenology (Fancher, 1990). This form of pseudoscience proposed that various cognitive faculties were localized within certain parts of the brain, and if the brain manifested a lump in a particular area, that lump confirmed the existence of the faculty, and the size of the lump determined the developmental level of the faculty (Campbell, 1989; Chaplin, 1985).
After reading the two aforementioned books by Demasio and Luria, I realized that the science of neuropsychology had evolved greatly since the days of Gall and was assisted by the advent of various brain imaging techniques and the vast array of lesion studies (Carlson, 1995; Demasio & Anderson, 1993; Geschwind & Iacoboni, 1999; Heilman & Valenstein, 1993; Kolb & Whishaw, 1995; Lezak 1995; Luria, 1973; Rourke, Bakker, Fisk, & Stang, 1983; Walsh, 1994). This encouraged me to pursue a greater clinical understanding of the role the brain plays in human behavior, pathology, and treatment. The vast domain of human neuropsychology at first appeared to be insurmountable. This was before I was introduced to Luria’s theory in his book The Working Brain, which, for me, reduced the complexities of the human brain to a more workable form. First he viewed the cortex as two separate functional units: One he referred to as the sensory unit, which was located in the back or posterior portion of the cortex; the second he referred to as the “motor unit” located in the front of the cortex or the frontal lobes. Notwithstanding the apparent generalized localization of function proposed by Luria in the sensory and motor units, he posited the idea that each functional unit contains its own hierarchical system, theorizing that human mental faculties are not localized to one specific area of the brain. The cooperative effort of these hierarchical systems allows each unit to function. This opened many doors and allowed me to begin to construct an operationalized understanding of the brain and human neuropsychology in order to enhance my own theoretical approach and outlook. As a result of current research, the following description of Luria’s hierarchical model has come under question (Kolb & Whishaw), but I present his pioneering work in a historical context.
It is important to keep in mind, as you read the following information, that each functional unit (sensory and motor) has its own primary, secondary, and tertiary zones; yet in the process of functioning, the two units will work cooperatively, moving between the two zones. As stated previously, the cortical structure of the three functional units is hierarchical, placed one over the other. The design is laid out in the order of primary, secondary, and tertiary, with the functions being: reception/transmission; processing/programming; and intricate mental activity across numerous cortical regions, respectively.
More specifically, the first of these functional units is concerned with the waking or regulation of tone. It is here that we experience our best opportunity to regulate our mental processes. Pavlov referred to this as having an optimal level of cortical tone (Luria, 1973). In this state, we are able to take in and process information, unlike during the sleeping state where optimal cortical tone decreases. The reticular formation of the brain stem is responsible for regulation of cortical tone (Walsh, 1994).
The second of these units takes in information from the world around it. Once it has gathered the information, it then assimilates and stores it. This function manifests behaviorally as an orienting reflex. The concept of “orientation reflex” is attributed to Pavlov (Luria, 1973). In contrast to the primary zone, which according to Walsh (1994) is focused on sensation, the secondary zone is directed more towards perception. This is supported by the fact that perceptual issues arise when an insult occurs to a secondary zone. Its location, as described by Luria, (1973) “…is located in the lateral regions of the neocortex on the convex surface of the hemispheres, of which it occupies the posterior regions, including the visual (occiptal), auditory (temporal) and general sensory (parietal) regions” (p. 67).
The third and last zone, as described by Luria (1973), has the job of programming, regulating, and verifying of mental processes. Moving from the second zone to the third demonstrates that humans are more involved in processing incoming information, rather than just passively observing that information. Intent or conscious activities come into play. A person creates a plan of action, activates the plan, has a feedback loop, which checks on the progress and regulates the process by continuing, changing, or stopping the plan. The third or tertiary zone is situated in the frontal lobes of the human brain. Fuster (1999) offers a list the various sections of the frontal lobes. He begins with the primary motor cortex, which controls the manifestation of movement, both cognitively and skeletally. Next is the premotor, cortex whose job it is to assist in more intricate planned/directed movement, including verbal interaction. Lastly is the prefrontal cortex, which is highly involved in following through, physically and verbally, on designated plans and ideas.
