Models Of Psychotherapy Flashcards
PSYCHODYNAMIC THEORY
Pertaining to the cognitive, emotional and volitional mental processes that consciously and unconsciously motivate behavior. Theses processes are the interplay between genetic and biological heritage, the sociocultural milieu, past and current realities, perceptual abilities and distortions and ones unique experiences and memories.
What is psychodynamic theory?
PSYCHODYNAMIC THEORY Psychoanalytic psychotherapy (Freud) Analytic theory (Jung) Individual psychology (Adler) The neo-Freudians The ego-analysts Object-relations theorists
Types of psychodynamic therapy
PSYCHODYNAMIC THEORY
The hypothesis and treatment applications about human personality and its development as proposed by Freud. Influential between 1940-1965. Two separate but interrelated theories comprised personality.
Psychoanalytic psychotherapy
PSYCHODYNAMIC THEORY
1.personality has 3 structures
A)Id- present at birth, consist of individuals unconscious drive/needs. Seeks immediate gratification of need to avoid tension. Operates on pleasure principal.
B)ego- 6 months; responds to Ids inability to gratify all needs; defers gratification until an appropriate object is available in reality; employs
secondary process thinking (perception, sensation, memory and logical thinking). Operates on reality principle. Acts as mediator b/w Id and superego.
C) superego- 4-5 years; internalization of societal norms; rewarded behaviors become part of ideal norms; punished behaviors are incorporated into conscious; tries to block the Ids socially unacceptable drives.
2. Conflict b/w any two of these 3 structures produces anxiety. The ego responds to anxiety produced by unresolved conflict by resorting to one of the following defense mechanisms:
3. These defense mechanisms all operate on an unconcious level and they all serve to deny reality
Personality theory
PSYCHODYNAMIC THEORY
The partial or complete arrest of personality dev at one of the psychosexual stages
Fixation
PSYCHODYNAMIC THEORY
Individual engages in a repetitious ritual to abolish the results of a previous action.
Undoing
PSYCHODYNAMIC THEORY
Replacing an unobtainable or unacceptable goal with one that is attainable and acceptable.
Substitution
PSYCHODYNAMIC THEORY
Memories are separated from the emotions that once accompanied them
Isolation
PSYCHODYNAMIC THEORY
A mental mechanism in which one tries to make up for real or imagined characteristics that are considered to be undesirable
Compensation
PSYCHODYNAMIC THEORY
A mental process in which a person forms and image of another person who is important and then thinks, acts and feels in a way that resembles the other person’s behavior
Identification
PSYCHODYNAMIC THEORY
Anxiety or emotional conflict is transformed into overt physical manifestations or symptoms such as pain, loss of feeling or paralysis
Conversion
PSYCHODYNAMIC THEORY
The individual has thoughts or feelings that are inappropriate to the current situation
Dissociation
PSYCHODYNAMIC THEORY
Protects the personality for anxiety and guilt by disavowing or ignoring unacceptable thoughts, emotions or wishes
Denial
PSYCHODYNAMIC THEORY
A mental mechanism in which an individual derives feelings from another person or object and directs them internally to an imagined form of the person or object
Introjection
PSYCHODYNAMIC THEORY
Unacceptable aspects of ones own personality is rejected or attributed to another person or entity
Projection
PSYCHODYNAMIC THEORY
An individual behaves or thinks in ways or assumes values that are the opposite of the unconcious trait
Reaction- formation
PSYCHODYNAMIC THEORY
Behaviors and thought patterns that indicate a return to earlier or more primitive levels of development
Regression
PSYCHODYNAMIC THEORY
The individual unconsciously pushes certain unacceptable memories, ideas and desires from the conciosness
Repression
PSYCHODYNAMIC THEORY
Transfers certain thoughts, feelings and wishes onto other thoughts and feelings that are more desirable
Displacement
PSYCHODYNAMIC THEORY
Desires and distinctive drives that are consciously intolerable and cannot be directly realized are diverted into creative activities that are acceptable to the individual and society
Sublimation
PSYCHODYNAMIC THEORY
An individual explains or justifies an action or thought to make it acceptable when it is unacceptable at a deeper psychological level
Rationalization
PSYCHODYNAMIC THEORY
The individual ignores feelings/emotions and analyzes problems as objectively as possible but but usually in a stylized overly-rational way
Intellectualization
PSYCHODYNAMIC THEORY Free association Transference/ counter transference Analyzing/ interpreting resistance Ego analysis Dream interpretation
Techniques of psychoanalytic psychotherapy:
PSYCHODYNAMIC THEORY
Hypothesis that personality is more a result of striving for self -realization than a result of methods used to reduce anxiety. Jung is father. Rejected the notion that libido is primarily sexual in nature and he placed great emphasis on the role played by and individuals aspirations, goals, and plans for the future
Analytic theory
PSYCHODYNAMIC THEORY
- Personality incorporated a number of interacting structures and systems
- Psyche or mind consists of 3 structures:
A.Consciousness or ego- Part of the psyche that represents consciousness, memories, perceptions thoughts or feelings:
B. Personal unconcious contains experiences memories etc. that were once conscious but have been forgotten repressed or suppressed. Experiences in this structure eventually become grouped into complexes.
