SOCW 601 Other Slide Part 2
Promotes Resiliency by
Addressing risk factors associated with lack of coping strategies to address illness related stressors, family stressors, lack of support Supports protective factors by providing family with information and support to develop self-efficacy
Links to Anxiety Disorders
"Memories have an important role in shaping the child's expectations regarding the reoccurrence of threats, failure of protective intervention, and feelings of helplessness. These factors can become so pervasive that they govern the child's emotional life and behaviors."
Treatment Questions
"Suppose one night when you were asleep, there was a miracle and the problem was solved. How would you know? What would be the difference?" Enable families to construct the steps they view as necessary to make these changes possible "Suppose one night when you were asleep, there was a miracle and the problem was solved. How would you know? What would be the difference?" Enable families to construct the steps they view as necessary to make these changes possible
Cognitive Behavioral Therapy: Distortions
. Mind reading: You assume that you know what people think without having sufficient evidence of their thoughts. "He thinks I'm a loser." 2. Fortune telling: You predict the future--that things will get worse or that there is danger ahead. "I'll fail that exam" and "I won't get the job." 3. Catastrophizing: You believe that what has happened or will happen will be so awful and unbearable that you won't be able to stand it. "It would be terrible if I failed." 4. Labeling: You assign global negative traits to yourself and others. "I'm undesirable" or "He's a rotten person." 5. Discounting positives: You claim that the positives that you or others attain are trivial."That's what wives are supposed to do--so it doesn't count when she's nice to me."Those successes were easy, so they don't matter." 6. Negative filter: You focus almost exclusively on the negatives and seldom notice the positives. "Look at all of the people who don't like me." 7. Overgeneralizing: You perceive a global pattern of negatives on the basis of a single incident. "This generally happens to me. I seem to fail at a lot of things." 8. Dichotomous thinking: You view events, or people, in all-or-nothing terms. "I get rejected by everyone" or "It was a waste of time." 9. Shoulds: You interpret events in terms of how things should be rather than simply focusing on what is. "I should do well. If I don't, then I'm a failure." Personalizing: You attribute a disproportionate amount of the blame to yourself for negative events and fail to see that certain events are also caused by others. "The marriage ended because I failed" 11. Blaming: You focus on the other person as the source of your negative feelings and you refuse to take responsibility for changing yourself. "She's to blame for the way I feel now" or "My parents caused all my problems." 12. Unfair comparisons: You interpret events in terms of standards that are unrealistic—for example, you focus primarily on others who do better than you and find yourself inferior in the comparison. "She's more successful than I am" or "Others did better than I did on the test." 13. Regret orientation: You focus on the idea that you could have done better in the past, rather on what you can do better now. "I could have had a better job if I had tried" or "I shouldn't have said that". 14. What if? You keep asking a series of questions about "What if" something happens and fail to be satisfied with any of the answers. "Yeah, but what if I can't catch my breath?" 15. Emotional reasoning: You let your feelings guide your interpretation of reality—for example, "I feel depressed, therefore my marriage is not working out." 16. Inability to disconfirm: You reject any evidence or arguments that might contradict your negative thoughts. For example, when you have the thought "I'm unlovable", you reject as irrelevant any evidence that people like you. Consequently, your thought cannot be refuted. "That's not the real issue. There are deeper problems. There are other factors."
Psychological Testing: Twelve Assumptions In Testing and Assessment
1.Psychological Traits and States Exist: A Trait is defined as any distinguishable, relatively enduring way in which one individual varies from another"(Guilford, 1959). States are similar, yet tend to be less enduring(Chaplin, 1988). 2.Psychological States and Traits can be quantified and measured By Construct By design of the questions Test item weight(s) Society values of trait Technical considerations 3.Various methods of measuring the same thing can be useful. Tests may differ due to theory, empirically, rationally, interpretation procedures, format and stimulus materials 4.Assessment can provide answers to some of life's most momentous questions. Competency to stand trial? Who should be hired? Who should be awarded custody? Scholarship/Awards? 5. Assessment can pinpoint phenomena that require further attention or study. The broad concept of Diagnosis, such as reading ability, DSM-IV diagnosis, compelling evidence for trial, I&O psych. pros and cons in an assembly line, etc... 6. Many sources of data are part of the assessment process. The number, type and sources of data depend upon the question being posed and factors related to the reliability and validity of the instruments being used. 7. Various answers of ERROR are part of the assessment process. ERROR- Refers to a long standing assumption that factors other than what a test attempts to measure will influence performance on the test...it is expected, not a mistake. 8. Tests and other measurement techniques have strengths and weaknesses. There are limitations to every test, thus it is important to be aware of how limitations can be compensated for by data from other sources 9. Test-related behavior predicts non-test related behavior. Meaningful generalizations can be made from test data to behavior outside the testing situation 10. Present day behavior sampling predicts future behavior. 11.Testing and Assessment can be conducted in a fair and unbiased manner 12.Testing and Assessment benefit society.
Psychological Testing: What is a Good Test?
A Good Test should: Clear instructions for scoring, administration, and interpretation. Economy of time to administer and score and interpret Sound Psychometrics
Family responses to an Alcoholic/Addict getting clean and sober.
A family member can replace the addicted person's role by becoming the family's Alcoholic/Addict. This immediately resolves the crisis, as family members can maintain their old roles and live by the old rules. The family may dissolve into many parts. The other parent may divorce the recovering parent. The family might have had so much pain recently, that they are willing to go to great lengths to get some relief. This suggest the family may reach out for support and recovery as a unit. The family may undertake the deep work and commitment that is required to develop a whole new set of family rules.
