This model of integrative practice takes the best from the psychodynamic and cognitive behavioural traditions to create an experientially-based approach. It believes that good practice is responsive to the needs, wishes and abilities of clients and that delivering care should be enjoyable in being able to help even with the most complex problems and borderline psychosis. The key principles of theory are stated below.
The understanding of the connection between personality, social context and multiple psychological problems is that these are forms of intentionality connected together in more complex social ways to produce semi-fixed habits and abilities. Human beings are biopsychosocial entities who live in a meaningful world. The devil is in the detail though, concerning precisely how individuals can be understood. The commonality between all the therapies and phenomenology is that they both share the idea that mental processes create the senses of the objects of attention.
Even behaviour therapy believes that two or more mental processes can get added together. To be more precise in the definition requires the further understanding that mental processes never appear directly. They only appear in the manner of givenness of the sense of an object appearing. The manner of givenness is - as seen, as heard, as read about, as drawn, as referred to by symbols. Even natural scientific studies like cognitive science conclude on cognitive architecture. Equivalently psychoanalysis discusses how condensation, resistance and transference work. The Husserlian language for this in 1913 was studying "noesis-noema correlations". Husserl used further terminology like noetic phenomenology and elucidating the links between the object and the mental acts involved. So what defines phenomenology is the study of the links between how things appear and the spelling out of how mental processes are related to the appearances. Noetic refers to mental processes. Noemata are the manifold senses of an object. The point is that it is a universal occurrence that objects appear in very many senses and we are are aware of them in very many ways. Hence what an object is, its meaning, is always for consciousness and exists as a core, central to all the views of it, in all the ways we can be aware of it. Thus the two variables about any object is how its noesis correlates with its noema. A bit clumsy perhaps but it stipulates that there is always a connection but the sense of something and the manner of being aware of it.
The term “intentionality” is taken in the German sense rather than the English one of just meaning purposeful. Intentionality concerns the many ways in which people have meanings and conscious experiences of all kinds. Types of intentionality include the five senses of perception, the conceptual intentionality of internal dialogue and speech in language and the empathising of what others’ experiences might be. There are combinations of intentionality such as imagining what another person might be thinking or feeling, through looking at their body, for instance. Being in a meeting, group or crowd concerns how types of intentionality get pooled together. The diagram gives an impression of the whole. The word “intentional” means that processes and relationships are conscious and about some object of attention. However, because the starting point and the ending point is always meaningful experience in a social context, this mandates a theoretical attempt to grasp the whole of understanding the way begun by Immanuel Kant and furthered by Edmund Husserl. The very same objects is the concern of the empirical approaches of cognitive science, the social and deveopmental approaches in psychology, neurobology and the like, but without co-ordinated theoretical efforts they are doomed to failure. A case in point is the difficulties in making a unified approach in meta-cognitivism and the developmental study on the entry of infants into language and culture in the first few years of life. But in the context of making sense of psychotherapy prtactice itself, the intentionality model is unashamedly theory before practice, but not as theory without research or without the practice of social skills towards good measurable outcomes for clients.
What I want to provide first is an overview, a map, of the whole. The territory is the relationship between suffering and well being. These two areas are not completely different but co-exist, simultaneously or one after the other. The bad news is that there will always be suffering and the potential to suffer. (But suffering will not last forever). The good news is that well being can be attained but it needs effort, practice and sufficient time to gain proficient skills. (But well being will not last forever either). The commonality between the psychotherapies, Buddhism and the philosophy of Friedrich Nietzsche is that effort is required to attain well being. A life without striving and struggle is not living fully. If all that human beings seek is avoiding suffering, then mediocrity follows. The soil of suffering is the ground from which well being can grow. However, the conditions for growth need to be ripe in order to create the crop of well being from the plant called life. Without soil, water, light, shelter and the efforts of gardening there will be no crop.
Less metaphorically, the relationship between suffering and well being is a two-way transition. The infant, if well cared-for, can fall from the state of grace of well being into suffering. This is a direction of travel that can happen temporarily or for longer periods of time.
Travel in the other direction is also possible. Suffering can be turned back to well being through effort, skill and a clear understanding of what genuinely satisfies. The direction of cure or recovery demands self-care and the individual creating conditions that satisfy rather than perpetuating the suffering.
