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Who is TLDP good to use with?
Clients with Chronic, pervasive, dysfunction ways of relating to others.
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How is TLDP different than traditional psychodynamic theory?
- Less interpretation
- Past plays a much smaller role
- No time devoted to the unconscious
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What is the focus of TLDP?
changing ingrained patterns of interpersonal and intrapersonal relatedness.
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Briefly explain object relations theory.
A person's idea of who they are comes from their interactions with others, specifically early caregivers.
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Describe circular causality in TLDP
A person's maladaptive relationship pattern will persist because it is being maintained in current relationships.
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How does TLDP view their clients?
Clients are viewed as stuck instead of sick.
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Why does the change process continue after TLDP therapy?
The change process will continue after therapy because of the reinforcement gained from a new way of interacting with others.
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What are the main TLDP principles?
- People are inherently social creatures
- Maladaptive patterns are acquired early in life and repeated in current relationships
- Maladaptive patters will be reenacted in the therapeutic relationship.
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What are the two major goals of TLDP?
- A new experience
- A new understanding
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What do you want the client to get out of therapy in TLDP?
A new experience not an explanation.
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Why is a new understanding important in TLDP?
It can help the client recognize patterns in their lives and can create some empathy for themselves.
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What is the cyclical Maladaptive Pattern similar to?
Examining automatic thoughts
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What is the cyclical maladaptive pattern?
This is the pattern of maladaptive interactions that is present in the client's life. Often involve inflexible self-defeating expectations and behaviors and negative self-appraisals.
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What are the acts of the self
interpersonal thoughts, feelings, behaviors, motives, and perceptions that the client has.
- people will think I'm stupid
- I feel inadequate
- I wish I had someone to share the financial burden
- We were perfect together
- Isolating themselves from others
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what are expectations of others' reactions?
How the client thinks that others will respond to their behavior.
i.e. "people will be unsupportive of me"
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what are expectations of others' reactions connected to?
The clients attachment fears
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what are acts of others toward the self.
The way the client interpret the behaviors of other people.
i.e. they didn't ask me to go because they think I'm boring
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What are acts of the self toward the self?
Introject -- how the client treats himself.
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How are negative introjects learned?
By experiencing the way others treat us.
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Why is countertransference important in TLDP?
The client evokes behaviors and emotions in the therapist and our reactions can be used to understand the client's cyclical maladaptive patterns.
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What are the 4 phases of treatment in TLDP?
- Initial Phase
- Beginning Phase
- Middle Phase
- Termination
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What happens int he initial phase of TLDP?
The therapist let's the client tell their story in their own words. Very non-directive.
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What happens in the beginning phase of treatment in TLDP?
- attend to themes
- be aware of reciprocal reactions
- look for reenactments in the therapeutic relationship.
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What happens in the middle phase of treatment in TLDP?
- Develop a cyclical maladaptive pattern narrative
- Use CMP to outline the goals
- Facilitate a new experience of more adaptive relating.
- Develop understanding
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What happens in the termination phase of TLDP?
review progress and skills
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What helps you decide when to terminate in TLDP?
- client experiences more rewarding interactions
- Increased emotional fluidity
- countertransferential reactions become more positive.
- Client has deeper understanding
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What would exclude someone from TLDP?
- Inability to attend to interpersonal content
- Interpersonal focus could cause harm
- Problems treated more effectively with something else.
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Who makes a good candidate for TLDP?
- Someone with emotional discomfort.
- Basic trust
- Willingness to look at interpersonal issues
- Ability to relate to therapist.
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What are two cultural influences to be aware of when using TLDP?
- How people express themselves
- How someone's interpersonal world is organized.
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Why is it important to consider multicultural perspectives?
Our population is always changing and ethnic diversity is flourishing.
It is important to provide competent services to these folks.
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What are three basic considerations when addressing multicultural competence?
- Client's worldview
- Therapist's worldview
- Safety
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What risk is involved in the therapeutic relations in brief therapy with multicultural folks?
They may not have other support in the majority culture and so ongoing support could be needed.
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How can you be careful not to pathologize diversity?
Do not assume certain thoughts, feelings, or behaviors are abnormal, they may be normal in the client's culture.
