Marriage and Family Therapy Exam Review

Individually based theory and therapy models 02

2011-03-21T07:46:00.000-07:00

Analytic Therapy- Carl Jung

Therapeutic Goals

■ Reintegration
o Merging past and present
o Explore the Conscious/unconscious
o Develop self knowledge
o Individuation- reclaiming undeveloped parts of self through reflection on life/past

Key Ideas

■ View of Man
o Man’s behavior is conditioned not only by his individual/racial history (causality) but also by aims and aspirations (teleology- explanation of behavior based on future goals)

■ Collective Unconscious
o Shared by all but modified by personal experience

■ Personal Conscious
o Unique life experiences and perceptions

■ Theory of Personality
o Psyche
■ Conscious/unconscious
o Personal Conscious
■ Only understood through dreams and analysis and makes itself known through complexes and emotions
o Personal Shadow
■ Archetypal representing thoughts, feelings, and actions that disown by projecting them outward (contains everything that could or should be part of the ego that the ego denies or refuses to develop, either positive or negative)
■ Reclaiming is an essential task for mature personality.
o Archetype
■ Pathway of communication between unconscious and conscious
■ Understanding archetypes (images of unconscious) helps one to understand the self
o Principles of Opposites
■ Animus vs. Over Characteristics
■ Conscious vs. Unconscious
■ Personal vs. Shadow
■ Mind vs. Body

Megan

2009-10-22T18:14:00.000-07:00

After completing a biopsychosoicial assessment, and an additional session with Mel and Megan, you begin to formulate assumptions about the personal and interpersonal strengths, resources, and difficulties that brought them to marital counseling. Megan expressed in the initial session with you that she has concerns relating to her relationship with her husband, Mel, and that she would like at least some individual counseling sessions with you to discuss personal issues that she feels uncomfortable discussing with Mel in the room. Mel grimaces and looks at Megan with a disdainful look and tells you that he does not have anything to hide and whatever she has to say she should say in front of him. From what Megan stated in the beginning sessions, you discern that if Megan’s concerns are expressed in front of Mel, this could result in emotionally and/or physically negative repercussions against Megan. In therapy, Mel has openly demonstrated his anger, criticism, resistance, and difficulty relinquishing control over Megan. Megan hinted that Mel and her father bear certain similarities in their behavior, and use of control mechanisms with her. You see through Mel’s covert attempts to keep certain aspects of their relationship secret and his attempts to control Megan through modulating his tone of voice, carefully choosing his words and body language and their effect on Megan. You suspect that there is the possibility of domestic violence in the marriage. You further suspect that from Megan’s comments that she has witnessed or experienced domestic violence in her family of origin, with her father as the perpetrator.

From assessment information, therapists _____________ clients; therapists interpret information to determine if an emotional or mental disorder is present, rather than _______________. If an emotional or mental disorder is present in a client, it is ____________________. :

A) Diagnose; making a value judgment of the client’s worth; a single aspect of that individual, not a prime descriptor of his or her life

B) Assess; diagnose a client’s value; considered in the treatment plan

C) Describe a client’s condition; describe the client’s condition; the essential characteristic of that person and determines the course of treatment

D) Determine whether to proceed with therapy; ruling out and dismissing possibilities of other diagnoses from the initial assessment only; neither ethical nor unethical to discuss the diagnosis with the client

Explanation: According to Hohenshil, 1993, “Diagnosis…is the meaning or interpretation that is derived from assessment information and is usually translated in the form of some type of classification system.” Diagnoses describe a person’s condition, and do not determine the worth or value of a client. People are individuals, not the disorder; clients have a particular type of mental or emotional disorder that is only one aspect of the person, not the fundamental descriptor of his/her life or person. Diagnoses change based upon information gathered from subsequent contact with the client in therapy.

Study for the MFT exam on your iPhone or iTouch

2009-09-06T21:03:00.000-07:00

Finally you can study for the MFT exam on the go! MFT Exam Pro contains 200 MFT practice exam questions for the National Marriage and Family Therapy MFT Exam Review for the AAMFT test. Multiple choice data banks cover exams areas questions such as - Adlerian, Behavioral,Cognitive, Psychoanalytic, Solution-Focused and TA; Human Development, stages proposed by Freud, Erikson - Mahler and Bandura; Ethics, Laws and Multicultural therapy; Couples Therapy- Imago and Emotion Focused; Family Therapy- Whitaker and Satir’s psychodynamic approach - Narrative and Strategic; Physical/Emotional Abuse and Substance abuse; DSM and Mental Health and other areas on the exam. In the new 1.3 version the MFT Exam Pro includes the ability to select ALL questions to be reviewed at one sitting. A function has been added that keeps tract of missed questions for review.

Find iPhone apps at AppStoreHQ

Experiential Family Therapy (e.g. Carl Whitaker)

2007-08-07T12:11:00.000-07:00

A) Assumptions

1. Based on a pragmatic stance with the belief that theory can hinder clinical work
2. Each family member has the right to be themselves
3. Based on the belief of the family being an integrated whole, not as a collection of discrete individuals
4. Familial togetherness and cohesion is associated with personal growth
5. Emphasis on the importance of involving extended family members in treatment (especially the expressive and lively spontaneity of children)
6. Basis of this bold and inventive approach to family therapy was the result of Whitaker’s spontaneous and creative thinking
7. Stresses the importance of genuineness
8. Techniques are secondary to the therapeutic relationship
9. Whitaker believed in this a theoretical approach based on the assumption that many times, theory is way for therapist to create distance from clients; it also helps to control the anxiety of therapists by allowing them to hide behind their “theory”.
10. Emotional expression is thought to be the medium of shared experience and the means to fulfillment (personal and family).
11. Whitaker suggested that self-fulfillment depended on family cohesiveness.

B) Why People Do What they Do? (What Motivates Them?)

1. To be authentic and able to freely express oneself
2. Being autonomous while also feeling they are a part of the family
3. To have intimacy
4. Self-actualization and self-determination

C) How Do People Get In Trouble?

1. Symptoms and interpersonal problems stem from the lack of emotional closeness and sharing among family members.
2. The needs of the family may be suppressing the rights of the individual.
3. Keeping family secrets can lead to the dysfunction of family members.
4. The family has infringed upon its individual members’ growth and freedom.
5. Personal choice has been comprised.
6. Families put on a façade which restrains its members from being authentic.

