LMFT CA Flashcards
Satir Communications Therapy
Therapist: active facilitator
Resource detective
Genuine and warm
Honest and direct
Satir Communications Therapy
Treatment goal:
To increase congruent communications
Improve self esteem and self confidence
Personal geowth
Satir Communications Theory
Incongruity communications:
Discrepancies between verbal/non verbal cues
Satir Communications Theory
Placater:
Apologizing, never disagreeing, trying to please
Satir Communications Theory
Blamer:
Attacking others
Fault finder
Dictator/boss
Satir Communications Theory
Computer:
Super reasonable, intellectual, distant, always correct
Satir Communications Theory
Distracter:
Seeking approval by acting out, irrelevant
Satir Communications Theory
Leveler:
Congruent in beliefs about self and others
Satir Communications Theory
Modeling communications:
Therapist uses “I” messages
Expresses thoughts and feelings
Avoids stating what others are thinking
Honest
Satir Communications Theory
Family life chronology:
Gather fam history as far back as possible, ideology, value, rules, disruptions, moves, events
Satir Communications Theory
Family life chronology:
What family has been through and how it impacts the family
How past unresolved events are carried out presently
Satir Communications Theory
Family sculpting:
Put people into spatial metaphor- a physical representation of family member characterizations
Satir Communications Theory
Take Responsibility:
Encourage to Responsibility for how they felt,what they experienced, what meaning they made, the feelings they had ABOUT their feelings
Satir Communications Theory
Metaphors and storytelling used to help clients understand their roles
Satir Communications Theory
Transforming rules: assisting clients to create more functional, less rigid guidelines
Satir Communications Theory
Phases of treatment
Beginning: est rapport, a sense of equality/hope
Satir Communications Theory
Phases of treatment
Beginning: Assess communications patterns, stances, concerns,
Identify treatment focus and goals
Satir Communications Theory
Phases of treatment
Middle: increase familial congruent communication
Satir Communications Theory
Phases of treatment
Middle:
Support and strengthen each individual’s sense of uniqueness and self esteem
Satir Communications Theory
Phases of treatment
End:
Help family practice/implement/and integrate changes and awareness of larger familial patterns
Structural Family Therapy
Therapist role:
Active and involved
Help family understand how fam structure/relationships/hierarchies can be changed
Structural Family Therapy
Therapist role: Help family understand the impact of rituals and rules, how to integrate new family patterns of interaction
Structural Family Therapy
Treatment Goals
Restructure family system to allow for symptom relief/constructive problem solving
Structural Family Therapy
Treatment Goals
Change dysfunctional transactional patterns and create new ways of relating
Structural Family Therapy
Treatment Goals
Help create flexible boundaries
Structural Family Therapy
Primary Concepts
Alliances: subgroups based on gender,generation,developmental tasks
Structural Family Therapy
Primary Concepts
Coalitions: alignments where 2 or more fam members join to form alliance against other family members
Structural Family Therapy
Primary Concepts
Power Hierarchy: Leadership/Direction supplied by adults. If parents insecure or bullied,power dynamic upside down, leading to chaos
Structural Family Therapy
Primary Concepts
Subsystems: families self organize by generation, relationship, necessity
Structural Family Therapy
Primary Concepts
Family Map: Therapeutic tool used only by therapist to depict: subsystems, alliances, coalitions and boundaries.
