INTRODUCTION 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:

Behaviour Affect Sensation Imagery Cognition Interpersonal Drugs/biology

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. TABLE 1 Frequently used techniques (adapted from Lazarus 1981) 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. TABLE 2 Modality Profile of Type A client with high blood pressure. MODALITY PROBLEM PROPOSED TREATMENT Behavioural education. Do one task at a time; Examine irrational beliefs that may cause polyphasic, 'hurry up' behaviour. Dispute irrational beliefs Anger management. Biofeedback and relaxation training. Coping imagery. Dispute irrational beliefs; failure attacking exercises; coping-statements Teach self-acceptance

Behaviour

Type A behaviour: quick Behavioural education. talking/eating/walking. Polyphasic behaviour Impatient Feels angry at work Physically tense Images of losing control 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

Affect Sensation Imagery Cognition Interpersonal

Passive-aggressive Spends little time in recreational Assertion training. Discuss pastimes with family or friends benefits. Liaise with medical specialist about medication and treatment programme. Relaxation training. Weight reduction programme. Reduction programme- use drink diaries Stop smoking programme.

Drugs/ Biology

High blood pressure Headaches Overweight alcohol a week Smokes 30 cigarettes a day

The client and counsellor/trainer negotiate which interventions to use first depending upon health related priorities and what is manageable and not overwhelming for the client. CONCLUSION Today I hope that I have given you some insight into what happens to clients once they have been referred to my Centre for stress counselling or training if they are suffering from stress

related disorders. A part of the assessment may also include the use of the Occupational Stress Indicator (Cooper et. al., 1988). I have not had time today to discuss other techniques and methods that a multimodal stress counsellor and trainer may use in 'one-to-one' or group situations. Those of you interested in the approach may find Structural Profiles, tracking and bridging interventions very helpful in your area of work. I can only refer you to the relevant publications (Lazarus, 1981; Palmer and Dryden, 1991; Palmer, 1992; Palmer and Dryden, 1995).