Gambling Disorder, what is it:

Gambling disorder:

Gambling disorder (previously called pathological gambling) is recognized in the DSM-5 as a behavioral addiction. It involves persistent and recurrent problematic gambling behavior that leads to significant distress or impairment. 

Here’s a detailed overview from a clinical psychology perspective:

Key Features

Persistent gambling behavior despite negative consequences (financial, social, occupational, or legal).

Loss of control: Repeated unsuccessful efforts to reduce or stop gambling.

Preoccupation: Constantly thinking about gambling, planning future bets, or thinking of ways to get money for gambling.

Tolerance: Needing to gamble with increasing amounts of money to achieve the desired excitement.

Withdrawal-like symptoms: Restlessness or irritability when attempting to cut down or stop gambling.

Chasing losses: Trying to recover lost money by gambling more, often worsening the problem.

Deception: Lying to family members, friends, or therapists about gambling behaviors.

Risking significant relationships or opportunities: Gambling interferes with work, relationships, or educational/career prospects.

Relying on others for financial rescue: Seeking loans or financial help to relieve desperate financial situations caused by gambling.

Diagnostic Criteria (DSM-5)

  • Diagnosis is typically made when 4 or more of the above behaviors occur over a 12-month period.
  • Severity can be classified as:
  • Mild: 4–5 criteria
  • Moderate: 6–7 criteria
  • Severe: 8–9 criteria

Psychological and Behavioral Factors

  • Cognitive distortions: Beliefs like “I’m due for a win” or “I can control the outcome.”
  • Emotional triggers: Stress, boredom, loneliness, or depression may intensify gambling urges.
  • Comorbidities: Often co-occurs with substance use disorders, mood disorders, or impulse-control disorders.

Treatment Approaches

Cognitive Behavioral Therapy (CBT)

  • Targets cognitive distortions and helps develop healthier coping strategies.

Motivational Interviewing (MI)

  • Enhances motivation to change gambling behavior.

Self-help programs

  • Gamblers Anonymous or other peer support groups.

Pharmacotherapy

  • CONSULT A PSYCHIATRIST

Family therapy

  • Helps repair relationships and develop a supportive environment.

Red Flags

  • Increasing secrecy about finances.
  • Borrowing money to gamble.
  • Mood swings or irritability when not gambling.
  • Frequent thoughts about gambling.

Shervan K Shahhian

Understanding Dissociative Difficulties:

Dissociative Difficulties:

Dissociative difficulties refer to problems in maintaining a consistent sense of self, consciousness, memory, emotions, or perception of reality. They occur when a person experiences disruptions in how they process or integrate their thoughts, feelings, and experiences. These difficulties can range from mild and transient to severe and chronic.

Common Features of Dissociative Difficulties

  • Depersonalization: Feeling detached from one’s own body, thoughts, or emotions (e.g., “I feel like I’m watching myself from outside”).
  • Derealization: Feeling that the external world is unreal or dreamlike.
  • Amnesia: Gaps in memory, often for stressful or traumatic events.
  • Identity confusion: Uncertainty about who one is, feeling “fragmented” or having conflicting self-states.
  • Identity alteration: Experiencing distinct shifts in behavior, preferences, or sense of self (can occur in Dissociative Identity Disorder).

Possible Causes

  • Trauma: Especially early childhood trauma, abuse, or neglect.
  • Chronic stress: Ongoing emotional or physical stress can lead to dissociative coping mechanisms.
  • PTSD and Complex PTSD: Dissociation is a common symptom.
  • Certain mental health conditions: Borderline Personality Disorder, severe anxiety, or depression can include dissociative symptoms.

Impact on Daily Life

  • Difficulty remembering conversations or events.
  • Feeling emotionally numb or disconnected from life.
  • Struggling to stay present in relationships, work, or school.
  • Episodes of losing time or feeling unreal.

Approaches to Support & Treatment

  • Grounding techniques: Mindfulness, sensory awareness, and orienting exercises to bring attention back to the present.
  • Psychotherapy:
    • Trauma-focused therapy (e.g., EMDR, Somatic Experiencing).
    • Parts work (e.g., Internal Family Systems).
    • Cognitive-behavioral approaches to manage triggers.
  • Stabilization before trauma processing: Learning emotional regulation and safety skills.
  • Medication: Sometimes used for co-occurring depression, anxiety, or PTSD symptoms.

