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Names of the influential theorists for Bowen

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Murray Bowen, Philip Guerin, Thomas Fogarty, Betty Carter, Monica McGoldrick, Michael Kerr, Elizabeth Scoweren

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When and where the Bowen theory developed

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(1) late 40s: Menninger Clinic in Houston (2) 1954 NIMH (3) 1959 Georgetown University (4) 1975 Georgetown family center

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Detraingulation

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(Bowen) The process by which an individual removes himself from the emotional field of two others (silence, boundaries, mirroring back what triangle was)

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Differentiation of self

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(Bowen) psychological separation of intellect and emotions and independence of self from others; opposite of fusion; on an interpersonal level, the ability to experience both intimacy and independence

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Emotional cutoff

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(Bowen) Bowen's term for flight from an unresolved emotional attachment

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Family life cycle

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(Bowen) stages of family life from separation from one's parents to marriage, having children, growing older, retirement, and finally, death

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Family of origin

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(Bowen) a person's parents and siblings; usually refers to the original nuclear family of adult

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Fusion

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a blurring of psychological boundaries b/w self and others and a contamination of emotional and intellectual functioning; opposite of differentian

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Genogram

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(Bowen) a schematic diagram of the family system, using squares to represent male family members, circles to indicate female family members, horizontal lines for marriages, and vertical lines to indicate children

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I-position

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(Bowen) a statement that acknowledges one's personal opinions rather than blames others ("you never...") or moralizes ("children should always...")

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Multigenerational transmission process

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Bowen's concept for the projection of varying degrees of immaturity to different children in the same family; the child who is most involved in the family emotional process emerges with the lowest level of differentiation and passes problems on to succeeding generations

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Process questions

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Bowen- questions designed to help family members think about their own reactions to what others are doing

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Relationship experiments

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(Bowen) suggestions for trying new ways of responding to family stresses, designed more to help family members understand how emotional processes work than to solve problems

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Triangle

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(Bowen) a 3 person system; the smallest stable unit of human relations; they exist neither good or bad; triangle is about power; conflict w/ 2 people: 3rd comes in to diffuse; the triangle may include other entities - i.e. pets, objects of value (money), valued center concept (religion, politics, education)

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Undifferentiated family ego mass

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Bowen's early term for emotional "stuck-togetherness" or fusion in the family, especially prominent in schizophrenic families

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Main goals in Bowen theory

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•Differentiation of each individual. •Ending triangles between families. • Learning to control emotional reactivity. •Learning to manage anxiety appropriately. ***expose inner workings of family dynamics over period of time and everyone taking responsibility for their own lives

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Stance of therapist in Bowen theory

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•Remain neutral in the relationship and not become enmeshed. •Create a therapeutic triangle. •Avoid triangulation. •Control reactivity •Have clients speak to you (therapist) and not each other to control emotionality. *therapist- a process of active inquiry

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Bowenian theory of dysfunction

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The dual need for individuality and togetherness provoke emotional anxiety which is processed and dealt with in the short-term, in mostly unconscious motivations and behaviors, in biological pathways developed over millions of years of evolution, that are dysfunctional for the long term well-being of both the individual and the family group (emotional fusion)

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Bowenian theory of change

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The therapist gets the members of the group to see the process and structure of both their rational and dysfunctional interactions, and helps increase each member's ability to distinguish between thinking and feeling, and learning to use that ability to resolve relationship problems *lowering anxiety and increasing self-focus: the ability to see one's own role in interpersonal process are the primary mechanisms for change

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Bowenian stages of therapy

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• Stages of Therapy: 1) Assessment of family history, processes ,and structure 2) Coaching clients on developing skills necessary for differentiation of self; 3) consulting clients on the functioning and management of their own emotional systems and family networks, *begin process of detriangulation and differentiation that will profoundly and permanently change the entire family system

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Bowenian diagnosis/assessment

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History of presenting problem, history of nuclear family, family life cycle events, and location/moves. History of two or more generations of family of origins, sibling positions, family life cycle events, and location/moves.

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Bowenian techniques/methods

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Genogram, Neutralizing triangles (relies on the therapist managing own countertransference), Process Questions (focus on increasing perception and thinking and decreasing emotional reactivity), Relationship Experiments ( helps to clarify the emotional processes involved), Coaching/Consulting (keeps the therapist out of the role of relationships fixer), The I Position, (One of the most direct ways to break the cycles of emotional reactivity).

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Strengths of Bowenian theory

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Presents a systemic way of understanding family systems. Blends intrapsychic and interpersonal approaches together, does not require the therapist to have the right answers in order to help the clients, The concept of Societal Emotional process is compatible with the later understanding of diversity and feminist concepts. The theory was designed in light of research into evolutionary biological systems and validity has been shown.

