MFT National Exam Study Guide – Flashcards
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Who is the founder of Bowenian therapy?
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Murray Bowen & James Framo (follower, although some argue he is more object-relations, he feels he is transgenerational)
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Which theory focuses on ledgers and balances?
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Contextual therapy
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Who created the rubber fence theory?
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Wynn
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Who created the term garage mechanic?
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Carl Whitaker
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What is the emphasis in Bowenian therapy?
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Differentiation of self
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What is Bowen's differentiation of self defined?
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refers to the autonomy of function which results in being less reactive to family systems dynamics and other members emotional states; the extent to which they have learned to manage emotionality.
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what is the core problem in Bowenian theory?
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triangles and emotional reactivity
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what are Bowenian's key techniques?
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genogram and process questions
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who are the founders of experiential therapy?
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Virginia Satir & Carl Whitaker
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What is the emphasis in experiential therapy?
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authenticity and self-actualization
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what is the core problem in experiential therapy?
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emotional suppression and mystification
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what are key techniques used in experiential therapy?
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confrontation and structured exercises
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who are the founders of solution-focused therapy?
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Steve de Shazer and Insoo Kim Berg
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What is the emphasis in solution-focused therapy?
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language creates reality
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What is the core problem in solution-focused therapy?
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problem talk
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what are key techniques used in solution-focused therapy?
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focusing on solutions and identifying exceptions
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who are the founders of strategic therapy?
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Don Jackson and Jay Haley
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What is the emphasis in strategic therapy?
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homeostasis and feedback loops
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what is the core problem in strategic therapy?
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more-of-the-same solutions
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what are key techniques used in strategic therapy?
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reframing directives
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who are the founders of psychodynamic therapy?
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Nathan Ackerman, Henry Dicks, and Ivan Boszormenyi-Nagy
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What is the emphasis in psychodynamic therapy?
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drives self objects internal objects
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what are the core problems in psychodynamic therapy?
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conflict projective identification fixation and regression
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what are the key techniques used in psychodynamic therapy?
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silence and interpretation
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who are the founders of narrative therapy?
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Michael White & David Epston
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what is the emphasis in narrative therapy?
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Narrative theory & social constructionism
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what is the core problem in narrative therapy?
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problem-saturated stories
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What are key techniques used in narrative therapy?
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externalization, identifying unique outcomes, & creating audiences of support
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who are the founders of structural therapy?
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Salvador Minuchin
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what is the emphasis in structural therapy?
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subsystems and boundaries
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what is the core problem in structural therapy?
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enmeshment and disengagement
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what are key techniques used in structural therapy?
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enactments and boundary making
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who are the founders of cognitive behavioral therapy?
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Gerald Patterson, Robert Liberman, and Richard Stuart
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what is the emphasis in cognitive behavioral therapy?
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reinforcement, extinction, and schemas
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what is the core problem in cognitive behavioral therapy?
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inadvertent reinforcement and aversive control
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what are key techniques used in cognitive behavioral therapy?
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functional analysis and teaching positive control
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what theory emphasizes negative-feedback loops or cycles?
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Structural
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what theory emphasizes positive-feedback cycles?
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strategic
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what theory emphasizes the importance of structure in dysfunction?
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structural
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what theory emphasizes the importance of maladaptive behavioral sequences in dysfunction?
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strategic
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what theory is straight-forward and confrontive?
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structural
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what theory is indirect and nonconfrontive?
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strategic
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in what theory does the therapist generally work with the whole family?
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structural
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in what theory does the therapist often work with only 1 or 2 members of a family system?
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strategic
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what theory focuses on immediate in-session behaviors?
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structural
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what theory retrospectively focuses on out-of-session behavioral sequences?
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strategic
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what theory focuses on behavioral sequences?
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strategic
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what theory focuses on in-session enactment?
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structural
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what theory emphasizes out-of-session directives?
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strategic
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what is ambivalence in couples therapy?
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one or both partners may be unwilling to forgive past behaviors
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how would assessment and therapy initiation be conducted in a structural approach?
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the therapist would work with the family to help them realize how their actions or behaviors might be contributing to the problem
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who is the founder of MRI Brief Therapy?
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Paul Watzlawick
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What are examples of mandated reporting?
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Tarasoff, child abuse, dependent adult abuse, and elder abuse
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what is enmeshment?
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inappropriate rigid boundaries (in a family system everyone is thinking and feeling alike)
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what is redefining?
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putting a positive connotation on behavior that is usually considered to be undesirable
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who is the founder of collaborative therapy?
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MC Bateson
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Why did the Milan associates interview families about their history?
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to find evidence of how the children's symtpoms became necessary for the system
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what is accommodation in the structural process?
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the process by which a couple transitions from courtship and adjusts to a partnership
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Solution-focused family therapists prefer to focus the treatment time on the past, here and now, future, or present?
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future, where problems can be solved
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What is the main goal of the Bowenian model?
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differentiation of self
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What is fair exchange?
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the process by whereby members of a system act upon each other and the system
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The structural family therapy view of health families states that healthy families....
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accommodate to change in circumstances
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Schemas can _____ family member's perceptions and affect their responses to each other's actual behaviors.
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distort
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Contextual therapy pays attention to background history and past experiences in order to
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assess ways in which individuals have been hurt in the past
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Which of the following represents a key strength of the Mental Research Institute?
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its interdisciplinary staff
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Being easily driven by emotionality, lacking a sense of self, inability to express your own thoughts and constantly reacting to those around you, are characteristics of what type of person?
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an undifferentiated person
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Experiential therapists believe that as a result of parental attempts to control children's feelings, children:
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Learn to suppress emotions
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The strategies used in Cognitive Behavioral family therapy are designed to:
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Modify the specific contingencies of reinforcement for each family
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According to Minuchin, the common or signature pattern for troubled middle-class families consists of:
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An enmeshed mother and a disengaged father
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What is one of the dangers of triangulation?
