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455 Cards in this Set

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Strategic Therapy - Key Theorists
Jay Haley and Cloe Madanes
Strategic Therapy
Strategic Therapy - Key Concepts
Symptoms Serve a Purpose
Hierarchy
Family Development
Communication and Control
Love and Violence
Strategic Therapy
Strategic Therapy - Goals
Interrupt the covert hierarchical structure and covert alliances

Change the style of interaction in the social unit
Strategic Therapy
Strategic Therapy - Structure of Therapy
Highly structured initial session divided into 4 states - social, problem, interaction, and goal-setting
Strategic Therapy
Strategic Therapy - Assessment
Conceptualizing the Problem:
Voluntary vs Involuntary
Helplessness vs Power
Metaphorical Meaning vs Literal Meaning
Hierarchy vs Equality
Personal Gain vs Altruism
Strategic Therapy
Strategic Therapy - Techniques
Directives
Metaphoric Task
Paradoxical Injunction
Ordeal Therapy
Pretend Techniques
Restraining and Going Slow
Positioning
Strategic Therapy
Hierarchy
Strategic Therapy
The natural organization and distribution of power within any organizational system -- or --
repetitive sequences of who tells whom what to do
Strategic Therapy
Family Life Cycle States
Strategic Therapy
1. Courtship Period
2. Marriage
3. Childbirth and young children
4. Middle Marriage
5. Weaning parents from children
6. Retirement and old age
Strategic Therapy
Family problems develop around four basic intentions according to Madanes
1. To dominate and control
2. To be loved
3. To love and protect others
4. To repent and forgive
Strategic Therapy
Social State
Therapist observes family interaction, mood, relationship dynamics, and organization of the family members
Strategic Therapy
Problem Stage
Therapist gathers information about the problem situation
Strategic Therapy
Interaction Stage
Family discussion about the problem, providing therapist with opportunity to observe communication patterns, organization, and power hierarchies
Strategic Therapy
Goal-Setting Stage
* Conclusion of initial session
* highlight and clarify problem situation while addressing therapeutic goals and precisely defining the presenting problem
* problem defined in "operational" terms
Strategic Therapy
Directives
Assignments to be performed inside and outside of the therapeutic session; key intervention for SFT
Strategic Therapy
Metaphoric Task
A statement or activity that represents or resembles something else
Strategic Therapy
Paradoxical Injunction
Directive or extended message that is apparently inconsistent with itself or with the purpose of therapy; prescribing the symptom changes the behavior from a spontaneous act to a conscious act
Strategic Therapy
4 Basic types of Paradoxical Injunction
*Compliance-based
*Defiance-based
*Exposure-based
*Control-based
Strategic Therapy
Compliance-Based Paradoxical Injunction
Hoping for compliance, i.e. instruct a worrier to worry for set period each day
Strategic Therapy
Defiance-Based Paradoxical Injunction
Hoping for defiance, i.e. ineffective parents are instructed to ask permission from child before setting rules
Strategic Therapy
Exposure-Based Paradoxical Injunction
Revealing covert alliances, i.e. father gives daughter a quarter each time she defies mother in situation where father and daughter have coalition against mother
Strategic Therapy
Control-Based Paradoxical Injunction
Aims at Gaining control of behavior, i.e. Instruct couple to argue for 20 minutes each day to gain more awareness of how they start and stop an argument
Strategic Therapy
Ordeal Therapy
Assist in alleviating the symptom by making it more trouble to maintain the symptom than to give it up
Strategic Therapy
Pretend Techniques
Techniques that (a) allow the system to maintain homeostasis without the person genuinely suffering from the symptom, (b) often have a paradoxical effect of highlighting the control one actually has over the symptom, and (c) serve to disrupt problem patterns in the family
Strategic Therapy
Positioning
Therapist addresses resistance by exaggerating it to hopelessness and the illusion of no alternatives. Serves to encourage the client family to prove to the therapist that they are as good as other people
Strategic Therapy
Structural Family Therapy - Key Theorists
Aponte, Fishman, Minuchin, Montalvo
Structural Family Therapy
Structural Family Therapy - View of Families
Views the family as a system structured according to set patterns and rules that govern family interactions
Structural Family Therapy
Structural Family Therapy - Structure/Subsystems
Family is composed of multiple subsystems that function within the whole; therapist looks at the family as more than an aggregate of differentiated subsystems and considers it as an organism in itself
Structural Family Therapy
Structural Family Therapy - Focus of Treatment
therapist must be aware of other relevant data and systemic processes that may be affecting the situation, not just the identified presenting problem by the patient
Structural Family Therapy
Diffuse Boundaries
Lead to Enmeshment
Structural Family Therapy
Rigid Boundaries
Lead to disengagement
Structural Family Therapy
Covert Coalition
members establish a destructive coalition, which serves as a source of conflict
Structural Family Therapy
Subsystems
individual, spousal, parental, sibling, etc
Structural Family Therapy
In Structural Family Therapy, Family Structure is influenced by...
cultural norms
interactional patterns
family history
intergenerational rules
Structural Family Therapy
In Structural Family Therapy, the therapist works with the family by educating and assisting them to become aware of ....
structure, boundaries, patterns, rules, and detrimental familial processes
Structural Family Therapy
Structural Family Therapy Goals
Obtain assurance that the structural process will provide benefits for the entire family
Structural Family Therapy
Structural Family Therapy - Goals
Alter the dysfunctional structure to promote problem solving and facilitate growth of the system and to resolve symptoms
Structural Family Therapy
In Structural Family Therapy, restructured family systems include:
generational hierarchy, parental coalition, spousal subsystem, and clear boundaries between all individuals and subsystems
Structural Family Therapy
Structural Family Therapy - Results in....
Subsystems are restructured and reorganized to eliminate the presenting complaint
Structural Family Therapy
Structure of Structural Family Therapy (3 Phases)
(a) joining and accommodating
(b) mapping family structure
(c) intervening
Structural Family Therapy
Joining & Accommodating
therapist enters the family system in a hierarchical stance as the "leader"
Structural Family Therapy
Family Map
% Structural Family Therapy %

a static entity that identifies each family member's position in the family while highlighting interaction patterns, conflicts and coalitions

Through the process of family mapping, the therapist devises an initial hypothesis, compiles diagnostic information, and begins intitial goal setting procedures
Structural Family Therapy
Intervening
% Structural Family Therapy %

Therapists uses techniques that strengthen and clarify structure and boundaries
Structural Family Therapy
Structural Family Therapy Assessment of Systems Structure Includes:
boundaries
complementarity
hierarchy
conflict management
Structural Family Therapy
Boundaries in Structural Family Therapy are ...
Clear
Diffuse
or
Rigid
Structural Family Therapy
Complementarity Problems in Structural Family Therapy are ...
pursuer-distancer
active-passiv
dominant-submissive
Structural Family Therapy
Hierarchy in Structural Family Therapy is ...
determined and maintained by the systems rules, boundaries and interactional patterns; refers to the arrangement and structural delineation of power within the system
Structural Family Therapy
Conflict Management in Structural Family Therapy is ...
The system's ability to resolve conflict and negotiate solutions.

Disengaged families - members avoid contact to avoid conflict
Enmeshed families - cross-generational coalitions develop to manage conflict
Structural Family Therapy
Spontaneous Behavioral Sequences
Similar to enactments, except behaviors are spontaneous rather than directed by the therapist
Structural Family Therapy
Challenging Family Assumptions
Discover the family's narrowed perception of reality and challenge their reality be educating them on appropriate family structure
Structural Family Therapy
Challenging the Symptom
Challenging the family structure, and challenging the family reality
Structural Family Therapy
Reframing
Enacting, focusing, and intensity
Structural Family Therapy
Affective Intensity
"When did you divorce your husband and marry your son"?
Structural Family Therapy
Shaping Competence
Highlighting the positive, strengths, and progress
Structural Family Therapy
Boundary making
Done by physically or verbally intervening, altering spatial proximity, or recognizing and highlighting inappropriate boundaries
Structural Family Therapy
Unbalancing
* Broadening the focus
* involves temporarily taking sides to change family interaction
* by expanding the problem beyond the family focus the therapist raises hope that a different way of looking at the problem will bring a solution
Structural Family Therapy
Structural Family Therapy - Techniques
Joining
Planning
Family Mapping
Enactments
Structural Family Therapy
Joining
* more an attitude than a technique
* therapist tracks interaction and communication, adapts and accommodates to their style, rules, and patterns
* joining involves mimesis which includes using, matching, and acknowledging the system's metaphors and themes
Structural Family Therapy
Planning
* therapist theorizes about the family structure while remaining curious about is structural reality
* Initial hypothesis is tested in joining with the family and observing the structure and then is altered or discarded.