C. The collective unconscious contains experiences of past generations. These experiences are manifested as archetypes for universal thought forms. - The ultimate life goal is to achieve the state of individuation. This occurs when the unconscious aspects of personality are incorporated into the contents and the four psychological functions (thinking, feeling, sensing and intuiting) achieving unity.
Analytic theory–
Theory based on following tenants
PSYCHODYNAMIC THEORY
- Word Association test
- Dream analysis
- Symptom analysis
- Life history
The techniques of analytic theory.
PSYCHODYNAMIC THEORY
The school of thought about the development of personality and psychopathology. Originated by Alfred Adler. Emphasizes a persons lifestyle and the individuals striving to overcome inadequacy feelings.
Individual psychology
PSYCHODYNAMIC THEORY
- Inferiority feelings develop during childhood as a result of real or more importantly perceived biological, psychological or social weaknesses while striving for Superiority is an inherent tendency toward a perfect completion. Healthy individuals are cooperative for the common good. Unhealthy individuals are self-centered, competitive and power-hungry.
- Style of life is also influenced by birth order, family atmosphere and the family constellation.
- Mental disorders represent a mistaken style of life. The lifestyle is characterized by maladaptive compensation for feelings of inferiority, a preoccupation with achieving personal power and an undeveloped social interest.
- The therapeutic goal of alderian psychotherapy is to help a client replace a mistake and lifestyle with a healthier more adaptive one. The most healthy lifestyle is one that is characterized by a high degree of social interest.
Individual psychology is based on the following tenants:
PSYCHODYNAMIC THEORY
- Establish an alliance between therapist and client
- Help the client identify his/her lifestyle and its consequences
- Reorient the client’s attitudes to reflect a more adaptive lifestyle
- Study of dreams
- Interpretation of resistance and transference
- Role-playing
- Giving encouragement and advice
The techniques of individual psychology:
PSYCHODYNAMIC THEORY
A theoretical orientation that basically follows Freudian theory that puts greater emphasis on socio-culture cultural factors, interpersonal relationships and psychosocial development into and through adulthood
The Neo-freudians
PSYCHODYNAMIC THEORY
A) Social factors are the primary determinants of personality
- Horny was interested in early interpersonal relationships - Sullivan emphasized interpersonal relationships throughout the lifespan - Fromm was interested in the impact of society on personality development
B) horny believed that parental behaviors caused basic anxiety within a child
- Sullivan distinguished between three modes of cognitive experience (prototaxic, parataxic, and syntaxic). He believed that parataxic distortions were often the causes of maladaptive behavior.
- Fromm believed that maladaptive behavior is a result of society inhibiting people from fulfilling their human nature. He distinguished the five following character styles:(Receptive, exploitative, hoarding, marketing and productive). Only the productive type allows an individual to fulfill human nature. The other types lead to dysfunctional behavior.
The basic tenets of neo- Freudians are:
PSYCHODYNAMIC THEORY
- Therapist as participant observer
- Interpretation and insight
The techniques of Neo Freudians
PSYCHODYNAMIC THEORY
Emphasize the impact of the ego personality development. They believe healthy behavior is under conscious control. When the ego loses its autonomy from the Id or from reality behavior is no longer under conscious control and pathology may ensue. Techniques and goals are similar to those of psycho analysis. Reparenting may help the client build more healthy defenses. (Theorist are Freud, Hartmann, Ernest Kris, David Rappaport and Erick Erickson)
The ego analyst
PSYCHODYNAMIC THEORY
Conceptualize the individual relationships with others based on early parent-child interactions and the internalized self images that are result of these interactions.
Object relations theorist
PSYCHODYNAMIC THEORY
A) Maladaptive behavior is the result of abnormalities in object relations
B) The ego is present, whole and integrated at birth
C) Satisfying relationships keep the ego intact (Especially with mom)
D) Ungratifying relationships cause the ego to internalize introjects to gain control
E) Internalization involves splitting the object into three components that corresponds the way the individual has experience the object:
-Ideal (gratifying)
-Rejecting(Depriving)
-Exciting (enticing)
F) Mahler outlined individuation and separation as essential to the development of the internal object relations. She developed five developmental phases.