To many, the frontal lobes were considered the “seat of all higher cognitive processes” (Filskov, Grimm, & Lewis, 1981, p. 62), but this is not completely correct. It is now recognized that the frontal lobes do not work alone; they instead utilize a network approach to function effectively. Regardless, it is important to note that the term “executive function” (Chow & Cummins, 1999; Grigsby & Stevens, 2000; Lezak, 1995; Samango-Sprouse,1999) is commonly used in the literature to refer to the systemic/supervisory approach used by the frontal lobes to plan, instigate, control, and monitor behaviors.
Another reason that neuropsychology was of interest to me was due to the fact that, as a person who had initially been involved with clients on a physical level, i.e. such as movement in the martial arts and self-defense, I always had an interest in the neural components of physical/motor movement. In addition, it was quite common, while working with my clients and their families that they were often looking for tangible or measurable answers to their questions concerning etiology, diagnosis, treatment, and outcome. Offering the family an empirically-supported (in many cases) and physically- based answer as an option, seemed to be less vague, especially to the client/family who had not been involved in the mental health arena. For example, there are many predictors and warning signs of youth violence i.e. uncontrolled anger, impulsivity, substance abuse, rejection, etc. (Moeller, 2001). When explaining to the parents of the child who is experiencing violent behaviors that there is some support in the research concerning frontal lobe dysfunction and aggression (Connor, 2002), as one of the predictors of violence, can offer the parents an alternate vantage point to view the issue. I have had many years of personal experience working in a psychiatric hospital setting. In that time, I have seen that many people are more comfortable with a medical model, where measurability is usually obvious even to the layperson i.e. coughing, bleeding, death, etc. It is not unusual that their reaction to the inclusion of a neuropsychological option is often more receptive, especially if there has been some psychological testing to support your feedback and/or to offer a baseline (Lezak, 1995).
Therefore, learning about the concept of executive functioning has added to my understanding of human nature in a multitude of ways. For example, upon entering the field of mental health, the first population I had the opportunity to work with was adolescents. It was quite common for me initially to be given the clients with more aggressive tendencies, especially if there was concern by the staff that they might aggressively act out. As a result of this along with my experience with aggressive persons in rape crisis and domestic violence centers, I gained an early interest in learning about the etiology of violence and aggression for the sake of client safety, treatment intervention, and for the benefit of patient/survivor, his/her parents, and other family members.
In approaching this challenge, I became aware that there are a vast amount of theories pertaining to conduct issues in children ranging from parenting skills and family factors to school concerns and peer involvement (Webster-Stratton & Reid, 2003). Added to this is the role the frontal lobes play in the process. This gave me the insight to include questions, which could offer further clues to the etiology of the aggression and/or conduct problems i.e. developmental inconsistencies, head trauma, type of birth, substance use during pregnancy, etc. This is supported by a theory arrived at by many researchers, which posits that the frontal lobes have been closely connected and have the ability to control aggression and impulsivity. Consequently, damage to this area increases the risk for aggressive/impulsive tendencies (Connor, 2002; Lezak, 1995; Miczek, Mirsky, Carey, DeBold, & Raine, 1994; Pincus, 1995; Moeller, 2001; Regoli & Hewitt, 1997.
In addition, Damasio’s book Descartes’ Error (1994), offers insight into the important role the brain plays in understanding human nature and behavior. I stated earlier that Gall’s phrenology had long been discredited, and Damasio concurred when he reported that the majority of the findings of Gall were disproved. However, Damasio does give credit to Gall for his concept of brain specialization, which has since been radically refined, but reiterates the fact that there are no specific independent centers in the brain and instead functions as a result of the contributions of various systems working together.
At the time of my initial reading of Descartes’ Error, most of the information was beyond my comprehension. Yet, one historical incident, which has been reported by many researchers (Carlson, 1995; Demasio,1994; Grady, 1999; Grigsby & Stevens, 2000; Pincus, 1999; Regoli & Hewitt,1997; Weingarten,1999), caught my attention and increased my interest in neuropsychology. This was the case of Phineas Gage, who in 1848 was involved in a freak accident. Gage was a supervisor for a railroad gang which was installing track through the state of Vermont. His assignment for that day was to blast out stone from a hillside in order to lay new track. It is important to note that before the accident, Gage was in good physical condition, very personable (his crew liked him), he had an intellectually sufficient understanding of his job, and could fully manage any responsibility given to him by his boss. These skills were especially essential, as he was entrusted with the assignment of handling and detonating explosives. The event that occurred that day left Gage to live out the rest of his life in turmoil (known and unbeknownst to him); however, its significance in the field of neuropsychology posed a mystery and offered extensive insight into the workings of the human brain, personality, reason, and emotion. Yet in the words of Damasio, “Gage posed more questions than he gave answers” (p. 18).