Structural Family Therapy
Family Mapping
Constructed through observations and interactions with the family
Structural Family Therapy
Family Mapping - 6 Areas to Assess For when observing Interaction
1. family structure and transactional patterns
2. Flexibility and the ability to restructure
3. Resonance (sensitivity to the individual members' actions)
4. Family life context (support and stress)
5. Family life developmental stage
6. Ways the problem issue is maintained through family interactions
Structural Family Therapy
3 Components of Enactments
1. recognize sequences by observing the spontaneous transactions of the family and decides which dysfunctional areas to highlight
2. directs the enactment by directly aksing to family to reenact a specific problem conversation or event
3. directly intervenes and redirects the interactions
Structural Family Therapy
Milanic Systemic Approach - Key Theorists
Boscolo
Cecchin
Palazzoli
Prata
Hoffman
Tomm
Penn
Milanic Systemic Approach
Milanic Systemic Approach - History
Attempted to put into practice the systemic ideas of Gregory Bateson, viewing family interaction as a set of rules the is best intervened upon with paradox
Milanic Systemic Approach
Milanic Systemic Approach - Key Concepts
*Epistemology and Epistemological Error
*Games
*Meaning Versus Action
*Tyranny of Linguistics
Milanic Systemic Approach
Epistemology
Study of knowledge and knowing
Milanic Systemic Approach
Epistemological Errors
Erroneous set of beliefs or distinctions that an individual or family uses to make sense of the world (i.e. one individual's behavior can be the "cause" of another's behavior)
Milanic Systemic Approach
Games
Unacknowledged strategies and destructive patterns of family interaction in which members attempt to control each other's behavior.
Milanic Systemic Approach
Meaning Versus Action
Therapist distinguishes between meaning and action to help correct epistemological errors
Milanic Systemic Approach
Tyranny of Linguistics
The therapist uses language to create new interpretations of the situation (i.e. he shows depression, acts depressed, or appears to be depressed, rather than he is depressed)
Milanic Systemic Approach
Milan Systemic Approach - Goals of Therapy
Focus of Treatment - New Meaning
* focus on providing new meanings and distinctions that will alter unproductive rules for family behavior and the family game
Milanic Systemic Approach
Milan Systemic Approach - Structure of Therapy
* Long-Term Brief Therapy
* highly structured
* relatively few sessions (generally 10) are held approximately once a month
* time between sessions is required for interventions to take effect
Milanic Systemic Approach
Milan Systemic Approach - Five Segments of Therapy Session
Pre-session
Session
Intervention
Intersession
Intervention
Discussion
Milanic Systemic Approach
Milan Systemic Approach - Techniques
A Learning Process
Team Approach
Hypothesizing
Circular Questioning
Neutrality
Positive Connotation
Counterparadox
Rituals
Invariant Prescription
Milanic Systemic Approach
A Learning Process Technique
Through the process of trial and error and the resulting feedback, additional information is acquired and used to formulate new interventions
Milanic Systemic Approach
Team Approach Technique
1 or 2 of the team members work directly with the family and the others watch behind a one-way mirror; results in a collective mind that is self-correcting
Milanic Systemic Approach
Hypothesizing (Technique)
therapist continually develops hypothesis about family interaction patterns and games and modifies them as the family presents additional information
Milanic Systemic Approach
Circular Questioning
Serve to highlight systemic interaction patterns in the family; focus on specific behaviors rather than feelings or interpretations
Milanic Systemic Approach
Types of Circular Questioning
Relational and interaction pattern questions ("What does your father do when you argue with your mother')
Future oriented questions ("If your mother stopped worrying, what would your father do")
Comparisons and Rankings Questions ("Who gets the most upset when you fail")
Before and after change questions ("What were the fights like before versus after father's heart attack")
Milanic Systemic Approach
Relational and Interaction Pattern Questions (Circular)
"What does your father do when you argue with your mother"
Milanic Systemic Approach
Future-oriented questions (Circular)
"If your mother stopped worrying, what would your father do"
Milanic Systemic Approach
Comparisons and Ranking questions (Circular)
"Who gets most upset when you fail"
Milanic Systemic Approach
Before and After Change Questions (Circular)
"What were the fights like before versus after father's heart attack"
Milanic Systemic Approach
Neutrality Technique
Therapist remains allied with all family members and avoids involvement in family coalitions. Milan therapists maintain a strictly neutral manner and attempt to avoid blaming anyone for anything
Milanic Systemic Approach
Positive Connotation (Technique)
Symptomatic behavior is reframed with a positive connotation.
Assist in establishing that all family members are on the same level, highlights the system's homeostatic tendency, and prepares the way for the paradox
Milanic Systemic Approach
Counterparadox (Technique)
Request that the family not change although they came to therapy in order to change, referring to the dysfunction as "right and legitimate"
Milanic Systemic Approach
Rituals (Technique)
Assigned as an intervention that helps provide clarity and consistency in family relationships; highly structured events that are prescribed by the team
Milanic Systemic Approach
Invariant Prescription (Technique)
The prescription requires that the parents forma tight alliance and reestablish their relationship as a couple by having them engage in activities that are kept secret from the children; consists of 4 parts
Milanic Systemic Approach
4 Parts of Invariant Prescription (Technique)
1. Therapist directs the parental unit to maintain a sense of secrecy about the therapy session to which the children are not invited
2. Parental unit is told to go on secret outings
3. Maintaining secrecy from the children even when asked about the outings
4. Directs parental unit to keep a personal diary or notebook that will contain a record of every piece of verbal or nonverbal behavior from children and others that may have resulted from the prescription.
Milanic Systemic Approach
Mental Research Institute Approach (MRI) - Key Theorists
Theoretical Background:
Bateson
Erickson
von Foerster

Clinical Application
Risch
Jackson
Watzlawick
Weakland
Mental Research Institute Approach (MRI)
MRI founding director
Don Jackson
Mental Research Institute Approach (MRI)
MRI - Key Concepts
Problem
The Interactional View
The Problem is the Attempted Solution
More of the Same
First and Second order Change
Communication
Report and Command Functions
Metacommunication
Double Bind
Symmetrical and Complementary Relationships
Mental Research Institute Approach (MRI)
MRI - Problem (Key Concept)
Persistent failed attempts to change some distress; created and maintained through the mishandling of difficulties
Mental Research Institute Approach (MRI)
MRI - Interactional View (Key Concept)
Therapist focuses on current behavioral patterns and sequences
Mental Research Institute Approach (MRI)
MRI - The Problem is the Attempted Solution (Key Concept)
Problems arise and are maintained as the result of:
1. mistaken attempts at changing an existing difficulty
2. Initiating changes when they are not necessary
3. Not taking action when change is necessary, and/or
4. Making changes at the wrong level
Mental Research Institute Approach (MRI)
MRI - More of the same (Key Concept)
Therapist focuses on reversing the "more of the same" solutions
Mental Research Institute Approach (MRI)
MRI - First Order Change (Key Concept)
A change in the system's interactional patterns; occurs when the system itself remains unchanged
Mental Research Institute Approach (MRI)
MRI - Second Order Change (Key Concept)
Requires change in the organization of the system and is characterized by a change in the client's perspective and assumptions, a change in the system, and is referred to as "change of change"
Mental Research Institute Approach (MRI)
MRI - Communication (Key Concept)
* All behavior is communication at some level
* MRI therapists closely observe the various levels of communication between people and identify how these patterns contribute to the maintenance of problems
Mental Research Institute Approach (MRI)
MRI - Report and Command Functions (Key Concept)
Every communication has 2 aspects: report (content) and command (relationship). Report = literal message and Command = action that cues the message recipient on how to interpret the message and thereby defines the present relationship.
Mental Research Institute Approach (MRI)
MRI - Metacommunication (Key Concept)
Refers to the command aspect (or action or behavior) of communication; it is the communication about the communication. Includes non-verbal clues
Mental Research Institute Approach (MRI)
MRI - Double Bind (Key Concept)
Destructive form of paradoxical communication.
Examples of double bind messages: "be spontaneous", "love me". Therapist intervenes upon double binds by addressing the metacommunication.
