MFT Exam Flashcards
(248 cards)
1
Q
Circular Causality
A
Systems theory views causality as circular (recursive) rather than linear. In other words, A influences B which influences A which influences B, etc.
2
Q
Common Factors
A
Common factors are also referred to as nonspecific factors and are common to most forms of therapy. According to Lambert (2003), 30% of variability in psychotherapy outcomes is attributable to common factors (e.g., the therapeutic relationship, person-centered facilitative conditions, insight and other learning factors).
3
Q
Cybernetics
A
Cybernetics is concerned with systems that are self-regulating via negative and positive feedback loops. A negative feedback loop reduces deviation and helps a system maintain the status quo, while a positive feedback loop amplifies deviation and disrupts the status quo.
4
Q
Negative Feedback Loop
A
A negative feedback loop reduces deviation and helps a system maintain the status quo
5
Q
Positive Feedback Loop
A
A positive feedback loop amplifies deviation and disrupts the status quo
6
Q
Double-Bind Hypothesis
A
As described by Bateson, Jackson, Haley, and Weakland (1956), double-bind communication is an etiological factor for schizophrenia and involves conflicting messages - e.g., “do that and you’ll be punished” and “don’t do that and you’ll be punished” - with one message often being expressed verbally and the other nonverbally. In addition, the recipient of the contradictory messages is not allowed to comment on them or seek help from someone else.
7
Q
Empirically Supported Treatments
A
Empirically supported treatments (ESTs) are treatments that have been found to be effective by experimental studies that meet rigorous research criteria for a particular client population experiencing a particular disorder or condition.
8
Q
Evidence-Based Practice
A
Evidence-based practice involves combining clinical expertise and research evidence (e.g., research on empirically supported treatments and common factors) to identify the best treatment for a particular client given his/her unique characteristics and circumstances.
9
Q
Family Resilience Framework (Walsh)
A
Walsh’s (2006) family resilience framework was designed to guide clinical assessment and intervention when working with families facing stressful situations and identifies the key processes that strengthen a family’s resilience. These processes are categorized in terms of three domains: family belief systems, family organization patterns, and family communication processes.
10
Q
Who Designed the Family Resilience Framework?
A
Family Resilience Framework (Walsh)
11
Q
Family Resilience Framework: Three Domains
A
Family belief systems, family organization patterns, and family communication processes.
12
Q
First-Order Change
A
A first-order change is temporary or superficial and does not alter the family system (e.g., does not alter the system’s fundamental rules).
13
Q
Does not alter the system’s fundamental rules
A
First-Order Change
14
Q
Second-Order Change
A
A second-order change is permanent and involves a fundamental change in the family system (e.g., an alteration in the system’s fundamental rules).
15
Q
An alteration in the system’s fundamental rules
A
Second-Order Change
16
Q
General Systems Theory
A
General systems theory was proposed by the biologist von Bertalanffy who defined a system as an entity that is maintained by the mutual interactions of its components and proposed that the actions of interacting components are best understood by studying them in their context.
17
Q
Who Proposed General Systems Theory?
A
Biologist - Von Bertalanffy
18
Q
Homeostasis
A
Homeostasis is the tendency for a family (or other system) to act in ways that maintain its equilibrium (customary way of functioning) over time and to resist change.
19
Q
Identified Patient
A
The identified patient is the “symptom bearer” who has brought the family to therapy and who is identified by other family members as the person with the problem.
20
Q
“symptom bearer”
A
The identified patient is the “symptom bearer” who has brought the family to therapy and who is identified by other family members as the person with the problem.
21
Q
Indications For Couple Therapy
A
Couple therapy is likely to be effective when the presenting problem is clearly related to the couple’s relationship; the development of problems in one partner coincided with the onset of relationship conflict; or the couple is thinking about ending their relationship and wants to resolve issues with the help of a therapist.
22
Q
Contraindications For Couple Therapy
A
Couple therapy may be contraindicated when domestic violence is currently present in the relationship; one partner is so severely disturbed that his/her behavior makes couple therapy impossible; or one partner is having an affair and is unwilling to admit to or give up the affair.
23
Q
Indications for Family Therapy
A
Family therapy is likely to be effective when a family member’s symptoms are manifestations of problems in the family system; improvement in one family member is likely to cause (or has caused) the development of symptoms in another family member; or a family member has symptoms that are known to be effectively treated by family therapy (e.g., substance abuse, an eating disorder, conduct disorder).
24
Q
Contraindications for Family Therapy
A
Family therapy may be contraindicated when a family member’s presenting problem is not related to family functioning; key family members are unavailable or unwilling to participate in family therapy; or one family member is so severely disturbed that his or her behavior makes family treatment impossible.
25
Models Of Family Functioning
A number of models have been developed that conceptualize the "healthy family" in terms of optimal family functioning. The McMaster model, Olson's circumplex model, and the Beavers systems model are models of family functioning that are based on a systems approach and provide assessment instruments to evaluate the aspects of functioning identified by the models.
26
Second-Order Cybernetics
Second-order cybernetics asserts that an observer of a system is always part of the system and both influences and is influenced by the system.
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Cybernetics of cybernetics
Second-Order Cybernetics
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First-order cybernetics
First-order cybernetics which assumes that an observer can study and alter a system while remaining separate from it.
29
Social Constructionism
A strand of postmodernism that is based on the assumption that knowledge is constructed through social interactions and is context dependent.
30
Stages Of Psychosocial Development (Erikson)
Erikson's theory of personality development proposes that the individual faces different psychosocial crises at different points throughout the life span.
31
Advertisements
Guidelines for advertisements are provided in state laws and the Code of Ethics. For example, Standard 9.1 requires MFTs to "accurately represent their competencies, education, training, and experience," and Standard 9.2 requires them to "ensure that advertisements and publications in any media are true, accurate, and in accordance with applicable law." In addition, Standard 9.8 requires MFTs to "correct, wherever possible, false, misleading, or inaccurate information and representations made by others concerning the therapist's qualifications, services, or products."
32
Barter
Barter is addressed in Standard 8.5 of the Code of Ethics, which states that accepting goods or services from clients should ordinarily be avoided but may be acceptable only when "(a) the supervisee or client requests it; (b) the relationship is not exploitative; (c) the professional relationship is not distorted; and (d) a clear written contract is established."
33
Accepting goods or services from clients should ordinarily be avoided but may be acceptable only when (3)
"(a) the supervisee or client requests it; (b) the relationship is not exploitative; (c) the professional relationship is not distorted; and (d) a clear written contract is established."
34
Child Abuse
The exact provisions of state reporting laws vary, but all states (a) require therapists to make a report to an appropriate authority whenever they know or suspect that child abuse has occurred and (b) grant reporters immunity from civil or criminal liability when the report has been made in good faith. There are no time limits on child abuse reporting: As long as the victim is still a minor, therapists have an obligation to file a report of child abuse.
35
Client Records
MFTs are ethically and legally obligated to maintain adequate client records. The ownership of client records is governed by law; but, in general, the therapist or organization where the therapist works owns the physical record, while the client owns the content of the record. Client access to records is addressed in the Code of Ethics and HIPAA: Standard 2.3 of the Code requires MFTs to provide clients with "reasonable access" to their records, but HIPAA's Privacy Rule states that clients may be denied access to his or her personal health information when a provider believes that access "is reasonably likely to endanger the life or physical safety" of the client or other person.
36
Confidentiality
Confidentiality is derived from the right to privacy and refers to the obligation to protect clients from unauthorized disclosure of information revealed in the context of a professional relationship. Maintaining client confidentiality is both an ethical obligation and legal requirement.
37
Insurance Fraud
Insurance fraud is both unethical and illegal. Acts that constitute insurance fraud include routinely waiving copayments without informing the insurance company; assigning an inaccurate diagnosis in order to be paid by the insurance company; and billing the insurance company for a missed appointment without making it clear that the appointment was missed.
38
Insurance Fraud
Insurance fraud is both unethical and illegal. Acts that constitute insurance fraud include routinely waiving copayments without informing the insurance company; assigning an inaccurate diagnosis in order to be paid by the insurance company; and billing the insurance company for a missed appointment without making it clear that the appointment was missed.
39
Interruption of Therapy
Standard 1.9 of the Code of Ethics requires MFTs to continue a therapeutic relationship only as long "as it is reasonably clear that clients are benefiting from the relationship," and Standard 1.11 prohibits MFTs from abandoning or neglecting clients who are receiving treatment "without making reasonable arrangements for the continuation of treatment."
40
Termination of Therapy
Appropriate actions to take when it's necessary to terminate therapy include discussing termination with clients to identify and resolve their concerns, providing pretermination counseling, and making referrals to other therapists.
41
Personal Problems
MFTs are obligated to take appropriate action whenever personal problems or other factors might interfere with their ability to provide effective professional services. For example, Standard 3.3 of the Code of Ethics requires MFTs to "seek appropriate professional assistance for issues that may impair work performance or clinical judgment."
42
Holder Of The Privilege
The client is ordinarily the "holder of the privilege," but a therapist can claim the privilege on behalf of a client, and there are legally defined exceptions to privilege.
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Privilege
Privilege is a legal concept that protects a client's confidentiality in the context of legal proceedings.
44
Referral Fees
Standard 8.1 of the Code of Ethics prohibits MFTs from accepting or paying "kickbacks, rebates, bonuses, or other remuneration for referrals." Note, however, that referral fees are acceptable when they represent the actual costs of making the referral.
