The question ‘who am I?’ is at the fundamental core of humanity (Broderick, & Blewitt, 2010). One’s self concept is how seeks to answer that question by formulating a description and mental representation of that individual (Niepel, Brunne, & Preckel, 2014). William James discussed the differences of “I” and “Me” when discussing the self-system. He made the distinction that “me” centers on defining an individual’s self-concept and who they project to others (Broderick, & Blewitt, 2010).
Charles Cooley’s looking-glass-self metaphor is derived from the idea that we gain a sense of self, and therefore self-concept by observing the appraisals or criticisms from others, particular attachment figures. The influence of such interactions impact outward behaviors and social awareness (Broderick, & Blewitt, 2010). Within a culture there are varying themes including gender roles, social connections, academic, and career expectations that shift and impact an individual’s self-concept (Broderick, & Blewitt, 2010. & Wagner, Gerstorf, Hoppmann, & Luszcz, 2013).
Self-concept internally as an external description of features, characteristics and attributes through interactions with others (Broderick, & Blewitt, 2010). The role of early care givers is important in establishing self-concept in that secure attachments allow a child to develop positive self-worth and self-concept (Broderick, & Blewitt, 2010). Studies show that there is a strong correlation between self- concept and achievement. Individuals with a positive self-concept show tendencies toward continued self-enhancement and motivation in several domains throughout life (Niepel, Brunne, & Preckel, 2014). On the contrary, individuals with poor self-concept show trajectories toward maladaptive behaviors, delinquency, and substance abuse (Steiger, Allemand, Robins, & Fend, 2014).
Self-concept possess elements of stability and change throughout an individual’s lifespan and eventually begins to differentiate form others with maturity (Broderick, & Blewitt, 2010). Adolescence is marked by a period of rapid changes throughout multiple domains. Transitions such as those in adolescence are marked by shifts in domain competencies and the development of new skills that shape social interactions and identity (Wagner, Gerstorf, Hoppmann, & Luszcz, 2013).
Self-concept cannot completely be isolated from the self-system. Self-concept helps to shape and formulate self-esteem and self-regulation. The interaction of biopsychosocal and spiritual domains continues to impact fluctuations in the self-system (Broderick, & Blewitt, 2010). Individuals with a positive self-concepts show tendencies toward an overall higher self-esteem and self-regulation through transitional life phases (Steiger, Allemand, Robins, & Fend, 2014).
Broderick, P. C., & Blewitt, P. (2010). The lifespan: Human development for helping professionals (3rd. ed.). Boston, MA: Allyn & Bacon.
Niepel, C., Brunner, M., & Preckel, F. (2014). The longitudinal interplay of students’ academic self-concepts and achievements within and across domains: Replicating and extending the reciprocal internal/external frame of reference model. Journal Of Educational Psychology, doi:10.1037/a0036307
Steiger, A. E., Allemand, M., Robins, R. W., & Fend, H. A. (2014). Low and decreasing self-esteem during adolescence predict adult depression two decades later. Journal Of Personality And Social Psychology, 106(2), 325-338. doi:10.1037/a0035133
Wagner, J., Gerstorf, D., Hoppmann, C., & Luszcz, M. A. (2013). The nature and correlates of self-esteem trajectories in late life. Journal Of Personality And Social Psychology, 105(1), 139-153. doi:10.1037/a0032279
Existential philosophy reflects the desire to understand a deeper human condition through the emphasis of purpose and meaning. It is often reflected in the form of angst experienced by individuals in their daily lives and in the post agricultural societies. The industrialization and increased automation of work increases individual isolation and decreases a purposeful connection to work (Sterner, 2012). Thus, existential philosophy is applicable when seeking to identify patterns within contemporary work relations.
The philosophical emphasis on freedom, meaning, and death suggests that existential psychology is somewhat amorphous and can be applied to many aspects of a client’s wellbeing. Working to align with client’s values related to meaning and purpose presents a well-suited approach to working thought periods of adjustment. If an individual’s career trajectory is viewed as a series of adjustments related to work, existential philosophy becomes applicable when navigating adjustments within a complex system of employment related concerns (Sterner, 2012).
Sterner (2012) argues that in a postmodern workforce, less emphasis is placed on the alignment of traits when seeking career opportunities. Workers often seek career opportunities that reflect the fundamental existential pillars of purpose and meaning. There is a common duality that exists between the individuals and their environment in which the individual and the environment engage in reciprocal interactivity and influence. This creates a sense of tension as the point in which the individual stops and the social sphere begins is often ambiguous, creating a sense of fluidity and motion. Physics would ultimately describe the phenomenon as interacting field systems (Martin, 2003, & Wagmans, et. al., 2012) and the concept would extend into other domains of philosophy, psychology, social science, and economics.
Gestalt concepts in psychology and philosophy recognize that the individual is more then the sum of its parts by being both part of and different then its parts. In essence, the reciprocity between the individual internal and external filed of influence create a ‘whole’ in which perception switches between the internal and external by means of temporal states and sensory input (Wagmans, et. al., 2012, Kohler, 1947, & Ellis, 1930). It is this perception of pressure from the internal self and the external world that drive motivation, and the construction of meaning and purpose.
Contemporary Career Conceptualization
The contemporary concept of work has evolved as societal changes occur forcing the reevaluation of the ‘career’ to reflect such change. Prior to the 21st century, careers were akin to a linear trajectory or the movement up a defined career ladder (Swanson, & Fouad, 2015). Social and economic changes within a more digital, multicultural, and global economy shift the average career trajectory. Jobs have become less permanent and reflect the proliferation of temporary assignments (Brown, & Lent, 21013).
Today one’s career path often consists of several protein careers in which the individual constructs their own unique narrative (Swanson, & Fouad, 2015, & Brown, & Lent, 2013). Contemporary careers are no longer conceptualized as a ladder. Instead individual career progression often resembles a trellis in which a series of lateral, parallel, and perpendicular steps lead to a larger career goal.
Career Construction Theory and the Life Design Paradigm
Mark L. Savikas is one of many contemporary career theorists who expanded on the work of Super’s life-span, life-space theory. He proposed his Career Construction Theory and the Life Design Paradigm as a way to understand the broader connection of the ‘self’ to career and vocational paths. The origins of Career Construction Theory have roots in Super’s work, yet diverge to so some degree (Swanson, & Fouad, 2015) to emphasize the active role of the individual in vocational evolution.