Mental Research Institute Approach (MRI)
MRI - Symmetrical and Complementary Relationships (Key Concept)
symmetrical interactions - participants mirror each other's behavior
complementary interactions - one person assumes a position and the other assumes the opposite position.
Symmetrical relationships risk becoming competitive, while complementary relationships can become oppressive. Therapist assesses for extremes in either form of relationship
Mental Research Institute Approach (MRI)
MRI - Goals of Therapy
Focus on interrupting attempted solutions that are maintaining the problem;
Break the operationalized goals into small, concrete steps to help the family achieve a sense of confidence and progress as early as possible. Therapists asks "at a minimum, what change would indicate to you that a definite step forward has been made?"
Mental Research Institute Approach (MRI)
MRI - 5 questions in Case Planning
1. What is (are) the attempted solutions? What command (metacommunication) is common to the solution used bye the client? What are the minefields to avoid?
2. What would be a 180-degree shift from the attempted solution
3. What specific behavior would operationalize this shift?
4. Given the family's position, how can the therapist "sell" the behavior?
5. What might the client report that would signal that the intervention has been successful and the case is ready for termination?
Mental Research Institute Approach (MRI)
MRI - Structure of Therapy (4 stages)
1. Identify and explore the problem
2. Identify attempted solutions and the results of such solutions
3. Formulate a concrete goal
4. Intervene utilizing MRI techniques and the client's language
Mental Research Institute Approach (MRI)
MRI - Assessment (4 step procedure)
1. Define the problem and identify how it is a problem
2. Determine which solutions have been tried and identify the outcome of such attempts
3. Obtain a clear description of the concrete change to be achieved
4. Formulate and implement a plan to produce change
Mental Research Institute Approach (MRI)
MRI - 4 Ways Solutions can be Mishandled
1. Attempting to be deliberately spontaneous
2. Seeking a no-risk method when some risk is inevitable
3. Attempting to reach interpersonal accord through opposition
4. Confirming the accuser's suspicions by defending onself
Mental Research Institute Approach (MRI)
MRI - Techniques
Initial Interview questions
Reframing
Prescribing the Symptom
Relabeling
Dangers of Improvement "Go Slow"
Making the Covert Overt
Advertising Rather than Concealing the Problem
Bellac Ploy
Mental Research Institute Approach (MRI)
Initial Interview Questions (Technique)
1. What is the problem that brings you here today
2. How is it a problem
3. What does it stop you from doing or make you do that you do not want to do?
Mental Research Institute Approach (MRI)
Reframing (Technique)
Change the conceptual and/or emotional setting or viewpoint in relation to which a situation is experienced and place it in another frame which fits the facts of the same concrete situation equally well or even better, thereby changing its entire meaning.
Mental Research Institute Approach (MRI)
Reframing (Technique)
Emphasize the importance of using the client's language when reframing the problem for the reframe to have significance to the client
Mental Research Institute Approach (MRI)
Prescribing the Symptom (Technique)
Therapeutic double bind - therapist encourages the client to engage in symptomatic behavior. Engaging consciously in previously spontaneous behavior renders resistance unnecessary.
Mental Research Institute Approach (MRI)
Relabeling (Technique)
"withdrawal" = needing personal space or needing time to think. The situation does not change, but the meaning attributed to it changes
Mental Research Institute Approach (MRI)
Dangers of Improvement "go slow" (Technique)
Clients are paradoxically instructed to "go slow" so that assignments are carried out carefully.
Mental Research Institute Approach (MRI)
Making the Covert Overt (Technique)
Therapist prescribes behaviors in such a way that covert processes are highlighted.
Mental Research Institute Approach (MRI)
Advertising Rather than Concealing the Problem (Technique)
Have the client advertise a socially inhibiting or embarrassing handicap, which has the paradoxical effect of reducing anxiety
Mental Research Institute Approach (MRI)
Bellac Ploy (Technique)
Complimenting another with the paradoxical result of making that person so (i.e. complimenting a stranger about his/her kindness, that person is more likely to act in that way)
Mental Research Institute Approach (MRI)
Communications Approach - Key Theorists
Banmen
Gerber
Gomori
Satir
Communications Approach
Communications Approach - History
Satir argued that the power of warmth and love was essential in therapy
Communications Approach
Communications Approach - Key Concepts
Four Primary Assumptions
Primary Survival Triad
Body, Mind, and Feelings
Communication
Self-Worth
Survival Stances
Communications Approach
4 Primary Assumptions (Key Concept)
1. People naturally tend toward positive growth
2. All people possess the resources for positive growth
3. Every person and every thing or situation impact and are impacted by everyone and everything else
4. Therapy is a process which involves interaction between therapist and client and in this relationship each person is responsible for him/herself
Communications Approach
Primary Survival Triad (Key Concept)
Consists of the child and both parents. Has a significant impact on both self-worth and survival stances
Communications Approach
Body, Mind, and Feelings (Key Concept)
Methods of communication and form the second triad in Satir's theory.
Communications Approach
Communication (Key Concept)
All forms of behavior are considered communication. Discrepancies between verbal and non verbal cues contribute to interpersonal dysfunction and are referred to as "incongruent communication".
Communications Approach
Self-Worth (Key Concept)
Satir's approach strives to acknowledge and validate each person's inherent worth
Communications Approach
Survival Stances (Key Concept)
People adopt survival stances to protect their self-worth against verbal and nonverbal, perceived and presumed threats.
Communications Approach
5 Survival Stances (Key Concept)
Placater (say yes to everything, disregard our own feelings of worth)
Blamer (blaming stance to ward of perceived threat)
Superreasonable (computerlike, rigid, devoid of feelings)
Irrelevant (reflects unrelated and distracting behaviors)
Congruence (words and feelings match)
Communications Approach
Communications Approach - Goals of Therapy
Focus is on growth at the individual and systemic levels based on the assumption that growth will result in symptom reduction.
Communications Approach
Communications Approach - 3 Goals for Improved Communication in the Family System
1. Congruence
2. High Self-Esteem
3. Personal growth
Communications Approach
Communications Approach - Structure of Therapy (6 Stages)
1. Status Quo
2. Introduction of a Foreign Element
3. Chaos
4. New Possibilities/New Options and Integration
5. Practice/Implementation
6. Goal Attainment/The New Status Quo
Communications Approach
Communications Approach - Assessment
Assessment of (a) family system's symptomatic behavior, (b) communication patterns and stances, and (c) the influence and exploration of family of origin issues
Communications Approach
Communications Approach - Symptomatic Behavior
Serves as the system's homeostatic mechanism and attempts to maintain homeostasis or the status quo
Communications Approach
Communications Approach - Communication and Survival Stances
Exploration of the family's congruent/incongruent communication patterns and each person's survival stance
Communications Approach
Communications Approach - Family of Origin
Reviews and assesses family of origin issues for a better understanding of the current situation and may create a family life fact chronology to record information
Communications Approach
Communications Approach - Techniques
Role of Therapist
Modeling Communication
Family Life Fact Chronology
Family Sculpting
Metaphors
Self-Mandala
Parts Party
Ingredients Intervention
Transforming Rules
Temperature Reading
Family Reconstruction
Communications Approach
Role of Therapist (Technique)
The therapist is an equal, unique individual whose role is to assist in the process of facilitating change; therapist is a "change agent"
Communications Approach
Modeling Communication (Technique)
Therapist models congruent communication by following 3 guidelines:
1. Must speak in the first person by communicating and responding with "i" messages
2. Must express thoughts and feelings directly while avoiding statements or declarations about what others may think or feel
3. Must be honest with others
Communications Approach
Family Life Fact Chronology (Technique)
Depicts important events in the life of the family; charting technique that involves 3 complete generations of the family system; used as preparation for family sculpting and family reconstruction
Communications Approach
Family Sculpting (Technique)
Clients and/or therapist physically place family in a position that symbolizes their role in the family system (from the sculpter's perception)
Communications Approach
Metaphors (Technique)
Metaphors are powerful tools for promoting change; used to communicate ideas that language cannot directly describe or to introduce threatening material
Communications Approach
Self Mandala (Technique)
Consists of an innermost circle with the phrase "I am" and eight concentric circles arranged in the following order: physical, intellectual, emotional, sensual, interactional, nutritional, contextual, and spiritual; used to discuss clients strengths, resources, and challenges
Communications Approach
Parts Party (Technique)
Identifies, transforms, and integrates inner resources and assists in the process of identifying and acknowledging one's wholeness and parts
Communications Approach
Ingredients Intervention (Technique)
6 questions increase awareness and address exploration of one's interaction with others:
