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Reasoning in mental health 6 > Class 8 > Flashcards

Class 8 Flashcards

1
Q

Characteristics of Healthy Families

A
  1. Secure attachment
  2. External Environment
  3. Emotional expression
  4. Verbal communication
  5. Power
  6. Coping
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2
Q

Secure attachment

A

Emotionally accessible, responsive, engaged. Authoritative co-parenting; reasonable family organization
(Dysfunction: anxious or avoidant attachment)

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3
Q

External Environment

A

Can seek, accept network and community resources needed for growth and development
(Dysfunction: no friends, refusal of added help at school as child is normal)

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4
Q

Emotional expression

A

Are permitted to display full range - joy, surprise, sadness, shame, fear, sadness. Adults generally stay grounded emotionally & regulated in emotional or frustrating situations.
Empathic response. Differences heard, explored, respected; Minimal conflict; reconciled quickly.
(Dysfunction: anger or sadness ignored or minimized, uncontrolled reactions to situations)

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5
Q

Verbal communication:

A

Open ( subjects as appropriate to age and development)
Allow direct expression of & listen ,respect each other’s thoughts, feelings, worries; differences of opinion allowed
(Dysfunction: everyone must agree, have same emotion; speaking for another, sullen acting out, excessive criticism, blaming )

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6
Q

Power

A

Parent(s) as the clear executive team (“benevolent dictatorship”), rules are age and development appropriate (options and negotiations), authoritative style.
(Dysfunction: authoritarian (coercive and/or permissive style), child has all the power, parent - child alliance against others)

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7
Q

Coping

A

mutual support, cohesive unit, create meaning of adversity, positive appraisal (reframing), info-seeking,
role & belief flexibility, collaborative problem-solving of issues, humour
(Dysfunction: generally high emotional reactivity, frequent conflicts, rigid roles, rigid beliefs, denial of problems, scapegoating, use of threats, violence)

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8
Q

Systemic Family Therapy

A
  • Psychotherapy that works with the family as a unit in the same sessions.
  • Based on systems theory
  • Systems’ view is non-pathologizing; family caught in narrow problematic patterns for “good”, self- protective reasons (eg issue that caused fight not discussed as too afraid to hurt each other, swept under the carpet)
  • Average length: 5 - 20 sessions
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9
Q

Family

A

a transactional system where difficulties in any member have an influence on every other member, on the whole family as a unit ( eg father with clinical depression )

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10
Q

Indications for Family Therapy

A
  • Persistent frequent family conflict (eg: parents fighting re how to discipline, not a team re care-taking)
  • Child or adolescent: anxiety disorders, depression, conduct disorders, substance abuse, disordered eating
  • Conduct disorders co-morbid with neurodevelopment disabilities (intellectual, autism spectrum, ADHD)
  • 1st break psychosis
  • Major change or trauma that family struggling to address effectively (child with special needs, major illness etc)
  • Grieving an unexpected and sudden loss which is interrupting usual functioning
  • Adjustment to a new family member(s) (birth, adoption, blended families)
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11
Q

Contra-indications for Family Therapy

A 
Therapy unlikely to be effective : inability to engage in the work; unsafe
• Psychosis in parents
• Antisocial personality disorders
• Persistent , severe physical abuse
• Family members with the following will require other professionals to work in tandem:
- Chronic severe depression
-Chronic addiction behaviours
- High suicidal risk
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12
Q

4 Dominant Approaches:

A
  1. Cognitive-behavioural family therapy
  2. Structural family therapy
  3. Brief Strategic family therapy
  4. Emotionally -focused family therapy
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13
Q

Cognitive- behavioural Family Therapy (CBFT):

A
  • One’s thoughts influence feelings and behaviours ( “I am never good enough “…)
  • Premise is that family members’ thinking patterns (and linked feelings and behaviours) cause maladaptive choices & behaviours within the family.
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14
Q

(CBFT) Focus of work:

A

Present focused and goal -oriented

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15
Q

(CBFT) Strategies:

A
  • Identify problematic behaviours. Change behaviours with psychoeducation eg parental skill training : antecedent, behaviour, consequence (ABC) training
  • Identify automatic cognitions (thoughts, beliefs) which may be interfering with + behaviour change (eg “he’s just a bad kid like my ex-husband was”)
  • Invite change of automatic thoughts so that goals can be set for new adaptive thoughts & coping. Use re-framing ( cognitive - restructuring)- “the witch daughter may be crying out in distress because of …”)
  • Case example strategies
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16
Q

Indications CBFT

A
  • Conduct disorders
  • Childhood ADHD
  • Childhood anxiety disorders
  • Adolescent eating disorders
  • Paediatric bipolar disorder
  • Paediatric OCD
  • Trauma symptoms
  • Prevention of suicide attempts
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17
Q

