Interventions With Clients/ Client Systems; Psychotherapy & CM Flashcards

Question

What do Individual Theories and Types of Psychotherapy cover? (Interventions with CTs/ CT systems; Psychotherapy & Case management)

Answer 1

Neo-Freudians Harry Stack Sullivan placed an emphasis on the importance of relationships over the lifespan. He believed that personality consists of the relationships that contributed to its formation along with the dynamisms (the quality of being characterized by vigorous activity and progress), or reciprocal patterns, that resulted from these relationships. Sullivan recognized the role of cognitive factors in personality development and proposed three modes of cognitive experience: 1. Prototaxic mode in which Sullivan believed that the first few months of life are related to a discreet series of momentary states. 2. Parataxic mode entails seeing causal connections between events that occur at about the same time but are actually unrelated. Sullivan believed maladaptive behavior is attributable as "parataxic distortions" (misperceptions that involve responding to a person as though he/she is a significant person from the past), which are due to arrest in the Parataxic mode. 3. Syntaxic mode occurs at the end of the first year of life and is characterized by logical, sequential, internally- consistent, and modifiable thinking. Sullivan was the founder of the Interpersonal School of Psychotherapy. He viewed the SW as both participant and observer and expert in interpersonal relationships.

Answer 2

Neo-Freudians Erich Fromm was considered to be a Humanistic psychoanalyst*. His theoretical ideas represent a blending, in part, of Marx's societal Determinism (the individual is determined by the economic system) and Freud's biological determinism. Fromm went beyond Freud and Marx in that he believed that the individual could transcend biological and societal factors. Fromm saw freedom as the core feature of human nature, believing that we can "... find principles of action and decision making which replace the principles of instincts." He believed that human beings are individuals, with their own thoughts, feelings and a sense of what is right and wrong, and that they are ultimately responsible for their behavior. He further believed that human beings have characteristic ways of trying to escape their individual identity (i.e. their freedom) which results in self-alienation. Fromm stated that an important determinant of which escape mechanism we choose is the nature of our family of origin. Fromm identified two "unproductive" type of families: (1). The Symbiotic Family is one in which members are enmeshed and devoid of individual personalities. (2). The Withdrawing Family is a family in which members exhibit indifference toward each other. Punishment may be ritualistic, without feeling or involve guilt-loading and withdrawal of affection. An alternative form is a permissive approach that leaves children without appropriate adult guidance. Children derive their values from the media and members of their peer group. (Humanistic psychoanalyst- looks at people from a historical and cultural perspective rather than a strictly psychological one. It is more concerned with those characteristics common to a culture). Erich Fromm identified Five Personality Types or "orientations" which are described in economic terms, four of which are unhealthy orientations. 1. Receptive orientation-They receive satisfaction from outside factors, and thus they passively wait for others to provide them with things that they need. For example, they want someone to provide them with love and attention. 2. The Exploitative orientation-people aggressively take what they want rather than passively receiving it. These types of people do whatever they can to get what they want; even if it includes stealing, or snatching something away from somebody else just to get it. 3. Hoarding-oriented- people save what they already have obtained, including their opinions, feelings, and material possessions. It may be love, power, or someone’s time. 4. Marketing orientation- People who are marketing orientated see themselves as commodities and value themselves against the criterion of their ability to sell themselves. They have fewer positive qualities than the other orientations because they are essentially empty. 5. Productive orientation- the healthy personality. "the person without a mask"- a person who understands hie or her biological and social nature while accepting responsibility and embracing personal freedom. A healthy, productive family is one in which parents appropriately assume the responsibility of teaching their children rationality and providing a loving environment. In these families, children are treated as individuals and are not expected to simply conform to the wishes of parents. The reason is valued above rules.

Answer 3

Jungian Psychotherapy Associated with Carl Jung, libido is defined as a general psychic energy, and it is believed that behavior is determined by past events as well as future goals and aspirations. Jungian Personality Theory states that personality is the consequence of both conscious and unconscious factors. The Conscious personality is oriented toward the external world. The Unconscious personality consists of two parts: the personal unconscious and the collective unconscious. The personal unconscious contains experiences that were once conscious but are now repressed or forgotten (or unconsciously perceived). The collective unconscious is the repository (a place, building, or receptacle where things are or may be stored.) of latent memory traces and primordial images that causes people to understand certain phenomena in the same way (archetypes). Archetypes of particular importance to personality development include the self, which represents a striving for a unity of the different parts of the personality; the persona or public mask; the shadow or dark side of the personality; the anima or feminine archetype; and the animus (hostility or ill-feeling.) or masculine archetype. Carl Jung believed that personality consists of two attitudes (i.e. extroversion and introversion) and four basic functions (i.e. thinking, feeling, sensing, and intuiting). The focus of therapy is to rebridge the gap between the conscious and the personal and collective unconscious via interpretations, dreamwork, etc. Jung also considered the psychotherapeutic use of abreaction, a type of catharsis. Abreaction refers to the process ridding oneself of the intense feelings associated with a previously painful or traumatic experience. Jung later decided that the release of the pent-up feelings was not as important in the healing process as was the SW-CT relationship.