1. What do i hear and see?
2. What meaning do I make of what I hear and see?
3. What feelings do I have about the meaning I make?
4. What feelings do I have about these feelings?
5. What defenses do I use
6. What rules for commenting do I use?
Communications Approach
Transforming Rules (Technique)
3 steps involved in transforming a rule into a more functional guideline:
1. Change the should to a can
2. Expand from never to sometimes
3. Identify possibilities of I can
Communications Approach
Temperature Reading (Technique)
Client and/or family share specific information about:
*Appreciations and Excitements
*Worries, Concerns, and Puzzlements
* Complaints and Possible Solutions
* New Information
* Hopes and Wishes
Communications Approach
Family Reconstruction (Technique)
Implemented in a large group setting that takes several hours to complete. Phase 1, family shares its life story, followed by:
* Sculpting the family of origin
* Sculpting mother and father's family of origin
* Sculpting Parents' Meeting and Marriage
* Resculpting the family of origin
Communications Approach
Panic Disorder
At least 2 panic attacks in order to be considered panic disorder
Parasomnias
Abnormal behaviors during sleep
Genital State
Freud: final stage of psychosexual development
Cyclothymic disorder
Long-term depressed mood alternating with mood elevation (less severe than major depressive or manic episode)
Conduct Disorder
Cruelty to animals, lying and arson
Autism
Pervasive development disorder that includes social impairment, communication impairment and limited range of interests
Erickson
Ego psychology: development of ego identity, 8 stages of development (theoretical background development of MRI)
Alzheimer's disease
Most Common type of dementia
Displacement
Unacceptable emotions are redirected from dangerous objects or safer ones with this defense mechanism
Dissociative fugue
Loss of memory and identity confusion accompanied by sudden travel away from home
Hallucinations
Things are sensed (seen, heard, felt, smelled, tasted) that are not present; a psychotic symptom; auditory hallucinations are most common
Client-centered therapy
Empathy, unconditional positive regard and genuineness are needed
DSM-IV axes
Five of them
Classical conditioning
According to Pavlov, a behavior is learned when a stimulus is paired with an unconditioned stimulus to bring about a conditioned response
Anhedonia
Inability to feel pleasure
Types of panic attacks
Unexpected, situationally bound, and situationally predisposed
Collective unconscious
Carl Jung theorized that humanity has an understanding of human history through this
Alfred Adler
Individual psychology: overcoming feelings of inferiority, developing social interest.
Magnitude
Strength of correlation, expressed as a numerical value of "r"
Dependent personality disorder
People want to find others to take care of them, tendency to be compliant, passive, and irresponsible; fearful of abandonment; do not like to be alone.
Examples of depressants
Sedatives (barbiturates and benzodiazepines), alcohol
Treatments for delirium
Treat medical conditions, benzodiazepines for drug withdrawal, psychosocial treatments
Effects of long-term alcohol abuse
Anxiety, hallucinations, insomnia, hand tremors, vomiting, delirium
Informal or emergency civil commitment
Two doctors can sign a commitment order for a short length of time (24 hours to 20 days)
Schizoid personality disorder
Prefer to be alone, low levels of emotion
Agoraphobia
Anxiety about being somewhere from which escape is difficult or embarrassing, sometimes in regard to a panic attack
Schizophreniform disorder
Schizophrenic symptoms have duration of less than 6 months
Obsessive-Compulsive personality disorder
Perfectionistic, controlling, excessively orderly
Effects of Alcohol Use
Neurotransmitter systems are affected, loss of inhibitions, motor coordination impaired, speech impaired, decision-making impaired, blackouts, seizures, hallucinations
Sleepwalking disorder
Complex motor behavior during sleep
Reaction formation
"Wrong" feelings are converted into their opposites with this defense mechanism
Alzheimer's disease
Onset is gradual, damage is irreversible, memory loss, inability to learn new information
Axis IV
Environmental and psychosocial problems (DSM-IV)
Control group
Independent variable is not manipulated in this group
Systematic desensitization
Form of counterconditioning developed by Wolpe
Depersonalization disorder
Reoccurring episodes of depersonalization, such as feeling like a robot or living in a dream
Catatonic schizophrenia
Motor disturbances
Operant conditioning
Skinner: Reinforcers and punishments will affect the learning of behaviors and their maintenance
Affect
Displayed emotions
Generalized Anxiety Disorder
Chronic anxiety and worry for at least six months
Agnosia
A symptom of dementia in which an individual cannot name or recognize objects
Acute pain disorder
Pain has lasted less than 6 months
Effects of nicotine
Dependence, withdrawal, cancer, heart disease, high blood pressure, confusion and convulsions (high doses)
Counterconditioning
Stimulus response is replaced by another response
Moral Anxiety
Guilt and shame that results from immoral behavior
REBT
Rational Emotive Behavior Therapy (Ellis)
Sensorium
Awareness of the environment
Validity
Test measures what it says it measures
Omen formation
Belief that disturbing events may be foretold
CS
Conditioned stimulus is a neutral stimulus that is paired with an unconditioned stimulus (Example: Pavlov's bell)
Etiology of dementia
Substance abuse or medical conditions (examples are Huntington's disease or Alzheimer's disease)
How amphetamines work
Increase norepinephrine and dopamine activity in the body
Statistical significance
Probability that a relationship happened by chance
Opiate withdrawal symptoms
Nausea, diarrhea, muscle pain, insomnia; may last a week
Dependent variable
Variable measured in an experiment
Research
Obsessive-Compulsive Disorder and insight
Individual who has OCD realizes the irrationality and excessiveness of the obsessions/compulsions
DSM-IV-TR
Common OCD obsessions
Contamination, sexual, aggressive, bodily complaints, order, perfection
DSM-IV-TR
Negative symptoms of schizophrenia
Behavior deficiencie, including speech deficits, flat affect, motivational deficits
DSM-IV-TR
Independent variable
Manipulated in an experiment
Non-purging
Bulimics who fast or exercise and do not regularly purge
DSM-IV-TR
Moderate mental retardation
IQ is 40-55, 10% of mentally retarded population
DSM-IV-TR
Pedophilia
Sexual arousal in regard to children
DSM-IV-TR
Situational sexual dysfunction
Dysfunction that occurs at certain times, places or with certain partners
DSM-IV-TR
Latent content of dreams
Unconscious desires that are masked by symbols in dreams
Developmental coordination disorder
Motor skills disorder
Significantly interferes with academic achievement or activities of daily living
* Manifested in marked delays in achieving motor milestones, dropping things, clumsiness, poor performance in sports, or poor handwriting
DSM-IV-TR
Symptoms of low sexual desire
Infrequent masturbation or sexual relations, few sexual fantasies
Scientific statements
Testable, based on observations, linked to measurable outcomes
Research
Anorexia nervosa, restricting type
Restricts amount of food, exercises, does not binge
DSM-IV-TR
Psychoanalytic therapy
Resolving childhood conflicts and removing repression
Treatments for sexual dysfunction
Education, alleviation of performance anxiety
UCR
Unconditioned response that is naturally produced by a stimulus (example: salivation of Pavlov's dogs in response to meat)
Conversion symptoms
May include paralysis, blindness, hallucinations, deafness, seizures, among others; a neurological condition is suggested
Histrionic personality disorder
Attention-seeking, excessive emotionality, easily influenced; may be inappropriately sexual and vague in speech
DSM-IV-TR
Social learning theory
Bandura theorized that we learn by watching and imitating people
Cognitive-Behavioral Therapy
Rett's disorder
Pervasive developmental disorder that appears after the first 5 months of normal development and before 48 months.
