Exam 1

Question 0

Definition of psychotherapy

Answer 0

The informed and intentional application of clinical methods and interpersonal stances* derived from establish psychological principles** for the purpose of assisting people in modifying their behaviors, cognitions, emotions and/or other personal characteristics in directions that the participants deem desirable***

• in some models active change mechanism is treatment method, in other models the relationship is considered primary change agent
• • allows for clinical and/or research validation, but implies rigor of validation
• ** client(s) agree to goals

Question 1

Having a theoretical base from which to operate accomplishes what five specific objectives?

Answer 1

Having a theoretical base from which to operate:
Provides an understanding of the clinical phenomena
Defines the amount of relevant information
Organizes the information
Prioritizes our conceptualization
Informs/directs our treatment

Question 2

Why have a theoretical model/models?

Answer 2

A psychotherapy model gives you consistent perspective regarding human behavior, psychopathology, and the mechanisms of therapeutic change. Without a guiding theory informing our sessions therapist would be directionless in the face of being bombarded with literally hundreds of pieces of information and impressions in a single session.
Consciously or unconsciously: treat client as we like to be treated, treat client according to what keeps them comfortable, treat clients based on momentary or core countertransference issues, treat clients only with treatment methods with which we are skilled
The treatment goals often gets lost, and the therapist and client spend sessions chasing rabbit trails. Even if the relationship itself is healthy, if this is therapy, there must be the ultimate goal towards which this relationship is moving.

Question 3

What is a therapeutic alliance; what do data strongly support regarding the importance of having one?

Answer 3

Therapeutic alliance: demonstrably effective therapeutic qualities that are associated with positive outcomes in therapy

Therapeutic alliance is first and foremost. It is undoubtedly a highly relevant construct in psychotherapy. In process outcome research in individual psychotherapy, the most important finding that has emerged from a considerable number of studies is that the alliance assessed early in treatment predicts ultimate therapeutic success across a variety of clinical issues and treatment modalities.

Question 4

Therapist competency consists of which three components?

Answer 4

1. The person – who the counselor is
2. Knowledge – what the counselor knows
3. Skills – what the therapist can do

Question 5

Therapeutic Frame

Answer 5

Potentially highly emotionally, intimately charged dynamic of the therapeutic setting.
Desire is to take advantage of the benefits of the emotional dynamics of the dyad while minimizing the risks.
Primary purpose of the therapeutic frame is to create “an envelope or membrane around the therapeutic role that defines the characteristics of the therapeutic relationship.”
Specific element of the frame include: office setting, scheduling/duration of appointments, fees, purpose/goals/methods/process of treatment (sometimes called the treatment contract).
Therapeutic frame consists of boundaries that limit certain behaviors.

Question 6

Boundary Crossing

Answer 6

Departure from the verbal or physical distance typically maintained in the therapeutic interaction, a benign deviation from standard practice: harmless to both, exploitative, may even support for advanced therapy

Question 7

Boundary Violation

Answer 7

A boundary crossing that:
is in violation of ethics, is not done in the service of the client’s well-being/growth (and, in fact, may harm the client), is motivated by the therapist’s (extra therapeutic) gratification, it takes a therapist out of the professional role as therapist, takes the client out of the role as client

Question 8

Definition of object relations theory?

Answer 8

Psychodynamic-based theory, which explicates the key role of our relationship to others in the dynamic process of the developing self structure
How others affect the developing of ourselves
Disorders of the self rather than personality disorders

Question 9

What is meant by object?

Answer 9

Objects are both real others in the world as well as internalize representations/images/distortions of others.

Question 10

Definition of attachment:

Answer 10

Care seeking: Instinctive, species-wide need to seek closeness/proximity to specific other who is willing and able to comfort, protect (when needed) and mirror/help organize one’s feelings.

Question 11

Definition of caregiving:

Answer 11

Bonding: instinctive, species -wide need to monitor a specific person, to encourage exploration of the other, to comfort, protect and to mirror/help organize that person’s feelings when needed.

Question 12

Definition of exploration:

Answer 12

An instinct to follow one’s innate curiosity and desire for mastery, when one feels safe to do so.

Question 13

Secure Base

Answer 13

Someone to whom they could come in distress and from whom they could find support to venture, explore, and discover their authentic self. Can come to and get their needs met.

Question 14

Internal working model:

Answer 14

Object relations are initially formed by our early interactions with primary caregivers and serve as “internal working models” for important (intimate) relationships throughout our lives.

Mental model of self and attachment partner that regulates, interprets, distorts/impacts, and predicts thoughts, feelings and behaviors related to attachment.
Conscious and unconscious experiences
Conscious and unconscious strategies
Attachment related goals and needs

Question 15

Three suggestions to help decrease performance anxiety in new therapist:

Answer 15

1. Focus more on what you are learning than how you are performing.
2. Focus more on the client and what the client is really saying rather than on yourself and your own performance
3. Receive active support from their supervisors and instructors including real life illustrations

Question 16

Interpersonal process combines dimensions of which three theoretical traditions?

