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118 Cards in this Set

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3 categories of Behaviorism:
Classical Conditoning, Operant Conditioning, Social Learning Theory
Classical Conditioning:
unlearning problematic connections (phobia, anx, addictions) using counterconditioning and classical extinction.
Counterconditioning:
based on reciprocal inhibition where two incompatible responses can’t happen at the same time.
Aversive Conditioning:
paring a negative stimulus with a deviant bx (like smoking or drinking). Can be done in vivo = Antabuse, in imagination = covert sensitization. Used with paraphilias (has short-term benefits but not long-term and is assoc. with high rates of recidivism.
Systematic Desensitization:
for phobias (Wolpe). Uses anx hierarchy and relaxation paired with a real or imagined feared situation.
Sys. Des. used to be considered best for phobias, but now long, intense exposure is the most efficacious (specifically flooding).
Sensate Focus:
(Masters and Johnson) using pleasure as a counterconditioning response to sexual performance anx. Pleasure is through body massages and discontinued when anx appears. The couple is initially required to abstain from intercourse. Sensate focus targets the excitement phase.
Assertiveness Training:
uses the assertive response which is antagonistic to social anx. Practice by role playing with therapist then real-life situations.
Classical Extinction:
presenting the CS w/o the US until CR disappears.
Flooding:
in vivo or in imagination. Client is presented with the CS (spider) and then prevented from fleeing. Prolonged exposure better (45 min) Best for agoraphobia, OCD, specific phobias (better than sys desens)
Implosive Therapy:
(Stampfl) conducted in imagination only. After exposure to the feared object in imagination the therapist interprets possible psychosexual themes.
Operant Conditioning:
Interventions based on reinforcement or punishment. 1st a functional assessment of behavior is done to define the target bx and determine antecedents, consequences and contingencies that are maintaining the bx
Reinforcement:
3 types primary, secondary and generalized conditioned
Primary Reinforcers:
reinforce everyone, all ages and in all cultures (food)
Secondary Reinforcers:
acquired through training and experience (praise)
Generalized Conditioned Reinforcers:
not inherently reinforcing but take on value by giving person access to other reinforcers (money, tokens).
Shaping:
person is reinforced for each step towards the target bx.
Token Economies:
tokens used to reinforce good bx, taken away for bad bx
Contingency Contracting:
negotiation for prob interactions b/t 2+ people.
Premack Principle:
using a high freq bx to reinforce a low freq bx
DRO aka (DRI & DRA):
combination of extinction (ignore) and positive reinforcement (reward)
Self Reinforcement:
element of bx self-control and self-regulaion procedures
Positive Punishment:
adding a aversive stimulus to decrease a bx. Thought stopping (rubber band) only suppresses the bx but doesn’t stop it. (most effective when the punishment is of max intensity and occurs soon after the negative bx)
Escape Learning:
can’t avoid aversive stimulus completely but can lessen its duration by emitting the desired bx.
Avoidance Learning:
can completely avoid aversive stimulus by emitting the desired bx in time.
Overcorrection:
type of punishment that involves restitution/reparation and physical guidance (if a child messes up 1 room she has to clean 2 rooms).
Social Learning Theory:
modeling adaptive bx to replace maladaptive bx used with phobias, also used to improve social skills and repair bx deficits.
Symbolic Modeling:
watching filmed model gradually interact w/feared sit.
Live or In Vivo Modeling:
watching a live model interact with feared sit.
Participant Modeling:
watching and interacting with a live model who gradually guides them. Good for children with phobias
DBT:
Marsha Linehan structured outpatient tx for Borderline Personality Disorder, with the key dialectic being “acceptance” and “change” and although the past is not ignored the tx focused on present bx and current factors controlling that bx
DBT clients must follow 4 conditions:
1) They must work in individual tx for a specific length of time (usually 1 yr) and attend all sessions.
2) Reduce suicidal bx if present
3) Work on tx interfering bx.
4) Attend skills training.
Primary Modes of DBT:
Individual Tx: Indiv therapist is primary & main work is in indiv sessions
Telephone Contact: to support client applying skills and to avoid self-harm
Skills Training: In group context, focuses on Core Mindfulness, Distress Tolerance, Emotion Regulation, Interpersonal Effectiveness.
Therapist Consultation: Therapists also required to do own DBT in consult groups
Ellis (Rational Emotive Therapy):
tx is direct and aims to convince clients of their irrationality. Irrational beliefs underlie emotional disturb.
ABC Model:
A) Activating Event
B) Belief
C) Emotional/Bx consequences

Ellis believed that it is not the event but one’s belief about the event
DEF is the result of tx:
D) Disputing intervention
E) adopting a more Effective philosophy
F) represents new Feelings.