45
Response to a Subpoena
Response to a Subpoena
(1) The first step is to determine if the subpoena is a legally valid demand. (2) If the subpoena is valid, a response is required (e.g., the recipient must appear in court at the time requested), but the therapist should first contact the client to discuss the implications of providing the requested information. (3) If the client consents to disclosure and there is no valid reason for withholding the information, the therapist should provide the requested information. If the client does not consent, the therapist or his/her attorney can attempt to negotiate with the party who issued the subpoena. (4) If the client does not consent and the requesting party continues to demand that the information be provided, the therapist can seek guidance from the court. (5) When a request for confidential information arises for the first time during testimony at a deposition or in court, the therapist should claim the privilege on the client's behalf and refuse to provide the information until ordered by the court or authorized by the client or the client’s legal representative to do so.
46
Scope Of Competence
MFTs are legally and ethically required to practice within their scope of competence, which refers to the limits of what an MFT is qualified to do based on his or her education, training, and experience.
47
Sexual Misconduct
Sexual misconduct is addressed in laws and the Code of Ethics: Standards 1.4 and 1.5 of the Code prohibit MFTs from engaging in sexual intimacy with current and former clients and with "known members of the client’s family system." Standard 4.3 prohibits MFTs from engaging "in sexual intimacy with students and supervisees during the evaluative or training relationship between the therapist and student or supervisee."
48
Technology-Assisted Professional Services
Technology-assisted professional services refer to diagnosis, treatment, supervision, and other professional services that are provided using telecommunication technologies (e.g., the telephone or Internet). Ethical guidelines for these services are provided in Standard VI of the Code of Ethics. For example, Standard 6.1 requires MFTs to "(a) determine that technologically-assisted services or supervision are appropriate for clients or supervisees, considering professional, intellectual, emotional, and physical needs; (b) inform clients or supervisees of the potential risks and benefits associated with technologically-assisted services; (c) ensure the security of their communication medium; and (d) only commence electronic therapy or supervision after appropriate education, training, or supervised experience using the relevant technology.
49
Unpaid Fees
MFTs may terminate therapy with a client because the client has not paid his/her fees but must take appropriate steps before doing so. These steps include discussing the policy for nonpayment of fees during the informed consent process, giving the client a reasonable period of time to pay outstanding fees before terminating therapy, and sending a letter to the client informing him/her of what action will be taken if the fee is not paid. Although MFTs may use a collection agency to collect unpaid fees, they must give the client an opportunity to pay the fees that are owed within a specified period of time before doing so and then give the collection agency only essential information (Standard 8.3). In addition, MFTs must not withhold client records solely because of nonpayment of fees (except where allowed by law) when those records "are requested and needed for a client's treatment" (Standard 8.6).
50
Unprofessional Conduct
Examples of unprofessional conduct by MFTs and MFT interns are provided in state laws and the Code of Ethics. For example, Standard 3.12 of the Code identifies the following as unprofessional conduct that may result in termination of membership in AAMFT or other appropriate action: conviction of any felony or of a misdemeanor related to an MFT's qualifications and functions; suspension or revocation of licensure; continuing to provide professional services when impaired by physical or mental causes or abuse of alcohol; and failing to cooperate with AAMFT's investigation and resolution of an ethical complaint.
51
Indicators of Child Emotional Maltreatment - Child
Child indicators are extremes in behavior, consistently makes derogatory remarks about him/herself, has attempted suicide, has a habit disorder, and reports a lack of attachment to the parent or caregiver.
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Indicators of Child Emotional Maltreatment - Adult
Parent/caregiver indicators are constantly blames or belittles the child, is unconcerned about the child, overtly rejects the child, abuses alcohol or drugs, and reports being maltreated as a child.
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Indicators Of Child Neglect - Child
Child indicators are frequently absent from school, begs or steals food or money, lacks medical or dental care, is consistently dirty, lacks appropriate clothing, and reports there is no one at home to provide care.
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Indicators Of Child Neglect - Adult
Parent/caregiver indicators are indifference to the child, chronic illness or mental disorder, and reports being neglected as a child.
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Indicators Of Child Physical Abuse - Child
Child indicators are unexplained burns, bruises, etc. that vary in stage of healing, wears clothing to hide injuries, is afraid of parents/caregivers, and reports being physically mistreated.
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Indicators Of Child Physical Abuse - Adult
Parent/caregiver indicators are offers conflicting or unconvincing explanation for child's injury, describes the child in negative ways, uses harsh discipline, abuses alcohol or drugs, has poor impulse control, and reports being physically abused as a child.
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Indicators Of Child Sexual Abuse - Child
Child indicators are difficulty walking or sitting, sudden disturbances in sleep and changes in appetite, sudden onset of anxiety, depression, or other symptoms, unusual sexual behavior or knowledge, abuses alcohol or drugs, and reports being sexually abused.
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Indicators Of Child Sexual Abuse - Adult
Parent/caregiver indicators are overly protective or jealous of or disinterested in the child, socially isolated, distorted perception of the child's role, and reports being sexually abused.
59
Indicators Of Elder/Dependent Adult Financial Abuse
Indicators in the adult victim include unusual activity in bank account; unpaid bills or lack of medical care or amenities despite adequate financial resources; has changed will or property title in a way that benefits "new friends or relatives"; has signed documents he/she can't understand; and reports loss or theft of money, jewelry, etc.
60
Indicators Of Elder/Dependent Adult Physical Abuse
Indicators in the adult victim include physical injuries that have not been cared for properly, are in various stages of healing, and/or are incompatible with explanations for them; signs of physical restraint; evidence of inadequate or inappropriate medication; fear, depression, confusion, agitation, and/or other behavioral signs; frequent use of emergency rooms or "doctor-shopping"; and reports being hit, slapped, kicked, or mistreated.
61
Indicators Of Elder/Dependent Adult Sexual Abuse
Indicators in the adult victim include complains about abdominal pain, unexplained vaginal or anal pain or bleeding, or recurrent genital infections; has unexplained changes in behavior (e.g., aggression, withdrawal); and reports being sexually assaulted.
62
Indicators of Intimate Partner Violence
The female survivor of IPV may complain of insomnia and physical symptoms; have symptoms of PTSD, chronic anxiety, or depression; report suicidal ideation or attempts; have obvious injuries at various stages of healing and/or a history of frequent emergency room visits for injuries with questionable explanations for those injuries; exhibit anxiety or fear while being interviewed; and be fearful of her partner and turn to her partner before answering questions. The male perpetrator may consistently speak for his partner, be overly overprotective of and condescending toward her, and attempt to control the situation.
63
Interventions For Clients Who Pose A Danger To Others
The appropriate intervention depends on level of risk and causes of the violent behavior. Voluntary hospitalization of a client who is a danger to others is usually an option before initiating an involuntary hold. However, involuntary hospitalization must be considered when the danger the client poses is imminent and due to a mental disorder or chronic alcoholism and the client has refused or is unable to comply with the recommendation to enter a psychiatric hospital voluntarily. Outpatient management is indicated when the client is sincere in his/her desire to change and the risk for violence is low.
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Response to a Crisis
(a) Cognitive symptoms: flashbacks, intrusive thoughts, nightmares, and impaired memory, concentration, and decision-making. (b) Affective symptoms: shock, disbelief, fear, anger, irritability, anxiety, sadness, guilt/shame, sense of helplessness, feelings of loss/emptiness, and fear of losing control. (c) Behavioral symptoms: difficulty with activities of daily living, social withdrawal, inability to perform work-related tasks, behavior that is inappropriate/inconsistent with thoughts/feelings, impulsive and dangerous actions, and substance abuse. (d) Physical symptoms: sleep disturbances, appetite changes, muscle tension, nausea and diarrhea/constipation, sweating, hyperventilation, agitation, headaches, and exaggerated startle response.
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Risk Factors For Child Maltreatment
(a) Child risk factors: low birth weight and prematurity, difficult temperament, chronic illness, physical disability, emotional disorder. (b) Parent/caregiver risk factors: lack of understanding child development, poor parenting skills, justification of maltreatment, family history of child maltreatment, substance abuse and/or mental health problems, demographic factors (young age, low education/income, single parent). (c) Family risk factors: nonbiological, transient caregivers; social isolation; and family disorganization, dissolution, or violence. (d) Community risk factors: community violence, disadvantaged neighborhood (unemployment and poverty, residential instability).
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Risk Factors For Lethality In Intimate Partner Violence
Risk factors for lethality include the following: (a) The survivor fears being seriously injured by the perpetrator. (b) The survivor and/or perpetrator have a history of uncontrolled continuous use of alcohol or other substance. (c) The perpetrator is obsessed with his partner and has negative reactions to her autonomy. (d) The perpetrator has used a weapon against his partner or threatened to kill his partner, has engaged in sadistic violence or other bizarre forms of violence, or has been convicted for a violent crime or violated a restraining order.
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Risk Factors For Suicide
The primary risk factors for suicide include (a) suicidal thoughts and behaviors (e.g., suicidal threats, giving away possessions, a specific suicide plan with access to lethal means, history of previous attempts); (b) certain psychiatric diagnoses (e.g., Major Depressive Disorder, Bipolar Disorder) and psychiatric symptoms (e.g., feelings of hopelessness, dysphoria, severe anxiety); (c) certain psychosocial factors (e.g., chronic stress or a recent severe stressor, lack of social support, family history of suicide or mental illness); and (d) specific demographic characteristics (older age, male gender, non-Hispanic White or American Indian, and divorced, widowed, or single).
