Psychotherapy: Teyber: Chapter 10: Working through and termination – Flashcards

*clients try out with others the emotional relearning that has occurred with the therapist. *Linking changes that have occurred with the therapist to changes with significant others in their current lives.

sequence of steps.

*some initial relief of symptoms may result

1) Invites them to express their concerns directly and fully 2) Listens intently with respect and empathy 3) Is able to enter their subjective worldview -grasp the core meaning of concerns 4) Work collaboratively with the client on treatment plan that yields hope 5) Helps client feel connected to caring "other" 6) Demonstrates a practical ability to help solve at least some small part of the client's immediate problem or symptoms

*When therapist respectfully challenges client's faulty schemas and beliefs about how relationships must and always will be. *This refers to connection to a coherent, reflective, and integrated inner voice that is the foundation for self efficacy and self agency.

1) Client experiences the therapist as a go-to person 2) Therapist successes in focusing clients inward on their own thoughts, feelings, and response patterns and away from their preoccupation with he problematic behavior of others. (INTERNAL FOCUS) 3) Pace of change accelerates when clients begin to express each sequential feeling in their affective constellations. 4) As client's conflicted emotions emerge, the therapist is also better able to conceptualize clients' relational schemas and the pathogenic belief that accompany them. -Therapist then focuses treatment on how these clients are reexperiencing the same relational patterns, faulty assumptions, and affective themes throughout the various issues and concerns they present. -Process comments 5) ***Reenactment in the therapeutic relationship = failure or success**** -transference -client induced countertransference -therapist induced countertransference *Client needs repetitive real life experience of change for most successful outcome.

*MFT *3 "P's" 1) Pick 2) Provoke 3) Perceive

1) Therapist begins in earnest to assist the client to actively transfer the client's here and now relearning to other relationships. 2) Many clients will come back the next session, following a corrective emotional experience with the therapist, and relate successes and failures in their attempts to relate in this new way with others in their life.

1) Change begins in the therapeutic relationship 2) Therapist will encourage client to try out new ways of responding with them in the therapy setting 3) Therapist can anticipate that client will test them 4) Therapist provides a corrective emotional experience 5) Working through 6) Clients change first with with acquaintances they do not know well -lower risk 7) Followed by change with supportive others who are important to the client. 8) Some clients will try to change old response patterns with: A) developmental figures Others will: B) primary others and then transition to formative issues with developmental figures.

Interpersonal

1) The current interaction or interpersonal process that is transpiring with the therapist. 2) When reviewing crisis events in the client's life or the crisis events that originally prompted the client to seek treatment. 3) In developmental relationships with family members. 4) In current relationships with friends and significant others in which the client's emotional problems are being activated.

*are anxious that therapist will not be consistently available and their needs will not be met. *Talk about problems in diffuse, overwhelming terms. *Difficult for these clients to accept and internalize the therapists' benevolence toward them and so they have difficulty developing a sustained, coherent, and compassionate sense of self. *Working though will be harder for these clients.

*reflective *consider different perspectives *Explore new ways of being with others *Discerning more selectively with whom to disclose and trust

*Likely to have difficulty both recognizing and disclosing their needs *engaging emotionally with the therapist *Primary task is to help client consider the possibility that "being in relationship" does no inevitably hold the threat of intrusive control from others. *Asking for help is separate from weakness

*When dismissive client has the real life experience that the unwanted responses they expected did not occur in this relationship, can the client begin to translate this reparative experience to relationships outside the therapy room where they often have been hurt in the past in these familiar ways.

realistic terms. *As this occurs, transference projections and eliciting maneuvers have been jointly identified and are being resolved.

anticipate and negotiate the successes and failures that are likely to follow.

1) Helping clients realistically anticipate how each new person is likely to respond to their changes. 2) Helping clients spell out in detail how they are likely to feel, and what they are likely to say and do, if they receive a version of the old unwanted response to their healthier new behavior. 3) By role playing and providing new, more adaptive responses that, after rehearsing in therapy, clients can use at this discouraging moment, instead of repeating what they have usually done in such circumstances in the past.

*still be struggling with their core conflicts. *Therapist will still have to consistently work to provide corrective emotional experiences.

1) Clients begin to look back on their formative experiences that shaped their problems they are now resolving. 2) Clients begin to look ahead and think more about who they want to be in the future

emotional regulation

*Liberating for clients to explore the familial interactions and developmental experiences that shaped current conflict. *Not productive for therapists to lead client back in time. *Instead, a mutual exploration of familial and developmental experiences can teach therapists and clients a great deal about the faulty schemas and coping strategies that clients originally learned.

*Both meaningful insight and sustainable behavior change follow or result from clients' new or reparative experience with the therapist.

lead the therapist back to the developmental experiences that shaped some of their problems.

1) internal focus for change 2) grief work -clients mourn and come to terms with what they have missed developmentally

1) Stop disavowing and acknowledge to themselves what was legitimately wrong 2) Stop their own participation in any ongoing mistreatment 3) Grieve for the support, protection, or validation they wanted but have missed

when they introduce healthier new behavior into their family systems it will often be met with significant resistance.

help clients come to terms with both the good and the bad news about their current situations/past relationships

1) Because of therapists own splitting defenses they downplay or minimize the extent and continuing influence of painful developmental experiences -In contrast, therapist only want to blame the caregivers, make then "bad" and ignore the strengths and positive contributions that also were present in the relationship. 2) Therapist often want to bypass the work of mourning. -therapist reluctance occurs because of own unfinished family of origin and grief work.

* As clients make behavioral changes and feel better as they work through their problems they focus of therapy will begin to move toward future plans that reflect like enhancing aspirations and goals for the client. *the transition from solving problems to leading a fuller and more meaningful life

*described the profound influence of the dream in shaping the structure of adult life and the course of personal development.

genuine interests and passions might be, or to choose their own goals and pursue their own ambitions. *Clients need to be actively encouraged as they enter this stage to explore and formulate their OWN personal dreams based on their own interests.

actively pursuing what they really want to do, or successfully attaining what they want in life, commonly threatens attachment ties and arouses both separation anxiety and separation guilt-leading client to retreat from progress or undo their success in treatment.

1) Stretch their personal comfort zone and actively engage with clients in these forthright and direct ways right from the beginning 2) Are able to "get" what is most important to the client and provide empathic understanding, few clients drop out prematurely.

Needs to be something that demonstrates behaviorally that you, as a therapist, are someone who has the ability to be helpful and make a difference.

*Emphasizes education about the therapeutic relationship and redefining social norms to include straight talk about what might be going between the client and the therapist.

*Having the client's mind in mind

1) From clients 2) From their own observations 3) From significant others in the client's life

*Clients work is finished

reactive toward the therapist as they begin to discuss ending.

unambiguously acknowledge and sensitively address the reality of the ending.

managing their own guilt or defensiveness in the face of clients' anger over the ending.

*Therapist need to acknowledge the similarity of the clients feelings at termination and at past separations, and then explore with clients what they can do together to make this termination different and better from such problematic endings in the past.

1) Looking back and reviewing what has changed 2) Looking ahead and making realistic plans for coping with problems that are likely to come up 3) Saying good-bye.

1) Review progress 2)Predict challenging events or anxiety arousing situations 3) Practice in dealing with these triggering issues or familiar patterns *role playing both effective and ineffective responses to threatening or unwanted interactions that clients are likely to face in the future.