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can freeze conflict in place
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A man discussed his difficult and painful childhood with his therapist. When asked by the therapist, if he hoped things would be easier for his children than for him, the man responded: 'Why should they?' According to Contextual therapy, this is an example of:
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Destructive entitlement
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Jessica, a divorced mother of two adult children, is at your office and tells you that one son moved in with a young woman his age and that they both admit that the young woman "pushed him into it." Jessica's son is very intelligent, attractive, and has a quiet personality. Jessica is angry at the young woman for "trapping my son" and tells you that the young woman has taken over her son's life and she (Jessica) never gets to see him anymore. Jessica wants you to help her with her feelings of resentment and anger at her son and this woman. Jessica's other adult son is also very intelligent and came home to live with his mother after several failed relationships. Jessica resents her son living in her home, "making a mess, not paying for anything and not finishing school." Jessica's ex-husband is a professional man who is successful financially, but has no relationship with his sons. As a structural therapist, which interventions would you use to help this family?
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Enactments and boundary making; work with family strengths
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According to Psychoanalytic theory, mental conflict arises when:
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Children learn that expressing natural impulses brings punishment
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In Bowenian therapy, a person who is too close to other members of the family would be referred to as:
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Enmeshed
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Strategic family therapy focuses on:
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pragmatic problem solving strategies
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Determining the baseline frequency of the problem behaviors occurring in the family system is necessary in order to:
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Be able to accurately measure progress
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Communications theory is defined as the study of:
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The exchange of verbal and non-verbal messages in relationships
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In the context of brief therapy, what does MRI stands for?
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Mental Research Institute
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When Janet, a 26-year-old childhood sexual abuse survivor, was in elementary school, she could not concentrate on her schoolwork, and received barely passing grades. Although she is very bright, she still cannot work up to her intelligence level. She did not resolve the Eriksonian stage of:
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Industry versus inferiority
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A group whose leader spends her time modeling behaviors such as listening, empathy, and tends to structure the group experience, is in which of the following developmental stages:
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Initial
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In the early stages of group therapy, members begin to complain about not being able to ask questions and having to self-disclose. What would Yalom suggest is the best method to handle the situation?
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Bring up resistance as an issue in group dialogue
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NFT indicates that instead of focusing on reframing client's negative interpretations, it is more effective to focus on:
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Creating a new and more positive story
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Choice of marital partner is determined, according to Bowen, by way of:
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Replication of familiar family interaction; similar levels of differentiation; choosing their own alter ego
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According to Contextual therapy, __________ is a major issue in all close relationships.
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Fairness
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By giving credit to people, Contextual therapists teach clients to:
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Also give credit to each other
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Strategies used in Cognitive Behavioral family therapy are also geared at:
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Identifying distorted or inaccurate thinking patterns that affect the system
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Dick and Doris show up for therapy with their children Dick Jr., Dirk, and Dotty, ages 15, 8, and 5. The parents say that 15 year old Dick Jr. is the real problem, since he won't try to get along, argues frequently, and generally does just the opposite of what he should. As the reality trained therapist that you are . . .
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You would probably think to yourself, a dysfunctional system is causing behavioral symptoms
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Anthony and Brenda come to counseling on the advice of Brenda's doctor. Brenda tells you that Anthony sits in front of the television all day and won't pay attention to her at all. Anthony tells you that Brenda is always doing something around the house and ignores him, so he just watches television. A Strategic family therapist would see this interaction as an example of:
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Circular causality.
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What is the therapist stance in Transgenerational or Bowenian Therapy?
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neutral, objective, coach, or consultant
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In Bowenian therapy does the therapist talk more about facts or feelings?
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facts
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What therapy focuses on problem-solving?
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Strategic
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What therapy grew out of the communications theory?
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strategic
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Which therapy is Cloe Madanes associated with?
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strategic
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What therapy is Milton Erickson associated with?
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Gestalt therapy (and the Mental Research Institute)
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Why is structural therapy so popular?
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It's simple, inclusive, and practical
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Who is the only female founder in family therapy?
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Virginia Satir
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Who are the founders of psychoanalytic therapy?
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Erik Erikson and Erich Fromm
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What is the most extreme theory of the family therapy
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Feminist theory
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Who is the founder of the feminist theory?
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Deborah Luepnitiz
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What is the emphasis of feminist therapy?
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questions systems theory, deliberately political
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What is the key concept in solution-focused therapy?
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the solution is within the client
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What are key concepts associated with Transgenerational therapy?
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differentiation, individuation, transgenerational projection process, genogram, and triangulation
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What are key concepts of contextual family therapy?
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invisible loyalties, ledger balances, entitlement, indebtedness, and legacies
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What theory is associated with individuation?
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Transgenerational or Bowenian
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What are key concepts of object relations therapy?
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introject, cross-confrontation, and self-confrontation
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What is an alliance?
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a bond or affiliation between two or more family members
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What is an allopoetic system?
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systems that can be controlled from the outside, such as machines
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what are autopoetic systems?
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systems that are self-organizing and self-maintaining; biological systems and human systems are an example. Can be described as second order cybernetics
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what is balancing power?
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equalizing access to power in the couple hierarchy
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what is the battle for structure and who described it?
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the demand that the family capitulate to the therapist's way of operating while in therapy. Described by Whitaker.
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What is behavioral family therapy based on?
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principles of learning and behavior change.
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Who is seen as the problem in behavioral family therapy?
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all family members
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How are boundaries characterized?
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rigid or flexible and as diffuse, open or closed
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What is centrifugal?
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a family system dynamic in which members are expelled or encouraged to operate at the outer periphery
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What is centripetal?
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a family system dynamic in which members tightly emotionally bound to one another and encouraged to remain so
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what is change?
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the process by which structural elements of a system are transformed to new states or levels of organization
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what is circular questioning?
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a method of interviewing and hypothesis validation. Each family member comments on the behavior and interaction of two other members
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Who introduced co-therapy?
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Carl Whitaker
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What are coalitions?
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two family members joined together against a third. Usually formed across generational boundaries. Described by Minuchin's structural model
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What is cybernetics?
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the study of how systems are controlled and how information feedback loops work
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What is differentiation of self?
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The autonomy of functioning which results in being less reactive to family system dynamics and other members' emotional states.
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What are diffuse boundaries?
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boundaries that are not clearly defined or maintained. Allows for blurring of generational roles and responsibilities. Can lead to enmeshed relationships.
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What is discontinuous change?
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sudden change in family system organization usually brought on by a crisis which effects the perception of a problem.
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What is disengagement?
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loose internal emotional bonds and rigid boundaries, combined with diffuse boundaries with external systems, such as spouses with families or origin
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What is a dyad?
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a system based on interactions between two people
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What is egosyntonic?
