Final Exam Flashcards
Describe the challenges to traditional MFT models in the 21st century.
-Modern models -
-therapist is expert
-lack cultural awareness
-not as systemic
-longer-term gains achieved during treatment was not sustained by large portion of couples
-People began to reject hubris:
-Therapist is the expert
-Absolute truths
-Challenge the assumptions of gender roles, religion, science, classism, etc.
Describe sociocultural factors pertinent to MFT’s
-Multiculturalism (pluralism)
-Race
-Social class
-Gender
-Sexual identity
-Spirituality and religion
-Physical ability (ableism)
-Non-traditional families
-Intellectual disability (autism)
-What experience do we have in/with each of these populations?
-How do we address a lack of experience with specific populations?
-Many of these are interwoven (intersectionality)
-How do each of these things contribute to you as a therapist?
-Sociocultural perspective looks at you, your behaviors, and your symptoms in the context of your culture and background
Describe the major differences between Modern and Postmodern MFT models
-Modern:
-Therapist is expert
-Lack cultural awareness
-Not as systemic
-Postmodern:
-Therapist is expert on communication, not on client’s life
-Absolute truths do NOT exist
-Challenge the assumptions
-Challenge assumptions of gender roles, religion, science, classism, etc.
-More systemic
-More about collaboration
-More egalitarian relationship (more equal, but can never be truly 50/50 because they’re paying you)
-Make sure clients feel heard
-Postmodern family therapy is differentiated from modernist approaches by its disavowed of truth claims, and its encouragement of “voices” or narratives
Be able to articulate the feminist critique to modern MFT models
-Rachel Hare-Mustin (1978)
-Gender bias
-Modernist notion of equal responsibility
-Does equal responsibility blame the victim?
-Traditional gender roles
-History of blaming “enmeshed mothers” for familial problems
-Modern models exhibit gender bias
-Modern MFT models do not take power and privilege into account. This then overshadows important factors that impact women.
-Saw as family therapy’s benighted sexual politics, minced no words in criticizing the taken-for-granted practice of over-implicating mothers, deferring to fathers, and generally refusing to examine the family as a social and historical formation
Understand the difference between cultural competence and cultural sensitivity
-Cultural competence - being aware of your own cultural beliefs and values and how these may be different from other cultures
-Cultural sensitivity - remaining considerate towards other cultures, being aware that cultural differences and similarities exist
Understand the role of power in relationships and in society
-Balance of power in relationships
-Who handles finances?
-Who handles emotional matters?
-Who makes social arrangements?
-Who decides where to live and when to move?
-Who decides how the housework is split?
-How does power impact relationships?
-What balance do you want in your relationships?
-What would you change in your current/past relationship(s)?
-The roles each partner plays when faced with a specific challenge or situation
Contextual Family Therapy
-Ivan Boszormenyi-Nagy
Understand the importance of fairness in relationships
-Indebtedness vs. Entitlement
-We don’t want to be fully indebted or entitled to everything
-Families are healthiest when there is a balance between indebtedness and and entitlement
-Fairness in relationships allows family members to give more freely and request for heir needs to be met
Relational ethics
-Degree of fairness or reciprocity in relationships
-Cornerstone of contextual therapy
-Families stick together because of sense of reliability and trustworthiness
Relationship ledger
-Balance of give and take in a relationship
-This is something that is done unconsciously, but sometimes it can be conscious
-When there is an unbalanced relationship ledger, this is how problems occur
-Current relationship or with previous generations
-A sense of trust has been violated; past injuries
-A person has not been given what they are owed
Entitlement
-Destructive - Repetition or Reversal:
-1. Over-entitlement
-Not concerned with ledger
-Rigid way of viewing world
-2. Under-entitlement
-Concerned with ledger, but doesn’t work to balance it/but the way you manage it keeps it in the same spot
-Giving and giving to point where you lose self (too flexible)
-May not give partner opportunity to reciprocate (ex: when expected fathers don’t care about their own needs because wife is pregnant, and they think they don’t matter in that time)
-Purists may not use/like the terms over or under entitlement
-Constructive:
-1. Establish a balance/pattern that works well
-How problems occur: Reliance on destructive entitlement
-Expectation of giving by others who do not owe the debt
-Inability to acknowledge the efforts of others/an inability to receive
-Inability to give to others
-Inability to express needs or let partner help with your needs
-How change occurs: Earn constructive entitlement through being trustworthy, fair, and giving to others
Loyalty
-Split loyalties
-Kids choosing between mom and dad
-Choosing between current partner and FOO
-Other examples?
-Choosing between work and career vs. family
-Choosing between spouse and best friend
-Choosing between partner vs. family of origin
-Choosing between addictive substance and family
-Invisible loyalties
-Loyalties we don’t know exist
-Examples?
