Theories Flashcards
CBT Change occurs through…
Learning to modify dysfunctional thought patterns
CBT Role of Therapist
Collaborative teacher using structured learning experiences, teach coping skills, provides homework
CBT Treatment Goals
Recognize negative thought patterns, replace them with healthier ways of thinking, symptoms/problems are relieved, develop coping skills
CBT Negative Cognitive Triad
- View of self 2. View of the world 3. View of future
CBT Automatic Thoughts
Thoughts that individuals are often not aware of and are not assessed for accuracy
CBT Schemas
Network of rules for information processing that are shaped by developmental influences and other life experiences
These rules dictate how individuals think about and interpret the world and play a role run self-worth and coping skills
CHANGING SCHEMAS = MAJOR TARGET OF CBT
CBT Interventions
Psychoed on negative triad
Socratic questioning
Reframing
Cognitive restructuring
Homework
Self-monitoring
Behavioral experiments
Systematic desensitization
Anxiety management training
Assertiveness training
Behavioral activation
Communication skills training
Downward arrow
Exposure
Finding alternatives
Labeling distortions
Mastery/pleasure ratings
Opposite action
Problem-solving training
Relaxation training
Successive approximation
Three-column technique
Thought record
CBT Beginning Phase
Therapeutic relationship, functional analysis to assess/define the problem and negative thought patterns, educate and explain CBT, set collaborative goals
CBT Early/Middle Phase
Identify negative thought patterns, uncover negative schemas, assign homework to self-monitor, label cognitive distortions, reframe thoughts, learn/practice new skills
CBT End Phase
Review gains, identify skills learned, rehearse for new situations, anticipate future struggles
CBT Sub Modalities
CBT
Rational Emotive Behavior Therapy (REBT)
DBT
Reality Therapy
REBT Changes occurs through…
Changing irrational beliefs to rational beliefs
REBT Role of Therapist
Instructor, confrontational, direct
REBT Tx Goals
Help clients alter illogical beliefs and thinking patterns in order to overcome psychological problems and mental distress
REBT ABC
A = Activating event
B = Beliefs
C = Consequences
REBT Main Concepts
ABC
Common irrational beliefs
Self-acceptance
Other-acceptance
Life-acceptance
REBT Beginning Phase
Psychoed about REBT, identify underlying irrational thought patterns/beliefs and resulting feelings and Bx
REBT Middle Phase
Challenge mistaken beliefs, dispute using direct and confrontational methods, change unwanted Bx using meditation, journaling, guided imagery, etc.
DBT Change occurs through…
Mindfulness, developing skills to manage distress tolerance and emotion regulation, improving interpersonal problem-solving skills
DBT Role of Therapist
Ally, validation, offer alternatives, coach
DBT Tx Goals
Improve emotional and cognitive regulation
DBT Interventions
Mindfulness
Distress tolerance
Interpersonal effectiveness
Emotion regulation
Homework
DBT Beginning Phase
Move client from being out of control to achieving behavioral control, teach mindfulness and distress tolerance skills, address self-harm Bx
DBT Middle Phase
Fuller emotional experience, support client to learn to live, define life goals, build self-respect, find peace and happiness
DBT End Phase
Finding deeper meaning through spiritual experience
REALITY Change occurs through…
identifying and meeting needs, satisfying relationships
REALITY Role of therapist
nurturing/supportive/nonjudgmental
- patient coach
REALITY Key concepts
choice: sense of control, empowerment, responsibility
we all have 5 needs: love/belonging, power/achievement, freedom, fun/relaxation, survival
all behavior is seeking to have needs met
act irresponsibly when imbalanced/needs unmet
REALITY Interventions
self-evaluation
focus on present choices, avoid past problems
explore wants, needs, perceptions (not feelings)
action plans
humor
CLIENT/PERSON-CENTERED Change occurs through…
Creating conditions for Ct to grow through therapeutic relationship with presence of congruence/genuineness, unconditional positive regard, empathy
HUMANISTIC
CLIENT/PERSON-CENTERED Role of therapist
Nondirective
Helper who sets the stage and believes Ct is able to do what is necessary for growth and self-actualization
Ct determines goals of therapy
CLIENT/PERSON-CENTERED Tx Goals
Self-acceptance
Congruent between Ct’s idealized and actual selves
Increased self-understanding
Decreased levels of defensiveness, insecurity, guilt
