· These thoughts and feelings may be experienced consciously at one time or the defense mechanism the ideas or feelings from ever reaching consciousness

Motivational Interviewing

A collaborative conversation style for strengthening a person’s own motivation and commitment to change

· Tenets

o MI is a conversation about change

o MI is collaborative

o MI is evocative (seeks to strengthen the persons own motivation and commitment)

o MI acknowledges ambivalence

o MI uses change talk

· Goals

o Helping participants find their own reasons to change

o Exploring and resolving their ambivalence about the change

· Techniques Utilized

o The more talking the clients do, the more likely that they are to change

o Uses open questions

o Helps clients see the gap between things that are important to them and their current behaviors or choices which do not support their goals

o Disarms dissonance

o Uses affirmations

o Uses reflection: repeating what was said and rephrasing (these are simple), paraphrasing and reflection of feeling (complex)

· Strengths

o Used for substance abuse disorders, corrections, education, mental health disorders, employment services, and primary care (diet, exercise, smoking)

· Weaknesses (?)

· Relevant Terms

o Evocation: drawing out the participants own desire and reasons for change before educating and advocating for change

o Collaboration: Non authoritarian, active listening, starting where the participant is, guiding without taking the wheel

o Ambivalence: a state of mind in which a person has co-existing but conflicting feelings about something, it is a fundamental part of the change process (I want to but I don’t want to)

o Change talk: concern about the problem, shares potential benefits of change and the costs of not changing

o Dissonance: “I am angry that I am in therapy” respond with “That does seem difficult, but how can you make the best of the situation?

o Affirmations: statements that encourage appropriate attempts made by the client; one that reflects behavior, another is a deeper level that identifies something positive about the person’s character

Solution Focused Brief Therapy

o Future focused

o Goal oriented

o Optimistic

o Anti deterministic

o Core belief: you don’t need to know the cause of a problem to solve it

§ Minimal interest in HOW the problem came about

§ Focus instead on what is possible

§ Minimal attention to diagnosis or history

· Tenets

o People can obstruct their own solutions

o Has parallels with positive psychology

o Look for what is working

o Problem focused thinking can actually be the problem

o Focus on small, attainable goals to increase confidence and momentum

o Avg length is 1-8 sessions, often just one session

o Rapid working alliance

o Clear definition of treatment goals

o Here and now orientation

o Small changes lead to larger ones

o The problem doesn’t occur all the time (there are exceptions)

o If something is working do it more, if something is not working, do something different

o If its not broken don’t ix it

o We have some control over our choices

· Goals (?)

· Techniques Utilized

o Client is asked to describe their problems

o Develop well formed goals

o Ask about times when the problem was not present (exceptions)

o Provide a summarization of the problem, encouragement, and action steps

o Work backward asking the clients to envision the resolution of their problem

o Elements of the desired solution (exceptions) often are already present in the clients life

o Types of questions utilized in SFBT

§ Exception questions- tell me about a time you felt better

§ Miracle Questions-if a miracle occurred overnight how would you know it was solved and what would be different?

§ Scaling Questions- On a scale of 1-10 rate your anxiety right now

· Strengths (?)

· Weaknesses (?)

· Relevant Terms (?)

Family Systems Theory (FST)

· Focuses on how families behave as systems: communication and interactions, how they adapt to stress, a change in one person affects the whole family

· People are best understood by assessing the interactions between and among family members

· A family is subject to internal pressure from developmental changes in its own members and external pressure from the need to accommodate the social institutions around the family

· Responding to demands requires constant transformation of family members so they can grow while the family system remains continuity

· When family reacts to stress with rigidity, dysfunctional behaviors occur

Clients problematic behavior may

1. Serve a purpose for the family

2. Be a symptom of intergenerational dysfunctional patterns

· Tenets

o Family= the client

o Tends to be present focused

o Typically shorter term, solution focused

o Change happens through groups, not just with individuals

· Goals (? )

· Techniques Utilized (?)

· Strengths

o Acknowledges the systems around the individual

o Highlights our relational nature

o Avoids scapegoating individuals

o Future benefits

· Weaknesses

o Requires cooperation of many individuals

· Relevant Terms

o Boundary: a metaphor that stands for particular regularly occurring transactions between subsystems, regulates the amount of energy that flows from one system to another

§ Enmeshed vs. Disengaged

o Enmeshed: refers to families in which there is extreme sensitivity amount the individual members to each other and to their primary subsystems. Even small behaviors reverberate quickly and with increasing magnitude throughout the entire system. There is little interpersonal distance and considerable blurring of boundaries

o Alliances: scapegoating and cross generational coalitions

§ Scapegoating: parents express absence of conflict but are united against a child/ children. This reduces pressure on the spousal subsystem and redirects the stress to children

§ Cross-generational coalitions: A parent and child aligning against other parent

o Hierarchy (Most destructive): as used in general systems theory, this refers to a rule of ordering such that some elements of a system are subordinate to other elements.

