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Mental Health, Religion & Culture

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Four noble truths based problem solving: a therapeutic view

Tanaphong Uthayaratana, Nattasuda Taephant & Kullaya Pisitsungkagarn

To cite this article: Tanaphong Uthayaratana, Nattasuda Taephant & Kullaya Pisitsungkagarn (2019) Four noble truths based problem solving: a therapeutic view, Mental Health, Religion & Culture, 22:2, 119-129, DOI: 10.1080/13674676.2018.1512565

To link to this article: https://doi.org/10.1080/13674676.2018.1512565

Published online: 14 May 2019.

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Four noble truths based problem solving: a therapeutic view Tanaphong Uthayaratana , Nattasuda Taephant and Kullaya Pisitsungkagarn

Department of Counseling Psychology, Chulalongkorn University, Bangkok, Thailand

ABSTRACT This paper presents the application of the four noble truths based problem solving (FNTBPS) approach to supplement the contemporary and traditional Thai Theravada Buddhism literature on psychological healing. This paper outlines the core concept of FNTBPS, its key components and application, using an illustrated case example of Tom (ตอ ม), a 50-year-old Thai man facing psychological problems due to his worsening eyesight. Lastly, this paper outlines the therapeutic implications of how an understanding of psychological healing via the knowledge of FNTBPS can be used for case formulation and treatment planning.

ARTICLE HISTORY Received 10 June 2018 Accepted 11 August 2018

KEYWORDS Four noble truths based problem solving; problem solving; Theravada Buddhism; Thai Pali Cannon; counselling

Problems are a fact of life that nearly everyone has to face. Problems can be viewed as situational, such as organisational restructuring, unfulfilling relationships, grief and loss. As D’zurilla and Goldfried (1971, p. 107) stated, “our daily lives are replete with situa- tional problems that we must solve in order to maintain an adequate level of effective function”. Western psychology posits that ineffective problem solving is related to psychological disturbance and turmoil such as depression, anxiety, adjust- ment difficulties and suicide (Belzer, D’Zurilla, & Maydeu-Olivares, 1998; D’zurilla & Gold- fried, 1971; Heppner & Petersen, 1982; Heppner, Witty, & Dixon, 2004; Nezu, 2004; Platt & Spivack, 1972). Recognition of the need to implement solutions to manage proble- matic situations has led to the introduction of psychotherapies and psychological inter- ventions that focus on promoting psychological wellness through effective problem solving (Becker-Weidman, Jacobs, Reinecke, Silva, & March, 2010; Heppner, 1978; Nezu, Nezu, & D’Zurilla, 2013).

While the Western literature on problem solving provides fruitful knowledge and thera- peutic implications, this article aims to introduce an alternative definition of problems and problem solving based on a Buddhist perspective, which complements the Western approach. From the Buddhist perspective, a problem is a problematic psychological reac- tion to a situation, referred to as dukkhā or psychological suffering. Dukkhā can be described as a problem of the mind, which sometimes continues even after the proble- matic situation has been resolved. Theravada Buddhism (Buddhadãsa Bhikku, 1992; Chris- topher, Christopher, & Charoensuk, 2009; Daya, 2000; Payutto, 2012; Stanley, 2015; Van Gordon, Shonin, Griffiths, & Singh, 2015) focuses on dealing with these kinds of problems

© 2018 Informa UK Limited, trading as Taylor & Francis Group

CONTACT Tanaphong Uthayaratana noel.tanap@gmail.com

MENTAL HEALTH, RELIGION & CULTURE 2019, VOL. 22, NO. 2, 119–129 https://doi.org/10.1080/13674676.2018.1512565

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and delineates how the four noble truths can be applied to deal with them in everyday life. This paper describes the therapeutic application of the four noble truths based problem solving (FNTBPS) approach.