More positive relationships and increased comfort with others
Increased ability to experience and express feelings in here and now
CLIENT/PERSON-CENTERED Key Concepts
Congruence (Th’s genuineness with Ct)
Unconditional positive regard
Empathy
Self-actualization
Locus of control
Non-directive therapy (Ct can lead discussion)
GESTALT Change occurs through…
Increased awareness of here and now experience
BOTH EXPERIENTIAL AND HUMANISTIC
GESTALT Role of Therapist
Authentic and present other
Non directive and non judgmental
Increase Ct awareness of present moment
GESTALT Tx Goals
Ct to become aware of what they are doing, how they’re doing it, how they can change themselves, and learn to accept themselves
GESTALT Key Concepts
Phenomenological method (Explore experience and abstain from interpretation)
Dialogical relationship (Th presence allows Ct to become fully present)
Experiential
Here-and-now focus
GESTALT Interventions
Empty chair
Experiments
Body techniques
Focus on the process
EXISTENTIAL Change occurs through…
Finding philosophical meaning in face of anxiety by choosing to think/act authentically and responsibly
EXISTENTIAL Role of Therapist
Provide encounter with “real” other
Presence
Help Ct focus on personal responsibility for making decisions
EXISTENTIAL Tx Goals
Ct discovers own life meaning, confronts anxiety inherent in living, experiences agency and responsibility in construction of their life
EXISTENTIAL Key Concepts
Self-awareness
Accept RESPONSIBILITY that comes with FREEDOM
Unique identity
Meaning of life is never fixed
ANXIETY is part of human condition
Death is basic human condition that gives significance to life
EXISTENTIAL Interventions
Focus on moment to moment process
Empathic availability
Process situation with increased support
Honoring the pain
EXPERIENTIAL/SYMBOLIC Change occurs through…
Authentic meeting of Th and Ct in present moment by expanding Ct’s range of experiences
EXPERIENTIAL/SYMBOLIC Role of Therapist
Authentic, playful, creative
EXPERIENTIAL/SYMBOLIC Tx Goals
Growth and increased flexibility
EXPERIENTIAL/SYMBOLIC Interventions
Battle for structure (Th establishes rules and atmosphere of Tx; includes need for entire family to be in therapy)
Battle for initiative (Motivation for change must come from family)
Trial of labor
Activating constructive anxiety
Play, humor, craziness
EXPERIENTIAL/SYMBOLIC Beginning Phase
Engage family as authentic people, battle for structure, all members to attend, family wins battle of initiative, gather info about boundaries/coalitions/roles/level of conflict
EXPERIENTIAL/SYMBOLIC Middle Phase
Develop sense of cohesion, create alternative interactions, highlight inappropriate boundaries, role-play situations, use play and craziness
EXPERIENTIAL/SYMBOLIC End Phase
Highlight accomplishments, identify possible blocks, role-play future scenarios, each member expresses feelings about experience of therapy
NARRATIVE Change occurs through…
Separating person from the problem and creating new narrative that emphasizes competencies and strengths
NARRATIVE Role of therapist
Collaborator
Investigator
Ct as expert
Co-author
NARRATIVE Tx Goals
Understand problem-saturated story and externalize problem
Deconstruct problem-saturated stories and create healthier narratives
Awareness of Ct strengths
Increase sense of control over direction of life
NARRATIVE Main Concepts
Problem-saturated stories
Alternate stories
Thick story (Dominant narrative)
Thin story (Alternate story)
Externalizing the problem
Deconstructive questions
Mapping the influence (Effects of problem in Ct’s life)
Unique outcomes
Enlisting a witness
Written artifact
NARRATIVE Interventions
Ct shares problem-saturated story
Externalizing questions
Map the influence
Explore unique outcomes
Assist Ct in re-authoring
Enlist a witness to hear new story
NARRATIVE Beginning Phase
Ct is invited to tell problem-saturated stories
NARRATIVE Early/Middle Phase
Problem is externalized, map the influence, identify unique outcomes, re-author story, enlist witness
NARRATIVE End Phase
Written artifacts, document new narrative, write letters to self/others
SOLUTION-FOCUSED Change occurs through…
Accessing Ct’s strengths and resources, emphasizes finding solutions to problem
SOLUTION-FOCUSED Role of Therapist
Consultant/Coach
SOLUTION-FOCUSED Tx Goals
Ct implements small and large changes
Ct builds on current strengths and resources
SOLUTION-FOCUSED Interventions
Exception questioning
Miracle questioning
Scaling questions
Presupposing change (“What’s different/better since the last time we met?”)