Answer 4

Leading theorists include Anna Freud, Heinz Hartman, Ernest Kris, David Rapaport, and Erik Erikson. The believed that the SW does not simply allow the therapy to be free-flowing, as it the case with classical analysis. Since psychoanalytic psychotherapy is briefer, the SW is more active and more directive (e.g. giving advice and making suggestions). Psychoanalytic psychotherapy is more individualized. Compared to traditional psychoanalysis, psychoanalytic psychotherapy is more: * brief (weekly rather than daily sessions) * direct ( less free association and more face to face discussions) * reliant on positive transference to facilitate progress * focused on the present The patient and SW may sit face-to-face. A free association may not be used in favor of direct conversation between the SW and CT. A transference neurosis will likely not be allowed to develop. The CT may be seen less frequently than on a daily or almost daily basis. The SW may rely more on a positive transference to facilitate progress. Interpretations may be limited to present situations. Providing the patient with a "corrective emotional experience" is given greater emphasis than "consciousness-raising".

Answer 5

In describing Autonomous Ego Functions, Heinz Hartman, an Ego psychologist, disagreed with Freud's contention ( assertion) that the ego develops out of the id and that the capacities of the ego are dependent on the instinctual drives. He maintained that the capacity for ego and id is present at birth, having evolved in the human species as part of the process of adaption. He saw the ego as having its own independent source of energy and as developing independently of instinctual drives and internal conflicts. He saw the ego as having purposes beyond intrapersonal (is the communication with oneself, and so only one person is involved in it.) conflict. He believed that the ego strives for adaption, competence, and mastery. Some ego functions that Hartmann identified as conflict-free and autonomous from instinctual drives include perception, memory, intelligence, thought processes, motor activity, and reality testing. He believed that humans experienced pleasure when they exercise these ego functions.

Answer 6

Ego Psychology theorists identified Defense Mechanisms, such as repression, regression, projection, reaction formation, displacement, sublimation, denial, introjection, rationalization, undoing- Human Behavior and Development in the Environment. When conflict arises between id and superego, the individual experiences anxiety. This anxiety is a signal to the individual (to the ego) to do something to alleviate the anxiety such as to utilize a defense mechanism. As a result, anxiety is alleviated and the disturbing impulse is kept at bay. Sigmund Freud's theories include defense mechanisms with the primary focus on repression. Anna Freud more broadly identified other defense mechanisms. Development Theory- (Human Behavior and Development in the Environment) Developmental theories explain the biological, psychological, social, and emotional development as stages over a portion (childhood, adolescence, adulthood, old age) or the whole of the life span. Developmental theories influence social work practice by providing a basis for assessing and understanding a client's physiological, psychological, and emotional development. Such theories are primarily used in the assessment stage of social work practice where a social worker assesses the current level of development and functioning and uses this information to assist in explaining the client's situation, to determine the most appropriate form of intervention, and to hypothesize about future outcomes. Developmental theories are also useful during the evaluation and ending stages to determine any shifts or changes in levels of development.

Answer 7

Ego- Oriented Approaches to Treatment place greater emphasis on the present than the past and attempts to increase awareness of and conscious control over behavior. Assessment is holistic, focusing on environmental stressors, accessibility to needed resources, trauma, developmental difficulties, and deficits in ego functioning. Two categories of intervention include: 1. Ego- supportive interventions restore, maintain and enhance adaptive functioning (ego mastery or the ability to mediate between basic primal needs of an individual and the higher moral standard). Psychologically- based interventions are helpful. In addition, environmentally-based interventions can be useful as the CT works to change his environment to alter his behavior (i.e. removing cookies from the pantry to avoid binge eating). The treatment focus is on conscious thoughts and feelings. Interventions are more directive and structured, and treatment can be either short-term or long-term. Ego- supportive interventions are used with CTs who have deficits in ego strength, low tolerance for anxiety and poor impulse control. 2. Ego- modifying interventions involve modification of basic personality patterns. These interventions are psychologically based and are long term. Treatment focuses on the past and the present, as well as the conscious, preconscious, and unconscious. SWs seek to help CTs use increased insight and conflict resolution. SWs use positive and negative transference as a tool in therapy. The therapeutic interventions are nondirective and use interpretation. Ego-modifying interventions are typically used with those having good ego strength to address maladaptive patterns. The intervention may also be used with individuals with ego deficits and severely dysfunctional patterns. Ego psychology is probably the most significant mode for SW and clinical expertise in that it deals with mastering stages of development, emphasizes the development of coping behaviors, and integrates psychological and social realms.

