EXAM 2

Question 1

Postmodern/ social constructionist/ language based models

Answer 1

1. Cultural groups develop through conversation
2. Individuals/ cultural groups perceive reality differently
3. Therapists: no one ‘correct’ reality
4. Collaborative, conversational
5. Client-directed outcomes
6. Non pathological
7. 2nd generation

Question 2

Collaborative language systems

Answer 2

1. change process is dialogical > problems dissipate through conversation
2. Therapist:
   A. Not knowing stance, non expert
   B. Embrace client reality: trust
   C. Ask conversational questions
   D. Listen responsively: affirmation, encouragement, honor

Question 3

Dominant narrative

Answer 3

1. Language used by family to create a story or explanation of problem > tries to explain origin of problem or persistence in family
2. How family operates
3. How family understands its issues
4. What is preventing family from feeling capable in resolving current problems

Question 4

Solution focus process

ABC

Answer 4

A. Language of family conveyed to therapist
B. Language of family therapist as therapist questions what family says
C. Collaborative language therapist and family co-create
1. Therapist: elicit family dominant narrative
2. Identify exceptions to problems
3. Identify alternative narratives> gaps in dominant narrative
4. Co-create new narratives that utilizes strengths and weaknesses
5. Future focused, goal orientated, brief

Question 4

Solution focused: techniques

Answer 4

1. Miracle questions: “over the course of the night, a miracle happens, and your problem is gone. What’s different for you, feelings, thoughts, behavior?
2. Scaling questions: scale from 1 to 10, how would you rate X about your family?
3. Exception question: when is there a time you’re not fighting?
4. Coping questions: what keeps you going when you’re struggling?
5. Compliments to family/ feedback: help reduce anxiety, helps bring conversational tone, reinforces strengths based approach
6. Formula first session talk: between first and second session, ask client “observe and describe what happens in your life that you would like to keep happening?”

Question 5

Solution focused therapy

Answer 5

1. Embrace client reality > shift reality to hidden opposite > problem talk to solution talk
   A. Ex. Couple who come in, frequently quarrel > shift: draw attention to times when couple does not quarrel, what is different about those times
2. Solution focused therapy > possibility therapy: shift client attention away from problem to absence of problem, add spiritual component > add strengths
3. Techniques from hypnotherapy
4. Collaboration: no need for history taking
5. Nonpathologizing: no need to understand cause of problem
6. Change through dialogue: multiple solutions and no ‘right’ solution
7. Directive with solution: client chooses goals, client capable and has ability to construct solutions

Question 6

Narrative therapy

Answer 6

1. Must bring in historical oppression (language, culture, persecution, gender/ses inequities)
2. Nonpathologizing:
3. No directives > hear clients story > change through conversation
4. Deconstructing questions (separation of problem from individual) + unique outcomes = conversation
5. Multiple realities

Question 7

Narrative therapy goals

Answer 7

1. Develop new narrative
2. New dominate beliefs > respond and cope to current/future issues
3. Deconstruct then reconstruct new narrative
4. Getting at “why” of problem is elusive, multiple truths

Question 8

Narrative therapist

Answer 8

1. Active listening and questioning
2. Facilitates family story, identify dominant beliefs
3. Externalizations problems
4. Strengths based and empower

Question 9

Narrative techniques

Answer 9

1. Externalize and reframe new narrative using different language
2. Ex. “Our son is very rebellious” (parents)
   - when rebelliousness takes over, what does it make him do? (Therapist)

Question 10

Narrative techniques: Tree of life

Answer 10

1. Roots
2. Ground
3. Trunk
4. Branches
5. Leaves
6. Fruits

Question 11

Limitations of collaborative language systems: social control

Answer 11

1. Social control issues
   A. Ex. Parent who disciplines child w/ belt
   -welfare authorities involved: remind client action is illegal, invite alternatives, goal to end welfare involvement
   -citizens protest: therapist cannot approve of behavior > report if mandated,
   -if behavior objectionable (not dangerous/ illegal) use deconstructing questions, “ was the method of discipline working? Was child really listening to you?” > open other avenues of conversation