G) Object relations theorist view psychotherapy as an opportunity to provide the client with a special type of parenting that facilitates reintegration of the ego
Tenants of object-relations theory
PSYCHODYNAMIC THEORY
- An active role by therapist in therapy
- Assuming the role of the object is common
Techniques of object-relations theory
HUMANISTIC/EXISENTIAL THEORY
Encompassing client centered therapy, Gestalt therapy transactional analysis, existential therapy and reality therapy this form of psychotherapy is a diverse collection of techniques.
- To understand the person one must understand his experience
- Individuals are unique and whole
- The focus is on the here and now
- Individuals have inherent potential for self-actualization and self-determination
- Therapy is an authentic, collaborative, egalitarian relationship between client and therapist
- Traditional labels and assessment techniques are rejected
What are tenants of HUMANISTIC/EXISENTIAL THEORY
HUMANISTIC/EXISENTIAL THEORY
Is based on the hypothesis that all people have an innate self- actualizing tendency. Carl Rogers is the founder of this movement. He believed that:
A) The self must remain unified, organized and hold to grow towards self actualization
B) The self becomes disorganized when there is incongruence between the self and experience
C) Incongruence between self and experience produces anxiety
D) When the unified self is threatened the individual may attempt to alleviate the anxiety through distortion or denial(defenses)
E) Defensive maneuvers are counter to self actualization
F) Positive self regard is the key to self actualization
Client-centered therapy
HUMANISTIC/EXISENTIAL THEORY
-if the therapist provides the right environment the client will achieve congruence between self and experience
-The right environment is provided by furnishing three facilitative conditions:
. A unconditional positive regard (the therapist genuinely cares about the client and affirms the clients worth as a person)
. Accurate empathetic understanding (the therapist has the ability to see the world as the client does and conveys the understanding to the client)
. Congruence (The therapist must be genuine in therapy)
-Therapy is nondirective and client centered
-Clients are the experts of their own inner processes
Techniques of client-centered therapy
HUMANISTIC/EXISENTIAL THEORY
Based on the assumption that each individual is capable of assuming personal responsibility and living fully as an integrated person. Fritz pearls is the founder.
What is gestalt therapy?
HUMANISTIC/EXISENTIAL THEORY
A) Individuals should recognize the existence of gaps and distortions in their own thinking
B) Individuals will spontaneously express emotions and perceptions
C) Individuals will become aware of and take responsibility for their actions
D) People tend to seek closure
E) a person’s gestlats reflect his or her current needs
F) a person’s behavior represents a whole that is greater than the sum of its parts
G) Behavior can only be fully understood in context
H) a person experiences the world in accord with the principle of figure and ground
I) the personality has two parts: the self and the self image
-Self is the creative aspect of the personality that promotes the individuals inherent tendency for self actualization
-Self image is the “darker side”of the personality-it imposes external standards and hinders growth and self actualization
J) Maladaptive behavior is seen as growth disorder that involves the abandonment of the self for the self image
K) Maladaptive behavior is often the result of one or more boundary disturbances which all reflect identification with the self image:
* Introjection -means a person psychologically swallows whole concepts (Person accepts without understanding). Introjectors have difficulty distinguishing between “me” and “not me” in therapy.
* Projection -making someone or something in the environment responsible for what originates from one self
* Retroflection- doing to self what one wants to do to others
* Confluence -no boundary between self and environment
I) Awareness is a necessary precondition for appropriate change in behavior
Basic tenets of Gestalt therapy
HUMANISTIC/EXISENTIAL THEORY
- Therapist avoid labels
- Historical events only important when they directly impact current functioning
- Transference is counterproductive
- Directed awareness -direct questions keep clients in the here and now
- Language-therapist directs client to begin sentences with “I” to help them assume responsibility for actions
- No questions-questions foster intellectualizing and masked feelings
- games of dialogue- role playing and empty chair technique have client express feelings directly
- Assuming responsibility-therapist direct clients to use the phrase “I take responsibility for their own thoughts, feelings and actions”
- Dream work-elements of recurring dreams are representations of parts of the self that have not been fully accepted
Techniques of Gestalt therapy
HUMANISTIC/EXISENTIAL THEORY
Commonly used in group settings, was developed in the late 1950s by Eric Berne. It has elements of humanistic therapy as well as psychoanalysis, Gestalt psychology, rational emotive therapy psychodrama and behavioral therapy.
What is transactional analysis (TA)?