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phenomena or experiences which are consistent with the perceived needs or ideals of an individual
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what is emotional cutoff?
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a rigid boundary which prevents emotional interaction between individuals who otherwise have strong bonds. Often intended to avoid the pain of unresolved emtional conflicts.
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what therapy is emotional cutoff associated with?
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transgenerational or Bowenian
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what is entropy?
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the tendency of a system to become disordered and random, unless controlled by outside forces
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What is the emphasis of the strategic model?
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positive-feedback cycles, maladaptive behavioral sequence of dysfunction
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Did Jay Haley feel symptoms were meaningful to solve problems?
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yes
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What is the stance of the therapist in strategic therapy?
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active, deliberate, joins with the family, responsible for therapy, focuses on presenting problem, uses language of the family, and observer
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How is diagnosis & assessment achieved in strategic therapy?
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non-historic, family life cycle, transition points, data from self report, observing family interactions
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Is object relations associated with the objects or the fantasies of the objects?
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fantasies of the objects in the psyche
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What is the stance of the therapist in object relations therapy?
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non-directive, observer, and fosters insight and understanding
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Of Bowen's transgenerational model, the contextual model and object relations which is the least directive?
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Object relations
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What are some methods and techniques of object relations therapy?
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listening, observing, responding to unconscious material, interpreting, developing insight, and encouraging expression of repressed impulses
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Who are the founders of psycho educational therapy?
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Carol Anderson and Hogerty
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Is psycho educational therapy brief or long term?
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brief
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What type of therapeutic setting is psycho educational therapy generally used in?
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hospital settings
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What is the most comprehensive theory in family therapy?
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Bowen Transgenerational Theory
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Who is known as the feminist Bowenian therapist?
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Betty Carter
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Bowen was an exception in that he was more committed to systems theory as a way of thinking than as a set of interventions (true or false)
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true
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According to Bowenian transgenerational theory, the past generations have a powerful influence on the present. (true or false)
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true
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Does Bowenian therapy belive that the best way to treat a child is to treat the parent?
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yes
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Differentian of self refers to....
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the autonomy of function which results in being less reactive to family systems dynamics and other members emotional states; the extent to which they have learned to manage emotionality.
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What two counterbalancing forces drive human relationships according to Bowenian theory?
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1. Individuality: independence & 2. Togetherness: companionship
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Does Bowenian theory believe that family is with us everywhere we go?
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yes
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Name the 6 interlocking concepts of Bowenian or transgenerational theory?
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1. Differentiation of self 2. Triangulation 3. Nuclear family emotional process 4. Family projection process 5. Transgenerational (or multigenerational) projection process 6. Sibling position
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What 2 two concepts were added to Bowen's 6 interlocking concepts in the 1970s?
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1. Emotional Cutoff: the way people manage anxiety between generations 2. Societal emotional process: sexism, class, ethnic prejudice, gender
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Define Bowen's emotional cutoff.
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the way people manage anxiety between generations. The greater emotional fusion between parents and children, the greater the likelihood of cutoff.
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Describe an example of emotional cutoff.
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Some people seek distance by moving away, others seek distance emotionally by avoiding personal conversations or insulating themselves with the presence of third parties.
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What is the scale used to determmine differentiation of self?
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good to poor
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Describe some key concepts with differentiation of self (the cornerstone to Bowen's theory).
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The capacity to think and reflect, the ability to be flexible and act wisely, the ability to balance thinking and feeling, intrapsychic and interpersonal concept, and able to take a stand on issues.
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What determines the basic level of self in a person?
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Bowen's differentiation of self.
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What is an undifferentiated self?
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Greater emotional fusion into a common self with others, easily moved to emotionality
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what is the hallmark of transgenerational therapy?
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the emphasis on the powerful influence that past generations have on present
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what is the main tenet in transgenerational theory?
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the transmission of unresolved conflicts, beliefs, and roles that pass from generation to generation
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Transgenerational therapsits work with the family of origin, true or false?
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true
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Who was Bowen's original focus on ?
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the relationship between mother and schizophrenic patient
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what does the degree of differentiation determine?
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the basic level of self in a person from poor to good
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how is basic self defined?
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by "I am" statements. Ex: "I am a person who believes in..."
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In the undifferentiated self is there greater of lesser emotional fusion into a common self with others?
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greater emotional fusion
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When does fusion happen?
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Within a shared relational pattern with others and reaches its greatest intensity in the emotional interdependency of marriage
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what is the degree of fusion dependent on?
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the basic level of differentiation in each of the two people before marriage
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how does pseudo self differ from basic self?
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it is negotiable and fluid
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what does the pseudo self contain?
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principles, ideas, and beliefs acquired through the relationship
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If you are poorly self-dfferentiated and move with the pseudo self does your heart or your head rule?
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your heart
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what are the primary goals in a poorly self-differentiated person?
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love, happiness, comfort
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is there more or less of the pseudo self in people who have an icreasingly defined level of basic self?
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less
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with people who have an increasingly defined level of basic self how are their decision smostly based?
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on objectivity
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True or false: People with a high degree of self-differentiation about tte different thinings and feeling
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true
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does the basic self change a little or a lot?
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a litle
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can the degree of differentiatiion of self be used as an over-all assessment in the life processs
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yes
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what 3 areas will symptoms be expressed in Bowen theory
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1.marital conflict 2. dysfunction in one of the partners 3. projection to one or more of the children
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what absorbs huge amounts of the undifferentiation in a marriage?
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conflict
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Define family projection process
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the part of the process by which parents project their undifferentiation onto one or more of the children
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does the child selected for the family projection process end up with a higher or lower level of differentaition of self?
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lower level
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true or false: children who grow up outside the family projection process may emerge with a higher level of differentiation of self than the parents
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true
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the sibling position of ___ ____ is an important piece of info when evaluating the family in transgenerational therapy
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each parent
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according to Bowen what is the smallest stable relationship system with emotional forces in constant motion?
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the triangle
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in therapy who effects change in the whole system and how the triangle functions?
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the most central person
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define triangulation
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telling a partner in a dyad something about the third person in a triangle
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name a commong triangular pattern
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mother and child leave dad as outsider
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how many positive sides are in a triangel? How many negative sides are in a triangel?
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two positive sides and one negative side
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what is the goal in transgenerational therapy?