Chronic Trauma: Factoid
A great majority of survivors neither abuse nor neglect their children Men with histories of childhood abuse are more likely to be aggressive towards others, while women are more likely to be victimized by others or injure themselves
Research links
A survey of more than 4,800 respondents ages 15 to 64 revealed that of those who occasionally were slapped or spanked as children had the following characteristics: 21 percent developed anxiety 7 percent experienced major depression 13 percent had an alcohol problem 17 percent had a drug abuse problem or anxiety disorder. Positive associations were also found for Anxiety Disorders and Major Depression,
Psychological Testing
A test is defined as a measuring device or procedure that measures variables such as: Intelligence Personality A test is defined as a measuring device or procedure that measures variables such as: Intelligence Personality Aptitude Interests Attitudes Values
Solution Focused Family Therapy Promotes Resiliency by
Addressing risk factors associated with belief systems that are negative and pessimistic about possibilities for the family and the ability to meet family needs and lack of effective coping strategies. Supporting protective factors by changing negative and pessimistic belief systems to those that give hope and enable family to improve
Physical Abuse-Facts
According to a study in Ohio, results showed that 70% of 800 family physicians and 59% of 400 pediatricians supported spanking (McCormick KF, 1992). Parents who were hit as children are more likely to hit their children. A large American study showed that 49% of adults had been hit with five different types of implements as children, and 44% of those had been injured at least twice.
Anxiety, memories and the brain
Additionally, Ratey refers to the amygdala being "implicated in anxiety, panic disorder, PTSD, and attention deficit hyperactivity disorder" (2002) Thus, it appears that there may indeed be a connection between the early experiences of spanking and the later possibility of developing an anxiety disorder. Childhood helplessness from spanking incidents is stored in the hippocampus and flavored with fear by the amygdala.
Multisystems Family Therapy Promotes Resiliency
Address multiple risk factors related to the family , lack of social support and community resources Support protective factors by helping families gain coping strategies, problem solving abilities, improve family organization and leadership, provide role models of strength, access support and adequate resources
Social Learning/Cognitive Approaches Promotes Resiliency by:
Addressing the risk factors related to belief systems, family coping strategies, and family interaction patterns Supporting protective factors by addressing belief systems and organizational patterns, and offering role models Belief systems-replace negative beliefs with a sense of self-efficacy Belief systems which promote use of appropriate coping strategies, promoting hope and courage Belief systems which address negative beliefs from the past, allowing people to access sources of help
Trauma: Hyperarousal
After traumatic events, the human system attempts to remain on permanent alert for additional danger. Easily startled Reacts irritably to small provocations Sleeps poorly They often have difficulty tuning out repetitive stimuli. The trauma "reconditions" the human nervous system
Assessing Use and Abuse of Medications, Alcohol, and Drugs
Alcohol use and abuse Use and abuse of other drugs Dual diagnosis: Addictive and mental disorders Using interviewing skills to assess substance use
Social Learning/Cognitive Family Therapy Theoretical Background
Began with the behaviorist tradition that examined how behavior is promoted through reinforcement system (contingencies) Operant conditioning model of voluntary behavior: positive increase, negative—increase, punishment-decrease, extinguish—decrease after initial increase Contingency contracting with couples
Solution Focused Family Therapy Role of the Therapist
Assumes a "not knowing" stance with the family -family members are the experts regarding their family and their solutions Asks questions to elicit family goals, their view of potential solutions, and behavior patterns that exemplify exceptions to the problem stance Helps the family shift from problems to solutions (modest goals) Acts as encourager— Acknowledges, conveys understanding, empathy Possibility- future orientation when problem will be solved, problem will be solved Stance of curiosity—how will the family solve the problem Therapist must convey empathy Family members need to feel understood before they are ready to take the next step
Psychoeducational Family Counseling
Basic Emphasis: Enable family members to cope more effectively with illness and other problems facing the family
Effects of IPV and Trauma
Basic Trust: It is the foundation of faith. Traumatic events create a crisis of faith The survivors sense of faith is severely shattered when the traumatic event involves the betrayal of important relationships. Guilt is common when survivor witnessed suffering of others. Basic Trust: It is the foundation of faith. Survivors tend to struggle with and intense desire for closeness/ neediness and intense fear and desire to isolate separate (Approach<>avoidance...check BPDO) Intense, unstable relationships
Beck's Cognitive Triad
Beck's Cognitive Triad represents three types of negative thoughts present in depression, as proposed by Aaron Beck (1979). The triad forms part of his cognitive theory of depression. involves negative thoughts about: The self (i.e., the self is worthless) The world /environment (i.e., the world is unfair), and The future (i.e., the future is hopeless).
Social Learning/Cognitive Approaches Theoretical Background
Began with the behaviorist tradition that examined how behavior is promoted through reinforcement system (contingencies) Operant conditioning model of voluntary behavior --positive —increase, negative—increase, punishment-decrease, extinguish—decrease after initial increase Contingency contracting with couples
Social Learning/Cognitive Family Therapy Major Tenets
Behavior is learned People learn from social context how people behave and how others are likely to respond Belief systems influence learning and performance of behavior Individuals behave to maximize rewards
Social Learning/Cognitive Approaches Treatment Process
Build on the identified nature of the problem Identify positive changes Strategize for success Realistic, specific, positive Educate the family about the learning process Help family members develop needed new skills Build on ways to generalize new skills Help families reinforce positive behavior
What is Cognitive Behavioral Therapy?
CBT aims to quickly resolve maladaptive thoughts or behaviors without necessarily delving too deeply into why they may occur. CBT helps individuals deal with their difficulties by changing their thinking patterns, behaviors, and emotional responses.
Assumptions of Cognitive Behavioral Theory: Differentiation from REBT
CBT differs from REBT (Ellis) in several ways, including but not limited to: Rules (CBT) vs "irrationality" (REBT) Greater empiricism than REBT Reliance on evidence instead of logic and rationality, CBT tends to be "more structured and precise" than REBT (Prochaska & Norcross, 2003).