Question 12

Limitations: strongly held therapist values and beliefs

-normal family development

Answer 12

1. Listening nonjudgmental
2. If client has abhorrent ideas > how does it happen that this worldview makes sense to the client?
3. Rigid set of “correct” life stages not in alignment w/ nonpathologizing stance
4. May discount all notions of development
5. Norms and stages tempered with respect for clients perceptions/ multiple interpretations

Question 13

Collaborative language therapy techniques

Answer 13

1. Curiosity: open mind, genuine interest, asking questions
2. Respect for clients resources: clients goals, client ability to solve problems, clients language
3. Engaging questions: invite client into shared discovery
4. Affirming/ conveying hope: frequently pointing out clients progress, hard work, courage. Therapist interprets client action in positive ways
5. Reflect: therapist shares own thoughts/reactions with client on ongoing basis
6. Solution focused/ exceptions: when is client not experiencing problem
   - miracle question: “what if you woke up one morning and problem was gone?”
   - scaling questions: rate intensity of problem on 1 to 10
7. Narrative/ deconstructive questions: questions about larger social/cultural issue.
8. Narrative/ Externalizations: problem apart from person
   - “how is anorexia terrorizing you?”

Question 14

Collaborative language therapy: diversity

Answer 14

1. No issue is raised that is not raised by the client
2. Cultural competency may risk reinforcing stereotypes > reduce therapist focus on individual
3. Cultural competency assist therapist in understanding history of marginalization/ discrimination
4. Focus on social justice and cultural diversity > cultural/ ethnic groups, women, class > narrative therapist raises issue when not directly raised by client

Question 15

Transgenerational family therapies

Answer 15

1. Attend to dynamics across more than two generations
2. Attend to how the past affects the present
3. No interest in individual pathology
4. Focus on family across generations develop patterns of behaving/ responding to stress that prevents healthy development and lead to problems
5. Client focus on understanding how certain patterns develop and change the way they resolve past issues and interact with families

Question 16

Bowen family systems therapy

Answer 16

1. Mentally ill individuals caught up in patterns of family fusion > they are symptom bearers for the family rather than characteristically flawed or ill
2. Differentiation of self: ability to maintain strong sense of self while maintaining connection with strong emotional system
   - I can use opinions and advice of others, but make independent decisions
   - it is a process, not a personality trait
3. Differentiation of thinking from emotion: making decisions about behavior rather than reacting to intensity of emotional system
4. Fusion: without autonomy, individuals fused with others, unable to think for themselves
   - opposite of differentiation
5. Life difficulties arise because individuals ruled by emotion and depend on others good will
6. Think while under emotional strain, not feel
7. Anxiety basis of all symptomology

Question 17

Bowen: triangles

Answer 17

1. Smallest stable unit of a system: emotions
2. One or both of individuals brining third person into relationship
3. Third part of triangle may be work, hobby, issue
4. All systems form triangles
   - ex. Parents in argument, child interrupts to tell story, story avoids argument > after may be more calm to resolve issue
5. Rigid triangle: problem, the same issue, person, problem > severe and prevents system from dealing
   - ex. Drugs/alcohol, affair

Question 18

Bowen: nuclear family emotional process

Answer 18

1. Typical family patterns of dealing with stress on order to reduce anxiety
2. useful if moderate and flexible
3. Harmful if used severely or exclusively
4. If mild, emotions can calm down, thinking available
5. If heated, difficulties thinking of alternatives
   -“I couldn’t think clearly”
6. Patterns to reduce anxiety
   A. Conflict: resolve healthily or with mental, emotional, physical violence
   B. Symptom: physical, emotional, mental, social
   -headache, stress headache, chronic back pain
   -depressed/ anxious, cancer
   -alcohol abuse
   C. Distancing:
   -mild: agreed upon time out
   -moderate: keep from becoming anxious, keep from developing intimacy
   -extreme: divorce, cutting off oneself from others
   D. Triangling: one or two people reducing anxiety by involving third person

Question 19

Bowen: healthy families

Answer 19

1. Functional, neither healthy nor unhealthy
2. Balance needs for autonomy and intimacy over time and across situations
3. Functional families in crisis: pull together, assist emotionally, gradually redifferentiate > higher states of differentiation
4. Enmeshment normal when:
   A. Couple engaged/ married
   B. Children first born
5. Families move through life stages without undue difficulty
6. Flexible with conflict

