Treatment 2

Question 0

general systems theory

Answer 0

system is an interaction of component parts, which seeks to attain homeostasis

Question 1

2 theoretical models that have influenced family therapists

Answer 1

general systems theory

cybernetics

Question 2

cybrenetics

Answer 2

focuses on the circular nature of feedback loops

feedback loops can be positive or negative

Question 3

negative feedback loops

Answer 3

Cybernetics
tends to decrease deviation in a system
e.g. thermostat - fx to minimize changes in temperature; when temp rises, cooling systems bring it down and vice versa; thus maintaining homeostasis

Question 4

positive feedback loops

Answer 4

cybernetics
increases deviation or change
e.g. lasting change in a family’s dynamics as a result of psychotherapy

Question 5

psychodynamic family therapy

Answer 5

facilitating individual maturation in the context of the family system
freeing family members from unconscious patterns of anxiety and projection rooted in the past
major emphasis: helping family members clarify communication and admit honest feelings

Question 6

Lidz two deviant types of marital relationships

Answer 6

marital schism and marital skew

lead to impaired parenting and disrupted sex-role learning for the child

Question 7

Marital schism

Answer 7

Lidz
severe, chronic discord and disequilibrium
threats of separation common and recurrent
communication centers on power struggles and efforts to avoid facing the schism between the spouses
parents tend to seek support from their children and attempt to diminish the worth of the parent to the childrne

Question 8

Marital skew

Answer 8

Lidz

relationship skewed toward meeting the needs of one member at the expense of the needs of others

Question 9

family sculpting

Answer 9

technique that can be used to address marital schism or marital skew
therapist interprets the sculpture and modifies it in ways to suggest new relationships

Question 10

object relations family therapy

Answer 10

Framo
focuses on transferences and projections between couples or family members
problems caused when members unconsciously project unwanted elements of themselves onto others in the family
members experience dissatisfaction and try to change one another
therapy focuses on helping each family member become aware of what is being projected and address unwanted elements within each person

Question 11

healthy family according to structural family therapy

Answer 11

healthy family - hierarchy with strong parental coalition on topmost level
boundaries clear and firm, yet there is flexibility in the system that allows for autonomy and interdependence, individual growth, and adaptive restructuring in response to developmental and environmental demands

Question 12

StrUctural Family Therapy (U!)

Answer 12

MinUchin (U!)
family viewed as single, interrelated system
system assessed along variety of dimensions: hierarchy of power, clarify and firmness of boundaries, significant alliances and splits (subsystems)

Question 13

pathological family according to structural family therapy

Answer 13

results from structural imbalances e.g. malfunctioning hierarchical arrangement or poor boundaries that are too rigid or too diffuse

Question 14

three chronic boundary problems (Minuchin)

Answer 14

triangulation
detouring
stable coalition

Question 15

triangulation

Answer 15

Minuchin
child caught in middle of parents’ conflict
each parent demands that child side with him/her
when child sides with one parent, viewed as attacking other
child ultimately becomes paralyzed

Question 16

detouring

Answer 16

Minuchin
parents express their distress through one child, who becomes identified patient
creates false sense of harmony between parents, with parents blaming the child as source of family’s problems or united to protect sick, weak child

Question 17

stable coalition

Answer 17

Minuchin

one parent unites with child against other parent in rigid cross-generational coalition

Question 18

goal of Structural Family Therapy

Answer 18

unbalance or reorganize the family’s structure in such a way that dysfunctional elements are removed
therapist takes role as expert - diagnoses dysfunctional elements and develops interventions to correct them

Question 19

therapist in structural family therapy

Answer 19

at outset - joins with family and attempts to understand family’s dynamics by adopting its style of interaction
therapy then focuses on shifting members’ positions in order to disrupt malfunctioning patterns and strengthen parental hierarchy, with goal of creating clear and flexible boundaries

Question 20

Structural Family Therapy strategies for unbalancing family’s homeostasis

Answer 20

therapist taking sides, blaming, and forming coalitions

Question 21

effectiveness of Structural Family Therapy

Answer 21

highly effective in treatment of asthma, diabetes, and anorexia in childhood and adolescence as well as treatment of adults with drug addictions

Question 22

Communications Family Therapy

Answer 22

focuses on communication and its impact on family functioning
coined term “double bind”

