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Treatment Interventions > Treatment 2 > Flashcards

Treatment 2 Flashcards

0
Q

general systems theory

A

system is an interaction of component parts, which seeks to attain homeostasis

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1
Q

2 theoretical models that have influenced family therapists

A

general systems theory

cybernetics

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2
Q

cybrenetics

A

focuses on the circular nature of feedback loops

feedback loops can be positive or negative

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3
Q

negative feedback loops

A

Cybernetics
tends to decrease deviation in a system
e.g. thermostat - fx to minimize changes in temperature; when temp rises, cooling systems bring it down and vice versa; thus maintaining homeostasis

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4
Q

positive feedback loops

A

cybernetics
increases deviation or change
e.g. lasting change in a family’s dynamics as a result of psychotherapy

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5
Q

psychodynamic family therapy

A

facilitating individual maturation in the context of the family system
freeing family members from unconscious patterns of anxiety and projection rooted in the past
major emphasis: helping family members clarify communication and admit honest feelings

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6
Q

Lidz two deviant types of marital relationships

A

marital schism and marital skew

lead to impaired parenting and disrupted sex-role learning for the child

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7
Q

Marital schism

A

Lidz
severe, chronic discord and disequilibrium
threats of separation common and recurrent
communication centers on power struggles and efforts to avoid facing the schism between the spouses
parents tend to seek support from their children and attempt to diminish the worth of the parent to the childrne

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8
Q

Marital skew

A

Lidz

relationship skewed toward meeting the needs of one member at the expense of the needs of others

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9
Q

family sculpting

A

technique that can be used to address marital schism or marital skew
therapist interprets the sculpture and modifies it in ways to suggest new relationships

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10
Q

object relations family therapy

A

Framo
focuses on transferences and projections between couples or family members
problems caused when members unconsciously project unwanted elements of themselves onto others in the family
members experience dissatisfaction and try to change one another
therapy focuses on helping each family member become aware of what is being projected and address unwanted elements within each person

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11
Q

healthy family according to structural family therapy

A

healthy family - hierarchy with strong parental coalition on topmost level
boundaries clear and firm, yet there is flexibility in the system that allows for autonomy and interdependence, individual growth, and adaptive restructuring in response to developmental and environmental demands

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12
Q

StrUctural Family Therapy (U!)

A

MinUchin (U!)
family viewed as single, interrelated system
system assessed along variety of dimensions: hierarchy of power, clarify and firmness of boundaries, significant alliances and splits (subsystems)

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13
Q

pathological family according to structural family therapy

A

results from structural imbalances e.g. malfunctioning hierarchical arrangement or poor boundaries that are too rigid or too diffuse

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14
Q

three chronic boundary problems (Minuchin)

A

triangulation
detouring
stable coalition

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15
Q

triangulation

A

Minuchin
child caught in middle of parents’ conflict
each parent demands that child side with him/her
when child sides with one parent, viewed as attacking other
child ultimately becomes paralyzed

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16
Q

detouring

A

Minuchin
parents express their distress through one child, who becomes identified patient
creates false sense of harmony between parents, with parents blaming the child as source of family’s problems or united to protect sick, weak child

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17
Q

stable coalition

A

Minuchin

one parent unites with child against other parent in rigid cross-generational coalition

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18
Q

goal of Structural Family Therapy

A

unbalance or reorganize the family’s structure in such a way that dysfunctional elements are removed
therapist takes role as expert - diagnoses dysfunctional elements and develops interventions to correct them

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19
Q

therapist in structural family therapy

A

at outset - joins with family and attempts to understand family’s dynamics by adopting its style of interaction
therapy then focuses on shifting members’ positions in order to disrupt malfunctioning patterns and strengthen parental hierarchy, with goal of creating clear and flexible boundaries

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20
Q

Structural Family Therapy strategies for unbalancing family’s homeostasis

A

therapist taking sides, blaming, and forming coalitions

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21
Q

effectiveness of Structural Family Therapy

A

highly effective in treatment of asthma, diabetes, and anorexia in childhood and adolescence as well as treatment of adults with drug addictions

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22
Q

Communications Family Therapy

A

focuses on communication and its impact on family functioning
coined term “double bind”

