MFT Clinical Exam Study

Satir Therapy: Theory of Change

Change happens through self-awareness and improved communication. Humanistic approach

Satir Therapy: Therapist Role

Active facilitator, Resource detective, Therapist is genuine and warm, Honest and direct

Satir Therapy: Treatment Goals

Increase congruent communication, improve self-esteem, and personal growth.

Satir Therapy: Incongruent Communication

Discrepancies between verbal and non-verbal cues

Satir Therapy: Styles of Communication

The rules that govern family interaction function as a method of ensuring the maintenance and preservation of the family’s current functioning level

Satir Style: Placater

Apologizing, never disagreeing, trying to please.

Satir Style: Blamer

Attacking others, fault finder, dictator, boss.

Satir Style: Computer

Super reasonable, intellectual, distant, always correct.

Satir Style: Distracter

Seeking approval by acting out, irrelevant.

Satir Style: Leveler

Congruent in their beliefs about self and others.

Satir Intervention: Family Chronology

Gathering history as far back as possible. Include: ideology, values, rules, disruptions, moves, and major events. What the family has been through and how those events impact the family. How past events and unresolved issues are carried out presently.

Satir Intervention: Family Sculpting

Put people into a spatial metaphor – a physical representation of family members characterizations.

Satir Therapy: Beginning Phase

Establish rapport, a sense of equality and hope. Assess communication patterns, stances, and concerns. Identify treatment focus and goals.

Satir Therapy: Middle Phase

Increase the family’s congruent communication. Support and strengthen each

individual’s sense of uniqueness and self-esteem.

Satir Therapy: End Phase

Help family integrate changes and increase awareness of larger patterns.

Structural Family Therapy: Theory of Change

Change occurs through restructuring the family's organization.

Structural Therapy: Treatment Goals

●Restructure family system to allow for symptom relief and constructive problem solving.

● Change dysfunctional transactional patterns and create new ways of relating.

● Help create flexible boundaries.

Structural Family Therapy Concept: Alliances

Subgroups based on gender, generation, or developmental tasks.

Structural Family Therapy Concept: Coalitions

Alignments where members form a bond against another family member.

Structural Family Therapy Concept: Power Hierarchy

Leadership and direction provided by adults/parents. Sometimes when parents are intimidated or insecure, the power is upside down and it leads to chaos.

Structural Family Therapy Concept: Subsystems

Families organize themselves by generation, relationship, and necessity.

Examples: marital subsystem – spouses; parental subsystem: parents; executive subsystem: people who run the family; sibling subsystem – kids.

Structural Family Therapy Concept: Family Map

A tool the therapist will use to depict the relationship dynamics in the family including sub-systems, alliances, coalitions and boundaries. This tool is used to conceptualize the case outside of the actual therapy. It is not used or shared with the family.

Structural Family Therapy Concept: Disengaged Boundaries

Where family members are isolated from each other. Can lead to AOD use and is a result of rigid boundaries.

Structural Family Therapy Concept: Enmeshed boundaries

Family members are overly dependent and too closely involved and reactive to other family members. Can lead to inc*st.

Structural Family Therapy Intervention: Joining

Therapist’s first task; involves blending in with the family, adapting the family’s affect, style, and language.

Structural Family Therapy Intervention: Tracking

The therapist pays close attention to family members and how they relate to one another during an enactment or spontaneous behavioral sequence, noticing boundaries, coalitions, roles, rules, etc.

Structural Family Therapy Intervention: Unbalancing

Supporting someone who is in a one-down position, thus changing hierarchical position.

Structural Family Therapy Intervention: mimesis

The therapist tracks the family’s style of communication and uses it.

Structural Family Therapy Intervention: Enactment

The actualization of transactional patterns under the control of the therapist. It allows the therapist to observe how family members mutually regulate their behaviors, and to determine the place of the problem behavior within the sequence of transactions.

Structural Family Therapy Intervention: Boundary Making

Special case of enactment, in which the therapist defines areas of interaction that he rules open to certain members but closed to others. Example: a son is asked to leave his chair (in between his parents) and go to another chair on the opposite side of the room, so that he is not “caught in the middle”.

Structural Family Therapy: Beginning Phase

Join with family; both accommodate to and challenge rules of family system; assessment/mapping of hierarchy, alignments, and boundaries; reframing of problem to include whole system.

Structural Family Therapy: Middle Phase

Highlight/modify interactions, utilize enactments, and unbalance the system.

Structural Family Therapy: End Phase

Review progress, reinforce structural change, and provide future tools.

General Systems Theory: Theory of Change

Change occurs by helping the system view the problem in the context of the family, rather than view an individual as the problem.

General Systems Theory: Role of the Therapist

The therapist helps the family explore: Belief systems and family values. Rules and roles that are present in the family, The family hierarchy, Expectations, Defense mechanisms and their purpose

General Systems Theory: Homeostasis

Systems tend to resist change and keep things the same, maintained through negative feedback loops.

General Systems Theory: Negative Feedback

(attenuating): Behavioral reactions used by families that correct departures from the system’s normal state and return the system to its previous state of homeostasis. Corrects against change.

