PQE Prep
Emotionally focused therapy: What is considered the root of family problems
"""Denial of Impulses and Suppression of Feelings""
Narrative: Plotting Narratives in the Landscapes of Action & Consciousness
"Based on work of Jerome Bruner, developed by Freedman & Combs
James Alexander, Bruce Parsons & Thomas Sexton
"Developed Functional Family Therapy Used with families with defiant and conduct disorder youth"
Joseph Wolpe
"Developed Systematic Desensitization
Collaborative FT: how see the therapy system
"as a unique form of language generating system that organizes itself around the identification of a problem
James Alexander, Bruce Parsons & Thomas Sexton
"Developed Functional Family Therapy
Emotionally focused therapy: What is considered the root of family problems
"""Denial of Impulses and Suppression of Feelings"" Dysfunctional families tend to be less tolerant of the emotions of children, especially those that signal individuality Belief people strive for self-actualization, but society and family prohibit this (family myths, mystification)"
Satir: Process of coaching clients to have authentic, congruent communication
"""Hallmark"" Technique: Involves ""ingredients of the interaction"" combined with specific communication coaching strategies like the following:
Satir: Process of coaching clients to have authentic, congruent communication
"""Hallmark"" Technique: Involves ""ingredients of the interaction"" combined with specific communication coaching strategies like the following: --Ask clients to start statements with ""I"" rather than ""you"" --Have them take full responsibility for feelings, rather than blaming others (not ""you made me feel"" . . . instead ""when x happened I felt) --encourage direct, honest discussions (not vague or implying) --Identify double binds"
Paul Watzlawick, Janet Beavin, Don Jackson
"""Pragmatics of Communication""
CBT: Role of Therapist
"""Teacher"" or ""Coach"" that uses directive and educational approach
CBT: Role of Therapist
"""Teacher"" or ""Coach"" that uses directive and educational approach Not joining and empathizing (if used, not considered an intervention in and of itself)"
Beliefs of Social Constructionism
"1. All truths are social constructions (therefore no one has the answers)
Categories considered in Mental Status Examination
"1. Appearance
Two battles in therapy (according to Whitaker)
"1. Battle for structure - should be won by therapist (sets boundaries and limits for therapy) 2. Battle for Initiative - should be won by client (client must have more investment and initiative to change than therapist)"
CBT: Marital Myths (Gottman)
"1. Communication Training Helps (only in short-term)
CBT: Marital Myths (Gottman)
"1. Communication Training Helps (only in short-term) 2. Anger is a dangerous emotion (doesn't predict divorce, associated with higher marital satisfaction in long term) 3. Quid Pro Quo Error (""this for that"" is in unhappy marriages)"
Special considerations for interviewing adolescents
"1. Consider the degree of emotional liability and stress
According to Functional Family Therapy, what are the purposes of behavior
"1. Contact or closeness (merging)
According to Functional Family Therapy, what are the purposes of behavior
"1. Contact or closeness (merging) 2. Distance or independence (separating) 3. Combination of the two (midpointing)"
Emotionally Focused: Therapy Goals
"1. Create secure attachment for both partners
Emotionally Focused: Therapy Goals
"1. Create secure attachment for both partners 2. Develop new interaction patterns that nurture and support each partner 3. Increase direct expression of emotions, especially those related to attachment needs"
CBT: Four Horsemen of the Appocolypse
"1. Criticism (something globally wrong with partner) - most common in women
CBT: Four Horsemen of the Appocolypse
"1. Criticism (something globally wrong with partner) - most common in women 2. Defensiveness 3. Contempt - seeing oneself as superior (best predictor of divorce) 4. Stonewalling - withrdraw physically or mentally from interaction (most common in men)"
Unique characteristics of Constructivist Therapy
"1. Focus more on caring than curing
Unique characteristics of Constructivist Therapy
"1. Focus more on caring than curing 2. Egalitarian partnership with clients as opposed to therapist as expert 3. Use of a therapeutic ""reflecting team"" 4. Adopted therapist position of ""not knowing"" so both therapist's and client's expertise is used to dissolve problem 5. Based on hermeneutics - knowledge is really about personal interpretation, so there is no central truth 6. Focus on how individuals construct their own realities"
CBT: CBFT Goals
"1. Help family members learn to identify automatic thoughts that reflect their underlying schemas
CBT: CBFT Goals
"1. Help family members learn to identify automatic thoughts that reflect their underlying schemas 2. Modify specific patterns of behavior to alleviate the presenting problem (not structure, organization, or relationships)"
Symbolic-Experiential Goals
"1. Increase family cohesion (sense of nurturance and confidence in ability to solve problems; boundaries)
Symbolic-Experiential Goals
"1. Increase family cohesion (sense of nurturance and confidence in ability to solve problems; boundaries) 2. Promote Personal Growth (for all members) 3. Expand the Family's Symbolic World "
Milan - key contributions
"1. Invariant Prescription (parents do therapy secretly)
Milan - key contributions
"1. Invariant Prescription (parents do therapy secretly) 2. Circular Questions 3. Positive Connotation (for problem behaviors) 4. Paradoxical intervention"
Solution-Focused: Primary assumptions
"1. It isn't necessary to know what causes problems in order to make things better
Solution-Focused: Primary assumptions
"1. It isn't necessary to know what causes problems in order to make things better 2. Negative mindset is what impedes people from resolving problems 3. Clients are experts on their own situations 4. People are resilient and resourceful 5. Life is socially constructed - there is no one correct way to live, so clients set the goals"
Solution-Focused: Characteristics of Goals
"1. Meaningful to client
CBT: Behavioral Therapy Assessment
"Based on Kanfer & Phillip's SORKC Model of Behavior stimulus, state of organism, target response, nature and contingency of response"
Solution-Focused: Characteristics of Goals
"1. Meaningful to client 2. Interactional (how interactions with others will change, not feelings) 3. Situational (where exactly should behavior occur) 4. Small Steps 5. Clear role for client 6. Realistic
Solution-Focused: Therapy steps
"1. Problem description
3 Main types solution-based therapy
"1. Solution-Focused Brief Therapy (Steve de Shazer)
3 Main types solution-based therapy
"1. Solution-Focused Brief Therapy (Steve de Shazer) 2. Solution-Oriented Therapy (Bill O'Hanlon) 3. Solution-Oriented Ericksonian Hypnosis (Milton Erickson)"
Steps in Milan therapy
"1. Used circular questions to explore problem and to provoke families to see their dynamics
Steps in Milan therapy
"1. Used circular questions to explore problem and to provoke families to see their dynamics 2. Provide a positive connotation for problem behaviors (why members might be cooperating with the problem) 3. Paradoxical interventions, family rituals"
Solution-Focused: Techniques used for "divorce busting"
"1. Video Talk - helping couple distinguish between facts, stories and feelings so they can understand the difference between behaviors and their interpretation of behaviors
Three Categories for Client Motivation (de Shazer)
"1. Visitors (don't have complaint, forced into therapy - need to build an alliance, don't offer suggestions)
Three Categories for Client Motivation (de Shazer)
"1. Visitors (don't have complaint, forced into therapy - need to build an alliance, don't offer suggestions) 2. Complainants (identify problem, but expect therapy or other person to change - do observation-oriented tasks, identify exceptions, never question that the IP is the problem) 3. Customer (identify problem and ready to take action - do reframing, identify what works, action-oriented tasks)"
Collaborative: Two key questions in case conceptualization
"1. Who is talking about the problem?
Collaborative: Two key questions in case conceptualization
"1. Who is talking about the problem? 2. How does each understand the problem?"
