Lmft Flashcards
1
Q
prescribing the symptom is what type of therapy?
A
Strategic family therapy
2
Q
honoring the pain is..
A
an existential intervention
3
Q
Enactment is when …
+ what type of therapy
A
Ct’s enact a typical fight in a session.
Its structural family therapy.
4
Q
Talking about and naming the pain
A
Existential
5
Q
prescribing the symptom is…
A
a form of strategic family therapy. ie. prescribing time to procrastinate.
6
Q
deconstructing problem-saturated stories is what type..
A
narrative
7
Q
Differentiation is..
A
Bowenian
8
Q
Scaling questions are..
A
Solution-focused
9
Q
Ordeals are..
A
Strategic. an ordeal is an intervention that seeks to extinguish a maladaptive behavior by introducing an activity that is more of an “ordeal” to engage in than the problem behavior itself.
10
Q
coping questions are
A
solutions-focused
11
Q
family sculpting is..
A
satir/communicative
12
Q
establishing a holding environment is..
A
psychodynamic/object-relations
13
Q
rearranging how people sit in a room is..
A
structural
14
Q
using experiments is what type of therapy..
A
gestalt
15
Q
affirmations/compliments are..
A
Solutions-focused
16
Q
therapist directive
A
strategic
17
Q
Self actualization
A
client-centered/ humanistic
18
Q
facilitate de-triangulation
A
Bowen
19
Q
empathy + self-actualization + unconditional positive regard
A
client-centered/humanistic
20
Q
exposure
A
CBT
21
Q
understand problem effects
A
narrative- it aims to change the effects of a problem.
22
Q
teach I-statements
A
satir/communication + Bowen
23
Q
in CBT change occurs by
A
learning how to modify maladaptive thought patterns
24
Q
schemas
A
in CBT, A network of rules or templates for information processing that are shaped by developmental influences and other life experiences.
25
cognitive distortions
overgeneralization- one negative event generalizes to a whole arena
arbitrary inference- drawing conclusions without evidence
polarized thinking (black/white)
personalization (seeing yourself as the cause of negative external event)
selective abstraction- taking detail out of context and ignoring totality of situation
26
Socratic questioning ("what do you mean when you say x..." "can you provide one example." is a type of what intervention.
CBT
27
Reframing is a type of
CBT intervention
28
cognitive restructuring is when..
ct. identifies irrational maladaptive thoughts, questions evidence, and generates alternate responses.
29
self-monitoring is also known as
| in what intervention
diary work
| in CBT
30
systematic desensitization
pairs relaxation with stressful stimuli (CBT)
31
anxiety management training
ct. practices relaxation until anxiety is reduced + continues with imagery (CBT)
32
behavioral activation
is used to help depressed clients to schedule activities + incentives
33
downward arrow
CBT technique: if this is true, what does it mean about your life?
34
mastery/pleasure ratings
ct. uses activity chart and rates the pleasure/mastery they derive from activity. CBT
35
successive approximation
a plan for ct. to engage in planning towards an ultimate goal + allow ct. to achieve success at each step. CBT
36
opposite action is what kind of intervention
CBT:
| ie when mad, say something nice.
37
thought record
expands on the three column technique, with columns to record alternate response to automatic thoughts and behavioral or emotional outcomes to changing thought.
38
beginning phase of CBT treatment
establish safe relationship, complete functional analysis to assess the problem/ thought patterns, educate and explain CBT, set collaborative goals.
39
middle phase CBT treatment
```
assign homework to self-monitor thoughts,
uncover negative schemas,
label cognitive distortions,
reframe thoughts,
learn/practice new skills.
```
40
end CBT phase
rehearse, anticipate future struggles, review gains.
41
treatment goal in CBT
relieving symptoms by replacing maladaptive thoughts with adaptive ones
42
negative cognitive triad
view of self
view of the world
view of prospects for future
43
in first CBT session, a therapist must:
provide psychoeducation about CBT. negative triad. (thoughts about self, other, + future.)
44
in humanistic therapy change occurs by
congruence, genuineness, unconditional positive regard + empathy
45
humanistic treatment goals
- congruence between idealized self and current self.
- self-understanding
- self-acceptance
- decreased defensiveness
46
congruence of a therapist means
a thx. is transparent to client, doesn't hide behind a professional facade.
