Marriage and Family Therapy - Flashcards

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Freudian

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Excessive anxiety produced from unresolved conflicts among Id Ego and Superego

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Adlerian

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Behavioral and Emotional Discouragement as a result of mistaken beliefs and goals

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Behavioral

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Problematic Behavioral responses to specific environment

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Person-Centered

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Anxiety resulting from discrepancy between self-perception and one's experience

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Gestalt

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Inability to make informed choices due to lack of awareness

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CBT

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Disabling Anxiety resulting when simple preferences are irrationally seen as dire needs

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Reality Therapy

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People choose irresponsible ways of dealing with pain that results from not being able to control their experience in the world

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Existential

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Living under self-serving illusion that one is enslaved and that someone else can free them

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Intrapsychic Paradigm

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Individual Psychological distress is the result of conflicts among various aspects of the individual psyche (individual is seat of pathology and the object of therapeutic intervention). Human psychological processes are subject to the same laws as govern physiological processes and can be observed through the scientific method

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Interpersonal Paradigm

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-Individual Psychological distress is the result of pressures to maintain or restore balance wtihin the social system, understanding an individual's family system is crucial to understanding individual behavior -can't understand the whole by looking at the parts, the whole is greater than the sum of the parts -human bx arises within a social system and can only be understood by looking at the system -Human Bx is attributable to circular rather than linear causality -changing one part affects the whole -tendency in a system to seek equilibrium or homeostasis -When a system is out of equilibrium, feedback mechanisms act to attempt to restore balance -Therapeutic intervention must focus on relationships within the entire family system rather than individual members

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ALternatives to the typical family life cycle

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Single parent, blended, culturally different, double household, bi-racial/cultural, gay/lesbian/transgender, Grandparent-led, grandparent inclusive, foster families, adoptive families

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System Levels

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Social, cultural, political, economic, gender, religion, ethnicity, etc.

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Vertical Stressors

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Family patterns, myths, secrets, legacies

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Horizontal STressors

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Developmental life cycle transitions, unpredictable (untimely death, chronic illness, accident)

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What to look for in beginning of family counseling

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Rules and metarules, assigned/ascribed roles, power sturcture, overt/covert methods/channels of communication, methods for negotiation and problem solving, homeostatic mechanisms, subsystems, boundaries, structure, flc stage, Horizontal/Vertical stressors

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Structural, Figurehead

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Salvatore Minuchin

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Relationship to existing theory

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Alfred Adler: -Family constellation Social aspect of being human ability of humans to change children ad identity diffusion

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Structural, Major Premise

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Individual symptoms are best understood as rooted in the context of family transaction Patterns and a change in family organization or structure must occur before the symptoms can be relieved

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Structural, Major tenets

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General systems theory, Family strucutre, Subsystems, boundaries, alignment and power

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General Systems Theory tenets

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Circular Causality and feedback loops

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Circular Causality

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Change in person a, causes changes in person b, and so on

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Feedback loops

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System looks at output and makes adjustments for desired outcomes, uses Accelerating and attenuating

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Repetitive transaction patterns

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Predictable interaction patterns

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Generic constraints

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moderator of transactional patterns and are based on typical "rules" such as heirarchy

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Idiosyncratic constraints

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Unique spoken or unspoken family rules that moderate the transactional patterns and interactions

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Strucutral, Spousal subsystem

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Family stability and models inteimacy and commitment

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Structural, Parental subsystem

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Could be nuclear or extended Provides guidance and limit setting

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Structural, Sibling subsystem

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First peer social interaction, negotiation, competition, support, friendship

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Structural, Rigid Boundaries

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Maximum autonomy, minimum interaction

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Structural, Diffuse Boundaries

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Maximum interaction, minimum autonomy

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Structural, power

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Individual influence on system

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Structural, alignment

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Joining with others to increase relative power

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Structural therapeutic frame of reference

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Present and future, process over content, therapist versus technique

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Structural view of pathology

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When families cannot adapt due to: Pathology Heirarchy, boundaries and alignments

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Structural, pathology of hierarchy

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Faulty hierarchy and lack of complementarity

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Structural, pathology of boundaries

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Disengagement and enmeshment

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Structural, pathology of alignments

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Stable coalitions, detouring: Two or more combine power against another, Triangulation: parents compete for child allegiance