2) practical techniques for managing dissociative episodes?

Here are practical techniques often used to manage dissociative episodes and stay grounded in the present:


1. Grounding Through the Senses

These help reorient awareness to the here and now:

  • 5-4-3-2-1 Technique: Name 5 things you see, 4 you can touch, 3 you can hear, 2 you can smell, 1 you can taste.
  • Temperature Shift: Hold an ice cube, splash cool water on your face, or drink a cold beverage.
  • Texture Awareness: Touch something with distinct texture (rough fabric, smooth stone) and describe it aloud.

2. Movement-Based Grounding

Engages the body to reconnect with the present moment:

  • Stomping or marching in place: Feel your feet making contact with the ground.
  • Stretching or yoga poses: Focus on the sensation of muscles lengthening.
  • “Name what you’re doing” technique: As you move, narrate it (e.g., “I am walking to the window, I am opening the curtains”).

3. Cognitive Grounding

Brings the mind back from detachment or confusion:

  • Orientation Statement: Say aloud: “I am safe. I am in [location]. The date is [today’s date].”
  • Mental Exercises: Count backward from 100 by sevens, recite a poem, or list categories (e.g., “types of fruit”).
  • Reminder Cards: Carry a card with calming facts about the present (“I am [name], I am 35 years old, I live in [city], I am safe now”).

4. Emotional & Self-Soothing Strategies

Addresses underlying overwhelm that triggers dissociation:

  • Breath regulation: Inhale for 4 counts, hold for 4, exhale for 6–8 counts.
  • Self-talk: Gentle, affirming phrases like “This feeling will pass” or “I can handle this moment.”
  • Safe-space visualization: Imagine a calm, safe place and focus on sensory details of being there.

5. Longer-Term Prevention & Coping Skills

  • Identify triggers: Keep a journal of when dissociation occurs to recognize patterns.
  • Develop a “grounding kit”: Include items like a scented lotion, textured object, photo of a safe place, or a favorite song playlist.
  • Therapeutic support: Work with a trauma-informed therapist to process underlying causes and build resilience.
  • Daily regulation: Adequate sleep, balanced nutrition, and regular movement reduce vulnerability to dissociation.

Shervan K Shahhian

Understanding Superstitions and Magical Thinking:

Superstitions and Magical Thinking:

Superstitions and Magical Thinking refer to beliefs or behaviors that involve assuming a cause-and-effect relationship between actions, symbols, or rituals and outcomes, despite lacking scientific or logical evidence.

1. Superstitions

Superstitions are culturally or personally held beliefs that specific actions, objects, or rituals can bring good luck, ward off bad luck, or influence outcomes.

Examples:

  • Carrying a lucky charm (e.g., rabbit’s foot, four-leaf clover).
  • Avoiding walking under ladders.
  • Believing breaking a mirror brings seven years of bad luck.

Psychological Functions:

  • Control in uncertainty: Provides a sense of agency in unpredictable situations (sports, exams, illness).
  • Cultural identity: Reinforces group traditions and shared meaning.
  • Anxiety reduction: Rituals can soothe fears in high-stress environments.

2. Magical Thinking

Magical thinking is the belief that thoughts, words, or actions can directly cause events to happen in the physical world, without a clear causal link.

Examples:

  • Believing that thinking about an accident will make it happen.
  • Performing a ritual to ensure success (e.g., tapping a surface three times for good luck).
  • Associating unrelated events as having hidden connections (e.g., wearing a specific shirt makes a team win).

Developmental & Clinical Contexts:

  • Childhood: Common in early cognitive development (Piaget’s preoperational stage, ages 2–7).
  • Religion & Spirituality: Rituals and prayers can have elements of magical thinking.
  • Mental Health: Excessive or rigid magical thinking can be seen in OCD, psychosis, or certain anxiety disorders.

Differences Between the Two

  • Superstitions are often externalized, learned from culture, and repeated behaviors.
  • Magical thinking is more internalized, often personal beliefs about one’s own mental influence over reality.

Psychological Perspectives

  • Cognitive-behavioral: Views them as cognitive distortions or coping mechanisms.
  • Anthropological: Sees them as adaptive cultural practices that historically reduced uncertainty.
  • Neuroscientific: Links to pattern recognition and the brain’s tendency to find connections, even when none exist.