D) How To Help People

Goals of Experiential Family Therapy
• The primary goal of experiential therapy is to reduce defensiveness and unlock deeper levels of experiencing by freeing the clients from their impulses.
• Goals for the family
o improved communication and reduced conflict
o growth, not stability: symptom reduction is secondary to greater freedom of choice
o increased personal integrity (congruence between inner experience and outer behavior)
o less dependence,
o expanded experiencing
o emphasis on the feeling side of human nature
o improved autonomy for each member
o improved agreement about roles
o merger of needs for individual growth and strengthening the family unit.
1. The therapist’s active and forceful personal involvement and is the greatest way to bring about changes in families with the goal of promoting flexibility among family members.
2. A goal of therapy is to help family members open up and more fully be themselves by freely expressing what they are thinking and feeling.
3. The therapist conducts a family therapy session with the intent of it being a growth experience for him/herself, thereby inspiring the family to do the same; therefore, the therapist helps family members focus on the here and now by the therapist “being with” the family.
4. Focus on expanding immediate personal experiences and increasing the family’s awareness by achieving a higher level of intimacy.
5. Unmask pretense, create new meaning, and liberate family members to be themselves.
6. Aim for authenticity as there is no right or wrong way to be.
7. Attempt to unmask and tap into family secrets.
8. Guide the family through three specific phases: engagement (the most powerful), involvement (dominant parent figure, adviser) & disentanglement (more personal, less involved).

E) What Techniques And Skills Are Used?

1. Whitaker pioneered the use of co-therapists as a way to maintain objectivity.
2. Incorporates highly provocative techniques/interventions intended to create turmoil, turn up the emotional temperature, and intensify what is going on here and now in the family while then coaching the family how to get out of the turmoil.
3. Believed in doing therapy with a “crowd” in the room.
4. The therapist is active and directive to help create an intensified affective encounter for family members which allows for the family’s own healing and self-actualizing processes to take hold.
5. Therapist takes a theoretical stance as a way to intensify what the family members are presently experiencing and encourage them to reach into their unconscious to understand what is really going on in the family.
6. Facilitation of individual autonomy and a sense of belonging in the family.
7. Encourage spontaneity, creativity, the ability to play, and the willingness to be “crazy”.
8. The therapist's role is more of a facilitator. Through the use of reflection, he/she exposes the process of family interaction while joining the family process as a genuine and non-defensive person.

F) What Are The Limitations On Those Skills Or Techniques?

1. A great limitation is that this approach de-emphasizes theory and the use of “one-size, fits all” techniques.
2. Therapy follows a subjective focus and centers around the subjective needs of the family members (leaving room for bias or skewed perceptions).
3. This approach relies on a highly involved therapist model where the therapist must be visible, take risks, and get involved with family in the sessions.
4. Since success depends on the collaboration of several people, drop-out rates are high.

G) What Are The Professional Implications?

1. Whitaker typically relied on his own personality and wisdom, rather than any fixed therapeutic techniques to stir things up in families, so it is a hard theory to “teach” in terms of technique.
2. Whitaker believed in a confrontative approach which may not work well with fragile families.
3. This method incorporates an intuitive form of therapy which lower-functioning families/family members may not grasp.
4. He also acquired the reputation as the most disrespectful among family theorists since he often attacked or sought to overthrow traditional or popular ideas in family theory.
5. Some families may not appreciate the unrestrictive, intuitive, non-interventionist, and sometimes outrageous nature of this approach.
6. Rather than focusing on alleviating symptoms, this approach focuses on enhancing the quality of life of the family members. Although some focus on changing the family system may develop, it is not the primary goal. Therefore, this method may not be well suited for families who are looking for crisis management.

Family Therapy for Couples

2007-07-31T13:13:00.000-07:00

■ Behavioral couples therapy has been the most researched.
o Attempts to reduce substance abuse directly and through restructuring the dysfunctional couple interactions that frequently help sustain it

■ Integrative Couples therapy addresses some of the limitations of behavioral couples therapy.
o Helps couples to make arguments less harmful by teaching partners accept their differences.
o Therapy based on the importance of how a couple fights, not whether they fight or not.

■ Insight Oriented couples therapy and emotionally focused couples therapy have also been subjected to clinical trail investigations and found to be superior to no treatment.
o Is a combination of behavioral therapy and helping couples understand power struggles, defense mechanisms, and other negative behaviors.

■ Emotionally focused couples therapy maintains that relationship difficulties stem from the disowning of feelings and attachment needs, creating negative Interactional cycles and ineffective communication patterns.
o It has shown greater efficacy than no-treatment await-list controls.
o Enables couples to identify and break free of their destructive emotional cycles such as when one person criticizes and the other withdraws.
o The therapy helps couples build trust in each other.

■ Evidence for the use of Strategic therapy techniques in the context of couples therapy found an integrated systemic therapy model was equally effective as emotionally focused couples therapy and more effective than await-list control in alleviating relationship distress and improving target complaints and conflict resolutions.

Family Therapy for Eating Disorders

2007-07-30T07:34:00.000-07:00

■ How Eating Disorders Affect Families

o Eating disorders can consume the client in obsessive, negative thinking and behaviors, and consume the client’s relationships with family members.

o Clients demonstrate the following symptoms
● They become depressed, isolated, and tired.
● They avoid relationships because in order to avoid the pressure to eat.
● They are physically depleted.

o For Family members
● Seeing a family member starve or damage her or his body is stressful.
● Parents, spouses, or others become intrusive in their efforts to get the person to eat or to stop purging.
◆ The result may be that the see them as enemies trying to control them rather than help.

o The symptoms have become the individual’s way to avoid facing problems more directly or are an attempt to feel in control when the rest of life feels out of control.

