For individuals in the U.S. & U.S. territories
In Multimodal Therapy, Dr. Arnold A. Lazarus demonstrates this technically eclectic but theoretically consistent approach to therapy. The multimodal orientation begins with the assumption that therapy must assess seven discrete but interactive modalities (abbreviated by the acronym BASIC ID, which stands for Behavior, Affect, Sensation, Imagery, Cognition, Interpersonal factors, and Drug/Biological considerations). This psychoeducational framework encourages therapists to improvise and tailor therapy to the client. In this session, Dr. Lazarus works with a client who has issues with people-pleasing and blame. Dr. Lazarus demonstrates how his preliminary BASIC ID assessment rapidly and accurately helps target areas for therapeutic focus.
This video features a client portrayed by an actor on the basis of actual case material.
The client, Jim, is the supervisor of a crew of four waiters at a banquet house. Last week, one of the guys on his crew, Todd, arrived late for a function that Jim's crew was catering. When Jim asked Todd why he was late, Todd was vague, mentioning a problem he was having with his roommate as the cause for his lateness. Jim continued to ask questions, and Todd blew up, accused Jim of "prying," started knocking trays and glasses around, and stormed out. Jim was left with a three-person crew to cater the function, and the catering did not go smoothly. Some of the guests were annoyed with the service, and the customer who was hosting the affair complained to the manager, Jim's boss. Jim was called into the manager's office, reprimanded for having an inefficient crew, and given a warning that he would be demoted from his supervisory role if he did not "shape up."
Jim was angry at his boss, angry at Todd for "causing" these problems, hurt that Todd walked out, and feeling rejected and unappreciated by both his boss and Todd. Jim reported that he had been trying to help Todd for several months both at work and in his personal life by picking up the slack for him on the job and by listening to and offering solutions to his roommate problems.
After Jim's boss talked to him, Jim walked around for hours fuming and thinking, "My boss is unfair and Todd is inappreciative. I might lose my job. Why is everyone so unfair? Why am I made responsible for Todd? Can't Todd see how much I've tried to help him? I am the best crew leader, and now I might be demoted."
This went on for hours, and Jim could not let go of these feelings. Jim had one recurring thought: "This is not the first time I have felt this way."
Jim recalled a couple of previous times that he had had these feelings.
Once, in college, Jim was working on a collaborative term paper with a study group. He was the group leader responsible for compiling the final product. One of the group members was not contributing his share because of problems with his girlfriend. Jim tried to help him out with his girlfriend, but the group member thought Jim was intruding. He got angry at Jim and switched groups. The term paper was incomplete, everyone "blamed" Jim, and they almost failed the course. Jim felt hurt, angry, and betrayed.
When Jim was in high school, he and his brother thought it would be a good idea for his younger brother to join the football team. Although his parents were against it, Jim was able to convince them to let his brother be on the team. His brother broke his arm at practice and was let off the team. After this, his brother was miserable. He let his schoolwork slip, and he started cutting classes. Jim's parents were upset about the younger boy's acting out, and they blamed Jim for the whole situation. "After all," they said, "you talked him and us into this whole football thing.'" Jim was upset. He had been trying to be helpful and kind and was blamed for something that, as he put it, "he had nothing to do with."
After the first session, Dr. Lazarus gave Jim the Multimodal Life History Inventory (LHI) to complete and a copy of Dr. Lazarus' book Don't Believe It for a Minute: Forty Toxic Ideas That Are Driving You Crazy. Jim was asked to bring the completed LHI to his second session, and to discuss the "toxic ideas" (after reading the book) that he found most applicable to himself. He complied with both requests.
During the second session, Dr. Lazarus and Jim went over several items on the LHI that had not been filled in. Jim reported that he found Don't Believe It for a Minute exceedingly helpful. They discussed various toxic ideas from the book, especially those relating to criticism, people-pleasing, being blamed, and the notion that "life should be fair." They then decided to focus on Toxic Idea #23 "Don't Be Selfish: Put Others First." Jim volunteered that he found this bibliotherapy "liberating and energizing."
