Exam Prep Flashcards
Strategic Family Therapy
FOUNDER:
Jay Haley
MAIN IDEAS:
Directives
-Using non-linear (systemic) tasks to upset the family system to create change with the smallest possible change
Strategic positioning
- Role of therapist shifts depending on client needs (if family views therapist as a master and authority figure, the therapist adopts this role)
- One-down position
CASE CONCEPTUALIZATION
Involuntary vs Voluntary Helplessness vs Power Metaphorical vs Literal Hierarchy vs Equality Hostility vs Love
INTERVENTIONS: Paradoxes Double Binds Prescribing the Symptom Relabeling One-down position
Bowen Family Therapy
FOUNDER
Murray Bowen
MAIN IDEAS
Human-focused therapy
Primary tool for change is therapist’s own differentiation
Differentiation
-Level to which a person is able to separate their internal world from their external world (to put it VERY basically)
-Similar to Maslow’s “self-actualization”, Jung’s concept of the “Self” (Persona (interpersonal) + Shadow (intrapersonal) = Self) or Nietzsche’s “Superman” (to some degree)
Multigenerational trauma
-Negative patterns continue through generations
-Grandfather experienced something and became cold and emotionally distant, so father learned to behave this way and became cold and emotionally distant and in turn grandchild became cold and emotionally distant
Family is own self-contained system
-Families can become very enmeshed (undifferentiated ego mass)
Triangles
CASE CONCEPTUALIZATION
Increase differentiation
Decrease emotional reactivity to chronic anxiety
INTERVENTIONS
Not as much focus on interventions when compared to other models because therapist uses self to embody the theory
Genograms
Process questions
Contextual Family Therapy
FOUNDER
Ivan Nagy
MAIN IDEAS
Balanced ledgers
Therapist as expert
Be partial to every family member
CASE CONCEPTUALIZATION
Multiple generations are involved in conceptualizing the case
“Ledgers” are unbalanced
-Family each has their own stuff going on that is contributing to the problem, if we can “balance” the ledgers, we can create a better family system. We do this through partiality to each person in the family and making everyone feel heard and acknowledged
INTERVENTIONS
Multidirected partiality
Empathy for each family member
Crediting
Acknowledgement of Effort
Structural Family Therapy
FOUNDER
Salvador Minuchin
MAIN IDEAS
Boundaries -Clear -Enmeshed -Rigid Enactments Assessment -Role of the family in the problem -Subsystems -Cross generational coalitions (mom and son against dad, for example) -Boundaries -Hierarchy -Strengths
CASE CONCEPTUALIZATION
Build alliance
-Therapist needs to join with family first and foremost
Evaluate and assess
-Assess the family the items listed above
Address problems in assessment
INTERVENTIONS
Enactments Challenge family worldview -Challenge common assumptions (kids need to come first, quid pro quo, etc) Crisis induction Unbalancing Shaping family truths Compliments
Satir Experiential Therapy
FOUNDER
Virginia Satir
MAIN IDEAS
People naturally trend towards positive growth
Everything is connected and impacts everything else
Therapy is a process between therapist and client where everyone is responsible for themselves
Communication stances
-Congruent
-Placator
-Blamer
-Superreasonable
-Irrelevant
Therapist is a warm individual that cares about the clients, instilling hope and being very humanistic (Carl Rogers style)
CASE CONCEPTUALIZATION
Therapist use of warmth and empathy
Six Stages:
-Status quo (what is the current state of the family/couple?)