Answer 16

Object relations theory, attachment theory, cogntive behavioral therapy

Question 17

EMS – what are they?

Answer 17

Early maladaptive schemas (EMSs) are defined as stable and enduring themes that develop from ongoing patterns of parent-child interaction during childhood that are significantly dysfunctional, and which are elaborated and extend on into adulthood.

Question 18

How to identify core schemas?

Answer 18

Pay close attention to events that trigger high levels of affect, the client’s most serious and enduring life problems, and the early origins of the client’s emotional distress.

Question 19

How did therapist hope to impact core schemas?

Answer 19

The therapist tries to invalidate the client’s schema by providing a therapeutic relationship that counteracts or disconfirms what the client experienced in the past.

Question 20

Family rules/family myths – what are they, similarities, differences, what purposes do they both serve?

Answer 20

Family rules: determined who spoke to whom, about what, and when. Covert rules also cover affective expression.

Family myth: family rules, roles, and faulty communication patterns often serve to maintain family myths that, in turn, function to avoid anxiety arousing issues in the family. “We have a happy family and no one is ever sad.”

Govern family relations and establish repetitive, predictable patterns of family interaction, can be culturally sanctioned or determined.

Question 21

Corrective Emotional Experiences

Answer 21

Providing a new and more satisfying response to the clients’ old relationship patterns than they have usually found with others. That is, working collaborative with clients, the therapist helps clients identify maladaptive relational patterns or themes that commonly occur with others, and works together with clients to alter this problematic pattern, disconfirm the faulty expectations or schema, or changes this familiar but unwanted interpersonal scenario in their real-life relationship or therapeutic interaction.

Question 22

Process Comments: What are they?

Answer 22

Here and now, present focused interventions that can uncover important new issues to explore in treatment, resolve misunderstandings that arise between the therapist and client, and bring intensity to the therapeutic relationship by moving the dialogue beyond surface issues.

Question 23

Four Step Process Our Authors Suggest in Creating CEE

Answer 23

1. Identify the faulty beliefs and expectations, maladaptive relational patterns, and ineffective coping styles that keep occurring and causing problems in the client’s life.
2. Anticipate how these patterns or themes that are disrupting relationships with others may be expressed or come into play in the current interaction with the therapist – especially along the process dimension or way they are interacting together (for example, arguing, distancing, controlling)
3. Provide new or corrective responses that help to resolve rather than repeat this familiar but problematic pattern in the relationship with the therapist
4. Help clients generalize this new way of interacting to others in their everyday lives

Question 24

Response Specificity/Client Specificty

Answer 24

Client response specificity means that therapists need to tailor their responses to fit the specific needs of each individual client – one size does not fit all! Therapists need to have the flexibility to listen to the cues, assess clients’ responses, and search for the best way to respond to this particular client.

Question 25

Primary goal of therapist in initial session/first stage therapy.

Answer 25

To establish a working alliance that accepts the client’s need for understanding and guidance while equally encouraging the client’s own initiative and responsibility. The client feels that the therapist is trustworthy and competent.

Question 26

How is a collaborative approach different from a directive and/or nondirective approach?

Answer 26

A collaborative approach gives the client and therapist a feeling and experience of a partnership. Directive and nondirective approaches are too heavily active or don’t provide enough direction. They lead to the success residing with the therapist rather than the client.

Question 27

Primary reason many clients come to us feeling not understood.

Answer 27

Many clients feel this way because their subjective experience was not validated in their family of origin.

Question 28

Two key components to “empathetic understanding”.

Answer 28

1. Discerns the client’s thoughts and feelings
2. Effectively communicates her understanding of this to the client, engendering in the client the feeling “my therapist really gets me!”

Question 29

Reasons many therapist resist using “3rd ear”.

Answer 29

Feeling awkward themselves are concerned that they might embarrass the client.
Feeling incompetent or unsure of how to respond if they do go beyond the surface and respond to the bigger feeling or issue.
Feeling reluctant to violate cultural norms or familial rules against forthright or more direct communication.
Feeling a need to protect or take care of others by shielding them from their own pain or distress.
Feeling afraid of potential boundary violations or feeling too close to the client if they share deeply with the client and risk personal involvement.
Having their own unresolved issues activated by the clients underlying message or overt communication.

Question 30

Central/core themes clients will manifest in three interrelated domains.

Answer 30

1. Repetitive relational themes or interpersonal patterns
2. Pathogenic beliefs, automatic thoughts, or faulty expectations
3. Recurrent affective themes or central feelings

Question 31

Self–involving statements vs. self–disclosing statements.

Answer 31

Self-disclosing statements refer to the therapist’s own past or personal life experiences.

