03_Brief Therapies Flashcards
Brief Therapies:
Shared Characteristics
Time-limited (6-30 sessions)
Focus on present-day concerns
Therapist has active role
Client is actively engaged in change process
Four Brief Therapy Models
Interpersonal Therapy
Solution-Focused Therapy
Transtheoretical Model
Motivational Interviewing
Interpersonal Therapy (IPT):
Origins
Klerman and Weissman (1984)
Originally developed as treatment for depression
Expanded to bipolar disorder, bulimia, substance abuse
Interpersonal Therapy:
Theoretical Influences
Adolf Meyer psychobiological approach
Sullivan interpersonal theory
Bowlby attachment theory
Interpersonal Therapy:
Eclectic approach
Combines elements of psychodynamic tx and CBT
Interpersonal Therapy:
Maladaptive Behavior Etiology
Lack of strong attachments early in life lead to problems in social roles and relationships
Interpersonal Therapy:
Main focus
Current social relationships
Interpersonal Therapy:
Primary Treatment Goals
Symptom reduction
Improved interpersonal functioning
Interpersonal Therapy:
How to Reduce Symptom Severity
Psychoeducation
Installation of hope
Pharmacotherapy, when needed
Interpersonal Therapy:
Four Primary Problem Areas Targeted In Therapy
Unresolved Grief
Interpersonal Role Disputes
Role Transitions
Interpersonal Deficits
Interpersonal Therapy:
Treatment Strategies
Encouragement of Affect
Communication Analysis
Modeling
Role-Playing (establish new ways of interacting)
Shazar’s Solution-Focused Therapy:
Main Assumption
Focuses on solutions to problems rather than the problems themselves
“You get more of what you talk about”
Solution-Focused Therapy:
View of Maladaptive Behavior
Understanding the etiology of a problem behavior is irrelevant
Focus is on solution only
Solution-Focused Therapy:
Therapeutic Relationship
Client = expert
Therapist = consultant/collaborator
Solution-Focused Therapy:
Three Questions
Miracle Question
Exception Question
Scaling Question
Solution-Focused Therapy:
Miracle question
Miracle happens overnight:
How do you know a miracle occurred?
What would be different?
Solution-Focused Therapy:
Exception question
Can you think a time in the past week when you did not have the problem? (or not as severe)
Solution-Focused Therapy:
Scaling Questions
On a scale from 1 to 10, …
…how did you feel last week?
…how motivated are you?
Prochaska’s Transtheoretical Model of Behavior Change:
Basis of Model
Identification of 10 empirically supported interventions
Derived from analysis of 18 therapy approaches
Transtheoretical Model:
10 Interventions
Consciousness raising
Self Liberation
Social Liberation
Dramatic Relief
Self Reevaluation
Counterconditioning
Environmental Reevaluation
Reinforcement Management
Stimulus Control
Helping/Supportive Relationships
Transtheoretical Model:
Original Application
Smoking cessation and other addictive behaviors
Transtheoretical Model:
Current uses
Addictive Behaviors
Weight Control
Treatment Compliance
Intimate Partner Violence
Financial Management
Transtheoretical Model:
View of Maladaptive Behavior
Model does not address etiology or characteristics of maladaptive behavior
Focus = factors that facilitate behavior change
Transtheoretical Model:
Six Stages of Change
Precontemplation
Contemplation
Preparation
Action
Maintenance
Termination
Transtheoretical Model:
Precontemplation Stage
Low insight into need for change
No intention to change
Denial or unsuccessful previous attempts to change
Transtheoretical Model:
Contemplation Stage
Awareness of need for change
Awareness of pros and cons of changing
Intention to take action within next 6 months
Ambivalence, lack of commitment to change
People can remain in this stage for an extended period
Transtheoretical Model:
Preparation Stage
Plans to take action in immediate future
(within one month)
Has a realistic plan of action
Transtheoretical Model:
Action Stage
Individual takes concrete steps to change behavior
Often begins with public commitment to change
Transtheoretical Model:
Maintenance Stage
Behavior change has been maintained for at least 6 months
Transtheoretical Model:
Termination Stage
Individual feels they can resist temptation
Confidence in no risk for relapse
Transtheoretical Model:
Assumptions
Progression through stages is not necessarily linear
Stages may be repeated several times
Interventions are most effective when they match individual’s stage of change
Transtheoretical Model:
Mediating Variables
Decisional balance
Self-efficacy
Temptation
Transtheoretical Model:
Decisional Balance
Strength of perceived pros and cons of the poem behavior
Plays a role in all stages
Particularly important during contemplation stage
Transtheoretical Model:
Self-efficacy
Confidence in ability to cope with high-risk situations without relapse
Transtheoretical Model:
Self-efficacy most needed for these two stage shifts
From contemplation to preparation
From preparation to action
Transtheoretical Model:
Temptation
Intensity of the urges to engage in problem behavior
Inversely related to self-efficacy
Decreases in later stages
Motivational Interviewing (Miller & Rollnick):
Original uses
Developed for clients ambivalent about behavior change
First used for alcohol addiction
Motivational Interviewing:
Current Uses
Alcohol Addiction
Smoking Cessation
Eating Disorders
Diabetes
Pain Management
Motivational Interviewing:
Theoretical Foundations
Rogers’ person-centered therapy
Bandura’s notion of self-efficacy
Motivational Interviewing:
Rogerian Influeneces
Empathy
Reflective listening
Non-confrontational responding to resistance
Motivational Interviewing:
Self-Efficacy
MI explicitly addresses client’s beliefs about their ability to change
Motivational Interviewing:
Focus of Treatment
Factors that impede ability to change maladaptive behaviors
*MI does not focus on etiology
similar to trans-theoretical model
Motivational Interviewing:
Primary Therapy Goal
Enhance intrinsic motivation through examination and resolution of ambivalence
Motivational Interviewing:
Four Therapeutic Principles
Express empathy
Develop discrepancies between current behavior and goals/values
Roll with resistance
Support self-efficacy
Motivational Interviewing:
“Microskills”: OARS
Open-ended questions
Affirmations
Reflective listening
Summaries
Motivational Interviewing:
Open ended questions
Questions that cannot be answered with “yes” or “no or other brief reply
Motivational Interviewing:
Affirmations
Expression of empathy and understanding
Motivational Interviewing:
Reflective Listening: 3 Components
Restatements
Paraphrasing
Reflection of feeling
Motivational Interviewing:
Summaries
Type of reflective listening
Especially useful for facilitating transitions