Indications of Abuse of Commonly Used Drugs
Central nervous system depressants (alcohol, Benzodiazepines, and various barbiturates) Intoxicated behavior with/without odor, staggering or stumbling, "nodding off" at work, slurred speech, dilated pupils, difficulty concentrating. Central nervous system stimulants (amphetamines, including methamphetamine or "speed") Excessively active, irritable, argumentative, nervous, dilated pupils, long periods without eating or sleeping Cocaine and crack (also CNS) Energetic, euphoric, fixed and dilated pupils, possible tremors (euphoria quickly replaced by anxiety, irritability, and/or depression, sometimes accompanied by hallucinations and paranoid delusions. Opiods (opium, heroin, morphine) Scars on arms or back of hands from injecting codeine drugs, fixed and constricted pupils, frequent scratching, loss of appetite, (but frequently eat sweets). May have sniffles, red and watering eyes, and cough until another "fix," lethargic, drowsy, and alternate between dozing and awakening ("nodding"). Cannabinols (marijuana, hashish) In early stages, may be euphoric and appear animated, speaking rapidly and loudly with bursts of laughter; pupils may be dilated and eyes bloodshot; may have distorted perceptions such as increased sense of taste or smell; increased appetite; in later stages, may be drowsy. Hallucinogens (LSD, STP, DOM, Mescaline, DTM, DET) Behavior and mood vary widely, may sit or recline quietly in trancelike state or appear fearful or even terrified; dilated pupils in some cases; may experience nausea, chills, flushes, irregular breathing, sweating, or trembling of hands; may experience changes in sense of sight, hearing, touch, smell, and time. Inhalants and volatile hydrocarbons (chloroform, mail polish remover, metallic paints, carbon tetrachloride, amyl nitrate,butyl, isobutyl, nitrous oxide, lighter fluid, fluoride-based sprays) Reduced inhibitions, euphoria, dizziness, slurred speech, unsteady gait, giddiness, drowsiness, nystagmus (constant involuntary eye movement). Anabolic and androgenic steroids Increased muscle strength and reduced body mass; aggression, competitiveness, and combativeness.
Borderline Personality Disorder
Childhood abuse is highly prevalent among patients with BPD. Almost all patients with BPD seem to have suffered from some from maltreatment by parents such as physical punishments, emotional abuse, threats, severe psychiatric problems in the parents, or sexual abuse" Frantic efforts to avoid real or imagined abandonment Unstable, intense relationships Identity disturbance Impulsivity/self damaging acts Mood reactivity, irritability, dysphoria, anxiety Anger issues Chronic empty feelings Stress related paranoid ideation or severe dissociative symptoms
Strategies for Improving Outcome
Client emotional awareness Client insight Client willingness to accept responsibility for change Client therapist alliance relationship
Social Learning/Cognitive Approaches Role of the Family Counselor
Coach Help learn new behavior, opportunities for practice, offer feedback, and motivates to perform Provides a model of new skills, helps modify cognitions to promote learning and performance
Cognitive Behavioral Therapy : History
Cognitive Theory is founded on intellectual traditions dating back to the stoic Greek philosopher Epictetus, (AD 55-135) who stated "what upsets people is not things but their judgment about things (1983)." The theory is based in part, on a phenomenological approach to psychology, as proposed by Epictetus and other Greek Stoic philosophers and more contemporary theorists such as Adler, Alexander, Horney, and Sullivan. Aaron T. Beck is the primary pioneer of Cognitive Behavioral Therapy, suggesting it as a short term, goal oriented therapy that focuses on the relationship between thoughts, emotions and behaviors "that uses an information-processing model to understand and treat psychopathological conditions" (Beck, 1976, 2013).
Social Learning/Cognitive Approaches Theoretical Framework
Cognitive theory paradigm—examines the role of belief systems that influence behavior Shaped by family, culture, individual experiences Social learning-Cognitive is inherently a positive model; If a person can learn one behavior, they can learn another more positive one Social learning paradigm—examined how behavior is learned as well performed Role of the modeling process as a way of learning behavior Importance of the thoughts of the individual in terms of the learning and performing process Expectancies influence performance Self-efficacy—belief can carryout behavior
Diabetes and cultural adaptation
Community based program American Indians with diabetes. Involvement of respected community leaders in the planning and implementation process Meeting organized around a shared meal—culturally appropriate and relevant for diabetes Information regarding the illness and management Cultural aspects of talking circles, music, drumming, create arts Informal time for sharing and support
Substance Abuse: Protective
Community supports that offer involvement in schools and activities, supportive mentors Family and peers: positive relationships between parents and youth, appropriate levels of monitoring, good parent-child communication. Pro social peers Individual: Cognitive and behavioral skills to be successful in activities, social and problem solving competence, pro social attitudes.
Treatment Process
Create a working alliance with family as PARTNERS Assessment: What are the issues facing the family and person with the illness? What are their resources? Maximizing the family coping resources Provide accurate information—illness, signs, treatment, relapse Information about the impact on the family and how to care for all family members Arranging for supportive help (potential role of support groups
Sexual Abuse/Exploitation
Defined as engagement in, allowing a child to be engaged in, or exposing a child to sexual stimulation, sexual contact, or sexual penetration that violated the social taboos of society or to which a child cannot give informed consent Sexual penetration: Sexual Contact Incest Sexual abuse --a trauma that contributes to depression, pain, anxiety, potential risk of substance abuse, self blame Longer period and multiple partners increases the distress Protective: emotional support from family and friends, spirituality, Treatment response depends on if the home is safe for the child and what are other family needs People who have been abused earlier helped by approaches that give people a sense of control over their lives, to absolve sense of blame and guilt, and to feel cared for in current family relationships. Give people a sense that abuse of the past does not have to be part of the future Potential value of family models Psychoeducational—educate all of family about impact of abuse and helpful responses Solution focused—give people a sense of control of the direction of treatment—reinforces sense of control --Narrative—re edit story to emphasize strengths of survival and new possibilities --Object relations can address shadows of the past
Interpersonal Violence
Defining violence against intimate partners consists of three kinds of behaviors: Physical Violence Sexual Violence Threats of physical and/or sexual violence Stalking Psychological emotional abuse
THE ROLE OF THEORY Definition
Definition: In scientific circles, theory is generally defined as a set of statements used to explain the data in a given area (Marx & Goodson, 1976). "In psychotherapy, a theory (or system) is a consistent perspective on human behavior, psychopathology, and the mechanisms of therapeutic change" (Norcross, 1985). A psychotherapy theory describes the clinical phenomena, delimits the amount of relevant information, organizes the information, and integrates it all into a coherent body of knowledge that prioritizes our conceptualization and directs our treatment" (Prochaska & Norcross, 2003). " Without a guiding theory...clinicians would be vulnerable, directionless creatures bombarded with literally hundreds of impressions and pieces of information in a single session" (Prochaska & Norcross, 2003).
