Treatment Planning Flashcards
AMERICAN INDIAN CLIENTS
Therapists working with American Indian clients should
- be familiar with relevant historical events
- build trust and credibility during initial sessions by demonstrating familiarity with and respect for the client’s culture and admitting any lack of knowledge
- adopt a collaborative, problem-solving, client-centered approach that avoids highly directive or confrontational techniques
- and incorporate elders and traditional healers into the treatment process
LaFromboise et al. (1990) recommend network therapy, which incorporates family and community members into the treatment process and situates an individual’s psychological problems within the context of his/her family, workplace, community, and other social systems.
ARAB AMERICAN CLIENTS
Effective therapies for Arab American clients include
- couple or family therapy
- cognitive-behavioral therapy
- psychoeducation
- and problem-solving approaches
Guidelines include:
- discussing what to expect from therapy and the therapist-client relationship in the initial session
- addressing concerns the client has about possible incompatibility of therapy with the client’s values and beliefs
- determining each family member’s level of acculturation and degree to which acculturation conflicts contribute to problems
- considering how religious or ethnic discrimination and hostility impact the client
- and considering whether to include culturally relevant rituals into therapy and/or consulting with traditional healers
ASIAN AMERICAN CLIENTS
Asian American clients may prefer a directive, structured, goal-oriented, problem-solving approach focused on symptom-alleviation. Therapists are seen as experts/authority figures.
Therapists should
- encourage clients to take part in identifying goals and solutions
- emphasize formalism in therapy
- establish credibility and competence early in therapy (e.g. disclose qualifying educational background/experience)
- prevent premature termination by providing immediate, meaningful benefits
- and be aware that mental health problems may be expressed as somatic complaints.
Cognitive-behavioral, solution-focused, and other brief therapies may be effective if modified to focus more on the family than the individual and consider cultural and social factors.
BEHAVIOR THERAPY
There is no single behavior therapy but, instead, a diverse collection of therapies and interventions that are based on the principles of
- classical conditioning
- operant conditioning
- and social learning theory
- emphasize current behaviors
- and adopt a scientific approach to assessment and treatment.
The primary goal of therapy is to alleviate the client’s problems by decreasing maladaptive behaviors and increasing more adaptive ones.
The therapist-client relationship is collaborative, and clients are expected to take an active role in therapy by participating in goal setting, monitoring their own behaviors, and learning and practicing new skills.
The process of therapy can be described in terms of the following steps -
- clarifying the problem
- formulating initial treatment goals
- describing the target behaviors that need to be changed to achieve treatment goals
- measuring each target behavior as soon as it is identified and at regular intervals during therapy
- identifying the antecedents and consequences that maintain each behavior
- designing and implementing a treatment plan
- and evaluating the success of the treatment plan
COGNITIVE-BEHAVIORAL THERAPY
Cognitive-behavioral therapy (CBT) is based on these assumptions:
- cognition mediates emotional and behavioral dysfunction
- modifying cognitions can change dysfunctional emotions and behaviors
- behavioral and cognitive strategies are both useful and can be integrated.
Beck’s CBT focuses on cognitive schemas, automatic thoughts, and cognitive distortions and proposes that each psychological disorder involves a different cognitive profile, e.g., depression involves the “cognitive triad” of a negative view of oneself, the world, and the future.
The primary goal is to modify the dysfunctional cognitions that maintain maladaptive behaviors and emotions.
CBT is structured, goal-oriented, and time-limited. It incorporates various strategies to achieve therapy goals, e.g., activity scheduling, behavior rehearsal, questioning the evidence, and cognitive rehearsal.
ADLERIAN THERAPY
Adler replaced Freud‘s emphasis on the role of instinctual drives in the development of personality with an innate tendency toward social interest, and he viewed mental disorders as being due to adoption of a mistaken style of life that is characterized by maladaptive attempts to compensate for feelings of inferiority, a preoccupation with achieving personal power, and a lack of social interest.
The primary goal of therapy is to help the client develop a healthy style of life that is characterized by social interest and a sense of belonging.
The process of Adlerian therapy can be described in terms of four phases —
- establishing a therapeutic relationship
- exploring the client’s style of life
- encouraging self-understanding
- helping with reorientation (making changes)
AFRICAN AMERICAN CLIENTS
Experts recommend the use of an ecological systemic approach when working with African American clients — for example, Boyd-Franklin’s (1989) multisystems model for African American families addresses multiple systems, intervenes at multiple levels, and empowers the family by utilizing its strengths.
Systems that may be incorporated into treatment include
- the extended family and nonblood kin,
- the church and
- other community resources, and
- social service agencies.
Experts also recommend
- using a time-limited, goal-oriented, problem-solving approach and
- fostering empowerment by promoting egalitarianism in the therapeutic relationship and
- helping the client develop the skills needed to increase the client’s sense of control over his/her life.
