Treatment Planning Flashcards
1
Q
Theory: Psychodynamic:
Assumptions
A
- Humans have a powerful unconscious mind
- Behavior is mostly driven unconsciously
- Awareness will bring change
2
Q
Theory: Psychodynamic:
Defining the Problem
A
- Unresolved childhood conflict
- Typically unconscious
3
Q
Theory: Psychodynamic:
Goals of Therapy
A
- Resolve childhood conflict
- Bring unconscious material into conscious awareness (make the unconscious conscious)
4
Q
Theory: Psychodynamic:
Interventions
A
- Explore - open ended questions
- Also free association techniques
- Offering insight - therapist observations - used sparingly
- Interpretation - applying meaning to behavior, dreams, decisions, or anything else
5
Q
Theory: Psychodynamic:
Role of Therapist
A
- Expert
- Blank slate - so that a client can project unconscious material onto you
6
Q
Theory: Psychodynamic:
Key Concepts
A
- Id, Ego, Superego
- Superego keeps the Id in check
- Ego is the mediator
- Defense mechanisms
- Transference
- Countertransference
7
Q
Theory: Psychodynamic:
Defense Mechanisms
A
- Repression - removing troubling thoughts or memories from conscious awareness
- Denial - blocking immediate events from entering conscious awareness
- Projection - attributing your own traits, thoughts, or feelings to someone else
- Regression - in times of stress, falling back to earlier behavior patterns
- Displacement - acting out against a safer target
- Rationalization - distorting facts to make them less threatening (ex. I had no choice)
- Reaction formation - behaving in direct opposition to one’s true (and threatening) beliefs
- Sublimation - generally considered the healthiest defense mechanism, this involves satisfying an urge or drive in a socially acceptable way
8
Q
Specific models: Psychoanalytic:
Attachment Theory
A
-A model for understanding childhood behavior
9
Q
Attachment Theory:
Key concepts
A
- Early childhood bonding events set attachment style
- Caregiver responses set child’s interval working models of thought, emotion, social behavior
- A good amount of childhood behavior is designed to maintain proximity to attachment figure
10
Q
Attachment Theory:
Tx Models and Techniques
A
- Several models of therapy for children rely on attachment theory concepts (child parent therapy, circle of security)
- Focus on facilitating appropriate parental responses
- Examination of parent and child history
- Parent training
- Joint play, facilitated by therapist
11
Q
Object Relations:
Key Concepts
A
- “Objects” are internal representations
- “Object relations” are mental representations of:
- Object as perceived by self
- Self in relation to object
- Relationship between self and object
- As infants, we split objects into good and bad
- As we grow and mature, integrate to cohesive whole
12
Q
Object Relations:
Techniques
A
- Insight-oriented therapy - awareness of split or repressed objects and efforts to integrate
- Psychoanalytic techniques
13
Q
Specific models: Psychoanalytic:
Self Psychology
A
All 3 are:
Attachment Theory
Object Relations
Self Psychology
14
Q
Self Psychology:
Key Concepts
A
- Self
- Selfobject
- Selfobject-function
- Optimal frustation
15
Q
Self Psychology:
Techniques
A
- Empathy (“vicarious introspection”)
- Typical psychoanalytic techniques; differences are in underlying philosophy
16
Q
Theory: CBT
Key Concepts
A
- Classical conditioning
- Operant conditioning
17
Q
Theory: CBT
Assumptions
A
- The cognitive triangle:
- Faulty thinking leads people to feel a certain way, impacting their behavior
- Thoughts can be changed, behavior can be unlearned
- Dysfunctional patterns are caused by prior experience
18
Q
Theory: CBT
Role of the Therapist
A
-Expert
19
Q
Theory: CBT
Key Concepts
A
-Schema - Global constructions of one’s character
20
Q
Theory: CBT
Interventions
A
- Cognitive Restructuring
- Charting (thought record, log, or journal)