Psychological Testing: Psychometrics
Definition: The Science of Psychological Measurement Reliability: The consistency of the measuring tool, the precision with which the test measures and the extent to which error is present in measurement. Validity: Does the instrument measure what it is supposed to measure? Adequate sampling? Do scores reflect construct? Do scores relate to other tests of same measure? Are scores inversely related to measures of opposite constructs?
Interviewing for Substance Abuse Potential
Do you, or did you ever, smoke cigarettes? For how long? How many per day? Do you drink? What do you drink? (beer, wine, liquor?) Do you take any prescription medications regularly? How do they make you feel? Do you use any over-the-counter medications regularly? How do they make you feel? Have you ever used any illegal drug? When was the last time you had a drink/used? How much did you drink/use? When was the last time before that? How much did you have? Do you always drink/use approximately the same amount? If not, is the amount increasing or decreasing? (If it is increasing) Does that concern you? Do most of your friends drink/use? Do (or did) your parents drink/use? Have you ever been concerned that you might have a drinking/drug problem? Has anyone else ever suggested to you that you have (or had) a drinking/drug problem? How does drinking/using help you? Do other people report that you become more careless, or angry, or out of control when you have been drinking/using? Do you drink/use to "get away from your troubles?" What troubles are you trying to get away from? Are you aware of any way in which drinking/using is interfering with your work? Are you having difficulties or conflict with your spouse or partner because of drinking/using? Are you having financial difficulties? Are they related in any way to your drinking/using? Have you ever tried to stop drinking/using? How?
Role of the Counselor
Educates and provides support for family in dealing with a difficult situation Helps to insure that the needs of other family members are not neglected
Psychological Testing: The Settings?
Educational Settings Counseling Settings Clinical Settings Private practice Research Consulting Forensic Prison Business Settings
Solution Focused Family Therapy
Emphasizes family strengths and resources to promote positive change Focus in on solution Places spot light on what families can do
Theoretical Background
Grew out of the work related to families with a member with Schizophrenia and recognition that some of the problems were in response to the distress created by living with an ill member, rather than the cause Family distress had the potential to increase the risk of relapse Also-growing appreciation of the role of family in caring for people with illness—families came to be viewed as potential resource
Grief and Loss
Importance of validating feelings of loss and grief before people ready to move on Miracle question -help people begin to think in terms of possibility of emotional healing Questions regarding coping Scaling—identify resources Tasks as healing strategies- eg rituals
Psychological Testing: Types of Validity
Face Validity: This refers to how relevant the test items appear to be to the user. Content Validity: Is the content of the test representative of the universe of behavior the test was designed to sample Predictive Validity: How accurately the scores on a particular test predict some criterion measure. Construct Validity: Anxiety Intelligence Clerical Aptitude Motivation Marital Satisfaction
Major Tenets of Psychoeducation
Families are the major support systems for people with illness Family members are partners with the professionals Family members need appropriate tools (information, skills) Family members need support to cope
Solution Focused Family Therapy Applications
Families involved with protective services— Collaborative partnership including LISTENING, LISTENING, LISTENING, LISTENING Coping Questions How have you managed to .....? What would .....say about you Exception questions Scaling question (degree of willingness, confidence) Miracle question Do more of what works Do something different (Michelle Weiner Davis) Do the Opposite Prediction Task
Applications
Families with a member (parent, child) with a mental illness Importance of coordination with all parties Value of the social and clinical needs Medication management Families as partners What are their strengths, limitations Address sense of loss Provide needed information Create a crisis plan Encourage family to develop a support network
Major Tenets
Family members are not responsible for the mental illness of family members Family context and relationships have an impact on the illness and are influenced by it Family members can help identify signs of relapse and help prevent serious relapse Culture helps define how illness is experienced and the family member response.
Substance Abuse
Family studies indicate that alcoholism has a high rate of familial transmission (Bierut et al, 1998) Adoption and twin research suggest that transmission of substance abuse involves some genetic mediation (APA, 1994; Hesselbrock, 1995). Family behavior around drinking patterns has also been implicated in the transmission of alcoholism. Negative communication styles, such as demand-withdraw, are common in alcoholic marriages, and help to perpetuate the drinking problems in the relationship Marital violence is strongly related to alcoholism...estimates of lifetime drug use disorders comorbid with alcohol dependence is as high as 80% (Rotgers, Morgenstern and Walters, 2003).
Sexual Abuse-Facts
In a study reported by Wissow (2002), Parents who reported that they had been physically or sexually abused were more likely to report spanking (62%) compared with those who had no history of abuse (56%).