47
non-directive means
ct. is able to lead the session
48
self-actualization
reaching ones fullest potential
49
locus of control
ct. is able to take control of their lives rather than follow direction of others who were previously in control
50
does client-centered therapy have phases of treatment?
no
51
In Gestalt, change occurs by
increased awareness of here-and-now experience in a dialogic relationship. Both existential and humanistic.
non-directive, non-judgmental.
52
Gestalt treatment goals
The goal is for clients to become aware of what they are doing, how they are doing it, and how they can change themselves, and at the same time, learn to accept and value themselves.
(self-acceptance)
53
Phenomenological Method is
Describing what the therapist sees without the interpretation.
I see you're crying.
I'm wondering what you're experiencing right now.
54
Dialogical relationship
Therapists presence allows client to become fully present.
55
Experiential in Gestalt means,
Through experiments, the therapist supports the client’s direct experience of something new, instead of merely talking about the possibility of something new.
"I wonder what it would be like for you to say it again with a fuller voice, louder voice-
'I'm angry with my partner.'
56
Empty chair technique
Imagine your mom sitting in the chair. What would you imagine saying to them?
57
Experiments in Gestalt
ie. empty chair,
| suggesting tensing the fist, etc
58
Existential Therapy theory of change is through
finding philosophical meaning in the face of anxiety by choosing to think and act authentically and responsibly. The core question addressed in existential therapy is "How do I exist?" in the face of uncertainty, conflict, or death
Emphasizes personal choice -
Recognition of life/death.
moment to moment process
therapeutic relationship
59
Role of therapist in existential treatment
- help ct. confront anxiety inherent in living
- ct. experiences agency and responsibility in the construction of their life
- all people have
60
key concepts in existential theory
- FREEDOM: As free beings, everyone must accept the responsibility that comes with freedom.
- INTERPERSONAL: we know ourselves through our relationship with others.
- CHANGE: each person continually re-creates themselves.
- SELF-AWARENESS: all people have capacity for self-realization
- DEATH/LIFE: death gives significance to life
61
holding + empathic availability
Holding refers to a process of holding up the problem experience so it may be seen, remembered, and re-experienced by the client.
Empathic availability is committed presence to the “other” and openness to the pain and potentials of the other even when such openness is difficult and unpleasant
62
Mastering the emotional pain vs.
Honoring the pain
reflection and behavioral experimentation that helps a client discover unique healing activities that are useful in processing and defusing the problem situation.
celebrating the meaning potentials and opportunities in the problem situation that the client actualizes and makes real.
63
Experiential/Symbolic Therapy theory of change
Change happens through the existential encounter – the authentic meeting of the therapist and the client in the present moment and by expanding the client’s range of experience.
Being met by a genuine/authentic other is what changes the client that allows ct. to experience themselves in a new way.
Humanistic approach + influenced by Gestalt. Generally used with families.
64
Experiential/Symbolic Therapy treatment goals
growth + increased flexibility
65
Battle for Structure
Therapist establishes the rules and working atmosphere of treatment. Includes the need for entire family to be in therapy.
Experiential.
66
Experiential - Battle for Initiative:
Family states agenda for each session. Therapist doesn't work harder than clients.
Experiential Therapist would wait if family is quiet- to bring up what they want to talk about.
67
Trial of Labor is in what theory and what is it
Understanding the roles, boundaries, beliefs, history and levels of conflict within the family
Experiential
68
Activating Constructive Anxiety is what + in what type of therapy..
Reframing anxiety as efforts toward competence (fear of failing to accomplish what one is capable of)
Experiential
69
Play, Humor and “Craziness:” Tapping irrational side. Finding solutions in creative interactions is what type of therapy..
Experiential
70
Beginning phase of Experiential Treatment
Engage family as authentic person.
Battle for structure (all therapy family unit is present)
Family wins battle of initiative (they take initiative)
Gather information about boundaries, coalitions, roles and level of conflict.
71
Middle phase of Experiential Treatment
```
Develop sense of cohesion.
Create alternative interactions.
Highlight inappropriate boundaries.
Role play situations.
Use play and “craziness”.
```
72
final phase of experiential treatment
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.
73
rational emotive behavioral therapy theory of change
Change occurs through changing irrational beliefs to rational beliefs, which improves clients’ emotional and behavioral functioning.
