Theories Flashcards
Narrative therapy theory of change
Theory-separating patient from the problem and creating a new narrative or story which emphasizes client’s strengths.
Narrative therapy role of the therapist
Collaborator
Investigator
Co- author
Views client as expert on their own lives
Takes individuals culture into account ; SO, gender religion
Narrative therapy treatment goals
De-construct problem saturated stories in order to create more helpful stories
Re-authoring the story- having a new story emerge
Narrative therapy interventions
Externalizing the problem
Social constructivism
Deconstructive questions
Mapping the influence - detailed description of the problems effect on the person
Identifying unique outcomes - times in clients life when they have been able to resist the influence of the problem.
Enlisting a witness
Writing a letter to self or others to reauthor the story
Narrative therapy Phases of treatment
Beginning - client is invited to tell their problem saturated stories ( reason for treatment)
Middle- the problem is externaliZed . Mapping the influence / effects of the problem, identify explore unique outcomes - reauthor story, enlist witness
End phase -document and support new story , write a letter to self or other.
Post modern therapies
Narrative therapy
Solution focused therapy
Solution focused theory of change
Change occurs through accessing clients strengths and resources - emphasizes finding solutions to a problem , not on discovering the cause or origins of the problem .
Solution focused Therapist’s role
Therapist is a consultant , coach
Solution focused treatment goals
Client implements small and large changes to achieve their preferred future
Client builds on current strengths and resources
Solution focused interventions
Miracle questioning
Scaling questions - client is asked to rate problem on scale and ask how they would move up and down the scale
Presupposing change - asking questions focusing on progress
Coping questions- how have you coped?
Affirmations/ compliments - affirming how hard it is for the client to even come to therapy for example .
Solution focused phases of treatment
Beginning - join with client competencies, envision preferred future , begin to identify clients strengths , use solution oriented language ; come up with achieveable goals
Middle - identify strengths, resources and traits client has already used to deal with problem, utilize solution talk, identify exceptions to problems , utilize scaling questions to reflect on change, compliment client / cheerlead.
End- assist client to maintain change, identify hurdles or perceived Barriers.
What does a systems therapist do?
A systems therapist looks at the client in the context of the system (the family and culture).
Systems therapies- What does homeostasis mean?
Homeostasis is a family’s predictable pattern of function . Often times the symptom is supported by families homeostasis. When interventions are introduced there is going to be a stage of disequilibrium until family finds a new homeostasis.
Systems- Bowen therapy- what is the theory of change?
Change occurs by understanding multigenerational dynamics and increasing differentiation.
Bowen ( systems) family therapy- therapists role?
Coach / educator - on how problems have been transmitted.
Supervisor
Investigator - of dynamics
Neutral - not taking sides- making members talk directly to each other.
Bowen (systems) family therapy; treatment goals
Reduce anxiety ( anxiety / tension when family is in crisis) heightened arousal due to family problem
Self differentiation
Decrease emotional fusion - family members have different feelings
Bowen ( systems ) therapy; key concepts
Triangles
Differentiation of self - seeing yourself as a distinct other with different thoughts and emotions
Nuclear family emotional system - one persons emotional state affects others in the family
Family projection process - how parents project their emotional problems onto a child
Multigenerational transmission process- differences in differentiation over time
Emotional cutoff - cutting someone off from family due to u resolved emotional issues.
Genogram - assessment and treatment tool- family graph
Bowen ( systems ) family therapy interventions
Therapist has a non anxious secure presence
Reframing
Genogram
De-triangulation
Increasing differentiation
Teaching I statements
Opening cut off relationships
Interrupting arguments / escalation
Therapist models new ways to communicate and interact
Bibliotherapy- assigning reading material
Bowen phases of treatment
Beginning - create genogram of emotional connections , differentiation , triangulation , and identify any dysfunctional patterns.
Early/ middle - teach and model differentiation through communication skill building , detriangulation , encourage reunification from cutoff fam members , teach fam how to take responsibility for their feelings and thoughts
End - review new skills and progress. Overview of family projection process and when to use new skills learned - i statements , differentiate.
Strategic therapy ( systems ) theory of change
Change occurs through action oriented directives and paradoxical interventions .
Strategic therapy - role of therapist
Delivers directives that facilitate change , particularly around patterns of communication
Focused on solving problem / eliminating symptoms
Designs a specific approach for each persons presenting problems.
Strategic therapy interventions
Paradoxical directives - ( prescribing the symptom) maneuvers that are in apparent contradiction to the goals of therapy- gives client control.