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Robert's Seven-Stage Crisis Intervention Model (R-SSCIM)
Roberts's (2000) seven-stage crisis intervention model has been applied to a variety of situational and maturational crises. It stages, in order, are: conduct a thorough crisis assessment; establish rapport; identify major problems; explore feelings and provide support; generate and explore alternatives; develop and implement an action plan; plan follow-up sessions.
69
Situational Crises
A situational crisis is triggered by a sudden, uncontrollable, and usually unanticipated event that threatens the person's sense of psychological, biological, and/or social well-being (e.g., serious physical illness, unexpected death of a loved one)
70
Maturational Crises
Maturational (developmental) crisis is embedded in developmental processes and occurs when a person is struggling with the transition from one life stage to another (e.g., transition from childhood to adulthood, change in social status).
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Delusion
A false belief that is based on an incorrect inference about reality.
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Illusion
A misinterpretation of a real external stimulus.
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Hallucination
Hallucinations are sensory perceptions that occur without external stimulation of the relevant sensory organ. Example: Voices that don't exist
74
Narcissistic Personality Disorder
A pervasive pattern of grandiosity, a need for admiration, and a lack of empathy.
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The essential feature of Borderline Personality Disorder
A pervasive pattern of instability in interpersonal relationships, self-image, and affect and marked impulsivity.
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Histrionic Personality Disorder
A pervasive pattern of emotionality and attention-seeking.
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Antisocial Personality Disorder
Characterized by a pattern of disregard for and violation of the rights of others.
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Schizoid Personality Disorder
A pervasive pattern of detachment from social relationships and a restricted range of emotional experience and expression that begins by early adulthood.
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Schizotypal Personality Disorder
Involves deficits in interpersonal relationships, as well as peculiar communication, thinking, appearance, and behavior.
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Schizoaffective Disorder involves characteristics of both...
Characteristics of both Schizophrenia (psychotic) and a Mood disorder/symptoms
81
Social Phobia
Involves an irrational fear of situations in which the individual is exposed to the scrutiny of others.
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Cyclothymic Disorder
Involves the presence of numerous periods of hypomanic symptoms that do not meet the criteria for a hypomanic episode and numerous periods of depressive symptoms that do not meet the criteria for a major depressive episode.
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Administering the Beck Depression Inventory-II would give you information about...
How depressed the woman is, but not about her history and other relevant data you would need for an accurate and complete assessment.
84
Obtaining hospital records would give you some needed information...
Such as previous diagnosis, length of stay, and prescribed medications. However, you need even more information for a complete assessment.
85
The diagnosis of Brief Psychotic Disorder requires...
The presence of one or more of four characteristic symptoms with at least one symptom being delusions, hallucinations, or disorganized speech and with symptoms being present for at least one day but less than one month. Symptoms often develop after exposure to an overwhelming stressor, but this is not required for the diagnosis.
86
A diagnosis of Schizophrenia requires...
The presence of at least two active-phase symptoms for at least one month with at least one symptom being delusions, hallucinations, or disorganized speech plus continuous signs of the disorder for at least six months.
87
The symptoms of Schizophreniform Disorder are similar to those of Schizophrenia but have a duration of...
One to six months
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Schizoaffective Disorder is the appropriate diagnosis when the individual has a history of concurrent symptoms of Schizophrenia and a manic or major depressive episode with at least ...
Two weeks without prominent mood symptoms
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Panic Disorder requires...
Recurrent unexpected panic attacks with at least one attack being followed by one month of persistent concern about having additional attacks or about their consequences and/or involving a significant maladaptive change in behavior related to the attack.
90
Illness Anxiety Disorder involves...
A preoccupation with having a serious illness, an absence of somatic symptoms or the presence of mild somatic symptoms, a high level of anxiety about one's health, and performance of excessive health-related behaviors or a maladaptive avoidance of doctors, hospitals, etc.
91
Specific Phobia is characterized by...
Intense fear of or anxiety about a specific object or situation, with the individual either avoiding the object or situation or enduring it with marked distress.
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For Kubler-Ross, the five stages of reacting to the death of a loved one or the knowledge that one is going to die soon include, in sequence...
Denial, anger, bargaining, depression, and acceptance. (Remember the acronym DABDA.)
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Bowlby's adaptation to separation model
Which describes the reaction of young children who are separated for a long period of time from their primary caretakers.
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Bowlby's model includes, in order...
Protest, despair, and indifference (or detachment).
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Symptoms of major depressive disorder are often exhibited in older adults...
Memory loss and forgetfulness. These symptoms are not due to any brain abnormalities.
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The term "pseudodepression" is used to describe...
Physiologically-induced lethargy, apathy, and withdrawal.
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Major Neurocognitive due to Alzheimer's disease
A form of a neurocognitive disorder that is associated with brain deterioration that may often be apparent in a CT scan.
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Vascular neurocognitive disorder
A form of a neurocognitive disorder and would not be associated with a negative CT scan.
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Genogram
A schematic diagram of a family's relationships and usually includes at least three generations.
100
A primary purpose of a genogram is to...
To identify behavior patterns that recur in the family.
101
According to Bateson (as well as Jackson, Haley and Weakland), a double-bind must have the following features or characteristics:
Two or more people involved in an ongoing relationship; one person in the relationship has more power than the other; the person without power cannot escape from the relationship; two or more contradicting or conflicting injunctions are given to the person with less power
102
Disruptive Mood Dysregulation Disorder
Characterized by severe recurrent temper outbursts with an irritable or angry mood between outbursts.
103
According to second-order cybernetics...
Objectivity is impossible because the therapist becomes a part of the observed system. The system does not create a problem; the problem creates a system.
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A "classic" symptom of major depressive disorder is:
Sleep disturbance (insomnia or hypersomnia) is one of the three "classic" symptoms of major depressive disorder.
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Paranoid Personality Disorder
Involves a pervasive distrust and suspiciousness of others that leads to the misinterpretation of the motives of others as malevolent.
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Obsessive-Compulsive Personality Disorder
Involves a pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency.
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Antisocial Personality Disorder
Involves a pervasive pattern of disregard for and violation of the rights of others. You have no evidence of antisocial acts in this case.
108
Compensatory behavior is a diagnostic criterion for __________ but not for ____________ and, therefore, differentiates the two disorders.
Compensatory behavior is a diagnostic criterion for Bulimia Nervosa but not for Binge Eating Disorder and, therefore, differentiates the two disorders.
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The disturbance in body image associated with _____________ involves an excessive emphasis on body shape and weight in self-evaluation.
The disturbance in body image associated with Bulimia Nervosa involves an excessive emphasis on body shape and weight in self-evaluation.
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Compensatory behavior is not a requirement for _____________.
Compensatory behavior is not a requirement for Binge Eating Disorder.
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Dysmenorrhea
A medical condition that is characterized by physical pain during menstruation.
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Cyclothymic Disorder
Which involves alternating periods of hypomanic and depressive symptoms.
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Malingering
Involves the voluntary production of false or grossly exaggerated physical or psychological symptoms for the purpose of obtaining an external reward.
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Disengagement
A structural term that describes behavior in which people are psychologically isolated.
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Joining
A structural term for accepting and accommodating to families in order to win their confidence and overcome resistance.
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Diffuse
A term used to describe a boundary that is confused or blurred
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Insight
An individual's understanding of what motivates their behavior
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Reflective listening
An intervention where the listener tries to clarify and restate what the other person is saying
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Behavioral reinforcement
Is intended to be used to increase the frequency of a particular behavior
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Reframing
This involves re-interpreting the Clt's intrusive behavior from a positive perspective instead of a negative one.
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A primary goal of Bowenian therapy
Differentiation of Self: The patient is better able to separate thinking from feeling
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Differentiation of Self
The patient is better able to separate thinking from feeling - involves taking the "I" position, which is roughly the same as speaking for onself.
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According to family systems theory...
A family operates in a way that allows it to maintain its balance or homeostasis, even if this balance is dysfunctional.
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Sager proposed that marriage contracts exist on three levels:
(1) The first level, conscious verbalized, is what each mate tells the other clearly and directly about his/her expectations. (2) Level two, conscious but not verbalized, includes the expectations, beliefs, fantasies, etc., of each partner, that are not verbalized because fear or shame is connected with their disclosure. (3) The third level is beyond awareness, and includes each partner's unconscious and unverbalized desires and needs.
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Chomsky's linguistic theory
Which proposes that language includes two structures: surface (the words and organization of sentences) and deep (the underlying meaning of a sentence).
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Bowen, the theorist most associated with extended family systems therapy, encourages therapists to...
Eencourages therapists to remain neutral and objective (i.e., to avoid becoming emotionally triangled) and to assume the role of an active expert, or "coach."
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Enmeshment
Is said to exist when there are diffuse psychological boundaries between subsystems and between individuals. In enmeshed families, autonomy is lost and there is a high degree of reactivity between individuals.
128
According to Jackson's "redundancy principle," repetitive family behaviors can be viewed as a reflection of which of the following?
Redundancy refers to all of a family's behaviors that regularly repeat themselves. The observation of redundancies in family interactions permits the therapist to recognize the "rules" that exist between family members. These rules govern the behavior and interaction patterns of family members.
129
According to Minuchin, ________________ in enmeshed families are weak and poorly differentiated.
According to Minuchin, boundaries in enmeshed families are weak and poorly differentiated. Enmeshment results in a loss of autonomy and is characterized by a high degree of resonance or reactivity between individuals.
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Catharsis
The emotional release of repressed, unconscious material and affords a client insight into the relationship between his/her behavior and unconscious processes.
