Exam 1 : edgette ch 1-8 Flashcards
TRUE OR FALSE:
teen therapy clients improved more than 76-80% of teens not in therapy
TRUE
for parents: the act of seeking help is accompanied by ______, because they think they will be ________?
for parents: the act of seeking help is accompanied by GUILT, because they think they will be CRITICIZED?
especially for: LOW INCOME & MINORITY
Parents of CHILD need to know: you are ________?
NOT JUDGING THEM
child needs to know: you are _________?
child needs to know: you are NICE
Parent of TEEN, need to know: you ________?
teen parent needs to know: you won’t think they’re as bad as their adolescent sees them
teens need to know: you are ___________?
teens need to know: you are on their side
How does adult therapy differ from CHILD therapy?
children immature, dependent & can be taken out at any time
(parents start & control therapy)
How does adult therapy differ from TEEN therapy?
can understand / participate
teens are dependent
process of separating (identity formation)
uncomfortable with close adult relationships
can be taken out at any time
At what point do teens try to test/get out of therapy?
Why?
3-6 months in therapy - (teens want to get out before) start of deep vulnerable work
What occurs in stage 1 of separation-individuation?
use of anger to create distance in relationships
What occurs in stage 2 of separation-individuation?
tentative / fragile / beginning of balanced thoughts
What occurs in stage 3 of separation-individuation?
coherent / balanced thinking
“perhaps parents arent all bad. perhaps im not all good”
This is an example of stage ___ of separation-individuation?
stage 2 : tentative / fragile / beginning of balanced thoughts
“perhaps parents arent all bad. perhaps im not all good”
“sometimes parents and I do bad things and good things”
This is an example of stage ___ of separation-individuation?
stage 3 : coherent / balanced thinking
“sometimes parents and I do bad things and good things”
“parents are all bad. I am all good”
This is an example of stage ___ of separation-individuation?
stage 1 : use of anger to create distance in relationships
“parents are all bad. I am all good”
The first session is with the parents?
TRUE
what occurs during first session with parents?
- paperwork
- attune to parents concerns
- affirm therapy can help
- discuss fee/schedule
- discuss communication / teen privacy
- confidentiality
- prepare parent for 6 month test (where teen resists therapy - due to deep work)
What occurs during the second session with teen?
(begin assessment)
- talk about reasons for being in therapy
- teens reaction to being in therapy
- confidentiality & limits
- end w/parent & teen discussion about treatment plan (who comes in next week & how often)
Children project onto play: …..?
(expectations, fears & wishes)
- what they EXPECT to happen
- what they FEAR might happen
- what the WISH would happen
What is structured play therapy?
specific activities using play media to address issues
therapist uses structure to create play situation to lead child in directions beneficial to therapy
structured play therapy: choose tasks that are…..
- developmentally appropriate
- address child issues
- focus on goals of theray
- presented in a way that guides child to address issues without forcing them
what is the role of structured play therapy, that is beneficial for reluctant clients 7 yrs + ?
play that:
evokes childs unconscious
challenges defense mechanisms
encouraging child in beneficial direction
what is the role of therapist in structured play therapy that is beneficial for reluctant clients 7 yrs + ?
facilitate & advance therapy process
choose topics/activities that focus on theme of therapy without triggering maladaptive defenses
Structured play therapy:
Intensity = extent to which sessions/activities:
a. evoke anxiety
b. challenge self-disclosure
c. increase awareness
d. focus on feelings
e. focus on here-and-now
f. focus on threatening issues
TRUE
Structured Play Therapy :
In deciding whether to do an activity - assess in terms of ______ and _______?
In deciding whether to do an activity - assess in terms of INTENSITY and SEQUENCE
Structured Play Therapy :
What is the focus of stage 1?
Stage 1 = Opening (less intense)
focus = develop trust & client/therapist relationship
find out likes/dislikes
Structured Play Therapy :
What is the focus & goal of stage 2?
Stage 2 = Working-Through (more intense)
focus =
- focus on intense issues/feelings (goal of therapy)
- child should feel more comfortable w/activities that challenge them to address intense issues with greater depth
- movement btwn high and low intensity
Structured Play Therapy :
What is the focus & goal of stage 3?
Stage 3= Termination (less intense)
focus = therapist decrease intensity to prepare for termination (despite clients desire to continue working on intense issues )
Structured Play Therapy :
In stage 1, the Client is ready to move to stage 2 when…?
child is positive about therapy
more talkative
more comfortable
Structured Play Therapy :
In stage 2, the Client is ready to move to stage 3 when…?
addressed/processed issues & feelings related to issues
if time-limited sessions & child hasn’t worked through issues –> move to termination phase anyway
Structured Play Therapy :
In stage 3, decrease the intensity of sessions by focusing on…?
decrease intensity by:
integration of learning
coping skills
future orientation
a criticism of play therapy is that it can force a child to deal with issues before they’re ready
TRUE
a criticism of play therapy is that it can trigger maladaptive defenses/coping behavior
TRUE
Ethical/Legal concerns in child/teen therapy?