The Buddhist perspective has been used in many types of therapeutic interventions, e.g., mindfulness and meditation (Gamaiunova, Brandt, & Kliegel, 2016; Grabovac, 2015; Kabat-Zinn & Hanh, 2009; Stanley, 2015; Van Gordon et al., 2015), counselling and psy- chotherapy (Choudhuri & Kraus, 2014; Daya, 2000; Dryden & Still, 2006; Pokeao, 2010), inte- gration of Buddhism into Western psychology (Mikulas, 2007; Wilber, 2001), coping (Tyson & Pongruengphant, 2007) and addictive behaviour (Marlatt, 2002). This integrative paper presents the theoretical framework and application of FNTBPS to supplement the Western approach to problem solving, the psychological healing process and counselling and therapy. The rest of this paper is structured as follows. First, it outlines the Western and Theravada Buddhism approaches to problem solving, then introduces the case of Tom to illustrate the Western approach to problem solving and identifies some gaps that can be filled by FNTBPS. FNTBPS is described along with an illustration of how it can be applied it to Tom’s case, with more detail on how to practise FNTBPS and some of the factors that it involves. Finally, an example of the therapeutic application of FNTBPS in the context of counselling is presented.

Western problem solving

In Western psychotherapy, problem solving (D’zurilla & Goldfried, 1971; Heppner & Peter- sen, 1982; Nezu et al., 2013; Shure, 2001) suggests the enhancement of problem-solving efficacy and appraisal. It is assumed that psychological well-being can be enhanced by a systemic strategy for managing problematic situations: problem definition and formu- lation, generation of alternatives, decision making, solution implementation and verifica- tion, together with the proper problem orientation (i.e., being optimistic about problems and one’s ability to solve them) (Nezu, 2004; Nezu et al., 2013) and problem-solving apprai- sal (Heppner & Petersen, 1982). Enhanced problem-solving efficacy should increase psychological well-being.

From a Western perspective, there are two ways of viewing ineffective problem solving. The first involves impulsivity and avoidance: being too rash, careless and impulsive, and acting too late and procrastinating or being overly dependent on others to find solutions (Heppner et al., 2004; Nezu, 2004). The second entails a sol- ution that fails to meet its objective or that may even perpetuate the problem (D’zurilla & Goldfried, 1971).

Western problem solving also suggests that there are psychological factors that affect the effectiveness of problem solving, such as one’s “problem orientation”, which refers to the manner in which one perceives problems, in either an optimistic or a pessimistic way (Nezu et al., 2013). Another factor is problem-solving appraisal (Heppner et al., 2004), which refers to how one perceives one’s capability to solve the problem at hand. These psychological factors can be enhanced through cognitive interventions; namely, cognitive restructuring to increase the ability to manage problematic situations. Western problem solving as applied to counselling and psychotherapy focuses significantly on managing problematic situations and should benefit from the Theravada Buddhist perspective, which focuses on solving the problem of the mind or the suffering itself.

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Theravada Buddhist problem solving

Theravada Buddhism, in contrast, focuses mainly on dealing with the person’s suffering. This approach also views the application of problem solving as a way to promote psycho- logical health via the development of insight through psychological processes. The ulti- mate goal of this type of problem solving is to end suffering in everyday life and to keep track of suffering cessation (Payutto, 2013). This problem-solving approach is based on the four noble truths, the Buddhist explanation and direction for suffering cessa- tion. The four noble truths involve the understanding of the nature of suffering, its cause, its cessation and how to cease it. Therefore, practitioners can apply the understanding of the psychological process of suffering to integrate suffering cessation into problem solving in daily life and thus end the suffering. Hence, the FNTBPS approach is proposed. While Western problem solving focuses more on managing problematic situations, FNTBPS focuses more on managing psychological suffering through the psychological process (Payutto, 2002), as illustrated in the case of Tom outlined below.

A case illustration of Tom

To facilitate the illustration of the concept and the implications of traditional problem solving, this section commences with a case example. Although the case is hypothetical, it is likely to encompass concerns generally experienced in daily life. Tom (ต อม) is a 50-year- old adventurous Thai male who has experienced headaches for the past month. He became terrified when he noticed that he could not see as clearly as he used to. The more he thought about how awful his life would be if he had to use spectacles due to his poor eyesight, the more he became distressed, which prevented him from seeing a doctor. First, Tom’s problem is conceptualised based on traditional Western problem solving. Then, the FNTBPS conceptualisation is provided.

Western problem solving and its application to Tom’s case

After studying Western problem solving, Tom noticed his avoidant problem-solving style, as he did not actively engage in resolving his vision problem for a month, which made the problem even worse. He decided to stop procrastinating and started trying to solve his problem systemically. Here, Tom’s poor eyesight is defined as the problem, and the main- tenance of his eyes as the solution.