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Limitations of Bowenian theory

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More research is required (much has been done since 2000 and is ongoing), It's methodology of working directly with individuals may unnecessarily preclude working with the family unit as a whole; There is current disagreement whether the concept of differentiation of self is congruent with women, people of color, or individuals from cultures who tend to value a collective group identity over an autonomous individual identity. Research tends to validate there is congruence.

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Names of influential theorists in the strategic theory

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Gregory Bateson, Milton Erickson, Jay Haley, Salvador Minuchin, Don Jackson, Richard Fisch, Arthur Bodin, Paul Watzlawick, John Weakland, Cloe Madanes, Mara Palazzoli, Boscolo, Gianfranco Cecchin, Guiliana Prata, James Keim, Jerome Price, Pat Dorgan

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When and where the strategic theory developed

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The birthplace of all 3 was the mental research institute (MRI): theory was inspired by Gregory Bateson and Milton Erickson *1952: funded by rockefeller grant to study paradox cummunication, Bateson invited Haley, Weakland, Jackson, and Fry to join Palo Alto *1958: Jackson funded MRI (staff: virginia satir, jay jaley, weakland, waltzlawick, bodin, beaven) *1967: Haley joined Salvador Minuchin at the Philadelphia child guidance center *1976: Haley moved to DC to work with Cloe Madanes at the family therapy institute *Milan 1967: (8 psychiatrist who used ideas of Bateson, Haley, and Watzlawick) Palazzoli, 1971-formed a center for the study of the family in Milan where they developed the Milan systemic Model

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Circular Causality

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(Strategic) the idea that events are related through a series of interacting loops or repeating cycles

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Circular questioning

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(strategic) a method of interviewing developed by Milan associates in which questions are asked that highlight differences among family members *bigger pic of what is going on *use reference domain

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Cybernetics

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(strategic) the study of control processes in systems, especially analysis of the flow of information in closed systems

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Directives

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(strategic) homework assignments designed to help families interrupt homeostatic patterns of problem-maintaining behavior

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Double bind

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(strategic) conflict created when a person receives contradictory messages on different levels of abstraction in an important relationship and can't leave or comment

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Family Homeostatis

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(strategic) the tendency of families to resist change to maintain a steady state

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Family ritual

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(strategic) a technique used by Selvini Palazzoli and her Milan Associates that prescribes a set of actions designed to change a family system's rules

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Family rules

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(strategic) a descriptive term for redundant behavioral patterns

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Feedback loops

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(strategic) the return of a portion of the output of a system, especially when used to maintain the output within predetermined limits (negative feedback) or to signal a need to modify the system (positive feedback)

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First-order change

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(strategic) superficial change in a system that stays invariant

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Function of symptoms

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(strategic) the idea that symptoms are often ways to distract or protect family members from threatening conflicts

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General systems theory

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(strategic) a biological model of living systems as whole entities that maintain themselves through continuous input and output from the environment; developed by Ludwig Von Bertalanffy

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Hierarchical structure

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(strategic) family functioning based on clear generational boundaries, whereby the parents maintain control and authority

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Identified patient

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(strategic) the symptom bearer or official patient

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Metacommunication

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(strategic) every message has 2 levels, report and command; is the implied command or qualifying message

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Neutrality

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(strategic) Palazzoli's term for balanced acceptance of family members

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Ordeal

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(strategic) a paradoxical intervention in which the client is directed to do something that is more of a hardship than the symptom

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Paradox

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(strategic) a self-contradictory statement based on a valid deduction from acceptable premises

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Paradoxical intervention

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(strategic) a technique used whereby the therapist directs family members to continue their symptomatic behavior. If they conform, they admit control and expose secondary gain; if they rebel, they give up their symptoms

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Positive connotation

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(strategic) Palazzoli's technique ascribing positive motives to family behavior to promote family cohesion and avoid resistance to therapy

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Pretend techniques

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(strategic) Madane's playful paradoxical intervention in which family members are asked to pretend to engage in symptomatic behavior. The paradox is if they are pretending to have the symptom, the symptom cannot be real

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Reframing

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(strategic) relabeling a family's description of behavior to make it more amenable to therapeutic change; for example, describing someone as "lazy" rather than "depressed."