RET tx uses direct instruction, persuasion and logical disputation. Other RET techniques include modeling, homework, relaxation, and rehearsal. Used with a # of disorders
Beck (Cognitive Therapy):
emphasizes hypothesis testing to alter beliefs
Bx assignments and homework test validity of beliefs, Socratic Questioning
Psy sx are b/c of maladaptive thoughts, which are automatic and uncon.
Depressive Triad:
negative view of Self, World, Future.

Techs include; daily logs, activity sch., cog awareness and build mastery. Goal: identify neg. cognitions, develop flexible schemas rehearse cog and bx responses.
Meichenbaum:
Cog-Behavioral Modification (CBM): focuses on “self-statements,” Socratic questioning and collaboration.
Self-Instruction Therapy:
uses modeling and graduated practice w/ some RET to help adults/kids w/ task completion probs (valid w/ kids ADHD)

5 step procedure:
1) Therapist Modeling
2) Therapist Verbalization
3) Client Verbalization
4) Client silently talks through. Task
5) Independent task performance.
Similar to Protocol Analysis (describing task solution)
Stress Inoculation Training:
empirically validated with PTSD, used w/ excessive anx, stress, anger and medical problems.
Education and Cognitive Preparation: 1st Taught it’s not the event but their reaction & interpretations of the events. Coping skills also taught.
Coping Skills Acquisition: relax, self-statements, imagery, thought stop Application of Skills in Imag/ In Vivo: increase stress levels, relapse prevent
Rehm (Self-Control Model of Depression):
integrates cognitive and bx models of depression. Pure Bx states: too low a rate of response-contingent reinforcement. Improvement = increase reinforcement for adaptive bx.
Reinforcement can be self-generated rather than external & low involvement in activities is a result of neg. self-evaluations, lack of self-reinforcement & high rates of punishment.
Marlatt: Relapse Prevention:
addiction is an overlearned habit. Relapse is an inevitable part recovery and can be learned from. Marlatt’s model helps addicts identify triggers for relapse including external factors, interpersonal situations and internal states (thoughts, feelings, physiological sensations).

The most common trigger is the client’s negative emotional state.

Assistance is provided to develop new skills or bx for dealing with triggers (talking to friends or exercising instead of using drugs).
Classical Psychoanalysis: Freud:
human nature is “deterministic” determined by irrational forces, unconscious motivations, biological and instinctual drives and the psychosexual events of the 1st 6 yrs of life.
Freud's structural model of the psyche:
ID: most primitive part of the psyche, ruled by eros (life instinct) and aggression (thanatos or death instinct) Present at birth. uncon, lacks org and disregards reality. Operates on the Pleasure Principle. The Id is found in dreams, slips, jokes and free assoc.

EGO: operates on the Reality Principle, main task is to satisfy Id by socially acceptable means. Ego is the ‘executive’ controlling the conscious

SUPEREGO: Indiv. conscience/morals, internalized parental standards. Forces Ego to satisfy Id, embodies perfection, uses guilt, it evolves as the child successfully passes through the Oedipal Stage.
Primary Process:
attempts to reduce tension through dreams and hallucinations
Secondary Process:
meeting demands of reality (delaying gratification) by thinking and speaking.
Anxiety:
Freud thought that anxiety occurred when the Id impulses became too strong and edged into consciousness.
Defense mechanisms deceive us & distort reality to keep Id urges out
Defense Mechanisms:
Repression: most basic and common def mech that underlies all others. Freud called it “motivated forgetting.”