Psychotherapy is the helping profession that understands the full breadth of human being as biopsychosocial. For some, the tendency towards suffering might be biological in origin due to genetic and other biological and material influences. For others, the causative influences are psycho-social conditions, past and present, of the meeting between the personal and the social in terms of trauma and other social conditions that produce a personal response. Therapy is helpful in that it can define problems, explain them and enlist clients to self-care. Essentially, what counts are the lived experiences of suffering actually lessening and being replaced by well being and on-going self-care.
Similarly, the influences that are creative of well being are also biopsychosocial. If biological-material conditions are right and the psycho-social context in the present is managed well, then it is possible to create an amount of well being relative to the type of problems being faced. This is even so when the problems being addressed are biologically-inherited forms of mental illness and the personality disorders. Even in these cases, with understanding, practice and effort, it is possible to achieve a degree of well being parallel to those who are born with a physical handicap.
To summarise: There is a potential for on-going movement between suffering and well being throughout the lifespan. The totality of influences is biopsychosocial. What therapy does is know how to help people create more well-being than suffering. The direction of initial on-set or relapse is a qualitative set of experiences of narrow living, inaccurate and defensive understanding and belief, and purposes that are dysfunctional in that they do not provide proper satisfactions. The direction of recovery is towards psychological well being, the good life, where clients can look after themselves well after therapy has finished. This is also a set of experiences that are functional in that they provide proper satisfactions through wider, more accurate understanding and beliefs. The state of well being is one of coping, resilience and robustness, of happiness and satisfaction despite all the bad things that may have happened. Therapy works by helping clients select the understanding and beliefs for adequate role performance and the attainment of genuine satisfactions. Good choices are those guided by the relevant regions of experience that have been properly interpreted.
The other key terms that need to be understood include the difference between an object of attention and the many senses that are possible about it. For instance, an object of attention could be another person, a thing, an abstract quantity, a general concept or a socially-maintained tradition of some sort. All such senses will be different according to the type of intentionality involved. It is possible to see another person in the flesh, to think about them in their absence, to draw them, or write a poem about them. All these are different experiences of the same object of attention. The sense conveyed could be the same. Or the senses being portrayed could be different according to how they are experienced. If the person is currently apprehended in anger, then there may be more complex feelings of disappointment, anger and hate. And the sense of loving them is currently lost or not accessible, perhaps. Objects of attention are also called cultural objects. This is a very general term and a reminder that social meanings get added to objects of meaning. There was a first occurrence of sense that gets updated everytime it is experienced. Sometimes the first sense is strong enough to still be present many years later. Or perhaps the first-ever sense is only occasionally present.
The other key term to understand is that of context or horizon. All objects of attention and the types of intentionality that behold them, occur in various contexts of sense, person and time. The diagram below brings these concepts together in order to show how they relate as a whole.
A figure to show how intentionality, sense, object and context occur together.
So to explain the diagram above, let me recap the very general terminology being used. Intentionalities are mental processes of all kinds, simple and compound sorts. These mental processes only appear through what they produce: conscious experience. All believed and dis-believed objects of attention are cultural objects. In this way, the entire contents of the human world are referred to. It is important to note that selves and others can attend to one and the same cultural object, although there is no guarantee that any two persons will have the same description of their perspective on it. Indeed if they were to have the same experience, it would mean that they had become the same person, rather than remaining two different people. So what is being discussed are the ways in which meaning is social and socially-accessible rather than some entirely personal experience. The idea of context means that there are progressively larger contexts in which public cultural objects make sense. For children, there is the great importance of what parents and the immediate family of known persons think and feel. As children grow and venture outside of the home there are then the increasing contexts of social meanings of culture, society and history and ultimately the sum total of experiences of the entire world.
What the above means for therapy is that psychological problems are attempts at solutions that are due to intentional processes that contribute a series of interconnected experiences: Specifically, emotions, behaviours, temporal experiences, social and personal experiences form a whole and are distributed across the lifespan. Specific problems like worry or avoidance are created through temporal and social connections.
