Theories of change / Therapy theories

Question 1

Psychodynamic Therapy

Answer 1

Change through insight and understanding of early, unresolved issues
• Insight oriented therapy
• A belief that psychopathology develops especially from early childhood
experiences
• Understanding the influence of the past on current behavior
• Explore client’s transference
• Identify defense mechanisms
• Non-directive, open-ended sessions based on free association
• Good for high functioning people capable of insight, relationship problems

Question 2

Behavioral Therapy

Answer 2

Behavioral Therapy
Change of behavior through reinforcements and punishment; good for children with behavioral problems; goal is to identify the problem, monitor behavior, reinforce desired behavior

Question 3

Positive Reinforcement

Answer 3

Occurs when a behavior
(response) is followed by a stimulus that is rewarding, increasing the
frequency of that behavior.

Question 4

Negative Reinforcement

Answer 4

Think of it as escaping -occurs when a behavior (response) is
followed by the removal of an aversive stimulus, thereby increasing that behavior’s frequency. Ex: Wife nags husband until he does something, then the nagging stops.

Question 5

Positive punishment

Answer 5

(punishment) Occurs when a behavior (response) is followed by a stimulus, such as introducing a shock or loud noise, resulting in a decrease in that behavior. Ex: spanking

Question 6

Negative Punishment

Answer 6

(Penalty) (also called “Punishment by Contingent Withdrawal”): occurs when a behavior (response) is followed by the removal of a stimulus. Ex: taking away a child’s toy following an undesired behavior, resulting in a decrease in that behavior.

Question 7

Token Economy

Answer 7

(Contingency Management) is an exchange system using the principles of operant conditioning where a token is given as a reward for a desired behavior. Tokens may later be exchanged for a desired prize or rewards such as power, prestige, goods, or services.

Question 8

Attachment Theory

Answer 8

A model for understanding how attachment to early caregivers affects our long term functioning
• How a caregiver responds to an infant/toddler’s cues shapes that child’s view of the world.
• Used to assess the bond between mother and child. Observing how child responds when caregiver leaves and returns to room.
• Poor attachment leads to indiscriminate attachment and lack of trust.

Question 9

Cognitive Therapy

Answer 9

Change through learning to modify dysfunctional thought patterns
• Clients explore patterns of thinking and beliefs that lead to self-destructive
behaviors.
• Once an individual understands the relationship between thoughts, feelings,
and behaviors, the individual is able to modify or change existing patterns of
thinking to cope with stressors in a more positive manner.
• Focus on automatic thoughts, schemas, assumptions, beliefs
• Good for Anxiety, Depression, Bipolar Disorder

Question 10

Solution Focused Therapy

Answer 10

Change through accessing client’s strengths and resources
• Brief, goal-directed therapy focused on client’s strengths and resources
• Focuses on what the client wants to achieve instead of focusing on the
problems
• Focuses on the client’s strengths and resources in order to create a more
effective future
• Miracle Question
• Good for short-term problems

Question 11

Gestalt Therapy

Answer 11

Change through increased awareness of here-and-now experience
• Focuses on the process, what is actually happening, and the content, what is
being talked about
• Emphasizes what is going on in the present moment within both the client
and the therapist rather than what has happened
• Empty Chair technique example of bringing issue into present moment

Question 12

Structural Family Therapy

Answer 12

Change through remodeling the family’s organization
• Many family problems arise as a result of maladaptive boundaries and
subsystems within the family system.
• A systems approach that address relationship dynamics of whole family
• 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.
• Enmeshed families known for incest
• Disengaged families known for substance abuse
• Good for families that are having problems with in-laws

Question 13

Bowen Family Therapy

Answer 13

Change through understanding multigenerational dynamics
• Individuals cannot be understood in isolation from one another but rather as
a part of their family.
• Family members are driven to achieve a balance of internal and external
differentiation, which causes anxiety, triangulation, and emotional cutoff.
• This can be changed by understanding multigenerational or current family
dynamics and patterns.

Question 14

Logotherapy

Answer 14

Change through finding meaning in life
• Founded upon the belief that it is the striving to find a meaning in one’s life
that is the primary, most powerful motivating and driving force.
• Understanding purpose

Question 15

Feminist Therapy

Answer 15

Change through recognizing disempowering social forces and empowering client
• The therapist helps the client recognize disempowering forces or influences,
a process which can ultimately empower the client.
• The therapist recognizes that with every symptom there is a strength, and
also shows the client that she is her own rescuer and equal to the therapist.
• Good for eating disorders