■ Family Risk Factors for Disordered Eating

o Interactional patterns in families of eating disordered patients tend to constrain autonomy and the expression of intimacy

o Disruptions in attachment relations are characterized by destruction communication
● Behavioral family therapy, which Eating disorders may develop if a person has no other way to speak or represent feelings.
● Family dynamics, problematic communication patterns, losses, or stresses like abuse have contributed to negative feelings the person could not deal with directly

■ Family Based Behavioral Interventions for Eating Disorders

o Emphasizes parental control over eating and incorporates cognitive restructuring and problem-solving training, has also been tested in comparison to individual therapy for anorexic clients

o The model of behavioral family therapy was more effective than an individual approach because it focused on the building of ego strength and facilitated autonomy in terms of increasing body weight from pre to post treatment

o Treatments were equally effective in outcomes such as eating attitudes, body shape dissatisfaction, and depressive symptoms

Individually based theory and therapy models 01

2007-07-17T07:42:00.000-07:00

Psychoanalysis- Freud/Erikson/Mahler

Role of Therapist

■ Invisible- Blank Screen (detachment)
■ Fosters transference
■ Focus on Resistance

Therapeutic Goals

■ Bringing the unconscious to the conscious
■ Strengthen the ego

Key Ideas

■ Deterministic- problems are rooted in the first six years of life and trapped in unconscious motivations
■ Reality Principle- maximize gratification minimize punishment
■ Biological Drives- sex and instincts
■ Parts of Personality- Id/Ego/Superego
■ Id- Pleasure principle, “Demanding Child,” deterministic, unconscious, satisfy basic survival
■ Ego- Reality principle, “Traffic Cop,” mediator between Id and Superego
■ Superego- Moral Principle, “The Judge,” strive for perfection

Psychosexual Stages of Development

■ Oral Phase- 0-1 years, greedy, mistrust, unable to form intimate relationships
■ Anal Phase- 1-3 years, anal retentive, aggressive
■ Phallic Phase- 3-6 years, identity disturbance (Oedipal/ Electra complex)
■ Latency- 6-12 years, Socialization stage
■ Genital- 12+, Interpersonal relations freedom to love/work

Techniques

■ Brief psychodynamic therapy (BPT)- treating selective disorders within an established time.
■ Hypnosis
■ Dream Interpretation
■ Free Association
■ Projective Techniques
■ Freudian Slips

Feminist Family Therapy 01

2007-07-17T07:27:00.000-07:00

Foundations

■ Feminist movement Emerged in the late 1960’s continuing into the 1970’s.

■ Rachel Hare-Mustin
o One of the first women to challenge the family-therapy establishment.
o 1978 wrote "A Feminist Approach to Family Therapy"

■ Feminism is a theory that focuses on the recognition of the inferior status of women and the reasons for that inequality.

■ The strategies used in this theory are intended to lead to the recognition and validation of inequality and what changes can be made to end it.

■ It acknowledges that gender roles and socialization affect
o each individual in the family system
o interpersonal relationships in the system
o relationships between the family and society
o the client and therapist exchange.

■ Originally family theories simply ignored sexual stereotyping in families.
o Complementarity
● systemic concept which suggests an temporary inequality between partners
● The inequality is complementary and serves to stabilize the relationship.
● Does not take into consideration that women are ultimately at a disadvantage living in a society which keeps the women in a disadvantaged position structured by:
o Neutrality
● A position recommended that encourages the therapists to maintain a position of neutrality with the couple or family.
● The goal is to have all members of the family feel sided with and not against.
● However the relationship is unequal to begin with so it is maintaining a position of inequality by siding equally
o Circularity
● Suggests that responsibility for interactional dyads is equal.
● For example, it would suggest that even in cases of domestic violence, she is equally responsible for the abuse as him.
● The therapist who remains neutral by means of silence in a clinical situation like this is encouraging the unequal distribution of power in the system.

Functional Family Therapy (FFT) 01

2007-07-11T10:21:00.000-07:00

■        Family-based prevention and intervention program.

■        Successful in a variety of contexts used primarily to treat high-risk youth and their families.

■        The model allows for successful intervention in complex and multidimensional problems through culturally sensitive, flexibly structured clinical practice.

Treatment Goals

■        Identify the primary focus of intervention (the family)

■        Reflect an understanding that positive and negative behaviors both influence and are influenced by
multiple relational systems

■        Multisystemic prevention program
        o        focus on the multiple domains and systems within which adolescents and their families live.
        o        multilevel intervention
                ●        treatment system
                ●        family and individual functioning
                ●        therapist as major components.

■        Works first to develop family members’ inner strengths and sense of being able to improve their situations.

■        Provide the family with a platform for change and future functioning that extends beyond the direct support of the therapist and other social systems.

■        Includes a systematic and multiphase intervention map
        o        Phase Task Analysis
                ●        Forms the basis for responsive clinical decisions.
                ●        Gives FFT a flexible structure by identifying treatment strategies with a high probability of success.

■        Flexibility extends to all family members and thereby results in effective moment-by-moment decisions in the intervention setting.
        o        Practice is both systematic and individualized.

Assessments in Family Therapy

2007-07-10T07:50:00.000-07:00

Self-report scales

■ Cost effective to administer

■ Provide information on how family members evaluate their own functioning.

■ The Dyadic Adjustment Scale (DAD)
                ■ 32-item measure of marital quality and marital adjustment
                ■ Four subscales measure
                        • marital satisfaction
                        • cohesion
                        • consensus
                        • affective expression

■ The Family Environment Scale (FES) is a 90-item true/false measure assessing how family members perceive their family environment along the three domains of relationships, personal growth and system maintenance.

■ The Family Questionnaire (FQ)
        o Brief measure of perceived criticism and overinvolvment.

■ The Family Assessment Device (FAD)
        o 60-item scale that assesses the six dimensions of the McMaster Model of Family Functioning
                ■ Communications
                ■ problem solving
                ■ affective responsiveness
                ■ affective involvement
                ■ roles
                ■ behavior control

Interview-based family assessment instruments

■ More labor intensive and require rater training.

■ Provide an outside perspective on how a family functions compared to other families.

■ The Camberwell Family Interview
        o Requires extensive training
        o Used to assess levels of criticism and overinvolvment.

■ The Five Minute Speech Sample
        o Method of assessing expressed emotion in relatives of patients with psychiatric disorders.

■ The McMaster Clinical Rating Scale (MCRS)
        o Based on a family interview conducted by a rater
        o Assesses the same six dimensions of family functioning as the FAD in addition to assessing the overall health/pathology of a family.
        o Inter-rater and test-retest reliability as well as concurrent and discriminative validity.
        o Can take from 45 to 90 minutes depending on the experience of the rater.

