One of the problems I originally encountered training practitioners in the field of occupational stress management and counselling was ensuring that they undertook a thorough assessment of their clients. It is too easy to overlook relevant details if only cognitions or specific behaviours are examined. On investigating many different therapeutic approaches I read about Multimodal Therapy (Lazarus, 1981). This approach appeared to offer an assessment and treatment/training programme that could easily be adapted to the field of stress management and counselling (Palmer and Dryden, 1991, 1995). The approach was developed by Arnold Lazarus who was formerly a well known behaviour therapist who had worked with Joseph Wolpe. Even though Lazarus found behaviour therapy quite effective it was not always successful and he believed that important details were overlooked in the assessment procedures. He later went on to develop multimodal assessment and therapy which he asserts covers all aspects of an individual's personality. RATIONALE & METHOD
The basic framework comprises the following seven modalities:
This blueprint is known by the acronym BASIC ID and is used for the basic assessment of clients. During the assessment the different modalities are examined by asking questions similar to the following:
B- What would you like to start doing/stop doing?
A- What makes you angry, sad, etc?
S- What do you like/dislike to hear, taste, etc?
I- What do you picture yourself doing in x weeks, x years?
C- What are your main musts, shoulds, beliefs?
I- How do you get on with others; do you act passively etc?
D- Do you take medication? Do you smoke? How is your health?
To aid assessment and to make the most use out of therapeutic time, at home clients complete an in-depth 15 page questionnaire which focuses on life history and the different modalities. It also asks the client what approach he/she would like the trainer/counsellor to take e.g. 'I would like a hard working, no nonsense approach'. The counsellor then adapts his/her approach to the needs of the client thereby helping the therapeutic or training alliance. The techniques most frequently used from each modality are in Table 1.
| BEHAVIOUR |
| Behaviour rehearsal, Exposure programme Modelling, Reinforcement programmes Self-monitoring and recording, Shame attacking Empty chair, Fixed role therapy Psychodrama, Response prevention/cost Stimulus control, Paradoxical intention |
| AFFECT |
| Anger expression, Anger/anxiety management Feeling identification |
| SENSATION |
| Biofeedback e.g. GSR, biodots, Hypnosis Relaxation training, Threshold training Meditation, Momentary relaxation Sensate focus training, Relaxation response Massage |
| IMAGERY |
| Coping imagery, Time projection imagery Anti-future shock imagery, Mastery imagery Positive imagery, Thought stopping imagery Aversive imagery, Associated imagery |
| COGNITIVE |
| Bibliotherapy, Cognitive rehearsal Disputing irrational beliefs, Problem solving Challenging faulty inferences, Constructive self-talk Thought stopping |
| INTERPERSONAL |
| Assertion training, Contingency contracting Fixed role therapy, Communication training Friendship/intimacy training, Social skills training Role play, Graded sexual approaches Paradoxical intention |
| DRUGS/BIOLOGY |
| Lifestyle changes, Stop smoking programmes Diet, Weight control Exercise, Medication Referral to specialists |
Table 1 includes the most commonly used techniques. However, the list is not exhaustive and many other techniques are used by competent practitioners (see Palmer and Dryden, 1995). Once the client's problems and therapeutic/training goals are assessed, appropriate techniques are discussed and selected with the client e.g. the client may prefer to try hypnosis instead of the Benson Relaxation Response for tension. A Modality Profile is produced in which the client's problems and the agreed interventions are recorded. Table 2 illustrates a typical Modality Profile of a Type A client who was referred for stress management to reduce high blood pressure.
| MODALITY | PROBLEM | PROPOSED TREATMENT |
| Behaviour | Type A behaviour: quick Behavioural education. talking/eating/walking. Polyphasic behaviour Impatient |
Behavioural education. Do one task at a time; Examine irrational beliefs that may cause polyphasic, 'hurry up' behaviour. Dispute irrational beliefs |
| Affect | Feels angry at work | Anger management. |
| Sensation | Physically tense | Biofeedback and relaxation training. |
| Imagery | Images of losing control | Coping imagery. |
| Cognition | I must always reach my deadlines otherwise it will be awful. Others must recognise my contribution I can't stand not getting what I want. Beliefs of low self-esteem | Dispute irrational beliefs; failure attacking exercises; coping-statements Teach self-acceptance |
| Interper- sonal | Passive-aggressive Spends little time in recreational pastimes with family or friends | Assertion training. Discuss benefits. |
| Drugs/ Biology | High blood pressure Headaches Overweight alcohol a week Smokes 30 cigarettes a day |
Liaise with medical specialist about medication and treatment programme. Relaxation training. Weight reduction programme. Reduction programme- use drink diaries Stop smoking programme. |