§ Children running the family

§ Power concentrated in one person

§ Hierarchical imbalances caused by circumstances

o Acute Anxiety= associated with specific and real threats or danger

o Chronic Anxiety= associated with imagined threats or danger

§ A response to existing dysfunction in the system

§ Sometimes accumulated over generations

§ Makes the system overreact to small stressors

Structural Family Therapy (SFT) (Not on study guide but in the folder)

· Focuses on the structure of the family system, boundaries, power of hierarchies

· Makes a structural diagnosis- an analysis of alliances, boundaries, and interactional patterns

· Tenets(?)

· Goals

o Makes a structural diagnosis- an analysis of alliances, boundaries, and interactional patterns

o A healthy family remains the same while nonetheless subtly prompting growth and change within its members

· Techniques Utilized (?)

· Strengths (?)

· Weaknesses (?)

· Relevant Terms

o Boundaries

o Feedback

o Homeostasis

o Hierarchies

o Alliances

o Equilibrium

Gottman’s Approach (Marital)

· Tenets

o Friendship is vital to marriage

§ Lean into your partners psychological world

§ Communicate respect and admiration

§ Turn towards the other person

o Manage conflict constructively using repair

o Facilitate a relationship that is generally focused on positive emotions

o HOW you talk about an issue matters

· Goals (?)

· Techniques Utilized

o Must stay above the immediate argument and watch for all three strains

o The counselor must be in charge of the room

o Avoid multi-directed partiality- showing partiality to one spouse while showing empathy to the other

o Must not over identify with one spouse over the other

o Must separate issues and address them one by one

o Couples often fight about things in an automated manner

§ Replace automated responses of pain and defensiveness with compassionate understanding

o Emphasizing the demand of working as an us rather than a me

· Strengths

o Can predict with 90% accuracy which couples will stay married and which couples will divorce

o Can predict which couples will be happy/ unhappy

· Weaknesses (?)

· Relevant Terms

o Masters: gentler with one another, 5:1 positive to negative emotions during conflict, repair and exit conflict, “turning towards leads to more turning towards)

o Disasters: cannot exit negative emotions during conflict, they sink into hopelessness

o Four horsemen

§ Criticism

· Describing a problem as a flaw in someone’s personality

· To combat- complain without blame

§ Defensiveness

· The key is to accept responsibility for at least a small part of the problem

· To combat- take responsibility

§ Contempt

· I’m smarter/ better than you

· To combat- build culture of appreciation

§ Stonewalling

· To withdraw from the conversation (anecdote: self soothe and stay connected)

· To combat- do psychological self-soothing

o Sound Relationship House

Exposure Therapy (was in the folder but not the study guide)

· A set if psychological treatment techniques (with behavioral or CBT theoretical origins) for pathological fear that is typically observed in people with anxiety disorders

· Exposure and Response Prevention: When obsessional fear is confronted without performing rituals

· Used for those with OCD

· Obsessions: recurrent, intrusive thoughts and impulses that evoke anxiety

· Compulsions: deliberate behavioral rituals or mental acts performed to neutralize the obsessional anxiety, these provide temporary relief, but do not extinguish the anxiety

· Anxiety leads those with OCD to believe that there are exaggerated estimates of harm and its severity

· Habituation- stress decreases in response to repeated exposure to the stimulus. Person must be exposed to the fear repeatedly to learn that their anxiety will diminish without the ritual.

What is reactance theory?

· We rebel when others try to control us

· An increase in the rate and attractiveness of a problem behavior is likely if a person feels that his personal freedom is being infringed upon or challenged

Psychodynamic Defense Mechanisms (?) Could this be the four horsemen?

High and Low DoS (family systems theory)

· Balance between individuality and togetherness in families (differentiation of self or DoS)

o “ the capacity to be an individual while part of a group”

· “the autonomous ability to be in emotional contact with others yet still autonomous in ones emotional functioning”

· High DoS= flexible person with less anxiety

· Low DoS= rigid person with high anxiety

What is multi-directed partiality?

showing partiality to one spouse while showing empathy to the other

What is triangulation?

· Family Systems theory

· Seen in divorced parents and children (2 v 1) you have to decide between two people which brings someone into the situation unfairly