Multisystems Family Therapy Role of the Counselor
Flexible in the use of the self and assume a variety of roles in dealing with families and the wider system Advocate — for family regarding services, etc. Broker— between family and community services Educator - of family and community Encourager for family - don't give up, Action oriented Strength perspective Location flexible
Substance abuse
Focus on what is going well-times the person does not drink, use, or abuse Emphasis on the strengths within the client, family context, to help stop abusing substances Value of identifying roles (customer, complainant, visitor) Might be a customer for related problem-get driver's license Help family recognize first steps along the way to the goal—helps promote sense of mastery Acknowledge the hard work involved Look for evidence of success Relapse—focus on prior success and encourage to work on goal as soon as possible
Scaling questions
From a scale of 1-10, how serious is the problem? What would help it move by one? How motivated are you that you can make this change (1-10) What would help you? How confident are you that you could make this change? What would help Therapist acknowledges small changes
Home Visits
Give a clearer picture of stresses and strengths Guidelines- How would you feel if you were the family and having such a visit You are on the family's turf Join in culturally appropriate ways Power of genuine praise Act and dress to use self in an effective way Empowerment the goal-family gets the credit Importance of personal safety Office know where you are Get guidance from the family Know the area Don't enter, feel free to leave if hint of danger
Family Preservation Models
Goal of children remaining in the home if possible. Intensive, short term services with a focus on the family and the community. Counselor plays an active role in daily life Problem solving, support, advocate, help family learn new coping strategies
Social Learning/Cognitive Applications
Parent child relationships Parents helped to learn new skills and ways to reinforce them Communication skills -verbal and nonverbal Issue of anger control Problem solving
Interpersonal Violence: Statistics
Hansen, Harway, and Cervantes (1991) used two hypothetical cases to study family therapists ability to recognize IPV. The cases included physical assault, a protection order and a miscarriage due to the abuse. Only 22% identified the problem as violence and 17% as an abusive relationship 39% selected options such as a lack of communication, trust or secrecy. Only 10% addressed the need for protection 48% called for further assessment 28% recommended couples counseling
Solution Focused Family Therapy Goals of Treatment
Help families reach the goals they define Helping families focus on what they are doing right Expanding families ability to use their skills Help families restore and use their skills
Social Learning/Cognitive Approaches Assessment
Identify if the is issue in the area of: Lack of appropriate skills? Motivation (why bother?) Signaling system (who me?) Beliefs (not my job) Value of joint effort with family ?
Family Focused Case Management
Importance of establishing trust Mobilize family resources Link with community resources Advocate Coordinator
Facts Regarding Abuse
In the USA, approximately three million children are reported for abuse and/or neglect each year. Fifteen out of every 1000 children are substantiated as having been abused In a survey of 16 000 adults attending an HMO (As cited in Hamblen, 2002) in California, 22% reported having been sexually abused and 12% physically abused as children. In a random sample of 1225 women members of an HMO, 18.4% reported a history of childhood sexual abuse, 14.2% reported physical abuse, and 24.1% reported having been emotionally abused during childhood.
Multisystems Family Therapy Treatment Approach
Includes family and wider context Strength based Collaborative Organized around 4 steps 1.Joining—Strength Based approach Families have experienced disrespect Families are overwhelmed Frequently "sent" by someone else May need to reach out to others Be on the look out for potential sources of help 2. Initial assessment Dual emphasis on strengths with a risk assessment Assess joining process Assess what is realistic—not overwhelm people more Look at issues of poverty of spirit robs people of sense of meaning and hope Importance of timing -families need to trust why the counselor wants the information Wait for genogram until trust 3. Problem solving People frequently overwhelmed by life problems combined with leadership issues Importance to engage family to prioritize problems Identify which problems can be changed Action oriented approach, concrete solving process, small specific goals Prepare them for setbacks -how handle them Collaboratively developing small tasks-success reduces sense of powerlessness Value of role play Active involvement of worker in daily activities 4. Restructuring the family Enactment—family members enact family drama Value of a positive enactment Strengthen leadership
Substance Abuse: Risk
Individuals without attachment to schools Genetic vulnerability Sensation seeking, attention deficit, hyperactivity, poor impulse control
Multi System Levels
Individual—coaching individual for change can't guarantee response of others 2-3 Family System Value of structural approach -leadership Problem solving and solution approaches Explore resources within "family" network 4-5 Church, community, social service network Linkage, advocacy, mediator roles, educate the community, create new community services, (Help family access services, community design more effective services )
T-Score
It is a type of standard score with no negative scores. The mean = 50, standard deviation set at 10, with 5 standard deviations above the mean = 100 and five below the mean = 0 Easily correlated to other standard Scores for comparison.