HUMANISTIC/EXISENTIAL THEORY
A) There are four life positions:
* I'm okay- you're okay
* I'm okay -you're not okay
* I'm not okay -you're okay
* I'm not okay you're not okay
We all start out at birth in the I'm okay-you're okay position depending on how our parents raises us, that position changes
B) There are three ego states
* adult (Loosely matches Freud ego)
* Parent (Correlates to super ego)
* Child(the I’d)
Positive parenting leads to an appropriate balance between the ego states
C) The script is a persons life plan. It is comprised of fantasy characters, games, physiological attributes and parental injunctions
D) Maladaptive behavior reflects an unhealthy life script, largely
attributable to parental practices
E) I’m okay-you’re not okay is characteristic of paranoid individuals
F) I’m not-okay you’re-okay is characteristic of individuals with depression, fear and mistrust
G) I’m not okay-you’re not okay = schizophrenia
H) The goal is to integrate the three egos states
Tenants of transactional analysis
HUMANISTIC/EXISENTIAL THEORY
Therapist and client agree on a contract that defines goals for therapy and involves four different analysis:
- Structural analysis-client is taught to identify three ego states and is given permission to express all three
- Transactional analysis-often involves observing the client transactions in a group and using the empty chair technique
- Game analysis-techniques are used to identify a client’s games
- Script analysis-clients current script is identified and client is helped to develop an autonomous/scriptless behavior
Techniques of transactional analysis
HUMANISTIC/EXISENTIAL THEORY
Is a form of psychosocial and behavioral intervention in which the client is helped to develop a success identity based on love and worth. it was developed by William glasser.
Reality therapy
HUMANISTIC/EXISENTIAL THEORY
A) Focuses on behavior rather than feelings
B) Focus is on present and future rather than past
C) Responsibility is a central concept and is defined as the “ability to fulfill one’s needs and to do so in a way that does not deprive others of the ability to fulfill their needs”
Basic tenants of reality therapy
HUMANISTIC/EXISENTIAL THEORY
- Verbally active therapist are confrontive and intellectual
- The concept of mental illness is rejected
- Transference is viewed as detrimental
- Emphasis is on conscious process
- Emphasis is on value judgments, especially clients ability to judge right and wrong
- Seeks to teach clients specific behaviors that will fulfill their basic needs
Techniques of reality therapy
Approaches to treatment using selected concepts and techniques that decrease maladaptive behaviors and increase more adaptive ones. It is not a single approach to therapy. That is, it combines elements of behaviorism, social learning theory, action therapy, functional school in social work task centered treatment and cognitive therapies. The cognitive behavioral therapies arose in the 1970s as a response to an increasing interest in the role that cognitive factors play in shaping human behaviors.
What is cognitive-behavioral theory?
COGNITIVE-BEHAVIORAL THEORY
A) emphasis is on current behaviors
B) a scientific approach is used
C) Cognitive processes influence behavior
D) Restructuring an individuals cognition can alter his or her behavior
Tenants of cognitive behavioral theory
COGNITIVE-BEHAVIORAL THEORY
Classical conditioning and operant conditioning
Behavior therapy
COGNITIVE-BEHAVIORAL THEORY
The therapies are primarily focused on helping a client unlearn previously learned connections between a specific stimulus and a maladaptive response. These theories attempt to:
* Provide the individual with a more adaptive response to the stimulus or
* Decrease the occurrence of a pleasure producing but maladaptive response
Classical conditioning-(A.k.a.respondent conditioning or Pavlovian conditioning)
COGNITIVE-BEHAVIORAL THEORY
Systematic desensitization
aversive counterconditioning
assertiveness training
The three most common applications of classical conditioning theory:
COGNITIVE-BEHAVIORAL THEORY
(Classical conditioning)
Gradually eliminates fear and anxiety associated with an object or event. Relaxation exercises and imagery relaxation techniques are used as a client is exposed to increasingly higher anxiety provoking situations. This is called interposition or pairing. About 75% of the way through the training that therapist begin in vivo desensitization. Useful to treat phobias, recurrent nightmares, insomnia, alcoholism and interpersonal problems.
Systematic desensitization
COGNITIVE-BEHAVIORAL THEORY
(Classical conditioning)
Is designed to eliminate a maladaptive behavior by associating the behavior with the real or imagined aversions stimulus. Example: a treatment for alcoholism is to give a client anabuse. The medication makes the client sick when the client consumes alcohol. Therefore sickness is paired with ingestion of alcohol.
Aversive counterconditioning
COGNITIVE-BEHAVIORAL THEORY
(Classical conditioning)
Decreases anxiety and problematic interpersonal situations by increasing the likelihood that an assertive response will occur. Client learns through behavioral rehearsal, modeling and relaxation training to directly express feelings, needs and demands.
Assertiveness training
COGNITIVE-BEHAVIORAL THEORY
Behaviors are strengthened or weakened by altering the consequences that follow them. Thus the goal is generally to increase desirable behaviors or to decrease undesirable behaviors. These therapies are widely used in institutions like hospitals, schools and prisons.