Coping questions
Affirmations/compliments
SOLUTION-FOCUSED Beginning Phase
Join w Ct competencies, envision preferred future, identify Ct strengths, solution-oriented language, achievable goals
SOLUTION-FOCUSED Middle Phase
Identify strengths/resources, exceptions to problem, scaling questions, feedback and compliments, highlight small changes
SOLUTION-FOCUSED End Phase
Identify things they can do to continue change, identify hurdles that could get in the way
PSYCHODYNAMIC Change occurs through…
Insight and understanding of early, unresolved issues
PSYCHODYNAMIC Role of Therapist
Nondirective
Holding environment for Ct to develop secure attachment
PSYCHODYNAMIC Main Concepts
Past influences present
Underlying conflicts
Defense mechanisms
Transference
Countertransference
Interpretation
PSYCHODYNAMIC Tx Goals
Uncover/interpret unconscious impulses and defenses
Examine Ct self-awareness and understanding of influence of past to present Bx
Enhance Ct’s ego strength
Decrease unhealthy defense mechanisms
Allow Ct to access painful feelings in safe environment
Examine early relationships, attachments, interactions to discover issues from FOO projected in current relationships
PSYCHODYNAMIC Interventions
Establish holding environment
Observe/reflect ways Ct projects previous object relationships into therapeutic interactions
Th points out Ct patterns of distortion and manipulation to maintain relationships
Avoid being pulled into Ct maladaptive patterns (countertransference)
Identify/resolve underlying causes of internal and relational conflict
Interpret transference
PSYCHODYNAMIC Assessment
Early development as decisive factor influencing later development
Past and unconscious
Ct asked to identify thoughts/feelings re events in past
PSYCHODYNAMIC Beginning Phase
Establish holding environment, rapport/therapeutic alliance through listening, explore Ct experience, empathy, interpretation, neutrality
PSYCHODYNAMIC Early/Middle Phase
Promote insight/growth, increase individuation, work through termination/abandonment issues
PSYCHODYNAMIC End Phase
Terminate therapy when Ct is able to put new insights into action
OBJECTS RELATIONS Change occurs through…
Both reparative experiences within Tx relationship and from new insight into entrenched object relations pathology
OBJECTS RELATIONS Role of Therapist
Neutral
Emphasis on transference/countertransference
New and good object
OBJECTS RELATIONS Tx Goals
Provide reparative experience
Build new internal structures
Gain insight into how past relationships impact Ct functioning
Improve relationship with self/others
OBJECTS RELATIONS Key Concepts
Objects
Internalization
Self and object representations
Ego
Splitting
Projection
Projective identification
Introjection (Subject replicates in themselves Bx, attributes, etc. in surrounding world, especially of others people)
OBJECTS RELATIONS Beginning Phase
Establish holding environment, rapport/therapeutic alliance through listening, explore Ct experience, empathy, neutrality
OBJECTS RELATIONS Middle Phase
Promote insight/growth through interpretation, confront resistance and defense mechanisms, transference/countertransference, identify and process projective identification
OBJECTS RELATIONS End Phase
Work through termination and abandonment issues, consolidate interpretations, review insights gained
SELF PSYCHOLOGY Change occurs through…
Empathetic attunement and strengthening self structures through optimal responsiveness
SELF PSYCHOLOGY Role of Therapist
Empathetic understanding
Optimal responsiveness
Allows self-object transference and repair of disruptions
SELF PSYCHOLOGY Tx Goals
Develop self-cohesion and self-esteem
Locating better self objects
SELF PSYCHOLOGY Key Concepts
Self-Objects (Attuned caretakers)
Self-Object needs (Mirroring, idealization of others, twin/alter ego)