Used to conceptualize, but never used with clients in therapy
Structural Family Therapy
Primary Concepts
Disengaged boundaries: Family members isolated from each other. Can lead to AOD (?) use and is a result of rigid boundaries
Structural Family Therapy
Primary Concepts
Enmeshed boundaries: Fam members overly dependent, involved, reactive to other family members. Can lead to incest
Structural Family Therapy
Interventions
Joining:
1st step, therapist blends in with family using their style, affect, language (code switching)
Structural Family Therapy
Interventions
Tracking: therapist observes how family reacts, relates, to each other, boundaries, coalitions, roles, rules, etc. during spontaneous behavioral sequence
Structural Family Therapy
Interventions
Mimesis: Therapist tracks family style of communication and mimics it
Structural Family Therapy
Interventions
Unbalancing: therapist supports underdog, changing the hierarchical dynamic/position
Structural Family Therapy
Interventions
Reframe: Changing problematic perspective from family’s original perception
Structural Family Therapy
Interventions
Enactment: Therapist initiated actualization of family transactional patterns so therapist can observe how family: regulates, and origin of behavior problem within sequence of fam actions
Structural Family Therapy
Interventions
Boundary Making: special case of enactment, mandated/imposed by therapist, open to some fam members, closed to other
Structural Family Therapy
Phases of Therapy:
Beginning
Join w fam, to both accomodate/challenge rules of family system, assessment/mapping of Hierarchy, alignments, boundaries, reframing prob w/in whole system
Structural Family Therapy
Interventions
Middle
Highlight/change interactions,utilize enactments of issues to challenge participants and unbalance system
Structural Family Therapy
Interventions
End
End:
Review progress, reinforce structural change, provide tools for future issues
Strategic Theory
Theory of Change
Theory of Change:
Change occurs through action oriented directives and paradoxical interventions
Strategic Theory
Role of Therapist
Role of Therapist:
Delivers directives that facilitate change, specifically around communications patterns
Strategic Theory
Role of Therapist
Role of Therapist:
Focuses on solving problems, eliminating symptoms
Strategic Theory
Role of Therapist
Role of Therapist:
Designs a specific approach for each person’s presenting problems
Strategic Theory
Treatment goals
Treatment Goals:
Solve the presenting problems
Strategic Theory
Treatment Goals
Treatment Goals:
Change dysfunctional patterns of interactions
Strategic Theory
Interventions
Interventions:
Paradoxical Directives: Contradictory maneuvers which seem to go against treatment goals, but are designed to actually achieve them. Undermines resistance and confrontation with therapeutic instructions by leaving client in charge
Strategic Theory
Interventions
Positioning:
Positioning:
Therapist takes more extreme, exaggerated view of problem, forcing clients to rebel and reframe to a competency point of view
Strategic Theory
Interventions
Homework:
Homework:
Outside therapy assignments essential to positive therapeutic outcome. Purpose is for family to change identified maladaptive behavior
Strategic Theory
Interventions
Prescribing the Symptom:
Prescribing the Symptom:
Client encouraged to engage/practice the “Symptom”
Strategic Theory
Interventions
Ordeals:
Ordeals:
Substitution behavior when client encounters negative behavior, i.e., Can’t sleep? Then clean basement…
Strategic Theory
Phases of treatment
Beginning
Beginning:
Define prob, determine level of client’s comprehension of prob, assess familial patterns re: relating/communicating continued problem, state goals/behaviors needed to change problem
Strategic Theory
Phases of treatment
Middle
Middle:
Review attempted solutions, assign ordeals, prescribe problem,re-label behavior, instruct client new way to respond to problem
Strategic Theory
Phases of treatment
End
End:
Plan how to maintain positive new behavior, for future challenges, emphasize positive changes achieved
General Systems Theory
Theory of Change:
Theory of change:
Change occurs by systemically viewing problem in context of family, NOT individual
General Systems Theory
Theory of Change:
Theory of Change:
Family system becomes focal point of therapeutic interventions
General Systems Theory
Role of Therapist
Role of Therapist:
Therapists helps family to explore:
Belief systems/family view
Rule/roles present in family
Family Hierarchy
Expectations
Defense mechanisms/purposes of them
General Systems Theory
Main Concepts
Main Concepts:
Homeostasis: Systems resist change, maintained through negative feedback loops
General Systems Theory
Main Concepts
Main Concepts:
Feedback loops: can be positive (amplifying/moving toward change) or negative (attenuating/corrects against change)
General Systems Theory
Calibration
Calibration: Normal family operating system
General Systems Theory
Main Concepts