Therapeutic techniques to address Excessive Magical Thinking:

Here are evidence-based therapeutic techniques commonly used to address excessive magical thinking (especially when it leads to distress, dysfunction, or is part of conditions like OCD, anxiety, or psychosis):

1. Psychoeducation

  • Goal: Help clients understand what magical thinking is and how it operates.
  • Method:
  • Explain the difference between correlation and causation.
  • Normalize occasional magical thinking while highlighting when it becomes problematic.
  • Use examples relevant to the client’s experience (e.g., “Wearing a certain shirt doesn’t actually influence a sports game’s outcome”).

2. Cognitive-Behavioral Therapy (CBT)

  • Cognitive Restructuring:
  • Identify irrational beliefs (“If I don’t knock on wood, something bad will happen”).
  • Challenge them with evidence (“What proof do you have that not knocking on wood caused harm before?”).
  • Replace with rational alternatives (“Accidents happen regardless of this ritual”).
  • Behavioral Experiments:
  • Test beliefs in a controlled way (“Let’s see what happens if you skip the ritual once”).
  • Gather real-life evidence to weaken the perceived link between thought/action and outcome.

3. Exposure and Response Prevention (ERP) (for OCD-like magical thinking)

  • Process:
  • Gradual exposure to feared situations (e.g., not performing a ritual).
  • Preventing the compensatory behavior (not “undoing” the supposed bad luck).
  • Over time, anxiety decreases, and the client learns feared outcomes do not occur.

4. Metacognitive Therapy (MCT)

  • Focus: Changing beliefs about thinking itself (“If I think it, it will happen”).
  • Techniques:
  • Detached mindfulness — viewing thoughts as mental events, not threats.
  • Challenging “thought-action fusion” (the belief that thinking something makes it more likely).

5. Mindfulness-Based Interventions

  • Purpose: Reduce over-identification with thoughts.
  • Practice:
  • Labeling thoughts as “just thoughts” (e.g., “I’m having the thought that…”).
  • Present-moment awareness to reduce compulsive rituals driven by imagined futures.

6. Reality Testing & Socratic Questioning

  • Examples:
  • “Has this ritual ever guaranteed safety before?”
  • “What happened the last time you didn’t do it?”
  • Encourages rational evaluation rather than blind belief.

7. Addressing Underlying Emotional Needs

  • Insight: Magical thinking often arises to manage anxiety, uncertainty, or lack of control.
  • Approach:
  • Teach emotional regulation skills (breathing, grounding techniques).
  • Strengthen tolerance for uncertainty (“I can handle not knowing”).

8. Pharmacological Support

  • CONSULT A PSYCHIATRIST

Shervan K Shahhian

Understanding Over-Saving Disorder:

Over-Saving Disorder:

Over-Saving Disorder (also called Compulsive Saving or Hoarding of Money) is not an official diagnosis in the DSM-5, but it is recognized in psychology and financial therapy as a maladaptive money behavior. It involves an excessive and irrational tendency to save money far beyond what is necessary for security or future needs, often leading to emotional, relational, or functional problems.

Key Features

Excessive Fear of Spending — Persistent anxiety about running out of money, even when finances are secure.

Over-Accumulation — Saving far beyond realistic future needs; reluctance to invest, donate, or spend on self-care.

Emotional Drivers — Underlying fear, guilt, or trauma related to scarcity (often rooted in childhood deprivation or financial instability).

Functional Impairment — Neglecting health, relationships, or life satisfaction because of refusal to spend.

Control and Safety — Money becomes a symbol of control, security, or self-worth.

Possible Psychological Roots

  • Trauma or Scarcity Background: Growing up in poverty, economic instability, or with financially anxious caregivers.
  • Anxiety Disorders: Generalized anxiety, obsessive-compulsive traits (money as a “safety ritual”).
  • Control Issues: Using money to feel safe in an unpredictable world.
  • Identity & Self-Worth: Belief that having (and not spending) money defines one’s value.

Consequences

  • Strained relationships (partners feeling deprived or controlled).
  • Missed opportunities (investments, experiences, medical care).
  • Chronic anxiety and inability to enjoy financial stability.

Treatment Approaches

Cognitive-Behavioral Therapy (CBT): Challenging catastrophic thinking about spending.

Financial Therapy: Combining psychological insight with financial planning.

Gradual Exposure: Practicing small, meaningful spending to build tolerance. Addressing Trauma: Processing early experiences of scarcity or neglect.

