Interventions Midterm

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Interventions Midterm
2013-02-13 18:03:43

Interventions Midterm
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  1. Why do we want to learn brief psychotherapies?
    We want the most practical approach and many areas where we work will expect them.
  2. What are some settings that will expect brief psychotherapies?
    • Agencies
    • Medicaid/medicare
    • Managed care
    • Private practice
  3. What two areas are brief therapies especially effective in treating?
    • Mood disorders
    • Anxiety disorders
  4. 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.
  5. What are the characteristics of brief therapy?
    • Evidence Based
    • Fewer than 20 sessions
  6. What 4 things are involved in brief therapy?
    • Planning
    • Efficiency
    • Focus
    • Patient selection
  7. When is brief therapy appropriate?
    Motivated clients and people who are in transition.
  8. Who is not appropriate for brief therapy?
    people with characterlogical issues or those who have a difficult time forming relationships or trusting.
  9. 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
  10. 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.
  11. What three phases make people change in treatment?
    • Engagement
    • Discrepancy
    • Consolidation
  12. What is Engagement in treatment?
    • establishing a working alliance
    • client vents
    • therapist looks for patterns
    • treatment goals are developed
  13. 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.
  14. What is consolidation in treatment
    practicing new skills, internalizing and maintaining new behaviors or patterns.
  15. 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
  16. what is the stem in the martini analogy?
    common factors such as patient variable, relationship, and expectancy.
  17. what is the cup part of the martini analogy?
    therapeutic interventions
  18. Name 4 factors that have a positive effect on treatment outcome.
    • therapist acceptance
    • flexibility
    • warmth
    • therapeutic alliance
  19. 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.
  20. name three ways you can help clients be ok with being influenced by therapy.
    • safety
    • security
    • respect
  21. the specific technique you use accounts for what percent of improvement?
  22. what are 3 important common factors?
    • patient variables
    • relationship
    • placebo/expectancy effects/hope
  23. what percent of change is attributed to a person's circumstances?
  24. 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
  25. what does it mean to have psychological mindedness?
    being introspective, willing to explore on a deeper level.
  26. 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.
  27. 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.
  28. What 2 things do you want to balance when working with a client?
    confrontation and support
  29. why is focusing only on what the client is doing wrong harmful?
    It is demoralizing and reinforces negative self-appraisal.
  30. why is being too positive or supportive harmful to the client?
    It invalidates their experience and is in conflict with their self-perception.
  31. what percent of people are ready to change when they come into treatment?
  32. What are the 6 stages of change?
    • precontemplation
    • contemplation
    • preparation
    • action
    • maintenance
    • termination
  33. what is precontemplation
    a client lacs awareness of problems
  34. what is contemplation
    client accepts that a problem exists
  35. what is preparation
    A client considers making changes
  36. what is action?
    active attempts to make improvements
  37. what is maintenance?
    anticipation of future stressors
  38. how can a therapist help move a client toward the later stages of change?
    motivational interviewing
  39. what percent of improvement is accounted for by relationship factors?
  40. What do you need to develop a therapeutic alliance?
    • a collaborative atmosphere
    • mutual trust and acceptance
    • mutual goal setting
  41. how can you facilitate a therapeutic atmosphere?
    • empathy
    • unconditional positive regard
    • warmth
  42. 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.
  43. what is catharsis?
    release of emotional tension
  44. how can a client experience master?
    • increased control
    • increased understanding
  45. what five factors make up relationship facotrs?
    • therpeutic alliance
    • corrective emotional experience
    • catharsis
    • identification
    • feeling of mastery
  46. what is pathogenesis?
    the degree wo which the therapist uses dependent individuals to satisfy their own needs
  47. what percent of change to hope factors account for?
  48. what does placebo mean in a therapeutic sense?
    not doing any specific interventions
  49. what is the primary use of motivational interviewing?
    increase commitment to behavior change
  50. how many sessions are usually used for MI?
    4 sessions
  51. who is MI useful with?
    • clients who are ambivalent
    • substance abuse
    • lifestyle changes
  52. what is MI?
    a collaborative, client-centered form of guiding to elicit and strengthen motivation for change.
  53. name 4 things that MI can treat
    • substance abuse
    • weight management
    • medication compliance
    • school truancy
  54. what technique is often used in various contexts such as therapists, doctors, teacher, and case managers?
    motivational interviewing
  55. name three ways you know when to use MI
    • ambivalence not lack of knowledge
    • stage of change
    • inherent desire to change in client
  56. What are the 2 ingredients of MI?
    • relational
    • technical
  57. what is the relational component of MI
    • empathy and acceptance
    • nonjudgemental
    • emphasis on reflective listening and understanding the client's perspective
  58. what is the technical component of MI?
    • directive
    • target behavior
    • focus on why they should change not how
    • selective attention
  59. 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.
  60. when is MI not appropriate?
    • no target behavior
    • misunderstanding who provides motivation
    • righting reflex
  61. what is the righting reflex?
    The therapist's urge to solve client problems
  62. who generates the reasons for change in MI?
    the client
  63. what are 4 things to help practice MI?
    • express empathy
    • support self-efficacy
    • roll with the resistance
    • develop discrepancy
  64. 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.
  65. what are 4 MI techniques?
    • open-ended questions
    • affirmations
    • reflections
    • summaries
  66. What are the 4 components of DBT?
    • individual therapy
    • phone coaching
    • skills group
    • consultation group
  67. what is the purpose of consultation group in DBT?
    individual and group therapists to meet with other DBT therapists
  68. 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
  69. 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
  70. What is the purpose of the diary care?
    to track skills, and self-harm and follow up week to week.
  71. what are the 6 components of a behavioral analysis
    • problem behavior
    • prompting event
    • vulnerability
    • link bx to actions, sensations, thoughts feelings
    • consequences
    • solution analysis
  72. what is the purpose of phone coaching?
    to help client's decide what skills to use
  73. what is phone coaching NOT?
    phone therapy
  74. how long is phone coaching restricted after self-harm?
    24 hours
  75. what 4 areas do skills group focus on?
    • mindfulness
    • interpersonal effectiveness
    • emotion regulation
    • distress tolerance
  76. what is the DBT skills group format?
    • mindfulness exercise
    • review homework
    • break
    • presenting new skills
  77. what is the purpose of mindfulness skills?
    Learning to be in control of your own mind instead of it controlling you.
  78. what are the 3 states of mind in mindfulness skills?
    • emotion mind
    • reasonable mind
    • wise mind
  79. name the 3 mindfulness what skills
    • Observe
    • Describe
    • Fully Participate
  80. What is the observe skill?
    sensing or experiencing without describing or labeling the experience