Satir: Family Reconstruction
"A psychodramatic reenactment of significant events in three generations of family life; the ""star"" identifies key events and chooses group members to re-enact pivotal experiences and relationships;
Satir: Family Reconstruction
"A psychodramatic reenactment of significant events in three generations of family life; the ""star"" identifies key events and chooses group members to re-enact pivotal experiences and relationships; Enables person to see themselves and their parents with new eyes, thus seeing the present and future in a new perspective - offering hope and greater possiblities for change
CBT: Dattilio - Cognitive Distortions about Families
"Arbitrary Inference - based on little evidence
CBT: CBFT Treatment Steps
"Assessment (behavioral and cognitive baseline)
CBT: CBFT Treatment Steps
"Assessment (behavioral and cognitive baseline) Target behaviors and thoughts for change (specific - don't just try to improve communication) Educate (irrational thoughts and dysfunctional patterns) Replace and Retrain"
Symbolic Experiential Therapy: Keys to Therapeutic Relationship
"Authentic use of self (show true emotions, model authenticity) Maintain clear and unwavering integrity Be responsible to the family, not for the family (active, but not directive) Stimulate mutual growth - both for therapist and family Use Co-Therapists - one confrontational, one nurturing"
CBT: Operant Conditioning
"B.F. Skinner
CBT: Operant Conditioning
"B.F. Skinner ""Bread and butter"" of CBT interventions, especially parent training Operant - voluntary responses - frequency determined by their consequences Useful for parents because can control reinforcers and punishment Used to modify or ""shape"" behavior"
CBT: Behavioral Therapy Assessment
"Based on Kanfer & Phillip's SORKC Model of Behavior
Narrative: Plotting Narratives in the Landscapes of Action & Consciousness
"Based on work of Jerome Bruner, developed by Freedman & Combs Inquire about actions and meaning of actions as envisioned in the preferred narrative"
Basic Premise of Behavioral Family Therapy
"Behavior is maintained by its consequences
Basic Premise of Behavioral Family Therapy
"Behavior is maintained by its consequences Behavior will change when the contingencies of reinforcement are altered"
Neil Jacobson & Andrew Christensen
"Behavioral Couples Therapy - improved (more long-term) by emphasizing acceptance of one's partner (humanistic focus)
Neil Jacobson & Andrew Christensen
"Behavioral Couples Therapy - improved (more long-term) by emphasizing acceptance of one's partner (humanistic focus) Became ""Integrated Behavioral Couples Therapy"""
How is Solution-Focused similar to and different from MRI model?
"Both belief people are constrained by narrow views of their problems which perpetuate rigid patterns of false solutions; both aim to solve presenting problem quickly
How is Solution-Focused similar to and different from MRI model?
"Both belief people are constrained by narrow views of their problems which perpetuate rigid patterns of false solutions; both aim to solve presenting problem quickly -- MRI aims to help clients do less of what doesn't work and SFT promotes more of what does work -- MRI focuses on behavior, whereas SFT emphasizes cognition as well as behavior --MRI urges clients to DO things differently, whereas SFT urges them to VIEW things differently"
CBT: Gottman Therapeutic Relationship
"Coach - empower couples to take ownership of their relationship
CBT: Gottman Therapeutic Relationship
"Coach - empower couples to take ownership of their relationship Doesn't soothe, but coaches them to soothe themselves and each other"
Collaborative: Role of therapist
"Conversational artist whose expertise is in the area of creating space for and facilitating a dialogical conversation; therapist is expert on process, client is expert on content
Collaborative: Role of therapist
"Conversational artist whose expertise is in the area of creating space for and facilitating a dialogical conversation; therapist is expert on process, client is expert on content therapist seen as ""conversational partner"" - both client and therapist are transformed in the process"
CBT: Distance and Isolation Cascade
"Couples emotionally disengaged, lack friendship, few efforts to soothe
CBT: Distance and Isolation Cascade (Gottman)
"Couples emotionally disengaged, lack friendship, few efforts to soothe Indication of problem relationship even without 4 Horsemen"
Stages of Change
"Created by Prochaska
Stages of Change
"Created by Prochaska 1. Precontemplation (no intention of changing behavior) 2. Contemplation (consider problem, not made commitment to change) 3. Preparation (small changes made) 4. Action (overt behaviors and considerable time and energy) 5. Maintenance (for at least 6 months)"
Symbolic Experiential Therapy Interventions
"Creating confusion and disorganization
Symbolic Experiential Therapy Interventions
"Creating confusion and disorganization Here-and-Now Experiencing Redefining and Expanding Symptoms Spontaneity, play and ""craziness"" Separating interpersonal from personal distress Augmenting despair & amplifying deviation Absurd fantasy alternatives
Frank Dattilio
"Developed Cognitive-Behavioral Family Therapy
Frank Dattilio
"Developed Cognitive-Behavioral Family Therapy Adapted Aaron Beck's concept of schemas to families"
Joseph Wolpe
"Developed Systematic Desensitization Used to treat phobias and sex disorders Believes anxiety is a persisten response of the autonomic nervous system acquired through classical conditioning"
CBT: Rational Emotive Therapy: A-B-C Theory
"Developed by Albert Ellis to analyze irrational thinking
CBT: Rational Emotive Therapy: A-B-C Theory
"Developed by Albert Ellis to analyze irrational thinking A-Activating Event B-Belief about the meaning of the event C-emotional or behavioral consequence based on the belief Most clients only see connection between A and C"
Functional Family therapy
"Developed by Barton & Alexander
Functional Family therapy
"Developed by Barton & Alexander Members of unhappy families attribute their problem to negative traits in others, so attributional shifts are necessary to make behavior change possible, but behavior change is necessary to reinforce new and more productive attributions Uses cognitive theory, systems theory, learning theory"
Collaborative: Appropriately Unusual Comment
"Developed by Tom Anderson
Collaborative: Appropriately Unusual Comment
"Developed by Tom Anderson If comments are too usual, they won't be useful in constructing new meaning; if they are too unusual, they won't fit into client's worldview and be meaningful and able to provoke new perspectives"
Animal Attribution Storytelling Technique
"Diana Arad
Virginia Satir
"EFT therapist; part of MRI group before developing her own Satir Growth Model that infused humanistic values and a systemic approach; focused on fostering individual growth and improving family interactions; techniques used include experiential exercises, metaphors, coaching, self of the therapist
Emotionally Focused therapists focus on emotions (types, where?)
"Early phase: Secondary Emotions (anger, frustration, withdrawal)
Emotionally Focused therapists focus on emotions (types, where?)
