Interventions and Phases Flashcards
CBT
Beginning: Establish safe and supportive therapeutic relationship; Complete a functional analysis to assess and define the problem and negative thought patterns; Educate and explain CBT; Set collaborative goals.
Middle: Identify negative thought patterns; Uncover negative schemas;
Assign homework to self- monitor thoughts and moods and behaviors; Label cognitive distortions; Reframe thoughts; Learn and practice new skills and
behaviors.
End: Review gains; Identify skills learned; Rehearse for new situations; anticipate future struggles.
REBT
Beginning: Provide psychoeducation about REBT. Identify underlying irrational thought patterns and beliefs and the resulting feelings and behaviors.
Middle: Once these underlying feelings have been identified, the next step is to challenge these mistaken beliefs. In order to do this, the therapist must dispute these beliefs using very direct and even confrontational methods. Ellis suggested that rather than simply being warm and supportive, the therapist needs to be blunt, honest, and logical in order to push people toward changing their thoughts and behaviors. Clients are also encouraged to change unwanted behaviors using such things as meditation, journaling, and guided imagery.
End: Review progress made and apply learned skills to anticipated future struggles.
Reality Therapy
Beginning: Create a therapeutic environment – both supportive and challenging;
Ask clients what they want from therapy: discuss direction of their lives; define the wants of the client
Middle: Explore choices client is making in current relationships; Identify other possible choices; encourage client to focus on what they can control, formulate
action plan for change
End: Review what client learned; plan for maintenance of new behavior
DBT
Beginning: Move client from being out of control to achieving behavioral control. Mindfulness and distress tolerance skills are taught. Focus on addressing self-harming behaviors
Middle: Fuller emotional experiencing; support the client to learn to live; define life goals, build self-respect, and find peace and happiness
End: Finding a deeper meaning through a spiritual existence
Client/Person-Centered
Congruence: Therapist’s genuineness with client, shares his/her feelings
honestly, does not hide behind professional facade—therapist is transparent
with feelings, thoughts, and beliefs
• Unconditional Positive Regard: Complete acceptance of the client, a
nonjudgmental respect of client and his/her feelings allows clients to feel less
anxious about their perceived weaknesses and taking risks.
• Empathy: Therapist accurately senses the feelings and personal meanings
the client is experiencing and is able to communicate this understanding to
the client
• Self-Actualization: Innate tendency of all human beings to reach their fullest
potential
• Locus of Control: Through the therapeutic relationship, clients are able to
take control of their lives rather than follow the direction of others who were
previously in control.
• Non-Directive Therapy: Clients are allowed to lead the discussion.
Gestalt
Key Concepts
• Phenomenological Method: Exploring experience by description and
abstaining from interpretation
• Dialogical Relationship: Therapist’s presence allows for the client to
become fully present.
• Experiential: Through experiments, the therapist supports the client’s direct
experience of something new, instead of merely talking about the possibility of
something new. • Here-and-Now Focus: The past is discussed in terms of how the past affects
the present.
Interventions
• Empty Chair Technique: Used to explore patients’ relationships with
themselves or others in their lives. A form of role-playing, the client addresses
an empty chair as if another person was in it in order to act out two or more
sides of a discussion.
• Experiments: Encourages the client to experience a feeling rather than just
talk about it.
• Body Techniques: Bring patients’ awareness to their body functioning or help
them to be aware of how they can use their bodies to support excitement,
awareness
• Focuses on the process, what is actually happening, and the content, what is
being talked about.
Existential Therapy
Key Concepts
• All persons have the capacity for self-awareness. • As free beings, everyone must accept the responsibility that comes with
freedom.
• Each person has a unique identity that can only be known through
relationships with others.
• Each person must continually recreate himself. The meaning of life and of
existence is never fixed; rather, it constantly changes.
• Anxiety is part of the human condition.
• Death is a basic human condition that gives significance to life.
Experiential/Symbolic
Beginning: Engage family as authentic person. Battle for structure. Encourage all members to attend. Family wins battle of initiative. Gather information about
boundaries, coalitions, roles and level of conflict
Middle: Develop sense of cohesion. Create alternative interactions. Highlight inappropriate boundaries. Role play situations. Use play and “craziness”.