DSM-IV-TR
Insanity defense
Not usually successful; used in about 2% of trials
Dyssomnias
Sleep disorders that include:
* Primary Hypersomnia
* Narcolepsy
* Breathing-Related Sleep Disorder
* Circadian Rhythm Sleep Disorder
DSM-IV-TR
Gestalt therapy
Insight therapy that holds the view that people are basically good, emphasizes our needs and wants, unfinished business, personal responsibility (Perls)
Symbolic/Experiential Therapy Approach
Projection
Unacceptable desires are attributed to other people as a defense mechanism
Insanity defense
Not usually successful; used in about 2% of trials
Substance dependence
Addiction: increased tolerance, history of relapses, withdrawal symptoms, much energy used in procuring and recovering from substances
Projection
Unacceptable desires are attributed to other people as a defense mechanism
Substance dependence
Addiction: increased tolerance, history of relapses, withdrawal symptoms, much energy used in procuring and recovering from substances
Disorganized speech in schizophrenia
Incoherent, illogical, loose associations
DSM-IV-TR
Speech and cognition
Cognition judged by content, rate, and continuity of speech
Sexual masochism
Pain or humiliation causes sexual arousal; a paraphilia
DSM-IV-TR
Cognitive-Behavioral Therapy
Learning, storing and retrieving information; structuring experiences; techniques include cognitive restructuring, modeling, and counterconditioning
Cognitive-Behavioral Therapy
Natural environment type of phobia
Childhood onset, fear of natural disasters and the environment
DSM-IV-TR
Depersonalization
Feelings of detachment from self
Genuineness
Therapist honestly communicates emotions and experiences
Biopsychosocial approach
Psychopathology is caused by biological, psychological and social factors
Sleep terror disorder
Waking up from sleep and feeling intense fear, individual has limited memory of the event
DSM-IV-TR
Oedipus complex
Child in the phallic stage sexually desires opposite-sex parent and fears same-sex parent. The fear is ameliorated by identification with same-sex parent.
Hallucinations
Things are sensed (seen, heard, felt, smelled, tasted) that are not present; a psychotic symptom; auditory hallucinations are most common
Victims of incest
Most likely victims are daughters
Facial agnosia
Inability to recognize familiar people
DSM-IV-TR
Axis I
All mental disorders, except developmental disorders and personality disorders (DSM-IV)
Schizophrenia, residual subtype
Major symptoms have subsided
Hallucinations
Things are sensed (seen, heard, felt, smelled, tasted) that are not present; a psychotic symptom; auditory hallucinations are most common
Victims of incest
Most likely victims are daughters
Facial agnosia
Inability to recognize familiar people
DSM-IV-TR
Axis I
All mental disorders, except developmental disorders and personality disorders (DSM-IV)
DSM-IV-TR
Schizophrenia, residual subtype
Major symptoms have subsided
DSM-IV-TR
Paraphilias
Disorders in which sexual arousal is inappropriately caused: voyeurism, exhibitionism, fetishism, sexual sadism, sexual masochism, pedophilia
Etiology of GAD
Individuals appear to be more aware of threats at an unconscious level
Insight therapy
Helps people understand their motivations
Individual psychology
Alfred Adler's model of psychology in which people struggle against feelings of inferiority and develop social interest
Panic attacks
Period of intense fear that includes at least 4 out of 13 symptoms listed in DSM-IV Derealization Feelings of unreality
DSM-IV-TR
Transvestites
Achieve sexual arousal by wearing clothes of the opposite gender
DSM-IV-TR
Secondary process thinking
Ego uses it to plan and make decisions
Bulimia nervosa symptoms
Binge eating, compensatory behaviors to prevent weight gain; self-esteem depends on body weight and shape
DSM-IV-TR
Manic episode
At least 1 week; symptoms may include hyperactivity, flight of ideas, elevated mood, inflated self-esteem, decreased need for sleep
DSM-IV-TR
Medical model
Abnormal behavior is diagnosed as a disease
Childhood disintegrative disorder
Regression appears after 2 years of normal functioning and before 10 years
DSM-IV-TR
Onset of social phobia
Usually in mid-adolescence
DSM-IV-TR
Standardization
Similar procedures are used each time test is administered
Research
Unconditional positive regard
Client is treated with dignity and respect
Obsessive-Compulsive Disorder and insight
Individual who has OCD realizes the irrationality and excessiveness of the obsessions/compulsions
DSM-IV-TR
Conduct disorders
Infringes on the rights of others and/or break social rules
DSM-IV-TR
Erikson
Development of ego identity
Axis V
Global adaptive functioning (DSM-IV)
DSM-IV-TR
Projection
Unacceptable desires are attributed to other people as a defense mechanism
Fixation
Freud: Stuck at a stage of development
Insomnia
Problem of not getting enough sleep
Empathy
Understanding the perspective of clients
Disorganized speech in schizophrenia
Incoherent, illogical, loose associations
DSM-IV-TR
Hypochondriasis
Fear of having a serious disease, the fear often becoming an important part of the individual's self-concept; no medical basis found
DSM-IV-TR
Treatments for mood disorders
Medications, ECT, cognitive therapy, interpersonal therapy
ECT
Electroconvulsive therapy in which seizures are produced by sending electrical impulses through the brain
Antisocial personality disorder
"Psychopathy" or "sociopathy"; disregard for the rights of others; tendency to be aggressive, dishonest, impulsive, irresponsible and unlawful
DSM-IV-TR
Chronic sexual dysfunctions
"Lifetime" dysfunctions, not starting after a period of normality
DSM-IV-TR
Examples of opiates
Opium, heroin, morphine, codeine, methadone
Dissociative Identity Disorder
Identities or personality states (alters) in an individual, formerly known as multiple personality disorder
DSM-IV-TR
ECT
Electroconvulsive therapy in which seizures are produced by sending electrical impulses through the brain
Korsakoff syndrome
Alcohol abuse or vascular illnes causes brain (thalamus) damage that results in amnestic disorder
Kleine-Levin Syndrome
Individuals may sleep 18-20 hours
Rational-emotive therapy
Clients substitute rational thoughts for irrational thoughts
Learning disorders
Reading disorder, disorder of written expression, mathematics disorder
DSM-IV-TR
Jung
Founder of analytical psychology; libido as general life energy, collective unconscious, spiritual needs, masculine and feminine traits in each person, personality traits, self-actualization)
Obsessions
Thoughts and urges that are irrational or intrusive
Patterson and antisocial behaviors
Patterson theorized that they were caused by lack of parental monitoring, failure to teach social and academic skills, and inconsistent parenting
DSM-IV-TR
Dissociative amnesia
Inability to remember important personal information, reversible, may follow stressful events
DSM-IV-TR
Effects of depressants
Central nervous system slows down; person feels calmer
Prevalence of Alzheimer's disease
In the U.S., approximately 4 million, most are 60 years old and older
Polysubstance use
Use of various psychoactive drugs
Crack
Form of cocaine that is hard
Prevalence of schizophrenia
1 out of 100 lifetime prevalence
Risk factor
Condition that increases the likelihood of getting a disorder
Rorschach inkblot test
Most widely used projective test
Hypoactive sexual desire
Lack of sexual desire
DSM-IV-TR
Correlational method
Research that examines relationships among factors, does not determine cause and effect
Displacement
Unacceptable emotions are redirected from dangerous objects or safer ones with this defense mechanism
Reliability
Test gives consistent results over time
Sensitivity training groups
Purpose is to improve empathy skills and promote personal growth
Risk factors for substance abuse
Availability of drugs, stressors, mental disorders, genetic factors
IQ score
IQ tests measure the ability to do some cognitive tasks
DSM-IV-TR
Shared psychotic disorder
Individual develops a delusion similar to person's with whom there is a close relationship
DSM-IV-TR
Enuresis
Voiding of urine in inappropriate places
DSM-IV-TR
Sensorium
Awareness of the environment
Content of clinical interview
Life history, family, education, culture, sexual history, religion, mental status exam, current problems, affect, mood
Origin of opiates
Poppies
Learning approach
Bandura: we learn through modeling and seeing models being rewarded and punished
Cognitive-Behavioral Therapy
Severe retardation
IQ is 25-40
DSM-IV-TR
Alleviation of withdrawal symptoms
Use of the same or similar drug
Axis II
Personality and developmental disorders (DSM-IV)
DSM-IV-TR
Paranoid personality disorder
Distrustful, suspicious, jealous and may want to harm others and be hostile
Compulsions
Time-consuming and ritualistic actions (physical or mental) that a person feels driven to do
DSM-IV-TR
Panic disorders and medication
Benzodiazepines and tricyclic antidepressants, relapse is common when medication is stopped
DSM-IV-TR
Obsessive-Compulsive Disorder and insight
Individual who has OCD realizes the irrationality and excessiveness of the obsessions/compulsions
Avoidant personality disorder
Feelings of inadequacy, fear of negative evaluation and social situations, fear of being shamed, may lead very restricted lives.