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the goal is to work on changing or modfying the important triangle in the family, usually the marital couple
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what is the most efficient way to reach the goal in transgenerational therapy?
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create a new triangle between the two primary people of the dyad and the therapist
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what was fusion originally coined as?
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undifferentiated family ego mass
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what does emotional cutoff tend to produce?
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1. emotional distance between the partners 2. physical or emotional dysfunction in one partner 3. marital conflict 4. projection of problems onto the children
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what is a genogram?
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a tool used to assemble a 3 generational family history. Its a diagram that depicts patterns and influences.
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what are the concepts of contextual therapy?
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invisible loyalties ledger balances entitlement indebtedness legacies
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describe an example of emotional cutoff
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husband emotionally reactive to family keeps emotional distance from wife. She becomes anxiously attached to child. Because this relieves his anxiety, he accepts the overinvolvement reinforcing the entanglement and his distance. This cripples the child emotionally and causes less differentiation of self in child. Child is more prone to anxiety
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define sibling position
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children develop personality characteristics based on their position in the family
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what are firstborn characteristics?
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tendency to identify with power and authority, employ size and strength to defend their status, and try to minimize the cost of having siblings by dominating them
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what are characteristics of laterborns?
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underdogs in the family, identify with oppressed and question the status quo, more open to experience
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How is emotional cutoff achieved?
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some people seek distance by moving away, others seek distance emotionally by avoiding personal conversations or insulating themselves with the presence of 3rd parties
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what is the theory of dysfunction in transgenerational therapy?
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lack of differentiation results in marital conflict, dysfunction in a spouse or symptoms of dysfuction in one or more children
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what is the theory of change (goals) in transgenerational therapy?
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increase the ability to distinguish between thinking and feeling within self and others. use this skill to direct one's life and solve problems. develop person-to-person relationships; see family members as people rather than emotionally charged images; learning to observe one's self in triangle; and detriangling oneself
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What are the stages of transgenerational therapy?
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emphasize extended family; entire family need not be present; use of genogram; reduce anxiety; increase differentiation; open communication; and resolve triangles
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what is the transgenerational therapist stance?
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neutral objective coach consultant
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what adoes a therapist need in transgenerational therapy?
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good knowledge of triangles and an optimal level of emotional distance
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true or false: Bowen looked at techniques with disdain
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true
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true or false: Bowen believed that understanding how family systems operate is more important than procedures
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true
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what are some methods/techniques in transgenerational therapy?
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process over content; process questions; relationship experiments; genogram; taking "I" positions; detriangulation or neutralizing triangles; coaching; displacement stories; and long-term therapy
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is trangenerational therapy short term or long-term?
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often long-term
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what are process questions?
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queries designed to explore what's going on inside people and between them. Designed to slow people down, diminish reactive anxiety & start thinking how they participate in their problems
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give an example of a process question
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when your boyfriend neglects you, how do you deal with it? What about you wife's criticism hurts you most?
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do therapists talk more about facts or feelings in transgenerational therapy?
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facts
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do Bowenian therapists move in occasionally to challenge, confront, and explain?
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yes
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describe relationship experiments
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designed to help clients experience what it's like to act counter to their usual emotionally drive responses
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what is the primary purpose of relationship experiments
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to help people discover their ability to move against the ways their emotions are driving them
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name some key terms in transgenerational therapy
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individuation genogram symbiosis anxious attachment displacement story pursuer-distancer managing countertransference
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what is the emotional sensitivity between patients and their mothers?
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symbiosis
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_____ _____ is a pathological form of closeness driven by anxiety
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anxious attachment
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what is a displacement theory?
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a device for helping family members achieve sufficient distance to see their own roles in the family system. It's about other families with similar problems
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what should you explore with pursuer-distancer patients?
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help the pursuer explore their own inner emptiness. Ask "what's in your life other than this person (distancer). Often pursuers need is due in part as a result of unfinished business
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what is managing countertransference?
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emphasizing the neutrality required to avoid triangulation
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how would you describe the therapist in transgenerational couples therapy?
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active, questioning each spouse, yet more like a referee
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as a transgenerational therapist what are your 4 objectives when working with a couple?
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1. keep the emotional system meaningful and toned down enough for them to cope objectively without too much emtional reactiveness 2. keep yourself out of the emotional field between the couple 3. establish what Bowen calls an "I" position, part of the differentiation of self 4. Teach the couple how emotional systems operate and encourage them to work toward their respective self-differentiation to their families of origin
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what is the goal of working with one spouse in therapy?
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help them understand the part their self plays in the family system until the unmotivated spouse is willing to cooperatively join in therapy
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what do Bowenian therapists do when working with individuals?
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encourage clients to stay, check ideas, look for new observations that will confirm or deny the hypotheses and develop ways to change reactions
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what does Bowen suggest as the optimal distance from family of origin?
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200 miles to permit visits and yet be far enough away from the emotional field of the family
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where is emphasis in differentiation placed?
answer
on the "I". Every step toward self-differentiation is checked by an opposing emtional force of "togetherness" that is used to keep the emotional system of the family in check
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according to Bowen, what are three predictable steps in the family reaction to self-differentiation?
answer
1. "You are wrong" or some version of that 2. "Change back" which can be communicated in many ways 3. "If you do not, these are the consequences...."
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what does using the "I" position do?
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enables one to assume responsibility for one's own behaviors. Avoids holding others accountable for having one's needs met, one's happiness fulfillment, etc
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is self-differentiating more successful when the family is in emotional equilibrium or in crisis?
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when the family is in crisis
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what did Bowen encourage to avoid the pitfalls of parental "we-ness" in parent-child triangles?
answer
individual relationships between each parent and the child
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what are the 2 important steps in the process of self-differentiation from the parental family?