Career Construction Theory and the Life Design Paradigm focus on the process through which individuals construct their sense of self, engage is self-determinism by deliberate vocational behavior, and construct personal meaning form their careers. The primary concept emphasized and active self-construction which begins during childhood. (Savickas, 2013, & Swanson, & Fouad, 2015).
The construction of the self is a multilayered process consisting of complex phases of reflecting and experiencing. Language represents a way to shape identity by providing a means to project subjective aspects of the self and who the individuals intends to be. During childhood, children serve as actors playing a social role (Brown, & Lent, 2013) within the context of their environment. Here beliefs surrounding personal abilities, values, and actions are incorporated into the self-schema which is then reflected back into their environment for appraisal (Lo & Abbott, 2019, & Tafarodi, 1998). This can also be illustrated and supported through Charles Colley’s looking glass theory.
As individuals mature, the sense of self becomes subjective. Savikas (2013) suggests that the individual embarks on a journey of self-discovery and become an agent. Self-discovery and subjectivity reflect the individual’s journey toward self-determination. The individual can progress through a hierarchy of goals and achievements that resemble a bureaucratic social structure. This self-discovery process mirrors Maslow’s hierarchical development toward self-actualization. The self as agent reflects a sense of career adaptability that has its evolutionary origins in Super’s concept of career maturity (Brown, & Lent. 2013, & Swanson, & Fouad, 2015).
Individuals move through their career path transitioning from actors to agents, and finally authors. Reflection of patterns throughout the individual life enables the construction of experiences and influences into a constellation of purposeful goals. The narration of experiences enables individuals to construct resumes and occupational plotlines that represent the sequence of career transitions and adjustments. This helps to crystalize meaning and purpose in the individual’s relationship to work (Savikas, 2013, & Brown, & Lent. 2013).
Savikas’ concept of career adaptability evolved out of Super’s concept of career maturity in which the individual moves through four dimensions related to concern, control, curiosity, and confidence. The concept of career concern and career indifference introduces the use of Holland’s RIASEC code during career and vocational education trajectories thar reflect the optimism of the individual as actor. The concept of career control and career indifference reflects the choice or apathy one might experience as a self-discovery agent. Career curiosity and career indifference further reflect the curiosity of career construction and adaptation. Career confidence and career inhibition reflects the self-efficacy of success or failure along a career progression illustrated by the individual as author (Swanson, & Fouad, 2015).
Happenstance Learning Theory
In a similar manner, contemporary career theorist John D. Krumboltz considered the everchanging influences and interests that shape career progression. He introduced the Happenstance Learning Theory which acknowledged career progression as a free flow of exploration that need not be planned. His theory focused on achieving satisfaction in the individuals personal and professional life by participating in various beneficial activities such as lifelong learning and remaining open and alert to alternative opportunities (Krumboltz, 2008).
The happenstance of unpredictable events leads to outcomes that no one could predict or foresee. This echoes the idea of an unknow destiny permeates Krumboltz work. Krumboltz believed that human behavior is the product of both planned and unplanned experiences from which the individual learns and develops skills, beliefs. Preferences, sensitivities, and emotions. The idea of destiny enters by way of the life experiences and influences which the individual cannot control. Individuals are able to alter their destiny by choosing to focus on a particular aspect of their situation and employ a particular belief or behavior. Individuals who are open to various options and outcomes are able to capitalize on the unknown and engage in self-initiated actions related to personal strengths learned over the lifetime (Krumboltz, 2008).
The idea of destiny is rooted in the existential postmodern concept of purpose and meaning. The notion of freedom and choice reflect the dimensions of adaptability to circumstance and hazard. Destiny in essence is designed to question the freedom and choice related to the deterministic notion of external forces (Dion, 2009).
Krumboltz was highly interested in understanding the various influences on human behavior. He cites the work of several noteworthy theorists including Ellis, Bandura, Watts, Zimbardo, and Schroeder to illustrate the various influences. Genetic influence illustrates aspects of heritability that connect brain function to social behavior. Twin studies connect psychological variables of interests, aptitudes, and career interests to genetic predisposition (Krumboltz, 2008). Genetics also acknowledges that predispositions make up some of the internal influence that is beyond the control of the individual.
Learning experiences are constant throughout the lifetime and stem from observations about the larger world. Learning shapes generalizations and enables individuals to self-identify with a particular way of being and cement beliefs based on social feedback. Associative forms of learning enable children to observe the environmental behaviors of others as well as the corresponding consequence. Judgments are made that relate to preferred behavior by means of emulation. Here the family environment and socioeconomic status, and media influence the types of learning experiences available (Krumboltz, 2008, Thelamour, et. al., 2019).
The environment in which an individual finds themselves has a powerful influence on beliefs and behaviors. The concept of individual attachment illustrated through Bowlby’s attachment theory connects patterns of behavior to environmental conditions and self-concept. Bonds with key individuals throughout the lifetime influence the level of lifelong anxiety and confidence (Krumboltz, 2008, Broderick, & Blewitt, 2010, & Gibson & Schwartz, 2008). The experiences within one’s community and social environment further solidify identity, values, and belonging.
These influences and many more combines with dimensions of social inequality that provide or limit opportunities for individuals as they follow areas of developed interest. Individuals align themselves with education, mentors or leaders, and environments that reflect their particular life space at any given moment. This alignment or happenstance of circumstances enable people to find themselves in roles unrelated to their initial career ambitions or intended career fields. Personal fulfillment is found through the expansion of knowledge and interdisciplinary learning across many spheres of environmental influence. This enables the individual to develop a rich arsenal of experiences that enable fluid movement throughout the career trajectory. (Krumboltz, 2008).
Comparison and Application
In many ways, both Career Construction Theory and the Life Design Paradigm and Happenstance Learning Theory view career progression as a personal journey. Both theories recognize the influence of life experience, situations, and circumstance on career and vocational outcome. Over the course of the lifetime various fields of influences shape the individual and create a ‘whole’ or ‘self’. The individual is both consisting of sum of their influences and experiences yet separate from their influences and experiences as outlined in gestalt philosophy. Reactions or adaptations to the internal and external drive the progression of a career journey.
Key differences in the theories lie in the active or passive role of the individual. Career Construction Theory and the Life Design Paradigm views the individual as an active participant in building and shaping their career potential. This is keenly noted in Savikas’ (2013) self-deterministic framework as the individual fulfills the role of actor, agent, and author of their career progression. Three key types of interventions occur throughout the vocational lifespan. Vocational guidance reflects the matching of traits and aptitudes developed during early roles of individual as actor. Career education refers to the various stages of career readiness and vocational development as the individual assumes agency. Career counseling focuses on stories and themes throughout the individual life narrative and personal design paradigm through a narrative interview that guides further career progression (Swanson, & Fouad, 2015).
