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Question

How Does the Therapist Provide UPR?

Answer 1

The therapist sees the client as a person of worth * The therapist trusts the client* * The therapist is genuine and authentic with the client * good and bad * The therapist aims to communicate empathic understanding of the client’s perspectives * UPR does not mean endorsing all of the client’s behaviors

Answer 2

show compassion * show interest * listen carefully and remember what clients say * affirmations when they are genuine * **making a sincere effort counts no matter how successful it is**

Answer 3

Decades of psychotherapy research confirm that the relationship between therapist and client is a key therapeutic factor * Aspects of Person-Centered Therapy make it not as inclined toward being studied * PCT therapists may have caution toward both assessments and diagnostic labels because they function like conditions of worth * Using diagnoses does not place clients at the center of treatment * The person-centered perspective is that designing treatments for specific disorders (e.g., generalized anxiety disorder or post-traumatic stress disorder) misses the point—which is to treat the individual, not the disorder.

Answer 4

Not as strongly supported by research as some other models * PCT’s emphasis on the self and self- actualization may not work for clients who value collectivistic over individualistic identity and goals

Answer 5

Marsha Linehan oInitially developed as a treatment for women who were exhibiting SI/SIB and suffering from Borderline Personality Disorder (BPD) oHas since been found to be successfully applied to other mental health conditions oAn integrated theory with a basis in CBT

Answer 6

Emotional dysregulation is the cause of psychopathology o Emotional dysregulation occurs because of a combination of biological predisposition, environmental factors, and learning

Answer 7

Biology: emotional responses to environmental stimuli that occur more quickly, are more intense, and have a slower return to baseline than other people Environmental: grew up and/or are currently living in environments that are a poor fit for their emotional sensitivity o Over time, this social environment can become “chronically and pervasively” emotionally taxing and invalidating o Often, people with BPD are survivors of chronic childhood trauma and/or have adverse attachment styles o The people who they depend on and who are a threat to them are often one and the same o Child effectively learns they have to escalate to be heard o Then when punished they might try to regulate using maladaptive behaviors because they don’t have a roadmap for healthy regulation

Answer 8

Dialectical philosophy emphasizes that reality includes opposing forces that constantly shift and change oThrough DBT, clients are encouraged to grapple with both sides of this seeming contradiction and to arrive at greater acceptance of transitory meaning– things will change, two things can be true oPromotes acceptance and tolerance rather than resistance

Answer 9

Mindfulness is a practice that involves paying attention to the present moment without judgment oObserving and making intentional choices rather than automatically acting/reacting

Answer 10

Clients are doing the best they can o Clients want to improve o Clients need to do better, try harder, and be more motivated to change o Clients may not have caused all of their problems, but they have to solve them anyway o Clients must learn new behaviors in all relevant contexts o Clients cannot fail therapy o Therapists treating BPD (and other highly emotional dysregulated clients) need support

Answer 11

Enhancing skills and capabilities o E.g., mindfulness, emotional regulation oImproving client motivation oGeneralizing skills and capabilities from therapy to outside of therapy oStructuring the client’s environment to support and validate the client’s capabilities o*Improving the therapist’s capabilities and motivation to treat patients with BPD*

Answer 12

Individual therapy oGroup skills training oPhone skills coaching between sessions oTherapist consultation team meetings oCan include family sessions

Answer 13

DBT has received empirical validation, including some LT studies, for BPD and other conditions with emotional dysregulation symptoms

Answer 14

Research support is largely for the structured and intensive full DBT protocol oThe full protocol is an intensive commitment

Answer 15

A person-centered counseling approach for addressing the common problem of ambivalence about change * Originally developed to help people with addiction, and later other health- related behaviors, but has since been applied to other areas in which people want to make changes in their lives

Answer 16

Ambivalence: simultaneously wanting and not wanting something, or wanting both of two incompatible things * MI can be used effectively at all stages of change, but is particularly helpful when individuals are in the precontemplation or contemplation stages, where ambivalence is high.

Answer 17

When faced with a client who is ambivalent about whether to make changes, it’s not unusual for professional helpers to be tempted to push clients toward health. Miller and Rollnick (2013) call this the righting reflex. * problematic because when someone feels ambivalent, they are apt to argue the opposite side when pushed in one direction, or at least point out problems and shortcomings of the proposed solution * In doing this, they would be arguing away from change * MI therapists don’t confront or pressure clients * Instead, they use listening skills to encourage clients to talk about the reasons why and why not, and their reasons and motivations for positive change

Answer 18

Open-ended questions * Affirming * Reflecting * Summarizing * Listen for instances of change talk and sustain talk * Research has shown that clients who engage in more change talk are more likely to make efforts toward enacting positive change

Answer 19

In addition to careful listening and other person-centered skills of collaboration, acceptance for the client as a worthy person as-is, and compassion toward the client’s struggles, MI therapists use evocation * Evocation: the process of drawing out a client's own reasons for change, rather than simply providing information or advice

Answer 20

Scaling questions are designed to gauge motivation for change and confidence in one’s ability to change * “How important is [the change] on a scale of 0-10, with 0 being not important at all, and 10 being the most important?” * “How confident are you in your ability to make this change, on a scale of 0-10, with 0 being not confident at all and 10 being the most confident?” * “Why are you a ____ and not a lower number?” * **Why ask it that way instead of the other direction?** * Follow up with reflection (**why?**) * Goal: to move from ambivalence to a plan for change that they feel committed to and capable of pursuing

Answer 21

MI has been found useful for strengthening the motivation for behavioral change in patients with various behaviorally influenced health problems, for promoting treatment adherence, and to optimize medical interventions.

Answer 22

Subjective empathy: Identifying with clients in the here and now through intuition, and imagining your clients’ experiences. Interpersonal empathy: Communication back and forth about clients’ phenomenological experiences (including feedback from clients). Objective empathy: Using theoretical knowledge and resources to better understand clients (Clark, 2010).

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