Historically, this case drew the attention of not only the medical field, but also those interested in legal, ethical, and moral issues (Pincus, 1999). It appears that this also gave Antonio Demasio the opportunity to reopen the debate on Cartesian dualism. He states in Descartes’ Error, that Descartes’ error was “…the separation of the most refined operations of mind from the structure and operation of a biological organism” (p. 250).
As an aside, part of my interest in this case has to do not only with the obvious resiliency of the human body, but also the intricate and subtle role our brain plays in who we are as an individual on many different levels. The accident should have killed Gage, but by some miracle, he survived. When the blast occurred, an iron spike entered the left side of his face by the cheek and exited from the top, frontal portion of his head. On a physical level, Gage appeared to be normal, short of being blind in his left eye, but all his limbs functioned, along with his hearing, touching, tasting, and smelling faculties (Demasio, 1994). Even though after the accident physical appearances were minimally affected, there was a dramatic change in his personality and behaviors i.e. he became inattentive, socially uninhibited, lost his sense of judgment, etc. (Carlson, 1995; Grady, 1999; Kertesz, 1999).
I entered graduate school a tabula rasa in relation to an overall theoretical orientation, yet held my own notions about how to help people in need. I was a physical person first; I then embraced a cognitive-behavioral orientation. I became aware early in my career as a martial arts teacher, that the human body could withstand trauma. This became especially clear working with battered women and children survivors. It was only after delving into neuropsychology, which albeit still lacks precise and complete explanations (Damasio, 1994), that I obtained a clearer awareness of the internal workings of the human condition and offer my clients and their family members greater insight into this condition. In turn, these clients were introduced to a broader outlook on pathology and a more realistic understanding of recovery.
In closing this section, I wish to state that there have been many perspectives, which have constructively guided my study of psychology, some more than others. As I began my research for this paper, realizing the space constraints I was under, I reflected on the vast array of theories and research that make up or influence my theoretical style. I was at a loss to know which ones to include; which ones had the deepest affect. I also thought about the individual, family, and group sessions I conducted, during both practicum and internship, and remember how fortunate I was to have the option to integrate the many different perspectives I studied. The beauty of my upbringing in graduate school, to use a neuropsychological term, is that I have become “hardwired” to question all that I am learning, as discussed in the next section of this paper when I talk about learning how to critically think. This will keep me keenly aware of the necessity to always evolve and change when I see that I have stopped growing and/or improving.
3) How your work as a psychologist is influenced by both theory and research.
As stated in my introduction, my first exposure to behavioral health came as I was assisting people on a physical level with issues of self-defense. In that sense, the client wanted something that was measurable and tangible. In other words, were the techniques they were learning going to work in a real life situation? Virtually every concept and application required an explanation, often in a very linear and/or cause-and-effect manner. I carried with me into the field of mental health the understanding and necessity that things be measurable, at least to a certain degree.
When I first encountered various master’s level therapists, it appeared to me that intervention techniques were applied from a limited repertoire of approaches and in some cases, these approaches were quite dated. This is not to say that the outcomes were bad or the techniques were applied inappropriately. Often I would hear that their workloads were such that they were unable to find time to read journal articles or any of the latest research (Kottler, 1993). This, of course, could be the result of the managed care crisis, which placed extreme workloads on many mental healthcare workers (Hersch, 1995). I appreciated the various counselors and therapist I worked with at various agencies, but felt a need to research more extensively the reasons why certain approaches were taken with certain clients and what the latest literature had to offer in relation to them. Entering the field of clinical psychology gave me the encouragement, opportunity, and tools to properly investigate the abundance of research and the numerous theoretical orientations being utilized throughout the field.
