Therapy with Special Groups

1. Therapy with Special Groups Couples, Families, and Children

2. Couples Therapy I • Emotionally focused Couples Therapy • Alter emotional responses & interaction styles to create stronger bond • Negative affect creates emotional distress • More secure attachment leads to relationship stability • 9 treatment steps (p. 424) • Assessment, changing interaction styles, & integration

3. Couples Therapy II • Behavioral Marital Therapy (BMT) • Applies reinforcement principles to the couple’s interactions • Contingency contracting: one spouse changes a behavior in exchange for the other spouse’s behavioral change • Support-understanding: increase positive behaviors, feelings • Problem-solving: train positive communication skills

4. Modern Couples Therapy • Integrative Behavioral Couples Therapy • Differs from BMT b/c balances change with acceptance • Functional analysis: antecedents, consequences • Elements: behavior exchange, communication/ problem-solving training, empathic joining, role-playing, self-care

5. Efficacy of Couples Therapy • Great variability • IBCT higher in efficacy • EFT, BMT adequate efficacy • Humanistic approaches lower • In general, modestly effective

6. Couples who are ideal candidates for couples therapy: • not severely distressed • inverse relationship between age and outcome • emotional engagement • more sex, affective communication, quality of emotional affection; even conflict • couples whose members are androgynous—do not subscribe to traditional gender roles • relatively few stressors and personal problems • e.g., depression • "higher levels of experiencing"--greater emotional involvement and self-description

7. Process of change in couples therapy 1. one person expresses a feeling, resulting in a perceptual change in the listener 2. learning to express needs 3. acquiring understanding • taking responsibility for one's own experiences • receiving validation from the partner

8. Prevention • Interventions most useful immediately after milestones like the birth of a child

9. When to dissolve a relationship? • The issue of domestic abuse • Often considered reason to dissolve • many therapists treat couples without being aware of domestic violence within the relationship • people have different definitions of abuse

10. Family Therapy • Emphasis on communication skills • Problems as failure to communicate • General systems theory: family seen as a system which therapy can alter for the better • Increase information gathering among family members • Goals: de-emphasize each individual’s problems & focus on family as a whole • Different approaches have different specific goals

11. Systems Theory Elements 1. A system consists of a set of elements. 2. Each element acts reciprocally with other elements. 3. A system acts to maintain homeostasis. 4. A system employs well-defined procedures to maintain its integrity.

12. Family Rx Characteristics • Clear definition of problem • members may see problem differently • Family history gathering • Can lead to greater understanding & communication among members • Shared frame of reference

13. Conjoint Family Therapy • One therapist sees entire family at same time • Nondirective, passive role • Therapist as a modeler & facilitator of effective communication amongst family members

14. Other Approaches • Concurrent family therapy • One therapist sees all family members in separate sessions • Collaborative family therapy • Each family member sees different therapist • Therapists meet to discuss the family

15. Behavioral approaches • View the family in reinforcement contingency terms • Therapist creates functional analysis of family’s difficulties • Identify problematic behaviors, rewards, & consequences • & train more functional approaches instead

16. Structural therapy • Minuchin • type of CBT • family dynamic that supposedly caused the problem is altered; therapist forces family to find new ways in which to interact • very invasive type of therapy • note that invasive is not necessarily bad-- maybe that's what it takes

17. Therapy with Children • > 230 approaches • Family therapy, parent-child therapy, individual child therapy, group therapy • Modification of techniques may be necessary depending on child age &/or development • Ex. Less emphasis on introspective, abstract, verbal processes • Often nondirective

18. Psychoanalytic Child Rx • Anna Freud: children must achieve insight into their feelings, problems • More symptom oriented • Teach children that behaviors can be defenses against anxiety, fear, sadness

19. Play Therapy • Can be psychoanalytic, cognitive-behavioral, etc. • Play used as a vehicle of communication • Conducted in playroom • Use behaviors, statements made as hints to the child’s frame of mind • How relate to others • Anxieties, fears • Case ex. S.M.: arranging toys • Reenacting of problem situations • Attempts at problem resolution

20. Behavior therapy • Most commonly used Rx for child behavioral problems • Parents & teachers often involved in Rx plan • Case ex. E.S.: school plan • Parent management training: train parents to modify a child’s behavior at home • Increases likelihood of positive response to Rx

21. Parent-Child Interaction Therapy • Child is seen in clinic by therapist • Parents interviewed in clinic and trained at nondirective play therapy techniques’ • Given handouts with instructions • 5 min. daily of parent-child interaction at home • Designed to increase positive interactions b/w parents & child, increase child’s sense of importance & mastery • Progress reviewed at weekly sessions

22. Efficacy of child Rxs • Generally found effective • However, few treatment efficacy studies done with children • Behavioral & cognitive-behavioral approaches tend to be found more effective for more diagnoses • However, easier to examine empirically than other treatment approaches • May be a result of research methods instead of greater efficacy

23. Ethical issues 1. consent2. confidentiality3. conflict of interest between parents and kids