Clinical Psychology 4

Question 1

What did Bowen add to Family Systems theory?

Answer 1

• consideration of extended family members

- intergenerational process of family dysfunction

Question 2

What are the eight interlocking constructs of Bowen’s Extended Family Systems theory?

Answer 2

• differentiation of the self
• triangulation
• nuclear family emotional system
• family projective process
• emotional cutoff
• multigenerational transmission process
• sibling position
• societal regression

Question 3

In Bowen’s Extended Family Systems theory, what is “differentiation of the self?”

Answer 3

an individual’s ability to separate his/her intellectual and emotional functioning from the family; low ability results in “fusion” with other family members

Question 4

In Bowen’s Extended Family Systems theory, what is “triangulation?”

Answer 4

when two family members’ conflict involves a third person, e.g., a child becoming paralyzed by parents’ conflicting demands (no-win)

Question 5

In Bowen’s Extended Family Systems theory, what is the “nuclear family emotional system?”

Answer 5

a nuclear family’s mechanisms for dealing with tension and instability

Question 6

In Bowen’s Extended Family Systems theory, what is “family projective process?”

Answer 6

projection of parental conflicts and family problems on to children

Question 7

In Bowen’s Extended Family Systems theory, what is “emotional cutoff?”

Answer 7

children’s dysfunctional methods for removing themselves from emotional ties to parents; leads to lack of self-differentiation

Question 8

In Bowen’s Extended Family Systems theory, what is the “multigenerational transmission process?”

Answer 8

escalation of family dysfunction across generations, leading to severe dysfunction

Question 9

In Bowen’s Extended Family Systems theory, what is “sibling position?”

Answer 9

effects of birth order, e.g., older children being expected to be responsible for younger ones

Question 10

In Bowen’s Extended Family Systems theory, what is “societal regression?”

Answer 10

impact of social stress on family system

Question 11

What is the primary goal of Bowen’s Extended Family Systems therapy?

Answer 11

encouraging differentiation of the self, a lack of which underlies problems of triangulation, projection, emotional cutoff, and multigenerational dysfunction

Question 12

What are two typical interventions in Bowen’s Extended Family Systems therapy?

Answer 12

• genograms: schematics of at least three generations of family systems, including relationships, geography, and significant life events
• triangulation: therapist casting her/himself as neutral third member between client pairs to help reduce fusion and increase self-differentiation

Question 13

How did Minuchin’s Structural Family therapy contribute to family systems theory?

Answer 13

added concise, directive, here-and-now framework for understanding and treating family dysfunction; the therapist undermines homeostasis, jarring the system to a more functional level

Question 14

What are four key concepts in Minuchin’s Structural Family therapy?

Answer 14

• family system: family is a system, not a collection of individuals
• family structure: members relate to each other based on implicit structure, with rules, rituals, etc.
• subsystems: members form groups within the family system
• boundaries: rules determining amount and type of contact between members; extreme ends of range are enmeshment and disengagement

Question 15

What are three types of boundary problems that occur in Minuchin’s Structural Family therapy when a subsystem uses non-subsystem members to address subsystem conflicts?

Answer 15

• triangulation: parents demanding a child side with him/her against the other (as in Bowen)
• detouring: parents reinforcing a child’s deviant behavior as a distraction from problems between parents
• stable coalition: parent siding with a child against a parent

Question 16

What are some of the goals and techniques of Minuchin’s Structural Family therapy?

Answer 16

• primary goal is to restructure family to be more functional
• joining: therapist blends in with family by adopting family language and style (mimesis) and identifying with their values and history (tracking)
• family map: charting transactional patterns of members, assessing specific patterns in general system
• restructuring: role playing relationships and situations to be understood and changed (enactment) and positively relabeling behavior (reframing)
• blocking: preventing family from engaging in normal dysfunctional behavior so as to adopt new patterns

Question 17

What distinguishes Haley’s Strategic Family therapy?

Answer 17

• emphasis on power struggle between homeostasis of family dysfunction and therapist’s attempts to disrupt those patterns
• focus on the current problem (in service of improving overall system)

Question 18

What are some of the techniques in Haley’s Strategic Family therapy?

