MAP605_Advanced Counselling Skills I

Assertive Training 145 Phrases that dismiss own needs Constructive ‘criticism’ without Blame put on others (for example, ‘not important blame or assumptions really’) Sarcasm and other put- downs Explores option Ways of getting round problems Characteristics of Assertive People  Are able to freely express their feelings, thoughts and desires  Maintain and initiate cordial relationships with people.  Are aware of rights.  Are able to control their anger. (the feeling isn’t repressed but rather deal with more effective and rational)  Have good self esteem  Are adjusting with other people Characteristics of Non Assertive behaviour (Sometimes Called “Passive Behavior”)  Not expressing feelings, needs, and ideas; ignoring personal rights; and allowing others to infringe upon them.  Usually emotionally dishonest, indirect, inhibited, and self-denying. often let other people choose for them and end up feeling disappointed in themselves and angry with them;  At their best they can be described as passive, at worst as a doormat.  People often choose nonassertive behavior to avoid unpleasant situations, tension, conflict, and confrontation. Characteristics of Aggressive Behavior  Express their feelings, needs, and ideas at the expense of others.  Aggressive individuals stand up for their rights, but ignore the rights of others; they may dominate or humiliate other people.  This behavior is expressive, it is also defensive, hostile, and self-defeating. CU IDOL SELF LEARNING MATERIAL (SLM)

146 Advanced Counseling Skills - I Techniques in Assertiveness Training Following are techniques as described by Manuel Smith, in his 1975 book When I Say No, I Feel Guilty, offered some of the following behaviors:  Broken record: Refers to simply repeating requests or refusals every time one encounters resistance. The key in this approach is resistance. A disadvantage would include that if resistance continues, the requests may lose power every time it is repeated. If requests are repeated too often, it may negatively impact the authority of words.  Fogging: Consists of finding some limited truth to agree within what an antagonist is saying. More specifically, one can agree in part or agree in principle. Fogging may be a helpful technique if people are behaving in a very manipulative or aggressive method. Rather than arguing back, fogging aims to give a nominal, calm response using terms that are placating however not defensive, whereas at a similar time not agreeing to fulfill demands. Fogging involves accepting with any truth that will be contained within statements, though critical. By not responding within the expected method, indifferent words by being defensive or disputative, the other person will cease confrontation because the desire isn't being achieved. When the atmosphere is less heated, it will be possible to discuss the issues more reasonably. Fogging is therefore termed as a result of the individual acts sort of a ‘wall of fog’ in to that arguments square measure thrown, however not came back.  Negative inquiry: Negative enquiry is used to find out more about critical comments and is a good alternative to more aggressive or angry responses to criticism. It consists of requesting further, more specific criticism.  Negative assertion: Is agreement with criticism without letting up demand.  I – statements: I – statements can be used to voice one's feelings and wishes from a personal position without expressing a judgment about the other person or blaming one’s feelings on them.  The Stuck Record Technique: The technique employs the key assertive skill of 'calm persistence'. It involves repeating what you want, time and time again, without raising CU IDOL SELF LEARNING MATERIAL (SLM)

Assertive Training 147 the tone of your voice, becoming angry, irritated, or involved in side issues. Continually repeating a request will ensure the discussion does not become side-tracked and involved in irrelevant argument. The key is to stay calm, be very clear in what you want, stick to the point and not give up.  Accept a compromise only if you are happy with the outcome. Problems in Assertiveness Training  The first major problem for assertion training involves negative evaluations of assertive people by others  Confusion between assertion and aggression  Problem involves transfer of training, the difficulty experienced by trainees in generalising assertive from the training context to real-life situations  Finally some of the difficulties in applying assertion training outside the training context may be due to intuitive training procedures that are inadequately based on research  May be practiced in an unbalanced way, especially by those new to the process  Assertiveness manuals recognize that \"many people, when trying out assertive behaviour for the first time, find that they go too far and become aggressive.  Unassertiveness courts one set of problems, over-assertiveness creates another. Applications  A useful tool in the prevention of alcohol-use disorders. Psychological skills in general including assertiveness and social skills have been posed as intervention for a variety of disorders with some empirical support.  In connection with gender theory, “Tannen argues that men and women would both benefit from learning to use the others’ style. ... So, women would benefit from assertiveness training just as men might benefit from sensitivity training”. CU IDOL SELF LEARNING MATERIAL (SLM)