Question 20

Bowen: goals

Answer 20

1. Differentiation of self > problematic behavior not focus
2. Detriangulation of harmful rigid triangles
3. Calm emotions
4. Changes in triangles and differentiation = symptom removal
5. Therapist as one member of a triangle
6. Modify relationships

Question 21

Bowen: techniques

Answer 21

1. Chief technique > the therapist ability to remain calm
2. Therapy as member of triangle: remain calm, and not pulled into anxiety of family = differentiation for family members
3. Therapy for therapists to increase their own differentiation
4. Genograms: map of family happenings > see triangles and patterns of stress
5. Detriangle: think about positions when less emotional > prepare for new family patterns
6. I statements: talk to/ through therapist, using “I” helps differentiate emotion from thinking > less reactivity
7. Role playing: act out scenarios > coached by therapist
8. Journaling: written account of experiences > reactions
9. Letter writing: family members communicate in writing (private or shared)
10. Conference: not all members of family need to be in session, one member perfectly fine

Question 22

Bowen: Genogrami

Answer 22

1.

Question 23

Bowen: couples

Answer 23

1. Conflict
2. Symptom
3. Distancing
4. Triangulating

Question 24

Bowen p: parents and multigenerational transmission process

Answer 24

1. Parents differentiation pass to their children
2. Successive low levels of differentiation results in mental illness/ physical impairment
3. Good circumstance slows process, negative circumstance speeds up stress

Question 25

Divorce rates

Answer 25

1. 45% of first marriages end w/in 20 yrs
2. High need for couples programs
3. Less than 1/3 couples seek premarital counseling
4. Couples seek counseling when already highly distressed > most considering divorce

Question 26

Preventative approaches

Answer 26

1. To develop healthy, lasting marriages
2. Skills and education about relationship > relationship education
3. Enhance couple relat. before significant problems
4. Communication training

Question 27

Premarital counseling/ marriage enrichment concepts

Answer 27

1. Most programs are eclectic > more than one theory
2. Preventative philosophy
3. Better to prevent than to fix a problem
4. Focus on communication and conflict resolution skills
5. Focus on nurturing partner bond and exploring expectations

Question 28

Pathology: relationship distress

Answer 28

1. Couples attach, bond, commit > marriage > no encounter of significant issues, little chance to test ability to handle conflict
2. Couples w/o conflict management skills fall into patterns that damage relationship
   - escalation: increasing negative comments > anger/ frustration
   - invalidation: denigration of partners thoughts, feelings, character
   - withdrawal/avoidance: unwilling/reluctant to talk (men more likely)
   - negative interpretation: consistent beliefs motives of partner are more negative than they are in reality

Question 29

Gottman marriage success
4 horseman?
Flooding?

Answer 29

1. Couples who stay married: 5 positive comments to 1 negative comment during conflicts
2. Couples who divorce: equal ratio of positive comments to negative
3. Four horsemen of apocalypse: couples who will divorce
   A. Criticism: deficit in character (you are lazy)
   B. Contempt: superiority, sarcasm, put-downs, name calling, lack of respect
   C. Defensiveness: avoidance of responsibility, making excuses
   D. Stonewalling: withdraws, stops participating (men more likely)
4. Flooding: physical arousal accompanied by negative thoughts > conditioning negative response to partner and relationship

Question 30

Distance and isolation cascade

Answer 30

1. Chronic flooding > belief problems in marriage severe > no point in trying to fix

Question 31

Relationship enhancement

Answer 31

1. Married or engaged couples
2. Taught 10 skills
3. Expressive skill: speakers better at own needs, desires, feelings
4. Empathic skill: listeners compassion of emotional needs of speaker > how to respond
5. Discuss and negotiate skill: positive atmosphere when discussion difficult > deep feels of root issue
6. Facilitation skill: exit negative communication cycles
7. Conflict management: regulate emotions > manage difficult conflict
8. Problem/conflict resolution skill: creative, mutually satisfying solutions
9. Changing-self skill/ helping others-change skill: help individuals bring about desired changes > altering own behavior for self improvement
10. Transfer and generalization skill/ management skill: using RE skills in everyday life w/people besides partners > maintain over time