- Disputing irrational beliefs
- Thought-stopping/though replacement
- Psychoeducation
- Logical Fallacies
- Overgeneralization
- Catastrophizing
- Black and white thinking
- Fortune telling
- Pst hoc propter hoc (bc one thing happened, after another, it happened bc of that thing)
- There are many more
- Behavior modification
- Shaping
- Desensitization/exposure
- Mindfulness
- Token economy
21
Q
Specific models: CBT Based
-DBT-Dialectical Behavioral Therapy
A
- Aims to create stability by helping people hold together dialectics, or conflicting ideas that coexist
- Therapeutic relationship is a key driver of change
22
Q
DBT-Dialectical Behavioral Therapy:
Goals
A
- Functionality
- Acceptance
- Motivation
- Skills
23
Q
DBT-Dialectical Behavioral Therapy:
Methods
A
- Individual therapy
- Group skills training
- Phone sessions for crisis
- Consultation for care providers
24
Q
DBT-Dialectical Behavioral Therapy:
Skills being taught and practiced
A
- Mindfulness
- Interpersonal effectiveness
- Distress tolerance
- Emotional regulation
25
Specific models: CBT Based
| -Rational-Emotive Behavior Therapy (REBT)
- Philosophically holds that events aren’t good or bad
| - How we think about events causes emotional difficulty
26
Rational-Emotive Behavior Therapy (REBT)
- Core philosophies that lead to disturbance:
- Self- I must always perform well
- Others - Other people must always treat me well
- Conditions under which I live must always be easy
- A-B-C-D-E-F Model of disturbance and change
- Therapy helps clients identify, dispute irrational beliefs
- Examples include demands, awfulizing, low frustration tolerance, depreciation
- Avoid shoulds, musts, oughts when absolute or rigid
27
Rational-Emotive Behavior Therapy (REBT)
:
| Interventions
- Identify target problems, values, and goals
- Examine problems for irrational beliefs
- Work actively and forcefully against irrational beliefs
- Ultimately achieve self-acceptance, other-acceptance, life-acceptance
28
Theory: Humanistic:
| Assumptions
- People are inherently good
- People inherently want themselves and the world to be better
- People determine the course of their own lives
- Therapist as collaborator, not expert
29
Theory: Humanistic:
| Interventions
-Primary Intervention: Therapist style/way of being
30
Theory: Humanistic:
| Key Concepts
- Warmth
- Empathy
- Genuineness
- Acceptance
- Unconditional positive regard
31
Theory: Humanistic:
Interventions:
Gestalt
- Empty chair
| - Active confrontation
32
Theory: Humanistic:
Interventions:
Existential
-Here and now
33
Theory: Humanistic:
| Intervention (All 3):
-Modeling authenticity
34
Theory: Humanistic:
| Role of the Therapist (All 3):
-Collaborator: The client is the expert on their own life
35
Specific models: Humanistic
- Client Centered Therapy
- Gestalt Therapy
- EFT (Emotionally Focused Therapy)
36
Client Centered Therapy(Also known as person centered therapy):
Key Concepts
- Humans are naturally self-actualizing
- Clients have the answers within themselves
- Therapist’s job is to create conditions for change
37
Client Centered Therapy(Also known as person centered therapy):
Conditions for change
- Accurate empathy
- Unconditional positive regard
- Self-congruence
- Therapist-client psychological contact
- Client incongruence
- Client perception of therapist UPR(Unconditional positive regard) and AE(Accurate empathy)
38
Gestalt Therapy:
| Key Concepts
- Gestalt (whole)
- Unfinished business
- Paradox of change
39
Gestalt Therapy:
| Techniques
- Empty chair
- Role play
- Fantasy
- Experiments (safe emergencies)
40
EFT (Emotionally Focused Therapy)
-Developed as a couple therapy model, expanded to families
41
EFT (Emotionally Focused Therapy):
| Key Concepts
- Attachment as a lifelong process and need
- Many relationship problems are efforts to meet attachment needs safely
- Attachment injuries