148 Advanced Counseling Skills - I 10.3 Summary Assertiveness training is an efficient treatment for certain conditions, like depression, social anxiety, and issues ensuing from implicit anger. Assertiveness training can even be helpful for those who would like to boost their interpersonal skills and sense of self-esteem. 10.4 Key Words/Abbreviations  AT (assertiveness training)  Aggression: feelings of anger or antipathy resulting in hostile or violent behaviour  Interpersonal skills: the ability to communicate or interact well with other people.  Passive communication: style in which individuals have developed a pattern of avoiding expressing their opinions or feelings, protecting their rights, and identifying and meeting their needs. 10.5 Learning Activity 1. Recall and analyse any instance when you were unable to assert. Applying the techniques in assertion training, reconstruct the situation the way you would want it to be. ----------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------- 2. Complete the statement by inserting one word only In order to assertive at work, I need to/to be ___________. ----------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------- 10.6 Unit End Questions (MCQ and Descriptive) A. Descriptive Type Questions 1. Define assertive training. 2. Discuss the types of assertiveness training. CU IDOL SELF LEARNING MATERIAL (SLM)

Assertive Training 149 3. What is the difference between aggression and assertive training? 4. What are the goals of assertiveness training? 5. Evaluate the techniques of assertiveness training. B. Multiple Choice Questions 1. Struck record technique employees the __________ assertive skill. (a) Calm persistence (b) agitation (c) criticism (d) negative enquiry 2. The techniques of AT were described by __________ in 1975. (a) Manuel smith (b) Joseph Wolpe (c) Andrew Salter (d) Skinner 3. The statement “I’m not ok, you are ok implies __________ type of assertiveness. (a) Non assertive (b) assertive (c) aggressive (d) manipulative 4. Assertiveness training was introduced by __________. (a) Manuel smith (b) Joseph Wolpe (c) Andrew Salter (d) Skinner 5. __________ explored the use of Assertiveness training in his book on treating neurosis. (a) Manuel smith (b) Joseph Wolpe (c) Andrew Salter (d) Skinner Answers 1. (a), 2. (a), 3. (b), 4. (a), 5. (b). CU IDOL SELF LEARNING MATERIAL (SLM)

150 Advanced Counseling Skills - I 10.7 References 1. “Assertiveness” in Dorland’s Medical Dictionary. 2. Wolpe, J. (1958) Psychotherapy by Reciprocal Inhibition, (California: Stanford University Press, 1958), 53-62. 3. W. Eduard Craighead/Charles B. Nemeroff eds., The Corsini Encyclopedia of Psychology and Behavioral Science: Volume I (2002) p. 142. 4. Craighead/Nemeroff eds., p. 142. 5. Driven by Research on hundreds of families: The Seven Principles for Making Marriage Work; by John Gottman, PhD, Randomhouse, May 16, 2000; coined the \"Four Horsemen of the Apocalypse”, four patterns of communicating which end including criticism, contempt, defensiveness, and stonewalling. 6. William T. O’Donohue/Jane E. Fisher eds., Cognitive Behavior Therapy (2008). 7. Daniel Goleman, Emotional Intelligence (London 1996) p. 266. 8. Facing Co-dependence: What It Is, Where It Comes from, How It Sabotages Our Lives by Pia Mellody, Andrea Wells Miller, and J. Keith Miller. 9. Paul Gilbert, Overcoming Depression (London 1998) p. 219 from DBT as researched by Marsha M. Linehan, Professor, Department of Psychology, Director, Behavioral Research and Therapy Clinics at the University of Washington. 10. Henry Virkler, Speaking the Truth with Love (2009) p. 48. 11. Marie Reid/Richard Hammersley, Communicating Successfully in Groups (Psychology Press, 2000) p. 49. 12. Virkler, p. 74. 13 Smith, M.J. When I say no, I feel guilty 1975. 14. Rich Pfeiffer, Relationships: Assertiveness Skills (2010) p. 28. 15. \"Assertiveness training in addiction\". drugalcoholrehab.com. Drug Alcohol Rehab Now. Retrieved 30 April 2018. CU IDOL SELF LEARNING MATERIAL (SLM)

