Individual Flashcards
Sketch of Interpersonal Theory of Suicide with citation
Joiner (2006)
Detailed Schematic of Interpersonal Theory of Suicide
Joiner (2006)
Strategies to reduce risk of suicide
*Hospitalization when necessary (limit ability to act of suicidal desire by reducing means, can receive medication, opportunity to consider perceptions of burdensomeness/belonging)
*Remove access to lethal means
*Elicit social support
*Joiner recommends a commitment-to-treatment statement – this is different than a “no suicide contract”. Has potential to foster feelings of belongingness because the focus is on the therapeutic relationship. When created collaboratively, can foster feelings of competence (the opposite of burdensomeness).
*Clearly defined crisis plan
*Hope card at beginning of treatment (include concrete steps to take in times of crisis – more than just numbers to call – includes mood regulation techniques, pleasant activities. This is created collaboratively)
*Mood graphing
*Creation of a Hope Kit
Four Factors of Death by Suicide (IPT)
- Perceived Burdensomeness
- Thwarted Belongingness
- Acquired capability
- A desire for suicide
Perceived Burdensomeness
“the idea that one is defective or flawed such that not only oneself is brought down but, even worse, one’s existence burdens family, friends, and society”/”I am a burden”
Tons of evidence from the animal kingdom and anecdotal evidence, but Joiner et (2002) found in a study notes found a link between perception of burdensomeness and completed suicides as well as death by more violent methods.
Failed Belongingness
social alienation - “the experience that one is alienated from others, not an integral part of a family, circle of friends, or other valued group”
Conner et al (2007) found that low feelings of belongingness predicted lifetime history of suicide attempts
Suicide rates go down during times of celebration (Joiner, et al, 2006) and during times of commiseration (Biller, 1977).
Acquired capability
have been habituated to the pain/fear of self injury
Theoretical Support include: Orbach et al (1996) who have shown that psychiatric patients with histories of suicide attempts have higher pain tolerance.
The work of Holm-Denoma, Witte et al (2008) showed a link between anorexia/pain tolerance and a sort of “fearlessness” about their bodies - Running marathons on a broken foot.
The Big 5 (diagnoses with elevated risk of suicide)
- Major depressive disorder
- Bipolar Disorder
- Anorexia Nervosa
- Schizophrenia
- Borderline Personality Disorder
Unified Protocol - cite and define
Barlow (2006)
The Unified Protocol (UP) is a form of cognitive-behavioral therapy (CBT) for individuals diagnosed with anxiety disorders, depression and related disorders (which we refer to as emotional disorders).
Goal of UP
to help patients learn new ways of responding to uncomfortable emotions that reduce symptoms across a patient’s range of problems.
Rationale for UP
- High comorbidity amongst anxiety and depressive disorders.
- This comorbitity is that to be due to core deficits present across the range of dianoses
- These dficits include
- biologically-based propensity for strong emotions
- aversice reactions to these emotional experiences
- leads to reliance on emotionally-avoidant coping strategies
The Unified Protocol was developed to explicitly address the core deficits shared across emotional disorders. We believe that targeting processes common across diverse disorders is a more efficient way of addressing comorbid conditions simultaneously than targeting the symptoms of each diagnosis individually.
UP Treatment Modules
- Setting Goals and Maintaining Motivation
- Understanding Emotions
- Mindful Emotion Awareness
- Cognitive Flexibility
- Countering Emotional Behavior
- Understanding and Confronting Physical Sensations
- Emotion Exposures
- Recognizing Accomplishments and Looking to the future
Agency
Safran & Muran (2000)
Agency is the need for self-definition or individuation
Relatedness
Safran and Muran (2000)
Relatedness is the innate need for establishing and maintaining relatedness (connection) with others.
One person vs. Two Person Psychologies
Safran & Muran (2000)
Two-person psychology: both therapist and patient are contributors to their interactions/relationship.
VS.
One-person psychology: the therapist can be a neutral observer who stands outside the interaction.
Agency vs. Relatedness
It is said that the two are always in conflict with one another.
It is believed that humans have the need for both symbiosis with the other and for solitude.
Example: the natural need to mature and individuate from parents and yet this threatens relatedness to them.