Positioning - therapist takes more exaggerated view
Homework- directives to change dynamics
Prescribing symptom- therapist tells them to enact the symptom/ problem
Restraining - discourage change to quickly to facilitate faster change
Ordeals - unpleasant tasks assigned when symptoms occur
Strategic phases of treatment
Beginning - define the problem , state goals , and what would be the signs of change
Middle- review attempted solutions , assign ordeals , prescribe problem , relabel behavior , instruct the client to respond to the problem in a new way .
End -plan for maintenance of new behavior , plan for future challenges , emphasize positive changes made.
Structural family therapy (systems) theory of change
Change occurs through restoring the families organization
Structural family therapy; therapists role
Therapist is actively involved
Joins the families culture using their language
Like the “friendly uncle”
Helps family understand how structure can be changed
Structural fam therapy treatment goals
Restructure fam system to allow for symptom relief and problem solving
Change dysfunctional transactional patterns and create new ways of relating
Help create flexible boundaries
Structural fam therapy Primary concepts
Family maps
Alliances
Coalitions -
Hierarchy - leadership and direction provided by the adults
Subsystems -families organize themselves by generation , relationship and necessity; example- parent subsystem…. etc.
disengaged boundaries - fam members are isolated for one another can lead to AOD use as well as rigid boundaries.
Enmeshed boundaries - overly dependent and too closely involved.
Joining - therapists first task , involves blending in with the family , adapting the family’s affect style , and language .
Tracking - therapist pays attention to how family’s interact ; boundaries , roles , coalitions..
Mimesis- therapist tracks family’s style of communication and uses it
Unbalancing supporting someone who is in a one down position thus changing hiercarchal position.
Structural fam therapy phases of treatment
Beginning -join with family , accommodate and challenge rules of family system , assessment / mapping of family hierarchy, alignments , boundaries, reframing of problem to include the whole systems problem.
Middle -highlight and modify interactions , utilize enactment of issues to challenge participants and unbalance system .
End - review progress made , reinforce structural change , provide tools for future.
Satir communicAtions therapy /Satirian therapist / communications therapist
Theory of change
Change happens through self awareness and improved communication. Humanistic systems approach. Very growth oriented.
Satir communications therapy
Role of therapist
Active facilitator
Resource detective - looking for untapped strengths and family’s uniqueness
Therapist is genuine and warm- idea of being congruent
Honest and direct
Satir communicAtions treatment goals
Goal is to increase congruent communication , improved self - esteem / confidence , and personal growth
Satir communicAtions
Key concepts
Incongruent communication: discrepancies between verbal and nonverbal cues.
Styles of communication
Dysfunctional styles ; placater, blamer, computer , distracter.
Family life chronology - fam history - idealist , values , rules , disruptions , moves and major events . How events are carried out presently.
Satir communicAtions
Interventions
Modeling communication - I statements , express feelings directly, be honest.
Family sculpting - put people into a spatial metaphor to represent family member characterizations
Take responsibility - encouraging clients to take responsibility for how they feel , therapist will point out sarcastic comments
Metaphors and story telling - to understand their roles
Transforming roles -
Satir communicAtions
Phases of treatment
Beginning - establish rapport , sense of equality and hope. Assess communications patterns, stances and concerns , identify tx goals , family life chronology.
Middle- increase fam congruent communication , support and strengthen each persons individual sense of uniqueness and self - esteem.
End - help family practice , implement , and integrate changes and increase awareness of larger familial patterns.
Psychodynamic approaches
Which are they?
Object relations Self psychology Adlerian therapy Depth psychology Attachment based therapy
What is the psychodynamic approach
People have unconscious motivations , drives , and processes that impact how they function. These are constructed by early childhood caregiving dynamics. Therapeutic relationship is a tool for therapy.
Object relations psychodynamic
Theory of change
Change occurs through both reparative experiences within the treatment relationship and from new insight into and modification of entrenched object relations pathology.
Object relations
Role of therapist
Neutral
Emphasis on transference and countertransference
Therapist as a new and good object
Object relations
Treatment goals
Providing reparative experiences and building new internal structures
Gaining insight to how past relationships impact clients functioning - changing past object relations pathology
Improving relationships with self and others
Object relations
Key concepts
Objects : refers to persons in the external world individuals seek objects ( others) from birth
Internalization: early infant caretaker interactions lead to the person internalizing basic attitudes towards self and others
Self and object representations - infants form images of themselves and others - these become internal structures
Ego- the structure responsible for dealing with the world , for instituting defense mechanisms , for internalizing external objects and for integrating and synthesizing self and object representations.
Splitting - when two contradictory states are compartmentalized and not integrated. Such as love and hate. Two extreme views of people.
Projection- projecting undesirable feelings or emotions onto someone else, rather than admitting to or dealing with unwanted feelings.
