Mervin Smucker. The Emotion of Shame

Shame is one of the most powerful, painful and potentially destructive emotions known to humans. The essence of shame is the fear of negative evaluations of others by means of exposure of one’s undesirable qualities or actions. The word shame originates from the Indo-European word „skam“ which means to hide (so as to avoid exposure). The very first human story recorded in the Bible – the account of Adam and Eve in the Garden of Eden – is a story about shame and how Adam and Eve became wrought with fear of judgment and negative consequences after eating of the „forbidden fruit“.  Researchers (e.g., Paul Gilbert) have identified two subtypes of shame: (1) Internal shame: perceived qualities of the self that the individual judges to be negative (e.g., bad, weak, inadequate, digusting or repugnant); that is, attacks on the self by the self; (2) External shame: refers to qualities of the self that others view as bad, weak, inadequate, disgusting or repugnant); that is, attacks on the self by others.

Dr. Mervin Smucker is an international trauma consultant and author of numerous articles and books on trauma and cognitive-behavioural therapy interventions.

Mervin Smucker. Agenda-setting in Cognitive Therapy

Cognitive therapy is a time-limited, structured approach that involves a high degree of active involvement from the therapist and the client. An agenda is collaboratively set with the client for each session to ensure that critical issues are identified and addressed and that enough time is allocated each agenda item. Agenda items may include a review of self-help assignments and issues explored in the previous session, therapist feedback pertaining to the previous and current session, an assessment of interventions that have been effective (or not effective) thus far, and current, here-and-now issues that need to be addressed. Agenda items are then prioritized, and the therapist and client determine collaboratively which agenda goals are realistic to accomplish in one session. Allowing time at the end of each session to briefly review what has been discussed and accomplished is also an important part of the session agenda (See Beck et. al., 1979).

Dr. Mervin Smucker is an international trauma consultant and author of numerous articles and books on trauma and cognitive-behavioural therapy interventions.

Mervin Smucker. Factor Analysis of the Children’s Depression Inventory in a Community Sample

In a study conducted by Craighead, Smucker, Craighead, & Ilardi (1998) published in Psychological Assessment, a factor analysis of the Children’s Depression Inventory (CDI; Kovacs, 1992) was conducted with a large nonclinical, community sample of 1,777 pre-adolescents and 924 adolescents. The data yielded the following five first-order factors: externalizing, dysphoria, self-deprecation, school problems, and social problems for the pre-adolescent group. The adolescent group yielded the same five factors plus a sixth factor (biological dysregulation). A confirmatory factor analysis supported the stability and replicability of the obtained factor structures. Both of these sample groups produced two higher order factors: internalizing and externalizing. In addition, more pre-adolescent boys reported higher depression scores on the total CDI (17 and above), while more adolescent girls reported higher CDI scores (17 and above) as well as relatively higher scores on the biological dysregulation factor.

Dr. Mervin Smucker

Mervin Smucker. The rural nature of the Amish and their eschewing of the modern world.

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.

Mervin Smucker

Mervin Smucker. The Post-Imagery Questionnaire (PIQ).

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.

Mervin Smucker

Mervin Smucker. Masterson’s Theory of Abandonment Depression.

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.

Mervin Smucker. Homework Assignments in Imagery Rescripting & Reprocessing Therapy (IRRT).

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.

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Mervin Smucker. Post-Imagery Rescripting Guidelines for Crisis Management.

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:

  1. describes the upsetting situation,
  2. verbalizes his or her thoughts and feelings about the situation,
  3. explains to the therapist (in imagery) how s/he has already attempted to cope with the upsetting situation,
  4. 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.

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Mervin Smucker (2012). Who are the Old Order Amish today?

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.

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Mervin Smucker (2015). Stories under the Story

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.

Mervin Smucker