Mirroring (Approving/confirming responses)
Optimal frustration
Mirroring transference (Ct seeks acceptance/confirmation of self)
Twinship transferece (Ct experiences Th as someone like themselves)
Idealizing transference (Ct looks up to Th)
Adversarial transference (Need for supportive relationship that Ct can oppose in order to grow)
Experience-near empathy (Th steps into Ct shoes)
SELF PSYCHOLOGY Early Phase
Establish holding environment, demonstrate Th is able to provide containment, provide experience-near empathy, explore Ct’s problem/Hx
SELF PSYCHOLOGY Middle Phase
Repair disruptions of self-object transference, addressing enactments, empathizing with losses, mourning loss of self-objects, mourning ambitions/fantasies, identify alternative self-objects
SELF PSYCHOLOGY End Phase
Reflect on Tx process, acknowledge and process issues related to termination
ATTACHMENT-BASED Change occurs through…
Exploration of past and current relational attachments and trauma in environment of healing, secure, and reliable relationship
ATTACHMENT-BASED Role of Therapist
Secure base
Accepting, caring, non judgmental
Safe to explore emotional experiences
ATTACHMENT-BASED Tx Goals
Awareness of Ct’s problematic Bx and emotional patterns formed in childhood as attempts to maintain attachment to primary caregivers
Repair capacity to regulate affects
Resolve emotional or social disruptions in Ct’s life
Improve quality of attachment with others
ATTACHMENT-BASED Key Concepts
Attachment Bx system
Secure attachment
Anxious-preoccupied
Dismissive-avoidant
Fearful-avoidant
ATTACHMENT-BASED Beginning Phase
Attunement, empathy, collaboratively identify Ct’s attachment style
ATTACHMENT-BASED Middle Phase
Disruptions explored (past and current), support Ct ability to regulate and express emotions, teach Ct to have reflective stance towards themselves
ATTACHMENT-BASED End Phase
Repair, sharing subjective interpretation, create new reality of painful events for Ct in order to get rid of unwanted emotions and reactions
GENERAL SYSTEMS Change occurs through…
Helping system view problem in context of family rather than individual
Family system becomes focal point of therapeutic interventions
GENERAL SYSTEMS Role of Therapist
Explore:
Belief systems/values
Rules and roles
Hierarchy
Expectations
Defense mechanisms
GENERAL SYSTEMS Tx Goals
Move system towards equilibrium
Assist fam in exploring healthier interactions to decrease dysfunctional patterns
Help family challenge beliefs
Assist individual fam members in seeing their role
Increase fam member’s ability to understand different experiences/perceptions of others
Assist in correcting unhealthy feedback loops
GENERAL SYSTEMS Main Concepts
Homeostasis (System resists change)
Negative feedback (Bx reactions that corrects against change and returns to previous state of homeostasis)
Positive feedback (Bx reactions that allows system to adapt to change but initially is destabilizing)
Calibration
Wholeness
Equifinality (Same results accomplished by diff fam systems)
Equipotentiality (Same experience in fam system can end with various results later in life)
First order change (Surface level and temporary)
Second order change (Deeper level and alter system’s rules/organization)
Nonsummativity (Fam system treated as whole)
Boundaries (Open vs. closed)
GENERAL SYSTEMS Interventions
Observe feedback loops
Explore fam structure/circular causality
Reframe presenting issues as system rather than pathologizing one person
Explore each member’s role in dysfunction
Challenge communication
BOWEN Change occurs through…
Understanding multigenerational dynamics and differences
BOWEN Role of Therapist
Coach/educator
Supervisor
Investigator
Neutral
BOWEN Tx Goals
Reduce anxiety in fam system
Self-differentiation
Decrease emotional fusion
Improve communication skills