74
REBT:: Role of therapist is in being
Confrontational to irrational beliefs
75
Key concepts in REBT
A- Activating event
B- Beliefs
C- Consequences (emotional response to belief)
Common irrational beliefs.
76
DBT Theory of Change.
- mindfulness
- developing skills to manage distress tolerance and emotional regulation
- improving interpersonal problem solving skills
- Emphasis on accepting uncomfortable thoughts instead of struggling with them.
77
Role of therapist in DBT
Ally
Coach
Validates and offers experience
78
DBT treatment goals
The goal is for clients to improve their emotional and cognitive regulation
79
Key concepts in DBT
Mindfulness: The practice of being fully aware and present in this one moment
Distress Tolerance: How to tolerate pain in difficult situations, not change it Interpersonal Effectiveness: How to ask for what you want and say no while maintaining self-respect and relationships with others
Emotion Regulation: How to change emotions that you want to change
Homework: Clients are assigned skill-building tasks between sessions.
79
Key concepts in DBT
Mindfulness: The practice of being fully aware and present in this one moment
Distress Tolerance: How to tolerate pain in difficult situations, not change it Interpersonal Effectiveness: How to ask for what you want and say no while maintaining self-respect and relationships with others
Emotion Regulation: How to change emotions that you want to change
Homework: Clients are assigned skill-building tasks between sessions.
80
effectiveness is a key concept in
DBT
81
"self-acceptance, other-acceptance, and life-acceptance" is part of which..
REBT
82
DBT first phase of treatment + second phase + third
first: Move client from being out of control to achieving behavioral control. Mindfulness and distress tolerance skills are taught. Focus on addressing self- harming behaviors
second phase:
Fuller emotional experiencing; support the client to learn to live; define life goals, build self-respect, and find peace and happiness
third: Finding a deeper meaning through a spiritual existence
83
theory of change in narrative therapy
by separating person from the problem and creating a new narrative emphasizing a persons strengths
84
narrative therapy treatment goals.
deconstruct problem story to create more agency + re-authoring the story.
takes into consideration intersectionality and how it impacts problem
85
Externalizing the Problem
Separating person from problem in Narrative Therapy.
"In what contexts is depression most likely to take over?"
"What is anxiety trying to tell you to do?"
86
Social Constructionism
explore where messages are coming from. context, history, cultural context.
some values are collectively subjective.
87
deconstructive questions
helps unpacking language.
concerned with language + meaning intended.
They encourage clients to situate their narratives in broader contexts.
ie. "what does that word mean to you?"
88
mapping the influence (of the problem)
What is the impact of the problem on your life?
| Narrative therapy
89
identifying unique outcomes
times in a clients life where they were able to resist the effects of the problem.
narrative therapy.
90
enlisting a witness
in later stages, inviting someone else to support + be a witness to the re-authoring prices.
write a letter to self about new story.
91
phases of treatment in narrative therapy
1) invite ct. to tell problem-saturated story. work on externalizing problem.
2) problem is externalized. Mapping the influence/effects of the problem; Identify/explore unique outcomes; Re-author story; Enlist a witness
3) Document and support new story; Write letter to self and others
92
solution focused therapy theory of change
through accessing clients strengths and resources.
93
therapist role in solution focused
therapist, consultant, coach - providing a lot of encouragement.
94
treatment goals in solution focused therapy therapy
Client implements small and large changes to achieve their preferred future
Client builds on current strengths and resources
95
exception question + miracle question
solutions-focused.
Exception: “Tell me about the times when you don’t get angry.”
Miracle: “Imagine that tomorrow morning you wake up and a miracle has happened. What would be different that will tell you a miracle has happened and your problem has been solved?”
96
“You said that things are between a 4 and a 5. What would need to happen so that things were between a 5 and 6?” is a type of what intervention in what type of therapy
is an example of scaling questions in solutions-focused therapy.
tools to assess the progress and identify what's working.
97
presupposing (positive) change
is solutions-focused.
"What’s different, or better since the last time we met?”
assuming there are also positive changes occurring.
98
coping questions is an example of
solutions-focused therapy.
Example: “How do you keep going each day even when it feels like there is no hope?”
-illustrating resources ct. already has
99
affirmations/compliments
Regularly acknowledge, progress, strengths and resources. Example: Tell the client, "I am impressed you are sitting in that chair again after what you just went through".
