Theories Flashcards
Beginning: Engagement Phase - Being authentic self; building a trusting warm therapeutic
environment; battle for structure and battle for initiative; assessment of family roles and
structures.
Symbolic Experiential Therapy
Middle Phase - Redefining the presenting problem; focus on family efforts toward
growth; therapist is confrontational; engages in “therapy of the absurd” to disrupt the system
and elicit change.
Symbolic Experiential Therapy
Late Phase: Minimal family interventions are used here as the family becomes more able to
handle their problems in a spontaneous and effective manner.
Symbolic Experiential Therapy
End: Separation Phase - Treatment ends at this point. The family recognizes their ability to use
their own resources and assume greater responsibility for how they choose to live.
Acknowledgement between therapist and family of mutual interdependence and loss.
Symbolic Experiential
Communicate empathy and compassion toward the family.
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Playfully engage with all family members.
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Encourage family members to delve deeper into understanding their relationships.
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Discourage family members from placing blame for problems on one person.
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Symbolic Experiential Therapy
Provide feedback specifically designed to activate conflict/stress within the system.
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Redefine symptoms as attempts to move toward growth.
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Share authentic reactions to what family members express in sessions.
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Focus on the emotional process taking place in the therapeutic setting.
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Use stories and metaphors to help inspire clients toward a new perspective.
Symbolic Experiential Therapy
Treatment Goals
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Initial goal is to increase the family’s level of anxiety.
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Increase each family member’s understanding of their role in creating or perpetuating
the problem.
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Symbolic Experiential Therapy
Disrupt rigid patterns that exist in the family to allow for greater flexibility and room for
growth.
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Assist family in redefining symptoms as an effort for growth/change.
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Increase healthy boundaries between both family members and the family system and
others.
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Increase family’s sense of connectedness while also developing a sense of healthy
separation and autonomy.
Symbolic Experiential Therapy
organizational structure to include clear
boundaries and a proper family hierarchy.
Structural Family Therapy
Help the family understand how family structure (relationships and hierarchies) can be
changed.
● Help create clear and healthier boundaries.
● Strengthen the spousal subsystem and the family’s hierarchy.
● Restructure the family system to allow for symptom relief and constructive
problem-solving.
● Alter dysfunctional transactional patterns.
Structural Family Therapy
Beginning: Joining and accommodating; assess family interactions through use of family
mapping; learn about coalitions, subsystems, alliances; reframe presenting problems as a
function of the system.
Structural Family Therapy
Early/Middle: Highlight and modify interactions; utilize enactments of issues to challenge
participants and unbalance the system.
Structural Family Therapy
End: Review progress made; reinforce structural change; provide tools for future.
Structural Family Therapy
Role of the Therapist
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The therapist works collaboratively with the client and uses a goal-focused approach to
address the symptoms that the client presents
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The therapist creates structured sessions and frequently provides homework for clients
to work on between visits
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Focuses on relationship
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Demonstrates empathy
Cognitive Behavioral Therapy
Beginning: Establish safe and supportive therapeutic relationships; complete a functional
analysis to assess and define the problem and negative thought patterns; educate and explain
CBT; set collaborative goals.
CBT
Early / Middle: Identify negative thought patterns; uncover negative schemas; assign homework
to self-monitor thoughts, moods, and behaviors; label cognitive distortions; reframe thoughts;
learn and practice new skills and behaviors.
CBT
End: Review gains; identify skills learned; rehearse for new situations; anticipate future
struggles.
CBT
Treatment Goals
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Relieve symptoms or problems
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Cognitive Restructuring: Identify unrealistic automatic thoughts and change them to
create more positive and accurate schemas
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Modify maladaptive behaviors
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Develop positive coping skills and problem-solving strategies
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Change unhealthy schemas
CBT
Theory of Change
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Change occurs through accessing client’s already existing strengths and resources.
Solution Focused Therapy
Beginning: Envision preferred future; begin to identify client’s strengths; use solution-oriented
language; come up with achievable goals by using a miracle question; identify exceptions to
problems.
Solution Focused Therapy
Early/Middle: Identify strengths, resources, and traits the client already has used to deal with
problems; utilize solution-talk; utilize scaling questions to reflect on the nature of change the
client has experienced; feedback to clients that include compliments and tasks; catch and
highlight small changes.