Question 23

double bind

Answer 23

Family Communications THerapy
maladaptive communication that typically involves at least three elements
1) injunction telling person if they do/don’t do something they will be punished
2) secondary injunction which is generally nonverbal, conflicting with the first at a more abstract level, also enforced by punishment
3) tertiary injunction prohibiting victim from escaping the field (e.g. by not allowing the victim to point out the inconsistency)

Question 24

double bind theory of schizophrenia

Answer 24

saw double binds as contributing to etiology of schizophrenia not empirically supported

Question 25

Communications Family Therapy techniques

Answer 25

direct - teaching, pointing out problematic communication patterns indirect - paradoxical interventions that prescribe the symptom (e.g. telling couple with marital problems to fight at least three hours a day)

Question 26

Strategic Family Therapy

Answer 26

Haley | combines structural approach (hierarchies) and communications approach (communications and interactions)

Question 27

normal family functioning according to Haley

Answer 27

involves flexibility, large behavioral repertoire for problem-solving, clear rules governing family's hierarchy

Question 28

pathology according to Haley

Answer 28

results from malfunctioning hierarchy, or triangles and coalitions across the hierarchy

Question 29

treatment using strategic family therapy

Answer 29

focuses on resolving presenting problem only, defined by behavioral objectives and criteria underlying pathology or conflicts not addressed focus on interrupting rigid feedback cycle and defining clearer hierarchy

Question 30

Systematic Family Therapy

Answer 30

Milan group | circular questioning and prescription of rituals

Question 31

circular questions

Answer 31

Systemic Family Therapy e.g. asks each family member to express his/her views on the relationships and differences between other family members transforms families' ways of thinking from linear and causal to reciprocal and interdependent

Question 32

prescription of rituals

Answer 32

Systemic Family Therapy typically include some component of secrecy, isolation, recording in notebooks, or parental outings framed as disappearances

Question 33

Family Systems Therapy

Answer 33

Bowen healthy families have clearly differentiated family members and there is an overall balance of intellectual and emotional forces pathological families function as single organism and identified patient is that part of the organism through which overt symptoms are expressed family emotional system (undifferentiated family ego mass) - central concept

Question 34

family emotional system

Answer 34

undifferentiated family ego mass | refers to emotional oneness that exists and shifts about within family in definite patterns of emotional reciprocity

Question 35

multigenerational transmission of pathology

Answer 35

Bowen Family Systems Therapy | pathology in family repeated throughout generations

Question 36

assessment of family - Bowen's Family Systems Therapy

Answer 36

evaluates family on degree of fusion vs. ability to differentiate and analysis of emotional triangles in presenting problem (3 party system arranged so that closeness of two members tends to exclude third

Question 37

goal of treatment - Bowen's Family Systems Therapy

Answer 37

shift "hot triangle" that relates to presenting problem work with most most psychologically available family members to achieve enough personal differentiation so that hot triangle does reoccur personal differentiation from family of origin - ability to become one's true self in face of familial or other pressures that threaten loss of love or social position

Question 38

genogram

Answer 38

originated with Bowen | survey of family going back several generations

Question 39

Solution-Focused Therapy

Answer 39

Steve de Shazer aims to set up positive expectations in both therapist and client typically very brief (as little as 3-4 sessions) encourages clients to focus on strengths and identify solutions, either ones that have worked in past or might work in future

Question 40

Solution-Focused Therapy - three types of questions

Answer 40

miracle question exception question scaling question

Question 41

miracle question

Answer 41

Solution-Focused Therapy "Suppose one night, while you were asleep, there was a miracle and this problem was solved. How would you know? What would be different?"

Question 42

exception question

Answer 42

Solution-Focused Therapy asks clients to think about times when they didn't have the problem so they can discover what they were doing that was effective at that time helps to foster more positive outlook in which problem is controllable

Question 43

scaling question

Answer 43

Solution-Focused Therapy | asks patients to rate their problem on a scale of 1-10 (10 being how they would feel the day after the miracle)

Question 44

Narrative Therapy

Answer 44

Michael White symptoms thought to result from clients developing stories that are "problem-saturated" descriptions filled with a sense of powerlessness

Question 45

role of therapist in Narrative Therapy

Answer 45

helping clients "re-story" by casting their difficulties for a "struggle for control" with symptom symptom externalized as though it were entity separate from the client asks questions to demonstrate "unique outcomes," those successes that have been hidden by the focus on problems