CYBERNETICS
The term “cybernetics” was coined by Weiner (1948) to describe systems that are self-regulating by means of feedback loops, which can be either negative or positive:
Negative feedback loops reduce deviation and help a system maintain the status quo, while
positive feedback loops amplify deviation and, thereby, serve to disrupt the system’s status quo.
EMOTIONALLY FOCUSED THERAPY (EFT)
EFT for couples is a brief empirically supported therapy that focuses on the role of emotion in a couples relationship and views relationship distress as the result of attachment insecurity that can be traced to early relationships in a partner‘s family of origin and that produces a predictable sequence of responses when the partner experiences disappointment, hurt, or fear in his/her relationship.
The primary goal of EFT is to expand and restructure the couple’s emotional experiences with each other so they can develop a secure bond and new interactional patterns.
Therapy is organized around three treatment stages:
- Assessment and Cycle De-Escalation
- Changing lnteractional Positions
- Consolidation and Integration
EXTENDED FAMILY SYSTEMS THERAPY
Bowen’s extended family systems therapy extends systems theory beyond the nuclear family and views behavior disorders as the result of a multigenerational transmission process in which progressively lower levels of differentiation are transmitted from one generation to the next.
The primary goal of therapy is to increase the differentiation of all family members. Therapy begins with the construction of a genogram, which depicts the relationships between family members, the dates of significant life events, and other important information.
The therapist often sees two members of the family (spouses) and forms a therapeutic triangle in which the therapist comes into emotional contact with the family members but avoids becoming emotionally triangled.
FREUDIAN PSYCHOANALYSIS
Freud described the personality as consisting of the id, ego, and superego, and Freudian psychoanalysis emphasizes the impact of unresolved unconscious conflicts involving the id’s impulses that occurred during a person’s childhood on the person’s current personality and behavior.
The primary goal of therapy is
- to reduce or eliminate pathological symptoms by bringing unconscious material into conscious awareness
- integrating previously unconscious material into the personality
- strengthening the ego so that behavior is determined more by rational processes than by instinctual drives.
The therapist acts as a “blank screen” in order to encourage the development of a transference relationship, and the therapist’s primary task is to analyze the client’s transference as well as his/her free associations, dreams, and resistances in order to facilitate the client’s catharsis and insight into the relationship between his/her unconscious processes and current behaviors.
The process of psychoanalysis involves four overlapping phases —
- opening phase
- development of transference
- working through transference
- resolution of transference
GENERAL SYSTEMS THEORY
General systems theory was proposed by the biologist von Bertalanffy (1968) who described a living system as “composed of mutually dependent parts and processes standing in mutual interaction” (p. 33).
He distinguished between two types of systems: A closed system has rigid, impermeable boundaries, does not interact with its environment, and is resistant to change
while an open system has permeable boundaries, interacts with its environment, and is adaptable and receptive to change.
Family therapists view families as primarily open systems.
GESTALT THERAPY
Gestalt therapists view neurotic (maladaptive) behavior as a “growth disorder” that involves an abandonment of the self for the self-image and is often due to a disturbance in the boundary between the self and the environment that interferes with the person’s ability to satisfy his or her needs and maintain a state of equilibrium.
The major goal of therapy is to help the client become a unified whole by becoming aware of and integrating the various aspects of the self,
and this goal is accomplished through the use of variety of techniques that are designed to lead clients toward greater awareness of their current thoughts, feelings, and actions, including games of dialogue, assuming responsibility, and dream work.
HISPANIC/LATINO CLIENTS
Hispanic/Latino clients often prefer an active, directive, and multimodal approach that focuses on the client’s behavior, affect, cognitions, interpersonal relationships, biological functioning, etc.
Therapy guidelines include
- emphasizing “personalismo” (except during initial contacts when “formalismo” is preferred);
- recognizing that differences in level of acculturation within a family are often a source of individual and family problems
- considering the impact of religious and spiritual beliefs
- being aware that Hispanic/Latino clients may express their mental health problems as somatic complaints
HUMAN VALIDATION PROCESS MODEL
Satir‘s human validation process model is an example of experiential family therapy and views maladaptive behavior as the result of the “interchange of low self-esteem. incongruent communication. poor system operations, and faulty family roles” (Henderson & Thompson. 2011. p. 502).
The primary goal of therapy is to enhance the growth potential of family members by raising their self-esteem and helping them communicate congruently and solve problems more effectively;
and the therapy process can be described in terms of six stages —
- status quo
- introduction of a foreign element
- chaos
- integration of new possibilities
- practice
- new status quo
Satir considered the therapist’s “use of the self‘ to be the key instrument of change and described the therapist as having multiple roles including role model, facilitator, mediator, advocate, and teacher.