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23
Q

double bind

A

Family Communications THerapy
maladaptive communication that typically involves at least three elements
1) injunction telling person if they do/don’t do something they will be punished
2) secondary injunction which is generally nonverbal, conflicting with the first at a more abstract level, also enforced by punishment
3) tertiary injunction prohibiting victim from escaping the field (e.g. by not allowing the victim to point out the inconsistency)

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24
Q

double bind theory of schizophrenia

A

saw double binds as contributing to etiology of schizophrenia
not empirically supported

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25
Q

Communications Family Therapy techniques

A

direct - teaching, pointing out problematic communication patterns
indirect - paradoxical interventions that prescribe the symptom (e.g. telling couple with marital problems to fight at least three hours a day)

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26
Q

Strategic Family Therapy

A

Haley

combines structural approach (hierarchies) and communications approach (communications and interactions)

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27
Q

normal family functioning according to Haley

A

involves flexibility, large behavioral repertoire for problem-solving, clear rules governing family’s hierarchy

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28
Q

pathology according to Haley

A

results from malfunctioning hierarchy, or triangles and coalitions across the hierarchy

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29
Q

treatment using strategic family therapy

A

focuses on resolving presenting problem only, defined by behavioral objectives and criteria
underlying pathology or conflicts not addressed
focus on interrupting rigid feedback cycle and defining clearer hierarchy

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30
Q

Systematic Family Therapy

A

Milan group

circular questioning and prescription of rituals

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31
Q

circular questions

A

Systemic Family Therapy
e.g. asks each family member to express his/her views on the relationships and differences between other family members
transforms families’ ways of thinking from linear and causal to reciprocal and interdependent

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32
Q

prescription of rituals

A

Systemic Family Therapy
typically include some component of secrecy, isolation, recording in notebooks, or parental outings framed as disappearances

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33
Q

Family Systems Therapy

A

Bowen
healthy families have clearly differentiated family members and there is an overall balance of intellectual and emotional forces
pathological families function as single organism and identified patient is that part of the organism through which overt symptoms are expressed
family emotional system (undifferentiated family ego mass) - central concept

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34
Q

family emotional system

A

undifferentiated family ego mass

refers to emotional oneness that exists and shifts about within family in definite patterns of emotional reciprocity

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35
Q

multigenerational transmission of pathology

A

Bowen Family Systems Therapy

pathology in family repeated throughout generations

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36
Q

assessment of family - Bowen’s Family Systems Therapy

A

evaluates family on degree of fusion vs. ability to differentiate and analysis of emotional triangles in presenting problem (3 party system arranged so that closeness of two members tends to exclude third

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37
Q

goal of treatment - Bowen’s Family Systems Therapy

A

shift “hot triangle” that relates to presenting problem
work with most most psychologically available family members to achieve enough personal differentiation so that hot triangle does reoccur
personal differentiation from family of origin - ability to become one’s true self in face of familial or other pressures that threaten loss of love or social position

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38
Q

genogram

A

originated with Bowen

survey of family going back several generations

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39
Q

Solution-Focused Therapy

A

Steve de Shazer
aims to set up positive expectations in both therapist and client
typically very brief (as little as 3-4 sessions)
encourages clients to focus on strengths and identify solutions, either ones that have worked in past or might work in future

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40
Q

Solution-Focused Therapy - three types of questions

A

miracle question
exception question
scaling question

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41
Q

miracle question

A

Solution-Focused Therapy
“Suppose one night, while you were asleep, there was a miracle and this problem was solved. How would you know? What would be different?”

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42
Q

exception question

A

Solution-Focused Therapy
asks clients to think about times when they didn’t have the problem so they can discover what they were doing that was effective at that time
helps to foster more positive outlook in which problem is controllable

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43
Q

scaling question

A

Solution-Focused Therapy

asks patients to rate their problem on a scale of 1-10 (10 being how they would feel the day after the miracle)

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44
Q

Narrative Therapy

A

Michael White
symptoms thought to result from clients developing stories that are “problem-saturated” descriptions filled with a sense of powerlessness

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45
Q

role of therapist in Narrative Therapy

A

helping clients “re-story” by casting their difficulties for a “struggle for control” with symptom
symptom externalized as though it were entity separate from the client
asks questions to demonstrate “unique outcomes,” those successes that have been hidden by the focus on problems