Regression: guarding against anx by retreating to bx of a safer stage of dev

Projection: seeing our own uncon urges in another’s bx, outcome=paranoia

Displacement: transferring feelings from one object to another (phobias)

Reaction Formation: engaging in bx that are the exact opposite of the Id

Intellectualization: distancing self from feelings

Rationalization: having self-satisfying yet incorrect reasons for one’s bx

Sublimation: finding socially acceptable ways to discharge energy from unconscious desires. Thought to be normal and desireable.
Millon:
came up with primary defenses for each personality disorder.

Schizoid = intellectualization
Narcissistic = rationalization
Paranoid = projection
Borderline = regression
Histrionic = dissociation
Dependent = introjection
Antisocial = acting out
Alloplastic:
reactions to stress that involve trying to change or blame the external environment (used by people with Personality Disorders)
Autoplastic:
reactions to stress that involve trying to change or blame oneself (used by neurotics i.e. depression, anxiety)
Focus of Psychoanalytical tx:
to make the unconscious, conscious especially the conflicts b/t the Id’s urges and the use of Ego Defenses.

Free Association: Cornerstone of psychoanalysis. Includes 4 steps: clarification, confrontation, interpretation, and working through.

Transference: seen as a form of resistance to be worked through.
Ego Psychology:
focuses on ego’s ability to adapt and integrate. Views the individual as having the capacity to master life not a helpless Id “rider”
Heinz Hartmann:
“Father of Ego Psy” ego develops parallel to Id not out of it. People driven by passion and thought. Differentiated. b/t defensive ego and autonomous ego functions. Coined term “conflict free sphere” for ego functions outside the unconscious conflict (perception, learning, memory, locomotion)
Anna Freud:
Ego has the capacity for mastery by reconciling drive conflicts w/ reality. Ego gives us a fuller picture of the Id and Superego. Interpreted kids words not play (Klein) formed bonds with kids, not neutral
Erik Erikson:
Combined Ego Psy w/ psysocial lifespan. Ego matures in epigenetic sequences built on mastery of the prior stage. Had 8 stages, 1st 5 correspond with Freud’s but Erikson included 3 stages of adult ego development. Human bx is an interaction b/t the internal world (Id, Ego) and the external social world.
Object-Relations:
deals with the capacity to have satisfying relationships. Object refers to infant/other relationship. We are “object-related” from birth (innate). Tx focuses on integrating split-off and good/bad parts into whole realistic object representations (object constancy) Therapist is active.
Melanie Klein:
infant uses splitting (good breast/bad breast) for fear her hostile feelings will destroy the loved object, which prevents object constancy. Worked a lot with kids, saw play as free assoc, Tx with kids was much like adults.
D.W. Winnicott:
“good enough mother” pathology = abandoning “true self” for “false self” i.e. shutting off true feelings and bx to please others, also came up with terms "holding environment" and "transitional object" Worked with children, and saw tx as recreating and repairing the child/caregiving bond
Margaret Mahler:
6 stages of dev.
1) normal infantile autism
2) symbiosis
3) differentiation
4) practicing
5) rapprochement
6) object constancy.

Separation is becoming a discrete entity by distancing, individuation is the process of becoming psy independent (mature independent ego functions).
Kohut:
Self Psychology: Focused on the pre-Oedipal stages. “Primary Narcissism” is healthy and where the baby gets its “self-object” needs met (mirroring, idealizing, twinship). “empathic attunement” by mom = very important
Neo-Freudians:
focused on the social/cultural factors in personality. Maladaptive bx comes from faulty learning. The tx relationship is used to highlight the client’s faulty perceptions and interpretations of other’s bx.
Harry Stack Sullivan:
Interpersonal theory. Liked Piaget.

3 modes of existence (causality/reality):
Prototaxic (birth-7mo)
Parataxic (8-11mo)
Syntaxic (12mo-2yr)

ITP: 16 wk time-limited tx connects probs w/ interpertations
Karen Horney:
neurosis: culturally defined construct from feelings of alienation, anx, hostility towards adults. Basic anx = safety, familiarity, security.