100
phases of treatment in solutions-focused : number one
| short phase treatment
Highlight strengths; Envision preferred future; begin to identify client’s strengths; use solution-oriented language; come up with achievable goals.
101
solutions-focused middle phase treatment
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.
102
solutions-focused third phase
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.
103
theory of change in psychodynamic theories
Change occurs through insight and understanding of early, unresolved issues.
unconscious processes that impact functioning.
104
role of therapist in psychodynamic theory
Assumes a non-directive role
Establishes a holding environment for the client and the opportunity to develop a
secure attachment relationship.
feelings towards client (countertransference)
clients feelings toward therapist (transference)
105
underlying conflicts in psychodynamic theory
Infants and children all form attachment relationships with their caregivers (some are secure and healthy, some are insecure, avoidant, ambivalent, etc.) These patterns are repeated in adult relationships causing perpetual conflict, failed relationships or an inability to enter into an intimate relationship with another adult.
106
defense mechanisms is key concept in
psychodynamic theories, which can include
Inability to solve problems, high frustrations, lots of conflict, difficulty moving forward in life, difficulty maintaining close relationships with other adults.
107
making interpretations is what type of intervention
is a key work in psychodynamic.
108
object relations theory of change
Change occurs through both reparative experiences within the treatment relationship and from new insight into and modification of entrenched object relations pathology.
aka through the therapist and within other relationships.
109
Object-relations psychodynamic treatment goals
Providing reparative experiences and building new internal structures.
• Gaining insight to how past relationships impact client’s functioning
• Improving relationships with self and others
110
Object-relations treatment goals
* Providing reparative experiences and building new internal structures.
* Gaining insight to how past relationships impact client’s functioning
* Improving relationships with self and others
111
internalization
Early infant-caretaker interactions lead to the person internalizing basic attitudes toward self and other, characteristic relational patterns and a repertoire of defenses and internal capacities.
object-relations/psychodynamic theory
112
ego in psychodynamic theory
The structure responsible for dealing with the world, for instituting defense mechanisms, for internalizing external objects and for integrating and synthesizing self- and object-representations.
113
Self- and Object Representations through internalization
Infants form images of themselves and others. Once formed, they are fundamental internal structures that affect the ways in which individuals view themselves and others.
114
*projective identification in object-relations/psychodynamic
a person will project a thought or belief that they have onto a second person.
the second person is changed by the projection and begins to behave as though he or she is in fact actually characterized by those thoughts or beliefs that have been projected.
therapist takes on feelings themselves + takes on feelings of the projection.
114
projective identification
Refers to a psychological process in which a person will project a thought or belief that they have onto a second person. Then, in most common definitions of projective identification, there is another action in which the second person is changed by the projection and begins to behave as though he or she is in fact actually characterized by those thoughts or beliefs that have been projected.
115
introjection
unconscious adoption of the ideas/thoughts
116
phases of treatment object relations
Beginning: Establish a holding environment (boundaries/containment). 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. "therapist notices feeling a certain way to client." =process projective identification.
End: Work through termination and abandonment issues. Consolidate interpretations. Review insights gained in therapy
117
self-psychology theory of change
Change occurs through empathetic attunement and strengthening the self- structures through optimal responsiveness.
118
self-psychology theory of change
Change occurs through empathetic attunement and strengthening the self- structures through optimal responsiveness.
119
role of therapist in self-psychology
repair disruptions between thx. and ct.
allow for reparenting process
mirroring, approving.
optimal responsiveness (refers to the therapist's acts of communicating his understanding to his patient.)
Allows emergence of self-object transferences and the repair of disruptions
120
Self-psychology treatment goals
+ key concepts
Developing self-cohesion (healthy view of themselves) and self-esteem (true self.)
Mirroring
idealization of others
twin/alter ego
121
self-object
Early self-objects are those empathetic or attuned caretakers who perform vital functions for the infant that it cannot carry out itself.
Ones experience of another person (object) as part of, rather than as separate and independent from, one's self
122
optimal frustration (self-psych)
A healthy window of Ct's needs not being met all the time
When a self-object is needed, but not accessible, this
will create a potential problem for the self, referred to as a "frustration"
123
types of transference (self-psych)
Mirroring Transference: The patient seeks acceptance and confirmation of
the self
Twinship Transference: The patient experiences the therapist as someone
like himself
Idealizing Transference: The patient looks up to and admires the therapist
Adversarial Transference: The need for a supportive relationship that the
patient can oppose in order to grow
Experience-Near Empathy: When therapist steps into client’s shoes and
imagines what it is like to be the client
124
phases of treatment in self-psych
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.