What this means is that psychological change occurs through taking a new perspective on oneself and one’s problems. Psychological change is part of a greater whole including behavioural, social, emotional and linguistic changes. Altering a form of intentionality will change the sense of a problematic object, from a felt-sense to an intellectual sense, for instance. Cultural objects cannot be removed and the past cannot be changed in reality. But the senses of these objects of attention can be different according to changing the context of understanding - and the perspective taken towards ‘the same’ object or event. For instance, a traumatic memory can have a number of meanings associated with it. The memory means something about the cause of the trauma, about the self who was traumatised, it means something in terms of the emotional sense that co-occurs when the memory comes to mind. It means something else all together when it is described to another person. The factual existence of the memory can be in doubt if third parties dispute that the event remembered ever happened. If there are other parties who can explain the event in the traumatic memory, then the circumstances of its occurrence might become clear and it could be more reliably understood. All of these experiences are intentional and about the same event but are experientially different and the mental processes involved are different.
Where the psychodynamic and cognitive behavioural traditions converge is that they both are concordant as long as conscious events are attended to. Research shows that the quickest way to achieve change for many problems is through changing current behaviour in order to change meaning. However, the way to engage clients is through speech and providing an explanation of their problems in ways that are fully understandable to them. Thus speech and understanding changes the meaning of their problems even prior to them altering their behaviour.
If discussion is the main medium of therapy, then there can be spontaneous changes in sense that occur first of all through conceptual intentionality in combination with the whole of the senses of the client. The meaning of memories, events, thoughts, actions and feelings are altered through creating new contexts for understanding the behaviour of self and others. The four key concepts above are intentionality, sense, object and context.
Psychological problems have complex causes. Changes in sense are attainable through changing the type of intentionality involved: changing the sense of the same object, changing the context of meaning and changing the duration of time spent on attending to the object. Clearly, changing one object of attention for another will also change the subsequent senses gained. The worth of the intentionality model is having a simple system of concepts that are flexible yet provide a structure for thinking through the experiences of clients in order to think creatively about what can be helpful in creating change.
The argument for a qualitative psychology of conscious experience to guide interventions is against an excessive reliance on natural psychological science as a guide for practice. The formulation of intentionality is that it should help client and therapist agree the nature of the problem and the nature of the answer. When intentionality features as a central concept, it is in the service of promoting accountability and the explanation of techniques to the public and colleagues. Hermeneutics is a form of explanation for the approaches of each client and therapist.
The line of argument taken below notes the limits of quantitative psychology and answers the problem of the naturalistic attitude first. This understanding of intentionality forms the basis of the rapprochement between the talking and action therapies. The ability to choose, and choosing between intentionalities and objects of attention, occurs through free will. The naturalistic attitude ignores individual choice and the intentionality of consciousness in the social world. The view is that there is pseudoscience in therapy research. For the biopsychosocial perspective, what is required is basic understanding to interpret the qualitative experience of psychological problems. A biopsychosocial perspective has not yet been attained in the developmental psychology of psychopathology and so currently there is no consensus and that cannot guide practice.
The most all-embracing problem of therapy is an excessive reliance on justifications concerning the material, biological, neurological and physical substrate of human being. This is a problem because an over-emphasis on one aspect of the whole decreases, mistreats or ignores the other two aspects of human being. The naturalistic emphasis in therapy is a problem because the biopsychosocial whole is irreducible to any one of its parts. The problem is a hasty focus on one third of the causal factors involved. In philosophy, clear thinking prior to action, this is called the problem of the naturalistic attitude. In psychology, the same problem is known by a series of equivalent terms. It has been referred to as Scientism, physical reductivism, materialism, material reductionism and psychologism. Briefly, the problem of the naturalistic attitude is due to a philosophical position that believes that empirical psychology is a sufficient procedure for all justifications including ideal knowledge (like theory, mathematics and logic). Edmund Husserl countered this in the Logical Investigations (Husserl, 1970a), by pointing out that there are real and ideal types of knowledge. He furthered an appreciation of an ideal theory of meaning: This means that speech and writing work because people know in an ideal way, what the referents of speech are. The referents of speech are the same in metaphor and sarcasm, in Mandarin or French. Similarly for Husserl, ideals need to be found and understood in philosophy and psychology to create a preliminary theoretical overview to co-ordinate action. Husserl’s phenomenology exists to find the ideals of consciousness in relation to other consciousness, the world of meaning and the objects of attention in it. Phenomenology does not replace empiricism but is preparatory for it.