3 neurotic trends:
1)moving compliantly towards
2)moving aggressively towards
3)moving detachedly away.
Eric Fromm:
bx comes from sociocultural/economic conditions. Believed freedom frightens people. 2 modes of existence “having” and “being”
Adlerian: Individual Psy:
people strive for superiority or personal competence and try to master life. Humans motivated by social urges not sexual urges. Happiness or success = social connectedness and ability to transcend the self, but struggling for power = bad behavior. Child feels inferior due to real/perceived weakness, which can either motivate mastery or neurosis. Lifestyle affected by family/sibs & birth order is important. Tx = is future-oriented/prob-solve & looks at mistaken goals. Inspired the STEP prog.
Jungian: Analytic Psy:
psyche contains the conscious ego, personal unconscious & collective unconscious, which contains archetypes, inherited primordial images/ideas common to all members of a race. Anima (female) Animus (male) Neurosis is interference from archetypes in person’s progress towards personality integration and potential. Neurosis seen not as illness but striving towards psy maturity/individuation. Tx = gaining awareness of uncon w/ focus on symbols, myth w/a direct exchange of ideas w/ therapist to promote growth
Humanism/Existentialism Interventions:
Emphasis on subjective exp. and trust that the client will make positive choices based on freedom, choice, purpose, meaning & the focus is on the present.
Rogers: Client/Person-Centered Tx:
people all have the inborn capacity for purposive, goal-directed bx. Pathology comes from an incongruence b/t the Self (true feelings) and the inability to be aware of and express these feelings. Phenomenal Self = private world of experience & meaning. No interpretations only accepting, caring environment.
Tx tools:
1) Empathy
2) Warmth (Uncon Pos Regrd)
3) Genuineness (congruence). Tx = clarifying feelings w/o judging them
Perls: Gestalt Tx:
People structure experience as wholes.
Figure (what is attended to)
Ground (what is ignored) Healthy = flexible, adaptive contact w/ self and environ. Tx = awareness of whole personality and integration of blocked parts.
Resistance
1) Introjection
2) Projection
3) Retroflection
4) Deflection
5) Confluence.
Focus on the Present using the Empty Chair tech. Dreams (playing diff parts) and actively challenging transference
Glasser: Reality Therapy:
Influenced by existentialism and RET. Key feature is responsibility. Tx focuses on clarifying client’s values and to get them evaluate their bx and plans in relation to those values, to get them to accept responsibility.
Control Theory, which states we create an inner world that satisfies our needs but may not jive with the real world.
Tx = helping client’s to see the consequences of bx and come up w/ realistic solutions. Uses Contracts, humor, paradox, skillful questioning. Used w/ juvenile delinquents, prison inmates and (SWF) Schools Without Failures
Berne Transactional Analysis:
looks at becoming aware of intent behind communication & eliminating deceit so bx can be interpreted accurately.
Key concepts:
1) Ego States (parent, adult & child)
2) Transactions (b/t two person’s ego states: social/overt or psy/covert. complementary/crossed/ulterior)
3) Games
4) Strokes (pos or neg)
5) Life Scripts
Community Interventions:
Community psy focuses on the prevention, tx and rehab or mental health issues through the use organized community programs. CMHC were created by the 1963 act for inpatient, emergency, consult, daycare and research and education. Goal to intervene earlier and extend MH reach.
Caplan's categories of consultation:
Client-Centered Consultation: consultant helps consultee w/ an indiv. case

Consultee-Centered Case Consultation: consultant helps consultee w/ difficulties she is having working w/ clients (inexperience, lack of skill)

Consultee-Centered Administrative Consultation: focus is on consultee’s difficulties that limit effectiveness in instituting program change.

Program-Centered Admin Consult: focus is on developing, expanding or modifying an existing program.