- parent with legal rights signs consent form - (vs. physical)
- ideally signed consent from both parents
- if parents rights are taken way = court decides for child
- report consensual sex (under 18yrs - anal or oral)
consensual sex:
you MUST report: anal or oral sex of under 18yrs
TRUE
you CANT REPORT: normal intercourse of 16-18yr olds
TRUE
STRUCTURED play therapy?
behavioral
CBT
solution-oriented
(stays on emotional level of client = NOT TOO DEEP)
UNSTRUCTURED play therapy?
narrative
psychodynamic
child-centered
stages of structured play therapy for “9 yr old angry bully”
Ex. Angry bully age 9
Stage 1: (less intense, -develop relationship)
Build legos, likes/dislikes, make collage
Stage 2: (intense-address issue)
Exposure therapy, role play,
Stage 3: (less intense-reinforce learned skills)
Practice coping techniques
when working with parents: you must collaborate on a goal the teen cares about
TRUE
Most Parental Concerns:
1. Internalizing:
Symptoms: emotional distress, anxiety, depression, low self-esteem, somatization
- Externalizing:
Acting out, being disruptive, delinquency, noncompliance
TRUE
On-going communication with parents includes?
On-going communication with parents: • Assessment and monitoring of change • Helping parents understand their child • Parent training/guidance (skills, tips, advice) • Parent counseling (refer out)
Therapist over desire to help = compromises therapy
TRUE
Name 5 ways that therapist lose credibility?
- desiring teens approval
- being too careful
- being “too helpful”
- hiding your stumped
- trying to control therapy
Therapist Losing Credibility:
1. Desiring Teens approval
teens only control/power withhold talk & approval
respect (vs rapport) = can’t connect w/someone you don’t respect
curiosity generates conversation = rapport capable of handling therapy (confrontation etc)
candid disclosure of difficulty = connection
Therapist Losing Credibility:
being too careful
§ Therapist avoid saying wrong things that will upset teen
Teen is aware of this: therapy unchallenging or tests therapist
Therapist Losing Credibility: Presenting onself as too helpful:
Hold teen accountable for making use of therapy
When therapist tries harder than teen = therapy stops & causes defensiveness (teen sees therapists efforts as a threat to independence)
Teens need to know you will be real & tell them things others wont based off your experience (you’re on their side)
Express helpfulness indirectly (tone, facial expressions)
Female therapist w/male teens–>careful not to exude maternal warmth
Express helpfulness indirectly w/anticipation that teen will be active partner
Therapist Losing Credibility:
Trying to hide the fact that youre stumped
teens know
use candor = Make a statement about your experience that invites curiosity (don’t ask to change)
“I have no idea how to respond when you challenge me like that”
Candor and genuineness intrigues client to discover they don’t want to act like that
Therapist Losing Credibility:
Trying to exert control over therapy
Therapist only have control over parameters of therapy - NEVER ITS PROCESS
Can’t control clients unwillingness to change, talk or tell the truth
Don’t communicate that you have control – no control of process or teens engagement
Don’t make them tell you things
Teen refuses help work with parents on enforcing consequences, understanding teens behaviors & look at how family dynamics contribute
When a therapist communicates that those things can be controlled - therapist credibility dissolves (to teen who knows better)
3 questions adolescents hate?
- how does that make you feel
- do you think that such a good idea
- why do you think you did that?
3 questions adolescents hate?
how does that make you feel
Reflects pursuit of emotion at expense of accountability
teens take action impulsively based on how they feel (feeling without context
predictable, stereotypic)
3 questions adolescents hate?
do you think that such a good idea
Trying to be neutral about clients response
Masking of feeling/opinion compromises therapists genuineness
Communicate opinion directly, the teen picks it up anyway and the teen will respond directly
ask with candor “why do that?”
Asking the client for a response when its not being freely offered puts too fine a point on the fact that he is considering another perspective - let him alone to change his mind
3 questions adolescents hate?
why do you think you did that?
Teens don’t know - doesn’t produce insight that therapist wants - teens can’t use insight to change & use insight as a excuse to continue behavior
“I’d love to see you come up with another way to handle that” or candor “what an unfortunate choice”
3 therapies that dont work?
sham therapy
logical therapy
thief therapy
what is sham therapy?
Therapist sits w/passive, unresponsive client & doubts any value from therapy - but continues doing the same thing
Therapist tries harder to generate convo, make meaning & get client to see help
*don’t pretend - directly address “I keep hoping we’ll find some way to interest one another, but im out of ideas”
what is logical therapy?
