6645 Midterm Review|6645 Midterm Review LATEST UPDATE.

Mental Research Institute (MRI) assessement technique

Assessment focuses n the symptom(s) and does not look at history. Looks for instances
of circular causality and determines sequences of symptom maintaining behaviors
Who are the theorists associated with MRI?
Watzlawick, Wekland, Fisch, Jackson and Sluzki
sensate focus exercises
exercises designed to reduce anxiety and teach mutual pleasuring through non-genital
touching in non-demanding situations
attachment
seeking closeness in the face of stress
Anxiously attached children
have overly protective and intrusive parents
Avoidantly attached children
have emotionally unavailable parents. The child will make initial attempts at seeking
comfort from his or her caregiver, but when it becomes apparent that the caregiver will
not respond, the child eventually gives up
complimentarity
refers to the reciprocity that is the defining feature of every relationship
process/content
Focus on "how" people talk rather than "what" they talk about; the most productive shift
a family therapist can make; focusing on the underlying processes that are contributing
to the content is key
enmeshment
offers access to support, but at the expense of independence. Enmeshed parents are
loving and attentive; however, their children tend to be dependent and may have trouble
relating to people outside their family
family life cycle
a series of stages determined by a combination of age, marital status, and the presence
or absence of children
Narrative Therapy
emphasizes the fact that families with problems come to therapy with defeatist
narratives that tend to keep them from acting effectively-Michael White
Personal Construct Theory
According to George Kelly, we make sense of the world by creating our own constructs
of the environment. We interpret and organize events, and we make predictions that
guide our actions on the basis of these constructs.
Reframing techniques
Process of redefining events from a different point of view; relabeling behavior to shift
how family members respond to it
constructivism
teaches us to look beyond behavior to the ways we interpret our experience. Moreover,
in a world where all truth is relative, the perspective of the therapist has no more claim
to objectivity than that of the clients
social constructionism
a sociological theory that argues that people actively shape their reality through social
interaction; it is therefore something that is constructed, not inherent; it looks to uncover
the ways in which individuals and groups participate in the construction of their
perceived social reality
Solution Focused Therapy
the best way to solve a problem is to discover what people do when they're not having
the problem
triangles in family therapy
Relationship problems often turn out to be triangular (Bowen, 1978), even though it may
not always be apparent
cybernetics
when a family functions like a closed system, the response to a problem may actually
perpetuate it; to employ this concept clinically, therapists simply identify how family
members have been responding to their problems and then get them to try something
different.
Bowen Family Systems Therapy
1. Two counterbalencing life forces are togetherness and individuality
2. Differentation of self
3. Relationship Triangles
4. Understanding not problem-solving is the goal-ask process questions
5. Use of genograms to outline relational dynamics
Murray Bowen
one of the pioneers of family therapy, emphasized theory as opposed to technique,
distinguishing his work from the more behaviorally oriented family therapists. Bowen’s
extended family systems model is the most comprehensive theory in family therapy.
The goal in the Bowenian model is differentiation of self, namely, the ability to remain
oneself in the face of external influences, especially the pressures of family life
Philip Guerin
Guerin's highly articulated model outlines several therapeutic goals, which emphasize
the multigenerational context of families, working to calm the emotional level of family
members, and defining specific patterns of relationships within families
differentiation of self
cornerstone of Bowen's theory is both an intrapsychic and an interpersonal concept;
roughly analogous to ego strength; is the capacity to think and reflect, to not respond
automatically to emotional pressures; it is the ability to be flexible and act wisely, even
in the face of anxiety
A differentiated person
capable of strong emotion and spontaneity but also possessing the self-restraint that
comes with the ability to resist the pull of emotionality
Emotional Triangle
Virtually all relationships are shadowed by third parties—relatives, friends, even
memories and driven by anxiety
triangulation
lets off steam but freezes conflict in place. It isn't that complaining or seeking solace is
wrong, but rather that triangles become chronic diversions that undermine relationships.
unifferentiated family ego mass
describe an excess of emotional reactivity, or fusion in families. If you know someone
who overreacts to what you're trying to say because he or she is given to emotional
outbursts, then you know how frustrating it can be to deal with emotionally reactive
people
T or F: Lack of differentation in a family produces reactive children
True: manifests as emotional overinvolvement or emotional cutoff from the parents,
which in turn leads to fusion in new relationships—because people with limited
emotional resources tend to project all their needs onto each other. Because this new
fusion is unstable, it is likely to produce one or more of the following: (1) emotional
distance; (2) physical or emotional dysfunction in one partner; (3) overt conflict; or (4)
projection of discord onto children
emotional cutoff
Describes how some people manage anxiety in relationships. Some people seek
distance by moving away; others do so emotionally by avoiding intimacy or insulating
themselves with the presence of third parties
Process
patterns of emotional activity
process questions
Bowenian technique where questions designed to help family members think about their
own reactions to what others are doing to foucs on rational planning and personal
responsibility
relationship experiment
Second major technique in Bowenian therapy designed to help clients try something
different from their usual emotionally driven responses. Some of these experiments may
help resolve problems, but their primary purpose is to help clients develop the ability to
resist being driven by their emotions
Self-focus
A cornerstone of Bowenian couples therapy in addition to reducing anxiety
I-positions
Therapeutic technique in which clients are encouraged to make non-reactive
observations and statements of opinion, in order to define their positions as
differentiated selves.
