Theories and Phases of Treatment Flashcards

Question

• EXISTENTIAL THERAPY  End

Answer 1

o (HUMANISTIC/EXISTENTIAL THERAPIES) | NO DISTINCT PHASES OF

Answer 2

``` (HUMANISTIC/EXISTENTIAL THERAPIES)  Beginning • Engage family as authentic person • Battle for structure • Encourage all members to attend • Family wins battle of initiative • Gather information about boundaries, coalitions, roles and level of conflict ```

Answer 3

``` (HUMANISTIC/EXISTENTIAL THERAPIES)  Middle • Develop sense of cohesion • Create alternative interactions, even in sessions (if you say a dismissive parent, identify that another person has a different perspective) • Highlight inappropriate boundaries • Role play situations • Use play and “craziness” ```

Answer 4

(HUMANISTIC/EXISTENTIAL THERAPIES)  End • Highlight accomplishments and reflect on growth • Identify possible block to future growth • Role play future scenarios • Each member expresses feelings about their experience of therapy

Answer 5

(POST MODERN THERAPIES) | • Client is invited to tell their Problem-Saturated Stories – the reason client is seeking therapy

Answer 6

``` (POST MODERN THERAPIES) • The problem is externalized • Mapping the influence/effects of the problem • Identify/explore unique outcomes • Re-author story • Enlist a witness ```

Answer 7

(POST MODERN THERAPIES) • Document and support new story • Write letter to self and others

Answer 8

``` (POST MODERN THERAPIES) • Join with client competencies • Envision preferred future • Begin to identify client’s strengths • Use solution-oriented language • Come up with achievable goals • For test, always answer with solutions • Ask the Miracle Question ```

Answer 9

(POST MODERN THERAPIES) • Identify strengths, resources and traits client already has used to deal with problem • Utilize solution-talk • Identify exceptions to problems • 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 • Compliments/Cheerleading

Answer 10

(POST MODERN THERAPIES) • Assist 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 the changes they made • Help anticipate bumps in the road

Answer 11

(PSYCHODYNAMIC THERAPIES) o MAIN IDEAS  Psychodynamic Theory focuses on insight connected to client past experiences and early childhood relationships  The interplay of client and therapist is important (transference and countertransference)  Psychodynamic approach is broad  Have the belief that people have unconscious motivations, drives, and processes and this impacts how they function  Look at unconscious process constructed by early childhood experiences, specifically with caregivers  When looking form this approach, you support client gaining insight to how they function in the world as it relates to early childhood experiences  Not just intellectual understanding but also the feelings and memories associated with self-understanding  Reliving past experiences with early caregivers  Staying with and exploring different situation form the past to what’s going on in current life (feeling neglected/not listened to)  The therapeutic relationship is the tool for healing  Countertransference and transference are important  Different emotional reactions to each client and vice versa  Focuses on interpretation (make meaning and make sense out of symbolism of language or play)

Answer 12

(PSYCHODYNAMIC THERAPIES) • Establish a holding environment • Build rapport and therapeutic alliance through listening, exploration of client’s experience, empathy, and maintaining neutrality • Create a safe environment • Make clear boundaries (time; functional boundaries) • Neutrality = still wanting to have a little distance between client (not much self-disclosure) ask them what it’s like to be in a relationship that’s a little lopsided

Answer 13

(PSYCHODYNAMIC THERAPIES) • Promote insight and growth through interpretation • Confront resistance and primitive defense mechanisms • Focus on transference/countertransference dynamic • Identify and process projective identification • Different levels of interpretation: o what’s going on with how they feel about others; imagine what client may have felt (ex: “my boss made me upset,” so, therapist puts words to what client may have experienced, for example, “dismissed”) o Another level of interpretation would be to link to past experiences (ex: early child hood experience) o Interpretation regarding therapist/client relationship (if client feels rejected by therapist); this is the most intense, so don’t do until there is a well-established relationship with client • Confront (does not mean confrontation, it means more so bring the clients awareness up)

Answer 14

(PSYCHODYNAMIC THERAPIES) • Work through termination and abandonment issues • Consolidate interpretations • Review insights gained in therapy • A lot of times people haven’t experienced proper terminations of relationships

Answer 15

(PSYCHODYNAMIC THERAPIES) • Establish a therapeutic holding environment • Demonstrate that the therapist is able to provide containment • If a client gets highly emotional, therapist can be a warm presence • Therapist won’t get flooded or anxious • Can tell therapist something and therapist can HOLD IT, calmly • Provide “experience-near” empathy (stay with where client is – “sounds like you’re really struggling with …”) • Don’t challenge right away • Explore client’s problem and history (early childhood and relationships)

Answer 16

(PSYCHODYNAMIC THERAPIES) • Repair disruptions of the self-object transference (repair problems between therapist/client) • Addressing enactments • Empathizing with losses and blows to self • Mourning loss of self-objects (loss of job, relationships, rejection, loss of not having a good mother, acceptance of loss and a sadness that’s allowed to happen, be able to cry for their young self) • Mourning ambitions and fantasies (a lot of times these ambitions came into being as a defense, okay to mourn) • Identify alternative self-objects (people they can talk to and be accepted by)

Answer 17

(PSYCHODYNAMIC THERAPIES) • Reflect on treatment process • Acknowledge and process issues related to termination • Put words to what experience is like to end that relationship • Intense feelings can come up around termination

Answer 18

(PSYCHODYNAMIC THERAPIES) • Invitation and exploration of material the client brings to therapy, including relational situations, dreams, experience, imaginings, fantasies etc.

Answer 19

(PSYCHODYNAMIC THERAPIES) • Placing client experience into a mythopoetic lens, looking at images, myth, story, imagination and archetypal patterns within the conscious and unconscious happenings of the client’s life • Looking for meaning by orienting one’s experience into the greater human story

Answer 20

(PSYCHODYNAMIC THERAPIES) • Integration of unconscious material often marked by acceptance of taboo subjects and previously discarded aspects of the personality (dark material) • Acknowledgement of self-awareness and inner wisdom • Acceptance of negative personal characteristics

Answer 21

(Psychodynamic Therapies) • Establishing the Relationship: Adlerian therapists seek to make person-to-person contact with clients rather than starting with “the problem.” Therapists start by helping clients become aware of their assets and strengths. Completes assessment using early recollections, questionnaires, and family constellations exploration. Summary is shared with client. Focus is on dynamics that may have influenced the sense of self, inferiority and the world. • Focus on personal goals

Answer 22

(Psychodynamic Therapies) • Encourage self-understanding and insight through interpretation. Clients are positively encouraged to overcome their feelings of insecurity through therapist’s optimism. Collaboratively explore ways in which client can feel more deeply connected in his social context. Support client to turn dysfunctional styles of life into more functional, socially beneficial ones. • Encourage client to overcome feelings of insecurity • Look at dysfunctional styles of life Maybe explore changing goals (money to better dad)

Answer 23

(Psychodynamic Therapies) • Putting insights into practice. Encouraging clients to take risks with new behaviors to act as if they are the people they want to be. • Get to a point of having a life interest of contributing socially as opposed to inferiority

Answer 24

(Psychodynamic Therapies) • Attunement is the key intervention in the early stage and consists of forging of a personal relationship between the therapist and the patient. The therapist provides a secure base by reliably demonstrating empathy and care. Collaboratively identifying client’s “attachment style," that is, problematic behavioral and emotional patterns, formed in early childhood as attempts to maintain attachment to primary caregivers.

Answer 25

(Psychodynamic Therapies) • Disruptions are explored in the middle phase. Disruptions include those in the early life of the client as well as those in current relationships, including the relationship with the therapist. Support client’s ability regulate and express emotions in relationally difficult situations, teaching clients to have a reflective stance toward themselves.