Answer 8

Object Relations Models came from classical psychoanalytic theory and Ego psychology. Since Feud's theory of human development had its basis almost exclusively in his work with adult patients, some psychoanalytic thinkers, notably Melanie Klein, Ronald Fairbairn, Margaret Mahler (the British School of objects relations theory), Otto Kernberg, Heinz Hohut, and James Masterson (American contributors) questioned its validity. Objection Relations Therapy is a psychodynamic approach* to therapy. The focus is on early childhood experiences and relationships with significant others in childhood, in particular, Mother, as well as the resulting personality structure. The therapeutic process also looks at the impact of unconscious fantasies and impulses. Therapy is focused on childhood relationships and experiences that influenced personality development. *(Psychodynamic approach-includes all the theories in psychology that see human functioning based upon the interaction of drives and forces within the person, particularly unconscious, and between the different structures of the personality.) Intervention strategies include encouraging the CT to talk about childhood experiences, interpretation of the impact of the childhood experiences on present functioning and relationships, dream analysis of transference or resistance, and provision of a therapeutic environment that supports adjustments in the individual's sense of self, in his or her psychological functioning, and in the nature of his or her relationships. Brief forms of psychodynamic therapy have been developed in recent years that appear to hold promise for working with individuals with substance abuse problems and depressions.

Answer 9

Melaine Klein a psychoanalytic writer who based her theorizing about human development specifically on her work with children saw the internal world of the child-focused more on relationships with others than on instincts and drives. According to Object Relations theorists, infants are innately- naturally relationship (object) seeking. The infant's relationship with the mother provides the basis for the development of the infant's sense of self and a pattern for all subsequent relationships. The infant internalizes (introjects) qualities of the mother and, subsequently, splits these introjects into positive and negative aspects. The infant initially experiences the mother as good or bad, depending on whether the mother is fulfilling or frustrating his or her needs at the moment. Over time, the child typically becomes aware that the same person can have both positive and negative qualities. This is referred to as "splitting", as an important step in developmental tasks of childhood. Splitting can also be seen as a defense mechanism in older individuals. In order to relate to significant others, an individual, may "split" the significant other into two parts, good and bad, in an effort to cope with the painful feelings associated with that person. For example, a child who has an abusive parent may use splitting as a defense mechanism, thus separating the "good" parent (loving) from the "bad" parent abusive. The child may form either a secure or insecure attachment to the mother. Secure attachment- is formed when the mother and child relationship has been predominately positive. Insecure attachment- is formed when the relationship has been predominantly negative. Human behavior reflects the nature of early experiences with the mother (or primary caregiver) and, to a lesser degree, with other significant individuals (e.g. father, grandparents).

Answer 10

Characteristics of humanistic models include an emphasis on the uniqueness and wholeness of the individual, a belief in the individual's inherent striving for self-determination and self-actualization, and a focus on current behavior. Humanistic/ Existential models also have a view of therapy as involving an authentic, collaborative, and *egalitarian relationship between SW and CT. There is a belief that to understand a person, one must understand his/her subjective experience. This model rejects traditional assessment techniques and diagnostic labels. The leading theorists of the Humanistic/ Existential movement include Carl Rogers, Fritz Perls, and Eric Berne. (Egalitarian- *social value- relating to or believing in the principle that all people are equal and deserve equal rights and opportunities.) (Social value-is the quantification of the relative importance that people place on the changes they experience in their lives. E.g.Respect. Justice/Fairness. Honesty. Service/Giving Back/Contribution. Responsibility. Family. Community.)

Answer 11

Person-Centered Therapy (Carl Rogers) This theory includes the belief that human beings have an inherent tendency towards self-actualization (i.e. achievement of their full potential). People will naturally grow and self-actualize in a warm, caring, authentic, nonjudgmental, empathic, and understanding environment. Maladaptive behavior results when the person experiences conditions of worth (i.e. significant others communicate to the child that their love and acceptance of him or her is contingent on conformity to their standards). The child then internalizes some of these conditions and comes to define an experience as positive or negative based on the internalized conditions of worth rather than on the capacity of the experience to enhance the person. There is a belief that individuals' defense block awareness of the organization processes that would naturally propel them in a direction of growth. The critical component of this therapy is the experiential relationship between SW and CT (i.e. the therapeutic alliance). The SW is non-directive (i.e. respectful of the self-directing capacity of the CT). The SW's attitudes, rather than technical skills or a specific knowledge base, are the critical ingredients, the CT is free to experience all elements of self and to reclaim parts of previously disowned because of conditions of worth.

Answer 12

Gestalt (Fritz Perls) The major concept of this therapy includes the belief that human beings are constantly discovering and reconstructing who they are. A person's behavior represents a whole, not differing pieces. Behavior can be fully understood only in the context of the present. An increased awareness of the here-and-now experience allows the individual to choose and to make a greater sense of his/her existence. This therapy is based on the theory that personality consists of the self and the self-image. The self is the creative aspect of the personality that promotes the individual's inherent tendency for *self-actualization. Self-image is seen as the darker side of the personality that can hinder growth and self-actualization by imposing external standards. The child's early interactions with the environment often determine which aspect dominates. (Self-actualization- Person-Centered Therapy achievement of their full potential, especially considered as a drive or need present in everyone).