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Transference
A client's experience of feelings, attitudes, fantasies, etc. toward the therapist that represent a projection or displacement and repetition of reactions to a significant other in the client's past.
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Countertransference
Is the therapist's unconscious emotional responses toward a client. According to Freud, such responses can interfere with the therapist's objectivity.
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Mimesis
Literally means imitation. It is used to accommodate to a family's style, tempo, and affective range; i.e., to join with a family - Structural Family therapy
134
According to Satir, which of the following is most characteristic of the way a mature person communicates with others?
According to Satir, a mature person is in touch with his/her feelings, communicates clearly with others, and views differentness as an opportunity for growth rather than as a threat.
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Self-instructional training
Self-instructional training is a cognitive-behavioral method developed by Meichenbaum which usually involves five steps, from observation to performance of a target behavior. It has been used successfully in teaching hyperactive children basic problem-solving skills.
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Negative Transference
The patient has unconsciously projected feelings and attitudes from her past that were originally associated with her stepfather onto the therapist.
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Resistance
In psychoanalysis, resistance is a client's reluctance to talk about certain material in session.
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A client is seeing an Existential therapist. What kinds of interventions and approaches should the client expect?
Therapy will focus on taking responsibility for choices and making meaning of experience.
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Fusion
Bowen described fusion as a blurring of psychological boundaries between self and others, and a resulting contamination of emotional and psychological functioning.
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Enmeshment is a term more associated with...
Enmeshment is a term more associated with Minuchin
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When using interpretation...
A therapist suggests a new meaning or way of viewing a problem or event in response to feelings or meanings the client expresses.
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Confrontation
Would have involved pointing out a discrepancy or inconsistency within the client's perceptions or attitudes, between the client's perceptions and the objective facts, or between the client's verbal and nonverbal behaviors.
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A "supportive" response
A "supportive" response is generally one that conveys you have "heard" the client and that his thoughts, feelings, or behaviors are not unusual.
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Summarization
Summarization is used, among other things, to tie together several of a client's ideas or feelings to help him see the connections among them. This usually entails emphasizing topics or themes that a client frequently brings up
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Symmetrical communication
Is characterized by equality between the partners. It can lead to conflict and competition (symmetrical escalation) when each partner tries to "one-up" the other.
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Complementary interactions
Complementary interactions are based on inequality with one partner assuming a dominant role and the other a subordinate position.
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Mystification
Refers to masking what is really going on through denial in order to maintain the status quo.
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Pseudohostility
Occurs when real conflicts are denied and obscured by superficial bickering.
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Second-order change
Second-order change is basic changes in the structure and functioning of a system that alter its fundamental organization. A symptomatic family can be said to undergo second order change when a therapeutic intervention fundamentally disrupts the pattern of symptomatic interaction so it ceases.
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First-order change
First-order change are changes in a system that are superficial and leave unaltered the fundamental organization of the system.
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A behavioral treatment plan measures client progress by using _____________ that refers back to _____________ behaviors.
measurable objectives and baseline
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According to Prochaska and DiClemente's (1982) stages of change (transtheoretical) model, a person in the preparation stage...
A person in the preparation stage is planning to take action in the near future (usually defined as in the next month).
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According to Prochaska and DiClemente's (1982) stages of change (transtheoretical) model, a person in the action stage...
A person in this stage is currently taking actions to alter his/her behavior.
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According to Prochaska and DiClemente's (1982) stages of change (transtheoretical) model, a person in the contemplative stage...
A person in this stage intends to take action in the next six months.
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The most recent version of the Prochaska and DiClemente model distinguishes between six stage of change:
Precontemplation, contemplation, preparation, action, maintenance, and termination.
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Acculturation
Acculturation refers to the extent to which an individual from one cultural group has adopted the beliefs, attitudes, values, and other characteristics of another cultural group and can be conceptualized in terms of four categories: integrated, assimilated, separate, and marginalized.
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Acute Stress Disorder
Acute Stress Disorder involves exposure to actual or threatened death, severe injury, or sexual violation in at least one of four ways (direct experience of the event; witnessing the event in person as it happened to others; learning that the event occurred to a close family member or friend; repeated or extreme exposure to aversive details of the event) plus at least nine symptoms from any of five categories - intrusion, negative mood, dissociative symptoms, avoidance symptoms, arousal symptoms. Symptoms have a duration of three days to one month and cause clinically significant distress or impaired functioning.
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Adjustment Disorders
The Adjustment Disorders involve the development of emotional or behavioral symptoms in response to one or more identifiable psychosocial stressors within three months of the onset of the stressor(s). Symptoms must be clinically significant as evidenced by the presence of marked distress that is not proportional to the severity of the stressor and/or significant impairment in functioning, and they must remit within six months after termination of the stressor or its consequences.
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Agoraphobia
A diagnosis of Agoraphobia requires the presence of marked fear or anxiety about at least two of five situations (using public transportation, being in open spaces, being in enclosed spaces, standing in line or being part of a crowd, and being outside the home alone). The individual fears or avoids these situations due to a concern that escape might be difficult or help will be unavailable in case he/she develops incapacitating or embarrassing symptoms; and the situations nearly always provoke fear or anxiety and are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety. The fear or anxiety is persistent, is not proportional to the threat posed by the situations, and causes clinically significant distress or impaired functioning.
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Anorexia Nervosa
The essential features of Anorexia Nervosa are (a) a restriction of energy intake that leads to a significantly low body weight; (b) an intense fear of gaining weight or becoming fat or behavior that interferes with weight gain; and (c) a disturbance in the way the person experiences his or her body weight or shape or a persistent lack of recognition of the seriousness of his/her low body weight.
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Antisocial Personality Disorder
Antisocial Personality Disorder is characterized by a pattern of disregard for and violation of the rights of others that has occurred since age 15 and involves at least three characteristic symptoms - e.g., failure to conform to social norms with respect to lawful behavior; deceitfulness; impulsivity; reckless disregard for the safety of self and others; lack of remorse. The person must be at least 18 years old and have a history of Conduct Disorder before 15 years of age.
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Attention-Deficit/Hyperactivity Disorder (ADHD)
ADHD is the appropriate diagnosis when the individual has at least six symptoms of inattention and/or six symptoms of hyperactivity-impulsivity and symptoms had an onset prior to 12 years of age, are present in at least two settings (e.g., home and school), and interfere with social, academic, or occupational functioning.
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Avoidant Personality Disorder
Avoidant Personality Disorder is characterized by a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, as indicated by at least four characteristic symptoms - e.g., avoids work activities involving interpersonal contact due to a fear of criticism, rejection, or disapproval; is unwilling to get involved with people unless certain of being liked; is preoccupied with concerns about being criticized or rejected; views self as socially inept, inferior, or unappealing to others.
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Beck Depression Inventory - Second Edition (BDI-II)
THE BDI-II is used to assess the mood, cognitive, behavioral, and physical aspects of depression for individuals ages 13 to 86.
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Bipolar I Disorder
A diagnosis of Bipolar I Disorder requires at least one manic episode that lasts for at least one week, is present most of the day nearly every day, and includes at least three characteristic symptoms - e.g., inflated self-esteem or grandiosity; decreased need for sleep; flight of ideas. Symptoms must cause marked impairment in social or occupational functioning, require hospitalization to avoid harm to self or others, or include psychotic features. This disorder may also include one or more episodes of hypomanic and/or major depressive episodes.
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Bipolar II Disorder
A diagnosis of Bipolar II Disorder requires at least one hypomanic episode and at least one major depressive episode. A hypomanic episode lasts for at least four consecutive days and involves at least three symptoms that are also associated with a manic episode but are not severe enough to cause marked impairment in social or occupational functioning or require hospitalization. A major depressive episode lasts for at least two weeks and involves at least five characteristic symptoms, at least one of which must be a depressed mood or a loss of interest or pleasure.
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Borderline Personality Disorder
The essential feature of Borderline Personality Disorder is a pervasive pattern of instability in interpersonal relationships, self-image, and affect, and marked impulsivity. At least five characteristic symptoms must be present - e.g., frantic efforts to avoid abandonment; pattern of unstable, intense interpersonal relationships that are marked by fluctuations between idealization and devaluation; an identity disturbance involving a persistent instability in self-image or sense of self; recurrent suicide threats or gestures; transient stress-related paranoid ideation or severe dissociative symptoms.
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Brief Psychotic Disorder
Brief Psychotic Disorder is characterized by the presence of one or more of four characteristic symptoms (delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior) with at least one symptom being delusions, hallucinations, or disorganized speech. Symptoms are present for at least one day but less than one month with an eventual return to full premorbid functioning.
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Bulimia Nervosa
Bulimia Nervosa is characterized by (a) recurrent episodes of binge eating that are accompanied by a sense of a lack of control; (b) inappropriate compensatory behavior to prevent weight gain (e.g., self-induced vomiting, excessive exercise); and (c) self-evaluation that is unduly influenced by body shape and weight. For the diagnosis, binges and compensatory behaviors must occur, on average, at least once a week for three months.
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Conduct Disorder
The diagnosis of Conduct Disorder requires a persistent pattern of behavior that violates the basic rights of others and/or age-appropriate social norms or rules as evidenced by the presence of at least three characteristic symptoms during the past 12 months and at least one symptom in the past six months. Symptoms are divided into four categories: aggression to people and animals; destruction of property; deceitfulness or theft; and serious violation of rules. Symptoms must cause significant impairment in functioning, and the disorder cannot be assigned to individuals over age 18 who meet the criteria for Antisocial Personality Disorder.