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Second order change

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(strategic) basic change in the structure of a system

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Strategic therapy

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any of several artful approaches that aim to manipulate behavior change to solve family problems

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Goals of strategic therapy

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Altering specific patterns of communication that maintained problems; the primary goal of hypothesizing in Haley's approach is to understand the heart of the family drama that symptoms revolve around. Haley focused on the meaning behind people's problems and therefore believed problems should have reasonable solutions. The answer is to help families find new ways to solve their problems

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Stance of therapist in strategic

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The Milan associates strove to maintain an attitude of neutrality. They didn't apply preconceived goals or normative models. Instead, by raising questions that helped families examine themselves and that exposed hidden power games, they trusted that families would reorganize on their own

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Stages of therapy in strategic

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MRI follows 6-step treatment: introducing the treatment setup, inquiring about and defining the problem, estimating the behavior that is maintaining the problem, setting goals for treatment, selecting and making behavioral interventions, terminating therapy

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Diagnosis/Assessment for strategic

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The goals of an MRI assessment are to (1) define a resolvable complaint (2) identify attempted solutions that maintain the complaint (3) understand the clients unique language for describing the problem; the first 2 goals show where to intervene, while the 3rd is relevant to how

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Techniques/Methods for strategic

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Paradoxical interventions, pretend techniques, prescribing the symptom, restraining, directives

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Strengths of strategic theory

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When communication takes place in a closed system-and individual's fantasies or a family's private conversations-there's little opportunity for adjusting the system. Only when someone outside the system provides input can correction occur. Because the rules of family, the best way to examine them is to consult an expert in communication

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Limitations of strategic theory

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Manipulative aspects; when communications and therapists were confounded by the anxious inflexibility of some families, they may have exaggerated the irrational power of the family system - therapists so focused on outcome; misinterpretation of metaphors for the problems

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Influential theorists for Experiential therapy

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Virginia Satir, Carl Whitaker, Greenberg and Johnson, Schwartz

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When and where experiential theory developed

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o Whitaker and his entire faculty resigned at Emory University and established the Atlanta Psychiatric Clinic. ________ psychotherapy was born of this union, and the group produced a number of provocative and challenging papers.• Humanistic nature: experienced immediate, here/now experiences *Gestalt and encounter groups *Different from family therapy *Focus: emotional experience not dynamics of interaction *Emphasis: feelings and individuals not systems and action •Development: Carl Whitaker *Emory University Department of Psychiatry (1946-1955): resigned when department wanted a psychoanalytic approach *Established Atlanta Psychiatric Clinic

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Countertransference

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(Experiential) Emotional reactivity on the part of the therapist

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Emotionally focused couples therapy

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(Experiential) A model of therapy based on attachment theory, in which the emotional longings beneath a couple's defensive reactions are uncovered as they are taught to see the reactive nature of their struggles with each other, developed by Leslie Greenberg and Susan Johnson

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Existential encounter

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(Experiential) a relationship based on direct personal contact, rather than artificial professional roles

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Family myths

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(Experiential) a set of beliefs on a distortion of historical reality and shared by all family members that help shape the rules of governing family functioning

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Family sculpting

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(Experiential) A nonverbal experiential technique in which family members position themselves in a tableau that reveals significant aspects of their perceptions and feelings

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Internal family systems therapy

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(Experiential) a model of family therapy that uses systemic principles and techniques to understand and change intrapsychic processes, developed by Richard Schwartz

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Mystification

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(Experiential) R.D. Laing's concept that many families distort their children's experience by denying or relabeling it

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Parts

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(Experiential) Richard Schwartz's term for the various reactive elements that make up a person's subpersonalities

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Role-playing

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(Experiential) acting out the parts of important characters to dramatize feelings and practice new ways of relating

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Self-Actualization

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(Experiential) Carl Roger's term for the innate human tendency for each of us to seek what is best for us. A tendency that gets subverted by the need to please but can be released again in the presence of unconditional positive regard.

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Goals for Experimental therapy

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o In place of determinism, existentialists emphasized freedom and the immediacy of experience. Where psychoanalysts posited a structuralized model of the mind, _______ treated individuals as whole persons and offered a positive model of humanity in place of that they saw as a pessimistic psychoanalytic model. Instead of settling for a reduction of their neuroses, _____ believed that people should aim for self-fulfillment.