-Introduction of foreign elements (introduce new ideas and help clients communicate better)
-Chaos (what occurs after the intro of foreign elements as family tries new things or attempts to revert to homeostasis)
-Integration of new possibilities (integrate new skill)
-Practice (practice new skill)
-New status quo (new state of the family)
INTERVENTIONS
Facilitating emotional expression Softening family rules Communication enhancement Sculpting Touch
Cognitive-Behavioral Therapy
FOUNDER
Donald Baucom, Frank Dattilio, Norman Epstein, John Gottman
MAIN IDEAS
ABC Theory
Cognitive distortions
Schemas
CASE CONCEPTUALIZATION
Assessment
Target behaviors/thoughts for change
Educate
Replace and retrain
INTERVENTIONS
Psychoeducation Conditioning (operant and classical)
IFS
FOUNDER
Richard Schwartz
MAIN IDEAS
Parts
- Manager
- Firefighter
- Exile
- Self
CASE CONCEPTUALIZATION
We all have parts
Parts are neither good nor bad. They make up who we are and the Self guides them
Internal changes affect external behavior
Help the Self lead the parts and achieve balance and the external world will fall into line
INTERVENTIONS
Imaging and non-imaging
Parts work
“Going back in time”
Assessing internal dialogue
Solution Focused
FOUNDER
Steve de Shazer, Insoo Kim Berg, Bill O’Hanlon, Milton Erikson
MAIN IDEAS
Therapists are not solution givers (this is a collaborative therapy)
Strengths-based therapy
Context surrounding problems are less important than finding solutions to them
Exceptions
-Same thing as unique outcomes/sparkling moments in Narrative
-Therapists identify exceptions
CASE CONCEPTUALIZATION
Length of treatment is brief (in SFBT) Goal is to help client form and enact PREFERRED solutions Solutions must be what client wants Solutions must be: -Meaningful to client -Interactional -Situational -Small steps -Clear role for client -Realistic -Legal and Ethical
INTERVENTIONS
Identifying small steps towards progress Exceptions Miracle question Scaling questions -"where are you on a scale from 1-10?"
EFT
FOUNDER
Sue Johnson
MAIN IDEAS
Attachment theory
-Each person’s attachment style leads to issues within the relationship, identify the attachment ruptures and clients can learn to meet the needs of the partner with the rupture
Therapist is warm and caring (very Virgina Satir-like)
Primary and Secondary emotions
-Primary emotions represent attachment fears and needs
-Secondary emotions are emotions about primary emotions
Pursuer/Withdrawer (Again, Satir)
-Especially with insecure attachment, pursuer/distancer tends to show up (anxious attachment chases avoidant attachment and avoidant runs from anxious. Anxious wants connection, avoidant is wary of it)
Contraindicated with abuse, already separating couples and couples with different goals
CASE CONCEPTUALIZATION
Step 1: De-escalation of negative cycles
Step 2: Change interactional patterns and create engagement
Step 3: Consolidation and integration
Tasks
Task I: Creating and maintaining alliance
Task II: Assessing and formulating emotion
Task III: Restructuring interactions
INTERVENTIONS
Enactments
Tango
TEMPO
RAVE
Narrative Therapy
FOUNDER
Michael White
MAIN IDEAS
Clients form stories (narratives) about their experiences which give meaning to them
Narratives shape how we view the world
If new narratives can be created, client will see the past and present in a new light
Narratives are not to be destroyed, rather built upon
Dominant/Local discourses (cultural vs more intimate stories about experience)
Preferred narratives (what client would like to view experience as)
Unique Outcomes/Sparkling Moments (times when the problem wasn’t a problem e.g., “I thought my wife would yell at me but she didn’t”)
Externalization
-The client is not the problem, the problem is the problem
-Use of language (“the addiction” vs “you’re addicted”)
Collaborative therapy
-Therapist is “co-author”
CASE CONCEPTUALIZATION
Problem-saturated stories
Discourses
Unique outcomes/sparkling moments
Early phase:
Identify, explore and map current narratives
Identify unique outcomes/sparkling moments
Externalize
Middle phase:
Target immediate symptoms and presenting problems
Late phase:
Target personal and relational identity
Target expanded community
INTERVENTIONS
Mapping -Influences of persons and problems -Landscape of action and identity Externalization -Use of externalizing language Scaffolding questions Identifying unique outcomes/sparkling moments Permission questions Internal state questions Intentional state questions
AAMFT Code of Ethics Standard I
Responsibility to clients
We don’t discriminate
-We see everyone and anyone who requests us, unless we can’t see for a reason like competence
We get informed consent before beginning therapy
-We don’t do therapy unless the client has signed the appropriate paperwork and understands it
We don’t have multiple/dual relationships with clients
- We don’t see people with dual relationships like friends or family
- We don’t become friends with clients and see them outside of therapy
We don’t have sexual intimacy with current or former clients or anyone in their family
-For good reason
We comply with ethical conduct and laws associated with it (HIPAA)
We do not abuse our power as therapists
-We’re just people who talk to other people about their problems. We don’t manipulate others or use the authority clients think we have for own ends
We respect client autonomy
- If they want to leave, they can
- If they want a different therapist, that’s fine
We only continue relationships with clients as long as it’s beneficial to them
-If it’s no longer beneficial, we have no business there anymore
We give referrals to clients
-When they move, request a new therapist, need help we can’t offer ourselves, etc.