Question 16

Task Centered / Problem-solving Therapy

Answer 16

Task-Centered/Problem-Solving Therapy
Change through supporting clients to take actions to address the problems in their lives; Short term
• Focus of help is on client-defined problems and goals; Practitioner is open about purposes and nature of service, eschews hidden agendas.
• The client’s problems, goals, and the nature and duration of service are explicitly stated and agreed upon by both practitioner and client.
• Analysis of a problem leads to consideration of the kinds of actions needed to solve it, what might facilitate those actions, and obstacles standing in the way of their implementation
• Change is affected primarily through problem-solving actions or tasks the client and practitioner undertake OUTSIDE the interview. The practitioner helps clients select tasks.
• Practitioner facilitates task work through assisting the client in planning task implementation and establishing the motivation for carrying out the plan.
• Practitioner helps client rehearse and practice the task and analyze obstacles to its achievement.
• Reviews of the client’s accomplishments on each task allow the practitioner to provide corrective feedback on the client’s actions and serve as the basis for developing new tasks.
• Good for lower functioning individuals—schizophrenia, homeless

Question 17

Dialectical Behavior Therapy

Answer 17

Aims to change behavioral, emotional, and thinking patterns associated with dysfunction
• Developed to treat intense emotional swings, impulsiveness, confusion regarding the self (identity), and suicidal behavior
• Teaches mindfulness, interpersonal effectiveness, emotion regulation, distress tolerance, and self-management.
• Good for Borderline Personality Disorder

Question 18

Narrative Therapy

Answer 18

Change occurs by externalizing problem and creating a new narrative or story, which emphasizes the client’s competencies and strengths.
• Problems are viewed as separate entities from the client
• Therapist “externalizes” problem, separates it from client
• Highlights “unique outcomes” when the client could resist the problem
• Therapist “maps the influence” of the problem

Question 19

Trauma Informed Therapy

Answer 19

To be trauma-informed means to be aware of the complex impact of trauma on a client, including how it affects their efforts to cope. A trauma-informed approach integrates a thorough knowledge of this impact into every aspect of treatment.
• This includes having an understanding of not only the psychological impacts of trauma, but the neurological, biological, and interpersonal effects of trauma.
• A trauma-based approach includes the view of the client having been hurt by someone or something.
• Emotional/psychological and physical safety are crucial. Trauma treatments do not begin while the trauma is still actively occurring; safety must be established first.
• Treatment focuses on the client’s gaining back control and empowerment in their lives.

Question 20

Trauma Focused Cognitive Behavioral Therapy

Answer 20

Trauma Focused Cognitive Behavioral Therapy (TFCBT) is an evidence based treatment for children and adolescents used to treat the effects of trauma.
• TFCBT involves the child’s parents/caregivers, with individual sessions for both the child and the parents, as well as parent-child joint sessions).
• It helps reduce emotional and behavioral trauma symptoms and is a relatively short term treatment (generally 8-25 sessions).
• TFCBT includes three stages:
o 1. Stabilization: Stabilization skills are needed to help the child and parent tolerate the trauma processing that will occur in stage two. This stage includes psychoeducation, relaxation skills, and parenting skills.
o 2. Trauma narrative: The trauma narrative allows the child to tell the story of their trauma. Over the course of several sessions, the child gives increasing details of what happened during the traumatic event. It often begins with factual details and then moves into their thoughts and feelings from this time as well. This intervention both helps make sense of their experience and serves as a form of exposure therapy to the painful memories; over time as the child repeats their narrative, the emotional and physiological reactivity progressively decreases.
o 3. Integration and consolidation: This is the final phase of TFCBT and occurs after the creation and processing of the trauma narrative. It focuses on enhancing personal safety and future growth.

Question 21

EMDR

Answer 21

Alleviates symptoms of trauma through Eye Movement Desensitization and Reprocessing (EMDR) of trauma.
• This treatment is based on an 8 step highly structured protocol
• Based on idea that trauma overwhelms normal cognitive and neurological
coping
• Clients recall distressing images/memories while engaging in bilateral
stimulations/controlled eye movements
• Utilizes desensitization techniques
• Used for people who have experienced trauma and are still emotionally
effected by the event in some way
• Therapists must engage in thorough training and supervision before they can
offer EMDR treatment unsupervised.

Question 22

Exposure Therapies

Answer 22

Exposure therapies involve exposing the client to the source of anxiety in a safe environment. Exposure to the object of their fears allows them to overcome their anxiety.
• Exposure therapies are used to treat a variety of anxiety disorders including phobias, PTSD social anxiety, and even generalized anxiety.
• Exposure can be an intervention strategy used within cognitive behavioral therapy to help individuals confront fears.
• Systematic Desensitization is used to treat phobias. It involves the client being exposed to progressively more anxiety provoking situations/material as they are taught relaxation skills to manage their anxiety.

Question 23

Prolonged Exposure Therapy

Answer 23

Prolonged Exposure therapy is an evidence based treatment for PTSD.
• This therapy helps clients to gradually approach 1. their trauma-related
memories and subsequent feelings and 2. situations and places that cause
anxiety as a result of their trauma.
• Prolonged Exposure therapy uses imaginal and in-vivo (in person) exposure.
• Imaginal exposure includes the retelling of the trauma memory.