Answer 26

(Psychodynamic Therapies) • Repair occurs during the late middle phase and the end of treatment. Repair stage of the therapy aims to alter the patient’s current reactions to the events that cause them emotional distress by sharing their own interpretations of the event. By sharing their own subjective interpretation, the therapist helps create a new reality of the painful events for the patient in order to get rid of unwanted emotions and reactions. • View different possibilities • Give them different reposes to situations o TEST: attachment is specifically focused on how they attach in their relationships, how they regulate their own emotional process, understanding how the client came to understand how relationships work

Answer 27

(Systems Theories) o Systems Approach  believes problems are a part of entire system and interactions between all the parts of the system (child misbehaving is misbehaving because it is supported by relationships in the system)  problem is everyone’s issue (the way the family is handling the stressors)  look at whole dynamic at play (family unit) o Note: What it means to be a systems therapist o Look at person and problem as imbedded in family system o That person’s symptoms serve a function in relation to the family o Can’t look at individual in isolation (born in to family with rules, expectations, strengths, weaknesses) o TEST: answer that take into account the person’s relations with their family (scenario with an individual, but asks how you would work with the family) o Looking at an individual in the context of that person’s family  Instead of looking at a single problem, look at how they relate to their system; how the family views the symptoms, and how the symptoms make sense in that family.  Possibly invite family into session  Interested in transgenerational rules and meanings o Help person change their context and how they relate to the broader system  Increasing boundaries with parents  Become connect with other family members they haven’t had relationships with o Using the system as an assessment of what the problem is and using the system as a solution to what the problem is o Solutions based on who the people relate to their systems o Homeostasis: a family finds a way of functioning that is predictable  How a family functions and finds its rhythm  Identified patient holds the family’s problems  When changes are made in the identified patient, the family will be disrupted until it finds a new functioning homeostasis o Can also use and seek help through broader relationships (supports outside of the immediate family) o Theory of Change:  Change occurs by helping the system view the family as the problem rather than an individual as the problem.  The family system becomes the focal point of therapeutic interventions. o Role of the Therapist:  The therapist helps the family explore: • Belief systems and family values. • Rules and roles that are present in the family. • The family hierarchy. • Expectations • Defense mechanisms and their purpose. o Main Concepts:  Homeostasis: Systems tend to resist change and thus deal with issues by keeping things the same rather than dealing with problems. • Maintained through negative feedback and input loops.  Negative Feedback: Behavioral reactions that correct a deviation of the system and return it to the previous state of homeostasis.  Positive Feedback: In an effort to maintain homeostasis, the system participates in new behaviors, which then creates and reinforces negative communication patterns and exacerbate the problem.  Calibration: The normal operational system of the family.  Wholeness: The whole system is combined of individuals. • Each individual can have an effect on one another causing change to the whole system.  Equifinality: The same results can be accomplished by different family systems. • Example: A man experienced the death of his mother when he was a young child, whereas a woman experienced the divorce of her parents when she was an infant. As adults, both of these individuals experienced Major Depression despite having different early experiences.  Equipotentiality: On the other hand, the same experience in a family system can end up with various results later in life. • Example: Two siblings go through the same experience of being verbally abused when they were young. Later in life one sibling struggles with being in relationships whereas the other sibling struggles with Depression. Therefore, despite the same experience early on, different results occurred.  First Order Change: Change that happens within the family system but has no effect on the system, leaving it unchanged.  Second Order Change: Changes that do impact the family system and how it functions.  Non-Summativity: The family system is treated as a whole and not just each individual family member. o Treatment Goals:  Move the system towards an equilibrium.  Assist clients in identifying conflicts that are currently affecting them.  Assist the family in exploring and recognizing defense mechanisms that help them deal with dysfunctional family behaviors or patterns. o Interventions:  No Fault: Individuals are not blamed within the family system for existing problems. • There is no “identified patient.”  Reframing: Conflict within the family is not accredited to a specific individual, rather the family system is the problem and thus the prime focus.

Answer 28

(Systems Theories) • Create a family diagram of multigenerational emotional connections; assess individuals’ levels of differentiation and triangulation; identify dysfunctional patterns that have been passed along through the generations

Answer 29

(Systems Theories) • Teach and model differentiation through communication skill building; detriangulation; encourage reunification from cutoff family member; teach the family how to take responsibility for their feelings and thoughts • Teach people difference between thoughts and feelings and the difference between their own feelings and the feelings of others • Show that the system is perpetuating the problem (parents did it to them)

Answer 30

(Systems Theories) | • Review new skills and knowledge gained in therapy

Answer 31

(Systems Theories) • Define the problem; determine how the client understands the problem; assess family’s destructive patterns of relating and communicating the continued problem; clearly state goals – what behaviors need to change and what would be the signs of change • Cleary state the goals and what problem to eliminate

Answer 32

(Systems Theories) • Review attempted solutions; assign ordeals; prescribe the problem; relabel behavior; instruct client to respond to the problem in a new way

Answer 33

(Systems Theories) | • Plan for maintenance of new behavior; plan for future challenges; emphasize positive changes made.

Answer 34

(Systems Theories) • Join with family; • both accommodate to and challenge rules of family system; • assessment/mapping of hierarchy, alignments, and boundaries; • reframing of problem to include whole system • Help family identify how they are creating the system ex: “well, dad doesn’t listen to mom, so how will kids listen”

Answer 35

(Systems Theories) | • Highlight and modify interactions; utilize enactments of issues to challenge participants and unbalance system

Answer 36

(Systems Theories) | • Review progress made; reinforce structural change; provide tools for future

Answer 37

(Systems Theories) • Establish rapport, a sense of equality and hope. Assess communication patterns, stances, and concerns. Identify treatment focus and goals. • Family life chronology

Answer 38

(Systems Theories) • Increase the family’s congruent communication. Support and strengthen each individual’s sense of uniqueness and self-esteem.

Answer 39

(Systems Theories) | • Help family practice, implement, and integrate changes and increase awareness of larger familial patterns