Question 32

Couple communication program

Answer 32

1. For all relationships
2. 11 specific communication skills for talking and listening
3. Practice skills with coaches, feedback after observation
4. Awareness wheel: used to increase individual self-awareness
5. Listening cycle: expand awareness of partner, 5 listening skills
6. Mapping an issue: process of resolving conflicts
7. Identify positive/negative styles of communication
8. Skill mats: floor mats > explore and process experiences, issues

Question 33

The prevention and relationship enhancement program (PREP)

Answer 33

1. Empirically tested
2. skills-orientated approach > factors that can lead to breakdown
3. Typically 13 hour group program
4. Better communication and conflict resolution skills
5. Explore expectations of relationship
6. Explore attitude and choices of commitment
7. Enhance bond with fun, friendship, sensuality

Question 34

Practical application of intimate relationship skills (PAIRS)

Answer 34

1. Designed for couple to maintain intimacy
2. 120 hour group training
3. Dialogue guide: express thoughts, feelings, assumptions
4. Communication and problem solving
5. Uncover hidden expectations, unexamined beliefs, mind reading
6. History of individual > genogram > discover early messages, rules, myths, loyalties, values
7. Dealing w/intense emotions to facilitate bonding
8. Enhance physical intimacy
9. Clarify expectations and goals

Question 35

PREPARE/ ENRICH program

Answer 35

1. Online inventory customized to each couples situation
2. PREPARE: couple who prep for marriage
3. ENRICH: designed for married couples
4. Facilitator reports detailed feedback on couple
   - strengths/ weaknesses
   - workbook w/ exercises for developing skills and strengthening relationship
5. Measures cohesion and flexibility in each partners family of origin
6. Measures personality

Question 36

Relationship education with diverse populations

Answer 36

1. PREPARE/ ENRICH available in Spanish and other languages
2. PREP specifically for African American Christian couples
3. Funding to strengthen relationships of low income couples > strengthen well being of children
4. Same sex couples receiving attention > relationship education tailored to their needs
5. Attention for remarrying couples, stepfamilies, military, prison, cohabitation couples

Question 37

Mental illness

Answer 37

1. One of largest economic, social burdens
2. 2.5 trillion cost globally
3. MI associated w/ distressed marital and family relations, increase likelihood divorce
4. Most common anxiety and mood disorders

Question 38

Anxiety and mood disorders

Answer 38

1. 22.3% adults meet criteria for anxiety disorder every year
2. 18.1% adults “ for mood disorder
3. Common tx is psychotherapy and pharmacotherapy
4. Presentations of symptoms are culturally dependent

Question 39

Physical illness

Answer 39

1. Chronic disease, diabetes, heart disease, obesity leadin cause disease in U.S

Question 40

The biobehavioral family model

Answer 40

1. Developed to explain role of family functioning in physical illness
2. General systems theory + structural family therapy
3. Family emotional climate, biobehavioral reactivity, disease activity
4. Stress of family emotional climate contributes to symptoms of poor emotion regulation and taxes biological systems > person susceptible to physical illness
5. Medically family therapy: biomedical + psychosocial= more holistic
   - Latino and African Americans less likely to have health insurance
   - “ receive lower quality care
   - Latinos disproportionally use general medical providers when seeking to for mental health

Question 41

Substance abuse

Answer 41

1. Family predisposition: family functioning plays significant role in sub. abuse
2. Behavioral couples therapy (BCT): daily sobriety contract + relationship focuses interventions
   - catch your partner doing something nice hw: record caring acts
   - communication sessions: face to face expressing emotions
3. Multidimensional family therapy (MDFT): substance abuse w/adolescence, all factors (individual, interpersonal, and familial) contributes to development, course, maintenance of sub. abuse
   - targets: 1. Adolescent 2. Parents 3. Family interacting 4. Community social systems
   - use enactments
   - successful in low income, minority teens
   - more effective than individual therapy
4. Diversity: racial minorities respond more poorly to tx, greater risk for relapse