Techniques for Eliciting Thoughts and Assumptions
Leahy (2003) outlines the following as ways in which to elicit thoughts and assumptions: Explain how thoughts create feelings (Exp. " no one likes me") Distinguish thoughts from facts (I will never have friends) Look for variations in a specific belief (Exp. What is going on when you are less depressed? Are you always depressed at the same level?). Categorize the distortion in thinking
Social Learning/Cognitive Family Therapy Basic Themes
Learn new skills, Perform more effective behaviors Modify beliefs
Common Dynamics and Responses of Abused Children
Low self esteem Mistrust Fear of Rejection Extreme vigilance Withdrawal Compulsive lying Anger and destruction Pretending illnesses Sleep related problems Low self care skills Verbal abuse to others Lack of friends Attention seeking behavior Compulsive stealing Irrational fears Poor follow through on tasks Bizarre or excessive sexual play with peers Fire setting Destruction of property Excessive temper tantrums Depressed mood Daydreaming Avoidance of others Intentional self harm Suicidal attempts Perfectionism Paranoia Constant worrying False beliefs that affect behavior Being picked on by other children Blaming of others Poor attention span Severe eating problems Rapid/extreme mood changes Low work effort School refusal Impulsivity Physical aggression Sensory disturbances Negative communication
MAST ( Michigan Alcohol Screening Test)
MAST is a simple, self-scoring test that helps assess if you have a drinking problem. Answer yes or no to the following questions: 1. Do you feel you are a normal drinker? ("normal" is defined as drinking as much or less than most other people)___ Yes ___ No 2. Have you ever awakened the morning after drinking the night before and found that you could not remember a part of the evening?___ Yes ___ No 3. Does any near relative or close friend ever worry or complain about your drinking?___ Yes ___ No 4. Can you stop drinking without difficulty after one or two drinks?___ Yes ___ No 5. Do you ever feel guilty about your drinking?___ Yes ___ No 6. Have you ever attended a meeting of Alcoholics Anonymous (AA)?___ Yes ___ No 7. Have you ever gotten into physical fights when drinking?___ Yes ___ No 8. Has drinking ever created problems between you and a near relative or close friend?___ Yes ___ No 9. Has any family member or close friend gone to anyone for help about your drinking?___ Yes ___ No 10. Have you ever lost friends because of your drinking?___ Yes ___ No 11. Have you ever gotten into trouble at work because of drinking?___ Yes ___ No 12. Have you ever lost a job because of drinking?___ Yes ___ No 13. Have you ever neglected your obligations, family, or work for two or more days in a row because you were drinking?___ Yes ___ No 14. Do you drink before noon fairly often?___ Yes ___ No 15. Have you ever been told you have liver trouble, such as cirrhosis?___ Yes ___ No 16. After heavy drinking, have you ever had delirium tremens (DTs), severe shaking, visual or auditory (hearing) hallucinations?___ Yes ___ No 17. Have you ever gone to anyone for help about your drinking?___ Yes ___ No 18. Have you ever been hospitalized because of drinking?___ Yes ___ No 19. Has your drinking ever resulted in your being hospitalized in a psychiatric ward?___ Yes ___ No 20. Have you ever gone to any doctor, social worker, clergyman, or mental health clinic for help with any emotional problem in which drinking was part of the problem?___ Yes ___ No 21. Have you been arrested more than once for driving under the influence of alcohol?___ Yes ___ No 22. Have you ever been arrested, or detained by an official for a few hours, because of other behavior while drinking?___ Yes ___ No Scoring the MAST Test Score one point if you answered "no" to the following questions: 1 or 4. Score one point if you answered "yes" to the following questions: 2, 3, 5 through 22. A total score of six or more indicates hazardous drinking or alcohol dependence and further evaluation by a healthcare professional is recommended. Sources National Council on Alcoholism and Drug Dependence of the San Fernado Valley. "Michigan Alcohol Screening Test (MAST)." Retrieved July 2007.Alcohol Concern. Primary Care Alcohol Information Service. Retrieved 2007.
Solution Generating Questions
Magic Wand Crystal Ball Miracle questions Time Machine Questions Fly on the wall Consider: Preparation, imagination, behavioral, small "baby" steps
Philosophical Schools of Theory
Modernist: CBT, Psychodynamic, Object Relations, Eriksonian, Kohlberg (levels of moral development), Transactional Analysis, Psychoanalysis, Piaget's cognitive development. Humanistic: Person Centered (Rogerian), Rational Emotive Therapy, Cognitive Behavioral Therapy, Reality Therapy, Emotionally Focused, (Satir), Symbolic Experiential (Whitaker). Systemic: Systems theories, Strategic, MRI Problem-Focused Approach, Cybernetics, System theory, Structural Theory, Existential Therapy, Gestalt. Postmodern: Transpersonal, Constructivism, Social Constructionism, Feminist Theory, Narrative Therapy (Societal, Political).
Natural disasters
Nature of community resources important—but every community can feel a sense of loss and disaster Importance of nourishing and enlisting the natural systems of the community and the strengths in the community—supports a system that will stay and remain part of the community Community resiliency 1. Building community through strengthening the already existing support systems 2. Validate the trauma experience through a community narrative 3. Reestablish the normal rhythms of life 4. Engage in collective healing rituals
Cultural Issues
Need to recognize and take into consideration the cultural meaning of the illness and views of treatment and who represent the "family" and the supportive circle Importance of recognizing who are the trusted and key members of the community Shape the program to fit with the cultural messages and procedures
Physical Abuse
Occurs as the result of acts or omissions by the child's caretaker. Non-accidental physical injury is also included. Examples include: Welts, bruises, and abrasions Ocular, head, chest, abdominal or other serious injuries Lacerations and burns Fractured bones or teeth Pharmacological abuse Munchausens's Syndrome by proxy
Cognitive Behavioral Therapy : The CBT Process
One of the primary issues relative to treating depression is to make certain to reduce severe symptoms such as weight loss, suicidal ideation and sleep disturbance. Beck (1979) suggests contingency management, i.e. providing assignments to the client in a way which promotes early success. Activity logs are helpful in quantifying problems, such as time spent in bed, amount of food/fluid intake and rating of moods, clarification of thoughts and provides clues about underlying mechanisms Depressed individuals who are participating in CBT are encouraged to monitor and write down the thoughts that pop into their minds (called "automatic thoughts"). This allows the patient and their therapist to search for patterns in their thinking that can cause them to have negative thoughts which can lead to negative feelings and self-destructive behaviors. A person who is depressed may have the belief, "I am worthless," with a therapist's help, the individual is encouraged to challenge these irrational beliefs. Part of this process involves viewing such negative beliefs as hypotheses rather than facts and to test out such beliefs by "running experiments."