We do not abandon our clients (I hear about abandonment a lot from clients)
- We let them know we are going to take a day off or be late or need to cancel or are moving, etc. ahead of time
- We don’t just drop clients out of nowhere
We get written consent to record sessions
-This one is big for us in supervision. They need to know and be ok with us recording
We clarify the nature of relationships with third parties
-For example, a client refers a friend to us. We have to make sure both clients know the score as far as relationships
AAMFT Code of Ethics Standard II
Confidentiality
Limits of confidentiality
- Make sure clients are clear on these
- Need to make sure they are discussed before talking about any issues
Written authorization to release client information
-Clients need to sign an ROI before we can share their information with another party
Client access to records
- Clients are allowed access to records about themselves
- Except if access to the records is going to cause serious harm
- In couples therapy, each individual needs to have written permission for the other to view the records about themselves (wife needs to give permission for the husband to view the wife’s records)
Confidentiality in non-clinical activities
-We need written permission from clients in order to use their information in anything non-therapy related such as research
Protection of records
-We keep good protection of client records and store them in secure areas
Preparation for practice changes
-In the event of moving practices, opening a new practice or death, we make sure client records are properly dealt with
Confidentiality in consultations (this refers to consulting with colleagues)
-We keep confidentiality even when talking to colleagues and other professionals
AAMFT Code of Ethics Standard III
Professional competence and integrity
Maintenance of competency
- We are expected to maintain our competency as therapist
- Utah expects 40 hours of continuing education
Knowledge of regulatory standards
- We stay up to date with new regulatory laws and seek out training to understand them
- For instance, when there are changes to HIPAA or the state of Utah regarding therapy, we need to know about them
Seek assistance
- We seek assistance for ourselves when we need it in order to maintain our ability to do therapy. For example, if we’re dealing with some personal stuff, maybe we need to seek out our own therapist or a doctor
- This is so that we can best help the client in the long run
Conflicts of interest
-We don’t create conflicts of interest like seeing the daughter of our personal trainer (odd example, but still)
Maintenance of records
-We maintain accurate and up to date records in compliance with the law
Development of new skills
- We continually seek to improve our skills as therapists
- We only start seeing clients in a new specialty area once we’ve completed appropriate training (we don’t do EMDR until we’ve gone through and passed EMDR training)
Harassment
-We don’t engage in any form of harassment with clients, coworkers, etc.