Happenstance Learning Theory views the individual as a passive participant who employees various personal strengths to capitalize on unpredictable circumstances and situations. This enables individuals to adapt and move through transitions of life in general. The flexibility of happenstance enables career transformation during difficult times such as economic decline and periods of unemployment (Krumboltz, 2008).
Our Present Predicament
As we enter another period of economic uncertainty and instability, career and vocational counseling will impact the wellbeing of many individuals. The use of both Career Construction Theory and the Life Design Paradigm and Happenstance Learning Theory provide insight to fulfillment and transition. Both theories are strongly rooted in the existential and gestalt philosophy that acknowledges the influence of external spheres and the conflict between freedom and determinism. Using the narrative interview derived form a stage like progression of constructed and deliberate choices allows counselors to better understand the needs and goals of the individual. The fluidity of happenstance and circumstance enables individuals to reduce anxiety related to the unknown and situations that are outside of their control, while finding meaning and purpose in their relationship to work.
Broderick, P. C., & Blewitt, P. (2010). The lifespan: Human development for helping Professionals (3rd. ed.). Boston, MA: Allyn & Bacon.
Brown, S. D., & Lent, R. W. (Eds.). (2013). Career development and counseling : Putting theory and research to work. Retrieved from https://ebookcentral-proquest-com.library.capella.edu
Dion, M. (2009). Human Destiny at the Edge of Existential Categories of Life: Musil and Kundera in Dialogue. Existence, Historical Fabulation, Destiny, 345–357. doi: 10.1007/978-1-4020-9802-4_22
Lo, A., & Abbott, M. J. (2019). Affective, cognitive, and behavioural responses to repeatedly demanding performance expectations across adaptive and maladaptive dimensions of perfectionism. Canadian Journal of Behavioural Science / Revue Canadienne Des Sciences Du Comportement, 51(4), 278–289. https://doi-org.library.capella.edu/10.1037/cbs0000144
Thelamour, B., George Mwangi, C., & Ezeofor, I. (2019). “We need to stick together for survival”: Black college students’ racial identity, same-ethnic friendships, and campus connectedness. Journal of diversity in Higher Education, 12(3), 266–279. https://doi-org.library.capella.edu/10.1037/dhe0000104
Wagemans, J., Elder, J. H., Kubovy, M., Palmer, S. E., Peterson, M. A., Singh, M., & von der
Vocational and career counseling has always had direct ties to historical events and cultural trends. The notion that people dedicate large swaths of time to work is a testament to the socio-cultural importance of work. Parsons recognized this in during the second industrial revolution in the early 1900s; a period known for extreme economic inequality and intense labor disputes. His ideas emphasized an occupational fit during a time of increased urbanization, need for factory labor (Stebnicki, 2015), and a culture consisting of extremes.
During the mid-1900s, the rise of fascism and Nazi occupation in Europe saw many noteworthy psychiatrists and psychologists seek refuge from persecution in America. Concepts such as behaviorism, Gestalt philosophy, cognitive, and personality theory mixed with existing emphasis on scientific measurement and correlative outcome (Hunt, 2007). Interests in gender roles, social values, and childhood upbringing paved the way for career theorists to recognize the evolution of occupational interest over the course on one life. The 1950s saw an integration of work and leisure into the construct of the self and the cold war era saw the increased demand science and technology industries (Stebnicki, 2015, & Sperdakos, 2002).
Economic factors influence career and vocational trajectories. The Socio-cognitive model highlights levels of commitment and anxiety related to career decision making. Contextual societal supports provide means to self-efficacy and comfortability in career exploration while barriers inhibit exploration, goal setting, and potential outcome (Lent, Wang, Morris, Ireland, & Penn, 2019). This is true on a more intimate familial level as well as a larger social level. In economic recessions or depressions, barriers to employment are high leaving those with limited means in a more vulnerable position to secure career fulfillment. Emphasis is placed on survival and securing monetary income. During times of economic expansion, there is often a reduction in societal barriers that afford more people the latitude to engage in career exploration.
We are presently living through an event which will certainly leave its mark and shape our future. The COVID-19 crisis has fundamentally altered the concept of economy and work. Quarantine and social distancing measures have limited commerce in most industries deemed non-essential. This has resulted in a rapid increase of unemployment as companies and freelancers are unable to maintain operation.
Viruses and pandemics are nothing new. Humans have existed alongside of deadly viruses and bacteria since the beginning of time. Each rise of deadly illness has had effects on the civilizations and economies effected. Anxiety surrounding the illness itself is compounded by the economic response of the governments of the time. The preparedness or unpreparedness of a society has a lasting effect on the greater social psyche. Such notions have effects that echo through the public and private sectors of work (Wolf, 2020).
While we may not yet understand the extent of COVID-19’s impact on work, we do understand that there will likely be fundamental shifts in its aftermath. Many companies have set up opportunities for employees to continue to sustain employment via remote work (Wolf, 2020) through various digital platforms. This shift is likely to highlight the value of remote work for many industries. Career and vocational counselors will be part of the adaptation assisting both employers and employees navigate the challenges and benefits of a more remote workforce.
The greater psychological community has widely accepted the idea that isolation has negative consequences. At present we are seeing polarized responses to social distancing and quarantine measures which is both health and financially oriented. This becomes rather apparent if one follows activity on any social media platform. The commonality between polarized responses appears to be the complex combination of fear and anxiety caused by unknown health outcomes, financial means, and the break down in daily schedules or structure.
Children are impacted as education remains halted. Parents struggle to balance work, continued remote education, and daily childrearing obligations in households with a moderate income. Children of low-income household loose access to the benefits provided by public schools such as student food programs and afterschool care (Wilkinson, & Pickett, 2007). Many low-income households may be unable to provide optimum alternatives for continued education.
Income inequality and extreme class striations impact overall health and psychological outcomes. Those existing in neglected or impoverished communities face hardships that those in higher income and socio-economic classes do not. As income disparity and stratification increases, trust, corporation, and reciprocity decrease between class divisions (Wilkinson, & Pickett, 2007). This breakdown increases the potential for criminality and exploitation as a form of to make ends meet (Wolf, 2020). We have begun to witness reports of larger employers engaging in exploitive practices of both customers and employees as well as reports of increased petty crimes in COVID-19 affected communities.