General Systems Theory: Positive Feedback

(amplifying): Behavioral reactions that amplify departures from the system's normal state, which initially destabilizes the system and eventually changes the family’s homeostasis. Allows system to adapt to change.

General Systems Theory: Calibration

The normal operational system of the family.

General Systems Theory: Wholeness

The notion that the whole system, all units combined, is greater than the sum of its parts.

General Systems Theory: Equifinality

The concept that the same results can be accomplished by different family systems.

General Systems Theory: Equipotentiality

The concept that the same early experience in a family system can end up with various results later in life.

General Systems Theory: First Order Change

Changes that occur in the family that are more surface level and temporary. They do not affect the rules or organization of the system. These changes do not try to get at the underlying cause of the issues, but are instead behavioral in nature. These changes tend to be short-lived.

General Systems Theory: Second Order Change

Changes that occur at a deeper level and fundamentally alter the system’s rules and organization. The system is reorganized in order to achieve a different, healthier level of functioning that can survive over time.

General Systems Theory: Nonsummativity

The family system is treated as a whole and not just each individual family member.

General Systems Theory: Boundaries

Abstract lines defined by implicit and explicit rules separating parts of a system or different systems.

○ Open System: a system that allows for the continuous flow of information from outside the system.

○ Closed System: Systems that maintain boundaries that cannot easily be crossed; impenetrable.

General Systems Theory: Treatment Goals

● Move the system towards an equilibrium.

● Assist the family in exploring and recognizing healthier interactions to decrease dysfunctional family behaviors or patterns.

● Help family challenge and rework their beliefs.

● Assist individual family members in seeing their role in any given dynamic.

● Increase each family member’s ability to understand the different experiences and perceptions of others in the family.

● Assist in correcting problematic or unhealthy feedback loops.

Strategic Therapy: Theory of Change

Change occurs through action-oriented directives and paradoxical interventions.

Strategic Therapy: Therapist Role

Solve the presenting problems and Change dysfunctional patterns of interaction

Strategic Therapy: Paradoxical Directives

Maneuvers that are in apparent contradiction to the goals of therapy, yet are actually designed to achieve them; paradoxical interventions help avoid confrontation with therapist’s instructions; undermines resistance by keeping clients in charge.

Strategic Therapy: Positioning

Therapist takes a more exaggerated and extreme view of the problem and the family is obligated to rebel. That leads to them seeing the ways in which they have competency.

Strategic Therapy: Homework

Assignments or directives that take place outside of therapy are essential to the therapy having a successful outcome. The underlying goal of the homework is to try to change the way the family dynamics function around the presenting problem that was identified in session.

Strategic Therapy: Prescribing the Symptom

A strategy where the therapist encourages or instructs the client to engage in or practice the symptom.

Strategic Therapy: Homework

Assignments or directives that take place outside of therapy are essential to the therapy having a successful outcome. The underlying goal of the homework is to try to change the way the family dynamics function around the presenting problem that was identified in session.

Strategic Therapy: Ordeals

A symptom prescription where clients carry out harmless but unpleasant tasks whenever symptoms occur.

Strategic Therapy: Restraining

The therapist will discourage change or changing too quickly in an effort to elicit the desire to change from the client.

Strategic Therapy: Beginning Phase

Define the problem; determine how the client understands the problem; assess family’s destructive patterns of relating and communicating the continued problem; state goals – what behaviors need to change and what would be the signs of change.

Strategic Therapy: Middle Phase

Review attempted solutions; assign ordeals; prescribe the problem; relabel behavior; instruct client to respond to the problem in a new way.

Strategic Therapy: End Phase

Plan for maintenance of new behavior; plan for future challenges; emphasize positive changes made.

Bowen Therapy: Theory of Change

Change occurs by understanding multigenerational dynamics and differentiation.

Bowen Therapy: Therapist Role

Coach/educator, supervisor, investigator, and neutral.

Bowen Therapy: Treatment Goals

Reduce anxiety, increase self-differentiation, decrease emotional fusion, and improve communication. Decrease recurrence of dysfunctional patterns, Reduce emotional reactivity, Facilitate de-triangulation

Bowen Concept: Triangles

A triangle is a three-person relationship system. It is considered the building block or “molecule” of larger emotional systems because a triangle is the smallest stable relationship system.

Bowen Concept: Differentiation of Self

Families affect how people think, feel, and act, but individuals vary in their susceptibility to a “group think” and groups vary in the amount of pressure for conformity. Differences between individuals and groups reflect differences in people’s levels of self differentiation

Bowen Concept: Nuclear Family Emotional System

The concept of the nuclear family emotional system describes four basic relationship patterns that govern where problems develop in a family. People’s attitudes and beliefs about relationships play a role in the patterns, but the forces primarily driving them are part of the emotional system.

Bowen Concept: Family Projection Process

The primary way parents transmit their emotional problems to a child.

Bowen Concept: Multigenerational Transmission Process

How small differences in differentiation between parents and offspring lead over generations to marked differences.

Bowen Concept: Emotional Cutoff

Managing unresolved emotional issues with family by reducing or totally cutting off emotional contact.

