Orienting Questions: System's Thinking Couple and Family Therapy Flashcards
(34 cards)
What are some models that have proven family therapy to be effective
Johnson (Emotionally Focused Treatment, Functional Family Therapy (Sexton), Multisystemic Family Therapy (Henggler, Bourdain & Brunk), Eco-Systemic Family Therapy (Jones & Lindblad-Goldberg), and Gottman’s Couple Therapy
Why was CBT shown to be effective at first
was during the jump in the medical model, and CBT was measurable
-Got a jump start because it was quick and measurable which people looked for in healthcare
Difference between evidence based therapy and evidence supported practice
-Evidence Based Therapy is the strict of the strict, there is a manual for a certain population, and we can randomized controlled trials
-Evidence Supported Practice (ESP) is just that there are theories behind what you are doing and evidence behind it as well
-A way to practice with unique cases that had a lot going on
What happened in the early 1980s with Family and Couple Therapy
-Couple and Family Therapy was more complex, in regard to determining what was successful in treatment.
-But, once researchers began to understand how to study family therapy, the data has consistently been positive.
What did Gurman and Kirshen find
-MFT is efficacious and FT is often more effective or as effective an individual when the problem is attributed to a family conflict.
-Both behavioral and non-behavioral were superior (2/3) to no treatment
What did Shadish, Ragsdale, Glaser, and Montgomery find?
-during met-analysis found that the effect size for couples and family therapy was comparable to other psychotherapy modalities.
-Family was at least as effective as individual, but, some studies showed superior treatment for individual children with conduct problems.
-Couples therapy shows to be a little bit less effective, because often times people do not want to always be there
Pinosf and Wynne research?
-Their research from 1995 concluded that sufficient data exists to support that family therapy is effective and
-There is no evidence of family therapy causing harm
What are the four primary common factors in family therapy
Conceptualizing the problem in relational terms, Disrupting Dysfunctional Relational Patterns, Expanding the direct treatment system, and Expanding the therapeutic alliance
explain conceptualizing the problem in relational terms
-Rather than saying Tom is depressed, saying there is something happening between people that is causing Tom to be frustrated
-Other factors that may not be causing the problem, but you cannot separate from the problem
-This position stands in sharp contrast from the premise that problems exist in the person (DSM)
-Relational often works when the problem is viewed from a relational lens (Davis & Piercy, 2007)
-Problems, as dealt with by most models, are seen as patterns learned in family of origin and are then seen by cognitive, affective and behavioral aspects that drive the current maladaptive cycle.
explain disrupting dysfunctional relational patterns
-How do individual therapists disrupt patterns?
-Anything that reduces a dysfunctional, ongoing pattern is something effective psychotherapy-wise
-Many people do not realize that they are stuck in an ongoing loop, until it is pointed out to them
-All of the fully empirically supported relational models have some technique to disrupt dysfunctional interpersonal patterns.
-Family therapists are serving the system, typically do not have close relationships with individuals like in individual therapy
explain expanding the direct treatment system
-One learns more about the patient system, specifically the interpersonal factors
-The therapist gains a better alliance with multiple members for the “in person” aspects
-Bringing in the people that you are talking about, instead of just hearing about the unsupportive boyfriend, bring him in
-In order to bring people in, you have to come to a clear agreement about what will be shared with the people you are bringing in; treatment will not be successful if there are secrets, people have to be open, Browning has people sign a consent form that secrets cannot happen and if they do he will talk about it with everyone or have the person share it themselves
-Meet individually or in subsystems, have to make it clear that if something that is shared that is toxic to the entire family, he cannot be held to keep that information
what can be the results of expanding the direct treatment system
-The collective observing ego is more likely to have strong empathy if more people understand what is happening
-A transforming break-through is more likely when it occurs in the presence of many others.
-The problem-maintaining structure is easier to determine when one sees it in action.
-Whether dealing with the larger system directly or indirectly, the breaking of dysfunctional patterns in consistently mentioned as useful.
explain expanding the therapeutic alliance
-Important for all therapies
-Multiple alliances happening, alliances within the system and also therapist’s alliances with others in the system
Can be a Two edged-sword
-Not all alliances are equally important
-Have to have some sort of alliance with everyone, have to at least respect each person’s position
-The issue of multiple alliance is not well researched
explain practical application of the common factors
-What is the function of the problem in the family?
-Is there a pattern that can be interrupted or altered?
-Whom might I invite to treatment?
-How do I keep some alliance with all, but not be too overly aligned with anyone (unless this is an intervention in itself)?
how does family therapy differ from individual
-Focus
-Number in the room
-Confidentiality
-Reducing negativity in the room
How to reduce negativity
Always keep on the lookout for the negative energy increasing. If so:
-Reframe
-Move to process
-Sub-system
-Information through you
-You become the script-writer (Dan Wile)
explain reframe primer
A reframe is an alternate perspective, that is not a trick, but, in fact, is equally possible. You, the clinician, need some evidence that your alternate perspective (the reframe) might be equally true.
-When you give a reframe, you should have some evidence to support the reframe
-Pose it as a possibility
-Be careful when reality testing is at play
-“While you say your mom never supports you, is it possible she is not sure what would even be supportive to you? You mentioned that she has no idea what nursing training even involves.”
explain moving to process
-The two family members are caught in a back and forth about a topic that no one will be right. You move to reflecting on their relationship.
-Nice part of systems work, you can leave the content behind, even though you two disagree you care so much about the person that you care enough to hear the other’s perspective
-Any time you go from content to process you are almost always going to lower the temperature in the room
-“You two have found a topic that guarantees that neither one of you will ever win the argument. You two have fundamentally different ideas of what “being responsible” is. But notice how much you want the other to respect your opinion. There is a strange closeness that comes from desperately wanting the other to acknowledge your view.”
explain becoming a scriptwriter
-Each family member disqualifies the opinion of the other over and over.
-Ex. You are working with a couple and know the two are mad at each other, the guy feels like the woman needs to know he cares about her but is not showing affection; you stop her and say I think what he is trying to say is…. “in your family no one really hugged, no one showed affection, you do care, but you are not sure how to show it”
-As you do it, you glance at the guy and see if you are getting it right
-You are putting the words in, and you are constantly checking in to make sure you are getting it right
“I suspect that Tom is saying that he really wants you to trust that he is taking your concern seriously, but since he doesn’t say it exactly the way you want, you don’t believe him. Is that true, Tom, you do understand why Larry is worried about your behavior at work?”
explain circular causality
problems are sustained by an ongoing series of actions and reactions, and one need not return to the first cause.
explain equifinality within different models and family therapy
there are multiple ways to get to the same end
-You can do different techniques to get to the same end point of success
is family therapy group therapy
-NO
- Distorted perception within a family
- Strangers
-Short History
-Revealing is easier to strangers
-Less fallout
-Everyone is equal
explain cybernetics
through the process of feedback loops, a system is self correcting.
explain homeostasis within family therapy
-tendency towards an equilibrium, if a change occurs, drift back to homeostasis
-Both right and wrong, in early family therapy it was with very dysfunctional families so it was believed that we have to do crazy intense interventions to blow the entire family up and then rearrange it
-This is not always wrong, but there are often times families that are not this dysfunctional and it could just be a minor push that creates change, homeostasis says that this is not possible, but this is not true
-Can be helpful, but not an equal factor across all families
-A family that has low levels of homeostasis is easier to change, not so caught in the idea that this is how we function