Assertive Training 151 16. O'Donohue, William (2003). \"Psychological skills training: Issues and controversies\". The Behavior Analyst Today. J.D. Cautilli. 4(3): 331-335. doi:10.1037/h0100021. Archived from the original on 2015-05-27. Pdf. Archived 2015-02-09 at the Wayback Machine. 17. Speer, Susan (2005). \"Gender and language: 'sex difference' perspectives\". In Speer, Susan A. (ed.). Gender talk: feminism, discourse and conversation analysis. London New York: Routledge. p. 31. ISBN 9780415246446. 18. Tannen, Deborah (1990). “Gossip”. In Tannen, Deborah (ed.). You just don't understand: women and men in conversation. New York: Ballantine Books. pp. 121-122. ISBN 9780345372055. 19. Michael Argyle, Social Situations (Cambridge 1981) p. 50. 20. Deborah J. Swiss, The Male Mind at Work (2001) p. 20. 21. Assert Yourself (A and C Black Publishers Ltd, London 2009) p. 8. 22. Mark Eisenstaedt, Freedom from Agoraphobia (2003) p. 203. 23. Sue Bishop, Develop Your Assertiveness (2006) p. 13.  CU IDOL SELF LEARNING MATERIAL (SLM)

UNIT 11 RELAXATION TRAINING Structure: 11.0 Learning Objectives 11.1 Introduction 11.2 History and Development 11.3 Types of Relaxation Techniques 11.4 Terminating The Session 11.5 Other Major Relaxation Techniques 11.6 EMG Biofeedback 11.7 Summary 11.8 Key Words/Abbreviations 11.9 Learning Activity 11.10 Unit End Questions (MCQ and Descriptive) 11.11 References 11.0 Learning Objectives After studying this unit, you will be able to:  Explain and analyze the development, types and techniques in Relaxation Training.

Relaxation Training 153 11.1 Introduction Relaxation training is an integral part of behaviour therapy. Relaxation training is used for a wide range of distressing, maladaptive learning such as anxiety, phobias, aggression, psychosomatic triggers that lead to autonomic arousal. [Autonomic arousal is marked by chronic and persistent arousal of the autonomic nervous system not caused by any medical condition.] Relaxation training focuses on any activity, method, process, procedures that enable the individual to relax, attain a peaceful, calm state and reduce anxiety, stress and anger levels. It is a self control procedure that facilitates the person to develop a set of responses that foster modification of autonomic arousal. It is the individual's responsibility to change and manage his/her life and health. 11.2 History and Development Relaxation strategies have been used as an integral component of major therapeutic traditions. The technique (progressive relaxation) stems primarily from the work of Edmund Jacobson . It is a detailed procedure for reducing muscular tension. The premise of the technique is based on relaxing the muscles which could relax the mind as well. In 1929, he published his book progressive relaxation, explaining that the individual experiences anxiety when there is muscular tension. The technique focuses on tightening and relaxing specific muscle groups in sequence. It facilitates awareness of your body and physical sensations. The progressive muscle relaxation technique aims to induce a deep state of musle relaxation, Jacobson presumed that such a state could reduce arousal in both the central nervous system and the autonomic nervous system, the outcome of which would restore or promote psychological and physical well being. This view is also in correlation with James - Lange theory of emotion, which stated there is a strong, close, interactive correlation relationship between bodily states and emotional states. Johannes Schultz, in 1932, noted that physiological changes are accompanied by certain feelings. Repetitive set of visualisations are used to that induce a state of relaxation and is based on passive concentration of bodily perceptions (e.g., heaviness and warmth of arms, legs), which CU IDOL SELF LEARNING MATERIAL (SLM)

154 Advanced Counseling Skills - I are facilitated by self-suggestions. The technique is used to alleviate many stress-induced psychosomatic disorders. In 1950, major development led to the emergence of progressive relaxation and its progeny as the technique of choice over autogenic training, Joseph wolpe’s adaptation of progressive relaxation as an essential component of systematic desensitization. He believed that muscle relaxation was a physiological state that was incompatible with anxiety. In the late 1950’s and 1960’s passive relaxation procedures such as autogenic training, medication and guided imagery were more widely incorporated into behavioural therapies, relaxation procedures were not only used as a part of comprehensive procedures but was also increasingly used as isolated techniques. There was an increasing demand of relaxation techniques as the need grew for cost effective, quicker methods of relaxation. The demand for learning self help approaches to relaxation also grew subsequently. 11.3 Types of Relaxation Techniques  Autogenic training: Both visual imagery and body awareness are used to induce a deep state of relaxation in an individual. The person is asked to imagine a peaceful place or incidents and then focuses on different physical sensations, moving from the feet to the head. For example, one might focus on a calm heartbeat, warm sensations etc. Psychological benefits include: 1. Increased pain tolerance 2. Reduction in anxiety, depression and symptoms of fatigue 3. Increased resistance to stress Physiological benefits include: 1. Decrease in Blood pressure, cholesterol, tension and respiration 2. Increase in peripheral blood flow 3. Decrease in migraine, insomnia, digestion and back pain CU IDOL SELF LEARNING MATERIAL (SLM)