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Structural, function of symptoms

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i. Maintain homeostasis ii. Relieve tension by externalizing to symptom bearers

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Structural, Therapeutic Objective

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i. To revise transactional patterns such that the family system is: 1. Hierarchically organized 2. Has complementarity of member functions 3. Has coordination among subsystem functions 4. Has clear environmental boundaries

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Structural, Role of therapist

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distant relative, active vs passive

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Structural, therapeutic process and techniques: Joining and Accomodating

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-Adjusting to the communication style and perceptions of a family -Maintanence (Acknowledging and supporting desirable bx) -Memesis: Adopting affective range and style of family

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Structural, Assessment and Disgnosis

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Ongoing, evolving process of formulating hypothesis about a family's areas of successful and pathological functioning

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Structural, tracking

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Pursuing themes in nominal communication

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Structural, Family mapping

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Graphic illustration of family sturcutre

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Structural, Restructuring techniques

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Enactment, Boundary making, Unbalancing, regulating intensity, challenging unproductive assumptions, support, education, guidance

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Regulating intensity

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STructural intervention Confronting homeostatic responses

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Challenging unproductive assumptions

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Structural technique, relabeling the family function served by problematic bx

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Human Validation Process, Figure head

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Virginia Satir and Carl Whitaker

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HVP, Relation to existing theory

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Frankl (personal freedom), Perls (detached parts of self), Rogers (self-actualization)

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HVP, Major Premise

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i. Communication and self-esteem are reciprocal foundations of mental health ii. Self esteem influences communication effectiveness iii. Communication influences the development of self-esteem

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HVP, Major Tenets

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i. General systems theory (circularity and homeostasis) ii. MRI communications Theory

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HVP, MRI Communications theory

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Seed Model, Human Mandala, Self esteem, Communication (antecedent and by product of self esteem), Congruence, Rules

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HVP, Human Mandala

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Parts of self: a. Physical, intellectual, emotional, punctuation, sensual, interactional, contextual, nutritional, and spiritual

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HVP, Self esteem

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antecedent and by-product of communication a. Grounded in the "Primary survival Triad"

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HVP, Communication

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Antecedent and by product of self esteem a. Target of Intervention b. Styles: i. Blamer ii. Super Reasonable iii. Distractor iv. Placator v. Congruent or "level"

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HVP, Congruence

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a. A manner of communication b. A desirable state of being

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HVP, Rules

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a. Must be few, reasonable, relevant, flexible, and consistently applied b. A key focus of intervention

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HVP, frame of reference

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i. Present and future ii. Transgenerational consideration iii. Process over content

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HVP, View of Pathlogy

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i. Flawed solutions ii. Parental messages to each other and children are incongruent with feelings iii. Results in anxiety and stress, often transferred to an IP

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HVP, Function of symptoms

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i. Indicate a "blockage of growth" and imbalance in parts of the system ii. Have a homeostatic function for the system iii. Usually transferred to an IP iv. Prevent adaptation

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HVP Therapeutic Objectives

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i. Facilitate adaptation through improved communication and self esteem ii. Redirect energy tied up in symptomatic bx

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HVP, Role of the therapist

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i. Create warmth and safety ii. Correct gaps and inconsistencies in communication iii. Model congruence

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HVP, Therapeutic Process

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i. Establish trust but avoid induction ii. Facilitate awareness iii. Awareness to new understanding iv. Practice new understanding in session v. Use new understanding outside vi. Family sculpture vii. Ropes viii. Presupposition ix. Anchoring x. Denominalization

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Strategic Family therapy, Figureheads and relation to existing theory

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i. Jay Haley (figurehead) ii. Chloe Madanes (figurehead) iii. Salvadore Minuchin iv. Don Jackson v. Gregory Bateson (cybernetics) vi. Milton Erickson (paradox)

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Strategic, Major Premise

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i. Implicit struggles to control the definition of relationships ii. Only problematic when covert iii. Enacted through family communication iv. The focus of intervention

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Strategic, Major Tenets

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General Systems theory (Circularity and Homeostasis) ii. MRI Communications Theory 1. Power and Control 2. Communication a. Punctuation b. Report and command c. Symmetrical and Complementary d. Paradoxical injunction (the "double bind") e. Digital vs. analog 3. Ist and 2nd order change

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Strategic, Frame of reference