Therapist tries to talk a client into doing the sensable/reasonable thing
Teen already thinks they’re doing the sensible thing
Bring up the issue but don’t explore it b/c it will cause teen defensiveness
“I think if you were able to find a face-saving way to get back in school without it being a big deal you would go for it”
what is thief therapy
○ Therapist are more in a hurry for the client to give up her symptom or problem than the client
§ Adolescents hold tightly onto a way of being out fear of being robbed of a beahvior/attitude that have tied to their identity
§ Teens like their problems (behaviors, beliefs) b/c they stabilize their identity and are an outlet for them to express their emotions
○ Kids need to know that we nto a therat to their feelings, opinions, rage orperson before they ever will be able to suspend them logn enough in the relationship to let us in .
Problem with teen therapy comes from therapists need to change someone who isn’t interested in changing or has little faith in the efficacy of therapy
When you’ve had multiple sessions & no progress (no safety concerns)…..
talk to teen about lessening sessions
Dangers of rescuing clients
therapist needs to acknowledge “negatives” about teens so they know:
- we are real / genuine
- we can handle them
Teens Therapy
not independent process of separating (identity) can understand/participate unable to comfortable enter adult relationships 3-6 months test can be taken out
child therapy
immature mind
not independent
can be taken out at any time
Developmental attitudes/needs of teen that impact therapy?
- change behavior privately
- no public acknowledgement of change
- changes must be self-determined
- teens choices understandable within context
- stuck in being right/cant give up point of view
- doesnt count unless they solve problems themselves
- if they stop acting out = they “gave in” (cling to point long after theyve privately abandoned it)
therapy fails when a therapists?
- approach teens as willing participants
- think you can change them
- confront teens refusal to do what they never agreed to do in the first place
therapist must remain unphased by teens negative behaviors
TRUE
teens resistance reflects our inability to provide a service to them that is attractive & useful
TRUE
humor, candor, industry & sense of genuine curiosity can help teens more than dismay for their lack of appreciation
TRUE
Goal: get clients interested in changing views (why its so appealing for them to be “angry”) VS trying to help them get over a problem they dont want to change
TRUE
therapist must understand teens current views & why its appealing
focus on what keeps teen stuck now VS how it came to be
teens resistance means…
therapy isn’t inviting enough or teen doesn’t want it
Therapist changes for teen therapy?
- more joining & rapport building (intro- less formal, build rapport before addressing issues(
- depersonalize rejection (dont try to persuade/change client - therapists only duty = safety)
- assume less responsibility for change & more for creating env that invites it
(dont want change more than client - hope teen responsible for making use of therapy ) - belief in self to inspire change
(dont worry about what to say - presence is enough - model adaptive behavior)
genuiness & candor that invites change = thoughtful frankness that invites client to look at themselves
TRUE
dont impose change
genuine therapy with resistant teen requires:
balancing discretion + candor
respect personal space + fowardness (mahler - hatching = allow them to explore alt)
timing + deliberately addressing issue
Candor is….
holding up 2 conflicting parts of self & just looking at them
(dont try to resolve conflict or suggest change)
*offering yourself without imposing –> what you see about them
personal experience of them that is inquisitive
when teen dismissed everything you say
“I dont think theres anythign i could think of to say that you wouldn’t reject. I know this isn’t your idea of a good time, but can you think of something we could do to lighten up?”
do demand for client to change - offer personal experience
when teens behaviors are disagreeable (you dont like them)
DONT:
- modify behavior w/rewards or consequences
- interpret behaviors as resistance
- try to protect clients feelings
DO:
- sit with resistance & directly address it
- voice your experience of client
when client wont speak to you
no interest in making them talk (not your job- allow them to withhold talking)
help client WANT to talk
directly ask them where to go from here/what you can do
bring in family member
when teen is disrespectful
dont react or challenge client
point out their role
assess motivation behind remarks w/out interpretations
use empathy to dissolve defenses
when teen says they dont have a problem
dont get them to admit problems are related to choices
help parents understand expectations, set firmer limits, consequence for non compliance & hold teen accountable
*critical that parents are ready to hear & be open/flexible in responding w/genuine desire to help
ask what their parents would day
when teen says they dont trust you
teen tries to get therapist to prove trusthworthiness
redefine therapy as functioning without trust
dont allow teen to turn talking into quid pro quo (you do for me i do for you)
when teen tries to pick a fight (teens way of controlling)
forecasting the inevtiable (anticipating conflict) & troubleshoot it
defuses anticipated friction
allows it to be externalized from client/therapist & experienced together
when teen talks about everyone else
dont interpret it as a way to avoid
show interest in story
address it after a sessions
when teen complains about everyone else
dont try to convince them - pose questions that cause them to come up with conclusions themselves
