Counseling families, diagnosis, neurocounseling, and advanced concepts Flashcards
What is the DSM?
- Book of nosology. DSM-III (1980) moved focus from psychodynamic to medical model, grow in size until the DSM-IV in 2000. Still need to use ICD codes for insurance
- DSM-5 released in 2014 – lots of controversy.
- Each chapter is a classification of similar disorders or spectrum of disorders that match the ICD and chapters follow age-related or developmental patterns. The new DSM is nonaxial
- Includes gambling in section on additions and combined diagnoses of substance abuse vs. substance dependence
- eliminated the term “mental retardation” replaced w/ intellectual disability, ASD replaces autistic disorder, Aspergers disorder, etc, ADHD is in the neurodevelopment category
- depressive disorders include disruptive mood dysregulation disorder - intended to reduce the number of kids under 10 diagnosed and treated with bipolar disorder
- gender identity disorder has been replaced with gender dysphoria - 6 months of feelings of difference assigned gender
- etc etc
What are some of the benefits of a formal diagnosis?
- gives counselors a shared language to communicate with other practitioners, clients, families, and health system
- client might feel better knowing he/she is not the only person w/a given condition and family and friends might be more compassionate
What are some of the drawbacks of a formal diagnosis?
- diagnosis becomes a part of person’s identification (I can’t help it, I have ADHD, etc)
- Diagnostic labels make client feel like rate difficulty is outside of his or her control and therefor he or she is not responsible for various behaviors
- could become scapegoat for family problems and not allowed to be independent
What happens to the client’s and counselor’s brains during counseling?
According to recent neuroscience research, both the client’s and counselor’s brains change during therapy. Recently, people believe it is helpful to know what is going on in the brain to help counseling and so use things like fMRI and PET scans to measure different types of brain activity.
What is neuroplasticity?
This is the concept that the human brain can change and new neural connections can be made even later in life, regardless of our genetics or life experience. It is as if the brain is rewiring itself.
What is neurogenesis?
neurogenesis is the concept that new neurons can be formed – exercise, for example, can boost serotonin release to fight depression.
How do different therapies influence neuroplasticity?
Counseling techniques that focus too much on the negative can have an undersirable impact by influencing the interaction between the amygdala and frontal cortex. Cognitive therapy or reframing does roughly the opposite and can increase serotonin and thus positive thoughts.
What is the mirror neuron concept?
The mirror neuron concept indicates that a neuron or neurons fire if you perform behavior and that the SAME neuron fires if you witness the behavior in someone else. We see this a lot in terms of how we feel empathy or, say, how we feel fear if we watch someone else being chased. These examples highlight IPNB (interpersonal neurobiology) and show that empathy can now be measured in the brain.
What are some other neurobiological observations about human behavior?
- The brain fires at a high level when we see a face similar to our own
- children growing up in an impoverished setting have higher than desirable levels of stress hormones like cortisol, which hinders performance and lessens the chance of escaping poverty
What is cognitive enhancement therapy (CET)?
Cognitive Enhancement Therapy (CET) is included in the evidence-based neurocounseling modalities. Here the clients, often diagnosed with schizophrenia, use neurocognitive video games and coaching to improve functioning.
What is some of the criticism of neurocounseling approaches?
- Some say that our field grew out of a humanistic tradition and that this neurobiological approach fails to look into the entire human experience
- Counselors and researchers might be attaching too much important to increased blood flow in various areas of the brain
- Many researchers do not agree that fMRI and PET scans are safe. What might be necessary to decide about medical intervention might not be wise for research, diagnostic, or counseling purposes. And these specific tests might not be quite accurate enough.
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What is the concept of the identified patient?
This is a dynamic in which people come in looking for help for a kid or a family member but must counselors believe that the entire family system is dysfunctional and thus is the identified patient and in need of treatment. Historically the identified patient was seen as the person who was having the problem.
