Fluency Material Flashcards
EBBP (Evidence-based behavioral practice) model
1, Best available research
2. Client’s characteristics, preferences, state, needs, values
2. Resources (therapist’s expertise)
3 components of therapeutic alliance
agreement on bonds, goals, tasks
Session 1 Preliminaries
Purpose: clarification & orientation, project competence
“Before we get started, there are some preliminary items to take care of”
1. Introduce self:
Names (how you and client will address one another, pronouns)
Graduate student therapist (have degree, seeking advanced degree)
Supervision (discuss, record, watch–help me provide best service to you)
2. Review Confidentiality (threat of harm to self or others, child and elder abuse)
3. Indicate that there is electronic medical record (session notes, brief and to the point, access restricted to clinic/supervisory staff)
4. Review session length & frequency, session fee & payment options
5. Orient to psychotherapy (works best when we collaborate, see each other regularly, and test ideas out in daily life)
6. Explain purpose of initial sessions, get to know one another for me to start to understand your concerns, listen, ask ?s for you to see what, it is like to interact with me
7. Opening- What brings you in today? What brings you in to therapy at this time?
HEADSSS Assessment of current functioning
Home
Education/employment
Activities
Drugs (medications & substance use)
Suicide
Sleep
Sex
AD[D]RESSING framework
Age/generational differences
Disabilities (developmental or acquired)
Religion/spirituality
Ethnicity/race
SES (Socio Economic Status)
Sexual orientation
Indigenous heritage
National origin
Gender identity
3 therapist behavioral domains of the Shifting Cultural Lens model
- Process model (understanding client’s perspective; using CFI and AD[D]RESSING)
- Sharing therapist’s perspective with client
- Shared narrative (integration of views, soliciting buy-in, negotiating different treatment options)
3 therapist skills for evincing a multicultural orientation
Cultural humility
Incorporating cultural opportunities
Cultural comfort
Stages of change & four processes of MI
- Precontemplation: resistance to recognizing a problem, not seeing a need for change
Nurturing parent (engaging): connecting/rapport - Contemplation: have yet to make a commitment to change or action, considering making a change but has not decided yet
Socratic teacher (focusing): developing a direction for motivational enhancement - Preparation: report the intention to take action in the near future, decided to make changes and is considering how to make them
Experienced coach (evoking): change talk - Action: overt changes in behavior, experiences, and/or environment, actively doing something to change
Expert advisor/consultant (planning): specified actions - Maintenance: prevent relapse and stabilize behavior change, maintaining the change
Assessing stage of change in 2-3 questions
“Do you think [behavior] is a problem for you?”
No: “What leads you to say that?”
Yes: “What are your thoughts about making a change? When do you plan to make a change?”
“How important is it that we focus on [behavior]?”
“How confident are you that you can change [behavior]?”
“How ready are you to address [behavior]?”
“How ready are you to address [behavior] in therapy?”
“How ready are you to brainstorm strategies/skills to address [behavior]?”
OARS (Motivational Interview, basic interaction techniques and skills)
Open-ended questions
Affirmations
Reflections
Summary
DARN-CAT (change talk: mechanism of action in MI)
Desire: wish or want for change
Ability: given the resources, change may be possible
Reasons: pros and cons of behavior change
Need: how change impacts priorities
Commitment: communicating decision to make a change
Activation: identifying steps for change
Taking steps: what the client is doing to initiate change
Decisional balance
Function: develop discrepancy between current behavior and who the person wants to be
1. “What are the pros/benefits of maintaining your current life?”
2. “What are the cons/costs of making a change?”
3. “What are the cons/costs of maintaining your current life?”
4. “What are the pros/benefits of making a change?”
Simplified: create list of reasons to stay the same (status quo) versus reasons to change
Solution-focused questions – MECSTAT
Miracle questions: pretend the problem is solved…what are you doing differently?
Exceptional questions: What will you do to make this happen again?
Coping Questions: How are you preventing this from getting worse?
Scaling Questions: On a scale of 1-10, where 1 is the worst it’s ever been, where is the problem today?
It is important to ask why the number is not lower (to evoke change talk)
Time-out: 10-minute break for reflection or consultation
Accolades: emphasizes strengths and abilities in patients
Task: Negotiated task
8 steps to chain/functional (1-5) & solution (6-8) analysis
Identify problem behavior (PB)
Identify prompting event/precipitating factors
Identify vulnerability factors
Identify “links on chain” (i.e., thoughts, emotions to the PB)
Assess consequences to PB
Repair consequences to PB
Identify alternative solutions
Identify prevention strategies
Suicide ideation prompts
- “Have you wished you were dead or wished you could go to sleep and not wake up?”
- “Have you actually had any thoughts of killing yourself?”
If YES to 2, ask questions 3, 4, 5, and 6. If NO to 2, go directly to question 6. - “Have you been thinking about how you might do this?”
- “Have you had these thoughts and had some intention of acting on them?”
- “Have you started to work out or worked out the details of how to kill yourself? Do you intend to carry out this plan?”
- “Have you ever done anything, started to do anything, or prepared to do anything to end your life?”
If YES to 6, ask: “Was this within the past three months?”
Current homicidality/threat assessment interview (8 items)
1) Frequency, intensity, duration and justification of violent ideation
2) Reasons for violent ideation
3) Specificity of plans
4) Availability of method(s), availability of opportunity
5) Preparatory behaviors of any type
6) Self-control
7) Reasons for not acting or acting differently / deterrents to violence
8) Intent
DBT acceptance skills
Distress tolerance
TIPP skills
Temperature, Intense exercise, Progressive relaxation, Paced breathing (3-5; e.g., holding ice, hot/cold shower, snap rubber band on wrist)
DBT acceptance skills
Distress tolerance
Self-soothing
5 senses (vision, touch, hearing, smell, taste)
DBT Distress tolerance
ACCEPTS
ACCEPTS:
Activities
Comparisons
Contribute to others/society
Emotion change actions
Push away distress temporarily
Thoughts to distract
Sensations to distract
DBT Change skills
Interpersonal effectiveness
DEAR MAN (objective goal)
Describe the situation
Express your feelings about it
Assert what you want (or say no, might necessitate “broken record”)
Reinforce the other & why it’s in their interest to give you what you want
Be Mindful
Appear confident
Negotiate
DBT Change skills
Interpersonal effectiveness
GIVE (relationship maintenance goal):
Be Gentle
Act Interested in the other person
Validate the other person’s point of view
Use an Easy manner
