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Psyc 474 > Nov 19 > Flashcards

Nov 19 Flashcards

1
Q

couple’s therapy background

A

therapy with 2 people

historically, a married couple

nowadays, couples therapy methods have been applied to MANY close relationships

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2
Q

expanded types of couples that couples therapy now addresses

A
  1. unmarried, dating couples
  2. central couples in a polyamorous network
  3. friends/workplace relationships

NO LONGER LIMITED TO MARRIED COUPLES, or even to romantic couples

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3
Q

clinical considerations in couples therapy

A
  1. agreeing on goals
  2. keeping secrets?
  3. involving other family members?
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4
Q

clinical considerations in couples therapy: AGREEING ON GOALS

A

dyads - they may have different priorities

different understandings of fault/blame

more complicated in couples compared to traditional therapy with one person

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5
Q

clinical considerations in couples therapy: KEEPING SECRETS

A

confidentiality agreement with 2 individuals

case example:

  • married couple with child reporting long history of difficulty communicating, unsatisfactory sex life, few common interests
  • session 1: couple agrees to goals to enhance communication and emotional intimacy
  • end of session: wife returns under pretence of having left her wallet, but discloses an affair and intention to end the marriage

WHAT’S YOUR MOVE?

legally BOUND to keep this secret - do you continue to pursue the established goals, refer them to someone else, say you’ll only continue with the therapy if she comes clean?

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6
Q

clinical considerations in couples therapy: INVOLVING OTHER FAMILY MEMBERS

A

sometimes appropriate to switch to family therapy

in-laws can contribute to problems

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7
Q

as a contemporary client: why go to couples therapy?

A
  1. feeling stuck in a harmful relationship dynamic
  2. wanting support navigating a transition or difficult conversation (sex, finances, kids)
  3. sexual dysfunction
  4. individual mental health concerns (PTSD, most commonly)
  5. positive psychology reasons (build insight, strengthen the relationship)
  6. individual concerns
  7. intimate partner violence
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8
Q

cultural considerations and couples therapy

A

western ideals of “love”

heteronormative definitions of love

^ these aren’t the basis of every committed relationship

need to adapt to the couple, avoid enforcing norms/biases inherent in your culture

ie. love may not be the goal of all therapies

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9
Q

3 theoretical approaches to couples therapy

A
  1. the Gottman method
  2. solution-focused couples therapy (SFCT)
  3. emotion-focused couples therapy (EFCT)
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10
Q

quick intro: the Gottman method

A

develop from pattern-detection in observational research

research driven, behavioural, skills-based

agnostic theory

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11
Q

quick intro: solution-focused couple’s therapy

A

firmly grounded in behaviourism

positive psychology orientation

short term, acute problem management

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12
Q

quick intro: emotion-focused couple’s therapy

A

developed from qualitative interviewing and observational research

firmly grounded in attachment theory

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13
Q

Gottman couples therapy developed by…

A

Dr John Gottman

Dr Robert Levenson

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14
Q

how did Gottman and Levenson develop the Gottman method?

A
  1. filmed LIVE INTERACTIONS and measured PHYSIOLOGICAL CHANGES to assess EMOTIONALITY

^ skin conductance, blood velocity, gross motor activity, heart rate

  1. LONGITUDINAL studies with replications

^ followed couple for up to 20 YEARS
^ studied many types of dyads (not just romantic)

  1. repeated measurements of both SUBJECTIVE and OBJECTIVE outcomes

^ ie. marital dissatisfaction, happiness, conflict behaviours, emotionality, relationship status of couples

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15
Q

what was the goal of Gottman and Levenson in their research?

A

predict marital dissolution and understand what conflict behaviours were real problems in relationships

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16
Q

5 Gottman research findings - conflict

A
  1. couples are very stable
  2. most relationship problems didn’t get solved
  3. lots of fun stats: “couples that stay together have 5 positive interactions for every negative interaction”
  4. defined ‘meta-emotion’ - the way people feel about emotions
  5. defined several common relationship dynamics and conflict behaviours, and identified which were related to outcomes of interest
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17
Q

Gottman - couples are very stable

A

80% stability in conflict behaviours and marital satisfaction

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18
Q

Gottman - most relationship problems didn’t get solved

A

69% were ‘perpetual problems’ based on personality differences

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19
Q

Gottman - meta-emotion

A

they defined this

the way people feel about emotions

found that differences in meta-emotion drove a lot of conflict

meta-emotion mismatches predicted DIVORCE with 80% ACCURACY

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20
Q

meta-emotion differences predicted divorce with…

A

80% accuracy

ie. one partner seeing authenticity of other as self-indulgent, and other partner seeing partner’s expressivity as withholding

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21
Q

4 horsemen of the relationship apocalypse

A

criticism

contempt (greatest predictor of relationship failure)

defensiveness

stonewalling

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22
Q

criticism antidote

A

“I” statements

I feel, wish, need…

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23
Q

contempt antidote

A

be RESPECTFUL

deliberately integrate more statements of appreciation and care into conversation