-Loyalty to God/religion
Legacy
-Continuing one’s role from their family of origin in their new relationships
-A responsibility or feeling of obligation to live your life a certain way or preserve aspects of yourself/your heritage due to pressure from you FOO
-Can be healthy or unhealthy (more easily seen when unhealthy)
-Can often be seen in immigrant families
Multi-directed partiality
-Type of intervention
-Most important therapeutic tool in contextual
-Sides with every family member, including those not present
-Empathy and consideration for each family member
Crediting
-Type of intervention
-Acknowledging the efforts of clients and others
-The therapist credits individuals so they can in turn credit others
Accountability
-Exoneration?
-Hold others accountable yet remove blame placed on others
-Forgiveness (not the same as exoneration, but important)
-One holds themself accountable, while the other works to forgive
-Exoneration & Accountability
-Help client see positive intent and forgive past debts
-Establish new, trusting relationship with balanced ledger
SFBT
-Insoo Kim Berg
-Steve deShazer
Understand the basic assumptions of SFBT
-Clients have the resources and strengths to solve problems
-Maybe some have fewer, some have more, but everyone has them
-Unnecessary to understand the whole history/cause of problem
-Quick change is possible
-A small change is all that is necessary
-People are resourceful and can take initiative, they just need to get the ball rolling
-Focus is on what is possible and changeable
-Have realistic goals
Best hopes
-Best hopes for therapy?
-Why might this be helpful for a therapist to ask?
-What truly matters to the client
-Client motivation
-Direction for therapy
-Therapist can immediately become aligned with client goals
-Don’t be hasty! Make sure you know the best hope, so that you can frame the miracle question USING their best hope
-Best hopes = goal
Miracle question
-Miracle question (may be asked session 1 or 2)
-“Imagine that when you go to bed tonight, a miracle happens. The miracle is that the problem that brought you here is gone! However, since you were asleep, you are unaware that a miracle happened.
-What would be the first things that you notice that let you know that this miracle happened?”
-What would be different?
-The wording of the miracle question is VERY important; knowing the goal is very important
-Don’t necessarily have to use word “miracle” (maybe use “shift” etc.; some may be non religious, etc.), can be creative with kids (ex: Harry Potter cast a spell…)
-Change must be of significance to client
-Works together with “best hopes:
-Miracle must be defined
-This makes goal formation vital
-Element of imminence (tonight!)
-Client must be unaware the miracle happened
-Clues to how client knows miracle occurred
-When might the MQ be inappropriate or misused?
-If you don’t define the miracle (ex: If parents who have a kid with autism, and the miracle isn’t specified, they may say that their kid would no longer have autism, which isn’t possible)
-Don’t be hasty! Make sure you know the best hope, so that you can frame the miracle question USING their best hope
Difference question
-So what difference would it make if your miracle occurred?
-What difference would it make for others?
-How would this change impact each member of the family system?
-This question helps explore meaning
-Can intensify and deepen the reason for the goal
-Encourages clients to explore if potential changes are realistic, feasible, and worthwhile
-Confidence means that I’m able to control aspects of my life.
-Type of intervention
Scaling question
-Makes goal measurable
-Can measure change
-10 (Great/Perfect/desired goal) —– 1 (Bad, worst)
-10 is always going to be where the client wants to be
-On a scale of 1 to 10, where 1 stands for “I am the worst possible parent ever, and 10 stands for the best parent ever, what number would you give yourself today?
-Suppose I ask your spouse the same question, what would he/she say?
-Suppose I ask your children, what number would they say?
-These are ways to involve family members/friends
-Where are you now?
-Where do you want to be?
-Not all clients needs to get to 10 (most don’t need to reach 10)
-How will you know when you reach ………?
-How do you think you could move from a 3 to a 4?
-What difference would that make in your life?
Exception question
-No problem exists 100% of the time
-Find times when clients did not have problems or when the problems are less severe
-Are there times where you are able to do……………
-How did you do that?
-What has the client tried and what haven’t they tried?
Summary message
-Type of intervention
-Therapist’s understanding
-Compliment positive steps
-Normalizing
-Suggested task (take it or leave it)
-You do not follow up on task next session (because you don’t want it to seem like a directive)
Narrative Family Therapy
-Michael White
-David Epston
-Thomas Szasz
Different type of stories
-Dominant stories
-Problem-saturated stories
-Subjugated stories
-Unique outcomes or sparkling events
Dominant stories
-The dominant narrative that shapes a person’s identity and/or behavior
-The story they most often tell others
Problem saturated stories
-Stories that take hold and cause people to perpetuate the problem story