Question 42

Family violence

Answer 42

1. Intimate partner violence: 25% men, 8% men victimized by partner during their lifetime
2. Coercive controlling violence: violence, intimidation, coercion to control partner
   - blaming, isolation, emotional, use of children, male privilege, threats
   - more severe and frequent than other couple violence
   - high likelihood of injury
   - perpetuated by men more
3. Violent resistance: violence that takes place as immediate reaction to assault intended to protect oneself from injury
   - women trying to protect selfs and children
   - may escalate violence , results in injury (2x likely to be injured as those who do not defend themselves)
4. Situational couple violence: resulting from escalation of situation or argument
   - no pattern of controlling or intimidating behaviors
   - violence of pushing, shoving, grabbing
   - no fear of partner, both men and women
   - less likely to escalate
5. Separation instigated violence: violence between partners who are separating or divorcing
   - both men and women
   - no previous history of violence
   - destroying property, weapon brandishing, ramming partners car

Question 43

Couple therapy and intimate partner violence

Answer 43

1. Universal screening: to asses minimizing risk and safety for individual being abused
   -initial couple session
   -individual session
   -agreement to conjoint couple therapy
   -if 7 criteria not met, individual and group modalities only employed
2. Domestic violence focused couples tx (DVFCT): if criteria met
   -eliminate all violence
   -.promote individual responsibility for actions
   -improve relationship
3. Diversity of DV
   -feminists argue violence is NOT equal among men and women
   A. Men more likely to be violent
   B. Men less likely to be intimidated, and injured
   C. Women more likely to use violence as self defense, escape, retaliation
   D. Men perpetuate violence to maintain power and control of heterosexual relationship > selective innattention

Question 44

Child abuse

Answer 44

1. 3.7 million referrals to protective services 2011
2. Majority of victims abused by parents
3. Family and nonoffending parent support > better outcomes for victims
4. Filial therapy: child centered play therapy administered by parents
   - play therapy: play as medium for child to express feelings and seek mastery of conflicts
   - core beliefs of play therapy: A. Relationship that develops between practitioner/child B. Nondirective, unconditional acceptance of child/ child’s actions in play setting C. Variety of play materials
   - most effective outcomes involve parent in play therapy
5. Diversity child abuse
   - more child abuse w/socionomic disadvantage, parents likely high stress > high stress = increase risk of child abuse
   - minority stress, acculturation, discrimination liked to greater stress, less sensitivity, greater abuse
   - stepparent, poor parent-child attachment, physical separation highly ass. w/abuse

Question 45

Divorce

Answer 45

1. Couples most likely to divorce are those which both partners are 20 or younger,
2. individuals w/lower incomes and education more likely than ind. w/higher income and Ed
3. Women w/5 college years and good income more likely than poorer less educ. women
4. 1/2 of marriages
5. 1.5-3 years to adjust and stabilize one’s feelings of divorce process
6. Three stage divorce process therapy

Question 46

Three stage divorce therapy process: predivorce

Answer 46

1. The predivorce: one partner disenchanted, emotional divorce
   - unfulfilled emotional needs, financial prob., third party, sub abuse, Violence, unhappiness, depression, anger
2. Children in home frequently develop emotional/behavior problems
3. Most couples do not seek therapy at this stage
4. Therapists 1. help couple assess and work toward resolution of marital conflict 2. Help parents begin to address children’s needs during process
5. Conjoint therapy
6. 2/3 Divorces initiated by women most likely tx

Question 47

Three stage divorce process: the divorce stage

Answer 47

1. Divorce is made, separation begins
2. Potential for severe stress and crisis
3. Healthy separation:
   A. good management: knowing about and prep for defusing tension at high stress, giving everyone time for adjustment
   B. Firm relationship rules: cope w/role losses, and est. new roles
4. Divorce mediation: property, financial etc. to aid couple make decisions
5. Binuclear family: children divide their time between households
6. New activities and routines
7. Seperation into community
8. Therapy addresses divorce restructuring: transitions in divorce, coping effectively, emotional pain, problem solving, stress management
9. Children need clear explanation, adequate parenting, attention and support