Values-Based Spending: Learning to align money use with personal values and life goals.

Clinical Strategies for working with clients who Over-Save:

Here are clinical strategies for working with clients who exhibit Over-Saving Disorder (compulsive saving behaviors):

1. Assessment and Understanding the Behavior

  • Explore Money History: Ask about childhood experiences with money, scarcity, or parental attitudes.
  • Identify Core Beliefs: Uncover thoughts such as “If I spend, I’ll lose everything” or “I’m only safe if I have enough.”
  • Assess Impairment: Determine how saving impacts relationships, health, and quality of life.
  • Distinguish From Hoarding: Clarify that this is about saving/withholding money, not physical clutter.

2. Build Awareness and Psychoeducation

  • Normalize Anxiety but Challenge Extremes: Explain how financial caution is healthy, but rigidity can be harmful.
  • Psychoeducation on Money Psychology: Teach how over-saving often stems from fear rather than rational planning.
  • Highlight Opportunity Costs: Help them see what they’re missing out on (relationships, experiences, health).

3. Cognitive and Emotional Interventions

  • Cognitive-Behavioral Therapy (CBT):
  • Challenge catastrophic predictions (“If I spend $100, I’ll end up homeless”).
  • Replace with balanced thoughts (“I have savings, and spending on health is an investment.”).
  • Schema Therapy: Address deep-rooted schemas (scarcity, control, mistrust).
  • Emotion-Focused Work: Validate fear, then explore the emotional meaning of money (security, love, identity).

4. Behavioral Strategies

  • Values-Based Budgeting: Create a budget that includes a mandatory “joy” or “well-being” spending category.
  • Gradual Exposure: Start with small, safe expenditures to reduce anxiety.
  • Behavioral Experiments: Track emotional responses before and after spending to challenge irrational fears.
  • Set Boundaries for Saving: Establish a cap for savings beyond which money must be allocated elsewhere.

5. Relational & Systemic Work

  • Couples/Family Therapy: If over-saving creates conflict, facilitate communication and compromise.
  • Integrate Financial Professionals: Collaborate with financial planners to reassure client of objective security.

6. Address Underlying Trauma and Anxiety

  • Trauma-Informed Care: Explore whether early deprivation or financial instability still drives fear.
  • Mindfulness & Somatic Regulation: Teach skills to tolerate anxiety associated with spending.

7. Long-Term Goals

  • Shift from fear-based saving to purposeful financial planning.
  • Foster a healthy money identity: “I am secure and can enjoy my resources responsibly.”
  • Encourage legacy thinking: Spending as a way to create meaning (experiences, generosity, relationships).

Shervan K Shahhian

OCD Triggers, what are they:

OCD Triggers:

Obsessive-Compulsive Disorder (OCD) triggers are thoughts, situations, or experiences that provoke obsessive thoughts and/or compulsive behaviors. These triggers vary from person to person but often fall into common categories.

Here are some of the most frequently reported OCD triggers:

Common OCD Triggers by Theme:

1. Contamination

Touching doorknobs, public toilets, money, or other “unclean” objects

Being around sick people

Dirt, germs, or bodily fluids (saliva, sweat, blood)

2. Harm or Responsibility

Fear of accidentally harming someone (e.g., leaving the stove on, hitting someone with a car)

Intrusive thoughts of causing harm (e.g., stabbing a loved one)

Responsibility-related guilt or fear of being blamed

3. Symmetry and Order

Items not being perfectly aligned

Uneven numbers or “wrong” arrangements

Needing to perform tasks in a certain pattern or order

4. Sexual or Violent Intrusions

Disturbing sexual thoughts about children, relatives, or inappropriate partners

Intrusive images or urges of violent acts

Fear that thoughts mean you’re a bad or dangerous person

5. Religious or Moral Scrupulosity

Fear of offending God or violating religious rules

Obsessive praying or confessing

Intrusive blasphemous thoughts

6. Relationship OCD

Doubts about loving one’s partner

Intrusive thoughts about infidelity (on your part or theirs)

Constant need for reassurance about the relationship

7. Health-Related OCD (Hypochondria overlap)

Obsessions about having a serious illness

Bodily checking or Googling symptoms excessively

8. Superstitions and Magical Thinking

Fear something bad will happen unless a ritual is done

Assigning meaning to numbers, colors, or patterns

Triggering Situations or Events

Stressful life changes (e.g., moving, job change, illness)

Watching or reading the news

Visiting certain places (e.g., hospitals, religious sites)

Conversations that touch on taboo subjects

Fatigue, hunger, or hormonal changes (can lower resistance to obsessions)

Notes:

Triggers don’t cause OCD, but they activate existing symptoms.