Relaxation Training 155  Breathing: One hand is placed on your chest and the other on your belly. One is supposed to take a deep, slow, deep breath, inhaling in as much air one can. Simultaneously, your belly should be pushed against by your hand. Hold your breath and then slowly exhale.  Progressive muscle relaxation: Slowly tensing and then releasing each muscle group individually, starting with the muscles in the toes and finishing with those in the head is the premise of the technique. Psychological benefits include: 1. Improved self image and confidence 2. Reduction in anxiety, depression  Meditation: The two most popular forms of meditation in the U.S. include Transcendental Meditation (students repeat a mantra, a single word or phrase) and mindfulness meditation (students focus their attention on their thoughts and sensations). Some psychological effects include: 1. reduction in anxiety 2. Improved locus of control 3. Greater self actualization 4. Improved sleep 5. Reduction in fears and phobias 6. Reduction in eating disorders  Guided imagery: Similar to autogenic training, guided imagery involves listening to a trained therapist or a guided imagery CD to move into a state of deep relaxation. Once in a relaxed state, the images that come up in your mind can help you uncover important realizations about your emotional, spiritual, and physical health. Assessment/Considerations before who Choose Relaxation Techniques With the increasing popularity, behaviour therapists applied it indiscriminately especially when anxiety was the major concern. Extensive, unselective use of any technique, could delay the use of a more effective approach. Hence the therapist should consider the following:- CU IDOL SELF LEARNING MATERIAL (SLM)

156 Advanced Counseling Skills - I (a) Determine whether maladaptive anxiety, tension or related emotions are part of the client’s problem. The same can be determined through the initial interview, self reports of anxiety, and behavioural indications of tension, psychological tests or rating scales. Anxiety can sometimes be indirectly implied. (b) Gauge whether anxiety reduction should be the primal or immediate focus of attention. (c) The therapist should rule out any physical or organic causes for anxiety and anxiety related symptoms. Procedure (a) Once the need for the relaxation technique is established, the therapist should explain the rationale and nature of the procedure in detail, to help the client gain greater insight of the process and is motivated to cooperate. (b) Once the rationale is accepted, the therapist should explain the specific procedure that will be used. (c) Encourage the client to practice to enhance learning. Everyone always experiences certain amount of tension, in the course of life experiences on reaches certain level of adaptation under which one functions day to day. The goal of relaxation training is to learn to reduce muscle tension in the body below your adaptation level at any given time one desires. The essential principle is that once the muscles are tensed, they are going to experience a deeper state of relaxation. In progressive relaxation, the focus is to produce significant and reductions in tension. The most effective method to achieve this is by inducing a good deal of tension in a particular muscle group (raise the tension level above the adaptation level) and at once release the tension. The release creates a momentum which then allows the muscle tension to drop below the adaptation level. An important advantage of creating and releasing tension is that it gives one chances to focus close attention upon and become aware of each muscle group tension. The contrast between creating tension and relaxation gives one an excellent opportunity to compare the two and appreciate the relaxed state. CU IDOL SELF LEARNING MATERIAL (SLM)