Answer 13

Gestalt (Fritz Perls) Neurotic behavior is considered a developmental disorder resulting from early experience. It involves the abandonment of the self in favor of the self-image and results in an inability to see oneself as a whole person. Neurotic behavior stems from a disturbance in the boundary between the self and the external environment. There are four major boundary disturbances identified in Gestalt therapy: 1. Introjection occurs when the person believes the external perception of the whole. The person has difficulty distinguishing between "me" and "not me" and may be overly compliant. 2. Projection refers to disowning aspects of the self by assigning them to other people. For example, if you extremely dislike an individual, a form of projection would be for you to portray the scenario that he or she dislikes you instead. Paranoia is an extreme form of projection. 3. Retroflection is described as doing to oneself what one wants to do to others. It involves redirecting anger one has for another person inward. This can be exhibited in extreme self-blame in response to appropriate feedback given to a person. Rather than expressing anger with the person, that anger is expressed inward and becomes self-blame. 4. Confluence is the absence of a boundary between the self and the environment. This causes intolerance of any differences between oneself and others and often underlies feelings of guilt and resentment. Gestalt therapy focuses on increasing awareness and clarity of the experience of the moment for both the CT and the SW. Interpretations are seen as less valuable or reliable than the individual's perceptions and feelings. Through dialogue and structured experiences or experiments, discrepancies between the SW's and the CT's experiences are explored in an effort to increase the CT's awareness of what he is doing and how he is doing it. The CT is also assisted in learning to accept himself fully.

Answer 14

Gestalt (Fritz Perls) The goal of therapy is to help the CT achieve integration of the various aspects of the self in order to become a unified whole. The SW avoids the use of diagnostic labels. The CT's history is seen as relevant only as it impinges (have an effect or impact, especially a negative one) on the here-and-now. The SW-CT relationship is referred to as an I-Thou dialogue relationship reflecting caring, warmth, acceptance, and authenticity. Gestalt therapy utilizes the following focusing techniques: 1. Directed awareness is a technique whereby the SW helps the CT become aware of his/her immediate experience. 2. "No questions" is a technique that places the focus on increasing one's own awareness of his/her experience in the here-and-now. 3. "I language" is a technique that involves the SW's use of "I" statements rather than making impersonal interpretations. The SW will often share his/her experience of the here-and-now (e.g. what the SW sees and hears). 4. Enactment is a technique, which involves asking the CT to act out feelings or thoughts to increase awareness (e.g. empty chair, role-playing, psychodrama, exaggerating a feeling, thought or motion). 5. Guided fantasy visualization is a technique that involves having the CT create a mental image of an experience. 6. Loosening/ Integrating techniques involves encouraging the CT to think in a new way (e.g. asking the CT to imagine believing the opposite of what he/she believes about something; having the CT locate where in his or her body-specific emotion of located). 7. Body techniques are techniques used for increasing the CT's awareness of their bodies and helping them to learn new ways of using their bodies to create additional self-awareness and to engage in meaningful contact with others. 8. Dreamwork is a technique, which focuses on recurring dreams. 9. "Stay with it"/ "Feel it out" is a technique that involves encouraging the CT to allow himself to continue to feel the emotion of the moment. This technique increases the CT's capacity to experience his or her feelings fully.

Answer 15

``` Transactional Analysis (Eric Berne) Berne incorporates elements of psychoanalysis, Gestalt psychology, Rational Emotive Behavior Therapy, psychodrama, and behavior therapy. Transactional Analysis is often used in group settings and teaches individuals to trust one another. ``` The psychological theory of Transactional Analysis includes the following concepts: * Ego States are specific patterns of thoughts, feelings, and behaviors. * The Adult is the rational part of the personality. * The Parent is the critical or nurturing part of the personality. * The Child is the creative, intuitive- instinct, and emotional part of the personality, rebellious or conforming. * Life Position refers to the four possible life positions. The "I'm ok, you're ok" is considered a healthy life position. The other three positions (i.e. "I'm ok, you're not ok," "I'm not ok, you're ok", and "I'm not ok, you're not ok") are considered unhealthy. * Lifescript is the life plan a person creates during childhood, which forms the core of the person's identity and his or her destiny. This theory is based on beliefs about self and others. * Environmental Conditions, especially parenting, affect all individuals. * Recognition is viewed as an existing innate (inborn; natural) need of individuals.

Answer 16