Exposure and Response Prevention (ERP), a core CBT method, helps reduce sensitivity to triggers.

Avoidance of triggers often strengthens OCD in the long run.

Shervan K Shahhian

Understanding Compulsive Buying Disorder (CBD):


Compulsive Buying Disorder (CBD):

Compulsive Buying Disorder (CBD), also called oniomania, is a behavioral addiction characterized by recurrent, excessive, and uncontrollable shopping or spending, often leading to distress, financial problems, or social/occupational impairment. It’s more than just enjoying shopping; it’s driven by a psychological urge that can feel irresistible.

Here’s a detailed overview:

1. Key Features

Preoccupation with buying: Persistent thoughts about shopping or planning purchases.

Loss of control: Inability to resist the urge to buy, even when aware of negative consequences.

Emotional triggers: Shopping often provides a temporary mood boost, distraction, or relief from negative emotions like anxiety, depression, or boredom.

Post-purchase guilt: Feelings of regret, shame, or guilt after spending.

Financial and social impact: Accumulation of debt, conflicts with family, and social withdrawal.

2. Psychological and Emotional Factors

Often associated with impulse control disorders or other mental health conditions like:

Depression

Anxiety disorders

Bipolar disorder

Obsessive-compulsive tendencies

Shopping can serve as emotional regulation, a way to cope with stress or low self-esteem.

3. Causes & Risk Factors

Biological: Possible dysregulation in brain circuits related to reward, impulsivity, and decision-making.

Psychological: Poor coping skills, low self-esteem, perfectionism, or need for social approval.

Social/Cultural: Consumer culture, advertising, and easy access to online shopping can exacerbate symptoms.

Trauma or stress: Childhood neglect, abuse, or financial insecurity may contribute.

4. Consequences

Financial: Debt, bankruptcy, unpaid bills.

Emotional: Guilt, shame, depression, anxiety.

Interpersonal: Conflicts with family/friends, secretive behavior, social withdrawal.

Legal: In extreme cases, theft or fraud to sustain buying behavior.

5. Treatment Approaches

Psychotherapy: Cognitive-behavioral therapy (CBT) is most effective; focuses on:

Identifying triggers and patterns

Developing coping strategies

Challenging dysfunctional thoughts about shopping

Medication: SEE A PSYCHIATRIST

Self-help and support groups: Organizations like Shopaholics Anonymous provide peer support.

Financial counseling: Practical strategies to manage money and prevent relapse.

CBD is considered a real psychological disorder, not just “bad spending habits,” and early intervention improves outcomes.

Shervan K Shahhian

Understanding Hysteria:

Hysteria:

“Hysteria” is an old psychological and medical term, no longer used today, but historically very influential.

Origins

  • Ancient Greece: The word comes from the Greek hystera (meaning “womb”). Hippocrates and later physicians thought symptoms of hysteria came from a “wandering uterus” inside women’s bodies.
  • Middle Ages / Renaissance: It was linked to witchcraft, demonic possession, or spiritual weakness.
  • 19th century medicine: Doctors described hysteria as a disorder — mostly in women — causing fainting, paralysis, seizures, emotional outbursts, or strange bodily symptoms without clear physical cause.

In Psychology & Psychiatry

  • Jean-Martin Charcot (1800s, Paris): Studied hysterical seizures, showing they were psychological, not neurological.
  • Sigmund Freud & Josef Breuer: Treated hysteria with hypnosis and developed the “talking cure,” which laid the foundation for psychoanalysis. Freud proposed that hysteria came from repressed traumatic memories.
  • 20th century: The concept evolved into what we now call somatic symptom disorders, conversion disorder, or sometimes dissociative disorders.

Today

  • The term “hysteria” is no longer a clinical diagnosis (it was officially dropped in DSM-III, 1980).
  • Modern psychology recognizes that the symptoms once called “hysterical” often come from trauma, stress, or unconscious processes.

In psychology, the idea of hysteria has gone through a major transformation.

