Weeks 1-6 Flashcards
Problem Centered Guideline
All interventions should be linked, in some way, to the client system’s presenting problems or concerns.
Strength Guideline
Until proven otherwise, it is assumed that the client system can utilize its strenghts and resources to lift constraints and implement adaptive solutions with minimal and direct input from the therapist.
Assessment and Intervention Inseparability Guideline
Assessment and intervention are two inseparable and coocurring processes that span the course of therapy and lead to increasingly refined hypotheses and therapeutic plans that facilitate problem resolution.
Sequence Replacement Guideline
The primary task of the therapist is facilitating the replacement of the key problem sequences with alternative, adaptive sequences that eliminate or reduce the problem.
Empirically Informed Guideline
The practice of psychotherapy must be continually informed with empirical/scientific data in order to be maximally effective and efficient.
STIC
Educational Guideline
Therapy is an educational process in which therapists give away their skills, knowledge, and expertise as quickly as clients can integrate them.
Empowering clients, reduce likelihood of future trouble (preventive)
Cost Effectiveness Guideline
Therapy begins with less expensive, more direct, and less complex interventions and moves to more expensive, indirect, and complex interventions as needed.
Interpersonal Guideline
When possible and appropriate, it is always better to do an intervention, regardless of its nature, within an interpersonal as opposed to an individual context.
Temporal Guideline
Therapy generally begins with a focus on the here-and-now and progresses to a focus on the past as more complex and remote constraints emerge within therapy.
Address proximal before remote constraints.
Failure Driven Guideline
Therapeutic shifts occur when the current interventions fail to modify the Web sufficiently to permit implementation of the adaptive solution to the presenting problem.
Feedback to try something different.
Alliance Priority Guideline
Growing, maintaining, and repairing the therapeutic alliance takes priority over the principle of application (matrix arrow) unless doing so fundamentally compromises the efficacy and/or integrity of the therapy.
1950’s Paradigm consisted of:
- Scientific method dominated science.
- Logical positivism dominated philosophy. (Dismiss concepts that can’t be verified empirically)
- Biomedical reductionism dominated medicine (devoid of context, study in isolation)
- Psychoanalytic therapy (problem located inside of person)
- Mechanism = Nature works according to mechanical laws (linear causality)
- Mind/body dualism
Emergence of importance of family:
- Hospital movement: a. as patients got better, other family member got worse as if needed symptomatic member, and b. patients frequently improved in hospital but got worse when went home
- Small group dynamics: Similar = boundaries, complementarity (resistant to change), dependency, pairing. Different = continutiy, commitment, shared distoritions.
- Child Guidance Movement: preventing adult neuroses (Adler); still ignored fathers
Systemic view emerged in various fields:
- Physics = challenged reductionism, objectivism, mind/body dualism, & mechanism because of theory of relativity and quantum mechanics
- Medicine = refute reductionism with biopsychosocial model
- Biology = von Bertalanffy’s general systems theory (whole greater than sum of parts)
- Cybernetics = Weiner study of communication and control through self-regulation, feedback
4 Stages of Emerging FT
- Family Therapy Tracks
- Model Development
- Questioning & Consolidation
- Integration, EST’s, and Common Factors
Pure Systems Track
- West Coast
- Threw baby out with bath water
- Bateson, Macy Conferences, Theory of Logical Types
- Equilibrium Black Box Model
- key take away: work with whole family
Theory of Logical Types
Whatever involves all of a collection must not be one of a collection.
Bateson applied to communication double binds and hypothesized it played a role in the development of schizophrenia.
First time put psychology in context. (Schizophrenia made contextual with communication between parents and pateint)
Equilibrium Black Box Model
Self-regulated feedback model wherein the problem serves as feedback to regulate equilibrium (homeostasis) of the family; problem located in family, not individual.
Therapy goal: Dsirupt the family homeostasis and disrupt the symptom from the equilibrium-preserving negative feedback loop.
Feedback (in Black Box model)
Part of system’s output (the problem) is fed back into the system as information.
Homeostasis
Problem is used to maintain the homeostasis of the system; problem serves a function
Black Box
Only need consider the inputs and outputs and can ignore what goes on inside of black box (i.e. the mind); emphsis on ACTION (as opposed to psychoanalytic emphasis on meaning and emotion)
Psychoanalytic Track
- Preserve psychoanalytic prespective but make it interpersonal
- Not drive reduction but human striving for connection
- Disturbances in interpersonal processes create fixations in individual development & limit person’s ability to relate interpersonally
- Object Relations Theory
- Attachment Theory
- Goal of Therapy = Close gap between experienced and actual motivation.
Battle of the Brand Names
Pure Systems vs. Psychoanalytic
Differences magnified, centers emerged to offer training
Stage of Questioning and Consolidating
- Open the black box in Pure Systems and reintroduce meaning, emotion
- Shift from expert stance to collaboration
- Failure Driven
- Questioning centrality of homeostasis
- 2nd order cybernetics = changing rules of system rather than change within the rules
Common mechanisms of change common to ALL therapies:
- Client factors
- Therapist effects
- Therapeutic relationship
- Expectancy effects
- Nonspecific treatment variables
Common factors unique to couple and family therapy:
- Conceptualizing difficulties in relational terms
- Disrupting dysfunctional relational patterns
- Expanding the direct treatment system
- Expanding the therapeutic alliance
What is a system?
A rule governed, self-regulating entity consisting of parts or subsystems that are interrelated so that change in one part leads to changes in the other parts that ultimately impact the part that initiated the change process.