If you are seeing a couple in therapy, can you tell one member of the couple something the other member of the couple has confided in you in confidence?
No. According to ethics guidelines, counselors must not disclose information about one family member in counseling to another without prior consent.
What are the divorce statistics in the US?
- The average divorce takes place after 8 years of marriage
- About 50% of marriages end in divorce
- 65% of second marriages end in divorce
- 70% of third marriages end in divorce
- Remarriages are common - 4 in 10 new marriages are remarriages
- Most divorcees do not stay single for long: 30% remarry within 12 months of being divorced and on average, divorcees remarry in 3-4 years
Can a counselor engage in a romantic or sexual relationship with a student or supervisee ?
No. This is unethical. This refers to in person as well as electronic relationships.
Who is the fastest growing clientele for professional counselors?
People experiencing marriage and family problems. Coursework for CAACREP programs and those set forward to meet the AAMFT curriculum (for marriage and family therapists) are similar though not identical
What is circular/reciprocal causality?
Most family counselors believe in circular causality (vs linear causality – a causes b). This is when person A’s reaction influences person B’s response, which then influences person A’s next response, and so on. Thus, since everyone is influencing everyone else, the problem resides in the family rather than in a given individual.
Performing family therapy often seems to resemble group therapy, though most group models do not work well with families because they are a very specific kind of group.
What is cybernetics?
Cybernetics was pioneered in the early 1940s and named by MIT mathematician Normed Wiener. Weiner was asked to investigate how guns could be aimed to hit moving targets. In his work, which was initially related to machines, was ultimately used to analyze family therapy thanks to Gregory Bateson who suggested that the family has feedback loops that self-correct the family system.
What is homeostasis?
Homeostatsis, which can be good or bad, refers to maintaining a balanced state. Note that while this balanced state CAN be healthy, it is not necessarily. The family will attempt to hold onto a given pattern of functioning that, though stable, may be quite dysfunctional.
What is adaptability?
This refers to a family’s ability to change or to display flexibility in order to change. Adabptability is the ability of the family to balance stability (also known as morphostatis) as well as change (also known as morphogenesis).
What is enmeshment?
This occurs when family members are over involved with each other and thus lose their autonomy.
What is nonsummativity?
This is a concept suggesting that any system including the family is greater than the sum of its parts (I.e. the individuals in it) and therefore it is necessary to examine patterns rather than merely each individual’s behavior.
What is morphostatis and morphogenesis?
- Morphostasis: the ability of the family to balance stability
- Morphogenesis: a family’s ability to change.
Note that adaptability is the ability of a family to balance BOTH morphostais and morphogenesis.
What are mandatory ethics vs. aspirational ethics?
- mandatory ethics are guidelines that are strictly enforced – if you violate a mandatory ethic, there are consequences for your actions. Mandatory ethics can also be called standards of practice
- Aspirational ethics describe ideal or optimal practice. Pro bono services would fall into the category because it would be difficult to win an ethics’ violation against a counselor because he wouldn’t see a counselor for free! Counseling ethics do mention pro bono work, but they do not stipulate the principle as limited to “seeing a client for free’ so the best answer seems to be aspirational. There will likely be many vague questions about this stuff on the exam
What is experimental conjoint family therapy and who is it associated with?
Conjoint Family therapy is a type of therapy that implies two or more family members are in therapy at the same time and was created by Virginia Satir. She felt that a major goal of therapy was to improve communication between family members. According to Satir, four basic patterns prevented good communication under stress.
Satir also used family sculpting to help visualize family dynamics.
How did Satir’s experimental conjoint family therapy clash with Minuchin’s structural family therapy?
Virginia Satir was a social worker who began seeing families in private practice in 1951. She felt that the family could be healed via love, while Minuchin, the father of structural family therapy, felt that family therapy was a science requiring therapeutic interventions well beyond warmth. Satir and Minuchin clashed.
What are Satir’s defensive posters?