As career and Vocational counselors, we will need to consider these effects on the concept of work and society as we engage in recovery efforts. Counselors can use their advocacy platforms to aid in increased pay and benefits for low wage essential workers and consult with companies surrounding recruitment strategies for hard to fill positions. This may include shifts in compensation benefits, in the notion of work life balance, and the flexibility to increase remote work options.
Work offers social connection, inclusion, and friendships for many people (Brown & Lent, 2013). In the absence of work, many communities are coming together to offer support. Digital groups are forming to increase social activity, and many are finding meaning in volunteer activities to help aid those most effected. It may be safe to suggest that we are beginning to see a shift in the relationship between purpose and social contract within vocational spheres that reflect a more corporative society.
In the upcoming months and throughout the duration of the pandemic crisis, career and vocational counselors will play a significant role in helping many who are employer and unemployed. Counselors can help emphasize, create, and develop a new sense of route and structure to combat social isolation, loneliness, and loss of purpose due to the lack of work. Counselors will also help people connect to and learn new digital networking platforms in order to access work. Most important, career and vocational counselors can help society shift the emphasis away from being ‘the best’ and our obsession with hyper productivity to one in which we embrace radical acceptance and become comfortable in our personal limitations.
Hunt, M. (2007). The story of psychology. New York, NY: Anchor Books. ISBN 9780307278074
Lent, R. W., Wang, R. J., Morris, T. R., Ireland, G. W., & Penn, L. T. (2019). Viewing the Career Indecision Profile within a theoretical context: Application of the social cognitive career self-management model. Journal of Counseling Psychology, 66(6), 690–700. https://doi-org.library.capella.edu/10.1037/cou0000367
Socioeconomic status includes aspects of ownership, wealth, and class identity. Gradients between rich and poor highlight the variation of outcome linked to mental and physical health outcomes, access to resources, opportunity, and education. Socioeconomic status provides a pathway to power through access and acceptance in a status-driven western economy. As socioeconomic differences increase, so does the subjective emphasis on the importance of status and income (Wilkinson, & Pickett, 2017).
Dominance hierarchies form a social organizational structure through which individuals are stratified into a class system. Stratifications encompass more than financial status, further dividing individuals based on cultural drivers and social values. Stratified societies maintain a ranking system used to evaluate and maximize perceived value within the hierarchy. Social ranking is based on access to valuable or scarce resources and the accumulation of resources provides a pathway to power (Wilkinson, & Pickett, 2017).
Egalitarian framework counterbalances resource-based social ranking systems to a small degree through the value of generosity and selflessness. Cultural aspects associated with selflessness and community provide an avenue through egalitarian endeavors provide recognition and prestige. However societal inequality increases internal status-driven anxiety as socioeconomic based access becomes a valuable attribute (Wilkinson, & Pickett, 2017).
According to an intrapersonal perspective, global self-esteem is based on an individual’s perception of performance in domains deemed important. American societal constructs emphasize a high degree of value and prestige associated with socioeconomic status and occupations. High education, income, and status-based occupations are valued in American society and serve as a basis of assessing an individual’s worthiness (von Soest, Wagner, Hansen, & Gerstorf, 2018). This in turn serves as a validation for self-esteem in adults.
Interpersonal framework emphasizes the role of social interaction and social symbolism on self-esteem. Individuals who maintain healthy social interactions experience higher self-esteem outcomes. On the contrary, individuals with poor social connections experience low self-esteem outcomes. The internalization of the perceptions of others establishes a framework for self-evaluation. Individuals with low socioeconomic status are often marginalized and alienated in professional roles. Threats of social exclusion negatively influence self-perception (von Soest, Wagner, Hansen, & Gerstorf, 2018) leading many individuals to increase socioeconomic standing as a form of social inclusion.
Social mobility becomes restricted by socioeconomic class origins as cultural worldviews are influenced by economics and access to resources. The expectations and demands that culture places on the individual limits the ability to transcend socioeconomic stratifications. Awareness of the degree in which socioeconomic stratification impacts self-esteem drives many high achieving individuals to pursue avenues to socioeconomic advancement (Sánchez, Liu, Leathers, Goins, & Vilain, 2011).
Individuals experience class mobility in three directions, their class or origin, their current class, and their class as others ascribe them. Throughout life, individuals move between classes shifting their sense of self and belonging. Individuals of lower or working classes find themselves straddling class divisions and developing the need to operate between two distinct class identities. Lower income classes are often faced with the choice to be loyal to their class of origin, while striving to achieve career goals. In order to achieve career goals, individuals are often forced to assimilate into cultural norms and expectations of a higher socioeconomic class. This frequently results in the individual feeling alienated from both class environments (Ardoin, 2018).
Imposter Phenomenon relates to one’s desire to appear in a particular manner within a peer group (Langford, & Clance, 1993). Individuals shift between social classes throughout educational and career progression. Transitioning socioeconomic class is a source of anxiety for many individuals. Individuals in working classes find themselves to be out of place when working toward financial and occupational advancement. There is a lack of comfortability and belonging to both the aspirational social class and the social class of origin (Ardoin, 2018). Straddling socioeconomic classes results in behavioral adaptations of separate personas when interacting in each class.
American mythology maintains the belief that higher education is a pathway to upward mobility despite the socioeconomic stratifications of one’s origin (Sánchez, Liu, Leathers, Goins, & Vilain, 2011). Socioeconomic position encompasses aspects of education and the prestige associated with institutions of higher education. Higher education continues to be an avenue for socio-economic mobility by serving as a training ground for the labor market. Human capital theory connects educational qualifications to employee productivity and thus increased earning potential. Employers often select employees based on educational credentials (Delaney, & Farren, 2016).
Institutions of higher education have a longstanding history of inequality and exclusionary practices based on socioeconomic status. The increasing cost of education, ranked and selective admissions, and tuition assistance contribute to contribute to illusion of education as a privilege. Students are often expected to conform and assimilate in order to “catch up” to more well-off peers (Ardoin, 2018).
Many individuals from lower socioeconomic classes choose avenues of distance learning or pursue lower level higher educational qualifications in order to balance financial and academic responsibilities (Delaney, & Farren, 2016). Those who do gain entrance to prestigious institutions or purse high level educations experience a marginalization and find difficulty connecting to peers in higher socioeconomic positioning (Ardoin, 2018). As higher education is a prerequisite for many forms of employment, individuals from lower socioeconomic standing are forced to assimilate with a new socioeconomic culture while mitigating the dissonance of class identity.