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From a CBT perspective, how do we develop a culturally competent practice?
Assess needs with emphasis on culturally respectful behavior
Identify culturally relevant strengths and supports
Clarify what part of the problem is environment and which is cognitive
Validate the client's experience of oppression
Help make changes that reduce stressors, increase strengths and supports, build skills for more effective interactions with environment.
Collaborate more than confront
question helpfulness not validity
Do not challenge core cultural beliefs
Use client's strengths and supports to develop helpful cognitions
Ensure homework is culturally congruent.
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What is a person's worldview?
the sum of an individual's experience, including social, religious, and political beliefs common within a person's reference group.
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How can a therapist learn about the client's worldview?
approach with healthy curiosity and do outside research.
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What is a micro-aggression?
Brief and commonplace daily verbal, behavioral, or environmental indignity that may or may not be intentional. They communication hostility, derogatory or negative slights and insults.
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Why is saying that you don't see color/gender/ race etc. dangerous?
We are ignoring the fact that we all have deeply ingrained prejudices that we may or may not be aware of.
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What is ethnocentrism?
we are inherently immersed in our own culture and see it as better than others.
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When do biases arise in multicultural counseling?
When there are obvious differences and when they seem to have similar backgrounds.
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Why is having an awareness of your own worldview important?
It will allow you to see how your culture could impact therapy.
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Is it true that a therapist's own minority status is an indication of cultural competence?
No
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When is it important not to universally disregard pathological behavior?
When there is safety or risk involved.
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What are 4 ways that you can become culturally competent?
- attend trainings
- self study
- consultation with knowledgeable people
- get supervision from an expert
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Interpersonal Therapy was developed as what?
an adjacent treatment for a medical trial for MDD.
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What is IPT?
Psychodynamically informed, but not oriented
Focuses on modifying disrupted relationships or expectations
Focus on Here and Now
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How are IPT and Solution Focused similar?
They are both time limited and then space out sessions. The conclusion is not termination
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What is the stress diathesis model?
There are certain predispositions and when that comes in contact with a stressor that is triggered it is the perfect storm. In IPT it is tied to attachment style.
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According to IPT what is responsible for communication style?
Attachment style
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What does IPT focus on?
Symptom relief and the current interpersonal world.
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What does IPT NOT focus on?
Unconscious, Past, or internal conflict.
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When conceptualizing from an IPT perspective how are interpersonal crises described?
- Communication skills are not adaptive
- Social support is not sufficient
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What are the goals of IPT?
To get needs met through effective communication and increased social support.
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IPT has shown efficacy with what disorders?
Depression, Anxiety, Eating Disorders
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How is homework created in IPT?
through collaboration
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What are 4 IPT techniques?
- Warmth, empathy, etc.
- Open-ended questions
- Brainstorming
- Outside tasks
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Describe Secure Attachment
- able to give and receive care
- able to communicate needs
- good social support
- more protection against distress
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Describe anxious ambivalent attachment
- uncertain/insecure
- dependent
- poor social support
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Describe Anxious Avoidant attachment
- avoidant/insecure
- antisocial
- poor social support
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What are the 3 attachment styles in IPT?
- Secure
- Anxious ambivalent
- Anxious avoidant
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what are those with less secure attachment more prone to?
psychiatric symptoms
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What can happen when there is a disruption of attachment?
Increase vulnerability to psychiatric symptoms
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What is one example of how a securely attached person can experience a disruption.
The loss of someone, particularly in an unusual way could cause a disruption.
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According to attachment theory, how does dysfunction come about?
an acute crisis, and attachment disruption, or inadequate social support.
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How might insecure individuals communicate in counterproductive ways?
- They may be demanding
- They may be unclear
- Others could react with hostility
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What are the 5 phases of treatment in IPT?
- Evaluation
- Initial Sessions
- Intermediate Sessions
- Conclusions of Acute
- Maintenance treatment
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How many session does IPT typically have?
12-20
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When doing assessment in IPT, what are you looking for?
Their attachment style and their communication style.
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Is a diagnosis necessary in IPT
No
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What are 4 desirable characteristics for a client in IPT?
- specific interpersonal focus
- secure attachment
- speaks clearly about interpersonal reactions
- good support system
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What occurs in the initial session of IPT?