Answer 40

o EVIDENCED BASED PRACTICE  Easy to study  Structured  Collaborative  Devise strategies to eliminate symptoms, thereby leading to change o CLEAR TREATMENT PLAN  Start with functional analysis of thinking and behaviors  Thoughts and beliefs about the world contribute to behaviors and feelings  When people become clear on problematic thinking patterns, interventions help to alter automatic thoughts  For test, look for question addressing thinking patterns and beliefs o THEORY OF CHANGE  Change occurs by learning to modify dysfunctional thought patterns and how people think about themselves and the world and the future  Once a patient understands the relationship between thoughts, feelings, and behaviors, s/he can modify or change the patterns of thinking to cope with stressors in a more positive manner and have more flexibility and options about their behavior and experiences o ROLE OF THERAPIST  The therapist is a collaborative teacher who uses structured learning experiences that teach patients to monitor and write down their negative thoughts and mental images  The goal is to recognize how those ideas affect their mood, behavior, and physical condition  Teaching how to change thinking  Teach people how to prioritize treatment goals  Therapists also teach important coping skills, such as problem solving and scheduling pleasurable experiences  Work with client to determine where to start  The therapist creates structured sessions and provides homework for clients to continue to work on problems in-between visits  Focus on skill building  CBT is very structured  HW is big o TREATMENT GOALS  Number one goal is to relieve symptoms  Patients learn to recognize negative patterns of thought, evaluate their validity, and replace them with healthier ways of thinking  Patients’ symptoms or problems are relieved  Patients develops positive coping skills and strategies for future problems too  A common Cog-B goal is exploring a client's cognitive triad  Extinction is a goal o MAIN CONCEPTS  Negative Cognitive Triad • 1. View of self (“I’m not worth anything.”) • 2. View of the world (“Everybody hates me.”) • 3. View of prospects for the future (“There are no hopes for my future.”) • These are the sources of people’s problems • It is likely that a person’s cognitive triad is slanted towards current or recent situations, and they could benefit from reframing their views and highlighting their strengths and ability to recover from these situations • Teach the client about CBT and negative triad  Automatic Thoughts • Thoughts about oneself or others that individuals are often not aware of and thus are not assessed for accuracy or relevancy • We don’t really have an awareness of these thoughts (ex: no one is gunna like me here) • CBT teaches people about these thoughts and how to identify, explore, and alter them  Maladaptive Automatic Thoughts • These are automatic thoughts that are typically centered on negative themes or distorted reflections that are accepted as true • People just accept these as true  Schemas • A network of rules or templates for information processing that are shaped by developmental influences and other life experiences • These are how automatic thoughts are generated – they stem from the schema • These rules dictate how individuals think about and interpret the world and play a role in regulating self-worth and coping skills • Changing schemas is a major target of CBT  Overgeneralization • Single negative event is seen as a never-ending pattern of defeat • One mistake leads to “I never do anything right” (one bad test = never gunna be good at school)  Arbitrary Inference • Cognitive distortion that leads to drawing conclusions without evidence or facts to support those conclusions (if I try to join conversation and people stop talking, we think they stopped cuz they don’t like us, but it was really a private conversation that only a few people should hear)  Selective Abstraction • Attending to detail while ignoring total context • Taking detail out of context and missing the totality of the situation (an actor makes a small mistake in a play, but thinks the whole play was bad)  Personalization • Seeing yourself as a cause of negative external event (a neighbor doesn’t say high, and you think they don’t like you for some reason or because you because you did something)  Polarized Thinking • Thinking in extremes, viewing things as black or white (all good or all bad/splitting)  Assumptions/Expectations • Cognitive-behavioral therapist would focus on assumptions and expectations (i.e., explicit statements about any subject) that people have about anything to determine any larger biases (i.e., "distortions”) they use to interpret themselves and the world o INTERVENTIONS  Social Skills Training  Aversive Conditioning • The intention of aversive conditioning (pairing an unpleasant stimulus with a habituated response) is to eliminate the anxiety response by making it even more uncomfortable than it already is  Educational Approach • Collaborative • Teaching about how thoughts impact behaviors and feelings and how to address them: o journaling o thought stopping o logs  Socratic Questioning • Questioning allows the therapist to stimulate the client’s self-awareness, focus in on the problem definition, expose the client’s belief system, and challenge irrational beliefs while revealing the client’s cognitive processes • Questions that dive below the surface of a person’s thinking (ex: what lead you to believe this; is there evidence) • Are there alternate ways of thinking about the situations • Thought process that the person used to reach their conclusion  Reframing • Thinking differently by “reframing” negative or untrue assumptions and thoughts into ones that promote adaptive behavior and lessen anxiety and depression  Cognitive Restructuring • Teaches client to identify irrational, distorted, or maladaptive beliefs, question the evidence for the belief, and generate alternative responses • Doesn’t happen in one session: o help people identify thoughts and beliefs o then question evidence o then find alternate responses • Step by step approach  Homework • To assist with cognitive restructuring, clients are often assigned homework • Typical CBT homework assignments may include activities in behavioral activation, monitoring automatic thoughts, reviewing the previous therapy session, and preparing for the next therapy session  Self-Monitoring • Also called diary work, self-monitoring is used to record the amount and degree of thoughts and behaviors • This provides the client and therapist information regarding the degree of a client’s negative affirmations • Thought record  Behavioral Experiments • The experiment process includes experiencing, observing, reflecting, and planning • These steps are conducted through thought testing, discovery, activity, and/or observation • Ways people can try something new to observe and reflect • Assign different things for people to do  Systematic Desensitization • Pairs relaxation with exposure to something stressful • Clients are taught to relax in anxiety producing situations • Big in CBT and good for PTSD • Teach how to relax, then expose • Real life exposure or imagery  Anxiety Management Training • Teaches skills for specific situations using imagery • The client practices relaxation until anxiety is reduced then continues with imagery  Assertiveness Training • Teaches client to specify desires and needs using minimally effective responses to assert their position (what’s the least they need to do in order to convey needs and wants) • Used with unassertive or overly aggressive clients. • “I” statements • Involves role playing  Behavioral Activation • Increases activity for depressed or passive clients by using activity scheduling and incentives • Assigning activity (may or may not use incentive) • Brisk walks can sometimes be more effective than meds • Incentives mean get something for doing something  Communication Skills Training • Used in couples’ therapy to help couples talk about feelings and problems • About helping people manage conflict • When in stressful situation, we rely on primitive behaviors • “I” statements • Assertive training • Teach how to listen without interrupting or advice • Don’t jump in with problem solving • How to identify when getting overly aroused and upset (flooded) • When flooding happens to just one person, the other person may not notice it  Downward Arrow • Used to uncover underlying assumptions • “If this is true, what does it mean about you and your life” • Keeps moving down to get to the underlying view of the world/yourself  Exposure • Client faces fear stimuli without resorting to escape or avoidance maneuvers • Can be done in real life or with imagery • Kids = coping cat (exposure therapy through imagery)  Finding Alternatives • Clients review all possible options and alternatives for either interpreting a situation or resolving a problem (what are other options that could be happening)  Labeling Distortions • Teaches client to recognize and label particular distortions in thinking that can lead to problems with interpretations of events • Provide psychoeducation about overgeneralization and the various negative patterns of thinking  Mastery/Pleasure Ratings • Clients use activity chart and rates mastery or pleasure that they derive from activity • Person’s skill level at a task; degree to which they enjoy the task • Ex: when they do an activity, they didn’t want to do, but end up liking it, this creates connections between what they imagined it would be like and what it is like  Opposite Action • Client is encouraged to engage in behavior that is counterintuitive or opposite to what she or he may feel at time (e.g. when feeling very angry, say something kind or decent)  Problem-Solving Training • Step by step approach • Teaches a step approach of orienting to the problem, problem definition, generation of alternatives, decision making and solution implementation and verification of results • Solution may not always work (try something, but check in and verify if the “solution” is working; reflect) • Ongoing process • Reflect on outcomes  Relaxation Training • Teaches client to relax muscles to condition a relaxation response to counter tension • Uses imagery, music, and other stimuli to assist in acquiring response • Before exposure stuff, see if coping skills are good  Successive Approximation • Client and therapist collaborate in developing a plan for the client to engage in steps that approximate a goal, to allow the client to have success at each step along the way to the goal • Experience success along the way • Purpose is to experience successes along the journey (ex: engage in relaxation techniques 1st and this would be the goal at first)  Three-Column Technique • Client collects record of automatic thoughts and lists the situation in which the thought occurred, the automatic thought, and the associated feelings • Initial HW assignment  Thought Record • Expands on the three-column technique, with columns to record alternative responses to the automatic thought and behavioral or emotional outcomes of changing the thought (ex: they didn’t talk to me because she is feeling sick, I know can relax)  Diversion Technique • An intervention, not a goal • You would suggest that a person who is anxious do something else with that energy, like take a walk or get some exercise  Building An Alliance • In the Cognitive-Behavioral framework, consists of creating a problem list and educating the clients about the approach

Answer 41

o THEORY OF CHANGE  Precursor to CBT  Change occurs through changing irrational beliefs to rational beliefs, which improves clients’ emotional and behavioral functioning  About beliefs people have o ROLE OF THE THERAPIST  Instructor  Confrontational (this is different from CBT, where they try to build tools)  Direct o TREATMENT GOALS  Help clients alter illogical beliefs and thinking patters in order to overcome psychological problems and mental distress o KEY CONCEPTS  A.B.C. • A – Activating Event: o something happens in the environment around you • B – Beliefs: o you hold a belief about the event or situation • C – Consequence: o you have an emotional response to your belief  Common Irrational Beliefs • Feeling excessively upset over other people's mistakes or misconduct (other people need to be perfect, and if not, you get upset) • Believing that you must be 100 percent competent and successful in everything to be valued and worthwhile • Believing that you will be happier if you avoid life's difficulties or challenges (anytime there is a challenge, they are negatively affected) • Feeling that you have no control over your own happiness • That your contentment and joy are dependent upon external forces  Self-Acceptance • I have both good and bad points • I can have flaws • Despite my good and bad points, I am no worthier or less worthy than any other person  Other-Acceptance • Sometimes other people will not treat me fairly • There is no law that other people must treat me fairly all the time • People who don't treat me fairly are no worthier or less worthy than any other person  Life-Acceptance • Life does not always work out the way that you want • There is no rule that life has to go the way that you want • Although life will not always be pleasant, it is never awful or completely unbearable

Answer 42

o THEORY OF CHANGE  Change happens through mindfulness, skills to manage distress tolerance and emotional regulations, and improving inter-personal problem-solving skills  Emphasis on accepting uncomfortable thoughts instead of struggling with them  This stems from CBT and mindfulness o ROLE OF THE THERAPIST  Ally  Validate and offer alternatives (combo of validating anger as well as how to deal with it) o TREATMENT GOALS  The goal is for clients to improve their emotional and cognitive regulation o KEY CONCEPTS & INTERVENTIONS  Mindfulness • This is what separates from CBT • The practice of being fully aware and present in this one moment • Acceptance of the feelings  Distress Tolerance • How to tolerate pain in difficult situations, not change it  Interpersonal Effectiveness • How to ask for what you want and say no while maintaining self-respect and relationships with others  Emotion Regulation • How to change emotions that you want to change • Looking at experiences that people have in situations • What happens when they learn how to accept those emotions  Homework • Clients are assigned skill building tasks between sessions • Incorporates individual, group work, and contacting therapist in between session