- Primary and secondary emotions
42
EFT (Emotionally Focused Therapy):
| Therapeutic process
- 9 steps in 3 stages
- De-escalation
- Changing interaction cycles
- Consolidation
43
EFT (Emotionally Focused Therapy):
| Key Change Events
-Blamer softening, withdrawer re-engagement
44
EFT (Emotionally Focused Therapy):
| Techniques
- Heightening
- Empathetic conjecture
- Evocative responding
- Validation
45
Theory: Systems
| Primary Systemic Therapies
- Bowen
- Structural
- Experiential
- Strategic
46
Traditional Psychotherapy
- Psychodynamic
- CBT
- Humanistic/Existential/Gestalt
47
Departure in Systems
- Contextual
- The individual cannot be understood outside of their context
- De-emphasis on childhood, unconscious
- Less concern with examining an individual’s internal world
48
Systemic Therapy’s Origins
- Cybernetics
- Communication constantly influences both sides
- General Systems Theory
- How biological systems thrive in an environment
49
Key Systemic Assumptions
- Individuals are members of complex systems
- Complex systems are governed by rules
- Behavior can be understood as the product of those rules
- Human suffering is either necessary for systemic functioning, or a result of too
50
Key Concepts in Family Systems Theory
- Identified Patient: Symptom holder for pathology is the system
- Homeostasis
- Boundaries and subsystems
- Common subsystems: parental, partner, sibling
- Rigid/diffuse boundaries
- Open versus closed systems
- Overt and covert rules
- Roles
- Power and hierarchy
- Feedback loops
- Positive loops move away from stability (change a homeostasis that isn’t working anymore)
- Negative loops move toward stability (get back to homeostasis that is working)
51
Systemic models:
Structural:
Key Concepts
- Power
- Enmeshment
- Alignments (+) and coalitions (-)
- Rules, roles, and hierarchy
- Boundaries and subsystems
52
Systemic models:
Structural:
Goal of Therapy
- Fix the family structure
- Organize subsystems
- Redistribute power
- Repeal outdated rules
53
Systemic models:
Structural:
Role of the Therapist
- Coach
| - Disruptor
54
Systemic models:
Structural:
Goals by Stage
- Early stage goals: Joining and accommodating
- Join w family
- Accommodate to rules, patterns, structure
- Assess family structure and boundaries
- Assessment Process
- Family map
- Observation
- Middle stage goals
- Re-establish parental subsystem and generational hierarchy
- Strengthen spousal subsystem
- Develop clear boundaries among all subsystems
55
Systemic models:
Structural:
Interventions
- Enactment
- Acting out a family interaction in session
- Unbalancing
- Tracking
- Reframing
- Circular questioning
- Boundary demarcation (boundary making)
56
Systemic models:
Strategic:
Key Concepts
- Informed by communications theory
- Everything in communication
- Circular causality
- Black box
- Double bind
57
Systemic models:
Strategic:
Role of Therapist
- Expert
| - Focus on outsmarting a resistant system
58
Systemic models:
Strategic:
Defining the Problem
- The problem is the problem
| - Take family definition of the problem at face value
59
Systemic models:
Strategic:
Interventions
- Paradoxical injunction
- Directives
- Prescribing the symptom
- Ordeal
- Ritual
60
Systemic models:
| Experiential
-Experiential therapies believe that the experience of therapy itself will serve as the agent of change
61
Systemic models:
Experiential:
Key Concepts
- Largely rooted in Humanistic and Existential ideas
| - Assumption: Human beings are fundamentally good
62
Systemic models:
Experiential:
Defining the Problem
- The problem is suppression of the true and natural person
- Inauthentic communication
- Satir’s model has been named in a number of ways, including as a “Communications Approach”, the “Human Validation Process Model,” and the “Satir Growth Model.” She also used the simpler title “Peoplemaking” in one of her books.