Operant conditioning
COGNITIVE-BEHAVIORAL THEORY
- Positive reinforcement- strengthening a desired behavior or response by presenting a reinforcing stimulus contingent on performance of the response
- Shaping -new patterns of behavior are fashioned by reinforcing progressively closer approximations of the desired behaviors and not reinforcing other behaviors
- Token economy -clients are given tokens whenever they fulfill specified task or behave according to some specified standard. The tokens can be redeemed for goods or privileges.
- Time out -refers to time out for positive reinforcement. Essentially undesirable behaviors are followed by the teacher removing access to various forms of reinforcement for a predetermined length of time
- Extinction-The elimination or weakening of the condition response by discontinuing reinforcement after the response occurs. Temporarily extinction burst may occur.
- PreMack principle-A high probability behavior is used to reinforce a low probability behavior.
- Contingency contracts-an agreement is made specifying the behaviors to be performed for certain consequence to follow.
Most common applications of operant conditioning
COGNITIVE-BEHAVIORAL THEORY
Founded by Albert Ellis this therapy is based on the premise that neurosis is called by the continual repetition of certain common irrational ideas. The goal is to help the client identify their irrational ideas underlying the emotional disturbance and to replace the beliefs with appropriate ones. It is active and uses such techniques as modeling, problem-solving, behavioral rehearsal, in vivo desensitization and cognitive homework.
Rational emotive therapy
COGNITIVE-BEHAVIORAL THEORY
Founded by Aaron Beck posits that emotional disorders are the result of your irrational thoughts about oneself and the external world. The goal is to help the client be aware of irrational automatic thinking and to help the client relabel events more accurately. These irrational thoughts are logical arrows and they include:
* arbitrary inference-drawing conclusions without evidence * Overgeneralization-drawing general conclusions on the basis of one event * Selective abstraction -attending to the detail while ignoring the total context * Personalization-erroneously attributing external events to oneself * Polarized thinking-thinking in a black and white fashion
Cognitive restructuring therapy
COGNITIVE-BEHAVIORAL THEORY
Developed by Meichenbaum as a method for altering maladaptive self statements. It is a cognitive restructuring technique that involves identifying and replacing a clients maladaptive cognitions with more adaptive ones.
Self-instruction
COGNITIVE-BEHAVIORAL THEORY
This therapy involves stopping excessive ruminations, self-criticism, depressive ideas and other unwanted thoughts by using techniques Like covertly yelling “stop stop stop” or snapping a rubber band that is worn around the wrist.
Thought stopping
COGNITIVE-BEHAVIORAL THEORY
Developed by Meichenbaum as a way to help people deal with stressful events by increasing their coping skills. It involves educating the client, rehearsing the skills with the client and helping the client apply the skills through in vivo processes.
Stress Inoculation
COGNITIVE-BEHAVIORAL THEORY
These techniques are administered by the client himself. Used to increase behaviors that occur less frequently then desired (studying for example) and to decrease self interest behaviors (over eating). The techniques most closely associated with this therapy are self-monitoring, stimulus control, self reinforcement ,self punishment and bio feedback.
Self-control procedures
FAMILY THERAPY
General systems theory provides the primary theoretical basis for much of family therapy theory. All family therapist incorporate some systems theory into their work. Communication theory is also essential to most family therapies. The following elements derived from systems theory and communication theory are core concepts of family therapy.
FAMILY THERAPY
A family is an open system his energy is garnered from interacting with its environment. It receives input from the outside and is amenable to change based on conditions in its environment. However families are also subject to move toward disorder and disorganization or entropy. Therefore families need a continual input from outside sources to withstand entropic forces. The more closed a system the more it is susceptible to entropy.
Open versus closed systems
FAMILY THERAPY
Every part of the system is related to every other part of the system. Changing one part then produces change in all parts.
Wholeness
FAMILY THERAPY
The whole is equal to more than the sum of its parts.
Non-summativity
FAMILY THERAPY
Different behaviors by living organisms that can lead to the same results
Equifinality
FAMILY THERAPY
One cause may produce separate results
Equipotentiality
FAMILY THERAPY
A system or organism will maintain stability and when disrupted will strive to restore previous stability
Homeostasis
FAMILY THERAPY
used to maintain homeostasis, negative feedback recalibrates the system and restores balance
Negative feedback
FAMILY THERAPY
Upsets homeostatic balance and amplifies the system deviation from the steady-state. Structural Unbalancing and reframing are examples of positive feedback that a therapist might use.
Positive feedback
FAMILY THERAPY
It is impossible to not communicate. Communication is a multilevel process and includes body language, silence, posture, tone and content.
All behavior is communication
FAMILY THERAPY
All communication has at least two levels:
- Surface= Overt content
- Metacommunication= Qualifies, contradicts or comments on overt context.