Projective identification-refers to psychological process where someone projects a thought or belief onto someone else- and that person will begin to behave as though he is in fact actually characterized by that thought or belief .
Interjection- subject replicates behaviors attributes from their world including from people. Aggression from little boy who watches dad perpetrate dv.
Object relations
Phases of treatment
Beginning - establish a holding environment , build rapport and therapeutic alliance through listening and exploration of clients experience, empathy and neutrality.
Middle- promote insight and growth through interpretation. Confront resistance and primitive defense mechanisms , focus on transference / countertransference dynamic, identify and process projective iD
End - work through termination and abandonment issues. Consolidate interpretations. Review insights gained in therapy.
Self psychology
Theory of change
Change occurs through empathic attunement and strengthening self structures through optimal responsiveness . Re -parenting of the client.
Self psychology
Role of therapist
Emphasis on empathic understanding
Optimal responsiveness
Allows emergence of self object transference and repair of disruptions
Self psychology
Tx goals
Developing self cohesion and self esteem
Being more in touch with themselves
Locating better self objects
Key concepts
Self - objects - early caretakers
Self object needs - mirroring , idealization of others , twin / alter ego
Mirroring - approving and confirming responses
Optimal frustration - self object is needed but not accessible - potential problem
Mirroring transference - the patient seeks acceptance from therapist of the self
Twinship transference - patient sees himself like therapist . Feels validating
Idealizing transference - patient looks up and admires therapist ( good thing)
Adversarial transference - a therapist that they can disagree with in order to grow and still be safe.
Experience - near empathy- therapist steps into clients shoes and imagines what it’s like - body sensations - mirrors it back to them.
Self psychology
Tx interventions
Establish holding environment
Provide experience near empathy
Repair disruptions of self object transference
Addressing enactments
Empathizinf with losses and blows to self
Mourning loss of self objects
Self psychology
Phases of tx
Early - establish holding environment where therapist is able to provide containment. Provide experience near empathyS. Explore clients problem and history.
Middle - repair disruptions of self object transference , address enactments , empathizing with losses and blows to self , mourning loss of self objects , mourning ambitions and fantasies , identify alternative self objects .
End - reflect on tx process, acknowledge and process issues related to termination.
Adlerian therapy
Theory of change
Occurs by increasing clients self -awareness and challenging and modifying his or her fundamental premises , life goals , and basic concepts.
Adlerian therapy
Role of therapist
Accepting Encouraging Respectful Optimistic Co- thinker Relationship is collaborative and built on trust
Adlerian treatment goals
Challenge clients basic premises and life goals
Develop socially useful goals and increase social interests
Believes that therapist should help clients incr see social interest and become a bigger part of the community. Adlerian is the only theorist that has this as tx goal.
Increase sense of belonging
Parenting goals- if children are acting out it’s because they feel like they don’t belong
Adlerian therapy
Primary concepts
Altruism- people who practice report higher levels of happiness
Inferiority- inferiority feelings are always present as a motivating force in behavior . Adler proposed that inferiority feelings are the source of all human striving . Individual growth results from compensation , from our attempts to overcome our real or imagined inferiorities.
Early recollection- used as an assessment tool. Stories of events before age 10. Include what client thought and felt at that time.
Family constellation- ecploration of fam atmosphere and relational dynamics that prevailed when young .
Lifestyle assessment - identifying through a questionnaire or clinical interview what clients underlying goals are- through early recollections.
Social context - widened view that problems were not simply intrapsychic and incorporated the notion that the social context of persons lifestyle contributed as well .
Social interest - therapeutic goal was to develop social interest where client had genuine feelings of empathy for others instead of a need to conquer their feelings of inferiority.
Adlerian therapy
Interventions
Dream interpretation - Adler considered dreams as an open pathway to true thoughts emotions and actions. Dreams enable us to see our aggressive impulses and actions
Summary- shares result of assessments as a narrative that is discussed with client
Role playing - middle stages of therapy . Practice new behavior
Guided imagery- change negative imprints form childhood.
Encouragement - helping client build courage. Becoming aware of strengths and feeling more connected towards other. Not focusing on problem
.
Adlerian
Phases of tx
Beginning - establish relationship , make contact before problem , become aware of assets and strengths ; completes lifestyle assessment and family constellations . Summary is shared with client. Focus on dynamics that may have influenced sense of self , inferiority and the world.
Middle - encourage self understanding and insight through interpretation. Overcome feelings of insecurity through therapists optimism, collaborate to increase social connectedness.
End -putting insights into practice . Encouraging clients to take risks with new bx to act as if they are the people they want to be .