63
Systemic models:
Experiential:
Role of the Therapist
- Consultant
| - Caring, accepting, validating of any form of honest expression
64
Systemic models:
Experiential:
Goals of Therapy
- Improve self-esteem
- Become choiceful and intentional
- Become responsible and accountable
- Become congruent
65
Systemic models:
Experiential:
Communication Stances
- Stances sometimes labeled “survival stances” because they are ways of protecting self-worth
- Blamer
- Placater
- Super-reasonable
- Irrelevant
- Normal and healthy: congruence
66
Systemic models:
Experiential:
Goals by Stage
- Early stage goals: Making contact
- Establish rapport and hope
- Assess communication stances and patterns
- Identify treatment focus and goals
- Middle stage goals: Chaos
- Increase congruent communication
- Strengthen each individual’s self-esteem
- Late stage goals: Integration
- Practice, use, and integrate changes
- Increase knowledge of problem issue and family patterns
- Solidify a new way of functioning including openness to possibility
67
Systemic models:
Experiential:
Interventions
- Family sculpting
- Parts party
- Family drawing
68
Systemic models:
| Emotionally Focused Therapy
- Susan Johnson’s model, initially developed for couples
- Focus on attachment injuries and attachment science
- Goal is to alter a couple’s interaction pattern
- Resolve attachment injuries
- Establish secure attachment bond
69
Systemic models:
Emotionally Focused Therapy:
Stages
1. De-escalation
2. Changing interactional patterns
3. Consolidation and integration
70
Systemic models:
Emotionally Focused Therapy:
Interventions
- Reflection and validation
- Evocative responding
- Heightening
- Empathetic conjecture
71
Systemic models:
Emotionally Focused Therapy:
Key Change Events
- Blamer softening
| - Withdrawer re-engagement
72
Systemic models: Multigenerational (Bowen):
| Key Concepts
- Emphasis on family of origin
- Differentiation and fusion
- Chronic anxiety
73
Systemic models: Multigenerational (Bowen):
| Eight Core Concepts
- Differentiation/fusion
- Differentiation: I can be fully myself in the presence of others
- Fusion: My ability to be okay depends on the well-being of others
- Undifferentiated family ego mass
- Triangles
- Nuclear family emotional process
- Family projection process
- Multigenerational transmission process
- Cutoff
- Sibling position (birth order)
- Societal emotional process
74
Systemic models: Multigenerational (Bowen):
| Role of Therapist
- Expert: Educator and coach
| - Should be a non-anxious presence (in other words, the therapist needs to be well differentiated)
75
Systemic models: Multigenerational (Bowen):
| Interventions
- Genogram
- Psychoeducation
- Communication skills - “I” statements
- Detriangulation
- Family of origin work: going home again
76
Theory and models: Multigenerational:
| Postmodern Approaches
- Label for several theories w common philosophy
- Narrative Therapy
- Solution Focused Therapy
- Collaborative Language Systems
77
Theory and models: Multigenerational:
Postmodern Approaches:
Concepts
- Reality cannot exist independently of observation process
- Problem exist when people say that a problem needs to be addressed
- Social constructionism - focus on meaning-making
- Problem saturated story
78
Theory and models: Multigenerational:
Postmodern Approaches:
Methods
- Changing client meanings through dialogue
- Deconstruct common beliefs, examine their value. Look for times when existing language doesn’t fit
- Externalization (Narrative) - Through language, separate person from dx
- Deconstruction(Narrative, CLS)
- Moving problem talk to solution talk (Solution Focused)
- Creation of new, more accurate language around the problem
79
Theory and models: Multigenerational:
Postmodern Approaches:
Role of Therapist
- Philosophical position less defined by function, more by way of being
- Source of optimism and hope
- Collaborator
- Non-expert as to clients’ experience; expert on the process of change
80
Theory and models: Multigenerational:
Postmodern Approaches:
Interventions: Narrative Therapy
- Locating unique outcomes
- Externalization
- Mapping influence/statement of position map
- Situating comments
- Reflecting teams
- Letters, certificates, definitional ceremony
81
Theory and models: Multigenerational:
Postmodern Approaches:
Interventions: Solution Focused Therapy
- Formula first session task: Notice what happens with your (relationship, family, whatever brought you to therapy) that you would like to continue
- Miracle question (one kind of solution generating question; time machine, magic wand)
- Scaling questions
- Exception questions
- Coping questions
82
Theory and models: Multigenerational:
Postmodern Approaches:
Interventions: Collaborative Language Systems
- “Appropriately unusual” comments
- Experimenting w possible new meanings
- Share inner dialogue
- Reflecting teams