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Stance of experimental therapist

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Extremely active, emotionally open, not interested in changing them, but interested in finding their rhythms, being able to join them, and helping them go inside to those scary places, intense and personal, usually have a cotherapist

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Theory of dysfunction - experimental

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Root cause of family problems is emotional suppression, interference with emotional growth, it's not the feelings or needs that clients have that are problematic, but the disowning and disallowing of these feelings, Social pressure that hinders self-actualization

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Theory of change - experimental

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(1) for families to grow, communication b/w family members and self-expression of individuals must both be working (2) family members must first get in touch with their feelings before change can happen within the family system (3) the assumption is that if each partner is able to access and own new aspects of self in a relationship context in terms of these new experiences, then new adaptive responses will occur

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Stages of experimental therapy

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o Whitaker's first sessions were fairly structured, and they included taking a family history. For him, the first contacts with families were opening salvos (def. heavy burst of firing or bombing) in "the battle for structure". • He wanted the family to know that the therapist was in charge. This began with the first telephone call. • Whitaker insisted that the largest possible number of family members attend; he believed that three generations were necessary to ensure that grandparents would support, not oppose, therapy and that their presence would help correct distortions. If significant family members wouldn't attend, then he would generally refuse to see the family. o Satir: we attempt to make 3 changes in the family system • First, each member of the family should be able to report congruently, completely, and honestly on what he sees and hears, feels, and thinks, about himself and others, in the presence of others. • Second, each person should be addressed and related to in terms of his uniqueness, so that decisions are made in terms of his uniqueness, so that decisions are made in terms of exploration and negotiation rather than terms of power. • Third, differentness must be openly acknowledged and used for growth. o The task of therapy is seen as unblocking defenses and releasing people's innate vitality. o The process of therapeutic intervention has been described in nine treatment steps: • Assessment—creating alliance and explicating the core issues in the couple's conflict using attachment theory. • Identifying the problematic interaction cycle that maintains attachment insecurity and relationship distress • Uncovering the unacknowledged emotions underlying interaction positions • Reframing the problem in terms of a problematic cycle with underlying emotions and attachment needs • Encouraging acceptance and expression of disowned needs and aspects of the self • Encouraging acceptance of the partner's new openness • Encouraging the expression of specific needs and wants and creating an intimate, emotional engagement • Facilitating new solutions to unresolved relationship issues • Consolidating new positions and more honest expression of attachment needs

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Diagnosis/Assessment in experimental therapy

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Less focus on the presenting problem and more focus on the emotions surrounding the issue. Do not focus on the family structure. Assessment takes place as the therapist gets to know the family. As the therapist integrates him/herself into the family dynamics they can learn a great deal about the people they are working with. The main goal of the assessment phase is learning about defenses and how the individual members perceive the family

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Techniques/methods of experimental therapy

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o There are no techniques, only people. This epigram (def. short poem, witty form of expression) neatly summarizes the faith in the curative power of the therapist's personality. It isn't so much what therapists do that matters, it's who they are. • They are active and some use a number of evocative techniques. Some use structured devices such as family sculpting and choreography; others like Virginia Satir and Carl Whitaker rely on the spontaneity of just being themselves. o Experiential family therapy works from the inside out, helping individuals uncover their honest emotions and then forging more genuine family ties out of this enhanced authenticity. o Techniques that promote communication and interaction. The emphasis on altering interactions implies an acceptance of whatever level of individual experience is already present. The assumption is that opening up individuals to their experience is a prerequisite to breaking new ground for the family group. o Helping people relax defensive fears so that deeper and more genuine emotions can emerge p.158 o Use a number of expressive techniques: family sculpting, family puppet interviews, family art therapy, conjoint family drawings, role playing, and gestalt family techniques.

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Strengths of experimental theory

answer

o Helps family members get beneath the surface of their interactions to explore the feelings that drive them - helps people drop their defenses and come together with more immediacy and authenticity o Emphasized immediate, here-and-now experience o Focused on emotional experience o Emphasized individuals and their feelings o Nurturing open, natural, and spontaneous experiencing. The healthy family offers its members the freedom to be themselves. o Emotionally focused couples therapy has received a good deal of empirical support

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Limitations of experimental theory

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o Did not focus on the dynamics of interaction o Not well suited for family therapy in regards to dealing with systems and action o Problem solving skills nor particular family structures are not considered as important a o Lost popularity in the 1980s due to the change to systems thinking

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Name of influential theorists for psychoanalytic theory

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Sigmund Freud, Carl Jung, Harry Sullivan, Nathan Ackerman, Melanie Klein, Jill and David Scharff, Ivan Boszormeny-Nagy

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When and where psychoanalytic theory developed

answer

50s to 60s, east coast, NIMH

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Contextual therapy

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(psychoanalytic) Boszormenyi-Nagy's model that includes an appreciation of relational ethics

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Delineations

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(psychoanalytic) parental acts and statements that express the parents' image of their children; may be objective or distorted

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Entitlement

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(psychoanalytic) Bozormenyi-Nagy's term for the amount of merit a person accrues for behaving in an ethical manner toward others