According to Satir, four basic patterns prevented good communication under stress. She called these defensive postures or stress positions.
- placating - you try to please everyone out of a fear of rejection. This style causes the person to sacrifice his own needs as a way of dealing with stress. The placater is a people pleaser.
- blaming - basically says “it’s your fault I’m the way I am” and might sacrifice others to feel good about himself or point fingers to avoid dealing with his own issues
- being overly reasonable - likely to engage in the defense mechanism of intellectualization. This person is described as “functioning like a computer” to keep his or her emotions in check. This person is emotionally detached. Could also be called the responsible analyzer
- being irrelevant - Will distract the family from the problem by constantly talking about irrelevant topics
Who is Ludwig von Bertalanffy?
He was the biologist who popularized the notion of the connectedness of all living things or the so-called systems theory model. The analogy is that the family is more than merely the separate persons but rather a system with rules and patterns that connect members, etc. Murray Bowen based his family therapy on systems theory.
Who was Carl Whitaker?
Carl Whitaker, sometimes called the dean of experiential family therapy, was fond of saying that experience not education is what changes families. He said that experience goes beyond consciousness and that the best way to access the unconscious is symbolically. Whitaker’s theory is also referred to as experiential symbolic family therapy.
Whitaker could be described as atheoretical. He asserted that theory is often used as an excuse to keep therapists emotionally distance from the family. Whitaker promoted “craziness” and creativity of family members.
How did Carl Whitaker interact with the family?
His posture would be to join the family and experience it as if he were a family member. Whitaker was a psychiatrist by training and he intentionally minimized the importance of theory, noting that therapeutic interaction is more of an art.
Whitaker also believed that a co-therapist is helpful.
What is psychotherapy of the absurd?
Whitaker would sometimes use “psychotherapy of the absurd” types of activities in his work. For example, he might ask a couple who was having a power struggle to actually have a tug of war in order to see who really had control.
Who is Maxine Maultsby Jr.?
Maultsby is a psychiatrist who is noted for creating rational behavior therapy (RBT) that is similar to Ellis’s REBT except it also has a written self-analysis.
What is David Premack’s principle or law?
Premack, a behaviorist, suggests that a family member must complete an unpleasant task (known as a low-probability behavior or LPB) before he or she would be allowed to engage in a pleasant task known as a high-probability behavior or HPB. This is known as Premack’s principle.
So, for example, the therapist might say to one of the family members, “you must complete your sociology essay before you can use the family car and go out with your friends”.
Note that behavioristic family and marriage therapists also generally rely on the same theorists as individual behaviorist therapists.
What is quid pro quo in the context of family therapy?
In Latin, quid pro quo means “one thing for another” or “something for something”. This is a technique that makes use of a behavioral contingency contract in order to get one person in the family to do something as long as the other member agrees to do something comparable. So for example, if the therapist suggested that since the child likes to play golf, every time he cuts the grass the father would take the kid to play golf – and has them sign a contract agreeing to the policy.
Note that quid pro quo can also refer to an ethical violation (or even legal violation), particularly in the context of sexual harassment – I.e. “I’ll supervise you as long as you sleep with me” is quid pro quo.
How do behaviorists think about time-outs?
Behvariorists consider time-outs to be a form of extinction. In this instance, the child is removed from an environment so that they do not receive reinforcement for dysfunctional behavior.
What is the concept of reciprocity in marriage and family therapy?
The concept of reciprocity in a marriage assets that in most cases, people will reinforce each other at about the same level over time (I.e. each will participate in the tasks of the marriage and household equally, each will appreciate and support the other equally, etc). When this doesn’t happen, it typically results in marital discord.
What is systematic desensitization and how might it be used in marital therapy?
Joseph Wolpe’s systematic desensitization pairs feared mental imagery with relaxation to eliminate the fear. This could be used in a case when, for example, a couple is having sexual problems based in anxiety.
What is thought stopping?