Therefore, starting out new in the field and realizing the importance of assimilating pertinent literature in a timely manner, I needed to learn how to be a critical thinker, to question what I read, to decide what was not necessary, to fully understand the information, and find appropriate applications. My major goal is to offer the best possible help to my clients and someday contribute to the literature in field of psychology. I was fortunate to have had a local faculty member who was a prolific writer, researcher, and clinician. He constantly stressed the concept of critical thinking. Many of our face-to-face meetings were comprised of dissecting articles, looking for the flaws, and arriving at ways to improve the article as if to rewrite it. I still recall reading my first technical article for a critical thinking seminar and assuming it had to be valid; because it was quite technical and published in a respected journal. When my faculty supervisor finished his critique of the article I realized it was riddled with problems. Aside from having to acquire the various skills in order to properly, assess an article, i.e. understanding methodology, statistics, external vs. internal validity, etc., etc., it gave me the impetus and confidence to improve my own writing, research, and self-evaluation skills.
My next step in understanding the process of research came about when my local faculty, in conjunction with another faculty member, was in the process of designing, testing, and administering an instrument and needed research assistants. The lesson at hand unfolded in a manner that was very advantageous for all of the research assistants. We were able to follow a theory through its evolution. The theory was often the focus of discussion during our meetings when I first entered graduate school. Two years later, an article discussing the model for case conceptualization was published and soon after we were involved in assisting with administering the instrument to help test the theory. The experience was valuable in numerous ways. We had the opportunity to see the concept go through its many changes and eventually published in book form. It was obviously inspiring, but, more importantly, it allowed us the chance to see the research process first- hand from its inception to fruition. I now feel more confident and competent in the area of critical thinking and look forward to conducting my own research, starting with my dissertation.
Furthermore, critical thinking has allowed me to look at and utilize theories in a more productive manner. I have become aware that, as I am applying the theory, I am also testing it. Critical thinking encourages looking for ways to improve theory and not merely take it at face value. Often I found many theories to be cumbersome, too broad, especially when working in the clinical setting. Rosenthal and Rosnow (1991) offer a useful distinction between a theory and a hypothesis. They posit that a theory closely resembles a large map, demonstrating a group of concepts and how they are logically connected. Hypotheses differ in that they are compared to a small map representing a close up, more tightly focused view. It has proven more effective for me to reduce theories to a more workable state, especially when applying a theory in a clinical setting. When working with a new client or family, it is usually more advantageous at the beginning to leave all theoretical options open. The next step is to deduce the best possible approach and then reduce that to a more applicable form.
I will demonstrate the aforementioned with an example discussed in more detail in the following section on diversity. I was working with a young girl whose first language was Spanish, but had acquired a basic conversational grasp of English. Her desire, probably as a result of her immersion with her non-Spanish-speaking peer group and seeing herself as very acculturated (gathered from self-report), was to blend in with her new host culture as much as possible and give the appearance of having a high comfort level in her new setting, in both social and verbal areas. Having just learned Cummins’ theory of BICS vs CALP (Cummins, 1984) speakers (see details in section four), I was eager to apply what I had just learned. Upon initially hearing her speak, I was taken aback by her control of the English language. She made statements and remarks any teenage adolescent girl would make who had grown up in this country, watching television, going to the mall with friends, attending school, etc. I thought that since she had learned English at a younger age, she had acquired a better grasp than had someone the age of my parents, who started speaking English in their early twenties. Using Cummins’ theory, at first I thought she was a CALP speaker in both Spanish and English. In was not until I was administering the Thematic Apperception Test (TAT) and Roberts Apperception Test for Children (RATC), that I started to see a breakdown in her delivery. She was experiencing cognitive conflict as she started emoting and would revert to Spanish when she needed an emotional descriptor. Along with her need to code switch (language mixing) (Heredia & Altarriba, 2001) to communicate what she was feeling, you could also sense a level of embarrassment with her when she needed to speak Spanish. I have found the reverse of this true with myself when speaking Spanish and having to revert to English, when I get nervous in either clinical or some social situations.
In conclusion, how has my work as a psychologist been influenced by theory and research? I believe that the foundation I have constructed has been based on an honest desire to educate myself with the literature and to critically follow up on information, which might assist me in being more thorough, effective, and functional as a psychologist. This statement might seem to create limits on my application of approaches, but I have also not lost the sense that I, too, have something to offer, and my personal explorations and theories should not be limited by a need to rely solely on empirically-supported data. I have always admired a statement by Albert Einstein, which states, “If at first the idea is not absurd, then there is no hope for it” (MacHale, 2002, On-line).
How your psychological perspective responds to issues of diversity in cultural beliefs, values, and behaviors.
