Treatment Models Final Flashcards
Behavioral Parent Training
If parents change contingencies around problematic behavior, the child’s behavior will improve.
Operant conditioning.
Contingency Contracting
Behavioral exchange between people.
Who introduced the cognitive piece to cognitive-behavioral therapy?
Albert Ellis
Rational Emotive Therapy
Social Learning Theory (Bandura) and what it means about behavior
People learn through observation (ex. vicarious reinforcement).
What this means:
1) Behaviors aren’t necessarily changed by altering antecedents and consequences
2) Internal mental states instrumental to behavior change
3) Learning something new does not mean you are going to change.
1980’s CBT: Epstein, Baucom, Dattilio
1) how communication training affects couples
2) behavior contracts
3) cognitive restructuring
4) problem solving training
3 Distinct Directions of Behavior Family Therapy
1) Behavioral Parent Training
2) Behavioral Couples’ Therapy
3) Conjoint Marital Sex Therapy (sexual dysfunction from personal/interpersonal causes)
Unlike early MFT models, in BFT
Theory precedes practice
Key Principle of BFT
Behavior will change as contingencies of reinforcement are altered.
Not techniques but method of inquiry.
Assessing behaviors, thoughts, emotion around problem.
Underlying Assumptions of BFT/CBT
1) All behavior (normal and abnormal) is acquired and maintained in identical ways, inclusive of cognitions and affect.
2) Behavior disorders represent learned maladaptive behaviors only, no concern with underlying motives.
3) Maladaptive behavior (symptoms) is the disorder, not a manifestation of underlying problem.
4) Focus on here and now, unneccessary to discover where disorder was learned
5) Maladaptive behavior can be unlearned and replaced.
6) Treatment involved application of experimental findings, specified, objective, and easily replicate.
7) Assessment is ongoing part of treatment
8) Treatment outcomes are measureable chages.
How do symptoms develop according to BFT/CBT?
Caused by dysfunctional patterns of reinforcement, maintained by environmental events preceding and following each member’s behavior.
Events/contingencies along with mediating cognitions determine form and frequency of behavior.
No normative behavior.
See family as feeling burdoned by problem and unwittingly responding to this burden in way that maintains the poblem.
Goal of Behavior Therapy
1) Reduce or replace problematic behavior
2) Reinforce and augment/increase positive behavior
3) Education and thus empower clients to maintain positive changes and interrupt/replace problematic sequences of behavior and thought
4) Teach communication and conflict management skills
Defined by client
BFT Interventions
1) Clinical Procedures (ex. skills training)
2) Systematic desensitization
3) Reinforcement (pos. more effective)
4) Contingency contracting/management (agreements to make certain changes if other makes changes/giving and taking away rewards based on others behavior)
5) Modeling (done by therapist)
6) Shaping (intermediate steps to reach goal)
7) Cognitive restructuring
8) Token economics (use points to reward good behavior)
Set-up of BFT
Focus on changing dyadic interaction; not insistent on participation of entire family.
Role of BFT therapist
Educator = where personal skills acquired, not personal style
Trainer = think about issues in ways you are trying to make them change
2 levels of BFT Assessment
1) Problem analysis, one at a time
2) Functional analysis of target behavior (antecedents, consequences)
Includes assessment of strengths as well as weaknesses
Done through observation
Process of BFT
1) Establish therapeutic relationship
2) Develop positive expectancies = hope
3) Define client concern, increase clarity, break down behavior
4) Implement change
5) Client follow through (with intervention, issues with intervention)
6) Assess Progress
ALWAYS USE CLIENT FEEDBACK TO DETERMINE NEXT STEP IN PROCESS
Development of Behavioral Couples Therapy
Moved beyond exclusive focus of observable behaviors to include functional analysis of thoughts and feelings.
Howard Markman longitudinal research on causes of marital distress. Communication and conflict resolution preventive program.