Answer 43

o THEORY OF CHANGE  Change occurs through identifying and meeting needs as well as developing satisfying interpersonal relationships o ROLE OF THE THERAPIST  The main function of the therapist is to create a nurturing relationship with the client  Supportive, non-judgmental, patient coach o TREATMENT GOALS  Client learns more effective ways of meeting his or her needs  Clients learn to engage in self-evaluation  Clients gain a sense of inner control of their lives  Clients learn to change what they do as a key to changing how they feel and getting what they want o KEY CONCEPTS  Based on Choice Theory, which asserts that each of us is a self-determining being who can choose future behaviors and hold ourselves consciously responsible for how we are acting, thinking, feeling, and for our physiological states  Client has a choice  Everyone has four needs (love/belonging, power/achievement, freedom, and fun/relaxation)  Every choice is based on seeking one of these needs  Sometimes needs compete with one another  When people get out of balance, they feel only one need is important, so they’ll put more energy in that one need, further exacerbating the problem  Some people may have only been working on one “need”  Psychoeducation may help them identify what they can work on  People are always trying to meet one of their needs  People are in control of what they are currently doing and have the power to make different choices  Client’s act irresponsibly when one or more of their basic needs aren’t being met o INTERVENTIONS  Focus on the areas where clients have choices  For test, focus on choices, not past, focus on present  Focus on present choices, avoid discussions of problems in past or symptoms  Challenge client to examine and evaluate their own behavior  Explore client wants, needs, and perceptions  Doing and directing – focus on what client is currently doing and thinking  Discuss feelings only when related to client’s behaviors/choices  Teach self-evaluation (does present behavior have a reasonable chance of getting you what you want)  Formulate action plan for change – focus on positive, attainable action steps  Review results of plan and adjust accordingly  Use humor

Answer 44

o EMPHASIZES UNDERSTANDING HUMAN EXPERIENCE AND THE CLIENT  Do not emphasize the symptoms  You emphasize what the person is experiencing; their point of view  From Carl Rogers  The therapist is a unique individual  Authentic connection between client and therapist  Unconditional positive regard for the whole person  Non-judgmental  People are always growing and surviving  Make room for peoples’ experiences  Establishing rapport  Make room for identifying judgments they have about themselves  Address past guilt and shame  Accept self and things they feel bad about o HUMANISTIC THEORY  Focus on acceptance and growth  People constantly grow and try to be happier and better  Acceptance is important, because people disown aspect of self as unacceptable and their past shames are un-processed  The therapist is a unique individual  Try creating a nurturing and authentic environment promoting acceptance for who they are (make room for parts they don’t like about themselves)  Viewing people as inherently good and avoids diagnosing people, avoids what ideal person should be o THEORY OF CHANGE  Change occurs by creating conditions for the client to grow through the therapeutic relationship with the presence of three essential components: congruence/genuineness, unconditional positive regard, and empathy o ROLE OF THE  Therapist is nondirective.  A facilitator (helper) who sets the stage and believes the client is able to do what is necessary for growth and change, self-actualization  Client determines goals of therapy and even how many sessions they want to come to o TREATMENT GOALS  Self-acceptance  Congruence between client’s idealized and actual selves (live more authentically)  Increased self-understanding  Decreased levels of defensiveness, insecurity, and guilt  More positive relationships and increased comfort with others  Increased ability to experience and express feelings in the here and now (improved awareness) o KEY CONCEPTS  Congruence • Therapist’s genuineness with client, shares his/her feelings honestly, does not hide behind professional façade or therapy models — therapist is transparent with feelings, thoughts, and beliefs (this is also modeling for the client)  Unconditional Positive Regard • Complete acceptance of the client, a nonjudgmental respect of client and his/her feelings allows clients to feel less anxious about their perceived weaknesses and taking risks • This helps lower defenses  Empathy • Therapist accurately senses the feelings and personal meanings the client is experiencing and can communicate this understanding to the client  Self-Actualization • Innate tendency of all human beings to reach their fullest potential  Locus of Control • Through the therapeutic relationship, client can take control of their lives rather than follow the direction of others who were previously in control • More awareness of the choices they have • Unconditional empathy = client experiences their experiences in a new way  Non-Directive Therapy • Clients lead the discussion

Answer 45

o FOCUS ON HERE AND NOW  Genuine encounter  The therapist is a unique individual  With each client we are going to fit a little differently  Bring your own person in the room  There are themes: • work in here and now • stay with emotion • full body awareness (“what are you feeling right now”)  Gestalt also pays attention to how things are unfolding and the energy of the therapy • Tone of voice, body language o THEORY OF CHANGE  Change occurs through increased awareness of here-and-now experience in a dialogic relationship  Both existential and humanistic o ROLE OF THE THERAPIST  The therapist is an authentic, present other  Non-directive and non-judgmental (people are free to make their own choices)  No right way to be in the world  Increase the client’s awareness in the present moment o TREATMENT GOALS  The goal is for clients to become aware of what they are doing, how they are doing it, and how they can change themselves, and at the same time, learn to accept and value themselves  Idea of self-acceptance o KEY CONCEPTS  Phenomenological Method • Exploring experience by description and abstaining from interpretation (ex: see them cry or look sad, you say “I see you tearing up, what are you experiencing;” just a description, no interpretation) • Interpretation my limit what the client could possibly say  Dialogical Relationship • The therapist’s presence allows for the client to become fully present • The therapist is not the expert of the client’s feelings • Importance in therapist being open to client’s experience and not being an expert on the experience  Experiential • Through experiments, the therapist supports the client’s direct experience of something new, instead of merely talking about the possibility of something new (“I wonder what that would be like for you if you said that a little bit louder and sterner”) • Just opportunity for client to experience something new • Even client’s reaction to suggesting is important  Here-and-Now Focus • The past is discussed in terms of how the past affects the present • Focus on how they feel as they are describing the past o INTERVENTIONS  Empty Chair Technique • For the test, the may put this as a wrong answer on a different therapy • Used to explore patients’ relationships with themselves or others in their lives • A form of role-playing, the client addresses an empty chair as if another person was in it in order to act out two or more sides of a discussion • If you “bring the person into the room” it can be very therapeutic to express those feelings to the “person” • Belief that if we bring relational difficulty into the room, person can be in the here and now and get closure (finish business) • Talk to a part of themselves (hole in heart) or directly to themselves  Experiments • Encourages the client to experience a feeling rather than just talk about it • Stand up, raise voice  Body Techniques • Bring patients' awareness to their body functioning or help them to be aware of how they can use their bodies to support excitement, awareness • Focuses on the process, what is happening, and the content, what is being talked about • What’s going on in the body (ex: what does sadness feel like)

Answer 46

o FOCUS ON RESPONSIBILITY AND FREEDOM  Able to respond (responsibility)  The therapist is a unique individual  The meaning people have in their life  How they choose to think and act  People have freedom to choose how they will react to situations  People’s problems come from not exercising choice  Everyone is responsible for their life’s meaning and the choices they make  You drive the car of their life o THEORY OF CHANGE  Change occurs through finding philosophical meaning in the face of anxiety by choosing to think and act authentically and responsibly  The core question addressed in existential therapy is "How do I exist in the face of uncertainty, conflict, or death”  Emphasizes personal choice about how they want to live life o ROLE OF THE THERAPIST  Provide an encounter with a “real” other  Presence of the therapist is essential  Help the client focus on personal responsibility for making decisions o TREATMENT GOALS  Client discovers his own life meaning (purpose)  Client confronts anxiety inherent in living (anxiety is a part of human condition, not about getting rid of it, but handle it, making choices, responsibility for choices)  Client experiences agency and responsibility in the construction of their life o KEY CONCEPTS  All persons have the capacity for self-awareness  As free beings, everyone must accept the responsibility that comes with freedom (with freedom is anxiety)  Each person has a unique identity that can only by known through relationships with others  Each person must continually recreate himself; the meaning of life and of existence is never fixed, rather, it constantly changes  Anxiety is part of the human condition  Death is a basic human condition that gives significance to life o INTERVENTIONS  Focus on moment-to-moment process, not on the explicit content  Holding refers to a process of holding up the problem experience so it may be seen, remembered, and re-experienced by the client, in the presence of the empathetic person  The goal is not to take away pain, but to be with them in that pain  Empathic availability is a committed presence to the “other” and openness to the pain and potentials of the other even when such openness is difficult and unpleasant  Telling, talking about, and naming emotional pain places the emotional experience and pain into the world of mutual encounter, where the relationship between client and practitioner can be used to process the situation under circumstances of increased support  Mastering the emotional pain is a process of reflection and behavioral experimentation that helps a client discover unique healing activities that are useful in processing and defusing the problem situation  Honoring the pain refers to the process of celebrating the meaning potentials and opportunities in the problem situation that the client actualizes and makes real (relate to the pain in a different way); view as something you have endured; there is a significance in the pain; it shaped who you are