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False self

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(psychoanalytic) Winnicott's term for a defensive facade that comes to dominate some people's dealings with others

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Fixation

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(psychoanalytic) Partial arrest of attachment or mode of behavior from an early stage of development

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Good-enough mothering

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(psychoanalytic) Winnicott's term for the average-expectable parenting, which is sufficient to nurture a reasonably healthy child

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Idealization

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(psychoanalytic) a tendency to exaggerate the virtues of someone; part of the normal developmental process in children's relationships to their parents and intimate partnerships

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Identification

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(psychoanalytic) not merely imitation but appropriation of traits of an admired other

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Internal objects

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(psychoanalytic) mental images and fantasies of oneself and others; formed by early interactions with caregivers

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Introjection

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(psychoanalytic) a primitive form of identification; taking in aspects of other people, which then become part of the self-image

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Invisible loyalties

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(psychoanalytic) Boszormenyi-Nagy's term for unconscious commitments that children take on to help their families

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Mirroring

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(psychoanalytic) Kohut's term for the expression of understanding and appreciation - not praise but appreciation of what the other is feeling

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Narcissism

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(psychoanalytic) Self-regard. The exaggerated self-regard most people equate with narcissism is pathological narcissism

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Object relations

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(psychoanalytic) Internalized images of self and others based on early parent-child interactions that determine a person's mode of relationship to other people

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Object relations theory

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(psychoanalytic) derived from Melanie Klein and developed by the British school (Bion, Fairbairn, Guntrip, and Winnicott) that emphasizes relationships and attachment rather than libidinal and aggressive drives as the key issues of human concern

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Projective Identification

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(psychoanalytic) a defense mechanism whereby unwanted aspects of the self are attributed to another person and that person is induced to behave in accordance with these projected attributes

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Regression

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(psychoanalytic) return to a less mature level of functioning in the face of stress

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Selfobject

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(psychoanalytic) Kohut's term for a person related to not as a separate individual but as an extension of the self

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Self psychology

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(psychoanalytic) Heinz Hohut's version of psychoanalysis that emphasizes the need for attachment and appreciation rather than sex and aggression

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Separation-individualism

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(psychoanalytic) The process whereby the infant begins, at about 2 months, to draw apart from the symbiotic bond with mother and develop his/her autonomous functioning

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Transference

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(psychoanalytic) Distorted emotional reactions to present relationship based on unresolved early family relations

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Unconscious

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(psychoanalytic) memories, feelings, and impulses of which a person is unaware. Often used as a noun, but more appropriately limited to use as an adjective

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Stance of psychoanalytic therapist

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Looks beyond behavior to the hidden motives below, creates an atmosphere of trust and security and proceeds slowly, analytic neutrality

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Psychoanalytic theory of dysfunction

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Unconscious impulses and defenses against them, basic wants and fears that keep individuals from interacting in a mature way

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Psychoanalytic theory of change

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Identify projective mechanisms, acknowledge and accept previously split off part of individuals egos, determine how present difficulties emerged from unconscious perpetuate of conflicts

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Diagnosis/assessment for psychoanalytic theory

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1-how does the family interact around the symptom, and how does the family interaction affect the symptom? 2-What is the function of the current symptom 3-what disaster is feared in the family that keeps them from facing their conflicts more squarely 4-how is the current situation linked to past trauma 5-how would the therapist summarize the focal point in a short, memorable statement?

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Psychoanalytic techniques/methods

answer

listening, empathy, interpretations, analytic neutrality

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Strengths of psychoanalytic theory

answer

the importance placed on the past in this theory allows for a full assessment that limits misjudgment due to lack of information

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Limitations of psychoanalytic theory

answer

Has been criticized for absolving people for responsibility for their actions, resistance to empirical standards for therapy - difficult to measure, symptom reductions is not the goal but the presence or absence of unconscious conflicts

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CBT: influential theorists

answer

• ivan Pavlov • joseph wolpe • b.f. skinner • Gerald patterson • Robert liberman • Richard stuarto influential _____ therapists • Albert Ellis & Aaron Beck • emphasized the need for attitude change to promote and maintain behavioral modification • Donald Baucom, Norman Epstein, Frank Dattilio

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CBT: when and where the theory developed

answer

o 1970s for more behavior-based therapy; 1980s/1990s for more _____approach o evolved from behavior family therapy and social learning theory - expanded by the introduction of cognitive interventions to address unhelpful assumptions and distorted perceptions o University of North Carolina (Baucom), University of Maryland (Epstein), Harvard & University of Pennsylvania (Dattilio)