Anxiety & differentiation
Two pivotal concepts in Bowenian Therapy
extended family systems therapy
Murray Brown
Viewed dysfunction as part of intergenerational process
Goals/Techniques - differentiation of self in all family members
Genograms
Triangulation w/ tx
Skowron's Differentiation of Self Inventory (DSI)
An assessment that contains four subscales:
1. Emotional Cutoff
2. "I"-Position
3. Emotional Reactivity
4. Fusion with others
DSI
correlates with chronic anxiety, psychological stress, and marital satisfaction
Chabot Emotional Differentiation Scale
designed to measure the intrapsychic aspect of differentiation—the ability to think
rationally in emotionally charged situations
Multigenerational Transmission Process
In Bowenian family therapy, the process by which roles, patterns, emotional reactivity,
and family structure are passed from one generation to another. Poorly differentiated
individuals tend to marry one another and over several generations produce offspring
who are increasingly less differentiated and as a result suffer from severe mental
disorders including schizophrenia.
Bowenian Techniques
1. Genograms
2. Neutralizing triangles
3. Using process questions
4. Relationship experiments
5. Coaching as a means of avoiding triangles
6. "I"-positions-create a stabilizing effect
Strategic therapy
MRI's bief therapy, Haley and Madane's, Milan systemic model which were all
developed at the Mental Research Institute (MRI), where strategic therapy was inspired
by Gregory Bateson and Milton Erickson, the anthropologist and the alienist
paradoxical interventions
A technique used in strategic therapy whereby the therapist directs family members to
continue their symptomatic behavior. If they conform, they admit control and expose
secondary gain; if they rebel, they give up their symptoms.
first-order change
When only a specific behavior within a system changes.
second-order change
When the rules of a system change.
The MRI Approach
(1) identify positive-feedback loops that maintain problems;
(2) determine the rules that support those interactions
(3) find a way to change the rules in order to interrupt problem-maintaining behavior.
hierarchical structure
Family functioning based on clear generational boundaries, where the parents maintain
control and authority.
Prescribing ordeals
An Erickson technique: A type of paradoxical intervention in which the client is directed
to do something that is more of a hardship than the symptom.
The goals of an MRI assessment are:
1) define a reasonable complaing
2) identify attempted solutions that maintain complaing
3) understand the client's unique language for understanding the problem; The first two
goals show where to intervene; the third suggests how.
Milan Model Assessment
Begins with a preliminary hypothesis, which often assumes that the identified patient's
problems serve a protective function for the family. Therefore, assessments of the
presenting problem and the family's response to it are based on questions designed to
explore the family as a set of interconnected relationships
Milan Model Assessment
The ultimate goal of assessment is to achieve a systemic perspective on the problem.
MRI Approach
1. Introduction to the treatment setup.
2. Inquiry and definition of the problem. 3.Estimation of the behavior maintaining the
problem.
4.Setting goals for treatment.
5.Selection and making behavioral interventions. 6.Termination.
Haley & Madanes (Strategic family therapy)
--Formulated that rules followed a hierarchical order; improving the hierarchical and
boundary problems would prevent dysfunctional feedback loops from starting, a sort of
"plan ahead" strategy.
--Believe families go through dysfunctional stages to get to functional ones.
--Focused on behavioral change, arguing that before the family can think or feel
differently, they must act differently.
directives
Cornerstone of the Haley Madanes approach of thoughtful suggestions targeted to the
specific requirements of each case.
interactional stage
In the Haley/Madanes approach encouraged them to discuss their points of view among
themselves; the therapist can observe, rather than just hear about, the interchanges
that surround the problem
Pretend Techniques (Haley and Madanes)
Have family to pretend to have the symptom together.
Eg: telling lies
object relations theory
We relate to others on the basis of expectations formed by early experience
internal objects
mental images of self and others built up from experience and expectation
anaclitic depression
an illness described by Spitz describing the behaviors of excessive crying, sleep
difficulties, and physical illness; a turning away from the world and withdrawal into
apathy as a result of failed attachment
prjective identification
the subject perceives an object as if it contained unwelcome elements of the subject's
personality and evokes responses from the object that conform to those perceptions
psychoanalytic theory, psychoanalytic technique
There are four basic techniques: listening, empathy, interpretations, and analytic
neutrality
affect
signal of intrapsychic conflict;
Four Channels of psychoanalytic family therapists
(1) internal experience
(2) the history of that experience
(3) how family members trigger that experience
(4) how the context of the session and therapist's input might contribute to what's going
on between family members
arbitrary inference
a cognitive distortion where the individual draws a conclusion without any evidence
selective abstraction
A cognitive distortion that involves forming conclusions based on an isolated detail of an
event.
Overgeneralization
a cognitive distortion where isolated incidents are taken as general patterns