Relaxation Training 157 Relaxation is a skill which is enhanced with practice. Initially it takes approximately 20 to 30 minutes to experience the entire procedure properly, with practice eventually it will take approximately 10 to 15 minutes to be relaxed. One should focus his/her thinking on the muscle system. The process begins by tensing a particular muscle group. Say “relax “(it may be helpful for you to count up to 5 as you are tensing a particular muscle group, for example ..1..2...3....4...relax ). Then relax that muscle group immediately. At first, exercise each muscle group at least twice. As one practices, one will find which muscle groups are most effective in helping you to relax. The client must be seated in a comfortable chair preferably a reclining one that is capable of being adjusted to whatever positions the client finds most relaxing. The head should be resting on the back of the chair with legs extended and arms resting on the arms of the chair (Most often in the nearly horizontal position which most clients prefer). In this way, the support is given by the chair and none of the body muscles are used to support the body. The counselor should demonstrate the tensing and relaxing of the muscle groups named on the outline, before the client begins to practice and adapt to the actual tensing and relaxing of the muscle. The client is given the opportunity and encouraged to try any exercises he/she is uncertain of doing correctly. The client is 1st instructed to close his/her eyes (any contact lenses removed), and then room darkened with any outside noises being neutralised (Air-conditioners, fans and “white noise generators “are helpful here ). The ambiance for relaxation training is then set and is ready to begin. A partial transcript from an audio tape recording of relaxation session with a client who had tired relaxation four times previously (once in the counselor’s office and three times in the privacy of his room) is presented below. An ellipsis (. . . . ) denotes an interval of 5 to 15 seconds. O.k. Just settle back in the chair and relax as best as possible. Take a few deep breaths and begin to feel yourself let go . . . . Now, extending both arms straight out clench your fists more and more tightly as I count up towards 5 . . . 1. . . 2 . .. 3 . . . good . . . 4 . . . Relax. Just let your arms drop wherever they will and begin to appreciate the difference between the feelings of tension, which you felt a few seconds ago, and the feelings of relaxation in your hands and arms CU IDOL SELF LEARNING MATERIAL (SLM)

158 Advanced Counseling Skills - I now . . . Now let’s concentrate on the muscles in your forearms, extending both arms straight out once again only this time pushed forward with your hand ...1...2...3...4...hold it..., now relax. Just let your arms go up and concentrate on the warm, tingling feelings of relaxation spreading throughout your forearms ......O.k., fine, let’s concentrate now on the muscles in your upper arms . To do this bend both arms at the elbow and flex your biceps, more and more as I count towards 5. ...1....2....3....4....Relax. Attend to the heavy,warm feelings associated with the relaxation as they spread downwards throughout your arms right to the tips of your fingers.....Let’s concentrate now on the muscles in your forehead (or frown) by raising your eyebrows....1....2....more and more....3....4....now do the opposite of tension and relax ..... Just let all the muscles in your forehead smooth out and become smoother and smoother ..::..OK .Let’s work on the area surrounding eyes and nose .Close your eyes more and more tightly as I count up towards five...:1...:2...:3..::feel the tension ....4...:Relax . While keeping your eyes closed, just enjoy the soothing come feeling in your eyes, similar perhaps to that which you feel when closing your eyes after reading for a long period of time.... Now, let’s work on the area surrounding your lips, cheeks and jaw ....Just draw the corners of your mouth back further and further, try and get there ear to ear grin....1....2....3....4.... Relax, just left your jaw hang loose....appreciate the feeling of relaxation.....Now, grit your teeth and feel the tenseness in your throat muscles get greater and greater as I count towards five ....1....2....3....4....Relax Just let your neck hang loose .Let it relax at whatever position it feels most comfortable ....as you continue to relax further and further notice how your breathing has become more and more regular ...:Good....now let’s concentrate on your shoulder muscles, go ahead and shrug your shoulders and try and touch your ears....1....2....3...Good....4....Relax, let your shoulders slump and attend to the warm, tingling feeling as they spread throughout your shoulders and connect up with the relaxation in your arms....let the tingling feeling spread throughout your arms right to the tips of your fingers .....now, go ahead and ark your back more and more as I count up toward 5.....1.....2.....3.....4 ....hold it ....now, relax . Let your whole body just slump back into the chair.....Let the chair support the weight of your body, just let your whole body relax further and further.....O.K. Let’s concentrate now on your stomach muscles more and more as I count up to 5.....1....2....3.....4.... Hold it .....now relax, just let your stomach muscles go ....remember, each time you breath out your stomach muscles relax .... and each time you breath in this relaxation begins to spread throughout CU IDOL SELF LEARNING MATERIAL (SLM)