Refugee trauma
Past traumas can have long shadows Risk of PTSD for members, social isolation, loss of traditional support network, worry about loved ones, loss of income and roles. Potential discrimination from community Protective Support of others in the refugee committee Resiliency approach valuable Builds on family strengths Community focus using community leaders Community support that values the culture Supportive relationships for youth who have been traumatized Create life as normal as possible
Multisystems Family Therapy Major Tenets
People live in a complex world that needs to be included in the assessment and treatment Counselors need to use a variety of intervention strategies, flexible roles Families need to treated with respect, given decision making power Empowerment Focus on strengths of overwhelmed people
Forms of abuse
Physical Abuse Sexual Abuse Psychological Maltreatment Neglect
Background
Potential mechanisms by which family influences disease management emotional climate within the home influences the physiological system of the pt. secure attachments linked to improved stress responses family relationships influence self-care behavior
Stages in the Change Process
Pre-contemplation-Family and abuser not really acknowledge the problem Contemplation—Aware of problem but family still covering up Contemplation/preparation—Family willing to acknowledge nature of problem—abuser not Family prepare self for plan of action Action-Individuals aware of a problem and taking steps to create change Maintenance—Relapse prevention Issues facing both family and person abusing substances
Social Learning/Cognitive Approaches Goals of Treatment
Promote family functioning by helping members learn appropriate skills, Promote a motivation system that encourages members to perform behavior that meets the needs of family members, Address the belief systems that foster effective behavior by family members
Delinquency/Conduct Problems
Protective Supportive parent-child relationships Positive discipline techniques Monitoring and supervision Family advocacy for needs of children
THE ROLE OF THEORY
Provides Direction Provides a system of understanding information Conceptualizes health, pathology, reality and the therapeutic process (Gehart, 2011). "A therapeutic model is better understood as a tool that increases therapist effectiveness rather than the "one and only true path" that resolves the clients problem"(Gehart, 2011).
Violence and Its Impact on Families
Psychopathological Repercussions Impact on Significant others Increased Risk of Suicide Fulfillment of Family Roles Intergenerational Effects Parentification of Children Family Systems Dynamics Survivors Participation in Family Life
Resolving the Trauma
Recovery is never complete...advise clients that PTSD symptoms are likely to recur under stress. The best indicator of resolution is the survivors restored capacity to take pleasure in her life and engage fully in relationships with others
Score
Refers to a code or a summary statement, usually but not necessarily numerical in nature. Scoring methods vary, and differ in interpretation of the scores.
Format
Refers to the form, plan, structure, arrangement and layout of test items as well as to related consideration such as time limits
Recovery
Reframe the patients mourning as an act of courage rather than humiliation Recognize revenge fantasies are common, and may provoke increased feelings of horror and humiliation Revenge can never change or compensate for the harm that was done.
Substance Abuse-Research
Research by Macmillan (1999) and colleagues speaks to the possible link between spanking and problems later in life..."adults who remembered being slapped or spanked as children were twice as likely to report current alcohol abuse or dependence or to have externalizing problems (e.g., illicit drug abuse or dependence, antisocial behavior) compared with adults who did not report being slapped or spanked as children"
Delinquency, Conduct Disorders of Youth
Risk: community violence, poverty, limited access to services, high mobility within neighborhood and community disorganization Poor parental supervision and lack of involvement in the lives of children, family conflict, parental models of inappropriate behavior Lack of investment in schooling
Substance Abuse: A Family Disease
Roles within the family organized to cope with substance abuse Risk factors for youth substance abuse Community context that condones alcohol or illegal substance use by adolescents Neighborhoods of violence, crime, drug use Family and peers with alcohol and drug abuse Family conflict, lack/overly severe discipline, Poor parent-child communication, sexual abuse, low parental monitoring, child maltreatment.
Solution Focused Family Therapy Treatment Process
Seek to find resources within the family and expand on them Identification of positive elements (compliments) Direct—observe something useful and comment Indirect—ask questions from the perspective of others who know the family Self—questions that prompt family to describe a strength
Physical Abuse-Studies
Several international studies have shown that corporal punishment does not help children internalize rules of behavior. Instead, it is more likely to persuade them that violence is legitimate More than half of U.S. states have passed laws banning physical punishment in schools, and 10 countries around the world have banned physical punishment in homes through either legislative or court action
Recovery: Final Points
Survivors cannot assess themselves fairly until they clearly understand that no action on their part absolves the perpetrator of responsibility for their crime. The survivor needs help from others to mourn her losses The solidarity of a group provides the strongest protection against terror and despair
Survivors of Child Abuse
Survivors typically describe extremely chaotic and ineffective family and social environments (Long and Jackson, 1994) The inadequate family and support systems failures contribute to more psychopathology than the actual abuse itself Deprivation spectrum includes three categories: Attachment deficits Inadequate social learning Inappropriate modeling
How to Support a Newly Recovering Family.
Stress "Self-focus" for individual family members. The beginning process requires each person to get as healthy as possible. Keep system as calm as possible. Focus on getting support for themselves. Make small, practical, manageable goals for the family during initial crisis. Make referrals, when possible, that treat the entire family. Address lack of trust and fear of relapse Begin to teach new coping skills to deal with changes.