Structural Family Therapy

A

Premise : child or adolescent difficulties are due to family structural imbalance where parents are not the
parents (children are in charge) or they cannot respond to changing demands (transition from childhood
to adolescence; R Family case)

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18
Q

Structural Family Therapy Focus of work:

A
  • Present versus the past; oriented towards change in family structure
  • Directive style of therapist
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19
Q

Structural Family Therapy Strategies:

A
  • Draw a genogram of family structure so family can see problems
  • Role plays in session :
    -to help parents be a “united front” , clearly in charge . Children can then be children ( relieve the “parentified child”).
  • to practice interactions which are developmentally appropriate to child or adolescent: time-out,
    active listening & empathic questioning by parents of adolescent
  • Homework between sessions so family can practice new interactions at home.
20
Q

Brief Strategic Family Therapy

A

Premise : identified symptom (eg. running away adolescent) is considered as serving a function for the family : reflecting the family’s difficulty is solving a problem (eg. couple conflict)

21
Q

Brief Strategic Family Therapy Focus of work:

A

“Join” with family, a full partner in change

22
Q

Brief Strategic Family Therapy Strategies

A

encourage families to behave as if therapist not present : guides family members to speak to each other versus to therapist .
-therapist directs, re-directs or blocks communication; helps members shift to healthy alliances , guides learning of family conflict resolution, behaviour management skills, parental leadership.

23
Q

Emotionally-focused family therapy

A

Based on well-substantiated attachment theory , an interpersonal theory where individuals are always placed within the context of their closest relationships .
Humans are social and homo vinculum (bonding is essential for survival).
Premise : family is the “secure base” which allows for “effective dependency to move in the world, explore , take risks , be competent”.

24
Q

Focus of work in EFFT:

A
  • Collaborative approach with family who are experts of themselves
  • Oriented to change
  • Uncover unacknowledged emotions and unmet needs that are behind the “family dance “of problematic interactions that cause distress and undermine
    secure attachment (eg. rejection, neglect, abandonment behind the conflicts re homework or chores). R Family
25
Q

EFFT Strategies

A

Identify deep emotions , “enactments” : explain directly to each other in session ;de-escalate conflict . Therapist guides family to shift to mutual understanding and new responsive & caring interactional patterns .
Once “ felt security “ in the family , more open to new skills’ learning or problem solving on their own.

26
Q

1st Session with family therapist:

A
  • “Joining” with each family member: “Let’s get to know each other as humans first” (linear questions, genogram, ecomap, commendation, humour )
  • Ask each family member “could you let each of us know why you came today / might be most worried about?” Note emotional & verbal responses to the question & each other.
  • Family Dance ( distressing interactional cycle): When stop, validate if usual “dance” at home. What does each think about it? (beliefs) .How does each person feel? ( attachment vulnerabilities). Ask each how have tried to
    “solve”.
  • Gentle probing of suicidal gesture, assessment of current risk.
  • Establish goals: can use solution focused question: Ask each what would see if magic wand would take problems away ( each of their solutions to own main worry)
  • Reflect observed family dance , distress of each and all members , commend courage in coming & talking ; questions for therapist, invitation to another session.
27
Q

Next and subsequent sessions (10 weekly sessions)

A
  • Collaborative Stance: thoughts, concerns, questions from previous session; questions to monitor progress
  • Brief psychoeducation supportive statements: to decrease blame, learn parenting as we go & from our own parents : ask parents if could describe how they were raised (children very interested in this!).
  • Linear Questions re family of origin nurturance (who did you turn when needed comforting ?) and discipline (who was the disciplinarian: how was it done?). History of
    attachments.
  • Reflection & evocative questions: what are hidden emotions and needs underneath current problematic family dance?
  • Ask if wish to discuss most recent mother - daughter “screaming match” Note details of the dance.
    Look for, wonder about “softer emotions” of “hurt”, “fear” behind the anger; ask family to speak about this directly with each other ( evoking , supporting a new conversation /dance).
    Once conflict is de-escalated ,mutual understanding and responsive care-giving is practiced & supported several times : shifting family to a new interactions :“corrective
    experience of secure attachment”
    Family then able to focus on calm and constructive discussion / negotiation of pragmatic solutions.
28
Q

The 7 Principles of Making Marriage Work

A
  1. Enhance your Love Maps
  2. Nurture Fondness and Admiration
  3. Turn Towards each other instead of Away
  4. Let your partner influence you
  5. Solve your solvable problems
  6. Overcome gridlock
  7. Create shared meaning
29
Q

Enhance your Love Maps

A
  • Partners intimately familiar with each other’s inner world- salad and T.V: interests, hopes, dreams, values. Ongoing curiosity about each other - asking of questions (eg how do you find being a father?)
30
Q

Nurture Fondness and Admiration:

A
  • Friendship at the core; like each other, mutual respect.