46
Q

Behavioral Family Therapy

A

normal family functioning results when adaptive behavior is rewarded, maladaptive behavior is not reinforced, benefits of being a member of the family outweighs its costs

47
Q

Cognitive-Behavioral Family Therapy

A

relationship-related cognitions are seen as underlying cause of feelings and behavior of family members

48
Q

Marital Behavioral Therapy

A

Richard Stuart
developed approach that combines operant learning principles with social exchange theory
behavioral exchanges between spouses ultimately lead to satisfaction or dissatisfaction
contingency contracting
caring days

49
Q

social exchange theory

A

behavior in relationships is maintained by its ratio of costs and benefits

50
Q

contingency contracting

A

Stuart’s marital behavioral therapy

each spouse agrees to perform certain behaviors in exchange for other spouse performing certain behaviors

51
Q

caring days

A

Stuart’s marital behavior therapy

one day a week, spouse deliberately performs behaviors that have been requested by other spouse

52
Q

most crucial component of successful group therapy

A

cohesiveness
analogous to relationship or rapport in individual therapy
defined as attractiveness of group to its members
cohesive groups show greater acceptance, intimacy and understanding, and permit greater expression of hostility and conflict among group members and towards leaders

53
Q

Yalom’s three stages of group evolvement

A

initial stage
second stage
third stage

54
Q

Yalom’s initial stage

A

participation hesitant
content and communication of group members stereotyped and restricted
group discusses topics of little personal significance and searches for commonalities
group members typically talk to therapists rather than with one another

55
Q

Yalom’s Second Stage

A

characterized by conflict among group members, rebellion towards group leaders, and attempts at dominance

56
Q

Yalom’s Third Stage

A

development of closeness, intimacy, and cohesion

group members talk freely with each other

57
Q

Yalom’s view - open conflict or disagreement between leaders and self-disclosure

A

1) healthy and can be positive model for group members

2) frequently beneficial to group participants

58
Q

Research on groups - those most likely to drop out; those who are most likely to fail

A

1) patients with significant denial, high degree of somatization, lower motivation, severe pathology, lower SES, lower IQ, generally less likable
2) patients with fewest skills

59
Q

group composition

A

ideally consist of members who are heterogeneous in terms of conflict, homogeneous in terms of ego strength
size; 7-8 members, 5-10 acceptable range

60
Q

confidentiality in groups

A

impossible to mandate and enforce confidentiality, but importance of confidentiality should be brought up early on and members should be periodically reminded
“honor system”

61
Q

crisis theory

A

at equilibrium, person’s usual coping techniques are operating sufficiently to handle daily problems
during crisis, person faced with obstacle that is, for a time, insurmountable by the person’s customary methods of problem-solving

62
Q

Caplan’s for phases of a typically crisis situation

A

1) when crisis beings, person feels emotional tension and disorganization, and tries to manage the situation by previously learned coping mechanisms
2) coping efforts fail to resolve problem and further disorganization occurs
3) greatly increased tension level with further mobilization of internal and outside resources, perhaps helping-seeking and/or change of direction and goals
4) if intensified efforts fail to resolve the crisis, extensive personality disorganization and emotional breakdown may occur

63
Q

crisis intervention

A

rapid treatment crucial; terminated as soon as it appears crisis has been resolved and patient understands steps that led to its development resolution

1) rapid establishment of rapport
2) reviewing steps that led to crisis
3) helping patient gain understanding of his/her maladaptive reactions
4) helping patient develop more adaptive ways of dealing with crisis and strategies to avoid hazardous situations that are likely to produce future crises

64
Q

community interventions

A

focuses on prevention, treatment, and rehabilitation of mental disorders through use of organized community programs

65
Q

consultation (four categories)

A

1) client-centered case consultation
2) consultee-centered case consultation
3) consultee-centered administrative consultation
40 problem-centered administrative consultation