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Aversive control

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CBT: using punishment and criticism to eliminate undesirable responses; commonly used in dysfunctional families

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Behavioral exchange theory

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CBT: an explanation of behavior in relationships as maintained by a ratio of costs to benefits

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Classical conditioning

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CBT: a form of respondent learning in which an UCS, such as food, leads to an UCR, such as salivation, is paired with CS, such as a bell, the result of which is that the CS begins to evoke the same response; used in the behavioral treatment of anxiety disorders

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Cognitive-behavior therapy

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treatment that emphasizes attitude change as well as reinforcement of behavior

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Contingencies of reinforcement

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CBT: the specific pattern of reinforcing (or punishing) consequences of a behavioral sequence

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Contingency contracting

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CBT: a behavior therapy technique whereby agreements are made between family members to exchange rewards for desired behavior

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Contingency management

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CBT: giving rewards and punishments based on children's behavior

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Extinction

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CBT: eliminating behavior by not reinforcing it

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Functional analysis of behavior

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CBT: in operant behavior therapy, a study of a particular behavior, what elicits it, and what reinforces it

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Modeling

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CBT: observational learning

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Operant conditioning

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CBT: a form of learning whereby a person or animal is rewarded for performing certain behaviors; the major approach in most forms of behavior therapy

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Premack principle

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CBT: using high-probability behavior (preferred activities) to reinforce low-probability behavior (nonpreferred activities)

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Quid pro quo

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CBT: literally, "something for something"; an equal exchange or substitution

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Reinforcement

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CBT: an event, behavior, or object that increases the rate of a particular response

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Positive reinforcement

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CBT: an event whose contingent presentation increases the rate of responding

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Negative reinforcement

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CBT: an event whose contingent withdrawal increases the rate of responding

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Intermittent, or irregular reinforcement

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CBT: the most resistant to extinction

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Reinforcement reciprocity

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CBT: exchanging rewarding behaviors b/w family members

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Role rehearsal

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CBT: the use of role-playing, especially in couples therapy

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Schemas

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CBT: cognitive constructions, or core beliefs, through which people filter their perceptions and structure their experience

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Shaping

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CBT: reinforcing change in small steps

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Social learning theory

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CBT: understanding and treating behavior using principles from social and developmental psychology as well as from learning theory

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Systematic desensitization

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CBT: gradual exposure to feared situations paired with relaxation

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Theory of social change

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CBT: Thibaut and Kelley's theory according to which people strive to maximize rewards and minimize costs in relationships

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Time-out

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CBT: a behavioral technique for extinguishing undesirable behavior by removing the reinforcing consequences of that behavior; typically, making the child sit in a corner or go to his/her room

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Token economy

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CBT: a system of rewards using points, which can be accumulated and exchanged for reinforcing items or behaviors

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Goals of CBT

answer

• healthy communication skills • considered to be the most important feature of a good relationship • forming good relationships by having an exchange of positive responses and minimal unpleasantness • to have the ability to cope w/ problems when they arise

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Stance of CBT therapist

answer

o involved - must be comfortable w/ teaching and training o active and directive, but still pays attention to unhappy emotions and the assumptions underlying them

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CBT: theory of dysfunction

answer

o symptoms are viewed as "learned responses" o people often inadvertently reinforce responses that cause them the most distress (family members will often unknowingly reinforce undesirable behavior) • ex. parents "punishing" children for misbehavior - really giving them what they want: attention o intermittent reinforcement (sometimes reinforcing, sometimes ignoring) is the most resistant to extinction o reciprocal reinforcement - when both parties (sometimes unknowingly) reinforce each others' undesirable behavior o aversive control (ex. nagging, crying) - often leads to a vicious cycle o poor problem-solving skills o lack of reinforcement for positive behavior in distressed families o unhealthy schemas that are learned in childhood - often negatively affect relationships

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CBT theory of change

answer

o behavior will change when the contingencies of reinforcement are altered

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Stages of CBT therapy

answer

o 1. resolve targeted family problems through identifying behavioral goals o 2. learn theory techniques for achieving these goals o 3. use social reinforcers to facilitate this process o ***throughout all stages, the therapist recognizes the role of cognitive factors in resolving relationship problems***