1. Classical View (1800s — early 1900s)

  • Jean-Martin Charcot (Paris neurologist) studied patients with dramatic paralysis, fainting, seizures, and loss of speech without medical cause. He treated them with hypnosis, showing symptoms could be influenced psychologically.
  • Sigmund Freud & Josef Breuer: Saw hysteria as rooted in unconscious conflict and repressed trauma. Their case studies (like Anna O.) became the foundation of psychoanalysis. They described hysteria as the “conversion” of emotional distress into bodily symptoms.

2. Mid-20th Century

  • Hysteria became an umbrella label for puzzling symptoms with no physical explanation.
  • It carried heavy gender bias (diagnosed mostly in women, often dismissed as “emotional” or “irrational”).
  • Critics in psychology and psychiatry pushed for more precise, less stigmatizing diagnoses.

3. Modern Psychology (since DSM-III, 1980)

The term hysteria was dropped, replaced with more specific categories:

  • Conversion Disorder → psychological stress manifests as neurological symptoms (e.g., paralysis, blindness, seizures without medical basis).
  • Somatic Symptom Disorder → excessive distress about physical symptoms.
  • Dissociative Disorders → when trauma or stress causes disruptions in memory, identity, or consciousness.

4. Psychological Understanding Today

  • What used to be called “hysteria” is now seen as the mind-body connection under stress and trauma.
  • Symptoms are not “faked” but are real expressions of psychological distress.
  • Modern therapy focuses on trauma-informed care, stress regulation, and integration rather than labeling someone as “hysterical.”

Shervan K Shahhian

Understanding Therapeutic Philosophy:

Therapeutic Philosophy:

A therapeutic philosophy is the guiding set of beliefs, principles, and values that shape how a therapist understands human nature, emotional distress, and the process of healing.

It’s not just a treatment method — it’s the “why” behind the therapist’s approach, influencing what techniques they choose, how they relate to clients, and what outcomes they prioritize.

Here’s a structured breakdown:

1. Core Assumptions About Human Nature

Every therapeutic philosophy starts with a view of what people are fundamentally like.

  • Humanistic — People are inherently good and capable of growth.
  • Psychodynamic — Unconscious forces and early experiences shape personality and behavior.
  • Behavioral — Behavior is learned and can be changed through conditioning.
  • Existential — People seek meaning, authenticity, and must face the reality of mortality.

2. Understanding of Distress

Therapists differ in how they believe psychological suffering arises:

  • Trauma-oriented — Distress comes from unresolved emotional wounds.
  • Cognitive-behavioral — Distress is maintained by faulty thinking patterns and behaviors.
  • Systemic — Problems arise within relationship and family systems, not just the individual.

3. Role of the Therapist

Philosophies define how active, directive, or collaborative the therapist should be:

  • Guide and facilitator — Helps clients discover their own solutions (humanistic).
  • Expert and interpreter — Offers insight into unconscious processes (psychoanalytic).
  • Coach and strategist — Teaches skills and assigns structured exercises (CBT).

4. Goals of Therapy

The philosophy shapes what “healing” means:

  • Symptom reduction — Relief from depression, anxiety, trauma symptoms.
  • Personal growth — Greater self-awareness, self-acceptance, purpose.
  • Relational change — Healthier communication and connection with others.

5. Values and Ethics

Therapeutic philosophies also include moral commitments:

  • Respect for autonomy — Clients direct their own healing.
  • Non-judgment — All experiences are valid in the healing space.
  • Empowerment — Helping clients reclaim agency.

Examples of Therapeutic Philosophies:

Here are examples of therapeutic philosophies from well-known therapists and schools of thought, showing how each one’s core beliefs shape their approach:

1. Carl Rogers — Person-Centered Therapy

Philosophy:

  • People have an innate drive toward growth, self-understanding, and fulfillment.
  • Healing happens in a non-judgmental, accepting environment.
  • The therapist is a facilitator, not a fixer.

Core values:

  • Unconditional positive regard — accepting clients without conditions.
  • Empathy — deeply understanding the client’s perspective.
  • Congruence — therapist authenticity and transparency.

2. Viktor Frankl — Logotherapy

Philosophy:

  • The primary human drive is the search for meaning.
  • Even in suffering, people can find purpose.
  • Meaning is discovered, not invented, through choices and attitudes.