    Teflon Mind

    Use your five senses
  81. What is the Describe Skill?
    using words to label your observations

    Just the facts
  82. What is the fully participate skill?
    entering wholly into an activity
  83. What are the 3 how mindfulness skills?
    • non-judgmentally
    • one-mindfully
    • effectively
  84. What is the non-judgmentally skill?
    focus on who what when and where without evaluation of good or bad
  85. What is the one-mindfully skill?
    • Do one thing at a time
    • let go of distractions
  86. What is the effectively skill?
    know your goal and focus on what works to get there
  87. how can the how and what skills be best combined?
    • Observe one-mindfully
    • describe non-judmentally
    • participate effectively
  88. Describe a mindfulness practice exercise
    get sometime that can be experienced and ask them to mindfully attend to it.
  89. name three things that might be good to use in a mindfulness exercise
    • hot tea
    • an orange
    • play dough
  90. 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?
  91. 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

    improving self-respect
  92. what acronym is used to get goals met in DBT
  93. What acronym is used for getting or keeping a good relationship in DBT?
  94. What acronym is used for improving self-respect in DBT?
  95. what does DEAR MAN stand for?
    • describe
    • express
    • assert
    • reinforce
    • mindful
    • appear confident
    • negotiate
  96. what does GIVE stand for?
    • gentle
    • interested
    • validate
    • easy manner
  97. what does FAST stand for?
    • fair
    • apologies
    • stick to values
    • truthful
  98. why is it important to prioritize the 3 reasons for interpersonal effectiveness in each situation?
    You may not be able to achieve all three
  99. What are distress tolerance skills?
    skills for tolerating painful events and emotions when you can't make them better right away
  100. what are 5 distress tolerance skills?
    • distracting
    • self-soothe
    • improve the moment
    • pros and cons of tolerating distress
    • accepting reality
  101. What are the 3 goals of emotion regulation
    • understand emotional experience
    • reduce emotional vulnerability
    • decrease emotional suffering
  102. what two ways can we understand our emotional experience
    • identify and label emotions
    • understand the purpose of emotions
  103. how can we reduce emotional vulnerability
    • use please master skills
    • increase positive emotions
  104. what tow ways can we decrease emotional suffering?
    • let go of painful emotions
    • change painful emotions through opposite action.
  105. 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
  106. According to cognitive therapy what is the key element of depression
    negative biased judgments people have about themselves
  107. What are 4 characteristics of cognitive therapy?
    • operationalized
    • short term
    • structured
    • information processing
  108. What are two key components of cognitive therapy?
    • identifying cognitions
    • identifying automatic thoughts
  109. 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
  110. What are core beliefs
    fundamental beliefs about the self
  111. what is a schema
    the ways that people organize their experience
  112. 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.
  113. What are the two categories of negative core beliefs?
    • Helplessness
    • Unlovability
  114. What can the downward arrow technique help discover?
    How automatic thoughts are a product of a person's core beliefs
  115. 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
  116. 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
  117. What is a capsule summary?
    therapist summarizes clients experience in cognitive model terms.
  118. 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
  119. 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.
  120. what is the cognitive triad for cognitive distortions?
    • negative view of self
    • negative view of world
    • negative view of future
  121. what is the cbt triad
    • thoughts
    • emotions
    • behaviors
  122. 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
  123. what are the two focus areas of behavior therapy?
    • problem focused
    • present focused
  124. What are the goals of behavior therapy?
    • learn skills
    • corrective experiences
    • generalization
    • client to become their own therapist
  125. what is one way to start generalization in behavior therapy?
  126. what are 5 behavior techniques?
    • exposure
    • relaxation
    • problem solving
    • role playing
    • homework
  127. what part of behavior therapy is a good predictor of treatment outcome?
    homework compliance
  128. what are two types of relaxation?
    • breathing training
    • PMR
  129. What are 2 types of exposure?
    • In vivo
    • Imaginal
  130. what are three components of the behavior relationship?
    • collaborative
    • credible rationale
    • use of metaphors
  131. What are safety behaviors?
    behaviors that a client engages in to help them separate themselves from anxiety.
  132. What three things does a therapist need out of an assessment?
    • understanding of problem
    • understanding of diagnosis
    • identify specific behaviors
  133. What is stress inoculation?
    a way for clients to manage stress
  134. what is the goal of stress inoculation?
    to teach clients that stress and anxiety are normal and develop skills for managing them
  135. what is the goal of PMR?
    to learn what tension feels like in order to identify it and let it go
  136. what is PMR
    progressive muscle relaxation means systematically tensing and relaxing specific muscle groups in the body.
  137. who is PMR contraindicated for?
    people with high blood pressure.
  138. 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
  139. What is the goal of guided self dialogue?
    to focus on internal dialogue
  140. what is guided self dialogue similar to?
    cognitive restructuring, but it is done in their head in the moment.
  141. what is guided self dialogue?
    replacing irrational, unhelpful, or negative, with rational, facilitative, and positive self dialogue.
  142. 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
  143. What are two ways to implement guided self dialogue
    • rubber band
    • sticky notes
  144. What are the three goals of exposure therapy?
    • activate fear structure
    • provide new info that is incompatible
    • corrective experience.
  145. What are two diagnoses that often use imaginal exposure?
    OCD and PTSD
  146. how long should exposures last?
    until habituation occurs.
  147. 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
  148. What is interoceptive exposure
    deliberately inducing feared physical sensations to learn to be less afraid of body sensations
  149. what is interoceptive exposure typically used for?
    Panic Disorder
  150. men are at and increased risk of what if in a conflicted relationship
    high blood pressure
  151. women are at an increased risk of what if in a distant relationship
  152. What are the 3 exclusion criteria for couples work?
    an ongoing affair that one person isn't okay with.