``` Transactional Analysis (Eric Berne) Transactional Analysis therapy consists of the following concepts and techniques: * The role of the SW is to be a facilitator of change and growth. ``` * The SW completes a structured analysis of the individual's ego states (Critical Parent or Nurturing Parent: Adult: Free Child or Adapted Child) using an Egogram (i.e. a graph of the relative energy of the different ego states.) The SW may assist the CT in changing the energy balance of these states. * Certain structures are associated with personality pathology (i.e. ego states with overlapping boundaries.) * Transactional analysis involves an examination of the interactions between the ego states of two individuals. The types of transactions are identified as the following: - Social interactions are observable transactions. - Psychological interactions are covert, often discernible thorough examination of body language. * The SW does an analysis of the "stereotyped games" (i.e. dishonest interpersonal interactions) people play in their relationships. These games reinforce the individual's belief system. Individuals vary in terms of the games they participate in with others (e.g. when the SW and the CT alternate between playing the role of the victim, rescuers, and persecutor). Understanding the self-perpetuating role one plays in the relationship will enlighten the CTs, brining a clearer picture of their relationship patterns. * The SW creates a script analysis of crucial transactions between parents and the child in the early years. The script analysis reveals why the individual chooses to play the specific games that he/she plays. This provides important information in coming to an understanding of the individual's personality development.

Answer 17

It is often used with children instead of talk therapy alone. With preverbal (not able to speak) children, play therapy may be the sole form of therapy. The basic premises are that children's emotional conflicts are manifested in their play (assessment) and that the reenactment, in play therapy, of those experiences and situations that underline emotional conflict con facilitate the healing process (intervention). Play therapy also lessens children's self-consciousness while simultaneously talking about difficult subjects, such as abuse, and facilitating overall communication.

Answer 18

Group Composition There is considerable controversy relative to whether groups should be heterogeneous (variable in characteristics) or homogeneous (similar in characteristics). There is a general agreement that group members should have approximately the same level of intelligence. Groups should typically be homogeneous in terms of the developmental level of members. Rudolf Dreikurs believed members should be matched by age, particularly in children's groups, and that there should be no more than two years difference between the oldest and the youngest. With adolescents, group leaders should consider chronological age as well as the developmental level (e.g. young teens who have not resolved the identity issues arising in this developmental period should not be placed in a group with more mature teens or young adults). In general, the inclusion of both genders in groups of children is not recommended; although, some adolescents can handle mixed groups. Mixed groups traditionally have the most lasting effects on adults. There is controversy about whether group members, in treatment groups, should have the same problem. Yalom (Irvin David Yalom is an American existential psychiatrist) believes it is best to have heterogeneity for conflict areas and homogeneity for ego strength. Glaver and Gavin maintain that a group that is too homogeneous, in terms of undesirable characteristics (deviant behavior), will lead to the reinforcement of these traits. Garvin, Reid, and Epstein believe that similarities among members of task-oriented groups are important as these groups are more effective when the members share common goals. Homogeneous groups tend to gel faster, become more cohesive, offer more immediate support to the group members, have better attendance and less conflict, and provide more symptomatic relief. Homogenous groups can, however, remain superficial and are ineffective for altering character structure. Group therapy is not indicated for children younger than 8yrs.

