Why do we want to learn brief psychotherapies?
We want the most practical approach and many areas where we work will expect them.
What are some settings that will expect brief psychotherapies?
- Managed care
- Private practice
What two areas are brief therapies especially effective in treating?
- Mood disorders
- Anxiety disorders
who is brief therapy work intensive for?
The therapist. There is a lot of prep work, you are active and directive and still being collaborative.
What are the characteristics of brief therapy?
- Evidence Based
- Fewer than 20 sessions
What 4 things are involved in brief therapy?
- Patient selection
When is brief therapy appropriate?
Motivated clients and people who are in transition.
Who is not appropriate for brief therapy?
people with characterlogical issues or those who have a difficult time forming relationships or trusting.
What 6 thinks do you want to look for when screening for brief therapy?
- Duration of problem
- Interpersonal history
- Severity of problem
- Complexity of problem
- client's understanding of the problem
- social support
How can brief interventions be helpful to clients who have chronic or severe problems?
you can still use brief interventions over the course of a longer treatment, for example DBT is a series of brief interventions.
What three phases make people change in treatment?
What is Engagement in treatment?
- establishing a working alliance
- client vents
- therapist looks for patterns
- treatment goals are developed
What is discrepancy in treatment
The client looking at what is helping them and what is not helping them, working out new patterns, and trying them out in real life.
What is consolidation in treatment
practicing new skills, internalizing and maintaining new behaviors or patterns.
In the martini glass analogy what is the base?
"person" part of the therapist. Positive or negative characteristics that will make or break the martini
what is the stem in the martini analogy?
common factors such as patient variable, relationship, and expectancy.
what is the cup part of the martini analogy?
Name 4 factors that have a positive effect on treatment outcome.
- therapist acceptance
- therapeutic alliance
Name 2 good therapist traits.
ability to help someone open up to threatening thoughts and feelings.
help clients be okay with being influenced by therapeutic interactions.
name three ways you can help clients be ok with being influenced by therapy.
the specific technique you use accounts for what percent of improvement?
what are 3 important common factors?
- patient variables
- placebo/expectancy effects/hope
what percent of change is attributed to a person's circumstances?
what are 5 patient variables?
- ability to relate to therapist
- degree of psychological mindedness
- severity and number of symptoms
- ability to see a central problem
- life circumstances
what does it mean to have psychological mindedness?
being introspective, willing to explore on a deeper level.
when you are orienting a client to treatment, what is it important to underscore?
that the therapist is there as a guide, but that the client will be doing the bulk of the work.
what are 3 reasons that psychoeducation is important?
- orients client to treatment
- increases awareness of behaviors and their outcomes
- learn that some assumptions the client holds are inaccurate.
What 2 things do you want to balance when working with a client?
confrontation and support
why is focusing only on what the client is doing wrong harmful?
It is demoralizing and reinforces negative self-appraisal.
why is being too positive or supportive harmful to the client?
It invalidates their experience and is in conflict with their self-perception.
what percent of people are ready to change when they come into treatment?
What are the 6 stages of change?
what is precontemplation
a client lacs awareness of problems
what is contemplation
client accepts that a problem exists
what is preparation
A client considers making changes
what is action?
active attempts to make improvements
what is maintenance?
anticipation of future stressors
how can a therapist help move a client toward the later stages of change?
what percent of improvement is accounted for by relationship factors?
What do you need to develop a therapeutic alliance?
- a collaborative atmosphere
- mutual trust and acceptance
- mutual goal setting
how can you facilitate a therapeutic atmosphere?
- unconditional positive regard
what is a corrective emotional experience?
when the client perceives the therapist in a more constructive and supportive manner than significant figures in their life.
what is catharsis?
release of emotional tension
how can a client experience master?
- increased control
- increased understanding
what five factors make up relationship facotrs?
- therpeutic alliance
- corrective emotional experience
- feeling of mastery
what is pathogenesis?
the degree wo which the therapist uses dependent individuals to satisfy their own needs
what percent of change to hope factors account for?
what does placebo mean in a therapeutic sense?
not doing any specific interventions
what is the primary use of motivational interviewing?
increase commitment to behavior change
how many sessions are usually used for MI?
who is MI useful with?
