Theoretical Interventions

Question 1

Interpretations

Answer 1

-Psychodynamic
-Link an unconscious process—a defense, wish, fear, memory, or misunderstanding—with conscious experience
-Make connections between internal processes, in-session events, relationships, history, and symptoms
-Are causal explanations that explain why the client functions as he does
-It is ineffective to offer interpretations before clients can accept them. Often it is best to offer connections and explanations gradually
-Working through: insights are applied to a variety of everyday client experience

Question 2

Psychoeducation

Answer 2

-Psychodynamic
-When insight reveals gaps in the client’s repertoire, psychoeducation provides new cognitions, attitudes, and behaviors
-For example: Investing in relationships involves risk of hurt, but if we gather information and proceed cautiously, we can have good relationships
-Dynamic work can identify needed CBT interventions
-For example: A client who is frightened of her anger might benefit from anger management training

Question 3

Corrective emotional experience

Answer 3

-Psychodynamic
-involves emotional relearning through the therapeutic relationship
-this should involve more than generic acceptance:
-When maladaptive learning about self and others is revealed in the transference, counselors can create interpersonal experiences that specifically counter this learning
-Client expressions of interpersonal pessimism, fear, or shame are opportunities for this type of intervention
-The client internalizes the therapist’s view of him
-Insight based child management: therapists work with caregivers to provide corrective experiences without necessarily interpreting the dynamics for the child

Question 4

Family Systems

Answer 4

-Systemic insight: systemic insight can be provided by articulating patterns and rules of interaction that formerly were implicit and unexamined
-Reframing: Therapists can sometimes change the perceived meaning of a behavior by providing a new explanation for it. Typically, this is done to reduce anger and increase empathy for a family member.
-Therapist directives
>counselors use directives to initiate new experiences
of interaction in the family.
>The rationale for the directive might or might not be
explained. Sometimes it is: “Try it—you might like it.”
>Directives can be for in-session or at-home
behaviors and interactions.
>Directives create new types of interactions that
family members might not discover on their own.
Often, therapists direct participants to behave in new
and unaccustomed ways.
>Some directives suggests ways for estranged family
members to spend more time together sharing an
enjoyable activity.

Question 5

Positive Feedback Loops

Answer 5

-Family Systems
-Explaining positive feedback loops:
>It is useful to explain how this mechanism operates
in the family. A diagram consisting of two semicircle
is useful. Positive feedback loops are paradoxical
because each person causes the behaviors he dislikes
in the other.
>Each individual’s attempted solution is viewed by the
other person as the problem. People respond to
failure by intensifying the behaviors that have fueled
the problem. Both parties’ behavior is logical but
counterproductive. The loop will go on forever if
nothing changes.
>In one type of loop, hurt is transformed into anger
within each person; when this anger is expressed,
the other person is hurt, the same transformation
occurs, and so on.
-Treating positive feedback loops:
>The solution is to reverse the direction of the loop.
Then, the more Person A does what Person B wants,
the more Person B will do what Person A wants.
>Neither party can solve her own problem. However,
both people can solve each other’s problems.
>Optimally, the solutions are enacted simultaneously.
—both people should go first.
>When the loop has polarized the two parties on
some dimension, the solution is for each to “drop the
rope” and initiate movement toward the moderate
middle.

Question 6

Exposure

Answer 6

-Behavior therapy
-exposure means putting clients in the situations they fear and helping them remain there long enough to discover that, other than anxiety, nothing terrible will happen.
-Typically, anxiety increases, peaks, and then declines a great deal.
-There is desensitization to feared stimuli and extinction of conditioned fear.
-Exposure is an experiential form of learning that is not duplicated by verbal reassurances.
Imaginal exposure is done in the imagination.
-In vivo exposure is more effective, when practical.
-Anxiety hierarchies
>client rank-orders feared situations.
>Then moves from the bottom to the top.
>Always try to end sessions with a success e
experience, so if client cannot tolerate exposure,
move to a less frightening situation.

Question 7

Contingency contracting

Answer 7

-Behavior therapy
-Ex: behavior chart
-Step 1: set goal – not too hard, not too easy
-Step 2: Obtain reward menu from the child.
-Step 3: Figure out the exchange rate.