Advocacy Consultation: consultant advocates for social change.
Prevention:
3 stages:

Primary (prevent onset)

Secondary (prevent mild cases from becoming serious)

Tertiary (minimize seriousness)
Child Abuse:
1 million kids abused each year w/ b/t 2000-4000 deaths
Physical Abuse:
32% under 5 yo
27% 5-9 yo
27% 10-14 yo
14% 15-18 yo
-Abused kids: ½ born premature and viewed by parents as developmentally slow, different and hard to discipline. Kids are from poor, socially isolated homes where the perpetrators have inappropriate expectations of kids.
-Most common perpetrators of physical abuse are female
-80% of perps live in same home, 80% of abused kids live in homes with 2 parents and 20% live in single parent homes.
-90% of perps were abused and have no hx of psy issues but substance abuse is quite common
Sexual Abuse:
150,00-200,000 new cases of sex abuse are reported each yr

family members are most common perps:
50% of the time (fathers, step-dad, uncles older sibs)

father/daughter incest = weak mom, 25% kids under 8 yo; peak 8-12
Domestic Violence:
National Violence Against Women Survey (7/2000) stated that 25% of women and 7.5% of men report being raped or physically assaulted by an intimate partner s/t in their life.
- Every yr 1.5 million women and 800,000 men are victims of domestic violence. With women it is more chronic and results in serious injuries.
- 22% of women in hetero relat. 11% of women in lesbian relat. 23% of men in homosexual relat. & 7% of men in hetero report domestic violence.

- Verbal abuse best predicts violence

- Spousal abuse occurs most freq w/crack or Etoh abuse, especially severity
- Abusers tend to be immature dependent, non-assertive and feel inferior

- Best long-term result comes from arrest of the husband
Expressive and Instrumental abuse:
Expressive Abuse: less deliberate & results from difficulty managing emotions

Instrumental Abuse: more deliberate and using violence as a means of control.

Expressive better for psy tx but will become Instrumental over time.
Rape:
is an act of violence and humiliation used to express power and/or anger. Sexual feelings not typically part of act & many rapists exp dysfunct
- Etoh is involved w/ at least 50% of rapes
- Most men who rape are b/t 14-24 yo & 50% are white and close to 50% are Black and most rapes occur within race. Highly underreported w/ 1 in 10 being reported. Half by strangers and half by known men.
Divorce:
At time of divorce kids have social, academic and bx probs. Some become aggressive withdrawn & lose interest in school & social life
- At ages 3-6 yo kids feel responsible, at 7-12 yo school suffers, at 13-18 yo they feel they could have prevented it & feel hurt & are critical of parents
- Recovery tends to take b/t 3-5 yrs w/ a third of kids experiencing lasting trauma.
- Initially girls do better, but vulnerable as adolescents & if mom remarries. Young kids are more anx at time of divorce but adapt more quickly. Adult kids of divorce parents = more depress/marital probs, low SES/health
Outcome Research: Meta-Analysis:
applies methods of empirical research to the process of reviewing the literature. Findings from individual studies are quantified by effect size, which is a measure of standard deviation units of difference b/t treated and untreated subjects.
- Meta-analysis has found an average effect size of .85, which means that a treated person is better off than 80% of the untreated sample.
- In another study 50% of clients improved by measurably by the 8th session and 75% were improved by the end of six months.
Efficacy Research:
used in Evidence Based Tx (EBT) has tight experimental control to maximize internal validity, but finds easily dx, non-complex disorders for research. If 30% helped = effective (not real world)
Effectiveness Research:
tx as practiced in real world, but only a few studies. ‘95 Consumer Reports study: 90% did well after tx, with clients who couldn’t choose length or therapist doing worse, but no random assign.
Client Variables:
Therapeutic outcome is most related to characteristics of the client, especially their ability to relate and amenability to new learning.
- 23% of client dropout after the 1st session and 70% dropout before the 10th
- Clients of low SES and education dropout earlier but are usually assigned to less experienced therapists. Blacks terminate earlier than Whites but this is related to SES not ethnicity. SES affects tx duration, but not outcome.

Age 65+ lowest psy dis, 25-44 highest, college & rural/sub lower
Therapist Variables:
Tx is facilitated when the therapist is female or of same gender as client. Attractiveness, trust and expertise account for 35% of outcome variance and more exp. therapists have lower dropout rates.
Therapy Relationship:
Quality of tx relationship as important as method with most important aspects being: therapeutic alliance, cohesion in group tx, empathy, goal consensus and collaboration. Also, positive regard, genuineness, feedback, alliance repair, self-disclosure, managing counter-transference
Total Quality Management (TQM):
focused on the continuous improvement of an organization by looking at needs of the customer and quality of work and finished product.