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i. Present ii. Action vs. Insight iii. Problem-solution iv. Therapist vs. technique

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Strategic, View of Pathology

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Flawed solutions, Symptoms (inverse hierarchy, symmetrical escalation, crystalized interaction patterns)

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Misguided solutions (redefining relationships)

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1. Necessary action not taken 2. Unnecessary action taken 3. Action taken at wrong level

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Strategic, Function of symptoms

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Misguided solutions, Primary focus of therapy

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STrategic, therapeutic objectives

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i. Eliminate relational dynamics supporting the presenting problems ii. Achieve 2nd order change iii. Avoid "Induction"

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Role of therapist

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to trick the logical watchdog, to direct problem resolution, neutrality, tactical and strategic

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STrategic, therapeutic process

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1. Brief Social stage 2. Problem (observation) stage 3. Interactional stage 4. Goal setting stage 5. Task setting stage (application of problem-specific techniques) 6. Directives 7. Paradoxical intervention a. Redefine, prescribe, restrain 8. Positive connotation (Milan) 9. Circular Questioning (Milan) 10. Pretend Techniques 11. Metaphorical tasks 12. Observation teams

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Bowenian, Figure head

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Murray Bowen

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Bowenian, relation to existing theory

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ii. Charles Darwin (evolutionary heritage) iii. Sigmund Freud (projection process)

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Bowenian, major premise

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i. Common human heritage of counterbalancing life forces 1. Independence vs. togetherness 2. Emotion vs. intellect ii. Under duress: an imbalance on the side of emotion iii. Applies to individuals, families, societies iv. The focus of intervention

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Bowenian, Multigenerational transmisison process

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a. Mutual attraction of similar differentiation b. May result in less differentiation in children

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Bowenian, Chronic anxiety

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1. Evolutionary heritage 2. Individuality vs. togetherness 3. Fuels the differentiation process

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Bowenian, Differentiation (of self)

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1. Inetellectual-Emotional distinction 2. High differentiation-intellect guided-"solid-self" 3. Low differentiation-emotion guided-"pseudo self"

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Bowenian, Family Projection

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1. Impaired parental differentiation "projected" and magnified onto the most vulnerable children a. The parent focues on a child out of fear that something is wrong with the child; b. The parent interprets the child's bx as confirming the fear; and c. The parent treats the child as if something is really wrong with the child

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Bowenian, Multigenerational transmission process

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a. Mutual attraction of similar differentiation b. My result in less differentiation in children

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Bowenian, Fusion

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undiffertiated family ego mass, 1. Emotional oneness 2. Reactive decision making

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Bowenian, traingles

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smallest stable system, 1. Dyads will always induct a third party

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Bowenian, Nuclear family emotional processes

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1. Symptoms 2. Reduce anxiety

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Bowenian, Emotional cutoff

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1. Escape fusion 2. Physical or emotional 3. No useful purpose

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Bowenian, Societal regression

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fused societal decision making

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Bowenian, Sibling position

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1. Oldest: confident and controlling 2. Middle: most independent and rebellious 3. Youngest: most self-aware and manipulative

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Bowenian, Frame of reference

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i. Change occurs in the present ii. Considers impact of 3 past generations

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Bowenian, View of pathology

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i. Highly fused: little individuality ii. Low member differentiation of self iii. Negotiable member self-image

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Bowenian, function of symptoms

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i. Purposeful, to relieve anxiety of fusion 1. Emotional distance 2. Emotional cutoff 3. Marital conflict (over-under-adequate reciprocity) 4. Transmission of spousal/family problems to children 5. Physical/emotional dysfunction of a spouse

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Bowenian, Therapeutic Objectives

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i. Reduce fusion ii. Increase differentiation of self iii. Avoid "Induction" iv. Reduce emotional distance/cutoff v. Resolve unfinished business with family of origin

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Bowenian, Role of therapist

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i. Emotional Neutrality ii. Avoidance of triangulation iii. Increase awareness of family dynamics 1. Interpret 2. Teach 3. Coach iv. Model differentiation of self

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Bowenian,

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i. Family assessment ii. Instruction in function of family emotional systems iii. Development of a "therapy triangle" iv. Anxiety reduction techniques v. Resolution of cutoffs vi. Communicating through the therapist vii. Maintaining the "I Position" viii. Displacement stories ix. Relationship experiments x. Genograms xi. Back-home visits