Surface and metacommunication
FAMILY THERAPY
This is a form of paradoxical communication in which an individual expresses a message that could be interpreted into 2 or more contradictory mutually exclusive ways. The recipient of the message is then stuck prevented from escaping the consequences of commenting on the contradiction.
Double-blind
FAMILY THERAPY
- Facilitating communication of thoughts and feelings
- Shifting and changing inflexible roles and coalition
- Modeling, educating and myth dispelling
- Strengthening the family system
- Increasing separation or individuation of family members
- Strengthening the marriage
Goals of family therapy
FAMILY THERAPY
The presenting problem is a relationship issue with or the presenting problem exists in an individual but impacts the entire system profoundly
Family therapy is definitely indicated
FAMILY THERAPY
The therapist has worked with an individual and has minimal success. the therapist may then shift the focus to treating the family and upsetting homeostasis.
Family therapy may be indicated
FAMILY THERAPY
Key members are unavailable, hospitalized or jailed. It’s also not effective when one member is so disturbed that sessions cannot proceed. Finally when the martial coalition is so fragile that direct exploration may be detrimental individual therapy is best sought.
Family therapy is contraindicated
FAMILY THERAPY
Extended family systems therapy, Structural family therapy, Communication family therapy, Strategic family therapy, Satirs process theory, Behavioral family therapy
Most widely used models of family therapy
FAMILY THERAPY
Extended family systems therapy
Extends general systems theory beyond the nuclear family. The dominant founder of the school is Murray Bowen. He believes that the extended family is a key element in the development and treatment of family dysfunction. The goal of this type of therapy is to increase the level of self-differentiation in all family members. In other words family therapy seeks to increase the ratio of solid self (which is consistent and nonnegotiable) to pseudo-self (which varies as pressure varies in relationships.)
Extended family systems therapy
FAMILY THERAPY
Extended family systems therapy
Refers to a individual’s ability to separate intellectual and emotional functioning. Low levels of differentiation, the higher the possibility that the individual will become “fused” to family members emotionally.
Differentiation of self
FAMILY THERAPY
Extended family systems therapy
Occur when a two-person system experiences instability. A third person, usually a family member who has a low level of differentiation is recruited into the system to reduce anxiety.
Emotional triangles
FAMILY THERAPY
Extended family systems therapy
The transmission of parental conflicts and emotional immaturity onto the children.
Family projective process
FAMILY THERAPY
Extended family systems therapy
Is a false sense of differentiation, achieved by avoiding content with one’s family of origin.
Emotional cut off
FAMILY THERAPY
Extended family systems therapy
Is the notion that dysfunction is a result of lack of differentiation through several generations.
Multi generational transmission process
FAMILY THERAPY
Extended family systems therapy
Is the notion that a child’s function in the family is related to birth order and that position affects future relationships.
Sibling position
FAMILY THERAPY
Extended family systems therapy
Refers to the idea that emotional factors in society affect the emotional functioning of family.
Societal regression
FAMILY THERAPY
Extended family systems therapy
- Look at what hooks or triggers an individual in their family
- The therapist will complete a genogram
- The therapist will become part of the therapeutic triangle by becoming triangled into the marital dyad an effort to free the children
- The therapist will become the coach
Techniques of extended family systems therapy
FAMILY THERAPY
An orientation based on identifying and changing maladaptive arrangements interactions and the internal organization of subsystems and boundaries of a family. Salvador Minuchin is the primary developer of this theory. Structural family therapist view family dysfunction as resulting from inflexible family structure. Thus restructuring the family is the principal .
Structural family therapy
FAMILY THERAPY
- Family system: the family is more than the individual bio psychodynamics of its members
- Family structure: families having implicit structure that determines how family members relate to each other
- Subsystems: family functions are carried out by systems that are comprised of groups of members who joined together on the basis of family function
- boundaries: these are the regions separating to social or psychological systems. They are the rules that determine how family members are or subsystems are expected to relate to one another. Healthy families tend to have clear boundaries and unhealthy families tend to have rigid boundaries or boundaries that are not consistently clear.
Tenants of structural family therapy
FAMILY THERAPY
- Joining the family occurs when the therapist adopts the affect, language and style of the family. The therapist takes a leadership role.
- The therapist accommodates to the family by maintenance, tracking and the mimesis.
- The therapist evaluates the family structure and derives the goals of therapy.
- The therapist restructures the family by:
* Actualizing transactional patterns
* Making boundaries
* Escalating stress
* Assigning task
* Utilizing the symptom
* Manipulating mood
* Providing support, education and guidance
The techniques of structural family therapy
FAMILY THERAPY
Recognizes the role of communication and family and individual dysfunction. This therapy was primarily developed by Jay Haley and the Palo alto group. They believe that causality is circular. Therefore, the symptom of family dysfunction is both the cause and the effect of dysfunctional communication patterns. The goal of this therapy is to alter the interactional patterns (like blaming, criticizing, mindreading and overgeneralizing) that maintain the presenting symptom.