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1. develop the person-to-person relationship with each parent 2. understand the emotional system and patterns of the triangle
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what is the "dirty middle" of therapy according to James Framo?
answer
the stage in couples therapy where one of them has to change
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true or false: the genogram can be used as a third party-tool to help a dyad stabilize?
answer
true
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what unconscious things can a genogram bring out?
answer
wishes, fears, values of family members
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contextual therapy comes from what model of therapy?
answer
transgenerational
question
according to Nagy and contextual therapy what reaches across generations and greatly affects an individual's present behavior?
answer
unconscious and invisible loyalties or bonds
question
the contextual model is based on what premise?
answer
that the human condition of fairness results in a cross-generational "ledger" that tracks what has been given to the individual and what is owed
question
what does the cross-generational ledger track?
answer
what has been given to an individual and what is owed
question
what does Nagy see as the role of the therapist in contextual therapy?
answer
as trying to loosen the hold of invisible loyalties and their relationship on the various family symptoms, while ultimately moving family members to new possibilities
question
is it important to help the family recognize the trustworthiness that resides within each of its members?
answer
yes
question
what are relationship determinanats in contextual therapy?
answer
facts, individual psychology, behavioral transactions, and relational ethics
question
what is the theory of dysfunction in contextual therapy?
answer
the trustworthiness of relationship breaks down because fairness, caring, and accountability are absent. Fairness and justice isn't equal for all family members
question
what is the theory of change (goals of therapy) in contextual therapy?
answer
a preventative plan for current and future generations; restore people's capacity to give thru fair relating and trust; balance behavior and beliefs
question
what is the contextual therapist's stance?
answer
active, personal engagement, co-therapy, raises issues of relational balances, catalyst of resources, advocate for all within the basic relational context, that is the multgenerational extended family including the dead.
question
what therapy includes multigenerational family including the dead?
answer
contextual therapy
question
what are the methods/techniques of contextual therapy?
answer
focus on family resources; observations are made on all 4 dimensions; assessment is an ongoing process; developmental stage and interpersonal loyalties lead to beliefs; triangles assessed
question
what method or technique is the main focus in contextual therapy?
answer
the focus on family resources
question
what are the 4 dimensions in which observations are made in contextual therapy?
answer
1. facts 2. individual psychology 3. behavioral transactions 4. relational ethics
question
what therapy is considered an ethical approach to family therapy?
answer
contextual therapy
question
define parentification
answer
the distortion of a relationship in which one's spouse or children are induced to function as if they were one's parent
question
what does parentification in contextual therapy allow for children?
answer
allows children to internalize and identify with the responsible role of the parent, allowing for the emotional growth of the child
question
what are questions a therapist needs to ask in regards to parentification to determine if its inappropriate?
answer
what part does this place in the relationship? who benefits? how do the benefit? what are its effects on the parent, child, the spouse?
question
what does inappropriate parentification do?
answer
creates distortion in relationships
question
what are some ways parentification may occur?
answer
possessively (ex: oral or dependency), aggressively, or sexually
question
what is a key dimension in contextual therapy?
answer
possession vs. loss of loved ones
question
according to contextual therapy what is one's gretest satisfaction?
answer
in coming together in a relationship (ex: raising a child)
question
according to contextual therapy what is one's greatest unhappiness?
answer
connected to loss or a coming apart (ex: loss of a child)
question
does contextual therapy follow the premise that while we give we receive?
answer
yes
question
how does one demonstrate leadership in contextual therapy?
answer
by following
question
according to Nagy and contextual therapy while examining one's attitudes, beliefs, and feelings about a parent a person'a relationship to their child can become......
answer
both parent and child
question
according to parentification and contextual therapy the scapegoat is..
answer
the saddest of all human beings and tremendously powerful in keeping the system intact (some couples "have to" stay together just to handle what the scapegoat child will do next)
question
what are the major concepts in contextual therapy?
answer
destructive entitlement; entitlement; exoneration; justice/fairness; ledger; loyalty (filial and invisible); merit; multidirectional partiality; parentification; relationship determinants and trustworthiness
question
what are the stages to de-parentify a family member in contextual therapy?
answer
Stage 1) parents begin to attribute "parental" significance to the therapist, pressure on the child to be parent lowers; consequently the identified parent may experience symptom relief (some families may try to terminate therapy early) Stage 2) involves addressing the entire spectrum of family dynamics as the family reveals them
question
what does Nagy feel are signs of progress in de-parentifying a family member?
answer
parents compete with their children for the therapist's attention as if the therapist were the parent; the children begin to try out new age-appropriate familial roles; children attempt to make their parents respond in parental manner
question
parentification is a dynaimc rooted in what family system?
answer
the family loyalty system
question
is contextual therapy short or long-term?
answer
often long-term
question
how many family members are treated in contextual therapy?
answer
as many as are interested and willing to come
question
who decides (and how) what family members are seen in contextual therapy?
answer
the therapist based on info. given by the family
question
is co-therapy encouraged in contextual therapy?
answer
yes
question
what is the 4 dimensional framework in contextual therapy?
answer
1. facts 2. individual psychology 3. behavioral transactions 4. relational ethics
question
how is loyalty defined in contextual therapy?
answer
as a sense of indebtedness to one's family (debts and entitleness)
question
what is destructive entitlement? Give and example
answer
when fairness is not present. Ex: father is absent and oldest son takes on the role as father. When he has a child of his own he feels that he can be absent himself..."I've already done that role"
question
define loyalties
answer
unconsious commitments that children take on to help their families to the detriment of their own well-being
question
what are the stages of therapy in contextual therapy?
answer
unit of treatment is chosen by therapist; enagement; cognition exploration of family history; affective discharge or insight; alter perceptions; expand trust to increase options
question
how does the therapist represent the dead in contextual therapy?
answer
brings in open chairs
question
are prescriptions and directives given in contextual therapy?
answer
no
question
is the work done in or out of session in contextual therapy?
answer
in session which is different than Bowen who is more out of session
question
what is the "well-child" according to Nagy?
answer
a silent or seemingly "neutral" role which may contribute to parentification. The child is the epitome of health and good performance
question
what is the "well-child" parentified?
answer
the "well-child" contributes to the loyalty system of the family by playing certain prescribed and premature roles and not to live an age-appropriate life
question
what does the "well-child" do for a family?
answer
gives them an air of propriety, of dignity
question
how might the "well-child" feel?
answer
desperate about their situation and unable to see themselves surviving outside of their designated role
question
how might parentification "work"?
answer
if both spouses are able to place a similar demand on one another
question
what is a dynamic ledger in contextual therapy?
answer
a ledger that determines most of the interactions in the nuclear family relationship
question
why, according to Nagy, are ethical, behiavoral, and loyalty inseparable?
answer
because our ethics originate with internalizations of our relationships with our parents
question
according to contextual therapy what are the most forceful determinants of conduct and why?
