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Learning to Be Assertive -- Part II

Using guided imagery/desensitization techniques to help with assertiveness.

In my last blog ("Learning to Be Assertive - Part I") I discussed some therapeutic techniques that may be used in overcoming timidity, shyness, and insecure feelings in the workplace as well as in social situations. I explained how my patient, "Anthony," was able to use behavior modification techniques to overcome a lifelong problem of dependence and be more assertive both at work and in his social life.

In this blog, I will introduce two more techniques--guided imagery coupled with systematic desensitization--that help patients like Anthony become more assertive.

When using these techniques, it's helpful to spend a couple of sessions getting historical background on the issues, as I did with Anthony. From a global point of view, Anthony came to understand that his very pampered upbringing--in which he was well cared for, was not expected to be independent, and had most things done for him--led to his feeling and thinking he was helpless. As a young adult and throughout his 20s, Anthony came to feel that he was unable to succeed at many things, from moving up the ranks in his company to dating women. Without the targeted, short-term overview of events in his past that we did together, the origins of his pattern of thought and behavior might have gone on for years and even spread to other areas of his life.

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Therefore, in addition to the behavior modification techniques discussed in the last blog, I introduced Anthony to another strategy to aid in becoming more assertive: a guided imagery and desensitization technique for overcoming the timidity, shyness, and insecure feelings he had been experiencing for many years. It's a simple approach to desensitizing oneself to a potential stressful situation by helping the patient get into a deeply relaxed state, and then using a guided imagery technique to help his brain and body become accustomed to new ways of feeling about and coping with specific stressful situations.

First, I helped Anthony get into a relaxed and open-minded state. There are many relaxation techniques. One of the easiest and most effective is the 20 Steps Technique. Briefly put, the patient imagines 20 heavily carpeted stairs in his favorite color. He is encouraged to walk slowly down those plush stairs. As he pictures himself descending each step-slowly-he finds himself becoming more and more relaxed by degrees.

Once in a relaxed state, I invited Anthony to imagine a large, blank TV screen and project a specific anxiety-producing event onto the screen-one that he had been avoiding. For instance, Anthony imagined asking his boss for vacation time. While relaxed, he projected this encounter with his boss on his imaginary screen, and replayed it over and over-so many times that he eventually became desensitized to the feelings he previously associated with it (fear, self-consciousness, tension, insecurity, etc.). With this simple guided imagery/desensitization technique, as the patient imagines and replays the experience, he begins to be more relaxed about the real event. This is how one aspect of the process of desensitization works.

These different approaches to assertiveness training may be combined or used alone, depending on the circumstances, problems to be addressed, or what an individual is most comfortable with. What is important is the therapeutic ability to solve certain psychological problems in a circumscribed manner with behavior modification, cognitive behavior therapy, or guided imagery linked to desensitization techniques. This, without an endless exploration of a person's bends, twists, and turns in life, which many times are subject to multiple interpretations that may appear valuable and interesting, but do not solve the problem in the near term nor allow the person to move forward.

I was pleased to see that Anthony was able to overcome his social problem. He was motivated, willing, and able to learn new skills to overcome this problem relatively quickly using hands-on assertiveness training without having to endure endless archeological digs that so often characterize talk psychotherapy.

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This blog aims to present psychiatric/psychological information to a general readership, offering insights into a variety of emotional disorders, as well as social issues that affect our emotional well-being. It includes the ideas and opinions of Dr. London and other leading experts. This blog does not provide psychotherapy or personal advice, which should only be done by a mental health care professional during a personal evaluation.

Robert London, M.D., has been a practicing physician/psychiatrist for more than three decades.

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