Communication family therapy
FAMILY THERAPY
- ) People are always communicating because all behavior is communicative.
- ) All communication has a report (content) and a command (nonverbal indicators which make a statement about the communicators) function.
- ) Family rules serve to maintain homeostasis and family interactions are governed by these family rules.
- ) Communication patterns are symmetrical (reflecting inequality between communicators) or complementary (reflecting inequality between communicators).
- Systems are subject to equinfinality.
Basic tenants of communication family therapy
FAMILY THERAPY
- Direct interventions are used to point out problematic interactions as they occur. Family members are taught to communicate clearly and directly by using “I” statements and interpreting interactional patterns.
- Indirect interventions are used to co-opt the family and to join opposite of what is being asked of them. These interventions are sometimes more effective than direct ones. Paradoxical prescription and relabeling are two common indirect interventions.
Techniques of communication family therapy
FAMILY THERAPY
Focuses on the interactional patterns that maintain problematic behavior. It uses problem oriented strategies to disrupt those patterns. Developed by Jay Haley, Cloe madenes, the Milan group and MRIs Bateson. Dysfunction is regarded as the cause and result of rigid and repetitive interactional patterns. The goal is to resolve the families current problem.
Strategic family therapy
FAMILY THERAPY
- Systems view of problem maintenance: Family dysfunction reflects the attempt by the family to maintain homeostasis
- Triadic view of problem maintenance: Family problems typically involve interactions between at least three family members
- Systems view of intervention: Any positive change in the family system can lead to improvements and other parts of the system
- Circular model of causality
- The two types of change are:
- First order change: Superficial (does not cause change in system
- Second-order change: Basic change in structure and functioning of family system
Basic tenants of strategic family therapy
FAMILY THERAPY
- Identify the problem
- Specify explicit concrete goals for therapy
- Select and apply appropriate treatment strategies
The techniques for strategic family therapy
FAMILY THERAPY
Stresses the feeling aspect of communication in a family. Emotional needs of the family members as well as the familys pain are the focus. Family pain derives from the stress of maintaining homeostasis when communication is incongruent. The goals are to get the identified patient “off the hook” and to get the family away from the cause and effect blaming model.
satir’s process theory
FAMILY THERAPY
- Communication styles: Four our dysfunctional (Blaming= Discount the other; Placating = discounting self; computing = discount feelings; distracting = discount the context and one is healthy (leveling = all parts of the message match).
- Games: There are four types(Rescue= One member placates, one blames or disagrees one distracts; Coalition= To agree, one disagrees; Lethal= Everybody placates and agrees with no regards to their own needs; growth= Everybody includes others and themselves in the interaction)
- Maturation: Mature people are in touch with feelings. They view different ness as an opportunity for growth.
- Triangles(Same as Bowens)
- Values: Positive assumptions about human potential and growth. She helps families modify rules that are no longer relevant and causing family pain.
- Self-esteem: Is viewed as a basic drive in all human beings. Low self-esteem causes incongruent family communication.
Basic tenant of satir’s process theory
FAMILY THERAPY
- Therapist or active and directive
- Family simulation and communication games
- Therapist has clients experiment with roles and behaviors
- Generally the whole family is the client (but subsystems may be treated if they agree to share the information with others later)
Techniques for satir’s process theory
FAMILY THERAPY
Is characterized by a view of behavior as learned. The focus is on observable behaviors.
The goal is to modify behavior (decrease undesirable or increase desirable). This therapy is based on classical and operant conditioning, social learning theory and social exchange theory.
Behavioral family therapy
FAMILY THERAPY
- Dysfunctional behaviors are viewed as symptoms (or learned responses).
- Using behavioral techniques without looking into the underlying dysfunction in the family is of limited value.
Tenants of behavioral family therapy
FAMILY THERAPY
- Assessment involves conducting a functional analysis, which includes determining the behaviors the family wants to change (target behaviors) and determining how those behaviors are being maintained. The frequency of behaviors is typically determined in this stage.
- The therapist selects an appropriate intervention and systematically applies it to the behaviors. Operant techniques like timeout, punishment and extinction might be used to eliminate behaviors. Operant techniques like positive reinforcement, negative reinforcement and shaping maybe used to strengthen desirable alternate behaviors. The therapist may use a contingency contract to delineate target behaviors and reinforcements.
- The therapist (and generally the clients) collect data related to the frequency of the target behaviors at various times during the intervention to evaluate the interventions effectiveness.