Question 46

Behavioral Family Therapy

Answer 46

normal family functioning results when adaptive behavior is rewarded, maladaptive behavior is not reinforced, benefits of being a member of the family outweighs its costs

Question 47

Cognitive-Behavioral Family Therapy

Answer 47

relationship-related cognitions are seen as underlying cause of feelings and behavior of family members

Question 48

Marital Behavioral Therapy

Answer 48

Richard Stuart developed approach that combines operant learning principles with social exchange theory behavioral exchanges between spouses ultimately lead to satisfaction or dissatisfaction contingency contracting caring days

Question 49

social exchange theory

Answer 49

behavior in relationships is maintained by its ratio of costs and benefits

Question 50

contingency contracting

Answer 50

Stuart's marital behavioral therapy | each spouse agrees to perform certain behaviors in exchange for other spouse performing certain behaviors

Question 51

caring days

Answer 51

Stuart's marital behavior therapy | one day a week, spouse deliberately performs behaviors that have been requested by other spouse

Question 52

most crucial component of successful group therapy

Answer 52

cohesiveness analogous to relationship or rapport in individual therapy defined as attractiveness of group to its members cohesive groups show greater acceptance, intimacy and understanding, and permit greater expression of hostility and conflict among group members and towards leaders

Question 53

Yalom's three stages of group evolvement

Answer 53

initial stage second stage third stage

Question 54

Yalom's initial stage

Answer 54

participation hesitant content and communication of group members stereotyped and restricted group discusses topics of little personal significance and searches for commonalities group members typically talk to therapists rather than with one another

Question 55

Yalom's Second Stage

Answer 55

characterized by conflict among group members, rebellion towards group leaders, and attempts at dominance

Question 56

Yalom's Third Stage

Answer 56

development of closeness, intimacy, and cohesion | group members talk freely with each other

Question 57

Yalom's view - open conflict or disagreement between leaders and self-disclosure

Answer 57

1) healthy and can be positive model for group members | 2) frequently beneficial to group participants

Question 58

Research on groups - those most likely to drop out; those who are most likely to fail

Answer 58

1) patients with significant denial, high degree of somatization, lower motivation, severe pathology, lower SES, lower IQ, generally less likable 2) patients with fewest skills

Question 59

group composition

Answer 59

ideally consist of members who are heterogeneous in terms of conflict, homogeneous in terms of ego strength size; 7-8 members, 5-10 acceptable range

Question 60

confidentiality in groups

Answer 60

impossible to mandate and enforce confidentiality, but importance of confidentiality should be brought up early on and members should be periodically reminded "honor system"

Question 61

crisis theory

Answer 61

at equilibrium, person's usual coping techniques are operating sufficiently to handle daily problems during crisis, person faced with obstacle that is, for a time, insurmountable by the person's customary methods of problem-solving

Question 62

Caplan's for phases of a typically crisis situation

Answer 62

1) when crisis beings, person feels emotional tension and disorganization, and tries to manage the situation by previously learned coping mechanisms 2) coping efforts fail to resolve problem and further disorganization occurs 3) greatly increased tension level with further mobilization of internal and outside resources, perhaps helping-seeking and/or change of direction and goals 4) if intensified efforts fail to resolve the crisis, extensive personality disorganization and emotional breakdown may occur

Question 63

crisis intervention

Answer 63

rapid treatment crucial; terminated as soon as it appears crisis has been resolved and patient understands steps that led to its development resolution 1) rapid establishment of rapport 2) reviewing steps that led to crisis 3) helping patient gain understanding of his/her maladaptive reactions 4) helping patient develop more adaptive ways of dealing with crisis and strategies to avoid hazardous situations that are likely to produce future crises

Question 64

community interventions

Answer 64

focuses on prevention, treatment, and rehabilitation of mental disorders through use of organized community programs

Question 65

consultation (four categories)

Answer 65

1) client-centered case consultation 2) consultee-centered case consultation 3) consultee-centered administrative consultation 40 problem-centered administrative consultation

Question 66

client-centered case consultation

Answer 66

consultant helps consultee with individual case | e.g. helps therapist develop treatment plan for child with conduct disorder