- clients who are ambivalent
- substance abuse
- lifestyle changes
what is MI?
a collaborative, client-centered form of guiding to elicit and strengthen motivation for change.
name 4 things that MI can treat
- substance abuse
- weight management
- medication compliance
- school truancy
what technique is often used in various contexts such as therapists, doctors, teacher, and case managers?
name three ways you know when to use MI
- ambivalence not lack of knowledge
- stage of change
- inherent desire to change in client
What are the 2 ingredients of MI?
what is the relational component of MI
- empathy and acceptance
- emphasis on reflective listening and understanding the client's perspective
what is the technical component of MI?
- target behavior
- focus on why they should change not how
- selective attention
what is an issue of using MI in the healthcare field?
the doctor is the expert in the room and this can cause the client to feel that they can't change and set them up for failure.
when is MI not appropriate?
- no target behavior
- misunderstanding who provides motivation
- righting reflex
what is the righting reflex?
The therapist's urge to solve client problems
who generates the reasons for change in MI?
what are 4 things to help practice MI?
- express empathy
- support self-efficacy
- roll with the resistance
- develop discrepancy
how does developing discrepancy help people become motivated to change?
when people experience a mismatch between where they are and where they want to be they may become motivated to change.
what are 4 MI techniques?
- open-ended questions
What are the 4 components of DBT?
- individual therapy
- phone coaching
- skills group
- consultation group
what is the purpose of consultation group in DBT?
individual and group therapists to meet with other DBT therapists
What are the 4 stages in DBT therapy?
- decrease self-harm
- deal with emotions and traumatic experiences
- working with problems of everyday living
- move toward a fulfilling life
what is the structure of an individual DBT session?
- review diary card
- do a behavioral analysis of life threatening bx
- therapy interfering bx
- quality of life issues
- teach skills
What is the purpose of the diary care?
to track skills, and self-harm and follow up week to week.
what are the 6 components of a behavioral analysis
- problem behavior
- prompting event
- link bx to actions, sensations, thoughts feelings
- solution analysis
what is the purpose of phone coaching?
to help client's decide what skills to use
what is phone coaching NOT?
how long is phone coaching restricted after self-harm?
what 4 areas do skills group focus on?
- interpersonal effectiveness
- emotion regulation
- distress tolerance
what is the DBT skills group format?
- mindfulness exercise
- review homework
- presenting new skills
what is the purpose of mindfulness skills?
Learning to be in control of your own mind instead of it controlling you.
what are the 3 states of mind in mindfulness skills?
- emotion mind
- reasonable mind
- wise mind
name the 3 mindfulness what skills
- Fully Participate
What is the observe skill?
sensing or experiencing without describing or labeling the experience
Use your five senses
What is the Describe Skill?
using words to label your observations
Just the facts
What is the fully participate skill?
entering wholly into an activity
What are the 3 how mindfulness skills?
What is the non-judgmentally skill?
focus on who what when and where without evaluation of good or bad
What is the one-mindfully skill?
- Do one thing at a time
- let go of distractions
What is the effectively skill?
know your goal and focus on what works to get there
how can the how and what skills be best combined?
- Observe one-mindfully
- describe non-judmentally
- participate effectively
Describe a mindfulness practice exercise
get sometime that can be experienced and ask them to mindfully attend to it.
name three things that might be good to use in a mindfulness exercise
- hot tea
- an orange
- play dough
what are some questions to ask after a mindfulness exercise?
how long were you able to stay mindful
what got in the way of being mindful
were you able to refocus when you noticed you were wandering
What did you notice after practicing mindfulness?
What are 3 important reasons to learn interpersonal effectiveness skills?
getting your objectives and goals met in a situation
getting or keeping a good relationship
what acronym is used to get goals met in DBT
What acronym is used for getting or keeping a good relationship in DBT?
What acronym is used for improving self-respect in DBT?
what does DEAR MAN stand for?
- appear confident
what does GIVE stand for?