125
when thinking empathy or empathetic attunement, think...
self-psychology.
Experience-Near Empathy: When therapist steps into client’s shoes and
imagines what it is like to be the client
126
self-psychology phases of treatment
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.
127
enactment
the acting out of an important life event rather than expressing it in words. See psychodrama.
the concept of enactment is usually used to explain the re–experience of a role assumed during childhood.
what does the relationship remind you of... a similar thing playing out*
with partner as with father.
128
empathizing with mourning is in what theory
is self-psychological...
ie cry for young self that didn't have an available caregiver.
129
attachment-based theory (psychodynamic) -
| theory of change.
created by John Bowlby.
Change occurs through exploration of past and current relational attachments and trauma in the environment of a healing, secure and reliable relationship
130
role of therapist in attachment theory
- secure base for ct to explore past + present
- share most traumatic experiences
- exploring the nature of the client’s attachment pattern
131
attachment-based therapy treatment goals
Raise awareness of client’s problematic behavioral and emotional patterns, formed in early childhood as attempts to maintain attachment to primary caregivers
* Repair the capacity to regulate affects
* Resolve any emotional or social disruptions within the patient’s life
* Improve quality of attachment with others
132
attachment phases of treatment
1) attunement, empathy, identifying attachment style
2) explore relational disruptions past + current. support clients ability to regulate + self-reflect
3) repair + thx shares interpretations to help ct. create new reality of painful events to alleviate emotional suffering
133
stages of treatment in psychodynamic therapy
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.
134
Systems Therapist would..
Look at person + problem embedded in a family system.
Persons problematic behavior serves a function in function to family.
Can’t look into a person without their family + culture.
135
Bowen Treatment Goals
Reduce anxiety and emotional turmoil in family system
Self-differentiation within the context of family
Decrease emotional fusion
Improve communication skills
Decrease recurrence of dysfunctional patterns Reduce emotional reactivity
Facilitate detriangulation
136
homeostasis (rhythm)
a systems theory term
| that describe show a system (a family) finds a way of functioning that is predictable
137
Multi-generational intervention + who created multigenerational family awareness
Geneogram or Family Map
is Bowen + structural
A Bowen therapist would be acting like : Coach/educator, supervisor, Investigator, neutral.
138
I-Statements are taught by
Bowen / Satir / Communication
139
Bowen treatment goals
Reduce anxiety and emotional turmoil in family system
Self-differentiation within the context of family Decrease emotional fusion
Improve communication skills
Decrease recurrence of dysfunctional patterns Reduce emotional reactivity
Facilitate detriangulation
140
Triangulation
to bring in a third party to alleviate anxiety within a relationship.
- Could be using a substance.
- Could be a child
detriangulation is Bowen
141
Differentiation of Self
Families and other social groups tremendously affect how people think, feel, and act, but individuals vary in their susceptibility to a “group think” and groups vary in the amount of pressure they exert for conformity. These differences between individuals and between groups reflect differences in people’s levels of differentiation of self.
intrapsychic- differentiating between thoughts + feelings. Can you be disappointed about rejection and realize the feeling is separate from personal identity?
Can you differentiate enough to know have balance when triggered, to feel feelings but maintain being collected?
Providing psychoeducation about the difference between thoughts and feelings could be Bowenian.
142
Nuclear Family Emotional System
Bowen.
| Family members are interdependent on each other + affect each other.
143
Family Projection Process:
The family projection process describes the primary way parents transmit their emotional problems to a child. The projection process can impair the functioning of one or more children and increase their vulnerability to clinical symptoms. It's transmitted generationally.
think from family to child.
-bowen
144
Multigenerational Transmission Process:
mall differences in the levels of differentiation between parents and their offspring lead over many generations to marked differences in differentiation among the members of a multigenerational family.
over time, members of families become more differentiated.
145
Emotional Cutoff was coined by
(Bowen)
aka ghosting family
The concept of emotional cutoff describes people managing their unresolved emotional issues with parents, siblings, and other family members by reducing or totally cutting off emotional contact with them.