Aspects of social expression through dress, dialect, and manners contribute to the perception of a particular social standing sending a message that is then affirmed by society (Ardoin, 2018, & Wilkinson, & Pickett, 2017). Individuals with low self-esteem rely on the validation of others and are often compelled to adopt the behavioral patterns and appearance of the aspirational social class. Straddling socioeconomic class divisions contribute to additional dissonance surrounding one’s identity. The feeling of fraudulence may be increased due to conforming with social class expectations of two groups in varying environments. The desire to be validated within the aspirational in-group is compounded by intense fear and anxiety that that group will recognize an individual’s fraudulence (Gibson & Schwartz, 2008) which ultimately increase the occurrence of Imposter Phenomenon at the socioeconomic level.
Sánchez, F. J., Liu, W. M., Leathers, L., Goins, J., & Vilain, E. (2011). The subjective experience of social class and upward mobility among African American men in graduate school. Psychology of Men & Masculinity, 12(4), 368–382. https://doi-org.library.capella.edu/10.1037/a0024057
von Soest, T., Wagner, J., Hansen, T., & Gerstorf, D. (2018). Self-esteem across the second half of life: The role of socioeconomic status, physical health, social relationships, and personality factors. Journal of Personality and Social Psychology, 114(6), 945–958. https://doi-org.library.capella.edu/10.1037/pspp0000123
Wilkinson, R. G., & Pickett, K. E. (2017). The enemy between us: The psychological and social costs of inequality. European Journal of Social Psychology, 47(1), 11–24. https://doi-org.library.capella.edu/10.1002/ejsp.2275
Socioeconomic status encompasses more then just income. It includes aspects of ownership, wealth, and class identity. Social gradients between rich and poor showcase varying degrees of well-being linked to mental and physical health outcomes, access to resources, opportunity, and education, and provide a pathway to power through the existence of a status-driven western economy (Wilkinson, & Pickett, 2017).
Individuals residing in a higher socioeconomic status have
access to healthcare and education which present opportunities for global
wellbeing. Education and career endeavors associated with higher income offer a
sense of prestige that is often unavailable to those of lower socioeconomic
standing (Wilkinson, &
Pickett, 2017). Individuals in lower socioeconomic classes are often considered
‘disadvantaged’ in terms of health outcomes, access, and opportunity. The
association with being ‘disadvantaged’ leads to social isolation and alienation
complex and can be addressed from framework spanning several disciplines including
psychology. However psychological services often fall short when providing
services for low income populations. Classism and negative biases often
influence the service provider and distinctions between white collar and blue-collar
mentalities are not acknowledged in the therapeutic setting. This further exacerbates
alienation and leads to a breakdown in understanding between the therapist and
the client (Smith, 2009).
have attempted to provide access to psychological services to lower income individuals
through means of community mental health programs. Clinicians trained through
higher education observed that individuals from lower socioeconomic status appeared
unable to “grasp” concepts addressed through therapy (Smith, 2009).
Misconceptions surrounding relatability and priority further alienate the client
from the therapist.
developing psychological services for lower income populations, once can
utilize Maslow’s Hierarchy of needs as a framework. Maslow suggests that in
order for individuals to address higher level concerns, basic needs must be
satisfied (Wedding, & Corsini, 2014). In application, psychologists must recognize that
individuals at lower socioeconomic statuses often struggle to secure basic
needs such as food and shelter. Thus, priorities differ from individuals who have
obtained security in low level needs and are able to focus on higher level
motivators such as belonging, emotional wellbeing, and self-actualization.
client centered approaches are likely benefit those at lower socioeconomic
levels as the focus on a client’s strengths rather then limitations and
encourage the client to take an active role in the course of their program. Strength
based client focused approaches rely heavily on collaboration when treatment
planning and recognizing that clients may experience challenges unforeseen to
the therapist. Strength based approaches also place the client in the position
as the expert shifting the power differential between client and psychologist (Snyder
& Lopez, 2006).
family systems theory incorporates both the systemic and structural framework
when working with low income individuals. Family systems therapy addresses
poverty as it effects the individual and conceptualizes a client’s relationship
to poverty when formulating a treatment approach (Smith, 2005). The therapist
becomes aware of their interactions as a component of the system structure and
thus the impact on the client.
When working with a diverse client population it is important to acknowledge varying ideological concepts between demographic groups. In other words, a diverse population of clients requires a therapist to utilize a diverse repertoire of treatment approaches. Elements such as race, gender, age, religion, and sexual orientation impact the client’s response to particular therapeutic approaches. A therapist must recognize and utilize the best fit and appropriate approach for each individual client. Often when working with diverse population, it becomes necessary to integrate elements from varying psychotherapeutic approaches. Such integration allows for the necessary flexibility in clinical treatment that yields evidence based best practice results.
Methods of Integrating Psychotherapies
The integration of psychotherapeutic treatments can be as diverse as the theories themselves. However integration often takes the form of one of four main pathways. Each pathway allows a therapist to customize and blend psychotherapeutic treatments and modalities to best fit a particular client’s receptiveness and needs (Wedding, & Corsini, 2014).
Technical eclecticism is a research specific approach to integrating psychotherapeutic theories. This integration style allows unrelated concepts of varying therapeutic theories to be integrates and combined. Technical eclecticism draws on research which compares effective treatments to particular problems and client characteristics and utilizes concepts and techniques from varying theories (Wedding, & Corsini, 2014).
Theoretical integration includes multiple therapies which are combined to achieve the best result. The overarching concept blends together multiple theoretical approaches in order to create a more effective conceptual framework for treatment. Integration of psychodynamic and interpersonal, cognitive and behavioral, or systems, and humanistic are most widely used in combination (Wedding, & Corsini, 2014).
Combining treatments based on common factors is an integrative approach that identifies core similarities of varying treatment modalities. Treatment techniques are then developed based on key combinations of commonalities. Combining common factors focuses on the effective commonalities in theoretical concepts of treatment processes rather than the individual theoretical differences (Wedding, & Corsini, 2014).
Assimilative integration is an integrative technique that utilizes one primary therapeutic theory as a foundation. It then selects specific elements of other theoretical approaches to assimilate into a single treatment modality. This combinations allows a foundation in one coherent system of treatment with the ability to interject a broader range of treatment techniques (Wedding, & Corsini, 2014).