Goal: reduce ineffective, wasteful programs and involve the entire organization and empower employees.

TQM five premises:
1) Customer Focus
2) Total Involvement
3) Measurement
4) Systematic Support
5) Continuous Improvement
Quality Assurance:
monitoring and evaluating a plan’s health care services in terms of availability, accessibility, adequacy & appropriateness.
QA uses monitoring patterns and outcomes of care, satisfaction surveys, reviewing targeted dx & tx, comparing current and past performance.
Utilization Review:
focused on conserving cost and resources using reviews, second opinions and case management.

Goal: evaluate medical necessity, appropriateness, cost effectiveness and quality or services.
Risk Management:
reduce inapp practices to limit liability for malpractice
Biofeedback:
Involves Operant Conditioning of involuntary Autonomic Nervous System (ANS) functions to decrease sympathetic arousal (combined w/ relaxation).
Thermal Biofeedback:
Temperature biofeedback measures peripheral skin temp and is commonly used to tx migranes and Reynaud’s disease.

Goal: to increase peripheral skin temp, often combo w/autogenic tx (warm/heavy)
Electromyography (EMG):
measures surface muscle tension and is used to tx tension headaches and TMJ and back pain.

Goal: to either reduce EMG levels or equalize tension in parallel muscle groups. Often combo w/ progressive or passive relaxation training and for neuromuscular rehab.
Electroencephalography (EEG):
measures brain waves and is used to tx people suffering from hyperactivity or seizure disorders.
Galvanic Skin Response (GSR):
also called Electrodermal Response (EDR), measures skin conductivity or sweat. Used in combo with relaxation training for GAD w/ the goal of reducing GSR levels
Feminist Therapy
Feminists promote independence and autonomy. Do not attempt to “bond” b/c they don’t want to foster dependence. View sexism as underlying cause of problems and don’t focus on “pathology.” Strive for egalitarian relations w/client and make approp. self-disclosures, advocate socio-political change
Prochaska’s Transtheoretical Model of Bx Change:
used w/ addiction, eating disorders and weight management and promoting health-related bx.
1) Precontemplation (denial of prob, no intention to change)
2) Contemplation (ack prob, but ambivalent, no attempts to change)
3) Preparation (committed to change and begin plan: benefits > barriers)
4) Action (Bx change is initiated, others recognize progress toward change)
5) Maintenance (After 6 mo of Action; prevent relapse, maintain gains)
Five-Factor Theory of Personality (The “Big 5” Model):
“OCEAN” 5 basic personality traits:
1 )Openness to Experience
2) Conscientiousness
3) Extroversion
4) Agreeableness
5) Neuroticism; Scored high to low on each
Family Therapy: General Sys. Theory:
System is interaction of component parts seeking homeostasis
Cybernetics:
focuses on the circular nature of feedback loops. Negative Feedback loops: tend to decrease change in the system to maintain status quo. Positive Feedback loops: increase change to promote more positive environment
Psychodynamic Family Tx:
focus on individual maturation, clarifying communication, increasing honesty. Marital Schism (separation), Marital Skew, Family Sculpting
Object Relations Family Tx:
(Framo) focus on awareness of transference & projection b/t family members. Family of origin sessions (each family)
Minuchin: Structural Family Tx:
family is a sys w/ hierarchy of power. Strong parental coalition and clarity, firmness of boundaries important.

Rigid Triads: Triangulation (kids caught in middle of parents = paralyzed),
Detouring (blame one kid as source of probs IP),
Stable Coalitions (kid & 1 parent unite)

Goal: unbalance & reorganize w/clear flexible boundaries. Therapist joins family & uses taking sides, blaming & forming coalitions
Communications Family Tx:
MRI group (Palo Alto): Satir, Watzlawick, Bateson, Jackson & Haley.

Coined term Double Bind : maladaptive comm. that has 3 elements:
1) If person does something they will be punished
2) Non-verbal cue conflicting w/ 1st element & punishment 3) Inability of person to escape.