But the naturalistic attitude of natural psychological science acts as though understanding can only be gained through empirical means. If this were true, it would follow that people who have psychological problems are not good scientists and need to apply science to themselves. The problem of the natural attitude is that psychological science acts as though intellectual work is absent from the creation of its results. The consequence of the problem concerns how to create a justified position for understanding psychological life, specifically as psychological, and not the by-product of natural-material processes. Psychological here means emotional, relational and concerning intentionalities about conscious lived experiences such as behaviours, thoughts, feelings and beliefs. This is a restatement of the purpose of theory and empiricism because an exclusive focus on natural being means that only natural-material cause is worthy of attention. Hence, the naturalistic attitude rules out the complex inter-connections between the three aspects of the biopsychosocial whole. It contradicts the as-yet-unknown overall inter-action between each aspect.
Furthermore, the manner of argument in psychological science is suspect. The problem is that the quantitative model is built on the following confusion between two forms of argument, modus tollens and modus ponens. Modus ponens is the argument that when a theory is true, observations from its perspective are held to be true. Modus tollens is the argument that if an observed finding is false with respect to a theoretical prediction, then the theoretical prediction is also false. Thus, quantitative psychology puts the cart before the horse. In quantitative psychology that uses statistics, the premises are always unsound because they are averages and not actual reflections of the highly complex inter-related factors under consideration.
On the contrary, the proper relation between theory and practice is that theory comes first, but it is not the sole measure of what is real. Rather, theory serves its purpose determining what should be considered. One alternative to modus ponens is putting the pure before the applied. What this means is that theory serves a role in identifying what counts and this can inform practice. Accordingly, the use of statistics in large areas of the experimental approach to therapy is completely unjustified because the situation of measuring quality of life, supplied by a specific input from the therapy, is statistically indeterminate. When changes of meaning and lifestyle itself are the matters at hand, these subjects are not capable of supporting scientific evaluation in the proper sense of science. Furthermore, the experimental designs used and the size of the groups used are frequently far too small for the statistical packages used. Theory is refined by consideration of the applied to create a new pure: in an on-going inter-play between the pure and the applied.
It is a stark fact that the ontological dualism of biological traits and chemical aspect of meaningful psychological problem is never going to be met by material treatments or science - but only by a psychosocial treatment that helps clients understand and change their own behaviour. What counts in therapy practice is the experience of practising. When practice is understood from the inside of what it feels like to provide and receive care, then the experiential basis can be understood and theorised. Intentionalities form part of helping clients re-assess how they make the end-products of their own conscious experience. How people have experience and the intentionalities involved is the concern of qualitative theories that attend to the lived experiences of meaning. The intentionality model exists to balance opposing forces between theory and practice, empirical research and ethics. In the qualitative view, nothing about therapy is factual or measurable in the scientific sense. The intentionality model supplies a simple structure and is flexible and designed for the delivery of individual care. The values that it upholds are the preferences for flexibility, immediate responsiveness in sessions and how to structure individual meetings and series of meetings towards specific agreed goals.
Briefly, natural science is a perfectly acceptable approach for understanding material being, inanimate matter and acting towards it. Natural science appears in psychology as psychophysics that, for instance, could never possibly grasp what it means to see. Natural science appears in therapy as ideas of natural cause and invariable, measurable effects. It uses statistics to measure psychological distress. Its purpose is not to understand distress. Nor can it understand those who do not sufficiently understand themselves or others.
Generally, in the natural view of attachment theory, a brief introduction on inter-responsiveness between child and carer, or between two adults, then leads into a discussion of neurological processes as the genuine representation of what empathy is, how child development occurs and how memory processes work. Typically in this type of research, psychological justification is begun but suddenly broken off to discuss the material substrate only, with none, or only the slightest regard for personal choices and intersubjective influence. Thus, intersubjective influence is not treated as intersubjective but as neurological or physiological and anything but psychosocial. On the contrary, the task of a pure or theoretical psychology of secure attaching and its vicissitudes, discerns what is significant as opposed to what is peripheral.
One way of stating the task for therapists is that they need to be able to understand and digest the distress and negativity that they might feel, as a result of listening to painful and distressing material. It is a limitation of therapists that they should only work with the level of distress with which they can cope. A person who specialises in particularly distressing material like rape, neglect, sexual abuse, suicide and self-harm may need to limit their exposure and monitor the way in which they deal with their feelings. Some negative and traumatic objects when brought to attention and communicated have the consequence of strong negative emotion that is passed on to the listener.