Solution Focused Therapy
End: Assist the client to identify things they can do to continue the changes they have made;
identify hurdles or perceived barriers that could get in the way of maintaining the changes they
made.
Solution Focused Therapy
Humanistic, phenomenological approach.
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Process-oriented therapy that focuses on the client’s present moment experience of self,
family, and world.
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Individuals have an innate capacity for growth or self-actualization.
Gestalt
Change occurs through an increased awareness of the here-and-now experience.
Gestalt
Role of the therapist:
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Authentic other
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Active, with focus on the present moment
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Spontaneous and creative
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Dialogic relationship
Gestalt
Phenomenological Method: Recognizes the importance of understanding and focusing
on the client’s perception of reality.
Gestalt
Dialogic: The idea that a person develops in relationship to others. In therapy, the
relationship between client and therapist provides an environment in which the client can
grow and develop a healthier sense of self.
Gestalt
Paradoxical Theory of Change: When a person is able to accept things as they are, they
are then more willing and able to move toward change.
Gestalt
Treatment Goals:
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Increase awareness of the environment, being present in the moment, and knowing
oneself.
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Increase ability to regulate the whole being, including thoughts, feelings, emotions.
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Assume responsibility for one’s destiny and identity.
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Increase ability to integrate and accept all sides of oneself.
Gestalt
Behavioral reactions used by families that correct departures from the system’s normal state and return the system to its
previous state of homeostasis.
Negative Feedback
Behavioral reactions that amplify departures from the system’s normal state, which initially destabilizes the system and
eventually changes the family’s homeostasis.
Positive Feedback
A system’s tendency towards growth and change, it can change its form while maintaining balance. A result of positive feedback loops.
Morphogenesis
A system’s tendency towards maintaining its shape.
Morphostasis
Changes that occur in the family that are more surface level and
temporary. They do not affect the rules or organization of the system. These changes do
not try to get at the underlying cause of the issues, but are instead behavioral in nature.
These changes tend to be short-lived.
First Order Change
This is the notion that the whole system, all of the units combined, is greater than the sum of its parts. The interactions between the individuals have an effect on the system as a whole.
Wholeness
The belief that parts of a system connect with each other in an organized and consistent manner, and these connections give structure to the system.
Organization
The family system is treated as a whole and not just each individual family member.
Non-Summativity
Refers to a system that allows for the continuous flow of
information from outside the system.
Open System
Systems that maintain boundaries that cannot easily be crossed, they are impenetrable
Closed System
Systems that are too opened or too closed gradually break down and become more and more disorganized and dysfunctional.
Entropy
Refers to a systemic state that is balanced between both open
and closedness. Information can enter the system or be screened out when not appropriate or change occurs as needed.
Negative Entropy
Individual family members arrive at the same result although they began at different starting points.
Equifinality
In contrast to equifinality, this term refers to individual family members sharing the same experiences within the system, but ending up with various results later in life.
Equipotentiality
Beginning: Observes family interactions, feedback loops; reframe presenting issue as a systems issue, removing focus on identified patient; explore family structure, roles, and rules. Identify the presenting problem and how family members participate in co-creating it; create a genogram.
General Systems/ Cybernetics
Early/Middle: Challenge existing communication style; reinforce healthy boundaries, challenge
and restructure unhealthy boundaries; develop healthy rules and roles in family, help family members express their internal experiences, discuss balance between positive and negative feedback loops.
General Systems/ Cybernetics
Review and reinforce new skills and knowledge gained in therapy.
General Systems/ Cybernetics
-Interventions
Create a genogram
● Observe the feedback loops that occur within a family system.
● Explore the family’s:
○ Belief systems and family values
○ Rules and roles that are present in the family
○ The family hierarchy.
○ Expectations
○ Circular causality between members of the family
General Systems/ Cybernetics
-Interventions
● Reframe presenting issues as system issues rather than pathologizing one person’s
symptoms.
● Explore each family member’s role in dysfunctional interactions.
● Make process comments as opposed to focusing on content.
● Comment on individual family member’s perspectives.