I have had many rich opportunities in the area of cultural diversity. Having been raised in a family where both of my parents were monolingual Spanish speakers until their early twenties and having grown up in two very different areas of the state, I have a heightened awareness of the important role language and culture plays in everyday life. I have found this to be especially valuable when intervening with cognitive and emotional needs on a cross-cultural level. I was personally caught in a confusing role, since my parents did not want me to grow up with a Spanish accent when I spoke English; they decided to suspend my bi-lingual learning until I was in high school. In retrospect, this was probably not the best decision to be made, since it made learning Spanish much more difficult for me in my later years, but my parents did not want me or my siblings to encounter the problems they had in education and in the job market.
That being said, the benefits I gained from my developmental years with my parents have served me well. Even though we were not being taught Spanish per se as children, we noticed that our parents utilized their bi-lingual abilities sometimes explicitly and sometimes implicitly depending on the circumstances in their raising of my siblings and me. Reflecting back is significant, revealing, and amusing. The most telling events were times when our parents felt the need to communicate with each other without us knowing what they were saying. In the case where only one language is spoken in the home, most parents would usually spell out what they did not want the kids to know; our parents would say it in Spanish. This did not directly teach us the language, but, via the exposure, we were able to vicariously work on our vocabulary and pronunciation. At the time, it was a prime age for “hard-wiring” our brains in order to improve our facility of the language (Huttenlocher, Haight, Bryk, Seltzed, & Lyons, 1991; Rourke, et al., 1983).
The previous example I listed is explicit, but there was much more going on implicitly than realized. This came to light when I started doing research in my graduate studies. Something that occurred periodically, and often was generated by our behavior as children, our parents became frustrated with us as a result of our behavior. We noticed that both of our parents would eventually start to speak in Spanish when emotions started rising, and they felt a need to reprimand us. Of course, as children, we did not link our behaviors to our parents’ frustration and their shift to Spanish when emoting; However, we were aware that we were in real trouble when they started speaking Spanish. It has been reported that one’s emotions are closely connected to the language one learns as a child (Guttfreund, 1990). While assessing for pathology, with some contradictory results, some Hispanics will appear more symptomatic if interviewed in their second language (English). (Marcos, Alpert, Urcuyo, and Kesselman, 1973). On the other hand, Price and Cuellar (1981) revealed just the opposite, reporting that Spanish-speakers interviewed in Spanish presented with increased symptoms. I am not assuming that my parents were in need of psychological treatment, but the experience did make me aware of the dynamic between emotion and bilingualism.
In addition, one of my supervisors during my practicum training introduced me to a linguistic proficiency theory formulated by Jim Cummins (1984), which looked at the differences between the cognitive and emotional aspects/content/proficiency of language with a focus on bi-lingualism. I cannot do justice to the theory in this paper, but, generally, Cummins developed the concepts of Basic Interpersonal Communicative Skills (BICS) and Cognitive Academic Language Proficiency (CALP). BICS, according to Cummins, refers to one’s ability to communicate on a surface level or the type of speaking used in everyday conversation. Whereas CALP suggests the ability to academically manipulate the language, with a focus on semantics and functionality. Applying the BICS/CALP theory to my parents and my siblings, I could surmise that my parents were BICS speakers in English and CALP speakers in Spanish, and my siblings and me would prove to be the opposite.
Armed with this information, I began to investigate other instances, both in the literature and in personal clinical experiences, where cognitions and emotions were directly impacted by language. During my practicum, I was assigned a fourteen-year-old, female, bi-lingual (Spanish/English) client, who had recently relocated to this country. After meeting with my supervisor, it was determined that I should be prepared to test and assess in both Spanish and English. As I stated at the beginning of my paper, when I started teaching self-defense at the Albuquerque Rape Crisis Center, I started out, or so I thought, as the teacher, but quickly became the student. This situation began to unfold in a similar manner. The tests we decided to administer were the Woo d c o c k - M u H o z L a n g u a g e S u r v e y ( S p a n i s h a n d E n g l i s h f o r m s ) , L a n g u a g e D o m i n a n c e A s s e s s m e n t : L a n g u a g e U s e , P o w e r T e s t , C o d e S w i t c h i n g , B a t e r i a W o o d c o c k P s i c o - E d u c a t i v e e n E s p a H o l S u b - p r u e b a s : 7 , 9 , 1 0 , T h e m a t i c A p p e r c e p t i o n T e s t ( T A T ) a n d R o b e r t s A p p e r c e p t i o n T est for Children (RATC). The last two tests often switched from Spanish to English as guided by the client. The outcome revealed that this young girl had begun to lose some of her Spanish proficiency and was demonstrating an increase in her level of acculturation to this country. In the most extreme cases she would rely on Spanish to talk about certain situations, but appeared to “want” to use English whenever possible.