End: Highlight accomplishments and reflect on growth. Identify possible block to future growth. Role play future scenarios. Each member expresses feelings about their experience of therapy.
Depth Psychology
Beginning: Invitation and exploration of material the client brings to therapy, including relational situations, dreams, experience, imaginings etc.
Middle: Placing client experience into a mytho-poetic lens, looking at images, myth, story, imagination and archetypal patterns within the conscious and unconscious happenings of the clients life. Looking for meaning by orienting one’s experience into the greater human story.
End: Integration of unconscious material often marked by acceptance of taboo subjects and previously discarded aspects of the personality. Acknowledgement of self-awareness and inner wisdom.
Alderian Therapy
Beginning: Establishing the Relationship: Adlerian therapists seek to make person-to-person contact with clients rather than starting with “the problem.” Therapists start by helping clients become aware of their assets and strengths. Completes assessment using early recollections, questionnaires, and family constellations. Summary is shared with client. Focus is on dynamics that may have influenced the sense of self, inferiority and the world.
Middle: Encourage self-understanding and insight through interpretation. Clients are positively encouraged to overcome their feelings of insecurity through therapist’s optimism. Collaboratively explore ways in which client can feel more deeply connected in his social context. Support client to turn dysfunctional styles of life into more functional, socially beneficial ones.
End: Putting insights into practice. Encouraging clients to take risks with new behaviors to act as if they are the people they want to be.
Attachment-based
Beginning: Attunement is the key intervention in the early stage and consists of forging of a personal relationship between the therapist and the patient. The therapist provides a secure base by reliably demonstrating empathy and care. Collaboratively identifying client’s “attachment style,” that is, problematic behavioral and emotional patterns, formed in early childhood as attempts to maintain attachment to primary caregivers.
Middle: Disruptions are explored in the middle phase. Disruptions include those in the early life of the client as well as those in current relationships, including the relationship with the therapist. Support client’s ability regulate and express emotions in relationally difficult situations, teaching clients to have a reflective stance toward themselves.
End: Repair occurs during the late middle phase and the end of treatment. Repair stage of the therapy aims to alter the patient’s current reactions to the events that cause them emotional distress by sharing their own interpretations of the event. By sharing their own subjective interpretation, the therapist helps create a new reality of the painful events for the patient in order to get rid of unwanted emotions and reactions.
Self-Psychology Psychodynamic Therapy
Early: Establish a therapeutic holding environment. Demonstrate that the therapist is able to provide containment. Provide “experience-near” empathy. Explore client’s problem and history.
Middle: Repair disruptions of the self-object transference. Addressing enactments. Empathizing with losses and blows to self. Mourning loss of self objects. Mourning ambitions and fantasies. Identify alternative self-objects.
End: Reflect on treatment process. Acknowledge and process issues related to termination.
Object Relations
Beginning: Establish a holding environment. Build rapport and therapeutic alliance through listening, exploration of client’s experience, empathy, and maintaining neutrality.
Middle: Promote insight and growth through interpretation. Confront resistance and primitive defense mechanisms. Focus on transference/countertransference dynamic. Identify and process projective identification.
End: Work through termination and abandonment issues. Consolidate interpretations. Review insights gained in therapy
Psychodynamic
- Emphasis on early development
Stages of Treatment:
1. Establish a holding environment.
2. Build rapport and therapeutic alliance through listening, exploration of client’s
experience, empathy, interpretation, and maintaining neutrality.
3. Promote insight and growth; increase individuation.
4. Work through termination/abandonment issues
Solution Focused
Key terms: Exception questioning, Miracle questioning, Scaling questions, Coping questions, presupposing change, Affirmations
Beginning: Join with client competencies; Envision preferred future; begin to identify client’s strengths; use solution-oriented language; come up with achievable goals.
Middle: Identify strengths, resources and traits client already has used to deal with problem; Utilize solution-talk; Identify exceptions to problems; Utilize scaling questions to reflect on the nature of change the client has experienced; Feedback to clients that include compliments and tasks; catch and highlight small
changes; compliments / cheerleading.
End: Assist client to identify things they can do to continue the changes they have made; Identify hurdles or perceived barriers that could get in the way of the changes they made.