There are a number of consequences to understand how an excessive focus on the natural misconstrues the meaning-oriented changes that are the proper substrate of helping people change their psychological lives by helping them change it themselves. The meaning of attachment relationships currently falls outside of the domain of what can be studied by natural psychological science. Attachment as a lived experience is psychologically meaningful.
Through thought alone it is clear that the material being of humans is not the same as meaning, values, intentions, beliefs and practices in the sociocultural world. This is not to state that the biopsychosocial perspective is currently impossible or over-ambitious. The concern is that natural psychological science lives or dies by its own precision. A day may come when it can be specified that the personalities and problems of a specific client can be explained because of the specific impact of their inherited traits, in relation to triggering social environments, in relation to their intentionality and choices. At some point in the future, it may well be possible to specify precisely how inherited material developments inter-act with culture and personal choice for an individual. Until then, there is uncertainty about the amount of natural cause in relation to the amount of psychosocial.
As therapists have no means of diagnosing or providing material changes in the brain, for instance, they lack the means of providing physical remedies to psychological matters. Even if natural causes do predominate in any specific case, certainty about that would not help the practitioners of the psychological therapies. This is because practice concerns how to create actual outcomes with real people (given their limitations, those of therapists and the situation as a whole). Practice employs social skills and encourages specific things happen for clients, the general public. Practice is not technical know-how by itself.
An excessive focus on material being and the problem of psychologism need to be tackled in proposing the intentionality model as a qualitative psychology of conscious meaningful experience.
The remainder of this entry are notes of a lecture for a skills workshop on integration and formulation by Ian Rory Owen PhD, for the Society for the Exploration of Psychotherapy Integration in the UK, given on 2 May 2009, at Regents College, London.
To provide a brief overview of the intentionality model leading to the skill of the practice of formulation. There will be time for practising formulation with simple and then complex cases and closing with a discussion.
First a brief overview of the intentionality model will be provided. Next formulation will be presented as a major unifying task that models co-operation and security in the therapeutic relationship. The idea of formulating on paper will be practised at first with simple cases and then with much more complex ones.
Clients want help and change. They do not know about the differences between the various types that are available (generally). Clients are embarrassed about asking for help and feel shame about the problems they have. Self-disclosing about the problems is difficult for them. Clients do not want to have brand names types of therapy. Clients want to lead problem-free, or problem-minimal, lives and have choice and understanding about their experiences.
Therapists want to help but their investment of time and effort in purist non-integrative brand-name approaches blocks their ability to be objective about their own effectiveness. In this way, inaccurate high self-esteem of therapists can block the ability to be properly effective in delivering change. To be effective can only be achieved by building in feedback from clients. Being effective means being able to understand outcome results that say that CBT is most useful for single disorders and be able to understand why this is the case. Actually applying CBT with people with complex multiple problems is the usual case of practice. In order to be properly effective, therapists need to understand, work with and manage the relationship in a transparent and equitable way because it is the medium for the delivery of the care being provided. The rejection of clients, because they have worries and difficulties about entering therapy and self-disclosing (etc etc), is a failure to deliver care.
Here are some drawbacks of common positions within the field overall:
Behaviourism is wrong to suggest that hermeneutics is not relevant. This attempts to disconnect meaning from its version of pragmatism. On the contrary, meaning is the base experience of being alive and aware.
Psychoanalysis and psychodynamics are wrong to hypothesise in terms of unconscious emotion, unconscious intent and unconscious communication. There is nothing wrong with the descriptive use of the word unconscious. If some object or aspect of observable communication is not currently conscious, then it is acceptable to say that it is currently outside of awareness. The problem is that emotions are always conscious when they are felt as are intentions when they are acted on and communications.
Lifestyle choices and developmental windows of opportunity were set down consciously in the past. They were consciously chosen at the time of making them. That is not to state that all the emotional and moods influences on a person are always understandable at the time of being so influenced.
Cognitive behavioural therapy (CBT) is wrong to place so much store on the empirical evidence for randomised control trial (RCT) research on single axis I problems and axis II personality types. The core of practice is improvisational art, hermeneutics and good communication skills in order to share a formulation and get informed consent for practice. Formulation is one place where hermeneutics is in action.
Security of attachment in the professionally-provided time-limited relationship is promoted through clarity of roles and boundaries in terms of knowing how to provide care. Specifically, security is increased through an attention to detail of how to provide talk and relating and meaning-altering interventions for complex short- and long-term psychological problems. It is the attention to the detail of how to practice that enables therapists to remain calm and for clients to value sessions and receive help. It is insufficient to provide clear boundaries and no care. The reality of the performance of sessions is most important.