In other areas of cultural diversity, I have had opportunities, which have been very instrumental in shaping my psychological perspective. These opportunities have also increased my sensitivity, and broadened my awareness. For half of my practicum hours, I was given the chance to work on the Acoma Sky City Reservation, specifically the elementary school, which is located one hour from Albuquerque. This also proved to be a very enriching experience in many ways. I was learning the customs and gaining knowledge of Native peoples, yet simultaneoulsy realizing and attempting to address my own acquired stereotypic thinking.
In retrospect, I appreciate the experiences my parents gave me and my culturally-diverse clients helping me to realize my limitations. Yet, I also became very aware of my own weaknesses as a Hispanic therapist and future psychologist, feeling caught between two worlds with a tenuous grip on each one. Although watching my parents navigate their everyday situations, my young Hispanic client struggle with language and acculturation, and my Native American clients continue to feel the affects of oppression, this has offered me a vantage point to better prepare for what lies before me, which I know will make me a better, more responsible psychologist.
Alford, B. A. & Beck, A. T. (1997). The Integrative Power of Cognitive Therapy.
New York: The Guilford Press.
Beck, A. T. & Weishaar, M. (1989). Cognitive therapy. In A. Freeman, K.M., Simon, L.E. Beutler, & H. Arkowitz, (Eds.), Comprehensive handbook of cognitive therapy (pp. 21-36). New York: Plenum Press.
Beck, A.T., Rush, A.J., Shaw, B.F., & Emery, G. (1979). Cognitive Therapy of Depression. New York: The Guilford Press.
Campbell, R. J. (1989). Psychiatric Dictionary (6th ed.). New York: Oxford University Press.
Carlson, N. R. (1995). Foundations of Physiological Psychological (3rd ed.). Needham Heights, MA: Allyn & Bacon.
Chaplin, J. P. (1985). Dictionary of Psychology (2nd ed.). New York: Dell Publishing.
Chan, .W. T. (1969). A Source Book In Chinese Philosophy (W. T. Chan, Tran.). Princeton, NJ: Princeton University Press.
Chow, T. W. & Cummings, J. L. (1999). Frontal-subcortical circuits. In B. L. Miller & J. L. Cummings, (Eds.), The Human Frontal Lobes: Functions and Disorders (pp. 3-26). New York: The Guildford Press.
Connor, D. F. (2002). Aggression & Antisocial Behavior In Children And Adolescents: Research and Treatment. New York: The Guilford Press.
Cox, R. H. (1990). Sport Psychology: Concepts and Applications, (2ed.), Dubuque, IA: Brown.
Cummins, J. (1984). Bilingualism and Special Education: Issues in Assessment and Pedagogy. Austin, Tx.: Pro-Ed.
Demasio, A. R. (1994). Descartes’ Error: Emotion, Reason, and the Human Brain. New York: Avon Books.
Damasio, A. R. (1999). The Feeling of What Happens: Body and Emotion in the Making of Consciousness. New York: Harcourt, Brace, & Company.
Damasio, A. R. & Anderson, S. W. (1993). The frontal lobes. In K. M Heilman & E. Valenstein, (Eds.), Clinical Neuropsychology (3rd ed.) (pp. 409-460). New York: Oxford University Press.
Edwards, D.J.A. (1989). Cognitive restructuring through guided imagery. In A. Freeman, K.M., Simon, L.E. Beutler, & H. Arkowitz, (Eds.), Comprehensive handbook of cognitive therapy (pp. 283-297). New York: Plenum Press.
Ekman, P. (1980). The Faces of Man: Expressions of Universal Emotions in a New Guinea Village. New York: Garland STPM Press.
Elliott, C.H. & Lassen, M.L. (1998). Why Can’t I Get What I Want? Palo Alto, CA: Davies-Black Publishing.