Solution Focused Therapy 01

2007-07-09T13:15:00.000-07:00

Theory Foundation

● Solution-focused therapists look for solutions that have worked.
● Therapy is conversational processes by which therapists help clients shift their thinking from negative to positive.
● Therapists use creative tasks to engage clients in actions that lead to new perspectives and behavior.
● Looking for exceptions- when was the problem not a problem?
● The client’s effectiveness has been blocked by a negative mindset.
        o Drawing their attention to times when they were doing well helps clients to see things differently.
● The art of solution focused therapy then becomes a matter of helping clients not only to see that their problems have exceptions, but also to realize that these exceptions are solutions that they already have in their repertoire.
● Therapists look to the future when problems can’t be solved.
        o Changing the way people talk about their problems
        o Language creates reality.
                ● Go from problem talk to solution talk.

Normal Behavior Development

● Therapists do not impose their view of “normality”.
● There are no absolutes.

Goal of Treatment

● Help client shift from talking about problems to talking about solutions.
● Therapist and client work to build on the solutions that emerge from optimistic conversations.
● Therapist must be careful to create modest, concrete, and reachable goals.
● Assessing future goals
        o What do you think the problem is now?
        o How will you know when the problem is solved?
        o How will you know when you don’t have to come here anymore?
        o What will have to be different for that to happen in terms of your behavior, thoughts, and feelings?
        o What will you notice is different about other involved in the situation?

Narrative Therapy 01

2007-07-09T13:04:00.000-07:00

Founders

● Michael White
        o Became interested in ways people constructed meaning in their lives rather than just ways they behaved.

● David Epston
        o Emphasized that to maintain new narratives, clients need supportive communities
        o Advocates writing letters to clients

Model of Therapy
● Narrative metaphor focuses on self-defeating cognitions- stories people tell themselves about their problems.

● Consider alternative ways of looking at themselves and their problems.

● Narratives therapists:
        o Take keen interest in their client’s stories
        o Search for times in their histories when clients were strong/resourceful
        o Use questions to take non-imposing, respectful approach to any new story put forth
        o Never label clients
        o Help clients separate from dominant cultural narratives they have internalized so as to open space for         alternative life stories
        o Believe problems arise because people are indoctrinated into narrow and self-defeating views of         themselves
        o Externalize the client’s problems
        o Encourage clients to think of themselves as struggling against their problems
        o Believe that neither the client or the family is the problem, the problem is the problem
        o Not interested in family’s impact on the problem, but rather the problems impact on the family.
        o Shifted attention to cultural beliefs and practices as source of problems

Family Therapy in the 21st Century 01

2007-07-02T07:48:00.000-07:00

■ Erosion of boundaries
        o Schools of therapy are becoming less divided; therapists are borrowing techniques from almost all areas.
        o Therapists have seen the need to adjust their therapy to fit the specific client.

■ Postmodernism
        o Contemporary anti-positivism
        o Viewing knowledge as relative and context dependent
        o Questions assumptions of objectivity that characterize modern science
        o In family therapy, challenging the idea of scientific certainty, and linked to method of deconstruction
        o Most accepted practices were deconstructed- shown to be social conventions developed by people with         their own agendas.

■ The Feminist Critique
        o Exposed gender bias in existing models and advocated a style of therapy that called into question         systems theory itself.
        o Feminists stated that therapist failed to see that the archetypal family case of the over involved mother         and peripheral father is best understood not as a clinical problem but as a product of a historical process         hundreds of years in the making.
        o Belief that gender inequality should be primary concern for family therapists

■ Social Constructionism and the Narrative Revolution
        o Constructivism
                ◆ A relativistic point of view that emphasizes the subjective construction of reality.
                ◆ Implies that what we see in families may be based as much on our preconceptions as on what’s                 actually going on.
        o Collaborative Model
                ◆ A more egalitarian view of the therapist’s role.
                ◆ A stance advocated by critics of what they see as the authoritarianism in traditional approaches to                 family therapy
        o Reflecting team
                ◆ Tom Anderson’s technique of having the observing team share their reactions with the family at the                 end of a session.
                ◆ Observers will come out from behind a one way mirror to discuss their impressions with the                 therapist and family.
        o It was thought that therapist were doing therapy TO the client as opposed to WITH the client.
        o A therapist should take a not-knowing stance which leads to genuineness.
        o This therapy came from the biblical study called hermeneutics= the art of analyzing literary texts or         human experience, understood as fundamentally ambiguous, by interpreting levels of meaning.
        o Social constructionism
                ◆ Like constructivism, challenges the notion of an objective basis for knowledge.
                ◆ Knowledge and meaning are shaped by culturally shared assumptions.

Cognitive Behavioral Family Therapy 01

2007-06-29T13:39:00.000-07:00

Key Concepts

◆        Behavior Exchange Theory
        o        Explanation of behavior in relationships as maintained by a ratio of costs to beliefs

◆        Classical Conditioning
        o        A form of respondent learning in which an unconditioned stimulus, such as food, which leads to an unconditioned response, such as salivation is paired with a condition stimulus, such as a bell, the result is that the bell will evoke the same response
        o        Used in behavior treatment of anxiety disorders

◆        Cognitive behavior therapy
        o        Treatment that emphasizes attitude changes as well as reinforcement of behavior.

◆        Contingencies of reinforcement
        o        The specific pattern of reinforcing, or punishing consequences of a behavioral sequence

◆        Contingency contracting
        o        A behavior therapy technique whereby agreements are mad between family members to exchange rewards for their desired behavior.

◆        Contingency management
        o        Giving rewards and punishments based on children’s behavior

◆        Aversive control
        o        Using punishment and criticism to eliminate undesirable responses
        o        Commonly used in dysfunctional families

◆        Functional analysis of behavior
        o        In operant behavior therapy, a study of a particular behavior
                ■        What elicits it
                ■        What reinforces it

◆        Operant conditioning
        o        A form of learning whereby a person or animal is rewarded for performing a certain behavior
        o        The major approach is in most forms of behavior therapy

◆        Premack principle
        o        Using high probability behavior to reinforce low probability behavior

◆        Reinforcement
        o        An even, behavior, or object that increases the rate of a particular response
        o        A positive reinforcer is something that is added that increases the rate of a behavior.
        o        A negative reinforcer is something that is taken away that increases the rate of a behavior.
        o        Intermittent or irregular reinforcement is the most resistant to extinction.