Gottman and Kerokoff couple conflict
Markman predictors of marital distress:
1) Gender differences
2) Withdrawal
3) Escalation
4) Negative Interpretations
5) Invalidation
6) Erode the Positives
Why did cognitive-behavioral couples therapy arise?
From the belief that couples’ assessment and treatment is more complex than allowed for in purely behavioral approach.
Assessment must include behavior, cognitions, affect
Behavioral Factors in Marital Dysfunction
1) Exchange higher rate of negative behavior and lower rate of positive behavior
2) Use less effective and more aversive communication
3) Use less effective problem-solving skills
4) Use more coercive methods for trying to change partner’s behavior
Cognitive factors in marital dysfunction:
1) Assumptions about nature of partner and marriage
2) Standards about how partner and marriage should be
3) Attributions about causes of positive and negative events
4) Expectancies about likelihood that particular couples’ event will occur in future
5) Perceptions when observing own interactions with partner
Affective factors in marital dysfunction
1) Partner’s degree of positive and negative emotions toward partner and marriage
2) Partner’s awareness of emotions and causes of emotional states
3) Degrees to which partners express emotions and respond to each other’s emotional expression with empathic listening
4) Forms and intensities of affect that can interfere with good marital functioning
MRI Strategic more than just new type of therapy -
Process over content.
New conceptualization of interactions.
Premise of Communications Approach:
Process will give you insight into family rules and dysfunction.
Family rules based on regularity, not regulation.
All behavior communicates.
Now accepted by all family therapists.
Common factors to all Strategic approaches (MRI, Haley/Madanes, Milan/Systemic):
1) Downplay resistance
2) Therapy should be brief
3) Health premise
4) Change can occur suddenly and rapidly
5) Downplay intrapsychic process
6) Understanding and tracking sequences of interaction in the here and now.
7) Clear therapeutic goals
8) Anticipating how families might react to interventions
9) Creative use of directives
Foundation of MRI:
1) General Systems Theory = pos/neg feedback, change in subsystem affects others, equifinality, homeostasis, whole > sum of parts
2) Cybernetics
3) Communications Theory
4) Erikson’s methods of working with families
MRI: How individual symptoms maintained
Early research led to recognition that individual symptoms reflect family dysfunction.
These symptoms only persist if maintained by family system.
Feedback loop.
First formal family therapy training program
According to communications theory, every communication has 2 aspects: (MRI)
1) Report (content)
2) Command (relationship aspect) = defines report aspect; key to understanding what was said, nonverbal cues
Erikson’s Methods (influenced MRI)
1) Symptom-focused, not just tip of iceberg
2) Unconscious as seed of wisdom and creativity, free it from inhibition to help solve problems
3) Change action or context to get people to break habitual patterns
4) Hypnosis showed people could change quickly
5) Therapist’s responsibility to change client, not collaborative
6) Paradoxical techniques used to avoid client resistance
How do symptoms devleop according to MRI?
1) Solution to alleviate problem contributes to problem maintenance or exacerbation
Solution becomes the problem
2) Problems arise out of ordinary life; failure to adapt to change
3) Families seen as stuck in positive feedback loops to maintain homeostasis; what brings them to therapy
4) Respond to change as negative feedback; change is treated as a threat instead of an opportunity for growth
MRI Goals of therapy:
1) Break family’s repetitive but negatively self-perpetuating cycle so clients become more flexible in problem solving strategies
2) 2nd order change sought where system’s structure and function change so family is no longer stuck.
1st order change regarded as cosmetic fix and unlikely to last
3) Set clear, reachable goals so clients know when treatment is successful; will even conclude therapy if other problems are apparent
Practice of MRI approach:
1) Identify more of the same positive feedback loops that maintain the problem
2) Identify the rules that support these interactions
3) Find way to change rules
No speculation about function of the symptom or problematic boundaries or coalitions
In MRI, degree of stuckness determines intervention:
Less stuck = Use cognitive, straightforward manner
More stuck = Paradoxical intervention
When family is resistant to change and likely to use therapist’s analysis to confront each other outside of therapy
MRI Interventions
1) Prescribing the symptom
2) Relabeling (reframing)
3) Out-positioning
4) Restraining
Prescribing the symptom
MRI intervention
Prescribe family to continue or embellish the behavior they complain about.