answer
ethical acounts are the most forceful determinants because their effect is channeled through internalized commitments
question
according to Nagy where do our ethics originate?
answer
with internalizations of our relationships with our parents
question
who elects th parentified member in contextual therapy?
answer
the system as a whole
question
what is the decision of who becomes parentified based on?
answer
previous family relationships and by the development background of each family member
question
true or false: in some families members take turns being parentified?
answer
true
question
when do parentification attempts become pathologic?
answer
when they begin to seriously hinder a child's emotional development
question
what is a double-bind in contextual therapy?
answer
the child is expected to be obedient, yet also behave in accordance with his parentifiec position
question
what is the cost of parentification to the child?
answer
individual development and autonomy. Child is the role of victim
question
what does parentification represent in contextual therapy?
answer
an effort at recreating the past relationship with one's parent in a present relationship with one's child or spouse
question
where does object relations therapy stem from?
answer
Principles found in psychoanalysis
question
what branch of therapy does object relations come from?
answer
Bowen's transgenerational
question
who are the founders of object relations?
answer
James Framo (although he asserts that he is not), Normal Paul, D. Scharff and J. Scarff
question
what does object relations theory propose?
answer
that parental images are developed by children and assessed as either good or bad
question
true or false: in object relations it isn't objects that are in the psyche, but fantasies of objects
answer
true
question
object-relations therapy is similar to what set of principles
answer
neo-Freudian psychoanalytic
question
what is a central element of object relations therapy
answer
the transference of repressed introjects (feelings, beliefs) with both negative and positive ojbect identification onto others
question
what is a goal in object relations therapy?
answer
to try to help members of a couple identify and own their introjects (feelings, beliefs), noting when they are projecting them onto one another
question
what is introjection?
answer
a dysfunctional process of identity formation in which the person takes on beliefs, percptions, and/or feelings of others and which results in a distorted self image
question
define projection
answer
a defense against unwanted feelings or beliefs about oneself, in which these elements are attributed to others and often inducing them to behave as if these characteristics were true to them
question
what are the major concepts of object relations?
answer
projection of internalized, repressed ego objects; internal objects such as mental images of self and otehrs, and self in relation to others build from experience and expectation; interpersonal view of the introjected objects; peopel relate to people in the present partly on the basis of expectations formed by early experience
question
what are some buzz words in object relations?
answer
introject; cross-confrontation; and self-confrontation
question
is symptom relief a goal in object relations?
answer
no
question
how is object relations similar to structural therapy?
answer
it searches for structures underlying the presenting problem
question
what is the theory of dysfunction in object relations?
answer
negative aspects of repressed, introjected early "objects" (primarily parents) are projected onto the spouse or children
question
define projected identification?
answer
often the person that is projected upon begins to believe/accept that projection
question
what is the theory of change in object relations?
answer
expression of repressed objects; resolution of negative aspects of repressed objects; individualization of family members; detachment & differentiation from the "bad" object
question
what are the stages of object relations therapy?
answer
engagement stage; projected identification stage; confrontation (brings insight); termination; therapy is often long-term
question
what is the stance of the object relations therapist?
answer
non-directive (unlike Bowen and Contextual); observer; and fosters insight and understanding
question
what are the methods/techniques in object relations?
answer
listening; observing; responding to unconscious mateial; interpreting; developing insight; encourage expression of repressed impulses
question
what is used for diagnosis/assessment in object relations?
answer
self-report; family of origin history; analyzing the defensive system of the family; analysis of intrapsychic material; and degree of indivdidualization between family members
question
what are some similarities of object relations and strategic therapy in the Milan tradition?
answer
Both use history taking, pattern recognition, and working with the mutual impact of the family system
question
who are some therapists (and their orientation) whose work reflects many basic concepts of psychoanalytic psychotherapy?
answer
Bowen who guides the individual through the family projection process. Boszormenyi-Nagy who works with individuals in the context of loyalties and ethics. James Framo who works with transgenerational projected identifications of the introject
question
what is the libidinal system in object relations characterized by?
answer
need; excitement, longing
question
what is the antilibidinal system in object relations characterized by?
answer
aggression, rage, and contempt
question
what is the central ego in object relations?
answer
the ideal neutral object free from exciting and rejecting aspects
question
true or false: object relations ascribes to the theory that insight is necessary for change to occur and that working thru is necessary to fully master the gains made from change
answer
true
question
what happens in object relations when there is failure to conceive a child?
answer
painful unconscious object relations are simulated
question
what theory focuses on problem solving?
answer
strategic
question
what theory did strategic therapy stem from?
answer
communications theory
question
what therapists are associated with strategic therapy?
answer
Jay Haley, Cloe Madanes, and Milton Erickson
question
How is the first interview conducted in strategic therapy and why?
answer
presented in a "recipe" format, suggesting that although we are concerned with the outcome of therapy it is the beginning that is of importance
question
what do MRI Brief Family Therapy, Strategic, and Milan Systemic Model have in common?
answer
they all propose that therapy is a kind of human engineering that is strategically designed and implemented by a therapist
question
what does the MRI approach pay attention to?
answer
interactional sequences rather than hierarchy or power
question
what is MRI known for?
answer
the development of second-order change and thinking the solution is the problem
question
how are problems in families maintained in strategic therapy?
answer
by a faulty hierarchy in the family
question
what is one of the main tenets in MRI?
answer
the solution is the problem
question
does the strategic model focus more on dysfunction or healthy families?
answer
dysfunction
question
true or false: both MRI and strategic view the family's problems as essentially a fixed behavioral reality needing to be changed.
answer
true
question
true or false: both MRI and strategic believe that the therapist's role is to engineer change
answer
true
question
who influenced the Milan Systemic School?
answer
MRI (Mental Research Institute)
question
true or false: Milan Systemic Therapy attends more to beliefs, the way things are perceived and how people learn
answer
true
question
in Milan systemic therapy is therapy an evolving process and the family and evolving system?
answer
yes
question
what are the major concepts in Milan systemic therapy?
answer
family system is evolving constantly; hypothesizing; circularity; neutrality; double-bind; invariant prescription; homeostasis; attend to beliefs, not behavior; and positive connotation
question
what is the theory of dysfunction in MIlan systemic?
answer
family caught up in an unacknowledged "dirty game," problems maintained by behavioral sequences, and family's old epistemology does not fit its current pattern of behavior
question
what is the theory of change (goals) of Milan systemic therapy?