"Early phase: Secondary Emotions (anger, frustration, withdrawal) Later Therapy: Raise awareness of primary emotion underlying secondary emotion (attachment fears and needs, vulnerable emotions, i.e. helplessness)"
Typical Day Interview
"Eliana Gil
Emotionally Focused: Therapeutic Relationship (perspective and techniques)
"Empathic Attunement (therapist attunes to each person's emotions, mostly nonverbally using posture and reflecting emotion)
Emotionally Focused: Therapeutic Relationship (perspective and techniques)
"Empathic Attunement (therapist attunes to each person's emotions, mostly nonverbally using posture and reflecting emotion) Acceptance (nonjudgmental, honors clients ""as they are"") Genuineness (therapist is real and emotionally present, able to admit mistakes) Continuous Monitoring of Alliances (make sure to constantly balance focus on both partners) Joining the System (build an alliance with the system itself)"
CBT: Frank Dattilio
"Emphasizes beliefs about families - two schemas (growing up, families in general) - influence how peoplre react
CBT: Reinforcement Interventions
"Encouragement & Compliments
CBT: Reinforcement Interventions
"Encouragement & Compliments Contingency Contracting (offer something if desired behavior) Point charts and token economies Shaping - reinforcing change in small steps"
CBT: Couple Cognition Types
"Epstein and colleagues
CBT: Couple Cognition Types
"Epstein and colleagues 1. Selective Perceptions 2. Attributions (inferences about positive or negative aspects of relationship) 3. Expectancies (predictions of likelihood of events in relationship) 4. Assumptions (basic beliefs about character of partner or relationship) 5. Standards (characteristics partner or relationship ""should"" have"
Virginia Satir
"Experiential therapist; part of MRI group before developing her own Satir Growth Model that infused humanistic values and a systemic approach; focused on fostering individual growth and improving family interactions; techniques used include experiential exercises, metaphors, coaching, self of the therapist Wrote "Conjoint Family Therapy"
Three Roles of Symptom in relation to Family (structural)
"Family as ""Ineffectual Challenger"" (maintains enmeshment or disengagement by not challenging symptomatic member)
Three Roles of Symptom in relation to Family (structural)
"Family as ""Ineffectual Challenger"" (maintains enmeshment or disengagement by not challenging symptomatic member) Family as ""Shaper"" of symptoms - shapes individual's experiences and behaviors Family as ""Beneficiary"" of symptoms - symptoms perform a regulatory funciton in maintaining the family structure"
Salvador Minuchin
"Father of Structural Family Therapy
CBT: Gottman Treatment
"First uses highly detailed assessment system
CBT: Gottman Treatment
"First uses highly detailed assessment system Intervention is around psychoeducation about what works or not, as well as structured exercises (videotape conversations)"
Steve de Shazer
"Founded Solution-Focused Brief Therapy
Steve de Shazer
"Founded Solution-Focused Brief Therapy Influenced by Erickson's trance work and Ludwig Wittgenstein's view of language as inextricably woven into fabric of life"
Bill O'Hanlon
"Founder of Solution-Oriented Therapy
Bill O'Hanlon
"Founder of Solution-Oriented Therapy Emphasized significance of language Aims to transform client viewing as well as solve the problem while attending to the broader contextual issues that impact the client's situation"
Top Behavioral Family Therapists
"Gerald Patterson (parent training, social learning theory, Minuchin)
Example of Social Constructionism Therapy
Narrative Therapy - problems are embedded in points of view about individuals and their situations
Top Behavioral Family Therapists
"Gerald Patterson (parent training, social learning theory, Minuchin) Robert Liberman (role rehearsal, modeling) Richard Stuart (contingency contracting, reinforcement reciprocity)"
CBT: Goal Setting
"Goals identified in assessment
CBT: Goal Setting
"Goals identified in assessment Stated in behavioral and measurable terms Often have a written contract - agree to follow instructions and do homework"
Theoretical Foundations for Experiential Family Therapy
"Humanistic
Theoretical Foundations for Experiential Family Therapy
"Humanistic --People naturally tend toward positive growth --All people possess resources for positive growth --Systemic --Everyone and every thing acts on and is acted upon everything else --Therapy is a process that involves interaction between therapist and client, and each person is responsible for him/herself
CBT: Negative Affect Reciprocity (Gottman)
"Increased probability that one's partner's emotions will be negative immediately following negative in the other
CBT: Negative Affect Reciprocity (Gottman)
"Increased probability that one's partner's emotions will be negative immediately following negative in the other Most consistent correlate of marital satisfaction/dissatisfaction - best measure of total amount of negative affect in relationship"
Binet-Simon Scale
"Individually administered instrument that focused on assessing judgment, comprehension, and reasoning
Behavior examples of family enmeshment
"Interrupting or speaking for one another
Behavior examples of family enmeshment
"Interrupting or speaking for one another Mind-reading and making assumptions High levels of protectedness and/or concern Demanding loyalty at expense of individual needs Feeling threatened when there is a disagreement Complaints of symptoms residing in one or more individuals"
Family Puppet Interviews
"Irwin & Malloy
Three Main Steps in Structural Family Therapy
"Joining & Accommodating
Three Main Steps in Structural Family Therapy
"Joining & Accommodating Structure Mapping & Diagnosis Restructuring"
Minuchin: 7 steps of therapy
"Joining, enactment, structural mapping, highlighting and modifying interactions, boundary making, unbalancing, challenging unproductive assumptions
Brief Strategic Family therapy
"Jose Szapocznik
Brief Strategic Family therapy
"Jose Szapocznik Developed to address drug abuse problems in Cuban youth and other minorities Considers broader social life and process of conflict resolution"
Role Playing
"Kempler
Family Art Therapy
"Kwiatkowska
Examples of Family Disengagement
"Lack of reaction and few repurcussions, even to problems
Examples of Family Disengagement
"Lack of reaction and few repurcussions, even to problems Freedom for members to do as they please Few demands for or expressions of loyalty and commitment Parallel interactions (doing different things in same room)"
John Gottman
"Leading researcher of factors that lead to divorce
John Gottman
"Leading researcher of factors that lead to divorce Developed ""The Marriage Clinic Approach"" to couples therapy"
Ecosystem Structural Family therapy
"Marion Lindblad-Goldberg
Ecosystem Structural Family therapy
"Marion Lindblad-Goldberg Used with kids with severe emotional or behavior problems and their families in the context of the community Families usually compromised by trauma Examines biological and developmental influences, as well as current and historical familial, cultural, and ecological influences Assumes child and parental functioning are inextricably linked to their environment"
Satir: Sculpting or Spatial Metaphor
"Most distinctive intervention
Satir: Sculpting or Spatial Metaphor
"Most distinctive intervention Have members take turns putting other members in physical positions that represent how they see each person's role in the family; sometimes the sculptor assigns lines for people to say to represent how he/she is thinking, feeling, viewing the situation Highly effective nonverbal confrontation that bypasses cognitive defenses; person is literally able to see how he/she is contributing to the problem"
CBT: Aversive Control
"Nagging, crying, withdrawing
CBT: Aversive Control
"Nagging, crying, withdrawing Major determinant of marital unhappiness Spouses typically reciprocate aversive behaviors - vicious cycle"
CBT: Repair Attempts (Gottman)
"One partner tries to ""make nice"" to end the conflict, soothe the other, or soften the complaint
CBT: Repair Attempts (Gottman)
"One partner tries to ""make nice"" to end the conflict, soothe the other, or soften the complaint Distressed couples typically reject repair attempts When combined with 4 Horsement, can predict divorce"
CBT: Functional Analysis
"Originated in systemic theory
CBT: Functional Analysis
"Originated in systemic theory Identifies precise contexts, antecedents, and consequences of problem behavior For couples identifies strengths, problems, sex/affection, individual functioning, social context"
Two prominent relationship enrichment programs
"PREPARE - Premarital Personal and Relationship Inventory
CBT: Classical Conditioning
"Pavlov - ""conditioned and unconditioned stimuli and responses""
CBT: Classical Conditioning
"Pavlov - ""conditioned and unconditioned stimuli and responses"" Used primarily to treat anxiety disorders"
CBT: Four ways of shaping behavior in Operant Conditioning
"Positive Reinforcement (reward by adding something desirable)
CBT: Four ways of shaping behavior in Operant Conditioning
"Positive Reinforcement (reward by adding something desirable) Negative Reinforcement (reward by removing undesirable) Positive Punishment (reduce undesired bheavior by adding something undesirable) Negative Punishment (reduce undesired behavior by removing something desirable)"
CBT: Behavioral Therapy Techniques
"Premack Principle - high probability behavior is chosen to reinforce behavior with a low probability of occurrence
CBT: Behavioral Therapy Techniques
"Premack Principle - high probability behavior is chosen to reinforce behavior with a low probability of occurrence Time-Out"
CBT: Case Conceptualization
"Problem Analysis (turning vague descriptions into ideas of behavioral interactions and emotional consequences)
CBT: Case Conceptualization
"Problem Analysis (turning vague descriptions into ideas of behavioral interactions and emotional consequences) Assessment of Baseline Functioning (contexts, antecedents, frequency, consequences for behavior A-B-C Theory Family Schemas Couple Cognition Types"
Robert Liberman
"Prominent behaviorist
CBT: Harsh Startups (Gottman0
"Raising an issue using negative affect in first minute of conversation
CBT: Harsh Startups (Gottman)
"Raising an issue using negative affect in first minute of conversation When women use frequently, more likely to end in divorce
CBT: Albert Ellis
"Rational Emotive Therapy
CBT: Albert Ellis
"Rational Emotive Therapy A-B-C Theory (activating event, belief, consequences)"
Symbolic-Experiential Therapy (SET) - why unique
"Referred to as ""therapy of the absurd"" - unconventional, playful
Symbolic-Experiential Therapy (SET) - why unique
"Referred to as ""therapy of the absurd"" - unconventional, playful relies almost entirely on emotional logic (not cognitive); worked from ""heart sense""; didn't intervene in behavior sequences and instead focused solely on emotional process and family structure"
Internal Family Systems Therapy
"Richard Schwartz Conflicting inner voices are personified as sub-personalities or ""parts"" Based on idea that people in conflict with each other are also in conflict with themselves (conflict is a polarization of only part of what they feel) Therapist introduces the language of ""parts"" and asks members to visualize them and then helps them to calm down"
CBT: CBFT Therapeutic Relationship
"Role of Directive Educator and Expert
CBT: CBFT Therapeutic Relationship
"Role of Directive Educator and Expert Use Written Contracts Followed classical medical model (distant), but now more empathy and warmth to get patient compliance"
Solution-Focused: Taking a break and giving feedback
"SFT is often practice in a team approach with colleagues observing behind a mirror; take a 10 min break and compose a ""summary message"" that is given to the clients
CBT: Aaron Beck
"Schemas - core beliefs
Internal Family Systems Therapy
"Schwartz
EFT: Three Stages of Therapy
"Stage 1: De-escalation of Negative Cycles
EFT: Three Stages of Therapy
"Stage 1: De-escalation of Negative Cycles State 2: Change Interactional Patterns Stage 3: Consolidation & Integration
Carl Whitaker
"Symbolic-Experiential Therapy founder;
Carl Whitaker
"Symbolic-Experiential Therapy founder; Psychoanalytically trained; changed focus from client problems to problems as part of dysfunctional interactions"
CBT: Family Schemas
"Taken from Aaron Beck's ideas of individual schemas
CBT: Family Schemas
"Taken from Aaron Beck's ideas of individual schemas People have two - about family of origin, about families in general"
Narrative: What are problems?