DSM-IV-TR
Symptoms of fetal alcohol syndrome
Learning disabilities, cognitive disorders, behavior disorders, skin folds at corner of the eye, small head, and thin upper lip--Pregnant women should not consume any alcohol
DSM-IV-TR
Origin of cocaine
Coca plant
Exhibitionism
Sexual arousal associated with exposure of genitals; element of risk important to the arousal
DSM-IV-TR
Disruptive behavior disorders
Include oppositional defiant disorder and conduct disorder--behaviors are negative, hostile, and defiant, and infringe on the rights of others
Former name of gender identity disorder
Transsexualism
DSM-IV-TR
Cluster B personality disorders
Dramatic or emotional cluster: borderline, antisocial, narcissistic, histrionic
DSM-IV-TR
Generalized Anxiety Disorder
Chronic anxiety and worry for at least six months
DSM-IV-TR
Stereotyped body movements
Repetitive movements and rigid behaviors
Post-traumatic stress disorder
After a traumatic event, symptoms are intrusive memories, avoiding emotional triggers, emotional numbness, and arousal
DSM-IV-TR
Symbolic-Experiential Family Therapy - Key Theorists
David Keith
Walter kempler
Thomas Malone
August Napier
Laura Roberto
John Warkentin
Carl Whitaker
Symbolic-Experiential Family Therapy
Symbolic-Experiential Family Therapy - History
Grew out of humanistic psychology and Gestalt Therapy; focused on change occurring through the growth process
Symbolic-Experiential Family Therapy
Symbolic-Experiential Family Therapy - Key Concepts
Person of the Therapist
Existential Encounter
Therapy of the Absurd
Individuation
Family Interaction
Symbolic-Experiential Family Therapy
Symbolic-Experiential Family Therapy - Focus
Focuses on the growth of all individuals involved and completion of developmental tasks
Symbolic-Experiential Family Therapy
Symbolic-Experiential Family Therapy - Goals of Therapy
Symptom Relief
Cohesion
Creating Transgenerational Boundary
Growth
Symbolic-Experiential Family Therapy
Symbolic-Experiential Family Therapy - Structure of Therapy
Phases of Treatment
1. Creating alternative interactions
2. Replacing key players in certain conflicts with one's self
3. Increasing the focus on others besides the scapegoat
4. Avoiding blaming the caretaking parent or spouse

In the late phase, the family operates as a mobile milieu therapy unit within the family co-therapist suprasystem
Symbolic-Experiential Family Therapy
Symbolic-Experiential Family Therapy - Assessment
* Competency-Based Assessment - focuses on competencies rather than problems
* Shells of context (outermost - extended family to innermost - identified patient)
* Trial of Labor (assessment interview)
* Consider the following characteristics: disorganized boundaries, coalitions to avoid conflict, conflict, role rigidity, delegates, pseudomutuality/emotional cutoff, and parental empathy
Symbolic-Experiential Family Therapy
Symbolic-Experiential Family Therapy - Techniques
Battle for Structure
Battle for Initiative
Expanding Distress to include Each Member
Activating Constructive Anxiety
Redefining Symptoms
Fantasy Alternatives
Separating Interpersonal and Intrapersonal Stress
Affective Confrontation
Co-Therapist
"Craziness", Play and Humor
Symbolic-Experiential Family Therapy
Battle for Structure (Technique)
* Therapist's responsibility to establish the rules and working atmosphere at the beginning of treatment; therapist must be firm and unyielding
Symbolic-Experiential Family Therapy
Battle for Initiative (Technique)
* Must be won by the family
* may involve encouraging the family to state the agenda for each session, not forcing the therapist's agenda for change, waiting in silence for the family to take the initiative, not working harder than the family, or allowing the family to determine how change is to happen
Symbolic-Experiential Family Therapy
Expanding Distress to Include Each Member (Technique)
* Shifts tension and anxiety
* Encourages cohesion, avoids blame, and demands group solution
* Augmenting distress forces member to break from covert ultimatums
Symbolic-Experiential Family Therapy
Activating Constructive Anxiety (Technique)
* Positively reframing symptoms as efforts toward competence and by overtly addressing the life-cycle transitions each family member is facing
Symbolic-Experiential Family Therapy
Redefining Symptoms (Technique)
* Symptoms are redefined as efforts toward growth in order to expand the family's sense of freedom. Often, metaphors, or stories are used to redefine symptoms or to help families view symptoms in a new perspective
Symbolic-Experiential Family Therapy
Fantasy Alternatives (Technique)
* "What if..."
* Absurd fantasy alternatives (if you took your son's clothes he couldn't go out and buy drugs)
Symbolic-Experiential Family Therapy
Separating Interpersonal and Intrapersonal Stress (Technique)
* Distinguish actual relational problems from individual reactivity to these problems
Symbolic-Experiential Family Therapy
Affective Confrontation (Technique)
* Therapist confronts the family with the therapist's subjective emotional experience of working with the family (i.e. bored, angry, etc). By speaking subjectively at times, the therapist induces family members to allow their own subjectivity to emerge.
Symbolic-Experiential Family Therapy
Co-Therapist (Technique)
* Co-therapists can be useful in maintaining and broadening perspective
Symbolic-Experiential Family Therapy
"Craziness", Play and Humor (Technique)
* May take the form of play, humor, drama, or any other form that makes sense with the family.
* Encouraged as a means to discovering solutions and promoting growth
Symbolic-Experiential Family Therapy
Intergenerational Family Therapy - Key Theorists
Murray Bowen
Betty Carter
Thomas Fogarty
Edwin Friedman
Philip Guerin
Michael Kerr
Monica McGoldrick
Daniel Papero
Intergenerational Family Therapy
Intergenerational Family Therapy - History
aka Bowen Family Systems, evolved from psychoanalytic principles
Intergenerational Family Therapy
Intergenerational Family Therapy - Key Concepts
Togetherness and Individuality - the two counterbalancing life forces that the differentiated person is able to successfully balance.
* Differentiation of Self
* Triangles
* Nuclear Family Emotional Process
* Undifferentiated Family Ego Mass
* Family Projection Process
Multigenerational Transmission Process
* Sibling Position
* Emotional Cutoff
* Societal Emotional Process
Intergenerational Family Therapy
Togetherness and Individuality (Key Concept)
* Togetherness - person's ability to engage in meaningful connection with another
* Individuality - person's ability to maintain a clear sense of self and identity
Intergenerational Family Therapy
Intergenerational Family Therapy - Goals of Therapy
* Decrease anxiety
* Increase differentiation in one or more family members
Intergenerational Family Therapy
Intergenerational Family Therapy - Structure of Therapy
3 Phases:
Initial Assessment
Genogram
Differentiation
Intergenerational Family Therapy
Intergenerational Family Therapy - Assessment
Assesses togetherness and individuality through
(a) family of origin
(b) triangles
(c) level of differentiation
Intergenerational Family Therapy
Intergenerational Family Therapy - Assessment - 10 Basic Questions
1. Who initiated therapy
2. What is the symptom and which family member or family relationship is symptomatic
3. What is the immediate relationship system of the symptomatic person
4. What are the patterns of emotional functioning in the nuclear family
5. What is the intensity of the emotional process in the nuclear family
6. What influences that intensity
7. What is the nature of the extended family systems
8. What is the degree of emotional cutoff from each extended family member
9. What is the prognosis
10. What are the important directions for therapy
Intergenerational Family Therapy
Intergenerational Family Therapy - Techniques
Detriangulate
Nonanxious Presence
Genogram
Process Questions
Supporting Differentiation
"Going Home Again"
Displacement Stories
Coaching
Intergenerational Family Therapy
Detriangulate (Technique)
* Dissolve dysfunctional triangles and reduce fusion
Intergenerational Family Therapy
Nonanxious Presence (Technique)
* The idea that the therapist must maintain a nonanxious presence when engaging with the family, even in the face of heated conflict
Intergenerational Family Therapy
Genogram (Technique)
* used as an assessment tool and as a technique to provide insight and introduce the possibility for a calm, rational discussion.