Answer 47

o THEORY OF CHANGE  Change happens through the existential encounter – the authentic meeting of the therapist and the client in the present moment and by expanding the client’s range of experience  Generally used with families o ROLE OF THE THERAPIST  Authentically being with client  Playful, creative o TREATMENT GOALS  The goal is for growth and increased flexibility  People have fixed ways of being, so this therapy looks to expand behaviors o KEY CONCEPTS & INTERVENTIONS  Battle for Structure • Therapist establishes the rules and working atmosphere of treatment • Includes the need for entire family to be in therapy • For the test, if answer says, “include whole family” pick that one  Battle for Initiative • Motivation for change must come from family • Includes having family state agenda for each session, waiting silently for family to take initiative, allowing family to determine how change is going to happen (don’t work harder than family) • Wait until they speak  Trial of Labor • Understanding the roles, boundaries, beliefs, history and levels of conflict within the family (clear understanding of family dynamic)  Activating Constructive Anxiety • Reframing anxiety as efforts toward competence and anxiety directed towards something positive (fear of failing to accomplish what one is capable of)  Play, Humor and “Craziness” • Tapping irrational side • Finding solutions in creative interactions (clinically appropriate laughing and joking)

Answer 48

o MAIN IDEA  Focuses on deconstructing common beliefs and examining those beliefs and values in an individual’s life  People construct reality and it comes from cultural beliefs (ex: what is success, is it money, being well rounded, helping)  Looks at peoples’ thoughts and behaviors in the context of their culture  Make a link between culture and how they got those ideas of how things should be and how they shouldn’t be  It changes over time and with cultural shifts  Postmodern is exploring the words people use  Also look at the story that the client has about self: • mapping the problem (ex: understanding how anxiety is impacting life) • separate the person from the problem • the person isn’t there problem • client has a say over their experience o THEORY OF CHANGE  Change occurs by separating patient from problem and creating a new narrative or story, which emphasizes the client’s competencies and strengths (person has story about self, work with exploring that story and then create a new story, brings out competencies and strengths) o THERAPIST’S ROLE  Collaborator  Investigator  Co-author  Views individuals as the experts on their own lives (considers ALL cultural and other minority class influences) o TREATMENT GOALS  Deconstruct problem-saturated stories in order to create more helpful stories  Have more direction in life  Re-authoring the story — having a new story emerge o INTERVENTIONS  Externalizing the Problem • Separating the person from the problem story (ex: “what is anxiety trying to tell you to do”) • Separate a person from their depression • What does depression do when it comes around; in what context is depression most likely to take over; depression is not part of the person; what happens when depression takes over • Externalize symptoms  Social Constructivism • Where the messages are coming from • Focus is on the present and past — the current problem and the history of the problem • Special attention is given to social issues, such as culture, gender, race, disability, social class  Deconstructive Questions • Questions that clarify meaning and help people unpack their stories • They encourage clients to situate their narratives in broader contexts (what does it mean to be ….) • Explore the language people use and clarify the meaning (ex: if someone says they are an underachiever, you go deeper; “tell me what you mean by underachiever”)  Mapping the Influence • Process of eliciting from the client a detailed description of the problem’s effect and influence on client’s life and relationships (“What is the impact of these symptoms on your life; how does it make you feel as a mother; how do his tantrums affect your life”) • How problem impacts the identity of the person  Identifying Unique Outcomes • Times in the client’s life during which the client was able to resist the effects of the problem • Was there ever a time when you felt strong/not depressed/not anxious • Can also be a fantasy, what would it look like if they did • If a person can’t identify any, use fantasies  Enlisting A Witness • Inviting someone who has a sense of who the client is to support & witness the re-authoring process • Sharing of their experience  Writing A Letter • Client writing a letter to self and others to reinforce a new story

Answer 49

o SHORT TERM  Solution focused tends to be shot term therapy  Does not evaluate the root cause of the problem  Create solutions to problems  Collaboratively design a situation with expectations for change; create a situation that client would want to have happen  For test, would not use the word problem o THEORY OF CHANGE  Change occurs through accessing client’s strengths and resources  Emphasizes finding solutions to a problem, not on discovering the cause or origins of the problem  No exploration of past issues  Focus on present and future o THERAPIST’S ROLE  Therapist is a consultant, coach  Lots of encouragement o TREATMENT GOALS  Client implements small and large changes to achieve their preferred future  Client builds on current strengths and resources  Client defines problem/goal o INTERVENTIONS  Exception Questioning • The therapist asks the client to think of a time in his life when the problem did not exist and what the client did differently during this time • The goal here is to focus on what has worked in the past to provide the client with a positive perspective (ex: “Tell me about the times when you don’t get angry”)  Miracle Questioning • The therapist asks the client to envision how the future will be when the problem no longer exists and what life looks like then (ex: “Imagine that tomorrow morning you wake up and a miracle has happened. What would be different that will tell you a miracle has happened, and your problem has been solved”)  Scaling Questions • The therapist asks the client to think of a scale ranging from the worst things could be to the best; the client then rates his current position on the scale and is asked to identify how he could move up or down the scale • The client is also encouraged to identify what point on the scale would be good enough or where his “perfect future” is (ex: “You said that things are between a 4 and a 5. What would need to happen so that things were between a 5 and 6?”)  Presupposing Change • Rather than focusing on the problem that brought the client in, the therapist can ask the client questions to focus on the positive changes that have been occurring (ex: “What’s is different or better since the last time we met?”)  Coping Questions • If a client has trouble identifying positive change, coping questions are asked by the therapist in order to illustrate resources that the client already has. This can include validating the client’s difficulties while also showing that she is still able to get up in the morning, go to school, etc. This highlights the client’s strengths without undermining her view of reality. These questions are supportive while also challenging the client and shifting the focus away from problem-focused narratives. Example: “How do you keep going each day even when it feels like there is no hope?”  Affirmations/Compliments • Regularly acknowledge, progress, strengths and resources (Example: Tell the client, "I am impressed you are sitting in that chair again after what you just went through")

Answer 50

o OBJECT RELATIONS  Biological drive theory = drive to get needs met  Looks at relationships in lives developed/shaped through external relationships  Object is good or bad  In therapy, the therapist becomes the object  Projection = defense mechanism where somebody is putting their feelings on to another person  Projective identification = therapist takes on identification of that client’s feelings (if therapist feels frustrated, it is the client’s frustration that the client is projecting onto the therapist, so now therapist starts to feel the client’s feelings - if client mad, therapist will become mad) o THEORY OF CHANGE  Change occurs through both reparative experiences within the treatment relationship (therapist becomes new object) and from new insight into, and modification of, entrenched object relations pathology (new and different experiences with the therapist; gaining insight into past relationships with parental objects)  Be curious about a person’s early child hood experiences  Be curious about how client felt belittled by the therapist  How the person’s views of self and others were formed and how they are shaping interactions today O ROLE OF THE THERAPIST  Emphasis on transference and countertransference  Neutral  Therapist as a new and good object o TREATMENT GOALS  Providing reparative experiences and building new internal structures (the person would have views of themselves that will allow them to rely on self-soothing talk in stressful situations)  Gaining insight to how past relationships impact client’s functioning (“this reaction feels bigger than current situation;” question link to past)  Improving relationships with self and others (how feelings connected to past)  Sometimes people have a way of relating to others in a way that is not satisfying, but they continue to engage in the same manner, because they learned it from somewhere o KEY CONCEPTS  Objects • Refers to persons in the external world • Individuals seek objects (others) from birth • We are inherently object seeking  Internalization • Early infant-caretaker interactions lead to the person internalizing basic attitudes toward self and other, characteristic relational patterns, and a repertoire of defenses and internal capacities (babies and toddlers internalize and start to make sense of the world and themselves; the world is hostel, or it is safe)  Self/Object-Representations • The Internalization Process = infants forming images of themselves and others, and once formed, they are fundamental internal structures that affect the ways in which individuals view themselves and others • If a child experiences that they are too much for parents, they learn that they must pretend to be happy all the time; if mother is warm, the child starts to take in the idea that the world is safe and accepting and vice versa  Ego • The structure responsible for dealing with the world, for instituting defense mechanisms, for internalizing external objects, and for integrating and synthesizing self/object-representations • Creates defense mechanisms; some can be primitive, and others can be complex  Splitting • When two contradictory states, such as love and hate, are compartmentalized and not integrated • Related to ego • Somebody is either all good or all bad; can switch fast • Hard time maintaining relationships cuz people usually will disappoint us • Therapist wants to work on bringing these two sides together  Projection • Involves projecting undesirable feelings or emotions onto someone else, rather than admitting to or dealing with the unwanted feelings  Projective Identification • Refers to a psychological process in which a person will project a thought or belief that they have onto a second person, then the second person is changed by the projection and begins to behave as though he or she is in fact characterized by those thoughts or beliefs that have been projected • Only used with Object Relations; maybe a test answer • Therapist or other person takes on the feelings of the client/crazy person • This is the manipulation of the client/crazy person  Introjection • Where the subject replicates in themselves, behaviors, attributes, or other fragments of the surrounding world, especially of other people (ex: child grew up in angry home, they become angry and violent; angry = I’m supposed to lash out)