This is a behaviorist technique created by psychiatrist Robert Liberman and social worker Richard Stuart. Thought stopping is intended to…stop thoughts. A man who was fantasizing about his neighbor’s wife, for example, would be taught to yell “Stop!” in his mind as loudly as possible each time he had a sexual thought about his neighbor.
What is causal comparative research?
This is research that occurred in the past (ex post facto) and the researcher did not have control over the independent variable. A t-test COULD be used to explore whether there differences between two groups.
However, note that a t-test would not be used in a correlation study.
What is family sculpting?
Family sculpting, popularized by Virginia Satir, is an experiential/expressive technique in which a family member places other family members in positions that symbolize their relationships with other members of the family. Finally, the member places him or herself. This helps the therapist understand family dynamics that may have been missing from a mere discussion of family issues.
Which theorist is associated with psychodynamic family counseling?
Nathan Ackerman. Ackerman, an analytically trained child psychiatrist, recommended studying the family vs. just the child being brought in as the identified patient. Some experts consider this the true beginning of the family therapy movement.
Because he was analytically trained, Ackerman, unlike many family therapists, was concerned with the internal feelings and thoughts of each individual – as well as the dynamics between them. Prior to Ackerman, it was considered inappropriate to include family members in analytic treatment.
What is an object in psychoanalytic family therapy?
In this context, object means a significant other with whom a child wishes to bond. This is the notion that an individual (or an individual’s ego) attempts to establish a relationship with an object (often a person or part of the body) to satisfy needs. When this doesn’t happen, anxiety occurs.
What is does the term interoject mean?
In a psychoanalytic family therapy, the term introjects really means that the client unconsciously internalizes the positive and negative characteristic of their objects into themselves. Eventually these introjects (taking in personality attributes of others that become part of your own self-image) determine how the person will relate to others
What is the psychoanalytic concept of splitting?
Splitting occurs when the client sees an object (another person) as either all good or all bad. Splitting allows one to keep anxiety in check by making objects predictable. This tendency begins in childhood, usually by categorizing one’s mother as all good or all bad. It could be expressed in therapy as seeing the therapist as all good or all bad.
Removing dysfunctional introjects from childhood is curative.
What is first-order and second-order change in family therapy?
- First-order change can be described as changes hat are superficial – behavioral changes occur but the organization or structure of the system do not change. First-order change often ameliorates symptoms but the changes are often temporary
- second-order change is when the actual family structure changes in a way that altered and undesireable pattern of behavior. Second order change is more desirable than first order change.
What is a greek chorus in the context of family therapy?
A greek chorus refers to a consultant or supervisory team that observes a session from behind a one-way mirror and sends messages to the therapist or the family. This so-called treatment team approach is very popular with strategic therapists. The counselor may accept or reject notions put forth via the Greek chorus.
What is persistent depressive disorder
This was previously labeled dysthymia but was updated in the DSM-5 to refer to a low-level chronic depression that occurs for more days than not, for two years or more.
Who are James Framo and Robin Skynner?
James Framo and Robin Skynner are both famous psychoanalytic family therapists.
- Framo believes that important objects (usually parents) often fuel “love-hate” feelings in kids. The more pathological the early life experiences are the more that person as an adult will make all relationships fit the internal “love-hate” scenario from childhood
- Skynner is a British psychoanalyst who feels that kids who had poor role models as children possess protective systems. This means that such individuals harbor unrealistic expectations of people in current relationships carried over from childhood.
Who are Cloe Madanes and Jay Haley?
Cloe Madanes and Jay Haley are associated with the strategic family therapy, also known as the MRI approach.
In this paradigm, the therapist gives directives or prescriptions, often paradoxical. Reframing and relableing problems is comon in this modality. This approach warns us that double-bind communication could cause serious psychopathology.
More focused on techniques for change than theoretical constructs. Less concerned with changing family structure or hierchy than focusing on the faulty cycles of interaction that are set into motion by misguided attempts to solve problems. Lots of focus on circular causality, feedback loops, homeostasis and cybernetics.