- Out loud communicating of appreciation of the small things (eg her humour, washing the floor, asking about your day)

31
Q

Turn Towards each other instead of Away

A
  • Small bids for partner’s attention, chit-chat , connecting with each other (eg brief back and forth re newspaper article), daily helpfulness, touching
  • 5:1 ratio of positive to negative interactions
  • Builds “ emotional bank” buffer which helps survive hard times.
32
Q

Let your partner influence you

A

Honouring and respecting each other opinions, finding common ground for decisions. Not about one person holding the reins

33
Q

Solve your solvable problems:

A
  • All partners fight

- Post-fight repair is the crucial distinguishing factor; avoid “festering wounds”.

34
Q

Overcome gridlock:

A
  • Definition: imagine 2 stuck fists with no room for air (compromise)
  • With perpetual problems (69%): are able to talk, listen, adapt to, modify, reduce great pain
35
Q

Create shared meaning

A

Common mission in life: creating meaningful purpose that is shared ( eg a family culture that includes space for individual dreams)

36
Q

Contra-indications to Couple Therapy

A
  • On-going emotional and /or sexual affair *
  • On-going physical abuse
  • On-going untreated addictions
37
Q

Couple Therapies

A
  1. Cognitive- behavioural Couple Therapy
  2. Gottman Method
  3. Emotionally Focused Couple Therapy
38
Q

Couple Therapies Length

A

5- 20 sessions

39
Q

C-B Couple Therapy:

A
  • Oriented to reducing marital distress by education and skills training.
  • Effective for reducing marital distress via communication & problem solving training & behavioural contracts between partners (starting or stopping behaviours)
40
Q

Gottman Method:

A
  • Oriented to “building a Sound Relationship House”: couples learning skills to foster affection & respect; break through conflicts’ gridlock. Foster deeper understanding of why they do what they do.
  • Key insight is that within the couple, negative emotions (“4 Horsemen of the Apocalypse”) have more power to hurt the relationship than positive emotions can help.
  • 5-step model for resolving conflict of solvable problems
  • Effective in reduction of marital distress by uptake of 7 Principles; report 20% relapse rate after couple intensive workshop (vs 30-50% of standard treatment)
41
Q

EFT Couple Therapy:

A
  • Oriented to the reduction of marital distress by:
    • Identifying couple conflict issues and the 4 negative interaction cycles ( “Demon dialogues”) in which their issues are expressed. ( eg pursue / withdraw)
    • In session, couple turn to each other and work to understand unacknowledged emotions and needs & change their “stuck” cycle of hurtful emotional responses to each other. ( case example of bedridden pregnancy)
    • Focus both on inner world of individual and the couple “dance”.
    • Effective in reducing marital distress by development of a more secure attachment; stable results over 2 years
42
Q

First session

A
  • “Get to know each other as humans”
  • Ask both for their description of why they are seeking therapy.
  • Empathic validation of observed negative interaction cycle (“demon dialogue” of pursue/criticize withdraw/avoid . “Protest of secure attachment needed in relationships”). Cycle re-framed as joint enemy.
    Gently probe
  • With caring and respect:
  • Ask questions re previous ways to solve “the problem”. Result of each: “impasse”
  • Ask each re their goals for therapy - agree “want to try and work it out” (with an implied threat of separation if he cannot change his opinion)
  • Ask for history of relationship (where they met, what attracted them to each other etc).
  • Ask each what is working well in relationship (Many current shared values and activities; examples of mutual support, satisfying sex life)
    -Commend strengths (hope- instilling)
43
Q

Sessions #2 and #3

A

Individual sessions for each partner

  • Foster therapeutic alliance with each partner alone
  • Observe & interact with each partner in the absence of the other
  • Ask questions re commitment to relationship, substance abuse, physical violence, affairs , past hurtful incidents (“attachment injuries”) , history of attachment in families of origin ( “who comforted you ?”)
  • Check hypotheses.
  • Secrets not kept by therapist; sharing encouraged.
44
Q

Subsequent sessions:

A
  • Continue to focus and acknowledge individual emotions (creating “secure base”)
  • With empathic expansion of the story, repeated & carefully timed presentation of data. Couple agrees to only business -related interactions.
  • With evocative questions: expand to emotions & thoughts, beliefs about themselves & each other
    behind her criticism /pursuit and his withdrawal /avoidance
  • Look for, and, note & commend positive bids for contact (reaching for emotional engagement)
  • Eventually these new exposures & interactions become “powerful bonding events” = more secure attachment for safety net of future discussions & problem-solving
45
Q

Couples therapy, all 3 therapies

A

are concerned with the couples’ distress caused by
rigidly held positions , beliefs (cognitions, expectations)
• all 3 therapies currently deal with emotions;

Reasoning in mental health 6 (10 decks)

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