Decrease recurrence of dysfunctional patterns
Reduce emotional reactivity
Facilitate de-triangulation
BOWEN Key Concepts
Triangles
Differentiation of self
Nuclear family emotional system
Family projection process (Parents transmit emotional problems to child)
Multigenerational transmission process (Families pass down emotional attachment/level of emotional expression)
Emotional cutoff (People managing unresolved emotional issues by reducing emotional contact w them)
Genogram
BOWEN Interventions
Reduce emotional reactivity by talking TO THERAPIST
Reframing (Problem as multigenerational vs. individual)
Genogram
De-triangulation (Th as part of healthy triangle)
Increasing differentiation
Teach I Statements
Interact/interrupt family (Conflict is prohibited)
Models
Bibliotherapy (Th as educator)
BOWEN Beginning Phase
Family diagram of multigenerational emotional connections, assess levels of differentiation and triangulation, identify dysfunctional patterns passed through generations
BOWEN Early/Middle Phase
Teach/model differentiation through communication skills, de-triangulation, reunification from cutoff fam members, teach fam how to take responsibility for feelings/thoughts
BOWEN End Phase
Review new skills and knowledge gained
STRATEGIC Change occurs through…
Action-oriented directives and paradoxical interventions
STRATEGIC Role of Therapist
Deliver directives
Focus on solving problem/eliminating Sxs
Design specific approach for each person’s presenting problem
STRATEGIC Tx Goals
Solve presenting problems
Change dysfunctional patterns
STRATEGIC Interventions
Paradoxical directives (Contradict goal of therapy)
Positioning (Th takes exaggerated view of problem)
Homework
Prescribing the symptom
Restraining (Th discourages change)
Ordeals (Sxs prescription where Ct carries out unpleasant tasks when Sxs occur)
STRATEGIC Beginning Phase
Define problem, determine how Ct understands problem, assess destructive patterns, state goals and what Bx need to change
STRATEGIC Middle Phase
Review attempted solutions, assign ordeals, prescribe problem, relabel Bx, instruct Ct to respond to problem in new way
STRATEGIC End Phase
Plan for maintenance of new Bx, plan for future challenges, emphasize positive changes made
STRUCTURAL Change occurs through…
Restructuring family’s organization
STRUCTURAL Role of Therapist
Active and involved
Friendly uncle
Help fam understand how fam structure can be changed
STRUCTURAL Tx Goals
Restructure fam system to allow for Sxs relief and constructive problem solving
Change dysfunctional patterns
Create new ways of relating
Flexible boundaries
STRUCTURAL Main Concepts
Alliances
Coalition (2+ against another member)
Hierarchy
Subsystems
Family map
Disengaged boundaries
Enmeshed boundaries
STRUCTURAL Interventions
Joining
Tracking
Mimesis (Uses fam communication)
Unbalancing (Support someone in one-down position)
Reframe
Enactment
Boundary making
STRUCTURAL Beginning Phase
Join, challenge rules of system, assessment/mapping of hierarchy, alignments, and boundaries, reframe problem to include whole system
STRUCTURAL Middle Phase
Highlight and modify interactions, utilize enactments to challenge members and unbalance system
STRUCTURAL End Phase
Review progress, reinforce structural change, provide tools for future
SATIR COMMUNICATIONS Change occurs through…
Self-awareness and improved communication
HUMANISTIC
SATIR COMMUNICATIONS Role of Therapist
Active facilitator
Resource detective
Genuine/warm
Honest/direct
SATIR COMMUNICATIONS Tx Goals
Increase congruent communication
Improve self-esteem/confidence/personal growth
SATIR COMMUNICATIONS Interventions
Incongruent communication (verbal vs. nonverbal)
Styles of communication
Placater (Pleasing)
Blamer (Attacking)
Computer (Intellectual/correct)
Distracter (Acting out)
Leveler (Congruent)