What are some concepts and techniques in Jay Haley’s Strategic therapy?
- Strategic therapy is pragmatic and often focuses on abating symptoms - it is very action-oriented and solution/symptom focused
- Haley believed in giving clients directives (I.e. “if. your daughter threatens suicide this week, I want the entire family to stay home and nobody leaves for the day”)
- Used paradoxical concepts like:
- double-bind concept (a paradoxical directive - saying both to do and not do something)
- prescribing the symptom - I,e. telling a smoker to go smoke a bunch
- restraining - warning the family or individual about the negative consequences of change
- positioning - when a helper accepts the client’s predicament and exaggerates it
- relabeling - also called redefining and reframing - this is when you redefine a situation in positive context to make the situation or behavior seem acceptable to the client. The situation is described in a positive light to evoke a different emotional response.
- Believed that a malfunctioning hierarchy is evident in most dysfunctional families – I.e. the perverse triangle (when two members are different hierarchical levels team up against a 3rd member)
- Assets that a symptom controls a situation when everything else has failed. Symptoms are sometimes viewed as a metaphor for a difficulty being expressed by another family member
- Also sometimes known as the MRI model or the communication model
What is Jay Haley’s double bind concept?
This is a no-win situation characterized by contradictory messages such as “never smoke again” (in example, this is told using hypnosis) and “smoke as much as you want”. It constitutes a paradox in the sense that the person is told he or she can engage in a behavior that they wish to abide. Although it is used therapeutically, Gregory Bateson believed that when parents repeatedly double-bind children it could result in schizophrenia. This is considered both a paradoxical intervention and a directive.
One of the reasons why this works is because when a person follows a paradoxical directive, the symptoms are under therapeutic control - I.e. the client could say, “you hypnotized me and I smoked 5 cigarettes after the session” and the therapist would say, “of course you didm I told you to smoke as many as you could”. Essentially, the helper prescribes what the client or family would probably do anyway and tells them to exaggerate it. This is known as prescribing the symptom
How does strategic family counseling consider the person with the power in the family?
Haley believed the person with the power in the family has the authority to make rules and enforce them. and he believed that you enhance the power of a family member within the context of therapy by speaking to him or her first during the initial session of therapy.
What is Cloe Madanes theory of family therapy?
- Cloe Madanes believes in the concept that symptoms serve a function - I.e. a child sees her mom is depressed so throws a glass cup on the floor, which brings her mother out of the depressed state and makes her angry and powerful
- This is also an example of incongruous hierarchy. In normal family hierarchy, the mother controls the daughter but in this case, since the daughter is in control, the hierarchy is incongruous.
- She believed that one of the keys to family functioning is to help children find more direct ways to help their parents so that their symptoms (I.e. throwing a cup) no longer serve a viable purpose
- Advocated somewhat paradoxical pretend techniques
What are Cloe Madanes’s pretend techniques?
Madanes used a pretending technique in which the family enacts a make-believe scenario of the problem (I.e. a child who has panic attacks pretends to have one during the session and the parents pretend to help him). Most experts maintain that the pretend technique is more gentle and less confrontational than traditional paradoxical interventions.
What is “restraining” in family therapy?
In restraining, the therapist may warn the family or individual about the negative consequences of change. The counselor might tell the family to take it very slow or expect a relapse. Restraining helps overcome resistance by suggesting that it might be best if the family does not change!
What is positioning?
Positioning occurs when a helper accepts the client’s predicament and then exaggerates the situation. Positioning paints an even more negative picture of the situation for the client than restraining (warning the family or individual about the negative consequences of change).
The strategic interventions of restraining, positioning, prescribing the symptom, and relabeling are all examples of paradoxical interventions since they defy common sense.
What is behavioral disputation?