Self-involving statements express the counselor’s current reactions to what the client has just said or done.

Question 32

Three primary situations in which process comments may be problematic.

Answer 32

1. Therapist need to be aware of their own countertransference and only make process comments when an interaction occurs two or three times.
2. Don’t put clients in a double-bind where you ask for their feedback and then challenge and undermine their openness.
3. Therapist want to be conscious when working with clients from a culture they lack familiarity with. Direct discussion may be culturally frowned on.

Question 33

According to our authors, three primary contributors to ruptures in the alliance.

Answer 33

1. Covert or overt hostility from the client (referred to as client negativity).
2. Reenactments or interpersonal scenarios that clients keep reenacting with others that ensnare or embroil the therapist.
3. The simple human misunderstandings that occur in every meaningful relationship.

Question 34

Research cited about therapist dealing with hostility/negativity from clients (be specific).

Answer 34

In a series of studies known as Vanderbilt I and II, clients problematic relational patterns routinely elicited counter-hostility and punitive control from seasoned therapist, and when these “complementary” responses occurred, it led to poor therapeutic outcomes. That is, clients with angry, distrustful, and rigid interpersonal styles tended to evoke counter-therapeutic hostility and control – even in a carefully selected sample of highly trained and experienced therapist.

Question 35

Why therapists are reluctant to approach client resistance?

Answer 35

New therapists are not so aware of the multiple meanings and conflicted feelings associated with the decision to enter therapy. Therapist are reluctant to explore and work with resistance because they fear it has to be addressed in a blaming or critical way or in a way that puts the therapist in a superior position. Most new therapist have strong needs for their clients to like them, which makes dealing with resistance less likely. Therapist often do not inquire about signs of potential resistance in order to ward off unwanted criticism.

Question 36

Four step sequence to approaching maladaptive/outdated coping patterns.

Answer 36

1. The therapist is trying to help clients identify their outdated coping strategies with others. Clarify how clients may be continuing to do this now in their current interactions with others.
2. The therapist validates the protection this interpersonal coping strategy once provided.
3. The therapist holds a steady intention to track the process dimension and ensure the therapeutic relationship does not repeat this problematic pattern that has transpire so often with important others.
4. The therapist’s ultimate goal is to help clients transfer this new experience or re-learning with the therapist and apply it with others in their lives

Question 37

Three questions to formulate a working hypothesis regarding client’s constellation of concerns, etc.

Answer 37

1. What does the client elicit from others?
2. What is the threat?
3. How will the client express resistance?

Question 38

“3R’s” when therapy has stalled.

Answer 38

1. Ruptures: when there has been a misunderstanding or interpersonal conflict between the therapist and the client that disrupted the working alliance.
2. Re-enactment: when in some actual or metaphorical way, the same type of problem or unwanted interaction that the client is having with others is being played out between the therapist and the client.
3. Resistance: when clients are simply unaware of the multiple and often contradictory feelings that have been activated by acknowledging realistically that certain problems really exist, asking for help, exploring difficult topics with more specificity and even by succeeding in treatment, making meaningful changes, and getting better.

Question 39

What the authors state is the most common source of resistance.

Answer 39

Shame

Question 40

Ways in which success in therapy can be threatening to clients.

Answer 40

Acting in a successful new manner threatens their attachment ties to caregivers who did not support their independence or success. Becoming stronger or improving in therapy makes some clients feel cut off from parental approval and affection, disloyal to caregivers, guilty about hurting, leaving, or surpassing the parent. The healthy new behavior is inconsistent with their cognitive schemas.

Question 41

Elements of a “good enough” caregiver.

Answer 41

Consistently present (psychologically and physically)

Motivated to respond to needs of the other

Able to read cues regarding needs

Be competent regarding providing needs

Follow child’s need lead

Provide physical safety when needed

Provide emotional regulation when needed

Allow/encourage exploration and mastery

Provide affective attunement

Never abdicate the role of parent

Question 42

Affective regulation (importance and how it works)

Answer 42

Developmental progression of developing affective competence: mom interprets/regulates for child, mom helps child interpret/regulate, child interprets/self soothes. Therapist replaces role of mom to teach client how to regulate their emotions.

Secure base is important to this affect regulation so that clients can receive the developmental experience they may not have gotten growing up: I can solve and manage the feelings that come up for me.

Question 43

Affective Competence

Answer 43

Being able to access (feel) and process emotions while maintaining the integrity of the self and the (safety providing) relationship. Without feel and not deal or deal and not feel.

Question 44

Defensive Exclusion

Answer 44

Affect isn’t accepted by the parent, they feel like they can’t experience or use the emotion, aspects of the self that are protected, validated, mirrored, responded to are integrated into the self. Those which are not , are defended against to a greater or lesser degree.

Question 45

How does all of this relate to therapy?

Answer 45

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