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24
Q

defensiveness antidote

A

take RESPONSIBILITY

even for just a small part of an ongoing problem

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25
stonewalling antidote
take BREAKS of at least 20 mins during conflicts when one partner feels overwhelmed and then continue problem solving afterwards
26
the sound relationship house: Gottman
two pillars: trust and compassion from base to roof: 1. build love maps 2. share fondness and admiration 3. turn towards instead of away 4. the positive perspective 5. manage conflict 6. make life dreams come true 7. create shared meaning
27
Gottman's couple's therapy is based on...
observational findings it's not based on an overarching theory
28
Gottman's couple's therapy consists of...
1. ASSESSMENT: couple plus therapist 2. INDIVIDUAL SESSIONS & QUESTIONNAIRES (with each partner) 3. build a SOUND RELATIONSHIP HOUSE
29
role play of Gottman couples therapy
couple partners talk about how they are feeling criticize their partners, not constructive therapist helps them identify their feelings and instructs them to switch to using I statements collaborative, skills-based
30
Gottman therapy is best used for...
1. couples who want to INCREASE RELATIONSHIP SKILLS 2. couples who want to FIX RELATIONSHIP ISSUES 3. people who are "PSYCHOLOGICALLY MINDED" ^ want to learn psychological constructs and tools
31
Gottman therapy is not suited for...
1. treating INDIVIDUAL ISSUES/understanding either individual better 2. mental health issues 3. domestic violence
32
takeaways from Gottman
1. huge EVIDENCE-BASIS for types of conflict 2. SPECIFIC, evidence-based replacement BEHAVIOURS 3. NOT theory driven (no theoretical explanation of how couple got to this point) 4. therapy materials hidden behind PAYWALL
33
solution-focused couple's therapy (SFCT) developed by...
Steve de Shazer and Insoo Kim Berg married couple
34
SFCT is _____-oriented
goal
35
SFCT is based on...
1. positive psychology 2. behavioural interventions so it's STRENGTHS-BASED and ACTION ORIENTED
36
SFCT has little/no focus on...
the PROBLEM/MECHANISMS of the problem
37
SFCT focuses on...
identifying RESOURCES clients have and USING them
38
SFCT is construed as a... (think: expert)
collaborative therapy with no expert in the room patients are the experts on themselves
39
SFCT therapists provide/identify...
concrete interventions and solutions SOCRATIC questioning used to keep conversation concrete and measurable "we think of it as possibility thinking"
40
SFCT intervention specifics
1. PRE-SESSION CHANGE QUESTION (has any change occurred since you made the appointment?) 2. MIRACLE 10 QUESTION (if you woke up and suddenly were at a 10/maximally achieved your goal, what are the first things you and others would notice as indicators?) 3. LOOK FOR PREVIOUS SOLUTIONS 4. LOOK FOR EXCEPTIONS TO THE PROBLEM 5. USE PRESENT AND FUTURE FOCUSED QUESTIONS 6. COMPLIMENT! 7. INVITE COUPLE TO EXPERIMENT WITH DOING MORE OF WHAT WORKS 8. SCALING QUESTIONS 9. COPING QUESTIONS
41
Insoo Berg in action - SFCT video
1. goal negotiation - together, what do you want to change? 2. eliciting change 3. reinforcement of change - ie. compliments
42
SFCT is best used for...
1. finding solutions to SPECIFIC PROBLEMS ^ frequent conflict, difficulty compromising 2. EMERGENCY RESPONSE to acute couple problems ^ no explicit refusal to work with domestic violence, although this likely varies between clinicians
43
SFCT isn't used for...
people who want to UNDERSTAND not super interested in WHYs
44
SFCT takeaways
not all therapies focus on the past ^ sometimes the most effective approach is to focus on possibilities for the FUTURE complex problems may not require complex solutions
45
emotionally-focused couple's therapy (EFCT) developed by...
Dr Susan Johnson and Leslie Greenberg
46
EFCT is a ______, _______, ______ couple's therapy
brief, structured, collaborative
47
EFCT is grounded in...
attachment theory
48
EFCT was developed from...
1. clinical work 2. qualitative research with couple ^ empirically developed
49
attachment theory review
1. experiences in infancy and childhood shape relationship patterns throughout life 2. secure attachment: caregiver is safe haven, provides soothing and meets care needs > suffering is regulated 3. insecure attachment: neglectful or inconsistent caregiving > suffering abounds without soothing
50
EFCT theoretical model: adult love
adult relationship conceptualized as 2-WAY ATTACHMENT BOND bonds come with associated "SCHEMAS" regarding partner's and one's own DEPENDABILITY for comfort partner should be a SAFE HAVEN attachment needs are a huge MOTIVATOR for INDIVIDUAL CHANGE/GROWTH
51
what does EFCT look like?
1. identify client's CURRENT DANCE (observation and de-escalation) 2. help clients be CLEARER about what they're MISSING (assembling emotions, fostering care, validation, understanding) 3. helps client PRACTICE caring responses (enactments in sessions)
52
"the EFT Tango" steps
1. reflection 2. validation 3. evocative reflections & questions 4. tracking & reflecting interactions 5. reframing
53
"the EFT Tango" quote
"really, though, it's about attunement. you are becoming attuned to each partner in the present moment, feeling the emotional and interactional patterns, and helping clients see them too" - Sue