Exploitation
-We don’t exploit others. Pretty self-explanatory
Gifts
- We can accept gifts if it’s appropriate
- Appropriate is defined by cultural standards
- We can accept gifts or not by determining if it’s going to help or harm the therapeutic relationship
Scope of competence
- We stick to our domains
- We don’t deal with issues that are outside of our area of expertise or competence
Public statements
-We are careful when making public statements because of the influence we have the ability to exercise over others/a community
Professional misconduct
-We engage in misconduct when:
We are convicted of a crime
Engage in things that could be a crime
Do something that would get us kicked out of a professional organization
Get our licenses or certifications revoked by a disciplinary body
Continue practicing when we are no longer competent
Fail to cooperate with AAMFT
-These can all lead to losing our licenses
AAMFT Code of Ethics Standard IV
Responsibility to Students and Supervisees
Exploitation
- We don’t exploit our students or supervisees
- We are aware of the influence we have and we don’t take advantage of that
Therapy with students or supervisees
- Dual relationships apply here
- No therapy with those under our charge (this does not refer to sitting in on them doing therapy or vice versa)
Sexual intimacy with students or supervisees
-As with clients, no sexual relationships
Oversight of supervisee competence
- We don’t allow those under our charge to do more than they are capable of
- This refers to competence. If a student or supervisee is not properly trained to handle a case or situation, we don’t let them
Oversight of supervisee professionalism
-We make sure that those in our charge are professional in their conduct
Existing relationship with students or supervisees
- We avoid having supervisees that we know personally or are related to
- Dual relationship rules apply
Confidentiality with supervisees
-Confidentiality rules apply between supervisor and supervisee except in certain cases such as when mandated by law or when talking to others responsible for the supervisee such as a university program (it would be ok for my off-site supervisor to discuss me with Dr. Fawcett or Dr. Peterson)
Payment for supervision
-Supervisors don’t take financial advantage of supervisees
AAMFT Code of Ethics Standard V
Research and publication
Institutional approval
-We must receive institutional approval to do research through a university’s IRB
Protection of research participants
- We protect the confidentiality of participants (Dr. Kopp and I had to make sure we utilized two schools in our research so participants didn’t know one another for what we were doing)
- We protect research participants in general (we’re not Stanley Milgram)
Informed consent to research
-Research participants have a right to know what they’re getting themselves into
Right to decline or withdraw participation
-Participants have a right to decline something within the research or fully withdraw from it should they want to
Confidentiality of research data
-We have a responsibility to make sure data we collect is stored properly and securely. Personal data is gathered and is protected, therefore we have to maintain it’s security (again, in Dr. Kopp and I’s research, we collected photos, so we needed to make sure that personal information was kept well-secured)
Publication
- We don’t fabricate results
- We don’t take credit where it isn’t ours to take
- We only take credit for our own work
Authorship of student work
-We don’t attach ourselves as a co-author to students’ research unless we actually contributed to the research itself in a substantial way
Plagiarism
-Pretty self-explanatory. We don’t plagiarize
Accuracy in publication
-We have a duty to make sure that things published are accurate and factual
AAMFT Code of Ethics Standard VI
Technology Assisted Professional Services
Technology assisted services
- We must make sure that technology services are appropriate for clients
- Make sure clients know the risks of technological services (greater risk for breach of confidentiality)
- Ensure security of the service
- Only use the technology after being trained on it
Consent to treat or supervise
- We must obtain consent in order to use technology services with clients
- We must ensure confidentiality and make sure the service is secure
Confidentiality and professional responsibilities
- Clients need to be aware of the risks of using technology for therapy
- We need to make sure to maintain confidentiality with technology
Technology and documentation
-We must maintain the security of notes and other forms of documentation and make sure the client is aware of the risks of it
Location of services and practice
-We don’t use technology in order to practice outside of our bounds (I can’t use teletherapy as an excuse to see clients in Delaware when I’m not able to practice there)
Training and use of current technology
- We need to be sure to be trained in the use of whatever technology we’re going to use
- We carefully pick which technology services we will use and properly vet them
AAMFT Code of Ethics Standard VII
Professional evaluations
Performance of forensic services
-We actually can perform forensic services! (I didn’t know that)
Testimony in legal proceedings
- When we provide testimony, we don’t say anything that isn’t based in fact or available evidence
- We are very careful with what we say
- Legal proceedings are very sticky for therapists. If we say something that ends up being wrong, we can be in for a LOT of trouble, that’s why we really gotta know our stuff
Competence
-We demonstrate competence when we do legal things. We show that we know what we’re doing
