INTRODUCTIONOne 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, HypnosisRelaxation training, Threshold trainingMeditation, Momentary relaxationSensate focus training, Relaxation responseMassage

IMAGERY

Coping imagery, Time projection imageryAnti-future shock imagery, Mastery imageryPositive imagery, Thought stopping imageryAversive imagery, Associated imagery

COGNITIVE

Bibliotherapy, Cognitive rehearsalDisputing irrational beliefs, Problem solvingChallenging faulty inferences, Constructive self-talkThought stopping

INTERPERSONAL

Assertion training, Contingency contractingFixed role therapy, Communication trainingFriendship/intimacy training, Social skills trainingRole play, Graded sexual approachesParadoxical intention

DRUGS/BIOLOGY

Lifestyle changes, Stop smoking programmesDiet, Weight controlExercise, MedicationReferral 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

Behaviour Type A behaviour: quick Behavioural education. talking/eating/walking. Polyphasic behaviourImpatient

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-statementsTeach self-acceptance

Interper- sonal Passive-aggressive Spends little time in recreational pastimes with family or friends

Assertion training. Discuss benefits.

Drugs/ Biology

High blood pressureHeadaches 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.

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.

CONCLUSIONToday 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).