Answer 19

``` Closed group (new members not added after a cut-off period) are most effective for short-term, task-oriented therapy. Open groups (new members may be added at any time) offer members fresh input and allow them to benefit from the success of graduates; however, they can often impede the development of trust, acceptance, and cohesiveness. ``` Assimilation of new members is another concern in group work. A new person's assimilation into a group depends on the following factors: 1. the size of the group- large group are less affected by a new member 2. the age of the group-if a group is fairly young, it typically accepts a new member with relative ease. When a group has been meeting for a long period of time and is fairly cohesive, the members may treat a new person with some resentment. Some groups are simply more flexible and accepting than others. Group Size influences the effectiveness of treatment. Treatment groups are usually most effective when they include between seven and ten members. Having fewer than seven members limits opportunities for learning while including more than ten members limits the opportunity for individuals participation. Groups with three to six members can function effectively if the number of participants remains more or less constant.

Answer 20

Stages of Group Development Despite variation in the number and naming of stages put forward by the various models of group development, commonalities can be discerned-perceive or recognize (something) (Wheelan et al., 2003). A general description of a five-stage sequence follows, with reference to the models of Tuckman (1965), Garland et al., (1973), and Weelan et al., (2003). 1. At the outset (start/ beginning of something) of its life, the group is in a "forming" (Tuckman, 1965) or "preaffiliation" (Garland et al., 1973) stage. The members will experience anxiety, seek guidance from the group leader(s) on appropriate behaviors, and engage in tentative self-disclosures and sharing. 2. Once established, the group will enter a stage characterized by a "storming" stage (Tuckman, 1965) or "counterdependency and flight" (Wheelan et al. 2003), defined by struggles around issues of "power and control" (Garland et al. 1973). Competition and conflict among the members, anxiety about the safety of the group, and the authority of the leader are common concerns. Confrontation s of the leader reinforce member solidarity and openness. Many theories of group development hold that these struggles over authority and status are essential for the emergence of genuine cohesion and cooperation. 3. In a third stage of "norming" (Tuckman, 1965) or "intimacy" (Garland et al. 1973), a consensus on the group tasks and a working process emerge. The group begins to demonstrate "trust and structure" (Wheelan 2005), cohesion and openness.

Answer 21

Stages of Group Development 4. A fourth stage of "performing" (Tuckman, 1965), "work" (Wheelan et al. 2003) or "differentiation" (Garland et al. 1973), is characterized by a mature and productive group process and the expression of individual differences. The group has the capacity for focusing on the task of therapeutic work and the members engage in an open exchange of feedback. If the group has a time-limited format or certain members prepare to "graduate" during this stage, elements of disillusionment and disappointment can emerge. 5. The finale stage addresses the issue of termination, whether of individual members or the group as a whole. Concerns associated with "adjourning" (Tuckman, 1965) and "separation" (Garland et al. 1973) prompt the emergence of painful effects and *oscillations between conflict and defensiveness and mature work. The members' appreciation for each other and the group experience, along with efforts at prepping the group members to be more independent in future group activities, are goals in this termination stage. (os·cil·la·tion-movement back and forth at regular speed) Group members benefit from group therapy in a number of ways. Yalom considers the group to be a *microcosm of the real world and believes that it provides members with the following: hope, universality, *altruism, learning, self-understanding and insight, existential learning, family re-enactment, guidance, *catharsis, group membership, and identification. Research indicates that group components such as interpersonal input, catharsis, self-understanding, and cohesiveness may be viewed by members as the most important factors. The importance of these factors is a function of the type of group and of the characteristics of individual members. Higher functioning CTs rate interpersonal learning and universality as most important, while lower- functioning CTs rate *instillation of hope most important. (mi·cro·cosm-a community, place, or situation regarded as encapsulating in miniature the characteristic qualities or features of something much larger.) (al·tru·ism-the belief in or practice of disinterested and selfless concern for the well-being of others.) (ca·thar·sis- the process of releasing, and thereby providing relief from, strong or repressed emotions.) (instillation is a noun. It is related to the verb instill, which means to impart knowledge gradually or to put droplets of liquid into something.)

Answer 22

The 11 "Curative (able to cure) Factors" in Group Therapy proposed by Irvin Yalom: 1. Altruism can result when group members help each other. The experience of being able to give something to another person can lift a member's self-esteem. Group members can develop more adaptive coping styles and interpersonal skills by receiving help from others. 2. Catharsis is the experience of relief from emotional distress through the free and uninhibited expression of emotion; members tell their story to a supportive audience, resulting in relief from chronic feelings of shame and guilt. 3. Existential Factors are defined as the process of learning that one has to take responsibility for one's own life and the consequences of one's decisions. 4. Cohesiveness is an important and foundational factor in therapeutic outcomes. Human beings instinctually desire group acceptance and belonging Personal development can only take place in an interpersonal context. A cohesive group is one in which all members feel a sense of belonging, acceptance, and validation. 5. Imparting Information (A.K.A. Guidance) refers to learning factual information from other members in the group (e.g. learning about treatment options or services)

Answer 23

The 11 "Curative (able to cure) Factors" in Group Therapy proposed by Irvin Yalom: 6. Imitative Behavior (A.K.A. Identification) refers to group members developing social skills through the modeling process, observation, and imitating the SW and other group members (e.g. sharing personal feelings, showing concern). 7. Instillation of Hope occurs when group members are inspired and encouraged by another member who has overcome the problems with which they are still struggling. 8. Interpersonal Learning (A.K.A. Interpersonal Input) refers to group members achieving a greater level of self-awareness through interaction and feedback from others. The stage of "Self- Understanding" or "Insight" often falls into this category. 9. Development of Socializing Techniques (A.K.A. Interpersonal Output) refers to the group setting that provides a safe and supportive environment in which members can take risks by extending their repertoire of interpersonal behavior and improving their social skills. 10. Corrective recapitulation of the primary family experience refers to when members unconsciously identify the group worker and other group members with their own parents and siblings, which is a form of transference specific to group psychotherapy. The SW's interpretations can help group members gain an understanding of the impact of childhood experiences on their personality and they may, in turn, learn to avoid unconsciously repeating unhelpful past interactive patterns in present-day relationships. 11. Universality is the recognizing of shared experiences and feelings among group members and acknowledging that the "problems" may be widespread or be universal human concerns. There are reduced feelings of isolation, validation or experiences, and increased self-esteem.