Answer 18

• directives: direct instructions
• paradoxical directives: instruction to engage in problematic/symptomatic behavior
• reframing: offering an acceptable new meaning to an old behavior
• circular questioning: asking each family member to describe relationships and noting differences; helps members see issues from different perspectives

Question 19

Describe Stuart’s Operant Interpersonal Therapy.

Answer 19

A type of marital therapy based on operant conditioning and social exchange theory. Focuses on frequency and range of reciprocal positive reinforcements exchanged by the couple.

Question 20

Describe object-relations family therapy and how it is different from systems-based family therapies.

Answer 20

Based on psychodynamic principles, it argues that insight is a core requirement for family change and that intrafamily relationships can be understood in terms of transferences.

Question 21

What are some of the techniques of object-relations family therapy?

Answer 21

• non-directive listening
• analysis of transference, countertransference, and resistance
• development of safe environment
• interpretation of children’s play

Question 22

Who is generally credited as founder of group therapy?

Answer 22

J. L. Moreno, who develop group interaction and therapy techniques for a range of populations. He founded an association and journal for group therapists.

Question 23

What are the advantages of heterogeneous vs. homogeneous therapy groups?

Answer 23

Homogeneous groups may develop acceptance and understanding sooner, but difference among members of heterogeneous groups may provide for greater communication. Most therapists strive for a balance.

Question 24

List five factors to consider when forming a group.

Answer 24

• developmental level, which should be similar in children’s groups
• gender, also should be similar in children’s groups
• intelligence level, similarity here is believed to be most important for most groups
• stability, especially important for short-term, task-focused groups
  
  • closed: group starts and ends with same members
  • open: group admits new members over time
• size, ideally seven to ten

Question 25

List Yalom’s three principle stages of group therapy.

Answer 25

• formation, focusing on orientation, structure, purpose; characterized by inhibition, dependence upon leader
• power struggle, focusing on interpersonal interaction; characterized by members establishing their place in group, hostile communication toward leader
• cohesion, focusing on establishment of mutual trust; characterized by supportive and positive communication, increased self-disclosure and participation, a mature group

Question 26

List three responsibilities of the group therapy leader.

Answer 26

• knowledge of and skill with group dynamics and conflict management
• ability to identify and work with multiple transferences and countertransferences
• encouragement of group participation

Question 27

List three advantages of group co-therapy, as described by Yalom.

Answer 27

• complementing and supporting each other’s observation, knowledge and ideas
• increasing members’ potential transferential reactions
• male-female teams can evoke primary family transferences and model functional, respectful parenting

Question 28

What are two cautions to be remembered regarding group co-therapy, as described by Yalom?

Answer 28

• co-therapists must have a good relationship themselves, or the group will be distracted and unsettled
• co-therapists should not openly disagree with each other until group cohesion has developed, at which point it can model healthy disagreement

Question 29

List Yalom’s eleven therapeutic factors for group therapy.

Answer 29

• interpersonal learning*
• cohesiveness*
• catharsis*
• installation of hope
• universality
• imparting information
• altruism
• recapitulation of the primary family
• development of socializing techniques
• imitative behavior
• existential factors

*most important

Question 30

Which of Yalom’s eleven therapeutic factors are considered most important and why?

Answer 30

• Yalom believed the first three are most important
• high functioning groups rate interpersonal learning and universality as most important
• low-functioning rate installation of hope highest
• cohesiveness is most associated with group member improvement and outcome success; it is a prerequisite for other factors
• early confrontation, later positive alliance, later affective confrontation, fewer leader interventions in later sessions are associated with better outcomes

Question 31

What practices does Yalom recommend to reduce premature group member termination and enhance group therapy outcomes?

Answer 31

• prescreening of potential members

- post-selection preparation

Question 32

What are some advantages and disadvantages of concurrent group and individual therapy?

Answer 32

• advantage: themes identified in group can be explored in individual therapy
• advantage: useful for borderline PD and narcissistic PD, which require extensive intrapersonal exploration and external support
• disadvantage: attention received in individual therapy may discourage group self-disclosure