66
Q

client-centered case consultation

A

consultant helps consultee with individual case

e.g. helps therapist develop treatment plan for child with conduct disorder

67
Q

consultee-centered case consultation

A

consultant helps the consultee with difficulties he/she is having in working with patients, whether the problem stems from inexperience, lack of skill, or difficulties with objectively
e.g. therapist who commonly experiences countertransference toward patients diagnosed with borderline PD meets with consultant to work on ways to address her reactions

68
Q

consultee-centered administratibe consultation

A

consultant focuses on consultee’s difficulties that limit effectiveness in instituting program change
e.g. consultant meets with therapist who works in psychosocial rehabilitation in order to increase therapist’s knowledge about this type of program with goal that the program be implemented more effectively

69
Q

program-centered administrative consultation

A

consultant focuses on developing, expanding, or modifying a program
e.g. consultant meets with a group of clinicians to help them develop or improve a program for pre-gang teens

70
Q

advocacy consultation

A

consultant advocates for social change

71
Q

primary prevention

A

attempts to prevent onset or occurrence of a disease or disorder and thereby reduce its incidence (or number of new cases)
e.g. alcohol and drug education, Head Start, vaccinations

72
Q

secondary prevention

A

focuses on early identification and prompt treatment of an illness or disorder that already exists

goal: stop relatively mild disorders from becoming more serious and prolonged
e. g. mammograms, hotlines, aggressively treating children with conduct disorders to prevent development of antisocial personality disorder, screening children for learning disabilities and providing special programs early on, prompt treatment of earthquake victims evidencing trauma, etc.

73
Q

tertiary prevention

A

focuses on reducing residual effects of a chronic disability or minimizing further negative consequences of an established, serious disorder
e.g. vocational rehabilitation and day treatment centers for patients with schizophrenia, 12-step program for alcoholics or addicts

74
Q

physical abuse

A

32% under age of 5, 27% 5-7, 27% 10-14, 14% 15-18
more than half of all cases of abused or neglected children were born prematurely or had low birth weight
typically viewed by parents as developmentally slow, different, hard to discipline

75
Q

_____ children especially vulnerable to physical abuse

A

hyperactive

76
Q

most abused children come from________

A

poor, socially isolated homes where perpetrators have inappropriate expectations of their children

77
Q

most common perpetrators of physical abusers

A

female
80% of abusers live in home
90% severely abused as kids
most do not have history major psychiatric problems, but substance abuse common

78
Q

household composition of abused children

A

80% live in homes with two parents, 20% with one parent

79
Q

sexual abusers

A

50% family members

fathers, step-fathers, uncles, older siblings most common

80
Q

% of sexual abuse cases under 8 years old

sexual abuse peaks….

A

25%

between ages of 9 and 12

81
Q

domestic violence against women

A

violence against women most common, tends to be more chronic and result in more serious injuries

82
Q

intimate partner violence

A

underreported, especially by men

83
Q

reports of intimate partner violence among types of relationships
-raped, stalked, physically assaulted

A

23% men in gay relationships
22% women in heterosexual relationships
11% women in lesbian relationships
7% men in heterosexual relationships

84
Q

race and ethnicity and incidence of violence

A

impact lessened when other variables controlled for

85
Q

variable the best predicts likelihood of violence

A

presence of verbally abusive partner

86
Q

many reports indicate that spousal violence occurs most frequently…
other reports suggest that the occurrence of spousal abuse…

A

in concert with alcohol or crack abuse

is not correlated with substance use per se, but severity of abuse is

87
Q

abusive men are more likely…

A

to have come from violent homes and have witnessed spousal abuse
may have a higher rate of being abused themselves
tend to be immature, dependent, non-assertive, and generally feel inferior
abusive act is self-reinforcing, cycle of abuse continues and escalates over time

88
Q

best long-term result of abuse

A

arrest of husband

89
Q

expressive vs instrumental spousal abuse

A

expressive abuse - less deliberate, results from difficulty managing emotions; more amenable to treatment, but typically becomes instrumental over time if left untreated
instrumental abuse - more deliberate attempt to use violence as a means of control

90
Q

rape

A

often occurs in concert with another crime

alcohol involved 50% of time

91
Q

age of most men who rape

A

14-24

92
Q

reporting of rape

A

highly underreported

93
Q

children of divorce

A

at time of divorce, children of divorce tend to have more social, academic, and behavioral problems than children from intact homes