answer
helping the family develop alternative epistemology (belief) by creating an environment in which new information is introduced into the family system
question
what is the therapist stance in Milan systemic therapy?
answer
mixed gender treatment teams; neutrality (from Bowen) - maintain a neutral position; focuses on ways to think differently; and generate hypothesis regarding why the family behaves the way it does
question
what is similar about the therapist's stance in transgenerational and Milan Sytemic therapy?
answer
they both are neutral
question
what are some methods/techniques in Milan systemic therapy?
answer
hypothesizing; circularity; neutrality; invarian prescription; rituals; paradox; positive connotation
question
how is diagnosis/assessment done in Milan systemic therapy?
answer
information learned before meeting is used in formulating the hypothesis; hypothesis leads directly to interventions
question
do Milan systemic therapists see the entire family?
answer
yes
question
what are the stages of therapy in Milan systemic therapy?
answer
pre-session; session interview with family behind one way mirror; interventions (ex: paradoxical prescript); hypothesis testing; team discussion of session; therapist presents conclusions; post-session of team and therapist; sessions 1 month apart; short-term
question
Is Milan systemic therapy short or long-term?
answer
short term
question
who are the Milan systemic theorists?
answer
Palazzoli; Cecchin; Boscolo; and Prata
question
define circularity
answer
the cause of one event is understood to have been itself caused by others, thus creating an endless (and begin-less) circular chain of events
question
can you identify 1 person in circular causality as having caused a problem? why or why not?
answer
it is meaningless to identify one person because all elements of the problem are thought to be coexisting and reciprocally reinforcing problems can't be maintained if even one element is removed.
question
describe an intervention used in Milan systemic therapy
answer
having the family act out their behaviors thru a ritual (exposing the family to a different way of viewing their problem)
question
what are the 3 key concepts in Milan systemic therapy?
answer
hypothesizing; neutrality; and circularity
question
what information might a Milan systemic therapist use to forumulate the hypothesis pre-session?
answer
referring person; name, ages, education and jobs of family members; person designated as the IP (identified patient); the problem; information about ther person calling; and other data
question
what does the hypothesis do in Milan systemic therapy?
answer
leads to choices for therapeutic interventions
question
in family therapy is hypothesis building considered experimental?
answer
yes
question
what does the information gathered lead the therapist to do with the hypothesis in Milan sytemic therapy?
answer
extend into other hypotheses, confirm a hypothesis or reject a hypothesis
question
what 3 activities are part of the experimental method?
answer
observation; formulation of a hypothesis; and experimentation
question
who did the Milan team take much of its formulation of systems from?
answer
Bateson
question
define entropy
answer
the tendency of a system to become disordered and random unless controlled by outside forces
question
does entropy decrease or increase as infomration increases? why?
answer
it decreases because one could conclude that the more information in the system, the more organization in the system
question
how might a therapist accrue authentic information in Milan systemic therapy?
answer
by circular questioning: every member of the system must describe their view of the relationship between other dyads of the system
question
what does circular questioninig accomplish in Milan systemic therapy?
answer
lessens resistance if one part of the system comments on another part. Sheds light on triangulations. Breaks the rule in dysfunctional families about secrets. Extracts relationship information
question
how would the Milan team say the family would describe the therapist who folowed the Milan system?
answer
the family would be unable to tell what the therapist actually "did," but could describe the manner of doing
question
what do Milan therapists say is helpful in gathering information?
answer
ask about specific behaviors or interactions from each of the subsystem members
question
who designed the MRI brief therapy model?
answer
Watzlawick, Weakland, and Fisch (MRI=WWF)
question
what does MRI stand for?
answer
Mental Research Institute
question
what is paradoxical in MRI?
answer
came out of Erickson's application of hypnotherapeutic principles to turn resistance to advantage (paradox is self-contradictory)
question
define paradoxical intervention
answer
a strategic intervention that is built around a statement that contains one meaning and which contradicts itself. This subtle contradiction is used to perturb the system and to generate change. Example: Issued as a demand "be independent!"
question
what are key terms in MRI Brief Therapy?
answer
paradoxical, emphasis and belief
question
what are the major concepts of MRI therapy?
answer
communication theory (levels, rules, and congruence), first vs. second order change; cybernetics/positive feedback; life cycle transition points are significant; focus on the presenting complaint; treatment can be one person; most motivated person in family is used; primary determinant is other people's behavior
question
what is the theory of dysfunction in MRI brief therapy?
answer
attempts at solutions become the problem; viscious cycles of mishandled attempts to solve the problems; family engages in "more of the same," maintain the problem
question
what is the theory of change (goals) in MRI Brief Therapy?
answer
behavior first; then beliefs will change; change the complementary, interdependent nature of the symptoms; 1st order change behavioral tasks; change interactional sequences by identifying the viscious cycle
question
what is the therapist stance in MRI?
answer
directive, in charge
question
what are the methods/techniques of MRI brief therapy?
answer
active; clients are viewed as customers; attend to process over content; team and one way mirror often used
question
what type of diagnosis/assessment does MRI use?
answer
non-historic; symptom-focused; sequence of symptom-maintaining behaviors; instances of circular causality
question
what are the stages of therapy in MRI?
answer
set-up & definition of the problem; identify and interrupt behavior maintaining problems; set goals; behavioral intervention (direct or paradoxical); client position treatment needs maneuverability to find out who is person most wanting to change; prescriptive; what solution tried and discard; what solution being used; termination; short-term therapy
question
define first-order change.
answer
from the MRI school; adaptations and changes in structure which do not effect the system's organizational principles
question
define second-order change
answer
from the MRI school; a change in the rules that govern the emotions and behavioral patterns of the system, resulting in fundamental system re-organization
question
what two items does MRI take from Erickson?
answer
1. goal is not clarifying the problem, but altering or modifying it by a redefinition 2. taking what the client gives and using this in some positive manner
question
is brief therapy symptom oriented?
answer
yes
question
how are problems viewed in MRI brief therapy?
answer
as problems in interactions with people; as ordinary life difficulties that have been badly handled; as likely to develop if over or under emphasis is put on daily struggles; as normal transitions leading to difficulties
question
what does problem resolution require in MRI?
answer
an interruption of the positive feedback loops thru substituting different behavior patterns
question
how is change affected in MRI?