"The problem is the problem; people and actions aren't the problem;
Narrative: What are problems?
"The problem is the problem; people and actions aren't the problem; Believe problems are separate from people - imposed on them"
Emotionally Focused: Therapist's Role
"Therapist IS: --Process consultant (helps reprocess emotional experiences) --Choreographer (help restructure relationship dance) --Collaborator (follows an dleads therapeutic alliance) Therapist IS NOT: --Coach (teaching communication skills) --""Wise creator of insight"" (past or future) --Stragegist (doesn't use paradoxes or problem prescriptions)"
Structural: Joining - Process
"Therapist adjusts to the communication style, language, rhythm, and perceptions of family members; Uses the following:
Structural: Joining - Process
"Therapist adjusts to the communication style, language, rhythm, and perceptions of family members; Uses the following: ""Maintenance"" - support specific behaviors and verbalizations ""Tracking"" - use clarification and amplification and approval to reinforce individuals and subsystems ""Mimesis"" - adopt family's communication style and conform to its affective range"
Symbolic Experiential: Trial of Labor
"Therapist attends to two broad patterns: structural organization and emotional processes and exchanges within the family Structure: permeable boundaries within family, clear boundaries around family, flexible roles, alliances and coalitions, boundaries between generations (generation gap), gender-role flexiblity, ""ghosts"" (members creating cross-generational stress) Emotional Process differentiation and individuation, tolerance of conflict, problem solving, sexuality, loyalty, parental empathy, playfulness, cultural adaptations, symbolic process"
Satir: Interventions
"Therapist's use of self (role model for congruent communication)
Satir: Interventions
"Therapist's use of self (role model for congruent communication) --Ingredients of Interaction (teach about relational processes) --Facilitating Emotional Expression --Softening Family Rules --Communication coaching, role play, enactment --Family Sculpting or Metaphor --Parts Party (clients use members to represent parts of self)"
Collaborative FT: Problem Dissolving
"Therapists don't see themselves or clients as ""solving"" a problem, but rather ""dissolving"" the problem through dialogical process (no longer experienced as a problem)
How do Solution-Focused therapists view problems?
"They reject the notion that problems serve ulterior motives or that people or families somehow need problems
How do Solution-Focused therapists view problems?
"They reject the notion that problems serve ulterior motives or that people or families somehow need problems --believe solutions are often unrelated to the way problems developed, so no need to explore the root of problems (""problem talk"")"
Three Phases of Enactment
"Tracking & Mapping (observation of interactions) Eliciting Transactions (the invitation) Redirecting Alternate Transactions (the most important part)"
Symbolic Experiential: Tools for Assessment
"Trial of Labor (assess structure of organization and emotional process) Focus on Competency (emphasize strengths, competencies, resources)
Emotionally Focused Therapy (EmFT)
"Type of Experiential Family Therapy
Emotionally Focused Therapy (EmFT)
"Type of Experiential Family Therapy Most thoroughly researched and empirically validated for treating couples Created by Sue Johnson and Les Greenberg Focuses on the emotional system of the couple and uses heightened affect to help them restructure their interactional patterns, increase emotional intimacy, and address attachment needs Focuses on intrapsychic and interpersonal issues"
Functional Family Therapy - focus
"Understand the function of problem behaviors and then modify cognitive sets so members can see how t
Functional Family Therapy - focus
"Understand the function of problem behaviors and then modify cognitive sets so members can see how t Then work on parent training and communication skills"
Emotionally Focused: Softening Emotions
"Used to create emotional bonding, change interactional patterns, and redefine the relationship as safe and connected
Emotionally Focused: Softening Emotions
"Used to create emotional bonding, change interactional patterns, and redefine the relationship as safe and connected --softening occurs when previous blamer asks from a position of vulnerability for partner to meet his/her attachment needs --critical partner softens stance and words and more vulnerable or anxious partner can then reduce emotional reactivity and defensiveness Therapists facilitate by encouraging expression of underlying attachment-based fears (hurt, disappointment, fear of abandonment)"
Narrative: Relative Influence Questioning
"Used to help client externalize the problem by
Narrative: Relative Influence Questioning
"Used to help client externalize the problem by 1. Mapping the influence of the problem 2. Mapping the influence of the persons (discover unique outcomes)"
Solution-Focused: "Formula First Session Task"
"Used to increase client hope in the therapy process and motivation for change
CBT: Sound Marital House (Gottman)
"Used to increase positive affect and increase ability to reduce negative affect in conflict
CBT: Sound Marital House (Gottman)
"Used to increase positive affect and increase ability to reduce negative affect in conflict love maps, admiration, turning twoard (emotional bank account), positive sentiment override, problem solving, making dreams come true, creating shared meaning"
How does Emotionally Focused Therapy conceptualize adult love?