Core values:

  • Freedom to choose one’s response to life’s challenges.
  • Suffering can be transformed into growth.
  • Responsibility toward oneself and others.

3. Aaron Beck — Cognitive Therapy

Philosophy:

  • Distress is maintained by distorted thoughts and beliefs.
  • Changing thoughts changes feelings and behavior.
  • Clients can learn to challenge and reframe their thinking.

Core values:

  • Collaboration between therapist and client.
  • Practical, skills-based interventions.
  • Empowering clients with tools they can use independently.

4. Irvin Yalom — Existential Therapy

Philosophy:

  • Psychological distress often stems from avoiding life’s givens: death, freedom, isolation, and meaninglessness.
  • Facing these truths openly leads to authentic living.
  • The therapeutic relationship is a real, mutual encounter.

Core values:

  • Radical honesty in the therapy room.
  • Encouraging personal responsibility.
  • Helping clients create a meaningful life.

5. Salvador Minuchin — Structural Family Therapy

Philosophy:

  • Problems often arise from dysfunctional family structures and boundaries.
  • Change happens by reorganizing how the family interacts.
  • The therapist joins the family system to promote healthier patterns.

Core values:

  • Focus on relationships rather than only the individual.
  • Flexible boundaries are healthier than rigid or enmeshed ones.
  • Lasting change comes from shifting interactional patterns.

Shervan K Shahhian

Motivational Interviewing (MI), what is it:

Motivational Interviewing (MI):

Motivational Interviewing (MI) is a client-centered, directive counseling style used to help people explore and resolve ambivalence about behavior change. It was originally developed by William R. Miller and Stephen Rollnick, primarily in the context of addiction treatment, but it’s now widely used in various healthcare, mental health, and social work settings.

Core Principles of Motivational Interviewing

Express Empathy

  • Use reflective listening to convey understanding of the client’s experience.
  • Avoid judgment or confrontation.

Develop Discrepancy

  • Help clients recognize the gap between their current behavior and their personal goals or values.
  • This creates motivation for change without pressure.

Roll with Resistance

  • Avoid arguing or opposing resistance.
  • Resistance is seen as a signal to change strategies, not confront the client.

Support Self-Efficacy

  • Emphasize the client’s ability and power to make changes.
  • Highlight past successes and strengths.

Key Techniques (OARS)

Technique Description Open-ended Questions Encourage clients to explore their thoughts and feelings in depth. Affirmations Recognize client strengths and efforts. Reflective Listening Mirror back what the client says to show understanding and prompt deeper reflection. Summarizing Reinforce what has been discussed, especially change talk, to consolidate motivation.

 Stages of Change Model (Transtheoretical Model)

MI is often used to help people move through the stages:

Precontemplation — Not considering change.

Contemplation — Ambivalent about change.

Preparation — Planning to change soon.

Action — Taking active steps.

Maintenance — Sustaining the new behavior.

 Example in Practice (Addiction Context)

Therapist: “It sounds like a part of you really wants to cut back on drinking, but another part is worried about losing your social life. That’s a tough place to be.”

Client: “Yeah… I know it’s a problem, but I don’t know if I’m ready.”

Therapist: “You’ve been thinking about this a lot. What would be different in your life if you did make that change?”

Common Applications

  • Substance use treatment
  • Health behavior change (diet, exercise, medication adherence)
  • Smoking cessation
  • Criminal justice settings
  • Mental health therapy

Shervan K Shahhian

Fostering Critical Thinking & Self-Awareness in Mental Health Consultation:

1. Use Socratic Questioning (Critical Thinking Tool)

Help clients examine beliefs and assumptions by asking structured, open-ended questions:

  • “What evidence supports this thought?”
  • “Could there be another explanation?”
  • “What would you say to a friend who believed that?”

Goal: Move from automatic beliefs to evaluated understanding.

2. Encourage Reflective Journaling (Self-Awareness Tool)

Assign or explore prompts such as:

  • “What did I feel today, and why?”
  • “What patterns am I noticing in how I respond to stress?”
  • “What triggers me, and what need might be underneath that?”

Use these insights in-session to develop emotional literacy and personal narratives.

3. Challenge Cognitive Distortions (Blend Both Skills)

Use CBT or REBT techniques to identify distorted thinking:

  • Label common patterns: catastrophizing, black-and-white thinking, etc.
  • Practice re-framing: “What’s a more balanced or helpful way to see this?”