146
Bowen Techniques
Reframing (as a multigenerational problem)
Interrupt Arguments
I statements
Interrupts arguments
Opening cut-off relationships
Modeling Communication
Bibliotherapy: Assigning reading material
146
Bowen Techniques
Reframing (as a multigenerational problem)
Interrupt Arguments
I statements
Interrupts arguments
Opening cut-off relationships
Modeling Communication
Bibliotherapy: Assigning reading material
147
Bowen Stages of Treatment
Beginning: Create a family diagram of multigenerational emotional connections; assess individuals’ levels of differentiation and triangulation; identify dysfunctional patterns that have been passed along through the generations
Early/Middle: Teach and model differentiation through communication skill building; de-triangulation; encourage reunification from cutoff family member; teach the family how to take responsibility for their feelings and thoughts. I statements, differentiation of thought/feelings.
End: Review new skills and knowledge gained in therapy
148
General Systems theory of change + key concepts.
Change occurs by helping the system view the family as the problem rather than an individual as the problem.
Homeostasis: Systems tend to resist change and thus deal with issues by keeping things the same rather than dealing with problems.
○ Maintained through negative feedback and input loops.
● Negative Feedback: Behavioral reactions that correct a deviation of the system
and return it to the previous state of homeostasis.
● Positive Feedback: In an effort to maintain homeostasis, the system participates
in new behaviors, which then creates and reinforces negative communication
patterns and exacerbate the problem.
● Calibration: The normal operational system of the family.
● Wholeness: The whole system is combined of individuals .
○ Each individual can have an effect on one another causing change to the whole system.
● Equifinality: The same results can be accomplished by different family systems. ○ Example: A man experienced the death of his mother when he was a
young child, whereas a woman experienced the divorce of her parents when she was an infant. As adults, both of these individuals experienced Major Depression despite having different early experiences.
● Equipotentiality: On the other hand, the same experience in a family system can end up with various results later in life.
149
Paradoxical interventions is a part of..
Strategic family therapiy.
150
theory of change in strategic therapy
Change occurs through action-oriented directives and paradoxical interventions.
151
role of therapist
+ treatment goals
in strategic.
role of therapist
* Therapist delivers directives that facilitate change, particularly around patterns of communication.
* Focuses on solving problem/eliminating symptoms
* Designs a specific approach for each person’s presenting problem
treatment goals:
* Solve the presenting problems
* Change dysfunctional patterns of interaction
152
ordeals in strategic therapy
Particular type of symptom prescription in which clients are encouraged to carry out harmless but unpleasant tasks whenever symptoms occur; example: having to get up and clean the basement every time the client cannot sleep.
153
prescribing the symptom is a strategic form that----
includes the symptom ie "scheduling time to worry"
* engage in the problem
* a type of homework
154
positioning is an intervention that describes
therapist takes an extreme view of the problem so that ct. has an opposite reaction
"ie wow that's hopeless..."
therapist is not destined to be the holder of hope.
can invert power dynamics
think positioning power dynamic.
*Eliminates feeling powerless to the problem.
within strategic therapy
155
restraining
The therapist will discourage change or changing too quickly in an effort to elicit the desire to change from the client. Telling someone "I don't want you to stop fighting"
strategic.
156
Phases of Treatment in Strategic Therapy
Beginning: Define the problem; determine how the client understands the problem; assess family’s destructive patterns of relating and communicating the continued problem; state goals – what behaviors need to change and what would be the signs of change
Middle: Review attempted solutions; assign ordeals; prescribe the problem; relabel behavior; instruct client to respond to the problem in a new way
End: Plan for maintenance of new behavior; plan for future challenges; emphasize positive changes made.
157
Structural Treatment Goals
Restructure family system to allow for symptom relief and constructive problem solving
Change dysfunctional transactional patterns and create new ways of relating
Help create flexible boundaries
Having folks try out new ideas/behaviors + changes emerge from that.
158
Health according to Structural Family Therapy
- Hierarchy with elders at the top
- Parental alliance (parents are aligned)
- Spouses have their own differentiation
- Clear boundaries within systems
Coalitions: Alignments where 2 or more family members join together to form a bond against another family member
159
Family Map
A tool the therapist will use to depict the relationship dynamics in the family including sub-systems, alliances, coalitions and boundaries. This tool is used to conceptualize the case outside of the actual therapy. It is not used or shared with the family.
are not done with family - in structural/bowenian.