Relaxation Training 159 your entire body ........further and further ....notice how you are breathing freely and deeply, freely and deeply ....Let’s shift our attention now to the muscles in your thighs ....straighten out both your legs and bend both your legs and bend your toes back towards your head, feeling the tension in your thighs ...1....2...3....more and more.....4...Relax, let your legs drop and attend to the difference in this large muscle group between the feeling of tension and now the feelings of relaxation ....a warm, tingling feeling spreading throughout your legs ....Once again, go ahead and straighten out both your legs only this time bend your toes away from your head, tensing your calf muscles ....1....2....3....4....now, relax ....no more tension at all now, nothing but relaxation .....enjoy the calm, soothing feeling of relaxation as it spreads right to the tip of your toes....In order to help you relax even further I’m going to mention the various muscle groups you have been tensing and relaxing, only this time don’t tense them, simply relax them further and further ......try and get that extra bit of relaxation in each muscle group as I mention it......your forehead ...:the area around your eyes and nose ....your lips, cheeks and jaw ....just begin to feel a wave of relaxation spreading downward across your facial muscles .....Let this continue to spread downwards through your neck muscles ....across your shoulders.....down through your arms right to the tip of your fingers. Across your chest and down your back ....:into your stomach muscles .....Notice how your breathing becomes more and more regular as the waves of relaxation continue download through your thighs ...:.and calves.....right to the tips of your toes. * (the purpose of the above transcript is solely to demonstrate to the readers the process of relaxation training.) Upon completion of the relaxation or desensitisation session, the following is used to help the client emerge from the relaxed state: You have been relaxing very well ...: In order to help you replace some of that tired heavy feeling in your body with some fresh energy I am going to count backwards from 5 to 1 .....and when I reach the count of one you will open your eyes and feel quite refreshed and calm....5....4....3....you may begin to stretch if you wish ...2.....1. Note should be made here that the first few times a client practises relaxation he’s encouraged to tense and relax each muscle group twice. Total time for the procedure takes CU IDOL SELF LEARNING MATERIAL (SLM)

160 Advanced Counseling Skills - I approximately 25 minutes. However, in the preceding taped example about 13 minutes were required to have a client become fully relaxed. Each client is encouraged to practice relaxation once per day in the privacy of his/her own room until one gets a “feeling “of relaxation (usually 1 to 2 weeks). After every session of relaxation, a detailed inquiry is made of the client to determine which exercises are most beneficial to the relaxation process. Once about 5 sessions of relaxation training are completed with the client, the relaxation is usually individualised to allow the client to emphasise majorly on those muscle groups found to be most effective in aiding relaxation and to disregard those muscle groups not enhancing the relaxation process. General Principles for Progressive Relaxation Outlined by Bernstein and Given (i) Instruct the client how to tense the muscles. (ii) The client begins tensing when the therapist says “Now”. The tension should be maintained for at least 5 – 7 seconds, wherein the client is focusing attention on the feelings of tension. (iii) The client then must release the tension and initiate relaxation upon the cue word “relax”. The client is instructed to focus on the feelings of relaxation as they replace the feelings of tension. Appropriate phases should be used to help direct the client’s attention to the relaxation for about 30-40 seconds. (iv) The tension relaxation cycle must be repeated for the same muscle group (step 1 – 3). The client now experiences the relaxation for 30 – 40 seconds. (v) The client signals if the muscle is not completely relaxed (indicated by raising a finger). If singled by the client, the tension – relaxation cycle should be repeated with different descriptions to highlight the sensations. The client should again be asked to signal if the muscles are not completely relaxed. An alternate approach to relaxing the muscles should be derived and will be helpful. Often, the client tends to tense multiple muscle groups automatically in spite of being instructed to focus on only one muscle group. This obviously interferes with the relaxation induction. In order to reduce the likelihood of the same, the therapist must CU IDOL SELF LEARNING MATERIAL (SLM)

Relaxation Training 161 specifically suggest to the client that he/she tenses only the muscle group under consideration, making a conscious effort to not tense the other muscle groups. The tendency of tensing muscles other than the target group is frequently noted, and it is important to be unlearned. (vi) Steps 1-5 should be repeated for the next muscle group. Once all the muscle groups are relaxed, the focus of attention by the therapist then must shift towards the feelings of relaxation throughout the body, using breathing as a focus. Once the client has had about 30 seconds to focus on total body relaxation, the therapist then continues with guided imagery. The therapist initially guides the client into a scene that has previously agreed upon, using a peaceful voice. The client must be encouraged to embellish the images. In case imagery is to be done in a group setting then the therapist must consider the following:  Not use imagery at all.  Use some relaxing imagery such as lying on a beach.  Use neutral imagery. The imagery helps the client focus on relaxing rather than the concerns that brought him/her to therapy. 11.4 Terminating The Session The therapist counts backwards from 5 to 1, telling the client the he/she will be more aware alert with each number, although comfortable, composed and relaxed. At number 3, the therapist can instruct the client to subtly move his/her hands and legs. At number 2, the client is asked to open the eyes. At number 1, feel alert and awake and still relaxed. CU IDOL SELF LEARNING MATERIAL (SLM)