Essential nature of a system is the set of relationships among the parts that constitute the whole.
Cybernetics
Study of feedback mechanisms in self-regulating systems
Negative feedback & pathology
Indicates how far off the mark a system is straying and the corrections needed to get it back on course.
Ex. guilt, punishment, symptoms
Pathology when prevents family from making necessary changes, too rigid.
Positive feedback & pathology
Info that confirms and reinforces the direction a system is taking.
Ex. self-fulfilling prophecy, bandwagon effect
Pathology when left unchecked leading to runaway process (ex. phobia)
General Systems Theory (von Bertalanffy)
- Wholistic
- Organismic (permeable boundaries)
- Perspectivistic
- Organization rules (equifinality)
- Non-summativity (whole greater than sum of parts)
- Levels
- Recursiveness
- Circularity
Characteristics of Human Systems
- Negentropy (violate 2nd law of thermodynamics)
- Equifinality
- Develop and change over time.
- Exhibit active behaivor that occurs independent of external stimuli
- Employ symbolism to creat meaning
- Recursive
- Teleological (goal-directed)
- Perspective
- Levels
Stability and change in systems
Systemic adaptation to internal and external changes requires ongoing regulation of balance between positive and negative feedback processes.
- Morphostatic vs. Morphogenic
- 1st order vs. 2nd order change
- Epigenesis = progressive development, influenced by internal/external environment
- Differentiation
- Telic Decentralization = personal goals diverge from those of the family system
1st and 2nd Order Change
1st Order: Change within the rules of the system; not a cure but possible therapeutic goal of acceptance
2nd Order: Change in the rules of the system/a change in the system itself; purpose of therapy
Morphostatic vs. Morphogenic
Morphostatic = homeostatic; deviation minimizing processes (error activated); negative feedback/constraining loops
Morphogenic = deviation amplifying processes; change when necessary to adapt; positive feedback
Causality in Systems
- Multiple: events influenced and determined by multiple factors.
- Differential: factors involved in causality vary in their influence
- Recursiveness: factors (behavior, belief, emotion) consisently and reciprocally influence one another, even though the order, frequency, and intensity with which they appear may vary
Therapeutic System
Interaction of client (direct/indirect) and therapist (direct/indirect) systems
Context for The Blueprint
Theoretical Pillars of IPCM
Presuppostions that answer questions about human nature; how problems created/maintained (constraints) and how change takes place (constraints identified and lifted)
- Epistemiological
- Ontological
- Differential Causality
- Constraint Theory
Epistemiological Pillar
Perspectivism: there is an objective reality but humans can never know it.
Human knowledge becomes more accurate over time but never complete.
Some achieve closer reality than others.
Ontological Pillar
General Systems Theory = levels of systems
Hierarchies, wholeness, self-regulation, feedback, homeostasis
Differential Causality Pillar
Web of mutual influence with systems contributing differently to process/outcome.
Constraint Theory Pillar
Problems exist because some factor(s) constrain(s) problem resolution; “negative explanation”; Problem becomes entrenched over time as people despair in trying to solve it
Therapy = Identification and removal of constraints that prevent problem solving
Isomorphism
As probability for one event/belief increases, probability for other events/beliefs decreases
NOT CAUSAL EXPLANATION
Isomorphism (in Constraint Theory)
Levels of biopsychosocial system are governed & therefore can be understood with one set of similar principles:
Ex. Organization, development, patterning/sequences, internal process/mind, gender, culture
Power of small/short family transactions to represent and change larger family structure
Hallmarks of IPCM
- Comprehensive: applicable to wide range of problems that clients present and to various modalities.
- Integrative: across modalities and models/orientations; underlying and unifying principles (Guidelines); identifying common factors
- Multi-Systemic: focus on problems and solutions within the biopsychosocial system at all levels
- Empirically Informed: supported by randomized clinical trials and use STIC throughout therapy to provide feedback about client functioning and progress
Core Concepts of IPCM
1) Therapy Guidelines
2) Problem-Centered Contract: get everyone’s perspective and strenght-based
3) Problem-Centered Context: sequences of action, meaning, and emotion; most concrete, accessible, & changeable aspects of a problem; includes PS and AAS
4) Therapy System
Blueprint operates within context of core concepts
Essence of IPCM (therapeutic steps)
1) Define the problem = primary outcome criterion
2) Locate the problem in a problem sequence
3) Identify an alternative adaptive sequence (collaborative)
4) Implement AAS
5) Identify constraints to AAS
6) Lift constraints
7) Repeat (lifting additional constraints, identifying new problem)
Delineating the Problem Sequence (recursive collaborative goals):
1) Identifying Presenting Problem: each perspective/agreement vs. disagreement patterns; history (onset, context, vicisstudes/oscillations/ebb and flow, precipitating circumstances); consensual problem priority list
2) Identifying Attempted Solutions: what, who, when, outcome/reactions; identify strengths, motives, link to problem
3) Identifying Biological System: failure in presenting problems to vary consistenty with context
4) Identifying Meaning (Emotional): facilitate (ex. anger) or inhibit (ex. depression) problem solving; interrupt sequence at turning point
5) Identifying Meaning (Cognitive): Intentions attributed to own and others behavior; empathy (or lack)
6) Identifying AAS: develop an understanding of what is different; contextual determinants; provide leadership/expertise; build off of client values, ideas, strengths
Blueprint for Therapy
Hypothesizing
Planning
Conversing
Feedback