answer
by clearly stating a small goal of change
question
is the question of "why" addressed in MRI brief therapy? Why or why not?
answer
no it is not because "why" questions lead into underlying causes of the problem, etc. and attempt to promote insight which isn't he goal of brief therapy
question
who does the team of therapists consist of in MRI brief therapy?
answer
the therapist and observers
question
how long does the team of therapist and observers generally meet in MRI Brief Therapy?
answer
half an hour after each session to discuss. cases are discussed weekly in a longer meeting.
question
what are the 6 overlapping stages of MRI brief therapy?
answer
1. client introduced to treatment arrangement 2. inquiry and definition of the problem. Behavioral picture of problem. 3. estimation of which behaviors maintain the problem. What is top priority? 4. treatment goals set as concrete observable behavior. What is the least amount of change acceptable to client. Set goal by 2nd session. 5. behavior interventions determined and made. Relabel behavior. Suggest change 6. termination usually at end of 10 sessions. Review course of therapy gains and issues.
question
what question is essential to ask a client in MRI brief therapy?
answer
"what is the least amount of chagne acceptable?"
question
what does an MRI brief therapist need to determine in early treatment sessions?
answer
"where the patient lives"
question
is homework utilized in MRI brief therapy?
answer
yes
question
for homework in MRI therapy, how many times might a client be asked to enact a changed behavior?
answer
only once or twice until the next session
question
why is homework used in MRI brief therapy?
answer
to promote the best use of time in between sessions and put the change out in the patient's real word
question
what is the MRI brief therapist a specialist in?
answer
influence
question
what is the therapeutic double bind in MRI brief therapy?
answer
encouragement of symptomatic or other undesirable behavior in order to lessen such behavior or bring it under control; promotes progress regarding how patient responds
question
give an example of a paradoxicial instruction in MRI brief therapy
answer
advise patient to go slowly. When change is reported ask them to slow down. Paradoxically, this usually produces faster results. When rapid change is produced, suggest a relapse to old behaviors. This increases control.
question
how do many people refer to MRI techniques?
answer
as manipulative
question
when is termination performed in MRI?
answer
usually by the end of ten sessions
question
how is termination performed in MRI?
answer
by reviewing the course of therapy, pointing out the gains and any unresolved issues. The future beyond is discussed.
question
what two questions are asked in the evaluation of MRI brief therapy?
answer
1. has behavior changed as planned? 2. has the complaint been relieved?
question
who conducts follow-up evaluations in MRI brief therapy?
answer
a group member who was not involved in treatment
question
according to Bowen what 2 counterbalancing life forces drive human relationships?
answer
individuality and togetherness. Each of us needs companionship and a degree of independence
question
what did Bowen discover about family?
answer
it is with us wherever we go.
question
according to Bowen what is the most important unfinished business of our lives?
answer
unresolved emotional reactivity
question
what clinic was Bowen a part of and when?
answer
Menninger Clinic from 1946 to 1954
question
how did others refer to the emotional sensitivity between patients and their mother that attracted Bowen?
answer
symbiosis
question
How did Bowen view what others termed symbiosis?
answer
an exaggeration of a natural process, a more intense version of the tendency to react emtionally to one another that exists in all relationships.
question
what family systems model is the most comprehensive in family therapy?
answer
Murray Bowen's transgenerational model
question
where did Bowen move to in 1954?
answer
National Institute of Mental Health (NIMH)
question
how does Bowen define anxious attachment?
answer
a pathological form of closeness driven by anxiety
question
what is the hallmark of the fused (emotionally stuck together) anxious attachment families?
answer
a lack of personal autonomy
question
true or false. Bowen believed there is no discontinuity between normal and disturbed families but that all families vary along a continuum from emotional fusion to differentiation
answer
true
question
who are two of Bowen's most prominent students?
answer
Philip Guerin and Thomas Fogarty
question
How was Bowen different from the rest of family therapy's pioneers?
answer
the others were pragmatists, more concerned with action than insight, more interested in technique than theory. Bowen saw theory as a way of thinking not interventions
question
according to Bowen, do we have more or less autonomy in our emotional lives than we assume? why?
answer
we have less autonomy because most of us are more dependent and reactive to one another than we like to think
question
what 6 interlocking concepts did Bowen say shapes the interplay of indivduality and togetherness?
answer
1. differentiation of self 2. triangles 3. nuclear family emtional process 4. family projection process 5. multigenerational transmission process 6. sibling position
question
what two additional interlocking concepts did Bowen add in the 1970s?
answer
1. emotional cutoff 2. societal emotional process
question
what 3 of Bowen's original 6 concepts all refer to how family problems are passed down thru the generations? what do we call this now?
answer
1. nuclear family emotional process 2. family projection process 3. multigenerational transmission process They all combine to one concept: multigenerational emotional process
question
what is the cornerstone of Bowen's theory?
answer
differentiation of self
question
define differentiation of self
answer
the capacity to think and reflect, to not respond automatically to emotional pressures, internal or external. It's the ability to be flexible and act wisely, even in the face of anxiety.
question
describe the differentiated person.
answer
able to take stands on issues; able to balance thinking and feeling; capable of strong emotion and spontaneity but also possessing the self-restraint that comes with the ability to resist the pull of emotional impulses.
question
describe an undifferentiated person.
answer
easily moved to emotionality; their life is driven by reactivity to those around them; react impetuously with submissiveness or defiance toward other people; find it difficult to maintain their own autonomy; agree with what u say or argue everything.
question
how do undifferentiated people react around anxious issues?
answer
asked what they think, they say what they feel; asked what they believe, they echo what they've heard. They either agree with whatever you say, or argue with everything.
question
how do differentiated people react?
answer
able to take stands on issues because they're able to think things through, decide what they believe, and then act on those beliefs
question
what is the major influence on the activity of triangles?
answer
anxiety
question
how does anxiety influence triangles?
answer
as anxiety increases, people experience a greater need for emotional closeness- or, in reaction to pressures from others, a greater need for distance. The more people are driven by anxiety, the less tolerant they are of one another and the more polarized by differences.
question
According to Bowen, when two people have problems they are unable to resolve and they get to the ponit where it's hard to talk about certain things what happens?
answer
one or both partners will turn to someone else for sympathy or the conflict will draw in a third person to try to help. Thus, a triangle is formed.