This is associated with Albert Ellis’s REBT. In REBT the primary goal is to dispute and change the client’s cognitions. In behavioral dispute, the client tries to behave in a way that is markedly different from his normal, though undesirable, pattern.
What is cultural encapsulation?
This is when a counselor imposes goals from his or her own culture on people from another culture. This is a no-go in counseling.
What are some statements that are trends among African American families?
- Fewer African American people are getting married
- African American people are less likely to be concerned about gender roles (I.e. both men and women cook meals, work outside the home, etc)
What family therapy approach might make the most sense when working with an African American family?
Bowen’s family therapy, Minuchin’s structural therapy, or Haley’s strategic therapy. Several studies indicate that African American families are less likely to seek professional treatment because they often rely on the extended family and the church for support and guidance. When family counseling is utilized, problem-focused, brief, or multigenerational approaches seem to fare best.
What might the best approach be when counseling Asian American families?
Solution-focused/problem-focused modalities.
What are some mental health trends among Asian American families, according to recent research?
- Asian Americans might be mentally healthier than the general population (8.6% had mental health symptoms compared to 17.9% for the population at large)
- Those with a DSM diagnosis were less likely to seek treatment (34.1% for Asian Americans vs. 41.1% for the general population)
What are some trends among Latinx families?
- They have a higher unemployment rate than the national average and often live in poverty. They earn high school diplomas and college degrees less than the national average.
- Latnix people often expect mental health treatment to mimic treatment they receive from their medical doctors, so short-term behavioral family therapy or structural approaches work well
What is the family therapy term “cohesion”?
Cohesion refers to the level of emotional bonding between family members, as well as the family’s level of enmeshment or disengagement.
What is the circumplex family model?
The circumplex family model, created by Olson, Sprenkle, and Russell, suggests that family functioning can be described in two dimensions:
- cohesion - the family’s level of emotional bonding between family members
- adaptability - the family’s balance between stability and change or, in other words, between morphostatis and morphogenesis)
They believed that the key factor is that the family should have balance in both cohesion and adaptability.
What are some trends in Native American families?
- They are a very diverse group, belonging to over 550 state-recognized tribes
- extended family and the tribe are very important
- A high percentage of children are placed in foster care homes, residential facilities, and non-Native adoption homes
- Have significant issues with both alcoholism andsuidiced. Suicide is the leading cause of death among Native Americans/Alaska Natives between 10-34 and alcohol is involved in 69% of the suicides for all age brackets in this cultural groups. The high rates of suicide and alcoholism create issues with suicide bereavement, fetal alcoholism, and cirrhosis of the liver
What is Murray Bowen’s intergenerational family therapy?
- One of the primary goals of intergenerational family therapy is differentiation - that one can separate one’s intellect from one’s emotional self
- Believed in the phenomenon of triangulation - When a dyad having problems puts a third person in the middle to try to reduce stress on the dyad
- Used genograms as a therapy tool – believed they must go back at least 3 generations.
- Is concerned with the nuclear family emotional system (family’s emotional system is influenced by previous generations)
What is Bowen’s concept of triangulation?
Bowen’s concept of intergenerational family therapy asserts the phenomenon of triangulation: That when a dyad is under stress, a third person is recruited to help stabilize the difficulty between the original dyad. This could even be a child placed in the middle of the conflict. This rarely helps the situation and typically makes the situation between the original pair worse.
What is Bowen’s concept of differentiation?
Bowen understood differentiation as ability to be in emotional contact with others yet still autonomous in one’s own emotional functioning.
Fusion, the opposite of differentiation, occurs when individual choices are set aside in service of achieving harmony in the system. A person who does not possess differentiation does not have a clear sense of the self and others.
What is Bowen’s concept of the nuclear family emotional system?
This is concept that although the current family in therapy has an emotional system, this emotional system is influenced by previous generations, whether they are alive or dead. Bowen originally referred to the nuclear family emotional process as an “undifferentiated family ego mass” since families with difficulties display a high degree of fusion.