At the end of the second session, Dr. Lazarus pointed out to Jim that in his desire to please others and to be helpful, he did tend to go too far and "pry" into their lives. In college, he had appointed himself his team member's "shrink" and only managed to irritate the guy. Similarly, at work, on hearing Todd's difficulties with his roommate, instead of letting it go or simply asking whether there was anything he could do to help, Jim went too far, did not mind his own business, and landed in hot water.
At the next session (the one depicted on the videotape), Dr. Lazarus ties together a few loose ends from the first two sessions and then proceeds to demonstrate how a preliminary BASIC ID assessment (derived mainly from the Multimodal Life History Questionnaire) sets the stage for more intensive assessment and problem-targeted therapy.
The multimodal approach rests on the assumption that unless seven discrete but interactive modalities are assessed, treatment is likely to overlook significant concerns. Initial interviews and the use of a Multimodal Life History Inventory (Lazarus & Lazarus, 1991) provide an initial overview of a client's significant Behaviors, Affective responses, Sensory reactions, Images, Cognitions, Interpersonal relationships, and the need for Drugs and other biological interventions.
The first letters yield BASIC ID, an acronym that is easy to recall. These modalities exist in a state of reciprocal transaction and flux, connected by complex chains of behavior and other psychophysiological processes.
The therapist, usually in concert with the client, determines which specific problems across the BASIC ID are most salient. Whenever possible, the choice of appropriate techniques rests on well-documented research data, but multimodal therapists remain essentially flexible and are willing to improvise when necessary. They are technically eclectic but remain theoretically consistent, drawing mainly from a broad-based social and cognitive learning theory (because its tenets are open to verification or disproof). Multimodal therapy is essentially psychoeducational and contends that many problems arise from misinformation and missing information. Thus, with most outpatients, bibliotherapy, the use of selected books for home reading, often provides a springboard for enhancing the treatment process and content.
An assiduous attempt is made to tailor the therapy to each client's unique requirements. Thus, in addition to mastering a wide range of effective techniques, multimodal counselors or clinicians address the fact that different relationship styles are also necessary. Some clients require boundless warmth and empathy, others prefer a more austere businesslike relationship. Some prefer an active trainer to a good listener (or vice versa). Because the therapeutic relationship is the soil that enables the techniques to take root, it is held that the correct method delivered within and geared to the context of the client's interpersonal expectancies will augment treatment adherence and enhance therapeutic outcomes. Another issue that requires careful scrutiny is whether individual therapy, couples therapy, family therapy, or participation in a group (or some combination of the foregoing) seems advisable. Judicious referrals are effected when necessary and feasible.
Lazarus, A. A., & Lazarus, C. N. (1991). Multimodal life history inventory. Champaign, IL: Research Press.
- Dryden, W. (1991). A dialogue with Arnold Lazarus: "It depends." Bristol, PA: Open University Press.
- Keat, D. B. (1990). Child multimodal therapy. Norwood, NJ: Ablex Publishing.
- Kwee, M. G. T., & Roborgh, M. R. H. M. (1987). Multimodale therapie [Multimodal therapy]. Lisse, Holland: Swets & Zeitlinger.
- Lazarus, A. A. (1989). The practice of multimodal therapy. Baltimore, MD: Johns Hopkins University Press.
- Lazarus, A. A. (1992). The multimodal approach to the treatment of minor depression. American Journal of Psychotherapy, 46, 50–57.
- Lazarus, A. A. (1992). Multimodal therapy: Technical eclecticism with minimal integration. In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of psychotherapy integration (pp. 231–263) New York: Basic Books.
- Lazarus, A. A. (2004). Multimodal therapy. In R. J. Corsini & D. Wedding (Eds.), Current psychotherapies (7th ed.). New York: Wadsworth.
- Nelson-Jones, R. (in press). Theory and practice of counseling (2nd ed.). London: Cassell & Collier Macmillan.
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