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CBT, figureheads and relationship to existing theory

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i. John Watson (classical conditioning) ii. Skinner (operant conditioning) iii. Albert Bandura (social learning theory) iv. Aaron Beck (cognitive therapy) v. Albert Ellis (Cognitive behavior therapy) vi. Harlod Kelley (social exchange theory) vii. Robert Liberman (Behavioral couples therapy) viii. Gerald Patterson (Behavioral Parent Training) ix. James Alexander (Functional Family Therapy) x. William Masters (Conjoint Sex Therapy)

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CBT, Major Premise

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i. Cognitive and Behavior patterns are maintained when reinforced in their environment ii. Discordant relational patterns are reinforced in the family environment iii. Family reinforcement patterns must be the targets of intervention

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CBT, major tenets

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Classical Conditioning, operant conditioning, social learning theory, cognitive restructuring, Social exchange theory

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Classical conditioning

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Watson 1. Unconditioned stimulus + neutral stimulus = conditioned stimulus

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Operant conditioning

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Skinner 1. Positive and negative reinforcement 2. Shaping (successive approximation) 3. Contingency contracting

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Social Learning Theory

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Bandura 1. Imitation vs. direct experience 2. Importance of modeling

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Cognitive restructuring

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Ellis, 1. ABC theory of dysfunction 2. Must change belief systems

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CBT Frame of reference

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i. Change occurs in the present ii. Therapeutic focus is on current environmental reinforcements

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CBT, View of Pathology

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i. Flawed solutions to relational problems due to 1. Inadequate positive reinforcement of functional behavior 2. Negative reciprocity-mutual withholding of relational rewards for self-protection 3. Member coercion (covert efforts to get greater reward)

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CBT, function of symptoms

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1. Considered undesirable and maintained by their consequences (their reinforcers)

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CBT, Therapeutic Objectives

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i. Altering family behavior and interactions patterns by changing contingencies that reinforce and maintain them

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CBT, role of therapist

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i. Same as for all behavioral/cognitive behavioral models: 1. Active and directive 2. Accepting of client's problem definition 3. Responsible for clients problem definition 4. Responsible for clinical goals and interventions ii. Similar to behavioral therapy process 1. Explanation of family therapy process 2. Problem analysis 3. Functional analysis 4. Adding or extinguishing targeted reinforcers 5. Training in self-monitoring 6. Assessing and recycling as needed

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CBT, therapeutic models and techniques

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Bx parent training (patterson/OC and social learning theory), bx couples therapy, functional family therapy,

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CBT, bx parent training

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1. Accepting the problem as the problem 2. Baseline setting 3. Bx parenting skills training 4. Contingency contracting

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Bx couples therapy

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liberman/cognitive, OC, social exchange theory, social learning theory 1. Bx exchange training - "caring days" 2. Therapeutic contracts 3. Relabeling/normalizing relational distortions (inferences, abstractions, overgeneralizations)

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Functional family therapy

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alexander/C.C./S.O/ systems theory 1. Identifying bx functions (Payoff) merging, separating midpointin" 2. Teaching more functional bx to carry out identified functions

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Conjoint sex therapy assumptions

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i. Relational problems sexual dysfunction ii. Sexual dysfunction relational problems iii. Marriages can founder and be rescued on the basis of sexual dysfunction iv. No such thing as an uninvolved partner in sexual dysfunction

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Conjoint Sex therapy symptoms

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1. desire disorders (lack of to addiction) 2. arousal disorders (male erectile dysfunction) 3. orgasm disorders (premature to too extended) 4. sexual pain disorders (female vaginismus) 5. problems with sexual frequency (disparities between partners desires)

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Conjoint Sex therapy, techniques

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1. Sexual history assessment & medical examination 2. Education - distinguishing between fact and fiction in sexual relationships 3. "Sensate Focus" - desensitization training to reduce anxiety 4. Communication training - building a language for exchange of affection

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Psychodynamics theory, Figureheads/relation to Existing theory

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i. Sigmond Freud - Psychic structure ii. Ronald Fairbairn, Melanie Klein - Object Relations Theory iii. John Bowlby, Mary Ainsworth - Attachment Theory iv. David & Jill Scharff - O. R. Family Therapy

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Psychodynamics, major Premise

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i. People develop self-concept and relate to others based on internalized images of previous relationships with other people (the so-called "objects" of the relationships) ii. Foundational object relationships (+ and -) form through a child's relationship to primary caregivers iii. Family interactions based on attached meanings to these early images iv. Family intervention requires attention to both the internal images and associated behavior patterns

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Psychodynamics, introjection

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: Internalization of + ; - object relations (O.R.) "Bad daddy, bad me"

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Psychodynamics, identification

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Assumption of role prescribed by an internalized (O.R.)