"Using Bowlby's theory of attachment Attachment is an innate force, neither complete independence or overdependence is possible, attachment offers a secure base, emotional accessibility builds bonds, rear and uncertainty activate attachment needs, process of separation distress is predictable, there are a finite number of insecure attachment styles
Satir: Therapeutic Presence (components, techniques)
"Warmth and humanity (from Carl Rogers) - requires therapist congruence
Satir: Therapeutic Presence (components, techniques)
"Warmth and humanity (from Carl Rogers) - requires therapist congruence Making Contact - done first with self, then with clients - involves connecting on all levels (self mandala); physical, intellectual, emotional, sensual, interactional, contextual, etc. (mind, body, spirit) Empathy - not taking sides, but honoring experience without validation Conveying hope Establishing credibility"
CBT: Treatment of Sexual Dysfunction
"Wolpe - Systematic Desensitization
CBT: Treatment of Sexual Dysfunction
"Wolpe - Systematic Desensitization Decondition anxiety, resist negative thoughts Sensate Focus (relax while being touched)"
Collaborative FT: how see the therapy system
"as a unique form of language generating system that organizes itself around the identification of a problem --Seen as problem-organizing, problem-dissolving systems"
Narrative: Therapist position
"co-author or co-editor
Narrative: Therapist position
"co-author or co-editor --success of approach relies on therapist being open to voices of clients and being mindful of sociopolitical issues"
Primary focus of EFT
"emotional layer - assessment and intervention targets the emotional exchanges in relation to the presenting problem
Primary focus of EFT
"emotional layer - assessment and intervention targets the emotional exchanges in relation to the presenting problem Addresses individual and family concerns as distinct problems"
Key MRI concepts
"homeostasis and circular causality
Key MRI concepts
"homeostasis and circular causality -- symptoms are messages about some aspect of the family system -- problem solution attempts could become the problem"
Clear Boundaries
"normal" - allow for emotional contact while simultaneously allowing each person to maintain a sense of identity and differentiation
CBT: Two Key Elements of Happy marriage (Gottman)
"overall sense of positive affect
CBT: Two Key Elements of Happy marriage (Gottman)
"overall sense of positive affect ability to reduce negative affect during conflict"
CBT: Premack Principle
"used to increase desired behaviors
Undifferentiated Family "Ego Mass"
(Bowen) Emotionally fused due to lack of differentiation
David Schnarch
(Bowen) Sexual Crucible Model; Intergenerational Family Therapy
Robert Liberman
(CBFT) "Prominent behaviorist Introduced role rehearsal and modeling to family therapy"
Richard Stuart
(CBFT) Behaviorist; introduced Contingency Contracting and Reinforcement Reciprocity
Patterson & Forgatch
(CBfT) Developed the most prominent approach to parent training
Symbolic-Experiential Therapy (SET) - who founded
(Experiential) Carl Whitaker
Paul Watzlawick, Janet Beavin, Don Jackson
(MRI Systemic Therapy) """Pragmatics of Communication"" -- Describe all behavior as a type of communication and categorize all interactions as either symmetrical (egalitarian) or complementary (opposite in some way)"
James Framo
(Object Relations, Psychoanalytic) Parental Interjects; Family of Origin Therapy; invited whole families to sessions
Narrative: Letters and Certificates
(Peggy Penn) Letters document narratives and certificates celebrate the new story
People who brought race to consciousness in family therapy
(Postmodern) Nancy Boyd-Franklin and Ken Hardy
Boszormenyi-Nagy
(Psychoanalytic) Importance of ethics in family systems; "ledger of entitlement and indebtedness"; used to maintain trustworthiness, fairness and loyalty; intergenerational therapy
Nathan Ackerman
(Psychoanalytic) Individual pathology reflects family distortions & dynamics
James Framo
(Psychoanalytic) Parental Interjects; Family of Origin Therapy; invited whole families to sessions
Margaret Mahler
(Psychoanalytic, Object Relations) Separation-Individuation; child's differentiation from parent after renouncing symbiotic fusion
Heinz Kohut
(Psychoanalytic, object relations) Self-objects, developed self-psychology
Insoo Kim Berg
(Solution-focused) co-founder of Milwaukee Brief Family Therapy Center (with de Shazer) solution-focused
Five Communication Stances
(experiential) congruent, placator, blamer, superreasonable, irrelevant
Cross-Generational Coalition
(structural) Problematic; formed between parent and child against another parent ("teams"); common in divorces; often "covert"; evidenced by secrets and complement the child and disparage the other spouse
Narrative: Deconstructive Listening
Type of listening that looks for gaps in our understanding - opens up space for new meanings and understandings
Stage 3 of EFT: Consolidation & Integration (components)
--Facilitate new solutions to old problems
Stage 3 of EFT: Consolidation & Integration (components)
--Facilitate new solutions to old problems --Consolidate new positions and new cycles of attachment"
State 2 of EFT: Change Interactional Patterns (components)
--Promote identification of disowned attachment needs (connect to relational interactions)
State 2 of EFT: Change Interactional Patterns (components)
--Promote identification of disowned attachment needs (connect to relational interactions) --Promote acceptance of partner's experience along with new interaction sequences --Encourage expression of needs and wants while increasing emotional engagement and bonding
De-escalation of Negative Cycles phase of EFT (components)
--create alliance and delineate conflict in attachment struggle --identify negative interaction cycle --access unacknowledged emotions and underlying interactional positions --Reframe problem in terms of negative cylce and attachment needs, with the cycle as the common enemy
Goals of Satir's Family Reconstruction:
--identify roots of old learning and their role in the present
Goals of Satir's Family Reconstruction:
--identify roots of old learning and their role in the present --develop a more realistic picture of the client's parents --Discover unique strengths and potentials"
CBT: Indicators of Happy Marriage (Gottman)
5:1 ratio of positive to negative
Constructivism
A given situation can be interpreted in many ways
Social Constructionism
A person's view is a product of conversations, dialogues, interactions
Reframing
A positive connotation is given to a negative behavior (i.e. mother yelling at son is explained as her caring); very important interpersonal skill for therapist; by accepting the behavior, the person will often decrease the behavior
Symbolic Interactionism
A theory designed to understand how changes in society affect people; assumptions are that humans act toward people and things based on meanings they ascribe to them, meaning is created through interactions, interactions are necessary for developing a sense of self, symbols are mechanisms of communication of meaning; Mead, Cooley, Thomas, Blumer; ideological commitment to progress and democratic values
Legacy
A transgenerational mandate that links endowments of the current generation to its obligations to future generations
CBT: Contingency Contracting
Agreement by parents to make certain changes following changes made by their children
Narrative: Most common goal
Alter the problem-saturated story to reflect a preferred narrative (which is defined by the client)
Utilizing Symptoms (structural)
Altering the function that a symptom serves in the family system by encouraging, deemphasizing, or relabeling it
Introjection
An unconscious psychic process by which a person incorporates into his own psyche the characteristics of another person or object
Collaborative FT: who is included in therapy?
Anyone who is talking about "the problem" (family, friends, doctors, school personnel)
Satir: Role of Therapist
As a "guide"
Collaborative FT: Shifting membership
As the problem gets redefined and changes, so do the people who need to be a part of the conversation
Multigenerational Patterns
Assessed using genogram and interview; shows emotional management patterns and provides clarity to what's feeding the problem
Freudian Psychoanalysis
Assumes humans are dictated by biological drives - sexual and aggressive
Harry Aponte
Attends to issues of spirituality, poverty and race in SFT
Harry Aponte
Attends to issues of spirituality, poverty and race in SFT, studied under Minuchin
Richard Stuart
Behaviorist; introduced Contingency Contracting and Reinforcement Reciprocity
Solution-Oriented Therapy founder
Bill O'Hanlon
CBT: Primary reinforcements
Biologically determined (sex, food)
Ledger of Entitlement & Indebtedness
Boszormenyi-Nagy; ethics in families; used to maintain fairness, trustworthiness and loyalty; includes entitlements, invisible loyalties, revolving slate (revenge on other for past transactions), split loyalties, legacy (transgenerational mandate that links endowments of current generation to future)
Intergenerational People
Bowen, Boszormenyi-Nagy
Object Relations Theory
Bridges psychoanalysis (individuals) and family therapy (social relationships); assumes we relate to others on basis of expectations formed by early experience; early relationships leave "internal objects" or mental images of self and others
Jose Szapocznik
Brief Strategic Family Therapy
Richard Emerson
Brought Social Exchange Theory to level of family; humans are self-interested and engage in negotiations to maximizze profits, but "dependence, power and balance" are also considerations in families
Advantage of multiple aptitude batteries
Can indicate where an individual's strengths and weaknesses are
Social Network Map & Grid
Captures family behavior in the context of its social network and social support - kind of support, frequency, reliability, importance to family, degree of closeness, length of relationship
Symbolic-Experiential Therapy (SET) - who founded
Carl Whitaker
Two important Symbolic-Experiential Theorists
Carl Whitaker, Walter Kempler
Herbert Blumer
Coined "Symbolic Interactionism" and outline basic premises
Norbert Wiener
Coined the term "cybernetics"
Gregory Bateson & John Ruesch
Communication theory - contributed to family therapy
Jetse Sprey
Conflict theory; focused on innate nature of inequality of human interactions and benefits of conflict - change, unification; took theory to level of marital dyad and families
CBT: Reinforcers
Consequences that accelerate behavior
CBT: Punishersq
Consequences that decelerate behavior
Difference between Constructivism and Social Constructionism
Constructivism focuses on how individuals create their own realities, whereas Social Constructionism emphasizes power of interaction and how are beliefs are fluid and shaped by social contact
Collaborative: Dialogical Conversation
Conversation in which a mutual exchange of ideas and understandings take place, which allows for the generation of new meanings and ideas, which opens new possibilities for action and relating.
