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16. Group and Family Therapy

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Group therapy
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a form of psychotherapy where multiple clients participate in sessions together and interpersonal interaction is typically emphasized
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Purpose of group therapy
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groups provide clients with the sense that they are not alone in a way that individual therapy cannot
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Interpersonal interaction
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an emphasis of most forms of group therapy where therapists attempt to improve clients’ abilities to relate to others in healthy ways
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focus of group therapists’ work
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highlight the way group members feel, communicate, and form relationships with on another
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Irvin Yalom
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a leading figure in contemporary group therapy, especially the interpersonal approach
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Yalom’s view of group therapy
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it presents the display of clients’ problematic interpersonal tendencies within a group
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Yalom’s view of psychological problems
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psychological problems stem from flawed interpersonal relationships
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Yalom’s specific therapeutic factors for group pschotherapy
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instillation of hope, universality, imparting information, altruism, corrective recapitulation of the primary family group, development of socializing techniques, imitative behavior, interpersonal learning, group cohesiveness, catharsis, existential factors
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Universality
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a therapeutic factor in group therapy; the experience that one’s problems are not unique but are common to others (putting people who experience the same problem together to discuss, which helps them share more about their struggles)
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groups within universality
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homogeneous and heterogeneous groups
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Homogeneous groups
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therapy groups where all members share a common characteristic such as a diagnosis
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Heterogeneous groups
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therapy groups where no single common characteristic (such as a diagnosis) is shared by all members; they will often come to realize that although their symptoms may differ, the core issues that underlie them may be of smaller importance value
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Group Cohesiveness
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a therapeutic factor in group therapy; feelings of interconnectedness among group members and the equivalent of the therapist-client relationship in individual therapy; it sets the stage for healing factors
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importance of group cohesiveness
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it is crucial to maintain a trusting, collaborative relationship directly with the client and to foster a group where clients develop trusting, collaborative relationships with one another as well
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Interpersonal learning
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a therapeutic factor in group therapy; learning from the in-group interpersonal experience
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what does this feature of group therapy provide
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an opportunity for relationship practice – they form relationships with one another and work to improve them assuming that their gains will benefit their personal relationships outside the group too
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Social microcosm
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a phenomenon in group therapy where the relationship tendencies that characterize clients’ relationships with important people in their personal lives (ex. mother) predictably characterize the relationships they form with their fellow group members
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here and now
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a focus in group therapy on the present interpersonal interactions with fellow group members rather than events that have happened in clients’ lives outside the group
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two activities among group members to maximize the use of the here and now
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interaction (he calls “experience”) and reflection/discussion of that interaction (he calls “illumination of process”) – through the course of interaction, group members communicate directly with one another
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process that the therapist urges clients to do
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to reflect on the process of group therapy, to talk about the way clients talk to one another, and to enlighten each member about his or her interpersonal tendencies – once the client learns about their tendencies, they can decide to change them which could improve the relationships
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feedback
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might drive away important people without knowing why so feedback is important – feedback usually motivated clients to change their behavior
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Practical Issues in Group Therapy
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group membership; preparing clients for group therapy; developmental stages of therapy groups; cotherapists; socializing between clients
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Group membership
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want just the right amount of people (5-10 clients) but many therapists find that having 7-8 members
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Open-enrollment groups
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in contrast to closed-enrollment groups, therapy groups where individual members are allowed to enter or leave the group at any time
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strength of open-enrollment groups
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at any point in time, the group included members at many stages of improvement; new group members use old group members as models
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Closed-enrollment groups
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in contrast to open-ended groups, therapy groups where all members start and finish therapy together, with no new members added during the process; cohesiveness can be easier to establish and maintain because of the stability of membership
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why would a therapist not include a person into group therapy
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if they interfere with the client’s ability to interact with others and reflect on their interaction – including psychosis, organic brain damage, acute crisis, and pragmatic issues
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Purpose of preparation for group therapy
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to correct any misconceptions and maximize therapeutic benefits
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process of preparing for therapy
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hold pregroup individual meetings where therapists can explain the process and provide realistic and encouraging data about how well their therapy works for most clients; can also inform clients of the kinds of activities that will take place and the behaviors that can maximize benefits they recieve
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Developmental stages of therapy groups
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initial stage – clients are cautious and concerned about whether they will be accepted into the group competitive second stage – there is some competition for position within the social pecking order third stage – cohesiveness forms, members feel closely connected and trusting of one another, and the group sessions become more consistently productive as clients learn about and improve on their interpersonal skills