◆        Role rehearsal
        o        The use of role playing, especially useful in couples therapy

◆        Schemas
        o        Cognitive constructions or core beliefs through which people filter their perceptions and structure their experience

◆        Social Learning Theory
        o        Understanding and treating behavior using principles from social and development psychology as well as from learning theory

◆        Systematic desensitization
        o        Gradual exposure to feared situations paired with relaxing

◆        Time out
        o        A behavioral technique for extinguishing undesirable behavior by removing the reinforcing consequences of hat behavior.
        o        Typically a child must sit in a corner or go to his/her room.

◆        Token Economy
        o        A system of rewards using points, which can be accumulated for reinforcing items or behaviors

Psychoanalytic Family Therapy 01

2007-06-29T13:30:00.000-07:00

Foundations

◆        Rooted in the “psychological self”

◆        Emerged in the 1980s in response to object-relations theory as a way to probe beneath family dialogues to explore individual family member’s fears and longings.

◆        Based in Freudian concepts (intrapsychic)

◆        Expanded by Nathan Ackerman

◆        Grew in proportion at the National Mental Health Institute in the 1950s.

◆        Brought to prominence by Jill and David Scharff in the 1980s at the Washington School of Psychiatry.

How it Works

◆        Method of therapy to discover some of the basic wants and fears that keep individuals from acting in a mature way based in the interpretation of unconscious impulses and the defense against them

◆        Human interaction is rooted in depth and complexity of psychic organization.

◆        Psychodynamic theory is useful to understand the self in the family system.

◆        Freudian drive psychology states that anxiety is rooted in unexpressed sexual and aggressive drives that children are taught to repress.

◆        The balance of this conflict should be shifted by either strengthening defenses or relaxing them to permit some         gratification.

◆        Self psychology
        o        Human beings long for appreciation.
        o        Acceptance from parents leads to strong self confident personalities

Experiential Family Therapy 01

2007-06-22T13:01:00.000-07:00

Foundation:

⋅ Humanistic- Here and Now
⋅ Gestalt- role-playing, emotional confrontation
⋅ Psychodrama- sculpting, family drawing

Founders:

⋅ Virginia Satir
⋅ Carl Whitaker

Basic Model:

⋅ Cause and effect of family problems is emotional suppression.
⋅ Tendency to confuse the instrumental and expressive functions of emotion.
        o Try to regulate children’s actions by controlling child’s feelings.
        o Dysfunctional families are less of the emotions that signal individuality.
        o Children grow up estranged from themselves.
⋅ Help families to uncover their honest emotions and forge more genuine family ties from enhanced authenticity.

Theoretical Concepts

⋅ Whitaker- self fulfillment depends on family cohesiveness.
⋅ Satir- importance of good communication among family members
⋅ Techniques promote communication and interaction.
⋅ Emotion organizes attachment responses and serves a communicative function in relationship.
⋅ Relax defensive fears (based on bad attachment emotions) so genuine emotions can emerge, and in turn illicit from partners or family a more compassionate and nurturing response.

Structural Family Therapy 01

2007-06-14T11:55:00.000-07:00

Founders:

o Salvador Minuchin
o Philadelphia Child Guidance Clinic
o Minuchin Center for the Family in New York

Theory Foundation

o Three constructs of structural family therapy:
        - Structure
        - Subsystems
        - Boundaries

o Family structure
        - The functional organization of families that determines how family members interact.

o Hierarchical structure
        - Family functioning based on clear generational boundaries, where the parents maintain control and authority.

o Subsystems
        - Smaller units of families, determined by generations, sex or function

o Boundaries
        - A concept used in structural family therapy to describe emotional barriers that protect and enhance the integrity of individuals, subsystems, and families.

o Disengagement
        - Minuchin’s term for psychological isolation that results from overly rigid boundaries around individuals and subsystems in a family.

o Enmeshed
        - Minuchin’s term for loss of autonomy due to a blurring of psychological boundaries

o Accommodation
        - Elements of a system automatically adjust to coordinate their functioning.
        - People may have to work on it

Strategic Family Therapy 01

2007-06-14T11:32:00.000-07:00

Founders

o Milton Erickson
- Strategic approach of the therapy, pragmatic, problem solving approach.

o Jay Hayley
- Developed his own brief therapy model focusing on context and possible function of symptoms.
- Instructed clients to act in a manner contradictory to maladaptive pattern.

o Cloe Madanes
- Founded Family Therapy Institute with Hayley.

Basic Principles

o Strategic Family Therapy focuses on the process.
o It is clever, prescriptive and systematic- it can also be considered manipulative
o The basic belief is that people are always communicating.
- Communication is either "report" -(what happened) or "command" -(do something)
* Command messages are patterned as family rules.

o Family Homeostasis:
- Rules maintain family homeostasis and keep things the same
- Negative Feedback: conservative efforts to keep things from changing.

o Circular Causality:
- Does not look for looking for underlying motives for behavior
- Instead, points to circular causality (a change of communication patters) in the form of feedback loops (chains of stimulus and response)

o Feedback Loops
- Problems are made worse when a problem behavior elicits a response that makes it continue or worsen.
- This chain of stimulus and response is called a "Positive feedback loop" it is the center piece of the strategic model.

o Types of change include:
- First order change- when a behavior in the system changes
- Second order change- when the rules that affect a behavior change
* Rules are changed by re-framing interpretation of a behavior.
* Family rules around hierarchical structure often a cause of family problems

Gottman's Theory of Couples Therapy 01

2007-06-11T08:44:00.000-07:00

7 Principles for Making Marriage Work

1. Enhance Love Maps
o Develop a deep knowing about each other
o Demonstrate interest in each others lives and priorities

2. Nurture Fondness and Admiration
o Develop awareness of the things about your partner that you admire
o Fondness and admiration are antidotes for contempt
o Re-write the history and update the philosophy of your marriage

3. Turn toward each other in stead of away
o Make deposits into emotional bank accounts
o Engage in stress-reducing conversations
o Be on your partners side

4. Let your partner influence you
o Learn to accept influence
o Power sharing
o Emotional intelligence

5. Solve your solvable problems
o Soften your start up
o Learn to make and receive repair statements
o Sooth yourself and each other
o Compromise
o Be tolerant of each others faults

6. Overcome Gridlock
o Moving from gridlock to dialogue
o Give voice and share your dreams
o Steps to resolutions
o Become a dream detective
o Make peace

7. Create shared meaning
o Family rituals
o Align roles and expectations
o Share personal goals
o Symbols: create, define and share

Bowenian Family Systems Therapy Intro 00

2007-06-10T11:43:00.000-07:00

Bowenian Family Systems Therapy

Foundation

* Started by Murray Bowen
* Began at Meninger Clinic in late 1940s working with schizophrenics
* Bowen was stuck by the emotional sensitivity between patients and their mothers.
* At the heart of the problem was anxious attachment, a pathological form of closeness.