Answer 51

o SELF-PSYCHOLOGY  Emotional Attunement = someone who lacked mirroring ends up disregulated (compensate for that loss)  In therapy, use empathetic attunement for healing o THEORY OF CHANGE  Change occurs through empathetic attunement and strengthening the self-structures through optimal responsiveness  Real focus on understanding the client and client experience o ROLE OF THE THERAPIST  Emphasis on empathetic understanding and optimal responsiveness  Reparenting  Allows transferences of self-object experience  Be conscious of repairing any disruption between client and therapist (part of healing process) o TREATMENT GOALS  Developing self-cohesion and self-esteem  Want person to have more accurate view of self  Improve self-esteem  Get more accurate view of self  Locating better self-objects o KEY CONCEPTS  Self-Objects • Early self-objects are those empathetic or attuned caretakers who perform vital functions for the infant that it cannot carry out itself • If someone doesn’t have an empathetic and available self-object, child has to deal with this rejection in a negative way  Self-Object Needs • Mirroring • Idealization of others • Twin/alter ego  Mirroring • Approving and confirming responses • Mirroring = approval and confirmation response • Example, did the child have parent available when they took first steps, were they met with approval or was no one in the room  Optimal Frustration • When a self-object is needed, but not accessible, this will create a potential problem for the self if its long term (neglect or abuse), referred to as a "frustration" • Note: constant mirroring is not good, cuz then they will think world must always be there for them  Mirroring Transference • The patient seeks acceptance and confirmation of the self from therapist • They come to therapy wanting to get some kind of confirmation and acceptance  Twinship Transference • The patient experiences the therapist as someone like himself • There is a comfort and safety in this • Looking for someone to look up to • It’s a validation  Idealizing Transference • The patient looks up to and admires the therapist • Stems from child wanting to idealize parents  Adversarial Transference • The need for a supportive relationship that the patient can oppose, in order to grow • Person that has been taught that they just have to go along • A therapist can be a person that cares for them, but they can also push back  Experience-Near Empathy • When therapist steps into client’s shoes and imagines what it is like to be the client (thoughts feelings, body sensations) • Like mirroring to the extreme • Showing client that you really understand feeling and experience • Work with client to really understand what they were experiencing • Therapist works with client to clarify understanding, but different than interpretation • This is more of an empathetic attunement • Test: o self-psychology question, look for empathy answer

Answer 52

o DEPTH PSYCHOLOGY  Based in Jungian approach  Soul psychology  People have a soul and you are treating that soul o THEORY OF CHANGE  Change occurs through exploring and integrating material from both unconscious and conscious levels of understanding  Unconscious processes include dreams, images, symptoms, intuitions and other non-volitional experiences (things that happen unconsciously)  The soul is speaking out through the symptoms  Soul is a big word in depth psychology o ROLE OF THE THERAPIST  Client and therapist form a critical alliance, which invites client into exploration of connections and meanings that are below the surface of conscious awareness and engages the transpersonal, mysterious space between therapist and client  Fellow journey men o TREATMENT GOALS  Increase self-awareness and inner wisdom  Integration of repressed experiences and shadow material (darker side of somebody; selfishness, greed; capacity for a darker side)  The goal is often referred to as individuation (a process that fosters self-awareness through inner and outer exploration of the unconscious and conscious, the individual and the wider community), by which one discovers a more potent sense of meaning and purpose in life o KEY CONCEPTS  Depth • Refers to a way of seeing that which lives underneath the cultural, historical, spiritual, psychological manifestations of human experience • Recognizes the “collective unconscious” which is passed down through generations and is shared by all people (ideas, meanings, and symbols) • Could be described as a universal library of human knowledge often represented by “archetypes” or basic patterns of human behavior and situations that seem to be common amongst all people (e.g. the hero, the mother, the father, the orphan, the explorer etc.); archetypes come into play at different stages and points of life  Active Imagination • Is an intervention used to amplify, interpret and integrate the unconscious and includes working with dreams and the creative self via imagination, images etc. • Active imagination relies on a client’s undirected observation of their imagination or dreams, allowing the images or dreams to speak for themselves as much as possible without overbearing influence from the conscious mind  Psyche and Soul • Widely used terms in Depth Psychology • Soul is the dimension of the person that makes meaning possible, turns events into experiences and deepens the human experience • Depth Psychology attunes itself to the way psyche reveals itself  Mythology • Personal symptoms, conflicts, and stuckness contain a mythic or transpersonal/archetypal core that when interpreted can reintroduce the client to the meaning of his struggles (e.g., the pain of leaving home can be reimagined as the ageless adventure of the wanderer setting out into the unknown) • Difficult choices can be made easier if related to a story

Answer 53

o ADLER  People have a need to be socially responsible  Give back to others  Like positive psychology (ex: tell people with depression to do nice things for other people)  Interested in early family constellation: • memories of childhood situations • nature of relationships between family members • understand past family dynamic • past is informing how the client is currently functioning in life • people are often behaving out of a feeling of inferiority • identify situation when inferiority was at play in decisions and behavior o THEORY OF CHANGE  Change occurs by increasing client’s self-awareness and challenging and modifying his or her fundamental premises, life goals, and basic concepts.  People behaviors are goal oriented, and motivated by inferiority o Therapist’s Role  Accepting, encouraging, respectful, optimistic  Co-thinker  Relationship is collaborative and built on trust o Treatment Goals  Challenge the client’s basic premises and life goals (what is the underlying motivation of what they are doing every day, what’s the purpose)  Develop socially useful goals and increase social interests (work to help clients to become more socially engaged, caring for others, taking care of the world)  Increase the client’s sense of belonging (all of children’s behaviors are aimed at belonging; problematic behavior is linked to belonging) o Primary Concepts & Interventions  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, these are stories of events that a person says occurred before the age of 10. These are specific incidents that include what the client thought and felt at the time. • Get a sense for how the client makes sense of their world  Family constellation: • Exploration of the family atmosphere and relational dynamics that prevailed in the family when the person was a young child. (relationships and perceptions of family nature of those relationships and have the client talk about them)  Lifestyle Assessment: • Identifying, though a questionnaire and or clinical interview consisting of early recollections, the goals and motivations of the client • Where did your goals come from, how does it impact you, was it handed down from someone else and does it work for you o Social Context:  Widened the view that problems were not simply intrapsychic and incorporated the notion that the social context of the person’s lifestyle contributed as well.  How does your community shape you? o 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.  Enhances feelings of belonging and connectedness  Dream Interpretation: • Adler's considered dreams as an open pathway to true thoughts, emotions and actions. According to his view, dreams enable us to clearly see our aggressive impulses and desires. Adler considered dreams as a way of compensating for the shortcomings in life. Dreams offer a kind of satisfaction that may be more socially acceptable. • Understand impulses and desires  Summary: • Therapist shares the results of the assessments as a narrative summary that is discussed with client. • Conclusions that the therapist has drawn from therapy  Role-Playing: • In the middle stages of therapy, role-playing offers clients opportunities to add missing experiences to their repertoire, and to explore and practice new behavior in the safety of the therapist's office. • Explore missing experiences.  Guided Imagery: • Guided imagery can be used therapeutically to change the negative imprints of childhood family members that weigh heavily on a client and often ignite chronic feelings of guilt, fear, and resentment. These techniques are typically used in the middle stages of therapy. • Validate their feelings about that those experiences  Encouragement: • Helping the client to “build courage” by becoming aware of their strengths, feeling connected to others, and having a sense of hope. • Therapist and client connect