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Cyclothymic Disorder
Cyclothymic Disorder involves fluctuating hypomanic symptoms and numerous periods of depressive symptoms that do not meet the criteria for a major depressive episode, with symptoms lasting for at least two years in adults or one year in children and adolescents. Symptoms cause significant distress or impairment in functioning.
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Delirium
A diagnosis of Delirium requires (a) a disturbance in attention and awareness that develops over a short period of time (ordinarily hours to a few days), represents a change from baseline functioning, and tends to fluctuate in severity over the course of a day and (b) an additional disturbance in cognition (e.g., impaired memory, disorientation, impaired language, deficits in visuospatial ability, perceptual distortions). Symptoms must not be due to another Neurocognitive Disorder and must not occur during a severely reduced level of arousal (e.g., during a coma), and there must be evidence that symptoms are the direct physiological consequence of a medical condition, substance intoxication or withdrawal, and/or exposure to a toxin.
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Dependent Personality Disorder
Dependent Personality Disorder is characterized by a pervasive, excessive need to be taken care of, which leads to submissive, clinging behavior and an intense fear of separation.
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Dissociative Amnesia
A diagnosis of Dissociative Amnesia requires an inability to recall important personal information that cannot be attributed to ordinary forgetfulness and causes clinically significant distress or impaired functioning. It is often related to exposure to one or more traumatic events.
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Enuresis
Enuresis involves repeated voiding of urine into the bed or clothes at least twice a week for three or more consecutive months. Urination is usually involuntary but can be intentional and is not due to substance use or a medical condition. Enuresis is diagnosed only when the individual is at least five years old or the equivalent developmental level.
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Erectile Disorder
A diagnosis of Erectile Disorder requires the presence of at least one of three symptoms (marked difficulty in obtaining an erection during sexual activity, marked difficulty in maintaining an erection until completion of sexual activity, marked decrease in erectile rigidity) on all or almost all occasions of sexual activity. Symptoms have persisted for at least six months and cause clinically significant distress.
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Factitious Disorder
Individuals with Factitious Disorder Imposed on Self falsify physical or psychological symptoms that are associated with their deception, present themselves to others as being ill or impaired, and engage in the deceptive behavior even in the absence of an obvious external reward for doing so. Individuals with Factitious Disorder Imposed on Another falsify physical or psychological symptoms in another person, present that person to others as being ill or impaired, and engage in the deceptive behavior even in the absence of an external reward. For both types of Factitious Disorder, falsification of symptoms can involve feigning, exaggeration, simulation, or induction (e.g., by ingestion of a substance or self-injury).
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Family Life Cycle Stages (Carter & McGoldrick)
McGoldrick, Carter, and Garcia-Preto's (2011) family life cycle distinguishes between seven predictable stages (leaving home, forming a couple, families with young children, families with adolescents, launching children and moving into midlife, families in late middle age, and families nearing the end of life) and identifies the developmental tasks that families face during the transition to each stage. Inadequate accomplishment of any task can lead to crisis and disequilibrium.
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Gender Dysphoria
For Gender Dysphoria in Children, the diagnostic criteria are a marked incongruence between assigned gender at birth and experienced or expressed gender as evidenced by a strong desire to be the opposite sex and at least five symptoms - e.g., strong preference for wearing clothes of the other gender; strong preference for cross-gender roles during play; strong preference for toys and activities typically used or engaged in by the other gender; strong preference for playmates of the opposite gender; strong desire for primary and/or secondary sex characteristics of one's experienced gender. For Gender Dysphoria in Adolescents and Adults, the marked incongruence between assigned gender and experienced or expressed gender must be manifested by at least two symptoms - e.g., marked incongruence between one's primary and/or secondary sex characteristics and one's experienced or expressed gender; strong desire for the primary and/or secondary sex characteristics of the opposite gender; strong desire to be of the opposite gender; strong conviction that one has the feelings and reactions that are characteristic of the opposite gender. For both disorders, symptoms must have a duration of at least six months and cause clinically significant distress or impaired functioning.
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Generalized Anxiety Disorder (GAD)
GAD involves excessive anxiety and worry about multiple events or activities, which are relatively constant for at least six months, the person finds difficult to control, and cause clinically significant distress or impairments in functioning. Anxiety and worry must include at least three characteristic symptoms (or at least one symptom for children) - restlessness or feeling keyed up or on edge; being easily fatigued; difficulty concentrating; irritability; muscle tension; sleep disturbance.
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Genito-Pelvic Pain/Penetration Disorder
This disorder is diagnosed in the presence of persistent difficulties involving at least one of the following: vaginal penetration during intercourse; genito-pelvic pain during intercourse or penetration attempts; anxiety about genito-pelvic pain before, during, or as a result of vaginal penetration; tensing of pelvic floor muscles during attempted vaginal penetration. Symptoms have persisted for, at a minimum, about six months and cause clinically significant distress.
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Graphic Assessment Techniques
Graphic assessment techniques include the genogram and ecomap. The genogram depicts family relationships over several generations and provides information on significant life events, family structure and roles, etc., while the ecomap provides information on the strength and nature of relationships between family members and people, institutions, and agencies in the social environment.
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Histrionic Personality Disorder
Histrionic Personality Disorder is characterized by a pervasive pattern of emotionality and attention-seeking as manifested by at least five characteristic symptoms - e.g., discomfort when not the center of attention; inappropriately sexually seductive or provocative; rapidly shifting and shallow emotions; consistent use of physical appearance to gain attention; considers relationships to be more intimate than they are.
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Initial Interview
The primary goals of the initial interview with new clients are to (1) establish rapport (e.g., by joining the family); (2) describe the structure and process of therapy; (3) identify and prioritize client problems; (4) clarify client expectations and goals for therapy; and (5) define the next steps (who will be attending future sessions, setting up the next appointment, etc.).
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Insomnia Disorder
Insomnia Disorder is characterized by dissatisfaction with sleep quality or quantity that is associated with at least one characteristic symptom - difficulty initiating sleep; difficulty maintaining sleep; early-morning awakening with an inability to return to sleep. The sleep disturbance occurs at least three nights each week, has been present for at least three months, occurs despite sufficient opportunities for sleep, and causes significant distress or impaired functioning.
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Intellectual Disability
Intellectual Disability is diagnosed in the presence of (a) deficits in intellectual functions (e.g., reasoning, problem solving, abstract thinking); (b) deficits in adaptive functioning that result in a failure to meet community standards of personal independence and social responsibility and impair functioning across multiple environments in one or more activities of daily life; and (c) an onset of intellectual and adaptive functioning deficits during the developmental period. Four degrees of severity (mild, moderate, severe, and profound) are based on adaptive functioning in conceptual, social, and practical domains.
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Major Depressive Disorder
Major Depressive Disorder
A diagnosis of Major Depressive Disorder requires the presence of at least five symptoms of a major depressive episode nearly every day for at least two weeks, with at least one symptom being depressed mood or loss of interest or pleasure. Symptoms are depressed mood (or, in children and adolescents, a depressed or irritable mood); markedly diminished interest or pleasure in most or all activities; significant weight loss when not dieting or weight gain or a decrease or increase in appetite; insomnia or hypersomnia; psychomotor agitation or retardation; fatigue or loss of energy; feelings of worthless or excessive guilt; diminished ability to think or concentrate; recurrent thoughts of death, recurrent suicidal ideation, or a suicide attempt. Symptoms cause clinically significant distress or impaired functioning.
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Malingering
Malingering is included in the DSM-5 with Other Conditions that May Be a Focus of Clinical Attention. It involves the intentional production, faking, or gross exaggeration of physical or psychological symptoms in order to obtain an external reward (e.g., to avoid criminal prosecution or obtain financial compensation).
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Mental Status Exam
A mental status exam (MSE) uses observation, questions, and simple tasks to obtain information on several aspects of a client's current mental state (e.g., appearance, thought content, affect) and is useful for determining if a client's symptoms warrant referral to a physician or psychiatrist.
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Minnesota Multiphasic Personality Inventory-2 (MMPI-2)
The MMPI-2 is an objective measure of personality for individuals aged 18 and older. It is used to assist with diagnosis and treatment planning and provides scores on a number of clinical, content, supplementary, and validity scales
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Narcissistic Personality Disorder
Narcissistic Personality Disorder involves a pervasive pattern of grandiosity, a need for admiration, and a lack of empathy as indicated by at least five characteristic symptoms - e.g., has a grandiose sense of self-importance; is preoccupied with fantasies of unlimited success, power, beauty, love; believes he/she is unique and can be understood only by other high-status people; requires excessive admiration; has a sense of entitlement; lacks empathy; is often envious of others or believes others are envious of him/her.
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Narcolepsy
Narcolepsy is characterized by attacks of an irrepressible need to sleep with lapses into sleep or daytime naps that occur at least three times per week and have been present for at least three months. The diagnosis also requires episodes of cataplexy, a hypocretin deficiency, or a rapid eye movement latency less than or equal to 15 minutes.