160
Alliance vs. coalition
Alliances: Subgroups based on gender, generation, developmental tasks
Coalitions: Alignments where 2 or more family members join together to form a bond against another family member
161
Bowen Triangulation
way to reduce anxiety in a family.
162
Structural Subsystem
Subsystems: Families organize themselves by generation, relationship, and necessity. Examples: marital subsystem – spouses; parental subsystem: parents; executive subsystem: people who run the family; sibling subsystem – kids.
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Structural Subsystem
Subsystems: Families organize themselves by generation, relationship, and necessity. Examples: marital subsystem – spouses; parental subsystem: parents; executive subsystem: people who run the family; sibling subsystem – kids.
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Structural Boundaries
Disengaged Boundaries: Where family members are isolated from each other. Can lead to AOD use and is a result of rigid boundaries
Enmeshed Boundaries: Family members are overly dependent and too closely involved and reactive to other family members. Can lead to incest.
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Joining, tracking, mimesis,
joining- blending in the family
tracking - how they relate to one another
mimesis - taking on their style of communication
structural
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Joining, tracking, mimesis,
joining- blending in the family
tracking - how they relate to one another
mimesis - taking on their style of communication
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Joining, tracking, mimesis,
joining- blending in the family
tracking - how they relate to one another
mimesis - taking on their style of communication
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Unbalancing, reframing
unbalancing: helping the ct. member in the "one down" position
reframing: putting the presenting problem in a perspective that is both different from what the family brings and more workable.
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Enactment in Structural Therapy
To see how the problem is unfolding in session.
The actualization of transactional patterns under the control
of the therapist. It allows the therapist to observe how family members
mutually regulate their behaviors, and to determine the place of the problem
behavior within the sequence of transactions.
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Structural: Boundary Making
Special case of enactment, in which the therapist defines areas of interaction that he rules open to certain members but closed to others. Example: a son is asked to leave his chair (in between his parents) and go to another chair on the opposite side of the room, so that he is not “caught in the middle”
Enactments allow for boundary making.
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Structural Phases of Therapy
Beginning: Join with family; both accommodate to and challenge rules of family system; assessment/mapping of hierarchy, alignments, and boundaries; reframing of problem to include whole system
Middle: Highlight and modify interactions; utilize enactments of issues to challenge participants and unbalance system
End: Review progress made; reinforce structural change; provide tools for future
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Satir theory of change
Change happens through self-awareness and improved communication. A humanistic approach.
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Role of Therapist in Satirian therapy.
* Active Facilitator
* Resource Detective (looking for resources ct. already has.)
* Therapist is genuine (congruent) and warm
* Honest and direct
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Satirian therapist or Communication treatment goals
The goal is for clients to increase congruent communication, improved self- esteem/confidence/uniqueness in themselves and personal growth
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Incongruent Communication (Satirian)
vs congruent communication
Discrepancies between verbal and non- verbal cues.
Congruent communication: ct. is able to share what they think/feel about themselves + others
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Family Life Chronology
(Satirian)
Gathering history as far back as possible. Include: ideology, values, rules, disruptions, moves, and major events. What the family has been through and how did those events impact the family. How past events and unresolved issues are carried out presently
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Styles of Communication
(Satir)
placater: people-pleaser, apologizer
blamer: dictator, boss, attacking others
leveler: congruent in their beliefs about self and others
computer: (logical/distant/ likes to be correct)
distracter: Seeking approval by acting out, irrelevant
working to peoples strengths + potentials - "what would it be like to use that sense of humor (sarcasm) for good?"
Metaphors and Storytelling: Used to help clients understand their roles
Take Responsibility: Encouraging clients to take responsibility for how they felt, what they experienced, what meaning they made, what feelings they had about their feelings.
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Family Sculpting
Family Sculpting: Put people into a spatial metaphor – a physical representation of family members characterizations
-Satir-
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Satirian Phases of Treatment
Beginning: Establish rapport, a sense of equality and hope. Assess communication patterns, stances, and concerns. Identify treatment focus and goals.
Middle: Increase the family’s congruent communication. Support and strengthen each individual’s sense of uniqueness and self-esteem.
End: Help family practice, implement, and integrate changes and increase awareness of larger familial patterns
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Transforming Rules (Satir)
Looking like family of origin rules and assisting clients to create more functional, less rigid guidelines.