Informed consent
-We get consent (or try to) and inform clients that we may need to discuss in legal proceedings and give them all the information they need to understand what we will be doing should the need arise
Avoiding conflicts
-When involved in therapy which involve legal proceedings (court mandated therapy), we clarify our role and discuss the potential conflicts involved in treatment
Avoiding dual roles
-We don’t become therapists for those who have given a forensic evaluation for. For example, if the court calls us to give an evaluation for a defendant or someone, we don’t give that person therapy later on. It’s essentially an extension of dual relationships here but in court terms
Separation of custody evaluation from therapy
-When clients are involved in a custody battle or similar, we don’t do evaluations or give recommendations about custody. We simply treat. We don’t overstep our bounds here
Professional opinions
-We don’t give our professional opinions about those we haven’t directly interviewed. So, if a prosecutor or someone asks us to give our opinion on someone involved with a court proceeding (say the uncle of the defendant who was involved), we don’t give our opinion on them unless we directly interview them. It’s not our role. We play things very close to our chests in court proceedings
Changes in service
-If something happens with the legal system that impacts us providing services to someone, we make sure the client is informed (this goes with non-abandonment)
Familiarity with rules
-We gotta know the rules when we are involved with forensic stuff. We gotta know our roles and how it’s all supposed to go
AAMFT Code of Ethics Standard VIII
Financial arrangements
Financial integrity
-We’re not corrupt politicians. We don’t accept kickbacks, rebates, etc. However, fee-for-services is not prohibited
Disclosure of financial policies
-We make sure the client is aware of our financial policies including the use of collections agency (and maybe the Yakuza and La Cosa Nostra) for non-payment
Notice of payment recovery procedures
-We give advance notice to clients who have not paid of our intention to use collections agencies or legal action. We still maintain confidentiality as much as possible
Truthful representation of services
-Whatever services we provide, we give an honest accounting of to the people involved
Bartering
-We normally don’t accept bartering, but special conditions do exist: a client requests it, it’s not exploitative, the professional relationship is not distorted, and a written contract is provided
Withholding of records for non-payment
-We don’t keep records out the hands of clients who need them based solely on non-payment on the client’s end
AAMFT Code of Ethics Standard IX
Advertising
Accurate professional representation
-We represent ourselves accurately. No lies, no embellishing. We are what we say we are
Promotional materials
-We make sure that advertisements and publications in media are true and represent what they claim to represent
Professional affiliations
-We don’t say we’re a partner or an associate of a firm if we are not
Professional identification
-We don’t use any material representing us or our work that has false information on it
Educational credentials
-We only claim degrees that have relevance to what we’re doing and represent training we actually have (it doesn’t matter if we have a history degree. It’s not relevant)
Employee or supervisee qualifications
-For those that might be working for us or are under supervision with us, we don’t lie about their qualifications (Rob and Brad can’t say I’m an LMFT for instance)
Specialization
-We only promote ourselves as a specialist when we have actually had the training and become competent in the use of said specialty (we don’t say we’re a specialist in EMDR when we just know a little about it)
Correction of misinformation
-When possible, we correct all misinformation about us and our services
Common concerns in ethics
Confidentiality
- Maintaining client confidentiality is a hugely common ethical concern
- Especially with teletherapy and communication, it’s not especially secure and can cause issues with ethics
- At least for me, I have a mom that likes to sit just outside the door (without me knowing) when her daughter is in session with me
- Notes are HUGE one, too. How many therapists have lost their licenses to improper notes?
- Including too much in notes or too little can result in legal trouble should a court ever subpoena them
- Another common breach of confidentiality comes with teletherapy and people being around. I had to cancel a session recently because they were in the car with their girlfriend and niece to start a session
Non-abandonment
- Lately, I’ve been encountering many people who were abandoned by their past therapist
- Scheduling is a big one, as well. Being clear on scheduling and cancelations is big
Obtaining consent
- When doing the others cards, I can’t believe the amount of times obtaining consent came up
- We need to obtain consent from clients to do just about everything, so when that consent isn’t obtained, we can get in a lot of trouble
Dual relationships
- Since we don’t see people we have a dual relationship with, it can get tricky sometimes
- People often want to talk to you when they learn you’re a therapist, but we can’t see them as a therapist without violating a dual relationship
Sexual relationships
-Unfortunately, I’ve heard about this already. The nature of therapy is such that romantic relationships tend to flourish within it. We have to be really careful about clients falling in love with us or vice versa