Help family take step back and not do what therapist prescribes.
The network of relationships that maintain the problem will be exposed.
Relabeling (reframing)
MRI intervention
Frame problem as not a problem but protective.
Ask questions to unlock sequence, help family break it down and re-frame it on their own.
Ex. Child acting out as protecting parents from conflict
Out-positioning
MRI intervention
Talk about/exaggerate worse thing that could happen to help client see they are over-reacting.
Restraining
MRI intervention
Don’t want families to embrace change too quickly because might be overlooking things change would require.
“May not work right away” “Takes time” “Go slowly”
Want clients to go, “Oh no, we can handle it, we’ll do it quickly” (paradoxical)
MRI Brief Therapy Project (Weakland)
Generic model for how problems form (from attempted solutions) and how they can be effectively resolved.
Developed for all modalities.
Therapy can be brief.
MRI Brief Therapy Project: 3 ways in which family mishandles solutions
1) Action is necessary but not taken = family solution is to deny that problem exists
2) Action is taken when it shouldn’t be = Family solution is an effort to solve something that isn’t really necessary
3) Action is taken at wrong level = family solution is an effor to solve problem within framework that makes solution impossible (1st order change)
Goal of MRI Brief Treatment
Resolution of presenting problem.
Requires 2nd order change
Role of MRI Brief Therapist
Responsible for change.
Part of family, not an outsider looking in.
MRI Brief Treatment Set-Up
See whoever is motivated to attend.
No insistence that all family attend.
MRI Brief Treatment Process
1) Therapy presented as being of short duration (10 sessions). Gives hope for change.
2) Therapist thinks small, is satisfied with minor but progressive changes and tells clients to do the same.
Minuchin’s influence on Haley
Developed a belief in importance of hierarchal structure in families and focused on triad as unit that maintains family stability
Triad = be able to identify three levels of sequence and three levels of hierarchy
(vs. behavioral focus on dyad)
Madanes - Strategic Humanism
Expanded beyond problem-focused and structural goals to include more growth-oriented objectives like balance, harmony, and love
Similarities between MRI and Haley/Madanes
1) Sequences of behavior
2) Communication patterns (feedback loops)
3) Here and now (as opposed to past/intrapsychic)
Unique aspects of Haley/Madanes
1) Importance of hierarchal structure; functional structures with clear boundaries = assumption of sound family function
2) Functionalist emphasis on cybernetic and Eriksonian influences (symptom in individual serves function for family)
Use of power or control = function of symptom
3) Lengthened duration of sequences beyond S1 and S2 (ex. year to year)
4) Concept of stages in therapy; must approximate change over time
How Symtpoms Develop in Haley/Madanes
1) Regarded as strategies to adapt to current situation (vs. solve problem as in MRI)
2) Haley: Believed that control struggles were inevitable in relationships, thus focused on how power and control was expressed through the symptom (ex. ordeals)
3) Madanes: Symptoms as metaphors for internal states or interactional sequence
4) incongruous hierarchy = child involved in parental role, being one-up and one-down at same time
Individual is more disturbed in direct proportion to the number of malfunctioning hierarchies in which he is embedded.
5) Haley believed all symptomatic behavior is voluntary
Haley/Madanes Goals of Therapy
1) To improve/change the family’s hierarchal and boundary problems that support dysfunctional sequences
2) later, Madanes: focus on increasing balance, harmony, and love
Haley/Madanes Set-up
See whole family.
Needed for structural assessment so know how to intervene.