Answer 24

The Group Social Worker's Role includes the creation and maintenance of the group, illumination of the here-and-now (group process), and creating a group culture and a sense of safety. Other Issues Relative to Groups include Co-leadership, which can be very helpful in group therapy if the co-leaders are not in competition. Working with a co-leader makes it easier to monitor individual members of the group. Co-leadership is helpful if an individual group member goes into crisis; one leader can tend to the crisis while the other continues to facilitate the group. It is important for co-leaders to meet before group therapy to prepare and after the group to debrief. Another issue is Concurrent Group and Individual Therapy. Yalom does not believe that concurrent group and individual therapy is necessary or beneficial. He believes that individual therapy can drain off affect from the group. Some SWs; however, believe it is helpful if there is ongoing communication between the group SW and individual SWs. Some predictors of a group member's premature termination include high use differences between that group member and other members of the group. Three types of transference can occur in the group setting: 1. transference to the SW (parental figure) 2. transference to other group members (siblings) 3. transference to the group itself (mother-womb symbol) Johari Window is a graphic model of interpersonal behavior that can be applied to many different theories of group interaction and is useful in evaluating interpersonal interaction and group effectiveness. This model is more likely to be successful if individual group members have been prepared for the group experience. Groups high on cohesiveness are associated with better outcomes.

Answer 25

Family Systems Theory (Murray Bowen) It extends general systems theory beyond the nuclear family. The goal of therapy is the achievement of a higher level of differentiation of self on the part of each family member. Therapy often involves working with one family member, with the premise that when one family member changes, others will follow. Each family member is guided by the SW to take responsibility for his or her own role for the problematic issue. In order to keep the tension between family members at a minimum, each family member directs his or her comments to the SW. The eight interlocking concepts in Family Systems Theory include: 1. Differentiation of Self is described as family members' ability to discriminate between their identities and experiences and that of other family members (rather than having fused identities). 2. Nuclear Family Emotional System (formerly called Undifferentiated Family Ego Mass) has reference to a family in which members' identities are fused. 3. Triangles is a term that denotes that relationships have periods of closeness and periods of distance. Triangulation occurs during periods of distance-an "outsider" takes sides with one person in the relationship (e.g. a wife is irritated with her husband, shares this information with their daughter, and the daughter bands with the mother). Family problems are typically triangular. 4. Societal Emotional Process is a term used to denote that the emotional system governs behavior on a societal level, similar to that found in a family, promoting both progressive and regressive periods in society.

Answer 26

5. Emotional Cutoff is an unhealthy way of dealing with intergenerational differentiation (e.g. a young adult may sever ties with parents). 6. Sibling Position is often associated with the development of specific personality traits. 7. Family Projection Process is the process thought which parents transmit their lack of differentiation onto their offsprings. 8. Multigenerational Transmission Process has reference to the transmission, through the generations, of the family's emotional process.

Answer 27

Therapeutic Techniques include the following: The Therapeutic Triangle refers to an SW "joining" or engaging in work with a couple. The SW, through avoidance of triangulation, helps the couple address, with each other, the difficulties they are experiencing. A Genogram is a graphic representation of family relationships that includes a minimum of three generations. Circles represent females, squares represent males, and marriage is represented with a solid line. The genogram often includes important information about family members, including, but not limited to, birth and death dates, occupations, and the nature of relationships between different family members. Questioning uses process questions to explore the dynamics of family relationships. The purpose of these questions is to shift the focus of family members from how others are causing them grief to what they are doing to contribute to family difficulties. Detriangulation is a process in which the SW avoids taking sides with partners and encourages each of them to take responsibility for their part in the family problems. Coaching is a technique whereby the SW helps the family along each step of the way so they know exactly what they are to do. - Communication/ Experiential Family Therapy came out of the Mental Research Insitute in Palo Alto in the 1960s with Gregory Bateson, Don Jackson, Virginia Satir, and Jay Haley. It saw the primary purpose of symptoms as being the maintenance of homeostasis in the family. Pathological families were seen as stuck in strong dysfunctional communication patterns and viewed any change as a threat to the integrity of the system. The primary goal of therapy is to alter the interactional patterns that maintain the presenting symptoms.

Answer 28

Communication/ Experiential Family Therapy includes the following basic principles: All communication has both a report and a command level or function. Reusch and Bateson (1951) labeled the information or content portion of a message the report. They labeled the relationship defining aspects of the message the command. The command aspect of a message suggests how the sender views him or herself, how the sender views the receiver and how the sender imagines the receiver views the sender, etc. Watzlawick, et al. (1967) suggested that often the relationship aspects of the communication are sent and received without the full awareness of either sender or receiver. Relationships are either symmetrical or complementary (not a value judgment). Symmetrical relationships are egalitarian relationships, in which roles are mirror images. (egalitarian-relating to or believing in the principle that all people are equal and deserve equal rights and opportunities) Complementary relationships are relationships that involves a fit between different roles. The Principle of Equifinality in Communications/ Experimental Therapy means that the same results can be obtained via different means. The Circular Model of Causality refers to behaviors of different subsystems that reciprocally impact each other.