- Interpersonal inventory
- determine problem areas
- present rationale
- develop treatment contract
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What is an interpersonal inventory?
- description of important people
- i.e. interpersonal circle or interpersonal formulation
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What are the 4 problem areas in IPT?
- Grief
- Role transition
- Interpersonal disputes
- Interpersonal deficits
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Is it true that in the initial stage of IPT you choose one relationship to work on and determine one problem area that it falls into?
Yes
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What information do you provide to the client in the initial stage of IPT?
- Interpersonal nature
- need to discuss relationships
- goal is to modify communication patterns or expectations
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When working on a specific interpersonal problem in the intermediate stage of IPT how do you explore a client's experience?
- Communication
- Unrealistic expectations
- Brainstorming
- Implementation
- Review
- Modification
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What happens during the maintenance stage of IPT?
extend intervals between sessions
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What are 8 IPT techniques?
- clarification
- communication analysis
- interpersonal incidents
- use of affect
- role playing
- problem solving
- homework
- use of the therapeutic relationship
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What is clarification in IPT?
asking them direct questions about relationship, or discord that they are experiencing
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What is communication analysis in IPT?
Asking very direct questions to get very specific details of verbal and nonverbal content of a communication.
Helping them see that nothing is all good or all bad.
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What is use of affect in IPT?
helping the client recognize their own affect and get them to communicate how they are feeling.
Often pointing out incongruence.
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What allows the therapist to model new modes of interpersonal behavior and communication?
Role Playing
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What can role playing allow the client to do?
- develop insight
- practice skills
- gain perspective
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What is the hall mark with solution focused treatment?
You want to help the client change
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how many session are ususally in solution focused therapy?
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What is the goal of solution focused therapy?
to help people become the best individuals they can be, given their goals, possiblities and skills.
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What are the 7 core tenets of solution focused therapy?
- If it's not broken, don't fixt it
- If it works, do more of it
- If it isn't working, do something different
- small steps lead to big change
- solution may not be related to the problem
- language for solutions is different than language of problems
- There are always exceptions
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What is the therapist's role in solution focused therapy?
introduce new skill, experiences and ways of viewing
encourage and support change
build confidence and empowerment
build internal locus of control
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How is the miracle question useful?
allows client to see possible solutions
help with goal setting
allows client to see what they would be doing differently
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What can scaling be used for?
- point out success
- find out what works
- set goals
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why is it important to search for exceptions in solution focused therapy?
can provide insight about what to do
can help them feel less stuck
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Why are compliments and tasks important?
- they are reinforcing adaptive efforts
- can build on strengths to achieve goals
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Is there termination in Solution focused therapy?
often the relationship is left open and the client may return for booster sessions.
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what is the focus on soltion focused therapy?
finding the skills that the client has to implement change in the positive present and future.
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What is the goal of ACT?
To create a rich and meaningful life while accepting the pain that life brings
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What are some conditions the ACT can help with?
- depression
- chronic pain
- anxiety
- stress
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What are the six core pathological processes
- conceptualize past and feared future
- experiential avoidance
- cognitive fusion
- lack of values
- unworkable action
- attachment to conceptualized self
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What should be included in an ACT assessment
- look for examples of the 6 core pathological processes
- give a brief values exercise
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what types of goals are not useful in ACT?
emotional goals and dead person goals
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What are the 6 core therapeutic processes?
- contact with present
- acceptance
- defusion
- values committed action
- self as context
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What are 5 general ACT interventions?
- metaphors
- psychoeducation
- mindfulness exercises
- worksheet
- homework
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What is creative hopelessness
the idea that you are constantly pushing away pain, and that results in more struggle and additional pain. clipboard metaphor
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What are 3 defusion interventions?
- leaves on a stream
- world's greatest story teller
- questioning workability
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What are 3 acceptance interventions?
- struggle switch
- the curious scientist
- demons on the boat
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what are 3 contact with the present moment interventions?
- mindfulness eating
- notice 5 things
- drop the anchor
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what are 2 self as context interventions
- chessboard metaphor
- sky and weather metaphor
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when working on committed action and creating goals, what types of goals do you want to make?
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