Haley/Madanes role of therapist
Responsible for change (like MRI) by the way one participates with the system
Therapist is highly directive and active.
Often takes authoritative stance, especially at start of therapy but ends with more egalitarian roles
Should not side consistently (unless causing a crisis) with anyone in the family against anyone else but temporarily for only way he can induce change
Process of Haley/Madanes
1) Approach therapy in stages
2) Interventions: directives, pretend techniques
Interventions for Haley/Madanes
Design strategy for each specific problem, with step-by-step tactics.
Directives = not advice giving but direct suggestions, coaching, homework, assignment of ordeal-like behavior
Paradoxical directive = flooding; an abnormal situation is made into a parody of that situation
Ordeals (Haley) = Price for keeping a symptom outweighs that of giving it up
Madanes known for pretend techniques
Major development in Milan/Systemic different from other strategic approaches:
Look at behavior AND meaning/cognition
Recursive
Why called Milan/Systemic?
Most consistent with Bateson’s circular epistemiology
Notion of information is central to how look at systems and families.
Information = the difference that makes a difference
Milan characterized by search for differences in behavior, families and perspective; efforts to uncover connections that link members and keep family/system in balance.
Premise of Milan/Systemic
Mental phenomena reflect social phenomena, thus a mental problem is really a problem in social interaction
Milan/Systemic circular epistemiology
Members caught in recursive patterns
Therapist can stay neutral because not there to say what’s good/bad
Linear thinking seen as incomplete.
Moral judgment (if any) is directed at pattern, not the person.
Therapist is also part of pattern he/she is observing (2nd order cybernetics)
Milan/Systemic use of Language in therapy
1) Use it to break out of linear thinking
2) stories, metaphor
3) Keep problems in context
4) Show how others are affected by problem in the family
5) Distinctions about labels so less pathologizing (aggressive vs. acting aggressively)
Tyranny of Linguistics (Milan/Systemic)
Keeps therapist and client thinking in linear terms because language itself is linear.
Must change language to look at problems more relationally.
“to seem” or “to show” in place of “to be”
Father is showing depression vs. Father is depressed.
Milan/Systemic relationship between meaning and action
Believed change in meaning brings change in action.
Positive reframes/connotations for explicit interventions.
Prescribe rituals for implicit interventions.
Introduce change in family’s belief system
How symptoms develop in Milan/Systemic
Symptoms = family efforts to maintain system’s homeostatic behavior
Seen as functional
Reactions to symptoms give useful information about how family is organized
Goals of Milan/Systemic Therapy
1) Change rules in order to change behavior (2nd order change)
2) Activate families to create new belief or behavior
3) Less behavioral than other strategic; designed to expose covert collusions and reframe motives for strange behavior
Set-up of Milan/Systemic
See entire family
When impasse reached, involve others in therapy, either family member or team member to increase consultation
Frequency of sessions = monthly
Milan/Systemic Team Approach
1) Pre-Session = hypotheses for circular patterns
2) Interview = 50-91 min., 1-2 therapists
3) Intersession = 15-45 min. team discusses families, new hypotheses
4) Intervention = 5-15 min. therapist delivers teams conclusions and quickly ends session
5) Post-Session = 5-15 min. analyze familiy’s reaction to intervention and plan for next session
Milan/Systemic Interventions
1) Positive connotation
2) Ritual
3) Help family come up with own hypotheses so not imposing therapist’s hypotheses on them
4) Circularity
5) Neutrality
Milan/Systemic Positive Connotation
Reframing symptoms as serving a protective function.
Avoids implication that family members benefit from the patient’s symptoms but as preserving the family’s overall harmony
Milan/Systemic Ritual
Interrupt family’s patterns; promote new way of doing things (and thus alter meaning)
Engage families in a series of actions that run counter to or exaggerate rigid family rules and myths.
Detailed, exact, roles for everyone
Dramatize positive connotations.