Multisystems Family Therapy Theoretical Structure
Structural Family System-need to promote leadership and effective organization Ecological approach -transaction between family and levels of environment Ecostructural approach - Options and power—sense of control important Purpose and meaning—need this in life Role of poverty in crippling families
CAGE Mnemonic
The CAGE questionnaire was developed by Dr. John Ewing, founding director of the Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill. CAGE is an internationally used assessment instrument for identifying problems with alcohol. 'CAGE' is an acronym formed from the letters (Cut-Annoyed-Guilty-Eye). C) Have you ever felt it necessary to CUT DOWN on your drinking? A) Has anyone ever told you they were ANNOYED by your drinking? G) Have you ever felt GUILTY about your drinking? E) Have you ever felt the need to have a drink in the morning for an EYE OPENER? If 2 or more of the answers are yes → High index of suspicion for alcohol addiction
Psychological Testing: Three Parties
The Test Developer The Test user Examiner effect The Test Taker Test anxiety Cooperation Pain/Distress Alertness Prior Coaching Luck? Personal attributions
Solution Focused Family Therapy Major Tenets
The emphasis in on the future The solution can be unrelated to the origin Problems can develop lives of their own People cannot solve problems because they have been locked into negative views People really want to change People are suggestible Language helps shape reality People are the experts on their family
Challenging, Evaluating and Restructuring Thoughts
The following are some of the most common ways in which to challenge, evaluate and restructure negative and distorted thoughts of depressed individuals: Cost Benefit analysis (Advantages vs. disadvantages of...attending a function?) Where's the evidence this thought is true? What cognitive distortions might you be making? Is it possible that________? What is the worst thing that could happen? How likely is that to happen? Metaphorical imaging How likely is that to happen? Metaphorical imaging What is the quality of the available evidence? Defense attorney (Leahy, 2003) What is another way of looking at this situation/thought? What are some possible alternatives? As-if" technique ( ie, imagine yourself as confident...what would you be doing?) Extending a negative memory What/will additional information change your opinion? What would you tell_______ if they were thinking the same thing? What would _____ tell you? Is there a "double standard"? How much of this has to do with "acceptance". Using behavior to challenge the negative thought (ie...perhaps the negative thought is true? My wife says I don't listen to her). Old View/ New View Complete automatic thought records, name the distortions Make the abstract concrete, ie "I'll fall apart" (Persons, 1989). Providing educational materials Providing facts and statistics Conducting experiments as homework, Providing realistic and constructive thought lists Examining the childhood origins of faulty assumptions Bibliotherapy/ Daily affirmations/ Scripture
Reconnection
The goal is not to get rid of the trauma...it is to integrate, a belief in the restorative power of truth telling...no longer about shame and humiliation, but rather that of dignity and virtue.
Abuse and Neglect: "Impact on Adult Survivors"
The impact of abuse on adult survivors can result in many social, educational, and familial problems. Research supports the premise that childhood abuse contributes to the etiology of many different psychological disorders, including personality disorders and physical problems in later years.
Neglect
The most common form occurs when a caretaker is unable to or fails to care for a child's basic needs of food, clothing, shelter and medical care. This includes failure to provide adequate nutrition, supervision and clothing. Educational Neglect: Parents failure to comply with State laws which require school attendance Medical Neglect: Failure to provide a child with necessary medical/health care and/or medications, dental care, and immunizations. Abandonment: Occurs when a parent or caretaker leaves a child alone with no intention of returning
Trauma resolution?
The trauma is resolved only when the survivor develops a new mental schema for understanding what has happened.
Intrusion
The traumatic even becomes encoded in an abnormal form of memory; Returns consciously through flashbacks Nightmares/dreams Alters the course of normal development due to the repetitive intrusion into the survivors life. Traumatic memories lack narrative context...the linguistic encoding is inactivated...the nervous system relies on sensory forms of memory.
Assumptions of Cognitive Behavioral Theory
There is a transactional relationship between cognitions, affect and behavior The interpretations are ongoing Individuals develop idiosyncratic beliefs that guide their behavior, resulting in "selective attention". A "feed forward system" is established, ie self fulfilling prophecy, thus strengthening the faulty cognitions Clinical syndromes and emotional states can be distinguished by the specific content of the belief system and associated cognitive processes
Forgiveness and Compensation
These concepts interfere with the mourning process, with neither being truly attainable Forgiveness and compensation "ties her fate to the perpetrator...holding the recovery hostage to the perpetrators whims".
MMPI-2 and MMPI-A
They are the most widely used and researched objective personality inventories in the World There are over 50 foreign language translations Has passed cross cultural methodological scrutiny By 1989 there were over 140 MMPI translations in 46 countries A large number of research studies document the reliability and validity of the instruments. Detects invalid recorders very well Simplicity of administration and scoring Consistent across administrations Reliable evaluations Interpretation possible within a normative framework
Psychological Maltreatment
This is evident in the other forms of abuse This occurs when the parents or caretakers are held responsible for an impairment of a child's intellectual, psychological, or emotional capacity, or an impairment of a child's capacity to view him or herself with dignity and self-worth. Verbal Abuse Emotional Neglect Emotional Abuse resulting from physical abuse, sexual abuse, and neglect Abandonment
Trauma
Traumatic events change: Physiological arousal, Emotion, Cognition and Memory The fragmentation of memories from trauma serves as a self protection function to the victim.
IPV and Trauma
Traumatic events overwhelm individuals ordinary adaptations to human life Psychological trauma is a feeling of "Intense fear, helplessness, loss of control, and threat of annihilation". What disorders share these symptoms? Sympathetic Nerve System State of Alert...The Amygdala role in the process Threats invoke intense feelings of fear and panic, change arousal patterns... Fight or flight response Trauma effects persons ability to remember events...may become hypervigilant, irritable, disconnect symptoms from the actual source
Reenactment?
Traumatized survivors find themselves reenacting some aspects of the trauma scene in disguised form, placing themselves at risk for additional harm, often unaware of what they are doing...An attempt to MASTER the traumatic event.
Psychological Testing: Beck Depression Inventory
Two subscales Cognitive-affective Somatic performance Strengths: Brevity Easy to score and administer Test-Retest after one week = .93 Internal Consistency = .86 Weaknesses: No validity Scales High face validity issues, ie...easy to fake good or fake bad. BAI: Similar issues, Internal consistency .92 Test-Retest .75
General Familial Characteristics
Value punishment Disorganized Low empathy Impulsive High mistrust High/low expectations Substance abuse Criminal history Hostility Immature/Dependent Socially isolated Mental Illness Fanatical belief system More negative than positive parenting Domestic violence
Solution Focused Family Therapy Treatment: Key Questions
What do you want to continue (Formula One) "After first session, during next week observe and identity what happens in family that you want to continue" Family looking for exceptions