Due to the western problem-solving method, Tom reconstructed his thoughts and modified his behaviour in a healthier way. At first, he changed his procrastinating thought pattern by facing the problem. After careful consideration of his situation, Tom visited the doctor to try and solve the problem and changed his behaviour to promote healthy behaviour and prevent future myopia. After solution-focused problem solving and trying his best to cope with the situation, Tom felt better.

Whereas Western problem solving suggests ways to manage problematic situations via situational modification, it does not focus to the same extent on the resulting psychologi- cal distress. The distress may result in internal turmoil and frantic attempts to control the turmoil to the extent of going beyond the problem per se. In the case of Tom, the distress and suffering continued even after his eyesight was corrected by spectacles using the

MENTAL HEALTH, RELIGION & CULTURE 121

Western problem-solving approach. Tom became distressed by having to wear glasses. This second type of distress can be addressed by FNTBPS.

Four noble truths based problem solving (FNTBPS) and its application to Tom

FNTBPS was first introduced by Payutto (2012) based on the four noble truths principal. Uthayaratana (2018) conducted an empirical study to develop a scale that encompasses the FNTBPS to extend the benefits of Western problem solving. Drawing from the theor- etical grounding and rationale of the scale, the authors aimed to apply the theoretical fra- mework of FNTBPS to supplement psychological healing, especially for non-clinical populations (i.e., within a counselling context).

FNTBPS comprises four actions based on an understanding of how suffering is formed and how to cease it according to the four noble truths (see Figure 1).

Dukkhā in FNTBPS means to recognise and become aware of current psychological suffering. According to Buddhism, psychological suffering is a psychological reaction to a situation; the reaction may involve feelings (e.g., depression, anxiety, grief, anger, excitement or loneliness) or thinking styles such as catastrophic thinking, rumi- nation, and self-blaming. The Buddhist perspective considers that such psychological reactions or suffering occur and can be managed via the cause of the psychological process itself (Dãghanikàya. Mahàvagga, D.II.294-295). The main purpose of Buddhist teaching is to deal with this psychological suffering.

Tom faced changes in his eyesight as a result of aging. He had already managed the changes through a medical process. However, Tom still experienced noticeable psycho- logical suffering whenever he thought about using spectacles. With the understanding of dukkhā, Tom examined his own state of mind and found that his anxiety distressed him. He was anxious that he might not be able to enjoy his adventurous activities due to his eyesight problem, especially if he had to use spectacles. This caused his psychologi- cal suffering.

Figure 1. The four noble truths based problem solving thinking.

122 T. UTHAYARATANA ET AL.

Samudāya in FNTBPS means to reflectively examine and identify the psychological process that causes the experience of suffering and thus eliminate it. Generally, the process of samudāya consists of craving (tan hā) (Dãghanikàya. Mahàvagga, D.II.296), cling- ing (upādāna) and ignorance (avijjā) (Buddhadãsa Bhikku, 2014). The three components are described in detail as follows.

Craving is the state of the mind that reflects a desire for something, which is usually incongruent with the current state. Craving happens due to the value that one gives to that specific state. Craving can be inflated into clinging, which is the state of mind that reflects attachment to a desired object. One of the objects of clinging is one’s own self, especially the sense of self. Craving and clinging occur through ignorance, which is basi- cally a misperception that one has about the value of any focused object. The fixation in turn leads to desire. The fixation is rooted in the misperception of the nature. Such misper- ception is relevant to the recognition and acceptance of the impermanence and the changes that are inevitable in life. The fixation results from the lack of realisation that there is nothing that can be held onto as part of the self. With this ignorance, one can project the value of one’s own self onto any object. This leads to craving, clinging and suffering. The experience of all psychological suffering consists of craving, clinging and ignorance.

Tom reflected on his anxiety. He found that it was due to the craving that he desired not to use spectacles. This directly threatened his adventurous activities that he valued and clung to. Tom noticed that he had projected himself into the pleasurable experience of being adventurous, and this led to his resentment about having to use spectacles. Tom found that his suffering was rooted in his craving and clinging to the pleasure of adventure that he perceived as part of himself. This can be construed as ignorance.