Wholeness: whole systemic synergy, result of all individuals interacting on the system as a whole
General Systems Theory
Main Concepts
Equfinality: Same results can be achieved with different systems/actions
I.e., one kid experiences divorce, another experiences parental death: Same outcome= depression
General Systems Theory
Main Concepts
Equipotentiality:
Two people experience identical experience but have very separate outcomes later in life
General Systems Theory
Main Concepts
First Order Change
First Order Change:
Short lived, superficial Change occurring at the family level with no lasting/ permanent effects
General Systems Theory
Main Concepts
Second order Change
Second Order Change:
Changes occurring at a deeper level, fundamentally altering systems rules, reorganizing into permanent healthier functioning
General Systems Theory
Main Concepts
Nonsummativity
Nonsummativity:
Family system treated as a whole, not just each individual family member
General Systems Theory
Main Concepts
Boundaries (open system):
Boundaries (open system): System which allows for continuous flow of information from outside the system
General Systems Theory
Main Concepts
Boundaries (closed system):
Boundaries (closed system):
System which maintains impenetrable Boundaries, which cannot be crossed or breached
General Systems Theory
Treatment Goals
Treatment Goals:
System moving towards equilibrium
Assist family to reduce dysfunctional behavior/patterns, how to recognize implement healthy positive behavior/patterns
General Systems Theory
Treatment Goals
Treatment Goals:
Help family challenge/rework beliefs/patterns
General Systems Theory
Treatment Goals
Treatment Goals:
Assist individuals to see their roles in family dynamic
General Systems Theory
Treatment Goals
Treatment Goals:
Increase individuals to see/understand the other’s different experiences and perceptions in the family
General Systems Theory
Treatment Goals
Treatment Goals:
Assist in correcting problematic or unhealthy feedback loops
General Systems Theory
Interventions
Interventions:
Observe family system feedback loops
General Systems Theory
Interventions
Interventions:
Explore Family’s:
Belief systems/values
Rules and roles
Family Hierarchy
Circular causality between family members
General Systems Theory
Interventions
Interventions:
Refreame presenting issues as system issues instead of pathologizing individual’s symptoms
General Systems Theory
Interventions
Interventions:
Explore each family member’s role in dysfunctional interactions
General Systems Theory
Interventions
Interventions:
Challenge communication which occurs within family system
Bowen Family Therapy
Therapist’s Role:
Therapist’s role:
Coach/educator
Supervisor
Investigator
Neutral
Bowen Family Therapy
Treatment Goals:
Treatment Goals:
Reduce anxiety
Bowen Family Therapy
Treatment Goals:
Treatment Goals:
Self differentiation within family context
Bowen Family Therapy
Treatment Goals:
Treatment Goals:
Decrease emotional fusion
Bowen Family Therapy
Treatment Goals:
Treatment Goals:
Improve Communication Skills
Bowen Family Therapy
Treatment Goals:
Treatment Goals:
Decrease recurrence of dysfunctional patterns
Bowen Family Therapy
Treatment Goals:
Treatment Goals:
Reduce Emotional Reactivity
Bowen Family Therapy
Treatment Goals:
Treatment Goals:
Facilitate de-triangulation
Bowen Family Therapy
Key Concepts:
Key Concepts:
Triangles:
Three person relationship
Smallest building block of system
Bowen Family Therapy
Key Concepts:
Key Concepts:
Differentiation of self: difference between individuals and groups and the degree of pressure/integration towards each other (i to g, g to i)
Bowen Family Therapy
Key Concepts:
Key Concepts:
Nuclear family emotional system:
Emotional oncept of four basic relationship patterns w/in nuclear family that governs where problems will develop
Bowen Family Therapy
Key Concepts:
Key Concepts:
Nuclear Family:
Forces driving peoples attitudes/beliefs Re: relationships play a role in patterns but primary driving forces are part of emotional system
Bowen Family Therapy
Key Concepts:
Family Projection Process:
Family Projection Process:
Primary mode of how parents transfer their emotional problems to a child.
Bowen Family Therapy
Key Concepts:
Multigenerational Transmission Process
Multigenerational Transmission Process:
Notion that small differences in communication over generations leads to marked differentiation among individuals in multigenerational fam
Bowen Family Therapy
Key Concepts:
Emotional Cutoff:
Emotional Cutoff:
People managing unresolved Emotional issues with family members by reducing or cutting off all contact with them
Bowen Family Therapy
Key Concepts:
Genogram
Tool which acts as both an assessment and treatment tool
Bowen Family Therapy
Interventions:
Reduce emotional reactivity
Reduce emotional reactivity:
Have family members talk to therapist
Bowen Family Therapy
Interventions:
Reframing:
Reframing:
Presenting problem as multigenerational problem caused by factors beyond the individual
Bowen Family Therapy
Interventions:
Genogram