Answer 54

o Attachment Theory  looking at early impact and attention to the child, thus impacting adulthood  originated and developmental model (not a lot of interventions assigned to this theory, however, a lot of therapies now incorporating attachment theory, ex: EFT)  important thing is how client relates to therapist  Adult Attachment Interview: • three words to describe your mom, dad, whoever, then ask for supporting memory to support the words • pay attention more to the client’s delivery • assess if they get aroused, disorganized, flat affect, or if they have a balanced view) most don’t have balanced view)  TEST: may ask about attachment theory as an assessment tool, pay attention to more process issues of therapy o How we are parented affects how we interact with others in the future o Theory of Change  Change occurs through exploration of past and current relational attachments and trauma in the environment of a healing, secure and reliable relationship.  Relationship between client/therapist is heling (reliable, empathetic) all feelings are welcome  In home where parents are highly emotional and enmeshed, kids become easily overwhelmed as adults  Bad = parents are absent or enmeshed and overwhelmed  The kid’s emotional needs are not being met (how to not be shamed or not get in trouble)  Also, attention to what is going on in current relationships o Role of the Therapist  Provide a sufficiently secure base to enable a person to explore emotional experiences of the past and the present  Create a secure, accepting, caring, non-judgmental, and reliable environment where the patient can feel comfortable sharing their most traumatic experiences and exploring the nature of the client’s attachment pattern o Treatment Goals  Raise awareness of client’s problematic behavioral and emotional patterns, formed in early childhood as attempts to maintain attachment to primary caregivers (what the client learned to expect from others)  Repair the capacity to regulate affects  Resolve any emotional or social disruptions within the patient’s life  Improve quality of attachment with others o Key Concepts  Attachment behavior system: the process in which infants and caregivers have an organized pattern of signals and responses that leads to a development of a protecting trusting relationship. The emotional bond that develops between adult romantic partners is partly a function of the same motivational system--the attachment behavioral system.  Secure Attachment: the person has easy access to wide range of feelings and memories, positive and negative. Has a balanced view of parents and has worked through hurt and anger from the past. Has developed a strong sense of self and empathy for others. (very rare)  Preoccupied/Anxious Attachment: The person is still embroiled with anger and hurt at parents. They sometimes value intimacy to such an extent that they become overly dependent on the attachment figure both past and present. They often recall role reversal in childhood and have hard time seeing their own responsibility in relationships. They dread abandonment. Poor ability to regulate their own emotions.  Dismissive/Avoidant Attachment: The person dismisses the importance of love and connection – and the value of emotions in general. Often idealizes parents, but actual memories don’t corroborate. They dislike looking inward and often have a shallow, if any, self-reflection. They often are very independent, dismissive of their own emotionality and have difficulty tolerating the heightened emotions of others.  Fearful/Avoidant Attachment: The person usually has a history of trauma and or loss. Similar to Dismissive/Avoidant they dismiss the importance of love and connection but usually out of fear or a belief that they are unworthy of love. They have a difficulty trusting others and may feel uncomfortable with emotional closeness.

Answer 55

o BOWEN  multigenerational transmission of problems  people have different roles in family  different levels of differentiation  these are passed from gen to gen  would have the unit draw out a family tree with different characteristics of the family  triangulation • ex: an affair (when there is tension, rope in a third party to alleviate tension between two people) o THEORY OF CHANGE  Change occurs by individual understanding multigenerational dynamics and increasing differentiation.  This is the only therapy that is concerned with the past 3 generations of family (people’s issues are transmitted through the family) • Person • Parents • Grand parents • Great grand parents o THERAPIST’S ROLE  Coach/educator  Supervisor  Investigator (investigate the dynamics)  Neutral: don’t take sides or speak for another member of the unit  Bowenian therapist acts as a neutral coach to help a couple learn about their relationship o TREATMENT GOALS  Reduce anxiety and emotional turmoil in family system • Not just worry, but tension in family when family is having a problem • Heightened arousal that doesn’t have a direction or support • Takes over  Self-differentiation within the context of family  Decrease emotional fusion (allowed to have different reactions)  Improve communication skills (“I” Statements, owning my own emotional experience)  Decrease recurrence of dysfunctional patterns (educate people so they don’t keep doing it)  Reduce emotional reactivity • Give people the skills to tell difference between thoughts and emotions • Bowenian emphasizes dampening emotional reactivity  Facilitate detriangulation o KEY CONCEPTS  TRIANGLES • A triangle is a three-person relationship system. It is considered the building block or “molecule” of larger emotional systems because a triangle is the smallest stable relationship system. • Anxiety in a 2-person system may lead to adding a third person to reduce anxiety, AND it doesn’t have to be a person, it could be work, drugs, etc. o Parent may start talking shit about the other parent to the child o triangles = a loss of differentiation • Bowenian therapist would ask each about the impact of triangles on communication and closeness in a family • TEST: Bowen = multigenerational mapping/genograms or triangulation  DIFFERENTIATION OF SELF • 2 aspects (intrapsychic and interpersonal differentiation) o INTRAPSYCHIC DIFFERENTIATION  their own differentiation (separating feelings from thought) Can you differentiate between what’s a thought and what’s a feeling?  Can a person have an emotional response and still hold on to a logical thought? Can they have an emotional response and keep it separate from who they are as an individual? Do they lose all functioning to think through an appropriate response? Can you feel feelings, but logically analyze the situation and maintain calmness?  TEST: psychoeducation o INTERPERSONAL DIFFERENTIATION  how separated does a person feel from their family (can they be a person in their own right)  If spouse starts to get agitated, does the other get agitated • Families and other social groups tremendously affect how people think, feel, and act, but individuals vary in their susceptibility to a “group think” and groups vary in the amount of pressure they exert for conformity. These differences between individuals and between groups reflect differences in people’s levels of differentiation of self. • Look far back in system to see how things are passed down • differentiation of self is achieved with the help of de-triangulating and decreasing fusion  Nuclear Family Emotional System: • Individual are interdependent on the other family members’ processes. There are emotional forces happening in the family that happen in recurrent patterns. What are the emotions pulsating through the family? o If dad comes home from work mad, mom gets mad, then kids get mad. • The concept of the nuclear family emotional system describes four basic relationship patterns that govern where problems develop in a family. People’s attitudes and beliefs about relationships play a role in the patterns, but the forces primarily driving them are part of the emotional system.  Family Projection Process: • The family projection process describes the primary way parents transmit their emotional problems to a child. The projection process can impair the functioning of one or more children and increase their vulnerability to clinical symptoms. o How is it passed/transmitted down from generations to generation? o Ex: how is conflict handled in family (open or closed and hidden) o This is one benefit to doing multigenerational mapping  Multigenerational Transmission Process: • The concept of the multigenerational transmission process describes how small differences in the levels of differentiation between parents and their offspring lead over many generations to marked differences in differentiation among the members of a multigenerational family. • Have everyone discuss how they learned their styles of being in the family  Emotional Cutoff: • The concept of emotional cutoff describes people managing their unresolved emotional issues with parents, siblings, and other family members by reducing or totally cutting off emotional contact with them. o Maybe have a repair with that other person as an intervention, because client has gained tools to manage that relationship.  Genogram: • Extensive study of family’s history. Acts both as an assessment and treatment tool • TEST: called family map, genogram, diagram (not like “mapping the problem” in narrative therapy) in structural therapy you do genograms away from the family • information-gathering tool that connects present issues with family-of-origin issues  Pseudo-Self • pseudo-self describes an individual who follows the beliefs and values of others, so a Bowenian therapist would evaluate whether the children in the family have developed pseudo-selves  Undifferentiated Family Ego Mass • refers to intense interdependence between family members, which results from triangles within a family system • by helping the couple deal with one another in a differentiated manner, Bowenians believe the whole family will begin to act in a more differentiated way  Marital Dyad • parents withstand the anxiety that occurs in stressful situations without resorting to bickering, withdrawal, or other avoidance mechanisms o Interventions  Reduce emotional reactivity by having family members talk directly to the therapist one at a time, to decrease anxiety and tension in the room first, therapist needs to present a very non-anxious presence. Be present and a secure base. Separate yourself from their emotional experience. Bowenian therapist focuses on the parents more than the children in a family • Reframing: o Reframe the presenting problem as a multigenerational problem that is caused by factors beyond the individual o Problem is part of a bigger picture o Makes making choice and changes easier • Genogram: o Create a multigenerational map of family emotional system • De-triangulation: o Therapist becomes part of a "healthy triangle" where the therapist teaches the couple to manage their own anxiety, distance, and closeness in healthy ways o Don’t take sides o Support each individual o Support communication to each other o Teach “I” statements to own their own emotional experience • Opening Cut-off Relationships: o Encouraging and supporting clients to reengage with estranged family members o • Interacts with Family: o Interrupts arguments – open conflict is prohibited as it raises anxiety o wants lower levels of anxiety • Models: o Demonstrates new ways to interact and communicate  “I” statement, role playing (talking to sister), modeling communications • Increasing Differentiation: o By forming supportive relationship with family members to explore the origins and effects of their family’s beliefs and behaviors • Teaching “I” Statements: o Increases differentiation • Bibliotherapy: o Assigning reading material o Educator • Psychoeducation o educate the couple/family about the impact of stress on their relationship • Role Play Differentiation o practice more differentiated behavior o by helping the couple deal with one another in a differentiated manner, Bowenians believe the whole family will begin to act in a more differentiated way o role play is used by all Family systems therapists to help them understand each other’s' perspectives • Teaching Communication Skills o an essential alternative intervention for Bowenian therapists • Journaling o an alternative intervention that a Bowenian therapist favors in helping a couple improve their communication without encouraging them to react to one another • Enhancing Cognitive Process o Bowenian therapist would focus on enhancing a client's cognitive processes, not on identifying feelings • ASSERTIVENESS TRAINING o Bowenian therapists will model and teach assertiveness skills • EMPTY CHAIR WORK o Bowenian therapist might use empty chair work to help clients practice more differentiated behavior with their families-of-origin