when teen plays coy (shy)
ask why they work so hard to get you to ask them something
dont ask them to explain
dont engage in it “when you want to tell me I’d love to hear it”
when teen tries to regale me with tales of misadventure (teens way of trying to shock you)
balance not intervening (when you knwo theyll just reject your help) + not condoning through silence
dont minimize dangers of stories - but have SMALL reaction (dont get caught up in it)
when teen storms out & doesn’t return
- ensure safety
- when they return/next session: restore relationship by apologizing for your part in them leaving
dont accomodate - run after / talk them into staying
relate to them - diffuse anger
help them with your own thoughts on what you thought happened
when teen says you dont understand
ask why client has such little faith in ability to communicate
ask them to help you understand
when teen says they can change whenever they want
smile and say “thats great” - dont challenge them to prove it
dont press it
all teen to do it on their own time
ask what else to do
Family sessions with challenging teen focuses on:
preserving teen dignity
relate w/genuiness + candor
hold teen accountable
help parents to attune to teens
Family sessions with challenging teen:
Preventing problems in the first place
get parents in from start: discuss concerns in front of teen
start sessions by addressing parents:
dont take parents view of problem at face value
teens understand more than credited for
observe/comment on family absences
position yourself in alignment with everyone at the expense of no one
TRUE
Family sessions with challenging teen:
Problems
parents expect you to do all the work
parents indulge in teens dismissive attitude in session
teen wont talk (dont address teen in beginning of therapy –>throws them off)
Family sessions with challenging teen:
Exceptions (when teen/parents should meet together)
when teen is out of control (therapy revolves around helping parents)
teen at residential treatment (discuss concerns of parents/ teens concerns )
parents psychologically unavailable
Teens behavioral problems begin as interpersonal ones
parents get overwhelmed & avoid teen
Ways that families dont deal with emotional factors in teens behavioral problems?
denial/avoidance bulling feelings fear of getting angry fear of teen getting out of control protecting family members fear of saying wrong thing feeling too beleaguered too controlling
Helping “too-careful parents”
(mahler - practicin stage)
instill parents confidence by:
- emoting (show appropriate response to teen
- point out ways they try too hard
- help them understand their fears in being more direct:
- comfortable w/repercussions
- dont reward expected behaviors
- reinforce consequences for non compliance - coach them in how to confront & relate to teen with candor
- help parent work through past & find times when they were able to parent with more authority
its important for parents to realize that they can’t allow teen threats to stop them from parenting
TRUE
Helping Beleaguered parents (hopeless)
acknowledge, validate & empathize with parents feelings
how their attitude affects teen
articulate choices
assess resilience
connect to resources
(evoking compassion from teen RE: parents = teen emotionally taking care of parents)
helping controlling parents
*ENSURE THERE IS NO POST-SESSION RETRIBUTION
help parents be less defensive (find underlying emotion “fear”)
normalize experience of parental need for control + teen need for autonomy
utilize partner to relinquish control
in toxic families:
help teen become more independent (rather than helping family work through problems)
acknowledge how bad it is for teen & focus on future indendepence
3 rules for family therapy that are reviewed in first session with teen + parent
- do what is in the best interest of everyone (dont take action based off one persons request)
Ex. dad wants you to pray- teen is uncomfortable
- family therapy might not be best for all teens to process issues (determine whether this is helpful for teen before continuing)
- address ride home (dont continue therapy after sessions)
(teen needs to be initiator of follow up) - punishment (teens are worried about being punished for things talked about in therapy)
3 things to prevent burnout for therapist
- continual inspiration/motivation
- consultation (clinical advice)
- personal therapy
When therapist tries harder to make therapy work with passive teen & continues to do same thing
SHAM THERAPY - dont pretend therapy is working
*directly address it
when therapist tries to talk teen into doing “right thing”
LOGICAL THERAPY - teens already thing theyre doing the right thing
*bring up the issue but dont explore it (defensiveness)
when therapist are more in a hurry for teen to change than the teen is
THIEF THERAPY - teens hold to their views/actions out of fear b/c it is tied to their identity
teens like their problems b/c it stabilizes identity + is used as an outlet for expressing emotions
*teens need to know we are not a threat to their personality/behaviors/views
Why shouldnt you say “How did that make you feel?”
Predictable / stereotypic
Allows teen to act on how they feel (without considering them in context)
Why shouldnt you say: “Do you think thats a good idea?”
Hiding your opinion = compromises genuineness
Communicate opinion/values directly without judgement or demand for change (teens aren’t upset at opinions – upset with dishonesty)
Don’t force them to respond (obviously that teen is considering alt)
Why shouldnt you say: “Why do you think you did that?”
Teens don’t know
Insight doesn’t produce change used as an excuse to continue behavior
Use candor “what an unfortunate choice” “id love to see you eventually come up with some other way to handle that”