  153. 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.
  154. what are the 3 dimensions of relationship difficulties
    • individual
    • relationship
    • environment
  155. the person who tends to be the withdrawer and don't want to address issues are
    emotionally avoidant
  156. What do you need to do with an emotionally explosive person?
    • set boundaries
    • give them a specific time to be emotional
    • build distress tolerance
  157. what can you do with an emotionally avoidant person?
    • give them a preset time 
    • increase partners awareness of difficulty
  158. what are individual factors?
    • affiliation
    • need for intimacy
    • need to be giving
    • need to attend or be attended to
  159. what is primary distress
    partners experiences of unresolved differences and unmet needs.  i.e. feeling unloved
  160. what is secondary distress?
    partners dysfunctional way of interacting in response to unresolved issues.  i.e. increasing demands for affection
  161. What are relationship factors
    • mutual engagement
    • demand/withdraw
    • mutual avoidance
  162. What are environmental factors?
    social and physical such as families, communities, and cultures

    • financial
    • employment
  163. 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
  164. What are 2 types of behavioral interventions
    • guided behavior change
    • skills based interventions
  165. What are two types of guided behavior change?
    • broad-based 
    • focused
  166. what is broad-based change
    improving overall emotional tone of the relationship
  167. what is focused change
    identifying a specific theme in the relationship and collaborating to come up with ideas they can implement
  168. What is important in guided behavior change
    that each person commits to constructive change regardless of their partner's behavior.
  169. what is reviewd in the conversation on sharing thoughts and feelings
    skills for sharing thoughts and emotions and skills for listening to a partner
  170. what is important when sharing?
    be specific
  171. what is important when listening
    take your partner's perspective
  172. 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
  173. What does cognitive interventions help couples do?
    reevaluate cognitions and view events in a more balanced way
  174. what are some cognitive interventions you would use in couples therapy?
    • cognitive restructuring
    • downward arrow
    • socratic questioning
    • guided discovery
  175. why do you want to be careful with socratic questioning in couples therapy?
    could provide ammunition for later arguments
  176. What is guided discovery
    therapist ceates experiences where the partners may start to questions their thinking and behavior.
  177. 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
  178. 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
  179. What are 3 types of dynamics in EFT?
    • pursue-distance
    • withdraw-withdraw
    • attack-attack
  180. What is Sensate Focus
    treatment designed to help couples experiencing sexual problems
  181. describe stage 1 of Sensate focus
    take turns touching, but erogenous zones off limits

    become aware of sensations
  182. describe stage 2 of sensate focus
    touching is expanded to all areas

    hand riding
  183. describe stage 3 of sensate focus
    mutual touching
  184. why does sensate focus work?
    it is a form of in vivo desensitization