”Conceptualizing the goal of treatment as learning to constructively negotiate the need for agency versus the need for relatedness thus provides a broader, more comprehensive framework for change than the goal of self-development” (p.34).
What are the recommended practices of a counselor in two-person psychology
Clinical Implications of two-person psychology
Safran and Muran (2000)
- Clinical formulations must be guided and revised from the here-and-now.
- Therapist must reflect on her contributions to the interaction.
- It is never safe to assume the session parallels patterns of the patient’s daily life. Be open.
- Disembed!
- Talk about being stuck
Metacommunication
Safran & Muran (2000)
a way of disembedding from a relational configuration when there is a therapeutic impasse, consists of an attempt to step outside of the relational cycle that is currently being enacted by treating it as the focus of collaborative exploration: that is, communicating about the transaction or implicit communication that is taking place. Thought of as mindfulness in action.
General Principles of Metacommunication
Safran & Muran (2000)
- Participation and Orientation - invite, we-ness, awareness rather than change
- Attention and Focus - here and now, concrete and specific, clients responsivenes and experience
- Expectation - resolution attempts lead to more ruptures, repeat the same impasse
Two types of ruptures
Safran & Muran (2000)
Withdrawal and confrontation
Withdrawal Ruptures
the patient withdraws or partially disengages from the therapist, his or her emotions, or some aspect of the therapeutic process
Confrontation rupture
the patient directly expresses anger, resentment, or dissatisfaction with the therapist or with some aspect of the therapy
Patients favor the need for agency over relatedness
Types of Rupture Markers (picture)
Withdrawal Markers
Safran & Muran (2000)
- Denial
- Minimal response
- Shifting the topic
- Intellectualization
- Storytelling
- Talking about the other
Confrontation Markers and/or Complaints about
Safran & Muran (2000)
- The therapist as a person
- The therapist as competent
- The activities of therapy
- Being in therapy
- Parameters of therapy
- Progress in therapy
Resolution Model for Withdrawal Ruptures
Resolution Model for Confrontation Ruptures
Bordin (1979)
believed that a good alliance is a prerequisite for change. According to him, the strength of the alliance is based on the agreement between the client and the therapist about the tasks and goals of therapy, and the quality of the relational bond between them.
Goal, Task, Bond
Interventions to address ruptures in alliance
pic
Direct Interventions for Task/Goal Ruptures
a basic intervention for addressing alliance ruptures consists of outlining or reiterating the treatment rationale. Therapists can then clarify any misunderstandings.
Also, therapists can employ microprocessing tasks. Microprocessing tasks consist of exercises assigned to patients in order to help them develop a concrete understanding of the type of internal process that play a role in therapeutic change. For example, patients in cognitive therapy can be asked to report on their automatic thoughts in session as a way of helping them learn how to self-monitor.
Indirect interventions for ruptures on tasks and goals
- Reframing the meaning of tasks and goals
- Changing tasks and goals
Direct Interventions for problems in bond
Clarify misunderstandings. When the alliance becomes strained because the patient mistrusts the therapist or does not feel respected by the therapist, the therapist can attempt to clarify what is going on in the therapeutic interaction with an eye toward resolving misunderstandings. It can be critical for therapists to acknowledge their contribution to the misunderstanding.
Explore core relational themes
Indirect interventions for problems in bond
Alllying with the resistance
New relational experience is the other indirect intervention that involves addressing the bond component of the alliance through actions, rather than through direct exploration. By refraining from acting in a way that confirms the patient’s maladaptive relational schema or by unhooking from a vicious cycle that is being enacted, therapists can provide patients with a new relational experience that will help them to modify existing schemas
Exploring core relational themes
Direct intervention for problems in all three areas (Goal, task, bond)
The exploration of a rupture in the alliance can lead to an in-depth exploration of a vicious cycle that is being enacted in the here-and-now. During this type of exploration, it is critical for the therapist to work collaboratively with the patient to explore the current transaction in its own terms and not to make any assumptions about the extent to which the current interaction reflects relational patterns that are characteristic for the patient. In exploring such themes, it is critical for therapists to explore their own contribution of the interaction.
example: A patient who fails to do homework assignments in cognitive therapy may have a particular sensitivity to feeling dominated and controlled by others.
ARC
Barlow, et. al., (2011, 2018)
The UP House