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Neurocognitive Disorder Due to Alzheimer's Disease
This disorder is diagnosed when the criteria for Major or Mild Neurocognitive Disorder are met, there is an insidious onset and gradual progression of impairment in one or more cognitive domains (or at least two domains for Major Neurocognitive Disorder), and the criteria for probable or possible Alzheimer's Disease are met: For Major Neurocognitive Disorder, probable Alzheimer's Disease, there must be evidence of a causative genetic mutation or there must be a decline in memory and at least one other cognitive domain, a steadily progressive and gradual decline in cognition without extended plateaus, and no evidence of a mixed etiology. Otherwise, possible Alzheimer's disease is diagnosed. For Mild Neurocognitive Disorder, probable Alzheimer's Disease, there must be evidence of a causative genetic mutation; and, for possible Alzheimer's Disease, there must be no evidence of a causative genetic mutation and evidence of a decline in memory, a steadily progressive and gradual decline in cognition without extended plateaus, and no evidence of a mixed etiology.
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Obsessive-Compulsive Disorder (OCD)
OCD is characterized by recurrent obsessions and/or compulsions that are time-consuming or cause clinically significant distress or impairment in functioning: Obsessions are persistent thoughts, impulses, or images that the person experiences as intrusive and unwanted and that he/she attempts to ignore or suppress, and compulsions are repetitious and deliberate behaviors or mental acts that the person feels driven to perform either in response to an obsession or according to rigid rules.
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Obsessive-Compulsive Personality Disorder
Obsessive-Compulsive Personality Disorder is characterized by a persistent preoccupation with orderliness, perfectionism, and mental and interpersonal control that severely limits the individual's flexibility, openness, and efficiency. At least four characteristic symptoms must be present - e.g., exhibits perfectionism that interferes with task completion; is excessively devoted to work and productivity to the exclusion of leisure activities and friendships; is reluctant to delegate work to others unless they are willing to do it his/her way; adopts a miserly spending style toward self and others.
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Oppositional Defiant Disorder
Oppositional Defiant Disorder involves a recurrent pattern of an angry/irritable mood, argumentative/defiant behavior, or vindictiveness as evidenced by at least four characteristic symptoms that are exhibited during interactions with at least one person who is not a sibling - e.g., often loses temper; often argues with authority figures; often actively refuses to comply with requests from authority figures or with rules; often blames others for his/her mistakes. Symptoms have persisted for at least six months and have caused distress for the individual or others in his/her immediate social environment.
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Panic Disorder
Panic Disorder is characterized by recurrent unexpected panic attacks with at least one attack being followed by one month of persistent concern about having additional attacks or about their consequences and/or involving a significant maladaptive change in behavior related to the attack.
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Paranoid Personality Disorder
Paranoid Personality Disorder involves a pervasive pattern of distrust and suspiciousness that entails interpreting the motives of others as malevolent. The diagnosis requires the presence of at least four characteristic symptoms - e.g., suspects that others are exploiting, harming, or deceiving him/her without a sufficient basis for doing so; reads demeaning content into benign remarks or events; persistently bears grudges; is persistently suspicious about the fidelity of his/her spouse or sexual partner without justification.
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Paraphilic Disorders
The Paraphilic Disorders include Voyeuristic, Exhibitionistic, Frotteuristic, Sexual Sadism, Pedophilic, Fetishistic, and Transvestic Disorders. These disorders are characterized by an "intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners ...[that] is currently causing distress or impairment to the individual or ... has entailed personal harm, or risk of harm, to others" (APA, 2013, pp. 685-686).
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Persistent Depressive Disorder
Persistent Depressive Disorder is characterized by a depressed mood (or in children and adolescents, a depressed or irritable mood) on most days for at least two years in adults or at least one year in children and adolescents as indicated by the presence of at least two characteristic symptoms - poor appetite or overeating; insomnia or hypersomnia; low energy or fatigue; low self-esteem; poor concentration or difficulty making decisions; feelings of hopelessness. During the two- or one-year period, the individual has not been symptom-free for more than two months, and symptoms cause clinically significant distress or impaired functioning.
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Posttraumatic Stress Disorder (PTSD)
For adults, adolescents, and children older than six years of age, the diagnosis of PTSD requires (a) exposure to actual or threatened death, serious injury, or sexual violence; (b) presence of at least one intrusion symptom related to the event; (c) persistent avoidance of stimuli associated with the event; (d) negative changes in cognition or mood associated with the event; and (e) marked change in arousal and reactivity associated with the event. For children six years of age or younger, this diagnosis requires (a) exposure to actual or threatened death, serious injury, or sexual violence in at least one of the following ways; or learning that the event occurred to a caregiver: (b) presence of at least one intrusion symptom related to the event; (c) persistent avoidance of stimuli related to the event or negative changes in cognitions and mood related to the event; and (d) alterations in arousal and reactivity associated with the event. For individuals of all ages, symptoms must have a duration of more than one month and must cause clinically significant distress or impaired functioning.
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Premature Ejaculation
Premature Ejaculation is diagnosed in the presence of a persistent or recurrent pattern of ejaculation during partnered sexual activity within about one minute of vaginal penetration or before the person desires it. The disturbance must have been present for at least six months, be experienced on all or almost all occasions of sexual activity, and cause clinically significant distress.
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Racial/Ethnic Identity
Racial/ethnic identity refers to a person's sense of group or collective identity based on his/her perception that he/she shares a common racial or ethnic heritage with a particular group. A client's racial/ethnic identity may have a substantial impact on assessment and treatment.
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Schizoid Personality Disorder
Schizoid Personality Disorder involves a pervasive pattern of detachment from interpersonal relationships and a restricted range of emotional expression in social settings with at least four characteristic symptoms - doesn't desire or enjoy close relationships; almost always chooses solitary activities; has little interest in sexual relationships; takes pleasure in few activities; lacks close friends or confidents other than first-degree relatives; seems indifferent to praise or criticism; exhibits emotional coldness or detachment.
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Schizophrenia
A diagnosis of Schizophrenia requires the presence of at least two active phase symptoms - i.e., delusions, hallucinations, disorganized speech, grossly disorganized behavior, negative symptoms - for at least one month with at least one symptom being delusions, hallucination, or disorganized speech. There must be continuous signs of the disorder for at least six months, and symptoms must cause significant impairment in functioning.
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Schizotypal Personality Disorder
Schizotypal Personality Disorder is diagnosed in the presence of (a) pervasive social and interpersonal deficits involving acute discomfort with and reduced capacity for close relationships and (b) eccentricities in cognition, perception, and behavior as manifested by the presence of at least five symptoms - e.g., ideas of reference; odd beliefs or magical thinking that influence behavior; bodily illusions and other unusual perceptions; is suspicious or has paranoid ideation; inappropriate or constricted affect; lacks close friends or confidents other than first-degree relatives; excessive social anxiety.
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Separation Anxiety Disorder
Separation Anxiety Disorder involves developmentally inappropriate and excessive fear or anxiety related to separation from home or attachment figures as evidenced by at least three symptoms - e.g., recurrent excessive distress when anticipating or experiencing separation from home or major attachment figures; persistent excessive fear of being alone; repeated complaints of physical symptoms when separation from an attachment figure occurs or is anticipated. The disturbance must last at least four weeks in children and adolescents or at least six months in adults and must cause clinically significant distress or impaired functioning.
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Social Anxiety Disorder (Social Phobia)
Social Anxiety Disorder involves intense fear or anxiety about one or more social situations in which the individual may be exposed to scrutiny by others. The individual fears that he/she will exhibit anxiety symptoms in these situations that will be negatively evaluated; he/she avoids the situations or endures them with intense fear or anxiety; and his/her fear or anxiety is not proportional to the threat posed by the situations. The fear, anxiety, and avoidance are persistent (typically lasting for at least six months) and cause clinically significant distress or impaired functioning.
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Specific Phobia
Specific Phobia is characterized by intense fear of or anxiety about a specific object or situation, with the individual either avoiding the object or situation or enduring it with marked distress. The fear or anxiety is not proportional to the danger posed by the object or situation, is persistent (typically lasting for at least six months), and causes clinically significant distress or impaired functioning.
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Stages Of Psychosexual Development (Freud)
Freud's theory of psychosexual development proposes that the id's libido (sexual energy) centers on a different part of the body during each stage of development and that personality results from the ways in which conflicts at each stage are resolved. The five stages of development are oral, anal, phallic, latency, and genital.
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Stages of Psychosocial Development (Erikson)
Erikson's theory of personality development proposes that the individual faces a different psychosocial crisis at different points throughout the lifespan. These are: trust vs. mistrust; autonomy vs. shame and doubt; initiative vs. guilt; industry vs. inferiority; identify vs. role confusion; intimacy vs. isolation; generativity vs. stagnation; and integrity vs. despair.
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Substance Use Disorder
The Substance Use Disorders are characterized by "a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems" (APA, 2013, p. 483) as manifested by at least two symptoms during a 12-month period - e.g., substance used in larger amounts or for a longer period of time than intended; persistent desire or unsuccessful efforts to cut down or control use; craving for the substance; recurrent substance use despite persistent social problems caused or worsened by substance use; recurrent substance use in situations in which it is physically dangerous to do so; tolerance; withdrawal.
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Substance-Induced Disorder
The Substance-Induced Disorders include Substance Intoxication, Substance Withdrawal, and Substance/Medication-Induced Mental Disorders. The latter "are potentially severe, usually temporary, but sometimes persisting central nervous system (CNS) syndromes that develop in the context of the effects of substances of abuse, medications, or toxins" (APA, 2013, p. 487) and include Substance/Medication-Induced Psychotic Disorder, Substance/Medication-Induced Depressive Disorder, and Substance/Medication-Induced Neurocognitive Disorders.
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Tourette's Disorder
Tourette's Disorder is characterized by the presence of at least one vocal tic and multiple motor tics that may appear simultaneously or at different times, that may wax and wane in frequency but have persisted for more than one year, and that began prior to age 18.