Basic Model

* Interested in system theory way of thinking.
* Bowen though we have less autonomy in our emotional lives than we assume.
* Most of us are more dependant and reactive to one another than we would like to think.
* Bowen describes how the family, as multigenerational network of relationships, shapes the interplay of individuality and togetherness using six interlocking concepts:
+ Differentiation of self- Ego Strength
# The capacity to think and reflect, instead of responding automatically.
# The ability to think and act wisely in the face of anxiety.
+ Boundaries
# Be yourself in spite of others
+ Triangulation
# Anxiety is a major influence.
# As anxiety increases, people experience a greater need for emotional triangles.
# Two people in a conflict will draw in a third person to try and fix the problem or take sides.
# This lets off steam but freezes conflict in place.
+ Nuclear Family Emotional Process
# Undifferentiated family ego mass.
# FUSION= families that are emotionally stuck together.
# Especially noticed in schizophrenic families.
+ Multigenerational Transmission
# Passing chronic anxiety from generation to generation.
+ Emotional Cutoff
# The way people manage anxiety between generations.
# The greater the emotional fusion between parents and children, the greater likelihood of a cutoff.
+ Societal Emotional Process
# Used early in the field of family therapy to acknowledge the influence of societal pressures/influences.
# Later used by feminist Bowenians Monica McGoldrick and Betty Carter who added gender and ethnicity.

Integrative Couples Therapy 01

2007-06-04T07:10:00.000-07:00

History

1969 Richard Stuart introduced behavioral elements into couples therapy.
1970s couples therapy was based on behavioral change.
As couples theories evolved, behavior and adjustment techniques used to adjust social skills were introduced.
1980s communication skills became and integral part of the healthy functioning couple
Couples therapy began to incorporate family intervention elements in addition to behavioral elements and communication skills building.
1993 Jacobsen and Anderson founded the Integrative Couples Therapy Model.

Theoretical Foundations

Eclecticism
o A mix of different counseling methods
o More freedom because not limited to one theoretical view.
Theories commonly used:
o Problem-focused
o Narrative
o Brief/Solution-focused
o Cognitive Behavioral
o Bowen Family Systems Theory

Core Premise

Circular Model of Causation
o The foundation of Integrative Therapy is the idea of a circular process of assessment, goal setting, interventions, maintenance, and validation.
o It is a non-linear model
o Any one of these concepts can be revised throughout the session at any given point.
The focus is to create a blame free therapeutic environment.
Integrative Therapy emphasizes that the couple work together to overcome their difficulties giving them a common goal.

History of the marital and family therapy field

2007-05-31T07:49:00.000-07:00

Emergence of focus on making changes in total life systems.
Focus on the relationships rather than on the elements themselves.
Began due to dramatic change in the form, composition, and structure of the American family (single parents, blended families, dual-career families).
Because interconnectedness exists among family members, actions of the members affect the health or dysfunctional of each individual and family as a whole.
Organism= form of life composed of mutually dependent paths and processes standing in mutual interaction.
Family stabilizes and changes by using negative feedback loops.
Allow family expansion and contraction within the limits of a range of behaviors.
Focuses on exploring interactive dynamics.

Research
Research showed that various forms of family therapy worked at least as strong as other forms of psychotherapy.
National survey of family therapists and their clients found that over 97% of clients were satisfied with service they received.

Original Inhibitors of Family Therapy
Myth of rugged individualism
Healthy people were seen as adequate to handle their own problems
Religion
Perception handed down from Puritans that those who prospered were ordained by God.
To admit one had difficulties was to admit that one was not among the elect.
Historically people confided in clergy, lawyers, doctors rather than mental health professionalism because they knew the families living in the small communities.
Theoretical emphasis was on psychoanalytic and behavioral psychology.

Reasons for Family Therapy
Change in thought of linear causality in which A causes B, used in individual therapy, to circular causality, used in systemic therapy in which A and B influence each other.
Family therapy does not depend on role plays or simulations.
Emphasis cuts through to the reality of a situation more quickly and efficiently.
Members of a family are given the same message simultaneously.
Eliminates secrets.
Increases openness and communication.
Takes less time than individual counseling.
Usually no more than 10 sessions.
Approach of seeing the forest instead of the trees.
Larger scope that examines problematic behavior allows therapists to find more unique ways to address them.
Growth in number of women in colleges and demand for courses in family life education.
Work of county home extension agents in 1920.
Agents began working with families educationally.
Helped them better understand the dynamics f family situations.

Imago Couple's Therapy 01

2007-05-30T07:24:00.000-07:00

What is Imago?
Latin word for image
An unconscious profile of positive and negative traits in a partner.

Goals of Therapy
To align our conscious mind (which usually wants happiness and good feelings) with the agenda of the unconscious mind (which wants healing and growth).
Assist clients in developing conscious, intimate, and committed relationships
Heal each others childhood wounds
Teach clients to call each other back to original wholeness.
Help clients to visualize their Dream Relationship daily.
Keep clients, and teach clients how to keep each other emotionally and physically safe at all times.
Work to end all behaviors that avoid intimacy.

Couples Goals
Give each other caring behaviors daily.
Give each other surprises monthly.
End all criticism
Ask directly for what we want.
Express all negative feelings appropriately.

Role of the Therapist
To intimately connect partners with each other.
Act more like a coach rather than developing a deep therapeutic relationship with the couple.
To help the couple develop skills to build communication and intimacy.
To help the couple become more available to each other.
Facilitate the couples dialogue using leading and stemming questions.

Intimacy Based Therapy- David Schnarch 01

2007-05-20T21:07:00.000-07:00

What is Intimacy Based Therapy?