Empirical and evidence based research shows that the integration of theoretical approaches provides advantages from a variety of therapeutic modalities. Integrative therapies tend to focus on the clients individual circumstance and experiences rather than an overarching or abstruse theory (Ponterotto, 2013). Studies show that by integrating psychotherapeutic modalities for individual clients, the client attains the best possible outcome.
It is possible to conduct quantitative research without understanding epistemology however qualitative research relies on awareness of philosophical perspectives among client sub cultures. Qualitative research recognizes the sociocultural compounds of expression and experiences within a various populations and accounts for their voice or cultural input in the effectiveness. Qualitative research accounts for social, cultural, and economic realities for clients that impacts the structure and relationship of the therapeutic process (Ponterotto, 2013).
Mahrer’s 1989 Study
The Mahrer’1989 study investigated the integration of various psychotherapeutic techniques with concrete operating procedures. Mahrer utilized videotapes and transcripts to identify therapist’s behaviors that promoted client change. He believed that particular behaviors could be utilized and integrated into a range of options to achieve therapeutic goals. (Richert, 2007).
Concrete operations is describes as a set of ordered behaviors that a therapist would perform in sequence in order to elicit particular behaviors from a client. A therapist would utilize activities such as s Socratic questioning, teaching disputation, and the recording of automatic thoughts to implement a broader range of cognitive problem solving. Four specific theoretical orientations were selected for the integration into concrete operations procedures; humanistic and existential, cognitive and constructivist, analytic and dynamic, and interpersonal. (Richert, 2007).
According to Mahrer’s study, a constructivist therapeutic approach integrated most effectively with concrete operational procedures. Constructivist approach integrates unconditional positive regard, transference-counter transference while utilizing empathic reflections, two-chair dialog exercises, metacommunication or therapist self-disclosure, and dream work. Mahrer believed that a constructivist approaches proved favorable for integration due to emphasizing meaning-based practice, disputing irrational beliefs and self-monitoring procedure adapted from REBT and CBT (Richert, 2007).
Changing demographics in the United States calls for the continued development and integration of psychotherapy approaches. The ethnic and cultural diversity in which a clinician sees in their clients is increasing. More people from ethnicities who previously did not seek treatment are turning to therapist and clinicians with traumatic histories. Often these immigrant populations are underserved, under insureds, and receive treatment that is ineffective (Cook, & Tedeschi, 2007).
It is important to remember that when working with culturally diverse clients a therapist enters and experiences a foreign world and mindset. Empathy, respect and understanding of differences is imperative. A therapist must be able to suspend any preconceived concepts or stereotypes surrounding a particular population. (Ponterotto, 2013).
Blended elements from varying psychotherapeutic theories are effective when working with diverse populations. It is important for the therapist to keep an open mind about integrating treatments in the same manner as the must to toward each individual client. An effective integrative therapist recognizes the individual needs and limitations to therapy and creates a personalized therapeutic plan for each individual.
Wedding, D., & Corsini, R. J. (Eds.). (2014). Current psychotherapies (10th ed.). Belmont, CA: Brooks/Cole. ISBN: 9781285083711.
Ponterotto, J. G. (2013). Qualitative research in multicultural psychology: Philosophical underpinnings, popular approaches, and ethical considerations. Qualitative Psychology, 1(S), 19-32. doi:10.1037/2326-3598.1.S.19
Richert, A. J. (2007). Concepts, processes and procedures: An introduction to the special issue on integration of concrete operating procedures. Journal Of Psychotherapy Integration, 17(1), 1-9. doi:10.1037/1053-04126.96.36.199
Cook, J. R., & Tedeschi, R. G. (2007). Systems of care and the integrative clinician: A look into the future of psychotherapy.Journal Of Psychotherapy Integration, 17(2), 139-158. doi:10.1037/1053-04188.8.131.52
The concept of personality has evolved over the years as
theoretical climates in psychology shifted concerning the nature of humanity.
The origins of the word personality stems from the Latin persona meaning to
wear a mask or project a role. While there is no one definition of personality,
it is acceptable to understand personality as patterns of relatively consistent
patterns of traits, characteristics and behaviors unique to an individual (Feist, Feist, & Roberts, 2013).
In general, personality involves unique and variable traits,
motives, cognitions, contexts, and biological factors that occur within an
individual. Such components are consistent over a long duration of time.
Personality emphasizes the concept of unique differences amongst individuals as
well as the way unique components integrate to form a person as a whole.
Additionally, it considers individual adjustment and temperament within the
confines of a social or cultural setting (John, Robins, & Pervin,
Personality psychology has its origins in psychology,
psychiatry, sociology, and anthropology and came into the forefront in the
1930’s due to the industrial urbanization and mass education. Many early
theories emphasized individuality and uniqueness as a result of public interest
in dramatic displays of psychopathology and fear of depersonalization became
popular. Psychologists sought to identify the dimensions of people in general,
construct typologies or sub groupings, and understand individual idiosyncrasies
(John, Robins, & Pervin, 2010).
Theories stemming from psychometric or analytic origin sought to
quantify personality as the sum of individual traits and inter-correlations of
traits with the aim of controlling or modifying behavior. Qualitative studies
of personality aimed to understand the coherence of consistent patterns of
behavior throughout an individual’s life, known as traits (John, Robins, &
Post WWII, psychologists shifted away from organizing traits
of a whole person and sought to investigate specific traits, motives,
cognitions, and their social context. The five factor model identifies key
factors into which individual traits fall. Typologies and folk concepts also
emphasized the idea of traits adhering to distinct patters. The influence of
sociology provided foundational concepts surrounding the social context or
cultural themes relevant in describing individuals while psychoanalytic theory
emphasized individual motives and goals forming the core of personality (John,
Robins, & Pervin, 2010).
The 1950’s and cold war era saw yet another shift in the
origin of personality. Behaviorism and the cognitive revolution emphasized the
bandura’s theory of self-concept and self-schema as an explanation of personality.
Social learning theory also influenced the study of personality and the
interest in ways sociocultural environments influence personality. Cross
cultural studies identified cultural dimensions such as collectivism and
gendering impacting personality.
Advancements in biological studies on behavior have linked
psycho-chemical forces in various structures within the brain and nervous
system to the arousal of traits illustrated in the five factor model (John,
Robins, & Pervin, 2010). Debates
still continue today as to the origin and various components of personality.
Theoretical orientation highly influences psychological views surrounding
Feist, J., Feist, G. J.,
& Roberts, T. (2013). Theories of personality (8th ed.). New York, NY: McGraw-Hill.