Answer 56

o Strategic  therapist interested in focusing on a specific problem  not concerned with multigenerational or triangulation  focus on each individual problem and help people address problem differently, thus helping the family system when change occurs  extremely directive (“boss”)  assign an ordeal (every time you want to do “x”, do “Y” first, then do “x”)  prescribing the problem (plan on fighting after…)  short term (focus on one problem)  utilize restraining and positioning strategies o Theory of Change  Change occurs through action-oriented directives and paradoxical interventions. • Therapist is very directive • Target specific problems • One theory where therapist TELLS you what to do. o Role of the Therapist  Therapist delivers directives that facilitate change, particularly strategies around patterns of communication.  Focuses on solving problem/eliminating symptoms  Designs a specific approach for each person’s presenting problem o Treatment Goals  Solve the presenting problems  Change dysfunctional patterns of interaction o Interventions  Paradoxical Directives: • Maneuvers that are in apparent contradiction to the goals of therapy, yet are actually designed to achieve them; paradoxical interventions help avoid confrontation with therapist’s instructions; undermines resistance by keeping client in charge  Positioning: • Therapist takes a more exaggerated and extreme view of the problem and the family is obligated to rebel. That leads to them seeing the ways in which they have competency. • “WOW, YOUR SITUATION IS SOOOOO HOPELESS!!!” • Idea is that the family rebels • Taps into own hopefulness  Homework: • Assignments or directives that take place outside of therapy is essential to the therapy having a successful outcome. The underlying goal of the homework is to try to change the way the family dynamics function around the presenting problem that was identified in session. • Again, help the person to relate to their problem in a different way, for ex, not saying you shouldn’t worry, just worry during specific times • Don’t fight with problem  Prescribing the Symptom: • A strategy in which the therapist encourages or instructs the client to engage in or practice the symptom. • No longer powerless to the problem  Restraining: • The therapist will discourage change or changing too quickly in an effort to elicit the desire to change from the client. • Idea of not power struggling with the problem  Ordeals: • Particular type of symptom prescription in which clients are encouraged to carry out harmless but unpleasant tasks whenever symptoms occur; example: having to get up and clean the basement every time the client cannot sleep. • Again, changing persons relationship with the problem • Giving them more power

Answer 57

o Structural  created by Menusian  longer treatment  look at whole system and construction of family and how they relate  hierarchy (who is in charge)  who’s aligned to and against who  how closed or open they are  is there enmeshment  too much sharing (mom crying to daughter about issues with husband)  join with the family (mimesis) take on language and cultural values  frame things as part of a system  enactments (seeing how family deals with issues in session)  frame it how the system is supporting the problem, not attribute the problem to one specific family member  observe how people are sitting in room  instruct people to change where they are sitting  will incorporate diagram (genogram, family map, family constellation of relationships) • should not do this diagram with family o Theory of Change  Change occurs through restructuring the family’s organization.  Focused on the organization of the family system • Problem because other things are going on • Look at bigger picture of family functioning o Therapist’s Role  Therapist is active and involved.  The therapist helps the family understand how family structure (relationships and hierarchies) can be changed, the impact of rituals and rules, and how new patterns of interaction can be integrated into the family  Become part of the family  Mirror their mannerisms (mimic them)  Understand the culture of the family first, then make change  Help family understand how the family structure is contributing to the problem o Treatment Goals  Restructure family system to allow for symptom relief and constructive problem solving (how do families move through life stages, sometimes get stuck in transition)  Change dysfunctional transactional patterns and create new ways of relating • What are they currently doing that is keeping the problem going? • Try out new behaviors  Help create flexible boundaries  A healthy functioning family = • Clear generational hierarchy • Parental coalition • Spouses have a clear subsystem • Clear boundaries between individuals and subsystems o Primary Concepts:  Family map: • Map out symbolic representation of the difference relationships of the family members (not done with the family, cuz your joining the family culture, mapping with them would make you an outsider) • Helps with diagnostic formulation and treatment goals  Alliances: • Subgroups based on gender (mom and daughter), generation, developmental tasks  Coalitions: • Alignments where 2 or more family members join together to form a bond against another family member  Power Hierarchy: • Leadership and direction must be provided by the adults, typically parents. Sometimes when parents are intimidated or insecure, the power is upside down and it leads to chaos  Subsystems: • Families organize themselves by generation, relationship, and necessity. Examples: marital subsystem – spouses; parental subsystem: parents; executive subsystem: people who run the family; sibling subsystem – kids.  Disengaged Boundaries: • Where family members are isolated from each other. Can lead to AOD use and is a result of rigid boundaries  Enmeshed Boundaries: • Family members are overly dependent and too closely involved and reactive to other family members. Can lead to incest. o Interventions  Joining: • Therapist’s first task; involves blending in with the family, adapting the family’s affect, style, and language  Tracking: • The therapist pays close attention to family members and how they relate to one another during an enactment or spontaneous behavioral sequence, noticing boundaries, coalitions, roles, rules, etc.  Mimesis: • The therapist tracks the family’s style of communication and uses it.  Unbalancing: • Supporting someone who is in a one-down position, thus changing hierarchical position. o Therapist actually takes the weaker person’s side  Reframe: • Putting the presenting problem in a perspective that is both different from what the family brings and more workable. o Moving from the ID patient to how the system is the problem  Enactment: • The actualization of transactional patterns under the control of the therapist. It allows the therapist to observe how family members mutually regulate their behaviors, and to determine the place of the problem behavior within the sequence of transactions. o See problem unfold in the session o Therapist can track and highlight what is going on o Try again, but this time I don’t want you to give up o Main intervention in middle phase of treatment o Allows for boundary making  Boundary Making: • Special case of enactment, in which the therapist defines areas of interaction that he rules open to certain members but closed to others. Example: a son is asked to leave his chair (in between his parents) and go to another chair on the opposite side of the room, so that he is not “caught in the middle”

Answer 58

o Theory of Change  Change happens through self-awareness and improved communication. A humanistic approach. o Role of the Therapist  Active Facilitator  Resource Detective • Looking for the different strengths and untapped resources of family • People are trying to grow and interact • Looking for resources that have been flying under the radar due to family functioning  Therapist is genuine and warm (congruence, match what they say)  Honest and direct • Trust worthy o Treatment Goals  The goal is for clients to increase congruent communication, improved self-esteem/confidence and personal growth • Communicate what you feel see and think to others when you are with them (may say things are great, but it looks like your sad) • Help people internal and external match • Improve self-esteem, everyone has a uniqueness and eventually respected, and they respect others’ differences • Growth: respect for differences o Key Concepts & Interventions  Incongruent Communication: • Discrepancies between verbal and nonverbal cues.  Styles of Communication: • The rules that govern family interaction function as a method of ensuring the maintenance and preservation of the family’s current functioning level. Dysfunctional styles are: o Placater:  Apologizing, never disagreeing, trying to please everyone o Blamer:  Attacking others, fault finder, dictator, boss o Computer:  Super reasonable, intellectual, distant, always correct o Distracter:  Seeking approval by acting out, irrelevant  Modeling Communication: • Use “I” messages; express thoughts and feelings directly; avoid statements about what others are thinking or feeling; be honest. • Supports people to express thoughts and feelings • Avoid trying to know what others are thinking  Family Life Chronology: • Gathering history as far back as possible. Include: ideology, values, rules, disruptions, moves, and major events. What the family has been through and how did those events impact the family. How past events and unresolved issues are carried out presently  Family Sculpting: • Put people into a spatial metaphor – a physical representation of family members characterizations o Exaggerate and cartoonize the different roles (distractor, Placater, etc.)  Take Responsibility: • Encouraging clients to take responsibility for how they felt, what they experienced, what meaning they made, what feelings they had about their feelings. o Own what they are feeling and meaning o Telling a sarcastic family member, “wow, you have a wicked sense of humor.” Acknowledging the issue that is problematic, but trying to build off of it to identify those family resources  Metaphors and Storytelling: • Used to help clients understand their roles (Cinderella)  Transforming Rules: • Looking at past family rules • Assisting clients to create more functional, less rigid guidelines • Challenging family of origin rules • Find more functional guidelinesexistentialcggdf

Theories and Phases of Treatment Flashcards

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