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CBT diagnosis/assessment

answer

o behavioral parent training • based upon kanfer and phillips' SORKC model of behavior • S = stimulus • O = state of the organism • R = target response • KC = nature and contingency of consequences • assessment entails observing and recording the frequency of the behavior to be changed, as well as the events that precede and follow it • interviews (usually w/ mother) are designed to provide a definition of the problem and a list of potential reinforcers • observations may be conducted behind a one-way mirror or during a home visit o behavioral couples therapy • clinical interview • rating of specific target behaviors • marital questionnaires (ex. Locke-Wallace Marital Adjustment Scale) • assessments are designed to reveal strengths and weaknesses in a couple's relationship and the manner in which rewards and punishments are exchanged • interviews are used to specify and elaborate target behaviors o cognitive -behavior approach • explore core schemas o treatment of sexual dysfunction • complete medical exam • extensive interviews to determine the nature of the dysfunction • establish goals for treatment

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CBT techniques/models

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• behavioral parent training o accepts the parents' view that the child is the problem and will generally meet w/ one parent and the child o most commonly used approach: operant conditioning o shaping • reinforcing change in small steps o token economies • uses points to reward children for successful behavior o contingency contracting • involves agreements by parents to make certain changes following changes made by their children o contingency management • giving and taking away rewards based on the children's behavior o time-outs • punishment for children o premack principle • high-probability behavior is chosen to reinforce behavior with a low probability of occurrence • behavioral couples therapy o accentuate the positive o strive to maintain optimistic expectancies and a collaborative set o ask couples to make a list of pleasing things their partners do during the week o training in communication skills o problem-solving training o help couples to confront areas of disagreement and openly vent disagreement and anger o quid pro quo contract • where one partner agrees to make a change after a prior change by the other • also can do a good faith contract - where both partners agree to make changes that aren't contingent on what the other does o behavior exchange procedures • taught to increase the frequency of desired behavior • this teaches couples ways of influencing each other through positive reinforcement o cognitive-behavior approach to family therapy o help family members see how illogical beliefs serve as the foundation for their emotional distress o modify their beliefs and expectations by putting them on a more rational basis o focuses in greater depth on patterns of family interaction o emphasize schemas o treatment of sexual dysfunction o systematic desensitization o assertiveness training o sensate focus - where couples are taught how to relax and enjoy touching and being touched o specific techniques: • squeeze technique • teasing technique • desensitization of a man's anxiety • discussing sexual expectations

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Strengths of CBT

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• careful assessment and evaluation • focuses a lot on communication and problem-solving skills • the most carefully studied form of family treatment

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Limitations of CBT

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• some may see approach as too methodical • although it addresses emotions, some may say that it still focuses too much on behavior change and not enough on emotional change • maybe not enough focus on therapeutic alliance and empathy

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Influential theorist for solution-focused

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• Steve de Shazer: founder of _____ therapy • Insoo Kim Berg: a leading practitioner of the model

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When and where Solution-focused developed

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• Brief Family Therapy Center (BFTC) o Grew out of the work of de Shazer, Berg, and their colleagues o Dissatisfied with the MRI model • Compared to MRI o Both • Pragmatic • Aim to solve problems o Solution-focuses • Focuses on attempts that have worked (exceptions) • Focus on cognition o MRI • Attempts that fail • Behavior

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Complainant

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SF: de Shazer's term for a client who describes a complaint but is at present unwilling to work on solving it

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Constuctivism

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SF: a relativistic point of view that emphasizes the subjective construction of reality. It implies that what we see in families may be based as much on our preconceptions as on what's actually going on

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Customer

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SF: de Shazer's term for a client who describes a problem and is motivated to work on solving it

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Exceptions

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SF: de Shazer's term for times when a client is temporarily free of his/her problem. Therapists focus on exceptions to help clients build on successful problem-solving skills

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Formula first-session task

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SF: therapists routinely ask clients at the end of the 1st session to think about what they do not want to change about their lives as a result of therapy. This focuses them on strengths in their lives and begins the solution-generating process

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Miracle question

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SF: a technique that asks clients to imagine how things would be different if they woke up tomorrow and their problem was solved. Therapists use this to help clients identify goals and potential solutions

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Scaling questions

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SF: identify exceptions and to build a positive mind set. Using 1-10 scale, clients rate how much they want to resolve their problems, how bad the problem is, how much better it is than it was at the time of the last session, and so on. If the problem is rated 4, the therapist can ask why it isn't a 1 or how the client can move it to a 5.