According to the four noble truths, the factor that directly causes suffering is the psychological process itself. Suffering stems from craving, clinging and ignorance (Bud- dhadãsa Bhikku, 1992). In other words, if one’s mind is operating with a desire in an ignor- ant way, one will fall into a state of suffering. The Buddhist perspective views that there is nothing that happens without a cause (Ricard & Trinh, 2001). Similar to suffering, there is no dirt of dukkhāwithout the contamination of samudāya. One of the main reasons that an individual cannot overcome his own suffering is that he does not recognise his psychologi- cal reaction and its causes, which could be managed through the psychological process itself.

Nirodha in FNTBPS refers to setting a goal and making a plan to cease suffering and to evidence one’s own state of suffering cessation. Suffering cessation occurs when tan hā is eliminated (Dãghanikàya. Mahàvagga, D.II.298). The cessation of suffering can be described as a peaceful mind or harmony. The peaceful and harmonious state arises when the mind is congruent with the situation and the nature of impermanence. Suffering cessation, along with compassion, occurs when the mind is not influenced by desire in an ignorant way (Payutto, 2012). Hence, the craving for nirodha itself can lead to suffering, as described above, for nothing can be held by the self.

After noticing the causes of his suffering, Tom became more aware of the destructive functions of craving, clinging and projecting himself onto the pleasure of adventurous activities. The more he observed the nature of this pleasure, the more he noticed that this feeling was so fragile, momentary and transient that it was impossible for him to stay in the same initial state, no matter how hard he tried. He realised that holding on

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to such pleasure was similar to holding on to the fresh breeze that blew in summer time. Doing so could not protect him from the heat but made him feel even more uncomforta- ble. He became weary of the craving for comfort and realised that a peaceful state of mind existed when he was not holding on to the pleasure. After experiencing this peaceful state of mind, Tom realised his potential to cease the suffering. Then, he set this peaceful state as the goal of his problem solving.

Magga in FNTBPS means following through the plan to transform one’s state of mind through the path of suffering cessation. Magga, the “eightfold path”, refers to the eight interrelated paths for suffering cessation (Dãghanikàya. Mahàvagga, D.II.299). When one’s mind operates based on magga, suffering disappears. The eightfold path consists of eight components – understanding, thinking, speech, action, role/career, effort, mind- fulness and concentration – which together form the psychological and behavioural process of suffering cessation. Suffering cessation is rooted in the understanding of the four noble truths and the laws of nature (i.e., impermanence, changes and non-self). Under- standing involves moderating one’s thinking in response to the current situation, so that it does not entail desire through ignorance (i.e., being more compassionate, grateful, accept- ing, benevolent and non-attached, and with less craving and clinging). When an intended behaviour (i.e., action, speech) is performed in a less craving and clinging way, it inflicts less harm and brings more peace to oneself and to others, and also enhances one’s focus on present tasks such as those involved in the responsibilities of one’s role or career. The aforementioned process requires a mind that is capable of sustaining concen- tration on the here and now (i.e.,mindfulness), together with the effort required to conduct both the psychological and behavioural processes to move toward suffering cessation (Buddhadãsa Bhikku, 1992, 2006; Marlatt, 2002; Payutto, 1988, 2012).

After becoming aware of the causes of his suffering and the possibility of suffering ces- sation, Tom put his effort into becoming mindfully aware of the cause of his anxiety to prevent himself from being influenced by his suffering. With the realisation that the desire for pleasure contributed to his suffering and the understanding that pleasure cannot be held onto, Tom noticed that he became less anxious about wearing spectacles. He became more compassionate toward himself. He became grateful for the past, when his body gave him opportunities to enjoy all of the adventurous activities and accepted the change in his eyesight. He decided to continue his healthy behaviour, not because he wished to regain his good eyesight but because he wanted to express care and grati- tude toward his body. He stopped complaining about his eyesight, which improved the atmosphere between him and his colleague. He noticed a peaceful feeling whenever he gave all of his attention to a present task, because there was no interference from psycho- logical suffering. Tom found that the more effort he put into living his life, the more focused on the here and now and the more mindful and understanding he became of impermanence, changes and non-self, the more he moved toward his goal – a peaceful state of mind. As he practised FNTBPS, he was able to transform his unaware anxiety into peace and harmony.