162 Advanced Counseling Skills - I In case the therapist desires and feels the need then, the client can be asked to rate his/her feelings on a 10 point rating scale, 10 being heightened anxiety and 1 being relatively low levels of anxiety. The therapist should encourage the client to practice the relaxation skills at least twice a day. The therapist could assist the client to plan out a weekly schedule specifically with regards to the relaxation practice, as to when and where it will occur. A reminder sheet might also be given to the client that lists the muscle groups and how to tense and relax them with the schedule one should follow. The client can also be given an audio tape of the session to aid practice sessions at home. The goal of relaxation training is to help the client self – relax, and not become dependent on the tape. With time, the client should become increasingly less dependent on outside help to initiate relaxation. Most often 3-4 sessions of directed relaxation, the client is successful at deeply relaxing both during the session and at home after which the therapist can begin combining the 14 muscle groups in 5 or more groupings. These groups could be as follows: 1. Both hands and arms 2. All facial muscles 3. Chest, shoulders, upper back, stomach 4. Buttocks in both upper legs 5. Both lower legs and feet Once the client is accustomed to this modification, the client is then instructed to relax the muscle groups without tensing first by focusing on the natural tension in each muscle group with the use of cue words such as “relax” in order to release the tension and let the muscle groups deeply relax. Once the final group of muscle group is relaxed, the client is then encouraged to self- direct him or herself in 45- 60 seconds of relaxation imagery. Therapists also teach cued – controlled relaxation which involves instructing the client to relax by simply saying “relax” to him or herself, briefly focusing on sensations of relaxation in each of the major muscle grouping and also briefly concentrating on relaxation imagery. CU IDOL SELF LEARNING MATERIAL (SLM)

Relaxation Training 163 The aim of cued controlled relaxation is that the client learns to relax unnoticeably and quickly in almost every situation and setting. A common error by therapists is to rush through the relaxation techniques. Even if the therapist guides the client at an appropriate speed, clients may have a tendency to rapidly complete the process especially if the tension is high. This in turn will lead to minimum relaxation. Generally practitioners agree that the tension phase should be at least 5 seconds with a minimum of 10 seconds of relaxation. Some also recommend longer periods of relaxation. The above are guidelines and the therapist can alter the same based on the client’s needs and with the individual response style of the client. 11.5 Other Major Relaxation Techniques Progressive relaxation is one of the most widely used relaxation techniques among behaviour therapists, although there are a wide array of relaxation techniques that are available. Amongst these techniques the most commonly used techniques are:  Autogenic Training  EMG Biofeedback Autogenic Training Also known as autogenic therapy is a passive form of controlling arousal developed by Johannes Schultz. It has gained widespread popularity in Europe. Autogenic training is a set of 6 psychophysiological exercises that resorts to the use of short formulas or auto suggestions, which client focuses on. The formulas primarily focus on the feelings of heaviness and warmth, abdominal warmth, regulation of cardiac activity and respiration and cooling of the forehead. These 6 exercises are designed in a specific sequence, in which the client must master each level before the next is introduced. CU IDOL SELF LEARNING MATERIAL (SLM)