Intergenerational Family Therapy
Process Questions (Technique)
* involve exploring family emotional processes and are designed to decrease reactive anxiety and help people think rationally about their situation
Intergenerational Family Therapy
Supporting Differentiation (Technique)
* Focusing on the family member who is most motivated to work toward differentiation
Intergenerational Family Therapy
"Going Home Again" (Technique)
* Encourages clients to go home and re-experience their nuclear family without emotional reactivity
Intergenerational Family Therapy
Displacement Stories (Technique)
* Stories about other families with similar problems that therapists share with the clients in order to help the family gain a clearer understanding of its own process
Intergenerational Family Therapy
Coaching (Technique)
* Therapist works as a coach in regard to teaching families about the family process
Intergenerational Family Therapy
Cognitive-Behavioral Therapy - Key Theorists
Albert Bandura
Aaron Beck
Albert Ellis
Norman Epstein
Neil Jacobson
Gerald Jones
Arnold Lazarus
Robert Liberman
Donald Meichenbaum
Gerald Patterson
Ivan Pavlov
B.F. Skinner
Richard Stuart
Joseph Wolpe
Cognitive-Behavioral Therapy
Cognitive-Behavioral Therapy - History
Developed as a reaction to the psychodynamic approach
Cognitive-Behavioral Therapy
Cognitive-Behavioral Therapy - Key Concepts
Classical Conditioning
Operant Conditioning
Reinforcement
Primary and Secondary Reinforcements and Punishments
Extinction
Premack Principle
Social-Exchange Theory
Social-Learning Theory
A-B-C Theory
Family Schema
Parent-Skills Training
Behavioral Marital Therapy
Conjoint Sex Therapy
Functional Family Therapy
Cognitive-Behavioral Therapy
Cognitive-Behavioral Therapy - Goals of Therapy
Cognitive Behavioral change; to alter unproductive behavior and cognitive patterns to alleviate the problem and maladaptive symptoms
* little emphasis placed on "growth" or "insight"
* possible general goals are:
1. increase desired behavior/cognitions
2. decrease undesirable behavior/cognitions
3. improve problem-solving skills
Cognitive-Behavioral Therapy
Cognitive-Behavioral Therapy - Structure of Therapy
1. Baseline Assessment
2. Intervention
3. Extinction
Cognitive-Behavioral Therapy
Cognitive-Behavioral Therapy - Assessment
Therapists asssess for the relational dynamics in relation to the problem issue by doing the following:
1. Behaviorally define the problem
2. Functional Analysis
3. Baseline
4. Contract
Cognitive-Behavioral Therapy
Cognitive-Behavioral Therapy - Techniques
Therapeutic Contracts
Contracting (quid pro quo, good-faith)
Functional Analysis
Modeling
Systematic Desensitization
Reinforcement Schedule
Shaping
Charting
Time Out
Token Economy
Disputing Irrational Beliefs
Psychoeducation
Sensate Focus Technique
Cognitive-Behavioral Therapy
Classical Conditioning
Food Bell Salivate
Cognitive-Behavioral Therapy Key Concept
Operant Conditioning
* Desired behavior is voluntarily performed and controlled by reinforcement
Cognitive-Behavioral Therapy Key Concept
Reinforcement
* event or behavior designed to increase or decrease a specific response
Cognitive-Behavioral Therapy Key Concept
Positive Reinforcement
* aims at increasing the frequency of a behavior (aka reward)
Cognitive-Behavioral Therapy Key Concept
Negative Reinforcement
* increases the frequency of a desired behavior by removing adverse stimuli when the desired behavior is elicited (parent stops nagging when child cleans room)
Cognitive-Behavioral Therapy Key Concept
Punishment
* distinguishes itself from negative reinforcement in that it decreases undesirable behavior
* can take the form of aversive consequences such as yelling or spanking, or the removal of positive consequences such as losing tv privileges
Cognitive-Behavioral Therapy Key Concept
Intermittent Reinforcement
* refers to not consistently reinforcing a behavior; behaviors that are intermittently reinforced are the most difficult to extinguish
Cognitive-Behavioral Therapy Key Concept
Contingencies of Reinforcement
* when and how behaviors are reinforced
Cognitive-Behavioral Therapy Key Concept
Reciprocal Reinforcement
* refers to family situations where the behaviors of each member serve as the stimuli and reinforcements for the others, resulting in a complex series of interlocking behaviors
Cognitive-Behavioral Therapy Key Concept
Primary and Secondary Reinforcements and Punishments
* Primary reinforcement/punishment = biologically determined reinforcements (food/sex)
* Secondary reinforcement/punishment = learned association (praise, criticism, and attention)
Cognitive-Behavioral Therapy Key Concept
Extinction
* process in which a behavior is diminished by not reinforcing it; person has no motivation for continuing the behavior
Cognitive-Behavioral Therapy Key Concept
Premack Principle
* high probability behavior can be used to reinforce low probability behavior; watching tv is contingent upon doing homework
Cognitive-Behavioral Therapy Key Concept
Social-Exchange Theory
* in Interpersonal interactions people attempt to maximize rewards and minimize costs
* 2 people rewarding each other at equitable rates is called reciprocity
Cognitive-Behavioral Therapy Key Concept
Social-Learning Theory
* people learn not just from doing, but also from watching others do
Cognitive-Behavioral Therapy Key Concept
A-B-C Theory
* (A) activating events do not cause the problem (C) consequence, but rather the intermediary believe (B) about A causes C
Cognitive-Behavioral Therapy Key Concept
Family Schema
* set of similarly held beliefs about family and life
* provides the template or set of rules that organize a family's behaviors and interactions
Cognitive-Behavioral Therapy Key Concept
Parent-Skills Training
* therapist provides educational information to parents and often serve as a consultant to the parent
Cognitive-Behavioral Therapy Key Concept
Behavioral Marital Therapy
* recognizes that the behavior of each is the antecedent and consequence of the other
Cognitive-Behavioral Therapy Key Concept
Conjoint Sex Therapy
* therapist serves as an educator on sexual physiology and techniques; interventions address maladaptive behavior patterns and cognitions
Cognitive-Behavioral Therapy Key Concept
Functional Family Therapy
* Aims at achieving cognitive and behavioral changes in the family system by challening negative traits attributed to others in the family
Cognitive-Behavioral Therapy Key Concept
Therapeutic Contracts
* written and specify the goals of therapy and obligations of the client and therapists
Cognitive-Behavioral Therapy Technique
Contracting
* Quid pro quo contracts - one person agrees to a change after the other has made a requested change
* Good faith contracts - 2 people mutually agree to make changes
Cognitive-Behavioral Therapy Technique
Functional Analysis
* involves figuring out what stimulus conditions control the targeted behavior while identifying the precise contexts in which the problem is likely to be most and least prominent
Cognitive-Behavioral Therapy Technique
Modeling
* new behaviors are learned by observing the behavior of others
Cognitive-Behavioral Therapy Technique
Systematic Desensitization
* Introduced by Joseph Wolpe
* Used as a procedure to address various forms of anxiety and phobias
* Process involves altering a person's physiological response to a specific stimulus (person slowly exposed to the feared stiumulus in incremental states)
* reciprocal inhibition is often part of the process and involves pairing the anxiety arousing stimulus with a relaxation response
Cognitive-Behavioral Therapy Technique
Reinforcement Schedule
* defines the contingencies for reinforcement of a behavior and established the relationship between a behavior and its consequences
Cognitive-Behavioral Therapy Technique
Shaping
* based on operant conditioning; refers to the process in which a complex behavior is divided into subparts
* contingencies of reward and punishment are provided to these subparts until all the behaviors comprising the whole are elicited
Cognitive-Behavioral Therapy Technique
Charting
* asking the client to keep a record of the targeted problem behavior between sessions; can be used to obtain a baseline and monitor progress
Cognitive-Behavioral Therapy Technique
Time Out
* Used to alter problem behaviors
Cognitive-Behavioral Therapy Technique
Token Economy
* a system of rewards using points, which can be exchanged for reinforcing items or behaviors
Cognitive-Behavioral Therapy Technique
Disputing Irrational Beliefs
* Challenge client's irrational beliefs about the problem situation that may be causing or exacerbating the situation
Cognitive-Behavioral Therapy Technique
Psychoeducation
* Educating clients on various topics
Cognitive-Behavioral Therapy Technique
Sensate-Focus Technique
* early phase sex therapy technique; couple focus on enjoying basic touch without the pressure of having to perform sexually
Cognitive-Behavioral Therapy Technique
Solution-Focused Therapy - Key Theorists
Kim Insoo Berg
Steve de Shazer
Patricia Hudson
Eve Lipchik
Scott Miller
William O'Hanlon
Jane Peller
Michelle Weiner-Davis
John Walter