Question 67

consultee-centered case consultation

Answer 67

consultant helps the consultee with difficulties he/she is having in working with patients, whether the problem stems from inexperience, lack of skill, or difficulties with objectively e.g. therapist who commonly experiences countertransference toward patients diagnosed with borderline PD meets with consultant to work on ways to address her reactions

Question 68

consultee-centered administratibe consultation

Answer 68

consultant focuses on consultee's difficulties that limit effectiveness in instituting program change e.g. consultant meets with therapist who works in psychosocial rehabilitation in order to increase therapist's knowledge about this type of program with goal that the program be implemented more effectively

Question 69

program-centered administrative consultation

Answer 69

consultant focuses on developing, expanding, or modifying a program e.g. consultant meets with a group of clinicians to help them develop or improve a program for pre-gang teens

Question 70

advocacy consultation

Answer 70

consultant advocates for social change

Question 71

primary prevention

Answer 71

attempts to prevent onset or occurrence of a disease or disorder and thereby reduce its incidence (or number of new cases) e.g. alcohol and drug education, Head Start, vaccinations

Question 72

secondary prevention

Answer 72

focuses on early identification and prompt treatment of an illness or disorder that already exists goal: stop relatively mild disorders from becoming more serious and prolonged e. g. mammograms, hotlines, aggressively treating children with conduct disorders to prevent development of antisocial personality disorder, screening children for learning disabilities and providing special programs early on, prompt treatment of earthquake victims evidencing trauma, etc.

Question 73

tertiary prevention

Answer 73

focuses on reducing residual effects of a chronic disability or minimizing further negative consequences of an established, serious disorder e.g. vocational rehabilitation and day treatment centers for patients with schizophrenia, 12-step program for alcoholics or addicts

Question 74

physical abuse

Answer 74

32% under age of 5, 27% 5-7, 27% 10-14, 14% 15-18 more than half of all cases of abused or neglected children were born prematurely or had low birth weight typically viewed by parents as developmentally slow, different, hard to discipline

Question 75

_____ children especially vulnerable to physical abuse

Answer 75

hyperactive

Question 76

most abused children come from________

Answer 76

poor, socially isolated homes where perpetrators have inappropriate expectations of their children

Question 77

most common perpetrators of physical abusers

Answer 77

female 80% of abusers live in home 90% severely abused as kids most do not have history major psychiatric problems, but substance abuse common

Question 78

household composition of abused children

Answer 78

80% live in homes with two parents, 20% with one parent

Question 79

sexual abusers

Answer 79

50% family members | fathers, step-fathers, uncles, older siblings most common

Question 80

% of sexual abuse cases under 8 years old | sexual abuse peaks....

Answer 80

25% | between ages of 9 and 12

Question 81

domestic violence against women

Answer 81

violence against women most common, tends to be more chronic and result in more serious injuries

Question 82

intimate partner violence

Answer 82

underreported, especially by men

Question 83

reports of intimate partner violence among types of relationships -raped, stalked, physically assaulted

Answer 83

23% men in gay relationships 22% women in heterosexual relationships 11% women in lesbian relationships 7% men in heterosexual relationships

Question 84

race and ethnicity and incidence of violence

Answer 84

impact lessened when other variables controlled for

Question 85

variable the best predicts likelihood of violence

Answer 85

presence of verbally abusive partner

Question 86

many reports indicate that spousal violence occurs most frequently... other reports suggest that the occurrence of spousal abuse...

Answer 86

in concert with alcohol or crack abuse | is not correlated with substance use per se, but severity of abuse is

Question 87

abusive men are more likely...

Answer 87

to have come from violent homes and have witnessed spousal abuse may have a higher rate of being abused themselves tend to be immature, dependent, non-assertive, and generally feel inferior abusive act is self-reinforcing, cycle of abuse continues and escalates over time

Question 88

best long-term result of abuse

Answer 88

arrest of husband

Question 89

expressive vs instrumental spousal abuse

Answer 89

expressive abuse - less deliberate, results from difficulty managing emotions; more amenable to treatment, but typically becomes instrumental over time if left untreated instrumental abuse - more deliberate attempt to use violence as a means of control

Question 90

rape

Answer 90

often occurs in concert with another crime | alcohol involved 50% of time

Question 91

age of most men who rape

Answer 91

14-24

Question 92

reporting of rape

Answer 92

highly underreported

Question 93

children of divorce

Answer 93

at time of divorce, children of divorce tend to have more social, academic, and behavioral problems than children from intact homes

