The Old Order Amish are a rural people who place a high value on farming. In spite of their refusal to adopt technological conveniences in their homes and utilize modern equipment on their farms, they have developed some of the most productive and stable agricultural communities in North America. Their rejection of trends, which have changed other rural communities, such as consolidation of schools and migration to the cities, has enabled the Amish to remain a cohesive, homogeneous group. The Amish view themselves as separate from “the world”, want to have no part of the worldly values that define the modern culture around them, and are quite content to live in isolation from the mainstream of secular society.
The (PIQ) was developed as a means of obtaining immediate and direct client feedback about the imagery rescripting session just experienced. The PIQ consists of two forms: PIQ-A and PIQ-B. While some overlap exists between the two forms, specific items vary in accordance with the particular phase of rescripting which the client is in at the moment.
The PIQ is administered by the clinician immediately following the completion of an imagery session. The clinician introduces the PIQ to the client as follows:
I would like to ask you a few questions about the imagery session we just completed. I will be asking you to rate your response to each item on a 0-100 scale. Do you need a few moments to get reoriented?
Once the client has indicated a readiness to begin, the clinician reads aloud the items of the PIQ-A beginning with Item A:
On a scale from 0-100, how vivid was the imagery you experienced during our session today? Zero would indicate that you could not develop the imagery at all, 100 would indicate that the imagery was extremely vivid.
After recording the client’s response on the line to the left of Item A, the clinician then proceeds to Items B, 1, 2, and so on, following the same procedure until all items have been administered.
When the client’s responses to all of the PIQ items have been recorded, the clinician notes the items with an asterisks [*] next to them. These are the “reversed” items and are converted to “real” scores in the following manner:
Where X equals the Client Rating Score (i.e. the actual number reported on a reversed item),100 minus X equals the Real Item Score.
The Real Item Score of each item without an asterisks is the actual number reported by the client. The total PIQ quantitative score is the sum of all individual Real Item Scores of items 1-10. (Items A and B of both PIQ forms are not tabulated in the total PIQ score.) Total scores in each PIQ form range from 0 to 1000.
The higher the total PIQ score, the more acute is the degree of abuse-related cognitive dysfunctionality and affective distress. At the completion of Imagery Rescripting treatment, a significant drop in the total PIQ scores should be noted. Although the PIQ appears to have good face validity, psychometric data are not yet available for either form.
Masterson (1985) conceptualizes the self-destructive, acting-out behaviours of BPD individuals as attempts to manage their feelings of „abandonment depression“, which include rage, anxiety, fear of being alone, and depression, accompanied by a functional loss of soothing introjects and transitional objects. Accordingly, it is this individuation-separation threat (which may also be triggered by symptomatic improvement in treatment) that is thought to reactivate the „abandonment depression“ of earlier experiences. This, in turn, often invokes the primitive, defenses of projective identification, splitting, and denial leading to the following manifestations: (1) Acting-out, impulsive, self-destructive behaviours; (2) emotional dysregulation, e.g.,, inappropriate anger, lability of affect; (3) unstable, intense interpersonal relationships; and (4) identity disturbances and unstable self-boundaries predisposing to transient psychotic episodes. This triad of the separation-individuation threat leads to abandonment depression that results in the activation of destructive defenses with their associated clinical manifestations constitutes Mastern’s conceptualization of the core dynamic features of borderline phenomena.
Dr. Mervin Smucker is an international trauma consultant and author of numerous articles and books on trauma and cognitive-behavioural therapy interventions.
Homework assignments are an essential component of IRRT. Typically, each IRRT session is audiotaped. Clients are given a copy of the just-completed IRRT session and are asked to: (1) listen daily to the audiotape of the entire IRRT session; (2) record SUDs levels immediately before and after listening to the audiotape, as well as their highest SUDs rating while listening to the audiotape; (3) record their subjective reactions to the audiotaped session immediately after listening to it; (4) document efforts (in a journal) to self-calm and self-nurture; (5) record frequency and intensity (on a 0-100 scale) of flashbacks experienced between therapy sessions; and (6) bring homework in for review at the beginning of the next IRRT session.
If a crisis arises or serious difficulties are encountered between outpatient imagery sessions, before calling the therapist or counselor a client is instructed to first visualize, and record in a journal, an imaginary conversation with the therapist, in which the client:
- describes the upsetting situation,
- verbalizes his or her thoughts and feelings about the situation,
- explains to the therapist (in imagery) how s/he has already attempted to cope with the upsetting situation,
- then “listens” carefully to the therapist’s response and attentively writes down what s/he “hears” the therapist saying.
If, after having this imagery conversation with the therapist, the client still feels the need to call, s/he may do so. However, the client is informed that upon making such a call, the therapist’s initial response will be to ask him/her to report on (a) whether s/he was able to visualize him-/herself having a conversation with the therapist, (b) what s/he has written down from that imagery conversation, and (c) what s/he “heard” the therapist say in response.
The Old Order Amish today are a German-speaking religious sect who have maintained a distinctive, consistently traditional way of life since their migration to North America in the eighteenth century. The Amish emerge as unique, not only because of their austere lifestyle but also because they have steadfastly maintained it despite the all-pervasive forces of twentieth and twenty-first century modernization. Today, there are Old Order Amish communities in some 20 states, a Canadian province, and several Latin American countries. There are an estimated several hundred thousand Old Order Amish today, with the largest settlements in Indiana, Ohio, and Pennsylvania.
Most of us live by stories, whether or not we are aware of this. For instance, some of us believe the story that if we work hard, we will succeed. Others may believe that they’ve been cheated in life, and therefore life owes them something. Some believe that if they live a life of service and giving to others they will be rewarded in the afterlife. In cognitive therapy, such stories are called underlying assumptions, beliefs, and schemas. These stories can be adaptive or maladaptive, depending on their context and content, and lead to habitual responses to situations. For instance, a person with a “powerlessness” schema deeply believes the story that no matter what they do, they are powerless to change their situation. Effectively working with such persons requires addressing this maladaptive story and helping them to “rescript” it into a story of empowerment.
Viktor Frankl’s years of personal experience spent as a prisoner in the Nazi concentration camps led him to pursue the question of how to make sense of, or find larger meaning and purpose in senseless suffering. In particular, he purported that meaning may be found in seemingly hopeless situations, even when facing a fate that cannot be changed. At such a time, an individual is challenged to activate his or her uniquely human potential at its best, and thereby transform a personal tragedy into a triumph of human achievement. As noted by Frankl: „When we are no longer able to change a situation – just think of an incurable disease such an inoperable cancer – we are challenged to change ourselves … suffering ceases to be suffering at the moment it finds a meaning (p. 116).“