Genogram:
Creates intergenerational family emotional map
Bowen Family Therapy
Interventions:
Detriangulation:
Detriangulation:
Therapist becomes part of healthy triangle, teaching couple how to manage their own anxiety, distance and closeness in a healthy manner
Bowen Family Therapy
Interventions:
Increasing Differentiation
Increasing Differentiation:
The formation of supportive relationships w/ family members to explore origins and effects of their family beliefs and behaviors
Bowen Family Therapy
Interventions:
Teaching “I” statements
Teaching “I” statements:
Increases differentiation
Bowen Family Therapy
Interventions:
Opening Cutoff Relationships
Opening Cutoff Relationships:
Encouraging and supporting clients to re-engage with estranged family members
Bowen Family Therapy
Interventions:
Interacts with Family
Interacts with Family:
Interrupts arguments: open conflict prohibited because it raises anxiety
Bowen Family Therapy
Interventions:
Models
Models:
Demonstrates new ways to interact and communicate
Bowen Family Therapy
Interventions:
Bibliotherapy
Bibliotherapy: Assigning reading material
Bowen Family Therapy
Phases of Treatment:
Beginning:
Beginning:
Create emotional connections multigenerational Family diagram
Bowen Family Therapy
Phases of Treatment:
Beginning:
Beginning:
Assess individuals’ levels of differentiation and triangulation
Bowen Family Therapy
Phases of Treatment:
Beginning:
Beginning:
Identify dysfunctional intergenerational patterns which are being passed on
Bowen Family Therapy
Phases of Treatment:
Early/Middle:
Early/Middle:
Teach and model differentiation through communication skill building, detriangulation, and encourage reunification w/ cutoff family members
Bowen Family Therapy
Phases of Treatment:
Early/Middle:
Early/Middle:
Teach family how to take responsibility for their feelings and thoughts
Bowen Family Therapy
Phases of Treatment:
End:
End:
Review new skills and knowledge gained in therapy
Attachment Based Theory
Theory of Change
Theory of Change
Occurs in safe relationship environment by exploration of past/present attachments/relationships/trauma
Attachment Based Theory
Therapist Role
Therapist Role:
Provide secure base to enable exploration of past/present emotional experiences
Attachment Based Theory
Treatment Goals
Treatment Goals:
Make client aware of their problematic emotional/behavioral patterns formed in childhood to maintain attachments
Attachment Based Theory
Treatment Goals
Treatment Goals:
Repair capacity to regulate effects
Attachment Based Theory
Treatment Goals
Treatment Goals:
Resolve any emotional or social disruptions in patient’s life
Attachment Based Theory
Treatment Goals
Treatment Goals:
Improve Quality of Attachments w/others
Attachment Based Theory
Attachment Behavior System
Attachment Behavior System:
How infant/primary caregivers signal/interact needs
Attachment Based Theory
Attachment Behavior System
Attachment Behavior System:
Adult romantic bonds partially based on childhoods bonds w/caregiver
Attachment Based Theory
Secure Attachment
Secure Attachment:
Client has strong sense of self and has resolved any past attachment issues
Attachment Based Theory
Preoccupied/Anxious Attachment
Preoccupied/Anxious Attachment:
Client still angry/hurt at parents
Attachment Based Theory
Preoccupied/Anxious Attachment
Preoccupied/Anxious Attachment:
Overly dependent on attachment figure, both past and present
Attachment Based Theory
Preoccupied/Anxious Attachment
Preoccupied/Anxious Attachment:
Client dreads abandonment, cannot see own role/responsibility in relationship
Attachment Based Theory
Dismissive/Avoidant Attachment
Dismissive/Avoidant Attachment:
Dismisses importance/value of love in relationships, also emotions
Attachment Based Theory
Dismissive/Avoidant Attachment
Dismissive/Avoidant Attachment:
Idealized parents although memories do not corroborate
Attachment Based Theory
Dismissive/Avoidant Attachment
Dismissive/Avoidant Attachment:
They dislike self-reflection, or have very shallow views of it
Attachment Based Theory
Dismissive/Avoidant Attachment
Dismissive/Avoidant Attachment:
Very independent, dismiss self emotionality,
Attachment Based Theory
Dismissive/Avoidant Attachment
Dismissive/Avoidant Attachment:
Great difficulty tolerating heightened emotionality of/from others
Attachment Based Theory
Fearful/Avoidant Attachment
Fearful/Avoidant Attachment:
History of trauma/loss
Attachment Based Theory
Fearful/Avoidant Attachment
Fearful/Avoidant Attachment:
Dismiss importance of love/connection but based on fear or their own “unworthiness”
Attachment Based Theory
Phases of Treatment
Beginning
Beginning:
Attunement
Identifying client’s attachment style
Attachment Based Theory
Phases of Treatment
Middle
Middle:
Exploration of disruptions in past present relationships, even w/ therapist
Attachment Based Theory
Phases of Treatment
Middle
Middle:
Support/teach client how to regulate/express emotions in difficult situations
Teach self reflection
Attachment Based Theory
Phases of Treatment