Milan/Systemic Circularity
Undermine family’s belief system by using the language of relationship, not of “what is”.
“if” questions and future-oriented questions that imply patterns, not facts.
Circular questions, how it’s all related.
Nurtured by curiosity.
Milan/Systemic Neutrality
Therapist should not allign with any one person, not say if good/bad to hold a certain position in family.
Often manifest as distance until altered by Milan Associates to mean a stance of curiosity.
Therapeutic responsibility begins with seeing your own position in the system.
Post-modern approach of Milan Associates
1) Emphasized neutrality as more effective way to quietly challenge families; CURIOSITY
2) Therapist and family seen as mutually influencing forces, producing opportunity for change as by-product; more collaborative
3) Therapist not responsible for particular outcome (unlike Haley and MRI) but role is to perturb the system so family finds own answers
4) Believed that system does not create problem but problem creates the system (opposite of Minuchin)
Interventions of Milan Associates
Circular questions with goal of eliciting difference:
- Difference in perception of relationships
- Difference in degree
- Now/then differences
- hypothetical or future differences
Less strategic
Selvini-Palazzoli’s Invariant Prescription
For very stuck families
Goal=to unhinge collusive parent-child patterns by strengthening the parental alliance and reinforcing the boundary between generations.
Difference and Similarities between Collaborative Language Systems Approach and Narrative Therapy
Collaborative Language Systems does not have a preferred outcome/story
Similarities:
1) Explore meaning - generate conversations
2) Regard therapy as collaborative
Why collaborative in Collaborative Language Systems Approach
Assume that clients are not heard when therapy is done to them.
New meanings should emerge from holding empathic conversations
How Symtpoms Develop in Collaborative Language Systems Approach
1) Created through language
2) Not fixed entities
3) Stories people have agreed to tell themselves
4) IMPORTANT: Social utility the stories play in explaining one’s life
5) Symptoms create system (like Milan)
Goals of Collaborative Language Systems Approach
1) To dissolve problems in conversation by co-creating stories that open up new possibilities
2) Established by client
Role of therapist in Collaborative Language Systems Approach
1) Not narrative editor of client story, but in language with client as learner
2) Therapist taught by client who is in-the-know and the expert
Process of Collaborative Language Systems Approach
1) Emphasis on careful dialoguing about problem; hope new feelings emerge
2) Therapist begins without any ideas about what should or should not change; no presession hypothesizing
3) Therapy is reconstructive, intending to free client from particular self-account and open way for adopting alternative accounts of themselves.
Intervention used by Collaborative Language Systems Approach:
Use of team behind mirror.
1) Creation of “as if” team: client chooses a team member to listen as client’s mother and another member as client’s husband
2) Actual family members give feedback to client as to how they thought client talked
How schizophrenia observations and studies led to creation of Psychoeducational Approach:
1) Hospitalized schizos frequently relapsed when released to custody of family at discharge.
2) Existing interventions, including family therapy, did not stave off rehospitalization
3) Studies on expressed emotion show that highly charged emotional exchanges increased likelihood of relapse
4) Expressed emotion (criticism, hostility, and emotional over-involvement) leads to emotional arousal and this overload triggers relapse
Shift in problem formulation in Psychoeducational Approach:
1) Shift from family causing problems to problems happen to family
2) Usual search for causes within family only around guilt and defensiveness and sometimes resulted in either relapse or failure
Goal of Psychoeducational Approach
To supplement and renew family resources.
To build on family strengths.
Goal is for symptoms to be reduced rather than cured.
Create hope that can have reasonable family life.
Role of Psychoeducational therapist
Collaborative partner
Set-up for Psychoeducational Approach
Work with individual family.
Work with multi-family groups.
Process of Psychoeducational Approach
Emphasize skills, problem management, and explicit description of treatment goals (ex. CBT)
Lower expectations to reduce pressure on the patient to perform normally.