Direct Technique: teach/pointing out comm.
Indirect Technique: paradoxical
Haley: Strategic Family Tx:
Combo of Minuchin’s hierarchy and Communications Family Tx with focus on communication & interactions. Focus is on family’s presenting prob ONLY (interrupt rigid feedback cycle, clearer hierarchy thr paradox intervention)
Milan Group: Systemic Family Tx:
Uses Systems Tx, Cybernetics (feedback loops) and Strategic (comm., reframe, paradox)

Circular Questioning: Usually one person or subsystem controls family. Circular questioning: asks members to express views on members and relationships within the family. Changes family thinking from linear/causal to reciprocal/interdependent.

Prescription of Rituals: involve secrecy/isolation/notebooks/parent outings
Bowen: Family Systems Tx:
Healthy families have clearly differentiated members & a balance of intellectual/emotional forces.

Unhealthy families function as a single organism w/ an IP thr which overt sx are expressed.

Family Emotional System = emotional oneness/emotional reactivity
Multigenerational Transmission Process: pathology repeats thr generations

Goal: personal differentiation from family of origin so true self can emerge.
Assessment is on 2 levels: degree of fusion and emotional triangles (closeness of 2 members excludes the 3rd) in presenting prob. Therapist shifts hot triangle, & focuses on emotionally avail family member by de-triangling & repairing emotional cutoffs: Started Genograms
Solution-Focused Tx:
(Shazer) roots in MRI group. Focus is on strengths & solutions, either past ones or future. Uses expectations in both client and therapist. Brief Tx 3-4 sessions.

Miracle Question (what would be diff?)
Exception Question (when did this not happen?)
Scaling Question (1-10)
Narrative Therapy:
(Michael White) non-systems view. Sx result from “problem saturated descriptions” filled w/ powerlessness. Main technique “Restory” clients difficulties are portrayed as “struggle for control” w/ their sx. Sx are externalized, exceptions are examined and a new identity emerges.
Cognitive-Bx Family Therapy:
Tx = assess cognitive appraisals of family to promote relationship-related cognitions that cause growth and adaptive functioning.
Marital Behavioral Therapy:
Most are similar.
1st bx analysis of couple
2nd positive reciprocity
3rd comm skills are taught including “I” statements.

(Stuart) combined operant learning and Social Exchange theory. Costs & benefits ratio maintains relationship. Quid pro quo contracts. “caring days” Focus of tx is not on conflict, but to increase reciprocity and commitment.
Group Therapy
Groups provide members opportunity to experience multiple simultaneous transferences, which highlight their interpersonal difficulties & pathology.
Yalom:
12 distinct beneficial factors for groups:
1) insight
2) instillation of hope
3) universality
4) imparting information
5) altruism
6) corrective recapitulation of the primary family group
7) development of socializing techniques
8) imitative bx
9) interpersonal learning
10) group cohesiveness
11) catharsis
12) existential factors.

Cohesiveness: most critical component of successful group tx, cohesive groups have greater acceptance, intimacy understanding and permit conflict.

Initial Stage: members attempt to get oriented, participation is hesitant, stereotyped & restricted. Search for commonalities, give & seek advice, talk to therapist not each other.

Second Stage: conflict among members, rebellion towards leaders, attempts at dominance.

Third Stage: closeness, intimacy & cohesion. Self-disclosure is beneficial.

Dropout = denial, somatization, severe pathology, low motivation & low SES and/or IQ
Crisis Intervention
Crisis is an internally experienced, acute disturbance resulting from a person’s inability to cope with the events experienced.
Crisis Theory:
centers on concept of homeostatic equilibrium.
Caplan delineated four phases of a typical crisis situation:
1) when crisis begins person feels emotional tension & disorganization & tried to manage w/ previous coping mechanisms
2) coping mechs fail further disorganization occurs
3) increased tension level, other internal and external resources used
4) if these fail extensive personality disorganization & emotional breakdown occur.
Crisis Treatment:
Rapid tx is the most crucial aspect so that chronic sx don’t develop.

Tx includes: establishing rapport, reviewing steps that led to crisis, helping client understand maladaptive reactions, coming up w/ more adaptive ways of dealing w/ crisis. Crisis Intervention is terminated as soon as the crisis is resolved and client understands steps that led to the incident. Different from short-term tx b/c focus is on crisis not obtaining higher level of functioning