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Cotherapist
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a therapist who coleads group therapy sessions with another therapist (usually two therapists)
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advantages of a cotherapist
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the presence of a second set of eyes and eats to notice the range of verbal and nonverbal communication produced by a room full of clients; the cotherapists’ ability to model collaborative relationships for group members (with the main therapist); a recapitulation of the family group (usually for clients who grew up in two-parent homes)
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Recapitulation of the family group
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a phenomenon in group therapy where a group evokes the same dynamics as a client’s family of origin (ex. therapists involving one male and one female)
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pitfalls of cotherapy
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when the cotherapists don’t trust each other, compete with each other, or step on each other by approaching group therapy with incompatible therapy methods – there styles need to be identical to work
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Socializing between clients
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socializing outside of therapy is a problem for group therapists known as extra-group socializing
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Extra-group socializing
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a problematic and discouraged behavior among group therapy members; interacting as friends, romantic partners, and so on outside the group sessions; the people who are socializing outside of therapy may become more loyal to one another than the other members of the group (can affect members who view this strong relationships or those within the relationship)
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Ethical issues of group therapy
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confidentiality
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Confidentiality
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as mandated by the code of ethics of the American Psychological Association, upholding the privacy of clinical information – the problem is that the fellow group members might violate a client’s confidentiality, so clients must sign agreeing to keep all information heard and spoke of in that room
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consequences of a client violating the confidentiality of another
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can seriously affect the professional or personal life of the client whose confidentiality has been violated – therefore many clients won’t want to speak of their issues so therapists do their best for this not to occur
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how do therapists prevent clients from violating confidentiality
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exemplifying impeccable behavior regarding confidentiality, frequent reminders about confidentiality, and group discussion of any confidentiality violations that do occur
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How well does group therapy work
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group therapy is better than having no treatment and is as effective as individual therapy; only a select few of disorders are found to be effectively diminished by using group therapy; cohesiveness within the group is a major contributor to successful outcome in group therapy (group therapy is also less expensive)
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Family therapy
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a form of psychotherapy where family members attend sessions together and a primary goal is the improvement of dysfunctional characteristics of the family system
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therapists beliefs of psychological symptoms
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that psychological symptoms were a byproduct of the dysfunctional families where the clients lived – one person may exhibit the symptoms but the problem actually belonged to the entire system
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Systems approach
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a foundation of family therapy where clinical problems originate in the family system rather than in an individual family member; of this system, circular causality explains psychological problems better than linear causality does – therapists believe that a relationship is maintained over time no matter the problem by mutually influential, ongoing interaction between family members
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Linear Causality
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in contrast to circular causality, a theory typically endorsed by individual therapists where events from the past cause or determine events in the present in a “one-way street” manner (the way a parent treats a child influences the child’s behavior
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Circular causality
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in contrast to linear causality, a theory typically endorsed by family therapists where events influence one another in a reciprocal way (a parent’s and child’s behavior each affect the other continuously = “two-way street”)
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what most significantly contributes to psychological problems
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unhealthy communication patterns among family members
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Communication patterns
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an area commonly targeted by family therapists as the source of psychological symptoms and an area for improvement in family therapy
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Functionalism
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in family therapy, the belief that although psychological symptoms may appear maladaptive, they are in fact functional within the family environment of the individual (ex. parents fighting then child has psychological issue that wasn’t planned but helps the parents work together more)
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Homeostasis
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in family therapy, the notion that systems have the ability to regulate themselves by returning themselves to a comfort zone or “set point”
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therapists belief of homeostasis
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if the symptoms effectively return the family to a more familiar, comfortable, safe way of interacting, they have served a valuable and often unrecognized function within the family
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How does family therapy begin
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with a thorough assessment of the family’s functioning and continues throughout therapy
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the usual assessment practice
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focus on such issues as defining the presenting problem, understanding family members’ beliefs about its causes, and appreciating the relationships within the family (the practices can vary according to the particular approach to family therapy that the therapist uses)
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important step when assessing a family
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to asses who the family includes (some include many aunts and cousins, some include the immediate family) – asking who do you consider family can go a long way and help the therapist get a better perception of family (the differences if the concept of family may be the major problem for them)
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helpful technique for understanding relationships within a family
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genogram
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Genogram
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a pencil-and-paper assessment technique in family therapy involving the creation of a family tree that incorporated detailed information about the relationships among family members (including the structure of relationships – marriages and babies – and quality – very close or abusive etc.)