Question 48

The three stage divorce process: the post divorce

Answer 48

1. The psychic divorce: stage of devastation or exciting new challenges
2. Coping w/loneliness, regaining self confidence, rebuilding social relationships, emotional closure
3. Divorce adjustment: identity not tied to status of being married to or the ex-spouse, function in daily life, relatively free of psychological symptoms, positive self esteem
4. Re-divorce after remarrying 14% higher than first marriage
5. Diversity with divorce: gender income gap narrowing, women still have more economic disadvantages

Question 49

Feminist therapist role

Answer 49

1. more philosophical > applies various orientations
2. Gender fair, flexible multicultural, interactionist, life span orientated
3. Role unique to particular client
4. Consistent monitoring of personal judgments, biases
5. Committed to understand oppression (sexism, racism etc)
6. Modeling proactive behavior
7. Trust in client to move forward in positive manner
8. Relation to client non-hierarchal
9. Client relies in internal (not external) locus of control
10. Relationship is not sufficient enough to produce change > insight, introspection, self-awareness
11. Therapist not an all knowing expert

Question 50

Feminist assessment and diagnosis

Answer 50

1. Dsm est. through male gender role as ‘normal, ‘ women more prone to becoming pathologized
2. Distress vs. psychopathology
3. Pathology is a Victim blaming stance
4. Symptoms are coping and survival strategies > reframe and shift etiology to the environment
5. Challenge and change messages from media, culture, society

Question 51

Feminist techniques

Answer 51

1. Tailor intervention to clients strengths, empowering client, and evoke consciousness
2. Focus on informed consent (how therapy works), clarify expectations, identify goals, contract to guide therapy
3. Client empowered to become equal participant: client in charge of direction, length, procedures (what’s the most powerful thing you could do right now?)
4. therapist self disclosure: to model, normalize women’s collective experience, empower, establish informed consent
   - how has client and therapist conformed to hetero normative ideals >how this has helped Therapist
   - therapist clearly states her values and beliefs> let client choose to work together or not
5. Gender role-analysis: identify messages received, body image expectancies
6. Gender role-intervention: place concerns into context, “in our society beauty is portrayed as females who are thin, long straight hair, attractive clothing,” > insight into expectations shaping life. Unity w/women.
7. Power analysis: identify power imbalance as barrier: how do men have more power than women
8. Bibliotherapy
9. Assertiveness training: communication increases power, ameliorates depression and anxiety
   - ask for what you want and need
   - explore consequences of being assertive
10. Reframing/relabeling: shift from blaming the victim to consideration of social factors
    - depression linked to social pressures
    - “I’m inadequate” > I don’t conform to ideals (I’m strong and healthy woman, not selfish or masculine)
11. Social action: suggest clients become volunteers in activities like rape crisis center, lobbying lawmakers, community Ed.
    - leads to empowerment
12. Group work: women discuss lack of voice in society
    - raise consciousness and support
    - challenge patterns by practicing behavioral skills, taking interpersonal risks
    - a hw task to bring about change outside of therapy

Question 52

Feminism diversity

Answer 52

1. Men allowed in feminism, can give feminism therapy: men explore male privileg, explore sexist behavior, redefine masculinity and femininity to traditional values, support women just society
   Strengths:
2. Feminism calls to attention oppression and discrimination
3. Empower all individuals to create equality in society
4. Culturally competent by working w/ culture by exploring consequence and alternatives
   Shortcomings:
5. Problems with working w/ women who do not share beliefs of challenging traditional norms, power in relationships, freedom of career etc
6. Therapist values may be too strongly influential and conflict w/ client
7. Culture most important in cultures that keep women in subservient roles > client empowered to to make own significant choices

Question 53

Postmodernists: Social constructivism

Answer 53

1. Realities do not exist independent of observational processes
2. Value clients reality without disputing whether it is accurate or rational
3. Reality based on language and function of situation one lives
4. Depression = adoption of self as depressed
5. Therapist disavows role of expert > client as expert
6. Collaborative relationships more important than technique and assessment
7. Question language that guides understanding of the world
8. Language and concepts are how we understand historically and culturally
9. Knowledge is constructed through social processes
10. Negotiated understandings are practices that affect social life