Question 94

age of child and divorce

Answer 94

3-6 year olds typically feel responsible 7-12 year old show decreases in school performance adolescents feel they could have prevented divorce but at same time, also feel hurt by and critical of parents

Question 95

recovery from divorce

Answer 95

in general, takes 3-5 years | most children adjust well, up to one third experience lasting trauma

Question 96

girls vs boys' adjustment to divorce

Answer 96

initially girls seem to have better adjustment than boys do, but girls become increasingly vulnerable in adolescence and if mother remarries

Question 97

younger children vs. older children's adjustment to divorce

Answer 97

younger children are more anxious at time of divorce and have less realistic outcomes,but adapt more quickly and have fewer bad memories than children who are older at time of divorce

Question 98

research: adults who grew up in intact families vs. adult children of divorced parents

Answer 98

adult children of divorced parents tend to have higher levels of depression and marital problems and lower levels of SES and health

Question 99

Eysenck (1952) - meta-analysis

Answer 99

reported that 2/3 of all neurotics improved over a two year period whether or not they received treatment noted that treated people actually seemed to do worse criticized for non-random assignment to treatment vs. no treatment, providing attention to so-called non-treated condition (which could account for their improvement) and lack of distinction between therapists administering treatment

Question 100

spontaneously improvement rate

Answer 100

40%

Question 101

subsequent meta analytic studies after Eysenck (e.g. Smith, GLass, and Miller, 1980)

Answer 101

average effect size of .85 in comparing treated to non-treated individuals i.e. at end of treatment, average treated person better off than 80% of untreated sample

Question 102

Howard et al.'s meta-analytic study of treatment outcomes

Answer 102

50% of patients improved by 8th session, 75% improved by end of 6 months

Question 103

Luborsky et al. (1975)

Answer 103

treatment outcomes essentially similar for all types of treatment

Question 104

1995 Consumer Reports Study

Answer 104

analyzed responses of 7,000 people to questionnaires about mental health treatment 90% of treated patients did well long-term treatment yielded better outcomes than short-term medication in addition to therapy didn't lead to improved outcomes no specific modality led to better outcomes for any disorder psychiatrists, psychologists, and SWs did not differ in effectiveness, but did better than marriage counselors and long-term family doctoring patients whose length of therapy or choice of therapy was limited by insurance did worst

Question 105

limitations of Consumer Reports study

Answer 105

absence of control group, non-random assignment, possibly biased sample, reliance on retrospective self-report contradicted some efficacy studies - e.g in most efficacy studies, 65% of patients improved and short-term therapy was highly effective

Question 106

psychotherapy outcome research - therapist variables - gender - ethnicity match - experience

Answer 106

treatment facilitated with female therapist or when patient and therapist of same gender relatively little different in outcome whether patient and therapist are matched for ethnicity patients tend to prefer therapists of own ethnicity and may participate more in early stages in treatment, thus there may be fewer premature terminations more experienced therapists have lower drop-out rates

Question 107

psychotherapy outcome research - therapy relationship

Answer 107

quality of relationship is as important to outcome as method of treatment use

Question 108

general psychotherapy outcome research findings 1) group vs. individual 2) group with lowest rates of psychiatric disorders 3) group with next lowest rate 4) group with highest rate 5) most common disorder in people over 65 6) women vs. men (seeking treatment) 7) married vs. divorced or single individuals 8) college vs non-college graduates 9) suburban and rural vs. inner city

Answer 108

1) no difference 2) people over age 65 3) 45-64 4) 25-44 5) dementia 6) women more likely to seek treatment 7) married men and women less frequently seek treatment and have less psychopathology 8) rates of psychiatric disorders lower for college graduates 9) rates of psychiatric disorders lower for suburban and urban inhabitants

Question 109

Total Quality Management (TQM)

Answer 109

philosophy and set of guiding principles that focus on continuous improvement of the organization, its procedures, and services that it provides for its customers

Question 110

5 premises of TQM

Answer 110

``` customer focus total involvement measurement systematic support continuous improvement ```

Question 111

Quality Assurance

Answer 111

involves monitoring and evaluating a plan's health care services in terms of availability or accessibility, adequacy, and appropriateness

Question 112

theme interference

Answer 112

problems that the supervisee (or consultee) is experiemce that can affect patients' progress