Anderson’s phased interventions for the Psychoeducational Approach:
1) Engage family
2) Set educational programs (1 day skill survival workshops where families learn about schizophrenia and about expressed emotion findings)
3) After discharge, regular out-patient sessions for one year or more to help achieve stability outside hospital (ex. structural treatment)
McFarlane Multi-Family Group intervention in Psychoeducational Approach
1) Support from other families felt in way therapist can’t give; level of empathy
2) Go slow, set limits
3) Solve problems step by step
4) Ignore what can’t change
5) Pick up on early signs
6) Other family members should carry on with business as usual
Constructivism and Social Constructivism
Constructivism = no objective reality, only what we create in our minds
Social constructivism = influenced and constructed by interpretations of context and social interactions
Narrative Theory
1) Elevated meaning to primary importance over behavior
2) Family seen as product of particular client assumptions
3) Therapist more humble, collaborative, but still a leader
4) Increased attention to values behind family assumptions and behind therapist’s own assumptions
5) Trust client resources; valuable to therapy
Narrative metaphor in Narrative Therapy
Understanding how experience creates expectation and how expectations then shape experience through creation of organizing stories
Question not about truth but about which points of view are useful and which lead to preferred effects/stories for client.
In the service of self-coherence.
Ask client to reexamine problematic stories
White’s post-structural view of self in Narrative Approach
The “self” as socially constructed phenomena, not on inside but through interaction.
Self emerges when interpersonal conversations are internalized as inner conversations.
Inner conversations are then organized into stories by which we understand experience.
Narrative Therapy’s view of power
Foucalt: People with power define people’s lives by creating dominant stories people must live within.
Treatment as a political process.
Concerned with role of therapist’s power at client’s expense.
Dominant stories affect client’s lives
Deconstruct stories so people can separate out their sense of self from dominant (problem-saturated) story.
Basic Assumptions of Narrative Therapy:
1) People do not need or want problems; People have good intentions, so appreciated client resources
2) People are profoundly influenced by discourses around them (dominant stories)
3) People are not their problems; focus on language
4) People can develop alternative, empowering stories once separated from their problems and from internalized cultural myths (externalize symptom and develop personal agency)
How Symptoms Develop in Narrative Approach
1) Problems arise due to narrow and self-defeating view of self (the problem-saturated story)
2) Problem is not inherent in the client; there is no functionalist element to system
3) Not interested in cause of problem but in how the problem negatively impacts the client’s life.
4) Narrative therapist has no constructs for what is normal abnormal
Goals of Narrative Therapy
Defined by client (like strategic)
Alter the problem-saturated story to reflect a perferred narrative for client; Reduce totalizing views of other family members
Access client’s healing initiatives to resolve presenting problem through:
1) Learning about the storied nature of human experience/problem
2) Learning to value own personal life experiences and stories without automatically deferring to normative stories; client separates
3) Learning the externalization process to address future problem-saturated stories; re-author their lives
Role of Narrative therapist:
Collaborative yet directive due to clear and consistent therapist agenda to change story.
Situate self with client.