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Vineland Adaptive Behavior Scales, Second Edition (Vineland-II)
The Vineland-II is used to evaluate personal and social skills of children, adolescents, and adults with Intellectual Disability, Autism Spectrum Disorder, ADHD, brain injury, or Major or Mild Neurocognitive Disorder and to assist in the development of educational and treatment plans.
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Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV)
The WAIS-IV is an individually administered intelligence test for individuals ages 16:0 to 90:11. It provides a Full Scale IQ score, scores on four Indexes, and subtest scores.
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Adlerian Therapy
Adler replaced Freud's emphasis on the role of instinctual drives in the development of personality with an innate tendency toward social interest, and he viewed mental disorders as being due to adoption of a mistaken style of life that is characterized by maladaptive attempts to compensate for feelings of inferiority, a preoccupation with achieving personal power, and a lack of social interest. The primary goal of therapy is to help the client develop a healthy style of life that is characterized by social interest and a sense of belonging. The process of Adlerian therapy can be described in terms of four phases - establishing a therapeutic relationship, exploring the client's style of life, encouraging self-understanding, and helping with reorientation (making changes).
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African American Clients
An ecological systemic approach is recommended when working with African American clients. For example, Boyd-Franklin's (1989) multisystems model for African American families addresses multiple systems, intervenes at multiple levels, and empowers the family by utilizing its strengths. Systems that may be incorporated into treatment include the extended family and nonblood kin, religious and community resources, and social service agencies. Time-limited, goal-oriented, problem-solving approaches are recommended. Empowerment should be fostered by promoting egalitarianism in the therapeutic relationship and helping the client develop the skills needed to increase a sense of control over his/her life.
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American Indian Clients
Therapists working with American Indian clients should be familiar with the historical events that have affected their lives; build trust and credibility during initial sessions by demonstrating familiarity with and respect for the client's culture and admitting any lack of knowledge; adopt a collaborative, problem-solving, client-centered approach that avoids highly directive or confrontational techniques; and include elders and traditional healers in treatment. LaFromboise et al. (1990) recommend using network therapy, which incorporates family and community members into the treatment process and situates an individual's psychological problems within the context of his/her family, workplace, community, and other social systems.
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Arab American Clients
Effective therapies for Arab American clients are couple or family therapy, cognitive-behavioral therapy, psychoeducation, and problem-solving approaches. Guidelines for therapists include discussing the client's expectations from therapy and the therapist-client relationship during the initial session; addressing any concerns the client has about possible conflicts between therapy and the client's values and beliefs (e.g., by conveying his/her respect for Arab American culture); determining each family member's level of acculturation and degree to which acculturation conflicts are contributing to family problems; considering how religious and ethnic discrimination and hostility may impact the client's life; and considering whether incorporating culturally relevant rituals into therapy or including traditional healers is appropriate.
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Asian American Clients
Asian American clients may prefer a directive, structured, goal-oriented, problem-solving approach that focuses on alleviating specific symptoms and view the therapist as a knowledgeable expert and authority figure. The therapist should encourage clients to take part in identifying goals and solutions; emphasize formalism in therapy; establish credibility and competence early on (e.g., by disclosing the therapist's educational background and experience); and prevent premature termination by providing an immediate and meaningful benefit. Asian American clients may express their mental health problems as somatic complaints. Cognitive-behavioral, solution-focused, and other brief therapies may be effective if modified to focus more on the family than the individual and to take cultural and social factors into account.
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Behavior Therapy
There is no single behavior therapy but, instead, a diverse collection of therapies and interventions that are based on the principles of classical conditioning, operant conditioning, and social learning theory, emphasize current behaviors, and adopt a scientific approach to assessment and treatment. The primary goal of therapy is to alleviate the client's problems by decreasing maladaptive behaviors and increasing more adaptive ones. The therapist-client relationship is collaborative, and clients are expected to take an active role in therapy by participating in goal setting, monitoring their own behaviors, and learning and practicing new skills. The process of therapy can be described in terms of the following steps - clarifying the problem, formulating initial treatment goals, describing the target behaviors that need to be changed to achieve treatment goals, measuring each target behavior as soon as it is identified and at regular intervals during therapy, identifying the antecedents and consequences that maintain each behavior, designing and implementing a treatment plan, and evaluating the success of the treatment plan.
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Cognitive-Behavioral Therapy
The cognitive-behavioral approaches to therapy are based on the assumptions that (a) cognition mediates emotional and behavioral dysfunction; (b) modifying cognitions can change dysfunctional emotions and behaviors; and (c) behavioral and cognitive strategies are both useful and can be integrated. Included in this category is Beck's cognitive-behavioral therapy (CBT), which focuses on cognitive schemas, automatic thoughts, and cognitive distortions and proposes that each psychological disorder involves a different cognitive profile - e.g., depression involves the "cognitive triad" of a negative view of oneself, the world, and the future. The primary goal of CBT is to modify the dysfunctional cognitions that are maintaining the client's maladaptive behaviors and emotions. Therapy is structured, goal-oriented, and time-limited and incorporates a variety of behavioral and cognitive strategies to achieve therapy goals (e.g., activity scheduling, behavior rehearsal, questioning the evidence, and cognitive rehearsal).
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Contextual Family Therapy
Boszormenyi-Nagy's contextual family therapy is based on the assumption that patterns of behavior are passed down from one generation to the next and emphasizes "relational ethics," which refers to fair and trustworthy interactions between family members. It also assumes that relationships are always influenced by the "four dimensions of relational realities" - facts, individual psychology, transactional patterns, and relational ethics. The primary goal of therapy is to help family members recognize and negotiate imbalances in their "ledgers of merit."
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Couple Sex Therapy
Currently, couple sex therapy reflects a biopsychosocial approach that views sexual dysfunction as the result of a combination of biological, psychological, and relational factors. It often includes some or all of the following mechanisms of change: (a) mutual responsibility for resolving the problem; (b) information and education about human sexuality; (c) positive change in attitudes toward sexuality; (d) reduction of performance anxiety; (e) improved communication about sex; (f) changes in destructive gender roles and lifestyles; (g) enhancement of the marital relationship; (h) physical and medical interventions; and (i) direct changes in sexual behaviors. Sensate-focused techniques include: the start-stop and squeeze techniques, the bridge maneuver, and the coital alignment technique.
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Cybernetics
The term "cybernetics" was coined by Weiner (1948) to describe systems that are self-regulating by means of feedback loops, which can be either negative or positive: Negative feedback loops reduce deviation and help a system maintain the status quo, while positive feedback loops amplify deviation and, thereby, serve to disrupt the system's status quo.
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Emotionally Focused Therapy (EFT)
Emotionally Focused Therapy (EFT) is a brief empirically supported therapy that focuses on the role of emotion in couples. Couples' distress is attributed to attachment insecurity originating in childhood, producing a predictable sequence of responses to disappointment, hurt, or fear in the relationship. The primary goal of EFT is to expand and restructure couples' emotional experiences so they can develop a secure bond and new interactional patterns. EFT involves three treatment stages: Assessment and Cycle De-Escalation; Changing Interactional Positions and Consolidation and Integration.
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Extended Family Systems Therapy
Bowen's extended family systems therapy views behavior disorders as the result of a multigenerational transmission process in which progressively lower levels of differentiation are transmitted from one generation to the next. The primary goal of therapy is to increase the differentiation of all family members. Therapy begins with the construction of a genogram, which depicts the relationships between family members, the dates of significant life events, and other important information. The therapist often sees two members of the family (spouses) and forms a therapeutic triangle in which the therapist comes into emotional contact with the family members but avoids becoming emotionally triangled.
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Freudian Psychoanalysis
Freud's personality theory consists of the id, ego, and superego. Psychoanalysis focuses on unresolved unconscious conflicts that impact personality and behavior. The aim is to reduce or eliminate pathological symptoms by bringing unconscious material into consciousness, integrating that material into the personality, and strengthening the ego so that behavior is determined more by rational processes than by instinctual drives. The therapist acts as a "blank screen" to encourage a transference relationship. Transferences, free associations, dreams, and resistances are used to facilitate catharsis and expand one's understanding of unconscious processes and current behaviors. There are four overlapping phases: opening phase, development of transference, working through transference, and resolution of transference.
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General Systems Theory
General systems theory was proposed by the biologist von Bertalanffy (1968) who described a living system as "composed of mutually dependent parts and processes standing in mutual interaction" (p. 33). He distinguished between two types of systems: A closed system has rigid, impermeable boundaries, does not interact with its environment, and is resistant to change, while an open system has permeable boundaries, interacts with its environment, and is adaptable and receptive to change. Family therapists view families as primarily open systems.
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Gestalt Therapy
Gestalt therapists view neurotic (maladaptive) behavior as a "growth disorder" that involves an abandonment of the self for the self-image. This is often due to a disturbance in the boundary between the self and the environment that interferes with the person's ability to satisfy his/her needs and maintain a state of equilibrium. The goal of therapy is to help the client become a unified whole by becoming aware of and integrating the various aspects of the self. This is accomplished using a variety of techniques that are designed to lead clients toward greater awareness of current thoughts, feelings, and actions, including games of dialogue, assuming responsibility, and dream work.