- easy manner
what does FAST stand for?
- stick to values
why is it important to prioritize the 3 reasons for interpersonal effectiveness in each situation?
You may not be able to achieve all three
What are distress tolerance skills?
skills for tolerating painful events and emotions when you can't make them better right away
what are 5 distress tolerance skills?
- improve the moment
- pros and cons of tolerating distress
- accepting reality
What are the 3 goals of emotion regulation
- understand emotional experience
- reduce emotional vulnerability
- decrease emotional suffering
what two ways can we understand our emotional experience
- identify and label emotions
- understand the purpose of emotions
how can we reduce emotional vulnerability
- use please master skills
- increase positive emotions
what tow ways can we decrease emotional suffering?
- let go of painful emotions
- change painful emotions through opposite action.
What are the six parts of the emotion sequence?
- prompting event -- somehting happens
- interpretation-- you have thought or belief
- body changes-- physical reaction
- body language --characteristic gesture
- action urges -- what you want to do
- after-effect -- what happens after
According to cognitive therapy what is the key element of depression
negative biased judgments people have about themselves
What are 4 characteristics of cognitive therapy?
- short term
- information processing
What are two key components of cognitive therapy?
- identifying cognitions
- identifying automatic thoughts
give two examples of how a person's perception can be inaccurate when they are distressed
depression -- hopelessness, failure, inadequacy
anxiety -- fear the work is a dangerous place
What are core beliefs
fundamental beliefs about the self
what is a schema
the ways that people organize their experience
what is the diathesis stress model?
people may have an experience that is negative and they may become activated if it matches their core belief.
What are the two categories of negative core beliefs?
What can the downward arrow technique help discover?
How automatic thoughts are a product of a person's core beliefs
What are the 3 levels of conceptualization in cognitive therapy?
Current thoughts, behaviors, and emotions
precipitating factors -- what trigger the situation
Developmental framework -- how did early experiences shape core beliefs
What is the therapist's role in cognitive therapy
- provide psychoeducation
- examine key thoughts or beliefs
- make suggestions about beliefs
- collaborate on goals, problem solving, and examining evidence.
- capsule summaries
What is a capsule summary?
therapist summarizes clients experience in cognitive model terms.
how can planned experiments help the client?
If successful they can be corrective experiences that can be used as evidence next time a triggering situation arises
What is the session structure in cognitive therapy?
- evaluate and set the agenda
- bridge between sessions -- what happened this week that is related to treatment
- psychoeducation, teaching and practicing skills.
what is the cognitive triad for cognitive distortions?
- negative view of self
- negative view of world
- negative view of future
what is the cbt triad
what are 3 reasons behavioral activation is important
- give clients a sense of mastery
- give clients a sense of accomplishment
- will help them start to feel better
what are the two focus areas of behavior therapy?
- problem focused
- present focused
What are the goals of behavior therapy?
- learn skills
- corrective experiences
- client to become their own therapist
what is one way to start generalization in behavior therapy?
what are 5 behavior techniques?
- problem solving
- role playing
what part of behavior therapy is a good predictor of treatment outcome?
what are two types of relaxation?
What are 2 types of exposure?
what are three components of the behavior relationship?
- credible rationale
- use of metaphors
What are safety behaviors?
behaviors that a client engages in to help them separate themselves from anxiety.
What three things does a therapist need out of an assessment?
- understanding of problem
- understanding of diagnosis
- identify specific behaviors
What is stress inoculation?
a way for clients to manage stress
what is the goal of stress inoculation?
to teach clients that stress and anxiety are normal and develop skills for managing them
what is the goal of PMR?
to learn what tension feels like in order to identify it and let it go
what is PMR
progressive muscle relaxation means systematically tensing and relaxing specific muscle groups in the body.
who is PMR contraindicated for?
people with high blood pressure.
what are the steps of structured problem solving
- set realistic goals
- generate list of possible solutions
- evaluation pros and cons of solutions
- choose a solution
- implement the solution
- evaluate the outcome
- praise or reinforce
What is the goal of guided self dialogue?
to focus on internal dialogue
what is guided self dialogue similar to?
cognitive restructuring, but it is done in their head in the moment.
what is guided self dialogue?
replacing irrational, unhelpful, or negative, with rational, facilitative, and positive self dialogue.
what are 5 ways to engage in guided self dialogue?