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Solution-focused therapy

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de Shazer's term for a style of therapy that emphasizes the solutions families have already developed for their problems

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Visitor

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SF: de Shazer's term for a client who does not have a complaint, and does not wish to work on anything

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Goals of solution-focused

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• Shift language: focus on solutions and not problems • Identify solutions: exceptions • Modest goals o Clear and specific o Concrete and reachable

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Stance of solution-focused therapist

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• Client is the expert • Therapist only assists client

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Solution-focused theory of dysfunction

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• Normal family development o Characteristics • Flexible structures • Clear boundaries • Well-organized hierarchies • Use positive reinforcement control • Offer secure attachment • Provide mutual need satisfaction o Clients are assumed to be resilient and resourceful • Problems are seen as normal life cycle conditions • Families have the ability to construct solutions that enhance their lives o An asymptomatic perceptive on family normality • Family that has been freed of their presenting problem • Return to own unique functional way of life • Development of behavioral disorders o Don't address disorders • Labeling draws away from the exceptions • Avoid such conjunctures o Solutions are unrelated to the way problems develop • Don't want to engage in problem talk • Exploring etiological factors focus on problems

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Solution-focused theory of change

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• People of have the skills to solve problems o Sometimes just need to shift focus to solutions o Some people may need to search for abilities • Help people identify solutions or the exceptions to the problems o Change the way people talk about their problems o Brief: easier to get people to view problems differently than change behavior

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Solution-focused assessment/diagnosis

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o General Sequence • 1st: brief description of problem • 2nd: directly asking how things will be different in their lives when problems are solved • 3rd: ask about exceptions o Involves • Attendance: anyone who is concerned with problem • Little intake information • Perceptions rather than feelings • Affirming the clients position o Different from problem solving approaches • Therapist isn't expert • Doesn't determine the problem or • How to solve it • Active approach of therapist: move client away from worrying and forwards steps to solutions • Assess current level of progress o 1-10 scale • 1 = problem at worst • 10 = therapeutic goal o Determine specific actions for goals o Evaluate progress • Assess clients motivation for change o Visitor: a client who doesn't wish to be part of therapy; doesn't have a complaint; does not want to work on anything o Complainant: client who describes a complaint but is presently unwilling to work on solving it o Customer: a client who describes a problem and is motivated to work on solving it

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Strengths of solution-focused

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• Quick solutions o Good for managed care o Many providers accept this model • Pragmatic focus on coping makes it applicable to any problem o Couples therapy o Family therapy o Domestic violence o Sexual abuse o Alcoholism o Sex therapy o Schizophrenia o Self-help books • Applied outside the therapeutic practice o Nursing care o Educational settings and model schools o Business systems

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Limitations of solution-focused

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• Emphasis on solution talk o Simplistic and manipulative • Too cook-book style • Difficult to implement o Puts clients off from empathy and understanding • Some people want the therapist to understand problem and provide insight • Problems for collaboration and the therapeutic relationship • No a lot of current research

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Influential theorists for narrative therapy

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• Michael White: founder • David Eptson: second most influential leader o Emphasized narrative metaphors o Self-help leagues • Jill Freedman and Gene Combs: combined strategic therapy and political activism • Jeffery Zimmerman and Vicki Dickerson o Taught _____therapy at MRI with John Neal o ______therapy with difficult adolescents and couples • Stephen Madigan: focused on eating disorders • Harlene Anderson and Harry Goolishian: forerunners of the family therapy model based on _____ therapy

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When and where narrative therapy developed

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• White: interested in Bateson o But more interested in how people construe their world o Not behavioral patterns • Define how problems affect people rather than something people are doing • Focus: self-defeating cognitions

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Deconstruction

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Narrative: a postmodern approach to exploring meaning by taking apart and examining taken-for-granted categories and assumptions, making possible newer and more sound constructions of meaning

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Externalization

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narrative: Michael White's technique of personifying problems as external to persons

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Hermeneutics

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Narrative: the art of analyzing literary texts or human experience, which are understood as fundamentally ambiguous, by interpreting levels of meaning

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Problem-saturated stories

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narrative: the usual pessimistic and blaming accounts that clients bring to therapy, which are seen as helping keep them stuck

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Reconstruction

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Narrative: the creation of new and more optimistic accounts of experience

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Relative influence questions

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narrative: questions designed to explore the extent to which the problem has dominated the client vs. how much he/she has been able to control it

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Social contructionism

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narrative: like contructivism, it challenges the notion of an objective basis for knowledge. Knowledge and meaning are shaped by culturally shared assumptions

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Unique outcomes

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narrative: Michael White's term for times when clients acted free of their problems, even if they were unaware of doing so. Therapists identify unique outcomes as a way to help clients challenge negative views of themselves

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Collaborative model

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a more egalitarian view of the therapist's role; a stance advocated by critics of what they see as the authoritarianism in traditional approaches to family therapy

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Not-Knowing

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Anderson and Goolishian's term for approaching families with as few preconceptions as possible

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Reflecting team

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Tom Andersen's technique of having the observing team share their reactions with the family at the end of a session

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