Bowen Concept: Genogram

Extensive study of a family's history that acts as both an assessment and treatment tool.

Bowen Intervention: Reframing

Presenting the problem as a multigenerational issue caused by factors beyond the individual.

Bowen Intervention: De-triangulation

Therapist joins a healthy triangle to teach clients to manage anxiety, distance, and closeness.

Bowen Therapy: Beginning Phase

Create a family diagram of multigenerational emotional connections; assess individuals’ levels of differentiation and triangulation; identify dysfunctional patterns that have been passed along through the generations.

Bowen Therapy: Middle Phase

Teach and model differentiation through communication skill building; de-triangulation; encourage reunification from cutoff family members; teach the family how to take responsibility for their feelings and thoughts.

Bowen Therapy: End Phase

Review new skills and knowledge gained in therapy.

Attachment Therapy: Theory of Change

Change occurs through exploration of past and current attachments and trauma in a secure relationship.

Attachment Therapy: Therapist Role

Provide a secure base and an accepting, caring, reliable, non-judgmental environment.

Attachment Therapy: Treatment Goals

Raise awareness of problematic patterns, repair affect regulation, resolve any emotional or social disturbances, and improve attachment quality.

Attachment Concept: Secure Attachment

The person has easy access to a wide range of feelings and memories, positive and negative. Has a balanced view of parents and has worked through hurt and anger from the past. Has developed a strong sense of self and empathy for others.

Attachment Concept: Preoccupied/Anxious Attachment

The person is still embroiled with anger and hurt at parents. They sometimes value intimacy to such an extent that they become overly dependent on the attachment figure both past and present. They often recall role reversal in childhood and have a hard time seeing their own responsibility in relationships. They dread abandonment.

Attachment Concept: Dismissive/Avoidant Attachment

The person dismisses the importance of love and connection – and the value of emotions in general. Often idealizes parents, but actual memories don’t corroborate. They dislike looking inward and often have a shallow, if any, self-reflection. They often are very independent, dismissive of their own emotionality, and have difficulty tolerating the heightened emotions of others.

Attachment Concept: Fearful/Avoidant Attachment

The person usually has a history of trauma and or loss. Similar to Dismissive/Avoidant, they dismiss the importance of love and connection but usually out of fear or a belief that they are unworthy of love. They have difficulty trusting others and may feel uncomfortable with emotional closeness.

Attachment Therapy: Beginning Phase

Attunement is the key intervention in the early stage and consists of forging a personal relationship between the therapist and the patient. The therapist provides a secure base by reliably demonstrating empathy and care. Collaboratively identifying client’s “attachment style," that is, problematic behavioral and emotional patterns, formed in early childhood as attempts to maintain attachment to primary caregivers.

Attachment Therapy: Middle Phase

Disruptions are explored in the middle phase. Disruptions include those in the early life of the client as well as those in current relationships, including the relationship with the therapist. Support client’s ability to regulate and express emotions in relationally difficult situations, teaching clients to have a reflective stance toward themselves.

Attachment Therapy: End Phase

Repair occurs during the late middle phase and the end of treatment. Repair stage of the therapy aims to alter the patient’s current reactions to the events that cause them emotional distress by sharing their own interpretations of the event. By sharing their own subjective interpretation, the therapist helps create a new reality of the painful events for the patient in order to get rid of unwanted emotions and reactions.

Self Psychology: Theory of Change

Change occurs through empathetic attunement and strengthening the self structures through optimal responsiveness.

Self Psychology: Therapist Role

Emphasis on empathetic understanding and optimal responsiveness; allows emergence of self-object transferences and the repair of disruptions.

Self Psychology: Treatment Goals

Developing self-cohesion and self-esteem, and locating better self-objects.

Self Psychology Concept: Self-Objects

Early empathetic or attuned caretakers who perform vital functions for the infant that it cannot carry out itself.

Self Psychology Concept: Self-Object Needs

Mirroring, idealization of others, and twin/alter ego.

Self Psychology Concept: Mirroring

Approving and confirming responses.

Self Psychology Concept: Optimal Frustration

When a self-object is needed but not accessible, creating a potential problem for the self.

Self Psychology Concept: Mirroring Transference

The patient seeks acceptance and confirmation of the self.

Self Psychology Concept: Twinship Transference

The patient experiences the therapist as someone like himself.

Self Psychology Concept: Idealizing Transference

The patient looks up to and admires the therapist.

Self Psychology Concept: Adversarial Transference

The need for a supportive relationship that the patient can oppose in order to grow.

Self Psychology Concept: Experience-Near Empathy

When therapist steps into client's shoes and imagines what it is like to be the client.

Self Psychology: Beginning Phase

Establish a holding environment, demonstrate containment, provide experience-near empathy, and explore client problems and history.

Self Psychology: Middle Phase

Repair disruptions, address enactments, empathize with losses, mourn loss of self-objects, and identify alternative self-objects.

Self Psychology: End Phase

Reflect on the treatment process, and acknowledge and process issues related to termination.

Object Relations: Theory of Change

Change occurs through reparative experiences within treatment and new insight into and modification of entrenched object relations pathology.