John, O. P., Robins, R.
W., & Pervin, L. A. (Eds.). (2010). Handbook of personality: Theory and research (3rd ed.). New York, NY: Guilford
Press. ISBN: 9781609180591.
Schizophrenia cannot be explained in its entirety by one particular theoretical model and the underlying neurobiological foundation for the disease is still relatively unknown. Rather it is the descriptions and observations of the primary psychotic symptoms that have allowed several theories surrounding schizophrenia to evolve (Mishara, & Schwartz, 2013). Historically, schizophrenia was considered to be constructive in which anomalous experiences provide the construct of one self. Early clinical observations emphasized subjective self-experiences and altered self-awareness. The concept of self-experience is still referenced in modern work with schizophrenia. (Parnas, & Henriksen, 2014).
The earliest depictions of schizophrenia were recorded in France during the 12th century but were not linked to any particular disorder. Writing described individuals who deviated from what was considered to be normal self-perception; anomalous self-experiences. In many cases writing illustrate a disunity of consciousness in which a person’s thinking, perception, movement, and vision were disjointed and incongruent with presented stimuli (Parnas, & Henriksen, 2014).
The modern understanding of schizophrenia rose form the work of Emil Krapelin, an influential German psychiatrist working in the late 19th and early 20th century. Krapelin research surrounding the combination of symptoms and psychiatric illness from a biological origin highlighted two forms of psychosis; manic depression and dementia praecox (Ebert, & Bär, 2010). The disturbance known as Krapelin’s dementia praecox consisted of the phenomenon currently recognized as schizophrenia. During his research, Krapelin described the deterioration of what he believed to be perception and attention in combination with muscular tension (Mishara, & Schwartz, 2013).
Throughout the late 1800’s and early 1900’s core symptoms were studied by individuals from a psychodynamic perspective such as Carl Jung, Josef Berze, and Hans Walter Gruhle. Many of these theorists called attention to various cognitive and affective characteristics of the disorder. Jung in particular was fascinated by patients displaying confused speech which he described as a state of sleep-drunken-ness and confusion. Their theories critiqued by many other early psychotheorists and the phenomenon later was renamed schizophrenia in 1908 by Eugen Bleuler (Mishara, & Schwartz, 2013).
Bleuler theorized individuals with schizophrenia experienced a general loose association with a fissure personality which was highly influenced by Jung’s work. Bleuler believed that such loose associations allowed aspects of the unconscious to invade the consciousness and lead to an ego disorder. The unconscious invasion would erode the functioning of the ego to the level in which it exists in dreams. Gruhle added to Bleuler’s work and theorized that the primary symptoms of schizophrenia operated independently and observed a dysfunction between the cognitive and the affective components of the disorder (Mishara, & Schwartz, 2013).
Josef Berze criticized Jung’s work and theories believing that the symptoms were due to a reduction in mental activity rather than attention. He theorized that mental activity is more closely related to consciousness than affect and highlighted the concept of a disruption in self as the essences of schizophrenia. Berze also noted diminished mental activity in goal setting, linguistic coherence, and the ability to access the autobiographical self. Much of his work was inspired by emerging neurobiological research. He theorized that schizophrenia symptoms originated at a subcortical area, specifically the thalamus which gave rise primitive drives and motivations (Mishara, & Schwartz, 2013).
Jaspers integrated and critiqued his predecessors work in his book General Psychopathology published in 1913. (Mishara, & Schwartz, 2013). Highly influenced by the philosopher Descartes, he solidified the concept of self-experience pertaining to schizophrenia. Jaspers recognized that an individual may have and recognize experiences that are invalid and referred to positive symptoms as first person symptoms (Parnas, & Henriksen, 2014).
During the 1940s Freud’s psychoanalytic work continued to influence much of the theories surrounding schizophrenia and emphasized an etiological root stemming from early relationships. Psychoanalytic writers produces detailed descriptions of the schizophrenic experience including disruptions in interpersonal relationships and the self-experience due to the psychosis (Hamm, & Lysaker, 2016).
Writers such a Freud and Searles illustrate individuals that were detached from the world and redirected psychic energies inward during psychosis. Such writings provide the concept of an altered self-experience from which the schizophrenic individual is unable to integrate life experiences. Psychodynamic approaches took a pessimistic view of schizophrenia treatment which failed to produce empirically supported and measurable treatment modalities. Eventually, such treatment modalities fell out of favor and were replaced by psychosocial and cognitive behavioral perspectives (Hamm, & Lysaker, 2016).
With the publication of the ICD 8 and 9, Schizophrenia was recognized as a disturbance of personality and involved disorder concepts of individual uniqueness and self-direction. During that time the term personality referred to a subjective self rather than the personality descriptions used in contemporary psychology. Research surrounding a subjective self could be measured using systematic approached however lacked reliability in its methods. This notion soon fell out of favor and was replaced with an operational model following the publication of the DSM-III in 1980 (Parnas, & Henriksen, 2014).
The DSM-III emphasized behavioristic components of schizophrenia which stress observable features over the subjectivity and inference of previous theories. Biological concepts such as genetics in the etiology of schizophrenia were highlighted and lead to the emergence of a spectrum of observable features and predictors. Among the most noted were deficits in emotion, eccentricity, and thought disorder which caused interpersonal difficulties in social and occupational function. The inclusion of the diathesis stress model illustrated how core vulnerability combined with environmental stressors and produce cognitive changes observed in schizophrenia (Parnas, & Henriksen, 2014).
Asenjo Lobos, C., Komossa, K., Rummel-Kluge, C., Hunger, H., Schmid, F., Schwarz, S., & Leucht, S. (2010). Clozapine versus other atypical antipsychotics for schizophrenia. The Cochrane Database of Systematic Reviews, (11), CD006633. Advance online publication. http://doi.org.library.capella.edu/10.1002/14651858.CD006633.pub2
Ebert, A., & Bär, K.-J. (2010). Emil Kraepelin: A pioneer of scientific understanding of psychiatry and psychopharmacology. Indian Journal of Psychiatry, 52(2), 191–192. http://doi.org/10.4103/0019-5545.64591
Hamm, J. A., & Lysaker, P. H. (2016). Psychoanalytic phenomenology of schizophrenia: Synthetic metacognition as a construct for guiding investigation. Psychoanalytic Psychology, 33(1), 147-160. doi:10.1037/a0038949
In most psychotherapeutic environments the term CBT is tossed around all the time. CBT in research; my insurance providers prefer CBT; CBT; CBT; CBT. So what is this CBT stuff? CBT is short for cognitive behavioral therapy and essentially addresses both thoughts and the underlying emotions that influence behavior. This is achieved by bringing together components of both cognitive therapy and behavioral therapy is a direct and effective manner.