Ellis, A. (2001). Overcoming Destructive Beliefs, Feelings, and Behaviors. Amherst, NY: Prometheus Books.
Fancher, R. E. (1990). Pioneers of Psychology (2nd ed.). New York: W. W. Norton & Company.
Filskov, S. B., Grimm, B. H., & Lewis, J. A. (1981). Brain-behavior relationships. In S. B. Filskov & T. J. Boll, (Eds.), Handbook of Clinical Neuropsychology (pp. 39-73). New York: John Wiley and Sons.
Fuster, J. M. (1999). Cognitive functions of the frontal lobes. In B. L. Miller & J. L. Cummings, (Eds.), The Human Frontal Lobes: Functions and Disorders (pp. 187-195). New York: The Guildford Press.
Geschwind, D H. & Iacoboni, M. (1999). Structural and functional asymmetries of the human frontal lobes. In B. L. Miller & J. L. Cummings, (Eds.), The Human Frontal Lobes: Functions and Disorders (pp. 45-70). New York: The Guildford Press.
Gibbs, R. W. & Wilson, N. L. (2002, Fall). Bodily action and metaphorical meaning. Style [On-line]. Available: http://www.findarticles.com/cf_0/m2342/3_36/94775629/p13/article.jhtml?term=
Grady, C. L. (1999). Neuroimaging and activation of the frontal lobes. In B. L. Miller & J. L. Cummings, (Eds.), The Human Frontal Lobes: Functions and Disorders (pp. 196-230). New York: The Guildford Press.
Greenberg, L. S., Safran, J., & Rice. L. (1989). Experiential Therapy: Its relation cognitive therapy. In A. Freeman, K.M Simon,., L.E. Beutler, & H. Arkowitz, (Eds.), Comprehensive Handbook of Cognitive Therapy (pp. 169-187). New York: Plenum Press.
Grigsby, J. & Stevens, D. (2000). Neurodynamics of Personality. New York: The Guildford Press.
Guttfreund, D. G. (1990). Effects of language usage on the emotional experience of Spanish-English and English-Spanish bilinguals. Journal of Consulting and Clinical Psychology, 58, 604-607.
Halberstadt, A. G. & Saitta, M. B. (1987). Gender, nonverbal behavior, and perceived dominance: A test or the theory. Journal of Personality and Social Psychology, 53 (2) (257-272).
Heilman, K. M. & Valenstein, E. (1993). Introduction. In K. M Heilman & E. Valenstein, (Eds.), Clinical Neuropsychology (3rd ed.) (pp. 3-16). New York: Oxford University Press.
Heredia, R. R. & Altarriba, J. (2001). Bilingual language mixing: Why do bilinguals code-switch? Current Directions in Psychological Science, 10, 164-168.
Hersch, L. (1995). Adapting to health care reform an managed care: Three strategies for survival an growth. Professional Psychology: Research and Practice, 26, 16-26.
Huttenlocher, J., Haight, W., Bryk, A., Seltzer, M., & Lyons, T. (1991). Early vocabulary growth relation to language input and gender. Developmental Psychology, 27, 236-248.
Kallin, K., Jensen, J., Olsson, L. L., Nyberg, L., & Gustafson, Y. (2004). Why the elderly fall in residential care facilities, and suggested remedies (Original research). Journal of Family Practice [On-line]. Available: http://www.findarticles.com/cf_0/m0689/1_53/112592267/p1/article.jhtml
Kertesz, A. (1999). Language and frontal lobes. . In B. L. Miller & J. L. Cummings, (Eds.), The Human Frontal Lobes: Functions and Disorders (pp. 261-276). New York: The Guildford Press.
Kolb, B. & Whishaw, I. Q. (1996). Fundamentals of Human Neuropsychology (4th ed.). New York: W. H. Freeman and Company.
Koss-Chioino, J. D. & Vargas, L. A. (1999). Working with Latino Youth: Culture, Development, and Context. San Francisco, CA: Jossey-Bass Publishers.
Kottler, J. A. (1993). On Being a Therapist (Rev. ed.). San Francisco: Jossey-Bass Publishers.
Levesque, C., Zuehlke, A. N., Stanek, L. R., & Ryan, R. M. (2004). Autonomy and competence in German and American university students: A comparative study based on self-determination theory. Journal of Educational Psychology, 96 (1), 68-84.