Techniques of behavioral family therapy
FAMILY THERAPY
Additional family therapy concepts
-Family myths are a set of beliefs shared by all family members concerning each other and mutual positions with in the family which go unchallenged.
-a family is a rule governed system that behaves in an organized, repetitive pattern of interactions with one another. There are covert and overt rules. Covert rules are the most powerful rules because they are not directly stated.
-Families participate in rituals which are regular, predictable behaviors that “feel right”. They are the family’s way of doing things. They may either increase family cohesiveness or be experienced as burdensome, empty and difficult demands.
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FAMILY THERAPY
Additional family therapy techniques and procedures
- Psychodrama-Clients perform roles (maybe themselves or someone else). Family sculpture and role reversal or two psychodrama techniques.
- convening the family-Bringing in as many family members as possible.
- Unhooking the identified patient-Talking about the roles that all family members play (not just the alcoholic, for example)
An intervention for helping individuals who have emotional or social maladjustment problems. Two or more individuals are brought together under the direction of a professional therapist. The individuals share their problems with other group members. Ways to resolve the problem, information about resources and emotional experiences are shared in the group. Groups may be closed or open.
Group therapy
Stages of group therapy
Pre-affiliation Power and control Intimacy Differentiation/Development of group identity Separation
GROUP THERAPY
Group members tend to be ambivalent about belonging. They may be guarded and fearful in this stage. A member in the pre-affiliation stage would be least likely to take risks. Attention will be focused on the leader.
Pre-affiliation
GROUP THERAPY
Members tend to lose guardedness and ambivalence. Members began to establish roles in the group as leaders, followers, talkers, passive members etc.
Power and control
GROUP THERAPY
Members continue to lose guardedness, continue to establish roles, and begin to become genuinely concerned about the well-being of the other members of the group. This tends to be the longest of the five phases. Group goals are usually reached here (As well as individual goals). Individuality is subordinated to the needs of the group.
Intimacy
GROUP THERAPY
Members develop a greater sense of their own unique problems and ability to solve them within themselves.
Differentiation/Development of group identity
GROUP THERAPY
Members regain their sense of individuality. Members become reintroduced to life without the group.
Separation
GROUP THERAPY
Forming a group
- Groups can be heterogeneous (different in their area of disturbance age etc. or homogeneous (similar in terms of important characteristics).
- Most experts agree that groups should consist of members to share the same level of intelligence.
- Many experts believe the group member should be similar in terms of their developmental level.
- Dreikurs believes that group members (especially children) should be matched for age.
- With young children sexually homogenous members are preferred.
- With adolescents, the focus of the group determines the preference for sexual homogeneity of members.
- Different researchers recommend either homogeneity or heterogenity of problem.
- Homogenous groups tend to gel faster, become more cohesive, offer immediate support to members, have less conflict, have better attendance and quickly provide symptomatic relief.
- Homogenous groups also tends to remain at superficial levels and are inefficient for altering character structure.
- Heterogeneous groups offer more potential for deep, lasting change.
- Groups can be open (allowing members to join and terminate at different times) Or closed all members began and end at the same time.
- Therapy groups are most effective when they consists of between seven and 10 members.
- Group cohesion is maximized when members participate in defining the group’s goals and norms, and perceive the group to be valuable for achieving the desired and
GROUP THERAPY
- High denial
- High somatization
- Low motivation
- Low psychological mindedness
- Low socioeconomic status
- Low social effectiveness
- Low IQ
Traits associated with premature termination
GROUP THERAPY
- Leadership style will vary according to approach to therapy. However the leader is expected to use his or her personality on behalf of patient development.
*The leader should convey concern, acceptance, empathy and genuineness. - The leader should strike a balance between intrapersonal and interpersonal orientation.
- A leader should be more active earlier in the group. At this time they tend to be the focal
point. - The leader should transfer part of his or her power to the group when signs of realism appear.
- The leader should clarify events and communications that take place in the group.
- The leader should self disclose, confront and challenge.
- The leader sets goals and develop rules.
- The leader creates and maintains the group.
- The leader builds the culture of the group.
- The leader activates and aluminates the here and now orientation.
The group leaders roles and responsibilities
GROUP THERAPY
- Information (from other group members and the leader)
- Hello (encouragement and support offered by other members instill hope)
- Universality (learning that others share similar problems help members feel less isolated)
- Altruism (provides members with opportunities to learn that they can help others)
- Interpersonal learning (learn to interact with others)
- Imitation (learn new behaviors by observing and imitating)
- Correctional recapitulation of the primary family (group format helps individuals resolve problems that stem from past relationships)
- Catharsis (learning to express feelings increases trust and understanding.)
- Group cohesiveness (members achieve a sense of belonging.)
- Existential learning (opportunities to learn important general rules of living.)
Current factors of a group (yalom, 1975)