Another function of the mind relevant to the four noble truths is suffering cessation. The cessation of suffering is a peaceful state of mind that is free from psychological pain. Magga is the cause of suffering cessation.When one becomes mindful of one’s pres- ence with an experiential understanding that everything is impermanent and cannot be held by oneself, all causes of suffering (i.e., craving, clinging and ignorance) cease to

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operate. The peaceful state of mind is rooted in this understanding. Any action – mental, verbal or behavioural – performed with this understanding is an action that is operated by a peaceful mind. Mindfulness of one’s own suffering, its cause and the path to cessation or the act of FNTBPS, is a process ofmagga.Whenmagga is operating, one senses a peaceful state of mind, which is nirodha.

The practice of FNTBPS

To practise FNTBPS means to be aware of one’s current psychological suffering and its cause, which allows one to practise psychological and behavioural suffering cessation. FNTBPS is based on the understanding that psychological suffering is directly caused by the psychological process itself. The suffering can be managed if the individual follows the gist of the FNTBPS.

FNTBPS can be considered as a daily exercise for suffering cessation. It can be practised by anyone, anywhere, whenever a problem or psychological suffering is perceived. FNTBPS is based on the fundamental factor of mindfulness, as the meaning in Pali as sati. The more mindful one becomes, the more effectively one is able to cease suffering, especially as mindfulness helps to endow the individual with the understanding of imper- manence, changes and non-self (Daya, 2000; Marlatt, 2002; Stanley, 2015). Vice versa, the more one practises FNTBPS, the more one practises mindfulness through observing one’s suffering, the cause of suffering, suffering cessation and the path of suffering cessation.

Therefore, mindfulness is the first action in the process of FNTBPS. This includes not only the awareness of a problematic situation, but also the problematic psychological reac- tion that one has toward that situation. It is important to recognise that the psychological reaction, feeling or thought is the current problem of the mind (Payutto, 1988). With that recognition, one can go to the next step of reflecting on the cause of the psychological reaction. This can be done by observing how craving, clinging and ignorance contribute to the current suffering (e.g., the occurrence of desire and attachment, the projection of the self). After the problem conceptualisation, the next step is to set a goal and form a plan to cease psychological suffering, to apply the exact understanding of how the mind reacts to the situation, to be aware, think or act to ease the suffering, and to plan what can be done to manage the situation. The last step is to put the plan into practice to cease suffering through both psychological and behavioural means. This should lead to the management of both psychological suffering and the problematic situation, through the practice of anything that brings peacefulness to the mind instead of the old problematic psychological reaction. Apart from the process of problem solving, mind- fulness is still necessary to observe whether suffering has really ceased and to work out what more could be done to alleviate the suffering (Khuddakanikàya. Mahàniddesa, Nd1.262).

Mindfulness is essential in the aforementioned process. The more one practises mind- fulness, the more accurately one perceives one’s own state of the mind, and the more effective one becomes in ceasing suffering. Mindfulness also enhances the understanding of impermanence, changes and non-self, because the more one observes, the more one realises that nothing, even the suffering itself, can stay unchanged or held by the self (Daya, 2000; Marlatt, 2002). This understanding leads to acceptance and problem- solving appraisal (Heppner et al., 2004; Uthayaratana, 2018), with the realisation that

MENTAL HEALTH, RELIGION & CULTURE 125

suffering can be ceased. FNTBPS is also considered a means of emotion regulation itself, due to its efficacy in dealing with suffering, anger and inconvenient emotions. Through FNTBPS, one can practise mindfulness, or meditation, to become faster and more effective in ceasing suffering (Gamaiunova et al., 2016; Stanley, 2015), and even to go further and prevent suffering (Buddhadãsa Bhikku, 1992; Payutto, 2012).

Using FNTBPS within the counselling context

Given the promise of FNTBPS, it is worth examining the therapeutic implications for coun- selling and psychotherapy. Therapeutic goals involve assisting clients to move toward the cessation of the suffering that they are experiencing (Daya, 2000). The knowledge, under- standing and experience of FNTBPS could help counsellors and therapists to conceptualise clients’ problems. Its four components give a clear picture of the process of change, from suffering to suffering cessation, which therapists can apply to understand a client’s situ- ation and then use that understanding for treatment planning. FNTBPS can be applied in therapy as a therapeutic goal, for case conceptualisation and to understand the process of changing the mind and treatment planning. These therapeutic applications lead to directions for further examination of FNTBPS, such as the development of an objec- tive measurement of FNTBPS and more evidence-based research on its application and therapeutic outcomes.