Looking Glass Self
Cooley; how people's perceptions of how other people view them shapes their concept of self
Robert Yerkes
Created group-administered tests (for army) - Army Alpha and Beta
Prochaska
Created stages of change
Ivan Nye
Created structure for using Social Exchange Theory
Francis Galton
Credited with launching testing movement
Melanie Klein
Psychoanalytic; Co-founded object relations, Projective Identification - subject perceives object as if it contained unwelcome elements of the subject's personality AND evokes responses from the object that conform to those perceptions; i.e. parent projects anxiety, child behaves in confirming way
Melanie Klein
Psychoanalytic; Projective Identification - subject perceives object as if it contained unwelcome elements of the subject's personality AND evokes responses from the object that conform to those perceptions; i.e. parent projects anxiety, child behaves in confirming way
Daniel Stern
Psychoanalytic; child develop is NOT a gradual process of separation and individuation; differentiation starts and birth and continues through life in complex ways or relating
Sexual Crucible Model
David Schnarch (Bowen); marriage is a vessel that contains volatile tranformational processes; sexual/emotional intimacy is intertwined in process of differentiation; most appropriate for psychologicaly-minded clients
Sexual Crucible Model
David Schnarch; marriage is a vessel that contains volatile tranformational processes; sexual/emotional intimacy is intertwined in process of differentiation; most appropriate for psychologicaly-minded clients
Projective Identification
Defend against anxiety by projecting unwanted parts of selves on others
Alfred Adler
Departed from Freud. Believed psychotherapy should include "social interest" or the awareness individuals have of their relational world, the desire to belong and to make a contribution to it (1911)
John Bowlby
Developed "Attachment Theory" - addresses family interactions and the emotional development of children and adults
Jose Szapocznik
Developed "Brief Strategic Family Therapy" to address Cuban adolescent drug abuse problems
Marion Lindblad-Goldberg
Developed "Ecosystem Structural Family Therapy"
Patterson & Forgatch
Developed the most prominent approach to parent training
Mental Research Institute (MRI) People
Don Jackson, Watzlawick, Weakland, Fisch
Structural Functionalism
Durkheim, Parsons, Merton; seeks to interpret society as a structure with interrelated parts; informed by positivism and quest for verifiable facts; individuals are seen as serving a purpose through status, position and relations in effort to maintain societal equilibrium; families serve to provide members and socialize them to societal rules and norms
CBT: Major Issue in Families according to Cognitive Therapy
Dysfunctional schemas (beliefs and assumptions) about specific family roles
Marion Lindblad-Goldberg
Ecosystem Structural Family Therapy
Source of Behavior Problems in Intergenerational Therapy
Emotional fusion, passed down through generations; based on "anxious attachment"
Multigenerational Transmission Process
Emotional processes passed on through generations
Undifferentiated Family "Ego Mass"
Emotionally fused due to lack of differentiation
According to Minuchin, what is the most important technique to master?
Enactments - people describe themselves one way, but behave differently
Psychoanalytic Therapy
Essence is uncovering and interpreting unconscious impulses and defenses against them; analyzes individuals intead of interactions; involves knowing where to look to discover basic wants/fears
Structured Interview
Established set of questions given in the same manner and sequence
Initial Goal of CBT
Examine how family members reinforce one another's behaviors to maintain symptoms and relational behaviors
EmFT: Negative Interaction Cycle
Examples: nag/withdraw, pursuer/distancer, criticize/defend)
Systemic Family Development
Expanded FD single generation focus - intergenerational, interactional perspectives of families' life cycle; more systems-oriented (foundation for challenging previous assumption of universality); more process-oriented; families share development of a stressor, change and adaptation, role and relationship shifts (doesn't focus on families going through particular stages at particular times)
Most well-documented factor in the relapse of schizophrenia
Expressed Emotion (criticism, hostility, and emotional overinvolvement)
Pseudomutuality
Extreme family myth of harmony
Carter & McGoldrick Model
FD: Developmental stages, but also different levels of analysis (individual, family, social context); useful in exploring life stressors and how they interact with family stories, triangles, roles over time; emphasizes a balance between connectedness and separateness; analyzed individual from family therapy perspective
Laszloffy
FD: Systemic Family Development
Genogram
Family tree that maps key multigenerational processes, relationships; both an assessment and intervention tool
Ludwig von Bertalanffy
Father of "systems therapy" - applied biological concept of systems as oganisms of interrelated parts, where each part is distinguished by boundaries and all systems have higher and lower levels to humans
Frank Parsons
Father of guidance (counseling)
Psychoanalytic - Root of Psychological Problems
Fear-dictated flight from object relations
Undifferentiated Person
Feel compelled to react and express their feelings before thinking and reflecting on what belongs to whom
Solution-Focused: "Utilization Technique"
Finding ways to leverage whatever the client presents as a strength or interest to develop meaningful actions and plans that will lead in the direction of solutions (i.e. use client's love of dogs as means to help him socialize more with people
Main difference between first- and second-generation family therapies
First generation based on theories about family processes; second generation avoided theory that labeled "normal" or "healthy" families and instead focused on theories related to the process of change
Murray Bowen
Founder of Intergenerational Family Therapy; identified importance of differentiation
Wilhelm Wundt
Founder of science of psychology
Sue Johnson & Les Greenberg
Founders of Emotionally Focused Therapy
Father of Guidance
Frank Parsons
Behavioral People
Gerald Patterson
CBT: Contingency Management
Giving and taking away rewards based on kids' behavior
Strategic People
Haley, Montalvo
Collaborative: Therapist stance
Hallmark: curiosity - interest in clients' unique life experiences and the meanings generated - fueled by a social constructivist epistemology
Founders of constructivist Collaborative Therapy
Harlene Anderson and Harry Goolishian
Founders of constructivist Collaborative Therapy "Not Knowing"
Harlene Anderson and Harry Goolishian
Collaborative Family Therapy: Founders
Harry Goolishian, Harlene Anderson, Tom Anderson
Who developed the Minnesota Multiphasic Personality Inventory (MMPI)
Hathaway and McKinley
CBT: Patterson & Forgatch tool for getting Baseline Functioning
Have parents use monitoring and tracking
Selfobject
Heinz Kohut; experience of another as part of yourself; done by child; need to grow and separate
Narrative: Deconstructive Questions
Help people unpack their stories or see them from different perspectives; begin to see how they were constructed; situate their lives in a broader context
Satir: Softening Family Rules
Helped families soften rules by changing them to guidelines; encouraged families to have as few rules as possible and to be flexible
Social Exchange Theory
Homans, Schneider, Emerson, Nye; studies individuals by focusing on the dynamics of their relationships and the motivations that drive them, thus allowing for predictions of behavior; assumes people are self-interested and make choices based on cost-benefit analysis; assumes they are rational and engage in negotiations; needs of individual, not society drive behavior
Family Projection Process
How parents project their immaturity onto on or more children; the child who is focus of parent's anxiety will be less differentiated
Self-Object Relations Patterns
How represent primary caregiver (ideal, rejecting, exciting); splitting (all good or bad); projective identification (project unwanted parts of self on others); repression; parental interjects (internalized negative aspects of parents)
CBT: Keys to shaping behavior with reinforcement and punishment
Immediacy and consistency
Paradoxical Injunction
Imposing a directive that places the client in a therapeutic double bind that promotes change, regardless of client compliance with the directive; used when resistance to the directive is anticipated
Paradoxical Injunction
Imposing a directive that places the client in a therapeutic double bind that promotes change, regardless of client compliance with the directive; used when resistance to the directive is anticipated (Strategic)
Goals of Intergenerational Therapy
Increase autonomy by making unconscious processes conscious; decrease interactions based on projects or revolving slate of entitlements; increase capacity for intimacy without loss of self (fusion); develop reciprocal commitments that are fair and balanced; don't try to change people - help learn about themselves; trace pattern of family problems; modify most important triangle (marriage)
Collaborative: goals
Increased self-agency, transformation of self-identity
Nathan Ackerman
Individual pathology reflects family distortions & dynamics
Psychoanalytic - conditions for behavior change
Insights worked through; climate of trust; work slowly; identify projective mechanisms; acknowledge and accept split-offs; help understand how problems emerge from unconscious perpetuation of conflicts from own families
Reinforcement Reciprocity
Instead of focusing on how the undesired behavior could be reduced, focused on how the exchange of positive behavior could be maximized
Parental Interjects
Internalized negative aspects of parents
Narrative: Audience/Witness
Invite significant others to experience the client's new narrative
Narrative: Externalizing the Problem
Involves linguistically separating the problem from the person - often refer to it as a noun and something that acts upon the client
Satir: "Parts party"
Involves the client using group members to represent aspects of their self; facilitates a process in which the client is better able to recognize and accept different aspects of self and identify which contexts they are useful
Who created the first "mental test"?