94
Q

age of child and divorce

A

3-6 year olds typically feel responsible
7-12 year old show decreases in school performance
adolescents feel they could have prevented divorce but at same time, also feel hurt by and critical of parents

95
Q

recovery from divorce

A

in general, takes 3-5 years

most children adjust well, up to one third experience lasting trauma

96
Q

girls vs boys’ adjustment to divorce

A

initially girls seem to have better adjustment than boys do, but girls become increasingly vulnerable in adolescence and if mother remarries

97
Q

younger children vs. older children’s adjustment to divorce

A

younger children are more anxious at time of divorce and have less realistic outcomes,but adapt more quickly and have fewer bad memories than children who are older at time of divorce

98
Q

research: adults who grew up in intact families vs. adult children of divorced parents

A

adult children of divorced parents tend to have higher levels of depression and marital problems and lower levels of SES and health

99
Q

Eysenck (1952) - meta-analysis

A

reported that 2/3 of all neurotics improved over a two year period whether or not they received treatment
noted that treated people actually seemed to do worse
criticized for non-random assignment to treatment vs. no treatment, providing attention to so-called non-treated condition (which could account for their improvement) and lack of distinction between therapists administering treatment

100
Q

spontaneously improvement rate

A

40%

101
Q

subsequent meta analytic studies after Eysenck (e.g. Smith, GLass, and Miller, 1980)

A

average effect size of .85 in comparing treated to non-treated individuals
i.e. at end of treatment, average treated person better off than 80% of untreated sample

102
Q

Howard et al.’s meta-analytic study of treatment outcomes

A

50% of patients improved by 8th session, 75% improved by end of 6 months

103
Q

Luborsky et al. (1975)

A

treatment outcomes essentially similar for all types of treatment

104
Q

1995 Consumer Reports Study

A

analyzed responses of 7,000 people to questionnaires about mental health treatment
90% of treated patients did well
long-term treatment yielded better outcomes than short-term
medication in addition to therapy didn’t lead to improved outcomes
no specific modality led to better outcomes for any disorder
psychiatrists, psychologists, and SWs did not differ in effectiveness, but did better than marriage counselors and long-term family doctoring
patients whose length of therapy or choice of therapy was limited by insurance did worst

105
Q

limitations of Consumer Reports study

A

absence of control group, non-random assignment, possibly biased sample, reliance on retrospective self-report
contradicted some efficacy studies - e.g in most efficacy studies, 65% of patients improved and short-term therapy was highly effective

106
Q

psychotherapy outcome research - therapist variables

  • gender
  • ethnicity match
  • experience
A

treatment facilitated with female therapist or when patient and therapist of same gender
relatively little different in outcome whether patient and therapist are matched for ethnicity
patients tend to prefer therapists of own ethnicity and may participate more in early stages in treatment, thus there may be fewer premature terminations
more experienced therapists have lower drop-out rates

107
Q

psychotherapy outcome research - therapy relationship

A

quality of relationship is as important to outcome as method of treatment use

108
Q

general psychotherapy outcome research findings

1) group vs. individual
2) group with lowest rates of psychiatric disorders
3) group with next lowest rate
4) group with highest rate
5) most common disorder in people over 65
6) women vs. men (seeking treatment)
7) married vs. divorced or single individuals
8) college vs non-college graduates
9) suburban and rural vs. inner city

A

1) no difference
2) people over age 65
3) 45-64
4) 25-44
5) dementia
6) women more likely to seek treatment
7) married men and women less frequently seek treatment and have less psychopathology
8) rates of psychiatric disorders lower for college graduates
9) rates of psychiatric disorders lower for suburban and urban inhabitants

109
Q

Total Quality Management (TQM)

A

philosophy and set of guiding principles that focus on continuous improvement of the organization, its procedures, and services that it provides for its customers

110
Q

5 premises of TQM

A 
customer focus
total involvement
measurement
systematic support 
continuous improvement
111
Q

Quality Assurance

A

involves monitoring and evaluating a plan’s health care services in terms of availability or accessibility, adequacy, and appropriateness

112
Q

theme interference

A

problems that the supervisee (or consultee) is experiemce that can affect patients’ progress

Treatment Interventions (3 decks)

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