* Belief that marriage is a “people growing” machine
* Belief that sexual expression holds the highest potential for personal integrity and differentiation
* Supports expression of eroticism and deals positively with the anxiety of disconnection
* Belief in learning to develop sexual potential and intimacy

What is a crucible?
A vessel made of a refractory substance such as graphite or porcelain, used for melting materials at high temperatures.

What is a sexual crucible?
We learn to develop sexual potential and intimacy by
* Leaving our comfort zones
* Confronting our sense of self
* Confronting our anxiety
* Confronting our own discomfort with change and growth
* Confronting our differentiation

In doing this we create a “sexual crucible” a highly non-reactive container where igniting exploration of self and differences through conflict promotes change, growth, and true intimate connection with another- something altogether different than existed before; more than the sum of its parts.

Goals of therapy:
* Look at sexuality as a window to examine current adjustment, life concerns, and unresolved emotional development.
* Construct and hold a crucible of two interlocking conflicts in the relationship to work toward the enhancement of differentiation and intimacy in the relationship.
* Address the multidimensional aspect s of the problem with an isomorphic intervention (isomorphic= making change since one area creates change in another).

Emotional Focused Couples Therapy 05

2007-05-20T07:44:00.000-07:00

Home work for Couples:

Stage 1
• Write down key points of the session
• Write down the “dance” cycle
• Write down daily appreciations

Stage 2
• Two fifteen minute talks to discuss the process
• Rate their degree of closeness

Stage 3
• Ask the partners to take one risk
• Write down their vision of the relationship one year from now
• Introduce ritual behaviors to enhance the relationship
• Share one feeling every day
• Establish a special date night

At Various Steps
• Instruct the couple to talk about specific content in a structured way
• Assign content highlighted in the session
• Instruct that they stick to the 10-minute time frame and separate talking sessions by 24 hours
• Instruct that they not analyze, debrief, or use the sessions against each other but wait until the next session to process the discussion

Emotional Focused Couples Therapy 05

2007-05-20T07:42:00.000-07:00

E) Techniques

Stage 1: The De-escalation of Negative Cycles of Interaction
Step 1. Creating an alliance
Step 2. Identifying the negative interactional cycle
Step 3. Accessing the unacknowledged emotions
Step 4. Reframing

Skills used:
• Empathy – a necessary prerequisite for and an integral part of all EFT interventions.
• Focus on accessing and expanding primary emotional responses, which are often presented as secondary, reactive responses.
• Reflection
• Validation
• Implicit emotions explicit
• Placing secondary emotions in context
• Empathic conjecture/interpretation
• Evocative responding (reflections/questions)

Stage 2. Changing Interactional Positions
Step 5. Promoting identification with disowned attachment emotions, needs
Step 6. Promoting acceptance of partner’s experiences
Step 7. Facilitating expression of needs and wants and creating emotional engagement

Skills used:
• Safe working distance
• Heightening
• Focus on primary attachment emotions
• Deepen each client’s engagement with primary, underlying emotion
• Seeding attachment softening Disquisition

Stage 3. Consolidation and Integration
Step 8. Facilitating the emergence of new solutions to old relationship problems
Step 9. Consolidating new positions and new cycles of attachment behaviors

Skills used:
• Tracking and reflecting
• Enactment
• Externalization
• Reframing
• Restructuring interactions
• Heightening new responses

Techniques Specific to Difficult Therapeutic Impasses
• Diagnostic picture or narratives
• Specific “picture” painted by therapist of couple’s positions
• Presents limited choices of future
• Individual sessions
• Address specific emotional responses that block engagement
• Useful when crisis occurs

The “How” of Interventions
RISSSC
Repeat key words and phrases
Image to capture and hold emotion
Simple words and phrases
Slow pace
Soft voice
Client’s Words in a collaborative, validating way

Emotional Focused Couples Therapy 04

2007-05-18T21:04:00.001-07:00

A) Assumptions
• Partner’s needs, desires, and primary emotional responses are seen as healthy and adaptive.
• It is how these needs are enacted in a context of perceived danger that creates problems
• Therapist validates experiences and responses rather than teaching them to be different.
• People are seen as being stuck in absorbing emotional states and in self reinforcing interaction cycles rather than as being deficient.
• They are simply stuck in set ways of relating to each other.

B) Motivation
Normal Couple Functioning
• Adult love is a bond, an emotional tie with an irreplaceable other who provides a secure base from which to confront the world and a safe haven- a source of comfort, care, and protection.
• A Bond consists of behavioral, cognitive, and attachment elements.
• It involves a set of attachment behaviors, a set of emotional responses, and strategies to regulate such responses, and an inner representation of prototypical interacts, which constitute working models of self and other in this context.

C) Dysfunction
Development of Behavior Disorder
• Emotional detachment of one or both partners.
• Unacknowledged feelings that underlie interactional positions.
• Attachment needs that continue to go unmet.
• Primary emotions that are excluded from individual awareness and not explicit in the partner’s interactions

D) Intervention
Goals of EFT
• Reorganize emotional responses
• New corrective emotional experience of engagement.
• Create shift in interactional pattern
• Initiate new cycles of interaction
• Secure bonding
• Focus on attachment concerns
• Safety, Trust, Contact
• Grasp hidden rationale behind “irrational” responses

E) Techniques
Stage 1: The De-escalation of Negative Cycles of Interaction
Step 1. Creating an alliance
Step 2. Identifying the negative interactional cycle
Step 3. Accessing the unacknowledged emotions
Step 4. Reframing

Skills used:
• Empathy – a necessary prerequisite for and an integral part of all EFT interventions.
• Focus on accessing and expanding primary emotional responses, which are often presented as secondary, reactive responses.
• Reflection
• Validation
• Implicit emotions explicit
• Placing secondary emotions in context
• Empathic conjecture/interpretation
• Evocative responding (reflections/questions)

Stage 2. Changing Interactional Positions
Step 5. Promoting identification with disowned attachment emotions, needs
Step 6. Promoting acceptance of partner’s experiences
Step 7. Facilitating expression of needs and wants and creating emotional engagement

Skills used:
• Safe working distance
• Heightening
• Focus on primary attachment emotions
• Deepen each client’s engagement with primary, underlying emotion
• Seeding attachment softening Disquisition

Stage 3. Consolidation and Integration
Step 8. Facilitating the emergence of new solutions to old relationship problems
Step 9. Consolidating new positions and new cycles of attachment behaviors

Skills used:
• Tracking and reflecting
• Enactment
• Externalization
• Reframing
• Restructuring interactions
• Heightening new responses

Techniques Specific to Difficult Therapeutic Impasses
• Diagnostic picture or narratives
• Specific “picture” painted by therapist of couple’s positions
• Presents limited choices of future
• Individual sessions
• Address specific emotional responses that block engagement
• Useful when crisis occurs

The “How” of Interventions
RISSSC
Repeat key words and phrases
Image to capture and hold emotion
Simple words and phrases
Slow pace
Soft voice
Client’s Words in a collaborative, validating way

F) Limitations
• It can be used with many different types of couples:
• GLBTQ, older, with chronic illness, PTSD, or depression.
• It can be used across many, different cultures.
• However, it is not useful with:
• Couples who are clearly separating, no commitment.
• Couples who are in a clearly abusive relationship, unsafe to be vulnerable.