James McKeen Cattell
Gregory Bateson & John Ruesch
Jay Haley worked with Bateson at Bateson Project, Stanford. (Strategic) Communication theory - contributed to family therapy
Selfobject
Kohut; experience of another as part of yourself; done by child; need to grow and separate
Problems with early assessments
Lacked theoretical foundation, somewhat transparent and easy to fake, culturally biased
Diffuse Boundaries
Lead to enmeshment; do not make a clear distinction between members; create a strong sense of mutuality and connection at the expense of individual autonomy
Norman Epstein
Leader in developing CBT with couples
Rigid Boundaries
Leads to disengagement; excessive tolerance for deviation; autonomy and independence emphasized at expense of emotional connection, creating isolation that may be more emotional than physical
CBT: Secondary reinforcements
Learned associations (praise, criticism, attention)
Narrative: Letters and Certificates
Letters document narratives and certificates celebrate the new story
Intergenerational Therapy Interventions
Listening (no advice, reassurance, validation or confrontation); empathy; interpretation and promoting insight; working through; detriangulation
CBT: Reciprocal Reinforcement
Maintains undesirable behavior (kid throws tantrum, mom gives in and is rewarded by calmer kid0
Milan Team
Mara Selvini Palazzoli, Luigi Boscolo, Giuliana Prata, Gianfranco Ceccin
Separation-Individuation
Margarat Mahler; gradual separation and differentiation of child from parent; if doesn't occur, get fusion and overly intense emotional attachments
Solution-Focused: Theoretical Bases for approach
Mental Research Institute, Ericksonian Hypnosis
Manipulate Mood in the Family (structural)
Modelling an exaggerated reflection of a frequently manifested mood in the family (i.e. yell louder if they yell)
Perspective of symptom bearer in eyes of structural family therapy
NEVER see as the source of the problem - family interactions are targeted for intervention (do consider potential biological problems)
What do structural therapists assume about how families should be structured
NOTHING - makes no assumptions
People who brought race to consciousness in family therapy
Nancy Boyd-Franklin and Ken Hardy
Grandfather of Family Therapy
Nathan Ackerman
Shortcomings of Intergenerational Therapy
Neglects power of working directly with nuclear family (focus on individuals and extended family); don't use power of working with families in action - speak to each member individually
Does Minuchin see families as dysfunctional?
No; sees problem in structure; focuses on family strengths
Role of Therapist in Intergenerational Family Therapy
Non-anxious presence; modeling differentiation; providing insight; creating a safe space
Holding Environment
Nurturing therapeutic relationship and space; contextual (handling of therapy arrangements); centered (connection with family)
David & Jill Scharff
Object Relations Family Therapy
Ronald Fairbairn
Object Relations Therapy; "splitting"
Splitting
Object relations therapy; ego is divided into structures that contain part of the ego, part of the object, and the affect associated with the relationship; external object is experienced one of three ways - ideal (satisfied), rejecting (anger), exciting (longing); if not resolved, see things as "all good" or "all bad"
CBT: Extinction
Occurs when no reinforcement follows a response
Transference Between Family Members
One person projecting onto others interjects and repressed material
CBT: Premise of Cognitive Therapy
Our interpretation of other people's behavior affects the way we respond to them
Idealization
Parents provide idealized model from which children draw strength - develop a grandiose sense of self; if not emerge from this stage, become narcissistic
Emotional Cut-Off
Person is so emotionally fused with other that must physically separate to be comfortable
Differentiation
Person's ability to separate intrapersonal (thoughts & feelings) and interpersonal (know difference between self and others); balance of togetherness and autonomy
CBT: Characteristics of Gottman Sessions
Positive affect, dyadic (therapist minimal intervention), emotional learning (nonthreatening), nonidealistic
Cross-Generational Coalition
Problematic; formed between parent and child against another parent ("teams"); common in divorces; often "covert"; evidenced by secrets and complement the child and disparage the other spouse
Collaborative FT: what are problems
Problems are not experienced unless someone interprets a situation as "problematic" (others might see as normal or non-stressful)
Intergenerational Family Therapy
Process-oriented; viewing/assessment of family dynamics is key; relies heavily on self-of-the-therapist; doesn't emphasize techniques or interventions; uses genograms; models differentiation; change achieved through insight and therapuetic relationship; goal is to increase clients' levels of differentiation and tolerance for anxiety; cannot be learned in books; builds off of psychanalytic therapy
Solution-Focused: "Presuppositional Questions"
Questions that imply the inevitability of future change - used to generate hope
Emotionally Focused Therapy (EmFT): Interventions
Reflection of emotion, validation (understanding), evocative responding, heightening, empathic conjecture and interpretation, tracking and reflecting interaction patterns, reframing problems contextually, enactments/restructuring/choreography, turning the emotional experience into a new response, self-disclosure
Intelligence Quotient
Ratio of mental age level to chronological age
EFT: Superreasonable
Recognizes context; ignores self, other
EFT: Irrelevant
Recognizes none; ignores self, other, context
EFT: Placator
Recognizes other, context; ignores self
EFT: Blamer
Recognizes self, context; ignores other
EFT: Congruent
Recognizes self, other, context; ignores none
Major goals of Structural Family therapy
Restructure the family, realign boundaries, establish hierarchies - all to promote growth and resolve problems
Negative Reinforcement
Reward by removing undesirable
Person who created group-administered tests
Robert Yerkes (funded by army)
Boundaries
Rules for managing physical and psychological distance between family members and subgroups, for defining the regulation of closeness, distance, hierarchy, and family roles; Minuch calls it "organic" and a living process
In Emotionally Focused therapy, how important is symptom relief?
Secondary to increased personal integrity and expanded experiencing - presenting problem gets them in the door, but the real problem is "emotional sterility"
According to EFT, what does a "healthy" family look like?