● Challenge the communication that occurs within the system.
General Systems/ Cybernetics
Treatment Goals
● Assist the family in exploring and recognizing healthier interactions to decrease
dysfunctional family behaviors or patterns.
● Help the family challenge and rework their beliefs.
● Assist individual family members in seeing their role in any given dynamic.
General Systems/ Cybnernetics
● Increase each family member’s ability to understand the different experiences and
perceptions of others in the family.
● Assist in correcting problematic or unhealthy feedback loops.
● Help the family understand that the cause of issues are a result of parts or the whole
system participating in a particular dynamic.
● Help the family achieve negative entropy.
General Systems/ Cybernetics
Treatment Goals
. Increase relationship closeness
. Address conflict productively
. Build a life of shared meaning together
Gottman
Interventions
.Teaching couples about flooding and training them to take their pulse to decrease
conflict
.Training couples to take breaks when one of them becomes flooded
.Identifying dysfunctional patterns and teaching couples new behaviors.
.Have couples share things they appreciate about one another.
Gottman
Beginning: Joining and accommodating; assess family interactions through use of family
mapping; learn about coalitions, subsystems, alliances; reframe presenting problems as a
function of the system.
Structural Family Therapy
Early/Middle: Highlight and modify interactions; utilize enactments of issues to challenge
participants and unbalance the system.
Structural Family Therapy
End: Review progress made; reinforce structural change; provide tools for future.
Structural Family Therapy
Beginning: Maintain a not-knowing stance; explore client’s view of the problem and
obtain a detailed understanding of their views; identify and engage with the problem-organizing
system; collaboratively develop goals for treatment.
Collaborative Therapy
Early/Middle: Engage as conversational partner; utilize reflexive or inventive questions;
co-construct new meaning of the problem, new stories.
Collaborative Therapy
End: Once the therapeutic conversation no longer involves the problem, and/or the
client gains a sense of agency, termination is appropriate; reinforce the client’s new
meaning.
Collaborative Therapy
-Children who have a hard time building their vocabulary
-Reduced vocabulary
-“Me go park”
-Have a hard time with anything longer than. 5-word sentence
-Limited sentence structure
Language Disorder
-Stuttering
-Sound or syllable repeated
-Broken words
-Shows up in 0-5 yrs old
Child Onset Fluency Disorder
-Worrying about A NUMBER of things
-School, sports, home, peers, etc
-Physical symptoms: tension, problems sleeping, problems concentrating
-Physical sx here that you wouldn’t see in Separation Anxiety Disorder
-Sx have to be present in 6 mos in both children and adults.
Generalized Anxiety Disorder
-Sx present for at least 2 years
-Hypomanic state alternating with a low level Mild Depressive episode
-Hypomania alternating with an unspecified Depressive disorder
Cyclothimia
-Defining differences have to do with the timeline
-Sx up to 1 month
-Delusion
-Non bizarre delusion
-Bizarre delusion
-Hallucinations (visual or auditory)
-Disorganized speech
-Disorganized bx
-Negative sx (flat affect, quiet, don’t respond to discussion,
Brief Psychotic Disorder
Defining differences have to do with the timeline
-Sx between 1 month to 6 months
-Delusion
-Non bizarre delusion
-Bizarre delusion
Hallucinations (visual or auditory) Disorganized speech Disorganized bx
-Negative sx (flat affect, quiet, don’t
respond to discussion,
Schizophreniform Disorder
-Defining differences have to do with the timeline
-Sx up to 6 months
-Delusion
-Non bizarre delusion
-Bizarre delusion
-Hallucinations (visual or auditory)
-Disorganized speech
-Disorganized bx
-Negative sx (flat affect, quiet, don’t respond to discussion,
Schizophrenia
-Ego syntonic
-Lacking an interest in social relationships
-LONERS
-They don’t see a point in sharing time with others.
-Lack an interest in social relationships
-They have no interest in connecting with others.
-Very withdrawn but not with an awareness or longing to connect w/ others.
-They don’t have any belief or trust that connecting with anyone will help them.
-Common that they have flavors of depression due to isolation
-Isolates often
-Pervasive; over the course of someone’s life
Schizoid Personality Disorder
-Precursor to Schizophrenia
-Characterized by odd behavior or thinking
-These people are just a little bit off.