- assess the probablility of a negative event
- manage avoidance
- control self defeating thoughts
- engage in desired behavior
- praise for attempt and follow through
What are two ways to implement guided self dialogue
What are the three goals of exposure therapy?
- activate fear structure
- provide new info that is incompatible
- corrective experience.
What are two diagnoses that often use imaginal exposure?
OCD and PTSD
how long should exposures last?
until habituation occurs.
what are 5 steps to in vivo exposure
- create a hierarchy
- begin with moderate and work up
- first exposure in session
- client does exposures as homework
- beware of safety behaviors
What is interoceptive exposure
deliberately inducing feared physical sensations to learn to be less afraid of body sensations
what is interoceptive exposure typically used for?
men are at and increased risk of what if in a conflicted relationship
high blood pressure
women are at an increased risk of what if in a distant relationship
What are the 3 exclusion criteria for couples work?
an ongoing affair that one person isn't okay with.
in CBCT what are the three foundations
improve skills to maintain relationship
explore interpretations and evaluations that contribute to distress
look at dysfunction responses to relationship event and the inappropriate information process that led to it.
what are the 3 dimensions of relationship difficulties
the person who tends to be the withdrawer and don't want to address issues are
What do you need to do with an emotionally explosive person?
- set boundaries
- give them a specific time to be emotional
- build distress tolerance
what can you do with an emotionally avoidant person?
- give them a preset time
- increase partners awareness of difficulty
what are individual factors?
- need for intimacy
- need to be giving
- need to attend or be attended to
what is primary distress
partners experiences of unresolved differences and unmet needs. i.e. feeling unloved
what is secondary distress?
partners dysfunctional way of interacting in response to unresolved issues. i.e. increasing demands for affection
What are relationship factors
- mutual engagement
- mutual avoidance
What are environmental factors?
social and physical such as families, communities, and cultures
what are 4 components of couples therapy?
- identify 1-2 themes
- stop maladaptive ways of interacting
- increase adaptive ways to deal with issues
- communication skills
What are 2 types of behavioral interventions
- guided behavior change
- skills based interventions
What are two types of guided behavior change?
what is broad-based change
improving overall emotional tone of the relationship
what is focused change
identifying a specific theme in the relationship and collaborating to come up with ideas they can implement
What is important in guided behavior change
that each person commits to constructive change regardless of their partner's behavior.
what is reviewd in the conversation on sharing thoughts and feelings
skills for sharing thoughts and emotions and skills for listening to a partner
what is important when sharing?
what is important when listening
take your partner's perspective
What are 5 cognitive variables that affect relationships
- selective attention--what each person notices
- attributions--inference about others bx
- expectancies--predictions about future
- assumptions--what each person believes
- standards--what they think relationship should be like
What does cognitive interventions help couples do?
reevaluate cognitions and view events in a more balanced way
what are some cognitive interventions you would use in couples therapy?
- cognitive restructuring
- downward arrow
- socratic questioning
- guided discovery
why do you want to be careful with socratic questioning in couples therapy?
could provide ammunition for later arguments
What is guided discovery
therapist ceates experiences where the partners may start to questions their thinking and behavior.
what are 4 components of guided discovery
- construct a situation where new info is gained
- discuss pros and cons of each point of view
- role-play one another's viewpoint
- watch video of themselves and discuss
What can you do if you notice a couple polarizing?
have a discussion of advantages and disadvantages of thinking one person is right and other is wrong
What are 3 types of dynamics in EFT?
What is Sensate Focus
treatment designed to help couples experiencing sexual problems
describe stage 1 of Sensate focus
take turns touching, but erogenous zones off limits
become aware of sensations
describe stage 2 of sensate focus
touching is expanded to all areas
describe stage 3 of sensate focus
why does sensate focus work?
it is a form of in vivo desensitization