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Gottman Model Of Couples Therapy
The Gottman model of couples therapy is based on sound marital house theory which includes these seven aspects: build love maps, share fondness and admiration, turn toward, maintain a positive perspective, manage conflict, make life dreams come true, and create shared meaning. Gottman's research identified several interaction patterns that distinguish stable couples from couples who are at risk for divorce. For example, the "four horsemen of the apocalypse" (criticism, defensiveness, contempt, and stonewalling) and the 5:1 ratio (stable couples have a 5:1 ratio of positive to negative interactions during conflicts, while the ratio for unstable couples is closer to 1:1). The primary goal of therapy is to build a sound marital house by increasing positive interactions and decreasing negative ones.
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Hispanic/Latino Clients
Hispanic/Latino clients often prefer an active, directive, and multimodal approach that focuses on the client's behavior, affect, cognitions, interpersonal relationships, biological functioning, etc. Therapy guidelines include emphasizing "personalismo" (except during initial contacts when "formalismo" is preferred); recognizing that differences in level of acculturation within a family are often a source of individual and family problems; considering the impact of religious and spiritual beliefs; and being aware that Hispanic/Latino clients may express their mental health problems as somatic complaints.
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Human Validation Process Model
Satir's human validation process model is an example of experiential family therapy and views maladaptive behavior as the result of the "interchange of low self-esteem, incongruent communication, poor system operations, and faulty family roles" (Henderson & Thompson, 2011, p. 502). The primary goal of therapy is to enhance the growth potential of family members by raising their self-esteem and helping them communicate congruently and solve problems more effectively. The therapy process involves six stages: status quo, introduction of a foreign element, chaos, integration of new possibilities, practice, and new status quo. Satir considered the therapist's "use of the self" to be the key instrument of change. The therapist plays multiple roles including role model, facilitator, mediator, advocate, and teacher.
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Indications/Contraindications For Family Therapy
Family therapy is most effective when a family member's symptoms are manifestations of problems in the family system; improvement in one family member is likely to cause (or has caused) the development of symptoms in another family member; and a family member has symptoms that are known to be effectively treated by family therapy (e.g., substance abuse, an eating disorder, conduct disorder). Family therapy may be contraindicated when a family member's presenting problem is not related to family functioning; key family members are unavailable or unwilling to participate in family therapy; or one family member is so severely disturbed that his or her behavior makes family treatment impossible.
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Integrative Behavioral Couple Therapy (IBCT)
IBCT is an extension of traditional behavioral approaches that "assumes that relationship problems result not just from the egregious actions and inactions of partners but also in their emotional reactivity to those behaviors. Therefore, IBCT focuses on the emotional context between partners and strives to achieve greater acceptance and intimacy between partners as well as make deliberate changes in target problems" (Christensen et al., 2006, p. 1181). It proposes that it is normal for couples to have areas of differences and disagreement but that these lead to distress when partners habitually respond to them with mutual coercion, vilification, or polarization, and its primary goal is to end dysfunctional repetitive interactions by fostering acceptance of differences and disagreements. Therapy focuses on repetitious problematic interactions, which are identified with a functional analysis and then addressed using a combination of acceptance, tolerance, and change techniques.
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Lesbian, Gay, and Bisexual Clients
Interventions used with heterosexual clients are ordinarily acceptable to LGB clients as long as they do not reflect a heterosexist bias and the therapist has adequate knowledge about LGB issues. Guidelines for working with LGB clients include having a lesbian, gay, and bisexual friendly office; being aware that an LGB client's problems may be related to exposure to prejudice and discrimination, internalized homophobia, a lack of social support, or other unique issues faced by members of this population without automatically assuming that this is the case; being familiar with the sexual identity of an LGB client and how it relates to his/her coming-out process; understanding that there are differences among people who are lesbian, gay, or bisexual in terms of experiences and concerns related to their sexual orientation; and being familiar with community resources that would be helpful to LGB clients. In addition, affirmative forms of psychotherapy (e.g., Chernin & Johnson, 2003) have been developed specifically to help LGB individuals value and accept their sexual orientation.
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Medical Family Therapy
The primary goal of medical family therapy to help a family adapt to the illness of a family member (e.g., to adapt to changes in family roles, new sources of stress and financial hardship, and communicating with health professionals). It combines family systems theory with the biopsychosocial model and focuses on promoting a balance of agency and communion.
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Milan Systemic Family Therapy
Milan Systemic Family Therapy asserts that a family is "a self-regulating system which controls itself according to rules formed over a period of time through a process of trial and error" (Selvini-Palazzoli et al., 1978, p. 3). The "rules of the family game" consist of repetitive patterns of interactions that are played out in unacknowledged alliances that are used by family members to control each other's behavior. Games involving deceit and power struggles, "dirty games," promote homeostasis. The objective is to help the family understand problems in alternative ways and identify new solutions, i.e., "play a different game." A therapeutic team divides sessions into 5 parts: a pre-session team discussion, a family interview, a discussion of the interview by team members, a family prescription, and a post-session team discussion.
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Object Relations Family Therapy
Object relations family therapy is an adaptation of psychodynamic family therapy. Practitioners integrate intrapsychic and interpersonal approaches by replacing Freud's instinctual drives with an innate need for satisfying relationships. They propose that a person's current relationships are related to his/her expectations about relationships, which can be traced to early relations with attachment "objects" (especially the child's mother). When a young child perceives his/her mother to be not only nurturing but also frustrating, the child internalizes images ("introjects") of the mother to gain internal control over her and, thereby, alleviate his/her own anxiety. These introjects become part of the child's personality and influence the way he/she interprets future relationships.
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Person-Centered Therapy
Rogers's person-centered therapy is based on the assumptions that people possess an inherent ability for growth and self-actualization and that maladaptive behavior occurs when "incongruence between self and experience" disrupts this natural tendency. The primary goal of therapy is to help the client achieve congruence between self and experience so that he/she can become a more fully-functioning, self-actualizing person. This goal is accomplished when the therapist provides the client with three facilitative conditions (empathy, genuineness, and unconditional positive regard) that enable the client to return to his/her natural tendency for self-actualization.
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Postmodernism
Advocates of postmodernism reject the "belief in the possibility of objective knowledge and absolute truth" and replace it with the assumption that reality "is inevitably subjective and that we do indeed dwell in a multiverse that is constructed through the act of observation" (Becvar & Becvar, 2003, p. 92). Postmodernism adopts the social constructivist contention that language is the means that people use to express their constructions. Consequently, advocates of postmodern approaches to therapy contend that constructions such as positive and negative feedback, homeostasis, and boundaries are not objective facts but, instead "linguistic tools with which to describe and understand families" (Goldenberg & Goldenberg, 2012, p. 111).
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Psychodynamic Family Therapy
Practitioners of psychodynamic family therapy regard family dysfunction to be the result of unresolved intrapsychic conflicts within individual family members (or, from an object relations perspective, as the result of pathological introjects). The primary goal of therapy is modification of the personalities of individual family members so that they can relate to one another on the basis of their current situation rather than the past. Although psychodynamic family therapists rely on psychoanalytic principles as the basis for understanding individual and family dynamics they differ in terms of the extent to which they use traditional psychoanalytic techniques in therapy.
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Readiness for Termination
The primary factor to consider when determining a client's readiness for termination is the achievement of therapy goals; and, ideally, the termination process begins when the therapist and client agree that the goals have been accomplished. However, in some situations, termination may be appropriate when all goals have not been fully achieved but the client has acquired the skills needed to deal with any remaining problems or because the therapist and client have agreed that therapy has not been successful and should be terminated (Barker, 1992).
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Recovery-Oriented Care For Mental And Substance Use Disorders
In contrast to medical and acute care models, recovery-oriented care focuses on recovery (rather than pathology) and provides services during all phases of recovery: pre-recovery identification and engagement, recovery initiation and stabilization, and long-term recovery maintenance. Its goals are broader than those of traditional treatments and address reducing the client's symptoms as well as facilitating the client's efforts to create a more satisfying and meaningful life. As described by the National Consensus Statement on Mental Health Recovery, its ten fundamental components are self-direction, individualized and person-centered, empowerment, holistic, non-linear, strengths-based, peer support, respect, responsibility, and hope.
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Solution-Focused Family Therapy
Solution-focused family therapy focuses on solutions to problems rather than on the problems themselves. It views maladaptive behavior as the result of becoming "stuck" in dealing with a problem due to continued reliance on the same ineffective methods for resolving it. Practitioners believe that all families have the strengths and resources they need to resolve their problems, and the general goal of therapy is to help the family access and apply their strengths and resources. In therapy, family members are viewed as the "experts," while the therapist acts as a consultant and collaborator who poses questions and uses strategies to help them achieve their goals. Commonly used questions include the miracle question, exception questions, and scaling questions.
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Strategic Family Therapy
Haley's strategic family therapy focuses on transactional patterns and views symptoms as interpersonal events that serve to control relationships. An underlying assumption of therapy is that behavior change results in changes in perceptions and emotions and, consequently, therapy focuses on symptom relief (rather than insight). The first stage of therapy is considered to be the determinant of the course of therapy and consists of four stages: social, problem, interaction, and goal-setting. Therapists use a variety of strategies to achieve therapy goals, including paradoxical interventions (e.g., ordeals, prescribing the symptom, reframing) that are designed to alter the behavior of family members by helping them see a symptom in an alternative way, helping them recognize that they have control over their behaviors, or using their resistance in a constructive way.
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Treatment Goals And Objectives
Treatment goals and objectives are identified from a problem list that is derived from the results of a thorough assessment and represent the desired outcomes of therapy. Goals are broad, comprehensive, and long-term and restate the client's presenting problems in positive terms, while objectives are specific, short-term, and measurable and describe the changes that are needed to achieve each treatment goal.