-Believe in aliens or talk about aliens
-Have ideas of reference
-They can have magical thinking (6th sense)
-Bizarre fantasies
-Odd thinking & speaking
-Can have suspiciousness or paranoid ideation
-They HAVEN’T crossed into a psychotic episode
People will be in this stage PRIOR to showing signs of Schizophrenia.
Schizotypal Personality Disorder
You HAVE to have a Psychotic episode
-They often times lack close friends because they are so odd
-Dress bizarrely
Schizophrenia
Self explanatory: come up w/ a preliminary diagnosis (they will never give me ALL the info, can’t definitely diagnosis anybody, but I can diagnosis preliminarily, meet the cx for the 1st time. When I walk away I may say ok this person has unspecified MDD or MDD). I might end up w/ MDD & unspecified MDD in the same answer - both is ok. KNOW my DSM section WELL).
1/6 Question Categories:
Diagnosis
-Easy, I’ll be asked to assess.
-Pick answers that GATHER information, NOT GIVE information but GATHER information. Providing psycho edu is NOT the answer, get HISTORY, complete depression or anxiety assessment tool.
-Answers tend to be wide, comprehensive & inclusive.
2/6 Question Categories: Clinical Assessment
-Anytime I have child abuse, elder dependent adult abuse, harm to self/ others, DV, substance use & severe medical issue these are crisis questions (I’m always looking out for these things!). Can I recognize these things & can I respond to the m adequately. Make sure I’m not under or overreacting. I need to make sure that I respond to the FACTS not the feeling. Pretend that the strategy I used is calling child protective services. The FACTS that I have. The only time when it’s ok to break up a unit of tx and NOT involve the entire unit. I need to respond to that crisis issue FIRST!
3/6 Question Categories: Crisis
-Most of the time it’ll ask me ETHICALLY/LEGALLY what should the thx do?
-Sometimes it’ll simply give me a purely ethical or legal situation & ask me how I’ll proceed.
-Gifts, dual rx, competency, subpoenas, insurance fraud.
-Make sure I’m matching what the info is in the vignette and what the question is asking!
-If it’s asking me legally what should the thx do, DON’T pick an ethical answer.
-If it asks me clinically what should the thx do, I need to have something clinically & legally.
4/6 Question Categories: Law & Ethics
-Tx plan or Tx Goal Questions
-Pick answer that deals w/ goals NOT interventions. Goals take several sessions to COMPLETE. DON’T pick intervention for Tx Planning Questions.
-Go WIDE, broad, inclusive & comprehensive.
-Come up w/ a tx plan that addresses ALL these things.
5/6 Question Categories: Treatment Planning
-Very clinical, in the room, immediate, in the next moment, pretending I’m w/ the cx in the room. Very clinical, present & immediate in my answer!.
Clinical situation. For tx questions, these questions exist to test my ability to connect w/ ppl! Meet w/ cx where they’re at! In a clinical sense. Connect w/ them.
6/6 Question Categories: Treatment-Clinical Question
-Ask myself what MUST be done, what MUST be the answer.
-If cx comes in w/ a bruise, extremely depressed, issues w/ step dad, giving away their possessions (I MUST assess for suicide in the answer).
-A question that doesn’t address the crisis IS NOT CORRECT.
Question Category: Crisis Question
-Most of the time, Law & Ethics questions will ask me legally or ethically BUT sometimes the scenario will reflect a legal situation (supboena, gifts, invited to wedding, boundary, dual rx, purely legal or ethical issue, signing paperwork!). I’ll know bc it’s a legal issue. Signing paperwork.
-Treatment interventions: clinical/ treatment. How should the therapist proceed? These are usually treatment or clinical. I’m not asked to clinically assess or evaluate for tx plan, legal or ethical.
Question Category: Law & Ethics
-Strategy to use in these: what is the next minute what I’ll say or do; very clinical & present moment focused! Acknoweldge, normalize, connect, validate
-Always in the room, clinical in nature, & immediate (first thing that comes out of my mouth).
-Connect to this feeling. Clinical situation (build safety, rapport).
Treatment-Planning Question