164 Advanced Counseling Skills - I Exercises focus on the following:  Exercise one: Feelings of heaviness.  Exercise two: Warmth.  Exercise three: Heartbeats.  Exercise four: Breathing.  Exercise five: Abdominal sensations.  Exercise six: Coolness of the forehead. Once the six exercises are mastered the therapist then introduces two supplementary exercises. One involves concentration exercises with an aim to enhance the client’s ability to generate vivid mental images. The second involves specialised exercises to produce specific psycho physiological effects. Autogenic training has been noted to be useful in treating many different issues, including migraines, hypertension, asthma, somatisation, anxiety, depression and dysthymia, and insomnia or other sleep issues. Autogenic training professionals indicate several physical and mental health issues that should not be treated with this approach: severe heart problems, diabetes, symptoms of psychosis, delusional behavior, paranoia, and dissociation. 11.6 EMG Biofeedback Biofeedback refers to number of procedures that provide information about one or more biological responses. Generally biofeedback aims to teach the client to use the feedback to gain conscious control of a biological response over which the client had no control over earlier. Biofeedback is a self control procedure used for a variety of problems. Electromyographic (EMG) biofeedback is used as a general relaxation. In practice most of the applications of EMG Biofeedback involves attaching 3 small electrodes on the forehead to measure the tension levels mainly from the muscles in the upper facial area – known as Frontalis EMG Biofeedback since the electrodes focus above the frontalis muscles. EMG feedback is effective, generally less expensive than other relaxation procedures such as progressive relaxation. CU IDOL SELF LEARNING MATERIAL (SLM)

Relaxation Training 165 Parameter of Suitable sensor, Interest transducer, detector Directional Change Display/feedback - Visual, Audio, INVOLUNTARY VOLUNTARY Tactile, Combination Recognition of change at conscious level Fig. 11.1 11.7 Summary Our fast – paced society and hurried life push our minds and bodies to the limit, even at the cost of mental and physical wellbeing. According to the Mind/Body Medical Institute at Harvard University, 60 to 90% of all medical office visits in the United States are for stress related disorders. Stress most often has adverse ill effects on both health and the immune system. These techniques are beneficial while coping with stress and promoting long term health by calming the stress and anxiety ill effects. These techniques generally focus on refocusing attention, increasing body awareness and exercises to integrate the mind and body together. These practices lead to a healthier perspective in stressful circumstances. 11.8 Key Words/Abbreviations  Relaxation: any method, process, procedure, or activity that helps a person to relax; to attain a state of increased calmness  EMG: Electromyography  Tensing: simple technique involves the tensing and relaxing of all of the major muscles in your body in order of from your head to your feet. CU IDOL SELF LEARNING MATERIAL (SLM)

166 Advanced Counseling Skills - I  Muscle groups: the different muscle groups are foot, lower leg and foot, entire leg, hand, entire right arm, buttocks, stomach, chest, neck and shoulders, mouth, eyes, and forehead  Imagery: is a stress management technique, where you use your imagination to picture a person, place, or time that makes you feel relaxed, peaceful and happy. 11.9 Learning Activity 1. Develop your own image that is soothing and makes you relaxed used in the guided imagery step of relaxation. ----------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------- 2. Using the transcript mentioned in the process of relaxation techniques and the visual you created in activity one. Practice a relaxation session with your friend. ----------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------- 11.10 Unit End Questions (MCQ and Descriptive) A. Descriptive Types Questions 1. Discuss the history and development of relaxation techniques. 2. Write a detailed note on the procedure used in relaxation training. 3. Describe the other techniques of relaxation. 4. Note the considerations before the therapist chooses the relaxation techniques B. Multiple Choice/Objective Type Questions 1. The technique of progressive relaxation stems from the work of __________. (a) Jacobson (b) Schultz (c) Skinner (d) William Wundt CU IDOL SELF LEARNING MATERIAL (SLM)

Relaxation Training 167 2. There are mainly __________ muscle groups. (a) 12 (b) 14 (c) 17 (d) 5 3. Autogenic therapy was developed by __________. (a) Schultz (b) Jacobson (c) Freud (d) Rogers 4. Autogenic training is a set of __________ psycho physiological exercises. (a) 3 (b) 4 (c) 6 (d) 10 5. Frontalis EMG Biofeedback primarily focuses on __________ muscle group. (a) Frontalis (b) Occipitofrontalis (c) temporoparietalis (d) superior auricular Answers 1. (a), 2. (b), 3. (a), 4. (c), 5. (a). 11.11 References 1. A Brief History of Autogenics. (2011). Retrieved from http://www.autogenictherapy. com.au/autogenics_history.html 2. Stetter F., and Kupper, S. (200 2). Autogenic training: A meta-analysis of clinical outcome studies. Applied Psychophysiology and Biofeedback, 27(1). 45-98 3. Behaviour therapy, techniques and empirical findings, John Masters et al, 3rd edition 4. Behaviour therapy, S Jena.  CU IDOL SELF LEARNING MATERIAL (SLM)