3 Stages of Narrative Therapy
1) Recast problem as an affliction by focusing on effects, not causes of problem
2) Find unique outcomes (when problem isn’t the problem) or sparkling events when client has triumphed over the affliction to show that change is possible (provide hope)
3) Recruitment of support
Stage 1 of Narrative Therapy: Recasting problem by focusing on effects
1) Problems are personified and seen as entities that feed on polarizations and misunderstandings (alien invaders)
2) Map influence of problem on client
3) Map influence of client on problem
Stage 3 of Narrative Therapy: Recruitment of support
Client’s efforts at reauthoring shown by evidence of competence over the problem
Reinforcement of new story by finding audience to support progress
Interventions of Narrative Therapy:
1) Set of questions regarding relative influence of therapist’s power to augment externalization (refer to problems as alien invaders)
2) Reconstruction/Reauthoring = creating new and more optimistic accounts of experience; often by using past victories over the problem as evidence to bolster new self-narrative
3) Witnessing or writing letters to reinforce client’s new story; sense of being cheered on
4) Deconstructing destructive cultural assumptions = make the connection to cultural narrative more explicit
Deconstruction questions in Narrative Therapy
Who says this is problem
What are effects of problem
Helps clients unpack their stories to see them from different perspectives
Help externalize the problem
Opening Space questions in Narrative Therapy
Opening space in client to see he/she could have better life; doesn’t have to be this way
Highlight unique outcomes
Preference questions in Narrative Therapy
Stand up to problem vs. giving in to it
Make sure unique outcomes represent preferred experiences
Postconstructuralism
Don’t believe in any internal structures that might determine behavior
Solution-Focused therapy
Focus and assumptions of Solution-Focused Therapy
Focus: cognitions and behavior
Assumptions:
1) Language determines meaning, so need to change language to change meaning
2) There are multiple perspectives of reality; thus non-normative
3) Client already knows what they need to do to solve complaints
4) Rejection of resistance; clients come to therapy to cooperate and may only resist therapist’s interpretation or intervention
5) Small change is all that is needed (snowball)
6) Change is inevitable; issue is when
7) Effective treatment can be done without therapist knowing the presenting problem
8) Focus on future
How symptoms develop in Solution-Focused Therapy
1) Arise from faulty attempts at problem solution (like MRI)
2) Client seen as “stuck” (like MRI)
3) Client constrained by narrow views of problem and thus perpetuate rigid patterns of false solutions
General goal of Solution-Focused Therapy
Defined by what client wants different in their lives
Start solution process - shift context from complaint narrative to solution narrative
Workable goals of Solution-focused therapy:
1) Small rather than large
2) Salient to client
3) Described in specific, concrete behavioral terms
4) Achievable within practical context of client’s life
5) Perceived by client as involving hard work (not easy but doable)
6) Described as start of something rather than end of something
7) Treated as involving new behaviors rather than absence or cessation of existing behaviors
Role of Solution-focused therapist
Active in moving client away from worry about predicaments and toward steps to solution
See anyone interested in presenting problem.
Coach and guide.
2 fundamental strategies of solution-focused therapy
1) Develop well-defined goals in client’s frame of reference
2) Generate solutions based on exceptions
Assessment of category of client-therapist relationship in solution-focused therapy
Pre-treatment stage
These qualities of the therapeutic relationship are fluid
1) Visitor = just checking it out
2) Complainant = Not interested in looking for solutions
3) Customer
Solution-focused therapy interventions:
1) Questions about perceptions (not feelings)
2) Giving compliments (should point to what to do more, not what to eliminate)
3) Specific assignments
4) Problem description including previous attempts
5) Goal setting by helping client think of constructive actions they can take
Solutions-focused questions about perceptions:
1) Exception-finding qustions (provide hope)
2) coping questions (show clients that by simply enduring they are are more resourceful than they realize)
3) Miracle questions (use when difficult to find a workable goal)
4) Scaling questions (1-10), used to assess progress as well as pick realistic goal
Specific assignments in Solution-focused therapy:
1) Formula first-session task = what do you want to have happen more often?