Behavior therapy is centered on the concept that human behavior serves a function and results from stimuli within the individual’s environment. Behaviors result in response to environmental stimuli and behavioral patterns result from the reinforcement or punishment received from the interaction between the individual and their particular environment. The psychosociocultural viewpoint encompasses a wide range of therapeutic strategies that aim to change the environmental factors that stimulate maladaptive behaviors (Wedding, & Corsini, 2014).
Cognitive theory is a theory of personality in which individuals respond to life events cognitively, motivationally, and behaviorally. An individual perceives, interoperates, and assigns meaning to particular life events. Maladaptive behaviors and affects are caused due to the misinterpretation of stimuli, situations, and events. Cognitive therapy aims to adjust the way the individual processes incoming information by examining the individual’s belief about their self, the world, and others (Wedding, & Corsini, 2014).
Five Concepts That Add Dimension
Both behavior and cognitive therapy recognize that personality is consistent and an individual’s response to environmental stimuli can be predicted. Behavior therapy acknowledges five core domains from which personality can be assessed. Behavior therapy teaches flexibility within an individual’s personality domains and introduces healthy coping mechanisms and responses for environmental stimuli (Wedding, & Corsini, 2014).
Cognitive therapy recognizes schemas to explain and predict responses to environmental stimuli and situational cues. A network of affective, motivational, and behavioral schemas known as modes asses and interoperate situations. Some modes are rooted in instinct and are referred to as primal modes. Primal modes are often ridged, automatic, and absolute. Primal thinking leads to maladaptive behavior. Cognitive therapy teaches a client to consciously override primal modes through means of deliberate thinking and problem solving (Wedding, & Corsini, 2014).
Behavior therapy focuses on the behaviors and actions that are conditioned responses to external stimuli. Cognitive therapy focuses on the affect and mental interpretation of a particular stimuli (Zaretsky, Segal, & Fefergrad, 2007). Due to similarities, behavior therapy and cognitive therapy are often combined in a treatment known as cognitive behavioral therapy. CBT targets the bias mental interpretations acknowledged in cognitive therapy and teaches the client to regulate emotions causing maladaptive behaviors (Harvey, Bélanger, Talbot, Eidelman, Beaulieu-Bonneau, Fortier-Brochu, & … Morin, 2014).
CBT is often used as a primary treatment for depression and mood disorders. By leveraging a client’s awareness of the changes in their cognition, (Zaretsky, Segal, & Fefergrad, 2007) treatment techniques encompassing mindfulness, relaxation, meditation, exposure, (Wedding, & Corsini, 2014) and modeling teach the client ways to regulate their affect and reduce symptoms (Zaretsky, Segal, & Fefergrad, 2007).
When addressing depression, cognitive therapy addresses the client’s negative views of one’s self, their experiences, and future. A client’s interpretation of their environment is often bleak and the client maintains a pessimistic bias toward themselves and their future. Motivational symptoms appear such as a lack of energy and sometimes paralysis that inhibits the completion of everyday life tasks. Increasing activity and social exposure combined with combating negative interpretations of situations are used to alleviate the cognitive components of depression (Wedding, & Corsini, 2014).
Behavior therapy addresses the conditioned response to stimuli. Behaviors increase due to reinforcement (Wedding, & Corsini, 2014). Maladaptive coping strategies and behaviors continue to reinforce depressive behaviors. Treatments focused on positive social exposure and activity work to reinforce positive experiences for the depressed individual and reduce exposure to negative experiences such as isolation. Exposure to positive stimuli aids in reinforcing non-depressive behaviors (Ryba, Lejuez, & Hopko, 2014).
Modeling behaviors occurs when an individual observers others in a sociocultural environment. Anxiety or phobias are maladaptive behaviors that can be learned through modeling abuse (Wedding, & Corsini, 2014). If an individual observes a social fear or anxiety about a particular situation, it is likely to be interoperated as a truth. An individual may model the anxious or phobic behavior learned from observation.
Behavior therapy addresses the hyperarousal brought on by anxiety and phobia by combining exposure and relaxation training. Practicing relaxation techniques while exposed to environmental stimuli helps alleviate the physical stress and tension associated with phobia and anxiety. Cognitive therapy teaches an individual to reevaluate the particular stimuli and interoperate it as less threatening (Wedding, & Corsini, 2014).
Substance abuse is often coupled with depression and anxiety. The recognition of psychosocial factors maintain the maladaptive belief and subsequent behaviors are addressed by combining cognitive and behavioral therapies (Harvey, Bélanger, Talbot, Eidelman, Beaulieu-Bonneau, Fortier-Brochu, & … Morin, 2014). Substance abuse may begin as a molded socioenvironmental behavior and become reinforced through positive social experiences. Reinforcement of addictive behaviors may be reinforced when a client engages in self-medication to alleviate depression and anxiety symptoms.
Stimulus control is a behavioral technique that can be used to help individuals with substance abuse issues and addiction. Principles of classical conditioning state that conditioned cues illicit behavioral responses. Stimulus control aims to correct the problems associated with a particular stimuli (Wedding, & Corsini, 2014). For example, a client may associate a place or event with the acquisition and consumption of substances. Clients are encouraged to avoid places and situations which are cues for their addiction.
Wedding, D., & Corsini, R. J. (Eds.). (2014). Current psychotherapies (10th ed.). Belmont, CA: Brooks/Cole. ISBN: 9781285083711.
Harvey, A. G., Bélanger, L., Talbot, L., Eidelman, P., Beaulieu-Bonneau, S., Fortier-Brochu, É., & … Morin, C. M. (2014). Comparative efficacy of behavior therapy, cognitive therapy, and cognitive behavior therapy for chronic insomnia: A randomized controlled trial. Journal Of Consulting And Clinical Psychology, 82(4), 670-683. doi:10.1037/a0036606
Ryba, M. M., Lejuez, C. W., & Hopko, D. R. (2014). Behavioral activation for depressed breast cancer patients: The impact of therapeutic compliance and quantity of activities completed on symptom reduction. Journal Of Consulting And Clinical Psychology, 82(2), 325-335. doi:10.1037/a0035363