Secure enough to support and encourage individual freedom, open, natural, open to spontaneous experiences
Kohut
Selfobjects
David Schnarch
Sexual Crucible Model; Intergenerational Family Therapy
Constructivism
Shifted emphasis from focusing on patterns of interactions to perspectives that people with problems have about them - meaning itself becomes the primary target for change
Conflict Theory
Sociological theory used to explain the impact and results of social, political and material inequality of social groups; Marx and Jetse Sprey theorists; Sprey expanded to inequality of human interactions and how conflict can be beneficial; assumes humas are self-interested, that resources are scarce, and conflict is good - encourages flexibility, compromise and solidifies/unifies groups
Hallmark technique of Emotionally Focused Therapy (EmFT)
Softening emotions
Scaling Questions
Solution-Focused
Scaling Questions
Solution-Focused "Ask clients to identify small steps (concrete and specific) toward goal attainment --Important because when client makes a small change they are more intrinsically motivated to make more --Usually have them rank on a scale of 1 to 10 --Used to reduce goals that seem daunting and far off --allows focus on previous solutions and exceptions and to punctuate new changes"
Splitting
Split objects into good or bad by repressing the rejecting and/or exciting objects; come to see partners as all good or all bad
Standards for development and use of instruments
Standards for Educational Psychological Testing
First standardized achievement battery
Stanford Achievement Test (SAT)
Solution-focused: Two key areas of case conceptualization and assessment
Strengths & Resources, and Client Motivation
Robert Merton
Structural Functionalism; developed concept of deviance; distinction between manifest (conscious intentions) and latent (objective consequences of actions, often unintended) functions; said not all society work is for the whole - some is for dominant group or individual
Talcott Parsons
Structural Functionalism; purpose of individuals is to preserve the whole (society) by conforming to society's norms and rules; learn through socialization
CBT: Thought Records
Structured journaling to help clients analyze their own cognitions and behaviors and develop more adaptive responses - includes trigger situation, automatic or negative thoughts, emotional response, evidence for thoughts, evidence against, cognitive distortions, alternative thoughts
Isomorphic Sequences
Structured; patterns of behavior in one level of training mirror or replicate other patterns; therapist needs to not get sucked into replicating the patterns; changing any of them may not change the basic structure (interaction patterns)
George Herbert Mead
Studied individuals and initiated interest in how we develop a sense of self; founder of Symbolic Interactionism; self is an actor, not passive recipient (contrast to Parsons, Durkheim); people are thoughtful and reflective; through interaction we pass through three stages of social and personal development; abstractly understand the inner self "I" and "me" (expected behavior)
Common substance abuse assessment instruments
Substance Abuse Subtle Screening Inventory, CAGE
Charles Horton Cooley
Symbolic Interactionism; coined the "looking glass self" - how people's perceptions of how other people view them shapes their concept of self
Assigning Tasks (structural)
Tasks for individuals or subsystems to be accomplished in the session or at home
Multidirectional Partiality
Therapist accountable to everyone, even if family member isn't there; involves "sequential siding"
Detriangulation
Therapist maintains neutrality, provides positive triangle that relieves anxiety and promotes insight; don't say "you are entitled to feel that way" because shuts down differentiation
Symbolic Experiential Therapy: How does Case conceptualization
Therapist relies on in-the-moment authentic encounters; they "intuit" their conceptualization because they are grounded in a systemic understanding of families and focus primarily on the family's emotional system; therapists "feel" their way through the system
Intergenerational Tools
Therapist's differentiation, genograms, process questions, detriangulation, "coming home," "I-statements", "relational experiments" (homework assignments); displacement stories
Collaborative FT: Primary tool
Therapist's stance, a "way of being in a relationship" that is postmodern and believes in social constructionism (knowledge is created, language is a medium for constructing reality)
Satir: Facilitating Emotional Expression
Therapists help clients express difficult-to-articulate emotions; therapists hears the story, but listens for the emotions (expressed or unexpressed) and use questions and empathic reflections to focus clients on the deeper emotinos
Collaborative FT: Process of Problem Dissolving
Through dialogical conversation, clients and therapists co-create new meanings regarding the problem. Each new interpretation or description of th eproblem informs different actions and attitudes toward the problem; reinterpretation leads to the problem no longer being experienced as a problem, but rather something the client can manage
Attachment Injuries (Johnson)
Traumatic occurrences that damage the bond between partners and, if not resolved, maintain negative cylces and attachment insecurities
Emotional Triangle
Use of a third person or object to alleviate tension; trying to change the third thing perpetuates the actual problem
Monica McGoldrick & Betty Carter
Used Bowen's theory to develop model of Family Life Cycle; included social emotional process in analysis - impact of gender and ethnicity
Solution-Focused: "Coping Question"
Used to generate hope when client is not reporting progress - focus on how things haven't gotten worse and how they coped
CBT: Types of happy marriages (Gottman)
Volatile couples, validating couples, conflict-avoiding couples
Most widely used instrument to assess children's intelligence
Wechler Intelligence Scale for Children
Transference
When a client projects onto the therapist attributes that stem from unresolved issues with primary caregivers
Narrative: When do problems develop
When a person's lived experience differs from the dominant social narratives
Countertransference
When therapist projects back onto clients, losing neutrality and having strong emotional reactions; helps clients better understand what they bring out in others
Feminist therapy: Key Assumptions
Women's experiences are central to understanding families; gender is socially constructed; social and historical contexts are important; families take many forms; social change is critical - "the personal is political"; there is no objective, unbiased observation of humans
First personality assessment
Woodworth's Personal Data Sheet (developed for army)
Projective Identification
also merging (Boszormenyi-Nagy), family projection (Bowen)
Highly differentiated person
can clearly separate thoughts from feelings and self from others; better able to negotiate tension and challenges in intimate relations; able to reflect
Insoo Kim Berg
co-founder of Milwaukee Brief Family Therapy Center (with de Shazer)
Satir: Primary Therapeutic Goals
congruence, high self-esteem, personal growth -- which all assist in the process of improving communication and growth w/in the family system
Five Communication Stances
congruent, placator, blamer, superreasonable, irrelevant
Solution-focused: Why popular with insurance companies and counties
efficient and respectful of clients, pragmatic focus on coping rather than curing
Hill and O'Brien's model for counseling - name the stages
exploration, insight, action
Relabeling
if blaming is typical of a family, an adjective that is positive in connotation is substituted for one that is negative (i.e. instead of someone being called controlling, the therapist would relabel as overburdened)
Revolving Slate
in family ethical ledger; destructive process when someone takes revenge or insists on entitlements in one relationship based on relational transactions of another
CBT: Accepting Influence (Gottman)
marriages in which men are unwilling to accept influence from wives (suggestions, requests) are 80% more likely to end in divorce
"ghosts" in symbolic experiential therapy
members creating cross-generational stress
How impactful on the counseling process are clients expectations about counseling before they arrive?
not very
SBT: Key characteristics
positive, active, focus on solutions (not problems or past), key attention to language
Solution Based Therapy: Key characteristics
positive, active, focus on solutions (not problems or past), key attention to language
Family Myths
protect family members from facing painful truths and also serve to keep outsiders from learning embarrassing facts
Positive Punishment
reduce undesired behavior by adding something undesirable
Negative Punishment
reduce undesired behavior by removing something desirable
Satir: role of symptom
serves as the system's homeostatic mechanism and attempts to maintain homeostasis or the status quo
Ecomap
shows the interactions the family has outside the family environment - assess support and areas for improvement, flow of resources
CBT: Written contract
spells out goals and expectations, structures relationship, increases client motivation and dedication
Research on Intergenerational Therapy
supports relationship between differentiation and anxiety, marital satisfaction and distress; supports emphasis on self-of-the-therapist
Why do Solution-Focused therapists focus on the meaning of the problem for clients?
the meanings people attribute to behavior limit the range of alternatives they will use to deal with the situation - generally don't ever question the original assumption about the meaning of a behavior
CBT: Most difficult behavior to extinguish
those that are intermittently reinforced
What did Satir believe that therapy and change involved?
warmth, genuineness, and congruent communication
CBT: Contingencies of Reinforcement
when and how behaviors are reinforced