Answer 29

Forms of dysfunctional communication include the following: * blaming and criticizing * mind-reading (when a family member represents his or her interpretations of the beliefs or feelings of other family members as reality.) * making incomplete statements * making statements that imply that events are unalterable when they are not * over-generalizing * double-bind communication: communication that involves contradictory demands; the recipient of the communication cannot comment on the contradictions in the communication and is unable to escape the inevitable consequences of only being able to meet one of the demands. * denying that one is communicating * disqualification of the communication of another member of the family

Answer 30

Virginia Satir Utilized a communications approach that increasingly emphasized the feelings and self-esteem of individual family members. Her approach used a more humanistic model in clarifying family communications. Satir joined the family to facilitate a family process that promoted the well-being of family members. The family was seen as a system seeking balance. Satir looked at the cost to each member of the family of maintaining the present balance in the family. She saw a symptom in a member of a family as evidence of a blockage in growth in the family. Satir saw explicit and implicit family rules as coming out of the parents' approach to their own self-esteem; these rules create the atmosphere of the family or the context for the development of the children's self-esteem. In therapy, Satir assisted each family member to become as whole as possible through deliberate efforts to build self-esteem and self-worth and through the correction of dysfunctional communication patterns. Satir identified five Styles of Communication (also referred to as poses). Four of these styles serve to protect family members from revealing who they really are; one is functional.

Answer 31

Satir identified five Styles of Communication (also referred to as poses). 1. The Placater is a communication style that is characterized by agreement, apologizing, and/or efforts to please. 2. The Blamer accuses, criticizes and dominates. 3. The Super-reasonable family member maintains an outward appearance of calm and coolness and is emotionally detached. 4. The Irrelevant family member seeks to distract others and seemingly has difficulty relating to what is going on in the moment. 5. The Congruent Communicator sends clear, straightforward messages and is genuine. Satir taught family members how to communicate congruently via assisting them to use their senses fully, to get connected with their true feelings, and to be accepting of their feelings. She saw this as the mechanism through which self-esteem is built, and saw self-esteem as providing people with the basis to change dysfunctional relationships. Satir identified a Healthy Family as one in which family members can directly request what they need, get their needs met, and where individuality is supported and encouraged. The SW is a model for the changes the family needs to make. He/she must be congruent and demonstrate how to change dysfunctional communication patterns. The SW teaches family members how to connect with their own feelings, how to listen, and how to verify one's understanding of another member's communication.

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Structural Family Theory (Salvador Minuchin) is based on the premise that all families have an underlying organization, which may be adaptive or maladaptive. Maladaptive patterns of interaction underlie symptoms observed in individual family members. Through observation of family interactions, Structural Family Therapy identifies the maladaptive structural elements that underlie maladaptive family interactions, as well as relationships between the family and nonfamily entities, and then makes changes in these structural elements. Important concepts of Structural Family Theory include: Alignments are coalitions between subsystems in the family that serve a specific purpose. Power hierarchies is a term that refers to the distribution of power in the family. Subsystems are some part of the family (e.g. the parents) Interpersonal boundaries are rules that control the amount of involvement family members have with each other and with others who are not a part of the family. Disengagement occurs when family members and subsystems of the family are isolated from each other emotionally and in terms of their interaction. Enmeshment occurs when family members and subsystems of the family are overly involved and concerned with each other resulting in minimal autonomy in functioning. Complementarity refers to the extent to which different family roles (e.g. husband-wife patterns of providing support to each other) are in harmony with each other. Inflexible family structures are rigid structures that do not lend themselves to being changed in the face of changing family circumstances (e.g. environmental and developmental crises).

Answer 33

Techniques of Structural Family Theory include: Joining has reference to the SW's entrance into the family's interactional system. It includes forming a strong bond with family members, acknowledging the various perspectives of members, and accommodating the family's organization and patterns. Joining is more central to Minuchin's approach. Evaluating family structure refers to the mapping of underlying structures of the family (structural diagnosis, or the identification of the problem and its structural dynamics). Restructuring the family involves changing the family structure via enactment (the process of passing legislation/ acting something out), spontaneous behavior sequences and reframing (e.g. increasing the involvement of an uninvolved father and decreasing the involvement of an overly-involved mother). Enactment means that the SW has the family or a subsystem of the family act out, in session, how they typically deal with a specific type of problem. The enactments are defined and directed by the SW. When the enactment creates a problem, the SW may push family members to continue in the vein they are going or, alternatively, he or she will comment on the problem. Spontaneous behaviors sequences occur when the SW highlights an interaction that is naturally occurring in the moment and assists the family in modifying problem sequences. Reframing means redefining the family's perspective on problems (i.e that they are the problems of individual family members or caused by the environment) as problems with the structure of the family.

Answer 34

Strategic Family Therapy (Jay Haley) emphasizes change techniques over theory. Strategic Family Therapy is consistent with the influence of Milton Erickson's work. Strategic family SWs believe in the possibility of rapid change and use resistance of family members in the services of change. Communication is seen as defining relationships. Every relationship involves a struggle for power; that is, a struggle for who defines the relationship. Symptoms are tactics to control; they define the relationship. The SW is very directive and relieves symptoms by helping patents find alternatives ways of defining relationships. This type of therapy is especially useful with change-resistant families.

Interventions With Clients/ Client Systems; Psychotherapy & CM Flashcards

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