In a case such as Tom’s, the counsellor may apply FNTBPS by assisting Tom to recognise and become aware of his current psychological suffering by applying counselling inter- viewing techniques (e.g., attending, paraphrasing, summarising, questioning and empathy) (Ivey, Ivey, Zalaquett, & Quirk, 2012; Levitt, 2002) to identify and conceptualise Tom’s dukkhā based on FNTBPS. The counsellor could assist Tom to become aware of his current psychological reaction to his eyesight problem. Then, the counsellor could apply knowledge of samudāya to help Tom to identify the form of craving or clinging that led to his current suffering. A clearer picture of the form of Tom’s psychological suffering and its underlying cause would provide the counsellor with a clearer case conceptualis- ation that would lead to treatment planning via FNTBPS.

The next step, nirodha, has been shown to be essential for the counselling process in various ways. To begin with, the counsellor can use her nirodha to provide a therapeutic pres- ence (Srichannil & Prior, 2014) with empathy and compassion, which are qualities that are ben- eficial in therapy (Marlatt, 2002). The counsellor can become a role model of a person who has achieved less psychological suffering. Then, the counsellor can guide the client to a state of reduced suffering. In the case of Tom, counselling sessions helped him become more aware of his own destructive psychological functions of craving and clinging, which presented as the wish to experience the same pleasure as when he had good eyesight. With the help of the counsellor, Tom became more aware and accepting of the impermanence and the changes that happen in life, and to evince a peaceful state of nirodha.

The counsellor could assist Tom to function psychologically in the way of magga, to become more at ease with the state of suffering cessation by eliciting Tom’s understanding of impermanence, changes and non-self. In this step, metaphors can be used, especially those that are congruent with the client’s suffering and the laws of nature. In Tom’s case, the counsellor could elicit Tom’s understanding by using the metaphor of Tom clinging to the pleasure of participating in adventurous activities such as holding onto the fresh

126 T. UTHAYARATANA ET AL.

breeze that blows in summer time, which does nothing than to cause irritated suffering. The therapist can shift Tom’s thinking toward being grateful for the pleasure that he used to have and move on to the next part of his life. Then, referring back to the understanding of the four noble truths and the laws of nature, the therapist can help Tom to practise the path of magga by planning concrete behavioural and psychological responses that he can use to deal with his eyesight. These responses involve i) action: making a plan to maintain his physical health; ii) speech: talking to himself and others about his eyesight; iii) role/career: paying attention to the present task; iv) effort: sticking to the plan for suffering cessation; v) mindfulness: being aware of any psychological reaction; and vi) con- centration: focusing on here and now, not the change in his eyesight.

Applying FNTBPS to therapy requires an experiential practice and understanding of the theoretical framework of FNTBPS and the four noble truths. Counsellors will benefit from engaging in FNTBPS in their own daily problem solving. Daya (2000) suggested that “as the counsellor’s level of comfort with the Buddhist principles increases, the effectiveness of his/her interventions will also increase” (p. 269). The more the therapist understands FNTBPS, the clearer the picture that can be obtained for therapeutic application. Assimilating the understanding of suffering management into daily life helps the therapist to become congruent with the way Thai Buddhist counsellors practise to master their counselling com- petency (Pokeao, 2010; Srichannil & Prior, 2014; Tuicomepee, Romano, & Pokaeo, 2012). The therapeutic application of FNTBPS to deal with psychological suffering can be summarised by the Thai idiom that means “to practice is to succeed”. Small steps toward mindfulness via FTNBPS lead to bigger steps toward suffering cessation, both as a counsellor and as a client.

Disclosure statement

No potential conflict of interest was reported by the authors.

Funding

This paper was funded by The 100th Anniversary Chulalongkorn University for Doctoral Scholarship Fund and the 90th Anniversary of Chulalongkorn University Fund (Ratchadaphiseksomphot Endow- ment Fund).

ORCID

Tanaphong Uthayaratana http://orcid.org/0000-0002-6660-9084

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MENTAL HEALTH, RELIGION & CULTURE 129

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Abstract
Western problem solving
Theravada Buddhist problem solving
A case illustration of Tom
Western problem solving and its application to Tom’s case
Four noble truths based problem solving (FNTBPS) and its application to Tom
The practice of FNTBPS
Using FNTBPS within the counselling context
Disclosure statement
ORCID
References