Lezak, M. D. (1995). Neuropsychological Assessment (3rd ed.). New York: Oxford University Press.
Luria, A. R. (1973). The Working Brain: An Introduction to Neuropsychology. New York: Basic Books.
MacHale, D. (2002). Wisdom [On-line]. Available: http://www-history.mcs.st-andrews.ac.uk/Quotations/Einstein.html.
Mann, F. (1972). Acupuncture: Cure Of Many Diseases. London: Pan Books, Ltd.
Marcos, L. R., Alpert, M., Urcuyo, L. & Kesselman, M. (1973). The effects of interview language on the evaluation of psychopathology in Spanish-American schizophrenic patients. American Journal of Psychiatry, 130, 549-553.
Masters, J. C., Burish, T. G., Hollon, S. D., & Rimm, D. C. (1991). Behavior Therapy: Techniques and Empirical Findings (3rd. ed.). Stamford, CT: International Thomson Publishing.
Miczek, K. A., Mirsky, A. F., Carey, G, DeBold, J. & Raine, A. (1994). An overview of biological influences on violent behavior. In A. J. Reiss, K. A. Miczek, & J. A. Roth, (Eds.), Understanding and Preventing Violence: Vol. 2. Biobehavioral Influences (pp. 1-20). Washington, D.C.: National Academy Press.
Moeller, T. G. (2001). Youth Aggression and Violence: A Psychological Approach. Mahwah, NJ: Lawrence Erlbaum Associates, Publishers.
Pincus, J. H. (1995). Aggression, criminality, and the frontal lobes. In B. L. Miller & J. L. Cummings, (Eds.), The Human Frontal Lobes: Functions and Disorders (pp. 547-556). New York: The Guildford Press.
Price, C. & Cuellar, I. (1981). Effects of language and related variables on the expression of psychopathology in Mexican psychiatric patients. Hispanic Journal of Behavioral Sciences, 3, 145-159.
Regoli, R. M. & Hewitt, J. D. (1997). Delinquency in Society (3rd ed.). New York: The McGraw-Hill Companies, Inc.
Rosenthal, R. & Rosnow, R. L. (1991). Essential of Behavioral Research (2nd ed.). New York: McGraw-Hill.
Rourke, B. P., Bakker, D. J., Fisk, J. L., & Strang, J. D. (1983). Child Neuropsychology: An Introduction to Theory, Research, and Clinical Practice. New York: The Guildford Press.
Sachs, O. (1985). The Man Who Mistook His Wife For His Hat. New York: Touchstone.
Samango-Sprouse, C. (1999). Frontal lobe development in childhood. . In B. L. Miller & J. L. Cummings, (Eds.), The Human Frontal Lobes: Functions and Disorders (pp. 584-603). New York: The Guildford Press.
Vest, J., Cohen, W. & Tharp, M. (1997, June 2). Tailgating, giving the finger, outright violence-Americans grow more likely to take out their frustrations on other drivers. U. S. News and World Report [On-line]. Available: http://wjcohen.home.mindspring.com/usnclips/usn%20road%20rage.htm
Walsh, K. (1994). Neuropsychology: A Clinical Approach (3rd ed.). New York: Churchill Livingstone
Webster-Stratton, C. & Reid, M. J. (2003). The incredible years parents, teachers, and children training series: A multifaceted treatment approach for young children with conduct problems. In A. E. Kazdin & J. R. Weisz, J. R. (Eds.), Evidence-Based Psychotherapies for Children and Adolescents (pp. 224-240). New York: The Guilford Press.
Weingarten, S. M. (1999). Psychosurgery. In B. L. Miller & J. L. Cummings, (Eds.), The Human Frontal Lobes: Functions and Disorders (pp. 547-556). New York: The Guildford Press.
Yalom, I. D. (1975). The Theory and Practice of Psychotherapy (2nd ed.). New York: Basic Books, Inc.
Yeou-Cheng, M., Nagler, J., Lee, M. H. M., & Cabrera, I. N. (2001). Impact of music therapy on the communication skills of toddlers with pervasive developmental disorder. In R. J. Zatorre & I. Peretz (Eds.), The Biological Foundations of Music (pp. 445-447). New York: The New York Academy of Sciences.
Young, J. E. & Klosko, J. S. (1993). Reinventing Your Life. New York: Dutton
Table of Contents