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Psychodynamics, containment

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object relations between parent and child necessary for self-control

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OR, Holding environment

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environment necessary for containment to ocur

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separation/individuation

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the process of developing a personality that is different from primary objects yet able to draw support from them

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attachment theory

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a structured model of separation and individuation; autism-symbiosis-individuation

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Whole object relatedness

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healthy outcome of OR development, able to see others as an integrated whole

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transitional object

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An inanimate object adopted to "stand in" in the absence of a primary object

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Splitting

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1. O.R.s separated into either all-good or all-bad categories 2. Minimize distress by recalling only good and repressing bad a. (Plausible explanations for narcissistic and borderline personality disorders)

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Projective identification

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1. Projecting unwanted aspects of self onto another 2. Identifying with the person as the object of those projections 3. Attempting to control them within the other person rather than face personally

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OR, Frame of reference

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i. Past and present 1. Focuses on intrapsychic (O.R.) conflict 2. Focuses on impact of that conflict on family interaction - from symptomatic child to projective parent 3. Insight vs. action oriented

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OR, View of pathology

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i. Members cannot see others as whole objects (splitting) ii. Relationships are defined by projections forcing members into rigidly defined roles

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OR, Function of symptoms

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i. System Protection: intrapsychic and interpersonal conflict projected onto individuals ii. Flawed solutions view: intrapsychically impaired individuals develop chronically dysfunctional interaction patterns.

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OR therapeutic objectives

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i. Expose defensive projective identifications ii. Facilitate whole object relatedness among family members iii. Promote secure attachment among family members

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OR, Role of therapist

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i. Foster a holding environment ii. Maintain neutrality iii. Interpret object relations iv. Serve as transference object v. Stay sensitive to countertransference

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OR, Therapeutic Process

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i. Create holding environment ii. Assess O.R.s through observation iii. Work through projective identifications iv. Develop alternative ways of perceiving and relating v. Analysis of countertransference

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OR, Therapeutic Techniques

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i. Listening ii. Analytic neutrality iii. Transference iv. Interpretation v. Attachment therapy interventions

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Secure attachment

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Can achieve comfort and trust in close relationships, no intervention necessary

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Ambivalent insecure

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Desires but, distrusts and tests relationship security. Intervention: Ensure consistent expectations, trustworthiness, clear communication, and tolerance in close relationships

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Avoidant insecure

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Avoids close relationships; relates as needed for personal gain. Intervention: Ensure unambiguous expectations, sociatal rules training, and logical consequenses for SR violations. Avoid inductions

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Disorganized insecure

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Simultaneously desires and fears close ambiguous relational cues. Intervention: Ensure safety, trustworthiness, clear and consistent cues in close relationships

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Strategic: Punctuation

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each believ es that what she or he says is caused b y what the other person says

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Strategic: report and command

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report: content, Command: relationship

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Paradoxical injunction/Report and command

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issues an injunction to another that simultaneously contains two levels of messages or demands that are logically inconsistent and contradictory, producing a paradoxical situation for the recipient.

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First-order changes

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superfi cial behavioral changes within a system that do not change the str ucture of the system itself

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Second-order changes

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require a fundamental revision of the system's structure and function.

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therapeutic double bind

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describes a variety of paradoxical techniques used to change entrenched family patterns

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prescribing the symptom,

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strategic therapists try to produce a runaway system by urging or even coaching the client to engage in or practice his or her symptoms, at least for the pr esent time

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relabeling

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essentially changing the label attached to a person or pr oblem from negative to positive) attempts to alter the meaning of a situation by altering its conceptual and/or emotional context in such a way that the entir e situation is perceived diff erently

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Circular questioning

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involves asking each family member questions that addr ess a difference or defi ne a r elationship between two other members of the family

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