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Interpersonal Therapy - View of maladaptive behavior
related to problems in social roles and interpersonal relationships that are traceable to a lack of strong attachments early in life
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Interpersonal Therapy - Goals
recognizes contributions of early experience, biological predispositions, and personality but focuses on current social relationships
primary goals are symptom reduction and improved interpersonal functioning
achieved through education about disorder, installation of hope, and psychopharm when needed
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Interpersonal Therapy - techniques - four problem areas on relationships
targets four primary problem areas in relationships
unresolved grief
interpersonal role disputes
role transitions
interpersonal deficits
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Interpersonal Therapy - techniques - how many stages of therapy are there and what do they focus on?
three stages
initial stage - assessment for diagnosis, the interpersonal context in which symptoms occur, and problem areas that will be the focus of treatment
middle phase - use strategies to address problem areas, which may include encouragement of affect, communication analysis, and modeling and role-playing to learn new ways of interacting
final phase - review progress, discuss termination, and methods of relapse prevention
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Solution-Focused Therapy - basic premise
based on the assumption that "you get more of what you talk about" and, consequently, focuses on solutions to problems rather than on the problems themselves
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Solution-Focused Therapy - View of maladaptive behavior
understanding the cause of a problem behavior is irrelevant and focus, instead, on solutions to problems
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Solution-Focused Therapy - goals
The client is viewed as the expert while the therapist acts as a consultant/collaborator who poses different types of questions designed to assist with recognizing and using strengths and resources to achieve specific goals
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Solution-Focused Therapy - techniques - What are the 3 questions typically used?
miracle question - you awake up and your problem is gone, what would be different?
exception question - Can you think of a time in the past week when you did not have the problem (or it was less troublesome)?
scaling question - On a scale from 1 - 10 how did you feel last week? On a scale from 1 - 10 how motivated are you?
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Solution-Focused Therapy - techniques - What is the structure of therapy?
clients identify specific goals, responds the 3 questions, and at the end of the session, the therapist compliments successes and provides a task to complete before the next session
subsequent sessions begin with asking "what's better since we last met?" and the strategies are repeated
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Transtheoretical Model - basic premise
change entails progress through a series of predictable stages and on an analysis of 18 major approaches to therapy that led to the identification of 10 empirically supported change processes (interventions)
was developed for substance use, but has been others in other treatments
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Transtheoretical Model - what are the 10 change processes
consciousness
raising
self liberation
social liberation
dramatic relief
self-reevaluation
counterconditioning
environmental reevaluation
reinforcement management
stimulus control
helping/supportive relationships
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Transtheoretical Model - View of maladaptive behavior
does not address the cause or characteristics of maladaptive behavior, but, instead, focuses on factors that facilitate behavior change.
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Transtheoretical Model - techniques - what are the 6 stages of change? Describe each one
precontemplation - little insight into the need for change and/or does not intend to change
contemplation - aware of the need for change, intends to take action in the next 6 months, but not committed to change
preparation - plans to take action in the immediate future (a month or so) and has a realistic plan of action for modifying behavior
action - takes concrete steps to change behavior
maintenance - has maintained a change in behavior for at least 6 months and is taking steps to prevent relapse
termination - feels they can resist temptation and is confident that is no risk for relapse
progression through stages is not always linear and people may go through stages multiple times
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Transtheoretical Model - techniques - when are interventions most successful?
When they match the stage of change
Example - conscious raising, dramatic relief, and environmental reevaluation are useful for transition from precontemplation to contemplation
Example - helping relationships, counterconditioning, reinforcement management, and stimulus control help from action to maintenance
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Transtheoretical Model - techniques - What are the three mediating variable that affect motivation and at what stage of change are they most useful?
Decisional balance - the strength of perceived pros and cons of the problem behavior - present in all stages but most important for determining motivation during contemplation
self-efficacy - confidence that they will be able to cope with high-risk situations without relapsing and is an important to move from contemplation to preparation and from preparation to action
temptation - the intensity of urges to engage in problem behavior and inversely related to self-efficacy. Usually high during initial stages but lower during later stages
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Motivational Interviewing - basic premise
For those who are ambivalent about changing behavior.
stresses therapist empathy, reflective listening, and responding in nonconfrontational ways (Rogers - Client Centered Therapy)
explicitly addresses beliefs about ability to change and assumes interventions are most effective when they match the stage of change (transtheoretical model)
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Motivational Interviewing - View of maladaptive behavior
does not focus on cause of behavior but on factors that impedes ability to change behavior
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Motivational Interviewing - goals
to enhance the client's intrinsic motivation to alter behavior by helping to examine and resolve ambivalence about changing.