This helps clients learn to analyze and reframe automatic thoughts with awareness.

4. Practice Mindfulness for Self-Observation

Introduce mindfulness-based strategies (like MBSR or ACT) to help clients:

  • Notice thoughts/emotions without judgment
  • Develop inner distance from reactive patterns

Mindfulness strengthens the “observer self,” a cornerstone of self-awareness.

5. Explore Values & Beliefs Through Dialogue

Instead of “fixing” clients, partner with them in curious exploration:

  • “Where did that belief come from?”
  • “Is it serving you now?”
  • “What values do you want to live by?”

This enhances both metacognition and authentic decision-making.

6. Build Insight-to-Action Bridges

Awareness alone isn’t always enough — link reflection to practical changes:

  • “Now that you’ve recognized this pattern, what would a small next step look like?”
  • Help set SMART goals based on new self-understanding.

Summary Table:

Tool Targets Example Socratic Questioning Critical Thinking“What’s the evidence for that belief?” Journaling Self-Awareness “What emotion came up, and why? ”Cognitive Restructuring Both “What’s a more realistic thought?” Mindfulness Self-Awareness“ Let’s notice that thought without judging it.”Values WorkBoth “Does this belief align with who you want to be?”

Here’s a “Possible” therapeutic approach that applies critical thinking and self-awareness tools to clients struggling with anxiety, depression, and identity issues. Each issue includes key strategies, sample questions, and intervention ideas.

1. Anxiety: Overthinking, Catastrophizing, and Fear Patterns

Therapeutic Goal:1. Anxiety:

Build awareness of anxious thought loops and develop rational, calm alternatives.

Tools & Approaches:

Critical Thinking: Challenge Automatic Thoughts

  • Socratic Questions:
  • “What’s the worst that could happen — and how likely is that?”
  • “What evidence supports this fear? What evidence contradicts it?”
  • Cognitive Reappraisal:
  • Help them weigh facts vs. assumptions.

Self-Awareness: Recognize Triggers & Patterns

  • Identify physical signs of anxiety (e.g., tight chest, shallow breath).
  • Explore thought-emotion-behavior cycles:
  • “When you felt anxious, what were you thinking? What did you do?”

In-Session Practice:

  • Use thought record worksheets.
  • Practice grounding techniques while reflecting on the thoughts (bridging thinking and feeling).

2. Depression: Negative Self-Beliefs, Hopelessness, Inertia

Therapeutic Goal:

Illuminate and disrupt distorted self-concepts, activate small meaningful actions.

Tools & Approaches:

Critical Thinking: Deconstruct Core Beliefs Tools & Approaches:

  • “Where did that belief (‘I’m not good enough’) come from?”
  • “If your best friend said this about themselves, what would you say?”

Self-Awareness: Reconnect With Emotion and Energy

  • “What emotions are you pushing down right now?”
  • “What gives you even a little energy or meaning?”

Values Work (ACT-based):

  • Explore what truly matters beyond depression.
  • “When you feel most alive or authentic, what are you doing?”

In-Session Practice:

  • Create a belief map: “What do I believe about myself? Where did that come from?”
  • Track energy/mood in relation to daily activities (behavioral activation).

3. Identity Issues: Confusion, Fragmentation, Lack of Direction

Therapeutic Goal:

Facilitate self-exploration and coherence through narrative and values clarification.

Tools & Approaches:

Critical Thinking: Examine Inherited Beliefs

  • “What roles or labels have been placed on you by others?”
  • “Which parts feel authentic, and which feel imposed?”

Self-Awareness: Build Coherent Self-Narrative

  • Life timeline exercise: “What are the key turning points in your life?”
  • “What themes keep coming up in your story?”

Values Clarification:

  • “What kind of person do you want to become?”
  • “What matters more to you: safety, honesty, freedom, belonging…?”

In-Session Practice:

  • Identity journaling: “I am ___, I’m not ___, I want to be ___.”
  • Design a “Personal Compass” with core values, meaningful goals, and role models.

Summary Chart

Issue Critical Thinking Self-Awareness Sample Tools Anxiety Challenge catastrophizing Notice physiological + emotional patterns Thought records, grounding Depression Question core beliefs Track mood, values, and motivation Belief mapping, mood logs Identity Question social roles & labels Build personal narrative, clarify values Journaling, compass work

Shervan K Shahhian