Solution-Focused Therapy - History
Evolved from de Shazer's work with the MRI problem-focused approach
Solution-Focused Therapy - Key Concepts
Solution and Future Focus
Strengths and Resources
Beginner's Mind
Change is Constant
Language and Meaning
Hope
Solution-Focused Therapy - Goals
Solution Focus
Goals and Goal Setting
Solution-Focused Therapy - Structure of Therapy
Define the problem in client's language
Identify exceptions
Establish Goals
Solution Focused Therapy - Assessment
Motivation
Solvable Problems
What Worked
Exceptions
Strengths and Resources
Solution Focused Therapy - Techniques
Formula first Session Task
Miracle Question
Exception Question
Compliments
Scaling Questions
"on track"
Eliciting Strengths and Resources
Inspiring Solutions and Solution Building
Narrative Therapy - Key Theorists
David Epston
Michael White
Jeff Zimmerman
John Winslade
Gene Combs
Vicki DIckerson
Robert Doan
Jill Freedman
Stephen Madigan
Gerald Monk
Alan Parry
Narrative Therapy
Narrative Therapy - History
1990 Book "Narrative Means to a Therapeutic Ends" by White & Epston
Narrative Therapy
Narrative Therapy - Key Concepts
The Textual and Narrative Metaphors
Unique Outcomes
Dominant and Subjugated (local) Knowledges
Language
Politics
The Problem is the Problem
Therapist Positioning
Narrative Therapy
Narrative Therapy - Goals
Alter the problem-saturated story to reflect a preferred narrative
Narrative Therapy
Narrative Therapy - Structure of Therapy
* Begin with a unique outcome
* Make sure the unique outcome represents a preferred experience
* Plot the story in the landscape of action
* Plot the story in the landscape of consciousness
* Ask about a past experience that has something in common with the unique outcome or its meaning
* Ask questions that link the past episode with the present
* Ask questions to extend the story into the future
Narrative Therapy
Narrative Therapy - Assessment
Knowing the person apart from the problem
Unique Outcomes
Mapping Effects
Narrative Therapy
Narrative Therapy - Techniques
* Deconstructive Listening
* Deconstructive Questions
* Externalizing the Problem
* Relative Influence Questioning
* Plotting Narratives in the Landscapes of Action and Consciousness
* Preference and Permission Questions
* Exploring Specifications for Personhood
* Situating Comments
* Letters and Certificates
* Audience/Witnesses
Narrative Therapy
Unique Outcomes
Narrative Therapy
Experiences that would not be predicted by the plot of the problem-saturated narratives
Deconstructive Listening
Narrative Therapy
Listening that opens up space for new meaning and understandings
Deconstructive Questions
Narrative Therapy
Help people unpack their stories or see them from different perspectives
Externalizing the Problem
Narrative Therapy
Linguistically separating the problem from the person
* Involves personifying the problem
* defining the problem to be externalized and using externalizing questions
Relative Influence Questioning
Narrative Therapy
Process of mapping the influence of the problem and mapping the influence of the person
Plotting Narratives in the Landscapes of Action and Consciousness
Therapist first gets specifics on the actions that occurred to bring about the unique outcome, then transitions to inquire about the meaning the person attributes to these events
Narrative Therapy
Preference and Permission Questions
Narrative Therapy
Ensure that the unique outcome is consistent with the client's preferred reality and not the therapists.
Psychoanalytic Theory - Key Theorists
Sigmund Freud
Erickson
Psychoanalytic Theory - Goals
* Resolution of clients' problems to enhance the clients' ability to cope with life changes
* Working through unresolved developmental states
* Become able to cope more effectively with the demands of society in which they live
Psychoanalytic Theory - Techniques
Free Association
Analysis of Dreams
Analysis of Resistence
Interpretation
Jungian Analytical Theory - Key Theorists
Carl Jung
Jungian Analytical Theory - Four functions that determine Perception
Sensation
Thinking
Feeling
Intuition
Myers-Briggs Type Indicator
A popularized adaptation of Jung's principles of typology
Jungian Analytical Theory - Goals
Individuation and Personality Unification
Jungian Analytical Theory - Interventions
Dream analysis
Adlerian Theory (Individual Psychology) - Key Theorists
Alfred Adler
Adlerian Theory (Individual Psychology)
A cognitive, goal-oriented social psychology interested in a person's beliefs and perceptions, as well as the effects that person's behavior has on others.
* Not a set of techniques, but a comprehensive philosophy of living
Adlerian Theory (Individual Psychotherapy) - Fundamental Principles
1. Behavior is Goal Oriented
2. Humans are fundamentally social, with a desire to belong and have a place of value as an equal human being
3. The individual is indivisible and functions with unity of personality
(all 3 are aka purposiveness, social interest, and holism)
Adlerian Theory (Individual Psychotherapy) - Interventions
Lifestyle analysis
Encouragement
Existential Theory - Key Theorists
Kierkegaard
Nietzsche
Camus
Sartre
Heidegger
Buber
Existential Theory - Major Constructs
Approaches to Existentialism
Death
Freedom
Isolation
Culture
Meaninglessness and Meaningfulness
Authenticity and Vulnerability (Two sides of the existential self)
Existential Relationships
Hazards on the Journey
Existential Theory - Focus
A developmental perspective
A focus on potentials
A worldview
Existential Theory - Goals
Confront anxieties about the givens of existence
Existential Theory - Interventions
Understanding the client's world
Sharing existence in the moment
Fostering a centered awareness of being
Encouraging self-responsibility
Working with Dreams
Confronting Existential Anxiety
Learning to put closure on Relationships
Centered Awareness of Being
Self-Responsibility
Disclosing and Working through Resistence
Person-Centered Theory (Rogerian Theory) - Key Theorists
Carl Rogers
Person-Centered Theory (Rogerian Theory) - Major Concepts
* The autonomous self
* Reliance on One's own unique Experiences
* The Desire and ability to make positive personal changes
* Movement toward the actualization of potentials
Person-Centered Theory (Rogerian Theory) - Techniques
Empathic Understanding
Confidence in the Client
Client's unique perspective
Congruence of the person
Person-Centered Theory (Rogerian Theory) - Goals
Movement from incongruence to congruence
Person-Centered Theory (Rogerian Theory) - Techniques
Being Genuine
Active Listening
Reflection of Content and Feelings
Immediacy
Appropriate self-disclosure
Personalized Counselor or Therapist Actions
Gestalt Theory - Key Theorists
Fritz Perls
Max Wertheimer
Wolfgang Kohler
Kurt Koffka
Sandor Ferenczi
Paul Goodman
Gestalt Theory - Key Concepts
Awareness is the key to Gestalt
* Focus is not on facilitating behavioral changes in the client, but on helping the client to develop insight and interpersonal awareness
* Individual cannot be understood in isolation, must be understood within his/her social and historical context and unqiueness
Gestalt Theory - Main Constructs
Phenomenological Field
Differentiation and Contact
Boundaries
Dichotomies and Polarities
Foreground and background
Gestalt Theory - Goals
* Identify themes that are central to client's self-organization
* Conceptualizing the issues and concerns
* Establishing and maintaining a safe professional environment
* Providing an atmosphere that invites contact between client and counselor
Gestalt Theory - Intervention Strategies
* Clarify and sharpen what the client is already aware of
* Bring into focal awareness what was previously known only perphierally
* Bring into awareness that which is needed but is systematically kept out of awareness
* Bring into awareness system of control
Gestalt Theory - Specific Intervention Strategies
* Location of Feelings
* Confrontation and enactment
* Empty chair or two-chair strategy
* Making the rounds
* Dream work
* Unfinished business
* Rehearsal
* Minimization
* Exaggeration
* Reversal
* Exposing the obvious
* Explicitation or translation
* Retroflection (playing the projection)
* Let the little child talk
* Say it again
* I take responsibility for ...
* I have a secret
* Contact and withdrawal
* Can you stay with this feeling
Rational Emotive Behavior Therapy - Key Theorists
Albert Ellis
Rational Emotive Behavior Therapy - Goals
Help clients develop a rational philosophy that will allow them to reduce their emotional distress and self-defeating behaviors
Rational Emotive Behavior Therapy - Interventions
* Disputing
* Rational-emotive imagery
* Rational role-laying
* Bibliotherapy
* Shame attack exercies
* Rational coping self-statements
Rational Emotive Behavior Therapy - Key Construct
Emotional distress results from dysfunctional thought processes
Rational Emotive Behavior Therapy - Change Occurs
Change occurs as counselors help clients work through the A-B-C model of emotional disturbance; irrational beliefs are replaced with rational alternatives that result in more moderate healthy emotions and self-enhancing behaviors.
Reality Therapy Theory - Key Theorists
William Glasser