2) Prediction task = predict exceptions, create mindset to expect exceptions
3) Generic formula tasks = do something different, make an exception
4) Do more of what works
5) Do the opposite (notion that many problems are maintained by attempted solutions)
Termination of solution-focused therapy
1) When goals are accomplished
2) When client has learned solution process or new relationship between problem and solution
Cognitive Distortions
Resulting from schemas (subconsciously bias beliefs) developed throughout childhood that may cause symptoms
1) Magnification and Minimization (giving too much or too little importance to events)
2) Arbitrary inference (jumping to conclusions without evidence)
3) Selective abstraction (certain details are highlighted while other important info is ignored)
4) Overgeneralization (Isolated incidents taken as patterns)
5) Personalization (events are arbitrarily interpreted in reference to oneself)
6) Dichotomous thinking (all good/bad)
7) Labeling and mislabeling (behavior attributed to undesirable personality traits)
8) **Mind reading **
Intervention questions used in Narrative Therapy
1) Deconstruction
2) Opening Space
3) Preference
4) Story Development
5) Meaning
6) Questions to extend story into future (Stage 3) aka who will see and value it in future
1-6 occur relatively sequentially
7) Relative Influence
Re-Authoring as intervention in Narrative Therapy
Therapist asks client what past victories over the problem say about the client.
Evidence of competence can serve as the start of new narratives
Behavior Exchange Theory
A good relationship is one in which giving and getting are balanceed (high ratio of benefits to costs)
Affection, communication, and child care most important elements of marital satisfaction
Type of reinforcement most resistant to extinction is:
Intermittent Reinforcement
Premack Principle (in BFT/CBT)
High-probability behavior (popular activities) is chosen to reinforce behavior with a low probability of occurrance.
Goals of CBT Family Assessment
1) Identify strengths and problems
2) Place individual and family functioning in context of developmental stages
3) Identify cognitive, emotional, and behavioral aspects of family interaction that might be targeted for intervention
Dattilio’s Two sets of schemas about family life
1) Related to parents’ experiences growing up in their own families
2) Related to families in general, or personal theories of family life
Family member’s individual schemas are usually either similar or complementary
2 General categories of intervention in CBT
1) Substituting positive for aversive control
2) Skills training
Madanes Pretend Technique
paradoxical
family members asked to pretend to engage in symptomatic behavior
by pretending to have a symptom, the symptom cannot be real
Sequence of Madanes use of metaphor:
1) Change the meaning of the metaphorical action by replacing symptom with another action so new metaphorical action has a positive function in family without the consequences of symptomatic behavior
2) Change the action of the symptomatic member
3) Change the metaphorical solution so that nonsymptomatic famiy member does not need the symptomatic behavior of the member involved in steps 1 and 2 (render the symptoms unneccessary)
Milan/Systemic Hypothesizing
Used to try and maintain stance of curiosity.
Metaphor of story telling.
Milan/Systemic view of evolving systems
Systems are always changing or evolving and only appear to be stable.
Family patterns evolve through trial and error and members construct a social reality to explain pattern.
Reflexive of relationship between meaning and action.
Therapist tries to identify points of apparent “stuckness” at which new “connectedness” are introduced to liberate the family to continue to evolve without the need for symptoms.
Postmodernism
Doubt whether absolute truth can ever be known
Feminist Critique of cybernetics and FT
Cybernetics blamed the victim and rationalized the status quo, ignoring emotionally isolated, economically dependent, and overresponsible positions in familes as factors.
Reexamine roles.
Set of core skills for Relationship Enhancement programs
1) Expressive (owning) skill
2) Empathis responding (receptive) skill
3) Conversive (Discussion-negotiaion/engagement) skill
Language in solution-focused therapy
Problem-talk is negative, focuses on the past, and often implies the permanence of problems; thus avoid discussion of etiology of problems
vs.
Language of solutions is more hopeful and future-oriented
MRI vs. Solution-focused
1) do less of what doesn’t work vs. do more of what does work
2) focus on behavior vs. focus on cognition AND behavior
3) urge clients to DO things differently vs. urge clients to VIEW things differently
Relative Influence questions in Narrative Therapy
Explore how the problem has managed to disrupt or dominate the family vs. how much they have been able to control it
Story Development questions in Narrative Therapy
To develop a new story from the seeds of (preferred) unique outcomes
Meaning questions in Narrative Therapy
To challenge negative images of self and emphasize positive agency
Future questions in Narrative Therapy
To support changes and reinforce positive devleopments
