Quiz 3 Flashcards
(16 cards)
Components of TF-CBT
P…Practice
- Psychoeducation
- Parent Component includes parenting skills
- Relaxation
- Affect identification and regulation
- Cognitive coping
- Trauma narration and cognitive processing of traumatic experiences
- In vivo mastery of trauma reminders
- Conjoint child-parents sessions
- Enhancing safety and future development
What is the importance of a trauma narrative?
(5)
- Control intrusive & upsetting trauma imagery
- Reduce avoidance of “triggers” - cues, situations, people, places & feelings associated with the trauma
- Identify unhelpful thoughts about the trauma
- Help the child / caregiver recognize, anticipate & prepare for reminders of the traum
- Desensitize to talking about the trauma
Do Nots: Child Trauma Narratives
(12)
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Problematic/Suggestive Questions
- Very specific questions
- Repeat the same questions
- The “question stem” sets up the answer
- Subtly reinforce certain responses
- Gather only confirmatory evidence & avoid questions that may produce other responses
- Use threats or bribes
- “Stereotype inducement” of perpetrator
- Tell the child they are helping the investigation
- Tell the child that their friends have already helped (peer pressure)
- Repeat misinformation
- Use visualization
- Provide misinformation (false memory)
DOs: Child Trauma Narratives
(7)
- Reasons to directly discuss traumatic events:
- Desensitization (aka gradual exposure)
- Resolve avoidance symptoms
- Correction of distorted cognitions
- Give context to traumatic experiences
- Reduce intrusive imagery
- Model adaptive coping
- Identify and prepare for trauma/loss reminders
3 primary strategies to prepare parents for hearing a child trauma narrative
- assess readiness
- prepare parent along the way
- address parent blocking beliefs
How do you assess parent readiness to hear a trauma narrative?
(9)
- Handle their own & child’s emotions
- Can support & praise the child
- Own concerns have been addressed
- Can model coping
- Has willingness & ability to hear about trauma
- Committed to improved & open communication
- Able to ask open ended & non-threatening questions
- Is comfortable with own narrative of the event
- Sharing trauma narrative may be an ongoing process
How do you prepare a parent along the way to hear a trauma narrative?
(6)
- Explore parent’s knowledge about traumatic event
- Ask parent to share own experience of trauma
- Share with parent what child says in therapy & narrative
- Practice supportive response
- Help prepare parent questions for child
- Moving from primacy of the therapist-child and therapist-parent interactions to the parent-child interactions during sessions
What are a few examples of parent blocking beliefs?
- I should have known this would happen
- I should have kept my child safe
- My child will never be happy again
- Our family is destroyed
- My child’s childhood is ruined
- The world is terribly dangerous
- My child can never recover
- I can only be happy if my child is happy
- I can’t trust anyone anymore
- Being strong for my child means I should never feel upset
- Good parents know the right thing to say to their children
- Why is this so upsetting for my child?
- I can’t believe I have to do all this work
DBT-A dialectical dilemas
- DBT-A Dialectical Dilemmas: Miller & Rathus’ Middle Path
-
Too loose v. too strict
- Clear, consistent rules AND negotiate on some issues
-
Making light of problem behaviors v. making too much of typical adolescent behavior
- Recognize when bx crosses the line/try to get help AND recognize what is typical
-
Holding on too tight v. forcing independence too soon
- Give adolescent guidance/support and rules so they can figure out how to be responsible AND slowly give greater amounts of freedom while some reliance on others
-
Too loose v. too strict
DBT-A Middle Path
- Acknowledging the other person’s thoughts and feelings (and self)
- “I get it”, “That must be hard”, “I see why that must be so nerve wracking”
- “I am trying to/I want to understand…”
- Can deescalate emotions
- Validation is NOT agreement
- Also not praise or reassurance
- Teach family members to validate in context of current situations!
Way to define a problem in parent-adolescent conflict
-
Barkley’s PSCT: Define the Problem
- Short, nonaccusing statement of the situation or person’s bx & why it is a problem
- Avoid blame with “I” v. “you” statements
- Okay to have different perspectives
- Don’t have to agree on each other’s problem definitions
- Check for accuracy in understanding each perspective
- Speaker says they understood
What are philosophies of a BEH contract?
(4)
- Too many fun things make taking things away or offering rewards useless
- Fun activities need to be recontextualized as privileges, which can be earned
- Psychoeducation: parents have control over many things… identify what & when
- **Need to provide consistent, specific, predictable, & immediate feedback!!
What are parts of an actual BEH contract?
- I, _____, agree that I will make my bed every day before I leave. If my bed is made, I can…If it is not made, I cannot…
- Can use a point system with daily and weekly privileges (age 13 and younger)
- Tell parents to hang in there! Goal is to alter parent bx, teen’s bx is a bonus at first
- Add response cost later (take pts away)
- Parent needs to follow-through and be able to oversee punishments (e.g. be home)
Ben-Porah: Validation Strategies to Adjuct Parent Training
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Techniques for parents
- Parental psychopathology: a poor predictor of child psychopathology and child treatment outcome
- Parents often have difficulty generalizing BMT skills when feeling emotional during actual conflicts
- Affect regulation difficulties often combined with an invalidating environment
- Most PT programs do not focus on parental symptom management
-
DBT Techniques
- Validating parents’ own experiences
- Mindfulness: observing and describing thoughts, physiological sensations, and behaviors (self and child’s) nonjudgmentally & in the moment (not past or future)
- Emotion coaching: labeling self and child’s emotions
- Opposite action: do the opposite of the behavioral urge following an emotion
Vidair: Key Aspects of a Termination Session
(8)
- Consolidate gains made in treatment, plan for the future, and celebrate work
- teach children to become their own therapists from the start of treatment, clarifying expectations and eliciting parental assistance as developmentally appropriate,
- foster a therapeutic alliance early on to engage children and parents in the process of skills acquisition
- facilitate skills generalization and maintenance to prepare families for termination
- consolidate treatment gains and a final therapy product in the final session
- plan for relapse prevention and booster sessions
- celebrate child and parent progress
- facilitate a “good goodbye” by modeling, eliciting, and validating positive and negative feelings while reinforcing the idea that the child is ready to be their own therapist.
Kazdin: Improving Attendance in Treatment
- Early research: Single prompts such as reminder calls
- RCT: 30-minute phone call prior to intake appointment.
- Those who received a phone call or phone call + intake were more likely to show up for sessions.
- Only call + intake showed improved attendance in subsequent appointments
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Strategic Structural Systems Engagement (SSSE)
- Family techniques to reduce resistance and increase initial engagement
- RCT for Latino adolescents with substance abuse disorder in the SSSE Tx condition were more likely to attend intake and less likely to drop out
- Second Latino RCT confirmed efficacy in increased engagement
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Question Formulation Technique
- Why: Increase participation in treatment-related decisions and decrease dropout
- Teaches: identification important decisions treatments relevant to care and generate carefully constructed questions directed to providers. Empowerment shifting model.
- Studies
- Successful in minority groups
- Higher use of mental health providers, higher attendance, low dropout
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DECIDE
- Studies
- Greater engagement with providers and more self-management. NOT associated with a greater increase in retention
- RCT in motion
- Studies
-
Overview
- Most focus on initial engagement and not drop out
- No engagement strategies found for Asian and Native American youth
- Issues
- Limited reporting of demographic information
- Lack of representation
- Need to know if rates of participation vary based on SES
- Not to health access inequity