End
End:
Repair Stage: teaches clients how to change emotionally distressive behavior by re-interpreting it for/with client
Object Relations Theory of Change
It occurs via reparative experiences during treatment
Object Relations
Theory of Change
Change occurs from New insight and modification of entrenched object relations pathology
Object Relations
Treatment Goal
Providing reparative experiences
Object Relations
Treatment Goal
Building new internal structures
Object Relations
Treatment Goal
Gaining new insight how past relations impact current functioning
Object Relations
Treatment Goal
Improving relationships with others
Object Relations
Concepts
Object refers to persons in external world
Object Relations
Concepts
Individuals seek objects from birth
Object Relations
Concepts
Internalization:
Early infant interactions w caregiver determine manner of internalizing
Object Relations
Concepts
Internalization:
Characteristics of relational patterns, repertoire of defenses and internal capacities
Object Relations
Concepts
Self and Object-Representations:
Infant viewed image of self & others determine lifelong view of self and others
Object Relations
Concepts
Ego:
Structure which deals with world, defense mechanisms
Object Relations
Concepts
Ego:
Internalizes external objects
Object Relations
Concepts
Ego:
Synthesizes self and object relations
Object Relations
Concepts:
Splitting
Splitting:
When two diametrically opposed states exist and are not integrated i.e.,
Love/Hate
Object Relations
Projection
Projection:
Projecting unresolved negative feelings onto somebody without acknowledgement/dealing with feeling
Object Relations
Projection Identification
Projection Identification:
When the recipient of Projection starts to change and act according to what’s being projected onto them
Object Relations
Concepts
Introjection
Introjection:
The replication of behaviors, attributes, or other fragments of the surrounding world,especially people, within oneself
Solution Focused Therapy
Change occurs by accessing client’s strengths and resources
NOT
By focusing on cause/origin
Solution Focused Therapy
Therapist role:
Consultant, coach
Solution Focused Therapy
Goals
To implement small and large change to achieve desired future
Solution Focused Therapy
Goals
Client builds on current strengths and resources
Solution Focused Therapy
Exception Questioning
Exception Questioning
When did problem not exist and what was client doing differently
Solution Focused Therapy
Exception Questioning
Exception Questioning:
Use what worked in past to give client positive perspective
Solution Focused Therapy
Miracle Questioning
Miracle Questioning:
Visualize future and their life w/out problem,
What would be different so you know prob solved?
Solution Focused Therapy
Scaling Question
Scaling Question:
Rate current problem from worst to best, discuss how to change problems number on scale
Solution Focused Therapy
Presupposing change
Presupposing Change:
Ask client what’s improved since last visit
Solution Focused Therapy
Coping questions
Coping Questions
Supportive but challenging questions
Solution Focused Therapy
Affirmations/Compliments
Affirmations/Compliments:
It acknowledges progress, resiliency, strengths and resources
Psychdynamic Theory
Therapist non-directive
Psychdynamic Theory
Therapist establishes a holding environment and an opportunity to form a secure attachment relationship
Psychdynamic Theory
Past influences present
Early wounding in relationships are unconsciously repeated in current relationships
Psychdynamic Theory
Underlying Conflicts
Infantile Caregiver attachment patterns are all repeated in adulthood, potentially causing inability to create stable adult attachments
Psychdynamic Theory
Defense mechanisms
Unconsciously used to strengthen and protect ego from negative thoughts or feelings associated with past experiences
Psychdynamic Theory
Tranferance
Client transferring unresolved emotional responses from past individuals onto therapist
Psychdynamic Theory
Cointer Transference
Therapist transfers unconscious emotional responses from their own past onto client
Psychdynamic Theory
Interpretation
Therapist tells client hypothesis regarding past events impact on client currently
Psychdynamic Theory
Main Concepts
Role of the past and unconscious is very important
Psychdynamic Theory
Main Concepts
Clients asked to identify thoughts and feelings regarding past events
Psychdynamic Theory
Main Concepts
Uncover and interpret unconscious impulses/defenses
Psychdynamic Theory
Main Concepts
Assess clients self awareness of how past influences present behavior
Psychdynamic Theory
Main Concepts
Enhance clients ego and self esteem
Psychdynamic Theory
Main Concepts
Decrease use of unhealthy defense mechanisms
Psychdynamic Theory
Main Concepts
Allow client to access, address, and resolve painful feelings in a safe environment
Psychodynamic Theory
Main Concepts
Examine early relations/attachments/interactions to discern impact of family of origin projected onto present relationships