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how is everything represented in genograms
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males are boxes, females are circles, relationships are lines between two people, quality of relationships are the types of lines selected
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Positives of genograms
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helpful to understand the complexities of the family and the process of creating a genogram can also be a constructive way for the therapist to engage with the family and begin to establish a healthy relationship
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Family life cycle
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a seven-stage theory of family development that can be modified to account for the wide variety of families that a family therapist may see; created by Betty Carter and Monica McGoldrick; realizing the variations of a family and the cycle created following the knowledge, therapists have a useful starting point when working with families
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1. Leaving home
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single young adults become independent and self-sufficent
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2. Joining of families through marriage or union
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a new couple forms a new family system, and the spouse is incorporated into existing family systems
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3. Families with young children
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taking care of children; adjusting the marriage; and managing child-related, financial, and other responsibilities are among the primary tasks
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4. families with adolescents
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parents provide children with increasing amounts of independence and may adopt caretaking roles for their own parents as well
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5. launching children and moving on in midlife
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adjusting to the “empty nest”, managing relationships with children’s partners, and taking on the grandparent role are central
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6. families in late middle age
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focus shifts to managing declining health and adapting to new roles in the family and community
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7. Families nearing the end of life
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accepting the realities and inevitability of death (own and others), and frequently reversing the caretaker role between older and younger generations exemplify this stage
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how is this cycle determined
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based off of many variations of a traditional family
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Variations to the traditional family
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divorced, step-families, single-parent, families with gay/lesbian members, families of diverse or blended ethnicities or religions, families with parents in nontraditional gender roles, nonmarried cohabiting couples, couples without children, families that have experienced an unexpected or premature loss, and families with many years between offspring
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what do these families experience in these environments
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high frequency of chronic stress, sudden losses, and households headed by single females
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Conflict Tactics Scales (CTS)
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a questionnaire designed to assess how individuals behave when family conflicts arise, often used to explore interpersonal abuse or violence; reliable and valid
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Process of the CTS
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an individually administered self-report questionnaire that includes about 40 questions taking around 15 minutes to complete it
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Identified patient
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in family therapy, the family member whose symptoms are most obvious or problematic to other members; most families enter therapy with this person believing that the problem is coming from this person
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Griffin’s categories of family therapy approaches
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ahistorical, historical, and experimental styles
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Ahistorical styles
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emphasizing current functioning and deemphasizing family history (most common in contemporary clinical psych)
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Historical styles
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emphasizing family history and typically longer duration than ahistorical (including Bowenian/intergenerational family therapy and psychodynamic approaches)
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experimental styles
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emphasizing personal growth and emotional experiencing in and out of sessions (including Whitaker and Satir’s approaches)
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Family structure
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in family therapy, the implicit rules that govern family members’ behavior; if flawed problems will follow in the relationships in the family and may manifest as psychological symptoms in some members of the family
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Salvador Minuchin
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a leading figure in structural family therapy
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emphasis of structural family therapy
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to improve the structure of families as means of improving the functioning of the members; therapists emphasize subsystems within families and boundaries between the subsystems
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Subsystems
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an essential concept in structural family therapy; subgroups of family members separated by boundaries
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boundaries
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an essential concept in structural family therapy; the divisions between family subsystems; they should be capable of being able to pass through just enough to allow emotional closeness between family members but rigid enough to allow for independence as well. If boundaries are too open, family members can becomes enmeshed and if too rigid they can become disengaged
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enmeshed
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in structural family therapy, an unhealthy type of relationship between family members resulting from overly permeable boundaries between subsystems
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disengaged
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in structural family therapy, an unhealthy type of relationship between family members resulting from overly rigid boundaries between subsystems
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important task of structural therapy
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uncovering and correcting and clarifying family rules with an emphasis on developing a clear hierarchy of power within family
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Murray Bowen
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a leading figure in family therapy who is closely associated with the concept of differentiation of self
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Differentiation of self
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in contrast to the categorical approach, an approach to diagnosis based on the issue of severity of an individual’s symptoms on a continuum or dimension, rather than the presence or absence of disorder
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emotionally fused
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in family therapy, a type of family relationship resulting from incomplete differentiation of self where family members remain overly emotionally connected with one another. therefore, these families have little tolerance for differences in feeling or belief or how one may feel (all think the same is the belief)
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undifferentiated ego mass
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in family therapy, a term used to describe an emotionally fused family
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goal in therapy dealing with emotionally fused families
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to acknowledge the lack of differentiation, explore factors that may have caused or are currently maintaining it, and encourage relationships characterized by less fusion and more independence
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triangles
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in family therapy, a phenomenon where one or both of two family members in conflict attempt to bring a third member into the conflict to gather support
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Triangles in family means
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involves parents experiencing differences and a child recruited to side with one parent
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contemporary approaches (solution-focused and narrative therapies); ethical issues in family therapy (cultural competence, confidentiality and diagnostic accuracy); how well does it work – didnt read
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Solution-focused therapy
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a contemporary approach to family therapy that relies on solution-talk and similar techniques in attempting to solve families’ problems
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strategic family therapy
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a pragmatic, problem-focused approach to family therapy where solution-focused therapy evolved
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Steve deShazer
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a leading figure in solution-focused family therapy
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Insoo Kim Berg
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a leading figure in solution-focused family therapy
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“Solution-talk”
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an essential aspect of solution-focused family therapy where therapists emphasize positive outcomes that the future may hold rather than unpleasant situations that characterize the present to help clients begin to adopt a more positive point of view
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Formula first-session task
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in solution-focused family therapy, a technique where clients are instructed to take note in the upcoming week of aspects of their lives they want to continue
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exception questions
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in solution-focused family therapy, a technique where therapists ask families to recall situation when the problem was absent or less severe
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miracle questions
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in solution-focused family therapy, a technique where therapists ask families to imagine life without the problem
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scaling questions
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in solution-focused family therapy, a technique where therapists ask families to rate the severity of a problem over time and emphasize strategies the families have used to cause the reductions in severity
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narrative therapy
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a contemporary form of family therapy that emphasized the revision or the stories that family members use to explain and interpret the events in their lives such that the stories describe the members more positively
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Cultural competence
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for clinical psychologists, the ability to work sensitively and expertly with culturally diverse members of a heterogeneous society