The premise of practising only according to a single non-integrative brand name of therapy is wrong. There are great lacks of certainty and consensus within all aspects of the subject areas that could be capable of justifying practice. Therapy exists in the middle of competing claims for justifying any aspect of practice.
On the contrary, there are only small distinguishable differences between the brand name types of talk and action therapies.
The main aspect of practice is to tailor interventions to meet individual client needs and abilities. Only offering a small number of interventions will inevitably be unable to meet the full range of the needs and abilities of clients. For instance, what is also ineffective is beginning CBT with someone whose ability to trust is very low. Starting a talking therapy that never gets close to supporting actual change is also unacceptable.
There is great difficulty in writing a therapy manual for practice because there is a substantial inability to standardise practice.
Changes in psychological health involve complex changes in all aspects of intentionality and sense (the duration of a sense). Changes in practical intentionality are most likely to change mood and that has knock-on effects on self-esteem. The most general strategies for change are:
Change the sense gained of any object of attention and the length of time spent on it.
Change the objects attended to.
Change the contexts of understanding involved.
Definition: Intentionality, sense, object and context are four ubiquitous aspects to the definition of any problem and the provision of an answer.
Intentionality: The many ways in which the mind is conscious of people, self, things, ideas and the views of others. For instance, here are some simple types:
Perceiving events in the here and now: vision, hearing, body sensation. The bodily sensation of ones own body is a type of perception.
Imagining that something might happen at an unspecified time.
Behaviour is (often) a purposeful practical intentionality towards some desired outcome.
Emotion is often about values or represents how self is relating towards others and is felt in the body but also mediated by thoughts and beliefs.
Empathy is the learned appreciation of the perspective of others and can be immediate or absent, strong or weak, intellectual, affective, remembered, anticipated or imaginative.
Conceptual intentionality occurs in internal dialogue, all written and verbal communication, and in intellectual forms of notation (music, maths).
Signitive forms e.g. road signs, the weather.
Believing that something is (or is not) the case.
There are also complex nested types of intentionality:
Remembering what a visual scene looked like.
Remembering what another person said and what they meant.
Anticipating what would be seen.
Anticipating what would be said.
Imagining what someone might think or feel.
The concept of intentionality works to explain and map experiences of different sorts. It is an easily understandable medium that needs no explanation of the basics such as what imagination is, or what memory is. These experiences are common although they may not be fully understood. Thus, the worth of phenomenology is to make a common language to enable co-operative working, collaborative empiricism.
For instance in health anxiety, the full experience is that a person worries in internal dialogue about what it means that their heart is palpitating. What they experience is the consequence of the belief that they are having a heart attack. This belief brings on a panic episode where they feel that their throat is closing up and that they cannot breathe. This produces the further idea that they are going to die and at this point they can imagine their family gathering around their death bed and see them crying. The next thought is that their life has been wasted and that they have done nothing with the opportunities that they had.
Clearly, every step in the above concerns a different type of object experienced in a different intentional way.
Worry in internal dialogue produces physical sensations of anxiety.
The bodily sense of anxiety is interpreted as evidence to support the belief that a heart attack is current.
The belief that there is a current heart attack increases the anxiety level to produce a panic attack.
The panic experience includes difficulty in breathing and produces the belief that their throat is closing.
The visual imagination of their own death is the next experience.
Finally, that promotes the conceptually-expressed thought that their life has been misspent.
Consciousness is self-reflexive and how to reflect on it
Not only do we have experiences but we automatically know that we have them. Many therapies work by increasing awareness of the problem through discussion or other means. Encouraging clients to be aware of their problems brings them into a sharper focus. The general process is: Stop.
Reflect and stand back.
Think and understand.
Re-engage in a new way and act differently.
The intentionality of consciousness is an easy concept to grasp that renders experiences understandable and discussible with people from all walks of life. Further, once it is understood that talking therapy works by changing meaning and the manners of being aware, then it is possible to spot how clients are oriented in time, place and person when they speak. CBT is re-written in this way to become a much more direct way of understanding the problems of personality functioning and groups of psychological problems that co-exist. When intentionality is understood as a key concept, it enables the analysis of the manners of awareness that are the psychological problem and that enables clients to understand how to help themselves.
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