54
EFCT video: Sue in action
Rhea just wants to be heard, doesn't need to be told she's right, or for him to fix things ^ validating and reflecting her needs helps her calm down ^ she needs reassurance that he loves her and is trying Sue tries to distill her core emotions & attachment needs ^ gets Rhea to speak them aloud to her husband therapists job is to distill the message and need from the client
55
EFCT is best used for
1. fixing problems ^ trust breach, fear/anger, mental illness in one/both members 2. strengthening relationship
56
EFCT not used for...
1. couples with Intimate Partner Violence (IPV) ^ because someone who's physically hurting you can't be a safe haven 2. couples who are separating ^ because if you're separating, you aren't trying to make the partner your safe haven
57
the types of couple's therapy that can be used for couples with IPV
SFCT (not EFCT or Gottman method)
58
EFCT takeaways
1. the one therapy to EXPLICITLY FOCUS ON LOVE/CONNECTION as the desired outcome 2. requires that the THERAPIST be a SECURE BASE for both partners, and then help the partners BECOME THAT for one another
59
measuring success in couple's therapy - historically
historically: did they stay together (married)? ^ evidence for this isn't perfect: - 30% relapse in 2 years - 38% divorce in 4 years trouble with INTERNAL VALIDITY: ^ selection bias: people come for couple's therapy when things are already going wrong (and likely have been for a while)
60
how do we construct a control group against which we can measure couple's therapy success rate?
(not ethical to deny people care outright when they come seeking it) several common options in clinical care: 1. waitlist control group 2. psychoeducation-only group 3. non-treatment seeking couples 4. compare sample stats to known population statistics
61
couple's therapy relative efficacy
1. hard to find RECENT comparison research between the diff approaches ^ because recently now all of them are integrated 2. most work suggests that ALL the schools of couple's therapy are EQUALLY EFFECTIVE 3. suggests that the most important aspects are "COMMON FACTORS" ^ ie. relationship with therapist, getting the therapy you want, collaboration etc
62
couple's therapy: an integrative stance
doesn't necessarily mean you can SWITCH COMPLETELY between solution-focused and EFCT with patients trained in many forms of practice and adapt an individual client's care to their mindset/goals/presenting problems may integrate specific tools or elements of a perspective
63
couple therapy, and systemic interventions for adult-focused problems: the current evidence base BACKGROUND
narrative review looking at couple therapy EFFICACY summarizes meta analyses when available summarizes efficacy of different treatment modalities for: - relationship distress - psychosexual problems - IPV - anxiety disorders - mood disorders - alcohol problems - psychosis - adjustment to chronic physical illness
64
couple therapy systematic review HIGHLIGHTS
1. 40% couples report they "benefit a great deal" from couple therapy 2. 30% "benefit somewhat" 3. couple therapy overall (including SFCT, EFCT, educational approaches) beneficial for those with mild-moderate IPV 4. ^ not appropriate for severe partner violence
65
couple therapy systematic review: for mildly distressed couples
SFCT and EFCT approaches EQUALLY EFFECTIVE
66
couple therapy systematic review: for moderately distressed couples
EFCT had better outcomes
67
what therapies are evidence based for anxiety disorders?
EFCT and other behavioural therapies and most couple therapies are evidence-based for depression and other mood disorders
68
most couple therapies _______ _______ _______ for patients with a range of chronic health conditions
improved health outcomes meta analysis across 52 studies, including HIV, stroke, cancer, cardiovascular diseases, chronic pain longer treatments with ill patients and their spouses (vs other fam members) were most effective
69
why is Gottman therapy not mentioned in many relative efficacy studies?
1. everyone integrates psychoeducation and interventions from Gottman ie. "I" statements 2. Gottmans have lots of control over their materials (paywall) ^ lots of efficacy studies comparing GCT to a control condition (because Gottmans fund these), but not comparing it to other therapies
70
Carr 2019: common factors for treating relationship distress
FOUNDATION: case formulation highlighting interactional sources of distress 1. alter couple's view of problem to be more objective and dyadic 2. decrease emotion-driven, dysfunctional behaviour 3. elicit emotion-based, vulnerable behaviours 4. increase constructive communication 5. promote strengths and reinforce gains
71
Dr Sue Johnson concluding quote
"when you change the way somebody dances with the most important partner in their life, you are changing so much. you change how they deal with their emotion. you change how they see other people. you change their models of self. you start to create secure bonding and what we know, from all the research in psychology, is being able to securely bond with another person is associated with every factor predicting resilience and health that psychology has ever named"

Psyc 474 (23 decks)

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