Modeling communication (I statements)
Family life chronology
Family sculpting
Take responsibility
Metaphors and storytelling
Transforming rules
SATIR COMMUNICATIONS Beginning Phase
Rapport, sense of equality/hope, assess communication, identify Tx goals
SATIR COMMUNICATIONS Middle Phase
Increase fam congruent communication, support/strengthen individual uniqueness and self-esteem
SATIR COMMUNICATIONS End Phase
Help fam practice and implement changes, increase awareness of larger familial patterns
When individuals are undifferientiated they also tend to cut themselves off emotionally, or even geographically from their families of origin- what term is this as Bowen would describe?
Undifferentiated ego mass
When undifferentiated parents transmit their immaturity, or lack of differentiation to the children is what type of process by Bowen?
Family projection process
Bowen’s notion that all generations are part of a continuous natural process with each generation pressing up against the next. “past on from generation to generation”
Multigenerational transmission process
What happens within multigenerational transmission process -what is the notion?
That each subsequent generation tends to move towards a lower level of differentiation if unresolved emotional attachments and fusion are present.
Does Bowen’s model require the whole family to be present in treatment? What does it require?
NO; that the entire family gain an understanding of how the entire system operates across multiple generations
-“understanding not action is the vehicle of cure..”
MRI brief
Founders: Weakland, Don Jackson, Watzlawick
Concepts: communication theory; 1st & 2nd order change; feedback loops; focus on the presenting complaint; repetitive patterns of family interactions
Problem: attempts at solutions become the problem; circular causality; “more of the same” maintains problem
Change: goals are small and clear; altering patterns of behaviors; change in one part, leads to change in others
Therapist: active, process over content, therapist responsible for outcomes, consulting team w/ 1 way mirror*
Milan Systemic
Founder: Mara Palazzoli and others..
Concepts: new epistemology, allows new ways of interacting; positive connotation*; invariant prescription; homeostasis; change beliefs rather than behaviors
Problem: family caught in power game; problems maintained by interactional sequences; homeostasis resists attempts to change; old way of living, doesnt fit the new way
Change: develop new epistemology by delivering new information to the system
Therapist: observing teams; mixed gender dyads; neutrality; hypothesizing; circular questioning
EFT
Founder: Sue Johnson & Greenberg
Concepts: attachment theory; negative interaction cycle; core conflicts; primary and secondary emotions; dependence/ independence.
Problem: perceived danger and relational insecurity leads to reactive behaviors in a recursive pattern of negative interactions
Change: access primary emotions; change interactional patterns through new experiences; create secure attachments
Therapist: unconditional positive regard
Marital Schism
this term occurs when partners are preoccupied with their own problems, they don’t accommodate to each other’s roles, and compete for their childs affection, loyalty, and support-
can occur within the schizophrenia families
Marital Skew
this type of terms occurs when one partner is extremely controlling and the other submissive and dependent, distorts reality by pretending the family is normal
-schizophrenia study term
Double Bind Hypothesis
term that predicts that schizophrenia develops in a child when the child is repeatedly exposed to contradictory verbal and nonverbal messages from his/her parents and not allowed to comment on the contradictions
-study by bateson, Jackson, Hayley, and Weakland