Emotional Focused Couples Therapy 03

2007-05-18T20:44:00.000-07:00

Theoretical Foundations

Attachment and EFT
• Seeking and maintaining contact with others is primary motivating principle in human beings.
• Secure contact is an innate survival mechanism.
• Building blocks of secure attachment are emotional accessibility and responsiveness.
• When security of bond is threatened, attachment behaviors are activated.
• Individual differences in attachment styles:
• Secure: self is viewed as basically lovable and others are viewed as generally reliable and responsive. Expectations are positive and foster development of trust and closeness.
• Anxious: uncertainty as to lovable-ness of self and the legitimacy of attachment needs, which renders dependency on others as uncertain.
• Avoidant fearful: distrust of others and corresponding desire to limit any dependency on them, based in fear.
• Avoidant dismissing: distrust of others and corresponding desire to limit any dependency on them, based on inadequacy.
Styles are predispositions to organize perceptions and responses in particular ways in intimate relationships
At any time in a relationship the quality of attachment will be the result of partner’s attachment predispositions and present interactions that mediate the effects of such dispositions.
It is important to note that styles are not viewed simply as maps or sets of expectations for relationships. They also imply ways of processing attachment information, influencing whether or not partners can readily access, process, and coherently communicate attachment information.

Experiential and EFT
• People actively process and construct their experience in interactions.
• The power of therapist’s empathy and validation create a positive context for exploration and creation of new experiences.
• Human beings have a capacity for growth and positive adaptive ness of emotional responses and needs.
Therapist must:
• Focus and reflect on partner’s emotional experience
• Validate and accept experience.
• Attune to and empathetically explore experience.
• Expand client’s experience by process questions.
• Direct client to engage in a task that fosters a new kind of processing experience.

Systemic and EFT
• Power of context
• Focus on structure and process of interaction.
• Negative interactional cycles couples generate are self maintaining.
• Focus on circular rather than linear causality.
• The EFT therapist direct and choreographs new interactions, which evoke new emotional responses in the partners.

The power of context. Each partner’s behavior is seen in the context of, and as a response to, the other’s behavior. Each partner also is seen as in some sense creating the responses of the other, often without any awareness of how this occurs.

There is a constant focus on the structure and process of interaction, that is, on how such interaction is organized. Degrees of closeness/distance and dominance/submission are monitored and made explicit.

The rigid negative interactional cycles distressed couples generate are seen as self-maintaining and as a primary factor in the deterioration of the relationship

There is a focus on circular rather than linear causality. This lends itself to a focus on patter and sequence and how elements in an interactional pattern reciprocally determine each other, as in “I withdraw because you nag, and you nag because I withdraw.”

Emotional Focused Couples Therapy 02

2007-05-18T20:38:00.000-07:00

Process is a Journey

FROM
• Alienation
• Vigilant Defense and Self Protection
• Passive Helplessness
• Desperate Blaming
• Focus on Flaws
• ISOLATION
TO
• Emotional Engagement
• Openness and Risk Taking
• Sense of being able to actively create dance
• Sense of how each partner makes it difficult for the other to be responsive and caring
• Discovery of ones’ own fears and longings
• CONNECTEDNESS

The Process of Change
Stage 1: Cycle de-escalation
Stage 2: Withdrawer Engagement
Stage 3: Blamer softening

Cycle de-escalation is a first order change. The way interactions are organized remains the same, but the elements of the cycle are somewhat modified.
For example, the more withdrawn partner in a couple begins to risk more engagement in the relationship while the more hostile partner becomes less reactive and angry.

Withdrawer engagement is a second order change. There is change in the interactional position in terms of control and accessibility for contact. The withdrawn partner asserts needs rather than stonewalling and becomes more emotionally engaged

Blamer softening is also a second order change. The previously hostile and more active spouse risks expressing own attachment needs and vulnerabilities, allowing for interactions that challenge the trust level in the relationship.

These stages are interwoven and reciprocally determining. Once these change events have reorganized the couple’s interactions, prototypical bonding events can take place.

Emotional Focused Couples Therapy 01

2007-05-18T19:54:00.001-07:00

Introduction

Emotion is the music of the dance between partners, learn to change the music and change the dance.

What is EFT?

• EFT expands experience and interactions.
• It is the accessing and reprocessing of emotional response underlying partner’s interactional position. The reprocessing of inner experience is used to expand the interpersonal context. In turn the structuring of new interactional events expands and redefines each partner’s inner experience.
• It facilitates a shift in positions towards accessibility and responsiveness- which are the building blocks of secure bonds.
• It creates new interactional events that redefine the relationship as a source of security and comfort for each of the partners.
• When EFT is successfully implemented, each partner experiences the other as a source of security, protection, ad comfort.
• Each partner can then assist the other in regulating negative affect and constructing a positive and potent sense of self.

EFT Structure

• Step 1: Assessment- Create an alliance and delineate conflict issues in the core struggle
• Step 2: Identify negative interactional cycle.
• Step 3: Access unacknowledged emotions underlying interactional positions.
• Step 4: Reframe the problem in terms of underlying emotions and attachment needs.
• Step 5: Promote identification with disowned needs and aspects of self and integrate these into relationship interactions.
• Step 6: Promote acceptance of the partners experience and new interaction patters.
• Step 7: Facilitate the expression of needs and wants and create emotional engagement.
• Step 8: Facilitate the emergence of new solutions to old relationship problems.
• Step 9: Consolidate new positions and new cycles of attachment behaviors.