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Motivational Interviewing - techniques - what are the four general principals that guide the selection of strategies used in therapy?
express empathy
develop discrepancies between current behavior and personal goals and values
roll with (rather than oppose) resistance
support self-efficacy
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Motivational Interviewing - techniques - What are the techniques (micro skills) that are summarized with the acronym OARS?
O - open ended questions - cannot be answered with yes or no
A - affirmations that express empathy and understanding
R- reflective listening which builds rapport and includes restatements, paraphrasing, and reflective listening
S - Summaries which are a type of reflective listening and are especially useful for facilitating transitions
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The primary goals of interpersonal therapy are _______ and improved interpersonal functioning. Interventions ordinarily address one or more of four problem areas - unresolved grief, interpersonal role disputes, _________, and/or interpersonal deficits.
symptoms reduction
role transition
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A solution-focused therapist asks clients questions to help identify solutions to problems. These include the miracle question, _______ questions, and scaling questions
exception
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The transtheoretical model is based on the assumption that the best interventions are those that match the client's _________. It distinguishes between six stages - ____________, contemplation, preparation, action, maintenance, and termination. A person in the _______ stage intends to take action within the next six months, while a person in the maintenance stage has maintained a behavior change for at leas ________ months.
stage of change
precontemplation
contemplation
six
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Motivational interviewing combines transtheoretical model with elements of __________ and Bandura's notion of self-efficacy
client-centered therapy
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Unresolved grief, interpersonal role disputes, role transitions, and interpersonal deficits are the primary targets of:
A.motivational interviewing.
B.solution-focused therapy.
C.reality therapy.
D.interpersonal therapy.
interpersonal therapy
Recognizing that the four problems listed in the question are all related to interpersonal relationships would have helped you identify the correct answer to this question. The interventions used in interpersonal therapy address one or more of four problem areas—unresolved grief, interpersonal role disputes, role transitions, and/or interpersonal deficits.
Answer A: Motivational interviewing primarily addresses the client's beliefs about his/her ability to change.
Answer B: As the name suggests, solution-focused therapy targets solutions to the client's problems.
Answer C: Reality therapy assumes that people are responsible for the choices they make and focuses on how people make choices that affect the course of their lives.
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Kai formerly abused alcohol but has now maintained sobriety for six months and is actively working to avoid relapse. Applying the transtheoretical model, Kai is in which of the following stages of change?
Maintenance
The transtheoretical model distinguishes between six stages of change: precontemplation, contemplation, preparation, action, maintenance, and termination. A person in the maintenance stage has maintained a change in behavior for at least six months and is taking steps to prevent relapse.
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The techniques of consciousness raising, social liberation, dramatic relief, self-reevaluation, and reinforcement management are most associated with which of the following?
A.Interpersonal therapy
B.Reality therapy
C.Transtheoretical model
D.Personal construct theory
C
For the exam, you want to be familiar with the basic premises and strategies of the four approaches listed in the answers to this question. The transtheoretical model identifies 10 empirically supported strategies that include those listed in this question and proposes that an intervention is most effective when it matches the strategies used to the client's stage of change.
Answer A: IPT is associated with four primary problem areas: unresolved grief, interpersonal role disputes, role transitions, and interpersonal deficits.
Answer B: Reality therapy is closely associated with five basic innate needs: survival, love and belonging, power, freedom, and fun.
Answer D: Personal construct therapy is associated with personal constructs, fixed-roles, and the repertory grid.
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During the first therapy session, a therapist asks a client to imagine that she wakes up the next morning and her problem has been solved. He then asks, "When this occurs, what will be the first sign that a miracle has happened?" Apparently, this therapist is a practitioner of:
solution-focused therapy.
The therapist in this question has posed the "miracle question." The miracle question is used by solution-focused therapists to help clients envision their lives without the presenting problem and identify ways for resolving that problem.
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Motivational interviewing combines the transtheoretical model of change with:
a client-centered approach.
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